TAP CHfY DL/gC HpC CXN THCT - S6 11-12/2018
6. DeConde A.S, Mace J.C et al (2016), "Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis". The Laryngoscope, 127(3), pp. 550-555.
7. Kim BG., Kang JM. et al (2015). "Do sinus computed tomography findings predict olfactory dysfiinction and its postoperative recovery in chronic rhinosinusitis patients", Am JRhinol Allergy, 29, pp. 69-76.
8. Mascarenhas JG, Chen VG et al (2013), "Long-term outcome of endoscoppic sinus surgery for chronic rhinosinusitis with and without nasal polyps", Braz J Otorhinolaryngol, 79(3), pp. 306-311.
9. Mujaini A.A, Wall U et al (2009), "Functional Endoscopic Sinus Surgery: Indications and Complications in the Ophthalmic Field", Oman Medical Journal, 24(2), pp. 70-80.
10. Ryan MW. (2014), "Chronic Rhinosinusitis with Nasal Polyposis", Baileys Head & Neck Surgery Otolaryngology, 1, pp. 525-534.
11. Shimizu T (2013), "Mucus, Goblet Cell, Submucosal Gland", Nasal Physiology and Pathophysiology of Nasal Disorders, pp. 1-14.
(Ngdy nhdn bdi: 14/11/2017 - Ngdy duy?t ddng: 05/01/2018)
DANH GIA KET QUA PHAU THUAT VA MANG NHI BANG CAN CO T H A I DlTOfNG DIEU TRI VIEM TAI GIU*A M ^ N CO THUNG NHI
T ^ I KHOA TAI MUI HONG BENH VIEN B A K H O A CA MAU N A M 2016 D I : N 2017
Tran Thanh Nhe', Budng Hitu Nghf*, Nguyin Tien DUng^
1. B^nh viin Da khoa Cd Mau 2. Tru&ng Dgi hgc YDugc Cdn Tha
*Email:[email protected] TOM T A T
Bgt v6n de: Tgi Cd Mau ky thugt vd mdng nhi bdng cdn ca thdi ducmg dugc tiin hdnh tit ndm 2010 din nm. Tuy nhien chua cd ddnh gid ndo vi kit qud phau thudt ndy. Muc tieu nghiin ciiu:
ddnh gid ket qud phdu thudt vd mdng nhT bdng cdn ca thdi duang diiu tri viim tai giiia mgn co thung nhi tgi khoa Tai MUi Hgng Binh vi^n Da khoa Cd Mau. Doi tuang va phuang ph^ nghien ciru: 49 binh nhdn viem tai giita (VTG) mgn eg thung nhi dugc vd nhi bdng cdn ca thai duang tir 4/2016 din 7/2017, md td cdt ngang. tiin cuu cdphdn tich. Ket qua: nii (69,4%) nhiiu han nam (30,6%). Nhdm tudi tir 18 - 50 tudi chiim ty l^ cao nhdt 71,4%; cdn nhdm b^nh nhdn tren 50 tuoi chi cd 28,6%. Kiiu diic ddn truyen chiim ty li cao nhdt 81,6%, diic hdn hgp chiim 10,2%, thinh Igc dd binh thu&ng 8,2% Muc do gidm thinh Igc trung binh la 39,29 dB ± 77,02; diic mice dg nhe 53.1%, viea 24,5% ngng 6,1%, ddc 2%, binh thu&ng 14,3%. Ty 14 lanh mdng nhT sau mo 3 thdng 95,9%. Thinh Igc trung binh sau md 3 thdng Id 29.80 dB ± 16,68, cdi thien trung binh 9,49 dB. Ket qud sau mo 3 thdng tot 67%; trung binh 28.6%; xdu 4.1 %.Kit lu^n: nen vd nhT cdng s&m cdng tot khi tai khd di bdo vi niim mgc hdm nhi, xuang chSm vd xuang con. Cdn ca thdi duang diing de vd nhT cho ty 1$ thdnh cdng cao.
Tir khda: viem tai giiia, thung nhT. cdn ca thdi duang.
178
TAP CHI Y DirtyC Hpc CAN THP - sd 11-12/2018 ABSTRACT
ASSESS THE RESULTS OF MYRINGOPLASTY BY FASCIA IN TREATING CHRONIC OTITIS MEDIA WITH PERFORATION AT EAR
NOSR THROAT DEPARTMENT OF CA MAU GENERAL HOSPITAL FROM 2016 TO 2017
Tran Thanh Nhe, Duong Huu Nghi, Nguyen Tien Dung Background: The technique of myringoplasty by fascia has been performed from 2010.
