NGHIEN CUtF HINH THAI TON THlTONG TAI CHO (T) CUA UNG THU" THANH QUAN TRONG vASAU MO
TongXudn Thang TOM TAT
Ddnh gid, phdu tich b^nh phdm ung thu thanh qudn sau mo de rut kinh nghiem vd dieu tri hgu phdu. Muc tiiu: Phdu tich vd ddnh gid hinh thdi ton thucmg tgi cho cda ung thu thanh qudn trong vd sau mo di dua ra chi dinh tia xg vd hda chdt phii hop . Boi tirg^g Phtrang phdp: Gom 34 b$nh phdm duac phdu tich vd xet nghiem MBH sau md. Hen ciru, md td timg truang hop. Ket qud vd bdn lu^n: tuoi trung binh 52.9 ± 8,9, nam giai ( 97%), nic (3%) MBH Id ung thu bieu mo vdy (100%). Ton thuang dgi thi tgi cho sau mo: hinh thdi siii vd loet phoi hap 19/34 binh nhdn, tdn thuang cd 3 tdng thanh qudn 13/34 benh nhdn Thai gicm tie khi sinh thiit din khi phdu thudt. 55,9% trong khodng 2 tudn. Ket luan : ung thu bieu mo vdy (100%). siii vd loet phdi hap (44,1%).
Tir khda: Ung thu thanh qudn, Tdn thuang tgi cho sau mo SUMMARY
Evaluation for local lesion of laryngeal carcinoma for operation are most importance Objective Dissection and evaluations of the lesion of laryngeal carcinoma at in and post operation Materials and methods: Case study, of 34 patiens of the laryngeal carcinoma . Results: average 52,9 ± 8,9. Squamous Celle Carcinoma (100%) Forms vegetable growth and ulcers 44,1 %. Extension of the all tree laryngeal sites (sub glostic, glostic and hypoglostic) 13/34 cases .Times from biopsy to operation in 2 weeks (55,9%). Conlusion : Forms mixt (vegetable growth and ulcers) 44,1% in the lesions of laryngeal cancer.
Keys words:. Laryngeal carcinoma.
1. D^T VAN DE tich vd ddi chiiu tdn thuang tgi cho sau mo , , . . , . 1 1 . : : - • »' u de dua ra chi dinh tia xa vd hoa chdt sau Ung thu thanh quan la khoi u ac tinh
xuit phat tir lop bi^u mo cua thanh quan.
Xu huong la phiu thuat bao t6n t6i da chuc 2. DOI TlTONG VA PHlTONG PHAP nang cua ca quan . Phau thuat luon gap NGHIEN ClTU
mlu thuln giua muc tieu l^y hk benh tich j . i . G6m 34 benh nhan co du tieu chuAn va kha nang giu dugc chiic nang cua ca j ^ ^ ^^^^ ^..^ ^^ ^ ^ . ^ ^..^ j ^ quan. Danh gia t6n thuang tai cho chinh ^~. ^^^^ ^^^ ^ ^ ^ ^ 1/3/2012 xac truac, trong va phau tich benh phmn ^j^^ ^^ 30/9/2012. Benh nhan duac sau mo giup kinh nghiem cho chi dinh dieu ^^^ ^^^ ^^^ ^ . ^ ^^ ^^^ ^j^^ ^^^
tri hau phau thich hgp. De tai "Nghien cuu ^ ^ ^ ^ ^ . ^.^ ^^^
ton thuang tai ch6 (T) cua ung thu thanh
quan trong va sau m6" vai muc tieu sau: 1) 2.2. Tien curu mo ta cat ngang tung ca co Ddnh gid hinh thdi tdn thuang tgi cho cua can thiep.
ung thu thanh qudn trong luc md. 2) Phdu ' B6 mon TMH, DHY Hi N6i
N h ^ Mi 20.2.2013. Duyltb^i 5.3.2013 ^
Tap chl Tai MQi Hgng Vi^t Nam - Volume (58-14). N°2 - Apr, 2013
2.3. Cac ngi dung nghien cim: Ddnh gid ton thuang tgi cho trong vd sau phdu thugt: Voi cac b?nh nhan c5t bdn phhn, trong mo ddnh gid ton thuang tai chS \h vi tri, hinh thdi, dp lan trdn vd xam lan. Voi cdc b?nh nhan cdt todn phan, trong mo ddnh gid dp lan tran ciia ton thuang ra vimg hg hpng.
