XI, Nhu vdy khdng phdi edt thdn kinh Id xdy ra bidn chdng hodn todn md cQng cd tru'dng ho'p khdng gdy bidn ehdng. NVHC chdc nfing eho dd khdng edt bd thdn kinh XI thI vSn cd 21,63% bidn chdng nhung dl chdng ehi Id 7,25%, Di chdng ndng nd xdy ra khi NVHC tridt cdn (75%) hode cdi bidn (40%), khdng thdy sy khde bidt vdi nghidn cdu cda tdc gid Phgm Thdng di chdng thdn kinh XI do NVHC tridt cdn Id 73% [3]. Trong nghidn cdu di ehdng chung thdn kinh XI Id 8,58% thdp han nghidn cdu eda Bocea (14,49%) [5]
Bidn chdng thdn kinh tai Idn khi NVHC tridt cdn Id 75%, edi bidn Id 100% vd NVHC chdc ndng Id 33,88%.
NVHC chpn Ipc chl cd 1 phiu thudt (7,14%). Dl chdng dd Igi thi NVHC chdc ndng cd 6,12% trong khi dd NVHC tridt cdn cd 75% vd edi bidn Id 60%.
K^T LUAN
* Cie biin chdng sau phiu thuit: Bidn ehdng sdm 18.71% tn/dng ho'p. Trong dd 11,61% vidm tdy vdt md, tg dieh (9,03%), chdy mdu (2,58%), rd bgch huydt (0,65%), phii m$t (3,87%), Bidn chdng mudn chd ydu Id bidn ehdng thdn kinh 35,45%, di chdng id 10,45%,
' Ddf chiiu cie biin ehdng do nao vit H^eh ed vdi phwang phip phiu thuit
' Bidn ehdng sdm do NVHC cd 2 bdn Id 21,2%, ngo vdt tridt edn hode cdi bidn 77,78%,
- Bidn ehdng thdn kinh XI do ngo vdt tridt cdn (75%) vd cdi bidn (100%) do edt thdn kinh XI. Od Igi di chdng thSn kinh XI gdp chd ydu do ngo vdt eai bidn (40%) hode tridt cdn (75%). Ngo vdt ehde ndng khdng cit thdn kinh XI bidn ehung (33.88%), ngo vdt chpn Ipc khdno gdp bdnh nhdn ndo. Cdc phlu thudt ngo vdt hgch cd ddu gdp t»'dn chdng thdn kinh Tai Idn. Trong dd ngo vdt chon Ipc 7,14%; ngo vdt chdc ndng 33,88%; ngo vdt tridt can 75%; ngo vdt eai bidn 100%. Vi vdy bdnh nhdn thu'dng cd rdi logn edm gide da.
T A I L l f u THAM K H A O
I P h g m Hodng Anh, Nguydn Bd Dd'c vd CS (2001) 'Tinh hlnh binh ung thw d Viit nam'. Tgp ch( thdng tin y hoc 2. Vidn thdng tin thu vidn y hoc tmng u'ong (tri 9),
2. Nguydn Dinh Phde vd CS (2005) °Dic diem lim sing vi kit qui diiu tri phiu thuit cQa ung thw thanh quin- h$ hong t$i khoa Ung bwdu Binh Viin Tai MOi Hong trung wong tir 2000-2004". Ky ydu cdng trinh nghidn edu khoa hoe Tai MOi Hong todn qude 2005.
3. Phgm Thdng (2004) "Nghiin cOv tai biin vi di chdng tin thwong diy XI cOa nao vit hach ci tiit cin 6 binh nhin ung thw thanh quin h$ hong'. Ludn vdn WSt nghidp bdc Bp chuydn khoa II, 2004.
4. Trdn Minh Trifdng (2007) 'Gdp phin nghiin cdu hach c6 trong urm thw thanh quin tai khoa tai mQi hong Binh viin Chy Riy'.Y hoc thyc hdnh 3. Tr. 27 - 29
5 Boeca E (1984) 'Funotkjnal neck dissection: an evaluation and mview of 843 Cases". Laryngoscope 1984.
94 (7): 942-945.
6, Cheng PT (2000) 'Objective compassion ofshoukler dysfunction after three neck dissectton techniques'. Ann Otol-rhinol laryngol 2000 Aug; 109(8); 761-766
7, Gender E et al.(2003)'Complications of neek dlssection'.Acta Otolaryngol 123:795-801.