However, there has not had an assessment about it Objectives: assess the resuts of myringoplasty by fascia in treating chronic media otitis with perforation at ear.nose.throat department at Ca Mau general hospital. Materials and method: 49 chronic otitis media patients with perforation are been performed myringoplasty by fascia from 4/2016 to 7/2017, horizontal description, analysed progressive. Results: female (69.4%) more than male (30.6%). Age group from 18 to 50 accounts for the highest rate of 71.4%; while the group over 50 years old only 28.6%. Conductive hearing loss type is the highest proportion 81,6%, mixed hewing loss is 10,2%, normal is 8,2%
The average hearing loss level is 39.29 dB ± 17,02; the mild deafness is 53,1%; moderate is 24.5%, heavy is 6,1%, profound is 2%. normal 14,3%. The rale of eardrum healing 3 months postoperative is 95,9% The 3 months postoperative average hearing is 29,80 dB ± 16,68, improve average 9,49 dB. The 3 months postoperative results is good 67%, moderate 28,6%; bad 4,1%. Conclusion:
should myringoplasty as soon as possible when ears dry to protect media ear mucosal epithelium, mastoid bone, ossicular chain. Myringoplasty by fascia is high successfiil rate.
Keywords: otitis media, myringoplasty, fascia.
I. DAT V A N DE
Chdt lieu dl chinh hinh tai gifta bdng can ca thai duong dugc cac tac gia tren the gidi su dyng tft nhiing nam 1950. Theo Simita Chhapola va Iiuta Matta cung da chftng minh rdng can ca tiiai duong dung nap rdt tdt d tai gifta, tdn tai dft lau va dugc nudi dudng chft yiu bdng each thdm thdu va khuSch tan kS tft khi ghep dSn khi niem mac phu kin mang nhi. Tgi Ca Mau ky thuat va mang nhi bdng can ca thai duang dugc tien hanh tft nam 2010 din nay. Tuy nhien chua cd danh gja rmo vS kSt qim pMu thu^ imy. Do dd chftng tdi tiSn hanh thyc hien dl tai vdi myc tiSu danh gia kit qim phau thugt va mang nhi bang can ca thai duong diiu tri viSra tai giua mgn cd thiing nhi tgi khoa Tai Miii Hpi^ BSnh vien Da khoa ca Mau.
II. DOI TU'ONG v A PHX/ONG P H A P NGHIEN ClTU 2.1. B^i tiromg nghien ciiru
- Tieu chimn chpn mau
+ Benh nhan dugc chdn doan viSm tai gifta man tinh cd thftng mang nhi dugc diiu tri va nhi don tiiudn bang can ca thai ducmg tai khoa Tai - Mui - Hgng Benh vien da kh
+ Niem mac hdm nhi (hdng, ttan lang), chuoi xuong con cdn.
+ Phim CT Scan: khdng thdy hinh anh cholesteatoma tten phim.
+ Ndi soi tai cd thiing mang nhi + Cd kit qua thinh lyc dd.
+ Benh nhan dugc phau thuat va nhi don thudn, manh ghep la can ca thai duang dugc dat theo phuang phap Underlay
- TiSu chimn loai trft
179
TAP CHI Y Dl/gC Hpc CAN THg - SO 11-12/2018
+ Benh nhan dugc chan doan dgt cap viem tai gifta mgn cd hay khdng cd kem theo cac biSn chung nguy hiem ciia dgt cap gay ra.
+ cac benh nhan viem tai giua man cd thftng mang nhi nhung khdng dugc phdu thuat va nhi don thudn bdng can ca thai duang va ket hgp vdi cac phlu thii$t khac.
+ Benh nhan cd viSm nhiem mui xoang va hgng dang tiSn triln + Cd bSnh an nhung khdng ghi lgi day dft diln tiSn qua ttinh diiu tii.
+ Benh nhan khdng tai kham dftng hen.
2.2. Phirong phap nghien cftu
- Thilt kS nghien cftu: md ta cat ngang, tiSn cftu cd phan tich.
- Cd man va phuang phap chpn mlu: thu|n ti?n, chftng tdi thu th^p dugc n = 49 benhrMn
- Ngi dung nghiSn cftu:
+ Dgc diSm chung: tudi, gidi.
