NHAN XET VE DAC DIEM LAM SANG, CAN LAM SANG VA PHUONG PHAP DIEU TRI CUA UNG THITDIEU MO NOI MAC TUT CUNG GIAI DOAN I TAI BENH VllN K
N G U Y E N V A N T U Y S N - Benh vidn K
T6M TAT
D6I twang: 96 bdnh nhdn dwaic chin doAn Ung thw ndi mac tw cung (UTNMTC) giai doan IA, IB, IC dwac diiu triphAu thuAt tia xa tai bdnh vidn (BV) K tCr 1/2007 din 1/2010. Phuvyng phAp: phwang phAp md tA hdi ciru cit ngang. Kit qui : Tudi tmng binh IA 58, dudi 40 thap (1,1%), do tudi hay g$p id sau mdn kinh trdn 50 tudi 96,8%. Tridu chirng hay gdp nhit cua UTNM TC IA ra djch am dao IA 57,3%. ra mdu bit thw&ng Am dao sau man kinh la 33,3%,. Sidu dm, MRI c6 glA tri cao trong chin doAn UTNMTC, dAc bidt MRI cdn danh gid dwac mirc do xAm lin UT va di cdn hach gdp phin dAnh giA giai doan. UTBMT ndi m^c fd cung chiim ty Id cao nhit 92,7%, cdc tip md hoc khdc rit it gap-Hiu hit cdc BN c6 dd md hoc bidt hda cao 60,4%, bidt hoA thip chi chiim 26%,. Trong 96 BN, giai doan IB chiim ty IS cao nhit 52,1%, giai doan IA s&m chi gap12BN(12,5%) khi UT cdn khu trO niem mac f d cung. Diiu trj phiu thudt chi dinh tren tit ca 96BN nghien cwu trong dd nh&m vdt hach chiim da sd vdi 89,6% do trong NC it gap UT giai doan sdm IA. Cac biin chCrng do phiu thuat rit It gap cao nhit IA biin chwng tiit nidu la 5,2% Diiu tri tia xa sau mo chi tiin hanh tren 39BN(40,6%), chu yeu vdi giai doan IC (97,2%,). Cac biin chwng do tia xa cung it gap va chu yiu la viem loot da chiem 38,5%,. Kit luan. UTNMTC giai doan I c6 TC lam sang va can lAm sang dien hinh, thw&ng gap a phu nir mdn kinh, dieu tn chu ydu phau thudt vA tia xa, it cac biin chwng xAy ra trong cd trinh dieu tri
Tip khoa: Ung thw ndi mac tir cung, MRI SUMMARY
Evaluation of clinical,subclinical and treatments of endometrial carcinoma stage I at K Hospital.
Subjects: 96 patients diagnosed with endometrial cancer stage IA,IB,iC were treated with surgery and radiotherapy from 1/2007 to 1/2010. Methods, cmss- sectlonal retrospective method described. Results:
The average age is 58, after menopause over 50 years is 96.8%.Tthe vaginal symptoms was 57.3%, abnonnal vaginal bleeding after menopause is 33.3%.
Ultrasound, MRI has high value in the diagnosis of endometrial cancer, MRI evaluation of the degree of invasion and lymph node metastasis The most frequent pathohistiogical type was Endometrioid adenocarcinoma (92.7%), the others were very iow,with high histological grading accounted for 60.4%, low grade only w as 26%,. Stage IA accounted for 12.5%,, 52.1% stage IB higher Surgery performed all of 96 patiens with allmost were total histerectomy
and pelvic lymphanedectomy (89.6%,). The post operative complications were very rare, unnal disoder occurred in 5.3%,. There were 39 patiens received post operative radiotherapy with mostly stage IC (97 2%), with local dermatitis orcurred 38.5%
Conculsions: Stage I endometrial carcinoma performed typical clinical symptoms, occurred in post menopausal women Treatment with surgery and post opertative radiothrapy, rare complications.
