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目的探讨小儿急性阑尾炎双源CT(DSCT)表现及其诊断价值。方法回顾性分析笔者所在医院经手术及病理学检查证实的97例小儿(14岁以下)急性阑尾炎的CT表现特点。结果 97例中,单纯性阑尾炎7例,化脓性阑尾炎20例,坏疽性及穿孔性阑尾炎58例,阑尾周围脓肿12例。CT图像上显示小儿阑尾位置:28例阑尾显示不清;其余69例中盆位阑尾20例(29.0%),回肠前位15例(21.7%),回肠后位11例(15.9%),盲肠后位12例(17.4%),盲肠下位3例(4.3%),盲肠外侧位1例(1.5%),其他位置7例(10.2%)。小儿阑尾炎CT平扫及三维重建的影像表现为阑尾增粗、肿胀,阑尾腔内粪石影,阑尾周围脂肪密度升高,邻近腹膜增厚,相邻回盲部增厚,肠系膜淋巴结增大,周围脓肿形成,腹腔和(或)盆腔积液。CT对小儿急性单纯性阑尾炎的确诊率为85.7%(6/7),化脓性阑尾炎的确诊率为80.0%(16/20),坏疽性及穿孔性阑尾炎的确诊率为100%(58/58),阑尾脓肿的确诊率为100%(12/12),总确诊率为94.8%(92/97)。结论 DSCT能较好地显示小儿阑尾的解剖位置及其周围组织结构的病理改变,具有较高的诊断准确性,可为临床术前提供强有力的信息。
Objective To investigate the performance of dual-source CT (DSCT) in children with acute appendicitis and its diagnostic value. Methods A retrospective analysis of the author’s hospital confirmed by surgery and pathology 97 cases of children (14 years of age) of acute appendicitis CT features. Results In 97 cases, 7 cases were simple appendicitis, 20 cases were purulent appendicitis, 58 cases were gangrenous and perforated appendicitis, and 12 cases were abscess around the appendix. CT images showed the location of children’s appendix: 28 cases of appendix showed unclear; the remaining 69 cases of pelvic appendix in 20 cases (29.0%), ileum in 15 cases (21.7%), ileum in 11 cases (15.9% The posterior position was found in 12 cases (17.4%), the lower cecum in 3 cases (4.3%), the cecum outside in 1 case (1.5%) and the other positions in 7 cases (10.2%). Appendicitis in children with CT scan and three-dimensional reconstruction of the appendix showed thickening, swelling, appendix cavity dung stone shadow, increased density around the appendix fat, adjacent to the peritoneal thickening, adjacent ileocecal thickening, mesenteric lymph nodes increased, Abscess formation around, abdominal and (or) pelvic fluid. The diagnosis of acute appendicitis in children was 85.7% (6/7), the diagnosis of suppurative appendicitis was 80.0% (16/20), the incidence of gangrenous and perforation appendicitis was 100% (58/58 ), Appendix abscess diagnosis rate was 100% (12/12), the total diagnosis rate of 94.8% (92/97). Conclusion DSCT can better show the anatomical location of pediatric appendix and its surrounding tissue structure of the pathological changes, with high diagnostic accuracy, for clinical preoperative provide powerful information.