Tgp cht Tai MQi Hpng Vigt Nam - Volume (61-33). N°3- September, 2016
PHAN TICH MpT SO NGUYEN NHAN TAI PHAT CUA NANG VA RO GIAP LlTOl
Ta Phuang Thi/, Nguyin Quang Trung'
TOM TAT
Muc tilu: Phdn tich mot sd nguyin nhdn tdi phdt cua nang vd rd gidp luoi Bii tufng va phumg phap:36 binh nhdn dugc chdn dodn Id nang vd rd giap ludi tdi phdt vd fdcjliiu tti bdng phdu thudt lgi benh viin Tai MU Hgng Trung uang vd blnh viin Bai hgc YHa ngi tir thdng 3/2011 den thdng 8/2016 Phuang phdp thdng ki md td tirng ca cd can thtep. Ke, qud:t)a sd Id henh nhdn nu (chiim 64%), dg tudi ttung binh Id 14 benh nhan den kham chuyeu vi nang tdi phdt (chiim 52,8%). Trudc phdu thudt ldn ddJcolS benh nhdn vilm nhiim 1 lan (chiim 41.7%), 14 binh nhdn viem 2 ldn (chiim 38 9%) Sau phau thugtjdn 1, sg tdi phdt xay ra d nhdm dudi 5 tudi chiim ty H cao nhdl, 18/36 binh
M"l(f'r •^''^'^' * '' ""^ "'^' '" " "*"'" ^^^ '"** '° •*''•'« i^'"* "«" (Mim
'l.If)-So benh nhdn tdi phdt khdng dugc cdt xuang mdng a iin phdu Ihuat ttudc id 25 (chtem 69,4%) Kit lu^n.Qua nghien cm, 36 binh nhdn nang vd ro gidp ludi tdi phdt
Chung 16, nhdn thdy cdc nguyen nhdn tdi phdt: ' - Tinh ttgng viem nhiim trudc phdu thugt
- Tiin hdnliphdu thugt dudi 5 tudi - Khong cdt Ihdn xuang mdng khi phdu thudt.
SUMMARY
Objectives:To analyze some causes of thyrogiossai duct cyst recurrence Subjects and Methods.36 palienis were diagnosed with thyrogiossai duct cyst recurrence and T ' t Z " " • ^ " ^ ' " ^ ^ '^'""'"''' """P""' ""^ « " ° ' '^'^'"'^'•l UntversityHospitai from03/2011 to 08/2016 Prospective study. ResuUs.Mostly female patients (64%) mean age 14. patients examined mainly because of recurrent cysts (52.8%) One time inflammation before f surgery: 15patients (41.7%). two times inflammation before 1"
surgery: 14 patients (38.9%) After iSurgery. relapse is seen most frequently in under 5 yew-s old: 18 patients (50%) 25 patienls withhyoid boneremain after l^surgery accounted m 'he highest percentage is 69.4% Conclusion.By studying 36 patients with thyrogiossai
duct cyst andfistitla recurrence, we find the following reasons of recurrence:
-Status of preoperative Infection - Surgery for patients aged under 5 years - Remain hyoidbone after 1"surgery.
Key words: thyroglosssal duct cyst, recurrence ' Bfnh vifn Tning utmg Thii Nguyfn
' B$ m6n Tai MOi Hpng-Tntdng D?i hoc Y H4 Nft- NhSn l * : 22/8/2016. Duyet bii: 30/8/2016
Tap chi Tai MQi Hpng Vi^t Nam - Volume (61-33). N°3- September. 2016 1. B ^ T VAN DE
Nang v i rd giap-luoi ia benh ly bam sinh vung c6 thudng gap. Benh hinh thanh do su tdn tai ciia dng giap luoi, ong niy dugc t ^ bdi su di chuyen cua tuyfin giip trong thdi ky bao thai, tir vi tri 16 tit d dmh V ludi din vi tri binh thudng cua nd la d trudc sun khi quan thii 2 va thii 3, vi mpt 1^
do nao do dng nay khong thoai triln v i mit dan di sau smh. Nang cd thi phit trifin d bat cii doan nio ciia dirong dng giip luoi.
