临床不典型急性阑尾炎的超声诊断

目的: 探讨高频超声结合低频超声检查在临床不典型阑尾炎诊断中的应用价值.方法: 选择症状体征不典型, 临床诊断腹痛待查患者65例, 分别使用3.5-4.0 MHz普通腹部探头和7.0-10.0 MHz高频探头做超声检查, 经手术后病理证实为急性阑尾炎共65例, 结合其临床特征分析非典型急性阑尾炎超声声像图表现.结果: 65例患者超声提示急性阑尾炎54例, 显示率为83.08%.高频超声肿大阑尾显示率与低频超声相比差异有统计学意义(83.08% vs61.53%, χ2=4.32, P<0.05).低频超声结合高频超声显示非典型阑尾炎有一些间接征象:阑尾粪石33例(61.11%), 周围肠管扩张25例(46.29%), 阑尾周围积液21例(38.88%), 阑尾周围包块14例(25.92%), 肠系膜淋巴结肿大10例(18.52%).结论: 高频结合低频超声检查能提高肿大阑尾及周围结构显示率, 可成为临床不典型急性阑尾炎首选辅助诊断方法.     

183例急性阑尾炎患者超声检查结果分析

对183例急性阑尾炎患者行低频超声、高频超声和彩色多普勒超声检查,分析其声像图特征,并与手术病理结果对照.结果 超声诊断与手术病理的总符合率为90.2%(165/183).认为低频超声、高频超声联用能明显提高肿大阑尾的显示率,多普勒超声有助于阑尾炎的分型.     

联合应用高、低频超声对老年人急性阑尾炎的诊断价值

文献报道在所有的阑尾炎病例中,老年患者约占10%。随着我国人口的逐渐老龄化,老年急性阑尾炎的发病率也逐渐增高,加上老年人机体抵抗力低下,同时并存多种疾病,常延误诊断,故切实地研究这一人群疾病的诊治特点,提高阳性诊断率有现实意义。高、低频超声相结合诊断急性阑尾炎是一种无创、直观、诊断准确率高,简便易行的检查方法。本研究回顾性分析我院临床上疑有急性阑尾炎经术前超声检查并经手术证实的70例老年患者,结果如下。1资料与方法1.1临床资料于2006年7月至2010年12月我院就诊经术前超声检查并收治住院的可疑急性阑尾炎的老年患者70     

低频超声联合高频超声对胆囊增生性疾病的诊断价值

目的探讨低频超声联合高频超声诊断胆囊良性病变的临床价值。方法回顾性分析2015年1月-2016年1月新疆图木舒克市人民医院门诊收治的经手术病理证实为胆囊良性病变患者110例。所有患者均先行常规低频超声检查并记录检查结果;然后联合高频超声进行检查并记录结果。对比分析常规低频超声检查和联合高频超声检查的病理诊断符合率。计数资料组间比较采用χ2检验。结果110例患者中,常规低频超声检查与病理诊断结果相符合的有83例;联合高频超声检查与病理诊断结果相符合有102例,其中胆囊息肉样病变70例(68.63%),胆囊腺肌增生症32例(31.37%),另有8例误诊,误诊率为7.3%;低频超声联合高频超声检查的病理诊断符合率(92.73%)明显高于低频超声检查(75.45%),差异有统计学意义(χ2=12.266,P=0.001)。结论低频超声联合高频超声检查,有利于提高胆囊良性病变的诊断准确率。     

Alvarado评分联合逐步加压右下腹彩超检查在急性阑尾炎诊断中的应用

目的 探讨Alvarado评分联合逐步加压超声在急性阑尾炎诊断中的应用价值.方法 选择我院收治的经术后病理证实为急性阑尾炎患者186例,术前对所有患者进行Alvarado评分联合逐步加压右下腹彩超检查.结果 在186例急性阑尾炎患者中,Alvarado评分联合逐步加压右下腹彩超检查诊断正确者162例,诊断准确率为87.1％.单独使用Alvarado评分的ROC曲线下面积是0.796.Alvarado评分联合逐步加压超声检查诊断急性阑尾炎的灵敏度为90.7％,特异度为87.5％.结论 Alvarado评分联合逐步加压超声检查对诊断急性阑尾炎有较高的价值.     

彩色多普勒超声在老年急性阑尾炎诊断中的应用

老年急性阑尾炎的起病、症状、体征及实验室检查均有其特点~([1]),并且其病理类型特点、超声显示特点、超声显示率及病理类型诊断率等尚有继续研究的空间.本文对89例老年阑尾炎进行了彩色多普勒超声检查,旨在探讨彩色多普勒超声在老年急性阑尾炎诊断中的应用价值.     

