Y HOC VIET NAM THANG 4 - S6" 1/2012 mach mau: thu'dng la ddng mach nao tru'dc va
thdng tru'dc, ddi khi la dpng maeh canh. Chiing tdi cd 29,7% benh nhan cd hinh anh mach mau nao nam trong khdi u. Ti le tir vong va ket qua xau chil yeu do nguyen nhan nay [1]; 3) Mat do khdi u; vdi nhu'ng khdi u chac thi kha nang cat bd khd khan hdn nhu'ng khdi mem va xdp.
Nhu'ng khdi u cd giam tfn hieu tren T2 thi thu'dng la chac, va neu tang tfn hieu tren T2 thi hau het la u mem va xdp.
V. KET L U A N
U mang nao tren yen thu'dng gap d nCT, tuoi trung binh la 48,6 tudi, bieu hien lam sang chii yeu la giam thi li/c d 83,8%; 32,4% mil mdt hoae hai mat, va ban manh d 59,4%, Tren chyp CLVT 8 1 , 1 % khoi u ddng hay tang nhe tf trpng, bat thuoc can quang manh. Tren ehup CHT khdi u ddng tfn hieu d 5 4 , 1 % tren T l va 51,3% tren T2; 100% bat thuoc doi quang tir; 86,5% cd dau hieu dudi mang cii'ng.
TAI LIEU THAM KHAO
1. AI-Mefty.O, Smith.RR (1991), "Tuberculum sellae meningiomas" in Meningiomas, Raven Press. New York, 395-411.
2. Bassiouni.H, Asgari.S, Stolke.D (2006),
"Tuberculum sellae meningiomas: function outcome in a consecutive series treated microsurgicaily". Surgical Neurology 66, 37-45.
3 Li.X, Liu.M, Liu.Y, Zhu.S (2007), "Surgical management of tuberculum sellae meningiomas".
Journal of Clinical Neuroscience, 14, 1150-1154.
4. Sekhar.LN, Ramanathan.D, Ferreira.M (2011) "Postoperative visual outcome of suprasellar meningiomas". World Neurosurgery, 75[2]: 219-221.
5. Spangenberg.P, Rohde.V, Mayfrank.L, GilsbachJM (2004), "Microsurgery of tuberculum sellae meningiomas". International Congress Senes 1259, 71-74.
DANH GIA KET QUA TAO HJNH T U A N G THI/DNG NHI
Cao Minh Thanh*
TOM TAT
Myc tieu: Danh gia ket qua tao hinh thUdng nhT tren benh nhan viem tai dfnh khu trii thu'dng nhi.
Thiet ke nghien cii'u: Mo ta c6 can thiep. So sanh cac tneu chirng trUdc va sau phau thuat.
Benh nhan: Thu'c hien nghien ciru tren 21 tao hinh tudng thUdng nhi.
Ket qua: Ty le u tai giam tir 80,9% trUdc phau thuat xuong c6nl4,3% sau phau thuat. Dau tai giam tir 57,1% xuong con 4,8%, khong co trUdng hop nao chay mil tai sau phau thuat.
Ket luan: Tao hinh tUdng thu'dng nhi lam giam cac trieu chirng kho chiu cho ngudi benh, khdng lam giam siTc nghe sau phau thuat, gop phan lam giam sir tao thanh Cholesteatoma thUdng nhT.
SUMMARY
RESULT FOR EFFICIENT RECONSTRUCTION EPITYMPANUM OF WALL
Objective: result fbr effident reconstruction epltympanum of wall in patients who have been ercsion the wall of antrum with local adhesive atbc.
* Trudng Dai hqc Y Ha Noi
Phan bien khoa hgc: PGS.TS. Nguyin Oinh Phuc
Designs study: Prospectve analysis of preoperative and postoperative symptoms.
Patients: We studied 21 patients with the wall of antrum eroded due to adhesive otitis.