+ Ca nang: chay djch tai, nghe kem, ft tai...
+ Ndi soi: ty I? mang nhi lanh - khdng lanh sau md 3 thang.
+ Thinh lyc : tten thinh lyc don am sau md 3 thang
• Thinh lyc cai thien: khi sftc nghe giam so vdi trudc phdu thu^t > 5 dB.
• Thinh lyc khoi^ tiiay ddi: khi sftc nghe bdng hoac giam so vdi trudc pMu thuat < 5 dB.
• Thinh lyc te hon: khi sue nghe tang so vdi trudc phlu thugt > 5 dB.
+ TiSu chuan danh gia kSt qim phlu thugt khi tai kham:
• Tdt: mang nhi lanh, ndi soi khdng thay lo thiing mang nhi. Thinh lyc cai thiSn.
• Trung binh: mang nhi lanh, ndi soi khdng thay Id thftng mang nhi. Thinh lyc khdng thay ddi.
• xdu: mang nM khdng lanh, ndi soi thdy Id tiiung nmi^ nhi cdn. Thmh lyc te hon.
I H . K E T Q u A N G H I E N C U U 3.1, Dac diSm chung
BiSu dd 3.1. Phan bd viem tai giuu man tinh thung nhi theo gidi (n = 49) Nhgn xet: Sd b^nh nhan nft chiim da so (69,4%).
liHR^h
a H 2 8 ^ % ^ ^
W^mms
• 18-50
• >50
' 5^W
c-
BiSu i& 3.2. Phan b6 theo tubi (n = 49)
TijiPCHiY Dirgrc HQC CAN THa - s611-12/2018 Nhan xet: Benh nhSn dSn diSu tri va mang nhi co tu6i tir 18 - 50 (71,4%).
• Tan SO 81.6%
Digc din truygn
1.
40
10,2%
Diec hdn hop 5
8.2%
Binh thuang 4 Bieu do 3.3. Phan b6 kieu diec tren thinh l\rc d6 don am (n = 49) Nhan xet: Da s6 benh nhan dijc dan truySn (81,6%), 8,2% co thinh luc bmh thuong.
^ 1
24,5%" l ^ ^ i ? Nh.(2,-40dB)V.a(4,-«0dB, ^f^^' D?ic (>80dB) 1 Bieu dd 3.4. Phan logi mftc dd giam thinh lyc (n = 49) Nhgn xet: Benh nhan cd mftc dd dilc mftc do nhe va vfta chiim da sd (77,6%)
• Lanh
• Khdng lanh
6,1%
Sau 1 thdng 46
3
95,9%
4,1%
Sau 3 thang 47
2 BiSu dd 3.5. Phan bd ty le lanh mang nhi sau phau thuat (n = 49) Nhan xet: Cd 93,9% sd benh nhan mang nhi lanh sau 1 thang.
Bang 3.1. Phan bd cai thiSn thinh lyc do sau md 3 tiiang (n = 49) Cai thien
Khdng thay d6i Tehon Tong cong
So Iiromg 34 14 I 49
Ty 1$ % 69,4 28,6 2,0 100%
Nhan xet: Sau 3 thang phau thuat va mang nhi cd 69,4% benh nhan cai thien tl Bang 3.2. K i t qua phau thugt sau md 3 thang (n = 49)
Ket qua phau thuat sau mo 3 thdng T6t
Trung Binh Xau T6ng cQug
Tan so (n) 33 14 2 49
Tyle(%) 67,3%
28,6%
4,1%
100%
181
TAP CHi Y DirpC Hpc CAN THO - S6 11-12/2018 Nhan xet: 67,3% b^nh nhan kSt qim tot sau PT 3 tiiang; 4,1% cd ket qua xdu.
IV. BAN LUAN
Cd 5 ly do khiSn benh nhan khd chiu dl vao vien kham benh. Trong dd ly do chiim tJ IS cao nhdt la chay dich tai 46,9%. Trong nghien cftu cfta chftng tdi cd nhiSu benh nhan da hi chay mft tai nhilu dgt, mdi dgt nhu v^y dugc dieu tri ngi khoa cho tai khd thi benh nhan khdng cdn quan tam din tinh ttgng mang nhi cfta minh da bi thiing, hg eft suy nghi khi tai bi chay mu thi din diSu tri tilp cho du da dugc giai thich tinh ttgn^ b?nh khdng nSn dl lau.
