Tgp chi Tai MQi Hgng Vi$t Nam - V o l u m e (59-19). N°1 - March. 2014
NGHIEN CUtJ DAC DIEM LAM SANG VA KET QUA DIEU TRI BirdC DAU BENH VIEM V.A 6 TRE L 6 N VA
NGlTcn L 6 N B A N G N O I S O I T A I B £ N H VIEN TRl/OfNG
DAI HQC Y Diroc THAI NGUYEN NAM 2013
Trdn Di^ Ninh *, Nguyin Todn Thdng**
Viem V.A la viim to chuc lympho a vdm mUi hong (Vegetations Adenoides), Id binh rdt thudng gap a tre nhd. Hiin nay, noi soi vdm duac dp dung rdng rai cho thdy viem VA cdn gap nhieu o tre lan vd ngudi l&n. Muc tieu: Md td dgc diim ldm sdng binh viim V.A & tre ldn vd nguoi lan. Ddi titgtng: 323 tre l&n vd nguoi l&n duac chdn dodn viem V.A qua ndi soi tgi binh vien Truang Dgi hpc Y Duac Thdi Nguyen. Phuang phdp: Dich te hpc md td vd nghien citu can thiip. Ket qud - Thdo ludn: Viem V.A & tre l&n vd ngu&i l&n duac biiu hien v&i nhiiu hinh thdi ldm sdng khdc nhau, thu&ng gdy cdc bien chimg & tai (56,2%). Tren b$nh nhdn viim VA thu&ng cd su hien dien cdc binh ly & mui xoang (58,8%) vd cdc binh ly
& hpng (59,4%). Ngo V.A ndi soi bu&c ddu cho kit qud rdt khd quan.
SUMMARY
CLINICAL CHARACTERISTICS AND PRELIMINARY TREATMENT OUTCOME OF ADENOIDITIS VIA ENDOSCOPY IN OLDER CHILDREN AND ADULTS AT THAI
NGUYEN PHARMACO-MEDICAL COLLEGE HOSPITAL IN 2013 Tran Duy Ninh, Nguyen Toan Thang
Adenoiditis, i.e. the inflammation of the lymphatic tissue at the nasopharynx (adenoid), is a very common disease in enfants and younger children. Nowadays, with the use of nasopharyngeal endoscopy, it is believed that adenoiditis is also seen commonly in older children and adults. Objectives: To describe clinical characteristics of adenoiditis in older children and adults. Participants: 323 children and adults diagnosed endoscopically as having adenoiditis at the Thai Nguyen Pharmaco-medical College Hospital Methods:
Descriptive epidemiological and interventional study. Results and discussion: Adenoiditis in older children and adults presents with a variety of clinical characteristics, commonly resulting in ear complications (56,2%). On patients with adnoiditis, there were frequently sino-nasal diseases (58,8%) and throat problems (59,4%). Endoscopic adenoidectomy showed satisfactory preliminary outcome.
1. Ddt van d^
V.A (Vegetations adenoides) la mot tfi chiic lympho a vom mui hpng, binh thuang
mpi tre em dfiu co. Lop tan nang ndy ddy khoang 2mm, nam trong niem mac n6c vom vd thdnh sau ciia vom. Khi to chiic ndy hi vifim vd qua phdt thi trfir thanh nhung khfii to
• D^ hpc Y Thii Nguyen ppi j ^ g^ y^j^ (vifim V.A). Theo kmh difin
*• B^nh vi§n Th4i Nguyen
Nh§n bii 5/1/2014. Duy^t in 15/1/2014
37
Tap chi Tai MQi Hong Vifit Nam - Volume (59-19). N°1 - March, 2014 siii vom dupc phat trifin den cao dp tir 2 dfin
5 tufii [1], sau do thodi trifin ddn. Vi vay, lau nay bfinh vifim V.A chu yfiu dupc quan tdm doi voi tre nho va vific chdn dodn bfinh ca ban phdi dua vdo nhiing trieu chiing mupn cua nhimg ca quan kfi can. Ngay nay voi su phdt trifin manh me cua ky thuat npi soi, cac nha ldm sang tai miii hpng (TMH) dd nhdn thdy mpt ty lfi khong nho tre Ion va nguoi lan bi viem V.A ciing vai su hifin difin cdc benh ly khac trot^ TMH. Tuy nhifin, cho den nay nghien ciiu bfinh vifim V.A o tre Ion vd nguoi ldn con chua dupc dfi cdp toi nhifiu.
