LM SNG, NGUYN NHN V KT QU IU TR BNH VIM TUYN GIP CP M TR EM Study of clinical characteristics, causes and result of the treatment

t for acute, suppurative in children Nguyn Th Hon, Nguyn Th phng, Nguyn Th Hng Bnh Vin Nhi Trung ng
Trng khoa Ni tit - Chuyn ho - Di truyn, Bnh Vin Nhi Trung ng. a ch :15A ng 119 Ty sn, ng a H ni. Hng dn bo v thnh cng 11 Cao hc, 3 BSCK II v 1 BS ni tr. 40 cng trnh nghin cu khoa hc ng : Tp ch Nhi khoa, Tp ch Ri lon chuyn ho v Ni tit, Tp ch Ri lon di truyn Nht Bn, Tp Ch NCKH ca c... TS Nguyn Thi Hon Hng nghin cu: (1) Ni tit: i tho ng v bin chng. Bnh suy gip bm sinh v pht hin sm bnh ti cng ng. Nguyn nhn gy dy th v chuyn gii tr em. iu tr chm ln trong ln yn v HC Turner.(2) Chuyn ho: RLCH Mucopolysaccharidosis, Ci xng khng Vitamin D tr em, to xng bt ton.(3) Cc bnh v di truyn: Bnh thn kinh c ph bin tr em nh bnh teo c Duchenne, bnh thoi ho c tu tr em. ti khoa hc:(1) Sng lc s sinh bnh suy gip tr em .(2) S dng k thut phn t xc nh t bin gene trong 2 bnh thn kinh c di truyn ph bin Teo c Duchenne v thoi ho c tu.

Summary Acute, suppurative thyroiditis is a defect of the thyroid gland caused by bacteria. The disease is usually encounted in adults, rarely in children. For the last years, Department of Endocrinology Metabolism Genetics , NHP treated some patients with recurrent acute, suppurative thyroiditis. Consequently, the subjective of the research is to study clinical characteristics, causes and result of the treatment for acute, suppurative in children. We carried the study of 66 cases of acute, suppurative thyroiditis aged from 41 days to 15 years, comprising 17 males and 23 females in a period 1997-2003. The study showed that the majority of the patients had inflammation symptoms, thyroiditis and neck pain in hyperextension. Inflammation of the left lobe of thyroid gland was seen in 85.71%. Patients who had recurrent thyroiditis (more than 1 time) occupied 74.29%. Throat endoscopy found pyriform sinus fistula on the left side in 89.28%. Combination of antibiotics (Tarceforksym and Amikacin) and aspiration/drainage had a good result. After inflammation period, operation was done to remove pyriform sinus fistula in 57.98% of patients or to close fistula. I.t vn