8, Grayson K Rodgers (1992) 'Lipki and volume analysis of neck drainage in patients undergoing neck dissection'. American Joumal of Otolaryngology 1992, Vol 13, Issues: 306-309.
9, Jose Magrin (2000) 'Bilateral RadKal Neck Dissection: Results In 193 Cases'. Joumal of Surgical Oncology 2000; 75: 232-240
10, Martijn M Stuiver (2008) 'Impact of shoukier complaints after ne(^ dissec^kxi on shoukier disability and quality of life'. Otolaryngology - Head and Necfc Surgery 2008,139:32-39
MOT SO THAY u6\ VE M I I N DjCH TREN NGUfiTl B I N H HEN PHE QUAN BO NHA TRUdC VA SAU DlE'U TRj GIAM M A N CAM OAC Hl£U
OAT V A N
oi
Giam m i n cam dde hidu (GMCDH). Id mdt phudng phdp dtiu trj dd daac sCr dung Idn ddu hdn 90 nam nay. do hai bde sT ngudi Anh Id Noon vd Freeman (1911) thoc hidn. Vdi nguydn tde chung:
dira ddn cdc tinh chat ed chOa dj nguydn gdy bdnh vdo cd U i l mdn cdm. vdi lidu luong vd ndng dd tdng dan, nham ldm thay dSi cdeh ddp ijmg midn djch cda cd t h i mdn cam, d i n ddn vide khdng xdy ra cac tridu chdng cda bdnh,
Vdy nhOtig thay d^i dap dng mien djch cOa cd t h i mdn cam didn ra nhu" thd ndo ?
Nhd vdo nhung thdnh tou nghidn cdu cda Cooke va Loveless (1935 - 1943), cda Ishizaka (1967), Lichtenstein (1968)...vd gdn ddy bang nhidu phuung phdp hien dai, cd dd chfnh xac cao, nhieu tdc gia da chi:fng minh dUdc trong qua trinh didu tri GMCQHda cd nhOhg thay doi sau:
Tang cdc khang the phong bd thude Idp IgG
T R | N H MANH HUNG (lgG1 vd lgG4) vd todn phdn.
- Sir tdng Idn cda cdc khdng t h i phong bd, se ddn ddn vide Cio chd sir t i n g hop khang t h i IgE (dde hidu vd todn phdn).
- Cdc khdng U i l phong be thude tdp IgG cd kha ndng gdn vdi cdc dj nguydn manh hdn tCf 2 0 - 3 0 lan so vdi Idp khdng t h i IgE.
Cd sir tranh chdp vj trf gan tren b l mat mastocyte vd basophile giOa 2 Idp khang t h i IgG va IgE.
- Phdc hdp midn djch glifa IgG - Di nguydn, khi gdn len bd mdt mastocyte vd basophile se khdng gay phd hdy nhOiig te bdo nay, do dd cac chat hda hpc trung gian s5 khdng duoc gidi phdng, vi vdy cdc trieu chdng ldm sdng se khor^ xuat hidn. Ngodi ra cdn cd mdt sd thay d l i khac vHfA^n dich:
+ Tdng sinh lympho T Cto che ddc hidu.
+ Cd sir thay doi ro ret cdc cytokines: d i i n hlnh Id interieukin 2 (IL2) tdng cao.
Y H O C T H i r r H A V H r777^ _ c A B/-.mT
+ Bd t h i todn phan (0) va C3, C4 tang Idn mdt each cd 1? nghta.
•'trong qua trinh dieu tri G1VIC0H eho 35 ngUdi binh hen phe quan (HPQ) do bp nhd, chdng tdi da tien h^nh mdt so phi/ong phap nghien cdu nham danh gia su thay doi ve m i l n dich tren ngudi bdnh.
Do do ehdng tdi thue hidn de tdi ndy nham mue tidu nghiSn edu sau:
1- Xae dinh nong dp IgE vd IgG todn phdn trong huy^t thanh ngudi bdnh HPQ.
' 2-Danh gia su thay ddi cda IgE vd IgG toan phdn tn/6c va sau dieu tri GMCDH,
3- Tim hieu sir thay doi ddng td bdo lympho T3, T4, T8 gida ngudl binh thudng vd ngudi bdnh HPQ vd sirtliay dli cda chdng trudc vd sau didu tri GMCDH.
