BỆNH CROHN

1. DIEN DAN Y HOC^
Chuyen de trong thang
MOT SO HIEU BIET MOI 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,...
I. TY LE MAC BENH
1. Ty le hien mac (prevalence): 8,3 - 214 ea eho
10'ngubi dan.
2. Ty le moi mac (incidence): rat khae nhau tuy
theo timg nubc timg vung lanh tho: b chau Au: ty
le chung cho toan chau Au: 0,3 - 9,8 truang hgp
cho 10' ngubi dan mbi nam.
Incidence theo thai gian eho 100.000 dan
(105):
Thuy Si: 6,1/105 nam 1964, 9,8/105 nam
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:
tir 1955 - 1989 la 4,9 dan. Nhung tinh timg nam
ngubi ta thay eii 5 nam ty le do tang 15%) va dimg
lai b miic 4,6 - 4,9. 6 Eeosse: tir 1955 din 1987
ty le mac chung la 5,4; nhung tinh rieng timg nam
ngubi ta thay nam 1955 la 1,3 va 1985 la 9,8 va
dimg lai b miic do.
Nauy hi 1991 - 1993 la 7,9; Island tir 1980 -
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
4; tir 1991 - 1993 la 4,4. Ci Phap tir 1988 - 1990 la
3,2; b Bruxelle (Bi) tii- 1992 - 1997 la 4,1 tir 1993
- 1996 la 4,8. C
* Hy Lap tii' 1990 - 1994 la 3,9. Ci
Florence (Y) tii- 1991 - 1993 la 3,8; a Palermo (Y)
hi 1991 - 1993 la 6,6; a Tay Ban Nha tir 1979 -
1989 la 0,9; tir 1991 - 1993 la 5,2; b B6 Dao Nha
hi 1991-1993 la 1,6 din 6,6.
Nhin chung ngubi ta thay ty le mbi mac tang
len theo thbi gian.
3. Nguyen nhan: ngubi ta cho rang yeu tb mbi
truang dbng vai tro quan trgng. Thube la, thuoc
tranh thai va virus la nhirng yeu tb nguy ca hay
gap nhat.
4. Tuoi hay gap: chung quanh tubi 20 la hay gap
nhat ngubi Ion tubi tren 40 ehiem 10 - 15%), a tre
em eung cb the gap nhung hiem.
5. Ty le nam/nQ': mgt sb nghien ciioi thay ty le mac
giiia nam va nii khong eb sy khae nhau dang ke,
mgt so nghien cim khac lai thay nii mac nhieu han
nam mgt ehiit. Dae biet mgt sb viing ngubi ta lai
thay ty le db khae nhau ro ret:
- O Hy Lap nir mac nhieu han nam.
- Ci Crete nam lai mac nhieu ban nii mgt each ro
ret.
I
I
. NOI SOI DAI TRANG VA RUOT CUOI
Mgt dae diem quan trgng ve hinh anh ngi soi
cua benh CROHN la ranh gibi tbn thuang niem
mac bng tieu hoa rat ro rang giiia viing tbn thuang
va viing binh thuang. Hinh anh tbn thuong eb
nhieu, nhung cb the chia 2 loai: tbn thuang tien
trien va tbn thuang thanh seo, hai ton thuong eb
the nay dan xen vbi nhau.
*Nguyen Trudng khoa Tieu hod - Benh vien Bgch Mai
s648(Thang0i/2010) YHOC LAM SANG I 13

2. DIEN DAN YHOC
Chuyen de trong thang
1, Cac ton thuong tien trien
a. Hdng ban (erytheme): la nhiing mang hoac giai
mau db chay theo ehieu dgc bng tieu hoa, mau
khae vbi mau niem mac binh thuang b ben canh,
khbng con nhin thiy ro mach mau ma binh thubng
van nhin thay.
b. Phil ne: a niem mac va nhat la b ha niem mac,
cac nip nhan sung to, dan den hep long ruot, dbi
khi thiy dang hat phbi hgp vbi loet chgt tao thanh
hinh anh lat gaeh.
c. Loet: eb nhieu hinh thai khae nhau:
- Loet dgng aphte: kieh thube khoang vai mm, hinh
lim tim, day mau trang bao bgc bbi mgt quang
mau db, nam b vung niem mac binh thubng.
