影响不典型阑尾炎超声诊断的Logistic二元回归分析

目的探讨导致不典型阑尾炎超声误诊及漏诊的影响因素。 方法回顾性分析被漏诊或误诊的急性不典型阑尾炎的临床、解剖及超声等特点，并进行二元因素赋值，通过Logistic回归分析比较以上因素对超声诊断阑尾炎影响。 结果经6步回归分析，发现大量肠气、右下腹积液、腹膜后位阑尾、右下腹局部回声增强是成人阑尾炎被超声误诊漏诊是主要原因，而肠系膜淋巴结显影及憩室炎是小儿阑尾炎误诊的主要因素（均P=0.000，且模型分类判对率均大于85%）。 结论右下腹回声增强、积液以及肠内气体干扰是导致超声误诊漏诊急性阑尾炎的主要原因，对于小儿急性右下腹痛应仔细鉴别其与肠系膜淋巴结炎及麦克尔憩室炎的区别。  

Logistic regression for risk factors impacting ultrasound diagnosis for patients with acute appendicitis

Objective To investigate the cause of atypical appendicitis ultrasound misdiagnosis and missed diagnosis of influencing factors. Methods The clinical,anatomy and ultrasonic characteristics of atypical appendicitis with missed diagnosis or misdiagnosis were retrospectively analysed. The effect of the factors on ultrasonic diagnosis of appendicitis were explored by Logistic regression analysis after assignment for dual factors. Results Bowel gas, the right lower quadrant abdominal effusion ,retroperitoneal appendix and local echogenicity were the main factor of adult appendicitis with ultrasonic misdiagnosis through 6 step regression analysis. Diverticulitis was a major cause of pediatric appendicitis misdiagnosis (P= 0.000, classification and model of rate of not less than 85%). Conclusion The right lower abdomen echogenicity, effusion and intestinal gas interference is a major cause of lead to misdiagnosis and ultrasound misdiagnosis of acute appendicitis. The mesenteric lymphadenitis and Michael diverticulitis should be carefully identified for children with acute lower abdominal pain .