DieU K^T GlAC

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Nguydn nhin chu yeu g i y benh ly tuy ring l i do bien chu-ng cua s i u ring, chiem ty Id 92,3%-.

Vj tri Id siu thudng gap d RHL thCr hai him dudi l i CO ring phia mit xa.

So lugng OT: RHL1 him dudi cd 4 ong OT chiim ty Id khi cao 53,6%) va 3 OT l i 46,4%), thudng phin bo 2 OT g i n (gin ngoii v i g i n trong) v i 1 hoic 2 OT xa. RHL2 him dudi chu yeu cd 3 OT, chiim 70,8% va 2 OT l i 20,8%).

Hinh anh X-quang: ton thuang tidu xuang vung quanh cuong ring la 11,54%o, giin diy chang l i 32,69% v i khdng ed ton thuang l i 55,77%.

TAI LIEU THAM KHAQ

1. Trin Thj Lan Anh (2005). Dinh g i i sa bd hidu qua lim sing su- dung trim xoay NiTi Protaper

trong dieu trj tuy. Luin v i n Thae sy y hpc, Trudng Dai hpc Y H i Ndi, 41 - 4 2 .

2. Nguyin Thj Ngpc Dung (2007). Nhin xet danh gii lim sing, Xquang v i dinh gii kit qua diiu trj tuy ring 6,7 him dudi vdi dung cu file cam tay thudng vdi dung eu file Protaper miy, Luin vin chuydn khoa cip 2, Trudng Dai hpc Y H i Ndi, 37.

3. Nguyin Dang Du'ang (2006). Nhin xet hinh t h i ong tuy rang 6,7 him dudi d benh nhin tren 60 tuoi v i kit qua diiu trj, Luin vin thae sy Y hpc, Trudng Dai hpc Y H i Ndi, 1 - 30.

4. E. Kim, A. Fallahrastegar, Y. Hur, Y. Jung, S. Kim (2005). Difference in root canal length between Asians and Caucasians, International Endodontic Journal, 38 (3), 149-151.

Summary

CLINICAL AND X RAYS CHARACTERISTICS OF FIRST MOLARS, SECOND MOLARS IN PATIENTS WITH ENDODONTIC TREATMENT

Describe the clinical and X - rays features of the mandibular first and second molars in patients with endodontic treatment. Methods: a longitudinal randomized controlled clinical trials, no comparison was made on 52 first and second molars of mandible of 50 patients, aged 15 60, whom indicated endodontic treatment without surgery. Results: Irreversible pulpitis was 63.47%. Complication of dental caries was 92.3%.

Number of root canals: Mandibular first molar has 4 root canals relatively high percentage of 53.6% and 3 root canals was 46.4%), usually distributed 2 root canals in mesial root (mesiobuceal and mesiolingual) and 1 or 2 root canal in distal root; the mandibular second molars has generally 3 canals, 70.8% for 3 canals and 20.8% for 2 canals. X ray images: bone resorption appear in periradieular tissues relatively percentage of 11.54%, 32.69%) was stretching the ligaments and no injury was 55.77%). Conclusions: The major disease of endodontic treatment of the mandibular first and second molars are irreversible pulpitis.

Caries often found in mandibular second molars are near the gingiva on distal surface. In X - ray images, patients with no injury has more than 50%).

