Kfch thudc dogn xuang mdc cd t h i huy ddng phil hgp vdi tgo hinh khuylt dogn xuang hdm dudi.
TAI
LieU THAM
KHAO1. Le HCPU Hung (1995). Ode d i l m hinh thdi - nhan chung sp ngudi Vipt hidn dgi. Ludn dn tien sT Y hpc, Dgi hpc Y Hd Ndi.
2. N g u y i n Vipt T i l n (1995). Nghidn CLPU ipng dgng ky thudt ghdp xuang mdc cd ndi mgch nudi trong dieu trj m i t dogn xuang ddi. Ludn dn tiln sT Y hpc, Hpc vidn qudn Y.
3. Carr A.J, Macdonald D A, Waterhouse N (1988). The blood supply of the osteocutaneous free fibular graft. The Journal of Bone and Joint Surgery, 70B(2): 3 1 9 - 3 2 1 .
4. Choi W.S., et al (2001). Topographical anatomy of the fibula and peroneal artery in Koreans. Int. J. Oral Maxiltafac. Surg, 30: 329-332.
5. Schusterman M.A. and Reece G.P (1992).
The osteocutaneous free fibular flap: Is the skin paddle reliable?. Plastic and Reconstructive Surgery, 90: 787-793.
6. Strauch B., Yu H.L. (1993). Atlas of microvascular surgery. Thieme Medical Publishers, New York.
7. Wei F.C, Seah C S and Tsai Y.C. (1994).
Fibula osteoseptocutaneous flap for reeonstmction of composite mandibular defects. Plastic and Reconstructive Surgery; 93(2): 294 - 304.
8. Wei F.C, Mardlni S (2003). Optimizing Results in Mandible Reconstruction Using Osteointegrated Dental Implants. Seminars in plastic surgery; 17(4): 383 -386.
9. Wolff K.D, Holzle F (2005). Fibular Flap.
Raising of Microvascular Flaps Springer - Verlag Beriin Heidelberg New York.
Summary
ANATOMIC STUDY OF FIBULA FREE FLAP AND APPLICATIONS IN MANDIBULAR DEFECT RECONSTRUCTIONS
Thirty dissected specimens of fibular vessels in Vietnamese cadavers show that the artery origins from the tibioperoneal trunk in all specimens and is accompaanied by two veins. The length of vascular pedicle of the fibula flap ranged between 3.1 and 6.7cm, with an average off 4.5cm. The mean external dimensions of the artery, the large vein and the amalle vein are 2.4mm. 2.5mm and 1.9mm respectively. The number of perforator from the artery ranges from 1 to 8, with an averge of 4.97. The Ratios of the two types of perforator (museulocutaneous) are 42.3% and 57.7%, respectively. These distribute mostly in the segments 6/10 (83%) and 4/10 (80%). The average dimensions of fibular are 34.1cm in length, 1.2cm in thickness and 1.5cm in width.
Keywords: Fibula, peroneal artery
KY THUAT CHI^U LASER ND: YAG QUANG DONG B^ MAT TlfNG OI^M K^T HOP VOI
L A M X E PMACH
G I A N O ^ D I ^ UTRj Dj DANG TINH MACH
NONG TRONG KHOANG MIENG.
Phgm Huu Nghj B0nh vi0n Trung uxyng Quin dgi 108 Diiu tri cdc dj dang tinh mach ndng trong khoang midng bing laser Id phwang phdp hidn dang dwcrc xem Id hidu qud vd an todn. Laser Nd.YAG cd khd ndng gdy quang ddng vd xuydn sdu Idn nhit ndn thwdng dwgc dung di diiu tri cdc dj dang tinh mach ndng trong khoang midng. nhit Id khi cd kich thwdc Idn. Kl thudt chiiu tmc tiip laserNd.VAG Idn bi mdt nidm mac cCia tdn thwang di quang ddng tCmg diim c6 n/jupc diim Id di lam thung mach mdu hodc phai diiu trj kdo ddi, nhit Id khi gdp cdc hd, hang tinh mach Idn. Kl thuat chiiu laser Nd: YAG quang ddng twng diim kit hgfp vdi ldm xep mach gidn Id mdt kl thudt mdi trong diiu tn di dang tmh mach ndng trong khoang midng. KT thudt ndy dux?c thtjec hidn di ddng. cd hidu qud cao vdi 100% kit qua tot tren 34 bdnh nhdn vd da td ra cd wu thi han vl ddng dlnh thdnh mgch di ddng vd It gdy thiing thdnh mach.
