Cov kab mob ntawm lub cev sab sauv yog qhov "tsim" nyuaj uas hloov ntshav los ntawm lwm cov hlab ntsha. Yog li ntawd, thrombosis ntawm cov hlab ntsha subclavian hloov pauv cov ntshav txav mus rau tag nrho caj npab.
Lub ntsiab lus thiab ua rau tshwm sim
Qhov ua rau thrombosis ntawm cov hlab ntsha subclavian yog cov hauv qab no:
- kev kub ntxhov los yog qeeb qeeb;
- tsis txaus ntshav txhaws (nyob rau hauv kev cuam tshuam ntawm txhua yam, vim muaj kab mob ntawm caj ces thiab caj ces);
- Cov hlab ntsha subclavian tuaj yeem tshwm sim los ntawm qhov loj thiab txawv txav ntawm pob txha loj hlob, uas tuaj yeem tshwm sim los ntawm pob txha pob txha los yog cov tsos ntawm qhov tsis zoo ntawm lub ncauj tsev menyuam tav.
Subclavian vein thrombosis tsuas yog tsis tshua muaj tshwm sim los ntawm cov ntshav txhaws tsim nyob rau lwm qhov hauv lub cev. Qhov no tshwm sim yog txuam nrog lub koom haum ntawm tib neeg circulatory system. Thrombosis ntawm lub sab sauv extremities tshwm sim los ntawm kev sib cais ntawm cov ntshav txhaws nyob rau hauv lub plawv cov leeg. Feem ntau, subclavian vein thrombosis tsis tshua muaj txiaj ntsig yog tias cov txheej txheem qeeb.
Symptomatics
Thrombosis ntawm cov hlab ntsha subclavian tshwm sim los ntawm kev ua kom lub cev ntau dhau thiab kev ntxhov siab. Qhov xwm txheej no ua lub luag haujlwm tseem ceeb hauv kev tsim cov thrombus. Qee zaum, cov ntshav txhaws tuaj yeem tawm tsis hais txog qib ntawm kev ua haujlwm ntawm lub cev, tab sis qhov no tshwm sim tsawg heev. Kev thaiv ntawm cov hlab ntsha subclavian muaj qhov tshwm sim nce lossis ploj, tshwm sim los ntawm influxes. Tsis muaj qhov tshwm sim loj heev los ntawm thrombosis, vim tias cov ntshav ncig tau hloov los ntawm lwm cov hlab ntsha. Txawm li cas los xij, cov ntshav no tsis txaus los ua kom tag nrho cov ntaub so ntswg ntawm cov ceg tawv. Hauv ICD-10, subclavian vein thrombosis muaj tus lej I82.8.
daim duab kho mob tseem ceeb
Cov tsos mob tseem ceeb ntawm subclavian vein thrombosis yog raws li hauv qab no:
- mob caj npab;
- ib lub ntsej muag ci ntsa iab ntawm daim tawv nqaij;
- mob hnyav ntawm caj npab nrog glossy sheen;
- cim qhia txog kev puas siab puas ntsws: limbness, twitching, thiab lwm yam.
Lwm cov tsos mob ntawm pathology
Cov tsos ntawm cov kab mob venous ntawm caj npab yog qhov nyuaj tsis pom, tshwj xeeb tshaj yog rau cov neeg tawv nqaij dawb. Txoj kab uas hla ntawm cov leeg yuav nyob ntawm qhov loj ntawm cov thrombus thiab qhov nce hauv thrombus hypertension.
Cov txheej txheem mob feem ntau yog pom thaum lub cev tawm dag zog. Qhov mob tuaj yeem tshwm sim tas li, pulsate, "bursting", tab sis nyob rau hauv txhua rooj plaub nws yog khaus heev. Feem ntau, qhov mob yog nyob thoob plaws ntawm caj npab, hauv thaj tsam ntawm lub xub pwg nyom thiab caj dab, thiab hauv qee qhovcov ntaub ntawv tseem nyob saum lub hauv siab thiab nraub qaum.
o tshwm sim ntawm caj npab tag nrho. Yog tias koj nias rau ntawm thaj chaw edematous, fossa tsis nyob hauv qhov chaw no. Tes acquires ib qho txawv heaviness thiab hardness. Yog tias cov txheej txheem o tau mus ntev heev, cov ntshav ncig tau cuam tshuam thiab ua rau muaj kev cuam tshuam, vim tias cov thrombosis ntawm cov hlab ntsha subclavian nkaus xwb.