Phuomg phip difiu tri then chdt ciia nang va rd giap-luoi la phfiu thu^t. Cho dfin nay phlu thuit theo phuang phip SisUimk vfin dugc ip dyng v i dugc xem la phuong phip dieu tri tri?t dfi nhit nang va rd giip - iudi d Vifit Nam ciing nhu trfin thi gidi [1], [6],[8].
Hifin nay, tai nudc ta dilu tri bfing phau thufit nang va rd giap-lu&i dugc thyc hien rOng rai d nhilu chuyfin khoa khac nhau vdi nhihig cich thiic phau thuit khdng hoan toin gi6ngnhau, mac dii viy vin cd b?nh nhan bi tai phit sau mo. Dfi giiip hilu them v l vfin dh nay chiing tdi tiln hinh nghifin ciiu; "Phdn tich mgt sS nguyin nhdn tdi phdt cua nang vd rd gidp luai"
2. D O I Tir<?NG VA PHlTONG PHAP N G H l i N ClTu
2.1. Boi tifQmg Dghien ciru
Gdm 36 benh nhfin dugc chan doin la nang v i rd giip ludi tii phit, dugc dilu tq bang phau thuat tgi b^nh vifn Tai Miii Hpng Trung uong v i b?nh vi?n Dai hpc Y Ha npi tir tiling 3/2011 din thing 8/2016.
2.1.1. THu chuan Ufa chgn b^nh nhan
^B?nh nhin dugc lya chpn tiieo tieu chuan sau:
> Da dugc phlu tiiuit nang va ro giip-ludi
> Cd nang ho$c/va iS rd vung cd trudc tren dudng seo md cii hay dgc theo dudng giip l i ^ .
> Dugc sieu i m viing c6
> Dugc phfiu thuat tai khoa Tai Miii Hpng-Bf nh vifin D ^ Hgc Y Ha N^i v i Bfinh vi?n Tai MGi Hpng TW.
> Co ghi chep hd so b§nh i n d i y dii
> Dong y tham gia nghifin Cliu.
2.1.2. Tiiu chuan hgi trdr
Bfinh nhan khdng du cac tieu chuin
A
2.2. Phmmg phap nghien cihi 2.2.1. Thiet ki nghien cdru Nghifin Cliu md t i tung ca c6 can thi?p 2.2.2. Phmmg phdp chgn m&u Chpn mau thu$n tifin 2.3. CSc bvd-c tien h i n h
2.3.1. V&i nhdm hdi ciht:
Tip hgp ho so bfnh an dip iing dugc tifiu chuin i\ra chpn.
- Thu th§p dif lifu, Iiy s6 Ii?u diln vio bpnh i n mlu.
2.3.2. Vdi nhdm tiin citu Lim bfnh an mau.
Dugc khim lfim sing, sifiu am dh I chan doin xie dinh Ii nang v i rd giip ludi \t
tii phit. j - Cho Iam cic x€t nghifm co bin
phye vy phlu thuat.
Phlu thu|t liy bd nang, dudng rd.
- Khim, danh gii trong phlu thu^t ^ 2.4. Xir ly sS lifu
Thu thlp s6 lifu vio bfnh i n mlu, xie lap moi tuong quan gii^ cic chi so nghien Cliu, xii ly sd lifu tiieo chuang trinh SPSS ' 16.0.
