Nhan xet ket qua soi phe quan tre em trong 4 nam (2007-2010) tai Benh vien Nhi Trung uomg
4-year results of bronchoscopy in pediatric patients in the National Chidren's Hospital
Dao IMinh Tuan Benh vien Nhi Trung uong
Tom tat
Soi phe quan la phUdng phap tham dd chan ddan va can thiep dieu trj cac benh ly hd hap tre em. Muc tieu: nhan xet ket qua va tai bien eua ndi sdi phe quan; tlm hieu md hinh cae benh ly hd hap 6uac soi phe quan trong 4 nam (2007-2010) tai Benh vien Nhi Trung Udng. PhUdng phap: hdi eUu, md ta. Ket qua: tre 1-5 tudi dugc Sdi phe quan la chfnh. Sdi dng mem la chu yeu (88%), 2/3 trUdng hdp gay te ddn thuan, tai chd. Hdn 60% dugc chan ddan ket hdp can thiep dieu tri. Nhieu ky thuat dUde sU dung khi sdi phe quan nhu lay dj vat, bdm hut rUa phe quan phe nang... Benh pham dich rUa phe quan phe nang cd gia tri de xet nghiem chan doan benh. Ty le tai bien thap. Md hinh benh ly hd hap dugc ehi djnh sdi da dang. Da sd thudc nhdm benh viem nhiem phe quan phdi, dj dang dUdng thd va di vat dUdng thd.
TCfkt)6a: soi phe quan, can thiep, tre em.
Summary
Bronchoscopy is diagnostic method and intervention treatment for respiratory diseases in children.
Aims: to study the results and complications of bronchoscopy, distribution of children's respiratory diseases was performed bronchoscopy in a 4-year period from 2007 to 2010 at the National Children's hospital.
Methods: a retrospective and descriptive study. Result: almost patients were from 1 to 5 years old. 88%) of those patients were used fibroseopy. 62.5% of eases were performed diagnostic bronchoscopy combined with intervention treatment. There were sdme techniques in combination with bronchoscopy including broncholarage, foreign-body removing. The rate of complication was low. The respiratory diseases were as follows: chronic bronchopneumonia, foreign body removing, respiratory track malformation.
Keywords: bronchoscopy, intervention, children.
1. Dat van de thdi gian 4 nam tU 1/2007 den 12/2010 tai Benh vien Soi phe quan la mdt phuang phIp t h i m dd va can ^hi Trung uong nham muc dfeh:
thiep rat ed hieu q u i ddi vdi nhieu benh ly hd hap d tre ?• Nhdn xet ket qud vd tai bien cua phuang phdp em. TU n l m 2001 den nay viec I p dung ky thuat soi soi phe qudn trong thdm dd chdn dodn vd can thiep phe quan tre em dugc tien hinh thudng quy tai khoa ^ieu tri cdc benh ly hd hdp tre em.
Hd hap Benh vien Nhi Trung uang. Tdng ket va phan 2. 77m hieu md hinh cdc benh ly hd hdp tre em tfch sd benh nhi dugc tien hanh soi phe quan trong dugc tien hdnh soi phe qudn.
Phan bien khoa hoc: PGS.TS. NGUYEN DINH TIEN
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2. Doi tuong va phUOng phap nghien cuTu 2.7. Ddi tuang nghien cdu
Gdm 1018 trudng hpp benh nhi dugc tien hanh soi phe quan trong thdi gian 4 nam tU 2007 dan 2010 tai Benh vien Nhi Trung uang.
2.2. Phuang phap nghien cdu
- Nghien eUu md t l .
Tat c l cac benh nhi da soi phe quin deu dugc tien hanh qua cle bude: ehuan bj, tien me, soi phe quan, theo ddi sau soi. Dien bien qua trinh soi dugc ghi hinh va md ta eu the trong bien ban soi phe quan.
* Chi djnh soi phe quan vdi muc dfeh t h i m dd chan d o l n nhU: nghi ngd ed dj vat dUdng thd, nghi ngd dj dang dudng thd bam sinh hole mic phli (sau chan thuong, sau dat ndi khf q u i n thd may keo dai g l y hep...)
Hinh anh dai the: hinh dang, khau kfnh, mau sic cua niem mac dudng thd, tinh trang viem xung huyet, cle nep van rail, cac vdng sun khf phe quan, cac CUa mieng Id phe quin... Cle thanh phan ehUa trong Idng dudng thd dugc ghi nhan nhu dj vat, djch tiet, djch mu, td ehUc b l dau vdi cle d i e diem ve sd lupng, mau sic, dp quanh dfnh, mui...