- Loet ndng: la nhiing loet chgt chi nam b niem
mac day nbng, phai nhin ky mbi thay, kich thube
hinh dang eua loet chgt rat khac nhau, chiing cb
the hgp thanh mang Ion chay theo chieu dgc tao
thanh hinh anh duong ray tau hoa, hinh ban db.
- Loet sdu: an tbi ha niem mac, kich thube hinh
the khae nhau, loet nang eb the de tra ca lap ca va
bong niem mac ra.
- Loet xa ehai: gay hep Ibng ruot, phan niem mac
ehung quanh 6 loet eimg, eo keo niem mac binh
thuang lai, lam hep long ruot.
d. Lo do: b ruot cubi nhieu hon b dai trang, mieng
lb db bi phil ne xung huyet, kieh thube chi khoang
vai mm nen rat khb phat hien khi soi.
2. Cac ton thuong thanh seo
fl. Loet da thdnh seo: khbng ebn nhin thay ro b
loet ma thiy mgt vung tring nhat hinh thai khae
nhau, phing hoac 16m hoac ca hai phbi hgp vbi
nhau, eac nep nhan binh thuang bi eo keo.
b. Gid polype: db la nhirng hat Ibi kieh thube khae
nhau lam hep long ruot.
c. Seo gdy hep: nam b giiia dam niem mac binh
thubng.
3. Chan doan phan biet benh CROHN tren noi
soi: eb nhieu tbn thuong ruot do nhieu nguyen
nhan khae nhau gay ra eQng cb nhiing hinh anh ngi
soi gibng benh CROHN can phai phan biet.
a. Trw&c tien Id cdc viem ruot do nhiem khudn:
38%) nhung ngubi tieu chay mau miii ma lam sang
thubng ehan doan la viem ruot khbng ro nguyen
nhan thubng la viem ruot nhiem khuan, bao gbm:
lao, coli 0157-H5, yersinia, salmonella, chlamydia
trachomatis, eae ky sinh vat: amibe, schistosomia,
virus: CMV, Herpes,...
b. Ngodi ra con cdn phdi phdn biet v&i cdc ton
thwomg do nguyen nhdn khde nhw:
- Viem ruot do thieu mau.
- Viem tiii thira.
- Loet don dgc khbng ro nguyen nhan a trye
trang.
- Viem dai trang do thube, nhat la khang sinh.
- Viem dai trang do ha bach cau.
- Benh Behcet.
c. Cuoi ciing Id phan Met giira CROHN vd viem
dgi trwc trdng chay mdu: ve hinh anh ngi soi rat
hay nham lan giiia hai benh nay.
Hinh anh giam mao maeh
Hbng ban
Hinh da granit, de ehay mau
Hinh lat gaeh
Gia pholype
Loet dang aphte
Loet nong
Loet sau, ngoan ngoeo
CROHN
+
++
+
++
++
+++
+++
+++
Viem DTTCM
+++
+-H-
+++
_
+++
_
+
-
14 I YHOC LAM SANG So 48 (Thang 01 /2010)

3. 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.
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
day, nhung hien nay eon sb nay len rat cao, ehiem
17 - 75% nhirng ngubi cb tbn thuang nghi ngb
(CROHN) tren ngi soi. Tuy nhien, rat khb xac
dinh ty le benh crohn trong nhan dan. Trong mgt
nghien cim tren 129 benh nhan eb tbn thuang
nghi CROHN tren ngi soi, 28%) dugc xae dinh
benh CROHN qua sinh thiet (trong do 19% cb u
hat) b tre em ty le nay con cao han, chiem 60%.
Cae hinh anh tbn thuang ciing gibng nhu
a duong tieu hoa dubi: nep nhan day, loet trgt,
loet dge ngoan ngoeo, hep lbng...Cb the chi tbn
thuang duong tieu hoa tren, nhung ciing cb the
phbi hgp ea hai.
