Lub aorta yog cov hlab ntsha loj tshaj plaws uas tsis muaj kev sib koom ua ke. Nws belongs rau lub voj voog loj ntawm cov ntshav ncig thiab txhawb nqa tag nrho cov kabmob ntawm peb lub cev nrog cov ntshav. Lub aorta tau muab faib ua 3 ntu thiab 2 ntu - plab thiab thoracic. Feem ntau (nyob rau hauv 95% ntawm cov neeg mob) yog aneurysm ntawm lub plab aorta, uas peb yuav tham txog hnub no.
Aneurysm yog ib qho loj lossis protrusion ntawm lub aorta. Tus kab mob no tseem yog lub hauv paus ntawm ntau qhov kev sib tham, vim tias cov kws kho mob tsis tuaj yeem pom zoo txog qhov kev nthuav dav ntawm cov phab ntsa vascular tuaj yeem kuaj tau tias yog aneurysm. Yav dhau los, kev kuaj mob tau lees paub thaum lub aorta loj dua 2 zaug lossis thaum nws txoj kab uas hla tau nthuav dav ntau dua 3 cm. Tab sis vim tias lub aorta muaj txoj kab uas hla ntawm 15 txog 32 cm, lub tswvyim ntawm "ntau tshaj 3 cm" yog kom meej meej. heev vague. Yog li ntawd, nyob rau hauv 1991, ua tsaug rau kev tshawb fawb los ntawm American cov kws tshawb fawb, aneurysm pib suav hais tias yog ib qho kev nthuav dav ntawm lub aortic lumen los ntawm 50% ntau dua li nws txoj kab uas hla. Tab sis qhov no thiablub ntsiab lus tseem arbitrary.
Cov lus nug no tseem ceeb tshwj xeeb tshaj yog thaum xaiv cov tswv yim ntawm kev cuam tshuam kev phais, txawm li cas los xij, alas, nws tseem qhib. Lub caij no, kwv yees li 15,000 tus neeg Asmeskas tuag txhua xyoo los ntawm aneurysms. Feem ntau, lawv tsuas tsis muaj sijhawm los kuaj xyuas nws.
Tus kws kho mob twg kho tus mob aneurysm?
Tus kab mob no yog kho los ntawm tus kws phais mob vascular, txij li qhov kev kho tseem ceeb ntawm qhov teeb meem yog kev ua haujlwm. Yog tias qhov kev ua haujlwm tsis tau qhia, tus neeg mob yuav tsum tau saib xyuas los ntawm tus kws kho mob, kws kho plawv lossis kws kho mob (tus kws kho mob tshwj xeeb), ua tib zoo saib xyuas lawv tus mob. Ib qho aneurysm yog insidious txaus uas nws tuaj yeem pib loj hlob sai sai, ua rau muaj kev pheej hmoo ntawm nws qhov teeb meem loj tshaj plaws - rupture.
Leej twg txaus ntshai?
Aneurysm yog kuaj pom ntawm ob tus txiv neej thiab poj niam (tom kawg, txawm li cas los xij, tsawg zaus). Txawm li cas los xij, nws tau pom tias hauv cov txiv neej hnub nyoog tshaj 65 xyoo, nws tshwm sim ntau zaus. Qhov no feem ntau yog vim kev mob siab rau ntau yam kev haus luam yeeb, tshwj xeeb tshaj yog kev puas tsuaj rau cov laus.
Yog li, pawg pheej hmoo suav nrog:
- cov neeg mob ntshav siab;
- smokers;
- cov tib neeg hauv nws tsev neeg muaj mob plab aorta lossis lwm yam kab mob plawv thiab / lossis pathologies ntawm peripheral ncig twb tau kuaj pom lawm;
- rog dhau thiab sedentary.
Nco ntsoov! Cov kev tshawb fawb qhia tau tias muaj ntau yam mob aneurysms tau txais los ntawm cov poj koob yawm txwv.
Hom mob plab aortic aneurysms: kev faib tawm
Aneurysm ntawm lub plab aorta tau muab faib ua ob peb hom nyob ntawm nws cov duab, thaj chaw thiab cov yam ntxwv pathological:
- Saccular (zoo li lub hnab uas txuas nrog lub caj dab mus rau lub lumen ntawm lub aorta).
- Spindle. Cov duab zoo ib yam li spindle, uas los ntawm lub qhov yog txuas nrog lub lumen ntawm lub aorta. Feem ntau hom mob aneurysm.
