黄嘉成　张燕辉　朱培桢　王永华

深圳市宝安区松岗人民医院放射科，广东深圳518105

MSCT薄层扫描对肥胖患者不典型急性阑尾炎的诊断价值

黄嘉成张燕辉朱培桢王永华

深圳市宝安区松岗人民医院放射科，广东深圳518105

目的探讨MSCT薄层扫描对肥胖患者不典型急性阑尾炎的诊断价值。方法选择2014年5月～2016年5月间60例拟诊为不典型急性阑尾炎的肥胖患者60例为研究对象，均接受MSCT薄层扫描，分析其MSCT特征，以术后病理及临床治疗结果为标准，观察MSCT薄层扫描对肥胖患者不典型急性阑尾炎诊断效力。结果患者主要CT征象包括阑尾增粗、阑尾结石、阑尾腔内积液、阑尾周围间隙模糊、阑尾周围脓肿、盲肠末端水肿、小肠淤张。外径0.6～3.1 cm，平均（1.3±0.2）cm。MSCT共诊断47例急性阑尾炎，排除13例阑尾炎，以术后病理及临床治疗结果为标准，共诊断准确54例，误诊6例。诊断灵敏度、特异度及诊断符合率分别达到91.8%、81.8%和90.0%。结论MSCT薄层扫描能够清晰显示肥胖患者不典型急性阑尾炎的形态学特征，具有很高的诊断价值。

阑尾炎曰肥胖曰螺旋CT曰薄层扫描

［Abstract］Objective To investigate the diagnostic value of thin slice MSCT scanning in the diagnosis of atypical acute appendicitis in obese patients.Methods From May 2014 to May 2016，60 cases of obese patients who were diagnosed as atypical acute appendicitis，which were selected as the study subjects.All accepted MSCT thin layer scanning，its MSCT characteristics was analyzed.The results of pathology and clinical treatment were standard，the effect of MSCT thin layer scanning on the diagnosis of atypical acute appendicitis in obese patients were observed.Results The main CT signs included enlargement of the appendix，calculus of appendix，effusion in appendix，blurring around the appendix，abscess of appendix，edema of the end of the appendix，small intestine.Outside diameter 0.6-3.1 cm，average（1.3±0.2）cm.MSCT was diagnosed in 47 cases of acute appendicitis，excluding 13 cases of appendicitis，The results of pathology and clinical treatment were standard，a total of 54 cases were diagnosed correctly，6 cases were misdiagnosed.Diagnostic sensitivity，specificity and diagnostic accuracy were 91.8%，81.8%and 90.0%，respectively.Conclusion MSCT thin layer scanning can clearly show the morphological characteristics of atypical acute appendicitis in obese patients，have high diagnostic value.

［Key words］Appendicitis；Obesity；Spiral CT；Thin layer scanning

急性阑尾炎是普外科常见的急症，具有典型的临床症状和体征，根据病史、临床症状、体格检查及实验室检查，大多可以确诊，但由于阑尾位置异常、病变特征多样等因素，部分阑尾炎表现不典型，使诊断难度增大［1，2］。超声是急性阑尾炎常用的影像学检查方法，具有操作简便，软组织分辨率高的优点，临床诊断价值高，但在体质量指数＞30 kg/m2的肥胖患者，皮下及腹腔脂肪影响超声波的穿透，不利于阑尾病变的显示，导致诊断敏感性及准确率降低。……