Besisu kwemithambo aortic: iimpawu, isifo, unyango

Le aorta yeyona azygos inkulu umthambo. Lingcwaba lomfo kwegazi kwaye ondla onke amalungu igazi emzimbeni wethu. Le aorta yahlulwe yangamacandelo 3 nezahlulo-2 - esiswini kunye thoracic. Amaninzi (95%) bafumana kwemithambo le aorta esiswini, nto leyo esiyifumana namhlanje kwaye siza sithethe.

Kwemithambo - sisongezelelo okanye equmbile le aorta. Esi sifo nangoku ngenxa iingxoxo ezininzi, kuba oogqirha akakwazi ukuza uluvo elizenzayo ilingene ukwandiswa udonga nemithambo ukuba une i kwemithambo. ehlolwa baqiniswa kunye nokwanda aorta ka-2 okanye ukwandisa ubukhulu bayo ngaphezu kwama-3 cm. Noko ke, ngenxa yokuba aorta unalo ububanzi of cm-15 ukuya 32, imbono "ngaphezulu kwe-3 cm" ngokucacileyo ngendlela engacacanga. Ngoko ke, ngo-1991, enkosi uphando zezazinzulu American baqalisa kwemithambo ingqalelo ukukhula engaqhelekanga le mithambo le aorta nge-50% ngaphezu ubudeki yayo yesiqhelo. Kodwa le nkcazo thile ngokwesigqibo esicalanye.

Lo mba ubaluleke kakhulu ekukhetheni ngamaqhinga zokungenelela ngotyando, kodwa, yeha, namanje evulekile. Ngelo xesha, ukususela kwemithambo kunyaka ngamnye ubulala malunga 15,000 baseMerika ngonyaka. Kwiimeko ezininzi, oko nje ayinayo ixesha basibone.

Yintoni ugqirha selapha i kwemithambo?

Iziphatha isifo ugqirha semithambo, njengoko unyango esingundoqo iingxaki zokusebenza. Ukuba umsebenzi ayiboniswanga, isigulane kufuneka babonwe gqirha, a cardiologist okanye internist (yingcali internal medicine) esweni ngokusondeleyo imeko yabo. Kwemithambo kakhulu eziyingozi, oko ngesiquphe uqale ukukhula, okwandisa ingozi ezimbi kakhulu iingxaki zayo - umsantsa.

Ngubani na isengozini?

An kwemithambo unesifo kokubini amadoda nabafazi (le yokugqibela, Noko ke, lingaphantsi kakhulu). Noko ke, waphawula ukuba amadoda amadala ngaphezu kweminyaka engama-65, oko kwenzeka rhoqo. Oku kwenzeke ubukhulu becala ngenxa angathabatheki abantu abaninzi ukuba ukutshaya, nto leyo yingozi ingakumbi ebudaleni.

Ngoko ke, engozini ziquka:

• abantu abaphethwe wegazi;
• oqalayo;
• amaqumrhu apho usapho kuye kwafunyaniswa ukuba kukho kwemithambo le aorta esiswini okanye esinye isifo sentliziyo kunye / okanye isifo kwegazi peripheral;
• abanini abatyebe kunye nabantu abaphila ukuphila umzimba.

Isilumkiso! uphando engqinekayo, aneurysms abaninzi lilifa izinyanya.

Iintlobo aneurysms le aorta esiswini: yokuhlela

kwemithambo ngenzolo aortic yohlulwe iintlobo ngokuxhomekeke yayo imilo, ukuthengwa kunye neempawu zophendlo lwezifo:

1. Sac (kufana kwisingxobo ukuba wesibeleko enxulumene mithambo le aorta).
2. Fusiform. Imilo osimelela ngentonga, oludityaniswe ngomngxuma le mithambo le aorta. Ifom oqhelekileyo kwemithambo.

