T?p chi Tai Mui Hpng Vi$t Nam - Volume (57-7). N°1 - M a r c h . 2012 Hpng Trung uang chiing toi riit ra ket
lu^n sau:
4.1. D5c dicni ciiii vi khuan tronR viem xoang tre em
Ty 1? phan l?p dugc cic chiing vi khuan trong dich niii 6 ngich mQi giOa 14 45,53%. a xoang khong phan lap dugrc tru6rng hpTi nio.
- Cic vi khuin gay viem mOi xoang man tinh ct irc em thu6ng gip li:
Staphylococcus aureus: 36%
Streptococcus pneumoniae 8%
Klebsiella pneumoniae: 24%
Enterohacler cloacae • 8%
Pseudomonas aeruginosa- 16%
Enterococci 4%
Pseudomonas putida. 4%
4.2. Mire d^ nhay cam ciia vi khuan dva tren ket qua khang sinh do
Cic VK gay viem xoang c6 ty I?
khing thu6c KS rat khic nhau va cao nen cin phai lim xet nghiem vi khuan va khang sinh do de co ket qua dieu tri tot.
Tu cau ving khing 100% voi PEN nhay nhay cam 100% voi VAN, CIP, LVX, SXT, LNZ.
Cic khing sinh co tic dung lot trong viSm xoang la; cephalosporin, quinolone, aminoglycosides, vancomycin, co-trimoxazol.
TAI LIfll THAM KHAO
1. American Academy of Pediatries ( 2010), "Subcommittee on Management of Sinusitis and Committee on quality Improvement". Clinical practice guideline: management of sinusitis in pedialric.\.pp,79H-8(l8.
2. Ilnlogcr W.E, Italzin CA, Pursons D.S (1991): "Paranasol sinus bony anatomic varicaticorsand mucosal abnomalilies: CT analysis for endoscopic sinus surgery".
Laryngoscope, vol 1111. p56-64.
3. Brook llzhak (2011): Microbiology of sinusitis, the proceedings of the American thoracic Society 8. pp 90-100.
4. Parsons D.S (1996): Chronic sinusitis". Otolaryngologic Clinic of North America, vol 29, No I. W.B, Sauders company. Philadelphia, pp 1-8.
5. Ramadan HH (2005): Pediatric sinusitis: update, / Otolaryngol. 2005 jun. 34 SuppI 1: pp 14-17.
DANH GIA VAI TRO NUT MACH TRl/OC PHAU THUAT NQI SOI U XO MACH VOM MUI HQNG
Li- Minh Ky', Nguyen Quang Trung**
T 6 M TAT
U xo mach vom mui hgng li kh6i u lanh tinh co ting sinh m?ich vi thu6ng gip cr nam thanh nien, thudng bieu hien chay mau mui tii phat \ a thieu mau cr miJrc dg khic nhau. Gin day co su phit triin kl thuat chup mach vi tic mach chgn Igc pho bien hom gop phan ho trg phau thuat u xo mach noi chung va die biet la trong phau thuat ngi soi u xa mach vom mui hgng. Miic tieu: Dinh gia vai tr6 phuang phap nut mach tron|
phau thuat lay u xa mach vom mui hgng. Phinmg phdp: Tien curu, thong ke mo ta Ket qud • Nghien ciiu 44 truang hgp da dugc diiu trj U xa mach vom mui hgng tai Benh
* B$nh vi^n Tai MOi Hong TW, " BO mftn TMH BHY Hi NOi Nhjn bii 25/1/2012 DuyOt in 10/2/2012
Tap chi Tai Mui Hong Vl$t Nam -Volume (57-7). N°1 - March. 2012
vien Tai Mui Hgng Trung uong tir thdng 1/2005 den thdng 6/2011. Tat cd benh nhan deu dugc chup CT Scan, chyp mach vd tdc mach chgn Igc truoc phau thuat. Ket lugn:
Chup mach va tac mach truoc mo dat hieu qua cao trong phau thudt ngi soi u xo mach vom mui hgng.
