Yamaphaphu Vienna. Ezingasadingeki emithanjeni yamaphaphu

Yamaphaphu Vienna (isithombe kukhonjisiwe ngezansi) - esibuthakathaka okuletha lwemithambo yegazi is ahlanganiswe oksijini emaphashini kuze ATRIUM kwesokunxele.

Kusukela kuma-capillary yamaphaphu ihlangana zibe lezizitsha emithanjeni ngaphezulu ukuthi ithunyelwa bronchi, bese izingxenye izingxenyana zegazi, futhi wamaphaphu iziqu ezinkulu esangweni kwakhiwa (ezimbili impande ngamunye) ukuthi zibhekiswe nendawo engxenyeni engenhla ATRIUM ngakwesokunxele. Ngaphezu kwalokho, ngamunye imiphongolo ukungena intuba ahlukene: kwesokunxele - ohlangothini kwesokunxele ATRIUM kwesokunxele kanye ilungelo ukusuka kwesokudla. Kwesokudla emithanjeni yamaphaphu, kulandela atrial (ngakwesokunxele) transversely aphambana le ATRIUM ngakwesokudla (emuva zakhe).

yamaphaphu engaphandle (kwesokudla) Vienna

Kwakheka segmental vein izingxenye maphakathi kanye engenhla wamaphaphu iyizingxenye.

• R.apicalis (apical legatsha) - emelelwa iDemo isiqu emithambo yegazi, okuyinto isendaweni Lobe engenhla (mediastinal ubuso bayo) kanye sithwala igazi elinikeza ukusuka kwesinye isihloko ingxenye. Ngaphambi kokungena ku ilungelo aphakeme vein yamaphaphu njalo kuhlangene segmental (bakhulise) legatsha.
• R. posterior (legatsha ngemuva) ithwala nokuqoqwa kwegazi kusukela ingxenye esemuva. Lokhu legatsha - lo kunayo yonke enkulu Vienna emithanjeni (segmental), okuyinto zitholakala Lobe engenhla. Kulesi isitsha kuyinto angawodwa izingxenye eziningana: poddolevoy vnutrisegmentarny ingxenye kanye ingxenye eqoqa igazi interlobar ndawo ubuso etshekile izimbotshana.
• R.anterior (phambili legatsha) sithwala igazi elinikeza kusukela engenhla ukubuthwa share (noma anterior ingxenye). Kwezinye izimo, kungenzeka ukuhlanganisa amagatsha front futhi bakhulise (uma iwela isiqu ezivamile).
• R.lobi medii (maphakathi Lobe legatsha) uthola igazi ilungelo wamaphaphu izingxenye (share kwesilinganiso sayo). Kwezinye izimo, lokhu kuthatha ifomu elilodwa Vienna emgqonyeni bese ugelezela elingenhla kwesokudla vein yamaphaphu, kodwa ngokuvamile kwakheka ayesisebenzisa is izingxenye ezimbili: medial kanye lateral ekuleli ngokulandelana izingxenye medial kanye lateral.

yamaphaphu Lower (kwesokudla) Vienna

Lokhu isitsha uthatha igazi namanoni aphezu aphansi (izingxenye zalo 5) futhi inflow ezimbili eziyinhloko: umthambo basal legatsha ezivamile engenhla.

Igatsha engenhla

Ihlala phakathi basal izingxenye engenhla. Yakheke kusukela emithanjeni eyengeziwe kanye main, kufanele kube phambili bese phansi, wedlula ngemuva apical segmental bronchus. Lokhu gatsha phezulu konke ezingenalutho ku ephansi kwesokudla vein yamaphaphu.

Ngakho ukucinana kwemigudu yokuphefumula Vienna yakhiwa ezintathu inflow main: lateral, medial engenhla, etholakala ngezilimi eziningi kwezingu-intersegmental kodwa ungagijima vnutrisegmentarno.

Ngenxa ezengeziwe igazi outflow umthambo eyalo ingxenye engenhla (onesiqongo) esifundeni poddolevuyu segmental umthambo ezingemuva Lobe engenhla (posterior yayo ingxenye).

