Y HQC V l | T NAM THANG 6 - SO 2/2013 cd tu' vong do phau thuat. Bien chu'ng sdm hay
gap la bf dai sau mo 26,8% BN. Bien chu'ng mupn tiet nieu, tieu hoa khdng gap d 86,58% BN phau thuat ddn thuan; d nh&ng BN dieu t n xa t n sau md cd 2 / l l B N (18,2%) cd bien chiing dp 2- chay mau tri/c trang. Thdi gian theo doi trung binh 24 thang, ty le sdng them 5 nam khdng benh la 92,7%, toan bd la 93,4%, ty le tai phat, di can la 2,4% (2/82BN). IBN tai phat mdm cut am dao sau 4 thang,dy can phdi va tu" vong, IBN sau 5 thang dy can xu'dng chau, phdi va t d vong.
Mat khac, phu'dng phap cdn cd nhu'ng u'u diem khac nhu': thdi gian dieu tri ngan hdn cac phu'dng phap khac, cd the bao tdn buong tru'ng d phu nu'tre, theo ddi sau dieu tri de dang hdn.
V. KET LUAN:
UTCTC giai doan I b l , U<2cm cd ton thu'dng khu tru tai vung co t d cung.Ket qua nghien cdu cho thay,ty le ung thu" xam lan parametre thap (1,2%), khdng cd BN nao cdn ung thu'tai vanh am dao sau md.Ty le dy can hach chau la 13,42%. 86,56% BN khdng ran xa trj bo xung sau md'.Nhu'vay, chi dinh phau thuat triet can nen du'dc ap dung de dieu trj UTCTC giai doan I b l , U<2cm.
TAI LIEU T H A M K H A O :
1. Nguyen Ba Du'c (2007)" chan doan va dieu tri benh ung thu". Nha xuat ban Y hpc, trang 325 - 331.
2. AJCC (2002), "Cancer staging manual", cen/ix uteri, sixth edition, pp. 520 - 532.
3. Ayhan A., Baykal C. (2004), "A compansion of nCO stage IB adenocarcinoma and squamous cell carcinoma", Int J Gynecol Cancer, 14, pp. 279 - 285.
4. Averette H. E., Nguyen H. N., Donato D. M., Penvalder D. M., Sevin B. U., Estape R., et al.
(1993), "Radical hysterectomy for invasive cervical cancer: a 25 - year prospective expenence with the Miami technique". Cancer, 71, pp. 1422 -1437.
5. Bourghardt.E, Baltzer(1992). Results of surgical treatement of 1,028 cervical cancer studied with volummetry.Cancer.70.pp 648-55.
6. Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C (1997). "Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer". Lancet. 350.pp 535 - 540.
7. Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C (2001) "Class II versus class I I I radical hysterectomy in stage IB - IIA cervical cancer: a prospective randomized study". Gynecol Oncol.
80.pp3-12.
Tir VONG DO UNG THlTTAI THANH PHO CAN THO, 2GG5-2008
L e T r a n N g o a n * , Le Hoai C h u ' d n g * * T O M T A T :
Muc tieu: Md ta thUc trang t d vong do ung thu' theo ICD-10 trong cpng ddng thanh pho Can ThO, 2005-2008. Phu'dng phap: Phu'dng phap nghien ciru md ta du'dc ap dung; Sd lieu du'dc thu thap bang 3 ddt dieu tra dinh ky hang nam cho danh sach t d vong cac nam 2005-2006, 2007 va 2008. Ket qua: Ba loai ung thu" phdi, gan va da day la nguyen nhan gay t d vong cho 72,6% nam va 42,2% nd ung thu'. Ty le tu" vong do tat ca cac loai ung thu'chuan hda theo tuoi d nam:
79,5/100.000 va nU: 54,7/100.000. Ung thu' h\ tii vong cao nhat la gan (ASR 31,9/100.000 d nam va 11,2/100.000 d nij-); thd nhi la phdi (ASR 20,2/100.000 d nam va 7,0/100.000 d nd); thd ba la da day (ASR 7,1/100.000 d nam va 5,0/100.000 d nO'). Ket luan:
Ung thu la nguyen nhan t d vong quan trong cho ca 2 gidi va nam bi ung thd cao hdn 1,5 lan nCr.
