nhan xet:
- Soi p h i quan ed ap dung eae ky thupt l i y bpnh p h i m c h i n doan t l bao hpe, md hpc cd y nghTa Idn trong vipc hd trp cho e h i n doan xae dinh bpnh.
- Sinh thilt p h i quan e h i n doan la xet nghipm e i n , dCi va la tieu c h u i n vang cho e h i n doan.
- Tuy nhien khdng phai luc nao sinh thiet cung cd t h l thuc hien dupe.
o l nang cao hieu s u i t e h i n doan trong nhirng trudng hop ma sinh thilt edn han c h i thi:
Chpc hut xuyen thanh khi p h i quan la mpt ky thupt hd trp vdi sinh thilt trong ehin doan xac djnh ung t h u p h i quan nguyen phat.
Soi p h i quan dng eCrng la mpt ky thupt khdng ddi hoi trang bj tdn kem nhung r i t hipu qua trong c h i n doan benh ly hd h i p ,
T A I LIEU THAM K H A O
1. N G U Y E N LIEN HOP, Chan doan ung thu phe quan bang phuong phap chpc do, Cong trinh nghien cuu khoa hoc y duoc, 1979, NXB Y hoc 1980; 78,
2, N G 6 TH! THU THOA, Chan doan te bao hpc trong ung thu phe quan phoi tai vien K. Cong trinh nghien cuu ung thu-Vien Ungthu 1987, 73.
4. HOANG H O N G T H A I V A C Q N G SU. Nh§n x6t
budc dau ve giS tri cua ky thuat chpc hut cya khi p h i quan bing kim nho trong chan doan ung thu phoi qua npi soi phe
quan ong curng tai khoa Ho hap benh vien Bach Mai, Ky yeu cong trinh nghien curu khoa hpc Dai hpc Y khoa H^ Npi, So 4/1995, trang,57.
5. CASTELLA J., BUJ J., PUOL C. Diagnosis and staging of brochogenic carcioma by transtracheal and transbronchial needle aspiration. Ann - Oncol, 1995; 6 supl 3; 21-4.
6. D E B O I R A H . S H U R E . Transbronchial biopsy and needle aspiratipn. Chest 95; May 1989.
7. EDUADO S C H I E P P A T T I , Mediastinal lymph node puncture through transtracheal carina. Surgery - gynecology-obs 8, 1958; 243-244,
8. GUPTA D,, GULATI M, Fluoroscopic transbronchial aspiratipn for diagnosis of peripheral pulmpnary nodule, Indian- J- Chest- Dis- allied - sci 1996; Jul- Sep; 38 (3); 163- 167.
9. HARROW E., WANG K.P, The staging of lung cancer by bronchoseopie transbronchial needle aspiration.
Chest-Surg-Clin-Ann 1996, May; 6(3) 223-235,
10. WANG KP, Transbronchial needle aspiratipn biopsy for histological specimens. Ann - Oto - Rhino - Laryngo 94.
1985; 382-385,
11. S C H I E S S L E R . W . La ponction transbronchique et transtracheale des adenopathies p6ri - trach6o - bronchiques. Communication, Seance du 1 F6vrier 1962;
551 - 569.
DANH GIA KET QUA
P H A UTHUAT DIEU TRI DINH MEP TROOfC DAY THANH QUA NOI SOI
H / O N G THj MINH HUONG Truing Dai hgc YHi Ngi
TOM T A T
Dinh mep triede day thanh (DT) la tinh trgng day thanh 2 ben bi dinh d mep truac eae miec do khac nhau lam cho chiec nang phat am va hd hip bj anh hudng.
