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遇建东.腹部超声在小儿急性阑尾炎不同病理类型诊断中的价值[J].中国现代医生,2021,59(15):113-116
腹部超声在小儿急性阑尾炎不同病理类型诊断中的价值
Value of abdominal ultrasound in diagnosis of different pathological types of acute appendicitis in children
  
DOI:
中文关键词:  腹部超声  小儿  急性阑尾炎  病理类型  诊断价值
英文关键词:Abdominal ultrasound  Children  Acute appendicitis  Pathological type  Diagnostic value
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作者单位
遇建东 黑龙江省佳木斯市妇幼保健院超声科黑龙江佳木斯 154002 
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中文摘要:
      目的 探讨腹部超声在小儿急性阑尾炎(AA)不同病理类型诊断中的价值。方法 回顾性分析我院2018 年3 月至2020 年4 月收治的94 例AA 患儿的临床资料,术前均行腹部超声检查,以手术病理结果为金标准,评估腹部超声诊断小儿AA 分型的符合率、不同病理类型图像特点、诊断价值及诊断效能。结果 83 例经术后病理证实为AA 的患儿中,80 例经腹部超声检查提示AA,小儿AA 分型诊断符合率为96.39%(80/83),二者差异无统计学意义(P>0.05)。腹部超声图像表现:急性单纯性阑尾炎,阑尾轻度肿大,阑尾直径增大≥0.60 cm,可见清晰的壁层结构,腔内多表现为均质点状低回声;急性化脓性阑尾炎,阑尾明显肿大,阑尾直径增大≥1.0 cm,黏膜下层断续,腔内以低回声为主的混合回声,阑尾周围见少量液性暗区包绕;急性坏疽性阑尾炎,阑尾肿胀显著,阑尾直径增大≥1.50 cm,阑尾壁结构不完整,黏膜下层断续、消失,腔内回声不均匀,部分伴粪石梗阻,周围网膜系膜增厚,阑尾周围可见不规则液性暗区。腹部超声诊断小儿AA 的阳性预测值、阴性预测值、灵敏度、特异度、准确率为98.75%、71.43%、95.18%、90.91%、94.68%。腹部超声对小儿AA 诊断的ROC 曲线下面积为0.835(95%CI:0.760~0.891)。结论 腹部超声对小儿AA 在疾病诊断、病理分型诊断中具有较高的准确率。
英文摘要:
      Objective To investigate the value of abdominal ultrasound in the diagnosis of different pathological types of acute appendicitis (AA) in children.Methods The clinical data of 94 children with AA admitted to our hospital from March 2018 to April 2020 were retrospectively analyzed.Abdominal ultrasound examination was performed before operation.The coincidence rate of AA typing in children,image characteristics of different pathological types,diagnostic value and diagnostic efficiency of abdominal ultrasound were evaluated with surgical and pathological results as the gold standard.Results Of the 83 cases with AA confirmed by pathology,80 cases were diagnosed as AA by abdominal ultrasound.The diagnostic coincidence rate of AA classification in children was 96.39% (80/83),and there was no sig nificant difference between the two methods (P>0.05).Abdominal ultrasound images showed acute simple appendicitis:slight enlargement of appendix,increase of appendix diameter ≥0.60 cm,clear parietal structure,and homogeneous punctate hypoecho in cavity;acute suppurative appendicitis:the appendix was obviously swollen,the diameter of the appendix was increased by ≥1.0 cm,the submucosa was intermittent,the cavity was dominated by mixed echo with hypoecho,and a small amount of liquid dark area was seen around the appendix;acute gangrenous appendicitis:the appendix was obviously swollen,the diameter of the appendix increased ≥1.50 cm,the structure of the appendix wall was incomplete,the submucosa was intermittent and disappeared,the echo in the cavity was uneven,some of them were accompanied by fecal stone obstruction,the surrounding omental mesangium was thickened,and irregular liquid dark areas were seen around the appendix.The positive predictive value,negative predictive value,sensitivity,specificity and accuracy of abdominal ultrasound in the diagnosis of AA in children were 98.75%,71.43%,95.18%,90.91% and 94.68%,respectively.The area under ROC curve for abdominal ultrasound diagnosis of AA in children was 0.835 (95%CI:0.760~0.891).Conclusion Abdominal ultrasound has a high accuracy in diagnosis and pathological classification of AA in children.
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