TAI Lieu THAM K H A O
1. Quich Thanh Lim v i cfing sy (2004); Oilu tri viim gan siiu vi mgn tinh vdi Nissel kit q u i theo ddi sau 1 n i m . Y hpc thinh phi Hi Chl Minh tip 8 phv bin si 1. tmng 23-30.
2. Abdel-Salam OM, Sleem AA, Moray FA et al (2007), Effects of biphenyldlmethyl-
dieartjoxylate administration alone or combined with silymarin in the CCL4 model of liver fibrosis In rats Scientific World Joumal.,7:1242-55
3 Hyo-Suk Lee., Yong Tae Kim, Hyun Chaee Jung et al (1991). Prospective, randomized, control trial with
Diphenyl dimethyl dicarboxylate in chronic active lii diseases: The effect on lowing serum, alani aminotransferase level. The Korean journal of inter\
Medicine. Vol40. No 2, 1991.172-178.
4. Sawy SA. Shafey AM, Bahrawy HA et al (200 Effect of dimethyl diphenyl bicarboxylate on normal a ohemically-injured liver .East Mediterr Health J.8(1):l 104.
5. Gao M, Zhang J, Liu G et al (2005). Effect diphenyl dimethyl bicarboxylate on concanavalin induced liver injury in mice. Liver Int. 25(4):904-12
TfNH UNH HOAT CUA VAT D O I T R U & C N G O A I TRONG P H A U T H U A T TAO H I N H
PHAM TH| VI$T DUNG, T R A N THI£'T SON Sd m6n PhSu Thu0t T90 Hinh tnrtmg D?i Htfc Y Hi Ni
T6M TAT
Myc dich: Tim hiiu cic d^ng v^t dUi tm&c ngoii duvc ip dyng trin lim sing.
Dii tuvng vi phuong phip nghiin cOv: TO" thing 1/2007 din 6/2011, 74 v$t da cin dui trutrc ngoii dS du^ S(> dyng di tQO hinh cic khuyit phin mim I6n d khip cic vung cua ca thi do cic nguyin nhin ung thw.
chin thuKmg, dj tit bim sinh... Cic v^t ddi truCtc ngoii dw?c dOng du^ d^ng v^t da cin, da ca, cin mCt c6 cuing ho$c ty do cd su' dung ky thuit vi phiu m^ch miu di tii lip tuan hoin. Trutrc khi tio hinh t^i noi nhin v$t duvc di nguyin d^ng, lim mdng, xi theo hinh tSn thuang hoic xe thinh cic dio ti c/idc dt/a trin cic cuing m^ch khic nhau di phii hqp vdi myc dIch t$o hinh.
Kit qua: Cd 74 vgt dux;/c su- dyng cho 68 binh nhin cd khuyit to chuc ICm t^i cic vung khic nhau cua ca thi. V9t nhd nhit c6 diin tich 70 cm2, v^t Idn nhit li , 330 cm2. trung binh 193cm2. Trong si 74 vgf tfu^c phiu tich c6 2 v^t khdng su- dyng duvc do khdng tim thiy nhinh xuyen phu hop phii phiu tich dOi bin dii diin ngay trong ciing mdt lin mi, 8 vgt bj ho^i tir toin bd do tic m^ch trong dd c6 4 binh nhin duvc mi l^i lin 2 thinh cdng bing v^t dui bin dii diin. 3 v^t ho^i ttr mdt phin dii hii ghip da bi sung. Da si v^t duvc sir dyng dudi d^ng v$t da m& di che phu, 3 v^t cin mCr d^
/90 hinh ddn via ti chOc teo lip vCing m$t vi 2 v$t duvc liy them can di t^o treo trinh sa tri tmng t^o hinh mdi Cic v$t duvc si> dyng dw6i d^ng v^t nguyin miu hay lim mdng, xi theo hinh tin thuxma. Kit qui t$o hinh dim bio ci vi m$t chirc ning vi tham mp.
