Ib qho teeb meem txaus ntshai ntawm mob appendicitis yog ib qho appendicular abscess. Nws tuaj yeem tshwm sim ob qho tib si ua ntej cov txheej txheem phais thiab hauv lub sijhawm postoperative. Raws li kev txheeb cais, qhov teeb meem loj tshwm sim hauv 3% ntawm cov neeg mob thiab yuav tsum muaj kev cuam tshuam tam sim los ntawm cov kws phais.
Yog vim li cas
Nyob rau hauv ib qho abscess yog to taub cov ntaub so ntswg o, uas yog tsim los ntawm ib tug txwv purulent kab noj hniav. Feem ntau, tus neeg sawv cev ntawm qhov teeb meem no yog Escherichia coli. Tsis tas li ntawd, qhov ua rau ntawm qhov tshwm sim ntawm tus kab mob appendicular abscess yog tib neeg:
- Kev kuaj mob tsis zoo: ntau qhov yuam kev ua hauv chav kawm tshawb fawb uas ua rau muaj kev cuam tshuam ntawm kev mob appendicitis.
- Lub sijhawm tos ntev vim tias tshem tawm cov tsos mob. Cov xwm txheej zoo li no yuav tshwm sim los ntawmrau lub xub ntiag ntawm lwm yam kab mob nrog cov tsos mob qhia tau hais tias, nrog rau kev noj tshuaj tua kab mob. Raws li txoj cai, kev tshem tawm cov paib tau sau tseg hauv cov neeg mob laus.
- kev kho mob tsis zoo.
- hu tsis tau sijhawm nrog lub chaw kho mob.
Kev txhim kho Mechanisms
Thaum thawj theem ntawm kev loj hlob ntawm tus kab mob, ib qho infiltrate yog tsim - cov hlwb o tuaj yeem sib sau ua ke thiab nruj nreem txuas rau ib leeg. Yog hais tias, txawm tias qhov kev kho kom zoo, lub foob tsis daws, tab sis, ntawm qhov tsis sib xws, abscesses, kev cuam tshuam kev phais xwm txheej ceev tau qhia. Txwv tsis pub, abscess tuaj yeem tawg mus rau hauv lub plab kab noj hniav, ua rau nws mob. Kev hloov pauv ntawm cov txheej txheem pathological mus rau hauv txoj hnyuv lumen lossis retroperitoneal qhov chaw tuaj yeem ua tau. Tsis tas li ntawd, cov txheej txheem purulent kis mus rau cov ntaub so ntswg nyob ze.
Symptoms
Kev tsim ntawm infiltrate muaj cov cim qhia uas feem ntau tshwm sim hauv mob plab hnyuv:
- Nyob zoo ib tsoom phooj ywg;
- nce hauv lub cev kub;
- tawm hws ntau dhau;
- mob hauv cheeb tsam iliac.
Raws li tus kab mob appendicular abscess, cov tsos mob hauv qab no tshwm sim:
- Yuav ua tsis tau lub cev txav mus los vim kev mob pob txha.
- Intestinal abscess yog nrog los ntawm kev mob plab me ntsis thiab ib feem ntawm plab hnyuv.
- Nrog raupulsating mob tshwm liab thiab o ntawm daim tawv nqaij.
- Thaum lub plab pelvic abscess ntawm appendicular keeb kwm cuam tshuam los ntawm qhov mob thiab o hauv plab plab. Thaum lub sij hawm defecation, tus neeg mob kuj muaj kev tsis xis nyob, thiab cov txheej txheem ntawm tawm cov quav yog nrog los ntawm mucous secretions. Ncua tso zis.
Thaum kuaj mob, lub cev kub yog qhov tseem ceeb. Yog tias nrog mob plab hnyuv loj nws nce me ntsis (txog 37.5 ° C), tom qab ntawd nrog cov kab mob appendicular abscess tus pas ntsuas kub qhia tau 39-40 ° C.
Diagnosis
Cov kev kho mob tshwm sim ntawm qhov teeb meem zoo ib yam li cov tsos mob ntawm qee yam kab mob, yog li ntawd, ua ntej ntawm tag nrho cov, nws yuav tsum sib txawv ntawm lawv.
Tsis tas li ntawd, kev kuaj mob ntawm appendicular abscess suav nrog cov haujlwm hauv qab no:
- Kev xeem thiab kev xeem keeb kwm. Tus kws kho mob soj ntsuam thaj tsam ntawm iliac kom pom qhov infiltrate. Nrog rau qhov sib sib zog nqus palpation, qhov sib xyaw ntawm cov kua hauv feem ntau tsis pom. Raws li txoj cai, lub infiltrate yog ntom thiab immobile. Feem ntau, qhov quav los yog qhov chaw mos palpation yog ua kom pom qhov mob induration, uas yog lub hauv qab ncej ntawm abscess. Tus kws kho mob saib xyuas tus neeg mob tus nplaig - thaum muaj mob, nws yog ntub thiab kab nrog ib txheej tuab. Nyob rau hauv tus txheej txheem ntawm kev ua pa, koj tuaj yeem pom qhov poob ntawm lub plab nyob rau hauv txoj cai iliac cheeb tsam.
- kuaj ntshav. Nws yog ib qho tseem ceeb rau kev txiav txim siab qib ntawm leukocytes hauv cov ntshav. Nrog rau ib qho appendicular abscess, muaj qhov nce ntxiv hauv lawv.
