摘要
目的 探讨超声对复杂性急性阑尾炎(CAA)和非复杂性急性阑尾炎(UAA)的鉴别价值.方法 回顾性收集经手术及病理证实的CAA 394例和UAA 398例.采用Logistic多因素回归分析探讨不同变量在预测CAA中的灵敏度和特异度.结果 多因素分析得出CAA的显著风险因子包括:年龄≥44岁[比值比(OR)=1.769,P=0.014]、就诊时间≥24 h(OR=2.009,P=0.003)、中性粒细胞百分比≥86％(OR=3.692,P＜0.001)、阑尾外径≥10.6 mm(OR=1.593,P=0.031)、阑尾周围系膜厚度≥7 mm(OR=5.487,P＜0.001)、阑尾腔内结石梗阻(OR=2.606,P＜0.001)、阑尾壁异常(OR=13.078,P＜0.001)、阑尾周围有积液(OR=2.321,P=0.017).预测模型的灵敏度和特异度分别为77.5％和88.9％.结论 当患者年龄偏大、就诊时间较晚、中性粒细胞百分比显著升高,超声显示阑尾外径明显增大、阑尾周边系膜显著增厚、阑尾结石梗阻、阑尾壁异常、阑尾周围积液时,需高度怀疑CAA.
Abstract
Objective To investigate the value of ultrasound in distinguishing between complicated acute appendi-citis(CAA)and uncomplicated acute appendicitis(UAA).Methods A total of 394 patients of CAA and 398 patients of UAA confirmed by surgery and pathology were analyzed retrospectivly.Logistic multivariable regression analysis was employed to calculate the sensitivity and specificity of various variables in predicting CAA.Results The signifi-cant risk factors for CAA which were identified by the multivariate analysis included:age≥44 years[odds ratio(OR)=1.769,P=0.014],time of admission≥24 hours(OR=2.009,P=0.003),neutrophil percentage≥ 86％(OR=3.692,P＜0.001),appendiceal diameter≥ 10.6 mm(OR=1.593,P=0.031),thickness of periappendiceal mesentery≥7 mm(OR=5.487,P＜0.001),appendicolith obstruction(OR=2.606,P＜0.001),abnormal appen-diceal wall(OR=13.078,P＜0.001),peri-appendiceal fluid(OR=2.321,P=0.017).The sensitivity and specificity of the predictive model were 77.5％and 88.9％,respectively.Conclusions CAA should be highly suspected when the patients are older,having a longer duration from symptom onset to admission,and exhibiting significantly elevated neutrophil percentages.Additionally,this suspicion is further supported by the presence of significantly enlarged ap-pendiceal diameter,markedly thickened periappendiceal mesentery,appendicolith obstruction,abnormal appendiceal wall,or periappendiceal fluid.
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