Appendicitis yog ib qho mob ntawm daim ntawv ntxiv ntawm caecum. Txawm hais tias kev txhim kho tsis tu ncua ntawm kev phais niaj hnub no, tseem muaj ntau qhov teeb meem ntawm cov kab mob no. Qhov no yog vim ob qho tib si rau kev paub txog cov pej xeem tsawg thiab tsis txaus siab nrhiav kev pab kho mob, thiab rau qee tus kws kho mob tsis tsim nyog. Yog li ntawd, cia peb saib seb tus kab mob no tshwm sim li cas thiab muaj teeb meem dab tsi tom qab mob appendicitis tuaj yeem tshwm sim.
kab mob appendicitis yog dab tsi?
Appendicitis yog ib yam kab mob uas tshwm sim los ntawm o ntawm phab ntsa ntawm lub appendix (vermiform appendix ntawm caecum). Nws yog nyob rau hauv qis sab xis ntawm lub plab, uas tseem hu ua iliac cheeb tsam. Hauv cov neeg laus lub cev, daim ntawv ntxiv tsis ua haujlwm, yog li nws tshem tawm (appendectomy) tsis ua rau tib neeg noj qab haus huv.
Feem ntau, cov kab mob ntxiv ua rau mob rau cov neeg muaj hnub nyoog tshaj 10 xyooqis dua 30.
Cov tsos mob tseem ceeb
Ua ntej peb mus ncaj qha rau qhov teeb meem tom qab mob plab hnyuv loj tuaj yeem tshwm sim, cia peb saib seb cov tsos mob twg yuav pab kom xav tias muaj mob rau lub sijhawm nrhiav kev pab kho mob.
Yog hais tias mob ntev ntawm lub plab hnyuv siab raum tsis tuaj yeem tshwm sim nws tus kheej tau ntev thiab tsis ua rau tus neeg mob tsis yooj yim, ces tus mob appendicitis muaj cov tsos mob tshwm sim:
- ntse mob hnyav nyob rau hauv lub plab sab sauv (epigastrium), uas maj mam nqis los thiab mus rau sab xis (hauv cheeb tsam iliac);
- mob hnyav thaum tig mus rau sab xis, thaum hnoos, taug kev;
- nro ntawm cov leeg ntawm phab ntsa plab anterior, uas tshwm sim vim qhov mob tshwm sim hauv tus neeg mob thaum txav cov leeg plab;
- muaj peev xwm tsub zuj zuj ntawm cov pa hauv cov hnyuv, cem quav;
- subfebrile kub (txog 37.5 °С).
Kev faib tawm ntawm cov kab mob appendicitis
Tej zaum nws tsis muaj teeb meem tiag tiag rau tus neeg ua haujlwm saib xyuas qhov mob ntawm qhov mob ntxiv rau nws qhov xwm txheej. Txawm li cas los xij, nws yog ib qho tseem ceeb heev rau tus kws phais kom paub txog hom kab mob appendicitis, vim hais tias nyob ntawm qhov no, nws muaj peev xwm txiav txim siab qhov kev cia siab ntawm cov kab mob ntxiv thiab qhov yuav tshwm sim ntawm cov teeb meem. Nws kuj txiav txim siab txog kev phais mob.
Cov kab mob appendicitis hauv qab no yog qhov txawv:
- catarrhal lossis yooj yim yog daim ntawv ntau tshaj;
- superficial;
- phlegmonous - purulent o ntawm cov txheej txheem;
- gangrenous - nrogkev loj hlob ntawm cov txheej txheem necrosis;
- perforative - nrog rau kev puas tsuaj ntawm daim ntawv ntxiv thiab nkag mus ntawm cov hnyuv hauv plab rau hauv plab kab noj hniav.
Nws yog hom phlegmonous thiab gangrenous uas yog qhov tsis zoo tshaj plaws ntawm kev txhim kho ntawm cov teeb meem. Cov kab mob appendicitis no yuav tsum tau ua tib zoo saib xyuas ntawm tus kws phais thiab kev phais tam sim ntawd. Thiab qhov perforated tsos, qhov tseeb, yog ib qho teeb meem tom qab gangrenous appendicitis.
Tseem muaj teeb meem
Cov teeb meem tom qab mob plab hnyuv tuaj yeem muab faib ua ob pawg loj.
