Vim tuyn nc bt

Vim tuyn nc bt l hin tng tuyn nc bt mang tai b vim nhim do vi khun hoc virut, nm hoc d ng. Vim tuyn nc bt: (nhim khun tuyn nc bt cp) phn ln tuyn mang tai v tuyn di hm. Biu hin in hnh bng sng cp tnh ca tuyn, au tng v sng tng khi n. iu tr bng khng sinh, gim au, h st bnh s thuyn gim. iu tr tht bi trong trng hp c du hiu nghi ng p - xe cht hp ng, si hoc khi u gy nn s tc nghn. Siu m hoc CT scan c th gip chn on.

I. NGUYN NHN GY VIM TUYN NC BT:

1. VIM TUYN NC BT DO VIRUT: Loi vim tuyn nc bt hay gp nht l quai b, bi v t ngi no trong i m khng b mt ln. Theo hip hi chng bnh nhim trng ca Php th mi nm c khong 300 000 ngi mc quai b. Vit Nam th vn cha c mt thng k no Nguyn nhn v triu chng ca vim tuyn nc bt do Virut: 1. Nguyn nhn:

Tc nhn bnh nguyn l Paramyxovirus vi vng ADN xon cn i, c v, i tuyn v i thn kinh, c kh nng gy min dch v kh nng lm ngng kt hng cu. Virus c truyn do tip xc trc tip hay do nhng ht nc bt bn ra t ming bnh nhn. Bnh lu hnh theo tng a phng vng n i, nhng i khi n cng c th pht trin thnh nhng t dch nh vo ma ng xun, cao im l vo thng ging. Bnh hay gp tr em v thanh nin, la tui hay b nht l 5 tui. T l mc bnh tng t gia nam v n, nhng nam th hay b bin chng hn: vim tinh hon, vim mng no, vim no, ic... 2. Triu chng:

Giai on bnh l t 18 - 21 ngy, v c th ly cho ngi khc. giai phu bnh hc: Vi khun gy tn thng t chc k l ch yu, gy: ph n, gin mch, thm nhim lympho bo v tng bo. C th gy hoi t nang tuyn ri rc, lm thay i quan im "quai b l bnh hi phc hon ton". Biu hin chnh l sng vng quanh tai v au. Th lm sng hay gp l th quai b tr em, ch nh hng n tuyn nc bt. Giai on xm nhp ko di trong mt thi gian ngn 24 - 36 ting, y l giai on c kh nng ly nhim cao nht. Lm sng: st cao, mch nhanh, mt mi, au tai nht l khi n, s vng tuyn mang tai i khi cng c th gy au (Thng im Rillet quanh tuyn: khp thi dng hm, xng chm, gc hm di), kh ming v nim mc quanh ng stenon . Khi xut hin nhng triu chng trn thi k dch la hnh th cn phi cch ly bnh nhn. 2. VIM TUYN NC BT DO VI KHUN: 2.1. Vim tuyn mang tai m cp ngi ln: Nguyn nhn : Nhim trng ng tit v t chc nhu m thng l do: - Nhim trng ngc dng t nhng vi khun ming i ln: l nguyn nhn hay gp. - Do nhim trng mu. - Do vi khun lan t nhng nhim trng ln cn vo: vim khp thi dng hm, vim xng hm, vim m t bo vng mt, vim hch mang tai.v.v. D l nguyn nhn no th cng cn c nhng yu t thun li: - Gim hay mt bi tit nc bt sau nhng th thut gy mt nc, sau nhng iu tr an thn kinh hay tng nng gip. - Gim kh nng min dch do qu suy mn hoc s dng thuc gim min dch. - Ri lon chc nng khng vi enzyme nc bt do vim ty hoi t chy mu. 40% trng hp l do staphylococcus aureus, Streptococcus viridans v S. hemolyticus. 8% trng hp l do Pneumocoques v colibaccilles. Vim tuyn mang tai cn c th do Listeria, nhiu trng hp xut hin sau phu thut ng tiu ha hay sau phu thut ghp tng. vim tuyn sau bnh mo co. Triu chng:

