MUC LUC (SO 907)
• N G U Y I N DUY Cl/dNG, => Nghien ciilU d | c diem lam sang, can lam sang cua xuat huyet tieu hda do T R A N THj HUONG gian vd tTnh mach thut quan d benh nhdn xa gan co nghien nidu va khdng
nghidn n/pu
•VU ANH T U A N , => Ket qua phdu thuat cat todn bp tuyen vO nao vet hach ndch sau xa trj trong THAN HCTU VINH dieu trj ung tiii/vO tai Benh wen Bach Mai
• N G U Y I N V A N HUONG => Ddnh gia ket qua p h i u thudt thoat vj ben nghet tai Benh vien HQu nghi da khoa Nghe An
•Lfi TH! BiCH L l i N => Kien thCfc, thuc hdnh trong dieu trj ARV cOa benh nhdn HIV/AIDS vd mdt sd Lt THj BINH hoat dpng hd trd ci}a cdng ddng tai tmng tdm y te Huyen TCT Liem, Ha Ndi
• N G U Y I N THE VINH ^ Mpt sd yeu t d lien quan den kidn thijrc c^a hpc sinh ve HIV/AIDS tai hai VU DOC L O N G tmdng phd thong tmng hoc thanh phd Hai Phong nam 2013
•DINH QUOC THANG ^ Ban ve phuc ldi y te Viet Nam hien nay
• N G U Y I N V A N HI$P, ^ Nhan xet tinh hinh sau ho ranh rang ham ldn thu* nhat d tre em 6-12 tudi tai TONG MINH SON lang tre md coi Biria - Hd Npi 2014
•CAO TRUdNG SINH => Xdc djnh t^ Id tdng huyet dp phan iimg d benh nhan nhdi mau nao giai doan cap CO tdng huyet ap bang theo ddi huyet ap luu dpng 24 gid
•YHTH ^ Thdng tin y hpc
DANH GIA KET QUA DIEU TRj PHAU THUAT TAC RUOT DO UNG THITDAITRUIC TRANG
T6l\rt T A T
Af(/c tieu nghiin cdu: Dinh gii kit qui thil dd xd tri phiu thuit eip cdu <Tiiu tq tic mgt do ung thu d?l tn/c tring. Doi tugng vi phuong phip nghien cdu: Nghidn cdu md ti hdi cdu 58 binh nhin phau thuit cip cdu diiu tn tie mdt do ung thu dai tnjc tring td thing 1/2010-12/2013 t^i bdnh vidn hdu nghi da khoa Nghi An. Kit qua: Tudi trung blnh 66,16 ± 12.5(32-86) tudi; Nd35 (60.3%). Nam 23 (39.7%). Lf do vio vidn dau bung(100%), bl tmng d?l tidn (93,1%); cic tridu chdng biiu hiin thudng gip li:
bijng chudng (96.5%), bl tmng d$t tidn (98,3%), sieu im cd g^ f hinh inh tic mdt (72,4%). Vi tri khdi u, xd If phiu thuit: Ung thu dai tring phai 24 (41.4%), cit bd khdi u nil ngay 10 (17.2%), cit u vi lim HMNT 13 (22,4%). Ung thu dai tring ngang 5 (8.6%):
Cit u vi lim HMNT 3 (5,2%). Cit nil ngay 1 (1,7%), lim HMNT 1 (1,7%). Ung thu d^i tring trii 21 (36,2
%): cit u vi lim HMNT 20 (34,5%). Ung thu tryc tring 8 13,8%): phiu thuit Hartmann 4 6,9%), Cit u 4 (6,9%). Kit qui diiu tri: khdng gap td vong. biin chdng chung li 34,5%. Kit lu$n: Tac rudt ti bien Chung gip nhiiu cda ung thu d?l tring phii va dai tring trii Khi xd tri tic mdt do ung thu d^l tring cd ging glil quyit tic mdt vi ung thu ngay thl diu vdi diiu kiin eho phdp; dii vdi ung thu tnie tring thl eo ging giii quyit tic mdt vi u nhung nen lim HMNT._
Tu khda: Tic mdt, ung thu d^i tnrc tring, phiu thuit.
NGUYEN V A N HUONG B^nh vi^n Huu nghj da khoa Ngh^ An SUMMARY
ASSESSMENT RESULTS SURGICAL TREATMENT OF INTESTINAL OBTRUCTION COLORECTAL CANCER
Objective: Assessment and management attitudes emergency surgery results obstmction tmatment of colorectal cancer.