Tip khda: laser Nd:YAG; dj dgng tTnh mgch
TCNCYH Phi^ trwang 77(6) - 2011
I. OAT
V A N01^
Hipn nay dieu trj cae dj dgng tTnh mgch trong khoang mieng chu y l u bang cae phuang phap tiem xa (sclerotherapy), phiu thudt va laser, trong dd dieu trj bang laser da trd thdnh 1 phuang phap dugc nhieu ngudi bilt din tren the gidi vi tinh hipu qua va an toan [1, 8, 9, 10, 11]. Cac logi laser thudng dugc diing la: laser CO^, laser Nd:YAG phat lien tgc (continuous wave), laser Argon, laser KTP, cdc logi laser mdu, laser ban dan, laser Nd:YAG xung dai (long pulse), laser Alexandrite xung ddi [1, 2, 4, 5, 7]. o l dieu tri cdc dj dgng tTnh mgch Idn ngudi ta hay diing laser Nd:YAG, laser CO^
vd laser ban din cdn cdc laser khde chf dieu trj dugc tdn thuang d mu-c mao mgch va tTnh mgch nhd khoang 1-2 mm dudng kinh [1. 5].
Laser COj vd laser ban din dimg 6k cat bd thay dao md vd bay hai tdn thuang ndn cd hgn c h l cua phuang phdp phiu thudt [7]. Laser Nd:YAG cd kha nang gay quang ddng va xuyen sdu Idn nhit ndn thudng dugc diing d l dieu tri eae dj dgng tTnh mgch ndng trong khoang mieng [2].
Cae kTthudt dieu tri bang laser Nd:YAG gdm: (1) Ludn laser vdo trong tdn thuang, chilu quang ddng: ludn day dan laser vdo trong kim chpc qua da, niem mge den tdn thuang 6k quang ddng (Intralesional Nd:YAG laser photocoagulation) [2,4]; (2) Chilu true tiep quang ddng tirng diem ldn b l mat niem mge ciia tdn thuang vdi cdc mipc: cd t h i chilu quang ddng din mu-c trang [2, 5] hay chilu chf din mire d l co nhd, tdi Igi [6]. Mgch gian dugc dieu trj do laser gay tdn thuang tm-c tilp d thanh mgch va do gidn tiep tip khdi mdu hip thu nang lugng laser ndn cd nhiet dp cao. Nhugc dilm cua cdc kT thugt nay Id de lam thung mgch mau hoge phai dilu trj keo ddi, nhit la khi gap cae hd, hang tTnh mgch Idn. o l khae phgc nhugc dilm tren, chung tdi xin trinh bay kT thugt sau md chung tdi tgm gpi Id: "KT thudt chilu laser Nd:YAG quang ddng b l , mat tipng diem kit hgp vdi Idm xpp mgch mdu "6k dieu trj dj dgng tTnh mgch ndng trong khoang mieng.
II. 0 6 l TLKONG VA PHU'ONG
P H A P 1. Quy trinh kTthudtSau khi vd cam, khdi tTnh mgch gidn 6uf(}/c lam xpp hit mau, hidn lam bing cdch de dp bang tay eho din khi xpp hodn todn. Tilp theo chieu laser Nd:YAG quang ddng tipng dilm vao nai tTnh mgch da xpp hodn todn. Cdc thdng sd laser: chl dp lien tgc, cdng xult 20 - 25 W, thdi gian xung: 0,5 1 gidy. Spot size: 2 3 mm.
Chu y khdng dugc lam thiing tTnh mgch. Chilu den ddu liii tay dd dp din dd vd Idm nhu vdy cho din khi hit tdn thuang. Tdt nhat la chieu laser theo hudng luu thdng cua ddng mau v l tTnh mgch canh trong: bit diu tip viing ngogi vi rdi din viing trung tdm. Sau khi chilu laser, khdi tTnh mgch gian, khdng gidn phdng trd Igi la dgt yeu clu.
2. Chi djnh va chdng chi djnh
Chl djnh: Cae dj dgng tTnh mgch ndng d trong khoang mipng d vj tri cd t h i lam xpp dugc (hipn de dp trge tilp dugc bang tay).
Chdng chf djnh: Cac dj dgng tTnh mgch dang bj tie, vidm, loet.
Chdng chf djnh tgm thdi: Cdc dj dgng tTnh mach ndng d vj tri khdng t h i de dp trge tilp 6ufac bing tay.
