rp chiYDwrc ftpc - TruUng Oo> hpc r DifiTC Hue - Jflp 6, stf 5 - thdng 10/2016
DANH GIA DAC OIEM LAM SANG VA CAN LAM SANG BENH NHAN UNG THU BIEU M d KHOANG MIENG
Nguyin Vdn Minh', Nguyin Hong Lgi', Dgng Thi Kim Anh' (1) Khoa Rang Hdm Mgt, Tru&ng Dgi hgc YDugc Hue- Bgi hgc Hue
(2) Khoa Rdng Hdm Mgt - Binh viin Trung uang Hue
Tdm tat
Dat van de: Oinh gia dgc diem lim sang, md bgnh hpc va xie djnh mdi Men quan gi&a dl can hgch vting vdi dp md hpe ciia ung thu bilu md khoang migng. Odi tupng v i Phuang phap nghign c&u: Md ta tien c&u, cat ngang tren 32 bgnh nhan ung thu bilu md khoang mieng dupc dieu trj tgi khoa Rang Ham Mat Benh vign Trung uong Hue t& thing 7/2015 den thing 7/2016. Ket qui: Dg tudi hay ggp l i 51-60 tudi, ty Ig nam/n& la 1,9/1, khdi u hay ggp b ludi (40,6%) va sin migng (34,4%), da sd khdi u khdng xim lln td eh&c lan can va ed dudng kinh ldn ban 2 em (>80%). Ty Ig di can hach vting la 43,8% va cd mdi tuang quan thugn gi&a ty lg di can hgch vdi kieh thudc u (p<0,OS). Logi md bgnh hpc chu yeu la ung thu bieu md te bao vay. Sy khae nhau ve ty 1? di can hgch viing d nh&ng nhdm bgnh nhin ed dp md hpe khic nhau khdng cd y nghTa thdng ke (p>0,05).
Kit luin: Kich thudc u eang ldn thi ty Ig di cin hach vting eang cao. Khdng cd mdi lien quan gl&a ty le di can hgch vung vdi dp md hpc ciia ung thu bilu md khoang mieng.
T& khda: Ung thu biiu mo khoang miing, kich thu&c u, di cdn hgch, md binh hgc.
Abstract
EVALUATION OF CLINICAL AND PARACLINICAL FEATURES IN PATIENTS WITH CARCINOMA OF ORAL CAVITY
Nguyen Van Minh', Nguyen Hong Lo?, Dang Thi Kim Anh' (1) Faculty ofOdonto Stomatology, Hue University of Medicine and Pharmacy - Hue University
(2) Department ofOdonto Stomatology - Hue Central Hospital Bacl^round: To evaluate the clinical, hystopathologycal features and correlation betvueen lymph node metastasis and hystopathologycal grade in patients with carcinoma of the oral cavity. Materials and Methods: From July 2015 to July 2016, 32 patients with carcinoma of the oral cavity at Hue Central Hospital Results: The most common age group from 51 to 60 years and the male/female ratio was 1.9/1. Tumor were usually observed around the the tongue (40.6%) and oral floor (34.4%). Most of the tumor size is larger than 2 em diameters (> 80%). The regional lymph node metastasis rate was 43.8% and there was a positive correlation between lymph node metastasis and tumor size (p <0.05). Squamous-eell carcinoma was mainlytype of histopathology. Difference between the rate of lymph node metastasis in patient groups with dilferent histopathological grade show no statistical significance (p> 0,05). Conclusion: the greatertumor, the higher regional lymph node metastasis. There is no relati'onship between the lymph node metastasis rate and histopathological grade of oral carcinoma.
Keywords: Carcinoma of oral cavity, tumor size, lymph node metastasis, histopathology.
1. DAT VAN DE
Ung thu l i mpt trong nh&ng nguyen nhan chinh giy t& vong, ty Ig mae ung thu cd chilu hudng tang len ca ve so lupng va da dgng ve mgt bgnh [11]. Ung thu bieu md (UTBM) khoang migng l i mpt trong t i m logi ung thu phd bien nhat, la bgnh phat sinh do sy bien ddi ae ti'nh niem mge phii toan bp khoang
migng. Theo Td eh&c Y te ThI gidi, UTBM te bio viy ehiem khoang 80% - 90% ung thu khoang migng [5], [10]. Mgc dil eae phuang tign chan doan va dieu tn da phat trien nhung tien lupng bgnh vin cdn kem, nguygn nhan ehii yeu la do sy dl can hgch viing [8].
