<-<- NGHIEN CUlU KHOA HOC
O A N H GIA HigU QUA DI^U TRj SfO L 6 | SAU TRUNG CA BANG AP NITO UKNH
Nguyen Sy Hoa*
T6M TAT
Muc tiiu: ddnh gid hiiu qud dieu tri seo loi sau trCfng cd bdng dp nito lanh.
Phiiang phdp nghien cClii: thd' nghiim Idm sdng tren 22 benh nhdn dieu tri tai Benh vien Da lieu Trung uang tit 01/12/2009 den 30/06/2010. Kit qud ddnh gid dUa vdo Idm sdng: sUxep hit thuang ton, mdu sdc, thdi gian dieu tri vd tdc dung phu cua phuang phdp dieu tri.
Ket qud: thdm my Id tieu chi ddu tiin md benh nhdn tdi khdm vd dieu tn chiem 59,1%. 54,5% thuang ton d viing ngUc vd trUdc xuang dc. Ti le xep thuang ton seo loi hodn todn sau 6 thdng dieu tri Id 72,7%.
77 li gidm cdc triiu chifng ca ndng nhu ngda, dau tai thuang ton Id 84,2% vd 94,3%. Binh nhdn thudng duac dieu tri tit 4-6 Idn. Tdc dung khdng mong muon id gidm hodc mdt sdc to sau dieu tri id 81,8%.
Ket ludn: dieu tn seo loi sau tning cd bdng dp nita lanh Id phuang phdp hiiu qud tuang doi cao.
Tfl khoa: seo Idi sau trflng ca, nito lanh.
I.DATVAND^
Seo Idi nguyen nhan do trflng ca la mpt benh ly thudng gap. Benh thudng gap 6 nhflng ngUdi tr& tudi, cd tien sfl trflng ca nang, dieu trj khong triet de hoac khong dieu trj.Thuong tdn thudng gap 6 vung da cang nhu hai ben ham, vung ngUc, vung ba vai... d i n den mat tha'm my va gay cac trieu chflng co nang nhu ngfla, dau...
tai thuong tdn. Hinh dang cua seo rat khac nhau, tfl cd chan, su si nhieu miii cho den mem mai vdi be mat nhan, ranh gidi deu dan, bd seo chdm ra khdi ranh gidi vdi da lanh. Cd the nho cao khdi be mat da lanh tfl vai mm den 2-3cm.
* Benh vien Da liiu Trung uang
Mat dp see cd the cflng va dan hdi; thudng gay ngfla va dau tai cho; sec cd the gay co keo va han che van dpng cua vung co the bj benh. Mau dd, tim hay ciing mau vdi mau da. See co the lien tuc phat trien, tang kich thUdc trong mot thdi gian dai, khong co bieu hien sU thoai lui va rat de tai phat sau dieu trj.
Dieu trj seo Idi khong chi nham dUa see benh ly ve trang thai blnh thudng, han che tai phat seo, phong tranh nhflng bien chflng do benh gay nen ma con giai quyet yeu cau ve tham my.
Cd nhieu phuong phap dieu tri seo Idi nhU: phau thuat cat bd, laser, ap lanh, xa tri, phu gel silicon, tiem 5FU, corticosteroids vao npi thuong tdn...
hoac phdi hpp cac bien phap tren theo nhieu
So 04 (Thang 06/2011) DA LlEU HOC
NGHIEN CUU KHOA HOC
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each, tuy nhien m o i p h u o n g phap cd nhflng Uu nhupc diem rieng va ket q u i cung khac nhau tuy t f l n g nghien cflu.
Tai khoa Laser Phau thuat, Benh vien Da lieu Trung UOng, sd benh nhan den dieu trj seo Idi ngay cang tang. Phuong phap dieu trj t h u d n g dupe chi djnh la t i e m corticoids npi thUOng t d n , tuy nhien p h u o n g phap nay can than t r p n g khi chi djnh cho benh nhan bj seo Idi do nguyen nhan trflng ca, vl cd the lam nang hon t i n h trang trflng ca cua benh nhan. Do do, chiing t o i tien hanh nghien cflu nham khao sat m p t sd yeu t d lam sang lien quan va danh gia hieu qua dieu trj seo Idi sau trflng ca bang ap nito lanh.
