Тромбофлебит после операции довольно часто протекает бессимптомно, а у многих пациентов он осложняется венозным тромбоэмболизмом (ВТЭ). Состояние, при котором тромб из одного отдела сосудистого русла мигрирует в другой. Наиболее частым клиническим проявлением послеоперационного ВТЭ являются тромбоэмболия легочной артерии (ТЭЛА), когда сгусток крови, образовавшийся в ногах, перемещается в легкие. Это одна из основных причин смерти среди пациентов в послеоперационном периоде.
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Что такое венозный тромбоэмболизм
Образование сгустка крови (тромба) может произойти в любом участке венозной системы. Но чаще всего такая ситуация возникает после операции при тромбофлебите нижних конечностей. Формирование сгустка в сосудах, расположенных в мышечных фасциях ног, вначале может происходить незаметно, а первым проявлением довольно часто является венозная тромбоэмболия — отрыв фрагмента тромба и его миграция в другие отделы венозной системы.
Перемещаясь с током крови, «кусочки» тромба из нижних конечностей сначала попадают в правые отделы сердца, а затем в систему легочной артерии. В зависимости от калибра блокированного сосуда и продолжительности закупорки, возникает соответствующая симптоматика. Данное патологическое состояние является потенциально опасным для жизни больного. Статистика говорит о следующем:
- установлено, что примерно у 30% хирургических пациентов развивается тромбоз глубоких вен в послеоперационном периоде;
- данная патология в 50% случаев протекает бессимптомно;
- риск фатальных тромбоэмболий после операции составляет 1 — 5%.
При следующих видах хирургического вмешательства наблюдается чаще всего венозный тромбоэмболизм:
- ортопедические (например, операции при переломах крупных костей, протезирование тазобедренного сустава);
- абдоминальные (резекция кишечника, желудка);
- гинекологические;
- урологические;
- нейрохирургические;
- сосудистые (операции на сердце и кровеносных сосудах).
Особому риску развития ВТЭ подвержены пациенты, у которых выполняется иссечение варикоза. Тромбофлебит после операции удаления вен, которые расположены непосредственно под кожей, встречается довольно часто. Помимо того, что перед вмешательством, как правило, сосуды уже «скомпрометированы», во время хирургических манипуляций травмируются их стенки, что приводит к усиленному тромбообразованию.
Факторы риска послеоперационной тромбоэмболии
Основная причина формирования тромба в глубоких венах нижних конечностей — длительная обездвиженность больного как во время операции, так и после хирургического вмешательства. Мышцы ног, сокращаясь, помогают продвигаться крови по сосудам к сердцу. Их пассивность в послеоперационном периоде приводит к застою ее в нижней части тела, особенно это касается голени. В свою очередь «переполнение в венах ног» приводит к повышению риска тромбообразования в них.
Чтобы реализовалась основная причина тромбоза — обездвиженность после операции — необходимо присутствие факторов риска, состояние организма пациента, которые сопровождаются дисбалансом свертывающей и противосвертывающей систем крови. Это встречается в следующих ситуациях:
- период лечения раковых заболеваний;
- возраст старше 60 лет;
- обезвоживание организма;
- тромбофилии (унаследованное или приобретенное патологическое состояние, характеризующееся нарушением системы свертываемости крови, при которой увеличивается риск развития тромбоза);
- ожирение (индекс массы тела более 30 кг/м2);
- наличие одного или нескольких сопутствующих заболеваний (например, болезни сердца, метаболические, эндокринные или респираторного заболевания, острые инфекции);
- уже был в анамнезе или существует семейная история «эксцесса с тромбом»;
- применение заместительной гормональной терапии или контрацептивных таблеток, которые содержат эстроген;
- варикозное расширение вен, особенно с признаками воспаления;
- беременность через 6 месяцев послеродового периода.
Саму операцию в дополнение к обездвиженности можно расценивать как причину образование тромбов. Любое хирургическое вмешательство сопровождается нарушением целостности сосудов, в результате чего в крови активизируются факторы свертывания, участвующие в образовании сгустка. Кроме того, в кровяное русло попадают фрагменты ткани, коллаген, жир. Кровь, вступая с ними в контакт, начинает сворачиваться.
Клинические проявления, диагностика
Заподозрить послеоперационный тромбофлебит можно, если внезапно появилась боль и отечность одной из ног. Помимо этого, возможны следующие проявления патологии:
- боль усиливается при вставании или при ходьбе;
- присутствует усталость в ногах;
- чувство жжения, распирание в конечности;
- набухание подкожных вен;
- возможен резкий подъем температуры, озноб.
