急、慢性扁桃体炎

解放军第89医院唐少松扁桃体炎Tonsillitis定义：扁桃体作为咽淋巴环的重要结构，位于呼吸道和消化道的上端，最先接触自口鼻进入的病原，在机体抵抗力下降时容易受到病原体侵犯而发炎。主要包括急﹑慢性扁桃体炎。Definition:Tonsilistheimportantstructureofthepharyngeallymphaticcircle,locatedattheupperofrespiratorytractanddigestivetract,whichisfirstcontactwithpathogenfrommouth/nose.Thatiseasilyinvadingbypathogen,thentakesplaceinflammation,includingacute/chronictonsillitis.解放军第89医院唐少松急性扁桃体炎Acutetonsillitis定义：腭扁桃体的急性非特异性炎症，常伴有急性咽炎，是一种咽部常见病，多发于儿童﹑青年，在季节更替，气温变化时容易发病。可分为卡他性﹑化脓性两型。Definition:Theacutenon-specialinflammationofPalatinetonsil,beinglinkedtopharyngitis.Thatisthecommondiseaseandmoretakesplaceinchildren/youth,includingcatarrh/suppuratingtype.解放军第89医院唐少松病因Etiology感染主要致病菌为乙型容血性链球菌葡萄球菌肺炎双球菌腺病毒厌氧菌机体防御能力下降常见诱因受凉﹑劳累﹑潮湿﹑烟酒传染性飞沫或直接接触传染，通常呈散发性，偶有爆发流行InfectionThemaingermswasBstreptococccusStaphylococciPneumonia-diplococcusAdenoviruses/AnaerobesTheabilityofbodydefencewasdescentCommonfactorcold/tired/wetness/smoking/drinkingInfectivitydroplet/directlycontacting解放军第89医院唐少松临床特征Clinicalfeature急性卡他性扁桃体炎：咽痛低热轻度全身症状：乏力﹑酸痛﹑精神差粘膜急性充血肿胀，扁桃体表面无渗出物血象：白细胞总数及中性白细胞升高AcutecatarrhaltonsillitisPharyngealpain/LowfeverLightlytotalsymptom:achingpain/inertiaAcutecongestionofmucosa,havinglittleexudatesontonsilsurfaceBlood:TheamountofWBC/neutrophilwashigh.解放军第89医院唐少松临床特征Clinicalfeature急性化脓性扁桃体炎起病急，局部和全身症状较重咽痛剧烈，反射痛，吞咽困难畏寒﹑高热：幼儿可高热抽搐，呕吐﹑昏睡扁桃体肿大，周围充血，表面有脓点或假膜，假膜不超出扁桃体范围，易擦拭去，不出血下颌角淋巴结肿大﹑压痛血象：白细胞总数及中性白细胞升高ActuesuppurativetonsllitisRapidlyillness,havingmoresymptomsoftotal/localbody.Pharyngealpainintensity/flectingpain/disphagiaFeelingcool/highfever:tic/vomiting/lethargySwellingoftonsil/peri-tonsilhyperemia,havingpusandfalsemembraneontonsilsurface.swellingoflymphaticnodesiaangleofmandible,havingpressingpain.Blood:TheamountofWBC/neutrophilwashigh.解放军第89医院唐少松急性化脓性扁桃体炎解放军第89医院唐少松急性化脓性扁桃体炎解放军第89医院唐少松诊断Diagnosis典型病史+咽部检查鉴别诊断：咽炎猩红热溃疡性咽炎Typicalhistory/pharyngealexaminationDifferentialdiagnosisPharyngitisScarletfeverUlcerativepharyngitis.解放军第89医院唐少松并发症Complication局部并发症：扁桃体周围脓肿急性中耳炎：儿童常见急性淋巴结炎咽旁脓肿：较少见全身并发症:(机体对链球菌所产生的Ⅲ型变态反应)风湿热急性关节炎﹑心肌炎急性肾炎Localcomplications:peritonsillarabscessAcuteotitismediaAcutelymphadenitisParapharyngealabscessComplicationsoftotalbody:(theⅢtypeofallergicreactioninducedbystreptococcus)RheumaticfeverAcutearthritisAcutenephritis解放军第89医院唐少松治疗Treatment抗菌消炎是本病的治疗原则，青霉素是首选药物。