Abscesses feem ntau hu ua cov txheej txheem inflammatory nrog kev tso kua paug. Lawv qhov xwm txheej yog, feem ntau, kis tau. Tus neeg sawv cev ntawm tus kab mob nkag mus rau lub thickness ntawm cov ntaub so ntswg, lub cev tiv thaiv react rau nws nrog "squads" ntawm leukocytes. Raws li qhov tshwm sim ntawm kev tawm tsam ntawm cov hlwb thiab cov neeg ua haujlwm txawv teb chaws, cov kua paug yog tsim. Qhov tseeb, qhov loj no yog lub cev ntawm cov leukocytes tuag thiab cov neeg tuag hauv kev sib ntaus sib tua ntawm cov kab mob thiab cov kab mob.
Yog tias tus qauv ntawm kev txhim kho abscess zoo sib xws hauv ntau qhov xwm txheej, ces qhov chaw ntawm txoj kev loj hlob ntawm cov txheej txheem inflammatory yuav txawv heev. Raws li, cov teeb meem, ua rau mob, txoj kev ntawm nws qhov kev kuaj mob thiab kev kho mob yuav txawv. Ib qho ntawm cov no yog psoas abscess. Peb yuav txheeb xyuas nws cov yam ntxwv ntxiv.
Qhov no yog dab tsi?
Psoas abscess yog cov txheej txheem purulent inflammatory uas tshwm sim nyob rau hauv lub thickness ntawm cov leeg iliopsoas. Nws yog dab tsi? Cov leeg no muaj ntau yam:
- Psoas major.
- Psoas minor.
- Iliac leeg.
Nws lub hom phiaj ncaj qha yog raws li hauv qab no: txuasqaum thiab pelvic pob txha nrog femurs. Cov leeg kuj koom nrog hauv flexion ntawm tus txha nraub qaum thiab ob txhais ceg ntawm lub duav sib koom.
Vim li cas psoas abscess? Los ntawm Latin lub npe ntawm iliopsoas nqaij - m. iliopsoas. Raws li, rau qee yam laj thawj, qhov mob yuav tshwm sim hauv nws, nyuaj los ntawm purulent paug.
Psoas abscess in ICD-10
Nyob rau hauv International Classification of Diseases, qhov no abscess yog tsim los ntawm tus lej M60.0 - "Kev kis mob myositis". Cov no yog cov kab mob nqaij (M60-63), kab mob ntawm cov nqaij mos (M60-79), nrog rau cov kab mob ntawm cov ntaub so ntswg thiab cov musculoskeletal system (M00-M99).
Psoas abscess hauv ICD-10 yog ib hom kab mob ntawm cov ntaub so ntswg sib sib zog nqus. Ntxiv rau nws, pyomyositis (ib qho kab mob tseem ceeb ntawm cov leeg pob txha) yog qhov txawv hauv pawg M60.0. Psoas abscess muaj npe nyob rau hauv classifier raws li ib tug abscess ntawm psoas loj nqaij. Nws kuj txhais tau tias yog kab mob ntawm cov leeg nqaij.
Qhov txawv ntawm pyomyositis
Y Hauv pyomyositis, cov kab mob tseem ceeb yog Staphylococcus aureus. Tab sis sib xyaw microflora kuj tseem tuaj yeem tshwm sim. Raws li rau psoas abscess, tsis muaj tus neeg sawv cev tshwj xeeb.
Muaj lwm qhov sib txawv tseem ceeb ntawm cov neeg sawv cev ntawm pawg M60.0 raws li ICD-10. Psoas abscess yog los ntawm nws qhov xwm txheej thib ob. Qhov tseeb, nws yuav yog qhov tshwm sim ntawm cov txheej txheem inflammatory (los yog mob hematomas) hauv cov ntaub so ntswg. Pyomyositis yog thawj cov txheej txheem inflammatory uas tuaj yeem txhim kho hauv cov leeg nqaij puas.
