Fibro-cavernous tuberculosis: cov tsos mob thiab kev kho mob. Kev tiv thaiv thiab lub tswv yim

Fibrocavernous pulmonary tuberculosis - ib tug puas tus kab mob, lub txwm ntawm uas nws yog ib lub nyob rau hauv lub cais ntsws kab noj hniav. Nyob rau hauv cov tshuaj, nws yog hu ua "kab noj hniav". Kev txom nyem yog ib kauj ruam nyob rau hauv lub mob ntawm pulmonary tuberculosis. Feem ntau, xws li ib tug pathology lub tsev kho mob yog erased cim.

Nta ntawm tus kab mob no

Feem ntau, fibrous-cavernous tuberculosis cai nyob rau hauv neeg laus cov neeg mob. Nyob rau hauv thaum yau, thawj TB mob tsis tshua muaj heev.

Cavernous pathology ua raws li cov sij hawm ntawm infiltrative tuberculosis, tab sis nws tshwm sim hais tias muaj disseminated los yog patchy, lub hom pathology.

Fibrocavernous daim ntawv kuaj nyob rau hauv 5% ntawm cov neeg ntawm tuberculosis.

Cavernous tuberculosis raws li ib tug stepping pob zeb rau txoj kev loj hlob ntawm fibro-cavernous pathology

Ib tug yam ntxwv feature ntawm pathomorphological cavernous tuberculosis yog muaj ib zaug xwb kab noj hniav, tsis muaj mob thiab fibrotic hloov nyob rau hauv lub bronchi, qog cov hlab ntsha thiab surrounding cov ntaub so ntswg. Tus kab mob yog tsis ntau tshaj li 2 xyoos.

caverns zoo muaj tshwm sim nrog lub tsim ntawm:

• rumen;
• tuberculoma;
• ib tsom xam ntawm tuberculosis;
• tsau tshuaj kab noj hniav.

Nyob rau hauv lub qhaj ntawv ntawm kom zoo txoj kev kho cavernous tau daim ntawv mus nyob rau hauv fibrocavernous tuberculosis, fibrosis uas yog xam qhovkev nyob rau hauv cov phab ntsa hauv cov kab noj hniav thiab surrounding ntsws parenchyma. Tsis tas li ntawd cai ntau foci ntawm kab mob sib kis.

symptomatology ntawm tus kab mob

Feem ntau, fibrous-cavernous tuberculosis yog laus nyob rau hauv ib tug mob ntsws. Cov kev loj hlob ntawm tus kab mob no tshwm sim nyob rau 3-4 lub hlis ntawm tawg paj txi txiv txoj kev kho ntawm lwm hom ntawm tus kab mob ntsws. Txoj kev ua ntawm tus kab mob yog tshwj xeeb yog kaj nyob rau hauv lwj theem.

Lub ntsiab tsos mob ntawm tus kab mob no yuav muab suav hais tias:

• asthenia;
• tsis qab los noj mov;
• tsis muaj zog hnoos;
• hnoos tau ntshav;
• los ntshav;
• crackles nyob rau hauv lub cev qhuav dej ntawm cov kab noj hniav.

Tom qab tsim ntawm cov kab noj hniav tsos mob ua scarce, Cia li hnov thiab nonspecific. Tus neeg mob tej zaum yuav tsis txaus siab ntawm lub tuam tsis muaj zog, qhov nkees, poob phaus, thiab muaj cov uas tsis muaj qib tshav kub.

Nyob rau hauv txoj kev loj hlob ntawm latent TB tej zaum yuav qhia los ntshav nyob rau hauv lub ntsws uas muaj rau cov tsis muaj yog vim li cas.

Anamnesis ntawm cov neeg mob kev txom nyem los fibro-cavernous tuberculosis implies fluctuating kawg. Team sib ntawm mob thiab zam txim rau lub sij hawm tej zaum yuav ntev txaus los yog, conversely, cov mob theem yuav tshwm sim feem ntau heev.

Fibro-cavitary tuberculosis muaj ntau yam kev soj ntsuam cov tsos mob. Nws yog tshwm sim los ntawm ib tug pathological txheej txheem, raws li zoo raws li lub attendant teeb meem.

Muaj ob hom ntawm tus kab mob: ib tug tsawg los yog kuj ruaj khov, qhov twg nyob rau hauv tus ntawm cov kws khomob stabilization tshwm sim thiab tus neeg mob yog nyob rau hauv txoj kev zam txim, tsis tu ncua rau ob peb xyoo.

