张巍

【摘要】 目的 探讨超声与CT检查在急性阑尾炎诊断中的意义。方法 回顾性分析537例经手术病理证实的急性阑尾炎患者的临床资料， 观察超声及CT检查结果， 分析超声、CT漏诊患者手术时及病理所见、声像图特征。结果 537例患者中， 临床均以右下腹部压痛或腹部不适为主诉申请影像学检查。521例患者申请超声检查， 诊断准确497例， 准确率为95.4%;漏诊24例， 漏诊率为4.6%。82例申请CT检查， 诊断准确79例， 准确率为96.3%， 漏诊3例， 漏诊率为3.7%。两种检查方法的诊断准确率比较差异无统计学意义（χ2=0.149， P>0.05）。漏诊患者影像报告均提示未见阑尾炎的影像表现， 而手术及病理结果提示为阑尾炎相关改变。结论 超声、CT检查诊断阑尾炎在影像学检查中具有同等重要的价值。超声可作为诊断阑尾炎的首选， 同时结合CT检查， 综合分析来提高诊断准确性。

【关键词】 超声;CT;诊断;急性阑尾炎;价值分析

DOI：10.14163/j.cnki.11-5547/r.2020.22.014

Value analysis of ultrasonography and CT in diagnosis of acute appendicitis   ZHANG Wei. Ultrasonic Division， Feicheng Mining Center Hospital， Feicheng 271608， China

【Abstract】 Objective To discuss the significance of ultrasonography and CT in diagnosis of acute appendicitis. Methods The clinical data of 537 patients with acute appendicitis confirmed by operation and pathology were analyzed retrospectively. The results of ultrasound and CT examination were observed. The characteristics of ultrasonography and CT missed diagnosis during surgical and pathological findings and sonograms was observed. Results In 537 patients， the main complaint was right lower abdominal tenderness or abdominal discomfort. 521 patients applied for ultrasound examination， 497 cases were diagnosed accurately， the accuracy rate was 95.4%; 24 cases were missed diagnosis， the missed diagnosis rate was 4.6%. 82 patients applied for CT examination， 79 cases were diagnosed accurately， the accuracy rate was 96.3%; 3 cases were missed diagnosis， the missed diagnosis rate was 3.7%. There was no statistically significant difference in diagnostic accuracy between the two methods （χ2=0.149， P>0.05）. The imaging reports of the missed diagnosis patients showed no imaging manifestations of appendicitis， but the surgical and pathological results suggested changes related to appendicitis. Conclusion   Ultrasonography and CT are of equal importance in the diagnosis of appendicitis. Ultrasonography can be the first choice in the diagnosis of appendicitis， at the same time， combined with CT examination for comprehensive analysis to improve the accuracy of diagnosis.

【Key words】 Ultrasonography; CT; Diagnosis; Acute appendicitis; Value analysis

急性阑尾炎是外科常见病， 是最多见的急腹症[1]。多数患者发病时病情较为危急， 症状典型， 但也有部分患者发病时， 没有出现剧烈疼痛等明显的症状， 临床容易出现误诊， 需要采取及时、准确的诊断措施， 尽快明确诊断并进行有效治疗， 以使患者尽快康复。如急性阑尾炎患者未得到及时有效的治疗， 很容易引发多种并发症， 严重者甚至有生命隐患[2]。急性阑尾炎的诊断方法多种多样， 近年来， 随着医学影像技术的发展， 超声、CT已广泛应用于该病的检查， 能够为临床工作提供有效的参考依据。本文通过2016年1月～2019年10月近3年来本院经手术确诊的537例急性阑尾炎患者的超声、CT检查资料， 对比分析不同影像學检查方法在该疾病诊断中的优势及不足， 以提高影像学诊断急性阑尾炎的准确性。现报……