Parapharyngeal thiab retropharyngeal abscesses, zoo li paratonsillar abscesses, yog cov teeb meem ntawm cov txheej txheem inflammatory hauv qhov ncauj kab noj hniav thiab nasopharynx, feem ntau cuam tshuam rau palatine tonsils. Yog tias cov teeb meem txaus ntshai no tshwm sim, koj yuav tsum hu rau tus kws kho mob otolaryngologist tam sim.
Definition of concept
Abscess yog cov txheej txheem purulent inflammatory hauv cov ntaub so ntswg uas tshwm sim los ntawm kev kis kab mob, nrog rau kev puas tsuaj rau cov ntaub so ntswg, cov tsos ntawm cov kab noj hniav uas muaj cov kua qaub, feem ntau tshwm sim hauv cov rog subcutaneous, cov leeg, cov plab hnyuv siab raum thiab qhov chaw nruab nrab ntawm lawv.
Tau txhais lub tswv yim, peb tuaj yeem hais tias parapharyngeal abscess yog qhov tsim muaj fiber ntau hauv qhov chaw peripharyngeal. Qhov chaw yog txwv los ntawm phab ntsa sab nraud ntawm lub pharynx, sab hauv ntawm lub mandible, lub prevertebral fascia, thiab lub fascia ntawm parotid salivary caj pas. Qhov chaw parapharyngeal yog ntim nrog cov ntaub so ntswg uas muaj cov hlab ntsha thiab cov hlab ntsha, thiab muaj kev tawm mus rau mediastinum.
Caus ntawm parapharyngeal abscess
Lawv yog:
- Pharyngitis thiab tom qab mob ntawm qhov chaw pharyngeal tshwm sim los ntawm cov kab mob (staphylococci, streptococci, E. coli thiab lwm yam) tuaj yeem ua rau cov kua paug tawm mus ntxiv raws lub caj dab.
- Tonsillitis nrog kev kho tsis txaus tuaj yeem ua rau hnyav dua los ntawm paratonsillar abscess uas dhau mus rau qhov chaw peripharyngeal.
- Mastoiditis (mob ntawm cov txheej txheem mastoid) los ntawm cov tympanomastoid fissure tuaj yeem kis tus kab mob mus rau cov ntaub so ntswg peripharyngeal.
- Periodontitis - qhov tsos ntawm purulent kab noj hniav nyob rau saum cov hauv paus hniav ntawm cov hniav. Yog hais tias qhov no pathology tsis kho, ces tus txheej txheem kis mus rau lub puab tsaig. Thiab txij li lub puab tsaig qis yog ib qho ntawm cov ciam teb ntawm qhov chaw peripharyngeal, ib qho abscess tuaj yeem tsim nyob rau hauv nws, kis los ntawm lub puab tsaig.
- Purulent otitis media, tau mus txog parotid salivary caj pas, nkag mus rau hauv qhov chaw parapharyngeal, ua rau cov txheej txheem inflammatory.
- Kev raug mob rau caj dab los ntawm cov khoom ntse kis tau thiab ua rau lub caj pas abscess. Kev puas tsuaj tuaj yeem tshwm sim thaum qhib qhov paratonsillar abscess, thaum lub ntsuas ntsuas tau nkag mus tob dhau los ntawm phab ntsa ntawm lub pharynx mus rau qhov chaw peripharyngeal.
Kev kho mob tshwm sim
Ib tus kab mob parapharyngeal abscess yog tus yam ntxwv los ntawm qhov mob hnyav hauv caj pas, qhia ntau dua los ntawm sabswb. Qhov mob hnyav dua thaum nqos qaub ncaug, haus dej thiab zaub mov. Cov nqaij ntshiv yog compressed kom lub qhov ncauj qhib nyuaj. Qhov no hu ua trismus. Mob los ntawm caj pas tuaj yeem tawg mus rau pob ntseg, sab hauv lub puab tsaig, taub hau. Txhawm rau txo qhov mob, cov neeg mob feem ntau qaij lawv lub taub hau mus rau sab qhov chaw uas muaj kab mob. Yog tias koj hnov lub caj dab los ntawm sab no, ces qhov o yog txiav txim siab, qhov mob hnyav zuj zus tuaj, pom cov qog nqaij hlav rhiab heev.
Muaj kev puas tsuaj loj hauv kev noj qab haus huv. Lub cev kub nce mus txog cov cim pyretic (ntau dua 39 degrees). Muaj cov cim tsis muaj zog, mob lub cev, tawm hws, ua daus no, mob taub hau. Kev qab los noj mov tsis zoo, thiab yuav ploj mus tag nrho, vim qhov mob nws tsis tuaj yeem nqos zaub mov. Tsis tas li ntawd, muaj ntau ntau cov qaub ncaug, qhov tsis xis nyob thaum nqos uas ua rau tus neeg mob hnoos nws tawm.
Dab tsi yog qhov txawv ntawm pathologies?