Results: tinnitus reduced from 80,9% to 14,3%
postoperative, Earache preoperative decreased from 57,1% to 4,8% postoperative too.
Conclusion: Reconstruction epltympanum of wall improved symptoms for the patients and without hearing loss postoperative, decreasing to created Cholesteatoma in antrum.
I. DAT VAN OE
Benh ly thu'dng nhT thu'dng gap la viem, Cholesteatome, viem tai dfnh khu tru (tiii co k e o ) [ l ] , [ 2 ] . Nhu'ng benh ly nay thu'dng lam cho tu'dng thirdng nhT bi mat mdt phan hay toan bp (do tu'dng xu'dng bj pha huy tir tif), lam cho phan mang chiing ldm vao trong dinh vao cd xu'dng biia, dau xu'dng biia hoac tdi tan khdp bua de.
Neu khdng can thiep thi nd ed the tien trien thanh Cholesteatome thu'dng nhT [ 3 ] . Viem tai
Y HOC VIET NAM THANG 4 - SO 1/2012 dfnh chi khu tru d thu'dng nhT thu'dng khdng gay
gian doan xu'dng con. Viem tai dinh pha huy gai nhT sau va lam mdt phan mang cang dfnh vao nganh xudng xu'dng de va xu'dng ban dap, trong nhuYig tru'dng hdp nay thi gay huy nganh xudng xu'dng de va xu'dng ban dap, da sd cac tac gia deu cho rang do rdi loan c h u t nang vdi va ap \dc am d thu'dng nhT la nguyen nhan gay nen [ 2 ] , [ 4 ] . Trong tru'dng hdp viem tai dinh chi khu trii d thu'dng nhT thu'dng gay cam giac dau trong tai va u tai, nhuTig sire nghe benh nhan binh thu'dng hoac giam nhe. De giai quyet nhij'ng trieu chu'ng ciia ngu'di benh, cung nhu* ngan ngira sir tien trien thanh benh tich Cholesteatme de t^i nay du'dc thu'c hien vdi muc tieu: Danh gia ket qua phau thuat tao hinh tu'dng thWdng nhi trong viem tei dinh tdn thWdng tWdng thWdng nhi.
IL 0 6 1 T U 0 N G VA PHUONG PHAP NGHIEN COU 2 . 1 . f}dl tu'dng nghien cuti
Benh nhan du'dc chan doan viem tai dfnh, phau thuat tao hinh tu'dng thu'dng nhT tir 2007-2011.
Tieu chuan chpn benh nhan:
-I- Npi soi: Tu'dng thu'dng nhT bi tieu huy 1 phan hay toan bd.
Chan doan viem tai dinh khu tru thu'dng nhT dp 3&4.
+ Oo^sirc nghe ddn am: tnidc va sau phau thuat, + Phau thuat: tao hinh tu'dng thu'dng nhT.
-I- Npi soi tai danh gia sau phau thuat: 3 va 6 thang.
- Tieu chuan loai triT: Cholesteatome thu'dng nhT.
-i- Viem tai dfnh khu t m thu'dng nhT: dp 1 & 2.
-I- Khdng dii cae tieu ehuan tren.
2.2. Phu'(jng phap nghien cu'u Md hinh nghien ciiU: thy'c nghiem lam sang.
Phu'dng tien nghien ciTu
Ndi soi optic 1.9 va 4.0 mm loai 30°, 0°.
May chup CLVT cat ldp, lat cat 0,75mm.
May do thinh li/c SD50 ciia Dire.
Kfnh hien vi phau thuat. Khoan vi phau, bd dung eu phau thuat tai.
• Chat lieu nghien ciTu: Mang sun va sun binh tai.
• Ky thuat: tao hinh tu'dng thu'dng nhT du'dng trong ong tai.
• Oanh gia ket qua: 3&6 thang sau phau thuat Npi soi tai: danh gia tu'dng thu'dng nhT.
