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

The relationship between spiral computer tomography angiography (SCTA) in the diagnosis of pulmonary embolism (PE) and deep venous thrombosis of the lower extremity

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。

Objective：To explore the relationship between pulmonary embolism （PE） in the SCTA and different type of deep venous thrombosis of the lower extremity for prevention and treatment. Methods： Twenty-two cases were examined with enhanced CT using a 16-slice CT, vein of the lower extremity was examined with color Doppler flow imaging （CDFI）. Results： Seventeen cases were found embolism in the trunk of bilateral pulmonary artery, 4 cases in right, 1 case in left. The lesions involved pulmonary arteries and branches in all cases. The typical findings in CT image were partial filling defect and completely filling defect; secondary signs were decreasing of pulmonary markings, pleural effusion and pulmonary infarction. Fifty-eight lesions of venous thrombosis were examined with CDFI in 22 cases, 4 were central type, 5 were peripheral type and 13 were mixed typy. Conclusion： Thrombosis in the mixed type is tend to propagate, and the thrombosis is fresh and un-firmly adherent to the vein wall ,so is easily chipped off and resuiting in PE. The thrombolytic therapy and partial obstructive veins may be associated with PE.