Bnh xut hin t ngt hay t t trn mt th trng gy yu. Sng, nng, , au r vng tuyn mang tai, mt hoc c 2 bn. L ng Stenon , cng mu v r m. C th c vim ming i km, au nhiu nht l khi nhai v khi h ming, s au. Nhim trng ton thn: nhit tng, mch tng, mt mi, suy sp. Nu khng c iu tr th dn n abces tuyn, biu hin bng tnh trng ton thn nng n, sng to, kht hm, au tai v i khi d m da. Chn on: Da vo chp cn quang tuyn: h thng ng tit gin, ngt qung cho ta hnh nh "hnh c ci". Nhu m tuyn cn quang r v khng ng nht. C th thy hnh nh nt nim mc, hp ng tit hoc si tuyn. Xt nghim mu thy tng bch cu a nhn. Nu c nn ly m ng Stenon nui cy v lm khng sinh . Chn on phn bit: vim tuyn mang tai cp do si. Gii phu bnh: Cc chng vi khun tan mu thng tn cng vo mch mu xung quanh h thng ng tit. Nhng Enzyme tiu Protein tc ng ln khong k gia nhng nang tuyn lm tiu v abces ha. Vim khong k nng n. Vim c th di dng xung huyt, t m hay hoi t. 3. iu tr : - Ton thn: Dng khng sinh theo khng sinh , c th bng ng ung hoc tim. Flucloxacilline i vi nhim trng do Staphylococcus, Erythromycine hay Amoxycillin cho Streptococcus, Hemophilus, Bacteroide hoc trc khun Gram (-). C th iu tri b xung bng cc loi khng Enzyme nh Aprotinine. Rch dn lu qua da nu c p xe. - Ti ch: gi v sinh rng ming, sc ming bng cc dung dch st khun. 2.2. Vim tuyn mang tai mn tnh hi vim ngi ln: y khng hon ton l mt th lm sng m thng l do hu qu ca nhng tn thng tuyn nc bt. Gim tit nc bt l mt tc nhn quan trng gy khi pht v lm ko di bnh. Thng hay gp ph n, nam/n: 7,5/1. Nguyn nhn : vim tuyn mang tai mn tnh thng xut hin sau nhng bnh l gy nc bt lp i lp li (vim ng stenon, gin ng stenon), hi chng Sjogren, vim tuyn mang tai tr em khng p ng iu tr, hay si tuyn nc bt. V vi khun: thng l do Streptococcus hemolitic v staphylococcus. Triu chng : sng vim tuyn lp i lp li, thng l mt bn. au va phi v tng i khu tr. u ng stenon r ra mt t dch c hoc m. Chp cn quang tuyn ng vai tr quan trng trong chn on: cho thy h thng ng tit gin khng lin tc, c bit trong t chc nhu m thy nhiu im gin ng phn nhnh ln 2 v 3 (hnh "cy tr hoa" hay "n ghm sng sn").

Kim tra nc bt cho php xc nh chng gy bnh v khng sinh . Chn on phn bit vi vim tuyn mang tai d ng mn tnh, sialodnose, khi u mang tai ang nhim trng. Giai phu bnh hc: ng tit c nhiu im gin, thm nhim t bo Lympho xung quanh nang to thnhse, kh-i u mang taimpho. Mt s nang tuyn b ph hy, d sn. X ha t chc k, sau cng l to thnh u m. 3. iu tr :

