膿瘍：修订间差异
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'''膿瘍'''（{{lang-en|abscess}}）又稱'''膿腫'''，是[[組織 (生物學)|组织]]、[[器官]]或[[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。汉语视语境另有其他异名，如：'''肿疡'''<ref>苏淑玲,魏荣洲,洪纯隆.脑干隐球菌肿疡:以偏瘫合并同侧小脑运动失调为临床表现-病例报告[J].The Kaohsiung Journal of Medical Sciences, 1988, 4(8):481-485.</ref>、'''疮疡'''<ref>[1]张双强,裴晓华,张艳冉,等.疮疡外治临床研究进展[J].世界中西医结合杂志, 2014, 9(11):5.DOI:10.13935/j.cnki.sjzx.141136.</ref>、'''瘀脓'''<ref>李春花.中医祛腐生肌法促进肛周脓肿、肛瘘术后创面愈合的临床与实验研究[D].北京中医药大学,2009.</ref>、'''淤脓'''<ref>杨瑞,王军.引古鉴今治疗糖尿病足体会[J].中医外治杂志, 2010(4).DOI:10.3969/j.issn.1006-978X.2010.04.043.</ref>、'''积脓'''<ref>卢东明,廖尚范,吴用样,等. 肾包膜下积脓二例报告[J]. 中华泌尿外科杂志,2021,42:(11)：869-870. DOI:10.3760/cma.j.cn112330-20200923-00676</ref>等。但积脓另可表示术语 empyema，它与脓疡意义相近，但多指脓胸。
'''脓疮'''是指[[皮肤]]在感染过程在[[脓]]（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]]。▼
脓疡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<ref name=NEJM2014>{{cite journal|last=Singer|first=AJ|author2=Talan, DA|title=Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus.|url=https://archive.org/details/sim_new-england-journal-of-medicine_2014-03-13_370_11/page/1039|journal=The New England journal of medicine|date=Mar 13, 2014|volume=370|issue=11|pages=1039–47|pmid=24620867}}</ref>。一旦形成，应考虑切开引流。
==外部链接==▼
* [http://www.nlm.nih.gov/medlineplus/ency/article/001353.htm MedlinePlus Medical Encyclopedia - Abscess]▼
* [http://www.nlm.nih.gov/medlineplus/ency/article/000863.htm MedlinePlus Medical Encyclopedia - Skin Abscess]▼
接近體表的膿瘍會有紅、腫、熱、痛等症狀，觸診病灶時感覺其內部充滿液體<ref name=NEJM2014/>，皮膚發紅的範圍常比腫起的範圍更大<ref name=El2009>{{cite book|last=Elston|first=Dirk M.|title=Infectious Diseases of the Skin.|date=2009|publisher=Manson Pub.|location=London|isbn=9781840765144|page=12| url=http://books.google.ca/books?id=esPkuOxZajYC&pg=PA12|access-date=2015-01-06|archive-date=2014-10-30|archive-url=https://web.archive.org/web/20141030154936/http://books.google.ca/books?id=esPkuOxZajYC&pg=PA12|dead-url=no}}</ref>。常見的體表膿瘍包括發生在[[毛囊]]的[[癰]]<ref name=Schiergens2015>{{cite book|last=Schiergens|first=Tobias|title=BASICS Chirurgie|date=2015|publisher=Urban & Fischer Verlag/Elsevier GmbH|location=München, BY, Deuschland|isbn=3437425188|pages=27|edition=Auflage 3 |chapter=Grundlagen}}</ref>（影響範圍較大）與[[癤]]（影響範圍較小）等<ref name=Rosen2014Chp120>{{cite book|last=Marx|first=John A. Marx|title=Rosen's emergency medicine : concepts and clinical practice|date=2014|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=1455706051|pages=Chapter 120|edition=8th ed.|chapter=Dermatologic Presentations}}</ref>。
[[Category:医学]]▼
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膿瘍源自[[病原菌]]的[[感染]]<ref name=Cox2007>{{cite book|last=Cox|first=Carol Turkington, Jeffrey S. Dover ; medical illustrations, Birck|title=The encyclopedia of skin and skin disorders|date=2007|publisher=Facts on File|location=New York, NY|isbn=9780816075096|page=1|url=http://books.google.ca/books?id=GKVPHoIs8uIC&pg=PA1|edition=3rd ed.|access-date=2015-01-06|archive-date=2020-01-25|archive-url=https://web.archive.org/web/20200125051302/http://books.google.ca/books?id=GKVPHoIs8uIC&pg=PA1|dead-url=no}}</ref>，在病灶處常有許多不同種的細菌同時感染<ref name=El2009/>。在美國與世界許多地區裡，在膿瘍中最常見的菌種是[[抗藥性金黃色葡萄球菌]]<ref name=NEJM2014/>，在[[發展中國家]]偶爾也可見到由[[寄生蟲]]引起的膿瘍<ref name=Rosen2014Chp137>{{cite book|last=Marx|first=John A. Marx|title=Rosen's emergency medicine : concepts and clinical practice|date=2014|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=1455706051|pages=Chapter 137|edition=8th ed.|chapter=Skin and Soft Tissue Infections}}</ref>。通常診斷要從外型以及切開後觀察確定<ref name=NEJM2014/>，[[超音波]]在無法確定診斷時或許有幫助<ref name=NEJM2014/>，而更為深處的膿瘍則可能需要以[[磁共振成像]]<ref name=李2014>{{cite journal|authors=李娜; 程悦; 沈文|title=多参数 MRI 对前列腺脓肿的诊断价值.|journal=实用放射学杂志|date= 2014年12期|volume=2014|issue=12|pages= 2016-9 |doi= 10.3969/j.issn.1002-1671.2014.12.018}}</ref><ref name=Smith2014>{{cite journal|last=Smith|first=GA|coauthors=Kochar AS; Manjila S; Onwuzulike K; Geertman RT; Anderson JS; Steinmetz MP|title=Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques.|journal=Neurosurgical focus|date=Aug 2014|volume=37|issue=2|pages=E11|pmid=25081960}}</ref>或[[X射線電腦斷層掃描|電腦斷層]]才能發現<ref name=Rosen2014Chp137/>（比如說{{link-en|肛門膿瘍|anorectal abscess}}、{{tsl|de|Douglas-Raum#Douglas-Abszess|道格拉斯膿腫}}等）<ref name=陈2014>{{cite journal|authors=陈愈彬, 杨钦泰; 王涛; 黎景佳; 叶进; 刘贤; 张革化|title=增强CT对扁桃体内与扁桃体周围脓肿的鉴别诊断价值.|journal=中华耳鼻咽喉头颈外科杂志|date= 2014年2期|volume=49|issue=2|pages= 131-5 |doi= 10.3760/cma.j.issn.1673-0860.2014.02.008}}</ref>。
