急性阑尾炎的超声诊断价值

目的 探讨超声对急性阑尾炎的诊断价值。方法 对148例急性阑尾炎患者进行超声检查。结果 病变阑尾回声及周围的回声特征与病理类型相关。其中急性单纯性阑尾炎48例（32．4％），急性化脓性阑尾炎56例（37．9％），坏疽穿孔性阑尾炎24例（16．2％），阑尾周围脓肿20例（13．5％）。结论 超声是诊断急性阑尾炎的有效方法。     

彩色多普勒超声对急性阑尾炎的及超声特征诊断价值

【目的】探讨彩色多普勒超声对急性阑尾炎的诊断价值。【方法】回顾性分析96例经手术病理或临床证实的急性阑尾炎患者应用彩色多普勒超声诊断的临床资料,分析超声诊断与手术病理结果的符合率及超声特征。【结果】术前超声检查各型阑尾炎与手术病理诊断符合率92．7％（89／96）,漏诊3例,误诊4例。急性单纯性阑尾炎：长轴切面呈“腊肠样”盲端结构,横断面呈“同心圆”;急性化脓性阑尾炎：轮廓尚清,层次较模糊,黏膜毛糙回声中断,表现为强回声斑、团,后伴声影,阑尾壁及周围组织有丰富血流信号;急性坏疽性阑尾炎：阑尾轻度或明显肿大,轮廓、层次不清晰,黏膜部分显示或显示不清,阑尾管壁缺血、坏死、容易继发穿孔,周围有较多渗出液;阑尾周围脓肿：阑尾形态完全消失,阑尾区可见不规则无回声区,低回声或混合性回声团。【结论】彩色多普勒超声对急性阑尾炎的诊断及分型具有重要参考价值。     

阑尾炎声像图特征与病理改变关系的初步探讨

目的 探讨阑尾炎声像图特征与病理改变的关系。方法 对75例临床拟诊为阑尾炎的患者进行超声检查，注意观察小肠积液、小肠壁增厚、大网膜移位、肠系膜淋巴结肿大与各型阑尾炎的关系，并与手术及病理结果对照分析。结果 术前超声检出各型阑尾炎与手术病理诊断符合69例（69/75），误诊2例，漏诊4例。声像图特征为阑尾增粗，直径≥6mm，阑尾壁厚度≥2mm，黏膜毛糙、回声中断或消失，阑尾腔内积液。其中超声检出单纯性阑尾炎27例（27/30）：超声显示阑尾轻度肿大，病理见阑尾病变局限于黏膜层及黏膜下层，黏膜部分脱落有浅表溃疡；化脓性阑尾炎22例（22/23）：超声显示阑尾肿大明显，病理见阑尾炎症水肿较重，黏膜溃疡扩大，阑尾腔内积脓，阑尾周围炎性渗出物增多；坏疽性阑尾炎10例（10/12）及阑尾周围脓肿10例（10/10）：超声显示阑尾形态消失，轮廓、壁层次不清，出现阑尾黏膜溃烂，腔内积脓积血，组织部分或全部坏死及阑尾穿孔等病理表现。结论 各型阑尾炎声像图特征与病理改变密切相关。     

高频超声对急性阑尾炎及其分型的研究

目的：探讨各型急性阑尾炎的高频超声特点。方法：对72例各型急性阑尾炎进行高频超声检查，检查结果与临床病理进行对照研究。结果：1．急性单纯性阑尾炎组其阑尾形态规整，外径常为7～12mm，阑尾壁分层尚清晰，内膜线可见；2．急性化脓性阑尾炎组其阑尾形态规整，外径常为13～15mm，阑尾壁分层不清，内膜线消失，阑尾腔为无回声或为充满散在高回声光点的弱回声区；3．坏疽性及穿孔性阑尾炎组其阑尾形态不规整，阑尾区呈片状弱回声区或无回声区；④阑尾周围脓肿其阑尾结构不清，病变区见边界不规整的混合性包块回声。结论：高频超声对诊断急性阑尾炎及其分型具有较重要的价值。     

