Y HOC VIET NAM THANG 1 - SO 1/2012
NGHIEN CUrU MOT SO HINH ANH BAT T H U ^ G Of VUNG MUl -XOANG TREN PHIM CT SCAN
Phan Mong Hoang* - Nghiem Dvtc Thuan*
TOM T A T
Mo ta cat ngang 95 phim CY Scan mui-xoang, Chung toi thu diTcJc nhQ-ng bat thiTdng sau: CIJ Concha bullosa cuon mul giu^ (CMC): 33/95 (34.7 %), (2) Cuon mul giCta dao ngt/ac: 8/95 (8.4 %), (3) Te bao Onodi: 6/95 (6.3 %), (4) Khuyet thanh ngoai xoang sang: 3/95 (3.2 %), (5) Khuyet thanh tren xoang sang: 1/95 (1.1 %), (6) Vach ngan xoang bu'dm gan
vao ong dong mach canh trong: 19/95 (20 %), (7J Te bao Haller: 2/95 (2.1 %), (8) Khihoa cuon mui tren 2 ben . 1/95 (1.1 %), (9) Khihoa mao ga xWcfng sang : 1/95 (1.1%), (10) Thoat vi mo quanh 6 mat vao trong khoi sang: 1I9S.
Tit khoa: Khi hoa cuon nrtui, cuon mui dao ngu'dc, te bao Onodi, te bao Haller.
SUMMARY
Study some inusual pictures of the nasal sinus on CT Scan films
Ooss-secbonal study: 95 sinus (ZY Scan films.
Results: (1) middle concha bullosa: 33/95 (34.7
%), (2) paradoxical middle turbinate: 8/95 (8.4 %), (3) Onodi cell: 6/95 (6.3 %), (4) the lack of lateral wall of ethmoid bone: 3/95 (3.2 %), (5) the lack of superior wall of ethmoid bone: 1/95 (1.1 %), (6) the septum of sphenoid sinus adheres to ICA: 19/95 (20
%), (7) Haller cell • 2/95 (2.1 %), (8) superior concha bullosa: 1/95 (1.1 %), (9) pneumotization of crista gain: 1/95 (1.1%), (10) periorbital tissue enters ethmoid sinuses: 1/95.
Keywords: concha bullosa, paradoxical turbinate, Onodi cell, Haller cell
I. OAT V A N O E
Vdi cau true nhieu ngach va hoc phu'c tap nhu* vijng mui-xoang, mot phau tru'dng thoang va du rong luon la dieu mong muon cua cac phau thuat vien khi tien hanh phau thuat no! sol.
VI vay bat ky mot bat thu'dng nao d vung mui- xoang cung lam trd ngai den qua trinh phau thuat, doi khi gay ra tai bien nang ne. Do do, Chung toi tien hanh nghien diw mot so bat thu'dng thu'dng 6 vijng mui xoang qua hinh anh CTScan vdi 2 muc tieu:
1. Mo ta cac bat ttiu&ng d vung mOl xoang qua liinh anh phim CTScan mGixoang.
2. Xac dinh b' le cua tuhg loai bat thu&ng lien quan den qua trinh phau thuat ngi soi mui xoang.
II. PHUONG P H A P N G H I E N C D U
2.1. Doi tu'dng nghien cuTu: 95 phim CT Scan mui-xoang tai BVOKKV Cu Chi nam 2011.
2.2. Dung cu nghien cu'u:
May CT HiSpeed Dual 2 lat cat, Hang GE, san xuat nSm 2008, thdi gian bao hanh 5 nam (den 2013).
2.3. Tieu chi chon m l u :
* Tieu chi li/a chpn: Tat ca phim CI scan mui-xoang d ngu'di tii* 16 tuoi trd len, khong bi Chan thu'dng dau-mat, tai benh vien Da khoa Khu vt/c Cu chi.
* Tieu chi loai triT:
Phim C\ scan d benh nhan bj chan thu'dng dau-mat hoac da phau thuat npi soi mui xoang.
- Phim CT scan cua benh nhan nho hdn 16 tuoi.
Phim CT Scan d benh nhan c6 tien can chan thu'dng vung dau-mat.
2.4. PhuTcfng phap nghien cuTu: Mo ta cat ngang
III. KET QUA VA B A N L U A N
3.1. Concha bullosa cuon mui giu'a (CMC) .' 33/95 (34.7 % ) .
Trong do :
- Mot ben : 18/95 (18.9 %) - Hai ben : 15/95 (15.8 %)
Concha bullosa cuon mui giu'a (CMC) chiem ti le 1/3, day la so lieu tu'dng doi cao va tao ra sif chu y vl no gay si/ bit tac trong hoc mui cung nhu' Chen ep vao phu'c hdp lo thong xoang.
3.2. Cuon mui giu'a dao ngitdc: 8/95 (8.4%), trong do :
Mot ben : 5/95 (5.3 %) - Hai ben : 3/95 (3.1 %)
Cuon mui giu'a dao ngu'dc chlem 8.4 % gay tiep xuc vach ngan mui (contact point) lam benh nhan nhiTc dau.
3.3. Teljao Onodi: %I°E> (6.3 %), trong do : Mot ben : 5/95 (5.2 %)
Hai ben : 1/95 (1.1 %)
Te bao Onodi chiem 6.3 %, tl le nay dac biet canh bao cho phau thuat vien, vl de lam ton thu'dng than kinh thj khi nao sang sau.
