Die DIEM U M SANG. CAN LAM SANG BENH UNG THlTVOM M O I HONG GIAI DOAN I
Lt VAN Q U A N G - B4 mon Ung thif- Tru6ng D^i hgc Y Ha N^
N G U Y £ N V A N T U Y i N - Khoa xa diu m$t c6- B$nh vien K T6MTAT
Muc tidu: Nhdn xdt dde diim Idm sang, edn Idm sdng bdnh ung tiid vdm giai doan l-ll duae chin doan vd a^ tii tai B&nh vidn K. Bii tUang vd pbuong phdp: Gdrn 126 bdnh nhan duae chin dodn ung thu vdm mQi bong, giai doan I, II, dugc diiu tii tai Bdnh vidn K til 01/2008 din 4/2012. SCf dung phiiang phdp nghidn cOu md ti hdi cdu. Kit qui: Tuii gdp nhidu nhit tif 40-59, dinh cao nhit 50- 59 tuii, t^ Id nam/nd Id 1,7/1. Vdo vidn vi dau n&a diu, xi ra mdu mui, chiim t} Id 77,9%. Thdi gian td kbi cd tridu chdng diu lidn din lihi di khdm bdnh td 2 tuin din trdn 3 thdng Id 91,3%. Hinh thdi u, thi sdi chiim 73,8%, tiip theo Id thi bdn hpp chiim 17,5%, thilodt chiim 1,8%. Vi tri t^ thuong, khii u xam lin cda mui sau chiim t^ le 77%. Tren hinh inh CT, MRI phdt hien khoi u xdm lin khoang Rosenmuller chiim t^l$ cao vdi 46,1%, bach c$n hau chiim 7,1%. Giai doan khii u T2 cao ban giai doan khii u T1, giai doan hach NO chiim chd yiu vdi 69,6%, giai doan Nl chiim 10,4%. Kit ludn: Ung thu vdm gdp d bit kjr Ida tuii nio, tuy nhien Ida tuoi hay gdp nhit Id tCf 40 din 59, tuii mic bdnh tivng blnh Id 52. T^ Id nam/nd 1,7/1. Da si ngudi bdnh din ifhdm 2 tuin din > 3 thdng, chiim 91,3%. Ly do din khdm bdnh chd yiu Id dau nOa diu va xi ra mdu mui, (^iim 68,2%. B$c diim hinh thdi u, thi sdi chiim t^
1$ cao nhit 73,8%. U xdm lin khoang Rosenmuller chiim t^ 1$ cao vdi 46,1%, hach cdn hiu chiim 7,1%.
Giai doan u, giai doan T2 chiim t^ Id cao 77%.
Tdkhda: B$c diim Idm sdng cdn Idm sdng, ung thu vim.
SUMMARY
THE CUNICO-PATHOLOGICAL CHARATERISTICS OF NASOPHARYNEAL
CANCER STAGE I, II
Objective: To evaluate the clinico- pathological characterstics of nasopharyneal cancer patients staged I, II diagnosed and bvated in K hospitai Patients and meOiods: 126 nasopharyneal cancer parents diagnosed, staged I, II and treated in K hospital hom 01/2008 to 04/2012. The retrospective descriptive study. Results: The most often seen ages ranged bxmt 40 to 59 with Oie pick was horn 50 to 59.
The male to female ratio was 1.7/1. Admission reasons were migraine and epistaxis accounted for 77.9%. The duration of symptoms, hom the time appearing the tirst symptoms to the moment of examination, ranged from 2 weeks to 3 months accounted for 91.3%. Morphologically, the protivdes 73.8%, tiie mixtes 17.5%, the ulcers 1.6%. Locally posferidr nasal fossa invaded tumors accounted for 77%. Radtologically (CT and MRI), Rosenmuller cavity invaded tumors accounted for 46.1%, parspharyneal lymf^ node invasion 7.1%. T2- tumors
wem more hvquent tiian T1, NO was tiie most frequent (89.6%), Nl 10.4%.
Keywords: The clinico-patholo^cal charaeteristics. nasopharyneal cancer.