Tur khoa: u xa vom mui hgng, chyp mach, tdc mach S U M M A R R Y
Background: Juvenile nasopharyngeal angiofibromas (JNA) are histologically benign, highly vascular tumours found in adolescent men. Recent improvement in embolization has facilitaed the endoscopic resection of JNA.Objective: The purpose of this article was determine the results of embolization before endoscopic surgery of JNA.
Methodology: The medical records of patients who underwent embolizations were reviewed. Results: 44 patients underwent successful resection of JNA by way an endoscopic approach with preoperation embolization. All of patients have been done CT Scan and embolization in preoperative. Endoscopic resection provides several advantages over more traditional surgical techniques, which include the avoidance of facial incision and plating of the maxilla and the minimization of bone removal.
Conclusion:Embolization is safe effective in our experience & can be performed 24- 48h before endoscopic surgery.
Keys w o r d s : juvelin nasopharyngeal angiofibromas
tich viing chan bam hon, ddm bdo lay u I. DAT VAN DE
U xo mach vom mui hpng la khoi u ldnh tinh co tang sinh mach vd thuang gap a nam thanh nien. Mac dii u xo mach vom mui hgng la khoi u lanh tinh nhimg do chan bdm u a phan tren ho chan buam khau cdi vd khoi u c6 khd ndng xam ldn qua cdc ngdch viing sg mdt, de ep xirang viing lan can dong thai co the gay chdy mau rdt dOr dgi vi vay nen viec di^u tri co nhiSu kho khan vd ti le tdi phdt cao.
Phdu thudt Id lira chgn hang dau trong di^u tri u xo mach vom mui hgng, CO nhi§u duang phau thuat khac nhau dugc chia tam hai nhom chinh la phdu thuat du-ong ngodi c6 dien va phdu thudt ngi soi trong do phau thuat duong ngodi bao g6m cac duong nhu xuyen khau cai, mo canh mui, Rouge-Denker, duang lot gang tang mat giiia...
ICiSm sodt lugng rndu mdt trong phdu thuat u xo la mgt vdn d^ Ion, neu kiem sodt chdy mau t6t thi sg d l phau
triet de hon vd hau phau nhe nhang hon, ngugc lai neu chdy mau 6 at trong mo thi kho Idy het dugc u nhat Id khi phdu thudt ngi soi va co the mdt mdu nang gay nguy hiem den tinh mang benh nhan.
I i . DOI T i r q N G VA PHirOfNG PHAP NGHIEN C i r u
2.1. Doi tu-yng nghien ciru: Nghien cihi tren 44 truong hop da dugc dieu tri u xa mach vom mui hgng tai Benh vien Tai Mui Hgng Trung uong tir thang 1/2005 danthdng 6/2011.
2.1.1. Tieu chuan lira chpn
Dugc chan dodn Id U xa mach vom mui hgng tren lam sdng vd mo benh hgc. Benh nhdn duoc chup CLVT hoac MRI. Dugc chup mach vd nut mach truoc mo. Dugc dieu tri phau thuat ngi soi tai Benh vien Tai Mui Hgng TU"
2.1.2. Tiiu chudn logi trir: Benh nhan khong du cdc tieu chudn tren Benh nhan khong ddng >' tham gia nghien cuu.
Tap chi Tai Mui Hpng Vi$t Nam - Volume (57-7). N°1 - March. 2012 2.2. Phuong phap nghien ciru; Thong
ke mo ti
2.2.1. Cdch thiic tiin hdnh: Tat ci hcnh nhan dugc ngi soi dinh gii trudc phau thuat. Chup CT Scan dinli gii giai do^n u theo plian loai cua Andrews, Bcjnii nhan a giai dogn 1 vi 11 duoc l^a chgn phau thuit ngi soi lay u. I icn hinh chyp mach vi tic mgch chgn Igc tgi khoa chan
doin hlnh inh Bfnh \\^n Bach Mai 24h- 48h IruiVc phau thugt.B$nh nhan dugc tiin hinh phau thuat ngi soi lay u duoi gay me ngi khi quin lai B?nh vi$n Tai Mui I Igng TLT. Danh gii lugng miu mat trong phau thuat, Ihoi gian phau thuat, bien chung vi tii phit.
