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目的探讨导致不典型阑尾炎超声误诊及漏诊的影响因素。方法回顾性分析被漏诊或误诊的急性不典型阑尾炎的临床、解剖及超声等特点,并进行二元因素赋值,通过Logistic回归分析比较以上因素对超声诊断阑尾炎影响。结果经6步回归分析,发现大量肠气、右下腹积液、腹膜后位阑尾、右下腹局部回声增强是成人阑尾炎被超声误诊漏诊是主要原因,而肠系膜淋巴结显影及憩室炎是小儿阑尾炎误诊的主要因素(均P=0.000,且模型分类判对率均大于85%)。结论右下腹回声增强、积液以及肠内气体干扰是导致超声误诊漏诊急性阑尾炎的主要原因,对于小儿急性右下腹痛应仔细鉴别其与肠系膜淋巴结炎及麦克尔憩室炎的区别。
Objective To investigate the influencing factors of misdiagnosis and missed diagnosis of atypical appendicitis. Methods The clinical features, anatomy and ultrasonography of acute atypical appendicitis, which were missed or misdiagnosed, were retrospectively analyzed. The binary factors were assigned and the above factors were compared by Logistic regression to evaluate the effect of ultrasound in the diagnosis of appendicitis. Results Six-step regression analysis showed that a large number of intestinal gas, right lower quadrant effusion, retroperitoneal appendix, right lower quadrant local echo enhancement is the main cause of adult misdiagnosis of appendicitis was missed, while mesenteric lymph node imaging and diverticulitis were misdiagnosed children with appendicitis The main factors (all P = 0.000, and the classification rate of the model classification were more than 85%). Conclusions The enhancement of right lower quadrant echo, effusion and gas in the intestine are the main reasons leading to misdiagnosis of missed appendicitis in acute right appendicitis. For children with acute right lower quadrant pain, their differences from mesenteric lymphadenitis and Michel diverticulitis should be carefully identified.