TAP CHi Y HOC VtiT NAM TAP 459 - THAMG 10 - SO 1 - 2017 khi chi pjif ddn vi tang len theo eae kich ban. Hal
la, nghien eutj mdi do lu'dng chi phf y te tru'c tiep, chu'a danh gia du'dc ganh nang do chi phi gian tiep. Ba la nghien eiru ehi xem xet ehi phf (fleu trj^ndi tru. Mac du chi phf ndi tru cd ty trpng Idn nhat so vdi chi phi ngoai trii va ehi phi phuc hoi chdc nang [ 5 ] , tuy nhien, phan tieh nay ddc lu'dng thap hdn ganh nang kinh te do cac gay xu'dng cd lien quan den loang xu'dng gay ra.
V. KET LUAN
Gay xu'dng d ngu'di Idn tudi, dae biet la eac dang gay xu'dng ed lien quan den loang xu'dng la ganh nang benh tat va kinh te Idn eho xa hdi.
Chi phi y te try'c tiep dieu trj ndi tru trung binh 1 ca gay xu'dng diii la 33,49 trieu VND,1 ea gay XiTdng cot sdng len tdi 52,59 trieu \INQ. Chi phf vat tu' y te chiem ty trpng ldn nhat trong ca hai loai gay xu'dng. Khdng cd sir khac biet ed y nghia thdng ke ve chi phf dieu trj trung binh d cac nhdm dp tuoi, gidi tfnh, benh mac kem hay tham gia BHYT. Khi chi phi ddn vj tang len 100%
theo chinh sach tfnh dung, tfnh dii, chi phf dieu tri_^cd the tang tir 7-30%. Nghien edu nay cd u'u diem la nghien edu dau tien u'dc tfnh chi phf dieu trj cac gay xu'dng cd lien quan den loang xu'dng
d Viet nam, ket qua ed the irng dung trong hoach djnh chfnh sach va la nen tang eho eac nghien ciTu danh gia kinh te trong tUdng lai.
TAI Ll|U T H A M KHAO
1. Tong cue thong ke (2017), Chi sd gia tieu dung, 2. Wardlaw D. va Meirhaeghe 3.V. (2010).
Another chapter for vertebral compression fractures. The Lancet, 376{9746). 1031-1033.
3. Looker A.C., Orwoll E.S., Johnston CC. va cpng sU. (1997). Prevalence of low femoral bone density in older U.S. adults from NHANES Hi. J Bone Miner Res Off J Am Soc Bone Miner Res, 12(11), 1761-1768.
4. Qu B., Ma Y., Yan M. va cong siT. (2014). The economic burden of fracture 'patients with osteoporosis in western China. Osteoporos Int J Estabi Result Coop Eur Found Osteoporos Nad Osteoporos Found USA, 25(7), 1853-1860, 5. Williamson S., Landeiro F., McConnell T. va
cong sir. (2017). Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporos Int J Estabi Result Coop Eur Found Osteoporos Natl Osteoporos Found USA.
6. Ambrish Mithal (2013), International Osteoporosis Foundation, The Asian Audit:
Epidemiology, costs and burden of osteoporosis in Asia 2013, International Osteoporosis Foundation.
7. Sheryl F Vondracek and Sunny A Linnebur (2009). Diagnosis and management of osteoporosis in the older senior. Oin Interv Aging.
DANH GIA KET quA DIEU TRI U HAT THANH QUAN TAI PHAT SAU PHAU THUAT BANG PPI vA TIEM CORTICOID v A o TON THiraNG Nguyin Thi Hao*, Lirong Thi Minh Hirffng*'
TOMTAT^^
Corticosteroid la thuoc ed tae__dun3 ehdng viem va hgn eh€ qua trinh hinh thanh to ehUe hat hieu qua.