Ngokutsho iimpawu zophendlo lwezifo kwezi ntlobo zilandelayo aneurysms:

1. True. kwandiswa udonga lwayo isitya, njengoko wambumba umntu ezininzi kweengqimba le aorta.
2. Pseudoaneurysm. Kubonakala emva ukwenzakala ngenxa kuphuhliso hematoma eliguquguqukayo.
3. Exfoliating. Ngamanye iindonga zayo delaminate kunye kwisisu intramural ezaliswe hematoma, owathi ngenxa eludongeni yokuvelisa amalungu nemithambo edibene mithambo le aorta.

Ukwahlula phakathi kuyo kunye eyendawo:

1. Kwemithambo le aorta infrarenal esiswini yi ngaphezulu / ngaphantsi kwesebe yegazi kwezintso.
2. Suprarenal ungaphezu imithambo eyayizalwa
3. kwemithambo Total sisasazeka lonke ubude benqanawa.

Zintoni izinto ezibangela aneurysms?

• Yegazi, apho eludongeni nemithambo uba lalingqingqwa kwaye ulahlekelwa luthambe, kwaye kwasekwa phezu kweendonga zayo ngokohlobo umonakalo ezityebileyo atherosclerotic. Indlela ezakhiwe ngayo umonakalo ziquka cholesterol yingozi kunye namanye amafutha. Nangona oogqirha ukuba kumiselwa ngokupheleleyo nendlela osichaphazela ngayo uphuhliso yegazi, kwemithambo, kodwa kucingelwa ukuba ngenxa kwesi sifo kuvela iingxaki yegazi kwi ngesitya zokumisa nonikezelo izondlo. Ngenxa yoko, inyama nemithambo yonakele, kulandele cleavage yayo. Ngenxa yoko, le uphethwe "kwemithambo aortic esiswini".
• Isifo seswekile "osithandayo" Umthambo igazi umxhelo. Idla kunye retinopathy, nephropathy, aneurysms.
• Imizila yemfuza. Kwezinye syndromes iziphene (Ehlers -. Danlos syndrome, yiMarfan Erdheim pathologic esinganyangekiyo necrosis medial, njl) kwemithambo abachatshazelwa, kuquka aorta esiswini. Kuyenzeka rhoqo ukufumana ubudlelwane phakathi kwemithambo aorta esiswini kunye nezifo yemfuza.
• izifo ezosulelayo. Ezi ziquka izifo ezichaphazela umaleko engaphakathi kwentliziyo (endokart) - negcushuwa, ekdokardit, salmonella, etc ...
• Ukwenzakala esiswini. Ngokomzekelo, xa Njengokungeniswa ongqingqwa esifubeni okanye aorta esiswini kunokuchaphazeleka.
• iinkqubo arhabaxa. aortoarteriit Nonspecific, umzekelo, ebangela buthathaka eludongeni aortic. Nangona kunjalo, ulwazi oluthile kulo mba kodwa. Kodwa izifo non-yokukrala kweendonga nemithambo rhoqo kwenzeka ngenxa umonakalo atherosclerotic.

Ngokubanzi, amaxesha amaninzi unobangela aneurysms ukuba ukutshaya, ungenzi ngokwasemzimbeni kunye nobudala. Kubaluleke kakhulu ukuba besiya kuba ekuhambeni kwexesha. Aneurysms ye aorta thoracic kwaye esiswini uneempawu ezahlukeneyo, ngoku cinga thina.

Ziintoni iimpawu zesebe esiswini kwemithambo aortic?

Amaninzi, aneurysms zange uzenza waziva, kwaye kwafunyaniswa ukuba kwazenzekela kuphando. Njengoko siyeka amalungu, ukuphazamisa ukukwazi kwabo ubomi, oko unesifo ngokuchanekileyo, kuba kubalulekile ukuqhuba ultrasound esiswini. Oogqirha ukuqaphela ukuba ingakumbi "imfihlo" kwemithambo thoracic. Alinako iboniswe kwaphela okanye kubangele iintlungu esifubeni, ukhohlokhohlo kwakunye nokubamba-bamba umphefumlo. Kwimeko yongxamiseko ukwanda got kwemithambo le aorta esiswini.

