Một số hiểu biết mới về bệnh CROHN

DIEN DAN Y HOC^
Chuyen de trong thang
MOT SO HIEU BIET M O I VE BENH CROHN
Nguyen Khanh Trach*
Binh duac md td ddu tien ndm 1932, nhung cho den nay vdn cdn nhien vdn de chua sdng td: nguyen
nhdn, ca che sinh benh, dieu tri,...
Nhin chung ngubi ta thay ty le mbi mac tang
I. TY LE MAC BENH
1. Ty le hien mac (prevalence): 8,3 - 214 ea eho
len theo thbi gian.
10'ngubi dan.
3. Nguyen nhan: ngubi ta cho rang yeu tb mbi
2. Ty le moi mac (incidence): rat khae nhau tuy
truang dbng vai tro quan trgng. Thube la, thuoc
theo timg nubc timg vung lanh tho: b chau Au: ty
tranh thai va virus la nhirng yeu tb nguy ca hay
le chung cho toan chau Au: 0,3 - 9,8 truang hgp
gap nhat.
cho 10' ngubi dan mbi nam.
Incidence theo thai gian eho 100.000 dan
4. Tuoi hay gap: chung quanh tubi 20 la hay gap
nhat ngubi Ion tubi tren 40 ehiem 10 - 15%), a tre
(105):
Thuy Si: 6,1/105 nam 1964, 9,8/105 nam
em eung cb the gap nhung hiem.
1977, nlu tinh tir 1965 - 1983 thi ty le db la 6,6; tir
1983 - 1987 ty le db la 6,7 - Stockholm Phin Lan:
5. Ty le nam/nQ': mgt sb nghien ciioi thay ty le mac
tir 1955 - 1989 la 4,9 dan. Nhung tinh timg nam
giiia nam va nii khong eb sy khae nhau dang ke,
ngubi ta thay eii 5 nam ty le do tang 15%) va dimg
mgt so nghien cim khac lai thay nii mac nhieu han
lai b miic 4,6 - 4,9. 6 Eeosse: tir 1955 din 1987
nam mgt ehiit. Dae biet mgt sb viing ngubi ta lai
ty le mac chung la 5,4; nhung tinh rieng timg nam
thay ty le db khae nhau ro ret:
ngubi ta thay nam 1955 la 1,3 va 1985 la 9,8 va
- O Hy Lap nir mac nhieu han nam.
dimg lai b miic do.
- Ci Crete nam lai mac nhieu ban nii mgt each ro
Nauy hi 1991 - 1993 la 7,9; Island tir 1980 -
ret.
1989 la 3,1 nhung tir 1991 - 1993 tang len 7,8. 6
Anh tir 1991 - 1993 la 3,8; b Due tir 1981 - 19841a
II. NOI SOI DAI TRANG VA RUOT CUOI
4; tir 1991 - 1993 la 4,4. Ci Phap tir 1988 - 1990 la
Mgt dae diem quan trgng ve hinh anh ngi soi
3,2; b Bruxelle (Bi) tii- 1992 - 1997 la 4,1 tir 1993
cua benh CROHN la ranh gibi tbn thuang niem
- 1996 la 4,8. C* Hy Lap tii' 1990 - 1994 la 3,9. Ci
mac bng tieu hoa rat ro rang giiia viing tbn thuang
Florence (Y) tii- 1991 - 1993 la 3,8; a Palermo (Y)
va viing binh thuang. Hinh anh tbn thuong eb
hi 1991 - 1993 la 6,6; a Tay Ban Nha tir 1979 -
nhieu, nhung cb the chia 2 loai: tbn thuang tien
1989 la 0,9; tir 1991 - 1993 la 5,2; b B6 Dao Nha
trien va tbn thuang thanh seo, hai ton thuong eb
hi 1991-1993 la 1,6 din 6,6.
the nay dan xen vbi nhau.
