彩色多普勒超声诊断下肢深静脉血栓的价值研究

目的：探讨彩色多普勒超声对下肢深静脉血栓形成的诊断价值。方法：应用彩色多普勒超声诊断仪检查临床拟诊为下肢深静脉血栓87例,观察静脉管腔内回声、血栓形成的范围、血流分布及频谱特征。结果：观察发现,左下肢静脉血栓发生率显著高于右侧;彩色多普勒超声可表现为腔内强弱不等回声和充盈缺损,显示无血流信号或血流频谱不随呼吸变化。结论：彩色多普勒超声对下肢深静脉血栓的诊断具有简便、快速、无创、可靠等特点,可作为首选方法,为临床治疗及疗效评价提供可靠依据。     

二维及彩色多普勒血流显像诊断下肢静脉病变的意义

目的 评价彩色多普勒血流显像检测临床下肢静脉病变的应用价值。方法 对临床下肢静脉病变90例107条下肢静脉进行彩色多普勒血流显像检查。结果 彩色多普勒血流显像可迅速清晰地显示下肢的解剖图像，其中检出61例64条下肢静脉有血栓形成（急性血栓31例，慢性血栓30例），8例9条深静脉瓣功能不全，31例34条为下肢静脉曲张。结论 下肢深静脉血栓形成有一定的声像特征，彩色多普勒血流显像检出敏感性高，可对血栓作出定位，定范围和管腔阻塞程度的判断，是帮助临床选择治疗方案和客观评价药物疗效的重要方法。判断有无深静脉功能不全，可为临床手术和治疗提供可靠依据。     

彩色多普勒超声在下肢深静脉血液高凝状态的临床应用价值

目的：早期发现、早期诊断下肢静脉血栓,分析和探讨彩色多普勒超声在下肢深静脉血栓形成前期的应用价值。方法：通过分析156例经彩色多普勒超声检查四肢深静脉血栓形成及血栓形成前期的图像特点及临床治疗经过与疗效复查情况。结果：彩超检查下肢深静脉血管可了解血管的形态结构、管腔血栓形成的程度及彩色血流动力学等改变。及早发现血液高凝状态即血栓前期,并在血栓形成之前及时采用药物治疗,达到临床治愈。结论：彩超检查对四肢深静脉血栓的形成具有很高的敏感性和特异性,是一种可靠的诊断依据,对临床治疗有较好的指导作用。     

彩色多普勒超声在诊断下肢深静脉血栓形成后继发性动静脉瘘形成中的临床价值

目的探讨彩色多普勒超声血流显像在诊断下肢深静脉血栓形成后深静脉血管腔内多发动静脉瘘形成的临床价值。方法收集下肢深静脉血栓腔内继发性动静脉瘘患者59例,行双侧下肢深静脉彩色多普勒超声检查,对确定的病变位置和范围,测量最大流速,阻力指数。结果本组59例病例中累及髂外静脉者18例,股总静脉15例,股浅静脉12例,腘静脉7例,肌间静脉6例,其中1例发生于浅静脉血管腔内,病变血管血栓再管化率低于10%,血管阻力指数为0.33～0.48。结论下肢深静脉血栓形成后深静脉血管腔内多发动静脉瘘形成在彩色多普勒超声现象中具有特征性表现,是诊断本病的首选影像学检查方法。     

彩色超声对老年下肢静脉病变的诊断价值

目的：探讨彩色超声检查老年下肢静脉病变的临床价值。方法：应用彩色超声检查168例老年下肢静脉病变患者的血管形态、血管壁内、中膜厚度（IMT）、有无斑块、管腔狭窄或闭塞及血流动力学改变等。结果：超声检查发现下肢深静脉血栓24例（14.3%）;股静脉瓣膜功能不全68例,为40.5%;下肢深静脉管径明显增宽,血流缓慢甚至形成涡流者8例为4.8%（8/168）,下肢深静脉管径明显增宽,血流缓慢甚至形成涡流者22例为14.3%。134例下肢肿胀的患者中,下肢静脉血栓形成者23例（17.2%）,58例（43.3%）股静脉瓣膜功能不全,5例下肢静脉管径扩张血流缓慢,14例下肢有明显的皮下软组织水肿,12例下肢不适或疼痛,怀疑肺动脉栓塞22例。结论：彩色多普勒超声检查对老年下肢静脉病变的早期诊断、预防及治疗有重要的临床意义。     

