NGHIEN cdu MOT SO DAC DIEM LIEN QUAN DjCH TE BENH MONG THjT AT MAT
TOM T A T
Myc tidu: Tim hiiu mdt sd d$c diim lien quan dich td cua bdnh mdng thit d mit
Doi twgng vd phuong phdp nghi&n cd'U:
Nghi&n cCru duoc tiin hdnh theo phwang phdp md td cBt ngang v&i 91 mdng thit & mit
Kit qud: Mdng tdp trung nhiiu & lira tudi > 40 (96,8%), chO ydu & lOa tuoi > 50 (77.8%).
Ty le giira b&nh nhdn nam vd nw Id tuong dwang nhau (33/30 = 52.3%/47.7%).
Chidm da sd Id mdng gdc trong (90.9%), chi ed 9.1% Id mdng k&p. Sy khdc bi&t ndy cd y nghia thdng k&(p<0.001).
68.3% so b&nh nhdn cd mdi trwdng lao ddng thw&ng xuy&n tiip xOc v&l cdc yiu to gdy nen benh mdng nhw gid. bui. tia f d ngoai (ldm mdng, bd ddi).
Tir khda: Mdng thit SUMMARY
Background, to find out some elements related epidemiology of pterygium
Patients: 63 patients diagnosed pterygium and treated at of ophthalmologic of 103 Hospital and Institute of Aviation Medicine 7/2008 to 4/2009 (msident in hospital)
Method: Cross - Obsen/ation stady.
Conclusion: Pterygium heavily concentrated in age> 40 (96 8%), mainly in the age gmup> 50 (77.8%).
The ratio between male and female patients was similar (33/30 = 52 3%/47.7%).
The majonty of pterygium of the inside comer of eye (90.9%), only 9 1% is double pterygium. This diffemnce is statistically significant (p <0.001).
68.3% of patients have working environment with regular exposure to factors such as wind, dust, ultmviolet mys (fanner, soldiers).
Keywords: pterygium DAT V A N Dt
Mong Id mot k h i i tdng san xo mach ctia mfl dudi k i t mae nhdn d u , cd hinh tam giac ma dinh quay v l phia trung tdm gidc mac, day quay ve phia cue Ig (nlu Id mflng gflc trong) ho§c vd phia cting dd ngodi (nlu Id mflng gflc ngodi). Ddy la mflt benh p h i biln trong nhSn khoa, Id mdt trong nhung nguyen nhan quan trpng gdy giam thj lyc vd mti Ifla [1,2].
Bdnh phdn b i khflng d i n g deu ve mat dja du, p h i bien d cdc nudc nhidt ddi vd cdn nhiet ddi, khi hdu nflng I m , thdi lugng ndng eao, it gdp han d xir Ignh Yeu t i moi trudng nhu bui, gifl, dnh ndng mdt trfl'i cfl vai trfl quan trpng trong co chd benh smh. Ct Viet Nam, theo thing kg ctia Bgnh vidn Mdt trung uong (1996) ty le n^udi m l c bdnh mflng Id 5,24% trong t i n g s i ddn dieu tra, trong do t$p trung nhieu d vung ven biln midn trung [3,5,6],
LE oCrc HANH - Bdnh vidn Trung uong Quan ddi 108 LE DINH ANH - B&nh vi&n 103.
Vl ly do dd chOng tfli tien hdnh nghign edu de tdi vfli mue tieu. Nghl&n cuv ddnh gid rndt sd ddc diim li&n quan dich te b&nh mdng thit a mit
D 6 | TU'ONG VA PHU'ONG PHAP NGHIEN CLfU 1. Ddi tugng nghidn c d u
Nghien euu tidn hdnh trgn 63 benh nhdn dugc c h i n dodn Id mflng thjt d i l u trj tgi Khoa Mat Benh vien 103 vd Khoa M i t Vien Y hgc Hang Khflng tu' thdng 7/2008 den 4/2009 (cd bdnh dn nfli tm).
Loai trd nhdng b^nh nhan khflng hgp tdc nghign cuu, nhdng mgng thit cd nguin gdc do vet thuong giae mgc hodc khdng rfl rdng.
2. Phuong phdp nghien cdu Thing ke theo h i so bdnh dn bdnh nhdn.
Benh nhdn dd duoe c h i n doan bgnh. dd mdng.
