Y HQC VIET NAM T H A N G 6 - s 6 2/2013 viec dung vac xin viem gan B va dieu tri loet da
day do nhiem trung Helicobacter pylori tdt hdn, hai loai ung thu* nay se giam mac va t d vong cho ca hai gldl. Ngoai cac yeu t d nguy cd do hut thudc, nhiem trung bdi vi khuan va Virus, ba loai ung t h u nay cd them nguy cd do Dioxin (3-6).
Chung ta can trien khai cac nghien culi Djch te hpc phan tich de xac dinh mdi lien quan nay. Ty le t d vong do ung thu' tang nhanh theo tuoi d ca nam va nu', dac biet tang cao d cac nhdm tuoi tren 60 d ca hai gidi (Hinh 2). Ket qua nay gdi y, ke t d 40 tud'i, hang nam, moi ngu'di nen kham sang Ipc phat hien ung thu' sdm ddi vdi gan, phd'i va da day de giam nguy cd bi t d vong do ba loai ung thu' nay.
O thanh phd Can Thd, nam ung thu' cao hdn 1,5 lan so vdi nd, ty xuat nay nhd hdn 2 d cac nddc khac trong khu vu'c; Nhat Ban 1,9, Trung Quoc 1,8, Philippines 1,2, Singapore 1,5 va Thailand 1,5 (Bang 2). Ket qua nay gdi y kha nang phdng mdi mac ung thu* cho nam gidi la kha thi khi chung ta nghien cdu phat hien nguy cd gay ung thu' cho nam gldl va kiem soat cac yeu t d nay thanh cdng.
Mdt so ban che cua cdng trinh nghien cdu:
Benh nhan t d vong do ung thu' khdng cd sd lieu ve giai phau benh. Oac thu vung sdng nu'dc, giao thdng du'dng bd khd khan, viec ghi nhan va thdng ke nguyen nhan t d vong cd rat nhieu khd khan, ty le t d vong do ung thu' trinh bay trong nghien cdu nay cd the thap hdn thdc te nhieu.
V. KET LUAN:
Ty le t d vong do tat ca cac loai ung thu' chuan hda theo tud'i d nam: 79,5/100,000 va nd:
54,7/100.000. Nam b\ tii vong do ung thu' cao
hdn 1,5 lan nu". Ung thu' bj tu' vong cao nhat la gan {ASR 31,9/100.000 d nam va 11,2/100.000 d nil'); t h d nhi la phdi (ASR 20,2/100.000 d nam va 7,0/100.000 d nu"); thLf ba la da day (ASR 7,1/100.000 d nam va 5,0/100.000 d nuO-
TAI Ll|U T H A M K H A O :
1. MOH (2006) Health statistics yearbook, 2006 (Hanoi, Ministry of Health).
2. Dal, L. C , Quynh, H. T., Thanh, L et aL (1986) Map of Dioxin sprayed in the Second Indidochlna War, Paper presented at the Second National Symposium on Herbicides and Defoliants in War:
the long -Term Effects on Human Health, Hanoi, Viet Nam.
3. Schecter, A., Dai, L. C, Thuy, L. T. et al.
(1995) Agent Orange and the Vietnamese: the persistence of elevated dioxin levels in human tissues. Am J Public Health, 85, 516-22.
-I. Axelson, O., Sundell, L., Andersson, K. et al.
(1980) Herbicide exposure and tumor mortality. /\n updated epidemiologic investjgatkm on Swedish railroad workers, Scand J Wor1< Environ Health, 6,73-9.
5. Fingerhut, M. A., Halperin, W. E., Marlow, D.
A. et al. (1991) Cancer mortality in workers exposed to 2,3,7,8-tetrachlorodit}enzo-p-diDxin [see comments], N Engl ] Med, 324, 212-8.
6. Flesch Janys, D., Steindorf, K., Gum, P. &
Becher, H. (1998) Estimation of the cumulated exposure to polychlorinated dibenzo-p- dioxins/furans and standardized mortality ratio analysis of cancer mortality by dose in an occupationally exposed cohort. Environ Health Perspect, 106 Suppl 2, 655-62.
