2019年10月24日 星期四

治療複雜腹部主動脈瘤

我們的身體滿布血管,當中最大的要算主動脈,位於人體的胸腔及腹部,不停地隨看心跳擴張收縮,運送血液由心臟到全身各器官。若主動脈壁不正常地擴張便會形成主動脈瘤,較常出現於腹部主動脈。其風險是一旦主動脈瘤破裂,便會大量出血,病人會於短時間內失血致死。

因此,大多數患者會接受微創血管腔内手術醫治腹部主動脈瘤,但一些形狀較複雜的血管瘤未必適合用微創手術而需接受開放式手術,開放式手術創傷性較大,一些身體狀況較差的患者未必能承受。幸而,現時有些鞏固儀器能於微創血管控內手術時使用,令一些本來不能用微創手術又不適合開放式手術的患者受惠。

腹部主動脈瘤患者多為年長人士,男性及有家族史的人患病風險亦較高。現時,醫學界仍未真正了解其成因,但主要與血管退化有關。年齡增長,動脈粥樣硬化及主動脈壁產生過多的溶解酵素等都會令血管壁失去彈性而慢慢擴張,最終血管壁會抵受不住正常血壓而破裂。

大部分腹部主動脈瘤都沒有徵狀,多數於接受超聲波或電腦掃描檢查時偶然發現,若出現腹部及背部痛是則可能是爆破先兆,應立即求醫。


現年60多歲的何先生(化名)曾患有肺癆及接受「心臟通波仔」手術,所以肺功能及整體身體狀況都較差。他於身體檢查時意外發現一個頗大的腹部主動脈瘤,且有爆裂風險。理論上他要盡快接受手術,但由於其血管瘤形狀不能穩固放置支架,故不適合微創手術,他身體狀況又接受不了開刀手術,進退兩難。

幸好在新技術配合下,如今也有辦法。醫生首先在血管内植入支架,即使血管瘤的形状不理想,支架不穩固,但新穎的血管腔內鞏固裝置,就好像螺絲釘般把支架固定於血管壁,何先生於術後3日已出院。

外科專科醫生謝卓華



 





資料來源: 信報
以上所提供的資訊僅作為教育及參考用途,如果你有任何醫療問題,
應向醫生查詢,而不應單倚賴以上提供的資料。

2019年10月16日 星期三

怎樣避免乘飛機後出現血栓?

上星期解釋過為何乘飛機後會腳腫,若機程長而雙腳缺乏郁動,靜脈內的血液便有機會因靜止不動而形成血栓,若血栓被沖至肺部,最嚴重可以致命。

但讀者們又不用太擔心,因為這情況是完全可以預防的。首先是要認識有此風險的存在,因絕大部份患者是對這情況一無所知,那便無從預防。

最基本是要保持小腿肌肉的運動,如把腳掌上下郁動,不時離開座位走動一下,已足以保持小腿靜脈血液的流動。應多點喝水,以保持血液內的水分;但應避免喝酒或咖啡,因這些利尿的飲品會令體內水分流失,血液濃度提升,容易型成血栓。

有些朋友喜歡乘長途機時服食安眠藥,好讓他們即使坐着也可以睡得多點,但其實這是不適當的,因為這會無可避免地令小腿缺乏郁動。

此外,穿着壓力襪是簡單而有效的預防措施,  選購時應確保是漸進式壓力的設計,即最緊的地方是於足踝部位,壓力逐漸向上遞減,以增加深層靜脈血液的流量,一般人穿着10-15mmHg壓力已足夠,但靜脈曲張患者,肥胖,孕婦等,則可穿着比較緊的。

一些再高危的人士,如癌症患者,行動不便,大手術後等,可由醫生處方一些薄血的藥物,避免血栓形成。明白這些,環遊世界也不用擔心了。


外科專科醫生謝卓華












資料來源: AM730
以上所提供的資訊僅作為教育及參考用途,如果你有任何醫療問題,
應向醫生查詢,而不應單倚賴以上提供的資料。

2019年10月10日 星期四

Why DVT can strike anyone, any time and how to avoid a killer blood clot (2)

The first documented case of DVT was reported during the middle ages. In 1271, a 20-year-old Norman cobbler complained of pain in his lower leg. A visit to the tomb of canonised King Louis IX was advocated, where the cobbler massaged dust into his leg.

Subsequent DVTs were diagnosed in pregnant and postnatal women, believed to be the consequence of “evil humours” during pregnancy and post-delivery – meaning a build-up of unconsumed breast milk.

During the first world war, exhausted young soldiers in the trenches suffered from blood clots in their legs, caused by sleeping upright in chairs, their legs beneath them. Today’s taxi and bus drivers are at risk as they sit immobile for long stretches.






Tse says the incidence of DVT among Hongkongers is on the rise. “Overall annual incidences of thromboembolic disease in Hong Kong is 30 per 100,000 of the population; hospital mortality rates associated with DVT are 7.3 per cent.”

The US Centres for Disease Control and Prevention suggests the incidence is higher in America – one to two per 1,000.

One-third of people with DVT or a pulmonary embolism will have a recurrence within 10 years; 10 per cent to 30 per cent of people will die within one month of diagnosis. In the US, one person is diagnosed with DVT every minute, and a sufferer dies as a result of its complication, pulmonary embolism, every six.

Among those with DVT, half will have long-term complications (post-thrombotic syndrome) – as I do: a nagging pain presents in my right calf after prolonged standing or exercise due to enduring damage to valves in the vein.





Flying isn’t the only cause of DVT, and not all people who fly long-haul will develop it. Given the frequency of air travel today, though, it’s a risk we all need to take more seriously. I certainly do: I drink lots of water – “two litres during a seven-hour flight because the atmosphere in the cabin means you dehydrate 20 per cent faster”, my surgeon said.