Mue tieu: Nghien cuu dac diim lam sang eua dinh DT va danh gia kit qua phiu thuat cit tach dinh DT qua ndi soi. Doi tugng nghien cieu: Gom 32 bgnh nhan dinh mep trudc DT diiu tri tai Benh vien TMH trung uang tu nam 2005-2008. Phieang phip: md ta timg tnrdng hap cd can thigp. Kit qua: Trigu chung ea nang quan trgng nhat la khan tiing, mat tieng (100%,), khd thd TQ dg I (21,88%), do II (25%,). Dinh do 1 cao nhat 40,63%, dg 2:
12,5%, do 3: 21,88%, do 4: 25%. Kit qua phiu thuat:
Ndi soi cat- tach dinh cd sie dung mitomycin C tgi eho cho kit qua tdt: 53,13%,, kit qua trung binh 25%o, kit qua xiu: 21,87%,. Kit luan: Diiu tri dinh mep trudc DT rat khd khan, de phdng tranh cae nha TMH can rat thgn trgng khi can thigp tren DT.
Tie khda: Dinh mep tnede day thanh 2 ben, phiu thugt tach dinh day thanh, mitomycin C
SUMMARY:
Aesess treament results of laryngeal web by endoscopy
Laryngeal web is the status that two vocal cords were been adherent in anterior comissure. Both two functions speech and breathe were Involed. Objectives:
Studying clinical characterstics and treatment results of laryngeal web. Patients: 32 patients who were treated In National ENT hospital from 2005-2008. Method: clinical
analysis Results: The major symptom was hoamess (100%,) and laryngeal dyspnee gradel: 21.88%, grade 2:
25%,. Laryngeal endoscopic: type: 40.63%,, type 2:
12.5%,, type 3: 21.88%,, type 4:25%,. Treatment results:
good: 53.13%, moderate: 25%, and bad: 21.87%.
Conclusions: This technique which is dificult to manipulate and the Oto- rhino- laryngologlst are always be careful to do laryngeal microsurgery to prevent laryngeal web.
Keywords: laryngeal web, endoscopic lysis and topical mItomycin-C
DAT VAN Bt
Dinh mep trudc day thanh (DT) la tinh trang bd tv do day thanh 2 ben bj dinh l i l n thanh mpt khdi. Khi bj dinh mep trii'de bpnh nhan bj khan t i l n g , phat am rat khd khan, n l u dinh tdi Vi giti'a day thanh se lam cho benh nhan khd thd TQ va ngu ngay r i t to.
Cd r i t n h i l u nguyen nhan gay dinh mep trudc DT 2 ben nhu viem nhiem, c h i n thuong va b i m sinh.
T u lau da cd n h i l u phuong phap p h l u thupt vdi myc tieu la dam bao eho benh nhan vua phat am tdt vira khdng bj khd thd. Tuy nhien, cho d i n nay phau thuat tach dinh DT van la 1 p h l u thuat chua dem lpi k i t qua nhu mong dgi vi kha nang dinh tai phat r i t cao.
Tir khi ed dng dan sang lanh, npi soi treo TQ diing optic 0 dp cd phdng dpi da duoc irng dung d l cat-tach dinh DT 2 ben, cham mitomycin C tpi vCing phau thu^t d l chdng tang sinh td chire hpt nham chdng tai dinh cho k i t qua kha quan. Nghien ciru dugc thuc hipn vdi myc tieu: , ,,,., „- „
64 Y HOC THVC HANH (667) - S 6 7/2009
-Nghien ciru dac diim lam sang cua sgo dinh mep trudc DT 2 ben
-Danh gia kit qua phiu thugt eat - tach dinh DT 2 ben, cd chim mitomycin C tai chd cat.
D 6 I TU'O'NG VA PHLfONG PHAP NGHIEN CIJ'U - Gdm 32 benh nhan dinh mep trudc DT 2 ben, dupc phau thuat elt-tach dinh DT tif nam 2005 din 2008, khdng phan bipt tudi gidi nghl nghiep.
- Phuong phap nghien cuu: md ta tirng ca cd can
thiep, t - Phuong tien nghien ciru:
Bp npi soi treo Kari-Storz (Due), optic 0 dp 4mm, dai 30cm ndi camera.
Dung cy vi phau thanh quan: cae lopi pince va keo, tam bdng, dng hut
Xylocaine 6%, Mitomycin C 2 mg. Adrenaline 0,1%.
