VIETNAM MEDICAL JOURHAL H°2 - FEBRUARY • 2017 la u d eo tuyen giap. Theo Lee , c6 7,3%_khoi u
d eo tuyen giap dtfdc phat hien qua sieu^am [ 7 ] , trong nghien cufu cua chung toi t y !e gap nhieu nhat la TIRADS 4 v d 7 4 , 2 % va TERADS 5 la 17,5%, cd 1 % la T[RADS 2 tren sieu arn. Ttfdng du'dng vdi nghien ctfu cua Le Van Thong nam 2014 la 7 1 , 1 % vdi TERADS 4 va 17,9% vdi TIRADS 5 [1].
- Xet nghifim t e bao hoc: Trong nghien cijtf cua chung toi, do nhay cua te bao hpc len den 95,8%. Nguyen nlian co the la do sinh thiet te bao hoc tai benh vien iJai hoc Y Ha Npi dutfc tien hanh thu'dng quy hdn.
- Mo benh hoc: Qua nghien cdu chung toi thay CO tdi 96,9% la ung thtf bieu mo tuyen giap the nhu, nhu nang va- co 3 , 1 % la the nang va khong cd tru'dng hdp nao the tuy hoac the khdng biet hda. Ket qua nay cao hdn so vdi ket qua nghien ctfu ciia cac tac gia Le Van Quang, the nhu chiem ty le 79,5% va the nang la 16,5% [ 4 ] .
4 . 2 . Tlnh trang di can hach
-H^ch t r e n Iam sang va sieu a m : Qua nghien ctfu chung tdi thay t y le hach dtfdc kham phat hien tren lam sang la 17,5% tri/dng hdp, Ti le phat hien hach tren sieu am cao hdn chiem ty le 23,7% chtfng to sieu am nhay hdn trong viec phat hien hach.
-Di can hach: Ty le di can hach trong nghien cuXi cua chung toi la 5 8 % , cao hdn so vdi cac tac gia khac. Theo Yale va cong stf (2005) ty le di can hach d benh nhan ung thtf bleu mo tuyen giap tiie biet hoa la 49,7%.
Doi chieu giffa hach tren lam sang va sieu am vdi ket qua giai p h l u benh hach sau mo nhan thay: Co 70,6% benh nhan kham thay hach tren lam sang phat hien di can hach va 54,7% benh nhan khong kham thay hach tren lam sang co di can h?ch. Theo ChCr Quoc Hoan (2013) cd 93,5% hach tren lam sang khang dinh la di can.
cd 10,2% di can hach c6 khong phat hien di/cfc trSn lam sang [ 3 ] . Vdi sieu am ta cung cho ket qua tu'dng dtfdng vdi 7 3 , 9 % hach phat hien qua sieu am cd di can va 5 1 , 7 % benh nhan cd di can hach tiem an,
V. Kit LUAN
UTTG gap nhieu d ntf trung nien vdi bieu hi$n ndi khoi d vung co.
Sieu am la phtfdng tien ddn gian, hieu qua de phat hien u tuyen giap; te bao hpc co dp nhay cao len den 9 5 , 8 % va the mo benfi hpc hay gap nhat la the nhu.
Di can hach gap d 5 8 % benh nhan, nhieu trtfdng hdp cd di can tiem an, khong phat hien dtfdc hach tren lam sang cung nhtf sieu am.
TAI UEU T H A M KHAO ^ 1. I r a n Van Thong (2014). Danh gia k^ sdm did
phau thuat ung did luyen giap ^i Benh \0i{)ai hoc YHa Noi, Luan van thac s\ y hoc, Dal hocY Ha N6i.
2. Lin 3, Hsueh C. and Chao C. (2016). Soft tissue invasion of papillary thyroid carcinoma, Clin Exp i^etastasis.
3. Chtf Quoc Hoan (2013). Nhan xet mot ^6^
di&n iam sang, ti ie rsc nhom mo binh hoc ra A#
qua diiu tii ung did tuyen giap tai Binh vi?^m.
Luan van Bac sT ngi tru benh vien, Dai hoc Y Ha [ i ^ S 4 . Le Van Quang (2002). Nh|n xet d§c diemflap' sang va cac phircing phap dieu tri ung thiTtuyerf giap tai Benh vien K tiT nam 1992 - 2000, Tap dii
Yhoc. 431, 323-326.
