Y Hc TP.

H Ch Minh * Tp 14 * Ph bn ca S 1 * 2010

Nghin cu Y hc

PHN TCH LM SNG V X-QUANG U NGUYN BO MEN

Phan Hunh An*, Trn Cng Chnh*, Hunh Anh Lan**, Nguyn Th Hng**

TM TT
M u: U nguyn bo men l loi u do rng thng gp Vit Nam. Vic chn on trc m quyt nh cch thc iu tr v tin lng. Mc tiu: Kho st mt s c im lm sng v X-quang ca u nguyn bo men tng kh nng chn on chnh xc u nguyn bo men trc m. Phng php: Thit k nghin cu ct ngang m t v phn tch, qua hi cu 52 trng hp u nguyn bo men ti Bnh Vin Rng Hm Mt Trung ng nm 2007 v 2008. Kt qu: U nguyn bo men chim 30,8% cc u xng hm, v 6,6% cc tn thng hc ming c gii phu bnh. U thng gp nht t 20 n 40 tui (46,2%). T l nam/n l 1,1/1. a s u xy ra xng hm di (90,4%), nht l cnh ngang vng rng sau v gc hm (71,2%). L do khin bnh nhn i khm nhiu nht l sng mt (94,2%). Phng xng-bin dng mt l triu chng lm sng ph bin (96,2%) v u thng c kch thc ln hn 5 cm (80,8%). Trn phim X-quang ton cnh, hnh nh thu quang ch yu l dng nhiu hc (75%), dng mt hc t gp hn (23,1%). T l tiu ngt chn rng l 59,6%, nhiu nht ngi di 20 tui (91,7%) (p<0,05). 36,5% u c rng ngm, thng gp trong u dng mt hc (66,7%) v ngi di 20 tui (75%) (p<0,05). U dng mt hc cng c c im ph bin vng sau ca hm di, hy xng nhiu v gy tiu ngt chn rng nh u dng nhiu hc (p>0,05). Kt lun: Cn kt hp phn tch lm sng vi X quang thu thp nhiu thng tin c th gip cho chn on trc m chnh xc hn, nht l i vi u dng mt hc. T kha: U nguyn bo men, chn on trc m, c im lm sng v X-quang ca u nguyn bo men, xng hm di, cnh ngang vng rng sau v gc hm.

ABSTRACT
A CLINICAL AND RADIOGRAPHIC ANALYSIS OF AMELOBLASTOMA Phan Huynh An, Tran Cong Chanh , Huynh Anh Lan, Nguyen Thi Hong * Y Hoc TP. Ho Chi Minh * Vol. 14 - Suuplement of No 1- 2010: 274- 281 Background: Ameloblastoma is a common odontogenic tumor of the jaws in Vietnam. The preoperative diagnosis determines the treatment method and prognosis. Objectives: To investigate the clinical and radiographic features of ameloblastoma and to increase the possibilities of the accurate preoperative diagnosis. Method: A cross-sectional retrospective study was conducted on 52 new cases of ameloblastoma treated in the National Odonto-Stomatology Hospital in 2007 and 2008. Results: The ameloblastoma prevalence was 30.8% among all tumors of the jaws, 6.6% among all biopsy cases of the oral cavity. Ameloblastoma was mostly found between 20 and 40 years old (46.2%). The male/ female ratio was 1.1/1.This lesion occurred predominantly in mandible (90.4%), the angle and molar-ramus areas were the most common sites. The chief complaint was swelling (94.2%). Enlarged bone and deformation of the face were typical symptoms (96.2%). The tumor size was often larger than 5 cm diameter (80.8%). On panoramic
* Bnh vin Rng Hm Mt Trung ng a ch lin h: BS. Phan Huynh Anh ** Khoa Rng Hm Mt - i hc Y Dc Tp.HCM T: 0979173933 Email: anrhm03@gmail.com

