M'mimba kung'ambika aneurysm: zizindikiro, matenda, mankhwala

The msempha ndi yaikulu mtsempha wamagazi azygos. Mkaziyo ali kufalitsa zokhudza zonse ndi chakudya ziwalo zonse za magazi m'thupi wathu. The msempha lagawidwa m'magawo 3 ndi mbali 2 - pa m'mimba ndi thoracic. Nthawi zambiri (95%) anapeza aneurysm wa msempha m'mimba, zimene tiri nazo lero ndipo ife kulankhula.

Aneurysm - ndi inalipo kapena oumbidwa kwa msempha. matenda adakali ndi maziko a zokambirana zambiri, chifukwa madokotala simungakhoze kubwera kwa lingaliro chimodzi, zimene digiri ya kukula kwa mpanda mtima zikhoza amawapeza aneurysm ndi. matenda kale linatsimikizidwa ndi kuwonjezeka mu msempha nthawi 2 kapena kuwonjezera m'mimba mwake ake oposa 3 cm. Komabe, Popeza kuti msempha ali m'mimba mwake wa masentimita 15 ndi 32, mfundo "kuposa 3 cm" mwachionekere yosokoneza kwambiri. Choncho, mu 1991, chifukwa cha kafukufuku wa asayansi American anayamba aneurysm ankaona nthenda kukulitsa wa lumen kwa msempha ndi 50% kuposa awiri mwake. Koma tanthauzo izi ndi umasinthasintha.

nkhani Zimenezi n'zofunika kwambiri kuti asankhe njira za phukusi opaleshoni, koma, kalanga, udakalipo. Pakali pano, ku aneurysm chaka chilichonse imapha anthu pafupifupi 15,000 a ku America pa chaka. Nthawi zambiri, si nthawi matenda.

Kodi dokotala wakhala amachitira ndi aneurysm?

Chimachitira matenda mtima dokotala, monga chithandizo chachikulu mavuto ntchito. Ngati opaleshoni sitingachisonyeze, wodwala ayenera kuonedwa ndi dokotala, ndi cardiologist kapena internist (katswiri wa mankhwala mkati) kuwayang'anira mosamala chikhalidwe chawo. Aneurysm kwambiri sioneka, zikhoza mwadzidzidzi kuyamba kukula, kuwonjezera chiopsezo cha akuluakulu a mavuto ake - kusiyana.

Amene ali pa chiopsezo?

An aneurysm amawapeza amuna ndi akazi (yotsirizira Komabe, kuli). Komabe, anaona kuti akulu kuposa zaka 65, kumachitika kawirikawiri. Izi zimadalira chifukwa kukhudzika kwa anthu ambiri ndi kusuta, zomwe makamaka zoipa ukalamba.

Choncho, ali pangozi:

• anthu odwala matenda oopsa;
• osuta;
• ma imene banja anawapeza ndi aneurysm wa msempha m'mimba kapena zina matenda a mtima ndipo / kapena matenda a kufalitsa zotumphukira;
• eni onenepa ndi anthu amene amatsogolera moyo wongokhala.

Chenjezo! Kutsimikiziridwa kafukufuku, aneurysms ambiri tinatengera kwa makolo.

Mitundu ya aneurysms wa msempha m'mimba; gulu

M'mimba kung'ambika aneurysm lagawidwa mitundu yambiri malingana kake, kutanthauzira ndi mbali pathological:

1. Sac (chokhala ngati thumba kuti kudzera pa khomo pachibelekeropo kugwirizana ndi lumen kwa msempha).
2. Fusiform. Mawonekedwe a spindle, chimene chikugwirizana mwa kutsegula kwa lumen kwa msempha. The yofala kwambiri aneurysm.

Malinga ndi makhalidwe pathological mitundu zotsatirazi aneurysms:

1. N'zoona. chotengera ake kukodzedwa khoma, monga kupangidwa kwa kuchuluka zigawo kwa msempha.
2. Pseudoaneurysm. Zikuoneka pambuyo zoipa chifukwa cha chitukuko cha hematoma kugunda.
3. Exfoliating. I.e. makoma ake delaminate ndi intramural M'mimbamo wodzazidwa ndi hematoma, amene khoma la mtima minofu zowonongeka chikugwirizana ndi lumen kwa msempha.

Kusiyanitsa ndi kutanthauzira:

1. Aneurysm ya infrarenal msempha m'mimba ndi pamwamba / m'munsimu aimpso mitsempha nthambi.
2. Suprarenal loposa mitsempha nthambi
3. Total aneurysm likuyenda pamodzi kutalika lonse la chotengeracho.

ndi zimayambitsa aneurysms chiyani?