68
Tap chi Tai MQi Hpng Viet Nam - Volume (61-33). N°3- September, 2016
3. KtT QUA VA BAN hV^
3.1. Phan bo theo gidi vii tuoi fai thai diem nghien cihi
Trong nghien ciru nay, chiing toi nltan thay CO 23/36 benh iih§n nii chilm gan 64%, 13/36 benh nhan nam chiem g5n 36%. So sanh voi cac nghien ciru cua tSc gii trong niroc vh nang va ro gi^p luSi thi c6 Sir khac biet: tac gia Phiing Tiln Hieu benh nhan nam 14 35/54 (chito 64,8%), bpih nhan nO la 19/54(35,2%) [3], tic gia Nguyin Thj T6 UySn co 47 benh nhan v6i ti 1§ nam/nS = 2/1 [2]. Nghian ciru cua AUard nghiSn cliu viM mlu 16n la 1.747 b ^ nhan, co 870 nani/877 nS[5].
Qua nghiSn ciru nhSn thdy, nang va ro giap liroi tii ph4t g^p 6 mpi lua tu6i, thip nhat li 2 tudi, cao nhit l i 46 tuli, tnmg btah 14 tuli. C6 18/36 b^nh nhan taoi nh6 hon 9, chilm t^ 1$ cao nhit la 50%, chicd 3/36 b?nh nhin tuoi >30, chiem ty 16 thap nhat li 8,3%, c6n Iji l i 9/36 benh nhan dp hioi hr 10-19, chiem 25% v i 6/36 benh nhin taoi tir 20-29 chilm 16,7%.
Tuy v^y phii c6 nhirng nghien ciru v6i c5 mau 16n sg cho kit qui ding tin c§y hon.
3.2. Ly do vio vi$n
Ttong nghien ciru niy, ly do b$nh nhan vio vi?n thudng gSp li c6 nang tii phit, c6 19/36 b?nh nhSn, chiem 52,8% va 15/36 b^nh nhan vio vi$n vdi ly do cd lo td tii phit chiy djch, chi cd 2 b|nh nhin vio vi$n vdi ly do cd IS td khdng chiy djch, khdng cd b?nh nhin vio vi?n vi i p xe.
3 J . Ty 1$ nang v i rd giiip lufti tii phit
^ ^ ^ y 1$ nang v i rd tii phit g$p l i ngang W H ^ c d 19/36 b^nh nhin vio vi§n dupc chan doin l i nang giip ludi tii phit, chilm
' ,J3%, 17/36 b?nh nhan li td giip luoi it, chilm gin 47%.
3.4. Tinb trang viem tnrdfc pbau tbu^t l a n i
Bang 3.1: Tinh trgng vidm nhilm fru'dc phlu thuit IJn1
^ ^ ^ § 6 lin viem Hinh Ihii v i S m ^ ^
Viem tiy Ap xe giy rd djch
Khdng vidm
%
0 0 0 7 7 19,4
1 13 2 0 1S 41.7
2 13 1 0 14 38,91
>2 0 0 0 0
°
Tdng 26
3 7 36 100 NghiSn cuu cd 7/36 b?nh nhin tnrdc phau thuit lan 1 khdng cd hi?n tapng viSm nhiem (chilm 19,4%), 3/36 bfnh nhin cd i p xe gay rd djch, 15/36 bSnh nhin cd hiSn tirpng viSm tay I lin trudc phlu thujt lin l(chiSm 41,7%), 14/36 bfnh nhin cd hifn hrpng viem 2 Ian tnrdc phlu thuit lin 1 (chilm 38,9%).
