Header Page of 161 B GI O V OT O YT TRNG I HC Y H NI V KHC I NGHIấN CU VAI TRề CA NI SOI MNG PHI NG MM TRONG CHN ON NGUYấN NHN TRN DCH MNG PHI LUN N TIN S Y HC H NI 2016 Footer Page of 161 Header Page of 161 GI O V OT O YT TRNG I HC Y H NI V KHC I NGHIÊN CứU VAI TRò CủA NộI SOI MàNG PHổI ốNG MềM TRONG CHẩN ĐOáN NGUYÊN NHÂN TRàN DịCH MàNG PHổI huy n ng nh : Lao Mó s : 62720150 LUN N TIN S Y HC Ngi h ng d n khoa hc: PGS.TS Nguyn hi Lng Footer Page of 161 Header Page of 161 H NI 2016 LI CAM OAN Tụi l V Khc i, hc viờnnghiờn cu sinh khúa 28, chuyờn ngnh Lao, xin cam oan: õy l lun bn thõn tụi trc tip thc hin d i s h ng d n ca PGS.TS Nguyn hi Lng Cụng trỡnh ny khụng trựng lp v i bt k nghiờn cu n o khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp thun ca c s ni nghi n cu Tụi xin hon ton chu trỏch nhim tr c phỏp lut v nhng cam kt ny H Ni ngy 16 thỏng 09 nm 2016 Tỏc gi V Khc i Footer Page of 161 Header Page of 161 CC CH VIT TT ADA : Adenosine deaminase AFB : Trc khun khỏng cn khỏng toan (Acid Fast Bacillus) ANA : khỏng th khỏng nhõn (Antinuclear Antibody) AQP : Aquaporin BCG :Bacillus Calmette-Guerin CEA : Carcinoembryonic antigen CS : Cng s CYFRA : Cytokeratin-19 fragment CT : Chp ct l p vi tớnh (Computed Tomography) DMP : Dch mng phi IFN : Interferon gamma KLS : Khoang li n sn MP : Mng phi MRI : Cng hng t (Magnetic Resonance Imaging) LDH : Lactate Dehydrogenase NSMP : Ni soi mng phi TDMP : Trn dch mng phi VATS : Ph u thut ni soi lng ngc cú h tr video (Video Assisted Thoracic Surgery) VEGF :Yu t tng trng ni mch (Vascular endothelial growth factor) VK : Vi khun XN : Xột nghim Footer Page of 161 Header Page of 161 MC LC T VN CHNG 1: TNG QUAN 1.1.Bnh sinh hc trn dch mng phi Gii ph u, t chc hc m ng phi Sinh l hc m ng phi 1.1.3 Bnh sinh ca cỏc trn dch mng phi ỏc phng phỏp chn oỏn xỏc nh trn dch mng phi Thụng qua thm khỏm lõm s ng v bnh s 1.2.2 Chn oỏn hỡnh nh 10 1.3 ỏc phng phỏp chn oỏn nguy n nhõn tr n dch mng phi 14 1.3.1 Xột nghim dch mng phi 14 1.3.2 Cỏc k thut xõm nhp 23 1.4 Nghiờn cu v ni soi mng phi ng mm 26 Lch s ca ni soi m ng phi 26 h nh, chng ch nh v bin chng ca ni soi m ng phi 28 Quy trỡnh ni soi m ng phi ng mm 31 1.4.4 Hỡnh nh i th mng phi cỏc bnh lý trn dch mng phi 33 1.4.5 Cỏc ng dng lõm sng ca ni soi mng phi 34 Kt qu nghi n cu v ni soi m ng phi n c ngo i 37 Tỡnh hỡnh nghi n cu ni soi m ng phi ti Vit Nam 40 CHNG 2: I T NG V PHNG PHP NGHIấN CU 43 2.1 i tng nghi n cu 43 Footer Page of 161 Header Page of 161 nh nhõn nghi n cu 43 Ti u chun la chn bnh nhõn ni soi mng phi 43 3.Ti u chun loi tr bnh nhõn ni soi mng phi 43 Phng phỏp nghi n cu 44 2.2.1 Thit k nghi n cu 44 m u 45 Ni dung nghi n cu 45 X