引發(fa)(fa)腹腔膿(nong)(nong)腫(zhong)(zhong)的(de)(de)原因有很(hen)多(duo),一般均繼發(fa)(fa)于急性(xing)腹膜炎(yan)或引起繼發(fa)(fa)性(xing)腹膜炎(yan)的(de)(de)各(ge)種疾病,腹腔膿(nong)(nong)腫(zhong)(zhong)可分為膈下膿(nong)(nong)腫(zhong)(zhong)、盆腔膿(nong)(nong)腫(zhong)(zhong)和腸間膿(nong)(nong)腫(zhong)(zhong),不同部(bu)位(wei)的(de)(de)膿(nong)(nong)腫(zhong)(zhong)癥狀是不一樣的(de)(de):
1、膈下膿腫
全(quan)身癥(zheng)(zheng)狀:發(fa)熱是膈下膿腫的(de)一大(da)常見(jian)癥(zheng)(zheng)狀,表現(xian)為(wei)持續的(de)高熱,脈搏增(zeng)快,舌苔厚膩。然(ran)后開(kai)始出現(xian)全(quan)身乏力、衰弱、盜(dao)汗、厭食、消(xiao)瘦,血液檢查可發(fa)現(xian)白細(xi)胞數(shu)量明顯升(sheng)高,中性粒細(xi)胞所(suo)占(zhan)比例也增(zeng)加。
局(ju)(ju)部(bu)癥狀(zhuang):發生膿(nong)腫(zhong)(zhong)的(de)(de)部(bu)位可(ke)有持續性的(de)(de)鈍痛(tong),深呼(hu)吸的(de)(de)時(shi)候可(ke)加重疼痛(tong)。疼痛(tong)的(de)(de)位置(zhi)常常位于(yu)肋(lei)緣下(xia)和劍突(tu)下(xia)方。膿(nong)腫(zhong)(zhong)若位于(yu)肝下(xia)方靠后,則可(ke)出現(xian)腎區的(de)(de)疼痛(tong),有時(shi)疼痛(tong)可(ke)放射至頸部(bu)、肩部(bu)。膿(nong)腫(zhong)(zhong)刺激膈(ge)肌(ji)可(ke)引起嗝逆。膈(ge)下(xia)的(de)(de)感染可(ke)通(tong)過淋(lin)巴系統回流(liu)引起胸(xiong)(xiong)(xiong)膜(mo)、肺反應,出現(xian)胸(xiong)(xiong)(xiong)水、咳嗽、胸(xiong)(xiong)(xiong)痛(tong)等不適。膿(nong)腫(zhong)(zhong)若穿破(po)到胸(xiong)(xiong)(xiong)腔(qiang)可(ke)發生膿(nong)胸(xiong)(xiong)(xiong)。近些年由于(yu)大量濫用(yong)抗生素,腹腔(qiang)膿(nong)腫(zhong)(zhong)的(de)(de)局(ju)(ju)部(bu)癥狀(zhuang)多不典型。嚴重時(shi)候可(ke)出現(xian)局(ju)(ju)部(bu)皮膚凹陷性水腫(zhong)(zhong),局(ju)(ju)部(bu)皮膚發燙(tang)、溫度(du)升(sheng)高(gao)。患側胸(xiong)(xiong)(xiong)部(bu)呼(hu)吸時(shi)胸(xiong)(xiong)(xiong)廓活動幅度(du)變小,肋(lei)間(jian)隙不如健側明顯。肝臟濁音界擴大升(sheng)高(gao)。約25%的(de)(de)患者膿(nong)腔(qiang)中含有氣體,可(ke)叩擊(ji)出四(si)層不同的(de)(de)音響區。
2、盆腔膿腫
盆腔腹膜的(de)(de)(de)面積較(jiao)小,吸收毒素的(de)(de)(de)能力較(jiao)差(cha),因此,盆腔膿(nong)腫的(de)(de)(de)全(quan)身癥(zheng)(zheng)(zheng)狀較(jiao)輕而(er)局部癥(zheng)(zheng)(zheng)狀卻(que)相對(dui)明(ming)顯(xian)(xian)。在(zai)急(ji)(ji)性腹膜炎的(de)(de)(de)治療過程(cheng)中、闌尾炎穿(chuan)孔或(huo)結(jie)腸(chang)(chang)(chang)、直(zhi)(zhi)(zhi)腸(chang)(chang)(chang)術后的(de)(de)(de)患(huan)者(zhe),出現體溫正常后又再次升高、典型的(de)(de)(de)直(zhi)(zhi)(zhi)腸(chang)(chang)(chang)或(huo)膀(bang)胱刺激癥(zheng)(zheng)(zheng)狀,如里急(ji)(ji)后重(自覺(jue)大(da)便(bian)排不凈)、大(da)便(bian)頻繁而(er)量少、大(da)便(bian)混(hun)有(you)粘液、尿(niao)頻、尿(niao)急(ji)(ji)、尿(niao)痛、排尿(niao)困難等(deng)等(deng),則(ze)應考(kao)慮(lv)到盆腔膿(nong)腫的(de)(de)(de)可能。腹部則(ze)多無明(ming)顯(xian)(xian)的(de)(de)(de)癥(zheng)(zheng)(zheng)狀。直(zhi)(zhi)(zhi)腸(chang)(chang)(chang)指檢可發現肛管(guan)括約肌松(song)弛(chi),在(zai)直(zhi)(zhi)(zhi)腸(chang)(chang)(chang)前壁可觸(chu)及直(zhi)(zhi)(zhi)腸(chang)(chang)(chang)腔內膨隆,有(you)觸(chu)痛,有(you)時可有(you)波動感。
3、腸間膿腫
腸間(jian)膿(nong)腫(zhong)的患者多(duo)表現(xian)為化膿(nong)性感染(ran)的癥狀,因感染(ran)灶相對封閉隔離(li),較少引起全(quan)身(shen)反(fan)應,發(fa)(fa)熱癥狀不及上述兩種腹腔膿(nong)腫(zhong)明顯,多(duo)為低(di)熱。但腹部的癥狀與體(ti)征則相對突出(chu)。患者常出(chu)現(xian)局限性的腹痛(tong),多(duo)為隱痛(tong),并(bing)有(you)腹脹(zhang)等不適,查體(ti)可(ke)(ke)出(chu)現(xian)腹部壓痛(tong)且可(ke)(ke)觸及腹部腫(zhong)塊。膿(nong)腫(zhong)若咨詢穿破進入腸管(guan)或膀胱,則形成內瘺,膿(nong)液可(ke)(ke)隨大(da)小便(bian)排除。此外,腸間(jian)膿(nong)腫(zhong)還可(ke)(ke)引發(fa)(fa)機械性腸梗阻(zu),出(chu)現(xian)腹痛(tong)、腹脹(zhang)、嘔(ou)吐、停止排氣(qi)、排便(bian)等梗阻(zu)正(zheng)常。