T C N C Y H P h y trUdng 8 0 ( 3 B ) - 2 0 1 2
mucous membranes and STIs In HIV/AIDS infected people In Hal Phong In 2009 was 15%. If detected early and promptly treated of these infections, will surely contribute to prolong the longevity and improve the quality of the life for people with HIV/AIDS. Over time of research on 1.733 patients with HIV/AIDS who had the skin, mucous membrane diseases and STIs at Dermatology Center of Hai Phong city from July 2008 to August 2010, the results show that 77% patients had the skin, mucous membrane diseases, 20% of patients had STIs and 3% of patients had both groups skin diseases and STIs. Our research also shows that the skin, mucous membrane diseases In HIV Infected people were most common prurigo (32%), herpes zoster (8.9%), seboirtioic dermatitis (6.9%). The most common STIs were condilomata acuminata (15%) and herpes simplex (1.2%), gonorrhea (1%), syphilis (0.5%). All basic lesions of HIV infected patients are the same basic lesions of patients without HIV/AIDS infection. But in HIV infected patients, clinical manifestations are more frantic, and with certain rare diseases.
K e y w o r d s : HIV, A I D S , STIs
K^T QUA Dieu TR! UNG THU' DU-QNG VAT BANG PHAU T H U A T MOHS TAI BENH VIEN DA LlEU TRUNG WONG
Nguyen Sy Hoa
Bpnh vipn Da li^u Trung tfongNghiin ciru dupe thpv hiin nhim dinh gii kit qui tim sing, tim ly ngudi binh sau phiu thuit cit bo doan ducmg vat do ung thu ti bio ga/ bing phiu thuit Mohs Kit qui eho thiy 13 trong si 23 tnrdng hpp ung thu ti bio vay duong vit dupe phiu thuit theo phuang phip Mohs. 69.9% bpnh nhin tren 50 tuii.
Sau 19 thing theo ddi, khing cd truirng hpp nio tii phit. Bpnh nhin thoii mil, hai ldng han tmng sinh hdpt nhu tiiu tiin, quan hi tinh dpc: chua cd trudng hpp nio trd tpi dd tii phat. Phiu thupt cit dopn duang vit dd ung thu ti bio viy theo phuung phip Mohs mang ipi nhiiu uu diim nhu giO- duvc tii da dogn duung vpt sau cit bd ti chirc ung thu. boat dpng tinh dpc, tiiu tiin tit han cac phuang phip khae. Tim Ijr ngudi bpnh duvc eai thipn han. it mie cam han.
T i r k h o a : U n g t h u ' du'O'ng v a t , u n g t h i r te b a o vay.
I. OAT V A N B 6 duang v^t Id ung thy t l bSo vay, thydng ggp Ung thu dyang v$t 14 mpt logi u I c " " 9 " ' * ' * " ' " * • ' " * ' '™"9 " ' * " "^ " 9^P '^°'"
tinh cd kha nang di can din cac ca quan phG " " 9 " ° ' ' '''*• ^ '"'? *^ "=30 nyde Tay Au, ung tgng gay ti le tCr vong cao. Tren 95% ung thy " i " tlfong vgt chllm khoang 0,4 - 0,6% cac
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T C N C Y H P h y tri/dng 80 (3B) - 2012
logi ung t h u . 0 ede n u d e k e m phdt t h i n n h u d chau A, chau Phi, va Nam My, ung t h u d u a n g vgt c h i l m t d i 2 0 % cae logi ung t h u ac tinh.
Nhat Id d Uganda 1 % d d n ong m d c ung t h u duong v g t [ 1 ] ,
V10C dieu trj ung t h u d u a n g vgt tuy thube vao giai dogn eua b0nh. Phat hign s d m vd p h l u thugt cdt bb rgng khoi u v a n Id p h u a n g phap duyc n h i l u tac gid tren the gidi dp dyng. T r u d c day phuang phdp phau thudt eo dien thbng Ihudng Id cdt dogn d u a n g vdt g i n s d l x u a n g mu k i t h y p v d i vet hgch bgn hai ben. Tuy nhidn, trinh trgng khbng cb d u a n g vgt sau dieu tri dSi gay anh h u d n g r l t Idn den cugc song sinh hogt cua ngudi b0nh. Viee phau t h u | t dam bao logi bb toan bg t l bdo ung t h u dong thdi bao ton duyc lol da phan d u a n g vgt cbn lai Id muc tieu ciia cae thay thube lam sdng.