3.5. Doi cbieu tinb tr^ng viSm tnrdrc pbau thuat lin 1 vdi s l lin p h l u t h u i t
Bang 3.2; Ddi chiiu tlnh trgng viim tn^dc phlu thuit lln 1 vdi sd lln phiu thuit
\ - Sdlln
^ \ ^ v l 6 m Sd Hn P T ^ \
1 Hn 2 lln 3 lln
%
0
7 0 0 7 19.4
1
11 4 0 15 41,7
2
10 3 1 14 38.9
>2
0 0 0 0 0
Tdng
28 7 1 36 100
Tgp chi Tai MQi Hpng Vi§t Nam - Volume (61-33). N°3- September, 2016
Trong i^hien cihi nay ta nhan thiy co sy; liSn quan gifia sd Iin viem trudc phlu thuit vdi so lan phau thuat Cd 7/36 benh nhan khdng viem trudc phlu thu|it lan 1 thi sd Iin da md la 1, co 3/36 bfnh nhin viem 2 lan trudc phiu thuat lan 1 thi sd lin md l i 2 lan vi 1 bfnh nhan 6a. mo 2 Ian thi sd Ian viem trudc phiu Ihuit lin diu ciing la 2 lan.
Theo Tamer AInaimy, tac gii nghien Cliu tren 50 b?nh nhin v i nhin thay ty le tai phit cao hon d nhflng benh nhan cd vidm nhiem trudc phlu thuit.[4]
Tic gii Ostlie v i cong sy, nghiSn cuu tren 99 benh nhin, ciing chi ra ring sy viem nhiem trudc v i sau md lim tang nguy ca tii phat ciia nang va rd giip luoi.[7]
3.6. Doi chilu tuoi khi phau thu^t lAn 1 va so lan phau thuat
Bang 3.3 Ddi chi^u tudi khi phiu thu^t l i n 1 v i s6 \kn phau thu$t
\ Tudi PT
\ l i n i Sd l l n \ PT \
I l i n 2 l l n 3 l l n
%
<5
14
«
0 18 SO
5-10
6 0 0 6 16,7
11-20
3 1 8 22,2
>20
4 0 0 4 11.1
Tdng
28 7 1 36 100 Trong nghien cuu, tuoi phlu thu^t nhd nh^t l i 2, ldn nhit la 45. Sau phau tiiuEit 1 ^ l,sy tii phit xay ra d nhdm dudi 5 tu6i
chi6m tJ le cao nhit, 18/36 bfnh nhin,_
chi^m ty If 50%, ty If thip nhit la a ^ ^ ^
>20 tudi, cd 4/36 benh nhin, chiem 11,1%.
3.7. Tinh trang xinnig mong dl^n p h l u thuylt trvr&e
Bang 3.4: Tinh trgng xuong mdng d \k{\ p h i u thu$t tm-dc
\ T T xu-cng X^^mdng SdBn \ .
%
Chira c i t t h i n xirong
mdng 25 69,4
Q i d t t h i n xuong
mdng 11 30,6
Tdng
36 100 Cic bfnh nhin trong nghign c t i u f | da dugc dieu tri bing phlu thuat, nhung cich thiic phau thuit khong gi6ng nhau.
Chiing tdi nhan thiy tinh trgng tii phit xiy ra d 25 bfnh nhan chua dirge cit thin xuong mdng (chilm t^ If 69,4%), v i 11 bfnh nhan dS dugc cit tiiin xuong mdng (chi^mtj'lf 30,6%).
