Abdominal aortic aneurysm: mob, mob, kev kho mob

Lub aorta yog cov coob leeg azygos. Nws belongs rau lub mauj kev thiab nourishes tag nrho cov kabmob ntawm peb lub cev cov ntshav. Lub aorta yog muab faib ua 3 khej thiab 2 qhov chaw - lub plab thiab thoracic. Feem ntau cov feem ntau (95%) pom ib tug aneurysm ntawm lub plab aorta, uas peb muaj niaj hnub no thiab peb mam li tham.

Aneurysm - yog ib tug extension los yog su ntawm lub aorta. Tus kab mob yog tseem lub hauv paus ntawm ntau cov kev sib tham, vim hais tias cov kws kho mob yuav tsis tuaj mus rau ib tug unanimous lub tswv yim, dab tsi degree ntawm expansion ntawm lub vascular phab ntsa yuav kuaj raws li ib tug aneurysm. Nyuam qhuav pib mob tau paub tseeb hais tias nrog nce nyob rau hauv lub aorta 2 lub sij hawm los yog nthuav nws txoj kab uas hla ntau tshaj 3 cm. Txawm li cas los, muab qhov tseeb hais tias lub aorta muaj ib lub cheeb ntawm 15 mus rau 32 cm, lub tswvyim ntawm "ntau tshaj 3 cm" obviously heev vague. Yog li ntawd, nyob rau hauv 1991, tsaug rau cov kev tshawb fawb ntawm American zaum pib aneurysm xam tau tias yog kev txawv txav o ntawm lub lumen ntawm lub aorta los ntawm 50% ntau tshaj qhov qub txoj kab uas hla. Tab sis qhov no txhais yog dog dig arbitrary.

Qhov no qhov teeb meem yog tshwj xeeb yog ib qho tseem ceeb nyob rau hauv cov kev xaiv ntawm tactics ntawm kev phais kev cuam tshuam, tab sis, alas, yog tseem qhib. Meanwhile, los ntawm lub aneurysm txhua xyoo tuag txog 15,000 Americans ib xyoos. Nyob rau hauv feem ntau, nws tsuas tsis tau lub sij hawm mus kuaj.

Yuav ua li cas tus kws kho mob tau kho ib tug aneurysm?

Nws hlub ib tug kab mob vascular kws phais neeg, raws li lub ntsiab kev kho mob rau ua hauj lwm cov teeb meem. Yog hais tias lub lag luam yog tsis muaj, tus neeg mob yuav tsum tau pom los ntawm ib tug kws kho mob, ib tug kws kho plawv lossis internist (tus kws sab hauv tshuaj) rau soj ntsuam lawv tus mob. Aneurysm heev insidious, nws yuav mam li nco dheev pib loj hlob, ua kev pheej hmoo ntawm cov loj tshaj plaws ntawm nws cov teeb meem - lub ntxi.

Leej twg thiaj yuav kis tau?

Ib aneurysm mob nyob rau hauv ob qho tib si cov txiv neej thiab cov poj niam (lub yav tas, li cas los xij, yog tsawg npaum li cas). Txawm li cas los, nws pom hais tias nyob rau hauv cov txiv neej laus dua 65 xyoo, nws tshwm sim ntau ntau zaus. Qhov no yog kev lom zem ntau vim rau qhov mob siab rau ntawm coob tus neeg haus luam yeeb, uas yog tshwj xeeb tshaj yog teeb meem rau cov laus uas muaj hnub nyoog.

Yog li ntawd, muaj kev pheej hmoo muaj xws li:

• cov neeg kev txom nyem los ntawm tawg;
• haus luam yeeb;
• chaw nyob rau hauv uas lub tsev neeg tau raug kuaj nrog ib tug aneurysm ntawm lub plab aorta los yog lwm yam kab mob thiab / los yog tus kab mob ntawm cov peripheral kev;
• tswv rog thiab cov neeg uas ua ib tug sedentary txoj kev ua neej.

Ceeb toom! Pov thawj kev tshawb fawb, ntau aneurysms yog pub los ntawm pog koob yawg koob.

Hom aneurysms ntawm lub plab aorta: kev faib

Abdominal aortic aneurysm muab faib ua ob peb hom nyob ntawm seb nws zoo lawm, localization thiab pathological nta:

1. Hnab (tsa ib lub hnab hais tias los ntawm lub ncauj tsev menyuam mob nrog rau lub lumen ntawm lub aorta).
2. Fusiform. Tus duab ntawm ib ntxaiv, uas yog kev cob cog rua ntawm ib tug qhib rau cov lumen ntawm lub aorta. Feem ntau daim ntawv ntawm aneurysm.