2. Soi ruot non: it lam, nhung la can thiet khi
nghi ngb tbn thuang b mgt non, hoac ngi soi cac
phan khac bng tieu hoa khbng thay tbn thuang
nhung lam sang hoac X quang thay van nghi ngb
Crohn, dae biet b tre em: tre eham Ibn, tieu ehay
keo dai, dau bung khong ro nguyen nhan,...
3. Vien nang soi (videocepsule): duge ap dung tu
nam 2000 thay cho ngi soi ruot non. Hien ebn rat
it nghien ciru ve ky thuat nay b benh CROHN.
4. Sieu am noi soi: la can thiet, nhat la khi cb bien
chiing hau mbn trye trang: ap xe, lb db. Dbng thai
nb con giup cho chan doan phan biet giiia benh
Crohn va benh VLDTTCM - Trong VLDTTCM
khbng thay dugc 5 lap, hoac 2,3 lap dau thay day
len. Trong benh CROHN thay dut quang a tirng
lap, hoac sb lap giam di.
IV. TON THUONG THAN KINH NOI TIET
TRONG BENH CROHN
O niem mac ruot cb 4 loai te bao:
- Te bao niem mac hinh try dang te bao ruot non
hay te bao niem mac dai trang.
- Te bao nhay.
- Te bao Paneth (ruot non va manh trang).
- Te bao than kinh ngi tiet. }
a. Cac te bao nhom than kinh noi tiet: gbm
nhieu loai khac nhau, san xuat nhieu ngi tiet tb
polypertide khac nhau. Trong benh CROHN va
S6 48(Thang01/2010) YHOC LAM SANG I 15

4. DIEN DAN YHOC
Chuyen de trong thang
VLDTTCM eb the phbi hgp vbi nhiing thay dbi b
niem mac hbi trang nhu: dj san, gia polyme hoac
te bao nhay, dj san te bao paneth; mat te bao nhay
hay ngugc lai la tang sinh te bao nhay, nhilng thay
doi nay duge coi la thir phat. Ngubi ta thay giam
mat do te bao than kinh ngi tiet b tryc trang benh
nhan VLDTTCM va tang len 8 - 16 tl bao/khe
tuyen (binh thubng la 4 te bao). Ngubi ta ebn thay
trong benh crohn cb tang te bao ngi tiet b ca hbi
trang binh thuang hoac cb ton thuang. Ngubi ta
Cling thay trong benh crohn va VLDTTCM giam
te bao dai trang chira somatostatine, tang the bao
mien dieh cb phan ung vbi serotonine.
b. He thong than kinh ruot: ton thuong dam rbi
than kinh ruot, phi dai tang sinh sgi than kinh,
ton thuang than than kinh va te bao gliale ruot.
Chung quanh cac tbn thubng nay la cac te bao
viem lympho, plasmomastoeyte, CD27. CD27
ehii yeu bao gbm lympho va plasmocyte, nb cb
mat b mat te bao dubi dang cb homodimere cb
lien quan den CD70. CD70 cb mat b lymphocyte
boat dbng, ngoai ra ngubi ta con tim thay khang
nguyen Leu 19 cb lien quan din NCAM (neural
cell adhesion molecule) b bl mat sgi than kinh.
V. HOMOCYSTEIN MAU
Sb dT ngubi bi CROHN va VLDTTCM eb
the bi huyet khbi tTnh mach la do eb hien tugng
tang homoeystein mau. Dieu nay ngubi ta mbi
biet den gan day. Nghien eitu tren 171 benh
nhan bi crohn, djnh lugng homocyitein mau,
forlate, vitamine B12 va protein C, ngubi ta
thay ket qua nhu sau:
Homoeystein mau: 14,8ymol/l (binh thubng
4,4 - 12,4^mol/l).
Tang homoeystein mau trong benh crohn gap
b 89 benh nhan (chiem 52%o) nb eb lien quan den
tubi, gibi (nam) hiit thube la, dam do vitamine B12
trong mau, tien su eat hbi trang (vbi p < 0,05). Ci
ngubi benh Crohn da mb, homoeystein mau eb
lien quan den ehieu dai doan ruot bi cat bb, nam
gibi va hut thube la.