5. Kluijfliout W. et al (2016). Requency of Higli Risk Characteristics Requiring Total Tbyroidectomy for 14' an V\/eJ] Differentiated Thyroid Cancer, Thfmid.
6. Nguyin Tien Lang (2008J^, Danh gia k& qua phiu thuat cat toan bo tuyen giap phoi hdp vp 1131 diiu tri ung thd tuyen giap tfie biet hoa, Luan van tot nghiep BS CK I I , Dai hoc Y Ha I>l6i.
7. Lee Y., et a1(2016) Cliiiicopathoiogic characteristics and pattern of central lymph node metastasis in papillary thyroid cancer located In the isthmus. Laryngoscope.
VIEM TUYEN TIEN LIET MAN TINH VA
HOI CHU'NG DAU VUNG CHAU H O N G - T A N G SINH MON MAN TINH Tran Van Hinh*, Nguyin Phifffng Hong**
M TAT Bftyah de. Viem tuyen tien Net m?n tinh (VTTL MT) va hoi chutig dau vijng chau h6ng-t3ng sinh mon man tinh (HC DVCH-TSM MT) do nhieu nguyen nhan gay ra. Chan doan va dieu trj con nhieu kho ktiSn.
Muc dich cua bai viet la neu lin cO scf cua viec ctian doan, dieu trj can benh va hoi chutig nay. Phudng phap: Tham khao c^c cong trinh nghien cuU ve VTTL MT va HC DVCH-TSM MT da du'dc cong bo trong nhij'ng nam gan day. Ket gua: VTTL MT va HC DVCH- TSM MT la thu'dng g|p, trong do VTTL MT do vi khuan (loai II) chi chiem tu" 5 - 15%, con lai nguyen nhin
*Wpc viin Quan Y
** Phong kham Da khoa Au Viet.
Chju trach nhiem chfnh: Tran Van Hinh Email: [email protected] Ngay nhan bai: 18.9.2016 Ngay phan bign khoa hoc: 3.01.2017 Ngay duyet bai: 10.01.2017
TAP CHi Y HOC VIET NAM TAP 451 - T H A H G 2 - SO 2 - 2017
cua dai da so HC DVCH-TSM MT la phan iitig viem tuyen tien liet khdng do vi khuSn (loai IIIA) va khong do phan utig vfem tuyen t^'en Iret (loai IIIB). Chan doan dda vao thii" nghiem Stamey- Meares hay ddn gian hdn la xet nghiem nu'dc tieu du'dc lay sau xoa n3n tuyen tien liet (NT LSXN TTL) va x^ nghiem tinh djdi. Lieu phap khang sinh dai han, dda theo khang sinh dS duWc chi djnh Idii thu" nghiefn hoac cac xet nghien noi tren tim thSy vi khuan gSy benh. Xoa nan tuyen tien l[et^ nhat la khi benh nhan duWc tru' dau, gop phan ho trd cho lieu phap khang sinh. Ketluair.
vm. MJ va HC DVCH-TSM MT la thu'cing gIp. Cd'sd aJa chan doan va dieu trj la thu* nghiem Stamey- Meares hoac ddn gian hrSn la xet nghiem NT LSXN TTL va xet nghiem tinh dich.
SUMMARY
CHRONIC BACTERIAL PROSTATTnS AND CHRONIC PELVIC PAIN SYNDROME Purpose. Qironic Bacterial Prostatitis (CPB) and chronic pelvic pain syndrome (CPPS) are due to many
Diagnosis and treatment remain obstades.
K)se of t^e artide is to raise basis of the 1 and treatment of the disease and the
Mediod: To refer research projects on _ I CPPS w/hich have been published in recent years. Results: the CBP and CPPS are common, in
\Nhidi the CBP is caused by a type of bacteria (Category 2) representing only 5-15%, remaining causes of majority cases of the CPPS is inflammatory CPPS (category IIIA) and noninflammatory CPPS (category IIIB). The diagnosis is based on Meares- Stamey tests or simply giving post-message urine ample to be tested and semen analysis. Long-term antibiotic use, based on sntibiogram Is indicated w/hen malignant bacterium are found by above-mentioned tests. Prostate massage helps support to the antibiogram. Conclusion: The CBP and CPPS is common. The basis of diagnosis and treatment are Meares-Stamey tests or simply giving post-message unne sample to be tested and semen analysis.