Чтобы подтвердить диагноз, выполняются, как правило, следующие методы исследования:
- Дуплекс УЗИ. Неинвазивный метод, который позволяет оценить прямоток в венах нижних конечностей, определить, где находятся тромбы.
- Контрастная венография. Сегодня этот метод диагностики патологии вен ног, который предусматривает введение в венозное русло контрастных веществ, используется редко.
- Компьютерная томографическая или магнитно-резонансная венография. Достаточно информативные методики, но из-за дороговизны они редко используются в клинической практике.
В случае тромбирования легочной артерии возможны следующие симптомы:
- внезапно возникшая одышка;
- резкая боль в грудной клетке, которая усиливается при глубоком вдохе или кашле;
- тахикардия (ускоренное сокращение сердца);
- частое дыхание;
- потливость;
- беспокойство;
- кровохарканье;
- потеря сознания;
- признаки коллаптоидного состояния.
Чтобы подтвердить тромбоз легочной артерии, врач может назначить:
- рентгенографию грудной клетки;
- электрокардиографию (ЭКГ);
- анализ на D-димер;
- КТ (компьютерную томографию);
- магнитно-резонансную томографию (МРТ);
- допплерографию;
- эхокардиографию.
Профилактика венозной тромбоэмболии
Еще на этапе поступления в хирургический стационар у каждого пациента проводится оценка вероятности образования тромба в послеоперационном периоде. После чего врач в каждой конкретной ситуации назначает соответствующие профилактические мероприятия, которые можно условно разделить на механические и фармакологические.
Под немедикаментозным способом профилактики подразумевается ношение компрессионного трикотажа или использование специально разработанных пневматических приспособлений. Медикаментозный вариант предусматривает использование различных препаратов, которые разряжают кровь. Для этого используются следующие лекарственные средства:
- Аспирин улучшает реологию крови, считается единственным препаратом из этой группы, который обладает доказанными профилактическими свойствами в отношении венозной тромбоэмболии, возникающей в послеоперационном периоде.
- Низкомолекулярные гепарины (эноксапарин, дальтепарина, фондапаринукс) относятся к антикоагулянтам прямого действия, непосредственно инактивируют различные факторы свертывания крови.
- Варфарин, аценокумарол, фениндион и дикумарин — антикоагулянты непрямого действия. Являются антагонистами витамина К, нарушают синтез в печени протромбина и других факторов свертывания крови.
Довольно часто перенесенный тромбофлебит у хирургических больных может перейти в так называемый посттромбофлебитический синдром. Это хроническое состояние, как результат воспаления сосудистой стенки и пребывания тромба в венах нижних конечностей, может появиться, если не была проведена должным образом реабилитация тромбофлебита после операции.
Профилактика тромбофлебита глубоких вен нижних конечностей и тромбоэмболий легочных артерий у больных хирургического профиля остается актуальной проблемой современной медицины. На сегодняшний день использование мероприятий, предотвращающих развитие венозной тромбоэмболии в послеоперационном периоде, активное участие в которой должен принимать и сам пациент, считается рутиной в хирургической практике. Это осложнение лучше предотвратить, чем потом лечить, что требует выполнения дорогостоящих диагностических процедур и длительного применения антикоагулянтов.
Тромбофлебит после операции довольно часто протекает бессимптомно, а у многих пациентов он осложняется венозным тромбоэмболизмом (ВТЭ). Состояние, при котором тромб из одного отдела сосудистого русла мигрирует в другой. Наиболее частым клиническим проявлением послеоперационного ВТЭ являются тромбоэмболия легочной артерии (ТЭЛА), когда сгусток крови, образовавшийся в ногах, перемещается в легкие. Это одна из основных причин смерти среди [. ]
Зачастую тромбоз глубоких вен несет серьезную угрозу жизни. Острый тромбоз требует немедленного лечения. Симптомы на нижних конечностях, особенно голени, могут диагностироваться не сразу. Операция требуется также не всегда.
Оторвавшийся тромб несет смертельную угрозу для человека. Профилактика тромбозов вен и сосудов способна снизить риск фатальной угрозы. Как предотвратить появление тромбоза? Какие средства против него самые эффективные?
При варикозе проводится операция минифлебэктомия. Она может быть выполнена по Варади, Мюллеру. Послеоперационный период короткий, но наблюдать протоки и состояние вен нужно на протяжении года. Осложнениями могут быть шишки, уплотнения и прочие.
Не каждый врач с легкостью ответит, как различить тромбоз и тромбофлебит, флеботромбоз. В чем принципиальная разница? К какому врачу обращаться?
Профилактика тромбоза сосудов должна проводиться комплексно. Это и диета, и правильное питание, препараты и витамины. Вся информация в статье.