DAT VAN DE
Ung thi/ vdm mOi hpng la benh gSp nhidu nhdt trong cdc benh ung thu vDng dau - co. Theo ghi nhdn ung thil Hd Ndi giai doan 2001 - 2004, d Viet Nam ung thir vdm diTng ddu trong cdc t>€nh ung thir vDng dau CO, dtJmg tiiiir 5 d nam gidi vdi t^ le mac b€nh ehuin thep tudi la 7,3/100.000 dan, d nQ gidi bSnh diJmg thO: 8 vdi t^ Id mac bdnh chuIn thee tudi la 4/100.000 dan. Hang nam c6 khoSng 350 den 400 benh nhan ung thU vdm mui hpng, dUdc xa tri tai Bgnh vidn K Hd Npi.
Tridu chijmg benh d giai doan sdm thudng nghdo nan, b&nh nhan khdng dd y hoSc de nham vdi cdc tridu chiimg cQa cac bSnh tai mui hong, do dd bdnh duoc chdn dodn chi] ydu d giai doan III, IV vi vay kdt qua dieu tn cdn han chd. Chan dodn sdm b§nh ung thir vdm hpng, khdng nhCmg dem lai kdt quS di^u tri rat cao, ma cdn tranh di/pc nhiing bidn chijihg do tia xa gay ndn, cung nhir dd tdn kem vd kinh td, NgSy nay nhd cd nhidu phUdng tien tidn tidn, hidn dai nhiT ndi soi TMH, chup CT, MRI, PET CT ... giOp chdn doan chfnh xac vd phdt hien bSnh d giai doan sdm, nen c6 nhidu bdnh nhSn ung thir vdm hong, da dudc chdn dodn xac djnh cQng nhif chdn doSn giai do^n sdm hdn. De cd cd\ nhin tdng t h l vd tridu chCmg lam sang va cdn lam sang ci^a ung thir vdm giai doan sdm. Do dp chOng tdi tidn hanh nghidn ciTu ndy n h l m muc tidu "Nhan xdt ddc diim Idm sdng, cdn Idm sdng bdnh ung thd vdm mui hong giai doan 1,11".
DOI Tl/ONG VA PHUONG P H A P NGHIEN CCTU 1. Ddi tudng nghien c i i u : Gdm 126 bdnh nhdn dudc chdn dean ung thir vdm mui hong, giai doan I, II, dinilc dieu trj tai Benh vidn K tir 01/2008 - 4/2012.
• 77eu chuan Ida ebon
- Ung thl/ vdm hong giai doan I, It, theo phan loai UICC 2002.
- Khdng cd hach, hoSc chi cd 1 hach dddng kfnh Idn nhdt < 2 cm.
- Xa tri don ^ u d n , b l n g may xa gia tdc, khdng bd dd 3\iu tri.
-Didu tri landau.
* 77du chuan loai trd
Bdnh nhan kh6ng dO tidu chudn life chpn.
Bdnh nhan bd dd didu tri.
Bdnh nhan cd chdng chl dinh xa tri.
Bdnh nhan cd 2 ung thi/dong thdi.
Bdnh nhan cd thai hoSc dang cho con bd 2. Phifdng phdp nghien cCru: Md tS hdi eCru.
3. Xufly so'lieu: Blng phan mdm SPSS 16.0.
Y HOC THVC H A N H (924) - S6 7/2014 71
KET QUA NGHIEN COU 1. Dac diem lam sang
Bang 1. Phan bd benh nhan theo nhdm tudi va gi6i
Nhom tuoi 20-29 30-39 4049 50-59
>60 Tdnq so
Nam So benh
nhSn 3 7 18 34 16 78
NS So benh
nhan 2 4 13 16 13 48
Tong sfi So benh
nhan 5 11 31 50 29 126
T} le%
4,0%
8,7%
24,6%
39,7%
23,0%
100,0%
Nhan xet; Tuoi mac benh g§p nhieu nhat la tir 40- 59, dinh cao nhat la tir 50- 59, t^ Id nam/nir la 1,7/1.
Bang 2. Ly do kham t)enh Trieu chOnq
CItal Dau nCra dau Xi ra m^u mui Nqat, lac mui
Tonq
SoBN 20 42 44 20 126
TJIe%
15,9 33.3 34,9 15,9 100 Nhan xet: Ly do vao vien dau nCfa dau, xi ra mau mui, chidm tj' le cao nhdt vdi 77,9%.
