NGHIÊN cứu VAI TRÒ của nội SOI MÀNG PHỔI ỐNG mềm TRONG CHẨN đoán NGUYÊN NHÂN TRÀN DỊCH MÀNG PHỔI

Bễ GIAO DUC VA AO TAO Bễ Y Tấ TRNG AI HC Y HA NễI V KHC AI NGHIÊN CứU VAI TRò CủA NộI SOI MàNG PHổI ốNG MềM TRONG CHẩN ĐOáN NGUYÊN NHÂN TRàN DịCH MàNG PHổI LUN AN TIấN S Y HC HA NễI 2015 Bễ GIAO DUC VA AO TAO Bễ Y Tấ TRNG AI HC Y HA NễI V KHC AI NGHIÊN CứU VAI TRò CủA NộI SOI MàNG PHổI ốNG MềM TRONG CHẩN ĐOáN NGUYÊN NHÂN TRàN DịCH MàNG PHổI Chuyờn nganh : Lao Mó s : 62720150 LUN AN TIấN S Y HC Ngi hng dõn khoa hc: PGS.TS Nguyn Chi Lng HA NễI 2015 LI CAM OAN Tụi la V Khc i, hc viờn nghiờn cu sinh khúa , chuyờn nganh Lao, xin cam oan: õy la lun bn thõn tụi trc tip thc hin di s hng dõn ca PGSTS Nguyn Chi Lng Cụng trỡnh khụng trựng lp vi bt k nghiờn cu nao khỏc ó c cụng b ti Vit Nam Cỏc s liu va thụng tin nghiờn cu la hoan toan chớnh xỏc, trung thc va khỏch quan, ó c xỏc nhn va chp thun ca c s ni nghiờn cu Tụi xin hoan toan chu trỏch nhim trc phỏp lut v nhng cam kt H Ni ngy 16 thỏng 11 nm 2015 Tỏc gi V Khc i MUC LUC Tờn mc Trang CAC CH VIấT TT ADA : Adenosine deaminase AFB : Trc khun khỏng cn khỏng toan (Acid Fast Bacillus) ANA : khỏng th khỏng nhõn (Antinuclear Antibody) AQP : Aquaporin BCG : Bacillus Calmette-Guerin CEA : Carcinoembryonic antigen CS : Cng s CYFRA : Cytokeratin-19 fragment CT : Chp ct lp vi tớnh (Computed Tomography) IFN : Interferon gamma KLS : Khoang liờn sn MP : Mang phi MRI : Cng hng t (Magnetic Resonance Imaging) LDH : Lactate Dehydrogenase NSMP : Ni soi mang phi TDMP : Tran dch mang phi VATS : Phõu thut ni soi lng ngc cú h tr video (Video Assisted Thoracic Surgery) VEGF :Yu t tng trng ni mch (Vascular endothelial growth factor) DANH MUC HèNH NH, BIU , S DANH MUC BNG T VN Tran dch mang phi (TDMP) la mt hi chng bnh thng gp trờn lõm sang Chn oỏn TDMP da vao lõm sang, cn lõm sang (Xquang, siờu õm, chc hut dch ) khụng khú, nhng chn oỏn nguyờn nhõn TDMP nhiu gp nhiu khú khn Nhng tin b ca khoa hc ky thut ng dng Y hc nh xet nghim dch mang phi, sinh thit mang phi mự, sinh thit mang phi cú hng dõn ca SA, CT ó gúp phõn xỏc nh c nguyờn nhõn gõy tran dch mang phi Nhng nguyờn nhõn hang õu gõy TDMP la lao mang phi, ung th, viờm phi, iu ung c cỏc nc phỏt trin va ang phỏt trin iu nh hng rt ln n hiu qu iu tr va tiờn lng cho bnh nhõn tran dch mang phi, c bit la cỏc trng hp tran dch mang phi ỏc tớnh Theo Trnh Th Hng va cng s [1], nhng nguyờn nhõn thng gp gõy tran dch mang phi ti BV Bch Mai nm 2007 la ung th (23,8%), Lao (37,6%), cỏc nguyờn nhõn khỏc nh viờm phi mang phi, suy tim chim ty l thp, nhiờn cú 15,2% trng hp tran dch mang phi cha xỏc nh c nguyờn nhõn Ngoai cỏc phng phỏp kinh in chn oỏn nguyờn nhõn TDMP nh xet nghim sinh húa, t bao dch mang phi, sinh thit mự mang phi cho kt qu chn oỏn t 80% , nhiờn võn 20-25% trng hp tran dch cha c chn oỏn nguyờn nhõn Nhng trng hp nay, ni soi mang phi giup chn oỏn thờm vi chớnh xỏc lờn ti trờn 90% s cỏc trng hp tran dch mang phi, c bit la cỏc trng hp tran dch mang phi ỏc tớnh [2], [3], [4] Soi mang phi ng cng ó c thc hin ti mt