ТРАДИЦИОННЫЕ И СОВРЕМЕННЫЕ МЕТОДЫ ДИАГНОСТИКИ И ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКИ ПАРАТОНЗИЛЛЯРНОГО АБСЦЕССА, ПЕРСПЕКТИВЫ ПРИМЕНЕНИЯ УЛЬТРА-СОНОГРАФИИ
Обзорная статья
Дата публикации: декабря 7, 2022
Ключевые слова
паратонзиллит
паратонзиллярный абсцесс
компьютерная томография
паратонзиллярный абсцесс
компьютерная томография
Как цитировать
[1]
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Аннотация
Паратонзиллярный абсцесс – это ургентное заболевание, с которым ЛОР-врачи встречаются крайне часто и требует незамедлительного хирургического лечения. Паратонзиллярный абсцесс является конечной патогенетической точкой паратонзиллита, который необходимо лечить консервативно. Клинические проявления, жалобы, стадии и сроки патогенеза не всегда коррелируют, формирование паратонзиллярного абсцесса происходит в среднем за 3 – 5 дней. Вышеуказанные временные рамки крайне условны и вариабельны. Достоверность и верификация диагноза ПТА при изолированном физикальном обследовании пациента крайне ограничена: чувствительность изолированного ЛОР-обследования пациента составляет 78% и специфичность – 50% с учетом современных достижений в медицине. В клинической практике рутинно используется: физикальный осмотр, пункция паратонзиллярной области, компьютерная и магнитно-резонансная томография. Пункция паратонзиллярной области имеет 10 – 24% ложно-отрицательных результатов и не позволяет достоверно дифференцировать паратонзиллит от паратонзиллярного абсцесса и связана с риском травматизации рядом расположенных крупных сосудов. КТ имеет высокую чувствительность и специфичность по отношению к паратонзиллярному абсцессу, но компьютерная томография не может быть рутинно использована, ввиду осложнений связанных с лучевой нагрузкой. Магнитно-резонансная томография, наряду с КТ, так же используется с целью диагностики гнойно-воспалительной патологии головы и шеи. МРТ позволяет лучше могут быть визуализированы мягкие ткани, жидкостные образования и крупные сосуды. С другой стороны, необходимо помнить о недостатках, связанных с процедурой и противопоказаниях к применению МРТ в различных клинических ситуациях. В дополнение к вышеуказанным методам с целью диагностики и дифференциальной диагностики паратонзиллярного абсцесса может быть применена ультра-сонография, которая является доступным, малоинвазивным, дешевым методом. УЗИ, помимо прочего, может быть использована для ассистенции при пункции паратонзиллярного абсцесса.Литература
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2. Карнеева О. В., Дайхес Н. А., Поляков Д. П. Протоколы диагностики и лечения острых тонзиллофарингитов // РМЖ. – 2015. – Т. 23. – №. 6. – С. 307-310. [Karneeva O. V., Daihes N. A., Polyakov D. P. Protocols for the diagnosis and treatment of acute tonsillopharyngitis // BC. – 2015. – V. 23. – №. 6. - P. 307-310. In Russian].
3. Солдатов И.Б. Оториноларингология: учебник. Под ред. И.Б. Солдатова, В.Р. Гофмана. Санкт-Петербург. – 2000. – C. 446. [Soldatov I.B. Otorhinolaryngology: textbook. Ed. I.B. Soldatov, V.R. Hoffmann. St. Petersburg. – 2000. – P. 446. In Russian].
4. Пальчун В.Т., Магомедов М.М., Лучихин Л.А. Оториноларингология: учебник. 2-е изд., исправленное и дополненное Москва. – 2011. – С. 656 [ Soldatov I.V. Otorhinolaryngology: textbook. Unit I.V. Soldatov, V.R. Hoffmann. – Saint Petersburg. – 2000. – Р. 446. In Russian].
5. Носуля Е.В. Паратонзиллит // Вестник оториноларингологии. – 2013. – №78(3). – С. 65-70. [Nosulya E.V. Paratonsillitis // Bulletin of Otorhinolaryngology. – 2013. – № 78 (3). – Р. 65-70].
6. Mansour C. et al. Comparison of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of peritonsillar abscess //European Archives of Oto-Rhino-Laryngology. – 2019. – V. 276. – №. 9. – P. 2595-2601. Doi: 10.1007/s00405-019-05542-1.
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8. Herzon F. S. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines //The Laryngoscope. – 1995. – V. 105. – №. S3. – Р. 1-17.
9. Millar K. R. et al. Suspected peritonsillar abscess in children // Pediatric emergency care. – 2007. – Т. 23. – №. 7. – Р. 431-438. DOI: 10.1097/01.pec.0000280525.44515.72
10. Ellen R.W.et al. Tonsillectomy and/or adenoidectomy in children: Indications and contraindications. Peritonsillar cellulitis and abscess // UptoDate. – September 2021.
