^ ^ ^ ^ NGHIEN CCIU KHOA HOC
OANH GIA HlgU QUADI^U TR! BeNH SUI MAO GA SINH DUG
BANG PHAU THUAT LASER cOg vA so SANH K^T QUA
DI^U TR! BgNH SUI MAO GA SINH DUG BANG DAO DlgN TAI MOT S 6 PHONG KHAM DA Lliu -
KHU VUC THANH P H 6 THAI NGUYEN
Nguyen Quy Thai*
TOMTAT
Moc tiiu nghiin cCfu: 1. Ddnh gid hiiu qud diiu tri sdi mdo gd sinh due bdng phau thudt Laser CO^
tai khoa Da liiu, Benh viin Da khoa Trung Uang Thdi Nguyin. 2. So sdnh kit qud diiu tri binh sui mdo gd sinh due bdng dao dien tql mpt so phdng khdm da lieu - khu vUc Thdnh pho Thdi Nguyin.
Doi tWdng va phWcfng phdp: gom 76 binh nhdn duae ehdn dodn sui mdo gd sinh due duae diiu tri bdng phdu thudt Laser CO^ tql khoa Da liiu, Binh viin Da khoa Trung uang Thdi Nguyen vd phdng khdm Da liiu, Trung tdm Da liiu Thdi Nguyin. Nhdm ehdng lleh sd: 77 binh nhdn sui mdo gd sinh due dupe diiu tri bdng dao dien.
Ket quA nghiin cCfu: hiiu qud diiu tri tot d nhUng binh nhdn sdi mdo gd sinh due ed kich thUdc sui tu 1-2cm Id 70,05%. Thdi gian diiu tri, ti li biin ehUng, mUedp tdi phdt, biiu hiin khdng mong muon d nhdm can thiip thdp han so vdi nhdm ehdng (p < 0,001-0,05). Tdc gid kit ludn: phdu thudt Laser CO^
trong diiu tri sui mdo gd sinh due Id mdt phuang phdp ed hieu qud eao vd thudn tiin khi sd dung, nin duae lua chpn Uu tiin khi benh nhdn khdng ddp Ung vdi ede tri lieu thdng thudng khde.
Tfl khod: sui mao ga sinh due, phau thuat Laser CO^.
I.DATVAND^
Sui mao ga sinh due hay Genital Warts la mpt trong nhflng benh lay truyen qua dUdng tinh due (LTQDTD) thudng gap. Theo Nguyen Van Huan (2000), sui mao ga sinh due chiem tfl 6-10% trong tdng sd ede benh LTQDTD tai Qudng Ninh. Benh nhan bj benh la do nhiem nhieu ehCing virus HPV (Human Papilloma Virus) ddng thdi gay nen. Tuy nhien, hau het
* Trudng Dai hoc YDuac Thdi Nguyen
ede trudng hpp nhiem HPV khdng cd b i l u hien trieu chflng, dUdi lam sang hoac khdng nhan biet. Muc dfch dieu trj sui mao ga sinh due la loai bd cdc tdn thuong lam sang nham cd the lam giam tfnh lay nhiem eua benh va tha'm ml cho ngUdi benh.
Mae du, da ed nhieu phuong phdp dieu trj sui mao ga sinh due dupe dp dung (hod chat, dieu trj lanh, dao dien...) nhUng hien van chUa ed each dieu tri nao that hoan hdo cho tat ed ede benh nhan. Nhflng nam gan day khi
S6 04 (ThSng 06/2011) DA LlEU HOC | 2 5
NGHIEN CUU KHOA H O C ^ ^ i ^ - ^
edng nghe Laser phat trien va duac iing dung nhieu trong Y hpc, dac biet vdi vai trd chu yeu la "con dao md" thi viec dieu trj sui mao ga sinh due bang phau thuat Laser CO^da duac nhieu CO sd y t e dang dp dung. Do vay, nghien cflu ddnh gid hieu qud dieu tri cung nhU khd nang de tiep can eua edng nghe mdi nhU Laser CO^, gdp phan lam eo sd giup eho thay thudc va benh nhan lua chpn phUOng phap dieu trj thfch hpp la van de can thiet.
