{"id":4571,"date":"2024-01-29T07:54:27","date_gmt":"2024-01-29T07:54:27","guid":{"rendered":"https:\/\/ambercell.pixel-dev.lt\/individuala-aizsardziba\/"},"modified":"2024-03-25T06:55:38","modified_gmt":"2024-03-25T06:55:38","slug":"individuala-aizsardziba","status":"publish","type":"page","link":"https:\/\/ambercell.eu\/lv\/vadiba\/efektiva-procesu-vadiba\/individuala-aizsardziba\/","title":{"rendered":"Individu\u0101l\u0101 aizsardz\u012bba"},"content":{"rendered":"\t\t
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Par hronisk\u0101m iegur\u0146a s\u0101p\u0113m (CPP) uzskata s\u0101pes, kas saglab\u0101jas ilg\u0101k nek\u0101 6 m\u0113ne\u0161us un ir pietiekami stipras, lai trauc\u0113tu norm\u0101lu ikdienas un profesion\u0101lo darb\u012bbu [1,2]. Hroniskas s\u0101pes iegurn\u012b var b\u016bt saist\u012btas ar iegur\u0146a varikoz\u0101m v\u0113n\u0101m un ir paz\u012bstamas k\u0101 iegur\u0146a v\u0113nu sastr\u0113gums [3,4]. T\u0101 ir bie\u017ei nediagnostic\u0113ta iegur\u0146a venoz\u0101s asinsrites slim\u012bba, kas izraisa hroniskas s\u0101pes iegur\u0146a rajon\u0101 sieviet\u0113m pirms menopauzes un reprodukt\u012bv\u0101 vecum\u0101 [5,6].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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\n\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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\u0160ai patolo\u0123ijai ir tipiskas paz\u012bmes, piem\u0113ram, iegur\u0146a varikozes, s\u0101pes iegurn\u012b.<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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\u0160ai patolo\u0123ijai ir rakstur\u012bgi t\u0101di simptomi k\u0101 iegur\u0146a varikozes, s\u0101pes iegurn\u012b, kas pastiprin\u0101s, ilgsto\u0161i st\u0101vot, s\u0113\u017eot, p\u0113c dzimumakta, menstru\u0101ciju un gr\u016btniec\u012bbas laik\u0101 [5]. Galvenie izmekl\u0113jumi \u0161\u012bs patolo\u0123ijas noteik\u0161anai ir neinvaz\u012bvi radiolo\u0123iskie izmekl\u0113jumi, piem\u0113ram, UG, CT, MR venogr\u0101fija, kas pal\u012bdz izsl\u0113gt citus s\u0101pju c\u0113lo\u0146us un \u013cauj apsv\u0113rt minim\u0101li invaz\u012bvas \u0101rst\u0113\u0161anas iesp\u0113jas [3]. <\/p>\n

Hroniskas iegur\u0146a s\u0101pes sieviet\u0113m, ko izraisa v\u0113nu st\u0101ze iegurn\u012b, ir \u0101rst\u0113jama patolo\u0123ija. Iegur\u0146a v\u0113nu un oln\u012bcu v\u0113nu embolija terapija ir dro\u0161a un efekt\u012bva iegur\u0146a v\u0113nu nepietiekam\u012bbas \u0101rst\u0113\u0161anas metode, kas iev\u0113rojami samazina s\u0101pes sieviet\u0113m ar VSD [2]. Hroniskas iegur\u0146a s\u0101pes sieviet\u0113m ir svar\u012bga un bie\u017ei sastopama probl\u0113ma vesel\u012bbas apr\u016bpes iest\u0101d\u0113s [1]. L\u012bdz 10 % ginekolo\u0123isko konsult\u0101ciju, aptuveni 12 % histerektomiju un l\u012bdz pat 40 % laparoskopiju m\u0113r\u0137is ir noteikt STS c\u0113loni [2]. Tom\u0113r daudz\u0101m sieviet\u0113m ar LDS netiek veikts VSD skr\u012bnings, kas var rasties aptuveni 31% pacientu [7]. <\/p>\n

Diagnostic\u0113jot v\u0113nu st\u0101zi iegurn\u012b k\u0101 hronisku iegur\u0146a s\u0101pju c\u0113loni, var\u0113tu ietaup\u012bt vesel\u012bbas apr\u016bpes resursus un uzlabot pacientu dz\u012bves kvalit\u0101ti.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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VSD epidemiolo\u0123ija<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Venoz\u0101 st\u0101ze iegurn\u012b ir bie\u017ei nediagnostic\u0113ts hronisku iegur\u0146a s\u0101pju c\u0113lonis sieviet\u0113m. Literat\u016br\u0101 VSD bie\u017ei d\u0113v\u0113 ar\u012b par “iegur\u0146a s\u0101pju sindromu”, “sievie\u0161u varikok\u0113li”, “iegur\u0146a v\u0113nu sastr\u0113gumu” un “iegur\u0146a v\u0113nu nepietiekam\u012bbu”. Venozu st\u0101zi iegurn\u012b parasti nov\u0113ro jaun\u0101m sieviet\u0113m vecum\u0101 no 20 l\u012bdz 30 gadiem ar vair\u0101k nek\u0101 vienu dzemd\u012bbu reizi, un par to var aizdom\u0101ties p\u0113c tam, kad ir izsl\u0113gti citi hronisku iegur\u0146a s\u0101pju c\u0113lo\u0146i, piem\u0113ram, endometrioze, adenomioze, ur\u012bnce\u013cu vai ku\u0146\u0123a un zarnu trakta trauc\u0113jumi [10]. Viens no hronisku iegur\u0146a s\u0101pju c\u0113lo\u0146iem ir v\u0113nu st\u0101ze iegurn\u012b [10]. <\/p>\n

