Y HOCVIET NAM THANG-3-301/2012 Mang gang sach, diing mpt lan khi che
bien va phat thyc pham chin d c d s d tuy^n 2. Kien nghj:
- To chu'c cam ket cua ngu'di kinh doanh thirc an du'dng phd vdi chinh quyen dja phu'dng, ho trd cac dieu kien n h y xii ly chat t h a i , cap nu'dc sach ...
- Chi cue An toan ve sinh thdc pham tap huan cho tuyen du'di. Tang cu'dng tap huan cho cd sd kinh doanh thyc an du'dng phd de hp hieu day dii van ban quy pham phap luat cua nha nu'dc va trach nhiem ciia hp doi vdi ngu'di tieu diing. To chirc kham su'c khde, cay phan tim ngu'di lanh mang triing.
- Tang cu'dng kiem tra cd sd thyc an du'dng phd 1 ttiang/l lan. Tang cydng cap giay chimg nhan dii dieu kien ve sinh an toan thyc pham cho sd sd.
- tAiic xii phat can tang cao hdn de cd tac dung ran de.
TAI UEU T H A M KHAO
1. Bo Y te (2000). Tieu chuSn co sd dat v§ sinh thOc Sn dudng pho. Quyet dinh cua Bp trudng Bo Y le
ve viec ban hanh tieu chuarv ccJ sil dat ve sjut}, QDBYTSp'3199/2000/QD-BYT,, , , -, ^^^
2. Bo Y te (2001). Quyet dinh cCia 86 trUcfng B Y T " ^ viec ban hanh "Quy dinh ve dieu l<ien bao darnan toan thi/c pham tai cac nha an. bep an tap the^va CO sd kinh doanh che bien sUat an sin" (BYT So 4128-2001 Q D / B Y T ) , •• - ' i ' . ' : ,.-. ,'' 3. Bo Y te- Cue an toan ve sinhthifc pham.'(20G5j
"Mpt so cong trinh nghien ctJu ve v6 sinh, an-to^n thuc pham". Bo Y te. HNKH an toan ve sinh thuc pham lan thuliums ., , I, Moushumi Ghosh^; Sidhi Wahi^; Mukesh KumaH" et all (2007), Prevalence of enterotoxigenic Staphylococcus aureus and Shigella spp. in seme raw street vended Indian foods. International Journal of Environmental Health Researdi, Voiume 17, Issue'i2 Apnl 2007, pages 151
5. Rheiniander T, Olsen M, Bakang 3A et ajl (2008), Keeping up appearances: perceptions of street food safety in urban Kumasi, Ghana, 0 Urban Health. 2008 Nov;85(6);952-54 6. Arambulo P 3rd, Almeida CR, Cuellar :i
(1994), Street food vending In Latin America, BL|11 Pan Am Health Organ. 1994 Dec;28(4)'344-54'""
' Ministry of Public Health, Thailand (2002) Food Sanitation Standards. Bangkok, 8. FAO (1994), Get best from your,fapd, -
PHAU THUAT NOI SOI CHINH HINH VACH NGAN BANG KHOAN VI PHAU
Cao Minh T h a n h *
T 6 M TAT
Myc tl^u nghien cufu: danh gia phu'Ong phap chinh hinh vach ngan mui bSng khoan vi phau dU^i noi soi. Thiet ke nghien cu'u: tien cyu. Ntfi thy'c hien:
Benh vien dai hocy Ha Noi ty9/2010 den 12/2011 Ooi tu'dng: 42 benh nhan du'dc chan doan la di hinh vach ngan, du'dc phau thuat noi soi chinh hinh vach ngan mui bang khoan vi phau. Ket qua: sau phau thuat khong co tru'dng hdp nao con tneu chimg ngat mui mpt ben va dau dau. Trieu chimg chay mui va hat hdi sau phau thuat chi con 9,5% va 7,1% so vdi tru'dc phau thuat !a 76,2% va 54,8%. Ket Juan:
ngi soi chinh hinh vach ngan bang khoan vi phau dat du'dc k^t qua tdt va khong co tai bien gi.
SUMMARY
RESULTS OF NASOSEPTAL PLASTY W n H MICROMOTOR DRILL CONTROL ENDOSCOPE
Objective: to assess the value of method's nasoseptal plasty with micromotor control endoscope,
* Tru'dng dai hgc y Ha Ngi
Phan bien khoa hgc: PGS.TS. Nguyin Tan Phong
" " Study designr Prospective study. " ' Setting: In Ha Npi hosp-university of medrcine.