Material and menthod: we performed a mtmspectlve study describes 58 patient with emergency surgical tmatment of obstmction due to colorectal cancer In the Nghe an General FriensNp Hospital from January 2010 to december 2013.
Results: 58 patients with an average age of 66.16
± 12.5 (32-86) years old. Female 35 (60.3%), Male 23 (39.7%). The reason ts the highest admission abdominal pain (100%) and being hit by defecation (93.1%); expression of the common symptoms are:
abdominal distention (96.5%), being hit by defecation (98.3%), ultrasound Images suggest Intestinal obstmction (72.4%). Tumor location, surgical handling: right colon cancer to 24 (41.4%), to mmove the tumor and circulate connection digest 10 17.2%), cutting the tumor and do anal Artificial 13 22.4%).
Transverse colon cancer 5 (8.6%): Removal of ttn tumor and ostomies 3 (5.2%), tumor resection and gastmintestinal clmulation connection 1 (1.7%), do ostomies 1 (1.7%). Left colon cancer 21 (36.2%) to remove the tumor and ostomies 20 34.5%}- Colorectal cancer 8 (13.8%): Surgical Hartmann 4
(6.9%), tumor msectton and ostomies 4 (6.9%).
Treatment outcomes: not meet death, common colr^)lk:atlons is 34.5%
Conclusions: Obstmdlon Is eneountemd multiple eomplKations of colon cancer and colon to the left.
When the management of obstruction due to colon cancer ileus trying to solve immediate and cancer patients with conditions allow, for cancer Rectal Is trying to solve obstmction but u should do ostomies
Keywords: Obstmction, Colometal Cancer, Surgicaf
DAT VAN Dt
Ung thu' d?i tryc trdng (UTDTT) diing hdng thu- 3 trdn thd gid'i. Cf cdng ddng cac nu'd'c phdt triln, UTDTT diing hdng thCf hai, dang cd xu hudng tdng ldn d mdc thu-Cfng g§p nh^t Ddy Id loai ung thu- c6 lidn quan chat che vd'i chd dd dinh du-dng. UTDTT chu y^u phdt tri^n td cdc ti bdo tuydn cua nidm mac dai trdng, xdm ldn vdo thdnh mot lan ra cdc td chiic xung quanh. Di cdn theo hai du'd'ng: du-d-ng bgch huylt tdi cdc nhdm hach, du-d-ng mdu td'i gan, phdi, xu-cng...
Tiic mdt Id mpt bidn chiing thu'd'ng gdp nhat cua ' UTDTT. Trong nu'dc, ty Id ndy khodng 12-15% [1], [•*]. [5]. Trong c^p ciiu, x i i ly t i c rudt do UTDTT cdn cd nhidu 'j kidn khdc nhau: Cdt dai trdng 1 thl hodc 2 thi; viin dd ddt ra Id cat u ngay thl dau hay Idm h$u mdn nhdn tao dd gidi quydt tAc rudt sau do giai quydt thi 2 c^t u khi cdn kha ndng clit du'pc. Vdn dd thii 2 Id cdt u thl ddu thl cdn ndi ngay hay khdng. ChOng tdi thyc hi$n nghidn ciiu ndy mudn ndu Idn nh&ng nhdn xdt vd thdi dd x i i tri trong cdp ciiu vd kdt qud dieu tri tdc mdt do UTDTT.
D6\ TU'ONG VA PHU'ONG P H A P NGHIEN CI>U 1. Ddi tu'p'ng nghidn cd'u.
Nghidn ciiu 58 b$nh nhdn du'p'c ph§u thudt cdp ciiu didu tri tdc mdt do UTDTT tai bdnh vidn h&u nghi da khoa Ngh$ An trong 4 ndm (1/2010 - 12/2013), khdng tinh ddn nhO'ng tru'dng hp'p bdn tdc rudt.
2. Phu'O'ng phdp nghidn cd'u: Nghidn ciiu md ta hdi CU'U kdt hp'p tidn ciiu.
3. Cdc chi tidu nghidn cu'u:
Tudi, gid'i, nghd nghidp, c h i n dodn vi tri khdi u, phu'Ong phdp x i i 1;^ phdu thudt, thd'i gian p h i u thudt, cdc bidn chiing tnang md, tdn thu'O'ng giai phdu bdnh, thdi gian ndm vidn sau md. cdc bidn chiing sau md...