Keywords: endometrial cancer stage, K Hospital DAT V A N D e
Ung thu ndi mac t u cung (UTNMTC) thudng gdp 70% d phu nd sau mdn kinh, 25% tien man kinh vd 5% trong dd tudi sinh de Tai Vidt Nam, ung thu ndi mac tu cung cd ty Id m i c Id 2,5/100.000 ddn, ty Ip tu vong Id 0,9/100.000 dan, dung hdng thu 12 trong edc loai ung thu d nu gidi Trong 5 ndm g i n ddy ty le mdc bdnh ndy cd xu hudng gia tang tai Viet nam [3,4], Tuoi ung thu ndi mac t u cung gdp chu y l u d phu nu sau man kinh (75%), da sd trong khoang 55- 60 tudi. khoang 5% xuat hien d tudi dudi 40; m i t cdn bang estrogen d nhung ngudi ed vdng kinh khdng phdng noan; dieu tn ndi t i l t thay t h i bdng estrogen, nhung ngudi ed kinh sdm (trudc 12 tudi) va man kinh muon (sau 50 tudi); khdng sinh eon; beo phi, che dd an nhiiu md ddng vdt; mdc bdnh tang huylt dp; ddi thdo dudng; mac ung thu vu hodc ung thu budng fn>ng; dQng thudc tamoxifen dieu trj ung thu vO [1.2].
Phat hipn benh giai doan cang sdm thi ty Id chua khdi cdng cao, dd cdn Id ca sd quan trong glQp cho cac bdc sT lua chpn cdc phuang phdp dieu trj phQ hap eho tung benh nhan Phuong phap dieu tri benh ung thu ndi mac t u cung' Bao gdm phdu thudt, tia xa, hda chat va ndi tiet, Hau h i t cac BN duge phat hipn deu d giai sdm. Tai BV K h l u h i t gap cdc BN d gia doan I, II vd da duac dilu tri kjp thdi do dd chdng tdi t i l n hdnh nghien cuu ndy vdi myc tieu nhan xet mpt sd ddc dilm Idm sdng, cdn 1dm sdng c h i n dodn vd phuang phdp dieu tn Ung thu ndi mac t d cung giai doan 1.
0 6 l TU-ONG, PHU'aNG PHAP NGHIEN CU'U 1. Ddi tUQ'ng nghien c u u :
96 BN duoc chan dodn UTNMTC giai doan IA, 1B,IC duoc dieu tn phdu thudt tai BV K t u 1/2007 den 1/2010
Tieu c h u I n lua chpn benh nhan :
- Cdc BN ung thu NMTC giai doan 1 bao gdm IA, IB, IC theo FIGO 1988
- Cdc BN dupe d i l u tri lan ddu tai bdnh vidn K - Khdng m i c cdc bdnh UT khac tren cQng mdt bdnh nhdn
- Cd hd sa theo ddi day du
Y HQC THVC HANH (868) - SO 5/2013
2. Phiro-ng phdp nghidn c d u
2,1 Thilt k l nghidn cuu; phuang phdp md td hdi cdu cd theo ddi dpe
2,2. Cdc budc t i l n hdnh
- Thu thdp theo m i u bdnh dn nghidn cuu Cy t h i nhu sau.
- Ode d i l m 1dm sdngTudl gidi, t i l n s u bdn thdn, cdc tridu chdng cy t h i tgi ch& ca ndng, thyc t h i nhu ra mdu kdo ddi sau mdn kinh hodc rong kinh, dau byng hg vj
- Cdn Idm sdng
Sidu dm d byng, t u cung p h l n phy, chup e l t Idp VI tinh (CT scaner), chyp cdng hudng t u (MRI)
- Chin dodn giai dogn bdnh.
