Besisu useshonile yomthambo i-aorta: izimpawu, uphethwe, ukuphathwa

I-aorta kwekulu Umthambo azygos. It kungokwalabo kwegazi futhi uyasondla zonke izitho zomzimba igazi emzimbeni yethu. I-aorta kuhlukaniswe 3 nezingxenye 2 - i-besisu futhi thoracic. Ngokuvamile (95%) atholakala useshonile le-aorta besisu, okuyinto esinawo namuhla futhi sizobe ukukhuluma.

Useshonile - kuyinto isandiso noma ezinkulu le-aorta. Lesi sifo namanje ngesisekelo kwezingxoxo eziningi, ngoba odokotela ongeza umbono evumelana ngazwi linye, ukuthi ngezinga elithile ukunwetshwa odongeni semithambo kungenziwa okwatholakala useshonile. Lucwaningo lwangaphambili kwaqinisekiswa ngokwanda kuleli aorta izikhathi 2 noma ukwandisa ubukhulu bayo abangaphezu kuka 3 cm. Nokho, unikezwa iqiniso lokuthi le-aorta alinalo ububanzi 15 kuya kwezingu-32 cm, welithi "ezingaphezu kuka 3 cm" ngokusobala ngempela ezingacacile. Ngakho-ke, ngo-1991, sibonga ucwaningo lososayensi zaseMelika zaqala useshonile kubhekwe ukukhulisa okungavamile mafutha anciphisa isikhala esingaphakathi le-aorta ngu-50% ngaphezu ubukhulu bayo evamile. Kodwa le ncazelo Kuthi ezingafanele.

Lo magazini kubalulekile ikakhulukazi endabeni yokukhetha amacebo yokungenela kuhlinzwa, kodwa-ke ngeshwa, namanje evulekile. Phakathi naleso sikhathi, isifo sokuvuvukala kwemithambo unyaka ngamunye ubulala baseMelika mayelana 15,000 ngonyaka. Ezimweni eziningi, kuvele akanayo isikhathi ukuxilonga.

Yini udokotela bekulokhu welapha isifo sokuvuvukala kwemithambo?

It ephatha isifo udokotela ohlinza imithambo yegazi, njengoba ukwelashwa esiyinhloko izinkinga zokusebenza. Uma ukusebenza ayiboniswa, isiguli kumele lithathwe udokotela, wenhliziyo noma wemithi yangaphakathi (onguchwepheshe imithi yangaphakathi) ukuqapha eduze isimo sabo. Useshonile ngempela kunganakekile, kungaba kungazelelwe eqala ukukhula, okwandisa ingozi ezimbi kakhulu ngenxa yezinkinga zayo - igebe.

Ubani isengozini?

Useshonile sitholakale kokubili amadoda nabesifazane (okokugcina Nokho, ingasaphathwa). Nokho, waphawula ukuthi amadoda abaneminyaka engama 65, kwenzeka kaningi. Lokhu kungenxa yokungabikho ugqozi abantu abaningi ukubhema, okuyinto eyingozi ikakhulukazi yokuguga.

Ngakho, abasengozini bahlanganisa:

• kubantu abaphethwe nomfutho wegazi ophezulu;
• ababhemayo;
• izinhlangano lapho umndeni ubulokhu ukuthi nginesifo useshonile le-aorta besisu noma ezinye izifo zenhliziyo nemithambo yegazi kanye / noma isifo se-kwegazi neuropathy;
• abanikazi ukhuluphele futhi abantu abaphila ukuphila umzimba.

Isexwayiso! ucwaningo Eliqinisekisiwe, aneurysms abaningi ngofuzo okhokho.

Izinhlobo aneurysms le-aorta besisu: ngezigaba

Besisu useshonile yomthambo i-aorta ihlukaniswe izinhlobo eziningana kuye ezakheke, kwasendaweni nezici sokugembula:

1. Sac (sifana sikhwama ukuthi ngokusebenzisa wesibeletho elihlobene ne Isikhala sayo esingaphakathi le-aorta).
2. Fusiform. Ukuma uthi lokuphotha, okuyinto ixhunywe ngembobo ukuze mafutha anciphisa isikhala esingaphakathi le-aorta. Uhlobo oluvame kakhulu useshonile.