Neurological disorder tshwm sim txawv rau txhua tus. Rau ntau tus, cov ntiv tes ntawm lub limb twitch, lawv xav tias tingling, kub hnyiab. Cov ceg tawv uas raug cuam tshuam yuav raug txwv hauv kev txav mus los.
Yog tias mob thrombosis ntawm cov hlab ntsha subclavian dhau mus ntev, daim duab kho mob ntawm tus kab mob yuav plooj thiab tsis meej. Puffiness thiab qauv ntawm cov hlab ntsha xyaum ploj mus. Feem ntau, tseem muaj qhov tsis tshua muaj tshwm sim ntawm cov leeg nqaij raug mob rau sab nraud stimuli, txwv kev ua haujlwm ntawm lub cev muaj zog, cov leeg nqaij atrophy thiab mob thaum lub cev hnyav. Qee qhov xwm txheej, kev xiam oob khab raug muab rau thrombosis ntawm cov hlab ntsha subclavian.
ntsuas ntsuas
Kev kuaj mob pib nrog kev sau ntawm anamnesis - uas yog, tus kws kho mob yuav tsum xam phaj tus neeg mob kom ntxaws txog cov tsos mob uas cuam tshuam nws thiab txog thaum twg thiab hom kev ua si ntawm lub cev tuaj yeem ua rau muaj qhov tshwm sim. Qhov no yog qhov tsim nyog txhawm rau txhawm rau txheeb xyuas seb cov txheej txheem thrombosis tau mus ntev npaum li cas.
txhawm rau kuaj mob ntev lossis mob hnyav ntawm cov hlab ntsha subclavian, siv cov kev kuaj mob hauv qab no:
- radiography thiab sib nqusresonance imaging los tsim qhov ua rau ntawm pathology thiab txheeb xyuas qhov chaw ntawm thrombus;
- subclavian leeg duplex scan;
- ntsuas ntshav ncig hauv cov leeg raug mob - dopplerography;
- x-ray;
- kuaj ultrasound (ultrasound) ntawm cov leeg sib sib zog nqus;
- venography;
- Computed tomography (CT) ntawm lub xub pwg girdle.
Kev kho mob
Yog tias tus kab mob no tshwm sim los ntawm kev siv catheter, ces nws yuav tsum tau muab tshem tawm. Yog hais tias cov hlab ntsha me ntsis clogged, ces mus rau hauv zos kho mob. Lub limb yuav tsum nyob rau hauv thiaj li hu ua functional so, ntxiv mus, tsis muaj elastic bandages thiab ua tiav lub txaj so yog xav tau ntawm no. Nyob rau hauv txoj hauj lwm kab rov tav, caj npab yuav tsum tau tsa me ntsis saum lub siab, thiab nyob rau hauv txoj hauj lwm ntsug, nws yuav tsum tau dai, khoov ntawm lub luj tshib, nrog ib daim ntaub qhwv los yog phuam qhwv caj dab. Hauv kev kho mob hauv zos, cov tshuaj hauv qab no tau siv:
- compresses raws li cawv (kwv yees li 50%);
- "Hepatrombin", "Liotongel" - tshuaj pleev, uas muaj heparin;
- gel zoo li tshuaj pleev nrog troxevasin thiab rutoside nyob rau hauv muaj pes tsawg leeg;
- tsis yog-steroidal tshuaj tiv thaiv kab mob xws li Indomethacin Ointment, Indovasin, Diclofenac.
Muaj me ntsis txog kev kho tshuaj
Yog tias tus kab mob ua rau mob hnyav thiab nrog cov tsos mob hnyav heev, ces tus neeg mob raug tso rau hauv tsev kho mob. Muaj kev kho mob muaj cov tshuaj hauv qab no:
- tshuaj fibrinolytic - Fibrinolysin, Streptokinase, Urokinase, thiab lwm yam.;
- tshuaj tiv thaiv kab mob;
- angioprotectors;
- tshuaj tiv thaiv ntshav txhaws (thawj ob peb hnub nws tuaj yeem yog "Heparin" thiab "Fibrinolysin", thiab tom qab ntawd siv "Phenylin", "Sinkumar", "Fraksiparin");
- tsis yog-steroidal tshuaj tiv thaiv kab mob.