l s liu 59 o c nghiờn cu 60 CHNG 3: KT QU 62 c im lõm sng v cn lõm sng ca trn dch mng phi cha rừ nguyờn nhõn 62 c im chung ca i tng nghiờn cu 62 3.1.2 Triu chng lõm sng 64 3.1.3 Triu chng cn lõm sng 66 c im dch mng phi 68 3.2 Hiu qu chn oỏn v tai bin ca ni soi mng phi ng mm 70 So sỏnh c im lõm sng v cn lõm sng theo nguyờn nhõn gõy bnh 70 3.2.2 Hiu qu chn oỏn ca ni soi mng phi 79 CHNG 4: BN LUN 90 c im lõm sng v cn lõm sng ca trn dch mng phi cha rừ nguyờn nhõn 90 c im v tui gi i 90 c im lõm sng 91 c im cn lõm sng 92 4.2 Hiu qu chn oỏn v tai bin ca ni soi mng phi ng mm 97 Footer Page of 161 Header Page of 161 So sỏnh c im lõm sng gia cỏc nhúm nguyờn nhõn gõy bnh 98 So sỏnh c im cn lõm sng gia cỏc nhúm nguyờn nhõn gõy bnh 101 4.2.3 Hiu qu ca ni soi mng phi ng mm 108 4.2.4 Tai bin ca ni soi mng phi ng mm v x trớ 126 KT LUN 130 KIN NGH 132 DANH MC CC CễNG TRèNH NGHIấN CU Cể LIấN QUAN N LUN N TI LIU THAM KHO PH LC Footer Page of 161 Header Page of 161 DANH MC BNG Bng c im ca dch mng phi 14 Bng 1.2 Cỏc nguyờn nhõn gõy trn dch mng phi dch thm 16 Bng 1.3 Cỏc nguyờn nhõn gõy trn dch mng phi dch tit 16 Bng 1.4 Cỏc nguyờn nhõn ca trn dch dng chp v gi dng chp mng phi 22 Bng 1.5 Giỏ tr lipid dch mng phi trn dch dng chp v gi dng chp mng phi 23 Bng 3.1 S phõn b nhúm tui v gi i 62 Bng 3.2 Mc trn dch mng phi trờn Xquang ngc chun 66 Bng 3.3 c im tn thng tr n Xquang phi chun 66 Bng 3.4 Nng protein dch mng phi 69 Bng 3.5 Thnh phn t bo dch mng phi 69 Bng 3.6 Kt qu hỡnh nh tn thng qua ni soi ph qun 69 Bng 3.7 S phõn b tui theo nguyờn nhõn gõy bnh 70 Bng 3.8.Thi gian mc bnh theo nhúm bnh 71 Bng 3.9 Lý vo vin theo nguyờn nhõn gõy bnh 72 Bng 3.10.Cỏc triu chng c nngtheo nguy n nhõn gõy bnh 72 Bng 3.11 Cỏctriu chng thc th theo nguyờn nhõn gõy bnh 73 Bng 3.12 Cỏc triu chng ton thõn theo nguyờn nhõn gõy bnh 73 Bng 3.13 V trớ trn dch mng phi trờn phim Xquang ngc chun theo nguyờn nhõn gõy bnh 74 Bng 3.14 Mc trn dch mng phi trờn phim Xquang ngc chun theo nguyờn nhõn gõy bnh 74 Bng 3.15 c im tn thng tr n Xquang phi chun theo nguyờn nhõn75 Bng 3.16 c im tn thng tr n T Scanner ngc theo nguyờn nhõn 75 Bng 3.17 dy mng phi trờn CT ngc theo nguyờn nhõn trn dch 76 Bng 3.18.V trớ dy mng phi trờn CT ngc theo nguyờn nhõn 76 Footer Page of 161 Header Page of 161 Bng 3.19 c im hỡnh nh si u õm m ng phi theo nguy n nhõn 77 Bng 3.20 S ln chc hỳt dch mng phi n cú chn oỏn xỏc nh 77 Bng 3.21 Mu sc dch mng phi theo nguyờn nhõn 78 Bng 3.22 Nng protein dch mng phi theo nguyờn nhõn 78 Bng 3.23 Thnh phn t bo dch mng phi theo nguyờn nhõn 79 Bng 3.24 V trớ m mng phi ni soi mng phi 79 Bng 3.25 Mt s c im chung ca k thut ni soi mng phi 80 Bng 3.26 c im hỡnh nh