Aneurysm vs Pseudoaneurysm
Ob leeg aneurysm thiab pseudoaneurysm tam sim no tib yam. Ob leeg tam sim no yog pulsatile, mob hnyav. Tej zaum yuav muaj reddening nyob ib ncig ntawm ob. Vim qhov kev nthuav qhia zoo sib xws, qhov sib txawv yog qhov nyuaj thaum xub thawj siab ib muag. Txawm li cas los xij, muaj ntau qhov sib txawv nruab nrab ntawm aneurysm thiab pseudoaneurysm thiab uas yuav tau tham txog ntawm no kom ntxaws, qhia txog cov tsos mob, cov tsos mob, ua rau, kev tshawb nrhiav thiab kev kuaj mob, kev kuaj mob, thiab kev kho mob ntawm txhua tus mob.
Aneurysm
Aneurysm yog qhov txawv txav ntawm cov hlab ntsha. Aneurysm tuaj yeem yog fusiform lossis sac-zoo li. Aorta, iliac hlab ntsha, femoral thiab popliteal hlab ntsha yog cov chaw ntau. Kev cuam tshuam ntawm cov hlab ntsha lumen vim yog atheroma yog lub hauv paus ntsiab lus ntawm cov hlab ntsha proximal dilation. Hauv qee cov kab mob sib txuas xws li Marfan's, Ehlers-Danlos Syndrome, muaj qhov ua tau zoo ntawm cov phab ntsa ntawm cov hlab ntsha uas ua rau muaj kev cuam tshuam ntawm cov kab mob spontaneous dilatation. Cov kab mob xws li endocarditis thiab syphilis tertiary kuj paub tias ua rau mob aneurysms.
Feem ntau cov aneurysms daws qhov tshwm sim ntawm thrombosis, tab sis qee qhov aneurysms yuav tawg ua rau lub neej txaus ntshai los ntshav. Kev tawg yog tsis tshua muaj nyob rau hauv cov hlab ntsha dilated nrog txoj kab uas hla tsawg dua 5 cm. Tshaj li 5 cm, qhov kev pheej hmoo ntawm rupture nce exponentially. Thaum ntxov arterial dilatation tuaj yeem ua rau muaj kev ntxhov siab rau cov qauv nyob ib puag ncig. (Piv txwv li: plab aortic aneurysm yuav nias ntawm ureter, duodenum, thiab lumbar qaum). Rupture tshwm sim tam sim ntawd qhov mob hnyav thiab ntshav siab poob. Nws tuaj yeem ua rau lub raum colic, tab sis kev kuaj mob tam sim thiab kev ua haujlwm yog cawm txoj sia. Fistula tsim yog ib qho kev paub txog ntawm aneurysm rupture. Qee lub sij hawm cov ntshav txhaws tsim hauv qhov aneurysm tuaj yeem tawg thiab embolize.
Ultra suab scan thiab CT scan yog kuaj. Thaum cov hlab ntsha tsawg dua 5 cm hauv txoj kab uas hla, kev soj ntsuam tas li, tswj ntshav siab, thiab pw tsaug zog yog qhov tseem ceeb. Kev ntsuam xyuas tsis tu ncua ntawm txoj kab uas hla aneurysm yog qhov tseem ceeb. Cov tsos mob aneurysms thiab aneurysms loj dua 5 cm xav tau kev kho mob. Hauv cov xwm txheej xaiv, CT scan yuav pab tau rau kev txheeb xyuas qhov sib thooj ntawm cov hlab ntsha hauv lub raum. Kev ua haujlwm cuam tshuam nrog clamping lub aorta hauv qab lub raum cov hlab ntsha thiab clamping cov hlab ntsha iliac distal mus rau qhov aneurysm. Lub hnab aneurysm yog qhib longitudinally, thiab ntu aortic yog hloov nrog ib tug ncaj los yog ib tug bifurcated hluavtaws graft. Lub graft yog nteg nyob rau hauv lub aneurysm, uas yog ces kaw nyob rau hauv nws. Lwm txoj kev suav nrog kev hla cov khoom siv hluavtaws endoluminally los ntawm femorals. Kev ua haujlwm tuag ntawm ruptured aneuryms tseem nyob ib ncig ntawm 50%.
Pseudoaneurysm
Pseudo-aneurysms txhais tau tias tsis tseeb aneurysms. Nws yog tshwm sim los ntawm cov ntshav tawm tom qab raug mob. Ntshav sau sab nraum cov hlab ntsha thiab cov ntaub so ntswg nyob ib puag ncig nws tawm. Pseudo-aneurysms feem ntau tshwm sim raws li pulsatile, mob thiab qeeb expanding masses. Vim muaj reddening, lawv feem ntau tsis meej pem nrog abscesses.
Tej zaum yuav muaj keeb kwm ntawm catheterization lossis lwm yam khoom siv vascular invasive. CT scan thiab duplex ultrasound yog kuaj. Txawm hais tias pseudo-aneurysms tuaj yeem tshwm sim nyob txhua qhov chaw hauv lub cev, femoral thiab radial, ulnar thiab brachial pseudo-aneurysms tau dhau los ua ntau yam vim yog lub plawv catheterization thiab arterio-venous fistula tsim rau hemodialysis.
Txoj kev kho mob yog them nrog stents, sojntsuam compression, txhaj tshuaj thrombin thiab phais ligation. Npog stenting suav nrog kev taw qhia ntawm me me stent endoluminally kom tshem tawm qhov nthuav dav hematoma los ntawm kev ncig. Feem ntau muaj me me ncig mus rau hauv thiab tawm ntawm pseudo-aneurysm uas tuaj yeem pom nrog ultrasound. Qhov kev sojntsuam tuaj yeem raug nias tawm tsam lub caj dab ntawm qhov nthuav dav hematoma li 20 feeb. Thaum qhov kev sojntsuam raug tshem tawm, tsis muaj kev ncig ntxiv vim tias cov ntshav hauv cov hlab ntsha pseudo-aneurysm txhaws thaum lub sijhawm 20 feeb. Txoj kev no yog hu ua ultrasound sojntsuam compression. Thrombin yog ib qho kab mob uas tuaj yeem raug txhaj rau hauv pseudo-aneurysms nyob rau hauv kev taw qhia ultrasound. Kev phais ncaj qha ntawm caj dab ntawm qhov nthuav dav hematoma yog lwm txoj kev kho mob.
Qhov txawv ntawm Aneurysm thiab Pseudoaneurysm yog dab tsi?
• Aneurysm yog ib qho kev nthuav dav ntawm cov hlab ntsha thaum pseudo-aneurysm yog cov phab ntsa tawm ntawm cov ntshav tawm sab nraud ntawm cov hlab ntsha puas.
• Aneurysm thiab pseudo-aneurysms tuaj yeem nthuav dav, tab sis pseudo-aneurysms tsis rupture nrog dilatation.
• Kev tuag ntawm aneurysms ntau dua li ntawm pseudo-aneurysms.
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