Purulent o nyob rau hauv qhov ncauj kab noj hniav niaj hnub no feem ntau kuaj tau nyob rau hauv cov tshuaj. Ib qho ntawm cov kab mob no, uas yog tus cwj pwm los ntawm kev kawm hnyav, yog paratonsillar abscess ntawm tonsils. Tus kab mob no tseem hu ua phlegmonous tonsillitis, nws tshwm sim hauv cov neeg ntawm cov poj niam sib txawv, feem ntau ntawm cov hnub nyoog ntawm kaum tsib thiab peb caug. Cov pab pawg muaj kev pheej hmoo suav nrog cov neeg uas muaj lub cev tsis muaj zog, cov metabolism, nrog rau cov neeg uas muaj keeb kwm ntev ntawm kev haus luam yeeb. Cov tsos mob ntawm purulent o yog tshwm sim los ntawm kev kis kab mob hauv cov tonsils los ntawm festering follicles, kev puas tsuaj rau pharynx, o ntawm cov pos hniav thiab lwm yam kab mob hniav.
Problem Description
Paratonsillar abscess - o ntawm cov ntaub so ntswg ntawm cov tonsils ntawm cov xwm txheej purulent, theem kawg ntawm paratonsillitis, uas yog ib qho mob hnyav tshaj plaws ntawm kev puas tsuaj rau lub pharynx. Hauv 80% ntawm cov neeg mob, qhov ua rau ntawm kev loj hlob ntawm tus kab mob yog mob tonsillitis. Tus kab mob feem ntau tshwm sim thaum lub caij nplooj zeeg lossis caij nplooj ntoos hlav. Yog tias tsis kho, nws provokes kev loj hlob ntawm cov teeb meem xws li caj dab phlegmon,mediastinitis, sepsis.
Cov kab mob ua rau tus kab mob yog streptococci, pneumococci lossis Candida fungi. Nrog rau qhov swb ntawm tonsils, lawv cov recesses muaj cov kua paug, feem ntau yog qhov ua kom pom tseeb ntawm qhov mob yog ib sab. Tom qab ib txwm mob o, cov ntaub so ntswg ntawm cov tonsils yog npog nrog nti, uas ua rau muaj kev cuam tshuam ntawm kev tawm ntawm purulent tawm los ntawm kev nyuaj siab loj, yog li nws tsis yog tag nrho tshem tawm. Raws li qhov tshwm sim ntawm qhov no, tus kab mob kis mus rau qhov chaw paratonsillar, thiab ib qho paratonsillar abscess ntawm caj pas. Thaum lub cev tsis muaj zog, tus kab mob nkag mus tob rau hauv cov ntaub so ntswg.
Abscess zoo li ib puag ncig tsim ntawm cov xim liab, los ntawm qhov chaw uas cov ntsiab lus daj pom. Ntawm palpation, qee qhov chaw ntawm qhov tsim yuav yog mos vim cov ntsiab lus ntawm cov kua qaub hauv nws. Lub pharynx yog tsiv mus nyob rau hauv kev coj rov qab mus rau abscess.
kab mob daim ntawv
Hauv tshuaj, cov ntaub ntawv hauv qab no ntawm pathology yog qhov txawv:
- Anterior (anterosuperior) abscess, nyob rau hauv cov ntaub so ntswg puas tshwm sim tshaj tonsils. Feem ntau ulcers qhib ntawm lawv tus kheej. Hom kab mob no tshwm sim feem ntau.
- Posterior abscess yog tus yam ntxwv ntawm cov ntaub so ntswg puas ntawm lub nraub qaum thiab cov npoo ntawm cov tonsils. Pathology nyob rau qib thib ob hauv kev nthuav dav. Hauv qhov no, muaj kev pheej hmoo ntawm qhov mob txav mus rau lub larynx, uas tuaj yeem ua rau ua pa nyuaj.
- Cov abscess qis yog tshwm sim los ntawm kev loj hlob ntawm purulent o ntawm tus ncej qis ntawm tonsil. Pathology nyob rau hauv ntau zaustsim los ntawm cov kab mob ntawm cov pos hniav thiab cov hniav.
- Ib kab mob sab nraud ntawm phab ntsa pharyngeal thiab sab ntug ntawm cov tonsil. Qhov no pathology suav hais tias yog qhov hnyav tshaj plaws thiab tshwm sim hauv 5% ntawm cov neeg mob. Nyob rau hauv cov ntaub ntawv no, muaj kev pheej hmoo ntawm ib tug abscess rupture nyob rau hauv lub caj dab cov ntaub so ntswg.
