tranh qua tai cho day chang Zinn va bao sau trong thi an day nhan TTT
5.2. K y t h u a t xe b a o t r i r d c hinh trdn mang lai nhieu ldi the eho p h i u thuiit ngoai bao va dat TTT nhan tao:
Bao ve giac mac tdt hdn trong qua trinh phSu thuat (vi cd sir dung chat nhay) nhat la ddi vdi nhung mat cd tien phdng ndng.
Rda hut de dang hdn: vi xda bd dUdc nhUng vat bad trUdc.
Tang ty le dat TTT nhan tao trong bao, giu vUng TTT nhan tao d trung tam hdn nha't la d nhufng mat cd ddng t d gian to, liet do cdn gldcdm cap, nhCrng mat d d md'gldcdm cat mdng mat toan bp can phai khau mdng mat.
T A I U E U THAM K H A O
1. Nguyen Quoc Oat:Ket qua nghien cifu tinh hinh due bao sau thif phat sau md lay TTT ngoai bao va dat TTT nhan tao tai Quang Nam - Da NSng -
Cong trinh nghien cifu khoa hoc nganh Mat toan quoc, 1995, tap 1, 162/165.
2. Le Hoang Mai, Tru'dng Tuyet Trinh va cong su":
Phau thuat cSt be ket hdp dSt TTT nhan tao hau phong - Noi san Nhan khoa, sd 5/2001, 36-44.
3. Thai Thanh Nam: Du'dng ham cung mac phfa thai du'dng trong md due TTT ngoai bao, dat lOL hau phong - Noi san Nhan khoa, sd 4/2001, 3-11.
4. Vu Anh Tuan, JAULERRY, DAURIN: Nghien cifu thy hien ky thuat xe bao vdi thuoc nhom xanh Trypan tren mat c6 the thiiy tinh due trang - Ban tin Nhan khoa, hdi Nhan khoa TP H'6 Chi Minh so 7/2001, 6-9.
5. HARRIS D, S P E C H T C : Continous curvilinear capsulorhxis and nucleus fracturing Evulotion, technique and complication, Ophthalmol Clinic of North America, 1991, 98, 623-627.
6. T.NEUHANN: Le Capsulorhexis Chirurgie de la cataracte, Masson - Paris, 1996, 176-195.
7. M.WEBER, J.FLAMENT, J.SAHEL:
Capsulorhexis et extraction extracapsulaire mauelle du cristallin - Cosiderations theoriques et partiques, J.Fr, Ophtamol, 1994, 17, 3, 188-193.
NGHIEN Ciiu DAC OIEM MO BENH HOC-LAM SANG
U LYMPHO KHONG HOOGKIN NGUYEN PHAT NGOAI HACH VUNG OAU CO
Le Minh Ky*
TOM T A T
U lympho ac tfnh khong Hodgkin (ULKH)la mot trong nhufng benh ung thu" phd bien d Viet Nam.
Muc tieu de tai Nghien cifu dac diem mo benh hpc cua u lympho khong Hodgkin nguyen phat ngoai hach vung dau cd. Odi tu'dng va phu'dng phap nghien curu: 40 benh nhan di/dc chan doan la u lympho khong Hodgkin nguyen phat ngoai hach viing dau cd tif thang 1 nSm 2005 den thang 9 nam 2006 tai BV Tai Mui Hpng trung Udng, di/dc kham lam sang, lam cac xet nghiem mo benh hoc. Ket qua: vi tri hay gap nha't la vung mui xoang vdi ty le 52,5%, phan loai WF6 chiem 65% va WF7 vdi ty le 25%. U lympho te bao B Idn chiem ty le cao nhat 52,9%, tiep do la u lympho vung ria ngoai hach cua mo lympho phu thuoc niem mac (u MALT) chiem 35,3%, u lympho tu'dng bao chiem 5,9% va u lympho, nguyen bao lympho chiem 5,9%. Trong cac u lympho te bao T, u lympho te bao NK/ T, tip mui chiem ty le 83,3. Ket luan:Benh cd the bieu hien d bat ky vj tri nao cl vung dau cd. Hoa mo mien djch cd vj tri quan trpng trong chan doan va tien lUdng benh.
