Y HOC VIET NAM THANG 4 S O 2/2014

- Ty le MCR d nhdm RHN la eao nhat (44.46%),

tiep den la nhdm RHL (19.82%), nhdm rang cu^
(18.21%) va rang nanh la thap nhat (17.50%).
- Ty le MCR dp 1 cao nhat (63.04%), tiep theo la
dp 2 (30.36%), dp 3 ehiem 5.54% va d d 4 la
thap nhat (1.07%).
- Vi tri tdn thffdng MCR nhieu nhat d 1/3 ed
rang, mat ngoai d tren Ipi (90.36%). Ton thffdng
MCR dffdi lpi ehiem 8 . 2 1 % , khdng ed tdn thffdng
MCR mat trong.
TAI UEU T H A M KHAO
1. Vu Duy HUng (2008) "Nghien eiru tinh trang sau
rang, mon rang va nhu cau dieu tri d ngUdi cao
tud'i tai phffdng Yen Sd, quan Hoang Mai", Luan
an thac sy y hpc, Trddng dal hpc Rang Ham Mat

10. Blunek U (2001), "Improving cen/ical

restorations: a review of materials and
techniques", 3Adhes Dent, Vol. 3, N" 1, pp.33-44.
Borcic J, Anic I , Urek MM, Ferreri S (2004),
"The prevalence of non- carious cervical lesions in
permanent dentition", J Oral Rehabll, Vol.31, N02,
pp.117-123.
Dang Que Du'dng (2004), "Nhan xet ket qua
tram ton thUdng cd rang bang Composite co lot
Glass loncmer Cement", Luan an thac sy y hoc,
Trddng dai hoc Y Ha Npi
Kitchin PC (1941) " Associated with occlusal
erosion and 5'&.r\t:\on" Aust Dent J 44, ppl76-186.
Neo 3,, Chew CL (1996), " Direct tooth- eotored
matenals for noncarious lesions: a 3- year dlnial
report", Quintessence Int, Vol. 27, N3, pp.183-188.

DAC DIEM LAM SANG, NOI SOI, MO BENH HOC

VA HIEU QUA DIEU TRI LOET DA D A Y B A N G P H A C DO EAC

TAI BfiNH VIEN DA KHOA HUYEN TAM NONG (PHU THO)

Dao Nguyen Khai* vS cs
clinical signs; epigastric pain hold the highest rale
T6IV1 TAT
(97.9%), acid regurgitation is subsequent (54.1%).
Nghien ciru tren 96 benh nhan bi loet da day tff
About endoscopy: one ulcer with the dimension in the
n3m 2010 cho biet: Nam gap nhieu hOn nff (ty le
range of 0.5 to 1.0 centimeter; the location at antnim
nam/nff la: 2,42), vdi tuoi trung binh la 48,3 11,7.
- pyloric makes up the highest rate, 84.4%; 85.4%
Cac dau hieu lam sang noi bat gdm: Dau viing thUdng
and 53.4% respectively. Histological pathologic: Active
vj (97,9%), d ndng-p hdi (54,1%). Ve ket qua ngi soi:
01 6 loet, kich thudc o loet: 0,5-1,0 cm, vj tri hang vi" chronic gasthbs (92.6%) and atrophic gastritis
(83.3%) hold the highest rate. Result after treatment:
tien mon vi chiem ty le cao nhat, tUdng ffng la:
87.5% patients get over the pain, 12.5% of those
84,4%; 85,4% va 53,4%. Ve md benh hpc: Viem hoat
have
pain relieved. The ratio or sear is 86.4% and this
dgng (91,6%) va viem teo (83,3%) chiem ty le cao
of healing is 13.6%.
nhat. Ket qua dieu tri bang phac do EAC: Het dau viing
thUOng vi: 87,5%, giam dau viing thUdng VJ: 12,5%.
I. OAT VAN OE
Ty le lien seo dat; 86,4%, 6 loet dang lien seo: 13,6%.
SUMIVIARY
STUDY ON CLINICAL, ENDOSCOPIC
IMAGES, HISTOPATHOLOGY, TREATMENT
RESULTS E.A.C REGIMEN I N PEPTIC ULCER
PATIENS I N TAMNONG D I S T R I C T
HOSPITAL ( P H U THO)
The research on 96 peptic ulcer patients shows In
2010 shows that: Male suffers more than female (the
ratio is 2.42), the average age is 48.3 11.7. About
* Bpnh vien Da khoa Huyen Tam Nong
Phan bien khoa hpc: PGS.TS Vu Van Khien