Y Hc TP. H Ch Minh * Tp 14 * Ph bn ca S 1 * 2010

Nghin cu Y hc

radiographs, multilocular appearance (75%) was more often observed than unilocular appearance (23.1%). Root resorption occurred in 59.6%, predominantly in patients younger than 20 years old (91.7%) (p<0.05). Impacted tooth was in 26.5%, more frequently associated with unilocular pattern (66.7%) and in patients younger than 20 years old (75%) (p<0.05). The common site usually in the posterior region of the mandible and radiographic features (much bone destruction, root resorption) of unilocular tumors were similar to multilocular tumors (p>0.05). Conclusion: Clinical observations combined with radiographic analysis are recommended to lead to a nearly correct preoperative diagnosis, especially for unilocular ameloblastomas. Keywords: Ameloblastoma, preoperative diagnosis, clinical and radiographic features of ameloblastoma. Mandible, angle and molar-ramus areas. Bnh vin Rng Hm Mt Trung ng t T VN 01/01/2007 n 31/12/2008. U nguyn bo men l loi u do rng thng xy ra vng hm mt v kh pht hin sm(0,0). Mc d lnh tnh, him khi ha c v di cn, nhng u c tnh cht xm ln ti ch ph hy khng gii hn, gy bin dng vng hm mt, v kh nng ti pht cao(0,0). Vic chn on trc m quyt nh hng x tr v nh hng n tin lng. Nu u c dng thu quang nhiu hc in hnh th thng chn on trc m l u nguyn bo men v iu tr m rng trnh ti pht, nhng nu u c dng thu quang mt hc th thng phn vn hoc chn on nhm l nang v khng c k hoch m rng. V vy, chng ti tin hnh kho st phn tch mt s c im lm sng v hnh nh X-quang ca u nguyn bo men nhm cc mc tiu sau: M t cc c im lm sng ca u nguyn bo men v t l, tui, gii tnh, v tr, thi gian pht hin, l do n khm v triu chng lm sng ph bin. M t cc c im X-quang ca u nguyn bo men v dng u, kch thc u, tiu ngt chn rng v rng ngm. Phn tch s lin quan gia cc c im lm sng vi X-quang nhm lm tng kh nng chn on u nguyn bo men v nht l u nghuyn bo men dng mt hc.

Tiu chun loi tr: khng c chn on gii phu bnh, kt qu gii phu bnh khng phi l u nguyn bo men, u nguyn bo men kt hp vi u khc, u nguyn bo men ti pht. Thit k nghin cu: ct ngang, m t v phn tch. Thu thp d liu: (1) Ghi nhn cc ca xng hm v hc ming c chn on gii phu bnh. (2) Ghi nhn nhng d kin lm sng v cn lm sng, chn on v iu tr t cc h s bnh n. (3) c phim ton cnh kho st tn thng xng hm, do 2 Bc s c (ch s Kappa = 0,85). X l d liu: nhp v x l d liu bng phn mm SPSS 16.0. Phn tch s lin quan bng php kim Chi bnh phng, lin quan c ngha khi p < 0,05.

KT QU V BN LUN Lm sng
Trong nm 2007 v 2008 ti Bnh vin Rng Hm Mt Trung ng, c 783 ca tn thng hc ming c sinh thit v chn on xc nh bng gii phu bnh, trong s ny c 169 ca l u xng hm. Nh vy, t l u nguyn bo men trong tng s cc u xng hm (khng k nang) l 30,8%, v trong cc tn thng hc ming l 6,6%. Bng 1. U nguyn bo men phn b theo tui v gii tnh
Tu i Nam S % N S % T ng S % Gi tr p

I TNG - PHNG PHP NGHIN CU

Mu nghin cu: 52 bnh nhn c chn on xc nh da trn lm sng v gii phu bnh l u nguyn bo men, c iu tr phu thut ti

Y Hc TP. H Ch Minh * Tp 14 * Ph bn ca S 1 * 2010

ca 4 13 10 27 ca 8 11 6 25 ca 12 24 16 52

Nghin cu Y hc

< 20 2040 > 40 T ng

33,3 54,2 62,5 51,9

66,7 45,8 37,5 48,1

23,1 46,2 30,7 100

0,297

c im X-quang
1,9 % 23,1 % 75 %

U thng gp nht t 20 tui n 40 tui (46,2%) (bng 1). Tui trung bnh l 32,9 tui, nh nht l 11 tui, v ln nht l 66 tui. L do n khm thng gp nht l sng mt, chim 94,2%. Cc l do khc l au, lung lay rng, nh rng khng lnh. a s pht hin v iu tr di 1 nm (57,7%) v t 1 nm n 2 nm (32,7%). Tr hn, c 9,6% c chn on u sau 3 nm n 10 nm. Thi gian pht hin trung bnh l 14,4 thng (2 thng). Bng 2. V tr u nguyn bo men
V tr Hm trn C m Cnh ngang hm d i (vng rng sau) Cnh ngang v gc hm Gc hm v cnh ln Cnh ngang, gc hm v cnh ln N u rng hm d i T ng c ng S ca 5 2 3 32 7 2 1 52 T l % 9,6 3,8 5,9 61,5 13,5 3,8 1,9 100,0

