A pharyngeal abscess (ICD-10 code J39.0) hauv menyuam yaus pib tshwm sim tom qab muaj kab mob tshwm sim hauv lub cev. Thaum xub thawj, nws yuav manifest nws tus kheej nyob rau hauv daim ntawv ntawm rhinitis thiab tsis muaj ntau tsis xis nyob. Tom qab ntawd nws cuam tshuam rau cov qog ntshav qab zib nyob ib puag ncig thiab nkag mus nrog lawv mus rau hauv qhov chaw pharyngeal, qhov chaw uas nws ua rau muaj abscess.
Yog vim li cas
Npaj tuaj yeem txhim kho hauv cov menyuam yaus tiv thaiv keeb kwm ntawm cov kab mob sib kis hauv qab no:
- ARVI;
- measles;
- scarlet fever;
- flu.
Nyob rau hauv cov neeg laus, cov kab mob retropharyngeal abscess feem ntau yog tsim los ntawm keeb kwm ntawm kev raug mob nasopharyngeal, piv txwv li, thaum cov pob txha raug tho rau hauv nasopharynx, thaum kuaj cov kab mob hauv lub qhov ncauj, lossis thaum kub hnyiab.. Tsis tas li ntawd, tus kab mob no tuaj yeem tshwm sim hauv cov neeg laus los ntawm qhov teeb meem ntawm tonsillitis. Cov ua rau retropharyngeal abscess ntawm caj pas nyob rau hauv cov neeg laus tej zaum yuav tuberculosis los yog syphilis. Qhov no yog vim kev ua txhaum ntawm microflora ntawm nasopharynx thiab lub cev tag nrho.
Raws li kev txheeb cais, cov neeg mob uas muaj kab mob sib kis tau raug mob los ntawm pharyngeal abscess ntau dua li cov kab mob yooj yim. Txo kev tiv thaiv kab mob, ntshav qab zib, qog lossis HIV tuaj yeem ua rau tus kab mob no.
Symptoms
Cov tsos mob ua paug muaj nyob hauv qab no:
- mob caj pas;
- nce hauv lub cev kub txog 39-40 ° C;
- kev ua txhaum cai dav dav.
Tawm tsam keeb kwm yav dhau los ntawm lwm cov kab mob sib kis hauv tus neeg mob, cov tsos mob ntawm tus kab mob retropharyngeal abscess hauv cov neeg laus tau tshwm sim los ntawm kev tsis zoo ntawm kev noj qab haus huv.
Cov menyuam yaus tsim kev xav tsis txaus ntseeg ntawm kev pw tsaug zog, ua rau muaj teeb meem pw tsaug zog thiab tsis qab los noj mov.
Nyob rau hauv cov menyuam mos, tus kab mob no tuaj yeem ua rau pw tsaug zog.
thawj qhov tsos mob ntawm tus kab mob retropharyngeal abscess nyob rau hauv cov neeg laus yog qhov tsos mob ntawm caj pas, uas ua rau hnyav dua los ntawm nqos dej lossis zaub mov. Qhov mob no qee zaum hnyav heev uas cov neeg mob raug yuam kom tsis txhob noj mov ntau zaus. Muaj kev hloov hauv lub suab, feem ntau nws ua hoarse. Yog hais tias qhov abscess nyob rau sab sauv lossis qis ntawm nasopharynx, ces tus neeg mob muaj qhov ntswg congestion.
Yog tias tus kab mob loj tuaj, tus neeg mob yuav hnov mob txhaws. Cov kev tawm tsam no tshwm sim feem ntau thaum sawv ntsug, txij li hauv lub xeev no cov kua paug pib ntws thiab pib cuam tshuam nrog huab cua. Nrog ib qho abscess, o ntawm cov qog nqaij hlav tau tshwm sim. Yog hais tias tus pharyngeal abscess nyob rau hauv cov me nyuam ua rau o ntawm cov ntaub so ntswg ib puag ncig, ces o ntawm caj dab yuav tshwm sim.
Qhov chaw
Retropharyngeal abscess tuaj yeem faib raws liqhov twg nws nyob, mus rau hauv cov kev pom hauv qab no:
- Epipharyngeal hom abscess yog suppuration ntawm cov ntaub so ntswg, uas yog nyob rau saum lub palatine koov. Hom abscess no yog tus cwj pwm los ntawm qhov mob unilateral nyob rau hauv lub caj pas, mob nyob rau hauv cov leeg masticatory thiab lymph nodes nyob rau sab ntawm abscess.
- Mesopharyngeal tsos ntawm ib qho abscess. Qhov no abscess nyob nruab nrab ntawm lub hauv paus ntawm tus nplaig thiab ntug ntawm lub palatine arch.
- Hipopharyngeal tsos ntawm ib qho abscess. Qhov no abscess nyob hauv qab ntawm lub hauv paus cheeb tsam ntawm tus nplaig.
- Sib xyaw hom abscess - nyob hauv qhov chaw pharyngeal thiab lwm thaj chaw anatomical.
Shapes of flow
Retropharyngeal abscess yog cais raws li daim ntawv ntawm ntws mus rau hauv cov nram qab no hom:
- Daim ntawv pib. Nyob rau theem no, muaj o thiab liab. Daim foos no raug pom zoo kom kho nrog tshuaj.
- ntse zoo li. Feem ntau nws tshwm sim los ntawm suppuration ntawm cov qog nqaij hlav thaum kis tus kab mob streptococci thiab staphylococci. Daim foos no raug kho phais.
- Ntawm. Cov theem no tshwm sim tom qab kev kho mob tsis txaus ntawm daim ntawv mob ntawm tus kab mob. Daim foos no raug kho phais.
Kev nyuaj siab
Cov teeb meem ntawm retropharyngeal abscess tshwm sim vim kev kis tus kab mob. Qhov kev txav mus los ntawm txoj hlab pa sab saud yog qhov txaus ntshai tshwj xeeb.
Yog tias tus kab mob kis tau thiab nyob ntawm lub bronchi, ces qhov no yog qhov ua rau bronchopneumonia.
Thaum kis tus kab mob, muaj kev ua txhaum ntawm lub ntsws, uas ua rau muaj kev loj hloblawv muaj mob ntsws.
Tus kab mob no tseem tuaj yeem kis mus rau hauv kab noj hniav, ua rau kev loj hlob ntawm lub hlwb abscess lossis meningitis.
Kev ua pa nyuaj yog ib qho teeb meem loj. Nws tshwm sim vim qhov sib tshooj ntawm cov hlab cua vim muaj qhov hais tawm edema ntawm lub larynx ntawm qhov chaw ntawm rupture ntawm abscess. Thaum qhov tshwm sim ntawm qhov kev tawm tsam no, kev ua haujlwm ntawm lub plawv tuaj yeem cuam tshuam txog kev cuam tshuam txog lub plawv nres.
Ib qho teeb meem loj yog qhov tawg ntawm qhov abscess, vim lub sijhawm no muaj cov kua paug tawm ntawm cov phab ntsa ntawm lub pharynx. Nws tuaj yeem cuam tshuam cov hlab ntsha loj, uas tuaj yeem ua rau los ntshav lossis ntshav txhaws. Cov kua paug no tuaj yeem nkag mus rau hauv mediastinum, qhov uas nws tuaj yeem ua rau muaj kev loj hlob ntawm purulent mediastinitis, uas yog qhov ua rau mob sepsis.
Diagnosis
Kev kuaj mob ntawm tus kab mob retropharyngeal abscess yog ua los ntawm tus kws kho mob otolaryngologist (ENT) los ntawm kev nug tus neeg mob thiab kev kuaj xyuas tag nrho. Lub hom phiaj ntawm daim ntawv ntsuam xyuas yog los kawm txog qhov xwm txheej thiab lub sijhawm ntawm kev tsis txaus siab, thiab ntawm lub hauv paus ntawm qhov no - kom paub meej cov kab mob hauv qab, kom paub seb dab tsi tshwm sim los ntawm kev tsim cov abscess. Rau kev kuaj mob hauv cov menyuam yaus, cov ntaub ntawv hais txog qhov xwm txheej ntawm thawj cov tsos mob thiab lub xeev ntawm kev tiv thaiv kab mob tau teev tseg los ntawm niam txiv.
Tom qab ntawd, tus kws kho mob tau mus rau kev tshawb fawb soj ntsuam, uas suav nrog kev tshuaj xyuas tus neeg mob txhawm rau txheeb xyuas cov cim tshwj xeeb ntawm cov txheej txheem inflammatory ntawm tus kab mob, xws li liab ntawm pharyngeal mucosa, mob ntawm qhov chaw. thaum palpation,lymph nodes o.
Kev kuaj pom ntawm mucosa ntawm phab ntsa pharyngeal posterior thiab kuaj pom cov abscesses ntawm nws sab qis thiab sab sauv, siv pharyngoscopy. Kev kuaj ntshav dav dav thiab biochemical yuav pab txiav txim siab qhov mob hnyav thiab, raws li qhov no, tsim kho lub hom phiaj.
Y Bacterioscopy thiab kuaj kab mob bacteriological yuav pab txheeb xyuas cov kab mob microflora hauv cov mucous membrane, cov khoom siv biomaterial uas yuav yog smear los ntawm cov mucous ntawm lub pharynx. Txhawm rau txheeb xyuas qhov muaj thiab qhov chaw ntawm qhov chaw ntawm qhov txhab, nrog rau qib ntawm kev sib kis ntawm cov txheej txheem purulent, cov kev tshawb fawb niaj hnub siv, xws li CT thiab MRI.
Autopsy
Kev kuaj mob ntawm tus mob retropharyngeal (retropharyngeal) abscess tau ua ntau txoj hauv kev.
- Nrog rab riam phais. Cov cuab yeej yuav tsum tau qhwv nrog paj rwb ntaub plaub los yog daim kab xev nplaum. Nyob rau tib lub sijhawm, qhov txiav tsis pub dawb, kwv yees li 0.05 - 0.06 cm Kev txiav yog pib los ntawm hauv qab, los ntawm qhov chaw uas cov mucosal bulge pib. Qhov tob yog 0.5 cm, koj yuav tsum ua kom tiav qhov incision ntawm qhov feem ntau convex point ntawm abscess. Txhawm rau kom tsis txhob muaj cov kua paug nkag mus rau hauv lub larynx, nws yuav tsum tau qaij tus neeg mob lub taub hau tam sim ntawd tom qab ua qhov kev txiav tawm.
- txiab txiab. Txiab yog muab tso rau hauv qhov chaw siab tshaj ntawm suppuration. Txhawm rau kom tsis txhob muaj lub siab xav, yuav tsum ua ib qho me me ua ntej. Tom qab ntawd qhib lub cuab yeej kom nthuav dav cov npoo ntawm qhov txiav. Siv cov qauv no, cov qauv kuaj tuaj yeem coj mus ua ke rau lub hom phiaj ntawm kev kuaj mob thiab kev kho mob.
- Pus tuaj yeem ntws mus rau hauv caj dab yog tias qhov pharyngeal abscess qis. Tom qab ntawd nws yog qhov zoo dua los qhib qhov abscess nrog kev phais sab nraud. Nyob rau hauv rooj plaub no, nws raug pom zoo kom kos ib kab raws ntug anterior ntawm Musculus sternocleidomastoideus (sternocleidomastoid leeg). Yog tias ua tiav ib ntu loj, muaj peev xwm ua rau cov paj hlwb puas tsuaj.
Nyob rau hauv cov ntaub ntawv purulent txuam nrog pob ntseg, ntxiv rau qhov qhib, kev phais ntawm pob ntseg tau ua.
tshuaj kho mob
Kev kho mob ntawm cov kab mob retropharyngeal abscess yog siv tshuaj tua kab mob. Cov pab pawg hauv qab no tau siv tam sim no:
- Cephalosporins ("Ceftriaxone", "Cefepime").
- Macrolides ("Erythromycin", "Clarithromycin").
- Lincosamides ("Lincomycin", "Clindamycin").
Lub tshuab ua haujlwm ntawm cephalosporins thaiv kev rov ua dua tshiab ntawm cov qauv cellular ntawm microbes, uas ua rau lawv puas tsuaj tag. Nyob ntawm tus neeg sawv cev, lawv tuaj yeem muab tshuaj rau hauv cov hlab ntsha lossis intramuscularly.
Cephalosporins yog tshuaj rau cov menyuam yaus txhua lub hnub nyoog. Tab sis lawv txoj kev nyab xeeb hauv cov menyuam yaus hnub nyoog qis dua 6 hli tsis tau muaj pov thawj.
Macrolides thaiv ribosomes hauv cov kab mob, uas inhibits lawv txoj kev loj hlob. Macrolides feem ntau noj los ntawm qhov ncauj.
Lincosamides thaiv kev rov ua dua tshiab ntawm cov qauv protein hauv cov kab mob, uas ua rau qeeb lawv txoj kev faib thiab kev loj hlob. Nyob ntawm tus neeg sawv cev, lincosamides tuaj yeem muab tshuaj rau hauv cov hlab ntsha lossis intramuscularly. Qee cov tshuaj notuaj yeem txo qhov bioavailability ntawm cov zaub mov noj.
Cov tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob tuaj yeem siv ua ke nrog tshuaj tua kab mob. Tab sis lawv yuav tsum tsuas yog siv los ua qhov chaw kawg nkaus xwb, vim tias lawv tuaj yeem ua rau muaj kev cuam tshuam ntawm lub cev tsis muaj zog lawm.
kev kho neeg zoo
Kev kho mob nrog pej xeem cov tshuaj feem ntau yog ua los txhawm rau txo cov tsos mob ntawm caj pas abscess thiab nres kev txhim kho ntawm qhov mob. Nws tsis tuaj yeem kho pharyngeal abscess nrog cov tshuaj pej xeem. Qhov no yog vim qhov tseeb tias tus kab mob no muaj qhov tshwm sim tshwm sim.
Kev kho neeg pej xeem suav nrog gargling nrog cov kev daws teeb meem hauv qab no thiab decoctions:
- Cov tshuaj ntsev thiab dej qab zib tuaj yeem txo cov kab mob nyob ib ncig ntawm cov txheej txheem nqos. Txhawm rau npaj nws, koj yuav tsum noj ib tablespoon ntawm ntsev los yog dej qab zib thiab yaj nyob rau hauv ib khob dej sov. Gargle nrog cov txiaj ntsig daws, rov ua dua tsawg kawg tsib zaug thaum nruab hnub. Tus naj npawb ntawm cov dej yaug tuaj yeem nce ntxiv los ntawm diluting cov tshuaj nrog dej.
- Txoj kev tshuaj ntsuab rau yaug lub hom phiaj. Kev npaj ntawm xws li infusion pib nrog ziab thiab sib tsoo ntau yam tshuaj ntsuab, tom qab ntawd cov hmoov av tau nchuav nrog dej npau npau thiab tso cai rau brew rau ob peb teev. Kev yaug yog rov ua dua ob peb zaug hauv ib hnub.
- Kev noj cov kua txiv Kalanchoe hauv zos yuav tshem tawm qhov mob thiab txo cov tsos mob ntawm kev txhim kho abscess los ntawm kev tshem tawm cov quav hniav.
Huab cua
Kev kuaj mob raws sij hawm thiab kuaj pom ntawm retropharyngeal abscess yuav kho nws yam tsis muaj teeb meem. Raws li kev txheeb cais, yog tias tsis muaj teeb meem, tom qab ntawd lub sijhawm qhib ntawm qhov abscess feem ntau tso cai rau koj kom tshem tawm tag nrho yam tsis muaj qhov tshwm sim ntawm qhov tshwm sim txaus ntshai. Yog tias tsis kho tam sim ntawd thiab qhov tshwm sim ntawm qhov no, cov teeb meem tshwm sim, tom qab ntawd qhov kev tshwm sim tsis zoo, mus txog rau qhov tuag.
Kev Tiv Thaiv
Txhawm rau tiv thaiv kev txhim kho ntawm cov kab mob retropharyngeal abscess, cov kev ntsuas hauv qab no yuav tsum tau ua:
- kho tus kab mob ENT kom raug;
- kuaj pom ntxov thaum muaj kab mob ENT;
- kev tshem tawm lub cev txawv teb chaws ntawm caj pas;
- kho raws sijhawm ntawm cov pob txha purulent hauv caj pas;
- zam lub caj pas kub thaum noj zaub mov kub.
Thaum kuaj endoscopic, zam kev raug mob rau caj pas. Txawm li cas los xij, qhov no tshwm sim, tom qab ntawd ntsuas kev kho kab mob.
Kev ntsuas dav dav ntxiv txhawm rau tiv thaiv retropharyngeal abscess:
- siv lub caj pas rau haus dej kub thiab txias;
- normalization ntawm microflora ntawm caj pas;
- kev tiv thaiv kab mob;
- Y noj cov vitamins;
- khoom noj muaj txiaj ntsig.
