HHKH CHAO M C T N G Sfl N A M XAY DlfMG VA PHAT TRI^N BENH VIEN DA KHOA H 6 N G H G H I E P
DAC DIEM LAM SANG, CAN LAM S A N G C O A NANG RANG SITNG HOA VA KET QUA D i l u TRI TAI MOT SO B £ N H VIEN 6" H A NOI
TOM TAT
-Mac ti€u: Mo ta d§c diim lam sang, can ISm sang nh6m benh nhan co nang rang sCmg hoa diSu tri t&i m^t s6 benh vi6n a Hh NOi. Danh gia kSt qua dieu trj nang rang siJmg hoa a nhom b§nh nhan tren. D6i tirffng va phicffng phap nghien ciru: Nghien CIJTU h6i ciiu va tien cihi tien hanh tren 26 b|nh nhan bi nang rang sjjmg hoa gom hoi curu trSn 16 h6 so b?nh ^n v^ tiln cuu tren 10 b?nh nh§n t^i mpt s5 benh viSn 6 Ha Npi tii thang 1/ 2011 den t h ^ g 11/ 2014. Ket qua:
B?nh khong co sy khac bi§t vh giai va phan b6 rai rdc 6 cac liia tu6i tit 10 ddn 69 tu6i. Benh nhan vao vien chii yeu vdi ly do sung ne bien d^ng mat (73,1%), nang rang sCmg hoa phin ldn phan bo d viing rang ham duoi (73,1%), chu yeu 6 goc ham viing rang khon ham du6i, nang rang simg hoa it khi gay tieu chan rang rang canh nang, mk bi day chan rang di khoi vi tri nang (7,7%), nang rang simg hoa it khi gay phong xuong. Sau m6 1 tuSn kgt qua t6t la 7/10 ca chiSm 70%, sau mo tren 3 thdng kk qua tot 17/20 ca chilm 85 %, duy nh5t 1 ca (5%) xep lo^i trung binh do b?nh nhan vln con te moi dm.
Hai ca co diu hipu tai phat qua tham kham.
Tifkhoa: Nang rang sixng hoa
SUMMARY
CLINICAL, P A R A C L I N I C A L FEATURES AND RESULTS O F T R E A T M E N T IN O D O N T O G E N I C
KERATOCYST (OK) I N S O M E HOSPITALS IN H A N O I
* Binh viin Ba khoa Ndng nghiip
** Bqi hi>c YHa NQi
Chiu trach nhi?m chinh; Nguyin BaNgpc Email: [email protected] Ngay nhan bai: 18/10/2016 Ngay phan bi?n khoa hpc: 11/11/2016 Ngay duy^t bai: 06/12/2016
Nguyen Ba Nggc*, D a n g T r i e u Hung*' Objectives: Describe the clinical ant paraclinical features in patients with odontogenit keratocyst who were treated in some hospitals ir Ha Noi. Evaluation the results of odontogenic keratocyst treatment in patients above. Methods:
Retrospective and prospective study on 2f patients with odontogenic keratocyst Retrospective study on 16 patients anc prospective study on 10 patients in some hospitals in Hanoi from 1/2011 to 11/2014, Results: There is no diferrence between 2 genders and distribute scaterred from 10 to 69 years old. Deforming and swelling of the face i|
the main reason of hospitalizing (73,1%), odontogenic keratocyst follicle distribute in tootli of the lower jaw (73,1%), mainly in the wisdom teeth of lower jaw angle, OK rarely cause thickening of the tooth root next to targel capsule, which was pushed away from the location of root follicles (7,7%), OK rarely cause thickening of the bone bulging, a week postoperative good result is 7/10 case (70%), and after 3 months is 17/20 case (85%), only one case (5%) is rated as moderate because of keep numbing of lip and chin. Two cases have signs oi recurrence.
•it
Keywords: Odontogenic keratocyst (OK).
I.OATVANBE
Nang rang simg hoa (odontogenic keratocyst) la mot loai nang ciia xuong ham, xep thu ba trong cac loai nang do rang, sau nang th§n rang va nang chan rang. Nang rSng simg hoa la mpt dang dac biet cua nang do rang, duoc hinh thanh ti!r cdc t l bao con sol lai cua la rang (dental lamina), voi bilu mc lot long nang la bieu mo siJmg hoa.
