Cov kab mob epithelial coccygeal yog qhov nqaim channel uas cov qog sebaceous, cov hauv paus plaub hau nyob thiab uas yog kab nrog epithelium. Ntawm daim tawv nqaij, nws qhib nrog ob peb lub qhov tseem ceeb nyob rau hauv cheeb tsam ntawm intergluteal quav. Lawv tus lej tuaj yeem sib txawv ntawm ib mus rau ob peb. Cov kab mob no muaj ntau lub ntsiab lus: pilonidal, epithelial, pilar cyst, epithelial immersion, sacrococcygeal fistula, posterior navel.
Txoj kev xav
Epithelial coccygeal passage xaus dig muag hauv cov ntaub so ntswg subcutaneous. Cov tawv nqaij muaj thawj qhov uas tshwm sim thaum muaj kab mob tshwm sim.
Lawv qhov thaiv thiab cov neeg kho tshuab raug mob ua rau qhov tseeb tias cov ntsiab lus qeeb hauv lub lumen ntawm chav kawm, uas ua rau mob. Raws li qhov tshwm sim ntawm qhov no, txoj kev nthuav dav, nws cov phab ntsa tawg, thiab cov ntaub so ntswg rog tau koom nrog hauv cov txheej txheem. Qhov tshwm sim abscess tuaj yeem ncav cuag qhov loj me, tom qab ntawd nws tawg los ntawm epithelium, tsimsab nraud qhib ntawm purulent fistula, cais raws li theem nrab.
Qhov no pathology yog congenital. Txawm li cas los xij, cov neeg mob yuav tsis paub txog qhov muaj tus kab mob no ntev. Nyob rau lub caij txias, cov tsos mob ntawm tus kab mob tsis tshwm sim, los yog tej zaum yuav muaj qhov quav khaus, noo noo nyob rau hauv lub epithelium nyob rau hauv lub intergluteal cheeb tsam, thiab me me purulent paug tawm ntawm lub qhov quav.
Epithelial coccygeal passage raws li ICD
Kev faib tawm thoob ntiaj teb ntawm Kab Mob (ICD) yog cov ntaub ntawv yooj yim hauv cov tshuaj, siv los ua lub hauv paus tseem ceeb ntawm kev faib tawm. Raws li kev taw qhia ntawm WHO, nws raug tshuaj xyuas ib zaug txhua kaum xyoo. Hauv qhov system no, cov kab mob tau qhia los ntawm cov tsiaj ntawv Latin thiab cov lej. Qhov kev hloov tshiab no tau ua tom qab tau txais kev pom zoo ntawm Kaum Ib Hlis Kev Hloov Kho (ICD-10). Cov kab mob epithelial coccygeal muaj nyob rau hauv cov kab ke no nrog rau lwm yam pathologies.
Kev faib ICD-10 yog raws li peb tus lej code uas encodes cov ntaub ntawv kev tuag los ntawm ntau lub tebchaws rau WHO. Nyob rau hauv peb lub teb chaws, nws yuav tsum tau siv thaum lub sij hawm forensic psychiatric kuaj thiab nyob rau hauv kev kho mob psychiatry.
ICD-10 code rau epithelial coccygeal passage - L05.0 nyob rau hauv cov ntaub ntawv ntawm ib tug abscess. Pathology belongs rau XII chav kawm "Cov kab mob ntawm daim tawv nqaij thiab cov ntaub so ntswg subcutaneous." Thaum tsis muaj abscess, ICD code rau cov kab mob epithelial coccygeal yog L05.9.
Kev faib tawm
Tsis muaj kev lees paub dav dav ntawm tus kabmob raws li cov txheej txheem niaj hnub no. Cov txheej txheem tib yam ua rau kev ua haujlwm sib txawvkev cuam tshuam. Qhov no ua rau muaj kev tsis meej pem hauv kev ntsuam xyuas cov txiaj ntsig ntawm kev kho mob thiab ua rau tsis yog ib txwm ua raws li tus kws kho mob.