Keywords: molars, endodontic treatment without surgery, X - ray

K^T QUA LAU DAI

P H A U

THUAT

C A T

BE CUNG GlAC MAC CO GHEP

M A N G 6 |

DieU TRj GLOCOM

T A I P H A T

SAU

M 6

Trin Thanh Thuy Bdnh vidn HO-u Nghj

Dinh gii kit qua cua phau thupt cit be cung giic mpc (CGM) cd ghep ming di. Nghien ciru tren 35 mat gidcdm tii phit (sau PT) cd spo xa xau. Nghiin ciru md ti lam sang tiin ciru khdng ddi chung. Kit qua: Nhin ip (NA) tmng binh h9 tir 31,86 ± 6,335 mmHg (tnrdc mo) xudng 18,40 ± 2,67 mmHg (sau 12 thing PT). MUX: hp NA tmng binh tir 13.46 mmHg (42,25%,) din 19,35 mmHg (60,73%,). So lopi thude tra hp NA tmng binh giim tir 1,17 (tmdc PT) xudng 0,34 (sau PT 12 thing). Thj luc (TL) sau PT 6n dinh hoic ting han tmdc. Thdi diem cudi theo ddi, spo bpng tdt, khi, xiu ttrang img li 20%; 77,1%: 2,9% . Biin chimg trong va sau md khdng xay ra. Kit lupn: PT cat be CGM gh6p ming di

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TCNCYH Phu trwong 74 (3) - 2011

ed hieu qua vi an toin, cd thi la 11wa chpn tdt ddi vdi nhung trwdng hvp gidcdm tai phit sau md Id dd.

Tir khoa: phlu thuat cit be, ghep mang 6i

I. DAT

VAN

D i

Phiu thuit eit be CGM l i phuang phip pho biin diiu trj gidedm. Kit qua phau thuat niy se tao dugc khoang trdng giira kit mac v i cung mac dugc gpi la seo bpng. Bpng niy cd ehCre nang ehCra thuy djch v i tao hieu qua ha dugc NA va bao tdn dugc TL. Trai qua thdi gian, bpng cd q u i trinh liin seo. Hiu qua din tdi xa hoi v i mit ehu-e nang cua seo bpng. Cac nha nghien cCru ludn tim tdi cio vat lieu Crc ehi tao seo xa. Trong ljch su- nhan khoa, tren t h i gidi v i Viet Nam d i cd nhiiu bien phip die biet, vide sCr dung thude chdng chuyen hoa Mitomycin C v i 5 Fluorouraeil trong v i sau phau thuit eit be ngay cang phd biin.

Phuang phip niy ning cao hieu qua phiu thuat cit be rd ret nhung cd mdt vii tie dung khdng mong mudn nhu anh hudng din TL: viem giac mac, phu hoang diem do nhan ap thip...vi die biet la nguy ca rd vd seo bpng dua din nhiim triing seo bpng va nhiem triing ndi nhan. Vide tim chit lieu thay t h i ting hieu qua PT cit be ma han

"chi tdi da biin ehCrng rit c i n thiit.

Ming di ngudi l i md sinh hpc vd mach cd the cay ghep ddng loai. Ming niy da dugc FDA (My) ChCrng minh cd cie die tinh sinh hpc: kha ning Crc che qua trinh tao xa, Crc c h i q u i trinh ting sinh mach miu, chdng viem, khing khuin, Crc ehi miin djch, khdng bj thai loai manh ghep. Tren t h i gidi, ming oi ngudi da dugc su- dung de su-a chii-a nhii-ng roi loan b i mat nhan c i u . Tir nhirng nam diu thi ky 20 khi dat mang di dudi vat kit mac v i cung mac, seo bpng cua thd thye nghidm dugc cai thidn rd ret thdng qua ca che giam xa v i chdng viem. Nghien cu-u cua Lu H (2003), Stavrakas P (2008) diu dua ra nhin xdt su- dung PT cat be CGM ghep mang oi d ngudi hieu qua va an toin.

ChCing tdi d i cd bao cao kit qua ban diu (sau 5 thing) eua PT nim 2008. O i nhin djnh hidu qua PT liu d i i han ndn ehung tdi tien hinh thye hien d i t i i niy vdi muc tieu: Dinh gia kit qua liu d i i cua phau thuit cit be CGM cd ghep ming di.

II. OOl TU'QNG VA PHU'QNG

PHAP 1. Ddi tu'ang

35 mat gidedm gdc ddng, gdc md nguyen phit da PT c i t be cung giac mac nhan i p khdng diiu eh?nh (> 21 mmHg do bing nhin i p ke Goldman) ed seo xa xau tCr thing 08/2007 den thing 12/2009 tai khoa Gidcdm - benh vien Mit Trung uang.