Muc tieu eua de tai la:
1. Ddnh gid hieu qud diiu tri sui mdo gd sinh due bdng phdu thudt Laser CO^ tql khoa Da liiu, Benh vien Da khoa Trung Uang Thdi Nguyin.
2. So sdnh kit qud diiu tri binh sui mdo gd sinh due bdng dao dien tai mpt so phdng khdm da lieu - khu vUe Thdnh pho Thdi Nguyin.
2. D6| TUONG VA PHUONG PH AP NGHI£N CUU 2.1. Ddi tuong
Nhflng benh nhan dupe chan dodn sui mao ga sinh due, tU nguyen dieu trj tai mdt sd phdng khdm Da lieu thude khu vUc thanh phd Thdi Nguyen (khoa Da lieu, Benh vien Oa khoa Trung UOng Thdi Nguyen va Trung tam Da lieu Thdi Nguyen). Thdi gian nghien cflu trong 2 nam: t f l 2002-2003.
Tieu ehuan chan dodn: tai vung sinh due ed mdt hoac vai tdn thuong sui mao ga mem hoac phang det, mau do thjt tuoi, khdng dau (ehi chpn nhflng benh nhan ed kfch thUde sui la
l-2em dudng kfnh lam nghien cflu).
2.2. Phirong phap nghien cflu
- Phuong phdp nghien cUu\ sfl dung phuong phap nghien cflu can thiep, thiet ke thfl nghiem lam sang khdng ngau nhien.
- Chpn mdu nghiin cdu:
+ Nhdm can thiep: la nhflng benh nhan ed nam va nfl cd tdn thUong sui mao ga sinh due nhutren dupe dieu trj bang phau thuat Laser CO^.
-H Nhdm so sdnh hieu qud: la nhdm chflng Ijch sfl, nhflng benh nhan ed bieu hien tdn thuong nhutren dUpc dieu trj bang dao dien.
-I- Cd m i u : moi nhdm nghien cflu cd ft nhat 30 benh nhan se cd gid trj nghien cflu.
- Chi tiiu nghien cdu: ddnh gid cdc ehi sd ve thdi gian dieu trj, ti le bien chflng, tdi phat, tdc dung khdng mong mudn trong khi tien hanh thu thuat va so sdnh vdi nhdm dieu trj bang dao dien.
- Ki thudt thu thdp so lieu:
+ Phdng van trUe tiep.
+ Khdm lam sang.
+ Tieu chua'n ddnh gia
* Ket qud dieu tri tdt: sau mdt lan dieu trj khdng bi tdi phdt, khdng cd bien chflng, khdng cd bleu hien tdc dung khdng mong mudn trong qua trinh tien hanh thu thuat.
* Ket qud dieu trj chUa tdt: neu ed mdt trong eae bleu hien tren.
-XUIIso liiu: theo phuong phap thdng ke y hoc.
3. KETQUA NGHIEN CUU
Sau khi dupe phau thuat xong, benh nhan tiep tuc dupe theo ddi 10 ngay, neu thay tdn thuong khd, khdng cd seo, khdng tai phat, khdng ed bien chflng thi dMc coi la khdi. Thdi gian dieu trj tfnh tfl khi phau thuat cho tdi khi khdi va ra vien. Ket qua ve thdi gian dieu trj trung blnh cua phuong phdp phau thuat Laser COj va so vdi phau thuat dao dien dupe trinh bay d bdng 1.
2 6 I D A L l £ U H O C s6 04(Thanq06/201 1)
^ ^ ^ ^ N G H I E N CUU KHOA HOC
Bdng 7. So sanh so ngay dieu trj trung bmh (X)giCra2 phWdng phap
Phuong phap dieu trj X±SD
P (t test)
Laser CO^
(n = 76) 5,16± 1,46
Dao dien (n = 77) 7,38±2,03
< 0,001
Ket qua d bang 1 eho thay, sd ngay dieu trj trung blnh eua phuong phdp phau thuat Laser
COj la 5,16, thap hon so vdi phuong phdp dung dao dien (7,38), sU khac biet ed y nghTa thdng ke vdi p < 0,001.
