TCNCYH PhtJ trWdng 62 (3) - 2009
3. Dinh TA et al " the treatment of uterine leimyosarcoma. Results from a 10 - year experience (1990 - 1999) at Massachutsetts General Hospital. Gyneco Oncol 2004. 648 - 92.
4. Fung MFK et al: prospective longitudinal study of ultrasound sceening for endometrial abnormalities in women w i t h breast cancer receving tamoxifen. Gynecol Oncol 2003; 91 - 154.
5. Jenal A et al " Cancer statistics 2004. CA Cancer J Clin 2004 5 4 - 8 .
6. Montz FJ: signifinicance of "normal"
endometrial cells in cervical cytology from asymptomatic postmenopausal women receiving hormone remplacement therapy. Gyneco Oncol 2 0 0 1 . 8 1
7. Oliver Dorigo, Annekathryn Goodman.
"Premalignant and Malignant Disorders of the Uterine Corpus" Current Diagnosis and Treatment Obstetrics and Gynecology. 2007 Mc Graw Hill.
855 - 6 9 . Summary
SOME REMARQUES UTERINE CANCER AT
THE GYNECOLOGY AND OBSTETRIC CENTER HOSPITAL
Objective; assesement of the uterine cancer and the treatment. Method; a retrospective study. Result:
the endometrial carcinoma account for 9 4 . 7 % w i t h most part in menopausal women (82.2%), averange ages 57.97 ± 7.68 and there are 17.8% patients having still menstruel. W h i l e the averange ages of the uterine sarcoma is 48.60 ± 15.41 and the pain, rapidly enlarging uterus, mobility limited are the important signs. In the endometrial carcinoma, 8 5 , 5 % patients has an endometrial thickness > 5 m m by ultrasound, and 55.6% patients has the negative results of cervical Pap smear. Laparoscopic hysterectomy, bilateral salpingo - oophorectomy with lymphadenectomy has been performed in patients w i t h endometrial carcinoma (32.2%). Conclusion: abnormal bleeding after menopaused and an endometrial thickness
> 6 mm are common in the endometrial carcinoma menopaused women.
Keys words: endometrial carcinoma, sarcoma, bleeding vaginal, menopause, endometrial uterine
DaClNG XUYEN ME N H I QUA CONG FALLOPE TRONG DIEU TRI TON THU'DNG VUNG DINH X U O N G DA
Nguyin Tan Phong Tritdng Dai hgc Y Ha Ngi
Phau thuit khoet rdng da chum tiet can md rgng de dieu trj cic tdn thuang sau trong xUOng di ngay cing bgc Id nhdng nhugc diem nhU de tdn thuang day VII, rd dich nao tuy. Mijc tieu: sd dung ky thuat md cai tien khoet me nhT bang dUdng phdi hgp qua cdng Fallope de tranh nhdng tai biin tren. Ddi tUang va phuang phap nghien cufu: sd dung chup dt Idp vi Hnh do phan giai cao dinh gii dung vj tri tdn thuang. Sd dung ky thuit khoet me nhT lay tdn thuang dinh xUang da. Kit qua ya ket luan: 22 benh nhan tdn thuang dinh xuang da dat kit qui tdt bio ton hoin toin day VII khdng cd rd djch nao tuy.
Tit kboa: dinb xuang da, ky tbuat xuyen me nhT
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I. DAT VAN DE
Nhtfng tdn thifong xifdng s l u viing dinh xtfdng d l thudng do Cholesteatome, cha'n thtfdng xtfong d l , u hat hoac u day than kinh sd VIM. Loai benh ly n l y thtfdng gay ra nhtfng tai bien nguy hiem trifdc va c l trong p h i u thuat. De ngan chan v l phdng t r i n h nhtfng tai bien tren, chiing tdi I p dung mpt dudng md phdi hpp di difdi doan 2 cdng Fallope qua me nhl de lay benh tfch, sau dd bft lap h d md chum v l k h I u ddng dng tai ngoai. Muc tieu:
1. Mo ta hinh anh lim sang va chup cat Idp vi tinb danh gia dung vi tri kicb tbudc nhii'ng tdn thuang viing dinh xuang da.
2. Danb gia hieu qua dudng md xuyen me nhi bao tdn diy VII co bit lip hdc md va khiu tit dng tai ngoai.
II. DOT TUgfNG VA PHLfONG PHAP NGHIEN cOU
1. Ddi tUdng nghien ciiru
22 BN tudi tif 14 - 45; 14 nam, 8 ntf dtfoc chan doan tdn thUOng sau trong xifdng d i , mi't chifc nang nghe hoan toan (diee tie'p nhan > 90dB).
2. PhUcfng phap nghien ciiru: mo ta tifng ca co can thiep.
3. Cac budc tien hanh:
•* Tieu chuan chan doan:
- Npi soi tai phat hien tdn thtfong tai giCa;
- Nu stii bft ll'p dng tai.
- Chi't ba dau qua Id thung m i n g nhT.
- Mang nhT xanh tfm, rach.
- Chay. djch nao tuy l i n mau.
- Thfnh Itfc dd; bieu dd thfnh life diee tiep nhan hoan toan tai benh.
- Chup cat Idp vi tfnh; hinh I n h tieu huy XUdng vung dinh xUOng da va me nhT (kbdi u hoac Cholesteatome).
- Du'dng v8 qua tai trong (cha'n thifdng xifdng da).
