下肢静脈瘤を伴う患者における術前深部静脈超音波検査の意義

Clinical relevance of ultrasonographic examination for deep venous thrombus in urological patients with varicose veins of the legs

　間欠的空気圧迫法は，既存の深部静脈血栓（deep vein thrombosis：DVT）を有する患者には使用できないため術前に血栓の有無を知る必要があるが，適切なスクリーニング方法は定まっていない。下肢静脈瘤の存在は既存のDVTの予測因子になるのではないかと考え，下肢静脈瘤のある78例に対し，手術前に下肢静脈エコーを行った。のべ85回の検査において，DVTが検出されたのは1例（1回）のみであった（1.2％）。この頻度は一般住民におけるDVT有病率と大差なく，下肢静脈瘤の存在が下肢静脈エコーを推奨する理由にはならなかった。

　Intermittent pneumatic compression of legs is one of the methods to prevent deep vein thrombosis（DVT）and pulmonary emboli. However,its application in the perioperative period is contraindicated when DVT has already developed. In this context,appropriate screening methods should be established. On the hypothesis that varicose veins of the legs could be a factor to predict the presence of DVT,a total of 85 ultrasonographic examinations of deep veins in the legs were performed for 78 patients having varicose veins of the legs before urological surgery. Only 1 patient（1.2％）showed DVT upon ultrasonic examination. Since the detection rate was comparable to the prevalence of DVT in the general population previously reported,there is no strong reason to recommend ultrasonographic examination for patients having varicose veins of the leg.