tn thng m ng phi qua ni soi 80 Bng 3.27 Kt qu chn oỏn ca ni soi mng phi sinh thit 81 Bng 3.28 Kt qu chn oỏn ung th th m ca cỏc phng phỏp khỏc 82 Bng 3.29 So sỏnh kt qu chn oỏn ca ni soi mng phi sinh thit v i kt qu chn oỏn cui cựng 82 Bng 3.30 Giỏ tr chn oỏn chung ca ni soi mng phi 83 Bng 3.31 Kt qu ca ni soi mng phi sinh thit ly bnh phm lm cỏc xột nghim tỡm AFB, bactec, mụ hc chn oỏn lao mng phi 83 Bng 3.32 Giỏ tr ca ni soi mng phi sinh thit ly bnh phm lm xột nghim tỡm AFB, bactec, mụ hc chn oỏn lao m ng phi 84 Bng 3.33 i chiu nhúm bnh ung th v i nhúm chng (nhúm lao v viờm mn tớnh) 87 Bng 3.3 nhy, c hiu, cỏc giỏ tr d oỏn ca ni soi mng phi sinh thit chn oỏn tr n dch mng phi ỏc tớnh 88 Bng 3.35 Giỏ tr chn oỏn ca ni soi mng phi sinh thit 88 Bng 3.36 Tai bin ca ni soi mng phi 88 Thnh phn t bo dch mng phi theo nguyờn nhõn gõy bnh 107 Bng 4.1 So sỏnh giỏ tr chn oỏn ca ni soi mng phi v i cỏc tỏc gi khỏc 117 Bng 4.2 So sỏnh giỏ tr chn oỏn ca ni soi mng phi ng mm v i cỏc k thut khỏc 119 Footer Page of 161 Header Page 10 of 161 DANH MC BIU Biu 3.1 S phõn b gi i 63 Biu 3.2 Lý vo vin 64 Biu 3.3 Cỏc triu chng c nng 65 Biu 3.4 Cỏc triu chng thc th 65 Biu 3.5 Cỏc triu chng ton thõn 65 Biu 3.6 V trớ trn dch mng phi trờn phim Xquang ngc chun 66 Biu 3.7 c im tn thng tr n T Scanner ngc 67 Biu 3.8 c im hỡnh nh siờu õm mng phi 68 Biu 3.9 Mu sc dch mng phi 68 Biu 3.10 Kt qu chn oỏn ung th ca xột nghim t bo mnh sinh thit qua ni soi mng phi 85 Biu 3.11 Kt qu chn oỏn ung th ca xột nghim mụ hc mnh sinh thit qua ni soi mng phi 85 Biu 3.12 Nguyờn nhõn trn dch mng phi ỏc tớnh 86 Biu 3.13 Phõn loi type mụ bnh hc nhúm u trung biu mụ mng phi 86 Biu 3.14 Phõn loi type mụ bnh hc nhúm ung th phi di cn m ng phi 87 Footer Page 10 of 161 Header Page 155 of 161 137 Phm Huy Minh (2004) Nghiờn cu mt s c im lõm sng, cn lõm sng v vai trũ ca ni soi lng ngc chn o n tr n dch mng phi ỏc tớnh, Lun thc s y hc, Trng i hc Y hc H Ni 138 D M Epstein, L R Kline, S M Albelda, W T Miller (1987) Tuberculous pleural effusions Chest, 91(1), 106-109 139 Mayse M.L (2008) on malignant pleural effusion In fishmans pulmonary disease and disorder, 4th ed, Mc GrawHill, New York, 2, 1487-1504 140 Hurwitz S, Leiman G, Shapiro C (1980) Mesothelial cells in pleural fluid: TB or not TB? S Afr Med J, 57, 937-939 141 L Nattusamy, K Madan, A Mohan, et al (2015) Utility of semi-rigid thoracoscopy in undiagnosed exudative pleural effusion Lung India, 32(2), 119-126 142 Boutin C (1991) Manuel pratique des techniques pleurales SpringerVerlag, Paris6-52 143 Boutin C, Guerin J.C, Viallat J.R, et al (1992) Exploration des maladies de la plốvre, Matộriel utilisộ et technique dộtude