彩色多普勒超声对肿瘤患者下肢肿胀原因的评价

目的 :探讨彩色多普勒超声对肿瘤患者下肢肿胀的诊断价值。方法 :回顾性分析32例下肢肿胀的肿瘤患者的超声声像图特征,患者均经血管造影或手术证实。结果:本组32例中,17例下肢深静脉血栓,6例静脉受压,6例静脉受侵犯,3例淋巴水肿。深静脉血栓声像图表现为管腔内见实性回声,加压探头管腔不能闭合,CDFI栓塞部位无血流信号或血流充盈缺损;静脉外机械性压迫声像图表现为受压处静脉突然明显变细,管腔内未见异常回声,周围见实性团块回声,受压远端静脉未见异常;静脉受侵犯声像图表现为受侵血管旁见肿块包绕,管壁不连续、显示不清,管内充满与肿块相似的实性回声;淋巴水肿表现为皮下组织增厚,呈"颗粒状"。结论:彩色多普勒超声检查在肿瘤患者下肢肿胀原因诊断与鉴别诊断中具有重要的临床价值。     

直接法多层螺旋CT静脉造影诊断下肢深静脉血栓简

目的：探讨直接法多层螺旋CT静脉造影（MSCTV）诊断下肢深静脉血栓的临床应用价值。方法直接法多层螺旋CT（MSCT）下肢静脉造影17例,同期均行彩色多普勒超声血流显像（CDFI）检查。直接法MSCTV检查后,所得图像经处理后传送至工作站进行多平面重建（MPR）、最大密度投影（MIP）、表面遮盖（SSD）及容积再现（VR）重建。结果直接法MSCTV检查显示13例存在下肢深静脉血栓（DVT）,彩色多普勒超声检查显示10例,2例髂静脉及1例胫腓静脉血栓彩色多普勒超声未能检出。直接法MSCTV上DVT主要表现为静脉腔内造影剂充盈缺损、静脉节段性不显影、栓塞静脉远端扩张及其周围侧支循环静脉迂曲扩张、周围软组织肿胀、皮肤增厚。结论直接法MSCT能清晰显示DVT形成的部位、范围、侧支静脉情况及病变血管周围的解剖结构,对彩色多普勒超声不易检出的盆腔及小腿深静脉栓塞也能清晰显示,可以作为下肢深静脉血栓检查的常规方法。     

彩色多普勒血流显像在检查下肢深静脉血栓中的应用

目的：探讨彩色多普勒血流显像在诊断下肢深静脉血栓中的价值。材料和方法：对３５例下肢深静脉血栓患者进行彩超检查，年龄２５～７２岁，平４６８岁，其中２６例被Ｘ线静脉造影证实，２例手术证实。结果：下肢深静脉血栓的声像图特征是静脉管腔内出现实性回声，探头加压管腔不能被压瘪；彩色多普勒显示病变处缺乏血流信号或血流信号消失；脉冲多普勒显示频谱异常，即不随呼吸变化。结论：彩色多普勒血流显像具有操作简单，无创伤，可重复检查等优点，是检查下肢深静脉血栓的敏感方法。     

彩色多普勒超声在下肢深静脉血栓诊断中的临床应用

目的探讨彩色多普勒超声在下肢深静脉血栓诊断中的应用价值。方法选取本院收治的下肢深静脉血栓72例患者作为研究组,另外选择同期接受诊治的下肢无病变60例患者作为对照组,两组患者均接受彩色多普勒超声检查,比较两组患者的超声检查内径和CDFI值。结果72例下肢深静脉血栓患者血栓分型:中央型43例,占59.72%;周围型15例,占20.83%;混合型14例,占19.44%。急性期血栓见静脉管径扩张,回声低或近似无回声;而亚急性、慢性期管径无明显扩张,回声渐渐增强,管腔内见密集实性低回声充填,栓塞部位血管内径正常或增宽,探头加压管腔不能被充分压瘪;CDFI显示管腔边缘或中央可见细条状血流信号,局部出现"断流"或者血流呈"轨道"样。研究组患者的CFV、SFV、PTV、MGV内径值明显高于对照组,且差异具有统计学意义。研究组患者的CFV、SFV、POV的CDFI值高于对照组,且差异具有统计学意义。结论彩色多普勒超声能及时准确诊断血栓形成,诊断下肢深静脉血栓具有无创伤、无禁忌证、实时、可重复性等优点,是下肢深静脉血栓检查的首选方法。     

