DANH GIA KET QUA BIEU TRI PHAU THUAT UNG THU

VIETIIAM MEDICAL JOUBMAL H'1 - DECFMBEF! - 201S

1

DANH GIA KET QUA BIEU TRI PHAU THUAT UNG THU- PHOI KHONG TE B A O md CO HACH N2

T O M TAT

Muc tieu: Nhan dinh vai tro phau thuat dCH vdi benh nhan bj ung thu phoi khong te bao nho co hach N2 ve kha nang phlu thuat va nao hadi, cac phutjng phap phau ttiuat, ket qua sdm sau klii phiu thuat va ket qua dieu tii lau dai ttieo doi sau 2 nim. PhuUng phap nghien cCrti: doan he tieii cuu. Ket qua: 82 trudng hpp chan doan ung ttiu phoi dudc mo hd ho3c npi soi d t thuy hay 1 ben phoi kem nao hach N2. KSt qua mo hpc ti le te bao tiiyen diiem da so, mo md 79%, 13/82 tnidng hpp co biai chiihg trang do 4 tru'dng hdp h i vong do nhoi mau cp tim. 61 tnidng hpp ha bac giai doan sau mo. Vet hpch nhdm 5 tu'dng doi kho tiiyc hipn. Thdi gian song ttiem sau 2 nam qua ttiuit bian Kaglan meler la 18,3 tuan ± 6,5. Ket luan: CSt Uiiiy phoi l i phudng phap dieu bi hleu qua ngay ca khi co hach N2. Nao vet hach biet de d l dang ttiut hien hdn khi mo hd. Danh gla hadi sau mo giup xlc djnh lai diing giai doan de co chien lu'dc diSu frj v l dff hau cho bSnh nhin.

SUIVIMARY

THE EVALUAnON OF RESULT SURGERY I N TREATMENT OF NON- SMALL CELL LUNG

CANCER WITH N2 LYMPH NODE Objectives: IdenOly ttie rale of surgery for non- small cell lung cancer mitti N2 lymph node capable about surgery and Bie surgical approadi, the results immediately after surgery and after 2 years follow up.

Methods: cohort sudy design. Results: 82 cases of lung cancer were lobcaomy or pneumonectomy wltti N2 dissection lymph node by open or laparoscopic suigery. Resulls almost as adenocaranoma. Open surgery: 79%, 13/82 cases complications including 4 deaths due to myocardial infarction. 61 cases down stage after surgery. Lymphadenectomy group 5 is slighOy difficult. Time after 2-year survival by Kaplan Meier algonttim was 18.3 ± 6.5 weeks. Conclusion- Lobectomy Is an effective tteattnent method even lung rancer wltti N2 lymph node. Open surgery easier to radical lymphadenettomy. Postijpeiattve evaluation nodes helps detemilne ttie conect stage fpr freatinent soategies and outcomes for patients.

* Bqnh vlin a,q RSy

Chju hadl nhlpm diinh; Nguyen van Khoi Email: kholnguyenvan@yahoo.co.uk Ngiy nhpn bai: 9.9.2016 Ngay phan bipn khoa hpc: 1011.2016 Ngiy duyet bai: 18.11.2016

Nguyen Van Khfii*

Key word: Lung cancer, lobectomy

pneumonectomy ' I. OAT V3iN OE

Ung thff phoi (UTP) I I dang ung Biff phd tsgsi cua hp hd hap gay tff vong cao nhat cho nam gidl. Cd 14,1 trieu ngufti mdi mac ung ttitf Ifli ifPn 1,8 trieu ngufti bl UTP. fioi vdi UTP khong phai te bao nho is giai doan sdm cd the phau ttiuat. Seng do cd do I c b'nh rao, tien trien nhanh va tileu chffng l l m sing ngheo nan nSn da so bj phit hien d giai doan muon, hoac da co dl cSn hach. Digu ttt vi vay gap rat nhieu khp khin.