急性阑尾炎的超声诊断价值

目的 探讨急性阑尾炎的声像图特征，从而提高超声对急性阑尾炎的诊断正确率。方法 84例急性阑尾炎均为我院2002年9月至2004年4月住院患者，术前均行超声检查，术后与手术结果及病理证实。患者取仰卧位，在常规排除右肾及右输尿管、右附件（女性）疾病后于右下腹麦氏点周围行常规多切面扫查，采取探头加压法及必要时扩大扫查范围寻找病变阑尾。结果 84例急性阑尾炎超声诊断75例，诊断符合率为89％，漏诊9例，其中单纯性阑尾炎漏诊8例，坏疽性阑尾炎漏诊1例。结论 超声对急性阑尾炎是一种有效的诊断工具，能帮助临床诊断和提高那些不明确的阑尾炎的诊断准确率，降低阑尾阴性手术切除率，避免和减少阑尾穿孔的发生。     

急性阑尾炎的超声诊断及分型探讨

目的 分析急性阑尾炎的超声表现及病变程度，探讨急性阑尾炎超声分型的临床价值。方法 回顾分析122例经手术及病理证实急性阑尾炎的超声图像资料，对其声像图特征进行分型。结果 本组122例中，急性单纯性阑尾炎21例，超声诊断符合率76．2％（16／21）；急性化脓性阑尾炎66例，超声诊断符合率90．9％（60／66）；急性坏疽性阑尾炎18例，超声诊断符合率83．3％（15／18）；阑尾周围脓肿17例，超声诊断符合率100％。结论 超声对急性阑尾炎的诊断及分型具有重要的临床价值。     

急性阑尾炎CT检查的临床意义

目的 分析急性阑尾炎的临床、CT特征，探讨CT检查的临床意义。方法 回顾性分析经临床、CT随访和（或）手术、穿刺病理证实的急性阑尾炎45例（男21例，女24例），年龄38～86岁（平均66岁）。结果 45例中CT诊断为急性阑尾炎可能1例（2．22％）；急性阑尾炎8例（17．78％）；急性阑尾炎并阑尾周围炎14例（31．1l％）；急性阑尾炎并穿孔5例（11．11％）；阑尾脓肿13例（28．89％）；阑尾炎性肿块4例（8．89％）。急性阑尾炎的CT直接征象为阑尾肿大增粗（直径〉6mm）、阑尾壁增厚和阑尾石，间接征象有阑尾一盲肠周围脂肪内条索影等。临床诊断为急性阑尾炎可能6例；急性阑尾炎2l例；阑尾炎包块16例；另有2例因右上腹痛而拟诊胆囊炎，假阴性率为4．44％（2／45）。结论 CT对急性阑尾炎的诊断特别是对临床表现不甚典型的阑尾炎及其并发症的诊断，具有很高准确率。     

多层螺旋CT对急性阑尾炎的诊断价值

目的探讨多层螺旋CT（MSCT）对急性阑尾炎的诊断价值。方法收集临床疑诊和／或经手术和病理证实为急性阑尾炎患者35例，回顾分析其CT表现。结果26例确诊急性阑尾炎病例中主要CT征象有：阑尾肿大24例（92％），阑尾粪石10例（38％），回盲部肥厚12例（46％），阑尾周围炎20例（77％），局限性脓肿2例（8％）。对照手术病理，MSCT诊断急性阑尾炎准确率89％、敏感性92％、特异度74％、阳性预测值92％、阴性预测值71％。结论MSCT显著提高了急性阑尾炎的术前诊断能力，应成为临床首选的影像学检查方法。     

急性阑尾炎超声影像分析

目的结合阑尾炎的病理分型,分析急性阑尾炎声像图特征以提高其诊断准确率。方法应用凸阵、线阵探头分析41例阑尾炎患者的临床资料,总结不同病理分型的声像图表现。结果 41例患者超声发现病变阑尾40例,其中单纯性阑尾炎17例,化脓性阑尾炎15例,坏疽性阑尾炎8例,手术证实坏疽性阑尾炎1例;超声显示阑尾长轴呈肿大盲管样结构、短轴呈靶环征,壁增厚,无蠕动,管腔压闭性消失及穿孔阑尾管壁回声中断等自身变化继发改变。"超声麦氏征"阳性率100%。结论超声可清晰显示盲肠壁、阑尾孔及阑尾盲端,其典型的声像图特征有助于准确诊断急性阑尾炎。     

超声间接征象对急性阑尾炎的诊断价值研究

目的 探讨急性阑尾炎的超声间接征象阳性率、声像图表现、与炎症程度的关系及其临床意义. 方法 应用彩超检查160例急性阑尾炎患者,分析其间接征象. 结果 (1)急性阑尾炎时超声间接征象局部探头压痛及反跳痛阳性率较高(96.3％)、回盲部水肿(75.6％)、右下腹局部强回声(36.9％).(2)超声间接征象与手术病理结果一致性较好(P＜0.01).(3)超声间接征象阳性率与阑尾炎病理类型有关(P＜0.01),阑尾炎越严重,阳性率越高. 结论 超声间接征象能确切反映阑尾周围组织炎症,其阳性率与炎症程度有关,正确认识超声间接征象,有助于临床对急性阑尾炎的诊断.     

