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GIAN PHE

QUAN
PGS TS TRAN VAN NGOC

I.NH NGHA:

Gian bat thng man tnh


va xoan phe quan do :
pha hoai cau truc an hoi
va c trn thanh phe quan.

II. TAN SUAT:

+ Hiem gap trong 3 thap k


qua cac nc phat trien
Anh : giam t 48/10.000 en
10/10.000 BN NV( 1952 1960.)
My :(1946 1950 )giam t 47
ti ch con 2 ca 10 nam sau
(1956 1960).
VN : van la benh thng gapkhong co con so thong ke

III. GIAI PHAU BENH:

GPQ : PQ Trung bnh va tieu PQ.


PQ gian b lap ay mu, n/m viem
va loet, Xoan PQ.
Tuan hoan :M PQ ln ra
GPQ 2 ben : 30% , T.Di thng b
nhat. T.Di trai nhieu hn phai 3
lan
GPQ trung tam (canh ron) :ac
trng cua Aspergillosis phoi d ng
(APA- allergy pulmonary aspergillosis)
GPQ t. tren thng do APA, x nang
ngi ln hay lao.

GIAN PQ

IV. PHAN LOAI:


1/ Gian phe quan hnh tru
(cylindric bronchiectasis)
2/ Gian phe quan dang
varicose ( varicose
bronchiectasis)
3/ Gian phe quan hnh tui
[saccular (cystic) bronchiectasis]

Cac dang GPQ hay cac benh


tng t ve mat giai phau
benh:

GPQ nang (follicular bronchiestasis):

GPQ do co keo (traction bronchiectasis)


Ken phe quan bam sinh (congenital
bronchial cysts):
Ken bam sinh trung tam
Ken bam sinh ngoai bien
Biet tr phe quan phoi trong thuy
(intralobar bronchopulmonary
sequestration)

V. BENH SINH VA YEU


TO THUAN LI:
1/ Nhiem trung:
a.Si:
Ton

thng phe quan cap


tnh co the tien trien ti
gian phe quan nang.
Nhiem trung th phat

b.Ho ga
Viem

phoi hoai t th phat


gian phe quan
T no co the gay viem phe

c. Tac nhan khac:


Staph.aureus ,
Kleb.pneumoniae , Pseudomonas
aeruginosa .
d. Viem phoi hoai t
Vi khuan yem kh:
e.Lao:
M. tuberculosis , Mycobacterium
avium intracellular (MAI)
f.Nam: Histoplasmosis

2. S tac nghen:
a.DPQ do d vat:
b.Ung th
c.Tac am
* Aspergillus phe quan phoi d
ng:
* COPD

vim phi sau tc nghn

D vt

XNG HEO

3.Cac khiem khuyet phe


quan bam sinh
a. Kh phe quan:
Khiem khuyet sun phe quan
bam sinh
(William-Campbell syndrome )
Tracheo bronchomegaly
(Mounier-Kuhn syndrome):

b.Mach mau:
Phoi biet tr nhiem trung
va gian PQ
c. Bach huyet:
Hoi chng mong vang (yellow
nail syndrome):

4/ Suy giam mien dch: nhiem


trung va GPQ
5/ Bat thng di truyen:
a) Bat thng tru long cua
niem mac ho hap:
Hoi chng bat ong tru long
Kartageners syndrome:
b) Giam 1 antitrypsin : ton
thng pha huy PQ va phe
nang
c) X nang: (mucoviscidosis

d.Benh khac:
Hoi chng Young: GPQ + vo
sinh nam
Qua trnh viem:
e) Vai tro cua elastase va
protease trong ton thng
ng ho hap: COPD

VI. SINH LY BENH:


1/ Chc nang ho hap:
Roi loan thong kh hon hp : FEV1
va VC,FVC gjam kho th 2 th
2/ S thanh loc cua kh-phe quan :

Mat chc nang thanh loc kh


-PQ nhiem trung tai phat
nhieu lan
3/ Nhng thay oi huyet ong:
ong mach chu hoa ong mach
phoi HRM lng nhieu

VII. LAM SANG:

Ho am mu , lng nhieu
Ho ra mau : 40-70 %
Kho th
Kham thc the: ran am dai
dang, ngon tay dui trong
va tm tai

VIII. CAN LAM SANG:


1/ X quang ngc:
Hnh anh gi y : to ong ,
ng ray , tui nho co mc
nc hi

PHE QUAN BNH THNG

GIAN PQ

2/ Chup phe quan:


Giup xac nh chan oan .
t thc hien hien nay
BN kho chu hn CT scan : noi soi PQ ,
bm thuoc can quang vao PQ tng
ben
Chi ph cao hn CT scan
Li ch < CT scan
Se va Sp < CT scan

GIAN PQ

3/ CT scan:
Giup chan oan xac nh
Thuan tien cho BN
Khao sat ca 2 phe trng
Se : 90%
4/ Soi phe quan:
5/ Vi trung hoc:
6/ Can lam sang khac: tm
nguyen nhan GPQ

Dan phe quan dang hnh ong (cylindrical


bronchoectasis) vi dau hieu vong nhan

Dan phe quan dang hnh ong vi


dau hieu ng ray ( tram line
sign)

Dan phe quan dang hnh ong (cylindrical


bronchoectasis) va hnh nang (cystic

IX. CHAN OAN


PHAN BIET:

1/ COPD:
2/ Aspergillus phe quan phoi d
ng:
3/ thuyen tac MP nhoi mau
phoi
4/ D dang mach mau phoi gay
HRM
5/ Benh khac: di vat , lao ,viem
phoi

D vat trong long


phe quan/ Kh
thung khu tru
thuy di (P), th
th ra

Thuyen tac ong mach


phoi man

Thuyen tac ong mach phoi kem


nhoi mau phoi

Thuyen tac ong mach phoi kem nhoi


mau phoi

X. BIEN CHNG VA
TIEN LNG:

Nung mu tien trien


Ho ra mau
Suy ho hap mn va tam phe
man
Apxe nao
Xuat huyet phoi
Thoai hoa dang bot
( Amyloidosis.)

T vong