Raws li cov yam ntxwv ntawm cov kab mob, cov kab mob hauv qab no yog qhov txawv:
- Nyob. Nws cov phab ntsa ntawm cov hlab ntsha tau nthuav dav, vim nws tau tsim los ntawm ntau txheej ntawm aorta.
- Pseudoaneurysm. tshwm sim tom qab raug mob vim kev loj hlob ntawm lub pulsating hematoma.
- Exfoliating. Ntawd yog, nws cov phab ntsa yog stratified, thiab cov kab noj hniav tau ntim nrog cov kab mob intramural hematoma, uas txuas nrog lub aortic lumen los ntawm cov phab ntsa ntawm cov hlab ntsha puas.
Nws kuj yog qhov txawv ntawm qhov chaw:
- Infrarenal plab aortic aneurysm nyob saum toj / hauv qab ib ceg ntawm lub raum cov hlab ntsha.
- Suprarenal nyob saum cov hlab ntsha
- Tag nrho cov aneurysm yog kis raws tag nrho qhov ntev ntawm lub nkoj.
Dab tsi ua rau mob ntshav qab zib?
- Atherosclerosis, uas cov phab ntsa vascular ua tuab thiab poob elasticity, thiab cov ntaub ntawv rog ntawm nws cov phab ntsa nyob rau hauv daim ntawv ntawm atherosclerotic plaques. Plaque muaj cov roj (cholesterol) phem thiab lwm yam rog. Thaum cov kws kho mob tsis tau txiav txim siab raws nraim li cas atherosclerosis cuam tshuamtxoj kev loj hlob ntawm aneurysm, tab sis nws yog assumed tias raws li ib tug tshwm sim ntawm tus kab mob no, circulatory ntshawv siab tshwm sim nyob rau hauv lub hlab ntsha thiab muab cov as-ham nres. Yog li ntawd, cov ntaub so ntswg vascular puas lawm, ua raws li nws qhov kev sib cais. Raws li qhov tshwm sim, kev kuaj mob ntawm "abdominal aortic aneurysm" raug tsim.
- Mob ntshav qab zib mellitus, uas "nyiam" ntaus cov hlab ntsha. Nws feem ntau nrog retinopathy, nephropathy, aneurysm.
- Txiv neej. Hauv qee cov kab mob congenital (Ehlers-Danlos, Marfan, Erdheim's cystic medial necrosis, thiab lwm yam), cov hlab ntsha, nrog rau lub plab aorta, raug kev txom nyem. Nws feem ntau tuaj yeem taug qab qhov kev sib raug zoo ntawm qhov aneurysm ntawm lub plab aorta thiab kab mob caj ces.
- Kab mob sib kis. Cov no suav nrog cov kab mob uas cuam tshuam rau sab hauv lub plawv (endocart) - syphilis, ecdocarditis, salmonellosis, thiab lwm yam.
- Kev mob tau txais hauv plab. Piv txwv li, nrog rau lub hauv siab los yog lub plab, lub aorta yuav raug cuam tshuam.
- Cov txheej txheem mob. Tsis yog tshwj xeeb aortoarteritis, piv txwv li, ua rau cov phab ntsa aortic tsis muaj zog. Muaj tseeb tiag, tseem tsis tau muaj cov ntaub ntawv tshwj xeeb ntawm qhov teeb meem no. Tab sis cov kab mob uas tsis yog-inflammatory ntawm phab ntsa vascular feem ntau tshwm sim vim atherosclerotic plaques.
Feem ntau, kev haus luam yeeb, lub cev tsis ua haujlwm thiab hnub nyoog yog qhov ua rau muaj qhov mob hnyav tshaj plaws. Nws yog ib qho tseem ceeb heev uas yuav tau kuaj xyuas nws raws sijhawm. Thoracic thiab plab aortic aneuryms muaj cov tsos mob sib txawv, uas tam sim no peb yuav xav txog.
yog dab tsiCov tsos mob ntawm lub plab aortic aneurysm?
Feem ntau, qhov mob aneurysm tsis ua rau nws tus kheej hnov txhua qhov thiab raug kuaj pom los ntawm kev sib tsoo thaum kuaj. Txij li thaum nws tshem tawm cov kabmob, cuam tshuam lawv cov haujlwm tseem ceeb, kev kuaj mob tuaj yeem ua tsis raug, yog li nws tseem ceeb heev uas yuav tsum tau ua ultrasound ntawm lub plab kab noj hniav. Cov kws kho mob tau sau tseg tias qhov mob ntawm lub plab hauv cheeb tsam thoracic tshwj xeeb yog "kev zais cia". Tej zaum nws yuav tsis tshwm sim, lossis nws yuav ua rau mob hauv siab, hnoos, thiab ua tsis taus pa. Nyob rau hauv cov ntaub ntawv ntawm nws nce, ib qho aneurysm ntawm lub plab aorta dhau los ua cuam tshuam.
