Y HOC VIET NAM THANG 5 - SO 2/2013 khac biet: Tran Thanh Phong: nhiem triing khdi
mau tu quanh than la 11,6%, chay mau keo dai 2,9%, Hoang Long: chay mau la: 6,9%, rd nu'dc tieu la: 6%, Umbreit EC ca ty le urinoma la 17%, tac gia dan luXi qua, dat JJ nieu quan thanh cdng 8 1 % , phai can thiep phau t h u k 19% [ 5 ] , [ 4 ] . V. KET LUAN
Chan thu'dng than kin gap ty le cao d nam gidi 72,3%, iCa tuoi 20-40 chiem 63,8%. Bieu hien lam sang chinh la dai mau va khdi mau tu vung hd than. Ty le dieu tri bao ton dat 65,9%.
Ty le can theo doi tai khoa ngoai cac tru'dng hdp CTT dp I I I , IV cao 78,6%. Bien chiTng sau md can thiep vao than khdng. Nhu'ng bien chiTng xa sau dieu tr; CTT bao ton can c6 thdi gian nghien cu'u them de riit ra chi dmh dieu tri cu the hdn.
TAI LIEU T H A M KHAO
1. Pham Van Bui ( 2 0 0 5 ) , "Vai tro cua chup cat Idp dien toan trong chan doan va dieu tn chan
thu'dng va vet thu'dng than", Y hoc Viet nam thang 8-2005; tap 313: tr 639-45.
Vu Nguyen Khai Ca, Hoang Long va cs (2000), "Chan thUOng than kin nhan 190 tru'dng hop tai Benh vien Viet DiTc"; Bao cd Hoi nghi Ngoai khoa toan quoc thang 12 -2000.
Nguyen Phu'dng Hong (2005), "Nhij'ng chi dmh phau thuat trong chan thu'dng than", Y hoc
Viet nam thing 8-2005; tap 313: tr 639-45 Hoang Long (2008), "Nghien ciTu chan doan va dieu tri phau thuat bao ton chan thu'dng than", Luan an Tien sy Y hoc; Tru'dng Dai hoc Y Ha noi Tran Thanh Phong (2010), "Ket qua dieu tn khong phau thuat chain thUOng than kin nang tai Benh vien Nhan dan 115" ;Tap chi Y hoc Viet nam thang 11/2010, tap 375: tr 404-11.
McAninch J.M (1997), "Renal exploration after trauma; indications and reconstructive technique ", In McAninch J.M (ed)Traumatic and reconstrudive urology, Saunders Philadelphia; pp: 105-23.
Glenski W.J (1995), "Nonsurgical management of major renal lacerations associated with urinary extrations"; J Urol; 1995:153.
VAI TRO CUA SIEU AM TRONG CHAN DOAN PHAN BIET U LANH TINH VA AC TiNH CUA TUYEN MANG TAI
T O M TAT
Dat van de va Muc tieu: Sieu am la phu'dng phap tien dung va khdng doc hai nen dUdc chi dinh pho bien, giup danh gia tot ve giai phau va benh ly cua tuyen nUdc bgt mang tai. Chiing toi ben hanh nghien ciTu de tai nham danh gia vai tro ciia sieu am trong chan doan phan biet u ianh ti'nh va ac tinh qua cac dac diem hinh anh ciia u tuyen mang tai, Doi tu'dng va Phu'dng phap: 30 benh nhan sieu am cd ton thu'dng khu tru trong tuyen mang tai va deu du'dc phau thuat cd ket qua giai phau benh, tir thang 10 den thang 12 nam 2012 tai benh vien Rang ham mat trung LTdng va vien Tai mui hpng trung u'dng. May sieu am Volusion 730 ProV ciia hang GE (My), cd dau do phang dai tan rpng tir 5-12MHZ, cd Doppier mau. Cac dac diem lanh tinh hay ac tinh cua khoi u tuyen mang tai di/a vao: hinh dang (thuy miii, tron-oyal hay khong xic djnh), ranh gidi (ro hay khong ro), kich thu'dc (<2cm, 2'4cm va >4cm), cau triic (dong nhat, khdng dong nhat, nang djch), tUdi mau (khong, it mach, giau
* Benh vien Viet-Diyc
Phan bien khoa hoc: PGS.TSKH. Nguyin Dinh T u i n