s bnh viờn trung ng, th thut oi hoi bnh nhõn gõy mờ toan thõn, thc hin phong m, tng kh nng chn oỏn nguyờn nhõn nhng trng hp TDMP Ni soi mang phi ng mm chn oỏn TDMP ó c tin hanh nhiu nc phỏt trin trờn th gii va th hin c nhiu u im Tỏc gi An McLean va CS [5], ti bnh vin phớa Tõy Glasgow vng quc Anh, t thỏng nm 1997 n thỏng nm 1998 ó tin hanh mt nghiờn cu ỏnh giỏ va so sỏnh giỏ tr ca soi mang phi ng mm - sinh thit vi sinh thit mang phi bng kim Abram trờn tng s 16 bnh nhõn tran dch mang ung th phi thy rng nhy ca ni soi mang phi ng mm sinh thit la 81% so vi sinh thit bng kim Abram la 62% c bit tỏc gi cho rng ky thut cho phep quan sỏt trc tip trờn man hỡnh cỏc tn thng ca mang phi, nhu mụ phi, trung tht, ng thi õy cng la th thut xõm nhp an toan, ớt bin chng Ti Vit Nam ó cú nhiu nghiờn cu v ni soi mang phi ng cng chn oỏn bnh ly mang phi nhng cha cú nghiờn cu nao ỏnh giỏ vai tro ca ni soi mang phi ng mm chn oỏn nguyờn nhõn gõy TDMP Vỡ vy, chung tụi tin hanh nghiờn cu vi mc tiờu sau: 1.ỏnh giỏ c im lõm sng v cn lõm sng ca trn dch mng phi cha rừ nguyờn nhõn ỏnh giỏ hiu qu chn oỏn v tai bin ca ni soi mng phi ng mm CHNG 1: TNG QUAN 1.1 Bnh sinh hc trn dch mng phi 1.1.1 Gii phõu, t chc hc mng phi 1.1.1.1 Gii phu hc mng phi Mang phi la bao mc bao bc phi, gm lỏ va lỏ tng Gia hai lỏ la mt khoang o gi la khoang mang phi Bỡnh thng khoang mang phi cú mt ớt dch hai lỏ trt lờn c d dang Lỏ tang Lỏ tng bao bc xung quanh mt phi tr rn phi rn phi, lỏ tng qut ngc li, liờn tip vi lỏ thanh, theo hỡnh cỏi vt ma cỏn di (to lờn dõy chng phi hay dõy chng tam giỏc) Lỏ tng lỏch vao cỏc khe liờn thu va ngn cỏc thu vi Mt lỏ tng dớnh cht vao b mt phi, mt ngoai thỡ nhn, búng va ỏp sỏt vao lỏ Lỏ thnh Lút mt ca lng ngc, liờn tip vi lỏ tng rn phi va to nờn dõy chng tam giỏc luc nú i t rn phi n c hoanh Lỏ cun ly phi, dớnh vao cỏc vựng xung quanh phi nờn cú cỏc mt cng nh phi, lỏ to nờn cỏc tui cựng (gúc): gúc sn hoanh, gúc sn trung tht trc, gúc sn trung tht sau, gúc hoanh trung tht Khoang mng phi Khoang mang phi la mt khoang o Lỏ va lỏ tng ca mang phi luụn ỏp sỏt vao nhau, cú th trt lờn theo cỏc ng tỏc hụ hp Khi mang phi b viờm, mt ỏp sỏt vao ca hai lỏ mt nhn va c lờn hoc hn na tỡnh trng bnh ly, khoang mang phi cú th cú dch, m, mỏu, hoc hai lỏ dớnh vao cn tr cỏc ng tỏc hụ hp gõy khú th va au [6] 10 Bỡnh thng khoang mang phi cú ỏp lc õm (t -1 mmHg cui thỡ th bỡnh thng n -30 mmHg cui thỡ hớt vao gng sc) [7] Tuy nhiờn, nu mt ly nao ú lam mt ỏp lc õm khoang mang phi, nhu mụ phi se b xep li tu theo mc , mc nng nhu mụ phi se b co rum v phớa rn phi 1.1.1.2 Mụ hc mng phi c im cu trỳc chung C mang phi tng va mang phi c lút mt lp nht cỏc t bao trung biu mụ det Nhng t bao trung biu mụ cú kớch thc ng kớnh t ti 12 A [8] Trờn kớnh hin vi in t, thy b mt mang phi hoc la bng phng hoc la mp mụ nhiu l [9] (hỡnh 1.1) Nhng vựng mp mụ nhiu l bao gm hõu ht mang phi tng va cỏc phõn ca mang phi thanh: vựng di xng sn va cỏc ngỏch mang phi Hỡnh 1 Hỡnh nh ca mng phi trờn kớnh hin vi in t A: B mt mang phi mp mụ nhiu l vi cỏc b t bao b y