7. Jenkins, C. N., Dai, P. X., Ngoc, D. H. et al.
(1997) Tobacco use in Vietnam. Prevalence, predictors, and the role of the transnational tobacco corporabons, JAMA, 277, 1726-31.
DIEU TRI BAO TON KHONG MO CHAN THimNG TUY
Trinh V a n T u a n *
T O M T A T :
Nghien cdu nham danh gia ket qua dieu tn bao ton khdng md chan thu'dng tuy. Td 01/2006 den 12/2008 tai benh vien Viet Du'c cd 24 tru'dng hop chan thu'dng tuy du'Oc chi dinh dieu tri bao tdn khdng mo, trong do nam 22 (91,7%), nQ' 2 (8,3%); tuoi trung
* Trudng Dai hoc Y Ha Ngi
Phan bi?n khoa h9c: PGS.TS Nguyin DCPC T i l n 14
binh 24,4 ± 8,7 (dao ddng t d 8 - 46 tuoi). Nguyen nhan do tai nan giao thdng 20 (83,3%), lao dgng 1 (4,2%), sinh boat 3 (12,5%). Tinh trang mach va huyet ap luc nhap vien it thay doi, chi cd 2 tru'dng hdp (8,3%) huyet ap toi da <100mmHg. Xet nghiem amylase mau >220U/I luc 15 tru'dng hdp (62,5%).
Y HOC VIET NAM THANG 6 - SO 2/2013 Chan doan va phan do AAST du'a vao chup cat Idp 6
bung vdi do I: 13/24 tru'dng hdp (54,2%); dd I I ; 5/24 (20,8%); dp I I I : 4/24 (16,7%); do IV: 2/24 (8,3%).
Dieu trj bao ton khong md thanh cong 19/24 tru'dng hdp _(79,2%), chuyen mo 5/24 (20,8%). Thdi gian chuyen mo sau dieu tri bao ton trung binh 11,6 ± 12,6 ngay {tii 1 - 36 ngay). Thdi gian nam vien trung binh cua nhom dieu tn bao ton la 6,1 ± 3 ngay (tir' 2-13 ngay), cua nhdm chuyen md la 23 ± 15,6 ngay (td 11- 49 ngay). Ket qua dieu tri: tot 79,2%, trung binh 20,8%, khdng cd tu' vong trong nghien ciili.
Td khoa: chan thuting tuy, dieu tn bao ton khong md.
SUMMARY:
NONOPERATIVE MANAGEMENT OF PANCREATIC INJURY Study aimed at evaluating the results of nonoperative management of pancreabc trauma. From 01/2006 to 12/2008 at Viet Due Hospital in Hanoi, there are 24 cases of pancreatic injury indicated for the nonoperative treatment, included 22 males (91,7%), 2 females (8.3%); the average age was 24.4
± 8.7 (range from 8-46 years). The cause of injuries were 20 traffic accidents (83.3%), 1 working accident (4.2%), 3 living accidents (12.5%). Clinics were only 2 cases of changing hemodinamic (8.3%) with maximum systolic pressure under lOOmmHg. Examination of amylasemia increased 15 cases (62.5%), Diagnosis and classificabon of AAST-OIS based on CT scanner of abdomen including 13/24 cases of grade I (54.2%);
5/24 of grade I I (20.8%); 4/24 of grade I I ! (16.7%);
2/24 of grade IV (8.3%). The conservative management was successful in 19/24 cases (79.2%);
5/24 cases (20.8%) were operated. The time switch operation after the conservative treatment average 11.6 ± 12.6 days (range from 1 - 36 days). The average hospitalization of conservabon treatment group was 6.1 ± 3 days (range 2 - 13 days), the converting group to open surgery was 23 ± 15.6 days (from 11 to 49 days). Outcomes were good 79.2%, middle 20.8%, no mortality in this study.