Tam sim no, kev faib tawm ntawm cov kab mob epithelial coccygeal, tau npaj rau xyoo 1988 los ntawm Lub Xeev Lub Chaw Tshawb Fawb ntawm Coloproctology, suav tias yog qhov ua tiav tshaj plaws. Raws li nws, tus kab mob tau muab faib ua cov ntaub ntawv hauv qab no:
- tsis yooj yim;
- mob o mob tshwm sim los ntawm infiltration thiab abscesses;
- mob o, uas tib yam tshwm sim tau sau tseg, feem ntau rov tshwm sim, thiab purulent fistula;
- remission.
Yog li, qhov kev faib tawm no tsis cuam tshuam nrog cov kab mob epitheliococcygeal tract code.
Diagnosis
Feem ntau, kev kuaj mob ntawm "epithelial coccygeal tract" yog raws li:
- sib sau anamnesis;
- xam tus neeg mob;
- kev kuaj mob ntawm lub qhov quav.
Hauv thawj kis, cov xwm txheej ntawm qhov pib ntawm tus kabmob, kev ua haujlwm tsis zoo ntawm lub plab hnyuv siab raum, uas muaj keeb kwm ntawm kev raug mob rau thaj tsam sacrococcygeal, lub sijhawm thiab qhov xwm txheej ntawm kev tsis txaus siab raug txheeb xyuas.
Kev kuaj tus neeg mob yog ua thaum nws nyob hauv lub hauv caug-lub luj tshib lossis pw ntawm nws lub plab. Tus kws kho mob soj ntsuam cov mob ntawm lub epithelium ntawm lub pob tw, cheeb tsam sacrococcygeal, perianal cheeb tsam, tus naj npawb thiab qhov chaw ntawm lub qhov ntawm tus yam ntxwv ntawm no pathology. Thaum lub sij hawm soj ntsuam ntawm lub qhov quav thiab perineum, concomitant ailments tshwm sim: qhov quav prolapse, fistulas, hemorrhoids, qhov quav fissure. Thaumpalpation txiav txim seb puas muaj cov txheej txheem cicatricial thiab inflammatory hauv cheeb tsam sacrococcygeal.
Digital kev ntsuam xyuas ntawm lub qhov quav ntsuas qhov xwm txheej ntawm thaj chaw kawg, nrog rau qhov chaw ntawm Morganian crypts.
Tsis tas li ntawd, tus kws kho mob yuav sau ntawv mus kuaj ntxiv:
- Sigmoidoscopy. Hauv qhov no, qhov mucosa ntawm qhov distal sigmoid thiab lub qhov quav yog kuaj. Nyob rau hauv thawj zaug, lub xub ntiag ntawm inflammatory dynamics yog sau tseg. Qhov xwm ntawm vascular qauv kuj raug soj ntsuam.
- Fistulography. Nws tau ua tiav hauv cov teeb meem nyuaj rau kev kuaj mob sib txawv.
- Ultrasound ntawm thaj chaw sacrococcygeal. Nrog kev pab los ntawm txoj kev tshawb no, qhov tob ntawm qhov chaw ntawm kev tsom xam los ntawm integument ntawm daim tawv nqaij, cov degree ntawm kev koom tes nyob rau hauv o ntawm subcutaneous fatty ntaub so ntswg, nyob ib ncig ntawm cov ntaub so ntswg, muaj ib tug ntxiv passages, tus qauv thiab loj ntawm lub pathology., nws localization.
daim duab kho mob
Zoo ntawm nws, cov txheej txheem purulent nyuaj thiab qhov tsis sib haum xeeb ntawm cov kab mob epithelial coccygeal yog qhov txawv.
Hauv thawj kis, cov kab mob tuaj yeem ua rau mob hnyav lossis mob ntev, nrog rau kev tshem tawm. Yog tias cov khoom pov tseg tau qeeb hauv chav kawm, tom qab ntawd cov tsos ntawm qhov tsis hnov tsw nkag nrog cov contours pom tseeb, uas cuam tshuam nrog kev txav mus los.