Los ntawm ob peb cov tsos mob ntawm aneurysm, muaj ntau yam tshwm sim ua ke los yog sib cais:
- hnyav hauv plab, qhov tsis xis nyob ntawm qhov puv thiab lub plawv dhia zoo li lub plawv dhia.
- mob plab, tsis mob, es, mob, npub. Nws yog localized ncaj qha rau hauv lub dab teg los yog rau sab laug ntawm nws.
Thiab los ntawm cov cim qhia tsis ncaj, ib qho aneurysm ntawm lub plab aorta ua rau nws tus kheej hnov. Nws cov tsos mob txawv heev uas nws nyuaj rau xav tias muaj teeb meem tiag tiag hauv lawv. Qhov no yog vim qhov tseeb tias kev loj hlob aneurysm tuaj yeem cuam tshuam kev ua haujlwm ntawm ntau yam kabmob thiab lub cev. Yog li ntawd, nws tuaj yeem tsis meej pem nrog rau lub raum colic, pancreatitis, lossis sciatica.
Ischioradicular syndrome ua rau mob hauv qab nraub qaum (tshwj xeeb yog sab nraub qaum) thiab tsis hnov tsw ntawm ob txhais ceg nrog rau kev txav mus los.
Mob plab plab yog tshwm sim los ntawm ntuav, belching, raws plab lossis cem quav, nrog rau qhov tsis tuajqab los noj mov, ua rau poob phaus.
mob ischemia ntawm ob txhais ceg yog qhia nyob rau hauv circulatory disorders (txias ko taw), mob nqaij thaum taug kev thiab thaum so, lub sij hawm lameness.
Urological syndrome qhia nws tus kheej nrog kev tso zis, mob, hnov mob hnyav hauv nraub qaum thiab txawm tias pom cov qe ntshav liab hauv cov zis.
A ruptured plab aortic aneurysm pib nrog mob plab, tsis muaj zog, thiab kiv taub hau. Qee zaum qhov mob kis mus rau sab nraub qaum, puab tsaig lossis perineum. Nyob rau hauv cov ntaub ntawv no, tus neeg mob xav tau kev kho mob tam sim ntawd, raws li tus mob yog fraught nrog kev tuag. Feem ntau ib qho aneurysm tawg mus rau hauv nruab nrab ntawm txoj hnyuv me, plab lossis duodenum, tsawg dua mus rau hauv lub plab loj. Thaum lub plab aortic aneurysm ruptures, cov tsos mob tuaj yeem nrog xeev siab thiab ntuav. Nyob rau hauv lub plab mog sab laug, ib tug tsim yog palpated, maj mam nce thiab muaj zog pulsation. Nws ciam teb tsis hnov.
Thaum muaj qhov txhab pob txha tawg, cov tsos mob ci ntsa iab, tab sis lawv tuaj yeem yooj yim tsis meej pem nrog lwm yam kev phom sij rau kev noj qab haus huv, yog li qhov mob hnyav hauv plab lossis hauv siab, nco ntsoov hu lub tsheb thauj neeg mob.
Kev kuaj kab mob
Thawj theem kev kuaj mob yog kev kuaj xyuas los ntawm kws kho mob, leej twg, ntawm palpation, xav tias muaj zog hauv plab hauv plab, qhov no yog aneurysm ntawm lub plab aorta. Nws qhov kev kuaj mob suav nrog cov kev tshawb fawb uas tso cai rau koj pom tias muaj dab tsi tshwm sim hauv lub plab kab noj hniav. Ua ntej tshaj plaws, nws yog ib qho ultrasound, thiabxam tomography (CT) thiab multispiral computed tomography ntawm aorta (MSCT).
Yog xav tias muaj qhov mob plab aortic aneurysm, ultrasound ua rau nws muaj peev xwm paub meej tias nws muaj nyob nrog yuav luag ib puas feem pua. Nws qhia qhov tseeb qhov chaw ntawm qhov aneurysm, qhov mob ntawm phab ntsa vascular, qhov chaw ntawm qhov tawg, yog tias muaj.