2.2.2. Xir ly so Itfu: bing phan mem Epi-info 4.0
III. KET QUA \ A BAN LUAN .^.1. Chyp mach % Ji Ifu- mach (ru-iVc mn
3.1.1. Hinh thai khoi C\M\ Mil tren phim chiip mgch
Bing 3.1.1. Hlnh thii khii UXMVIUIH Ir6n phim chgp msch
Hinh t h i i k h i i u Kh6i g i i u mach KhOi It mach N
n 44 0 44
%
100 0 100
Nhan xet: tren phim chup he dgng mach nuoi khoi u thdy 44/44 trucmg hgp (100%) khdi u giau mach, tdng sinh va gidn cdc mach nuoi.
3,1.2. Hf mgch cap mdu cho khoi u
Bang 3.1.2. H$ mgch cip mdu cho kh6i u tr6n phim chgp mgch
H^ m^ch Canh n g o i i
Canh trong
MOt b i n Hai b i n MOt b i n Hai b i n Canh n g o i i - canh trong N
n 39 2 0 0 3 44
v.
88 7 4 5 0 0 6 8
too Nhan \cl:
• He mach cdp mdu cho khoi u chii yeu tir dgng mach canh ngodi, trong do 39/44 truang hgp (88.7%) tir h?
cdnh ngodi mgt ben, 2/44 trucmg h(?p (4.5 %) tir he cdnh ngodi 2 ben. Co
IM4 trucmg hgrp (6.8%) khoi u dugc cdp mdu them boi nhdnh ciia dpng mgch cdnh trong cimg ben.
• Khong CO truong hop ndo dugc cap mdu don thudn boi nhanh ciia he mach cdnh trong.
Tap chi Tai Mui Hpng Viet Nam - Volume (57-7). N°1 - March. 2012
Hinh anh ch^p m^ch Hinh anh chgp m^ch UXMVMH tru'dc nut m^ch UXMVMH sau nut m^ch
(S6 BA 7828) (S6 BA 7828) 3.1.3. Tdn suat gap cdc dgng mgch cap mdu cho khoi u
• DM ham trong 1 ben
• DM ham trong -hSu len cung ben
Bieu dd 3.1.3. Tan suat g$p cdc DM cap mSu cho khoi u
Nhan \ c t :
Tren phim chup mach thay 100%
truong hop kh6i u dug-c cap mau bai nhdnh ciia dgng mach hdm irong Cling ben hoac cd hai ben.
- Kh6i u ciing co the dugc cdp mdu them boi cdc nhdnh khdc cua dgng mach cdnli ngoai nhu: dgng mach hau len ciing ben (6.3%) hoac nhdnh ciia dgng mach canh trong ciing ben (6.3%) 3.1.4. Vgt lieu tdc mgch
- Vat lieu dugc sir dung de tac mach truoc m6 100% Id hat nhua PVA 3.1.5. Bien chung trong vd sau thu thudt nut mgch
Tgp chi Tai MOi Hpng Vi$t Nam - Volume (57-7), N°1 - March. 2012
100%
80%
60%
40%
20%
0% i
GiMmthPlRc Khdng biPh chPJng
Bi4u dA 3.1.5. Ty 1$ cdc b i i n chimg trong vA sau thii thu$t nut mgch Nhan \i't:
Trong va sau thu Ihuat chyp vd niil mgch co the gdp mgi so bicn chiing nhu non (4.2%). 2,1% iruitng hgp gidm Ihj \\xc theo dfli do tdc dgng mach trung tdm v6ng mac. 2.1% truong hap sol nh?.