Cdc BN trong NC dw(?c ddnh gia giai dogn sau khi p h l u thudt Theo FIGO 1988
Trong nghidn cuu ndy chung tdi ehi ddnh gid giai dopn 1
C h i n dodn md bdnh hpc (giai dogn bdnh): theo FIGO 1988 (Federation International de Genecoiogie et Obstetrique) { 3,4.7] Cdc BN trojig nghidn cdu du- ac ddnh gid giai dopn sau khi phdu thudt. UTNMTC dupe phdn lo^i md bdnh hpc nhu sau
Giai dogn I , Khu tru d t d cung, la , Tdn thuang d nidm mac t u cung lb, Tdn thuang lan trdn vdo co, dudi 50%
Ic. Tdn thuang lan trdn vdo ea. tren 50%
C h i n dodn md bdnh hpc [3,9]:
Ung thu NMTC 6w&c phdn loai nhu sau Ung thu b i l u md tuyin (UTBMT) d?ng ndi mac , hay gdp nhit, tidn lupng tdt
UTBMT thanh dich : dd dc tinh cao, g i n gidng vdi UT budng trdng, hay gdp giai doan mudn
UTBMT t l bdo sang , lan trdn phQe mac sdm, tidn luang x l u
UTBMT te bdo nhd: dd md hpc thap, tien luang x l u . it gdp
UTBM khdng biet hda: thudng phdt hien giai doan mudn, dl cdn sdm tien luong tdi,
Chi (^nh dieu tn: bao gdm Phdu thudt vd tia xa bd tra sau md. tuy theo tung giai doan vd md benh hoc,
Giai doan IA • P h l u thudt dan thuan bao gdm cdt t u cung todn bd vd p h l n phy hai ben. cd hodc khdng vdt hach chdu bjt hai ben
Giai dopn IB: Phdu thudt don thuIn bao gdm cdt t d cung todn bd p h l n phy hai ben vdt hpch bdt budc chdu bit hai bdn, d i l u trj bd tra tia xa sau md ddi vdi trypng hpp khdi u Idn > 4cm vd md bdnh hpc khdng thudn lpi (UT khdng phdi UTBM dgng ndi mgc vd dd md hoc thip)
Giai doan IC, PT c i t t u cung todn bd, p h l n phy hai bdn vdt hach chdu bjt b i t budc t i t ca BN d I u duoc d i l u tr; tia xa sau md
Tia xa sau md: bd trp lieu khung chdu bdng mdy gia tdc iiiu 45-50Gy, trong mdt s6 TH ed di cdn hgch cao bd sung them trudng chieu hach.
T i t ca deu t i l n hdnh khoa ngoai E vd khoa Xp 2 benh vien K
X u li sd lieu bdng phan mem SPSS 13 0
KtT QUA 1.D$c d i l m Idm sdng 1.1.Tu6l
Bdng 1. Phdn bd tudi (n= 96) Tu6i
<40 40-50
>50 Tu6i tmng blnh ThSp nh^t cao nhSt
SL 1 2 93
TL%
1,1 2.1 96,8 i 68 l<
39- 75 Trong dd trd nhdt Id 39 tudi, cao tudi nhit Id 75 t u l i , hay gdp n h i t trdn 50, trung binh 58T
1.2. Tri^u chOvg lAm sAng
Bdng 2, Cdc ddu hidu 1dm sdng thudng gdp(n=9E Tri^u ChCrng 13m sdng
Oau bi^nq ha vi Ra mdu dm 1 Ngodi CK kinh
flao 1 Sau man kinh Ra dich am dao Khflng TC Idm sdng
SL 4 4 32 55 1
4 TL%
4.2 4.2 33.3 67,3 1.1 Da sd BN ra djch dm dao Id 57,3%, ra mdu bit thudng dm dgo sau mdn kinh Id 33,3%. Cd 1 tnj'dng hpp bdnh nhdn tinh c d phdt hi$n qua khdm sdng Ipc qua sidu dm md khdng cd tndu chdng 1dm sdng.