Basal Imininingwane Vienna

Kuyinto isiqu iDemo emithambo yegazi, kwakheka eslphambanweni ephansi kanye engenhla emithanjeni basal amagatsha main okuyinto amanga ezijulile phambi kobuso ezivamile.

Basal phezulu Vienna. Ezakhiwe nokuhlanganiswa kwekulu basal segmental emithanjeni imithambo athwala igazi lisuka medial, anterior kanye izingxenye lateral.

phansi basal Vienna. Njengoba unamathele jikelele vein basal kusukela ubuso bayo ongaphakeme emuva. I inflow eyinhloko isitsha - basal posterior legatsha eqoqa igazi posterior basal ingxenye. Kwezinye izimo, le ephansi Vienna basal angaxhumana phezulu vein basal.

ADLV

Kuyinto yesifo senhliziyo azalwa naso lapho isenzeko itholwa neanatomichnoe emithanjeni yamaphaphu kuya ATRIUM (kwesokudla), noma kufakwe yakamuva ye cava vena.

Lokhu zokugula kuhambisana nenyumoniya njalo, ukukhathala, iphika, ukubambezeleka ngokomzimba, ubuhlungu inhliziyo. Njengoba zisetshenziswa ukuhlola: ECG, i-MRI, ama-X ray, catheterization inhliziyo, imisindo ephansi, futhi atriografiyu ventrikulo-, angiopulmonography.

Steel ukwelashwa isici kuncike hlobo yayo.

Uhlolojikelele

ADLV - isici azalwa naso futhi imayelana 1.5-3.0% sesimweni inhliziyo. Iningi ebonwe iziguli besilisa.

Ngokuvamile le nkinga is kuhlangene okweqanda (evulekile) iwindi kanye zamehlo septum phakathi ventricles. Kancane kancane (20%) - kusukela ezivamile isiqu igazi, hypoplastic lwesokunxele inhliziyo, VSD, dextrocardia, tetralogy of Fallot, futhi transposition izitsha ezinkulu, ngokuvamile inhliziyo ventricle.

Ngaphezu kwalezi ukukhubazeka, ngokuvamile obuhambisana nokuthanda ADLV extracardiac zokugula: hernias enkabeni, yokulimala ithambo kwetinhlavu kanye endocrine izinhlelo, diverticula emathunjini, izinso ukhamba, polycystic isifo sezinso futhi hydronephrosis.

Ukwahlukanisa ezingasadingeki yamaphaphu amanzi emithambo yegazi (ADLV)

Endabeni le confluence ngemithambo e kwegazi noma zibe ATRIUM kwesokudla, le nkinga ibizwa ngokuthi amanzi egcwele ezingasadingeki, uma isakhiwo ngenhla agelezela eyodwa noma ngemithambo ezimbalwa, isici enjalo ibizwa ngokuthi esinqunyiwe.

Ngokuhambisana ezingeni confluence ukwaba ezinye izinketho ezingenasici

• okufana Okokuqala: nadserdechny (suprakardialny). Ngemithambo yamaphaphu (ezifana isiqu ezivamile noma ehlukile) iyangena engenhla vena cava noma amagatsha awo.
• Inketho ezimbili: inhliziyo (intracardiac). emithanjeni yamaphaphu likhanyelwe phakathi itheku yenhliziyo noma ATRIUM kwesokudla.
• Samuntu Okwesithathu: podserdechny (lefoni noma subcardial). emithanjeni yamaphaphu faka cava portal noma vena aphansi (ngaphansi kakhulu imbobo lymph).
• Inketho wesine: kuhlanganisiwe. emithanjeni yamaphaphu kufakwe izakhiwo ezahlukene kanye emazingeni ehlukene.

Izici hemodynamics

Ngo utero isici asebenzayo ngokuvamile alikubonanga, ngenxa izici of kwegazi fetus. Ngemva kokuzalwa komntwana ukubonakaliswa hemodynamic achazwa kule ukwephuka kuthi inhlanganisela yayo nezinye anomalies azalwa naso.

