DANH GlA HIEU QUA HUY MO TUYEN GIAP BANG 1-131

Y H p c V I | T NAM T H A N G 9 - S 6 1/2012

DANH GlA HIEU QUA HUY MO TUYEN GIAP BANG 1-131 MH B|NH NHAN UNG THlTTUYgN GlAP TH^ BIET HAA SAU PHAU THUAT

TdM

TAT

M^c ti@u: Oanh gii hi0u qua huy mS tuyih giap tfSng 1-131 sau phau diu$t trin t>^h nhin (BN) ung etW tuySi giap (UTTSJ thS' bi^t hda. Ofil t u ^ n g nghlfin c i h i : 520 BN UTTG thg bl§t h6a du^c digu trj lieu hi!iy mo tuyen giap c^n 1^1 sau mo bSng 1-1311?!

TT Y hQC hat nhSn vd Ung budu BV B?ch Mai dude chia i^m 3 nhom: vdi ll@u 30 mQ, 50 mCI,100 mO.

K€t qud: 1. Cdc x ^ nghiem v^l biygn glSp b-udc diSu W 1-131: M6 giap c6n M sau md: 3,43 ± 2,26g. 0$

t?p frung M 3 1 tei vCing c6: 5,71 ± 4,81%. NBng d$

Thyroglobulin: 146,37±71,930 ng/ml. Nong dO TSH ciia tat cd cac benh nhan c^ 3 nh6m trung binh: 56,44

± 21,56 iiU/ml.2. Ket qua huy m6 tuyen gidp c6n lai sau phau thuat sau 6 thang dieu trj 1-131: Ty 1^ b^nh nhSn huy dUVc mo tuyen gi^p hoan toan sau 6 thing diSu b i 1-131: Lieu 30 mO: 33,3%. Ueu 50 mO:

60,1%. USu 100 mQ: 79,2%. Benh nhan khong buy d u ^ hoan toan sau dieu trj 6 thcing nhung cac chi so the tich mo giap, dp tap tiung 1-131, nong dp Tg d€u giam so vdi tmdc dieu tn. Ket lu^n: Oi@u trj UTTG the biet hoa bSng 1-131 la phuong phap dieu bi hieu qua va an to^n.

SUMMARY

Outcomes of the ablation of residual thyroid for the differentiated carcinoma patients after t o t a l

thyroidetomy by radioiodine.

(^jedjye: Assessing the outcomes of the ablation of residual thyroid for the differentiated tiiyroid carcinoma patients after total thyroidectomy.

Methods: 520 differenbated thyroid carcinoma patients after total thyroidectomy are administrated radioiodine with different doses of 30ma, 50ma and lOOmO at the Nudear Medicine and Oncology Center of Bach Mai Hospital.

Result: Before radioiodine adminisb^tion tiie remnant thyroid tissues are 3,43 ± 2,26g; 1-131 ttiyrald uptalces are 5,71±4,81%, semm Uiyroglobulin (Tg) concentrations are 146,37 ± 71,930 mg/ml, semm TSH concenb^tion are 56,44 ± 21,56 aUI/ml.

After 6 months of radioiodine therapy, the rate of total ablation with the dose of 30mQ is 33,3%, with ttie dose of SOmQ is 60,1% and wttii the dose of lOOmO is 79,2%. In the patients wiOi partial ablation, the volumes of remnant thyroid tissues, the 1-131 thyroid uptakes as well as semm thyroglobulin concentrations are reduced in comparison with the ones before radioiodine administration

In coTKiuson: Radioiodine therapy is ttie most

Mai T r 9 n g Khoa''^

effective and safe modality for the differentiated thyroid carcinoma.

I.