+ Danh gid tinh trang mflng: bang khdm tren sinh hien vi
- Vj tri mflng: d m i t phai hay mat trai. gflc trong, ngodi hay d 2 gflc
- Mdc dfl xdm l l n eua mflng tren giac mac de xdc djnh dfl mflng.
+ Phdn dfl theo phdn loai eua Benh vien mit Trung uong [1,2,3]:
• Dd I: D i u mflng vuot qud ria gidc mgc 1mm
* Dfl II: D i u mflng ehua tdi 1/2 bdn kinh gidc mac
• Dd 111: D i u mdng vuot qud 1/2 bdn kinh gidc mac
• Dd IV: D i u mflng tdi trung tam giae mac 3. S d l y s 6 lid
S u ly sd lieu b l n g chuong trinh EPI - INFO 6 04 A ctia To ehdc Y t l t h i gidi.
KtT QUA NGHIEN CU'U VA BAN LUAN Mflng dien hinh tren Idm sdng Id mflt to chuc tdn tao ctta k i t mgc cd hinh tam giac kem theo xo mach xam Idng qud ria vdo gidc mac.
Anh 1. ciu tgo mdng Theo Pico (1987). mdng g i m d 4 phln
- P h l n ludi trai: Quan sdt trgn sinh hiln vi thdy p h l n ndy Id mdt cung trdn, doi khi ed hinh rdng cua bao trudc mflt p h l n hay todn bd d i u mflng
- D i u mdng Ld p h l n phdt t r i l n trdn gide mac - C6 mdng. Ld p h l n ehuyin t i l p gida gide mgcvd
Y HOC TH^rc HANH (886) - S 6 11/2013
k i t mgc nhdn d u .
- Thdn mflng- trdi ddi t d vting ria tdi nep bdn nguygt (mdng gflc trong), hode tdi gdc ngodi mi (mflng gflc ngodi)[6].
Qud trinh tiin triin cOa mdng
Tidn tnIn cOa mdng thudng chdm trong nhilu ndm, efl thd nhanh chi trong vflng vdi thang Qud trinh hinh thdnh mflng thudng qua hai giai doan (Comand, 1989):
- Giai doan k i t mgc: giai doan ndy thudng rat ddi, cfl khi h i t ddi vdn khflng t i l n t r i l n sang giai doan sau vdi nhung b i l u hign phtj kdt mae ria gflc trong, sung huyet k i t mgc khe mi nhg, cfl the gian mgeh k i t mge vd CO kdo ctia k i t mgc nhdn d u v l phia ria tgo nen mdo cgnh ria Giai dogn ndy bgnh nhan thudng efl tngu chdng kleh thieh nhg k i l u dj vat, ddc biet khi di gifl, ning.
- Giai dogn gidc mgc (mflng thuc thy), s u g i lgn ctia m_ao eanh ria Idm m i t sy lign tuc ctia phim nudc mdt dan d i n rdi logn dmh dudng vd hinh thanh cdc i lodt gide mac nho Qud trinh bgnh ly ndy duoc lap di Idp lai tao seo vd s u xdm l l n ctia k i t mge nhan e l u vdi d i y tdn maeh vdo gide mac hinh thdnh mflng dien hinh [5].
Nhung biin chimg cda mdng
- Mflng trong qud trinh t i l n trien eo t h i gdy ra ede b i l n chdng sau,
- Vigm k i t mae - Chay nudc mdt,
- Song thj. do sy co rtit cua t i ehde xo Idm hgn chd vgn nhdn,
- Logn thi sy eo k6o gide mgc do mflng xdm l l n Idm b i l n d i i dfl eong gide mge
- Khuylt thj tmdng- do mdng ehe vdo vting quang hgc cCia gidc mgc
- Nang vtii b i l u mfl, b i l u mfl cfl the chui xuing dudi Idp dgm vd hinh thdnh nang chda djeh d thdn hodc d i u mflng
- Hidn tugng Dellen' Id d i l m loet gide mac d i u mdng.
T u thdng 7/2008 ddn thdng 4/2009 chting tfli dd t i l n hdnh nghign edu thdng kg cho 88 mdt etia 63 bgnh nhdn (30 nd vd 33 nam) Cfl 17 bgnh nhdn bi mflng mdt phai. 21 bgnh nhgn bi mflng m i t trdi vd 25 bdnh nhdn bi mflng d ca 2 mdt.