Ngokwe-izici zokucabanga okubangelwa isifo lezi zinhlobo ezilandelayo aneurysms:

1. Iqiniso. Its enwetshiwe isitsha odongeni, njengoba kumiswa sebuningini izingqimba le-aorta.
2. Pseudoaneurysm. Kubonakala emva ukulimala ngenxa ukuthuthukiswa hematoma ejabhile.
3. Exfoliating. Okuyi izindonga zawo delaminate futhi ingaphakathi intramural yagcwala hematoma, okuyinto ngokusebenzisa odongeni izicubu semithambo ehlangene mafutha anciphisa isikhala esingaphakathi le-aorta.

Hlukanisa emkhatsini futhi kwasendaweni:

1. Useshonile we infrarenal aorta besisu ingaphezu / ngezansi kwezinso imithambo legatsha.
2. Suprarenal ingaphezu imithambo ekhelini
3. useshonile Ubude kuhlakazeka kanye ubude lonke bomkhumbi.

Ziyini izimbangela ka aneurysms?

• Isifo sokuqina kwemithambo yegazi, lapho udonga semithambo iba uqweqwe ilahlekelwa umswakama waso, futhi kwakheka phezu kwezingange zawo ngesimo amafutha zingcwecwe atherosclerotic. Ukwakheka zingcwecwe zihlanganisa cholesterol eziyingozi kanye namafutha. Nakuba odokotela akunqunywa ngokugcwele ithinta indlela ukuthuthukiswa isifo sokuqina kwemithambo yegazi, isifo sokuvuvukala kwemithambo, kodwa kucatshangwa ukuthi ngenxa yalesi sifo avele iziyaluyalu sokujikeleza kwegazi isitsha khimilili supply izakhamzimba. Ngenxa yalokho, izicubu semithambo lilimele, kulandele cleavage yayo. Ngenxa yalokho, lo uphethwe "useshonile besisu yomthambo i-aorta".
• Isifo sikashukela "osithandayo" yesiteleka igazi Umthambo. It uvame ukuhambisana retinopathy, nephropathy, aneurysms.
• Ufuzo. Kwezinye syndromes azalwa naso (Ehlers -. Danlos syndrome, i-Marfan Erdheim pathologic fibrosis necrosis medial, njll) imithambo iyathinteka, kuhlanganise aorta besisu. Kuyinto ngokuvamile kungenzeka ukulandelela ubudlelwano phakathi useshonile aorta besisu futhi nezifo ngenxa yezakhi zofuzo.
• Izifo ezithathelwanayo. Lezi zihlanganisa izifo ezithinta ungqimba yenhliziyo (endokart) - ugcunsula, ekdokardit, salmonella, njll ...
• Sivame ukulimala esiswini. Ngokwesibonelo, ukushaqeka eqinile esifubeni noma aorta besisu uma zingase zithinteke.
• izinqubo okuvuthayo. aortoarteriit Nonspecific, isibonelo, kubangela lube buthaka odongeni yomthambo i-aorta. Nokho, akukho ulwazi oluthile ngale ndaba okwamanje. Kodwa yezifo ezingathathelani sokuvuvukala izindonga semithambo njalo zenzeka ngenxa zingcwecwe atherosclerotic.

Ngokuvamile, avame imbangela aneurysms kukhona ukubhema, ukungawuvivinyi umzimba kanye nobudala. Kubaluleke kakhulu ukuba akubheke ngesikhathi. Aneurysms le-aorta thoracic futhi besisu unezimpawu ezahlukene, okuyinto manje sicabangela.

Yiziphi izimpawu besisu yomthambo i-aorta umnyango useshonile?