Vim tuyn gip (VTG) cp m l tnh trng bnh l tn thng nhu m tuyn gip do vi khun thng thng gy nn vi cc biu hin cp tnh nh st, sng nng au TG, vim hng, kh nut, ging khn (11). Mc d VTG cp m khng gp nhiu so vi VTG do cc nguyn nhn khc nh VTG bn cp De Quervain, VTG mn tnh Hashimoto, nhng rt hay ti pht (2,4,7,8). VTG cp m tr em khng nhiu nhng hu ht u b ti pht nhiu ln. Theo bo co nm 1979 ca Takai gp 13 tr b VTG cp m u tm thy c l r hnh qu l thy tri tuyn gip. l l do chnh lm VTG cp m rt hay ti pht. Theo bo co ti Khoa Ni tit - Bnh vin Nhi trung ng trong 10 nm (19811990) c 36 trng hp chn on l VTG cp m (3). Tuy nhin trong nghin cu ny, nguyn nhn gy bnh VTG cha c phn loi nn VTG cp m cn xp chung trong bnh cnh ca VTG. Ngy nay vi phng php thm d hin i gip cho vic chn on bnh nguyn, bnh sinh VTG ni chung v VTG cp m ni ring. K thut chc ht tuyn gip bng kim nh khng nhng xt nghim t bo hc m cn nui cy, phn lp vi khun trong trng hp nghi ng VTG cp m do vi khun. Siu m TG c vai tr quan trng trong chn on VTG m da vo m ECHO khng ng nht v c trng m trong TG (9, 12). Ni soi h hng l xt nghim cn thit trong VTG cp m xc nh ng r bm sinh lin quan ti TG, c bit l r xoang l (14). gip cc bc s Nhi khoa c kinh nghim trong chn on, iu tr v phng ti pht cho nhng bnh nhn VTG cp m, chng ti tin hnh nghin cu vi mc ch: Nghin cu lm sng, nguyn nhn v nhn xt kt qu iu tr VTG cp m tr em. II.i tng v phng php nghin cu 1.i tng NC: 66 bnh nhn c chn on VTG cp m t 41 ngy n 15 tui. Tiu chun chn la: Triu chng lm sng: St, sng nng au vng TG, trn siu m tuyn gip to hn bnh thng (theo tui) v t chc TG c xc nh c m, xt nghim t bo hc VTG cp m gm c t bo vim v t bo tuyn gip. Xt nghim: Cng thc mu, tc lng mu, chc ht TG lm t bo hc, phn lp vi khun v lm khng sinh ti BV N hi T. Siu m tuyn gip, T4 v TSH c lm ti BV Ni tit. Ni soi h hng xc nh ng r xoang l c tin hnh khi bnh nhn ht vim m TG ti BV Tai Mi Hng T. Tiu chun loi tr l vim/abces vng c xung quanh TG, abces ng di li, u nang gip bi nhim, u tuyn gip c phn ng vim, vim TG do nguyn nhn khc. - iu tr : - Ni khoa: C 3 phc iu tr ni khoa khi cha c khng sinh : (A) Chloramphenicol 30mg/kg/24gi trong12-14 ngy, (B) Cloxaxilin 100mg/kg/24gi + Amikacint 3mg/kg/24gi trong 12-14 ngy, (C) Tarceforksym 100mg/kg/24gi + Amikacin 3mg/kg/24gi trong 12-14 ngy. Khi c kt qu khng sinh th iu tr theo khng sinh . Ngoi khoa: Chch tho m nu TG c abces.
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Hoc m bc tch ng r v ly ht ng r hoc m ct ng r v tht y xoang l khi ng r qu phc tp ti BV TMH T. 2. Phng php nghin cu: - Nhm tin cu: gm 35 bnh nhn iu tr t 1/2002 n 8/2003 - Nhm hi cu: gm 31 bnh nhn iu tr t 1/1997 n 12/2001 ti Khoa NT-CHDT, BV Nhi T. Cc s liu c x l theo phng php thng k Y hc. III.Kt qu nghin cu Bng 1: Phn b bnh nhn theo tui v gii Tui 41 ngy -5 tui 6 - 10 tui Gii n % n % Nam 17 25.76 11 16,67 N Tng 23 40 34,85 60,61 10 21 15.15 31,82

11 - 15 tui n % 2 3,03 3 5 4,54 7,57

Tng n 30 36 66 % 5.46 54,54 100

a s bnh nhi VTG la tui di 10 tui chim 92,42% T l nam/n l 1,2/1 Bng 2: Thi gian t lc khi bnh n khi vo vin vi abces TG Abces TG Khng abces C abces Tng Thi gian n % n % n % < 7 ngy 4 11,43 1 2,86 5 14,29 14,2 25 71,4 30 85,7 9 3 1 Tng 9 25,7 26 74,2 35 100 1 9 - a s bnh nhn n vin mun 7 ngy: 30/35 bnh nhn chim t l cao 85,71%. - 26/35 (74,29%) trng hp VTG cp m vo vin c bin chng abces. 7 ngy Bng 3: Mi lin quan gia tnh cht ti pht vi abces TG Ti pht Khng ti pht C ti pht Tng Abces n % n % n % Khng abces 7 20,00 2 5,71 9 25,71 Abces Tng 2 9 5,71 25,71 24 26 68,5 8 74,2 9 26 35 74,2 9 100 5