Muc tifiu:
- Mo ta dupc dac difim ldm sang bfinh vifim V.A a tre lorn vd nguoi 1cm qua tham khdm npi soi.
- Danh gid kfit qud buac dau nao V.A qua nfii soi.
2. Doi tugng va phuong phap nghien ciru 2.L Doi titpng:
Nhung benh nhan duac chdn dodn vifim V.A bdng phuang phdp nfii sol.
- Tifiu chudn lua chpn: Nhiing benh nhan tu nguyen tham gia nghien ciru.
Tifiu chuan loai tru: Nhung benh nhdn khfing dii difiu kien de thuc hifin tham kham TMH bang npi soi hoac khong bi viem V.A.
2.2. Dia diem: Khoa TMH - Benh vifin truang Dai hpc Y Dupc Thai Nguyen.
2.3. Thdi gian nghiim cuu: Tir thdng
2/2013 dfin thdng 12/2013
2.4. Phmfng phdp: Dich tfi hpc mo td va phuong phap can thiep
2.6. C&mdu vdphtiffngphdp chpn mau 2.6.1. Co'mdu:
* Trong nghien citu md td:
Ap dung cfing thiic:
Trong do:
n: S6 luong bfinh nhdn tfii thifiu cdn nghien ciiu.
Zi-a/2: Gid tri difim Z tai miic y nghia a, voi a - 0 , 0 5 ^ Z i ^ = l , 9 6 .
d: Dp sai lech mong mu6n giiia ty lfi thu duac tii mdu vd ty lfi thuc ciia quan the, chpn d = 0,05.
p: Ty le mac bifin chiing cua vifim V.A u6c lupng theo nghifin ciiu cua Nguyfin L?
Thuy ndm 2012 (p = 0,3) [5].
Voi cac thong sfi da dupc xdc dinh, cfi mdu toi thifiu 323 bfinh nhdn.
* Trong nghien citu can thiip: Nao V.A cho tdt ca cac benh nhan co chi dinh va tinh nguyen tham gia.
2.6.2. Phucfng phdp chpn mau: Chpn cfi chii dich, chpn todn bfi sfi bfinh nhan viem V.A dfin kham cho dfin khi du mau (troi^
nghien cuu mo ta). Nao V.A cho tdt ca cac bfinh nhan co chi dinh va tinh nguyen (trong nghifin ciiu can thiep). Danh gia kfit qud tren 50 truang hpp nao ddu tifin (co du
Tgp chi Tai MOi Hpng Vi6t Nam -Volume (59-19). N°1 - March, 2014
thfii gian theo doi sau nao V.A tfii thieu 6 thang).
2.7. Cac chisS nghien cihi:
Thfing tin chung vfi dfii tupng nghifin ciiu Dac difim lam sang bfinh vifim V.A o tre Ion vd nguoi lan
Mpt sfi bfinh ly TMH trfin bfinh nhdn viem V.A
Kfit qua budc ddu nao V.A bang hummer qua npi soi
2.8. Phuffng phdp thu thdp vd ddnh gid thdng tin:
Phong vdn true tiep bfinh nhan hoac ngu&i nha (vol bfinh nhan duoi 18 tuoi).
Tham khdm lam sang bdng phuang phdp npi soi, gay tfi (voi optic ciing 2,7mm ho^ 4mm) nhdm trufirc hfit phat hien bfinh nhan vifim V.A dfi lira chpn vdo mau nghien ciiu. Trfin cdc bfinh nhan vifim V.A tifip tuc thdm kham nfii soi dfi phdt hifin cdc benh ly khac vfi TMH. Tifiu chudn chdn dodn theo phdn loai bfinh Qufic tfi ICD 10. Cac kfit qua phong vdn, tham kham, theo doi sau nao V.A dupc ghi trfin phifiu da thifit ke san.
Tifin hanh nao V.A bdng hummer qua n^i soi tifin cac bfinh nhan tinh nguyfin, theo doi, danh gid kfit qua nao V.A sau 3 thdng vd 6 thdng. Cdc kfit qud dupc ghi tien phieu thifit ke sdn.
2.9. Pbmmgpbap pban tkb va x&ly so liiu:
Sii dung chuong trinh Epidata vd SPSS 16.0.
