VIETNAM MEDICAL JOURNAL N'^ • APRIL - 2018 52,2%. Ket qua nghien cUu tren cho thay cd sU
khac biet gida ngUcfi dddc tap huan kien thUe va sU hieu biet ve kien thdc dam bao ATVSTP, sd ngudi dUdc tap huan ed sU hieu biet v§ kien thUe dam bao ATVSTP cao gap 3,57 lan so vdt nhu'ng ngUdi ehUa dUdc tap huan kien thUc ATVSTP.
Ket qua nghien cdu eho thay ty le ngUdi che bten phuc vu mac tap de dat 90,8%, 60% sd nhan vien che bien dSu tdc gpn gang, dpi mu, cd 63% ngUdi ehe bten, mdng tay cat ngan, ban tay sach; cd 89,2% sd ngUdi che bten khdng dimg tay bde thUe an va 83,0% sd nhan vien che bien khdng khae nhd, ngoay tai kht che bten thuc pham. Ket qua nay cao hdn so vdi nghien ciiu ciia Pham Thu HUdng va cdng sU (Trung tam Y te dd phdng tinh) tat bep an tap the trUdng Mam non tren dja ban tiianh phd Sdn La nam 2009, deo tap de la 69,1%, dau dpi mu 21,82% [2].
Ket qua nghien cUu cho thay, ty le nhan vien CB, phue vu tai BATT biet chpn nguyen lieu thUc pham an toan ve mat cam quan la 81,5%; Thuc hanh riici rau an toan chtem ty le 78,4%; RUa tay sau kht dt ve sinh chiem 87,7%; Rife tay trudc kht ehe bien ta 72,3%. Ve sinh ban tay ngUdi che bien la rat quan trpng, vl ban tay la ndi tjep xuc vdt thUc pham nhteu nhat. Ket qua nghien cUu nay thap hdn so vdi nghien cUu cua Trung tam Y te dU phdng Ha Ndi tat bep an tap the trUdng Mam non tren dia ban thanh phd la 92,7% [6] va cao hdn so vdi nghien eUu ciia Tran Thj Thu HUdng tat BATT cac trudng Mam non quan Tay Ho - Ha Not nam 2004 la 61,7%
[3]. Day la mot nguy rat Idn, vi vt khuan cd the lay nhiem td ban tay ban sang thUc pham da che bien chm. Ty le nhan vien CB, pliue vu tai BATT thUc hanh dung ve ATVSTP la 70,8% va chUa
thuc hanh diing chtem 29,2%. Cd sU khae 1 ^ gii?a ngUdi dUdc ^ p huan kien thUc ATVSTP^^
thUe hanh dam bao ATVSTP, sd ngUdi da tham gla tap huan kien thUc ATVSTP thUe hanh dung nhteu hdn gap 3,18 tan so vdt nhiJng ngircfi chu^ dddc tap huan kien thUe ATVSTP.
V. KET L U A N
76,9% ngUdi ehe bien, phue vu tai eac bep an tap the dddc kham sUc khde dinh ky, 67,7%
dUdc ^ p huan kien thUc ATySTT*. Ty le hieu Wft Chung ve nguyen nhan gay d nhiem thUc pham la 58,5%; hieu biet chung ve tac hat cua TP khdng an toan la 53,8%. Cd 52,3% ngUdi die bien, phuc vu dat ve kien thUe ATVSTP, va 70,8% dat thiie hanh dung ve ATVSTP.
TAI UEU T H A M KHAO^
1. Cue An tofin thUc pham (Bp Y t ^ Bao cao Hoi nghi toan quoc ve cong tac bad dam VSATTP naiii 2014, 2015, 2016.
z. Ph^m Thu Hu'dng va cpng sU (2009) Tbifc trang kien thUc,^Uc hanh ciia nhin vien cnebieii thUc pham tai BATT trUdng Mam non tren dia ban thanh phS Sdn La.
3. Tran T h j T h u HuUng ( 2 0 0 4 ) ThUc trang laen thUc, thUc hanh ciia ngUdi phuc vu biJa ah tnia va thUc trang ve smh bep an ban tru cac trUcfng Mau giao q u | n Tay Hd - Ha Npi. Luan van thac sy Y Is c§ng cdng.
