老年急性阑尾炎穿孔CT征象预测探讨

CT Signs of Acute Appendicitis Perforation in the Elderly

本研究探讨CT征象在老年急性阑尾炎穿孔中的作用,以提高该病的诊断水平。回顾性分析经腹腔镜下阑尾切除术、病理证实的36例老年急性阑尾炎穿孔与同期102例老年急性阑尾炎未穿孔的CT影像资料作对照;明确显示阑尾直径、阑尾粪石、阑尾腔内积气、腔外积气、腹膜增厚、腹盆腔积液,差异有统计学意义(P<0.05);阑尾周围脂肪密度增高差异无统计学意义(P>0.05);其中阑尾腔外积气是阑尾炎穿孔定性诊断最直接征象(100%);行二元Logistic回归分析,阑尾直径、腹膜增厚、腹盆腔积液是影响阑尾穿孔的危险因素(P<0.05);通过绘制ROC曲线图,阑尾直径增粗(AUC=0.769)、腹膜增厚(AUC=0.696)、腹盆腔积液(AUC=0.601)。当阑尾直径增粗≥12.35 mm时、腹膜增厚伴腹盆腔积液联合诊断,ROC曲线下面积最高达0.840。由此可见CT图像特征可以为老年急性阑尾炎穿孔提供可靠的影像学指标,对临床治疗方案具有指导意义。

The purpose of this study was to investigate the role of CT signs in the perforation of acute appendicitis in the elderly,so as to improve the diagnosis level of the disease.The CT imaging data of 36 cases of acute appendicitis perforated by laparoscopic appendectomy and pathologically confirmed were retrospectively analyzed and compared with 102 cases of acute appendicitis without perforation.Appendiceal diameter,appendiceal fecalith,air accumulation in appendiceal cavity,air accumulation outside appendiceal cavity,peritoneal thickening and abdominal and pelvic effusion were clearly shown,with statistical differences(P<0.05).There was no significant difference in fat density around the appendix(P>0.05).The most direct sign in the qualitative diagnosis of perforation of appendicitis was extravehicular gas(100%).Binary Logistic regression analysis showed that appendix diameter,peritoneal thickening and abdominal and pelvic effusion were the risk factors for appendix perforation(P<0.05).The ROC curve showed that the diameter of the appendix increased(AUC=0.769),the peritoneum thickened(AUC=0.696)and the abdominal pelvic effusion(AUC=0.601).When appendectomy diameter thickened≥12.35 mm,peritoneal thickening combined with abdominal and pelvic effusion combined diagnosis,the area under ROC curve was up to 0.840.It can be seen that CT image features can provide reliable imaging indicators for the perforation of acute appendicitis in the elderly,and have guiding significance for clinical treatment.