DANH GIA KET QUA DIEU TRj UNG THlTBIEU MO TE BAO GAN BANG THUYEN TAG MACH HOA DAU TAI BENH VIEN HOU NGHj DA KHOA NGHE AN
Dl/ONG DINH C H I N H , NGUYEN TAT T H A N G B^nh vi^rt HOv nghj da khoa Nghd An
TOM T A T
Muc Oich: Ddnh gid hidu qui, dg an todn cOa phwong phdp thuydn tic m?ch hda diu qua dng thdng dieu tri bdnh nhdn ung thw biiu md ti bdo gan (UTBMTBG). Doi tutmg vd phuvng phdp nghi§n cdu: Nghidn cuv md td tiin ciki dwa trdn 71 bdnh nhdn dwac chin dodn UTBMTBG diiu tri t$i bdnh vien H(ru nghi Da khoa Nghd An tw 01/2012 din 12/2013. Ket qud: Bgnh nhdn UTBMTBG da sd Id nam gi&i (81%) vd dd tudi trdn 40 (78,9%). Nguydn nhan chinh gdy bdnh Id virus vidm gan B (77,5%).
Han mdt n&a ("52,1%) cd tdng AFP > 500 ng/mL, 59,2% cd kich thw&c u> 5cmvdda sd Id u gan dem ddc (78,9%). MOt: AFP tmng binh giim t(r 245.3 ng/mL xudng cdn 173,9 ng/ml sau 1 thdng vd cdn 151.2 ng/mL sau 2 thing kd t(r khi niHt mach. Kich thw&c trung binh cua khdi u gidm ti> 7.6 cm xudng 6,9 cm sau 1 thdng vi cdn 5,8 cm sau 2 thdng; cd 78.1%
trw&ng hgp cd gidm kich thw&c khdi u sau thuydn tic mach. Cd hidn twgng hOy hogi ti bdo gan sau thuydn tic m$ch nhwng da s6 diu trong gi&i han cho phdp.
khdng cd trw&ng hap ndo suy gan. Hay gdp hdi chOng sau thuydn tic gdm sdt (90.5%), dau bijng (85,7%) nhwng da sd ddu tiin triin tdt Cic tdc di^ng phu nhw budn ndn, ndn, nic vd rung tdc ddu tw hit, khdng cd tai biin ndng. Ti 1$ sdng sau 3 thdng, 6 thdng vd 9 thdng lin IwQt Id 77.5%, 42,3% vd 29,6%.
Kit ludn: Thuydn tac mach hda diu qua dng thdng cd hidu qui trong viec Idm gidm kich thw&c khdi u gan vd nong dd AFP, nhit li & nhO-ng tnr&ng hQp u gan dan ddc vd kich thw&c nhd. Ndn tidn hdnh nOt mgch thdnh 2 thi ndu khdi u lan tda 2 thuy gan di giim mdc di? hOy hoai ti bdo gan.
TiFkhda: Thuydn tic m^ch hda dau. ung thw biiu md ti bdo gan
SUMMARY
ObJective:To assess the effectiveness and safety of the use of Transcatheter Oily Chemoembolization (TOCE) in treating patients with hepatocellular carcinoma (HCC). Patients and Methods:
Prospective study based on 71 patients diagnosed HCC in Hospital of Nghe An Province from 01/2012 to 12/2013. Results: Most of patients with HCC were male (81%) and aged over 40 (78.9%). The main cause of the disease is hepatitis B virus (77.5%).
More than half (52.1%) had AFP>500ng /mL. 59.2%
had tumor size>5cm and mostly solitary liver tumors (78.9%). AFP levels decreased from 245.3 average ng/mL to 173.9 ng/mL after 1 month and was 151.2 ng/mL after 2 months (post-embolization). The average size of the tumor decreased from 7.6cm to
6.9cm after 1 month and 5.8cm after 2 months; with 78.1% having decreased tumor size after embolization Post embolization syndrome occurred, but most are winthin the limits allowed, no cases of liver failure. Common symptoms include fever after embolization (90.5%),abdominal pain (85.7%), the majority are making good progess. Side effects such as nausea, vomiting, hicupsand hair loss decreased on their own, with no serious compiicatons. The sun/lvai rate after 3 months, 6 months and 9 months repectively 77.5%, 42.3% and 29.6%. Conclusion:
TOCE is effective in reducing liver tumor size and AFP levels, especially In the case of single and/or small size tumors.