Thawj suav nrog cov teeb meem ntawm qhov mob nws tus kheej, uas feem ntau ua rau nrhiav kev pab kho mob tsis tu ncua. Cov no yog cov teeb meem xws li:
- appendicular infiltrate - tsim ntawm cov kab mob hauv plab hnyuv, mesentery thiab lwm yam plab hnyuv ib ncig ntawm daim ntawv ntxiv;
- abscesses hauv plab kab noj hniav (hauv lub plab me me, nruab nrab ntawm txoj hnyuv, hauv qab diaphragm);
- peritonitis - mob ntawm peritoneum;
- pylephlebitis - mob ntawm cov hlab ntsha portal (ib lub nkoj uas nqa cov ntshav mus rau lub siab), nrog rau nws cov ceg.
Cov teeb meem tom qab phais mob appendicitis feem ntau tshwm sim hauv qhov txhab thiab lub plab kab noj hniav. Txawm li cas los xij, tej zaum yuav muaj teeb meem hauv kev ua pa, urogenital thiab hlab plawv.
Cov kab mob infiltrate
Thaum teb cov lus nug ntawm qhov teeb meem dab tsi tuaj yeem tshwm sim tom qab mob plab hnyuv, ua ntej ntawm tag nrho cov, nws yog ib qho tsim nyog yuav tsum tau hais txog qhov tsim ntawm appendicular infiltrate. Nws yogib pawg ntawm cov kab mob thiab cov ntaub so ntswg ntawm lub plab kab noj hniav soldered ua ke, uas txwv lub appendix los ntawm tus so ntawm lub plab kab noj hniav. Raws li txoj cai, qhov teeb meem no tshwm sim ob peb hnub tom qab pib tus kab mob.
Cov tsos mob ntawm cov teeb meem tom qab mob plab hnyuv, tshwj xeeb tshaj yog appendicular infiltrate, yog tus cwj pwm los ntawm kev txo qis ntawm qhov mob hauv plab plab. Nws yuav tsis ntse, tab sis ntau blunt, tsis muaj ib tug meej localization, nce me ntsis thaum taug kev.
Thaum palpation ntawm lub plab kab noj hniav, koj tuaj yeem hnov qhov tsim tsis meej, uas yog qhov mob. Tsis tas li ntawd, qhov infiltrate ua denser, contours ua qhov muag plooj, qhov mob ploj mus.
Cov infiltrate tuaj yeem daws tsis pub dhau ib thiab ib nrab mus rau ob lub lis piam, txawm li cas los xij, nws tuaj yeem ua rau mob plab nrog kev tsim ntawm abscess. Nrog suppuration, tus neeg mob tus mob deteriorates sharply, kub tshwm, lub plab yuav mob palpation, cov nqaij ntshiv ntawm lub plab anterior phab ntsa yog tense.
Purulent, prognostically unfavorable teeb meem tom qab appendicitis yog tsim ntawm ib tug abscess ntawm appendix. Tab sis abscesses tuaj yeem tsim tsis tau ncaj qha rau hauv cov txheej txheem, tab sis kuj nyob rau lwm qhov chaw ntawm lub plab kab noj hniav. Qhov no tshwm sim thaum lub effusion nyob rau hauv lub plab kab noj hniav yog encysted thiab tiv thaiv kev loj hlob ntawm peritonitis. Feem ntau cov duab zoo li no tshwm sim tom qab phlegmonous appendicitis.
txhawm rau kuaj xyuas qhov teeb meem no thiab tshawb nrhiav cov abscesses hauv plab kab noj hniav, nws raug nquahu kom siv ultrasound thiab suav tomography. Yog hais tias abscesstau tsim los ua ib qho teeb meem tom qab appendicitis nyob rau hauv cov poj niam, nws pelvic localization yog yam ntxwv. Tom qab ntawd nws lub xub ntiag tuaj yeem txiav txim siab siv qhov chaw mos.
Saum toj no yog CT scan ntawm phab ntsa sab hauv plab abscess.
YPurulent peritonitis thiab pylephlebitis
Ob hom teeb meem no yog qhov tsawg tshaj plaws, tab sis qhov tsis zoo tshaj plaws rau tus neeg mob. Peritonitis yog ib qho teeb meem tom qab mob plab hnyuv loj tshwm sim tsuas yog hauv 1% ntawm cov neeg mob. Tab sis nws yog qhov pathology uas yog qhov ua rau tuag rau cov neeg mob appendicitis.