91.6% khong gdp HKII .tu
w
Hinh anh chup CLVT cua BN giam thi luc sau mit m?ch
( S 6 BA 11986)
Hinh anh c h u p m^ch ciia BN g i i m thj Ig'c sau nut m^ch
( S A B A 11986)
Hinh anh chyp d i y itiit(T) ciia BN giam thj l^c sau nut m?ch
( S 6 B A 11986)
F'
aruTcni^pday mSt{P) cua BN gidm thi \ijpc sau nut m^ch
( S 6 B A 11986)
3.2. Hieu qua ciia phau thuat noi soi c6 nut mach trini-c i
Tap chi Tai IVIQi Hong Viet Nam -Volume (57-7). N°1 - IVIarch 2012
3.2. 2. Th&i gian phau thugt
S i n g 3.2.2. ThW gian p h l u thuSt Irong UXMVMH Thiri gian (X)
X < 1 h 1 h s x s 2 h X > 2 h N
n 2 41 1 44
%
4 5 93 2 2 3 100
Nhan xet: thai gian hodn thanh 1 ca phau thudt k^o ddi tir l-2h chi6m ti le cao nhdt (93.2%), CO 2/44 trucmg hgp (4.5%) kh6i u nho ggn thoi gian phau thuat Idy bo u < th 3.2. 3. So lirgfng mdu mat trong phau thugt
Bang 3.2.3. S6 lu-g-ng mdu mat trong phSu thu$t Sd \vftfnq m<iu m i t (ml)
S250 250-500 600-750
> 7 5 0 N
n 30 10 3 1 44
%
68 2 22 7 6,8 2 3 100
Nhan xet: Lugrng mdu mdt trong phau thudt co can thiep nut mach truac mo * 250ml chi6m ti le cao nhat 68,2%.
3.2.4, So lirong mdu phdi truyen
Bdng 3.2.4. So lu'gng mdu phai truyen So luang mdu truy4n (don vi)
0 1 2 2 3
n 40 3 1 0
%
90,9 6,8 2,3 0
Nhan xet:
- Trong nghien curu ciia chung toi co 90,9% khong phdi truyen mdu.
- Khong CO trudng hgp ndo phdi truyen tir 3 don vj mdu tra len.
3.2.5. Cdc phirong phdp cdm mdu trong vd sau phdu thugt
3.2.6. Biin chung sau phdu thugt
Nhan xet:
• Phuang phdp cam mdu trong vd sau phdu thuat chii yeu Id dot dien vd nhet gelaspon + merocel ( 95,5%)
• 2/44 truong hgp (4,5%) cam mdu bdng nhet sonde foley va meche mui truac.
Tap chi Tai Mui Hpng Vi^t Nam - Volume (57-7). N°1 - March. 2012
100%
80%
60%
40%
20%
0%
Khdng bl6n Chdy m i u chicng
Dinh Bi4n chimg khic
Bi^u a6 3.2.6. Ty 16 cdc Nhan \<:i:
- Bien chung chdy mdu sau phau ihuat gdp 6.3%, 1 trucmg hgp bj dinh cuon vao vach ngdn sau phau thuat ngi soi lay u.
- Trong so 44 irutTOg hap ngi soi lay u xo mach vom mui hong ciia chiing toi khong co truang hop ndo co bicn chimg gi ndng ne. Benh nhan deu dugc riit merocel sau 48 h vd khong CO truang hop ndo chdy mdu sau mo dieu nay co cdi thien ddng de tinh trang hdu phdu ciia benh nhdn, so \ iri 3.2.7. Thdi gian ndm vien sau phdu thugt
bi6n chirng sau phdu thudt
lru6c ddy chiing toi khong co tdc m^ch truoc mo vd mo (heo dudng ngodi ihi thuong phdi nhet bac mui sau. mgt so it truang hop con phai mo khi qudn du phong chdy mau sau mo vd ly I? chay mau sau mo iruoc da> chiem 27.9%. Chiing loi khong gap bien chimg nhu tu mau 6 mdt, do dich ndo luy, chil h?p ong I?... sau phau thual ngi soi lay u xa mach.