Rev Mal Resp, 9, 81-87 144 Buchanan D.R, Neville E (2004) Thoracoscopy for Physicians A practical guide Arnold, London 145 Boutin C, Vialatt J.R, Aubier M, et al (1996) Pathologie pleurale Pneumologie, Flammarion Me decine-Sciences, Paris443-473 146 Tụ Th Kiu Dung, Phm Huy Minh, Phm Lờ Huy (2004) Ni soi lng ngc chn oỏn u trung biu mụ ỏc tớnh ca mng phi T p Th ng tin Y c, S chuy n Ung th u-c v bnh lý v thn kinh, 152-155 147 Kong XL, Zeng HH, Chen Y, et al (2014) The visual diagnosis of tuberculous pleuritis under medical thoracoscopy: a retrospective series of 91 cases Eur Rev Med Pharmacol Sci, 18(10), 1487-1495 148 Wang Z, Xu LL, Wu YB, et al (2015) Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion Respir Med, 109(9), 1188-1192 149 Willendrup F, Bodtger U, Colella S, et al (2014) Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark J Bronchology Interv Pulmonol, 21(3), 215-219 150 Wang XJ, Yang Y, Wang Z, et al (2015) Efficacy and Safety of Diagnostic Thoracoscopy in Undiagnosed Pleural Effusions Respiration, 90(3), 251-255 Footer Page 155 of 161 Header Page 156 of 161 151 Christopher DJ, Peter JV, Cherian AM (1998) Blind pleural biopsy using a Tru-cut needle in moderate to large pleural effusion an experience Singapore Med J, 39(5), 196-199 152 Ngụ Thanh Bỡnh, Nguyn Th Tuyt Nhi (2011) Giỏ tr ca sinh thit mng phi mự b ng kim Castelain chn oỏn nguy n nhõn tr n dch mng phi T p Y hc Thnh ph H Chớ Minh, 15(1), 415422 153 Maturu VN, Dhooria S, Bal A, et al (2015) Role of medical thoracoscopy and closed-blind pleural biopsy in undiagnosed exudative pleural effusions: a single-center experience of 348 patients J Bronchology Interv Pulmonol, 22(2), 121-129 154 Mishra AK, Verma SK, Kant S, et al (2016) A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion South Asian J Cancer, 5(1), 27-28 155 Niu XK, Bhetuwal A2, Yang HF (2015) CT-guided core needle biopsy of pleural lesions: evaluating diagnostic yield and associated complications Korean J Radiol 156 Adams RF, Gleeson FV (2001) Percutaneous image-guided cuttingneedle biopsy of the pleura in the presence of a suspected malignant effusion Radiology, 219, 510-514 157 Dhooria S, Singh N, Aggarwal AN, et al (2014) A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions Respir Care, 59(5), 756-764 158 Khan MA, Ambalavanan S, Thomson D, et al (2012) A comparison of the diagnostic yield of rigid and semirigid thoracoscopes J Bronchology Interv Pulmonol 159 Sakuraba M, Masuda K, Hebisawa A, et al (2006) Thoracoscopic pleural biopsy for tuberculous pleurisy under local anesthesia Ann Thorac Cardiovasc Surg, 12(4), 245-248 160 Verma A, Taha A, Venkateswaran