Kit lu$n: V^t cd thi rfupc liy vdi diin tich I6n. khi ning sO dyng v^t linh ho^t, cd thi cii biin di thay dii chit Hiu t9o hinh cho phu hop vdi cic myc dich ddn, phO, dyng hinh khdng gian ba chiiu cOa cic ca quan nii...cd thi lya chpn dit^o hinh cho nhOng tin khuyit i6n, phirc t^p tren cic vung khic nhau cOa ca thi.
TOf khoi: V^t dOi tnrdv ngoii, khuyit phin rnim lim, phau thu$t t90 hinh
VERSATILITY OF THE ANTEROLATERAL THIGH FLAP IN THE PLASTIC SURGERY
SUMMARY
Objectives: To get information fomns of i anterolateral thigh flap used in the clinical application
Patients and methods: From January 2007 to Ju\
2011, 74 anterolateral thigh flaps vmre transferred reconstruct various soft-tissue defects They were us under fonns: fasciocutaneous flaps, myocutaneo flaps, de-epithelialised thigh flaps as pedicled flaps as free microvascular Haps. Some ftaps were thinned divided into double-paddle skin flaps to suit the defects Results: 74 anterolateral thigh flaps were used foi variety of soft tissue defects of 68 patients. The sizes the ftaps ranged from 72cm2 to 193 cm2. Of the ftaps, 2 ftaps were not used because of the inexisten of the suitable perforator, 8 ftaps were total Mure.
ftaps were partial failure. Almost of the ftaps we cutaneous ftaps to recover skin defects, 3 D epitheliaiised thigh ftaps tor contour conecBon in he, and neck reconstruction, 2 myocutaneous ftaps for t lip reconstruction. Soft-tissue mconstruction with the fr^
anterolateral thigh ftap in various regions of the bo provides an excellent functional and cosmetic result
Conclusslons: the anten^ateral thigh ftap is 1 extremely versatile ftap. I/Vs use tttis ftap as the ffi choice fertile reconstruction of large soft-tissue defect Keywords.' AntemlatemI thigh ftap, large soft-tiss defects, plastic surgery
DATVAND^
Vgt dCii trudc ngoii (OTN) l i v^t t l chirc dya tr nhinh xuing cua ddng m?ch mQ diii ngoii, dv(;fc So v i cdng sy md ta l l n d I u tiin n i m 1984. Tir dd din n dS c6 nhilu nghiin cCru v l gill phlu v i irng dyng \i sing cua vgt. Nhilu t i c gia cQng d i b i o c i o sir dy vat n i y dudi c i e d^ng khie nhau cho c i c mge dich t hinh chuyin bi$t. Viic sCr dyng vgt dui tryde ngoii tr l i m sing rlt linh ho9t nhd bilt t i n dyng nhuYig tinh d gill phSu d i e thii ctJa v^t niy. Nghiin ciru niy du thyc hiin nhIm tim hilu tinh linh hogt cua v^t diii tnr ngoii khi i p dyng v^t trin l i m sing.
Myc tiiu: Tim hilu c i c d^ng vgt diii trudc ngi dype i p dyng trin l i m sing.