- C bnh nhn b ti pht t 4 n 7 ln. - 24/26 bnh nhn abces TG b ti pht cao chim 92,31%. Bng 4: Triu chng lm sng ca VTG cp S bnh nhn Tng s Tng s Triu chng mc BN nghin cu St n = 55 + Khng st 7 + Nh 3705 -> 3 <380C 23 0 + Va 38 -> 22 0 <39 C + Cao 390 m T l %

12,73 5,45 41,82 40,00

Sng nng TG 66 n = 66 100 Nut au 21 n = 35 60,00 Khn ging 7 n = 35 60,00 Nga c au 35 n = 35 100 Kh th 3 n = 35 8,57 Khc m 2 n = 35 5,71 100% bnh nhnVTG m u c triu chng vim TG, nga c au. Xt nghim: S lng bch cu tng trn 10 000 l ch yu chim 83,61% (51/61) bnh nhn, trong s bnh nhn c s lng bch cu t 15 000 tr ln chim 36,06%. Bch cu NTT tng t 65% tr ln l 50,82%. c bit s bnh nhn c t l BCNTT tng 70% chim 34,43% (21/61). Tc lng mu tng cao (gi 1 30 mm, gi 2 50 mm) gp 100% bnh nhn (n=37). Bng 5: Kt qu chc ht tuyn gip v XN t bo hc Kt qu C t bo m C t bo m v Tng s v t boTG khng c t bo TG XN t bo S bnh nhn 22 14 36 T l 61,11% 38.89% 22/ 36 (61,11%) bnh nhn c xc nh VTG m . Bng 6: Kt qu siu m chn on VTG cp m Kt qu TG to cha c TG c m m XN t bo S bnh nhn 13 23 100% Tng s 36

T l 36,11% 63.89% 100% 23/36 (63,89%) trng hp thy trong lng TG c m bt mu ECHO khng ng u v c trng m, cn li 36,11% (13/36) trng hp ch thy xc nh l th tch TG to hn bnh thng 26/28 trng hp kim tra T4 v TSH trong gii hn bnh thng. Bng 7: Kt qu ni soi h hng Kt qu ni soi c ng r khng c ng r Tng s S bnh nhn 28 3 31