Periappendiceal hyperechoic structure on sonography: a sign of severe appendicitis.

OBJECTIVE: We retrospectively investigated the clinical importance of the periappendiceal hyperechoic structure (PHS) using sonography in patients with appendicitis, which may reflect the omentum encapsulating the inflammation or spread of inflammation over the omental and adjacent mesenteric fat. METHODS: We defined the positive finding of a PHS as a noncompressible and enlarged (>6 mm in its maximal outer diameter) appendix surrounded by the hyperechoic structure that was not visualized in the right lower quadrant on sonography. We compared this finding with surgical records and pathologic diagnosis in 25 patients who underwent an appendectomy for appendicitis. RESULTS: Of 25 patients, there were 7 patients with positive PHS findings. The positive PHS rates were 100% (2 of 2), 29% (5 of 17), and 0% (0 of 6) for gangrenous, phlegmonous, and early appendicitis, respectively. There was a statistically significant difference by the Spearman rank test. The incidence rates of perforation (57% versus 6%), macroscopic purulent exudate or abscess (57% versus 6%), and prominent adhesion to the periappendiceal tissue (100% versus 22%) were higher in the patients with positive PHS findings. CONCLUSIONS: The PHS may indicate the possibility of serious inflammation, and accurate diagnosis and appropriate treatment should be decided.     

急性阑尾炎的CT表现

目的 探讨急性阑尾炎的CT表现。方法 对68例手术、病理证实为急性阑尾炎病人的腹部CT资料进行回顾性分析，对阑尾大小、有无阑尾结石、阑尾周围及盲肠末端的改变作了观察、分析。结果 68例中61例CT诊断为急性阑尾炎，7例假阴性，CT诊断急性阑尾炎的敏感性为89．7％。急性阑尾炎的CT表现主要有阑尾增粗(76．5％)，阑尾结石(29．4％)，阑尾周围炎性改变(66．2％)，阑尾脓肿(13．2％)，蜂窝织炎(10．3％)，盲肠末端肠壁增厚(7．4％)和局部淋巴结肿大(5．9％)。结论 急性阑尾炎可出现多种CT表现，熟悉这些表现有助于提高CT诊断阑尾炎的准确性。     

Differentiation of early perforated from nonperforated appendicitis: MDCT findings,MDCT diagnostic performance,and clinical outcome

To determine the CT findings and assess their diagnostic performance in differentiating early perforated appendicitis from nonperforated appendicitis, and to compare therapeutic approaches and clinical outcomes between two types of appendicitis. Our retrospective study was approved by our institutional review board and informed consent was waived. From July 2012 to July 2013, 339 patients [mean age 40.8 years; age range 19–80 years; 183 male (mean age 40.5 years; age range 19–79 years) and 156 female (mean age 41.2 years; age range 19–80 years)] who underwent appendectomy with preoperative CT examination for suspected acute appendicitis were included, with exclusion of 37 patients with specific CT findings for advanced perforated appendicitis. And they were categorized into nonperforated and early perforated appendicitis groups according to surgical and pathologic reports. The following CT findings were evaluated by two radiologists blinded to pathologic and surgical findings: transverse diameter of the appendix, thickness of the appendiceal wall, the depth of intraluminal appendiceal fluid, appendiceal wall enhancement, presence or absence of focal defect in the appendiceal wall, intraluminal appendiceal air, appendicolith/fecalith, periappendiceal changes, cecal wall thickening, and free fluid. The type of surgical procedures, performance of surgical drainage, and the length of hospital stay were recorded. Univariate and multivariate logistic regression analysis were used to determine the CT findings for differentiating early perforated appendicitis from nonperforated appendicitis, a total of 75 (22%) of the 339 patients was diagnosed with early perforated appendicitis. Focal wall defect [adjusted odds ratio (aOR), 23.40; p < 0.001], circumferential periappendiceal changes (aOR, 5.63; p < 0.001), appendicoliths/fecaliths (aOR, 2.47; p = 0.015), and transverse diameter of the appendix (aOR, 1.22; p = 0.003) were independently differentiating variables for early perforated appendicitis. The transverse diameter of the appendix (≥11 mm) had the highest sensitivity (62.7%) and focal wall defect in the appendiceal wall showed the highest specificity (98.8%). The prevalence of surgical drainage was higher (p = 0.001) and the mean hospital stay was approximately one day longer (p < 0.001) in the early perforated group than nonperforated group. CT can be helpful in differentiating early perforated appendicitis from nonperforated appendicitis, although the sensitivity of the evaluated findings was somewhat limited.     

