- Khdng cd su khdc nhau gida hai nhdm ER,PR(+) vd (-) ddng thdi v l di can hach vdi p>0.05.
TAI LIEU THAM K H A O
1. Bui bigu. Nguyen Vdn Tuyen. Tran Vdn Thuan.
Ung thy npi mac t d cung. Chan Dodn vd dieu trj Bgnh ung thy. NXB Y hpc Trang 334-338.
2 Nguyin Bd Ddc. Ung thy npi mgc td cung. Hda chit dilu tri ung thy. NXB Y hoc. 123-126
3 Scott M.Kaled M al. Corpus, Epithelial tumor.
Principales and practice of Gynecologic oncology 2009.
Limpicott William and Wilins. P 683-732
4. NCCN clinical practice guidelines In oncology.v.1.2009
5. Phgm Van Biing. Nghien o r u di can hgch chdu cua Ung thy npi mgc td cung GO I, 11. Lugn dn TSYH 2011
6. Creasman W. Odicino F. Maisonneuve P, et al.
Carcinoma of the corpus utems. Int J Gynecol Obstet 2006;95(Suppl 1):S105-S143.
7. Chu Hodng Hgnh (2005), "Nhdn xdt dgc diem ldm sdng, md b$nh hpc vd hoa mo mien djch cua ung thu bieu md npi mgc t d cung tgi bdnh vidn K", Ludn v3n Thgc Sy Y hpc, Trudng Dgi hpc Y Hd Npi
8. Hsieh CH, Chang Chien CO, Lin H, etal. Criterion for full pelvic lymphadenectomy in surgical staging of endometrial cancer? Gynecol Oncol 2002;86:28-33
9. Trimble EL, Harlan LC, Clegg L, et al. Pre- operative imaging, surgery, and adjuvant therapy for women diagnosed with cancer of the corpus uteri in community practice in the US. Gynecol Oncol 2005;96:741-748.
l)NG DUNG PHAN MEM GPA (GUUCOMA PROGRESSION ANALYSIS) TRONG DANH GIA TIEN TRIEN DENH GLOCOM
T6M TAT
M{ic dich: Ddnh gid hi^u qud cOa phin mim GPA tmng theo ddi tien triin bdnh gidcdm vd dwa ra khuyin cdo mwc nhdn dp dich & cdc giai doan bdnh.
Doi tu^g vd phuvTig phdp nghien c d u : 154 mit cua 96 bdnh nhdn gidcdm gdc ma nguyen phdt, nhan dp diiu chinh v&i diiu tri. Nghidn cOv md td tiin cCm theo ddi dgc trong 9 thdng. Bdnh nhdn dwgc khdm lai 3 thdng mdt lan. Tai mdi lin khdm, bdnh nhdn dwgc do thi li/c, nhan dp, khdm ddy mit. do thi trw&ng. do dd ddy l&p sal thin kinh quanh gai. Do thi tnr&ng It nhit 5 lin, 2 lan do ban diu vd 3 lin do theo ddi Di/a kit qud do thj trw&ng. ghi nhdn cdc chi sd MD (Mean Deviation), PSD (Pattern Standard Deviation).
VFi (Visual Field index), cdc diu hieu bdo c6 nghi ng& tiin triin vd khing djnh cd tien trien cOa phin mim GPA. Ddnh gid tiin triin bdng phin mim GPA dwa trdn tidu chuin cua hdi EMGT (Eariy Manifest Glaucoma Trial). Nghi ng& cd tien trien khi cd It nhat 3 diim tdn hai v&i p<5% Idp lai & 2 lan do thi trw&ng.