Cac phuang Sen chan doan hinh Inh nhSm danh gia cac giai doan va bin chat ciia Ipal ung thff trffde khi phau thuat nhff: CT sran, PET, sinh thiet u dffdi hffdng d i n ciia CT hole npl sol phe quin dan dffdng la nhDhg thinh cdng idn ciia y hpc hien dpi. Hach N2 dff bao mffc do dl dn tlieo dffdng bach huyet den vung frung thS cung ben va hoac ngay gan carina. Dlnh jB benh nhan UTP cd hach N2 cd chi djnh phau thuat giup tien luting ket q u i aeu fr| cung nhil giiip phau thuat vien vet hach ngin nguS dl cin v l glam tff vong cho b^nh nhan. Muc ti'eu nghlSn cffu ciia toi nhim khao sat d c die diem Bm sing, can l l m sing 8i danh gla ket qui dieu ti|

sdm va thdl gian 2 nSm sau mq bpnh nhin bl UTP khong ts bao nho cd hach N2 du^ic phau thuat kem vet hach.

IL BOI TUIJNG v A PHUOTMG P H A P N S H I E N CIJU 1 . Odi tu'dng nghien cii'u

^Tff 03/2013 - 03/2014 cd 82 a UTP dutK phau thuat tal BV Chd l ^ y Tp.HCM.

Tliu chuan chgn lua b$nh nhin - Bpnh nhan dffdc x l c chan duS vao Bni sang, cSn lam sing v i ket q u i g l i l phau b^nh If trffde, sau khi jphlu thuat

- Dffdc phlu thuat c i t phSl ttiep quy each ds nao vet hach N2.

^ - Theo doi tiong Uidl glan 02 nim sau kW phau thupt.

Tliu ChuSn lo^l trif

- KSt q u i glal phau bpnh khdng phu h « trudc v i sau khi ni3 K K TI- 96

y HOC V l t r HAM Tap <49-THAIIG 1 2 - s o 1-?m<;

ttiff

- Phau ttiuat khong nao nhdm hach N2 - Benh tii vong frffdc 02 nam kiiong do ung 2. Phu'dng phap nghien oi^i 2.1. Thiel ke nghien cffu: phffdng phap nghien cffu: Doan he Hen ciiu » r' f

2.2. Cac yeu to nghiSn cu'u

- Bac diem ciia benh nhan, lam sang v l can lam sang

+ Gidi, dp tudi va tudi trung binh.

+ d c tiiSu chuiig lam sing: ho, ho ra mau dau ngffc, kho thd

+ l « t qua Chan doan hinh I n h ; Xquanq ngffcCT sran, MIU, PET.

- Phffdng phip chan d o i n md hpc + Sinh thiet qua npi spi phe quan + Sinh thISt xuySn ngu'c bang kim - Xlc djnh giai doan

+ Ket q u i CT ngffc, PET hoac danh gia h-dng

^ r i ^ S p giai doan Hieo IiSn hiep chong ung ttiff

^ ^ ^ B (UICC 7th)

^ ^ N h d m hach phit hien

+ Trung ttiat tiSn: hach tiung that, canh khi quan tren, canh khi quin dffdi, sau khi quin

+ Trung ttiat dffdi: hach ngay rarina, ranh thffc quan va vung d i y ching phoi

- Phau thuit kem nao hach

•i-catttiiiy Cit hal Uiuy

+ Cat teian bo phoi 1 bSn - K9:^qua sdm:

^ Phau ttiuat khdng cd bien chuhg. Vet dudc -1-Khong bien chiihg, khong lay dffdc tiian bo hach

-1- Cd bien chuhg: chiy mau, nhilm tiling,

ran mo lai ^ ' + Tff vong

- Ket qua muon

^^ + Tai phat tai cho: tiin dich mang phoi, u t i l -I- Thdi gian tai phat

+ Di can xa 1.3. Xur li so lieu

_ Theo phan niem SPSS 15.0. Thdi gian Sdrig ttiem theo Kaplan Meier. Ngoii ra diinq phep kiem T, ti IS %, so sanh hal H ie test x2.

III. K f r QUA N G H I E N CU'U 1 . BSc diem nhom nghiin ctfu o , J ' ' ° ^ ' ? ° " " "3/2014, chiing toi chon dffdc 82 Penh nhan, bao gom:

1.1. Tuoi vd gidi .

- Nghien ciiu cd SO bpnh nhan nam, 32 bpnh nhan nff. Tl l | nff/nam = 1,5

- Tuol frung binh tiong nhom nghiSn cffu l i 60 ± 4,3 tiioi, nho nhat 49, Idn nhat 68 tuol.