4. p h u v n g phdp xO 1]^ s 6 l i ^ u : theo chuong trinh SPSS 16.0
K £ T Q U A NGHIEN C1>U
58 BN tdc rudt do ung thu- dgi tn/c trdng dupc phdu thudt cdp ciiu tgi Bdnh vipn HO'u nghj da khoa Nghd An td 1/2010 ddn 12/2013. trong dd cd 23 bdnh nhdn nam chidn 39,7% vd 35 bdnh nhdn nO- chidm 60,3%; tudi tmng blnh Id 66.16 ± 12.5 trong dd bdnh nhdn tudi thdp nhdt Id 32 tudi vd cao nhdt Id 86 tudi, gdp nhidu nhdt Id dd tudi 41-70.
Bang 1. Ly do vdo vidn, tridu chiing Idm s ^ g vd can Idm sdnq khi thdm khdm
Ly do vdo vien Suy ki^t {)au bgnq Ndn Chi/i7nq bunq Bi trunq ti#n, dai ti&n Rdi loan di cSu(s6n phin, ia mdu..) Cdc tri6u chi>ng lam sang^can l^m sing
Bgnq chuo^nq Ndn Quai mpt ndi Ddu hl^u ran bd
U d bgnq Ttiam tryc tranq cd u X quanq cd miic nu'd'c, miic ho'i SiSu am bgnq cd q^i y dSu hi|u tac rugt
Sieu dm bunq phdt hiSn khdi u BN 12 58 15 20 54 4 56 25 24 20 12 5 56 42 38
Tyld%
20.7 100 25,7 34,5 93,1 6.9 96,5 43,1 41,4 34,5 20,7 8,6 96.5 72,4 65.5 Ly do vdo vien Id dau bung 58/58 chidm 100%, tiep den Id bi tmng dai tien 54/58 (93,1%). NhO'ng tneu chiing ldm sdng thuong xudt hidn Id bung chud'ng (96.5%), ndn (43,1%), quai mpt ndi (41.4%). NhO'ng dau hidu cdn ldm sdng ggi;? Id X quang cd miic nu'd'c, miic hoi (96,5%), sidu dm gpi y tac mdt (72,4%).
Bang 2. Cdc trieu chiing lien quan ddn u dai trg'c trdng t n j ^ c khi gdy tdc mpt
Tri§u chi>nq
£)9i ti^n phSn cd nhay, mui, miu Tieu chav
Tao b6n Oau bunq Mot rin
BN 16 10 8 58 5
Ty IS % 25,7 17,2 13,8 100 8,6 Cdc ddu hi$u cd tidn tridu trudc khi BN cd ddu hidu t i c rudt Id Dgi tidn phdn cd nhdy vd mOi, mdu (27,5%), tidu chay (17.2%), cd xudt hidn cd tdo bdn vd BN vdn hay co ddu hidu mdt rdn; ddc bidt Id 100%
cdtidn sOdau bgng.
Bano 3. Chdn dodn trudc Chin dodn tru'dc md Tic rupt do u dgi tranq Tdc rupt do u tryc tranq Tac rudt chua rd nquydn nhdn
Vifem phuc mgc md
BN 42 5 9 2
Ty Id % 72,4
8.6 15.5 3.4 72,4% cdc BN dup'c chdn dodn trudc md bdng nghT tdi tac rudt do u dgi trg'c trdng dya vdo tidn su, benh s i i va thdm khdm Idm sdng vd c i n Idm sdng.
Bang 4. Chan dodn yi tri khdi u trong md Vi tri ktidi u
Oai trang phai
Manh trdnq D^i tranq len
Goc qan Dai tranq nqanq 6ai trang
trai Tn/c trdng
Gdc Idch DT xudnq Siqma
Cao Thdp
BN 9 4 11 5 6 3 12 4 4
Ty le % 15,5
6,9 19,0 8,6 10,3 5.2 20.7 6.9 6,9
Tdnq sd (%) 24(41,4)
5 ( 8 ^ 21 (36,2)
8(13.8) Trong m6 Xcic ffinh vj tri u n^m d d^i trfing phSI 24 BN (41,4), e9i tring ngang 5 (8,6), D?i trSng trSi 21 (36,2), Tn/c trfing 8 (13,8).