T l 90,32% 9,68% 100% 28/ 31 bnh nhn (90,32%) thy c ng r xoang l, 25/28 trng hp ng r bn tri l ch yu: 89,29% , khng c bnh nhn no b r 2 bn, c 5 chu phi soi li ln th 2 mi tm c ng r 3/31 bnh nhn (9,68%) khng c ng r c 3 bnh nhn ny u ch c soi 1 ln. Bng 8. Mi lin quan gia s ln ti pht VTG m vi ng r Ti pht Khng ti pht C ti pht Tng R xoang l n % n % n % Khng c ng r 3 9,68 0 0 3 9,68 C ng r 5 16,13 23 74,19 28 90,32 Tng 8 25,81 23 74,19 31 100 3 bnh nhn soi h hng khng c ng r xoang l th cng u cha ti pht Bnh nhn b VTG ti pht ch yu nhng trng hp soi h hng xc nh c ng r xoang l chim 74,19% (23/31) bnh nhn. C 5 bnh nhn c ng r nhng cha b ti pht ln no chim 16,13%. Nh vy, l r xoang l l nguyn nhn dn n VTG m ti pht nhiu ln (vi 2 = 5,74;P<0,02). * Kt qu nui cy phn lp vi khun t dch chc TG cho thy vi khun ch yu l lin cu Streptococcus chim 70,83% (17/24) bnh nhn. T cu vng S. aureus chim 12,50% (3/24), E.Coli chim 8,33% (2/24), Enterococcus v K.ozanoe chim 8,33% (2/24). *iu tr ni khoa: 3/5 (60%) bnh nhn dng phc A khi bnh: Chloramphenicol n thun 6/12 (50%) bnh nhn dng phc B khi bnh: Cloxaxilin phi hp vi Amikacin khi bnh Bnh nhn ch yu s dng phc C khi bnh: Tarceforksym phi hp vi Aminkacin 17/18 (98,44%) So snh hiu qu iu tr gia phc A v B, s khc nhau khng c ngha thng k vi 2 (A-B) = 0,29; P>0,05. So snh hiu qu iu tr gia phc A v C, s khc nhau c ngha thng k vi 2 (A-C) = 8,47; P<0,01. So snh hiu qu iu tr gia phc B v C, s khc nhau c ngha thng k vi 2 (B-C) = 5,6; P<0,02.
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* iu tr ngoi khoa: Bnh nhn phi chch tho mVTG chim t l cao 80% (28/35) iu tr ni khoa thnh cng gip bnh nhn khng phi chch tho m ch c 7/35 bnh nhn chim 20%. Trong s 28 bnh nhn soi h hng xc nh c ng r xoang l m c 19 bnh nhn ti BV TMH T: M bc tch ly ng r c tin hng 11 bnh nhn (57,89%); m tht y xoang l c tin hnh trn 8 bnh nhn (42,11%). IVBn lun Qua nghin cu 66 bnh nhn, chng ti thy VTG cp m gp tt c mi la tui t 41 ngy n 15 tui. Mc d cha c ti liu no ni v VTG cp m gp s sinh nhng thc t chng ti iu tr bnh nhn 41 ngy vim ton b tuyn gip. Tui hay gp l 5 tui tr xung chim 60,61% (40/66) bnh nhn (Bng 1). Nghin cu ca L Minh K v nang v r mang vng c bn cho thy tr di 5 tui hay mc nhim trng tai mi hng l yu t thun li kch thch biu m cn st li ca ng r bm sinh vng tai mi hng ch tit gy tch t v nhim khun (1). La tui hay gp VTG cp m di 5 tui l mt gi u tin v nguyn nhn c th lin quan ti vn d tt bm sinh. Trong nghin cu ny, chng ti nhn thy khng c s khc bit ng k gia nam v n vi P>0,05. Nhng khc hn vi VTG cp m ngi ln. Qua nghin cu 42 bnh nhn c chn on VTG cp m ti Khoa ni tit, BV Bch Mai ca tc gi L Trung Th, th ch c 7 bnh nhn l nam m c ti 35 n chim t l rt ln 83,83%. Nh vy ngi ln b mc VTG cp m c s khc nhau gia nam v n. S khc nhau v gii ca bnh VTG cp m ngi ln v tr em chng ti cha l gii c. Chng ti ch c th kt lun l tr em gii tnh khng nh hng n VTG cp m. iu ny ph hp vi cng b trn y vn (10). Mt s tc gi trong nc (6) v ngoi nc a ra kin rng VTG m lin quan ti vim nhim ng tai mi hng, h hp, nhim trng vng u, mt, c. Thc t trong nghin cu ca chng ti, bnh nhn VTG cp m gp nhiu vo nhng thng ma h, t l mc bnh nhim trngTMH, ng h hp trn cng cao cc nc nhit i nh nc ta nhng khng phi l c th