Cov mob uas tsis tshua muaj tshwm sim hauv qhov mob ntawm daim ntawv ntxiv yog pylephlebitis (septic o ntawm lub portal vein). Raws li txoj cai, nws yog ib qho teeb meem tom qab phais appendectomy, txawm li cas los xij, nws tuaj yeem txhim kho txawm tias ua ntej kev phais. Nws yog tus cwj pwm los ntawm kev tsis zoo ntawm tus neeg mob, ua npaws kub, thiab lub plab mob plab heev. Yog tias cov hlab ntsha uas nkag ncaj qha rau hauv daim siab cov ntaub so ntswg puas lawm, jaundice, daim siab loj, thiab daim siab tsis ua haujlwm. Qhov feem ntau tshwm sim ntawm tus mob no yog tus neeg mob tuag.
Teeb meem tshwm sim hauv qhov txhab ua haujlwm
Thiab tam sim no peb yuav tham txog cov teeb meem tom qab phais mob appendicitis. Thawj pab pawg ntawm cov teeb meem yog cov uas txwv rau kev phais mob. Feem ntau, inflammatory infiltrates thiab suppurations tsim. Raws li txoj cai, lawv tshwm sim 2-3 hnub tom qab tshem tawm ntawm daim ntawv ntxiv, thaum qhov mob uas twb muaj lawm hauv qhov txhab rov qab los,lub cev kub nce siab, cov mob hnyav zuj zus.
Nyob rau ntawm qhov txhab, thaum cov ntaub qhwv tshem tawm, qhov liab thiab qhov o ntawm daim tawv nqaij pom, cov xov ntawm cov ntaub qhwv tom qab txiav rau hauv daim tawv nqaij. Ntawm palpation, muaj qhov mob hnyav thiab qhov ntom ntom ntom tau hnov.
Tom qab ob peb hnub, yog tias koj tsis cuam tshuam rau lub sijhawm thiab sau ntawv kho mob, cov kab mob nkag mus yuav mob. Tom qab ntawd nws cov ciam teb tsis meej, palpation tuaj yeem nthuav tawm cov tsos mob ntawm kev hloov pauv, uas ua rau muaj cov kua dej purulent. Yog tias qhov abscess tsis qhib thiab ntws tawm, nws tuaj yeem ua tau ntev. Tom qab ntawd tus neeg mob qhov mob hnyav zuj zus tuaj. Nws poob phaus, emaciated, nws qab los noj mov yog txo, cem quav tshwm sim. Tom qab ib lub sijhawm, cov txheej txheem purulent los ntawm cov ntaub so ntswg subcutaneous kis mus rau ntawm daim tawv nqaij thiab qhib nws tus kheej. Qhov no yog nrog los ntawm cov kua paug tawm thiab pab tus neeg mob tus mob.
Ntxiv rau cov teeb meem uas tau teev tseg saum toj no tom qab tshem tawm cov kab mob appendicitis, cov kab mob hauv qab no tuaj yeem tshwm sim hauv lub qhov txhab tom qab:
- hematoma;
- ntshav;
- kev sib txawv ntawm ntug.
Hematoma
Kev tswj tsis tiav ntawm cov ntshav thaum phais tuaj yeem ua rau hematoma tsim. Qhov feem ntau hauv zos yog nyob rau hauv cov rog subcutaneous, tsawg dua feem ntau muaj cov ntshav ntawm cov leeg nqaij. Hnub tom qab tom qab kev ua haujlwm, tus neeg mob raug cuam tshuam los ntawm kev mob npub ntawm qhov chaw ntawm qhov txhab, qhov kev xav ntawm lub siab. Ntawm kev ntsuam xyuas, tus kws phais txiav txim siab qhov o ntawm sab xis hauv plab, mob ntawm palpation.
rautxhawm rau tshem tawm cov txheej txheem, nws yog ib qho tsim nyog yuav tsum tau tshem tawm ib feem ntawm cov phais phais thiab tshem tawm cov ntshav txhaws. Tom ntej no, cov seams yog superimposed dua, tsau rau saum nrog ib daim ntaub qhwv. Ib qho txias yog siv rau lub qhov txhab. Nyob rau hauv cov ntaub ntawv uas cov ntshav tseem tsis tau coagulated, ib tug puncture yuav ua tau thiab lub hematoma tshem tawm los ntawm puncture. Qhov tseem ceeb ntawm kev kho mob hematoma tsis yog ncua nws, vim tias qhov txhab tuaj yeem ua rau mob, uas yuav ua rau tus neeg mob hnyav zuj zus thiab qhov kev cia siab ntawm tus kab mob.
Bleeding
Daim duab hauv kab lus qhia txog ib hom kev phais tshem tawm ntawm qhov chaw los ntshav - clipping ntawm lub nkoj.
