Xu Yingding, Jeffrey R Brooke, Chang Stephanie T, DiMaio Michael A, Olcott Eric W
Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
J Ultrasound Med. 2017 Feb;36(2):269-277. doi: 10.7863/ultra.16.03109. Epub 2016 Dec 31.
To evaluate sonographic findings as indicators of complicated versus uncomplicated appendicitis in the setting of known appendicitis, a necessary distinction in deciding whether to proceed with antibiotic therapy or with appendectomy.
With Institutional Review Board approval and Health Insurance Portability and Accountability Act compliance, appendiceal sonograms of 119 patients with histopathologically proven appendicitis were retrospectively blindly reviewed to determine the presence or absence of the normally echogenic submucosal layer, the presence of mural hyperemia, periappendiceal fluid, appendicoliths, and hyperechoic periappendiceal fat and to determine the maximum outside diameter. Results were compared with the presence of complicated versus uncomplicated appendicitis on histopathologic examination and assessed by both univariate and mulitvariate logistic regression; confidence intervals (CIs) of proportions were assessed by the exact binomial test.
Thirty-two (26.9%) of the 119 patients had complicated appendicitis, including 11 with gangrenous appendicitis without perforation and 21 with gangrenous appendicitis and perforation. Loss of the submucosal layer was the only independent significant indicator of complicated appendicitis in multivariate regression (P < .001) and provided sensitivity and specificity values of 100.0% (95% CI, 89.1%-100.0%) and 92.0% (95% CI, 84.1%-96.7%), respectively.
Loss of the normally echogenic submucosal layer was the most useful sonographic finding for discriminating complicated from uncomplicated appendicitis, being the only finding independently and significantly associated with complicated appendicitis and, additionally, providing both high sensitivity and high specificity. This information may help a physician decide whether to proceed with antibiotic therapy or with appendectomy when treating a patient with appendicitis.
在已知阑尾炎的情况下，评估超声检查结果作为复杂性阑尾炎与非复杂性阑尾炎指标的情况，这是决定采用抗生素治疗还是阑尾切除术的必要区分。
经机构审查委员会批准并符合《健康保险流通与责任法案》要求，对119例经组织病理学证实为阑尾炎患者的阑尾超声图像进行回顾性盲法分析，以确定是否存在正常的高回声黏膜下层、壁层充血、阑尾周围积液、阑尾结石、高回声阑尾周围脂肪，并测量阑尾最大外径。将结果与组织病理学检查中复杂性阑尾炎与非复杂性阑尾炎的情况进行比较，并通过单变量和多变量逻辑回归进行评估；比例的置信区间通过精确二项式检验进行评估。
119例患者中有32例（26.9%）患有复杂性阑尾炎，其中11例为无穿孔的坏疽性阑尾炎，21例为坏疽性阑尾炎伴穿孔。黏膜下层消失是多变量回归中复杂性阑尾炎唯一独立的显著指标（P <.001），其敏感性和特异性分别为100.0%（95%CI，89.1% - 100.0%）和92.0%（95%CI，84.1% - 96.7%）。
正常高回声黏膜下层的消失是区分复杂性阑尾炎与非复杂性阑尾炎最有用的超声检查结果，是唯一与复杂性阑尾炎独立且显著相关的发现，同时具有高敏感性和高特异性。这些信息可能有助于医生在治疗阑尾炎患者时决定采用抗生素治疗还是阑尾切除术。