Bang 3. Thdi gian den kham Thfli gian
Tir 1 den 2 tuan TCr2 tuan den 1 th&ng
TCr1den3th^nq Tren 3 th^nq
TSng
So benh nhan 11 41 36 38 126
T»le%
8,7 32,5 28,6 30,2 100,0 N h a n x e t : T h d i g i a n t i r k h i c 6 t n e u c h i f n g d a u t i e n d e n k h i d i k h a m c h u y d u la t i r 2 t u a n d e n t r e n 3 t h a n g ( 9 1 , 3 % ) , t h d i j i a n d i k h a m tru'dc 2 t u a n c h i c d 8 , 7 % ,
2. D i e diem can lam sang
Bang 4, DSc diem, hinh thai khdi u tren ndi soi, phim CT, MRI
Dac diem
l^inh thai khdru
Tdn thi/ong tren CT,
MRi
The sui Thd ioa Thd tham nhiem
Thd h6n hop Thd dirdi niem Khoi u khu tnj tai vdm Kh^ u xam Ian c&a mui sau KhS u xam ian honq mieng
Kh^ u xam ian khoang Rosenmuiier Hach can hau
SdBN 93
2 3 22 6 34 42 1 49 9
73,8
%
1.6 24 . 17,5 4,8 27 33,3
0,8 46,1 7,1 N h a n x e t :
- Hinh thai u: The siii chiem t^ Id cao nhat (73,8%), tiep theo la the hdn hop chiem 17,5%, the loet chiem t^ le rat thap 1,6%,
- Vj trf tdn thuong: Khdi u xam lan cifa mui sau chiem ty le cao nhat (77%).
- T r e n h i n h a n h C T , M R I p h a t h i e n k h d i u x a m l a n k h o a n g R o s e n m u l l e r c a o ( 4 6 , 1 % ) , H a c h c a n h a u c h i e m 7 , 1 % ,
B a n g 5, G i a i d o a n T N M t r i f d c d i e u tri
Giai doan u (T)
Giai doan hadi (N)
Giai doan di can (M)
Nhdm giai doan (S)
Giai doan T i Giai doan T2 Giai doan hach NO Giai doan hach N l Giai doan MO Giai doan M l Giai doan 1 Giat doan 2 A Giai doan 2 B
SdBN 27 99 113 13 126 0 29 84 13
TflMl 21.4 78* 39.6 10^
no
0 23 66,7 10.3 N h a n x e t : G i a i d o a n k h d i u T 2 c a o h d n giai dead k h d i u T l , g i a i d o a n h a c h NO c h i e m chii y d u (89,6%), c d n g i a i d o a n N l c h i c h i e m c h i e m 1 0 , 4 % .BAN LUAN 1. Dac diem lam sang
Tudi, gidi: Ung thir vdm hpng (UTVH) cd thd gap 3 moi lira tuoi, tuy nhien ty le mac rat khac nhau tuy theo timg gidi, nhdm tuoi, Theo Pham Thuy LiSn, nSm 1984 qua nghien ciru ve djch td hoc, cho thay benh nhan tre nhat mac benh UTVH la 5 tudi, cao tudi nhat la 80, tJ le mac benh cao nhat cf nhdm cd do tudi tif 40 - 49 tudi. Theo nghien cifu cOa Ngd Thanh Tung nam 2001, dJnh mac cao nhat la tir 40 - 49 tuS, chiem 31,1%, ty le nam/nC/ la 2,8/1, Theo Nguyin Hiili Thdi nSm 2003, t^ Id mac cao nhat la tir 41 den 50 tudi, chiem 38,28%. Trong nghien eiili cDa chung toi ty le m l c cao nhat tap trung d khoang tif 40 den 59 tudi, trong do dinh mdc tir 50 den 59 tudi, c6 50 benh nhan chiem 39,7%, benh nhan tre nhat mac benh la 20 tudi, ngu'di eao tuoi nhat mac benh la 76 tudi, tudi mac trung binh la 52, Theo Ang va CS tJ IS nam/nu" la 2,4/1, trong nghien ciru cOa chiing toi t j te mac nam/nir la 1,7/1.
