N H A N X E T M O T S O D A C D I E M L A M S A N G
• • •
C U A U B I E U M O A C T I N H B E M A T N H A N C A U
^Nguyen Thu Thiiy*, Pham Thi Khanh Vaii**^
TOM TAT
Muc tieu: budc ddu nhan xet mdt so dac die/it lam sang va mo benh hoc cua u bieu md dc tinh be mat nhdn cdu.
Doi tirong vii phirong phap nghien ciiu: md td 1dm sdng khong cd nhdm ddi chirng 20 benh nhdn dime chdn doan u dc tinh bieu md be mat nhdn cdu tii nam 2008 den het thdng 6 nam 2009.
Ket qua: 12 (60%) benh nhdn la nam. Tuoi trung binh khoang 66 tudi (tir 19-91 tuoi). trong do 17 (85%) benh nhdn d dd tudi >40. Cd 9 (45%) tnrong hop la wig thu bieu md te bao vay xdm Idn, 4 (20%) trudng hop ung thir bieu md lai chd, 7 (35%) tnrong hop cd loan san te bdo vay d cdc mire dp 17 (85%) truong hop tdn thirong xudt hien d viing ria vd ket mac nhdn cdu. 18 (90%) ldn thuang dang not, nhu...
Ket luan: u bieu md dc tinh be mat nhdn can thudng gap d tudi trung nien vdcao tudi. Nam gap nhieu han nir. Tdn thumig thuong xudt hien a vimg ria ket giac mac vd cd dang cdc nhit, not.
Tit khoa: u bieu md dc tinh be mat nhdn cdu.
I. DAT VAN DE
U bieu mo ac ti'nh be mat nhan cau la benh hiSm gap, tdn thuong bao gom cac khoi u a bieu mo ket mac, bieu mo giac mac va bieu mo viing ria kit giac mac. Bieu hien ve mat lam sang da dang, mire do ac ti'nh ciia khoi u tiiy thuoc vao loai u biiu mo. trong do ac ti'nh nhat la ung thu bieu mo te bao tiet nhay. De chan doan xac dinh nguoi ta phai dira vao cac dau hieu lam sang va xet nghiem mo benh hoc. Chimg toi tien hanh nghien ciru nay vai muc tieu: birac dau nhan xet mot so dac diem lam sang va mo benli hoc cua u bieu mo ac tinh be mat nhan can.
*Bcnh vien Mdt Trung uang
**Bp mdn Mdt - Trudng Dai hoc Y Hd Ndi
II. DOI TUONG VA PHUONG PHAP NGHIEN CUU
1. Doi tiro'ng nghien ciiu
Gom 20 benh nhan duoc chan doan xac dinh u ac tinh bieu mo be mat nhan cau tai Benh vien Mat TW tir thang 01 nam 2008 den het thang 06 nam 2009.
2. Phuong phap nghien ciru
2.1. Thiet ke nghien ciru: nghien ciiu mo ta tien ciru khong co nhom doi chiing.
2.2. Quy trinh nghien ciru
- Hoi benh: qua khai thac benh nhan khi den kham benh, chiing toi ghi nhan:
NGHIEN CLfU KHOA HOC
+ Tuoi mac benh.
+ Gioi.
+ Tien sir lien quan den benh.
+ Thai gian phat hien ton thirong cho den khi den vien dieu tri.
+ Nhung dau hieu co' nang cua benh.
- Kham ton thirong thirc the bang sinh hien vi co chup anh: danh gia hinh dang man sac vi tn', kich thuac. pham vi ton thirong...
- Mo benh hoc: benh pham la nhirng manh to chiic u diroc lay khi phau thuat cat bo u. Benh pham diroc ngam trong dung dich Bouin. sau do diroc chuyen len khoa xet nghiem va lam xet nghiem giai phau benh.
III. KET QUA NGHIEN CUtJ VA BAN LUAN Nghien ciiu theo doi 20 benh nhiin duoc chan doan u ac tinh bieu mo be mat nhan can tir thang 01 nam 2008 den het thang 06 nam2009 da thu diroc cac ket qua sau:
1. Lam sang
/./. Dac diem benh nhan
- Gioi: nam chiem 60% (12 BN). nfr chiem 40%
(8 BN).
- Tuoi: plian bo benh nhan theo cac nhom tuoi nhu sau:
Nhom tuoi
<20 21 -40
41-60 I 4_
_ >60 13 Bang 1 clio thay: benh nhan (BN) > 40 tuoi
chiem ty le 85% va benh nhan >60 tuoi chiem 65%. Trong nghien ciiu nay benli nhan tre nhat la 19 tuoi, benh nhan gia nhat la 91 tuoi, trung binh la 66 tuoi. Tac gia Penelope (2002) va cong sir [6]
nghien ciru 26 truong hop ung thir bieu mo te bao vay dua ra ket luan: tuoi mac benh trung binh lii 69 tuoi va gap a nam (77%) nhieu hon nfr. ket qua nay phii hop vdi nghien ciru ciia chimg toi. Nhir vay. u bieu mo ac tinh thuang gap o benh nhiin trung nien va cao tuoi. ty le mac benli a nam hon nir.
