C IM VIM TY CP TR EM

TM TT
t vn : Vim ty cp (VTC) l mt bnh thng gp nht trong nhm
bnh l ty tr em. Bnh c th din tin nng e do t vong. Trn th gii
c nhiu cng trnh nghin cu VTC tr em. Ti n , VTC chim 59,1%62,5% trong tng s bnh l ty tng tr em. Ti min Nam Vit Nam cha c
thng k c th.
Mc tiu: Nhm tm hiu cc c im ca tr VTC ti bnh vin Nhi
ng 1 (BVN1) v bnh vin Nhi ng 2 (BVN2).
i tng v phng php: Nghin cu hi cu, tin cu m t lot ca
VTC ti khoa tiu ha BVN1 v BVN2 t 01/03/2003 n 31/03/2006.
Kt qu: Bnh gp n nhiu hn nam, a s > 5 tui. Trong 24 ca c 3
ca nng (12,5%), 9 ca VTC do bnh ng mt (37,5%), 7 ca khng r nguyn
nhn (29,1%). au thng v v i l hai triu chng thng gp. nhm nng,
bch cu (BC) mu v LDH mu cao hn, albumin mu thp hn so vi nhm
nh. Cc triu chng vng da, tng SGOT, SGPT, AP gp nhm bnh ng
mt nhiu hn nhm bnh ngoi ng mt. Trn siu m c 83,3% tng kch
thc ty. 4 ca cn can thip ngoi khoa (16,7%).

Kt lun: VTC tr em l bnh kh chn on. Bnh thng c chn

on da vo cc triu chng khng c hiu phi hp vi mt s xet nghim gi
. Siu m rt cn thit trong cng tc chn on v theo di din tin. T l tr
VTC khng r nguyn nhn cn kh cao.
ABSTRACT
Background: Acute pancreatitis is the most common disease of childrens
pancreatic problems. It can lead to the death. There were a lot of studies in
children throughout the world. In India, there were 51,9% - 62,5% cases with
acute pancreatitis among pancreatic problems. There are no study in children in
south of Vietnam.
Objectives: To understand the characteristics of children with acute
pancreatitis.
Patients and method: Retrospective, prospective descriptive study (cases
series) children woth acute pancreatitis at Chldren No.1 and Children No.2
between the period of 01/03/2003 and 31/03/2006.
Results: There were 24 cases in the review period. It was more prevalent
among girl, and children aged more 5 years old. Acute severe pancreatitis
occupied 3 patients (12.5%). There were 9 cases with biliary disease (37.5%) and
7 cases with unclear causes (29.1%). The common symtoms were abdominal pain
and vomitting. White blood cell and LDH of severe cases were higher than the
others. Jaundice rise of SGOT. SGPT, AP was more commond in patients with

biliary disease. The most radiological finding was swelling of the pancreas, found
by ultrasound. 4 patient required operative intervention (16.7%).
Conclusions: The diagnosis of acute pancreatitis in children can be
difficult. This is often due to ambiguous symtoms, signs and laboratory results.
Ultrasound is essential investigations in the diagnosis and subsequent follow-up.
Patients with unclear causes present in a rather high rate.
T VN
Vim ty cp l mt bnh thng gp nht trong nhm bnh l ty tr em.
Ti n , VTC chim 59,1%- 62,5% trong tng s bnh l ty tng tr em(5). Tn
sut mc bnh VTC ngy cng tng. Theo thng k Hoa K, ti bnh vin
Winsconsin, s ca VTC tng t 27 ca trong nm 1996 n 45 ca trong nm 2000(10).
Nguyn nhn VTC tr em rt a dng, gn y c nhiu nghin cu kt lun
bnh ng mt l nguyn nhn thng gp nht. VTC l qu trnh t hi phc. Tuy
nhin bnh c th din tin nng gy t vong hoc li nhiu di chng nu khng
c can thip ng lc. Trn th gii c nhiu nghin cu v VTC tr em. Ti
Vit Nam cng c nhiu nghin cu VTC nhng ch mi tp trung thc hin
ngi ln. Do chng ti tin hnh nghin cu hi cu v tin cu m t hng lot
ca VTC tr em ti khoa tiu ha BVN1 v BVN2 t thng 3/2003 n thng
3/2006 nhm ng gp thng tin v cc c im dch t hc, lm sng, cn lm sng,
nguyn nhn, t l bin chng v t l t vong; qua gip chng ta c ci nhn chung
v bnh VTC tr em min Nam Vit Nam.