Ua rau kab mob
Paratonsillar abscess yog provoked los ntawm ingress ntawm pathogenic microorganisms mus rau hauv cov ntaub so ntswg ntawm tonsils. Feem ntau, tus kab mob ua raws li cov kab mob thib ob, ua rau muaj teeb meem ntawm tonsillitis ntev.
Cov kab mob ntau yam suav nrog:
- kab mob ntawm lub pharynx nrog cov kab mob pathogenic vim yog kev loj hlob ntawm pharyngitis, tonsillitis lossis tonsillitis;
- kab mob hniav xws li gingivitis, caries, kab mob pos hniav;
- kab mob hauv caj pas los ntawm nruab nrab pob ntseg;
- txhim kho cov kab mob purulent hauv cov qog qaub ncaug;
- kev puas tsuaj rau lub qhov ncauj thiab caj dab, ua raws li kev kis kab mob.
Cov phenomena no tsuas yog ua txhaum ntawm tib neeg kev tiv thaiv.
Risk group
Pab pawg pheej hmoo suav nrog cov neeg uas muaj cov kab mob hauv qab no:
- mob ntshav qab zib mellitus;
- ntshav qab zib;
- kab mob cancer;
- kab mob HIV;
- obesity;
- congenital malformations ntawm tonsils thiab pharynx;
- kev tsim txom nicotine;
- hypothermia.
Symptoms of disease
Paratonsillar abscess manifests cov tsos mob nyob rau hauv daim ntawv ntawm ib tug muaj zog unilateral mob syndrome uas tshwm sim thaum nqos. Hauv qee qhovQee zaum, qhov mob yuav yog ob sab. Thaum lub sij hawm, qhov mob pib kis mus rau pob ntseg thiab lub puab tsaig sab. Nrog rau qhov no, muaj zog nce hauv lub cev kub, tsis muaj zog tsim, mob taub hau, thiab pw tsaug zog cuam tshuam. Lymph nodes nyob rau ntawm caj dab nce, ib qho tsis kaj siab tsw tshwm los ntawm qhov ncauj kab noj hniav. Kev loj hlob ntawm tus kab mob ua rau muaj kev loj hlob ntawm spasm ntawm cov leeg masticatory, kev hais lus ntawm tus neeg hloov, qhov mob hnyav zuj zus thaum tig lub taub hau.
Tsis zoo li angina, qhov mob mob hauv cov kab mob no mob hnyav dua, tam sim no txawm tias nyob hauv lub xeev siab. Nyuaj ua rau hnyav dua thaum ua ib qho kev txav, muab rau pob ntseg thiab cov hniav.
Ntau zaus rau hnub thib rau, tus kab mob paratonsillar abscess, ib daim duab uas lees paub qhov mob hnyav ntawm tus kab mob, ua rau qhov tseeb tias cov kab noj hniav purulent qhib. Qhov tshwm sim no yog nrog los ntawm kev pab ntawm tib neeg tus mob, txo qis hauv lub cev kub, qhov tsos ntawm cov kua paug hauv cov qaub ncaug. Qee qhov xwm txheej, qhov kev tawg ntawm abscess tau pom nyob rau hnub kaum yim. Yog cov kua paug nkag mus rau hauv qhov chaw peripharyngeal, abscess tsis qhib, yog li tus neeg mob tsuas yog zuj zus.
Paratonsillar abscess ntawm caj pas muaj cov tsos mob hauv qab no:
- mob caj pas;
- spasm ntawm masticatory nqaij;
- nqhis dej tsis meej;
- khees xaws ncauj tsev menyuam;
- muaj zog nce hauv lub cev kub;
- ua tsis taus pa, ua tsis taus pa;
- ua pa tsis zoo;
- kev txhim khokev nyuaj siab;
- tus kheej-qhib ntawm qhov abscess.
theem ntawm kev loj hlob ntawm pathology
Paratonsillar abscess ntawm caj pas (cov tsos mob daim duab txuas nrog) muaj peb theem ntawm kev loj hlob:
- Thawj yog theem edematous, uas yog tus yam ntxwv los ntawm o ntawm cov ntaub so ntswg ntawm tonsils, cov tsos mob ntawm o thiab lwm yam tsos mob ntawm pathology tsis tuaj. Nyob rau theem no, tus kab mob no tsis tshua kuaj tau.
- Qhov thib ob yog theem nkag mus, uas yog tshwm sim los ntawm cov tsos mob ntawm hyperemia, kev loj hlob ntawm qhov mob, thiab nce hauv lub cev kub.
