多层螺旋CT三维重建对不典型阑尾炎的早期诊断价值

目的探讨多层螺旋CT(multislice spiral CT,MSCT)三维重建对临床表现不典型阑尾炎的早期诊断价值。方法回顾性分析2011年1月至2014年12月收治的108例不典型阑尾炎手术病人的临床资料,对两组在性别比、年龄、主诉、伴随症状、体征和白细胞计数等方面资料进行统计,其中经MSCT检查的病人58例,为MSCT组,50例为非MSCT组。结果 53例术前MSCT检查的不典型阑尾炎经手术、病理证实为急性阑尾炎,诊断符合率91.4%,5例误诊:1例为回肠粘连性肠梗阻,1例右输卵管积脓伴盆腔炎,1例Meckel憩室炎伴鱼刺穿透伤,2例盲肠、升结肠憩室炎;非MSCT组诊断符合率78.0%,11例误诊:3例十二指肠球部溃疡穿孔,2例回盲部肿瘤,2例右侧输尿管下段结石伴肾积水,1例右侧卵巢囊肿蒂扭转,1例右侧卵巢黄体破裂,1例右侧输卵管峡部异位妊娠,1例肠系膜淋巴结炎。结论 MSCT阑尾三维重建技术能提高不典型阑尾炎的早期诊断水平,降低了误诊率,临床受益显著。

Multislice CT scanning with three-dimensional reconstruction in early diagnosis of atypical appendicitis

Objective To investigate the value of multislice spiral CT (MSCT)with three-di-mensional reconstruction in early diagnosis of acute appendicitis with atypical clinical features.Methods The clinical data of 108 patients preoperatively diagnosed as suspected appendicitis were retrospec-tively analyzed,and 58 patients were subjected to MSCT scan (MSCT group),the remaining were not given (non-MSCT group).Results In MSCT group,53 patients with acute appendicitis were confined by surgery and histopathology. The positive predictive value for pre-appendectomy MSCT was 91.5%.Five patients were misdiagnosed:1 case of adhesive ileum obstruction,1 case of right pyosal-pinx with pelvic inflammatory disease,1 case of Meckel diverticulitis with fish bone penetrating inj ury and 2 cases of cecum and ascending colon diverticulitis.The confirmed diagnostic rate of non-MSCT group was 78.0%.Eleven misdiagnoses were detected by exploratory laparotomy or postoperative CT scan:3 cases of duodenal bulbar ulcer perforation,2 cases of cecum tumor,2 cases of right lower ure-teral calculi with hydronephrosis,1 case of right ovarian cyst torsion,1 case of right corpus luteum rupture,1 case of ectopic pregnancy in isthmus of right uterine tube and 1 case of mesenteric lymphad-enitis.Conclusions MSCT scan with three-dimensional reconstruction of the appendix can improve early diagnosis level of atypical appendicitis,decrease the misdiagnosis rate and thereby provide signif-icant clinical benefit.