I TNG - PHNG PHP NGHIN CU

Dn s nghin cu
Tt c bnh nhn c chn on VTC ti khoa tiu ha bnh vin Nhi
ng 1 v bnh vin Nhi ng 2 t 01/03/2003 n 31/03/2006.
Tiu ch a vo
Bnh nhn tha 3 tiu chun sau:
- au bng cp
- Amylase mu 330UI/l
- Lipase mu 190UI/l
Hoc c bng chng VTC trn CT Scan
Tiu ch loi ra
Bnh bm sinh ngoi ng tiu ha gan mt.
X l d liu
Bng phn mm SPSS 10.0
KT QU
Trong thi gian nghin cu chng ti ghi nhn c 24 ca VTC, tui nh nht
l 1,5; ln nht l 15; tui trung bnh 8,74 4,03; trong 83,3% tp trung la
tui > 5. Bnh gp tr n nhiu hn tr nam vi t l n:nam l 3:1.
Lm sng

Chng ti nhn thy hu ht bnh nhn nhp vin v au bng (91,3%).

au bng v i l hai triu chng thng gp nht, trong a s bnh nhn au
vng thng v. Cc triu chng khc khng c hiu cng thng gp (bng 1).
Cn lm sng
Tng bch cu a nhn trung tnh (BCNTT) v tng Hct chim t l ln lt l
58,3% v 20,8%. Amylase mu v lipase mu u tng ngy u nhp vin vi nng
trung bnh ln lt l 1121,04 621,21 UI/l v 901,88 566,1 UI/l. Cc triu chng
sinh ha khc c ghi nhn bng 1 (bng 1).
Trn siu m, c 83,3% ca tng kch thc ty; 16,7% ca c t dch
quanh ty; 4,2% ca dn ng ty chnh.
Bng 1. Cc triu chng lm sng v cn lm sng ca bnh nhn VTC
Lm
sng

S
ca

T l
%

Cn
lm sng

au

S
ca

T
l %

CRP
24

bng

100,0

9/24

37,5

3/22

13,6

> 20mg/l
H
i

23

93,8 albumin
mu

Lm
sng

S
ca

St

T l
%

13

Cn
lm sng

54,2 ng

S
ca

T
l %

4/24

16,7

3/17

17,6

8/24

33,3

8/24

33,3

8/18

44,4

5/15

33,3

1/24

4,2

huyt

Vng
7

29,2 triglyceride

da
mu
Chng

Tng
6

25,0

bng

SGOT
Phn
Tng

ng

thnh

25,0
SGPT

bng
Tng
8

33,3
AP

Xut
Tng
huyt tiu ha
LDH

Lm
sng

S
ca

T l
%

Cn
lm sng

S
ca

T
l %

Ca++/mu
Th so snh gia hai nhm VTC do bnh ng mt v bnh ngoi ng
mt chng ti nhn thy cc triu chng vng da, tng SGOT (serum glutamate
oxalate transaminase), SGPT (serum glutamate pyruvate transaminase), AP
(alkaline phosphatase) gp nhm bnh ng mt nhiu hn nhm cn li (bng
2).
Bng 2. So snh c im gia nhm bnh ng mt v ngoi ng mt
Cc

Nhm

triu chng bnh

Nhm

ng bnh

mt n(%)

ng

ngoi
mt

n(%)
Vng

5(50,0)

2(14,3)

Tng

6(60,0)

2(14,3)

Tng

6(60,0)

2(14,3)

da

SGOT

SGPT
Tng

5(62,5)

3(30,0)

AP
Nhn xt c im gia hai nhm VTC nh v nng, chng ti thy rng
(bng 3)
Bng 3. c im ca nhm VTC nh v nhm VTC nng
Nhm

c
nh

im
BC

lc

nng
13,54

vin 6,42

nhp

Nhm

19,26
3,9

(K/mm3)
LDH
mu (UI/l)

452,71
256,1

Albumin
mu sau 48 gi 4,6
(g/l)
Nguyn nhn

820,67
194,1

38,93

32,67
3,51

Bnh ng mt l nguyn nhn thng gp nht (37,5%). Cc nguyn

nhn c ghi bng 4, trong s ca khng r nguyn nhn cn chim t l cao
(29,1%) (bng 4).
Bng 3. Nguyn nhn VTC
Nguyn
nhn

S
ca

T
%

Bnh ng

37,5

Si ty, u

8,3

8,3

4,2

4,2

4,2

mt

u ty
Sau

phu

thut
Chn
thng
Do
Valproate
Quai b

Nguyn

nhn

ca
Lupus
Khng

%
1

4,2

29,1

nguyn nhn
Bin chng
C 1 ca sc (4,2%); 3 ca vim phc mc do vim ty hoi t xut huyt
(12,5%); 1 ca u nang gi ty (4,2%). 1 ca t vong (4,2%).
iu tr
C 4 ca c can thip phu thut (16,7%), trong 3 ca phu thut v
vim phc mc, 1 ca phu thut ct u nang ng mt ch. 20 ca iu tr ni khoa
bao gm b dch, anti H2, khng sinh, nui n tnh mch.
BN LUN
y l nghin cu u tin v VTC tr em min Nam Vit Nam. Tng
t nghin cu ca cc tc gi ti Singapore v Trung Quc, tui mc bnh trung
bnh theo chng ti l 8,74(7,9). a s tr bnh tp trung la tui > 5 (83,3%), ti
Hoa K, hai tc gi Werlin v Lopez cng kt lun tng t (79,4% v 55%)(8,10).
Bnh thng gp tr nam nhiu hn n, kt qu ny ph hp vi tc gi Benifla
ti Iserael(3) v cng ph hp vi tc gi Nguyn Tm Dng ngi ln(8).

