TAI L l i u THAM KHAO
1. Ton Ttij Tjnh (2007), "Danh gia tiiuc trang lain thOc muc hanh vi YHCT cda y bac sy YHCT iinh Thai Nguyen'.
Ludn vdn thae sy y hpc - Tnidng Dai hpc Y Hd Npi.
2. Le Vdn DQng (2007J, Nghidn cOu thuc trang hoat ddng nghi cda mdt so ca sd YHCT tu nhdn tai tinh Hai Duang, Luan vdn Thae sy y khoa Hoc vien Quan y.
3. Pham Phii Vinh (2012). Nghien cdu thUC trang YHCT Lang San va de xuat mdt so giai phap di phat
triin YHCT Lang San, Luan vdn thae sy y hoe. Hpc vien Y dupc hpc CO tmyen Vidt Nam.
4. Tran DCfC Tuan (2012), Thuc trang sd dung y hgc CO truyin lai tuyen xa phudng thudc tfnh Hai Duang, Luan vdn ttiac sy y hpc. Hoe vien Y dUdc hpc co truyen Viet Nam.
5. Pham Viet Hoang (2013), ThUC trang y hgc cS truyin dnh Hung Yen va hidu qua can thidp ting cUdng boat ddng kham chda bdnh cda Bdnh vidn Y hgc d truyin tinh, Luan an tien sTy hpc, Dai hoe Y Ha Noi.
NGHIEN CUU DANH GIA GIAI DOAN UNG THlfTHim QUAN THEN SIEU AM NOI SOI
MAI TH] HOI, NGUYEN TRUNG U £ M , PHAM DllTC HUAN Bmh vi$n HOU nghi Viet Ddc TOM TAT
Ohg dung SANS trong chin doan giai doan ung thu thuc quan. Doi tugng - phUdng phip: Nghien cOu tiin cdu md ti 55 trudng hgp UTTQ dugc SANS xac djnh giai doan vd doi chiiu vdi kit qui giii phiu benh sau mi. Kit qui: Tuii trung binh 53,69 + 8,42; nam gidi chiim da si (96,36%), phan bi vi tri UTTQ 6 1/3 trdn - 1/3 gO/a - 1/3 dudi li 10,9% - 38,2% - 50,9%;
chiiu ddi cda tin thuang 55 ± 33,073 mm. MOc dd xim lin thinh T1 -T2-T3- T4 tuang dng la 14,5%
-18,2% - 58,2% - 9,1% vdi tp id chin dodn ddng Id 78,18%. dd nhay la 55.6% - 93%, dd die hidu la 84%
- 96,1%. tp Id hach dl dn la 53,85% vdi ip Id chin doin dOng ii 82,69%. Kit luan: SANS cd vai trd danh gii mdc dd xam lin thinh vd hach vdng trong benh Ip UTTQ.
TCf khda: tJng dung SANS, ung thuthuc quan.
SUMMARY
ENDOSCOPIC ULTRASOUND APPLIES ON EARLY DIAGNOSIS OF ESOPHAGUS CANCER
Methods: Descriptive research of 55 esophagus cancer cases who were diagnosed by endoscopic ultrasound and confirmed by histopathoiogy. Results:
Mean age: 53.69 + 8.42; male was dominant (96.36%), location of the tumor: upper part- middle part - lower part were 10.9% - 38.2% - 50.9%
respectively, length of the tumors: 55 ± 33.073 mm.
Tumor extension: T1-T2-T3- T4: 14.5% -18.2% - 58.2% 9.1% respectively with accurate rate of 78.18%, sensitive rate of 55.6- 93%, specificity rate of 84-96.1%. Nodes metastasis rate: 53.85% with the accurate rate of 82.69%. Conclusions: Endoscopic ultrasound have an important role in diagnosis of tumor extension and local nodes metastasis in esophagus cancer
Keywords: Endoscopic ultrasound, esophagus cancer.
O A T VA'N D i
Ung thu thUe quan (UTTQ) ed xu hudng gia tang, hien ddng thU 5 tai Viet Namtrong ung thu ndi chung.