D 6 I Tl/gNG VA PHUONG P H A P NGHlfeN cCfU 1- Ooi tUdng nghidn cdu:
4- Nhdm chdng, bao gdm 50 ngudi khoe manh, khfing CO tien sCr dj drig vd ede bdnh dj dng.
•' 5- Nhom ngudl bdnh' bao gdm 35 ngUdi benh hen phe quan do bp nha (difa vao cdc phUdng phdp chan doan dae hieu) da tham gia vdo qua trinh dieu tri GMCDH dUde 12 thang, 6 moi Ida tuoi khae nhau,
2- PhUdng phap nghien cdu: Tien cdu, ed sd dung tliualtoan thong kd y hoe,
6-Djnh luong khdng t h i IgE todn phan bang phuang phap ELISA trdn may ES33.
?• Dinh lUdng khdng the IgG todn phan tren may AUTO LAB - BM/Hitachi 704.
„ Liru :^: huyet thanh ngirdi benh hen phe quan bp nha dude lay trude vd sau dieu trj GI\flCDH 12 thang de 50 sanh.
^^8- Tinh tf id te bao lympho T3, T4, T8.
^"^guyen tac: binh thudng te bdo lympho T d ngudi vai(*iudt, cd nhufng cam thu quan (receptors) tii nhien vdi phan doan Fe eda IgG. Dua vao tinh chat ndy.
ngufli ta ed the san xuat ra dupe nhung khang t h i IgG dac tiieu ddi vdi cae ddng lympho ddn ddng (clon).
Neu gan tnrdc nhOng khang the IgG don ddng nay vdi tdng ddng te bao lympho T3, T4, T8, sau dd cho gan vdi anti-IgG (d chupt) da cd gan chdt hufnh cjiiang, ta se tfnh dupc ddng te bao lympho T ddn dong,
' KgT QUA NGHIEN c a u
'' 1-<N6ng do khang the IgE va IgG toan phan trong fiuyetithanh nhdm chdng.
Bang 1- Ndng dp khdng the IgE va IgG toan phan iiMm chdng.
«s?
s fe,
S.luBng (n) 30 30
N6ng dfi th^p ntii't ( Xmin) 36.99
632 N6ng dfi cao nh^t ( Xmax) 219.76
192S N6ngdfi
tmng binh Xmax 107,75 1447,39
NSng dfi ly thuyet (chuIn)
» 100 lU/ml
800- 1700mg/dl Nhu vgy, ndng dd khdng the IgE va IgG toan phdn tronglijygt thanh d nhdm ehdng, deu 6 ngudng theo tieu riiuln'cdangudi binh thudng.
2- SU thay ddi ndng dd khang t h i IgE todn phdn d ngudi bdnh hen p h i quan bo nha trudc va sau d i l u tri GMCDH (12 thdng)
Bdng 2- Sir thay ddi ndng dp khang the IgE trUdc va sau didu tri:
Ddn vj cda IgE dUOe tfnh bang: Ul/ml B6\
tirang TnJ6c di^u trj
S.iuang (n)
N6ng d6 ttilfp nhSl ( Xmin)
N6ng dfi cap nti^t ( Xmax)
N6ng dd trung binti Xmax
Qua k i t qud chdng tdi nhan thay:
- Ndng dd khdng the IgE sau didu tri thdp hdn so vdi tnidc dieu trj mdt edeh ed f nghTa, vdi P < 0,001.
- Ndng do khdng t h i IgE trude vd sau dilu tri v i n eao hon so vdi nhdm ehdng (P < 0,001)
3- SU thay doi ndng dd khang thd IgG todn phln d ngudi bdnh hen p h i quan bo nhd trude va sau ^ l u tri GMCDhi (12 thdng)
Bang 3- Su thay ddi ndng dd khang t h i IgG trudc vd sau d i l u tri:
Don v eda IgG dUdc tfnh bang: mg/dl Dfil tiWng
Tn/6c dieu tri Sau di^u
Sfi luong
(n) Nfing dfi
tti^p ' nhSt ( Xmin)
1832,5 Nfing dfi I
cao I Nfing 56 trung binti ( X max)
3743.0 0,001
Ket qua d bang 3 cho thdy:
- Ndng dp khang the IgG sau dieu tri cao hdn so vdi trudc dieu tri, va eao hdn nhdm ehCfng mot each ed 1? nghTa, vdi P < 0,001.
