濒临破裂腹主动脉瘤诊断中彩色多普勒超声的价值分析  

The value of color doppler ultrasonography in the diagnosis of impending ruptured abdominal aortic aneurysm

作　　者：王慧[1] 陈章颖[1] 李梓伦[1] 王冕[1] 崔进[1] 于楠 黄雪玲[1] 常光其[1] 王深明[1] Wang Hui;Chen Zhangying;Li Zilun;Wang Mian;Cui Jin;Yu Nan;Huang Xueling;Chang Guangqi;Wang Shenming(Department of Vascular Surgery,the First Affiliated Hospital of Sun Yat-sen University,National-Local Joint Engineering Laboratory of Vascular Disease Treatment,Guangdong Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院血管外科,血管疾病诊治技术国家地方联合工程实验室,广东省血管疾病诊治工程技术研究中心,广州510080

出　　处：《中华医学杂志》2020年第32期2507-2510,共4页National Medical Journal of China

摘　　要：目的探讨彩色多普勒超声(CDU)在濒临破裂腹主动脉瘤(IRAAA)临床诊断中的价值。方法回顾性分析2014年6月至2019年6月在中山大学附属第一医院血管外科收治并经CDU诊断提示IRAAA患者35例。所有患者均同时行CT血管造影(CTA)检查。对瘤体分型、瘤颈长度、最大径、附壁血栓、髂总动脉有无受累以及濒临破裂情况分析。利用CDU及CTA对术后患者进行1~12个月随访检查,评估手术效果(平均随访时间为2.6个月)。结果35例患者中,CDU诊断肾周型5例,肾下型30例;CTA诊断肾周型4例,肾下型31例。CDU误诊率为2.9%(1/35)。CDU发现IRAAA累及双髂总动脉21例,累及右髂总动脉3例,累及左髂总动脉2例,此结果与CTA检查结果完全一致。CDU对瘤体最大前后径、最大横径及附壁血栓厚度的测量与CTA测量结果相比差异均无统计学意义(P值分别为0.354,0.310及0.865)。CDU对瘤颈长度测量与CTA相比差异有统计学意义(P=0.006)。CDU显示3例瘤壁不连续,4例新月征,3例裂隙征,2例瘤壁局部囊袋状凸起,此结果与CTA检查结果完全一致。余23例患者CDU提示瘤壁局部菲薄。CTA提示21例瘤壁局部菲薄,2例无瘤壁菲薄征象。CDU误诊率为5.7%(2/35)。除3例未实施手术外,5例行开放手术(OR),27例行腹主动脉瘤腔内修复术(EVAR)。利用CDU及CTA对术后患者于1、3、6及12个月进行随访,所有患者人工血管及支架内血流通畅,5例患者出现少量内漏,其余患者瘤体内血栓形成,CDU与CTA随访结果完全一致。结论CDU对IRAAA瘤体大小、累及范围、濒临破裂情况等多角度分析判断,为IRAAA的筛查、诊断及术后随访提供可靠依据,具有重要的临床价值。Objective To study the value of color doppler ultrasonography(CDU)in diagnosis of impending ruptured abdominal aortic aneurysm(IRAAA).Methods A total of 35 cases with IRAAA which were identified by CDU in our department from June 2014 to June 2019 were retrospectively analyzed.All the patients were detected by computed tomographic angiography(CTA).The types,length of the neck of aneurysm,largest diameter,thrombosis,involvement of common iliac artery and impending ruptured conditions were compared.The postoperative patients were followed-up by CDU and CTA(mean time was 2.6 months).Results Among 35 patients,CDU diagnosed that 5 cases were pararenal types and 30 cases were infrarenal types.CTA showed that 4 cases were pararenal types and 31 cases were infrarenal types.The misdiagnosis rate of CDU was 2.9%(1/35).CDU showed that bilateral common iliac arteries were involved in 21 cases,right common iliac arteries were involved in 3 cases,and left common iliac arteries were involved in 2 cases.CTA detected the same results.There was no statistical difference between CDU and CTA for detection of the largest anteroposterior diameter,transverse diameter and the thickness of thrombosis(P values were 0.354,0.310 and 0.865).There was statistical difference in the detection of the length of the aneurysm′s neck(P=0.006).CDU showed 3 cases of focal wall discontinuity,4 cases of hyperattenuating crescent sign,3 cases of thrombus fissuration and 2 cases of saclike protuberance,which were consistent with the detection of CTA.CDU showed that locally thin wall of aneurysm was detected in the rest of 23 cases.CTA showed 2 patients were negative.The misdiagnosis rate of CDU was 5.7%(2/35).Three cases did not undergo surgery.Open repairs(OR)were performed in 5 cases.Endovascular aneurysm repairs(EVAR)were performed in 27 cases.The postoperative patients were followed up by CDU and CTA at 1 month,3 months,6 months and 12 months.All the artificial blood vessels and stents were patent.Endoleak was observed in 5 cases.Aneurysm sac thromb

关 键 词：超声检查 多普勒 彩色 腹主动脉瘤 诊断 

分 类 号：R543.16[医药卫生—心血管疾病] R445.1[医药卫生—内科学]