Keywortis: Oily Chemoembolization, hepatocellular carcinoma
DAT V A N D E
Ung thy b i l u md t l bdo gan (UTBMTBG) Id mOt trong nhdng logi ung thy phd b i l n nhit trOn t h i gidi vdi g i n 1 triOu tnj'dng hyp mdi m i c hdng ndm, ViOt Nam thuOc diOn nhdng n y d c d tl 10 mdi m i c hdng ndm cao nhit trOn todn d u , lOn tdi 100-150 tnj'dng hyp/100,000 ddn/ndmI3],
HiOn nay d nhilu phyang phdp dilu tn UTBMTBG, trong dd thuyen t i e mgch hda d i u qua dng ^fing (TOCE - Transcatheter Oily Chemoembolization) Id phyang phdp Idm tac mgch nudi d l Idm khdi u Qio^
trien, Mdc du TOCE Id phyang phdp dilu trj d tinh chit hd try tgm thdi nhung qua nhilu nghiOn cdu cho thiy phuang phdp ndy d k i t qud khd quan, d t h i thyc hi§n trOn nhdng tnj'dng hyp dd qud ehi dinh phdu thudt. giiip d i thiOn tinh trang bdnh. kOo ddi thdi gian sdng s6t ciio bOnh nhdn.
Cy nydc ta TOCE b i t d i u d y y c thyc hlOn td ndm 1999 d mOt sd benh viOn tuyen bung yang vd din d y y c md r i n g . Benh viOn Hdu nghi Da khoa NghO An dd dp dyng k? thudt TOCE vdo d i i u trj UTBMTBG t d d i u ndm 2011. vl vdy chiing tdi dd tiln hdnh nghiOn cdu ndy n h i m ddnh gid hieu qud vd d$ an todn cua phyang phdp TOCE trong viOc dilu \j\
UTBMTBG tai bOnh viOn Hdu nghi Ba khoa NghO An.
0 6 l TU'ONG VA P H U - O N G P H A P NGHIEN CLTU 1. Ddi t i r y n g nghiOn c d u
NghiOn edu t i l n cdu dya trOn 71 bOnh nhdn duyc c h i n dodn UTBMTBG dd d y y c dieu tri b i n g phuang phdp TOCE tai benh viOn HNDK Ngh'o An t d thdng 01/2012 d i n thdng 12/2013.
TiOu chuln lya chpn:
- UTBMTBG d y y e c h i n dodn dya trOn siOu dm, d t Idp vi tinh (CLVT), gidi p h l u bOnh,
KhOng cd huyit khdi tTnh mgch cda ho^c dao
Y H O C THU'C HANH (937) - S6 10/2014
chiiu ddng chay tTnh mach cda.
- KhOng cd d tnj'dng.
- Prothrombin > 50%.
Tidu chuln logi trd:
- Vdng da do t i e mdt (nguy ca nhilm khuin t d dudng mdt sau nOt)
- Cd bdnh phdi hyp: suy thgn. suy tim,,..
Cd tien sd dj dng.
X a gan giai doan Child-Pugh B, C.
Cd trydng.
Cd t i e tTnh mgch cda.
- Cd di can xa.
2. P h y a n g phdp nghien c d u NghiOn cdu mO td t i l n cdu.
1. Xdc djnh UTBMTBG vd mdc dd cOa benh - BOnh nhdn d y y c xdc i^nh c6 khdi u gan tren sidu dm d byng vd cd nhilm HBV, HCV hay cd tidn cdn nghiOn ruyu.
