超声在诊断可疑急性阑尾炎中的作用

目的　探讨超声检查在诊断可疑急性阑尾炎患者中的作用。方法　 35 6例临床怀疑急性阑尾炎患者接受超声检查。采用腹前壁逐级加压探查法 ,在患者感觉最敏感点 ,寻找阑尾。或采用从侧腹向回盲部移动探头寻找阑尾。结果　35 6例临床怀疑急性阑尾炎中 ,超声确诊并被证实的急性阑尾炎有 189例 ( 5 3 % ) ,右侧输尿管结石 2 3例 ( 6 % ) ,妇科疾患者5 6例 ( 16 % ) ,阴性声像图表现者 88例 ( 2 5 % )。其声像图特征 :阑尾壁厚度范围为 2 .0～ 12 .0mm ,平均范围为 ( 5 .0± 1.2 )mm ,阑尾最大前后径 (外径 )为 4.0～ 2 7.0mm ,平均范围为 ( 5 .6± 1.1)mm。其中 4～ 6mm者 5 2例 ,>6mm者 12 7例 ,阑尾周围脂肪组织回声减低 ,有不规则低或无回声者有 2 9% ( 5 5 /189) ,阑尾周围探及淋巴结肿大者有 12 % ( 2 3/189) ,右下腹肠管液体淤积、肠蠕动加快者有 73 % ( 138/189) ,彩色多普勒超声显示阑尾壁的血供丰富者 86 % ( 16 3/189)。阑尾穿孔者 6例 ,阑尾周围脓肿者 4例。结论　急性阑尾炎时 ,超声能判断阑尾肿大程度 ,阑尾位置 ,以及其他重要并发症等。

Value of Ultrasonography in Diagnosis of Suspicious Acute Appendicitis

Objective To evaluate the diagnostic value of ultrasonography in the doubtful acute appendicitis. Methods We examined 356 patients who had doubtful acute appendicitis by US. The explorative methods adopted the graded compression technique at the front abdomen wall. We searched appendix in the most painful spot that the patients felt or adopted the method from flank to ileocecum. Results There were 189(53%) acute appendicitis, 23(6%) right ureter stones, 56(16%) gynecologic diseases and 88(25%) negative ultrasonogrghic patients in the 356 suspicious acute appendicitis. The ultrasonographic signs of the acute appendicitis were the wall thickness ranging between 2.0 and 12.0mm, the average was (5.0±1.2)mm. The outer appendiceal diameters ranged between 4.0 and 27.0mm, the average was (5.6±1.1)mm. The echo decreased in the appendiceal surrounding fatty tissue, 29%(55/189) patients had irregular weak or non-echo structure. 12%(23/189) patients had swollen lymph nodes around appendix, 73%(138/189) patients had quick peristalsis and dilatation intestines in the right quarter, 86%(163/189) patients had blood flow increase in the appendiceal wall and its circumference in color Doppler US. The perforations in appendix were in 6 patients, the abscesses surrounding area were in 4 patients. Conclusion Ultrasonography can evaluate the swell appendiceal extent, situation and its complication.