VIETNAM H t U I U A L JUUKWftL M~1 - MAKt^H - ZUiq anh sieu am thay "bdng ddi da day" rat quan
trpng. Sau de hinh anh 2 mffc nffde hdi tren X_^quang ludn la dau hieu quan tnang trong chan doan xae djnh.
TAI UEU THAIVl K H A O
1. Sweed, Y. (2006). Duodenal obstruction (Vol.
Pediatric Surgery): Springer.
2. Bailey, P. V., Tracy, T. F., Jr., Connors, R. H., Mooney, D. P., Lewis, 3. E., & Weber, T. R.
(1993). Congenital duodenal obstruction: a 32- year revievtf. J Pediatr Surg, 28(1), 92-95.
i. Nixon H.H.,Tawes R. (1971), "Etiology and treatment of small Intestinal atresia: analysis of a
series of 127 jejunoileal atresias and compafison with 62 duodenal atresias " Surgery, 69 (1), 4l-si.
4. Lawrence, M. J., Ford, W. D., Furness, H. E Hayward, T., & Wilson, T. (2000). Ojngenm duodenal obstruction: early antenatal.
5. Vu Thi H6n;p Anh (2001). Nghien cuU die dim lam sang, can lim sing vi ket gui dieu tri 0u thuit tac ta tring bim smb. Luan van tot nghiep thac sy, Dai hgc Y Ha Ngi.
6. tf&ng Qui Quan (2011), " CTiih doin tic ti bing bam sinh tai benh vien Viet Ddc glal doan 2004-2011", Luan vaii tot lighjep bac sy nfii tri, Dai hoc y Ha Noi.
7. Akhtar, J., & Guiney, E. 3. (1992). CongenM duodenal obstruction. BrJSurg, 79i2), 133-135.
CHAN D O A N V A D I E U TRI TON THlTaNG TUYEN VU BANG THIET BI SINH THIET VU CO H 6 TRp*
HUT CHAN KHONG DU-ffl HUONG D A N SIEU A M
Huynh Quang Khdnh*, Vu Hihi Vinh*, Phan Bich Ngoc*, Nguyen Van Khoi*
T O M TAT
Unq thff vu dimq dau tronq cac nquven nhan unq thu" d nff Tronq nam 2014 Udc tinh ed 230.000 trUdnq hdp una thff mdi. Oirnq hanq thii 2 cac nquven nhan diet do unq thU 6 nff. U'dc t'nh co 40,000 nqudi chet tronq nam 2014. Giai doan benh, cac dau an sinh hoc:
la cac veu to dan dffdnq chinh tronq dieu tn "Ca nhan hoa" v^ "Ca the hoa". Kham lam sanq: xac nhan ton thUOnq Vli ed sd dffdc hav khonq? So sanh 2 vu: kich thu'dc, hinh danq? Dieh tiet niim vu? Hinh anh hoc:
dffa chil veu tren SiSu 3m, Nhu anh, Conq hffdnq tff (MRI). Sinh thiet; qiuo xae dmh tdn thUdnq la lanh hav ae? FNA: qiuD lav mau te baojioc. Lav mau mo hoc: ilia tren sinh thiet loi-kim, mo, sinh thiet cd ho trcl hut Chan khonq*^'. Ket luan: VABB la ky thuat lav mau rat danq tin cav thav cho sinh thiet loi-kim d nhffnq ton thffdnq BI-RADS 3 & 4A nho. Ooi vdi cac phau thuat vi&n tuyen vu, can xem xet thay the smh thiet md banq sinh thiet VABB cho nhOhq tdn thUdnq tuven Vli. Doi vdi benh nhan, VABB qiiio ton i't thdi qian eho viec b'm tdi, chcin doan, lam qiam chi phi theo doi v^ qiam di nhffnq xet nqhiem dat tien khac. VABB tiet kiem thdi qian hdn so vdi sinh thiet md.
Tii'Khda-. unq thu vu, sinh ffiiet vu, sinh thiet vu cd ho trd hut chan khong.