Ib qho teeb meem txaus ntshai tuaj yeem los ntshav los ntawm cov pob txha ntawm daim ntawv ntxiv. Thaum xub thawj, nws yuav tsis tshwm sim nws tus kheej hauv txhua txoj kev, tab sis tom qab tag nrho thiab hauv zos cov cim ntawm ntshav poob tshwm.
Ntawm cov cim qhia, cov tsos mob hauv qab no yog qhov txawv:
- mob taub hau thiab kiv taub hau;
- kev qaug zog;
- tawv nqaij;
- txias hws;
- txo cov ntshav siab thiab ua kom lub plawv dhia qeeb hauv cov ntshav hnyav.
Ntawm cov kev tshwm sim hauv zos ntawm qhov teeb meem no tom qab tshem tawm cov kab mob appendicitis, cov tsos mob feem ntau yog maj mam mob hauv plab. Thaum xub thawj, nruab nrab thiab tsis cuam tshuam rau tus neeg mob, nws qhia tau tias khaus ntawm peritoneum. Tab sis yog tias cov ntshav tsis nres nyob rau lub sijhawm, qhov mob yuav muaj zog, uas yuav qhia tau tias kev loj hlob ntawm diffuse peritonitis.
Nrog rau cov ntshav ntau ntxiv hauv lub plab kab noj hniav, tus kws phais txiav txim siab qhov tsis sib xws ntawm lub plab thaum kuaj. Nrog percussion(tapping rau ntawm phab ntsa sab hauv plab) lub suab npliag yog txiav txim siab nyob rau hauv qhov chaw uas cov ntshav sib sau, lub plab zom mov perist altic yog muffled.
Yuav kom tsis txhob hnov qab qhov teeb meem no thiab muab kev pabcuam raws sijhawm rau tus neeg mob, nws yuav tsum tau kuaj xyuas cov ntsuas no tsis tu ncua:
- tus neeg mob tus mob;
- ntshav siab thiab mem tes;
- mob plab, nrog rau cov tsos mob ntawm peritoneal irritation (feem ntau thiab cov tsos mob qhia yog Shchetkin-Blumberg).
Kev kho mob nkaus xwb nyob rau hauv qhov xwm txheej no yog relaparotomy, uas yog, rov qhib lub plab phab ntsa, txiav txim qhov los ntshav thiab nres nws phais.
Infiltrate thiab abscess: kho
Yuav ua li cas kho cov teeb meem tshwm sim tom qab appendectomy?
Kev kho cov infiltrate pib nrog novocaine thaiv. Cov tshuaj tua kab mob kuj tau sau tseg, txias ntawm qhov chaw ntawm qhov tsim no. Tsis tas li ntawd, tus kws phais mob, nrog rau tus kws kho lub cev, tuaj yeem sau ntau cov txheej txheem, xws li UHF. Yog tias tag nrho cov kev ntsuas no tau siv raws sijhawm, kev rov zoo yuav tsum nyob hauv ob peb hnub.
Yog tias kev kho mob tsis pab, tus neeg mob tus mob hnyav zuj zus tuaj, thiab cov tsos mob tshwm sim tshwm sim, nws yuav tsum tau tig mus rau kev phais.
Yog tias qhov abscess tsis tob, tab sis subcutaneous, nws yuav tsum tshem tawm cov sutures, nthuav cov npoo ntawm qhov txhab thiab tshem tawm cov kua paug. Tom ntej no, lub qhov txhab yog ntim nrog swabs moistened nrog ib tug daws ntawm chloramine los yog furacilin. Yog hais tias lub abscess nyob tob rau hauv lub plab kab noj hniav, uas yog feem ntautshwm sim thaum lub abscess tau lees paub ib lub lim tiam tom qab kev ua haujlwm, nws yog ib qho tsim nyog yuav tsum tau ua laparotomy thib ob thiab tshem tawm suppuration. Tom qab ua haujlwm, nws yog ib qho tsim nyog yuav tsum tau hnav khaub ncaws txhua hnub nrog kev ntxuav lub qhov txhab nrog kev daws ntawm hydrogen peroxide, tom qab tsim cov granulation ntawm lub qhov txhab, hnav khaub ncaws nrog cov tshuaj pleev, uas ua rau kom kho sai.
Feem ntau, cov teeb meem no tsis tso tseg, txawm li cas los xij, nrog kev sib cais ntawm cov leeg, kev tsim hernia yog ua tau.
