BNH VIN A KHOA THNH PH BUN MA THUT

KHOA TAI MI HNG

BS V NGUYN HONG KHI

HCH U MT C

Lu hnh ni b

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1. GII PHU V SINH L H BCH HUYT [1, 4, 5, 6, 7, 14]

H thng bch huyt l mt h thng mng li m v c quan, gm c h thng

mch bch huyt, cc m bch huyt v bch huyt, ngoi ra cn c cc cu trc lympho.

1.1. BCH HUYT

Bch huyt l mt cht lng trong sut, gm cc t bo lymphocytes, plasma r r

ra ngoi t mch mu v ca cc m c th. Bch huyt c ngun gc huyt tng, khi

mu c vn chuyn n cc m, lc i qua cc ging mao mch, mu lu thng

chm li to iu kin cho huyt tng v mt s thnh phn ca mu thot ra lng mao

mch n m (Hnh 1) sau khi qua qu trnh trao i cht, cc cht lng ny mang

theo cc cht thi ca t bo v cc t bo protein. Bch huyt chy c trong mch

bch huyt theo mt chiu nht nh l nh cc van trong mch bch huyt v s co bp

nhp nhng ca thnh mch vi tn s 10 12 ln/ pht vi vn tc chy l 4

5mm/giy. Khong 90% cc cht ny i vo tnh mch tr v h tun hon mu, 10%

cn li c thu nhn bi h thng mch bch huyt.

Hnh 1: S lu chuyn mu v thu nhn huyt tng m

Tissue fluid: huyt tng; arteriod: ng mch; venule: tnh mch;

lymphatic vessel: mao mch bch huyt; lymph capillary: mch mch huyt;

capillary: ging mao mch; interstitial space: khong k;

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1.2. MCH BCH HUYT

H thng mch bch huyt cng ging nh h thng mch mu, l h thng ng

chy khp c th, nhng mng li bch huyt phong ph hn mch mu v n vn

chuyn bch huyt. Tuy nhin khc vi mu, mu th c bm bi tim, nhng bch huyt

khng c bm h tr dng chy. Cu to h thng bch huyt vn chuyn bch huyt

theo hng i ln sut c th t cc phn ngoi vi (tay, chn) v i hng v pha c.

Trong qu trnh lu chuyn sut c th, bch huyt i qua cc hch huyt v ti y n

c lc. V khi n vng c n c vo tnh mch di n v li tr thnh huyt

tng mu.

Hnh 2: H thng mch u c Ngun http://www.lymphnotes.com/article.php/id/151/

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Hnh 3: H thng bch huyt ca c th

Ngun http://www.cancerhelp.org.uk/about-cancer/what-is-cancer/body/the-lymphatic-

system

H thng bch huyt bt u t cc mao mch bch huyt, khong 70% mao mch

bch huyt nm gn da hoc di da, 30% cn li l cc mao mch bch huyt su, ch

yu nm bao quanh cc c quan. Cc mao mch bch huyt, bt u bi nhng ng, m

u bt kn, thnh c lt ch bi 1 t bo, nhng t bo ny c xp chng ln nhau nh

vy c v mi t bo c gi cht vo m ln cn bi mt si nh. Thnh bch huyt

cng c cu to bi 3 thnh phn: lp m lin kt bn ngoi, lp c n hi gia, lp

ni b lt bn trong. V mch bch huyt cng c val nh tnh mch.

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Hnh 4 : phn u ca mao mch bch huyt v s thm nhp bch huyt

Ngun http://www.lymphnotes.com/article.php/id/151/

Hnh 5: Chu trnh vn ng bch huyt.

Bch huyt xm nhp

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Cc mao mch bch huyt ha nhp vi nhau v to thnh mch bch huyt nm

su trong c th. Cc mch huyt ln dn v nm gn cc mch mu ln. Mch bch

huyt cng ging tnh mch c val 1 chiu, ngn bch huyt chy ngc li. Cc c

thnh mch bch huyt co bp h tr dng chy bch huyt i vi mch bch huyt

vng lng ngc. Nh hnh 6

Hnh 6 : c thnh bch huyt co bp

Ngun http://www.lymphnotes.com/article.php/id/151/

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Hnh 7: Vng bch huyt

1.3. HCH BCH HUYT

Hch bch huyt l c quan nh c cu trc hnh trn hay ht u, hch bch huyt

thng c kch thc khong 1-1,5 cm nm trn ng i ca h thng bch huyt.

