应用放射性核素显像对下肢深静脉病变和肺血栓栓塞症的临床观察

目的　探讨下肢深静脉血栓形成与肺动脉血栓栓塞症之间的关系。方法　病例选择为1997年 9月～ 2 0 0 1年 5月临床诊断高度怀疑肺动脉血栓栓塞症患者 140例 (男 79例 ,女 6 1例 ) ,平均年龄为 39± 18岁。所有患者均行肺灌注、肺通气显像及下肢深静脉显像。其中 2 6例患者同时进行肺动脉造影 ,11例行X线下肢静脉造影检查 ,36例行下肢血管超声检查 ,18例行下肢容积血流阻抗图检查。结果　 140例肺血栓栓塞患者中有下肢静脉病变者为 12 0例 ,占 85 7%。近端病变 113例(80 0 % )。下肢深静脉显像与X线下肢静脉造影、下肢容积阻抗图及下肢血管超声检查符合率分别为 90 9% ,72 2 % ,80 0 %。结论　研究证实下肢静脉病变和血栓形成是肺动脉血栓栓塞症的主要致病因素 ,栓子主要来源于近端静脉血栓。放射性核素肺灌注 /肺通气、下肢静脉显像是诊断肺血栓栓塞症和下肢深静脉病变的有效方法。

Evaluation of the relationship between deep venous thrombosis and pulmonary embolism with radionuclide techniques

OBJECTIVE: The purpose of this study was to evaluate the relation between deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) by radionuclide imaging. METHODS: One hundred forty patients with PTE from September 1997 to March 2001 at this institution was confirmed by clinical manifestation, pulmonary perfusion (PPI)/ventilation scan (PPV) and deep venous radionuclide venography (RNV), which were performed in all patients. There were 79 males and 61 females, with an average age of 39 +/- 18 years. Twenty-six cases underwent pulmonary angiography; 11 underwent X Ray venography of lower extremities (XRV); 18 underwent impedence plethymography (IPG); and 36 underwent lower limb echocardiography (UCG). RESULTS: Of the 140 patients with PTE, 120 (85.7%) had lower limb venous pathological changes. Among them, 94 patients had risk factors for DVT. The agreement rates of RNV with XRV, UCG and IPG were 90.9%, 72.2% and 80.0%, respectively. CONCLUSIONS: The results indicated that DVT was highly prevalent in patients with acute pulmonary embolism. Thrombosis was a primary pathogenic factor for PTE, and thrombi were mostly from proximal veins. (99m)TC-MAA radionuclide imaging was a useful method for noninvasive detection of DVT and PTE.