• Atherosclerosis, imene khoma mtima amakhala wakuda ndi wotaya elasticity ake, ndipo anapanga pa makoma ake mu mawonekedwe a mipukutuyi mafuta atherosclerotic. The zikuchokera mipukutuyi komanso zoipa mafuta m'thupi ndi mafuta ena. Ngakhale madokotala mokwanira anatsimikiza mmene chitukuko cha atherosclerosis, aneurysm, koma amaganiza kuti chifukwa matenda imeneyi matenda magazi mu chotengera ndi mabasi kundipatsako kwa zakudya. Chifukwa, minofu mtima chawonongeka, kenako pogawanikana pamawere ake. Chifukwa, matenda ndi "m'mimba kung'ambika aneurysm".
• Shuga amene "amakonda" chidwi mtsempha wamagazi magazi. Nthawi limodzi mwa retinopathy, nephropathy, aneurysms.
• Chibadwa. Mu ena syndromes kobadwa nako (Ehlers -. Danlos syndrome, Marfan Erdheim pathologic enaake medial necrosis, etc.) mitsempha amakhudzidwa, kuphatikizapo msempha m'mimba. Nthawi zambiri n'zotheka mme- ubale pakati pa aneurysm msempha m'mimba ndi matenda chibadwa.
• matenda opatsirana. Zikuphatikizapo matenda zokhudza M'kati mwa mtima (endokart) - chindoko, ekdokardit, nsomba, etc ...
• Kuvulala kwa pamimba. Mwachitsanzo, pamene mantha olimba chifuwa kapena msempha m'mimba angakhudzidwe.
• Yotupa ndondomeko. Nonspecific aortoarteriit, mwachitsanzo, amachititsa chifooke khoma kung'ambika. Komabe, palibe tsatanetsatane pa nkhani pano. Koma matenda sanali yotupa makoma mtima pafupipafupi zimachitika chifukwa mipukutuyi atherosclerotic.

Ambiri, nthawi zambiri chifukwa cha aneurysms fodya, wongokhala ndi zaka. Nkofunika kwambiri oterewa nthawi. Aneurysms wa thoracic ndi m'mimba msempha zizindikiro zosiyanasiyana tikambirana.

ndi zizindikiro za m'mimba mtsempha waukulu dipatimenti aneurysm chiyani?

Nthawi zambiri, aneurysms konse zimapangitsa lokha anamva, ndipo anapezeka ndi mwayi mu kafukufukuyu. Monga akugwiritsa ziwalo, kusokoneza kuthekera kwawo kukhala ndi moyo, akhoza matenda molondola, chifukwa ndi zofunika kuchita ultrasound m'mimba. Madokotala dziwani kuti makamaka "mwachinsinsi" thoracic aneurysm. Izo sizingakhoze wasonyeza konse kapena ululu pachifuwa, chifuwa ndi kupuma movutikira. Pankhani ya kuwonjezeka mwamsanga ali aneurysm wa msempha m'mimba.

Zizindikiro zochepa aneurysm kuonetsetsa ena zimachitika limodzi kapena payekhapayekha:

1. Umalemera m'dera m'mimba, zogirigisha zosasangalatsa chidzalo ndi kugunda, omwe akufanana kugunda nakweza.
2. ululu m'mimba, wofatsa, kani, kupweteka, wosasamala khalidwe. Iwo isanafalikire zoyenera umbilicus ya kapena kumanzere.

Ndipo zizindikiro mozungulira zimapangitsa pakokha ankaona m'mimba kung'ambika aneurysm. Zizindikiro zake ndi zosiyana kuti iwo akuganiza vuto woona ndi zovuta. Ichi ndi chifukwa choona kuti aneurysm kukula angasokoneze ziwalo zosiyanasiyana ndi kachitidwe. Chifukwa cha zimenezi, akhoza kusokonezedwa ndi colic aimpso, kapamba, kapena sciatica.

syndrome Ishioradikulyarny amayambitsa kupweteka kumbuyo m'munsi (makamaka m'chiuno) ndi chisokonezo tilinazo mu miyendo pamodzi ndi gulu matenda.

syndrome m'mimba anaonetsa kusanza, belching, kutsekula m'mimba kapena kudzimbidwa, komanso kusafuna kudya, imbaenda kuwonda.

Matenda ischemia wa miyendo yafotokozedwera kuphwanya kufalitsidwa (ozizira mapazi), kupweteka minofu pa kuyenda ndi pa zina, nthawi kupunduka.