Y HOC THVC HANH (907) - S6 3/2014
Banq 5 , Phu'ffnq phfip phfiu thufit Vi tri khdi u Dai trdng
phai
Dgi trdng ngang
Dai trdng trai
Tryc trdng cao
Ilf
C^t Bai trfinq phai + noi ngay est eai trang phai + lam
HMNT Lfim HMNT
Noi tSt Cat Dai trang ngang + n6i
ngav est Dai trSng ngang + ISm
HMNT U m HMNT
Noi tat est Dai tr^nq trai + n6r nqav
Cat Dai trang trai + 1am HMNT L^m HMNT
NOI tSt CSt+ noi nqay
Cat + HMNT HMNT est cut true trdng
eSt+ noi nqay Cat + HMNT HMNT Cat cut tryc trSnq
BN 10 13 1 0 1 3 1 0 0 20 1 0 0 1 3 0 0 2 1 1
Ty le % 17,2 22,4 1,7
0 1,7 5,2 1,7 0 0 34,5
1,7 0 0 1.7 5,2 0 0 3.5 1,7 1.7 Dai trdng phai' Cat Dai trdng phai + Idm HMNT chidm nhieu hon (22,4%). Cdt Dgi trdng phai + noi ngay (17,2%), Dgi trang ngang: Cat u lam HMNT 3 (5,2%), cat u ndi ngay 1 (1.7%), HMNT 1 (1,7%).,Daj trdng trdi: Cdt Dgi trdng trai + ldm HMNT Id ca ban v6i 20 BN (34,5%). True trdng: cat u Idm HMNT 4 (6,9%), lam HMNT thi dau 4 (6.9%)
Bang 6 Ket qua dieu trj Cdc bien chynq VPM sau md Tac rupt sau md ptiai mp lgi hgu ph^u TSc rudt sau md khdng phai md Iai h|u
phlu Rd tieu hda sau md Bgc vdt md do hogi tO vet mo phai ddng
lgi vet mp Nhidm IrCinq vet mo Hoai ty hdu mdn nhdn tap phai md lgi Hogi ti> hdu mdn nhdn tgo khdng phai md
iai Tut hgu mdn nhdn tao
Tii vonq sau mo Tdnq sd
BN 0 0 1 0 2 12 0 4 1 0 20
Ty Id % 0 0 1,7
0 3,5 20.7 0 6,9 1,7 0 34,5 Bien chiing chung la 34.5%, nhieu nhat Id nhidm trCing vdt md (20,7), sau dd Id hoai t u hdu mon nhung khdng phai md (6.9%) Khong c6 BN ndo t u vong trong vd sau md.
BAN LUAN
Tdc rudt Id loai bien chiing thudng gdp nhieu nhdt so vdi cdc bien chiing khac ciJa UTDTT.
Nguydn Dai Binh thdng ke 10 ndm (1977-1986) tai BV Vi?t Diic vdi 210 ung thu dgi trdng dd thay 78 bidn chiing phai md cdp ciiu, trong dd: tac rupt 60 trudng hp'p (28,6%), dp xe quanh u (3,8%), thung gdy viem phuc mac (2,4%), thung vdo trang rdng (2,4%) [1] Tai TPHCM. Vd Tdn Long va Pham Van
Tdn vdi 127 bien chung trong tdng sd 385 tnr&ng hop UTDTT trong 5 riam (1978-1983) tai b^nh vi^
Chp' Ray; Trong do tdc rudt chidm 6,2% viem phtjc mac 4,4%, ap xe thanh bung 1,3%, xudt huyet tiSu hoa nang 0,5% va rd cac co' quan khac 0,5% [4].
* v d chdn dodn tdc rudt do UTDTT Trong nghien ciiu cua chiing tdi, lam sdng bilu hien rd cua hpi chung tac rupt thap vdi cac trieu ctiijng CO nang nhu dau bung tiing can 100%, bi trung 0^
tien 93,1%. Cdc trieu chiing thyc the nhu bung chudng 96,5%, quai rupt ndi 41,4%, dau hieu rlnW 34,5%, u phat hien khi khdm 20,7% va tham tofc trang cd khdi u 8,6%, Cac trieu chiing can Idm sang ro nhir X quang co hinh anh miic nudc va miic hoi 96,5%, Sieu am gffi y hinh anh tac rupt 74,2% hoac co u 65,5%, Chup cat Idp vi tinh (CLVT) phat hien tdc rupt do u dai tryc trang 36/40 BN chiem 90,0%.