T r a n Cong H o a n * mach). Kit qua: 32 khoi/ 30 tuyen mang tai dUdc sieu am c6 28 ton thu'dng lanh ti'nh (87,5%) va 4 khoi ac tinh (12,5%). Nhij'ng dac diem sieu am hudng tcfi de phan biet khoi u tuyen mang tai lanh ti'nh hoac ac tinh ve ranh gidi, bd gidi han, kich thu'dc deu khac biet CD y nghla vdi p < 0,05, con dac diem ve cau triic va tu'di mau khong khac biet c6 y nghla vdi p < 0,05. Ket luan: Sieu am la mot phu'dng phap c6 gia tr; va hij\j ich trong chan doan benh tuyen nirdc bot mang tai. No khong chi cho phep xac nhan hoac loai trii' si/ hien dien ciia mot khd'i, ms con chi ra ban chat lanh hoac ac tinh cua khdi trong nhieu trUdng hdp.
Tit khoa: U tuyen mang tai, sieu am.
SUMMARY
ROLE OF ULTRASOUND FOR BENIGN OR MALIGNANT DIFEFRENTIAL DJAGNOSTIS OF
PAROTID GLAND.
Background and Purpose: Ultrasound (US) is handy and non-toxic method and should be more
Y HOC Vl|T NAM THANG 5 - s 6 2/2013 popular to help good reviews about the anatomy and
pathology of the parobd salivary glands. This study aims to assess the role of ultrasound in the differential diagnosis of benign and malignant tumors through the image characteristics of parotid gland tumors. Subjects and Methods: 30 patients with lesions localized in the parotid gland on US and are surgical pathology results, from Oct to Dec 2012 at the central hospital of ENT and the central hospital of Odontology. The researching tool: ultrasonography machine Volusion 730 ProV, linear probe frequency of 5-12MHz, Doppier, GE, America. The characteristics of benign and malignant parotid gland tumors based on: shape (lobulated, rounded-oval or unspecified), border (clear or unclear), size (<2cm, 2-4cm and> 4cm), structure (homogeneous, heterogeneous, cysbc), blood flow (non, hypo, hypervascular). Results: US founded 32 masses on 30 parotid gland had 28 benign lesions (87,5%) and 4 malignant tumors (12,5%). The US charatertstics to defferentiate beingn or malignant parotid tumor on the shape, border and size are significant v^rith p <0,05, but on the structure and blood flow did not significant with p >0,05.
Conclusion: US is a valuable and useful method in diagnostis parotid gland diseases. It not only dose it enable confirmation or exclusion of the presence of a mass, but in most cases the benign or malignant nature of the mass.
/fe^ivorrfs.'Parotid salivary gland, utrasound.
I. O A T V A N O I
U tuyen nu'dc bpt mang tai chiem > 7 5 % cac u tuyen nu'dc bpt, phan Idn la u lanh tinh, u ac tinh chiem khoang 3 0 % [ 3 ] , trong dd cung phai ndi den cac tdn thu'dng viem hoac hach trong tuyen gia u. Ve lam sang, u tuyen nu'dc bpt mang tai d giai doan sdm rat khd phat hien do trieu chimg ngheo nan. Tuy nhien cac dau hieu hinh anh lai rat rd rang tren cac phu'dng phap chan doan hinh anh (chup Xquang, sieu am, cat Idp vi tinh va cdng hu'dng tir).
Trong dd sieu am la phu'dng phap tien dung va khong doc hai nen du'dc chi djnh pho bien, giup phat hien td'n thu'dng va cd the thay the du'dc phu'dng phap CLVT hoac CUT trong phan tich hinh anh td'n thu'dng ciia u tuyen mang. Mot sd dac diem hinh anh tren sieu am ciia mot khoi u tuyen nu'dc bpt gdi y den ban chat lanh tinh hoac ac tinh ciia khdi u. Vi vay, chiing tdi tien hanh nghien ciru nay nham danh
gia vai trd ciia sieu am trong chan doan phan biet u lanh tinh va ac tinh qua cac dac diem hinh anh cua u tuyen nu'dc bpt mang tai.
