qua ffifu tra vf sinH mdi trudng tgi 3 huyfn Quan Bg, Yf n Minh, Chif m Hda thupc khu vue miln niii phia Bac nam 2005, hau hit ngudi dan d cdc vimg mifn niii ndy deu khdng cd thdi quen ru-a tay xd phdng trudc khi an vd sau khi dgi tilu tifn. Ch? cd 0,2% d i i tupng thudng xuyf n rira tay xd phdng trudc khi dn vd 0,8% d i i tupng rua tay xd phdng sau khi dgi tieu tifn. Cung nhu cao hon ket qua dilu tra trong "Nghifn cii-u thdi quen sinh hogt eua ngudi ddn" la mpt Dg- dn Quic gia v l v i n d l rua tay dupe thg-c hifn g i n day do Worid Bank tiln hdnh dilu tra tgi 8 tinh nude ta. Tong s l doi tupng dupe du vin (quan sdt, phdng v i n , theo ddi) Id 720 ba mg cd con nhd dudi 5 tuoi, dang song tgi ede thj tran & khu vg-c ndng thdn cdc xa. Kit qua cho thay rang dgi da so doi tupng ru-a tay it nhlt 3 lan/ngay, tuy vgy, phan nu-a so dd chi ru-a tay vdi nude, 1/4 dting xd phdng thom vd phan cdn Igi diing eae chit tay ru-a khde; 60% so ngudi dg- vin chi rira tay vdi nude cho bilt hp thiy xd phdng khong d n thilt va vifc su- dgng xd phdng d l ru-a tay cd mli tuong quan true tilp d i i vdi trinh dp hpc v i n ciia ngudi du vin.
v l hdnh vi rira tay, trong so nhO'ng hogt dpng vf sinh ed nhdn, ru'a tay bdng xd phdng chi dupe 5% so ba me dupe phong van d l cfp d i n dau tifn. Trudng hpp rira tay thudng xuyf n nhat Id sau khi di v f sinh, theo do Id trude bira dn, sau khi lau ehiii eho tre vd sau khi n l u dn. Theo quan sat, ty If rua tay xd phdng thuc t l Id 5%
trude khi cho tre an vd 3% sau khi eho tre an. Sau khi cho tre di dgi tifn, chi cd 1/4 so ngudi dupe phdng v i n ed n>a tay blng xd phdng banh - ty If nay bang vdi ty If khi ngudi dg vin trg-c tiep di dgi tifn, 1/4 su- dgng logi
chit t l y ru-a khde. Dgc bift qua kit qua nghifn ciru eua chung^tdi cdn cho thiy nhirng ly do md nhu-ng dii tupng trg-c tilp chdm sdc tre dudi 5 tuli da khdng ara tay bang xd phdng Id khdng ed xd phdng (46,7%) vd khdng ed thdi quen ru-a tay bdng xd phdng (33,7%). Vdi nhirng ly do nay Id lydo nggy bifn eho nhii-ng hdnh vi khdng Idnh mgnh de d i n d i n cdc bfnh dudng tifu hda do bdn tay bin gay ra.
KtT LUAN
Thdi dilm ai-a tay bang xd phdng cua cac doi tupng nghien ciru chu y l u trudc khi dn (80,7%) sau dd giam dan sau dgi tifn, tilu tifn vd ddc bift nguy hilm ehi cd 1,7% s l doi tuong cd ru-a khi sau khi chdm sdc ngudi dm.
TAI LIEU THAM KHAO
1. Cgc Y t l Du phdng va moi trudng Vift Nam va Trung tdm u-ng dgng d p nude vf sinh mdi trudng (2008). Hign trgng rira tay xi phdng trudc vi sau can thidp tgi dja bin dw in do Unilever tai trg. Nhd xult ban Y hpc Ha Ndi
2. Cgc Y t l Dg phdng vd mdi trudng Vift Nam vd Trung tdm irng dgng d p nude vf sinh mdi trudng (2008). Dinh gii ty 1$ RTXP vi mdt s6 yeu to lidn quan ciia cic bi mg hign dang cham sdc con nho du^i 5 tuoi. Nha xuat ban Y hpc Hd Nfi