Trieu chirng ed nang. So sanh FTA (trung binh du'dng khi d 4 tan sd 0,5, 1, 2 va 4 kHz), ABG (khoang each giUa 2 du'dng khi va xu'dng) tru'dc va sau phau thuat.
• Xii ly sd lieu bang chu'dng trinh Epi6.04.
III. KET QUA
3 . 1 . Oac d i e m chung
- Trong 21 tru&ng hdp phau thuat cd 12 (57,2%) tao hinh tu'dng thu'dng nhT ddn thuan, cd 9 tru'dng hdp (42,8%) ket hdp tao hinh xu'dng con.
- Thcfi gian theo ddi trung binh la 15,2 thang, ngan nhat la 6 thang va dai nhat la 42 thang.
Trieu chuTig tru'dc phau thuat 3.2. Trieu chu'ng l a m sang Bang3.1;Tneii chCrnq cd nanq Trieu chu'ng ctf nanq(N=:21) J tai
Dau tai Ngtie kem Cliay mCr tai
n 17 12 9 5
80,9
%
57,1 42,8 23,8
Nhan x e t : Trieu chuTng thu'dng gap nhat la u tai 80,9%, trieu chu'ng u tai ehiem ty le 5 7 , 1 % , trieu chuYig nghe kem chiem ty le 42,8%, gap it nhat la chay mu tai chi chiem 23,8%. Su" khac biet cd y nghTa thdng ke vdi p = 0,049 (x2 = 7,82).
Bang3.2:lx\eu chiing thdc the Phan d9 viem tai
dinh(N=21) Bo 3 M 4
Khu tru cf thuang nhT n
5 7
41,7
%
58,3
Ket hcjp ca mang cang+ gian doan xu'dnq con n 0 9
%
0,0 100,0Y HOC VIET NAM THANG 4 - S6" 1/2012 Nhan x e t :
Viem tai dinh khu tru d thu'dng nhT va khdng gian doan xu'dng con chiem 12/21 (57,1%), cao hdn so vdi viem tai dinh lan xudng gde sau tren va cd ed gian doan xu'dng con chiem 9/21(42,9%).
Sd khac biet khdng cd y nghTa thdng ke vdi p = 0,84 (x2 = 0,04).
Trong viem tai dinh chi khu trii d thu'dng nhT gap viem tai dfnh dd 3 la 41,7%, thap hdn so vdi dd 4 chiem t y l e 58,3%.
- Trong viem tai dfnh lan xudng gde sau tren va cd ton thu'dng xu'dng con thi chi gap d viem tai dfnh thu'dng nhT dp 4.
3.3. Trieu chii'ng can lam sang Bang 3.3: Siic nqhe Su'c nghe (dB) PTA ABG
Ton thu'dng tu'dng thu'dng nhT 17,5 ± 8,7
7,5 ± 6,1
Ton thu'dng tu'dng thu'dng nhT+
xu'dng con 52,4 ± 11,7 41,2 ± 6,7 Nhan xet:
PTA & ABG eiia viem tai dfnh khu trii d thu'dng nhT nam trong gidi han binh thu'dng.
- PTA ciia nhdm viem tai dfnh thu'dng nhT lan rdng la 52,4 dB, la loai nghe kem trung binh.
Ket qua sau p h l u thuat 3.4. Trieu chii'ng cd nang Bang 3.4: Oac diem trieu chu'ng cd nang Trieu chOfng cd
nang Utai Dau tai Nghe kem Chay mu tai
Tru'dc phau thuat (N = 21) n 17 12 9 5
»/o 80,9 57,1 42,8 23,8
Sau phau thuat ( N = 2 1 ) n 3 1 4 0
14,3
%
4,8 19,1 0,0 Nhan x e t :
Trieu chirng ii tai tru'dc phau thuat la 80,9%, sau phau thuat chi cdn chiem 14,3%.
Dau tai tru'dc phau thuat chiem 5 7 , 1 % , sau phau thuat ehi edn 4 , 8 % .