* BV Tai Mui Hong TW
Phan bien khoa hoc: PGS.TS. Nguyin Hoang Sdn
SUMMARY
Some Immunochemical and histological remarks of the primary extranodal non Hodgkin
lymphomas of head and neck.
Objectives: study on clinical and histo- pathological characteristics. Patients and methods: 40 patients, with diagnosis of the primary extranodal lymphomas Non- Hodgkin of head and neck admitted in National ENT Hospital from 1/2005 to 11 2006. This was prospective, descriptive study.
Results: The most common site affected was sinonasal areas( 52,5%). According the Working formulation: WF6 was 65% va WF7 was 25%. The B cell lymphomas was 73,91% and T cell lymphomas was 26,09%, among them the NK/T type was common (83,3%). Conclusions: the primary extranodal non Hodgkin lymphomas of head and neck affected many sites at head and neck, Imunochemical and hitological features were important.
Y HOC VIET NAM T H A N G 2 - SO 2/2012
I.
OAT VANof
U lympho ac tinh la mot trong nhung benh ung thu phd bie'n 6 Viet Nam cung nhu d nhieu nude khac tren the gidi. Benh xuat phat td sy tang sinh khdng kiem soat dUde eua cac te bao ddng lympho. Benh dUdc chia ra hai nhdm chinh la benh Hodgkin va u lympho khdng Hodgkin.
Theo udc tinh cua hiep hdi ung thu My 1993 (American Cancer Society) ty le u lympho ac tinh chiem khoang 4% trong tdng sd ung thU 6 My. Ty le benh Hodgkin va u lympho khdng Hodgkin la'khoang 1: 5. Khoang 40% den 60%
ULKH bieu hien d vi tri ngoai hach va 1/3 den 2/3 trong sd nay xuat hien d vung dau cd.
O Viet Nam, tuy cung da cd mdt sd nghien cdu ve u lympho khdng Hodgkin ndi chung, nhung chua cd nhieu nghien cdu cu the ve cac dac diem cua benh hoc u lymphd nguyen phat ngoai hach vung dau cd nhat la ve md benh hoc. Chung tdi tien hanh nghien cdu nham muc tieu sau: Nghien cifu dac diem
mo benh hoc-lam sang cua u lympho khong IHodgkin nguyen phat ngoai hiach vung dau co.
II. o 6 l TUONG VA PHUONG P H A P NGHIEN CUU 2.1. Ddi ti/dng nghien cCfu:
40 benh nhan dUdc chan doan la u lympho khdng Hodgkin nguyen phat ngoai hach vung dau cd td thang 1 nam 2005 de'n thang 9 nam 2006; dUde dieu tri va theo doi dien bien benh tai khoa u bUdu va phau thuat dau ed Benh vien Tai Mui Hpng Trung Udng.
2.2. PhiTdng phap nghien cufu:
-Thiet ke nghien cdu: PhUdng phap nghien cdu tien cdu, md ta.
-Cac budc tien hann: Thu thap sd lieu ve benh nhan, sinh thiet tdn thUdng nghi ngd lam xet nghiem md benh hpc va nhuom hoa md miln djch de chan doan xac djnh benh. Cac xet nghiem dupe thyc hien tai Khoa giai phau benh BV Tai MQi Hpng trung Udng va Benh vien K.
Xijf iy cac so' lieu theo chUdng trinh Epi- Info 6.4.
KET QUA NGHIEN CUU 3.1. Gidi
Bang 3.1: Phan bd ULKH nguyen phat ngoai hach theo gidi
Gidi Nam NOf
So ca 27 13
Ty le % 67,5 32,5
Nghien cyu cija chung tdi bao gdm 27 nam va 13 nU. Ty le nam/ nU la 2.08/1.
