Cov nyias nyias nyias - lub peritoneum - uas nyob rau hauv ib daim ntawv los yog lwm yam nyob rau hauv feem ntau ntawm cov kabmob, muaj ib tug tshwj xeeb kev tiv thaiv. Yog li, piv txwv li, thaum mob tshwm sim, nws tuaj yeem txo qhov cuam tshuam ntawm thaj chaw, ua rau lub plab zom mov. Hauv kev kho mob slang, qhov no yog hu ua "soldering", uas yog, tsim cov adhesions ntawm cov kabmob uas nyob ib sab hauv txoj kev uas tau txais qhov chaw kaw.
Definition
Abscess ntawm lub plab kab noj hniav yog ib qho purulent o ntawm ib lub cev los yog ib feem ntawm nws, nrog ntxiv melting ntawm cov ntaub so ntswg, tsim ib kab noj hniav thiab ib tug capsule nyob ib ncig ntawm nws. Nws tuaj yeem tsim tau kiag li hauv txhua "hauv pem teb" ntawm lub plab kab noj hniav thiab tuaj yeem nrog cov tsos mob ntawm intoxication, kub taub hau thiab sepsis.
Dhau li ntawm qhov no, tus neeg mob yuav hnov mob, tiv thaiv cov leeg mob plab, xeev siab thiab ntuav. Qee zaum, thaum nyuaj, adhesions ua rau mob plab hnyuv.
Kab mob kis
Abscess ntawm plab kab noj hniav, uas tsis yog qhov xav tsis thoob, yog tsim tom qab kev phais thiab kho raws li qhov teeb meem ntawm hom kev kho no. Vim kev loj hlob ntawm tus naj npawb ntawm txhua xyookev khiav hauj lwm, tus naj npawb ntawm cov teeb meem no kuj nce zuj zus. Lub luag haujlwm loj hauv qhov no yog ua los ntawm kev txo qis hauv kev tiv thaiv kab mob thiab kev siv tshuaj tua kab mob dav dav, uas ua rau cov kab mob tsis zoo thiab ua rau muaj kev cuam tshuam tom qab kev tiv thaiv ntawm cov teeb meem.
Raws li cov lus xaus ntawm cov khoom ntxiv, ib feem pua ntawm cov neeg mob phais tau tsim cov kab mob tom qab phais. Daim duab no siab dua yog tias qhov kev cuam tshuam yog qhov xwm txheej ceev thiab tsis muaj sijhawm rau kev npaj ua ntej.
Risk factors
Qhov tseem ceeb txaus ntshai uas tuaj yeem ua rau mob plab yog, tau kawg, kev phais plab. Feem ntau, nws tshwm sim tom qab kev kho mob ntawm cov kab mob pancreas, gallbladder, stitching plab hnyuv loops.
Cov tsos mob ntawm qhov mob yog txuam nrog kev nkag mus ntawm plab hnyuv mus rau peritoneum, nrog rau nws cov noob hauv chav ua haujlwm. Nws kuj tuaj yeem tshwm sim los ntawm kev raug mob ntawm lub plab. Nyob rau ntawm qhov chaw ntawm compression, aseptic o yog tsim, uas tom qab flora koom nrog.
Nyob rau hauv ntau tshaj li ib nrab ntawm cov mob, cov abscess nyob rau hauv qab ntawm parietal (parietal) daim ntawv ntawm lub peritoneum, los yog ntawm nws parietal thiab visceral nplooj.
Yog vim li cas
Abscess ntawm lub plab kab noj hniav (ICD 10 - K65) tuaj yeem tshwm sim los ntawm kev mob plab, piv txwv li, lub sijhawm ntev compression lossis tshuab, kis kab mob ntawm txoj hnyuv (iersiteosis, salmonellosis, typhoid fever), kev loj hlob inflammatory txheej txheem nyob rau hauvkab mob los yog mucous daim nyias nyias, nrog rau tom qab perforation ntawm lub plab los yog plab hnyuv ulcer.
Muaj peb lub laj thawj:
- Kev tshwm sim ntawm tus kab mob peritonitis vim qhov tawg ntawm cov hnyuv, tsis ua haujlwm ntawm plab hnyuv anastomoses tom qab ua haujlwm plab, necrosis ntawm lub taub hau ntawm txiav, mob plab.
- Purulent pelvic inflammatory disease xws li salpingitis, parametritis, pyosalpinx, tubo-ovarian abscess thiab lwm yam.
- Mob mob ntawm tus txiav thiab lub gallbladder, ulcerative colitis.
