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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。
Objective To investigate the relationship between deep venous thrombosis of lower extremities and pulmonary thromboembolism. Methods From September 1997 to May 2001, 140 cases (79 males and 61 females) with high suspicion of pulmonary thromboembolism were clinically diagnosed. The mean age was 39 ± 18 years old. All patients underwent lung perfusion, pulmonary ventilation imaging and deep venous imaging. Twenty-six patients underwent simultaneous pulmonary angiography, 11 underwent X-ray venography, 36 underwent lower extremity vascular ultrasound examination and 18 underwent lower extremity flow impedance imaging. Results Of 140 pulmonary thromboembolism patients with lower extremity venous lesions were 120 cases, accounting for 85.7%. 113 cases of proximal lesions (80 0%). The coincidence rates of deep vein imaging of lower extremity and venous angiography of lower extremity, volumetric impedance of lower extremity and ultrasonography of lower extremity were 90 9%, 72 2% and 80 0% respectively. Conclusions The study confirmed that venous lesions and thrombosis of the lower extremities are the main causative factors of pulmonary thromboembolism. The embolus mainly comes from proximal venous thrombosis. Radionuclide lung perfusion / pulmonary ventilation, venous lower extremity imaging is an effective method of diagnosis of pulmonary thromboembolism and lower extremity deep vein lesions.