11. Сиренко Н.В. и др. Паратонзиллярные абсцессы у детей. Клинико-микробиологические методы исследования // Антибиотики и химиотерапия. – 2017. – Т. 62. – No 1–2. – С. 35–39. [Sirenko N.V. et al. Peritonsillar abscesses in childhood. Clinical and microbiological methods of investigation // Antibiotiki i himioterapiya (Antibiotics and chemotherapy). – 2017. –V. 62. – No 1–2. – P. 35–39. In Russian].
12. Klug T. E., Greve T., Hentze M. Complications of peritonsillar abscess //Annals of clinical microbiology and antimicrobials. – 2020. – V. 19. – №. 1. – P. 1-17. doi:10.1186/s12941-020-00375-x
13. Ding M. C. et al. Patients with comorbid rheumatoid arthritis are predisposed to peritonsillar abscess: real-world evidence //European Archives of Oto-Rhino-Laryngology. – 2021. – V. 278. – №. 10. – P. 4035-4042. doi:10.1007/s00405-021-06638-3
14. Huang C. M. et al. Deep neck infections in children //Journal of microbiology, immunology and infection. – 2017. – V. 50. – №. 5. – P. 627-633. doi:10.1016/j.jmii.2015.08.020
15. Aalling M., Klug T. E. Streptococcal toxic shock syndrome complicating a peritonsillar abscess //Infectious Diseases. – 2015. – V. 47. – №. 2. – P. 101-103.. doi:10.3109/00365548.2014.961543
16. Vijay V., Fattah Z. Lesson of the month 1: Lemierre's syndrome: a reminder of the ‘forgotten disease’ //Clinical Medicine. – 2018. – V. 18. – №. 1. – P. 100. doi:10.7861/clinmedicine.18-1-100
17. Sideris G. et al. Ubi pus, ibi evacua: a review of 601 peritonsillar abscess adult cases //Irish Journal of Medical Science (1971-). – 2021. – P. 1-5. doi: 10.1007/s11845-021-02796-9
18. Li R. M., Kiemeney M. Infections of the Neck //Emergency Medicine Clinics. – 2019. – V. 37. – №. 1. – P. 95-107.doi:10.1016/j.emc.2018.09.003
19. Passy V. Pathogenesis of peritonsillar abscess //The Laryngoscope. – 1994. – V. 104. – №. 2. – P. 185-190.
20. Chang G. H. et al. High Risk of Peritonsillar Abscess in End-Stage Renal Disease Patients: A Nationwide Real-World Cohort Study // International Journal of Environmental Research and Public Health. – 2021. – V. 18. – №. 13. – P. 6775. doi:10.3390/ijerph18136775
21. Grant M. C. et al. Establishing the need for an evidence-based treatment algorithm for peritonsillar abscess in children // Clinical Pediatrics. – 2018. – V. 57. – №. 12. – P. 1385-1390.doi:10.1177/0009922818778048
22. Wilson M. B. et al. Machine learning diagnosis of peritonsillar abscess //Otolaryngology–Head and Neck Surgery. – 2019. – V. 161. – №. 5. – P. 796-799.doi:10.1177/0194599819868178
23. Powell J., Wilson J. A. An evidence‐based review of peritonsillar abscess //Clinical otolaryngology. – 2012. – V. 37. – №. 2. – P. 136-145. doi:10.1111/j.1749-4486.2012.02452.x
24. Froehlich M. H., Huang Z., Reilly B. K. Utilization of ultrasound for diagnostic evaluation and management of peritonsillar abscesses //Current opinion in otolaryngology & head and neck surgery. – 2017. – V. 25. – №. 2. – P. 163-168.doi:10.1097/MOO.0000000000000338
25. Sagar P. et al. Impending rupture of internal carotid artery aneurysm mimicking peritonsillar abscess //The Indian Journal of Pediatrics. – 2018. – V. 85. – №. 10. – P. 911-913.doi:10.1007/s12098-018-2655-7
26. Kayhan F. T., Özkul N. Case report: exranodal non-Hodgkin’s lymphoma of the parapharyngeal space //Auris Nasus Larynx. – 1999. – V. 26. – №. 2. – P. 201-205.
27. González-Benito E. et al. Difficult airway in a patient with lymphoma. A case report // Revista Española de Anestesiología y Reanimación (English Edition). – 2021. – V. 68. – №. 5. – P. 297-300. doi:10.1016/j.redare.2020.05.024
28. Jeleff O. et al. Eitrige Lymphadenitis nach Abszesstonsillektomie bei Immunsuppression //H№ – 2012. – V. 60. – №. 7. – P. 622-625.doi:10.1007/s00106-011-2469-7
29. Ishii K. et al. Evaluation of safe surgical treatment of peritonsillar abscess using computed tomography //Nippon Jibiinkoka Gakkai Kaiho. – 2002. – V. 105. – №. 3. – P. 249-256.. doi:10.3950/jibiinkoka.105.249
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