超声引导下注射凝血酶治疗医源性假性动脉瘤  

Ultrasound-guided thrombin injection for treatment of iatrogenic femoral pseudoaneurysm

作　　者：江沛[1] 史树贵[1] 王益[1] 卢龙[1] 李光建[1] 郭燕丽[2] 陈康宁[1] 周振华[1] 

机构地区：[1]第三军医大学西南医院神经内科,重庆400038 [2]第三军医大学西南医院超声诊断科,重庆400038

出　　处：《局解手术学杂志》2016年第5期342-346,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：第三军医大学西南医院临床科研专项(SWH2014LC15)

摘　　要：目的探讨超声引导下注射凝血酶（FPA）治疗医源性假性动脉瘤的最佳部位和疗效。方法收集我院神经内科2010年1月至2015年6月32例发生医源性假性动脉瘤患者的临床资料,回顾性分析患者发生动脉瘤后压迫治疗效果、注射凝血酶的部位、方法、剂量和治疗效果。结果 2010年1月至2015年6月共进行脑血管病介入诊治手术3 573例,出现股动脉穿刺部位假性动脉瘤43例,占1.20%,经常规压迫伴加压包扎后11例好转,32例无效;对无效的32例进行了超声引导下选择远离瘤腔破口血流方向的部位进行凝血酶注射,剂量为（30±12）IU,注射后1 min内瘤腔消失,未发生远端栓塞事件。随访5~70个月,平均（38.69±20.79）个月,无再发及并发症发生。结论对常规压迫伴加压包扎无效的医源性假性动脉瘤,在超声定位下采用远离瘤腔破口血流方向的部位进行凝血酶注射,使动脉瘤填塞的成功率高,使用凝血酶剂量少,且并发症发生率低。Objective To investigate the best injection position and curative effect of ultrasound-guided thrombin injection（ UGTI） on femoral pseudoaneurysm（ FPA）. Methods Review the data of FPA cases in the neurology department of southwest hospital from January2010 to June 2015. Detailed clinical information of the patients,including the curative effect of local compression therapy,the position,method,dosage and curative effect of ultrasound-guided thrombin injection were collected and analyzed. Results From January 2010 to June2015,43 cases（ 1. 20%） of FPA were diagnosed in 3573 patients undergoing cerebrovascular interventional operation. Local compression therapy was effective in 11 of 43 FPA patients. The remaining 32 patients who had no response to local compression therapy were treated by UGTI,and the average dosage of thrombin was（30 ± 12） IU. All FPA were blocked successfully within 1 minute and without any distal embolism events after the first UGTI attempt. No relapse and complications occurred during the follow-up of 5 to 70 months,averagely（38. 69 ±20. 79） months. Conclusion UGTI is effective for treatment of FPA who had no response to local compression therapy. Thrombin injection at position far away from the blood flow direction of pseudoaneurysm neck crevasse with ultrasound-guided could bring about highe success rate,less amount of thrombin,and less complications.

关 键 词：股动脉假性动脉瘤 超声检查 凝血酶注射 血流动力学 注射部位 

分 类 号：R543.5[医药卫生—心血管疾病]