*Nguyen Trudng khoa Tieu hod - Benh vien Bgch Mai
s648(Thang0i/2010) YHOC LAM SANG I 13
DIEN DAN YHOC
Chuyen de trong thang
1, Cac ton thuong tien trien
loet ma thiy mgt vung tring nhat hinh thai khae
a. Hdng ban (erytheme): la nhiing mang hoac giai
nhau, phing hoac 16m hoac ca hai phbi hgp vbi
mau db chay theo ehieu dgc bng tieu hoa, mau
nhau, eac nep nhan binh thuang bi eo keo.
khae vbi mau niem mac binh thuang b ben canh,
khbng con nhin thiy ro mach mau ma binh thubng
b. Gid polype: db la nhirng hat Ibi kieh thube khae
nhau lam hep long ruot.
van nhin thay.
c. Seo gdy hep: nam b giiia dam niem mac binh
b. Phil ne: a niem mac va nhat la b ha niem mac,
thubng.
cac nip nhan sung to, dan den hep long ruot, dbi
khi thiy dang hat phbi hgp vbi loet chgt tao thanh
3. Chan doan phan biet benh CROHN tren noi
hinh anh lat gaeh.
soi: eb nhieu tbn thuong ruot do nhieu nguyen
c. Loet: eb nhieu hinh thai khae nhau:
nhan khae nhau gay ra eQng cb nhiing hinh anh ngi
- Loet dgng aphte: kieh thube khoang vai mm, hinh
soi gibng benh CROHN can phai phan biet.
lim tim, day mau trang bao bgc bbi mgt quang
a. Trw&c tien Id cdc viem ruot do nhiem khudn:
mau db, nam b vung niem mac binh thubng.
38%) nhung ngubi tieu chay mau miii ma lam sang
- Loet ndng: la nhiing loet chgt chi nam b niem
thubng ehan doan la viem ruot khbng ro nguyen
mac day nbng, phai nhin ky mbi thay, kich thube
nhan thubng la viem ruot nhiem khuan, bao gbm:
hinh dang eua loet chgt rat khac nhau, chiing cb
lao, coli 0157-H5, yersinia, salmonella, chlamydia
the hgp thanh mang Ion chay theo chieu dgc tao
trachomatis, eae ky sinh vat: amibe, schistosomia,
thanh hinh anh duong ray tau hoa, hinh ban db.
virus: CMV, Herpes,...
- Loet sdu: an tbi ha niem mac, kich thube hinh
b. Ngodi ra con cdn phdi phdn biet v&i cdc ton
the khae nhau, loet nang eb the de tra ca lap ca va
thwomg do nguyen nhdn khde nhw:
bong niem mac ra.
- Viem ruot do thieu mau.
- Loet xa ehai: gay hep Ibng ruot, phan niem mac
- Viem tiii thira.
ehung quanh 6 loet eimg, eo keo niem mac binh
- Loet don dgc khbng ro nguyen nhan a trye
thuang lai, lam hep long ruot.
trang.
d. Lo do: b ruot cubi nhieu hon b dai trang, mieng
- Viem dai trang do thube, nhat la khang sinh.
lb db bi phil ne xung huyet, kieh thube chi khoang
- Viem dai trang do ha bach cau.
vai mm nen rat khb phat hien khi soi.
- Benh Behcet.
c. Cuoi ciing Id phan Met giira CROHN vd viem
2. Cac ton thuong thanh seo
dgi trwc trdng chay mdu: ve hinh anh ngi soi rat
fl. Loet da thdnh seo: khbng ebn nhin thay ro b
hay nham lan giiia hai benh nay.
Hinh anh giam mao maeh
Hbng ban
CROHN
+
Viem DTTCM
+++
++
+-H-
Hinh da granit, de ehay mau
+
Hinh lat gaeh
++
+++
_
Gia pholype
++
Loet dang aphte
+++
+++
_
Loet nong
+++
+
Loet sau, ngoan ngoeo
+++
-
14 I YHOC LAM SANG So 48 (Thang 01 /2010)
DIENDANYHOC^
Chuyen de trong thang
++
Hep long mbt
+++
Cau niem mac
++
++
Tbn thuong tryc trang
TTTT doi xung va lien tue
TTTT mang khong dbi xung
++
++++
+++
-
Khoang each niem mac lanh
+++
-
Loet hbi trang
+++
-
Ghi chu:
+
(-): Khong cb, hoac ngoai le.
