Tap 5-so 4/2010 TAP CHI Y DUOC LAM SANG 108
K e t q u a d i e u t r i h o i n a c h b a n g p h u o n g p h a p n a o b o t u y e n A p o c r i n e Removal of Apocrine glands in armpit
Nguyen Sy Hoa Binh vien Da lien Tntng uang Tom tit
Hoi nach thuang gap cc ca nam va nu, co nhieu phuong phap dieu tri. Cac phudng phap noi khoa khong mang lai ket qua lau dai. Cac phuong phap ngoai khoa nhu cat bo hach giao cam, hut md, cat bo da vung ho nach. Cac phudng phap tren thudng phUc tap, nhieu bien chung. Phuong phap nao loai bo tuye'n Apocrine vung ho nach bang thia nao don gian, it bien chung, ke't qua dieu tri cao, benh nhan dl chap nhan.
Summary
Of armpits is often in male and female. There are lots of methods of treatment such as medicine, surgery. Methods of medicine do not get prolonged result. Methods of surgery such as removal of Sympathetic glands, liposuction, removal of skin with Apocrine glands are often complex and lots of complications. Removal of Apocrine glands in armpit by Curet is simple and few complications and high result of treatment and accepted patients.
1. Oat van de
Hoi nach la benh ly do tang tiet qua mtfc chat ba cua tuyen Apocrine vung ho nach, ke't hop vdi nhiem khuan gay mui khd chiu cho benh nhan va ngudi xung quanh nha't la khi lao ddng, van dong nang, benh nhan thie'u tir tin.
Cac phuong phap dieu tri ndi khoa nhu bdi cac thud'c trung hda, khCr mui tai cho, thud'c khang cholinecgic lam giam tiet chat ba, mo hdi.
Cac phuong phap dieu tri ngoai khoa nhu hut md, cat bo da viing ho nach, diet giao cam nguc tren thudng cd nhieu bien chu'ng nhu nhiem trung, seo xau, kho da ban tay...
Dua vao co che sinh benh hoc, Uu nhugc diem cua cac phuong phap trudc day, chung tdi tien hanh nghien ciru va irng dung phuong phap nao vet tuye'n Apocrine viing ho nach hai ben nham: Danh gia hieu qua lam het mui hdi nach cua phuong phap nay.
2. Ddi tupng va phuong phap nghien curu 2.1. Doi tirong nghien cuv
• 87 trudng hop dupe nao vet tuye'n Apocrine vung hd nach hai ben bang thia nao d cac Ida tudi, gidi khac nhau, thdi gian tU 1/2007 den 10/2009.
Phan bien khoa hoc: PGS.TS. BANG VAN EM
- Tieu chuan chpn benh nhan: tat ca cac benh nhan bi miii hdi nach, mpi tudi. Benh nhan tir nguyen dieu tri.
- Tieu chuan loai trir: benh nhan cd benh tim mach nang; benh nhan khdng ddng y dieu tri.
2.2. Phuong phap nghien cuu 2.2.1. Phuong phap nghien cdu Tien cdu, can thiep, tu so sanh trudc sau.
2.2.2. Phuong phap tien hanh
- Benh nhan dupe tham kham lam sang theo benh an mau. Sau khi benh nhan chap nhan dieu tri theo phuang phap, tien hanh cac xet nghiem co ban va tien hanh thu thuat.
- Chuan bi thu thuat:
+ Benh nhan dupe cao long nach, sat khuan rpng vung 2 hd nach 3-4 lan. Oanh da'u vung cd long nach moc.
+ Gay te dudi da viing hd nach bang Lidocain 0,5% khoang 20-30ml tuy theo dien tich da vung hd nach benh nhan.
+ Tien hanh thu thuat: Rach da d giira gan ria hd nach chd tha'p nha't khi nam, dai khoang 1,5-2cm.
Dung keo cong dai, dau tu bdc tach sat dudi da het dien tich da vung hd nach mang long. Dung thia nao nhd nao dudi da, het dien tich da bdc tach trudc.
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JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.5-NM/2010 Trong qua trinh nao, cac ngon tay trai giir tren da de
kiem soat dudng di cua thia nao. Toan bp tuyen Apocrine va to chirc m3 dudi da se dupe loai bo. Rira sach lai 1-2 lan bang nUdc muoi sinh ly 9°/00. Bat dan luu bang manh gang cao su nho, bang ep chat, khep nach.
Chu y: khong sir dung cac dpng tac dang tay nhu di xe may, xach vat nang trong 3 ngay dau. Rut din luu sau 24h.
