Oto Aytekin, Ernst Randy D, Mileski William J, Nishino Thomas K, Le Ot, Wolfe Gregory C, Chaljub Gregory
Department of Radiology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0709, USA.
AJR Am J Roentgenol. 2006 Oct;187(4):987-90. doi: 10.2214/AJR.05.1084.
The purpose of this study was to show the relation between McBurney's point and the appendix in patients undergoing 3D MDCT and to investigate the effect of this information on a surgeon's choice of appendectomy incision.
Among 142 adults undergoing consecutive MDCT studies, 100 patients (35 women, 65 men; mean age, 52.1 years) with an identifiable appendix on abdominopelvic MDCT examinations were selected for the study group. The presence of intraabdominal mass or a history of abdominal surgery were the exclusion criteria. Three-dimensional reconstruction of the CT data was performed with a surface shaded display algorithm. The locations of the base of the appendix and McBurney's point were marked on a single 3D image that allowed display of the skin surface markings for each patient. The superoinferior and mediolateral distances from the level of the appendix to the level of McBurney's point were measured, and the radial distance was calculated from these measurements. A surgeon experienced in emergency abdominal surgery reviewed 3D CT images and one axial image showing the appendix, and his choice of incision for each patient based on the CT information was recorded. The influence of the superoinferior and mediolateral distances of the appendix from McBurney's point on the surgeon's decision was analyzed with a multivariate logistic regression model.
The appendix was exactly at McBurney's point in only 4% of the patients. In 36% of the cases, the appendix was within 3 cm, in 28% of cases it was 3-5 cm, and in 36% of the cases it was more than 5 cm away from McBurney's point. Mean +/- SD superoinferior, mediolateral, and radial distances between the appendix and McBurney's point were 33.0 +/- 24.1, 20.8 +/- 19.3, and 42.1 +/- 26.7 mm, respectively. After reviewing the images, the surgeon would have altered his incision site in 35% of the cases. The surgeon preferred a higher incision in 28% and a lower incision in 7% of the cases. Both positive and negative superoinferior displacement away from McBurney's point were significant factors regarding the surgeon's decision to alter the incision (p = 0.005), and the superoinferior distance was more than 3 cm in 94% of the cases in which the surgeon would have altered the incision.
The location of the appendix varies widely among individuals, and McBurney's point has limitations as an anatomic landmark. Three-dimensional MDCT findings can be useful to surgeons customizing appendectomy incisions. Additional information about the location of the appendix in the CT report (if possible, together with a 3D image showing the location of the appendix) may be beneficial for surgeons performing appendectomy.
本研究旨在展示接受三维多层螺旋CT（3D MDCT）检查的患者中麦氏点与阑尾之间的关系，并探讨该信息对外科医生选择阑尾切除术切口的影响。
在142例连续接受MDCT检查的成年人中，选择100例（35例女性，65例男性；平均年龄52.1岁）在腹盆腔MDCT检查中可识别阑尾的患者作为研究组。排除标准为存在腹腔内肿块或腹部手术史。采用表面阴影显示算法对CT数据进行三维重建。在一张单一的三维图像上标记阑尾根部和麦氏点的位置，该图像可显示每位患者的皮肤表面标记。测量从阑尾水平到麦氏点水平的上下和内外侧距离，并根据这些测量值计算径向距离。一位有急诊腹部手术经验的外科医生查看了三维CT图像和一张显示阑尾的轴位图像，并记录了他根据CT信息为每位患者选择的切口。使用多变量逻辑回归模型分析阑尾与麦氏点的上下和内外侧距离对外科医生决策的影响。
仅4%的患者阑尾恰好位于麦氏点。在36%的病例中，阑尾距离麦氏点在3 cm以内，28%的病例中为3 - 5 cm，36%的病例中阑尾距离麦氏点超过5 cm。阑尾与麦氏点之间的平均±标准差上下、内外侧和径向距离分别为33.0±24.1、20.8±19.3和42.1±26.7 mm。查看图像后，外科医生在35%的病例中会改变其切口位置。在28%的病例中，外科医生倾向于选择更高的切口，7%的病例中倾向于选择更低的切口。阑尾相对于麦氏点的上下位移无论是正向还是负向，都是外科医生决定改变切口的重要因素（p = 0.005），在94%的外科医生会改变切口的病例中，上下距离超过3 cm。
阑尾的位置在个体之间差异很大，麦氏点作为解剖标志存在局限性。三维MDCT检查结果对外科医生定制阑尾切除术切口可能有用。CT报告中关于阑尾位置的额外信息（如果可能，连同显示阑尾位置的三维图像）可能对进行阑尾切除术的外科医生有益。