LDjOkTVXNDE
Bang 1: Phan loai VTTL MT vA HC BVCH-
Nam gidi tren 50 tuoi, bj dau vung chau hong-tang sinh mon keo dai tren 3 thang, cd tlie kem theo cac rdi loan du'dng tieu dtfdi va rdi loan xuat tinh, ho bi VTTL MT hay bl benh nam trong HC DVCH-TSM MT. Say la van de dtfdc thao luan rat nhieu trong cac hoi nghj khoa lipc quoc te chuyen nganh. Muc dich cua bai viet ia thong qua cac cong trinh nghien ctfu, da dtfdc cong bo tren cac sach bao khoa hoc tnang nhtfng nam gan day de neu len cd sd cho viec chan doan va dieu trj can benh va hoi chtfng ndi tren.
f I. DO! TirONG VA PHUONG PHAP NGHIEN CUU 2.1. Dich te hoc: Du^ vao so lieu cua Medline (PubMed), nam 2010, Sibert L va cs.
cho biet: Ty le gap cua hoi chtfng dau vung chau hong man tinh/VTTL MT la 10 000/100 000 dan, cua hoi chutig dau bang quang / viem bang quang ke la 239 - 306/100000 dan, cua dau mao tinh hoan-tinh hoan sau that-cat ong dan tinh la 15000 - 20000/100000 dan, cua dau khi phdng tinh va ctfc khoai la 1000-9000/100 000 dan (4). Ty legap cua cac dau viJng chau hong- tlang sinh mon man tinh khac it dtfdc ghi chep trong y van (4). Nhtf vay, VTTL MT va HC DVCH- TSM MT la rat thtfdng gap.
2.2. Phin loan Theo phan loai cij, viem tuyen tien liet bao gom cac hoi chtfng nhiem trijng, dau viJng chau hong, roi loan tieu tien va dau hieu luyen tien Iiet dau khi tham trifc trang.
Khi benh keo dai tren 3 thang, benh nhan b|
VTTL MT. Day la nguyen nhan thu'dng gap, buoc ngtfdi benh phai di kham chuyen khoa tiet nieu - nam hoc, 6 do tuoi tren 50, benh chiem khoang 10% (i). VTTL MT cd anh htfdng rat xau ddi vdi chat Itfdng cuoc song cua ngtfdi benh.
TSM MT cda NIH, 1090.
Loai I
n
n i A
IIIB IV
Ten Viem tuyen tien liet cap
tfnh do vi khuan.
Viem tuyen tien iiet man tinh do vi khuan.
Hpi chtfng dau vung chau hong-tang sinh mon man tinh do phan tfng viem
tuyen tien liet.
Hgl chtfng dau vung chau hong-tSng sinh mon man tfnh khong do phan tfng viem tuyen tiSn liet.
Viem tuyen tien liet
*NQudn: Theo Bishop M. C, nam 2008 (1) Cac dac trtfng cua dinh nghia
Nhiem trIJng cap tinh cua tuyen tien liet.
Viem DTN tai phat, BC va cay DT TTL,... khi khong co trieu chtfng.
Cac trieu chtfng cua HC DVCH- TSM MT. BC trong DTTTL / trong
rrr LSXN TTL / trong tinh djch.
Cac trieu chtfng cua HC DVCH MT. SO Itfdng BC trong DT TTL ft,
khong co y nghla.
Khonq CO trieu chtfnq lam sanq.
Phan loai cu (Drach va cs., 1978) Viem tuyen tien liet cap tinh do vi khuan.
Viem tuyen tien liet man tinh do vi khuan.
Viem tuyen tien liet man tfnh khong do vi khuan.
"Prostatodynie".
VrETNAM MEPICAL JOURNAL N°2 - FEBRUARY-2017
1 khong co trieu chu'ng. Bu'de phat hien tinh cc( (vf du PSA 1 i
tang), BC ± nhiem trung trong A mail NT LSXN TTL, Phan u'ng ' viem tronq nhu mo tuyen tiln liet. 1 -iF Caecum tiiviSitat, DTN: du&ng t&imu; BC: bach au; PSA: ithang nguyen dac hieu aia hjySt tal^
2.3. ca side Chan doan (ttiif nghiSm Stamey - Meares) Loai
I I I I I I A I I I B IV VBQ
VND XN BKL,BC BKL,BC DKL,BC DKL,BC OKL,BC eKL,BC BKL,
BC
V I NTND
>10Vml, + ' It 0 0 0 0 0 0 0
> lOVml
±>10Vml +
V2, NT B a
>10Vml, + It
± 0 0 0 0 0 0
> 107 ml 0 +
V3, NTTTL chong chi
dinh xoa bop TTL
> 107mi + 0 + 0 0 0 +
> lOV ml 0 +
DTTTL chong chi
{Jinh xoa bbpTTL
> 107ml + 0 + 0 0 0 +
± >io7 mi
0 0
Ban luan
+ nhiem trijng BTN cap tfnh, tai phat cay V3^ DT TTL, doi khi cp vi khuan. Khong co nhiem trung BTN cap tinh, tai;' 'J
phat.