6\^u tri UTTQ tdt nhit la p h i u thudt. cd the phdi hpp hda chat va tia xa tuy tCfrig giai doan. Tuy nhien thdi
gian sdng tmng binh eung ehl khoang 18 thdng ke tU khi phat hien bdnh [1]. Viee l i ^ chpn phuong phdp dieu tri la rat quan trpng, phu thupe vdo giai doan cfla bdnh, trang dd chfl yeu la mdc dp xam lan efla tdn thUdng u nguyen phat vao thdnh thUe quan, cd hay khdng d di d n hach hodc xam lan vao to chUc xung quanh. Viee ehan doan giai doan bdnh e6 the dus vao chup cat Idp vi tinh, edng hudng tU hay sieu am ndi soi (SANS) [2,3]. Trong do SANS dupc coi Id phUdng phap cd gia tn nhat trong viee danh gia xam lan thanh va hach khu vUC. Nghien ciiu trdn nhom benh nhdn UTTQ dUdc SANS trudc p h i u thuat nham mue di'eh "Dinh gii kit qui xic dinh xim lin thinh thuc quin vi di dn hach khu vuc cda ung thu biiu md thuc quin bing SANS".
o6'l T a p N G - PHUONG P H A P
Ddi tuong nghien cUu: Gom cac benh nhdn da dUdc chan doan xac dinh UTTQ qua ndi sol va co k i t qua giai phdu benh la ung thU bieu mo thuc quan, duoc lam SANS tai Bdnh vidn HQu nghi Viet DUe tU thang 01/2011 den thang 06/2013.
Phuong phap nghien cUu: Md ta t i l n cUu.
Phuong lien nghien ciiu: He thdng mdy SANS Olympus OF 160 UE.
Ky thuat sieu am npi soi: Benh nhdn dupe nhjn an udng khi t i l n hanh thfl thudt it nhat 6 gid, tU t t i l nam nghidng trai, chdn phai hdi gap va ra trudc, gdy me toan thdn hoac tai chd (gel xylocain 10%). DUa dng soi cd gan dau dd sieu dm vao thUe quan va tiep can vao vi tri ed tdn thUdng. quan sat hinh anh SANS, sau dd tien hdnh bom bdng de danh gia tdn thUdng u.
dua dau do sidu dm xuong da day danh gia tinh trang hach vung quanh tam vj va quanh DM than tang. Sau dd nit may len thuc quan de danh gia lai tdn thUdng u. ddng thdi xae i^nh di edn hach vung (nlu khdng d hep thuc quan).
Phdn tich hinh anh UTTQ tren SANS: V\ trf efla ton thUdng dupe ehia lam 3 phan (1/3 trdn -1/3 giO'a - 1/3 dudi); kich thude khdi UTTQ: ehieu dai u. dp ddy cfla tdn thUdng (mm). Xae djnh mdc dp xam lan thanh (phan loai T) dUa tren cd sd phan loai giai
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doan theo hd thdng TNM cfla To ehde Y te T h i gidi (WHO) ndm 2000.
Vj tri hach chia theo 3 nhom: Nhdm hach viing d bao gdm d c hach d giOa va dudi cfla d e ehudi haeh d n h trong (vung nen d - d ) , nhdm hach viing ngUc:
bao gdm d c haeh eanh khi phe quan, d c haeh nga ba khf p h i quan, d c h a d rdn phdi. d e hach nam canh dpng mach d f l va OiUC quan, nhdm hach ti^ong o bung: bao gdm d c d u d i hach tam - phinh vi, chudi hach thdn tang. Kfeh thudc haeh, hinh dang haeh hinh bau due hay trdn (chenh lech giite dudng kfnh khdng qua 20%). Hach dupc nghT den la haeh di can thudng d d e dde diem khdi trdn giam am giong am d a to ehiit u, ranh gidi ro, d the d d ludng nhieu, dudng kinh thudng a 10 mm. Cac hinh anh Vnu duoc d ddi chilu vdi ket qua giai phdu benh (GPB).