Viec tiem corticoid tru'c tiep vao u hat thanh quan da du'cJc bao cao, tuy nhien hieu qua ehife ro rang. Muc tieu: Md ta dac diem lam sang eua tdn thUdng u hat thanh quan, yeu to nguy ed trao ngUde hpng - thanh quan va danh gia ket qua dieu trj u hat thanh quan tai phat sau phau thuat bang PPI va tilm corticoid vao ton thu'dng. Ooi tUtfng va phu'dng phap: nghien ai\i can thiep lam sang dUpc thi/c hien tren 31 benh nhan u hat thanh quan tai phat sau phau thuat co iien quan den trao ngu'dc tipng thanh quan. Cac benh nhan dUde dieu tn bang udng PPI va tiem triamcinolone 80mg/2ml vao ton thUcJng du'di gay te tai cho. Ket qua: ed sy" khac biet dang ke ca ve chi so trieu ehiihg cd nang va diem dau hieu thi/e the cua
*D?ihgcYHaNgi
Chju tr^ch nhiem chinh: Nguyen Thi Hao Email: [email protected] Ngay nhan bai: 5.8.2017 Ngay phan bien khoa hgc: 12.9.2017 Ngay duyet bai: 26.9.2017
trao ngu'dc vao thang thir 3 va 6 sau dieu trj, va c6 sU cai thien quan trpng ve phan do u hat, Khong co ta'i bien. Ket luan^ Tiem corticoid vao ton thu'dng la mot phu'dng phap ho trp them ed hieu qua ben canh dieu tn npi khoa bang PPI trong dieu trj u hat thanh quan tai phat.
Tdkhoa: U hat thanh quan tai phat, tiem steroid, PPI
SUMMARY
EVALUATE THE EFFECTIVENESS OF PPI W I T H STEROID INJECTION I N PATIENTS
W I T H RECURRENT POST-OPERATIVE LARYNGEAL GRANULOMA Steroids are potent inhibitors of inflammation and wound repair. Local administration of steroids directly into the laryngeal granuloma has been reported, but its role remains unclear. Objective: to evaluate the effectiveness of intralesional corticosteroid injection in patients with laryngeal granuloma and to describe its advantages and limitations in this group of patients.
Subjects and methods: prospective interventional research on 31 patients of recurrent post-op laryngeal granuloma related with LPR. Pabents were injected
VIETNAM MEDICAL JOURNAL N°1 • OCTOBER - 2017 With Triamcinole acetate 80mg/2ml directly under local
anesthesia and oral PPI. Results: there were significant differences in both reflux symptom index and reflux finding scores at months 3 and 6, and there were significant improvement of granuloma. There were no complications. Conclusion: steroid injections are a valuable adjunct in management of recurrent contact granuloma.
Keywords: recurrent laryngeal granuloma, steroid injection, PPI
I. O^T VAN OE
U hat thanh quan (UHTQ) la ton thu'dng lanh tinh ciia thanh quan, thu'dng gap d mdt phan ba sau day thanh, hinh thanh do SLT qua phat td chu'c hat tir vet loet tren niem mac thanh quan, cd the d mdt ben hoac ea 2 ben.
Cac yeu t d nguy ed eua UHTQ gdm: lam dung giong, benh trao ngu'dc da day thi/e quan, tien su" dat dng npl khf quan. Phlu thuat eat u hat du'dc chi djnh de chan doan md benh hoc hoac khi anh hu'dng den du'dng thd va phat am. Tuy nhien ty le tai phat sau phau thuat cdn cao, ed the len tdi gan 92% [1]. Tren the gidi cd nhieu bien phap du'dc khuyen eao dieu trj npl khoa u hat tai phat: thuoc de che bdm proton (PPI), thay ddi ldi song, luyen giong, hoac hit triamcinolone, tiem corticoid tai chd... tuy nhien ket qua cdn chu^ du'dc thdng nhat. Thude PPI da du'dc sir dung tir lau trong dieu tri u hat do trao ngu'dc hpng - thanh quan (LPR) cho thay day la phu'dng phap cd hieu qua, dung nap tdt, tuy nhien t / le tai phat van cdn cao va thdi gian dieu trj dai.