Raws li cov pathological cov yam ntxwv ntawm cov hauv qab no hom ntawm aneurysms:

1. Yeej muaj tseeb. Nws txhab ntsha phab ntsa, raws li tsim los ntawm ib tug plurality ntawm khaubncaws sab nraud povtseg ntawm cov aorta.
2. Pseudoaneurysm. Nws zoo nkaus li tom qab raug mob vim hais tias ntawm txoj kev loj hlob ntawm pulsating hematoma.
3. Exfoliating. I.e. nws cov phab ntsa delaminate thiab intramural kab noj hniav uas muaj cov ib tug hematoma, uas los ntawm lub phab ntsa ntawm lub puas vascular nqaij yog kev cob cog rua nrog lub lumen ntawm lub aorta.

Paub qhov txawv nruab nrab ntawm nws thiab localization:

1. Aneurysm ntawm lub infrarenal mob plab aorta yog saum toj no / hauv qab no lub raum cov hlab ntsha ceg.
2. Suprarenal yog saum toj no rau hauv lub branching cov hlab ntsha
3. Tag nrho cov aneurysm yog kis tus kab mob nrog rau tag nrho cov qhov ntev ntawm cov hlab.

Yuav ua li cas yog qhov ua rau ntawm aneurysms?

• Atherosclerosis, nyob rau hauv uas lub vascular phab ntsa yuav tuab thiab loses nws elasticity, thiab yog tsim nyob rau nws phab ntsa nyob rau hauv daim ntawv ntawm cov roj atherosclerotic plaques. Muaj pes tsawg leeg ntawm lub plaques xws li teeb meem cholesterol thiab lwm cov rog. Thaum cov kws kho mob tsis siab txiav txim yuav ua li cas nws muaj feem xyuam rau txoj kev loj hlob ntawm atherosclerosis, aneurysm, tab sis nws yog lam xav hais tias vim tus kab mob no tshwm sim lub plawv mob nyob rau hauv cov hlab thiab tsis mov ntawm cov as-ham. Raws li ib tug tshwm sim, lub vascular nqaij yog puas, raws li los ntawm nws cleavage. Raws li ib tug tshwm sim, tus mob no yog "mob plab aortic aneurysm".
• Mob ntshav qab zib uas "hlub" tawm ntshav leeg. Nws yog feem ntau nrog retinopathy, nephropathy, aneurysms.
• Noob caj noob ces. Nyob rau hauv ib co congenital syndromes (Ehlers -. Danlos syndrome, Marfan Erdheim pathologic cystic nrub nrab necrosis, thiab lwm yam) cov hlab ntsha uas cuam tshuam, xws li cov mob plab aorta. Nws yog feem ntau tau rau lw lub kev sib raug zoo ntawm cov aneurysm mob plab aorta thiab caj kab mob.
• Kis kab mob. Cov no muaj xws cov kab mob uas cuam tshuam rau lub puab txheej ntawm lub plawv (endokart) - syphilis, ekdokardit, tus kab mob salmonella, etc ...
• Cov kev raug mob mus rau lub plab mog. Piv txwv, thaum ib tug zog poob siab rau lub hauv siab los sis mob plab aorta tej zaum yuav cuam tshuam.
• Inflammatory dab. Nonspecific aortoarteriit, piv txwv li, ua rau ib tug weakening ntawm lub aortic phab ntsa. Txawm li cas los, tsis muaj ib yam ntaub ntawv nyob rau hauv no qhov teeb meem tsis tau. Tab sis tsis yog-inflammatory kab mob ntawm lub vascular phab ntsa nquag tshwm sim vim atherosclerotic plaques.

Nyob rau hauv kev, feem ntau qhov ua rau ntawm aneurysms yog haus luam yeeb, lub cev inactivity thiab muaj hnub nyoog. Nws yog tsis tshua muaj ib qho tseem ceeb rau kev tshawb nrhiav nws nyob rau hauv lub sij hawm. Aneurysms ntawm lub thoracic thiab mob plab aorta muaj ntau cov tsos mob, cov uas peb tam sim no xav txog.

Yuav ua li cas yog cov tsos mob ntawm tus mob plab aortic aneurysm department?