(+): Hiem gap.
(++): Cb thi gap.
(+++): Thuang gap.
(++++): Hang dinh, bao gib eiing gap.
Tuy nhien phan biet eac hinh anh ngi soi tren day khbng phai la de dang don gian, nb dbi hbi ngubi
soi phai cb kinh nghiem.
3. Vien nang soi (videocepsule): duge ap dung tu
HI. CAC KY THUAT NOI SOI KHAC
1. Noi soi da day thuc quan: CROHN b da day
thuc quan rat hiem gap, chiem 0,5 - 13% truac
nam 2000 thay cho ngi soi ruot non. Hien ebn rat
it nghien ciru ve ky thuat nay b benh CROHN.
day, nhung hien nay eon sb nay len rat cao, ehiem
17 - 75% nhirng ngubi cb tbn thuang nghi ngb
4. Sieu am noi soi: la can thiet, nhat la khi cb bien
(CROHN) tren ngi soi. Tuy nhien, rat khb xac
chiing hau mbn trye trang: ap xe, lb db. Dbng thai
dinh ty le benh crohn trong nhan dan. Trong mgt
nb con giup cho chan doan phan biet giiia benh
nghien cim tren 129 benh nhan eb tbn thuang
Crohn va benh VLDTTCM - Trong VLDTTCM
nghi CROHN tren ngi soi, 28%) dugc xae dinh
khbng thay dugc 5 lap, hoac 2,3 lap dau thay day
benh CROHN qua sinh thiet (trong do 19% cb u
len. Trong benh CROHN thay dut quang a tirng
hat) b tre em ty le nay con cao han, chiem 60%.
lap, hoac sb lap giam di.
Cae hinh anh tbn thuang ciing gibng nhu
a duong tieu hoa dubi: nep nhan day, loet trgt,
IV. TON THUONG THAN KINH NOI TIET
loet dge ngoan ngoeo, hep lbng...Cb the chi tbn
TRONG BENH CROHN
thuang duong tieu hoa tren, nhung ciing cb the
O niem mac ruot cb 4 loai te bao:
- Te bao niem mac hinh try dang te bao ruot non
phbi hgp ea hai.
hay te bao niem mac dai trang.
2. Soi ruot non: it lam, nhung la can thiet khi
- Te bao nhay.
nghi ngb tbn thuang b mgt non, hoac ngi soi cac
- Te bao Paneth (ruot non va manh trang).
phan khac bng tieu hoa khbng thay tbn thuang
- Te bao than kinh ngi tiet. }
nhung lam sang hoac X quang thay van nghi ngb
a. Cac te bao nhom than kinh noi tiet: gbm
Crohn, dae biet b tre em: tre eham Ibn, tieu ehay
nhieu loai khac nhau, san xuat nhieu ngi tiet tb
keo dai, dau bung khong ro nguyen nhan,...
polypertide khac nhau. Trong benh CROHN va
S6 48(Thang01/2010) YHOC LAM SANG I 15
DIEN DAN YHOC
Chuyen de trong thang
VLDTTCM eb the phbi hgp vbi nhiing thay dbi b
boat dbng, ngoai ra ngubi ta con tim thay khang
niem mac hbi trang nhu: dj san, gia polyme hoac
nguyen Leu 19 cb lien quan din NCAM (neural
te bao nhay, dj san te bao paneth; mat te bao nhay
cell adhesion molecule) b b l mat sgi than kinh.