Loet da day ta trang (DDTT) la mdt benh kha

phd bien d Viet Nam va tren the gidi. Loet DDTT
la sff pha hiiy cue bp niem mac da day ta trang
do acid chlorhydrie va pepsin. Ton thffdng trong
loet DDTT thffdng vffdt qua Idp cd niem va day
la dae diem de phan biet giffa trdt ndng vdi loet
DDTT (1). Theo thong ke cua td chffe y te the
gidi (WHO), sd ngffdi loet DDTT chiem khoang 5
- 10% trong cpng dong. Vdi nhu'ng benh nhan
loet DDTT neu khdng dffdc dieu trj kjp thdi thi se
gay nen mpt sd cac bien chffng nhff: Thiing,
chay mau tieu hda, hep mdn vj, suy kiet.. TLT
nam 1983, sau phat hien quan trpng ciia

Y HOC VigT NAM THANG 4 - SO 2/2014

Marshall va Warren da cho biet Helicobacter te bao ung thif va xet nghiem H.pyion (+) xac
pylori (H.pylori) difclc col la nguyen nhan so mot dinh tren mo benh hpc.
2.2. Phu'dng phap nghien cu'u
gay loet DDTT. Hpi nghj dong thuan Marstrich ia
2.2.1. Phifdng phap nghien c&u: Hoi cCTu,
duS ra phac do dieu trj loet DDTT nhilm H.pylori
bang phac do gom: thuoc \ic che bdm Proton tien cu'u va theo dpi sau 45 ngay dieu tri.
2.2.2. Phu'dng tien; SLT dung miy noi sol
(Nexlum, Pantoloc .) va siy dung 2 loai khang
sinh phoi hdp (Amoxicillin, Clarithromycin)... Oe ong mem: EVIS 160 (Nhat Ban). Ndi thye hien:
tai nghien ciru sir dung phac do: Esomeprazole - Phong Npi soi - Khoa Noi chung - Benh vien
Amoxynlline - Clarithromycin (viet tat EAC) choHuyen Tam Npng (Phu Tho). Bpc ket qua nio
benh hpc (MBH) thu'c hien tai khpa Glal phau
benh nhan loet daday (LDD) vdl muc dich sau: benh - Benh vien Da khpa tinh Phu Tho.
Tim hieu dac diem lam sang, ngi soi, mo
2.2.3. Phac do dieu tri gom;
b$nh hgc va kei qua dieu tri LDD biing phac Esomeprazple (Nexium) 20mg: 2 vieri/lan x 2
do SAC tai binh vien huyen Vinh Tu'dng - lan/ngay (luc 9 gid va 21 gid) x 14 ngay;
Tinh Vinh Phiic,
Amcxycillln 500mg: 2 vien/lln x 2 ^n/ngay x 7
ngay; Clarithrpmyclne (Klacid): SOOmg: 1 vien
/lan x 2 lan/ngay x 7 ngay.
II.D6|TU'(?NG VA PHl/OfNQ PHAP NGHIEN COU
22,4. Theo doi; ve lam sang tru'de va sau dieu
2.1. Doi tircrng nghien cu'u
tri: tinh chat dau, d hdi, d chua... Theo doi o loet qua
Co 96 benh nhan dieu trj tai khoa Noi chung npi SOI trifdc va sau dieu tri (kiem tra lai sau 45
- Benh vien ba khoa huyen Tam Nong (Phu Tho) ngay) ve kich thirdc, vi tri, tinh chat. Danh gia o loet
tir: 01/2010 den 12/2013. Tieu chuan LDD gonfi: theo tieu chuan ciia Malano EL va Tamada F nam
CO 1 hay nhieu cac trieu chu'ng sau: Dau vung 1992 (1) gom: p Ipet da lien Sep (S); o loet dang
thu'dng vi, d hdi, d chua... Noi soi: 6 loet co kfch lanh (H); p loet dang hpat dpng (A).
thiTcIc > b.Scm. Ket qua mo benh hoc: khong co

