Y HQC VigT NAM THANG 1 - SO 1/2013 den benh vien, khong yeu eau 115. Oieu nay
phan anh he thong cap cu'u 115 chu'a dUdc mpi tang Idp dan chiing quan tam va sir dyng.
4.2. Ve phan bo benh nhan theo chuyen khoa: Cap ciTu npi khoa chiem da so 71,3%, sau do den ngoai khoa (17,4%). It nhat la cap cirtj san khoa: 1,7%. Cac benh cap ciiU npi khoa chiem da sd, cung phii hdp vdi tac gia Do Quoc Huy [2]. Tir ket qua nghien ciiU nay, cho phep chiing ta xay dytig mang lu'di thong tin ket noi vdi eac khoa cap ciilj ciia eac benh vien trong dia ban Ha Npi de ket ndi tru'dc khi van chuyen benh nhan den cae ed sd y te phii hdp theo tuyen chuyen khoa.
4.3. Ve phan bo b^nh nhan theo thdi gian So lu'dt benh nhan yeu cau cap eiru tap trung nhieu vao cac thang 10 (8,63%), thang 11 (8,47%), thang 12 (9,42%) va thang 6 (8,99%), thang 7 (8,71%), dd la cac thang nong va lanh nhat trong nam, ket qua nghien eiru eiia chiing toi ciing tu'dng ty* ciia tac gia Dang Van Chi'nh [1]. Tre em va ngudi gia, dac biet ngu'di cd benh man tinh nhu' tim mach, ho hap rat de phat benh.
Ve phan bo benh nhan theo gid trong ngay, nghien ciTu cho thay so lu'dt benh nhan yeu cau cap ciru tap trung nhieu vao khoang 8 - 1 0 gid va 20 - 01 gid trong ngay. Nhieu nhat la khoang 8 - 9 gid; it vao khoang 3 - 6 gid.
Tir ket qua nghien ciTu nay, se giiip nhii'ng nha quan ly bo tn' sap xep nhan ly'c y te, cung nhu' trang thiet bi phii hdp theo thdi gian trong ngay, cung nhu" trong nam de phue vu tot nhat nhu eau goi cap ciru va van chuyen cap ciru cua benh nhan, riit ngan thdi gian ehd ddi van chuyen, giiip benh nhan nhanh chong du'dc tiep can vdi eac cd sd y te chuyen khoa.
4 . 4 . V e t y 1$ b # n h n h a n cap c i h i du'dc chuyen d e n benh v i e n
Ty le benh nhan'du'dc Trung tam cap ciJti 115 chuyen den benh vien de tiep tuc dieu tri la 72,20%. So cdn lai khong ehuyen den benh vien la do benh qua nSng, tien lu'dng t i r vong, tir vong ho3c benh nhe co the ke ddn dieu tri tai nha.
V. KET lUfikH
Qua nghien eiru tinh hinh djch te ciia nhii'ng benh nhan cap eiru du'dc Trung tam cap ciiU 115 tiep nhan, chiing toi riit ra mpt so ket luan sau:
- Chii yeu benh nhan cap ciiXi 6 do tuoi tren 70.
Benh nhan bi eac benh cap ciTu npi khoa ehiem da so vdi 7 1 , 3 % ,
- Yeu cau cap ciiU nhieu nhat vao thang 12 va thang 6, vdi so lu'dt yeu rau cap cutJ tap tmng nhieu vao khoang 8 - 10 gid va 20 - 01 gid.
- Chi CO 72,20% benh nhan da duWc chuyen den t)enh vien de tiep tue dieu tri.
TAI LIEU T H A M K H A O
1, -Dang Van Chinh (2006), "Nghien ciTu tinh hinll cap ciru trUdc benh vien tai Nghe An". Ky y&i cong trinh nghien cuU khoa hoc nganh y teNghe An nam 2006, ir. 31-3^.
2, D6 Quoc Huy va cong s\i (2011), "Khao sat dac diem djch te, su* phan bo t)lnh cua cac tn/dng hdp cap ciru dUOc tiep nhan, xii tri qua he thong clip cinj 115 tai Thanh pho Ho Chi Minh. Yhgc Thanh pho Ho Chi Minh, 15(4), tr.105-111.