Patients; 42 patients having nasoseptal deformyties were operated nasal septum plasty wjth micnDmotor dnil. - ' ' Results: post-operatve no' meeting one-"aife stuffiness and iieaddache symptoms. Rhmorrhea and sneezing have only occupied 9,5% and' 7,1%
compared pre-operative 76,2% and 54,8%. — Conclusion: The results of nasoseptal plasty w/ith micromotor drill is good wrthout complication.
I. OAT V A N o f
Dj hinh vach ngan miji ia mot" benh ly thu'dng gap d ngu'di Viet Nam. Di hinh vach ngan mui co"the gap la; veo, mao, gai hoac xoang hdi ma nguyen nhan do s y phat trien bat thu'dng cua vach ngan mui hoac cac khoi xydng cd Hen quan, do chan thydng [ 5 ] . Hau qua ciia di hinh vach ngan thu'dng gay hep hdc mui ben dj hinh, can
Y HQC VIET HAM THANG 3 - SO 1/2012 trd thdng khi, giam thdng khi [ 1 ] . Bieu hien lam
sang khac nhau d moi ngu'di, moi loai dj hinh va myc dd dj hinh, cd the la yeu to thuan ldi trong benh viem mui xoang, hoac gay viem mui xoang keo dai. Chinh hinh vach ngan cd rat nhieu ky thuat va phu'dng phap, ky thuat cung thay doi theo phu'dng tien, mdi phu'dng phap cd u'u nhu'dc diem rieng [ 5 ] , Ndi soi chinh hinh vach ngan la mpt ky thuat pho bien hien nay [ 2 ] . Nhu'ng noi sol chinh hinh vach ngan bang khoan vi phau hien nay rat it ngu'di lam, vi vay nghien cyu nay tien hanh vdi 2 muc tieu:
1. Danh gia ket qua phSu thuat noi soi chinh hinh vach ngan bang khoan vi phau.
2. Neu len nhOdg uV, nhi/dc diem cua phi/dng phap nay, dediJa ra nhuhg chi dinh phu hdp.
II. 0 6 l T J p N G VA PHUONG PHAP NGHIEN CCfU 2 . 1 . 061 tu'dng nghien cu'u
Nhu'ng benh nhan du'dc chan doan la dj hinh vach ngan. Du'dc kham va dieu trj tai benh vien dai hoc y Ha Ndi t y 1/2010 den 1 2 / 2 0 l i .
Sd lu'dng benh nhan : 42 Tieu chuan chgn benh nhan + Kham npi soi chan doan la dj hinh vach ngan + Chypc CLVT mui xoang cd hinh anh lech, day chan, mao, gai hoac xoang hdi vach ngan.
+ Phau thuat; npi soi chinh hinh vach ngan bang khoan vi phau.
+ Benh nhan dong y tham gia nghien ciru - Tieu chuan loai tor': khong dii tieu chuan tren 2.2. Phifdng phap nghien cu'u
Nghien cyu tien cyu cd can thiep - Phu'dng tien nghien cyu + Bp noi soi Ackermann cd chup anh + May chup cat Idp vi tinh
+ Bp npi soi phau thuat Karlstortz cua Dye + Khoan vi phau Rotex, bp mui khoan catva kim cu'dng.
So sanh tru'dc va sau phau thuat 3 thang - Xil" ly sd lieu bang thuat toan thdng ke y hoc Epi 6.04.
III. KET Q u A NGHIEN CCU 3 . 1 . Tud'i va gidi:
Tuoi trung binh la 36,4. Trong dd tuoi nhd nhat la 15 va Idn nhat la 53.
- Gidi: ty le Nam/Nu- = 1,3.
3.2.Tneu chu'ng lam sang 3.2.1. Trieu chutig c(y nang
Bang 3.1: Ty le tan xuat cac trieu chyng lam sang Trieu chu'ng ( n = 4 2 )
n
%
Ngat mui 32 76,2
Hat lltfi 23 54,8
Cliay mui 15 35,7
Dau dau 14 33,3 Nhan xet: Tneu chyng ngat mui mot ben chiem ty le 76,2%, hat hdi chiem 54,8%, chay miji chiem 35,7%, dau dau chiem ty le thap nhat la 33,3%. Sy khac biet giu'a trieu chuTig ngat vdi cac trieu chutig khac cd y nghla thdng ke vdi p < 0,05.
