摘要目的 分析经尸体解剖诊断肺栓塞患者的栓子来源.方法 回顾性分析北京医院1962至2012年经尸体解剖确诊的43例肺栓塞患者的病理及临床资料,其中男42例,女1例,年龄65 ～101岁,平均(80±12)岁.结果 尸体解剖确诊肺栓塞患者栓子最常见来源于下肢深静脉14例(14/43);其次为肾静脉和前列腺静脉窦各4例(4/43),再次为前列腺周围静脉丛、肝静脉和膀胱黏膜下静脉各3例(3/43),其他来源包括右心房(心耳)、门静脉、胰腺周围静脉、前列腺、心脏和食管静脉各2例(2/43),右髂总静脉和右上肢肱静脉各1例(1/43);最终未发现栓子来源2例(2/43);非下肢深静脉血栓来源占60％(26/43).本组患者生前仅4例拟诊肺栓塞并发现下肢深静脉血栓.结论 经病理证实肺栓塞患者的血栓栓子来源广泛,除下肢深静脉外,半数以上来源于肾静脉、前列腺及前列腺周围静脉、肝静脉等腹、盆腔静脉及心内和上肢深静脉.当患者发生急性肺栓塞时,除下肢深静脉以外,尚需积极探查腹、盆腔静脉、上肢和右心,寻找可能的栓子来源,为个体化诊治提供帮助.

abstractsObjective To study the sources of emboli in patients with pulmonary embolism diagnosed by autopsy,and therefore to provide help in the diagnosis and treatment of thromboembolism.Methods We retrospectively analyzed the pathology and clinical data of 43 patients with pulmonary embolism diagnosed by autopsy from 1962 to 2012 in Beijing Hospital.Results In patients with pulmonary embolism diagnosed by autopsy,32.6％ of the emboli came from deep veins of the lower extremities,9.3％ from the renal vein,9.3％ from the prostate sinus,7.0％ from the venous plexus around the prostate,7.0％ from the hepatic vein and 7.0％ from the submucosal vein of the bladder.Other sources included the right atrium 4.7％,portal vein 4.7％,pancreatic peripheral vein 4.7％,prostate,heart,esophageal vein 4.7％,right common iliac vein 2.3％,right upper limb brachial vein 2.3％.No source of emboli was found in 4.7％ patients with pulmonary embolism.Non-lower extremity deep vein emboli accounted for 60.5％.Only 9.3％ of the cases were diagnosed with pulmonary embolism with deep vein thrombosis before death.Conclusion There was a wide range of sources of emboli in patients with pathologically proven pulmonary embolism.Although the deep veins of lower extremities are the most common,more than 60％ of the emboli came from the renal vein,prostate vein,hepatic vein and other abdominal or pelvic veins,the heart,and the upper extremity deep veins.In addition to the lower extremity deep veins,other sources of emboli should be actively examined when the patient was diagnosed with acute pulmonary embolism.