Iimpawu ezimbalwa kwemithambo anikezele ezithile zisenzeka kunye okanye ngokwahlukeneyo:

1. Ubunzima kwindawo isisu, kuyabuya engasi nenzaliseko kunye ukubetha, nto leyo efana nokubetha kwentliziyo ziyanyuswa.
2. iintlungu esiswini, ubulali, kunoko, ayeqaqanjelwa, umlinganiswa buthuntu. It yenzelwe ukuba ekunene kwi umbilicus okanye ekhohlo.

Nemiqondiso ngqo uzenza waziva kwemithambo esiswini aortic. iimpawu zayo ezahlukeneyo ukwenzela ukuba ngaba anorhano ingxaki lokwenyaniso kunzima kakhulu. Oku kungenxa yokuba kwemithambo olukhulayo uphazamise amalungu kunye neenkqubo ezahlukeneyo. Ngenxa yoko, oku kubhidaniswe yokulunywa kwezintso, pancreatitis, okanye sciatica.

Ishioradikulyarny syndrome kubangela intlungu ezisezantsi emva (ngakumbi, lo esinqeni) kunye ukuphazamiseka novakalelo imilenze kunye intshukumo disorder.

Besisu syndrome eyaboniswa nokugabha, belching, urhudo okanye ukuqhina, kwakunye ukungabi namdla, nto leyo ekhokelela umzimba.

ischemia Chronic emilenzeni ichazwa nokunyhashwa ejikeleza (ezinyaweni ezibandayo), iintlungu kwezihlunu ngexesha ihamba nokuphumla, ekuqhwaleleni ngamaxesha.

Yesinye cider yazisa ngokwalo ukuphazamiseka wokuchama, iintlungu, imvakalelo ubunzima ezisezantsi emva, kwaye nkqu imbonakalo egazi abomvu yokuchama.

Uqhekeko of kwemithambo ngenzolo aortic iqala nge nzuzo iintlungu esiswini, ubuthathaka jikelele kunye nesiyezi. Ngamanye amaxesha iintlungu unika esinqeni, nasemiphakathweni okanye uhanjiso. Kulo mzekelo isigulane kufuneka unyango ngoko nangoko, ekubeni urhulumente igcwele nokufa. Amaxesha amaninzi ikhefu kwemithambo kumbindi emathunjini amancinci, isisu okanye duodenum, ubuncinane - ibe esiswini zamafu. Xa eqwengiweyo kwemithambo ngenzolo aortic, iimpawu usenokuphelekwa isicaphucaphu nokugabha. Kwisahlulo sasekhohlo kumazantsi esisu na iviwe imfundo kancinane liyenyuka kunye igagasi esomeleleyo. imida yayo na iviwe ngesandla.

Xa uqhekeko iimpawu kwemithambo eziqaqambileyo kakhulu, kodwa abaqiniseki lula kunye nezinye iimeko eziyingozi zempilo, ngoko qiniseka ukuba ubize inqwelo yezigulana ukuze nayiphi na intlungu ahlekise esiswini okanye esifubeni.

lokufunyaniswa kwesifo

Inqanaba lokuqala diagnostic - novavanyo lonyango, wona usekwe phezu Ngokucofa uziva pulsation esiluqilima esiswini, lo ngowona kwemithambo esiswini aortic. Uxilongo iquka uphando ezivumela ukuba nomfanekiso oko kwenzekayo kwisisu. Okokuqala, oko ultrasound, kwaye Itomography ngekhompyutha (CT) kunye multislice ayinakubalwa Itomography le aorta (MSCT).

Ukuba kurhanelwa kwemithambo ngenzolo aortic, ultrasound ivumela ukuqiniseka phantse ngokupheleleyo ukuqinisekisa ubukho balo. Ibonisa indawo ngqo ze-kwemithambo, imeko eludongeni semithambo, indawo umsantsa, ukuba oko kwenzeka.