B l n g 1, S i lugng bdnh nhdn, sd mdt, s i lugng mdng vd sd mflng nghign cdu
Chisd Bgnh nhdn
Sfl mdt Sfl mflnq Sfl mflng nqhign etru
Tlnh chdt mflnq MOng
don 1 mdt
30 30 30 30
Mflng don 2 mat
25 50 50 50
Mflng kep
8 8 16 11
Tong cflng 63 88 96 91
vdo thing kg nghien edu vl nguygn nhdn hodc ed seo t i n thuang gide mac d vi tri mdng hode hen quan nguygn nhdn c h i n thuong chua rfl rdng, Nhu vay t i n g s i mflng nghien cdu Id 9 1 .
Ddc d i l m vg vj t r i mdng
Trong 63 benh nhan efl 17 bgnh nhdn bl mong m i t phdi (27,0%), 21 bgnh nhdn bi mflng mdt tr^i (33,3%) vd 25 benh nhdn bj mflng 2 m i t (39,7%).
B i l u do 1 cho thay vj tri mflng cdc m i t la tuong duong nhau (p>0,05)
n
Bleu do 1 Vl tri mdng
rp
DMAn • MSn B ilcm g6c agaiig k t p
n m
rMflng den Mgng cTcn Mgng kep gflc trong goe ngodi
Biiu ad 2 Phdn bd mdng Trong 88 m i t chting tfli ggp da sd mflng gflc trong (90,9%), ehi cfl 9 , 1 % Id mflng kgp Sy khdc bigt ndy efl •^ nghTa thdng kg (p<0,001)
D$c d i l m benh nhdn theo t u l i , g i d i vd dd mflng
Bdng 2. Phdn b i mflng theo nhflm t u l i vd gidi tinh Nhflm
tu6i S40 41-50 51-60 61-70 2 71 Cftnq X±SD
NO SL
0 7 9 11 3 30
TL
(%)
0.0 11.1 14.3 17,5 4,8 47,7 58,4 ±8,9Nam SL
2 5 13 9 4 33
TL
(%)
3,2 7,9 20,6 14,3 6,3 52,3 59,4 ±9,1Tflnc SL
2 12 22 20 7 63
sflBN TL(%) 3,2 19,0 34,9 31,8 11,1 100,0 59,0 ± 9,0
So sanh (P)
0,709
p>0,05
Sd m i t mdng thjt Id 88 trong dfl d 80 mdt mdng don vd 8 m i t mdng kgp. Trong s i 8 bdnh nhdn ed mdng kdp thi efl 5 mdng chCing tdi logi ra khflng dua
Trgn t h i gidi: theo Young Son (1972) [8]. bgnh mflng ehu y l u gdp d Ida t u i i trgn 30, ty Id mflng theo t u i i trong tong s i ngudi m l c benh Id:
+ < 40 tudi: khoang 27%.
+ >40 t u i i khoang 73%.
Theo thing kg ctia Vien Mdt Trung Lfong ndm 1996, mflng gdp d do t u i i dudi 20 t u l i Id 0,13%, d d d t u i i t r g n 5 0 l d 1 5 - 1 8 % [ 3 ] .
Nghien cdu eua chting tdi cho t h i y ty lg bdnh nhdn bi mdng t§p trung nhieu d Ida tudi > 40 (96,8%), t^p trung d Ida tuoi 41 - 70 (85,7%), chti ydu d Ida t u i i > 50 (77,8%), Chi cfl 2 trudng hgp t u i i 31 - 40
Y HOC THI/C HANH (886) - S6 11/2013
(3,2%) Sd luong benh nhan tdng d i n theo hudng ty Ig thugn vdi tudi. Bgnh nhdn nhd t u l i nhat trong nhflm nghign euu Id 39. S i bdnh nhdn nam va n d tuong duong nhau (33/30 = 52,3%/47,7%) & mdi nhdm t u l i thi ty le nam vd n u eung tuong duong nhau (p>0,05). Tuoi trung blnh cua nam cao hon so vdi nd, Tuy nhien sy khde bigt khflng efl y nghTa thing kg vdi p>0,05
K i t qua nghign cdu ctia chung tfli phti hop vdi mflt s i tdc gia khde, benh r l t It gdp d nhung ngudi nhd hon 30 t u i i , day la dfl t u i i mdi b i t d i u lao dflng.
