Y HOC VlfT NAM THANG 6 - SO 2I20U tren du'di 1 c5 so. C^c nghien culi mdi day da
cho ty le chi'nh xac ti/tfng td khi du" doan chi'nh xac tdi tren du'di 1 c9 so doi vdi ca template ky thuat so (6 coi chinh xac tdi 6 0 % - 8 1 % , chuoi chinh xac tdi 74 - 9 4 % ) va template vdi XQ quy u'dc (6 coi chinh xac tren du'di 1 c3 so tdi 67- 97%, chuoi l<hdp la 7 7 % - 98%) [ 3 ] , [ 7 ] .
Unnanuntana A. (2009) [7] tien hanh template cho khdp hang nhSn tao khong XM chi'nh xac tdi 4 2 , 2 % doi vdi o coi va 6 8 , 8 % doi vdi chuoi khdp. Ca temfilate bang tay va b l n g ky thuat so deu dd bao kha chinh xac c5 chuoi khdp trorig khoang tren du'di 1 cQ so. Template bang tay cd ty le chinh xac tren du'di 1 c3 so la khoang 60%. Franco F.N. (2010) [ 2 ] thay template chinh xac dSn ± 1 c3 so doi vdi ca chuoi khdp va o coi nhan tao dat 97,4%. Cac tac gia cung cho rang nhd template ma thdi gian mo co the n i t ngan hdn va chuan bj tot hdn ve c3 so va chung loai khdp su'dung.
Chung toi cho rang co the sCr dung ty le phong dai trung binh (1,06 vdi khoang each chup la ISOcni) de template ma khong nhat thiet phai tinh toan ty le phdng dai hinh anh XQ cua tii'ng TH cu the. VdS ket qua nay co the t h y c hien template rpng rai vdi hinh anh phdng dai i j 0 6 nhu'ng phai qui chuan chup XQ vdi khoang cach 150cm, hinh anh XQ lay dirdc ca 1/3T XD.
IV. Kfr LUAN
Ty le chinh xac cua template tru'dc phau thu^t doi vdi 6 col theo ty le phong dai XQ rieng bidt cua tiing benh nhan ± 1 c3 so la 52/72 (72,2%), ty le chfnh xac ± 2 cd so la 72/72 (100%) tru'dng hdp. Ty le chinh xac cua template tru'dc phau thuat doi vdi chuoi khdp theo ty le
phdng dai XQ rieng biet cua t i m g benh nhan ± 1 c3 so la' 61/72 ( 8 4 , 7 % ) , t y le chi'nh xac ciia template chuoi khdp ± 2 cd so la 72/72 (100%) tru'dng hdp.
T A I LIEU T H A M K H A O
1 . Carter L., Stovall D., Young T. (1995),
"Determination of accuracy of preoperative templating of noncemented femoral prostheses", J. Arthroplasty, 10. 507.
2. Franco F. N., Malik A., Gonzalez D.A. et al.
(2010), "Preoperative planning of prosthetic replacement in hip fractures in the elderly". Rev.
Esp. Cir. Ortop. Traumatol., 54(2): 136-145.
3. Gonzalez Delia Valla A., Beksac B., Peterson M.G. et a l . ( 2 0 0 6 ) , "A new technique to improve cup inclination accuracy in primary total hip arthroplasty". Hip. Int., 16: 250 - 2.
4 . Gonzalez Delia Valle A., Slullitel G., Piccaluga F. e t a l . ( 2 0 0 5 ) , "The predon and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty", I Arthroplasty, 20: 51- 58.
5. Patrick G., Justin de B., Danielle P. et al.
( 2 0 1 0 ) , "The accuracy of digital templating In uncemented total hip arthroplasty", J. Arthn^., 25(4): 529- 532.
6. Stephane D., Christine L. (2010),
"Determination of digitized radiograph magnification factors for preoperative templating in hip prothesis surgery", Skeletal Radic^., 39:
273- 277.
7. Unnanuntana A., Wagner D., Goodman S.B.
(2009), "The accuracy of preoperative templating in cemenless total hip arthroplasty", J.
Arthroplasty, 24:180.