CT okanye MSCT eyenziwa ukuchonga calcification, aortic thrombosis vnutrimeshkovy, nokoyikisa okanye ukwaphula isithuba esikhoyo.

Ukuba diagnostic tests ezidweliswe ngasentla musa ukuvumela ukuxilongwa (nangona oku kakhulu inqabile), otyunjwe aortography. Le ndlela ivumela-time real ukujonga aorta kunye amasebe awo ngokuthi unike ulwelo ekhethekileyo kungena isitya. Lowo ubonisa ukuba kukho urhano of sisilonda esidumbileyoesingaphakathi ezincinane visceral kunye kwezintso, eyaziwa imeko ebhedini distal igazi.

Iingxaki kwemithambo ngenzolo aortic

Le meko kuyingozi hayi nje kuphela ngenxa yempilo kodwa ubomi. Okokuqala, lo aorta kunokubangela Embolism (ukuvaleka) kwemithambo, iingxaki ezasulelayo, ukuphuhlisa ukusilela intliziyo.

Sokuhlaziya kwemithambo ngenzolo aortic - kwingxaki esiyingozi ukuba komsipha yayo negazi ungena zikhabane nemithambo umzimba. Ukuba yonke umaleko 3 kunye aorta breaks wakubo ngokupheleleyo, kukho kakhulu ilahleko igazi.

Kakade ke, ukuba ingxaki olubi kwemithambo - ngaba ikhefu. Izigulane ezininzi kunye aneurysms lunganyangwa uya kufa kwisithuba seminyaka emi-5. Phambi kokuba ukhulula umntu uziva intlungu esisu kunye kummandla empontshwa. Ukuba kwemithambo le aorta esiswini eqwengiweyo, esi sifo sizibonakalisa ngokuthi sibe nokopha lweenkcukacha esa yothuse nokufa. Ngoko ke ngokuqinisekileyo ubize inqwelo xa ahlekise esiswini kunye isifuba, njengoko kulibaziseka kuyingozi. Iinkcukacha-manani zibonisa ukuba 3% ezigulane kufa ngoko nangoko emva komsipha le aorta, lo gama abanye basahlala iiyure ezi-6 ukuya kwiinyanga ezi-3. Kwiimeko ezininzi, baya kufa kwiintsuku. esinganyanga njani i kwemithambo? Qwalasela oku kulandelayo.

Unyango aneurysms aorta esiswini

Abantu abaninzi ngempazamo abakholelwa ukuba uxilongo "kwemithambo le aorta esiswini," unyango kunokuba kuhlinzwa kuphela. Enyanisweni, kukho bonke ngabanye.

Ukuba kwemithambo ifikelela 4.5 cm ububanzi, umsebenzi ayiboniswanga, kuba yena uyakwazi kube nengozi enkulu ubomi ngaphezu ukunyuka empahleni ubukhulu. Ngokuqhelekileyo, umkhwa onjalo kuye kwaphawulwa kumadoda amakhulu abaphethwe co-morbidities, yaye ukongezelela akayeki ukutshaya (yaye onjalo unesifo ukuyeka ukutshaya kufuneka nje!). Kubo, umdlalo elindileyo, kuba nengozi komsipha aortic kwi sangqa loo malunga ne-3 kuphela% ngonyaka ngamnye. Kulo mzekelo, qho emva kweenyanga ezintandathu isigulane kunyanzeleka ukuba benze ultrasound ukufumana ubungakanani aorta. Ukuba udonga nemithambo ngcembe esandisa, oko uphawu eyintloko kutyando, kuba amathuba ngokwaphulwa linyuke-50%.