4. Oo T h j T h u T r a n g ( 2 0 0 9 ) , ThUc trang kien thifc, thj/c hanh ciia nhan vien che bien thUc pham ^ i BATT cac trUdng Mam non tat huyen Hoc Mon - thanh phd Ho Chi Minh
5. T r u d n g Oai hoc Y T h a i Binh ( 2 0 1 1 ) Giao trinh
"QuanTy an toan thUc pham".
6. Trung t 3 m Y t e d V phong Ha Npi (20041 2005) Khao sat ttiUe trang kien thUc. thUc hm- ciia ngUdi che bien thUe pham tai BATT tru^g Mam non tren dja b^n thanh phd Ha Npi. •$
PHAT HIEN BENH TUYEN VU BANG PHU'aNG PHAP KHAM LAM SANG vA TE BAO HOC CHOC HUT KIM N H 6 Du-ai HuaNG DAN SIEU AM
Tran Manh Ha*, Nguyen Van Hirag**
le benh va gia tn cua phUOng phap. Ddi tu^ng va phuVng phap nghiin cuir. 512 ngUdl benh i3i/((c kham lam sang va te bao hoc choc hut kirn nho tai Binh vien Dai hpc Y Thai Binh. Ket qui, Co 35,7% w) nan^ tuyen, 26,7% u xd tuyen lanh tfnh, 9,8% u nang tuyen lanh tinh, 3,7% viem tuyen vO va 4,3% ap « ; 8,4% ton thUdng khae gdm nang eSn suti, viem tac tuyen sOia, hach va u md. Chan doan ung thU hoSc nghi ngd chiem 11,4%. So vdi ket qua md benh hoc, phUdng phap kham lam sang va te bao hpc choc hut kim nhd dUpi hUdng dan sieu am eo do nhay 100%;
dp dac hipu 98,97%; gia tri tien doan diftfng 96,55%;
gia trj tien doan am 100%, ti le dUdng t'nh gia 0,80%;
T O M TAT
Myc ddu. Ap dung phUdng phap kham lam sang va te bao hpc elipc hut kim nho dUdt hUdng dan sieu am frong chan doan benh tuyen vii nhSm xae dinh ti
^Trddng D^lhgcY Ddpc Thii Binh
**Tnmg Dal hoc YHi Ngi Chju trach nhiem chinh: Tian Manh Ha Email: [email protected])m Ngay nhan bai: 2.2.2018 Ngay phan bien khoa hoc: 29.3.2018 Ngay duyet bai: 4.4.2018
TAP CHi Y HOC VI&T NAM TAP 465 - THANG 4 - S O 2 • 2018 ti le am tinh gia 0%. Ketluair. Kham lam sang va te
bao hpc choc hut kim nho dirdi hUdng dan sieu am la mpt phUdng phap chfnh xac, ca gia trj cao trong viec chan doan ^hat hi^n benh tuyen vu.
Td khda: kham lam sang vu, chpe hiit te bao bang kim nhd, si€u 3m vu.
SUIVIMARY
DETECTION OF BREAST DISEASE BY CUNICAL EXAMINATION AND FINE- NEEDLE ASPIRATION UNDER
ULTRASOUND GUIDANCE Objective: Application of elinical examination and fine needle aspiration under ultrasound guidance for patients wltti breast disease to determine prevalence of disease and value method. Subjects and Methods: 512 eases of clinical breast examination and fine needle aspiration in Thai Binh Medical University Hospital. Results: There are 35.7%
fibrocystic, 26.7% fibroadenoma, 9,8% benign cysts, 3.7% inflammation and 4.3% abscess; 8.4% other benign injuries. The diagnosis of cancer or suspected malignancy accounting for 11.4%. Compared with histopathology, clinical examination and fine needle aspiration under ultrasound guidance is method with a sensitivity of 100%; specificity of 98.97%; positive predictive value of 96.55%; negative predictive value of 100%, the false-positive rate of 0.8%; false- negative rate of 0%. Conclusions: Clinical examination and fine needle aspiration under ultrasound guidance is an accurate method, high- value, consistent with the diagnosis of breast disease.
Keywords: breast dinieal examination, fine needle aspiration, breast ultrasound.
