K4t qui phau thuat ndi soi dieu tn ung thu dai trdng tai Benh vien Quan Y 103 NguySn Vdn Xuy4n va cdng si/
Ket qua phau thuat npi soi dieu trj ung t h u dai trang tai Benh vien Quan Y 103
Nguyen Van Xuydn, BCii Tuan Anh, D 6 Sdn H^i Bgnh vi$n Quan Y 103
TCr khoa:
PhSu thuat HQI sol c ^ dai tr^ng, ung thu dai Irang
Dja chl lien he:
Nguyin Van Xuyen, Sd mon Phiu thu$t bung, Hoc vien Quan y 103
160 Phting Hung, Phuc La.
Ha 6 6 n g . Ha Noi Dien thoai: 0913260784 Email: nguyenvanxuyen1660@
gmail.com
Ngay ntian bdi: 30/9/2017.
Ngay duyet: 09/10/2017, Ngay chap nhan dang:
20/10/2017.
Tom tat
Dgt van di: D^nh gi£ ket q u i phSu thuat noi soi dieu tri ung thir dai tring tai Benh vien Quan y 103.
Phuang phdp nghiin ciiu: Hoi ciiU, c^t ngang m6 ta kh6ng d6i chtog 139 benh nhan du'dc ch^n doSn xSc dinh \k UTBT diTdc dieu trj bang PTNS triet can tai khoa Phlu thuat bung (BM2)-Benh vien Quan y 103 tiJf diang 1/2007 den thang 12/2016.
Ket qud: Do tudi trung bmh: 55,3 ± 14,2. Thdi gian mac bgnh TB: 5,12 ± 2,05 th^ng. Hay gap u d DT Sigma (38,85%). Phan ldn \k u th^ siii (76,26%) vk deu \k ung thu" bieu mo hayg'n.Ung thtf GD I 15,11 %; GD II: 25,18 %; GD n i : 59,71 %.Cic phUdng phSp phlu thuat: cat lokn b6 DT: 0,72%, cat nila DT ph^i :31,65%, c^tDT ngang' 15,11%, c^t niJa DT trai: 3,60%. cSt DT tiii cao:
10,07%, catDTtraithap:38,85%.Th&igian phlu thuat TB: 162,47± 31,61 phiit.
Ty 16 tai big^n trong mo: 4,32%. Bien chtfng sdm sau md: 5,76%. Ty 16 bie'n chtfng xa: 2,26%. Ty 16 tai ph^t sau md: 12,03%, ty 16 ttf vong: 9,02%. T^ 16 so'ng 3 n3m va 5 nam sau mo lan ludtla 85,51% va 70,73%.
Ket ludn: Phlu thuSt noi soi dieu tri ung thtf dai u-^ng mang lai ket qui khS quan cho ngtfdi benh Ty 16 sdng them vk tai ph^t sau md phu thugc vko giai doan ung thtf.
Dat van de
Ung thtf dai trang (UTDT) la benh hay gap tren the' gidi, dac biet d Tay Au \k Bac My. CJ Viet Nam, UTDT la benh dtfng Yikn% thu" hai trong cdc benh ung thtf dtfcfng tidu h6a .UTBT chu yeu 1^ ung thtf bieu m6 tuyen (UTBMT), tie'n tridn cham va di can mudn hcfn so vdi cSc ung thtf khac nen ne'u dtfdc chan doan sdm vk dieu tri triet de thi c6 tien Itfdng tot. Tai Benh vi6n QuSn y 103 da dp dung p h l u thuit noi soi (PTNS) cho cac benh ly cua dai tr^ng (DT) ttf nam 2004 va da thu dtfdc nhieu ke't qu^ dang khich le.
Tuy vay vSn chira cd de thi nao tdng ket mot each he thdng va day du ve ke't qua ciia PTNS dieu tri ung thtf DT. Xua't phat tiif nhtfng vin de neu tren, chiing
toi tie'n hknh de tai nhSm muc tieu: Ddnh gid ke't quJ ph5u thuat n6i soi dieu tri ung thtf dai trdng tai Benh vien Quan y 103.