Key words: pancreatic injury, nonoperative management of pancreatic injury
I. O A T V A N oi:
Oieu trj bao tdn khdng mo chan thu'dng bung du'dc biet den t d the ky 19._^Nam 1887, sau cupc ndi chien d My, Hiep hgi phau thuat Hoa ky da khuyen cao su" can thiet phai m d bung tham do vi nhu'ng tru'dng hdp dieu tri bao ton khdng md chan thu'dng bung cd ty le t d vong cao.
Khuyen cao nay da t r d thanh tieu chuan bat budc cho viec x d t r i chan thu'dng bung sudt qua hai cudc chien tranh the gldl. NhUng nam 1960-
1970, dieu trj bao ton khong mo chan thu'dng bung lai du'dc chi djnh trd lai. Nam 1990 nhieu trung tam dieu trj chan thu'dng d My va Nam Phi da cdng bo nhij'ng kinh nghiem cua hp ve viec lu'a chpn phu'dng phap dieu tri nay trong chan thu'dng bung.
Chan thu'dng tyy tru'dc day du'dc dieu tri chu yeu bang phau thuat, cho du chi la thu'dng td'n nhe khdng cd lien quan den dng tuy chinh. Nhd chan doan hinh anh, nhat la chup cat Idp dp phan glai cao, thu'dng ton tuy cd the sdm du'dc xac dinh va phan loai thu'dng td'n theo AAST. Chi dinh dieu tri bao tdn khdng md trong nhdng tru'dng hdp chan thi/dng tuy khdng cd thu'dng tdn dng tuy chinh giiip ngu'di benh tranh du'dc rui ro, bien chdng do phau thuat, rut ngan thdi gian nam vien, giam dang ke chi phi dieu t n ,
Tai Viet Nam, nhu'ng nam gan day cung da cd nhu'ng nghien cdu ve chan doan va dieu tri bao ton khdng md chan thu'dng tuy nhu'ng chu'a cd cdng trinh nao dl sau vao nghien cdu mdt each he thdng, Do dd, chiing tdi tien hanh de tai vdi muc tieu: Danh gia ket qua dieu tri bao ton khdng mo chan thu'dng tuy tai benh vien Viet Du'c Ha Ndi.
II. o 6 l TUONG VA PHUONG PHAP NGHIEN ClJfU:
2 . 1 . E)dl tu'dng nghien cu'u
Benh nhan du'dc chan doan chan thu'dng tuy do chan thu'dng bung kin tai benh vien Viet Ddc t d thang 1/2006 den thang 12/2008.
2.1.1. Tieu chuan Ida chpn Benh nhan d mpi Ida tud'i, gidi tinh, du'dc xet nghiem amylase va chup cat Idp d byng de phan dd thu'dng ton theo AAST khi vao vien.
Chan thu'dng tuy cd kem theo thu'dng tdn tang dac khac trong o bung nhu'ng khdng cd chi djnh md cap cdu.
Khdng cd thddng td'n tang rong va chan thu'dng so nao phdi hdp.
2.1.2. Tieu chuan loai trd Khdng du tieu chuan neu tren.
NhO'ng tru'dng hdp vet thu'dng tyy.
2.2. Phu'dng phap nghien cu'u Thiet ke nghien cdu: hoi cu'u md ta - Chi tieu nghien cdu: tuoi, gidi, nguyen nhan chan thu'dng, cac dau hieu lam sang, can lam sang, chyp cat Idp, cac thdng sd theo ddi trong qua trinh dieu tri bao tdn khdng mo nhu' mach, huyet ap, nhiet dp, tinh trang bung...
- Danh gia ket qua: chia lam 3 miTc dp:
15
Y HOC VIET NAM THANG 6 - SO 2/2013
• Tot: CO bien chu'ng nhutig khong phai dieu tri phau thuat, khoi ra vien.
• Trung binh: co bien chu'ng phai can thiep phau thuat, khoi ra vien.
• Kem: tir vong do mo hoac dieu trj bao ton.