Phau thugt theo p h u a n g phdp Mohs (ten cua Bdc sT Frederic Mohs, n g u d i My d l xuat 1941) la cdt bb to c h u c ung t h u d u d i s u kiem sodt eiia xet nghi0m t l bdo hge trong qua trinh phau thugt nham t i l l ki0m to c h d c lanh toi da va dbng k h u y l t d a mgt lan [8]. Phau thugt Mohs d u y c dp dung chu y l u trong ung t h u t l bao d a y t l bao vay v i i n g mgt - eo nham logi bb h i t t l bao ung t h u , t i l l kigm da va to ehuc lanh toi da, dbng k h u y l t da mgt lan. Ung t h u t l bao vdy d u a n g vat, ngodi x a m l l n tgi chb, cbn cb the di can vdo cae hgch bgn, hgch tieu khung theo d u d n g bgch m g c h . Dk t i l t ki0m phin to chdc d u a n g v0t khbng bi b0nh, g i d d g ddi toi da ciia d u a n g vgt, chiing tbi da ap dyng phuang phdp phau thugt Mohs de b0nh nhdn cb t h l sinh hogt tinh dye, tieu ti0n gan n h u binh t h u d n g sau dieu trj.
II. D 6 | T U - O N G V A PHU'aNG PHAP P h u a n g phap nghien c d u : Sir dyng p h u a n g phdp nghien c u u cat ngang tren ede b0nh nhan bi ung t h u le bao vay d u a n g vat d u y e phdu thu0t cdt dogn d u a n g v0t theo p h u o n g phap Mohs, eb so sdnh k i t qua lam sang, tam ly n g u d i b 0 n h , ty 10 tdi phat so v d i cdc p h u a n g phdp cdt dogn d u a n g vdt thbng t h u d n g . tgi Khoa Laser - Phau lhu0t Vi0n Da lieu Quoc Gia, nay la B0nh vign Da l i l u Trung u a n g .
Ooi l u y n g vd thdi gian nghien c u u : 13 bgnh nhdn ung t h u t l bao vay duang v g l (phdn Idn do hgu qua ehit hgp bao quy ddu khbng d u y e bbe tach hogc cdt da quy dau t u nho) d u y e phdu thudl theo p h u a n g phap Mohs, cb so sanh v d i 10 trudng h y p khdc d u y c cat dogn d u a n g vat Iheo phuang phap Ihbng t h u d n g ve k i t qua Idm sang, ty 10 tai phat, tam ly ngudi b0nh....trong thdi gian t d 01/2008 d i n 10/2009.
Phuang phap phau thudt Mohs: Dudi gay te gbc duang vgt, garo goe duang vdt, t i l n hanh bbc tdch da khbi niem mgc, danh ddu ranh gldl to chue xui vdi viing da lanh. Cat bb to chuc ung thu sat ria Ihuang ton. Danh dau, c l t hinh vanh khan lan 2. Danh d l u mdu cdt Idn 2 ( n l u ebn t l bao ung thu), gui phbng xet nghigm, cat Ignh.
nhupm, c h d 20 -30 phiit, n l u cbn to chuc ung thu, cat t i l p l l n 3, n l u h i t to chue ung thu, dong mbm eyt duang vat, t i l n hanh vet hgch bgnh hai ben n h u cdc phuang phdp khae.
Tong h y p , thong ke theo ho s a b0nh dn ve l u l l , nghe nghi0p, tien s d bgnh, m i l lien quan t r y c tiep den b0nh, p h u a n g phap phdu thugt, theo dbi bien chdng, di can, tai phat.