I. DAT VAN D I
Benh tuyen vu la mot trcing nhuYig benh ed ti le mac kha eao d phu ntf. Benh gom hai nhdm chfnh la benh tuyen vu khdng do u va do u. Qhc biet, trong nhdm benh tuyen vu do u, ung thU vu (UTV) ia nguyen nhan chfnh gay tUvong cao do ung thU ndi chung dot vdt phu nu' Viet Nam va the gidi. Theo Udc tinh ciia Hot Ung thU My, trong nam 2013 tai My cd 234.580 trUdng hdp UTV dUde phat hten mdt [1]. 6 Viet Nam, nghien cUu tai Ha Not giat doan 2006-2007 cho thay t / le m i c ung tliU chuan theo tudt ciia UTV ia 40,2/ioO.OOO dan [ 2 ] , Can Thd nam 2010 la 23/100.000 dan [ 3 ] .
PhUdng phap kham lam sang ket hdp choc hut te bao bang kim nhd dUdl hudng dan sieu am la mot phUdng phap mdt giup phat hien sdm cac benli tuyen vu. PhUdng phap nay cd the phat hien cac tdn thUdng nhd (dUdi 10 mm). Tai Viet Nam, chUa cd nhteu nghien ciiu danh gta ve gia trj cua phUdng phap tam sang ket hdp ehpc hiit tk bao hpc tuyen vu cd sieu am dan dudng trong chan doan cac benh tuyen vii. Chmh vi vay, chung tdi tien hanh nghien cirli sU dung
phUdng phap nay tai Benh vien Bat hpe Y Thai Binh vdi muc tieu:
1- Chan doin mot sd benh ly tuyen vu bang phddng phap lam sang kei hdp choc hut tebao bang kim nhd dddl hu'dng dan cua sliu im.
2- Ool chieu ket qua tebao hoc choc hut kim nhd dddl hudng dan cua siiu am vdi md benh hgc sau phau thuat
II. €>6l nrpiSIG VA PHUONG PHAP NGHIEN CUU 2 . 1 . D o i tu'dng nghien cihi: 512 trUdng hdp ngUdi benh den kham ve benh tuyen vu d nd gidi tai Benh vien Dai hpc Y t h a i Binh trong thdi gian nghien cinj tU thang 1 nam 2014 den thang 5 nam 2016.
2.2. Phu'dng phap nghien cu'u 2 . 2 . 1 . Thiet ke nghien cu'u: ThUe hien nghien cUu md ta ket hdp ddi chieu ket qua te bao hpc vdi md benh hpc sau phau thuat cac trUdng hdp ed u vu.
- Kham tam sang cac benh tuyen vii: SU dung phUdng phap hdt tien sU, benh sUva tham kham tam sang.
- Xet nghiem te bao hpe: SU dung phUdng phap chpe hiit te bao bang kim nhd dUdi hUdng d i n sieu am nhihig trudng hdp kham nghi ngd cd benh ly tuyen vu.
- Xet nghiem md benh hpc nhD'ng trUdng hdp cd tdn thUdng u vu sau phau thuat.
2.2.2. Chon mau: Chpn toan bd benh nhan phil hdp vdi tieu chuan ddi tUdng nghien cull, ed ehii dfch.
III. KET QUA NGHIEN CU'U
Bing 1. Kei qua kham lam sang vi choc hut te bio bang kim nhd dddl hUdng din cua siiu im.
Chan doan Viem cap tinh
A p x e Xd nana tuyen U nanq ianti tinii U xd tuyen lanii tinli
Ngtii ngd ung tiiu"
Unq tiiu' Clian doan l<tiac
T6ng
So lifOng 19 22 183 50 137
5 53 43 512
Ti 1$ °/ii 3,7 4,3 35,7 9,8 26,7
1,0 10,4
8,4 100,0 Ty le ngUdI benh xd nang tuyen la cao nhat (35,7%), tiep den la u xd tuyen lanh tinh (26,7%), u nang tuyen lanh tfnh chiem 9,8%.