Lub luag haujlwm tseem ceeb ntawm kev kho mob subclavian vein thrombosis nrog tshuaj yog los kho cov ntshav tsis zoo hauv cov hlab ntsha subclavian, Hais lus, kev kho tshuaj los ntawm ob hom tshuaj:
- tshuaj nrog cov tshuaj tiv thaiv kab mob uas pab ua kom cov ntshav txhaws thiab tiv thaiv cov tshiab (xws li "Heparin");
- tshuaj uas txhim kho cov metabolism hauv cov phab ntsa ntawm cov leeg, cov tshuaj tua kab mob thiab tshuaj tiv thaiv kab mob.
Thaum twg yuav phais?
Feem ntau cov tshuaj kho mob yuav kav ntev li ib mus rau ob peb lub hlis. Yog hais tias lub sij hawm no lub thrombus tsis tau daws, ces koj yuav tsum tau mus rau qhov kev pab cuam phais. Yog hais tias thrombosis ntawm cov hlab ntsha subclavian (sab laug los yog txoj cai) ntev dhau lawm, cov ntaub so ntswg necrosis ntawm sab sauv ceg yuav tshwm sim. Hauv qhov xwm txheej zoo li no, kev ua haujlwm kuj tau sau tseg, thaum lub sijhawm nws yuav tsum tshem tawm cov ntaub so ntswg uas tau tuag.
Txhawm rau tshem tawm cov ntshav txhaws, siv lub cuab yeej tshwj xeeb hu ua laparoscope. Nws nkag mus rau hauv cov hlab ntsha, ntes cov hlab ntsha thiab rub nws tawm. Rau lub hom phiaj no, ib tug me me incision yog ua nyob rau hauv armpit, uastso cai rau koj mus ze rau ntawm cov hlab ntsha subclavian, ib qho kev sib tsoo kuj ua rau hauv nws - laparoscope kis mus rau hauv nws. Nrog me ntsis raug mob rau cov phab ntsa vascular, ib tug tshwj xeeb catheter yog tso rau ntawd. Qee zaum, ib qho tshwj xeeb shunt tau muab tso rau hauv qhov chaw cuam tshuam ntawm cov leeg.
Nws tseem ceeb heev uas yuav tsum nco ntsoov tias yog tias tus neeg mob muaj kev sov siab, qhov mob ntse, muaj qhov o thiab cov txheej txheem ntawm liab lossis xiav ntawm lub xub pwg nyom, ces nws yog qhov ceev kom txuas txoj kev kho tshiab.. Tag nrho cov tsos mob no yuav qhia tau tias pulmonary embolism. Yog hais tias tus neeg mob tau kuaj pom muaj mob plab los yog gastritis, nws tau muab tshuaj suppositories. Tsis tas li ntawd, cov tshuaj "Aspirin" li niaj zaus raug tshem tawm los ntawm kev kho mob, nws yog ib qho tsim nyog los xaiv cov tshuaj ntawm tib lub zog, tab sis soluble hauv cov hnyuv. Txhawm rau kom tsis txhob rov tshwm sim dua thiab rov ua dua, cov tshuaj tiv thaiv kab mob yog siv los tiv thaiv kev ntsuas.
Qhov hnyav ntawm cov venous outflow thiab hnyav npaum li cas cov tsos mob thiab cov tsos mob ntawm tus kab mob tshwm sim lawv tus kheej raug cuam tshuam los ntawm qhov hnyav ntawm pathology ntawm cov hlab ntsha tseem ceeb, cov yam ntxwv ntawm kev tsim cov ntshav txhaws thiab tsim ntawm bypass. circulatory txoj kev. Yog tias tus neeg mob muaj idiopathic thrombosis, feem ntau nws yuav xav tau kev kho mob tshwj xeeb rau lub neej.
Surgery
Yog tias cov ntshav ncig los ntawm cov hlab ntsha yog qhov tsis zoo, thiab cov hlab ntsha ntawm cov hlab ntsha subclavian tau dhau mus ntev, ces mus rau ob hom kev phais hauv qab no.
Kho kom rov qab ntws tawm ntawm venousntshav. Txoj haujlwm no suav nrog ob peb kauj ruam:
- tshem tawm ntawm thrombus nws tus kheej, piv txwv li thrombectomy lossis recanalization;
- venous plasty: leeg grafting lossis bypass;
- phlebolysis, uas yog, kev sib cais ntawm lub nkoj los ntawm qhov ze tshaj plaws caws pliav nqaij, thiab scalenotomy, uas yog, qhov kev sib tshuam ntawm cov leeg uas nyob ib puag ncig cov pob ntawm cov hlab ntsha thiab cov hlab ntsha, lossis txawm tias tshem tawm cov ntu ntawm tus kheej. ligaments thiab nqaij.
