超声检查的阴性预测值对排除急性阑尾炎的临床应用价值  

The value of ultrasound in diagnosis of suspected acute appendicitis

作　　者：张伟[1] 吴海燕[1] 柏刚[1] 张本林[1] 张慧琴[1] 陈鹏[1] 

机构地区：[1]湖北医药学院附属东风医院超声科,湖北十堰442000

出　　处：《中华医学超声杂志（电子版）》2011年第10期2202-2206,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨超声检查的阴性预测值对排除急性阑尾炎的临床应用价值。方法回顾性分析临床上怀疑为急性阑尾炎的241例患者的超声声像图表现,根据声像图特点将其分为4级,再将超声检查结果与外科手术及病理结果进行比较。结果 241例患者中超声诊断阳性结果93例(2、3、4级),最终发现13例为假阳性结果;148例阴性结果(1级)中7例因临床症状及体征明显行手术治疗,病理结果均提示为急性单纯性阑尾炎。超声诊断急性阑尾炎的敏感度为91.95%(80/87),特异度为91.56%(141/154),阴性预测值为95.27%(141/148),阳性预测值为86.02%(80/93),准确性为91.70%(221/241)。结论超声检查具有较高的阴性预测值,可有效地排除阑尾炎,同时或可发现引起患者急性腹痛的其他病因,因此在急性右下腹痛患者的诊断和鉴别诊断中具有非常重要的作用。Objective To evaluate the negative predictive value(NPV)of sonography for the exclusion of acute appendicitis.Methods Two hundred and forty-one patients with suspected acute appendicitis who were examined by ultrasound in our hospital were reviewed retrospectively.Sonographic findings were divided into 4 grades from a normal appendix identified(grade 1)to frankly acute appendicitis(grade 4).Sonographic findings were compared with surgical and pathologic findings.Results A total of 93 patients had positive sonographic findings,with 13 cases were false positive results.The rest of the 148 patients with negative results(grade 1),7 patients with negative sonographic findings undergone surgery and were diagnosed as appendicitis.On the basis of these numbers,the sensitivity,specificity,NPV,the positive predictive value(PPV)of sonography were 91.95%(80/87),91.56%(141/154),95.27%(141/148),86.02%(80/93).Conclusions Sonography has a high NPV(95.27%) for the exclusion of acute appendicitis even if the appendix is not visualized,and may be able to find out other causes of acute abdominal pain.Therefore,ultrasound plays a very important role in diagnosis and differential diagnosis of patients with acute right lower abdominal pain.

关 键 词：超声检查 急性阑尾炎 

分 类 号：R445.1[医药卫生—影像医学与核医学]