Feem ntau cov feem ntau, aneurysms yeej tsis ua rau nws tus kheej muaj, thiab thiaj paub tias yog los ntawm lub caij nyob rau hauv cov kev sojntsuam. Raws li nws kev txav cov kabmob, cuam tshuam lawv muaj peev xwm ua neej nyob, nws yuav tsum paub hais tias yog lawm, vim hais tias nws yog qhov tseem ceeb rau kev ib tug mob plab ultrasound. Cov kws kho mob nco ntsoov tias tshwj xeeb tshaj yog "secretive" thoracic aneurysm. Nws yuav tsis tau qhia nyob tag nrho los yog ua rau mob hauv siab, hnoos thiab txog siav. Nyob rau hauv rooj plaub zuj zus num yog tau txais aneurysm ntawm lub plab aorta.

Ntawm ob peb cov tsos mob aneurysm faib ib co uas tshwm sim ua ke los yog nyias:

1. Heaviness nyob rau hauv lub plab, qhov tsis kaj siab nov ntawm nqaij tawv ntawm fullness thiab mem tes, uas tsa lub amplified lub plawv dhia.
2. Mob plab, me me, es, mob tej, npub cim. Nws yog laus txoj cai nyob rau hauv lub umbilicus los yog sab laug.

Thiab indirect tej yam tshwm sim ua rau nws tus kheej muaj mob plab aortic aneurysm. Nws cov tsos mob no thiaj li sib txawv uas lawv xav tias qhov tseeb qhov teeb meem yog heev yooj yim. Qhov no yog vim lub fact tias ib tug zuj zus aneurysm peev xwm cuam tshuam ntau yam nruab nrog cev thiab tshuab. Raws li ib tug tshwm sim, nws yuav tsis meej pem raum Colic, pancreatitis, los yog sciatica.

Ishioradikulyarny syndrome ua mob nyob rau hauv lub qis rov qab (nyob rau hauv particular, lub duav rov sauv) thiab ntxaug rhiab heev nyob rau hauv lub ob txhais ceg nrog ib tug muaj zog tsis meej.

Abdominal syndrome manifested los ntawm ntuav, belching, raws plab los yog cem quav, raws li zoo raws li tsis muaj qab los noj mov, uas ua rau yus poob phaus.

Mob ischemia ntawm ob txhais ceg yog qhia nyob rau hauv yuam cai ntawm kev (txias ko taw), leeg mob thaum lub sij hawm taug kev thiab thaum so, periodic lameness.

Prostate ntoo tshaj tawm nws tus kheej urinary mob, mob, zoo nkaus li ntawm heaviness nyob rau hauv lub qis rov qab, thiab txawm lub tsos ntawm cov ntshav liab nyob rau hauv cov zis.

Kev sib tawg ntawm lub plab aortic aneurysm pib nrog ib tug nce ntawm qhov mob nyob rau hauv lub plab mog, kev tsis muaj zog thiab kiv taub hau. Tej zaum tus mob muab rau lub duav rov sauv, puab tais los yog crotch. Nyob rau hauv cov ntaub ntawv no rau tus neeg mob xav tau kev pab kiag tam sim ntawd kev kho mob, vim lub xeev yog fraught nrog txoj kev tuag. Feem ntau cov aneurysm so nyob rau hauv nruab nrab ntawm cov hnyuv, lub plab los yog lub duodenum, yam tsawg kawg - mus rau hauv ib tug tuab plab. Thaum nraus mob plab aortic aneurysm, cov tsos mob tej zaum yuav tsum tau nrog los ntawm xeev siab thiab ntuav. Nyob rau hauv rau sab laug pane ntawm lub plab mog yog palpated kev kawm ntawv yog qhov maj mam nce thiab nrog ib tug muaj zog surge. Nws ib thaj tsam tsis palpated.

Thaum kev sib tawg ntawm lub aneurysm mob heev ci, tab sis lawv yog yooj yim meej pem nrog lwm yam kev kho mob tej yam kev mob, yog li yuav tsum hu rau ib tug tsheb thauj neeg mob rau tej yam ntawm mob mob nyob rau hauv lub plab mog los yog hauv siab.

mob ntawm tus kab mob no

Tus thawj diagnostic theem - kev xeem, uas nyob rau palpation pom tau tias ib tug zog mem nyob rau hauv lub plab mog, nws yog ib lub plab aortic aneurysm. Diagnosing nws muaj xws li kev tshawb fawb uas tso cai rau yuav pom tau dab tsi tshwm sim nyob rau hauv lub plab kab noj hniav. Ua ntej ntawm tag nrho cov, nws yog ultrasound, thiab xoo tomography (i) thiab multislice xoo tomography ntawm lub aorta (MSCT).

Yog hais tias nws yog xav tias mob plab aortic aneurysm, ultrasound tso cai yuav luag tsis paub tseeb kom paub meej tias nws xub ntiag. Nws qhia tau hais tias lub caij nyoog qhov chaw ntawm lub aneurysm, lub xeev ntawm cov vascular phab ntsa, qhov chaw ntawm cov kis, yog hais tias nws yuav siv sij hawm qhov chaw.