- Thib Peb - abscessing stage, uas tshwm sim rau hnub thib tsib lossis thib rau ntawm kev mob. Nws yog yam ntxwv los ntawm deformation ntawm lub pharynx thiab protrusion ntawm ib tug loj purulent tsim.
Cov Teeb Meem thiab qhov tshwm sim
Paratonsillar abscess ntawm caj pas, cov tsos mob thiab kev kho mob uas yuav tau tham hauv cov lus nthuav dav, feem ntau xaus rau kev rov zoo nrog kev kho mob raws sijhawm. Txwv tsis pub, purulent o kis mus rau hauv lub pharynx, uas tuaj yeem ua kev puas tsuaj rau nws cov phab ntsa thaum muaj kev cuam tshuam kev phais kom qhib qhov abscess. Tsis tas li ntawd, qee zaum pom qhov qhib ntawm paratonsillar abscess, uas cov kua paug nkag mus rau cov ntaub so ntswg noj qab haus huv uas nyob ze.
Cov xwm txheej no tuaj yeem ua rau muaj ntau yam teeb meem:
- phlegmon ntawm caj dab thiab caj pas;
- kev txhim kho ntawm sepsis;
- laryngeal stenosis ua rau ua tsis taus pa;
- purulent lesion ntawm lub plawv, aorta thiab veins;
- Y thrombophlebitis, abscesshlwb;
- meningitis, encephalitis;
- Ludwig's angina;
- Ytissue necrosis;
- Yjugular vein thrombosis;
- kev txhim kho ntawm kev poob siab;
- pom los ntawm cov hlab ntsha loj ntawm caj dab.
Qee yam teeb meem tuaj yeem ua rau tuag taus thiab yuav tsum tau kho tam sim.
Survey method
Kev kuaj mob paratonsillar abscess ntawm caj pas tsis yooj yim vim muaj cov tsos mob tshwm sim ntawm cov kab mob. Kev kuaj mob suav nrog cov ntsiab lus hauv qab no:
- Kawm txog anamnesis thiab kev tsis txaus siab ntawm tus neeg mob. Qhov no pathology tsim, feem ntau nyob rau hnub thib tsib tom qab mob tonsillitis. Tsis tas li ntawd, tus kws kho mob otolaryngologist tau saib xyuas qhov muaj foci ntawm kev kis kab mob thiab ua rau muaj kev puas tsuaj hauv qhov ncauj kab noj hniav.
- Kev kuaj mob ntawm tus neeg mob uas qhia tau tias tsis muaj lub taub hau txav, cov qog ntshav o, ua npaws, thiab ua pa tsis zoo.
- Pharingoscopy yeej ib txwm siv, vim nws yog cov ntaub ntawv qhia paub tshaj plaws hauv qhov no. Cov txheej txheem no ua rau nws muaj peev xwm txheeb xyuas qhov kev loj hlob ntawm lub kheej kheej tsim, uas yog them nrog ib qho edematous mucous membrane. Hauv qhov tsim no, cov ntsiab lus purulent tuaj yeem pom. Kuj tseem muaj qhov deformation ntawm lub pharynx, thawb lub amygdala.
- Lab kuaj ntshav.
- kab lis kev cai kab mob los txheeb xyuas tus kab mob ua rau tus kab mob, nrog rau nws qhov rhiab heev rau cov tshuaj tua kab mob.
- ntsuas ntsuas: ultrasound thiab CT ntawm lub caj dab, radiography ntawm lub taub hau. Cov txheej txheem no yog siv los txiav tximKev sib kis ntawm cov txheej txheem txawv txav mus rau cov ntaub so ntswg noj qab haus huv thiab lub cev.
Tus kws kho mob sib txawv ntawm cov kab mob xws li kab mob diphtheria, scarlet fever, qog nqaij hlav cancer, carotid aneurysm, mediastinal abscess.
Kev kho mob
Paratonsillar abscess kev kho mob suav nrog ib qho uas yog txhawm rau tshem tawm qhov ua kom pom tseeb thiab ua rau tus neeg sawv cev ntawm tus kab mob, nres qhov mob, txo qhov kev pheej hmoo ntawm cov teeb meem. Kev kho tus kab mob yog nqa tawm hauv tsev kho mob. Rau qhov no, kev phais, kev kho mob thiab kev kho mob nyuaj yog siv.
Kev kho tshuaj yog ua nyob rau theem pib ntawm kev loj hlob ntawm tus kab mob. Hauv qhov no, cov tshuaj hauv qab no tau sau tseg:
- Cov tshuaj tua kab mob dav dav. Ib qho tshuaj zoo hauv qhov no yog Amoxicillin. Cov tshuaj tua kab mob Tetracycline tsis ua haujlwm.
