Evetts B K, Foley C R, Latimer R G, Rimkus D S
Department of Surgery and Nuclear Medicine, Santa Barbara Cottage Hospital, CA.
J Am Coll Surg. 1994 Aug;179(2):197-201.
Patients with acute lower abdominal pain remain a diagnostic challenge. Although acute appendicitis is the most common surgical disorder, its accurate and timely diagnosis can be difficult. Historically, females of childbearing age are the most difficult patient group in whom to make the diagnosis of acute appendicitis; they have reported negative laparotomy rates ranging from 30 to 50 percent. Tc-99 hexamethylpropyleneamineoxide (HMPAO) labeled leukocyte scan has previously been shown to be very accurate in the detection of acute appendicitis.
One year ago, a blinded study using Tc-99 HMPAO labeled leukocyte scan was reported for the detection of acute appendicitis. That study consisted of 27 patients who presented with abdominal pain. The present report is a follow-up study of 37 additional patients in whom the Tc-99 HMPAO leukocyte scan was used to diagnose or discount acute appendicitis.
Twenty-seven patients had histologically proved acute appendicitis. Twenty-three of these were correctly diagnosed using the leukocyte scan, for a sensitivity rate of 85 percent. The overall specificity rate was 93 percent, with an overall accuracy rate of 89 percent. Thirty-one of 64 patients were females of reproductive age and represented 56 percent of all patients in the study with appendicitis. In this group, the Tc-99 HMPAO leukocyte scan had a sensitivity rate of 87 percent, specificity rate of 92 percent, and an overall accuracy rate of 89 percent. The Tc-99 HMPAO leukocyte scan also proved to be valuable in the diagnosis of other intra-abdominal inflammatory conditions. Eight scans interpreted as negative for acute appendicitis were positive for other conditions, including five that were positive for diverticulitis, one for a tumor, one for a tubo-ovarian abscess, and one for a small intestinal infarction.
The Tc-99 HMPAO leukocyte scan is a highly accurate, diagnostic, and minimally invasive test of use in patients with abdominal pain of unclear cause, in which the differential diagnosis includes acute appendicitis. It is of particular value in females of childbearing age, in whom the cause of lower abdominal pain is unclear.
急性下腹痛患者的诊断仍然是一项挑战。虽然急性阑尾炎是最常见的外科疾病，但其准确及时的诊断可能存在困难。从历史上看，育龄女性是最难诊断急性阑尾炎的患者群体；她们的阴性剖腹手术率报告在30%至50%之间。锝-99六甲基丙烯胺肟（HMPAO）标记白细胞扫描先前已被证明在检测急性阑尾炎方面非常准确。
一年前，有一项关于使用锝-99 HMPAO标记白细胞扫描检测急性阑尾炎的盲法研究报告。该研究包括27例腹痛患者。本报告是对另外37例使用锝-99 HMPAO白细胞扫描诊断或排除急性阑尾炎患者的随访研究。
27例患者经组织学证实为急性阑尾炎。其中23例通过白细胞扫描得到正确诊断，灵敏度为85%。总体特异度为93%，总体准确率为89%。64例患者中有31例为育龄女性，占该研究中所有阑尾炎患者的56%。在这组患者中，锝-99 HMPAO白细胞扫描的灵敏度为87%，特异度为92%，总体准确率为89%。锝-99 HMPAO白细胞扫描在诊断其他腹腔内炎症性疾病方面也被证明是有价值的。8例被解释为急性阑尾炎阴性的扫描结果在其他疾病中呈阳性，包括5例憩室炎阳性、1例肿瘤阳性、1例输卵管卵巢脓肿阳性和1例小肠梗死阳性。
锝-99 HMPAO白细胞扫描是一种高度准确、具有诊断性且微创的检查方法，适用于病因不明的腹痛患者，其鉴别诊断包括急性阑尾炎。它对育龄女性尤其有价值，因为她们下腹痛的病因不明。
