Ib Case Ntawm Percutaneous Angioplasty Thiab Conservative Treatment Rau Ob Tog Blunt Lub Raum Kev Mob Siab

Bluntmob raum hlab ntshatsis tshua muaj thiab tsis tau tsim kho tus qauv. Peb tshaj tawm ib rooj plaub ntawm ob tog bluntmob raum hlab ntshahauv qhov twgpercutaneous angioplastythiabkev kho mobtau ua. 4 tiam txiv neej. Thaum taug kev, nws raug lub tsheb thauj khoom thiab raug mob. Contrast-enhanced CT thiab angiography qhia kev cuam tshuam ntawm covtxoj cai lub raum hlab ntsha, tsis zoo sib xws nyob rau hauv lubtxoj cai lub raum parenchyma,kev puas tsuajmus rau lub dorsal ceg ntawm lubsab laug lub raum hlab ntsha, thiab ncua kev sib piv hauv dorsal sab laug raum parenchyma. Txawm hais tias peb muaj peev xwm muab ib qho stent nyob rau hauv dorsal ceg ntawm lub raum sab laug, sab xislub raum hlab ntsha occlusiontsis tuaj yeem kho tau percutaneously. Txawm hais tias kev phais revascularization tau txiav txim siab, nws tau txiav txim siab tias lub raum ua haujlwm txaus twb tau khaws cia lawm, thiab txoj cai lub raum cov hlab ntsha raug kho kom zoo. Ntshav siab uas tshwm sim tom qab phais tau kho nrog cov tshuaj qhov ncauj.Cov tshuaj creatinine4 lub hlis tom qab raug mob yog 1. Cov stent tau pom tias muaj patent ntawm qhov sib txawv-enhanced CT ntawm ₁₂mg/dl. Cov ntsiab lus Index:blunt lub raum hlab ntsha raug mobpercutaneous angioplasty,kev kho mob

Nyem qhov no kom tau txais Natural organic CISTANCHE EXTRACT nrog 25% ECHINACOSIDE thiab 9% ACTEOSIDE rau lub raum ua haujlwm

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Keeb kwm

Bluntmob raum hlab ntshayog ib qho kev raug mob uas tsis tshua muaj tshwm sim uas ua rau muaj kev nyuaj siab blunt trauma ₁) ₂). Tsis muaj cov qauv kev kho mob tau tsim, thiab kev phais revascularization thiab kev saib xyuas kev kho mob tau ua tiav, tab sis nyob rau xyoo tas los no, qhov txiaj ntsig ntawm percutaneous angioplasty tau lees paub ₃) ₄). Peb tshaj tawm ib rooj plaub ntawm ob sab blunt lub raum hlab ntsha raug mob nyob rau hauv uas percutaneous angioplasty thiab kev saib xyuas kev kho mob tau ua tiav los khaws cia.txaus lub raum ua haujlwm.

Nyob rau hnub 4 thiab 13 hauv tsev kho mob, qhib kev txo qis ntawm txoj cai acetabular puas thiab vertebral subluxation tau ua. Kev mob ntshav siab tau pom los ntawm hnub 22 hauv tsev kho mob thiab tau tswj nrog cov tshuaj tiv thaiv qhov ncauj. Kev tswj hwm qhov ncauj ntawm cov tshuaj aspirin ₁₀₀mg / hnub tau pib rau hnub 33 ntawm kev mob. Nws raug xa mus rau tsev kho mob hnub 43 lub tsev kho mob yam tsis tau txais hemodialysis. Serum creatinine 4 lub hlis tom qab raug mob yog 1. ₁₂mg/dl, eGFR yog ₈₃mL/min/₁. Nws yog ₇₃m₂. Contrast-enhanced CT pom tau hais tias lub stent muab tso rau hauv lub dorsal ceg ntawm lub raum sab laug raum cov hlab ntsha yog patent, thiab tsis muaj qhov sib txawv ncua sij hawm los yog atrophy nyob rau hauv lub dorsal sab ntawm lub raum sab laug, tab sis lub raum txoj cai, qhov twg cov ntshav khiav tsis muaj zog. yuav daws tau, yog atrophied loj heev.

Nws yog shrinking (Daim duab 3). Ntshav siab tau tswj tau zoo nrog cov tshuaj noj qhov ncauj.

