急性阑尾炎的CT诊断及临床应用价值

目的提高对CT在急性阑尾炎诊断中重要性的认识。方法回顾性分析经手术病理证实的87例急性阑尾炎的CT表现。结果 87例急性阑尾炎中,单纯性阑尾炎45例,阳性40例,阴性5例;化脓性阑尾炎28例,坏疽穿孔性阑尾炎7例,阑尾周围脓肿7例均出现相应的CT表现。CT表现为阑尾肿大,管径增粗,阑尾壁不同程度水肿,同时可合并周围炎性渗出或脓肿形成。结论 CT对急性阑尾炎的诊断及临床应用有很大的价值。     

高频超声对阑尾急性炎症的诊断价值

目的:探讨高频超声对阑尾急性炎症的诊断价值.方法:选取我院2009年12月至2010年12月收治的120例经手术或病理证实的急性阑尾炎的患者为研究对象,该组患者均采用低频、高频超声进行检查诊断,总结两种方法对急性阑尾炎的诊断率,并分析高频超声对不同类型的阑尾炎的诊断年之间的差异.结果:高频超声的诊断率为85.0％显著高于低频超声的45.0％,P＜0.01.且高频超声对阑尾周围脓肿的诊断率最高为100％,对单纯性阑尾炎诊断年较低为70.3％.结论:高频超声对急性阑尾炎有较高的诊断价值,能够较好的对其进行临床分型,且对阑尾周围脓肿的诊断率较高.     

急性阑尾炎高、低频彩色多普勒超声检查与术后病理对照分析

目的探讨高、低频彩色多普勒超声联合应用对急性阑尾炎诊断及分型的价值。方法对236例疑似急性阑尾炎患者,使用2.0~5.0MHz、8.0~14MHz探头进行腹部超声扫查,重点检查右下腹或压痛区域,并联合应用组织谐波、彩色多普勒血流图及能量图。观察阑尾形态、大小、壁层次结构及血流情况,与手术后病理结果进行对照分析。结果236例阑尾炎患者,经手术后病理确诊急性单纯性阑尾炎16例,化脓性阑尾炎159例,坏疽性阑尾炎36例,慢性阑尾炎24例,阑尾脓肿1例。超声确诊急性阑尾炎199例,其中单纯性阑尾炎9例,化脓性阑尾炎143例,坏疽性阑尾炎27例,慢性阑尾炎20例,阳性率84.3%。假阴性37例,占15.7%。结论高、低频彩色多普勒超声联合应用,观察阑尾形态、大小及壁层次结构改变在急性阑尾炎诊断及分型中有其重要价值。     

彩色多普勒超声检查对急性阑尾炎分型和指导治疗的临床分析

目的提高急性阑尾炎的超声诊断水平并指导临床治疗。方法用超声诊断仪检查78例初步诊断为急性阑尾炎的住院患者,出院时追踪复查或与手术、病理结果对照。结果彩色多普勒超声对急性阑尾炎检出率为92.3%,其中单纯性阑尾炎符合率为94.4%;化脓性阑尾炎符合率为93.3%;坏疽性及穿孔性阑尾炎符合率为73.3%;阑尾周围脓肿符合率为77.8%,部分单纯性阑尾炎和阑尾脓肿保守治疗效果满意。结论彩色多普勒超声在急性阑尾炎的诊断并分型和指导治疗方面具有重要价值。     

螺旋CT对急性阑尾炎病理分型的临床价值分析

目的评价多排螺旋CT对急性阑尾炎病理分型的价值。方法收集本院急性阑尾炎病例91例,对照术后病理结果,计算不同CT征象在不同类型急性阑尾炎中的发生率。结果阑尾增粗、阑尾壁增厚及阑尾腔内粪石大小在不同类型阑尾炎中差异均具有显著统计学意义(P0.05);阑尾腔内积液、阑尾周围脂肪间隙改变在急性单纯阑尾炎与急性化脓性阑尾炎之间及急性单纯性阑尾炎与急性坏疽性阑尾炎之间差异均具有显著统计学意义(P0.05);阑尾腔外游离气体及腔外粪石,阑尾周围脓肿在急性坏疽性阑尾炎与其他两型阑尾炎之间差异均具有统计学意义(P0.05)。结论综合不同CT征象对急性阑尾炎进行术前分型能有效提高准确率,对急性单纯性阑尾炎诊断准确度97.8%,敏感度90.5%,特异度100%;对急性化脓性阑尾炎诊断准确度94.4%,敏感度100%,特异度88.4%;对急性坏疽性阑尾炎诊断准确度94.5%,敏感度79.2%,特异度100%。术前明确分型可为临床确定手术方案及改善治疗结果提供很大帮助。     