Ntxiv rau cov lus saum toj no, qee zaum ua rau muaj qhov ua paug tuaj yeem yog o ntawm cov ntaub so ntswg perirenal, osteomyelitis ntawm lumbar qaum, tuberculous spondylitis. Feem ntau, staphylococci, streptococci, clostridia thiab ischerichia yog sown nyob rau hauv lub tsom ntawm o, uas yog, cov nroj tsuag uas nquag muaj nyob rau hauv txoj hnyuv.
Pathogenesis
Kev mob plab tom qab phais plab tshwm sim vim muaj cov tshuaj tiv thaiv kab mob ntau dhau los cuam tshuam rau hauv ib puag ncig sab hauv lossis rau kev tsim cov kab mob. Cov kab mob tuaj yeem nkag mus rau hauv lub plab kab noj hniav nrog cov ntshav lossis cov qog ntshav, nrog rau kev nkag mus rau hauv cov hnyuv. Tsis tas li ntawd, ib txwm muaj kev pheej hmoo ntawm kev kis mob ntawm tes ntawm tus kws phais mob, cov cuab yeej lossis cov khoom siv thaum lub sijhawm ua haujlwm. Lwm qhov tseem ceeb yog cov kabmob uas sib txuas lus nrog ib puag ncig sab nraud, xws li cov hlab ntsha lossis cov hnyuv.
Nws yog tsis yooj yim sua kom tshem tawm cov tsos ntawm inflammatory infiltrates tom qab ib tug nkag qhov txhab ntawm lub plab kab noj hniav, perforation ntawm ulcers thiab divergence ntawm sutures tom qab phaiskev kho mob.
Lub peritoneum reacts rau qhov tshwm sim ntawm qhov ua rau khaus (mob) hauv txoj kev stereotypical, uas yog, nws tsim fibrin rau ntawm nws qhov chaw, uas ua ke ua ke ntawm cov mucous daim nyias nyias thiab yog li delimits tsom los ntawm cov ntaub so ntswg noj qab haus huv. Yog hais tias, raws li qhov tshwm sim ntawm cov kua paug, qhov kev tiv thaiv no raug rhuav tshem, ces inflammatory detritus ntws mus rau hauv lub hnab ris thiab sloping qhov chaw ntawm lub plab mog. Nrog kev txhim kho ntawm qhov xwm txheej zoo li no, lawv twb tau tham txog sepsis.
Symptoms
Yuav ua li cas rau ib tug neeg thaum lub plab abscess? Cov tsos mob zoo ib yam li cov kab mob inflammatory:
- High, tshwm sim tam sim ntawd kub taub hau nrog ua daus no thiab tawm hws ntau.
- Kev mob plab hauv plab, uas ua rau hnyav los ntawm kev kov lossis siab.
- tso zis ntau ntxiv raws li lub peritoneum nruj thiab qhov no ua rau cov baroreceptors nyob rau hauv lub zais zis phab ntsa.
- Kev mob ntawm cov quav hauv daim ntawv ntawm cem quav.
- Ntsuab thiab ntuav thaum kub taub hau.
Tsis tas li, tus neeg mob yuav muaj lub plawv dhia ceev. Nws tshwm sim rau ob qho laj thawj: qhov kub thiab txias. Thiab tseem muaj cov tsos mob pathognomonic yog qhov nro ntawm cov leeg ntawm cov xovxwm. Qhov no yog kev tiv thaiv reflex uas tsis tso cai rau kev raug mob ntxiv mus rau qhov chaw mob.
Yog tias qhov abscess nyob ncaj qha hauv qab lub diaphragm, ntxiv rau cov tsos mob dav dav yuav muaj cov uas qhia txog qhov no. Thawj qhov sib txawv yuav yog qhov mob nyob rau hauv lub hypochondrium, nce thaum nqus tau thiab radiates.thaj tsam scapular. Qhov thib ob qhov sib txawv yog qhov kev hloov ntawm kev mus. Tus neeg tsis tuaj yeem pib saib xyuas ntawm qhov cuam tshuam thiab leans ntawm nws kom txo cov leeg nro.
Kev nyuaj siab
Abscess ntawm lub plab kab noj hniav (ICD 10 - K65) tej zaum yuav tsis kuaj pom yog tias nws tshwm sim los ntawm lwm yam mob hnyav, lossis tus neeg mob tsis nrhiav kev pab. Tab sis yuav tsum paub tias tej yam uas yuav ua rau muaj kev phom sij rau lub neej xws li sepsis thiab diffuse peritonitis tuaj yeem tshwm sim los ntawm tus cwj pwm tsis saib xyuas.