Trong lich sii y van t h i gioi, nang ranj sung h6a dugc mo ta dha tien boi Mikulic:
1876, va gkn mot t h i ky sau, thu^t ngi
TAP Cnr Y HOC VlgT NAM TAP 451 - THANG 2 • SO DAC BIgT -2017 ppdontogenic keratocyst" 15n dkn tien dugc
^cfi thieu boi Philipsen 1956. Tir do din nay da CO rat nhieu nghien cihi v l nang rang siitng hoa
^ Tren lam sang, trieu chihig ciia nang rang sung hoa ciing nhu nhom nang xuong ham noi chung thuong ngheo nan, X-quang cung CO the lln voi mot so ton thuong khac nhu nang than rang hay u men. Vi the, viec chan doan chinh xac phai dua vao giai p h l u benh.
Tuy nhien, thuc te ket qua giai p h l u benh doi khi khong tuong iing voi cac dac dilm lam sang. Dilu nay rat nghiSm trpng n l u nhu mpt nang rang simg hoa dup^ chin doan la u men hoac ngugc lai. Do huong d i l u trj ciia nang rang simg hoa thuong la bao tdn, con u men co xu huong di£u tri triet d l , tham chi illLKETQUA
E 3.1. Dac diem lam sang
phai cit do?n xuong hhm. N h u vay, viec chin doan chinh xac nang rang sumg hoa truoc phau thuat de dua ra phac do d i l u tri diing khong don gian.
II. Ddi TUQNG vA PHLTONG PHAP NGHIEN CLTU Doi tirffng: Chung tdi da tiln hanh nghiSn ciiu 26 behh nh§n gom hoi cuu tiSn 16 ho s o bSnh an va tien cuu tren 10 benh nhan. Gom ho so bSnh an va cac b | n h nhan dugc chan doan xac dinh la nang rdng siing h6a dugc dieu tri tai Benh viSn R ^ g ham mat Trung uong Ha Npi, Khoa rang ham mat Benh vien Dai hpc y Ha N6i, Khoa phau thuat tao hinh ham mat - Benh vien ViSt Nam Cu Ba tir thang 1/2011 d i n thang 11/2014.
»
1 i f
Bang 1. Dau hieu bong nhua theo kich thuoc nang Dau hieu bong nhtra
°Kich thirorc
< 3 c i n 3-5cm
' >5cm T6ng
Khdng n 11 7 0 18
%
42.3 26.9 0 69.2
Co n 0 2 6 8
%
0 7.7 23.1 30.8
Tong n 11
9 6 26
%
42.4 34.6 23.1 100 Nh^n xet:
- Dau hieu bong nhua ft gap a nang rang simg hoa, chiem 30.8%.
L - Diu hieu bong nhua it gap o nhung nang co duong kinh tu 3-5cm, chiem 7.7%.
f - Duong kinh nang cang ldn thi ty le c6 d i u hiSu bong nhua cang cao 23.1%.
r p = 0.00 su khac biet co ^ nghla thong ke.
Bang 2. Tri$u chung nhiem triing N h i l m triing Kich thvdrc
< 3 c m 3-5cm
>5cin Tong
Co n 1 5 6 12
%
3.8 19.2 23.1 46.2
K h o n g n 10 4 0 14
%
38.5 15.4 0 53.8
T6ng n 11
9 6 26
%
42.3 34.6 23.1 100
HHKH CHAO MiTNG 50 HAM XAY DUNG VA PHAT TRI^N B$HH VIEN BA KHOA NONG NGHlgP
Nh^n xet:
- S6 nang rang simg hoa co trieu chiing nhiem triing (ro mu ra ngoai, simg ne do niem mac, s6t..) CO 12 trSn tong so 26 b?nh nhan, chiem 46.2%.
- Ci nhOng nang c6 kich thudc iim hon 5cm. 23.1% co bilu hien nhiem trimg trong khi do si nay 6 nhGng nang c6 kich thuoc tir 3 - 5cm v^ < 3cm lan lugt la 19.2% va 3.8%.