- Danh gia, nhan xet cle yeu td t i c ddng tU ben ngoai vao dudng thd: su chen ep dudng thd gay hep, bien dang do hach trung that, do dj dang mach m l u d eudng tim, u d trung that...
Nhln xet dudng thd nhu dd khf thue quan bl'm sinh, khang djnh chan d o l n nhu ho ra mau, hole vi tri tdn thuong (noi ehly mau...).
Bom rUa phe q u i n phe nang lay djch rUa lam benh pham cd g i l tri cao trong xet nghiem sinh hoa, te bao, mien djch, vi sinh giup ehl'n doan nguyen nhan, mUe dp nang eua rl't nhieu benh ly hd hap tre em.
Sinh thiet niem mac khf phe quin, sinh thiet cae td chUe sui loet d thanh khf phe q u i n cho hinh anh md benh hpc eua cle tdn thuong d dudng thd giup chan d o l n cle trudng hpp benh ly phUe tap nhu lao, u...
Phdi hpp chup phe quan can quang (Bronehographie).
* Chi djnh soi phe quan vdi muc dfeh can thiep dieu trj nhU: Lay bd dj vat; Bom hut rUa lam thdng khf phe thung, p h l n thuy bj t i e do ddm quanh, djch viem, gay xep phdi hole thuy phdi; bom rUa dich mu trong cle trudng hpp g i l n phe quan bdi nhiem;
Nong g i l n khf phe quan khi bj hep bam sinh hay mac phai; Cat bd u hat, ddt lazer, u sui, granulome;
Cam m l u trong mdt sd trUdng hop.
* Phuang tien m I y mde he thdng soi phe quin:
+ Soi phe q u i n dng cUng: SU dung bd dng sol hang Karlstorz vdi cle kfeh cd dng soi khIc nhau tii size 2,5 -> 5. Cd sU dung dng kfnh tele de quan sat va hd trp.
+ Soi phe q u i n dng mem: SU dung bd dng soi mem Olympus vdi cae kfeh thude dng soi khac nhau tU 2,8mm den 5,2mm. Kem theo bd vi xCf ly hinh I n h , luu giU hinh I n h va truyen hinh I n h vao bd nhd.
XU ly sd lieu bang phuong phIp thdng ke yhpe.
3. Ket qua nghien cuTu
3.1. Tuoi, gidi cOa doi tuang nghien cdu
Bang 1 . Tudi, gidi cua cle benh nhan dugc soi phe q u i n
5-<10tudi
58 47 105
> 10 tuoi
46 24 70
Tong so
549 469 1018
3.2. So benh nhan duac soi phe quan theo tuoi
Bang 2. Phan bd benh nhan theo tudi va phuong phIp soi
LUa tuoi
<12thang 1 - <2 tudi 2 tudi - <5 tudi
5-10 tudi
> 10 tudi Tdng sd
Sd benh nhan soi phe quan dng eiing n
9 51 44 12 6 122
% 0,8 5,0 4,3 1,2 0,6 11,98
Sd benh nhan soi phequan dng mem n
233 360 146 93 64 896
% 22,88 35,36 14,34 9,13 6,28 88,10 3.3. Cac phuang phap gay te va gay me ap dung khi soi phequan
Bang 3. PhUOng p h I p gay me va g l y te khi soi phe q u i n
PhUdng phap gay me - Gay te tai chd ket hdp tien me - Gay me tdan than (tinh mach) -Gay me + gian ed
Tdng so
Sd benh nhan 291 706 21 1018
% 28,6 69,3 2,06 100,00 3.4. So BN soi phe quan vdi chi djnh tham do dieu tn va chi djnh can thiep dieu tn
Bang 4. Muc dfeh eua ehi djnh soi phe q u i n
Muc dfeh ehi djnh soi phequan
Chan doan dieu trj Tong sd
Sd benh nhan soi dng cUng
31 91 122
Sd benh nhan soi dng mem
351 545 896
Tdng sd
382 636 1018
% 37;5 62,5 100,00 Nhu vay so tre dugc soi phe q u i n vdi muc dfeh tham dd chan d o l n dan thuan chi ehiem 37,5%), cdn gan 2/3 trudng hpp dUdc soi phe q u i n vUa n h l m chan d o l n xle djnh ket hop can thiep dieu trj.