xung khụng u B: B mt mang phi bng phng vi ranh gii t bao khụng rừ rang va tha tht cỏc vi nhung mao, s lng ca cỏc vi nhung mao xut hin trờn mi t bao la khỏc Ngun: Wang NS (1974), The regional difference of pleural mesothelial cells in rabbits, Am Rev Respir Dis, 110, 623-633 129 108 Brezler M, Abeles H (1975) Differentiation between hydropneumothorax and destroyed lung by thoracoscopy with a flexible bronchoscope Chest(68), 267-268 109 Gwin E, Pierce G, Boggan M et al (1975) Pleuroscopy and pleural biopy with the flexible fiberoptic bronchoscope Chest(67), 527-531 110 BenIssac FE, Simmons DH (1975) Flexible fiberoptic pleuroscopy: pleural and lung biopsy Chest(67), 573-576 111 McLean AN, Bicknell SR, McAlpine LG, Peacock AJ (1998) Investigation of pleural effusion: an evaluation of the new Olympus LTF semiflexible thoracofiberscope and comparison with Abram's needle biopsy Chest(114), 150-153 112 Ernst A, Hersh CP, Herth F et al (2002) A novel instrument for the evaluation of the pleural space: An experience in 34 patients Chest(122), 1530-1534 113 Lee P, Colt HG (2003) Using diagnostic thoracoscopy to optimal effect J Respir Dis(24), 503-509 114 Lee P, Colt HG (2003) Thoracoscopy: an update on therapeutic applications J Respir Dis(24), 530-536 115 Wang Z, Tong Z H, Li H J, et al (2008) Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions: a comparative study Chin Med J (Engl), 121(15), 1384-1389 116 Prabhu V.G, Narasimhan R (2012) The role of pleuroscopy in undiagnosed exudative pleural effusion Lung India, 29(2), 128-130 117 Legha SS, Muggia FM (1977) Pleural mesothelioma: clinical features and theraputic implications Ann Intern Med(87), 613-621 130 118 Agarwal R, Aggarwal AN, Gupta D (2013) Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions: a metaanalysis Chest, 144(6), 1857-1867 119 Michaud G, Berkowitz DM, Ernst A (2010) Pleuroscopy for diagnosis and therapy for pleural effusions Chest, 138(5), 1242-1246 120 Gao BA, Zhou G, Guan L, et al (2014) Effectiveness and safety of diagnostic flexi-rigid thoracoscopy in differentiating exudativepleural effusion of unknown etiology: a retrospective study of 215 patients J Thorac Dis, 6(5), 438-443 121 Beheshtirouy S, Kakaei F, Mirzaaghazadeh M (2013) Video assisted rigid thoracoscopy in the diagnosis of unexplained exudative pleural effusion J Cardiovasc Thorac Res, 5(3), 87-90 122 Rozman A, Camlek L, Kern I, Malovrh MM (2014) Semirigid thoracoscopy: an effective method for diagnosing pleural malignancies Radiol Oncol, 48(1), 67-71 123 Poe,RH, Isrel RH, et al Utell MJ (1984) Sensitivity, specificity and predictive values of closed pleural biopsy Arch Intern Med(144), 325328 124 Borderas Naranjo F, Rodriguez-PanaderoF, et al (1989) Pleural metastatic tumors and effusion: frequency and pathogenic mechanisms in a post-mortem series Eur Respir J(2), 366-369 125 Locati LD, CeresoliGL, Ferreri AJ, et al (2001) Theraputic outcome according to histologic subtype in 121 patients with malignant pleural mesothelioma Lung