hay ngugc lai la tang sinh te bao nhay, nhilng thay
doi nay duge coi la thir phat. Ngubi ta thay giam
V. HOMOCYSTEIN MAU
mat do te bao than kinh ngi tiet b tryc trang benh
Sb dT ngubi bi CROHN va VLDTTCM eb
nhan VLDTTCM va tang len 8 - 16 tl bao/khe
the bi huyet khbi tTnh mach la do eb hien tugng
tuyen (binh thubng la 4 te bao). Ngubi ta ebn thay
tang homoeystein mau. Dieu nay ngubi ta mbi
trong benh crohn cb tang te bao ngi tiet b ca hbi
biet den gan day. Nghien eitu tren 171 benh
trang binh thuang hoac cb ton thuang. Ngubi ta
nhan bi crohn, djnh lugng homocyitein mau,
Cling thay trong benh crohn va VLDTTCM giam
forlate, vitamine B12 va protein C, ngubi ta
te bao dai trang chira somatostatine, tang the bao
thay ket qua nhu sau:
mien dieh cb phan ung vbi serotonine.
Homoeystein mau: 14,8ymol/l (binh thubng
b. He thong than kinh ruot: ton thuong dam rbi
4,4 - 12,4^mol/l).
than kinh ruot, phi dai tang sinh sgi than kinh,
Tang homoeystein mau trong benh crohn gap
ton thuang than than kinh va te bao gliale ruot.
b 89 benh nhan (chiem 52%o) nb eb lien quan den
Chung quanh cac tbn thubng nay la cac te bao
tubi, gibi (nam) hiit thube la, dam do vitamine B12
viem lympho, plasmomastoeyte, CD27. CD27
trong mau, tien su eat hbi trang (vbi p < 0,05). Ci
ehii yeu bao gbm lympho va plasmocyte, nb cb
ngubi benh Crohn da mb, homoeystein mau eb
mat b mat te bao dubi dang cb homodimere cb
lien quan den ehieu dai doan ruot bi cat bb, nam
lien quan den CD70. CD70 cb mat b lymphocyte
gibi va hut thube la.
Homoeystein mau
Vitamin B12
Folate
CRP
(nmol/l)
Binh thubng
Chenh lech toi da, thbi thieu
Trung binh
Sb benh nhan cb nguong khbng
binh thuang
(pmol/1)
(nmol/l)
(mg/l)
4,4 - 12,4
156-672
1,9-45,4
<8
4,1 -51
72 - 2000
1,4-44,6
1 -277
14,8
381,3
8,6
32,1
89
14
7
97
(52%)
(8%)
(4%)
(57%))
VI. DiEU TRI
oligonucleotide antisen.
- Bao gbm ba phuang phap chinh:
Dieu tri bang infliximab: 60% tru'bng hgp
+ Coctieoide tiem tinh mach.
dieu tri theo phuang phap cu khbng cb kit qua,
+ Nubi dubng bang duong tTnh mach.
dieu tri vbi inflixinmab cb kit qua - 55%o lb db
+ Infliximab.
lanh seo bang infliximb.
a. Dieu trj crohn bang infliximab
- Rutgeers va ACENT 1 da nghien cuu tren nhilu
Infliximab la khang the dan dbng ehbng
nhom benh nhan khac nhau so vbi placebo, thiy
TNFa, ngoai ra ebn cac cytokin khac ehbng viem
nhbm benh dieu tri bing infliximab thu dugc kit
dang dugc nghien ciin: cac cytokine phbi hgp vbi
qua rat tbt so vbi nhbm placebo, nhbm diing inf-
16 I YHOC LAM SANG s6 48 (Thang oi / 2010)
D I E N D A N YHOC^
Chuyen de trong thang
liximab 1 Omg/kg tbt han nhbm dung 5mg/kg.
diing hoac khbng phai diing corticoide, ngay nam
- Infliximab phai dung phbi hgp dai ban vbi cac
vien giam tir 134 ngay xubng 13 ngay, sb benh
thube giam miln dich: azathioprine va 6 mercap-
nhan phai can thiep ngoai khoa ciing giam tu 6
topurine hoac methotrexate. Ci benh nhan eb bieu
xubng 1 ngubi.
hien viem khap dang thap diing phbi hgp metho-
Cac phan ung phu do infliximab
trexate hang tuan cb tae dyng rat tbt. Dieu tri ea
- Nhiem trung: nhbm diing infliximab cb 32%)
ban bang thube giam mien dieh thuang phbi hgp
benh nhan so vbi 22%) b nhbm diing placebo.
vbi hien tugng giam khang the khang infliximab.