2. D6\ l a O N G VA PHUONG PHAP N G H I £ N C Q U 2 . 1 . D o ! tUtfng nghien cflu
Benh nhan dUpc cha'n doan mac seo Idi, tien sfl benh do nguyen nhan trflng ca. T h u o n g t d n CO ban la khdi seo phat trien cao va c h d m ra ngoai ranh gidi t d chflc da lanh x u n g quanh.
Phat trien lien tuc, k h o n g cd khuynh h u d n g t u thoai lui t h e o t h d i gian. Khdi seo cd mau sac t f l mau h d n g den mau nau hoac do. Mat dp seo cflng - chac, an dau. Trieu chflng co nang ngfla va dau tai cho. Thdi gian bj benh ft nhat la 9 thang.
2.2. PhUOng phap nghien cflu
* Thiet ke nghiin cdu: tien cflu, t h f l nghiem lam sang.
* Cdc budc tien hdnh:_
-Tfnh cd mau: c6 m i u thuan tien.
- Phuong phap dieu trj:
Benh nhan dUpc dieu trj 4-6 tuan m p t lan.
Dieu tri t f l 2-6 lan. Moi d o t dieu trj sfl d u n g dau ap nito lanh ap true tiep len t h u o n g t d n , m o i lan
d d n g va tan bang t r o n g t h d i gian la 30 giay, 2-3 lan ap cho m p t d p t dieu trj.
- Danh gia ket qua:
-I- Khdi benh khi thUOng t d n thoai trien bang phang vdi mat da, het ngfla, het dau tai thuong t d n . Thdi gian het thUong t d n , cac trieu chflng CO nang, tac d u n g p h u cua t h u d c dUpc danh gia t h e o mau cd s i n .
-h Danh gia ket qua t h e o mflc dp hai long cua benh nhan sau qua t r i n h dieu trj: Tdt, Kha, Kem.
* Cdc so lieu thu thdp: dUpc x f l If theo thuat toan t h d n g ke sfl d u n g phan m e m SPSS 15.0.
3. K^T QUA N G H I £ N C Q U
3 . 1 . Khao sat tinh hinh, dac diem lam sang
3.1.1. Tile theo gidi
I Nam
INL?
Bieu do 1. Ddnh gid ti le mdc givfa nam vd nit Nhcinxet:T\ le seo Idi do trflng ca 6 nam cao hon so vdi d nfl.
3.1.2. Lido den kham
Bang 1. Lido benh nhdn tdi kham va dieu tri
Tham m i Ngfla Dau Tdng
n 13
7 2 22
% 59,1 31,8 9,1 100 Nhdn xet: Hau het benh nhan den dieu trj vl anh h u d n g t h a m my (59,1%) va ngfla (31,8%).
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3.1.3. Yeu to gia dinh
• Cd
•Khong
Bieu do 2.77 le co tien sif gia dinh mdc seo loi Nhdn xit: C6 18,2% benh nhan cd tien sfl gia dinh cd seo Idi.
3.1.4. Solitang, kich thUcfc sea
Bdng 2. SolUaing va tong dien tich seo loi Sd
lUtfng see
<3 3-5
>5 Tdng
Dien ti
<Scm^
3 3 4 11
chseo SiScm^
1 4 7 11
Tong n 4 7 11 22
% 18,2 31,8 50 100 Nhdn xit: Sd lUpng tdn thiTOng seo Idi do trflng ca thi/dng gap la tren 5 tdn thuong (50%).
3.1.5. Phan bovi tri seo
Bing 3. Vi trlthUotng ton seo loi
Vj tri sec Trirdc xuong flc, nguc Bd vai
Vung CO delta Ham dudi Tdng
n = n 12
6 2 2 22
22
% 54,5 27,3 9,1 9,1 100 Nhdn xit: Vj trf ngUc va trUdc xUong flc la nhflng vung cd ti le seo cao nhat 54,5%.