- Kich thudc cang Ion thi ty le bieu hien nhiem triing khi tham kham lam s ^ g cang cao.
Va day ciing la ly do khien benh nhan den kham.
p = 0.001 su khac biet co ^ nghTa thong ke.
Bang 3. Phan b6 tinh tr^g phdng xuong theo vj tri nang Vitri
Phong xffoTig
Ham tren
%
Hiim du'di
%
Tong
Khong 19.2 46.2 65.4
%
M6t ban 7.7 19.2 26.9
H a i b ^ 7.7 7.7
TSng 26.9 19 73.1 26 100 J
Nhfn xit: ^ ^ - Da so cac nang rang simg hoa khong gay phong xuong tren 1 ^ s^g, chilm 17 nang
(65.4%).
- Trong 9 nang gay phong xuong thi c6 7 nang phdng 1 ban chiSm ty le 26.9% cao gip 3.6 ijn phIng xuong hai bdn (7.7%). p = 0.392 su khac biSt khong co y nghla thSng kS.
Bfag 4. Phan bd hinh dang t6n thuong tren phim X-qumg
"^ •"" Hinhd^ng ton thurong Kich thu^c ^ -^__
<3cm
3-5 cm
>5cm
Tong
N
%
N
%
N
%
N
%
Dtfn budng 11 42.3
9 34.6
2 7.7 22 84.6
Da buong 0 0 0 0 4 15.4
4 15.4
T6ng 11 42.3
9 34.6
6 23.1
26 100 Nhfn xil:
Trong nghien ciiu nay, hinh dang nang trSn phim x-quang cd 2 d?ng la don bu6ng (84.6%) vi da budng (15.4%). Nhu vay hinh dang don budng cao hon hin d^ng da bu6ng, s^
khac bi$t cd y nghia thing ke vdi p=0.000
- Nang cang ldn ty le hinh dang da budng cang cao, con dang don budng thi ngugc lai, chu yeu d nang co kich thuoc vita va nhd.
TAP CHl Y HOC VIET NAM TAP 451 - T H A N G 2 - SO DAC BIETjf2017
W Bfc diim tiiu chin ring ISn cfn nang
' Nhfn xet: Tren phim panorama va CT scanner thiy ty le nang gay tieu chan r3ng lan can hi CO 2/26 benh nhan chiem 7,7%, trong khi do tj' 1$ nang khdng iam tiSu chan r3ng la 2,3%.
V. B A N LUijlN
Ty le b?nh nhan bi nang rang simg hda iam cao hon nO. Ty 1$ nam: nil = 1,67:1
Nhdm tudi hay ggp nang rang simg hda ihit la nhdm tudi tvt 10-29 chilm ty le cao ihjt chilm 13 benh nhan (50%) d ca nam va lii. Sau dd din nhdm m6i 30-49 cd 9 benh ihan chilm ty le 34,6%. Nhdm b6nh nhan bi iang rang simg hda.hay gJp d nhdm tudi hap hon cd le do dugc chin doan va phat bien bSnh sdm hon, va do y thdc dugc viSc kh4m chiia b?nh cua ngudi dan.
Nang rang simg hda la mdt loai nang xitong h t o linh tinh tien triln itn thim thuong khdng bilu hi?n ra ngoai va chi tmh ci) phat hi$n khi chup x-quang. Cac nang ldn CO th£ cd cac trieu chiing: dau, simg ho^c cd lo dd. Tuy nhien mOt sd nang rang qua ldn l^i khdng g^y ra tridu chiing gi. Mdt s6 Budng hgp cho din khi nang to lam biln tl?ng mat hoSc bdi nhiem gay sung nl.
Sa sd cac nang cd gay phdng xuong so thay tren lam sang. Dilu nay dilng vdi co chl tiSu xuong cua nang rang simg hda chii ylu
la do tang ap luc thuy ffnh trong long nang, vi the nang thudng cd xu hudng phat triln to ra vl phia ban xuong mdng hom. T^ 1? phdng xuong d ham tren vi ham dudi khac nhau nhilu, d h t o tren la 7,7%, h t o dudi la 26,9%. Cd the do ty Id gap nang rang simg hda d h t o dudi cao hon d h t o tren.