Abadala, owabonisa ukuba kwemithambo le aorta esiswini, unyango desirably lwenziwa esebenzisa endovascular, kancinane indlela wesibeleko esigqibeleleyo. Ngexesha lo msebenzi, isigulana ilawulwa kwi kwemithambo a catheter apho kuquka stent. Ezibanjiswe aorta, kuvula kwaye Azigubungele kwemithambo, ngaloo ndlela ngokubuyisela kummandla ochaphazelekayo yomzimba wakhe. Iinzuzo ukusebenza ziquka nakho ukuguqulwa ezilula kunye nexesha elincinane wobuyiselo - kwiintsuku nje ezimbalwa. Kodwa le ndlela iye bokuqonda zalo, ngoko kubanjwa ayikho bonke. Eyona ethile iphambili yalo msebenzi - kwi-10% amatyala kukho ukufuduka distal na ukuma lusekiwe.

Ukuba unesifo "kwemithambo aortic esiswini", umsebenzi idla ivuliwe. Ngexesha indawo yakhe uchaphazelekayo womGaqo-aorta yasuswa kwaye endaweni sokwenziwa eyenziwe Dacron (ilaphu eyenziweyo esekelwe ipholiyesta). Ukwenzela ukubonelela ukufikelela kwi aorta, esebenzisa laparotomy udibaniso. Ubude zotyando edla malunga 2-3. Emva kotyando uhlala amabala ebonakalayo.

Isigulane wabuyisa malunga neeveki ezimbini. Omisa umsebenzi kwezinye iimeko kunokwenzeka kuphela emva kweeveki 4-10. Isigulane kuyathintelwa umsebenzi ngokwasemzimbeni, ubonisa uxolo uhamba.

Izimo ukuvula utyando

Ezingavumelekanga utyando phantsi kwale miqathango ilandelayo:

• iqhosha Recent engabalulekanga (hayi kwenyanga ngaphantsi kwesinye).
• insufficiency ezesifuba nezengekho miphungeni.
• insufficiency kwezintso.
• Iliac kunye yegazi femoral.

Rehabilitation emva kotyando

Kakade ke, ubukho iingxaki emva kotyando kuchaphazela ubudala yomguli kunye nezifo ezinxulumene. Kwakhona, imeko yomguli ukuze sibe sibi ukuba umzimba wayo sele buthathaka (HIV, Oncology, diabetes), kukho ukutyeba ngokugqithisileyo kunye nesifo senhliziyo. Ngaphezu koko, ukusebenza pre-ocwangcisiweyo unika isigulane ngakumbi kusenokwenzeka ukuba baphile kwakhona ngaphandle ungenelelo esiphuthumayo komsipha i kwemithambo aortic.

Iingxaki ekunokwenzeka kubangelwa zomzimba jikelele, engaquki ukuthwala bonke, uphuhliso losulelo, umonakalo izibilini ukopha. Inani elincinane kakhulu amatyala operation obulalayo.

Ukuba utyando ecwangcisiweyo, oogqirha bacebisa kwiveki phambi Ukuthwala yayo ukuyeka iziyobisi, ithinasi igazi, kunye neziyobisi anti-ukudumba (aspirin kwakunye nabanye.). Qiniseka ukuba ukwazisa ugqirha wakho malunga nokuba ngaba uthatha into uhlobo amayeza okwangoku, phambi kokuba ukusebenza.

Umngcipheko Ukuphinda ezincinane kakhulu, kodwa ukuba umntu uqala ukuphazamisa intlungu umva okanye isisu, isicaphucaphu, ukugabha, antsi kwi iinyawo okanye ukuziva jikelele mnandi, kufuneka bafune iingcebiso unyango ngoko nangoko.

Prevention kwemithambo

kwemithambo ngenzolo aortic kwenzeka ukuba akulula ukuba uthe akwavuma (kwaye, ngokuyinene, akuthethi bafumana mkhwa), ukutshaya, uya ukulawula uxinzelelo kunye nobunzima bakho. Kubalulekile kwakhona ukuba akhokele yokuphila obunentsebenzo nobunempilo. Hlala uphilile!