DAC DIEM LAM SANG BENH UNG THU* Lirai GIAI DOAN IIMV DU'O'C DIEU TRI HOA CHAT TRU-ffC PHAU THUAT VA/HOAC XA TRI
T6MTAT
M^c tiSu: Mo ta dSc diem lam sang benh ung thU Iu9i giai doan IIMV du'dc dieu tri hoa chat tru'dc phau tiiu$t va/ho$c X9 trj.boi tu'ang va phu'dng phdp nghien cufu: Mo ta hoi CIJ\J 117 benh nhan ung thU Iu9i phan di dpng du'dc dieu trj hoa chat bo trd tru'dc phau tiiuat vVho$c xa tri tai benh vien K va benh vien DHY Ha Noi tCr l/2o62-io/2010.Ket qua: Tuoi tmng
*{)^ihQcYHaNgi
Phan bl$n khoa hgc: PGS.TS N g u y i n Van Hieu
Le Van Quang*, Nguyin Xuan H^u*
binh la 49,65 ± 8,59, tijoi tr^n 40 (83,8%) .T'? J?
nam/nu' la = 4,3/1. Ly do vao vi?n chu yeu \h ^ n thUOng tai tu9i nhU noi u, loet, dau. Vj tri u hay g|p la d bd t y do (82,1%), ton thUdng d?ng sui loet v^ d^ng SUI hay g^p. Kich thudc u < 4cm chiem ty I? 54,7%;
kich thifdc u > 4cm chiem 45,3%, trung binh l i 4,2
±1,0 cm. U xam lan san mJ?ng chiem 51,3%, u lan tiSi phan luSi co dmh chiem 22,2%. Co 54,7% BN c6 h?ch tren lam sang, kich thu'dc hach < 3 cm chiem 53,2%, c6 1 hach chiem 71,8%, co tren > 2 hgch t^lSm 18,2%, hach viing duti^i ham, dudi c5m chiem ty* I?
Y HOC V|£T NAM THANG 6 - SO 2/2014 73,4%, canh cao vdi 31,3%. Giai doan T2 la 9,4%, giai
doan T3 la 29,9% va giai doan T4 1^ 60,7%. Giai doan III 27,4%, giai doan IV 72,6%. Ket luan: Ung OiU Iu8i hay gSp 6 lu^ tuoi tren 40, tneu chuYig lam sang chu yeu la noi u va dau tai tai lu^i. U hay gip d bis tii do cua lu@i va dang tong thuong hay gap la sut, loet.
Di cSn hach co sdm, v| tri hach di can hay gap la viing d\fdi ham, dUdi cSm
rij'khda:\am sang, ung thu" luSi SUMMARY
DESCRIPTION OF CLINICAL CHARACTERISTICS OF STAGE I I M V ORAL
TONGUE CANCER TREATED BY NEOADJUVANT CHEMOTHERAPY BEFORE
SURGERY AND/OR RADIATION Directives: Description of clinical characteristics of stage III-IV oral tongue cancer ti-eated by neoadjuvant chemotherapy before surgery and/or radiation. Patients and methods: 117 oral tongue cancer patients were treated by neo-adjuvant and/or radiation in K hospital and Ha Noi medical university hospital from 1/2002 to 10/2010. Retrospective descriptive study. Results: Mean of age 49,65 ± 8,59, most frequent age was older than 40 years (83,8%).
Male/female 4,3/1. The main reason for admission was local manifestation; tongue tumor, tongue ulcer and pain. The tumor site was common at lateral border of the tongue (82,1%), ulcerated protrude and protrude lessions were most frequent. Tumor size less than 4 cm accounted for 54,7%; tumor size bigger than 4 cm 45,3%; average size 4,2 ± 1,0 cm. Mouth floor invasion 51,3%; tongue root invasion 22,2%. 54,7%
had clinical cervical lymph node, lymph nodes sized smaller than 3 cm 53,2%, patients having only 1 lymph node 71,8%; more than 2 lymph nodes 18,2%;
submandibular and submental lymph nodes 73,4%;
level II lymph nodes 31,3%. T2 patients 9,4%; T3 29,9%; T4 60,7%. Stage III 27,4%, stage IV 72,6%.