Kademani v i cs,, Yamamoto va cs. eho rang cd mdi lign quan gi&a ty le di can hgch vdi kich thudc u va
156
Tgp chl YDugc hgc - Tru&ng Dqi hqc Y Dugc Hui- Tqp 6, sis - thdng 10/2016 dp md hpc eua ung thu bilu md [6], [12]. Tuy nhign,
theo Woolgar thi dp md hpc khdng phan inh m&c dp di can hgch viing (12). Do do, ehiing tdi thye hign nghign c&u nay nham eic myc tigu:
1. Ddnh gid dgc diim Idm sdng cuo binh nhdn ung thu biiu md khoang miing.
2. Ddnh gid dgc diem md binh hqc va xdc dinh mdi lien quan gi&a di cdn hgch vimg vdi dg mo hgc cua ung thu biiu mo khoang miing.
2. Ddi Hf<?NG vk PHU'CXNG PHAP N G H I I N C C U 2.1. Thiet k l nghien ciru: Nghien e&u md ta eat ngang.
2.2. M l u nghien c&u: 32 bgnh nhan (BN) UTBM khoang migng dupc Oieu tq tgi Khoa Rang Him Mgt Bgnh vign Trung UPng Hue.
2.3. Tiiu chi chpn mau
BN dupe chan doin lim sang, cgn lam sang v i md bgnh hpc l i UTBM khoang migng. BN ddng y tham gia nghign e&u.
2.4. Tigu ehi logi tr&
Ung thu d npi khic di can din ma UTBM khoang migng chi l i giai dogn mupn. UTBM khoang migng da dieu trj trudc day, nay vao vi?n vl t i i phit hogc di can xa.
2.5. Phutfng phip thu thgp sd ligu True tilp kham lam sang de phat hign eic dgc diem ve vj tri u, hinh t h i l tdn thuong, kich thudc va m&e dp xim lln ciia u, di can hgch vting va mdi llln quan gi&a ty Ig di can hgch vdi kich thude u, giai dogn bgnh theo TNM. Ghi nhgn eic dge dilm md bgnh hpc nhu logi md bgnh hpe, dp md hpc va mdi lien quan vdi ty 1? di can hgch vimg.
2.6. Heu chuan danh gia - Xip logi TNM (AJCC - 2010) [2]:
+ T: khdi u nguyen phat TO: khdng ed u nguyen phit.
T l : u cd dudng kinh < 2 em.
Bing 1. V| tri u va hi
T2: u ed dudng kinh 2-4 em.
T3. u ed dudng kinh > 4 em.
T4: u cd dudng kinh > 4 cm va xam lan td ch&c lan cgn.
+ N: hach vimg NO: khdng di can hach viing.
N l : mpt hgch ciing ben dudng kinh < 3 cm.
N2: N2a: mpt hach ciing bin dudng kinh 3-6cm.
N2b: nhieu hgch ciing bin dudng kinh < 6 cm.
N2e: hgch 2 ben, ben ddi dign hay nhieu bach dudng kinh < 6 em.
N3: hach cd dudng kinh > 6 cm.
+ M: di can xa
Mx: khdng xac djnh dupe di can xa.
MO: khdng ed di can xa.
M l : ed di cinxa, -Giai doan bgnh:
+ Glai doan 0: TisNOMO.
+ Giaidoani:TlNOMO.
+ Giai doan 11: T2 NO MO.
+ Giai dogn 111: T3 NO MO/Tl, 2, 3 N l MO.
+ Giai dogn IV. T4 N0,1 MO/Bat k^ T, N2, 3 MO/Bat kVT,BatkvN,Ml[2].
- Phan dp md hpe eiia UTBM vay theo Broder [2]:
+ Dpl (bigt hda tdt): ucd tren 75% tebao bigt hda.
+ Dg 11 (bigt hda trung binh): u ed t& tren 50%
din 75% t l bio bigt hda.
+ Dp 111 (bigt hda kem)- u cd t& 25% din 50% t l bio bigt hda.
+ Dp IV (khdng biet hda)' u cd dudi 25% t l bao bigt hda.
3. KET QUA
M i u nghien e&u gom 32 BN, tudi trung binh la 58,0 ± 9,8 tudi, dd tuoi hay gap la t& 51-70 tudi (71,9%), phd blln nhat la nhdm 51-60 tudi (43,8%).