Такая опасная патология, как гнойный тромбофлебит нижних конечностей, может возникнуть буквально из мелочи. Насколько опасно гнойное воспаление? Как лечить гнойный тромбофлебит?
Назначается операция кроссэктомия зачастую только по экстренным показаниям при тромбофлебите и других осложнениях с венами. Техника выполнения подразумевает извлечение проблемной вены. Послеоперационный период занимает до недели.
При закупорке различных сосудов тромбом проводится операция тромбэктомия. Она может быть аспирационная, легочная, выполняется также при геморрое. Однако изначально проводится лечение медикаментами. Восстановление после тромбэктомии короткое.
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Эндовазальная лазерная коагуляция вен. 1-я категория сложности. включая анестезиологическое пособие (местная анестезия).
Курс лимфопрессотерапии 10 процедур. Принимает Врач-флеболог кандидат медицинских наук
Прием проводит Врач-хирург высшей категории д.м.н., профессор Комраков. В.Е.
Однократный сеанс склеротерапии в пределах всей нижней конечности (пенная склеротерапия, микросклеротерапия).
Варикоз, тромбы, клапанная недостаточность, отеки на ногах
— все это повод выполнить УЗИ вен нижних конечностей
и пройти консультацию у флеболога.
Лимфопрессотерапия показана при
отеках нижних конечностей, лимфостазе.
Также она проводится в косметологической целью
Послеоперационный тромбоз нижних конечностей возникает вследствие закупорки просвета сосуда тромбом или эмболом, оторвавшимся в результате операции или занесенным в ее ходе воздушным пузырем или жировой прослойкой.
Причины возникновения тромбоза нижних конечностей
Вены нижних конечностей наиболее часто страдают вследствие послеоперационных осложнений. При кровообращении в ногах особенно важной является динамика кровотока в голенях. Если мышцы нижней части ноги страдают из-за послеоперационной малоподвижности или паралича, то интенсивность кровотока в них резко падает. А если это сочетается с такими факторами, как поражение сосудистой стенки или нарушение в системе свертываемости, то имеются все предпосылки для возникновения тромбоза.
Послеоперационный тромбоз нижних конечностей развивается и вследствие того, что при хирургическом вмешательстве активизируется тромбоцитарная система организма, призванная остановить послеоперационное кровотечение и способствовать заживлению поврежденных тканей. При условии пониженной динамики кровотока в нижних конечностях у лежащего человека есть угроза скопления тромбоцитов в плотный комок форменных элементов, перекрывающий просвет сосуда.
Это заболевание чаще всего поражает людей, уже имеющих патологию, предрасполагающую к его развитию:
• предшествующие параличи и парезы,
• обездвиженность в результате травмы.
Течение заболевания
Среди послеоперационных тромбозов нижних конечностей различают флеботромбозы и тромбофлебиты. В первом случае тромб возникает в неповреждённом сосуде. Он приносится током крови или возникает вследствие агрегации тромбоцитов. Чаще всего сосуд не перекрывается полностью, кровь имеет возможность двигаться в нужном направлении. Такой тромбоз не всегда можно вовремя заметить и предотвратить, так как клинические проявления или отсутствуют, или выражены очень слабо.
Во втором случае тромб появляется в толще сосудистой паренхимы, поврежденной в результате операции или во время существовавшего прежде воспалительного или травматического процесса. При этом возникает вторичное воспаление, связанное с нарушением кровоснабжения закупоренного участка и выделением продуктов распада тканей. Кровоснабжение в данной ситуации нарушается окончательно, тромб полностью перекрывает просвет сосуда.
Особенности локализации тромбов в нижних конечностях
Как уже упоминалось, чаще всего локализацией таких тромбов является область голени, соответственно, первым симптомом, указывающим на развитие послеоперационного тромбоза нижних конечностей, является боль в икроножной области. Постепенно к ней присоединяется ограниченность в подвижности ноги. Конечность отекает, краснеет, постепенно приобретая синюшный оттенок, наблюдается повышение температуры. Пациент ощущает, что нога как будто разбухает. При надавливании на мягкие ткани пациент ощущает резкую боль. Если тромбом закупориваются все три парные вены голени, то состояние может стать угрожающим, вплоть до потери конечности.
Если тромбоз поразил сосуды бедра, то главным симптомом становится отек. Этот вид тромбоза не так опасен, так как в бедре имеются коллатерали, поэтому полностью кровоснабжение тканей не прекращается. В остальном симптомы схожи с тромбозом сосудов голени. При надавливании на мягкие ткани пациент также ощущает боль. Конечность двигается с трудом. Постепенно нога приобретает синюшный оттенок и в ней начинает падать температура. Если вовремя не принять меры, то ткани ноги уплотняются, происходит вторичное сдавливание сосудов и начинается сильный воспалительный процесс. Боль приобретает пульсирующий характер.