iu tr khng sinh ton thn ch p dng trong giai on vim cp. phi ra ng tuyn thng xuyn, mt cch h thng vi cc dung dch khng sinh (rifamycin, framycetin). Chiu tia ngoi da: 600 Gy c tc dng gim bi tit ca t chc nhu m, tuy nhin n ch c tc dng tm thi. iu tr phu thut bng nhiu phng php: hay dng nht l tht ng stenon, mc d nguy c lm chn dng chy nc bt, chnh v vy n thng c b xung bng phng x 500 - 1200 Gy. Mt phng php iu tr thay th tht ng c nghin cu trn thc nghim l bm vo trong ng tit mt dung dch axit amin, tuy nhin phng php iu tr ny vn cn c nghin cu thm. Ngoi ra, mt phng php khc l ct dy thn kinh cn giao cm (ct dy thn kinh qua mng nh) cng thu c mt s kt qu, phng php ny tng t nh ct thng nh. Bin php cui cng l ct ton b tuyn mang tai, tuy nhin phng php ny cng tng i kh thc hin do m ri thn kinh mt i trong nhu m tuyn ang b vim mn tnh. Tin lng bnh tt hn khi bnh khi pht trc tui dy th. 2.3. Vim tuyn nc bt cp tnh tr em: Khoang ming tr mi sinh thng v khun, nhng s b nhim khun sau vi gi. Khi nu khng th ca m b khim khuyt th s mc vim cp tuyn nc bt mang tai hoc c th l di hm. vim tuyn c th mt bn hay c hai bn. Dng vim tuyn nc bt ny s lnh nhanh chng nu dng khng sinh y . 2.4. Vim tuyn nc bt mn tnh tr em: L bnh l tng i hay gp. Biu hin, tin lng v c th c sinh l bnh hc tng i khc vi th vim tuyn ngi ln. Bnh thng gp tr 3-6 tui. Nam/ n: 3/2. 1. Nguyn nhn :

Bnh vn cn mang tnh suy on. Nhng thng thy nhng bnh nhn c nhim trng trong ming (su rng, vim Amydale dng hc). Vi khun gy bnh cng

thng l nhng vi khun ca mi trng ming - hng: Streptococcus Hemolytiques, Staphylococcus thm ch cn c th thy c Pneumococcus. Tuy nhin khng c bng chng v mi lin quan gia vim tuyn mang tai vi nhng nhim trng ming. Bi l rng vim tuyn th thng nh hng n ton b nhu m tuyn m khng gy vim ng tuyn. C th nhng nang tuyn b hoi t st li khi b quai b s l v tr cho vi khun tp trung v gy vim mn tnh. Nhng nghin cu gy y trn knh hin vi in t cng khng nh kh nng a nguyn nhn, v c lin quan n virus. 2. Triu chng:

Thng bt u bng sng tuyn mang tai t ngt, khi n. Biu hin lm sng thng ging vi quai b nn hay lm chn on nhm. Vng mang tai sng, au, thng mt bn, ton b hay ch mt phn tuyn. au va phi, tng ln khi h ming hoc khi nhai. Vim u ng Stenon, nc bt c, c m, tng pH. Vim nhm hch cnh. Du hiu ton thn (st, mt) thng khng r. t khi dn n p xe - d. Tn thng d nhm vi quai b, ch c ngh n khi bnh tin trin lu hng thng, vi nhng t ti pht tip nhau. Mi t ko di 3- 10 ngy sau t ht. Chp cn quang tuyn: cho thy kch thc ca h thng ng tit vn bnh thng. Ring t chc nhu m th c nhiu im gin cho ta hnh nh "cy tr hoa" hay hnh nh "nhng mnh n ghm sng sn", nhng vin trn cn quang ny tn ti ngay c sau khi tho thuc. Chp nhp nhy th thng khng c hiu (cho hnh nh vim). Cn soi tm vi khun v lm khng sinh nc bt t ng Stenon. Xt nghim mu thy tng bch cu trung tnh, Amylase mu thay i khng ng k. Gii phu bnh: Thm nhim Lyphocyte - plasmocyte vo t chc k. Mt bit ha ng tuyn ng tuyn v d sn lp Malpighi ca t bo ng tuyn. Di knh hin vi in t thy xut hin nhng h thng ng kch thc 15 - 25 nm trong t chc tng bo xung quanh nhn ca nhng t bo ni mc tuyn mang tai. Nhng cu trc ng ny pht trin t li vng ni m v n c th l biu hin khng y ca mt nhim trng virus. iu tr: Dng khng sinh theo khng sinh , thng hay dng Ampicillin v Macrolide (spiramycin) bng ng ung: 2g/ ngy. phi dng khng sinh tip tc nhiu tun sau khi lnh v lm sng. Ra tuyn bng bm vo ng Stenon cc dung dch khng sinh: rifamycin hay framycetin cng mang li nhng hiu qu tt. Ra t 3-4 ln mi ln cch nhau vi ngy, lp li trong vng 4-6 thng. iu tr theo phc v phi kin nhn th mi m bo t c lnh bnh vnh vin (thng tui thiu nin). Theo mt s tc gi khong 80-90% bnh nhn t lnh thng khi n tui 13-15, iu ny c th l do yu t Hormon. t khi phi tin hnh hnh ct tuyn.