BSn canh dd cd mgt sd benh nhan vi khdng cd dieu kien kinh te de phlu thult nen chdp nhgn tinh ttang chay mft tai nhieu dgt nhu vay.
Qua dd chung tdi thdy nSn giai thich cho benh nhan rd rang de khdng cd thai dp xem thudng b ^ If lam anh hudng dSn cac cau tnic tai giiia, tai trong khi dS benh k6D dai.
Cd 1 diSu mau thuan ma nhiSu benh nhan thac mac la khi bj thftng nhi sao benh nhan vln nghe dugc binh thudng, viec dd giai thich cho ly do kham benh vi nghe kem chi chiim 18,4% (9/49 tiudng hgp).
DiSu nay cftng cd thi giai thich do tai ddi dien se nghe bu cho ben hi thung nhi nen benh nhan vln giao tilp sinh hogt hdng ngay nhu binh thudng. Cho dSn khi tmh cd nghe diSn thogi hay ngudi khac ndi chuyen ben tai benh khdng nghe rd thay cd sy chSnh l^ch ve sftc nghe gifta hai bSn tai khac xa nhau nhieu, hogc kem theo bpi nhiSm dgt cap tinh lam chay mft, ngfta tai, ft tai nSn mdi di kham benh. Ngoai ra cdn do khi benh mgn tinh keo dai, bi nhieu dgt cap do ddc tinh ciia vi khudn tac hai dSn tai tiong lam cho ngudng nghe dudng xuong bj anh hudng thi Iftc dd b§nh nhan cam giac sftc nghe cua 2 bSn tai khac biet nhau rd rang.
Vi vgy qua day ciing cho thay ddi vdi benh ly viem tai gifta mgn tinh cd thiing nhi y thftc benh nhan rat xem nhe, khdng lo idng, quan tam nhieu ve benh tat cfta minh vi no khdng gay trieu chftng rdm rd, khdng anh hudng dSn sinh boat thudng ngay cua hp tift nhung dgt cdp bdi nhiSm, nhdt la ttieu chiing nghe kem rdt Mu mdi cam thdy su khac bi^t rd ret gifta 2 tai.
Mftc do giam thinh luc trung buih la 39,29 dB ± 17,02. TrSn thinh lyc dd don am chiim tf le cao nhdt la dilc mftc dd nh? 53,1%, dilc vfta 24,5%.
Tuy nhien cd 4 trudng hop dilc nang va sau thi cd tdt ca 4/4 trudng hgp la dilc hdn hgp. Dieu nay giftp ich rat nhiSu ttong giai thich trudc md cho bSnh nhan la kha nang hdi phuc sftc nghe sau mo khdng nhilu. Vi vgy cdn giai thich cho nhftng b$nh nhan bj thftng nhi biet rang minh nSn va nhi cang sdm cang tdt d l bao ve va phuc hdi niSm mgc tai gifta va cac cdu trftc tai ttong, ttanh d l anh hudng qua lau thi khdng till phuc hbi dugc nhat la khi da anh hudng lan vao tai ttong.
Ty l^ lanh mang nhi rat cao trong nghiSn cftu cfta chftng tdi, sau 1 thang mang nhi dang tiin tiien lanh la 93,9%, sau 3 thang lanh hdn la 95,9%. sau md I thang cd 3 tiudng hgp thftng lai, sau 3 thang cd 2 tiTidng hgp thiing lgi cd thi do viSm nhiem dudng hd hap tten, cd I b?nh nhan tdm dS nude vao tai, bSn cgnh dd cdn luu y din kj? thugt dgt manh ghSp cung la yeu td gdp phdn vao thanh cdng ciia sy lanh mang nhi.
Sau md 1 tiiang thinh lyc trung binh la 36,53 dB ± 17,71 tdt hon so vdi trudc md la 39,29 dB (cai tiuen tinng bhih 2,76 dB), sy khac bi?t nay cd y nghia tiidng kS (Z = -3,559, n = 49, p < 0,001). Thinh lyc tinng binh sau md 3 thang la 29,80 dB ± 16,68 tdt hon so vdi I thang sau md (cai thien trung binh so vdi trudc md la 9,49 dB), sy khac biet nay cd y nghia thdng kS (Z - -4,491, n = 49, p < 0,001).