III. KET Q U A
Bang i/Oac diem lam sang va can lam sang LDD
Bjc aiem Chung
n (%)
Tupi trunq binh
8,3 11,7
Gidi (nam/nu')
68/28 (2,42)
PSc diem lam sang
Dau thu'dng vj
94/96 (97,9
52/96 (54,1%)
p hdi, d chua
Nong rat thu'dng vj
31/96 (32,3'
20/96 (20,8'
Day bunq, cham tieu
16/96 (16,6%)
Buon non
Chay mau tieu hoa
5/96 (5,2%)
Nh$n xet: Nam mac benh nhieu hdn nu'. Ve lam sang: Dau vung thu'dng vi chiem ty le cao nhat
(97,9%) tiep den trieu chutig d chua (54,1%)
Bang J?;D3c diem noi soi va mo benh hoc LDD
BSc diem
n (/o)
Dac diem
n (%)
So lu'dng o loet
Kich thu'dc 6 loet
1 6 loet
81/96 (84,4%)
0,5 -1,0 cm
82/96 (85,4%)
2 6 loet
8/96 (8,3%)
1,1 - 2,0 cm
9/96 (9,4%)
> 3 6 loet
7/96 (7,3%)
> 2 cm
5/96 (5,2%)
VI tri 6 loet
Mo benh hoc
Than vl
7/118i5i9%l Viem hpat dong
88/96 C91j6%l
Bd conq nho
43/118 (36,4%) Viem tep
80/96 (83,3%)
Bd conq ldn
5/118 (4,2%)
Dl san ruot
22/96i22^%L
I Hang
"a vi,
. . , tien
" ^ mon
" ' vi
"!
I 63/118(53,4%)
.^, * x y.,.^, . .M, t ^Loan
v , v i . . san
,i.
I 13/96
'^1^^ (13,5%)
\*^f^'"/ I
Nh$n xit; So Wijng 1 6 loet, kich thu'dc o loet: 0,5-1,0 cm, vj tri 6 loet hang vj, tien mon vj chiem ty
l| cao nhat, tirong Crng la: 84,4%; 85,4% va 53,4%. Viem hoat dong va viem teo chiem ty le cao nhat
trong MBH, tu'dng ulig la 91,6%; 83,3%.

Y HOC VIET NAM THANG 4 - SO 2/2014

Bang 3: H\eu qua dieu tri sau 45 ngay

fiac diem
n (o/o)

Dac d i e m

n (o/o)

Het dau thu'dng vi

84/96 (87,5%)

Lien seo

83/96 (86,4%)

Giam dau thffdng vi

12/96 (12,5%)

6 loet dang lanh

13/96 (13,6%)

To'ng

96/96(100%)

Tong

96/96 (100%)

Nhan xet: Sau 45 ngay dieu tri: 87,5% het dau, 12,5% giam dau. Ty le lien seo dat; 86,4%, o loet
dang lien seo: 13,6%.
IV. BAN LUAN
4.1. Oac diem cliung ve tuoi, gidi va lam
sang LDD
Huyen VTnh TffcJng thupe tinh Vinh Phiic,
nam d phia bae tiep giap Ha Npi, vi vay trinh dp
dan tri va dieu kien kinh te ngay cang gia tang...
Tff nam 2008, benh vien da khoa Huyen Tam
Nong da dffpc trang bj them ve he thong may npi
soi da day, do do da co dieu kien chuan doan va
dieu tri loet da day ta trang nhieu hdn.
Co nhieu tai lieu trong va ngoai nffdc trinh
bay ve dae diem tuoi va gidl d benh nhan loet
LDD. Tan suat benh tien trien theo thdi gian va
thay doi theo tffng nffcfe (4,5). Tuy nhien, ty le
nam mac benh nhieu hdn nH. Theo Boixeda D va
cs (4) cho biet ty le LDD nam/nff la: 1,56. Tai
Viet Nam, nghien CUXJ ciia Trjnh Tuan Dung (2)
la: 2,8, Trong nghien effu ciia chimg toi (bang 1)
ty le mac benh nam/nff la: 2,42
Ve tuoi; Tuoi trung nien hay gap trong LDD
(1-5), Nghien effu eiia chiing toi cho biet; tuoi
trung binh la: 48,3 11,7. Ket qua nghien cffu
nay cijng phii hpp nghien cffu eiia eae tac gia
trong va ngoai nffdc (1-5). Nghien cuXi cua Ta
Long (1) qua 5807 benh nhan LDD cho biet tuoi
trung binh d nam la: 49,0 11,2 va 41,8 13,1
doi vcfi nff.
Nghien cffu dac diemm lam sang LDD la mpt
van de kha phong phii va thiet thffc. Trong bang
1 eho biet: Oau thffdng vi, P hpi, p chua, nong
rat thffPng vi chiem ty le eao tffdng ffng la:
97,9%: 54,1%; 32,3%. Co 5/96 benh nhan
(5,2%) khi vao vien la do chay mau tieu hoa
(non ra mau va/hoac di ngoai phan den) da dffPe
npi soi xac djnh nguyen nhan la do LDD. Nhffng
ket qua nghien effu nay eiing phii hdp nghien
cffu trong va ngpai nffdc (1-4). Cac bao cao
trong nffdc deu thay rang: phan ldn cac benh
nhan LDD deu eo trieu chu'ng dau viing thffdng
vL Tuy nhien, co mot so trffdng hdp LDD nhffng
khong cd trieu chimg lam sang va ehi khi sol mcfi
phat hien thay 6 loet (6). Tuy nhien, ty le ''loet
cani' chiem t^- le rat thap- ma phan Idn benh
128