S, Tee A (2015) Effectiveness of medical thoracoscopy and thoracoscopic talc poudrage in patients with exudative pleural effusion Singapore Med J 161 Lờ Khc Bo, Trn Vn Ngc, ng Vn Ph c (2003) Giỏ tr sinh thit mng phi b ng kim xuyờn da chn oỏn nguy n nhõn laoung th gõy tr n dch - dy - u mng phi T p Y hc TP H Chớ Minh, 7(Ph bn ca s 1), 93-97 162 Botana Rial M, Briones Gomez A, Ferrando Gabarda JR, et al (2014) Tru-cut needle pleural biopsy and cytology as the initial procedure in the evaluation of pleural effusion Arch Bronconeumol, 50(8), 313-317 Footer Page 156 of 161 Header Page 157 of 161 163 Valsecchi A, Arondi S, Marchetti G (2016) Medical thoracoscopy: Analysis on diagnostic yield through 30 years of experience Ann Thorac Med, 11(3), 177-182 164 o n Th Phng Lan ( ) Nghiờn cu c im lõm sng, cn lõm sng v giỏ tr ca sinh thit ct xuyờn thnh ngc di hng dn ca ch p ct lp vi tớnh chn o n c c tn thng d ng u phi, Lun ỏn tin s y hc, Trng i hc Y H Ni, H Ni 165 Guimaraes MD, de Andrade MQ, da Fonte AC, et al (2011) CTguided cutting needle biopsy of lung lesions an effective procedure for adequate material and specific diagnose Eur J Radiol 166 Sivakumar P, Jayaram D, Rao D, et al (2016) Ultrasound-Guided Abrams Pleural Biopsy vs CT-Guided Tru-Cut Pleural Biopsy in Malignant Pleural Disease, a 3-Year Follow-up Study Lung, August 2016 167 Rezk NASA, Aly NYA, El-Hadidy TA, Dashti K (2015) CT-guided biopsy versus conventional brams needle biopsy in malignant pleural effusion Egypt J Chest Dis Tuberc, 64(2), 405-409 168 R Loddenkemper, P Lee, M Noppen, P.N Mathur ( 2011) Medical thoracoscopy/pleuroscopy: step by step Breathe, 8, 156-167 169 Lee P, Hsu A, Lo C, et al ( ) Prospective evaluation of ex-rigid pleuroscopy for indeterminate pleural effusion: accuracy, safety and outcome Respirology, 12, 881-886 170 Boutin C, Viallat J.R, Astoul P.H, et al (1994) Complication de la thoracoscopie mộdicale, 11 ố Congrốs de pneumologie de langue fran Vaise, volume des rapport Footer Page 157 of 161 Header Page 158 of 161 BNH N MINH HA Nguyn Tun H: nam 65 tui, chn oỏn: TDMP lao Ngy vo vin: 22/06/2012, ngy vin: 12/07/2012, mó h s: 7324 Hỡnh nh Xquang v CT scanner ngc Hỡnh nh mng phi: mng phi xung huyt cú cỏc nt nh ri rỏc v cỏc vỏch fibrin Tiờu bn s: 355 Bỏc s c Ngụ Th Quõn Khoa Gii ph u bnh, Bnh vin Phi Trung ng Kt qu mụ bnh: Tn thng lao in hỡnh Footer Page 158 of 161 Header Page 159 of 161 Trnh c D:Nam, 56 tui Chn oỏn: TDMP lao Ngy vo vin: 21/09/2012, ngy vin: 11/10/2012, mó h s: 10882 Hỡnh nh Xquang v CT scanner ngc Hỡnh nh mng phi: cỏc nt nh mu trng ng ri rỏc Tiờu bn s: 1332 Bỏc s c: Ngụ Th Quõn Khoa Gii ph u bnh, Bnh