Abscesses hauvretroperitoneum
Muaj ntau hom txheej txheem inflammatory:
- Ntshai ntawm qhov chaw retroperitoneal anterior. Cov no yog cov kab mob pancreatic thiab periintestinal abscesses. Thawj qhov yog qhov tshwm sim ntawm kev puas tsuaj rau pancreatitis lossis pancreatic necrosis. Cov tom kawg tsim nrog perforation ntawm duodenum, nyuv vim yog mob plab, qog lossis raug mob.
- Ntshai ntawm qhov chaw retroperitoneal posterior chaw. Cov no yog abscesses ntawm qhov chaw perirenal, uas tuaj yeem txhim kho nrog kev puas tsuaj rau appendicitis, pyonephrosis, thiab raug mob ntawm cov ntaub so ntswg perirenal. Tseem muaj subdiaphragmatic abscesses. Lawv tsim nrog diffuse peritonitis, perforation ntawm appendicitis, nrog rau qhib thiab kaw qhov txhab ntawm lub plab kab noj hniav.
- Psoas-abscess. Cov kab mob hauv qhov no tuaj yeem ncav cuag qhov ntau thiab tsawg thiab ua rau cov psoas loj.
Ua rau kab mob
Raws li pom los ntawm kev txheeb xyuas kev kho mob, feem ntau qhov mob no tshwm sim hauv cov neeg mob laus dua 30 xyoo. Qhov tshwm sim feem ntau yog Staphylococcus aureus. Qee zaum, cov kab mob tuaj yeem yog Escherichia coli, Pseudomonas aeruginosa, hemolytic streptococci.
Cov no yog cov laj thawj tseem ceeb ntawm psoas abscess. Nyob rau hauv cov ntaub ntawv no, tus kab mob kis los ntawm lub hauv paus qhov chaw mus rau lub iliopsoas nqaij. Raws li, cov kab mob nkag mus rau hauv cov hlab ntsha thiab cov hlab ntsha.
Qhov chaw ntawm tus kab mob
Vim li cas psoas abscess feem ntau tshwm sim tom qab phais? Txhawm rau teb cov lus nug, peb nthuav qhia lub ntsiabQhov chaw ntawm tus kab mob no:
- Cov txheej txheem mob tshwm sim hauv tus txha nraub qaum. Hauv particular, osteomyelitis, spondylodiscitis.
- Txhim kho qhov mob ntawm cov nqaij rog subcutaneous ib puag ncig cov leeg.
- Cov txheej txheem mob hauv cov kab mob hauv nruab nrog cev ze tshaj plaws rau cov leeg - pancreas, ob lub raum, txheej txheem appendicular (yog li ntawd, psoas abscess feem ntau yog qhov tshwm sim ntawm appendicitis).
- tuberculosis.
- raug mob hnyav rau cov leeg nqaij nws tus kheej, uas ua rau tsim cov hematoma hauv nws, uas tom qab ntawd ua rau mob.
- Kev kho mob ntawm tus txha nraub qaum thiab ib puag ncig cov ntaub so ntswg.
Tus kab mob no tseem txaus ntshai vim cov kua paug paug tsis zoo li qub. Lawv tuaj yeem kis mus rau cov nqaij rog nyob ib puag ncig thiab mus rau hauv lub plab mog.
Abscess spread
Peb twb tau hais lawm tias psoas txuas qhov qis ntawm tus txha nraub qaum mus rau tus ncej puab. Qhov ntawd tso cai rau nws koom nrog hauv flexion ntawm tus txha nraub qaum thiab lub duav. Yog tias peb saib ntawm qhov anatomical atlas, peb yuav pom tias cov leeg no yuav txuas rau sab nraub qaum, mus rau lub cev vertebral thiab ntau cov txheej txheem hla.
Qhov chaw no piav qhia txog qhov txheej txheem inflammatory kis li cas. Cov kab mob txha caj qaum uas tshwm sim nyob rau hauv lub cev vertebral los yog qhov chaw disc feem ntau kis mus rau vertebrae uas nyob ib sab. Los ntawm no, cov kua paug tuaj yeem ntws raws cov leeg lumboiliac, koom nrog hauv cov txheej txheem inflammatory.
Lwm txoj kev kis mus raucov leeg mob los ntawm lub plab. Raws li cov kua paug, nws tuaj yeem ntws mus rau cov leeg iliopsoas twb mus rau hauv puab tais.