Ly do vao vien va thdi gian den kham: Do giai phau vom hpng d vj trf khd kham, cac trieu chiing lam sang thudng la cac trieu chifng miron, khdng dSc hifu, nen ca benh nhan va thay thudc de bd qua neu khdng nghT den va benh nhan thu'dng dieu trj theo cac chuydn khoa khac trong thdi gian dau, khi dieu tri keo dai ma khong khoi, hoSc benh tien then nang, noi hach cd thi benh da d giai doan mudn, Theo Ngo Thanh Tiing nam 2001, ly do den kham vi ndi hach co chiem tJ le cao nhat 197/367 benh nhan, chiem 53,7%, ty le den kham tnfdc 3 thdng 24,3%. Trong nghien cifu cua chung tdi, chi nghien cifu benh nhSn giai doan I, 11 nen l^ do den kham chu yeu u tai, ngat tae miji va dau nifa dau, va thdi gian ddn kham cung sdm hon, Tru'dc day cd benh nhan khi phat hien c6 hach CO tir 1 nam. nhung nghT khdng dau, khong anh den SLfc khde nen khdng di kham, chi den khi c6 dlu hieu ton thifong than kinh so nao mdi di kham, vS thu'dng benh da d giai doan muon, Ddi khi ngifdi bSnh cd trieu chifng cua benh nhuTig khong dam ddi mSt vdi benh nen khdng dam di kham, den khi benh xam lan rdng anh hi/dng den sire khde mdi den viSn.Trong nghien ciru ci^a chiing tdi tJ le den kham sdm cao hon, cd the do ngliien cifu d giai doan sdm, hdn niia ngay nay do cdng tac truyen thdng, nhan thite v^
b|nh ciia ngu'di dan cung cao hdn nen tJ Id ddn khim benh d giai doan sdm ngay cang nhieu hdri.
72 Y HOC THirc HANH (924) - s6 7/2014
T r i ^ chdhg cd nSng:
Cdc tridu chirng Idm sang cOa bdnh phu thuoc vdo vj trf, mire dp xam Idn cOa khdi u va finh trang di c i n xa. Trong nghidn ciifu cOa chdng tdi gdm 126 bdnh nhdn kdt qua 73 bdnh nhdn bidu hidn dau dau diidm 57,9%, 82 benh nhan u tai chidm 65,1%, ngat t i c mui 64 b6nh nhan chidm 50,8%, 44 bdnh nhan cdiay mau mQi chidm 34,9%, vd 28 benh nhan dau hpng chiem 22,2%. cac ket qua tong nghidn cCru ciia chiing tdi cGng phu hdp vdi cac nghien ciru cua cac tac gia trong vd ngoai nude, Tuy nhien trong nghien ciru ciia chOng tdi t$ Id ndi haeh co chidm t^ Id rdt thap do chiing tdi chi nghidn cijni d giai doan sdm I, II. Nhd v$y cac tridu chljmg cd nang nhir dau n ^ dau, ii tai mflt bdn, ngat, tSc mui, khjt khae ra mdu mui la cac triSu chiimg hay gdp nhdt trong tienh ung thi/vdm mui hong giai doan I, ll,
Hinh thai khdi u: Trong nghien cifu cOa ehiing tdi, thd siJi cd t^ IS cap nhdt vdi 93 benh nhan chidm 73,8%, tidp theo Id the phdi hdp chidm 17,5%, thd diftSi nifem cd 6 bdnh nhan chidm 4,8%, thd tham nhiSm cd 3 bgnh nhan chidm 2,4%. Kdt qud ndy tUdng dddng vdi nghien ciTu cQa Ngd Thanh Tung nam 2001 Id 58,9%. Thd du6i nigm chidm t^ le 4 , 1 % dSy la thd khd khSn trong c h i n ddan va sinh thiet, ddi khi phSi sinh thidt nhidu lan mdl cd kdt qu^. Thd phdi hop sCil loat thudng gap trong cae trirdng hop khdi u ldn cd VLing tmng tam bj hoai tCir do thieu dinh dudng, dd l^i cdc d lodt xen lan td chiTc sui. Thd loet ft gSp chi chidm 1,6%.