nhan cd tff 1 den nhieu trieu chffng trd len, Vdi

nhffng trffdng hdp nay can phai ed kinh nghiem
khong chi ve lam sang, ma eon phai co nhieu
kinh nghiem trong npi soi de giup chan doan
benh ngay cang tot hdn, chinh xac hdn.
4.2. Dac diem noi soi va ket qua md
benh hoc tru'de di'eu trj
* Vi tri 6 loet: LDD Co the gap moi ndi tren
da day nhffng thffdng gap nhieu hang vj SP vdl
than vj, bd eong nhd (BCN) gap nhieu hdn so vdl
bd eong Idn (BCL). Trong ngiiien cffu ciia chung
tdi trinh bay bang 2 cho biet: loet bd cong nho,
loet hang vj va tien mon vj chiem ty le cao nhat,
tffpng ffng la; 36,4% va 53,4%. Nhu'ng ket qua
nay cung phii hdp nghien cffu trong va ngoai
nffdc (2,3,5). Tuy theo vj tri Jobnson da chia
thanh 3 the: the 1: loet viing tiep giap giffa hang
vj tien mon vj: the 2: Loet hang vj phoi hdp loet
HTT: the 3: Loet TMV. Tac gia cho rSng the 1
ehiem ty le cao nhat va nguyen nhan ciia no la
do sff phdi hdp viem da day vimg hang vj phoi
hdp giam toan, cd the do sff khuyech tan eiia ion
H_* va pepin vao niem mac da day de bj hU bien
san do trao ngffdc djch mat hoac do roi loan v|n
dpng ciia da day. Nhin chung, cac tac gia deu
thffa nhan; loet gdc bd cong nhd chiem ty le rat
cao, con loet hang vj thi gap nhieu hdn so than
vj. Cac tac gia cho rang loet than vj va phinh vj
thffdng cd lien quan tdi thuoc khang viem khong
steroid (NSAID), cdn loet bd cong nhd va loet
hang vj thffdng lien quan tdi nhiem H.pylon{^,l)
* So Iffdng 6 loet: Nhin chung cac nghien
cffu trong va ngoai nffdc deu thay rang phan ldn
LDD thffdng co mot 6 loet. Trong nghien ciru ciia
chimg tdi sd benii nhan cd mot 6 loet chiem ty
le: 84,4%. Tuy nhien, so benh nhan cd 3 6 loet
cung chiem ty le la: 7,3%. CJua dieu tra benh sii
va benh canh lam sang, chung toi thay rSng;
benh nhan ed 3 6 loet thffdng la benh nhan loet
lan dau, loet cap ti'nh va do tac ddng ciia nhieu
nguyen nhan nhff uong nhieu rffdu, bia. Nghien
ciru ciia Trjnh Tuan Dung cho biet 80% benli

