T9P chl Tai MDi Htjng V i | t Nam - Volume (57-8). N''2 - March. 2012 9. Richard T Ramsden, Hugh
Wheatley. "Developing surgical techniques in cochlear implantation"
Cochlear Implants International, 1(2), 67-81, 2000 © Whurr Publishers Ltd.
10. Robert J. Witte "Pediatric and Adult Cochlear Implantation".
RadioGraphics, September 2003.
11. Rolf Dieter Baltner; Azne Erenst.
"Rislc and Benefit of Deeply inserted Cochlear Implant electrode Arrays". 2006.
12. Thomas Lenarz. Cochlear Implantation, The Hannover Guideline".
2010.
13. Van de Heyning. " Cochlear Implants and Hearing Preservation." Vol 67,2010. Karger.
14. Ugo Fisch. Temporal bone dissection. The Zurich Guidelines" 2009.
Press.
15. Wikipedia. "Cochlear Implant".
William F.House.
16. NguySn T h | Bfch Thiiy, B& Hing Giang "So k^t c i c truimg hpp c4y 6c tai difn til da kinh t«i Bfnh Vifn Tai Mui Hpng tir nSm 2000 d^n 11/2008". Nfi san HOi nghj Khoa Hpc K^ Thu|it- BV Tai MOi Hpng TP HA C W Minh 12/2008, trang 13-20.
KtT QUA THiNH LV'C SAU PHAU THUAT
CHINH HINH TAI GI&A B A N G SyN
Nguyin Hoang Hiiy * T 6 M TAT
D$t v^n d^: s\tn dupe su dung trong chinh hlnh tai gi&a v6i m\ic dich ban ch^ tii phdt benh tich 6 tai gii^a, d^c tinh cung ciia svn c6 tic dyng giim tii phit tlji co Vio mang nhT, tuy nhien cung c6 the inh hu6ng den truyen am cua ming nhi. Hifn nay chua CO nhieu nghien cihi ve thinh I\rc sau phau thu^t v i nht bing s\m. M^c tieu: dinh gii ket qua thinh l\rc sau phau thuit chinh hlnh tai gii^a bing syn. D&i tir^rng v i phmng p h i p nghien cihi: nghien ctru hoi cim ttin 22 bfnh nhin dupe phlu thi4t v i nhi bing sun tai Khoa Tai - Bfnh vifn Tai Mui Hpng tnmg uomg tir 1/2009 den 12/2010. Ti&i chuan lua chpn la nhihig bfnh nhin x^p nht, vifm tai giiia m^n tinh trSn bfnh nhan x ^ nhT, trfn bfnh nhan r6i l o ^ chirc ning v6i ho$c tii phit sau phau thu^t. Tat c i bfnh nhan co nghe kdm dan truyen hojc hon hpp thien ve dSn diiyen. So sinh nguBng nghe trung binh (PTA) v i khoing cich giiJa dudng khi v i duimg xuong (ABG) trudc v i sau phlu thu^t. Ket q u i : Kk qui phvc h6i giii phlu ming nhT t6t, kh6ng c6 tii phit xqi nhi hoic thung nhi. PTA sau mo dupe cii thifn b tit c i cic tin so tir 500Hz din 4000Hz.
68,2% ABG trudc m6 trong khoing 20 - 29 dB, 63,6% ABG sau mo trong khoing 0 - 19 dB. Ket lu|n: v i nhi bing syn cho ket qui tot v^ sire nghe v i giii phlu, phlu thu^
dirge lifi chpn cho cic trudng hpp xfp nhi, vifm tai giOa ph6i hpp x?p nM, viem tai giOa rdi lo?n chirc ning vdi, viim tai giOa tii phit sau phlu thujt.
Ti* idida: chinh hinh tai giiia bing syn, v i nhi bing s^m, ket qui thinh luc sau mh
' Khoa Tai - B$nh vi$n Tat MQi Hgng tmng uong NhSn bii 15-4-2012, duy^t in 25-4-2012
Tgp chl Tai MQi Hgng Viet Nam - Volume (57-8). N°2 - March. 2012 SUMMARY
HEARING RESULT AFTER CARTILAGE TYMPANOPLASTY
Backgrounds: Cartilage tympanoplasty has been used to reduce recurrence or progression of middle ear disease. The rigidity of cartilage has obvious benefit in preventing tympanic membrane retraction, but concern has been raised regarding its sound conduction properties. Objective: to study the hearing results after cartilage tympanoplasty. Patients and Method: A retrospective study of 22 patients underwent cartilage tympanoplasty from 1/2009 to 12/2010 at Otology Department of National ENT Hospital. Pre-operative and post-operative PTA and ABG were compared. Result:
PTA was improved after surgery at each ofthe following frequencies: 500Hz, lOOOHz, 2000Hz and 4000Hz. 68,2% preoperative ABG within 20-29 dB versus 62,6%
postoperative ABG within 0-19dB. Conclusion: cartilage tympanoplasty has good hearing and anatomical result, is indicated for retraction pocket, chronic otitis media with ateleetasie, recurrent otitis media after surgery.
