Gangrenous appendicitis yog ib hom kab mob uas muaj cov ntaub so ntswg necrosis ntawm vermiform ntu thiab cov duab kho mob, uas ua rau nws muaj peev xwm sib txawv ntawm lwm hom ntawm cov txheej txheem inflammatory ncaj qha rau hauv daim ntawv ntxiv. Feem ntau, nws yog mob hnyav thiab provokes kev loj hlob ntawm kev mob hnyav heev. Tias yog vim li cas nws thiaj li tseem ceeb heev kom nrhiav kev pab los ntawm kws kho mob raws sij hawm, leej twg yuav txiav txim seb qhov ua rau ntawm cov txheej txheem pathological thiab muab tshuaj kho.
cov ntaub ntawv dav dav
Gangrenous appendicitis yog ib hom kab mob purulent variant ntawm o ntawm lub appendix, uas yog raws li kev puas tsuaj irreversible. Feem ntau, cov kev hloov ntawm ib tug necrotic xwm yog pom nyob rau hauv me me qhov chaw ntawm lub appendix. Gangrenous o yog ib hom mob sib txawv ntawm tus kab mob thiab tshwm sim tsuas yog nyob rau qee theem ntawm nws txoj kev loj hlob (2-3 hnub ntawm qhov mob).
Qhov laj thawj tseem ceeb ntawm pathology
Tus mob gangrenous appendicitis tshwm sim thaum cov txheej txheem inflammatory hauv cov txheej txheem tsis pom nyob rau thawj hnub. Ceslub cev rhiab heev ntawm lub paj hlwb ploj, yog li qhov mob syndrome yuav ploj mus. Ntau tus neeg mob txiav txim siab tias qhov txaus ntshai dhau lawm, koj tuaj yeem ncua sijhawm mus ntsib kws kho mob ib ntus. Qhov kev tsis saib xyuas ntawm tus kheej txoj kev noj qab haus huv tuaj yeem ua rau peritonitis.
Qhov tseem ceeb txaus ntshai rau qhov tshwm sim ntawm cov kab mob no, cov kws tshaj lij suav nrog cov hauv qab no:
- Nyob zoo ib tsoom phooj ywg.
- Clot formation.
- Atherosclerosis ntawm plab hnyuv.
Tag nrho cov xwm txheej no qhia tias qhov ua rau tam sim ntawm kev loj hlob ntawm pathology yog qhov hu ua microcirculatory ntshawv siab. Lawv cov txiaj ntsig yog kev ua txhaum ntawm cov ntshav ncig, vim li ntawd - necrosis ntawm cov txheej txheem. Lwm cov ntsiab lus ntawm pathogenesis (kab mob, autoaggression ntawm lub cev tiv thaiv kab mob) koom tsuas yog nyob rau hauv qhov chaw thib ob, tsuas yog aggravating lub chav kawm ntawm pathology.
Cov cim qhia dab tsi qhia txog kev mob ntshav qab zib?
Nyob rau lub sijhawm mob hnyav, ntuav rov tshwm sim, uas ua rau tus neeg mob tas li thiab tsis ua rau lub sijhawm tos ntev. Vim yog intoxication ntawm lub cev vim yog kev loj hlob ntawm ib tug putrefactive inflammatory txheej txheem, qhov kub thiab txias tej zaum yuav zoo li qub los yog qis.
Gangrenous appendicitis manifests as toxic scissors syndrome. Tus neeg mob muaj lub suab tachycardia (lub plawv dhia li ntawm 100 tus neeg ntaus ib feeb), tab sis qhov kub tsis nce.
Tus neeg mob tus nplaig qhuav nrog cov yam ntxwv daj txheej. Nyob rau hauv rooj plaub thawj gangrenous appendicitis, cov tsos mob yuav txawv me ntsis:
- mob tsis xis nyob hauv thaj tsam iliac, uas tam sim ntawd tshwm thiab sai sai.
- Lub plab mob hnyav, mob.
- Tus neeg mob tus mob yog qhov hnyav.
Yog tias ib tug neeg tsis tau txais kev kho mob txaus thiab raws sijhawm, tom qab tus kab mob no tshwm sim, cov kab mob gangrenous-perforated appendicitis tshwm sim. Pathology yog tus cwj pwm los ntawm perforation ntawm phab ntsa ntawm lub appendix nws tus kheej. Thaum lub sij hawm ntawm nws tam sim ntawd rupture, ib tug neeg muaj mob hnyav, uas dhau sij hawm pib maj mam kis mus rau hauv lub plab mog. Vim qhov nce intoxication ntawm lub cev, qhov kub thiab txias nce, pom tseeb tachycardia tshwm. Tus nplaig yuav qhuav heev, txheej acquires brownish tint. Tus neeg mob ntuav heev.
ntsuas ntsuas
Yog tias koj muaj cov tsos mob saum toj no, koj yuav tsum nrhiav kev pab kho mob tam sim ntawd. Yog tias xav tias pathology no, tus kws kho mob tshwj xeeb pib kuaj lub cev ntawm tus neeg mob. Ntawm palpation, raws li txoj cai, nro ntawm lub plab phab ntsa yog pom, lub plab yog me ntsis o. Tom qab ntawd ib qho kev sim kuaj ntshav yuav raug txiav txim, suav nrog kev kuaj ntshav thiab zis. Tsis tas li ntawd, ultrasound, X-ray thiab xam tomography yuav tsum tau. Raws li cov txiaj ntsig ntawm kev sim, tus kws kho mob tuaj yeem paub meej tias qhov kev kuaj mob gangrenous appendicitis.
txoj kev kho
Kev kho mob koom nrogphais tshem tawm ntawm daim ntawv ntxiv. Appendectomy yog ua nyob rau hauv ib txwm txoj kev los yog los ntawm laparoscopy.