Tdkhoa: Ung thd, dieu tra cpng dong
SUMMARY:
CANCER MORTALITY IN CAN THO CITY, 2005-2008 Objectives: To describe cancer mortality by ICD- 10 in general population of Can Tho City, 2005-2008.
Methods: Descnpbve cancer epidemiology was applied. Data was collected by three rounds m developing list of cases for 2005-2006, 2007 and 2008.
Results: Three cancer sites were responsible for 72.6% of male and 42.2% of female cancer. Age- standardized cancer mortality rates (ASR) were 79.5/100.000 in male and 54.7/100.000 In female. The leading cancer was liver (ASR 31.9/100.000 in male and 11.2/100.000 in female); followed by lung (ASR 20.2/100.000 in male and 7.0/100.000 in female) and stomach (ASR 7.1/100.000 In male and 5,0/100.000 In female). Conclusions: Cancer mortality was a serious problem in both males and females with male to female rabon was 1.5.
* Trudng Dai hgc Y Ha NQI, " B$nh vi$n Phu san Trung Wang Phan bien khoa hpc: PGS.TS Chu Van Thang 10
Y HOC VIET NAM THANG 6 • s 6 2/2013 Keywords: Cancer mortality, population-based
registration I. OJSkT V A N OE:
Thanh phd Can Thd d vung dong bang sdng Cull Long nu'dc ta, vung song nu'dc thudc ha lu'u sdng Me-Kdng, cd hai mua khd va mua mu'a, dan sd nam 2006 la 1.139.900 ngu'di. He thdng cham sdc Y te cd 160 tram Y te xa/phu'dng thudc 8 huyen/thanh phd, cd benh vien Trung U'dng Can Thd, cd 8 benh vien huyen phuc vu cham sdc su'c khde nhan dan, chan doan va dieu tri ung thu' cho nhan dan trong t i n h ( l ) . Oac diem dac biet la trong chien tranh chdng MT, t d 1961 den 1972, cd 57.000 ngu'di cua tinh Hau Giang bj phdi nhiem vdi Dioxin (2,3,7,8 - TCDD), chat gay ung t h u cho ngu'di phdi nhiem. Dien tich bj rai Dioxin la 270 Km2 ( 4 , 4 % dien tich cua tinh Hau Giang - trong dd cd thanh phd Can Thd)(2). Nong dp Dioxin (2,3,7,8 - TCDD) trong mau nhu'ng ngu'di phdi nhiem cao gap 5 lan so vdi nhu'ng ngu'di sdng d vijng doi chu'ng khdng phdi nhiem(3).
Nguy cd ung thu" tang cao cd y nghla thdng ke ddi vdi nhu'ng ngu'di phdi nhiem vdi Dioxin(4-6).
Sau thdi gian dai phdi n h i l m nhu' vay, mdt sd loal ung thu* du'dc gia thiet cd nguyen nhan la phdi n h i l m vdi Dioxin d thanh phd Can Thd. Tuy nhien, cho tdi nay, cd rat it cac cdng trinh nghien ciiu ve t d vong do ung thu' d thanh phd Can Thd du'dc thu'c hien. Do vay, chung tdi tien hanh de tai nay vdi muc tieu: Md ta thu'c trang t d vong do ung thu" theo ICD-10 trong cdng dong thanh phd Can Thd trong cac nam 2005-2008.
II. o d l TUONG VA PHUONG PHAP NGHIEN CCTU:
2 . 1 . O o i t u ' d n g n g h i e n cu'u: Ooi tu'dng nghien cdu la toan bd cac tru'dng hdp t d vong do ung thu' tai thanh phd Can Thd, trong glai doan 4 nam 2005-2008. Benh nhan du'dc chan doan mac ung thu' va ung thu' la nguyen nhan chfnh gay t d vong, du'dc ma nguyen nhan theo ICD-10 la COO- C95. Benli nhan la ngu'di cua thanh phd Can Thd theo dien thu'dng t r u , hoac mdi chuyen den nhu'ng da sinh song tren 6 thang d thanh pho C3n Thd. Toan bo cac tru'dng hdp t d vong d thanh pho Can Thd trong cac nam 2005-2008 cd nguyen nhan chfnh khdng do ung thu"; mdt sd tru'dng hdp cd nguyen nhan chfnh la ung thu' nhu'ng da chuyen di khdi thanh phd Can Thd tren 6 thang hoac la ngu'di cua tinh khac den sinh song tai thanh phd Can Thd du'di 6 thang; nhO'ng tru'dng hdp mac ung t h d nhu'ng nguyen nhan t d
Vdng chfnh lai do tai nan thu'dng tfch hoac cac benh khac bj loai t r d . Nghien cdu du'dc trien khai tai thanh phd Can Thd tren pham vj 160 xa/phu'dng cua 8 huyen/thanh phd.
