扁桃体炎

第一节急性扁桃体炎1定义1急性扁桃体炎是腭扁桃体的急性非特异性炎症，是很常见的咽部疾病。多发生于儿童及青年，多见春秋。2病因急性扁桃体炎主要致病菌乙型溶血性链球菌致病条件机体抵抗力下降，如受凉、过劳、烟酒过度等传播方式飞沫或直接接触3病理1急性卡他性扁桃体炎2急性滤泡性扁桃体炎3急性隐窝性扁桃体炎化脓性4临床表现1全身症状起病急，畏寒、高热、头痛、乏力等，小儿较重。2局部症状剧烈咽痛，放射至耳部，伴吞咽困难。53检查全身急性病容局部咽部粘膜弥漫性充血，以扁桃体及两腭弓严重。腭扁肿大，表面见脓点或假膜。下颌角淋巴结肿大。6并发症1局部并发症扁桃体周脓肿，急性中耳炎，急性鼻炎和鼻窦炎等2全身并发症急性风湿热、关节炎、心肌炎、肾炎。机制3型变态反应。7治疗1一般治疗隔离，休息。2抗生素主要疗法。首选青霉素，23天不见好转，改用其他药物。酌情应用糖皮质激素。3局部治疗含漱液漱口。4中医中药5手术已有并发症者，在急性炎症消退后行扁桃体切除术。8第二节慢性扁桃体炎9定义1急性扁桃体炎反复发作2扁桃体隐窝引流不畅，窝内细菌、病毒滋生感染10病因主要致病菌链球菌和葡萄球菌发病机制发病机制不明，与反复急性发作及自身变态反应有关。11病理1增生型腺体肥大2纤维型腺体萎缩3隐窝型有脓栓或囊肿12临床表现1急性扁桃体炎发作史。2平时自觉症状少，可有咽干、发痒、异物感等；小儿过度肥大可引起呼吸不畅；全身反应有消化不良、低热、头痛、乏力等。3检查扁桃体和舌腭弓慢性充血，隐窝口见点状物。扁桃体大小不定，常与周围组织粘连。下颌角淋巴结肿大。13鉴别诊断1扁桃体生理肥大无自觉症状。2扁桃体角化症隐窝口上皮过度角化。表现为白色尖形砂粒样，不易去除，擦去留出血创面。3扁桃体肿瘤活检。14并发症病灶性扁桃体炎的概念慢性扁桃体炎在身体受凉受潮、全身衰弱、内分泌紊乱、自主神经系统失调等情况下，易形成病灶，发生变态反应，产生各种并发症，如风湿性关节炎、风湿热、心脏病、肾炎等。此时称之为病灶性扁桃体炎。注意2点HTTP/WWW024SYSDFKCOM/HTTP/WWW024SYSDFKCOM/FKYZ/HTTP/WWW024SYSDFKCOM/FKYZ/FJY/HTTP/WWW024SYSDFKCOM/FKYZ/NDY/HTTP/WWW024SYSDFKCOM/FKYZ/PQY/HTTP/WWW024SYSDFKCOM/FKYZ/WYY/HTTP/WWW024SYSDFKCOM/FKYZ/YDY/HTTP/WWW024SYSDFKCOM/FKYZ/ZGNMY/HTTP/WWW024SYSDFKCOM/FKZL/HTTP/WWW024SYSDFKCOM/FKZL/CNMXF/HTTP/WWW024SYSDFKCOM/FKZL/DNLC/HTTP/WWW024SYSDFKCOM/FKZL/GFQJ/HTTP/WWW024SYSDFKCOM/FKZL/LCNZ/HTTP/WWW024SYSDFKCOM/FKZL/YDJSS/HTTP/WWW024SYSDFKCOM/FKZL/ZGJL/HTTP/WWW024SYSDFKCOM/GJJB/HTTP/WWW024SYSDFKCOM/GJJB/GJA/HTTP/WWW024SYSDFKCOM/GJJB/GJFD/HTTP/WWW024SYSDFKCOM/GJJB/GJML/HTTP/WWW024SYSDFKCOM/GJJB/GJNZ/HTTP/WWW024SYSDFKCOM/GJJB/GJXR/HTTP/WWW024SYSDFKCOM/GJJB/GJY/HTTP/WWW024SYSDFKCOM/JHSY/HTTP/WWW024SYSDFKCOM/JHSY/BGRL/HTTP/WWW024SYSDFKCOM/JHSY/GWY/HTTP/WWW024SYSDFKCOM/JHSY/WTYC/HTTP/WWW024SYSDFKCOM/JHSY/YWLC/HTTP/WWW024SYSDFKCOM/JZZN/LYLX/HTTP/WWW024SYSDFKCOM/KFAL/HTTP/WWW024SYSDFKCOM/LYLX/HTTP/WWW024SYSDFKCOM/NFM/HTTP/WWW024SYSDFKCOM/NFM/BDYC/HTTP/WWW024SYSDFKCOM/NFM/BJ/HTTP/WWW024SYSDFKCOM/NFM/FKJC/HTTP/WWW024SYSDFKCOM/NFM/GX/HTTP/WWW024SYSDFKCOM/NFM/TJ/HTTP/WWW024SYSDFKCOM/NFM/YJBT/HTTP/WWW024SYSDFKCOM/XJSB/HTTP/WWW024SYSDFKCOM/YYGY/HTTP/WWW024SYSDFKCOM/YYJJ/HTTP/WWW024SYSDFKCOM/YYXW/HTTP/WWW024SYSDFKCOM/ZJTD/HTTP/WWW024SYSDFKCOM/ZT/FKZX/YDJS/HTTP/WWW024SYSDFKCOM/ZT/RL/RLSJ/151询问病史有反复急性发作史。病灶感染通过急性发作表现。2实验室检查血沉、抗链球菌溶血素“O”、心电图等。16治疗1非手术疗法（1）抗菌药、免疫疗法、增强免疫力的药物等。（2）局部涂药、灌洗等。（3）增强体质。2手术疗法扁桃体切除术。17第三节扁桃体切除术18适应证1反复急性发作或多次并发扁桃体周脓肿。2过度肥大妨碍吞咽、呼吸、发声。3成为病灶或与邻近器官病变有关。4白喉带菌者保守治疗无效。5扁桃体良性肿瘤与扁桃体一并切除，恶性肿瘤慎重。6某些手术的前期手术，如茎突截短术。HTTP/WWWLJYY120COM/HTTP/WWWLJYY120COM/JHSY/HTTP/WWWLJYY120COM/JHSY/WTRL/HTTP/WWWLJYY120COM/JHSY/GWY/HTTP/WWWLJYY120COM/JHSY/WTYC/HTTP/WWWLJYY120COM/JHSY/SH/HTTP/WWWLJYY120COM/JHSY/QH/HTTP/WWWLJYY120COM/JHSY/RGLC/HTTP/WWWLJYY120COM/JHSY/ZD/HTTP/WWWLJYY120COM/JHSY/YL/HTTP/WWWLJYY120COM/FKYZ/HTTP/WWWLJYY120COM/FKYZ/YDY/HTTP/WWWLJYY120COM/FKYZ/PQY/HTTP/WWWLJYY120COM/FKYZ/WYY/HTTP/WWWLJYY120COM/FKYZ/FJY/HTTP/WWWLJYY120COM/FKYZ/NDY/HTTP/WWWLJYY120COM/FKYZ/ZGNMY/HTTP/WWWLJYY120COM/FKYZ/FKJC/HTTP/WWWLJYY120COM/FKZX/HTTP/WWWLJYY120COM/FKZX/CNMXFS/HTTP/WWWLJYY120COM/FKZX/HYXF/HTTP/WWWLJYY120COM/FKZX/YDJSS/HTTP/WWWLJYY120COM/FKZX/YJBT/HTTP/WWWLJYY120COM/FKZX/YCZX/HTTP/WWWLJYY120COM/ZGJB/HTTP/WWWLJYY120COM/ZGJB/GJML/HTTP/WWWLJYY120COM/ZGJB/GJFD/HTTP/WWWLJYY120COM/ZGJB/ZGJL/HTTP/WWWLJYY120COM/ZGJB/LCNZ/HTTP/WWWLJYY120COM/ZGJB/GJY/HTTP/WWWLJYY120COM/ZGJB/GJXR/HTTP/WWWLJYY120COM/ZGJB/GJNZ/HTTP/WWWLJYY120COM/WYBB/HTTP/WWWLJYY120COM/WYBB/BBLX/HTTP/WWWLJYY120COM/WYBB/BBZZ/HTTP/WWWLJYY120COM/WYBB/BBWH/HTTP/WWWLJYY120COM/WYBB/BBZL/HTTP/WWWLJYY120COM/WYBB/BBYY/HTTP/WWWLJYY120COM/BYBY/HTTP/WWWLJYY120COM/BYBY/SLGBY/HTTP/WWWLJYY120COM/BYBY/ZGXBY/HTTP/WWWLJYY120COM/BYBY/GJXBY/HTTP/WWWLJYY120COM/BYBY/MYXBY/HTTP/WWWLJYY120COM/BYBY/BYJC/HTTP/WWWLJYY120COM/FKYZ/PQYHTTP/WWWLJYY120COM/FKYZ/ZGNMY19禁忌证1急性炎症时2造血系统疾病及有凝血机制障碍者3严重全身疾病4呼吸道及其他传染病流行时5妇女月经期、月经前期、妊娠期6病人亲属中免疫球蛋白缺乏或自身免疫病的发病率高，白细胞计数特别低者。HTTP/WWWSDXB024COM/HTTP/WWWSDXB024COM/AZB/HTTP/WWWSDXB024COM/FL/HTTP/WWWSDXB024COM/JKCS/HTTP/WWWSDXB024COM/JKJJ/HTTP/WWWSDXB024COM/JPJS/HTTP/WWWSDXB024COM/JRSY/HTTP/WWWSDXB024COM/KFBL/HTTP/WWWSDXB024COM/LB/HTTP/WWWSDXB024COM/LYLX/HTTP/WWWSDXB024COM/MD/HTTP/WWWSDXB024COM/RXG/HTTP/WWWSDXB024COM/SZQPZ/HTTP/WWWSDXB024COM/YS/HTTP/WWWSDXB024COM/YYJJ/HTTP/WWWSDXB024COM/ZJTD/20手术方法剥离术挤切术21术后处理1术后体位2饮食3注意出血4创口白膜形成5创口疼痛HTTP/WWWSDFK024COM/HTTP/WWWSDFK024COM/BYBY/HTTP/WWWSDFK024COM/BYBY/GJXBY/HTTP/WWWSDFK024COM/BYBY/LCXBY/HTTP/WWWSDFK024COM/BYBY/MYXBY/HTTP/WWWSDFK024COM/BYBY/NFMBY/HTTP/WWWSDFK024COM/BYBY/PQXBY/HTTP/WWWSDFK024COM/BYBY/SLGBY/HTTP/WWWSDFK024COM/BYBY/XGXLC/HTTP/WWWSDFK024COM/BYBY/ZGXBY/HTTP/WWWSDFK024COM/FKYZ/HTTP/WWWSDFK024COM/FKYZ/BDYC/HTTP/WWWSDFK024COM/FKYZ/FJY/HTTP/WWWSDFK024COM/FKYZ/NDY/HTTP/WWWSDFK024COM/FKYZ/PQY/HTTP/WWWSDFK024COM/FKYZ/WYBB/HTTP/WWWSDFK024COM/FKYZ/WYY/HTTP/WWWSDFK024COM/FKYZ/YDY/HTTP/WWWSDFK024COM/FKYZ/ZGNMY/HTTP/WWWSDFK024COM/FKZL/HTTP/WWWSDFK024COM/FKZL/FJNZ/HTTP/WWWSDFK024COM/FKZL/LCA/HTTP/WWWSDFK024COM/FKZL/LCNZ/HTTP/WWWSDFK024COM/FKZL/ZGJL/HTTP/WWWSDFK024COM/FKZL/ZGNMA/HTTP/WWWSDFK024COM/FKZL/ZGNMYWZ/HTTP/WWWSDFK024COM/FKZL/ZGXJZ/HTTP/WWWSDFK024COM/FKZX/HTTP/WWWSDFK024COM/FKZX/CNMXF/HTTP/WWWSDFK024COM/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