Doi tiTdng va phi/dng phap nghien cu'u D6'i tt/^ng nghign cihi: NghiSn ctfu tren 139 BN dtfdc chan dodn xac dinh la UTDT dtfdc dieu tri bang PTNS tri6t can tai khoa Phau thudt bung (BM2) - Benh vien Qudn y 103 ttf thang 01 ndm 2007 den thang 12 nam 2016. T^t ck cac BN deu cd hd sd Itfu trff, bien bdn md, ket qud GPBL sau md vk dtfdc theo ddi, kiem tra sau md.
Phtfi^g phap nghi&n cu'u: Hdi ctfu, mo tii, c^t ngang khong ddi chtfng.
Tap chi phau thu^t npi soi va nfii soi Viel Nam (2017) S6 4 - Tap 7; 20 - 24
NguySn Vdn XuySn va c&ng si KSt qui phau thu&t noi soi dieu Iri ung thu dai trdng tai BSnh vi$n Qudn Y103
Ket quS nghien ciJu va ban luan 1. DSic di^m v l gim, tu^i:
Trong sd 139 BN trong nhdm nghi6n ctfu cd 84 BN nam (60,43%) vd 55 BN nff (39,57%). Ty le nam/
nff 1^:1,5/1. Do tudi trung binh Id 55,3± 14,2. Kdt qud ndy phii hdp vdi kdt qud nghign ctfu cua nhilu tac gid khde vd UTDT nhtf: To Quang Huy (2010) [3], An - Gao vk cdng stf (2010)[10]. Cdc nghien ctf\i tren cho thlCy mdi lien quan ty 16 thudn gifla UTDT vd tudi benh nhan, tudi cdng cao thi nguy cd mdc b6nh cang ldn.
2. D§c diem ISm sang:
Da sd BN cd thdi gian m^c benh dtfdi 6 thdng (68,35%). Thdi gian mic b6nh trung binh la: 5,12
± 2,05 thang. Ke't qud eua chdng toi phu hdp vdi nghiSn ctfu cua Vu Huy Hoa (2014) [2]. Nhu'ng BN ddn vien mudn chu ye'u d giai doan 2007-2010.
Phan ldn cdc BN co trieu chtfng cua ban tdc ru0t.
3. Ndi sol dai trang:
Phan ldn u the siii (76,26%) vd ddu gdy hep long dai trdng, di^u do ttfdng tfng vdi tneu chtfng Idm sdng cua ban tic rudt chidm da sd. Ket qua nghien ctfu ndy ciing ttfdng dudng vdi so Ii6u thd'ng ke cua Nguyen Anh Tuan (2011) [6]
4. D^c dB^m t^n thdting GPBL ^nh ^a trong mS:
4.1. Vitri khdi u:
quan trong de dinh htfdng phtfdng phdp PTNS.
4.2 Ton thitang gidiphSu b^nh:
So lU^ng (n=139)
T * l #
(%)
3,60 22.30 74,10 40,29
Phan chia giai do^n b$nh theo TNM va Dukes
- So lifting T# l# (%)
Manh tr^ng Bai trang lgn Q^i tr^ng ngang Dgi trang xudng Dgi trang Sigma T^ngso
U dai trdng sigma chiem ty- le cao nhS't (38,85%).
U manh trdng chiem ty 16 thifp nha't (5,75%). Ket qud ndy ttfdng dtfdng vdi nghiSn ctfu cua An - Gao vd cdng stf (2010) [10]. Vi tri khdi u Id tieu chuin
Phin ldn cdc khdi u d giai doan T2 vd T3 (chiS^m t^ le 96,4%). Ty le di cdn hach:59,71%. Trong sd 139 BN nghien ctfu: 40,29% 6 giai doan I (Dukes A) vd giai doan II (Dukes B). 59,71% sd BN ung thtf d giai doan III (Duckes C) vd khong cd BN ndo d giai doan Duckes D. Ke't qud ndy cua chung tdi ttfdng dtfdng vdi mdt so' tdc gid: Nguyen Thanh Tam (2009) [5], Mastalier B. vd cpng sif (2012)[8].