3. Indochina Research (2007), Dy in Qudc gia vi Vin dS rira tay - Nghidn ciru thdi quen sinh hogt cua ngudi dan.
Dilu tra co ban
4. American Red Cross (2005), Hand washing with soap in the mothers with children under 2 years in Viet Nam
5. Haris Interactive (2005), Survey of hand washing behavior in the America.
UEN QUAN GiffA MAT DO KHOANG XirffNG CANG TAY VA MOT SO CHI SO NHAN TRAC or SINH VIEN TRUdNG DAI HOC Y DUVC ciu TH0
T6M TAT
Mgt dg khoing xuong phy thu0c vio nhiiu yiu ti va cd thi dinh gia bang phwong phip do hap thy tia X ning Iwgng kep. Nghien cwu dugc tiin hanh tren 101 sinh vieri (51 nam vi 50 nir) tnrdng Dgi hgc Y Duoc Can
Tha nham xic ffinh mii lien quan giira mgt dg khoing xuong cang tay vi mgt so chi so nhin trac a sinh vien Tnrdng Dgi hgc Y Dwgc Cin Tha. Kit qua: BMD xuong cing tay tmng binh li 0,495±0.067g/cm^; BMD cua nhdm i160cm cao han nhdm <160cm. nhdm >50kg cao han nhdm <50kg. nhdm khdng gay cao han so vdi nhdm giy. Nhdm chliu cao <160cm co nguy co ,thiiu san xwang gap 4,38 lin nhdm > 160cm, nhdm can ngng
<50kg cd nguy ca thiiu san xwang gap 14.76 lin nhdm 2 50kg, nhdm BMI giy cd nguy co thiiu sin xuong gip
11,83 lin nhdm BMI khdng giy.
Tir khda: khoing xuong. tia X SUMMARY:
Relation between forearm bone mineral density and morphology indexes at the students of Can Tho University of Medicine and Pharmacy
Bone mineral density depends on many factors and can be assessed by measuring absorption of dual energy X-rays (DEXA). The study was conducted on 101
N G U Y I N TRUNG K | £ N , QUAN T H O Y T I ^ N
students (51 male and 50 female) at Can Tho University of Medicine and Pharmacy to detennine the relationship between forearm bone mineral density and morphology indexes. Results: BMD bone foreanv averaged 0.495±0.067g/cm'. BMD of the group H60cm. >50kg and no-skinny higher than group <160cm, <50kg and skinny. Group <160cm. <50kg and skinny had risk of osteopenia higher 4.38 times. 14.76 times and 11.83 times than group >160cm. >50kg and no-skinny.
Keywords: Bone mineral density. X-rays OAT V A N Dt
Hifn nay trfn todn t h i gidi, ede bfnh ly ve chuyin hda xuong ed xu hudng ngay cang gia tdng. Theo To chire Y t l t h i gidi (WHO, 1994), bfnh xuong dirng hdng thii- hai sau bfnh tim mgch [2]. Cdc bfnh ndy thudng dien ra tir tir vd khdng cd bilu hifn Idm sdng eho din giai dogn mupn gay nhilu biln chii-ng, anh hudng Idn d i n chit lupng cupe sdng vd trd thdnh gdnh ngng cho xd hpi. Trong dilu kifn hifn nay h l u nhu chua ed phuong phap dilu trj dgc hifu ndo mang Igi kit qua toi uu cho cae bfnh ly v l chuyin hda xuong, do vgy vifc phdng bfnh v i n Id Ig-a chpn ddu tifn. Mgt khac, vin cdn nhij-ng quan nifm sai lam cho rdng ddy Id bfnh cua ngudi Idn tuoi. Thg-c t l sg mit xuong sinh ly da bit dau
Y HOC THl/C HANH (763) - SO 5/2011 37
mdt so yiu t6 liin quan tdi loang xuang d phu nW sau man kinh thudc huyin Cim Binh tinh Hii Duong, Lufn dn tiin s7 Trudng Ogi hpc Y Hd Nfi, trang 25-33.
