Chang Chen-Chang, Tsai Chun-Yueh, Lin Cheng-Chieh, Jeng Long-Bin, Lee Cheng Chun, Kao Chia-Hung
Department of Surgery, China Medical College Hospital, No. 2 Yuh-Der Road, Taichung 404, Taiwan.
Hepatogastroenterology. 2003 Mar-Apr;50(50):426-9.
BACKGROUND/AIMS: Diagnosing acute appendicitis in children with equivocal signs and symptoms is usually difficult. The usual approach to the patient is hospital observation and frequent reexamination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy. The aim of this study is to assess and compare the value of the Tc-99m HMPAO (technetium-99m hexamethylpropyleneamineoxide) labeled white blood cell abdomen scan and abdominal sonography in the diagnosis of acute appendicitis in children with an atypical clinical presentation.
Forty children with acute abdomen and possible acute appendicitis but atypical findings were included in this study. After an intravenous injection of Tc-99m HMPAO white blood cells, serial anterior abdomen scans at 30 min, 60 min, 120 min and 240 min were obtained using a gamma camera. Meanwhile, at the point of maximal tenderness, abdominal sonography was performed with a graded compression technique for both longitudinal and transverse images.
Thirty-three children received operation for surgical and pathological diagnoses. The other 17 children did not receive operation but follow-up of at least a one-month period. The overall sensitivity, specificity, and accuracy of Tc-99m HMPAO white blood cell scan to diagnose acute appendicitis in children with atypical findings is 96.7%, 80.0%, and 90.0%, respectively. The overall sensitivity, specificity, and accuracy for abdominal sonography is 86.6%, 90.0%, and 88.0%, respectively.
The Tc-99m HMPAO white blood cell abdomen scan provides a more sensitive and accurate method for the diagnosis of appendicitis in children with atypical clinical presentation when compared with abdominal sonography.
背景/目的：诊断有模棱两可体征和症状的儿童急性阑尾炎通常很困难。对这类患者通常的处理方法是住院观察并频繁复查。然而，由于存在穿孔风险和剖腹探查阴性的情况，许多外科医生不愿延迟手术。本研究的目的是评估和比较锝-99m六甲基丙烯胺肟（Tc-99m HMPAO）标记白细胞腹部扫描和腹部超声检查在诊断临床表现不典型的儿童急性阑尾炎中的价值。
本研究纳入了40例患有急腹症且可能患有急性阑尾炎但有非典型表现的儿童。静脉注射Tc-99m HMPAO白细胞后，使用γ相机在30分钟、60分钟、120分钟和240分钟时进行系列前位腹部扫描。同时，在压痛最明显处，采用分级压迫技术进行腹部超声检查，获取纵向和横向图像。
33例儿童接受了手术以进行外科和病理诊断。另外17例儿童未接受手术，但进行了至少为期1个月的随访。Tc-99m HMPAO白细胞扫描诊断非典型表现儿童急性阑尾炎的总体敏感性、特异性和准确性分别为96.7%、80.0%和90.0%。腹部超声检查的总体敏感性、特异性和准确性分别为86.6%、90.0%和88.0%。
与腹部超声检查相比，Tc-99m HMPAO白细胞腹部扫描为诊断临床表现不典型的儿童阑尾炎提供了一种更敏感、准确的方法。