Khing dinh cd tien triin khi cd it nhat 3 diim ton h^i v&i p<5% Idp lai & 3 lin do thj truong. Niu tidn triin khdng ddnh gid dwgfc bing tdn hai khu tni thi khing dinh cd tidn triin khi chi sd VFi giam cd y nghTa thdng kd, biiu hidn bdng tdc dd tiin triin. Trong nhdm bdnh khdng cd tdn h^i tidn triin, ghi nhan chi sd nhdn dp theo cdc giai doan benh. Kit qud: Tai th&i diim 3 thdng, khdng cd mdt ndo tiin trien nang hon. T?i th&i diim 6 thdng, cd 1 mit nghi ng& tidn triin v&i 3 vj tri tdn h^i Tai th&i diem 9 thdng. cd 3 mat nghi ng& tidn triin (1 mit cd 4 vi tri ton h^i. 2 mat cd 3 vi tri tdn h^i), 4 mit giam chi sd VFi cd y nghTa thong kd (p<
0.05). trong dd cd 1 mit cd tdc dg tiin triin Id -38.9±
23,9'%/nSm. NhOng tnr&ng hgip nay cd biiu hi^n mit thdm l&p so'i than kinh trdn OCT, tuy nhien dd ddy l&p
NGUYEN TH! HA THANH, VU THj T H A I Khoa Gidcdm - Benh vien Mat Trung uxyng SQi mit di it han 20pm. Cd 7 mit diu cd m&c nhdn dp cao trdn 18mmHg & cdc lan tdi khdm. Trong nhdm 147 mit bdnh dn dinh, so sdnh cdc chi sd MD, PSD, VFi, dd ddy l&p sai than kinh quanh gai giwa thiii didm 9 thdng vd th&i diem ban dau thiy khdng cd sir khdc nhau. Chi so nhdn dp tmng binh trong nhdm benh dn djnh (nhdn dp dich) tuong Ong cdc giai doan sa phdt, tiin triin, trim trong, gin mO Id 17,8 ± 1.4, 16,4 ± 1,3. 15.1 ± 0.8, 14,5 ± 0,9 mmHg. Kit luSn:
Phin mdm GPA danh gid tiin triin binh gldc6m chinh xdc, khdch quan. Tj? Id mit c6 tiin tnin tmng 9 thdng theo ddi Id 4,5%. Nhan dp dich cdng thip & giai doan cang mudn.
Tir khda: GPA, gidcdm.
SUMMARY
Purpose: Evaluate effect of GPA software to follow-up glaucoma progression and recommend target lOP of different stage. Patients and Method:
154 eyes of 96 primary open angle glaucoma patients with treated glaucoma were prospectively enmlled and subjected to automated perimetry every 3- months In 9 months. Visual acuity, intmocular pressure (lOP), retinal nerve fiber layer (RNFL) thickness was recorded. The patient had completed at least 5 visual field tests, including the 2 baseline visual field and 3 test follow-up. MD, PSD, VFi, GPA progression symbols were recorded. Glaucoma progression was identified according to Early Manifest Glaucoma Trial criterion using Glaucoma Progression Analysis software. Possible progression required at least 3 test points deteriorated p<0,5 repeated in 2 visual field tests Likely pmgression required at least 3 test points deteriorated p<0,5 repeated in 3 visual field tests, in case unable evaluate by pattern deviation, defined progression if
Y HOC THUC HANH (937) - SO 10/2014
VFi had significant reduction with rate of progression.
lOP of no- progression was recorded in different stages. Results: After 3 months, had no-progression.
After 6 months, 1 eye had possible progression with 3 depressed test points. After 9 months, 3 eyes had possible progression (2 eyes had 3 depressed test points, 1 eye had 4 depressed test points). 4 eye had significant reduction of VFi. All of 7 cases lost of RNFL but less than 20pm and lOP were higher than ISmmHg in every exam. No progressive eyes had no significant difference in MD. PSD, VFi. RNFL thickness and target lOP of mild, advanced, serious, near end stages were 17.8 ± 1.4, 16.4 ± 1.3, 15.1 ± 0.8. 14.5 ± 0.9 mmHg. Conclusions: GPA software detected glaucoma progression accurate and objective. After 9 months, progressive incidence was 4.5%. The lower target lOP is. the later stage is.
Keywords: GPA, glaucoma DAT V A N D £
Gidcdm Id bgnh khong the chda khdi, theo s u i t cuOc ddi ngydi b$nh vd cd t h i gdy mCi. Tuy nhien cd t h i phdng trdnh d y y c mO do gidcdm n l u bdnh nhdn d y y c phdt hien, d i l u tri kip thdi vd quan trpng han nda la d y y c theo ddi thydng xuydn Vi vdy, viec theo ddi djnh ky de kjp thdi phdt hidn vd ngdn chan t i l n triln cua bdnh Id v i n d l then c h i t trong qud trinh d i l u trj b§nh, Tuy nhien, cho den nay, Idm t h i ndo de phdt hi$n duyc t i l n trien cOa bdnh hay xdc dmh dyyc bOnh I n ^ n h hodc dang ndng Idn vdn Id mdt thd thdch Idn vdi cac nhd nhan khoa tren todn the gidi.