CT los yog MSCT ua kom paub tias calcification, aortic thrombosis vnutrimeshkovy, tso hem thawj los yog zom ib tug uas twb muaj lawm ntxi.

Yog hais tias lub diagnostic kev ntsuam xyuas uas tau teev tseg saum toj no tsis pub muaj tseeb mob (txawm hais tias qhov no yog heev tsawg) tsa los ntawm aortography. Cov kev tso cai real-time saib lub aorta thiab nws cov ceg los ntawm qhia tshwj xeeb kua rau hauv cov hlab. Nws qhia tau hais tias yog hais tias muaj yog lub sijhawm twg los ntawm lesion ntawm visceral thiab raum cov hlab ntsha, paub lub xeev ntawm cov distal plawv txaj.

Teeb meem ntawm mob plab aortic aneurysm

Qhov no mob yog txaus ntshai tsis tsuas yog rau cov kev kho mob tab sis rau lub neej. Ua ntej ntawm tag nrho cov, cov aorta yuav ua rau ib tug embolism (txhaws) ntawm cov hlab ntsha, mob mob, tsim lub plawv tsis ua hauj lwm.

Dissecting mob plab aortic aneurysm - ib tug txaus ntshai yam tab kaum uas yog nws cov kev sib tawg thiab ntshav nkag mus rau hauv vascular khaubncaws sab nraud povtseg ntawm lub cev. Yog hais tias tag nrho cov stratified txheej 3 thiab lub aorta so kiag li, yog khaus ntshav poob.

Tab sis, ntawm chav kawm, qhov phem tshaj mob aneurysm - yog nws ib tug so. Muaj ntau cov neeg mob uas tsis kho aneurysms yuav tuag tsis pub dhau 5 xyoo. Ua ntej koj yuav rho ib tug neeg pom tau tias mob nyob rau hauv lub plab mog thiab nyob rau hauv lub lumbar cheeb tsam. Yog hais tias ib tug aneurysm ntawm lub plab aorta nraus, tus kab mob no yog yus muaj los ntawm profuse los ntshav uas ua rau yus poob siab thiab kev tuag. Yog li ntawd yeej hu tsheb thauj neeg mob nyob rau hauv cov ntaub ntawv ntawm mob mob nyob rau hauv lub plab mog thiab hauv siab, raws li qhov kev ncua yog txaus ntshai. Txheeb cais qhia tias tsuas yog 3% ntawm cov neeg mob tuag sai li sai tau tom qab kev sib tawg ntawm lub aorta, thaum lwm tus neeg nyob ntawm 6 teev mus rau 3 lub hlis. Nyob rau hauv feem ntau tus neeg mob, lawv tuag tsis pub dhau hnub. Yuav ua li cas yuav kho ib tug aneurysm? Xav txog cov nram qab no.

Kev kho mob ntawm aneurysms mob plab aorta

Muaj coob tus neeg tsuagzog ntseeg hais tias tus mob "aneurysm ntawm lub plab aorta," kev kho mob yuav tsuas yuav phais. Nyob rau hauv qhov tseeb, muaj tag nrho ib lub zuj zus.

Yog hais tias lub aneurysm nce mus txog 4.5 cm nyob rau hauv txoj kab uas hla, lub lag luam yog tsis muaj, vim hais tias nws muaj peev xwm nqa ib tug ntau dua uas yuav muaj rau lub neej tshaj qhov nce nyob rau hauv loj txog ntsha. Feem ntau, xws li ib tug qauv tau raug cai nyob rau hauv cov laus uas raug kev txom nyem los ntawm co-morbidities, thiab nyob rau hauv tas li ntawd tsis txhob haus luam yeeb (thiab nrog xws li ib tug mob nres haus luam yeeb cia li xav tau!). Rau lawv, ib tug tos kev ua si, vim hais tias cov kev pheej hmoo ntawm aortic rupture nyob rau hauv xws txoj kab uas hla tsuas yog hais txog 3% tauj ib xyoos. Nyob rau hauv cov ntaub ntawv no, txhua txhua rau lub hlis tus neeg mob yog yuam kom ua ultrasound mus nrhiav tau tawm qhov loj ntawm lub aorta. Yog hais tias lub vascular phab ntsa maj expands, nws yog cov thawj hais rau kev phais, vim hais tias qhov tshwm sim ntawm puas yog nce ntawm 50%.