高频超声在急性阑尾炎临床诊断中的应用

目的探讨高频超声诊断阑尾炎的临床价值。方法对经手术及病理证实的88例急性阑尾炎的超声声像进行回顾性分析。结果高频超声显像80例(90.9%,80/88),其中单纯性阑尾炎33例(84.6%,33/39),化脓性阑尾炎30例(93.7%,30/32),坏疽性阑尾炎7例(100%,7/7),阑尾周围脓肿10例(100%,10/10),各型阑尾炎具有显著声像图特征。结论高频超声能显著提高阑尾显像率,并利于对各型阑尾炎进行分类,从而可帮助临床选择恰当的治疗方法和手术方案。     

急性阑尾炎138例的超声诊断

目的：探讨急性阑尾炎的超声诊断价值。方法运用SA8000SE超声诊断仪,探头频率3.5~5.0MHz进行超声诊断,对经手术或病理证实的急性阑尾炎138例患者的超声图像进行分析。结果根据超声图像特征超声诊断为急性单纯性阑尾炎56例;急性化脓性28例;9例合并粪石;阑尾穿孔、周围脓肿40例;急性盆腔炎1例;排除急性阑尾炎4例。结论熟悉急性阑尾炎的超声表现,有助于提高临床诊断的准确性。     

超声检查对穿孔性阑尾炎与非穿孔性阑尾炎的鉴别诊断价值

目的评价超声检查对穿孔性阑尾炎与非穿孔性阑尾炎鉴别诊断价值。方法根据手术和病理结果,将85例急性阑尾炎分为穿孔组(33例)和非穿孔组(52例),总结分析术前穿孔性与非穿孔性阑尾炎的超声图像表现。结果阑尾壁连续性中断或回声失落、阑尾周围脓肿,阑尾腔外气体,对诊断阑尾穿孔有很高的特异性,为诊断阑尾炎穿孔的特异性征象。穿孔组阑尾直径明显大于非穿孔组,对诊断阑尾炎穿孔有一定价值。阑尾周围炎、肠间隙及盆腔积液在穿孔组发生频谱明显高于非穿孔组。阑尾腔内粪石,阑尾周围淋巴结肿大,局部探头压痛反跳痛,2组中发生率差异无统计学意义。结论超声检查在穿孔性阑尾炎与非穿孔性阑尾炎鉴别诊断中有一定的价值。     

急性阑尾炎的CT诊断及治疗探讨

目的探讨CT对急性阑尾炎的诊断价值。方法回顾性分析2012年3月至2014年1月间本院收治的60例急性阑尾炎患者临床资料,均行CT平扫或增强扫描,所有患者CT检查资料完整,且术后病理结果证实为急性阑尾炎。结果患者均成功实施手术,无失败病例;术后病理学报告发现单纯组急性化脓性阑尾炎患者29例,急性坏疽穿孔性阑尾炎13例,患者阑尾脓肿患者18例;增强组急性化脓性阑尾炎患者28例,急性坏疽穿孔性阑尾炎17例,患者阑尾脓肿患者15例。CT诊断急性化脓性阑尾炎的准确率为64.28%;CT诊断急性坏疽穿孔性阑尾炎的准确率为94.11%;CT诊断阑尾脓肿的准确率为93.33%。结论螺旋CT平扫加增强可以快速准确地显示急性阑尾炎及其并发症,可以作为拟诊急性阑尾炎而临床表现不典型患者的首选检查方法。     