CT scan lossis MSCT yog ua los txhawm rau txhawm rau kuaj calcification, dissection, intrasaccular thrombosis, hem rupture lossis rupture uas twb muaj lawm.
Nyob rau hauv cov xwm txheej uas cov kev tshawb fawb soj ntsuam saum toj no tsis tso cai rau kev kuaj mob kom raug (txawm tias qhov no tsis tshua muaj), aortography raug sau tseg. Txoj kev tso cai rau kev kuaj xyuas lub sijhawm ntawm lub aorta thiab nws cov ceg los ntawm kev qhia cov kua tshwj xeeb rau hauv lub nkoj. Nws tau tshwm sim nyob rau hauv cov xwm txheej uas muaj qhov tsis txaus ntseeg ntawm kev puas tsuaj rau cov hlab ntsha thiab lub raum, lub xeev ntawm cov hlab ntsha distal tsis paub.
Teeb meem ntawm plab aortic aneurysm
Tus mob no txaus ntshai tsis yog rau kev noj qab haus huv xwb, tab sis kuj rau lub neej. Ua ntej tshaj plaws, lub aorta tuaj yeem ua rau embolism (thaiv) ntawm cov hlab ntsha, kis kab mob, thiab ua rau lub plawv tsis ua haujlwm.
Kev tshem tawm cov hlab ntsha ntawm lub plab aorta yog ib qho teeb meem txaus ntshai, uas muaj nyob rau hauv nws cov rupture thiab cov ntshav nkag mus rau hauv cov khaubncaws sab nraud povtseg ntawm lub vascular lub cev. Yog tias tag nrho 3 txheej yog stratified thiab lub aorta tawg tag, cov ntshav poob qis tshwm sim.
Tab sis, tau kawg, qhov teeb meem phem tshaj plaws ntawm kev mob aneurysm yog nws qhov tawg. Ntau tus neeg mob uas tsis kho mob aneurysms tuag hauv 5 xyoos. Ua ntej so, ib tug neeg hnov mob hnyav hauv qab noplab thiab hauv cheeb tsam lumbar. Yog hais tias lub aneurysm ntawm lub plab aorta yog ruptured, lub chav kawm ntawm tus kab mob yog yus muaj los ntawm cov los ntshav ntau, uas ua rau poob siab thiab tuag. Yog li ntawd, nrog mob hnyav hauv plab thiab hauv siab, nco ntsoov hu rau lub tsheb thauj neeg mob, vim nws txaus ntshai rau ncua sijhawm. Raws li kev txheeb cais qhia, tsuas yog 3% ntawm cov neeg mob tuag tam sim ntawd tom qab aortic rupture, thaum lwm tus nyob ntawm 6 teev mus rau 3 lub hlis. Feem ntau, lawv tuag hauv ib hnub. Yuav kho mob aneurysms li cas? Xav txog hauv qab no.
Kev kho mob plab aortic aneurysm
Ntau tus neeg yuam kev ntseeg tias qhov kev kuaj mob ntawm "abdominal aortic aneurysm" kev kho mob tsuas yog phais xwb. Qhov tseeb, txhua yam ntawm no yog tus kheej.
Yog hais tias qhov aneurysm tsis ncav cuag ib txoj kab uas hla ntawm 4.5 cm, ces qhov kev khiav hauj lwm tsis tau qhia, vim hais tias nws tus kheej muaj peev xwm ua rau muaj kev pheej hmoo rau lub neej ntau dua li lub nkoj loj ntawm nws tus kheej. Feem ntau cov qauv no tau pom nyob rau hauv cov txiv neej laus uas raug kev txom nyem los ntawm comorbidities thiab, ntxiv rau, tsis txhob haus luam yeeb (thiab nrog xws li kev kuaj mob, nws yog ib qho tsim nyog yuav tsum tsis txhob haus luam yeeb!). Rau lawv, kev tswj hwm kev cia siab yog qhov zoo dua, vim tias qhov kev pheej hmoo ntawm aortic rupture nrog txoj kab uas hla no tsuas yog kwv yees li 3% ib xyoos. Hauv qhov no, txhua rau lub hlis tus neeg mob raug yuam kom ua ultrasound txhawm rau txhawm rau paub qhov loj ntawm lub aorta. Yog hais tias lub vascular phab ntsa maj mam nthuav, ces qhov no yog lub ntsiab qhia rau kev phais, vim hais tias qhov tshwm sim ntawm nws rupture nce 50%.