Tat cd ede benh nhan trong va sau khi phau thuat, neu ed tfl mdt trong sd cdc bieu hien sau: ehdy mdu, dau rdt, nhiem trung, sUng ne hoac loet se dupe quy Udc la cd bien chflng.
Ket qud theo ddi bien chflng ddac trinh bay qua bdng 2.
BAng 2. Ti li bien chWng d nhom dieu trf bdng phdu thuat Laser CO^
va so sdnh vdi nhom chWng (phdu thugt dao dien)
Phuong phap
Chdy mdu Dau rat Nhiem trung SUng ne hoac loet
Tdng sd
Laser CO SL
1 3 1 5 10
, (n = 76) Tile(%)
1,31 3,94 1,31 6,58 13,15
Dao dien (n - 77) SL
3 6 4 9 22
Tile(%) 3,89 7,79 5,19 11,68 28,57
Cia trip (d; Fisher s exact)
>0,05
>0,05
>0,05
>0,05
<0,05
Ket qud bdng 2 cho thay, trong nhdm dupe dieu trj bang phau thuat Laser CO^ ed 10 benh nhan bien chflng, chiem ti le 13,15%. Nhdm dieu trj bang dao dien ed 22 benh nhan (28,57%) bien chflng.
SU khde biet ed y nghTa thdng ke vdi p <0,05.
Sau thu thuat, neu theo ddi thay benh nhan ed xuat hien tai eho tdn thuong cu vdi kfch thude nhU trude hoac Idn hon va xuat hien them nhieu tdn thuong mdi se dUpc coi la tdi phdt. Ket qud theo ddi ti le benh nhan tdi phat 6\ipc trinh bay d bdng 3.
BAng 3. So sanh ti li tai phat d nhom can thiep so vdi nhom chWng
Tai phat PhUOng phap
Laser CO^
Dao dien Gid tri P
Co tai phat Tdn sudt
13 24
Vle(%) 17,10 31,16
Khong tai phat Tdn sudt
63 53
Tile(%) 82,89 68,83 c^ = 4,13; p<0,05
Tdng Ting so
76 77
Tili(%) 100 100
TI le tai phdt tai tdn thuong d nhdm dieu trj phau thuat Laser CO^ la 17,10%, d nhdm dieu tri bang dao dien (31,16%); sU khde biet cd y nghTa thdng ke vdi P < 0,05.
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BAng 4. Ti li binh nhan co bieu hiin tac dung khong mong muon do lieu phap d nhom can thiep va so vdi nhom chWng
^'""^-^^^^^ Tac dung phu phuong phap ^"""^^-^...^^^
Laser CO^
Dao dien Gid trj P
Co Tdn sudt
2 9
Tile(%) 2,63 11,68
Khong
Tdn sudt 74 68 c^ = 4,7;
Vle(%) 97,36 88,31 p < 0,05
Tdng
Tong so 76 77
Tili(%) 100 100
Qua bdng tren eho thay, ti le benh nhan xuat hien cdc tdc dung khdng mong mudn: ehoang, lo lang, hodng hdt, sp set, khdng hpp tdc vdi thay thudc thi deu dUpc coi la ed tdc dung khdng mong mudn. Ket qud theo ddi ti le benh nhan cd xuat hien tdc d nhdm can thiep la 2,63%, d nhdm chflng la 11,68%; sU khde biet ed y nghTa thdng ke vdi p < 0,05.
BAng 5. Ddnh gia tong hpp hiiu quA dieu trf siii mao ga sinh due bdng phdu thugt Laser CO^
va so sdnh vdiphWcfng phap diing dao dien
Ket qua phUOng phap
Laser CO^
Dao dien Gid trj P
Tdt
SL 54 41
Tili(%) 70,05 53,25
ChUa tdt
SL 22 36 c^ = 5,15;
Tili(%) 28,94 46,75 p < 0,05
Tdng
Tong so 76 77
Tili(%) 100 100
Ket qud nghien cflu d bdng 5 cho thay, hieu qud dieu trj sui mao ga sinh due bang phau thuat Laser CO^ eho ket qud tdt vdi ti le la 70,05%, cao hon ti le benh nhan dat ket qud tdt d nhdm dieu trj bang dao dien (53,25%); sU khde biet cd y nghTa thdng ke vdi p < 0,05.
