T A I LIEU THAM K H A O
1. Ta Van Binh (2006), "Bpnh Oai Thao Dudng tang glucose mau" tr.11 - 1 4 .
2. Le Thj Thanh Nhon (2002), " Nhan xet tinh trang quanh rang tren benh nhan Oai thao dudng", Luan an thae sTy hgc - Tnedng Dai hgc Y Hi Ngi.
3. Academy Report (2000), " Diabetes and periodontal disease" J. periodontol 2000; 71: 664 - 678.
4. Gugliemo Campus va CS (2005), " Diabetes and periodontal disease: A case
control study" J. periodontol 2005; 76: 418 - 425, 5. Steven P, Egebretson (2004), " Gingvival crevicular fluid levels of interleukin - 1 beta and glycemic control in patients with chronic periodontitis and type 2 diabetes" J, periodontol 2004; 75: 1203 -1208.
6. Sergio Guzman (2003), " Association between interieukin - 1 genotype and periodontal disease in a diabetic populatoin" J. periondontol 2003; 74: 1183 - 1190.
NQI SOI PHE QUAN ONG CUfNG CHAN DOAN ONG THO PHE QUAN TAI KHOA HO HAP BENH VIEN BACH MAI
TOMTAT
Ngl soi phi quan la mgt ky thuat tham dd c§n thiit trong benh ly cua ca quan hd hap. Ndi soi phi quan cd hai logi ong so (dng cirng va dng mim). Ong ndi soi phi quan cung b ang kim loai da cd tu han 100 nam nay.
1967 ong soi mim do S. Ikeda (Nhat ban) phat minh da dugc ung dung rdng rai a nhiiu nude. Mac du da ed ong soi mim ong soi phi quan bang kim vin khing djnh dugc gia tri cua nd trong chin doan va diiu tri bgnh phoi Muc tieu: danh gia higu qua chin doan cua ky thuat ngi soi phi quan ong cirng trong chin doan ung thu phi quan tgi khoa Hd hap Bgnh vign Bach mai. Doi tugng:
142 trudng hgp ed lam sang, Xquang, ehan doan md bgnh te bio hgc xac djnh ung thu phi quan dieu tri tai khoa trong nam nam 1996-2000. Phuang phap: Ngi soi phi quan bang ong soi cimg Fridel (CHDC Diec). Quy trinh ehuan bj soi va cae dung eg kem theo nhu vdi mgi cudc soi thiedng quy. Tiin hanh sol phi quan va thue hign cae ky thugt liy bgnh pham chin doan. Dung eg gom kim sinh thiit eung, kim chgc hut tu tao ca kim 21 G, dai 3 cm, lam kinh dan bgnh pham. Dgc va djnh typ tai khoa Hd hap Benh vien Bach mai.Kit qua: 142 tnedng hap nghien cieu (127 nam, 15 nie), cd 111 tnedng hap tren 50 tuoi. Dau nguc, khd thd, ho mau la 3 trigu chimg quan trgng, hay gap. Ton thieang ngi soi phi quan: u thiy rd trong Idng khi phi quan 28 trudng hgp, tham nhiim niem mac phi quan chiim hang thu 2 vol 24 trudng hgp. Cua phi quan gian rgng 66 trudng hgp (48%). Cac ky thugt ap dung trong ngl sol phi quan sinh thiet phoi hgp vdi cac ky thuat khac 76 tnedng hgp.
Chgc hut bang kim 66 tnedng hgp. Chan doan md benh te bao: 76 (53,5%o) trudng hgp ung thu biiu md vay, 27 trudng hgp(19%,) ung thu bieu md tuyin 16 (11%,) tliudng hgp ung thu ti bao nhd. Kit luan: soi phi quan dng cirng chan doan tren 142 trudng hgp ung thu phi quan sinh thiit phi quan chin doan cho tren 53,5%, sd trudng hgp.Chgc hut bing kim ehin doan dugc 128 trudng hgp(>90%,) so bgnh nhan. Ky thuat an toan khdng cd tai biin nao cin phai can thigp.
