髂静脉不完全阻塞的彩色多普勒超声诊断及漏诊原因分析

目的 探讨彩色多普勒超声诊断髂静脉（髂总或髂外静脉）不完全阻塞的声像图特征及漏诊原因。方法 采用彩色多普勒超声对109例112条髂静脉不完全阻塞患者的盆腔组织、髂静脉及整个下肢静脉行二维、彩色多普勒及脉冲多普勒扫查，观察血管结构、彩色血流充盈情况、血流速度及频谱形态，其结果与CT、MRI或静脉顺行X线造影检查进行对比分析。结果 112条髂静脉不完全阻塞患肢中第1次彩色多普勒检查准确提示仅70条，漏诊42条。对漏诊病例进行第2次超声复查后作出髂静脉不完全阻塞诊断。髂静脉不完全阻塞的声像图特征主要有血管不容易压瘪、彩色血流束呈充盈缺损或变窄、下肢深静脉血流缓慢及血流频谱呈持续流动的平直带状。漏诊原因是对下肢静脉探查不全，对提示髂静脉狭窄的股静脉或胭静脉血流缓慢、频谱形态平直等征象认识不足。结论 进一步认识髂静脉不完全阻塞的一系列声像图表现，可以提高彩色多普勒超声诊断髂静脉不全阻塞的准确性及减少漏诊。

Analysis of color Dopplor flow imaging diagnosis and missed diagnosis of iliac vein incomplete obstruction

Objective In order to raise CDFI accuracy for diagnosing iliac vein incomplete obstruction, the sonogram features and the reasons of missed diagnosis were analysed. Methods Two-dimensional ultrasound, CDFI and pulsed wave Doppler were performed in 109 patients with 112 iliac incomplete obstruction. The pelvic cavity tissues, iliac and lower limb veins were scanned to observe the blood vascular structures and color blood flow spectra and to measure the flow velocity parameters. The results were contrasted and analysed with CT, MRI or antegrade phlebography examination. Results Among the 112 iliac veins, 70 were detected accurately on the first CDFI with the accurate rate of 63% (70/112) . Fourty-two cases who were missed diagnosed at the first time were diagnosed correctly at the second examination. The sonographic features of the disease were mainly as follow :(1) The vein was not easy to be collapsed; (2) The color blood flow showed filling defect or narrowed; (3) The deep limp venous flow was slow with flat and straight spectral shape. The main reasons of the missed diagnosed were the incomplete exploration of lower limb veins and insufficient realization about the signs of the flow in narrow veins. Conclusions The diagnostic accuracy of CDFI can be improved and the missed diagnosis can be decreased through further realization about the series of sonogram characteristics of iliac vein incomplete obstruction.