Dng ngoi xng Dng mt hc Dng nhiu hc

Biu 1: Phn b cc dng u nguyn bo men Phn loi 52 ca u nguyn bo men da trn X-quang (biu 1) nh sau: Dng nhiu hc: 39 ca (75%), l dng ph bin nht. Dng mt hc: 12 ca (23,1%). Dng ngoi xng (nu rng): 1 ca (1,9%), khng hy xng. nh gi kch thc u trn phim ghi nhn 10 ca (19,2%) di 5 cm, 29 ca (55,8%) c kch thc t 5 cm n 10 cm, v 13 ca (25%) c u ln hn 10 cm. a s u biu hin hnh nh thu quang c ng vin cn quang un ln (76,9%). Tiu ngt chn rng kh ph bin (59,6%). Rng ngm gp trong 19 ca (36,5%), ch yu rng s 8 (94,7%).

Bng 3. Cc triu chng lm sng ph bin ca u nguyn bo men

Tri u ch ng Khng tri u ch ng Sng m t v lung lay rng Sng vng m t Sng m t v au Sng m t, au v lung lay rng Sng m t v t mi c m Sng m t, lung lay rng, t mi c m Sng m t, au, lung lay rng v d m Sng m t, au v d m au v d m rng nh khng lnh T ng c ng S ca 0 14 11 8 6 4 3 3 1 1 1 52 T l % 0 26,9 21,2 15,4 11,5 7,7 5,8 5,8 1,9 1,9 1,9 100,0

Lin quan gia lm sng v X-quang

Bng 4. Lin quan gia c im X-quang vi tui bnh nhn
Tu i b nh nhn
c i m Xquang
<20 tu i ( n = 12) S ca (%) 20-40 tu i (n = 24) S ca(%) >40 tu i (n = 16) S ca (%)

Gi tr p

D ng Ngoi xng M th c Nhi u h c Kch th c < 5cm 5-10cm > 10cm Tiu ngt chn rng Khng

0,534 0 (0,0) 4 (33,3) 8 (66,7) 0 (0,0) 5 (20,8) 19 (79,2) 1 (6,2) 3 (18,8) 12 (75,0) 0,261 2 (16,7) 6 (50,0) 4 (33,3) 3 (12,5) 13 (54,2) 8 (33,3) 5 (31,2) 10 (62,5) 1 (6,3) 0,036 1 (8,3) 12 (50,0) 8 (50,0)

a s u xy ra hm di (90,4%) (bng 2) v c triu chng phng xng-bin dng mt (96,2%) (bng 3).

Y Hc TP. H Ch Minh * Tp 14 * Ph bn ca S 1 * 2010

C Rng ng m Khng C 11 (91,7) 3 (25,0) 9 (75,0) 12 (50,0) 8 (50,0) 0,001 15 (62,5) 9 (37,5) 15 (93,7) 1 (6,3) Rng ng m Khng C Gi tr P

Nghin cu Y hc

31 (93,9) 19 (100,0) 0,527

13 (39,4) 5 (26,3) 0,340

6 (18,2) 1 (5,3) 0,242

18 (54,5) 9 (47,4) 0,618

Bng 5. Lin quan gia cc c im X-quang vi v tr u

c i m X-quang V tr u nguyn bo men
Xng hm d i (n = 46) S ca (%) N u rng hm d i (n = 1) S ca (%)

Bng 7. So snh u nguyn bo men xng hm dng mt hc v dng nhiu hc

c i m Hnh nh X-quang u nguyn bo men Um th c U nhi u h c (n = 12) (n = 39) S ca (%) S ca (%) 4 (33,3) 5 (41,7) 3 (25,0) 6 (50,0) 6 (50,0) 2 (16,7) 10 (83,3) 10 (83,3) 2 (16,7) 11 (91,7) 4 (33,3) 1 (8,3) 7 (58,3) 4 (33,3) 7 (58,3) 1 (8,4) 7 (58,3) 8 (66,7) 8 (20,5) 19 (48,7) 12 (30,8) 0,561 21(53,8) 18 (46,2) 0,500 3 (7,7) 36 (92,3) 0,235 19 (48,7) 20 (51,3) 38 (97,4) 13 (33,3) 6 (15,4) 20 (51,3) 6 (15,4) 21 (53,8) 12 (30,8) 24 (61,5) 11 (28,2) 0,648 0,382 0,759 0,526 0,376 Gi tr p