B i n g l ; VI fri ton thffdng - " •= *••• fcwii fcimvMu

t»ac ai6m ton thu'dng Ifbi Phai Trai Tdnq s6~

47 35

« « # n r e t - V j t r i ton ttiffdng phoi phil nhieu hdn bSn frai 1.2. B$c diem lam sang

Bing 2; frieu chuhg lam sing

Tl le %

57%

43%

100%

Lam sing

SOIianhnhan TV 16%

VlETHAM MEDICAL JOURNAL NH • DECEMBER - 2016 1.4. Ky Uiuat xac dinh mo hoc trdde mo

Bang 4: Cac phifdng phap chan doan giai phau benh trUdc mo Phu'tfng phap

Sinh tfiiet qua noi sol phe guan 1.5. Phau thuat

Bang 5: Phu'dng phap mo

Sinh thiet xuyen thanh ngi/c

Bang 6; ket qua m6 hoc va danh gia giai doan Loai t e bao

Ung thu' bieu mo tuyen Unq thd te bao gai Ung thtf phe quan phe nang

Ung thu" te bao idn lUA i n B 3. Odnh gia k i t qua sau mo Bang 7: Ket qua phau thuat

K6t qua sdim sau phSu teuat Bgnh nhan on, vet hach triet d e ~

On, vet hach khonq hoan toan~

Co bien chulig (chay mau, nhiem trung) 2 ca phau thuat lai

4 ca tu* vong _ Tong so Ket qua theo d6i Bang 8; ket qua lau d

Kgt qua trong 02 n a m ~ Tii vong < 6 thang

Tiy vong < l nam Tu'vong<2_nam

Tong so Dican xa Tong s6 82 benh nhSn"

SBTH

IV. B A N LUjGiN

1.0|c dl€m Chung cua nhom bfnh nhan Ung thu* phoi khong phai te bao nho da so gap nhieu trong UTP noi chung thu'dng xav ra d nam gicli ldn tuoi. Theo Kjedl Roth (2009)^**^ tf le nam gidi chiem 75% so vdi nu", tuoi trung binh \k 68, da sd phoi phai. Khi so sanh ve do tuoi va gidl, vj tri u phoi phai > phoi trai toi ciing thay

SgcaC%) ' 35(43%) 47(56%) x i i r t i i

P/iuang phap md Noi soi C^t 1 thuy Cat 2 thuy Cat 1 ben phoi

Tonq so

N 17 65 71 9 2 82 tru'dng hdp

Ti le % 2 1 % 79%

1 1 % 3%

Ti le %

99,7 0,3

Ti IS %

Ti I j %

tffdng doi phll hdp. Tdl chd ring gldi nam vdi ti le tJTP^cac chffng td thffc trang thdi quen hiit thuoc van con pho bien tal Vi?t Nam.

2 . & | c aSm i i m s i n g , cdc phu'tfng phip ChSn d o i n v i x i e djnh m6 hpc Inrtlc mS

- Ho v i dau ngffc l i hai fri^u chfftig OiuSng gap nhat trong nghien cilu. Ho do kich thidi niem mac phe quan l i phan xa Bng xuSt d| vjt 98

iL

YHOC WET NAM Tap 449-THANG 1 2 - S g l - 2 f f t 6 khoi dffdng ho hap - phan anh dnh bang u xam

j- 1311 rao niem mac phe quan. Dau ngut xayra Idli CO xam lan ming phSl ttianh hoac ming phoi - tang. Theo Bui CJii w a (2015)Oi, t i l e ho khan v i - dau ngffc la 43,5% v i 25,5% thap hdn cua tdl _ C85%, 8%) cd le do lac gia da chon benh nghien _ cffu d giai doan sdm, tneu chffng l i m sing chuS da_dang. Ngoii bieu chffng t n p tren ngffdi cao

• tuol khi Idl ghi nhan dd cd nhieu benh noi khoa di kem nhff benh phoi tac nghen man b'nli, benh ly tim mach la nhffng nguyen nhan lam phong phu nhieu trieu chffhg lam sing va thffc the.