TCNGYH Phg truang 80 (38) - 2012
II. K^T QUA
B^ng 1. Tinh hinh bgnh nhan dygtc phlu thugt MOHS theo t u l i
Tudi
TrSn 50 tuli 30 - 50 tuli
< 30 tuli Tong so
Ung n 16
4 3 23
t h y du'cng vgt
%
69,9 17,4 13,1
too
So BN dyg'c phlu thugt bing MOHS n % 6 37,5 4 100 3 100 13 56,5
Nhbm tuli trdn mde ung thu t l bdo vdy duang v0t eao nhlt, ehilm 69,9%; ty le thip nhlt d cdc ludi tuli dudi 30, ty 10 13%. Cb 56.5% b0nh nhdn bj ung thu te bdo vay duang vdt duyc dilu tri theo phuang phdp MOHS, trong db 100% b0nh nhdn dudi 50 tuoi duyc dp dyng dieu tq theo phuang phap ndy Dli vdi nhdng b0nh nhdn eb tuli tren 50,62,5% b0nh nhdn duye dieu trj theo phuang phdp co diln, elt toan bg duong vdt.
Bang 2. Cac phuang phap phau thugt va tinh hinh tai phat
Phyo'ng phap phau thuat
Phau thugt Mohs Phlu thugt clt gdc duong vgt
Vet hgch bgn hai ben bgn n % 13 100
10 too
Tai phat + di can xa n % 0 0 0 0
Phuang phap Mohs vd phau thugt cdt dogn bgn 2 ben) duyc thyc hi0n xen ke, thai gian theo cb bgnh nhan nao tdi phdt hogc di cdn.
IV. BAN L U A N
Nhbm tuli trdn mdc ung thu t l bdo vgy duang vgt cao nhat, chilm 69.9%; ty-10 thap nhat d cdc Ida tuoi dudi 30, ty Ig 13% (bdng 1). Theo cac nghidn euu tren the gidi, ung thu duang vgt thudng d nhdng ngudi cao tuoi.
Nghien cdu ciia Bill Mgnh Ha eho t h i y 52.2%
b0nh fihdn ung thu duang vgt d Ida lull tu 46- 65. Thanh nien chl g0p 3.6% [2].
Ung thu duang v0t It xay ra d nhung ngudi clt bao quy dlu tu nhb. Nhieu nghien cdu dd chdng minh d ngudi Hoi gido vdi phbng tyc cdt bao quy dau khi tre trai tu 4-9 tuoi dd Idm
duang vgt thbng thudng (deu duyc vdt hgch dbi lau nhat 19 thdng; it nhlt la 1 thang, chua
gidm ddng ke tf Ig mdc ung thu duang vgt d egng dong ngudi Hoi gido. Mli lien quan giua nhiem HPV (Human Papilloma Vinjs) vd ung thu duang vgt cung duyc nhieu nghien eiru tren the gidi chdng minh [5]. Tuy nhien, cachi gdy bgnh thye sy cho den nay van ebn chua duye rb rdng.
Cho d i n hl0n nay eb nhieu phuang phap dieu tri ung thu duang vgt. Nguyen tie chung Id logi bb to chue ung thu cang sdm cdng cb tidn luyng t i t [4]. Phuang phdp dilu tri n0' khoa bdng hod chat ho0c xg trj duyc dp dyng chii yeu doi vdi nhu'ng trudng hyp bgnh nhdn
T C N C Y H Phu truong 80 (3B) - 2012
khbng eb ehi djnh p h i u thu0t. Theo mgt so nghien e d u , ung t h u d u a n g vgt it ddp d n g vdi cae hod chat eung n h u tia xg v d t h u d n g tien luyng xau. Ti Ig di cdn vd t d vong cao.