ring cho cc nhim trng h hp, tai mi hng. Hn na trn 35 bnh nhn tin cu ca chng ti ch c 2 trng hp c km theo nhim trung h hp v tai mi hng. Trong 26/ 35 bnh nhn tin cu c abces TG trc khi n vin chim 74,29% (Bng 2). Nh vy bin chng abces TG gp bnh nhn cp m l rt ln. Kt qu ny cng ph hp vi nghin cu ca tc gi khc (7,8,9). Mc d cc tc gi ny cha a ra con s c th nhng nhn nh rng bin chng abces l thng gp v ch nh chch rch m l cn thit. T l mc bin chng abces bnh nhi VTG m cho n nay cha c tc gi no Vit Nam cng b. Trong nghin cu ca chng ti, thi gian n vin mun sau 7 ngy l ch yu chim 85,72% (30/35). Trong 30 bnh nhn n iu tr mun th c ti 25 chu b mc bin chng abces trc khi vo iu tr chim 71,43%. T l b abces TG nhm n iu tr mun cao hn hn nhm n iu tr sm (Bng 2). Trong khi c 5 bnh nhn
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n vin sm trc 7 ngy th c 4 chu khng b abces. Ch c 1 chu 41 ngy tui n vin sm b abces. Trng hp ny chng ti ngh rng c th do tr qu nh tui, sc khng km nn mc d c iu tr sm nhng khng trnh khi bin chng. Nh vy theo chng ti, mt nguyn nhn b bin chng abces TG l do bnh nhn n vin iu tr mun. V vy bnh nhn VTG cp m cn c iu tr sm theo mt phc hu hiu hn ch bin chng abces TG v phi chch abces dn lu m di ngy. Qua khai thc tin s v bnh s 35 bnh nhn c khm trc tip, chng ti thy t l bnh nhi b VTG ti pht rt cao 74,29% (26/35) bnh nhn. Trong khi ch c 25,71% (9/35) bnh nhn hoc khng ti pht hoc tm thi cha ti, a s cc chu ny mi vo vin ln u v cha c c hi ti pht c th do tui cn nh di 5 tui. Nghin cu ny ca chng ti cng gn vi nghin cu ca Takai cho thy c 13 tr VTG cp m th c 13 tr u ti pht (13). Cc tc gi khc cng thng nht VTG cp m hay ti pht v cho rng r xoang l l nguyn nhn gy ti pht nhiu ln nhng bnh nhn VTG cp m (10,11). Hu ht l do chnh bnh nhn vo vin iu tr khng phi v st m v triu chng sng to vng trc c , dng khng sinh thng thng v h st tuyn trc khng c kt qu. Triu chng vim ti ch TG gp 100% bnh nhn (66/66) (Bng 3). Kt qu ny ph hp vi nghin cu ca cc tc gi khc (4,6,7,8,10) v VTG cp m tr em. Chng ti khm trc tip trn 35 bnh nhn tin cu thy a s l vim thy tri TG chim 85,71% (30/35), bn phi rt t gp chim 11,43% (4/35), c 2 bn c s l 2,86% (1/35). VTG cp m gp ch yu thy bn tri trng hp vi d tt r xoang l cng ch yu gp bn c tri cng cng c nhn nh ca cc tc gi r xoang l l nguyn nhn VTG cp m (12,13,14). Theo chng ti, v t l VTG thy tri qu cao nn c th xem y nh l mt gi VTG cp m phn bit trn lm sng vi cc nguyn nhn vim vng c bn khc nh vim c c n chm, vim gip mng, vim hch. Trong nghin cu ny chng ti gp 100% (35/35) bnh nhn c au khi nga c. Triu chng nga c au, gp c khng au cng c cc tc gi m t. c bit Wilkins cho rng nga c au v gp c khng au l triu chng c gi tr chn on phn bit VTG cp m vi cc vim vng c do cc nguyn nhn khc. Triu chng nut au/nghn, khn ging, kh th, khc m gp cc t l khc nhau do TG chn p vo thc qun, thanh qun/kh qun, hay do abces v vo thc qun. Trong nghin cu ny, 36 bnh nhn c lm xt nghim t bo hc th c 22 trng hp c kt lun l VTG cp hay VTG c m v 14 trng hp c kt lun l t chc vim cp hay vim m m cha khng nh l VTG . Trong trng hp ny cn kt hp vi siu m chn on xc nh. Khi tin hnh siu m 36 bnh nhn, 23 trng hp (63,89%) xc nh c m. Kt qu ny gn trng vi xt nghim t bo hc chn on l VTG m (22 bnh nhn). c bit c gi tr l 14 trng hp xt nghim t bo ch l t chc vim m hay vim cp m cha xc nh l t chc l TG th kt qu siu m tr li l th tch TG to hn bnh thng. Siu m ngoi tuyn gip ngoi xc nh th tch TG to hn bnh thng cn xc nh TG c m hay cha da vo m ECHO, s khng ng nht hay c trng m trong TG (16,18,27,37,38,4244,52). T nhn xt trn y, theo chng ti cn s dng c 2 phng php ny chn on bnh VTG cp m s lm tng tin cy ca chn on. Tuy