OAT VAN

o i

Ung thu" tuyen giap (UTTG) chiem khoang 1 % cac loai ung thU. Nu' gidi mSc cao hdn nam gidi t i f 2 den 3 Ian. 6 Vi^t Nam theo so lieu thong ke ung thu* d Ha Noi, ty le mSc UTTG la 1,9/100000 dan, ty le mSc benh d nu' cao hdn nam 2,6 ISn. T?i Thanh pho Ho Chi Minh ty le mSc benh d nu' la 2,8/100000 va d nam la 1,5/lodoOO dan.

Doi vdi UTTG the biet hoa phac do phoi hdp: phau thuat, 1-131, hormon lieu phap dern lai ket qua tot nen du'dc ap dung kha pho bien. O Viet Nam, theo khuyen cao cua IAEA tir 1998, su"

dyng 1-131 de dieu tri UTTG the biet hoa da du'dc tien hanh tai mot so cd sd Y hoc hat nhan trong thdi gian qua. Cho den nay da co nhieu cd sd ap dung dieu trj nhu* Trung tarn Y hoc hat nhan va Ung bu'du- BV Bach l^ai, BV 108, benh vien 103, benh vien Trung u'dng Hue, benh vien Chd Ray, benh vien da khoa Da nang,...

Sau ktii phau thuat cat bo tuyen giap toan phan 4-6 tuan, dieu trj tiep tuc bang 1-131 de buy not mo tuyen giap con lai, di6t cac 6 ung thu' nho va diet cac te bao ung thU di can se han che tai phat va di can. Lieu bao nhieu la thich hdp VLTa du de huy mo giap cdn lai, it gay bien chifng phu, tiet kiem du'dc chi phf khong ran thiet cho benh nhan, tnang khi neu dung lieu qua thap tJii hieu qua huy mo giap lai khong cao. Van de nay con chuS CO y kien thong nhat.Cac cd sd litig dung lieu dieu t n chu yeu theo kinh nghiem la chinh. Chu^ co cong trinh nao danh gia mot each day du hieu qua huy mo giap cua cac l i i u 1-131 khacnhau. Xuat phat tijr thu'c te nSu tren, chung toi tien hanh dS tai nham muc di'ch;

Danh gii hieu qua huy mo Wyen giap bang 1-131 tren b^nh nhan ung thiftuyin giap the biet hoa sau phau thuat

II. D d i Tl/ONG VA PHUONG P H A P N G H I I N C O U 2 . 1 . S o l t i r i n g n g h i e n c i h i : 520 benh

* Tmng tarn Y hgc h?t nhan va Ung tKiiki-BV Bach flai Phan bl^ khoa hpc: PGS.TS. TrIn Xuan Tririfng

Y HQC Vi$T NAM T H A N Q 9 • S61/2012 nhan (BN) dU^c clian doiin \i ung thiT tuy^n gi^p

( i n T G ) the bi?t hda da 6\S!jc diSu tri lieu hijy md tuyen giap con 1^1 sau mo bSng 1-131 tgl TT Y h9c h^t nhan v^ Ung bu'du BV B^ch Mai.

a, Tliu chuSn l^fa chqn b$nh nhin:

- Chan doan xic d|nh \h UTTG thS bi|t hoi bSng md b^nh hpc.

- Oa phSu thu$t cSt b i tuySn giip toJn phSn va nao vdt hach c6 ngu cd.

- l i m sing 6 tinh tr^ng nhUdc giip, vdi TSH

>30 |iU/ml.

- Khong dung cic thu5c, ch€ pham cd iod, homion tuy§n giip tnASfc dieu trj 1-131.

b. TtSu chuin lofl triti B$nh nhan la phu nu' cd thai, phg n[^ dang cho con bij.

2.2. Phu'dng p h i p nghlSn cu'u; nghiSn cutj md t i hoi cihj v i tien cu^.

a. B$nh nhSn UTTG thii bl$t hda dWfc chia lAm 3 nhdm;

- Nhdm dung lieu 30 mO 1-131: gom 111 BN.

- Nhdm dung lieu 50 mCl 1-131: 198 BN.