高频和低频超声检查在阑尾炎间接超声征象中的诊断价值

目的比较高、低频超声检查对阑尾炎患者间接征象的显示差异,评价其在阑尾炎间接征象中的诊断价值。方法选择2011年1月至2014年5月中山市人民医院收治的阑尾炎患者153例,患者临床症状体征不典型,分别采用低频超声及高频超声检查并比较间接征象,并结合手术病理及随访结果进行分析。结果 153例均经术后病理及复查结果确诊,其中急性单纯性阑尾炎93例,阑尾周围脓肿19例,急性蜂窝组织性阑尾炎32例,急性坏疽性阑尾炎9例,超声诊断准确性为79.1%(121/153)。采用低频及高频超声检查对回盲部水肿、阑尾肿大增粗及阑尾壁增厚等间接征象的检出差异具有统计学意义(P0.05)。在高频超声显示的间接征象与术中所见征象的一致性检验中,所有的Kappa值均0.8。结论对临床症状体征不典型的阑尾炎患者,高频超声检查可提高间接征象的显示率,低频联合高频超声检查可以提高阑尾炎的诊断准确性。     

适于基层医院开展的改良腹腔镜阑尾切除术(附390例报告)

目的探讨适于基层医院开展的改良腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的应用技术。方法2009年12月～2012年1月采用适宜的麻醉方式、规范化三孔法操作、阑尾系膜单极电凝、自制简易圈套器结扎阑尾根部、自制标本袋阑尾取出等改良的LA技术操作,行LA 390例。结果 390例均成功完成LA,无一例中转开腹。手术时间15～120 min,平均30 min。术后病理:急性单纯性阑尾炎102例,急性化脓性阑尾炎199例,慢性阑尾炎58例,穿孔坏疽性阑尾炎25例,阑尾周围脓肿6例。异位阑尾16例:肝下2例,盲肠壁内3例,腹膜后位8例,盆腔低位3例;微型短小阑尾1例。390例术后随访2～24个月,平均6个月,无出血、肠瘘、肠粘连梗阻等并发症。结论改良的LA适于基层医院开展。     

B超检查对儿童急性阑尾炎的诊断价值

目的　探讨B超检查对急性阑尾炎的诊断价值。方法　对 15 2例临床疑为急性阑尾炎的患儿予以急诊腹部B超检查。结果　 63例超声诊断为急性阑尾炎 ,其中 5 9例急诊行切除阑尾术 ;另 4例因阑尾肿块行非手术治疗 6个月后延期手术 ,术后病理均证实诊断无误。其余 89例中 ,B超检查发现 4例为卵巢黄体破裂 ,2例胆总管囊肿 ,1例大网膜囊肿 ,1例肾积水 ,1例肾结石 ;80例考虑为肠系膜淋巴结炎 ,予非手术治疗 ,其中 76例痊愈 ,4例因症状不消失仍施以阑尾切除术 ,病理报告 2例为化脓性阑尾炎 ,2例为单纯性阑尾炎。结论　结合临床症状和体征 ,B超对阑尾炎的诊断有其实用价值     

阑尾肿瘤误诊为急诊阑尾炎行急诊阑尾切除术36例原因分析

目的 分析阑尾肿瘤误诊为急诊阑尾炎行急诊阑尾切除术的原因,总结以急性阑尾炎为主要临床表现的阑尾肿瘤的诊治体会.方法 2015-07-2020-06间商丘市第一人民医院胃肠肝胆外科共行急诊阑尾切除术2 031例,其中36例(1.77％)术中冰冻切片或术后常规病理学检查诊断为阑尾肿瘤.回顾性分析36例患者的临床及病理资料....     