Ill - K^T QUA
1. Tong sd bpnh nhan: 34.
- Gidi tinh: nam: 10 (29,4%); nu-: 24 (70,6) - Tudi: tip 2 din 72 tudi. trung binh: 32,8
2. Dge dilm lam sang
* Vj tri cua tdn thuang: tdn thuang ed t h i ggp d nhieu vi tri giai phiu khde nhau trong khoang midng (bang 1)
+ Bdng 1 cho thiy tdn thuang cd nhilu Id d niem mge ma, mdi vd ludi.
+ sd bpnh nhdn ed tdn thuang chilm tip 2 vj trf trd len Id 6 cas (17,6%).
* Tdn thuang chuc nang: cd 6 bpnh nhdn (17,6%) ndi ngpng, trong dd 5 ca cd tdn thuang d ludi, 1 ea ed tdn thuang d vdm mipng. khdng cd bdnh nhdn ndo bj nudt khd vd nhai khd, tuy nhien cd 8 bpnh nhdn (23,5%) nggi an thu-c an cii'ng vi sg chgm thuang gdy chay mdu.
Bdng 1. Vj trf giai phlu cua tdn thueng Vi trf Niem mge
ma
Niem mge mdi Lud>i Thanh hpng
Vdm midng
San mipng
Tdng so
Sdtdn thuang
14
-13 d mdi dudi, 1 d mdi trdn (trong dd 7 c l d
gdc mdp)
14 1 1 41
% 21,9 34.1 34.1 2.4 2,4 4.8 100
3. Kit qua dilu trj
Gdy te tgi chd. khu vgc: 33 ca. gdy md tTnh mgch: 1 ca la tre em.
KT thugt dilu trj Id kT thudt quang ddng b l mdt, tipng dilm bing laser Nd:YAG kit hgp vdi Idm xpp mgch gidn.
- Vipe dilu trj diln ra nhp nhdng, nhanh chdng, khdng chay mdu. vlt thuang do laser dugc lien ky 2. thdi gian liln vlt thuang tip 10 din 21 ngay, khdng cd bien chu'ng chay mau trong giai dogn hdu phiu.
- 28 benh nhdn dugc dieu trj 1 lln (82,4%).
6 bdnh nhan d n dieu tri han 1 lln (17,6%).
Thdi gian theo ddi sau dilu trj tip 4 din 36 thdng. ed 27 bdnh nhdn (79,4%) dugc kilm tra trge tilp vd cd 7 bdnh nhdn (20,6%) chi dugc ddnh gid kilm tra qua didn thogi.
Kit qua: t i t ca 34 bdnh nhdn (100%) diu dgt kit qua tdt. cd 29 bpnh nhdn (85,3%) hit hodn todn tdn thuang vd 5 bdnh nhdn (14,7%) hit phin Idn tdn thuang. Viing tdn thuang mgch mdu dugc thay t h i bdng md spo, khdng cd hipn tugng spo co keo, khdng cd tdn thuang day 7 vd cdc biln chu-ng khde. Khdng gdp tdi phdt d viing dilu trj vao thdi dilm kilm tra cudi ciing.
Cdc chipc nang 6[i(?c cai thien: dn udng thoai mai khdng edn tdm ly lo sg, hit hoge giam ndi ngpng.
- Minh hpa 1 sd kit qua dilu trj
1. Benh nhan V.T.B 45 tuoi, bj dj dang tmh mach nong a duoi luai va san mieng
'w^fc
Anh1. Trud-c khi dilu trj Anh 2. Kit qua ngay sau khi dilu trj bdng laser Nd:YAG vd^i kT thuat quang ddng tipng dilm kit hp>p v6>l de xep mach mau
TCNCYH Phi^ trwang 77(6) - 2011
Anh 3. Ket qua dieu trj sau 1 nam: khoi di dang tTnh mach bj mat 2. Benh nhan D.V.K, 20 tuoi, bi di dang tinh mach nong 6' niem mac moi du'O'i trai
Anh1. Trirac dieu tri
^
^ • ^
Anh 2. Ket qua ngay sau khi dieu trj bang laser Nd: YAG vcyi kT thuat quang dong tirng
dem ket hgp vo-i de xep mach mau
'*s#*)»'Siir^^^>,^;,;,->.. ^^.