Hch bch huyt pht trin cho n 8-12 tui, sau teo nh dn giai on dy

th.

Hch bch huyt khng phi l tuyn nh mt s ti liu m t m n l mt phn

ca h bch huyt v cng thuc h thng min dch, c cu to bi m t bo bao

quanh cc ng, nang, cc t bo trong hch bch huyt gm cc t bo lympho c nhim v

sn xut khng th v cc i thc bo c nhim v dn sch cc mnh vn. Xung quanh

hch l lp collagene, c nhng ch lm vo gi l rn hch l ni cc b mch i vo, ra.

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Cu trc ca hch lympho gm c 2 vng:

- Vng v: cha cc nang lympho trn, pha ngoi l cc t bo lympho dy c sm

mu. gia l vng trung tm mm cha cc nguyn bo lympho xp tha hn, sng hn.

Cc xoang v ngoi vi di bao tip nhn bch huyt i ti, qua xoang trung gian ti

xoang ty.

- Vng ty: c bao quanh bi vng v, c cu to bi mt lp t bo lin vng,

i thc bo, cc dy ty cha t bo lympho.

Hnh 8: Hch bch huyt v s lc bch huyt

Ngun http://www.lymphnotes.com/article.php/id/151/

Thng thng c khong 600 700 hch bch huyt trong c th, n ng vai tr

lc bch huyt trc khi bch huyt tr v h thng tun hon mu.

Bch huyt cha lc c a vo hch bi nhng mch bch huyt hng tm, ti

hch bch huyt c lc b cc cht thi, mm bnh s b thc bo bi cc i thc bo

v lm hch sng to ln. Hch bch huyt cng bt cc t bo ung th v lm chm s lan

truyn ung th, cho n khi cc t bo ung th trn ngp hch. Bch huyt sau khi c lc

s c a ra khi hch bi nhng mch ly tm tr v h tun hon mu. Ngoi ra bch

huyt cn c lc bi lch, tuyn c. Cc hch bch huyt c ngha quan trng trong

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chn on bnh. Hch bch huyt sng, nng, u, qu pht biu l nhng tnh trng

bnh l khc nhau, t nh nh vim hng cho n ung th. bnh nhn ung th, hch

bch huyt c tm quan trng n mc c th c dng chn on giai on ung th.

Hnh 9: H thng hch bch huyt

Ngun http://www.emedicinehealth.com/swollen_lym.../article_em.htm

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1.4. H THNG HCH BCH HUYT U MT C [1, 3,]

Bch huyt nng u, c dn lu bch huyt t da, sau khi u qua cc hch ti ch

hoc hch vng th vo nhm hch c nng (4 6 hch) nm dc tnh mch cnh ngoi.

Bch huyt su ca u, c dn lu bch huyt t phn u ca ng tiu ha v

ng h hp v cc c quan vng c (tuyn gip, thanh qun, c) vo nhm hch c

su nm dc theo ng mch cnh.

H thng hch bch huyt u mt c rt phong ph, c sp xp theo tng nhm. C

nhiu h thng phn nhm hch bch huyt.

1.4.1. Phn chia nhm hch bch huyt theo phn chia vng u mt

1.4.1.1. Nhm hch chm (occipitales)

C t 1 3 hch, nm vng chm, dn lu bch huyt da vng chm vo nhm

hch c nng.

1.4.1.2. Nhm hch sau tai (posterior auricular)

Thng c 2 hch, nm sau tai, dn lu bch huyt vng sau tai, trn tai v phn

sau ng tai ngoi, vo hch c nng.

1.4.1.3. Cc hch mang tai nng (nodi lymphatici parotidei superflciales)

C t 1 3 hch, nm trc bnh tai, dn lu bch huyt mt ngoi loa tai, da vng

thi dng vo nhm hch c sau trn.

1.4.1.4. Cc hch mang tai su (nodi lymphatic parotidei profundi)

Cc hch mang tai su gia tuyn mang tai v dc theo tnh mch cnh ngoi,

nhn hch bch huyt da vng thi dng, vng trn, m mt, tai ngoi v tai gia,

tuyn mang tai v nim mc mi. vo nhm hch c sau trn.

