中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2015年
6期
467-472
,共6页
余俊丽%刘广健%艳玲%刘小银%程文捷%陈瑶%覃斯%王韦力
餘俊麗%劉廣健%豔玲%劉小銀%程文捷%陳瑤%覃斯%王韋力
여준려%류엄건%염령%류소은%정문첩%진요%담사%왕위력
阑尾炎%超声检查%病理学
闌尾炎%超聲檢查%病理學
란미염%초성검사%병이학
Appendicitis%Ultrasonography%Pathology
目的：超声检查对不同病理类型阑尾炎的诊断价值。方法分析2012年6月至2013年12月中山大学附属第六医院经手术病理证实为阑尾炎且术前行超声检查的111例患者的超声表现。其中急性单纯性阑尾炎6例，急性化脓性阑尾炎45例，急性坏疽性阑尾炎15，慢性阑尾炎33例，慢性阑尾炎急性发作12例。采用Kruskal-Wallis检验比较不同病理类型阑尾炎患者术前超声测量的阑尾长度、宽度、管壁厚度，进一步组间两两比较采用Kruskal-Wallis检验；采用Fisher确切概率法比较不同病理类型阑尾炎患者超声表现差异，进一步组间两两比较采用Fisher确切概率法。结果111例手术病理证实为阑尾炎的患者中，90例患者术前超声检查提示阑尾炎，超声诊断准确率为81.08%（90/111）。急性单纯性阑尾炎、急性化脓性阑尾炎、急性坏疽性阑尾炎、慢性阑尾炎、慢性阑尾炎急性发作患者术前超声诊断准确率分别为83.33%（5/6）、91.11%（41/45）、93.33%（14/15）、60.61%（20/33）、83.33%（10/12）。不同病理类型阑尾炎患者术前超声测量的阑尾长度差异无统计学意义，但急性坏疽性阑尾炎患者术前超声测量的阑尾宽度均大于急性单纯性阑尾炎、慢性阑尾炎患者，且差异均有统计学意义[（13.79±4.48） mm与（7.60±1.52） mm比较，χ2=4.211，P=0.024；（13.79±4.48） mm与（9.35±5.01） mm比较，χ2=4.071，P=0.033]；急性化脓性阑尾炎、急性坏疽性阑尾炎患者管壁厚度均大于慢性阑尾炎患者，且差异均有统计学意义[（4.39±1.42） mm与（3.37±0.93） mm比较，χ2=3.931，P=0.043；（4.81±1.57） mm与（3.37±0.93） mm比较，χ2=4.274，P=0.021]。不同病理类型阑尾炎患者的超声表现在管腔内粪石、淋巴结肿大和合并包块方面差异均无统计学意义。在管壁层次不清及管腔扩张两方面，急性化脓性阑尾炎、急性坏疽性阑尾炎与慢性阑尾炎患者的超声表现差异均有统计学意义[管壁层次不清：91.11%（41/45）与54.55%（18/33）比较，P=0.003；93.33%（14/15）与54.55%（18/33）比较， P=0.045。管腔扩张：64.44%（29/45）与27.27%（9/33）比较，P=0.007；80.00%（12/15）与27.27%（9/33）比较，P=0.007]；在合并阑尾区积液方面，急性坏疽性阑尾炎与慢性阑尾炎患者的超声表现差异有统计学意义[53.33%（8/15）与6.06%（2/33）比较，P=0.006]。结论超声检查对阑尾炎尤其是急性化脓性和急性坏疽性阑尾炎有较高的诊断价值。超声测量阑尾宽度、管壁厚度及对管壁层次、管腔扩张程度及阑尾区有无积液等特征的观察对鉴别诊断慢性阑尾炎与急性化脓性阑尾炎、急性坏疽性阑尾炎有一定的价值；阑尾宽度对鉴别诊断急性坏疽性阑尾炎与急性单纯性阑尾炎有意义。超声检查对鉴别诊断急性化脓性与急性坏疽性阑尾炎、急性单纯性阑尾炎与慢性阑尾炎及慢性阑尾炎急性发作的价值有限。
目的：超聲檢查對不同病理類型闌尾炎的診斷價值。方法分析2012年6月至2013年12月中山大學附屬第六醫院經手術病理證實為闌尾炎且術前行超聲檢查的111例患者的超聲錶現。其中急性單純性闌尾炎6例，急性化膿性闌尾炎45例，急性壞疽性闌尾炎15，慢性闌尾炎33例，慢性闌尾炎急性髮作12例。採用Kruskal-Wallis檢驗比較不同病理類型闌尾炎患者術前超聲測量的闌尾長度、寬度、管壁厚度，進一步組間兩兩比較採用Kruskal-Wallis檢驗；採用Fisher確切概率法比較不同病理類型闌尾炎患者超聲錶現差異，進一步組間兩兩比較採用Fisher確切概率法。結果111例手術病理證實為闌尾炎的患者中，90例患者術前超聲檢查提示闌尾炎，超聲診斷準確率為81.08%（90/111）。急性單純性闌尾炎、急性化膿性闌尾炎、急性壞疽性闌尾炎、慢性闌尾炎、慢性闌尾炎急性髮作患者術前超聲診斷準確率分彆為83.33%（5/6）、91.11%（41/45）、93.33%（14/15）、60.61%（20/33）、83.33%（10/12）。不同病理類型闌尾炎患者術前超聲測量的闌尾長度差異無統計學意義，但急性壞疽性闌尾炎患者術前超聲測量的闌尾寬度均大于急性單純性闌尾炎、慢性闌尾炎患者，且差異均有統計學意義[（13.79±4.48） mm與（7.60±1.52） mm比較，χ2=4.211，P=0.024；（13.79±4.48） mm與（9.35±5.01） mm比較，χ2=4.071，P=0.033]；急性化膿性闌尾炎、急性壞疽性闌尾炎患者管壁厚度均大于慢性闌尾炎患者，且差異均有統計學意義[（4.39±1.42） mm與（3.37±0.93） mm比較，χ2=3.931，P=0.043；（4.81±1.57） mm與（3.37±0.93） mm比較，χ2=4.274，P=0.021]。不同病理類型闌尾炎患者的超聲錶現在管腔內糞石、淋巴結腫大和閤併包塊方麵差異均無統計學意義。在管壁層次不清及管腔擴張兩方麵，急性化膿性闌尾炎、急性壞疽性闌尾炎與慢性闌尾炎患者的超聲錶現差異均有統計學意義[管壁層次不清：91.11%（41/45）與54.55%（18/33）比較，P=0.003；93.33%（14/15）與54.55%（18/33）比較， P=0.045。管腔擴張：64.44%（29/45）與27.27%（9/33）比較，P=0.007；80.00%（12/15）與27.27%（9/33）比較，P=0.007]；在閤併闌尾區積液方麵，急性壞疽性闌尾炎與慢性闌尾炎患者的超聲錶現差異有統計學意義[53.33%（8/15）與6.06%（2/33）比較，P=0.006]。結論超聲檢查對闌尾炎尤其是急性化膿性和急性壞疽性闌尾炎有較高的診斷價值。超聲測量闌尾寬度、管壁厚度及對管壁層次、管腔擴張程度及闌尾區有無積液等特徵的觀察對鑒彆診斷慢性闌尾炎與急性化膿性闌尾炎、急性壞疽性闌尾炎有一定的價值；闌尾寬度對鑒彆診斷急性壞疽性闌尾炎與急性單純性闌尾炎有意義。超聲檢查對鑒彆診斷急性化膿性與急性壞疽性闌尾炎、急性單純性闌尾炎與慢性闌尾炎及慢性闌尾炎急性髮作的價值有限。
