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脓疡

脓疡(英语:abscess)又称脓肿,是组织器官体腔内的局限性化脓性炎症,外有脓肿膜包裹形成腔壁,内为脓液积聚的脓腔。主要特征是组织发生溶解坏死形成脓液,由于凝固酶的作用使病变局限形成脓腔,腔内脓液包括渗出液、细菌、坏死组织等[1]。一旦形成,应考虑切开引流。

接近体表的脓疡会有红、肿、热、痛等症状,触诊病灶时感觉其内部充满液体[1],皮肤发红的范围常比肿起的范围更大[2]。常见的体表脓疡包括发生在毛囊[3](影响范围较大)与(影响范围较小)等[4]

脓疡源自病原菌感染[5],在病灶处常有许多不同种的细菌同时感染[2]。在美国与世界许多地区里,在脓疡中最常见的菌种是抗药性金黄色葡萄球菌[1],在发展中国家偶尔也可见到由寄生虫引起的脓疡[6]。通常诊断要从外型以及切开后观察确定[1]超声波在无法确定诊断时或许有帮助[1],而更为深处的脓疡则可能需要以磁共振成像[7][8]电脑断层才能发现[6](比如说肛门脓疡英语anorectal abscess道格拉斯脓肿德语Douglas-Raum#Douglas-Abszess等)[9]

皮肤与软组织脓疡的标准治疗方式是切开引流英语incision and drainage[10]抗生素治疗对于原先健康的患者而言并没有帮助[1]。有少量的证据支持在引流后不用纱布填塞留下的空腔[1]。相对于等待其自行愈合,在引流后缝合空腔可能加速愈合且不会增加脓疡复发的机会[11]。单以针头进行引流而不进行切开常无法将脓疡引流干净[12]

近年来皮肤脓疡是常见的疾病,而且还有更为盛行的趋势[1]。罹患皮肤脓疡的风险因子主要是施打静脉药物英语drug injection,这个族群的皮肤脓疡盛行率有65%[13] 。2005年美国有三百二十万人因皮肤脓疡而至急诊就诊[14],而在澳洲,2008年有一万三千人因皮肤脓疡而住院治疗[15]

形成原因

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皮肤在感染过程在(死的中性白血球)周围形成的区域。这是一种防御性的组织反应,以防止感染性物质扩散到身体的其他部位。脓肿的最终结构是脓肿壁,或脓肿囊,由毗邻的健康细胞形成,以阻止脓感染周围的组织

参考来源

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  1. ^ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Singer, AJ; Talan, DA. Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus.. The New England journal of medicine. Mar 13, 2014, 370 (11): 1039–47. PMID 24620867. 
  2. ^ 2.0 2.1 Elston, Dirk M. Infectious Diseases of the Skin.. London: Manson Pub. 2009: 12 [2015-01-06]. ISBN 9781840765144. (原始内容存档于2014-10-30). 
  3. ^ Schiergens, Tobias. Grundlagen. BASICS Chirurgie Auflage 3. München, BY, Deuschland: Urban & Fischer Verlag/Elsevier GmbH. 2015: 27. ISBN 3437425188. 
  4. ^ Marx, John A. Marx. Dermatologic Presentations. Rosen's emergency medicine : concepts and clinical practice 8th ed. Philadelphia, PA: Elsevier/Saunders. 2014: Chapter 120. ISBN 1455706051. 
  5. ^ Cox, Carol Turkington, Jeffrey S. Dover ; medical illustrations, Birck. The encyclopedia of skin and skin disorders 3rd ed. New York, NY: Facts on File. 2007: 1 [2015-01-06]. ISBN 9780816075096. (原始内容存档于2020-01-25). 
  6. ^ 6.0 6.1 Marx, John A. Marx. Skin and Soft Tissue Infections. Rosen's emergency medicine : concepts and clinical practice 8th ed. Philadelphia, PA: Elsevier/Saunders. 2014: Chapter 137. ISBN 1455706051. 
  7. ^ 李娜; 程悦; 沈文. 多参数 MRI 对前列腺脓肿的诊断价值.. 实用放射学杂志. 2014年12期, 2014 (12): 2016–9. doi:10.3969/j.issn.1002-1671.2014.12.018. 
  8. ^ Smith, GA; Kochar AS; Manjila S; Onwuzulike K; Geertman RT; Anderson JS; Steinmetz MP. Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques.. Neurosurgical focus. Aug 2014, 37 (2): E11. PMID 25081960. 
  9. ^ 陈愈彬, 杨钦泰; 王涛; 黎景佳; 叶进; 刘贤; 张革化. 增强CT对扁桃体内与扁桃体周围脓肿的鉴别诊断价值.. 中华耳鼻咽喉头颈外科杂志. 2014年2期, 49 (2): 131–5. doi:10.3760/cma.j.issn.1673-0860.2014.02.008. 
  10. ^ American College of Emergency Physicians, Five Things Physicians and Patients Should Question, Choosing Wisely: an initiative of the ABIM Foundation (American College of Emergency Physicians), [January 24, 2014], (原始内容存档于2015-04-14) 
  11. ^ Singer, AJ; Thode HC, Jr; Chale, S; Taira, BR; Lee, C. Primary closure of cutaneous abscesses: a systematic review.. The American journal of emergency medicine. May 2011, 29 (4): 361–6. PMID 20825801. 
  12. ^ Füessl, HS. Ubi pus,ibi evacua–und dann?. MMW - Fortschritte der Medizin. Okt 2014, 156 (17): 44. doi:10.1007/s15006-014-3522-8. 
  13. ^ Langrod, Pedro Ruiz, Eric C. Strain, John G. The substance abuse handbook. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2007: 373 [2015-01-06]. ISBN 9780781760454. (原始内容存档于2014-10-31). 
  14. ^ Taira, BR; Singer, AJ; Thode HC, Jr; Lee, CC. National epidemiology of cutaneous abscesses: 1996 to 2005.. The American journal of emergency medicine. Mar 2009, 27 (3): 289–92. PMID 19328372. 
  15. ^ Vaska, VL; Nimmo, GR; Jones, M; Grimwood, K; Paterson, DL. Increases in Australian cutaneous abscess hospitalisations: 1999-2008.. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. Jan 2012, 31 (1): 93–6. PMID 21553298. 

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脓疡
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