Y HQC V|£T NAM THANG 7 • SO 2/2011
CHAN DOAN U MANG NAO TAI BENH VIEN DAI HOC Y HA N D I
Do Manh Thang*, KiSu Dinh Hung**
TOM TAT
M^c tieu: Md ta cac dafu hieu lam sang, hinh anh CLVT, CHT cua u mang nao tren benh nhan dieu trj tai khoa Ngoai, Benh vien Dai hpc Y Ha Ndl. Doi tUpng va phUOng phap nghien cuti: nghien culi tien cuU tren 52 benh nhan u mang nao dUdc chan doan dya vao lam sang va chan doan hinh anh tij' 6/2009 den 6/201. Ket qua va itet lu$n: 52 benh nhan da du'dc dieu tri, UMN hay gSp la 40-60 tudi (62,25%), tudi trung binh 46,98 ± 10,88. Cac trieu chutig lam sang hay gap la: Dau dau (86,54%) , ndn (28,85%), nhin md(38,46%), dpng kinh (19,23%), liet(19,23%). V| bi gap vom so (38,46%), canh du'dng giu'a (36,77%), nen sp (19,23%), liem nao (ll,44%).Tren phim CLVT thay khdi u ddng hoac tang ty trpng, ranh gidi ro, bat thudc can quang (96,15%), phtj quanh u (19,23%).
CHT cho thay hinh anh: khdi tron hoSc det, to'n hieu dong nhat, ranh gidi rd, giam b'n hieu tren T l , tang tfnh hieu tren T2, ngam thudc ddi quang manh 100%, phu quanh u (38,46%), "dudi mang cutig" (76,92%), nhan xet nay phij hdp vdi cac tac gia trong va ngoai nydc. Kfch thu-dc u tCf 3-6cm (69,23%).
Tiir khoa: Chan doan, u mang nao SUMMARY
Diagnosis of meningiomas at Hanoi Medical University hospital
Objective: Describe the clinical signs, computerized tomography images, magnetic resonance imaging of meningiomas patients at the Surgery Department of Hanoi Medical University Hospital. Subjects and Methods: the study on 52 patients with meningiomas. The patients were diagnosed base on clinical and imaging from 6 / 2009 to 6 / 2011. Results and conclusions: 52 patients were therapy, the most common age with meningitis is 40-60 years (62.25%), average age of 46.98 ± 10.88. The common symptoms are: headache (86.54%), vomiting (28.85%), blurred vision (38.46%), epilepsy (19.23%), paralysis (19.23%), tumor locations at cranial vault (38.46%), next to the midline (36.77%), base of the skull (19.23%), sickle brain (11.44%). The CT film showed: the tumor increasing the density, clear boundaries, caching dye (96.15%), edema around the tumor (19.23%). MRI showed: round or flat tumor, signal uniformity, clear boundary, hypointense on T l , increased signal on T2, absorption of contrast optical drugs 100%, edema around the tumor (38.46%),
* BV Viet Tiep Hai Phong; ** Bp mdn ngoai OHY Ha npi
-end-subdural" (76.92%), all tiiose observations consistent witii data of the intemational and national authors. Tumor size from 3-6cm (69.23%).
Keywords: Diagnosis, meningiomas 1. O^T V A N OE
l) mang nao (UMN) la nhiitig khdi u xuat phat tif nhung mao eua mang nhen, da sd la u lanh tfnh [1,3,4,6]. U mang nao tien trien cham, am tham nen nao ed thdi gian thich nghi. Dau hieu dau tien cua u mang nao chu yeu la dau dau nen d l nham vdi cac nguyen nhan khae, thydng cho rang dau dau do cam cum, do suy nhydc than kinh, hay cang thang trong cdng viec. Mdt sd khdi u gan day than kinh hay vijng chife nang quan trpng ed the chan doan sdm hdn nhd dau hieu chen ep cae day than kinh hay chen ep cac vung nay, hoac chan dean sdm nhd dau hieu ddng kinh. Phan nhieu nhQ'ng khdi u mang nao dydc chan doan mupn khi khdi u da Idn xam lan vao cac td churc lan can gay khd khan cho viec dieu trj. Chan doan sdm se gdp phan nang cao ket qua dieu trj va han che ty Id tif vong va dl chutig. Viec nghien eiili nhutig dae diem lam sang, can lam sang cua u mang nao se giup sang lpe va chan doan UMN sdm hdn, gdp phan cai thien hdn nO'a ket qua dieu trj, vi the chung tdi tien hanh de tai nay vdi muc tieu: A/d ta dae diem lam sang va can lam sang cua u mang nao
IL Ddi TUpNG VA PHUDNG P H A P NGHIEN COU 1. Doi tu'dng nghien cu'u
Odi tUdng nghien gom 52 BN dype chan doan la UMN dya vao cac dau hieu lam sang va chan doan hinh anh tai benh vien Dai hpc Y Ha Ndi trong thdi gian tii thang 6/2009 den thang 6/2011.