+ Tham kham TQ: Dung optic 70 dp kham TQ hope soi treo TQ danh gia mCre dp dinh DT 2 ben theo Cohen : Chia dinh TQ lam 4 dp (hinh 1):
-Dp 1 ; Dinh mep trude dudi 35% (A) f -Dp 2 : Dinh mep trude tir 35-50% (B)
;. -Dp 3 : Dinh mep trude tir 50-70% (C) -Dp 4 : Dinh mep trudc tir 75-90% (D)
Hinhl
Chuan bj phau thuat: Md khi quan (MKQ) khi cd diu hieu kho thd TQ dp II trd len.
\. Phuang phap phiu thugt:
- Benh nhan nam ngCra tren ban, gdi dudi vai.
- Oat npi khi quan qua lo MKQ hoac qua mui (nlu chua MKQ). Me NKQ.
- Npi soi treo TQ, dieu chinh dng soi d l toan bp TQ 3u:gc bpe Ip rd rang.
_ - Sir dyng optic 0 dp d l quan sat. Dimg keo vi phau thing cit- tach mang dinh day thanh 2 ben. Cit tach dinh tdi sat goc nhj dien tilp giap giira 2 DT (dinh chii' V ngupe), sat bd tu do 2 DT. Liy bd phin mang dinh.
- Cam mau bing bdng thim adrenaline pha loang.
Mitomyeine C 2mg pha vdi 1 ml nude cit thim vao bong khd da ve chat, ep vao vung bd tu do DT 2 ben vua cat- tach dinh, d l trong 5 phut, kilm tra l^i thiy vlt md khd thi ngung lai.
Cham sdc sau phiu thuat:
- Benh nhan dat npi khi quan: rut npi khi quan ngay khi tinh. Benh nhan da MKQ thi rut dng npi khi quan va dat lai canuyn.
- Dung khang sinh phd rpng, giam viem trong 5 ngay.
- Chim Mitomycin-C va bom thude TQ hang ngay bang Hidroeortison 25mg/1ml mdi ngay, 7 ngay, kilm tra hang ngay theo doi tiln triln eua mep trudc DT 2 ben.
- Bpnh nhan MKQ thi rut canuyn sau 10 ngay den 15 ngay.
- Biln chCrng saumd: theo doi cac diu hieu: chay mau, nudt dau, khd thd, khan tilng, Iran khi du'di da nay xung vung cd.
- Npi soi kilm tra lai trudc khi xuat vien, Kham lai sau 1, 3 va 6 thang
Oanh gia kit qua cudi cimg (sau phlu thuat 6 thang):
Chia lam 3 muc dp:
Tdt: khdng khan tilng, DT 2 ben nhan, phing, khdng dinh
Trung binh: Khdng khd thd, tilng khan vua, edn dinh dp 1 DT 2 ben
x i u : Cd khd thd khi gang sire, tilng khan nang, dinh mep trudc do 2
K^T QUA NGHIEN CLFU
1. Die diem lam sang cua dinh mep trudc DT 2 ben
- Tudi va gidi: Ti le mac benh eua nu' (28/32) nhilu gip 7 lin nam (4/32). Tudi ed ti Ip mie benh eao nhit la tip 36-55 tudi (68,75%).
- Nguyen nhan Bang 1. Nguyen nhan
Nguyen nhan Mang dinh bim sinh
Do chan thuong Do viem nhiem Khong rd nguyen
nhan Tdng
Sd trudng hop 6 16
7 3 32
Tile 18,75 50,00 21,88 9,37 100,00 Nguyen nhan hay gap nhit la ehin thuong (50%), Mang dinh TQ bim sinh (18,75%), viem nhilm: 21,88%, khdng ro nguyen nhan: 9,37%
+ Lam sang
- Khan tilng gap d 100% trudng hpp, ehu ylu la khan nang (75%).
- Khd thd TQ dp II (25%) phai tiln hanh md khi quan trudc khi phlu thuat, khd thd TQ dp I (21,88%).