Tren thyc td viec chdn doan tac rupt de m6 IS khong kho vdi lam sang bieu hien cua mpt hoi chiing tdc rudt thap dien hinh. Van de dat ra la iam tiie n^o dd chdn doan nguyen nhan tdc va tdc a dau mj\ la viec khd, Nhd cd s y hd trp cua sieu am va ciiyp CLVT nen trong nghien ciiu nay, chan doan trydc mo tdc rudt do ung thu dai tryc trang vdi 47/58 BN chiem tyle 8 1 % .
* Vd vj tri cua khdi u
Theo nhieu nghien ciiu thi vj tri khdi u c6 kh^c nhau nhung nhin chung thudng gap nhieu nhat Idd dai trang sigma, goc gan, goc lach va manh trdng [1], [2], [4], Theo kmh dien ung thu phan cuoi cua dgi trang ngang den daijrang sigma vdi tdn thuang th^m nhidm kidu vong nhan dd gay tdc rupt hon ung thyff cac VI tri khac [3], [4], [5]. Vi so lieu ciia chiing tdi ctil nghien ciru nhung benh nhan bi tac rudt do UTDTT da dupc p h i u thuat, nen ty le ung thu dai trang Sigma 20,7%, dai trang gdc gan 19%, manh trang 15%, goc lach 10,3%, nhidu ho'n nhiing vj tri khac
* P h u o n g phap x u tri tdc rudt do UTDTT +Ung thu d dai trang phai (p):
Theo quan didm cua nhu'ng nghien ciiu trudc Neu thuang tdn ung thu khdng lay dupc thi n&n md thong hdi trang thay cho hau mdn nhan tao (HMNT) hay noi hoi trang vdi dai trang ngang. Neu thyang tdn ung thy co thd lay dupc tht lam 1 thi hay 2 thi'
- Phuang phap 1 thi: Cdt dai trang trong cap CL>U va ndi ngay, cd dan luu dai trang (Quenu) hay khdng, hoac khong noi ngay va dua hai dau ra ngodi (Mikulicz)[4], [trich ddn tu'5]
- Phuang phap 2 thi: Thi 1 md thdng hoi trang ra da, sau vai tuan se chu dong Idm thi 2 de c^t dgi trang phai [4], [trich ddn tu 5],
Theo Barth [6] viec ddn luu ra ngoai du tam thdi hay vinh vidn la mpt giai phap xau. D i n luu hoi tr^ng lam nang them tinh trang roi loan nudc dien giai vS mdt dinh dudng, Du vay tac giai dua ra y kien n6n noi tdt hdi voi dai trang ngang tam thdi chi duoc si>
dung trong trydng hap u khdng the cdt duac vd c6 di can nhi§u nai d dai trang phai. Cdt u ngay thi dau vdi phuang phap cdt'/; dai trang phai la cd the va hpp 1^,
ttiir£mg ndi ngay c6 hi$u qua tdt hon.
Theo Guivarc'h f71 phuong phdp ddn liru manh trdng hay n& t i t (thdm chl trong tnrdmg hcrp di can gan hay phdc mgc) cdn phai logi bd vl nguy ca cao md kdt qud khdng tdt. Phuomg phdp chpn lua tdt nhdt Id cdt 14 dgi trdng (P), ndi ngay bdng mdy.
TTieo Panis Y [8] didu trj ngogi khoa tdc rudt do ung thu dgt trdng phdi duy nhdt Id cat dgi trdng phai vd thudng ndi ngay hdi - dai trdng ngang.
Kdt qud nghidn cO'u cOa chdng tdi trong 24 BN tac njdt do ung thu tfgi trdng phai (khdng cd BN ndo ndm d vj trl Vi phai cOa dai trdng ngang) thl cat u vd ndi ngay cd 13/24 (54.2%), cdt u vd Idm HMNT 10/24 (41,7%) dua hdi trdng ra da 1 (4.7%) khdng cd BN ndo thi/c hi$n ndi tdt
Nhin chung quan didm cCia chdng tdi gdn nhu thdng nhdt hidn nay trong xd- trl tdc rudt do ung thu dgi trdng phai trdn thd gidi vd trong nudc (ngoai bd mdt sd trud'ng hpp khdng the cdt dupc u vd cd di cdn nhidu nai) phuang phdp hup ly vd dup'c lua chpn td cdt Yl dgi trdng phdi, ndi ngay hdi - dai trdng ngang trong cdp ciiu [31,[41, [91,[10], [11] gdm nhO'ng k?
thudt sau:.