Cdc nhd nhdn khoa thudc cdc tnjng tdm nghidn cdu. nhilu benh vidn khdc nhau trdn t h i gidi hi$n dang dp dyng vd tiep tyc nghidn cdu khoang 15 tieu chuan ddnh gia tien triln bOnh gidcdm, vdi gan 350 nghien cdu ve tien triln bOnh t d han mdt thdp ky nay.
nhim tim ra tieu chuan vdng de ddnh gid t i l n trien b§nh sdm vd chinh xdc [4], Hign nay, phin m i m GPA (Glaucoma Progression Analysis) duac xem Id cdng cy t i l n tien nhat trong ddnh gia Wen trien benh gidcdm.
Khi xdc djnh d y y c bgnh I n djnh hay nang Idn thi mdc nhan dp cOa nhdm bdnh on djnh chinh Id mdc nhan dp an todn hay nhdn dp dich. Ddy Id mdc nhdn dp c i n phai dat dyyc trong qud trinh theo ddi vd dieu trj.
Chiing tdi thyc hien nghidn cdu ndy nhim 2 muc tieu:
1. Ddnh gia hidu qud cua phin mem GPA trong theo ddi tidn trien bdnh gidcdm.
2. Khuyin cao muc nhdn dp dich & cdc giai do^n bdnh.
D 6 l TU'O'NG VA PHU-aNG P H A P 1. Ddi typ'ng nghien c d u
BOnh nhdn gidcdm gdc md nguydn phdt da dyac d i l u trj ha nhan dp tai khoa Gidcdm bdnh vidn M i t trung uang.
Thdi gian nghidn cdu t d thdng 11/2012 d i n 8/2013.
- Tieu c h u I n l y a chon
Giocom gdc m d nguydn phdt da duyc i^eu trj t h u i c ha NA hodc phdu thudt ho^c phoi hyp ca thuic, phdu thudt.
Mdc NA sau dieu trj dat £ 21 mmHg.
T u l i > 18 t u l i - Tieu chudn logi t r d
+ Cdc hinh thdi gidcdm khdc: gidcdm bam smh, glOcdm nhdn dp khdng cao, gidcdm thd phdt
+ Gidcdm p h i i hyp cdc bgnh khdc cua mat' dye TTT, benh ly dich kinh vdng mgc. n h i l m trUng, rdi loan van nhdn. tdt khue xa. c h i n thuang.
2. P h y a n g phdp nghidn c d u - Thilt k l nghidn cdu
Nghidn cdu md ta tien cdu. theo ddi doc C d mdu n = 98 mat cua 59 bOnh nhdn.
- Phuang phdp tien hdnh:
+ Lya chpn benh nhdn theo tieu chuan + Thdng tin bOnh nhdn d y y c dien d i y du vdo philu theo ddi
+ Ddnh gia ddc d i l m bdnh nhdn: tuoi, gidi, thj luc, nhdn ap, thj trudng, day mat, giai doan bgnh (sa phdt: MD > -6dB, t i l n triln: -12dB £ MD £-6dB, t r i m trpng: MD < -12dB).
+ Benh nhan d y y c khdm lgi 3 thdng /1 l i n t d l i n khdm d i u tidn cho d i n h i t 9 thdng.
+ Danh gia ddc d i l m b^nh nhdn tai cdc thdi diem nghidn cdu:
Thj lye, nhan dp, thi trydng, ddy mat (dO ddy Idp syi than kinh quanh gal- RNFL), giai doan IJenh, phyang phdp d i l u tri
+ Danh gid t i l n tnen bdnh gidcdm tai cdc thdi d i l m nghidn cdu b i n g p h i n mem GPA, dya theo tieu chuIn cua hdi EMGT (Early Manifest Glaucoma Tnal). Do thj trudng it nhat 5 l i n , 2 l i n do ban dau vd 3 l i n do theo ddi. Dya kitqua do thj trudng, ghi nhdn cdc chi s6 MD (liflean Deviation), PSD (Pattern Standard Deviation), VFi (Visual Field index), cdc d i u hieu bdo ed nghi ngd tien trien vd khIng dmh co t i l n trien cua p h i n mem GPA. Nghi ngd co t i l n trien khi c6 it nhat 3 d i l m t i n hai vdi p < 5% Idp lai d 2 lan do thi trudng. d i u hidu nhdn b i i t Id x u i t hien hinh tam gidc nda den, nda trdng tgi diem ton hai. Khdng ^ n h cd tien tnen khi ed it nhat 3 iSim ton hai vdi p < 5%
lap lai d 3 l i n do thi trudng, dau hieu nhdn b i i t Id xuat hien hinh tam gidc den tai d i l m ton hgi.