P h u a n g phap t i l u u n h l t de dieu trj ung thu d u a n g vdt la p h l u thudt cdt bb lri0t d l khoi u. Dbi v d i n h u n g t r u d n g h y p k h l i u Igi chb, chi edn c l t bb khoi u v d l gidi hgn nai eat each khoi u 2cm. Cdt bb myt phan d u a n g vgt, tuang d u a n g v d i 1/3 xa thdn d u a n g vdt d u y c chi dinh eho ede k h l i u d giai dogn T l hodc T2,No. Cdt bb todn bb d u a n g v0t d u y c nhieu tac giai dp dyng doi v d i n h u n g t r u d n g h y p khoi u d giai dogn T3-T4. Phau thugt MOHS d u y c nhieu phdu thudt vibn dp d y n g tuy nhien k i t qua nghien c d u ciia tde tde gid cbn cb nhieu khac biet. Trong nghien c d u cua chiing tbi, Cb 56,5% bgnh nhdn bj ung t h u t l bao vay d u a n g vat d u y e dieu tri theo p h u a n g phdp MOHS, trong do 100% bgnh nhan d u d i 50 tuoi d u y e ap dung d i l u trj theo p h u a n g phap n a y Doi vdi nhung b0nh nhdn cb tuoi tren 50, 6 2 , 5 % benh nhan d u y c dieu tn theo p h u a / i g phdp co d i l n , cdt toan bg d u a n g vgt. Vigc duy tri mgt phan duang vdt cb y nghTa h i t s u e quan trgng dbi vdi bgnh nhan dgc bi0t Id n h d n g bgnh nhdn tre tuoi, dg tuoi ebn lam vigc, dbng gbp n h i l u cho xa hgi, cbn cb kha nang hogt dgng tinh dye, gbp phan g i d hgnh phiic gia dinh.
Nam 1985 Mohs FE va cgng s y thong bdo ket qua phdu thugt M O H S eho 29 t r u d n g h y p benh nhan bj ung t h u d u a n g vat vd tl 10 song sau 5 nam dieu trj la 6 8 % [7]. N a m 1987, Marc D. Brown vd cgng s y thbng bdo k i t qua phau thugt tren 20 b0nh nhdn bi ung t h u d u a n g vat.
bdng MOHS cb mgt t r u d n g h y p tdi phat tgi cho, 1 trudng h y p di can xa sau 3 nam d i l u tri [6]. Brandos vd cgng s y ddnh gid k i t qua d i l u tri cho 28 t r u d n g h y p bgnh nhan bj ung t h u duong vdt. Sau 40 thang dieu trj cb 3 0 % benh nhan tai phat tgi chb. Trong db cb 3 b0nh nhdn
bi ung t h u d glai doan T l , 1 bgnh nhdn d giai dogn T l va 2 t r u d n g h y p d giai doan T2 [3].
Ngo vdt hgch dbng vai trb quan trgng trong d i l u lr| ung t h u d u a n g vgt. T r u d c nhung nam 1920, vigc dieu trj hach di can trong ung t h u d u a n g vgt chii yeu bdng xg tri. T u ndm 1932, Dueuing eho r i n g de dieu trj ung t h u d u a n g vgt eb k i t qua l i t can lien hanh ngo vet hgch bgn hai bbn. T i t ca 23 b0nh nhdn b| ung thu d u a n g v0t Igi Bgnh vi0n Da lieu Trung u a n g , dii d u y e phau thugt theo p h u a n g phap eo d i l n hay MOHS deu d u y c vet hgeh ben 2 ben deu d u y e theo dbi sat sau dieu trj. Thdi gian theo dbi lau n h l t 19 thang; it n h l t la 1 thang, ehua cb bgnh nhan ndo tdi phat hogc di can.
V d i dge diem b0nh ly eiia ung t h u t l bao gai.
te bao day d da chii yeu Id xam lan tgi eho.
Ung t h u t l bao gai da d u a n g vgt eung xam lan tgi chb la chii yeu, trudng h y p mugn cb the di can hgch ben 2 ben. Trong nhieu trudng h y p vet hach ben 2 ben chi mang linh d y phong;
da so cae t r u a n g h a p da di can vdo hach ben, dogn d u a n g vat ngoai phan ton t h u a n g van binh t h u d n g .