Corticoid la mdt hormone steroid cd tae dyng ehdng viem manii, pho bien, vi vay mdt sd tac gia da (K xuat phu'dng phap dieu tri tiem corticoid tai cho vao tdn thu'dng u hat cho thay cd hieu qua eao trong giam kfch thu'de u hat va giam thdi gian dieu tri so vdi chi dieu trj ehdng trao ngu'dc ddn thuan [2]
Oe ta\:"Danh gia kit qua dieu tn u hat thanh quan do trao ngu'dc tai phat sau phau thuit bang PPI va tiem corticoid vao ton thu'dng"dddc thi/c hien vdi muc beu: 1. Mo la dac di&n lam sang cua ton thu'dng u hat thanh quan va yeu to nguy cd bao ngddc hong - tfianh quan. 2. Oanh gia kit qua dieu tii u hat thanh quan tai phat sau phau thuit bing PPI va ti&n coib'coid vao ton thu'dng IL D 6 | TU'O'NG VA PHU'aNG PHAP NGHIEN CO'U
2.1 Om tu'dng nghiSn CIJ'U TiSu chui'n Ida chpn binh nhan - Benh nhan du'dc chan doan u hat thanh quan, du'dc phau thuat cat toan bp khdi u, ket qua Giai phau benh (GPB): u hat; cd tai phat sau phau thuat
- Diem RSI > 13 va RFS > 7
- Benh nhan du'dc dieu tri bang PPI^ thay doi Idi sdng che dp i n , tidm corticoid tai chd u hat
- Du'dc theo ddi danh gia ket qua dieu tii trong 3 - 6 thang.
- Ddng y tham gia nghien cufu.
Tiiu chui'n loai trd. Benh nhan chu'a diTOc chan doan bang GPB hoac da dieu tri die phu'dng phap khac ngoal ngiiien ciTu
- C^c tru'dng hdp ehdng chi djnh eua bien phap dieu tri: suy tim, benh tieu du'dng, nhiem nam toan than, benh lao nang, tang huyet ap, loang xu'dng...
- Diem RSI < 13 va RFS < 7
- UHTQ do nguyen nhan khac: chan thudng do sol thanh quan, sau dat npl khi quan
- Khdng du'dc theo doi va danh gia ket qua day dil.
- Benh nhan khdng ddng y tham gia nghidn cirtj, 2.2. Phu'dng phap nghien cu'u Nghien ciTu can thiep lam san^ tien edu nhom benh nhan UHTQ tai phat sau phau thuat do trao ngddc hpng thanh quan (LPR), du'dc dieu tn bang PPI va tiem corticoid vao u hat.
2.3. Dja diem nghien cu'u: Khoa Npl soi - Benh vien Tai mui hpng TW
2.4. Thdi gian nghien ciJut thang 07/2016 tdi thang 10/2017
2.5. Phu'dng ti^n nghien cu'u:
- Benh an mau vdi day du thdng tin: tuoi, gidi, nghe nghiep, cac yeu to nguy ed
+Trieu chulig cd nang: theo thang diem RSI - vdl RSI > 13
+Trieu chirng thirc the: Theo thang diem RFS - vdi RFS >7. Danh gia vj tri, sd lu'dng, kich thu'de, hinh thai, be mat, phan dp u hat tlieo phan dp Fanwell va Belafsky.
+ Tlidng tin ve cac lan phlu thuat cat u hat: So lan phau thuat. Thdi gian tai phat sau moi (an phlu thuat. Dieu trj ho trd sau phau thuat khdng.
- Danh gia dap iTng dieu trj:
+Danh gia cai thien trieu chu'ng cd nang,thu'c the theo thang diem RSI, RFS
+Sir thay ddi kfch thu'de u hat theo bang phan dp ciia Farwell va Belafsky: Tot (giam 2 do hoac tieu bien hoan toan), kha (giam 1 dp), kem (khdng giam dp hoac to len).
+ Danh gia tai thdi diem ket thiic nghien ciili:
khdi hoan toan, dap iTng mdt phan, khdng dap ij'ng, lien quan den sd ISn tiem, thdi gian khoi trung binh
2.6. XuT IV va phan tich so lieu: Phan mem SPSS 20
252
TAP CHl Y HOC VIET NAM TAP 459 - THANG 10 - SO 1 - 2017
2.7. fiao du'c nghien cii'u: Du'dc sir ddng y ciia benh nhan, thdng tin du'dc giU bi mat, cac ket qua chi nham myc dich nghien cu'u va phuc vu viec kham chu'a bdnh
III. K ^ QUA VA BAN L U A N
3.1. Bac diem lam sang, hinh anh npi sol va mot so yeu to lieri^quan ciia u hat thanh quan tai phat sau phau thuat
Bac dii'm tud'i. Dp tudi mac benh trung binh 47,8±7,6, thap nhat 29, eao nhat 66. Nhdm tuoi gap nhieu nhat tir 36 den 55 tudi chiem t / le 80,6%.