Kev xav thiab kev soj ntsuam

Lub raum hlab ntsha raug mob yog tshwm sim los ntawm blunt trauma. ₀₅︲₀. Nws yog ib qho kev raug mob tsawg uas tshwm sim hauv ₀₈%₁)₂). Nyob ntawm seb hom kev raug mob, nws tuaj yeem muab faib ua lacerations thiab ruptures uas muaj tag nrho cov tuab ntawm cov hlab ntsha, thiab intimal kev puas tsuaj uas yog localized nkaus xwb rau intima. Kua muag thiab ruptures cuam tshuam rau lub neej prognosis vim los ntshav, thiab intimal raug mob cuam tshuam rau functional prognosis vim impaired ntshav txaus. . . Yog li ntawd, qhov ceev thiab cov ntsiab lus ntawm txhua qhov kev kho mob txawv, tab sis lub raum mob hlab ntsha tsis raug cais los ntawm kev raug mob hauv Japanese Society of Traumatology Organ Injury Classification ₂₀₀₈₅) thiab American Association for Surgery of Trauma Raum Injury Scale ₆). Raws li kev kho mob, hemostasis yog qhov tsim nyog thaum muaj los ntshav vim lacerations lossis ruptures. Ntawm qhov tod tes, tsis muaj kev xav txog kev kho kom zoo rau cov ntshav khiav tsis zoo uas tshwm sim los ntawm kev puas tsuaj tsis zoo li qhov no.

Kev kho mob ntawm blunt lub raum hlab ntsha intimal raug mob muaj xws li phais revascularization, kev kho kom zoo, thiab percutaneous angioplasty. Keeb kwm, kev phais revascularization tau sim, tab sis qhov kev ua tau zoo thiab lub raum ua haujlwm khaws cia tus nqi tsuas yog 3. ₃︲₈₀－. ₀%, ₀︲₄₂. ₉% tsis yog qhov tshwm sim zoo₂)₇)︲₉). Vim li no, nyob ib ncig ntawm 2012, kev phais revascularization tau sim thaum muaj kev puas tsuaj rau ib lossis ob lub raum, tab sis kev ua haujlwm ntawm lub raum noj qab haus huv tau khaws cia.

Tam sim no muaj cov lus ceeb toom uas pom zoo rau kev kho mob yog tias tus mob tshwm sim. Percutaneous angioplasty tau tshaj tawm thawj zaug hauv xyoo 2012 (2015), thiab suav tias yog ib qho kev xaiv tsim nyog vim tias nws txoj kev ua tau zoo ntawm 43% thiab lub raum ua haujlwm khaws cia tus nqi ntawm 20%. Hauv qhov no, muaj chaw rau kev sib tham txog dab tsi yuav tsum tau ua thaum percutaneous revascularization ntawm txoj cai lub raum hlab ntsha yog ua tsis tau. Peb ntseeg hais tias kev ua haujlwm ntawm lub raum txaus tsis tuaj yeem tswj tau yog tias txhua qhov kev raug mob raug kho kom zoo, yog li peb tau ua kom rov ua dua tshiab rau cov ceg dorsal ntawm sab laug raum cov hlab ntsha. Nws tau raug tshaj tawm tias muaj kev sib raug zoo ntawm lub raum parenchymal ntim thiab lub raum ua haujlwm. Tom qab nephrectomy, qhov seem ntawm lub raum ua haujlwm tau raug tshaj tawm kom nce ntxiv los ntawm ₂₀︲₂₅%. Hauv qhov no, thaum ntsuas tom qab ua haujlwm, lub raum parenchymal ntim yog ₁₄₀cm₃ ntawm sab xis thiab ₁₅₆cm₃ ntawm sab laug, qhia txog cov ntshav tsis txaus.

Tsis muaj teeb meem tshwm sim hauv lub raum sab laug ntawm lub raum ntawm ₉₃cm₃, thiab nrog kev kho kom zoo ib leeg, lub raum tsis ua haujlwm yog eGFR ₃₇︲₃₉mL / min / ₁. Nws xav tias yuav yog ₇₃m₂. Tom qab nephrectomy

eGFR<₄₅mL/min/₁. ₇₃m₂ is a poor prognostic factor (₁₁), suggesting that additional revascularization was necessary. Subsequently, a stent was successfully placed in the dorsal branch of the left renal artery, making it possible to preserve the entire left kidney. Considering the fact that one kidney had already been preserved in its entirety, the results of surgical revascularization, and the extent of the invasion, we concluded that the right renal artery was a unilateral renal artery injury before the advent of percutaneous angioplasty.