- T i t d bOnh nhan d y y c sinh thilt khdi u gan dudi hydng ddn siOu am vd chan dodn ung thu bleu md te bdo gan dya vdo md bOnh hpc,
2. Xdc dinh bOnh ly gan ca b i n , mdc dd suy te bdo gan, mdc dO hogi t d t l bdo gan vd nguyOn nhdn ung tiiy gan
- Xdc djnh bOnh ly gan ca bdn b i n g hOI chdng suy te bdo gan trOn Idm sdng, cdn Idm sdng vd phdn logi theo Child-Pugh.
- Khao sdt mdc dd hoai t d t l bdo gan dya vdo AST vd ALT.
- Xdt nghiOm HBsAg vd anti-HCV tim nguyen nhdn.
- Xdt nghidm t^nh luang ai-Fetoprotein (AFP).
3. Khdo sdt tdn thyang tgi gan vd ngodi gan T i t cd bOnh nhdn d y y c sieu dm o bung, CLVT gan ed tidm thudc d n quang, X-quang phdi d l ddnh gid vd sd luang, kich thydc, vj tri eua khdi u gan eOng nhu kha ndng xdm l i n mach mdu, di d n hgch vOng, di cdn xa.
- T i t ca benh nhdn d y y c idm DSA ngay tm'dc khi Idm TOCE di xic djnh hO mgch mdu nudi khdi u, phdt hiOn thOm cde t i n thyang nhd khdng t h i y dyyc d tren siOu dm vd CLVT.
4. Thyc hiOn TOCE tai khoa DiOn quang, benh viOn HNDK NghO An
- Bam hdn hyp gdm Lipiodol vd thudc chdng ung thy Famorubicin (vdi l i i u l y y n g tuy thudc vdo diOn tfch ca t h i vd kich thydc khdi u) vdo dpng mach nudi khdi u vd vdo edc nhdnh hg phan thiiy nudi dydng khdi u (siOu chpn Ipc sdu nhit tdi u ed the).
5. Theo ddi sau thu thudt - HOi chdng sau thuyOn t i c . - Tdc dyng phy ciia thudc.
6. Ddnh gid k i t qua
- Chyp DSA k i i m tra igi ngay sau thu thudt TOCE d l xdc i^nh nhdnh d0ng mgch d n thuyen t i e da bi niit hodn todn. - Sy thay ddi ndng do AFP.
D$c diem khdi u tren CLVT d d n quang (mdt thdng sau thO thuOt TOCE) v l kich thydc, mdc dp dpng Lipiodol, tdn thuang tdng n g l m thudc can
quang, tdn thyang ve tinh, di d n hgch, xdm lan mgch mdu,
7. XOt chi djnh Idm TOCE cOng cd
- T i t d tnfdng hyp d n tdn thyang tdng n g l m thudc d n quang.
- Cdc trydng hyp x u i t hiOn u vd tinh (u mdi xuat hiOn).
Xu> ly sd lieu
Cde sd liOu d y y c x d 1;^ theo d c thudt todn thdng kd, s d dyng p h i n m i m SPSS,
K£T QUA 1. Tudi vd gidi
Gidi tinh Do tudi
^
Nhin xdt: Da sd Id nam gidi vdi 8 1 % bOnh nhdn (63/71). Han mpt nda sd bOnh nhdn (51%) d dO tudi 40-60, chi cd 2 1 % bOnh nhdn dydi 40 tudi.
2. Thdi gian t d khi c 6 b i l u hien bOnh d i n khi d i l u tri
Thdi gian < 1 thdng 1-3 thang > 3 thdng SObOnh I 8 I 34 I 29"
nhan i (11.3%) I (47,9%) I (40,8%) . Nhan xdt: Chi d 11,3% bOnh nhdn d y y c d i l u trj trong vdng 1 thdng k l t d khi cd bieu hiOn bOnh,
3. XOt nghiem virus viem gan HbsAg (t-: Anti-HCV (+) Khdc Sd bOnh
nhdn 1 (77.5%) | (16.9%) | (5,6%) . Nhan xdt, P h i n Idn benii nhan (77,5%) ed xet nghiem HbsAg duang tinh, 16,9% bOnh nhdn c6 xet nghiem anti-HCV dyang tinh.