- Dao d&c nghien ciiu;
Nghien ciAi thUc hien tri/c tiep tren benh nhan nen cac thong tin rieng ve benh tat trong ho so benh an dUOc gan ma so de dam bao tfnh chinh xac, dUOc bao mat va chi dUdc SLT dung cho muc dich nghien cu'u.
III. KET QuA NGHIEN COU:
TU 01/2006 den 12/2008 tai benh vien Viet Du'c, chung toi da dieu trj bao ton khong mo chan thu'dng tuy cho 24 benh nhan, trong dd nam 22
(91,7%), nff 2 (8,3%); tuoi trung binh 24,4 ± 8,7 (dao dong tir 8 - 46 tuoi), tuoi dudi 20: 9 truflng hdp (37,5%). Nguyen nhan do tai nan giao thong 20 (83,3%), lao dong 1 (4,2%), sinh hoat 3 (12,5%). Tinh trang mach va huyet ap luc nhap vien it thay doi, chi co 2 tru'dng hdp (8,3%) co huyet ap toi da <100mmHg. Kham lam sang liic nhap vien: dau thu'dng vi 17 (70,8%), non 7 (29,26%), sot 5 (20,8)%, ia long 2 (8,3%); ih nghiem amylase mau >220 U/L 15 (62,5%). Chan doan va phan dp AAST dira vao chup cat Idp 6 bung, trong do do I: 13/24 trirdng hop (54,2%);
d6 II: 5/24 (20,8%); do III: 4/24 (16,7%)^; do IV:
2/24 (8,3%). Vj tri cac thu'dng ton giai phlu d tuy dUdc mo ta trong bang 1.
Bang 1. Lien quan Chi djnh dfeu trj
Baoton(N=20)
Chuyen mo (N=5)
qiC^a /WST va vi trf giai pt V i t r i
giai phau Dau Eo Than Duoi Dau Eo Than Cong
au thirdnq ton tuy B6AAST I
3 1 9
13 (54,2%)
I I
3
1 1 5 (20.8%)
I I I 1 1
2 4 (16.7%)
IV 1
1 •
2 (8,3%)
Cpng 4 (16,7%)
1 (4.2%) 5 (20.8%) 9 (37,5%) 1 (4,2%) 1 (4.2%) 3 (12,5%) 24 (100%)
Ton thu'dng d tuy ddn thuan cd 12 tru'dng hdp (50%), thu'dng td'n tyy phoi hdp vdi cac tang khac trong d bung 12 tru'dng hdp (50%): gan 5 (20,8%), than 3 (12,5%), lach 2 (8,3%) (bang 2).
Bang 2. Lien quan g\\ia AAST va thu'dng ton phdi hdp (n=24)
Chi djnh dieutri Bao ton (N=19) Chuye'n md (N=5)
Tang phoi hop Gan Lach Than CTSN Gan TMMP Conq
Do AAST cua tuv I
2 2 3 1
8 (33,3%) I I
1 1 (4.2%)
I I I
1 1 (4,2%)
I V 1
1 2 (8,3%)
C?ng 3 (12,5%)
2 (8,3%) 3 (12,5%) 1 (4.2%) 2 (8.3%) 1 (4,2%) 12 (50%)
Theo ddi huyet ddng trong qua trinh dieu tri thay cd sif khac biet ve mach cd y nghTa thong ke (p<0,05) gida hai nhdm dieu tri bao ton khdng mo va nhdm chuyen md, ket qua trong bang 3.
Bang 3. theo doi mach, huyet ap tronq qua trinh dieu tri.
Theo doi
< 36 gid
> 36 gid
Chi dinh Chuyen mo Bao ton Chuyen mo Bao ton
n 1 23 4 19
Mach 93,8 ± 9,1 85,6 ± 9.2 93,3 ± 8,6 82,9 ± 8,3
P 0,013 0,005
Huyet ap toi da 109,1 ± 10.7
111.8 ± 7 . 7 113,3 ± 8,7 109,7 ± 7,2
P 0,38 0,25
Y H p c VI$T NAM THANCS 6 • SO 2/2013
Qua trinh theo doi dieu tri bao ton, 5 tru'dng hdp (20,8%) phai chi djnh can thiep phau thuat do thu'dng ton tuy 2 (8,3%): 1 dd IV va 1 do I I I , mo do thUdng ton phoi hdp 3 (12,5%): 2 do I I v a ' l do I I I (bang 4).