-_ Ngoii ra, cac benh nhin tiong nhdm nghien cffu dudc chan doan duS vao cac phffdng b'en hinh i n h de xac dinh benh ly. X quang phoi thing thffdng quy thffc hiSn fren 82 benh nhan nghien cuu ghl nhin u frong nhu mo phoi dffdc

f

fnh dua v i d MRI hoac CT scan. Gia fri chgn cua CT frong nhan dien UTP la 75-80% vdi lay SM% theo nhieu tac giaO'. Nilendu c dare" danh gia hach frong LTTP fren CT scan hoac PET CT trdde mS cd dd chuyen 94%

v i dd chinh x i e l i 86% khi xac diiih nhdm hach N_2 cd dffdng kinh i 1,3cm thay vi hach > 1 cm se giy i m h'nh gia 2 1 % . CT con l i phffdng tien hifu hi?u thed doi v i danh gla dl cin hoic tal phat sau mo. Toi cd 79 benh nhan xac dlnh dffdc nhom hach N2 (96%) frffdc mS so vdl MRI (2V24) va PET (16/16) trong nghlSn cffu. Tuy nhlSn, khac nhau giiis ba phffdng phap xac dinh h|ch N2 bing CT, MRI hay PET khong cd i ngiiTa v5 m^t thong ke (T test,P =0,52, 0,46 va 0,67) MRI y i PET l i nhiihg phuBng tien chan doan hmh anh hiHng d a d i t b'en v i khi da dffdc chup CT, doi hdi mot phffdng B$n chan ddan hinh i i i h thff hal nhff MRI hoic PET gay ton kem th6m cho ngudi bSnh i i dieu can nhac.

_ - Chin doan md hoc c i n danh g i i trffde mo.

Xac djnh hach dl c i n , dl can xa kem tong frang b?nh njian ran p h i i khao sat theo nhieu nghien cuff. Lay mo fri/c tiep tff ton thffdng phoi tudng doi de ding neu nhin ro qua noi soi phe quin, thudng d frung tam. Nhffng ton thutjng phoi nam ngoal vl hoic giOs phSi, sinh thiet xuyen ngfft bSng kim d u « CT hffu hieu hdn. Tdi xac d|nh mo hoin t o i n cho 82 trffdng hiJp bing ca hal phffdng phap sinh thiet qua noi sol phe quan ho^c chqc sinh thiet phoi xuyen ngffc sau khi xac dinh v| fri ton diuung. Antonio'^' 2013 cd 123 ca UTP so sanh sinh thiel dudi CT (87,6%) hieu q u i hdn sd vdi noi soi phe quin sinh t h i a (72,7%).

Tuy nhen khi sinh thiet qua noi soi dutSi hutSng dan cua dau dd sieu am frong Idng phe quan EBUS (Endobnxhiai Utaasound) dd chinh x i e t i H ky thuat den 97,5% frong xac i j n h LITP. Tai Viet Nam, theo toi, ky thuat n i y frong hi'dng iai se dffdc ap dung xac chan ban chal ton thffdng phoi mot each rat hieu qua.

3. Kha nang phau t h u a t - N^o nhom hach_N2 va ban luan l i e l qua sau mo:

^ Cat thiiy phoi kinh dien dffdc nhieu tac g i i eo vu frong dieu tn UTP den l a n n a y " ™ . Vai fro hach N l , N2 de cap nhieu frong nhffng nim gan day frong xae djnh giai doan UT?. Xac dinh T (himor: khoi u), M (metatase: di can) v i N (nodule: not di can), xet k h i nang phlu thuat Xep giai doan fren benh nhan bi UTP con i n h hUdng^den phac do dieu fri. Phau thuat cat phoi gom eat 1 ttiiiy, 2 ttiuy hoae toan bd phoi kem n?o vet hach dffdc xem la phau fri theo quy rach. Cat 2 thuy phoi hay fren 2 thCiy l i mot chi d|nh cd b i n khi u da xam lam v i o thuy ke cin h?di di can vao cuong phSi hoae dpng macli phdi. Woodart GA ghi nhin tff vong sau 5 nim cua UT? giai doan IU co u xam lin ranh lien thuy 27%. Khi dl can hach N2- frung that hen hcSc frung that dffdi 32% va neu xam lan triit hep ran phoi ngay cho chia eua t h i n ehung dong maeh, Bnh mach v i phe quan goc ph3l 58%