cay V3, DT TTL, doi khi CD vi khuan.
V1,V2,V3, DTTTL CO the CO BC khi CO VND phoi help.
Bleu tri bang Nitrofurantoin va nhac iai.
;J
dc cum td Viet tat, XN: xet nghiem; BKL:
dim. khuan iac; BC: bach cau; VBQ: viem bang quang; VND: viem nieu dao; NT: nddc tieu; ND:
nieu dao; BQ: bang quang; TTL: tuyen tien iiet Ihd nghiem nay kho thtfc hien vl DT TTL ft khi thu thap dddc, hdn nu^ cac am tfnh gia la rat thtfdng gap. Tren thtfc te, cac benh nhan bi HC DVCHTTSM MT thtfdng da du'dc dieu trj iiang khang sinh. Rat cd the stf sinh soi nay nd cua vi khuan gay benh se bi dc che, ngay ca khi thoi diJng khang sinh mot thang trtfdc khi lam thtf nghiem. Ngoai trtfc khuan dtfdng rupt, doi vdi cac vi khuan khac va khi soi tu'di nghi ngd, can phai nuoi cay phan lap vi khuan (vf du vi khuan Gram dtfdng). Mgt bat ldi quan trpng khac la ket qua thu' nghiem khong cho phep dtf kien ket qua dieu tn. Mpt each ddn gian hdn la sCr dyng ntfdc tieu tru'dc va sau khi XN TTL (de soi tu'di va nuoi cay) nhd mot giai phap xen ke (1),(3). Cac trieu chtfng cua viem nieu dao, viem liang quang cting thu'dng phoi hdp vdi VTTL MT Ioal I I . Trong trtfdng hdp nay, cac te bao viem tang len va cay NT LSXN TTL phan lap dtfdc vi khuan gay benh, nhu'ng ket qua cua xet nghiem cay tinh dich thtfdng khong chac chan (1).
111. KET QUA VA BAN LUAN
3.1. WemWyaiS^lietmantiraidoviM Viem tuyen tien liet man tfnh do vl l<hu^M' mpt benh nhiem khuan man tinh hoac t a i f f e cua tuyen tien liet. Benh thtfdng gap d dp tuoi tre va trung nien. Benh ly nay dtfdc-de cap rat nhieu trong y van, niitfng benh chi chiem tii' 5 - 15% tong so VTTL MT ndi chung (2). Tren lam sang, thtfdng gap cac trieu chtfng kfch thfch (tfai rat, dai buot) hoac ft gap hdn la cac trieu chiilig tac nghen (dai kho, bi dai) cua dtfdng tiet njeu dtfdi. Benh rihan thtfdng than phien' dau tang sinh m6n, dau vung bung dtfdi ron, dau biu-fi'nh hoan, dau that Itfng hoac dau phan dtfdi cua tn/c trang. Mot dau hieu dac trtfng cua VTTL MT do vi khuan la benh nhan thtfdng bj viem du'dng ti§t nieu, viem nieu dao, viem mao tinh cap tinh tai phat, vdi stf nang len cua cac trieu chu'ng kicii thi'ch bang quang, doi khi phoi hdp vdi sot va tang ctfdng dp dau viJng chau hong-tang sinli mon, gay ra bdi cung mot loai vi khuan (thut^
la Escherichia Coii)(2). VTTL MT do vi khuan d^e xay ra d cac benli nhan, co benh d du'dng b|E nieu dtfdi (hep nieu dao, u tuyen tien liet, % ctfng cd bang quang) hoac dtfdc lam cac.;thiJ thuat d dtfdng tiet nieu dtfdi. Nhtfng thtfdng,jjp nhat la nhiem khuan ngtfdc dong, trao ng(#;
ntfdc tieu vao cac ong tuyen tien liet, khi COWG dj dang giai phau cua cac ong tuyen nay (1).