Ngokuvamile, aneurysms engalokothi enze ngokwayo wazizwa, futhi kwatholakala ukuthi nginesifo ngengozi kulolu cwaningo. Njengoba siyeka izitho, zikhala ikhono abo ukuba baphile, kungaba lapho ethola ukuthi unesifo kahle, ngoba kubalulekile ukuqhuba ultrasound besisu. Odokotela uqaphele ukuthi ikakhulukazi "nezimfihlo" useshonile thoracic. Ngeke kuboniswe nhlobo noma ukubangela ubuhlungu besifuba, nokukhwehlela kanye iphika. Endabeni siphuthuma got isifo sokuvuvukala kwemithambo le-aorta besisu.

Izimpawu ezimbalwa useshonile ukwaba abanye okuyinto zenzeka ndawonye noma eceleni:

1. Ukuzimuka endaweni esiswini, lokujabulela ezingemnandi ekugcwaleni nokushaya kwenhliziyo, okuyinto ungathi ukushaya kwenhliziyo iyakhula.
2. Ubuhlungu besisu, oluncane, kunalokho, bezwe izinhlungu, uhlamvu buthuntu. It itholakala khona kanye umbilicus noma kwesokunxele.

Futhi izimpawu engaqondile izenze wazizwa besisu useshonile yomthambo i-aorta. Izimpawu zayo zihlukile ukuze usola inkinga kweqiniso kunzima kakhulu. Lokhu kungenxa yokuthi isifo sokuvuvukala kwemithambo ezikhulayo zingaphazamisa izitho ezihlukahlukene futhi izinhlelo. Ngenxa yalokho, kungaba kudidaniswe colic kwezinso, pancreatitis, noma sciatica.

Ishioradikulyarny syndrome kubangela ubuhlungu beqolo (ngokukhethekile, okhalweni) kanye ukuphazamiseka ukuzwela emilenzeni kanye ukuphazamiseka ukunyakaza.

Besisu syndrome owabonakaliswa ukuhlanza, ukubhodla, uhudo noma ukuqunjelwa, kanye nokuntuleka ukudla, okuholela kwesisindo.

ischemia Okungalapheki imilenze lubonakaliswa ukwephulwa kwegazi (izinyawo abandayo), ubuhlungu bemisipha ngesikhathi uhamba futhi lapho esephumule, izinyonga gqwa.

Zendlala Yesinye cider umemezela ngokwayo iziyaluyalu womchamo, ubuhlungu, umuzwa ukusinda ephansi emuva, futhi ngisho nokubonakala kokungqubuzana abomvu egazi ashaye umchamo.

Ukudabuka we lesisu useshonile yomthambo i-aorta iqala nzuzo ubuhlungu esiswini, ubuthakathaka jikelele nesiyezi. Ngezinye izikhathi ubuhlungu unika okhalweni, imbilapho noma ukuxhuma. Kulesi simo kudingeka ukuba isiguli sibe usizo lwezokwelapha ngokushesha, ngenxa yokuthi isimo igcwele ukufa. Ngokuvamile le mbali useshonile phakathi emathunjini amancane, esiswini noma duodenum, okungenani - ibe esiswini obukhulu. Lapho idabukile besisu useshonile yomthambo i-aorta, kungenzeka izimpawu ephelezelwa isicanucanu nokuhlanza. Ngo ifasitelana kwesokunxele esiswini is palpated imfundo kancane okwandisa kanye yokwanda eqinile. Imingcele yayo kungukuthi palpated.

Ngezinye ukudabuka izimpawu useshonile igqamile kakhulu, kodwa badidekile kalula nezinye izimo zezempilo zibe yingozi, ngakho qiniseka ukuthi ukubiza i-ambulensi noma iyiphi ahlekise esiswini noma esifubeni.

sitholakele isifo

Isigaba sokuqala zokuxilonga - ngihlolwa, okuyinto ku palpation uzizwa okusizwa ukushaya eqinile lapho esiswini, kuba besisu useshonile yomthambo i-aorta. Ukuhlonza Ukugula sifaka ucwaningo evumela ngeso lengqondo lokho okwenzekayo ngaphakathi komgodi ongaphakathi kwamathumbu. Okokuqala, kubalulekile ultrasound, futhi computed tomography (i-CT) kanye multislice ngekhompyutha tomography le-aorta (MSCT).