vii/^f^Tmrf-ff^]v[Hp-7-7| 3 5 g / 2 (
D6\ TU'Q'NG V A PHU-aNG P H A P NGHIEN CLfU 1. o i l tifp-ng nghien ciru
^ Nghiin cCru dupe tien hinh tCr thing 1 n i m 2007 den thing 6 nam 2011 tgi khoa PTTH binh viin Saint Paul tren 74 vgt ddi trude ngoii cho 68 binh nhin (47 binh nhin nam v i 21 binh nhin nCr, tuli tir 12 din 69) Trong dd cd 21 binh nhin t i n thuang vCing dIu mit co, 20 binh nhin vet thuang bin tay, 23 binh nhin t i n thuang vCing cang b i n chin, 4 binh nhin t i n thuang vDng bpn, sinh dye. NhOng t i n thu-ang niy do chin thuang, sau cat bd seo binh ly, elt t l chCrc ung thu hoic viim loit nghl ngd i e tinh. t i n thuang do xp tri hoic d| t i t bIm sinh. Tat ca c i c trudng hpp niy dIu cd t i n khuyet t l chire Idn c i n che phu, c i n dfin hoic khuyit h l n mpt ea quan noi c i n dyng hinh khdng gian ba chiiu
2. Phipang phap nghien ciru
V?t da cin DTN dupe thilt k l theo hinh dgng ciia khuyet phln mim. Mpt dudng n l i gal chiu trudc trin v i bd ngoii xuang banh c h i dype coi l i tryc chlnh eiia vgt niy. X i c dinh c i c nhinh m^ch nudi da bing miy doppler d m tay Dudng rgeh da bin trong vgt dupe thyc hlpn dIu tiin nhim bde Id vich gian ca thing diii va ring ngoii, Tim nhanh xuyin da qua ca hay nhinh xuyen vich. tim nhinh xuong cua ddng mach mu diii ngoii, nai xult phit cua c i c nhinh xuyen. Bdc Ip nhinh xuIng din nguyen uy Phlu tich nhinh xuyen qua ca rpng ngoii. Rgch bd ngoii cua vat hay khdng tuy v i o chat Iliu c i n tao hinh cua vpt.
Vdi eic v^t t y do, vgt dupe eat rdi cuong mpch v i chuyin lin viing can tao hinh Cie mgeh cua vat (mdt ddng mgch va ha[ tTnh mach) dupe t i l lip tuin hoin nhd ky thuit vi phiu. Nai cho vpt a dCii dupe ddng tryc tilp hay dCing manh ghep da d l y toin bfi. Vdi cac vat dupe sir dyng a dang cudng mgcJi llln, mdt dudng ham dudi da nli giOa cuong mach va khuyit dupe thiet lap.
vat d\r(;tc ehuyen d i n nai can tgo hinh. Vgt ed the dupe lim mdng hoac se thanh nhieu dao to chirc cho phii hpp vdi t i n thuang.
Kit qua nghiin ci>u dirae dinh g i i trin ca 2 y l u to thim my v i chuc ning &ieo tirng dgng sir dyng vgt
K£T QUA
Cd 74 vgt dupe sir dung cho 68 binh nhin. Vgt nhd nhit cd diin tich 70 em2, vat Idn nhit l i 330 cm2, tmng binh 193cm2. Trong s i 74 vgt diycyc phlu tich cd 2 vat khdng su dyng dupe do khfing tim thIy nhanh xuyin phii hpp phai phau tich diii ben doi dipn ngay trong cung mfit l l n m l , 8 vgt bi hoai tu toin bd do rac mgdi trong dd cd 4 binh nhin dupe m l Igi lln 2 thinh cdng bing vgt dCii bin dii dipn, 3 vat hogi tu' mdt phln ddi hdi ghep da b l sung.
Trong s i 68 trudng ea, 7 vgt dupe tich thinh 2 dao da tuang doi dpc Igp dya trin 2 nhinh xuyin xuat phat tCr cCing mdt cuing mat^ de tao hinh 2 vCing ton thuang tuang all tich biit (vgt "chimeric"), 5 trudng hpp vgt dupe cit x i cho phO hpp vdi hinh dgng phd'c tgp cua t i n thuang.
9 vgt dupe su dyng dudi dgng cuing llln trong dd cd 5 vgt ngupe ddng che phu t i n khuyit do dian thuang Ifi xuang khdp vung g l i v i 1/3 tren cing chan, 3 vgt xufii ddng di tgo hinh i m dgo, 1 vgt che phu khuyet phan mim viing bpn
27 vgt dupe l i m mdng tdi 3mm dudi kinh hien vi phlu thuit d l phii hpp vdi y i u c l u che phu viing mit, vCing b i n ngdn tay.