+ Ung thiF d" dai trdng trdi:
Theo quan didm kinh didn, vj trl tac rudt do khdi u ndm d dgi trdng trdi thi ndn Idm HMNT d thl 1 vdi vj trl d dgi trdng ngang vd trong khi md neu ddnh gid thuang tdn cd t h i cdt bd duoc thl sau vdi tudn sd md Igi cdt dgi trdng trdi [2], [3]. [4], [7], [8]:
- Ndu tdc d' dgi trdng sigma hay tn^c trdng ldm HMNT d thi 1 ngay d dgi trdng sigma phia trdn khdi u. Ndu thuang tdn cd thd cSt bd dup'c thi sau vdi tudn cd thd mo Igi cdt dgi trdng vd ndi. Tuy theo vi tri u d- tn.cc trdng cd thd Idm phdu thudt Hartmann hay phdu thu$t Miles. Nhu v$y. trong khi md cdp ciiu tdc rudt phdi thdm dd ddnh gid thuang tdn dd quydt djnh cd ndn ldm thi 2 hay khdng.
- Theo NguySn Duang Quang, Nguydn Diic Ninh [trich ddn tif 1,4 vd 5] phuang phdp cat dgi trdng vd ndi ngay khdng dupc dp dyng trong tdc rudt d dgi trdng trdi md dd ngh) phdu thu$t 3 thi: Thl 1: Idm HMNT d dgi trdng ngang; Thi 2: cat Va dgi trdng trdi vd ndi, HMNT dupc giu' Igi; Thl 3: ddng HMNT.
Ndu theo cdch phdu thu$t 3 thl thdi gian ndm vi$n kdo ddi, nhidu bdnh nhdn khdng ddn ddng HMNT.
Nhung didu ddng quan tdm Id ty Id t i i vong vd bidn Chung cOa nhidu Idn md se cdng lgi vd tdng ldn. Thdi gian sdng thdm sau 3 ldn md vd ti#n nghi sinh hogt bj dnh hudng do phdi mang HWINT ddi ngdy.
Ndu theo phuang phdp md 2 thi kdm vdi dua dau trdn Idm HMNT ddng ddu dudi k i l u Hartmann hodc dua cd hai ddu ra Idm HMNT phd bidn vi thdi gian ph3u thudt nhanh. Nguy ca rd mi$ng ndi thdp nhat.
nhung bdt Ip'i chlnh ci3a md 2 thl Id ldm HMNT vd bdnh nhdn phdi ffidu chinh vd tdm sinh IJ' dd quen vdi HMNT trong mdt thdi gian ddi. Ndu phdu thu$t cdt vd ndi ngay thl ddu kdm vdi md- HMNT trdn ddng Id 1 cai tidn cOa md hai thl. Ld HMNT dup-c ddng sau 8 ddn 12 tudn nhung II tdm.
Ndu md 1 thi Id cdt doan dai trdng, ndt ngay thl ddu cd nhu'ng thudn Ip'i rd rdt. Tuy nhidn cudc md ddi hdi phdi kJ thu^t hom vd chdp nhdn nguy ca cao hon.
Nguy ca rd mi$ng ndi cd the giam han ch! bdng cdch chuydn cudc md cdp cOtJ thdnh md ban cdp ciiu vd thuc hien bdi nhu'ng phdu thudt vidn cd nhidu kjnh nghidm vd kdm s i i dyng phuang phdp tudi rua dgi trdng trong luc md vd khdu ndi bdng mdy. Tuy nhidn phuang phdp ndy mdt thdi gian va d i nhiim trung.
Trong nghien ciiu cua chung tdi tdc mdt d dai trdng trdi (kd cd Yi trdi cua dai trdng ngang) cd 26/58 BN (44,8%) trong dd cdt vd Idm HMNT 23/26 (84,7%), cdt ndi ngay 1 (3,8%), Ldm HMNT 2 (7,6%), khdng ndi tat ca ndo. Nhin chung cdc phdu thudt vidn vdn chua mgnh dan cat ndi ngay vi sa rd mieng ndi, da sd cat kdm HMNT hen md ddng HMNT (chpn phuang phdp md 2 thi).