3. VIM TUYN NC BT DO LAO: Tng i him, tuy nhin vn cn ph bin hn l do lu v nm. Vi khun lao thng gy vim tuyn mang tai (70%) hn l tuyn di hm (25%) v tuyn nc bt ph. Thng l nhim trng th pht, v thng l mt bn, v thanh nin. 6. Vim tuyn nc bt do lu: 7. Vim tuyn nc bt do nm: 3. Vim tuyn nc bt do tia x: 4. Vim tuyn nc bt do in Gii: Thng gp tuyn di hm (90%), tuyn mang tai t gp hn (10%). N gy gia tng nht nc bt, tht hp hay tc nhng ng bi tit tn cng. 4. VIM TUYN NC BT T MIN: 4.1. Vim tuyn nc bt d ng: Bnh l ny khng phi l him gp, m l kh chn on xc nh. Phn ng d ng xy ra chng t s c mt ca Lympho bo v tng bo. Loi phn ng ny hay gp tuyn nc bt, c bit l tuyn mang tai, l ni tp trung bch huyt cao. Yu t gy d ng thng l bi, phn hoa, mt vi loi thc n, thuc (phnylbutazone, nitrofurantoine)..... D ng bi v phn hoa thng km vi ph i tuyn 2 bn. Vim tuyn nc bt do thc n c ngh n nu bnh nhn c ph i tuyn kt hp vi ri lon tiu ha. Vim tuyn nc bt d ng ngy cng hay gp vi nhng thuc khng vim ch phm ca Phenylbutazone, sau khi dng thuc 3 - 5 ngy th xut hin sng tuyn mang 2 bn, t au, gim dn sau khi ngng thuc. Xt nghim mu thy tng bch cu trung tnh v bch cu a axt. Sng xut hin tr li khi dng thuc. Vim tuyn nc bt d ng do iod l th kinh in, c bit sau khi dng cht cn quang c iod. Vim tuyn nc bt d ng cng c th gp do nitrofurantoin, chloramphenicol, oxytetracyclin, thiouracil, thicianate. Vim tuyn nc bt do d ng thy ngn vi tng tit nc bt xut hin khi iu tr giang mai, c th l do nhim c. Vim tuyn nc bt do nm thng chn on nhm vi ph i tuyn nc bt do d ng, chn on phn bit da vo test d ng vi khng nguyn v iu tr th vi nm. Chn on da vo: chp cn quang tuyn cho thy tuyn cn quang m, khng ng dng, i khi c gin nang tuyn a dng. xt nghim thy tng bch cu a axit trong mu v trong nc bt. Test trong da vi khng nguyn nghi ng gip khng nh chn on.