3.2.Tuoi
Bang 3.2: Phan bd ULKH nguyen phat ngoai hach theo tudi
Tuoi < 18 19-29 30-39 40-49 50-59 >60
86 ca 11 13
Ty le% 12,5 7.5 10,0 27,5 32,5 10,0
Chung tdi thay rang tudi trung binh la 43,6 tudi va gap d mpi Ida tudi. Benh nhan nhd tud'i nha't trdng nghien cdu cua chung tdi la 6 tudi va Idn tudi nha't la 75 tudi. Trong dd tudi td 50- 59 la hay gap nha't vdi ty le 32,5%, sau dd la tudi 40- 49 chiem ty le 27,5%.Cac Ida tudi khac thi gap vdi ty le it hdn.
3,3. Vj tri ULKH nguyen phat ngoai hach vung dau co Bang 3.3: Phan loai ULKH nguyen phat ngoai hach theo vi tri
Vitri
Amidan khau cai Amidan day ludi
Vong Waldeyer (> 2/ 3 vj trf) Cac xoang canh mui
Hdc mui
Thanh sau hong Thanh mon Ha thanh mon Tuye'n mang tai trai
Sdca 11
1 3 10 11 1 1 1 1
Ty le % 27,5
2,5 7,5 25,0 27,5 2,5 2,5 2,5 2,5
Chung tdi nhan thay ULKH cd bieu hien nguyen phat ngodi hach cd the gSp d bat ky vi tri nao d vung dau cd, vi tri hay gap nhat la vung mui xoang 21 ca vdi ty le 52,5% Tie'p dd la cac vj tri cua vdng Waldeyer vdi 15 ca chiem ty le 37,5% trong dd cd 11 ca xuat hien d Amidan khau cai; 1 ca d Amidan day lUdi va 3 ca d nhieu vj tri cua vdng Waldeyer.
3.4. Md benh hoc: phan loai theo Working Formulation Bang 3.4: Phan loai ULKH nguyen phat ngoai hach t h e o ^ F
Nhom 06 ac linh thap
06 ac tinh trung binh
06 ac tinh cao
Phan nhom WF1 WF2 _ WF3
WF4 WF5 WF6 WF7 WF8 WF9 WF10
S o ^ ^
T
0 0 1 0 26
0 1 0
Ty le % 5,0
2,5 0 65,0 25,0 0 2,5
0
Chung tdi nhan tha'y vdi ULKH nguyen phat ngoai hach vung dau cd thi cd tdi 92,5% cd do ac tinh trung binh va chu yeu la WF6 chiem tdi 65% va WF7 vdi ty le 25%. Dp ac tfnh thap cd 2 trUdng hdp chiem ty le 5% va ca 2 trudng hdp nay thudc phan nhdm WF1. Chi cd 1 ca u lympho dang nguyen bao lympho thudc nhdm cd dp ae tfnh cao vdi ty le 2,5%.
3.5. Hoa md mien djch (HMMD)
Bang 3.5: Phan loai u lympho te bao B va T theo vj tri theo H M M D Vitri
Hoc mui
Xoang canh mui Amidan khau cai Amidan day ludi Vong Waldeyer Thanh m6n Ha thanh mon Thanh sau hong Tuye'n mang tai
Te bao B TB
B Idn 3 4 1
1
Lympho tu'dng bao
1
UMALT
1 2 2 1
Nguyen bao lympho
Te bao T TB
NK/T 4 1 1
;
1
TB Tidn
1
Trong nghien cdu 23 ca dUdc nhuom hoa md mien djch bao gom 17 trudng hdp chiem ty le 73,91% la u lympho te bao B va u lympho te bao T chiem ty le 26,09%.
Theo phan loai cua to chyc y te the gidi nam 2001, trong sd cac u lympho te bao B: u lympho te bao B Idn chiem ty le cao nha't 52,9%, tie'p dd la u lympho vung ria ngoai hach cua md lympho phu thudc niem mac (u MALT) chiem 35,3%, u lympho tUdng bao chiem 5,9%
va u lympho, nguyen bao lympho chiem 5,9%.
Trong cac u lympho te bao T, u lympho te bao NK/ T, tip mui chiem ty le 83,3%; cdn lai 1 ta/dng hdp u lympho te bao T Idn chiem ty le 16,7%.