Cov neeg laus, uas qhia ib qho aneurysm ntawm lub plab aorta, qhov kev kho mob yog desirably nqa tawm los ntawm txhais tau tias ntawm ib tug endovascular, tsawg kawg tus qauv. Thaum lub sij hawm lub lag luam, tus neeg mob yog muab mus rau hauv lub artery ib tug catheter los ntawm kev uas muaj stent. Ntes tau nyob rau hauv lub aorta, nws yuav qhib thiab npog leeg, li no hloov cov cheeb tsam ntawm nws lub cev. Cov kev pab cuam ntawm lub lag luam muaj xws li ib tug khaub-ncaws nyias tsiv ib tug me me thiab rov qab lub sij hawm - tsuas yog ib tug ob peb hnub. Tab sis qhov no method muaj nws tus kheej nuances, li ntawd, nyob rau yog tsis yog txhua txhua. Lub ntsiab drawback ntawm lub lag luam no - mus rau 10% ntawm cov neeg muaj tus distal tsiv teb tsaws ntawm cov tsim kev muag zaub.

Yog hais tias mob "mob plab aortic aneurysm", lub lag luam yog feem ntau qhib. Thaum lub sij hawm nws cov cheeb tsam ntawm lub aorta raug tshem tawm thiab hloov los ntawm ib tug prosthesis ua los ntawm Dacron (hluavtaws ntaub based on polyester). Nyob rau hauv thiaj li yuav muab kev nkag tau mus rau lub aorta, siv median laparotomy. Duration ntawm kev phais feem ntau yog hais txog 2-3 teev. Tom qab muab hlais tawm lawm tseem pom caws pliav.

Tus neeg mob zoo tu qab tso ob lub lis piam. Resumption ntawm ua hauj lwm nyob rau hauv tej rooj plaub yog tau tsuas yog tom qab 4-10 lub lis piam. Tus neeg mob yog txwv tsis pub lub cev ua si, qhia tau hais tias kev thaj yeeb thiab mus taug kev.

Contraindications qhib phais

Txwv tsis pub phais raws li nram qab no:

• Tsis ntev los no myocardial infarction (tsis tsawg tshaj li ib lub hlis).
• Plawv thiab pulmonary insufficiency.
• Raum insufficiency.
• Iliac thiab femoral cov hlab ntsha.

Rehabilitation tom qab phais

Ntawm cov hoob kawm, tus muaj muaj teeb meem tom qab phais cuam tshuam rau tus neeg mob lub hnub nyoog thiab txuam kab mob. Tsis tas li ntawd, tus neeg mob tus mob tej zaum yuav paug yog tias nws lub cev twb tsis muaj zog txaus (HIV, Oncology, mob ntshav qab zib), muaj rog thiab kab mob plawv. Ntxiv mus, pre-teem sij hawm zov me nyuam muab tus neeg mob feem ntau yuav kom ciaj sia thiab rov qab tshaj li thaum muaj xwm ceev cov kev pab ntawm kev sib tawg ntawm ib tug aortic aneurysm.

Mob tej zaum yuav tshwm sim raws li ib tug tshuaj tiv thaiv rau kom tsaug zog, uas tsis muaj tag nrho, txoj kev loj hlob ntawm kab mob, kev puas tsuaj rau hauv nruab nrog cev thiab los ntshav. Tus heev me me naj npawb ntawm cov neeg mob yog tuag lub lag luam.

Yog hais tias kev phais los, cov kws kho mob pom zoo kom ib lub lim tiam ua ntej nws nqa tsis txhob noj cov tshuaj, cov ntshav nyias, thiab anti-inflammatory siv tshuaj (cov tshuaj aspirin thiab lwm tus neeg.). Nco ntsoov qhia rau koj tus kws kho mob hais txog dab tsi zoo ntawm cov tshuaj uas koj noj thaum lub caij, ua ntej lub lag luam.

Qhov uas tsis tshua mob heev yog tsis tshua muaj me me, tab sis yog ib tug neeg mam li nco dheev pib disturb tus mob nyob rau hauv lub rov qab los yog plab mog, xeev siab, ntuav, xws li loog loog nyob rau hauv lub ob txhais taw los yog ib tug general lawm unwell, yuav tsum nrhiav kev kho mob tam sim ntawd.

Kev tiv thaiv aneurysm

Abdominal aortic aneurysm tshwm sim koj yuav tsis yog tias koj kam (thiab, hom phiaj, tsis tau tus cwj pwm), haus luam yeeb, yuav tswj lub siab thiab koj qhov ceeb thawj. Nws tseem ceeb heev los mus ua ib tug active thiab noj qab nyob zoo txoj kev ua neej. Nyob twj ywm noj qab nyob zoo!