4.2. Vim tuyn nc bt trong bnh t min:

Nguyn nhn: Vim tuyn c th xut hin n c, nhng thng th kt hp vi bnh to keo. Vim tuyn nc bt thng xut hin trong Lupus ban ri rc, sau l n x cng b, vim da c, vim quanh ng mch. Vim tuyn nc bt trong hi chng Sjogren th cng gn ging vi vim tuyn nc bt do bnh t min. Triu chng: Thng gp n, tui 30 - 40. Ph i tuyn mang tai 2 bn va phi. Ton thn: st, au khp, gim tit nc bt. Chn on: da vo sinh thit, thng sinh thit tuyn nc bt ph mi. Sinh thit nhng v tr khc v nhng xt ngim c hiu khc ph thuc vo loi t chc lin kt nghi ng. i vi vim da c v x cng b thng khng tm thy khng th khng nhn. Phn tch thnh phn nc bt thy gia tng ch s Natri n 20 - 30 mEq/l (bnh thng th ch s ny l 7 mEq/l) v ch s Clo Xt nghim mu thy tng ch s khng nguyn HLA-DR. iu tr: phc tp, ch yu l iu tr bnh nguyn. 4.3. Hi chng Sjogren (vim tuyn nc bt c biu m): Ngy nay ngi ta chn on hi chng Sjogren khi c xut hin tam chng: sng ha kt mc kh, gim tit nc bt, v mt bnh l h thng (thng l vim a khp dng thp). Theo iu tra cc nc pht trin th t l mc bnh l khong 1/ 200. Thng gp n (n/ nam: 9/1). Hay gp la tui 40 - 60, him khi gp tr em. Nguyn nhn: Hi chng Sjogren l mt bnh ca tuyn ngoi tit, do mt iu ha h thng t min ca cc tuyn ngoi tit. Ph hy tuyn c cha nhng t bo trung gian (Lymphocytaire). Hi chng "kh" c th xut hin u tin v n c vi: kh nc mt v kh ming. C th kt hp vi nhng bnh t min khc (thng l vim a khp dng thp). Bnh t min thng kt hp l vim a khp dng thp (15% trng hp). Hi chng Sjogren xut hin trong 30% bnh nhn Lupus ban ri rc, 70% x gan mt nguyn pht. N cng c th gp trong vim a c, vim quanh ng mch, vim tuyn gip Hashimoto, vim gan mn hot ng. 5. NANG TUYN NC BT 5.1. Nang nhy: Nang nhy thng pht trin t sn ming do tc tuyn nc bt ph hoc i khi l tuyn di li. Ngi ta hay dng thut ng "nang nhi" miu t nang nhy bi v nang nhn trong sut, v tng i ln ging vi bng ca con nhi. Nang thng nm hn v mt bn ca phanh li. Nang thng tng i ln, lm nh n ng tc nut v th. i khi nang t v, thot ra mt cht dch nhy qunh. Khu ln ti l mt phng php iu tr hiu qu cho hu ht cc trng hp nang nhi, mc d n vn li mt t l ti pht nh. Chnh v l do ny m mt s tc gi