2. Phu'ang phip

Su- dung phuang phap md ta lam sing tiin eu-u, khdng ddi ehCrng.

Phuang phap phiu thuit eit be CGM ghep mang oi:

Cac budc dugc tien hinh nhu phau thuit cit be cung giic mac dan thuan cd kit hgp dit mang 6i tren v i dudi vat cung mac vdi kich thude tuong Crng 10 x 10mm va 6 x 10mm.

Kit qua PT dugc danh gii khi ra vien, sau 1 tuin, 2 tuan, 1 thing, 3 thing, 6 thing, sau 12 thing.

Trong moi lin kham, benh nhin dugc kiim tra thj luc, nhin i p , mep mo, seo bpng, giic mac, tiin phdng, ddng tu-, the thuy tinh, gai thj, bien chu-ng trong v i sau mo.

-Danh g i i kit qua:

Thj luc; biin doi thj lye ed y nghTa khi:

Thj lye > 1/10 cd biin ddi it nhit mdt hing theo bang thj lye LandolL

Thj luc < 1/10 cd bat ky sy thay ddi nio.

+ Seo bpng: tdt (bpng thim tda lan, b i mit bpng vd mach); k h i (bpng thim tda lan nhung be mat nhieu mach miu); x i u (khdng tao bpng).

+ Sd loai thude tra ha NA trung binh dugc tinh bang tong sd eic loai thuoc tra cua t i t ca eic doi tugng nghien eCru chia trung binh.

3. Xii' ly sd lieu: bing chuang trinh SPSS 16.0.

III. KiT QUA

Nhdm doi tugng nghien cCru bao gom: 11 nam (34,4%), 21 nu- (65,6%); 26 mit gdc ddng (74,3%), 9 mit gdc md (25,7%)).

1. Kit qua thj lye: Sau mo TL cd cai thien (phan Idn cie mit tang hoac on djnh).

NA trung binh ha rd rdt so vdi trude mo cd y nghTa thong ke tai t i t ca cac thdi diim. MCrc ha NA nhieu nhit d thdi diim ra vien (60,73%), thap nhat d 12 thing sau PT(42,25%o).

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Thai gian Sau 1 tuan Sau 3 thing Sau 6 thing Sau 12 thing 2. Kit qua nhan ap

Thd'i gian Trude PT Ra vidn Sau 1 tuin Sau 2 tuin Sau 1 thing Sau 3 thing Sau 6 thing Sau 12 thing

Bang 1:

B i i n ddi Tl

Bang 2.

: B i i n ddi thj liPc co chinh kinh sau Tang

n 16 25 25 19

%>

45,71 71,43 71,43 54,29 Tinh trang nhan i p

Nhan i p 31,86 ±6,335

12,51 ±6,55 13,66 ±5,218

15,8 ±3,879 17,03 ±4,197 16,94 ± 3,421 16,34 ± 2,449 18,4 ±2,67

p h i u thuat d n djnh

n 19 10 10 13 tru'ac va sau

% 54,29 28,57 28,57 37,14 p h i u thuat Mii'c ha NA

19,35 18,2 16,06 14,83 14,92 15,52 13,46

n 0 0 0 3

Giam

% 0 0 0 8,57

Mire ha NA (%) 60,73 57,12 50,41 46,55 46,83 48,71 42,25

NA trung binh ha rd rdt so vdi trude mo cd y nghTa thong ke tai t i t ca cie thdi diim. MCre ha NA nhiiu nhat d thdi diem ra vien (60,73%)), thip nhit d 12 thing sau PT (42,25%)

3. Kit qua thude tra ha NA

So vdi trude mo, so loai thuoc tra ha NA bo xung trung binh d i giam tir 1,17 ± 0,514 (trude PT) xuong 0,14 ± 0,55 (ra vien), 0,17 ± 0.568 (sau.1 tuin), 0,17 ± 0,453 (sau 2 tuin), 0,34 ± 0,639 (sau 1 thing), 0,46 ± 0,701 (sau 3 thing), 0,43 + 0,698 (sau 6 thing), 0,34 ± 0,684 (sau 12 thing). So thuoc trude v i sau mo giam khic biet cd y nghTa thong ke (p < 0,001).

