阑尾粪石的超声特征

急性阑尾炎乃外科最常见的急腹症,阑尾粪石又　是引起阑尾腔梗阻导致阑尾炎急性发作的常见原因,　传统诊断手段加超声检查,大大提高了临床诊断符合　率。我们收集了近8年经B超诊断、临床手术、病理　证实的急性阑尾炎合并阑尾粪石的45例,旨在探讨阑     

急性阑尾炎的超声诊断价值

目的：熟练掌握急性阑尾炎的超声图像特征及超声诊断急性阑尾炎的影像价值。方法应用百胜MYLABSIX＋彩超,探头频率7．5～10 Hz对69例经超声诊断的急性阑尾炎患者影像诊断进行回顾性分析总结。结果69例阑尾炎中,急性阑尾炎、化脓性阑尾炎63例,诊断符合率76％,其中阑尾内有粪石或粪石嵌塞的3例,诊断符合率91％,阑尾周围脓肿3例,超声诊断符合率为95％,上述病例均行超声检查及手术病理证实。结论超声诊断急性阑尾炎为患者提供了一个直接、简便、安全的方法,为临床提供客观的诊断依据。     

63例阑尾炎的超声诊断

目的:探讨超声诊断阑尾炎的临床应用价值。方法:对经手术及病理诊断为阑尾炎的63例住院病例超声声像进行回顾性分析。结果:超声显示急性单纯性阑尾炎10例,化脓性阑尾炎26例(伴阑尾粪石3例),坏疽性阑尾炎(伴穿孔)2例,慢性阑尾炎急性发作(化脓性)12例,阑尾黏液囊肿1例,显示腹腔或盆腔积液3例。显示率达85.7%,诊断符合率为94.4%。结论:熟悉阑尾炎的超声表现,能为外科诊断提供帮助。     

变频超声在急性阑尾炎诊断中的应用价值

目的探讨变频超声在急性阑尾炎诊断中的应用价值。方法应用变频超声研究了69例急性阑尾炎的声像图变化，并与手术、病理结果进行比较。结果超声检查显示阑尾异常者56例（81.2％）右下腹呈气体多层反射，其他图像显示不清者8例（11.6％）；超声检查未发现异常者5例（7.3％）。69例患者中，急性单纯性阑尾炎14例，急性化脓性阑尾炎26例，其中6例伴有粪石，坏疽性穿孔性阑尾炎21例，阑尾脓肿8例。结论变频超声在诊断急性阑尾炎和在其他急腹症的签别诊断中具有重要作用。     

阑尾粪石征在急性阑尾炎CT诊断中的价值

目的探讨阑尾粪石征在多层螺旋CT(MSCT)诊断急性阑尾炎中的价值。方法回顾性分析60例经手术和病理证实的急性阑尾炎患者的CT表现。结果 60例急性阑尾炎患者中主要的CT征象有:阑尾粪石征36例(60.0%),阑尾肿胀伴阑尾周围炎(无阑尾粪石征)15例(25.0%),回盲部周围炎6例(10.0%),阑尾炎伴盲肠周围脓肿形成3例(5.0%),提示穿孔1例。所有患者均行急诊阑尾切除术,术后病理诊断为急性阑尾炎。结论阑尾粪石征在MSCT对急性阑尾炎的影像诊断中有着十分重要的意义。     

彩色多普勒超声诊断粪石阻塞性阑尾炎的临床意义

粪石是引发阑尾炎的病因之一[1],其可长期存在于阑尾腔内,并呈缓慢增长;或肠管内粪石落入阑尾腔内,压迫阑尾血管,引起阑尾出血坏死。其早期穿孔率高,应及早手术。通过彩色多普勒超声能明确观察阑尾有无肿大,阑尾腔内有无粪石阻塞及阑尾壁血流分布情况。现对我院26例经手术病理证实的粪石性阑尾炎的声像图特征报告如下。     