1.4.1.5. Cc hch sau hu (nodi lymphatici rebopharyngei)

C 1-3 hch nm trong mc m hu v vo hch c su trn.

1.4.1.6. Cc hch m (nodi lymphatici buccales)

C th khng c, thng nm bn trong ngnh hm di vo hch c su trn.

1.4.1.7. Cc hch hm di (nodi lymphatici mandibutares)

Nm trn mt ngoi ca hm di. Mch i vo hch di hm.

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1.4.1.8. Cc hch di hm (nom 1ymphatici submandibulares)

C 3-6 hch trc v sau tuyn nc bt di hm, trc v sau tnh mch mt.

Nhn bch huyt mi, m, mi trn, li v sn ming.

1.4.1.9. Cc hch di cm (nodi lymphatici submentales)

C t 2-3 hch, nhn bch huyt cm, mi di, m, nn ming v u li.

Hnh 10: cc nhm hch u mt c

http://uwlclinicaloncology2010.wikispaces.com/Oral+Cavity

Preauricular node: hch trc tai; parotid node : hch vng tuyn mang tai; facial node: hch

mt; submental node: hch di cm; sublingual node: hch di li; suprahyoid node: hch trn

xng mng; anterior deep and superficial cervical nodes: hch c su v nng trc; internal

jugular chain: chui hch tnh mch cnh; Posterior auricular nodes: nhng hch sau tai; occipital

nodes: hch chm; stemomastoid nodes: hch vung chm; supraclavicular nodes: hch thng n.

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Hnh 12: Hch u mt c

http://www.ehealthconnection.com/regions/youngstown/content/healthinfo_report.asp?src=

000083&typeid=10

Occipital: hch chm; Buccal: hch m; retroauricular: hch sau tai; parotid: hch mang tai;

submandibular: hch di hm.

1.4.2. Cc nhm hch vng c

C nhiu h thng phn nhm hch vng c:

1.4.2.1. Phn chia theo tng lp vng c: Cc hch bch huyt c nng, cc hch bch

huyt c su, cc hch bch huyt cnh tng (Cnh thanh qun, kh qun, tuyn gip )

- Cc hch bch huyt c nng:

+ Nhm hch bch huyt tnh mch cnh trc.

+ Nhm hch tnh mch cnh ngoi: lin h mt thit vi tnh mch cnh ngoi, nm

trn c c n chm, mch i vo hch c su trn.

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- Cc hch bch huyt c su: gm c 3 nhm hch:

+ Nhm tnh mch cnh trong: gm cch hch nm pha ngoi tnh mch v nhiu

hch pha trc tnh mch: nhm hch di c nh thn, nhm hch trn c vai

mng, nhm hch ni tn ht tnh mch cnh trong.

+ Nhm hch c su di gm 1 hch nm di c thang.

+ Nhm hch trn n.

- Cc hch bch huyt cnh tng:

+ Nhm hch sau hu bn, nhn bch huyt ca mi, vi nh, hng mi.

+ Nhm hch trc thanh qun: t 1-2 hch.

+ Nhm hch nm dc theo dy thn kinh qut ngc, nhn bch huyt ca thanh

qun, kh qun, thc qun, tuyn gip.

Hnh 13: Hch bch huyt v dn lu

http://www.taxotere.com/default.aspx

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Hnh 14: Hch vng mt c

Ngun Frank H. Netter

H thng phn chia nhm hch vng c trn y kh nh v kh xc nh trn

lm sng.

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1.4.2.2. Phn chia cc nhm hch vng c theo Reyt v Righini Chia thnh 6 nhm theo

hnh , [9, 10]:

- Nhm I: gm cc hch di hm v di cm, nm trong tam gic di hm. Cc hch

ny nhn bch mch ca mi, thp mi, sn ming v phn li di ng.

- Nhm II: nhm hch c trn (thanh qun, hng, tuyn gip, ming, tuyn mang tai, tai),

c gii hn trc trn l b di ca bng sau c nh thn, gii hn di l ng ngang

vi xng mng, gii hn sau l b sau c c n chm. Nhm ny nhn bch huyt t

vng kh q