Xur ly so' lieu: Sd lieu dupe xU i f theo phan mem thdng ke y hpe'SPSS pliidn ban 20.0,
Kir QuA
Trong thdi gian tU thang 01/2012 d i n thdng 09/2013 ehiing tdi thu thdp dugc 55 bdnh nhan dfl eae tieu ehuIn efla nghien eUu: Tudi tmng binh 53,69 + 8,42; nam gidi ehiem da sd (96,36%); trieu ehUng chfl yeu Id nudt nghen (80%). Phan bd vi tri UTTQ d 1/3 trdn - 1/3 giUa - 1/3 dudi Id 10,9% - 38.2% - 50,9%; chieu dai efla tdn thuong 55 ± 33,073 mm.
BSng 1: MUe dd xam lan thanh thue quan tren SANS
Bang 5: Ddi ehieu ket qua ehan doan hach khu vUC giOa SANS vdi MBHPT
MOc dd xdm idn thanh thi/c quSn DuiS nidm mac-Tl
Ldpco-T2 Ldp ngoai c0n9-T3 Vuot qua Idp nqoai cOng - T4
Tdng cdnq
N 8 10 32 5 55
T}id(%) 14,5 18,2 58,2 9,1 100,0 Bang 2: KhS ndng xac d[nh dp xdm l l n thanh thuc quSn glu^ SANS vdi giai phdu benh
T-GPB T-SANS Tl T2 T3 T4 Tdng
Tis 1 0 0 0 1
Tl 5 3 1 0 9
T2 2 7 2 0 11
T3 0 0 28 2 30
T4 0 0 1 3 4
Tdng 8 10 32 5 55
Chan doan ddnq H 5/8 7/10 2fra2 3/5 43/55
62,5
%
70,0 87,5 60,0 78,18 Bang 3: Dp nhay vd dp ddc hidu cfla SANS trong ehan doan giai doan T
T-SANS Tl T2 T3 T4
Bdnhay(%l 55,6 63,6 93,3 75,0
Bd dac hidu (%) 93,5 93,2 84,0 96,1 Bang 4; Chan doan tinh trang hach tren SANS
Chan dodn hach trdn SANS NO Nl Tdng
N 24 28 52
T}ie%
46,15 53,85 100.0
N-MBHPT N-SANS
NO Nl Tdng
NO 20 5 25
Nl 4 23 27
Tdng 24 28 52
Chdn doan ddng N 20/24 23/28 43/52
%
83,33 82.14 82.69 BAN LUAN
Danh gia mu'c d o x a m lan cua thanh t h i ^ quan tren SANS
Nghien cdu ehl ra rang ton thUdng ehfl yeu cfla UTTQ den Idp ngodi cung, tuong Ung vdi giai doan T3 (58,2%). sd trudng hdp tdn thUong d i n Idp duffl niem mac la 8 chilm t f le 14,5%, tdn thUOng vUOt qua Idp ngoai cung cd 5 trUdng hdp, chiem 9,1%. Ddi ehilu vdi k i t qua giai p h i u benh ehflng tdi t h i y dd chfnh xde cfla SANS trong xae djnh xdm lan thdnh cfla UTTQ Ung vdi d e giai doan f 1, T2. T3, T4 lan lupt la:
62,5%; 70,0%; 87,5% va 60,0%. T f Id xae djnh dflng giai doan xam lan thanh cfla UTTQ la 78,18%. NhU vdy khi ton thUdng UTTQ tdi Idp ngoai cflng thi tf Id chan doan chfnh xac cfla SANS la eao nhit (87,5%), dp ehinh xac thap hdn ea Id vdi ede t i n thUdng 3 ndng va tdn thUdng da vupt qua Idp ngodi eiing. Dilu nay ed t h i dUdc If giai dd dang bdi Id vdi cac tdn thuong d ndng da phan d i u cd dp ddy thdnh khdng dang ke nen vide danh gia tdn thUdng gdp nhilu kho khdn. Mdt khae, do mdy SANS cfla ehflng tdi c6 tin sd t h i p (tu 5 - 1 2 MHz) nen vide xdc djnh tdn thUdng d Idp niem mae, ed niem vd dudi niem mae c6 dd ehfnh xae khdng cao. De xac djnh ehfnh xac mUc do xam lan d eac Idp nay d n phai SIJT dung dau do sieu dm cd t i n sd cao (tU 20 - 30 MHz). Cd 5 trUdng hdp tdn thuong da vupt qua Idp ngoai eflng, trong do d 1 trudng hdp u gay hep hodn todn, may SANS khdng qua dUdc ehd hep nen khdng quan sat vd ddnh gia het ducie tinh trang xdm l l n thanh efla UTTQ, 4 trudng tipp cdn lai vdi sd lUdng I't va d Id do ehflng tdi d n thieu kinh nghiem ndn chUa dua ra dupe k i t qua ed dp ehfnh xde eao.