+ Ung t h v d triPc trang:
Ddi vdi ung thu tryc trdng thi phdn Idn dd xdm Idn cua u nguyen phdt Id T3 vd T4 ndn thudng duac chf dint] Idm HMNT cap ciiu. Sau dd, bdnh nhdn dup'c didu tri tham dd bang cdc phuang phdp khdc rdi xdt cat cyt true trdng sau. Phdu thudt md rdng trong tnfdng hap khdi u xdm ldn hoai t i i vdo cdc tgng ldn cdn cd the cdt bd thdnh mdt khdi. Vdi cdt dup'c u dCi khdng bao dam tridt cdn cung nen thyc hi$n ndu didu kien p h l u thu$t cho phdp vl nd giOp cai thien tridu chiing ddng kd vd giam thidu cdc bidn chirng trong qud trinh didu tri tridu chiing vd giam nh$ sau ndy [5].
[9],[10].[11].
Trong nghidn ciiu cua chdng tdi, cdt u vd vd idm HMNT 3/8 (37,%). Ldm HMNT 4/8 (50.0%). Cdt cyt tnfc trdng 1/8 (12,5%) ddy Id tafdng hap u hogi tO- vd xdm Idn tang vd xdt cdt bd duac vdi phdu thudt vidn cd kinh nghidm.
+ Vdi nhOng quan didm didu tn nhu v§y, chung tdi gdp bidn chd'ng chung Id 34,5%; Trong dd nhidu nhdt Id nhiim tnJng vet md (20,7%), sau dd Id hogi tCf hdu mdn nhung khdng phai md (6,9%), bye vdt md do hogi tip vdt md 3,5%, tyt HMNT 1,7%, dlnh mdt sau md 1,7% vd khdng cd BN ndo t i i vong trong vd sau md.
K^T LUAN
T i e mdt Id bidn chirng gdp nhidu nhdt trong sd cdc bidn chd'ng khdc cda ung thu dgi tn,FC trdng.
Cdch xii tri tdc mdt trong cdp cu'u tuy thudc vdo didu kien benh nhdn, kinh nghidm cua p h i u thudt vidn, dieu ki$n gdy me hdi sue vd ddc didm cua khdi u dd lya chpn phdu thudt dung ddn vd thtch hpp cho to'ng tmdng hpp cu thd Id rdt quan trpng.
Tdc mpt do ung thu dgi trdng phdi: Cdt 14 dgi trdng phai vd cd thd ndi ngay trong cap cuu hodc Idm HMNT khi cdn khd ndng cdt u. T i e mdt do ung thu dgi trdng trdi: Cdt dgi trdng trdi trong cdp cipu, cd thd dua 2 ddu ho$c ddng ddu dudi dua ddu trdn ra Idm HMNT. Sau 12 tudn md ldp lgi liru thdng tidu hda d thi 2. Tdc njdt do ung thu d tryc trdng, Idm hdu mdn nhdn tgo d thi 1, sau 3-4 tudn md Igi d thi 2. Cdt tn/c trdng ndi tay hodc bdng mdy hay p h l u thudt Miles.
Y HOC THVC HANH (907) - S6 3/2014
TAI LIEU THAM KHAO . ^ 1. Nguyen Dai Blnh: mpt sd nhgn xet budc ddu ve dieu trj ung thu dai trdng tai BV Viet Due trong 10 nam 1977-1986- luan van tdt nghidp bac sy npi tnJ, trudng DH Y Hd Npi. 1987 ma sd 30107.
2 Trinh Hdng San, Chu Nhat Minh, Do Diic Vdn:
Tdc rudt do ung thu dai trang:nhan xet ve chan doan, chi dinh va cdch xy tri qua 99 trydng hpp dupc md cdp ciiu tgi BV Vidt Diic (Ha Npi). Ngoai khoa 1996, 9.129-136.
3. Ha Van Quyet va cpng sy (2005), Nghien cuu chan doan va didu tii phau thugt tac ruot do ung thu dgi trang, Ngogi khoa so 3. tr 28-36.
4. Phgm Van tan, Vo Tan Long, Bui Van Ninh vd CS (2005), Xu' ly tac rupt do ung thu dgi true trang, Y hpc TP Hd Chi Minh, tap 9. sd 1, 99-105.
5. Le sy Thang (2005), Nghien cu'u_dgc dilm lam sang, can Idm sdng va kdt qua didu trj phdu thugt thi tac rupt do UTDTT tgi b^nh vien Viet Diic 1995-2005, Luan van tot nghidp bac sy chuyen khoa cdp II, Ha Npi.
6. BarthX;Lanricon A; RepellinPh; etal (1990), "Les occlusions aigue pon cancer colique: analyse, d'une sene
de 163 obsenrations", Lyon Chir. 86, pp 12-17.