 ch trng m bc nang cng ton b thnh nang. Tuy nhin, v nang nhi thng bao quanh dy thn kinh li, nn th thut bc tch nang d gy tn thng cho dy thn kinh ny. Nhng trng hp nang nhi c kch thc ln v xm ln su vo vng di hm hay vng tam gic di cm, th d nhm trn lm sng vi nang mng li, nang thanh mc hay nang dng da. Chn on phn bit vi nhng loi nang ny phi da vo chp cng hng t. Ct b ton b nang l phng php iu tr hiu qu duy nht bi v nang nhi thng gy nhng t nhim trng lp i lp li. Ct b ton b nang i hi c tay ngh cao v nu st li t chc nang th thng dn n nguy c ti pht thnh nhiu nang nhi. ng ch gia xng hm di v mi to ra mt ng vo rng ri gip ct b ton b nhng nang nhi ti pht nhng n c nhc im l li so khng thm m ngay gia mi di. 5.2. Nang thot nhy: Nang thot nhy c nguyn nhn do chn thng, thng l chn thng nh v bnh nhn qun i. Chn thng gy tn thng ng dn ca tuyn nc bt ph lm thot cht nhy vo t chc xung quanh. V tr hay gp l mi di. Nang biu hin di dng mt im sng trn, chc ging vi mt tn thng cng mi. Nn ct b ton b nang thot nhy v gi gii phu bnh xc nh chn on. 5.3. Nang biu m bch huyt trn bnh nhn HIV: Gn y, ngi ta ghi nhn s xut hin ca nhng tn thng dng nang ca tuyn nc bt chnh nh l mt biu hin ca nhim HIV. Chn on da vo s xut hin ca tn thng dng a nang, thng tuyn mang tai. V trong trng hp c triu chng trn th bnh nhn c xp vo nhm c nguy c nhim HIV cao. 6. VIM TUYN NC BT DO THM NHIM: Tuyn nc bt c th b tn thng trong nhiu bnh h thng khc nhau. mt vi bnh nhn, sng mt hay nhiu tuyn nc bt c biu hin di dng ging khi u. V vy, ngi Bc s cn phi xt n nhng nguyn nhn sau: 6.1. Thm nhim m (lipomatosis): T bo m l mt thnh phn bnh thng ca tuyn mang tai. T l m tng theo tui v bo ca mi ngi. 6.2. Sng tuyn nc bt (Sialosis): Thut ng "Sialosis" bao hm nhng trng hp sng tuyn nc bt lan ta do nhiu nguyn nhn khc nhau. Thng gp tuyn mang tai v la tui ca bnh nhn thng l 40 - 70. Trong mt vi trng hp, th khng tm thy nguyn nhn gy ph i tuyn. Thng th ph i tuyn l do i tho ng, ph nim, ngi nghin ru hay tc dng ph khi dng mt s thuc (v d: thuc tc dng giao cm, mt s thuc chng cao huyt p th h c c bit l Guanethidine). Chn on da vo bnh s, v chn on xc nh da vo sinh thit. Kim sot v loi b yu t nguyn nhn c th lm lui bnh. Tuy nhin, bin dng thm m thng tn ti v bnh nhn thng yu cu phu thut ct bt tuyn nc bt.

7. VIM TUYN NC BT DO SI: Si tuyn nc bt th khng phi l khng hay gp, c bit l tuyn di hm. Bnh nhn si tuyn thng b au tuyn khi n, khi nc bt bi tit ra b chn li pha sau ch tc. Si cng l mt nguyn nhn gy nhim trng ti pht. Chp Xquang tuyn khng chun b gip chn on xc nh si, nhng ch khong 40% si tuyn mang tai v 20% si tuyn di hm l cn quang. V trong trng hp ny Xquang cng s gip chng ta xc nh v tr tc nghn. Nhng vin si ln gy tc ng tit th nn phu thut ly b nu khng chng s dn n vim au tuyn. Tn si l mt th thut tng i ph bin, nhng ch cn rch m ng n gin cng c th gip si t thot ra. Mt phng php khc l ly si bng ng ni soi mm. Tuy nhin, i vi nhng trng hp si ln th nn ct b ton b tuyn.

II. IU TR BNH VIM TUYN NC BT:

iu tr bng khng sinh, chng vim, gim ph n, gim au trong vng 7 10 ngy theo khng sinh bng ng ung hoc tim. C th iu tr b sung bng cc loi khng enzym. Ra ng tuyn thng xuyn mt cch c h thng vi cc dung dch khng sinh. Ra t 3 4 ln, mi ln cch nhau vi ngy, lp li trong vng 4 6 thng. iu tr theo ng phc v phi kin nhn mi bo m t c lnh bnh vnh vin (thng tui thiu nin). Theo mt s tc gi, khong 80 90% bnh nhn t lnh khi n tui 13 15 tui, c th do s thay i hoc mn tui trng thnh. Ti ch: v sinh rng ming bng cc dung dch st khun.