TAP CHi Y Hpc VigT HAM T^P 451 - T H ^ G 2 - s 6 2 - 2017 Mam benh dac trtfng cua VTTL MT cd the
du'dc phSn lap ttf mau NT LSXN TTL, trong cac giai doan viem cap tfnh tai phat. Giffa cac giai doan do, nguon gdc ciia viem dtfdng tiet nieu tai phat la td VTTL MT, dtfdc chan doan nhd thtf nghiem Stamey - Meares kinh dien (xem bang 2). Cac mam benh nay dtfdc phan lap ttf cac chat djch, dtfdc coi nhtf la cua tuyen tien liet (DT TTL, NT LSXN TTL va tinh djch). Ngoai cac trtfc khuan Gram am va enterococcus faecalis, da dUdc biet ttf lau, cac nghien ctfu gan day (1),(2) cho biet ty le gap tang len cua vi khuan Gram dudng. Chlamydia trachomatis va nam du'dng sinh due. Cho den nay, gia tri cua thCr nghiem Stamey-Meares van dang dtfdc tranh luan trong cac hpi nghi khoa hpc chuyen nghanh (1).
3.2. Hdi chiihg 'dau vung chiu hdng-
&ng sinh mdn man Unh
HC DVCH-TSM MT la dau vijng chau h6hg-ti^t ni$u-sinh due khong do vi khuan, tien trien ft nhat tu' 3 thang trd ten, doi khi phdi hdp vdi cac rSi loan tieu tien va chtfc nang tinh due (1),(3).
Cho den nay, sinh benh hpc cua hpi chtfng nay van dang dtfdc thao luan, nhtfng can nguyeri cua no CO th^ do nhiem trung hoac do phan tfng viem. Nhiem trijng hoac phan u'ng viem bj keo vao qua trinh sinh benh hpc cua hpi chtfng nay khong phai nhu' cac nguyen nhan trtfc. tiep ma nhu" la cac yeu to khdi dau ciia hien ttfdng tang nhay cam than kinh (1). Nhtf vajf, HC DVCH-TSM MT khong phai la mot benh nhiem trung, nhtfng doi khi mpt benh, cd nguon goc nhiem trung, trd thanh m6t benh 1'^ chtfc nang cua viec di^u hoa cac thong diep dau ciia vijng chau hong-tang sinh mon (1).
Trong da so cac trtfdng hdp mac HC DVCH- TSM MT, benh nhan khong cd tien sd viem dudng tiet nifu tai phat. Cac trieu chtfng lam sang ciia hpi chtfng nay cung ttfdng td nhtf cac trieu chutig lam sang cua VTTL MT do vi khuan.
Doi vdi cac loai IIIA va IIIB ciia HC DVCH-TSM MT, tfnh chat tuyen tien liet dau khi tham trtfc trang thay doi that thtfdng. Trong xet nghiem NT LSXN TTL, so Itfdng bach a u binh thtfdng va so khuan lac ciia vi triing gay benh d dtfdi mtfc quy
•djnh gay ra viem tuyen tien liet. Chan doan phan biSt giffa 2 loai IIIA va IIIB dda vao stf hien dien jciia cac te bao bach cau trong DT TTL va trong miu NT LSXN TTL va/hoac trong tinh dich (1),(3) (xem bang 2).
Khi lam sieu am qua tru'c trang, co the quan sat ttiay nhieu dau hieu bat thtfdng, nhtfng stf hdp thtfc ciia chung van dang du'dc thao luan. Y
nghTa cua cac lang dpng can xi trong nhu mo tuyen tien liet chu'a dtfdc xac djnh. Ung thff tuyen tien liet doi khi dtfdc gdi ra d cac benh nhan, bi dau vung chau hong, cd tang PSA huyet thanh, tuyen tien liet khong deu va dau khi tham trtfc trang, mat dp am thay doi (6 ung thtf thtfdng cd mat dp am giam). Chan doan dtfdc khang djnh nhd sinh thiet tuyen tien It^t. C^c trieu chuiig ciia dtfdng tiet nieu dtfdi va dai mau dan den chf djnh do Itfu itfdng dong tieu, lam xet nghiem nieu dpng hpc, soi bang quang va lam cac xet nghiem chan doan hinh anh dtfdng tiet nieu tr§n. Tnang mpt so ft trtfdng hdp, dau tuyen tien liet dtfdc coi nhtf thu6c ve benh ly than kinh ciing va cac tham do chuyen biet dtfdc chf djnh lam tiiy theo cac triSu chuhg lam sang khac gdi y (1),(3).
