Cockett综合症的诊断与治疗PPT学习教案

1、会计学1Cockett综合症的诊断与治疗综合症的诊断与治疗All rights reserved by Dr. Gaoyong下肢静脉曲张病人的护理下肢静脉曲张病人的护理第1页/共77页All rights reserved by Dr. Gaoyong【定义定义】 下肢静脉曲张是指下肢浅下肢静脉曲张是指下肢浅表静脉因血流回流障碍而引起表静脉因血流回流障碍而引起的以静脉扩张、迂曲为主要表的以静脉扩张、迂曲为主要表现的一种疾病，晚期常合并小现的一种疾病，晚期常合并小腿慢性溃疡。腿慢性溃疡。第2页/共77页All rights reserved by Dr. Gaoyong第3页/共77页All

2、rights reserved by Dr. Gaoyong第4页/共77页All rights reserved by Dr. Gaoyong 静脉瓣膜： 使下肢静脉血流由下向上，由浅入深地单向回流。第5页/共77页All rights reserved by Dr. Gaoyong第6页/共77页All rights reserved by Dr. Gaoyong重体力劳动怀孕遗传因素长期站立慢性便秘肥胖慢性咳嗽第7页/共77页All rights reserved by Dr. Gaoyong第8页/共77页All rights reserved by Dr. Gaoyong第9页/共7

3、7页All rights reserved by Dr. Gaoyong第10页/共77页All rights reserved by Dr. Gaoyong第11页/共77页All rights reserved by Dr. Gaoyong 辅助检查辅助检查 1.大隐静脉瓣膜试验大隐静脉瓣膜试验第12页/共77页All rights reserved by Dr. Gaoyong第13页/共77页All rights reserved by Dr. Gaoyong第14页/共77页All rights reserved by Dr. Gaoyong3.深静脉通畅试验深静脉通畅试验第15页/

4、共77页All rights reserved by Dr. Gaoyong第16页/共77页All rights reserved by Dr. Gaoyong第17页/共77页All rights reserved by Dr. Gaoyong第18页/共77页All rights reserved by Dr. Gaoyong第19页/共77页All rights reserved by Dr. Gaoyong综述、静脉造影诊断和临床综述、静脉造影诊断和临床治疗经验报告治疗经验报告第20页/共77页All rights reserved by Dr. Gaoyong第21页/共77页Al

5、l rights reserved by Dr. GaoyongCockett征发生的关键征发生的关键第22页/共77页All rights reserved by Dr. Gaoyong年份 作者 尸检例检出数 %1908McMurrich311032.31943Erich3999523.81957May4308018.61968Megus10014141969Sztankay50010020合计 1460 299 20.5第23页/共77页All rights reserved by Dr. Gaoyong第24页/共77页All rights reserved by Dr. Gaoyon

6、g第25页/共77页All rights reserved by Dr. Gaoyong第26页/共77页All rights reserved by Dr. Gaoyong管腔狭窄程度41.7%100.0%血栓形成31.4%45.7%第27页/共77页All rights reserved by Dr. Gaoyong第28页/共77页All rights reserved by Dr. Gaoyong第29页/共77页All rights reserved by Dr. Gaoyong第30页/共77页All rights reserved by Dr. Gaoyong第31页/共77页A

7、ll rights reserved by Dr. Gaoyong第32页/共77页All rights reserved by Dr. Gaoyong第33页/共77页All rights reserved by Dr. Gaoyong第34页/共77页All rights reserved by Dr. Gaoyong 深静脉造影是最准确的诊断方法深静脉造影是最准确的诊断方法第35页/共77页All rights reserved by Dr. Gaoyong第36页/共77页All rights reserved by Dr. Gaoyong第37页/共77页All rights res

8、erved by Dr. Gaoyong第38页/共77页All rights reserved by Dr. Gaoyong第39页/共77页All rights reserved by Dr. Gaoyong第40页/共77页All rights reserved by Dr. Gaoyong第41页/共77页All rights reserved by Dr. Gaoyong第42页/共77页All rights reserved by Dr. Gaoyong第43页/共77页All rights reserved by Dr. Gaoyong第44页/共77页All rights re