Yog tias nws kis tau tus kab mob, mob hnyav zuj zus, nrog rau qhov mob mob. Cov tawv nqaij tshaj qhov infiltrate ua hyperemic thiab edematous. Muaj qhov nce hauv lub cev kub.
Nyob rau hauv cov txheej txheem mob ntev, cov xwm txheej ntawm tus neegNyob ruaj khov, muaj me ntsis purulent paug tawm ntawm qhov qhib ntawm txoj kev, tsis pom muaj hyperemia thiab edema. Nyob ib ncig ntawm lawv, cicatricial cov ntaub so ntswg dynamics tshwm sim. Qee qhov thib ob qhov kho tau zoo, lwm qhov txuas ntxiv ua haujlwm. Yog tias kev zam txim tau raug pom nyob rau lub sijhawm ntev, lawv kaw nrog nti. Lub hauv paus qhov tsis tsim ib qho kev xaiv thaum nias rau ntawm tus mob stroke.
Ib qho abscess hauv cheeb tsam coccyx tuaj yeem qhib los ntawm kws kho mob lossis nws tus kheej. Nyob rau tib lub sijhawm, kaw lub qhov txhab yam tsis muaj kev tsim ntawm fistula, qhov mob tshwm sim ploj, cov cim qhia sab nraud ntawm cov txheej txheem inflammatory ploj. Txawm li cas los xij, qhov tseem ceeb ntawm kev kis kab mob mus rau hauv lub xeev dormant thiab tuaj yeem ua rau muaj kev cuam tshuam ntau ntxiv nrog kev tsim cov abscesses, fistulas thiab phlegmon. Lawv tuaj yeem tuaj tom qab ob peb lub hlis, thiab tom qab muaj pes tsawg xyoo.
Nruab nrab ntawm lawv, tus neeg mob tseem raug cuam tshuam los ntawm kev tso tawm ntawm lub qhov, tsis xis nyob lossis mob npub ntawm thaj chaw coccyx, uas feem ntau tshwm sim thaum zaum.
Cov duab ntawm cov kab mob epithelial coccygeal tsis txaus nyiam.
kev kho mob
Nws yog siv rau hauv cov ntawv mob ntev. Tsis tas li ntawd, nws yog siv los npaj rau kev phais hauv epithelial coccygeal passage.
Kev kho mob suav nrog cov haujlwm hauv qab no:
- diathermy thiab cryotherapy - kev puas tsuaj ntawm fistulous epithelium los ntawm kev raug kub los yog qis, feem;
- hyperbaric oxygenation - oxygen yog nkag mus rau cov ntaub so ntswg nyob rau hauv lub siab, uas pab kho cov cuam tshuamzaj;
- txhua lub limtiam shaving npog lub intergluteal crease ntawm lub duav mus rau lub qhov quav, 2 cm dav;
- kev tu cev, suav nrog kev ntxuav thiab ziab ntawm thaj chaw intergluteal.
Surgery
Txoj kev tseem ceeb ntawm kev kho mob ntawm epithelial coccygeal passage yog kev ua haujlwm. Nyob rau hauv qhov kev txiav txim tam sim nws yog nqa tawm nrog ib tug mob daim ntawv ntawm o. Yog tias muaj daim ntawv mob ntev, tom qab ntawd kev ua haujlwm rau cov txheej txheem epithelial coccygeal yog ua raws li tau npaj tseg.
Hom kev phais yog txiav txim los ntawm cov hauv qab no:
- prevalence ntawm txheej txheem;
- nws theem;
- daim duab kho mob.
Thaum nws ua tiav, lub hauv paus tseem ceeb ntawm kev mob raug tshem tawm - ib txoj hauv kev nrog cov thawj thiab thib ob qhov, cov ntaub so ntswg nyob ib puag ncig tau hloov pauv raws li qhov tshwm sim ntawm pathology.