3, Ario Kiusura (2007), "Most Impoftan Rote Emergency Physicians", Resusdtadon. 55, p 92-96.
DANH GIA KET QUA DIEU TRf MONG THIT BANG PHOffNG PHAP GHEP KET MAC TI/THAN TAI BENH VIEN CHanAY
T6M TAT
Muc deu nghien cuU:
• Phan loai lam sang va chi djnh phau thuat dieu tn mwig thjt bang phi/ong phap ghep kS: mac \ii than,
- Oanh gia ket qua ciia phau thuat ghep ket mac t y than trong dieu tri mong thjt.
* Khoa Mat - Benh vien Cho Ray,
Phan bien khoa hoc: PGS.TS.TrIn Minh Trirang
N g u y i n HOtu Chu'c
Doi hygng va phu'dng phap nghien dhi:
Doi tu'dng nghien cuti: Benh nhan bj m6ng thit
> do 11, den kham va dieu trj tai benh vien Chd Ray tir 01 thang 6 nam 2009 den 01 thang 6 nam 2011
Phu'dng phap nghien cuti:
Thiet ke nghien cutr. Tien cu'u, thy'c nghiem 15m
Y HQC VlgT NAM THANG 1 - s 6 1/2013 sang, khong co nhom chirng.
Phudng phap chon mau: Lay hang loat tru'dng hdp.Benh nhan bi mong thjt tir do 11 trd len, co dieu kiin theo doi, tai kham ft nhat 6 thang.
Kei qua: Sd ludng benh nhan 20, Nam: 112 (55,7%), Nff: 89 (44,3%). Benh nhan >30 tuoi chiem 91,1%. Mong thit phia mui c6 87,1%. Benh nhan co nghe nghiep va cuoc song tiep xuc nhieu vdi nSng, gio va byi nhii nghe nong va nghe bien g3p 82,6%. Benh nhan co mong thit dp III va IV la 82,1%. NhiJng benh nhan nay chirc nang th| giac bi anh hUdng nhieu.
Khong gap tai bien trong phau thu§t, ty le tai phat: 7,0% sau 6 thang. Thi lu'c sau phau thuat cai thien, thj lUc >7/10 la 79,6%.
KStluan:
• Mong thit xuat hien vdi ty le cao d nhOYig ngu'di thu'dng xuyen tiep xuc vdi anh nSng, gio, bui.
Kha nang tai phat d nhiTng benh nhan mpng mau va xam lan nhieu cao hOn mong xO va xam lan it.
- Phan loai theo miTc do xam lan nen chia ttianh 4 nhom tir do I den do IV, cd y nghTa thi/c te trong dieu tri va theo doi, tien lu'dng.
Ghep ket mac tU than de dieu tri mong thjt cd ket qua tot, an toan, ky thuat khong phirc tap. Ty le tai phat thap:7,0%.
Til" khoa: Mong thit, Ghep ket mac tU than.
ABSTRACT
EVALUATION OF PTERYGIUM TREATMENT BY CONJUNCTIVAL AUTOGRAFT AT CHO RAY
HOSPITAL Objectives:
' Clinical classificabon and indications of surgical treatment for pterygium by conjunctival autograft.
- Evaluation of conjunctival autograft surgery in the treatment of pterygium.
Materials and methods:
Subjects: Patients with stage 2 pterygium, primary or recurrent, examined and treated at Cho Ray Hospital from June 1, 2009 to June 1, 2011
Methods: Study design: longitudinal, clinical trials, no control group.
Sampling: Series of cases. Pabents with stage 2 or higher pterygium, could be examined and followed for at least 6 months.
Results: Number of pabents 201, male: 112 (55.7%), female: 89 (44.3%). Patients > 30 years of age accounted for 91.1%. Nose-sided pterygium: 87.1
%. Patient witti high exposure to sun, wind and dust such as fermers and fishermen: 82.6%. Patients with stage 3 or 4 pterygium: 82.1%. These pabents had visual function severely affected.