- Nhdm dung lieu 100 mO 1-131: 211 BN.

+ Thuoc phdng xa: Ihuoc phdng xa 1-131:

Dang natriiodua (Nal) dung djch hoic vien nang dang uong do Trung tarn sin xuat ddng v| phdng

x^, Vi^n nghlSn cihi h^t nhin O i i^t sin xuat.

b. Cic bU6c tlSn hinh:Sau khi nh$n mu 1-131 huy m6 glip vOI cic mOc lOu khic nhau. B$nh nh&n dif^ dinh gii mCtc a( huy md glip btng cic chi tliu:

- Do dd t | p trung 1-131 t^l vung cd va xa hlnh toin thin: ilSu 1 - 2 mCi 1-131 sau 48 gid.

- D|nh luijng thyroglobulin (Tg) tru'dc dieu tr| v i sau 6 thing dISu tr| 1-131

- SiSu am tuygn glip d£ xic dinh lu'dng mo glip cAn lai

- Ofnh lu'(?ng nong dp cic hormone tuyen glip va TSH

c. Thiilblghiao:

+ Miy do iHu phdng x? (Caiiibrator Dose):

Caplntec-Hoa ky.

+ Miy do dd t i p trung 1-131 tuyen glip.

+ Miy SPECT Btogiaph 6 aJa tang Siemens-Sut + He thong may do dinh \\i()nq phdng xa mien djch' OAK-nELS -UK (Anh).

+ Miy sieu i m ALOKA - Nhat 2 . 3 . XuT iy sff li$u: So lieu nghien ohi duVc xu* iy thdng i<e theo chUdng binh phan mem EXCEL v i EPI-INFO 6.0.

III. KET Q u A NGHIEN CCfU

3 . 1 . D^c d i e m cua b^nh nhan UTTG t h € bl$t hda trong nghien cuTu

3.1.1. Tuoi vi gidi cda b^nh nhan

Tong sd 520 benh nhan ung thu bleu md the bidt hoa du'dc nghien diti gom 119 (22%) b^h nhan nam vdi tuoi trung binh i i 41,2 ± 15,7 va 401 (78%) benh nhan nif vdi hidi trung binh la 40,1

± 13,6. Ty id benh nhin nam/nff : l / 5 .

3.1.2. The mo b$nh hfc

Bing 1. The md benh hoc bdnh nhan nghldn cull

Nhu

ThSmd bdnh hoc Nang

Hon hop nhij - nang

431

TflSfM

82,9

9.2

Tong sS I 520 I 100 , Nh$n xit: UTTG the nhij chiem da sd (82,9%), th£ nang 7,9%, the hon h(;(p nhu - nang 9,2%.

3 . 2 . C i c x i t nghiem v S t u y g n g l i p tru'dc d(eu t r i hiiy m d g l i p b i n g 1 - 1 3 1

3,21. Khol lupngmdtuyihglip cdn I9I sau mSvi Of t$ptivng 1-131 viigeSb$nhiUiSn.

Tren cic benh nhan nghien cuU, 100% o6n td diiit glip quan sat thay tren x? hlnh vdi 1-131 (xa hinh +).

Bing 2. Khdi iUJng md tuyen giap con lai sau md v i dd tap trung 1-131 tai TG Nhdm b$nh nhSn

Nhom uong 30 mCi Nhom uong 50 mCi Nhom uong 100 mCi

Chung

n 111 198 211 520

Khfil lir«ng TG cftn lai (g) 3,42 ± 2,01 3,47 ±2,56 3,40 ± 2.11 3,43 ±2,26

Bd t i p tnina 1-131 (%) 5,70 ± 4.61 5,22 ±4.11 6,39 ± 5.69 5,71 ±4.81 Nh$n xit! LuBng md glip con lai sau md (xic djnh bing sieu 3m) trung binh la 3,43 ± 2,26g.