IV. DIEU TR!
4.1. Dieu tti theo quy u'dc
*Khang sinh: Chi dmh dieu trj khang sinh cho VTTL MT do vl khuan (Ioal I I , theo phan loai ciia NIH) la hdp ly (5). Lieu phap khang sinh dtfdc dung theo khang sinh do cua xet nghiem nuoi cay ntfdc tieu, dffdc lam trong cac giai doan viem dtfdng tiet nieu cap tfnh tai phat. Neu ket qua dieu tn khong ro rang, nuoi cay DT TTL hoac NT LSXN TTL cho phep sff Iffa clipn khang sinh chfnh xac hdn (5). Doi vdi mpt so benh nhan, d giffa nhdm II va IIIA (khong cd tien stf viem dffdng tiet nieu cap ti'nh tai phat, nhffng viem tuyen tien Iiet do vi khuan la ro rang - cay DT TTL, V3 phan lap dffdc vi khuan gay benh), chi djnh dieu tn khang sinh la hdp logic. Cac khang sinh thuoc nhom fluoroquinolon dffdc khuyen diing cho cac vi khuan Gram am (!),(?).
Gan day, cac xet nghiem sinh hpc phan ttf vi khuan cho biet mam binh khang tetracyclin rat hay xay ra. Hdn nffa, hieu qua dieu tn ciia tetracyclin la khong chac chan (1).
Doi vdi cac benh nhan loai III (theo phan loai ciia NIH), dap ffng vdi lieu phap khang sinh CO the dff kien dddc tCiy theo co cac manh cua bp glen ddn boi vi khuan, trdng xet nghiem sinh hpc ph3n ttf, hay khdng (1),(6). Nhin chung, khi nuoi cay va xet nghiem sinh hpc phan ttf am tfnh, khong nen dung khang sinli vi tdn kem va cac tac dung phu cua thuoc (1),(6).
*XN TTL cd the cd hieu qua, dac biet khi benh nhan dtfdc gay te viing hoac gay me toan than. XN TTL cd tac dung khai tiiong cac dtfdng ong^cua tuyen tien liet bj tac, giai thoat cac vi khuan bi tf dpng, cho phep khang sinh tham vao mo tuyen tien liet tot hdn. Cac vien sdi nhd cd the la mpt trong cac nguyen nhan lam tac cac
VIETHAM MEDICAL JOURHAL N''2 - FEBRUARY • 2017 dtfdng dng va ngan can viec giai thoat vi khuan,
cung nhff sff tham vao niiu mo tuyen tien liet ciia khang sinh. Cat tuyen tien liet bang npi soi qua nieu dao cd muc dfch lay bo cac tui sol, nhtfng chi djnh nay phai dffdc can nhac ky, dtfa tren cac yeu t d nhff tudi, tien sff viem dtfdng tiet nieu cap tinh tai phat, dai khd va y kien ciia benh nhan.
'•Thudc chen anfa/finasterid: Stf dung cac thuoc chen anfa van dang dtfdc tranh luan. Cac tac gia iing ho cho rang: Co bang chtfng cho thay d cac benh nhan b| VTTL MT / HC DVCH- TSM MT, cd that van nieu dao hoat ddng qua mtfc. Nhffng khong co mdi lien he giffa dap iihg dieu trj va tac cac dng tuyen, dffdc chffng minh bang xet nghiem nieu dpng hpc. Hdn ntfa, mpt thtf nghiem lam sang, dffdc tien hanh vdi viec sff dung cac thudc chen anfa, da khong cho cac bang chtfng ro rang (1). Bang chtfng ve hieu qua ciia fenasterid cd tinh thuyet phuc hdn, nhtfng d dtfdi mtfc dinh gia (1),
4.2. Dieu tri khac: Ham 1999, trong nghien cffu CO doi chffng vdi gia dffdc, Shoskes va cs. da cho biet "bioflavonoid quercetin" co tac dung cai thien cac trieu chffng cua HC DVCH-TSM, loai IIIA va IIIB (6). Thuoc cd nguon goc tff nhien va CO nhieu tac dpng khac bet, nhtf tfc che monoxit nitd, "tyrosin kinase" va tfc che nhieu "cytokins"
viem (6). Nhieu nghien ciru da chi ra rang trong DT TTL va tinh djch cua benh nhan loai IUA, ty Ie I L l va TNF-a tang cao hdn trong DT TTL va tinli dich ciia benh nhan toai IIIB.