Dac diem chung ciia nhffng nhdm BN ndy Id nhidu trtfdng hdp dtfdc phdt hien ung thtf d giai doan sdm ciia bdnh.
Ke't qua vi th^:
Tat cd 139 BN deu cd ke't qua GPB Id UTBMT.
Trong do, UTBMT biet hda cao Id hay gap n\\ii, chie'm ty 16 54,68%. Cd 11 trtffJng UTBMT khdng
Tap chi p h i u thuat nSi soi vS npi soi Vi§t Nam (2017) Si5 4 - Tap 7; 20 - ^4
Kef qui phau thudt n&i soi dieu tn ung thu dai trang t^i Benh vien Qudn Y103 Nguyen Vdn Xuyin v.
biet hda, chidm ty 16 7,91%.
5. Cac dgc did'm vd phlu thi4t n^i soi didu tri ung thtf dai trang
5.7. Phiitfngphdp phdu thuat:
PhUOng phap phau thuat T9 ie (%)
Cat toan bo dai trang C i t nOa ^ai trdng phii Cat dai trang ngang Cat nCia dai tring tr^i Cat dai trang trdi cao Cat dai trang trai thip Tong
15,11 3,60 10.07
Sd BN dtfdc PTNS dt dai trdng trdi thap chiem ty Id cao nhit 38,85% Cd 1 BN phdi cat todn b6 dai trdng. Le Hodng Anh (2012) [1], Mastalier B. (2012) [8] cung thS'y rang cat dai trdng trdi th§l'p chi6'm ty le ldn nhd't, didu ndy cung phii hdp vdi phan bd ung thtf d dai trdng, hay gdp UTDT sigma.
5.2 Th&i gian phdu thugt
Theo nghidn ctfu cia chtfng toi, thdi gian phlu thudt trung binh Id 162,47± 3I,61( dai nhat Id 350 phtft, ngan nha't: 90 phut). Ke't qud ndy ttfdng dtfdng vdi cdc tac gid khde.
5.3. Tai bien trong md
C6 6 trtfdng hdp (4,32%) tai bie'n trong md, ddu Id chdy mau trong qua tiinh phlu tich vd deu dtfdc xtf tri kip thdi.Ty 16 tai bie'n trong PTNS dieu tri UTDT cua chung toi ttfdng dtfdng vdi cdc nghi6n ctfu c^a Le Hodng Anh (2012) [1], Ngo Quy Lam(
2010) [4] vd khong phdn biet so vdi md md.
6. Kg't qua phSu thuSt 6.1 Kei qud s&m sau phdu thugt 6.1.1. Bien chiing s&m
Bien chihig sdm Nhiem l^hu^n vet md Xl rb mieng nfii Chdy mau mac Told Ap xe ton du Tdng so
2,88%
1,44%
0,72%
0,72%
5.76%
Trong sd 139 BN nghi6n ctfu, khdng cd trtfdng hdp nao ttf vong phau thudt, tf 16 bien chtfng sdm Id 5,76%. Nhffng trtfdng hdp ndy ddu dtfdc dieu tri bdo tdn, sau dd dn dinh ra vien.Khdng cd trtfdng hdp nao ttf vong phlu thuat. Ke't qud cua chiing tdi ttfdng dtfdng vdi Mastalier B. vd cong stf (2012)[81.