Diu hi$u bdng nhua it gip a nang rang simg hda vdi 8 b?nh nhan chilm ty Ie 30.8%.
Phim Panorama cd su tang kich thudc theo chilu dgc va biln dgng nhit dinh theo chilu ngang nhung day la phim phd bien, re tiln, dl chyp, khao s4t dugc tren di?n rdng nfa sau khi da can nhic ky chung tdi tiln htoi do kich thudc nang theo dudng kinh tai vj tri di qua dudng kinh ldn nhat ciia nang dva tren phim nay. Hinh anh x-quang ban diu cua nang rang simg hda la mgt vimg thau quang nhd, hinh trdn hoSc hinh trirng, vd xo TO phan biet vdi khdi xuong xung quanh. Khi nang md r^ng hon thi cd the mgt phin vd nao dd khdng rd rang. Mot sd nang tdn thuong dang vd sd chiing td su tSng trudng khdng ddng diu giOa cac phin trong nang.
HNKH CHAO MLftJG 50 NAM XAY DUNG VA PHAT TRI^N BgNH VigN DA KHOA NONG HGHlgP
Mpt so nang ton thuong dang vo s6 chiing to s\r tang trucmg khong dong d^u gitia cdc phlin trong nang.
Hinh dgng nang rang simg h6a tren phim x-quang co 2 dang la dang don bu6ng va da buong. Trong nghien cuu cua chiing toi thhy don buong chiem da s6 (84,6%), da buong (15,4%). Ngoai ra co su tuong quan giita kich thuoc nang va hinh dang nang. Nang cang Ion thi hinh dang da buong cang gap nhieu, con Iai dgng don bu6ng thi ngugc lai, chu yeu gSp a nang co kich thuoc nho va vira.
Ty le tieu chan rang lan can trong nang rang simg hoa th^p hon nhi^u so vdi cac nang khac do rang. Nhu nang than rang trong nghi6n ciiu cua Shear va Shuther (1976) ty 1^
tieu chSn rang lan can 55%. Hmh dnh nay dl lam nhim lan voi hinh anh cua u men xuong ham, tuy nhien kSt qua gidi phau benh Id quan trpng nhdt.
V. KET L U A N
- B^nh khong co s\r khde bi|t v^ gi6i va phdn bo rai rac d cac 16a tuoi tir 10 dSn 69 tu6i.
- B^nh nhan vdo vi?n diu ylu voi 1;^ do sung nl biln dgng mdt (73,1%)
- Nang rdng siitng hoa phan Ion phan b6 6 viing rdng rdng ham dudi (73,1%), chit ylu d
goc ham vung rang khon ham dudi.
- Nang rang simg hoa it khi gay ti6u chdn rang rdng cgnh nang, ma bj diy chdn rang di khoi vi tri nang (7,7%).
- Nang rdng simg hoait khi gay ph6ng xuong.
- T6n thuong thdu quang dfing d^u hinh tron hodc 6 van 1 bu6ng ranh gioi ro, it khi c6 hinh da budng (15,4%).
- Sau m6 1 tuin kit qua t6t Id 7/10 ca chilm 70%.
- Sau m6 tren 3 thang kit qua t6t 17/20 ca chiem 85 %.
TAI Ll|U THAM KHAO
1. Sach phau thu^t ham m^t, t^p II, nhd xudt ban giao di^c, 2013.
2. Sciubba JJ, Fantasia JE, Kahn LB... Atlas of Tumor Pathology: Tumors and cysts of the Jaw. 3^ ed Washington, DC: Aimed Forces Institute of Pathology; 1999:34-40.
3. Shear and Speight (2007) Odontogenic Keratocyst. Cysts of the Oral and Maxillofacial Regions fourth edition.
4. Farzan Naveen, Shoaib R Tippu, Vela Desai (2011), Maxillary keratccystic odontogenic tumor with calcifications: A review and case report, Joitmal of oral and maxillofacial pathology, Medknow pubilication.