SUMMARY
THE CURRENT ROLE OF ULTRASOUND- GUIDED VACUUM - ASSISTED BIOPSY I N DIAGNOSIS & TREATMENT BREAST DISEASE
*Binh wen Chd Ray
Chju trach nhiem chi'nh: Huynh Quanq Khanh Email: huynhquangkhanhbverOgmaii.com Ngay nh§n bai: 9.12.2017
Ngay phan bien khoa hoc: 3.2.2018 Ngay duy^t bai: 13.2.2018
Breast cancer is leading cause of cancer for women.
In 2014 estimated new cases of invasive breast cancer is about 230,000, It is the second leading cause of cancer death in women stimated 40,000 deaths in 2014. Stage and biology are main drivers of treatment
"Personalized" and "individualized". Oinical: Lumps are Palpable or not? Compare shape, size? Fluid released from the nipples? Imaging rely on: Ultrasould, Mammography, MRI. Biopsy: Benign or Malignant? FNA:
Cytology. Histology: Core Needle biopsy. Open exdsion, Vacuum-Assisted Biopsy. In conclusion: VABB Is a very reliable sampling technique instead of a core needle biopsy for BI-RAIDS category 3 and small 4A nodular lesion. Rar breast sugeons, replacing open exdsion biopsy with VABB to initially manage breast lesions should be considered. For patient reassurance, VABB shortens the time between detection and diagnosis by reduction cost of repetitive follow-ups more expensive additional examinations VABB is time-saving in comparison with open excision biopsy.
Key words: Breast cancer, core biopsy, VABB
I.OATVXNOE
Ung thff vu la loai ung thff thffdng g§p nhat va luon la noi am anh cua ngffcJi phu nff khi phat hien mpt bat thffdng nao do trong vu. Tuy nhien tuyen vu cua ngffdi phu nff khong chi bj ung thi ma eon eo the nhieu tinh trang benh ly khac, trong do da phan la lanh tinfi. Cac trieu chirtig cua tuyen vu thffdng gap la mot khSi u trong viJ, dau vu, hay ehay nffdc d dau vu (tiet djch niim vu). Cac trieu chutig nay co the la bilu hi|n cua nhieu loai tinh Ijang khac nhau ciia tuyen vO, lanh tfnh hole ac tinhj^^. ^
No Iffc ban dau de ehan doan cae bat thu'dng phat hi$n b i n g hinh anh hoc la choc hut te bao
132
TAP CHi Y HOC VIET HAM TAP 464 • THANG 3 - SO 1 - 2018 ijang kim nho (FNA). Tuy kha ehinh xac, FNA co
nhieu bat ldi. Han ehe quan trong nhat ciia FNA la mpt so Idn mau benh pham khong du de chan doan. Ngoai ra, can eo bac sT te bao hpc-giai phau benh dffdc dao tao bai ban de dpc ket qua va tren mau FNA khong the phan biet dffde ung thff xam lan hay ung thff tai eho. Bao eao cho thay trong trffdng hdp earcinom tieu thuy va caranom ong tuyen vu dang ong, FNA ehi ehi'nh xae trong 30% trffdng hdp. Vi nhffng ly do da neu tren, sff dung rong rai FNA la khong thffc te ^^\
Cuoi thap nien 80 va trong suot thap nien 90, sinh thiet loi-kim Idn (thffe hien dffdi hffdng dan eiia nhu anh hoae sieu am) da to ra la mot phffdng phap an toan va chinh xac de danh gia cac ton thffdng phat hien bang hinh anh, vdi ket qua co the so sanh dddc vcfi phffdng phap sinh thiet md. Sinh thiet loi-kim cho ket qua dae hieu hdn FNA va cho phep Iffdng aia sff xam lan, grade mo hpc va hda mo mien djeh. Ket qua bffdc dau lam vdi kim sinh thiet tff dpng bing ldm 14 Gauze da dffdc cai thien bang each sff dung eae thiet bi ho trd hiit ehan khong.
