術後無症候性深部静脈血栓症の発生頻度および肺塞栓症との関係

Relationship Between Asymptomatic Deep Vein Thrombosis and Pulmonary Embolism

　下肢，骨盤手術症例の術前と術後に超音波法を用いて検査し，患者の同意を得て手術側に静脈造影を行った131例について，近位型深部静脈血栓症（DVT）の有無と発生部位，臨床症状との関係，血管の閉塞程度と臨床症状の関係および肺塞栓症（PE）との関係を調べた．症候性DVTと無症候性DVTの発生頻度は42％と21％であった．完全閉塞型による症候性と無症候性DVTが76.2％と29.4％，部分閉塞型による症候性と無症候性DVTが23.8％と70.6％であった．症候性と無症候性DVTによるPEの発生頻度は23.8％と23.5％であった．術後無症候性DVTの早期診断が重症PEの予防に重要であると思われた．

　We examined 131 patients (only on the operated side) before and after pelvic and lower extremity surgery to demonstrate the relationship between deep vein thrombosis (DVT), with or without clinical manifestations, and pulmonary embolism (PE). DVT was investigated by ultrasonography and venography in all patients, and PE was investigated by pulmonary angiography, ventilation perfusion scintigraphy, or helical CT in all DVT patients. The results showed that the incidence of symptomatic DVT was 42% (21/50 patients), and higher than the 21% (17/81 patients) incidence of asymptomatic DVT. The incidence symptomatic DVT in the patients with complete occlusion of proximal veins was 76.2% (16/21 patients), and the incidence of asymptomatic DVT in the patients with partial occlusion was 70.6% (12/17 patients). The incidence of PE in patients with symptomatic DVT was 23.8% (5/21 patients), and it was 23.5% (4/17 patients) in the patients with asymptomatic DVT. It is very important to detect asymptomatic DVT in the early postoperative period.