3. Ket ket qua nghien c ^
• 0 6 -10 tuoi 11 - 20 tuoi
• 41 -^Otiim
• 21-30tuoi
• >'!Ottioi
Bieu ab 3.1. Ty IS m k b$nh vi6m V.A xep theo 3p tu6i ( p < 0 , 0 1 )
Nhdn xet: Tai thoi difim nghien cihi gdp benh vifim V.A o mpi liia tufii, trong do dp tufii 6-10 (21,1%); 11-20 (40,6%); 21-30 (22,3%); 31-40 (11,8%); 41-50 (2,8%); >50 tufii (1,5%).
Bieu (36 3.2 Ty 16 mdc b6nh vifim V A xep theo giffi tinh
Nhgn xet:
Ty lfi mdc bfinh viem V.A khong co sv khdc biet giiia nam va nii (p<0,05)
39
Tap chi Tai lUIGi Hong Viet Nam - Volume (59-19). N°1 - March, 2014
Ban DoV.A
Do tudi 6-10 11-20 21-30 31^0 41-50
>50 T6ng s6
Do1 SL
2 19 57 36 9 5 127
%
3,0 14,6 79,1 92,1 100,0 100,0 39,3
g3.1. Phan dd V.A theo dp tu6i So 2
SL 33 72 13 3 0 0 121
%
43,6 55,0 18,1 7,9 0,0 0,0 37,5
0 6 3 SL 26 27 2 0 0 0 65
%
38,2 20,6 2.8 0,0 0,0 0,0 17,0
Do 4 SL
7 13
0 0 0 0 20
%
10,3 9,9 0.0 0,0 0,0 0,0 6,2
Tong sd SL 68 131 72 38 9 6 323
%
10O0 100,0 100,0 1000 100,0 100,0 100,0
Nhgn xet:
Ci do tuoi 6-10 gap tkx ca cac dp V.A, trong do do 1 (3,0%); do 2 (48,5%); do 3 (38,2%) va do 4 (10,3).
Do tu6i 11-20, V.A vin con t6n tai a tit ca cac do, trong do do 1 (14,5%); do 2 (55,0%); do 3 (20,6%) va do 4 (9,9%).
Do tu6i 21-30, V.A chu ySu con t6n tai a dp 1 (79,1%) va do 2 (18,1%); dp 3 clii chiSm 2,8% va khong con V.A dp 4.
Dp tuoi 31-40 gap voi so lupng it hon, chu ySu V.A dp 1 (92,1%), dp 2 chi chiSm 7,9%, khong con V.A dp 3 va dp 4.
Den dp tuoi tren 40 gap it nhit va chi con V.A dp 1 (100,0%).
Bang 3 2. CSc IJ do din khSm benh Ly do din kh^m
To^n thSn
S6t Dau dau Ly do toan than khSc
Tonq s6
SL 5 7 2 14
TylS
(%)
1,6 2,2 0,6 4,3
Tai
IVIui - xoang
Hpng Thanh quan
Dau tai Citai Nghe k6m Chay nh^y, mu tai L^ do kh^c thu6c vetai Tonq s6 T^c mOi Chay nh^y, chay mumOi Ly do khSc thu6c mui - xoang Tong s6 Dau hpnq Ho
Thu^b-ng xuyen c6 dd-m 6" honq Li? do kh4o thuOc ve honq KhSn tilnq Tonq so
26 37 7 2 3 76 77 65 7 149
16 38 18 6 6 83
8,0 11,5 2,2 0,6 0,9 23,2 23,8 20,1 2,2 46,1
4,6 11.8 6,6 1,9 1.9 25,7 Nhdn xet: BSnh nhan viem V.A co thJ din kham voi rit nhi^u ly do khac nhau;
Tgp chi Tai MQi Hpng Vifit Nam - Volume (59-19). N"! - March, 2014 nhung ddu hieu todn thdn (sfit, dau ddu...)
(43%); cac trieu chiing 6 tai (dau, ii, nghe kem, chay tai) (23,2%); cac trifiu chiing o miii xoang (tdc miii, chay miii...) (46,1%); Vd nhung kho chiu or hpng - thanh quan (dau hpng, ho, CO ddm tiiuong xuyfin, khan tifing...) (25,7%). Do CO thfi la nhiii^ trifiu chiing cua V.A, trieu chiing cua cac bifin chiing do vifim V.A ho£ic cac b&ih ly khdc trfin bfnh nhan vifim V.A.