5. Phgm Ngpc Hoa, Nguyin Ogi Hting, Cao Thien Tupng (2003), "Cdc phuong phdp chan dodn hinh anh lodng xuong", Kj? yiu cic bio cio khoa hgc, Bfnh Vifn Chp Riy, trang 18-20.
6. Lf Anh Thu (2003), "Lodng xuong mft djch bfnh dm thim", Ky ylu cdc bdo cdo khoa hpc, Bfnh Vifn Chp Riy, trang 8-12.
7. VQ Thj Thanh Thuy (1996), Nghiin ciru mdt s6 yiu ti
lidn quan (^n nguy co liin ddt sdng do loing xu&ng d phu nW sau min kinh, Ludn dn tiln sT Y hpc Trudng Ogi hpc Y Hd Nfi, trang 24-28, 69-72.
8. Phgm Vdn Tu (2003), "Nhan xet mat df xuong ciia nam gidi binh thudng tir 50 tuli trd Idn blng phuong phap do hip thg tia X ndng lupng kep", Ky yiu cic bao cio khoa hgc, Bfnh vifn Chp Riy, trang 41-43.
9. Wari< J.D (1993), 'Osteoporosis: pathogenesis, diagnosis, prevention and management", Bailliere's Clin Endocrinol Metab, pp. 151-181.
MOT TRU&NG HOP U QUAI KHONG TRO^G THANH CUA THAI NHI DUUC PHAT HIEN QUA SIEU AM
LIAJ THI HONG, L§ QUANG VINH Tru&ng DH y Hd NQI Vien Bao ve Bi me vii Tre sff sinh
TOM TAT:
Sieu am sang lgc trudc sinh duac sCr dung chin doan nhOmg bai thudng hinh thai thai nhi trudc sinh trong do co bat thudng viing mSt thai. U quai vimg ham mSt (teratoma facials) la mdt loai khdi u duac sinh ra tir nhung te bao tiem nSng cQa thai. Day la nhOng khoi u that su cOa thai, doi khi no co tinh chat ac tinh. day la loai benh hiem g$p vdi ti le 1/42 000 ca de song.
TCr khoa: sieu am, hinh thai hoc, khoi u viing ham m$t, dinh chi thai.
SUMMARY:
Abstract: Prenatal screening using ultrasonography is a tool for diagnosis of malformation including facial malfomiation. Facial teratome is a tumor formed by potential embrional cells. This true embrional tumor, sometimes malign, is a rare pathology with occurrence ratio of 1/42 000 live births.
Keyword: ultrasonography, morphology, facial teratome, abortion.
OAT VAN Di:
Theo doi va quan l^/' thai nghen cho cac thai phu.
vdi muc dich lam giam ty le tCr vong me va tCf vong con la mpt trong nhOng nhiem vu hien nay cOa cham sdc Siifc khoe sinh san (CSSKSS). Ben canh van de nay thi viec theo doi sir phat trien ciia bao thai ngay tif khi cdn trong bung cija ngirdi me vdi mong mudn cho ra ddi nhufhg difa tre hoan thien, khoe manh ca ve the chat lan tinh than.
Sieu am la mot trong nhuftig phirong phap va phifdng tien dUdc sif dung de phat hien, theo doi di tat hay khuyet tat cua thai nhi, tif d6 cd the di/a ra nhOfng chi dinh dung dan trong viec nen tiep tuc duy tri thai nghen hay can chi'dinh dinh chi thai.
Khi tien hanh sieu am thai, da phat hien difdc nhiifng bat thi/dng cCia thai nhi va trong bai viet nay, xin neu mpt trifdng hpp u quai ciia thai nhi, la mpt loai khdi u rat hiem gap so vdi nhiifng ba't thifdng khac duoc phat hien qua sieu am. Khdi u vung ham mat da phan la nhufng khdi u ac tinh hay u khdng trildng thanh, tJletCf vong cao.
