Узбекистон республикаси согликни саклаш вазирлиги
Download 1.08 Mb. Pdf ko'rish
|
13-mavzu
|
bazaloidnыy,
borodavchatыy i papillyarnыy. Vospaleniyu bolshe podverjen pridatok yaichka, chem samo yaichko. Sredi tryox osnovnыx infeksiy, porajayuщix yaichko i yego pridatok (sifilis, gonoreya i tuberkulyoz), prichinoy vospaleniya pridatka yaichka pochti vsegda yavlyayutsya gonoreya i tuberkulyoz, v to vremya kak sifilis porajayet v pervuyu ochered yaichko. Epididimit i posleduyuщiy orxit obыchno svyazanы s infeksiyami mochevыvodyaщix putey (sistitom, uretritom, prostatitom), kotorыye rasprostranyayutsya v yaichko i yego pridatok cherez semyavыnosyaщiy protok ili po limfaticheskim kapillyaram semennogo kanatika. Prichina epididimita zavisit ot vozrasta patsiyenta. Epididimit redko nablyudayetsya u detey. V etom vozraste on, kak pravilo, svyazan s vrojdennыmi porokami razvitiya mochepolovoy sistemы i infitsirovaniyem gramotritsatelnыmi palochkami. U seksualno aktivnыx mujchin moloje 35 let osnovnыmi vozbuditelyami yavlyayutsya peredayuщiyesya polovыm putyom S. trachomatis i N. gonorrhoeae, v to vremya kak u mujchin starshe 35 let bolshinstvo infeksiy mochevыvodyaщix putey assotsiiruyutsya s YE.coli i Pseudomonas spp. Morfologiya. Bakterialnaya invaziya privodit k razvitiyu nespesificheskogo ostrogo vospaleniya, xarakterizuyuщyegosya venoznыm polnokroviyem, otekom i infiltratsiyey neytrofilami, makrofagami i limfotsitami. Infeksiya na ranney stadii ogranichivayetsya preimuщyestvenno interstitsialnoy soyedinitelnoy tkanyu, no vozmojno stremitelnoye rasprostraneniye infeksii s vovlecheniyem kanalsev i razvitiyem abssessa ili totalnogo gnoynogo rasplavleniya pridatka yaichka. Neredko pri nalichii epididimita mojet porajatsya yaichko s razvitiyem sxodnoy vospalitelnoy reaksii. Pri takom vospalenii yaichka i yego pridatka chasto proisxodit fibroznoye rubsevaniye, chto v bolshinstve sluchayev privodit k besplodiyu. Interstitsialnыye kletki Leydiga obыchno razrushayutsya ne polnostyu, poetomu seksualnaya aktivnost ne narushayetsya. Idiopaticheskiy granulematoznыy orxit nablyudayetsya v srednem vozraste i xarakterizuyetsya vnezapnыm nachalom, nebolshoy boleznennostyu yaichka i inogda pod’yomom temperaturы. Inogda zabolevaniye razvivayetsya nezametno v vide bezboleznennogo obrazovaniya, napominayuщyego opuxol yaichka. Gistologicheski orxit xarakterizuyetsya nalichiyem granulem, ogranichennыx semennыmi kanalsami. Eti granulemы napominayut tuberkulы, no otlichayutsya ot nix tem, chto granulematoznaya reaksiya rasprostranyayetsya diffuzno po parenxime yaichka mejdu semyavыnosyaщimi protokami. Predpolagayetsya autoimmunnaya priroda zabolevaniya, no tochnaya prichina ostayetsya neizvestnoy. Rasprostraneniye infeksii iz zadney uretrы na predstatelnuyu jelezu, semennыye puzыrki i potom na pridatok yaichka yavlyayetsya tipichnыm rezultatom zapuщyennoy gonokokkovoy infeksii. Proisxodyat vospalitelnыye izmeneniya, poxojiye na opisannыye pri nespesificheskix infeksiyax, s razvitiyem otkrыtыx abssessov pridatka yaichka, kotorыye mogut privodit k obshirnoy destruksii organa. V zapuщyennыx sluchayax protsess rasprostranyayetsya na yaichko i voznikayet gnoynыy orxit. Epidemicheskiy parotit eto sistemnoye virusnoye zabolevaniye, kotorыm chaщye boleyut deti shkolnogo vozrasta. V etom vozraste porajeniye yaichek nablyudayetsya chrezvыchayno redko, odnako v postpubertatnom periode orxit razvivayetsya v 20- 30% sluchayev. Kak pravilo, ostrыy interstitsialnыy orxit voznikayet priblizitelno cherez nedelyu posle poyavleniya pripuxlosti okoloushnыx jelez. Tuberkulyoz pochti vsegda nachinayetsya v pridatke yaichka, zatem mojet rasprostranitsya na yaichko. Infeksiya xarakterizuyetsya klassicheskimi dlya tuberkulyoza lyuboy lokalizatsii morfologicheskimi proyavleniyami kazeoznogo granulematoznogo vospaleniya. Kak priobretyonnыy, tak i vrojdennыy sifilis mojet stat prichinoy porajeniya yaichka i yego pridatka, odnako yaichko pochti vsegda pervыm vovlekayetsya v infeksionnыy protsess. V bolshinstve sluchayev orxit ne soprovojdayetsya epididimitom. Morfologicheskiye priznaki vospaleniya podrazdelyayut na dve formы: Download 1.08 Mb. Do'stlaringiz bilan baham: 
|