Gi tr p Tu i < 20 20-40 > 40 Gi i tnh Nam N V tr u Hm trn Hm d i Th i gian pht hi n < 1 nm 1 nm Tri u ch ng Sng m t au T mi Rng lung lay Kch th c u < 5cm 5-10cm > 10cm Tiu ngt chn rng Rng ng m

Xng hm trn (n =5) S ca (%)

0,534

D ng Ngoi xng M th c Nhi u h c Kch th c <5cm 5-10cm >10cm Tiu ngt chn rng Khng C Rng ng m Khng C

0,000 0 (0,0) 2 (40,0) 3 (60,0) 0 (0,0) 10 (21,7) 36 (78,3) 1 (100,0) 0 (0,0) 0 (0,0) 0,007 4 (80,0) 1 (20,0) 0 (0,0) 5 (100,0) 0 (0,0) 5 (100,0) 0 (0,0) 6 (13,0) 27 (58,7) 13 (28,3) 15 (32,6) 31 (67,4) 27 (58,7) 19 (41,3) 0 (0,0) 1 (100,0) 0 (0,0) 0,007 1 (100,0) 0 (0,0) 0,142 1 (100,0) 0 (0,0)

Bng 6. Lin quan gia c im X-quang vi triu chng lm sng ph bin

c i m X-quang Sng m t S ca (%) 1 (100,0) 11 (91,7) 38 (97,4) 0,648 9 (90,0) 28 (96,6) 13(100,0) 0,459 Tri u ch ng lm sng Rng au T mi lung lay S ca S ca (%) (%) S ca(%)

0,462 0,04

D ng Ngoi xng M th c Nhi u h c Gi tr P Kch th c < 5cm 5-10cm > 10cm Gi tr P Tiu ngt chn rng Khng C Gi tr P

1 (100,0) 4 (33,3) 13 (33,3) 0,382 2 (20,0) 14(48,3) 2 (15,4) 0,065

0 (0,0) 1 (8,3) 6(15,4) 0,759 0 (0,0) 4 (13,8) 3 (23,1) 0,274

0 (0,0) 7 (58,3) 20 (51,3) 0,526 4 (40,0) 15(51,7) 8 (61,5) 0,591

Cc im X-quang ca u khng khc bit c ngha gia nam v n (p>0,05). Lin quan c ngha (p<0,05) c tm thy gia tui bnh nhn vi tiu ngt chn rng, rng ngm trong u (bng 4), gia v tr u vi dng u v kch thc u trn phim X-quang, vi tiu ngt chn rng (bng 5), gia triu chng rng lung lay vi s tiu ngt chn rng (bng 6). Rng ngm thng gp trong u dng mt hc hn u dng nhiu hc (p<0,05) (bng 7).

BNLUN T l u nguyn bo men

U nguyn bo men l u biu m do rng lnh tnh ph bin nht trong cc u xng hm, chim 1% cc u nang xng hm ni chung(1,9), v 11-13% cc u do rng(12). Tng kt

20 (95,2) 30 (96,8) 1,000

9 (42,9) 9 (29,0) 0,304

5 (23,8) 2 (6,5) 0,072

5 (23,8) 22 (71,0) 0,001

Y Hc TP. H Ch Minh * Tp 14 * Ph bn ca S 1 * 2010

ti Bnh vin Rng Hm Mt Trung ng ca Lm Ngc n (1976-1993) cho kt qu t l 14,7% trong s cc u lnh tnh xng hm(5). Thng k 5.908 ca u xng hm (1976-2000), Hunh i Hi xc nh u nguyn bo men gp trong 351 ca, chim 6% cc u xng hm(3). Tuy nhin, kho st trong hai nm gn y (2007-2008), chng ti ghi nhn t l cao hn, chim 30,8% cc u xng hm. C th do nghin cu ny ch tnh nhng ca c chn on gii phu bnh xc nh u v khng tnh cc nang xng hm. Kt qu tng t nh mt nghin cu trc y ti H Ni ghi nhn t l l 28,4% trong cc u lnh tnh v c tnh xng hm, v l 50,5% trong cc u lnh tnh xng hm(7).