Ischemia-modified albumin as a predictor of the severity of acute appendicitis

Background: The early prediction of gangrenous/perforated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. Ischemia-modified albumin (IMA) was previously reported as a biomarker of various ischemia-based diseases. Our aim is to determine the predictive value of serum IMA in the severity of acute appendicitis. Methods: Sixty-two patients who underwent urgent appendectomy were included in the study. Plasma level of IMA was measured after diagnosis and before treatment. All patients were classified as noncomplicated (acute) appendicitis and complicated (gangrenous/perforated) appendicitis according to histopathological findings, and comparisons were made between the groups. Results: The data of 62 patients with a mean age of 30.1 years were statistically evaluated. The pathological diagnoses were acute appendicitis in 33 (53.2%), and gangrenous/perforated appendicitis in 29 (46.8%) patients. There were significant differences in computed tomography (CT) findings (P = .031) and IMA (P = .012) levels between the groups. A strong positive correlation between IMA levels and CT findings was also found (Spearman ρ = +0.688, P = .003). Conclusions: The IMA can be considered as a novel and useful marker to distinguish gangrenous/perforated appendicitis from noncomplicated appendicitis. The correlation of IMA with CT findings also enhances the predictive value of IMA.     

多层螺旋CT三维重建对急性阑尾炎的诊断价值

目的探讨多层螺旋CT三维重建对急性阑尾炎的诊断价值。方法搜集58例临床拟诊为急性阑尾炎的病例,行多层螺旋CT检查,并经工作站进行多平面重建及曲面重建,分析其CT表现并将诊断结果与手术病理结果对照。结果58例病人中,诊断急性阑尾炎53例,升结肠癌2例,右侧腹股沟疝2例,假阴性1例。急性阑尾炎多层螺旋CT的主要征象及出现频率如下：阑尾肿大增粗（管腔直径〉6mm）占96．2％,阑尾结石占17．0％,回盲部壁增厚占30．1％,阑尾周围炎占60．4％,阑尾周围脓肿占15．1％,阑尾穿孔占9．4％。结论急性阑尾炎有典型的CT征象,多层螺旋CT三维重建图像后处理技术能多方位显示阑尾本身及其周围组织情况,在急性阑尾炎的诊断中具有较高的临床应用价值。     

Acute appendicitis mimicking infectious enteritis: diagnostic value of sonography.

OBJECTIVE: To verify the role of sonography in screening of acute appendicitis in patients admitted to an infectious disease unit for suspected acute infectious enteritis. METHODS: One hundred eighty consecutive patients (102 male and 78 female; age range, 5-72 years; mean age, 31 years) admitted for suspected infectious enteritis or typhoid fever were prospectively studied with abdominal sonography within 48 hours after admission. None of the patients had peritoneal irritation. Forty-six patients (25%) had white blood cell counts of more than 10,000/mm3 (range, 10,300-18,000/mm3). The diagnosis of acute appendicitis was made when a detectable appendix with an anteroposterior diameter of greater than 7 mm could be seen on sonography. RESULTS: Eleven (6%) of 180 patients had thickened appendixes (anteroposterior diameter range, 7-14 mm); 2 of them had periappendiceal abscesses. Four (36%) of 11 patients with acute appendicitis had high white blood cell counts. All sonographic diagnoses of acute appendicitis and periappendiceal abscesses were confirmed at surgery. Sonography ruled out acute appendicitis in 169 patients. In all of them, clinical and sonographic follow-up excluded the diagnosis of acute appendicitis. Normal appendixes were shown on sonography in 38 (22%) of 169 cases and were not detectable in 131 (78%) of 169. CONCLUSIONS: Sonography of the appendix is a useful method for early assessment of acute appendicitis in patients thought to have enteritis or typhoid fever.     