Bang 3.3. Cdc bi^u hifin toan thdn trfin nhirng bfenh nhdn viem V.A C^c bilu hien toSn
than Gay ylu B^o phi BO mat V.A Bilu hi$n khdc T6nq s6
SL 15 3 5 1 24
Ty ie (%) 4,6 0,9 1,5 0,3 7,3 Nhdn xet:
Doi vcri tre lan vd nguoi Ion vifim V.A cac bieu hifin toan than rat ngheo nan, the trang giy yfiu chi gap 4,6%, bfi mat V.A 1,5% va dac biet gdp trfin nguoi beo phi 0,9%.
Bang 3.4. Cdc b$nh ly o' tai trfin nhifng b$nh nhdn vifim V.A
Cdc bOnh 19 a tai Bdn tic, tic v6i nhT ViSm tai glOa tilt djch
Vifim tai giu-a xo nhT Vifim tai giu'a xep nhi
Vifim tai gi&a d p tinh mil
Vifim tai gio-a man tinh mii nhdy Vifim tai gi&a mu man tinh T6ng s6 b$nh v l tai
SL 121 46
3 5 4 1 2 182
Ty ie (%) 37,5 14,2 0,9 1,5 1,2 0,3 0,6 66,2
Nhdn xet:
Ty lfi mac cac bfinh ly a tai trfin nhihig tre Ion va nguoi Ion vifim V.A rdt cao (56,2%). Trong do ddc bifit la bdn tdc, tdc voi nhi (37,5%); Vifim tai giiia tifit dich (14,2%); Xa nhi (0,9%); Xep nhi (1,5%).
Ngodi ra con glip vifim tai gifla cdp tinh mii (1,2%); Vifim tai gifla man tinh mu nhay (0,3%) va vifim tai giua mu man tinh (0,6%).
Bang 3.5. Cdc b$nh ly o" mOi - xoang tren nhifng bfinh nhdn vifim V.A Cdc bfinh ly a mOI -
xoanq Vifim mOi d p tinh Vifim mQi man tinh Vifim mui di i>ng Vifim xoang d p tinh Vifim xoang man tinh Veo vdch ngdn Tong s6 mic bfinh mui - xoang
SL 7 101 23
7 87 89 190
T} ifi(%) 2,2 31,3 7,1 2,2 26,9 27,6 58,8 Nhdn xet: 58,8% bfinh nhdn vifim V.A CO cac bfinh ly fif miii - xoang, trong do ddc bifit la vifim mui man tinh (31,3%); viem xoang man tinh (26,9%); vifim mui di iing (7,1%). Ddc bifit veo vdch ngan tren nhung bfinh nhdn vifim V.A kha cao (27,6%).
41
Tap chi Tai lyiui Hpng Vifit Nam - Volume (69-19). N°1 - H/larch, 2014 Bang 3.6. Cac bfinh ly a hong - amidan - thanh
quan trfin nhu-ng bfinh nhdn viem V.A
Bang 3.7. Kit qua bLfdc ddu nao V.A bdng hummer qua noi soi (n=50) Cac benh ly o- hpng -
a m i d a n - t h a n h quan
Benh hpng
Benh amidan
Benh thanh quan
Vifim hpng cdp tfnh
Vifim hong man tinh
Trao ngu-pc da day - Thu'c quan Tong s6 mac bfinh hpng Viem amidan man tinh
Viem thanh quan cap tinh Viem thanh quan man tinh T6ng sfi m i c benh thanh quan
SL
1
185
56
192
207
3
3
6 T y l e
(%)
0,3
57,3
17,3
59,4
64.1
0,9
0,9
1,8
Nhdn xet:
59,4% bfinh nhdn vifim V.A co cdc bfinh ly a hpng, trong do viem hpng man tinh (57,3%); Trao ngupc da day - Thirc quan (17,3%); 64,1% tre lan vd nguoi lan vifim V.A CO vifim amidan man tinh. Cdc bfinh ly a thanh quan ciing gap nhung vai tyle thip hon (1,9%).