Trong ca 20 benh nhan nay ton thirong chi xuit hien a mot mat. Trong do. MT: 9 truong hop.
MP: 1 truong hop. nhu vay khong co sir khac biet co y nghia thdng ke ve sir xuat hien ciia khoi u giira hai mat.
Trong 20 BN na\ cd 1 trudng hop la u tai
Ty le % 10 5 20 65
phat, 19 BN lii u nguyen phat. Thai gian tii' khi xuat hien trieu chirng dau tien den khi vao vien:
8 BN >1 nam. 6-12 thang la 4 BN. 3-6 thang la 2 BN. < 3 thang 4 BN. Con lai 2 BN khong xac dinh dugc thai gian do benh nhan khong co thiiy co dau hieu chii quan niio, BN duoc vo tinh pliiit hien benh khi di kham mat dinh ky. Nlur vay, lion mot nira so BN den vien muon sau khi co cac trieu cluing dau tien tir 6 thang tra len.
Qua khai thac hau het cac BN khong co tien sir dac biet lien quan den benh nlur mpt so nghien ciru ciia cac tac gia nuac ngoai [2. 3]. Trong 20 BN ciia cluing toi co 8 truong hop co tien sir hut thuoc la va deu la nam.
1.2. Diic diem him siing - Ddu hieu ca nang:
Biing I. Plain bo benli nhiin theo cdc nhdm tudi SO benh nhan (n)
I 9
Being 2. Ty le xuat hien ciia cdc trieu chimg cu niing
Trieu chiing cc nang Dau hieu n% Cong chung
Co Trieu chiing
Do mat dan thuan 6 (30%)
18 (90%) Co Trieu chiing Do mat kem com mat
12 (60%)
8 (40%) 18 (90%) Co Trieu chiing
Do mat, com mat, thi lire giam 12 (60%)
4 (20%)
18 (90%)
Khong co trieu chirng 2(10%)
Bang 2 cho thay co 1 8 BN (90%) den kham do co cac trieu chung tai mat. Trong do, do mat don thuan co 6 BN (30%), do mat kem theo vuong com mat 12 BN (60%) va trong 12 BN nay co 4 BN (20%) benli nhan den vi ngoai com do mat con do thj luc giam sut do khoi u to phat trien tir viing ria giac mac vao trung tam gay giam thj luc. Trong nghien ciiu ciia tac gia Murat Tunc va cong sir nam 1999, ty le gap trieu chirng
do mit la 68%, com mdt la 57% [5], 2 BN (10%) khong co bat ky trieu chirng nao nhung khi di kham mat dinh ky vo tinh phat hien benh. Day la nhung truong hop khoi u co kich thudc nho nen chua gay anh huong gi toi chirc nang thi giac ciia BN. Tien luong dieu tri doi vai nhung BN nay cung rat tot.
- Ddu hieu thuc the:
+ Vi tri ton thuong:
Bang 3. Vj tri xudt hien cua cdc khdi u
Vitri So benh nhan (n) Ty le %
Viing ria ket giac mac 13 65
Ket mac nhan can 4 20
Ket mac mi 1 5
Ciing do 1 5
Cue le 1 5
Bang 3 cho thay cac khdi u bieu mo ac tinh thuang xuat hien nhieu a viing ria ket giac mac (65%) va ket mac nhan cau (20%).
Diiu nay cung phu hop voi ket luan ciia Carol L. Shields va cong sir nam 2004 [3]. Ket mac viing ria va ket mac nhan cau la noi tiep xuc nhiiu vai anh sang va tia cue tim, do cung la
mot trong nhung yeu to lien quan den sir xuat hien ciia cac khoi u.
+ Kich thuoc ton thirong:
Nlur da neu tren cac khoi u chii yeu xuat hien
\ iing ria ket giac mac (65%), a nhirng trudng hop nay chiing toi tinh do rong ciia khoi u theo chu vi ria aiac mac.
Bang 4. Biing phdn bd ltd rpng eita khdi u theo chu vi viing ria giac mac Cac muc do <3 mui gid 3-6 mui gio* >6 mui giij
n 3 6 4
Ty le 23% 46% 31%
NGHIEN CLU KHOA HOC
Bang 4 cho thay do rong cua khoi u nho hon 3 miii gia co 3 BN (23%), con lai la ton thuong co kich thuac lan han 3 miii gia (77%), trong do co 4 BN (31 %) khoi u lon hon 6 mui gio lan ra qua mia viing ria giac mac. Nhu vay, phan lan cac BN khi den khoi u deu da co kich thudc ldn. Theo nghien ciru ciia mot sd tac gia nude ngoai thi ty le BN khi den kham khdi u cd do rdng nho hon 3 miii gid la 61%, tir 3-6 miii gid: 26%, tren 6 miii gid la 13%.