Sau mdt thdi gian ddi t i l p xOc vdi cdc nhdn t i gdy bdnh nhu gid. bui. tia t u ngogi.,, t d 40 t u i i trd lgn t j Ig m l e bgnh eao hon. Young Sun (1972) ed nhdn xdt la mflng ehu y l u x u l t hign d t u i i trgn 35 (63,8%) [8].
Theo Verin (1993) s i ngudi m l c benh mflng d dfl t u i i Id t d 26-86 (tuii tnjng blnh Id 56 tuoi) [7]. Trong nghign edu cua chting tfli, t u i i trung binh Id 59,0 ± 9,0 vd t u i i trung binh etia nam eao hon so vdi nu (59,4 ±9,1 so vdi 58,4 ± 8.9).
Nhu v$y, mgng x u l t hidn chu y l u d nhung ngudI trong dd tuoi lao ddng vd tdng d i n theo t u l i .
Bang 3. Phan t i i dd mflng theo gidi tlnh oo
mOng II III IV COnq
NL»
SL 24 21 3 48
TL 26.4 23,0 3.3 52,7
Nam SL 14 26 3 43
TL 15,4 28,6 3,3 47.3
COng SL 38 47 6 91
TL(%) 41,8 51,6 6,6 100,0
So sdnh
(P) 0,352
Mflng dp II benh nhdn n d chilm 26.4% cao hon so vdi sd benh nhdn nam (15,4%). Ngugc lai, d mdc mflng dfl III sd benh nhdn nam chilm 28.6% eao hon so vdi nd (23.0%). s y chdnh Idch khflng cfl y nghIa thing kg (p>0.05). Ty le giua bgnh nhdn nam vd nii Id tuong duong nhau (33/30 = 52 3%/47.7%).
K i t qua ctia chung tdi phti hgp vdi Verin (1993):
ty lg bgnh gida nam vd nd khflng efl gl khde biet [7]
Bdng 4 Lien quan gida nhflm t u i i vd dfl mflng Nhflm tu6i
£40 41-50 51-60 61-70
; 5 71 C$nq
Doll SL
0 10 14 11 3 38
TL{%) 0,0 11,0 15,4 12,1 3.3 41,8
QOIII SL
2 7 16 18 4 47
TL(%) 2.2 7,6 17.6 19,8 44 51,6
Dp IV SL
0 0 1 2 3 6
TL (%) 0.0 0.0 1.1 2.2 3.3 6.6
Cpnq SL
2 17 31 31 10 91
TL(%) 2,2 18,6 34,1 34,1 11,0 100,0
So sdnh (p) 0,191 0,625 0,664
Mflng dfl III chilm 51.6%, t§p trung nhilu d nhflm t u i i 50 - 70, mflng dp II chidm 41,8% vd khong cfl bgnh nhdn ndo £ 40 h\ mgng dfl II. Tuy nhign khflng cd s y khdc blgt v l phan bo dfl mflng theo nhom tuoi d cdc bdnh nhdn nghien edu (p>0 05).
Ddc d i l m v l n g h i nghi#p
Yeu td mfli trudng, n g h i nghigp dflng vai trfl quan trpng trong sinh benh hpe etia mflng. Mflng thudng gdp d nhdng vting nhieu n i n g nflng, gifl bui vd ty Id mflng khdng ddng d i u trgn t h i gidi cOng nhu d mfli quic gia, thudng gap nhit d cde nude nhiet ddi vd edn nhidt ddi, khi hau nflng am, thdi lugng nang cao, dgc bidt noi cfl nhilu gio edt (vimg biln) Theo Pico (1987) benh mflng gdp ehu y l u d ede nudc ndm t d vT dfl 35 den xlch dao [61. Theo Cornand (1989), ty lg mde bdnh mflng trgn the gidi Id 6-20% [5]
Bang 5 Phan bo benh nhdn theo nghe nghiep Nghg nghigp
Ldm rupng can bo
Khdc
So lupng Ty id (%)
19,0 CQng I 63 J 100,0 Nghien edu etia chting tdi eho k i t qua da so benh nhdn cd nghd nghiep Idm ruflng (44,4%), bfl dfli ehilm 23,9%, edn bfl, huu tri chilm 12,7% vd d c n g h i khdc (nfli trg, budn bdn,,,) chidm 19% Nhu v | y cfl ddn 68.3% sd benh nhdn cfl mfli trudng lao dflng v l t va, thudng xuygn t i l p xtic vdi d c yeu td gdy ngn
bdnh mdng nhu gifl. bui. tia t d ngoai (ldm ruflng, bO ddi), Ddc bigt trong didu kidn khI h$u etia nudc ta n i m trong khu vyc g i n xlch dgo: nflng. I m vd thdi lugng ndng cao D i l u ndy phti hgp vdi nhan dinh cua nhilu tdc gia: y l u td thu|n lgi eho mdng phdt triln Id dnh mdt trdi, gifl, cdt but.