Keyword: cartilage tympanoplasty, postoperative hearing result 1. Di^T VAN Bt
Phau thuat v^ nhT la phhi thuat thuong g$p nhieu nhat trong phau thuat chinh hinh tai giiJa. Chat lieu va nhT co the dung can co, mang sun, sun, tinh mach. S\m duoc Jansen sir dung dau tien nam 1958 de chinh hinh xuong con, nSm 1963 Salen va Jansen sir dung s\m de va nhi lan dau hen. Ng^y nay can ca thai duong thuang duoc sii dung nhieu nhat dk tdi tao mang nhi. Sy lira chon chat lieu va nhi con phu thupc vao b?nh tich 6 tai giua. Doi vai xep nhT, cholesteatoma, thiing nhT co r6i l o ^ chiic nSng voi, thung nhT tai phat thi sii dung sun co nhvhig uu diem han so v6i can CO thai duong d^ han che tai phat sau phau thuat nhu thiing nhT tai phat, ttii co keo, cholesteatoma.
Tuy nhien vSn de dM ra la su dung sun CO nguy co anh huong d£n sir hoi phuc sue nghe khong? Chinh vi vay chiing toi tiSn hanh dS tai nay vai muc tieu "Dinh gia ket qua thinh lyv sau phau thu^t chinh hinh tai giira bdng sun"
2. D 6 I TlTONG VA PHU'ONG PHAP NGHIEN c t r u
Nghi6n cihi hoi ciJru voi 22 b?nh nhan duoc chdn doan xep nht h o ^ viem tai giiia man tinh duac phau thuat va nhT bang sun tai khoa Tai - B^nh vi?n Tai Mui Hpng trung uong tir 1/2009 din 12/2010. Tieu chudn lua chpn \k nhihig benh nhan x^p nhT, viem tai giiia man tinh tren benh nhan xep nhT, tren b6nh nhan roi loan chiic nang voi hoSc tai phdt sau phau thuat va nhT bing can co thdi ducmg. Tat ca b$nh nhan co nghe kem dan truydn hodc hdn hpp thien ve dan truyen, dupe khdm npi soi tai vd do thinh luc truac phau thuat, trong phau thuat duoc ki6m tra s\r toan ven va s\r di dpng binh thucmg ciia chuoi xuong con trong phau thu^t, b^nh nhdn du^c theo doi sau phau thuat va dupe kiem tra thinh l\rc a cac thai diem 3 thang, 6 thang, 1 nam sau phau thuat. Tieu chuan loai trii: benh nhan nghe kdm tiep nhan hodc hon hpp thien ve tiep nhan, ton thuang xuang con, hgn ch6 hodc co djnh xuong con.
So sanh ngudng nghe trung binh (PTA) va khodng each giiia duong khi
29
Tgp chl Tai MQi Hpng Vi^t Nam - Volume (57-8). N"2 - March. 2012 v^ duing xuong (ABG) tru6c vd sau
ph^u thu^t. So li?u dup-c xir 1;? bfing phuang phdp th6ng kS y hpc bdng chuang trinh SPSS 10.0.
Phu-orng phdp phSu thu^t: sii dyng d u ^ g ong tai, trudc tai ho$c sau tai. ddnh gid tinh tr^ng b$nh tich 6 tai giQa, Idm m6i Ha l3 thiing, r^ch da 6ng tai tir 6h vd 12h ra sau tgo vgt 6ng tai ngodi mdng nhT, b6c vgt 6ng tai ngodi mdng nhT ki^m tra h6m nhT, s\r todn v?n vd di dOng ciia chuSi xucmg con, sy:
thong thodng ciia v6i nhT. Rgch da bb ngodi syn blnh tai, bpc 10 vd b6c tdch lly syn binh tai ciing mdng syn. Chuin bj mdnh vd bing cdch b6c tdch mdng syn Bdng 1. Cht djnh phdu thudt
khdi mOt m§t syn vd dfnh vdi syn d m^t c6n lgi, cdt bdt mOt niia chilu ddy syn.
D0t mdnh syn kiiu underlay dudi khung nhT vd dudi cdn biia, phin mdng syn nim tren thdnh sau ong tai ngodi. Ddt lai vat ong tai ngodi mdng nhT, d$t Gelaspon trong h6m tai vd ong lai ngodi co djnh mdnh vd, d$t Merocel tai.