Rau txhua yam kev ua haujlwm, tus neeg mob tau muab tso rau ntawm nws lub plab, nws ob txhais ceg sib nrug me ntsis kom nkag mus rau qhov sib txuas ntawm lub ntsej muag.
Cov ntaub ntawv hauv qab no ntawm kev cuam tshuam kev phais yog siv niaj hnub no:
- sinusectomy - subcutaneous excision ntawm epithelial coccygeal zaj;
- qhib haujlwm;
- excision nrog suturing lub qhov txhab kom nruj;
- marsupialization - qhib lub cyst nrog tshem tawm ntawm nws cov ntsiab lus thiab suturing cov npoo ntawm nws phab ntsa rau hauv lub qhov txhab;
- excision nrog repositioned flaps.
Kev txiav txim nrog kaw qhov txhab kaw
Nws yog siv rau qhov tsis sib xwstxav. Methylene xiav yog txhaj rau hauv lub qhov tseem ceeb txhawm rau txhawm rau txhawm rau thiab cov ceg ntoo. Cov kab lus yog excised nrog ob excising incisions nyob rau hauv ib qho thaiv nrog lub epithelium ntawm lub intergluteal quav nrog subcutaneous ntaub so ntswg, uas muaj cov nqe lus, nrog rau tag nrho cov muaj qhov, mus rau lub sacrococcygeal fascia.
Cov contraindications hauv qab no yog ib qho kev ua haujlwm zoo li no:
- muaj cov infiltrates hauv thaj tsam intergluteal;
- yav dhau los ua haujlwm nrog cicatricial deformity ntawm thaj chaw no.
Cov txiaj ntsig zoo tom qab kev phais raug pom nyob hauv 58-88% ntawm cov neeg mob. Txawm li cas los xij, cov teeb meem tuaj yeem ncav cuag 31%.
Marsupialization
Nws tau ua hauv daim ntawv mob hnyav hauv theem ntawm kev nkag mus.
Qhov kev txiav txim thawj zaug yog ua tib yam li tau piav qhia dhau los. Nyob rau hauv lub neej yav tom ntej, nws yog nqa tawm raws li nram qab phab ntsa ntawm txoj kev, cuam tshuam rau sab sauv seem ntawm sab phab ntsa. Tom qab ntawd lub epithelial npoo ntawm qhov incision yog sutured nyob rau hauv ib tug checkerboard qauv rau saum npoo ntawm lub coccyx thiab sacrum. Tshem tawm tom qab 10-12 hnub.
Ntau tshaj 93% ntawm cov neeg mob tau zoo.
Open Operations
Lawv tau ua nrog mob hnyav hauv theem abscess. Cov haujlwm zoo li no tau ua hauv ob theem. Nyob rau hauv thawj theem, lub abscess kab noj hniav yog punctured nyob rau hauv lub point ntawm qhov zoo tshaj plaws fluctuation, cov ntsiab lus yog pumped tawm nrog ib tug syringe. Nws yog qhib los ntawm kev ua ib tug longitudinal incision.
Tom qab kev tshem tawm ntawm qhov mob hnyav ntawm theem thib ob, kev txiav tawm maj mam ntawm cov ceg ntoo thiab cov kab mob coccygeal nws tus kheej, cov ntaub so ntswg ib puag ncig, tau nqa tawm, qhov txhab qhib.
zooCov txiaj ntsig, suav nrog kev txaus siab, tau pom hauv 79-87% ntawm cov neeg mob.
Kev txiav txim nrog qhov kho qhov txhab
Nws tau ua nrog cov kab mob tshwm sim lossis cov ntaub ntawv qib siab, uas muaj ntau qhov fistulous streaks ntawm lub pob tw.
Thaum siv cov txheej txheem ntawm kev phais mob, cov nqe lus raug tshem tawm nrog cov ceg ntoo, sab nraud fistulous qhib, cov ntaub so ntswg nyob ib puag ncig, tawv nqaij, infiltrates thiab kab noj hniav mus txog rau sacral fascia hauv ib qho thaiv.