V . K S T LUAN
HC DVCH-TSN MT la rat thffdng gap va do nhieu nguyen nhan gay nen, trong do VTTL MT do vi khuan chi chiem ttf 5 - 15%, con lai dai da so nguyen nhan la do phan tfng viern tuyen tien
liet, khong do vi khuan va khong do phan ffng, viem tuyen tien liet. Chan doan dtfa vao thu^
nghiem Stamey-Meares hoac ddn gian hdn la d u ^ vao xet nghiem (soi tu'di va nuoi cay) NT LSXN TTL va xet nghiem (soi tffdi va nuoi cay) tinh djch. Lieu phap khang sinh dai han dffa theo khang sinh do dffdc chi djnh, khi nuoi cay cac dich the {ddtic coi la ciia tuyen tien liet) trong cac ddt viem dtfdng tiet nieu cap tfnh tai pha^
tim thay, vi khu^n gay benh, Ngoai ra, XN, TTL nhat la khi benh nhan dtfdc trff dau, co the ho t r d cho lieu phap khang sinh. Nhin chung, chan doan va dieu tri' hpi chihig nay con la mpt thach thtfc ddi vdi gidi y hpc.
TAI LIEU THAIVI KHAO
1. BJshop M. C. (2008). Prostatite. Traite d'andrdo^
a i'usage des dinidens Springer; 217 - 224.
2. Delavierre D. (2014). La prostatie chronique est- elle une maladie infectieuse ? Prog, en Urol.-FMC.
24: 1 1 1 - 1 1 4 .
3. Krieger J. N., Nyberg L. et Nickel J. C. (1999).
NIH consensus, definition and classification of prostatitis. JAMA; 282:236 - 237.
4 . Sfbert L., Rigaud J., Delavierre D. et al, (2010). Epidemieologie et aspects esconomiques des douleurs pelviperineales chroniques. Prog, en Uroi, 20: 872-^^^.
5. Shoskes D. A. et Shahed A. (2000). F^esmce of bacterial signal in expressed prostatic secretions predicts response tD antibiotic therapy in men wltJi chrwiic pelMC pain syndrome. J, Urol.; 163, Sup^.: 23.
6. Shoskes D. A., Zeitlin 5. I., Shahed A. et aL (1999). Quercebn in men with category ID chronic prostatitis: a preliminary prospective, double blind, placebo controlled dial. Urology; 54: 960 - 963.
7. Weidner W., Ludwig M., Brahler E. et al, (1999). Outcome of antibiotic therapy with Ciprofloxacin in chronic bacterial prostatitis.
Drugs; 58, SuppI. 2: 103 - 106.
NGHIEN CU'U BAC DIEM HINH ANH CHUP CAT LOT VI TINH S 6 l NIEU Q U A N
T O M T A T
* i<^oa chan doan hinh anh, Binh viin Bach mai
**Tru'dng Dai hoc YHai Phong Chiu trach nhiem chinh: Nguyen Xuan Hien Email: [email protected] Ngay nhan bai: 5.11.2016 Ngay phan bien khoa hoc; 6.01.2017 Ngay duyet bai; 17.01.2017
Nguyen XuSn Hien*, Nguyin Van Khai**
Myc t i e u : Mo ta dac diem hinh anh soi nieu quan tren chup cat Idp vi tinh. Dm ttfdng va phu'dng phap: Nghien cffu mo ta c3l ngang 113 benh nhan vdi 122 vien soi nieu quan tren phim chup CLVT da day (64 day) Idp cat 0,75mm trffdc, sau tiem va thi mugn co tai tao MIP va 3D tai khoa chan doan hinh anh benh vien Bach Mai tff thang 1/2016 den thang 10^2016. Ket qua: soi nieu quan thu'dng g5p d (16 tuoi 50-59 la (37,74%). 06 tuoi trung binh 50,95 ± 15,05, Ty Ie nff/nam la l:2,14.Ty le soi d vi tri riieu quan 1/3 tren chiem 45,9%, it gap hdn sol d vi tri niiu
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