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Абсцесс, флегмона век PDF Печать E-mail
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08.02.2012 16:16

Абсцесс, флегмона век (regio palpebrae)

Топографическая анатомия

Границы области соответствуют границам орбиты. На границе век с лобной областью располагается полоска кожи с густым ростом волос — бровь (supercilium). Между свободным краем верхнего и нижнего века находится глазная щель (rima palpebrarum). Медиальный угол глазной щели закруглен и образует слезное озеро (lacus lacrimalis). На передней грани свободного края век в несколько рядов располагаются жесткие волоски —.ресницы (cilia). Послойная структура. Кожа тонкая, подвижная по отношению к подлежащим анатомическим структурам — мышце (m. orbicularis oculi), так называемому хрящу век (tarsus). В толще tarsus, являющегося плотной соединительно-тканной пластинкой, расположены сальные железы (glandulae tarsales), выводные протоки которых открываются в области свободного края век. Изнутри веки покрыты конъюнктивой (conjunctiva), плотно связанной с tarsus которая вблизи края глазницы переходит на глазное яблоко. Кровоснабжение осуществляется в основном из системы a. ophthalmica, ветви которой образуют на поверхности хрящей век артериальные дуги (arcus palpebralis superior et inferior). Отток венозной крови происходит в систему v. facialis, v. temporalis superflcialis, v. v. ophthalmicae.

Основные источники и пути проникновения инфекции

Гнойно-воспалительные заболевания кожи век, сальных желез, инфицированные раны, нагноившиеся гематомы, вторичное поражение в результате распространения инфекционно-воспалительного процесса из смежных анатомических областей (подглазничной, лобной, скуловой).

Характерные местные признаки абсцесса, флегмоны век

Жалобы на боль в области пораженного века умеренной интенсивности, нарушение бинокулярного зрения из-за сужения или полного закрытия глазной щели. Объективно: резко выраженная припухлость тканей века, часто распространяющаяся и на другое веко, гиперемия кожных покровов. Глазная щель сужена или ее невозможно открыть из-за отека и слипания век, конъюнктива века и глаза гиперемирована, наблюдается гноетечение. При пальпации под кожей века определяется инфильтрат, давление на который вызывает боль.

Пути дальнейшего распространения инфекции

Смежные анатомические области: область глазницы с распространением на решетчатую кость, подглазничную, лобную, скуловую области.

Методика операции вскрытия абсцесса, флегмоны век

1. Обезболивание — местная инфильтрационная анестезия на фоне премедикации.Место и направление кожных разрезов при абсцессе век

2. Разрез кожи проводят через центр воспалительного инфильтрата на всем его протяжении параллельно свободному краю века или краю глазницы (рис.23).

3. Расслаивая кровоостанавливающим зажимом рыхлую подкожную клетчатку и раздвигая волокна круговой мышцы глаза (m. orbicularis oculi), продвигаются к центру воспалительного инфильтрата, вскрывают гнойно-воспалительный очаг, эвакуируют гной.

4. В рану вводят узкий плоский дренаж из перчаточной резины или полиэтиленовой пленки.

5. Асептическая ватно-марлевая повязка.


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Обновлено 10.02.2012 12:09
 
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