彩超检查对急性阑尾炎的诊断价值

目的探讨彩色超声检查对急性阑尾炎的诊断价值。方法选取我院2008年1月—2009年12月住院治疗的69名经手术及病理检查证实的急性阑尾炎患者的彩超检查结果进行对比分析。结果彩超共诊断65例(94.2%),漏诊4例(5.8%)。其中急性单纯性阑尾炎彩超诊断22例(84.6%),漏诊4例(15.4%);急性化脓性阑尾炎彩超诊断18例,彩超诊断100%;急性坏疽性阑尾炎13例,彩超诊断100%;阑尾穿孔及周围脓肿12例,彩超诊断100%。结论彩色超声诊断急性阑尾炎方便、无创、诊断率高,有重要意义。     

磁共振成像与高频超声在乳腺癌诊断中的临床价值

目的探讨磁共振成像(MRI)与高频超声在乳腺癌诊断中的临床价值。方法选取临床怀疑为乳腺癌的80例女性患者,术后66例病理检查证实为乳腺癌,术前行MRI及高频超声检查,分析检查准确性。结果 MRI检测62例诊断为乳腺癌,18例诊断为良性病变;高频超声检测60例诊断为乳腺癌,20例诊断为良性病变;MRI与高频超声联合检测时67例诊断为乳腺癌、13例诊断为良性病变。MRI与高频超声诊断乳腺癌时敏感度、特异度、阳性预测值、诊断符合率比较差异无统计学意义(P>0.05),联合检查时敏感度、诊断符合率均高于单独任何一项检查(P<0.05),特异度、阳性预测值与单项检查比较差异无统计学意义(P>0.05)。结论 MRI与高频超声检查诊断乳腺癌的敏感性、特异性、阴性预测值、诊断符合率接近,以上方法联合检查能明显提高敏感性及诊断符合率。     

急诊超声诊断老年急腹症的临床应用及误诊原因

目的探讨超声诊断对老年急腹症的诊断价值及误诊原因。方法选取疑患老年急腹症的78例患者采用腹部超声检查,以手术病理或临床医师最终诊断为准,判断超声检查的应用效果,分析误诊病例。结果腹部超声诊断准确率为83.33%.实质脏器诊断准确率高于空腔脏器(P0.05)。急性阑尾炎误诊2例,消化道穿孔2例,肠梗阻3例,急性盆腔炎1例,泌尿系结石1例,胆道疾病2例,急性胰腺炎误诊1例,心梗误诊1例。结论超声对老年急腹症的诊断效果较好,但需注意患者的病史、临床表现、体征及实验室检测,必要时行CT检查,以免误诊。     

超声检查间接征象对老年急性阑尾炎的诊断价值

目的探讨超声检查间接征象在老年阑尾炎早期诊断中的应用价值。方法对214例疑诊为阑尾炎的老年患者的超声影像学资料进行回顾性分析。结果 214例患者中,60例超声检查未发现阑尾炎直接征象,仅表现为间接征象即超声扫查时右下腹压痛阳性,右下腹腹膜或系膜脂肪层增厚、回声增强,右下腹局限性肠管扩张、蠕动减弱或消失。其中5例仅有右下腹压痛阳性,1例手术证实为阑尾炎;12例具有两种间接征象（右下腹压痛阳性＋局限性肠管扩张9例,右下腹压痛阳性＋腹膜或系膜脂肪层增厚3例）,9例确诊阑尾炎;43例同时有三种间接征象,41例确诊阑尾炎。同时具有三种间接征象诊断阑尾炎的阳性预测值、阴性预测值、敏感性及特异性分别为0.95、0.41、80%、67%。结论超声检查间接征象对老年急性阑尾炎的早期诊断有重要价值。     

Ultrasonography in the diagnosis of acute appendicitis: a prospective study

The diagnostic accuracy and practical impact of high-resolution sonography were prospectively studied in 523 consecutive patients admitted to the hospital with suspected appendicitis. The criteria for ultrasound diagnosis of acute appendicitis included visualization of a noncompressible aperistaltic appendix, with a targetlike appearance in transverse view and a diameter greater than or equal to 7 mm. In 115 of 130 patients with proven appendicitis the inflamed appendix or appendiceal abscess could be visualized, giving a sensitivity of 88.5%. The mean diameter of ultrasonically visible appendices was 11.4 +/- 3.2 mm. The overall accuracy and specificity of sonography in the diagnosis of acute appendicitis were 95.7% and 98%, respectively. The predictive value of a positive test was 94.5% and that of a negative result 96.3%. In a separate analysis of the results in 121 women of childbearing age, who have a high risk of preoperative misdiagnosis, the overall accuracy was found to be 96.7%, with 82.6% sensitivity and 100% specificity. Twenty-four (89%) of the 27 patients with appendiceal rupture (incidence 20.8%) were correctly diagnosed with ultrasound. The other 3 cases (11%) were missed. Routine use of ultrasonography has significantly improved the diagnostic accuracy in patients with suspected appendicitis and has reduced the negative laparotomy rate from 22.9% to 13.2%.     