Uma kusolakala besisu useshonile yomthambo i-aorta, ultrasound evumela iqiniso cishe ngokuphelele ukuqinisekisa ubukhona bayo. Ibonisa indawo esiqondile useshonile, isimo odongeni semithambo, endaweni igebe, uma kuthatha indawo.

CT noma MSCT wenziwa ukuhlonza calcification, yomthambo i-aorta thrombosis vnutrimeshkovy, ukusongela noma aphule i igebe ekhona.

Uma ukuhlola ukuthi kungakanani abakwaziyo ebhalwe ngenhla ngokusekelwe eBhayibhelini ungavumeli ukusazi ngokunembile isifo esikuphethe (nakuba lokhu ngempela ezingavamile), oqokwe aortography. Indlela evumela real-time ukubuka aorta amagatsha awo ngokwethula uketshezi ekhethekile ku isitsha. Ubonisa ukuthi uma kukhona izinsolo lesion lemithambo visceral futhi kwezinso, isimo embhedeni distal kwegazi ezaziwayo.

Izinkinga of besisu useshonile yomthambo i-aorta

Lesi simo kuyingozi hhayi kuphela empilweni kodwa ukuphila. Okokuqala, i-aorta kungabangela embolism (ukuvaleka) kwemithambo yegazi, ukuxakeka ezithathelwanayo, ukuthuthukisa ukumelwa inhliziyo.

Sokuhlaziya besisu useshonile yomthambo i-aorta - kwetintfo esiyingozi okungukuthi ukudabuka yayo negazi engena izingqimba semithambo zomzimba. Uma zonke wakubo ungqimba 3 kanye aorta amakhefu ngokuphelele, kukhona okukhulu ukopha.

Kodwa-ke, izinkinga lalibhekisela useshonile - ingabe ikhefu. Iningi leziguli ezine-aneurysms ingelashwa bazofa eminyakeni 5. Ngaphambi unqamula umuntu ozwa ubuhlungu esiswini nasesifundeni lumbar. Uma useshonile le-aorta besisu ziklebhukile, lesi sifo libhekene ukopha kakhulu eholela ukwethusa ukufa. Ngakho-ke ngokuqinisekile ukubiza i-ambulensi uma ubuhlungu acute esiswini nasesifubeni, njengoba ukubambezeleka kuyingozi. Izibalo zibonisa ukuthi abantu 3% eziguli bafe ngokushesha ngemva ukudabuka le-aorta, kanti abanye bahlala kusukela amahora 6 izinyanga 3. Ezimweni eziningi, zife zingakapheli izinsuku. aphathe useshonile kanjani? Cabanga ngala maphuzu alandelayo.

Ukwelashwa nokuvikelwa aneurysms aorta besisu

Abantu abaningi ngephutha sikholelwe ukuthi uphethwe "useshonile le-aorta besisu," ukuphathwa kabi kungaba kuhlinzwa. Eqinisweni, kukhona wonke ngamunye.

Uma isifo sokuvuvukala kwemithambo ifinyelela 4.5 cm ububanzi, ukusebenza ayiboniswa, ngoba ingakwazi ukuthwala ingozi enkulu ngoba ukuphila ngaphandle anda ubukhulu bomkhumbi. Ngokuvamile, cishe lokhu kuthambekela okuye kwaqashelwa amadoda amadala abaphethwe co-morbidities, futhi ngaphezu akagcini ukubhema (kanye ukuxilongwa stop ukubhema enjalo nje kudingeka!). Kubo, umdlalo sokulinda, ngoba ingozi ukudabuka yomthambo i-aorta at ubukhulu onjalo imayelana 3% kuphela ngonyaka. Kulokhu, zonke izinyanga eziyisithupha isiguli ephoqelelwe ukwenza i-ultrasound ukuthola ubukhulu le-aorta. Uma odongeni semithambo kancane kancane yandisa, kuba inkomba esiyinhloko ukuhlinzwa, ngobe ematfuba ukwa luyanda ngo-50%.