3.1.6. Triiu chCfng cd nang
BAng 4. Triiu chiimg ccf nang tai thUcfng ton
Trieu chufng Ngfla Dau
Co n 19 13
% 86,4 59,1
Khong n 3 9
% 13,6 40,9
Nhdn xit: Trieu chflng ngfla va dau tai tdn thuong chiem ti le kha cao (86,4% va 59,1%).
3.1.7. Anh hifdng tdi cupc song
Bing 5. Ti li anh hUdng cua seo loi tdi chdt litctng cupc song
Anh hudng tori chat lUorng cuoc sdng Khong anh hudng
Anh hudng
n=22 n 17
5
% 77,3 22,7 Nhdn xit: Seo Idi trflng ca gay anh hUdng kha nhieu tdi cupc sdng ngUdi benh (77,3%).
3.2. Danh gia ve hieu quS dieu trj Bdng 6. Hiiu qui dieu trf
Khoi Khong khdi Tdng
n 16
6 22
% 72,7 27,3 100 Nhdn xit: Co 72,7% benh nhan xep hoan toan sau dieu trj.
3.2.1.11 li h& cdc triiu chiifng ccf nang
BAng 7. Cac triiu chvfng ccf nang sau dieu tri Trieu chflng ctf nang
sau dieu tri Het ngfla
Het dau
n 16/19 12/13
% 84,2 92,3 Nhdn xit: Sau dieu trj, trieu chflng ngfla va dau gidm ro ret (84,2% va 92,3%).
3.2.2. Danh gia ket quA dieu tri di/a theo miifc dp hai long
BAng 8. Ddnh gia ket quA dieu trj theo miifc dp hai long cua binh nhan
Diem danh gia see sau dieu trj Tdt
Kha Kem
n = 22 n
14 5 3
% 63,6 22,7 13,7 Nhdn xit: Ket quei tdt va kha chiem tl le cao (63,6% va 22,7%).
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3.2.3.77 li khoi binh va solan dieu trj BAng 9. Liin quan givfa solan dieu tri
va tiii khoi
So lan dieu trj 2 lan
3 lan 4 lan 5 lan 6 lan Tdng
Khoi n
1 2 4 3 6 16
% 6,3 12,6
25 18,6 37,5 100 Nhdn xit: Cac benh nhan dieu trj tfl 4-6 lan cd tl le khdi chiem ti le cao 81,1% (13/16 benh nhan).
3.2.4. Tac dung khong mong muon
BAng 10. Tdc dung khong mong muon sau dieu tri
Tac dung khong mong mudn Mat, giam sac td Teo da
Tdng
n=22 n
18 1 19
% 81,8
4,5 86,3 Nhdn xit: Tac dung khong mong mudn thudng gap la mat va giam sac td sau dieu trj la 81,8%.
4. BAN L U A N
Trflng ca thuOng gap nhat 6 lfla tudi day thi, cd the gay seo xau, dac biet d nhflng ngUdi cd CO dja seo Idi. Seo Idi sau trflng ca gap nhieu hon d nam gidi, chiem ti le khoang 52%, tuy nhien vl sd lUpng benh nhan cdn ft, nen chUa cd nhieu nhan xet ve ti le nay. Trong ket qua cua chiing toi cho thay 18,2% benh nhan tien sfl gia dinh cd ngUdi bj seo ldi. Ket qua nay tUOng duong ket qua nghien cflu cua Do Thien Dan la 16,4%, Dinh Hflu Nghi la 18,5% [1], [3]. Mpt sd nghien cflu cho thay mdi lien quan gifla cac gen HLA-B14, HLA-B21, HLA-BW16, HLA-BW35, HLA-DR5, HLA-DQW3 vdi sU phat trien cua seo
Idi. ThUc te cho thay yeu td gia dinh cd vai tro quan trpng trong sUxuat hien cua seo Idi.
Vj trf cua seo Idi sau trflng ca gap nhieu nhat la d ngUc va trUdc xUOng flc, chiem ti le 54,5%.
Sau do la tdi vung ba vai chiem 27,3%. Gill thfch dieu nay day la nhflng vung da cang, nguy co seo Idi cao. Day cung la vung tiet ba nhieu, benh nhan thudng cd cac tdn thUOng mun trflng ca, tfl do de gay nen seo Idi. Ket quii nay cCia chiing tdi tuong tU vdi cua Dinh Hflu Nghj la 56,3% [3].
