应用高频超声显像诊断急性阑尾炎的临床价值再探讨

目的探讨应用高频超声显像检查在急性阑尾炎诊断中的临床价值。方法运用高频超声探头对300例临床疑诊急性阑尾炎的患者行二维及彩色多普勒超声检查,并对他们的超声检查结果进行临床随访及分析,其中260例经手术及病理证实。结果高频超声诊断急性单纯性阑尾炎符合率88.06%;急性化脓性阑尾炎诊断符合率95.38%;急性坏疽性阑尾炎诊断符合率92.11%;阑尾黏液潴留符合率100%;阑尾周围脓肿诊断符合率100%;急性阑尾炎总诊断符合率为93.46%。结论在常规低频超声扫查的基础上重点应用高频超声扫查可使急性阑尾炎的诊断符合率明显提高,该方法可作为急性阑尾炎影像学检查的首选方法。     

基波、自然谐波和彩色多普勒超声对急性阑尾炎的诊断价值

目的探讨二维基波和自然谐波条件下,结合彩色多普勒超声在急性阑尾炎检查中的实用价值。方法对166例因腹部疼痛或可疑阑尾炎的患者,分别在二维基波、自然组织谐波和彩色多普勒超声条件下,使用7.0～10.0MHz高频和3.5～4.0MHz普通腹部探头做超声检查,分析阑尾区的图像特点,对比不同频率的探头对于阑尾显示的效果。结果全部病例经手术、病理或治疗后随访观察证实。166例病例中,超声确诊急性阑尾炎136例(81.9%),急性阑尾炎合并周围脓肿或炎性包块30例(18.1%),急性阑尾炎的彩色血流信号显示率62.0%。结论高频超声在显示肿大阑尾结构上更具有特异性,能明显提高肿大阑尾的显示率。彩色多普勒血流有助于急性阑尾炎的诊断。二维基波、自然谐波和彩色多普勒超声检查可作为临床诊断急性阑尾炎的重要依据。     

二维及彩色多普勒超声诊断急性阑尾炎

目的 探讨二维及彩色多普勒超声对急性阑尾炎诊断的方法及临床价值。方法 联合运用高低频探头结合法、加压法、顺逆旋转扫查法及顺逆旋转延伸扫查法，对280例阑尾炎患者行二维及彩色多普勒超声检查，并与手术结果进行对照分析。结果 280例急性阑尾炎患者中超声诊断正确255例(91．1％)。结论 二维及彩色多普勒超声可作为诊断急性阑尾炎的首选影像学方法，多种方法联合运用可提高其诊断率。     

Acute Appendicitis in Childhood

Acute appendicitis is the only common surgical condition found in children above the age of two, therefore if acute appendicitis can be ruled out, it is likely that the child does not need emergency surgery. Information can be obtained by close observation of the child's movements—he is not likely to be cooperative under questioning or examination. History of symptoms is important, laboratory tests may be helpful, but above all the physician should bear in mind the alternatives to appendicitis and rule these out before he decides on surgery.     

急性阑尾炎的B超诊断

目的 :讨论急性阑尾炎的超声诊断。方法 :回顾性分析经手术病理证实为急性阑尾炎 2 0 1例 ,应用超声诊断仪探查右下腹或全腹 ,发现异常低回声包块 ,测量其大小、观察其周边和内部回声以及盆腹腔积液情况 ,总结分析其声像图特点。结果 :本组 2 0 1例中 ,156例发现异常低回声包块 ,12例表现为肠管局部扩张 ,15例表现为游离液性暗区 ,4例表现为气体多层反射回声 ,14例无异常发现。根据其声像图特点 ,将其分为典型急性阑尾炎声像、非典型急性阑尾炎声像以及无异常回声型声像。结论 :急性阑尾炎部分表现为较典型的声像图 ,诊断准确率较高 ,但部分急性阑尾炎声像图表现不典型 ,易造成误诊、漏诊 ,因而 ,不能仅凭声像图作出诊断 ,而应结合临床病史 ,这样将有助于其诊断准确率的进一步提高     

急性阑尾炎的超声诊断分析

目的：回顾分析120例手术病理证实的急性阑尾炎超声声像图特征，以提高超声诊断能力。方法：患者术前B超检查留取图片，术后病理证实后分析。结果：本组急性阑尾炎病例超声检出率为86．7％，其中16例未检出者均为急性单纯性阑尾炎。结论：超声对急性阑尾炎的定性、定型诊断具有很高价值。     

Acute Appendicitis Complicated by Intussusception

Local intraarticular and extraarticular administration of steroids is firmly established as a highly effective, dependable method of therapy in rheumatoid arthritis, osteoarthritis and fibrositis. All practitioners who care for patients with these diseases should use the method more frequently. Strict aseptic precautions are necessary relative to the syringe, needle and material injected, and, probably even more important, accurate diagnosis is imperative. More than 75 per cent of the injections produce clinically significant benefit.     