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nhin, cho n nay Vit Nam cha c ti liu no cng b v gi tr chn on ca hai phng php ny i VTG cp m. Cng nh cc bnh nhim vi khun khc, VTG cp m bnh nhim khun thng thng, do vy phn ng chng ca c th l bch cu tng cao v s lng. Trong nghin cu ny, 51/61 (83,61%) bnh nhn c bch cu tng 10 000/mm3 tr ln, 16,39% c bch cu cao trn 20 000 /mm3. BCNTT tng gp 36/61 trng hp chim 59,02%. a s bnh nhn n trong giai on abces (26/35) nn ngoi tng BCNTT, c th cn huy ng mt s i thc bo v monoxit n dn xc vi khun, v vy BCNTT khng tng cao trong mt s trng hp. VSS tng cao tuyt i trong c 2 gi. Kt qu bch cu tng v VSS cao ph hp vi y vn.(4,6,10,11). Chng ti tin hnh ly mu bnh nhn VTG cp m kim tra chc nng TG v thy rng 26/28 (92,86%) bnh nhn c nng FT4 hoc T4 hon ton bnh thng. Ch c 1 trng hp T4 tng nh 158,4 nmol/L (bnh thng 50-150 nmol/L) v 1 trng hp FT4 gim nh 7,6 pmol/L (bnh thng 9-25 pmol/L). Cng tng t nh vy, TSH hon ton bnh thng 26/28 (92,86%) bnh nhn. Mt trng hp TSH l 8,4 Mu/ml v mt trng hp TSH l 0,56 Mu/ml. Nh vy c th kt lun l khng c s bin i v hormon TG bnh nhn VTG cp m. iu ny cng ph hp vi kt lun ca cc tc gi khc (6,7,10,11). Trong nghin cu ny, 42 bnh nhn c chc TG ly dch nui cy vi khun v c 24 bnh nhn nui cy vi khun c kt qu dng tnh chim 57,14%. Khi phn lp vi khun th Streptococcus chim t l cao nht 70,83% (14/24), sau l S.Aureus 12,50% (3/24), E.Coli 2/24 (8,33%), cc vi khun khc nh Enterococcus, K.oranoe ch gp 2/24 (8,33%). Trong 17 bnh nhn VTG do lin cu, chng ti bt gp hu ht cc type , tan huyt, c bit gp rt nhiu ln chng Viridan v Pneudomonac. Kt qu ny khng khc bit so vi nhn nh ca cc tc gi khc (10,11) cho rng lin cu, t cu, ph cu l cc vi khun thng gy VTG cp m. Trong nghin cu ny, 31 bnh nhn tin cu c soi h hng th 28 (90,32%) pht hin c ng r xoang l. T l tm thy ng r xoang l trong nhm ny thp hn so vi nhm ca Takai, c 13 (100%) bnh nhn VTG cp m u tm thy ng r. Theo cc nh tai mi hng, nguyn nhn ln u soi cha tm c ng r c th do vim nhim cha n nh hoc do ng r phc tp kh pht hin. Trong s 28 bnh nhn soi tm thy ng r xoang l, chng ti thy c ti 25/28 (89,29%) bnh nhn r thy tri chim 89,29%. T l ng r xoang l bn tri ca cc tc gi dao ng t 80% n 97,4% (1,8,13 ). Cc chuyn gia tai mi hng cho rng ni soi h hng l mt thm d quan trng, c gi tr chn on xc nh ng r xoang l. Cn cc tc gi nghin cu v VTG cp m th cho rng chnh r xoang l l nguyn nhn VTG cp m v lm bnh ti phtt. Do vy, ni soi h hng cho bnh VTG cp m l cn thit. V iu tr, phc C (Tarceforksym/Aminkacin) t t l thnh cng cao 91,11% (17/18) bnh nhn v t ra c hiu qu hn phc A v B vi P<0,01 v P<0,02, tng ng. Tarceforksym l Cephalosporin th h 3, l loi tc dng tt vi c vi khun Gram dng v Gram m, c vi khun k kh v ym kh. Thc t cho thy khi s dng Tarseforksym phi hp vi nhm dit vi khun Gram m l Aminkacin iu tr