3. KtT QUA
DO tuoi trung blnh trong nghlSn cdu Id 35,7 tu6i, tuoi nhd nhit Id 15 tu6i, nhilu nhit Id 57 tuli. Trong 22 b^nh nhdn cd 12 b^nh nhan nam, ty 1^ nam / n& Id 1,2:1.
Chl ainh phlu thutt X^p nhi
Viem tai giOa m$n tinh/xep nhT Vi6m tai giO'a man tinh
Vigm tai giOa man tinh tdi phdt sau phSu thu$t T6ng s6
n 13 3 4 2 22
Tfltfti) 59,1 13,6 18,2 9,1 100 Chi djnh phau thuat vd nhT bing
sun nhieu nhat trong x^p nhT Id 13 trudng hpp chiem 59,1%, tiep den Id trong viem tai giQa mgn tinh 18,2%, viem tai giiia man tinh phoi hpp vdi x?p nhT 13,6%, viem tai gi&a man tinh tai phdt sau phau
thugt 9,1% (Bang 1). Syn binh tai dw;rc sii dyng de vd nhi cho tat cd cdc trudng hgp, trong thdi gian theo ddi, khong co cdc biln chiing nhu tieu mdnh ghep, di chuyen manh ^ ^ p , tdi phdt tiii co k^, tai phdt l5 thiing mdng nhT.
Bdng 2. Ngudng nghe trung blnh trudc vd sau phdu thu^t PTA
500 Hz 1000 Hz 2000 Hz 4000 Hz
Tnj^mS 22,5 21,3 19,6 25,4
SaumS 13,4 10,8 5,5 15,9 Ngudng nghe tnmg binh sau m6
duac cai thi$n 6 tit ca cic tan s6 tii 500Hz dan 4000Hz. PTA truoc m6 6 cic tin s5 500Hz; lOOOHz; 2000Hz vi
4000Hz lan lugt la 22,5dB; 21,3dB;
19,6dB va 25,4 dB c6n PTA sau mo a cic tan so nay lan lugit li 13,4dB;
10,8dB; 5,5dB vi 15,9dB (Bidu do 1).
T9P chl Tai MQi Htjng Vi§t Nam - V o l u m e (57-8). N°2 - March. 2012
30 25 20 15 10
Bieuido 1. PTA Irirt^c visau ph^u thu^t Bing 3. Khoang cich duclyng khi v i du6ng xu-ong trub-c v i sau phlu thuit
ABG (dB)
0 - 1 9 20-29
>30 Tfing s6
TrwdK m6 n
2 15
5 22
%
9.1 68,2 22,7 100%
Sau tn6 n 14 6 2 22
%
63,6 27,3 9,1 100%
Khodng cdch giuB dudng khi vd dudng xuong (ABG) trudc mo gdp chu yeu trong khodng 20 - 29 dB chiem 68,2%, ngugc lgi ABG sau mo chii yeu gdp d muc 0 - 19 dB chiem 63,6%.
Trudc mo chi co 2 benh nhan cd ABG trong khoang 0 - 19 dB ngupc lgi sau mo trong khoang nay co 63,6% (Bdng 3).
4. BAN LUAN
Sun duprc sir dung thdnh cong trong phdu thugt chinh hinh tai giiia tir 40 ndm qua, syn cho ket qua dimg ngp tot, it tieu theo thdi gian. Liic dau sun chi dupe sii dyng trong phau thugt chinh hinh xuong con, ngay nay dupe sii dung trong nhieu ph§u thuat khdc nhau. Sun va mdng syn la vat lieu thudng xuyen dupe lua chpn dk tai tgo mdng nhT trong xep nhT hoac thimg nhT tai phdt. Y van cho thiy sun cho ket qua tOt ve hinh thai gidi phiu va ty le tdi phat thip, chinh vi vay syn dugc chi dinh chu yeu trong xep nhT, viem tai giOa phdi hpp vdi xep nhT, viem tai giiia cd roi logn chiic ndng voi
tai hodc viem tai giiia tai phat sau phau thuat. Trong nghien ciiu ciia chiing toi xep nhT chiem 59,1%, viem tai giiia phoi hgp vdi xep nhT chiem 13,6%, viem tai giua tdi phdt sau phau thudt chiem 9,1%.
K^t qud vh phuc h6i gidi phau cho thay khong cd benh nhdn bi tieu manh ghep, di chuyen mach gh6p, tdi phdt hii co keo hay tai phdt lo thimg mdng nhT.