T u k i t qua cua 13 b0nh nhdn ung t h u d u a n g vat d u y c phau thugt bdng ky thugt MOHS k i t h y p vdi ngo vet hgch bgn hai ben cho thdy phdu thuat Mohs " t i l t kigm" vd giu d u y e cae to chdc Idnh ciia d u a n g vgl. Benh nhdn van tieu tign sinh hogt tinh dye gan nhu binh thudng.Tleu tign It rai vdo bdn chdn do dogn d u a n g vgt ebn lai dai. Cb the quan h0 tinh dye gan n h u binh t h u d n g . Tdm ly ngdoi b0nh thodi mai, khbng b j a n h h u d n g sau dieu trj edt bb mgt phan d u a n g vat.
V.K£T LUAN
Ung t h u t l bdo vay d u a n g vgt t h u d n g do hgu qua eua chit hep bao quy ddu tien trien chgm, t h u d n g xam Ian tai cho. Bgnh t h u d n g ggp d tuoi trung nien va n g u d i cao tuoi. Phdu
3 7 1
T C N C Y H Phy trUdng 80 (3B) - 2 0 1 2
thudt theo p h u a n g phdp Mohs khbng chf khbi b0nh md ebn d l Igi dogn d u a n g v$t cb db ddi t i l da d l b0nh nhdn cb the t i l u ti0n, hogt dbng tinh dye. tam ly t y tin h a n , cdc p h u a n g phdp phSu thugl thbng t h u d n g d$c bi0l d cdc b0nh nhan Ire tuoi vd cbn khd nang hogt dbng tinh dye. Da s6 b0nh nhdn c h i p nhdn p h u a n g phdp nay.
T A I L I E U T H A M K H A O 1 . A m e r i c a n C a n c e r S o c i e t y (2011).
Penile cancer, last medical review. 9/1/2011.
wnAfw.cancerorg.
2. B i i i M g n h Ha (2002). Ddc d i l m Idm sdng, mb b0nh hgc ung t h u d u o n g vdt vd ddnh gid k i t qud song 5 ndm sau dieu trj p h l u thugt. Lugn dn t i l n sT - Hgc Vi0n Quan Y.
3. B r a n d o s S B . S e n g e l m a n R, HruzaG (2002). Mohs micrographie surgery for penile cancer: management and long term follow-up.
J Urol. 1 6 5 - 1 7 2 .
4. D o a n H u ' u N g h i ( 2 0 0 1 ) . U n g t h u d u a n g v0t, Bdi gidng ung t h u d u a n g v0t- Bg mbn ung t h u - T r u d n g Dgi hgc Y Hd Nbi- 200 - 205.
5. J o a n k i m D i l l e r , G e o V o n Krogh et a l ( 2 0 0 0 ) . E t i o l o g y of s q u a m o u s cell c a r c i n o m a of p e n i s , S c a n J Urol Nephrol S u p p l 2 0 5 : 1 8 9 - 193.
6. Mar D. B r a o w n , Christopher B.ZacIaryet al (1987). Penile tumor: their management by M o h s micrographie surgery.
J. Dermatol. Surg. Oncol, November . 13.11.
1 1 6 3 - 1 1 6 7 .
7. M o h s FE, S n o w SN et al (1985).
Microscopically controlled surgery in the treatment of carcinoma of the penis. J Urol Jun,133; ( 6 ) 9 6 1 - 9 6 6 .
8. M o h s S u r g e r y (1999). Fundamentals and techniques by Mohs, lne.11830 Westline Industrial Drive st.Lois, Missouri 63146.
S u m m a r y
RESULTS OF PENILE C A N C E R SURGERY T R E A T M E N T B Y M O H S ' AT THE NATIONAL H O S P I T A L OF D E R M A T O L O G Y A N D V E N E R E O L O G Y
Objective of the study was to evaluate chinical result and patient's mentality after amputation of penis due to squamous cell carcinoma by the tt/lohs'. The results showed that 13/23 patients with squamous cell carcinoma of penis were operated by Mohs. There was 69,9% off patients was more than 50 years old.
Non of 13 patients was relaped after 19 months of treatment. All of them was happy and satisfied with the treatment as well as with normal sexual activity. In conclusion, the Mohs saves maximal cancellous tissue of penis and keeps Penis's long after amputating. The good results and satifactation were noted in all patients treated by Mohs.
K e y w o r d s : Penile cancer, s q u a m o u s cell c a r c i n o m a .
