Tap chl Tai MOi Hpng Vidt Nam - Volume (57-10). N°4 - July, 2012
DANH GIA BAN CHAT U K H O A N G BE;N HQNG QUA
» 6 l CHitU L A M SANG VA CT SCAN Vdl M 6 B £ N H H Q C
TingXudn Thing*, Bo Ba Himg'
T 6 M TAT
U khoang quanh hgng (parapharyngeal space tumor- PPS) la nhtmg khSi u Idnh llnh hay dc tinh, phdt sinh viphdt triin d khoang quanh hgng [4,6]. CT, MRI. chup mgch ddnh gid chinh xdc vi tri u. Mo blnh hgc chdn dodn bin chat u. Mt/c tilu: DSI chiiu ddc diim ldm sdng vdi tdn thucmg tren CLVT va mo blnh hgc cia khSi u khodng bin hgng. Bii ttrfrng va PPNC: Gdm 53 blnh nhdn dugc chdn dodn vd diiu tri u khoang quanh hgng. Mo td timg ca, can thifp, tiin cuu Kit qua vi bin lufn: I. U dc tinh : Hgch c6 to ( 60%).
Thai gian tiin triin nhanh <3 thdng (80%), ngdm thudc can quang mgnh (90%), khong dSng ty trgng 100%, ranh gidi khong ro h-en CT 40%, 2. V Idnh tinh : Hgch cS to (4.65%), Thai gian tiin triin <3 thdng (9.3%), ngdm thudc cdn quang (37.2%), khdi u khong ddng ty trgng (32.6%). ranh gidi khdng ro tren CLVT ( 65%), Kit lugn: U dc tinh 10/53 (18,8%), Uldnh tinh 43/53 (81,2%).
Tir khoa : U khodng bin hong, CTscaner.
SUMMARY
Parapharyngeal space (PPS) are the belignant or malignant tumors and identified, namely those of salivary origin, neurogenic tumors and paragangliomas. Objective The clinical were analysed and comparisized with CT and anatomopathological data of 53 patiens PPS .Materials and methode : A retrospective of 53 patients from Central Otorhinolaryngology Hospital who were diagnosed as PPS and underwent excision from 2005 to January 2010. Results Rate seen in men 51,04 %), more than women 49,06%. In the malignant tumors (10/53 - 18,8% ) : the cervical lymph node( 60%), the time of evolution (under tree month 80%), the contrast absorbed (90%), hypersignal 100% 2. In the belignant tumors ( 43/53 - 81,2%) : the cervical lymph node (4.65%), the time of evolution (under tree month 9.3%), the contrast absorbed (37.2%), hypersignal (32.6%).
Conclusion: The malignant tumors 10/53 (18,8%), the belignant tumors 43/53 (81,2%).
Key Words: Parapharyngeal tumors. CTScan, MRI
1. DAT V A N Bt, thih hay dc tinh, phdt sinh vd phdt triln d U khoang quanh hpng (parapharyngeal Idioang quanh hpng [4,6]. Khoang ndy bao space himor- PPS) Id nhung khli u Idnh 8^™ khoang sau hpng, khoang hudc hdm
Tap chl Tai MOi Hpng Vidt Nam - Volume (57-10). N°4 - July, 2012
vd khoang sau hdm.[3,7]. Khli u khoang quanh hpng g$p khdng nhilu chi chilm 0.5% cdc khli u c i a ving diu e l vd da s l Id u Idnh tinh [9,10]. Nhung v l vj tri khu ttii vd nguIn g l c phdt sinh khli u thi Iji phiic t9p ndn khd chin dodn, dl bj nhIm lin. Khoang quanh hpng Id khoang cd c i u tnic gidi phlu phiic t^p lidn quan vdi ddy sp, m ^ h mdu vd thin kinh do dd nhihig khli u khoang quanh hpng Id nhiing khli u khd thdm khdm trdn ldm sdng . Cdc tri$u chiing Id cdc diu hi^u mupn ciia cdc co quan Ian cdn khi md khoi u dd khd to gdy chdn dp vd dnh hudng din cdc ciu tnic m ^ h mdu, than kinh xung quanh [3,4,8].