Tu khda: Ndi soi phe quan, Chgc hut kim nho xuyen thanh phi quan, ung thu phi quan
SUMMARY
Bronchoscopy is one of many neccesary technic for the diagnosis in praetic in Pulmonary disease.Ojective:
HOANG HONG THAI Bo mon Ngi - Dai hgc Y Ha Ngi
evaluation of the result of transbronchial Needle Aspiration on bronchoscopy by rigid tube for the diagnosis and staging in patients who had bronchogenic carcinoma
Material and method: Bronchoscope tube rigid of Fridel (Germany). Cross -sectional retospectif study.
Subjects: Transbronchial needle aspiration by tube rigid for the diagnosis and stging of bronchogenic carcinoma was pertormed in 142 patients of Respiratory Department of Bach Mai hospital from 3/1991 to 8/1996.
All patients who had malignant disease on clinic, chest radiography.Results Endoscopic and both histologic and cytologic specimens demontrating malignancy. 76 patients with squamous cell carcinoma (53.53%,) and 27 with adenocarcinoma (19.01%,). 16 patients with small cell carcinoma (11.26%,). 9 patients with adenosquamous (6.33%), 7 patients with large cell (4.94%) and 5 patients were difficult to typage (3.52%,).
Conclusion: transbronchial needle aspiration is a safe, and effective procedure to obtain a deep specimens of extrinsic compression or submucosal tissue for the diagnosis and staging of bronchogenic carcinoma. This technic is low risk.
Key words: Bronchoscopy, carcinoma.
DAT V A N DE
Npi soi phe quan e h i n doan trong ITnh vuc hd h i p la ky thuat da dupc su' dung tCr hon t h l ky nay. Cung vdi lam sang Xquang, nd tao thanh bp ba c h i n doan quan trpng ddi vdi eae thay thudc
Ngoai cac tripu ehCrng lam sang, Xquang giup c h i n doan t l bao hpc, md hpc ed y nghTa q u y l t djnh.
K l tCr khi S. Ikeda (Nhat Ban) la ngudi d i u tien phat minh ra loai dng soi m i m . Nd dupe sCr dung rdng rai trong tham kham khi p h i quan. Tuy nhien dng soi p h i quan b i n g kim loai v i n edn nguyen gia tri cua nd trong c h i n doan, trong d i l u tri bpnh ly p h i quan hipn nay.
Npi soi dng eCrng, tai khoa Hd hap benh vien Bach Mai da dong gdp p h i n Idn trong c h i n doan xae dinh eho nhilu bpnh nhan nhd vao ap dung mpt sd ky thuat phdi hpp lay benh p h i m trong khi soi.
Vi vay, chung tdi dgt v i n d l nghien eCru gia tri eua eae ky thuat phdi hpp l i y benh p h i m qua ndi soi dng eCrng d nhQ'ng bpnh nhan ung t h u p h i quan qua d l tai:
"Ngi soi phi quan ong cung va hieu qua cua eac ky thuat
Y HOC THVC HANH (667) - SO 7/2009 61
lay benh pham chin doan ung thu phi quan tgi khoa Hd hip benh vien Bach Mai".
Muc tieu cua d l tai la:
Danh gia gia tri cua npi soi p h i quan dng cii'ng va eac ky thuat l i y benh p h i m cho xet nghipm t l bao, md benh trong c h i n doan xac djnh ung thu p h i quan nguyen phat,
D 6 | TU'O'NG VA PHLPONG P H A P NGHIEN Cl>U A. Odi tu'O'ng
Benh nhan (BN) eua chung toi bao gdm cac BN cua khoa, eac BN eae khoa trong bpnh vipn ehuyin den e i n xac djnh c h i n doan, cae BN cua cac benh vien t u y i n dudi chuyen d i n d l c h i n doan va d i l u tri.