Y HOC VIET NAM THANG 4 - SO 2/2014

nhan cd 1 6 loet, so benh nhan ed 2 o loet va 3 6 ndi soi: o loet lien seo (86,4%), dang lien seo
loettUPng ffng la: 11.6% va 13.3%.
(13,6%).
Nghien cffu cua Nguyen Thuy Vinh (3) diing
* Kich thude o loet: So vdi loet HTT thi LDD
thffdng cd kich thu'dc Idn hdn. Thong thu'dng 6 phac do OAC va kiem tra lai sau 45 ngay thi ty le
loet thffdng cd dffdng kinh giao dpng tff 0,5-2 het dau la: 77.8% va ty te lien seo la: 81.9%.
em. Trong nghien effu ciia chiing tdi 6 loet ed Ket qua nghien cffu nay eung phii hdp nghien
kich thudc 0,5-1,0 cm chiem ty le eao: 85,4%. So cffu cua Boixeda D va cs (4). Ngay nay, nhd cd
benh nhan cd 6 loet 2 em chi chiem ty le: 5,2%. nhieu loai thudc mdi, ket hpp nghien cffu sau ve
Ket qua nghien cffu ciia ehiing tdi eung phu hdp ed che benh sinh cua loet va nghien cffu sau ve
nghien cffu ciia Trinh Tuan Dung, Nguyen Thuy HP da md ra mot ehan trdi mdi trong dieu tri
LDD - TT va thUc te trong nhieu nam qua da cho
Vinh (2.3).
* Ket qua mo trenh hpc: Md benh hpc ddng thay: Giam bien chffng do 6 LDD gay nen (thung,
vai trd rat quan trpng trong chan doan dung ban chay mau, hep mdn vj...) va giam ty le phau
chat ciia LDD. Nghien cffu tren the gidi (4.5) eho thuat eat da day.
thay loet ung thff hoa chi chiem 5-10%. vdl thdi
gian loet keo dai tren 10 nam. Nghien cffu bang V. KET LUAN
3 cho thay: viem hoat ddng va viem teo ehiem
Nam mac benh nhieu hdn nff (ty le; 2,42),
ty le eao nhat: 91,6% va 83.3%. Ty le dj san ruot vdi tuoi trung binh; 48,3 11,7. Ve lam sang:
va loan san rupt chi chiem; 22,9% va 13,5%.
Dau viing thffdng vj chiem ty le cao nhat
tuy nhien, day la nhu'ng ket qua xet nghiem (97,9%), tiep den trieu chffng d chua (54,1%).
Ian dau ve mo benh hpc ciia nhffng benh nhan
Ve ndi soi: 1 o loet, kich thffdc 0,5-1,0 em, vj
nay chffa tim thay ung thff. Chiing tdi cho rang; tri hang vi tien mdn vj ehiem ty le cao nhat,
Vdi nhffng benh nhan cd 6 loet > 2 em ran dffdc tffpng ffng la; 84,4%; 85,4% va 53,4%. Ve md
theo dpi het sffc chat ehe thong qua dieu trj tieh benh hoc: Viem hoat dpng (91,6%) va viem teo
cffc va kiem tra qua npi soi va sinh thiet nhieu (83,3%) ehiem ty le cao nhat. Ket qua dieu trj
Ian. Dong thdi, ijenh nhan can dffpe theo doi bang phac do EAC; Het dau vimg thffdng vj;
trong thdi gian trong nhieu nam. Ngay nay. 87,5%, giam dau viing thffdng vj: 12,5%. Ty le
ngffdi ta chu y rat nhieu den viem teo han^ vj va lien seo dat: 86,4%, 6 loet dang hen seo: 13,6%.
ngffdi ta cho rSng viem teo thffdng de dan den
ung thff hoa nhieu hPn (30%),
TAI LIEU T H A M KHAO
4.3. Hieu qua di'eu trj bang phac do EAC 1. Ta Long. Benh ly da day - ta trang va vi khuan
Hien nay, cd rat nhieu phae do dieu trj
Helicobacter Pylon. Nha xuat ban Vhoc 2003.
LDD bao gom sff dung thudc ffc che bdm 2. Trjnh Tuan Dung. Nghien cirU mo benh hpc loet
Proton, ket hdp 2 loai khang sinh. Trong cae
da day trUdc va sau dieu trj noi khoa. Luan an tien
thuoc ffc che bdm Proton hien nay thi thuoc
sy r hpc 2000.
Esomeprazole (biet dffde Nexium) dffdc Iffa ehpn 3. Nguyen Thuy Vinh. Nghien cuXi hieu qua ciia ba
nhieu hdn do cd nhieu ffu diem hdn so vdi cae
phac do: OAM, OAC, OMC trong dieu tri loet da
thuoe ffc che bdm Proton khac (Pantoloc.
day, ta trang H.pylori dUOng tinh va anh hudng
Rebeprazole...). Ve khang sinh: trffdc day hay sff
cua khang thuoc tdi cac phac do ffen. Luan ai.
dung phac do phoi hdp: Amoxicillin +
tien sy y hpc 2003.
Metrcinidazole. Tuy nhien, do tinh trang khang
4. Boixeda D, Martin DAG, Bermejo F, et al.
thuoe cua Metronidazole ngay eang tang, nen
Seven day Proton Pump Inhibitor, Amoxicillin and
nhieu tac gia da sff dung Clarthromycin thay the
Clarithromycin tnple therapy, factors that
cho Metronidazode. Do vay. chiing tdi da ap
influence HP eradications suscess. Rev Espferm
dung phac do (Esomeprazole + Amoxicillin +
Dig 2003; 95(3); 206-209
aianthmmycin: EAC).
5. Dixon MF. Helicobacter pylon and peptic
Ket qua nghien cdu trinh bay trong bang 3
ulceration: Histopathological aspects. J. Gastrol.
eho thay kiem tra lai sau 45 ngay cae trieu chffng
Hepatol 1991; 6; 125-130
Cd ban nhff: Het dau dat: 87,5%. giam dau;
12,5%. Ket qua lam sang phii hPp vdl ket qua