超声引导下压迫或并用抽取积血法治疗导管术后股动脉假性动脉瘤

Ultrasound-guided compression repair or ultrasound-guided compression-puncture hematocele repair in the treatment of post-cardiac catheterization pseudoaneurysms

目的: 介绍超声引导下单纯压迫修复法(U G C R)和压迫合并穿刺抽积血修复法(U G C P H R)治疗12例心导管术后股动脉假性动脉瘤的方法并评价其疗效.方法: 7例瘤体小于3 0cm×3 0cm者采用单纯压迫修复法,在超声引导下直接按压20～30min;5例瘤体大于3 0cm×3 0cm者采用压迫合并穿刺抽积血修复法,在超声监视下先将带注射器的18号套管针沿原穿刺口刺入瘤腔,再按住瘤颈阻断血流继续进入瘤腔,用注射器抽尽瘤腔内积血,继续按压20～30min后缓慢减压,仍有血流信号者可重复上述过程.结果: 12例均成功,局部无大块硬结形成.其中11例1次修复成功,1例先用UGCR法失败后改用压迫合并穿刺抽积血法成功.结论: 在超声引导下根据瘤体大小选择单纯压迫修复法或压迫合并穿刺抽积血修复法能有效治疗心导管术后假性动脉瘤,其操作简单、安全可靠、术后局部无大块硬结形成.

Objective： To introduce and evaluate the methods of ultrasound-guided compression repair （UGCR） or ultrasound-guided compression-puncture hematocele repair （UGCPHR） in the treatment of post-catheterization femoral arterial pseudoaneurysms. Methods： Seven patients with femoral arterial pseudoaneurysms（ 〈 30 cm×30 cm） were treated with UGCR and the femoral arterial rupture clefts were directly compressed guided by ultrasound for 20 ～ 30min. Five patients pseudoaneurysms （〉 30 cm × 30 cm） were treated with UGCPHR , a 18-gauge trocar with a syringe was placed into the pseudoaneurysm flow lumen along the primary cleft , this site was compressed to cut out the blood flow into the lumen and then all the hematocele was drawn out with the syringe, with slow decompression 20 ～ 30min after continuous compression, and the procedures above were repeated if blood flow signals still existed. Results： All the twelve caseswere successfully treated , without large hardening nodules. Eleven cases were treated successfully at one time, and one case was successfully treated with UGCPHR after its failure with UGCR. Conclusion： In the treatment of post catherization femoral arterial pseudoaneurysms , UGCR or UGCPHR depending on the size of pseudoaneurysms is effective , safe and technically simple , without local large hardening nodules in the post repair.