HOAN CANH PHAT HIEN:
-NhOfng benh nhan cd thai den Benh vien kham, difpc chi dinh lam sieu am. Cac sd do va chi sd di/dc thifc hien tuy thupc vao tudi thai nhi.
-Khi cham kinh 10 ngay, benh nhan di/dc lam sieu am xac djnh la thai trong tif cung.
-Sieu am lan thif 2 khi thai tuan thuf 9, di/de xac djnh la phdi thai binh thi/dng.
-Sieu am lan thilr 3 khi thai 21 tuan da phat hien ra khdi u nam d vung mat thai nhi.
TOM TAT BENH AN VA KET QUA SIEU A M : Tom tat benh an
Benh nhan : T.T.H.M 32 tudi Dja c h i : 35 T.X.S - Ha Npi
Tien sif benh tat: khdng mac benh gi trifdc va trong thdi ky mang thai.
Tien sir san khoa : + 1 con 6 tudi khoe manh + Hut thai 1 lan
Dac diem thai lan nay:
Kinh cudi cung : 08/11/2009
Sieu am 03/01/2010 : 1 thai trong tif cung : 1 thai trong tif cung, tim thai(+), chieu dai dau mdng la
19cm, nhin ro cifc dau va than.
Tif khi bat dau cd thai cho de'n ngay 04/04/2010, thai phu dUdc lam sieu am lan 3 de chan doan hinh thai hpc cho thai nhi.
Kei qiia sieu am : - 1 thai
- Cau true ngifc : binh thifdng - Cau true bung: binh thifdng - Ca'u true tur chi: binh thifdng
- Ca'u true mat: 2 mat binh thi/dng, xi/dng mui binh thifdng. Mom: nhin ro mdi di/di. Mdi tren khd xac dinh vi tha'y cd mot khdi u, be mat khdng deu tif phan mieng thai nhi di ra. Trong Idng khdi u, cd vijng thi/a am vang xen vdi vung dam am vang, kfch thudc khoi u gan bang 5,5 x 6cm.
Ngay 05/04/2010 benh nhan difOc nhap vifn, da hpi chan va chi djnh dinh chi thai nghen. Sau ddt Cytotec say ra mpt thai khoang 500g.
40
Y HOC THl/C HANH (763) - S6 5/2011
Mo ta dai the: Mdt khdi u gidng nhi/ polyp, ed chan xuat phat tif vdm mieng, mau trang nga xen l i n vung mau nau, dien cat cd mat dp khdng deu, viJng mem xen Idn vung cifng, khdng thay cd d hoai tCr.
Phan dau khdi thd ra khoi mieng, do kich thudc 7x 5cm.
VI the: Tren cae manh eat thay; md dang sun va dang xUOng, ngoai eon ed cac te bao bieu md than kinh, rai rac thay dng than kinh nguyen thu^. Md dem phu, giau soi lien ket.
Ket luan: u quai khdng trudng thanh, u quai vung ham cOa thai nhi ft dUOc neu ra trong y v i n .
inh: Kh6i u vimg him mSt, inh si§u am 2D
Chin doan trude sinh hien nay la mpt trong nhufng nhiem vu quan trpng cda cac Bae sT san khoa.
Sieu am chan doan trUdc sinh hien nay da va dang dUde ap dung, ket hpp vdi viec tham kham lam sang de quan \^ thai nghen.
Ngay tif khi thai 1 2 - 1 4 tuan tren sieu am da phat hien dUde mpt sd di dang, hay nhumg dau hieu gdi •) qua vifc do chieu day da gay (khoang sang sau gay), do chieu dai xUOng mui va viec quan sat tdngt the thai nhi, ddc bift la quan sat dupe vdm sp de chan doan sdm thai vd sp.
Benh nhan nay dupc sieu am khi thai tuan thif 9, thai binh thudng d tudi thai nay va khdng dUdc sieu am khi thai 12, 14 tuan. Khi thai 21 tuan lam sieu am hinh thai hpc, phat hien ra khdi u, ki'ch thUdc khdi u da to, dudng kfnh len den 5,5x 6em. So vdi cae loai dj dang va ba't thudng khde nhU dj dang eo quan tiet nifu 23%, dj dang cd quan than kinh 17%, dj dang tim 6%, dj dang mdt 5%, dj dang chi 4,5%, dj dang ed quan tieu hod 3,5%.