Ib tus kab mob parapharyngeal abscess yog ib lub caj pas abscess uas tsim nyob rau sab ntawm lub pharynx. Lub tsev kho mob thiab nws qhov chaw nyob tau piav qhia saum toj no.
A retropharyngeal abscess tuaj yeem tshwm sim hauv qhov chaw pharyngeal raws li qhov teeb meem ntawm pharyngitis, tonsillitis, purulent otitis media, osteomyelitis ntawm lub ncauj tsev menyuam vertebrae, qhov txhab ntawm cov qog ntshav nyob tom qab pharynx nrog tuberculosis, qhua pias, kub cev, vim rau kev raug mob rau phab ntsa tom qab pharyngeal thaum tshem tawm adenoids hauv cov menyuam yaus. Nws yog ntau dua nyob rau hauv thaum yau vim yog cov yam ntxwv ntawm cov lymphatic system.nasopharynx. Clinically pib nrog intoxication manifestations zoo ib yam li parapharyngeal abscess. Yog tias qhov abscess tsawg txaus, ces nws tuaj yeem ua rau ua txhaum ntawm kev ua pa vim kev koom tes ntawm lub larynx.
Qhov ua rau thiab cov tsos mob ntawm paratonsillar abscess zoo ib yam li cov kab mob yav dhau los. Nws yog tsim raws li qhov teeb meem ntawm tonsillitis (mob thiab mob ntev), periodontitis, pharyngitis, otitis media. Ib qho abscess tuaj yeem nyob ntawm qhov sib txawv ntawm qhov sib txawv ntawm palatine tonsil: nyob saum nws, qab, hauv qab tonsil, ntawm sab ntawm phab ntsa pharyngeal. Mob thiab spasm ntawm cov leeg masticatory yog yam ntxwv ntawm hom purulent lesion. Tus mob thiab qab los noj mov deteriorate heev, lub articulation ntawm kev hais lus yog cuam tshuam, muaj ib tug nce thiab mob ntawm lymph nodes nyob rau hauv lub puab tsaig thiab ntawm caj dab. Mob ua rau nws nyuaj rau tus neeg mob tig taub hau.
Kev nyuaj siab
Abscesses feem ntau lawv tus kheej muaj teeb meem ntawm cov txheej txheem inflammatory, tab sis qhov no tsis yog qhov txwv. Kev kis kab mob ntxiv tuaj yeem ua rau muaj qhov hnyav dua ntawm qhov xwm txheej. Ib qho ntawm cov kab mob no tuaj yeem ua rau tus neeg mob tuag. Nws tsis tuaj yeem ncua kev kho mob!
Edema ntawm lub larynx tuaj yeem dhau los ua ib qho teeb meem loj ntawm ib qho ntawm cov kab mob uas tau teev tseg vim kev kis kab mob thiab cov tshuaj tiv thaiv ntawm phab ntsa mucosal ntawm lub cev. Cov teeb meem yog nrog los ntawm kev mob hawb pob.
Thaum tus kab mob kis mus raws qhov chaw peripharyngeal ntawm lub caj dab mus rau mediastinum, cov kabmob uas nyob ntawd, suav nrog lub plawv, raug cuam tshuam.
Kev kis kab mob raws li cov kab mob neurovascular ua rau o ntawm cov leeg thiab cov hlab ntsha. Qhov no tuaj yeem ua rau thrombosis, uastxaus ntshai stroke thiab pulmonary thromboembolism. Kev puas tsuaj rau phab ntsa vascular los ntawm kev kis kab mob yog qhov nyuaj los ntawm cov los ntshav sab hauv, lub zog uas yuav nyob ntawm txoj kab uas hla ntawm lub nkoj.
Kev sib ze rau lub hlwb muaj kev pheej hmoo ntawm kev mob ntawm meninges - meningitis, nrog rau medulla nws tus kheej (encephalitis).
Vim muaj cov ntshav txaus ntawm nasopharynx, tus kab mob tuaj yeem nkag mus rau hauv lub cev tsis zoo, kis mus thoob plaws lub cev, ua rau mob sepsis, ua rau cov foci thib ob hauv lub cev.
Diagnosis
Yog hais tias tsis xis nyob hauv caj pas, spasm ntawm lub puab tsaig ntawm lub puab tsaig, nqos dej thiab lub cev kub, yuav tsum tau sab laj nrog kws kho mob otolaryngologist.
Nrog kev pab los ntawm pharyngoscopy (kev kuaj mob ntawm lub pharynx), tus kws kho mob yuav pom nrog ib tug parapharyngeal abscess ib tug pronounced reddening ntawm nws sab phab ntsa, nrog rau o thiab hyperemia ntawm lwm yam ntawm lub qhov ncauj - tonsils, uvula, soft palate, bulging ntawm palatine tonsil yog ua tau. Lub caj dab ntawm palpation ntawm sab ntawm qhov txhab yog mob heev. Tib yam siv rau cov qog nqaij hlav hauv tsev menyuam.