목적：초성검사대불동병리류형란미염적진단개치。방법분석2012년6월지2013년12월중산대학부속제륙의원경수술병리증실위란미염차술전행초성검사적111례환자적초성표현。기중급성단순성란미염6례，급성화농성란미염45례，급성배저성란미염15，만성란미염33례，만성란미염급성발작12례。채용Kruskal-Wallis검험비교불동병리류형란미염환자술전초성측량적란미장도、관도、관벽후도，진일보조간량량비교채용Kruskal-Wallis검험；채용Fisher학절개솔법비교불동병리류형란미염환자초성표현차이，진일보조간량량비교채용Fisher학절개솔법。결과111례수술병리증실위란미염적환자중，90례환자술전초성검사제시란미염，초성진단준학솔위81.08%（90/111）。급성단순성란미염、급성화농성란미염、급성배저성란미염、만성란미염、만성란미염급성발작환자술전초성진단준학솔분별위83.33%（5/6）、91.11%（41/45）、93.33%（14/15）、60.61%（20/33）、83.33%（10/12）。불동병리류형란미염환자술전초성측량적란미장도차이무통계학의의，단급성배저성란미염환자술전초성측량적란미관도균대우급성단순성란미염、만성란미염환자，차차이균유통계학의의[（13.79±4.48） mm여（7.60±1.52） mm비교，χ2=4.211，P=0.024；（13.79±4.48） mm여（9.35±5.01） mm비교，χ2=4.071，P=0.033]；급성화농성란미염、급성배저성란미염환자관벽후도균대우만성란미염환자，차차이균유통계학의의[（4.39±1.42） mm여（3.37±0.93） mm비교，χ2=3.931，P=0.043；（4.81±1.57） mm여（3.37±0.93） mm비교，χ2=4.274，P=0.021]。불동병리류형란미염환자적초성표현재관강내분석、림파결종대화합병포괴방면차이균무통계학의의。재관벽층차불청급관강확장량방면，급성화농성란미염、급성배저성란미염여만성란미염환자적초성표현차이균유통계학의의[관벽층차불청：91.11%（41/45）여54.55%（18/33）비교，P=0.003；93.33%（14/15）여54.55%（18/33）비교， P=0.045。관강확장：64.44%（29/45）여27.27%（9/33）비교，P=0.007；80.00%（12/15）여27.27%（9/33）비교，P=0.007]；재합병란미구적액방면，급성배저성란미염여만성란미염환자적초성표현차이유통계학의의[53.33%（8/15）여6.06%（2/33）비교，P=0.006]。결론초성검사대란미염우기시급성화농성화급성배저성란미염유교고적진단개치。초성측량란미관도、관벽후도급대관벽층차、관강확장정도급란미구유무적액등특정적관찰대감별진단만성란미염여급성화농성란미염、급성배저성란미염유일정적개치；란미관도대감별진단급성배저성란미염여급성단순성란미염유의의。초성검사대감별진단급성화농성여급성배저성란미염、급성단순성란미염여만성란미염급만성란미염급성발작적개치유한。
ObjectiveTo assess the diagnostic value of ultrasonography in the diagnosis and pathological classifi cation of appendicitis with pathological results.MethodsThe study included 111 cases who confi rmed by surgery and pathology in the Six Affi liated Hospital of Sun Yat-sen University from June2012 to December 2013. The image characteristics of ultrasonic images performed before surgery were analyzed retrospectively. The cases were divided into five groups based on the pathology: 6 acute simple appendicitis, 45 acute suppurative appendicitis, 15 acute gangrenous appendicitis, 33 chronic appendicitis, and 12 acute attack of chronic appendicitis. The length, width and wall thickness of the appendicitis measured by preoperative ultrasound between various pathological type were compared with Kruskal-Wallis statistical methord, and also used the same method to compared the one which had statistically signifi cance between the fi ve