V lm sng, au bng v i l hai triu chng thng gp (100% v

95,8%), trong au thng v chim n 62,5%. Ti n , tc gi Srikant Das
cng kt lun tng t vi 57,2% ca au thng v v 82% ca i(5). Trong 8 ca
xut huyt tiu ha c 7 ca xut huyt nh, pht hin khi thy dch nu ra sonde d
dy, 1 ca i ra mu do vim d dy t trng i km.
V cn lm sng, t l tng BCNTT theo chng ti l 58,3%, thp hn
nghin cu ca tc gi Nguyn Ngc Anh ngi ln (70%), c l do bin chng
nhim trng theo chng ti thp hn (34,8% v 46,7%)(1).
Cc triu chng vng da, tng SGOT, SGPT, AP gp nhm bnh ng mt
nhiu hn nhm bnh ngoi ng mt. iu ny ph hp vi nghin cu ca tc gi
Choi Hn Quc, theo nng SGOT, SGPT, AP trong mu bnh nhn bnh
ng mt cao hn nhm cn li vi p < 0,05(4).
Siu m gp phn rt ln trong chn on. Qua kho st c 83,3% ca tng
kch thc ty; 16,7% ca c t dch quanh ty; 4,2% ca dn ng ty chnh. Bn
cnh siu m cn gip theo di, pht hin cc bin chng ngoi khoa (dch
bng trong vim phc mc, vim ty xut huyt...). Ngoi ra siu m cn cho thy
nguyn nhn gy bnh si mt: 25%. V vy vic thc hin siu m bng nhiu ln
l phng php d lm v t tn km nhm gp phn vo chn on bnh v theo
di bin chng.
C 3 ca chn on nng da theo tiu chun Atlanta 1992. Nhn xt gia
hai nhm nng v nh chng ti thy rng gi tr trung bnh BC v LDH mu

nhm nng cao hn nhm nh ng thi nng albumin trung bnh nhm
nng thp hn nhm nh. Trong khun kh nghin cu ny chng ti khng th
kt lun v s khc bit ny. Tuy nhin, mt nghin cu vi s lng ln mu
ca tc gi DeBanto ti Hoa K kt lun s khc bit v cc gi tr BC,
albumin v LDH mu hai nhm nng v nh c ngha thng k, t ng
a ra kt lun: lc nhp vin BC mu > 18500/mm3, LDH mu > 2000UI/l; sau
48 gi albumin mu < 26 g/l l 3 trong s 7 yu t tin lng nng(6). Cn c
nghin cu chi tit khc nhn nh yu t tin lng nng ca VTC cp tr em.
V nguyn nhn, chng ti ghi nhn bnh ng mt thng gp nht
(37,5%), cao hn tc gi Werlin (12%)(10). C s thay i t l ny gia nhiu tc gi.
Tuy nhin, ti Singapore, Choi cho rng trong vng 5 nm tr li y, t l tr VTC do
bnh ng mt tng ng k. Theo ng, bnh ng mt ng hng th hai sau
thuc (29%)(4). Ti l VTC khng r nguyn nhn cn kh cao (29,1%), cao hn nhiu
so vi cc tc gi Werlin (8%), Choi (12%),Lopez (17%)(4,8,10). Do cn nhiu hn ch,
c th l nhng trng hp bt thng cu trc cy mt ty m cha c pht
hin thi im nhp vin, hoc gi nh cc ca t bin gen hay bnh l chuyn ha
m hin nay cha th pht hin c ti Vit Nam. Hy vng trong vi nm ti, t l
VTC khng r nguyn nhn s gim ng k.
KT LUN
Qua nghin cu 24 ca VTC ti BVN1 v BVN2 chng ti nhn thy bnh
thng go tr > 5 tui, n nhiu hn nam (n:nam l 3:1). Hu ht bnh nhn nhp

vin v au bng. au thng v v i l hai triu chng thng gp. Cc triu chng
vng da, tng SGOT, SGPT, AP gp nhm bnh ng mt nhiu hn nhm bnh
ngoi ng mt. nhng ca VTC nng, BC mu lc nhp vin v LDH mu cao
hn, ng thi albumin mu sau 48 gi thp hn nhng ca VTC nh. Siu m rt cn
thit cho cng tc chn o v theo di din tin. Bnh ng mt l nguyn nhn
thng gp nht. Tuy nhin, nhng ca khng r nguyn nhn cn chim t l cao gp
phn khng nh lm tng t l ti pht. V vy n lc tm nguyn nhn l nhim v
trong tng lai gn ca ngi thy thuc.