BENH LY TRUNG THAT

Thi gian: 2 tiet GV: Dng Nguyen Hong Trang oi tng : Y3 CT3 Nam hoc : 2011 - 2012

MUC TIEU:
1. nh khu va gii han trung that 2. Neu ac tnh cua benh ly trung that. 3. Trnh bay ton thng thng gap trong tng phan khu 4. Mo ta trieu chng c ban cua benh ly trung that va c che. 5. Neu nhng benh ly trung that hay gap. 6. Trnh bay cac phng phap chan oan khong xam lan.

DAN BAI
I. II. III. IV.

AC IEM CUA BENH LY TRUNG THAT TRIEU CHNG LAM SANG NHNG BENH LY TRUNG THAT HAY GAP CAC BIEN PHAP CHAN OAN

NOI DUNG
I. AC IEM CUA BENH LY TRUNG THAT 1. nh khu va gii han trung that * Gii han trung that: - Khe co ngc tren - C hoanh di - Mang c sn trc - Cot song va khp cot song sn pha sau - Mang phoi trung that hai ben. * Phan chia trung that: trung that c chia thanh 3 phan + Trung that trc: pha trc mang tim va cac mach mau ln

+ Trung that gia: ( con goi la khoang tang) t b sau trung that trc en mat trc cot song + Trung that sau: t mat trc cot song en mat trc xng sn 2. ac iem cua benh ly trung that - V phan trung that rat nho nen khi co khoi choan cho rat de gay chen ep nhng c quan trong trung that va bieu hien nhng trieu chng giong nh benh ly cua cua cac c quan nay. - Xac nh nguyen nhan thng kho khan do kho tiep can cac c quan trong trung that . - Mot so benh ly trung that co the lan toa hay khong co v tr chon loc trong trung that nh tran kh trung that, viem trung that, xuat huyet trung that Tuy nhien, cac benh ly khu tru nh nang va u trung that thng co v tr u the trong tng phan khu trung that. Mat khac , mot so benh ly ngoai trung that nh benh ly tuyen giap hay can giap, cac benh ly trong o bung cung co the gia dang u trung that va cung hay co v tr ac biet. Trong cac trng hp nay , viec nam vng nh khu ton thng giup co hng chan oan nguyen nhan e lam cac xet nghiem thch hp. 3.Cac benh ly hay gap trong tng phan khu trung that * Trung that trc: benh ly tuyen c, u te bao mam, u m, u tuyen giap, u tuyen can giap, nang nc co. * Trung that gia: benh ly hach, nang co nguon goc phe quan, nang mang phoi mang tim * Trung that sau: U than kinh, nang co nguon goc ruot, nang than kinh ruot. II. TRIEU CHNG LAM SANG Khoang phan na benh nhan khong co trieu chng lam sang, tre em co trieu chng ro rang hn ngi ln. Khi co trieu chng lam sang gi y benh ly ac tnh. Cac trieu chng thng gap:
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 Hoi chng tnh mach chu tren: do chen ep tnh mach chu tren. Khan tieng: do liet day than kinh hoanh Hoi chng Horner ( Claude-Bernard- Horner: ong t co, hep khe mi, lom nhan cau, nong mot ben ma va ra mo hoi ben kia) do liet giao cam co cung ben hay ton thng ban cau nao va hanh tuy Liet c hoanh: liet day than kinh hoanh Tran dch mang phoi dng trap: do ton thng ong ngc Nuot nghen: do ton thng thc quan Ho: chen ep hay co ton thng cay ho hap Kho th: do khoi u chen ep, xam lan cay ho hap, do tran dch mang phoi ,mang tim , suy tim. Ho ra mau: xam lan cay ho hap , suy tim. Roi loan nhp tim: tim b e ep hay ton thng thanh tim au ngc: do u xam lan mang phoi, xng sn,ot song, than kinh. ot qu, tang huyet ap: gap trong u te bao a sac Vu to: u san xuat beta- hCG Roi loan tam than: do tang canxi mau Nhc c: hoi chng can ung th trong u tuyen c III. MOT SO BENH LY TRUNG THAT HAY GAP 1.Benh ly khong phai u 1.1.Tran kh trung that - Tran kh trung that t phat - Tran kh trung that th phat 1.2.Viem trung that: cap- ban cap- man tnh x hoa 1.3. Xuat huyet trung that t phat 1.4. Thay oi v tr trung that trong hoi chng sau cat phoi 2. Benh ly nang trung that
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1.1. Nang co nguon goc phe quan 1.2. Nang co nguon goc ruot 1.3. Nang ruot- than kinh 1.4. Nang mang phoi- mang tim 1.5.Nang ong ngc 3. Benh ly khoi u trung that 1.1.Benh ly tuyen c: - U tuyen c - Carcinoma tuyen c - Carcinoid tuyen c - U m tuyen c - Tang san tuyen c

1.2.Cac u te bao mam trung that - U lanh tnh( con goi la u quai lanh tnh) - U ac tnh: u tinh(seminoma), u quai trung that ac tnh, u khong seminoma 1.3.Benh ly hach bach huyet trung that - Lymphoma - Hach trung that do di can - Hach lao trung that - Sarcoidose - Benh Castleman( con goi la tang san hach lympho khong lo) 1.4. U than kinh - U te bao than kinh - U bao than kinh 1.5. U trung mo - U m va sarcoma m - U si - U mach mau 1.6. U noi tiet - U tuyen can giap - U te bao a chrome trung that 4. Cac ton thng gia dang u trung that 1.1. Bu giap 1.2. Nang nc
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1.3. Ton thng khung xng long ngc - U nguyen song - Ap xe canh cot song - Thoat v mang nao 1.4. Tao huyet ngoai tuy 1.5. Ton thng mach mau 1.6. Benh ly thc quan 1.7. Ung th kh phe quan 1.8. Benh ly di hoanh