2. Cdn Idm sdng 2.1.Chan doAn hinh anh
Sidu dm ' 85/96 BN e h i l m 8 8 , 5 % phdt hidn ddy nidm mpe t u cung hodc u trong budng t u cung, 9 BN t u cung to h a n binh t h u d n g hodc khdng t h i y t6n t h u a n g nghi n g d chiem 11,5%. 2/96 BN nghi nqb hgeh di cdn. CTseanner.MRI: cd 62 BN d u o c chgp chyp CT hodc MRI thi ca 62 BN cd phdt hidn tSn t h u a n g tpl t u cung (100%). Trong d d 48Bn chyp MRI vd 14BN chyp CT scaner. 14/48 BN chup MRI xdc dmh d u a c ed x d m l l n Idp c a thdn e d cung hodc c6 t u cung, cd di c d n hach trong khi CT scaner khflng xdc djnh d u o c u x d m l l n c a t u cung.
2.2.Md b ^ n h h p c : Bao g d m tip m d hpc vd 36 bidt hda ung t h u
Bang 3. K i t qua m d bdnh hoc Ma b$nh hoc UTBMT danq nOi mac
UTBM 16 bdo vay UTBMT Ihanh dich UTBMT t6 bdo sdnq UTBMT t i bdo nho D6 bi0t h6a m6 hoc cao D6 bi$t h6a m6 hoc vira DO biit h6a m i hoc th^p
SL 89 5 1 1 0 68 13 25
TV IS 92.7
6.2 1.1 1.1 0 80.4 13.5 26 K4t qua Vin olio t h i y hSu het cSc BN trong nghien CLKU n^y id U T B M T dgng n6i mac chiem t} 1$
cao nhlit 92.7%. ung thu' b i i t h6a cao chi^m ti»i 60.4%.
3. Xgp giai doan benh sau phSu thuat Bdng 4. K^t qua x^p giai Joan (n=96)
Ty iS%
Y HQC THV'C HANH (868) - SO SlWi
Giai dogn IA sdm c h i l m tf le t h i p n h i t 12,5%, chO y l u gdp giai doan IB chiem 5 2 , 1 %
4.Cdc phipcng phdp d i l u tri 4.1.Didu trj phdu thudt
T i t ca 96BN deu dup'c d i l u tn p h l u thudt Bang 5. Cdc phuang phdp phdu thudt (n=96)
PhlFong phdp PT c a t TCTB - vet hach chdu C i t TCTB - kh6ng v « hach
SL 1 T L % 86 89.6 10 1 10.4 Chi cd 10% BN trong NC khdng vdt hgch chdu.
Bang 6. Cdc b i l n chdng phdu thudt (n=96)
Cdc bi£n c h u n q Chay mau Ro bgch huydt
Tac mdt Rdi losn l i ^ u t i ^ n Nhigm triiing vdt m 6
SL 3 2 0 5 3
T L % 3,1 2,1 0 5.2 3,1 Cdc bien chdng d I u c h i l m tl Id thip, cao n h i t id BC tilt ni^uehiem 5,2%
4.2.Didu trj tia x^ sau m l
Tiln hdnh trdn 39BN chi djnh theo k i t qud sau phlu thudt
Bdng 7: Dieu trj tia xa vdi cdc giai doan (n=39BN)
Theo qiai doan IA IB IC
SL 0 5 34
T L % 0 12,8 97,2 Cd 5BN giai doan IB cd chi djnh tia xp sau m l chilm 12,8%.
B i l n chirng trong qud trinh didu trj tia xa Bang 8. bien chung trong qua trinh d i l u tri tia xa (n=39)
BiSn chunq tia x ^ Vi6m d a ViSm ruQt Vi§m d u d n q tiet nidu
SL 15 4 S
T L % 38,5 10,2 20,5 Cdc BC trong qud trinh tia xa r i t it gap cao n h i t Id ddm da t i l p xuc trudng c h i l u tia la 38,5%.