Day la mdt loai khdi u cGa thai nhi rat hiem gap, gpi la u quai vung hdm mdt (teratome faciale), la mpt loai khdi u dupe sinh ra tir nhOlhg te bao tiem nang cija thai, day Id mdt loai te bao cd the phat trien thanh cac td chifc khac nhau tuy theo nhOfng ki'ch thich vao chung, nd t i p chung vdo hai cue cua thai hoac d cUc dau (thudng d vung ham mat gpi la u quai vung ham mdt), hodc la d eUc dudi (u quai vung cung cut:
teratome sacrococcygien). Day la nhufng khdi u that sU cOa thai, ddi khi nd cd tinh chat ac tfnh, day la loai benh hiem gap vdi tf le 1/42 000 ca de sdng. cd the gap thanh phan gom 3 la thai:
-La thai ngoai: da, te bao than kinh.
-La thai giiira: eo, xuong, sun.
-La thai trong: thanh phan eua dng tifu hoa Vj trf: vdm hpng, thanh quan, vung cung cut, buong trtfng.
Nguon gdc; ndi tiep giap ciia 3 la thai thi hay gap u d vdm hpng va vijng cijng cut, d buong trtJfng thi thudng do te bao mam sinh ra.
Tn/dc day ehUa cd sieu am thi ngUdi ta thay rang, tre de ra cd khdi u vijng ham mat chet tdi 78% trong 3 ndm dau, vi da phan la u ac tinh, trif khdi u Teratome d budng triing, vi vay benh nhan da dupe ehl djnh ehl thai nghen ngay sau khi phat hien ra khdi u eua thai.
K ^ ' T L U A N :
-Sieu am trong thdi ky mang thai la mdt phUOng phap hd trd cho theo ddi va quan ly thai nghen va sieu am cdn la mdt phUdng phap giup eho chan doan trudc sinh nham phat hien nhufng dj dang thai nhi ngay tif khi cdn trong bung me.
-U quai (Teratome) la mdt loai bat thudng rat hiem gdp so vdi nhOhg di dang khac ci!ia thai nhi.
-Khi phat hien ra nhOfng dau hieu bat thudng qua sieu am thi c i n phai hdi chan xem cd n f n dinh ehl thai nghen khdng.
TAI LI$U THAM KHAO
1.Bd mdn md hoc - phdi thai hoc (2001). Oai hoc Y Ha Ndi.
2. Pham Phan Dich, Nguyfn Van Ngpc, Dd Kfnh (1984). Te bao hoc, md hoc, phdi thai hpc. NXB Y hoe, 264 - 28.
3. Pham Thj Thanh Mai va cdng sU (2002). Dich te hoc di iat bim sinh d tre sd sinh tai Vien Bao ve ba me va tre sa sinh tU nim 1995 tdi thing 9 thang dau nim 1998. Tap ehi di truyen hpc va lifng dung chuyen san di truyen- y hpc, 7 12.
4.Blass HGK et al (2002). Brains and face in holoprosencephaly: pre and postnatal description of 30 cases. Ultrasound obstet gynecol, 19 - 24 - 38.
S.Doubilet PM, Benson (2003). Atlas of ultrasound in Obstetrics and Gynecology. Lippincott Williams &
Wilkins, chapter: 4, 5, 6, 7, 8, 9, 10, 11. 12, 13, pp 37 -192.
e.Gahan JPM, Porto M (1994). Diagnostic Obstetrical Ultrasound. J.B. Lippincotte Company, chapter 8, 9, 10, 11, 12 pp 134 - 282; chapter 16, 17, 18, 19, 20, 21, pp 326-475.
7.Holdriek HL et al (3.2004). Sacrococcygeal teratogia: prenatal assessment, fetal intervention and outcome. J.Pediatr.Surg, 39, 3, 430 - 438.
