Y HQC VIET NAM T H A N G 1 - SO 2/2012 Sakashita [5] cung khuyen cao rang khdng nen phau
thuat type C neu tong diem tU 5 trd xudng.
He thdng xUdng con binh thUdng chi gap 5/33 chiem 15,2% (bang 3.3) so vdi 28/33 chiem 84,8%.
SU khac biet cd y nghia thdng ke vdi p<0,01. NhU vay khi da ed di dang OTN thi thudng kem theo dj dang he thdng xUdng con do dd lam suy giam sUc nghe. Ket qua nay eung tUdng tU ket qua ciia Jahrsdoerfer [3], Ruben[5], Sakashita [6].
4.3. Mdi lien quan giUa loai di dang OTN vdi he t h d n g xUdng c o n va day VII
Trong loai di dang OTN chi gap 6/33 trUdng hdp khdng cd xUdng ban dap chiem ty le 1 8 , 1 % , gap d type B. Dj dang xUdng ban dap vdi 2 xUdng biia de chiem 5/33 (15,1%) chi g§p d type C & D (bang 3.4). Di dang 2 xUdng bua de, xUdng ban dap binh thudng chiem ty le 60,7%
(17/28), gap d ca 3 type A,B & C, khdng cd trUdng hdp nao gap d type D, ket qua nay tUdng tU ciia Jahrsdoerfer [2], [3], Hough [4]. Trong trUdng hdp xUdng ban dap binh thudng kha nang phau thuat cai thien sUc nghe cho benh nhan thudng ed ket qua kha quan, tUdng tU nhU xUdngng biia de binh thudng ehi cd dj dang xUdng ban dap thi ket qua phau thuat cung tUdng ddi tdt.
Day VII cd cau triic vi tri binh thudng trong dj dang OTN la 25/33 chiem 85,8% (bang 3.5) cao hdn so vdi vi tri day 7 bat thudng chiem 24,2%. SU khac biet cd y nghTa thdng ke vdi p<0,01. Vj tri bat thUdng ciia day VII chii yeu gap d type C & D , gidng nhu ket qua nghien cUu ciia Ruben [ 5 ] , Sakashita [ 6 ] .
V. KET LUAN
1. Oac diem dj dang OTN tren phim CLVT Di dang OTN gap tU khi sinh ra, ty le nam/nU= 2,5 lan.
Thudng gap di dang OTN type B&C 3 0 / 3 3 ( 9 0 , 9 % ) .
Dj dang OTN thUdng gap la hep dng tai (83,3%).
2. D^c d i e m xu'dng con va day V I I theo mUc dp dj dang OTN
Ty le di dang xUdng con trong di dang dng tai ngoai 28/33 (84,9%).
Khdng gap trudng nao dj dang toan bp he thdng xUdng con d type A&B.
Di dang hoac khdng cd xUdng ban dap chiem 11/28 (39,3%), gap d cac type A,B & C.
Day VII cd cau triic va vj trf bat thUdng chiem 8/33 (28,2%), chii yeu gap d type C&D.
T A I L I E U T H A M KHAO
1. De La Cruz A, Teufert KB Congenital aural atresia sygery. Long -term results. Otolaryngology
H + N Sugery pp 121 127.
2. Jahrsdoerfer RA, et al (1992) Grading system for the selection of patients CAA. Am 1 Otol; 13 (1):6 12.
3. Jahrsdoerfer RA, et.al (1985), High resolution CT scanning and auditory Oram stem response in congenital aural atresia: patient selection and surgical correlation, Otolaryngol Head and Neck 5i/rp(93), pp.292-298
4. Hough JD (1961): Malformations and anatomical variations seen in the ear during orerations on the stapes pp 34 38
5. Ruben. RJ(1989), Management and therapy of congenital malformations of the external and middle ears, otologic medicine and surgery, Churchill iivingstone, New York, pp.1135-1151.
6. Sakashita T et.al (1996): Congenital abnormalies of the external and middle ear, pediatric otolaryngology, 3"" ed, WB saunders Philadelphia, pp 333-370.
NGHIEN Gl)U Sir THAY DOI MOT SO XET NGHIEM
> • •
DONG CAM MAU 0 BENH NHAN HEMOPHILIA
TOM T A T
Nghien cUu sU thay ddi cac xet nghiem dong cam mau b 204 benh nhan Hemophilia: Ke't qua cho tha'y: co 3,45% giam, 19,7% tang sd lupng tieu cau:
11,11% CO cue mau ddng khong binh thudng;
N g u y i n Thj NQ *, Tran Thi Van Ha **
18,0% PT % giam, 100% APTT keo dai, 100% TT binh thu'dng, 32,35% fibrinogen tang. Co moi tUOng quan nghjch kha chat che giUa rAPTT va nong dp yeu to Vlli: Tudng quan nghjch vUa phai giCfa rAPTT va nong dp yeu to IX.