3.2.2. Trieu chu'ng thu'c the Bang 3.2:1^ le loai dl hinh vach nqan
Loai di hinii vacti ngan Mao
Gai Day Chan + lech Gai + xoanq hdi N
N=42 11 12 9 2 42
•A 25,2 28,6 21,4 4,8 100,0
Nhan xet: - Gal va mao vach ngan'chiem ty le 28,6% va 26,2% cao hdn ty le lech vach ngan va day chan+lech vach ngan trong yng la 19,0% va 21,4%. Sd khac biet khdng cd y nghTa thdng ke vdi p > 0,05.
Xoang hdi vach ngan chi gap trong 2 tru'dng hdp gai vach ngan chiem ty le 4,8%.
Y HOC VIET NAM THANG 3 - SO 1/2012
Hinh 3.1: Gai vach ngan Hinh 3.2: Mao vach ngan 3.3. So sanh trieu chu'ng tru'dc va sau phlu thuat
Thdi gian Trieu chu'ng
Ngat Hat hai Chay mui
Oau dau
Tri/6c phau thuat (n=42) n
32 23 15 14
76,2
%
54,8 35,7 33,3
Sau phau thuat (n=:42) n
0 3 4 0
0,0
%
7,1 9,5 0,0
Nhan xet:
Ty le ngat mui tru'dc phau thuat la 76,2%, sau phau thuat khong cd tru'dng hdp nao.
Hat hdi tru'dc phau thuat chiem 54,8% cao hdn so vdi sau phau thuat la 7,1%. Sir khac biet cd y nghla thong ke vdi p < 0,01.
Chay mui triTdc phau thuat chiem 35,7% cao hdn so vdi sau phau thuat la 9,5%. Su' khac biet cd y nghTa thdng ke vdi p < 0,05.
Oau dau trydc phau thuat chiem ty le 33,3% sau phau thuat khdng gap tru'dng hdp nao.
3.4. Tai bien
Bang 3.4: Ty le cac tai bien
Tai bien Loai di hinh vach nganLech Mao Gai Day Chan + lech Gai + xoanq hdi
Thung vach ngan (n=42)
0 0 0 0 0
Bong cu'a mui ( n = 4 2 )
2 3 2 0 1
Nhan xet: - Thung vach ngan khdng gap tru'dng hdp nao trong nghien cifu nay.
- Bdng cya mui do mui khoan ty de vao khi khoan la 8/42 chiem ty le 19,C
3.5. l/u va nhu'dc diem cua dung khoan vi phau trong chinh hinh vach ngan va each khac phuc
• Ou diem
- Oydng rach di trye tiep -^ai? phan dj hinh,
bdc niem mac va mang sun hoac xu'dng toi thieu chi vuS du bpc Id rd phan di hinh. Thdi gian rut ngan, kha nang phuc hoi va lien seo tot sau phau thuat.
Diing khoan de cat bd phan dj hinh phang hdn nhu'ng phydng phap khac, vach ngan ton thydng cung it hdn.
Nhu'dc diem
- Vdi nhu'ng lech vach ngan hinh chy S va
chi d phan sun thi diing khoan vi phau khdng
hieu qua bang cac phu'dng phap khac.
- Bdng phan cya mui do mui khoan ty vao khi khoan. De khdng xay ra tai bien nay ta dung mpt vong kim loai hoac nhya cyng dat vao cya mui de iam diem ty ciia mui khoan.
IV. BAN LUAN 1. Tud'i va gidi
Tuoi; cd the gap d mpi lu'a tuoi, tuoi trung binh la 36,4. Tuoi nhd nhat la 16 va ldn nhat la 53.
- Gidi: gap d ca nam va ny, vdi ty le
nam/ny = 1,3.
Y HOC VlgT NAM THANG 3 - SO 1/2012 2. Trieu chu'ng l a m sang
Ngat mui la tneu chu'ng thydng gap nhat trong di hinh vach ngan chiem ty le 76,2%
(32/42), thu'dng la ngat mpt ben, ngat khdng hoan toan. Hat hdi la trieu chiing thu'dng gap t h d hai chiem ty le 54,8% (23/42), da so cac tac gia deu cho rang nhu'ng di hinh vach ngan cd the la mpt gai kich thich gay nen trieu chyng nay, va la dieu kien thuan ldi gay viem mui xoang cung nhu' la tac nhan keo dai qua trinh viem xoang [ 1 ] , [ 4 ] . Oau dau chiem ty le 33,3% (13/42), dau dau thu'dng am I vung tran gap nhieu d gal vach ngan phan cao, cd che thi chu'a rd rang.