Cac chi so ddnh gid B a u ddu Dau tai
Dtai Nghe kfim Chay mu, chay nhay tai T i c mui Chay nhdy, chay mu mui
Ho Co d a m o
hpng Kham t i i n g V.A tai
phdt Tru'O'C
nao SL
5 3 7 4
2
23
17
8 6
1
%
10,0 6,0 14,0 8,0
4,0
46,0
34,0
16,0 12,0
2,0
Sau nao 3 thdng SL
0 1 0 1
0
5
2
1 2
0 0
%
0,0 2,0 0,0 2,00
0,0
10,0
4,0
2,0 4,0
0,0 0,0
Sau nao 6 thdng SL
0 0 0 0
0
0
1
0 1
0 0
%
0,0 0,0 0,0 0,0
0,0
0,0
2,0
0,0 2,0
0,0
oo Nhdn xet:
Theo doi sau nao V.A bang hummer vai phirang phap npi sau 3 thdng hau het cac trieu chiing dupc cai thifin ro ret va het sau 6 thang. Co 1 bfinh nhan sau nao 6 thang vdn chay miii do co vifim miii di iing vd 01 bfinh nhan vdn co dom trong hpng do bi trao ngupc da day thuc quan. Ddc bi^
sau 6 thdng khong co bfinh nhdn V.A tdi phat.
42
Tap chi Tai MQi Hpng Vi$t Nam - V o l u m e (59-19). N°1 - March, 2014
4. Ban lu^n
Kfit qua thdm khdm npi soi trfin 323 tre Ion va ngufiri lan viem V.A cho thdy: Trdi voi nhihig nh$n dinh tnro'c day vfi sir ton tai cua V.A vd vifim V.A (khi tham khdm bang cac d\mg cu thfing thirong) da cho rang vifim V.A chu yfiu gdp o tre nho va cung chua cfi sfi lipu cu thfi fif tre Ion vd nguoi Ion. Qua thdm khdm npi soi cho thay vifim V.A con g^p vol ty lfi cao o tre Ion va nguoi Ifin, tham chi ca nguoi trfin 50 tufii (Bifiu dfi 3.1). Vifim V:A khfing co su khdc bifit giiia nam vd nfl (Bifiu do 3.2). Kfit qua trfin ciing phii hpp voi nghifin ciiu ciia Nguyin Lfi Thuy [4] [5], Nguyfin Thanh Ha [2] va Trdn Duy Ninh [3] tren hpc sinh tifiu hpc, trung hpc co so va a nguoi Ion.
Vfi dp qua phdt cua V.A, kfit qud tai b^g 3.1 cho thay: a dp tufii < 20 V.A con gdp 6 t^t ca cdc dp (tu 1-4); < 30 tufii con V.A tii dp 1 dfin dp 3; < 40 tufii con V.A dp 1 va dp 2; Tir dfi tufii > 40 chi gap V.A dp 1.
Bpnh nhdn vifim V.A co thfi dfin khdm voi rat nhifiu 1;^ do khdc nhau. Do cfi thfi la nhflng ddu hieu toan than (4,3%), cac trieu chiing a tai (23,2%), mui - xoang (46,1%);
hay hpng - thanh qudn (25,7%) (Bang 3.2).
Difiu dfi cho thiy nfii soi vom dfi chan doan vifim V.A la rit cin thifit trong khi kham TMH.
Kit qud tham khdm toan than trfin cdc b ^ nhan vifim V.A (Bang 3.3) cho thiy phu hgp voi cac tai Upu kinh difin truoc ddy cdc trieu chiing toan than ciia viem V.A man tinh Ihufmg ngheo ndn, bfi mat V.A gap rat it (1,5%) vd khong difin hinh. Ddc biet, hifin nay viem V.A con gdp tren nguoi beo phi
(0,9%), do Id nhihig van M rat ddng luu y.
Tren nhih^ tre Ion va nguoi Ion vifim V.A CO 56,2% mdc cdc bfinh ly 6 tai (Bdng 3.4), dieu do chiing to qud trinh tfin tai vd vifim nhiem lau dai cua V.A dd gay rdt nhifiu bifin chiing a tai.
Trfin nhiing bfinh nhdn vifim V.A cung CO su hifin difin cua rdt nhifiu bfinh Iy khac nhau o mui - xoang (58,8% ) (Bang 3.5);
Vifim hpng man tinh (57,3%); Trao ngupc dg ddy - Ihuc qudn (17,3%); Viem amidan man tinh (64,1%) va vifim thanh qudn (1,9%) (Bdng 3.6). Trong khufin kho cua dfi tai chua co du bang chiing khoa hpc de xdc dinh dupc moi hfin quan gifla cdc bfinh noi trfin voi vifim V.A. Nhung ddu sao, s\r hifin difin cua V.A fif liia tufii nay la khfing phu hpp voi sinh ly ve su thoai trifin ciia V.A, vi vay vific nao V.A fif tre Ion vd nguoi Ion Id hfit siic can thiet.