Y HOC VIET NAM T H A N G 1 - SO 2/2012
SUMMARY
Objective: The research on changes in hemostasia tests and the relationship between factor VIIIC/IX level and the result of coagulation test in patients with Hemophilia.
Materials and methods: 204 patients with Hemophilia was analysed: BT, clot retraction, platelet count, PT APTT TT, fibrinogen, factor VIM/
IX assay.
Results: 3.45% patients had reduced platelet count, 19.7% had increased platelet count, abnormal clot retraction was found in 11.11%
patients, 18.0% patients had decreased PT%, 100%
had prolonged APTT, 100% had nonnal TT, 32.35%
had increased fibrinogen. rAPTT had a strong inverse congelation with the level of VIII factor and moderate inverse con-elation with the level of IX factor.
I. OAT VAN OE
Hemophilia la benh rdi loan ddng mau thudng gap nhat trong sd cac rdi loan ddng mau di truyen, do thieu hut yeu td VIII (Hemophilia A) hoae IX (Hemophilia B) hoae XI (Hemophilia C rat hiem gap). Chay mau la bieu hien ehinh va la nguyen nhan gay tir vong eung nhu eae bien ehUng chi'nh ciia benh nay.
Da ed nhieu nghien ciru ve lam sang, di truyen, xet nghiem benh Hemophilia; Tuy nhien ehua cd mdt nghien eUu nao danh gia mdt each kha day du ve ddng mau huyet tUdng va cam mau
ban dau d benh nay. Vi vay, ehiing tdi tien hanh de tai nay vdi mue tieu:
Nghien ciAi si/ thay doi mot so xet nghiem dong cam mau d benh nhan Hemophilia;
Tim hiSu moi tuong quan giCta nong do yeu to VIII/IX vd ket qui mot so xet nghiem dong mau.
II. o 6 l TUpNG vA PHUONG P H A P NGHIEN CUU 1. Odi tuong: Bao gom 204 benh nhan dUde ehan doan Hemophilia den kham va dieu trj tai Vien Huyet hoc Truyen mau Trung Udng tu th^ng 02/2011' den het thang 09/2011.
Trong dd ed 173 benh nhan Hemophilia A, 31 benh nhan Hemophilia B; 124 benh nhan Hemophilia mUe do nSng, 58 mUe do trung binh, 22 mUe do nhe theo tieu chuan eua Lien doan Hemophilia The gidi.
2. PhUdng phap: Sir dung phUdng phap nghien eUu eat ngang md ta phan tich.
3. Tien hanh nghien ciiru:
Tien hanh eac xet nghiem khao sat giai doan cam mau ban dau: Thdi gian mau ehay;
Sd lUdng tieu eau; Co cue mau ddng; Cac xet nghiem khao sat dong mau huyet tuang: PT;
APTT; TT; Fibrinogen; Oinh lUdng hoat tinh yeutdVIII/IX/XI.
Cae xet nghiem 6\J0c tien hanh tai khoa Odng mau, Vien Huyet hoe - truyen mau TW.
KET QUA
Bang 1. Thdi gian mau ehay
"^"----...T'he benh T G . M C ^ - - ^ ^
5 phut
> 5 phut
Nhan xet: ^Q>Q%
Bang 2. Sd lUdnc
S L T C ^ G ^ ^ i ) ^ ^ ^ ^
<150
TCr 150 den 400
>400 Tong
Hemophilia A n
60 0
% 100
0
Hemophilia n
11 0 benh nhan ed thdi gian mau ehay binh
tieu eau
Hemophilia A n
5 134
34 172
% 2,33 77,91 19,77 100,0
Hemo n 3 22
6 31
B
% 100
0
Tong n
71 0
% 100
0 thudng.
philia B
% 9,68 70,97 19,35 100,0
Tong n
8 156
40 204
% 3,94 76,85 19,70 100,0
P
>0,05
Nhan xet: 3.94% cd sd lUdng tieu eau giam <150G/I 19,70% sd lUdng tieu eau >400G/I
- Su khae biet ve sd lUdng tieu eau giUa 2 the Hemophilia A va B khdng ed y nghTa thdng ke ve vdi p > 0,05.