Theo k i t qua nghien ciiu d a K. Ziegler vd d n g sU nam 1991, t f Id chan doan dflng mUe do xam lln thanh (giai doan t ) efla UTTQ qua SANS Id 89% so vdi 5 1 % efla ehup CLVT. Mdt sd tde gia khac trdn the gidi nhu J. Vickers; F. K. Binmoeller; T.L. Tio eung da dua ra t f Id ehan doan dflng tUdng Ung Id 92%; va 89% [4,5,6]. Theo bao d o cfla E. Vazquez - sequeiros nam 2010 ttii t f le ehIn doan ehinh xde mUc dd xam lan thanh cfla ung thU thUC quan tren SANS la 85% (59%-92%) so vdi cfla ehup CLVT la 45% (40% - 50%) [7].
Trong nghidn cOu efla ehflng tdi, dd nhay vd dp dae hieu efla SANS d l chan doan mflt dp xdm lan thanh cfla UTTQ d d c giai doan T l Id 55,6% vd 93.5%; giai doan T2 Id 63,6% va 92,9%; T3 la 93,3%
va 84.0%; T4 Id 75.0% va 96,1%. NhU vdy T3 Id giai doan ma SANS d do nhay cao n h i t trong ehan doan mijte dd xam lan thanh cfla UTTQ. Theo thdng bao
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efla Jr. Gregory Zucearo vd eong su ndm 2005, dp nhay vd dp dde hidu efla SANS trong c h i n d d n giai doan T 3-4 tubng Ung Id 86% (79-92%) va 82% (74- 88%) [8].
Danh gid m i ^ do di cdn hach
Mue dfch ehan doan hach trong SANS bao gdm hach vidm va hach di can 6$ ddnh gia sd bd giai doan bdnh trude khi q u y l t djnh dieu tri. Trong nghidn eUu nay tren 52 trudng hdp SANS danh gia toan bd haeh (trung that va d bung) ed 45 tn/dng hdp phat hidn haeh trong dd 28 tru'dng hpp hach ed ddc diem dl d n (f^l) chiem 53,85%, d n lai 24 tmdng hdp khdng thay haeh di d n (NO) ehiem 46,15%. Khi doi chieu k i t qua chan doan di cdn haeh glOa SANS vdi k i t qua MBHPT sau md eho thay t f fe chan doan dflng cfla SANS d 2 nhdm hach NO va N l tuong Ung la 83,33%
vd 82,14% vd t f Id chung la 82,69%. Trong nghidn edu efla But Vdn Ldnh t f Id ehan doan dflng hach di d n cfla chup CLVT la 73,6%, dd nhay va dp dae hieu lln lupt la 48,3% va 98,4% [1]. Mdt nghidn eUu efla H.J. Dittler va edng sU ndm 1992 cho k i t qua chan doan haeh di d n ehfnii xae d mUc 50% - 60% [9],
K f f L U A N
SANS CO gia tri trong ehan doan giai doan benh UTTQ: Ddi vdi mUc dp xdm lan thdnh (T) thi T3 Id giai doan d tf Id ehan doan dflng, dp nhay va dp dac hidu tdt nhat (>80%); doi vdi di cdn hach thi t f Id xae dinh dflng la 82,69%.
T A I LlgU THAM K H A O
1. Pham DiilC Huan and Dd Mai Lam, Cit thUC quin ndi soi nguc phii vdi tu thi nim sip tmng dieu trj ung thu (/iyc quin. Nghidn cflu Y hpc, 2006. 54(43): p. 30 - 33.
2. Bui Vdn Lenh, D6 Dflc Van, Hoang DUc Kiet, Tridu chimg lam sing vi die diim hinh anh ung thu thuc quin trdn chup dt Idp vi tinh. Y hoc thuc hanh, 2006: p, 39 - 42.