Trong vd nhT bdng sun va mang sun, su phyc hoi ve gidi phau dugc chii y nhi^u hon sdc nghe. Ddc diem day vd ciing hon cua syn so vdi cdn co Id tm di€m de trdnh tui co kdo tdi phat nhung ciing dugc cho Id anh hudng den su truyen am ctia mdng nhT, tuy nhien mpt vdi nghien ciru cho ket qua tot ho^c chap nhan dupe v^ sue nghe khi vd nhT bdng syn. Trong nghien ciiu cua Amendee, ABG trung binh sau phau thuat Id 4 dB, cdn ket qud cda Adkins Id 5 - 10 dB, Levinson cho thiy 65% bfinh nhdn thu hep khodng cdch giiia dudng khi va dudng xuang trong khoang 10 dB con
31
T^p chl Tai MQi Hpng Vi#t Nam - Volume (57-8). N"2 - March. 201 z
tai giO'a tii phit sau phdu thu$t ho?c d6i 86% trong Ichoing 20 dB. Nim 1997
Domhoffer nghien cthj hoi cim so sinh ket qui thinh i^c cua nh6m vi nht bing syn vi ming syn so vdi nhdm vi nhi bing ming syn cho thiy sv khic bi?l khdng c6 y nghia th6ng ki giOa hai phuong phip, s\f phyc h6i ABG vdi sun vi ming syn li 6,8 dB cdn vdi ming syn li 7,7 dB. Trong nghiSn cilu cila chiing tdi da s6 bfnh nhin (68,2%) cd ABG trudc m6 nim trong khoing 20 - 29 dB, ngugrc l^i da so bfnh nhin sau tn6 (63,6%) cd ABG nim trong khoing 0 - 19 dB cho thiy da s6 bfnh nhin cd sftc nghe h^i phyc tot sau phiu thu|lt. Hon nO'a khi so sinh ngudng nghe trung blnh d tit ci cdc lin so 500Hz, 1000 Hz, 2000Hz vi 4000Hz deu cho thiy PTA giim d tit ci cac tin s6 cho thiy sue nghe cua bfnh nhan duQ^c cii thifn sau phiu thuat.
5. KfiT LUAN
Vi ming nhT bing syn vi ming syn cho ket qui phyc hdi tot ve sure nghe, ducjR: chi dinh thich hij^p doi vdi xgp nhi, viim tai gi&a phoi hop vdi x?p nhT, viem tai giiia cd rdi loan chuc ning vdi, v'litn
vdi nhiJng trudng hijp khdng cdn cin co thdi duong sau phiu thudt lin diu. DJc tinh Cling cila syn cho phip tdng tinh vOng b^n cOa ming nhi ngin ngua tii phdt tili CO kio nhimg cung khdng gdy inh hudng nhi^u tdi sir h6i phyc siic nghe.
T A I LIfU THAM K H A O 1. Adkins WY. Composite autograft for.
tympanoplasty in the treatment of ears with advanced middle ear pathology.
Laryngoscope 1990;100:244-247.
2. Amedee RG, Mann WJ, Riechelmann H. Cartilage palisade tympanoplasty.
Am J Otol 1989:10:447^50.
3. Levinson RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope 1987;97:1069-1074.
4. Nguyen Tin Phong. Phau thudt tai.
Nhi xuit bdn y hpc Hi Npi. 2001.
5. Nguyen Tan Phong. Npi soi chinh hinh tai giihi. Hpi nghi Tai Mui Hpng toin quoc. 2005.
DAC DIEM LAM SANG VA KET QUA DIEU TR) DI VAT TH^TC QUAN BANG ONG SOI MEM TAI BENH VT^N TAI MUI HQNG TW
Ltrefng Thj Mlnh Humtg*, Trin Thanh Hdi*
TOM T A T
Di vat thirc qudn Id cip ciiu thudng gip tuy ti If tu vong khdng cao nhtmg bien chung do dj vat thuc qudn gay ra van ndng ne gay ton kem ve kinh te, thdi gian vi sire khde ciia bfnh nhan. Myc tieu nghien cihi: Md la d^c diim ldm sang DVTQ va lanh gia kit qua soi gip DV bdng OSM. Doi tirpng v4 phiramg phdp: 48 bfnh nhdn dupe chdn dodn vd diiu tri DVTQ t?i khoa Nf i soi, bfnh vien TMH Trung uong, su dimg phuoiig phdp nghien cilu md td tvmg tnrdng hpp cd can thifp. K^t qui: Bdn chit DV chu ySu la DV hftu co chiem 89,58%, vj tri DV hay gdp d do?n TQ cd 87,5%; cdn l?i Id do?n TQ ngirc 10,42%; rat it gdp DV d do?n TQ hodnh vi bung 2,08%. Trifu chiing
* Dai hpc Y H i Npi
Nhin bii 15-4-2012, duySt in 25-4-2012
