多排螺旋CT诊断急性阑尾炎的价值分析

摘要

目的 分析急性阑尾炎多排螺旋CT表现并探讨多排螺旋CT(MSCT)对急性阑尾炎诊断价值.方法 回顾性分析15例经手术病理证实的急性阑尾炎及阑尾炎并发症的MSCT表现及分型,采用16排CT对全腹部进行多期扫描,利用多平面重组(MPR)、曲面重组(CPR)及最大密度投影(MIP)等后处理技术进行观察.结果 急性化脓性阑尾炎3例,急性坏疽穿孔性阑尾炎及阑尾脓肿12例,发生并发症10例,并发症均发生于阑尾坏疽穿孔或阑尾溶解病例,其中盆腔脓肿4例,腹腔脓肿3例,盆腔、腹腔均见脓肿1例,粘连性肠梗阻4例,腹腔脓肿伴输尿管炎性狭窄1例,阑尾脓肿累及盆腹壁致腹壁瘘、合并肓肠癌1例.术前14例正确诊断急性化脓性阑尾炎或阑尾脓肿,CT诊断率达93.3%.但急性化脓性阑尾炎与急性坏疽性阑尾炎无穿孔时鉴别困难.结论 急性阑尾炎MSCT表现具有一定特征性,对急性阑尾炎诊断具有重要价值.%Objective To analyze the CT appearance of acute appendicitis and investigate diagnostic value of MSCT on acute appendicitis.Methods The type and CT appearance of 15 cases with acute appendicitis proved by surgery and histopathology or clinic was analyzed retrospectively.Multi- stages scanning was carried out on the whole abdomen with 16 row CT.Post processing techniques including MPR, CPR and MIP were performed to observe the lesions.Results There were 3 acute suppurative appendicitis, 12 acute gangrene and perforative appendicitis and appendiceal abscess.Complication occurred in 10 cases with gangrene and perforative appendix or appendix molten.The complication included 4 pelvic abscess, 3 intra- abdominal abscess, 1 combined pelvic and intra- abdominal abscess, 4 conglutination bowel obstruction, 1 ureteritis stegnosis and 1 abdominal wall fistulae.The exact ratio of CT diagnosis on acute suppurative appendicitis and appendiceal abscess reached 93.3％ preoperatively.It is difficult to distinguish between acute suppurative appendicitis and acute gangrenous appendicitis without perforation.Conclusion The MSCT appearance of acute appendicitis was marked and of important value on diagnosis of acute appendicitis.