Anh 3. Ket qua dieu trj sau 9 thang: khoi di dang tinh mach bj mat
3. Benh nhan H.T.G, 24 tuoi, bi di dang tinh mach nong a moi duo'i phai.
- * ^ - - ' - • ^ • r -
Anh I.Trud-c dilu trj. Anh 2. K i t qua ngay sau khi dilu trj bdng laser Nd:YAG vd-i kT thuat quang ddng tiPng
d i m k i t hep vd'i de xep mach mau 23
Anh 3. Kel qua, sau dieu trj 3 nam, khdi dj d^ng mit hoan todn
IV. BAN LUAN
Mge tidu dilu trj ly tudng vdi cdc dj dgng mgch mdu ndi chung vd cdc di dgng tTnh mgch ndi rieng Id khdi phgc Igi d u true giai phiu, hinh thdi binh thudng cua mgch. tip dd phgc hdi Igi chuc nang eua mgch. Dilu nay cd nghTa Id mgch dj dgng se trd Igi binh thudng nhu chua bj tdn thuang. Tuy nhidn mge tidu ndy, cho tdi nay, hau nhu vin ehua lam dugc. Vipe dilu tri di dgng tTnh mgch hipn nay dugc tien hanh theo cdc mi>c dp khac nhau tip thlp den eao: bit hogt khdi dj dgng (nhu bang dp trong trudng hgp gidn tTnh mgch hiln trong, mang tinh tgm thdi...[9]) rdi tien tdi logi bd khdi dj dgng ra khdi vdng tuin hodn vd cudi ciing la xa hda khdi dj dgng. Phau thugt lly bd ngay tuang duang vdi vipe thgc hien cdc budc tren trong ciing 1 thi. Diing keo sinh hpc ddng vdn nhanh nhu Histoarcryl 40%
la phuang phdp thgc hipn cac budc theo 2 thi, dau tidn dua keo sinh hpc vdo trong Idng mgch 6k chilm chd. lip kin vd gdy tie Idng mgch cua khdi dj dgng sau dd chit gay xa lam tdn thuang gdy xa hda bit tic mgch gidn. Phuang phdp nay thudng dugc chf djnh cho cdc trudng hgp dj dgng trong ca, xuang hay ede dj dgng tTnh mgch Idn d vj trf khde vd phai theo ddi chdt trdn man hinh 6k khdng cho keo sinh hpc lan rdng ve cdc tTnh mgch trung tdm. Vdi cdc dj dgng tTnh mgch ndng trong khoang mipng, diing keo sinh hpc kit hgp vdi chit gdy xa thudng cd bien chipng khdng nhd la vidm loet hogi tu- rpng niem mac. Phuang phap phiu thudt tuy hipu qua nhung gdy tdn thuang it nhilu din cdc md lanh^xung quang nen se ggp nhilu khd khan va de cd biln chu'ng khi cac dj dgng tTnh mgch
ndng rdng Idn hay d cdc vj tri chdt hpp nhu ngdeh Igi trg Amydal... d trong khoang midng.
Do dd tim kilm 1 phuang phdp dilu trj chpn Ipc vdo cdc dj dgng tTnh mgch. It xdm lln Igi hidu qua eao ludn Id mong ir&c eua cdc thiy thudc.
Dilu trj ede dj dgng tTnh mgch ndng bdng laser Id 1 trong cdc phuang phdp dilu trj theo hudng chpn Ipc. Phuang phdp dimg laser Nd:YAG theo kT thudt quang ddng tirng dilm Idn b l mdt nidm mge cua tdn thuang dgt dugc hipu qua cao vdi cdc tdn thuang nhd nhung Igi d l Idm thiing mgch mdu ndn dilu trj khd khdn vd phai dilu trj keo ddi vdi cdc hd, hang tTnh mgch Idn.