Tylgnam/n& la 1,9/1.
inh t h i i tdn thuang Vi t r i u
Ludi San migng Khau eai e&ng
Hgu ham Mdi dudi Tdng
Sd BN {%) 13 (40,6) 11 (34,4) 4 (12,5) 3 (9,4) 1 (3,1) 32 (100,0)
Hinh t h i i tdn thuang Sill Loet Loet sill Thim nhilm e&ng
Tdng
SdBN(%) 5 (15,6) 6 (18,8) 18 (56,2) 3 (9,4)
32 (100,0) Vj tri u hay ggp nhat la d ludi v i san migng (40,6% v i 34,4%), ung thu mdi dudi ehiem ty Ig thap nhat (3,1%). Tdn thuang dgng loet stii chiem ty lg cao (56,2%) trong khi dgng tham nhilm c&ng thi it gap nhat (9,4%) (Bing 1).
IQURNAL Of MEDICINE AND PHARMACY 5 7 1
Tqp ch! YDuvc hqc- Truimg Dqi hqc YDugc Hui- Tap 6, so 5 - thdng 10/2016
Bang 2. Phin logi TNM va giai dogn bgnh T
T l T) T^
T4 J6ng
SoBN 5(15,6) 12 (37,5) 10 (31,3) 5 (15,5) 32 (100)
N NO Nl N2 N3 Tong
S S B N 18 (56,2)
7 (21,9) 7 (21,9) 0 (0,0) 32 (100)
M MO M l
Tdng
(%)
SoBN 31 (96,9)
1 (3,1)
32 (100) Giai d09n
benh 1 II III IV Tong
(%)
SoBN 3 (9,4) 10 (31,3) 10 (31,3) 9 (28,1) 32 (100) U ed dudng kinh dudi 2 cm chilm ty lg thip nhat (15,6%). Oa sd u khdng xam lan td ch&c lan egn (84,4%), Tgi thdi dilm din khim da phit hign dupc 43,8% trudng hpp cd di can hgch trgn lam sang. Xep logi giai doan bgnh theo TNM, giai dogn bgnh I chilm ty Ig thap (9,4%) v i giai doan II, Ml ehiem ty Ig cao nhat (31,3%) (Bing 2).
Bang 3. Uen quan gi&a ty Ig di can hgch vimg va kieh thudc u
^^^^^^ Giai do^n T Hgch viing ^ ^ ^ . ^ Khdng cd hgch Cd hach
Tdng
T1&T2
(%)
76,5 23,5 100,0
T3&T4
(%)
33,3 66,7 100,0
Tdng
56,2 43,8 100,0
Gii trj p
p<0,05*
Hgsd tuang quan
0,433
• Tuang quan Spearman
Cd mdi tuang quan thuin gi&a ty Ig dl can hach viing vdi kich thude u, u eang Idn thi ty lg di can hgch cang cao. He sd tuang quan Spearman la 0,433 the hign tuang quan trung binh. Su tuang quan nay cd y nghTa thdng kg (p<0,05).
Bang 4. Dae diem md bgnh hgc Loai tno benli hoc
UTBM te bao vay Loai mo benh hgc khac
Tong
S £ B N ( % ) 32 (100,0) 0 (0,0)
32 (100,0)
Dp md hoc Boi Boll Bo III Bo IV Tong
SoBN(%) 15 (46,9) 9 (28,1) 8 (25,0) 0 (0,0) 32 (100,0) Tat ca cac trudng hpp deu cd kit qua md bgnh hpc la UTBM te bio vay. Op md hpe I chiem ty Ig cao nhat (46,9%), khdng cd trudng hpp nao ed dfi md hge IV (Bang 4).
^ ^ ^ . , ^ ^ Ddmohgc Hgch vung ^ ^ ^ , ^ Khong CO hgch Co hach
Tong
Bang 5. Li&n Dpi
(%)
66,7 33,3 100,0
quan giO-a ty Ddu
(%)
44,4 55,6 100,0
e dl can hach vung va dp mo Dp III
1%) 50,0 50,0 100,0
long
(%)
56,2 43,8 100,0
hoc Gia trj p
p>0,05*
11 1
0,169
• Tuang quon Spearman
Cd su khic nhau ve ty Ig di can hgch gi&a 3 nhdm dp md hpc khic nhau. Tuy nhien, sy khie nhau nay khdng cd y nghTa thdng kg (p>0,05) (Bang 5).