TAP CHI Y Dl/pC Hpc CAN THa - S6 11-12/2018
Ket qua sau md 3 tiiang tdt 67%; tiimg bmh 28,6%; xdu 4,1%. Ty IS lanh nmng nhi trong nghien cftu cfta chftng tdi kha cao: sau 3 tiiang la 95,9%. Tdm lgi vdi chat Upu manh ghep bdng can ca thai duong va nhi ttong dieu tri viem tai gjiia man tinh cd thung nM da mang lgi ket qua tdt khdng nhOng trong nghien ciiu ciia chung tdi ma cdn trong nhftng nghiSn cftu khac ttong nude va d ngoai nude. Do do chung tdi cho rdng chdt lieu can ca thai duong nSn diing tilp tuc trong phdu thuat chinh hinh tai giua va tfty tinh trang cu till ttSn tftng bSrih nhan nm lua chgn can ca timi duong dk chinh hmh tai giua cho tin'ch hgp.
V.KET LUAN
Tudi tft 18 - 50 tudi chiem ty le cao nhat 71,4%, ty IS nft ggp nhieu han nam (69,4%/30,6%). Chay dich tai la ly do vao vien chiim ty 1$ cao rihat 46,9%. Kilu dilc dan truyen chiSm ty IS cao nhat 81,6%. Ty IS lanh mang nhi cao: sau I thang la 93,9%, sau 3 tiiang la 95,9%. Sau md I tiiang thinh lyc tixaig bmh la 36,53 dB ± 17,71; cai tiiien trung bmh 2,76 dB. Sau md 3 thang thinh lyc trung binh la 29,80 dB ± 16,68, cai thien trung binh 9,49 dB. Kit qua sau md 3 thang tdt 67%; tiimg binh 28,6%; xdu 4,1%.
T A I L I E U T H A M K H A O
1. Tran Van Khen, Nguyen Tien Dung (2010), "Danh gia ket qua phlu thult va nhT bang ky thuSt Underlay ttong dieu tri b?nh viem tai giii'a man tinh tgi bfnh vien tinh Khanh Hda", Tap chi tai mUi hgng Viet Nam, sd 2, phu ban 4, tt. 46 - 50.
1. 2. Pham Thanh The, Hd Le Hoai Nhan, Dd Chau Minh Ngpc, D6 Hoi (2009), "Danh gia hi?u qua viec ddng kin Id thung mang nhi bang ky thuat Underlay tai benh vi^n Tai Mui Hpng Can Tha ttong khoang thdi gian 2006 - 2009", Yhgc thuc hdnh, sd 670, phu ban 8,tt.46-48.
2. Anant C, Bhuvnesh K.S, Praveen C.V (2015), "Role of Cartilage as a Graft Material for Tympanic Membrane and in Middle Ear Reconstruction", International Journal of Otolcayngology and Head <& Neck Surgery, vol 4, pp. 66 - 72.
3. Huaili J, Zhigang Z (2014), "Cartilage Tends To Be a Better Choice than Temporalis Fascia for Tympanoplas^ under the Circumstance of Eustachian Tube Dysfiinction", Ann Otolaryngol Rhinol, vol 1,1^ 3, pp.1-5.
4. John L.D, Michael B.G (2014), "Reconstruction of the Tympanic Membrane and Ossicular Chain", Bailey's Head and Neck Surgery-otolaryngology fifth edition ,Wolters Kluwer Lippincott Williams & Wilkins, pp. 2465 - 2486.
5. Mahmood S, Abolhasan F, Ayeh T (2012), "A Short-term Comparison Between Resuh of Palisade Cartilage Tympanoplasty and Temporalis Fascia Technique", Iranian Journal of Otorhinolaryngology,\ol 3,^° 24, pp. 105-111.
6. Sanjana V.N, Jyoti P.D (2014), "Healing and hearing results of temporalis fascia graft Vs cartilage graft (Full thickness and half thickness) in type 1 tympanoplasty".
Otolaryngology online journal, vol 4, N 3, pp. I - 20.
7. S.Sunita C, hiita M (2012), "Cartilage-Perichondrium: An Ideal Graft Material?", Indian J Otolaryngol Head Neck Surg, 64, 3, 208-213.
(Ngdynhdnbdi: 13/06/2017-Ngdy duyit ddng: 02/07/2017)
183