4. K i t qua seo bpng sau p h i u thuat

Giai doan sdm sau PT, hiu hit seo bpng diu tdt. Thep thdi gian ty Id niy giam din ngugc lai ty Id seo khi ting din. 1 mit (2,9%o) seo x i u tai thdi diem 1 tuin v i 12 thing.

Bang 3. Tinh trang seo bpng sau p h l u thuat (%>)

Seo ^{Ra vien} ^{1 tuan} 2 t u i n 1 thing 3 thing 6 thing 12 thing

Tit 88,6 85,7 85,7 51,4 34,3 28,6 20

Khi 11,4 ^11,4 ^14,3 ^48,6 ^65,7 ^71,4 77,1

Xiu 2,9 ⁰ 2,9

5. Biin chii'ng: ChCing tdi khdng gip biin chirng gi die biet trong v i sau PT.

IV. BAN LUAN

Thj lye: so mit cd ting TL sau mo eua chung tdi khi cao bdi trude m i hiu hit bdnh nhin deu c6 NA rit cao, cie mdi trudng trpng suit bj phu nhiiu. Sau mo, NA ha tot v i hau nhu khdng ed

biin ehCrng gi trong v i sau mo ndn nhiiu mit trong nhdm d i ed TL cai thien han. Tuy nhien, do cie mit d i bj benh d giai doan ning ndn TL ed ting nhung khdng nhieu. Chi cd 8,57% mit tai thdi diim 12 thing giam TL do thuy tinh t h i due ting theo thdi gian.

Nhan ap: MCrc ha nhin i p so vdi trude mo nhiiu nhit trong khoang 1 tuin sau PT v i tuang

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TCNCYH Phu trwong 74 (3) - 2011

ddi on dinh sau 2 tuin, cd giam nhe theo thdi gian. ChCing tdi cd the ly giai hidn tugng niy bdi ming oi cd tie dung va sau dd tieu di trong vdng 36 ngiy [1]. D i y l i thdi diim sy tang sinh xa, phan u-ng vidm, mien djch xuit hien ndn ming oi phat huy hieu qua dung luc. Kit qua eua chung tdi tuang ty Lu H, Stavrakas P nhan i p sau PT d i u ha rat tdt.

Bang 4. MCPC thay ddi nhan ap tren m i t tang nhan ap tai phat T i c gia

Lu H (2003) [4]

Stavrakas P (2008) [5]

T.T.Thuy (2009)

n 17 20 34

NA tru'd'c md (mmHg) 39,72 ± 7,26

24 31,86 ±6,335

NA sau md (mmHg) 14,62 ±3,72

15,18 ±2,3 18,4 ±2,67

Mii'c ha NA 15,1 mmHg (38,0%) 8,82 mmHg (36,8%) 13,46 mmHg(42,25%) Thuoc ha nhan i p : Sau mo, sd loai thuoc tra

ha NA trung binh sau mo so vdi trude mo eua ehung tdi giam di rd ret cd y nghTa thong ke d mpi thdi diim nghien cCru. MCre dp ha niy eua ehung tdi (70,9%)) tuang duang cua Stavrakas P (78,1%) [5[.

