多层螺旋CT征象诊断急性阑尾炎病理类型的价值  

Multi-slice Spiral CT Signs in Diagnosis of Acute Appendicitis Pathological Subtype

作　　者：李光明[1] 李智锋[1] 孙小会[1] 唐剑辉[1] 蒋方旭 刘林[1] 

机构地区：[1]广东省清远市人民医院影像中心,广东清远511518

出　　处：《中国医学影像学杂志》2016年第6期451-454,共4页Chinese Journal of Medical Imaging

基　　金：广东省清远市科技局立项课题(2014B049)

摘　　要：目的探讨急性阑尾炎的临床表现,以及多层螺旋CT征象鉴别诊断急性阑尾炎各病理类型的价值。资料与方法收集经手术病理证实的急性阑尾炎221例,记录患者的临床资料及白细胞计数、中性粒细胞百分比,观察多层螺旋CT征象:阑尾管径、周围渗出、阑尾粪石、盲肠壁增厚、回盲部淋巴结及肠淤张,并分析不同病理类型(单纯性阑尾炎、化脓性阑尾炎、坏疽性阑尾炎)的各指标差异。结果 221例患者中,单纯性阑尾炎9例,化脓性阑尾炎192例,坏疽性阑尾炎20例。厌食纳差113例(51.1%),恶心呕吐137例(62.0%),转移性右下腹痛113例(51.1%),体温升高69例(31.2%),右下腹压痛220例(99.5%),反跳痛202例(91.4%);白细胞计数升高197例(89.1%),中性粒细胞百分比升高195例(88.2%);管径增粗221例(100.0%)。3种病理类型阑尾炎患者体温、中性粒细胞百分比差异有统计学意义(P<0.05),且按单纯性、化脓性和坏疽性阑尾炎依次增高;阑尾管径和阑尾周围渗出差异有统计学意义(P<0.05),且按单纯性、化脓性和坏疽性阑尾炎依次增粗或加重。结论体温、中性粒细胞百分比、阑尾管径和阑尾周围渗出鉴别诊断不同病理类型急性阑尾炎具有指导意义。Purpose To investigate the clinical value of multi-slice spiral CT（MSCT） signs in the diagnosis of pathological subtype of acute appendicitis with clinical manifestations. Materials and Methods 221 patients with acute appendicitis were confirmed by surgery and pathology. The clinical manifestations and MSCT signs of acute appendicitis were analyzed, including migratory right lower abdominal pain, vicious vomiting, temperature, right lower quadrant abdominal tenderness, rebound tenderness, white blood cell, the neutrophil percentage, diameter, effusion around the appendix, fecal stones, appendiceal wall thickening, lymph node, intestine stasis. The features were comparatively analyzed with the pathological subtype of acute appendicitis, including simple appendicitis, suppurative appendicitis and gangrenous appendicitis. Results Of all 221 patients, there were 9 cases of simple appendicitis, 192 cases of suppurative appendicitis and 20 cases of gangrenous appendicitis. Anorexia 113 cases（51.1%）, vicious vomiting 137 cases（62.0%）, migratory right lower abdominal pain 113 cases（51.1%）, temperature increasing 69 cases（31.2%）, right lower quadrant abdominal tenderness 220 cases（99.5%）, rebound tenderness 202 cases（91.4%）, increased white blood cell 197 cases（89.1%） and the neutrophil percentage 195 cases（88.2%）, diameter enlargement 221 cases（100.0%）. Temperature and the neutrophil percentage showed statistically significant difference among simple appendicitis, suppurative appendicitis and gangrenous appendicitis（P〈0.05）, and according to the simple, suppurative and gangrenous increased in turn. The diameter of appendix and the surrounding exudates showed statistical difference among each subtype（P〈0.05）, and according to the simple, suppurative and gangrenous enlarged or increased in turn. Conclusion Temperature, percentage of neutrophils and the surrounding exudate in MSCT signs play an important role in diagnosis of acute appendicitis subtype with clinical manifes

关 键 词：阑尾炎 急性病 体层摄影术 螺旋计算机 病理学 外科 诊断 鉴别 

分 类 号：R574.61[医药卫生—消化系统] R445.3[医药卫生—内科学]