STS tiek defin\u0113tas k\u0101 intermit\u0113jo\u0161as vai past\u0101v\u012bgas, kas ilgst aptuveni 3-6 m\u0113ne\u0161us, lokaliz\u0113jas v\u0113der\u0101 vai iegurn\u012b un nav saist\u012btas ar menstru\u0101lo ciklu vai dzimumaktu un gr\u016btniec\u012bbu [5]. Iegur\u0146a varikozes konstat\u0113 10-30% sievie\u0161u ar hronisk\u0101m iegur\u0146a s\u0101p\u0113m [3].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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VSD etiolo\u0123ija<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Venoz\u0101 st\u0101ze iegurn\u012b galvenok\u0101rt skar sievietes reprodukt\u012bv\u0101 vecum\u0101 (20-45 gadi). VSD att\u012bst\u012bbu ietekm\u0113 vides un anatomiskie riska faktori. Vides faktori ir gr\u016btniec\u012bba, iegur\u0146a \u0137irur\u0123ija, estrog\u0113nu terapija, aptauko\u0161an\u0101s, fleb\u012bts un darba raksturs, jo \u012bpa\u0161i ilgsto\u0161a s\u0113d\u0113\u0161ana vai smagu priek\u0161metu cel\u0161ana [11]. Nav zin\u0101ma \u0123en\u0113tiska vai etniska nosliece uz \u0161\u012bs patolo\u0123ijas att\u012bst\u012bbu, ta\u010du ir zi\u0146ots, ka t\u0101 bie\u017e\u0101k sastopama sieviet\u0113m, kuras dzemd\u0113ju\u0161as vair\u0101k nek\u0101 vienu reizi [12].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Tabula: PCS pacientu popul\u0101cija<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Venozo st\u0101zi iegurn\u012b var izrais\u012bt divi meh\u0101nismi: reflukss venozas nepietiekam\u012bbas d\u0113\u013c un obstrukcija [8,9]. Iedzimts gonad\u0101lo v\u0101rstu tr\u016bkums ir aptuveni 15 % sievie\u0161u popul\u0101cijas, un pat 60 % no \u0161\u012bm sieviet\u0113m var att\u012bst\u012bties VSD [3,13]. Prec\u012bzs venoz\u0101s v\u0101rstu\u013cu mazsp\u0113jas c\u0113lonis nav zin\u0101ms, ta\u010du ir zin\u0101ma hormonu ietekme uz v\u0113nu st\u0101zi iegurn\u012b. Gr\u016btniec\u012bbas laik\u0101 estradiols nom\u0101c asinsvadu sa\u0161aurin\u0101\u0161anos un izraisa dzemdes papla\u0161in\u0101\u0161anos un selekt\u012bvu dzemdes un oln\u012bcu v\u0113nu papla\u0161in\u0101\u0161anos, k\u0101 rezult\u0101t\u0101 palielin\u0101s venozo v\u0101rstu slodze [9]. Tiek uzskat\u012bts, ka v\u0113nas p\u0113c gr\u016btniec\u012bbas neatgrie\u017eas s\u0101kotn\u0113j\u0101 izm\u0113r\u0101, un tas var b\u016bt saist\u012bts ar venozo v\u0101rstu\u013cu nepietiekam\u012bbu [12]. Ir nov\u0113rots, ka VSD bie\u017e\u0101k sastopams sieviet\u0113m, kuras dzemd\u0113ju\u0161as vair\u0101k nek\u0101 vienu reizi [8,9]. Ar\u012b pacientiem ar v\u0113nu st\u0101zi iegurn\u012b simptomi pasliktin\u0101s menstru\u0101ciju un gr\u016btniec\u012bbas laik\u0101 un atvieglo vai izz\u016bd p\u0113c menopauzes [8]. Hormonu ietekmi uz VSD apstiprina ar\u012b fakts, ka p\u0113cmenopauzes period\u0101 daudzi simptomi regres\u0113 [12].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Iegur\u0146a v\u0113nu aizpl\u016b\u0161anu var trauc\u0113t ar\u012b obstrukt\u012bvu iemeslu d\u0113\u013c [9]. Visbie\u017e\u0101kais iemesls ir kreis\u0101s nieru v\u0113nas iespie\u0161ana starp aug\u0161\u0113jo mezenterisko art\u0113riju un aortu, kas paz\u012bstams k\u0101 “Riekstkoka” sindroms [8,9]. \u0160\u012bs patolo\u0123ijas sastopam\u012bba nav prec\u012bzi zin\u0101ma, ta\u010du ir nov\u0113rots, ka t\u0101 visbie\u017e\u0101k sastopama jauniem, veseliem cilv\u0113kiem, galvenok\u0101rt 30-40 gadus vec\u0101m sieviet\u0113m. \u0160\u012b sindroma gad\u012bjum\u0101 kreis\u0101s nieru v\u0113nas stenozes d\u0113\u013c rodas venozais spiediens, kapil\u0101rais spiediens un hemat\u016brija [14]. Prec\u012bzu diagnostikas krit\u0113riju \u0161ai patolo\u0123ijai nav, bet ir visp\u0101rpie\u0146emts, ka 39 gr\u0101du le\u0146\u0137im starp aug\u0161\u0113jo mezenterisko art\u0113riju un aortas aug\u0161da\u013cu, ko m\u0113ra ar CT sagit\u0101laj\u0101 griezum\u0101, ir 92 % jut\u012bgums un 89 % specifiskums simptom\u0101tiskiem pacientiem [8]. <\/p>\n