Cd benh nhan md giip con i^i tdi 12g, tren xa hinh quan s i t thay gan nhu' nguydn c i mot thuy tuydn

Y Hpc VI$T NAM T H A N B 9 - s 6 1/2012

giip. Vi md giip con iai nhieu nen BTT1-131 vOng cd cung con cao. Trtrdc diSu tri huy md giip, dd t$p trung 1-131 6 cac benh nhan cdn tit 1 % den 16%, trung binh i i 5,71 ± 4 , 8 1 % .

3.2.2 MSog afrgvi TSH aia b$nh nhin

J 3: NBng dd TSH va To huyet thanh cua benh nhan tru'dc dieu trj hu'/ md giap

Nhdm hinh nhin

TSH(uU/mn Tg (ng/ml)

Nhdm nhin 30 mCi 56,72 ± 17.60 153,40 ± 77,20

Nhdm nhin 50 mg 52,70 ± 19,60 122,30 ± 81,40

Nhdm nhin 100 mO 59,90 ± 27,50 163,40 ± 57,20

Chung 56,44 ± 21,56 146,37±71,930

Nh$nxit! Nong do Thyroglobulin huydt thanh cua bSnh nhan nghldn cu'u tru'dc khi uong lieu !•

131 huy md giip trung binh i i 146,37171,930 ng/ml. SU khic bidt ve nong do Tg d cic nhdm udng 100 m a , 50 mCl v i 30mCi khdng cd y nghta thdng kS (p > 0,05). TSH cua t i t c i cic benh nhan c i 3 nhdm truiSc dieu W 1-131 ddu dat mCfc tren 30 mU/i.

3.3. Ket qua huy md tuyen giip \Ang 1-131 sau 6 thing dieu tri Ai/i04.'Ketqua huy md giap sau 6 thing dieu tri 1-131

Liiu M 3 1 30 mO 50 mO 100 mO

n 111 198 211

Huy mo giip hoin t o i n 37 119 167

33,3%

60,1%

79,2%

X? hinh ( + ) va/ho$c Tg

>13 ng/ml 74 79 44

66.4%

39,9%

22,8%

P

<0,05 Nh$n x4t: Hieu qua huy hoan toan mo tuyen giap con lai sau mo dat 33,3% vdi lieu 30 mCi, 6 0 , 1 % vdi lieu 50 mCi va 7 9 , 2 % vdi lieu 100 mCi. Nhin chung liieu qua huy hoan toan mo tuyen giap con lai sau mo ty le thuan vdi lieu 1-131, lieu 1-131 cang rao, hieu qua cang cao. Hieu qua hu^ hoan toan mo tuyen giap ax\ lai sau mo vdi cac mu'c lieu khac nhau co su* khac biet co y nghTa thong ke.

Bang 5: fJo tap trung 1-131, va khoi lu'dng mo giap con lai tru'dc dieu trj 1-131 cua nhdm huy md gl^p hoan to^n va nhdm chu^ huy het mo giap

Nhom BN huy hoan toan mo giap (n =323)

Nhom BN chu^ hu^ het mo giap (n = 1971 Khoi luUng mo giap con sau

phau thuat (g)

2,86 ± 2,04

BTT 1-131 vCing co f%) 4,52 ± 4,13 7,47 ± 5.61 < 0,05

Nli$n x4h O cac benh nhan co mo giap chu^a huy het, khoi lu'dng mo giap con lai sau phau tJiuat trung binh la 4,79 ± 2,34g, Idn hdn rat nhieu so vdi nhom huy het mo giap hoan toan ia 2,86±2^04g (p<0,01). Do tap trung 1-131 cua cac benh nhan chuS huy het mo giap cung cao hdn:

7,47± 5 , 6 1 % , trong khi d nlidm huy het mo giap hoan toan la 4,52 ± 4,13%. I^lo giap con lai nhieu da anh huidng tdi thanh cong cua dieu trj, OTT1-131 tai viing co din cao la yeu to anh hu'dng den ket qua dieu tn.