Binh thubng
Chenh lech toi da, thbi thieu
Trung binh
Sb benh nhan cb nguong khbng
binh thuang
Homoeystein mau
(nmol/l)
4,4 - 12,4
4,1 -51
14,8
89
(52%)
Vitamin B12
(pmol/1)
156-672
72 - 2000
381,3
14
(8%)
Folate
(nmol/l)
1,9-45,4
1,4-44,6
8,6
7
(4%)
CRP
(mg/l)
< 8
1 -277
32,1
97
(57%))
VI. DiEU TRI
- Bao gbm ba phuang phap chinh:
+ Coctieoide tiem tinh mach.
+ Nubi dubng bang duong tTnh mach.
+ Infliximab.
a. Dieu trj crohn bang infliximab
Infliximab la khang the dan dbng ehbng
TNFa, ngoai ra ebn cac cytokin khac ehbng viem
dang dugc nghien ciin: cac cytokine phbi hgp vbi
oligonucleotide antisen.
Dieu tri bang infliximab: 60% tru'bng hgp
dieu tri theo phuang phap cu khbng cb kit qua,
dieu tri vbi inflixinmab cb kit qua - 55%o lb db
lanh seo bang infliximb.
- Rutgeers va ACENT 1 da nghien cuu tren nhilu
nhom benh nhan khac nhau so vbi placebo, thiy
nhbm benh dieu tri bing infliximab thu dugc kit
qua rat tbt so vbi nhbm placebo, nhbm diing inf-
16 I YHOC LAM SANG s6 48 (Thang oi / 2010)

5. D I E N D A N YHOC^
Chuyen de trong thang
liximab 1 Omg/kg tbt han nhbm dung 5mg/kg.
- Infliximab phai dung phbi hgp dai ban vbi cac
thube giam miln dich: azathioprine va 6 mercap-
topurine hoac methotrexate. Ci benh nhan eb bieu
hien viem khap dang thap diing phbi hgp metho-
trexate hang tuan cb tae dyng rat tbt. Dieu tri ea
ban bang thube giam mien dieh thuang phbi hgp
vbi hien tugng giam khang the khang infliximab.
Sy giam dap ling vbi truyen infliximab nhieu lan
thubng cb lien quan vbi sy eb mat ciia ATI (an-
ticorp anti Infliximab) cb the tranh dugc bang
each dung Infliximab 1 Omg/kg - Thube giam
mien dieh diing dong thai se gop phan lam giam
phan ung phy cua Infliximab va giam ngubng
khang the ADN, dimg infliximab se lam giam ty
le ean thiep: giam 34%) ngi soi (p = 0,01) giam
ty le kham benh 15% (p = 0,05) giam 15% ty le
phau thuat (p= 0,1) sb ngay nam vien, ty le phau
thuat trong 6 thang truac va sau dung infliximab
deu giam, 13/18 benh nhan eb ket qua tbt va rat
tbt trong do eb 6 benh nhan (4 ngubi cb 16 db)
dugc truyen infliximab nhieu lan, mgt benh nhan
khbng eb ket qua. Khbng eb benh nhan nao eb
phan ling phy.
- Cac nghien euu deu thay da sb benh nhan giam
diing hoac khbng phai diing corticoide, ngay nam
vien giam tir 134 ngay xubng 13 ngay, sb benh
nhan phai can thiep ngoai khoa ciing giam tu 6
xubng 1 ngubi.
Cac phan ung phu do infliximab
- Nhiem trung: nhbm diing infliximab cb 32%)
benh nhan so vbi 22%) b nhbm diing placebo.
- Nhire dau, ehbng mat, ii tai, rbi loan tieu hoa,
eae phan ung khi truyen: nhbm dimg infliximab
eb 17%) benh nhan so vbi 1% a nhbm dimg pla-
cebo. Theo doi 40 benh nhan dieu trj infliximab
5mg/kg trong 2-4 nam sau dieu tn thay 10 benh
nhan (chiem 25%o) eb dau ca - ban do, sbt va dau
khap, 10% benh nhan xuat hien khang the khang
ADN. Can ehii y kha nang lao phbi, do db phai
chup phbi truac khi dieu tri. Mgt bien chirng ebn
dang tranh cai vi y kien cua nhieu tae gia chua
thbng nhat, do la u lympho.