Conclusion: Oral tongue cancer was common at the age older than 40 years-old. The common clinical manifestation was tongue tumor and pain. The common tumor site was lateral border of tine tongue and Oie most frequent tumor type was ulcerated protrude and protrude. Cervical lymph node metastase was early and ttie most frequent group was submandibular, submental one.
Keywonis: Clinical characteristics, oral tongue cancer
I.DATVANDI
Ung thu* luQl la u ac b'nh nguyen phat tai Iu3l, trong do chu ygu la ung thu" bieu mo vay (chiem >95%) va la ung thu" thu'dng gap nhat trong cic ung thu" vung khoang mieng (chiem 30-40%). Theo thong ke cua Hiep hoi ung thU Hoa K9, tren toan the gidi hang n3m cd khoang 263.900 ca mdi mSc v i khoang 128.000 tru'dng
hdp tu' vong [1]. Ung thu" luQi la benh cd the phat hien va chan doan sdm, nhu'ng thu'c te ty le benh nhan den dieu tri d giai doan mupn (III, IV) d nu'dc ta con cao, mot phan do t)enh nhan chil quan khi thay ton thu'dng tai Iu9i gay khd chju nhuYig cd chju dutig khong di kham benh, mot phan do thay thuoc lam sang khong nghi den benh UTL. Viec chan doan ung thU Iu6i d giai doan mupn se kho khan cho viec dieu trj va ket qua dieu tri rat han che. Vdi mong muon khong ngimg cai thien chat lu'dng chan doan benh ung thu* luSi, chung toi tien hanh nghien CUXJ de tai nay nham muc tieu 'Wo ti d$c diem iam sing cua ung thif iu'oi giai do^n III-IV du'dc dieu tri hoi chit tru'dc phau thuat va/hoicxa tri"
11. Ddi TUpNG VA PHU'CTNG PHAP N G H I I N COU 2.1. fioi tu'dng nghien cihi: gom 117 BN dUdc chan doan la ung thu* iu0i phan di dpng giai doan III, IV (MQ) duUc dieu tx\ hoa chat bo trd tru'dc phau tiiuat va/ hoac xa tri tai Benh vien K va Benh vien OHY Ha Npi tjj 1/2002 den 10/2010.
2.1.1. Tieu chui'n iy'a chgn b$nh nhin - Tuoi < 70.
- Cac BN dUdc dieu tri lan dau.
- BN khong mac cac benh cap va man tinh tram trong
2.1.2. TiSu chui'n io^i tru"iJ^nh nhin
• Ho sd lull trU khong day du, that lac hp sd.
- Cac benh nhan khong du cac tieu chuan trSn 2.2. Phu'dng phap nghi€n ed'u 2.2.1. Thiei ice nghien c&u: Mo ta hoi CUXJ 2.2.2. Thu th$p cac thdng tin - Lam san^:
+ Tuoi, gidi.
+ Thdi gian tir luc cd tri?u chung dau tien den khi vao vien (tinh theo thang)
+ Cac trieu chimg cd n3ng: dau tai u, nuot vu'dng, nuot kho, nuot dau,...
+ Tai cho: vj tri u, soydng, kich Uiu'dc, hinh dang (siii, loet, tham nhiem..,), chay mau, mu'c do tham nhiem.
+ Tai viing: tinh trang hach, vj tri, so lu'dng, tinh chat hach...
- 0n lam sang: mo benh hpc va dp mo hpc - Glal doan binh:
+ Giai doan III: T3 No MQ; TJ NJ MQ; T2 Nj Mo;
T3 N, Mo
+ Giai doan IV(MO): T4 No Mo; T4 Ni Mo; Bat ky T, N2 Mo.
2.3. Xilr ly so li^u: xCr ly bSng phan mem SPSS 16.0.
Y HOC VlfT NAM THANG 6 - SO 2^014
III. KET QUA NGHIEN Ci>U
3.1. Tuoi, gidi: tuoi trung binh la 49,65 ± 8,59. Nhom tuoi du'di 40 chiem 16,2%; nhdm tren 40 tuoi chiem ty le 83,8% .Ty te nam/nu' la = 4,3/1.