Bang 6: Ket qua OTT1-131, khoi lu'dng mo giap cdn l^i va nong dp Tg tru'dc va sau dieu trj 6 thang cua cac bgnh nhan chua huy het mo giap.

Mo gi6p c6n lai (g)

Bo tgp trung 1-131 (%)

Tg (ng/ml) Trutfc dieu tri I-

,i ^ 131

Sau dieu trj 6 thang

Tru'dc dieu trj I- 131

Sau tJiSu tri 6 theing

Tru'dc dieu tri 1-131

Sau dieu tri 6 thang

4.79 ± 2 , 3 4 2,00 ± 0.80 156,9 ±132,8 I 73,7 ±48,2

P < 0.01 P < 0,01

~.. Nhinxi^ Ket qua cho thay mcic dilr chu^ huy du'dc hoan toan mo giap con lai sau mo, song sau b i u trj i-131 Ian 1 tat ca cac chi so khoi lu'dng mo giap, do tap trung 1-131 va nong do Tg cua cac b?nh nhan nay deu giam m6t each co y nghTa so vdi tru'dc dieu trj vdi p < 0,01. Cac benh nhan deu CO dap ijtig vdi dieu tri, mo giap da du'dc huy m6t phan kha Idn. Trung binh khoi lu'dng mo giap con lai 41,7% so vdi tru'dc" dieu tri, DTT M 3 1 tai vung co giam con 1/4 so vdi tru'dc dieu trj va Tg cung giam con 5 0 % so vdi tru'dc dieu trj. Cac benh nhan nay ran phai dieu trj tiep Ian thu" hai.

Y HQC VI$T NAM T H A N O 9 • 8 6 1/2012 IV. B A N lUi^N

4 . 1 . V£ a$c dl£ni Chung cua b f n h n h i n UTTGBH atiu tr| b i n g 1 - 1 3 1

« TUil vi giai aia binh nhin

Trong tdng sd 520 b^nh nhin UTTG thd bl$t hoi du'dc nghlSn ciju cd 119 (22%) bdnh nhin nam vdi tudi trung binh I i 41,29 ± 15,73 v i 401 (78%) bdnh nhin niJ vdi tudI trung binh I i 40,05

± 13,65. TV id bdnh nhin nam/nu' : l / 5 . Sd bdnh nhin nQ' nhiSu hdn sd bdnh nhin nam 5 ian. Kdt q u i niy ciia chung tdi tUdng duUng s6 lldu mdt sd cdng trinh khic da cdng bd [2], [5]. Simon (1996) tdng kdt 2376 bdnh nhin UTTG the bidt h o i d Su'c t h i y nff chiem 77,7%, rin nam chidm 22,3%. LuS tuSi mSc bdnh chii ydu tCr 18 den 45 (60,8%). Oiy cdn I i Via tudi iao ddng, do dd vide dISu tr| kdo d i i thdi gian sdng them cho bdnh nhin rSt cd y nghTa. Cic t i c g i i khic cung cdng bd bdnh nhan m i c bdnh d dp tudi tudng t i / [3]. Robert (2004) dieu tri cho 184 benh nhan thIy dd tudi trung binh ii 42,1±14,2.

Theo Ijevent (2004) bdnh nhan i m ' G cd tudi bung binh cao hdn Ii 53,0 ± 16,6 (tir 22 den 78 tudi).

* ThS mS binh hpc vi phin lofl giai to^n binh

Tu'dng t y ket q u i cua nhieu t i c g i i da cdng bd, trong nhdm nghien cuU cija chiing tdi UTBMTG die nhu chlem da sd (82,9%). Tlie nang v i the hon hdp chiem 1 7 , 1 % . Pedro dieu bi cho 274 benh nhan t n T G gSp 174 the nhii (69,3%), the nang 77 (30,7%). Simon (1996) g i p 66,4% the nhu, 2 7 , 2 % the nang. Mai Trpng Khoa, Phan Sy An v i cs [2] d bdnh vien Bach Mai cung g i p 7 6 % thd nhu v i 2 4 % the nang.

