A Prospective Study of Ultrasonography in the Diagnosis of Acute Appendicitis

超音波診斷急性闌尾炎之前瞻性研究

陳志州(Jyh-Jou Chen) ； 張簡吉幸(Chi-Sin Changchien)

《中華民國消化系醫學會雜誌》 8卷3期 (1991/09) Pp. 172-178

https://doi.org/10.6557/GJTa.199109_8(3).0003

摘要

為評估常規性3.5 MHz實時間線型探頭超音波於診斷急性闌尾炎之價值，以民國79年3月至6月間高雄長庚紀念醫院主訴急性右下腹痛之病人66例為對象進行此前瞻性研究，其中男性36例，女性30例，年齡分佈於7至77歲之間，平均年齡37.2歲。超音波檢查以3.5 MHz實時間線型探頭行右下腹掃描，必要時施加壓迫以排除腸氣。超音波診斷急性闌尾炎之標準為(1)於患者之右下腹發現中心高迴音，週邊低迴音之管狀構造，最好一端為盲端，(2)橫切此一管狀構造可得一靶狀結構，且直徑大於7mm, (3)此一管狀構造無蠕動現象，(4)壓迫此一管狀構造患者有疼痛感。患者之最後診斷，依據手術後之病理檢驗結果。未手術者以電話追蹤其結果。32例經病理檢驗證實為急性闌尾炎之病例中有23例於超音波檢查中可見急性闌炎之圖像，超音波診斷急性闌尾炎之敏感率為71.9%。偽陰性9例中，5例超音波圖可見腸阻塞(ileus)現象，其中一例為先天性大腸轉移不全，闌尾位於右上腹肝臟下方；另一例則為急性闌尾炎併黏液囊腫，超音波圖顯現靶子樣病變；另3例僅見腸阻塞。餘4例無特殊發現。無急闌尾炎34例中30例超音波檢查無急性闌尾炎圖像，超音波診斷急性闌尾炎之特定率為88%，4例偽陽性病例中，一例為輸卯管膿瘍，一例為盲腸之炎性腫瘤，2例經追蹤後無急性闌尾炎之症候，另分析超音波可見腸阻塞之病例，則超音波診斷急性闌尾炎之敏感率為66.6%。由此研究以3.5 MHz實時間線型探頭診斷急性闌尾炎之陽性預期率為85.2%，陰性預期率為76.9%，總正確率為80.3%，因此以3.5MHz實時間線型探頭診斷急性闌尾炎有其價值，但腸阻塞會增加診斷之困難，又右下腹其它疾病可能引導診斷錯誤，皆是以超音波診斷急性闌尾炎應提高警覺的地方。

關鍵字

超音波 ； 急性闌尾炎

並列摘要

To evaluate the diagnosis of acute appendicitis by ultrasonography, we used a 3.5 MHz linear array transducer with compression to prospectively study 66 patients complaining of acute onset of right lower abdominal pain. Within a period of 3 months, 36 male and 30 female patients with a mean age of 37.2 years (ranging from 7 to 77 years old) were enrolled in this study. The criteria for ultrasonographic diagnosis of acute appendicitis were aperistalsis and incompressibility of tubular structures with a cross diameter of more than 7 mm or/and abscess formation at the right lower abdomen. Of 32 patients with acute appendicitis confirmed by pathology, an inflammed appendix could be visualized by ultrasonography in 23 patients, the sensitivity was 71.9%. The overall accuracy and specificity were 80.3% and 88.2% respectively. The positive and negative predictive values were 85.2% and 76.9% respectively. Furthermore, in an analysis of 17 patients with ileus at the right lower abdomen on the sonogram, the sensitivity decreased to 66.6%. The accuracy of using a 3.5 MHz linear array transducer with compression to diagnose acute appendicitis is acceptable and the whole procedure is a worthwhile clinical practice.

並列關鍵字

acute appendicitis ； ultrasonography