4. K i t qud djnh l y y n g AFP t r y d c TOCE A F P (ng/ml.)
Nhdn xdt. Chi cd 14,1% (10/71) bOnh nhdn d AFP < 100 ng/mL. Han 1/3 (33,8% tyang dng vdi 24/71 tnj'dng hyp) ed AFP trong khoang 100-500 ng/mL. Cd 52,1% bOnh nhan d AFP > 500 ng/mL.
5. Kich t h y d c , sd I y a n g klidi u Kich thuoc khoi u (cm)
< 5 29 (40,8%)
5-10 34 (47,9%)
>10 8 (11,3%)
Sd lircmq khii u 1kh6i
66 (78,9%)
> 1 khoi 15 (21,1%)
Y HOC TWJC HANH (937) - S610/2014
Nhdn xdt: 40.8% bOnh nhdn cO kleh thydc u < 5 cm, g i n mOt nda (47,9%) ed kich thydc u 5-10 cm, cOn lgi chi d 8 bOnh nhdn (tyang dng 11,3%) ed ktch thydc u > 10 em.
6. S y thay ddi AFP vd kich t h y d c khdi u Thay dll kich
thir6c khii u S6lir(?tT0CE
(n = 105)
GISm kich thir6«
82 (78,1%)
Khong giam kich thuac
23 (21,9%) Nhin xit: Hon 3/4 tnjftng hpp (78.1%) kich thu'd'c u giam sau nOt mpch trong tfing so 105 lu'pt TOCE cOa 71 banh nhan. Chi cd 21.9% tnremg hpp kh6l u khonq qiam kich thu^S-c sau nUt mach.
TOCE TmJcTOCE Sau TOCE Ithana Sau TOCE 2 thanq
AFP (ng/mL) 245,3 ± 56,7 173,9 ± 34,5 151,2 ±35,8
Kich third'c khoi u (cm) 7.6 ±1.7 6,9 ±1.6 5.8 ±1.4 Nh$n xdt: Ndng dO AFP tnjng binh vd kich thudc tmng binh cua u cd xu hydng giam d i n sau nOt mgch,
7. Tdc dyng phu trong vong 3 ngay ddu sau TOCE
Tdc dgng phg Bu6n ndn, n6n
N^c
86 lu'pt TOCE (n=105) 45 (42,9%) 23(21,9%)
Ti le % 42.9%
Rgngt6c I 7(6.7%) | 6,7%
Nhdn xdt: TI 10 tdc dyng phy Id buon ndn, ndn Id eao nhit vdi 42,9%. t i l p theo Id nae chiem 21,9%, ehi d 6,7% trudng hyp d ryng tdc.
8. Tinh trgng hoai t d td bdo gan sau TOCE DOng mgch thuydn tSc
sau TOCE 1 ngdy sau TOCE 1
thdng sau TOCE 1
ngdy sau TOCE 1
thdng
Ddng mgch gan PhoacT
(n = 88)
DOng mgdi gan P vd T
(n = 17)
743,4 ±214,5
Nh$n xdt: Ndng dp transaminase (ALT vd AST) tdng lOn rO rOt sau niit mgch 1 ngdy, nhit Id d nhdm niit mgch khdng chpn loc. Transaminase cd xu hydng trd v l g i n mdc ban dau sau 1 thdng,
9. Ti l# sdng sau TOCE Thfri qian s6nq
3 thang 6 thanq 9 thanq
S6 banh nhan 66 (77.5%) 30 (42.3%) 21 (29,6%)
TTia%
77,5%
42,3%
29,6%
Nhdn xdt: TI 10 bOnh nhdn sdng sau 3 thdng Id 77,5%. sau 6 thdng chi c6n 42.3% benh nhdn song sdt vd tl 10 ndy chi cdn 29.6% bOnh nhdn sdng sau TOCE 9 thdng,
BAN LUAN Ddc d i l m chung
Da sd bOnh nhdn Id nam gidi (chiim 81%) vd dO
tudi thydng gOp Id t d 40 tudi trd len (78,9%). Kit qud ndy cQng phti hyp vdi d c nghidn cdu trong vd ngodi nude [2].[3],
Khoing thdi gian t d khi d trieu chdng cua bOnh d i n khi thye hidn TOCE p h i n Idn Id han 1 thdng (88,7%). Da sd bOnh nhdn cOa chCing tdi d i n viOn mudn vl nhilu 1;? do khdc nhau: p h i n Idn bgnh nhdn khi phdt hiOn triOu chdng ddu nghl ring minh chi b|
cdc bOnh 1^ v l gan thdng thydng vi vdy dyyc dilu trj b i n g cdc dan thudc dan gidn cOa d c d n bO y t l xd jshydng; mOt sd it bOnh nhdn mdc dii da dyyc phdt hlOn ung thy gan nhung do h i i u b i i t kOm ve bOnh tOt, vdn quan nlOm r i n g se dieu tri khdi benh bing cdc bdi thudc ddn gian (thudc ddng y, thudc nam.,] cOa cdc luangy, cdc t h i y lang.