Hbi tryc tiep benh nhan eho thay: 54%) benh
nhan tra loi tbt hoac rat tbt, 17%) benh nhan cho
biet cb cai thien benh, 26%o benh nhan tra Ibi
khbng thay thay dbi gi, 3% benh nhan cho biet
tinh trang benh nang len.
Ty le benh nhan eb ket qua tbt sau truyen
infliximab nhu sau:
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
24%
21%
21%
16%
16%
15%
10%
b. Dieu tri CROHN bang cac anti TNFa khac
Tac dung cua infliximab chiing minh vai tro
eiia TNFa trong sinh benh hge eua benh crohn,
do db ngoai infliximab, mgt sb anti TNFa khac
dang duge nghien curu va ap dung.
- CDP 5 71: khang the dan gibng IgG4 da dugc sit
dung eho 167 benh nhan vbi lieu lOmg, 20mg/
kg; dbng thai diing placebo, thay giam CDAl
xubng 70 diem hoac nhieu han sau 2 tuan dieu
tri vbi ty le 54,37%) va 0% eho mbi nhbm, eae
So 48 (Thang 01 /2010) Y HOC LAM SANG | 17

6. DIEN DAN Y HOC
Chuyen de trong thang
lb db Cling dugc bit mieng.
Uu diem ciia chat nay la da dugc thuan hoa
tren ngubi, nen tranh dugc each benh mien dieh.
Tuy nhien van con mgt sb benh nhan cb phan irng
khi truyen, xuat hien khang the khang ADN.
- Etanercept: la mgt chat tbng hgp chiia 2 chubi
monomere p75 giong nhau. Da ap dung tren
nguoi nhung chua tbng ket dugc
- RDP 58: ciing la chat anti TNFa tbng hgp, dang
trong giai doan thir tren sue vat.
c. Dieu trj crohn bang eac chat khong chong
TNFa
- Natalizamab: la mgt khang the dan dong IgG4.
Da ap dyng tren ngubi (30 benh nhan) vbi lieu
3mg/kg so sanh vbi placebo. Ket qua la 39%
benh nhan giam benh so vbi 8%) b nhbm pla-
cebo.
Mgt nghien eu'u mbi day vbi cac lieu khac
nhau:
- 3mg/kg dan dbc duy nhat.
- 3mg/kg 2 lan each nhau 4 tuan.
- 6mg/kg 2 lan each nhau 4 tuan.
Placebo.
Ty le lui benh lln lugt la 29%, 46%, 31%
va 27%. Nhu vay kit qua chua ro rang.
- ISIS 2302: la mgt oligonucleotide, ap dyng tren
ngubi thay 7/15 benh nhan cb tiln bg, trong khi
nhbm placebo cb 1/5 benh nhan cb tien bb.
Tuy nhien, mgt nghien cu'u khae tren 75
benh nhan lai thay ket qua khbng ro rang.
- RH4 IL hay ILIO: da ap dung tren ngubi, tiem
lieu tang dan 0,5 len 25mg/kg so sanh vbi place-
bo, thay cb ket qua tbt trong the vira tien trien it,
thi man tinh cb dgt cap, tra vbi corticoide. Mbi
day vbi sy phbi hgp vbi lacto - bacillus bang con
dubng gen, dung lieu cao tai chb tren sue vat
thay cb tac dyng tbt.
- ILll: lam tang kha nang ngan chan eua niem
mac ruot, lam giam viem - diing vbi lieu 16mg/
kg 2-5 lan/tuan, tb ra cb ket qua. ;
- IL 18: la mgt cytokin epithelial, thit tren sue vat
thay eb ket qua tbt, chua ap dung tren ngubi.
d. Dieu trj benh crohn bang thuoc co dien
Thuoc
Cortieoid uong
Sulfasalazine
5ASA uong (pentasa)
Azathioprine/
6 ercaptopurine
Cyclosporine: U6ng lieu thap
Tiem lieu cao
Methotrexate
Metronidhzole
Crohn khong
16 do
Cb
Cb
Cb
Co, tac dung cham
Khbng
7
Co
Co
Crohn co
lb do
Khbng
Khbng
Khbng
Cb
-
7
7
Cb
Giam lieu
corticoide
-
Khbng
7
Co
Klibng
-
7
7
Duy tri giam
benh
Khbng
Khbng
Cb
Cb
Khong
-
7
7
Ghi chu: Cb: Co hieu qua tren lam sang va theo kinh nghiem
Khbng: Khbng cb hieu qua.