Cancer, 34, 279-287 126 Boutin C, Rey F (1993) Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients Part Diagnosis Cancer, 72, 389-393 131 127 Rey F, boutinC, Viallat JR (1995) Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma: a randomized trial of local therapy Chest, 108, 754-758 128 Garcia JR, Sugarbaker,DJ, Richards WG, et al (1996) Extrapleural pneumonectomy in the multimodality therapy of malignant pleural mesothelioma Results in 120 consecutive patients Ann Surg, 224, 288294 129 Loddenkemper R, MathurPN (1999) Medical thoracoscopy: role in pleural and lung diseases In: Beamis JF, Mathur PN, eds Interventional Pulmonology New York: McGraw-Hill Inc 169-184 130 Mai J, Loddenkemper R, Scheffeler N, et al (1978) Prospective individual comparison of blind needle biopsy and of thoracoscopy in the diagnosis and differential diagnosis of tuberculous pleurisy Scand J Respir Dis, 102(suppl), 196-198 131 Wyser C WalzlG, Smedema J, et al (1996) Comparing the diagnostic yield of Abrams needle pleural biopsy and thoracoscopy Am J Respir Crit Care Med, 153, A460 132 Ohuchi M, Inoue S, Ozaki Y, et al (2014 Apr 22) Single-trocar thoracoscopy under local anesthesia for pleural space infection Gen Thorac Cardiovasc Surg 133 Jose Manual Porcel (2003) Etiology and pleural fluid characteristics of large and massive effusions Chest, 124, 978-983 134 Hersh CP, Feller-Kopman D, Wahidi M et al (2003) Ultrasound guidance for medical thoracoscopy: a novel approach Respiration(70), 299-301 132 135 Ernst A, Hersh CP, Herth F, et al (2002) A novel instrument for the evaluation of the pleural space: an experience in 34 patients Chest(122), 1530-1534 136 McLean AN, Bicknell SR, et al McAlpine LG (1998) Investigation of pleural effusion: an evaluation of the new Olympus LTF semiflexible thoracoscope and comparison with Abram's needle biopsy Chest(114), 150-153 137 Ngụ Quy Chõu (2003) c im lõm sang, cn lõm sang ca bnh nhõn tran dch mang phi iu tr ti khoa hụ hp bnh vin Bch Mai nm 2001 Tap chi Nghiờn cu y hoc, 26(6), 56-60 138 Nguyn Huy Dng (2012) Nghiờn cu giỏ tr ca soi lng ngc sinh thit chn oỏn trn dch mng phụi dch tit cha rừ nguyờn nhõn, Lun ỏn tin sy y hc, Hc vin Quõn y 139 MD Francáois-Xavier Blanc, MD Kinan Atassi, MD Jean Bignon, PhD, MD Bruno Housset (2002) Diagnostic Value of Medical Thoracoscopy in Pleural Disease Chest, 121, 1677-1683 140 V.K Mootha, R Agarwal, N Singh, et al (2011) Medical Thoracoscopy for Undiagnosed Pleural Effusions: Experience from a Tertiary Care Hospital in North India Indian J Chest Dis Allied Sci, 53, 21-24 141 Nguyn Lờ Nht Minh, Nguyn Chi Lng, V Khc i (2009) Nghiờn cu kt qu ni soi mang phi ng mm chn oỏn tran dch mang phi cha rừ nguyờn nhõn Tap chi y hoc thc hnh, 5(663), 19-21 142 Rozman A, Camlek L, Marc-Malovrh M, et al (2013) Rigid versus semi-rigid thoracoscopy for the diagnosis of pleural disease: a randomized pilot study Respirology, 18, 704-710 133 143 Leung AN, Muller NL, Miller RR (1990) CT in differential diagnosis of diffuse pleural