Bang 4. Lien quan qiO^ chi dinh dieu tri va thu'dng ton phoi hdp Chi dinh dfeu t r i
Bao ton Chuyen mo Conq
Tuv phoi hdp 9 (37,5%) 3 (12,5%) 12 (50%)
Tgy ddn thuan 10 (41,7%)
2 (8,3%) 12 (50%)
Cong 19 (79,2%)
5 (20,8%) 24 (100%) Thdi gian chuyen md sau dieu tri bao ton trung binh 11,6 ± 12,6 ngay ( t d
1 - 3 6 ngay). Thdi gian nam vien trung binh cua nhdm dieu tri bao ton la 6,1 ± 3 ngay (ti^ 2-13 ngay), cua nhdm chuyen md la 23 ± 15,6 ngay ( t d 11-49 ngay). Ket qua dieu tri chi cd 1 bien chu'ng chay mau sau md phai md lai trong nhdm chuyen mo; khdng cd bien chu'ng trong nhdm dieu tn bao ton; khdng cd tif vong trong toan bd nghien ciTu vdi ket qua tdt 79,2%, trung binh 20,8%.
IV. BAN LUAN:
Dieu trj bao ton khdng md chan thu'dng cac tang dac nhU gan, lach, than da du'dc thda nhan t d nhO'ng nam 60 cua the ky tru'dc, tuy nhien ddi vdi chan thu'dng tuy thi van con nhieu y kien trai ngu'dc nhau. Nhieu tac gia [5,6] cho rang chan thu'dng tuy can md sdm de tranh nhu'ng bien chu'ng nguy hiem nhu" viem phuc mac, viem hoai tu" tuy, ap xe... nhu'ng cung khdng it ngu'di cho rang nen dieu trj bao ton khdng mo, nhat la ddi vdi tre em khi thu'dng ton dng tuy chinh la tdi thieu. Mat khac tac gia cho rang do chan doan chan thu'dng tuy trong cap cdu dy'a chu yeu vao chup cat Idp de nhan dmh ton thu'dng, tuy nhien hinh anh v3 tyy hoan toan cd the thay du'dc tren chup cat Idp nhu'ng chu^ chac da cd thu'dng ton ong tuy. Theo tac gia, chi djnh dieu tri khdng md ngoai dda vao danh gia mu'c dp thu'dng ton AAST tren chup cat Idp dp phan giai cao cdn phai du'a vao thy'c te tham kham lam sang nhu' huyet dpng phai dn djnh, khdng cd viem phuc mac hoac khdng cd chan thu'dng khac phoi hdp nhat la thung tang rong, chan thu'dng sp nao nang...
Trong tru'dng hdp van nghi ngd thu'dng tdn dng tuy thi phal chi dinh them cac tham dd hinh anh khac nhu" chyp cpng hu'dng tiy (MRI), chup ngu'dc ddng dng tuy npi sol (ERCP) hoac chi dinh md.
Vai trd cua amylase, lipase mau trong chan chan thu'dng tuy cung du'dc nhieu tac gia de cap.
Nhieu nghien CLTU thay nong dp amylase mau tang cao sau chan thu'dng nhu'ng cd den 25% cd chan thu'dng tuy ma amylase mau van d mdc binh thu'dng. Mat khac, amylase tang khdng ndi len du'dc miTc dp ton thu'dng d tuy la nang hoac nhe, cd hay khdng d u t dng tyy. Nghien cu'u cua Blaauw (2008) trong chan thu'dng tuy thay amylase mau tang 9 0 % . Nghien ciru ciia chimg
tdi, amylase mau tang 62,5%. Cd sy' chenh lech nay, theo Haugaard cd the do thdi diem lay mau xet nghiem vi trong chan thu'dng tuy, amylase tang sau thdi die'm chan thu'dng t d 6-12 gid, tham chi mudn hdn tdi 2 - 5 ngay.