Cov poj niam uas tau mob plab hnyuv plab tuaj yeem tsim kev nkag mus ntawm lub hnab ntawm Douglas, uas yog kev nyuaj siab ntawm lub tsev menyuam thiab qhov quav. Txoj hauv kev rau kev kho mob ntawm qhov teeb meem no yog tib yam li rau kev nkag mus ntawm lwm qhov chaw. Txawm li cas los xij, ntawm no koj tuaj yeem ntxiv kev siv cov txheej txheem xws li sov enemas nrog furatsilin thiab novocaine, douching.
Teeb meem los ntawm lwm lub cev thiab lub cev
Nyob rau lub sijhawm rov qab los tom qab kev phais, tsis yog tsuas yog muaj teeb meem hauv lub qhov txhab tom qab lub qhov txhab tuaj yeem tshwm sim, tab sis kuj muaj cov kab mob ntawm lwm cov kabmob.
Yog li, thaum lub caij nplooj ntoo hlav, qhov tsos mob ntawm tus mob ntsws thiab mob ntsws yog qhov tshwm sim heev. Txoj kev tiv thaiv tseem ceeb yog kev kho mob. Nws yuav tsum tau pib sai li sai tau tom qab ua haujlwm. Nws yog ib qho tsim nyog los tiv thaiv tus neeg mob los ntawm kev pw tsaug zog hauv txaj, vim qhov no ua rau muaj qhov tshwm sim ntawm congestion hauv cov hlab ntsha. Tus neeg mob yuav tsum khoov thiab khoov ob txhais ceg, tig los ntawm sab mus rau sab, ua kev ua pa. Txhawm rau tswj qhov tsis tu ncua thiab raug ntawm kev tawm dag zog hauv tsev kho mob,ua ib tug Methodist. Yog tias tsis muaj, kev tswj hwm kev tawm dag zog yog nrog tus kws saib xyuas neeg mob ntawm lub tuam tsev.
Yog tias muaj teeb meem pulmonary txawm li cas los xij, kev kho tshuaj tua kab mob, expectorants thiab hnoos qeev (mucolytics) raug tshuaj.
Ib qho teeb meem tom qab laparoscopy ntawm appendicitis yog mob urinary tuav. Nws ua rau muaj peev xwm ua tau ob qho tib si cuam tshuam rau cov paj hlwb plexuses los ntawm sab ntawm lub qhov txhab phais, thiab tus neeg mob lub cev tsis muaj peev xwm mus rau hauv chav dej hauv txoj hauj lwm supine. Thiab txawm hais tias cov kws phais mob tsis tu ncua txaus siab rau tus neeg mob txog nws qhov tso zis, qee cov neeg mob txaj muag los tham txog qhov teeb meem no. Nyob rau hauv cov xwm txheej zoo li no, tus kws phais yuav pom qhov nro thiab o hauv thaj tsam suprapubic, tus neeg mob muaj mob hauv plab plab.
Tom qab catheterization thiab tshem tawm cov ntsiab lus ntawm lub zais zis, tag nrho cov kev tsis txaus siab ploj mus, tus neeg mob tus mob zoo dua. Txawm li cas los xij, ua ntej siv catheterization, cov txheej txheem yooj yim tuaj yeem siv tau. Qee zaum, tom qab tus neeg mob muab tso rau ntawm nws txhais taw, ib qho kev tso zis tshwm sim. Nws tseem tuaj yeem siv cov ntaub qhwv cua sov rau ntawm lub plab plab, diuretics.
Postoperative teeb meem hauv me nyuam
Hmoov tsis zoo, tam sim no, feem pua ntawm cov teeb meem tom qab kev phais mob hauv cov menyuam yaus hnub nyoog qis dua peb xyoos raug txiav txim siab - los ntawm 10 mus rau 30%. Qhov no yog vim qhov mob hnyav dua thiab kev txhim kho ntau zaus ntawm cov kab mob appendicitis.
Ntawm cov teeb meem tom qab mob plab hnyuv hauv cov menyuam yaus, cov kab mob hauv qab no feem ntau tshwm sim:
- infiltration thiababscess;
- postoperative ileus vim yog adhesion tsim;
- plab fistula;
- protracted course of peritonitis.
Hmoov tsis zoo, cov menyuam yaus feem ntau yuav tuag tom qab phais dua li cov laus.
Txawm hais tias muaj teeb meem los ntawm mob plab hnyuv loj zuj zus hnub no, nws tseem ceeb heev kom paub lawv cov tsos mob kom tiv thaiv qhov tshwm sim txaus ntshai.