vin Phi Trung ng Kt qu mụ bnh: Tn thng lao in hỡnh Footer Page 159 of 161 Header Page 160 of 161 3.Nguyn Th Thu H: n 47 tui Chn oỏn: T MP vi m mn tớnh Ngy vo vin: 08/08/2012, ngy vin: 05/09/2012 mó h s: 9637 Hỡnh nh Xquang v CT scanner ngc Hỡnh nh mng phi: mng phi thnh vựng thnh ngc dy, xung huyt Tiờu bn s: 880 Bỏc s c: Ngụ Th Quõn Khoa Gii ph u bnh, Bnh vin Phi Trung ng Kt qu mụ bnh: Viờm mn tớnh Footer Page 160 of 161 Header Page 161 of 161 Trng Vn : Nam, 34 tui Chn oỏn: U trung biu mụ ỏc tớnh mng phi Ngy vo vin: 23/09/2013, ngy vin: 15/10/2013 Mó h s: Hỡnh nh Xquang v CT scanner ngc Hỡnh nh mng phi: cỏc u sựi trờn mng phi thnh vựng thnh ngc Tiờu bn s: 6113 Bỏc s c: Ngụ Th Quõn Khoa Gii ph u bnh, Bnh vin Phi Trung ng Kt qu mụ bnh: U trung biu mụ ỏc tớnh Footer Page 161 of 161 Header Page 162 of 161 ng Minh T:Nam, 27 tui Chn oỏn: Ung th phi di cn m ng phi Ngy vo vin: 03/09/2013, ngy vin: 02/10/2013 Mó h s: Hỡnh nh Xquang v CT scanner ngc Hỡnh nh mng phi: tn thng thõm nhim sựi lan ta mng phi thnh Tiờu bn s: 5862 Bỏc s c: Ngụ Th Quõn Khoa Gii ph u bnh, Bnh vin Phi Trung ng Kt qu mụ bnh: ung th phi loi biu mụ tuyn di cn m ng phi Footer Page 162 of 161 Header Page 163 of 161 Nguyn Th Kh: N, 60 tui Chn oỏn: Ung th phi di cn m ng phi Ngy vo vin: 03/05/2013, ngy vin: 31/05/2013 Mó h s: 5353 Hỡnh nh Xquang phi thng Hỡnh nh mng phi: tn thng thõm nhim sựi v cỏc nt sựi nh ri rỏc ton b mng phi thnh vựng thnh ngc Tiờu bn s: 4062 Bỏc s c: Ngụ Th Quõn Khoa Gii ph u bnh, Bnh vin Phi Trung ng Kt qu mụ bnh: ung th phi loi biu mụ vy di cn m ng phi Footer Page 163 of 161 Header Page 164 of 161 NH N NGHIấN CU Mó bnh ỏn Khoa Phn hnh chớnh H v t n: Tui Gi i Ngh nghip: a ch : Ng y v o vin: Ng y ni soi m ng phi: Ng y vin: in bin bnh: L vo vin au ngc Khú th L khỏc Hen ph qun Vi m ph qun mn tớnh H t thuc lỏ St Tin s nh hụ hp Khụng cú l COPD Lao phi Tin s ung th nh ung th ó mc ỏc bnh kốm theo Tin s gia ỡnh: Lõm sng 3.1 Triu chng c nng au ngc:CúKhụng Mc au: t ngt T t au d di Khú th: úKhụng Footer Page 164 of 161 au õm Header Page 165 of 161 Mc khú th: Nh Va Nhiu Ho:CúKhụng Ho cú m Ho khan Ho mỏu Triu chng to n thõn: St: úKhụng Gy s t cõn: CúKhụng 3.3 Triu chng thc th: Nhp th: Tr n ln ph t T n ln ph t Tr n ln ph t ú rales CúKhụng H gim CúKhụng Lng ngc phng CúKhụng L p lng ngc CúKhụng Tn thng c quan khỏc Chn oỏn hỡnh nh Xquang phi thng V trớ tr n dch: n phi n trỏi Hai bờn Tớnh cht ca tr n dch m ng phi Mc tr n dch: Tr n dch t ớt trung bỡnh nhiu ú ng cong amoiseau Tr n dch khu tr V trớ: b n phi bờn trỏi M to n b mt b n phi Trung tht: y Tn thng khỏc: M ng phi d y CúKhụng Tn thng nhu mụ CúKhụng Mụ t: Footer Page 165 of 161 hai bờn k o