cho bnh nhn VTG cp m th hiu qu t ra r rt.T kt qu trn, chng ti rt ra kt lun l iu tr VTG cp m, tt nht l s dng phc C. Trong nghin cu ca chng ti, s bnh nhn phi chnh abces l rt ln 80% (28/35) bnh nhn. Th thut tuy khng nguy him nhng gy nhiu phin h cho c bnh nhn v thy thuc v thi gian dn lu m di, ra/thay bng vt thng hng ngy. Mt s tc gi ngh ct b thy TG b abces, nhng theo kt qu iu tr ca chng ti l chch m ti ch, liu php khng sinh, tt c bnh nhn u n nh v u c ch nh ni soi h hng v khng trng hp no phi ct b tuyn gip. Qua 19 bnh nhn c phu thut ti BV TMH T, chng ti thy 11/19 (57,89%) bnh nhn c m bc ng r, 8/19 (42,11%) bnh nhn ch c ng y xoang l. iu chng t vic bc tch tm v ly i hon ton ng r xoang l hin nay vn cn gp nhiu kh khn.Vic bc tch v ly b ng r s hiu qu hn ng y xoang l, v ng r cn li mt phn vn ch tit gy vim TG ti pht (12,14). Gn y L Minh K phu thut ly b ton b ng r c t l ti pht l 7,14%, m ng y xoang l ti pht l 25,00% (1).Trong nghin cu ca chng ti, thi gian bnh nhn c phu thut khong 2 nm, cha theo di v kt lun v bin chng ti pht ca tng cch thc phu thut. V.Kt lun 1.VTG cp m tr em thng gp nht la tui di 5 tui chim 60,61%, t l n/nam l 1,2/1. 2. Triu chng thng gp nht trong VTG cp m tr em: Vim TG, nga c au, thng gp vim TG bn tri 85,71%. T l VTG cp m ti pht rt cao chim 74,29%. 3. Xt nghim: Vi khun gy VTG cp m ch yu l lin cu (hay gp Viridan, Pneudomonac) chim 70,83%, sau l t cu vng 12,50%, t l nh l E.Coli (8,33%) v cc vi khun khc nh K.ozanoe, Enterococcus (8,33%). Xt nghim chc ht TG xt nghim t bo bo hc cho chn on VTG cp m chim 61,11%. Siu m TG c biu hin m ECHO khng ng nht v c nhng trng m trong TG chim 63,89%. Ni soi h hng l xt nghim quan trng nht trong chn on xc nh tm nguyn nhn d tt bm sinh VTG cp m tr em. Kt qu cho thy 28/31 (90,32%) bnh nhn c ng r xoang l trong bn tri chim t l cao 89,29%. 4.iu tr: Ni khoa: bng khng sinh phi hp Tarceforksym v Aminkacin c kt qu tt 94,44% bnh nhn. iu tr ngoi khoa: Chch tho m thy TG b abces chim t l cao 80,00%. Phu thut bc ng r 57,98% v ng y xoang l chim 42,11%.

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