Sinh thiet lam giai phau b?nh cdc vj tri nghi nga bi xam lan. Xu ly so li?u bdng phan mem SPSS 18.0 Doi chieu ket qud lam sang, npi soi, Panendoscopy, chup CLVT voi bfnh pham sau mo tinh ra gid tri Ace ( dp chinh xdc cua chan doan). Ace (%)=
(Duong tinh that + Am tinh that)/
tong so benh nhan 3. KET QUA
3.1. Phan bo lira tuoi v^ gioi mdc benh Do tu6i 40-60 tu6i chi^m toi 76,5%.
Tu6i trung binh: 52,9 ± 8,9 tu6i, Benh nhan tre nhat: 36 tuoi. Benh nhan lan tu6i nhdt: 77 tudi. Nam ( 97%), nii (3%) 3.2. Ket qua phau tich ton thirong sau phau thuat
3.2.1. Ket qud mo benh hpc sau phdu thuat
Bang 1. Ket qua m6 b§nh hpc sau phlu thu$t
Bdng 2. T6n thuong dgi thS cua khoi u sau phlu thu^t
Mo benh hpc Bilu m6 vSy Bieu md tuyen Kh^c N
n 34 0 0 34
%
100 0 0 100 Ung thu bieu mo vdy 100% , trong do CO 1 benh nhan co ket qua mo benh hpc la ung thu bieu mo tai cho.
3.2.2. Ton thirong d^i the cda khdi u sau phau thuat
Hinh th^i Si:ii Lo«
Tham nhilm Ph6i ho'p
n 14 1 0 19
41,2
%
2,9 0 55,9 C614 bpnh nhan Id hinh thdi sui. 1 loet c6 gid mac. Khong co benh nhan ndo co ton thuang tham nhiem don thuan . Phan 16n b?nh nhan c6 ton thuong dai the ph6i hpp 19/34 (55,9%).
3.2.3.Bdnh gid ton thu-ffng tgi cho cua UTTQ sau phdu thugt
Bang 3. Vj tri lan trdn cua t6n thuong sau phdu thudt Vitrl
Thanh mfln
Thanh mfln thu-ang thanh m6n Thanh mdn ha thanh m6n 3 ting thanh quan Ngodi thanh quan N
n 8 7 4 13
2 34 Sau phdu thuat: 8 b?nh phdm chi co ton thuong tai thanh m6n. 7 t6n thuong thanh mon va thupng thanh mon. 4 ton thuong thanh mon va ha thanh mon. 13 ton thuong cd 3 tang thanh qudn. 2 benh pham c6 ton thucmg lan ra ngoai thanh qudn
Phan dp ton thutmg tai cho sau phau thu^t
Bdng 4. Phdn 66 t6n thuong sau phau thudt
Tia Tib T2 T3 T4a N
n 2 4 10 16 3 34
5,9
%
11,8 29,4 44,1 8,8 100
Tap chl Tai MQi Hpng Vi$t Nam - Volume (58-14). N°2 - Apr., 2013
Sau phiu thu^t 15/ 34 co phan giai doan tdn thuong T3 chiSm (44,1%).
Khoang thoi gian tir khi sinh tbi^t dirong tinh den khi phlu thuat Bang 5. Thd'i gian tCj- khi sinh thilt (3ln
l^hi phiu thu^t Th&i gian
s 2 tuin 5 4 tuan
> 4 tuan N
n 19 13 2 34
%
56.9 38,2 5,9 100
Khoang thoi gian tit khi sinh thiet den khi phau thudt: 2/34 benh nhan mat > 4 tudn.
13/34 (38,2%) mat tir 2 d^n 4 tudn.
19/34(55,9%) tiong khoang < 2 tudn.
BAN LUAN
4.1. Ket qua mo benh hoc sau mo.
Trong nghien cuu cua chung toi, tat cd cdc benh nhan d§u c6 ket qua mo benh hpc la ung thu bieu mo vay. Chiing toi khong gap cdc ung thu loai te bao khac. Nguyen nhdn do ung thu bieu mo vdy Id hay gap nhdt trong UTTQ. Theo Raitiola, ung thu bi^u mo vay chilm khoang hon 90% [8].
Co nhiing nghien cuu co ti le gap tdi 95%- 96% [9]. Cac thi khdc hilm gap. Ung thu bilu mo vdy tai ch6 va ung thu bieu mo vdy Verrucous chi chiem ti nho.
4.2. Danh gia t6n thu-vng tai chS sau phau thuat
4.2.L Tdn thu-ong dgi thi cua khSi u Qua kit qua nghien cmi thiy c6 14 benh nhan co bilu hien siii don thudn . Phdn Ion t6n thuong tai cho ciia UTTQ c6 hinh thai tin thuang phii hap 19/34 benh nhan. Khii u trong UTTQ thuang c6 tin thuang siii (31/34 benh idian). Voi nhimg khoi u siii lan lam han chl viec danh gia vi
tri ton thuong bdng cac phuang tien thdm kham truoc mo nhu npi soi gidn tiep bang optic 70" tru6c ml, npi soi ong mim. Vi?c soi tr\rc tiep \6i cdc dung cy ho trp ( bay thanh qudn, ong hiit) co thi phan ndo khdc ph\ic dupe kho khdn nay. Tren the gioi cimg nhu 6 Viet Nam hdu nhu c6 rat it cdc nghien cuu ve hinh thai ton thuong trong UTTQ md cdc tdc gia chu yiu nghien cuu ve ket qua dieu tri UTTQ vi vay chiing toi khong CO so lieu de doi chieu so sdnh 4.2.2. Bdnh gid ton thirong tgi cho sau
phdu thugt
Sau phau thuat chiing toi thay co 8 b?nh nhan bi ton thuong tang thanh m6n don thuan, 7 benh nhdn ton tiiuong thanh mon- thuang thanh mon, 4 b§nh nhdn ton thuong thanh mon ha thanh mon, 13 benh nhan co ton thuong cd 3 tang thanh quan.