II. o 6 ) TUQNG VA PHUdNG P H A P NGHIEN CCU Nghien cu'u gom 30 benh nhan c6 ton thu'dng khu trii trong tuyen mang tai thay du'dc tren sieu am va deu du'dc phau thuat c6 ket qua giai phau benh, tir thang 10 den thang 12 nam 2012 tai benh vien Rang ham mat trung u'dng va vien Tai mOi hong trung u'dng. Tat ca cac kham xet du'dc thirc hien tren may sieu am may sieu*' am Volusion 730 ProV ciia hang GE (My), c6 dau dd phang dai tan rpng tir 5-12MHZ, c6 Doppier mau. Toan bd tuyen va cac ton thu'dng can phai du'dc danh gia vdi it nhat la hai mat phang vuong gdc vdi nhau. Ca viing c6 cung nen du'dc quet de danh gia cac hach bach huyet va tim kiem cac benh kem theo hoac cd lien quan.
Danh gia sir lanh tinh hay ac tinh ciia khoi u viing tuyen mang tai duS vao cac dac diem ve hinh dang (thuy mui, trdn-oval hay khong xac dinh), ranh gidi (rd hay khdng ro), ki'ch thu'dc (nhd: < 2 a n , tmng binh 2-4cm va Idn >4cm), cau true (dong nhat, khdng dong nhat, nang djch), tang sinh mach tren Doppier (khong, it mach, giau mach).
III. KET QUA
30 benh nhan cd khoi u viing tuyen mang tai gom cd 11 nam va 19 nii', tuoi tiT 24 den 79 (trung binh 47 ± 15,6). Tud'i du'di 40 cd 13 tru'dng hdp (41,9 % ) deu lanh tinh, tuoi tren 40 cd 4/18 trirdng hdp la ac tinh.
Phan bo giai phau benh (GPB) ciia 30 tru'dng hdp ton thu'dng viing tuyen mang tai du'dc chi ra trong bang 1. Chii yeu la nhu'ng ton thu'dng lanh ti'nh chiem 8 7 , 1 % (27/31), trong do u tuyen da hinh la hay gap nhat (35,5%). Nhutig ton thu'dng ac tinh it gap cd 4 tru'dng hdp (12,9%), gom ung thu' bieu md tuyen, u lien ket sun, u lympho non Hodgkin va di can ung thu' bieu md vay; trong do u lien ket sun khdng phai la u ciia tuyen mang tai, ma la u sun cua xu'dng ham len ke can.
Bang 1. Phan bo cac loai u tuyen manq tai theo GPB Loai ton thi^tfng u
U tuyen da hinh (U hon hdp) U lympho tuyen nanq (U Warthin) Viem xO hoa man tinh tuyen nttdc bot
n 10 4 4
%
33,3 13,4 13,4Y HOC VlfT NAM THANG 5 • SO 2/2013 Nanq tuyen nude bot
Nanq bleu bi Hach viem man Viem, ap xe tuyen nUdc bot Carcinoma bieu mo tuyen Mo CO yan di can carcinoma yay Sarcoma sun
U lympho ac tinh Non - Hodqkin Tonq
3 2 2
30
10 6,7 6,7 3,3 3,3 3,3 3,3 3,3 100,0 Trong 30 tuyen mang tai cd u du'dc sieu am thi cd 2 tru'dng hdp cd 2 khdi, nhu' vay td'ng cdng cd 32 khdi du'dc phan tich theo GPB theo bang 2. Trong dd cd 4 khoi du'dc khang dinh la ac tinh (12,5%) deu la nhCTng u cd nhij'ng dac diem sau: ranh gdi khdng rd, hinh dang khdng xac dinh, kich thu'dc
>2cm, khong phai cau true dich va it hoac khdng tang sinh mach. Nhu'ng dac diem nay cung cd the gap trong 28 u lanh tinh (87,5%): ranh gidi khdng rd cd 8/12, bd khdng dinh hinh cd 5/9, kich thu'dc 2-4 cm 1/20 va >4cm cd 3/6; ca ba dac diem nay deu cd khac biet cd y nghTa vdi p < 0,05. Cau triic dong nhat cd 8/9 va khong dong nhat cd 18/21, tang smh mach it cd 6/9 va vd mach cd 18/19, ca hai dac diem nay deu khdng cd khac biet cd y nghTa vdi p < 0,05.