Da s i vgt dupe sir dyng dudi dgng vgt da md d l che phd, 3 vgt c i n md di tgo hinh ddn v i o t l chdc teo l i p vLing m i t v i 2 vgt dirtyc liy thim c i n d l tgo treo trinh sa t r i trang tgo hinh mdi,
Ty 1$ hogi tCr vgt khfing khie biit nhilu gi&a cic hinh thii sO dyng vgt khic nhau ho$c giO'a cie dgng thinh phln khic nhau eCia vgt.
Trudng hpp lim sing 1:
Binh nhin nCr, 55 tuli, bj hogi tu xuang him dudi bin phii 5 nim do di ehCrng xg tri dilu trj ung thu sin miing. Bpnh nhin dupe phSu thuit cIt bd toin bfi xuang him dudi phai ciing vdi da v i niim mgc d m , m i phii hogi tu, loit v i xa cdng. T i n khuyit sau phlu thuit dupe che phCi bing vgt diii trudc ngoii dudi dgng vgt "chimeric" bao gIm 2 d i o da tCr hai nhinh xuyin xult phit tir CLing mdt nhinh xulng. D i o da Idn diing phO vCing m i , elm, c i phii. D i o da nhd dupe lit ngupc Igi thay t h i viing khuyit hing niim mgc m i . (hinh 1)
Hinh 1 A- Binh nhin tm'dc phiu thuit B. Vgt dupe se lim 2 dao da trin 2 nhanh xuyin khie nhau tir ciing mfit cuing mgch
C: Vgt da Idt trong miing sau phiu thuit D: Vgt da tgo hinh m i , cam, co sau phiu thuit Trudng hpp lim sang 2:
Binh nhin nam, 43 tuoi, bj bong c i n trudc khi v i o viin 3 nim. Sau bdng de Igi di chii'ng spo cdng lim hgn c h l gIp du5i eic ngdn bin tay phai. Binh nhin dupe phiu thuit elt bd toan bfi spo. Viing khuyit da sau cIt bd spo l i toin bfi mu ban tay v i mu cie ngdn tay. Ton thuang dupe che phii bdi mdt vgt diii trudc ngoai d i lim mong xe theo hinh t i n thuang v i chi dupe nudi dudng bang mOt nhinh xuyin. Sau mo vgt sing hoin toin, vgt da mem mgi, binh nhin cCr dfing g I p duoi dype cic ngdn. (hinh 2)
V^HOC THyCJHANH (777) - s 6 8/2011
A T[u6cphSutliuai n Tfong ph<Vi IhiiSt
c Sau ph^ulhuai
Hinh 2 BSn tay bi spo bong du'pc Igo hinh bang v^il dui trudc ngoai mong, se theo hinh ton Ihuang
Trudng tiop lam sang 3
B^nh nhan nam 13 tuoi, bi khuyet ph^n mem vung goi va 1/3 tren cing chan Itai do chan Ihuang Tori thuong 16 xuong va khcp nen khong the ghep da Benh nhan nho tuoi cung khong Ihich hap cho mo ehuyen vgt VI phau Vl vay, ton thuong dup-c che phu bang mot vgt dui tru'OC ngoai ngupc dong Sau mo vgt song tot, mem mai, benh nhan vgn dpng khap 961 binh thudng (liinh 3)
-^^J--
'e'^-':' • ^ /
Hinh 3:A:Tin thuang viing g l i v i 1/3 trln d n g chin B: Vgt ALT cuing ngypc ddng
C: Sau m l chuyin vgt BAN LUAN
TCr khi Song v i cdng sy su dyng vgt lln dIu tiin trong phlu thuit tgo hinh d i n nay d i cd r l t nhilu nghiin cO'u v i giai phlu v i ung dyng vgt trin l i m sing. C i c t i c gia dIu thing nhit ring v l m$t g i i i phlu, so vdi c i c vgt khic, vgt diii trudc ngoii cd r l t nhieu uu dilm: 1) Diin tich viing d p m i u r l t Idn ngay c i khi chi dya trin mfit nhinh xuyin. 2) Dudng kinh Idng mgch Idn, thuin lyl
cho chuyin vgt vi phlu. 3) cuing mgch d i i cd t h i s dyng dudi dgng cuing liln. 4) Vi tri v i s i luyng nhir xuyin tyang d i i hing d[nh... Do dd, vgt ngiy cir dupe irng dyng nhilu trln l i m sing. Trin thyc t l , d i c nhilu t i c g i i b i o c i o 8i> dyng vgt dydl c i c hinh thC khic nhau.vdi c l u tgo thinh phln vgt khic nhau d l t?
hinh khIp c i c viing cija ca t h i .