- Ultrasound thiab radiography ntawm lub plab kab mob. Nrog kev pab ntawm cov ntaub ntawvHom kev kuaj mob yog txiav txim siab los ntawm theem ntawm cov kua dej nyob rau sab xis ntawm lub plab, qhov chaw nyob thiab qhov loj ntawm purulent o.
Kev kho mob
Kev cuam tshuam phais tsis suav nrog rau theem ntawm infiltrate tsim.
Kev kho mob yog ua los ntawm tus neeg mob hauv tsev thiab suav nrog:
- ua raws li lub txaj so;
- daim ntawv thov rau lub plab hauv thawj peb hnub ntawm qhov txias, hauv hnub tom qab - cua sov;
- kev tswj hwm cov tshuaj novocaine rau lub hom phiaj ntawm kev kho mob (kev noj tshuaj kom txo qis qhov mob ntawm qhov mob tsis suav nrog);
- khoom noj tshwj xeeb.
Nyob rau hauv rooj plaub uas muaj kev vam meej resorption ntawm infiltrate, tom qab 2 lub hlis, ib tug npaj ua hauj lwm yog ua kom tshem tawm cov appendix (appendectomy). Qhov no yog vim qhov tseeb tias tom qab qee lub sijhawm, kev tawm tsam ntawm qhov mob thiab cov txheej txheem ntawm infiltrate tuaj yeem rov ua dua, ua rau muaj kev pheej hmoo ntawm cov teeb meem.
Thaum kuaj tau tus mob appendicular abscess, kev kho mob muaj kev phais xwm txheej ceev. Nyob rau hauv tus txheej txheem, lub abscess yog qhib thiab drained. Qhov kev nkag mus tau nyob ntawm nws qhov chaw nyob. Raws li txoj cai, kev nkag mus rau extraperitoneal yog siv. Lub qhov txhab raug ntxuav nrog tshuaj tua kab mob, tom qab uas cov kav dej tau raug ntsia.
Qhov qhib ntawm appendicular abscess yog ua raws li kev siv tshuaj loog. Raws li kev txiav txim siab ntawm tus kws kho mob, cov ntaub ntawv ntxiv yuav raug tshem tawm, uas yog qhov zoo dua.
Post-operative period
Rau tus neeg mob uas tau mobkev ua haujlwm, nruj txaj so yog qhia. Kev lim dej yuav tsum tau saib xyuas tshwj xeeb - kev ntxuav lub qhov txhab tsis tu ncua. Cov hlab yog tshem tawm tsuas yog tom qab cov kua paug tsis sib cais los ntawm kab noj hniav. Lub qhov txhab tom qab lawv tshem tawm tsis sutured, nws kho ntawm nws tus kheej. Cov tshuaj tua kab mob thiab tshuaj uas tshem tawm cov tsos mob ntawm intoxication yog qhia. Nyob rau tib lub sijhawm, kev kho mob yog ua los txhawm rau txhim kho lub cev.
Yog tias tsis tau tshem tawm cov ntaub ntawv ntxiv thaum lub sijhawm ua haujlwm, appendectomy tau ua 2 lub hlis tom qab tshem tawm tag nrho cov txheej txheem inflammatory.
Txhais tau
Yog tias koj tsis nrhiav kev pab tsim nyog hauv lub sijhawm, qhov tshwm sim ntawm qhov tshwm sim ntawm appendicular abscess yuav tshwm sim, tom qab ntawd muaj qhov tshwm sim ntau ntawm kev tsim cov teeb meem hauv qab no:
- purulent peritonitis - mob ntawm peritoneum;
- kab mob urinary tract;
- phlegmon - txheej txheem purulent uas sai sai kis mus rau cov ntaub so ntswg nyob ze;
- paracolitis - kev hloov pauv hauv cov fiber ntau ntawm qhov chaw retroperitoneal;
- daim siab abscess - kev puas tsuaj ntawm cov ntaub so ntswg noj qab haus huv thiab tsim cov kab noj hniav purulent;
- adhesive plab hnyuv obstruction;
- purulent thrombophlebitis - tsim cov ntshav txhaws thiab me me foci ntawm abscess nyob rau hauv cov leeg;
- fistulas ntawm phab ntsa plab - raws txuas cov kab mob hauv nruab nrog cev nrog rau saum npoo ntawm lub cev.
Raws li qhov kev cia siab, nws yog txiav txim siab los ntawm qib ntawm kev kuaj mob sai thiab kev cuam tshuam kev phais.
Kev Tiv Thaiv
Yuav kom tiv thaiv kev txhim kho kev phom sijteeb meem, tus neeg mob ntawm thawj lub cim ntawm mob appendicitis yuav tsum hu rau lub tsheb thauj neeg mob. Kev kuaj mob sai thiab kev cuam tshuam raws sij hawm yuav pab kom tsis txhob muaj abscess. Tsis quav ntsej cov tsos mob tuaj yeem ua rau tuag taus.
Appendicular abscess yog ib qho teeb meem loj uas tshwm sim los ntawm kev txhim kho cov txheej txheem purulent inflammatory. Thaum pib, cov tsos mob tshwm sim zoo ib yam li cov mob appendicitis. Raws li cov txheej txheem inflammatory tshwm sim, tus neeg mob lub cev kub nce mus rau theem siab, nws yuav ua tsis tau rau lub cev txav vim yog mob cramping. Nws yog ib qho tseem ceeb kom hu lub tsheb thauj neeg mob tam sim ntawd kom tsis txhob muaj kev phom sij.