6.1.2 Thdi gian phuc hoi luu thong sau mo vd thdi gian ndm vien sau mo
Thdi gian phuc hdi Itfu thong sau mo trung bmh Id 3,27± 1,08 ngay. Thdi gian ndm vien sau md trung binh la 10,08 ± 2,13 ngdy. Ngdn nh^t la 5 ngay, dai nhdt Id 20 ngdy. Trtfdng hdp cd thdi gian ddi nhat Id BN cd bi6'n chtfng nhidm khuan ve't md. Ke't qud nay cua chung toi ttfdng dtfdng vdi mdt so' tac gid: Le Hodng Anh (2012) [1], Morneau (2013) [9].Hdi phuc nhanh sau PTNS Id vS'n de dtfdc nhieu tdc gid trong va ngoai ntfdc nghien ctfu. Nd the hi6n tfu the cua PTNS so vdi md md kinh dien.
6.2. Ki't qud xa
D6'n thdng 12 ndm 2016,chung toi cd thdng tin cua 133/139 BN (95,68%) lien lac dtfdc de kiem tra ke't qud xa vd ddnh gid thdi gian sdng th6m sau mo.
6.2.1. Bien chiing xa sau phdu thudt Co 3 trtfdng hdp (2,26%) cd bi6'n chtfng xa Id tac rudt sau md. BN nhdp vidn lai 3 thdng sau md vd phdi ti6'n hdnh phdu thudt cdp ctfu. Nguy6n nhan cua tac ruot Id do UTDT di can tao day chang gay nghet vd khdi tdi phdt d mieng ndi dinh len thdnh bung.
Sau dd, cdc BN didn bie'n dn dinh, ra vi6n, khdng c6 them bien chtfng sau md vd cdn sdng tai thdi didm nghien ctfu. Theo nghiSn ctfu cua Hai-Long Bai(
2010), ty 16 bien chtfng phdi phlu thuat lai trong noi soi cat dai trang la 2,8% [7].
d.2.2. Tdi phdt sau mS:
96/133 (72,18%) BN cd ke't qud soi dai trdng sau md. Ty le tai phdt sau md Id 12,03% vdi 16 BN. Trong dd chi cd 3 BN d6'n vi6n md lai do bidn chtfng t^c rudt,l BN 68 tudi phdt hien tdi phdt nhiftig khdng ddn vi6n, 12 BN cdn lai da ttf vong do di cdn.
Tap chi p h i u thuat nOi soi va nfii soi Viet Nam (2017) S6 4 - Tap 7; 20 - 24
Nguyen Vdn Xuyen va c&ng su Ket qui phiu thuat n&i soi dieu tri ung thu dai trdng tai Benh vi&n Quan Y 103
Thcfi gian phat hi^n tai phat dd'i chig'u vdi k6't qua giai phSu b6nh sau m d
SdBN (n=16) 3 1 1 1 2 1 3 1 2 1
Thdi gian t^i phat 6 9 17 17 20 28 34 46 48 51
K@t q u i g i ^ phlu benh TNM
T3N2M0 T3N2M0 T3N2M0 T3N1M0 T3N2M0 T3N2M0 T3N2M0 T3N2M0 T3N2M0 T3N2M0
Type ung t h i i BMT khong biet hda BMT kheng biet h<ia BMT bielh6al<am BMT biSt hoa Item BMT biet hoa k^m BMT biet hoa vCIa BMT biet hoa viia BMT biet haa kam BMT bi&t hoa kem BMT biet hda vira
_ T J I e {%) 18 75 6.25 6 25 6 25 12.5 6,25 18.75 6 25 12.5 6.25
16 bdnh n h a n tdi phat sau md d e u cd ke't qud gidi p h l u bdnh la ung thtf giai doan III (da cd di cdn h a c h ) . Trong sd' dd, 4 BN cd thdi gian tdi phdt nhanh nha't (6 va 9 thang) d e u cd type U T B M T khong b i e t h d a . 12 BN cdn Iai cd k6't qud giai phdu b e n h Id U T B M T b i e t h d a vtfa va kdm, Didu ndy cho thd'y cd stf lien quan gifla tdi phat sau md vdi giai doan b e n h vd type md b6nh h o c cua ung thtf.