Cov neeg laus uas tau kuaj mobaneurysm ntawm lub plab aorta, kev kho mob zoo dua yog siv txoj kev endovascular, minimally invasive method. Thaum lub sijhawm ua haujlwm, lub catheter tau muab tso rau hauv tus neeg mob cov hlab ntsha, uas cov stent nkag mus. Ib zaug hauv aorta, nws qhib thiab kaw cov hlab ntsha, yog li hloov qhov cuam tshuam ntawm nws lub cev. Qhov zoo ntawm kev ua haujlwm suav nrog kev zam yooj yim dua thiab lub sijhawm rov qab luv - tsuas yog ob peb hnub. Tab sis txoj kev no kuj muaj nws tus kheej nuances, yog li nws tsis yog ua los ntawm txhua tus. Lub ntsiab drawback ntawm lub lag luam no yog hais tias nyob rau hauv 10% ntawm cov neeg mob, distal migration ntawm lub ntsia sawv ntsug yog sau tseg.
Thaum kuaj mob plab aortic aneurysm, kev phais feem ntau qhib. Thaum lub sij hawm tus txheej txheem, qhov cuam tshuam cheeb tsam ntawm lub aorta raug tshem tawm thiab hloov nrog ib tug prosthesis ua los ntawm Dacron (polyester-raws li hluavtaws ntaub). Txhawm rau muab kev nkag mus rau aorta, ib qho nruab nrab laparotomy yog siv. Lub sijhawm ua haujlwm feem ntau yog li 2-3 teev. Tom qab kev phais, qhov caws pliav tseem nyob.
Tus neeg mob rov zoo li ntawm ob lub lis piam. Kev rov ua haujlwm ntawm kev ua haujlwm hauv qee kis yog ua tau tsuas yog tom qab 4-10 lub lis piam. Tus neeg mob raug txwv tsis pub siv lub cev, so thiab taug kev.
Contraindications rau kev phais qhib
Kev cuam tshuam phais yog txwv tsis pub raws li cov xwm txheej hauv qab no:
- Lub plawv nres tsis ntev los no (tsawg kawg ib hlis).
- Lub plawv thiab lub ntsws tsis ua haujlwm.
- Renalua tsis tiav.
- cuam tshuam iliac thiab femoral hlab ntsha.
Lub sijhawm rov ua haujlwm tom qab phais
Tau kawg, qhov muaj teeb meem tom qab kev phais yog cuam tshuam los ntawm lub hnub nyoog thiab cov kab mob sib kis ntawm tus neeg mob. Tsis tas li ntawd, tus neeg mob tus mob yuav hnyav dua yog tias nws lub cev twb tsis muaj zog lawm (HIV, mob qog noj ntshav, ntshav qab zib), rog rog thiab mob plawv tshwm sim. Tsis tas li ntawd, kev npaj ua ntej ua rau tus neeg mob muaj txoj hauv kev zoo dua ntawm kev ciaj sia thiab rov zoo dua li kev cuam tshuam xwm txheej ceev rau kev puas tsuaj aortic aneurysm.
Cov teeb meem tuaj yeem tshwm sim raws li qhov tshwm sim rau kev siv tshuaj loog, uas tsis yog txhua tus neeg zam, kev loj hlob ntawm kev kis kab mob, kev puas tsuaj rau lub cev thiab los ntshav. Hauv cov neeg mob tsawg heev, kev ua haujlwm xaus rau kev tuag.
Yog tias npaj ua haujlwm, cov kws kho mob pom zoo kom txwv tsis pub cov ntshav thinners thiab tshuaj tiv thaiv kab mob (aspirin, thiab lwm yam) ib lub lis piam ua ntej kev ua haujlwm. Nco ntsoov qhia koj tus kws kho mob seb cov tshuaj twg koj tab tom noj ua ntej koj phais.
Kev pheej hmoo rov tshwm sim tsawg heev, tab sis yog tias ib tus neeg dheev pib txhawj xeeb txog qhov mob nraub qaum lossis plab, xeev siab, ntuav, loog ntawm ob txhais ceg lossis tsis xis nyob, koj yuav tsum mus ntsib kws kho mob tam sim.
kev tiv thaiv kab mob
Abdominal aortic aneurysm tsis tshua muaj tshwm sim yog tias koj tsis kam (thiab qhov zoo tshaj tsis tau txais tus cwj pwm no txhua) los ntawm kev haus luam yeeb, tswj koj cov ntshav siab thiab koj qhov hnyav. Nws tseem yog ib qho tseem ceeb rau kev coj noj coj ua thiab noj qab nyob zoo. Noj qab nyob zoo!