Chin dodn bmh dnh nhu CLVT, MRI chvp mach ... dd giup cho ddnh gid chinh xdc vi tri, so lupng, kich thudc, miic dp Ian rpng cua khdi u [4,6,10] Nghien ciiu d$t ra muc tieu sau: Boi chiiu die ttiim lam sing v&i tdn Ihircmg trin CLVT vi md bfnh hpc ciia khdi u khoing ben hgng di dinh gid bin chit u Irir&cphSu Ihu^t
2. D 6 I TirgiNG VA PHlTONG PHAP NGHIEN CCtJ
Gom 53 benh nhdn dupe chan dodn vd diiu trj u khoang quanh hpng
Tieu chuan Ig^ chpn B ^ nhdn dupe chvp CLVT khoang quanh hpng. Bpnh nhdn dupe Idm xet nghipm mfl bpnh hpc khoi u sau mo Dupe phSu thuat t?i khoa khli u B^nh vipn Tai Miii Hpng Trung Uong.
Thilt ke nghien ciru: Mfl td timg ca, can thipp, tiln ciiu.
3. KfeT QUA
3.1. D l i chilu BSI chiiu kich thir&c u trin CT vi ldm sing
Bdng 1. Odi chilu kich thudc u trdn CT vd Idm sdng
Kich thudc u trdn CT (cm)
<3
^3 N
Sdthdy u 1 32 33
Khdng 8d thdyu
4 16 20
N 5 , ^
"8 . 53 \ Nh^n xit: Theo kit qud nghiSn cuu cho th4y 32/48 BN (66.67%) kh6i u cd kich thudc >3cm sd thdy trSn ldm sdng trong khi dd chi cd 1/5BN (20%) khoi u cd kich thudc <3cm Id sd) thay dupe tren lam sang.
3.2. Doi chilu ranh gidri cda kh^i u tren CLVT \it\ bdn chkx mo bfnh h^c ciia k h l i u
Bdng 2: Ddi chilu ranh gidi cua u trfin phim chup CLVT v(>i ban chdt cua khdi u
^Mdbdnh
^ \ hpc RaniK gidi u \ Ranh gidi rd Ranh gidi khdng rd
N
U Idnh Tinh n 41 2 43
%
95.35 4.65
100 Udctlnh
n 6 4 10
%
60 40 100
X'.P.OR
p=0.0(l9 OR =13.687
NH^n xit: Cd 4/lOBN (40%) khoi u dc tinh cd ranh gidi khdng rd trdn phim CLVT nhung chi cd 2/43BN (4.65%) khli u lanh tfaih cd ranh gidi khflng rd tidn chvp CLVT.
Sv khdc nhau ndy cd ^ nghia tiling kd (p<0.05).
Tgp chl Tai MOi Hpng Vi$t Nam - Volume (57-10). N°4 - July. 2012
3.3. D6i chi^u tinh dhag nhat cAa khSi u tren CLVT vdi bdn ch^t mo b^nh hQC cua khoi u
Bang 3: Bdi chilu tinh ddng nhdt cOa khdi u trfen chyp CLVT v&\ bdn chdl mO b§nh hpc
cOa khdi u
\ M d bdnh N ^ hpc rinh ^ v Idng n h d t \ Ddngty tnjng Khdng ddng tfhpng
N
U Idnh tinh n 29 14 43
%
67.44
32.56 100
Udctlnh n 0 10 10
%
0 100 100
X^.P. OR
x'= 12.296, p^.0001 OR=1.714
Nhan xit: Cd 10/lOBN (100%) khdi u khong ddng t^ trpng d nhiing kh6i u dc tfnh trong khi dd chi cd 14/43BN (32.56%) khdi u khdng ddng ty trpng d nhOng khdi u lanh tinh.Su khdc nhau cd y nghia thdng ke (p<0.05).