This means I can’t help but walk up and down the aisle to get my blood circulating, as I get up to use the loo every hour, and instead of skinny jeans I wear toe-to-groin surgical stockings.

Air travel isn’t as sexy as it used to be.

Travel tips to prevent DVT

All air travellers, says Tse, should consider the following:
  • Stand up and walk around every hour or two;
  • Consider wearing knee-high (or higher) compression stockings;
  • Apart from the stockings, wear loose-fitting, comfortable clothing;
  • Avoid medications such as sedative or sleeping pills, and alcohol, which could impair your ability to get up and move around;
  • Flex and extend the ankles and knees periodically, avoid crossing the legs or sitting on your legs, and change positions frequently while seated

The US Centres for Disease Control suggests three simple exercises to help keep the blood flowing:

1. Raise and lower your heels while keeping your toes on the floor
2. Raise and lower your toes while keeping your heels on the floor
3. Tighten and release your leg muscles



Reference information:  SCMP
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your physicians for diagnosis and treatment. 

2019年10月9日 星期三

Why DVT can strike anyone, any time and how to avoid a killer blood clot (1)

Who has not heard of DVT – deep vein thrombosis? I thought it happened only in overweight, unfit people over the age of 50, people who smoked too much, exercised too little and got their comeuppance as they ate their way through airline meals on seriously long-haul flights.

So when I – under 50 at the time, fit, non-smoker, lean – awoke after being cat-curled in a seat on a six-hour flight with a pain in my right calf, I naturally assumed it was only a cramp. I stretched my skinny-jean clad legs out, said “ouch”, gave it a rub and disembarked, certain I’d walk the soreness off in no time.

Except that I didn’t. Two days later, the deep ache was waking me at night and I resorted to pain medication. A nagging voice in my head began to question whether this was more than a mere cramp. A cautious friend advised a visit to a doctor’s clinic; the doctor examined my legs: no redness, no heat, no swelling – just pain.

“I’m sure it’s not DVT,” he said, “but we can’t take a chance.”


He sent me off to the accident and emergency department, where I had a blood test for D-dimer – a protein fragment from the breakdown of a blood clot. The test indicated I had DVT, confirmed by an ultrasound.

An injection of blood thinners to further break down the clot was plunged into my abdomen so that a bruise bloomed black and as big as my fist. X-rays of my chest followed, to ensure my lungs were clear and three months of anticoagulants were prescribed.

I was appalled. DVT didn’t happen to people like me: the young (ish), the fit, the lean non-smokers. Oh yes, they do, said the vascular surgeon who examined me.

Deep vein thrombosis is the medical term for blood clots in the deep veins of the leg. If a blood clot forms inside a blood vessel, explains Dr Chad Tse Cheuk-wa, a surgeon who specialises in vascular and endovascular surgery at Hong Kong’s Veno Clinic, “it can clog the vessel and keep blood from getting where it needs to go. When that happens, blood can back up and cause swelling and pain.”

DVT is always considered serious, as any clot in a vein “can travel to other parts of the body and clog blood vessels there”, Tse said. “Blood clots that form in the legs, for example, can end up blocking blood vessels in the lungs. This can make it hard to breathe and sometimes, when they are large, can lead to death.” A blood clot that travels to the lungs is a pulmonary embolism.

Many things can predispose a person to DVT, including obesity, smoking and age, as well as certain medical conditions, some medications – including birth control pills and hormone replacement therapy (HRT) – and surgery. Dr Tse says prolonged travel – whether by plane, train or automobile – appears to confer a two- to fourfold increase in risk, and taking one long-haul flight a year increases the risk by 12 per cent.

My surgeon said immobility and dehydration are the key reasons flying is a risk – and he warned that “long-haul” can be as short as four hours. Immobility allows the blood in your legs to pool in your calves, and a lack of hydration allows that blood to become “sticky”. The combination of thick, slow-flowing blood is not good.

 ..........cont'





Reference information:  SCMP
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your physicians for diagnosis and treatment. 

2019年9月26日 星期四

懷孕期靜脈曲張的煩惱 (2)

產後可選擇微創方式治療

外科手術是治療靜脈曲張的傳統方法,病人一般在全身或半身麻醉下接受手術。以大隱靜脈抽除手術為例,醫生會在大腿近腹部及膝蓋 旁邊的位置,切開數厘米長的傷口,然後將有問題的靜脈抽出。手術無可避免地會引致瘀腫及疼痛等不適,傷囗亦會影響外觀;部分病人亦因而諱疾忌醫,拖延病 情。

可幸現時微創治療靜脈曲張的效果已與傳統手術相若,傷口微細之餘,痛楚亦減低。其中「靜脈腔內消融術」與「超聲波導引脈內注射」都是較常用的技術,在醫治早或中期的靜脈曲張,效果尤為理想。

「靜脈腔內消融術」的原理是於大腿造一個比針孔略大的開口,然後把光纖導管從傷口進入靜脈血管內(靜脈腔內)施行射頻或激光能 量,以破壞有毛病的靜脈。而「超聲波導引脈內注射」是把藥物注射到有毛病的靜脈,令靜脈萎縮。兩種微創治療皆在超聲波儀器的監察下進行,過程十分精確。

另外,當女士再次懷孕時,靜脈曲張有可能惡化,而且情況可能比先前更加嚴重,因此產後的婦女,如發現腳上的青筋或蜘蛛網般的紫紅色絲狀血管仍未退減,便應請醫生作出詳細檢查,以便於下次懷孕前先作出適當的治療。



外科專科醫生
謝卓華

 






資料來源:  she.com
以上所提供的資訊僅作為教育及參考用途,如果你有任何醫療問題,
應向醫生查詢,而不應單倚賴以上提供的資料。