Nghe kem tru'dc phau thuat chiem 42,8%, sau phau thuat cdn 1 9 , 1 % . Chay mil tai khdng gap tru'dng hdp nao sau phau thuat.
3.5. Trieu chu'ng thiTc t h e
Ndi sol tai: khdng gap tru'dng hdp nao tu'dng thu'dng nhT bi Idm hay thiing lai.
Anh 3.1:Jrddc phau thuat: Viem tai dinh d d 4 - N g d T h i M - N i j ' - 5 1 tudi
l.Chdm bita 2.Co biia 3.Mang cang 4.Thirng nhT 5.Gai nhT sau
Anh 3.2: Sau phau thuat 6 thang SBA: 1103624-FT;22/7/2011 6.Khdp biia-de 7. Nganh xudng xu'dng de
Y HOC VIET NAM THANG 4 - SO 1/2012 3.6. Su'c nglie dtfn a m
Banq 3 . 5 ; dac diem sire nahe tru'dc va sau phau thuat Su'c ngiie(dB)
PTA ABG
Ton thu'dng tu'dng thi/dng nhT (n=12) Tru'dc phau thuat
17,5 ± 8,7 7,5 ± 6,1
Sau phau thuat 16,1± 7,9 8,5 ±5,7
Ton thu'dng tu'dng thu'dng nhT+
xUdnq con ( n = 9 ) Tru'dc phau thuat
52,4 ± 11,7 41,2 ± 6,7
Sau phau thuat 34,5± 15,6
24,4± 9,9 Nhan xet: - PTA va ABG tru'dc va sau phau
thuat CO SLT khac biet, nhu'niTg khong co y nghla thong ke vifll p = 0,24 (F stastlstic= 1,42)
- PTA sau pliau thuat cua nhom co ket hop tao hinh xu'dng con la 34,5 dB ca gia tri nho hOn so vcii trudc phau thuat la 52,4 dB. Sir khac biet CO y nghTa thong ke vdi p = 0,00001 (F stastistic= 105,63).
IV. BAN LUAN 4.1. Oac diem chung
- Viem tai dinh khu tru thu'dng nhT (tui co keo thu'dng nhT), cd the gap til do 1 den do 4 [5], tuy nhien dp 1 va 2 thu'dng khong gay kho chiu cho benh nhan, do vay thu'dng khong can thiep gi. Tuy nhien dp 3 va 4 thu'dng gay cac trieu chu'ng lam benh nhan khd chju, do dd benh nhan mdi di kham benh.
- Thdi gian theo doi sau phau thuat tir 6- 42 thang, la thdi gian du dai de danh gia hieu qua phau thuat.
4.2. Trieu chu'ng tru'dc phau thuat Trieu chu'ng lam sang
- Trieu chu'ng thu'dng ga|) nhat la u tai chiem tdi 80,9%, cao hdn cac trieu chu'ng khac (bang 3.1). Su' khac biet cd y nghTa thong ke vdi p = 0,049 ((x2 = 7,82). U tai thu'dng khong ro rang, co lljc thay cam giac day nang trong tai nhu" bi nu'dc vao tai, cd luc thay tieng lach tach trong tai. Cd the do roi loan chu'c nang vpi nhT, tao nen ap luc am trong thifdng nhT nen gay cam giac day nang trong tai [2]. Oau tai chiem 57,1%
la trieu chu'ng thu" hai thu'dng gap (bang 3.1), dau tai cung khong ro rang, khong dau am i hay lien tuc, ma chi thinh thoang thay dau nhdi trong tai khi nuot va khi ngap, €au dd lai binh thu'dng.
Chay mu tai rat it gap, chi gap trong nhifng tru'dng hdp do qua trinh bong vay bieu bi lau tich tu lai sau do bj boi nhiem.