3.2. Ly do vao vi@n va thdi gian den vien
Barig 1. Ly do vao vien va thdi gian den vien
* Ly do vao vien ( n - 1 1 7 ) Noi u
Dau tai vung co u Vet \ok tai li/ai Nuot vu'dng, nuot dau Noi hach co
* Thdi gian den vien n=117)
< 3 thang 3 -12 thang
> 12 thanq
SoBN 38 30 22 19 8 59 53 5
Ty le o/o 32,5 25,6 18,8 16,3 6,8 50,4 45,3 4,3
WA^/i xet! Ly do vao vien noi u luSi chiem 32,5%, dau tai u chiem 25,6%, vet loet tai Iu9i chiem 18,8%, ndi hach co chiem ty le thap ia 6,8%. BN den vien < 3 thang chiem 50,4%, tir 3 6§r\ 12 thang chiem 45,3%. Co cd 4,3% den vien sau 12 thang.
3.3. fiSc diem khoi u
Bang 2. Vj tri, hinh thai, kich thu'dc va muTc do xam lan u tru'dc dieu trj:
* V i t r i u ( n = 1 1 7 ) Bdtu'do Mat du'di Iu8i Dau luBi Mat tren \dd\
Ham lu€l
' Hinii thii t6n thu'dng (n=117]
Siii loet Sill Loet
Sill loet tham nhiem
« Kich thu'dc u (n=117)
< 4 cm
> 4 cm
'Mu'c xam ran (n=117) - San mieng - Lu8l CO dinh - Tru tru'dc amydan - Qua du'dng qiife
SSBN 96
7 7 4 3 43 26 15 33 64 53 60/117 26/117 16/117 15/117
Ty l# % 82,1
6,0 6,0 3,4 2,6 36,8 22,2 12,8 28,4 54,7 45,3 51,3 22,2 13,7 12,8 Nhiin xgt:
- V! tri u hay g$p nhat la d bd tu' do (82,1%), it gap d ham luSi (2,6%).
- Ton thu'dng siii loet chiem 36,8%, dang sill 22,2%, dang loet chiem 12,8%.
- Kich thu'dc u <4cm chiem ty le 54,7%; kich thu'dc u >4cm chiem 45,3%, trung binh la 4,2±l,0cm.
- U xam lan san mieng chiem 51,3%, u lan tdi phan lu^i co djnh chiem 22,2%.
3.4. e$c diem h^ch
Bing3. Pac diem hach tru'dc dieu tri;
* Hach phdt hien tren lam sang (n=117) -Cd
- Khong
• Kich thu'dc hach Idn nhat (n=64)
• Kich thirdc < 3cm
SoBN 64 53 34
Ty le % 54,7 45,3 53,2
YHQCVlgTNAM'mAMG6-SO2g014 3 < Idch thu'dc <6 cm
Kich thu'dc > 6 cm
* So liTdng hach (n=64) 1
> 2
* \n tri hach Canh tren Dudi ham, cam Canh giQ;a Canh du'di Nhin xiu
- Co 54,7% BN cd hach tren lam sang. Kich thu'dc hach <3 cm chiem 53,2%, chi cd 4,7% BN co hach
>6cm.
- Trong so 64 BN cd hach, ty le BN cd 1 hach chiem 71,8%; 18 BN cd tren >2 hach chiem 18,2%. Vi tri hach vung du'di ham, du'di cam chiem ty le 73,4%; tiep den la canh cao vdi 31,3%.