Par norm\u0101lu le\u0146\u0137i starp aug\u0161\u0113jo mezenterisko un v\u0113dera aortu uzskata 45 gr\u0101dus vai vair\u0101k [15]. \u0160is sindroms visbie\u017e\u0101k tiek konstat\u0113ts nejau\u0161i asimptom\u0101tiskiem pacientiem. Citi venoz\u0101s asins pl\u016bsmas obstrukcijas iemesli var b\u016bt iedzimta vai ieg\u016bta apak\u0161\u0113j\u0101s vena cava neesam\u012bba un \u0101r\u0113ja v\u0113nu kompresija, ko izraisa v\u0113dera vai iegur\u0146a masa vai limfadenop\u0101tija. \u0160ie struktur\u0101lie VSD c\u0113lo\u0146i ir reti sastopami, bet tie ir j\u0101atpaz\u012bst, jo tie ir svar\u012bgi \u0101rst\u0113\u0161anas izv\u0113lei. Citi gon\u0101du varikozes un iegur\u0146a varikozes c\u0113lo\u0146i ir iegur\u0146a arteriovenozas malform\u0101cijas [8].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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VSD kl\u012bnika<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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S\u0101pes iegurn\u012b parasti ir bl\u0101vas, necikliskas un var pastiprin\u0101ties atkar\u012bb\u0101 no \u0137erme\u0146a st\u0101vok\u013ca, staig\u0101\u0161anas, dzimumakta un menstru\u0101ciju laik\u0101. S\u0101pes ilgst aptuveni 6 m\u0113ne\u0161us un ir lokaliz\u0113tas iegurn\u012b, krustu, cirk\u0161\u0146os vai apk\u0101rt\u0113jos rajonos [12]. Da\u017ei pacienti zi\u0146o, ka s\u0101pes ir vienpus\u0113jas un parasti bie\u017e\u0101k rodas kreisaj\u0101 pus\u0113 nek\u0101 labaj\u0101 pus\u0113 [8]. S\u0101pes parasti pastiprina ilgsto\u0161a st\u0101v\u0113\u0161ana vai s\u0113d\u0113\u0161ana un atvieglo gul\u0113\u0161ana. Tas palielin\u0101s ar\u012b tad, kad palielin\u0101s v\u0113dera iek\u0161\u0113jais spiediens, piem\u0113ram, gr\u016btniec\u012bbas laik\u0101, pirms menstru\u0101cij\u0101m un p\u0113c dzimumakta [3,8,9,16]. Dispare\u016bnija p\u0113c VAS skalas parasti ir 6 vai vair\u0101k balles, un t\u0101 bie\u017ei izstaro uz an\u0101lo atveri un var ilgt l\u012bdz pat 24 stund\u0101m [12]. Papildino\u0161as blakuspar\u0101d\u012bbas ir ar\u012b pilnuma saj\u016bta k\u0101j\u0101s, pastiprin\u0101ta v\u0113lme urin\u0113t, v\u0113dera uzp\u016b\u0161an\u0101s un slikta d\u016b\u0161a [3]. Da\u017eos gad\u012bjumos rodas ar\u012b neirolo\u0123iski un psihosomatiski simptomi, piem\u0113ram, depresija, letar\u0123ija [3,12]. <\/p>\n