Prostate cider akulengeza yokha matenda a njira ya mkodzo, ululu, kumverera kwa kulemera mu m'munsi kumbuyo, ndi maonekedwe a maselo ofiira a magazi mu mkodzo.

Chotupa cha m'mimba kung'ambika aneurysm imayamba ndi phindu ululu pamimba, ambiri kufooka ndi chizungulire. Nthawi zina ululu amapereka m'chiuno, groin kapena crotch. Pankhaniyi wodwala akusowa chithandizo mwamsanga, popeza boma ndi zinadzala ndi imfa. Kawirikawiri yopuma aneurysm pakati za m'mimba pang'ono chabe, m'mimba kapena duodenum, osachepera - mu mimba wandiweyani. Pamene chinang'ambika m'mimba kung'ambika aneurysm, matendawo akhoza limodzi ndi kunyansidwa ndi kusanza. Mu pane kumanzere wa pamimba ndi palpated maphunziro pang'onopang'ono kuwonjezeka ndi funde amphamvu. malire ake sali palpated.

Pa chotupa cha zizindikiro aneurysm chowala kwambiri, koma iwo ali mosavuta kusokonezedwa ndi zinthu zina matenda oopsa, choncho onetsetsani kuti itanani ambulansi aliyense wa ululu waukulu pamimba kapena chifuwa.

matenda a matenda

Woyamba matenda siteji - mankhwala bwinobwino zimene pa palpation akumverera pulsation amphamvu pamimba, ndi m'mimba kung'ambika aneurysm. Amaphatikizapo Kupeza Vuto kafukufuku amene amalola kuti muzione zimene zikuchitika zonse m'mimba. Choyamba, ndi ultrasound, ndi yopangidwa tomography (CT) ndi multislice yopangidwa tomography wa msempha (MSCT).

Ngati amaganiziridwa m'mimba kung'ambika aneurysm, ultrasound amalola ndithu pafupifupi mtheradi kutsimikiza kukhalapo kwake. Izo zimasonyeza Malo aneurysm, boma la pakhoma mtima, malo ogumuka, ngati izo zikuchitika.

CT kapena MSCT anachita kudziwa calcification, kung'ambika thrombosis vnutrimeshkovy, zingasokoneze kapena kuswa ndi kusiyana alipo.

Ngati mayesero matenda tanena musalole matenda zolondola (ngakhale ali osowa ndithu), oikidwa ndi aortography. njira walola zenizeni nthawi kuona msempha ndi nthambi zake mwa kuyambitsa madzimadzi wapadera mu chiwiya. Iye amasonyeza kuti ngati pali kukayikitsa chotupa cha mitsempha choipidwa ndi aimpso, wodziwika boma la wapotalikira magazi bedi.

Zovuta za m'mimba kung'ambika aneurysm

chikhalidwe ichi n'koopsa thanzi koma moyo. Choyamba, ndi msempha kungachititse embolism (blockage) ya mitsempha ya, zosokonezeka matenda, mtima kulephera.

Kugaŵa m'mimba kung'ambika aneurysm - vuto loopsa kuti ali chotupa yake, magazi akulowa zigawo mtima wa thupi. Ngati onse stratified wosanjikiza 3 ndi msempha yopuma kwathunthu, pali kwambiri magazi otayika.

Koma, ndithudi, vuto zoipitsitsa aneurysm - ndi yopuma. odwala ambiri ndi aneurysms Popanda kuchitapo kanthu adzafa pasanathe zaka 5. Musanayambe kusagwirizana munthu akuona ululu pamimba ndi kudera lumbar. Ngati aneurysm wa msempha m'mimba ong'ambika, matenda amakhala ndi magazi profuse chopita kudabwitsa ndi imfa. Choncho ndithu itanani ambulansi ngati ululu waukulu pamimba ndi chifuwa, ngati akuchedwa ndi woopsa. Kafukufuku amasonyeza kuti okha 3% odwala kufa pomwepo pambuyo chotupa kwa msempha, pamene ena amakhala maola 6 kwa miyezi 3. Nthawi zambiri, kufa pasanathe masiku. Kodi kuchiza ndi aneurysm? Taganizirani izi.

Chithandizo cha aneurysms m'mimba msempha

Anthu ambiri molakwa kuti matenda "aneurysm wa msempha m'mimba," chithandizo zitha kukhala opaleshoni. Ndipotu, pali onse payekha.