Sartypy, frong^ 137 benh nhan hoi effu dffdc phan nhom ngau nhien cat ttiiiy v i cSt 1 phoi cd vet hach N2: khong cd sff khac biet ve ca ti le tff vong sau phau thuat cung nhff chat lffdng cuoe song frong 6 tuan dau tien sau mo (17% 8i 32%

''.' °i'^^- TdVjihien t i c g i i neu sff khic bl6t Idii ve thdl gian mo rijt ngin dffl vdl piiiu thuat vien CO kinh nghiem [HR ( 9 5 % a ) 1,63 (0,92;2,9) va 4,16(1,92;9,05)] frong nao hach nhdm N2 d benh nhan giai ddan IIIAvdi thdi glan mo rut ngan > 45 phut. Cic nghien cffu gan day ghi nhan ye ti ie c i t 1 hay 2 thiiy hoae cat mot phoi CO chffc nang ho hap kem FEVl < 40% cd ti le tff vong nhff nhaul". Adam Laekeyi", H I? nani Iffu hdi sffc sau mo hoic thd may sau hau phlu

>3 ngay tff 6 - 8% nguyen nhan thffdng do chiy mau mom^eit phe q u i n , tff eic nhanh m i u nuoi hach. Nhiem frung hoac viem phoi sau mS, tlnh bang kem dap ftig vdi eic ttiuoc dan phe quin hoac benh phoi cd s i n l i m eho benh nhan phai Iffu va ttieo doi mgt ttidi gian tai phong hoi sffc.

rrong nghien cuti cua minh Adam Lackey cung neu vai bo cua benh nen nhff nhoi mau cd tim

1

VIETNAM MEmCAL JOURNAL N l - DECeWBER • 2016

OI h ^ c bjnh phdi tae righen nang chang han, til vong cua toi rao hdn cd le dobenh nghien oto lam tang ttldl gian lull hoi Sffc gap 3 Bn so vdi rad tuol cd benh ly noi khoa.

nhom khong CO b ^ h n e n ^ Park 6 ] ^ ttieo doi - Diem tian che a j a Park v i toi l i dm nao 325 ra rat phoi dUdl ho b d ro bot co 12 frffdng vet hach N2, dac biet nhdm h ^ 5 (eiia sS phe"

hdp ehay niau hoac nhiem tning sau mo (3,7%), chu). Thong thu«(ngcac t i c g i i cung thua nhSn 5 hf vong lien quan den ehay mau va viem phoi khi nang phlu thuat noi sol lay nhdm hach 5 ra't M phau, 43% ca ttiudc giai doan n i ( a =16- khd khan vi chiy mau. T61 ed 14 fruftng hdp 69) dffdc nao hach tnet de. Theo t i c gla, ti le frj' ' - • - = - - - . : • ^ "y^

vong ed_^ve nhu thap hdn so vdi phlu thuat cat thuy phoi hay cat toan bo phoi bdi phffdng phap ttiong thudng mo hd hoae noi soi.

y Tdi cd 9 ra cat 2 thuy (thiiy tren va giija phoi phii hoac giiia v i dffdi phoi phii), v i 2 ra cat 1 phoi tiai vi u xam lan ranh lien thuy va v i o ron phoi, mac du kieh thffdc cua u: 4,2-5,3em.

- - . hdp khong lay dffdc hdin toan nhdm hach 5 (nim trong nhdm 17 frffdng hdp mo nqi sol). So vdi Park 3 1 % , v i cac tac g i i , ed le do nhffhg benh nhin eua toi ed t i le mo md nhieu (79%) so vdi mo npl soi - do chua cd nhieu kinh nghiim vi thu thuat rat kho khan. Ngffdc Ial ca toi v i Parte, ghi nhan ti le vet nhdm hach 7 gan nhff tudng dffdng (76% v i 78%). Ve ti le an toan sau mS, S ' ^ ^ ^"- ™u'? T " ' ^ . ^''" ""9 " 65 trffdng hdp phlu thuat khong blen ehutio Baltayannisra^ve xuat dp md_ hpc va phffdng frffdng hdp phai mS Ial dd chiy mau vet mS vS phap mo: bieu mo tuyen chiem da so thffdng 4/82 trffdng hdp nhBl m i u ed tim tit vonq sau nam ngoai vi phoi cd the rat ttiuy, ung thff loai hau phlu tronq tSng sq 84 b«nh nhin cic gai ttiudng nim frung tam ddi khi phii cat 1 ben trffdng hdp nhllm friing vet m3 sau khi dSu tri phoL Khi so sanh vdl Park", ti le blen chuhg v i noi khoa dan on dinh « " m oieu tr|