Nhu vay, benh dugc phat hien sdm nen tien lugng dieu tri tot han [1, 4, 5], 0 7 BN eon lai cd 5 BN khdi u cd kich thudc > 4mm. 2 BN khdi u u nhd cd kich thudc 2-3 mm.
+ Dac diem cua khdi u:
Tdn thuang ndi gd len gdm nhieu cac nhu, not nhd vdi cac quai mach phan nhanh vao tao cho khdi u cd man hdng rirc. Day la dang tdn thuong
gap nhieu nhat vdi 18 trudng hop chiem 90%. Hai trudng hgp cdn lai be mat tdn thuang phang be mat cd dang gelatin.
2. Dac diem mo benh hoc
Qua ket qua xet nghiem md benh hoc trong 20 BN cd 9 BN (45%) la ung thu bieu md ti bao vay xam lan, tdn thuong da xam lan qua ldp mang day pha huy mang day va xam nhap sau xudng cac Idp khac. Ung thu bieu md tai chd cd 4 trudng hop (20%) tdn thuong ac tinh chi dimg lai d ldp bieu md, mang day van cdn nguyen ven. 7 BN (35%) cd qua san va loan san nang (tien ac tinh) bieu md nhung BN nay cd kha nang ac tinh hda cao neu khdng dugc theo ddi sat va dieu tri kip thdi.
U bieu md ket mac IV. KET LUAN
Qua nghien ciiu budc dau 20 trudng hgp u bieu md ac tinh be mat nhan cau chiing tdi riit ra mdt sd ket luan sau: ung thu bieu md ac tinh be mat nhan can a Viet Nam la benh hiem gap, benh xuat hien a nam nhieu hon nfr. chu yeu gap o' nhdm tudi
trung nien va ngudi cao tudi, khdi u thudng xuat hien a viing ria va ket mac nhan cau, cac vi tri khac hiem gap hon. Tdn thuang thudng gap cd dang not nhii vdi cac quai mach phan nhanh vao. Loai ung thu bieu md hay gap nhiit la ung thu bieu mo te bao vay.
TAI LIEU THAM KHAO
1. CAROL L. SHIELDS, HAKAN DEM1RCL EKATERINA KARATZA. JERRY A, SHIELDS.
(2004) "Clinical survey of Melanocyte and nonmelanocytic Conjunctival Turmos", Ophthalmology.
Ul, 1747-1754.
2. CAROL L. SHIELDS MD AND JERRY A. SHIELDS MD (2004). -Tumors of the conjunctival and cornea", Survey of Ophthamology, 49 (I). 2-24.
3. CERVANTES G ET AL (2002). "Squamous cell carcinoma of the conjunctival: clinicopathological fea- tures in 287 cases", Can J ophthalmol, 37 (J), 14-19.
4. MURAT TUNC, DEVRON H CHAR. BROOKS CRAWFORD, THEODORE MILLER (1999). "Intra- epithelia and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases", Br J Ophthalmol.
S3, 98-103.
5. PANDA A.. M BAJAJ, HS SETHI . N PUSHKER. H KUMAR. VK DADA (2002). "Squamous cell carcinoma of the conjunctiva". Br J Ophthalmol. 86, 1462.
6. PENELOPE A MCKELVIE. MARK DAN1ELL. ALAN MCNAB. MICHAEL LOUGHNAN. JOHN D SANTAMARIA (2002). "Squamous cell carcinoma of the conjunctiva: a series of 26 cases". Br .1 Ophthalmol, 88, 168-173.
SUMMARY
THE CHARACTERS OF MALIGNANT LESIONS OF SURFACE EPITHELIUM
Objective: to comment the character and histopathology of malignant lesions of surface epithelium.
Method: descriptive, non comperative study. Subjects: 20 patients with malignant lesions of surface epithelium were determined pathological and clinical character.
Results: 12 (60%) was male and 8 (40%) was female. The mean age of the patient was 66 years (range 19 to 91) with 85% of patients at the age over of 40 years. Squamous cell carcinoma: 9 (45%). Car- cinoma in- situ: 4 (20%), conjunctival intralepithelial neoplasia (CIN) or dysplasia: 7 (35%). Most lesions occuring at the linibus and lesions were nodular.
Conclusion: malignant lesions of surface epithelium usually occur at middle-aged and elderly.
occurring at male more than female. Lesions usually occur at the limbus and lesions are nodular.
Key words: malignant lesions of surface epithelium.
