小儿急性阑尾炎的双源CT评价  

Evaluation of Acute Appendicitis in Children with Dual-Source Computed Tomography

作　　者：朱洪基 余建群[1] 彭礼清[1] 

机构地区：[1]四川大学华西医院放射科,四川成都610041

出　　处：《中国普外基础与临床杂志》2015年第7期875-878,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨小儿急性阑尾炎双源CT(DSCT)表现及其诊断价值。方法回顾性分析笔者所在医院经手术及病理学检查证实的97例小儿(14岁以下)急性阑尾炎的CT表现特点。结果 97例中,单纯性阑尾炎7例,化脓性阑尾炎20例,坏疽性及穿孔性阑尾炎58例,阑尾周围脓肿12例。CT图像上显示小儿阑尾位置:28例阑尾显示不清;其余69例中盆位阑尾20例(29.0%),回肠前位15例(21.7%),回肠后位11例(15.9%),盲肠后位12例(17.4%),盲肠下位3例(4.3%),盲肠外侧位1例(1.5%),其他位置7例(10.2%)。小儿阑尾炎CT平扫及三维重建的影像表现为阑尾增粗、肿胀,阑尾腔内粪石影,阑尾周围脂肪密度升高,邻近腹膜增厚,相邻回盲部增厚,肠系膜淋巴结增大,周围脓肿形成,腹腔和(或)盆腔积液。CT对小儿急性单纯性阑尾炎的确诊率为85.7%(6/7),化脓性阑尾炎的确诊率为80.0%(16/20),坏疽性及穿孔性阑尾炎的确诊率为100%(58/58),阑尾脓肿的确诊率为100%(12/12),总确诊率为94.8%(92/97)。结论 DSCT能较好地显示小儿阑尾的解剖位置及其周围组织结构的病理改变,具有较高的诊断准确性,可为临床术前提供强有力的信息。Objective To evaluate the manifestations and diagnostic value of pediatric acute appendicitis with dual-source CT （DSCT）. Methods Retrospectively analysis of CT features of 97cases of surgically and pathologically confirmed pediatric acute appendicitis in our hospital were performed. Results Among 97 patients, 7 cases were diagnosed acute simple appendicitis, 20 cases with acute suppurative appendicitis, perforated and gangrenous appendicitis in 58 cases, and appendiceal abscess in 12 cases. According to the location of appendix confirmed by CT, 28 cases of appendicitis could not be clearly manifested, the cohort of the remaining 69 cases were composed of 20 cases （29.0%） with appendix located in pelvic, 15 cases （21.7%） with appendix in front of ileum, 11 cases （15.9%） with appendix behind ileum, 12 cases （17.4%） with appendix behind cecum, 3 cases （4.3%） with appendix below cecum, 1 case （1.5%） with appendix outside of cecum, and 7 cases （10.2%） with appendix located in other positions. CT and three-dimensional reconstruction findings were as followed： swelling enlarged appendix, appendicoliths, periappendiceal fat fuzzy, peritoneal thickening, ileocecal thickening, mesenteric lymphadenopathy, periappendiceal mass, and abdominal or pelvic fluid. The diagnostic rate of acute simple appendicitis with CT was 85.7% （6/7）, acute suppurative appendicitis was 80.0% （16/20）, perforated and gangrenous appendicitis was 100% （58/58）, appendiceal abscess was also 100% （12/12）, the overall diagnostic yield was 94.8% （92/97）. Conclusion DSCT can well demonstrate the anatomical location of appendix and pathological changes of surrounding tissues, and has higher diagnostic accuracy, provide powerful information for surgeons.

关 键 词：急性阑尾炎 阑尾位置 儿童 双源CT 

分 类 号：R726.5[医药卫生—儿科] R816.92[医药卫生—临床医学]