Cac benh nhan nay cd:
- Bilu hien lam sang, Xquang nghi ngd ung thu p h i quan
- Cac BN CO ho mau khong tim thay nguyen nhan - Khong cd ehdng chi dinh soi p h i quan
- Cd Xquang nguc t h i n g , nghieng mdi ehup - Cd chuc nang hd h i p eho phep t i l n hanh cupc soi - Cd mau chay, mau ddng binh thudng
- Hpp tac trong khi lam thCi thuat - Tudi tCf 1 6 - 7 5
B. P h u o n g tien
ChCing tdi sd dung may soi Fidel eua CHDC DCrc (eu)
- Ong soi bang kim loai, cd dng 9mm, 10mm, dai 45cm
- Kim sinh thilt eCrng
- Kim chpc hut t u tao ed canh budm g i n d dde kim d l xoay kim d l dang khi chpc hut. Kim dai 50cm, kim chpc hut dai 3em, eo kim 22G
- May hut, bom tiem 50ml d l hut benh p h i m - Dung dich ed djnh benh pham: cdn 95° va ete vdi luong tuong duong
- Lam kinh d l dan benh pham.
* Thuocmen
- Xylocain 2%, 5% gay te.Adrenalin Img/dng, d l c i m mau
- Depersolon 30mg- 5 dng phdng choang
* Cac phuo'ng tien cap ciru khac
- Bdng ambu, mat np thd oxy. Bp md khi quan C. P h u o n g phap t i l n hanh
Chuan bi benh nhan - Cho an t h i n tdi hdm trude
- An nhp trudc soi 2-3 gid (chao dudng, sCra) - Go bd ham gia ( n l u cd)
- Gay te thanh quan, h i u hpng theo nhu phuong phap kinh d i l n
- BN nam yen tTnh tren giudng trong budng soi - T i l n hanh soi vdi dng soi eung nhu vdi mpi trudng hop.
Co hai tinh huong
Niu thiy u trong Idng khi phi quan
- Sinh thilt u d 3 vj tri khae nhau, eho manh sinh thilt vao Ip dung dung djch Bouin.
- Dung que bong p h i t nhp tren b l mat khdi u dan len lam kinh.
- Diing kim chpc hut khdi u d 3 vj tri khac nhau. Bpnh p h i m hut dupc cung dan len lam kinh, cd djnh bang dung djch cd djnh.
- Chpc hut vao cua p h i quan g i n noi tdn thuong.
Niu khdng thay u trong Idng khi phi quan:
- Chpc vao viing niem mpc nghi ngd (chd niem mpc tham nhiem, phu ne, hay de ep tir ngoai vao).
- Chpc hut vao eua khi p h i quan g i n dd.
- XCr ly bpnh p h i m , cd djnh, d l khd rdi ehuyin d i n Khoa Giai phau benh hoae Bd mdn giai phau benh de dpe k i t qua va phan typ t l bao.
K^T QUA
Trong thdi gian qua ehung toi su' dung dng soi phe quan eCrng tren 142BN cho t h i y k i t qua dat dupc nhu sau:
Bang 1. Sd lupng benh nhan Tuoi
16-20 2 1 - 3 0 31 -40 41 - 5 0 51 - 6 0 61 - 7 0
>70 Tong so
Nam n 1 2 9 17 48 45 5 127
%
0,7 1.4 6,34 11,97 33,80 31,69 3,52 89,44
NCr n
1 1 2 8 3 15
%
0,7 0,7 1,4 5,63 2,11 10,56 Nhan xet: sd benh nhan nam nhilu hon sd benh nhan nCi'(127/15; 8/1).Tudi gap nhilu n h i t d dp tudi tren 50, ehilm hon 75% .
