彩色多普勒超声在腹主动脉瘤腔内修复术后支架感染诊断中的价值  

The value of color doppler ultrasonography in the diagnosis of endograft infections following endovascular aneurysm repair

作　　者：王慧[1] 苏连花[1] 李梓伦[1] 常光其[1] 黄雪玲[1] 王深明[1] Wang Hui;Su Lianhua;Li Zilun;Chang Guangqi;Huang Xueling;Wang Shenming(Department of Vascular Surgery,the First Affiliated Hospital of Sun Yatsen 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》2022年第1期67-72,共6页National Medical Journal of China

摘　　要：目的分析彩色多普勒超声(CDU)在腹主动脉瘤腔内修复(EVAR)术后支架感染患者诊断中的应用价值。方法回顾性分析中山大学附属第一医院血管外科2010年1月至2020年12月20例经计算机断层扫描血管造影术(CTA)诊断提示EVAR术后支架感染患者的临床资料。男16例,女4例,年龄49~86岁。所有患者均同时行CDU检查。对CTA及CDU显示的患者瘤体内漏、气泡影、脓肿、血肿、肠瘘及支架闭塞等情况进行对比分析。结果所有患者中,CTA检查显示内漏为9例,CDU检查显示内漏8例,漏诊率为1/9,误诊率为0,约登指数为0.89。其中CDU诊断Ⅱ型内漏3例,与CTA比较漏诊1例。CDU诊断Ⅰa型内漏3例,Ⅰb型内漏2例,与CTA检查结果一致。CDU及CTA均未检出Ⅲ型及Ⅳ型内漏。CDU显示气泡影8例,与CTA比较漏诊率为2/10,误诊率为0,约登指数为0.80。CDU检查脓肿、血肿、瘤体增大、支架闭塞以及瘤腔内液性暗区的比例分别为8/20、2/20、4/20、1/20及2/20,与CTA检查结果一致。CTA检查3例主动脉肠瘘(AEF)患者,CDU均未检出。CDU随访显示5例解剖外旁路通畅,解剖外旁路闭塞患者1例,感染范围及瘤腔气体影减少患者2例,瘤体内漏情况无明显变化者1例,以上随访结果与CTA检查一致。结论CDU可对EVAR术后支架感染患者瘤体内及瘤体周围感染情况进行全面评估,准确率较高,对患者的早期诊断、治疗及预后具有重要的临床意义。Objective To study the value of color doppler ultrasonography(CDU)in the diagnosis of endograft infections following endovascular aneurysm repair(EVAR).Methods The retrospective analysis of post-EVAR stent infections identified by computed tomography angiography(CTA)was conducted at the First Affiliated Hospital of Sun Yat-sen University from January 2010 to December 2020.There were 16 males and 4 females,aged from 49 to 86 years.All the patients were detected by CDU.The endoleak,bubbles,abscess,hematoma,aortic intestinal fistula(AEF)and occlusion of stent detected by CTA and CDU were analyzed and compared.Results Among 20 patients,9 cases with endoleak were detected by CTA,while CDU showed 8 cases with endoleak.The rate of missed diagnosis was 1/9.The misdiagnosis rate was 0,and the Youden index was 0.89.CDU detected 3 cases with typeⅡendoleak,and 1 case was missed when compared with CTA.Three cases with typeⅠa and 2 cases with typeⅠb were detected by CDU,which were consistent with those of CTA.CDU and CTA showed that there were no cases with typeⅢand typeⅣendoleaks.CDU detected 8 cases with bubbles in the sac.Compared with CTA,the rate of missed diagnosis was 2/10.The misdiagnosis rate was 0,and the Youden index was 0.80.The cases with abscess,hematoma,increasing size of the aneurysm,occlusion of stent and fluid sonolucent area in the sac detected by CDU were 8/20,2/20,4/20,1/20,2/20,which were consistent with CTA.CDU did not detect the 3 cases with aortoenteric fistula(AEF)which were identified by CTA.The follow-up of CDU showed that the extra-anatomic bypasses remained their patency in 5 cases,1 case occurred bypass occlusion.The range of infectious area and bubbles reduced in 2 cases.There was no change of endoleak in 1 case.All the follow-up results were consistent with those of CTA.Conclusion CDU can comprehensively evaluate the infection in and around the aneurysm in patients with stentinfection after EVAR,with a high auuraly,and has important clinical significance for the early diagnosis,treatm

关 键 词：动脉瘤 血管成形术 感染 超声检查 多普勒 彩色 血管造影术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R654.3[医药卫生—诊断学]