disease AJR Am J Roentgenol, 154, 487-492 144 Yilmaz U, Polat G, Sahin N, et al (2005) CT in differential diagnosis of benign and malignant pleural disease Monaldi Arch Chest Dis, 63(1), 17-22 145 Cao Xuõn Thc (2007) Vai trũ ca Lysozym v Interferon gamma chn oỏn trn dch mng phụi lao, Lun thc sy y hc, trng i hc Y Dc Thanh ph H Chớ Minh 146 Phm Huy Minh (2004) Nghiờn cu mt sụ c im lõm sng, cn lõm sng v vai trũ ca ni soi lng ngc chn oỏn trn dch mng phụi ỏc tinh, Lun thc sy y hc, Trng i hc Y hc Ha Ni 147 C Alemỏn, L Sanchez, J Alegre, et al (2007) Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures An International Journal of Medicine, 100(6), 351-359 148 D M Epstein, L R Kline, S M Albelda, W T Miller (1987) Tuberculous pleural effusions Chest, 91(1), 106-109 149 Mayse M.L (2008) Non malignant pleural effusion In fishmans pulmonary disease and disorder, 4th ed, Mc GrawHill, New York, , 1487-1504 150 Hurwitz S, Leiman G, Shapiro C (1980) Mesothelial cells in pleural fluid: TB or not TB? S Afr Med J, 57, 937-939 151 L Nattusamy, K Madan, A Mohan, et al (2015) Utility of semi-rigid thoracoscopy in undiagnosed exudative pleural effusion Lung India, 32(2), 119-126 152 Boutin C (1991) Manuel pratique des techniques pleurales, SpringerVerlag, Paris6-52 134 153 Boutin C, Guerin J.C, Viallat J.R, et al (1992) Exploration des maladies de la plốvre, Materiel utilise et technique detude Rev Mal Resp, 9, 81-87 154 Buchanan D.R, Neville E (2004) Thoracoscopy for Physicians A practical guide, Arnold, London 155 Boutin C, Vialatt J.R, Aubier M, et al (1996) Pathologie pleurale, Pneumologie, Flammarion Me decine-Sciences, Paris443-473 156 Tụ Th Kiu Dung, Phm Huy Minh, Phm Lờ Huy (2004) Ni soi lng ngc chn oỏn u trung biu mụ ỏc tớnh ca mang phi Tap chi Thụng tin Y Dc, S chuyờn Ung th õu-c va bnh ly v thõn kinh, 152-155 157 Kong XL, Zeng HH, Chen Y, et al (2014) The visual diagnosis of tuberculous pleuritis under medical thoracoscopy: a retrospective series of 91 cases Eur Rev Med Pharmacol Sci, 18(10), 1487-1495 158 Wang Z, Xu LL, Wu YB, et al (2015) Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion Respir Med, 109(9), 1188-1192 159 Ngụ Quy Chõu, Hoang Hng Thỏi, Chu Th Hnh, T Hu Anh (2004) Bc õu nhn xet v giỏ tr ca ni soi mang phi chn oỏn, iu tr tran dch mang phi va tran khớ mang phi tỏi phỏt Tap chi Y hoc thc hnh(499)(s 12/2004) 160 Willendrup F, Bodtger U, Colella S, et al (2014) Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark J Bronchology Interv Pulmonol, 21(3), 215-219 161 Wang XJ, Yang Y, Wang Z, et al (2015) Efficacy and Safety of Diagnostic Thoracoscopy Respiration, 90(3), 251-255 in Undiagnosed Pleural Effusions 135 162 Christopher DJ, Peter JV, Cherian AM (1998) Blind pleural biopsy using a Tru-cut needle in moderate to large pleural effusion an experience Singapore Med J, 39(5), 196-199 163 Ngụ Thanh Bỡnh, Nguyn Th Tuyt Nhi (2011) Giỏ tr ca sinh thit mang phi mự bng kim Castelain chn oỏn nguyờn nhõn tran dch mang phi Tap chi Y hoc Thnh phụ H Chi Minh, 15(1), 