高频超声对阑尾炎诊断的价值

目的分析高频超声对阑尾炎诊断的价值。方法对186例经高频超声诊断为阑尾炎患者的临床及影像学资料进行回顾分析,并与手术和病理结果进行对照。结果 186例患者均经手术治疗及病理检查,其中168例患者确诊为阑尾炎(急性单纯性阑尾炎患者30例,化脓性阑尾炎患者88例,坏疽性阑尾炎患者28例,阑尾周围脓肿15例,慢性阑尾炎7例),高频超声诊断准确率为90.3%。结论高频超声在阑尾炎超声诊断中具有很好的应用价值。更多还原     

超声检查对不同病理类型阑尾炎的诊断价值

目的探讨超声检查对不同病理类型阑尾炎的诊断价值。 方法分析2012年6月至2013年12月中山大学附属第六医院经手术病理证实为阑尾炎且术前行超声检查的111例患者的超声表现。其中急性单纯性阑尾炎6例,急性化脓性阑尾炎45例,急性坏疽性阑尾炎15,慢性阑尾炎33例,慢性阑尾炎急性发作12例。采用Kruskal-Wallis检验比较不同病理类型阑尾炎患者术前超声测量的阑尾长度、宽度、管壁厚度,进一步组间两两比较采用Kruskal-Wallis检验;采用Fisher确切概率法比较不同病理类型阑尾炎患者超声表现差异,进一步组间两两比较采用Fisher确切概率法。 结果111例手术病理证实为阑尾炎的患者中,90例患者术前超声检查提示阑尾炎,超声诊断准确率为81.08%（90/111）。急性单纯性阑尾炎、急性化脓性阑尾炎、急性坏疽性阑尾炎、慢性阑尾炎、慢性阑尾炎急性发作患者术前超声诊断准确率分别为83.33%（5/6）、91.11%（41/45）、93.33%（14/15）、60.61%（20/33）、83.33%（10/12）。不同病理类型阑尾炎患者术前超声测量的阑尾长度差异无统计学意义,但急性坏疽性阑尾炎患者术前超声测量的阑尾宽度均大于急性单纯性阑尾炎、慢性阑尾炎患者,且差异均有统计学意义[（13.79 ± 4.48） mm vs（7.60 ± 1.52） mm,χ²=4.211,P=0.024;（13.79 ± 4.48） mm vs（9.35 ± 5.01） mm,χ²=4.071,P=0.033];急性化脓性阑尾炎、急性坏疽性阑尾炎患者管壁厚度均大于慢性阑尾炎患者,且差异均有统计学意义[（4.39 ± 1.42） mm vs（3.37 ± 0.93） mm,χ²=3.931,P=0.043;（4.81 ± 1.57） mm vs（3.37 ± 0.93） mm,χ²=4.274,P=0.021]。不同病理类型阑尾炎患者的超声表现在管腔内粪石、淋巴结肿大和合并包块方面差异均无统计学意义。在管壁层次不清及管腔扩张两方面,急性化脓性阑尾炎、急性坏疽性阑尾炎与慢性阑尾炎患者的超声表现差异均有统计学意义[管壁层次不清：91.11%（41/45） vs 54.55%（18/33）,P=0.003;93.33%（14/15） vs 54.55%（18/33）,P=0.045。管腔扩张：64.44%（29/45） vs 27.27%（9/33）,P=0.007;80.00%（12/15） vs 27.27%（9/33）,P=0.007];在合并阑尾区积液方面,急性坏疽性阑尾炎与慢性阑尾炎患者的超声表现差异有统计学意义[53.33%（8/15）vs 6.06%（2/33）,P=0.006]。 结论超声检查对阑尾炎尤其是急性化脓性和急性坏疽性阑尾炎有较高的诊断价值。超声测量阑尾宽度、管壁厚度及对管壁层次、管腔扩张程度及阑尾区有无积液等特征的观察对鉴别诊断慢性阑尾炎与急性化脓性阑尾炎、急性坏疽性阑尾炎有一定的价值;阑尾宽度对鉴别诊断急性坏疽性阑尾炎与急性单纯性阑尾炎有意义。超声检查对鉴别诊断急性化脓性与急性坏疽性阑尾炎、急性单纯性阑尾炎与慢性阑尾炎及慢性阑尾炎急性发作的价值有限。     