3.5. Cac ky thuat tien hanh khi soi phe quan
Vdi cle muc dfeh tham dd chan d o l n hay can thiep dieu trj, cle bien p h I p ky thuat dugc tien hanh tuy theo cle trudng hpp cu the. Tdng hpp cic ky thuat dugc tien hanh khi soi phe q u i n the hien d bang 5.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol6-N°4/2011
Bang 5. Cle ky thuat tien hanh khi soi phe quin
Muc dfeh soi phe quan
Tham dd chan doan
Ket hdp can thiep dieu trj
Ky thuat tien hanh - Danh gia tdn thUdng dai the dUdng thd
- Phat hien nhan xet eae yeu td tac ddng tU ben ngdai vad dudng thd
- Benh pham djch rUa PQPN lam xet nghiem - Sinh thiet niem mac, thanh dUdng thd - Chup phe quan can quang
- Bdm hut rUa lam thdng thdang dUdng thd, dieu trj, xep, tac, gian phequan
- Lay bd dj vat
- Ndng gian khf phe quan bj hep - Ddt, cat bd u hat, u siji, Granuldma -Cam mau tai chd
- Chpc hut u nang nhay khf phe quan - Hd trp phau thuat tad hinh khf phe quan
Sd benh nhi 917 109
974 32 65 367
140 9 14
3 4 4
T^le%
90,1 10,7
95,6 3,1 6,2 63,1
13,7 0,8 1,3 0,3 0,4 0,4
3.6. Benh pham djch rda phequan phe nang thu duac khi soi phequan rat cd gia tri de xet nghiem giup cho chan doan benh
Bang 6. Cle xet nghiem tU djch rUa phe quin phe nang
Ldai tai bien -Sinh hda:
+ Ndng dp Albumin + Phan Ung Rivalta - Te bao:
+ Sd lUdng + Phan ldai te bad - Xet nghiem mien dich :
IgA, IgM, IgB -Visinh:
Sdi tUdi
Cay tlm vi khuan Cay tlm virus
Ky sinh trung, vi sinh vat khac
Sd benh nhan 726/974
726 700 690/974
690 690
148/974 970/974
48 966 318 120
Ty le % 74,53
70,84
15,19 99,58
3.7. Mo hinh benh ly ho hap duac chan doan trUdc va sau soi phequan Bang 7. Cle benh hd hap trUde v l sau soi phe q u i n
TT
1 2 3 4 5 6 7 8 9 10 11 12
Benh ly hd hap
Viem phe quan phdi Viem VPQP
Gian phequan
Xep phdi, xep thuy phdi Abees phdi
Lao phdi
Dj vat dudng thd cap Dj vat dudng thd bd quen
Dj dang mach mau phe quan, phdi Dj dang dudng thd va phdi
U phdi
Cac benh ly khac Tdng sd
SdBN trudc
soi 298 132 49 165
39 22 127
31 09 91 4 51 1018
Ty le %
29,27 17,87 4,81 12,27
3,83 3,14 10,5 4,02 1,17 6,0 0,3 6,67 100%
SdBN sau soi
263 204 32 121
23 55 91 49 11 73 3 93 1018
Ty le %
25,83 20,03 4,12 12,86
3,24 4,44 7,95 3,83 1,08 7,76 0,3 6,67
100
So BN sai lech chan doan so vdi trUde soi
35 72 17 44 16 33 36 18 2 18
1 42 334 Nhu vay sd sai lech chan d o l n trUde v l sau khi soi phe q u i n la 334/1018 = 32,80%).Viem phe q u i n phdi keo dai (Bronchopneumoniae chronic) ed khoing thdi gian benh keo dai > 1 t h i n g v l viem phe q u i n phdi tai nhiem (Bronchopneumonia recurrent) la nhUng dot viem phe q u i n phdi t i i di t i i lai nhieu lan. Hai benh ly nay ehiem ty le Idn trong cle ehi djnh soi phe q u i n tre em. Cd tdi gan 1/3 trUdng hpp dugc chan d o l n x l e djnh lai khIc vdi chan d o l n benh trudc khi soi phe quan.
3.8. Ty le cac tai bien gap phai trong va sau khi soi phi quan Bang 8. Tai bien trong va sau soi phe q u i n
Loai tai bien
Chay mau dUdng thd
Phu ne thanh quan gay khd thd cap Gay rang
Sd benh nhan soi dng cUng cd tai bien
n 22
9 5 26
% 18,0
7,3 4,1 21,3
Sd benh nhan soi dng mem ed tai bien
n 3 4 0 7
% 0,3 0,42
0 0,72 Ty le cd tai bien khi soi phe q u i n dng cUng la 21,3%) edn tai bien khi soi dng mem la 0,72%).
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4. Ban luan
Khdng cd sU khIc biet ve gidi trong sd cae ddi tupng nghien cUu.