3.5. Giai do^n bSnh
Giai doan HI cd 32 BN chiem 27,4%, giai doan IV cd 85 BN chiem ty le la 72,6%
3.6. Phan bo giai do^n T- N
Bing 4. Phan bo giai doan T- N tren lam sang
NO N I N2 N3 Tdng
So BN »/o
So BN
So
BN °/o BN So
% %
8.5 0,9 9A
T3 18,8
T6ng
26,5 1J7 60,7
45,3 34 29,5 23,1 2,6
Nh$n xit: trong so 117 BN cd 11 BN d giai doan T2 chieiii 9,4%; 35 BN d gia 29,9% va 71 BN d giai doan T4 chiem 60,7%
100 doan T3 chiem 3.7. H^ch di cdn vh glai doan T
Bing 5. Tinh tranq hach di c3n va qlai doan T tren lam sanq
T2,3 T4 Tonq
No SSBN
22 31 53
°/o 18,8 26,5 45,3
N12,3 SoBN
24 40 64
»/o 20,5 34,2 54,7
Tong SoBN
46 71
39,3
%
60,7 117 1 100
P 0,02
Nh$n xit:gia\ doan T4 cd ty le di can hach cao 40/117 BN chiem 34,2%; giai doan T2 va T3 ty I?
dl c5n hach la 24/117 BN, chiem 20,5%.
3.8. Cdc phiTdng phdp dieu trj: phu'dng phap cSt nijta luSi + vet hach hoSc c3t nii'a Iu9l+v^t hach+cat nuS xu'dng ham cd 55 BN chiem ty l | 47% (trong dd cd 2 BN cit niJa Iu9l+vet h?ch+c3t xu'dng ham). Phu'dng phap xa tr| c6 62 BN, chiem 53%.
iV. BAN VJ^ti
4.1. TuSi, gidi: mpi lu^ tuoi deu cd the bj ung thu, nhutig trong ung thu' luSi tudi mSc benh ndi Chung thu'dng tir tren 40 tudi. Lua tuoi hay gjp theo Yii va CS (1999) \i 50-59 tuoi [2].
Nghl§n cu\j cua Rana va CS (2011), tuoi trung binh Id 49,5 tuoi [3]. Trong nghien ciru cua Chung toi cd 83,8% so b?nh nhan tren 40 tuoi.
trong dd nhdm tuoi gSp nhieu nhat tif 41-60 tuoi (71,8%), tuoi trung binh la 49,65 ± 8,59 tuoi.
Trong tat ca cac nghien CLTU ve UTL deu cho thay nam mac nhieu hdn ni?, ty I? mSc b?nh d nam gidi cao hdn.Trong nghien CLTU cua chung tdi ty le nam/nij' = 4,3/1, phu hdp vdi nghien CLTU ciia Pham Cam Phu'dng (2005), ty 1$ nam/nii' Id 4,5/1 [4]. Theo nghien ciiti ciia John vd CS (2003), ty le nam/nii'la 3/1 [5],
4.2. Thdi gian tir khi c6 tri^u chii'ng Ciu tien den i<hi vdo vi^n vd iy do vdo vi$n:
Trong nghien cifu ciia chung tdi, so benh nhan den vien trong 6 thang dau ke tir khI cd trl|u chirng dau tien chiem ty 1^ 81,2%, thdi gian trung binh la 4,9 thang. Ket qua ciia chung tdl 43
y HOC VIET HAM THANG 6 - SO 2/2014 phil hdp vdi nghien culj cua Nguyen Oirc L0 la
78,6% [6], va Pham Cam Phu'dng la 80% [4].
Tuy nhien dieu nay chutig td toe dp phat trien ciia benh nhanh vi toan bp so benh nhan cua chung toi d giai doan III, IV; hdn nij^ ung thL/
luSi la ung thu' xuat hien tren vi tri de quan sat, nhay cam, li^n quan tru'c tiep den chu'c nang nhai, nuot, ndi khien benh nhan phai di kham benh sdm. Mpt so benh nhan tit khi bat dau cd vet loet nhd tai lu9i den khi benh nhan den vien da tren 12 thang j4,3%).
4.3. 03c diem u, h^ch tnfdc dieu trj: v|
tri u trong benh UTL cung co nhu'ng dac diem can lull y la hay gap d bd tiT do, sau do la mSt du'di lu@l vi ung thu' lu@i cd lien quan den cac benh ly man tfnh vung rang mieng, d vj tri i^u lu'di va m$t tren ft gap. Nghien ciili cua Pham Cam Phu'dng (2005), vj tri u d bd ty do chiem 81,8%, mat tren 7,3%, m^t du'di 7,3%, dau luSi 3,6% [4]. Nghien cihj ciia chung toi cung cho ket qua tu'dng ty, vi tri u d bd ty do chiem 82,1%, mat tren 3,4%, m|t dydi 6%, dau Iu8i 6% .