Ly do d I u tiin d l c i c phiu thuit viin lya chpn v;
diii trude ngoii eho c i c khuyit hing Idn l i vgt cd kic thude Idn trong khi It phii hi sinh d nai cho vgt. Mdt t t i e g i i b i o c i o l i y vgt tdi 25'35cm[4] m i khdng cd ho ti> m i p vgL C i c vgt b i , b i n b i , vgt ca lung rdng...cQr]
cho phip liy vgt vdi di|n tich Idn nhung phii thay dii t t h i sau liy vgt v i khfing t h i t i l n hinh ding thdi 2 kl phlu thuit do t i n thuang thudng n i m d mit tnrde c t h i .
Hon nl^a, d i y l i vat mgch xuyin Igi xult phit t nhinh xuing cOa h i thdng dOng mgch mQ diii ngoii- ti thing mgch chi phii cho h i u h i t c i c Ihinh phin vdii trudc diii n i n cd t h i l i y vgt dudi dgng da md hoic i thim c i n , ca tDy theo myc dich tgo hlnh. Vgt ed tfi dupe Idc bd thuyng bl d l sir dyng nhu mdt ehl lt{
ddn Khie vdi phuang phip ghip md Coleman, tror s i 3 vgt c i n md dupe si> dyng dfin trong nhdm nghii ciru, ngogi tn> 1 vgt bj hogi t u do t i c tTnh mgch, 2 u cdn Igi l i m d l y t l ehu'c r l t t i t , r l t it bj teo sau phi thuit. Trong m|t s i trudng hpp cd c i c viing l l n ttiuor eieh nhau b l ^ mfit vung da linh, d l che phu hit ti thuang trong khi v i n b i o t i n viing da linh v i chl ph n l i mdt cuing mgch, cd t h i chia vgt thinh nhilu dao c dya trin d c nhinh xuyin khic nhau tir ciing nhir xuing.
MOt trang nhO-ng y i u d u ca ban v l chit Itgu tror tgo hinh h i m m i t v i vOng b i n tay l i t i chi>e md dif da phii mdng, m i m mgi phu hyp vdi vile tgo dudr viin vung m i t v i cd t h i l i m thuin lyi cho nhOng ho ddng tinh t l viing b i n tay. Viic l i m mdng vgt dudi kir hiin vi phSu thuit ngay sau khi bdc vgt d i dupe nhk t i c g i i nghiin ciru d v l c a sd g l i i phiu v i dng dyi l i m sing. Nebojsa Rajacic v i cfing sy [6], Kimata, Wf Quel Yuan[10] cQng d i t i l n hinh lim mdng vgt t 2,3mm vdi k i t q u i t i t . Sue sing tuyit vdi cua vgt din g i i i thich bing 3 ly do:1) Ddng chiy i p lye Idri cOav nhy Song v i cdng sy d i md t i . 2) Sy md d e kenh tuJ hoin phy trong vung huylt d i n g v i vung tilm ting,_
Sy t i n tgi phong phu cOa mgng mgch dudi da. D l t&
dd an t o i n cho "vgt siiu mdng", vi$e phiu t l i ^ lim ma vgt n i n dyoc thyc hi$n dudi kinh hiin vi phiu thu|(^
b i o t i n nhinh xuyin di trong Idp md trin c i n sau^
thuit niy cho phip logi bd md md thira quanh nhi xuyin trong khi v i n d i m bao d p m i u tdi mgng n^
dudi da. O i y l i mOt trong nhOtig lyi t h i cua vgt "
xuyin ndi chung v i vgt diii tnrdc ngoii ndi ning.