Nyob rau hauv lub mob lub sij hawm lub kub sawv thiab kev loj hlob ntawm o nyob ib ncig ntawm cov kab noj hniav. Kub yuav ncav cuag tau ntau, yog tias ib tug tseem ceeb kab mob txuam kab mob thib ob cim.

Swb bronchi nrog mob hnoos hoarse, nyob rau hnoos qeev, hnoos qeev thiab kua paug muaj sib cais uas muaj teeb meem.

Ib tug neeg mob kev txom nyem los ntawm fibro-cavernous tuberculosis, dramatically poob ceeb thawj. Nws hais tias qhuav daim tawv nqaij, uas tau yooj yim wrinkles. Cov nqaij ntshiv ntawm tus neeg mob yog raug Atrophy. Lub hom phiaj ntawm lub pathological txheej txheem yuav xub pwg siv, cov rov qab thiab hauv lub cheeb tsam ntawm lub ribs.

Cov neeg mob yog cov nquag heev intoxication. Nyob rau hauv exacerbations ntawm ua pa kab mob kev insufficiency 1 thiab 2 degrees. Tom qab yuav tsum khij nce nyob rau hauv daim siab volume. Tej zaum yuav tshwm sim o.

Nrog rau kev vam meej ntawm tus kab mob cim lub yeej ntawm lub suab thiab hnyuv, uas ua rau yus mus rau ib tug weakening ntawm lub cev. Thaum kahesii, amyloid nephrosis thiab txhaws lub plawv tsis ua hauj lwm, koj muaj teebmeem kev kab mob raug unfavorable.

Cov ua rau tus kab mob

Kev puas tsuaj yuav tau triggered thaum twg soj ntsuam daim ntawv ntawm tuberculosis. Provocateur txoj kev loj hlob muaj peev xwm ua raws li superinfection. Los ntawm pathogens yuav tsum muaj xws li mycobacteria. Tag nrho huvsi muaj 74 cov npe. Lawv mus rau lub genus Mycobacterium. Txawm li cas los, tuberculosis nyob rau hauv tib neeg txhais conditionally xaiv hom, dubbed Mycobacterium tuberculosis.

Predisposing yam rau txoj kev loj hlob ntawm tus kab mob yog:

• raising rau theem ntawm kev sensitization;
• hloov nyob rau hauv reactivity;
• cov kab mob ntawm hauv nruab nrog cev;
• tsis tau phem.

Lub ntsiab theem ntawm tus kab mob

Nws txiav txim siab los faib rau theem tom ntej ntawm fibrous-cavernous tuberculosis:

• Ntxeem tau. Nws presupposes lub hav zoov ntawm ib tus mob o kom pom tseeb.
• Decay. Lub o hearth yog tsim ib tug kab noj hniav uas yog lawm ua tus sau nrog ib tug tshwj xeeb daim ntawv ntawm necrotic cov ntaub so ntswg - caseous loj. Qhuav ntsiab lus yuav ua kua, thiab maj poob tawm tom qab txhuav bronchus. Nyob rau hauv nws qhov chaw tshua hollow. Tom qab ntawd, nws pib mus sau nrog huab cua, thiab nyob ua txhaum ntawm kua nyob rau hauv lub bronchi - kua.
• Cov tsim muaj kab noj hniav. Kev kawm ntawv yog tsim nrog resorption ntawm perifocal o thiab fibrosis. Cov phab ntsa hauv cov anomaly muaj peb khaubncaws sab nraud povtseg. Lub puab txheej muaj cov caseous loj (polygenic txheej). Nyob rau hauv nruab nrab ntawm Granulation plhaub, hlua nrog loj epithelial hlwb. Txij li thaum lub txheej kab noj hniav feem yog them los ntawm ib tug capsule ntawm connective cov ntaub so ntswg.
• Yub. Nyob rau hauv tus txheej txheem no, cov kab noj hniav loj nce, thiab nyob ib ncig ntawm perifocal infiltration tshwm sim los yog yub. Cov txheej txheem yuav txoj kev loj hlob ntawm tshiab inflammatory txhab ntawm cavernous tuberculosis. Yog li npaj fibrocavernous daim ntawv ntawm tus kab mob.

nquag mob

Muaj cov nram qab no cov teeb meem ntawm fibro-cavernous tuberculosis:

• Hemoptysis.
• Ntshav nyob rau hauv lub ntsws.
• Lub xub ntiag ntawm percussion. Nws yog qhia nyob rau hauv ib cov roj shortening ntawm lub suab nyob rau hauv cov cheeb tsam ntawm pleural thickening thiab fibrosis.
• Mloog tsis muaj zog ua pa nyob rau hauv qhov chaw ntawm thooj ntawm cov pleura. Tsis tas li ntawd nyob crackles thiab bronchial ua tsis taus pa. Tej hawb pob qhia lub xub ntiag ntawm loj-qhov loj qhov me kab noj hniav. Nyob me me formations txawv voicing suab.

txoj kev mob

Yuav ua li cas thiaj paub tias yog fibro-cavernous tuberculosis? Lub keeb kwm ntawm tus kab mob thaum lub sij hawm ntawm tus mob, raws li ib tug txoj cai, twb muaj cov ntaub ntawv hais txog yav dhau los myocardial tuberculosis kab mob.

Nws yuav tsum tau muab sau tseg tias auscultatory tej yam tshwm sim yog me ntsis ntxiv. Ntxiv xeem siv X-ray qhia lub xub ntiag ntawm lub nplhaib zoo li tus duab ntxoov ntxoo nrog peripheral qhov chaw nyob rau hauv daim ntawv ntawm ib lub voj qe los yog voj voog. Tom qab cov ntaub ntawv tau los ntawm X-hluav taws xob diffraction yuav tsum tau differential mob nrog xws li pathology li mob ntsws rwj, peripheral cancer, bullous emphysema, pneumothorax, echinococcosis los yog encysted pleurisy.

Cov yuav txhawb tau Diagnostic thiab cov kev ua sim yog endoscopic hom kev kawm.

Hnoos qeev tsom qhia ib theem siab ntawm MTB. Kuaj kev ntsuam xyuas qhia ib theem siab ntawm kev rho tawm bacilli. Tej zaum cov txheej txheem yuav khaus. Tsis tas li ntawd staghorn nrhiav tau elastic fibers.

Nyob rau hauv lub qhaj ntawv ntawm cov hnoos qhia tuav bronchoscopy. Nws tso cai rau koj kom paub tias cov foci ntawm o nyob rau hauv ob lub ntsws thiab bronchial leeg, uas tiv thaiv tau lub kaw ntawm cov kab noj hniav.

Mus kuaj ntshav. Cov neeg mob nrog lub xub ntiag fibrocavernous tuberculosis cim lymphopenia thiab ceev ESR parameter rau 30-40 hli / h.

Thaum muaj ib qho kev nce ntawm ob kab mob ntawm leukocytes mus rau theem qhia 19 000-20 000, raws li tau zoo raws li ua cov theem ntawm qe.

Muaj siab cov ntsiab lus ntawm cov protein nyob hauv cov zis.

txoj kev kho tej hauv paus ntsiab

Nws eliminates lub fibro-cavernous tuberculosis? Kev kho mob yog nqa tawm nyob rau hauv ib tug lub tsev kho mob nyob rau hauv cov kab mob TB dispensaries.

txoj kev kho tswvyim yog raws li nyob rau hauv lub simultaneous siv peb los yog plaub cov tshuaj qhia tiv thaiv cov kev loj hlob ntawm pathology. Raws li ib tug txoj cai, siv lub "INH", "ethambutol", "Rifampicin" thiab "streptomycin". Tshuaj tej zaum yuav muab intravenously los yog ncaj qha mus rau hauv lub qhov ncauj kab noj hniav.

Kuj siv tuberkulinoterapiya, ua pa ce, lub cev txoj kev kho, laser kho, ultrasound thiab inductothermy.

Nqa cov kws khomob

Yuav ua li cas lwm tus yog tshem tawm fibro-cavernous pulmonary tuberculosis? Kev kho mob yuav qhov kev siv ntawm cov kws khomob. Cov txheej txheem cov kws kho rau ib tug neeg hauv paus nyob rau hauv raws li cov kev ntsuas ntawm rhiab heev rau cov tshuaj.

Feem ntau, yog tias kuj mus yooj yim txoj kev kho tiv thaiv kab mob ntsws yog nqa tawm nyob rau hauv raws li ib tug thib plaub kws khomob regime. Cov kev kho mob yuav lub neej coj siv ntawm cov tshuaj xws li "kanamycin", "Prothionamide", "Cycloserine", "PAS" thiab "fluoroquinolones". Lub caij ntawm cov kws khomob yog tsis tsawg tshaj 15-18 lub hlis.