Endabeni amanzi Imininingwane ezingasadingeki kuphazamiseka hemodynamic uzwakalise hypoxemia, sindisa hyperkinetic wenhliziyo kwesokudla kanye nomfutho wegazi ophezulu yamaphaphu.

Endabeni ngokwengxenye amanzi hemodynamics elifana nalelo abane ASD. Iqhaza ehola kungokwalabo ukwephula normal shunt arteriovenous, okuholela ekwandeni umthamo wegazi kumbuthano encane.

Izimpawu ezingasadingeki yamaphaphu amanzi emithambo yegazi

Izingane nale isici bevame yansukuzonke sibi zokuphefumula izifo ezibangelwa amagciwane kanye nenyumoniya, bathi ukukhwehlela, ongaphakeme kwesisindo tachycardia, iphika, ubuhlungu benhliziyo, cyanosis ukukhanya futhi babekhathele kakhulu.

Endabeni nomfutho wegazi ophezulu yamaphaphu kubonakala yobudala encane ivele ukumelwa inhliziyo, uzwakalise cyanosis futhi inhliziyo idolo.

ukuhlola

Isithombe auscultation at ADLV efana ASD, okungukuthi ikhipha engazinzile auscultated umsindo systolic ku projection emithanjeni imithambo (emithanjeni yamaphaphu) futhi wokuqhekeka ithoni 2nd.

• Izibonakaliso ECG zokulungile inhliziyo sindisa, ukuphambuka EOS ukuvinjelwa ngakwesokudla (akuphelele), kwesokudla bundle block legatsha.
• Lapho phonography izimpawu ASD.
• Ngo esimweni sithole iphethini ukukhanya bulging Umthambo yamaphaphu (arc yayo), ukwandisa ilungelo imingcele inhliziyo, "saber-Turkish" uphawu.
• Echocardiography.
• Yokuhogela izimbotshana inhliziyo.
• Venography.
• Atriografiya (kwesokudla).
• Angiography.
• Ventriculography.

Imiphumela yaloku kuhlola okungenhla Ukwahlukaniswa sale nephutha kumele kwenziwe:

• Lymphangiectasia.
• Yomthambo i-aorta atresia / valve mitral.
• izitsha transposition.
• stenosis Mitral.
• Stenosis kwelungelo / kwesokunxele emithanjeni yamaphaphu.
• Trehpredserdnym inhliziyo.
• ASD angawodwa.

ukwelashwa

Izinhlobo zokuhlinza amanzi ngokwengxenye kunqunywa omunye nasici, usayizi kanye nendawo ASD.

umyalezo atrial ukuqeda usebenzisa plastic noma suturing ASD. Izinsana kuze kube ngisho nalapho sengineminyaka emithathu ukuthi zisesimweni esibucayi ezibucayi, afeze ukuhlinzwa okuthuthukisa (atrioseptotomiyu evaliwe), okuhloswe ngalo ekwandiseni zokuxhumana interatrial.

Ubude olukhulu isici ukulungiswa (amafomu Imininingwane) kuhlanganisa manipulations eziningana.

• Ligation okuthunyelwe sokugembula emithanjeni semithambo.
• Kwemihlambi ngemithambo yamaphaphu.
• Ukuvalwa ASD.
• Anastomosis phakathi ATRIUM kwesokunxele kanye emithanjeni yamaphaphu.

Umphumela leyo misebenzi kungaba: nesanda yamaphaphu nomfutho wegazi ophezulu syndrome ne ukwehluleka itheku engeyokuqala.

Isibikezelo sezulu sezinsuku

Onalesi sifo inkambo engokwemvelo le nkinga okungekuhle, kusukela 80% eziguli ufe kungakapheli onyakeni wokuqala wokuphila.

Iziguli khona amanzi ngokwengxenye abangaphila ngendlela evumelana engu-amathathu. Ukufa iziguli anjalo ngokuvamile ehlobene kakhulu izifo yamaphaphu, noma yokumelwa yinhliziyo ezinzima.

Imiphumela ukulungiswa kuhlinzwa yokuphambana ngokuvamile eyanelisayo, kodwa lethality ezisanda kubelethwa ngesikhathi noma ngemuva kokuhlinzwa kuphezulu.