Ve chi dinh dieu trj bao ton khdng mo, tuy thudc vao mire dp thu'dng td'n AAST. Oieu tri bao ton khdng mo chan thu'dng tyy thich hdp vdi thu'dng tdn dd I, I I . Vdi dp I I I , tham chi dd IV cung cd the dieu tri bao ton khdng md nhu'ng tinh trang toan than phal on dinh va khdng cd cac dau hieu thanh bung bat thu'dng. Trong qua trinh dieu tri bao tdn can phai theo ddi chat che cac dau hieu lam sang nhu" mach, huyet ap, nhiet dp, tinh trang 6 byng.... Lam cac xet nghiem amylase, lipase mau hang ngay. Chi dinh tham dd hinh anh khi cd dau hieu larh sang nang len nhu' sieu am, chyp cat Idp, chup cdng hu'dng t d , chyp ngu'dc ddng dng tuy ndi soi.... Bien chu'ng cua phu'dng phap dieu tri khdng mo trong tru'dng hdp xau nhat nhu'ng it gap la chay mau, viem phiic mac, cd the dan den td vong neu khdng chi dinh chuye'n md sdm. Bien chifng hay gap hdn la viem tyy cap, ap xe, rd tyy, nang gia tuy... cd the dieu tn bang chpc hut dan lu'u du'di hu'dng dan cua sieu am hoac phau thuat sau nay.
Nghien ciTu ciia Blaauvj tai benh vien ciia trung tam Oai hpc Y St Radboud Ha lan tir 1975- 2003, 31 benh nhan du'di 15 tudi du'dc chi dinh dieu tri bao ton khdng md trong dd cd 2 tru'dng hdp (6,5%) thay cd thu'dng td'n dng tuy tren chup cat Idp. Ket qua dieu tri; 17 benh nhan (54,8%) khdi ra vien; 14/31 benh nhan (45,2%) tien trien thanh nang gia tuy, trong dd 6 tru'dng hdp phai can thiep bang p h l u thuat sau khi ra vien, cac tru'dng hdp khac nang ty' thoai trien; thdi gian nam vien trung binh la 24 ngay; khdng cd t d v o n g .
17
Y HOC VI^T NAM THANG 6 - SO 2/2013 Chung tdi chi djnh dieu trj bao ton khdng mo
cho 24 tru'dng hdp, chu yeu la tren 15 tudi 22/24 (91,7%), trong dd cd 6 tru'dng hdp (25%) thay cd tdn thu'dng dng tuy tren chup cSt Idp; 5 0 % co thu'dng ton ket hdp vdi cac tang dac trong^d bung (bang 2), chii yeu vdi gan. Qua trinh dieu tri bao ton phai chuye'n mo 5 tru'dng hdp (20,8%) trong do cd 2 dp I I , 2 dp I I I va 1 dd IV;
3/5 tru'dng hdp (60%) cd thu'dng tdn phdi hdp nhu'ng chi djnh md deu do tdn thu'dng d tuy.
Ket qua dieu trj bao ton khdng md, tdt: khdi ra vien 19/35 tru'dng hdp (79,2%); xau: bien chu'ng phai chi dinh mo 5 tru'dng hdp (20,8%);
thdi gian nam vien trung binh vdi nhdm bao ton la 6 ngay, vdi nhdm chuye'n mo la 23 ngay;
khdng cd bien chdng hinh thanh nang gia tuy va t d v o n g trong nghien ciru.
V. KET LUAN:
Dieu tri bao ton khong md trong chan thu'dng tyy cho ket qua tot, khdi ra vien 79,2%
sd tru'dng hdp, thdi gian nam vien trung binh ngan (6 ngay), khdng cd bien chu'ng va t d vong.
Vdi 5 tru'dng hdp (20,8%) phai chuye'n mo trong qua trinh dieu tri bao ton, thdi gian nam vien trung binh keo dai (23 ngay), 1 tru'dng hdp bien chirng chay mau phai md lai nhu'ng khdng cd t d vong sau md.