IV.CAC BIEN PHAP CHAN OAN BENH LY TRUNG THAT 1.Cac bien phap khong xam lan 1.1.Xquang - Chup thang nghieng cung cap nhng thong tin c ban ve ton thng, nhat la nhng ton thng khu tru - Soi di mang huynh quang giup: + anh gia anh hng cua u trung that tren hoat ong cua c hoanh + Phat hien liet c hoanh + Xac nh hoac loai tr cac ton thng nghi ng la mach mau 1.2.CT scanner - c thc hien e anh gia khoi u trung that trong hau het cac trng hp - Co the phat hien cac u ng knh nho( 35mm) ma Xquang khong thay c - Phan biet c mat o cac ton thng(mo ac, dch, m,ong voi) giup tranh sinh thiet nham mot so ton thng - Hng dan ng sinh thiet va phau thuat - Tuy nhien thng kho phan biet hien tng u ch tiep giap hay a xam lan cac c quan lan can. 1.3. Cong hng t hat nhan + Co kha nang:

-Tai tao hnh anh theo mat phang tran va mat phang ng doc -Khao sat cac mach mau ma khong can chch thuoc can quang -Kha nang phan biet cau truc mo tot hn, tham ch co the phat hien c ban chat ac tnh cua no + Do o phng tien nay co nhieu li iem hn CTscanner: -Khao sat mach mau ,than kinh tot hn ac biet trong trng hp nghi ng co xam lan -Thch hp cho nhng benh nhan khong the chch thuoc can quang ( suy than , d ng) -Khao sat tot cac v tr: khe co ngc, c hoanh, cac u trung that sau nghi ng co ton thng than kinh i kem + Nhc iem: at tien,ton thi gian, nam lau 1.4. Sieu am - Giup phan biet mo ac va nang - Khao sat tot ton thng thc quan va cau truc lan can nh phng phap sieu am qua thc quan - Co the hng dan sinh thiet - Khuyet iem: khong khao sat c toan dien giai phau hoc trung that. 1.5. Phong xa hat nhan: da tren kha nang bat chat ong v phong xa cua mot so khoi u Loai u trung that Chat anh dau phong xa -Bu giap chm I-131 hay I-123 -U te bao a sac I-131 -Lymphoma, cac mo viem Gallium -U tuyen can gip Selenomethionin -Niem mac da day lac cho Technetium 99m
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1.7. Positron Emisson Tomography CT: l s kt hp gia ng v phng x v chp ct lp ,c th pht hin u c kch thc rt nh kho st c tnh trng di cn cc c quan khc. 1.8. Cac chat anh dau sinh hoa: da vao kha nang che tiet cua mot so u trung that + U tan sinh te bao mam co kha nang tiet FP, hCG + Mot so carcinoide tuyen c tiet ACTH + U te bao a Chrome, mot so u hach than kinh tiet Catecholamines 2. Cac bien phap xam lan 2.1. Sinh thiet trc mo + Cac ton thng can sinh thiet: -Co trieu chng xam lan( au ngc nhieu, kho th, tran dch mang phoi,nuot nghen, hoi chng tnh mach chu tren) -Hach khong lo -U trung that co gia tang nong o FP, hCG va CEA trong mau -Ton thng bat Gallium 67 do nguy c Lymphoma cao + Khong nen sinh thiet trong trng hp -Nghi ng u tuyen c, nhat la u con trong bao v co nguy c lam chuyen t giai oan I sang cac giai oan sau -U co Cathecholamine trong mau tang cao. + Phng phap: choc hut xuyen thanh ngc bang kim nho -Bien chng hiem xay ra -Giup han che phau thuat khong can thiet -Thch hp cho benh nhan co chong ch nh phau thuat -Han che: kho lay u mau, khong giup xep giai oan benh 2.2.Can thiep ngoai khoa - Thng ap dung e lay mau benh pham chan oan Lymphoma hay cac ton thng can xep giai oan benh

- Cac phng phap: soi trung that qua ng co, soi trung that qua thanh ngc pha trc, soi long ngc, m trung that.

TAI LIEU THAM KHAO

1. Fishman's Pulmonary Disease and disorders,1998

2. Maladies Respiratoires,1993 3. Primary cysts and neoplasms of the mediastinum: recent charges in clinical presentation, methods of diagnosis management and results 1987,sept. 4. Classification of thymic epithelial neoplasms : a controversial issue coming to an end, 2001.

CU HI LNG GI
1. Chn cu sai v bnh l trung tht: A. V phan trung that rat nho nen khi co khoi

choan cho rat de gay chen ep B. Xac nh nguyen nhan thng kho khan do kho tiep can cac c quan C. Nam vng nh khu ton thng trong trung tht giup co hng chan oan nguyen nhan . D. U trung tht thng c pht hin sm

2. Hoi chng Horner ( Claude-Bernard- Horner) khng c :

A. ong t dn B. Hep khe mi C. Lom nhan cau, nong mot ben ma va ra mo hoi ben kia D. Liet giao cam co cung ben . 3. Cu no khng ng v bnh l trung tht: A. Khong phn na bnh nhn khng c triu chng B. Tre em t biu hin trieu chng nh ngi ln.

C. Khi co trieu chng lam sang gi y benh ly ac tnh. D. Thng gap hoi chng tnh mach chu tren do chen ep tnh mach chu tren. 4. Rt kh chn on bnh l trung tht do: A. Triu chng xut hin mun,khng c hiu B. Khng tip cn c cc c quan trong trung tht C. Phi dng cc bin php xm ln D. A v B

P N 1.D 2.A 3.B 4.A