105例阑尾炎的超声检查诊断分析

目的：探讨超声检查诊断急性阑尾炎的应用价值。方法：对我院105例急性阑尾炎患者声像图进行回顾性分析,并与手术及病理结果对照。结果：105例中超声诊断急性阑尾炎91例（符合率86.6%）。病理诊断为急性单纯性阑尾炎18例,超声诊断11例（符合率61.1%）;病理诊断为急性化脓性阑尾炎77例,超声诊断71例（符合率92.2%）;病理诊断为坏疽性及穿孔性阑尾炎8例,超声诊断10例（符合率80%）;阑尾周围脓肿1例,超声与病理诊断一致（100%）。结论：超声检查对急性阑尾炎的诊断有较好的实用价值。     

儿童急性阑尾炎的病理分型与超声声像对照分析

目的通过对儿童急性阑尾炎的病理分型与超声声像对照分析,总结儿童急性阑尾炎不同病理分型的超声直接与间接声像特点。方法回顾性统计413例经病理证实的儿童急性阑尾炎和200例正常病例的超声诊断结果,参照阑尾炎病理分型,分析不同病理类型阑尾炎的超声表现以及它们的主要差异。结论超声检查对不同病理类型急性阑尾炎具有重要的鉴别诊断意义。超声测量阑尾最大外径对鉴别单纯性阑尾炎与正常阑尾及其他类型阑尾炎具有统计学意义,鉴别化脓性阑尾炎与坏疽性阑尾炎具有统计学意义,鉴别坏疽性阑尾炎与阑尾周围脓肿差异无统计学意义。超声观察管壁层次结构、管壁连续性、管腔内回声及粪石、周围系膜网膜增厚程度、阑尾周围低回声等特征性表现对鉴别不同类型阑尾炎具有统计学意义。     

超声对急性阑尾炎阑尾周边高回声结构的分析

目的 探讨阑尾周边高回声结构的性质，评价其在急性阑尾炎超声诊断中的临床意义。方法 对75例急性阑尾炎患者声像图进行回顾性分析，并与手术及病理结果相对照，分析阑尾周边高回声结构与阑尾炎病理及病变现象之间的相互关系。结果 75例急性阑尾炎中阑尾周边高回声结构阳性者32例，阴性者43例。阳性者中单纯性阑尾炎2例，化脓性阑尾炎18例，坏疽性阑尾炎12例，分别占各阑尾炎类型总例数的13％（2／15），39％（18／46），86％（12／14），阑尾周边高回声结构阳性率与病理类型间呈正相关关系（r=0．451，P〈0．001），阑尾炎越严重，阑尾周边高回声结构阳性率越高。病理结果显示阑尾周边高回声结构阳性病例均伴有阑尾周围炎，且阑尾发生与周围组织粘连及穿孔的比率明显高于阑尾周边高回声结构阴性病例。结论 阑尾周边高回声结构是急性阑尾炎超声征象之一，是阑尾周围组织（大网膜、肠系膜脂肪）受炎症浸润发生急性炎性反应的表现，阑尾周边高回声结构阳性提示与周围组织粘连、阑尾穿孔等严重病变可能性大。     

高低频探头联合使用在急性阑尾炎中的诊断价值

目的探讨联合使用高低频探头在急性阑尾炎中的诊断价值。方法回顾性分析了122例急性阑尾炎的临床资料,对比超声诊断与手术病理结果。结果 122例中,超声诊断阑尾炎110例,漏诊8例,误诊4例,诊断符合率90.16%(110/122);术前超声诊断分型与术后病理分型对比,122例中作了分型的110例中有95例与病理分型一致,诊断符合率为86.4%(95/110)。结论高低频探头联合应用提高了阑尾炎诊断符合率,且在阑尾炎病理分型中有重要应用价值。     