Y HQC VlfT NAM T H A N G 1 - s 6 2/2012 Bang 3. Co cue mau ddng
"~~~~~---.___777e' b^nh Co cue mmT ~~~—.^
Khong co
Co khong hoan toan Co hoan toan Tong
Hemophilia A (1) n
0 5 55 60
% 0,00 8.33 91,67
100,0
Hemophilia B (2) n
0 3 9 12
% 0,00 25,0
75,0 1 100,0
n 0 8 64 72
rdng
% 0,00 11,11 88,89 100,0
P1-2
>0,05
Nhan xet: - 11,11% cd cue mau eo khdng hoan to^n.
Khdng ed sU khae biet ed y nghia thong ke ve ket qua xet nghiem eo eijc mau ddng giua Hemophilia A v^ Hemophilia B vdi p > 0,05.
Bang 4 Ket qua PT (%)
Hemophilia B (2)
% 3,23 9,68 87J0_
0 100,0
P1-2
>0.05
Tong n 2 35 167
0 204
% 0.98 17.16 81,86
0 100,0 Nhan xet: 0,98% PT% giam nang dudi 40%; 17,16% cd PT% tU 40 den 70%.
Khdng cd sU khac biet cd y nghTa thdng ke ve PT% giua Hemophilia A va B.
Bang 5. Ket qua APTT.
^~~-~-~^^.___The benh APTT(giayf ~ ~ — - - ^
X±SD Min-max
Hemophilia A (n=173) 90,12 ± 5,01
39.3 -185,0
Hemophilia B p {n=31)
80,30 ±24,31 j <0.05 42,5-165,0
Tong (n=204) 88,61 ± 25,09
39.3-185.0 Nhan xet Gia tri trung binh ciia APTT la 88,61± 25,09 giay
APTT d nhdm Hemophilia A dai hdn nhdm Hemophilia B, su khac biet cd y nghTa thdng ke vdi p < 0,05.
Bang 6. Ket qua
~~~~~~---~JTi£ ben h Fib ( g / l ) - ^ ^ - ^
>4 2-4
<2 Tong
ndng do fibrinogen Hemophilia A n
51 122
0 173
% 29,48 70,52
0 100,0
Hemophilia B n
15 16 0 31
% 48,39 51,61
0 100,0
P
<0.05
Tong n
66 138
0 204
% 32,35 67,65
0 100,0 Nhan xet: - Gap 32.35% ed fibrinogen > 4 g/l;
- Khdng gap trudng hdp nao fibrinogen < 2g/l.
48.39% Hemophilia B tang fibrinogen, cao hdn d nhdm benh nhan Hemophilia A la 29.48%; Su khae biet ed y nghTa thdng ke vdi p < 0,05.
Bang 7. Mdi tUdng quan giua ndng dp yeu td Vlll vdi thay ddi xet nghiem.
XN Ndng do yeu tdVIII
PhUdng trinh
pr/o 0,004
>0,05 173
rAPTT -0,56
<0,001 173 Y=0,03x+3,46
FIB 0,07
>0,05 173
Nhan xet- Cd mdi tUdng quan ty le nghieh kha chat ehe giOfa rAPTT va ndng do yeu td Vlll (vdi p < 0,001; r= -0,56). PhUdng trinh hdi quy la y= 0,03x+3,46.
- Su thay ddi PT, fibrinogen khdng cd mdi tUdng quan tuye'n tinh vdi ndng yeu td Vlll
Y HOC VI^T NAM THANG 1 - SO 2/2012 Bang 8. Mdi tUdnq quan
Nong dp yeu to IX
r P n Phu'dng trinh
PT%
-0,27
>0,05 31
rAPTT -0,41
0,02 31 Y = 0,01x + 4,05
Fib -0,04
>0,05 31
Nhan xet:
Cd mdi tUdng quan nghjch vUa phai giua rAPTT va nong do yeu td IX ( p< 0,02; r= -0,41).
PhUdng trinh hdi quy la y = -0,01 x + 4.05.
Suthay doi PT, fibrinogen, khdng ed mdi tUdng quan tuyen tinh vdi ndng do yeu td IX IV. B A N LUAN
- Thdi gian mau chay: Ke't qua eho tha'y 100% benh nhan Hemophilia trong nghien eiru ed thdi gian mau chay trong gidi han binh thudng.
