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疑似下肢深静脉血栓形成的诊断

Author
Brydon JB Grant, MD
Section Editors
Lawrence LK Leung, MD
Jess Mandel, MD
Deputy Editor
Geraldine Finlay, MD

引言

深静脉血栓形成(deep vein thrombosis, DVT)和急性肺栓塞(pulmonary embolism, PE)是同一疾病—静脉血栓栓塞症(venous thromboembolism, VTE)的两种表现。下肢DVT分为两类(图 1)：

  • 远端(小腿)静脉血栓形成，血栓保持局限在小腿深静脉或小腿肌间静脉，以及
  • 近端静脉血栓形成，其血栓累及腘静脉、股静脉或髂静脉。

这一概念得到下述事实的支持，即超过90%的急性肺栓塞病例是由于来自下肢近端静脉的栓子所致[1,2]。此外，抗凝治疗对这两种情况均非常有效。因而，旨在诊断DVT的试验对急性肺栓塞的诊断也具有重要意义。

可用于证实疑似下肢DVT是否存在的试验，以及对无创性检查在诊断急性成人肺栓塞中的作用的概述，将总结在此[3]。静脉血栓形成患者的评估(着重强调高凝状态筛查的指征和筛查方法)、DVT的预防以及儿童DVT的相关问题将单独讨论。 (参见“对确诊为静脉血栓栓塞的患者进行针对获得性和遗传性危险因素的评估”和“外科患者静脉血栓栓塞性疾病的预防”和“婴儿和儿童静脉血栓形成和血栓栓塞的发病机制和临床表现”和“婴儿和儿童静脉血栓形成和血栓栓塞的诊断和治疗”)

鉴别诊断

当处理疑似下肢DVT患者时，意识到仅有少数患者(在两项大型病例系列研究中分别为17%和32%)确实存在该疾病是很重要的[4,5]。该低比例表明了使用无创性检查以将进行不适当的抗凝治疗的可能性减到最低限度的重要性[6]。

                                  

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-24.
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