- Thue t h l : kham npi soi TQ:
Bang 2: MCrc dp dinh DT (theo Cohen) Muc do
1 2 3 4
Sd ca 13
4 7 8
Tile 40,63 12,50 21,88 25,00 - Dinh dp 1 cd ti Ip eao nhit 40,63%. Op 4 cd tl le cao thu 2: 25%, dd 3: 21,88%, dd 2 ed ti le thip nhit 12,5%
2. Danh gia kit qua phlu thuat - Kit qua phau thuat:
• Bang 3: Kit qua phau thuat Kit qua
Tdt Trung binh
Xau Tdng
Sd ca 17
8 7 32
Tilp 53,13 25,00 21,87 100,00 Ket qua tdt: 53,13%, trung binh 25%. xiu: 21,87%.
- Tai biln, biln chung
Y HOC THVC HANH (667) - SO 7/2009 65
Sui tai vCing mep trudc: 2 ca 6,25%, dinh tai phat 15 ea (46,88%).
BAN LUAN
1. Dac diem lam sang cua dinh mep tru'dc DT 2 ben
- Tudi va gidi: Ti le mac benh cua nii' (87,5%) nhilu gip 7 lin nam (12,5%). Sd dT nir mie nhilu hon nam vi nip CO ti le phau thuat u lanh tinh DT nhieu hon nam [1], [2]. Tudi ed ti le mic benh cao nhit la tip 36-55 tudi (68,75%).
- Nguyen nhan: Do ehin thuong ehilm 50% trong dd chu ylu la do thiy thudc gay ra, sau phau thuat u nhu 4 ea (12,5%), sau cat hat xo 8 ca (25%), 2 ca do dat ndi khi quan, 2 ea do tai nan giao thdng. Nhu vay, nen than trpng hon trong viee can thiep vao DT va dat npi khi quan.
- Nguyen nhan do viem nhiem gap 4 ca sau cum (12,5%), cdn 3 trudng hpp sau dilu tri lao TQ (9,38%).
- Nguyen nhan bim sinh gap 6 trudng hop, tit ca ehi cd dj dang TQ don thuan khdng phdi hpp vdi cac dj dang khae eCia eo t h l [4].
+ Lam sang
-Khan tilng la trieu ehCrng quan trpng nhit gap d 100% trudng hop, chu ylu la khan nang, mit tilng [5].
-Khd thd TQ dp II (8/32 ea-25%) phai tiln hanh md khi quan trudc khi phau thuat, khd thd TQ dp I (21,88%).
- Thuc t h l dua vao kham TQ: dinh dp 1 cd ti Ip eao nhit 40,63%, mCre dp nay ehu ylu gap d nhCrng benh nhan co can thiep tren day thanh [3], Dp 4 cd ti le cao thu 2: 25%, gap 2 benh nhan chin thuong TQ do tai nan giao thong, sau eat u nhu TQ 2 ea, mang dinh bim sinh 3 ea, va sau lao TQ 1 ea. Day la nhQ'ng trudng hop see dinh kha day, can thiep rit khd khan. Dinh dp 3:
21,88%, dp 2 cd tlje thip nhit 12,5%, 2. Danh gia k i t qua phiu thuat
- Kit qua dilu tri: Kit qua tdt: 53,13%, tuy vpy, ti Ip thanh cong nay cao hon nhilu so vdi phiu thuat tach dinh don thuin trudc day, kit qua tdt chi dat 20% [5].
Kit qua trung binh 25%, gipng van cdn khan nhung da giao tilp duoc, khdng phai deo canuyn. Kit qua xiu:
21,87%, cd 3 ea dinh tai phat dp 3 vin phai deo canuyn, cdn 4 benh nhan gipng khan nang, giao tilp khd khan do dinh hit chilu cao DT nen bd tu do tdn thuong nhilu.
- Tai biln, biln chCrng
- Sui tai vimg mep trudc: 2 ca 6,25%, day la mpt
trong nhirng biln ehung thudng gap trong cac can thiep tren DT [3], vi vay, viec phau thuat DT phai hit sire than trpng nhit la d nhtpng bpnh nhan cd co dia spo ldi.
