腘血管陷迫综合征超声表现及误诊原因  

Analysis of the Ultrasonographic Manifestations and Causes of Misdiagnosis of Popliteal Vascular Entrapment Syndrome

作　　者：张彦[1] 张莹莹[1] 闫光烈 ZHANG Yan;ZHANG Ying-ying;YAN Guang-lie(Department of Ultrasound,No.960 Hospital of China Joint Logistics Support Force of the PLA,Jinan 250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六○医院超声科,济南250031

出　　处：《临床误诊误治》2021年第1期1-5,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析腘血管陷迫综合征(popliteal vascular entrapment syndrome,PVES)超声表现及误诊原因、防范措施。方法回顾性分析6例PVES的临床资料。结果PVES 6例中超声检查误诊1例,误诊率16.7%。6例均表现为患肢间歇性跛行,超声检查可见腘动脉近段向内侧不同程度移位,腘动静脉间距离增宽,其中患侧腘动脉3例管壁轻度增厚,2例管腔狭窄,1例管腔闭塞。5例行超声位置应力试验(positional stress test,PST),均呈阳性改变。超声检查误诊1例,误诊为腘动脉血栓性闭塞并侧支血管形成,左胫后动脉、左足背动脉缺血性改变,未进行超声PST。6例结合临床表现和影像学检查诊断为PVES,皆接受手术治疗,其中5例行腘动脉松解术,1例行腘动脉松解加人工血管旁路手术。术后1、3和6个月随访,6例患肢彩色多普勒超声检查腘动脉、旁路血管、胫后及足背动脉血流通畅,跛行症状消失。结论超声检查简便、无创,可反映PVES血流动力学状态,可为临床界定手术时机、确定诊治策略、术后随访提供重要信息。临床工作中应充分结合各种影像学检查优势,相互补充,以提高PVES诊断准确率。Objective To analyze the ultrasonographic manifestations,causes of misdiagnosis and preventive measures of popliteal vascular entrapment syndrome(PVES).Methods The clinical data of 6 patients with PVES were analyzed retrospectively.Results Among the 6 cases of PVES,1 case was misdiagnosed by ultrasonography,with a misdiagnosis rate of 16.7%.All the 6 cases had a manifestion of intermittent claudication.Ultrasound examination revealed that the proximal segment of the popliteal artery shifted to the medial side,and the distance between popliteal arteries and veins widened.Of them,there was slight thickening of popliteal artery wall in 3 cases,and stenosis in 2 cases and lumen occlusion in 1 case.Positional stress tests(PST)were performed in 5 patients and all were positive.One case was misdiagnosed by ultrasonography as popliteal artery thrombotic occlusion with collateral formation and ischemic changes of the left posterior tibial artery and left dorsal artery.PST test was not performed.All 6 cases were diagnosed as PVES combined with clinical symptoms and imaging examinations,and all received surgical treatment.Among them,5 cases underwent popliteal artery lysis and 1 case underwent popliteal artery lysis and artificial blood vessel bypass surgery.During the follow-up of 1,3 and 6 months,the popliteal artery,bypass vessel,posterior tibial and dorsal foot arteries of the 6 affected limbs had smooth blood flow based on color Doppler ultrasound examination,and the claudication disappeared.Conclusion Ultrasonography is simple and non-invasive,which can reflect the PVES hemodynamic status,and provide important information for clinically defining the timing of surgery,determining the diagnosis and treatment strategy,and postoperative follow-up.In clinical practice,the advantages of various imaging examinations should be combined and complement each other to improve the accuracy of PVES diagnosis.

关 键 词：腘血管陷迫综合征 超声检查 误诊 腘动脉闭塞 

分 类 号：R543[医药卫生—心血管疾病]