4 . 2 . Kdt q u i m $ t sS x i t n g h i f nn tru'dc didu tr| 1 - 1 3 1 .

4.21. KhSI lu^ng mi glip cdn 1^1 vi 0^

tip trung 1-131 tru'dc khi OSu trf 1-131.

Mot trong nhifng muc tidu cua d i t i l i i dinh gia hidu q u i huy md giap cdn iai sau phau thuat d bdnh nhin LTTTG the bidt h o i bing 1-131 lieu 30 mCi, 50 mCi v i 100 mCi cho ndn ddi tuting nghien culj chdng tdi chpn nhutig b^nh nhin trdn x^ hlnh c&n quan s i t thay td chChc tuyen giip (duUng tinh). Khoi iu^ng tuydn giip con iai sau md d 520 BN dieu tri huy md giap i i 3,43 ± 2,26. Tai Trung tam Y hpc hat nhan va Ung bu'du, BV B^ich Mai thay cd tdil 9 1 % con md giip cdn 1^1 sau phSu thu$t [2]. Phan V i n D i n v i cs (2004) cdng bd ty Id md glip cdn sau phau thuat i i 8 5 % . Ba sd cic t i c gia ddu khing dinh

vai trd quan trpng cda phSu thu$t c i t toin phan tuydn giip ddi vdi b^nh nhin I H T G nhSm loai b6 td bio ung tha vl UTTG thu«(ng i i nhieu 8, ddng thdi cho phip l i m x? hlnh t o i n thin bing 1-131 tim cic d di c i n , t^o diSu kidn thu|n Idl chd dieu tr| hU'/ md giip bSng 1-131 thinh cdng. Tuy nhldn, cic t i c g i i cDng thua nhin vide ph3u thu$t tridt dd, idy du'dc hdt md giap la khdng dl ding, mdt ph3u thu$t vidn cd kinh nghldm ciing chi d?t thinh cdng khdng q u i 8 0 % [3],[5],[6].

€>d tdp trung 1-131 t^i viing TG tV Id tlni|n vdi khdi lu'dng md tuydn glip cdn 1^1 sau md. Oo tdp trung 1-131 trung binh cua nhdm benh nhan dliu trj huy md giip i i 5,71 ± 4,8

4.2.2 Ntng ai TSH vi ThyrogMMi (Tg)trMeilfiu tr/1-131 iiSuhu^rndgUp

Trong cic bdnh nhin ciia chiing tdi liSog dp Tg huydt thanh ciia bdnh nhan tn/dc khi udng lieu 1-131 hu'/ md giip trung binh i i 146,371 71,93 ng/ml. Levent xic djnh ndng dp Tg tidn mdt nhdm bdnh nhan LfTTG sau phau thudt tir 20 ng/ml den 3000 ng/ml, trung binh I i 419,3 ng/ml. Sau didu trj 6 thing, Tg glim nhuiig khdng cd 9 ngWa so vdi trudc dieu tii M 3 1 . Tham ch( d mdt sd benh nhin Tg Hep tuc ting.

Trinh Minh Chiu (2002) khio s i t tren 268 binii nhin thay ddi vdi nhdm chua dl d n cd bung v|

cua Tg i i 12 ng/ml, con nhdm da cd di cin Tg cao hdn nhieu, trung vi la 520 ng/ml.

Ndng dp TSH d bdnh nhin UTTG ran duljc l i n g rao t n ^ c khi cho bdnh nhin udng lieu I- 131 de xa hinh t o i n t h i n cung nhir dd dieu trj.