Nws yuav tsum tau muab sau tseg tias psoas abscess tuaj yeem yog kab mob thib ob uas tshwm sim tom qab Crohn tus kab mob, mob qog nqaij hlav hauv plab lossis diverticulosis. Tsis tas li, cov txheej txheem paraspinal, cuam tshuam rau cov leeg psoas, tej zaum yuav tshwm sim ntawm osteomyelitis.
Raws li peb tau sau tseg lawm, tuberculosis tuaj yeem raug hu ua ib qho ntawm cov ua rau psoas abscess. Qee qhov xwm txheej, qhov mob ntawm cov leeg iliopsoas yuav yog qhov tshwm sim ntawm kev tawg, qhib ntawm cov kab mob hauv nruab nrog cev. Piv txwv li, raum, pancreas.
Symptoms of disease
Cia peb xav txog cov tsos mob tseem ceeb ntawm psoas abscess:
- mob plab plab.
- Nyob rau hauv lub puab tsaig, nrog rau pem hauv ntej ntawm tus ncej puab.
- Paj hauv qab.
- Mob tau hnov hauv thaj tsam ntawm lub duav pob qij txha thaum lub ceg txuas ntxiv.
- lub cev kub, txias, ua npaws.
Tus neeg yuav yws txog qhov mob tas li ntawm sab laug lossis sab xis ib nrab ntawm lub plab plab. Mob syndrome tuaj yeem hnov hauv lawv tib lub sijhawm. Feem ntau muaj qhov tsis xis nyob hauv pem hauv ntej ntawm tus ncej puab. Nrog rau ib qho kev kis tus kab mob, nws kuj kis mus rau hauv lub puab tais. Nws zoo nkaus li cov leeg nro hauv thaj tsam ncej puab. Raws li lub puab tsaig, tus neeg mob yuav pom zoo li cov khoom sib xyaw ua ke.
Thaum taug kev, qhov mob kuj tuaj yeem hnov, uas twb kis mus rau sab nraub qaum. Ua npaws, siabQhov kub thiab txias yog cov cim qhia ntawm cov txheej txheem inflammatory hauv lub cev.
Tus mob yog qhov txaus ntshai vim tias daim duab kho mob feem ntau raug tshem tawm. Tshwj xeeb tshaj yog tawm tsam keeb kwm yav dhau ntawm tus neeg mob noj cov tshuaj uas tsis yog-steroidal anti-inflammatory, uas ib tug neeg sim ua kom poob qhov mob. Tus neeg mob tuaj yeem soj ntsuam los ntawm tus kws kho mob hlwb rau lub sijhawm ntev, thaum qhov ua rau mob mob tsis raug txiav txim siab.
ntsuas ntsuas
txhawm rau nrhiav qhov ua rau mob mob hauv qhov no, koj yuav tsum tau ua ntau tshaj ib txoj kev kuaj mob. Yog li, kev kuaj mob ntawm psoas abscess yuav tsum muaj cov hauv qab no:
- MSCT (computed tomography). Cov txheej txheem no yuav pab txiav txim qhov kev nthuav dav ntawm cov txheej txheem inflammatory. Thiab tseem hais txog nws txoj kev sib raug zoo nrog cov ntaub so ntswg nyob ze thiab cov khoom nruab nrog cev. Txawm li cas los xij, txoj kev no kuj muaj qhov tsis zoo - ntxiv hluav taws xob raug rau cov ntsiab lus.
- MRI (magnetic resonance imaging). Txoj kev no yog tus cwj pwm los ntawm tag nrho cov txiaj ntsig uas suav tomography yog qhov txawv. Qhov kom zoo dua ntawm MRI yog tias nrog kev pab ntawm cov txheej txheem no nws muaj peev xwm txiav txim siab thawj cov txheej txheem inflammatory hauv cov leeg. Ntawd yog, theem uas ua ntej lub purulent. Lwm qhov tseem ceeb ntxiv yog tias nrog hom kev kuaj mob no tsis muaj hluav taws xob raug rau tus neeg mob. Tab sis qhov tsis zoo ntawm MRI yog tias thaum lub sijhawm txheej txheem no tus neeg mob yuav tsum nyob twj ywm tsis muaj zog rau lub sijhawm ntev. Dab tsi yog qhov tsis yooj yim rau cov neeg mob mob hnyav. Tsis tas li ntawd, rau MRIMuaj ib tug xov tooj ntawm contraindications.