Trong s i 9 b|nh nhin duyc tgo hinh bing v ^ liln trong nhdm nghiin cCru. d 1 vgt xuli ddng v i 1 nguyc ddng bj hogi tfr do thilu m i u ding mgrffng sau m i . Cd t h i do kT ning phiu tich chua ^gtra nh&ng trudng hyp ban d I u , Nhttng trudng hyp cdn vgt Ovfvc d p m i u t i t v i tujing mgch du d i i d l vupn>
t i n thypng. Cunha Gomes [1] b i o c i o e i c trudng^
tgo hinh che phO khuyit vCing bgn. Sherigll Xiangeheng[8], Mehmet Mutaf [5] sO* dyng vgt c u i i i ^ xudi ddng cho nhOng khuyit vung sinh dye, day d
Y HOC THITG HANH (777) - s6 8
vdi kit qua tot. G. Shin- Chen Pan [9], Ray Yung- Chiou Lln [7], Gang Zhou [2], Chihn Yuan Chen.., cQng d i bio eio su dyng vgt dudi dgng nguae ddng eho nhung khuyit phln mem viing g i i v i 1/3 tren d n g chin v i d i lim sang to ea sd d p mau eCta vgt. Nhu viy, kit qua nghiin ciru niy cung thing nhit vdi nghiin eCru cua cic t i c gia khie ring: vgt ed t h i dudc sCr dyng mfit cich an toin dudi dgng vgt cuing liln trong nhO-ng trudng hpp t i n thuang viing l i n c i n nai cho vgt.
KET LUAN
Vgt diii trudc ngoii tuy cdn mdt s i dilm hgn ehl nhung vdi rlt nhilu uu dilm nhu: cd t h i l i y vgt diin tich Idn m i It hi sinh nai eho vgt, khi ning su dyng vgt linh hogt, ed t h i d i biln d l thay d i i chit Iliu tgo hinh cho phu hpp vdi eic mye dich ddn, phO, dyng hinh khfing gian ba chilu cua c i c ca quan n l i . ed t h i lya chpn d l tgo hinh cho nh&ng t i n khuyit Idn, phCre tgp trin eic viing khic nhau cua ca t h i .
TAI LI$U THAM K H A O
1. Cunha-Gomes.D.R. Bembde.H, Bhathena.N.M(2000). "The pedicled anterolateral thigh
island flap for inguinal defects". Eur J Plast Surg, 23. pp.
97-100
2. Gang Zhou. Qi-Xu Zhang, Guang-Yu Chen(2005),
"The eariier clinic experience of the reverse-flow anterolateral thigh island flap', British Joumal of Plastic Surgery, 58, pp. 160-164
3. Geoffrey G. Ha!lock(2007), " Muscle Perforator Flaps". Annals off^astic Surgery, 58, pp. 27-33
4. Isao Koshima, Yuzaburo Nanba, Tetsuya Tsutsui, Yoshio Takahashi (2003), "New Anterolateral Thigh
Perforator Flap Whith a Short Pedicle for Recontruction of Defects in the Upper Extremities", Ann Plasf Surg. 51, pp. 30-36
5 Mehmet Mutaf, Dag'han i_sik, 0 " mer Bulut and Berker Bu"yu"kgu"ral (2006), "True One-Stage Nonmicrosurgical Technique for Total Phallic Reconstruction", Annals of Plastic Surgery, 57 (1), pp.