Nghin cu Y hc

ch yu vng rng sau. Nhn nh ny nht qun cc nghin cu(9). Nhiu tc gi ghi nhn xng hm di thng b nht (hn 80%)(3,4,6,10); v thng phn sau ca xng hm (6175%)(6,11,12), c th l vng rng sau hm di-gc hm(1,3,4) v thng lin quan cnh ln(11,12). U hm di ph bin dng nhiu hc (78,3%), thng ln hn 5cm (87%) v d gy tiu ngt chn rng (67,4%) hn u hm trn (p<0,05). U nguyn bo men ngoi vi (ngoi xng) khi pht trong m nu rng, him gp, chim khong 2-10% cc u nguyn bo men v c tui trung bnh l 52,1 tui(9,11). Nghin cu ny ch gp 1 ca (1,9%) nu rng vng rng sau hm di nhng khng hy xng hm, trn mt bnh nhn n 51 tui.

Tui v gii tnh bnh nhn u nguyn bo men

Tui cc bnh nhn thay i t 11 tui n 66 tui. Tui trung bnh ti thi im chn on l 33 tui, ph hp vi y vn trong khong 33 n 39 tui(2,6,7). tui thng mc bnh nht t 20 n 40 tui, tng t cc nghin cu khc(3,11). U him gp tr em, ch chim 10%(6). Tuy nhin, chng ti nhn thy c n 23,1% di 20 tui. Nghin cu trc y ca Hunh i H cho thy s bnh nhn t 1 n 20 tui chim 18%(3). Cc nghin cu u nhn nh khng c s khc bit v gii tnh i vi u ny(10). Tng t, nghin cu ny cng cho kt qu t l nam/n l 1,1/1. Nh vy, c th thy rng u nguyn bo men min Nam Vit Nam c tui trung bnh v tui thng mc bnh hin nay vn khng thay i v khng khc so vi th gii, tuy nhin u khng qu him gp tr em nh cc nc khc. iu ny c nh hng n vic chn on v iu tr.

L do n khm v thi gian pht hin bnh

L do khin bnh nhn i khm nhiu nht l sng vng mt, chim 94,2%. S t cn li n khm do au trong xng hm, rng lung lay, nh rng khng lnh, b d m. Mc d lnh tnh v thng c pht hin trong 1-2 nm, nhng khi u hy xng nhiu, 78,8% c tn thng t hai v tr tr ln. iu ny phn nh ng bn cht ca u nguyn bo men, mc d khng phi c tnh v khng di cn nhng l loi u c tnh cht xm ln ti ch, u khng c v bao, sau khi lm v v xng u pht trin vo m mm xung quanh.

Triu chng lm sng ph bin

U nguyn bo men l loi u pht trin m thm kh pht hin giai on sm. Khi ngi bnh cm nhn c s sng phng xng hay mt mt cn xng th u pht trin ln. Triu chng phng xng gy bin dng mt l ph bin nht, chim 96,2% ; v thng kt hp vi triu chng khc nh lung lay rng (50%), au (36,5%), t mi (13,4%), d m (9,6%).

V tr u nguyn bo men
a s u xy ra xng hm di (90,4%), c bit cnh ngang vng rng sau, gc hm v cnh ln (84,7%). T l u hm trn l 9,6%, cng

c im X-quang ca u nguyn bo men

Dng u Kt qu cho thy 75% c dng nhiu hc v 23,1% c dng mt hc. Trong nghin cu ca

Y Hc TP. H Ch Minh * Tp 14 * Ph bn ca S 1 * 2010

Hunh i Hi, 65% u c dng nhiu hc v 35% l dng mt hc(3). Tht vy, theo y vn, u nguyn bo men c m t in hnh l tn thng thu quang nhiu hc (63-90%), trong khi u dng mt hc t gp hn (24-47%)(6,8). Thu quang mt hc thng c dng trn hay bu dc. Thu quang nhiu hc thng cho hnh nh dng bt x phng. U nguyn bo men dng nang l mt th loi ca u nguyn bo men, thng l mt bc cha dch, m ly chic rng ngm (80%), ch yu gp ngi tr, v thng ch cn iu tr bo tn ly u do t l ti pht 10 nm thp (10%)(1,8,11). Mt iu cn lu l dng mt hc trn phim X-quang cha chc l u nguyn bo men dng nang. V vy, chn on u nguyn bo men dng nang khng th ch da trn dng thu quang mt hc, m phi da trn chn on m bnh hc.