2 . 2 . Phu'dng p h a p n g h i e n cu'u:
Van dung phu'dng phap dich te hoc md ta doi vdi t d vong do ung t h u (Descriptive Epidemiology). Mau nghien cdu la mau toan bd (Toan bp cac tru'dng hdp t d vong do ung thu') du'dc van dung cho nghien cdu nay. Khi xa/phu'dng cd chat lu'dng sd lieu dat tieu chi nghien cdu, toan bp cac tru'dng hdp t d vong do ung thu' cua cac xa/phu'dng nay du'dc du'a vao dien nghien cdu. Tieu chf chpn xa cd sd lieu tdt nhu' sau: 1) Ty le t d vong thd ciia tat ca cac nguyen nhan thUp nhat la 300/100.000 (La ty le t d vong hang nam thap nhat cd the chap nhan dddc), ii) Dan sd khdng qua Idn, du'di 15.000 dan, ill) Ghi chep du'dc cac nguyen nhan t d vong tren 6 0 % trong danh sach dieu tra du'dc.
Danh sach cac tru'dng hdp t d vong nay do Sd Y Te thanh phd Can Thd phdi hdp vdi nhdm nghien cdu ciia tru'dng Oai hpc Y Ha Ndi, dieu tra theo mau "Bao cao nguyen nhan t d vong" theo mau so A6-YTCS, du'dc lay ra tir ket qua dieu tra ba_^ lan cho cac nam 2005-2006, 2007 va 2008.
Mau phieu bao cao nguyen nhan t d vong cd 3 phan: t h d nhat la thdng tin hanh chfnh, t h d 2 la hu'dng dan dieu tra nguyen nhan gay t d vong va phan t h d 3 la danh sach cac tru'dng hdp t d v o n g . Sd dan trung binh cua tirng xa/phu'dng dUpc thu thap cho tdng nam cua giai doan 4 nam 2005- 2008, tdng sd va rieng cho tdng gidi.
Phan mem thdng ke Excell 2009 va STATA 10.0 du'dc dung cho nhap sd lieu va phan tich sd lieu. Cach phan tfch: Ba chi sd du'dc tfnh cho nghien cdu nay la ty le tir vong do ung thu' theo ma ICD-10 so vdi tdng sd ung thu'; Ty le t d vong thd/100.000 va ty le chuan hda theo cau true dan sd the gidi (Age-standradlzed rate, ASR), cau true tudi each 10 nam: tir 1-9 va cao nhat la 80+. Odi vdi ty le thd va ASR/100.000, mau sd la sd "Ngiidi-nam", bdi vi danh sach t d vong tfch lijy trong 4 nam, sd dan cua tdng xa/phu'dng cijng du'dc nhan vdi 4 (Nam) cho sd ngu'di-nam.
Oao du'c t r o n g n g h i e n cu'u: Nghien cdu nay dieu tra hoi cdu nguyen nhan gay t d vong do ung thu' tai cac xa/phu'dng cho tram Y te thdc hien. Thdng tin nghien ciru du'dc gid bf mat ve tinh trang benh tat va thdng tin ca nhan. Ket qua nghien cdu khoa hpc cd bao cao Sd Y te thanh 11
Y HQC VlgT NAM THANG 6 - S6 2/2013 pho Can Thd de dung cho cdng tac phdng benh
va lap ke hoach phdng benh ung thu' ngay cang tdt hdn cho nhan dan.