- : Khong dugc thir nghiem, hoac chua ap dung.
Hieu qua khbng dugc biet ro.
7 •
18 I YHOC LAM S A N G S648(ThangOI /201 O)

7. DIEN DAN 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
- Ebkom tap hgp 1655 benh nhan Crohn nhan thiy
ty le bien ehiing ung thu hoa nhu sau:
+ The hbi trang don thuan : %.
+ The hbi trang dai trang : 3,2%).
+ The dai trang don thuan : 5%.
- Ebkom nghien ciru ty le ung thu hoa trong
VLDTTCM thay ty le bien ehiing ung thu hoa nhu
sau:
+ VDTT doan xa : 14,2%.
+ Viem toan bb dai trang: 33%.
+ Gillen nghien ciiu ty le ung thu hoa b benh nhan
Crohn va VLDTTCM thay ty le ung thu hoa gibng
nhau theo timg vi tri, RR = 18 dbi vbi Crohn va RR
= 19 dbi vbi VLDTTCM.
+ Friendman: theo doi 260 benh nhan Crohn trong
8 nam lien tyc, thay 16% ngubi eb loan san hoac
ung thu thyc sy.
- Benh Crohn cb hep Ibng ruot ty le bien chiing
ung thu cao: 6,8%, can phan biet hep do Crohn vbi
hep do ung thu (hep khbng dbi xiing, cimg, den
khbng qua dugc, bb khbng deu, cb hat va rit dl
chay mau).
S6 48(Thang01/2010) YHOC LAM SANG I 19

8. DIEN DAN YHOC
Chuyen de trong thang
- D I theo doi tai phat ung thu sau phau thuat, can
tiln hanh ngi soi djnh ky 6-12 thang sau mb. Ket
qua thay nhu sau:
+ Tai phat ve lam sang 5 nam sau mb: 30-50%.
+ Tai phat lam sang 10 nam sau mb: 45-75%o.
+ Tai phat qua ngi soi say ra sam han.
- Rutgeerts nghien cim ngi soi 1 nam sau phau
thuat eat hbi manh trang thay 37% benh nhan cb
tbn thuong hbi trang trube khi nbi. Getaid thay 3
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:
-I- Khbng cb hoac eb tbn thuong nhe (i 01): 90%
benh nhan 3 nam sau va 6 nam sau mb van khbng
eb trieu chirng tai phat.
+ Tbn thuang lan rbng vira phai (i 2) 3 nam sau
85% benh nhan, 6 nam sau mb cb 60%) benh nhan
van khbng eb trieu ehung tai phat.
+ Tbn thuong lan rbng ban (i 3) 3 nam sau eb 60%)
benh nhan, 6 nam sau mb eb 15% khbng cb trieu
ehiing tai phat.
+ Tbn thuong lan toa va loet mieng nbi (i 4) mgt
sb benh nhan nay 1 nam sau mb, va tit ea 100%
benh nhan 4 nam sau m6 diu eb trieu ehung tai
phat. Ngubi ta nhan thay tbn thuang nbi soi eang
nang va eang sam thi benh eang nang.
+ De danh gia tai phat sau phau thuat nbi dai
trang - hbi trang mgt each chinh xac, Rutgeerts
dua ra bang xep loai 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: >
5 cai, hoac chiem mgt viing rbng, hoac tu tap
chung quanh mieng nbi.
i 3 : Viem hbi trang dang aphtoide lan
toa vbi niem mac viem xung huyet.
Score i 4 : Viem hbi trang lan rbng vbi loet rbng,
cb hat hoac gay hep.
TAI LIEU THAM K H A O
/. Edward V.Loffus, Jr, MD, William Sandborn, MD (2004). "Drug therapy for inflammatory Bowel dis-
ease". 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)