Die diem gidt. 100% la nam gidi. Khdng gap tienh nhan ia nCT.
Cacymi tdnguy cd. chi edl9,4% sd benh nhan cd nghe nghiep lien quan den viec su* dung gipng nhieu nhu' giao vien, ca sy, ban hang, luat sir,.,
Cac yeu t d nguy cd hut thude cd 25,9%, uong ru'du 41,9%, nghien caffeine 3,2%, an tdi mudn 22,6%. Tuy nhien sd lu'dng benh nhan trong nghien ciili ciia chiing tdi chu'a dii ldn de danh gia du'dc het tac ddng ciia cac yeu t d nguy cd len benh sinh UHTQ.
Sd lan phau thuit trung binh: 1,3 lan, it nhat 1 lan, nhieu nhat 3 lan. Da sd phau thuat 1 lan chlem 74,2%. Cac benh nhan sau phau ttiuat deu du'dc dieu trj khang sinh, steroid ngan ngay va thude chong trao ngu'dc. Dieu nay eho thay UHTQ ed ty le tai phat eao sau phau thuat dil da ap dung cac phu'dng phap dieu trj ho trd.
Ttiiu chuhg cd nang. trieu chiTng ed nang hay gap nhat la cam giac dj vat hpng (90,3%), ho sau khi an hoac nam (90,3%) vdi mire dp trung binh nang nhat lan lu'dt la 2,7 ± 1,2 va 2,6
± 1,4. Dang hang (83,9%) va nhieu djch nhay trong hpng (83,9%) thu'dng gap, cae trieu chii'ng thu'dng d mu'e dp trung binh. Tong diem RSI trung binh la 16,2 ± 3,0.
Cac trieu ehuTig it gap la khd thd (22,6%) va n u ^ khd (38,7%), ed mire dp nang nhe nhat:
khd thd 0,3 ± 1,5 va nuot khd 0,8 ± 1,2, khdng CO benh nhan nao khd thd mire dp nang. Ket qua nay tuWng dong vdl nghien cii'u ciia Hillel va Pliam Thanh Hu'dng.
THeu ehdng thdc tlie: Trieu chu'ng phi dai mep sau gap 100% d cac mufc dp tir nhe den vira, diem trung binh la 1,8 ± 0,5, khdng ed tae nghen. Trieu ehiing phii ne day thanh va phii ne thanh quari ehiem 100% eae benh nhan, ehii yeu la mii'e dp nhe tdi trung binh lan lu'dt la 1,4 ± 0,5 va l,b±0,2. Tong diem RFS trung binh la 10,8 ± 1,7.
Ngoal ra cac trieu chulig hay gap la xda buong thanh that (77,4%). Trieu chu'ng ranh day
thanh gia gap vdi ty le it (16,1%) nhu'ng ia trieu chirng ed dp nhay va dp dac hieu cao trong chan doan LPR.
Die diem u hat Tat ea eac tru'dng hdp deu cd u hat d vimg mau thanh, ben trai gap vdi ty le eao hdn 64,5%, tu'dng td nghien ciTu ciia Hillel, Holinger. Cd 2 benh nhan u hat 2 ben chiem 6,5%, tu'dng tu' nghien eiru eiia Pham Thanh Hu'dng (6,5%), eua l^anish 3/21.
U hat thu'dng cd hinh dang mdt khdi trdn, khdng ehia thiiy hoac ehia nhieu thiiy, be mat nhin, chi ed 19,4% tru'dng hdp ed sill hoac loet be mat u hat.
Theo phan dd u hat eua Farwell va Belafsky, cd 67,7% u hat dd I I , 19,4% u hat dp I I I va 12^9% u hat dp IV, khdng cd u hat dp I tai thdi diem nghien ciTu, do nhu'ng benh nhan u hat dp I tai thdi diem phat hien khdng chi dinh tiem corticoid vao tdn thu'dng
VS liin quan gida phin do u hat va trieu ehdng ex/nang. chi sd RSI cd xu hu'dng tang d i n d nhihig benh nhan cd phan dp u hat Idn dan.
VS liSn quan gida phan do u hat va trieu ehdng thdc the eda LPR: khdng cd SLT khac biet ve chi sd RFS vdi cae do u hat, ed the do tdn thu'dng u hat chiu anh hu'dng eiia nhieu yeu td;
each phat am, sir dyng gipng nen khd danh gia du'dc ehinh xac mdi lien quan giiJa phan dp u hat va trieu chirng thu'c the eiia LPR.