Theo Bailey, phdn lan UTTQ tdng llianh mon CO 20% lan len thuang thanh mon, 20% lan xuing ha thanh mon va khodng 25% lan ra mep truoc [66].
Theo ket qua nghien cuu, chiing toi co 2 benh nhan a giai doan Tia, 4 benh nhan a giai doan Tib, 10 benh nhan a phdn dp T2 vd 15 benh nhan a phdn dp T3 va 3 benh nhan co phdn dp T4a.
4.2.3. Th&i gian tir khi smh thih t&i khi duac den hdnh phau thugt
Co 55,9% benh nhan duoc phau thudt sau sinh thilt trong vong 2 tudn, co 38,2%
truang hop benh nhdn dupe dieu tri sau 2-4 tudn, va co 2 benh nhan dupe dieu tri sau khi > 4 tuan.
Nhu vdy, phdn Ion benh nhan dupe bat ddu diiu tri trong khoang thoi gian < 2 tudn. Trong 2 truong hpp benh nhdn dupe diiu tri sau khi co kit qud gidi phdu benh
> I thang CO 1 benh nhan do benh ly tai
Tgp chl Tai MQi Hpng Vi$t Nam - Volume (58-14). N°2 - Apr, 2013
phii nen dd dupe tri hoan de dieu trj b?nh phii truoc khi tiln hdnh phau thudt.
KET LUAN
1. Mpt si ddc diem dich te hpc: Tuoi:
Ilia tu6i gdp nhilu nhat 40-60 tuoi, tuoi trung binh 52,9 ± 8,9 . Gidi: nam gioi ( 97%), it gdp d nir ( 3%).
2. Ton thuong tgi cho sau mo + Dai thi: chu yeu gdp hinh thdi ton thuang phoi hpp 19/34 benh nhan
+ Vi thi: 100% b^nh nhdn c6 kit qud MBH la ung thu bieu mo vdy
+ Phdn Ion benh nhan cd ton thuang cd 3 tdng thanh qudn 13/34 benh nhdn
- Thdi gjan tir khi sinh thiet den khi phau thuat: 55,9% trong khodng 2 tuan
TAI LIEU THAM KHAO 1. Pham Van Him (2009), Nghien cuu
hinh thdi lam sdng. noi soi vd doi chieu v&i ket qud phdu thugt cua ung thu thanh qudn giai dogn som, Luan vdn tot nghiep BSNT benh vien, Dai hpc Y HdNpi.
2. Nguyin Hoang Huy (2005), Nghien ciru Idm sdng vd bien ddi thanh dieu a benh nhdn ung thu thanh qudn, Ludn van tot nghiep bdc sy npi tni, Dai hpc Y Hd Npi.
3. Bill Vilt Linh (2002), Nghien cuu dgc diem Idm sdng. can lam sdng, kit qud dieu tri ung thu thanh qudn bdng phdu thudt vd xg tri, Luan vdn thac sy y hpc, Dai hpc YHd Npi.
4. Nguyen Dinh Phiic va cs (2005), "Ddc diem lam sdng vd ket qua dieu tri phau
thuat ciia ung thu thanh quan ha hpng tai khoa Ung Budu Benh vien Tai Miii Hpng trung uong tir 2000-2004", Ky yiu cong trinh nghiin cuu khoa hoc
Tai Mm Hpng todn quoc 2005.
5. Nguyen VTnh Todn (2007), Nghien ciru d^c diim Idm sdng, chup cat l&p vi linh ciia ton thuang ung thu thanh quan doi chieu vai phdu thudt, Ludn van tot nghipp BSNT b^nh vien, Dai hpc Y Hd Npi.
6. Tudc Tran Hihi (1984), Ung thu hg hpng thanh qudn, Nhd xuat ban Y hpc HdNpi.
7. Firat Y, Aygenf E, Firat AK, Oto A, Selpuk A, Firat MM, Ozdem C (2006),
"Computed tomography virtual laryngoscopy: comparison between radiological and otolaryngological evaluations for laryngeal carcinoma".
Kulak Burun Bogaz Ihtis Derg. 16(3), p. 77-104.
8. Chawla Sharad, Andrew Simon Carney (2009), "Organ preservation surgery for laryngeal cancer". Head & Neck Oncology. 1, p. 1-12.
9. Davidson J Gilbert R, Msh J, Witterick I, Brown D, Birt D, Freeman J, Gullane P (2000), "The role of panendoscopy in the management of mucosal head and neck malignancy-a prospective evaluation". Head Neck Oncol. 22(5), p. 449-455.
10. William B. Armstrong, David E.
Vokes, Robert H. Maisel (2010),
"Malignant Tumors of the Layrynx", Cummings otolaryngology- head
&neck surgery, Mosby, tr. 1482- 1511.107