下肢静脉血栓的彩超诊断

目的：探讨下肢深静脉血栓的特点及其诊断。方法：以二维声像图及彩色多普勒观察血管及血栓，记录管壁、管腔、血栓部位、血栓大小和栓塞程度及周围结构，CDFI充填及充盈残缺。结果：急性血栓4例，亚急性血栓2例，慢性血栓4例。结论：彩超是诊断下肢静脉血栓的的简便、快速、准确及选择治疗方案和评价疗效的重要首选方法。     

Gestational related changes in the deep venous system of the lower limb on light reflection rheography in pregnancy and the puerperium

OBJECTIVE: To assess whether light reflection rheography testing is affected by the changes that occur in the deep venous system of the lower limb in pregnancy and the puerperium. METHODS: Twenty five women with a singleton pregnancy were recruited to undergo duplex Doppler ultrasound examinations of the common femoral vein to measure the vessel diameter and the blood flow velocity. Light reflection rheography testing was subsequently performed and the rate of venous emptying in the lower limb calculated. Serial measurements using both techniques were made at 15, 28, 36 weeks, and term gestation and at 2 days and 6 weeks postpartum. RESULTS: Duplex Doppler ultrasound confirmed that there is progressive dilatation of the deep venous system in pregnancy, which reaches a maximum at term and reverses after delivery. There is an accompanying reduction in blood flow velocity, which reaches a nadir at term and increases after delivery. The rate of venous emptying as measured by light reflection rheography decreases with increasing gestation, but did not fall to a level consistent with venous occlusion by a deep venous thrombosis. CONCLUSIONS: Light reflection rheography has been shown to provide reliable results in pregnancy and the puerperium. Therefore, it is a potential tool for screening for deep venous thrombosis in this population.     

膜性肾病并发肾静脉血栓的彩色多普勒超声表现分析

目的探讨膜性肾病患者并发肾静脉血栓的彩色多普勒超声表现及其临床意义。方法膜性肾病27例,用二维超声和彩色多普勒超声观察肾脏的大小、形态、内部回声及肾静脉内是否有血栓。结果 27例中左肾主静脉血栓形成6例,段支1例,右肾主静脉血栓形成3例,段支1例,双肾主静脉血栓形成1例,本组27例膜性肾病患者并发肾静脉血栓的发生率为44%。结论彩色多普勒超声可作为诊断肾静脉血栓的首选方法。     

急性下肢深静脉血栓形成的多普勒超声诊断与手术对照

目的 :探讨常规超声和彩色多普勒超声 (CDFI)对急性下肢深静脉血栓形成 (DVT)诊断的价值。方法 :对 94例急性DVT病例进行了常规超声和CDFI检查并经手术证实。结果 :DVT声像表现为静脉内径增宽 ,腔内实质回声 ,按压静脉未变形 ,静脉瓣固定等 ,彩色多普勒可无血流信号或腔内充盈缺损确诊。本组病例均经手术证实 ,无一误诊。结论 :彩色多普勒与常规超声联合应用为诊断急性DVT的首选方法     

