超声造影在医源性假性动脉瘤诊断及治疗中的应用  

Application of contrast-enhanced ultrasound in diagnosis and treatment of iatrogenic pseudoaneurysm

作　　者：杨美玲 李丽丽 陈梅 王立波[1] 任秀昀[1] YANG Meiling;LI Lili;CHEN Mei;WANG Libo;REN Xiuyun(Department of Ultrasound,Hainan Hospital of PLA General Hospital,Sanya 572013,China)

机构地区：[1]解放军总医院海南医院超声诊断科,三亚572013

出　　处：《武警医学》2024年第12期1067-1070,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的 探讨医源性假性动脉瘤(IPSA)的超声造影诊断价值、治疗方式选择及治疗效果评估。方法 回顾性分析2013-01至2024-03在解放军总医院海南医院诊治的IPSA患者资料39例。治疗前均应用常规超声进行瘤体大小、瘘口直径、瘘口血流速度测量,必要时行超声造影检查。治疗方式:首选压迫治疗,压迫治疗失败者选择超声引导下凝血酶封堵,上述方式失败或有禁忌证者选择外科手术及覆膜支架植入术。并对治疗成功的各治疗组的瘤体大小、瘘口直径及瘘口血流速度等参数进行统计分析。结果 单纯假性动脉瘤34例(34/39,87.18%),复杂假性动脉瘤(合并动静脉瘘或多发动脉瘤等)5例(5/39,12.82%)。压迫组与凝血酶封堵组(P=0.048)、手术组(P=0.013)在瘤体大小上差异具有统计学意义;压迫组与凝血酶封堵(P=0.006)、手术组(P=0.043)在瘘口大小上差异具有统计学意义;压迫组、凝血酶封堵组、手术组在流速大小上差异无统计学意义。结论 超声造影为复杂性IPSA的有效诊断方法,凝血酶封堵术为压迫治疗失败的IPSA治疗的有效补救方法。Objective To explore the value of contrast-enhanced ultrasound(CEUS)in diagnosis,treatment and efficacy evaluation of iatrogenic pseudoaneurysms(IPSA).Methods A retrospective analysis was conducted on the data of 39 patients with IPSA diagnosed and treated at the Hainan Hospital of PLA General Hospital from January 2013 to March 2024.Before treatment,conventional ultrasound was used to measure the size of the aneurysm,the diameter of the fistula,and the blood flow velocity of the fistula.CEUS was performed when necessary.The treatment options were as follows:compression therapy as the first choice,followed by ultrasound-guided thrombin occlusion for those who failed in compression therapy,and surgical intervention or covered stent implantation for those who failed in the above treatments or had contraindications.Statistical analysis was conducted on the parameters such as aneurysm size,fistula diameter,and blood flow velocity in the successful treatment groups.Results There were 34 cases(34/39,87.18%)of simple pseudoaneurysm and 5 cases(5/39,12.82%)of complex pseudoaneurysm(combined with arteriovenous fistula or multiple aneurysms,etc.).Statistically significant differences were found in aneurysm size between the compression group and the thrombin occlusion group(P=0.048)as well as between the compression group and the surgical group(P=0.013).Similarly,statistically significant differences were observed in fistula size between the compression group and the thrombin occlusion group(P=0.006)and between the compression group and the surgical group(P=0.043).However,no statistically significant difference was found in blood flow velocity among the compression,thrombin occlusion,or surgical group.Conclusions CEUS is an effective diagnostic method for complex IPSA,and thrombin occlusion is an effective remedy for IPSA patients after failure of compression therapy.

关 键 词：超声造影 医源性假性动脉瘤 凝血酶 

分 类 号：R473.5[医药卫生—护理学]