超声内镜在血管介入诊疗中的研究进展

doi:10.16150/j.1671-2870.2025.04.002

摘要/Abstract

摘要：

本文系统综述了超声内镜（Endoscopic ultrasonography， EUS）在门静脉系及非门静脉系血管介入中的应用进展。在门静脉系介入领域，EUS引导下硬化剂注射、弹簧圈栓塞可封闭食管、胃及异位静脉曲张的穿支血管，降低复发率，尤其对难治性病例和巨大分流道患者展现显著疗效。此外，EUS引导门静脉测压技术成功率达95%，与肝静脉压力梯度高度相关，有望成为无创替代方案；EUS引导下细针穿刺活检则通过微创活检明确门静脉栓子性质，且无并发症报道。在非门静脉系介入中，EUS通过栓塞溃疡出血灶、假性动脉瘤及间质瘤滋养血管，为难治性病变提供精准治疗。尽管现有证据多源于小样本研究，但EUS血管介入技术（endoscopic ultrasound-guided vascular intervention， EUS-VI）的安全性和有效性已得到初步验证。未来需通过大规模随机对照试验进一步评估并优化技术标准，推动EUS-VI成为血管病变的一线诊疗选择。

关键词: 超声内镜, 血管介入, 门静脉高压, 门静脉测压

Abstract:

This study systematically reviews the advances in the application of endoscopic ultrasonography (EUS) in both portal and non-portal vascular interventions. EUS-guided sclerotherapy and coil embolization effectively occlude perforating vessels in esophageal, gastric, and ectopic varices, significantly reducing recurrence rates—particularly in refractory cases and patients with large shunt pathways. Moreover, EUS-guided portal pressure measurement achieves a technical success rate of 95% and demonstrates strong correlation with hepatic venous pressure gradient, showing potential as a non-invasive alternative. Meanwhile, EUS-guided fine-needle aspiration enables minimally invasive biopsy for definitive diagnosis of portal vein thrombi, with no complications reported. In non-portal vascular interventions, EUS provides precise therapeutic solutions for refractory lesions by embolizing bleeding ulcers, pseudoaneurysms, and feeding vessels of gastrointestinal stromal tumors. Although current evidence is predominantly derived from small-scale studies, the safety and efficacy of EUS-guided vascular intervention (EUS-VI) have been preliminarily validated. Future research should focus on large-scale randomized controlled trials to further evaluate and optimize technical standards, ultimately establishing EUS-VI as a first-line diagnostic and therapeutic option for vascular lesions.

Key words: Endoscopic ultrasonography, Vascular intervention, Portal hypertension, Portal pressure measurement

中图分类号:

程桂莲, 史天择, 胡端敏. 超声内镜在血管介入诊疗中的研究进展[J]. 诊断学理论与实践, 2025, 24(04): 365-372.

CHENG Guilian, SHI Tianze, HU Duanmin. Research progress on endoscopic ultrasonography in vascular interventional diagnosis and therapy[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(04): 365-372.

图/表 2

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