复杂性急性阑尾炎与非复杂性急性阑尾炎的超声鉴别  

Ultrasound Differentiation of Complicated Acute Appendicitis and Uncomplicated Acute Appendicitis

作　　者：任思玲 张敏 周晓晖 胡蔷 李琼[1] 田丽 黄邵斌[2] 练亿香[3] Ren Siling;Zhang Min;Zhou Xiaohui;Hu Qiang;Li Qiong;Tian Li;Huang Shaobin;Lian Yixiang(Department of Ultrasound Medicine,The Affiliated Changsha Central Hospital,Hengyang Medical School,University of South China,Changsha 410004,China;Department of Gastrointestinal Surgery,The Affiliated Changsha Central Hospital,Hengyang Medical School,University of South China,Changsha 410004,China;Department of Pathology,The Affiliated Changsha Central Hospital,Hengyang Medical School,University of South China,Changsha 410004,China)

机构地区：[1]长沙市中心医院(南华大学附属长沙中心医院)超声医学科,长沙市410004 [2]长沙市中心医院(南华大学附属长沙中心医院)胃肠外科,长沙市410004 [3]长沙市中心医院(南华大学附属长沙中心医院)病理科,长沙市410004

出　　处：《中国超声医学杂志》2025年第1期98-102,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨超声对复杂性急性阑尾炎(CAA)和非复杂性急性阑尾炎(UAA)的鉴别价值。方法回顾性收集经手术及病理证实的CAA 394例和UAA 398例。采用Logistic多因素回归分析探讨不同变量在预测CAA中的灵敏度和特异度。结果多因素分析得出CAA的显著风险因子包括:年龄≥44岁[比值比(OR)=1.769,P=0.014]、就诊时间≥24 h(OR=2.009,P=0.003)、中性粒细胞百分比≥86%(OR=3.692,P<0.001)、阑尾外径≥10.6 mm(OR=1.593,P=0.031)、阑尾周围系膜厚度≥7 mm(OR=5.487,P<0.001)、阑尾腔内结石梗阻(OR=2.606,P<0.001)、阑尾壁异常(OR=13.078,P<0.001)、阑尾周围有积液(OR=2.321,P=0.017)。预测模型的灵敏度和特异度分别为77.5%和88.9%。结论当患者年龄偏大、就诊时间较晚、中性粒细胞百分比显著升高,超声显示阑尾外径明显增大、阑尾周边系膜显著增厚、阑尾结石梗阻、阑尾壁异常、阑尾周围积液时,需高度怀疑CAA。Objective To investigate the value of ultrasound in distinguishing between complicated acute appendicitis(CAA)and uncomplicated acute appendicitis(UAA).Methods A total of 394 patients of CAA and 398 patients of UAA confirmed by surgery and pathology were analyzed retrospectivly.Logistic multivariable regression analysis was employed to calculate the sensitivity and specificity of various variables in predicting CAA.Results The significant risk factors for CAA which were identified by the multivariate analysis included:age≥44 years[odds ratio(OR)=1.769,P=0.014],time of admission≥24 hours(OR=2.009,P=0.003),neutrophil percentage≥86%(OR=3.692,P<0.001),appendiceal diameter≥10.6 mm(OR=1.593,P=0.031),thickness of periappendiceal mesentery≥7 mm(OR=5.487,P<0.001),appendicolith obstruction(OR=2.606,P<0.001),abnormal appendiceal wall(OR=13.078,P<0.001),peri-appendiceal fluid(OR=2.321,P=0.017).The sensitivity and specificity of the predictive model were 77.5%and 88.9%,respectively.Conclusions CAA should be highly suspected when the patients are older,having a longer duration from symptom onset to admission,and exhibiting significantly elevated neutrophil percentages.Additionally,this suspicion is further supported by the presence of significantly enlarged appendiceal diameter,markedly thickened periappendiceal mesentery,appendicolith obstruction,abnormal appendiceal wall,or periappendiceal fluid.

关 键 词：急性阑尾炎 超声 坏疽性阑尾炎 穿孔 

分 类 号：R445.1[医药卫生—影像医学与核医学] R656.8[医药卫生—诊断学]