IM. KET QUA NGHIEN COU:
Cd 39/160 xa/phu'dng cd sd lieu lien tuc bdn
nam 2005-2008 dat tieu chf la ddn vj cd so lieu tdt, dddc phan ti'ch va trinh bay ket qua cho nghien cdu nay. So ngddl-nam cua cac xa/phu'dng nay cd tong sd 1.121.879 la nam va 1.167.669 la r\\y va sd lu'dng theo nhdm tuoi va gidi trinh bay trong thap dan so, Hinh 1.
1 •)()•! 1
• 2<..l'»l
^ . > 7 0 7 < >
^ <>2402
"H"
11201.Hinh 1. Phan bo so ngu'cJi-nam theo gidi va nhom tuoi
Bang 1. So li/Onq va tv le tCr vonq/100.000 theo qicfi va nhom ICD-10 Ung thi/
Vunq hau honq Vom honq ThUc quan Da day Oai - tru'c tranq Gan TLII mat TUY l^ui xoanq Tlianh quan Phoi Tim XUOnq Oa Trung bieu mo Vu c6-than tir cunq Buonq trCrnq Sinh due nam Than Banq quanq r^at Nao Mau Khac Tonq
ICD- 10 COO-14 C l l CIS C16 C18-20 C22 C23 C25 C30-31 C32 C33-34 C37-38 C40-41 C43-44 C45 C50 C53-55 CS6 C60-63 C64-68 C67 C69-72 C71 C81-96
Nam So
5 9 3 54 34 242 1 2 3 6 151
2 8 3 5
2 2 6 2 21 23 32 616
r y le tho/
100.000 0,4 0,8 0,3 4,8 3,0 21,6 0,1 0,2 0,3 0,5 13,5 0,2 0,7 0,3 0,4
0,2 0,2 0,5 0,2 1,9 2,1 2,9 54,9
%
0,8 1,5 0,5 8,8 5,5 39,3 0,2 0,3 0,5 1,0 24,5 0,3 1,3 0,5 0,8
0,3 0,3 1,0 0,3 3,4 3,7 5,2 100
ASR /100000
0,6 1.3 0,4 7,1 4,2 31,9 0,2 0,2 0,3 0,9 20,0 0,3 0,8 0,4 0,6
0,2 0,2 0,9 0,2 2,4 2,5 3,9 79,5
Nii' So
3 3 3 39 33 89 1 1 1 57 5 3 4 29 54 8 4 2 1 15 30 53 438
Ty le tho/
100.000 0.3 0.3 0.3 3.3 2.8 7,6 0,1 0,1 0,1 4,9 0,4 0,3 0,3 2,5 4,6 0,7 0,3 0,2 0,1 1,3 2,6 4,6 37,5
Vo 0,7 0,7 0,7 8,9 7,5 20,3 1.2
0,2 0,2 13,0
1,1 0,7 0,9 6,6 12,3
1,8
0,9
"iS 0,2 3,4 6,8 12,1
100 ASR /lOO.OOO
0,3 0,2 0,4 5,0 4,0 11,2
0,1 0,1 0,2 7,0 0,7 0,3 0,5 3,7 7,0 1,0 0,5 0,2 0,1 1,9 3,1 7,1 54,7
Y HOC VlfiT NAM THANG 6 - SO 2/2013
Nhan xet; Tong so chung cho hai gicfi co 1.054 tru'dng hdp ung thiT cua 24 nhom nguyen nhan theo ICD-10: Nam 616 va nu' 438. Ba loai ung thu" phoi, gan va da day la nguyen nhan gay tiy vong cho 72,6% nam va 42,2% niJ ung thU. Ty ie tiy vong do tat ca cac ioai ung t h u chuan hoa theo tuoi d nam: 79,5/100.000 va nCf: 54,7/100.000. Nam bi tiJ' vong do ung thif cao hdn 1,5 ian nO'. Ung thu' bi tiJ vong cao nhat ia gan (ASR 31,9/100.000 d nam va 11,2/100.000 d niJ); thiJ nhi la phoi (ASR 20,2/100.000 d nam va 7,0/100.000 d nu-); t h i j ba ia da day (ASR 7,1/100.000 d nam va 5,0/100.000 dnu').