儿童阑尾类癌的临床与病理特点分析（附1例报告及文献复习）

目的提高对儿童阑尾类癌临床与病理学特点的认识。方法分析1例9岁女孩阑尾类癌临床与病理组织形态学及瘤细胞的免疫组织化学特点，并结合文献复习。结果患儿急性化脓性阑尾炎切除标本中发现阑尾远端肿块经HE及免疫组化确诊为阑尾类癌。结论本文就儿童阑尾类癌的临床表现、发生部位、病变特点、病理组织学分型、诊断、治疗进行讨论；阑尾类癌在儿童一般预后良好。     

Actinomycosis of the appendix. Case report

Abdominal actinomycosis is a chronic granulomatous suppurative disease caused by anaerobic Gram positive germs from Actinomyces species. The vermiform appendix and ileocaecal region have been recognized as the most commonly involved sites. Actinomycosis of the appendix is generally acute in presentation, mimicking a common acute appendicitis. We present a case of actinomycosis of the appendix in a 62-year-old male patient. The clinical presentation was as for a common acute appendicitis. The ultrasound examination sustained the diagnosis of acute appendicitis and an appendectomy was performed. The diagnosis was established by histo-pathologic examination. The cultures from intraperitoneal fluid were negative. The association of a long-standing antibiotic therapy to the surgical treatment resulted in definitive cure for this patient. Actinomycosis of the appendix is a rare disease that must be known, the diagnostic being the key for a successful treatment.     

经脐单孔与常规腹腔镜阑尾切除手术的比较研究

目的:探讨单孔腹腔镜阑尾切除手术的可行性。方法:对2011年1月—2011年12月收治的122例急性阑尾炎病例,按照随机原则分单孔腹腔镜组(61例)和常规腹腔镜组(61例),对两组的手术时间、术中出血量、肠道功能恢复时间、住院时间、并发症、中转率进行比较。结果:两组在术中出血量、术后肠道功能恢复时间、住院时间及术后并发症的比较,差异均无统计学意义(P>0.05),单孔腹腔镜组因粘连(2例)和腹膜后阑尾(1例)中转常规腹腔镜手术;坏疽性(穿孔性)阑尾炎的手术时间,单孔腹腔镜组明显长于常规腹腔镜组(P=0.004);单纯性阑尾炎和化脓性阑尾炎两组的手术时间无统计学差异(P>0.05)。结论:选择性对急性阑尾炎行单孔腹腔镜手术治疗是安全可行的;与常规腹腔镜比较,单孔腹腔镜治疗单纯性阑尾炎和化脓性阑尾炎同样具有恢复快、创伤小的优点,且比常规腹腔镜有更好的维护形体的效果。     

Detection of pinpoint tenderness on the appendix under ultrasonography is useful to confirm acute appendicitis

HYPOTHESIS: Ultrasonography can be efficiently performed using new criteria for the diagnosis of acute appendicitis. DESIGN: Prospective trial. PATIENTS: Eighty-nine patients admitted to the hospital with suspected appendicitis between March 1998 and November 2000. INTERVENTION: At hospital admission, a staff surgeon evaluated each patient and determined whether the patient had appendicitis requiring immediate surgery or another disease. Patients then underwent ultrasonography. A sonographic transducer was placed on the area of maximal tenderness. When the pathological manifestation was depicted, the examiner slipped a fingertip between the transducer and the patient's skin and then pressed the area of depicted pathological manifestation to find pinpoint tenderness. When maximal pinpoint tenderness was noted on the appendix or on pathological manifestations contiguous to the appendix, we diagnosed the condition as appendicitis. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values, and overall accuracy. RESULTS: The diagnosis of appendicitis by this criteria had a sensitivity of 86.7%, a specificity of 89.7%, a positive predictive value of 94.5%, a negative predictive value of 76.5%, and overall accuracy of 87.6%. All 50 patients with pinpoint tenderness noted on the appendix had appendicitis. The surgeon's initial clinical impression had a sensitivity of 83.3%, a specificity of 44.8%, a positive predictive value of 75.8%, a negative predictive value of 56.5%, and overall accuracy of 70.8%. CONCLUSIONS: The efficacy of ultrasonography using the simple criteria was superior to that of the surgeon's initial clinical impression (P<.001). Our ultrasonographic criteria for the diagnosis of appendicitis are simple to use and efficient.     

Dengue fever mimicking acute appendicitis: A case report

INTRODUCTIONDengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy.PRESENTATION OF CASEA 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus.DISCUSSIONThis unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery.CONCLUSIONThis case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis.