Abscess hauv Latin txhais tau tias "abscess". Nyob rau hauv cov tshuaj, lo lus no yog to taub raws li ib tug txwv tsub zuj zuj ntawm purulent exudate nyob rau hauv cov ntaub so ntswg thiab lub cev. Purulent o tuaj yeem tshwm sim nyob qhov twg. Cov nqaij mos abscess yog qhov chaw uas muaj purulent exudate thiab nyob hauv qab ntawm daim tawv nqaij hauv cov nqaij rog lossis cov leeg. Tus kab mob no tshwm sim los ntawm o, liab thiab mob ntawm daim tawv nqaij.
Lub tswv yim ntawm abscess
Abscess, lossis abscess yog kab mob purulent-inflammatory uas tshwm sim los ntawm kev puas tsuaj rau cov nqaij mos thiab tsim cov kab noj hniav hauv nws. Tus kab mob purulent-inflammatory tuaj yeem tshwm sim raws li tus kab mob ywj pheej lossis ua rau muaj teeb meem ntawm cov kab mob.
Kev ua paug tuaj yeem tshwm sim hauv cov leeg nqaij, cov nqaij mos subcutaneous, pob txha, kabmob lossis nruab nrab ntawm lawv. Nyob ntawm qhov chaw, paratonsillar, pharyngeal, appendicular, cov nqaij mos abscesses, thiab lwm yam. Tus kab mob yog exogenous (cov kab mob nkag mus rau sab nraud), tab sis muaj cov kab mob endogenous. Cov kab mob tuaj yeem kis tau los ntawm cov kab mob nyob ze thiab nyob deb.
Tus kab mob no tshwm sim heev. Raws li qee cov lus ceeb toom, kwv yees li 14 lab tus neeg mob nrhiav kev pab kho mob txhua xyoo uas muaj teeb meem zoo sib xws.
Qhov sib txawv tseem ceeb ntawm cov nqaij mos abscess (duab hauv qab) yog qhov muaj cov tshuaj ntsiav (pyogenic membrane). Cov tshuaj ntsiav zoo li no muaj nyob rau hauv abscesses ntawm txhua qhov chaw, txawm tias rau cov uas tshwm sim hauv cov kabmob sab hauv. Lub pyogenic daim nyias nyias ntawm cov nqaij mos abscesses plays lub luag haujlwm tseem ceeb - nws tiv thaiv kev sib kis ntawm cov txheej txheem purulent-inflammatory mus rau cov qauv anatomical nyob ze. Txawm li cas los xij, ntau dhau ntawm exudate tuaj yeem ua rau thinning ntawm cov tshuaj ntsiav, ua raws li nws qhov kev tawg thiab tso tawm cov ntsiab lus purulent mus rau qhov chaw nyob ib puag ncig.
Lwm qhov zoo ntawm cov nqaij mos abscesses yog lawv qhov chaw nyob. Abscesses nyob rau saum npoo, uas ua rau muaj kev kuaj pom tseeb tshaj plaws nrog rau kev teem caij kho kom txaus.
Raws li ICD-10, cov nqaij mos abscess muaj tus lej L02. Furuncles thiab furuncles kuj suav nrog. Cov txheej txheem thoob ntiaj teb faib cov kab mob ua cov nqaij mos thiab kab mob ntawm daim tawv nqaij.
Ntshai thiab nkag mus - qhov txawv li cas?
Thaum daim tawv nqaij raug mob vim kev phais lossis kev mob inflammatory pathologies, muaj teeb meem tshwm sim. Tus kab mob nkag mus rau hauv lub cev thiab ib qho abscess thiab infiltrate tsim. Kawg -Qhov no yog ib qho tsub zuj zuj ntawm cov ntaub so ntswg ntawm cellular ntsiab nrog ib tug admixture ntawm cov ntshav thiab lymph.
Txawm hais tias muaj ntau yam etiology thiab pathological anatomy, cov no yog ob yam txheej txheem pathological. Cov nqaij mos abscess txawv ntawm infiltrate raws li hauv qab no:
- Qhov muaj kua nyob hauv kab noj hniav kaw. Nrog rau abscess, cov kua yog purulent exudate, nrog rau infiltrate tsis muaj kab noj hniav txhua, cov ntaub so ntswg yog saturated nrog lwj khoom ntawm cov txheej txheem inflammatory.
- Infiltrate tuaj yeem tshwm sim los ntawm cov qog hlwb, thiab abscess tsuas yog tshwm sim los ntawm cov kab mob.
- Infiltration tuaj yeem ua rau muaj kab mob abscess, tab sis lwm txoj hauv kev tsis tshwm sim.
Kev faib tawm ntawm abscesses
Cov nqaij mos ulcers tau muab faib ua ntau txoj hauv kev. Lub etiotropic systematization yog suav hais tias yog ib qho tseem ceeb:
- Yooj yim - monomicrobial nrog cov ntaub ntawv kho mob hauv zos. Cov kab mob tseem ceeb yog staphylococcus aureus (feem ntau yog golden) thiab beta-hemolytic streptococcus. Feem ntau lawv yog me me, nyob rau saum npoo thiab yooj yim kho
- Complex - tuaj yeem yog mono- lossis polymicrobial. Tus neeg sawv cev ua rau yog Staphylococcus aureus koom nrog Escherichia coli, Proteus thiab lwm yam kab mob, feem ntau yog anaerobic. Cov complexes nkag mus tob rau hauv cov ntaub so ntswg, follicles. Raws li ICD-10, cov nqaij mos abscess thiab boils tau muab tso rau hauv ib pawg thiab muaj cov cai sib xws.
Kev faib tawm los ntawm qhov ntws:
- Mob, tus yam ntxwv los ntawm qhov me me ntawm qhov mob thiab ib txheej tshuaj ntsiav. Nyob rau theem pib ntawm o, cov phab ntsa ntawm cov tshuaj ntsiav yog them nrog purulentfibrous deposits thiab hais txog molten ntaub so ntswg.
- Cov kab mob ntev ntev yog qhov tshwm sim los ntawm kev kawm hnyav nrog cov tsos mob lom ntau. Ib tug bilayer pyogenic membrane yog tsim. Cov txheej sab hauv muaj granulations thiab ntsib cov kab noj hniav, txheej txheej muaj cov ntaub so ntswg paub tab.
Cov kab mob hauv qab no tau muab cais ua pawg:
- Txias - tsub zuj zuj ntawm cov kua paug hauv cov kab noj me me, tsis muaj qhov tshwm sim ntawm cov txheej txheem inflammatory (redness, mob, kub taub hau). Cov kab mob no yog endogenous thiab pom nyob rau hauv tuberculosis los yog actinomycosis.
- A o abscess yuav luag asymptomatic. Nws tuaj yeem txhim kho nyob rau hauv ob peb lub hlis yam tsis muaj cov cim qhia ntawm tus txheej txheem inflammatory. Qhov txaus ntshai nyob rau hauv qhov tseeb hais tias tib neeg tsis muab qhov tseem ceeb rau xws li abscess thiab tsis koom nrog kev kho mob. Lub sijhawm no, nws dhau mus ntev.
Ua rau subcutaneous abscess
Lub ntsiab yog vim li cas rau kev tsim ntawm abscess yog ingress ntawm pathogenic microflora rau hauv lub cev. Cov kab mob feem ntau ua rau tus kab mob yog staphylococcus aureus, tab sis kab lis kev cai txiav txim siab muaj lwm yam kab mob:
- YEpidermal, hemolytic, Staphylococcus aureus.
- Staphylococci, feem ntau beta-hemolytic, pneumococcal kuj pom. Cov tom kawg yog cov yam ntxwv ntawm qhov nyuaj endogenous abscesses.
- kab mob Gram-negative: E. coli.
- Proteus. Qhov chaw nyob ntawm hom noenterobacteria - av thiab dej. Cov kab mob nkag mus rau hauv lub cev, raws li txoj cai, los ntawm lub pas dej qias neeg.
- Pseudomonas aeruginosa yog tshuaj tua kab mob heev. Nws yog tus kab mob nosocomial (nosocomial) kab mob.
- Klebsiella muaj nyob rau ntawm daim tawv nqaij, mucous daim nyias nyias. Lawv cov dej num lom neeg tau txhawb nqa los ntawm lub cev tsis muaj zog.
- Shigels. Tus cab tus kab mob thiab qhov chaw kis kab mob yog tus neeg mob.
- Koch's wand.
Nws tuaj yeem txiav txim siab tus neeg sawv cev ntawm cov nqaij mos abscess los ntawm cov ntsiab lus purulent, ntau dua los ntawm nws qhov xwm txheej (tseem, xim). Cov kws kho mob muaj kev paub dhau los ua qhov kuaj pom ua ntej raws li cov yam ntxwv no.
- Cov kab mob putrefactive microflora (E. coli) yog cov xim grey thiab tsw ntxhiab tsw.
- Yog tias tus neeg sawv cev ua rau yog staphylococcus - daj-ntsuab purulent exudate.
- Tus ntxhiab tsw qab thiab xim xiav-ntsuab ntawm exudate yog tus yam ntxwv ntawm Pseudomonas aeruginosa.
Pyogenic microbes feem ntau nkag mus rau hauv lub cev thaum kev ua txhaum ntawm daim tawv nqaij (qhov txhab, khawb). Cov txheej txheem purulent tuaj yeem tshwm sim thaum cov kab mob kis los ntawm lymphogenous lossis hematogenous txoj hauv kev los ntawm cov foci ntawm qhov mob uas twb muaj lawm.
Feem ntau cov kab mob purulent-inflammatory yog tsim tawm tsam keeb kwm ntawm lwm yam kab mob ntev. Pab txhawb rau txoj kev loj hlob ntawm cov nqaij mos abscess chronic tonsillitis, sinusitis. Mob ntshav qab zib mellitus ua lub luag haujlwm tshwj xeeb hauv kev txhim kho cov kab mob.
Pathogenesis ntawm purulent-inflammatory disease
Abscess tshwm sim nyob rau hauv cov ntaub so ntswg tuag, qhov twg cov txheej txheem autolysis tshwm sim (self-solution ntawm hlwb nyob rau hauv tus ntawmenzymes), los yog nyob rau hauv cov ntaub so ntswg ua rau muaj kev txhoj puab heev ntawm pathogenic microorganisms.
Thaum tus kab mob nkag mus rau hauv lub cev, kev tiv thaiv kab mob tau qhib. Lub ntsiab "tiv thaiv" yog leukocytes (neurophilic, basophilic). 6-8 teev tom qab kev taw qhia ntawm tus kab mob, neurophiles los ntawm lub vascular txaj nkag mus rau hauv lub mucous daim nyias nyias. Nrog kev pab los ntawm chemoattractants, neurophilic leukocytes nkag mus rau qhov mob ua kom pom tseeb.
Nyob rau hauv thawj theem ntawm cov txheej txheem purulent, qhov chaw cuam tshuam yog infiltrated (impregnated) nrog cov kua dej inflammatory thiab leukocytes. Nyob rau tib lub sijhawm, nyob rau hauv kev cuam tshuam ntawm neutrophil enzymes, cov ntaub so ntswg tau yaj, ib qho chaw sab hauv uas muaj exudate yog tsim. Cov kua paug hauv cov kab noj hniav yog cov lysosomal enzymes ntawm neurophilic residues. Cov phab ntsa ntawm cov nqaij mos abscess nws thiaj li tsim tau ob txheej pyogenic membrane. Nws tiv thaiv exudate los ntawm kev sib kis mus rau cov txheej txheem anatomical uas nyob ib sab.
Kev kho mob tshwm sim ntawm tus kab mob abscess
Cov tsos mob ntawm abscesses yog tib yam li nrog cov txheej txheem inflammatory nrog los ntawm kev tsim cov kua paug. Qhov hnyav ntawm kev kho mob tshwm sim yog txiav txim los ntawm ntau yam:
- Txoj kev mob tib neeg. Tib neeg muaj ntau yam kev raug mob rau ntau yam kab mob, cov tshuaj tiv thaiv tuaj yeem tshwm sim hauv ntau txoj kev.
- Txoj kev kis tus kab mob. Qee hom kab mob, txawm tias tsawg heev, tuaj yeem ua rau mob hnyav.
- Kev mob plab.
- Nyob rau ntawm necroticpauv.
Abscesses muaj ob qho tib si hauv zos thiab cov tsos mob tshwm sim.
- Hyperemia ntawm qhov chaw mob.
- Siab o.
- Tswv cua kub hauv thaj tsam ntawm qhov abscess.
- pab.
- Nrog cov kev hloov pauv hauv qhov sib sib zog nqus, muaj qhov ua tsis taus pa, nce hauv lub cev kub txog 40 ° C nrog ua daus no.
Nrog tuberculous etiology, cov txheej txheem purulent-inflammatory kis deb ntawm qhov chaw ntawm keeb kwm. Piv txwv li, ib qho o ntawm cov nqaij mos ntawm tus ncej puab (tsuas yog ntawm qhov chaw nruab nrab) yuav tshwm sim.
Cov kab mob loj uas tau tshwm sim rau ntawm daim tawv nqaij ntawm caj dab cuam tshuam rau lawv txoj haujlwm. Thaum taug kev lossis txav koj txhais tes, qhov mob tshwm sim, uas txwv tsis pub lub cev muaj zog.
Lub pob tw pob tw pob txha uas tshwm sim los ntawm kev txhaj tshuaj intramuscular feem ntau yog nrog los ntawm qhov mob hnyav. Qhov chaw mob tuaj yeem siv rau ntawm burgundy lossis txawm xiav tint. Kev tsim ntawm hematoma tiv thaiv cov tshuaj ntsiav los ntawm kev tawg thiab tsim kev pheej hmoo ntawm sepsis.
Yuav muaj teeb meem dab tsi?
Nyob rau hauv cov txheej txheem purulent-inflammatory mob nrog rau qhov tseem ceeb intoxication, teeb meem tshwm sim hauv kev tshawb nrhiav qhov ua rau tus neeg mob tus mob hnyav. Tej zaum yuav muaj ntau yam laj thawj rau tus mob no:
- Purulent-resorptive fever - nqus cov khoom puas tsuaj rau hauv cov ntshav los ntawm kev tsom mus rau qhov mob. Nrog ib qho tseem ceeb ntawm cov kua paug, nws nkag mus rau hauv daim nyias nyias. Kev nqus tau tshwm simlymphogenous thiab hematogenous txoj kev.
- Kev kis tus kab mob los yog sepsis yog ib qho kab mob purulent uas tshwm sim los ntawm cov kab mob thiab lawv cov co toxins nkag mus rau hauv cov ntshav. Tus kab mob no tshwm sim los ntawm intoxication, thrombohemorrhagic syndromes, metastatic cov ntaub so ntswg puas.
- Lwm qhov teeb meem ntawm cov nqaij mos abscess yog phlegmon. Cov txheej txheem purulent yuav kis tau. Phlegmon yog tus cwj pwm los ntawm kev ua tsis taus pa, kub taub hau, mob ntawm thaj chaw cuam tshuam thaum txav los yog palpation.
- Neuritis tuaj yeem tshwm sim los ntawm purulent fusion ntawm phab ntsa ntawm cov hlab ntsha loj thiab cov hlab ntsha hauv lub cev.
- Osteomyelitis. Thaum cov txheej txheem purulent kis mus rau cov pob txha, qhov mob ntawm cov pob txha pob txha yuav loj tuaj.
Diagnosis
Tus kws phais mob purulent koom nrog kev kuaj lub cev, anamnesis, thiab teem caij kuaj ntsuas. Thaum ua kev soj ntsuam, tus kws kho mob tau saib xyuas qhov muaj cov kab mob yav dhau los, qhov tsos mob ntawm qhov mob tom qab raug mob, phais, txhaj tshuaj.
Thaum kuaj lub cev, tus kws kho mob txiav txim siab cov hauv qab no:
- Thaum lub sijhawm kuaj, muaj qhov o ntawm cov ntaub so ntswg thiab liab ntawm daim tawv nqaij nyob rau hauv thaj tsam ntawm abscess. Qhov kub ntawm qhov chaw ntawm qhov mob yog ntau dua. Cov tawv nqaij ntawm qhov chaw ntawm lub purulent tsim yog nyias heev, exudate pom los ntawm nws.
- Thaum palpation, muaj qhov nce ntawm qhov chaw ntawm qhov mob, tus neeg mob ntsib qhov mob thaum palpation. Thaum koj nias rau ntawm lub ntsej muag purulent, cov yam ntxwv nthwv dej tau sau tseg -fluctuation.
Kev kuaj mob muaj xws li kev sim kuaj:
- Txoj kev tshawb fawb microscopic tso cai rau koj los kawm txog morphological thiab tinctorial zog ntawm microbes.
- kab mob kab mob. Nrog nws cov kev pab, cov kab mob thiab nws cov tsis kam mus rau cov tshuaj tua kab mob yog txiav txim.
- kuaj ntshav kuaj.
- Yog xav tias tuberculosis, kuaj Mantoux tiav.
Instrumental diagnostic method:
- Ultrasound ntawm cov nqaij mos abscess tso cai rau koj los kawm tob thiab necrotic ulcers.
- Kev kuaj mob puncture yog ua rau tib lub hom phiaj raws li kev soj ntsuam.
- Kev kuaj X-ray raug txiav txim yog tias xav tias TB.
Kev kuaj mob sib txawv ntawm subcutaneous abscess
Cov kev kho mob tshwm sim ntawm abscesses muaj ntau yam nrog rau qee yam kab mob. Kev kuaj mob sib txawv tso cai tsis tsuas yog kom paub meej qhov kev kuaj mob, tab sis kuj txiav txim siab qhov xwm txheej ntawm qhov mob, qhov tob ntawm cov kab mob pyogenic, thiab txheeb xyuas qhov muaj cov ntaub so ntswg necrotic. Kev kuaj mob muaj xws li sonography, kuaj kuaj thiab lwm yam kev kuaj mob ntawm abscess yuav tsum txawv ntawm:
- Infiltration.
- Ib kab mob lwj. Raws li kev cuam tshuam ntawm cov khoom lwj, kev qaug cawv hnyav tshwm sim nrog cov tsos mob uas kuj yog tus yam ntxwv ntawm tus kab mob abscess.
- Lub cev txawv teb chaws. Cov nqaij mos abscess ntawm ultrasound zoo li tsaus nti ntawm cov kua dej nrog cov ntsiab lus grey sab hauv, thaum lub cev txawv teb chaws muaj cov yam ntxwv zoo li, cov iav me me yuav tsis tshwm sim.saib.
Kev kho cov nqaij mos abscess
Kev kho mob yog txiav txim siab nyob ntawm cov txheej txheem purulent, tus neeg mob txoj kev noj qab haus huv. Nyob rau hauv thawj theem, conservative txoj kev kho yog sau. Nws lub luag haujlwm tseem ceeb yog ua kom muaj qhov tshwm sim sab nraud ntawm cov tshuaj ntsiav. Thaum tshav kub kub compresses yog siv, ib tug cua sov ncoo yog siv. Lawv sau tshuaj tiv thaiv kab mob ("Demiksid", "Biopin" tshuaj pleev) thiab UHF kho.
Feem ntau, cov neeg mob tuaj rau theem tom qab ntawm cov kab mob purulent-inflammatory, thaum kev kho mob ntawm cov nqaij mos abscess tsis zoo. Xws li abscesses yog raug rau kev phais. Kev qhib thiab tso dej ntawm qhov ua kom pom tseeb ntawm qhov mob yog feem ntau ua los ntawm tus kws phais mob nrog tus kws saib xyuas neeg mob hauv chav kho mob sab nraud. Manipulation yog ua los ntawm kev siv tshuaj loog hauv zos los ntawm impregnating cov ntaub so ntswg nrog novocaine 0.5% los yog intravenous anesthesia (Epontol, Sodium Thiopental). Lub dissection yog nqa tawm raws tag nrho ntev ntawm lub abscess, thiaj li hais tias dawb outflow ntawm exudate yog guaranteed. Cov kab noj hniav qhib yog ntxuav nrog tshuaj tua kab mob kom txog thaum nws tau ntxuav tag thiab cov ntaub so ntswg tshem tawm. Rau kev phais tom qab phais, ib lub raj PVC, turundas nrog saline tov yog muab tso rau hauv cov kab noj hniav abscess.
Yog tias qhov tob tob tob los ntawm qhov me me, cov phab ntsa sab hauv yog ntxuav nrog nqus ntawm cov ntsiab lus, cov kab noj hniav yog drained nrog lavage thiab nquag aspiration.
Kev siv tshuaj tua kab mob rau cov nqaij mos abscesses yog kws kho mob, tom qab phais mob, qaug cawvcov tsos mob tsis txo qis. Kev siv tshuaj tiv thaiv kab mob yog pom zoo yog tias muaj kev kis kab mob los yog ua npaws-resorptive kub taub hau.
ntsuas kev tiv thaiv
Ntshai yog kab mob txaus ntshai heev. Ib qho kev tawg ntawm cov pyogenic daim nyias nyias nrog kev tso tawm ntawm purulent exudate mus rau hauv qhov chaw sab hauv hem nrog kev mob hnyav heev. Lub etiology ntawm tus kab mob yog to taub zoo, uas tso cai rau kev ntsuas rau nws kev tiv thaiv. Kev tiv thaiv tsis yog tshwj xeeb thiab txawv me ntsis ntawm cov cai tshuaj tua kab mob.
- Nyob rau lub sijhawm thiab kho qhov txhab ua tiav.
- Rau qhov kub hnyiab, frostbite, kho yuav tsum tau ua los ntawm kws kho mob thiab tswj cov txheej txheem kom txog thaum rov ua tiav.
- Ua raws li cov cai tshuaj tua kab mob rau kev txhaj tshuaj thiab lwm yam kev kho mob.
- Kev kho kom txaus rau txhua yam kab mob ntawm cov kab mob sib kis.
- Mus ntsib kws kho mob tam sim rau qhov mob uas tsis txaus ntseeg.
Kev saib xyuas qhov tsis zoo
Nrog rau kev kho raws sijhawm thiab teem caij kho kom txaus, qhov kev cia siab rau kev rov zoo yog qhov zoo. Thaum lawv rov zoo, cov tsos mob tsis zoo raug tshem tawm, cov neeg mob rov qab mus rau lawv lub neej zoo. Kev siv tshuaj tua kab mob rau cov nqaij mos abscesses tuaj yeem ua rau muaj kev cuam tshuam hauv plab hnyuv microflora. Txhawm rau kom rov zoo, koj yuav tsum noj cov tshuaj probiotics. Txwv tsis pub, cov kab mob tuaj yeem rov kis tau.