Bang 2. Lien qua n qiffa mot so dac diem SA vdi phan loai GPB cua u tuven manq taf
— _ _ _ _ _ _ _ _ ^ GPB sieu am ' ____
Ranh gidi
Hinh dang
Kich thu'dc
Cau true
Tang sinh mach Ro Khonq ro Thiiy mui Tron tioac oval Khonq xac dmh
< 2 cm 2 -4 cm
> 4cm Donq nhat Khonq ddnq nhat Cau true dich Khonq It mach Nhieu mach Tonq
Lanh tinli 20
8 6 17 5 6 19 3 8 18 2 18 6 4 28
Ac tinh 0 4 0 0 4 0 1 3 1 3 0 1 3 0 4
P
<0,05
< 0,05
< 0,05
>0,05
>0,05 32
'Sft^ijiV^ *^ •
Hinh 1. U tuyen mang tai tren SA: A:
U CO ranh gidi ro, hinh dang thiiy mui, cau true giam am khong dong nhat GPB: U tuyen lympho (U Warthin). B va C: U khong xac dmh
TrfM itJniai^ft ft!
Y HQC VlgT NAM THANG 5 - S6 2/2013 dudc hinh dang, ranh gidi khong ro. GPB: U
lympho ac tinh khong Hodgkin the nang (B) vd Ung thu bieu mo hiyen (C).
IV. BAN LUAN
Cac khdi u lanh tinh thu'dng gap nhat cua tuyen nu'dc bpt chii yeu la u tuyen da hinh (u hon hdp) va u V/arthin. Lam sang, bieu hien la khoi phat trien cham khdng dau. Tuy nhien, td'n thu'dng nhd cd the du'dc phat hien tinh cd bang SA. Cau triic am da dang (it am, rong am, khdng deu) va khd phan biet dddc cac khoi lanh tinh vdi nhau, tham chi giiTa cac khdi u lanh ti'nh va ac tinh [ 3 ] . '
Ngoai cac khdi u lanh tinh cdn cd cac ton thu'dng lanh tinh khac:
- Viem tuyen xd hoa tuyen niTdc bpt man tinh (u Kuttner) cd the gia mot td'n thu'dng ac tinh, ca ve lam sang va hinh anh. Thdng thu'dng tren SA thu'dng bieu hien la nhieu not giam am nhd nam rai rac tren mot nen am khong dong nhat, nhu'ng cung cd the la mot ton thu'dng khu trii giam am khdng dong nhat nam trong tuyen binh thu'dng [ 1 ] .
- U nang ddn thuan ft gap va cd the la bam sinh hoac mac phai. Nang bieu bi la nang bam sinh thanh c6 keratin ciia bieu mo vay va siT hien dien cua cac thanh phan cua da (nang long, tuyen md hoi, tuyen ba nhdn). Nang mac phai cd the do tac nghen ciia cac ong dan nu'dc bpt bdi u, sdi hoac viem. Lam sang thu'dng bieu hien nhu' mot khoi su'ng khdng dau nhu'ng cd the dau neu bi viem nhiem. SA khd phan biet hai loai nay cung nhu' ton thu'dng u dang nang khac. Hinh anh SA u nang c6 dien la hinh rong am, tang sang phia sau va khdng cd mach.