* Tieu chuan danh gia trUdc md
- Co ket q u i npi soi tai chup I n h (tdn thUdng tai giCfa).
- Ket qua do thfnh life; mi't nghe gan nhtf hoan t o l n tai benh.
- Cd ke't qua chup cat ldp vi tfnh chi ra tdn thifong vung dinh xtfdng da: vj trf, kfch thifdc, dp lan rpng va ty trpng.
- Danh gia liet d i y VII; cd ket q u i dien co va dien than kinh chi ra phan tram mifc dp thoai h o i va tdn thtfong spi true.
•* Tieo chuan danh gia sau md:
- Phuc hinh g i i i phau; dng tai kho sach ddng kfn hoan toan khong rd djch nao tuy tnfdc va sau tai.
- D l y Vli phuc h d i : he't meo mat, n h a m mat kin, d i e n cd va d i e n than kinh phuc hdi tren 8 0 % .
•* Ky thuat md:
- BN difpc gay me toan t h i n npi khf q u i n . - Dudng rach da.
Hinb 1. Dudng rach da sau tai binb chO S Lay tdn thtfdng vting dinh xtfdng d l
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TCNCYH Phil trWdng 62 (3) - 2009
I.. -
Li'p hdc.na.d bang md
'K "V
Hinb 2. lay Cholesteatome vdng dinh xUang da xuyen qua me nhl va day VII
Ll'y md bung
Hinh 3. Lay ma bung bit lap hdc md
I I L K E T Q U A
1 , N g u y e n n h a n va b i e n chufng triifdc m o
Hinb 4. Bit lap bdc md khoet rong da cbdm bang md va can ca
K h I u ddng tjt dng tai
r "
Hinh 5. Khau dong tjt dng tai tranb do dich nao tuy
Bien ehifng n
Rd djch nao tuy Liet d l y VII
Nguyen nhan
Cholesteatome
11 3 2
Cha'n thifdng xu'dng da
8 4 4
U hat
3
2. Ke't qua sau m d
22/22 trtfdng hpp b i o tdn chifc nang d l y VII trong dd cd 6 trUdng hpp phuc hoi lai ehifng nang day VII. 7 trddng hpp rd djch nao tuy difpc bft lap.
3. Tai bien
1/22 Cholesteatome t i i phat p h i i m d lai 3 lan 4. Khong cd trUdng hop nao ro d i c h nao tuy sau mo
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5. Ca 4 trudng hdp lift day VII dUpc phuc hdi gan nhtf hoan thoan sau 06 thang.
IV. BAN LUAN
Ton thuong slu vting dinh xifdng da thifdng gly tai bie'n nguy hiem la rd djch nao tuy, nguy cd bien ehifng viem mang nao de doa tfnh mang ngUdi benh. Vi vay ta't c l nhtfng tdn thtfong sau trong xtfong da thtfdng de doa nhtfng tai bien nay ke c l sau phiu thuit. Ky thuit md difdng xuyen me nhT cd bit ll'p hd'c md bang 3 ldp: md, can cd v l da tao nen mot hang rio bio ve vtfng chac ngan chan tholt vj mang nao v l rd djch nao tuy sau phiu thuit.
Ky thuat qua me nhT blng ctifdng phdi hpp qua tien dinh v l dc tai giup cho viec bio tdn d l y VII trinh hien ttfdng Met mat sau pblu thuit.
Uu diem cua difdng vao phd'i hop nay cdn cho phep lay benh tich vting dinh xifong da triet de hon.
V. KET LU/\N
1. Tai bie'n hay gap nha't ciia pblu thuat vung dinh xifdng d l la liet day VII, thif 2 la rd dich nao tuy.
2. Ky thuat khoet me nhT bang difdng phdi hdp I I phtfdng phip uU viet bio tdn chifc nang diy VII.
3. Ky thuit khIu dong hdc md khoet rdng chum d l md rpng bang 3 ldp; md - c l n cd - da la phtfdng phap an toln tranh rd dich nao tuy.
TAI LIEU THAM KHAO
1. Byron.); Bailey J.B., (1993). Head and Neck Surgery - Otolaryngology. Lyppincott Company.
Phyladelphia, .
2. Nguyin Tan Phong (2001). Phiu thuat Tai.
Nha xuit b i n Y hpc.
3. Nguydn Tan Phong (2004). Chan doln dien quang trong Tai Mui Hpng. N h l xuit b i n Y hpc.
4. Nelson A.R. (2006). Temporal Bone Surgical Disection Manual. House Ear Institute, Loss Angeles, CA, USA third ediction.
" • Summary _
TRANSLABYRINTH FOR REMOVING THE PETROUS APEX LESIONS
Radical Mastoidectomy and Petromectomy for the petrous apex has often caused the complication as facial nerve paralysis, CSFL. Objectives: evaluation of results of combined translabyringthectomy for removing the lesions of the petrous apex. Methods: 22 patients with suspected Cholesteatome, maligmant, temporal bone fracture have been removed the lesions of petrous apex and constructed the mastoid cave.
Result and conclusion: 22 patients have been diagnosed by high resolusion CT of the temporal bone. 11 cases cholesteatome, 8 cases temporal bone fracture and 3 cases maligmant. 22 patients no complication.
One case had Cholesteatoma recurrent. The combined translabyrinth technique to remove the lesions of the petrous apex is safe for facial nerve and preventing the CSFL.
Key words: petrous apex, Translabyrinth
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