No complication was reported, recun-ence rate: 7.0%
after 6 monBis. Postoperative vision improvement: patients with vision > 7/10 accounted for 79.6%.
Condusions:
- Pterygium is usually seen in people regularly
exposed to sun, wind and dust. The chance of recurrence in patients with hypervascular, invasive pterygium is higher than that in patients with fibrous and less invasive pterygium
- Classification based on the degree of invasion:
pterygium should be divided into 4 groups, from stage I to IV. This classification has practical significance in the treatment, monitoring and prognosis.
- Conjunctival autograft for the treatment of pterygium has good results, high safety, low technical complexity and low recurrence rate of 7.0%.
Keywords: Pterygium, Conjunctival autograft.
I.OAI CUONG
Mong thjt la mpt benh ly thu'dng gap eiia ket mac nhan cau. 0 6 la mpt nep mo sdi-mach mau hinh tam giac d viing khe mi, dinh hu'dng ve trung tam, cd xu hu'dng xam lan vao giac mac.
Mong thit thu'dng d phia trong khe mi, hiem khi d phia ngoai hoac ca hai. Nhii'ng yeu to thuan Idi lam mong thit de xuat hien va tien trien ta mat tiep xuc vdi anh nang, tia ci/c ti'm, bui, gid nhieu.
Benh la mpt hinh thai tang sinh lanh tinh ciia ket mac, cd the gap d tat ca cac ndi song thu'dng gap nhieu tai viing khi' hau nhiet ddi, mien bien. Tien trien nhanh hoac cham tiiy thupc vao tirng ea the va hoan canh moi tru'dng tiep xuc, lam viec. Benh ed the lam anh hu'dng den ehirc nang thi giac do gay nen loan thi khong deu, ehe dong tir, kich thich.
Van de dieu trj luon la mot thach do vdi cac nha Nhan khoa, cho den nay chuS ed ky thuat nao khae phyc du'dc tinh trang tai phat sau phau thuat. Theo nhieu nghien eiru, kha nang tai phat cd the gap tii" 2 , 1 % den 87,0% tiiy theo phu'dng phap phau thuat, dien tien ciia mong, tuoi benh nhan, moi tru'dng song va lam viec.
Cd nhieu ky thuat du'dc ap dung nhu": Cat bd toan bp phan mong, de lai phan ciing mac tran, may khep ket mac ddn thuan, tru'dt ket mac, viii dau mong, xoay ket mac, ghep ket mac tiT than, ghep te bao goe, ghep giac mac phien hoac ghep giac mac xuyen, dieu trj phoi hdp phau thuat vdi diing corticosteroids, mytomycin C.
Hien nay phu'dng phap ghep ket mac tu"
than sau khi eat bd mong thit du'dc nhieu tac gia tren the gicfi va trong nu'dc danh gia eao ve kha nang han che tai phat. Be danh gia mot each khach quan ve hieu qua ciia ky thuat nay, de tai
"£?5/j/? gia ket qua dieu tri mong thjt bang phu'dng phap ghep kit mac tif than tai benh vien ChdRay"6\i<iz thy'c hien vdi eac muc tieu sau;
y Hpc VigT NAM THANG 1 - s 6 1/2013
Phan loai lam sang va chl djnh phau
thuat dieu trj mong thit bing phu'dng phap ghep ket mac ty" than.
Danh gia ket qua eiia phau thuat.
II. 001TU0NG VA PHUONG PHAP NGHISN CCfU 1. Doi tu'dng nghien cii'u; Benh nhan bj mong thjt > dp II, den kham va dieu tn tai benh vien Chp Ray tir 01 thang 6 nam 2009 den 01 thang 6 nam 2011.
2. Phu'tfng phdp ngliiSn cihi:
Thiet ke nghien cihr. tien ciru, thy'c nghiem lam sang, khong cd nhdm chirng.
Phu'dng phap chpn mau: Lay hang loat tru'dng hdp.
- Tieu chuan chpn benh: Benh nhan bj mong thjt tif dp II trd len, cd dieu kien theo doi, tai kham it nhat 6 thang.