- Ultrasound (ultrasound kuaj ntawm lub plab kab noj hniav). Siv cov txheej txheem no, nws tseem tuaj yeem txheeb xyuas cov txheej txheem purulent-inflammatory cuam tshuam rau cov leeg iliopsoas, nrog rau lawv lub ntim. Tab sis piv rau cov saum toj no, qhov no yog ib tug tsawg dua txoj kev. Txawm li cas los xij, kev kuaj suab yuav luag ib txwm tso cai rau koj kom pom qhov chaw ntawm kev kis tus kab mob, qhov ntsuas ntawm cov txheej txheem inflammatory tshwm sim, thiab tseem ntsuas seb nws cuam tshuam li cas ntawm cov nqaij nruab nrog cev thiab cov ntaub so ntswg.
kho mob phais
Kev kho mob ntawm psoas abscesses. Ntawd yog, kev ua haujlwm yog ua los phais qhib qhov abscess. Tsuas yog kev saib xyuas kev kho mob tsis tuaj yeem nyob ntawm no yog vim li cas nrog nws txoj kev pab nws yuav tsis tuaj yeem tshem tawm cov kua qaub, ntxuav cov leeg thiab cov ntaub so ntswg thiab cov khoom nruab nrog cev los ntawm cov hlwb tuag.
Cov kab noj hniav yog ntxuav los ntawm cov teeb meem purulent, tom qab ntawd nws tau kho nrog tshuaj tua kab mob tshwj xeeb. Nruab cov qhov dej tshwj xeeb. Nyob rau hauv cov ntaub ntawv ntawm psoas abscess, kev kho mob tom qab phais yuav suav nrog kev noj tshuaj tua kab mob los ntawm kws kho mob.
Yog tias koj ua tus yam ntxwv ntawm kev ua haujlwm feem ntau, qhov no yog qhov qhib thiab tso dej ntawm qhov tsim abscess. Nws yog qhib nyob rau hauv ob txoj kev: lobotomically los yog los ntawm lub plab anterior phab ntsa ntawm sab xis los yog sab laug. Nws nyob ntawm qhov chaw ntawm qhov mob ntawm theem ntawm iliac crests. Lub peritoneum yog tev tawm mus rau nruab nrab.
kev kho mob
Kev kho mob hauv qhov notxuas ntxiv kev phais. Qhov no yog ib txoj kev kho kab mob tshwj xeeb, xaiv los ua tus account ntawm cov kab mob uas ua rau cov txheej txheem inflammatory.
Raws li kev kho mob niaj hnub no ntawm psoas abscesses, tus neeg mob tau muab tshuaj nrog cov tshuaj nquag hauv qab no:
- Ihtammol.
- Cefepim.
- Amicacin.
- Tobramycin.
- Pefloxacin YPefloxacin
- Ampicillin.
- YCiprofloxacin.
- Imipenem.
- Cefpirom.
- YLomefloxacin.
- YTicarcillin.
Yog tias peb tham txog kev kwv yees, ces lawv feem ntau yog qhov zoo. Muab hais tias muaj kev kho mob kom txaus txaus, thiab cov kab mob abscess tau kuaj pom thaum pib ntawm txoj kev loj hlob, thaum qhov mob tsis kis mus rau lwm lub cev thiab lub cev tseem ceeb. Hauv qhov no, kev sib xyaw ua ke ntawm kev phais thiab kev saib xyuas kev noj qab haus huv ua rau tus neeg mob rov qab ua tiav.
Psoas abscess yog ib qho mob hnyav heev uas cov txheej txheem purulent inflammatory tshwm sim nyob rau hauv psoas loj cov leeg. Nws tsis yog kho nrog tshuaj - yuav tsum tau phais sai, thiab tsuas yog tom qab ntawd kho cov tshuaj tua kab mob.