Лечение тромбоза нижних конечностей
Наш медицинский центр практикует лечение и профилактику послеоперационных тромбозов нижних конечностей. Он оснащен всем необходимым: самой современной диагностической аппаратурой, полностью оборудованной операционной, комфортным стационаром. В центре работают специалисты высочайшего уровня квалификации, обладающие всеми необходимыми лицензиями и сертификатами, постоянно совершенствующиеся в лучших клиниках города.
При постановке диагноза, как правило, затруднений не возникает, так как картина заболевания имеет ярко выраженный характер, а жалобы пациента не оставляют сомнений в случившемся. Несмотря на это для уточнения локализации тромба применяется дуплексное сканирование вен нижних конечностей, а также ангиография с применением контрастного вещества.
Лечение в данном случае показано только с применением хирургического вмешательства, заключающегося в удалении тромба. Медикаментозная терапия предусматривает в первую очередь применение гепарина, который вливается капельно в течение недели после операции. Это вещество препятствует последующему тромбообразованию.
Для предотвращения рецидива заболевания пациентам рекомендуется выполнение лечебной гимнастики и как можно более ранний подъем на ноги, сначала медленная, а затем все более интенсивная ходьба. Постельный режим желательно сократить до минимума. На прооперированную конечность накладывается эластичная фиксирующая повязка, нога постоянно находится в приподнятом под углом в двадцать градусов положении.
Вопросы и ответы по: тромб в ноге операция
Здравствуйте
у меня геморй около 20 лет , если он воспалялся то лечился свечами и мазями в течение недели , где то месяц назад он немного воспалился , недолечивши я проработала физически целый день , на вечер еле передвигала ногами , геморрой сильно воспалился , какбы на старом образовался новый уплотненый , опять лечение ( детралекс , гепатромбин Г , безорнил , свечи травяные ваночки и клизмы , лед и пар , воспаление прошло , масируя его там прощупываются как бы два овальных плотных шарика , кожа над ними синеватая , пробыла пол дня на ногах и чуствуется дискомфорт и боль , посетила проктолога , диагноз тромбоз , врач предложил там надрезать и почистить или сделать иссечение я решила подумать , лечение не прекращаю (только лед не прикладываю)
Возможно ли как то избавится от тромбов не делая операции?
Что лучше тепло или холод и можно ли масироавать тромб ?
спасибо
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Отсутствие физической нагрузки и сидячая работа приводят к застойным явлениям в сосудах ног и последующему развитию венозной недостаточности. Ее первые симптомы — тяжесть и боль в ногах, на это жалуются даже молодые люди. Варикоз подбирается все ближе.
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27-28 мая 2004 г. в санатории «Пуща озерная» под патронатом Академии медицинских наук Украины и Министерства здравоохранения Украины состоялась 1-я Украинская конференция с международным участием «Тромбозы в клинической.
Препараты α-эсцина широко используются во многих странах. В этой статье приведены данные по опыту применения α-эсцинсодержащего препарата Аэсцина (гель и таблетки) в различных лечебных учреждениях Украины и России. Так, Аэсцин широко.
Актуальность заболеваний венозной системы обусловлена многими причинами, прежде всего, их широкой распространенностью во всем мире, постоянным ростом заболеваемости, высоким уровнем инвалидизации. Считается, что у 12-16 % населения земного шара.
Инсульт вследствие высокой распространенности в популяции по сей день сохраняет лидирующие позиции в структуре общей заболеваемости и смертности населения.
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Результаты экспериментальных операций, проведенных учеными из Японии, возможно, откроют новые возможности для сосудистой хирургии. Страусы могут стать потенциальными донорами кровеносных сосудов для трансплантации людям.
Варикозное расширение вен нижних конечностей – болезнь распространенная. Она опасна своим осложнением – тромбофлебитом. До сих пор наиболее надежным методом лечения варикоза был хирургический – но теперь на смену ему все чаще приходит склеротерапия.
В результате инфаркта часть кардиомиоцитов, особых клеток, из которых состоит сердечная мышца, безвозвратно погибает – на их месте появляется грубая соединительная ткань. А ученые из США создали метод быстрого «выращивания» новых клеток миокарда.
Британец Малькольм Дэрби (Malcolm Darby), 70 лет, всю свою жизнь проходит в очках со сверх толстыми линзами, поскольку практически ничего не видел. Однако, после недавнего удара, который он пережил, у него вдруг обнаружилось отличное зрение. Как это ни парадоксально, мужчина считает, что инсульт – это лучшее, что случилось в его жизни.
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