9、served by Dr. Gaoyong第45页/共77页All rights reserved by Dr. Gaoyong转流转流第46页/共77页All rights reserved by Dr. Gaoyong第47页/共77页All rights reserved by Dr. Gaoyong第48页/共77页All rights reserved by Dr. Gaoyong侧位片可见侧位片可见狭窄之处狭窄之处第49页/共77页All rights reserved by Dr. Gaoyong球囊扩张狭球囊扩张狭窄之处窄之处第50页/共77页All rights reserv

10、ed by Dr. Gaoyong狭窄之处完狭窄之处完全扩张全扩张第51页/共77页All rights reserved by Dr. Gaoyong置入国产置入国产20 mm Z 型自膨式支架型自膨式支架第52页/共77页All rights reserved by Dr. Gaoyong再次造影再次造影血管通畅血管通畅第53页/共77页All rights reserved by Dr. Gaoyong支架安放到支架安放到位扩张良好位扩张良好第54页/共77页All rights reserved by Dr. Gaoyong再次造影侧位再次造影侧位显影血管通畅显影血管通畅第55页/共7

11、7页All rights reserved by Dr. Gaoyongn左股静脉-右股静脉耻骨上转流第56页/共77页All rights reserved by Dr. Gaoyong第57页/共77页All rights reserved by Dr. Gaoyong第58页/共77页All rights reserved by Dr. Gaoyong人工血管与左人工血管与左髂总静脉吻合髂总静脉吻合第59页/共77页All rights reserved by Dr. Gaoyong第60页/共77页All rights reserved by Dr. Gaoyong人工血管与下人工血管

12、与下腔静脉吻合腔静脉吻合第61页/共77页All rights reserved by Dr. Gaoyong术后一周左小腿溃疡基本愈合左右小腿周径基本一致术后一周左小腿溃疡基本愈合左右小腿周径基本一致第62页/共77页All rights reserved by Dr. Gaoyong第63页/共77页All rights reserved by Dr. Gaoyong第64页/共77页All rights reserved by Dr. Gaoyong人工血管人工血管耻骨上交耻骨上交叉转流术叉转流术第65页/共77页All rights reserved by Dr. Gaoyong人工血

13、管与左人工血管与左股静脉吻合股静脉吻合第66页/共77页All rights reserved by Dr. Gaoyong人工血管与右人工血管与右股静脉吻合股静脉吻合第67页/共77页All rights reserved by Dr. Gaoyong第68页/共77页All rights reserved by Dr. Gaoyong加做临时性动静脉加做临时性动静脉瘘并预留瘘并预留CV4线待线待2月后结扎月后结扎第69页/共77页All rights reserved by Dr. Gaoyong取自体左取自体左大隐静脉大隐静脉第70页/共77页All rights reserved by

14、 Dr. Gaoyong量取所需长度大隐量取所需长度大隐静脉并通过皮下隧静脉并通过皮下隧道至右股外侧道至右股外侧第71页/共77页All rights reserved by Dr. Gaoyong第72页/共77页All rights reserved by Dr. Gaoyong左大隐静脉与右左大隐静脉与右股外侧的浅静脉股外侧的浅静脉吻合吻合第73页/共77页All rights reserved by Dr. Gaoyong（一）术前护理（一）术前护理护理措施心理护理：介绍治疗目的、方法、注意事项等心理护理：介绍治疗目的、方法、注意事项等术前准备：术前禁食术前准备：术前禁食4小时、备皮、碘过敏试验小时、备皮、碘过敏试验 检查足背动脉搏动情况并标记检查足背动脉搏动情况并标记 绝对戒烟绝对戒烟 第74页/共77页All rights reserved by Dr. Gaoyong（二）术后护理（二）术后护理护理措施局麻或者全麻后护理常规局麻或者全麻后护理常规体位：平卧位，术侧肢体制动体位：平卧位，术侧肢体制动24小时小时病情监测病情监测监测生命体征，鼓励病人多饮水监测生命体征，鼓励病人多饮水观察伤口渗血情况观察伤口渗血情况观察术后肢体肿胀及肢体循环情况观察术后肢体肿胀及肢