新生儿阑尾炎临床及超声图像特点分析

目的总结新生儿阑尾的临床及超声图像特点。 方法选取2007年1月至2017年10月在首都医科大学附属北京儿童医院经手术或临床诊断的新生儿阑尾炎28例,总结其临床及超声图像特点。 结果28例新生儿阑尾炎患儿中超声可显示阑尾9例,其中3例阑尾外径<0.4 cm,6例阑尾外径≥0.4 cm;2例阑尾壁厚<0.2 cm,7例阑尾壁厚≥0.2 cm。19例新生儿阑尾显示困难,则重点观察阑尾周围改变。超声扫查提示：28例右下腹可见阑尾周围系膜肿胀,26例可见阑尾周围积脓或炎性包块;超声提示诊断新生儿阑尾炎22例,新生儿坏死性小肠结肠炎4例,消化道穿孔1例;1例因腹胀明显,初诊超声无异常发现,腹胀缓解后超声诊断新生儿阑尾炎。28例患儿中2例继发近端小肠粘连梗阻,2例阴囊内混浊积液。超声随访观察28例新生儿治疗后改变,其中保守治疗21例,18例1个月内超声复查可见周围炎症范围较上次检查缩小（4例5~10个月复发,2例再次手术,2例保守治疗后均好转）。7例手术治疗的患儿中,4例术后1周行超声复查,原病变区局部仅可见少许粘连。 结论新生儿阑尾炎临床症状多样,超声图像表现为阑尾周围系膜肿胀,阑尾外径增大（≥0.4 cm）和（或）阑尾壁增厚（≥0.2 cm）,可合并积脓和（或）炎性包块,超声检查可对患儿的诊断及治疗提供依据。     

结肠癌合并急性阑尾炎的超声诊断

目的 探讨结肠癌合并急性阑尾炎的超声影像特点及早期诊断的临床价值。方法 对79例经手术及病理证实为结肠癌合并急性阑尾炎患的临床及超声影像资料进行回顾性分析研究。结果 79例术前超声诊断为结肠癌合并急性阑尾炎71例，占89．9％；误诊为急性阑尾炎5例，占6．3％；误诊为胃穿孔2例，占2．5％；误诊为肠套叠1例，占1．3％。结论 超声显像对结肠癌合并急性阑尾炎的诊断及鉴别诊断有重要价值，早期诊断应得到进一步重视。     

超声检查在妇科急腹症的诊断与鉴别诊断中的价值探讨

目的探讨超声检查在妇科急腹症的诊断与鉴别诊断应用价值。方法回顾性分析138例妇科急腹症的超声检查结果并与临床诊断对照。结果本组138例,诊断正确123例,诊断符合率为89.1%。其中,异位妊娠45例,正确诊断率为91.1/%;黄体破裂27例,正确诊断率为81.5/%;卵巢囊肿蒂扭转24例,正确诊断率为87.5/%;急性盆腔炎42例,正确诊断率为92.9/%。结论超声检查对妇科急腹症的诊断正确率较高,当症状不典型,声像图改变又缺乏特异时,容易造成误诊或漏诊,此时须详细询问病史,密切结合临床症状、化验结果,以提高诊断正确率。     

Sonography of acute appendicitis in pregnancy

Background: Clinical evaluation of acute appendicitis is difficult in pregnant patients. Delay in diagnosis is associated with increased fetal mortality. The purpose of our study was to assess the value of sonography in the diagnosis of acute appendicitis in pregnant women. Methods: We obtained sonograms in 22 pregnant women suspected of acute appendicitis. All sonograms were performed using graded-compression to detect an enlarged appendix. The sonographic criteria for acute appendicitis were detection of a noncompressible blindended and tubular multilayered structure of maximal diameter greater than 6 mm. Results: The sonographic findings were correlated with surgical findings in seven cases and clinical follow-up in 15 cases. Acute appendicitis was diagnosed by sonography in three of 22 patients, and in all but one was confirmed by surgical and pathologic findings. In the remaining 19 patients, 15 improved on clinical follow-up; three were shown to have a normal appendix at surgery and one had focal acute inflammation at the tip of the appendix. Conclusions: Our experience suggests that graded-compression sonography is a useful procedure in pregnant patients suspected of acute appendicitis and has a similar accuracy as in nonpregnant women, especially in the first and second trimester.     