3.8. Doi chi^u tinh traing xuomg mdng vdl hinh t h i i lam sing t i i p h i t Bing 3.5: Dfii chidu tinh trgng xuong mdng
vdi hinh t h i i iam sSng t i i p h i t
\ ^ Tlnh tnsng
^ ^ u ' c y n g mdnj Hinh tha ^ \ ^ lim sSng \ ^
Nang t i i p h i t Rd l i i phit
%
Cdn nguydn
13 12 25 69,4
B i d t (1 p h i n hay t o i n hd thin)
6 5 11 30,6
Tdng
19 17 36 100
Tap chr Tai MOI Hpng Vift N ^ n -Volume {61-33). N°3- September, 2016
Trong 36 benh nhan cd 13/19 benh nhan nang tii phat khdng dugc cat than xuorng mdng d lan md tnrdc, 6/19 benh nhan d§ dugc cat than xuong mdng. Trong sd 17 bfnh nhan rd tii phated 12 benh nhan chua dugc cit than xuong mdng d Ian md trudc va 5 bfnh nhan d i dugc cat 3.9. Cich thu-c phau thu^t tai thdl dilm
nghien cuu
• BSI chieu dudng vdo phiu thuat vdi vftri cda nang vd ro tdi phdt Bing 3.6: Ddi chidu dudng v i o ph§u Uiu^t vdi
vj trl cOa nang v i rd tdi phit
\ Oirdnc
\ ^^
Vitrl \ (nang, \ Um) \
Diy lirdi
Trin xirong mdng
Tfin s$o cQ
Giip mdng
Thucng ITC
%
Dudng mdcO
0
7
12
15
0
34
94,4 Dirdng
ngang n i p l l n d
trdn
1
0
1
0
0
2
5,6 Tdng
1
7
13
16
0
36
%
2,8 19,4
36,1
41,7
0
100
Trong 36 bfnh nhan nghi&n ciiu, cd 3 4 ^ 6 b^nh nhan dugc phlu thuait theo dudng seo md cu (chidm 94,4%), 2/36 benh nhan dugc phau thuit theo duong nfip lin CO tren (chi6m 5,6%). S6 benh nhan cd nang v i rd giip luoi tii phit 6 viing giip mdng chilm gdm 15/36 bfnh nhan (chilm 41,7%), 13/36 benh nhin cd Id rd tr€n duong seo cii (chidm 36,1%), 7/36 bfnh nhin cd nang tii phat nam trSn xuong mong (chilm 19,4%), chi cd 1 benh nhin trong nghien ciiu cd nang nim trong day ludi (chilm 2,8%).
M&TLUAN
Qua nghifin ciiu 36 bfnh nhin nang va rd giap luoi tai phat, chiing tdi n h ^ thiy cae nguyen nhan sau gdp phin lim ting kha ning tii phat:
Tinh t r ^ g vifim nhiem tmdc phlu tiiuat
Tuoi phau thuat lin 1
Khdng cit than xuong mdng khi dilu tri bing phiu thuat.
TAI L l f u THAM KHAO 1. Nguyin Vin Thii, Nghifin ciiu d§c dilm
lam sing, c|n lim sing v i kit qui phlu J thuat u nang vi rd giip ludi. 2013: ky I ylu hgi nghi Tai Miii Hgng toin quic 1
lin tiiii 16. p. 495-508. \ 2. Nguyen Thi To Uyfin, D$c diem u nang j
v i rd giap ludi g^ip t^i vifn tai mOi hgng i
Tgp tdil Tai MOi Hgng Vi$t Nam - Volume (61-33). N'S- September, 2016
trung uong. 2001, Trudng Dai Hgc Y H i Ndi.
3. Phung Tiln Hieu, Nghifin ciiu hinh thai lam sang, md bfnh hgc va doi chieu vdi phau thuat cua u nang va rd giap-luoi.
2013, Trudng Dai Hgc Y H i Ngi.
4. AInaimy, T., Basem M. Sieda, and Taha Baiomy, "Thyrogiossai Cyst and Fistula:
Surgical pitfalls and causes of recurrence." The Egyptian Journal of Surgery, 2016.35.1: p. 49.
5. Allard, R.H., The thyrogiossai cyst.
Head & neck surgery, 1982. 5(2): p.
134-146.
6. Cardesa, A. and P. Stootweg, Pathology of the head and neck. 2006: Springer Science & Business Media.
7. DJ Ostlie, S.B., CL Snyder, J Watts...
Thyrogiossai duct infections and surgical outcomes. Joumal of pediatric- Elsevier, 2004
8. Goldsztein, H., A. Khan, and K.D.
Pereira, Thyrogiossai duct cyst excision- The Sistrunk procedure. Operative Techniques in Otolaryngology-Head and Neck Surgery, 2009. 20(4): p. 256-259.