- Thu thap so lieu.
- Thong ke vdi phan mem SPSS
til. KET QUA Dac diem dich te
Giditinh:So lu'dng benh nhan 201, Nam: 112 (55,7%), Nij-; 89 (44,3%) Tuoi:
Bang 1: Tuoi ciia benh nhan (n = 201)
STT1 2 3 4 5
Tuoi 20-30 31-40 41-50 51-60 Tong s o
So lUOnq 18 42 93 48 2 0 1
Ti le (°/o) 8,9 20,9 46,3 23,9 1 0 0 , 0
Mat benh: Mat phai: 108 (53,7%), mat trai: 93 (46,3%) Vltnmgng:?\\\3i mui: 175 (87,1%), phia thai du'dng: 26(12,9%) Nghe nghiep:
Bang 2: Nghe nghiep eiia benh nhan (n = 201)
STT1 2 3 4 5
Nghe nghiep Nonq nqhiep Nqu" nqhiep
Vien chLfc Nghe khac Tong so
So lu'cfng 97 69 19 16 201
Ti le ( % ) 48,3 34,3 9,4 8,0 100,0
Benh nhan la nhu'ng ngu'di lam viec, tiep xiie nhieu vdi anh nang va nhiJng yeu to kich thi'ch khac nhu' nghe nong, nghe bien cd ty le eao trong nghien ciru.
Bang 3. Thj lu'c tru'dc khi can thiep phau thuat (n=201)
STT1 2 3 4 5 6 7
Thi lire S T ( - t ) a e n O N T l m ONT > Im den 1/10
> 1/10 den 3/10
> 3/10 den 5/10
> 5/10 den 7/10
> 7 / 1 0 Tong s o
So lu'dng 3 7 12 18 22 139 2 0 1
Tv le (%) 1,5 3,5 6,0 8,9 10,9 69,2 1 0 0 , 0
Phan loai dp mong
Bang 4: Phan loai theo mire dp xam lan ciia mong thjt (n = 201)
STT1 2 3 4
D o mpng D o l l 0 6 III Bo IV Tong s o
So ludng 36 132 33 2 0 1
Ti le ( % ) 17,9 65,7 16,4 1 0 0 , 0
Y HOC Vl|T NAM THANG 1 - SO 1/2013
Trong nghien ciTu, benh nhan cd mong thjt dp III (dau mong xam lan den bd dong tir) va IV (dau mong xam lan den hoac vu'dt qua trung tam dong tir) cd ty le 82,1%. Nhii'ng benh nhan nay ehirc nang thj giac bj anh hu'dng nhieu.
Hinh thai mong:
H i r
ei5 32,3'!--o
h t h d i T i p n g t h i t
1 3 6 6 7 . 7 %
f °.
vlong m ^ u>/lpng XO
Bieu dio 1: Hinh thai lam sang mong thjt
Hinh thai mong mau trong nghien eiru gap nhieu hdn mong xd. Loai mong thjt nay cd kha nang tai phat thu'dng eao hdn mong xd,
Tai bien trong phau thuat: Khong gap tai bien trong phau thuat Bien chu'ng sau phiu thuat
Bang 5/Bien chiTng sau phau thuat (n=201)
STT1 2 3 4 5
Ten bien chu'ng Nhiem trunq Phu giac nnac Mo hat
Cuon manh ghep ket mac Seo qiac mac
SolUdng 1 3 1 4 1
TylS(»/o) 0,5 1,5 0.5 2,0 0,5
Manh ghep sau phau thuat cd the bi cuon lai, lam anh hu'dng den qua trinh lanh benh. Khi phat hien can du'dc xii tri' ngay bang each vuot lai va may bo sung, bang ep,
Ket qua dieu trj sau 6 thang
Bang 5/Tai phat sau phau thuat theo mu'c dp xam lan (n=201)
STT1 2 3 4
Do mong
Don
Do III Do IV Tong soTai phat 2/36 9/132 3/33 1 4 / 2 0 1
Tv le ( % ) 5,0 6,8 9,1 7,0
Mong ttijt xam lan nhieu ed ty le tai phat cao hdn, dp IV tai phat 9,1%, trong khi dp II tai phat 5,0%.