Bang 2. Cac b i l u hien lam sang thudng gap Trieu chung
Oau nguc Kho thd Ho mau Gay sut can
Khan tieng Hoi chCrng Pancoast Tobias
Hoi chung Pierre Marie Nuot nghen Hach thurong don to
Phil 2 chi dudi Chen ep dam roi giao cam co
Gan to, vang da
S6 lupng 91 83 74 59 43 35 26 28 19 6 4 2
Ty le (%) 64,08 58,45 52,11 41,54 30,28 24,64 18,31 19,71 13,38 4,22 2,81 1,40 Nhan xet: ba trieu chung hay gap nhit: dau nguc,khd thd, ho mau ehilm tren 50% sd benh nhan nghien cCru.Hpi chCrng can ung thu ehilm khoang 20%
sd trudng hpp .1 9 trudng hop da cd tham nhap ung thu vao hach thupng ddn
Bang 3. Cac d i u hieu Xquang Trieu chCrng
Co u ro:
Dinh Giua Day Xep:
Mot thuy Toan bp Trung that rpng
Tran dich Giong viem phoi
Tong cong
Phoi So luong
36 7 14
3 2 7 4 12 85
phai
%
25,35 4,92 9,86 2,11 1,41 4,92 2,82, 8,45
Phoi trai So lupng
30 15 7 3 5 1 6 67
%
21,13 10,56 4,92 2,11 3,52 0,07 4,23
Nhan xet: Hinh anh xquang tdn thuong chu y l u gap d thuy tren cua hai phdi, phdi phai nhilu hon phdi trai(36/30). 10% sd trudng hpp ed ton thuong xep phdi
Cd 8% sd trudng hop ed trung t h i t rdng . .,. „
62 Y HOC THVC HANH (667) - SO 7/2009
Bang 4. Tdn thu'ong qhi ni Ton thuong
U ro trong long khi phe quan Tham nhi§m, siii niem mac
Phil ne chit hep, chay mau niem mac De ep phe quan tir ngoai vao
Cua khi phe quan gian rong Tong so
nan duoc khi Phoi phai n 15 36 14 11
%
10,56 25,35 9,85 7,74
soi Phoi trai n 11 15 7 12
%
7,74 10,56
4,92 8,45 66 trudng hop = 46,48%
78 i 1 64 1 Nhan xet: Ton thuong ndi soi chu yeu thay siii tham nhilm niem mac phi quan 51 trudng hpp(41%)..U trong long khi.phi quan ehi ed 26 trudng hop(18,5%).Cua khi quan gian nghi cd thl cd hach to d trung thit chiem ty le 46,5%.
Bang 5. Kit qua liy benh phim cua cac ky thuat dupe ap dung
St: sinh thilt- chxt: chpc xuyen thanh phi quan- cr:
chpc xuyen cua khi phi quan Ten ky thuat
Sinh thiet don thuan - st + chxt - st + chxt + cr - st + chxt + cr + ap lam
- st + cr Chpc hut xuyen thanh khi phe quan 6cm thuan
- chxt + cr - chxt + cr + ap lam Chpc hut cua khi phe
quan don thuan - chpc xuyen khi quan
- cr + xt nguc
n 14 24 11 23 4 28 12 11 9 4 1
%
9,850 16,90 7,74 16,19
2,80 19,71
8,45 7,74 6,33 2,80 0,70
Cpng 76 trudng
hop
= 53,52%
52 trudng
hop
= 36,61%
14 trudng
hop
= 9,850%
Nhan xet: Nhu vay sinh thiet don thuan d 14 trudng hpp eho ty le: 9,850%. Sinh thilt cd phdi hop vdi cac ky thuat khae d 62 trudng hop 43,66%. Tdng cpng la 53,52%.
Chpc hut xuyen thanh khi phi quan don thuin va chpc hut xuyen cua khi phi quan don thuin d 37 trudng hpp vdi ty Ip 26,05%.
Chpc hut xuyen thanh khi phi quan + chpc hut cua khi phi quan cd phdi hop vdi cac ky thuat khac chin doan cho 128/142 trudng hpp nghien cu'u(chilm ty le 90,14%).