BAN LUAN I . D a c d i d m lam sdng 1.1,Tudi
Trong nghidn edu eua chung tdi BN tre n h i t Id 39 tudi, cao tuoi n h i t Id 75 tudi, tudi trung binh id 58 tudi tu-ong tu vdi nghidn edu cua Pham Van Bung (2005- 2008)cd dd tudi TB Id 54, tre n h i t Id 27 cao n h i t Id 77 tudi, Creasman vd cs (1984-2001) NC trdn 1000BN tuli TB cOng Id 60 tudi. K i t qua NC cua chCing tdi cho thiy tf Id BN dudi 40 tudi ehi c h i l m 1,1%, tuong t u vdi cdc k i t qua cdc nghien cdu Nonss, Gallup Id dudi 5%, Bdnh hay gdp BN sau man kinh trdn 50 tuoi trdn 75%, k i t qud nghidn cdu cua chCing tdi Id 81,7%, Dd tuli hay gap n h i t Id 55 d i n 70 tudi chilm trdn 90%.
1.2. Tndu chdng idm sdng
D i u hidu Idm sdng hay gdp nhdt eua UTNM TC Id ra djch dm dgo hodc ra mdu b i t thudng dm dao ngodi chu ky kinh hodc sau mdn kinh. K i t qua nghidn cuu eua chOng tdi hodn todn phO hpp vdi ddc dilm ndy vdi tri$u chdng ra djch dm dgo Id 53,%, ra mdu b i t thudng dm dgo sau mdn kinh id 32,5% Cd mdt trudng hpp bdnh nhdn tinh c d phdt hidn qua khdm sdng lpc qua sidu dm md khdng cd tridu chung 1dm sdng rd rdng Cdc tridu chdng Idm sdng trdn r i t ed gid trj trong phdt hidn UTNMTC, cdc BN d I u dupe phdt hidn giai dogn tuang ddi sdm do cdc d I u hidu b i t thudng d trdn hay xdy ra sau mdn kinh Id dd tudi thudng gdp n h i t cCia UTNMTC,
2.C$n Idm sdng 2.1. C h i n dodn hinh anh
Sidu dm : 85/96 BN chilm 88,5% phdt hidn ddy nidm mpc t d cung hodc u trong budng t u cung, 9 BN t d cung to hon binh thudng hodc khdng t h i y tdn thuang nghi ngd chiem 11,5%. 2/96 BN nghi ngd hgch dl cdn, CTseanner.MRI: ed 62 BN duoc chyp chyp CT hodc MRI thl ca 62 BN cd phdt hidn tdn thuong t^i t u cung (100%), Trong dd 48Bn chup MRI vd 14BN chyp CT scaner, 14/48 BN chup MRI xdc djnh duac cd xdm lan Idp ea thdn ed cung hodc ed tu cung. cd di can hach trong khi CT scaner khdng xdc djnh duac u xdm l l n co t d cung. T d k i t qua trdn cho t h i y sidu dm Id phuang phdp c h i n dodn nhanh dan gian cd the phdt hidn t i n thuang sdm nhung ehi phdt hidn duac ton thuang tai t u cung. khd ddnh gid duac mdc dp xdm lan vd di cdn hach. Hinh anh sieu dm thudng Id phdt hien u trong budng t u cung hodc ddy b i t thudng ndi mac t u cung. MRI Id phuang phdp c h i n doan hinh anh ed gid tn nhat vdi dp nhgy cao, ed the ddnh gia dwqec muc dd xdm l l n UT vd dl can hach [10],
2.2. Kdt qua Mo benh hpc:
Trong nghidn cuu cCia chung tdi UTBMT dang ndi mac t d cung chiem ty Id 92.7% tuang t y vdi cdc nghien cdu Creasman vd cs tren 90% [2], Hai t h l md hpc khdc rdt It gdp la UTBM thanh djch chilm 1,1%
va t l bdo sdng 1.1% tuong t u vdi nghien edu Creasman cdc the md bdnh hpc ndy chi gdp dudi 10% vd Id t h l md hoe khdng thudn lpi, V l x I p dd md hpc ung thu, theo NC eua chung tdi cho thdy h l u h i t cdc BN Id UT vdi dp md hoe bidt hda cao (60.4%), bidt hod t h i p chi chilm 26%. Ket qua tren tuong t d vdi tde gid Pham Van Bung, Grad I 45%, Grad 11 33,3%, Grad III it gdp n h i t 15,3% [1],
3. Xdp giai doan benh sau phdu thuat Bdng 3 cho thay 96 BN giai dogn 1 thi ti le IA, IB, IC tuang ung Id 12,5%. 52,1%, 35,4% NC eua Phgm Vdn Bung 2008 GD IA,1B,IC Id 26,7%, 41,3%, 17,3%
[1] tuong t d NC chung tdi chu yeu gdp GD IB, tuy
Y Hpc THVC HANH (868) - SO 5/2013
nhidn NC ehOng tdi BN gia dopn IC gdp nhilu han.
UTNMTC thudng phdt hidn d giai dogn sdm, ung thu thudng khu tni tgi t d cung, it dl cdn xa vd xdm Idn xung quanh, lidn ludng tdt d giai dogn sdm
4. Cdc phuo'ng phdp d i l u tr{
4 . 1 . D i l u trj phdu t h u ^ t
Trong NC chung tdi chi djnh p h l u thudt trdn 100%
BN nghidn cdu. Bao gdm 2 phuang phdp : C i t TCTB vd budng trdng hai bdn dan I h u i n khdng vdt hgch chdu bjt dp dgng trdn nhdm BN giai dopn IA u nhd vd t h l md bdnh hpc thudn loi, Nhdm ndy chi ehidm 10,4% do h l u h i t BN NC d giai dopn IB.IC. giai dopn IA ehi cd 10BN. K i t qua ndy tuang t y vdi NC eua Hsieh vd Scott Cdc BN gia dopn sdm khi UT cdn khu tru d nidm mgc t d cung, t i n thuang nhd thudng ed tidn lupng tdt vd khdng di cdn sdm Trong NC cua Chung tdi eh! cd 2BN nhdn giai dogn IA ed vdt hgch Id do 1BN khdi u >4cm vd 1BN s d t h i y hgeh trdn Idm sdng, Cdt t u cung todn bd, budng trdng hai bdn vd vdt hpeh chdu bjt hai bdn dp dyng trdn cdc BN GD IB, IC, Nhdm ndy ehilm da sd trong NC cua ehiing tdi Id 89,6% bdi GD IB, IC ehilm da s6 Theo k i t qud NC cua Creasmans trdn 500BN thi di cdn hpch IA, IB, IC Id 2%, 15%,35%, K i t qua tren cho t h i y vdt hach vai giai doan IB, IC Id e I n thiet,
Biln chung trong vd sau khi phdu thudt • Theo NC ndy ti Id cdc b i l n chdng Id r i t t h i p bao gdm chay mdu, tdc rudt sau md, rd bach huyet do vet hach rpng rdi, rdi loan t i l u tien do cat t u cung rdng vd vet hach, nhilm trOng v l t md, Trong cdc b i l n chdng trdn hay gdp nhit la b i l n chung tiet nieu 5/96Bn (5.2%) chu y l u do vdt hach rdng rdi vd c i t rdng vung paramet canh TC trong mdt sd BN ed u to xdm lan thanh mac.