Sonography in the diagnosis of appendicitis--a prospective study

In a prospective study the significance of ultrasonography in the diagnosis of appendicitis was evaluated. On 104 patients--57 women and 47 men between the ages of 5 and 88 years--with a preliminary diagnosis of acute appendicitis, ultrasonography was performed using a graded compression technique with small curved-array transducers following physical examination. In 32 of 36 patients with operatively confirmed appendicitis the inflamed appendix could be visualized clearly. All 6 perityphlitic abscesses and 4 of 5 perforations were detected correctly by ultrasonography. In 18 patients the use of sonography led to important differential diagnoses other than appendicitis, which in 4 cases required surgery. By direct visualization of the inflamed appendix and its periappendicidal complications the clinical diagnosis of acute appendicitis can be improved. As a result of sonographic detection or exclusion of other diseases, ultrasonography facilitates the--often difficult--clinical differential diagnosis of right lower abdominal pain.     

老年急性阑尾炎病情严重程度的超声评估及其临床应用

目的 探讨高龄急性阑尾炎患者的超声声像图特征与炎症病变严重程度的关系,为临床治疗提供影像学参考.方法 回顾性分析2011年1月至2021年1月中国人民解放军空军特色医学中心经临床及辅助检查诊断为急性阑尾炎、年龄>70岁的患者78例.剔除仅行保守、抗炎治疗患者21例,最终入组患者57例.按超声表现初步分为炎症反应轻、重2...     

Practical role of ultrasonography and clinical examination for the diagnosis of acute appendicitis. Prospective study]

The aim of this 100-patient prospective study was to compare three types of investigations in the diagnosis of acute appendicitis: initial clinical examination, initial appendicular ultrasound examination, and final results of repeated clinical examinations carried out within the first 48 hours. Final results included initial evaluation, obvious clinical results and definitive results from patients under 48 hour observation for uncertain diagnosis. Clinical initial or appendicular ultrasound examinations were poorly contributive to diagnosis (overall accuracy: 76 percent). On the contrary, repeated clinical examinations yielded a 100 percent sensitivity, a 94 percent specificity, a 94 percent positive predictive value, a 97 percent negative predictive value and a 97 p. 100 overall accuracy. No morbidity was noted in observing patients for 48 hours. Unwarranted appendectomies were carried out in 3 percent of cases. Ultrasonography of the appendix seems useful for the differential diagnosis of acute appendicitis.     

彩色多普勒超声结合高频超声探头对阑尾炎的诊断价值

目的 探讨彩色多普勒超声对急性阑尾炎超声检查的临床价值.方法 对63例急性阑尾炎的超声检查结果进行分析,并全部经手术及病理诊断证实.结果 阑尾炎的声像图表现具有相应的特征性,正常阑尾超声扫查不能显示,阑尾炎时阑尾的显示取决于阑尾的位置,肿胀程度和周围组织积液/脓肿的有无.结论 基于阑尾的解剖特点,超声诊断阑尾炎声像图具有特征性诊断效果,有利于手术适应证和保守治疗的选择,对回盲部疾病诊断和鉴别诊断很有临床应用价值.     

Ultrasonography of non-perforated appendicitis in young children

BACKGROUND/AIMS: The role of ultrasonography in diagnosing non-perforated appendicitis in young children is reviewed. METHODOLOGY: Between January 1997 and September 1999, three children with abdominal pain due to non-perforated appendicitis were admitted to the Nippon Medical School Hospital. Ultrasonography of the right lower quadrant was performed using a 7.5-MHz curved array transducer with the graded compression technique. RESULTS: Edema of the appendix was detected in all cases. The appendiceal diameter was 9 to 18 mm, and the thickness of the muscular wall was 3.5 to 6 mm. An echogenic submucosal layer, increased periappendiceal echogenicity, and the acoustic shadow of the proximal appendix was detected in each case. Localized fluid collection was not observed in any patient. Surgical and histopathological findings were nonperforated gangrenous appendicitis with fecal stone in all three cases. CONCLUSIONS: Ultrasonography provides valuable clinical information about the ileocecal region in children with acute abdominal pain. Even when the clinical diagnosis seems well established, performing ultrasonography routinely may help reduce the rate of perforation by decreasing the time required to establish the diagnosis.     