3.4. D6i chieu dac tinh ngam thuoc can quang tren C L V T vdi ban c\kkt mo benh hoc ciia khoi u
Bang 4: Ddi chilu d$c tinh ngdm thuoc can quang cua khdi u trfen chgp CLVT vdi bdn chit
md b$nh hpc cOa khdi u
\ ^ M d bdnh
\ ^ hpc Tfnh \ ^ ngam thudc\
Ngdm thudc can quang Khdng ngdm thudc cdn quang
N
Uldnh tinh
••
16 27 43
%
37.21
62.79
100 U d c tinh n 9 1 10
%
90 10 100
X'.P.OR
X^7.078, p=0.008 OR'^o.oee
Nh^tt xit: Cd 9/lOBN (90%) khli u nglm thulc cdn quang d nhOng khli u dc tinh hong khi dd ty 1$ ndy Id 16/43BN (37.21%) khli u Idnh tinh. Sv khdc bipt nhau giOa hai nhdm ty 1^ cd ^ nghia thing kd(p<0.05).
3.5. Doi chilu thdi gian dien biln bpnh vdi bdn ehit mo bf nh hpc ciia khoi u
Bdng 5 Qdi chilu thdi gian diln biln b$nh vdi bdn chdt md bdnh hpc ciia khdi u
Tinh
^ \ chdt u Thdi gian^v didn bidn ( t h d n ^
Thdi gian didn biln bdnh (thdng)
<3 n 3-6 7 - 9 10-12
>12 n N
Tinh chdt u
Ldnh tinh
4 4 2 3 7 27 39 43
Ac tinh
8 8 0 0 0 2 2 10
/".P. OR
y^= 19.292, p= 0.0001 OR=0.026
Nh^n xit: Cd 8/lOBN (80%) khli u dc tinh cd thdi gian diln biln b^nh <3 thdng.
Trong khi dd chi cd 4/43BN (9.3%) khli u ldnh tinh cd thdi gian diln biln bpnh <3 thdng. Sv khac biet nay cd -j nghia thing ke (p<0.05).
Tgp chl Tai MQi Hpng Vi^t Nam - Volume (57-10). N°4 - July, 2012
3.6. D6i chi^u hych c6 tren ldm sdng vdi hdn ch^t cda kh6i u
Bdng.6.: Ddi chilu hach cd trdn ldm sdng vdi bdn chdt cua khdi u
\Bdn chdt
\ "
HacH\
cd V
Cd hach
ci
Khdng cd hachcd
N Ac tinh n
6 4 10
%
60 40 100
Ldnh tinh n
2 41 43
%
4.65
95.35
100 X ' . P , 0 R
)t^15.316, p^O.0001 ORH).033
Nhin xit: Cd 6/1OBN (60%) khoi u dc tinh cd bach cd tren lam sang trong khi dd chi cd 2/43BN (4.7%) khoi u ldnh tinh cd hach cl trdn ldm sang. Sv khdc nhau ndy cd y nghia thdng ke (p<0.05).
4. B A N L U . ^
4.1. Dli chilu vj tri u tren chfp CLVT vdi md b^nh hpc khli u.
Trong 53 bpnh nhan u khoang quanh hpng thi thdy rdng u khoang hudc trdm gdp nhilu nhdt Id u nang 12/31BN (38.71%) sau roi din u bin hpp hiyin nude bpt 10/31BN (32.26%), hong 5 trudng hpp u dc tinh khoang hudc ham cd 2/5BN Id cd nguon glc tir tuyin nude bpt vd diu Id khli u bieu bi chl nhay (mucoepideimoid).