Thdi gian mau ehay keo dai khi ed bat thudng sd lUdng va ehat lUdng tieu eau. sUe ben thanh maeh, thieu hut mdt sd glycopotein can thie't cho qua trinh dinh va ngung tap tieu cau. d benh nhan hemophilia, do thieu hut yeu td Vlll hoae yeu td IX nen ddng mau huyet tUdng bi anh hudng, giam ddng trong khi dd giai doan cam mau ban dau hoan toan binh thudng; Tuy nhien day la mdt trong nhung xet nghiem dau tay dUdc sir dung va can thiet dd'i vdi benh nhan Hemophilia de giiip ehan doan phan biet vdi benh vonWillebrand.
So lupng tieu cau: Gap 76,85% ed sd lUdng tie'u cau trong gidi han binh thudng, 19,7% cd sd lUdng tieu eau tang va 3,45% cd sd lUdng tieu eau giam. Ngay sau khi ed ehay mau, phan img tu nhien eua ed the tang sd lUdng tieu cau de tham gia dam bao ehUe nang cam mau, tieu eau dang tang phan Ung de dam bao chUc nang earn mau eua ed the ed le la nguyen nhan gay nen 19,7% tang sd lUdng tieu cau. Xd gan do nhiem virus viem gan, do te bao gan bi pha huy bdi thude giam dau lieu cao, keo dai va lap lai nhieu lan la nguyen nhan gay giam tieu eau d benh nhan Hemophilia. Ngoai ra mdt sd trUdng hdp ehay mau nang cd the cung gay giam tieu cau, gidng nhu giam tieu cau d eae benh nhan cha'n thUdng chay mau.
Xet nghiem co CIJC mau: Day la xet nghiem danh gia mUc do co eiia cue ddng fibrin sau khi mau da ddng trong dng nghiem thuy tinh. SU co cue mau phu thude vao sd
lUdng tieu eau, lUdng fibrinogen va the tich khdi hdng eau. Trong nghien eUu nay, ehiing tdi gap 11,11% cue mau eo khdng hoan toan va ehi gap d nhUng benh nhan Hemophilia mUe dp nang, giam sd lUdng tieu cau.
Xet nghiem PT: day la xet nghiem thudng dUdc sir dung de danh gia dudng ddng mau ngoai sinh. Ke't qua eho tha'y ed 18% PT%
giam. Khdng ed sU khae biet giua Hemophilia A va B. Nhdm benh nhgn mUe do benh nang ed PT% thap hdn mUc do trung binh va nhe, sU khae biet ed y nghTa thdng ke vdi p < 0,05. Suy giam ehUe nang gan do virus, do dieu tri thudc giam dau lieu eao va keo dai la nguyen nhan ehinh gay giam PT % d behh nhan Hemophilia.
APTT: Day la xet nghiem ed dp nhay eao trong phat hien tinh trang thieu hut yeu td tham gia dudng ddng mau ndi sinh. Trong nghien eUu nay, 100% benh nhan Hemophilia ed APTT keo dai. APTT d nhdm benh nhan Hemophilia A keo dai hdn nhdm benh nhan Hemophilia B, sU khae biet ed y nghTa thdng ke vdi p < 0,05. Rd rang APTT la xet nghiem ed do nhay eao trong phat hien benh Hemophilia.
Mot ty le cao ca hemophilia A va B co ndng do fibrinogen tang, khdng gap trUdng hdp nao giam ndng do fibrinogen do hau het benh nhan deu cd tinh trang viem nhiem va deu 6\J0c truyen eae ehe pham ed ndng do fibrinogen eao. Ty le benh nhan ed fibrinogen tang d nhdm benh nhan Hemophilia B eao hdn nhdm Hemophilia A do tat ea benh nhan Hemophilia B deu dUde dieu trj bang huyet tUdng tUdi, trong khi dd hau het benh nhan Hemophilia A dUde dieu tri bang yeu td Vlll cd dac, tiia lanh yeu td Vlll. TUdng tu fibrinogen, TT la xet nghiem danh gia giai doan ehuyen fibrinogen thanh fibrin dudi tae dung eiia thrombin. Ket qua eho tha'y, khdng gap trudng hdp nao TT keo dai trong nghien eUu nay.
Ve mdi tUdng quan giUa ndng do yeu td Vlll/IX va ket qua mdt sd xet nghiem ddng mau:
mdi tUdng quan nghieh kha ehat che giUa rAPTT va ndng do yeu td Vlll (vdi p < 0,001; r= -0,56);
Y HOC VIET NAM T H A N G 1 - s 6 2/2012 TUdng quan nghieh vUa phai giUa rAPTT va
ndng do yeu td IX (vdi p< 0,02; r = -0,41). APTT la xet nghiem danh gia dudng ddng mau ndi sinh, vi vay, moi su thieu hut yeu td VIII/IX d benh nhan Hemophilia deu anh hUdng den ket qua eua APTT: ndng do yeu to VIII/IX cang tl-inp, APTT eang dai va do vay, rAPTT eang ldn.
