摘要
目的:通过前瞻性观察研究评估MSCT检查对急性阑尾疑诊患者阴性阑尾切除率的影响。方法:78例急性阑尾炎临床疑诊患者纳入研究。由急诊科医师根据临床资料(包括实验室检查)结合Alvarado评分做出临床诊断,分为两组:临床典型组(Alvarado评分≥7分)和临床不典型组(Alvarado评分<7分)。所有患者均行MSCT检查,由放射科医师做出CT诊断。治疗方案由外科医师综合参考临床与CT诊断结果后制定,最终诊断以手术病理和临床随访为准。计算临床与CT诊断的阴阳性结果及相关评价指标,并进行统计学处理。结果:MSCT检查的各个评价指标(准确度94.9%,敏感度95.6%,特异度93.9%,阳性预测值95.6%,阴性预测值93.9%,阳性似然比15.8,阴性似然比0.05)均明显优于临床诊断。78例患者中,35例属临床表现典型组,其中9例(25.7%)证实为急性阑尾炎阴性,此9例患者MSCT诊断结果全为阴性。结论:术前MSCT检查可明显降低急性阑尾疑诊患者的阴性阑尾切除率,避免不必要的剖腹探查。
Objective：To assess the impact of multispiral computed tomography（MSCT） on the rate of negative appendectomies（NA） by a prospective observational cohort study.Methods：78 patients with suspected acute appendicitis were entered into the study.First,all patients were clinically evaluated through Alvarado scores by emergency physician,who was asked to determine whether appendicitis was clinically evident（Alvarado Score≥7） or not evident（Alvarado Score〈7）.Then,all patients underwent MSCT and a decision to operate,observe,or discharge the patients was made by a surgeon.The final diagnosis was based on surgical pathology or clinical follow-up.Results：The test characteristics of clinical impression and MSCT were then calculated and the rates at which acute appendicitis was falsely diagnosed based on clinical impression and MSCT were compared using McNemar＇s test.The test characteristics of MSCT（Accuracy 94.9%,Sensitivity 95.6%,Specificity 93.9%,Positive predictive value 95.6%,Negative predictive value 93.9%,Positive LR 15.8,Negative LR 0.05） were markedly superior to clinical impression.Of the 35 patients in which the clinical impression was clinically evident appendicitis,9（25.7%） did not have appendicitis,the negative rate on MSCT in these 9 patients was 0.Conclusion：The performance of MSCT in patients with suspicion for acute appendicitis reduces negative appendectomies markedly and avoids unnecessary negative laparotomy in patients.
出处
《放射学实践》
北大核心
2011年第5期514-517,共4页
Radiologic Practice