+ Ghi nhdn chi sd nhdn dp d nhdm kiidng co ton hai tien triln theo cdc giai dogn benh.
- X d Vj so lidu b i n g p h i n mem SPSS 16 0 K^T QUA
1. Ddc d i l m bdnh nhdn nghien c d u 1.1. T u l i vd g i d i
- Ty le benh nhdn n d Id 34/59 chiim 57,6%, benh nhdn nam Id 24/59 chiem 42,4%,
- Ty Id bOnh nhdn theo t u l i : Bang 1: i^hdn b l benh nhdn theo tuoi
Nhom tuoi
<40 4 0 - 6 0
>60 T6nq
S6 lirpno 16 29 14 59
Ty le (%) 27,1 49,2 23,7 100 Benh nhOn phan bo d- dp tupi 10' 40 den 60 la cao nhit 49,2%.
Y HOC THirC H A N H (937) - SO 10/2014
1.2. Giai dogn benh Bang 2: Giai doan bOnh
Giai doan bgnh Sa phgt (MD > -6dB) Ti6n trien (-6dB < MD s -12dB)
Trdm'tronq(MD<-12dB) T6ng
S6 lyang 64 23 11 98
Ty 11 (%) 65,3 23,5 11,2 100 Ty le m i t d giai dogn sa phdt chiim t j Id cao nhit 65,3%.'
2. Dac d i l m cua nhdm bdnh c 6 tdn hai tidn
t r i l n , - Thdi dilm 6 thdng cd 1 mat nghi ngd tien triln
vdi 3 vj tri t i n hai.
- Tai thdi diem 9 thdng cd 3 mat nghi ngd t i l n triln bao gIm ca mat da c6 nghi ngd tien triln d thdi dilm 6 thdng. Trong dd 1 m i t cd 4 vj tri ton hai, 2 m i t cd 3 vj tri t i n hai
- Ca 3 mat deu d giai dogn sa phdt vdi MD > - 6dB. Nhdng tardng hyp ndy deu cd bleu hiOn giam Idp syi t h i n kinh tren OCT, tuy nhidn dd ddy Idp sai m i t di it han 20|jm. Ca 3 mat d i u cd mdc nhan dp cao tren 18mmHg d cdc lan tdi kham.
3. Ddc d i l m cua nhdm benh I n djnh 3.1. B i l n doi cdc chi sd cOa thj t r y d n g vd Idp s y i thdn kinh quanh gai
Bang 3: Bien doi cua cdc chi s6 thj trydng vd Idp syi t h i n kinh quanh gai
Cac chi sfl
MD (dB) PSD (dB) V F I RNFL{tJm)
Thfrl diem ban
dSu 5,8 ± 3,9 3,4± 2,9 61,9±
10,7 92,6± 8,9
Thdi diem sau 9 thanq 6,1±4,1 3,4 + 2,8 81,2±
11,3 90, 3±9,1
D$ l$ch trung binh ghep cap 0,28± 0,97 0,07±0,6 0,8± 2,8 1,8±1,9
P
p> 0,05 p> 0,05 p> 0,05 p> 0,05 Sau 9 thdng theo ddi, cdc chi s i v l thj trudng vd dp ddy Idp syi t h i n kinh khdc nhau khdng cd y nghTa thong kd
3.2. Nhan dp d cdc giai doan benh Chi sd nhdn dp trung binh ciia ca nhdm bdnh I n
^ n h Id 17,1 ±1,2 mmHg
Bang 4: Nhan dp trung binh d cdc giai doan benh Cac giai doan benh
So phat Tien tnen Tram trong
Nhan dp trung binh (mmHq) 17,5 ±1,2 16.9 ±1.3 15.8 ±0.9
P
<0,05
Chi s6 nhdn dp trung binh cua giai doan sa phdt cao han cdc giai dogn tien triln vd t r i m trong cd ^ nghTa thong ke.
