本文選題：彩色多普勒超聲 + 靜脈造影　； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：比較彩色多普勒超聲(Color Doppler ultrasound)與靜脈造影（Venography）對(duì)診斷下肢深靜脈血栓（Deep vein thrombosis DVT）的差異，并以靜脈造影作為標(biāo)準(zhǔn)來計(jì)算超聲檢查的特異性和敏感性,同時(shí)對(duì)比超聲對(duì)下肢各段深靜脈血栓診斷的差別。 方法：選取2012年至2013年于我院住院的36名臨床懷疑有下肢深靜脈血栓形成的患者。應(yīng)用彩色多普勒超聲依次探查雙側(cè)下肢股總靜脈、股淺靜脈、股深靜脈、乆靜脈、脛后靜脈、脛前靜脈、腓靜脈以及比目魚肌、腓腸肌間的靜脈，檢查這些靜脈是否有血栓形成。并同時(shí)于彩色多普勒超聲檢查的6小時(shí)內(nèi),對(duì)懷疑有血栓的患側(cè)行靜脈造影檢查。本組患者中，男性23例，女性13例，平均年齡63歲，以靜脈造影作為診斷金標(biāo)準(zhǔn)，應(yīng)用軟件SPSS13.0做配對(duì)四格表卡方檢驗(yàn)，比較彩色多普勒超聲與靜脈造影診斷下肢深靜脈血栓的區(qū)別，P0.05,認(rèn)為有統(tǒng)計(jì)學(xué)意義。先以下肢整體的深靜脈作為研究對(duì)象，并分別計(jì)算超聲診斷下肢深靜脈血栓的敏感性和特異性；隨后再以股靜脈、乆靜脈、脛后靜脈、脛前靜脈、腓靜脈、肌間靜脈分別作為研究對(duì)象，用相同的方法判斷超聲與靜脈造影對(duì)血栓診斷的差別及超聲檢查的敏感性及特異性。結(jié)果：本組36名患者中，超聲檢查31例有下肢深靜脈血栓，5例超聲檢查為陰性；造影檢查有30例患者有血栓，6例無血栓。以靜脈造影作為診斷金標(biāo)準(zhǔn)，經(jīng)配對(duì)四格表卡方檢驗(yàn)，P0.05，認(rèn)為超聲與造影對(duì)診斷下肢深靜脈血栓無明顯統(tǒng)計(jì)學(xué)差異。超聲診斷下肢深靜脈血栓的敏感性為0.933,特異性為0.778，準(zhǔn)確率為0.861。 將36名患者的下肢各段血管作為研究對(duì)象，分別對(duì)其進(jìn)行配對(duì)四格表卡方檢驗(yàn)，結(jié)果顯示：脛前靜脈的配對(duì)四格表卡方檢驗(yàn)的P0.05，，認(rèn)為超聲與造影對(duì)診斷脛前靜脈存在統(tǒng)計(jì)學(xué)差異；其余各段靜脈血管計(jì)算的P0.05，認(rèn)為超聲與造影的診斷無統(tǒng)計(jì)學(xué)上的差異。以靜脈造影作為診斷標(biāo)準(zhǔn)，超聲對(duì)股靜脈、乆靜脈、脛后靜脈、脛前靜脈、腓靜脈、肌間靜脈診斷的敏感性依次為：0.889、0.417、0.778、0.167、0.85、1，計(jì)算其特異性分別為1、0.833、0.778、1、0.813、0.909，其準(zhǔn)確率分別為0.972、0.694、0.778、0.722、0.833、0.944。本組有6例患者造影顯示脛前靜脈與脛后靜脈的匯合點(diǎn)較低，位于乆窩下緣，超聲誤將乆靜脈診斷為脛后靜脈，降低了對(duì)乆靜脈診斷的敏感性，另有3例患者脛前靜脈與脛后靜脈的匯合處較高，位于乆窩上緣，超聲誤將脛前或脛后靜脈誤診斷為乆靜脈，減低了其特異性。 結(jié)論：彩色多普勒超聲與靜脈造影對(duì)診斷下肢深靜脈血栓無明顯差別，可將其作為診斷下肢DVT的首選檢查方法。由于存在解剖變異超聲檢查乆靜脈段的血栓可能出現(xiàn)假陰性或假陽(yáng)性。對(duì)于脛前靜脈血栓的診斷，超聲與造影存在明顯統(tǒng)計(jì)學(xué)差異。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R543.6

【引證文獻(xiàn)】

相關(guān)期刊論文 前5條

1 張杰;;彩色多普勒超聲診斷下肢深靜脈血栓的臨床價(jià)值分析[J];中國(guó)醫(yī)藥指南;2015年07期

2 金瀟雅;;下肢深靜脈血栓的超聲診斷價(jià)值[J];世界最新醫(yī)學(xué)信息文摘;2015年81期

3 張妍慧;龍坤嶺;陳麗香;;彩色多普勒超聲在下肢深靜脈血栓分型的臨床應(yīng)用價(jià)值[J];世界最新醫(yī)學(xué)信息文摘;2015年A1期

4 黎玲;洪瓊;;彩色多普勒超聲在婦科腫瘤術(shù)后患者下肢深靜脈血栓診斷中的價(jià)值[J];長(zhǎng)江大學(xué)學(xué)報(bào)(自科版);2016年30期

5 劉輝;胡建平;;彩色多普勒超聲在下肢深靜脈血栓診斷中的應(yīng)用價(jià)值[J];中國(guó)社區(qū)醫(yī)師;2017年16期

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