- Macrolides yog siv thaum cov tshuaj tua kab mob tsis muab cov txiaj ntsig xav tau. Hauv qhov no, cov tshuaj cephalosporins thib peb tau muab.
Tus kws kho mob, ua ke nrog cov kev kho saum toj no, muab tshuaj tua kab mob, tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob, cov vitamins, immunomodulators. Gargling nrog tshuaj tua kab mob kuj pom zoo.
Surgery
Nyob rau theem thib ob ntawm pathology, paratonsillar abscess, cov tsos mob thiab kev kho mob uas tam sim no tau txiav txim siab, suav nrog kev siv kev phais. Tus kws kho mob qhib lub abscess nrog ib tug incision. Tab sis cov txheej txheem zoo li no tsis yog ib txwm ua rau tus neeg mob rov zoo, vim qee zaum lub qhov yog glued nrog fibrin, yog li nws yuav tsum tau nthuav tawm qhov txhab. Nyob rau hauv cov ntaub ntawv no, cov kua dej yog ua rau tsib hnub nyob rau hauv lub zos tshuaj loog.
Nyob rau hauv cov mob hnyav, ib qho abscessotonsillectomy yog ua, uas cov abscess yog emptied nrog rau kev tshem tawm cov cuam tshuam tonsil. Qhov no ua rau nws muaj peev xwm tshem tawm tag nrho cov kab mob. Tom qab ntawd, cov cheeb tsam raug ntxuav nrog cov tshuaj tua kab mob rau ob peb hnub. Tus kws kho mob kuj muab tshuaj tua kab mob. Kev kho lub cev tuaj yeem siv los ua kom lub qhov txhab zoo.
Rehab
Thaum lub sijhawm rov ua haujlwm zoo, tus neeg mob tau muab tshuaj kho mob, uas suav nrog cov tshuaj hauv qab no:
- Cov tshuaj tua kab mob hauv daim ntawv txhaj tshuaj intramuscular, xws li Ceftriaxone lossis Penicillin. Kev xaiv tshuaj yuav nyob ntawm tus neeg sawv cev ntawm tus kab mob.
- Kev taw qhia ntawm "Hemodez" txhawm rau tshem tawm lub cev.
- YGargling nrog tshuaj tua kab mob.
- Tiv thaiv kev txhim kho ntawm candidiasis thaum siv tshuaj tua kab mob.
- Antihistamines.
- NSAIDs tshem tawm qhov mob thiab mob.
Feem ntau, txhua yam tshuaj tau muab tshuaj raws li kev txhaj tshuaj vim tus neeg mob mob caj pas. Kev rov zoo yuav tshwm sim hauv peb lub lis piam. Nrog rau txoj kev loj hlob ntawm cov teeb meem, cov prognosis ua phem,ua tau tuag taus.
Huab cua
Kev kuaj mob ntawm tus kab mob yog qhov txaus siab rau kev kho raws sijhawm thiab ua tau zoo. Hauv qhov xwm txheej hnyav, sepsis tuaj yeem pib, ua rau tuag. Vim tias muaj kev pheej hmoo siab ntawm kev tsim qhov tshwm sim tsis zoo, kev kho mob pathology tau ua hauv tsev kho mob.
Kev Tiv Thaiv
Yuav kom tiv thaiv, ua ntej ntawm tag nrho cov, nws yog ib qho tsim nyog los kho lub cev tiv thaiv kab mob. Nws kuj tseem pom zoo kom kho cov kab mob ntawm lub qhov ntswg thiab caj pas kom raws sijhawm, saib xyuas kev huv ntawm qhov ncauj, mus ntsib kws kho hniav tsis tu ncua, thiab tshem tawm kev quav tshuaj. Kev ua lub cev, ua kom tawv nqaij, noj zaub mov kom zoo thiab noj qab nyob zoo yog qhov zoo rau kev tiv thaiv kab mob.
Paratonsillar abscess yog ib yam kab mob loj uas tuaj yeem ua rau muaj kev phom sij rau kev noj qab haus huv thiab txawm tias tib neeg lub neej. Yog li ntawd, nyob rau hauv thawj qhov tshwm sim ntawm pathology, nws yog ib qho tsim nyog yuav tsum sab laj nrog kws kho mob tam sim rau kev kuaj mob thiab kev kho mob. Yog tias tsis kho, cov teeb meem loj tuaj yeem tshwm sim, uas feem ntau ua rau tuag taus.