低机械指数灰阶超声造影诊断下肢深静脉血栓的价值

目的:对比分析应用低机械指数灰阶超声造影与彩色多普勒超声诊断下肢深静脉血栓(deep vein thrombosis,DVT)的价值。方法:分析30例临床拟诊为下肢DVT患者的临床及影像资料,以X线静脉造影或手术结果为金标准,对比分析彩色多普勒超声与实时灰阶超声造影与DSA或手术结果的一致性。结果:彩色多普勒超声与SonoVueTM低机械指数实时灰阶超声造影诊断下肢DVT的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为81.25%、55.00%、73.53%、81.25%、55.00%和93.75%、70.00%、86.76%、88.24%、82.35%;诊断小腿DVT的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为55.56%、55.00%、55.26%、52.63%、57.89%和83.33%、70.00%、76.32%、71.43%、82.35%;2种方法诊断大腿DVT的结果与金标准一致;超声造影微泡灌注到达时间、达峰时间和峰值强度健侧均小于患侧;对比剂微泡与股总静脉管壁间低回声厚度健侧小于患侧。结论:低机械指数实时灰阶超声造影与彩色多普勒超声均是诊断下肢DVT的良好方法;超声造影是超声诊断下肢DVT的一种补充手段,尤其是在常规超声显示困难的小腿DVT诊断中具有优势,值得进一步推广和应用。     

Colour Doppler ultrasound in deep venous thrombosis: a comparison with venography

Colour Doppler ultrasound is a new technical development allowing simultaneous grey scale imaging and a dynamic colour flow vascular image. To date, many real time ultrasonic studies have been assessed in the diagnosis of lower limb venous thrombosis and have been shown to be accurate in the femoral and popliteal segments. A double blind prospective study comparing colour Doppler with contrast venography in the diagnosis of lower limb thrombosis was performed in a group of 40 patients. Of the study group, 26 venograms were negative and 27 ultrasound examinations were negative. Of the 14 positive venograms there was one false negative colour doppler scan which missed a calf and lower popliteal thrombosis. Two cases of isolated calf vein thrombosis were successfully detected by colour Doppler. Overall, the sensitivity and specificity for detection of lower limb venous thrombosis, including calf vein assessment, were 93% and 100% respectively. Colour Doppler is easy to perform; the average scanning time being 15 minutes for complete assessment of a unilateral lower limb venous system. Spontaneous flow is evident in the femoropopliteal segment, whilst proximal calf vein flow can only be appreciated with the aid of distal compression. Eccentric thrombus and partially recanalized thrombus can be shown. Although the number of isolated calf vein thromboses was small, early experience suggests colour Doppler may be useful in the assessment of proximal calf vein patency.     

肺栓塞的CT诊断及与深静脉血栓形成临床类型的相关性研究

目的:通过22例患者的CT诊断,探讨肺栓塞的影像学特征和病变特点,以及下肢深静脉血栓形成临床类型与肺栓塞发生之间内在的相关性,总结其发病规律,为合理应用预防和治疗措施提供依据。方法:肺部检查应用多层螺旋CT机,采用轴位像扫描,扫描层面从肺尖至肺底,均行强化,了解肺栓塞发生部位及特点。应用彩色多普勒超声诊断仪检查患肢深部和浅部静脉,主要观察静脉腔内有无血流、管壁结构及血栓状况。统计下肢深静脉血栓形成患者临床发病类型。结果:双侧肺栓塞者17例,右侧肺栓塞者4例,左侧肺栓塞者1例。病变累及部位涵盖主肺动脉至亚段动脉等各级肺动脉,肺栓塞直接征象以充盈缺损和附壁血栓最多见,间接征象以肺纹理稀疏、胸腔积液和肺梗死病灶出现率最高。肢体静脉彩色超声检出静脉血栓病变部位58处,股腘静脉血栓病变发生率为70.69%。临床类型属中央型者4例,混合型者13例,周围型者5例。结论:下肢深静脉血栓形成混合型病变发展血栓蔓延,新鲜血栓松软不稳定且与静脉壁附着不紧密而极易脱落造成肺栓塞。病变部位静脉管腔不完全闭塞及溶栓治疗过程,对肺栓塞的发生有一定影响。     

彩色多普勒超声诊断下肢静脉疾病的临床价值——与DSA比较研究

目的 探讨彩色多普勒超声在下肢静脉疾病中的应用价值,并与DSA比较.方法 成用彩色多普勒超声仪对48例临床疑有下肢静脉疾病患者行二维彩色多普勒血流成像、脉冲多普勒及Valsalva试验等检查,并与DSA检查比较.结果 48例患者中有下肢深静脉血栓形成27例,其中15例合并下肢深静脉瓣膜功能不全,8例合并下肢浅静脉曲张,2例两者俱存,另有1例左侧腘窝囊肿合并腘静脉血栓,部分病例提示髂静脉流速减慢.单纯下肢静脉瓣膜功能不全5例,单纯下肢浅静脉曲张6例,6例两者俱存.4例超声检查正常,其中2例DSA提示有髂静脉受压.以DSA为诊断标准,诊断符合率为95.8%,两种方法行一致性检验,Kappa值为0.65.结论 彩色多普勒超声对下肢静脉疾病的临床诊断及疗效判断有重要的应用价值.     