415422 164 Maturu VN, Dhooria S, Bal A, et al (2015) Role of medical thoracoscopy and closed-blind pleural biopsy in undiagnosed exudative pleural effusions: a single-center experience of 348 patients J Bronchology Interv Pulmonol, 22(2), 121-129 165 Niu XK, Bhetuwal A2, Yang HF (2015) CT-guided core needle biopsy of pleural lesions: evaluating diagnostic yield and associated complications Korean J Radiol 166 AdamsRF, Gleeson FV (2001) Percutaneous image-guided cuttingneedle biopsy of the pleura in the presence of a suspected malignant effusion Radiology, 219, 510-514 167 Sahajal Dhooria, Navneet Singh, Ashutosh N Aggarwal, et al (2013) A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions Respir Care, 59(5), 756-764 168 Khan MA, Ambalavanan S, Thomson D, et al (2012) A comparison of the diagnostic yield of rigid and semirigid thoracoscopes J Bronchology Interv Pulmonol 169 Sakuraba M, Masuda K, Hebisawa A, et al (2006) Thoracoscopic pleural biopsy for tuberculous pleurisy under local anesthesia Ann Thorac Cardiovasc Surg, 12(4), 245-248 136 170 Trõn Vn Sỏu (1996) Nghiờn cu c im lõm sng, cn lõm sng v phụi hp mt sụ phng phỏp iu tr trn dch mng phụi t lao, Lun ỏn phú tin s khoa hc Y dc, i hc Y Ha Ni, Ha Ni 171 Lờ Khc Bo, Trõn Vn Ngc, ng Vn Phc (2003) Giỏ tr sinh thit mang phi bng kim xuyờn da chn oỏn nguyờn nhõn laoung th gõy tran dch - day - u mang phi Tap chi Y hoc TP H Chi Minh, 7(Ph bn ca s 1), 93-97 172 Nguyn Huy Lc, Mai Xuõn Khn (2010) Nghiờn cu nguyờn nhõn va kt qu gõy dớnh mang phi qua ni soi mang phi bnh nhõn tran dch mang phi ỏc tớnh Tap chi y hoc thc hnh, 6(723), 40-42 173 Verma A, Taha A, Venkateswaran S, Tee A (2015) Effectiveness of medical thoracoscopy and thoracoscopic talc poudrage in patients with exudative pleural effusion Singapore Med J 174 oan Th Phng Lan (2014) Nghiờn cu c im lõm sng, cn lõm sng v giỏ tr ca sinh thit ct xuyờn thnh ngc di hng dõn ca chp ct lp vi tinh chn oỏn cỏc tụn thng dang u phụi, Lun ỏn tin s y hc, Trng i hc Y Ha Ni, Ha Ni 175 Guimaraes MD, de Andrade MQ, da Fonte AC, et al (2011) CTguided cutting needle biopsy of lung lesions an effective procedure for adequate material and specific diagnose Eur J Radiol 176 LeeP, Hsu A, Lo C, et al (2007) Prospective evaluation of ex-rigid pleuroscopy for indeterminate pleural effusion: accuracy, safety and outcome Respirology, 12, 881-886 177 Sahajal Dhooria, Navneet Singh, Ashutosh N Aggarwal, Gupta D (2014) A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions Respiratory Care, 59(5), 756-764 137 178 Boutin C, Viallat J.R, Astoul P.H, et al (1994) Complication de la thoracoscopie mộdicale, 11 ố Congrốs de pneumologie de langue fran Vaise, volume des rapport 138 BNH AN NGHIấN CU Khoa Mó bnh ỏn Phn hnh chớnh H va tờn: Tui Gii Ngh nghip: a ch: Ngay vao vin: Ngay vin: phn bnh s: din bin Ly vo vin: au ngc Khú th St Ly khỏc Tin s bnh hụ hp: Khụng cú ly Hen ph qun Viờm ph qun mn tớnh Hut thuc lỏ COPD Lao phi Tin s ung th Bnh ung th ó mc Cỏc bnh kốm theo Tin s gia ỡnh: Bnh s: 3.1 Tớnh