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。

The value of ultrasonography in the diagnosis and pathological classification of appendicitis

ObjectiveTo assess the diagnostic value of ultrasonography in the diagnosis and pathological classification of appendicitis with pathological results. MethodsThe study included 111 cases confirmed by surgery and pathology in the Six Affiliated Hospital of Sun Yat-sen University from June 2012 to December 2013. The image characteristics of ultrasonic images performed before surgery were analyzed retrospectively. The cases were divided into five groups based on the pathology: 6 acute simple appendicitis, 45 acute suppurative appendicitis, 15 acute gangrenous appendicitis, 33 chronic appendicitis, and 12 acute attack of chronic appendicitis. The length, width and wall thickness of the appendicitis measured by preoperative ultrasound between various pathological type were compared with Kruskal-Wallis statistical method, and also used the same method to compared the one which had statistically significance between the five groups. As in the above case, Fisher exact test was used to compare the characters of ultrasonography included gradations of the appendix, the tube cavity expansion, stercorolith, the appendiceal abscess, mergering lymph node enlargement and the appendix around effusion, if there was statistically significance, the same method was used to compare between the five groups. ResultsTotally 90 of 111 cases were reminded appendicitis by preoperative ultrasound, the diagnostic accuracy rate was 81.08%, including acute suppurative appendicitis 91.11% (41/45), acute gangrenous appendicitis 93.33% (14/15), acute simple appendicitis 83.33% (5/6), chronic appendicitis 60.61% (20/33), chronic appendicitis onset acute 83.33% (10/12). There were no statistical differences of preoperative ultrasound measured between various pathological type of appendicitis in length, while the appendix width measured by preoperative ultrasound of acute gangrenous appendicitis was wider than the acute simple group and chronic group, and there were statistically significance between them (P<0.05), in the aspect of wall thickness, the acute suppurative appendicitis and the acute gangrenous appendicitis groups were thicker than the chronic group, and these differences had statistically significance (P<0.05). The stercorolith, lymph node enlargement and the appendiceal abscess in different types of appendicitis had no statistical difference. There were statistically differences (P<0.05) between the acute suppurative goup, acute gangrenous group and the chronic group respectively, both in gradations of the appendix and the tube cavity expansion. Also there were statistically difference (P<0.05) between the acute gangrenous appendicitis group and the chronic group in the aspect of the appendix around effusion. ConclusionsUltrasound is valuable in the diagnosis of appendicitis, especially for acute gangrenous appendicitis and acute purulent appendicitis. The measurement of appendix with wide diameter, wall thickness by ultrasond preoperatively, and the characteristics of the wall layers, lumen expansion degree and the appendix around effusion are valuable in identifying chronic appendicitis, acute suppurative appendicitis, and acute gangrene appendicitis. The ultrasonic measurement of appendix wide diameter could identify acute gangrenous appendicitis and acute simple appendicitis. Ultrasound had limited value in identifying acute suppurative, acute gangrenous appendicitis, acute simple appendicitis, chronic appendicitis, and chronic appendicitis onset acute.