Asebekhulile, eyembula useshonile le-aorta besisu, ukwelashwa desirably eyenziwa esebenzisa endovascular, kancane indlela koda. Phakathi ukusebenza, isiguli iqondiswa ku umfula ipayipi ngokusebenzisa eyayihlanganisa stent. Njengoba ayevaleleke aorta, ivula futhi ihlanganisa umfula, kanjalo esikhundleni endaweni ethintekayo wakhe. Izinzuzo operation zibandakanya ukuphatheka engasindi futhi inkathi yokutakula encane - kwezinsuku ezimbalwa nje. Kodwa le ndlela has umehluko wemisindo nemiqondo yamagama yayo, ngakho labetibambile akupheleli lapho. I ethile eyinhloko lo msebenzi - ku-10% amacala kukhona ukuthuthelwa distal ukuma aqine.

Uma ethola ukuthi unesifo "useshonile besisu yomthambo i-aorta", ukusebenza ngokuvamile ivuliwe. Phakathi endaweni yakhe abathintekayo le-aorta isuswe futhi salandelwa sokwenziwa eyenziwe Dacron (indwangu zokwenziwa esekelwe polyester). Ukuze unikeze ukufinyelela aorta, usebenzisa laparotomy lesemkhatsini. Isikhathi ukuhlinzwa ngokuvamile kuba amahora angu-2-3. Ngemva kokuhlinzwa uhlala isibanda ebonakalayo.

Isiguli walulama ngemva kwamasonto amabili. Uqalise umsebenzi kwezinye izimo kungenzeka kuphela ngemuva amasonto 4-10. Isiguli akuvunyelwe nakancane umsebenzi ngokomzimba, ebonisa ukuthula uhamba.

Izimo ukuvula ukuhlinzwa

Okunqatshelwe ukuhlinzwa ngaphansi kwale mibandela elandelayo:

• isilethikusebenza kwakamuva (hhayi esingangenyanga).
• esingamahlalakhona senhliziyo ebuthaka futhi yamaphaphu.
• esingamahlalakhona kwezinso.
• Iliac futhi imithambo femoral.

Ukuvuselelwa emva kokuhlinzwa

Yiqiniso, khona izinkinga ngemva kokuhlinzwa kuthinte yobudala lesiguli kanye izifo ezihlobene. Futhi, isimo lesiguli zingase zibe zimbi uma umzimba wayo isivele buthaka (HIV, Oncology, isifo sikashukela), kukhona ukukhuluphala futhi inhliziyo isifo. Ngaphezu kwalokho, ukusebenza zangaphambi lohleliwe unika isiguli maningi amathuba ukuze sisinde alulame kuka kokungenela eziphuthumayo at ukudabuka of useshonile yomthambo i-aorta.

Izinkinga zingase zenzeke ngenxa yokuphatheka ukuba ukubulawa kwezinzwa okuvamile, okuyinto ongaqhubeki zonke, ukuthuthukiswa ukutheleleka, ukulimala kwezitho ezingaphakathi kanye ukopha. Inani elincane kakhulu amacala kukhona ukusebenza esibulalayo.

Uma ukuhlinzwa okuhleliwe, odokotela batusa ngesonto ngaphambi esithwele yayo ayeke nokusebenzisa izidakamizwa, igazi thinners, nezidakamizwa eqeda ukuvuvukala (ama-aspirin nabanye.). Qiniseka ukuthi uyamazisa udokotela wakho mayelana nokuthi uluphi uhlobo imithi uthatha okwamanje, phambi kokuhlinzwa.

Ingozi Ukuphinda incane kakhulu, kodwa uma umuntu ngokuzumayo iqala abaphazamisa ubuhlungu emhlane noma esiswini, isicanucanu, ukuhlanza, ndikindiki izinyawo noma umuzwa jikelele ezizwa engaphilile, kufanele sifune iseluleko nodokotela ngokushesha.

Prevention useshonile

Besisu useshonile yomthambo i-aorta kwenzeka okungenzeka uma wenqaba (futhi, kuhle, akusho zihlakulele umkhuba), ukubhema, iyolawula ingcindezi futhi isisindo sakho. Kubalulekile futhi ukuba ahole yokuphila asebenzayo futhi unempilo. Hlala uphilile!