I 5 8 lOURNAL OF MEDICINE AND PHARMACV
Tqp ch! Y Duqc hgc - Tru&ng Dai hqc Y Dugc Hue- lis-thdng 10/2016 4. BAIM LUISLN
4.1. Dac diem lam sang
Trong nghien c&u nay, da sd BN cd dp tudi t& 50- 70 tudi, dfi tudi mac bgnh phd biln nhat la 51-60 tudi, ty le nam/n& l i 1,9/1. Kit qua nay phii hpp vdi thdng ke ciia UICC [7] Ty lg mac bgnh b nam cao han n& c6 the xuat phit t& thdi quen hut thudc va udng ruau d nam gidi nhilu han n& gidi
Ve vj trf, ung thu hay gap nhat b ludi (40,6%) va san migng (34,4%). Kit qua ciia chiing tdi tuang dong vdi Nguyin Thi Huang Giang [Ij, Pham Nguyen Tudng va cs. [3]. Nguyen nhan cd the do be mat ludi va san migng dupe phu bang ldp bilu mfi mong khdng s&ng hoa nendl bj tac dpng bdi cac tie nhan smh ung thu cung nhu cac chat gay hal trong thudc la va rupu [5].
Ve hinh t h i i tdn thuang, dang loet sill ehiem ty le cao nhat (56,2%) va dgng tham nhiem e&ng it gap nhat (9,4%). Khi khdi u ldn, viing trung tam hogi t&
do thieu dinh dudng, eic chat hoai t& bj dao thai ra ngoai de Igi d loet xen lan td ch&c sin.
Ve kich thudc u va dge diem hgch, da sd BN cd dudng kinh u Idn han 2 cm va khdng xam lan td ch&c lan cgn; ty le hgch phit hien tren lam sang la 43,8%.
Ve glai doan bgnh, giai dogn 1 chilm ty le thap, dieu nay phu hpp vdi thyc trgng ehung la da sd BN UTBM khoang migng duac chan doan dgiai dogn khi mudn [5]. So sanh vdi nghien c&u cting thyc hign tgi Bgnh vign Trung uang Hue eiia Phgm Nguyen Tudng va e.s [3], nghien c&u nay eung cho kit qui tuang ddng. tl My, theo nghign c&u ciia Marchiano va cs. [S], ty le di can hach viing thap han ket qua cua chting toi (31%) va da sd BN dupc chan doan d giai doan 1 va giai dogn 11. Cd the nhgn thiy, b nh&ng nudc phat triln, trinh dfi din trf cao, cac ea sd cham soe s&e khde ban dau va phuang tien chin doan hien dai nen BN UTBM khoang migng dupc chan doan b giai doan sdm han.
Ve mdi lien quan gi&a ty le di can hgch viing vdi kfch thudc u, trong nghien e&u cua chiing tdi cd sy tuang quan thugn gi&a 2 yeu td niy. Da sd BN d giai dogn T l va T2 khdng cd di can hgch (76,5%).
Ngupc Ial, d nh&ng BN giai dogn T3 va T4, di cin hgch chilm ty le eao (66,7%). Nhu vgy, kfch thudc u eang Idn thi ty Ig di can hach cing ting. Kademani va cs. [6] cung eho rang khi kfch thude u cing Idn thi ty led! can hgch cang tang
4.2. Die d i l m md benh hpc
Trong nghien c&u niy, tat ca cie trudng hpp deu ed kit qua md benh hgc la UTBM te bao viy. Ket
qua eiia Nguyen Thi Huang Giang [1] la 93,5%, eiia Phgm Nguyen Tudng v i cs. [3] la 97,7%. Theo mdt so nghien c&u, loai md bgnh hpc ciia UTBM khoang migng chii yeu la UTBM vay (95%) [2], [5].
Ve mdi lien quan gi&a ty le di can hgch vdi dd md hoc, trong UTBM, mot sd t l bao cd kha nang di can va nh&ng thay ddi euaciete bao nay quyet djnh dge ti'nh smh hpe ciia khdi u. De danh gii kha nang di can eiia nh&ng te bao nay, ngudi ta thudng dua vao dp md hpc ciia khdi u Phin dd mo hpc theo Broder dupc s& dung de tien lupng m&c dfi di can ciia ung thu va ehii ylu dya vao ty lg eua eic t l bao bigt hda trong khdi u. Mfit sd nghien c&u cho rang vigc phin dp md hpe chl dya vao m&e dp bigt hda ciia eic te bao trong khdi u la ehua dii va phan dp theo Broder it cd gia tri ti'en luang kha nang di can eiia ung thu [4], [12].
