Tus kab mob dab tsi tuaj yeem ua rau tib neeg cov hlab ntsha tuaj yeem raug rau? Vim li cas qhov teeb meem no tshwm sim, thiab yuav kho li cas? Peb yuav teb cov lus nug no thiab lwm cov lus nug hauv tsab xov xwm nthuav tawm.
cov ntaub ntawv dav dav
Ileofemoral thrombosis yog ib qho thrombosis uas cuam tshuam rau qhov tob femoral thiab iliac veins. Tus kab mob no tau muab tso rau hauv ib daim ntawv cais, vim tias nws yog ib qho kev mob hnyav heev thiab muaj kev pheej hmoo ntawm kev loj hlob ntawm pulmonary embolism.
Tus yam ntxwv ntawm tus kab mob
Ileofemoral thrombosis tuaj yeem tsim tsis tau tsuas yog hauv cov neeg laus, tab sis kuj tseem yog menyuam yaus. Nyob rau hauv cov ntaub ntawv no, xws li ib tug kab mob tshwm sim, thiab kev kho mob zoo heev. Cov menyuam yaus feem ntau tsis tau tsim muaj pulmonary embolism lossis rethrombosis.
Raws li cov neeg laus, rau lawv tus kab mob no coj nrog nws cov teeb meem loj heev. Yog li ntawd, nws yog ib qho tseem ceeb heev uas yuav tau txheeb xyuas lub sijhawm.
Cov tsos mob tseem ceeb
Thrombosis uas tau tsim nyob rau hauv cov leeg femoral lossis iliac leeg yog nrog los ntawm cov tsos mob xws li:
- me me xim av dots uas protrude ntawm ob txhais ceg thiab tsis ploj thaum nias;
- lub cev kub;
- muaj zogo uas tuaj yeem pom ntawm ob sab ceg qis lossis ntawm ib qho ntawm lawv;
- ntshav liab lossis xiav xim ntawm daim tawv nqaij;
- maj mam mob zuj zus ntawm ib lossis ob txhais ceg, thiab hauv puab tais (qee zaum).
Cov tsos mob ntawm tus mob thrombosis. Qib
Mob ileofemoral thrombosis muaj ntau theem ntawm kev loj hlob. Nyob ntawm lawv, cov tsos mob ntawm tus kab mob yuav muaj lawv tus kheej yam ntxwv. Xav txog lawv kom ntxaws ntxiv:
- Prodromal theem. Nyob rau theem ntawm tus kab mob no, tus neeg mob ntsib qhov mob ntawm ntau yam hauv zos. Lawv tuaj yeem hnov hauv thaj tsam lumbosacral, lub plab hauv plab, thiab tseem nyob rau thaj tsam cuam tshuam hauv qis qis. Qhov mob syndrome yog mob thiab npub nyob rau hauv qhov xwm txheej. Tus neeg mob kuj muaj qhov kub thiab txias hauv lub cev.
- theem ntawm cov tsos mob hnyav. Nws yog characterized los ntawm lub manifestation ntawm classical triad. Hauv lwm lo lus, tus neeg mob muaj qhov mob hnyav, ua kom tawv nqaij thiab mob. Los ntawm txoj kev, tom kawg yog hnov nyob rau hauv lub gastrocnemius nqaij, inguinal cheeb tsam thiab anteromedial nto ntawm tus ncej puab. Qhov xwm ntawm qhov mob yog khaus thiab diffuse. Raws li rau edema, nws captures tag nrho cheeb tsam thiab kis ntawm puab tais mus rau ko taw. Qee lub sij hawm qhov o tau pom ntawm cov leeg gluteal thiab ua ke nrog kev zoo siab ntawm kev puv thiab kev xav ntawm qhov hnyav hauv qis qis.
Vim qhov tseeb tias cov ntaub so ntswg edematous tawm dag zog rau cov hlab ntsha, muaj kev ua txhaum ntawm cov ntshav khiav, spasm thiab mob ischemia ntawm ob txhais ceg tsim, qhia hauv ntse.mob, tsis muaj rhiab heev thiab pulsation ntawm cov hlab ntsha.
Raws li tau hais los saum toj no, ib qho ntawm cov tsos mob ntawm tus kab mob hauv nqe lus nug yog kev hloov xim ntawm daim tawv nqaij. Lawv tej zaum yuav daj ntseg los yog cyanotic nyob rau hauv cov xim. Dawb xim tshwm sim vim spasm ntawm cov hlab ntsha uas txuam nrog. Cov mob no yog nrog los ntawm mob hnyav syndromes. Cov xim xiav lossis xim cyanotic tau pom thaum lub iliac lossis femoral artery tsis ua nws txoj haujlwm ncaj qha, uas yog, cov ntshav tawm los ntawm lawv yuav luag tag nrho. Hauv qhov no, cov tsos mob tseem ceeb heev yog qhov qhia tau hais tias cov kab mob saphenous pom ntawm tus neeg mob tus ncej puab.
