Schwerk W B, Wichtrup B, Rothmund M, Rüschoff J
Department of Internal Medicine, Philipps-University of Marburg, Federal Republic of Germany.
Gastroenterology. 1989 Sep;97(3):630-9. doi: 10.1016/0016-5085(89)90634-3.
The diagnostic accuracy and practical impact of high-resolution sonography were prospectively studied in 523 consecutive patients admitted to the hospital with suspected appendicitis. The criteria for ultrasound diagnosis of acute appendicitis included visualization of a noncompressible aperistaltic appendix, with a targetlike appearance in transverse view and a diameter greater than or equal to 7 mm. In 115 of 130 patients with proven appendicitis the inflamed appendix or appendiceal abscess could be visualized, giving a sensitivity of 88.5%. The mean diameter of ultrasonically visible appendices was 11.4 +/- 3.2 mm. The overall accuracy and specificity of sonography in the diagnosis of acute appendicitis were 95.7% and 98%, respectively. The predictive value of a positive test was 94.5% and that of a negative result 96.3%. In a separate analysis of the results in 121 women of childbearing age, who have a high risk of preoperative misdiagnosis, the overall accuracy was found to be 96.7%, with 82.6% sensitivity and 100% specificity. Twenty-four (89%) of the 27 patients with appendiceal rupture (incidence 20.8%) were correctly diagnosed with ultrasound. The other 3 cases (11%) were missed. Routine use of ultrasonography has significantly improved the diagnostic accuracy in patients with suspected appendicitis and has reduced the negative laparotomy rate from 22.9% to 13.2%.
对523例因疑似阑尾炎入院的连续患者进行了前瞻性研究，以评估高分辨率超声检查的诊断准确性及实际影响。急性阑尾炎的超声诊断标准包括：观察到不可压缩、无蠕动的阑尾，横切面上呈靶样外观，直径大于或等于7mm。130例经证实为阑尾炎的患者中，115例可见发炎的阑尾或阑尾脓肿，敏感性为88.5%。超声可见阑尾的平均直径为11.4±3.2mm。超声诊断急性阑尾炎的总体准确性和特异性分别为95.7%和98%。阳性检查的预测值为94.5%，阴性结果的预测值为96.3%。在对121例育龄期女性（术前误诊风险高）的结果进行单独分析时，发现总体准确性为96.7%，敏感性为82.6%，特异性为100%。27例阑尾破裂患者（发生率20.8%）中有24例（89%）通过超声得到正确诊断，另外3例（11%）漏诊。常规使用超声检查显著提高了疑似阑尾炎患者的诊断准确性，并将阴性剖腹率从22.9%降至13.2%。