4.2. Didu tri tia xa sau PT
Chi ed 39BN trong NC cd chi i^nh tia xa sau mo, ehi xa trj khung chdu b i n g mdy gia tdc t u ngodi vdo, chu y l u Id BN d giai doan IC Cdc BN giai doan IA, IB chi d i l u tn tia xa b l tra khi cd di cdn hach hodc u ldn>4cm. K i t qua NC cho t h i y chi cd 5BN IA,1B cd chi (^nh d i l u trj tia xa ehilm 12,8%. Cdn lai giai doan IC Id 97.2%.
Biln chdng do d i l u trj trong qud trinh d i l u tn tia xa cQng t h i p bao gdm vidm da tai chd tia xg, vidm njdt cd rdi loan tidu hda. vidm t i l t nidu cd rdi lopn t i l u tidn ddi budt rdt do vidm bdng quang Tuy nhidn hay gdp nhit vdn Id vidm da tpi chd chilm 38,5%.
K^T LUAN
Tudi trung binh Id 58, dudi 40 t h i p (1.1%), dd tudi hay gdp Id sau mdn kinh tren 50 tudi 96,8%. Tridu Chung hay gdp nhit cua UTNM TC Id ra dieh dm dao Id 57,3%, ra mdu b i t thudng dm dao sau mdn kinh Id 33,3%
Sidu dm, MRI cd gid trj cao trong c h i n dodn UTNMTC, ddc bidt MRI cdn ddnh gid dudc mdc dp xdm l l n UT vd di cdn hgch gdp p h l n ddnh gid giai dogn.
Trong NC cOa chCing tdi UTBMT nOi mgc t d cung ehidm ty 1$ cao nhdt 92,7%. cdc Hp md hpc khde rit II gdp.Hlu hdt cdc BN trong nghidn cdu ndy Id UTviiri dd md hpc bidt hda cao 60,4%, bi§t hod thip chf chilm 26%.
Trong 96 BN, giai dogn IB c h i l m ty Id cao nhit 52,1%, giai dogn IA sdm chi gdp12BN(12,5%) khi UT cdn khu tni nidm m?c t d cung.
D i l u trj p h l u thudt chi djnh trdn t i t cd SSBN nghidn cdu trong dd nhdm vdt hgch chilm da sIV&l 89,6% do trong NC It gdp UT giai dogn sdm IA. Cdc b i l n chdng do p h l u thudt r i t ft gdp cao nhdt Id biln chung t i l t nidu chilm 5,2%,
D i l u trj tia xa sau md ehi t i l n hdnh trdn 39BN chilm 40,6%, chu y l u vdi giai dogn IC (97,2%). Cdc b i l n chdng do tia xa cQng It gdp vd chu y l u Id vidm lodt da tgi trudng chilu tia ed 15/96BN (38,5%)
TAI LI$U THAM K H A O
1, Phgm Vdn Bung, Nghidn cuu di cdn hgch ch$u cua Ung thu ndi mpc t u cung GD I, II, Ludn dn TSYH 2011
2,Creasman W, Odicino F, Malsonneuve P, et al, Carcinoma of the corpus uten. int J Gynecol Obstet 2006;95(Suppl 1):S105-S143,
3,601 Didu, Nguyin Vdn Tuydn, TrIn Vdn ThuSn, Ung thu ndi mpc t u cung. C h i n Dodn vd dilu trj Bdnh ung thu, NXB Y hpcTrang 334-338,
4, Nguydn Bd Ddc, Ung thu ndi mgc t d cung. H6a c h i t d i l u trj ung thu, NXB Y hpc, 123-126
6, Gallup DG, Stock RJ, Adenocarcinoma of the endometrium in women 40 years of age or younger Obstet Gynecol 1984;64417-420.
6 Hsieh CH, Chang Chien CC, Lin H, et al Critenon for full pelvic lymphadenectomy in surgical staging of endometnal cancer? Gynecol Oncol 2002,86:28-33
7. NCCN clinical practice guidelines In oneology.v.1,2009
8- Norris HJ, Tavassoli FA, Kurman RJ.
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