Bang}
STT 1 2 3
Loai mong Monq mau
Mong xd Tong
Tai phat 13/136
1/65 1 4 / 2 0 1
Tv le (o/o) 9,6 1,5 7,0
Mong mau tai phat nhieu hdn mong xd mot each ro ret. Sy" khac biet cd y nghTa thong ke (p=o,obi)
BangS:Ta\ phat sau phau thuat theo tuoi benh nhan (n=201) STT
1 2 3 4 5
Nhom tuoi 20-30 31-40 41-50 51-60 Tong so
Tai phat 2/18 4/42 7/93 1/48 14/201
Tv le f%) 11,1
9,5
7,5
2,1
7,0
Y HQC VIET NAM THANG 1 - s 6 1/2013
Tuoi ciia benh nhan cung lien quan den kha nang tai phat sau phau thuat. Benh nhan co tuoi tir 20 den 30, tai phat 1 1 , 1 % , trong khi d dp tuoi 51-60 chl ed 2 , 1 % tai p h a t
Bang 9. Thj ly'c sau phau thuat 6 thang (n=201)
STT
1 2 3 4 5 6 7
Thi lu'c ST (-1-1 den DNT Im Tif DNT > Im den 1/10 Tir > 1/10 den 3/10 Tir > 3/10 den 5/10 Tir > 5/10 den 7/10
> 7/10 Tong sd'
So lu'dng 0 0 7 15 19 160 201
Tv le (%) 0,0 0,0 3,5 7,5 9,4 79,6 100,0
Thj lu'c sau phau thuat cai thien, benh nhan cd thi ly'c >7/10 la 7 9 , 6 % so vdi tru'dc phau thuat:
69,2%, sy khac biet ed y nghTa thong ke (P=0,005) IV. BAN LUAN
Trong nghien cu'u, so lu'dng benh nhan nam cd 55,7% va nU 44,3%. Vdi ket qua nghien ciTu ciia Ashok K. Sharma va cong su', vdi 150 benh nhan, cd 47 nti' (31,3%), 103 nam (69,7%), nhu' vay benh nhan nam trong nghien ciru nay cd ty le cao hdn. Song theo nghien cu'u ciia Oinh Thi Bich Thanh tren 199 benh nhan, ty le benh nhan nam la 47,2 %. Nhu' vay ve gidi tinh, mong thit khdng cd ti'nh dac thii eiia tirng gidi.
Benh nhan du'dc phau thuat cd tuoi > 30 chiem 9 1 , 1 % , nhieu nhat d dp tuoi 41 - 50, Vdi nghien ciru ciia Oinh Thj Bich Thanh, tuoi benh nhan > 30 cd 94,5%.
Mong thjt d mat phai: 102 (50,7%), mat trai: 99 (49,3%), nhu' vay giua 2 mat khac biet khong cd y nghla thong ke, phii hdp vdi ket qua nghien eiru eita Oinh Thi Bich Thanh va mpt sd tac gia khac. Vj t r i mong thit tai phia mui thu'dng gap nhieu hdn: 8 7 , 1 % cae tru'dng hpp. Oieu nay phii hpp vdi y van trong nu'dc va the gidi.
Sd lu'dng benh nhan tam nghe hoac mdi tru'dng song tiep xiie vdi nang, gid, bui nhieu nhu' Nong nghiep, Ngu* nghiep, chiem ty le rat cao:
166/201 (82,6%), Nhu'vay, nghien eiru cho thay nhu'ng yeu to thuan Idi hinh thanh mong thit cd vai tro quan trpng de benh xuat hien va tien trien, phu hdp vdi ket qua nghien ciTu ciia Oinh Thi Bieh Thanh, V\/ong VA. va cpng sy.
