外科学课件整理-非特异性泌尿男生殖系统感染、结核-15双语班.ppt

泌尿系结核肉眼（膀胱镜）观 A:Extensive tuberculosis of the kidney and ureter with calcification anf stricture formation B:Acutely inflamed ureter orifice(the orifice red ,inflamed and edematous) C:Tuberculous bullous granulations (they may completely obscure the ureteric orifice) Acute Tuberculous ulcer（Initially,they are in close proximity to the ureteric orifice ,but as the disease progresses they can apper in any part of the bladder) 3.免疫机能异常 动物实验研究结果还发现免疫机制和慢性非细菌性前列腺炎之间存在密切关系，后者被认为有可能是一种自向免疫性疾病。 4.前列腺淤滞： 性生活过度、盆腔充血、嗜洒、会阴部长时间受压（骑马、自行车）可引起前列腺充血，造成腺管阻塞，分泌物排不出，致局部出现“化学性前列腺炎”，可能为细菌性前列腺炎及前列腺痛发病的原因。 5.精神因素在慢性非细菌性前列腺炎的发病因素中可能也占有一席之地。 6.病原体 引起前列腺炎的致病菌与尿路感染中所见的细菌相似，以大肠杆菌最为最见，其次为变形杆菌、克雷伯杆菌、假单孢菌属等革兰阴性菌，革兰阳性菌中的肠球菌也可引起前列腺炎。 近年来随着性病的发生率上升，淋病性尿道炎的发生增多，淋球菌亦成为本病的致病菌之一。 结核杆菌、真菌、滴虫和病毒等也都可导致相关的特异性前列腺炎。 非细菌性前列腺炎很可能仍然是由细菌所引起的。对沙眼衣原体和解脲脲原体在慢性非细菌性前列腺炎中的作用尚存在很大争议。 7.机体抵抗力降低： 正常前列腺液中含强有力抗菌因子，具有杀菌作用，前列腺炎者，前列腺液抗菌因子降低，提示局部免疫力下降，使细菌在腺体内繁殖。 　 Acute epididymitis 病因：Caused by bacterial infection ascending from the urethra or prostate.The disease is less common in older males,but when it does occur,it is most often due to infection secondary to urinary tract obstuction or instrumentation. 临床表现：发热 红、肿、热、痛 诊断：症状+体征 Acute epididymitis Differential diagnosis： 1 The presence of urethritis probably indicate that the patient has epididymitis and not a torsion. 2.Physical examination in early epididymitis shows swelling limited tto the tail of the epididymis (85%) 3.Radionuclide scanning of scrotum. 4.Color-code duplex Doppler ultrasonography TReatment：Antibiotics Prednisone be of no value as an adjunct to antibiotic therapy in the treatment of epididymitis. Rest in bed Scrotum elevation Drainage of the