Nhu v^y cho thay phau thuat ngi soi Idy u xa mach giai doan I va II Id an todn vd hdu phau nh? nhdng.
B i n g 3.2.7. Thi^i gian nam Vl$n sau phSu thu$t Thcri gian n^m v i ^ n (X)
s 1 tu^n 1 luan < X £ 2 lu^n X > 2 luan N
n 8 32 4 44
%
18 2 7 2 7 9.1 100 Nhan xet:
Thoi gian nam vien lir 1-2 luSn sau phau Ihual la chii yeu (72.7%), 18.2% truong hop nam vien < 1 tuan va 9 . 1 % truang hgp n5m vien > 2 tuan.
Thoi gian nam vien trung binh la 9 ngay.
54
T9P chi Tai IWIui Hpng Vi$t Nam -Volume (57-7). N°1 - IVIarch. 2012 3.2.S. Ty If tdl phdt UXMVMH Iheo gial dogn
B i n g 3.2.8. T^ 1$ t i i p h i t UXMVMH Iheo giai doan Giai doan
1 II III IV N
Sd ixxiftrnq hg'p Avtfc p h l u thu^t 16
33 0 0 44
S i t i i p h i t 0
2 0 0 2
%
0 4.5 0 0 4,2
Nhan xet:
Ty le tai phat giai doan I Id 0%, giai doan II Id 4.5%.
- Chung toi theo doi benh nhdn trong thoi gian tir 6 thang den 6 ndm thi thdy 1 truoTig hgrp sot u a ho buom khau cdi va 1 truong hgp tdi phdt a thdnh ben xoang buam. Ty le ndy thdp ban nhieu so vai phdu thuat duong ngoai la 37,2%. Tuy nhien do nhom phau thuat ngi soi a giai doan som, vd thai gian theo doi con ngdn nen sir so sanh nay can bo xung them.
Tuy vay chiing toi cho rang 6 giai doan som nay ngi soi co uu the vuat trgi so voi duong ngoai vi phau thuat vien CO the tao ra phau truang tuong d6i rgng duoi ngi soi vd ngi soi giiip phong dai, quan sdt duoi nghieu goc khac nhau gop phan boc tdch cdc thiiy kh6i u t6t ban, ngodi ra trong khi Idm ngi soi phau thuat vien co th^ d6i chi^u vai CT Scan dg tap trung tim \\k cac thiiy cua kh6i u vi the lam gidm nguy co sot u va tdi phdt u.
IV. KET LUAN
Hi^u qua cua phau thuat co nut m^ch trird'c mo
Thoi gian phau thuat ngin: 93,2%
hodn thanh I ca phdu thudt tir l-2h
- So lugng mdu mdt trong phau thuat it: 68.2% mdt mdu < 250ml - So lugng mdu phdi truyen it; 90,9%
khong phdi truyen mdu.
- Phuang phdp cam mdu trong va sau phau thuat don gian: chii yeu Id cam mdu bdng dot dien vd nhet gelaspon+
merocel
- Bien chung sau phau thuat it vd nhe:
chdy mdu (chiem 6,3%), dinh cuon vao vach ngdn 1 truong hgp.
- Thoi gian ndm vien: trung binh Id 9 ngdy.
- Ty le tdi phat thdp: ty le tdi phdt theo phau thuat ngi soi Id 4,5%
TAI \A%V THAM KHAO
1. Nhan Triimg Son (1992). "Nhan 16 ca u xo vom mui hgng phau thuat tai benh vien nhi dong I". Ngdy lai mui hgng nhi 10-9-1992. Hoi tai mSi hgng TP Ho Chi Minh: 40-42
2. Tran Hihi Tuan (1990). "Gop phdn dieu tri u xo vom mui hgng". Ngi san Tai Miii Hpng sdl: 99-105.
3. Carrau RL, Snyderman CH, Kassam AB, Jungreis CA (2001).
"Endoscopic and endoscopic-assisted surgery for juvenile angiofibroma".
Laryngoscope 111: 483-487.