8.Whitlle Max T, Connor JM (1995). Prenatal dianosis in obstetric practice. 2nd edition, Blackwell science, chapter: 3, 4, 5, pp 12 - 57; chapter: 11, 12, 13, 14, 15, 16, 17, pp 121-227.
Y HOC THVC HANH (763) - S6 5/2011 41
U MACH HOC MAT
PHAM TRQNG V A N B6 mon mSt Dai hgc Y Hi Ngi TOM T A T
U mach hoc mat la m^t bgnh ly hie mit cd thi diiu trj khoi bang phau thugt Myc tieu: Nghien ciru dgc diem lim sing va kit qua diiu tri u mach hoc mil Doi twang vi phwong phip: 6 bgnh nhin bj u mgch hoc mat duoc phin tich benh canh lam sang va phuong phap diiu tri nhim rut ra nhung net chung vi rieng cho mdi bgnh canh cy thi. Ket qui: Cic bgnh nhin din khim vi loi mit, song thj hay giam thj lye. Hinh anh chyp cat Idp cho thiy nhOng dgc diem diin hinh cQa u mgch. Phiu thugt mang lai kit qua tot nhung biin chung syp mi hay lac cd thi xay ra sau mo. Kit luan: U mgch hoc mat cd nhOng die diem lam sang dgc thii va phau thugt mang lai kit qua tot
Tir khda: U mgch. hoc mat SUMMARY
Orbital hemangioma
Cavernous hemangioma Is an orbital tumor that can be cured surgically. Objectives: To study the clinical features and treatment outcome of orbital hemangioma.
Materials and methods: Six patients with carvenous hemangioma are analyzed for clinical features and treatment to highlight the aspects of Individual tumors.
Results: Most common reasons for examination and treatment are proptosis. double vision and fluctuated vision. Surgery gives good outcomes. However, post- operative complication can occur such as eye deviation and ptosis. Conclusion: Orbital hemangioma has characteristics and can be cured surgically.
Key word: Orbit, hemangioma OAT V A N Dt
U mgch hoc mat dgng hang Id khoi u Idnh tinh gay loi mat mpt bfn d ngudi trudng thanh [1, 2]. Loi mat, rli logn vgn nhdn, chen ep thj than kinh vd nhdn cau Id nhii'ng ly do ehi djnh phiu thudt [3]. Da s l khoi u ndm trong ehdp co cho nen phiu thugt lay u qua dudng md thdnh ngodi hoc mdt hay dupe dp dgng. Phiu thugt ddi hdi phai rgch da rpng, md xuong hoc mat. Tuy nhifn nlu u nam phia trong thj thdn kinh thi phiu thugt rlt khd khan, nguy eo gdy ton thuong thj than kinh cao [4]. Phoi hpp md thdnh ngodi de lay cho di chuyen nhdn c l u ra ngodi, u cd t h i dupe lly qua dudng rach kit mgc cimg do. Xii' tri v i n cdn rat nan giai vdi h i i u nam sau trong dinh hoc mat.
Trong nghifn eiru ndy, chimg tdi md ta ede trudng hop u mach hdc mat va kit qua dilu tri.
D O I TU'ONG VA PHU'ONG P H A P NGHIEN CU'U Chiing tdi hoi ciru ho so ciia 6 bfnh nhdn dd dupe dilu trj u mach hoc mat tai bfnh vifn mdt trung uong tir nam 2007 den ndm 2010. Cae ly do chi djnh phiu thudt bao gom chen ep thj thdn kinh va nhdn cau, rli logn van nhan vd song thj tirng luc, loi mdt nhg. Cdc bfnh nhdn deu dupc chgp CT scan hay MRI vd xdc djnh chin dodn khoi u mgch hoe mdt.
Tiiy theo dgc dilm eua khoi u, cdc bfnh nhdn dupc lay u qua cae dudng rgch vdo hdc mdt khac nhau:
1/ Vdi khoi u khu tru d hoc mat trudc: Rgch true tilp da trfn khoi u, phau tieh co, can vdeh hdc mat vd can
eo ndng mi. Tdeh dinh vd l l y khdi u bdng panh hay diu Ignh ddng.