Ngay nay, vdi nhffng cai tien ky thuat sau nay da cho phep sinh thiet dffdc eae ton thffdng ma chi xac dinh dffdc bang cpng hffdng tff (MRI). Sinh thiet loi-kim co ho trd thiet bj hut ch§n khong da t r d thanh phffdng phap vffdt trpi trong viec sinh thiet cac ton thffdng vu khong sd thay cung nhff dieu trj eae u lanh tuyen vu.
Bay la phffdng phap ft xam lan vdi gay te tai cho, an toan, ehinh xac.
II. T I N H H I N H P H A T TRIEN SINH THIET VO BANG
\dmM CO H6TRaMAY HUrCHAN KHONG (VABB) Sinh thiet vii co ho trd thiet bi hut ehan khong (VABB) la mpt ky thuat sinh thiet khoi u d vu bang may eo ho trd bang Iffc hut chan khong. Day la mpt ky thuat da dddc sang ehe va thffc hien tff nam 1995 tai My bdi eong ty Mamnnotome. Cho den nay co hdn 5 trieu ca sinh thiet bang Mammotome da thffc hien tren toan the gidi. Hdn 320 nghien effu lam sang dffdc thffc hien bang Mammotome vdi ket qua khichlet".
a Viet Nam, nam 2017, tai Benh vien Ung Bffdu TP. HCM, da bao cao ket qua bffde dBu ap dung Sinh thiet vii cd ho trd thiet bj hiit Chan kh6ng (VABB) trong dieu trj u sdi tuyen vil, ket qua cho thay rat kha quan.
Tinh hinh thffc hien ky thuat Sinh thiet vu cd ho trd thiet bj liiit chan khong (VAB): Tren the gidi ( ^ thffc hien ky thuat nay tff nam 1995, da CO nhieu nghien cffu bao cao ve ket qua thffc hien ky thuat nay '^^.
a Viet Nam, day la ky thuat mdi da bat dau ap dung d mpt so benh vien nhff benh vien Baeh Mai, benh vien K Ha Npi, benh vien Ung Budu TP. Ho Chi Minh dffdi sff hiding dan, giiip dd dm eac ehuyen gia den tff Han Quoc, My, Singapore.
Chung toi da trien khai thffdng quy ky thuat nay tai Khoa Ngoai Long Ngffc benh vien Chd Ray tii' nam 2017.
III. MAY SINH THIET VU CO HO T R p THIET B! HUT CHAN KHdNG (VABB)
3 . 1 Nguyen tac hoat dong: Sinh thiet vu cd ho Ird thiet bj hiit ehan kh6ng^(VABB) la mot ky thuat sinh thiet khoi u d vu bang may eo ho trd bang Iffe hut ehan khong.
Sinh tliiet vu cd ho trd thiet bi hiit ehan khong (VABB) dffde sff dung de sinh thiet mpt khoi u nghi ngd d vii. Ton thffdng nay ed the dffdc phat hien khi kham benh, hay tren ehan doan hinh anh nhff sieu am, nhu anh va MRI.
Oe sinh thiet khoi u, thay vi phai mo hd, bae sT se dffa kim eiia May VABB vao vii ciia benh nhan va diJng Iffe hiit ehan khdng defeat va hiit mau mo ra roi gdi di xet nghiem te bao hoe.
Sinh thiet nay dffdc thffc hien dffdi hffdng dan eua sieu am, nhu anh hay MRI ^•^\
Sinh thiet vii ed ho trd thiet bj hiit chan khong (VABB) cdn dffde sff dung de lay toan bp nhffng khoi u lanh tinh nhff bffdu sdi tuyen, bffdu nhu, viem vu ed kich thffde khdng Idn hdn 3em. Nhff vay benh nhan se tranh dffdc mpt eupe mo hd, khong bj seo. Dieu nay dgc biet cd ldi khi benh nhan cd nhieu khoi u d vii.
So vdi ky thuat sinh thiet ldi- kim (core biopsy) thi Sinh thiet vii ed ho trd thiet bj hut chan khong (VABB) se lay dffde nhieu mau mo hdn, trpng Iffdng mau mo idn hdn, do dd kha nang xac djnh ehinh xae chan doan mo hpe bao gom ehan doan hda mo mien dich se ehinh xae hdn.