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皮膚與軟組織膿瘍的標準治療方式是{{link-en|切開引流|incision and drainage}}<ref name="ACEPfive">{{Citation |author1 = American College of Emergency Physicians |author1-link = American College of Emergency Physicians |title = Five Things Physicians and Patients Should Question |publisher = American College of Emergency Physicians |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |page = |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-emergency-physicians/ |accessdate = January 24, 2014 |archive-date = 2015-04-14 |archive-url = https://web.archive.org/web/20150414005201/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-emergency-physicians/ |dead-url = no }}</ref>，[[抗細菌藥|抗生素]]治療對於原先健康的患者而言並沒有幫助<ref name=NEJM2014/>。有少量的證據支持在引流後不用紗布填塞留下的空腔<ref name=NEJM2014/>。相對於等待其自行癒合，在引流後縫合空腔可能加速癒合且不會增加膿瘍復發的機會<ref name=Singer2011>{{cite journal|last=Singer|first=AJ|coauthors=Thode HC, Jr; Chale, S; Taira, BR; Lee, C|title=Primary closure of cutaneous abscesses: a systematic review.|url=https://archive.org/details/sim_american-journal-of-emergency-medicine_2011-05_29_4/page/361|journal=The American journal of emergency medicine|date=May 2011|volume=29|issue=4|pages=361-6|pmid=20825801}}</ref>。單以針頭進行引流而不進行切開常無法將膿瘍引流乾淨<ref name=Füessl2014>{{cite journal|last=Füessl |first=HS| title=Ubi pus,ibi evacua–und dann?|journal= MMW - Fortschritte der Medizin|date=Okt 2014|volume=156|issue=17|pages=44|doi= 10.1007/s15006-014-3522-8}}</ref>。
<!-- 流行病學 -->
近年來皮膚膿瘍是常見的疾病，而且還有更為盛行的趨勢<ref name=NEJM2014/>。罹患皮膚膿瘍的風險因子主要是{{link-en|施打靜脈藥物|drug injection}}，這個族群的皮膚膿瘍盛行率有65%<ref>{{cite book|last=Langrod|first=Pedro Ruiz, Eric C. Strain, John G.|title=The substance abuse handbook|date=2007|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=9780781760454|page=373|url=http://books.google.ca/books?id=6LkNShsAw78C&pg=PA373|access-date=2015-01-06|archive-date=2014-10-31|archive-url=https://web.archive.org/web/20141031071003/http://books.google.ca/books?id=6LkNShsAw78C&pg=PA373|dead-url=no}}</ref> 。2005年美國有三百二十萬人因皮膚膿瘍而至急診就診<ref name=Taira2009>{{cite journal|last=Taira|first=BR|coauthors=Singer, AJ; Thode HC, Jr; Lee, CC|title=National epidemiology of cutaneous abscesses: 1996 to 2005.|url=https://archive.org/details/sim_american-journal-of-emergency-medicine_2009-03_27_3/page/289|journal=The American journal of emergency medicine|date=Mar 2009|volume=27|issue=3|pages=289-92|pmid=19328372}}</ref>，而在澳洲，2008年有一萬三千人因皮膚膿瘍而住院治療<ref name=Vas2012>{{cite journal|last=Vaska|first=VL|coauthors=Nimmo, GR; Jones, M; Grimwood, K; Paterson, DL|title=Increases in Australian cutaneous abscess hospitalisations: 1999-2008.|journal=European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology|date=Jan 2012|volume=31|issue=1|pages=93-6|pmid=21553298}}</ref>。
== 形成原因 ==
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== 參考來源 ==
{{reflist}}
▲== 外部链接 ==
▲* [http://www.nlm.nih.gov/medlineplus/ency/article/001353.htm MedlinePlus Medical Encyclopedia - Abscess] {{Wayback|url=http://www.nlm.nih.gov/medlineplus/ency/article/001353.htm |date=20070323131341 }}
▲* [http://www.nlm.nih.gov/medlineplus/ency/article/000863.htm MedlinePlus Medical Encyclopedia - Skin Abscess] {{Wayback|url=http://www.nlm.nih.gov/medlineplus/ency/article/000863.htm |date=20070320174820 }}
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[[Category:动物细菌性疾病]]
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