Hinh thai ton thu'dng UTL rat da dang, nhutig dang siti, loet, sui loet la thu'dng gap. Nghien culi cua chiing toi u dang siii loet chiem ty le cao nhat vdi 36,8%, dgng sui la 22,2%, dang loet la 12,8%.
Kich thydc khoi u > 4 cm chiem 45,3%, u <
4 cm la 54,7%; kfch thydc trung binh 4,2 ± 1,0 cm, Idn nhat 7 cm va nhd nhat 2cm. Trong so 117 BN, xam lan cua u xuong san mieng chiem 51,3%; luSi cd dinh 22,2%; tru tru'dc amidan 13,7% va qua du'dng giCi^ la 12^8%. Denise va CS (2009), cd 87% u Iu0i chi d phan \dd\ di dpng, 7% u Iu0j da lan xuong san mieng, 6% u lu@i da lan xuong san mieng va goc lu'di [7]
Mpt dac diem lam sang quan trpng khac la hach viing co, trong nhdm nghien culi cua chiing toi CO 64 benh nhan cd hach qua tham kham lam sang, chiem ty le 54,7%, trong dd kich thydc hach nho nhat la 0,5 cm, hach to nhat cd ki'ch thudc 8 cm va co djnh. Hach cd kfch thydc < 3 cm la 53,2%; hach ldn hdn 3 va nho hdn 6 cm chiem 42,1%. So benh nhan cd 1 hach la 58 benh nhan chiem 71,8%; vj tri hach hay gap la hach du'di ham, du'di cam chiem 73,4% va hach canh cao la 31,3%.
4.4. Giai doan benh: co 11 benh nhan d giai doan Tj chiem 9,4%, cd 35 benh nhan (29,9%) d giai doan T3 va 71 benh nhan d giai doan T4 chiem 60,7% vdi ton thu'dng xam lan tru tru'dc amidan, san mieng va/hoac xam lan cac cd
luSi. Xep giai doan TNM cho ket qua, ty le benh nhan d giai doan III la 27,4%, d giai doan IV la 72,6%. Day cung la hai giai doan hay gap nhat trong cac benh nhan UTL du'dc dieu trj d nu'dc ta tir tru'dc den nay. Theo nghien cuU ciia Nguyen Quoc Bao (1997), ty Ie benh nhan d giai doan III la 49%, giai doan IV 1^ 29% [8]. Trong 117 benh nhan trong nghien culi cua chiing toi co 64 benh nhan co hach, trong do hach di can Ni chiem 29,5%, N2 chiem 23,1%; N3 chiem 2,6%. Khi so sanh moi lien quan giii^ giai doan T va di can hach tren lam sang cho thay cd su* khac biet, d giai doan T4 cd ty le di can hach cao hdn (34,7%).
V. KET LU^N
Qua nghien cult 117 BN ung thy Iu9i phan di dpng giai doan III-IV, chung toi rut ra mpt so ket luan sau: Ung thu* lydi hay gap d lulia tuoi tr€n 40, trieu chutig Iam sang chu yeu la noi u va dau tat tai lu3i. U hay gap d bd t y do cua Iu3i va dang tong thu'dng hay gap la siil, toet. Di c3n hach CO sdm, vi tri hach di can hay gap la viing dirdi ham, dydi cam
TAI Ll|U THAIVI K H A O
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2. Yii W.N, Patel G.S, Breach M.N, et al (1999),
"Manangement of the No neck in early cancer of the oral tongue", Clin. Otolaryngol, 75 - 79.
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noi tni cac benh vien, trudng Ogi hpc y H^ Noi.
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lam sang va mot so yeu to tien lu^ng b^nh ung thu ludi dieu trj tai b^nh vien K", Li4n vSn tm nghiep bac sy npi tni cac b^nh vi$n, Tru&ng d?i, hoc y Ha noi.
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