4- Ket qua ve tfnh tf Id cdc ddng te bdo lympho T3, T4. T8
4.1- So sanh gius nhdm ehdng va ngudi HPQ bp nha
Bang 4- Ket qua te bao lympho T3, T4. T8 D S tuong
NC Nhfim ctidnq HPQ bo
nhd S.luang
(n) 22 25
Lynipho T3 j Lynipho T4 ( X=%) 1 ( X=%) 63,05 ±
12,39 68,72 ±
7,02 31,14 ±
3,12 29,09 ±
5,84
Lymptio T8 | { X=%) 27,55 ± 3,14 25,32 ±
3,40 Nhu vdy: - T l bdo lympho T3. T4 giijfa nhdm chdng vd HPQ bp nhd khac nhau khdng cd J nghTa thdng kd vdi P > 0,05, trong khi dd lympho T8 su khac bidt Iat ed;? nghta (P < 0,05).
4,2- Ket qua te bao lympho T3, T4, T8 tren nhdm HPQ bp nha trdde vd sau dieu tri
Bang 5- Ket qua te bao lympho T3, T4, T8 tnrde va sau dieu tri GMCDH
Dfii tuong NC Tnrflc di^u tri Saudifiu tri
S.luong (n) 25 25
Lymptio T3 { X=%) 58,72 ± 7,02 57,98 ± .
8,32 Lymptio T4
( X=%) 29,091 5,84 31,64±
7,26 Lymptio T8
( X=%) 25,32 ± 3,40 24,65 ±
6,32
Neu so sdnh kit qud eda t l bdo lympho T3, T4, T8 trdn nhdm HPQ bp nhd trude vd sau dilu tri, chdng ta cd t h i nhdn thdy: ehl ed t l bdo lympho T4 tdng Idn mdt cdeh cd # nghTa vdi P < 0.01, edn 2 nhdm td bdo t l bdo lympho T3, T8 khdng ed si/thay ddi vdi P > 0,05.
BAN L U A N V A K £ ' T L U A N
1- Ndng dd khdng thd IgE vd IgG todn phdn trong huydt thanh nhdm chdng, ddu d nguOng bInh thUdng (tUdng dUdng vdi dd chuan cda ngudi chdu d), ndng dd khdng t h i IgE vd IgG todn phdn ngUdI b$nh HPQ bp nhd cao hdn nhdm ehdng (P < 0,001).
2- Sau didu tri GMCDH (12 thdng), khdng t h i IgE todn phdn 6 ngudl bdnh HPQ bp nhd gidm mdt cdeh ed J nghTa so vdi tnJdc dilu tri vdl P < 0,001. Ngu4;fc Igi, ndng dd khdng t h i IgG todn phdn igi tfing Idn so vdl tnrdc didu tri vdi P < 0,001.
Nhdn xdt cda chdng tdi trong dd tdi ndy, hodn todn phd hop vdl nghidn edu eda nhilu tde o i l khde nhau trdn thd gidi, vd SI/ thay ddi eda khdng the IgE vd IgG todn phdn trude vd sau GMCDH.
3- Kit qud eda vide tInh t} 1$ t l bdo lympho T dudi nhdm (CD3, CD4. CD8), cy t h i Id t l bdo lympho T3, T4, T8, chdng tdi nhdn thdy: t l bdo lympho T8 d ngudl bdnh HPQ bp nhd gidm mdt cdeh cd •^ nghTa so vdi ngudi binh thudng. Sau ^ l u tri GMCDH (12 thdng), t l bdo lympho T4 tfing Idn mdt edeh ed y nghTa vdl P < 0,01 so vdi trUde dilu tri.
SUMMARY
Some changes of immunity on the asthmatic patients by hyposensetization methods
Hyposensetization or allergenic immunotherapy has been used extensively for 90 years, as a spc'tfe treatment. In aprospective study 35 patients with allergic asthma due to house dust mites were chosen for
hyposensetization treatment after 12 months, We have shown that;
> 1- There was significant decrease of antibody total IgE and increase in total IgG (P < 0,01).
2- Group lympho T8 cells in allergic asthma caused by house dust mites was significant less than that in healthy subjects. The hyposensetization treatment after 12 months, group lympho T4 cells was significant Increased (P< 0,01).
T A I L I $ U THAM K H A O
1- Nguydn Ndng An. Dai cUOng v l ede bdnh di dng.
Bdch khoa thub$nh hpc, tdp 1, Hd Ndi 1991,131 -140.
