目的:探讨超声造影引导下内镜下逆行阑尾炎治疗(ERAT)对单纯性阑尾炎的诊断和治疗价值。
方法:对2020年1月至2023年12月期间收集的105例单纯性阑尾炎患儿的临床和超声数据进行了回顾性分析。治疗前后的超声检查结果,以及术后随访和复发率,进行了总结和分析。
结果:96例患者(91.4%)成功插管。常规超声阑尾显示率为39.6%(38/105),而超声造影引导下阑尾可视化率为75%(72/105)。超声造影显示89例阑尾的各种形态学改变,比如扭曲,弯曲,刚度,粗糙的内壁,扩张直径,管腔变窄。此外,局部充填缺陷,这表明存在粪便结石或碎屑沉积,在68例患者中发现。没有发生造影剂的泄漏。治疗后评价显示阑尾直径改善,管腔,和填充缺陷(P<0.01)。89例患者的随访率为82例(92.1%),他们都恢复得很好,没有复发。复发率为7.9%(7/89)。在复发的患者中,5例患者经药物治疗后痊愈,2例患者经手术治疗后康复。
结论:超声造影引导下ERAT治疗单纯性阑尾炎是安全有效的。具体来说,附录增加了,这有助于评估治疗效果。ERAT作为一个有价值的补充方式来确定需要手术治疗急性阑尾炎。具有重要的临床价值。
OBJECTIVE: To determine the diagnostic and therapeutic value of contrast-enhanced ultrasound-guided endoscopic retrograde appendicitis treatment (ERAT) in patients with uncomplicated appendicitis.
METHODS: A retrospective analysis was performed on clinical and ultrasound data collected from 105 pediatric patients with uncomplicated appendicitis between January 2020 and December 2023. The ultrasound findings before and after treatment, as well as postoperative follow-up and recurrence rates, were summarized and analyzed.
RESULTS: Successful intubation was achieved in 96 patients (91.4%). The conventional ultrasound appendix visualization rate was 39.6% (38/105), while the appendix visualization rate after contrast-enhanced ultrasound-guidance was 75% (72/105). Contrast-enhanced ultrasound revealed various appendiceal morphologic changes in 89 patients, such as twisting, tortuosity, stiffness, rough inner wall, dilated diameter, and narrowing of the lumen. Additionally, local filling defects, which indicated the presence of fecal stones or debris deposition, were noted in 68 patients. No leakage of the contrast agent occurred. Post-treatment evaluation showed improvement in appendiceal diameter, lumen, and filling defects (P < .01). The follow-up rate was 82 of 89 patients (92.1%), all of whom recovered well without a recurrence. The recurrence rate was 7.9% (7/89). Among the patients with recurrences, five patients resolved after medical treatment and two patients recovered after surgical treatment.
CONCLUSIONS: Contrast-enhanced ultrasound-guided ERAT for uncomplicated appendicitis is safe and effective. Specifically, the appendix is increased, which facilitates an evaluation of therapeutic effectiveness. ERAT serves as a valuable supplementary modality to determine the need for surgical treatment of acute appendicitis, which is of significant clinical value.