2. D$c diem can lam sang
Trong nghiSn cifU ciia chiing tdi, tdt cS bdnh nhan ddu dUdc ndi spi TMH, chup CT, hoae MRI vdm hong, sp nSo dd chdn dodn xdc djnh vj tri, kfch thudc, mitc d$ xdm ldn cOa khdi u. Qua nghidn ciTu 126 bdnh nhfin thdy, vj trf khdi u khu trii tai vdm trdn 2 vj trf Id 27 bgnh nhdn chidm 21,4%, khdi u xdm Idn hcng mi$ng rdt hid'm gdp, chiem t^ le 0,8%. Trdn ldm sang cac khdi u xSm ldn ci3te mui sau chidm tJ le 72,2%.
Theo Bill Vinh Quang nSm 2012, khdi u xam Idn cCfa mQi sau Id 35,7%. Trong nghidn ciifu cda chiing tdi do (^i nghiSn cifu d giai doan I, II nen t^ \d ndy eao hdn.
Trong nghidn ciru cQa chiing tdi chi ddnh gia giai do^n I, II theo p h i n loai UICC 2002, ndn giai doan T1 cd 29 bSnh nhSn chidm 23%, giai doan T2 cd 97 b^nh nhan chidm 77%.
G^c didm h^ch cd di can: Di cdn hach CP rat hay gip trong ung thiT vdm hpng giai doan muon. Tuy nhian trong nghidn cijru ciia chung tdi t^ Id nay la rdt thdp do chi ddnh gid benh d giai doan I, II. T;^ Id di can hach cd la 13 bdnh nhdn chidm 10,3%, trong dd phat hi^n qua sidu dm td 4 bdnh nhdn chidm t9 Id 3,2%, h^ch sau hdu difdc phdt hien qua phim MRI, CT la 9 bdnh nhSn chidni t f 1$ 7.1%. Hach sau hau Id ch^ng di cSn h^ch dau tien tixsng ung thU vdm, hpng, nhi/ng khdng thd dUOc phdt hien dUOc bSng thdm.
kham ldm sdng. Trong nhidu nghidn ciJiLr tnjdc day cQa cac t i c g i l node ngodi. dd ghi nhdn mdi tUdng quan ch$t chS glDa di cSn xa vd bdnh nhdn c6 di cdn h^ch cd. Cdc tdc giS thdy i^ng, d nhOng bdnh nhan
cd hach co d giai dean N2, N3 co t^ le di cdn xa cao hdn h i n nhCTng bdnh nhdn d giai dean NO, N l . Tnsng nghien edU cua chung toi, t}enh n h i n d giai doan NO la 113 bdnh nhan chidm t^ le 89.7%, giai doan N l Id 13 benh nhdn, chidm t^ le 10,3%. Theo Ld Chi'nh Dai ndm 2004, nghien ciJru 321 bdnh nhan, giai doan NO la 9,18%, giai doan N1 la 8,14%, giai doan ' N 2 Id 48,56%, giai doan N3 la 34.12%.
Xep loai giai doan tienh: Trong nghidn cijru ciia chiing tdi gdm cac benh nhan d giai dean I, II ttieo UICC 2002, trong dd cd 27 bdnh nhan khdi u edn khu tni tai vdm, chidm t f le 21,4% (giai doan I), 86 benh nhan chidm t$ Id 68,3% (giai doan lia) vd 13 bdnh nhan chidm 10,3% (giai doan lib).
Ode didm, hinh thai, vi tri khdi u qua ndi soi. CT, MRI:
Ngay nay vdi viSc ra ddi ciia may ndi soi TMH giup thay thudc phat hidn ton thUdng, sinh thidt chdn doan md benh hoc mpt cac^ chfnh xac hon, gtdp qua trinh theo dpi sau dieu trj cd he thdng, hieu qua.
Ngoai ra npi soi giup danh gia, chdm sdc trong sudt qua trinh tru'dc, trong vd sau didu tn.