Ngoai ra, Sinh thiet vii cd ho trd thiet bj hut ehan khong (VABB) dffdi hffdng dan eiia Nhii anh va MRI la phffdng phap sinh thiet duy nhat hien nay dffdc sff dung cho nhffng trffdng hdp khoi u bj vi vdi hda, klidi u nhd, khoi u d vj tri khd.
3.2 Cau tao may Sinh thiet vii ed ho trd thiet bj hut chan khdng (VABB)
1. He thdng may sinh thiet chin khdng vu - He'thong th_an may
- Bd dieu khien - Cdng t^c chan - Binh hut 2. Kim sinh thiet
- Kich thffde chung: Chieu dai: 369.5mm;
Chieu dai mui kim: 109.0mm - Model : BXC145/ 8G - Model: BXC140/ lOG
VIETNAM MEDICAL JOURNAL N°1 - MARCH - 2018 IV. OWG OgNG VABB"mONG BENH L^TUYEN VU
Trffde khi thffe hien bat ky sinh thiet ton thffdng vii khong sd thay dffdi hffdng dan eiia hinh anh, nen thffe hien khao sat hinh anh hoc day dii, bao gom nhD anh vdi cac the chup bo sung hoae sieu am. Dieu nay nham muc dieh tranh sinh thiet eac anh gia do hien tffdng ehong hinh tren nhO anh hoae eac vi vdi hda phan tan nhutig bi danh gia la ket chum. Neu khdng nhan ra hinh anh bat thffdng ro rang dd khong phai la mpt ton thffdng that sff trffdc khi sinh thiet, ket qua giai phau benh lanh tinh se dffdc cho la khong tffdng hdp va se dffa den mpt can thiep khac de bo sung.
Ket qua nhij anh, sieu am va MRI cd the dddc phan loai theo mffe dp nghi ngd ac tinh bang each sff dung bang phan loai BI-RADS ciia ACR.
Ooi vdi nliii anh, tren tat ea ket qua nhu anh phai ed danh gia xep loai cuoi eung theo luat chuan hoa chat Iffdng nhu anh (MQSA). Odi vdi sieu am hay MRI, mae du khdng yeu cau cd danh gia xep loai cuoi eiing, cae xep loai nay van hffu I'ch de nhan djnh sff phu hdp ciia ket qua sinh thiet va de ehuan hda dieu trj''''.
Xep loai cuoi eung ciia nhu anti bao gom:
*BI-RADS 1: Nhu anh binh thffdng;
*BI-RADS 2: Dau hieu lanh tinh;
*BI-RADS 3: Cd the lanh tinh, de nghj theo doi vdi khoang each ngan;
•BI-RADS 4: Nghi ngd ac tfnh;
*BI-RADS 5: Rat gdi y ac tfnh;
*BI-RADS 6: Hinh anh tren benh nhan ung thff da biet;
*BI-RADS 0: Can danh gia them hinh anh bo sung hoae so sanh vdi eac phim trffdc dd.
Phan loai BI-RADS danh cho sieu am va MRI tuyen vu sff dung eiing mpt he thong vdi nhu anh. Hau nhff tat ca nhffng ton thffdng khong sd thay xep loai 4 va 5 can sinh thiet cung nhff tdn thffdng xep loai 3 d eae benh nhan qua lo au.
1 Chi dinh ap dung VABB - Khoi ton thffdng nhd - Bien dang eau true - Vi vdi hda
- Ton thffdng dang tuyen va dang nang Nhffng bat thffdng khuyech tan khdng ehuyen biet
- Cae nang phffc hdp va apxe
- Ket qua sinh thiet loi-kim nghi ngd hay that bai - Cit bd nhOtig ton thffdng lanh tinh 2 VATO dac biet iJtKi dung cho cac bfnh nh3n
*Khuyen cio ip dung VABB thay vi'slnh thiet Idl-kim. Chan doan phan loai BI-RADS loai 3 hoac not tdn thffdng 4A:
- Benh nhan khdng cd kha nang theo doi thffdng xuyen
- Benh nhan dff djnh ed thai - Benh nhan lo sd qua mffc
- Benh nhan cd ton thffdng tang kich thu'dc trong qua trinh theo doi
- Benh nhan cd nhffng trieu chimg ehii quan hoac dau vdi tdn thffdng BI-RADS 3 den 4.