Theo phan loai ciia Lucio Burato, benh nhan du'dc phau thuat trong nghien ciTu ed mong thjt
> do I I I chiem 8 2 , 1 % . Trong dd mong mau cd 67,7%. Y van cho biet mong thjt cd nhieu mach mau, kich thieh se cd ty le tai phat cao hdn.
Khi tien hanh phau thuat, cae tai bien nhu"
chay mau, lat manh ghep, raeh manh ghep hoac eac tai bien toan than khae khong gap. Nhy v i y day la mot phau thuat an toan. NhQ'ng bien
chirng sau phau thuat, khong tram trpng nhiT nhiem triing, phii giac mac, cuon mang ghep khi du'dc %\i tri kjp thdi. Cd i benh nhan de lai seo mong tren giac mac viing chu bien nen khong anh hu'dng den chirc nang thj giac.
Benh nhan du'dc theo doi va danh gia ket qua sau 6 thang tren cac tieu chi: tai phat, thj lye. Benh nhan bj tai phat chung g3p 14/201 benh nhan ( 7 , 0 % ) . Song d benh nhan cd mong thjt > dp I I I ty le l3i phat eao hdn dp I I . Mong mau tai phat 13/136 (9,6%) eao hdn mong xd;
1/65 (1,5%). Nghien eiru nay cung nhan thayty le tai phat cd lien quan den tuoi benh nhan. 0 ngydi tre, ty le tai phat eao hdn, Nhdm benh nhan tir 20 den 30 tuoi tai phat 1 1 , 1 % , trong khi nhdm 51 den 60 tuoi tai phat 2 , 1 % .
Nhy vay neu xet ket qua ve miTc dp tai phat, vdi 7,0% benh nhan bj tai phat chung cho ca nhdm nghien ciTu thap hdn ket qua nghien cyu cua Atiya Rahman: 10,0% vdi cat mong thjt cd ap mitomycin - C trong khi phau thuat. Theo nghien ciru eiia Phan Ke Ton va Ngo Duy Hoa, phau thuat bang phu'dng phap Me. Raynolds, ty le tai phat la 3 5 , 0 % sau 3 thang. Song, vdi cac tac gia khae nhu' Oinh Thi Bieh Thanh: 4,5%, Ashok K. Sharma: 2,6% ghep ket mac t y than tai phat, thi ty le tai phat trong nghien ciilJ nay cao hdn. Cd the do ty ie benh nhan co mong mau va xam lan nhieu hdn.
Ve thj lyc ciia benh nhan sau phau thuat cung la van de can quan tam. Ket qua cho thay thi lye tang len ed y nghTa thong ke so vdi tru'dc khi phau thuat. Do loai bd dydc mong thit che khuat dien dong X.\i va tinh trang loan thj khong deu. Trong qua trinh phau thuat, thao tac phai ton trpng eau triic sinh ly va s y bang phang ciia be mat giac mac, n h y vay se lam eho chat lydng thj giac tot hdn.
56
Y HOC VIET NAM THANG 1 - S6 1/2013 Ve tac dung cua ghep ket mac rdi t y than:
Cd rat nhieu tac gia cho rang benh nhan bj mong thjt la vi suy yeu te bao mam d viing ria do ton thu'dng dai dang bdi tia eye ti'm. O ngu'di binh thu'dng, cac mo d viing ria khde manh se ed tac dpng nhu" mpt rao chan ngan chan ket mac xam lan vao giac mac. Trong khi d d , d benh nhan mong thjt, eac te bao mam viing ria bi ton thu'dng lam hang rao nay khong eon bao dam du'dc chyc nang nti'a, nen can du'dc thay the bdi mpt ket mac lanh manh de ed the tai tao lai rao chan, tranh mo sdi mach du'di ket mac xam lan vao giac mac. Oay chinh la cd sd de giai thi'ch cho sy giam kha nang tai phat va ky thuat ghep ket mac rdi t y than trong dieu trj mpng thiit ngay cang du'dc danh gia eao. Cd nhieu y kien khac nhau trong phu'dng phap ghep ket mac t y than va ghep ket mac t y than viing ria. Kenyon KR. va CS (1985) tien hanh ghep ket mac t y than ddn thuan khong bao gom te bao viing ria de dieu trj mpng thjt eho biet tai phat 3/57 mat (5,3%), trang khi Stare S. va cpng s y bao eao ghep ket mac t y than viing ria tai phat gap 31,0%. Trong nghien ciiXJ nay, manh ghep du'dc lay la ket mac vung ria, cd t^ le tai phat la 7,0%, khi lay ket mac viing ria thuan Idi hdn lay tai ndi khae, dong thdi tac dyng ciia te bao mam tai ria giac mac cung nen du'dc quan tam v6\ muc dich sao eho kha nang tai phat thap nhat.