Vai trd chfnh eOa chan doan hinh anh ndi chung, cQa CT, MRI ndi rieng ddi vdi UTVH la rat quan trpng, nd giiip xac djnh mot each chinh xac vj tri, mOc dp xam lan, kfch thudc khdi u, mat khac cdn phdt hidn cd tdn thUdng xirong ndn sp hay khdng, ed xdm ldn, miic dp xam lan cac xoang, hdc m^t, xam Idn nao, mdng nao hay khdng. Bdc biet tdn thuong hach sau hau chi dupc phdt hidn qua hinh anh ciia CT, MRI. Ngoai ra chup CT, MRI cdn giOp phat hi^n dupe nhCfng trudng hpp UTVH thd dudi nidm, didu ndy noi soi khdng ddnh gia dupc. Bidu nay rdt quan trpng nd giup ngudi thay thudc lap kd hcach didu tri chfnh xac, h^n chd tdi da tdn thUdng vao cac md lanh lidn quan. Trong nghiSn CLTU cOa chiing tdi tdt ca benh nhan ddu dirpc chup CT, hoac MRI tnrdc didu tn ndn vide danh gia tdn thUOng tai vdm. hach sau hau mdt each chfnh xac tir dd lap kd hoach didu tri xa tri mpt each chfnh xac, hidu qud. Vai trd ciia CT, MRI da dUpc nhidu nghidn cifu bao cao, cd the lam thay doi tdi 43% giai doan bdnh cda khdi u. Od danh gia chfnh xac tdn thudng d vdm thl vi§c chup CT, MRI theo true Axial, vd Idp eat trdn Coronal vdi dp ddy 3mm tai v6m, 5mm tai vung cd. Trong nghidn cQu ndy, chiing tdi thay tJ Id ton thu'dng hach sau hdu la 7,1%.
Theo nghien ciTu ci^a Atula va cs ndm 1997, chup CT scan phdt hidn hach di c3n trdn 27% bdnh nhdn ung thu dau cd khi kham Idm sang khong phat hiSn dudc hach di can, Didu nay cho thdy chup CT, RMI cd vai bi> rdt quan trang trong danh gia chfnh xdc giai dean benh trong ung thiTvdm hpng.
KET LUAN
Qua nghien ciiu 126 t>dnh nhan ung thifvdm hpng giai doan !. II dUpe didu tri B6nh vidn K, tir 01/1008 ddn 4/ 2012, ehiing tdi njt ra nhijna kdt luan sau: Ung thu vdm hpng gdp d bdt ky lii^ tuoi ndo, tuy nhldn lira tudi hay gap nhdt Id tir 40 ddn 59, tudi mdc b i n h tmng blnh la 52. TJ Id m i c nam/n01,7/1, Da sd ngudi benh ddn kham 2 tudn ddn > 3 thang, chidm 91,3%.
L'ji dp ddn kham bdnh chO ydu la dau ni]ra ddu vd x) ra
Y HQC THUC H A N H (924) - S6 7/2014 73
mau mui, chidm 68,2%. Ddc diem hinh thai u. thd sui chidm t f le cao nhat 73,8% Giai doan u, giai doan T2 chidm ^ le cao 77%,
T A I L I E U T H A M KHAO
1. Ngo Thanh Tiing (2001), Nghien cifU dac diem lam sang va ket qua xa tri ung thu bieu mo khdng biet hoa vdm hong tai Benh vi$n K giai doan 93 - 95", Luan van thacsy Y khoa,
2. Bill Vinh Quang: "Nghidn ciru dieu tri ung thi/vom hpng giai doan 111, IV (MO) bang phdi hpp hoa - xa trj gia tdc 3 chieu theo hinh dang khdi u". Luan vdn tidn sy Y hpc.
3. Le Chinh Dai (2007) "Nghien ciTu dieu tri phdi hop hoa xa trj va xa trj ddn thuan benh ung thu vom mui hpng giai doan ill, IV (MO)", Luan van tien sy Y hpc.
4. Pham Thuy Lien (1991). "Ung thU vdm hong".
Bach khoa thU benh hpc tap 1. Nha xuat ban Bach khoa benh hoc Ha Ndi'trang'308 - 3 1 1 .
5. Nguyen H i ^ Thoi (2003): "Ung thUvdm hpng, thut hanh xa tri benh ung thu", Nha xuat ban Y hpc, trang 227 - 236.'
6. Sham JST, Cheung YK, Choy D, et al (1991), Cranial nerve involvement and base of the skull erosion in nasopharyngeal carcinoma. Cancer 68:422-426.
7. Brady LW, Heilmann, Molls M, Nieder (2010), Nasopharyngeal Cancer, Multidisciplinary Management, Springer
8. Chpng VFH, Fan YF, Khoo JBK (1996),
"Nasopharyngeal carcinoma with intracranial spread: CT and MRI characteristics". J Comput Assist Tomogr 20:563-639.