Feem ntau, ileofemoral thrombosis yog tus cwj pwm los ntawm kev txaus siab ntawm tus neeg mob. Txawm li cas los xij, nrog rau kev loj hlob ntawm tus mob hnyav, nws tuaj yeem ua rau mob hnyav heev. Qhov no qhia txog qhov pib ntawm qee qhov teeb meem loj.
Vim txoj kev loj hlob
Tib neeg txoj hlab ntshav tuaj yeem hloov pauv ntau yam. Feem ntau, cov neeg mob muaj qhov sib sib zog nqus vein thrombosis. Cov kab mob zoo li no tshwm sim vim cov ntshav khiav qeeb thiab tsis ua rau cov ntshav txhaws, nrog rau kev puas tsuaj rau cov phab ntsa venous.
Kev loj hlob ntawm ileofemoral thrombosis tuaj yeem tshwm sim nyob rau hauv muaj ib qho, thiab muaj ntau yam. Cov kws tshaj lij tham txog cov ntsiab lus hauv qab no uas ua rau muaj qhov tshwm sim ntawm tus kab mob no:
- raug mob;
- ntev txaj so;
- DIC;
- kab mob uas muajkab mob keeb kwm;
- lub sijhawm postpartum;
- kev tswj yug me nyuam;
- xeeb tub;
- malignant thiab benign pelvic masses;
- aneurysms ntawm iliac thiab femoral hlab ntsha, nrog rau lub plab aorta;
- popliteal cysts;
- Yretroperitoneal fibrosis;
- iatrogenic sib sib zog nqus vein raug mob.
feem ntau ua rau
Feem ntau, ileofemoral thrombosis ntawm qis extremities, tus cwj pwm los ntawm stagnation ntawm cov ntshav nyob rau hauv cov leeg, tsim thaum cev xeeb tub. Tsis tas li, tus kab mob no tuaj yeem tshwm sim los ntawm kev ua haujlwm ntev ntev thiab tsis txaus ntawm cov hlab ntsha venous.
Ib yam tseem ceeb hauv kev txhim kho tus kab mob hauv nqe lus nug yog cov kab mob ntawm hemocoagulation, suav nrog kev yug los lossis kis tau tus mob thrombophilic.
Diagnosis
Yuav ua li cas txo qis thrombosis kuaj mob? Cov tsos mob ntawm tus kab mob no yog heev pronounced. Tab sis ntxiv rau kev kuaj xyuas sab nraud ntawm tus neeg mob, cov kws kho mob feem ntau siv rau lwm txoj hauv kev tshawb fawb, uas tau nthuav tawm hauv daim ntawv:
- fibrinogen scan;
- duplex scan;
- radionuclide phlebography, uas yog ua tau yog tias tus neeg mob tsis kam rau cov tshuaj radiopaque;
- descending lossis ascending radiopaque phlebography.
Kev kho mob
Ileofemoral thrombosis yuav tsum tau kho raws nraim tib yam li lwm hom thrombosis. Feem ntau, kev kho tus kab mob no yog nqa tawm hauv tsev kho mob. Nws yog raws li kev noj cov tshuaj hauv qab no:
- tshuaj tiv thaiv kab mob;
- tshuaj tiv thaiv kab mob;
- tshuaj tiv thaiv kab mob.
Yog tias cov hlab ntsha iliac lossis femoral tsis cuam tshuam loj heev, thiab tus kab mob yog nyob rau theem pib ntawm kev loj hlob, ces cov tswv yim uas ua rau kom tawg ntawm cov hlab ntsha tuaj yeem siv los kho nws.
Yog tias muaj kev hem thawj ntawm thromboembolism, ces nws txoj kev tiv thaiv yog ua tiav. Cov txheej txheem no yog nqa tawm nrog kev pab los ntawm ligation ntawm lub femoral leeg, lub installation ntawm cava lim los yog plication ntawm inferior vena cava.
Yog tus neeg mob muaj mob ileofemoral thrombosis, ces lawv raug thauj mus rau tsev kho mob. Hauv qhov no, tus neeg mob yuav tsum nyob hauv txoj hauj lwm supine. Ua ntej qhov kev ntsuam xyuas, nws raug xa mus pw so, tom qab ntawd lawv ua ultrasound scan thiab phlebography.
Yog tias tsis muaj kev kuaj mob rau tus neeg mob, tom qab ntawd, nyob rau hauv kev saib xyuas ntawm cov kws kho mob tshwj xeeb, nws tau sau tshuaj tiv thaiv kab mob, uas yuav tsum tau noj rau kaum hnub.
Raws li cov kws tshaj lij, mob venous thrombosis yuav tsum tau kho kom dav, siv peb pawg tshuaj:
- thrombolytics lossis fibrinolytics;
- anticoagulants;
- tsis sib haum.