V. KET LUAN
Mpng thjt xuat hien va tien trien ed lien quan den mdi tru'dng song va lam viec, nhu'ng
ngu'di thu'dng xuyen tiep xiic vdi nang, gid, byi cd ty le mac benh eao. Kha nang tai phat d nhii'ng benh nhan mpng mau va xam lan nhieu cao hdn mpng xd va xam lan ft.
- Trong phan loai theo myc dp xam lan nen chia thanh 4 nhdm tii' dp I den do IV, cd y nghTa thyc te trong khi dieu tri, theo ddi va ben lu'dng.
- Ghep ket mac tu" than de dieu tri mpng thjt cd ket qua tot, an toan, ky thuat khoing phyc tap. Ty le tai phat thap: 7,0%.
TAI UEU THAM KHAO
1. Dinh Thj Bich Thanh v^ cong su", "Danh gia hieu qua ciia phau thuat mong thit ghep ket mac t y than", Y hoc thanh pho Ho Chi Minh, phu ban tap 6 (2009), trang: 261-270.
t . Atiya Rahman et al., "Recrrence rate of Pterygium fallowing surgical excision with intraoperative versus postoperative Mitomycin-C", Journal of the College of Physicians and Surgeons Pakistan, (2008), Vol. 18(8), pp: 489-492 3. Ashok K. Sharma et al., "Corneo - Conjunctival
auto grafting in pterygium surgery", JK Science (2004), Vol.6, No. 3, pp; 149-152.
4. Barraquer R., "Updated management of limbal dystrophies and degenerabons - part 1", Highlights Ophthalmol, (2005), 33: 7 - 8 . 5. Donald T.H. Tan "Ocular Surface Transplantation
Techiques For Pterygium Surgery", Pterygium surgery,(2000), pp. 125-141.
6. Donald TH TAN, et al., "Pterygium", Clinical Opthalmology-An Asian Perspective, (2006), 3(2), pp: 207-216.
7. Lucico Buratto, Robert L.Phillips and Giuseppe Canto "Pterygium surgery", (2000), pp: 33-36, 46-80.
THUC TRANG TY SO GIOI TINH KHI SINH VA MOT SO YEU TO LIEN QUAN TAI 5 HUYEN/THANH PHO T I N H NAM DjNH NAM 2010 - 2011
Nguyin Xuan Bai*, Vu Tai Anh*
TOM TAT
Nghien ciili trien khai tai 5 huyen/thanh pho tinh Nam Ojnh nam 2010 - 2011 vdi cuoc dieu tra cat ngang phong van 700 doi tu'dng la cac cap vp chong trong do tuoi sinh de ve thyc trang ty so gidi tinh khi sinh cho thay: cd 18,7% so 6oi ti/png sinh con thy 3 trd len. Ty so gidi tinh ciia con sinh ra lan gan day
* Tru'dng Dal hoc y Thai Binh
Phan bISn khoa hoc: GS.TS. Lircng Xuan Hiln
nhat la 122 trai/100 gai. So doi tUOng chiu ap lUc phai sinh con trai chiem 43,4%. Doi tLTOng cd quan niem co con trai de noi doi tong du'dng co nguy cO chan doan gidi tinh trUdc sinh cao gap 1,76 lan so vdi nhOng ngiTdi khong c6 quan niem tren. Doi tUOng theo dao thien chiia co nguy cd sinh con thy 3 trd len cao gap 2,21 lan so vdi ngi/di khong theo dao Thien chiia.