*Khuyen cao ap dung VABB thay vi mo - Nhffng ton thffdng vii sd thay dffdc chac ehan, nhffng ton thffdng khdng chac chan gay b au eho benh nhan.
- Khdng ket luan dffdc giffa ket qua lam sang va nhu anh, MRI.
- Tien sff gia dinh manh ve ung thff V. CAC B U d c c a BAN TRONG THU'C HANH VABB TUYEN VU
1. Trong khi thffc hien, benh nhan se nam trong tff the thoai mai tren ban mo va dffdc gay te d vj tri danh dau sinh thiet.
2. Dffdi sff hffdng dan ciia sieu am, kim sinh thiet se dffdc d u ^ vao vii d vj trf danh dau qua mdt vet rach rat nhd.
3. Khi kim sinh thiet dddc dffa vao dung vj tri ngay dffdi khdi u, se hiit va cat mau md eua ithoi u. Tuy theo tffng trffdng hdp, khoi u se dffdc lay mpt phan hoac toan phan de iam xet nghiem.
4. Sau khi sinh thiet hoan tift, vet rach ddn se dutfc ddng lai bang bang ep ma khdng ran phai khau v ^ ffiffdng. Bang se duWc ttiao ra vao ngay hom sau.
5. Benh nhan ed the ve sau khi nghi ngdi khoang i g i d . Benh nhan ed the trd lai hoat dpng binh thffdng nga^ trong ngay, nhffng nen tranli eac hoat dong the Iffc manh trong 24 gid dau. - 6. f r o n g trffdng hdp nghi ngd khoi u aetlnh, bae sT se thffc hien viec danh dau vj trf vu^ sinh thiet bang mieng danh dau HydroMARK de thuan tien cho viec dieu trj tiep tuc (neu can thiet) sau khi ed ket qua xet nghiem te bao hpc.
=^Cac each tiep can sinh thigt vu VABB:
Cach tiep can (hffdng dam kim) nen song song vdi thanh ngffc cang tot de tranh sd suat dam kim_ vao thanh ngffc va kha nang tran khi mang phdi. Trffdc khi sinh thiet, nen sieu am vung co tdn thffdng tren hai mat eat. Neu ed bat ky nghi ngd gi vf du ton thffdng la mdt nang hon hdp, ta cd the choc hut thff. Vi vijng sinh thiet da dul^
sat triing va gay te, neu can cd the chuyen tO' chpe hut sang sinh thiet loi-kim. Benh nhan dffdc dat d vj tri thoai mai, vdi canh tay ciling ben dat tren dau. Dieu nay se giiip cho da hd cang giiip dffa kim vao de dang hdn. Oat benh nhan nam nghieng mdt ben ben hay d mpt vi the hdi chech ed the tam di chuyen tdn thffdng ra xa
TAP CHi Y HOC VigT NAM TAP 464 - THANG 3 - SO 1 - 2013 thanh ngffc va thu ngan khoang each tff da
den tdn thffdng. Oieu quan trpng la bae sT lam thii thuat sinh thiet cung nhff benh nhan deu cd dffde mdt tff the thoai mai.
^ *Ky thuat sinh thiet vu VABB: Cae thiet bj ho t i d hut chan khdng, cd dinh hffdng va ram tay da dddc phat trien de sff dung cho sieu am.
Nhffng thiet b| nay rat chinh xae va hffu dung khi can sinh thiet mot khdi Iffdng idn md hoac khi lay hoan toan tdn thffdng. Oieu bat ldi duy nhat khi sff dung cac thiet bj nay la chi phi cao. Ky thuat sff dung eae thiet bj nay tffdng tff nhff sung sinh thiet tff ddng. Tot nhat la dau dd sieu am phai dddc dat d bd sau ciia tdn thffdng de bong Iffng sieu am khdng che khuat khoi bffdu.