LUa tudi dugc ehi djnh soi phe quan tap trung tU 1 den 5 tudi (843/1018 = 82,8%)) trong dd lUa tudi dugc soi nhieu nhat la tU 1-2 tudi. Dieu nay la phu hpp vdi ty' le benh ly hd hap nhap vien d lUa tudi nay la cao nhat. Sd tre < 1 tudi ngay cing dugc chi djnh soi rpng rai hon phan do ky thuat soi dugc ning eao, phan nhu eau can soi de phIt hien tdn thuang bl'm sinh dudng thd. Ty le benh nhln soi phe quan dng cUng la 11,98%. ChCi yeu la cae trudng hop dj vat dudng thd cap va bd quen. Sd cdn lai dugc soi phe quin dng mem (88,0%). Thdi gian gan day ty le soi phe quin dng mem ngay cang cao nham muc dfeh chan doan va can thiep dieu tri nhUng benh ly phUe tap, khd khIn. Hon nUa sU Uu viet cua ky thuat va han che tai bien cua dng soi mem cung ngay d n g dugc chUng minh. Viec tien hanh soi dng cUng ngay cang ft di, chi ap dung cho eae trUdng hpp dj v l t dudng thd can lay bd, hole mdt sd trudng hpp can can thiep dieu trj nhu ddt eat u sui Granulcome... ThUc te nay cung phu hpp vdi xu hudng hien nay tren the gidi la chu yeu sU dung dng soi mem, ft gay tai bien don giln va hieu q u i cho lupng thdng tin phong phu hon [3] [5] vao cle phe quin nhlnh nhd hon.
Cd tdi gan 1/2 cac trUdng hpp soi phe quan chi sU dung phuong phIp gay te tai chd ket hpp tien me. Sd phli gay me toan than (tinh mach) hole phai gay me va giln co chu yeu d cle trUdng hop nang, khd khan hay ehi djnh lay dj vat dudng thd. Dieu nay the hien su hoan thien hon ve ky thuat va sU phdi hop hieu q u i , ft bfen chUng trong edng t i e gay te, me khi soi phe q u i n [1]
So sinh vdi mdt sd t i c g i l khIc khi tien hanh soi phe quin nhu Albertini [1], hon 85% cac trudng hpp soi phe q u i n dng mem chi can gay te tai chd ket hop tien me tdt, ed su phdi hpp giUa bac si gay me va bac si soi.
Sd benh nhan dugc soi phe quan vdi muc dfeh vUa t h i m dd chan doan ket hpp vdi can thiep dieu trj ehiem gan 2/3 trudng hpp. Dieu nay ndi len su can thiet cung nhU hieu q u i eua phUdng phIp soi phe quan. Theo De Blic [2], soi phe quan giup feh
eho chan d o l n cle benh ly hd hap khd, phUe tap, ddng thdi cdn la mdt bien phIp dieu trj ed hieu qui mdt sd trudng hop nhU viem mu dudng thd keo dai, gian phe q u i n , xep t i e thuy phdi, die biet la chi djnh bat budc trong cle trudng hop di vat dudng thd [3] [4].
Cac ky thuat dugc tien hanh khi soi phe quan k h i phong phu. Tuy theo muc dfeh t h i m dd chan d o l n hay can thiep dieu tri. Hau nhU (>90%) cac trudng hpp mudn chan doan benh khi soi phe quin deu dUa vao cle nhan djnh tdn thuong dai the, nhUng p h I t hien sU t i c ddng tU ben ngoai vac dudng thd, v l dugc tien hanh bom rUa phe quin phe nang lay benh phl'm de xet nghiem tlm nguyen n h l n (vi sinh) cung nhU d i n h g i l tinh trang cija benh (mien djch, te bao...). Mdt sd trUdng hpp dUpc sinh thiet thanh phe q u i n l i m md benh hpc giup cho chan d o l n xac djnh benh.
Tuy nhien sd benh nhi dugc tien hinh sinh thiet edn han che. So vdi mdt sd trung t l m soi phe quan khac, viec sinh thiet thanh phe q u i n dugc tien hanh nhieu han [5]. Dai da sd chi sinh thiet trUe tiep niem mac hay thanh phe q u i n vdi noi lay benh pham sinh thiet d vj tri cle eUa mieng Id phe q u i n nghi ngd ton thuong ft khi tien hanh sinh thiet xuyen thanh phe q u i n nhu d ngUdi Idn [3]. Cle ky thuat can thiep dieu trj dupe sU dung nhU lay bd dj v l t , hut rUa phe q u i n phe nang lam thdng t h o i n g dudng thd, chong xep t i c phe q u i n thuy, p h l n thuy, nang giln khf phe q u i n bj hep, e l t dot u sui, Granulome, cam mau tai chd... eho thay k h i hieu q u i , sd benh nhi dUpc I p dung soi v l can thiep dieu trj nhU tren khi Idn.