Kl\u012bnisk\u0101s izmekl\u0113\u0161anas laik\u0101 ir svar\u012bgi mekl\u0113t dzemdes kakla jut\u012bguma paz\u012bmes un oln\u012bcu un dzemdes jut\u012bgumu bimanu\u0101l\u0101s izmekl\u0113\u0161anas laik\u0101. Ginekolo\u0123iskaj\u0101 izmekl\u0113\u0161an\u0101 konstat\u0113jot postkoit\u0101l\u0101s s\u0101pes un oln\u012bcu jut\u012bgumu, ginekolo\u0123isk\u0101 izmekl\u0113\u0161ana ir kombin\u0101cija ar 94 % jut\u012bgumu un 77 % specifiskumu iegur\u0146a v\u0113nu nepietiekam\u012bbas diagnozes noteik\u0161anai [3,12,17]. Svar\u012bgi ir nov\u0113rt\u0113t ar\u012b varikozu v\u0113nu t\u012bklus, kas var atrasties an\u0101laj\u0101 atver\u0113, vulv\u0101, s\u0113\u017eamviet\u0101 un aug\u0161stilbu aizmugur\u0113. Varikozas v\u0113nas skar aptuveni 10 % gr\u016btnie\u010du. Tas reti sastopams pirmaj\u0101 gr\u016btniec\u012bbas period\u0101 un parasti att\u012bst\u0101s otr\u0101s gr\u016btniec\u012bbas 5. m\u0113nes\u012b. Varikozu v\u0113nu risks palielin\u0101s l\u012bdz ar gr\u016btniec\u012bbu skaitu [12].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Ultrasonogr\u0101fisk\u0101 izmekl\u0113\u0161ana<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Sonogr\u0101fija tiek uzskat\u012bta par pirm\u0101s izv\u0113les diagnostikas testu, lai konstat\u0113tu v\u0113nu st\u0101zi iegurn\u012b, jo t\u0101 ir neinvaz\u012bva, viegli pieejama un l\u0113ta, k\u0101 ar\u012b piem\u0113rota, lai izsl\u0113gtu citas iegur\u0146a patolo\u0123ijas. \u0160is tests pal\u012bdz izsl\u0113gt iegur\u0146a s\u0101pju c\u0113lo\u0146us, piem\u0113ram, masu iegurn\u012b un ur\u012bnce\u013cu patolo\u0123ijas. Vienlaikus t\u0101 var pal\u012bdz\u0113t nov\u0113rt\u0113t kreis\u0101s nieru v\u0113nas okl\u016bzijas, g\u016b\u017eas v\u0113nas kompresijas, arteriovenozas malform\u0101cijas, iegur\u0146a hipervaskul\u0101ru masu, port\u0101l\u0101s hipertensijas un citu patolo\u0123iju kl\u0101tb\u016btni [12]. Ir iesp\u0113jams nov\u0113rt\u0113t ar\u012b papla\u0161in\u0101t\u0101s dzemdes un oln\u012bcu v\u0113nas, oln\u012bcu anom\u0101lijas un dzemdes palielin\u0101\u0161anos [5]. Parasti iegur\u0146a v\u0113nas ir taisnas un to diametrs nep\u0101rsniedz 4 mm [17]. <\/p>\n

Transabdomin\u0101l\u0101 UG (TAUG) ir v\u0113rt\u012bga, lai vizualiz\u0113tu kreiso oln\u012bcu v\u0113nu. Oln\u012bcu v\u0113nu diametram 6 mm ir 96 % prognoz\u0113jo\u0161\u0101 v\u0113rt\u012bba iegur\u0146a varikozes diagnostic\u0113\u0161anai. Transvagin\u0101l\u0101 ultrasonogr\u0101fija (TVUG) ir lab\u0101ka, jo t\u0101 nodro\u0161ina lab\u0101ku iegur\u0146a v\u0113nu pleksusa vizualiz\u0101ciju sal\u012bdzin\u0101jum\u0101 ar TAUG [12].<\/p>\n

SSD diagnostikas krit\u0113riji TAUG un TVUG ir \u0161\u0101di: l\u012bkumainas iegur\u0146a v\u0113nas ar diametru > 4-6 mm, l\u0113na (\u22643 cm\/s), atgriezeniska asins pl\u016bsma, papla\u0161in\u0101tas l\u012bkumainas v\u0113nas 16. miometrij\u0101, kas saist\u012btas ar abpus\u0113j\u0101m iegur\u0146a varikoz\u0113m un policistisk\u0101m izmai\u0146\u0101m oln\u012bc\u0101 [3,8]. Policistiski oln\u012bcu dziedzeri ir saist\u012bti ar VSD 56% gad\u012bjumu, bet parasti pacient\u0113m neveidojas hirsutisms un amenoreja [17]. UG priek\u0161roc\u012bba ir ar\u012b t\u0101, ka to var veikt pacientam st\u0101vus un veicot provokat\u012bvu Valsalvas paraugu, kas vislab\u0101k simul\u0113 anatomiskos apst\u0101k\u013cus un uzlabo venoz\u0101 refluksa vizualiz\u0101ciju [8]. <\/p>\n