IV. BAN LUAN
4.1. Gidi: Nghien cCru cua chung tdi thay rang ty le nam/ nOf la 2,08/ 1. So sanh ket qua nay vdi mdt so nghien cCru trong nddc nhi/
Nguyen Ba Ode [1] Le Oinh Hoe [2] thay rang nam mac benh nhieu hdn nU nhi/ng vdi ty le cao hdn la 2,62/ 1. Ty le nam/niJr trong nghien cdu cua chung tdi cung tddng dddng vdi ket qua nghien CL/U cua Vi/dng Thj Ngoc Thjnh vdi ty le nam/ nC/ la 2,18/1 [4]. Assanasen [5]
nghien cdu 77 benh nhan tliay t^y' le nam/ niJf la 1,2/1; Cdn theo Jacobs [6] ty le nay la 1,6/1.
4.2. Tuoi: Tudi trung binh trong nghien cCru cua chung tdi la 43,6 tudi. Trong dd tudi tif
Y HOC VIET NAM THANG 2 - SO 2/2012 50- 59 la hay gap nha't vdi ty le 32,5%, sau dd
la tudi 40- 49 chiem 27,5%. Ke't qua nay cung gan tUdng dUdng vdi ket qua nghien cdu cua VUdng Thj Ngpc Thjnh [4] vdi tudi trung binh la 44,9 tudi. Le Dinh Hoe [3] cung tha'y Ida tudi 50- 59 gap vdi ty le cao nhat 18,71%, tiep theo dd la tudi ty 60 69 chiem 19,24%. Tuy nhien theo hau he't cac tac gia thi benh gap phd bie'n d tudi td 30- 60 tudi. Trong nghien cdu, d tre em chung tdi chi gap 1 ta/dng hpp duy nhat 6 tudi.
4.3. Vj tri ULKH nguyen phat ngoai bach vung dau cd
U lympho khdng Hodgkin cd the' xuat hien tai bat cd vj trf nao d vung dau cd. Trong nghien cdu cua chung tdi thi vung mui xoang la vj trf hay gap nha't, chiem ty le 52,5%, sau dd la cac vj tri cua vdng Waldeyer chiem ty le 37,5%. Ke't qua nghien cdu nay cua chung tdi cd khac vdi nghien cdu cua mdt sd tae gia khac, theo nghien cdu cda Jacobs [6] thi hdn mdt nCra cac trUdng hdp la d vdng Waldeyer trong dd Amidan khau cai la vj tri hay gap nha't;
tac gia Assanasen [5] cung tha'y rang vdng Waldeyer la vi trf hay gap nha't vdi ty le la 54,55%;
theo Assanasen [5] thi vung mui xoang ddng d vj trf thd 2 vdi ty le tUdng yng la 24,67%.
Chung tdi cdn gap u lympho tai cac vj trf khac nhu thanh quan, thanh sau hpng, tuye'n mang tai.
4.4. IVIo benh hoc
Day la xet ngtiiem cd gia trj chan doan xac djnh benh. Chung tdi nhan tha'y vdi ULKH nguyen phat ngoai hach vung dau cd thi cd tdi 92,5% cd dp ac tfnh trung binh va chu yeu la WF6 chiem tdi 65%; sau dd la WF7 vdi ty le 25%. Nghien cdu cCia chung tdi cho tha'y sy phu hdp vdi ke't qua cCia cac nghien cdu khac trong nUdc ve u lympho khdng Hodgkin ndi chung: Nguydn Ba Ddc [1] cung thay rang vdi u lympho khdng Hodgkin, md benh hpc chu yeu cd dp ac tinh trung binh chiem ty le 83,1%
trong dd WF6 cd ty le cao nhat la 35,5%; sau dd la WF7 vdi ty le 34,7%. VUdng Thj Ngpc Thinh [4] cung tha'y dp ac tinh trung binh thudng gap nhat vdi ty le 72,55% trong dd WF7 cd ty le cao nhat la 45, 09%, tiep dd la WF6 19,6%. Nghien cyu cua Le Dinh Hoe [2] cung thay la dd ac tfnh trung binh cd ty le cao nhat, chiem 68,20% trong dd WF7 la hay gap nhat vdi ty le 29,49%, sau dd mdi la WF6 chiem 24,88%; tac gia nay thay rang dp ac tinh thap
va cao cd ty le gan tUdng tUdng nhau, tUdng dng la 13,36% va 16,13% uu the WF1 va WF9.