3.2. Oanh gia ket qua dieu trj UHTQ tai phat sau phau thuat bang thuoc PPI phdii hdp corticoid tiem tai chS
Thay ddi trieu ehdng ed nang. Tong diem RSI, tan suat xuat hien trieu chu'ng va mu'e dp nang eiia trieu chu'ng giam sau 3 thang va 5 thang dieu trj. Tong diem RSI trung binh tru'dc dieu trj 16,2 ± 3,0, sau dieu trj 3 thang va 6 thang 1^ 7,5 ± 3,8 va 3,5 ± 2,9, sd khac biet cd y nghTa thdng ke
Trieu chirng cd nang thu'dng gap nhat la cam giac dj vat hpng, gap vdi tan suat cao ke ca sau dieu trj, tuy nhien miTc dp nang giam ed y nghTa thdng ke
Cac trieu chiTng cd nang khac nhd khan tieng, dang hang, nhieu djch nhay hong, ndng rat ngu'e, tan suat xuat liien va miTc dp nang cung giam dang ke
Thay ddi triSu ehdng thu'c the. Tong diem RFS tru'dc dieu trj la 10,8± 1,7, giam dan sau 3 thang (7,0 ± 2,6) va 6 thang (3,3± 2,4) dieu t n . Su" khac biet ed y nghTa thdng ke.
Trieu chu'ng giam nhieu la phii ne day thanh, phij ne thanh quan, xda buong thanh that. Tai thdi diem 6 thang trong qua trinh theo ddi, dau
VIETNAM MEDICAL JOURNAL H°1 - OCTOBER - 2017 hieu phi dai mep sau giam khdng dang ke
(>50% sau 6 thang dieu tri), tuy nhien ve miTc dd nang giam cd y nghTa td 1,8 ± 0,5 xuong 0,62 ± 0,49.
VS kSi qua dieu tri u hat:
Bang 3.1. Mdc dp dap dng dieu tri Thdi digm
Ket qua ST Kem Kha Tot Tonq
Sau 3 thang N 7 17 7 31
22,6
%
51,8 22,6 100
Sau 6 thang n 1 16 12 29
3,4
%
55,2 41,4 100 Sau 3 thang dieu tri cd 7 benh nhan tien trien tdt, 17 kha, 7 kem chiem 22,6%. Theo nghien ciru ciia Pham Thanh Hu'dng chi dieu trj bang
PPI, trong 3 thang dau chi cd 38,7% dap ifng vdi dieu tri, cd tdi 61,3% khdng cai thidn. Su- khac biet cd y nghTa thdng ke.
Cd 29 benh nhan du'dc theo ddi sau 6 thang, trong dd cd 28/29 benh nhan tien trien tdt hoac kha (96,6%), 1 benh nhan khdng dap iTng digu tri (3,4%). Trong nghien cufu ciia Pham Thanh Hu'dng, cac benh nhan chi dieu trj npi khoa, ro 4/24 benh nhan (16,7%) khdng cai thien. Nhu"
vay nhu'ng benh nhan UHTQ tai phat sau phau thuat du'dc d ^ u trj ddng thdi PPI va tlem corticoid tai chd cd su' cai thien dang ke ve mufc dp u hat va thdi gian dap irng dieu tri ngan hdn so vdi chi dieu tr| PPI ddn thuan.
Anh 3.1. BN NguySn Van P. U bait mau thanh ben phai, tru'dc diSu ti-i Lien quan gida ket qua dieu tri va phin do u hat: Sau 3 thang, ket qua dieu trj khac biet khdng rd ret giu^ eac dp u hat. Sau 6 thang, ket qua dieu trj cd sy" khac biet giu'a cae dp u hat, dp I I I dap u'ng tot nhat, do I I da phan dap uVig kha, 1 tru'dng hdp dp IV dap irng kem.
Lien quan giffa so ian tiSm va phin do u hat sd lan tiem trung binh la 2,6 ± 0,6, so benh ntian tiem 1 lan ft nhat (2 BN), tiem 2 lan cd 10 BN, 3 lan cd 19 BN. Khdng cd sy' lien quan giCTa so lan tiem corticoid vdi phan dp u hat tai thdi diem tru'dc dieu trj.