Apak\u0161\u0113jo ekstremit\u0101\u0161u duplekssonogr\u0101fija j\u0101veic ar\u012b pacientiem ar aizdom\u0101m par VSD, \u012bpa\u0161i pacientiem ar netipisku varikozu v\u0113nu formu. Atipiskas varikozas v\u0113nas ir sastopamas aizmugur\u0113j\u0101s un s\u0101nu aug\u0161stilbu da\u013c\u0101s un ir patognomoniska iegur\u0146a v\u0113nu nepietiekam\u012bbas paz\u012bme [12].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Ultraska\u0146as foto galerija<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Datortomogr\u0101fijas noz\u012bme VSD diagnostik\u0101<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Ja ir aizdomas par struktur\u0101lu patolo\u0123iju, var izmantot datortomogr\u0101fiju. Ar CT var nov\u0113rt\u0113t v\u0113nu anatomiju, to papla\u0161in\u0101\u0161anos un varikozit\u0101tes [8]. Norm\u0101ls oln\u012bcu v\u0113nu diametrs sv\u0101rst\u0101s no 3,2 l\u012bdz 3,6 mm [18]. VSD diagnostikas paz\u012bmes: vismaz 4 ipsilater\u0101las papla\u0161in\u0101tas paraaortas v\u0113nas, no kur\u0101m vismaz vienas diametrs ir liel\u0101ks par 4 mm, vai gonad\u0101l\u0101 v\u0113na > 8 mm diametr\u0101, un nav citas struktur\u0101las obstrukcijas (Nr. 1) [3,8].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Att\u0113l\u0101. 1 Papla\u0161in\u0101tas gon\u0101du v\u0113nas<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Magn\u0113tisk\u0101s rezonanses att\u0113lveido\u0161anas noz\u012bme VSD diagnostik\u0101<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Magn\u0113tisk\u0101 rezonanse nodro\u0161ina labu m\u012bksto audu vizualiz\u0101ciju un labu iegur\u0146a org\u0101nu nov\u0113rt\u0113jumu [8]. Magn\u0113tisk\u0101s rezonanses rezonans\u0113 varikozes parasti nav redzamas T1 18 sekvenc\u0113s un T2 sekvenc\u0113s ir redzamas k\u0101 hiperintens\u012bvas, bet da\u017ek\u0101rt var b\u016bt izo un hipointens\u012bvas atkar\u012bb\u0101 no asins pl\u016bsmas \u0101truma (8. att\u0113ls). V\u0113l viens \u0161\u012b testa tr\u016bkums ir tas, ka tas tiek veikts pacientam gu\u013cot, k\u0101 rezult\u0101t\u0101 varikoz\u0101s v\u0113nas tiek slikt\u0101k vizualiz\u0113tas[3].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Parast\u0101s venogr\u0101fijas noz\u012bme VSD diagnostik\u0101<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Parast\u0101 venogr\u0101fija ir invaz\u012bvs diagnostiskais tests, kur\u0101 v\u0113nu sist\u0113m\u0101 ievieto katetru un izv\u0113l\u0113taj\u0101s zon\u0101s injic\u0113 kontrastvielu. \u0160\u0101d\u0101 veid\u0101 tiek p\u0101rbaud\u012bta v\u0113nu anatomija, diametrs un pl\u016bsma [12,20]. \u0160is tests ir nepiecie\u0161ams, lai apstiprin\u0101tu VSD diagnozi pirms emboliz\u0101cijas terapijas piem\u0113ro\u0161anas [12]. Konvencion\u0101l\u0101s venogr\u0101fijas diagnostiskie krit\u0113riji VSD diagnozes noteik\u0161anai ir \u0161\u0101di: oln\u012bcu v\u0113nu diametrs > 6 mm, iegur\u0146a v\u0113nu diametrs > 5- 10 mm, kontrasta aizture > 20 s, asins st\u0101ze iegur\u0146a v\u0113nu pleksus\u0101, vulvas un aug\u0161stilba var\u012b\u017eu piepild\u012bjums [3]. Lai gan \u0161is tests ir zelta standarts VSD diagnostik\u0101, tas j\u0101veic tikai tad, ja neinvaz\u012bvie testi nav p\u0101rliecino\u0161i [9].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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VSD \u0101rst\u0113\u0161ana<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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SSD izrais\u012btu hronisku iegur\u0146a s\u0101pju \u0101rst\u0113\u0161ana ar nestero\u012bdajiem pretiekaisuma l\u012bdzek\u013ciem (NPL) vai oln\u012bcu darb\u012bbu nom\u0101co\u0161iem l\u012bdzek\u013ciem bie\u017ei vien ir pirm\u0101s izv\u0113les \u0101rst\u0113\u0161ana, l\u012bdz ir pieejama invaz\u012bva \u0101rst\u0113\u0161ana.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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SSD izrais\u012btu hronisku iegur\u0146a s\u0101pju \u0101rst\u0113\u0161ana ar nestero\u012bdajiem pretiekaisuma l\u012bdzek\u013ciem (NPL) vai oln\u012bcu darb\u012bbu nom\u0101co\u0161iem l\u012bdzek\u013ciem bie\u017ei vien ir pirm\u0101s izv\u0113les \u0101rst\u0113\u0161ana, l\u012bdz ir pieejama invaz\u012bva \u0101rst\u0113\u0161ana.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Oln\u012bcu v\u0113nu spir\u0101les emboliz\u0101cija ir viens no lab\u0101kajiem \u0101rst\u0113\u0161anas pa\u0146\u0113mieniem, kura efektivit\u0101tes r\u0101d\u012bt\u0101js ir 70-100 % \u0160\u012bs \u0101rst\u0113\u0161anas m\u0113r\u0137is ir aizsprostot iegur\u0146a v\u0113nas, kas izraisa v\u0113nu st\u0101zi, un likvid\u0113t refluksu [22]. Indik\u0101cijas \u0161ai \u0101rst\u0113\u0161anai ir hroniskas s\u0101pes iegurn\u012b, kas ilgst > 6 m\u0113ne\u0161us, un dipare\u016bnija, iz\u0146emot citus s\u0101pju c\u0113lo\u0146us, k\u0101 ar\u012b izteiktas perine\u0101l\u0101s un perian\u0101l\u0101s varikozes [3].<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Literat\u016bra:<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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[2] Koo S, Fan CM. Iegur\u0146a sastr\u0113gumu sindroms un iegur\u0146a varikozit\u0101tes. Tech Vasc Interv Radiol 2014;17:90-5. https:\/\/doi.org\/10.1053\/j.tvir.2014.02.005. <\/h4>\n