Kev txiav tawm ntawm daim tawv nqaij-rog flaps yog ua los ntawm kev sib cais, feem ntau ntawm lub kaum sab xis ntawm 60 degrees mus rau qhov mob loj, vim nws muab cov ntshav zoo nrog kev txav mus los. Lub flaps yog ua rau qhov siab tshaj plaws thickness thiaj li yuav muaj tag nrho cov ntaub so ntswg subcutaneous.
Ntau tshaj 84% ntawm cov neeg mob tau txais txiaj ntsig zoo.
YSinusectomy
Nws yog ua tiav nrog kev tshem tawm ntawm cov txheej txheem inflammatory, nws daim ntawv mob nyob rau hauv lub sij hawm ntawm purulent fistula thiab uncomplicated course.
Nws yog excised los ntawm thawj mus rau theem nrab qhov nyob rau hauv daim tawv nqaij. Ua staining nrog methylene xiav. Tom qab kev txiav tawm, lub belled sojntsuam yog dhau los ntawm lub qhov thiab ib txoj hauv kev yog excised ntawm nws siv electrocoagulation. Cov qhov txhab uas tsim tsis sutured.
Cov txiaj ntsig zoo ncua qeeb, pom hauv 93% ntawm tus neeg mob.
Kev tswj hwm ntxiv
Tom qab kev phais rau cov txheej txheem epithelial coccygeal, cov neeg mob tau txais:
- Kev hnav khaub ncaws txhua hnub siv cov tshuaj hauv qab no: Povidone Iodine, Iodopyrone, Betadine, Hydrogen Peroxide, Dioxidine, Chlorhexidine.
- Kev raug UV txhua hnub thiab kev kho mob microwave.
- Kev siv tshuaj pleev kom kho cov ntaub so ntswg sai ("Methyluracil") nrog cov tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob ("Fuzimet", "Levosin", "Levomekol").
Kev kho mob lig
Nyob rau hauv rooj plaub no, cov txheej txheem inflammatory tuaj yeem npog tag nrho thaj chaw sacrococcygeal, uas tuaj yeem ua rau muaj ntau yam fistulas nyob rau hauv perineum, inguinal folds, thiab scrotum. Pyoderma thiab fungal kab mob tuaj yeem ntxiv rau lawv.
Yuav xav tau kev kho mob mus sij hawm ntev, kev txiav tawm ntawm daim tawv nqaij loj dua, kev phais ntau theem.
Huab cua thiab tiv thaiv
Kev rov zoo tuaj yeem tshwm sim ntawm txhua theem ntawm kev kho mob.
Rau kev tiv thaiv tus mob hnyav, nws yog ib qho tsim nyog yuav tsum tau ua cov kev ntsuas dav dav:
- kho cov kab mob sib kis hauv lub sijhawm;
- tshem tawm cem quav thiab raws plab;
- kho atherosclerosis thiab ntshav qab zib;
- tiv thaiv lossis tiv thaiv kab mob hauv lub sijhawm;
- txhawb kev tiv thaiv;
- saib xyuas tus kheej huv si, tshwj xeeb tshaj yog nyob rau hauv thaj chaw intergluteal.
Nyob hauv kaw
Epithelial coccygeal passage yog ib qho kev yug me nyuamcov ntaub so ntswg hauv thaj chaw uas cov ntaub so ntswg ntawm thaj av sacrococcygeal nyob. Feem ntau nws tshwm sim hauv cov tub ntxhais hluas hnub nyoog 15-30 xyoo. Kev kho mob feem ntau yog phais, radical. Hauv cov xwm txheej ib txwm, kev phais tau yooj yim zam los ntawm cov neeg mob. Qhov kev cia siab ntawm tus kab mob yog qhov zoo. Nrog rau kev kho tsis raws sijhawm, fistulas theem nrab tuaj yeem txhim kho ntawm qhov deb txaus los ntawm qhov chaw intergluteal.