- Nhire dau, ehbng mat, ii tai, rbi loan tieu hoa,
Sy giam dap ling vbi truyen infliximab nhieu lan
eae phan ung khi truyen: nhbm dimg infliximab
thubng cb lien quan vbi sy eb mat ciia ATI (an-
eb 17%) benh nhan so vbi 1% a nhbm dimg pla-
ticorp anti Infliximab) cb the tranh dugc bang
cebo. Theo doi 40 benh nhan dieu trj infliximab
each dung Infliximab 1 Omg/kg - Thube giam
5mg/kg trong 2-4 nam sau dieu tn thay 10 benh
mien dieh diing dong thai se gop phan lam giam
nhan (chiem 25%o) eb dau ca - ban do, sbt va dau
phan ung phy cua Infliximab va giam ngubng
khap, 10% benh nhan xuat hien khang the khang
khang the ADN, dimg infliximab se lam giam ty
ADN. Can ehii y kha nang lao phbi, do db phai
le ean thiep: giam 34%) ngi soi (p = 0,01) giam
chup phbi truac khi dieu tri. Mgt bien chirng ebn
ty le kham benh 15% (p = 0,05) giam 15% ty le
dang tranh cai vi y kien cua nhieu tae gia chua
phau thuat (p= 0,1) sb ngay nam vien, ty le phau
thbng nhat, do la u lympho.
thuat trong 6 thang truac va sau dung infliximab
Hbi tryc tiep benh nhan eho thay: 54%) benh
deu giam, 13/18 benh nhan eb ket qua tbt va rat
nhan tra loi tbt hoac rat tbt, 17%) benh nhan cho
tbt trong do eb 6 benh nhan (4 ngubi cb 16 db)
biet cb cai thien benh, 26%o benh nhan tra Ibi
dugc truyen infliximab nhieu lan, mgt benh nhan
khbng thay thay dbi gi, 3% benh nhan cho biet
khbng eb ket qua. Khbng eb benh nhan nao eb
tinh trang benh nang len.
phan ling phy.
Ty le benh nhan eb ket qua tbt sau truyen
- Cac nghien euu deu thay da sb benh nhan giam
infliximab nhu sau:
24%
21%
21%
16%
16%
15%
10%
Giam hoac mat lb db
Giam dau
Tang can
Giam sb lan di ngoai
Toan trang tbt len
An ngon hon
Giam sir dung eorfieoid
- CDP 5 71: khang the dan gibng IgG4 da dugc sit
b. Dieu tri CROHN bang cac anti TNFa khac
Tac dung cua infliximab chiing minh vai tro
dung eho 167 benh nhan vbi lieu lOmg, 20mg/
eiia TNFa trong sinh benh hge eua benh crohn,
kg; dbng thai diing placebo, thay giam CDAl
do db ngoai infliximab, mgt sb anti TNFa khac
xubng 70 diem hoac nhieu han sau 2 tuan dieu
dang duge nghien curu va ap dung.
tri vbi ty le 54,37%) va \0% eho mbi nhbm, eae
So 48 (Thang 01 /2010)
Y HOC LAM SANG | 17
DIEN DAN Y HOC
Chuyen de trong thang
lb db Cling dugc bit mieng.
Placebo.
Uu diem ciia chat nay la da dugc thuan hoa
Ty le lui benh lln lugt la 29%, 46%, 3 1 %
tren ngubi, nen tranh dugc each benh mien dieh.
va 27%. Nhu vay kit qua chua ro rang.
Tuy nhien van con mgt sb benh nhan cb phan irng
- ISIS 2302: la mgt oligonucleotide, ap dyng tren
khi truyen, xuat hien khang the khang ADN.
ngubi thay 7/15 benh nhan cb tiln bg, trong khi
- Etanercept: la mgt chat tbng hgp chiia 2 chubi
nhbm placebo cb 1/5 benh nhan cb tien bb.