The computed tomography appearance of recurrent and chronic appendicitis

The objective of this study was to determine computed tomography (CT) appearance of recurrent and chronic appendicitis. In 100 consecutive appendiceal CT examinations of proven appendicitis, 18 patients met criteria for recurrent (multiple discrete episodes) or chronic (continuous symptoms >3 weeks, pathological findings) appendicitis. CT findings were reviewed. Ten patients had recurrent appendicitis, 3 had chronic appendicitis, 3 had both, and 2 had pathological chronic appendicitis. CT findings in 18 recurrent/chronic cases were identical to 82 acute appendicitis cases, including pericecal stranding (both 100%), dilated (>6 mm) appendix (88.9% versus 93.9%), apical thickening (66.7% versus 69.5%), adenopathy (66.7% versus 61.0%), appendolith(s) (50% versus 42.7%), arrowhead (27.8% versus 22.0%), abscess (11.1% versus 11.0%), phlegmon (11.1% versus 6.1%), and fluid (5.6% versus 19.5%). CT findings in recurrent and chronic appendicitis are the same as those in acute appendicitis. Appendiceal CT can be beneficial for evaluating patients with suspected recurrent or chronic appendicitis.     

Sonography of acute appendicitis in childhood: perforation versus nonperforation.

We evaluated the sonographic findings in 133 consecutive children referred for suspected appendicitis. Fifty-eight of these patients (44%) ultimately underwent surgery, with 54 of these proved to have acute appendicitis. Thirty-one (58%) of the 54 had nonperforated appendicitis, and 23 (43%) had evidence of perforation. Previously described sonographic findings that have been employed in the diagnosis of appendicitis were evaluated, with the presence or absence of these findings being compared in patients with non-perforated and perforated appendicitis. In those patients who did not undergo surgery, the following findings were documented and compared to the findings in patients with proved appendicitis: (1) an identifiable appendix and its sonographic characteristics, (2) fluid localized to the right peritoneal reflection or periappendiceal region, or both, (3) free pelvic fluid, and (4) right lower quadrant adenopathy. Our results suggest that high-resolution, real-time sonography, using graded compression, is very sensitive in the identification of acute nonperforated appendicitis. Perforated appendicitis, however, can be a more difficult diagnosis because the appendix frequently decompresses with perforation and yet may not "wall off" or form a well-defined abscess. As a result, the appendix can be very difficult to identify.     

The gas-containing appendix: potential sonographic pitfall in the diagnosis of acute appendicitis.

The presence of gas within the appendix on plain abdominal radiographs is nonspecific and may or may not be associated with acute appendicitis. This finding, however, has not previously been reported with graded compression sonography of the right lower quadrant. Gas within the appendix was identified in four of 154 patients with a visualized appendix. All four patients had surgically confirmed acute appendicitis. Diagnostic difficulties were encountered in three of these four patients. In two patients, the findings were misinterpreted as an extraluminal gas-forming periappendiceal abscess. In an additional patient, the gas-filled appendix was initially mistaken for a segment of normal terminal ileum. The gas-filled appendix is a potential pitfall in the sonographic diagnosis of acute appendicitis. However, if other diagnostic criteria are met, gas within the appendix should not preclude establishing a sonographic diagnosis of appendicitis.     

改良Alvarado评分系统与妊娠期急性阑尾炎病理结果的相关性

[目的]探讨改良Alvarado评分系统与妊娠期急性阑尾炎术后病理结果的相关性及其在妊娠期急性阑尾炎诊断中的应用价值.[方法]回顾性收集2004年1月至2013年1月本院施行妊娠期阑尾切除术的69例临床资料,对各患者Alvarado系统评分结果与病理诊断进行分析.[结果]单纯型组患者平均Alvarado系统评分得分为(4.2±1.6)分,进展型组为平均得分为(7.0±1.9)分,两组间比较差异有统计学意义(P<0.01);评分系统与病理结果呈正相关关系(P<0.01).[结论]改良Alvarado评分系统能帮助早期诊断妊娠期急性阑尾炎并有助于选择外科治疗方案,对减少非必要性急诊手术率和急性穿孔的危险性上有重要价值.