2/ Vdi khii u trong ehdp co d 1/3 giu-a hoe mat: Md gdc ngodi mdt d l vdnh mi dupe rpng, rgch kit mge eiing do dudi va bdc Id khoi u. Cd t h i dimg dau lanh ddng de lly khdi u.
3/ Vdi khoi u nam trong ehdp co d 1/3 sau hoc mat:
Rgch da gdc ngodi mi, md thanh ngodi hoc mat, phiu tich vd di vdo khoi u n l u u khu trii d phia thdi duong.
Nlu u khu tru phia mui, di chuyin nhan cau ra ngodi va di vdo khoi u qua dudng rgch k i t mge cimg do.
Khoi u lly dupe dupc chan doan giai phiu bfnh la u mach dgng hang. Bfnh nhan dupc ddnh gid dp loi bang thudc Hertel, vgn nhan vd thi Ig-c trude vd sau mo.
KtT QUA
Sdu bfnh nhdn bao gom 5 nii- vd 1 nam vdi lira tuoi trung binh Id 49,8 ± 4,3 (40-62 tuoi). Cdc trifu chirng lam sdng Idm cho bfnh nhan d i n khdm bfnh bao gom loi mat dan keo ddi 2-48 thdng. Song thj vd hgn che vgn nhan xult hifn d 3/6 bfnh nhan. Cdc trifu chirng it gap hon la sd thiy u trfn mi mat hay giam thj Ig'c. Khdng ed bfnh nhdn ndo bilu hifn u chen ep thj than kinh (roi logn phan xg dong tir hudng tdm, teo vd phii gai). Khoi u chen ep gdy nip gap vdng mge xult hifn d 2/6 bfnh nhdn.
Bang 1. Ddc dilm lam sang
TT 1
2 3 4 5 6
Gidi/
Tudi Nam/
42 Nir/53 Nir/54 Nir/50 NHI 49 NO-/51
Trigu chimg So thJiy kh6i u mi tren L6i mat L6i mat L6i mat L6i mat R6i logn vgn nhan
Vj tri u Mi tren
Thanh du'di Thanh
ngoai Thanh ngoai Thanh ngoai Thanh trong
Phu'cng phap mfl Rgch da trge
t i l p Rach k f t mgc
cung 66 Ma thanh ngoai
Mo thanh ngoai M d thanh ngoai
M d thanh ngoai-Rgch k i t
mac cung 66 trong
Biln chirng Khong
Khong Sgp mi Lac trong
Khong Lac cheo
Sifu dm va chgp cat Idp da dupc dp dgng d 6 bfnh nhdn. Mgt dp sdng dm trong Idng khoi u khd cao. CT scan vd MRI eho thiy u ed hinh trdn hay bdu dgc, ranh gidi rat rd net, tach bift khdi cdc cau true xung quanh vd mat dp khdng ddng nhat (Hinh IB).
Chung tdi tilp cgn u qua dudng true tilp qua da, qua kit mge ciing do dudi vd md thdnh ngodi hoe mat. Diu Ignh ddng dupc sir dgng d 3/6 bfnh nhdn do khdi u ndm sdu d l ndng khoi u trong khi tdeh dinh.
T i t ea cdc khii u dfu dupe lay bd hodn todn. Thj Igc bfnh nhdn on djnh sau mo. Khdng bfnh nhdn ndo bj u tai phat. Biln chirng sau mo bao gdm sgp mi (1/6 bfnh nhdn) vd Idc trong (1/6 bfnh nhdn). Song thj sau mo xuat hifn d 3 bfnh nhdn vd hit hodn todn sau 6 thdng.
Khoi u cd bao xo mdng, khdng dinh vdo t l chirc xung quanh vd cd mdu tim dd rat dien hinh. Hinh anh vi t h i Id nhO'ng xoang mach mdu ed t l bdo npi md vdy quanh Id to chirc xo.
42 Y HOC THl/C HANH (763) - SO 5/2011