Cameron (1983), Pico (1987) cOng cho ring bdnh mdng chu y l u x u l t hign d noi g i n xlch dao vd xlch dao (noi CO nhieu nang nflng vd gifl, bui) [4,6].
K £ T LUAN
Mdng x u l t hign chti y l u d nhung ngudi trong dfl tudi lao dgng va ty le gdp tdng dan theo tuli, t$p trung nhilu d Ida t u i i > 40 (96,8%), ehtt y l u d lu'a t u l i > 50 (77.8%).
Ty le gida benh nhdn nam vd n d Id tuong duong nhau (33/30 = 52.3%/47,7%).
Da sd la mgng gflc treng (90.9%), ehi d 9,1% IS mdng kdp.
Y l u t i mfli tardng, n g h i nghidp dflng vai trd quan trpng trong sinh benh hgc ctia mdng. 68,3% sd bgiih nhdn cfl mfli tnj-dng lao ddng thudng xuydn tilp xOc vdi cdc yeu t i gdy ngn bdnh mdng nhu gid. byi, tiati) ngogi (Idm njdng, bfl ddi),
TAI LIEU THAM K H A O
1. Hoang Thj Minh Chdu (2004), "Kit mgc".
Nhan khoa gian yeu (Phan D i n chu bign) tgp 1.
ehuongV.tr 109-145.
2 Nguyen Duy Hod (1972). V i n de mflng thjL Nhan khoa thyc hanh, (3). tr 10-12.
Y HOC THUC HANH (886) - S6 11/2013
3. Ct) Nhin Ngi. Hodng Thj Luy. Hd Huy Tiln va d n g sy (1996), Dieu tra djeh tg hoc mu lod va mgt so bgnh v l mat. Cdngi trinh nghidn cdv khoa hgc cip bp, Vign mat,
4. Cameron M. E. (1983), Histology of pterygium: an electron microscopic study.
Br J. Ophthamol, (67), pp 115-172
5. Comand G (1989), Pterygium: clinical course and treatment.
Rev. Int Tmch. Pathol. Ocul. Tmp. Subtrop. Sante Pubhque. (66), pp 81 - 108.
6 Pico G. (1987), Surgery for pterygium.
Ophthalmic plastic and reconstmctive surgery.
Mosby. S.T Louis. (2). pp 168 -171
7. Venn P., Coulon P., Cals et al (1993), L autogreffe conjunctivaie dans la curr chirurgicale du pterygion, apropos de 186 cas,
Rrev. Intem. Trachoma et Path. Ocul Tmp. Subtmp Sante . (70), pp 235 - 245.