Ldi cam d n : nhdm nghien cdu xin chan thanh cam dn Khoa phau thuat cap cdu bung
benh vien Viet Ddc da giup d d trong qua trinh nghlSn cu'u va thu'c hien de tai.
TAI LIEU T H A M K H A O :
1. Stawicki SP (2007). Trends in nonoperative management of traumatic injuries: A synopsis.
OPUS 12 Scientlst;l (l):19-35.
2. Demetriades D, Velmahos G (2003).
Technology-driven triage of abdominal b-auma: The emerging era of nonoperative management Annu Rev Med; 54: 1-15.
3. Duchesne JC, Schmieg R, Islam S, Olivier j , McSwain N (2008). Selective nonoperatve management of low-grade blunt pancreatic injuiy:
are we there yet^. J Trauma. Jul; 65 (l):49-53.
-r. Trjnh Van Tuan, Nguyen Oijrc Tien (2012).
Nghien ciru chan doan va dieu tn chan thu'dng tyy tai benh vien Viet Ddc t d 2006 - 2008, Tap chlY hpc Viet Nam, 393, (2): 20-24.
5 BJaauur I, Winkelhorst IT, Rieu PN et all (2008). Pancreabc injury in children: good outcome of nonoperative treatment. J Pediatr Surg. Sep; ^3 (9): 1640-3
6. Haugaard MV, Penninga L, Gluud C, Wettergren A (2012). Non-operative versus operative treatment for grade I I I to V blunt pancreatic trauma in children (Protocol). The Cochrane Library 2012, Issue 4, 1-10.
7. Wood 3H, Partrick DA, Bruny JL, Sauaia A, Moulton SL (2010). Operative vs nonoperative managemnent of blunt pancreatic trauma in children. J Pediatr Surg. 2010 Feb;45 (2):401-6.
CHAN DOAN THAI MANG NHIEM SAC THE CHUYEN DOAN HOA HOP TAM
TOM T A T :
Chuyen doan hda nhap tam la chuyen doan xay ra d cac nhiem sac the tam dau, ngu'di mang chuyen doan hoa nhap tam thu'dng cd kieu hinh binh thu'dng, tuy nhien hp cd the sinh ra nhutig dira tre bat thUdng. Viec phat hien ra nhOtig thai mang nhiem sac the chuye'n doan nay cd y nghia cho chan doan va td van di truyen.
Myc tieu 1. Oanh gia gia tri cua cac test sang loc trudc sinh trcing viec phat hien cac thai mang NST chuye'n doan hoa hdp tam 2. Tim hieu mdi lien quan giiJa thai mang NST chuyen doan hda nhap tam vdi karyotype cua bd me, DOI tu'dng: 11 thai cd mang nhiem sac the chuyen ' Dgi hQC Y Ha NQI
Phan bi^n khoa hpc: PGS.TS Phan Thj Hoan 18
Hoang Thj Ngoc Lan*
doan hda nhap tam bong tdng sd 4014 thai lam xet nghiem nhiem s3c the. Ket qua: Cd 7/11 thai mang NST chuyen doan hda nhap tam loai 45 NST (cd 1/7 thai mang them 1 chuyen doan tu'dng ho khac). 4 thai mang nhiem sac the chuyen doan hda nhap tam loal 46 nhiem s k the. Cac thai mang NST chuye'n doan hoa nhap tam 45 NST (chuye'n doan can bSng) du'dc chan doan tniiic sinh chii yeu dyS vao tien su" va sang loc HTN nguy cd cao cho HC Down. Cac thai mang NST cjiuyen doan hoa nhap tam 46 NST (chuye'n doan khong can bSng) duW chan doan trudc sinh chu yeu di/a vao sieu am hinh thai thai.Cd 8/11 (72,72%) thai mang NST chuye'n doan co nguon gdc t d bd hoac me. Ket luan: TTiai mang chuyei