55
T9P chi Tai Mui Hpng Vi§t Nam -Volume (57-7). N°1 - March. 2012
4. Dancsi G, Panizza B, Mazzoni A, 7. Shepherd GP, Eric .IIVI (2005).
Calahrcsc V (2000). "Anicrior "lindoscopic versus Traditional approaches in juvenile nasopharyngeal Approaches for lixcision of Juvenile angiofibroma with intracranial Nasopharyngeal
extension". Otolaryngology Head and Angiofibroma".Laryngoscope 115;
NeckSurgerynl 277-283. 12011207.
5. Roger G, Tran Ba lluy P, Froelich 8. Scholtz AW, Appenroth E, Jolly KK, P, Van Den Abbccle T, Klossck JIM, Scoltz LU, Thumfast WF(200I).
Serrano E, Garabcdian EN, Herman P "Juvenile Nasopharyngeal (2002). "Exclusively endoscopic Angiofibroma: Management and removal of juvenile nasopharyngeal Therapy". Z.aryn^o.vcY)/?^ 111: 680-687.
angiofibroma: trends and limils" , j,peeter JG(1988), "Management of Archives of otolaryngology-Head and ^^^„.|^ angiofibroma". Laryngoscope NeckSurgery 128: 928-935. ^g. |oi6-1026.
6. Howard DJ, Lloyd G, Lund V . , „ • .1/ • • • T /-.nn.i ..V, J •. -J 10. / b a n c M, Garvis W, Linder T, (2001). Recurrence and Its avoidance in .,. , . , , . „ „ „ , .,, ,
' ., . „, „ , Fisch U (1998): "Update on the luvenile angioiibroma . Laryngoscope . „ . . .
Ill- 1059 1011 infratemporal tossa approaches lo nasopharyngeal angiofibroma".
Laryngo.scope 108:1717-1723.
NGHIEN c t r u DAC DIEM LAM SANG CUA DI HINH CUON G I C A Pham Manh Cong* Tong Xuan Thang**, Nguyen Cong Thanh** V6 Thanh Quang**
TOM TAT
Di hinh cuon mui giiia co the lim inh huong il ho$c nhieu den chuc nang sinh ly va gay viem mOi xoang. IVlyc tieu: Mo ta dac diem lam sang ciia di hinh cuon mui giiJa trong b?nh ly mui xoang. Doi ivitfng vi Phu-tfng phip NC: Gom 37 b^nh nhan dj hinh cuon giua, phuong phap nghien cuu tien curu, mo ta tung ca Ket qua vi Ban lu^n: Ty le gap 6 nir 26/37 (70,3%) nhieu hem nam 11/37 (29,7%), nam gap nhi^u a tu6i 36 - 45 (4/11), nu gap nhiSu 6 tu6i 46 - 60 (11/26). Cd 29 dj binh xoang hoi, 7 cu6n gitta dao chiSu, 1 cat khiic. Chay mui 37 (100%), dau dju g?lp 31 (83,8%), ngjt mui 30 (81,1%), Hat hoi 25 (67,6%), ngiri icem 17 (54,1%). Xoang hoi cuon giiia don thuin gap 28/29 truong hop chiSm ty 1? 96,5%, xoang hoi phoi h(rp gjp 1/29 (4,5%). Cu6n giira dao chieu don thujn gap 6/7 truftng hgip (87,5%), phoi h(jf g^p 1/7 (12,5%). Cu6n giiia cJl l<huc gap 1 trucmg hgp, Dj hinh cu6n giiia rjt il ph6i hijp vciti nhau. Ket luan: Tren 37 benh nhan co 29 di hinh xoang boi, 7 cuon giiia d^o chilu, I cat khiic.
Tir khoa: Di hinh cuon giiia, xoang hai, dao chilu.
SUMMARY
BACKGROUND: Middle turbinate deformities can do more or less to affect nasal physiological functions and cause sinusitis. The purpose of this paper is to
* BV H4 Giang " BV TMH TW Nhjn bai 6/2/2012. Duy^t in 10/2/2012 56