Seo bpng: Ngay sau mo, seo bpng cd hinh thii tot v i khi. Tuy nhien 1 mit (2,9%)) bj tudt chl kit mac (sau 1 tuin PT) v i chung tdi cd khau lai sau dd seo niy dugc dinh g i i l i tdt trong 12 thing theo ddi. Theo thdi gian, chung tdi nhin thay kich thude, dd gd eua seo van dugc on dinh nhung xuit hien mach miu trdn be mat seo. Do viy, sd seo tdt giam din thay vao dd seo khi ting tuang u-ng. Sau 12 thing PT, 1 mit seo x i u cd NA diiu ehinh vdi 1 loai thude. O i giai thich hien tugng niy, mdt sd tic gia cho ring khi ming di cdn ton tai thi ludn tiet mdt sd yiu td endostatin, thrombospondin 1, PEDF (pigment epithelium derived factor)... [2, 3] nen ed kha ning Crc ehi ting sinh tin mach nhung khi ming oi tieu tie dung bj han ehi di phin nio.

Biin chii'ng

Biin ChCrng trong phdu thuat: Cung nhu kit qua nghien cCru eua nhiiu tie gia tren the gidi trong qui trinh phiu thuiL chung tdi khdng gap biin ehCrng.

Bidn chirng sau phau thuat: Khic vdi nghidn cCru eua ehung tdi, Lu H, Stavrakas P gap mpt s6 biin chCrng nhe nhu phan Crng tiin phdng, bpng nang bao tenon.

V. KfiT LUAN

Phau thuit da tao seo bpng ed hinh thii tit va ed chuc ning ha nhin i p toL so thuoc ha nhin ap giam, thj lye d mCre on djnh hoic ting han trude mo, khdng bj biin ehCrng.

TAI

LIEU THAM

KHAQ

1. Barton K, et al (2001). Glaucoma filtration surgery using amniotic membrane transplatation, Invest Ophthamol Vis Sci, 42 (8), 1762 -1768.

2. Dua S.H, Gomes J.A.P, et al (2004). The amniotic membrane in ophthalmology, Sun/ey of Ophthalmology, 49(1), 51 77.

3. Hao Y (2000). Identification of antiangiogenic and antiinflammatory proteins in human amniotic membrane". Cornea, 19 (3), 384 - 352.

4. Lu H, Mai D (2003). Trabeculectomy combined amniotic membrane transplatation for refractory glaucoma, Yan Ke Xue Bao, 19 (2), 89-91.

5. Stavrakas P (2007). Amniotic membrane transplantation in glaucoma filtration surgery:

comparison between amnion shieldel trabeculectomy and standard trabeculectomy, Online Abstract Submission and Invitation System.

S u m m a r y

LONG TERM RESULT OF TRABECULECTOMY WITH AMNIOTIC MEMBRANE TRANSPLANTATION FOR THE TREATMENT OF

RECURRENT GLAUCOMA

To evaluate the effect of trabeculectomy combined AM transplantation. This clinical prospective study 35 eyes with primary glaucoma after unsuccessful trabeculectomy have fibroblastic flat bled. The mean preoperative intrapcular pressure (lOP) was 31.86 ± 6.335 mmHg (preeperative) which decreased to

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18.40 ± 2.67 mmHg (at 12 months preoperative). The decreased mean postoperative lOP from 13.46 mmHg (42.25%)) to 19.35 mmHg (60.73%). The mean number of glaucoma medications was reduced from 1.17 preoperatively to 0.34 at 12 months postoperatively. All eyes were remainded or increased their visual acuities. The was 27.2,% diffusion bleds, 72.7% functional bleds, 2.9% flat bled after 12 months. There was not complication in operation and posoperation. Conclusion: Trabeculetomy combined AM transplantation is a safe and effective. That should be evaluated as an good option for recurrent glaucoma.