Bing g: dinh ali iai aiai do^n - Ha b i c giai d o a n :

Trffdlc mo Sau mo

dinh S u Sii nhSii Z s t °, nhff l a trinh biy toi dffa vao ket qua eha-|i doan hinh inh i i na M rf» „ i l ^ ^ i ? ^ • ' ^ u ' 2 " * P*"' •''^" '•'""^ " ^ ^ " S hdp t i n g glal doan, dieu niy eho thiy g i n r d l ^ m n " r d i e t t ^ i l S u * : ^ "" "" * ° " = =^ ' " " ' " " ' '''^^ ' ^ ^ " ' ' * ' " ^ ^ ^ = ' ^ » '^^

- e i n h g i i k§t oua phau t h u i t sau 2 n i m t h e o do!

• n , „ Mil. , , ? ' ? " * " • % ' ' ° * n ttldi gian song them bing Uiuit frjan Kaplan meler Theo Nltolaos Bateyannls"l ttidi glan song dffdc phSu ttiujt'hd|c <40% ne™S phlu ttiuSL S r „ l S ^ A ° I I",? ™ . ^ ^ " ' ^ " ^ I^Sng te Woodard GA b i d c S ti i J S t ftffy phSl kim ^ too nho d gla ton 1 la 60 - 82,1% sau 5 nSm. hach keo d i l thdl gian S n g ttiim 2 9 ttii™^

Oglaidoan 2 la 50 - 66,4%. O glal doan 3, thdl vdl khong n?o hach v i t i l ? d r S n J sau m S l l gian song 6/ 2 - 5 nam chi tff 23% neu khdng 4% sau 2,5 n i m ttieo d S . v a w S l s S * '

«

YHOC VICT NAM T i p 449-THANG 1 2 - S f i l - M ^

* e m sau 2 n i m l i 14,3 hian ± 6,5 tuan, ti le dl f^v? ^J°,'!^ ^ 5 ^ ' •*' nhin tfiay khdng cd sff khae biet dang ke.

V. K f r LUAN

., « * ! .'?i?¥" " ? " ' ^" " ^ l*5ng te b i o nhd dffdc phat hipn va chan d o i n , neu cdn ehi dlnh, phau ttiu?t rat ttiuy phSl la phu'dng phap d g u fri an toan va hieu q u i ngay ca khi phat hien ddde hach N2.

• i . ' ^ l ^ ^ ^ ' * " > ' hay hdn 1 ttiuy khong anh hffdng den h le tff vong sau mo, phau thuat md uli Oie nao vet hach triet de hdn so vdi ndi SOI khi nao vet cac nhom hach N2, d i e blit nhom hach cua so phe chu

Danh gla lai nhom hach N2 sau khi phlu thu?t eho phip ha bac gial doan, giiip tten lieu thdl gian song eon eung nhff chien Iffdc dieu tri M l nhan hieu qua. Thdl glan song ttiem sau 2

« ^ i a M,3 tuan ± 6,5 tuan, gan tffdng t u nhff ac gla nffdc ngoii.