BAN LUAN
Trong nghien cdu ndy, bOnh nhdn phdn b l tyong doi d i u a 2 gidi, do t u l i chiim ty Id cao nhat Id t d 40^den 60 t u l i . So luang Idn benh nhdn d trong dp tuoi ndy ed t h i Id do benh gidcdm thudng d y y c phat hidn d dO tuoi trdn 40, dong thdi bgnh nhdn
dydi 60 t u l i c6 i ^ l u kiOn tdi khdm Uiydng xuydn han nhdng benh nhdn d dd t u l i tren 60.
- Mat d giai dogn sa phdt chiim t f 10 cao nhit 65,3%, d gial dogn ndy s y p h i i hyp do thj trudng thydng tot han so vdi cdc giai doan mudn.
- Sau 9 thdng, b i n g p h i n mem GPA, ty 1$ phdt hign benh cd t i l n t r i l n Id 3,1%. TJ Ig ndy thap han so vdi ty le cCia cdc nghidn cdu cQng dp dyng phan mim GPA nhyng cd thdi gian theo ddi ddi, 16% sau 3 ndm [1] vd 25.3% sau it nhat 5 nam theo ddi [5]. Dieu ndy hodn todn phii hyp vdi cdc nghien cdu ddnh gid tien t r i l n benh gidcdm bang nhdng tidu chuIn t i l n triln khdc dd Id khi thdi gian theo ddi cdng ddi thi t j 1$
bOnh ton hgi t i l n t r i l n cang tdng Idn. Nhdn dp d cdc l i n do cua ca 3 m i t d i u cao han 18mmHg, ddy \i mOt y i u to thiic day s y ndng len cOa benh. Vi nhdn dp Id yeu to nguy ca cd anh hudng nhieu nhit den t i l n tnen cua benh vd theo khuyin cdo cua hiOp h$i gidcdm the gidi thi mdc nhdn dp duyc coi Id an todn cOa mpi giai doan bOnh phai dudi ISmmHg [6].
- Trong nhdm bOnh I n i^nh. cdc chi s i v l tlii trudng vd Idp sal t h i n kinh quanh gai khdng cd sv thay doi v l ]? nghTa t h i n g kd. ddng thdi vdn cliu-a v y y t qua gidi han cua tieu chuan tien trien. Nhdn eip d giai doan tram trpng cd gid tri thap nhat, dieu ndy cix) thay nhan dp dich cdng can phai ha thap d cdc giai dogn mudn. C( giai doan tram trpng, nhdn dp S\c\\
c i n t h i p dydi 16mmHg.
K^T LUAN
- P h i n m i m GPA danh gia t i l n triln bdnh gidcdm chinh xdc, khdch quan. TJ 10 bOnh cd tiln tnen sau 9 thdng theo ddi Id 3,1%.
- Nhan dp dich can phai ha thap han d cdc giai doan muOn.
TAI LIEU THAM KHAO
1. Christian W, Govert P, Jansonius (2009),
"Glaucoma Monitoring in a Clinical Sefting Glaucoma Progression Analysis vs Nonparametric Pmgressieri Analysis in the Groningen Longitudinal Glaucoma' Study", Arch Ophthamol, 127(3), 270-274.
2. Donald L Budenz (2009), "Indentify pmgression with visual field: Past and Present - The latest advance in perimetry is designed to improve accuracy and effic/ency" Ophthalmology management 6,125-9.
3. Donald L Budenz, Chang (2008). "Clinical trial definitions of progression", International ophthalmology clinics, 48(4), 13-28.
4. Paul J, G Ernest. Herry J (2012). "The evidence base to select a method for assessing glaucomatous visual field progression", Acta Ophthalmologica, 90,101-108.
5 Tanna AP, Budenz DL. Bandi J (2012), Glaucoma Progression Analysis software compare with experi consensus opinion in the detection of visual field progression in glaucoma". Ophthalmology, 119(3), 468-73.
6. Tarek M, Mark B (2009), Guideline on design and reporting of glaucoma surgical trial. World Glaucoma Association published, Nertheland.
Y HOC THirC HANH (937) - S6 10/2014