Nghin cu Y hc

chng rt ph bin trong u nguyn bo men ngi tr. a s (71%) cc trng hp b tiu ngt chn rng c triu chng lm sng rng lung lay. y c th l l do bnh nhn i nh rng, cho nn nha s cn phi thn trng cnh gic chp phim pht hin u xng hm trc khi nh rng lung lay khng c nguyn nhn nhim trng r rng.

Rng ngm
T l rng ngm trong u l 36,5%. S lng rng ngm c th thay i nhng thng t 1 n 2 rng, hu ht l rng s 8. Rng ngm gp trong 66,7% cc u dng mt hc, nhng ch gp trong 28,2% cc u dng nhiu hc (p<0,05). Kt qu ny ph hp vi y vn v t l rng ngm trong u nguyn bo men dng mt hc (52-100%) cao hn dng nhiu hc (15-40%)(8). iu ny c th hiu do u nguyn bo men c th xut pht t nang thn rng(6,9). Nghin cu tm thy s lin quan c ngha gia tui bnh nhn vi s hin din rng ngm (p<0,05). T l rng ngm trong u l 75% nhm di 20 tui, gim cn 37,5% trong nhm 20-40 tui v ch gp 6,3% trong nhm trn 40 tui. C th do u xy ra sm nn nh hng n s mc rng, nht l nhng rng mc tr. Kt qu ny cng gi u nguyn bo men ngi tr c th lin quan vi mt nang thn rng trc .

Kch thc u Thc t, a s bnh nhn n khm v sng vng mt (94,2%), nhng khi u hy xng rt nhiu. 80,8% u ln hn 5 cm, mc d lnh tnh v thng c pht hin di 2 nm. Tiu ngt chn rng Tiu ngt chn rng l mt c im ph bin ca u nguyn bo men(12). Nghin cu ny ghi nhn t l 59,6%. S tiu ngt c th xy ra theo nhiu hng v nhiu dng khc nhau, nhng dng dao ct kh in hnh. Mt nghin cu trc y ghi nhn tiu ngt chn rng chim 81% trong 32 ca u nguyn bo men, 55% trong 20 ca nang thn rng, v 18% trong 33 ca nang nhim trng(12). Nh vy, s tiu ngt chn rng khng phi lun lun thy trong u nguyn bo men, nhng s xut hin ca n l mt gi c gi tr trong chn on, nht l khi c hnh nh dng dao ct. Tiu ngt chn rng xy ra n 91,7% ngi di 20 tui, nhng ch gp 50% ngi ln. C th do u xut hin sm, trong lc rng vnh vin mi to v ang mc, thm ch rng cha ng chp, nn tiu ngt chn rng l triu

Chn on u nguyn bo men trc m

Chn on xc nh u nguyn bo men da trn vic kt hp cc du chng X-quang v m bnh hc, nhng thng th chn on xc nh hi cu hn l tin cu. U nguyn bo men l u do rng thng gp nht xng hm, dng nhiu hc li l dng thng gp nht (75%) trong cc u nguyn bo men. Chn on trc m u nhiu hc l u nguyn bo men da trn xut cao, cc c im X-quang ni bt l v tr thng gp hm di vng pha sau 34/39 ca (chim 87,2%), mc