Cat tdn thUdng dang viem, ap xe chiem ty te thap, tUdng ijTng ta 3,7%, 4,3%. Cd 8,4% la cac ehan doan khae bao gom nang can siJa, viem tac tuyen sdz, viem ti§t djch lanh tfnh, u md... Cd 53
VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2018
tru'dng hdp du'dc chan doan LnV va 05 tru'dng nghiem te bao hoc dudi hu'dng dan sieu am, c6 hdp nghi ngd LITV. 251 tru'dng hdp u du'dc phau thuat va iam mo
' Trong so 512 tru'dng hdp dUdc chi djnh xet benh hoc, iiet qua nhu' sau:
Bang 2: Kei gua chan tfoan mo benh hoc u tuyen vii Chan doan mo benh hoc
U ianh tinh (n=195) Ung thu' (n=S6)
U xd, md U nang U xd tuyen
UTBM xam nhap khonq phai loai dac biet UTBI^ tieu thuy xam nhap
Tong
So lu'dng 8 48 139 50 6 2 5 1
Ti le % 3,2 19,1 55,4 19,9 2,4 100 Ket qua md benh hoe cae u lanh tfnh gdm chii yeu la u xd tuyen (55,4%), tiep den la^u nang dicii (19,1%), cac u l^nh ti'iih khac chiem ti ie thap (3,2%). Trong 56 trUdng hdp ung thU bieu md tuyen vii, theo phan loat ciia To ehUc y te the gidi nam 2012 cd 50 trUdng hdp UTBI«] xam nhap khdng phai ioai dac bletva 6 trudng hdp la UTBM tieu thity xam nhap.
' Bang 3: Doi chieu gida chin doan tebao hoc vdi md benh hoc.
—____J16benh hoc Te bao hoc^ '——__
Lanh tinh Nqhi nqd unq thu'
U n j t h u Tong
Lanh tinh 193
2 0 195
Ung thir 0 3 53 5 6
Tong 193 5 53 2 5 1
p(x')
0,001 (244,1)
Cd 249/251 trUdng hdp chan doan te bao hpe phiJ hdp vdi md benh hpc. Trong dd:
- Sd ca dudng tfnh tliat: 56 - Sd ca dUdng tinh gia: 2 - Sd ca am tfnh that: 193 - So ca am tmh gia: 0
Nhu vay, ket qua cac gia trj ciia phUdng phap te bao hpc choc hut kim nhd dUdt hUdng dan sieu am trong chan doan UTV trong nghien cUu nay se nhUsau:
Bing 4: Gii tri chan doin te bio hoc choc hut kim nhd dUdi hUdng dan siiu im
Gia tri
£)d nhay Od dac liieu Gta tri tien doan dUdng
Gia tri tien doan am Ti le dUdnq tinh qia Ti le am tinh gta
Ti le o/o 100 98,97 96,55 100 0,80 0 IV. BAN LUAN ^
4.1. Die diem te bao hgc choc hut kim nhd dudi hUdng dan cua sieu am
J"Udng t u nhu cd cau benh tuyen vii trong Chan doan ban dau va hinh anh sieu am, ty le ngUdi benh xd nang tuyen la cao nhat (35,7%)', tiep d§n la u xd tuyen lanh tinh (26,7%). Cac ton thUdng dang viem, ap xe va u nang tuyen lanh tinli chtem t / le thap, cd 8,4% la eac chan doan khac bao gom nang can sffa, viem tac tuyen su'a, hadi viem phan iing, u md. Chan doan te bao
hoc tuan theo cac tieu chuan ehan doan cua Syed Z. Alt va Anil V. Parwanl [4].
Ve te bao hpc, viec phan biet giiila cae lo^l ton thUdng deu dUa vao cae tieu ehf ve dac di^ii) hinh thai te bao, sd IUdng te bao va each sap xep ciia te bao tren phien dd. I^ae dii vay van co nhu'ng khd khan trong ehan doan phan biet do edn phu thude rat nhieu vao yeu t d ky thuat^ dac diem mau chpe hiit...
Nghien cUu t€ bao hoc ciia u xd tuyen eo 3' dac diem: nhieu te bao bieu md, cac nhan ban hinh trai xoan va cac manh md dem. Cac ^ bao bleu md thudng nhieu tao thanh cac dai te bao dfnh nhau ddi khi la cac dai rat Idn. SU giau te bao rd ret la mdt hinh anh thUdng ket hdp vdi ton thUdng ac tinh gap trong 67-75% cac trudng hdp u xd tuyen lanh tfnh, Trong cac dai cac te bao bleu md thudng sap xep cd trat tU, tiao tUdng It hoac viia phai, bd te bao thUdng ro.
