超声引导下较小股动脉假性动脉瘤凝血酶注射与单纯压迫法的疗效比较

The comparison between ultrasound-guided thrombin injection and simple compression repair in the treatment of small interventional femoral arterial pseudoaneurysms

目的:评价超声引导下股动脉假性动脉瘤瘤腔内注射凝血酶和单纯加压在治疗医源性股动脉假性动脉瘤中的应用价值。方法:在彩色多普勒超声引导下,30例股动脉假性动脉瘤患者先行加压压迫治疗,压迫治疗力量以患者能耐受,足背动脉搏动可触及为标准,加压时间为48h。压迫治疗不成功或不能耐受者18例,超声引导下采用20G穿刺针经皮穿刺,行瘤腔内注射凝血酶封闭治疗,凝血酶浓度为200U/ml,总量均≤500U。结果:30例患者中,12例股动脉假性动脉瘤患者采用超声引导下单纯压迫治疗取得成功,术后随访3个月无复发。18例压迫治疗不成功或不能耐受压迫治疗者行超声引导下瘤腔内凝血酶注射治疗,全部获得成功。术中及术后无并发症发生,术后随访3个月无复发。结论:股动脉假性动脉瘤如果瘤腔较小,瘤颈部较窄,可采用超声引导下单纯加压压迫治疗;如果瘤腔较大,瘤颈部较宽,复杂假性动脉瘤,患者不能耐受压迫治疗者可进一步采用超声引导下假性动脉瘤瘤腔内注射凝血酶治疗,可取得良好效果。

Objective：To evaluate the application value of ultrasound-guided thrombin injection （UGTI） against simple compression repair in the treatment of small interventional femoral pseudoaneurysms （PSA）. Methods：Thirty patients with small interventional femoral arterial pseudoaneurysms firstly received simple compression repair. The pressure should not beyond the endurability of the patients and the throbbing of the feet arterial should be palpable. With 48 hours of compression, 12 patients have been cured with satisfactory outcomes. The rest eighteen patients,who can not endure the therapy or who haven＇t been successfully cured,received percutaneous puncture with 20 G needle under ultrasound guidance, and were treated by intracavitary thrombin injection. The concentration of thrombin injection was 200 U/ml, the total volume dose was no more than 500 U. Results ： Twelve patients were successfully cured at the first time by simple compression repair. No recurrence and complication were found in a three-month followup. The other eighteen patients ,who can not endure the therapy or who haven＇t been successfully cured by this therapy ,were successfully treated afterwards by ultrasound-guided thrombin injection （UGTI）. No complication occurred during the operations or after the operations. and no recurrence and complication were found in a three-month followup. Conclusion：During the treatment of interventional femoral pseudoaneurysms （PSA）,simple compression repair is first recommended if the body of PSA is small,and the neck is narrow. Otherwise it should be treated by thrombin injection under sonographic guidance for better outcomes.