继发征象对小儿阑尾炎疑难病例超声诊断价值的研究  

Assessment of secondary signs in the diagnostic accuracy of equivocal ultrasounds for suspected pediatric appendicitis

作　　者：张蕾[1] 姜金波[2] ZHANG Lei;JIANG Jin-bo(Department of Ultrasounds, Linyi People's Hospital,Linyi 276003, China;Department of General Surgery , Qilu Hospital of Shandong University,Jinan 250012, China)

机构地区：[1]山东省临沂市人民医院超声科,山东临沂276003 [2]山东大学齐鲁医院普外科,山东济南250012

出　　处：《中国现代普通外科进展》2019年第7期526-529,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:超声检查在小儿阑尾炎的诊断中具有重要价值,是首选无创性影像学检查,为提高小儿阑尾炎超声诊断水平,探讨在超声检查不典型的情况下,寻找继发征象以提高超声诊断准确性。方法:对2000年至2018年小儿超声检查病例进行了回顾性研究,有825例临床怀疑阑尾炎的病儿接受了超声检查,筛选出阑尾局部积液等6项指标,以CT诊断和手术结果为标准,回归分析超声中的继发性征象和阑尾炎相关性。结果:825例中530例(64.2%)阑尾超声检查不典型,114例(21.5%)做了CT检查,172例(32%)被收入院观察,其中有超声继发征象者确诊阑尾炎几率更高(48.6%比14.6%,P<0.001;61.0%比33.6%,P<0.001)。和阑尾炎相关的超声继发征象包括阑尾局部积液(OR=13.3,95%CI:2.1~82.8),充血水肿(OR=2.0,95%CI:1.5~95.5),游离液体(OR=9.8,95%CI:3.8~25.4),阑尾结石(OR7.9,95%CI1.7~37.2)。阑尾壁增厚、肠蠕动和均质回声的脂肪组织与阑尾炎不相关。超声发现阑尾充血、局部积液或阑尾结石对阑尾炎诊断特异性达到96.6%,准确率88.3%。结论:右下腹超声检查发现的继发征象有助于提高阑尾炎诊断的准确率,可减少不必要的CT检查和收住院率。Objective:Ultrasound(US) is the preferred imaging modality for evaluating appendicitis. This study was to evaluate the role of secondary signs(SS) in improvement of diagnostic accuracy in equivocal US studies. Methods:Retrospective review identified 825 children presenting a right lower quadrant (RLQ) US and were suspected appendicitis. Multiple SS were included in the assessment. Regression models identified which SS were associated with appendicitis. Results:530 patients(64.2%) had equivocal US reports. Of 114(21.5%) patients with equivocal US undergoing CT, those with SS were more likely to have appendicitis(48.6% vs 14.6%, P<0.001). Of 172 (32.5%) patients with equivocal US admitted for observation, those with SS were more likely to have appendicitis(61.0% vs 33.6%, P<0.001). SS associated with appendicitis included fluid collection (adjusted odds ratio(OR) 13.3, 95% confidence interval(CI) 2.1-82.8), hyperemia (OR=2.0, 95% CI 1.5-95.5), free fluid (OR=9.8, 95% CI 3.8-25.4), and appendicolith (OR=7.9, 95% CI 1.7-37.2). Wall thickness, bowel peristalsis, and echogenic fat were not associated with appendicitis. Equivocal US that included hyperemia, a fluid collection, or an appendicolith had 96.6% specificity and 88.3% accuracy. Conclusion:Including SS in RLQ US improves the diagnostic accuracy of appendicitis. SS may guide clinicians and reduce unnecessary CT and admissions.

关 键 词：阑尾炎 超声检查 儿童 继发征象 

分 类 号：R574.61[医药卫生—消化系统] R445.1[医药卫生—内科学]