cht au ngc: t ngt T t au d di au õm 3.2 Mc khú th: Khụng au 139 Nhe Va Nhiu Ho mỏu 3.3 Tớnh cht ho: Ho khan Ho cú m Lõm sng 4.1 Toan thõn St Mch 4.2 Nhp th Trờn 20 lõn/phut T 21 n 30 lõn/phut Trờn 30 lõn/phut 4.3 Khỏm phi Cú rales HC gim Lng ngc phng Lep lng ngc 4.4 Tn thng c quan khỏc Hỡnh nh Xquang 5.1 V trớ tran dch Bờn phi Bờn trỏi Hai bờn 5.2 Tớnh cht ca tran dch mang phi Mc tran dch: Tran dch t ớt trung bỡnh Cú ng cong Damoiseau nhiu Tran dch khu tru V trớ M toan b mt bờn phi Trung tht y 5.3 Tn thng khỏc Mang phi day Tn thng nhu mụ Hch trung tht Mụ t keo 140 5.4 Chp ct lp vi tớnh: Cú Tn thng u Khụng Tn thng dng li nụt Tran dch mang phi t Tran dch mang phi khu tru Dõy mang phi Hc trung tht Thõm nhim, nt Khỏc 5.5 Siờu õm mang phi Tran dch mang phi t Tran dch mang phi khu tru Day mang phi Vỏch Khỏc Xột nghim 6.1 Cụng thc mỏu: 6.2 CEA 6.3 Hch : 6.4 Xet nghim dch mang phi: Tớnh cht dch mang phi + Dch c + Mau dch Vang chanh Hng o + S lng dch mi lõn chc hut: + S lõn chc hut dch + Dch tỏi lp nhanh PCR: Chm BK trc tip: Rivalta dch mang phi: dng tớnh bactec: õm tớnh Protein dch mang phi: Protein mỏu LDH dch mang phi: LDH mỏu Xet nghim t bao dch mang phi T bao XN lõn Hng cõu Bch cõu a nhõn XN lõn XN lõn 141 Lympho T bao mang T bao K Hỡnh nh ni soi ph qun Bỡnh thng Thõm nhim sõn sựi Thõm nhim chớt hep Chốn ep t ngoai Khỏc Ni soi mng phi T th ngi bnh: V trớ m mang phi: Chiu dai vt m: Thi gian thc hin NSMP: S lng dch hut ra: Mau sc dch MP: S lõn thc hin: Nhng hỡnh nh NSMP ca bnh nhõn TDMP Niờm mc sõn sựi Lỏ Lỏ tng Niờm mc cú cỏc nt, cc Lỏ Lỏ tng Niờm mc thõm nhim Lỏ Lỏ tng Niờm mc nhn Lỏ Lỏ tng Nt nho ri rỏc Lỏ Lỏ tng Dõy dớnh Vỏch fibrin Tn thng nhu mụ: Khỏc Chn oỏn s b qua NSMP: Mnh sinh thit mang phi Khỏc tng Chn oỏn t bo hc Dch mang phi Cú t bao UT Khụng cú t bao UT 142 Dch ph qun Cú t bao UT Khụng cú t bao UT Chc hut hch Cú t bao UT Khụng cú t bao UT STMP mự Cú t bao UT Khụng cú t bao UT STMP qua NSMP Cú t bao UT Khụng cú t bao UT ST qua SPQ Khụng cú t bao UT Cú t bao UT 10 Chn oỏn mụ bnh hc STMP mự Ung th Viờm Lao Khỏc ST qua SPQ Ung th Viờm Lao Khỏc ST hch Ung th Viờm Lao Khỏc STMP qua NSMP Ung th Viờm Lao Khỏc Nguyờn nhõn TDMP ung th Ung th mang phi Ung th phi U lympho ỏc tớnh Ung th khụng rừ ngun gc Phõn loi typ mụ bnh hc 11 Xột nghim vi sinh mnh sinh thit: AFB Bactec Nuụi cy Vi khun 12 Tai bin ca ni soi mng phi ng mm Chy mỏu Tran khớ mang phi au ngc St Tran khớ di da Khỏc 143 ... DUC VA AO TAO Bễ Y Tấ TRNG AI HC Y HA NễI V KHC AI NGHIÊN CứU VAI TRò CủA NộI SOI MàNG PHổI ốNG MềM TRONG CHẩN ĐOáN NGUYÊN NHÂN TRàN DịCH MàNG PHổI Chuyờn nganh : Lao Mó s : 62720150 LUN AN TIấN... toan, ớt bin chng Ti Vit Nam ó cú nhiu nghiờn cu v ni soi mang phi ng cng chn oỏn bnh ly mang phi nhng cha cú nghiờn cu nao ỏnh giỏ vai tro ca ni soi mang phi ng mm chn oỏn nguyờn nhõn gõy TDMP Vỡ... Nhng trng hp nay, ni soi mang phi giup chn oỏn thờm vi chớnh xỏc lờn ti trờn 90% s cỏc trng hp tran dch mang phi, c bit la cỏc trng hp tran dch mang phi ỏc tớnh [2], [3], [4] Soi mang phi ng cng