Txhim kho cov ntshav tawm. Qhov no kuj suav nrog ob peb kauj ruam:
- tshem tawm cov teeb meem kev siv tshuab, tshwj xeeb ntawm cov pob txha loj hlob;
- cuam tshuam rau lub paj hlwb, xws li perivenous sympathectomy.
Yog tias daim duab kho mob tau tshaj tawm thiab tus neeg mob hnov cov tsos mob mob heev, tom qab ntawd kev phais tuaj yeem kho tau kwv yees li 3-4 hnub tom qab qhov mob thiab o tuaj yeem txo qis me ntsis, tab sis ua ntej cov ntshav txhaws tshwm thiab txuas rau phab ntsa leeg. Feem ntau cov ncig yog rov qab los tom qab thrombectomy. Tab sis qhov tshwm sim ntawm cov txheej txheem no tsis yog ib txwm ua tau los kwv yees. Heev feem ntau, thrombosis tshwm sim ntau zaus, thiab cov hlab ntsha nyob rau hauv qhov chaw uas muaj kev cuam tshuam kev phais tau ua twb nteg. Thaum lub thrombus tau raug tshem tawm, nws yog ib qho tsim nyog yuav tau tshem tawm cov xwm txheej uas tuaj yeem ua rau raug mob rau cov hlab ntsha subclavian. Rau lub hom phiaj no, lub hauv paus ntawm cov leeg subclavian, clavicle los yog cov txheej txheem ntawm thawj tav raug tshem tawm, tus nqi-coracoid ligament thiab cov nqaij ntshiv anterior scalene yog excised.
Bypass thiab amputationhands
Yog tias nws tsis tuaj yeem ua rau thrombectomy, thiab nyob rau hauv cov ntaub ntawv ntawm kev hloov ntawm tus kab mob mus rau ib tug ntev daim ntawv, tom qab tshem tawm cov deformed seem ntawm lub ntsiab hlab ntsha, lawv ua yas los yog resort rau shunting. Ib tug shunt, uas yog, ib tug bypass, yuav ua tau ib feem ntawm cov hlab ntsha jugular los yog ib tug loj saphenous leeg. Yog tias tus kab mob no kho tsis tau, ces txhais caj npab yuav tsum tau txiav.
Tiv thaiv kev tiv thaiv thrombosis
Subclavian vein thrombosis yog ib qho teeb meem uas tsis muaj leej twg tiv thaiv, nws tuaj yeem tshwm sim hauv lub neej ntawm txhua tus neeg. Txawm li cas los xij, yam uas yuav cuam tshuam rau kev loj hlob ntawm tus kab mob no tuaj yeem raug cais tawm. Muaj kev pheej hmoo ntawm thrombosis ntawm cov hlab ntsha subclavian vim yog abscess, uas yuav tsum tau muab tshem tawm raws sijhawm. Hauv ntau qhov xwm txheej, kev zam tus kab mob yuav luag tsis yooj yim sua. Tab sis muaj qee cov lus pom zoo uas tuaj yeem txo qhov kev pheej hmoo ntawm cov ntshav txhaws. Cov kev ntsuas no suav nrog kev tawm dag zog txhua hnub thiab kev tawm dag zog lub cev, taug kev hauv huab cua tsis tu ncua, noj zaub mov kom zoo thiab kho txhua yam kab mob raws sijhawm.
Kev tiv thaiv pej xeem tshuaj
txhawm rau ntxiv dag zog rau cov phab ntsa vascular thiab tswj kev ua haujlwm ntawm cov ntshav ncig, nws raug qhia kom tsis tu ncua haus tinctures los ntawm St. John's wort, cranberries lossis rosehips. Thiab qhov tseem ceeb tshaj plaws, raws li kev tiv thaiv kev tiv thaiv, nws tsim nyog mus ntsib kws kho mob ntawm thawj qhov mob tshwm sim nyob rau sab sauv sab sauv, txij li thrombosis nyob rau hauv thawj theem tau kho sai dua thiab yooj yim dua li qhov tsis saib xyuas.theem. Nws yog qhov zoo dua los tiv thaiv txoj kev loj hlob ntawm tus kab mob nyob rau lub sij hawm tshaj li kev daws nws cov txiaj ntsig tom qab. Yog tias koj xav paub txog subclavian vein thrombosis hauv ICD, ces tus kab mob no muaj tus lej I82.8.