TSH cd t i n g rao nhtf vay thi 1-131 mdi t i p tmng vio md ung thu dunjc [2]. RSt khd b i a miit 15 IAJ la bao nhldu, nhutig Peny (2004), Schiumberger (1997) va mpt so t i c g i i thi milt TSH > 30 /lU/ml du cho c i xa hinh toin thin va dieu trj d^t hidu q u i . Sau phau thuat c i t Hen phin TG, honnon TG (chu yeu I i T , ) van tiq) t(|c iiAi hinh v! dS dut;lc sin xuStva dVtrii'bong n ^ cho ndn phai qua mpt thdi gian TSH mdi Bng rao, vio khoing 4 « t u S n a S t h e d e i t t d l g l i t i ! t t 6 i 3 0 /iU/ml nhu ydu rau nghien aitj. Vdi ly do dd ma bdnh nhin UTTG sau phSu thudt 4-6 tlSn mdi USi hinh dIdu ttl huj' md glip bing I-131[4].

Nhdm b|nh nhin cda chiing tdi diidc dieu tr| sau phSu thu$t tir 33 ddn 68 ngiy. TSt d b|nh nhin d tinh tr?ng nhutte glip, TSH thap nhSt i i 30,1 /lU/ml, rao nhat 132,2 /lU/ml, gia ^ trung binh TSH i i 56,44 ±21,56 lUfrri. Pefl khio s i t 176 bdnh nhan sau phau thuat d t hcali

Y HQC VigT NAM T H A N G 9 - s61/2012

toan TG, thay 90% cd TSH tang qui nguSng 30

//U/mi sau 3 tuan.

4.3. Ket qua tfiidu trj huy mo tuyen glip cdn If! sau mo bing 1-131

Tidu chuan dinh gii hui' md giip hoan toan la khdng cdn quan sit thay tren xa hinh md giip viing cd bit 1-131 va ndng dd Tg huyet thanh glim thap dudi 13 ng/ml [1], [5]. Trong nhdm nghldn culj ciia chiing tdi, md giap cdn 1^1 sau phau thudt da duWc huy sgch d 60% bdnh nhan nhdm udng lieu 50 mCi v i 79,2% d nhdm udng lieu 100 mCi. Vdi lieu 30 mCi t^ id huy hoin toin md giip chi dat 33,3%. Mai Trpng Khoa, Phan Sy An, Tran Oinh Ha (2006) cdng bd ket qui huy md glip hoin toin dat 56,3% vdi lieu 50 mCl v i 79,4% vdi lieu 100 ma. Phan Vin Dan v i cs (2004) dieu W vdi lieu tir 30-100 mCi dat hidu qui huy md giip 75%. Marcus (2005) dieu trj cho 20 bpnh nhan iidu 100 mCi dat ty id hu^ md giap hoin toin i i 16/20 (80%). Nhiitig bdnh nhin cdn md TG ch\ia du'dc huy sach phii dieu bitldp.

Qua phan tich trdn Chung tdi thay, ddi vdi tnjdng hdp sau phlu thuat md giip cdn iai khi idn (>3g), vide diing iiSu liuy md giip 100 mCi la hdp iy. Vdi mdt sd tru'dng hdp cu the neu tuyen giip con iai ft chi cdn vet tren xa hinh, cd the can nhac vdi lieu 50 mCl. Rosario dieu trj cho 235 bdnh nhin UTTG the biet hoa sau phau thuat bing 1-131 va cho biet trong nhdm dieu tn thinh odng cd DTT trung binh I i 5,4%; trong khi do d nhdm cdn md giip sau dieu trj cd DTT I- 131 trung binh la 8,2% [7]. Vdi nhOtig benh nhin khdi ludng md giip cdn lai <3g, DTT 1-131 tai viing cd duds 2% neu Ian dieu trj dau nhieu tic gia cho rang cd the diing lieu 50 mCi la dii.

Nhutig vdi lieu dieu tri lip iai, do cd hidu lihg

"trd", "nhdn thuoc" ndn lieu dieu W lai van phai 100 ma, tham chi mdt so tic gii nude ngoai cdn diing tdi lieu 150 mCi [5].