Npi soi tai de chan doan viem tai dinh ttlu'dng nhi, de danh gia dp viem tai dinh va vi tri tpn thLfcfng. Viem tai dinh co lam gian doan xifdng cori khong. Bang 3.2 cho thay viem tai dinh khu tru thu'dng nhT do 3 thu'dng khong td'n thifdng xu'dng con, viem tai dinh dp 4 da lan xuong goc sau tren
lam mat gai nhT sau thifdng gay gian doan nganh xuong xu'dng de va xu'dng ban dap.
. Trieu ChuTng can lam sang Do su'c nghe ddn am (bang 3.3) khong thay giam sire nghe d nhdm ton thifdng chi khu ti^u hoan toan d thUdng nhT. Nhu'ng d nhdm ma ton thu'dng da pha huy gai nhT sau va lan xudng goc sau tren cua mang cang thi sifc nghe giam ro, do xifdng con bi gian doan. Dieu nay chu'ng td rang viem tai dinh khu tru d thu'dng nhT mac du mang chung dinh chat vao ca khdp bua de cung gay giam SLTC nghe, sifc nghe chi giam khi cd gian do^n xu'dng con [1],[2].
4.3. Ket qua sau phau thuat
• Trieu chu'ng cd nang
- Sau phau thuat trieu chu'ng u tai va dau tai giam tif 80,9% va 57,1% xuong cdn 14,3 va 4,8% (bang 3.4). Bleu nay cd the giai thich do tao hinh tu'dng thifdng nhT nen da tap du'dc khoang thong khi can thiet cho thu'dng nhT, ap life thu'dng nhT can bang vdi ap life d phan mang cang. He thdng xifdng con rung dpng binh thu'dng khong bi can trd. Chay mu^tal cung het hoan toan sau phau thuat do Idp bleu bi bong ra khdng bi tich tu nhU trUcfc.
• Su'c nghe ddn am
Su'c nghe ddn am tru'dc va sau phau thuat cd thay dpi d nhdm khdng tao hinh xu'dng con (bang 3.5), nhu'ng khdng co y nghla thong ke vdi p = 0,24 (F stastistlc= 1,42). Bieu nay chifng td rang tap hinh tu'dng thudng nhi khong iam suy giam sifc nghe ciia ngu'di benh.
V. KI'T LUAN
Tao hinh tu'dng thifdng nhT lam giam cac trieu chifng khd chiu cho ngifdi benh. U tai va dau tai giam tif 80,9% va 57,1% xudng con 14,3% va 4,8%.
- Khdng lam suy giam sue nghe, ngan ngifa qua trinh tao thanh Cholesteatoma thu'dng nhT.
TAI UEU THAM KHAO
1. Manner AL (2003), "Adhesive aitis Media", A pocket guide to the ear, Thieme-Stugatt- Newyork, pp. 68-70.
Y HOC VIET NAM THANG 4 - SO 1/2012 Palva T e t a l (2001), "Anatomy and pathology
of the Epitympanum", Courlor atlas of the anatomy and pathology of the Epitympanum, Karger, pp.1-51.
Palva T et.al (2001), "Pathology related to amniotic fluid cellular content and superimposed infection", Courlor atlas of the anatomy and pathology of the Epltympanum, Karger, pp.61-62.
Palva T e t a l (2001), "Miciosurgical Approaches to imflammatory Ear disease", Coudor atlas of die anatomy and pathology of We Epitympanum, Karger, pp.94-97.
Sade J et.al (1981), "Atelectesis Retraction Pockets and Cholesteatoma", Acta Otolaryngol (92), pp.901-912.
CHAN DOAN CAC HJNH THAI TON THlATNG TIET NIEO
SAU PHAU THUAT S A N P H U KHDA
Hoang Long*
T 6 M TAT
Ton thu'dng tiet nieu sau mo san phu khoa ngay cang t3ng. Nghien culi nham muc tieu chan tfoan cac hinh thai ton thUdng tiet nieu sau phau thuat san phu khoa cua b§nh nhan du'dc dieu tn fan dau tai khoa Tiet nieu Benh vien Viet Su'c txi 4/2005 den 9/2010. 106 BN nu" tuoi tii 21 den 65 (trung binh 42.52 ± 10.47).