2. Phu'dng phap nghien cuti: md ta tiai dilJ 3. 00" lifu nghien cu'u: cae du* lidu chung ve benh nhan; tudi, gidi, trieu ehijtig lam sang, hinh anh chup eat Idp vi tinh, cdng hydng tif
4. Xur ly so lieu: sd lieu 6\idc thu thap va Y.\i ly theo chyong trinh SPSSIO.O.
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HQC VI$T NAM THANG 7 - SO 1/2011
III. KET QUA NGHIEN COU 3.1. Dae diem lam sang:
Gom 52 benh nhan UMN dyde md trong thdi gian tif thang 6/2009 den thang 6/2011 tai BV Dai hpc YHa Ndl.
Tuoi: Tudi nhat la 30 tudi, eao nhat la 76 tudi, trung binh 46,98 ± 10,88.
Gidi: Nam 18, nu' 34, ty le nO'/nam la 1,89 Bang 1. Trieu chu'ng lam sang eua UMN
Trieu chuTng lam sang Dau dau
Non Nhin md Dong kinh Liet van ddng
Rdi loan y thu'c, giao tiep Roi loan cam giac Khdng trieu chutig Sd thay khdi u vung dau
SdBN 45
15 20 10 10 5 3 2 1
Ty I I o/o 86,54 28,85 38,46 19.23 19,23 9,62 5,77 3,84 1,92 Nhan xet:S>a[i dau ehiem 86,54%, ndn 28,85%, liet 19,23%, ddng kinh 19,23%, 3.2. D|c diem can lam sang
Bang 2: Hinh anli UMN tren phim chup CLVT
Cac dau hi|u SdBN ty Id Vo
Dong hoSc tSng ty trong, ranh gidi rd 52 100,00
Ngam thudc can quang manh 50 96,15
Phu quanh u 10 19,23
Dau hieu can xi hda 5,77
Xam lan xu'dng so 9.62
Chay mau trong u | 1 I L92 , Nhdn xet: dong ty trpng va tang ty trpng, ranh gidi rd gap 100% cae BN, ngam thude can quang
manh gSp 96,15% cae trydng hdp
Bang 3: Hinh anh UMN tren chup cdng hifdng tif C&c dau hidu
Ranh gidl rd, t3ng tin hieu tren Ti, Giam ti'n hieu tren T^
Phu quanh u Duoi mcing cutig B§t thudc ddi quang tif Hoai tiJ trong u
sd BN 52 20 40 52
ty Id Vo 100,00
38,46 76,92 100,00
i ^
Nhan xet: ranh gidi rd,tang tfn hieu tren T, giam tin hieu tren T2 va bSt thudc ddi quang tif gSp 100%eac trydng hdp.
3.3 Vj tri khoi u:
Bang 4. VI tri khdi u mang nao Nen so
Vi tri khoi u Vdmso
Cgnh duftng glifa Uem nSo Tdngsd
SdBN 10 20 16 52
Ty le Vo 19,23 38,46 30,77 11,54 100,00 Nh$nx4t U d vom sp 38,46%, canh dydng giijla 30,77%, nen sp 19,23%.
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Y HOC VIET NAM T H A N G 7 • S d 2/2011
3.4. Kich thu'dc khoi u tren chup CLVT va CHT.
Bang 5. Kfch thUde khdi u mang nao.
Kich thudc khdi u DUdi 3 cm Tii 3-6 cm Tren 6 cm Tongsd
SdBN 4 36 12 52
Tvle%
7,69 69.23 23,07 100,00
Nhan xet: Da sd BN ed khdi u kfeh thyde Idn ti^ 3-6em
IV. BAN LUAN
4.1. Ve dae diem djch te hoc UMN 4.1.1. Phan bdbenh nhan theo tudi
Tudi trung binh la 46,98 ± 10,88. ket qua nay phij hdp vdi cac tae gia Dydng Dai Ha (40,86 ± 13,05), Nguyen Thanh Nam (43,8 ± 13,1) nhutig thap hdn cac tac gia nydc ngoai nhy Monitoba (58
± 15), cd the do tudi thp trung binh eua ngydi Viet Nam thap hdn.
4.1.2. Phan bo benh nhan theo gidi
Ty le nif/nam eua chung toi xap xi ^ 1 , phu hdp vdi eac nghien culi eua cae tac gia bong va ngoai nudc.