Hieu qua dieu tri: Thdi gian theo ddi ngan nhat 3 thang, dai nhat 15 thang, danh gia cd 45,2% (14/31) khdi hoan toan, khdng tai phat trong thdi gian theo ddi, thdi gian khdl trung binh la 5,7 ± 4,0 thang, trong dd 71,4% (10/14) tru'dng hdp khdl trong 6 thang dau, 4/10 benh nhan ed thdi gian khdi sau 6 thang.
Benh nhan u hat dp I I deu dap iTng vdi dieu trj, cd 33,3% khdi hoan toan. Cac benh nhan u hat dp I I I khdl 100% den thdi diem ket thue nghien ciTu. U hat dp IV cd 4 tru'dng hdp, trong do 1 tru'dng hdp khdl hoan toan, 2 tru'dng hdp dap ii?ig mdt phan (giam xuong dp I I I , I I hoac I), chi cd 1 tru'dng hdp dap iTng kem ed xu hu'dng to len sau 3 lan tiem va dieu trj npi khoa.
Sy' khac biet cd y nghia thdng ke vdi p = 6,003.
Anh 3.2. BN Nguyen Van P.
4 thing sau tiem lan 3 Ve tac dung khong mong mudn: Chiing tdi khdng ghi nhan cac tneu chirng di irng thuoc, tieu chay hay eac dau hieu khac khong mong mudn ciia Pariet 20mg cung nhiTcua corticoid III. KET LUAN
U hat thanh quan tai phat sau phau thuat co yeu to nguy cd trao ngu'dc hpng thanh quan thu'dng gap d nam, trung nien, lien quan den lam dung gipng
Trieu chii'ng cd nang thu'dng gap va miTc dp nang nhat la cam giac di vat hpng, ho sau khi an hoac nam. Cac trieu chu'ng dang hang, nhieu dieh nhay hpng, khd chju do ho, khan tigng thu'dng gap. Khd nuot va khd thd gap vdi tan suat thap va miTc dp nhe
Trieu chiTng thu'c the thu'dng gap la phi dai mep sau, phii ne day thanh va thanh quan, sung huyS
U hat d trong nghien edu gom dp I I , I I I , IV, thu'dng ben trai, cd the 1 hoac nhieu thuy, chii yeu la n h i n , ft siii loet.
Sau dieu trj PPI va tiem corticoid vao ton thu'dng, cac trieu ehiTng cd nang va thdc the deu giam cd y nghTa ve ca tdng diem, tan suat va miTc dp nang
Kfeli thu'de u hat giam cd y nghTa sau dieu trj tiem corticoid 3 thang - 6 thang, so sanh vdi chi dieu trj npi khoa thdng thu'dng. Ket qua dieu tri u hat khdng lien quan den sd lan tiem
TAP CHi Y HOC VigT HAM TAP 459 - THANG 10 - s6 1 - 2017 Trong thdi gian theo ddi ngan nhat 3 thang,
dai nhat 15 thang, danh gia cd 45,2% (14/31) khdi hoan toan, khdng thay tai phat trong thdi gian theo ddi, thdi gian khdi trung binh la 5,7 ± 4,0 thang, trong dd 71,4% (10/14) tru'dng hdp khoi trong 6 thang dau, 4/10 benh nhan cd thdi gian khdi sau 6 thang.
TAI LIEUTHAM KHAO
1. Yiitaio, R. and P.A. Lindestad, Laryngeal findings in patienls with contact granuloma: a tong-term fyllow-up study. Acta Otolaryngol, 2000.
120(5): p. 655-9.
2. Wang, C.P., et al.. Vocal process granuloma - A result of long-term observation in S3 patients. Oral Oncol, 2009. 45(9): p. 821-5.
3. Tian, S.Y., et al., Analysis of the curative effect of intralesional steroid Injection combined with acid-
suppressive therapy for laryngeal contact granuloma. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2016. 51(2): p. 90-4.
. Ph?m Thanh Hu'dng, LUdng Minh Hu'dng., Danh gia k& qua dieu hi noi khoa u hat thanh quan tai phat sau phau thuat 2015, Dai hocY Ha Noi.
. Farwell, D.G., P.C. Belafsky, and Cl. Rees, An endoscopic grading system for vocal process granuloma. 3 Laryngol Otol, 2008. 122(10): p, 1092-5.