8. Youngson R. M, (1972), Recurrence op pterygium after excision.
Br J. Ophthalmol, 56, pp 120 -125
NGHIEN CUU UNG DUNG KY THUAT LIQUI-PREP TRGNG CHAN DOAN l i BAG AM DAG CO TUT CUNG
LE QUANG VINH, VU BA QUYiT, NGUYEN KHANH DUONG, LUU THj HONG
TOM T A T
Myc tidu: 1) So sdnh chat Iwgng ti&u bdn gida hai phwang phdp xdt nghidm td bdo hgc Llqul Pmp va Pap cd diin 2) Ddnh gid sy pbO hgp chan dodn giira hai phuong phdp Liqui Pmp vd Pap eo dien vdi kit qud chin dodn md benh hoc. Ddi twong vd phirong phdp: Nghidn ciru md td dt ngang ed so sdnh tr&n 60 phy nO' ddn khdm phy khoa tgl bdnh vi$n Phu Sdn Trung uong da dwgc xdt nghiem theo hai phwang phdp Pap cd diin vd Liqui-pmp tir thdng 11 ndm 2012 ddn thdng 1 ndm 2013. Ket qud: Ty le tieu bdn dg( chit Iw&ng tdt theo k^ thudt LiquiPmp vd Pap cS diin lin Iwgt Id 79,9% vd 63.3%. Ty 1$ ti&u bdn khdng dgf y&u du chin aodn cua ky thudt Pap cd aidn cQng cao hon cd j / nghTa (p<0,05) so v&i ky thudt Uqul- pmp (15,0% so v&l 6.7%) V&l phwang phdp Pap co diin, ty Id dm tlnh gid vdi ede trw&ng hgp LSIL Id 11,0% vd dwang tlnh gid Id 17,3%. Cde trwdng hgp HSIL duong tlnh gid Id 16.7%. Vdi phwang phdp Liqui-Prep, ty 1$ Sm tlnh gid v&i cdc trw&ng hgp LSIL Id 8.0% vd duong tlnh gid la 9,0%. Cdc trwdng hgp HSIL duong tlnh gid Id 10.0%. Kit lu$n: Phuong phdp Liqul-Pmp cho chit tuong ti&u bdn tdt han va cd ad nhgy cao han phwang phdp Pap d diin
TCP khod: Te bdo hgc. LIqui-Pmp, md td dt ngang cd so sdnh.
SUMMARY
Objective: 1) To compare quality of specimens between two cytological testing methods Llqui Pmp and classical Pap smear 2) To assess diagnostic accumcy by comparing the results obtained by two methods Llqui Pmp and classical Pap smear with histopathological diagnostic msult Subjects and methods: This is a cmss-sectional descriptive comparative study conducted on 60 women who have mceived gynecological check-up at the National ONGYN Hospital and tested by two methods Liqui Pmp and classical Pap smear fmm November 2012 to January 2013. Results: The rates of well-pmpamd
specimens of Liqui Prep and classical Pap smear were 79.9% and 63.3%. respectively. The rates of specimens felt below standard of classical Pap smear was significantly (p<0.05) higher than LiquiPrep (15.0% to 6.7%, respectively). By classical Pap smear, false negative rate among the LSIL cases was 11.0%, while false positive rate was 17.3%. The false positive rate among the HSIL cases was 16.7%. The the Liqui-Prep, false negative rate among the LSIL cases was 8-0% while false positive rate was 9.0%.
The false positive rate among the HSIL cases was 10.0%. Conclusion: Liqui-Prep method provides higher quality of specimens with higher sensitivity compamd to the classical Pap smear
Keyword: Cytology. Liqul-Pmp. cmss-sectional descnptive comparative study
DAT VAN Dt
Ung thu d t d cung (UTCTC) Id t i n thuong dc tinh p h i bien d phu nd, dung thd hai sau ung thu vtt, Hdng nSm, efl khoang 520 000 phu nd mac mdi UTCTC trgn toan the gidi vd hon 274 000 ngudi chet do UTCTC NSm 2010, tai Viet Nam cfl 5 664 phu nd mdc ung thu co tu cung va ty le m l c mdi UTCTC Id 13,6/100.00 phu nu [1], Ndm 1939, tai Hoa K^.
Papanicolaou eiing vdi Herbet Traut tien hanh xgt nghigm te bdo am dao (Pap) de phdt hign UTCTC d giai dogn sdm [2]. Mgt trong nhung cflng nghg ldm thay d i i dang k l chit luong eac phien do la "Hg thing nghien cdu t l bdo dya tren chat long" vdi tgn goi ky thuat Liqui-Prep [3][4], nhdm tao ra nhung tigu ban dgp, rfl ngt. Chung tfli tien hdnh nghien edu de tdi ndy nhdm cdc myc tieu sau:
1 So sanh chat luong tieu ban giua hai phuong phdp xgt nghiem te bao hoc Liqui Prep va Pap co diln.
2. Ddnh gid s u phti hgp c h i n dodn giua hai phuong phdp Liqut Prep vd Pap e i dien vdi ket qua c h i n dodn mfl bgnh hgc
Y HOC THl/C HANH (886) - S6 11/2013