Subdiaphragmatic abscesses tuaj yeem yaj lub diaphragm thiab tawg mus rau hauv cov kab noj hniav pleural, tsim cov adhesions nyob ntawd. Cov xwm txheej zoo li no tuaj yeem ua rau lub ntsws puas. Yog li ntawd, yog tias koj kub taub hau lossis mob tom qab ua haujlwm lossis raug mob, tsis txhob cia siab tias txhua yam yuav ploj mus ntawm nws tus kheej. Hauv cov lus nug no, daim tshev ntxiv yuav tsis raug mob.
Diagnosis
Postoperative abscess ntawm lub plab kab noj hniav nyob rau hauv lub tsev kho mob yog heev yooj yim mus txheeb xyuas. Cov kev qhia tshaj plaws yog X-ray, ultrasound, CT thiab MRI ntawm lub hauv siab thiab lub plab. Tsis tas li ntawd, cov poj niam tuaj yeem ua qhov puncture ntawm qhov chaw mos fornix los kuaj xyuas cov kab mob purulent hauv qhov chaw nqes.
Ntxiv rau, tsis txhob hnov qab txog kev kuaj mob hauv chav kuaj. Hauv kev kuaj ntshav dav dav, kev nce qib ntawm erythrocyte sedimentation tus nqi (ESR) yuav raug pom, cov mis leukocyte yuav muaj kev hloov pauv mus rau sab laug, tej zaum txawm rau cov ntawv hluas, thiab cov lej ntawm leukocytes yuav nce ntxiv. Neutrophil suav.
Tus qauv hauv kev kuaj mob ntawm abscesses tseem kuaj ultrasound ntawm lub plab kab noj hniav. Muaj cov cim qhia tseeb uas qhia tias muaj cov kab mob inflammatory infiltrate:
- kev kawm muaj qhov pom meej meej thiab lub ntsej muag ntom ntom;
- kua hauv nws;
- cov ntsiab lus yog heterogeneous hauv cov qauv thiab muab faib ua txheej;
- muaj roj tshaj cov kua.
Kev kho mob plab abscess
Txoj kev tseem ceeb ntawm kev kho mob abscesses, tau kawg, tseem phais. Nws yog ib qho tsim nyog kom ntws cov abscess, yaug cov kab noj hniav nrog cov tshuaj tua kab mob thiab tshuaj tua kab mob. Kev saib xyuas kev noj qab haus huv tsis muab kev lees paub tias qhov mob yuav ploj mus, thiab cov kua dej hauv cov abscess yuav khiav tawm ntawm nws tus kheej.
Tau kawg, tom qab kev tsom xam raug tshem tawm, tus neeg mob yuav tsum tau muab tshuaj tua kab mob nrog tshuaj tua kab mob broad-spectrum. Raws li txoj cai, tus kws kho mob tau sau ob qho tshuaj tib lub sijhawm, uas muaj cov txheej txheem sib txawv ntawm kev ua thiab ua kom cov neeg sawv cev sib txawv ntawm cov kab mob microbial.
Nco ntsoov ceeb toom tus neeg mob txog qhov tshwm sim ntawm qhov kev kho mob no, xws li ntuav, tsis qab los noj mov, o ntawm papillary txheej ntawm tus nplaig, mob taub hau thiab tso zis ntau zaus. Thiab tus kws kho mob nws tus kheej yuav tsum nco ntsoov lawv thiab tsis txhob ntxiv rau hauv daim duab kho mob ntawm tus kab mob.
Huab cua thiab tiv thaiv
Abscess ntawm lub plab kab noj hniav (ICD code 10 - K65) yog ib qho teeb meem loj heev, yog li kws kho mob thiab cov neeg mob yuav tsumsaib xyuas kev tiv thaiv ntawm tus mob no. Nws yog ib qho tsim nyog los kho cov kab mob inflammatory ntawm txhua lub plab hnyuv, nws yog ib qho tsim nyog yuav tsum tau ua ntej thiab tom qab kev kho mob ntawm cov neeg mob, nrog rau kev ua kom tsis muaj menyuam cov cuab yeej thiab tes zoo.
Yog tias koj xav tias mob plab hnyuv lossis yog tias qhov kub thiab txias sai sai, koj yuav tsum tsis txhob tos daim paib saum toj no, tab sis koj yuav tsum tau mus ntsib kws kho mob tam sim ntawd. Nws tuaj yeem cawm koj txoj sia thiab kev noj qab haus huv.
Tus neeg tuag los ntawm lub plab abscess mus txog plaub caug feem pua. Nws tag nrho yog nyob ntawm seb tus txheej txheem yog li cas, qhov twg nws nyob thiab seb tus kab mob ua rau nws. Tab sis nrog kev nkag mus rau hauv tsev kho mob raws sij hawm, qhov tshwm sim ntawm qhov tshwm sim tsis zoo raug txo qis.
