下肢深部静脈血栓症の診断法の検討—血管超音波検査法を中心として

Study of Diagnostic Methods for Deep Vein Thrombosis in the Legs:With special reference to vascular ultrasonography

　下肢深部静脈血栓症（DVT）での血管超音波検査法（VU）の診断能を検証し，診断過程におけるVUの役割を検討した．下肢の腫脹を有し，VUと下肢静脈造影（VG）を行った31例42肢を対象とした．VUでは，①静脈内部エコーの存在，②探触子による圧迫で静脈が潰れないこと，③呼吸性および下肢の用手圧迫による流速変動の消失，を陽性基準とし，その正診率を検討した．また，検査前の臨床像をスコア化し，3群（DVTの可能性が高い群：H群，中等度の群：M群，低い群：L群）に分類して，各群でのDVTの割合を比較した．VGでDVTと診断されたのは22肢で，VUの特異度は95％（19／20），感度は95％（21／22）であった．検査前の臨床像分類ごとのDVT患者の割合はH群が92％，M群が58％，L群が22％であった．DVTの診断にVUは有用であり，さらに臨床像評価法を組み合わせることで，非侵襲的かつ的確な診断と迅速な治療が可能になると考えられた．

We confirmed the diagnostic capacity of vascular ultrasonography (VU) in deep vein thrombosis (DVT) of the legs and studied the role of VU in the diagnostic process. The subjects were 42 legs with swelling of the legs in 31 patients who underwent VU and ascending venography (VG) of the legs. In VU, the positive criter-ia were (1) the presence of intravenous echoes,(2) no crushing of the veins by compression with the probe, and (3) disappearance of flow rate changes due to respira-tion and manual pressure on the legs. The rate of correct diagnosis was studied. The clinical features before the examination were scored, and the subjects were divided into three groups (group H with a high possibility of DVT, group M with a moderate possibility, and group L with a low possibility).

The following results were obtained: 1) DVT was diagnosed by VG in 22 legs. The specificity of VU was 95% (19/20) and the sensitivity was 95% (21/22).

2) The percentage of DVT patients in the clinical feature classification before the examination was 92% in group H, 58% in group M and 22% in group L.

It was concluded that VU was useful in the diagnosis of DVT, and by combining VU with the clinical feature evaluation method. non-invasive and accurate diagnosis and rapid treatment should be possible.