Hau nhu khong chan doan TTTN trong mo ngoai tru' 1 ton thUdng BQ. Chan doan mugn sau 1 thang la 53.8% va sau 1 nam la 16%. Bieu hien lam sang thu'dng g§p nhat la ra nUdc heu am dao (67.9%). Tat ca cac hinh thai TTTN deu co mat. Trong 97 TTTN dOn thuan, 46.2% la ro BQ - AD, 26.4% la hep NQ 1 ben, 14.1% la ro NQ - AD, 0.9% la ro BQ - TC. O 9 BN co da TTTN (8.5%), 2 co hep NQ 2 ben (1 kem ro BQ - AD), 7 CO hep NQ 1 ben di kem 5 ro BQ - AD va 2 ro NQ - AD ben doi dien. Cat tir cung va mo lay thai la hai nguyen nhan chfnh gay TTTN vdi ty le lan \\i(St la 64.2% va 30.2%. Mo md cat tir cung gay ra TTTN nhieu hdn mo npi soi ((70.3% so v6i 29.7%). Tuy nhien, mo ngi soi gay da ton thUdng d 7/8 BN (87.5%) cao hdn PT md (12.5%), khac biet co y nghia thong ke vdi p < 0.05.
Td khoa: C3t tLf cung, hep nieu quan, ro nieu quan-am dao, ro bang quang-am dao.
SUMMARY
Diagnosis of the urological complication forms after gynaeco-obstetric surgery The rate of urological complications in gynaeco- obstetric surgery was more and more increasing. We would like to report our experience in diagnosis of the lesion forms of urological complication patients treated the first time in Department of Urology, Viet Duc hospital from 4/2005 to 9/2010. 106 females age from
•* Khoa Tiet nieu - Benh vien Viet Ddc Phan bien khoa hgc: PGS.TS. Nguyen Van Huy
21 to 65 (mean 42.52 ± 10.47). I t ' s almost impossible to diagnose these complications during operation except one case of bladder lesion. 63.8% of cases were diagnosed after 1 month and 16% after 1 year.
The frequency of clinical signs was vaginal urinary leakage (67.9%). Our data base showed all of the urological complication forms. In 97 simple lesion (91.5%): 49 were simple vesico-vaginal fistula (46.2%), 28 were ureteral stenosis (26,4%), uretero- vaginai fistula occupied 14.1% and 1 case of vesico- uteral fistula (0.9%). The multi lesion form was 8.5%:
2 bilateral ureteral stenosis (1 with vesico-vaginal flstula), 7 ureteral stenosis, in which, 5 cases combined with vesico-vaginal fistula and 2 cases with uretero-vaginal fistula of opposite side. The hysterectomy and cesarotomy were two principal causes with the rates were 64.2% and 30.2%, respectively. Open hysterectomy had complications more than laparoscopy (70.3% versus 29.7%).
However, The rate of multi lesion form causing by laparoscopic hysterectomy (87.5%) was higher than open hysterectomy (12.5%) with statistically significant level p<0.05.
Key words: Hysterectomy, ureteral stenosis,- uretero-vaginat fistula, vesico-vaginal fistula
1.
OAT VANo i
Ton thu'dng tiet nieu (TTTN) do phau thuat san phu khoa (PTSPK) la thu'dng gap va chiem khoang 1 % . Theo cac tac gia My, co 4 % cac PTSPK gay ton thu'dng nieu quan. Trong nhijtig nam gan day, chi dinh FTSPK du'dc ap dung ngay cang rpng d tat ca cac tuyen benh vien. Cac TTTN sau mo san phu khoa co xu hu'dng tang len va ngay cang phut tap do trinh dp cua phau thuat vien d tuyen