4. BAN L U A N
Vdi thiet ke thfl nghiem khdng ngau nhien, nhdm nhan lieu phdp can thiep (phau thuat Laser CO^) lai dUpc so sdnh vdi nhflng benh nhan dupe dieu trj theo phuong phap cO d mdt thdi diem trUdc, do vay, nhflng khd khan se gap phai trong qua trinh phan tfch va ddnh gid ket qud nghien cflu la khdng trdnh khdi. Nhat la viec phan tfch ede ehi tieu dieu trj, nhflng khac biet quan sdt dugc ed the bj han che va de dan tdi nhflng sai lech do ede bien nhieu tiem a'n (tudi, gidi, nghe nghiep...) khdng dupe
phan phdi deu d ed hai nhdm khi so sdnh. Mat khde, khi sfl dung nhdm chflng Ijch sfl (phau thuat bang dao dien), sd lieu ve eae phuong phdp dieu trj mdi va eu dUpe thu thap d hai thdi diem khde nhau, nhflng khac biet ve ket qud nghien cflu quan sdt 6\J(3c cung edn ed the do nhieu yeu td khac ehi phdi nhu sU edi thien ve chat lUpng djch vu y te, thj hieu eua ngUdi benh (tin tUdng va Ua chuong djch vu kT thuat y cao), kinh nghiem cua thay thudc... Tuy nhien, vdi mdt kT thuat mdi nhu phau thuat Laser CO^
ma hieu qua da tuong ddi rd rang thi hien nay
2 8 I D A L l i u H O C S6 04 (Thdng 06/2011)
NGHIEN CUU KHOA HOC
dang dupe dp dung vao dieu trj d nhieu eo sd y te chat lupng cao. Ddng thdi, cdc sai lech do yeu td may rui cung da doge ede nghien cflu vien ed gang han che vdi cdch chpn ed mau can thiet va dam bao hieu lUe thdng ke thfeh hpp d ngay tfl giai doan dau khi thiet ke nghien cflu.
Nhu vay, ddnh gid hieu qua dieu trj sui mao ga sinh due bang Laser CO^ vdi mdt thfl nghiem khdng ngau nhien ciJng nhUso sdnh vdi nhdm chflng Ijch sfl la ed the chap nhan va ede thdng tin thu dugc tfl ket qud nghien cflu van dam bao nhflng gid trj nhat djnh.
Ket qud (bdng 5) cho thay, ti le dieu trj thanh edng sui mao ga sinh due bang phau thuat Laser CO^ la 70,05%; cung vdi eae ket qud (bdng 1, 2, 3, 4) da khang dinh nhflng Uu diem vUpt trdi eua phuong phdp phau thuat Laser CO^ so vdi phuong phap dung dao dien dUa tren ede ehi sd ve hieu qud kinh te (gidn tiep qua thdi gian dieu tri), ti le bien chflng, tai phdt, tdc dung khdng mong mudn. Theo chung tdi, cdc ket qud nay la hoan toan phu hop vl ddi vdi mdy phau thuat Laser CO^ khi hoat ddng, chum tia Laser phdt ra nang lUpng Idn, nen cd the quang ddng, cam mdu, lam bde bay td chflc nhanh nhUng ft anh hUdng tdi ede vung xung quanh, diet khuan, gidm dau va ehdng lanh vet thuong. Hon nfla lai cd tia Laser He-Ne dan dudng giup eho viee dinh vi diem phau thuat dupe chinh xdc, ket hpp vdi he thdng true khuyu linh hoat xoay 3 chieu trong khdng gian eung nhutoan bd quy trinh van hanh va sfl dung thiet bj khdng qud phflc tap, nen cd the tao dieu kien eho kT thuat vien de dang thao tdc trong qud trinh cdt, ddt eae tdn thUong. Nhu vay, sU thuan tien nay se giup cho nhflng ngUdi lam kT thuat
cd eo hdi ddng khd nang de khai thde ede dae tfnh kT thuat va Uu diem eua edng nghe mdi nhu Laser COj.