T A I L l f u THAM K H A O

'• ?30i"5i-^.'^°'i ' ' ^ " ^ *• Donlgton (2013). Surgical management of lung cancer"

Semin Intervent Radiol Jun 30(2): 133-140

? r ! ? ™ g < ! " ) -Dagnostte value of endobronchial and endoscopic ulhasound guided

kSr^T^ ^ i ' ^ " * " ' ' " '? ' ^ ^ ^ '""9 ^ '

S S T L non-diagnostk conventional ghiques. a pmspecBve study BMC cancer, I. Bui Chi Viel, Le van Ci/dng, Nguyin ChSn Hung(2010), "Khao sat nhoSg dfc S m ISm T npc Tp.HCM tap 14, phu ban 4: 386-396 S S ^ L S ' J ° " ! }™ '•"»"' " " s e n . Rune Haavenaad et al (2009). "Predictor of long bme survival after lung cancer surae™- A

^ ^ s w j v e cohort study. BMC Pu?m\ed

• I ? i ! ^ " " « " " " " J ™ " " ' * "'^1' Chadrinos, Konstanbnos Zarogoulidis et al f20131 Lung tanter surgery: an up to date". Joumal of dioraac disease sep 5(suppl 4): 425-439 Nilendu c Puiandare and Venkatesh r ^ l ? ! ? ' ' " < ^ ' ' " ) ' ••"'S9'"9 " f lung Snrer-

mplcabons on staging and managemnenr fhe 1^-120 '^"^°^ *• '"^'"^ 25(2)!

- ' ? 1 1 „ ^ ' u " ^ " ' ''' " " " i * e» al (2012), ffSSr^' ' ^ ' ' ™ oncologic results. J Thorac cardiovasc Suig 143(2):383-389

ANH Hudm COA UNG THU- VOM MUI HONG OEN CHITC NANG NGHE

TISMTAT

Rrrtil™ "S: *^ 7 ? h ™ , • Nasopharyngeal Ss M u c ^ ' a ? ' , ' ' f " l ' ^ . ^ ^ * " " S t t i u v i i n g dau S S ' ^^ .2- * ? " """"^ "^n chffc n5ng nghe v i NO H S ' t f i l J ? ' * ' „ " > ? " '^»"3 ™ phuong pha™

BC Mo a klat ca, Ben cffu. Gom 374 tai trln 187 t«ih nhSn d«jc diSu ttt t,l khoa Xa I B^nh vien K tff Mng 5 n|m 2006 den ttiang 7 nSm 2007. K « qua m B«Il ! L ^ 2 " i l l ^ ' '! "=' P ' ' ^ * ' "^ "9he kem («,e%), y j m tal diSy mu 3(0,8%). Mang nhi due

£ s " ' ' \ ^ " * " • ' * • "^ " i * ' tti CO keo 1,6%;

NghiSm phip Valsalva M chiSn 48,6%, (±) 18,6%, 'Bfnh Min TalMIIItlqng TW

Ch|u bich n h l ^ chinh: VO Tnidng Phong Email: holtmh.hanol@yahoo.com NgSy nhjn bii: 14.9.16 NgSy phin b i ^ khoa hgc: 18.11.2016 Ngiy duylt bii: 25.11.2016

v a T r u f f n g P h o n g * tJ2. ? ' ? ' 5 ' , " ? ! - • " ' "hip Toynbee cho k j l qui duong dnh (+) diiSm 26%, (±) 25,7% v i M IS n h k m * - , r * r ^ . ' ^ ° * ' ' 5 2° - ^0 ^B chle-m 4 . ^ nhom 31 - 40 dB la 16,6%. Nhdm 41 - 50 dB l i S 55 m ' l " 5 ? ,"'-'* ' • ' * ' "^^ "She tot < 20 dB

« m 35,3%^ Ket luan: Ung thu vom miil hong anh niTJ™?!," ^ " • ^ " S ' 5 • ; * = " " i n s din fruyen thong qua ton thuong bit tic vol nhT

kem d f n S i $ ; i " " ' " • " " " " ' " " ' ' ' ' ™ '*'^' ' ^ SUMMARY

THE EFFECT OF NASOPHARYNGEAL CARCINOMA ON HEARING Nasopharyngeal Cardnoma-NPC Is rare in

SSr" TS^ ^'^ ""^ "^ "' '^^"

toT^'/,^l? °* "'"™n '^'^ =™"g the

I S J ^ „ . " * '^"^ '" ^=<n™' ObjecBves- i i ^ « S ^ T ^ S " ' ="" ^3"= that are related to of rp^- o f ^ r " " * ' " ^ ' ^ ' ^ ^ l " * * = influence or NPC on heanng and venblating fiinction of