Dae biet benh pham djch rUa phe q u i n phe nang thu dugc khi soi d l dugc xet nghiem tren cle linh vUe sinh h o i , te bao, mien djch, ve vinh... giup cho chan d o l n tinh trang benh ly cung nhu nguyen n h l n eua benh hieu q u i cao.
NhUng ehi djnh cua benh ly hd hap de soi phe quan la k h i da dang: tU viem phdi keo dai, t i i nhiem, g i l n phe q u i n , lao phdi, xep phdi, den dj vat dUdng thd, dj dang dudng thd va phdi... Nhu vay, chi djnh soi phe q u i n la rat rpng rai. Dae biet ve mat chan doan ed tdi 32,8%) cle trudng hpp dUpc chan doan sau soi khac vdi chan doan trudc soi. Dieu nay noi
len hieu q u i cua phuong p h I p soi phe q u i n . Nhu vay gan 1/3 trudng hpp dugc chan doan xle djnh nhd soi phe q u i n . Tie dung can thiep dieu tri nhu lay bd dj vat, bom hut rUa phe q u i n phe nang eua phuang p h I p sol phe q u i n dugc the hien rd ret.
Nhieu benh nhan sau soi phe q u i n , bom rUa hut mu d phe q u i n phe nang d l c i i thien tinh trang viem nhiem rd ret. Ket qua cua chung tdi phu hpp vdi cle t i c g i l khIc nhu Albertini [1].
Ty le tai bien cua soi phe q u i n tre em ndi chung thap (33/1018 = 3,24%o) chu yeu d soi dng eUng (21,3%)), cdn dng mem chi cd ty le tai bien la 0,72%).
Ket q u i n i y phu hpp vdi nghien cUu cua da sd cle tie g i l khIe [1], [2], [3]. Cle tai bien deu d mUc dp nhe, de xUtrf. Khdng cd trUdng hop nao tUvong hay phli can thiep hdi sUe tfch cUc.
5. Ket luan
1. LUa tudi tU 1-5 tudi dugc soi phe q u i n nhieu nhlt. Chu yeu cle trudng hpp dugc soi phe q u i n bang dng mem vdi sU g l y te tai chd ket hpp tien me.
Gan 2/3 trUdng hop dugc soi ket hpp t h i m dd chan d o l n va can thiep dieu tri. Nhieu ky thuat dugc tien hinh khi soi phe q u i n trong dd bom hut rUa phe q u i n xet nghiem va thdng t h o i n g dudng thd, lay bd dj vat, d i n h g i l tdn thuang dai the dugc tien hanh thudng xuyen (>90%) cle trUdng hpp). Nhieu ket q u i xet nghiem cd g i l trj (sinh h o i , te bao, mien djch, vi sinh) thu dugc tU djch rUa phe q u i n phe nang.
Ty le tai bien eua soi phe q u i n tre em khdng cao, chu yeu gap d soi dng cUng. Hon nUa mUc dp tai bien thudng nhe, ft g l y I n h hudng Idn.
2. Md hinh benh ly hd hap tre em dugc ehi djnh soi phe q u i n trong 4 n l m tai Benh vien Nhi Trung uang, k h i da dang, tap trung vao nhdm cle benh ly viem phe q u i n phdi keo dai, viem phe q u i n phdi tai nhiem, lao, gian phe q u i n , dj dang dudng thd va phdi... Dae biet dj vat dudng thd I I chi djnh bat budc cua soi phe q u i n tre em.
Tai lieu tham khao
1. Albertini M. (2001), Bronchoseopie intervertionnelle en reanination. In Labre A, Dutau G., eds. Endoseopie bronehique en pediatric. References en Pediatric, Paris: Elsevier, 123-56.
2. De Blic J. (2001), Lavage bronchoalveolaire. In Labre A, Dutau G. eds. Endoseopie bronehique en pediatric.
References en pediatric, Paris: Elsevier, 151 - 63.
3. Jiao AX, Liu XC (2010), The role of bronchoscopy in diagnosis and treatment of bronchopneumonia recurrent in children. Ihonghua Erke Za Zhi, Oct, 48 (10): 756-8.
4. Korlacki W, Koreeka K, Dzieliek J. (2011), Foreign body aspiration in children: diagnostic and therapeutic role of bronchoscopy. Pediatr. Surg. Int. Mar 13.
5. Labre A, Dutau G. (2001), Endoscope bronehique en Pediatric. References en pediatric. Paris: Elsevier, 198 p.