Keywords: trabeculetomy, amniotic membrane transplantation

XAC DINH LOAl VA DO NHAY

C A M V Q I K H A N G

SINH CUA VI

K H U A N G A Y

VIEM TAI GIO'A MAN

T I N H

THUNG

M A N G NHT Q

TRE EM

Pham Tran Anh Trwdng Dai hoc Y Hd Ndi

Nghien ciru nhim xic djnh loai vi dp nhay cim vdi khang sinh ciia vi khuan giy viem tai giira man tinh thung ming nhT d tre em tai bpnh vien Tai Mui Hpng Trung wang tir 01/02/2010 din 31/03/2010. Phwang phip nghien cwu: 38 bpnh nhi cd viem tai giwa man tinh thiing ming nhT mdt ben hoic ca hai ben dwac thim khim lim sing, mu tai dwac giri den phdng xet nghiem vi sinh ciia Benh vipn Tai Mui Hpng eiy tim vi khuin vi lim khing sinh dd. Phwang phip nghien cuv la tiin ciru, md ta cat ngang cd phin tich. Kit qua: Ti le eiy vi khuan dwang tinh li 78,95%,. Pseudomonas aeruginosa chiim tdi 28,12% chiim ti le cao nhit, tiip theo li Moraceila catarrhalis: 25%, Staphylococcus aureus:

21,87% va Hemophilus Influenzae: 15,62%. Kit qua khang sinh dd cho thiy eic vi khuan niy hiu nhw khing Ipi cie khang sinh phd biin dang sir dung. Kit luin: Hiu hit eic chung vi khuin nhw tu ciu ving, M.catarrhalis, H.influenzae deu khing lai cie khing sinh thdng dung. Cie vi khuan phin lap duvc cdn nhay cim vdi mdt vai khing sinh

cephalcspprin thi he 2, 3 vi cap phdi hvp amoxicilin/clavulanat

TIP khoa: viem tai giu-a man tinh 6- tre em, hinh anh vi khuan hoc, do nhay cam vai khang sinh

I. OAT V A N D ^

Viem tai giu-a (VTG) hien nay l i mdt bdnh rit hay gap trong tai mui hpng, tren khoang 2 - 5% din so theo udc tinh eua To chCre Y t i T h i gidi. Tie nhin giy VTG chu yiu l i vi khuin. 0" Viet Nam, viem tai giu-a man tinh (VTGMT) chiem khoang 3 - 5% cie bdnh ly tai mui hpng d tre em. So benh nhin niy neu khdng dugc diiu trj kjp thdi se ed nhiiu kha ning bj viem tai giu-a man tinh khi trudng thinh. Diiu niy giy trd ngai r i t Idn cho v i n de dieu trj vi diy l i mdt benh dien bien liy nim, giy diec, anh hudng nhiiu d i n phit trien [1, 2, 3].

Vidm tai giu-a man tinh thung ming nhT d tre em ed nhiiu nguydn nhin, trong dd nhiim khuin l i mdt trong nhu-ng nguyen nhin thudng gap nhit vdi muc tieu: Xic djnh loii v i dp nhay cam vdi khing sinh eua vi khuin giy vidm tai giu-a man tinh thung ming nhT d tre em tai benh vipn Tai Mui Hpng Trung uang tCr 01/02/2010 d i n 31/03/2010.

II. D 6 I TU'QNG VA PHU'QNG P H A P 1. Ddi tu'ang

38 benh nhin dip Crng du yeu ciu nghien cu-u dugc chpn tCr 45 trudng hgp bdnh nhin tre em dugc khim ndi soi, do thinh Igc, nhT lugng, chin doin viem tai giii-a man tinh thung ming nhT dugc diiu trj ndi tru v i ngoai tru v i xet nghiem vi khuin djch tai giu-a tai khoa Khim bdnh bdnh vidn Tai Mui Hpng Trung uang.

2. Tieu chuin lya chpn benh nhan

Cd benh i n diy du, dung quy djnh; Ndi soi chup anh mang tai, tinh trang mui hpng; Kit qua thinh luc do, nhT lugng; Kit qua xdt nghiem vi khuin mu tai.

3. Tieu chuin loai trip: Benh nhin khdng dong y tham gia nghien cCru.

4. Phu'ang phap: Tiin eu-u, md ta eit ngang ed phin tich.

5. Nghien ciru vi khuin