Cov neeg mob nrog lub xub ntiag fibrocavernous TB qhia tuav pathogenetic txoj kev kho uas yog aimed ntawm kev kho cov impaired zog sib txawv kab mob. Metabolizing neeg sawv cev siv, raws li tau zoo raws li npaj rau lub restoration ntawm lub cev, thiab hormonal agents.

Nrog ib tug dej siab kawg ntawm kev kho mob tom qab txog rau lub hlis zoo puab. Nws cim yuav txo tau nyob rau hauv qee ntawm bacilli, raws li zoo raws li txo thiab cov kab noj hniav kaw.

hauj lwm kev pab

Kho fibrotic kab noj hniav yog ib txwm nqa tawm heev maj mam. Yog hais tias thaum lub sij hawm hais saum toj no lub sij hawm yog tsis tau mus cuag zoo tau, lub fibro-cavernous pulmonary tuberculosis yog muab tshem tawm los ntawm kev phais. Nyob rau hauv cov ntaub ntawv no qhia tau hais tias lub unilateral ntsws resection. DVR nyob rau hauv ob lub tsev lag luam thiab cov txheej txheem. Nws kuj muaj ib tug high degree ntawm efficiency thiab tso cai rau koj mus cawm tau tus neeg mob tus muaj peev xwm mus ua hauj lwm. Lub neej luv ntawm ib tug neeg mob heev lengthened. Rho tawm ntawm mycobacteria nres.

Lwm yam ntawm kev phais yog ib tug phais lub cev qhuav dej kev kho, tawm tswv yim hauv lub imposition ntawm cov khoom cua pneumothorax.

Tom qab kev kho mob nyob rau hauv lub tsev kho mob nyob yog yuav tsum tau yuav tsum tau sanatoriums, pw kho mob , ua raws li los ntawm kev soj nyob rau hauv lub tsev kho mob.

raug

Feem coob ntawm cov fibro-cavernous tuberculosis amenable mus kho. Kab noj hniav ntawm me me qhov ntev raug kaw thiab cirrhosis. Kev kawm ntawv nrog lub xub ntiag ntawm txhav phab ntsa tshaj lub sij hawm refilled nrog caseous ntsiab lus uas provokes psevdotuberkulemy.

Txuam ntawm kua paug, lub xub ntiag ntawm aspergillosis, qhov kev kawm ntawm tuberculosis tsis tshua muaj.

tiv thaiv kev ntsuas

Fibrocavernous tuberculosis belongs rau hauv qeb ntawm cov kab mob tshwm sim los ntawm kev phiv kev yam. Feem ntau lub hauv paus ua kom muaj tus deterioration ntawm nyob qauv nyob rau hauv dej siab ntawm tus pejxeem.

Raws li statistics, cov txiv neej muaj mob 3 lub sij hawm ntau tshaj cov poj niam. Cov yooj yim pathology yog tsau nyob rau hauv lub hnub nyoog ntawm 20 mus rau 39 xyoo.

Nyob rau hauv thiaj li yuav tiv thaiv kom txhob qhia mus soj ntsuam cov cai nram qab no:

• kev tsim nyog tiv thaiv kev ntsuas;
• thaum ntxov qhia kom paub txog cov neeg cuam tshuam los ntawm tus kab mob;
• xaiv lub xeev cov nyiaj rau cov tshuaj;
• kev siv ntawm cov ua ntej kev xeem thaum ua ntawv thov rau ib txoj hauj lwm nyob rau hauv lub tsiaj nyeg sector;
• nce nyob rau hauv cheeb tsam rau kev pab ntawm cov neeg uas tau raug tshuaj mob nrog tus kab mob ntsws;
• raws sij hawm kev siv ntawm cov tshuaj txhaj tiv thaiv rau cov me nyuam mos nyob rau hauv thawj lub hlis tom qab yug tus me nyuam.

xaus

Fibro-cavernous pulmonary tuberculosis (teeb meem ua rau ib tug kev hem thawj rau lub xeev kev kho mob) yog ib tug kab mob. Raws li ib tug txoj cai, nws yog provoked cavernous tuberculosis. Tus kab mob muaj peev xwm yuav yus raws li ib tug unilateral los yog ob sab sib dho txhab.

Yav tas los Pathology nyuaj rau kho, nws yog tam sim no lub tshuaj muaj ib tug ntau ntawm cov sib txawv tshuaj modalities uas yuav xyuas kom meej ruaj khov zam txim rau ntau xyoo. Raws sij hawm kev kho mob muaj peev xwm cawm tus neeg mob tus muaj peev xwm mus ua hauj lwm.