愛脈朗百變?nèi)Ｓ脦?7疾病概述

1、疾病概述腫痛發(fā)病機制局部水腫病因多種多樣n吸收障礙吸收障礙n腎病綜合征腎病綜合征n肝功能衰竭肝功能衰竭n營養(yǎng)不良營養(yǎng)不良血漿膠體滲透壓血漿膠體滲透壓間質(zhì)膠體滲透壓間質(zhì)膠體滲透壓毛細(xì)血管通透性毛細(xì)血管通透性毛細(xì)管毛細(xì)管液體靜息壓液體靜息壓n靜脈栓塞靜脈栓塞n肝硬化肝硬化nCHFCHF靜靜脈脈淋淋巴巴管管淋巴水腫淋巴水腫（原發(fā)性或（原發(fā)性或次發(fā)性）次發(fā)性）動動脈脈組織間隙組織間隙液體靜息壓液體靜息壓毛細(xì)血管床毛細(xì)血管床Shaun Cho, et al.Peripheral edema, the American Journal of Medicine, November 2002, Volume

2、113,580-586n縮窄縮窄/ /狹窄狹窄n腎衰竭腎衰竭n妊娠妊娠1. Bergan JJ, et al. Pathogenesis of primary chronic venous disease: insights from animal models of venous hypertension. J Vasc Surg 2008; 47:183-92.2. Perrin M, et al. Pharmacological Treatment of primary CVD, Eur J Vasc Endovasc Surg. 2011; 41:117-125.3. Bergan J

3、J, et al. Chronic venous disease. N Engl J Med. 2006; 355:488-498.4. Brennan MJ. Lymphedema following the surgical treatment of breast cancer: a review of pathophysiology and treatment. J Pain Symptom Manage 1992; 7:110-6.三類局部水腫的產(chǎn)生機制腫痛多與靜脈、淋巴、微循環(huán)功能障礙有關(guān)Bergan JJ, et al. N Engl J Med. 2006; 355:488-49

4、8.Bergan JJ, et al. J Vasc Surg 2008; 47:183-92.Perrin M, Ramelet AA. Eur J Vasc Endovasc Surg. 2011; 41:117-125.Brennan MJ.,et al. J Pain Symptom Manage 1992; 7:110-6. 炎 癥靜脈擴張瓣膜損傷微循環(huán)障礙淋巴管損傷/阻塞血流改變淋巴回流障礙炎癥介質(zhì)釋放，毛細(xì)血管和靜脈壁C-纖維傷害感受器被激活毛細(xì)血管滲漏疼痛，瘙癢等異常感覺水 腫炎癥是病變發(fā)生中的核心環(huán)節(jié)慢性靜脈疾病慢性靜脈疾病是進(jìn)展性炎癥反應(yīng)性疾病Bergan JJ, et a

5、l. N Engl J Med. 2006;355:488-498.新英格蘭醫(yī)學(xué)雜志 2006炎癥反應(yīng)在CVD發(fā)生發(fā)展中起關(guān)鍵作用CVD的主要臨床癥狀沉重感腫脹感靜脈痛及痛性痙攣針刺感及燒灼感瘙癢痔病中國為痔病的高發(fā)國1.Sneider EB et al. Diagnosis and management of symptomatic hemorrhoids. Surg Clin North Am. 2010 Feb;90(1):17-32.2. Lohsiriwat V.Hemorrhoids: From basic pathophysiology to clinical managemen

6、t. World J Gastroenterol 2012 May 7; 18(17): 2009-20173. 黃乃健.中國肛腸病學(xué).濟南: 山東科學(xué)技術(shù)出版社，1996:6204.何洪芹等.滄州城鄉(xiāng)居民痔瘡的流行病學(xué)調(diào)查.實用預(yù)防醫(yī)學(xué).2012;19(6):841-3美國總?cè)丝冢?%50歲以上: 50%白種人常見1英國總?cè)丝冢?3%-36%2中國發(fā)病率: 51.6%3女性略高4痔的臨床癥狀困擾患者癥狀危害出血便時疼痛直腸墜痛腫物脫出流分泌物肛門瘙癢缺鐵性貧血嵌頓壞死感染：嚴(yán)重者可引發(fā)致死性門靜脈敗血癥內(nèi)痔按出血和腫物脫出程度分為, , , 級；外痔一般無癥狀，只有血栓形成時會伴有急性疼痛，

7、但一般在7-10天內(nèi)會緩解。American Gastroenterological Association Medical Position Statement: Diagnosis and Treatment of Hemorrhoids，GASTROENTEROLOGY 2004;126:14611462痔病的發(fā)病機理痔病的病理改變*: 靜脈叢擴張#: 上皮下肌組織碎片1mmLohsiriwat V.Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012 May 7; 18(17): 2009-2017病理改變靜脈異常擴張血管栓塞膠原纖維組織退行彈性纖維組織退行上皮下肌組織扭曲與破裂炎癥反應(yīng)肛墊下移學(xué)說肛墊的支持組織損傷或退化肛墊異常下移引發(fā)靜脈擴張的病理性改變痔病是惡性循環(huán)-炎癥和靜脈高壓為其中重要環(huán)節(jié)脫垂肛墊中的血液瘀滯、靜止、凝結(jié)炎癥血管壁膨脹，通透性和脆性增加肛墊易損傷、出血、水腫、滲出等靜脈高壓慢性靜脈功能不全Steven Cohen et. al ,Managing an underlying