Vj tri ciia kim dao ddng nhe oiu^ cac thiet bj, nhffng vi tri sau khi ban lay mau eua khac eiia kim trocar lay mau phai nam trong ton thffdng.
Tliiet bj eho phep lay ra dffdc nhieu m l u va benh pham dffdc lffu trff trong mdt buong chffa md.
Chu^ xac djnh dffdc so Iffdng cac loi md sinh thiet la bao nhieu de dam bao la sinh thiet dii bang cae thiet bi ho trd hiit ehan khdng, tuy nhien can Iffu y rang khi sinh thiet bang thiet bj tff dpng vdi kim 8 hoae 10 Gauze thi mau md sinh thiet dffde cd the tfch idn hdn. Ldi the chi'nh cua eae thiet bj ho t r d hut ehan khdng la ed the lay het bffdu, vi vay khdng thay bffdu con lai.
Phffdng phap nay khdng the thay the cho phau thuat md lay bffdu vi khdng danh gia dffdc tinh trang ria dien eat (trong trffdng hdp bffdu ae tinh). Tuy niiien, day la mot phffdng phap dffdc lite ehpn de loai bd bffdu sdi-tuyen hoac cac budu lanh khac neu can. Sau khi sinh tliiet cd the dat vat danh dau vdi mpt trong hai loai thiet bi, hoac thong qua mpt kim dong true hoae vdi mpt kim rieng biet.
VI. TAI BIEN CO THE XAY RA, BIEN PHAP XU* LY Cac bien chffng ciia sinh thiet loi-kim la khdng thffdng gap va hiem khi nghiem trpng.
1 Chay mau: tff mffc dp khd cam mau cho den hinh thanh khdi mau tu la bien ehuYig thffdng gSp nhat va da dffdc b^o cao ft hdn 3%
cac trffdng hdp sinh thiet bang cac thiet bj ed ho trd hut chan khdng vdi kim 11 Gauze. Cd (he vo y cat hay sinh thiet phai mot mach mau.
A'tf'i^; Trong hau het cac trffdng hdp, ciam mau cd the dat dffdc bang each ep vao viing dd tff 10 d^n 15 phut. Mac dii mdt sd ndi bang ep dio lam sinh thiet, dieu nay ndi chung la khdng can tfiiet. Trong nhffng trffdng hdp cam mau
\fh6 kh3n, dieu nay cd the hffu feh. NhiJYig benh nhan cd ehay mau keo dai hoac cd mpt khoi mau tu thay dffdc tren nhii anh chup sau thii thuSt
nen dddc thdng bao rang hp cd the sd thay mdt khdi bat thffdng sau khi sinh thiet.
2 Nhiem trung: la bien chffng khdng thffdng gap sau sinh thiet, mac du ed the xay ra neu ky thuat khdng dam bao vd triing. Nhiem triing thffdng xay ra nhieu hdn tren benh nhan tieu dffdng.
Xd ly: Ky thuat dam bao vd triing, dieu chinh dffdng huyet dn cho cac benh nhan ed tieu dffdng.
3 Sinh thiet t h i i t bai: Dieu nay cd the xay ra neu sinh thiet khdng dung wi tri, benh nhan di chuyen trffde khi dffa kim vao hoac dat kim chu^
den vj trf toi ffu. Phan tfeh cae iy do lam sinh thiet that bai ddi vdi cac tdn thffdng vdi hoa, ngffdi ta tim ra nguyen nhan sau day: Khi tdn thffdng nhd hdn hoae bang 5 mm, khi cac vdi hda thupc dang vd djnh hinh, hoae khi sung sinh thiet dffdc «ban» ben ngoai tuyen vii. Cac tac gia khac xae djnh rang chay mau nhieu cung la mpt yeu to gop phan vao that bai cua viec sinh thiet ton thffdng vdi hda.
Xdiy: Nen chup X quang benh pham thffdng qui de xac dinh vdi hda trong mau md da sinh thiet. That bai trong lay cac vdi hoa trong mau sinh thiet khdng ehi phy thudc vao so Iffdng mau md sinh thiet, ma edn phu thudc vao viec da sff dyng loai he thong sinh thiet nao. Cac bao cao clio thay ti le that bai khi sinh thiet eac ton thffdng vol hda la 16% khi sff dyng sung sinh thiet tff dpng 14 Gauze, trong khi la 1 % ddi vdi he tiiong ho trd hiit chan khong VABB kim 11 Gauze.