Nguydn nhdn Id do khdi dj dgng mgch gian to, cang mdu vd thdnh mdng vira de thung vipa can trd ddng dfnh thdnh mgch. V l mgt bpnh ly, mgch gidn dj dgng gdm 2 y l u td bdnh ly la thdnh mgch y l u vd dp Igc eua ddng mdu (ca dp Igc ddng vd tTnh) tgo nen [10]. Trong khi laser Nd:YAG chf tdc ddng chpn lpc cao vdo thanh mgch (sic t h i Id Protein) ma tac dgng kem vdo ddng mdu (sic t h i Id Hemoglobin) ndn ddng mdu ben trong Idng mgch se can trd tac dgng ddng dfnh thdnh mgch vi vdy d n logi bd ddng mdu trudc khi chilu laser. Chung tdi da chii truang d l trdnh Idm thung thdnh mgch va dilu trj ed hidu qua, vide d i u tidn Id phai logi bd ddng mdu trong khdi dj dgng trudc khi chilu laser (ddy cung Id cdch bit hogt dugc mgch gian hoat dpng) bing each lam xpp mgch mdu. KT thugt chilu laser Nd:YAG quang ddng tirng dilm kit hgp vdi lam xpp mgch mdu gdm 2 thanh phan:
Idm xpp mgch mau d l logi bd hit mdu trong Idng mgch trudc vd sau dd quang ddng tipng dilm bing laser Nd:YAG. Khi thgc hipn de dp lam xpp mgch mdu, hipn tgi chung tdi thudng
TCNCYH Phu trwang 77(6) 2011
dimg bang tay va thgc hipn de dang nhung khi tdn thuang d nhu-ng vj tri sdu trong hpng se khd thgc hipn dugc, ddy la diem hgn che eua kT thudt nay. Vdi kT thugt nay, chilu laser Nd:YAG quang ddng tirng d i l m r i t thugn Igi vd de ddng gay ddng vdn true tiep eae thanh mgch lam cdc thanh mgch dinh Igi sau se bj xa hda va khdi dj dgng tTnh mgch se mat ma khdng sg gay thung thanh mgch. K i t qua tdt ngay sau khi dieu trj cung nhu k i t qua xa vdi 100% k i t qua tdt (34 benh nhan) da chu-ng td tinh hipu qua cao cua
"Ky thugt chieu laser Nd:YAG quang ddng tirng diem k i t hgp vdi lam xpp mgch mdu "6k dieu trj dj dgng tTnh mgch ndng trong khoang mipng.
Oieu kien de thgc hien k^ thudt ndy Id ddng mdu phai luu thdng, mgch khdng bj t i e vd thdnh mgch dii vu-ng d l chju dugc dp Ige ddn nen ddng mau khi lam xpp ma khdng bj thiing. Do dd trudng hgp tTnh mgch dj dgng bj t i e , bj viem hay loet thupc nhO-ng trudng hgp d m chi djnh dp dgng ky thugt tren.
V. K^T LUAN
KTthudt chilu laser Nd:YAG quang ddng tirng dilm k i t hgp vdi lam xep mgch gian (bing tay) d l dieu tri dj dang tTnh maeh ndng trong khoang mieng la mdt kT thuat mdi trong dilu tri dj dgng tTnh mgch ndng trong khoang mieng. KT thuat nay dugc thuc hien de dang, cd hieu qua cao vdi 100% k i t qua tdt tren 34 bpnh nhan va da td ra cd uu t h i han so vdi kTthudt chilu laser Nd:YAG thdng thudng khdng lam xep mach dan khi dilu trj cdc dj dgng tTnh maeh ndng trong khoang.
T A I
LIEU THAM
K H A O. 1. Pham Hiru Nghj (2007). Ket qua budc dau dilu tri cac tdn thuang mach mau trong khoang mipng bang laser Nd:YAG. Tap chi Y dugc lam sang 108, sd dac biet thing 6/2007: 76- 79.
2. Apfelberg D B et al (1989). A preliminary study of the combined effect of Neodymium:YAG
laser photocoagulation and direct steroid instillation in the treatment of capillary/cavernuos heamngioma of infancy. Ann Plast Surg, vol:12, No 2, 94-105.
3. Seccia A et al (1991). Treatment of angiomas with sclerosing injection of hydroxypolyethoxydodecan. Angiology, Jan; 42 (1): 23-29. Abstract.
4. Werner J A et al (1998). Ultrasound- guided interstitial Nd:YAG laser traetment of voluminous hemangiomas and vascular malformations in 92 patients. Laryngoscope 108: April, 463-470.
5. Bekhor P S (2006). Long-Pulsed Nd:YAG Laser Treatment of Venous Lakes: Report of a Series of 34 Cases. Dermatol Surg, 32 (9): 1151-1154.
6. Eivazi B et al (2010). Laser treatment of mucosal venous malformations of the upper aerodigestivetract in 50 patients. Lasers Med Sci; 25: 571-576.
7. Genovese W J et al (2010). The Use of Surgical Diode Laser in Oral Hemangioma:
A Case Report. Photomedicine and Laser Surgery; Volume 28, Number 1:147-151.
8. Heidi U et al (2005). Neodymium- YAG Laser for hemangiomas and vascular malformations - long term results. Journal der Deutschen. Dermatologisehen Gesellschaft. 3 (6): 436-440, June.
9. Schmedt C G et al (2010). Update of endovenous laser therapy and the latest application studies. Medical Laser Application 25: 34-4.3.