Khl khao sit 32 trudng hpp UTBM vay khoang migng, ehung tfii nhin thiy khdng ed su lien quan gi&a ty Ig di can hach vting vdi dd md hpc eiia UTBM vay (p>0,05) (Bang 5) Tuy nhien, nghien c&u eiia chimg tdi ed cd mau nhd va phuang phap chpn mau thuin Hen nen ket qua ed the ehua mang ti'nh dgi dien cao. Ngoii ra, chung tdi chi dinh gii di can hach viing qua khim lam sang la chii ylu va kit hpp danh gia tren hinh anh cat Idp vi ti'nh.
Theo mpt sd nghien e&u, khoang 20% trudng hop di can hgch khong dupe phat hien tren lam sang, cat Idp vi tinh va cdng hudng t& [9]. Cac tie gia nay eho rang de ehan doan di can hgch chinh xac han, can lam xet nghigm mo bgnh hpe hgch sau phlu thugt ngo vet hach. Do dd, de dinh gia chinh xic mdi lien quan gi&a dl can hgch viing vdi dg md hpc CLia UTBM vay khoang mieng, can tilp tyc cd nh&ng nghien e&u ed cd miu ldn han, cie ddi tuang duac chpnvio nghien c&u mfit each nglu nhign va ehin doan ehinh xie hach di can sau phau thuat bang x^t nghigm mfi benh hpc
5. K^T LUAN
Tudi trung blnh la 58,0 + 9,8 tudi, ty Ig nam/n&
la 1,9/1. Ung thu hay gap d ludi va san mieng. Ty
|g di can hach trin lam sang khi cao (43,8%) va cd mdi tuang quan thugn gi&a ty Ig di cin hach vdi kich thude u.
Ung thu bieu mfi t l bao vay chiem uu t h i . Khdng ed mdi lien quan gi&a ty ie di can hach vimg vdi dp md hgc ciia ung thu bieu md vay.
TAIUEUTHAMKHAO 1. Nguyin Thj Huong Giang (2002), Nghien c&u dgc diim lam sang, mo binh hgc vd nhgn xet mgt so yiu ti
nguy ca ung thu bieu mo khoang miing tgi Benh vien K, Luan van tdt nghigp bac sT ngi trii cac bgnh vien, Trudng
Tgp ch! YDuvc hgc - Tru&ng Bgi hgc YDuvc Hue- Tqp 6, si 5 - thdng 10/2016
D g i h g c Y H a N o i , HaNgL
2. Han Th[ Van Thanh (2013), Nghien c&u diiu tri ung thu biiu md khoang miing co s& dgng kp thugt tgo hinh bang vgt ranh mui ma, Lugn an tien sTY hgc, Tru'dng Oai hgcYHaNpi, HaNgi.
3. Phgm Nguyen Tudng, Phiing Phudng va Nguyin Thanh Ai (2004), "Ung t h u khoang mi#ng: chan doan v i dieu t n tai khoa Ung budu b|nh vi?n Trung Uong Hue trong 5 nam (1999 - 2003)", Y hgc Viit Nam so dgc biit- thdng 4/2004. tr 141-151.
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263-268.
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8. Marchiano E., Patel T , EloyJ., et al. (2016), "Impact of Nodal Level Distribution on Survival in Oral Cavity Squamous Cell Carcinoma: A Population-Based Study", Otolaryngology-head and neck surgery, official journal of American Academy of Otolaryngology-Head and Neck Surgery, 22 (1), pp. 457-472.
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"Metastasis from oral cancer: an overview". Cancer Genomics-Proteomics, 9 (5), pp. 329-335.
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"Oral squamous cell carcinoma: clinicopathological features from 346 cases from a single Oral Pathology service during an 8-year period". Journal of Applied Oral Science. 21 (5), pp. 460-467.
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"Cancer statistics, 2015", C4- a cancer journal for clinicians. 65 (1), pp, 5-29.
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160 JOUSNALOF MEDICINE AI
