Tubo-ovarian abscess yog ib qho kab mob purulent kis thiab inflammatory kab mob ntawm lub tsev menyuam appendages, tshwm sim nyob rau hauv ib tug mob daim ntawv, nyob rau hauv uas lawv melting nrog lub xub ntiag ntawm encysted tsim. Qhov no pathology yog tshwm sim los ntawm unilateral mob mob nyob rau hauv lub plab mog, ntuav, xeev siab, dysuric mob, hyperthermia. Rau kev kuaj mob, kuaj qhov chaw mos, CT scan ntawm lub plab me me, transvaginal ultrasound, thiab ntau yam kev kuaj mob yog siv. Cov txheej txheem kho tshuaj suav nrog kev teem sijhawm ntawm cov tshuaj tua kab mob, NSAIDs, infusion therapy, immunomodulators. Nyob rau hauv cov ntaub ntawv ntawm kev kawm hnyav thiab tsis muaj txiaj ntsig ntawm kev saib xyuas kev kho mob, cov abscess raug tshem tawm.
Kev piav qhia ntawm pathology
Tubo-ovarian abscess yog ib qho ntawm cov txheej txheem mob gynecological inflammatory heev. Nyob rau hauv cov qauv ntawm kis kab mob ntawm lub plab hnyuv siab raum nyob rau hauv cov poj niam, nws qhia, raws li cov ntaub ntawv los ntawmntau qhov chaw, nce mus txog 6-17%. Pathology tau kuaj pom feem ntau hauv cov ntxhais hluas hnub nyoog qis dua 20 xyoo uas muaj kev sib raug zoo thiab kev lag luam, uas feem ntau yuav yog vim lawv cov kev sib deev muaj zog. Kev tshem tawm hom mob feem ntau tshwm sim: yuav luag ib feem peb ntawm cov neeg mob, daim duab kho mob hnyav tshwm sim tawm tsam keeb kwm yav dhau los ntawm cov txheej txheem kev puas tsuaj-inflammatory.
Kev tshwm sim
Kev tsim ntawm volumetric purulent-inflammatory formations nyob rau hauv thaj tsam ntawm lub tsev me nyuam appendages feem ntau ua tau nrog kev sib txuas ntawm ntau yam nyob rau tib lub sij hawm thiab yog ib qho teeb meem ntawm cov gynecological pathologies uas twb muaj lawm. Qhov pib tubo-ovarian abscesses yog qhov tsawg heev. Raws li cov kws kho mob, qhov tshwm sim ntawm tus kab mob no yuav tsum muaj kev sib xyaw ua ke ntawm cov xwm txheej hauv qab no:
- Kev muaj kev sib cav sib ceg. Hauv kev kuaj kab lis kev cai los ntawm kev ua kom pom tseeb ntawm qhov abscess, muaj, raws li txoj cai, ntau yam ntawm cov kab mob pathological. Hauv 25-45% ntawm cov neeg mob, gonococci tau txiav txim siab, hauv 25-35% - trichomonas, hauv 25-55% aerobic thiab anaerobic koom haum ntawm cov kab mob bacteroids, gardnerella, streptococci, peptostreptococci, mobiluncus, enterobacteria thiab lwm tus neeg sawv cev.
- Adhesions hauv plab kab noj hniav. Suppuration ntawm cov appendages feem ntau pom nyob rau hauv cov neeg mob uas muaj lub sij hawm ntev salpingitis, adnexitis, oophoritis, sab nraud qhov chaw mos endometriosis, thiab ib tug nplaum txheej txheem nyob rau hauv ib tug nyuaj daim ntawv ntawm ib tug mob ntev. Lub xub ntiag ntawm interorgan synechia accelerates thiabtxhawb kev tsim cov pyogenic daim nyias nyias uas txwv tubo-ovarian tsim los ntawm sab nraud.