对症治疗是解热镇痛局部治疗是含漱液+含片Thetherapeticprincipleofthisdiseaseisanti-bacteriaandeliminatinginflammation,penicillinisthefirst-lineofclinicaldrug.Reliefoffeverandpainwerethesecondtreatment.Localtreatmentwereusinggargle解放军第89医院唐少松预防prevention锻炼身体，增强体质，提高机体抵抗力。注意病人隔离，防止传染。Bodybuildingandreinforcementhealth,thenrisingresistanceofbody.Attentiontoinsulationofpatients,thatpreventsfrominfection解放军第89医院唐少松慢性扁桃体炎Chronictonsillitis由急性扁桃体炎反复发作或隐窝口内细菌﹑病毒孳生感染而演变成的腭扁桃体慢性炎症。Theinflammationofpalatintonsilinducedbytherepetitionattackingofacutetonsillitisorinfectionofbacteria/virusfromcrypt.解放军第89医院唐少松病因Etiology感染：乙型溶血性链球菌﹑腺病毒→反复急性发作→慢性炎症免疫因素：微生物→扁桃体→自身变态反应→慢性炎症Infection:streptococcusB/adenovirus→repetitionofacuteattacking→chronicinflammationImmuninginfactors:microorganism→tonsil→self-allergicreaction→infammation解放军第89医院唐少松病理pathology早期：隐窝口粘膜受损→上皮增生﹑溃疡﹑炎性渗出物后期：扁桃体疤痕形成→开口受阻→小脓肿Earlierperiod:themucosaofcryptsdamaged→epithelialproliferation,ulcering,inflammatoryexudatesAnaphase:theformationofscarintonsil→aperturehindering→thelittleabscess解放军第89医院唐少松临床表现Clinicalsituation反复急性发作病史咽部不适症状扁桃体肥大引起的症状全身慢性中毒症状体症：扁桃体慢性充血，疤痕粘连；隐窝口封闭，有时可见黄白色干珞样或点状分泌物；颌下淋巴结肿大。actueattacckingagainandagainTheupsetsymptomsinpharynxThesymptomsinducedbytonsilhypertrophyChronictoxicosisoftotalbodySings:Chroniccongestion/scarCryptswereclosed,havingsomewhitedischargesSwellingofsubmandbularlymphnodes解放军第89医院唐少松诊断Diagnosis病史+体症+症状鉴别诊断：扁桃体生理性肥大扁桃体角化症：白色沙砾样角化物，触之坚硬，不能拭去。扁桃体肿瘤：腺体肿大且有溃疡，需行活检确诊。History+signs+symptomDifferentialdiagnosissPhysiologichypertrophyoftonsilKeratosisoftonsil:thesmallwhitesand-likemasses,whicharedifficulttoremovebyswabbing.tumoroftonsil:theswellingandulceringoftonsil,pathologicevidenceisthefinaldiagnosis.解放军第89医院唐少松并发症Complication并发症：隐窝口内的细菌和毒素→变态反应→并发症风湿性关节炎风湿热肾病心脏病Complication:bacteriaanditstoxins→allergicreaction→complicationRheumaticarthritisRheumaticfeverNephrosisCardiacdisease解放军第89医院唐少松治疗Treatment保守治疗：免疫疗法辅以抗变应性措施：疫苗脱敏，胎盘丙种球蛋白，转移因子冲洗隐窝口手术治疗：扁桃体切除术ConservativetreatmentImmuno-therapyWashingcryptsOperationtonsillectomy解放军第89医院唐少松扁桃体切除术适应症１．反复炎症发作或并发扁桃体周围脓肿２．过度肥大，妨碍功能３．成为病灶４．角化症及白喉带菌者保守无效５．肿瘤解放军第89医院唐少松扁桃体切除术禁忌症急性炎症期（2－3周后手术）血液系统疾病全身疾病未经控制急性传染病流行季节或流行地区妇女经期、妊娠期自身或家属中免疫疾病、白细胞低解放军第89医院唐少松扁桃体手术后