彩色多普勒超声与静脉造影诊断下肢深静脉血栓的比较研究

发布时间：2018-07-03 10:26

本文选题：彩色多普勒超声 + 静脉造影　；参考：《河北医科大学》2014年硕士论文

【摘要】：目的：比较彩色多普勒超声(Color Doppler ultrasound)与静脉造影（Venography）对诊断下肢深静脉血栓（Deep vein thrombosis DVT）的差异，并以静脉造影作为标准来计算超声检查的特异性和敏感性,同时对比超声对下肢各段深静脉血栓诊断的差别。方法：选取2012年至2013年于我院住院的36名临床怀疑有下肢深静脉血栓形成的患者。应用彩色多普勒超声依次探查双侧下肢股总静脉、股浅静脉、股深静脉、乆静脉、胫后静脉、胫前静脉、腓静脉以及比目鱼肌、腓肠肌间的静脉，检查这些静脉是否有血栓形成。并同时于彩色多普勒超声检查的6小时内,对怀疑有血栓的患侧行静脉造影检查。本组患者中，男性23例，女性13例，平均年龄63岁，以静脉造影作为诊断金标准，应用软件SPSS13.0做配对四格表卡方检验，比较彩色多普勒超声与静脉造影诊断下肢深静脉血栓的区别，P0.05,认为有统计学意义。先以下肢整体的深静脉作为研究对象，并分别计算超声诊断下肢深静脉血栓的敏感性和特异性；随后再以股静脉、乆静脉、胫后静脉、胫前静脉、腓静脉、肌间静脉分别作为研究对象，用相同的方法判断超声与静脉造影对血栓诊断的差别及超声检查的敏感性及特异性。结果：本组36名患者中，超声检查31例有下肢深静脉血栓，5例超声检查为阴性；造影检查有30例患者有血栓，6例无血栓。以静脉造影作为诊断金标准，经配对四格表卡方检验，P0.05，认为超声与造影对诊断下肢深静脉血栓无明显统计学差异。超声诊断下肢深静脉血栓的敏感性为0.933,特异性为0.778，准确率为0.861。将36名患者的下肢各段血管作为研究对象，分别对其进行配对四格表卡方检验，结果显示：胫前静脉的配对四格表卡方检验的P0.05，，认为超声与造影对诊断胫前静脉存在统计学差异；其余各段静脉血管计算的P0.05，认为超声与造影的诊断无统计学上的差异。以静脉造影作为诊断标准，超声对股静脉、乆静脉、胫后静脉、胫前静脉、腓静脉、肌间静脉诊断的敏感性依次为：0.889、0.417、0.778、0.167、0.85、1，计算其特异性分别为1、0.833、0.778、1、0.813、0.909，其准确率分别为0.972、0.694、0.778、0.722、0.833、0.944。本组有6例患者造影显示胫前静脉与胫后静脉的汇合点较低，位于乆窝下缘，超声误将乆静脉诊断为胫后静脉，降低了对乆静脉诊断的敏感性，另有3例患者胫前静脉与胫后静脉的汇合处较高，位于乆窝上缘，超声误将胫前或胫后静脉误诊断为乆静脉，减低了其特异性。结论：彩色多普勒超声与静脉造影对诊断下肢深静脉血栓无明显差别，可将其作为诊断下肢DVT的首选检查方法。由于存在解剖变异超声检查乆静脉段的血栓可能出现假阴性或假阳性。对于胫前静脉血栓的诊断，超声与造影存在明显统计学差异。
[Abstract]:Objective: to compare the difference between color Doppler ultrasound and venography in the diagnosis of deep vein thrombosis DVT of lower extremity, and to calculate the specificity and sensitivity of ultrasound by using venography as the standard. At the same time, the difference of ultrasound in diagnosis of deep venous thrombosis in lower extremities was compared. Methods: from 2012 to 2013, 36 patients with suspected deep venous thrombosis of lower extremity were enrolled in our hospital. The common femoral vein, superficial femoral vein, deep femoral vein, body vein, posterior tibial vein, anterior tibial vein, peroneal vein and the veins between soleus and gastrocnemius were detected by color Doppler ultrasound. Check for thrombosis in these veins. At the same time, venous angiography was performed on the affected side of suspected thrombus within 6 hours of color Doppler ultrasonography. There were 23 males and 13 females with an average age of 63 years. Intravenous angiography was used as the diagnostic gold standard, and the software SPSS 13.0 was used for paired four-grid table-chi-square test. The difference between color Doppler ultrasonography and venography in the diagnosis of deep venous thrombosis in lower extremities was compared (P 0.05). The sensitivity and specificity of ultrasound in the diagnosis of deep vein thrombosis of lower extremity were calculated, and then the femoral vein, the posterior tibial vein, the anterior tibial vein, the peroneal vein, the femoral vein, the posterior tibial vein, the anterior tibial vein, the peroneal vein, The intramuscular vein was used as the object of study. The difference between ultrasound and venography in the diagnosis of thrombus and the sensitivity and specificity of ultrasound examination were determined by the same method. Results: among the 36 patients, 31 cases had deep venous thrombosis in lower extremity, 5 cases were negative, and 30 cases had thrombus and 6 cases had no thrombus. Using venography as the diagnostic gold standard and paired four square chi-square test (P0.05), it was concluded that there was no significant difference in the diagnosis of deep venous thrombosis in lower extremities between contrast-enhanced ultrasound and contrast-enhanced angiography. The sensitivity, specificity and accuracy of ultrasound in diagnosing deep venous thrombosis of lower extremity were 0.933, 0.778 and 0.861 respectively. The blood vessels of the lower extremities of 36 patients were examined by paired four-grid chi-square test. The results showed that there was a statistical difference between contrast-enhanced ultrasound and angiography in the diagnosis of anterior tibial vein, and that there was no statistical difference in the diagnosis between contrast-enhanced ultrasound and angiography. The diagnostic sensitivity of ultrasound to femoral vein, posterior tibial vein, anterior tibial vein, peroneal vein and intermuscular vein was 0.889- 0.4170.7780.1670.1670.851, respectively. The specificity of ultrasound was calculated to be 1 / 0.833 / 0.77810.8130.909, and the accuracy was 0.9720.694 / 0.7780.778/ 0.830.944, respectively. In 6 patients, the confluence of anterior tibial vein and posterior tibial vein was relatively low, located at the lower margin of the fossa. Ultrasound mistakenly diagnosed the vein as the posterior tibial vein, which reduced the sensitivity of the diagnosis of the vein. In the other 3 patients, the confluence of anterior tibial vein and posterior tibial vein was relatively high, which was located at the superior margin of the fossa. The ultrasound mistakenly diagnosed the anterior tibial vein or posterior tibial vein as the femoral vein, which reduced the specificity of the vein. Conclusion: there is no significant difference between color Doppler ultrasound and venography in the diagnosis of deep venous thrombosis of lower extremity. Because of the presence of anatomic variation ultrasound examination of venous thrombosis may be false negative or false positive. For the diagnosis of anterior tibial vein thrombosis, there was significant difference between contrast-enhanced ultrasound and angiography.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R543.6

【引证文献】