[3] Freedman J, Ganeshan A, Crowe PM. Iegur\u0146a sastr\u0113guma sindroms: intervencion\u0101l\u0101s radiolo\u0123ijas loma hronisku iegur\u0146a s\u0101pju \u0101rst\u0113\u0161an\u0101. Postgrad Med J 2010;86:704-10. https:\/\/doi.org\/10.1136\/pgmj.2010.099473. <\/h4>\n

[4] De Gregorio MA, Guirola JA, Alvarez-Arranz E, anchez-Ballestin MS, Urbano J, Sierre S. Pelvic Venous Disorders in Women due to Pelvic Varices: Treatment by Embolization: Experience in 520 Patients From the Department of Interventional Radiology (M Lejupiel\u0101d\u0113t anon\u012bmam lietot\u0101jam (n\/a) vietn\u0113 https:\/\/doi.org\/10.1016\/j.jvir.2020.06.017. <\/h4>\n

[5] Borghi C, Dell’Atti L. Iegur\u0146a sastr\u0113guma sindroms: literat\u016bras apskats. Arch Gynecol Obstet 2016;293:291-301. https:\/\/doi.org\/10.1007\/s00404-015-3895-7. <\/h4>\n

[6] Pyra K, Zbroja M, Cyranka W, Kuczy\u0144ska M, Sojka M, Jargie\u0142\u0142o T. Pelvic congestion syndrome: Joproj\u0101m nepietiekami diagnostic\u0113ts hronisku s\u0101pju c\u0113lonis sieviet\u0113m pirms menopauzes. Polish Arch Intern Med 2021;131:187- 9. https:\/\/doi.org\/10.20452\/pamw.15801. <\/h4>\n

[7] Khilnani NM, Winokur RS, Scherer KL, Meissner MH. Sievie\u0161u iegur\u0146a v\u0113nu darb\u012bbas trauc\u0113jumu kl\u012bniskais raksturojums un nov\u0113rt\u0113\u0161ana. Tech Vasc Interv Radiol 2021:100730. https:\/\/doi.org\/10.1016\/j.tvir.2021.100730. <\/h4>\n

[8] Bookwalter CA, Vanburen WM, Neisen MJ, Bjarnason H. Iegur\u0146a v\u0113nu sastr\u0113guma sindroma att\u0113lo\u0161ana un ne\u0137irur\u0123iska \u0101rst\u0113\u0161ana. Radiographics 2019;39:596-608. https:\/\/doi.org\/10.1148\/rg.2019180159. <\/h4>\n

[9] O MT, Gillespie DL. Iegur\u0146a sastr\u0113guma sindroma diagnostika un \u0101rst\u0113\u0161ana n.d. https:\/\/doi.org\/10.1016\/j.jvsv.2014.05.007. <\/h4>\n

[10] Basile A, Failla G, Gozzo C. Iegur\u0146a sastr\u0113guma sindroms. Semin Ultraska\u0146a, CT MRI 2021;42:3-12. https:\/\/doi.org\/10.1053\/j.sult.2020.07.001. <\/h4>\n

[11] Phillips D, Deipolyi AR, Hesketh RL, Midia M, Oklu R. Pelvic Congestion Syndrome: Etiology of Pain, Diagnosis, and Clinical Management 2014. https:\/\/doi.org\/10.1016\/j.jvir.2014.01.030. 30 <\/h4>\n

[12] Antignani PL, Lazarashvili Z, Monedero JL, Ezpeleta SZ, Whiteley MS, Khilnani NM, et al. Iegur\u0146a sastr\u0113guma sindroma diagnostika un \u0101rst\u0113\u0161ana: UIP konsensa dokuments. Int Angiol 2019;38:265-83. https:\/\/doi.org\/10.23736\/S0392-9590.19.04237-8. <\/h4>\n