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。     

高频超声及彩色多普勒血流显像对小儿急性阑尾炎的诊断价值

目的探讨高频超声及彩色多普勒血流显像(CDFI)对小儿急性阑尾炎的诊断价值。方法应用高频超声及彩色多普勒血流显像诊断小儿急性阑尾炎126例，均经手术病理证实，对各型小儿急性阑尾炎的声像图特征进行回顾性分析。结果126例小儿急性阑尾炎全部经手术病理证实，术前超声检出114例，超声检出率90.5％(114／126)，未检出12例，占9．5％(12／126)。术前超声分型与术后临床病理分型相符105例，符合率92.1％(105／114)，其中急性单纯性阑尾炎符合率89．1％(41／46)，急性化脓性阑尾炎符合率92．2％(47／51)，坏疽性及穿孔性阑尾炎符合率100％(11／11)，阑尾周围脓肿符合率100％(6／6)。结论高频超声不受小儿腹壁厚度的影响，结合彩色多普勒血流显像，对小儿急性阑尾炎的诊断及分型符合率高，可为临床早期制订治疗方案提供重要依据。     

小儿急性阑尾炎误诊分析

目的:探讨小儿急性阑尾炎临床特点及误诊原因.方法:回顾性分析2008年1月至2010年1月急诊收治155例小儿急性阑尾炎的临床资料,其中39例误诊.结果:术前诊断为其他疾病,手术确诊为阑尾炎23例:术前诊断为阑尾炎,手术证实为其他疾病16例.结论:对小儿急性阑尾炎的临床特点缺乏认识,腹部体征的掌握不准确及过多依赖辅助检查是误诊的主要原因.     

小儿急性阑尾炎的超声诊断分析

目的　分析小儿急性阑尾炎的超声表现、阑尾病变程度与时间的相关性、探讨小儿急性阑尾炎的超声诊断价值。方法　回顾性分析4 4例急性阑尾炎患儿的超声图像,4 0例均行手术,经病理证实。4例抗炎对症治疗。结果　单纯性阑尾炎、急性化脓性阑尾炎、坏疽穿孔性阑尾炎及阑尾周围脓肿的显示率分别为5 7%、95 %、75 %、83%。阑尾炎的最大外径与腹痛时间呈正相关(r=0 .5 9,P<0 .0 1)。结论　超声检查为小儿急性阑尾炎的诊断、分型提供了客观依据,病变阑尾的最大外径反映了阑尾的病变程度。     

Acute Appendicitis Following Motor Vehicle Accident

There are many recorded cases in the medical literature where it has been determined that blunt injury to the abdomen may injure any organ or structure within the abdomen. There were, however, no recorded cases of acute appendicitis resulting from blunt abdominal trauma.

The vermiform appendix is not immune to blunt abdominal trauma; in fact, by its anatomy and disposition, it is a very vulnerable structure.

One case is recorded in this paper where acute appendicitis has followed a steering wheel abdominal injury.

     

急性阑尾憩室炎的超声诊断

目的 探讨急性阑尾憩室炎的声像图特点。方法 回顾性地对4例经手术及病理证实的急性阑尾憩室炎病例的超声特点进行了分析总结。结果 超声主要特点是沿着呈不同程度增粗的阑尾边缘有一个或数个囊性突起，囊性突起边缘为高回声的薄壁，部分囊性突起内可见细小强回声光点漂浮。结论 腹部超声是术前诊断急性阑尾憩室炎的一种有价值的检查方法。     

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.     

急性阑尾炎的超声诊断价值

目的探讨超声诊断急性阑尾炎应用价值。方法采用线阵变频探头5．0～7．5MHz、6．0～10．0MHz结合凸阵变频探头2．6～5．0MHz对268例急性阑尾炎患采用逐级加压进行检查，观察结果与手术病理进行对照。结果急性阑尾炎超声诊断准确率为95．5％(256／268)，其中急性单纯性阑尾炎为93．7％(59／63)，急性化脓性阑尾炎为96％(192／200)，急性坏疽性阑尾炎为100％(5／5)。结论超声对急性阑尾炎的诊断有很高的实用价值。     

超声对急性阑尾炎显示方法的探讨

目的 提高超声对急性阑尾炎的显示率,从而提高超声诊断率。方法 利用顺、逆旋转扫查法及顺逆旋转延伸扫查法显示阑尾,并对６０例急性阑尾炎的术前超声检查结果与手术病理对照。结果 用此种方法超声共显示５５例（９１.67％）,超声诊断正确率91.67%,各种病理类型阑尾炎显示情况如下：单纯性阑尾炎１６例（84.12%)、化脓性阑尾炎２８例（93.33%)、坏疽性阑尾炎７例（１００％）。不同位置阑尾显示情况如上：回肠前位１７例（１００％）、盆位１５例（９３.７５）、盲肠后位１１例（78.57％）、回肠后位５例（８３.３３％）、４例盲肠下位及３例异位阑尾均显示。结论 顺、逆旋转扫查法及顺逆旋转延伸扫查法是显示急性阑尾炎全貌的较理想方法。     

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.