- Immune tsis muaj zog. Kev ua kom cov kab mob pathogenic microflora tshwm sim, raws li txoj cai, nrog kev txo qis hauv qhov zoo ntawm lub cev tiv thaiv kab mob. Yog vim li cas rau xws li kev tiv thaiv kab mob yuav ua rau exacerbation ntawm extragenital thiab qhov chaw mos pathology, mob khaub thuas hnyav, nquag kev ntxhov siab, ua kom lub cev muaj zog, ntev siv corticosteroids, cytostatics, acetylsalicylic acid derivatives, thiab lwm yam.
Cov laj thawj no feem ntau tau sau tseg hauv keeb kwm ntawm tubo-ovarian abscess.
Qhov kev pheej hmoo ntawm pathology yog siab tshaj plaws rau cov neeg mob uas feem ntau hloov cov neeg sib deev, lossis cov neeg uas muaj kab mob vaginosis lossis kab mob sib deev. Txoj kev pheej hmoo ntawm cov txheej txheem pathological nce ntxiv tom qab kev tswj hwm intrauterine (kev rho menyuam tawm, cais kev kuaj xyuas curettage, ntxig ntawm kauv, hauv vitro fertilization, hysterosalpingography, tshem tawm cov endometrial polyps, thiab lwm yam).
Pathogenesis
Kev nkag mus ntawm cov kab mob sib kis mus rau thaj tsam ntawm cov appendages feem ntau tshwm sim los ntawm txoj kev intracanalicular (nce) los ntawm qhov chaw mos, kab noj hniav thiab lub ncauj tsev menyuam. Qee qhov xwm txheej, cov txheej txheem inflammatory tshwm sim los ntawm kev sib cuag kab mob los ntawm serous integument ntawm cov hlab ntsha fallopian. Txog rau thaum kawg theem ntawm tubo-ovarian purulent tsim, cov txheej txheem pathological mus txog qee theem. Thaum xub thawjNyob rau hauv cov hlab ntsha, nyob rau hauv tus ntawm tus kab mob, lub mucosa yuav o, ces cov o pib kis mus rau lwm cov khaubncaws sab nraud povtseg ntawm phab ntsa - ib daim duab ntawm purulent salpingitis tsim nyob rau hauv ib tug mob daim ntawv. Obliteration ntawm lub lumen ntawm lub raj, raws li txoj cai, xaus nrog kev tsim ntawm pyosalpinx.
Los ntawm cov hlab ntsha, cov kab mob pathological kis mus rau qhov chaw ntawm zes qe menyuam thiab kis nws cov ntaub so ntswg, uas ua rau muaj qhov tshwm sim ntawm purulent mob oophoritis nrog kev tsim ntawm ntau cov kab noj hniav uas muaj cov kua qaub, cov phab ntsa uas sawv cev los ntawm cov ntaub so ntswg thiab granulation. Vim lub fusion ntawm abscesses, ib tug saccular tsim, uas yog hu ua "pyovar". Kev loj hlob ntawm tubo-ovarian abscess ntawm sab xis lossis sab laug xaus nrog kev puas tsuaj ntawm phab ntsa ntawm pyovar thiab pyosalpinx nrog kev sib txuas ntawm cov ntaub so ntswg sib txuas pyogenic. Cov txheej txheem pathological tuaj yeem ua mus ntev nrog kev maj mam nce hauv cov conglomerate thaum lub sij hawm exacerbation, nrog rau sclerosis thiab fibrosis ntawm cov ntaub so ntswg thaum lub sij hawm tshem tawm.
Cov tsos mob ntawm pathology
Tubo-ovarian abscess cov tsos mob feem ntau tshwm sim. Ib tug poj niam muaj mob hnyav hauv plab plab, uas tuaj yeem tawg mus rau thaj tsam lumbar, qhov quav, sab hauv ncej puab. Tus neeg mob tseem txhawj xeeb txog qhov ua daus no, ua npaws, xeev siab thiab ntuav. Qhov kub tuaj yeem nce mus rau 38 ° C lossis ntau dua. Nyob rau tib lub sijhawm, yellowish, dawb, ntsuab purulent leucorrhoea yog qhov raug, mob hauv cov txheej txheem.tso zis, plab hnyuv khaus nyob rau hauv daim ntawv ntawm raws plab. Vim muaj kev qaug dab peg, qaug zog, mob hlwb, qaug zog, tsis qab los noj mov tshwm sim.