Peb tau txiav txim siab tias kev kho kom zoo yog tsim nyog raws li cov lus pom zoo ntawm . Plaub lub hlis tom qab raug mob, lub raum kev ua haujlwm tau raug khaws cia txaus, thiab peb qhov kev txiav txim siab tau raug suav tias yog qhov ua tau. Txawm hais tias nyob rau hauv cov xwm txheej uas muaj cov ntshav ntws los ntawm cov hlab ntsha ntawm lub raum tsis txaus ntseeg ntawm ob sab, zoo li qhov no, nws muaj peev xwm ua kom lub raum ua haujlwm kom txaus tuaj yeem ua tiav nrog kev cuam tshuam me me los ntawm kev kho kom yooj yim ntawm percutaneous angioplasty. Muaj. Hauv qhov no, txawm hais tias percutaneous angioplasty tau raug tshaj tawm tias muaj qhov ua tau zoo, kev rov ua haujlwm ntawm lub raum sab xis tsis tau tiav. Nws tau raug taw qhia tias lub sijhawm ntev sov ischemia thiab ua tiav occlusion yog cuam tshuam nrog kev txo qis hauv kev phais revascularization, thiab nyob rau hauv rooj plaub no, nws siv sij hawm ntev rau revascularize, thiab txoj cai lub raum cov hlab ntsha tau tag nrho occluded. Nws tsis tuaj yeem tsis lees paub tias qhov no tuaj yeem ua rau qhov tsis ua tiav. Ntawm qhov tod tes, nyob rau hauv cov ntaub ntawv ntawm tag nrho occlusion nyob rau hauv daim ntawv summarizing percutaneous angioplasty hais saum toj no, lub sij hawm mus txog rau reperfusion yog.

Lub sijhawm nruab nrab yog ₆ teev, tab sis qhov kev ua tau zoo yog ₈₈%, qhia lwm yam muaj peev xwm thiab. Vim tias qhov kev raug mob tsis tshua muaj tsawg thiab cov neeg mob tsawg, nws yog ib qho nyuaj rau muab cov txiaj ntsig los ntawm kev paub ntawm ib lub tsev kawm ntawv, thiab peb ntseeg tias nws yog qhov tsim nyog los sau cov kev paub ntawm ntau lub tsev kawm ntawv.

Xaus

Kuv tau ntsib ib qho kev raug mob tsawg hu ua ob sab blunt lub raum hlab ntsha raug mob. Los ntawm kev ua percutaneous angioplasty ua ntej thiab ua tiav kev ua tiav ib nrab revascularization, peb muaj peev xwm khaws cia lub raum ua haujlwm txaus rau kev phais me me yam tsis muaj kev phais revascularization. Tsis muaj teeb meem ntawm kev txaus siab.

Cov ntawv nyeem

1) Sangthong B, Demetriades D, Martin M, thiab al: Kev tswj hwm thiab tsev kho mob cov txiaj ntsig ntawm kev raug mob rau lub raum hlab ntsha: kev tshuaj xyuas ntawm 517 tus neeg mob los ntawm National Trauma Data Bank. J Am Coll Surg 2006; 203: 612; 617 : kuv.

2) Bruce LM, Croce MA, Santaniello JM, thiab al: Blunt lub raum hlab ntsha raug mob: tshwm sim, kuaj mob, thiab tswj. Am Surg 2001; 67: 550; 556.

3) Whigham CJ Jr., Bodenhamer JR, Miller JK: Siv Palmaz stent nyob rau hauv thawj kev kho mob ntawm lub raum hlab ntsha intimal raug mob thib ob rau blunt trauma. JVIR 1995; ₆: 175︲ 178.

4) Beyer C, Zakaluzny S, Humphries M, et al: Multidisciplinary tswj ntawm Blunt Renal Artery Nyob rau hauv pawg neeg txiav txim nrog Endovascular Therapy nyob rau hauv qhov chaw ntawm Polytrauma: Ib Case Report thiab Review ntawm nws erature. Ann Vasc Surg 2017; 38:318:11; 318.e16.

5) Japanese Society of Traumatology Organ Injury Classification Committee: Kidney Injury Classification 2008 (Japanese Society of Traumatology). Japanese Journal of Trauma 2008; 22:265 : kuv.

6) Moore EE, Shackford SR, Pachter HL, et al: Organ raug mob modeling: spleen, siab, thiab raum. J Trauma 1989; 29: 1664; 1666.