- Banh gia ket qua: Bang sir het mui qua cam nhan cua benh nhan, nguoi xung quanh, bac sy dieu tri.
3. Ke't qua nghien cuu
3.1. Dac diem ddi tu'o'ng
Bang 3.1. Phan bd theo tudi tudi (n=119)
Tudi n %
17-38 27 22,7
39-50 92 77,3
Tdng 119 100
Tudi chu yeu la tU 39-50 chie'm 77,3%.
Bang 3. 2. Phan bdtheo gidi (n=119)
Gidi n %
Nam 32 26.9
NU 87 73,1
Tdng 119 100
NU den dieu tri nhieu hon nam. Bieu nay cho thay benh nhan nu quan tam den mui kho chiu tu1 nach nhieu hon nam.
3.2. Phuong phap dieu tri
Bang 3.3. Cac phuong phap dieu tri (n=119)
Cac phuong phap dieu tri n %
Phau thuat cat bd da vung hd nach 17 14,3
Dung thia nao vet toan bp tuyen Apocrine nhu trinh
bay d tren 87 73,1
Hut md 15 12,6
Tdng 119 100
So benh nhan dupe lUa chpn phUPng phap dung thia nao, nao vet tuyen Apocrine nhieu hon (87 trudng hop, chiem ty le 73,1%).
Bang 3.4. Ket qua het mui hdi nach sau dieu tri sau 1 thang, 3 thang
Cac phuong phap dieu tri 1 thang 3 thang
Cac phuong phap dieu tri n % n %
Phau thuat cat bd da vung hd nach (1) 17 100 17 100
Loai bd tuyen Apocrine bang thia nao (2) 82 94,3 71 81,6
Hut md (3) 5 33,3 0 0
So sanh P1p2>0,05 P1p2<0,05
P2p3<0,001 P2p3<0,00 P3p1<0,001 P3p1<0,00
100% benh nhan dupe cat bd da vung mang tuyen Apocrine he't mui sau theo ddi 1 thang, 3 thang. Ty le he't mui cua phuong phap nao vet tuyen tha'p hon, cd the vung ria cdn mpt so tuye'n lay chua het hoac sdt d vung trung tam.
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Tap 5-so 4/2010 TAP CHi Y DUOC LAM SANG 108
Hinh 3.1. Nao vet tuyen Hinh 3.2. Hut m3
Dieu tn hoi nach bang phuong phap nao vet tuyen (H1) va hut md (H2)
• " M
c—~~~
Hinh 3.3. Danh da'u vung cat bo da Hinh 3.4. DuOng khau sau cat bo da 4. Ban luan
Hoi nach khong anh huong de'n sire khoe, nhung de lai mui kho chiu cho ban than va ngudi xung quanh.
Ve dieu tri, co nhieu phuong phap noi khoa va ngoai khoa. Cac thudc trong dieu tri hoi nach chi tam thdi, khong he't mui triet de.
Cac phuong phap trong dieu tri ngoai khoa nhu da trinh bay tren, so benh nhan chap nhan dieu tri bang phuong phap nao vet tuye'n Apocrine cao nha't chie'm 73,1% va ket qua he't mui hoi nach sau 1 thang la 94,3% va sau 3 thang la 81,6%. Tuy nhien, phuong phap cit bd vung da hd nach cho ket qua het mui hoi tdt hon phuong phap nao vet tuyen. Nhung phuong phap nao vet tuyen don gian hon, dd thuc hien va it tai bien.
Cac bien chung cua nao vet tuye'n co the xay ra bien chung sdm nhu chay mau, tu mau hd nach.
Trudng hgp chay nhieu can rach rdng, cam mau khau da 2 Idp (it gap) va bien chung mudn gdm nhilm
trung, tu mau it, tham da vung ho nach (it gap).
Thudng dung khang sinh thdng thudng 5-7 ngay theo dudng udng hoac tiem. Trong so benh nhan chung tdi nghien cOu khdng cd cac tai bien Idn xay ra.
5. Ke't luan
Qua tien hanh nao vet tuyen vung nach Apocrin cua 87 trong so 119 trudng hop bi hdi nach cho ke't qua nhu sau:
Het mui hdi nach sau 1 thang la 94,3%, sau 3 thang la 81,6%.
Phuong phap nao vet tuyen Apocrin cho ket qua td't hon phuang phap hut md ho nach nhung tha'p hon cat bd da vung nach.
Tai lieu tham khao
1. James M., Swinehart MD. (2000), Colorado Dermatology centre Denver, Colorado Dermatol Surg, 26, pp. 392-396.
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