穿孔性与非穿孔性阑尾炎的CT鉴别诊断价值

目的　探讨穿孔性和非穿孔性阑尾炎的CT表现,评估CT对这两种类型阑尾炎的诊断和鉴别诊断价值。资料与方法　选择经手术和病理证实的32例阑尾炎,根据手术结果将其分为2组:穿孔性阑尾炎组(21例)和非穿孔性阑尾炎组(11例)。分析阑尾炎的各种CT征象,并比较穿孔性与非穿孔性阑尾炎之间的CT表现。 结果　蜂窝组织炎、腹膜腔脓肿、阑尾壁强化伴缺损和阑尾周围积气是阑尾炎的直接 CT征象,对穿孔性阑尾炎的诊断有很高的特异性(P<0.05),穿孔性阑尾炎组的阑尾肿大较非穿孔性阑尾炎组更为明显(P<0.05)。间接CT征象中肠壁增厚、腹水、回肠壁强化、阑尾腔内积气以及积气合并阑尾附近大肠炎在穿孔性阑尾炎组中出现的频率也明显高于非穿孔性阑尾炎组(P<0.05)。 结论　直接CT征象可用于判断阑尾炎是否伴有穿孔,间接CT征象对于难以鉴别的病例有一定价值。

CT Differential Diagnosis of Perforated and Nonperforated Appendicitis

Objective To explore the CT appearances of appendicitis and evaluate the value of CT examination in differential diagnosing perforated from nonperforated appendicitis.Materials and Methods Thirty-two patients with appendicitis confirmed by surgery and histopathology were selected. These patients were classified into two groups based on surgical results: perforated group (21 cases) and nonperforated group (11 cases). CT images were used to sum up various imaging features and compared CT features between perforated and nonperforated group. Results Appendix was larger in caliber in perforated group (P<0.05). Direct CT signs, included phlegmon, peritoneal abscess, defect of enhanced appendiceal wall and appendiceal extraluminal air, were more specific signs for perforated appendicitis (P<0.05). In indirect signs, such as bowel wall thickening, ascites, ileal wall enhancement, appendiceal intraluminal air, and combined intraluminal air and appendicolith, were also found in higher incidence in perforated group (P<0.05). Conclusion Direct CT signs can be used to differentiate appendicitis whether perforation is or not. indirect signs may be helpful in difficult cases.