Tuy nhien, mgt nghien cu'u khae tren 75
monomere p75 giong nhau. Da ap dung tren
nguoi nhung chua tbng ket d u g c
benh nhan lai thay ket qua khbng ro rang.
- RDP 58: ciing la chat anti TNFa tbng hgp, dang
- RH4 IL hay ILIO: da ap dung tren ngubi, tiem
trong giai doan thir tren sue vat.
lieu tang dan 0,5 len 25mg/kg so sanh vbi place-
c. Dieu trj crohn bang eac chat khong chong
bo, thay cb ket qua tbt trong the vira tien trien it,
TNFa
thi man tinh cb dgt cap, tra vbi corticoide. Mbi
- Natalizamab: la mgt khang the dan dong IgG4.
day vbi sy phbi hgp vbi lacto - bacillus bang con
Da ap dyng tren ngubi (30 benh nhan) vbi lieu
dubng gen, dung lieu cao tai chb tren sue vat
3mg/kg so sanh vbi placebo. Ket qua la 39%
thay cb tac dyng tbt.
benh nhan giam benh so vbi 8%) b nhbm pla-
- I L l l : lam tang kha nang ngan chan eua niem
cebo.
mac ruot, lam giam viem - diing vbi lieu 16mg/
Mgt nghien eu'u mbi day vbi cac lieu khac
kg 2-5 lan/tuan, tb ra cb ket qua.
nhau:
- IL 18: la mgt cytokin epithelial, thit tren sue vat
;
- 3mg/kg dan dbc duy nhat.
thay eb ket qua tbt, chua ap dung tren ngubi.
- 3mg/kg 2 lan each nhau 4 tuan.
d. Dieu trj benh crohn bang thuoc co dien
- 6mg/kg 2 lan each nhau 4 tuan.
Crohn khong
Thuoc
16 do
Cb
Cb
Crohn co
lb do
Khbng
Khbng
Cb
Co, tac dung cham
Khbng
Cb
Cortieoid uong
Sulfasalazine
5ASA uong (pentasa)
Azathioprine/
Giam lieu Duy tri giam
corticoide
benh
Khbng
Khbng
Khbng
7
Cb
Co
Cb
6 ercaptopurine
Cyclosporine:
U6ng lieu thap
Tiem lieu cao
Methotrexate
Metronidhzole
Ghi chu:
Cb:
Khbng
-
7
7
Klibng
-
Khong
-
Co
Co
7
7
7
Cb
7
7
Co hieu qua tren lam sang va theo kinh nghiem
Khbng: Khbng cb hieu qua.
-:
Khong dugc thir nghiem, hoac chua ap dung.
7•
18 I YHOC LAM
Hieu qua khbng dugc biet ro.
S A N G S648(ThangOI
/201 O)
DIEN D A N YHOC.
Chuyen de trong thang
Sff do dieu tri
'.'!!
The vira va nhe
5ASA diing tai chb
+
The nang
Corticoide tiem tTnh mach
Duy tri 5ASA
•
Them Corticoide uong
(Prednisone 40-60mg/kg
tren 6 thang)
Duy tri 5ASA
Mb
•
Azathioprin 1,5 - 2,5 mg/kg/ngay
hoac
6 mereaptopurine 1,5mg/kg/ngay
+
-•
Duy tri Azathioprine
hoac 6 mereaptopurine
Mb
Ghichd:
+ : Cb dap ung
- : Khbng dap ling
VII . TY LE UNG THU HOA VA TAI PHAT
SAU PHAU THUAT CAT BO UNG THU
+ Gillen nghien ciiu ty le ung thu hoa b benh nhan
- Ebkom tap hgp 1655 benh nhan Crohn nhan thiy
nhau theo timg vi tri, RR = 18 dbi vbi Crohn va RR
ty le bien ehiing ung thu hoa nhu sau:
= 19 dbi vbi VLDTTCM.
+ The hbi trang don thuan
: \%.
+ Friendman: theo doi 260 benh nhan Crohn trong
+ The hbi trang dai trang
: 3,2%).