Chan doan mo benh - t l bao
Ung thu bieu md dang bilu bi: 76 trudng hop(53,52%)
Ung thu bilu md dang tuyin : 27 trudng hpp(19,01%)
Ung thu bilu mo te bao nhd ; 16 trudng hpp(11,26) Ung thu hdn hpp tuyin vay: 9 trudng hpp (6,33%) Ung thu bilu md t l bao Idn: 7 trudng hpp (4,93%) Ung thu khdng dinh type: 5 trudng hpp (3,52%)
BAN LUAI^
Npi soi phi quan dng eCrng tham dd ben trong khi phe quan da dupe ap dung tCr hon the ky nay. Lpi ieh ma nd mang lai trong chin doan cung nhu dilu tri trong ITnh vuc benh ly hd hip la rit Idn [11]
Ngay sau khi ed sCr dung kim d l chpc hut vao cac tdn thuong d trung thit, d ngoai khi phi quan, da nang cao them gia tri cua npi soi trong chin doan bpnh ly phdi phe quan, nhit la trong ITnh vuc ung thu len rit nhieu
[3],[4],[8] :b9,;
Qua 142 trudng hpp ndi soi dng cung va phdi hop eac ky thupt liy bpnh phim cho xet nghiem t l bao, md hpc chuan doan xac djnh ung thu, chung toi cd - Ung thu phi quan gap nhilu d nam gidi hon nir ty le 10/1.
- Lira tudi hay gap la tren 50 tudi (112BN/142BN) tuong tu nhu bao eao eua nhilu tac gia trudc day tren thl gidi [7],8],[8],[9], va d Vietnam [4],[5].
- Bdn tripu chung hay gap nhat la dau nguc. sCit can nhanh, khd thd, ho mau (gap tren 60% sd BN), eho thiy BN din vien diu d giai doan mudn cua benh.
- Ton thuong d phdi phai va d thuy tren la hay gap, ehilm 25%, eao hon so vdi phdi trai (21.30%).
- Ton thuong npi soi chu ylu: tham nhilm niem mac, sui loet, chay mau gap nhilu nhit (72 trudng hop/142 chiem ty le 50,70%) it gap tdn thuong u rd ldi han vao trong Idng khi phi quan. Trong nghien eCru ed 26 trudng hpp/142BN chiem 18,31%.
v l phLPong dien chin doan
- Do tinh chit eCia tdn thuong nen sinh thilt phi quan ehi tiln hanh dupc d 76 tren 142BN. Trong khi do vdi kim chpc hut niem mac, xuyen thanh khi phi quan xuyen, xuyen eua khi phe quan cho ty le chin doan xae djnh eao nhit 128 BN ehilm 90,14%. Dilu nay dupc giai thich:
+ Ton thuong niem mac khd liy benh pham do sinh thilt vi tron trugt.
+ Mpt sd trudng hpp u d ngoai khi phi quan, sinh thilt khdng t h l tiln hanh dupe ma ehi eo kim choc hut xuyen thanh phi quan mdi liy ditac benh phim. Day la dilm manh cua ky thuat chpc hut xuyen thanh khi phi quan trong viee liy benh phim cho xet nghipm t l bao.
Chu d l nay da dupe nhilu tae gia tiln hanh nghien eCru d Hoa Ky (Wang, Shure.D, Harrow.E), Anh (Torrington), Phap (Schiessler, Fabvre), Trung Qudc (Chen.W), Nhat Ban (Kenkichi Oho, S.Ikeda). Nhilu tac gia cua mpt sd nudc d chau Au khae khi nghien eCru v l vin d l nay diu eho nhan xet tuong tu [5], [6],[7],[8]
So vdi ky thuat chpc hut xuyen thanh khi phi quan bang kim mim, kim eCrng cd han chi la chi tiln hanh dupe d eae phi quan phan dinh trd xudng, cdn cae phi quan phan thCiy nhit la eae phan thCiy eua dinh va eae phi quan dudi phan thiiy khdng tiln hanh dupe. Tuy vay, tren thue t l so sanh vdi kit qua sinh thiet, choc hut bang kim eCrng cho luong benh phim cd thl thda man d l tim va xae djnh typ t l bao hon so vdi chpc hut bang kim mem.
v l phucng dien t l bao hpc, md hpc
Cung nhu nhan xet cua nhilu tac gia trudc day v l nghien eCru ung thu, ung thu bilu md dang bilu bi gap nhiluhonca[1],[2][3],[4].