groups. As in the above case, Fisher Exact Test was used to compare the characters′ of ultrasonography included gradations of the appendix, the tube cavity expansion, stercorolith, the appendiceal abscess, mergering lymph node enlargement and the appendix around effusion, if there was statistically signifi cance, the same methord was used to the further comparison between thefi ve groups.ResultsTotally 90 of 111 cases of were reminded appendicitis by preoperative ultrasound, the diagnostic accuracy rate was 81.08%, including acute suppurative appendicitis 91.11% (41/45), acute gangrenous appendicitis 93.33% (14/15), acute simple appendicitis 83.33% (5/6), chronic appendicitis 60.61% (20/33), chronic appendicitis onset acute 83.33% (10/12). There were no statistical differences of preoperative ultrasound measured between various pathological type of appendicitis in length, while the appendix width measured by preoperative ultrasound of acute gangrenous appendicitis was wider than the acute simple group and chronic group, and there were statistically signifi cance between them (P<0.05), in the aspect of wall thickness, the acute suppurative appendicitis and the acute gangrenous appendicitis groups were thicker than the chronic group, and these differences had statistically signifi cance (P<0.05). The stercorolith, lymph node enlargement and the appendiceal abscess in different types of appendicitis had no statistical difference. There were statistically differences (P<0.05) between the acute suppurative goup, acute gangrenous group and the chronic group respectively, both in gradations of the appendix and the tube cavity expansion. Also there were statistically difference (P<0.05) between the acute gangrenous appendicitis group and the chronic group in the aspect of the appendix around effusion.ConclusionsUltrasound is valuable in the diagnosis of appendicitis, especially for acute gangrenous appendicitis and acute purulent appendicitis. The measurement of appendix with wide diameter, wall thickness by ultrasond preoperatively, and the characteristics of the wall layers, lumen expansion degree and the appendix around effusion are valuable in identifying chronic appendicitis, acute suppurative appendicitis, and acute gangrene appendicitis; The ultrasonic measurement of appendix wide diameter could identify acute gangrenous appendicitis and acute simple appendicitis. Ultrasound had limited value in identifying acute suppurative, acute gangrenous appendicitis, acute simple appendicitis, chronic appendicitis, and chronic appendicitis onset acute.