10. Scherer K et al (2007). Nd:YAG lasers (1,064nm) in the treatment of venous malformations of the face and neck:challenges and benefits. Lasers Med Sci 22:119.
11. Sarig O et al (2006). Laser Treatment of Venous Malfomiations. Ann Plast Surg 57:20-24).
Summary
ND:YAG LASER SURFACE PHOTOCOAGULATIVE TECHNIQUE IN COMBINATION WITH MAKING VESSEL COLLAPSE TO TREAT SUPERFICIAL VASCULAR MALFORMATIONS IN THE ORAL CAVITY
Treatment of venous malformations in the oral cavity with laser methods are now being seen as effective and safe. Nd:YAG laser may cause the greatest photocoagulation and penetration so often used to treat superficial venous malformations in the oral cavity, especially when vessis are large. Nd:YAG laser directed projective technique with each point to surface damage has a big disadvantage in which blood vessel is easy perforated and treatment is prolonged, especially with the venous lake. Nd:YAG laser surface photocoagulative technique in combination with making vessel collapse is a new technique for the treatment of superficial venous malformations in the oral cavity. This technique is performed easy and effective with 100% good results in 34 patients and has proved to be more dominant because easily making vessel wall coagulation and causing less vessel wall perforation.
Key words: Nd:YAG laser, venous malformations
U'NG DUNG VAT DA
C A N C A N HTAY NGOAl PHUC
H 6 I T 6 NKHUYET
P H A N M ^ M S A U P H A U T H U A T O I ^ U T R I
UNG THU* KHOANG MIENG
Nguyin Tai Sen, Nguyin Huy Canh Bdnh vi$n Trung uong Quin dQi 108 Nghien ciru duxyc thi/c hidn nhim mijc tieu danh gia kit qua bcfOc dau sir dgng vat da cin canh tay ngoai trong tao hinh cac khuyet to chirc vira va nhd. TCr thing 1 din thing 12 nim 2010, t$i khoa PT Ham mat va Tao hinh BVTU'QD 108, chiing toi da sir dgng 9 vgf da cin cinh tay ngoii de che phu khuyet san mi$ng sau cit khoi ung thwiuoi va sin mi^ng. Kit qui cho thiy. kich thwac vgf; 6 - 7 cm be rong, 12 14 cm chieu dii. 6/9 vat song toin bq, m0t v^t bi hoai tir. Vet mo nai liy v^t di/pc ddng tnrc tiep. Chung toi nh$n thiy vat da cin cinh tay ngoii li chit li^u tao hinh ding tin ciy di tao hinh cic khuyet vira vi nho vung co mat
TIP khda: vat canh tay ngoai
I. OAT
VAN O ^Ung thu dau mgt cd hay ggp, chilm khoang 10% tdng sd cdc u dc tinh. Trong dd, khoang 40% xay ra d mipng [1], 13% d sdn midng [4].
Phiu thudt d t bd tdn thuang thudng rdng, anh hudng rit Idn din chCPC ndng hd hip, phdt am, nhai nudt cua bpnh nhdn [1], do dd phgc hdi khuylt san mipng sau d t bd do ung thu la mdt yeu d u d p thilt. Cd nhilu vgt tg do da dugc ii-ng dgng rpng rai 6k phgc hdi Igi san mipng nhu vat ca nguc Idn, vgt da ca lung to... Tuy nhien, nhu-ng vgt nay kha day, kich thudc Idn ndn chl djnh phgc hdi khoang mipng thudng
hgn chl. Vgt da cdn d n g tay quay mdng, de Igi nhilu biln ehCrng nai eho vgt [5]. Vgt da can cdnh tay ngodi dugc Song R. md ta lln dau tien ndm 1982 [8]. Vgt ed uu dilm dd dly vipa phai, mim mgi, kieh thudc vgt phii hgp vdi nhung tdn thuang vipa vd nhd [7], cudng vgt hing djnh, de phiu tfch, phil hgp eho vide tdi tgo khuylt phan mim khoang midng va ham mgt [6]. Vi vdy, chung tdi tiln hdnh nghien CLPU nay vdi myc tieu: ddnh gid kit qua ban diu khi sip di^ng vgt da can canh tay ngodi phgc hdi khuylt phin mim san mipng sau d t bd khdi ung thu- cho 9 bpnh nhan tgi khoa phiu thudt Ham mgt- Tgo hinh, bpnh vidn Trung uang Quan dpi 108.