Bang Z Unq thtf d thanh pho Can Thd va mot so nu'dc tronq t(hu vu'c Qu'an the va thdi
gian Thanh pho Can Tho, 2005-08 Nhat Ban, 2002 Trunq Ouoc, 2002 Philippines, 2002 Sinqapore, 2002 Thailand, 2002
Nam TV le tho /lOO.OOO 54,9 303,5 154,0 86,7 166,9 97,9
Ty le chuan (ASR/100.000)
79,5 154,3 159.8 150,9 161,3 119,7
NO' Ty le tho /lOO.OOO 37,5 187,4 92,5 85,8 128,8 72,7
Ty If chuan (ASR/100.000)
54,7 82.2 86,7 123,7 108,7 79,3 Nhan xet: Nam va nu' cd ty le t d vong thd va chuan hda ASR thap nhat so vdi cac nu'dc cd ten trong Bang 2.
. _ » - . - - * • -
Hinh 2. Ty le/100.000 theo nhdm tudi va gidi
Nhan xet: Nam cd ty le t d vong do ung thu" cao hdn nu' d moi Ida tud'i. Ty le t d vong do ung thu' tang nhanh lien tuc d tuoi 4o hoac cao hdn. Rieng nhdm tuoi 60-69, b/ le giam nhe sau dd lai tang cao nhanh.
IV. BAN LUAN:
Toan bg 39 xa/phu'dng tham gia nghien cdu deu cd benh nhan ung thu'. Cac xa/phu'dng nay thudc vung dd thi kha cao tai cac quan npi thanh, hoac cac xa vung ndng thdn cua cac huyen- ndi moi tru'dng sdng chu'a bi d nhiem do cong nghiep va do thj hda. Su' phan bd ung thu' CO d cac vung dja d d nhu' vay gdi y nguyen nhan va nguy cd gay ung thu' dang ton tai trong mdi tru'dng sdng cua cac xa/phu'dng, cd ndi khdng lien quan 6 nhiem cdng nghiep hay cac loai d nhiem khac. Hien tu'dng nay gdi y chung ta can nghien cu'u cac tac nhan gay ung thu' tai cac^gia dinh, cac thon xdm cua cac dia phu'dng de cdng tac phdng benh cd hieu qua hdn.
£)ac die'm ndi bat la ba loai ung thu' phd'i, gan va da day la ba loai cd ty le gay t d vong cao nhat cho ca hai gidi. Tong ty le % ba loai ung thu' nay gay t d vong la: Nam: 72,6% va nd: 42,2%; b/ le t d vong chuan hda theo tud'i nhu sau: Nam:
79,5/100.000 va nti': 54,7/100.000. Ung thu' phdi la nguyen nhan phd bien t h d 2 trong cac loai ung thu' d ca hai gidi, nam cao hdn niJ, cd the du'dc giai thi'ch la nam gidi hut thudc la 50-73% trong nhij'ng nam 1990-2005, cdn nd hut thudc 2-4%
cung thdi gian tren (7). Viec bd hiit thudc la, thudc lao se giam benh nhan mac va t d vong do ung thu' phd'i. Ung thu* gan va ung t h d da day lien quan nhieu yeu t d , trong dd cd yeu td nhiem trung do viem gan B, viem gan C. Trong tu'dng lai.
13
Y HQC VIET NAM T H A N G 6 - s 6 2/2013 viec dung vac xin viem gan B va dieu tri loet da
day do nhiem trung Helicobacter pylori tdt hdn, hai loai ung thu* nay se giam mac va t d vong cho ca hai gldl. Ngoai cac yeu t d nguy cd do hut thudc, nhiem trung bdi vi khuan va Virus, ba loai ung t h u nay cd them nguy cd do Dioxin (3-6).
Chung ta can trien khai cac nghien culi Djch te hpc phan tich de xac dinh mdi lien quan nay. Ty le t d vong do ung thu' tang nhanh theo tuoi d ca nam va nu', dac biet tang cao d cac nhdm tuoi tren 60 d ca hai gidi (Hinh 2). Ket qua nay gdi y, ke t d 40 tud'i, hang nam, moi ngu'di nen kham sang Ipc phat hien ung thu' sdm ddi vdi gan, phd'i va da day de giam nguy cd bi t d vong do ba loai ung thu' nay.
