超声引导下凝血酶栓塞法治疗股动脉假性动脉瘤的疗效分析

Effect of ultrasound guided thrombin injection for treatment of femoral arterial pseudoaneurysm

目的探讨瘤腔内注射凝血酶治疗股动脉假性动脉瘤的疗效和安全性。方法78例股动脉假性动脉瘤的患者分别首选床边指压法(50例)和凝血酶注射法(28例)治疗。所有患者均使用GE LOGIQ9彩色多普勒超声仪确诊,凝血酶注射法组在超声引导下进行瘤腔内注射凝血酶栓塞治疗。结果指压法组50例患者中41例通过持续手指压迫治疗有效消除血管杂音和动脉瘤搏动,6例出现迷走神经反射,4例因不耐受再次压迫改用彩色多普勒引导下凝血酶注射法治愈,5例股动脉压迫治疗无效后改用凝血酶注射法治疗。凝血酶注射法组28例首选超声引导下瘤腔内注射凝血酶栓塞治疗的患者全部治愈,其中25例一次栓塞成功,2例经两次栓塞成功,1例出现血管迷走性晕厥;12例患者注射凝血酶后有体温轻度升高,自行好转;无动脉栓塞及静脉血栓形成、无凝血酶过敏表现、感染、出血等并发症。结论与指压法比较,超声引导下瘤腔内注射凝血酶的治疗方法有效性显著提高而不耐受性显著降低,是一种安全有效的方法。

Objective To evaluate the effect and safety of ultrasound-guided percutaneous thrombin injection for the treatment of postcatheterization femoral arterial pseudoaneurysm.Methods Seventy-eight patients with femoral anterial pseudoaneurysm were included in this study.Pseudoaneurysms were treated by bedside compression in 50 of these 78 patients（group A）,and by thrombin injection in 28 patients（group B）.All patients were diagnosed by GE LOGIQ 9 Color Doppler Ultrasound.Ultrasound guided thrombin injection for femoral arterial pseudoaneurysme were carried out in patients in group B.Results Closure of the pseudoaneurysm was successfully in 82 percent（41/50） of the patients in group A.Six patients had vagus reflex,4 patients could not tolerate repeating compression and 5 patients were not effectively cured by compression and needed to receive remedial ultrasound-guided percutaneous thrombin injection.Closure of the pssudoareurysm by percutaneous thrombin injection was successful in all patients in group B.Successful immediate closure were noted in 25 patients and 2 patients needed second thrombin injection.One patient had vasovagal syncope and 12 patients had mild fever.No distal embolization,infection,hemorrhage or allergic reaction occurred.Conclusion Compared to compression therapy for treatment of femoral arterial pseudoaneurysme,ultrasound-guided percutaneous thrombin injection is a simple,safe and effective treatment alternative.