Nghien cdu cua chung tdi thi dp ac tfnh thap ft gap hdn han vdi ty le 5% nhUng deu thudc phan nhdm WF1, 2,5% cd dp ac ti'nh cao la WF9. Nhu vay, du bieu hien d he thdng hach hay bieu hien nguyen phat ngoai hach vung dau cd thi ket qua md benh hpc cho thay rang vdi u lympho kndng Hodgkin thi dp ac tfnh trung binh la phd bien, trong dd chu yeu la WF6 va WF7 tuy ty le cd chenh lech nhau.
Theo nghien cdu cua ehiing tdi thi viec phan loai theo WF da bo sdt cac trUdng hdp u MALT va mdt sd trUdng hdp u lympho hdc mui vdi loet va hoai tCf lan rdng, hoac trudng hdp loet rpng d thanh sau hpng ma nhd hoa md mien dich, chung tdi da phat hien ra dUde. Do vay, trong dieu kien cho phep nen nhuom hoa md mien dich de' chan doan phan loai cung nhu djnh tip te bao.
4.5. Hoa mo mien djch
Hoa md midn djch da to rd vai trd quan trpng trong cha'n doan, dac biet trong mdt sd trudng hdp ma ke't qua sinh thiet nhieu lan am tfnh. Nghien cdu cua chung tdi chi tien hanh nhuom hoa md mien dich dUdc 23 ca trong dd 73,91% la u lympho te bac B, 26,09% u lympho te bao T. Ke't qua nay cua chung tdi cung phu hdp vdi nghien cdu cija Assanasen [5] vdi ty le'te bao B la 74,02% va te bao T 24,68%. Le Dinh Roanh [3] nghien cdu 225 trudng hdp u lympho. khdng Hodgkin va nhan tha'y cd 75,6% la u lympho te bao B, 20,9% la u lympho te' bao T. Chung tdi cung tha'y rang te bad B cd the gap d bat ky vj trf ngoai hach nao d vung dau cd nhUng loai te bao T khdng dac hieu (te bao T/NK) trong nghien cdu cija chung tdi chi gap d vung mui xoang dac biet cac trudng hdp cd tdn thUdng lan toa d hoc mui 1
hoac 2 ben (4/ 5 ca). Chung tdi cung gap 1 ca u lympho tUdng bao, theo Le Oinh Roanh thi day la loai tdn thUdng hiem gap [3], Trong sd u lympho te bao B, chung tdi gap nhieu nha't la loai te bao B Idn lan toa (52,9%); sau dd la u MALT (35,3%). Cdn vdi u lympho te bao T, chung tdi gap chu yeu la u te bao T/ NK, tip mui (83,3%). Assanasen [5] tha'y rang u lympho te bao B Idn lan toa chiem hdn mdt nda cac trudng hdp vdi ty le 58,43%, cdn loai u MALT gap vdi'ty le thap chi 3,9%.
V. KET LUAN
Benh gap d nam nhieu hdn nU vdi ty lo nam/ nU la 2,08/ 1. Benh bie'u hien d bat ky vj tri nao d vung dau cd, vung mui xoang va vdng Waldeyer la 2 vj trf ngoai hach hay g.;i|) nhdt vdi ty le tUdng dng la 52,2% va 37,5%.
Hoa md mien djch cho thay u lympho td bao B chiem ty le 7 3 , 9 1 % vd u lympho te bao T chiem 26,09%.
T A I L I E U T H A M KHAO
1 Nguyen Ba Oilfc (1995). Nghien CLfu chan doan va dieu tri u lympho ac tinh d Benh vien K Ha Noi tCf 1982-1993. Luan van tien sT chuyen nganh ung thu, 130 tr.
2. Le Dinh Hoe (1996). Nghien cifu ap dung phan loai m6 benh hpc u lympho kh6ng Hodgkin. Luan vSn PTS khoa hpc YdUdc, chuyen nganh giai phau benh. Oai hpc Y Ha N6i. 152 tr.