[13] Gavrilov SG, Vasilyev A V, Krasavin G V, Moskalenko YP, Mishakina NY. Endovaskul\u0101ras intervences Mejas-T\u0113rnera sindroma izrais\u012bta iegur\u0146a sastr\u0113guma sindroma \u0101rst\u0113\u0161an\u0101. J Vasc Surg Venous Lymphat Disord 2020;8:1049-57. https:\/\/doi.org\/10.1016\/j.jvsv.2020.02.012. <\/h4>\n

[14] Eliahou R, Sosna J, Bloom AI. Starp akmeni un cieto vietu: asinsvadu kompresijas sindromu kl\u012bnisk\u0101s un att\u0113lu veido\u0161anas paz\u012bmes. Radiographics 2012;32. https:\/\/doi.org\/10.1148\/rg.321115011. <\/h4>\n

[15] Al-Katib S, Shetty M, Jafri SMA, Jafri SZH. Radiolo\u0123iskais nieru asinsvadu radiolo\u0123iskais nov\u0113rt\u0113jums: multimodalit\u0101tes p\u0101rskats. Radiographics 2017;37:136-56. https:\/\/doi.org\/10.1148\/rg.2017160060. <\/h4>\n

[16] Labropoulos N, Jasinski PT, Adrahtas D, Gasparis AP, Meissner MH. Standartiz\u0113ta ultraska\u0146as pieeja iegur\u0146a sastr\u0113guma sindromam. Flebolo\u0123ija 2017;32:608-19. https:\/\/doi.org\/10.1177\/0268355516677135. <\/h4>\n

[17] Keefe NA, Roberts A. Iegur\u0146a sastr\u0113guma sindroms. IR Playb. A Compr. Introd. to Interv. Radiol., Springer International Publishing; 2018, pp. 163-9. https:\/\/doi.org\/10.1007\/978-3-319-71300-7_13. <\/h4>\n

[18] Yang DM, Kim HC, Nam DH, Jahng GH, Huh CY, Lim JW. Laika iz\u0161\u0137irtsp\u0113jas MR angiogr\u0101fija oln\u012bcu v\u0113nu refluksa noteik\u0161anai un klasific\u0113\u0161anai: sal\u012bdzin\u0101jums ar parasto venogr\u0101fiju. Br J Radiol 2012;85. https:\/\/doi.org\/10.1259\/bjr\/79155839. <\/h4>\n

[19] Whiteley MS. Objekt\u012bvi iegur\u0146a v\u0113nu refluksa m\u0113r\u012bjumi un v\u0113nu refluksa smaguma pak\u0101pes stratifik\u0101cija iegur\u0146a sastr\u0113guma sindroma gad\u012bjum\u0101 iegur\u0146a v\u0113nu refluksa d\u0113\u013c. Curr Med Res Opin 2017;33:2089-91. https:\/\/doi.org\/10.1080\/03007995.2017.1332987. <\/h4>\n

[20] Kobeissi SS, Majdalany BS, Majdalany CI, Kanaan CN, Gilbert LN, Khaja MS. Iegur\u0146a sastr\u0113guma sindroms. J Radiol Nurs 2019;38:82-5. https:\/\/doi.org\/10.1016\/j.jradnu.2019.03.003. <\/h4>\n

[21] Gennadievich Gavrilov S, Sazhin A, Krasavin G, Moskalenko E, Mishakina N. Endovaskul\u0101ras un endoskopiskas iejauk\u0161an\u0101s gonad\u0101laj\u0101s v\u0113n\u0101s efektivit\u0101tes un dro\u0161\u012bbas sal\u012bdzino\u0161\u0101 anal\u012bze iegur\u0146a sastr\u0113guma sindroma \u0101rst\u0113\u0161an\u0101. https:\/\/doi.org\/10.1016\/j.jvsv.2020.05.013.<\/h4>\n

[22] Liu J, Han L, Han X. V\u0113l\u0101kas gr\u016btniec\u012bbas ietekme p\u0113c oln\u012bcu v\u0113nu emboliz\u0101cijas pacient\u0113m ar iegur\u0146a sastr\u0113guma sindroma izrais\u012btu neaugl\u012bbu 2019. gad\u0101. https:\/\/doi.org\/10.1016\/j.acra.2018.12.024. <\/h4>\n

[23] Ganeshan A, Upponi S, Hon LQ, Uthappa MC, Warakaulle DR, Uberoi R. Hroniskas iegur\u0146a s\u0101pes iegur\u0146a sastr\u0113guma sindroma d\u0113\u013c: diagnostisk\u0101s un intervencion\u0101l\u0101s radiolo\u0123ijas noz\u012bme. Cardiovasc Intervent Radiol 2007;30:1105-11. https:\/\/doi.org\/10.1007\/s00270-007-9160-0. <\/h4>\n