Lf do benh nhan den kham va dieu trj seo Idi sau trflng ca vl tham my chiem ti le cao 13/22 benh nhan (59,1%), sau do If do ngfla 7/22 benh nhan (31,8%) va dau 2/22 benh nhan (9,1%).
Theo Dinh Hflu Nghj, benh nhan den kham vl ngfla chiem ti le cao nhat (46,2%), cdn trong nghien cflu cua chiing toi If do tham my cao nhat (59,1%). Giai thfch dieu nay benh nhan mac trflng ca seo Idi tudi kha tre, tam If thudng chii y den tham my nhieu hon [3]. Cd tdi 17/22 benh nhan (77,3%) ceim thay seo Idi sau trflng ca anh hudng tdi cupc sdng cua hp. Do do, dat ra van de can tim mpt phuong phap dieu trj thfch hpp la thuc sU can thiet.
Nhan xet ve ket qua dieu trj seo Idi sau trflng ca bang ap nito lanh, cd 16/22 benh nhan (72,7%) xep hoan toan thuong tdn sau 2-6 lan dieu trj. Ket qua nay tuong t u vdi ket qua dieu trj cua Dinh Hflu Nghi tiem triamcinolone noi seo cd 78,8% benh nhan cd seo bang phang vdi mat da lanh sau dieu trj va ket qua cua Rusciani L la 79,5% benh nhan dap flng tdt sau dieu tri seo Idi bang ap lanh [3], [6]. Day la mpt ket quH khd quan cho viec dieu trj seo Idi bang ap nito lanh, dii thdi gian nghien cflu chUa dai, viec danh gia sU phat trien trd lai cua seo Idi cdn han che.
Nhu vay, nito lanh d nhiet dp thap (-40°C den -
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196°C), CO khd nang tao nen bdng lanh gay pha huy td chflc xo va sol collagen, ddng thdi flc che sUtang sinh trd laL Nghien cflu cho thay thudng sau 4-6 lan dieu trj (81,1% sd benh nhan) thi hieu qud dieu trj la cao nhat.
Cd 16/19 (84,2%) benh nhan het ngfla va 12/13 (92,3%) benh nhan het dau tai tdn thuong sau dieu trj cho thay tac dung cua dp nito khi dieu trj seo Idi sau trflng ca. Mpt trong nhflng nguyen nhan gay ngfla va dau la do nhflng roi loan bat thudng tai cac dau mut than kinh bj chen ep trong thuong tdn seo. Giai thfch dieu nay khi dp nito lanh, cdc dau mut than kinh bj dong bang, mat khd nang dan truyen va ddng thdi bj phd huy dan do nhiet dp thap, dan den het cdc trieu chflng co nang tren.
Tdc dung phu Idn nhat cua dp nito dieu trj see Idi sau trflng cd la gay nen hien tUpng mat va gidm sac td da. Cd 18/22 benh nhan (81,8%) bi tdc dung phu nay sau khi ket thiic dieu tri. Nhiet dp thap gay pha huy td chflc xO va collagen nhung cung gay phd huy hoan toan cdc te bao sac td da, dan den tinh trang mat va gidm sac td sau dieu trj. Do do, can tU van trUdc cho benh nhan dieu nay trUdc khi thUc hien dieu trj.
Cd 14/22 benh nhan (63,6%) ddnh gid ket qud tdt va 5/22 benh nhan (22,7%) ddnh gid khd
TAILI|UTHAMKHAO
1. Dd Thien Dan, Do Duy Tinh, Nguyen The Hung, Pham Hiifu Nghj (1999), "Nhdn xit budc ddu ve hiiu qud cua phuang phdp phdu thudt laser CO^ ket hap tiem triamcinolone acetonide trong vd sau phdu thudt de dieu tri seo loi, seo qud phdt", Tap chf Y hpc thUc hanh, sd 8 (370), tr. 45-48.