Nws yuav tsum tau muab sau tseg tias kev kho mob anticoagulant yog raws li kev siv cov lus hauv qab no:
- qis molecular hnyav heparins;
- unfractionated heparins;
- Fondaparinux pentasaccharide.
Nrog rau kev txhim kho ntawm thrombolysis, uas yuav tsum tau siv streptokinase lossis urokinase, kev tuag ntawm cov neeg mob nce ntau vim qhov nce ntawm cov ntshav ntau. Hauv qhov no, txoj kev no tsuas yog siv rau hauv qhov xwm txheej hnyav, piv txwv li, yog tias muaj cov kab mob thrombosis tau nthuav dav tsis ntev los no, uas yog, tsis pub dhau ib lub lis piam dhau los.
Thrombolytic kho rau ileofemoral thrombosis yog nqa tawm tom qab lub cava lim tau teeb tsa. Qhov no yog vim qhov tseeb tias qhov kev kho no txhawb nqa kev hloov pauv ntawm cov ntshav txhaws mus rau cov hlab ntsha pulmonary, uas tuaj yeem ua rau muaj kev loj hlob ntawm thromboembolism.
Surgery
Nyob rau hauv ileofemoral thrombosis, muaj ntau yam kev cuam tshuam kev phais. Nws tau ua raws li cov cim tseem ceeb thiab nyob ntawm qhov kev pheej hmoo ntawm kev tsim pulmonary embolism.
Nws tseem yuav tsum tau sau tseg tias kev ua haujlwm feem ntau ua thaum muaj kev hem thawj ntawm cov kab mob venous thiab thaum cov txheej txheem pathological kis mus rau qhov tsis zoo vena cava.
Koj tuaj yeem tshem tawm cov thrombus tsim nyob rau sab laug iliac leeg retrograde. Cov txheej txheem no yog ua los ntawm kev qhib phlebotomy, uas yog ua nyob rau hauv cov hlab ntsha femoral. Nws yuav tsum tau muab sau tseg tias qhov kev xaiv no tsis yog ib txwm ua tau, txij li txoj cai iliac leeg tuaj yeem ua rau lub siab loj.
Raws li cov lus hais ntawm cov kws tshaj lij, kev ua haujlwm tshem tawm cov ntshav txhaws yuav tsum tsis txhob ua thaumCov txheej txheem nplaum tshwm sim nyob rau hauv lub lumen ntawm cov leeg, thiab nyob rau hauv lub xub ntiag ntawm intravascular septa.
Kev nyuaj siab
Yog tias mus ntsib kws kho mob tsis tu ncua, nrog rau kev kho mob tsis raug ntawm ileofemoral thrombosis, tus neeg mob tuaj yeem tsim teeb meem txaus ntshai nyob rau hauv daim ntawv ntawm pulmonary embolism. Yog li ntawd, nws yog ib qho tseem ceeb heev kom nkag siab tias thaum saib cov tsos mob, nrog rau kev xav tias thrombosis, koj yuav tsum hu rau tus kws kho mob tam sim ntawd.
tiv thaiv kab mob
Txhawm rau zam qhov tshwm sim ntawm tus kab mob hauv nqe lus nug, nws yuav tsum tau ua txhua yam kev tiv thaiv kev tiv thaiv uas yog txhawm rau txhawm rau txhim kho tus neeg mob thiab nws cov hlab ntsha tshwj xeeb.
Kuj, tus yuam sij rau lub neej ntev thiab noj qab haus huv yog kev ua haujlwm nruab nrab thiab noj zaub mov kom raug.
Txhawm rau kom zam dhau qhov kev loj hlob ntawm thrombosis, tus neeg mob yuav tsum ua tib zoo saib xyuas nws txoj kev ua neej. Koj yuav tsum tshem tawm txhua tus cwj pwm phem thiab mus ntsib kws kho mob tsis tu ncua.
Yog hais tias tus kab mob ntawm lub venous system twb pib tsim, nws yog tsim nyog los soj ntsuam tag nrho cov kev tiv thaiv kev tiv thaiv uas yog aimed ntawm tiv thaiv kom txhob muaj teeb meem. Cov txheej txheem no suav nrog kev tshem tawm tag nrho cov kev pheej hmoo, kev ua haujlwm nruab nrab, nrog rau kev xaiv cov tshuaj tiv thaiv kab mob thiab tshuaj tiv thaiv kab mob.
Raws li cov kws tshaj lij, ileofemoral thrombosis yog ib yam kab mob loj heev uas tuaj yeem ua rau muaj kev puas tsuaj loj rau tib neeg kev noj qab haus huv. Txawm li cas los xij, nws yuav tsum raug sau tseg tias tus kab mob no kho tau, suav nrog yog tias nwstau pib raws sij hawm. Qhov tseem ceeb tshaj plaws yog tsis txhob poob siab thiab tsis tso tseg, tab sis ua raws li tag nrho cov lus pom zoo ntawm tus kws kho mob paub txog.