Header Page 166 of 161 Hch trung tht CúKhụng 4.2 hp ct l p vi tớnh: ú Khụng Tn thng u:CúKhụng Kớch th c: Tn thng dng l i nụt Tr n dch m ng phi t Tr n dch mang phi khu tr y m ng phi Hch trung tht Thõm nhim, nt Khỏc: 4.3 Si u õm m ng phi: CúKhụng Tr n dch m ng phi t y m ng phi Tr n dch m ng phi khu tr Vỏch Khỏc: t nghim ụng thc mỏu: 5.2 CEA 5.3 Hch : X t nghim dch m ng phi: Tớnh cht dch m ng phi + ch c + M u dch: V ng chanh Hng + S lng dch mi ln chc h t: + S ln chc h t dch + ch tỏi lp nhanh PCR:dng tớnh õm tớnh K trc tip:dng tớnh bactec:dng tớnh õm tớnh õm tớnh Rivalta dch m ng phi: dng tớnh Protein dch m ng phi: Protein mỏu: Footer Page 166 of 161 hm õm tớnh Header Page 167 of 161 L H dch m ng phi: L H mỏu: X t nghim t b o dch m ng phi T b o XN ln XN ln XN ln Hng cu ch cu a nhõn Lympho T b o m ng T b o K Hỡnh nh ni soi ph qun ỡnh thng Thõm nhim sn s i Thõm nhim chớt hp hốn p t ngo i Khỏc: Ni soi mng phi T th ngi bnh: V trớ m m ng phi: hiu d i vt m: Thi gian thc hin NSMP: S lng dch h t ra: M u sc dch MP: S ln thc hin: Nhng hỡnh nh NSMP ca nh nh n TDMP Ni m mc sn s i Lỏ th nh Lỏ tng Ni m mc cú cỏc nt, cc Lỏ th nh Lỏ tng Ni m mc thõm nhim Lỏ th nh Lỏ tng Ni m mc nh n Lỏ th nh Lỏ tng Nt nh ri rỏc Lỏ th nh Lỏ tng y dớnh Vỏch fibrin Footer Page 167 of 161 Header Page 168 of 161 Tn thng nhu mụ: Khỏc Chn oỏn s qua NSMP: Mnh sinh thit m ng phi th nh tng Khỏc Chn oỏn t o hc ch m ng phi ú t b o UT Khụng cú t b o UT ch ph qun ú t b o UT Khụng cú t b o UT hc h t hch ú t b o UT Khụng cú t b o UT STMP m ú t b o UT Khụng cú t b o UT STMP qua NSMP ú t b o UT Khụng cú t b o UT ST qua SPQ ú t b o UT Khụng cú t b o UT Chn oỏn mụ nh hc STMP m Ung th Viờm Lao Khỏc ST qua SPQ Ung th Viờm Lao Khỏc ST hch Ung th Viờm Lao Khỏc STMP qua NSMP Ung th Viờm Lao Khỏc Nguy n nh n TDMP ung th Ung th m ng phi Ung th phi U lympho ỏc tớnh Ung th khụng rừ ngun gc Ph n loi typ mụ nh hc 10 t nghim vi sinh mnh sinh thit AFB Bactec Nuụi cy Vi khun 11 Tai in ca ni soi mng phi ng mm hy mỏu Footer Page 168 of 161 Header Page 169 of 161 Tr n khớ m ng phi au ngc St Tr n khớ d i da Khỏc Footer Page 169 of 161 ... Page of 161 GI O V OT O YT TRNG I HC Y H NI V KHC I NGHIÊN CứU VAI TRò CủA NộI SOI MàNG PHổI ốNG MềM TRONG CHẩN ĐOáN NGUYÊN NHÂN TRàN DịCH MàNG PHổI huy n ng nh : Lao Mó s : 62720150 LUN N TIN S... 23 1.4 Nghiờn cu v ni soi mng phi ng mm 26 Lch s ca ni soi m ng phi 26 h nh, chng ch nh v bin chng ca ni soi m ng phi 28 Quy trỡnh ni soi m ng phi ng mm 31 1.4.4... trớ m mng phi ni soi mng phi 79 Bng 3.25 Mt s c im chung ca k thut ni soi mng phi 80 Bng 3.26 c im hỡnh nh tn thng m ng phi qua ni soi 80 Bng 3.27 Kt qu chn oỏn ca ni soi mng phi sinh