Nhan tUdng ddi deu hinh tron hoac trai xoan, chat nhiem sac min, phan bd deu va mang nhSn nhan. Khoang 65- 80% cac trUdng hdp co the nhin thay rd cac hat nhan. Oieu nay eung de hieu vl u xd tuyen la mdt ton thUdng tang sinh, eac te bao ddi khi kha hoat ddng va gidng te baa,>
sda chda vdi nhan da liinh thai vUa phai, h?t nhan ro va cd cac hinh nhan chia thUdng du^
dang tten ki. Mdt sd nhan cd the cd nguon goc tif te bao cd bleu md [5].
Vdt u xd lanh tinh, phien dd thUdng ngheo te bao, cac te bao bieu md thUdng duYig rdi rac
TAP CHi Y HQC VigT NAM TAP 465 - THANG 4 - SO 2 - 2018 khdng dinh vao nhau hoac sap xep thanh timg
dam nhd, ddi kht lay dddc mdt sd dai sdi lien ket - xd. Hinh thai chia nhanh ciia cac dai bieu md, cac nhan tran hai cUc it phd bien hdn so vdi u xd tuyen. NhU vay, viec tim thay cac.dai nang va cac manh md dem nhd dac, kinh hoa gan vdi eac dai bieu md cd the gliip chan doan te bao hpc ehpc hut kim nhd trong u xcf vu. Viec nhan biet ro sU ed mat cua eac te bao diitig rieng te tren cac phien dd vdi nhan te bao lanh tinh ed the giiip phan biet vdi u ae tinh [ 5 ] .
Trong 53 trUdng hdp ung thU, hinh anh te bao hpe thUdng kha dac trUng bdi hinh thai te bao va nhan, sU sap xep ciia te bao tren vi trUdng. Mac du vay, viec xac dmh tdn thUdng ae tfnh cung cd nhu'ng khd khan trong chan doan te bao hpc. Do vay, xet nghiem nay van cho phep cd nhUng ket luan mang tfnh dmh hUdng; tl le nay trong nghien ciiu la 1,0%.
4.2. Dd/ chieu kei qua te' bao hpc choc hiit kim nhd dUdi hUdng dan cua siiu im vdi md b$nh hgc sau phau thuit.
Trong 251 trUdng hdp cd chan doan md benh hpe, ddt chieu ket qua te bao hpc chpe hut kim nlid vdi md benh hpe thi khdng cd trUdng hdp nao am tinh gia. Trong 05 trUdng hdp nghi ngd ung thu tren te bao hpc, cd 03 trUdng hdp cho ket qua dUdng tinh tren md benh hpe va 02 trUdng hdp am tinh.
Odi vdi trudng hdp cd ket qua dUdng tfnh, tren tam sang, sieu am va te bao hpc deu nghi ngd nhung day la typ hiem gap, dac diem te bao hpc thudng khdng dten hinh.
Vdi 02 trUdng hdp dUdng tfnh gia, hoi cii'u iai hd sd chiing tdt thay: trUdng hdp thU nhat la benh nhan nu* 21 tudi dang nudi eon bii, phat hten khdt u khoang 1 thang trUdc. Tren lam sang, khdi u cd kich thUdc khoang 1,5cm, vj tri d phia tren trong vu phai, mat do mem, di ddng
tUdng ddi de dang. Tren phien dd, chiing tdi thay cac te bao bieu md tuyen qua san manh, dimg rdi rac, ddi cho tap trung thanh timg dam nhd, bao tUdng rdng lo ro, nhan Idn khdng deu nhe bat mau kiem tinh diilig xen ke vdi eae hat md va day dac dai thUc bao. Phien do nay gdi y den hinh anii ung thU bieu md dng nhd. Tren tieu ban md benh hpe, cac dng tuyen qua san manh, kich thUde nhd tUdng dot ddng dang, bieu md tuyen ed nhan nhd deu, vay quanh eae ,dng tuyen thay xam nhap nhieu cac te bao viem ddn nhan nhU lymphocyte, dai thUc bao. Tren thUe te, ty le khdng phu hdp giti^ chan doan te bao hpc va chan doan md benh hpe thap hdn d ntiii'ng tdn thUdng phat trien tdn va lan toa nhUng thudng eao hdn d nhu'ng tdn thUdng xd hoa nhieu, eae typ bat thudng va eac ung thU bleu md dp thap. TrUdng hdp thU hai la benh nhan niJ' 45 tudi, cd dac diem te bao hpc tUdng t u nhu trudng hdp thU nhat nhUng te bao ngheo nan hdn, te bao viem ddn nhan chiem da sd.
