Ramachandran P, Sivit C J, Newman K D, Schwartz M Z
Department of Surgery, Children's National Medical Center, Washington, D.C. 20010, USA.
J Pediatr Surg. 1996 Jan;31(1):164-7; discussion 167-9. doi: 10.1016/s0022-3468(96)90341-3.
This study was designed to evaluate the sensitivity and specificity of abdominal ultrasonography as a diagnostic modality in a large series of children who presented with possible appendicitis. From August 1990 to July 1994, 452 children (203 boys, 249 girls) with an average age of 11 years (range, 1 to 20 years) underwent graded compression ultrasonography of the right lower quadrant of the abdomen for the evaluation of possible appendicitis. In the first 18 months of the study all patients with the possible diagnosis of appendicitis (group I; 180 patients) had abdominal ultrasonography after members of the surgical team evaluated and documented their findings in the medical record. In the second study period (30 months), abdominal ultrasonography was recommended only when the clinical diagnosis of acute appendicitis was equivocal (group II; 272 patients). Abdominal ultrasonography was performed using the graded compression technique with a 5.0-MHz linear array transducer. A positive ultrasound study for appendicitis was defined as the presence of an enlarged noncompressible appendix with an outer wall to outer wall diameter of greater than 6 mm, the presence of a complex mass, or the presence of an appendicolith. The sonographic data were correlated with surgical and pathological findings. Appendicitis was confirmed in 112 of the 452 cases. In 17 of these, the appendix was perforated. In the overall group of 452 children, abdominal ultrasonography had a sensitivity of 90%, specificity of 96%, and accuracy of 95%. There was no significant morbidity in the 11 patients with a false-negative study result. All 11 patients had an uncomplicated appendectomy. There were 11 false-positive results; 10 of these patients had a negative laparotomy result (negative laparatomy rate, 8.9%). For the two groups, the sensitivity and specificity of ultrasonography in the diagnosis of appendicitis were equivalent (group 1: 88% sensitivity, 96% specificity; group 2: 92% sensitivity, 97% specificity). On the basis of the high sensitivity and specificity rates, ultrasonography of the appendix can be a useful adjunct to standard examination in the diagnosis of acute appendicitis.
本研究旨在评估腹部超声检查作为一种诊断方法，在大量疑似阑尾炎患儿中的敏感性和特异性。从1990年8月至1994年7月，452名儿童（203名男孩，249名女孩）接受了腹部右下腹分级压迫超声检查，平均年龄11岁（范围1至20岁），以评估是否可能患有阑尾炎。在研究的前18个月，所有可能诊断为阑尾炎的患者（第一组；180例患者）在手术团队成员评估并在病历中记录其检查结果后，接受了腹部超声检查。在第二个研究阶段（30个月），仅当急性阑尾炎的临床诊断不明确时才建议进行腹部超声检查（第二组；272例患者）。腹部超声检查采用分级压迫技术，使用5.0兆赫线阵探头。超声检查阑尾炎阳性定义为存在不可压缩的肿大阑尾，阑尾外壁到外壁直径大于6毫米、存在复杂包块或存在阑尾粪石。超声检查数据与手术及病理结果相关。452例病例中112例确诊为阑尾炎。其中17例阑尾穿孔。在452名儿童的总体组中，腹部超声检查的敏感性为90%，特异性为96%，准确性为95%。11例超声检查结果为假阴性的患者未出现明显并发症。所有11例患者均接受了无并发症的阑尾切除术。有11例假阳性结果；其中10例患者剖腹探查结果为阴性（阴性剖腹探查率为8.9%）。对于两组，超声检查诊断阑尾炎的敏感性和特异性相当（第一组：敏感性88%，特异性96%；第二组：敏感性92%，特异性97%）。基于高敏感性和特异性率，阑尾超声检查可作为急性阑尾炎标准检查的有用辅助手段。