Y Hc TP. H Ch Minh * Tp 14 * Ph bn ca S 1 * 2010

hy xng nhiu (84,6% trn 5 cm), thng gy tiu ngt chn rng (61,5%). U dng mt hc khng phi him gp, chim 23,1% cc u nguyn bo men. U c hnh nh Xquang thu quang mt hc ging nh nang nhng chn on m bnh hc xc nh l u nguyn bo men. a s c rng ngm trong u (66,7%) v thng xy ra ngi tr. Nhng c im ny lm d chn on nhm l nang do rng, nht l nang thn rng. Tuy nhin, cho d u mt hc hay u nhiu hc th vn c nhng c im lm sng v Xquang phn nh thi xm ln ca mt u nguyn bo men m nang v nhng bu lnh tnh khc trong xng hm khng c. Kt qu nghin cu ny cho thy cc c im lm sng v v tr u, thi gian pht hin, triu chng sng mt, au, t mi, lung lay rng; cc c im X quang v kch thc u, tiu ngt chn rng khng khc bit c ngha gia u dng mt hc v u dng nhiu hc (p>0,05). Nh vy, nn cnh gic chn on trc m l u nguyn bo men i vi mt tn thng thu quang dng mt hc c gii hn r trong xng hm khi thy c mt hay nhiu c im sau: (1) V tr hm di cnh ngang vng rng sau, gc hm v cnh ln. Thm ch Cawson(1) ngh bt k hnh nh thu quang no trong gc hm nn ngh nhiu n u nguyn bo men cho n khi c chn on xc nh bng gii phu bnh. (2) Thi gian pht hin di 1 nm (83,3%) nhng hy xng nhiu. (3) Mc hy xng nhiu (66,7% trn 5cm). (4) Tiu ngt chn rng nhng khng c nguyn nhn do rng (58,3% cc u dng mt hc). Nu sau khi kho st lm sng v Xquang m vn nghi ng chn on u nguyn bo men i vi tn thng thu quang mt hc, nht l ngi tr, nn thc hin sinh thit.

Nghin cu Y hc

KT LUN
U nguyn bo men l loi u do rng thng gp Vit Nam. U ph bin ngi tr v xng hm di, thng gy phng xng v bin dng mt, biu hin hnh nh X-quang thu quang dng nhiu hc, c th dng mt hc. Thng c s lin quan gia mt s yu t lm sng nh tui, v tr u vi mt s c im Xquang nh dng u, kch thc u, tiu ngt chn rng, rng ngm trong u. S phi hp gia cc yu t lm sng v X-quang c nhiu thng tin c th gip chn on trc m chnh xc hn v quyt nh iu tr ng, nht l i vi u dng mt hc.

TI LIU THAM KHO

1. Cawson R.A., Odell E.W., Proter S. (2002). Essentials of oral pathology and oral medicine, 7th edition, Churchill Livingstone, Elsevier. Hong J., Yun P.-Y, Myoung H, Suh J.-D., Seo J.-H., Choung P.-H. (2007). Long-term follow up on recurrence of 305 ameloblastoma cases, Int J Oral Maxillofac Surg 36: 283288. Hunh i Hi (2001). U nguyn bo men qua hi cu 351 bnh n ti Vin Rng Hm Mt Tp.HCM t 1976 n 4/2000. Lun n chuyn khoa II i hc Y Dc Tp.HCM. Kim S.-G., Jang H.-S. (2001). Ameloblastoma: A clinical, radiographic, and histopathologic analysis of 71 cases, Oral Surg Oral Med Oral Pathol Oral Radiol Endol 91: 649653. Lm Ngc n, Bi Hu Lm (1994). U men xng hm ti min Nam Vit Nam: Phng php iu tr. K yu cng trnh khoa hc 1975-1993 Vin Rng Hm Mt, tr. 207-216. Neville B.W., Damm D.D., Allen C.M., Bouquot J.E. (2004). Oral and maxillofacial pathology, 2nd edition, Saunders, Elsevier. Nguyn Vn Th (1995). Lm sng hm mt. Vin Rng Hm Mt Tp. H Ch Minh. Philipsen H.P., Reichart P.A. (1998). Unicystic ameloblastoma. A review of 193 cases from the literature. Oral Oncol 34: 317-325. Philipsen H.P., Reichart P.A, Nikai H., Takata T., Kudo Y. (2001). Peripheral ameloblastoma: biological profile based on 160 cases from the literature. Oral Oncol 37: 17-27. Regezi J.A., Sciubba J.J., Jordan R.C.K. (2003). Oral pathology: Clinical pathologic correlations, 4th edition, Saunders. Sapp J.P., Eversole L.R., Wysocki G.P. (2004). Contemporary oral and maxillofacial pathology, 2nd edition, Mosby. Wood N.K., Goaz P.W. (2007). Differential diagnosis of oral and maxillofacial lesions, 5th edition, Mosby, Elsevier.

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Y Hc TP. H Ch Minh * Tp 14 * Ph bn ca S 1 * 2010

Nghin cu Y hc

Y Hc TP. H Ch Minh * Tp 14 * Ph bn ca S 1 * 2010

Nghin cu Y hc