- Cac hach bach huyet trong tuyen bj viem cap hoac man tinh cd the tang kich thu'dc, tuy nhien, cau triic tren SA van ^yiciz bao ton (giam am d vd va tang am d rdn), cd the cd mach mau trung tam nhat la trong viem cap tinh.
- Viem tuyen nu'dc bpt cap tinh, cd the hinh
thanh ap xe. Yeu to anh hu'dng bao gom mat nude va bai tiet tac nghen ong dan do sdi hoac xd hda. Lam sang thu'dng bieu hien sutig dau vdi do da. Tren SA, ap xe la ton thu'dng giam am vdi tang cu'dng am phia sau va gidi han khong ro [7].
Cac u ac tinh chiem khoang 3 0 % cac ton thu'dng khu trii ciia tuyen mang tai [ 3 ] , thu'dng gap nhat la ung thu" bieu mo bieu bi nhay (mucoepidermoid) va nang tuyen (adenoid cystic) [ 5 ] . Ung thu" bieu mo te bao vay, ung thiT bieu mo te bao acinic, va ung thu' tuyen it pho bien hdn. Khdng giong nhu* cac khoi u tuyen nu'dc bpt lanh tinh, khoi u ac tinh cd the phat trien nhanh, sd nan chac khong di dong va c6 the dau, c6 the gay liet hoac te nu^ mat. Hinli anh SA dien hinh la: khoi c6 hinh dang khong deu, bd khong ro, kich thu'dc Idn, cau true khong dong nhat va it tang sinh mach. Tuy nhien, cac khoi u ac tinh cung cd the giong khdi u lanh b'nh nhu' la dong nhat va bd gidi han ro [ 4 ] ,
Ket qua ciia chiing tdi cho thay: u lanh tinh thu'dng gap vdi cau true am khdng dong nhat 18/28 (64,28%), cdn lai la cau true nang va gia u. Trong so 4 tru'dng hdp ac tinh c6 3 tru'dng hdp cau triic khong dong nhat. Theo Yonetsu, u lanti tinh cd cau true dong nhat 20,93%, khong dong nhat 2 7 , 9 1 % , u ac ti'nh cd cau true dong nhat la 25,58%, khong dong nhat la 25,58%. Khoi u lanh tinh tren sieu am eo ranh gidi ro chiem ty \h IQjlZ (71,43%), ca 4 tru'dng hdp u ac tinh deu cd ranh gidi khong ro vdi p < 0,05. Co sy" khac biet giiTa ranh gidi vdi tinh chat lanh tinh va ac tinh cua khdi u vdi dp chinh xac > 9 5 % . Ve hinh dang, khoi u lanh ti'nh thu'dng gap la hinh tron hoac ovan (17/28), 5 tru'dng hdp hinh dang thuy mill cung la nhu'ng khoi u lanh tfnh, cd 4 u ac tinh deu cd hinh dang khong xac dinh (4/4). Co sir khac biet g i i i ^ hinh dang khoi u vdi do chfnh
Y HOC VI$T NAM THANG 5 - 5 0 2/2013 xac > 95%. Ve phan bo mach tren sieu am,
trong so 28 u lanh tinh eo 18/28 u khong cd tang sinh mach, 6/28 u cd ft mach, 4/28 u cd nhieu mach, trong so u ac tinh cd 3/4 u cd it mach.
Oieu nay the hien u lanh tinh thu'dng khdng cd mach hoac cd ft mach trong u, tuy nhien theo mot so tac gia thi tang sinh mach khdng the phan biet du'dc dd la lanh tinh hay ac tinh ciia khoi u. Theo Schick [6] thi tang sinh mach kem theo van toe dinh tam thu cao (> 25cm/s) thi cd the nghi ngd sir ac tinh, mat khac Bradley cho rang nhuTig khoi u cd tang chi sd RI thi cd the tang nguy cd ac tinh [2], tuy nhien nghien ciTu ciia chung tdi khong the hien dieu nay do chiing toi chi cd 4 u ac tinh nen chiing tdi khdng du'a ra nhan xet cu the ve dac tfnh nay.