Ultrasound diagnosis of Meckel diverticulitis in adults

Meckel's diverticulitis is a rare disease. In addition to physical examination, abdominal ultrasound can help to pinpoint the diagnosis. By presenting a case report we would like to demonstrate the typical ultrasonographic findings in acute Meckel's diverticulitis and differentiate it from acute appendicitis. A 60-year-old patient was admitted to our hospital with the diagnosis of acute appendicitis. Abdominal ultrasound was performed and a blind ending, liquid-filled segment of small bowel in the right lower quadrant of the abdomen found. This segment was not compressible, no peristalsis was evident, nor was there any anatomical association with the cecum. Locally we found free fluid and hints of inflamed mesenteric fatty tissue. A perforated Meckel's diverticulum was diagnosed and confirmed intraoperatively. The major ultrasonographic difference between an inflamed Meckel's diverticulum and acute appendicitis is its anatomical location. In contrast to the appendix there is no association with the cecum. A diameter of up to 40 mm and a well-defined wall of small bowel with 3 definite layers visible by ultrasound may help to distinguish between a Meckel's diverticulum and the appendix.     

Atresia of the appendix vermiformis:A rare case of developmental abnormality

Acute appendicitis,which requires immediate surgical intervention,is an important diagnosis in patients with acute abdomen.However,developmental abnormalities may interfere with the preoperative diagnosis and surgical treatment in some cases.Agenesis and atresia of the cecal vermiform appendix is an extremely rare clinical diagnosis.In addition,preoperative diagnosis may be difficult in some cases.Thus,diagnosis of the congenital absence of the vermiform appendix requires a thorough exploration of the retrocecal and ileocecal regions.A 59-year-old male was admitted from the emergency services with right lower abdominal pain.A celiotomy was performed with the suspicion of acute appendicitis.However,an atresia of the vermiform appendix was observed.The patient’s appendix was thus removed.Pathological examination confirmed suppurative appendicitis.This case underlines the importance of the clinical entity for surgeons who may deal with a similar case.     

A case of stump appendicitis after appendectomy]

Stump appendicitis is an acute inflammation of the residual appendix and a rare complication after an appendectomy. Although the signs and symptoms do not differ from acute appendicitis, the diagnosis is often not considered because of the past surgical history. Only a small number of stump appendicitis cases have been reported, but there has been no report of stump appendicitis in Korea. Herein, we report a case of stump appendicitis. A 28-year-old female was admitted to our hospital due to right lower quadrant abdominal pain. Fifteen months ago, the patient had a laparoscopic appendectomy under the diagnosis of an acute appendicitis, but she subsequently suffered from intermittent abdominal pain and fever. Abdominal ultrasonography and CT scan showed an inflamed appendiceal stump. Laparoscopic stump appendectomy was done and the biopsy revealed stump appendicitis.     

Diagnostic value of maximal-outer-diameter and maximalmural-thickness in use of ultrasound for acute appendicitis in children

MM： To evaluate the maximal-outer-diameter （MOD） and the maximal-mural-thickness （MMT） of the appendix in children with acute appendicitis and to determine their optimal cut-off values to diagnose acute appendicitis.
METHODS： In total, 164 appendixes from 160 children between 1 and 17 years old （84 males, 76 females; mean age, 7.38 years） were examined by high-resolution abdominal ultrasound for acute abdominal pain and the suspicion of acute appendicitis. We measured the MOD and the MMT at the thickest point of the appendix. Patients were categorized into two groups according to their medical records： patients who had surgery （surgical appendix group） and patients who did not have surgery （non-surgical appendix group）. Data were analyzed by MedCalc v.9.3. The rank sum test （Mann-Whitney test） was used to evaluate the difference in the MOD and the MMT between the two groups. ROC curve analysis was used to determine the optimal cut-off value of the MOD and the MMT on diagnosis of acute appendicitis.
RESULTS： There were 121 appendixes （73.8%） in the non-surgical appendix group and 43 appendixes （26.2%） in the surgical appendix group. The median MOD differed significantly between the two groups （0.37 cm vs 0.76 cm, P〈 0.0001）, and the median MMT also differed （0.15 cm vs 0.33 cm, P 〈 0.0001）. The optimal cut-off value of the MOD and the MMT for diagnosis of acute appendicitis in children was 〉 0.57 cm （sensitivity 95.4%, specificity 93.4%） and 〉 0.22 cm （sensitivity 90.7%, specificity 79.3%）, respectively.
CONCLUSION： The MOD and the MMT are reliable criteria to diagnose acute appendicitis in children. An MOD 〉 0.57 cm and an MMT 〉 0.22 cm are the optimal criteria.