4 Sff tu'dng hdp giu'a cac dau hieu tren nhu anh va ket qua sinh thiet: la bat budc.
Day la trach nhiem ciia bac sT thffe hien sinh thiet. Neu cac thii thuat nay dddc thffe liien bdi mpt bac si phau thuat ket hdp vdi mot bae si hinh anh hpc tuyen vii, nen phan cdng trach nhiem tim sir tffdng quan giffa cae dau hieu. Cac bao cao cho thay bat tffdng hdp thffdng xay ra trong trffdng hdp sinh thiet cae vol hoa nghi ngd hdn la sinh thiet cac tdn thffdng dang khdi.
Xdiy: Neu sinh thiet khdng thanh cdng hoae ket qua khdng phii hdp, co the lam lai sinh thiet bang nhu anh djnh vj tpa dp hoac sinh thiet md.
5 Che dp theo doi: Theo ddi tren nhu anh la thffdng qui neu ket qua sinh thiet lanh tfnh.
Thffdng thi chup 6 thang sau khi sinh thiet, Trong phan Idn trffdng hdp, khdng cd roi loan cau true tuyen vu tai vj tri sinh thiet. Lamm va Jaekman bao cao 5 trong 226 (2%) trffdng hdp sau khi sinh thiet dffdi hffdng dan dinh vj tpa dp vdi thiet bi ho trd hut ehan khdng VABB kim l i Gauze thay dffdc mpt mat dp bat thffdng tren nhu anh. Neu cd ty mau sau phau thuat, dieu nay cd the keo dai.
Xd ly: Ngffdi ta de nghj sff dung sieu am 135
VIETNAM MEDICAL JOURNAL N ' l - MARCH - 2018 hoac MRI de theo ddi vdi khoang thdi gian
ngin neu sinh thiet da dffdc thffc hien dffdi hffdng d i n ciia sieu am hoac MRI.
6 Chan doan a m tinh gia: cd the xay ra.
Khi sinh thiet dddc thffc hien dffdi hffdng dan cua sieu am, nguyen nhan ^thffdng lien quan tdi sai sdt ky thuat hoac lay mau, khonp nhan ra sff bat tffdng hdp giffa mo hpc va chan doan hinh anh hoac bat tffdng hdp giffa sieu am va nhu anh, hoae khdng tiep tuc theo doi benh nhan trong trffdng hdp ket qua sinh thiet lanh tinh'^'.
Xdly: Neu ket qua sinh thiet khdng phii hdp hoac nghi ngd, bao gdm tdn thffdng dang nhii hoie tang san tieu thiiy, nen sinh thiet iai. Neu ket qua sinh thiet loi-kim dffdi hffdng dan eiia sieu am la lanh tfnh thi sieu am lai 6 thang sau khi sinh thiet va sau do la moi nani mpt lan trong 2 nam ke tiep de dam bao la ton thffdng dn djnh tren hinh anh hoc.
VII. i g l DIEM CUA SINH THIET VU VABB TRONG TON T H U O N G TUYEN VU
- De tiiffc hien
- Xam ISn tdi thieu (khdng seo, gay te tai eho, khdng can benh nhan nam vien)
- Giam chi phi eham sdc sffc khde - Ket qua rat tot
- Ti le bien ehffng thap (3-5%) - Cd the lam lai neu can VIII. KET L U A N
Viec ap dung he Widng sinh thiet loi-kim cd ho trd may hut clian khdng (VABB) giup cho ehan doan sdm cae tdn thffdng nghi ngd ung
thff vu ngay ca khi khdng sd thay. Ngoai ra ii|, thdng nay cOng giup dieu trj cac ton thffdng lanh tfnh khac ciia vu nhff bffdu sdi tuyen, u nang tuyen vii...ma khdng can phai phlu ^ u l t . Ngoai ra, viec chan doan va dieu trj ton thffdng tuyen vu bang he thong smh thiet loi-ki|^
ed ho trd may hut chan khdng (VABB) cdn g ^ quyet noi io ve tham my cho benh nhan. Vdi viec thffc hien qua mpt kim rat nhd, phffdng phap nay khdng de lai seo. Do vay ehiing ta can xem xet ffng dyng ky tiiuat nay d eae cd sd dieu tri trong nffdc.