* Benh vien da khoa khu vi/c Cu Chi; ** Hoc Vien Quan Phan bien khoa hoc: GS.TS. Le Gia Vinh
Y HQC VigT NAM THANG 1 - S6' 1/2012 3.4. Khuyet thanh ngo^i xoang sang:
3/95 (3.2 % ) , trong do:
Mot ben: 1/95(1.1%) Hai ben: 2/95 (2.1 %)
Khuyet thanh ngoai xoang sang chiem 3.2
%, dieu nay gial thi'ch vi sao c6 mot so tru'dng hdp viem xoang sang de gay ra bien chiTng ap xe 0 mat.
3.5. Khuyet thanh tren xoang sang:
1/95 (1.1 %)
Khuyet thanh tren xoang sang chiem 1.1 %, tuy thap nhu'ng can dac biet chu y vi de gay bien chiTng npi sp.
3.6. Vach ngan xoang bu'dm gan vao dong mach canh trong: 19/95 (20%).
Trong do:
Ben (P): 4/95 (4.2 %) Ben(T): 15/95(15.8%)
Vach ngan xoang bu'dm gan vao dong mach canh trong chiem 20 %, vi vay khi md vao xoang bu'dm can thao tac nhe nhang neu pha v3 vach ngan de giai quuyet benh ti'ch. Dang chu y trong nghien CLTU ciia chung toi la ti le vach ngan gan vao dong mach canh trong ben trai chiem u'u the (gan 80%) so vdi ben phai.
3.7. Te bao Haller: 2/95 (2.1 % ) .
Te bao Haller du'dc tim thay 2/95 tru'dng hdp. Day la te bao sang du'di 6 mat, no gay bit hep vung phuTc hdp l6 thong xoang.
3.8. Khi hoa cuon mui tren 2 ben.-1/95 (1.1 %) Khi hoa cuon mui tren 2 ben du'dc tim thay 1 tru'dng hdp. Day la tru'dng hdp tu'dng doi hiem.
3.9. Khi hoa mao ga xu'cftig sang: 1/95 (1.1 %)
Khi hoa mao ga xu'dng sang du'dc tim thay i trudng hdp, day cung la mot bat thu'dng hiem gap.
3.10. Thodt v| md quanh 6 mat vao trong khdi sang: 1/95, hiem gap.
IV. KET LUAN
Qua mau nghien cu'u 95 phim CT Scan mui xoang, chung toi gap 10 bat thu'dng sau:
- Concha bullosa cuon mui giu'a (CMC):
33/95 (34.7 % ) .
- Cuon mOigiu^ dao ngu'dc: 8/95 (8.4%).
- Tebao Onodi: 6/95 (6.3 % ) .
- Khuy^ thanh ngoai xoang sang: 3/95 (3.2 %).
- Khuyet thanh tren xoang sang: 1/95 (1.1 %).
- Vach ngSn xoang bu'dm gan vao dong mach canh trong. 19/95 (20%).
- Tebao Haller: 2/95 (2.1%).
- Khihoa cuon mui tren 2 ben: 1/95 (1,1%).
- Khihoa mao ga xWdng sang: \I9S (1.1%).
- Thoat vi mo quanh 6 mat vao trong khoi sang:1/95.
TAI LIEU THAM KHAO
1. Anand V.K. et al (1993). CTofthe nasal cavity and paranasal sinuses and with emphasis on imflammatory disease. Practical endoxnpk: sinus surgery. Mc Graw-Hill Inc. pp. 42-52
2. Kopp W, Stammberger H, Potter R.(1988).
Special radiolgic image of the paranasal sinuses.
Eur ] Radiol; 8: 152-156.
3. Zinreich SJ, Kennedy DW, Rosenbaum AE, Gayler BW, Kumar A3, Stammberger H.
(1987). Paranasal sinuses: CT imaging requirements for endoscopic surgery. Radiology;
163: 709-775.
NGHIEN CQU CHAT LimNG CUOC SONG
CUA BENH NHAN BlfOTU GIAP DON THUAN SAU
P H A UTHUAT
TOM TAT
Nghien ciiu du'dc tien hanh tren 192 benh nhan bu'du giap ddn thuan du'dc dieu tn ngoai khoa tai benh vien Hij'u nghj Viet- Tiep tLT thang 01/2005 den thing 12/2008. Chat luWng song cua benh nhan sau phau thuat du'dc danh gia bang bang cau hoi SF-36 do Ware J.E., & Sherboume, CD, (1992) xay duTig. Ket qua nghien cu'u cho thay sau phau thuat bufdu giap ddn
* Benh vien HIJ'U nghj Viet Tiep Hai Phong Phan bien khoa hoc: GS.TS. Nguyin Van Hilu
Bui Thanh Doanh* va cong su' thuan, chat lu'dng cuoc song cua benh nhan bj anh hu'dng chu yeu 6 linh vi/c SLTC song va tinh trang site khoe chung. Diem trung binh cua linh vi/c sifc song va tinh trang sure khoe chung thap (52,50 ± 8,34 va 51,14
± 10,77); con chiTc nang the lu'c cung nhu" su' dau va kho chju van d mijrc cao^ (77,42 ± 11,10 va 80,99 ± 20,18) so vdi tong so diem chat lu'dng cuoc song (66,40 ± 12,19). Theo thdi gian thed doi sau phau thuat, tong diem chat lu'dng cuoc song cua cac benh
