Siewert B, Raptopoulos V, Mueller M F, Rosen M P, Steer M
Department of Radiology (AN 234), Beth Israel Hospital, Harvard Medical School, Boston, MA 02215, USA.
AJR Am J Roentgenol. 1997 Jan;168(1):173-8. doi: 10.2214/ajr.168.1.8976942.
The purpose of this study was to evaluate the effect of CT on the diagnosis and management of acute abdominal pain in patients who did not undergo surgery and to determine what population of patients would profit most from CT examination.
Clinical data and CT reports of 91 patients with acute abdomen (41 men and 50 women, 22-96 years old) were analyzed retrospectively. The accuracies of clinical evaluation and CT in revealing the cause of acute abdomen were compared, and the effect of CT on patient management was assessed. Analysis included the entire population of patients and these subgroups: (1) patients who had symptoms for fewer than 24 hr versus patients who had symptoms for 24 hr or more and (2) patients who had a history of abdominal diseases versus patients who had no such history.
Twenty-nine patients had signs or symptoms for fewer than 24 hr, and 62 patients had signs or symptoms for 24 hr or more. Fifty-nine patients had a history of abdominal disease, and 32 had no history of abdominal disease. In the entire population of patients, CT was superior to clinical evaluation for diagnosing the cause of acute abdomen (sensitivity was 90% for CT and 76% for clinical evaluation, p < .0005). Management was changed after CT in 25 patients (p < .0005). Similar differences were observed in the subgroups of patients with signs and symptoms for fewer than 24 hr, patients with signs and symptoms for 24 hr or more, and patients with no history of abdominal disease (p < .05). In the subgroup of patients with a history of abdominal disease, the differences between clinical evaluation and CT were not statistically significant.
CT is an excellent examination technique for patients with acute abdomen, regardless of the duration of signs and symptoms. CT is particularly useful in defining the cause and therapeutic strategy in patients with acute abdomen who have no history of abdominal disease.
本研究旨在评估CT对未接受手术的急性腹痛患者诊断和治疗的影响，并确定哪类患者能从CT检查中获益最大。
回顾性分析91例急性腹痛患者（男41例，女50例，年龄22 - 96岁）的临床资料和CT报告。比较临床评估和CT揭示急性腹痛病因的准确性，并评估CT对患者治疗的影响。分析包括所有患者以及以下亚组：（1）症状持续时间少于24小时的患者与症状持续24小时或更长时间的患者；（2）有腹部疾病史的患者与无腹部疾病史的患者。
29例患者症状持续时间少于24小时，62例患者症状持续24小时或更长时间。59例患者有腹部疾病史，32例无腹部疾病史。在所有患者中，CT在诊断急性腹痛病因方面优于临床评估（CT的敏感性为90%，临床评估为76%，p <.0005）。25例患者在CT检查后治疗方案发生了改变（p <.0005）。在症状持续时间少于24小时的患者亚组、症状持续24小时或更长时间的患者亚组以及无腹部疾病史的患者亚组中也观察到了类似差异（p <.05）。在有腹部疾病史的患者亚组中，临床评估与CT之间的差异无统计学意义。
对于急性腹痛患者，无论症状持续时间长短，CT都是一种优秀的检查技术。CT在明确无腹部疾病史的急性腹痛患者的病因和治疗策略方面特别有用。