Vao nhu'ng nam gan day ket qua chan doan te bao hpe chpe hiit kim nhd khdng dUng tai d mUc dp tfnh phan tram dung sai so vdi chan doan md benti hpc. Mot sd tac gia da ap dyng thuat toan thdng ke de tfnh dp nhay, dp dac hieu, dp chfnh xac va gia t n dU bao dUdng tinh eiia phUdng phap nay. Ket qua chan doan chfnh xac phu thudc vao tUng nghien eiiu nhUng thudng dao ddng tU 86-98%. Theo mdt sd nha giai phau benh hpe thi eac trUdng hdp "nghi ngd" dUdc coi nhu la dUdng tinh. Theo dd, sd ca dUdng tinh trong nghien cUu eua ehung tdt se la 56. Nhu vay, ket qua cac gia trj cua phUdng phap te bao hpc chpe hut kim nhd dUdi hUdng dan sieu am trong chan doan UTV trong nghien cull nay xet ve dp nhay, dp dae hieu, eac gia fri tien doan dudng, gla tri tten doan am ta rat eao, ngUdc tai b' te dUdng b'nh gia, am ta'nh gia la rat thap.
Bang 4; So s^nh gla tri TBCHKN gli^a cac tac gla Tac gia
NCnay HX Nqhiem (6)
Mulazim (7)
Oo n h a y 100%
100%
98%
O o d a c liieu 98,97%
99,4%
100%
Tien doan 96,55%
97,4%
97%
Tien d o a n (-)
100%
100%
100%
DifOng t i n h gia
0,8%
0%
A m t i n h gia 0%
0,6%
Ket qua tren cho thay viec ket hdp giti^
kham lam sang, xet nghiem te bao hpc choc hut kim nhd dudi hUdng dan sieu am trong chan doan UTV tii" cac u dang dSc la phUdng phap cd dp chinh xac cao, tUdng t i i vdi nhieu cdng trinh nghien zd\x ciia cac tac gla Huynh Xuan Nghiem [6], ddng thdi cung chinh xac hdn phUdng phap dipc hut kim nhd khdng co hudng dan sieu am cua cac tac gia Mizuno S (bang 4).
Vdi ket qua tren, cho phep sU dung phUdng phap te bao hpc ehpc hilt kim nhd dUdi hUdng dan sieu am nhU la mdt test trong sang Ipc, chan doan UTV bdi day la mdt test chan doan nham xac djnh dung trUdng hdp benh va khong benh.
Odt vdi test sang lpc thi xac dinh dp nhay la quan tnang, con trong test chan doan, xac djnh dp dac hieu la quan trpng, khdng bd sdt trUdng hdp cd benh, tUc la ntiutig trUdng hdp am tinh
VIETHAM MEDICAL JOURNAL N°2 - APRIL - 2018 gia. Mat khae phUOng phap nay eung eho phep
chan doan cac benh vii khae, dae biet la phat hten cae bift thUdng ve te bao hpc eiia eac benh vii khong ung thU de dieu tn kip thdi eac ton thUdng tien ung thU. Do phUdng phap chan doan te bao hpc la mdt ky thuat ddn gian, de thUe hien, cho ket qua nhanh ehdng, dp chfnh xac cao va gia thanh thap nen day la phUdng phap riit thfeh hdp vdi cae nUde dang phat trien (cac phUdng phap tham dd khdng xam nhap khae khdng phii hdp va khd ed the thUe hien dUdc). Ket qua nghien cUu ciia ehiing tdi cung eho thay phUdng phap ket hdp giu^ tham kham lam sang vdi chpe hiit te bao bang i<im nhd dUdi hudng dan ciia sieu am giiip chan doan kha ehinh xac eae benh ly tuyen vu va rat phii hpp vdi hoan canh thUc te tai Viet Nam noi chung va Thai Binh ndi rieng.
V. KET L U A N
1 . Chan doan mot so benh ly tuyen vu bang phu'dng phap kham lam sang ket hdp choc hut te bao bang kim nhd dUdi hu'dng dan cua sieu a m .
Trong 512 trUdng hdp dUde iam thUe hien ddng thdi eae ky thuat tham kham lam sang, chpe hilt te bao hpc dudi hudng dan sieu am.