Bang 6. Ty le phan bd theo gidi Tac gia
Alaywan, Sindou (1994) Badiane (1999)
Dydng Dai Ha (2011) Nguyen Thanh Nam (2007) Cua Chung tdi (2011)
Ty id nO'/nam 2 0,88 1,92 1,24 1,98
Sd lU^ng benh nhan 150
79 124
63 52
Trong u nao ty le nam thudng cao hdn nQ' nhyng trong u mang nao thi ngydc lai, ngydi ta cho ring do lien quan den hormone sinh due nO'.
4.2. DSc diem lam sang cua UMN.
Dau diu: hay gap nhat vdi ty le 86,540%.
Ket qua nay phu hdp vdi cac nghien culi cua Le Xuan Trung (1974) la 85%, Oydng Dai Ha (2011) la 89,5% va Nguyen Thanh Nam (2007) la 85,7%. Theo James, ^ le benh nhan u mang nao ed dau dau la 86,7%. Dau dau la dau hieu sdm nhat eua hdi chutig tang ap lye ndi sp, tuy nhien do khdng dae hieu va hay nham lan vdi cac benh ly thdng thydng khae nen thydng bj bd qua, do dd lam benh nhan den vien mudn.
Non: benh nhan bj ndn la 28,86%, theo Le Dien Nhi (38%) nay thap hdn eac tac gia Dydng Dai Ha (44,35%), Nguyen Thanh Nam (57,1%).
Sd lydng BN ndn cua chung tdi thap hdn cac tac gia kliac, co the do sd tydng BN cua chung tdi ft hdn cae tac gia khac, tuy vay ndn van co the eoi ia mpt trong nhutig trieu chu'ng lam sang quan trpng trong chan doan.
Nhin md: Nhin md thydng di kem vdi dau dau va ndn. Dd la 3 dau hieu ed nang quan trpng nhat de chan doan tang ap lye ndi sp. Khi benh nhan ed bleu hien nhin md thydng la giai doan mudn, khi u da chen ep va gay tang ALNS mure
dp nang. Trong nghien culi cua chung tdi cd 38,46% BN nhin md. Ket qua nay thap hdn mdt each rd ret so vdi nghien culi cua cac tac gia Dydng Dai Ha (70,2%), Pham Phydc Sung (61,7%) va Nguyen Thanh Nam (44,4%), sy khae biet nay ed the la do trong nghien euli cua chung tdi ft benh nhan UMN d nen sp, dae biet la u mang nao vung hd yen, ma tridu chutig thj giac lai la mdt trong nhutig dau hieu sdm cua UMN d vj tri nay.
Dong kinh: Zimmerman cho rang dpng kinh ia bieu hien lam sang thydng gap thif hai, sau eac trieu chutig cua hdi chutig tang ALNS, thydng la ddng kinh cue bd, ddi khi la ddng kinh toan the. Nguyen nhan dpng kinh la do u kfeh thfch tryc tiep vao vung vd nao hoae cung eo the do tang ALNS. Pelfield nhan thay 40% benh nhan UMN ed cdn ddng kinh, trong do khdng ft eac trydng hdp dpng kinh khdng chi la trieu chutig dau tien ma eon la trieu chutig duy nhat cua benh, keo dai mpt thdi gian va dydc chin doan va dieu trj khdng dung, sau do mdi dydc phat hien la u mang nao. Trong nghien euli cua chung tdi ed 19,23% BN bj dpng kinh. Ket qua nay tydng dydng vdi nghien euli eua Dydng Dai Ha (18,5%), Nguyen Thanh Nam (12,7%).
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VigT NAM T H A N G 7 • SO 1/2011
Lift vfin dong: Kelly giai thfch rang liet van ddng la do u phat trien chen ep vao cac trung khu van ddng cua vd nao. Liet van ddng thydng xuat hien tydng ddi mudn, khi khdi u da Idn.
Trong nghien cu'u eua chung tdi cd 19,23% benh nhan ed dau hieu liet van ddng. Ket qua nay phij hpp vdi nghien euli eua Dydng Dai Ha (23,4%), Nguyen Thanh Nam (28,6%) nliyng eao hdn nghien cifu cua P. Morokoff va cdng sy (9.2%).
Cd the do cac benh nhan dMc chan doan va phau thuat sdm hdn
4.3. Dae diem can lam sang UMN:
Phim chup CLVT:
* V§ kich thwdc u: Vdi 69,23% benh nhan cd kfch thyde u ti^ 3-6cm, ehiem ty le. Ket qua nay cung phu hdp vdi cae nghien culj cua Dydng Dai Ha [1] la 49,2% va Nguyen Thanh Nam [2] la 61,9%, dieu dd chu'ng td da sd BN deu dype chan doan d giai doan mudn.