Nhu tren chCing tdi da trinh bay; phin Idn BN din vien diu d giai doan khdng cdn mupn kha nang can thipp gi nira.^
Ve tai biln trong khi soi
Ho mau trong, sau khi soi la mpt vin de quan tam, trong nghien cii'u nay eua chung tdi co hai trudng hpp ho mau nang (1.40%) sau khi soi kit thuc gap d BN ed tdn thuong nang trong phi quan do ung thu sui loet d l chay mau.
Gay te tdt va cho thude giam ho, bpnh nhan hpp tae tdt trong khi soi gdp phin han ehi tai biln nang.
K£T LUAN
Qua 142 bpnh nhan nghien eCru tren, chung tdi ed
Y HOC THVC HANH (667) - SO 7/2009 63
nhan xet:
- Soi p h i quan ed ap dung eae ky thupt l i y bpnh p h i m c h i n doan t l bao hpe, md hpc cd y nghTa Idn trong vipc hd trp cho e h i n doan xae dinh bpnh.
- Sinh thilt p h i quan e h i n doan la xet nghipm e i n , dCi va la tieu c h u i n vang cho e h i n doan.
- Tuy nhien khdng phai luc nao sinh thiet cung cd t h l thuc hien dupe.
o l nang cao hieu s u i t e h i n doan trong nhirng trudng hop ma sinh thilt edn han c h i thi:
Chpc hut xuyen thanh khi p h i quan la mpt ky thupt hd trp vdi sinh thilt trong ehin doan xac djnh ung t h u p h i quan nguyen phat.
Soi p h i quan dng eCrng la mpt ky thupt khdng ddi hoi trang bj tdn kem nhung r i t hipu qua trong c h i n doan benh ly hd h i p ,
T A I LIEU THAM K H A O
1. N G U Y E N LIEN HOP, Chan doan ung thu phe quan bang phuong phap chpc do, Cong trinh nghien cuu khoa hoc y duoc, 1979, NXB Y hoc 1980; 78,
2, N G 6 TH! THU THOA, Chan doan te bao hpc trong ung thu phe quan phoi tai vien K. Cong trinh nghien cuu ung thu-Vien Ungthu 1987, 73.
4. HOANG H O N G T H A I V A C Q N G SU. Nh§n x6t
budc dau ve giS tri cua ky thuat chpc hut cya khi p h i quan bing kim nho trong chan doan ung thu phoi qua npi soi phe
quan ong curng tai khoa Ho hap benh vien Bach Mai, Ky yeu cong trinh nghien curu khoa hpc Dai hpc Y khoa H^ Npi, So 4/1995, trang,57.
5. CASTELLA J., BUJ J., PUOL C. Diagnosis and staging of brochogenic carcioma by transtracheal and transbronchial needle aspiration. Ann - Oncol, 1995; 6 supl 3; 21-4.
6. D E B O I R A H . S H U R E . Transbronchial biopsy and needle aspiratipn. Chest 95; May 1989.
7. EDUADO S C H I E P P A T T I , Mediastinal lymph node puncture through transtracheal carina. Surgery - gynecology-obs 8, 1958; 243-244,
8. GUPTA D,, GULATI M, Fluoroscopic transbronchial aspiratipn for diagnosis of peripheral pulmpnary nodule, Indian- J- Chest- Dis- allied - sci 1996; Jul- Sep; 38 (3); 163- 167.
9. HARROW E., WANG K.P, The staging of lung cancer by bronchoseopie transbronchial needle aspiration.
Chest-Surg-Clin-Ann 1996, May; 6(3) 223-235,
10. WANG KP, Transbronchial needle aspiratipn biopsy for histological specimens. Ann - Oto - Rhino - Laryngo 94.
1985; 382-385,
11. S C H I E S S L E R . W . La ponction transbronchique et transtracheale des adenopathies p6ri - trach6o - bronchiques. Communication, Seance du 1 F6vrier 1962;
551 - 569.