Ket qua cu the nhU sau: Ty ie ngUdi benh xd nang tuyen la cao nhat (35,7%), tiep den ia u xd tuyen lanh tfnh (26,7%). Cae ton thUdng dang viem, ap xe va u nang tuyen lanh tinh chiem ty le thap, tUdng img la 3,7%, 4,3% va 9,8%; cd 8,4% la eae chan doan khac bao gom nang can sii^, viem tac tuyen su^, hach viem phan Ung va u md. So benh nhan cd ket qua ehan doan la ung thu hoac nghi ngd ung thU la 58 trUdng hdp, tUdng Ung vdi 11,4%.
2. Odi chieu ket qua t e bao hpc ch^c hiit te bao bang kim nhd du'di hu'dng dan cua sieu am vdi mo benh hoc sau p h l u thuat.
Cd 251 trUdng hdp ngUdi benh dUde ehi djnti phau thuat va iam md benh hpe. So sanh icet qua vdi ehan doan te bao hoe ehpc hut te bao bang kim nhd dUdi hUdng dan ciia sieu am cho ket qua nhUsau:
Dd nhay: 100%
Dp dac hieu: 98,97%
Gia tri tien doan dUdng: 96,55%
Gia tri tien doan am: 100%
Ti le dUdng tfnh gia: 0,8%
Ti le am tfnh gia: 0%.
NhU vay, phUdng phap kham lam sang ket hdp xet nghiem choc hut te bao bang kim nho dudi hudng dan ciia sieu am la mdt cong eg co dp nhay va do dac hieu eao, rat ed gia tri trong clian doan eae tdn thUdng dang u cua tuyen vu.
TAI LIEU T H A M KHAO
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J . Nguyen Van Qui va cs (2011). Sing loc phit hiin sdm binh UT vu trong cdng dong tai TP CSn Thd giai doan 2008-2010. Tap'ehf Y hoc thUc hanh (756), so 3/2011: 32-36.
4. Ali S.Z, Parwani A.V. (2007). Breast Cytopathology 2007. Spnnger Science +BusineES Media, LLC: 1-16.
a. Cho EY. Oh YL. Fine needle aspiration cytology of sclerosing adenosis of the breast. Acta Cyologia.
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6. Huynh Xuan Nghiem, Tran Sdn Th^ch (2010J.
Qa tn dipc hut te bao bang kim nho du&' sieu am trong khoi u vii dang dac tai Benh vien Hung Vising.
7. Bukhari M.H, Arshad M, Jamal S, Niau S., Bashir S., Bakhshi LM, and Shaharyar (2011). Use of Fine-Needle Aspiration in the Evaluation o' Breast Lumps. Patholog Res Int.; 2011: 689521.
NGHIEN CU'U MOT SO YEU TO TIEN LU-gNG <y BENH NHAN NHOI MAU THAN NAO GIAI DOAN CAP
Bang Huy Du*, Vo Hong Khoi**, Le Van Thinh*'
TOIVI TAT
Myc tieu: Xae dinh mpt sd yeu to eo gia tn tien lupng nSng d benh nhan nhdi mau than nao giai doan cap. Doi tu'dng: Chiing to) ehpn 93 benh nhan dudc
*Benh vien Da khoa Lang Sdn
**Benh vien Bach Mai.
Chiu trach nhiem chinh: Oang Huy Du Email: [email protected] Ngay nhan bai: 3.2.2018 Ngay ph^n bien khoa hoc: 30.3.2018 Ngay duyet bat; 5.4.2018
chan doan la nhdi mau than nao giai do?n cap tai Benh vien Bach Mai trong thdi gian tU thang 7 nSrti 2016 den thang 7 nSm 2017. PhUdng phap: Nghien ciili mo ta tien cUu, theo doi dpc. Ketqua:Th&:ick phan tfch ddn bien, cac yeu to sau cd gia tri tier lupng: tuoi tren 60, diem Glasgow tif 3 den 8: Diem NIHSS _tren 20; roi loan ho hap, roi loan nuot; kich thudc p nhoi mau tren 20mm d vi tri hanh nao; kidi thudc d nhoi mau tren 20mm d cac vi trf ket hdp; tren xung mach TOF co hep tac dong mach than hen; v*
ty xuat chenh OR 2,17 den 64; P < 0,05. Theo phan tich da bien hoi quy cdn co nhihig yiu to sau CO gii tri tien iugng nang:Tu6\ tren 60, Glasgow tif 3-