Diagnosis
Tubo-ovarian qog yog qhov nyuaj rau kev kuaj mob. Qhov no tshwm sim vim muaj tus lej tseem ceeb ntawm qhov mob thiab cov tsos mob tshwm sim. Ua ntej ntawm tag nrho cov, lub anamnesis yog kawm thiab kev ntsuam xyuas yog nqa tawm. Txhawm rau tsim kom muaj kev kuaj mob kom raug, tus kws tshaj lij kuj tseem tuaj yeem sau ntau qhov kev sim kuaj, cov txheej txheem ntsuas ntsuas kuj tau ua.
Tubo-ovarian abscess ntawm ultrasound, tus kws paub txog kev paub yuav pom. Raws li qhov tshwm sim ntawm kev ntsuam xyuas, nws pom tseeb tias tsis muaj qhov sib txawv ntawm lub appendage thiab lub raj mis. Nws kuj tseem tuaj yeem txiav txim siab cov qauv cystic ntawm neoplasm nrog qhov tsis muaj qhov pom tseeb thiab cov kua dej hauv lub plab.
Kev faib tawm ntawm tubo-ovarian abscesses
Muaj ntau hom purulent formations:
- pyosalpinx;
- tubo-ovarian tumor;
- pyovarium.
Kev kho mob
Yog tias tus poj niam xav tias muaj cov khoom siv yaj, qhia mus pw hauv tsev kho mob sai, pw tsaug zog. Nrog rau cov ntshav siab ruaj khov thiab cov mem tes, qhov loj ntawm cov conglomerate mus txog 10 cm, tus neeg mob muaj cov phiaj xwm kev loj hlob, kev kho kom zoo yog pom zoo, uas ua rau nws tuaj yeem tsis kam phais hauv 80% ntawm cov neeg mob. Pom zoo rau kev kho mob ntawm tubo-ovarian abscesses:
- Tshuaj tua kab mob uas tseem ceeb rau kev txiav txim siabexciter rhiab heev. Txawm li cas los xij, tus kab mob no feem ntau tshwm sim los ntawm cov koom haum polymicrobial, yog li kev sib xyaw ntawm cephalosporins, penicillins, semi-synthetic tetracyclines, lincosamides, thiab lwm yam.
- Anti-inflammatory non-steroidal tshuaj uas txo cov zus tau tej cov thromboxane, prostaglandins thiab lwm yam kev kho mob ntawm cov txheej txheem inflammatory. Tib lub sijhawm, cov tshuaj muaj cov nyhuv analgesic.
- Muab rau hauv tus account cov tsos mob thiab tshem tawm cov teeb meem ntawm txoj kev kho tseem ceeb, lwm cov tsos mob thiab cov kab mob pathogenetic kuj siv - immunomodulators, eubiotics, diuretics, vitamins, infusion daws, sedatives. Yog tias tsis muaj qhov ua tau zoo ntawm kev kho tshuaj tua kab mob hauv 48-72 teev, kev phais raug pom zoo kom tshem tawm cov kab mob abscessive.
IVF rau tubo-ovarian abscess ntawm zes qe menyuam
Hauv vitro fertilization thaum qhov pathology tshwm sim tsis yooj yim sua. Raws li txoj cai, ua ntej IVF, ib tug poj niam tau txais kev ntsuam xyuas zoo los ntawm tus kws kho mob gynecologist, thiab yog tias pom muaj kab mob, lawv yuav tsum raug tshem tawm txawm tias ua ntej IVF txheej txheem pib. Ovarian abscess yog ib qho ncaj qha contraindication rau cov txheej txheem no.