[24] Jurga-Karwacka A, Karwacki GM, Schoetzau A, Zech CJ, Heinzelmann-Schwarz V, Schwab FD. Aizmirsta slim\u012bba: iegur\u0146a sastr\u0113guma sindroms k\u0101 hronisku v\u0113dera lejasda\u013cas s\u0101pju c\u0113lonis. PLoS One 2019;14. https:\/\/doi.org\/10.1371\/journal.pone.0213834. 31 <\/h4>\n

[25] Orczyk K, Wysiadecki G, Majos A, Stefa\u0144czyk L, Topol M, Polguj M. Kas j\u0101zina katram kl\u012bniskajam anatomam par kreiso nieru v\u0113nu iespie\u0161anas sindromu (Nutcracker sindroms): svar\u012bg\u0101ko atkl\u0101jumu apskats. Biomed Res Int 2017;2017. https:\/\/doi.org\/10.1155\/2017\/1746570. <\/h4>\n

[26] Gulleroglu K, Gulleroglu B, Baskin E. Nutcracker sindroms. World J Nephrol 2014;3:277-81. https:\/\/doi.org\/10.5527\/wjn.v3.i4.277.<\/h4>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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Produkti<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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\"Cascinations<\/figure>

KASCIN\u0100CIJA CAS-One IR<\/h3>

\u0160veices ra\u017eot\u0101ja CASCINATION izstr\u0101d\u0101ta stereotaktisk\u0101s navig\u0101cijas sist\u0113ma, kas pal\u012bdz pl\u0101not, navig\u0113t un likvid\u0113t audz\u0113jus akn\u0101s, plau\u0161\u0101s, nier\u0113s, aizku\u0146\u0123a dziedzer\u012b un kaulos perkut\u0101no interven\u010du laik\u0101. <\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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\"Tato<\/figure>

TATO<\/h3>

Jap\u0101nas ra\u017eot\u0101ja TERUMO izstr\u0101d\u0101tais stiprin\u0101jums, kas vienlaikus var izmantot l\u012bdz pat \u010detr\u0101m anten\u0101m. Tas ir \u013coti viegli lietojams, ergonomisks un nodro\u0161ina dro\u0161u proced\u016bru.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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\"CryoCare<\/figure>

CRYOCARE TOUCH<\/h3>

ASV uz\u0146\u0113mums VARIAN <\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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\"6-2_Cliniporator_full\"<\/figure>

CLINIPORATION VITAE<\/h3>

It\u0101lijas uz\u0146\u0113muma IGEA elektro\u0137\u012bmijterapijas sist\u0113ma IGEA, ko var izmantot gan virspus\u0113ju audz\u0113ju, gan parenh\u012bmas audz\u0113ju \u0101rst\u0113\u0161anai.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t<\/path><\/svg>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\tVisi produkti<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Par hronisk\u0101m iegur\u0146a s\u0101p\u0113m (CPP) uzskata s\u0101pes, kas saglab\u0101jas ilg\u0101k nek\u0101 6 m\u0113ne\u0161us un ir pietiekami stipras, lai trauc\u0113tu norm\u0101lu ikdienas un profesion\u0101lo darb\u012bbu [1,2]. Hroniskas s\u0101pes iegurn\u012b var b\u016bt saist\u012btas ar iegur\u0146a varikoz\u0101m v\u0113n\u0101m un ir paz\u012bstamas k\u0101 iegur\u0146a v\u0113nu sastr\u0113gums [3,4]. T\u0101 ir bie\u017ei nediagnostic\u0113ta iegur\u0146a venoz\u0101s asinsrites slim\u012bba, kas izraisa hroniskas s\u0101pes […]<\/p>\n","protected":false},"author":8,"featured_media":4353,"parent":5090,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4571","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"\nIndividu\u0101l\u0101 aizsardz\u012bba - Ambercell<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ambercell.eu\/lv\/vadiba\/efektiva-procesu-vadiba\/individuala-aizsardziba\/\" \/>\n<meta property=\"og:locale\" content=\"lv_LV\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Individu\u0101l\u0101 aizsardz\u012bba - Ambercell\" \/>\n<meta property=\"og:description\" content=\"Par hronisk\u0101m iegur\u0146a s\u0101p\u0113m (CPP) uzskata s\u0101pes, kas saglab\u0101jas ilg\u0101k nek\u0101 6 m\u0113ne\u0161us un ir pietiekami stipras, lai trauc\u0113tu norm\u0101lu ikdienas un profesion\u0101lo darb\u012bbu [1,2]. Hroniskas s\u0101pes iegurn\u012b var b\u016bt saist\u012btas ar iegur\u0146a varikoz\u0101m v\u0113n\u0101m un ir paz\u012bstamas k\u0101 iegur\u0146a v\u0113nu sastr\u0113gums [3,4]. 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Hroniskas s\u0101pes iegurn\u012b var b\u016bt saist\u012btas ar iegur\u0146a varikoz\u0101m v\u0113n\u0101m un ir paz\u012bstamas k\u0101 iegur\u0146a v\u0113nu sastr\u0113gums [3,4]. 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