D$c diem cOn lam sang
Xdt nghiOm vims: BOnh nhdn d xet nghiOm HbsAg (+) chiim ti le rat Idn vdi 77,5%, tyang dng vdi 55/71 bOnh nhda UTBMTBG r i t hay gdp d nhdng b$nh nhdn n h i l m vims viem gan B vd viOm gan C. TJ10 ndy phili hyp vdi d n g bd cua edc tdc gii trong vd ngodi nude [2].[4].
Djnh lyyng AFP: Da sd benh nhdn cd tdng AFP, trong dd cd han 1/2 sd bOnh nhdn (52,1%) c6 AFP tdng > 500 ng/mL. Sd bOnh nhan ed AFP tdng > 1000 ng/mL cDng ehilm hyn 1/4 (25,3%) trong tdng sd 71 bOnh nhdn nghiOn cdu. K i t qua ndy khd tyang ddng vdi nghidn edu ciia LO LOnh Lyang vd Le Quang HOa khi c6 52,7% bOnh nhdn d AFP trudc nOt mgch >
500 ng/mL nhyng cd den 39,5% bdnh nhdn d AFP >
1000 ng/mL, tyang ddi cao so vdi k i t qua 25,3%
bdnh nhdn cOa chCing tdi[1].
C h i n dodn hinh anh: Theo k i t qud sieu dm v^
chyp CLVT. 59.2% benh nhdn ed kich thydc khdi u >
5 cm vd da sd bOnh nhdn chi ed 1 khdi u gan (78.9%).
Chiing tOi gdp cdc khdi u n i m phan Idn d cdc thiiy gan phai. Johnson P.J cho rang edc khdi u gan phai dilu bj bing phyang phdp p h l u thuat gap nhieu khd khdn, thdi gian sdng sdt sau phdu thudt ngan vi vdy TOCE dyye cho Id phyang phdp y u wOt nhdt [4].
KOtquddlOutrj
Djnh lyyng AFP Id xOt nghiem phd bien khi bOnh nhan d y y c c h i n dodn UTBMTBG. AFP vda cd tdc dyng trong c h i n dodn cOng nhy trong tiOn lyyng bOnh nhdn UTBMTBG. AFP cdng cao thi tiOn lyyng bOnh nhdn cdng x l u . Cdc bOnh nhdn d y y c hen khdm Igi sau TOCE 1 thdng vd 2 thdng, ndng dd AFP sau TOCE d i u gidm d 100% sd bgnh nhdn cd mdc AFP tdng trudc niit mgch, dac biet Id sau niit mgch 1 thdng mdc AFP giam rd ret han d : mdc AFP trung binh gidm t d 245,3 ng/mL xudng cOn 173.9 ng/mL sau 1 thdng vd cdn 151.2 ng/mL sau 2 thdng k l t i r khi niit mgch ddi vdi nhdng bOnh nhdn chua tilp tgc nut mgch trong vOng 2 thdng.