TAI Ll|U T H A M KHAO
1. AIonso-Bartolome P, Vega-Bolivar A, Torres- Tabanera M, et al. Sonographicaiiy guided U-G directional vacuum- assisted breast biopsy as an alternative to surgical excision: utility and cost study in probably benign lesions. Acta Radiol 2004:
45:390-396.
2. American College of Radiology. ACR Brea^j Imaging Reporting and Data System (BI-RADSjf- breast imaging atlas. Reston, VA: American Coiitg^' of Radiology, 2003.
3. Brem RF, Schoonjans JM, Goodman SN, et al.
Nonpalpable breast cancer: percutaneous diagnosis with 11- and 8- gauge stereotactic vacuum-assisted biopsy devices. Radiology 2001;219:793-796.
4. Cho N, Moon WK, Cha JH, et al. Sonographkally guided core biopsy of the breast: comparison or 14-gauge automated gun and 11-gauge directional vacuum-assisted biopsy mettiods. Korean J Radit^
2005;6:102-109.
5. Savitii Krishnamurthy, Rache M. SmmoDK
"Pathology of the fcweast and Qinica! managemenf;
KuereKs Breast surgical oncology. 2010 by "HB McGraw-Hill Companies, Inc. 155-164.
LIEN QUAN GIO'A OSTEOCALCIN HUYET THANH VA CHUYEN HOA GLUCOSE 6- BENH N H A N DAI THAO DirCTNG TYPE 2
Ngd Dire Ky*, Doan Van De**, Dang Hdng Hoa*'
T 6 M TAT
f)St van tfe: Osteocalcin diidc san xuat bdi te bao osteoblast la t§ bao duy nhat bai Jiet co vai tro dieu hoa chuyen hoa khoang cua cd the, no co vai tro lam iSng dgng chat khoang trong xu'dng. Osteocalcin hoat dgng nhU mgt hormone trong ctJ the, no kt'ch thfch te bao beta tyy tiet insulin, dong thdi kich thich te bao
*Senh vien hOU nghi da khoa Nghe An
**Benh vien 103
***Benh vien E Hi Ngi Chju trach nhi|m chinh: Ngo Dffc Ky Email: [email protected] Ngay nhan bai: 26.12.2017 Ngay phan bien khoa hpc: 29.2.2018 Ngay duyet b^i; 6.3.2018
m9 giai phong hormone adiponectin la ehat lam Sng nhay cam vdi insulin. Phu'cfng phap nghien cffu:
ngliien CLTU mo ta cat ngang 151 benh nhan dai ttiao dUcfng type 2 so sanh vdi nhom chuTig la 67_,ngu'5i khong bi dai tfiao dffdng tu'dng dong ve dp tuoi. Ket qua nghien cu^: nong do Ostecalcin d benh nhan DTD type 2 (1,88 ± 1,21 ng / I) thap hdn co y ngh'a thong ke (p <0,01) so vdi nhffng ngUdi khdng co benh (2,52 ± 0,93 ng / I). Phan tich hoi quy tuySn tinh da bien cho thay nong dd osteocalcin huyet thanh ra tffdng quan nghich vdi HbAlc (p = -0.243; p = 0.02) va H0MA2-IR (p = - 0.243, p = 0.015) d b§nh_dai ttiao dffdng typ 2. Co su" tffdng quan thuan giffa nong do osteocalcin va ehffc nang te bao beta tuy (H0MA2-
% ^). Ket luan: Ndng dd Osteocalcin lien qiM nghich vdi HbAlc va H0MA2-IR d benh nhan b a dudng typ 2
Tdkhda: Osteocalcin, HbAlc, H0MA2 - IR 136