Nrog cov kab mob retropharyngeal abscess, phab ntsa tom qab ntawm lub pharynx yog edematous, liab, nws protrusion thiab fluctuation ntawm cov kua txiv tuaj yeem pom.
Nrog paratonsillar abscess, kev kuaj xyuas yuav pom qhov nce hauv palatine tonsil, kuaj pom cov paug tawm. Mob caj dab thiab cov qog ntshav tau hais tawm.
Lub caj pas swab tuaj yeem kuaj cov kab mob pathogenic uas ua rau cov txheej txheem abscessing.
Hauv kev kuaj ntshav dav dav - leukocytosis txog li 20 txhiab, kev hloov pauv hauv cov mis leukocyte hauvrau cov ntaub ntawv hluas ntawm leukocytes, nce ESR mus txog 40 mm / teev.
X-ray ntawm caj dab yog ua tiav hauv ob qhov projections. Cov duab yuav qhia txog cov kua paug. Nyob rau hauv cov ntaub ntawv ntawm kev nyuaj, kev ntsuam xyuas yuav tsum tau ntxaum los ntawm magnetic resonance los yog xam tomography ntawm lub caj dab thiab lub taub hau.
Kev kho mob ntawm parapharyngeal abscess
Cov neeg mob caj pas yuav tsum tau mus pw hauv tsev kho mob 90% ntawm lub sijhawm. Kev kho tus kab mob parapharyngeal abscess nyob ntawm qhov ua rau ua rau nws. Ntawd yog, kev kho cov kab mob tua kab mob yuav tsum coj mus rau hauv tus account lub spectrum ntawm cov kab mob uas tau ua kom tus kab mob. Cov tshuaj tua kab mob los ntawm cov pab pawg penicillin, cephalosporins, macrolides, carbapenems thiab metronidazole tau sau tseg. Feem ntau, kev kho infusion nrog saline daws thiab qabzib yog xav tau los daws kev qaug cawv. Cov tsos mob: tshuaj tua kab mob, tshuaj tua kab mob, tshuaj tua kab mob. Irrigation ntawm lub qhov ncauj thiab caj pas nrog antiseptic npaj nyob rau hauv kev daws. Physiotherapy (Magnet, UHF).
kev kho mob phais
Feem ntau, kev phais mob ntxiv rau kev kho mob ntawm cov tsos mob parapharyngeal abscess kom sai sai rau tus neeg mob.
Ib tus kab mob parapharyngeal tuaj yeem qhib tau ob txoj hauv kev. Nrog rau qhov me me abscess, qhov no yog ua tiav los ntawm lub qhov ncauj nrog cov tsis ntse forceps los yog ib qho muag muag kom tiv thaiv kev raug mob rau cov qauv nyob ze. Yog hais tias abscess loj, ces nws yog tsim nyog los txiav nws nrogsab nrauv raws ntug ntug ntawm cov leeg sternocleidomastoid, mus tob rau lub kaum sab xis ntawm lub puab tsaig. Cov kab mob purulent yuav tsum tau ntxuav nrog cov tshuaj tua kab mob thiab cov roj hmab yuav tsum tau tso tseg kom ntws tawm.
Retropharyngeal abscess raug txiav ntawm qhov chaw ntawm qhov mob loj tshaj plaws, qhov txhab raug ntxuav.
Paratonsillar abscess yog qhib nyob rau hauv cov tshuaj loog hauv zos los ntawm lub qhov ncauj, thawb cov ntaub so ntswg sib nrug nrog lub forceps kom tsis txhob muaj kev puas tsuaj rau cov hlab ntsha. Tom qab tshem tawm cov kua paug
kab noj hniav yog ntxuav nrog tshuaj tua kab mob thiab tshuaj tua kab mob.
Kev Tiv Thaiv
Nws suav nrog cov haujlwm hauv qab no:
- Kev kho mob raws sijhawm ntawm cov txheej txheem mob hauv nasopharynx (pharyngitis, rhinitis, tonsillitis).
- Kev tiv thaiv tsis tu ncua ntawm kev mob ntev ntawm cov kab mob ENT, nrog rau cov kab mob hnyav (hloov ntawm rhinitis rau sinusitis, otitis externa mus rau nruab nrab).
- mus ntsib kws kho hniav raws sij hawm nrog kev kho mob ntawm cov hniav carious, thiaj li tsis txhob coj cov kab mob mus rau pulpitis thiab periodontitis. Tshem tawm cov hniav lwj.
- Txhim kho lub cev los ntawm kev kho dej tawv.
- Kev tiv thaiv kev tiv thaiv los ntawm kev kho cov vitamin thiab kev txhaj tshuaj txhua hnub.
- mus saib cov kis las.
- tawm mus sab nraum zoov.
- Qu haus luam yeeb.
- noj qab nyob zoo.