经动脉序贯静脉置管溶栓治疗急性混合型下肢深静脉血栓26例的初步临床疗效观察

目的评价经动脉序贯静脉置管溶栓治疗急性混合型下肢深静脉血栓（lower extremity deep vein thrombosis,LEDVT）的安全性和有效性。 方法回顾性分析26例急性混合型LEDVT患者的临床资料。患者术前置入下腔静脉滤器,穿刺左侧肱动脉于患侧髂动脉置管溶栓,2～3 d后复查造影并穿刺患侧腘静脉行球囊扩张（percutaneous transluminal angioplasty,PTA）+手动抽栓（percutaneous mechanical thrombectomy,PMT）+置管溶栓（catheter directed thrombolysis,CDT）。观察血栓清除情况、患侧下肢周径变化情况及溶栓并发症等。 结果26例患者经动脉置管溶栓后24例（92.31%）腘静脉及膝下段深静脉血栓大部分溶解;之后行PTA+PMT+CDT操作1次者17例（65.39%）,操作2次者7例（26.92%）,操作3次后置入髂静脉支架者2例（7.69%）。血栓清除率Ⅲ级者22例（84.62%）,Ⅱ级者2例（7.69%）,I级者2例（7.69%）。治疗前膝上周径与健侧差值为（5.02±2.29）cm,治疗后差值为（0.74±0.18）cm,两者比较具有显著的统计学差异（t=7.601,P<0.001）。26例溶栓治疗无严重并发症。 结论经髂动脉置管溶栓序贯腘静脉PTA+PMT+CDT对于急性混合型LEDVT治疗安全有效。     

Scoring of extensive deep leg vein thrombosis displayed as wide-spread non-filling of contrast on phlebography. A comparison with colour doppler ultrasonography

PURPOSE: To evaluate whether wide-spread non-filling of contrast in vein segments, displayed on phlebography, is interpreted as deep venous thrombosis (DVT) on colour Doppler ultrasonography (CDU) and if the same score value is obtained. MATERIAL AND METHODS: Twenty consecutive patients were analysed by both phlebography and CDU with a scoring system. RESULTS: One hundred and fifty-one venous segments were initially analysed, but 19 (12.6%) were excluded because their entire extent could not be interpreted by CDU. The total score was 366 (mean 18.3) according to the phlebograms and 298 (mean 14.9) when interpreted by CDU, p=0.0001. The difference was due mainly to the scoring of the anterior tibial vein found to be open on CDU in most cases, and then the thrombotic burden percentage was 84% and 75%, respectively. In 19 of the 20 patients (95%) a DVT was confirmed by CDU. The great saphenous vein, the femoropopliteal vein, and the deep femoral vein, formed the main collateral circulation. CONCLUSION: Wide-spread non-filling of vein segments is due to an extensive DVT in the vast majority of cases. Scoring is possible by both phlebography and CDU and the difference in the results of the scoring is generally of minor importance.     

急性门静脉和肠系膜上静脉血栓形成的CT诊断

目的:分析急性门静脉及肠系膜上静脉血栓形成的临床及CT表现。方法:回顾性分析9例经手术及临床综合诊断证实的急性门静脉及肠系膜上静脉血栓形成病例的CT表现,9例均行CT平扫,3例行增强扫描。结果:9例CT平扫均显示门静脉或肠系膜上静脉增粗,7例见腔内高密度影,8例见腹腔积液,5例见小肠管壁增厚、水肿;3例强化扫描示静脉内低密度充盈缺损。结论:CT对诊断急性门静脉及肠系膜上静脉血栓形成具有重要意义;临床上对急性腹痛,不明原因腹水及可疑肠梗阻的病例,应注意观察其门脉系统情况。