V. KET LUAN
Qua nghien eUu sU thay dd'i mot sd xet nghiem ddng cam mau d 204 benh nhan Hemophilia tai Vien HHTMTW, ehiing tdi ed mdt sd ket luan sau:
1. Dae diem thay doi mdt sd xet nghidm ddng cam mau.
Sd lUdng tieu eau: 19,7% eae trudng hdp tang, 3,45% giam sd lUdng tieu eau.
Co cue mau ddng: 11,11% trudng hdp cue mau eo khdng hoan toan
PT: 18% PT% giam, gap ehii yeu d Hemophilia mUe do nang
APTT: 100% keo dai.
TT: 100% trong gidi han binh thudng.
Fibrinogen: 32,35% fibrinogen tang;
Khdng gap trUdng hdp nao fibrinogen giam: Ty
le fibrinogen tang d nhdm Hemophilia B cao hdn d nhdm Hemophilia A
2. Cd mdi tUdng quan nghjch kha ehat ehe giua rAPTT va ndng do yeu td Vlll; TUdng quan nghjch vUa phai giOra rAPTT va ndng do yeu td IX.
T A I LIEU T H A M KHAO
1. Nguyen Ngoc Minh. "Benh Hemophilia", Bai giang Huyet hoc- Truyen mau sau dai hoc, NXB Y hoc. 2007, tr.539- 548 2
2. Nguyen Anh Tri , "Sinh ly qua trinh dong mau"
Ddng mau Ung dung trong Icim sang, NXB Y hoc, 2000, tr.40-63.
3. Nguyen Anh Tri, Nguyen Thj NU , "Cap nhat xet nghiem dong cam mau tai Vien Huyet hpc Truyen mau Trung UOng, Y hoc Viet Nam, 2009, tap 355. tr.42-49.
4. Hermens W.Th, "Haemophilia- a blood clothing disorder, Bayer Inc. 1998. pp.9-14.
5. James J. Goedert, M. Elaine Eyster, Michael M. Lederman, "End-stage liver disease in persons with hemophilia and transfunsioassociated infections. Blood,2002, vol.100, pp.1584- 1589.
6. Styve K., "New developmentin laboratory diagnosis and monitonng. Haemophilia, 2010,
16 (SuppI.5), pp.61-66.
DAC OIEM PHAN BO MACH MAU TIT CUNG
VA U COTROfN TUT CUNG TROAC VA SAU CAN THIEP NOI MACH
Nguyen Van Ba*, Oo Quyet**, Le Van TrUdng***,
TOM T A T
U cO trdn tU cung la nhu'ng khdi u lanh tinh phat trien tU cd tU cung, benh gSp nhieu 6 cac phu nu' tren 35 tuoi. Ben canh phau thuat truyen thong, phu'dng phap can thiep npi mach tac dong mach tU cung cho ket qua dang khich le. Nghien cUu tien hanh tren 100 benh nhan dUdc can thiep tac mach tai benh vien TWQO 108 va Benh vien 103 tU thang 4/2008 din thang 10/2010 nham danh gia phan bd mach tren sieu am mau Doppler tai tU cung va u cd trdn trUdc va sau dieu trj. Ket qua nghien cUu cho thay cd hien tUdng dao ngUdc phan bd mach mau trong UCTTC va TC lanh: trUdc dieu trj thi mach phan bd nhiieu trong UCTTC (87,7%) va it trong TC lanh (94.9%). Chi sau dieu tri 3 thang, mach phan bd it va khdng co trong
UCTTC (93.9%), ddng thdi cd nhieu trong TC lanh (55.1%, dat tdi 83,8% sau 6 thang). SU khac biet trong phan bd mach UCTTC va TC trUdc - sau dieu trj cd y nghia thdng ke (p < 0.01).
TCr khoa: U cd trdn tU cung, can thiep npi mach, phan bo mach mau.
SUMMARY
CHARACTERISTIC OF VASCULAR ALLOCATION OF UTERUS AND UTERINE SMOOTH MUSCLE TUMOR OF PRE - AND POST - UTERINE ARTERY
EMBOLIZATION
Smooth muscle uterine tumors from musde of uterus is benign, more frequently in women over 35.
Besides the traditional surgery, uterine artery