Kich thudc khdi u nhin chung cQng cd xu hydng gidm d i n theo thdi gian: kich tiiydc tmng binh cOa khdi u giam t d 7,6 cm xudng 6,9 cm sau 1 thdng vi cdn 5,8 cm sau 2 thdng. C6 d i n 78,1% tn/dng hpp (82 l y y t TOCE) d giam kich ttiydc khdi u sau nOt mach vd chi c6 23 tnj'dng hyp trong tdng sd 105 luyt TOCE khdi u khdng gidm kich thydc. Trong cdc
Y HOC THVC HANH (937) - s6 10/2014
Uydng hyp c6 gidm kich thydc u thi da sd cd kich thydc k h i i u < 5 em, mOt p h i n Id sd ed kleh thydc 5-
• 10 cm vd chi ed 1 trydng hyp cd u > 10 cm ed giam kich thydc u sau nOt mgch. Nhy vgy khdi u cdng nhd thi hiOu qua cua TOCE cdng cao vd viOe nUt mach ciing cd Id that s y d n thiet d l lam tdng them hiOu qua triOt tieu khdi u d nhdng bgnh nhOn cd khdi u chua phdt trien qud Idn, ddy cQng la quan dilm cOa cde nghidn edu khdc [2],[3],[5].
TriOu chdng thydng g^p sau nCit mach Id sdt vd dau byng Id nhdng b i l u hiOn cua hOi chdng sau thuyOn tac, H l u h i t benh nhdn sau can thiOp deu xuat hiOn sot (90,5%) nhung d i u het sdt t y nhiOn, dCi vdy v i n cd 2 trudng hyp sdt kdo ddi han 3 tuan, trong dd 2 benh nhdn h i t sdt d t u i n thd 4 vd 1 bOnh nhdn h i t sdt d t u i n thd 5 sau niit mach. Khoang thdi gian sdt sau niit mgch tmng binh Id 8,5 ngdy, khdng ed trudng hyp ndo phdt hiOn d tinh trgng nhidm triling sau nCit mgch. Cd 85,7% trudng hyp cd dau byng sau can thiOp vdi nhilu mdc dO nhung ve c y ban da sd trydng hyp cd t h i kiem sodt dau b i n g thudc gidm dau vd triOu chdng dau byng gidm nhanh theo thdi gian, khdng cd bOnh nhdn ndo dau byng qud 1 t u i n sau TOCE. Thudc chdng ung thy cd gay cdc tdc dyng phu nhy budn ndn, ndn (gdp d 42,9%
trydng hyp), n I c (21,9%) Id hay gOp nhit nhyng da sd deu t y h i t sau 3 ngdy; ryng tdc chi gdp d 6,7%.
Khdng cd benh nhdn nao gdp cdc tai bien ndng nhu tyt huyit dp hay suy thgn.
v l tinh trang hogi t d t l bdo gan sau niit mach, chiing tdi dya vdo ndng dp ALT vd AST trong mdu, chia thdnh 2 nhOm thuyOn tac mgch gan cd chpn Ipc va thuyOn tac d 2 nhdnh dOng mgch gan phai vd trdi.
Kit qud cho thay mdc do tdng ndng dd ALT, AST trong mdu d nhdm niit ca 2 ddng mgch gan phai va trdi nhilu han so vdi nhdm nOt mgch ed chpn Ipc chi thuyen t i c ddng mach gan phdi hodc dpng mgch gan trdi, cy t h i : chi sd ALT tmng binh sau TOCE 1 ngdy lan lyat Id 252,6 U/L vd 367,4 U/L; chi sd AST tmng binh sau TOCE 1 ngdy l i n lyyt Id 339,7 U/L vd 643,4 U/L. Do dd d nhdng trydng hyp u Idn lan tda ca 2 thOy, ddng mach gan phaivd trdi dOu cd mgch nuoi u thi nOn niit mgch 2 thi. mdi thi chi thuyen t i e 1 ddng mach gan d l giam nguy ea hiiy hoai te bdo gan vd suy gan cd t h i xay ra sau thuyen t i c mach, Nhung TOCE v i n t h i hiOn sy an todn d ca 2 nhdm tren khi k i t qua theo dOi sau 1 thdng cho thay ndng dp ALT vd AST
deu giam g i n ve mdc ban d i u . k i t qua ndy phu hyp vdi nghiOn cdu cua Hd Tan Phdt vd cdng sy[2].