Trong dj hinh vach ngan thi hai loai gap nhieu nhat la gai vach ngan gap 12/42 chiem 28,6%, mao vach ngan gap 11/42 chiem 26,2%
(bang 3.2). Xoang hdi vach ngan gap 2 tru'dng hdp trong benh ly gai vach ngan, khdng gap tru'dng hdp nao xoang hdi ddn dpc.
3. Ket qua phau t h u a t
Sau phau thuSt khdng gap tru'dng hdp nao ngat mui va dau dau, trong khi do tru'dc phau thuat 2 trieu chu'ng nay chiem ty te tu'dng u'ng la 76,2% va 33,3%, s y khac biet nay cd y nghia thong ke. Oieu nay chiTng td rang phau thuat chinh hinh vach ngan bang ndi soi va khoan vl phau giai quyet du'dc benh ti'ch triet de (bang 3,3).
Trieu chyng hat hdi tru'dc phau thuat chiem ty le 54,8%, sau phau thuat chiem 7 , 1 % . Sy khac biet trydc va sau phau thuat cd y nghTa thdng ke vdi p< 0,01 (bang 3.3), dieu nay chyng td rang chinh hinh dj hinh vach ngan cai thien trieu chyng hat hdi ro ret, ket qua nay cung tu'dng t y c u a Stammberger [ 5 ] .
4. Nhu'ng kinh n a h i e m trong phau t h u a t bang khoan vi phau
Chi diing khoan vi phau chinh hinh vach ngan trong nhffng tru'dng hdp: gai, mao, day chan va xoang hdi vach ngan thi dem lai hieu qua rat tot. Dung khoan han che ton thu'dng vach ngan rdng nhu' cac phu'dng phap chinh hinh vach ngan cd' dien, do do thdi gian phau thuat
ngan, tranh du'dc cac bien chyng nhu" thiing vach ngan hoac tu mau vach ng^n sau phau thuat
Han che Idn nhat ciia npi soi chinh hinh vach ngan bang khoan vl phau la nhJng di hinh chi d phan sun, vach ngan dj hinh kieu chff S, t h y 2 la gay bdng cita mui hoac rach cudn mui neu diing cd mui khong thic hdp. Do vay khi dung khoan thi can phai co 1 thiet bl dat d cira mui nham cho khoan khong ty trye tiep vao cya mui thi se tranh du'dc tai bien nay
V. KET LUAN
1 . Dac diem cua d | hinh vach ngan - Tuoi trung binh la 36,4, gap d ca nam va nff vdi ty le gan nhu' nhau.
- Trieu chyng thu'dng gap nhat la ngat mOi mpt ben 76,2 (32/42).
- Dj hinh vach ngan hay gap nhat la gai vdi ty le 28,6 (12/42), mao vach ngan chiem ty le 26,2(11/42).
2. Ket qua sau phau t h u a t chinh hinh vach ngan
Ngat mui mot ben la 0,0%.
Oau dau chiem 0,0%.
Hat hdi chi cdn 7 , 1 % . Chay mui con 9,5%
- Khdng gap tru'dng nao thung vach ngan va dinh vach ngan.
TAI LIEU T H A M KHAO
1. McCaffrey TV (1993), "Nasal Function and Evaluabon", Head & neck Surgery-Otolaryngology, Lippincott Company, Vol(l), pp 262-288.
2. Messerklinger AS(1978)," Endoscopy of the nose.
Urban and Schwazenberg, BaHjmore-Munich, p.49.
3. Simmen D, Jones N(2005), "Manual of Endoscopic Sinus Surgery", Georg Thieme Verlag, pp 119-130.
4. Stammberger H (1987), "Endoscopic diagnosis and Surgery of the paranasal sinuse and anterior skull base". The messerklinger technique and adviced applications from the graz chool.
5. Wood RP et.al (1993), "Nasal Obstruction", Head & Neck Surgery- otolaryngology, Lippincott company, Voi (1), pp. 302-328.