2- Phan Thj Thu Anh, Phgm Ddng Khoa, Nguydn Tridu Vdn vd edng s^. Gdp phln nghidn edu chl sd trung binh eda cdc t l bdo Lympho B vd T d thanh nidn Vidt Nam, KJ y l u edng trinh NCKH DHY Hd Ndi - 1996. tdp 1,136-138.
3- Phgm Mgnh HCing. Cdc khfa canh mtdn djdi hpc trong bdnh hoc. Nhd xudt bdn Y hpe, 1992, 42 - 63.
4- Nguyfin Tridu Vdn, Bui Thi Mai An, Dd Trung Phdn vd edng s^. I t qud nghidn cdu sd luong cdc dudi nhdm lympho T b ngUdl khod mgnh vd mdt sd bdnh ly sit dgng mdy Facs counL Cdng trinh NCKH 1995-1996, B.V Bgch Mai, tdp II, 62 - 68.
5- Y. Ikeda, S. Makino. Measurement of total IgE in sera from normal subject and allergic patients by ehemiluminescent immunoassay. Arerugi 2 - 1994, 43 (2Pt1), 134-141.
6- T. Nakagawa, T. Takaishi, Y. Sakamoto . lgG4 Antibodies in patients with house dust mite sensitive bronchial asthma relationship with antigen specific immunotherapy. Int - Arch - Allergy - AppI - Immunol, 1983, 71(2), 122-125.
KET QUA D i i u TRj BENH PHING DAI TRANG B^M SINH
BANG PHAU THUAT M O T THI QUA Dli&NG HAU MfiN TAI B £ N H V I C N NHI TRUNG UUNG
TOM T A T
Myc dfch : Muc dich cOa bio cio niy li dinh gii kit qui phiu thuit mit thi qua dUiJng h$u mdn diiu trj binh phinh dai tring bSm sinh vi phin tich m^t s6y6u ti liin quan din kit qui. Rdt re quy trinh kp thuit eda phiu thuit tai Binh viin Nhi Trung udng.
Dii tupng vi phuang phip nghiin ciiu: Tit thing 3-2003 din thing 5-2008. 110 binh nhin (86 nam 78.2%, 24 nO 21,8%) bj binh PDTBS di dupe phiu thuit bing dubng qua h$u mdn (QHM) m^t thi. Tua tit 8 ngiy din 36 thing. Phuang phip QHM. li dan thuin phiu tich, sinh thiit vi dt-nii d^i tring vdi ing h$u mOn hoin toin bing dudng QHM. Kjf thuit dupc tiin hinh di/a theo kp thuit cQa De la Tonre-Ortega (1998). Tuy nhiin, kp thuit cda chimg tdi khic phuong phip nguyin bin d chd li di lai ing thanh ca hiu mdn-tn/c tring ^ ngin ban, tir 1,5-2 cm tinh titria hiu miri.^
BUI DL^C HAU, NGUViN THANH L|£M,
T R A N ANH Q U V N H , V U H 6 N G ANH B^h W ^ Nhf Trung uong KA qui : Trong nghiin cdu niy ctm thiy doan dai tring vd hach dii tit tn^ tring din 1/3 du^ sigma 79 trudng hpp, dii tit 1/3 giOa sigma tdi dai tring xuing 31 tnJdng hpp. 95/110 BN phiu thu$t bing dudng qua h$u mdn ddn thuin, 15 BN phii p/id? hpp mi khie. Thdi ^an mi trung binh 104,5 phdt. KMng cd tCf vong va WSn c/idng phiu ffiuit thip. Mit miu trong mi it, cd mdt trudng hpp ri miu miing nSi phSi truyin mau vi ta dm d ngiy thU hai sau md, 2/15 (13,3%) tntPng hpp cd dudng mipMS hpp bi nhiim trdng. 1(0,9%) BN phai mi l^i do cit chua hit tfogrj vd /igc/i. Thi^ gian nim vl$n trung Unh 5,2 ngiy. TH ci binh nhin diu ti/dai tiin khi xuit win.
Kit qui xa sau mi, qua theo ddi 95 (86,4 %) binh nhin. Thdi gian theo d& ngin nhit 24 thing, dii nhit 87 thing, trung binh 52,3 thing. Si binh nhan dai b'in chd dpng 1-2Jin trong ngiy li 62 (65.3%), 27 (28,4%) binh
V H n r THirn H A N H r???) _ c/i a^^nn