V. KET LUAN
Sieu am la mot phu'dng phap cd gia trj va hull fch trong chan doan benh tuyen nu'dc bpt mang tai. No khdng chi cho phep xac nhan hoac loai triT sir hien dien ciia mot khoi, ma cdn chi ra ban chat lanh hoac ac tfnh ciia khoi trong nhieu tru'dng hdp, vdi siT khac biet cd y nghTa thdng ke cua cac dac diem ranh gidi, bd gdi han va kfch thu'dc.
TAI LIEU THAM KHAO
1. Ah'uja AT, Richards PS, Wong KT, et al., (2003), "Kuttner tumour (chronic sclerosing sialadenitis) of the submandibular gland:
sonographic appearances". Ultrasound Med Biot, 29: 913-919
2. Bradley M3, Durham LH, Lancer JM. (2000),
"The role of colour flow Doppier in the investigation of the salivary gland tumour", Clin Radioi, 55: 759-762.
3. Ewa 2. Biaiek, WJeslaw Jakubowski, Piotr Zajkowski, et al, (2006), "US of the i^lajor Salivary Glands: Anatomy and Spatial Relationships, Pathologic Conditions, and Pitfalls", Radiographics, 26:3 745-763
-,. Hardee PS, Carter 3L, Piper KM, Ng SY.
(2001), "Metachronous bilateral primary adenocarcinoma of the submandibular glands", Oral Surg Oral Med Oral Pathol Oral Radiol Ended, 91:455^61
5, Paris 3, Coulet O, Facon F, Chrestian MA, et al. (2004), "Primary cancer of the parotid gland:
an anatomoclinical approach" [in French]. Rev Stomatol Chir Maxillofac 105: 309-315 6 Schick S, Steiner E, Gahleitner A, et al.
(1998), "Differentiation of benign and malignant tumors of the parotid gland: value of pulsed Doppier and color Doppier sonography", Eur Radiol, 8: 1462-1467.
7. Thiede O, Stoll W, Schmal F. (2000), "Clinical aspects of abscess development in parotitis" [in German]. HNO. 50: 332-338.
VE SINH THUC PHAM TRONG SEP AN TAP THE CAC KHU CONG NGHIEP TREN OIA BAN THANH PHO BAC NINH NAM 2011
Pham Minh Khue*, Tran Thi Kiem**
T 6 M TAT
Muc tieu: Md ta tinh trang ve sinh thUc pham, thUc hanh ve sinh an toan thUc pham (ATTP) cua ngu'di tham gia che bien thUc pham trong bep an tap the tai thanh pho Bac Ninh nam 2011. Doi tu'dng: 36 bep an tap the va 121 nhan vien che bien trong cac khu cong nghiep ciia thanh pho Bac Ninh. Phu'dng phap: Nghien ciTu mo ta cat ngang. Ket qua va ket luan: Co 13,9% bep an thUc hien dung cac quy dmh ve'sinh ATTP. Toan bo 100% bep an chua to chiTc xet nghiem phan va c6 87,6% nhan vien trUc tiep che bien khong kham SLTC khoe djnh ky. Viec sir dung dao, thdt, nu'dc sinh hoat dat beu chuan ve sinh dat 100%;^c6 tren 50% du dieu kien va theo nguyen tac mot chieu;
* Dai hoc Y Hai Phong, **Benh vien Bach Mai Phan bien khoa hoc: PGS.TS. Tr^n Hidu Hpc
phong an, ban an dam bao ve sinh (61,1%); cdng ranh hop ve smh (58,3%); thiing chu'a thiTc an thira khdng nap day (86,1%), thiing rac khong nap day de gan nOi che bien thiTc an chin (75%).
Tu' khoa: ve sinh thUc pham, bep an tap the, Bac Ninh.
SUMMARY
FOOD HYGIENE OF COLLECTIVE COOK HOUSE IN INDUSTRIAL ZONES - BACNINH CITY IN 2011
Food hygiene of collective cook houses m industrial zones -Bac Ninh city -2011. Objectives: to descnbe the situabon of food hygiene and to assess