Khflng gdp ttudng hpp u cd nguIn glc thin kinh ndo d khoang trudc hdm. Vdi u khoang sau tram thi u cd nguIn glc thin kmh lai chilm phan nhilu. Theo tdc gid Nguyin Dmh Phiic[4] u hiyin nude bpt khoang bdn hpng gdp 35.8%, U thin kmh
(schwannome) 25%, U nang 20.6%. Theo Siiarez.-Fente V, Liorente-Pendds JL, Gdmez-Martinez J, Garcia - Gonzdlez LA[49] qua 51 b|nh nhdn u khoang bdn hpng gdp u hIn hgrp tuyIn nude bpt ldnh tinh 37%, u c$n h^h 21%, u than kmh 8%.Tuy cd sv khdc nhau giiia cdc tdc gid trong nude vd nude ngodi nhung 1^ do cd thi Id do sl lupng b|nh nhdn nghidn cihi chua do 16n ndn din din sv khdc nhau ndy.
4.2. Dli chilu kich thirds u trin chfp CLVT vdri diu hifu sdr thiy u
Theo kit qud nghidn ciiu thay 48/53BN (90.57%) khii u cd kich thudc >3cm, 5/53BN (9.43%) khli u cd kich thudc
<3cm. Tuy nhidn chi cd 33/53BN (62.26%) khli u sd thiy dupe tren lam sdng. Theo Olsen[40] khli u phdi d^t kich thudc 2.5- 3cm mdi cd thi sd thay dupe tren ldm sdng.
4.3. Doi chilu ranh gidi u vdi bdn chit md b$nh hpc ciia khli u
Cd sv khdc bipt vl ranh gidi khoi u khflng rd hdn chvp CLVT giOa khoi u ldnh tinh vd khli u dc thih. 40% khoi u dc thih cd ranh gidi khflng rfl hdn chvp CLVT hong khi chi cd 4.65% khli u ldnh thih cd ranh gidi khflng rB hen chvp CLVT. T^
xult chenh chi ra sv khdc nhau ciia hai t^ 1$
ndy Id 13.667 vd sv khdc bi|t nhau nay cd j nghia thing ke (p<O.OS).
4.4. Dli chilu tfnh ding nhit ciia khli u ttin chyp CLVT v6i bin chiit mS b«nh hpc ciia khli u
Cd sv khdc bi$t giiia ty Id khli u khflng ding ty hpng d nhOng khoi u dc tinh vd
Tap chl Tai MOi Hpng Vidt Nam - Volume (57-10). N°4 - July, 2012
ldnh tinh. Cd 100% khli u khdng ding ty trpng or nhihig khli u dc tinh hong khi dd chi cd 32.6% khli u khflng ding ty hpng d nhiing khli u ldnh tinh. Ty suit chdnh chi ra sv khac nhau ciia hai t^ Id ndy Id 1.714 vd sv khdc bi$t ndy id cd y nghia thing kd (p<0.05).
4.5. Dli chilu d$c tinh nglm thulc cdn quang ciia khli u vdri ban chat md b|nh hpc ciia khli u
Cd sv khdc bipt nhau giiia ty id ngam thulc cdn quang tinh m^ch cda khli u lanh tinh vd khli u dc tinh. Chi cd I6/43BN (37.2%) khli u ldnh tmh cd nglm thulc cdn quang sau khi tidm thulc cdn quang, hong khi dd 9/1 OBN (90%) khdi ^ dc tinh cd ngdm thulc can quang. Kit qud hen cho thiy rd rang cd sv khdc biet giiia khdi u ldnh tinh va khli u dc tinh ve tinh chdt ngam thuflc cdn quang va ty suat chenh chi ra sv khac bipt nhau ciia hai ty 1$ nay la 0.066. Su khdc bi$t nay la cd -j nghia thing kd (p<0.05).