100-106
6. Nebojsa Rajacic, Raj Kumar Gang, Jaya, Krishnan, Rameshwar Lai Bang (2002), "Thin Anterolateral Thigh Free Flap", Annals of Plastic Surgery, 48 (3), pp, 269-275
7. Ray Yung-Chiou Lln, Wen-Hsiang Chien (2006),
"Experiences in Han/esting Type II Distally Based Anterolateral Thigh Flaps", Plastic and Reconstmctive Surgery, 118(1), pp. 282-286
8. Shengkang Luo, Wassim R affoul, Piaget. F and Daniel V. Efloff(2000). "Anterolateral Thigh Fasciocutaneous Flap in the Difficult Perineogenital Reeonstnjction", Plastic and Reconstmctive Surgery, 105(1), pp. 171-173
9. Shin-Chen Pan, Jui-Chin Yu, Shyh-Jou Shieh, Jing-Wei Lee, Bu-Miin Huang, and Haw-Yen Chiu(2004),
"Distally Based Anterolateral Thigh Flap; An Anatomic and Clinical Study", Plastic and Reconstmctive Surgery, 114 (7), pp. 1768-1775
^O.Wen- Guei Yang and al(2006), "Thin Anterolateral Thigh Peri'orator Flap Using a Modified Peri'orator Microdissection Technique and Its Clinical Application for Foot Resurfacing", Plast Reconstr Surg. 117, pp.
1004
NGHIEN ClilU THUC TRANG SUTDUNG DICH VU Y T^
CUA NGirfin DAN HUYEN VI XUYEN. TINH H A G I A N G
PHAM TRf D O N G , Trufing Dai hpc Y teeing cpng.
N G U Y I N D I N H D I ; , Sd Y t^Hi Giang.
TOM T A T
Y (e ca sd li tuyin dau tiin tiep xOc v&i nhin din tmng hi thong y ti nhi nut/c, c6 nhiim vy ftjyc hiin cic ndi dung chim sdc sOx: khoi ban dau cho nhan din tren dja bin. Ngiy nay do tic dOng ciia nen kinh ti thj tn/dng, ngutri nghio dang cd nguy ca khd tiip cin vdi • djch VU y ti cd chat lux^ng cao. Huy$n Vi Xuyin, tinh Hi Giang, hi thing m^ng Iwai y ti ca sd da tung birdc duvc cung ci vi hoin thiin. nhung ngudi din if diy cd khi ning tiip cin vdi dich vyyti.cd du^ sir dyng dich vy yti khi bj im dau khdng, mi>c dd dng bang tmng tiip can vi sO- dyng djch vy y ti cua ngudi din d nhOng nhdm thu nh$p khic nhau nhw thi nio? Di tri Idi cho nhOng cau hdi trin chiing tdi tiin hinh: "Nghiin cOv thyc trang sO- dyng djch vy y ti cOa ngudi din huyin Vj Xuyin, tinh Ha Giang". Nghiin cuv diipc tiin hinh tir thing 4 din thing 7 nSm 2007 tren 682 hi gia dinh, diia theo 4 mux: thu nhap khic nhau (nghio, tmng binh, khi vi giiu), bing phuang phip nghiin cOv md ti cit ngang cd pftin tich. Kit qui nghiin ciru da cho thiy. <^
sw bit cdng bing tmng tiip cin vi sir dyng djch vyyte
cua ngwiti din, ngudi nghio khd tiip c$n vi sir dyng ca sd y ti han so vdi ngudi giiu. Tir kit qua nghiin cOv si cung dp thong tin cho nhi quin ly, lip ke ho^ch, xiy dyng chlnh sich y ti phii hop vdi diiu ki$n thyc ti hi$n nay cOa dja phwang.
Tirkhda:dich vyyti, Huyin VjXuyin SUMMARY
STUDY ON REAL SITUATION USE OF BASIC HEALTH SERVICE IN VI XUYEN DISTRICT HA GIANG PROVINCE
Tivo Important tasks of national health policy are to ensure the right to access health care of everyone and to pmvide service vnthout any discrimination. To achieve those, it is crucial to design and manage the medical serwces in an effective way. A national pmgram, basic health, has developed to offer an initial and local health care service for everyone. However, low-income people are at the risk of accessing the service as a result of maritet economy. In order to investigate the equality in health care access, a statistical ^udy on appmach and use of basic health sen/ice in Vi Xuyen District, Ha
j Y HOC THVCHANH (777) - S6 8/2011