Thawj kis, tus kws kho mob tshem tawm cov kab mob ntxiv los ntawm kev phais hauv phab ntsa plab. Feem ntau, cov txheej txheem no yog ua los ntawm kev siv tshuaj loog.
Kev phais mob rau cov kab mob appendicitis los ntawm laparoscopy yog tus cwj pwm los ntawm kev raug mob tsawg. Tus kws phais ua rau ob peb lub microscopic punctures nyob rau hauv lub plab phab ntsa, los ntawm cov cuab yeej rau manipulation yog tso. Qhov tseem ceeb tshaj plaws ntawm cov no yog laparoscope - lub raj nrog lub koob yees duab kawg. Thaum lub sijhawm ua haujlwm, tus kws kho mob tau txais cov duab los ntawm nws ntawm lub computer screen, uas tso cai rau kev phais kom raug tshaj plaws.
Post-operative period
Lub sijhawm tom qab phais hauv cov neeg mob uas muaj qhov kev kuaj mob zoo li no muaj ntau yam nta:
- Siv tshuaj tua kab mob thiab tshuaj kho mob.
- Kev kho mob detoxification siv cov tshuaj saline, refortan, qabzib thiab albumin.
- kuaj ntshav txhua hnub.
- Tiv thaiv kab mob thiab kab mob thromboembolic. Hauv lub sijhawm postoperative, cov neeg mob tau sau tshuaj blockers ntawm gastric secretion ("Kvamatel", "Omez"), anticoagulants ("Clexane").
- hnav khaub ncaws txhua hnub thiab ntxuav qhov txhab.
- kev kho mob, zaws tshwj xeeb, ua pa tawm ua pa.
Kev phais mob plab hnyuv plab yog qhov kev phais mob hnyav heev. Txhawm rau tiv thaiv kev txhim kho cov teeb meem yav tom ntej, koj yuav tsum sivcov lus qhia hauv qab no.
Cia tham txog kev noj haus
Cov kab mob no yog tus yam ntxwv los ntawm cov teeb meem nrog txoj hnyuv, yog li tom qab kev phais, yuav tsum tau them nyiaj tshwj xeeb rau kev noj haus.
Nyob rau thawj hnub, yogurt muaj roj tsawg, cov dej ntxhia uas tsis muaj roj thiab lub teeb nqaij qaib broth tau tso cai. Hnub ob, yog tias lub sijhawm postoperative tsis nyuaj los ntawm qhov tshwm sim tsis zoo, koj tuaj yeem ntxiv cov qos yaj ywm mashed, kua cereals ntawm dej thiab tsev cheese casserole rau kev noj haus. Ib hnub tom qab, zaub mov yuav tsum muaj ntau haiv neeg raws li kev noj haus No. 5. Nws yog qhov zoo dua tso cov khoom noj rog, ntsim thiab cov nqaij haus luam yeeb.
Yuav Muaj Teeb Meem
Cov kab mob no suav tias yog qhov txaus ntshai heev, vim nws tuaj yeem ua rau muaj kev phom sij txaus ntshai heev. Cov txheej txheem no tseem ceeb tshwj xeeb rau cov neeg mob hluas.
Dab tsi yog qhov tshwm sim ntawm gangrenous appendicitis?
- YPurulent peritonitis. Qhov no yog ib yam mob txaus ntshai heev uas yuav tsum tau muaj kev phais mob tam sim ntawd. Yog tias tsis muaj kev pab raws sijhawm, yuav muaj ntshav lom.
- Tshuaj infiltrate. Nyob rau hauv cheeb tsam ntawm cov txheej txheem o, ib lub zos conglomerate yog maj mam tsim, muaj feem ntau ntawm cov kabmob thiab cov ntaub so ntswg. Qhov teeb meem no ib txwm xav tau kev kho mob mus sij hawm ntev.
- Septic thrombophlebitis. Cov txheej txheem inflammatory tsim nyob rau hauv cov phab ntsa venous. Raws li qhov tshwm sim, nws ua rau tsim cov ntshav txhaws hauv lumen ntawm cov leeg.
- Local purulent abscess. Xws li formations mas tsim nyob rau hauv cheeb tsam ntawm lub diaphragm.
Kab mob appendicitis yuav tsum tsis txhob ignored. Lub purulent gangrenous variant ntawm no pathology yuav tsum tau kho tam sim ntawd. Txwv tsis pub, qhov tshwm sim ntawm qhov teeb meem thiab txawm tias tuag nce. Xws li qhov mob yog qhov txaus ntshai tshwj xeeb rau cov menyuam yaus, hauv lawv tag nrho cov txheej txheem pathological txuas ntxiv sai dua.