7. Guivarc'h M; Boche D; Roulet- Andy J.C; et it (1992), 'occlusions aigue du colon pjM cancer. Indications chirurgicall en urgence", Ann Chir. 46.
pp 239-243
8. Panis Y; Fagnier P.L: Chimrgie des cancers du colom et du rectum. Rev Prot (Paris); 1994, 44. 2715- 2720.
g. Biondo Sebastiano, Kreisler Esther et al (2008),
"Differences in patient postoperative and long-term outcome between obstmctive and perforated colonic cancer". The American Journal of Surgery, 195, pp 427- 432.
10.Madison Cuffy. Farshad Abir, Riccardo A. etaL (2004), "Colorectal cancer presenting as surgical emaergencies", Surgical Oncology, 13. pp. 149-157.
11 .Yee Man Lee, Wai Lan Law, Kin Wah Chu, et al, (2001), "Emergency Surgery for Obstructing Colorectal cancer: A Comparision Between Right-sided and Left- Sided Lesions", Joumal Amencan College of Surgeons, Vol. 192, No.6, pp. 719-725.
KIEN THUTD CUA CAC BA ME NUOI CON NHO DU6l 24 THANG TUOI VE CAC BIEN PHAP TRANH THAI
PHAM XUAN THANH - Cue Quan If mdi trudng yte-B^ Yte N G U Y I N DOC THANH - Trudng Dai hge YDugc Thii Binh
TOM T A T
Diiu tm md ta cit ngang duge tien hanh tren 210 bi me dang nudi con dudi 24 thing tudi ve kien thuc eua cic ddi tugng vi cic bien phip tranh thai tren dia ban Phd Tho. Kit qua cho thiy: Tf Id bi me biet it nhat 3 bidn phip trinh thai hien d$i d muc khi cao (84,8%) tmng dd ty id biet vi bao cao su Idn nhit (98,1°/o). Tf Id ba me tra Idi dung vi thdi diem su dung bien phip tranh thai trd lai sau khi sinh con thap; cdn 3.3% so bi me khdng biet ve thai diem can su dung bien phip trinh thai sau sinh. Phan Idn cic bi me diu biet vd noi cd thi mua hoic nhin bao cao su, trong do tmm y te xi vi hieu thuoc ia hai dia chi dugc biet din nhiiu nhit (cung tf Id 86,7%), cdn lai la cong tac vien dan sd, y te thon ban (76,2%) vi phong kham tu (0,5%>). Tuy nhien, con tdi 1,9% khong biet cd the mua/nhan bao cao su a dau. Phin Idn cac ba me deu biet ve nai cd thi mua hoac nhan thudc trinh thai tmng dd tram y ti xi va hieu thudc cdng ia hai dia chi dugc biit den nhieu nhat (87,1% va 88,1% theo thu tu). Ly do hang diu bao cao su khdng duge su dung rdng rii duac cic bi me dua m li do e sg bao cao su cd tic dijng phu (59.5%). Cdn ly do thuoc udng trinh thai it dugc su dung dugc cic bi me dua ra la do vide hay qudn uong thudc (81,4%).
Tu khda: Ba me, bidn phip tranh thai SUMMARY
The descriptive cross-sectional sun/ey conducted on 210 mothers mising childmn 24 months of age on
their knowledge on family planning methods in Phu Tho pmvlnce. The results showed that: The mothers who know at least 3 modem methods of contraception was found at a high rate (84.8%), In the highest rate was found for condoms (98.1%). The rate of mothers who answered correctly on the time of use contraception after blrih is still low, while 3.3% of the mothers did not know about when to use contmception after birth Most of the mothers know where to buy or get condoms. Commune health centers and pharmacies are the two addresses which are most known (at the same rate of 86.7%), the rest ones are population, village health workers (76.2%) and private clinics (0.5%). However, while 1.9% of the mothers did not know where they can buy/receive condoms. Most of the mothers knew about where to buy or get oral pills; commune health centers and pharmacies are also the two most addresses (87.1%
and 88.1%, respectively). The top mason why condoms have been not widely used are that people are afraid of condom side effects C59.5%]. And reason why oral pills have been rarely used is that people may forget to use (81.4%).
Keywords: Mothers, contmceptives DAT VAN Dt
Theo dinh nghTa ciia Td chuc Y td Thd gidi (WHO), ke hoach hda gia dinh Id n i lyc cd y ttiiic cua cac cap v g chdng dd a d u chinh sd con vd khoang each smh con theo f mudn [6]. Kd hoach hod