Ngati aneurysm ukufika masentimita 4.5 awiri, opaleshoni sitingachisonyeze, chifukwa iye akhoza kukwaniritsa pangozi yaikulu moyo kuposa chinawonjezeka kukula chotengera. Childs, chizoloŵezichi yakula mu akulu amene amadwala co-morbidities, kuwonjezera sasiya kusuta (ndi woterowo matenda kusiya kusuta fodya basi ayenera!). Kwa iwo, masewera wodikira, chifukwa chiopsezo chotupa kung'ambika pa m'mimba mwake ngati ali okha 3% pa chaka. Pankhaniyi, miyezi sikisi iliyonse mtima ndi amakakamizidwa kuchita ultrasound kupeza kukula kwa msempha. Ngati khoma mtima pang'onopang'ono zambiri, ndi umboni chachikulu opaleshoni chifukwa imabwera chotupa ndi chinawonjezeka ndi anthu 50%.

Achikulire amene anawulula ndi aneurysm wa msempha m'mimba, mankhwala ndi desirably ikuchitika mwa endovascular ndi, asang'ambe njira. Pa opaleshoni, wodwala kutumikiridwa mu mtsempha wamagazi ndi catheter kudzera zimene zinaphatikizapo stent. Wagwidwa msempha, umathandiza ndi chimakwirira mtsempha wamagazi, potero kuchotsa zinkakhala m'dera la thupi lake. Ubwino ntchito monga portability opepuka ndi yaing'ono nthawi kuchira - masiku ochepa. Koma njira imeneyi ali zina zabwino zake, kotero unachitikira si onse. The drawback chachikulu cha ntchito imeneyi - 10% milandu pali wapotalikira kusamuka cha maimidwe anakhazikitsa.

Ngati anapezeka ndi "m'mimba kung'ambika aneurysm", ntchito zambiri lotseguka. Pa m'dera lake akhudzidwa kwa msempha chinatha ndipo m'malo mwa prosthesis zopangidwa Dacron (kupanga nsalu zochokera poliyesitala). Pofuna kupereka mwayi kwa msempha, ntchito apakatikati laparotomy. Nthawi opaleshoni zambiri ndi za 2-3 maola. Pambuyo pa opaleshoni amakhalabe kuonekera chilonda.

Wodwalayo anachira pafupifupi milungu iwiri. Resumption ntchito zina zimatheka pambuyo masabata 4-10. The wodwala koletsedwa zolimbitsa thupi, amasonyeza mtendere ndi akuyenda.

Contraindications kutsegula opaleshoni

Ndikoletsedwa opaleshoni pansi zinthu zotsatirazi:

• Recent m'mnyewa wamtima infarction (osati mwezi n'komwe).
• Mtima ndi m'mapapo mwanga insufficiency.
• Aimpso insufficiency.
• Iliac ndi mitsempha femoral.

Konzanso pambuyo opaleshoni

Kumene, pamaso pa mavuto pambuyo opaleshoni bwanji zaka wodwalayo ndi matenda kugwirizana. Komanso, mmene alili akhoza kuvutika ngati thupi lake kale wofooka (HIV, Oncology, shuga), pali kunenepa ndi mtima matenda. Komanso, ntchito chisanadze wopita amapereka mtima zambiri moyo ndi achire kuposa alowererepo mwadzidzidzi pa chotupa cha aneurysm kung'ambika.

Zovuta zikhonza kukhalapo monga anachita ochititsa dzanzi onse, amene wosachita onse, chitukuko cha matenda kuwonongeka kwa ziwalo ndi magazi. The ochepa kwambiri milandu amapha ntchito.

Ngati opaleshoni zakonzedwa, madokotala amalangiza sabata pamaso yonyamula katundu wake kusiya kumwa mankhwala, thinners magazi, ndi mankhwala odana ndi yotupa (aspirin ndi ena.). Onetsetsani kudziŵitsa dokotala wanu za mtundu wa mankhwala mukutenga pa nthawiyo, pamaso ntchito.

Chiopsezo zisadzachitikenso ndi yaing'ono kwambiri, koma ngati munthu mwadzidzidzi amayamba kusokoneza kupweteka kwa msana kapena pamimba, nseru, kusanza, kuchita dzanzi mapazi kapena maganizo ambiri akudwala, ayenera pitani kuchipatala mwamsanga.

Kuteteza aneurysm

M'mimba kung'ambika aneurysm amapezeka muli zokayikitsa ngati mukana (ndi, Choncho, si kukhala ndi chizolowezi), kusuta, udzalamulira kuthamanga ndi kulemera. M'pofunikanso kutsogolera yogwira ndi wathanzi moyo. Khalani wathanzi!