Tuy nhien, chung tdi eung thay viec nghien cflu dp dung cdng nghe nay can dupe tiep tuc tren mdt sd ehi tieu khde nhU gid thanh chi phf eua thu thuat, ede tdn thuong cd kfch thude Idn va d sau hon (Idng nieu dao, ed tfl eung), hay mpt sd hlnh thai khde, de cd the khang dinh hieu qud eua phuong phap mdt each toan dien. Tfl dd, se giup cho thay thudc va benh nhan cd them eo sd de lUa chpn mdt phuong phap dieu tri thfeh hpp ddi vdi moi ngUdi va tflng the benh khde nhau, nhat la ddi vdi sui mao ga sinh due la mdt benh ma kha nang dap flng vdi cdc trj lieu hien nay van cdn nhieu han che.
5. K^T L U A N
Qua nghien cflu hieu qua dieu tri sui mao ga sinh due bang phau thuat Laser CO^ tai mot sd phdng khdm da lieu d thanh phd Thai Nguyen, chung tdi cd ket luan nhU sau:
Hiiu qud diiu tri: ti le dieu trj thanh cdng (ket qua tot) d nhflng benh nhan sui mao ga sinh due ed dudng kfnh tdn thuong tfl l-2em la 70,05%. Cdc ehi sd ve thdi gian dieu trj, ti le bien chflng, mflc dp tdi phat, bieu hien tae dung khdng mong mudn d nhdm dUpc dieu trj phau thuat Laser CO^ deu thap hon so vdi nhdm dupe dieu trj bang dao dien (vdi p <
0,001-0,05).
Y kiin di xudt:
Dieu trj sui mao ga sinh due bang phau thuat Laser CO^ la mdt phuong phap nen dupe lUa chpn Uu tien khi benh nhan khdng hoac ft ddp flng vdi ede tri lieu thdng thudng khde.
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NGHIEN CUU KHOA HOC | ^ ^ ^ ^
TAILICUTHAMKHAG
1. Bo Y te, Vien Da lieu. "DUdng loi quoc gia chi dao chuang trinh quan ly cd hiiu qud ede binh Idy truyin qua dUdng tinh due d Viet Nam"
Ha Ndi-1996.
2. Bo Y te, Vien Da lieu. "HUdng ddn diiu tn cdc binh Idy truyin qua dUdng tinh due" Ha Ndi 12/1999. Tr. 73-81.
3. Uy ban Qudc gia phong chong AIDS.
"Kiim soat cdc benh Idy truyin qua dUdng tinh due - cdm nang thiit kivd quan llchuang trinh"
Ha Ndi 4/2000.
4 W.H.O - Vien Da lieu Viet Nam. "Tong quan vi quan II cdc nhiem khudn Idy truyin qua dudng tinh due". Ha Ndi 3/2000.
5. Nguyen Van Huan. "Mdrdng vd tdng cudng ea sd khdm chUa binh LTQDTD ed sU phoi hgp vdi mdng ludi y ti tu nhdn tai Thdnh phoHg Long, Tinh Quang Ninh ndm 1999". Npi san Da lieu. Tdng hdi Y DUpc hpc Viet Nam 2/2001. Tr. 27.
SUMMARY
EVALUATION OFTHE EFFECTIVENESS OF C02 LASER IN COMPARISION WITH ELECTROCAUTERY THERAPY IN TREATMENT OF GENITAL WART ATTHAI NGUYEN CITY
Objective: to evaluate the effectiveness of C02 laser in genital wart in dermatology department - Central Hospital in Thai Nguyen province and to compare the results of two therapies - C02 laser and electrocautery in genital wart treatment at some dermatology elinies in Thai Nguyen province.
Subject: 76 patients having genital wart treated by C02 laser in dermatology department- Central HospitaL 77patients with genital wart treated by electrocautery.
Results: 70.05% of patients with the wart with diameter of l-2em had good result Duration of treatment, complication, relapsing, unwanted effects in group treated by C02 laser were less than that of group treated by electrocautery statistically (p< 0.001- 0.05)
Conclusion: C02 laser in genital wart treatment is convenient and highly effective. It is considered a good choice for patients who resistant for other therapy.
Key words: Genital wart, C02 laser therapy.
3 0 I D A LIEU H O C S6 04 (Thang 06/2011)