6.2.i Thdi gian song them todn bd
Trong sd 133 BN cd thdng tin thi 12 trtfdng hdp (9,02%) da chg't, cdc BN nay ddu ttf vong do di cdn.
B N c o thong tin
BN 6(1 thdi gian theo ddi BN ti} vong BN con song Ty le sfing
Thdi gian song sau mo
thang thang thang thang
93,55 85,51
K6t qua nghi6n ctfu ty 16 sdng sau rao tai cdc thdi diem dtfdc tnnh bay tai bang tren cho thdy ty 16 so'ng 3 nam vd 5 nam sau md l^n Itfdt la 85,51%
va 70,73%.
T^ le sdng 5 nam sau md la tieu chu^n de danh gid k6't qud dieu tri ung thtf dtfdc hiu he't cdc nghien ctfu ap dung.Dd'i chie'u vdi sd lieu cua cdc tdc gid nhtf Td Quang Huy vd cdng stf (2010) [3], Hai-Long Bai vd cdng st/ (2010) [7], ty le sdng 5 ndm sau mo ctfa cdc BN trong nghi6n ctfu cfla chung tdi ttfdng ttf. Kdt qud cua chung tdi cao hdn cua Ngd Quy Ldm (2010)[4], Nguyen Thanh Tam(2009) [5]. Nguyen nhdn ty 16 sdng them sau md theo nghien ctfu cua cdc tdc gid ndy tha'p hdn cua chung tdi Id do trong dd cd ca cac BN ung thtf 6 giai doan IV (Duckes D). Didu ndy cho thS'y ydu t d quan trong bdc nhd't quy6't dinh stf sdng cdn ctf a BN sau dieu tri phau thuat UTDT chinh Id giai doan benh. Giai doan benh cdng cao, ty Id so'ng sau md cdng thd'p.
Ket luan
Qua nghien cflu ke't qud PTNS didu tri UTDT t r e n l 3 9 BN tai bdnh vien Quan Y 103 ttf thang 1/2007 de'n thang 12/2016 chtfng tdi nit ra mdt sd k e t l u ^ n sau:
Chi dinh p h l u thuat ndi soi ddi vdi ung thtf dai trdng 6 cdc giai doan I (15,11%), II (25,18%) vd 111(59,71%).
Bie'n chtfng sdm sau md: 5,76% vdi 2,88%
nhidm khuan ve't m d ; 1,44% xi rd mieng ndi;0,72% chdy mdu mac Told vd 0,72% ap xe tdn dtf. Khdng cd ttf vong phdu thuat, thdi gian phuc hdi Itfu thdng sau mo trung binh Id 3,27±
l,08ngdy. Thdi gian nam vien sau md trung bmh la 10,08 ± 2 , 1 3 ngdy.
Kiem tra dtfdc ket qud xa tren 133/139 BN (95,68%).Trong do 2,26% cd bien chtfng xa tac rudt sau md.Ty 16 tai phdt sau md Id 12,03%.Ty 16 ttf vong Id 9,02% (12 BN). Ty 16 sdng 3 ndm va 5 ndm sau md l i n Ifldt Id 85,51% vd 70,73%. Ty 16 sdng them vd tai phdt sau md phu thuoc vdo giai doan ung thtf.
Tap chl phdu Ihuat npi sol va npi soi Vi$t Nam (2017) 8 6 4 - T | p 7; 20 - 24
Ket qua phiu thu$t n&i soi diiu trj ung thu dai trang tai B$nh vi$n Qudn Y103 Nguyin Vdn Xuyen vd c&ng sg
Tai lieu tham khSo
1. L 6 H o a n g A n h ( 2 0 1 2 ) , "Nghifin cHu cSc bien chtfng s 5 m va xi tri c d c b i e n chtfng sau p h l u thuat npi soi d i e u tri u n g thtf dai trdng", L u a n v a n c h u y S n k h o a c a p U. H o c VlSn Q u a n Y, Hk N g i .