Ket qud chyp CLVT gan cd tiOm thudc cdn quang sau 1 thdng eho t h i y 100% trudng hyp u sau TOCE deu cd dpng vdt liOu nOt mach. phan khdi u cdn ngam thudc can quang r i t nhd,
Ve tl 10 sdng ciJa bdnh nhdn sau nOt mgch, theo k i t qua tgi thdi d i l m thu thdp sd liOu, tl 10 s i n g sau 3 thdng, 6 thdng vd 9 thdng Idn l y y t la 77,5%, 42,3%
vd 29,6%. K i t qua ndy cd p h i n kha quan han so vdi k i t qua nghiOn edu cua Ho T i n Phdt vd d i g s y vdi tl Id s i n g sau 3 thdng, 6 thdng vd 9 thdng l i n lyat Id 71,4%. 35.7% vd 12,5%[2], K i t qua ndy r i t ddng khich 10 khi thdi gian sdng trung binh k l t d khi d y y c c h i n dodn UTBMTBG cua ngudi chdu A chi Id 3 thdng vd sau 1 nam tl Ig song sdt chi la 7,8%[5].
K^T LUAN
Bgnh nhdn UTBMTBG da sd Id nam gidi (88.7%) vd dO tudi IrOn 40 (78,9%). NguyOn nhdn chinh gdy bOnh Id vims viOm gan B (77,5%). TOCE cho t h i y hiOu qua trong viOc Idm giam kich thudc khdi u vd giam ndng dd AFP, nhit Id d nhdng trydng hap u gan dan ddc vd kich thydc nhd. TOCE vdn dam bao s y an todn nhit i^nh khi chya xay ra bien chdng nang ndo vd cdc tdc dyng phu khdng qud ddng ngai vd da sd d t h i kiem sodt dyye. Nen t i l n hdnh TOCE thdnh 2 thi neu khdi u Idn. lan tda 2 thCiy d l giam mdc dO huy hoai t l bdo gan.
T A I LIEU THAM KHAO
1. Le LOnh Luang vd Le Quang Hda (2011), Danh gia kit qua bydc dau trong dieu trj ung thy bilu mo t l bdo gan bang ky thudt TOCE tgi BVDK Thanh Hda, Y hgc thuc hanh. 768(Sd 6/2011). pp. 160-163.
2 Hd T i n Phat, Phgm Quang Cd. Vo Hpi Trung Tryc (2009), Nghien cdu nguyen nhdn va kit qua dilu trj ung thy bilu md t l bdo gan bing thuyen tdc mgch hda dau, Yhgc thuc hanh. 675(Sd 9/2009), tr. 37-40.
3. Dancygier H. (2010), "Malignant Tumors", in Dancygier H., Editor, Clinical Hepatology: Principles and Practice of Hepatobiliary Diseases, Springer-Verlag, pp 1305-1350.
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5. Nakagawa T. (1999) Transcatheter Chemoembolization for HCC, Inten/entional Radiology, William & Wilking third edition 1999. p: 138-158
NGHIEN COU TINH TRANG SUC KHOE TAM THAN KINH or BENH NHAN MAC BENH GAN DO BUOU THEO THANG DIEM BECK
DINH TIEN DONG, N G U Y I N QUANG DUAT Benh vifn Qudn Y103
TOM T A T Nghidn cCni tren 42 BN mic bdnh gan do rwou Nghidn cwu tinh trgng sdc khde tdm thin kinh & chOng tdi thu dwQfc kdt qud nhw sau:
bdnh nhdn mac bdnh gan do nrg^u theo thang didm -Tudi tmng binh nhdm nghidn c(ru Id 48,19 ± BECK 8,59. Tudi cao nhit li 68. thap nhit Id 32 tudi.
Y HOC THUC HANH (937) - S 6 10/2014