O thanh phd Can Thd, nam ung thu' cao hdn 1,5 lan so vdi nd, ty xuat nay nhd hdn 2 d cac nddc khac trong khu vu'c; Nhat Ban 1,9, Trung Quoc 1,8, Philippines 1,2, Singapore 1,5 va Thailand 1,5 (Bang 2). Ket qua nay gdi y kha nang phdng mdi mac ung thu* cho nam gidi la kha thi khi chung ta nghien cdu phat hien nguy cd gay ung thu' cho nam gldl va kiem soat cac yeu t d nay thanh cdng.
Mdt so ban che cua cdng trinh nghien cdu:
Benh nhan t d vong do ung thu' khdng cd sd lieu ve giai phau benh. Oac thu vung sdng nu'dc, giao thdng du'dng bd khd khan, viec ghi nhan va thdng ke nguyen nhan t d vong cd rat nhieu khd khan, ty le t d vong do ung thu' trinh bay trong nghien cdu nay cd the thap hdn thdc te nhieu.
V. KET LUAN:
Ty le t d vong do tat ca cac loai ung thu' chuan hda theo tud'i d nam: 79,5/100,000 va nd:
54,7/100.000. Nam b\ tii vong do ung thu' cao
hdn 1,5 lan nu". Ung thu' bj tu' vong cao nhat la gan {ASR 31,9/100.000 d nam va 11,2/100.000 d nil'); t h d nhi la phdi (ASR 20,2/100.000 d nam va 7,0/100.000 d nu"); thLf ba la da day (ASR 7,1/100.000 d nam va 5,0/100.000 d nuO-
TAI Ll|U T H A M K H A O :
1. MOH (2006) Health statistics yearbook, 2006 (Hanoi, Ministry of Health).
2. Dal, L. C , Quynh, H. T., Thanh, L et aL (1986) Map of Dioxin sprayed in the Second Indidochlna War, Paper presented at the Second National Symposium on Herbicides and Defoliants in War:
the long -Term Effects on Human Health, Hanoi, Viet Nam.
3. Schecter, A., Dai, L. C, Thuy, L. T. et al.
(1995) Agent Orange and the Vietnamese: the persistence of elevated dioxin levels in human tissues. Am J Public Health, 85, 516-22.
-I. Axelson, O., Sundell, L., Andersson, K. et al.
(1980) Herbicide exposure and tumor mortality. /\n updated epidemiologic investjgatkm on Swedish railroad workers, Scand J Wor1< Environ Health, 6,73-9.
5. Fingerhut, M. A., Halperin, W. E., Marlow, D.
A. et al. (1991) Cancer mortality in workers exposed to 2,3,7,8-tetrachlorodit}enzo-p-diDxin [see comments], N Engl ] Med, 324, 212-8.
6. Flesch Janys, D., Steindorf, K., Gum, P. &
Becher, H. (1998) Estimation of the cumulated exposure to polychlorinated dibenzo-p- dioxins/furans and standardized mortality ratio analysis of cancer mortality by dose in an occupationally exposed cohort. Environ Health Perspect, 106 Suppl 2, 655-62.
7. Jenkins, C. N., Dai, P. X., Ngoc, D. H. et al.
(1997) Tobacco use in Vietnam. Prevalence, predictors, and the role of the transnational tobacco corporabons, JAMA, 277, 1726-31.
DIEU TRI BAO TON KHONG MO CHAN THimNG TUY
Trinh V a n T u a n *
T O M T A T :
Nghien cdu nham danh gia ket qua dieu tn bao ton khdng md chan thu'dng tuy. Td 01/2006 den 12/2008 tai benh vien Viet Du'c cd 24 tru'dng hop chan thu'dng tuy du'Oc chi dinh dieu tri bao tdn khdng mo, trong do nam 22 (91,7%), nQ' 2 (8,3%); tuoi trung
* Trudng Dai hoc Y Ha Ngi
Phan bi?n khoa h9c: PGS.TS Nguyin DCPC T i l n 14
binh 24,4 ± 8,7 (dao ddng t d 8 - 46 tuoi). Nguyen nhan do tai nan giao thdng 20 (83,3%), lao dgng 1 (4,2%), sinh boat 3 (12,5%). Tinh trang mach va huyet ap luc nhap vien it thay doi, chi cd 2 tru'dng hdp (8,3%) huyet ap toi da <100mmHg. Xet nghiem amylase mau >220U/I luc 15 tru'dng hdp (62,5%).