新生儿阑尾炎12例诊治分析

目的探讨新生儿阑尾炎的临床特点、诊断和治疗方法。方法回顾性分析我科2013年5月至2019年12月收治的12例新生儿阑尾炎患儿的临床资料。结果男7例,女5例,手术治疗11例(手术及病理均证实为阑尾炎),保守治疗1例。手术治疗患儿中,10例行阑尾切除术,1例行阑尾切除+回肠造瘘术;12例患儿中10例治愈出院,死亡2例。结论新生儿阑尾炎临床表现多无特异性,早期诊断难度较大,腹部超声检查可帮助诊断,积极手术和细致的围手术期治疗是提高治愈率的关键。     

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.     

The effect of blunt abdominal trauma on appendix vermiformis

Objectives: Trauma and appendicitis are the most common conditions of childhood for which surgical consultation is sought in emergency departments. Occasionally, appendicitis and trauma exist together, which causes an interesting debate whether trauma has led to appendicitis. We aimed to evaluate our patients with traumatic appendicitis and to discuss their properties in the light of the literature. Methods: We retrospectively reviewed the charts of children of blunt abdominal trauma accompanied by appendicitis. Results: Of 29 cases of blunt abdominal trauma that had required surgical exploration, five were found to have gross findings of acute appendicitis and underwent appendicectomy. Appendicitis was confirmed histopathologically. Conclusion: It should be kept in mind that children managed for severe blunt abdominal trauma may develop appendicitis. If clinical outlook suggests appendicitis in cases conservatively managed for blunt abdominal trauma, physical examinations, abdominal ultrasonography and/or abdominal computed tomography should be repeated for diagnosis of traumatic appendicitis. This approach will help to protect the patients against the complications of appendicitis that are likely to develop.     

Sonography in the Evaluation of Acute Appendicitis

Objective. The purpose of this study was to evaluate the negative predictive value (NPV) of sonography in the diagnosis of acute appendicitis. Methods. Right lower quadrant sonograms of 193 patients (158 female and 35 male; age range, 3–20 years) with suspected acute appendicitis over a 1‐year period were retrospectively reviewed. Sonographic findings were graded on a 5‐point scale, ranging from a normal appendix identified (grade 1) to frankly acute appendicitis (grade 5). Sonographic findings were compared with subsequent computed tomographic (CT), surgical, and pathologic findings. The diagnostic accuracy of sonography was assessed considering surgical findings and clinical follow‐up as reference standards. Results. Forty‐nine patients (25.4%) had appendicitis on sonography, and 144 (74.6%) had negative sonographic findings. Computed tomographic scans were obtained in 51 patients (26.4%) within 4 days after sonography. These included 39 patients with negative and 12 with positive sonographic findings. Computed tomography changed the sonographic diagnosis in 10 patients: from negative to positive in 3 cases and positive to negative in 7. Forty‐three patients (22.2%) underwent surgery. The surgical findings were positive for appendicitis in 37 (86%) of the 43 patients who had surgery. Patients with negative sonographic findings who, to our knowledge, did not have subsequent CT scans or surgery were considered to have negative findings for appendicitis. Seven patients with negative sonographic findings underwent surgery and had appendicitis; therefore, 137 of 144 patients with negative sonographic findings did not have appendicitis. On the basis of these numbers, the NPV was 95.1%. Conclusions. Sonography has a high NPV and should be considered as a reasonable screening tool in the evaluation of acute appendicitis. Further imaging could be performed if clinical signs and symptoms worsen.