. Hillel, A.T., et al.. Inhaled triamcinolone witti proton pump inhibitor fdr treament of vocal process granulomas: a series of 67 granulomas. Ann Otol Rhinol Laryngol, 2010. 119(5): p. 325-30.
. Wang, C.T., et al., Intralesional steroid injection:
an alternative treatment option for vocal process granuloma in ten patients. Clin Otolaryngol, 2013.
38(1); p. 77-81.
A N H HlfCTNG CIIA HOI XUAN H O A N TREN N H I S M SAC THE TINH H O A N CHUOT
TOIVI TAT
Nghien ciJU nay dUde thu'c hien nham xae dmh anh hu'dng tren nhiem sac the mo tinh hoan ciia Hdi xuan hoan (MXH). Doi tu'dng va phu'dng phap: 45 chuot nhat (rang dUc Mus muscullus chiing Swiss, 4 tuan tuoi. Chupt dupe chia iam 03 16, tach rieng diTc cai; Lo diiftig khong diing thuoc; Lo HXH lieu 3g/kg TLCT; Ld HXH lieu 9g/kg TLCT, diing lien tuc trong 30 ngay. Vao ngay thiT 31 giet chudt, lay te bao md tinh hoan de danh gia anh hudng cira HXH tren nhiem sac the. Ket qua va ket lu|n: HXH khdng gay ra cac dot bien ve so iuWng cung nhu" dot bien cau true NST te bao md tmh hoan diugt thue nghiem Wii so sanh vdi 16 chimg.
Td khda: NST mo tmh hoan chupt thye nghiem.
Hoi xuan hoan.
SUMMARY
THE AFFECTS OF HOIXUANHOAN ON TESnCLE CHROMOSOMES OF WHITE MICES
This study was conducted to determine the affect of HXH on testicle-chromosomes. Subjects and Methods: 45 male mices Mus museulus, Swiss, age of 4 weeks. The mices were divided into 3 groups: The control group were taken placebo; The study I taken HXH 3g/kg BW; The study II taken HXH 9g/kg BW;
The mices were kept taking dose for 30 days
*Hocvien Y Dude hgc cd'truyen ViitNam Chiu trach nhiem chfnh: Doan Minh Thuy Email: [email protected] Ngay nhan bai: 18.7.2017 Ngay phan bien khoa hoe: 5.9.2017 Ngayduyltb^i: 14.9.2017
Doan Minh Thuy*
consecutively. On the 31^' day, all mices were killed to test their testicle-chromosomes. Results &
Conclusions: HXH has not caused mutations in the number and structure of testicle chromosomes of expenmental mices when compared to the control.
Key words: testicle chromosomes of experimental mices, Hoixuanhoan
I. OAT VAN OE
Vd sinh la tinh trang vd chong sau mdt nam chung song, quan he tinh due binh thu'dng, khdng sir dung bat k^ bien phap tranh thai nao ma ngu'di vd van chu3 cd thai. Vd sinh xay ra trong khoang 10-15% cae cap nam nu' mudn cd con.
Y hpc hien dai da cd nhieu thanh ty'u khoa hpc trong dieu tri vd sinh, nhutig den nay van ciida dat du'dc ket qua nhu' y va kinh phi dieu trj thu'dng cdn cao. Viec tim kiem cac phu'dng phap, eae thude dieu tri ed hieu qua v i n la van de thUe tien, thdi sd, cap thiet dem lai hanh phiie eho ngu'di benh, gia dinh va xa hdi.
Cac phu'dng phap y hpc co truyen cd tae dung dieu trj vd sinh dUdc ghi trong y van tir xa xu'a nhu'ng chu'a ed nhieu edng trinh nghien ciTu danh gia mdt each he thdng, khoa hpc.
Hoi xuan hoan gdm nhu'ng vj thuoc cd tac dyng bd can than, ich tinh du'dng huyet. Chii trj chu'ng than du'dng bat tue, tinh huyet hu'. De cd cd sd khoa hoc va dam bao tinh an toan khi du'a bai thude vao sir dung trong lam sang dieu tri vd sinh. Chimg tdi tien hanh nghien eiTu nay nham muc tieu: Nghien cud anh hu'dng cua HXH tren nhiem sac the mo tlnh hoan chuot nhat trang.