8 nam lien tyc, thay 16% ngubi eb loan san hoac
+ The dai trang don thuan
: 5%.
ung thu thyc sy.
Crohn va VLDTTCM thay ty le ung thu hoa gibng
- Ebkom nghien ciru ty le ung thu hoa trong
- Benh Crohn cb hep Ibng ruot ty le bien chiing
VLDTTCM thay ty le bien ehiing ung thu hoa nhu
ung thu cao: 6,8%, can phan biet hep do Crohn vbi
sau:
hep do ung thu (hep khbng dbi xiing, cimg, den
+ VDTT doan xa
: 14,2%.
+ Viem toan bb dai trang: 33%.
khbng qua dugc, bb khbng deu, cb hat va rit dl
chay mau).
S6 48(Thang01/2010) YHOC LAM SANG I 19
DIEN DAN YHOC
Chuyen de trong thang
- D I theo doi tai phat ung thu sau phau thuat, can
ehiing tai phat.
tiln hanh ngi soi djnh ky 6-12 thang sau mb. Ket
+ Tbn thuong lan toa va loet mieng nbi (i 4) mgt
qua thay nhu sau:
sb benh nhan nay 1 nam sau mb, va tit ea 100%
+ Tai phat ve lam sang 5 nam sau mb: 30-50%.
benh nhan 4 nam sau m6 diu eb trieu ehung tai
+ Tai phat lam sang 10 nam sau mb: 45-75%o.
phat. Ngubi ta nhan thay tbn thuang nbi soi eang
+ Tai phat qua ngi soi say ra sam han.
nang va eang sam thi benh eang nang.
- Rutgeerts nghien cim ngi soi 1 nam sau phau
+ De danh gia tai phat sau phau thuat nbi dai
thuat eat hbi manh trang thay 37% benh nhan cb
trang - hbi trang mgt each chinh xac, Rutgeerts
tbn thuong hbi trang trube khi nbi. Getaid thay 3
dua ra bang xep loai nhu sau:
thang sau phau thuat da cb 60% benh nhan eb tbn
thuang, theo doi 3 nam lien thay cac tbn thuang
sau mb cb lien quan chat che vbi tbn thuong ban
dau ey the nhu sau:
Score i 0 : Khbng eb tbn thuang.
i 1 : Tbn thuang dang aphte a hbi trang it
< 5 cai.
i 2 : Tbn thuang dang aphte nhieu: >
-I- Khbng cb hoac eb tbn thuong nhe (i 01): 90%
5 cai, hoac chiem mgt viing rbng, hoac tu tap
benh nhan 3 nam sau va 6 nam sau mb van khbng
chung quanh mieng nbi.
eb trieu chirng tai phat.
i 3 : Viem hbi trang dang aphtoide lan
+ Tbn thuang lan rbng vira phai (i 2) 3 nam sau
toa vbi niem mac viem xung huyet.
85% benh nhan, 6 nam sau mb cb 60%) benh nhan
Score i 4 : Viem hbi trang lan rbng vbi loet rbng,
van khbng eb trieu ehung tai phat.
cb hat hoac gay hep.
+ Tbn thuong lan rbng ban (i 3) 3 nam sau eb 60%)
benh nhan, 6 nam sau mb eb 15% khbng cb trieu
TAI LIEU THAM
KHAO
/. Edward V.Loffus, Jr, MD, William Sandborn, MD (2004). "Drug therapy for inflammatory Bowel disease". Internal medicine. Vol 7, No4, P 21-23.
2. Team Marc Regimbeau, Yves Panis, Vincent de Panades (2005). "Mamifeslations anoperianales de la
malavie de Crohn ". Gastroenterologie clinique et Biologique. Vol 24, No 1, p 36-45.
3. Jean Paul Saint Anche, Isabele Valo (2002). "Definifim et cardcterisation histologique des tumours
neuroendoerinies. " La Revue du Praficien. Vol 52, No 3, p 250-256
20 I YHOC LAM SANG s648(Thangoi /2010)