3, Le Oinh Roanh (2004). Nghien cifu phat trien ky thuat hoa mo mi§n dich trong chan doan mpt sd benh ung thu. Bao cao ke't qua nghien cyu de tai cap bp. Bo Y te. Nam 2004, 128 tr.
4 Vu'dng Thj Ngpc Thjnh (2000). Nghien cifu bien ddi te bao mau ngoai vi, tuy xu'dng benh nhan u lympho ac Ifnh khong Hodgkin tnidc, sau dieu tii hoa chat. Luan van chuyen khoa cap II, chuyen nganh Huyet hoc truyen mau, tr 73.
1. Assanasen T, Wannakrairot P, Keelawat S, Pramprayoon N, Chaipipat M (2004).Extranodal malignant lymphoma of the upperaerodigestive tract in KingChulalongkorn Memorial Hospital according to WHO classification.Department of Pathoiogy, Faculty of Medicine Chulalongkorn University, Bangkok 10330, Thailand. J Med Assoc Thai.
2004 Sep. 87 Suppl 2 3249- 54.
5. Jacobs. C (1993). Lymphoma of the Head and Neck. Head and Neck surgery.
Otolaryngology. Volume 2 J.B.lippincott Company. Philadelphia, 1221- 1228
DAC DIEIVI CAN LAM SANG CUA TRE B| SUY THAN MAN TAI KHOA THAN-TIET NIEU BENH VIEN NHI TRUNG IfONG
Nguyen Thj Quynh Hu'dng*, Nguyen Thj Yen*
TOM T A T
Myc tieu. Nghien cifu dac diem can lam sang ciia tre bj suy than man (STf^) du'dl 15 tudi nhap vien tai Khoa Than- Tiet nieu benh vien Nhi Trung u'dng.
PhUOng phap: nghien cifu mo ta 57 benh nhan bi STM ty 1/1/2008 den 31/12/2009.
Kit qua: 40,4% benh nhan bi STf^ vao vien da la giai doan cudi, vdi MLCT trung binh la 6,49 ± 1,7 ml/phiit/l,73m^, nong do creatinin/mau trung binh CLia STM giai doan V la 1092,7 ± 433,4 |imol/l va nong dp ure/mau trung binh la 49 ± 20 mmol/l. Ty le giam canxi, tang phospho va toan chuyen hoa thi lai tang theo giai doan nang ciia benh. Myc dp thieu mau co tu'dng quan thuan myc do vya vdi MLCT (vdi r = 0,44, p = 0,001). Ty le thieu mau la: 84,2%, trong do thieu mau vya chiem chii yeu (45,6%) thieu mau nang chi chiem 14%, da sd la thieu mau ding sIc.Tuyet dai da sd suy than giai doan IV (92,9%) va V (91,3%) co thieu mau.
Kit luan: Benh nhan den vien thu'dng rat nang, gan mot nya sd benh nhan bj suy than man den vien trong giai doan cudi cho thaiy can phat trien chan doan sdm va phong cac benh than. Hau nhu'eac benh nhan
* Tru'dng Dai hgc Y Ha Npi
Phan bien khoa ftpc.PGS.TS. Nguyin Phu Dat
suy than man nhap vien deu can bii canxi, 1,25 (OH)2D3, erythropoietin va sat.
TCr khoa: suy than man, thieu mau, myc Ipc cau than, toan chuyen hoa.
SUMMARY
To study the paraclinical characteristics of hospitalized children with chronic renal failure
in the Uro-nephrology Departmentof the National Hospital of Paediatrics
Aim: To study the paraclinical characteristics of hospitalized children under 15 years old with chronic renal failure (CRF) in the Uro-nephrology Department of the National Hospital of Paediatrics
Methods: descriptive study of 57 patients with CRF from 01/01/2008 to 31/12/2009
Results: 40.4% of hospitalized CRF patients was the end stage of renal failure with average GRF 6.49 ± 1.7 ml/min/l,73m2, average ereatininemia was 1092,7 ± 433,4|amol/l and average uremia was 49 ±20 mmol/l. The rate of hypocalcemia, hyperphosphoremia and metabolic acidosis appeared more frequently in advanced stages of disease. The degree of anemia