4.6. Dli chilu thdri gian tiln trien bpnh vdi ban chat mfl bpnh hpc ciia khoi u
Cd su khac bi^t giua thai gian diln biln b$nh d khli u ldnh tinh va khli u dc, cd 8/lOBN (80%) khli u dc thih cd thdi gian dien biln benh <3 thdng hong khi dd chi cd 4/43BN (9.3%) khli u lanh tmh cd thdi gian dien biln bpnh <3 thdng. Nhu v4y cd thi thdy bdnh nhdn cd u ac tinh khoang quanh hpng thudng din vien sdm, cdc tri^u chihig tiln triln ram r0 hem cdc khli u ldnh tinh. T^ suit chenh chi ra sv khdc nhau ciia hai t^ le ndy la 0.026 (khodng tin cdy 95%
0.004- 0.165). Sv khdc nhau cd y nghia thing kd(p<0.05)
4.7. Dli chilu dau hifu cd hjch co trin ldm sdng vdi bdn chit mS bpnh hpc ciia khiiu
Cd sv khdc bipt nhau giiia ty Ip cd hach cl d khli u ldnh tinh vd dc tinh. Cd 6/1 OBN (60%) khli u dc tmh cd h?ch cl hdn ldm sdng hong khi dd chi cd 2/43BN (4.65%) khli u ldnh tinh cd h ^ h cl hen ldm sdng.
Ty suit chdnh chi ra sv khdc nhau cua hai ty Ip ndy id 0.033 (khodng tm cay 95%
0.005 - 0.218). Sv khac nhau ndy cd y nghia thing ke (p<0.05).
S. K&T IX^
1. U dc tinh : Hach cl to ( 60%). Thdi gian tiln triln nhanh <3 thdng (80%), ngam thulc cdn quang manh ( 90%), khflng ding ty trpng 100%, ranh gidi khdng rd hdn CT 40%, 2. U lanh tinh : Hjch c8 to (4.65%), Thdi gian tiln triln <3 thdng (9.3%), nglm thulc can quang (37.2%), khli u khdng ding ty trpng (32.6%). ranh gidi khflng ro hen CLVT (65%),
TAI LIfU THAM KHAO
1. Vfl Duy Dung (2004). Nghien ciru ddc diem ldm sdng vd hinh dnh chdn dodn u khoang quanh hgng gdp tgi benh vi$n Tai MQi Hgng Trung uong tir thdng 1-1999 din thdng 12-2004, Ludn vdn tit nghiep bdc s^ npi tni bpnh vien.
2. Phjm Bich Dao (1999). Nghien cm dgc diim ldm sdng vd md blnh hgc cdc khdi u quanh hong ggp tgi viln Tai
Tap chl Tai MOi Hpng Vijt Nam - Volume (57-10). N°4 - July, 2012
Mui Hgng, L u ^ vdn tit nghiep bdc sj n0i tni bdnh vi§n.
3. Nguyin Dinh Phiic (2009). "Nghidn cihi ddc dilm Idm sdng khli u khoang bdn hpng", Tgp chl nghien cm y hgc, 63(4), Tr. 44-49.
4. Acosta L, Montalvao P (2002).
"Parapharyngeal space tumors. Our experience I.P.O Francisco Gentil, Lisbon", Acta otorrinolaringol Esp,53iT), 485-490.
5. Ahn JY, Kang SV, Lee CH, Yoon PH, Lee KS (2005). "Parapharyngeal brachial cleft cyst extending to the skull base: a lateral transzygomatic- transtemporal approach to the parapharyngeal space", Neurosurg Rev, 28(1), 73- 76.
11. Bouilloud F, Jegoux F, Caze A (2008). "Parapharyngeal tumors:
diagnosis and treatment", Ann
Otolaryngol Chir Cervicofac, 125(4), 181-187.
12. Hughes KV 3 ' ^ Olsen KD, McCaffrey TV (1995).
"Parapharyngeal space Neoplasms", //eadWcc*, 17(2), 124-130.
13. Rosner M, Fisher W, Mulligan L (2001). "Cervical sympathetic schwannoma: case report", Neurosurger, 49(6), 1452-1454.
14. Saito DM, Glastonbury CM, El- Sayed IH, Eisele DW (2007).
"Parapharyngeal space schwannomas;
preoperative imaging determination of the nerve of origin". Arch Otolaryngol HeadNeckSurg, 133(7), 662-667.
15. Shahab R, Heliwell T, Jones AS (2005). "How we do it: a series of 114 primary parapharyngeal space neoplasms", Clin Otolaryngol, 30(4), 364-367.