V. KiT LUlBiN

Nghldn ciiu 520 BN LTITG the biet hda sau phau thuit du'dc dieu trj bing M 3 1 tai TT Y hpc hat nhan v i Ung bu'du BV Bach Mai chung tdi rilt ra,cic kdt luan sau day:

5.1. Oac diem cua bdnh nhan trong nghien cihi

520 benh nhin gom cd 119 (22%) nam, tudi trung binh I i 41,29 ± 15,73 v i 401 (78%)

nQ', tudi trung binh I i 40,05 ± 13,65. Ty id benh nhan nam/nCi :l/5.

- BN UTTG thd nhu: 82,9%), the nang:

7,9%, the hdn hdp nhii - nang: 9,2%.

5.2. Cic x i t nghidm v& tuydn giap tru'dc dieu trj 1-131

- Khoi iupng mo tuyen glip cdn 1^1 sau m6 vi di tip trung 1-131 vitng c6 binh nhin. + Md giip eon iai sau md: 3,43 ± 2,26g.

+ Dd tap trung 1-131 tai viing cd: 5,71 ± 4,81%.

- NSng di thyroglobulin (Tg) vi TSH d binh nhin

+ Ndng ddThyTogk)bulln:146,37±71,930 ng/ml.

+ Ndng dd TSH ciia tat ci cic bdnh nhan ci 3 nhdm trung binh: 56,44 ± 21,56 ^U/ml

5.3. Kdt qua huy md tuydn glip con 1^1 sau phSu thult sau 6 thing dieu trj 1-131

- Ty id bdnh nhan huy QMc md tuyen giap hoan toan sau 6 thing dieu tri 1-131

+ Lieu 30 mO: 33,3%

+ Lidu 50 mO: 60,1%

+ Ueu 100 mCi: 79,2%

- Bdnh nhan khdng huy dUdc hoin toin sau dieu tri 6 thing nhuiig cac chi sd the b'ch md giap, dd tap trung 1-131, ndng dd Tg deu giam so vdi trudc dieu tri.

TAI U | U THAM KHAO

1. Phan Sy An, Ti^n Dinh Hi, NguySn Quoc Bao (2003): Sir dgng lode ph6ng xa (1-131) trong dieu bi ung thi/ tuyen giap va ket qud ban dSu t^i b^nh vi^n Bach Mai. K/jpc thuchinh, so 461,49-55.

2. Mai Tr^ng Khoa (2010). Nghien ata ijYig dung lot ph6ng x? M 3 1 dieu tij b^nh ung thir bieu m6 bjyen gljp thS bl|t hoa. Be Bi dip b$, B? Y K.

3. Mai Trpng Khoa (2012). Y htic h;t nhSn (sich diing cho sau dat hgc). rJXB Y hgc.

4 Mai Itpng Ktioa, Phan Sy Aiv Titn Dinh H i , Nguyin QuSc Bao v i CS (2006): H ^ qua oja 1-131 trong diSu tri ung thu'tuygn giap the bi§t ho4 TapduY hQciim sing BV. Bach Mai, Mng 4/2001, ft 13-21.

5, Arsian N.(2001): l^st surgical ablation of thyroid remnants with high dose 1-131 in patients with differentiated thyroid carcinoma. Nud. Med.

ammun. 22, pp.1021-1027. .

6 Arsian N.(2001): Post surgical ablation of thyroki remnants with high dose 1-131 In patients with differentiated diyroid cardnoma. Nud. Med.

Commun. 22, pp,1021-1027.

7. Pedro W.S. (2004): Efficacy of low and high 1-131 dose for thyroid remnant abladon in patients with differentiated thyroid carcinoma based on post- operative cen/icai uptake. Nud. Med.

comnwnicadon, 25, pp.1077-1081.

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