2. Nguyen Huy Phan (1994), "Seo phi dai vd
cho thay qud kha tdt cua phuong phdp nay. Ket qud nay cung tUong t u vdi ket qud nghien cflu cua Zouboulis CC co 61,3% ddp flng rat tdt va tdt khi nghien cflu dieu trj seo Idi va seo qua phdt bang dp nito lanh [9].
5. K^T L U A N
Danh gid hieu qua dieu trj seo loi sau trflng cd bang dp nito lanh cho 22 benh nhan tai Benh vien Da lieu Trung Uong, chung toi riit ra mpt so ket luan nhUsau:
Tham my la If do Idn nhat ma benh nhan tdi khdm va dieu trj, co 13/22 benh nhan chiem 59,1%.
- Vj tri gap nhieu nhat la vung ngUc va trUdc xUOng flc chiem 54,5%.
Da sd benh nhan co cdc trieu chflng co nang ngfla va dau (86,4% va 59,1%).
Co 16/22 benh nhan xep hoan toan tdn thuong seo loi sau dieu trj dp nito tfl 4-6 lan.
-Tl le benh nhan het ngfla va dau sau dieu trj la 84,2% va 92,3%.
Tdc dung phu thuOng gap la mat va gidm sac td da sau dieu trj, tuy nhien can gidi thich dieu nay trUdc cho benh nhan.
Co 86,3% benh nhan danh gid tdt va khd phuong phdp dieu trj nay.
seo loi". Bdch khoa thU benh hpc tap 2, Ha Npi 1994, tr. 358-362.
3. Dinh HCifu Nghj (2010), "Ddnh gid hiiu qud dieu tri seo loi bdng tiem Triamcinolone acetonid trong ton thuang" Luan van tdt nghiep Bdc si npi trij, chuyen nganh Da lieu, Dai hpc Y Ha Npi.
4.VinodKSharma,SujayKhandpur(2009),
"Guidelines for cryotherapy", Indian Journal of
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NGHIEN CUU KHOA HOC
"^ »i^
Dermatology, Venereology and Leprology, Year 2009, Volume 75, Issue 8, p: 90-100.
5. MarkD. Andrews, M.D (2004),"Cryosurgery for Common Skin Conditions", American family physician. May 15,2004/ volume 69, number 10, pp: 2366-2372.
6. Rusciani L, Paradisi A, Alfano C, Chiumariello S, Rusciani A (2006), "Cryotherapy in the treatment of keloids", J Drugs Dermatol, Year 2006 Jul-Aug; 5 (7) pp: 591-5.
7. Sharad Mutalik (2005),"/?£WfM//»/?r/C/.f;
Treatment of keloids and hypertrophic scars", Indian Journal of Dermatology, Venereology
and Leprology, Year 2005, Volume 71, Issue 1, pp: 3-8.
8. SS Savant (2000), "DERMATO SURGERY:
Facial dermabrasion in acne scars and genodermatoses-A study of 65 patients", Indian Journal of Dermatology, Venereology, and Leprology, Year 2000, Volume 66, Issue 2, pp:
79-84.
9. Zouboulis CC, Blume U, Buttner P, Orfanos CE (1993), "Outcomes of cryosurgery in keloids and hypertrophic scars. A prospective consecutive trial of case series". Arch Dermatol, Year 1993 Sep; 129 (9), pp: 1146-51.
SUMMARY
EFFICACY OF CRYOSURGERY IN THE TREATMENT OF ACNE KELOIDS Objective: to evaluate the efficacy of treatment of acne keloids by cryosurgery.
Methods: clinical trials on 22 patients in National hospital of Dermatology and Vereonogy from 12/01/2009 to 30/06/2010. Assessment ofthe results based on the falling of injury, colors, duration of treatment and side effects of treatments.
Results: beauty is the biggest reason for the patient to medical treatment accounted for 59.1 %. 54.5%
lesions in the chest and sternum first Injury rate falling keloids completely after 6 months of treatment was 72.7%. Percentage of energy reduce the symptoms of itching, pain at injury is 84.2% and 94.3%. Patients are often treated from 4-6 times. Unwanted effects are hyperpigmentation after treatment was 81.8%.
Conclusions: treatment of acne keloids by using cryosurgery is a measure of efficiency is relatively high.
Keywords: Cryosurgery, Acne keloids.
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