Theo doi tren 50 bfinh nhan dupc nao V.A sau 3 thdng hdu hfit cac trifiu chiing dupc cdi thien ro ret vd hfit sau 6 thdng, dac bifit chua thay bfinh nhdn nao V.A tdi phdt (Bang 3.7). Tuy nhifin van con co 01 trucmg hpp chay mui keo dai (do co vifim miii di ung), 01 truang hpp con co dfifm thuong xuyen o hpng (do co bfinh trao ngupc da day - thuc qudn). Vi vay, dfi ddm bao cho kfit qua cua thu thuat n?o V.A, vific giai quyfit cac bfinh ly o mui hpng Id hfit siic can thiet.
Ket lu^n
Vifim V.A con gdp voi ty lfi cao 6 tie Ififn vd nguoi Ion va khfing co su khdc bifit theo gioi tinh. Nhung bfinh nhdn < 20 tufii co V.A tu dp 1 dfin dp 4; < 30 tufii con V.A 43
Tap chi Tai H/lui Hong Viet Nam - Volume (59-19). N°1 - March, 2014 til do 1 din dp 3; < 40 tu6i con V.A do 1 va
do 2; Tu do tudi > 40 chi gap V.A do 1.
Benh nhan viem VA co the dSn kham vdi i ^ nhilu benh canh lam siing Idiac nhaa Do cd Ihl la nhimg diu hieu toan than (4,3%), cac trieu chung a tai (23,2%), miii - xoang (46,1%) hay hong thanh quan (25,7%).
Viem V.A a tre 1cm va nguoi Ion gay nhilu biln chiing a tai (56,2%). dong thai CO su hien dien cua rat nhieu benh ly khac nhau: Viem miii - xoang (58,8%), viem hpng man tinh (57,3%), trao nguac da day - Thuc quan (17,3%), viem amidan man tinh (64,1%) va viem thanh quan man tinh (1,9%).
Theo doi ket qua sau nao V.A 6 thang dau bang htimmer voi phuong phap npi soi cho ket qua rat kha quan.
Tai Ueu tham khao 1. Ngo Ngpc Lien (2006), Gian yeu Tai Mui
Hpng, Nha xuit ban Yhoc, Tr.96-137.
2. Nguyen Thanh Ha, Tran Duy Ninh (2013), Thuc trang benh tai mui hong cua hoc sinh tieu hoc thdnh pho Thdi Nguyen ndm 2013, Tap chi Y hpc thuc hanh,s6 10, Tr. 108-113.
3. Trin Duy Ninh vaCS(2012J, "Thuc trgng benh lai mUi hong ciia hoc sinh trudng tieu hoc Cam Gid thdnh pho Thdi Nguyen ", Tap chi Tai mui hpng, so 6, Tr. 60-67.
4. Nguyen Le Thiiy, Tiin Duy Nmh (2012),
"Nghien cm benh viem V.A bdng phuang ph^ noi soi a hoc sinh truang trung hqc ca sa Nha Trang thdnh phd Thdi Nguyen", Tap chi Y hpc thuc hanh, s6 3, Tr. 94-100.
5. Nguyen Le Thuy, Trin Duy Ninh (2012), Nghien cuu ddc diim ldm sdng mot sS benh ly viing vom hong a tre Im vd nguai lan, Ky ylu Dai hpi hpi Tai mui hpng khu vuc Ha N6i, Tr. 59-63.
6. Cassano P., Gelardi M., Cassano M., (2003), "Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management"
http;//cat.inist.fi-/?
aModele=afficheN&cpsidt=15317755.
7. Charles D, Blustone and Richad M.
(2002), "Tonsillectomy, adenoidectomy, and UPP" Surgical atlas of pediatric otolaryngology, BC Decker inc , p. 381- 385.
Cac thdng tin lien quan den cac tac gia:
1. Tran Duy Ninh - Bp mon Tai miii hpng - Truong Dai hpc Y Duac - Dai hpc Thai Nguyen. Dien thoai 0915080823. Email:
ninhenttn(@yahoo.com.vn
2. Nguyin Toan Thing - BO m5n Tai mOi hpng - Truang Dai hpc Y Dupc - Dai hpc Thai Nguyen. Dien thoai 0984666988.
Email: [email protected].