DANH GIA KET QUA P H A U THUAT DIEU TRI DINH MEP TROOfC DAY THANH QUA NOI SOI
H / O N G THj MINH HUONG Truing Dai hgc YHi Ngi
TOM T A T
Dinh mep triede day thanh (DT) la tinh trgng day thanh 2 ben bi dinh d mep truac eae miec do khac nhau lam cho chiec nang phat am va hd hip bj anh hudng.
Mue tieu: Nghien cuu dac diim lam sang eua dinh DT va danh gia kit qua phiu thuat cit tach dinh DT qua ndi soi. Doi tugng nghien cieu: Gom 32 bgnh nhan dinh mep trudc DT diiu tri tai Benh vien TMH trung uang tu nam 2005-2008. Phieang phip: md ta timg tnrdng hap cd can thigp. Kit qua: Trigu chung ea nang quan trgng nhat la khan tiing, mat tieng (100%,), khd thd TQ dg I (21,88%), do II (25%,). Dinh do 1 cao nhat 40,63%, dg 2:
12,5%, do 3: 21,88%, do 4: 25%. Kit qua phiu thuat:
Ndi soi cat- tach dinh cd sie dung mitomycin C tgi eho cho kit qua tdt: 53,13%,, kit qua trung binh 25%o, kit qua xiu: 21,87%,. Kit luan: Diiu tri dinh mep trudc DT rat khd khan, de phdng tranh cae nha TMH can rat thgn trgng khi can thigp tren DT.
Tie khda: Dinh mep tnede day thanh 2 ben, phiu thugt tach dinh day thanh, mitomycin C
SUMMARY:
Aesess treament results of laryngeal web by endoscopy
Laryngeal web is the status that two vocal cords were been adherent in anterior comissure. Both two functions speech and breathe were Involed. Objectives:
Studying clinical characterstics and treatment results of laryngeal web. Patients: 32 patients who were treated In National ENT hospital from 2005-2008. Method: clinical
analysis Results: The major symptom was hoamess (100%,) and laryngeal dyspnee gradel: 21.88%, grade 2:
25%,. Laryngeal endoscopic: type: 40.63%,, type 2:
12.5%,, type 3: 21.88%,, type 4:25%,. Treatment results:
good: 53.13%, moderate: 25%, and bad: 21.87%.
Conclusions: This technique which is dificult to manipulate and the Oto- rhino- laryngologlst are always be careful to do laryngeal microsurgery to prevent laryngeal web.
Keywords: laryngeal web, endoscopic lysis and topical mItomycin-C
DAT
VANBt
Dinh mep trudc day thanh (DT) la tinh trang bd tv do day thanh 2 ben bj dinh l i l n thanh mpt khdi. Khi bj dinh mep trii'de bpnh nhan bj khan t i l n g , phat am rat khd khan, n l u dinh tdi Vi giti'a day thanh se lam cho benh nhan khd thd TQ va ngu ngay r i t to.
Cd r i t n h i l u nguyen nhan gay dinh mep trudc DT 2 ben nhu viem nhiem, c h i n thuong va b i m sinh.
T u lau da cd n h i l u phuong phap p h l u thupt vdi myc tieu la dam bao eho benh nhan vua phat am tdt vira khdng bj khd thd. Tuy nhien, cho d i n nay phau thuat tach dinh DT van la 1 p h l u thuat chua dem lpi k i t qua nhu mong dgi vi kha nang dinh tai phat r i t cao.
Tir khi ed dng dan sang lanh, npi soi treo TQ diing optic 0 dp cd phdng dpi da duoc irng dung d l cat-tach dinh DT 2 ben, cham mitomycin C tpi vCing phau thu^t d l chdng tang sinh td chire hpt nham chdng tai dinh cho k i t qua kha quan. Nghien ciru dugc thuc hipn vdi myc tieu: , ,,,., „- „