- Dinh mep trudc tai phat (46,88%) mac dii da sii' dung thudc uc ehi tang sinh TB: Mitomycin C, cho thiy mirc dp khd khan cua phau thuat.
KST LUAN
1. Dac diem lam sang dinh mep tru'dc DT 2 ben:
- Khan tilng la tripu chung quan trpng nhit gap 6 100% trudng hpp.
- Khd thd TQ dp II (8/32 ca-25%) phai tiln hanh mo khi quan trudc khi phiu thuat, khd thd TQ do I (21,88%).
- Thuc t h l dua vao kham TQ: dinh dp 1 ed ti Ip cao nhit 40,63%, Dp 4 cd ti le cao thu 2: 25%, dinh do 3:
21,88%, do 2 cd tijp thip nhit 12,5%
2. Danh gia ket qua phlu thuat
- Kit qua phau thuat: Ndi soi cit- tach dinh cho ket qua tdt: 53,13%, kit qua trung binh 25%, kit qua xiu:
21,87%. Vi vay, d l tranh dinh mep trudc DT cac nha TMH ein rat than trpng khi can thiep tren DT, khi viem TQ do cung nen dilu tri triet d l phdng dinh mep truoc DT.
TAI L I E U THAM K H A O
1. Trin Viet Hdng, Huynh Khac Cudng (2000), Crng dyng kT thuat npi soi dng cung vao vi phau TQ, Y hoc thanh phd Hd Chi Minh, sd dae biet hpi nghj KHKT Trudng Dai hpcY DuocTP. HCM lin thCr 19,1.69-72
2. Truong Ngpe Hung, Huynh Ba Tan (2005), Vi phau thuat TQ qua npi soi tai khoa Tai Mui hpng Bpnh vien Oa Nlng, Ki yiu cae edng trinh nghien cieu khoa hgc hdi nghj khoa hgc nganh Tai Mui Hgng, tr. 216-22
3. Trin Phan Ctiung Thuy, Pham Thanh Son (2005) Dilu tri lipt eo md thanh quan tai khoa Tai Mui Hpng bpnh vien Chp Riy, ki ylu cdng trinh nghien eCru khoa hpc, hpi nghj khoa hpc nganh TMH nam 2005, T.223-30
4. M. Hardingham and G.P, Walsh-Waring, (1975) The treatment of a congenital laryngeal web. The Journal of Laryngology & Otology, Cambridge University Press 89:273-280
5. Tip Fakultesi Hastanesi, Kulak Buain Bogaz Hastaliklari AD, Zeytinlibahee cad., (2004), The successful management of congenital laryngeal web with endoscopic lysis and topical mitomycin-C, international journal of pediatric otortiinolaryngology, volume 68, issue 2, p. 231- 235
TY LE NHIEM HIV 0 CAC NHOM DOI TOONG NGUY CO TAI HA NOI TRONG 10 NAM (1996 - 2005)
NGUYEN DLTC CHUNG - Trung tam Y te Du phdng Ha Ngi TRAN THj BfCH TRA - Cue phdng chong HIV/AIDS,Bg Yte TOM T A T
Human Immunodeficiency Virus (HIV) dang la dai dich lam anh hudng den sire khoe cgng ddng, nen kinh te ciia moi qudc gia, moi dan toe. Giam sat djch te hgc HIV de du bao dien bien cCia djch la rat can thiet. Muc tieu: Mo ta t^ le nhiem HIV d cac nhdm nguy ca trong 10 nam 1996 -2005 va nhan xet dac
diem lay nhiem HIV tai Ha Ndi. Ddi tugng va phuang phap: 3200 mau huyet thanh cOa 6 nhdm nguy cO khac nhau duac xet nghiem phat hien khang the khang HIV theo phuang each ll cCia bd Y te, ket qua giam sat HIV tir nSm 1996-2004. Ke't qua: nSm 2005 t^ le nhiem HIV d nhdm chich ma tuy (CMT) la 27,5%,, gai mai dam (GMD) la 13%o, phu nu" mang thai
66 Y HOC THVC HANH (667) - SO 7/2009