* Ve hinh anh u tren phim CLVT: Trong nghien euli eua chung tdi ed 96,15% benh nhancd hinh anh UMN la mdt khdi trdn hoac det, dong ty trpng hoac tang t^^ trpng ft so vdi nhu md nao lanh, ranh gidi rd va ngam thudc can quang rat manh. Ket qua nay phu hdp vdi nghien cuU eua oydng Dai Ha [1] va Nguyen Thanh Nam [2]. Phil quanh u cung ehiem 19,23%, hay gap d nhu'ng khdi u d vj trf tTnh mach cau lam can trd mau ve xoang tmh mach ho§c nhutig khdi u xam lan nhieu vao nao.
Phim chup CHT
100% benh nhan cd hinh anh tren phim CHT la cae khdi trdn hoac mang det, cd tfn hieu tydng ddi ddng nhat, ranh gidi vdi nhu md nao xung quanh rd, giam tfn hieu so vdi chat trSng tren T l va tSng tfnh hieu tren T2. Khdi u ngam thudc ddi quang tCf manh. Hinh anh nhy phiJ quanh u tren phim CHT hay g3p hdn so vdi phim CLVT, vdi ty le 38,46,0%, dd la do CHT phat hien phu nao nhay hdn CLVT."Dudi mang cutig" la hinh anh kha thydng gSp vdi ty le 76,92%. Dd la hinh anh day phan mang cutig d ngay sat phan dien bam eua u vao mang nao, dau iiieu nay la do phan utig khdng dae hieu ciia mang nao ddi vdi u hay do sy xam lan eua u vao mang cutig.
Cung vdi hinh anh tryc tiep eua u (ranh gidl rd, ngam thude nhieu, ed tang sinh mach), "dudi m^ng ciitig" la hinh anh dSe trutig eua UMN.
V. KET LUAN
Dae diem lam sang: UMN hay gap la 40- 60 tudi (62,25%), tudi trung binh 46,98 ± 10,88, ty le nfj/nam la l,89.Cae trieu ehifng lam sang hay gap la: Dau dau (86,54%), ndn (28,85%), nhin md (38,46%), ddng kinh (19,23%), liet (19,23%). Vj tri gap vom sp (38,46%), canh dydng giifa (36,77%), nen so (19,23%), liem nao (11,44%).
Dae diem can lam sang cua UMN vom so: Tren phim CLVT thay khdi u ddng hoac tang ty trpng, ranh gidi rd, bat thudc can quang (96,15%), phu quanh u (19,23%), CHT cho thay hinh anh: khdi trdn hoae det, tin hieu ddng nhat, ranh gidl rd, giam tin hieu tren T l , tang tfnh hieu tren T2, ngam thudc ddi quang manhl00%, phu quanh u (38,46%), "dudi mang ciitig" (76,92%), nhan xet nay phiJ hpp vdi cae tac gia trong va ngoai nyde {4,6,7}. Kfch thyde u tif 3-6cm (69,23%).
TAI LIEU THAM K H A O
1. DUOng D9I Ha (2011), Nghien cuV chan doan va kit qua dieu tri phau thuat u mang nao. Luan an Tien sy Dai hpc Y Ha Noi.
2. Nguyen thanh Nam (2007), Nghien cuV dSc diem lam sang, chan doan hinh anh va kit qua phau thuat u mang nao tren leu tai Benh vien Xanh Pon (2000-2007).Usax\ v3n Thac s9 Y hoc.
Dai hpc Y Ha Npi.
3. Ph?m PhUdc Sung (2005), Nghien cuU mgt sd dSc diem lam sang, hinh anh hgc va mo benh hgc cua u mang nao trong 5p.Luan vSn Thac sy Y hoc, tru'dng Dai hoc Y Ha Npi: 19-25.
4. Kieu Dinh Hung {2010), "Nghien cuV dSc diem lam sang, can lam sang u mang nao vdm sg t^i BV Viet Duf'.Tap chf Y hpc Vi§t nam, tap 369, trang 14-17.
5. Adams EF, Schrell MH {1990),"Hormonal dependency of cerebral meningiomas''J.tieurosurg. Vol 73. :750-755.
6. Kashimura H, Ogasawara H (2008), "Fusion of Magnetic Resonance Angiography and Magnetic Resonance Imaging for Surgical Planning for Meningioma''.Heuro Med Chir (Tokyo) 48: 418- 422.
7. Latchan R, Hirsch W {1991) "Computerized tomography of intracranial menlngiomas''.tAer\'mg\orms. Raven Press. New Yori<: 195-209.
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