2 . Vu H u y H b a ( 2 0 1 4 ) . "Nght&n ctfu k^t q u i p h l u thuSt noi soi d i l u tri u n g thiT dai H^ng s i g m a tai B e n h vien T r u n g rfdng Q u a n doi 108", L u d n vfln thac sy y h o c , H p c v i e n Q u a n Y, H& N 6 i .
3 T o Q u a n g H u y , N g u y e n D a i Binh. Biii D i e u (2010),
" K ^ t qua s6'ng t h g m 5 n a m sau d i e u tri tri6t cSn 158 tnrSng h d p u n g ihir b i e u m 6 d a i trtfc t r i n g x e p loai D u k e s B - C", T a p chi y h o c T p . H o Chi Minh, tSp 14, p h u b a n s 6 ' 4 , t r . 2 6 3 - 2 6 8 .
4 . Ngfi Q u y L a m ( 2 0 1 0 ) . " N g h i e n ctfu m6t s6 die &im l a m s^ng. cSn l a m s i n g v^ k€'t qud d i e u u i p h l u thuat tridt CSLU u n g thtf (Jai trSng sigma tai B 6 n h vifen QuSn Y 103". L u d n van t h a c sy y h g c . H o c v i e n Q u a n Y, Hd N 6 i .
5 . N g u y e n T h a n h T a m (2009), '"NghiSn ci?u ton thifdng h a c h L y m p h o tcong b e n h ly u n g thif dai trtfc t r i n g " .
L u d n d n Uen sy y h g c , H g c v i e n Q u a n y, Hd N S i . 6 N g u y i n A n h TuS^n, N g u y g n H 6 n g Hdi ( 2 0 1 1 ) , "Nghien
ciJu VI tri th^t d g n g m a c h m a c t r e o t r d n g di/(Si trong ngi soi d i l u m u n g thif dai t r i n g s i g m a vh tnfc t r i n g " . T a p chi Y - dtfdc l a m s i n g , t i p 6. phy b 3 n sfi" 2 , tr. 102- 108.
7 Bai H. L., C h e n B . , Z h o u Y . , W u X . T . ( 2 0 1 0 ) , "Five y e a r long- t e r m o u t c o m e s of L a p a r o s c o p i c surgery for C o l o n c a n c e r " . W o r l d J o u m a i of Gastroenterology 2 0 1 0 , 1 6 (39), pp. 4 9 9 2 - 4 9 9 7 .
8 M a s t a l i e r B , T i h o n C , S i n u o n S. ( 2 0 1 2 ) . "Surgical t r e a t m e n t of C o l o n c a n c e r " . J o u r n a l of M e d i c i n e and Life, 5 (3), pp. 3 4 8 - 3 5 3 .
9 M o m e a u M.. B o u l a n g e r J., C h a r l e b o i s P., Gervais N . ( 2 0 1 3 ) , "Laparoscopic v e r s u s o p e n s u r g e r y for the t r e a t m e n t of C o l o r e c t a l c a n c e r " , C a n a d i a n J o u m a i of S u r g e r y , 5 6 (5). p p . 2 9 7 - 3 1 0 .
10. X u A . G . , Y u Z . J , J i a n g B , W a n g X . Y . , Z o n g X H.,Liu J. H,. Lou Q.Y., G a n A . H . ( 2 0 1 0 ) , "Colorectal cancer in G u a n g d o n g p r o v i n c e of C h i n a : A d e m o g r a p h i c and a n a t o m y s u r v e y " . W o r l d J o u m a i of Gastroenterology, 16 (8), p p . 9 6 0 - 9 6 5
Tgp chl phau thugl n$l soi vd n$i soi Vi#t Nam (2017) S6 4 - Tdp 7; 20 - 24
