【作者】 李加平；

【导师】 李智贤；

【作者基本信息】 广西医科大学 ， 超声诊断学， 2003， 硕士

【摘要】 目的：探讨超声诊断下肢深静脉血栓的临床价值。方法：应用超声波检查法观察下肢深静脉血栓（DVT）不同时期的声像图及血流动力学变化特点，观察对象为61例66条拟诊为急性下肢深静脉血栓的患者。用二维超声（2DUS）观察股总静脉、股浅静脉、腘静脉、胫后静脉、大隐静脉、小隐静脉的管径、管壁回声、管腔内回声及血栓形成的范围；彩色多普勒血流显像（CDFI）和脉冲多普勒（PW）观察其血流动力学改变。还分别于发病2～5周内、半年后定期对患者进行检测，并辅以探头加压试验、Valsalva试验及挤压肢体远端试验。结果：61例急性DVT中56例单侧患者初诊时血管管径患侧较健侧明显增宽（P<0.01），血栓呈低回声，完全阻塞者管腔内未见彩色血流显示；不完全阻塞者管腔内可见彩色充盈缺损，脉冲多普勒于不完全阻塞处探及连续性低速血流频谱，随呼吸而变化较弱或不随呼吸而变化。治疗5周后复查：血栓回声稍强，患肢管腔较初诊时稍变小，但两者比较无统计学意义（P>0.05）；血栓部分出现再通，于血栓再通处可显示不规则狭窄或细小多枝状彩色血流信号，血流边缘不整齐，未见明显侧枝循环形成。半年后复查：血栓回声增强，患肢管径较初诊时明显变细（P<0.01），血管壁局限性或弥漫性增厚，再通者可见彩色血流信号显示，频谱呈低速连续性，血流通畅改善良好者，频谱可随呼吸而变化；患肢血流速较健肢低（P<0.01），此外伴有不同程度侧枝循环形成和继发性静脉瓣功能不全。 <WP=4>结论：血栓的不同时期声像图及血流动力学具有不同的特点，据此可判断血栓的病程，对临床疗效进行评估，进一步了解血栓后遗症，具有十分重要的意义。更多还原

【Abstract】 Objective: To evaluate the clinical significance of ultrasound diagnosis in deep venous thrombosis of lower extremities .Methods: To observe ultrasonic images and hemodynamic changes at each different stage of DVT by ultrasound .Sixty-one patients suspected as acute deep venous thrombosis were examined by ultrasound. 2DUS was used to detect the venous diameter, echoes, and thromboplastic scopes. CDFI and PW were used to detect blood flow, spectrum pattern, blood velocity and venous valvular function .All these cases were followed up after five weeks and half of a year . CFV, SFV, POV, etc were assessed by pressure detector examination ,Valsalva test and the action of pressing leg terminal.Results: In the first consulting test sixty-one patients suffered vascular diameter became wider than the normal side clearly(P<0.01) .There were no color blood flow sign in vascular cavity being all blocked.In vascular cavity being partly blocked ,there was pulsing Doppler detecting successive blood flow spectrum with low velocity at the segment being thrombosis partly, which changed little according to respiration or not. After five weeks treatment, the thrombosic <WP=5>echoes were enhanced and the suffered vascular diameter became smaller but not obvious (P>0.05). There was partly recanalization of some thrombi and there were abnormal strip branchful color blood flow signs at recanalization point , the blood flow margin was not tidy ,and there was no apprecibly developed collateral circulation. After six months: The thrombosic echoes were more enhanced, the suffered vascular cavity became smaller obviously than normal (p<0.01).There was locally or dispreadingly thicked at which parts.There were color blood flow signs in recanalizating venous and the spectrums were low velocity and consecutive.In the wholly recanalizating venous the spectrum could change according to following respiration, but the blood flow velocity of suffered venous was lower than the control side(P<0.05),and there were developed collateral circulation and venous valvular reflux at some degree.Conclusion:There were characteristic ultrasonic images and hemodynamic changes at each different stage of DVT. By means of them we can recognize the course of clinical treament and know the thrombosis sequela. This is of very important clinical significance.更多还原