3. F. Campbell, W. V. Bogomolets, and G. T. Williams.
Tumors of the esophagus and stomach. Diagnostic histopathoiogy of tumors, 2000.1: p. 313-328.
4. J. Vickers and D. Anderson, Oesophageal cancer s^ging using endoscopic ultrasonography. Br. J. Surg.
1997.85: p. 994-998.
5. F. K. Binmoeller, H. Seifert, and al.. Ultrasonic esophagoprobe for TNM staging of hightly stenosis esophageal caminome. Gastrointestinal endoscopy, 1995.
41(6): p. 547-552.
6. T.L. Tio. P.P. LO Coene, and al., Endosonography in the clinical staging of esophagogastric carcinoma.
Gasti-ointest. Endosc. 1990. 36: p. 2 -10.
7. Vazquez-Sequeiros, E., Optimal staging of esophageal cancer. ANNALS OF GASTROENTEROLOGY, 2010. 23(4): p. 230-236.
8. Jr. Gregory Zucearo and al. Endoscopic Ultrasound Ermrs in Esophageal Cancer. /American Joumal of Gastroenterology, 2005. 100: p. 601 - 606.
9. Dittler HJ, Pesarini AC, and S. JR.. Endoscopic classification of esophageal cancer: Correlation with the T stage. Gastmitest Endosc, 1992. 38: p. 662-668.
NGHIEN CIAI GAC DANG CHIA NHANH DdNG MACH MAC TREO TRANG DUDI VA l)NG DUNG TRONG PHAU THUAT NOI SOI DAI THUC TRANG
N G U Y I N Hiru THJNH, N G U Y I N HOANG BAC, Lg VAN QUANG, PHAM V A N TA'N, N G U Y I N V A N CHLTNG TOM T A T
Md dau: Trong phau thuit ndi soi (PTNS) dt dai tnjc tring, hiiu ro vi nim vdng giii phiu mach mau va SI/ phin nhanh cda ddng mach mac treo tring dudi (DM MTTD) la diiu rat quan trgng. Muc tidu nghidn cdu Id xic djnh tlld cac dang chia nhanh cda ddng mach mac treo trang dudi Cmg dung trong phau thuit ndi soi cit dai true trang.
Dii tugng va phuang phap nghidn cdu: Bio do hing loat ca dugc PTNS dt dai true trang d ghi hinh cudc phdu thuat vd DM MTTD dUdc bde Id ro tan gic.
ddng thdi phiu tich din chd phin chia c^c nhdnh cda ddng mach.
Kit qui: Cd 32 tn/dng hgp (15 nam, 17 nO), tuii tmng binh 59,2 ± 15,9 tuii. Trong do, cd 13 trudng hop (40,6%) la dang SS (DM DTT va DM DTCH khdng cd thdn chung) chiim tp Id cao nhit, 10 trudng bap (31,3%) Dang V (DM DTT, DM DT CH vi DM TT7" cd Chung 1 diim xuit phat). Dang Y (DM DTT- CH cd 1 thdn chung) cd 7 tn/dng hgp (21,9%). Chiim tp Id thip nhit li Dang Kb (khuyit DM DTT) cd 2 tn/dng hgp (6,2%).
Kit luan: Hiiu biit chi tiit vd suphin chia nhinh mach miu cda ddng mach mac treo trdng dUdi giOp cho phiu thuat ndi soi dt dai true trang an toan vi hidu qui.
Tirkhda: Phau thudt ndi soi, ddng mach mac treo tring dudi, ddng mach dai trdng trai
SUMMARY
BRANCHING PATTERN OF INFERIOR MESENTERIC ARTERY OBSERVED IN LAPAROSCOPIC COLORECTAL SURGERY
Background: Branching pattern of inferior mesenteric artery (IMA) and patterns of vascular supply to the left colon and rectosigmoid areas, though important during colorectal surgery. This study aimed to determine the rate of the branching pattern of IMA observed in laparoscopic colorectal surgery.
Materials and Methods: Thirty - two cases (15 males, 17 females) were studied and determined branching pattern of inferior mesenteric artery (IMA).
Results: IMA frequently branched into left colic artery and a common sigmoid trunk (Type SS) in 13
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