BimC DAU DANH GIA TAG DUNG CUA BAI THUOC HDT TREN BENH NHAN DAI THAO DlTfiTNG TYP II
NGUYEN THE THjNH - Hgc vien YDHCT Vidt Nam DAT VAN DE
vao nhiJfng nam cudi the ki XX va nhuTig nam dau cua the ki XXI, dai thao du'dng (DTD) la benh khong lay phat tnen nhanh nhat, la nguyen nhan gay tCf vong difng hang thiT tU, thif nSm d cac nifdc phat then, b§nh eung du'pc xem la "dai d[ch" d cac nu'dc dang phat then. Hien nay, benh DTD chiem ti \d cao nhat ve sd lu'png cac cong trinh nghidn ciru, tap chi va sach bao chuyen nganh [1].
Theo y hpc cd truyen (YHCT) DTD thupe pham vi chung "tiSu khat", dieu tri chu yeu la tieu khat hoa dam smh tan, Trong nhieu nSm nghien cifu va dieu trj, di/a vao kinh nghiem cCia nhan dan mot sd vitng kdt hpp kinh nghiem thifc te lam sang cho thay bai thudc HDT cd tac dyng tdt trong dieu tri DTD, Mac du bai thudc CO tac dung tdt, gia thanh re lai co nguon gdc tir thao dupc hoan toan la thudc nam, da phan cac vi thudc la mdn an hang ngay trong moi bi/a cdm cua gia dinh ngu'di Viet Nam, nhuYig cung chua cd nghien ciru cu the nao chifng minh tac dung cua bai thudc, Vi vay, chiing toi tien hanh nghien cifu de tai:
"Budc dau danh gia tac dung cCia bai thudc HDT tren benh nhan dai thao du'dng typ 2" nham muc tieu:
1. Danh gia tac dung ha glucose mau va mdt so chl so lipid mau cija bai thuoc "HDT" tren benh nhdn DTD typ 2.
2. Khao sat tac dung khdng mong muon cua bai thuoc tren mot sd' chi tieu lam sang va can lam sang.
001 Tl/ONG, PHUONG PHAP NGHIEN CLRJ 1. Chit lieu nghien ciiru
1.1. Thanh phan bai thuoc
La lot, kho qua, dt can, sinh dia, kim ngan hoa, bo cdng anh, cam thao.
1.2. Dang bdo chi
Thudc dirpc bao che dang nude sac tai khoa Du'pc, Benh vien Tu& TTnh,
- Dong till bang may ddng till SCA 2000 cOa hang SAMYAN - Han Quoc,
1.3. Cdch si}dung
Udng ngay 01 thang: 130ml/lan x 3 Idn/ngay tri/6c bita dn 1 gid,
1.4. Thdf gian ddng thuic: 60 ngay.
2. Dd'i tifdng nghien cihj
2.1. Tieu chuan chgn benh nhan theo YHHD Gom 30 benh nhan dirpc chdn doan la dai dudng typ 2 ca nam va nOf cd.
- Glucose huydt liic doi 7 - 13 mmol/L, - Tudi > 30.
- Cd hoSc khdng kem theo rdi loan lipid mau.
- Benh nhan tif nguyen tham gia vd cd didu kifin tuan thu quy trinh nghien cifu
2.2. Tieu chuan chon benh nhan theo YHCT
^ T h ^ b e n h T i f c h l i i ^
Vong chan
Van chan
V l n chan
Thiet Chan ThiTOTig tieu The trang beo hoac tnjng binh R§u li/ai vang m6nq,daulLfaid6
N6i to ro Hoi thd khSnq hei
Tnang ngircn buon birc Khat nudc uong nhi^u, migng khf) hong rao, hay di lieu vat nhieu ian
Mach honq scic Trung tieu
The trang gay kho Reu lirOi v^ng
Noi to ro HoHhdh6i
An nhieu mau d6i sOt c^n Th6m an ngpt Oai tiSn tao bl
Mach hoat s&c HatiSu
T h l trang g3y Reu Iu5i vang
N6itora Hoi thd khflnq h6i Di ti^u nhi€u ISn.
ninac tiiu due va dac Mieng khft hpng rSo. trong nguOl bu6n bye, bilt nit chdn tay Dau limg, tt&
dfim Mach trdm td sdc
Y HOC THUC HANH(924).s67/M14
