Y HOC Viei NAM THANG 3 • so 2/2015 B chilm 8,3% v i Child C ehiem 23,4%. SU thay
ddi BB cd lien qua den giai doan x d gan.
pH rdi loan c i n bang acid - base d benh nhan xd gan, rdi loan d dang nhiem kiem cd 38/60 benh nhan trong dd Child B cd 16/60 benh nhan chiem 26,7%, Child C cd 22/60 benh nlian chiem 36,7%. pH mau ddng mach t i n g khdng lien quan den giai doan x d gan.
T A I L I ^ U T H A M K H A O
1. Ha Van M j o , Vu BSng S i n l i (2009), "xd gan", b^nh hoc gan mat tgy, Nha xuHt ban y hpc,
^ . 4 7 6 - 4 9 5 .
2. Nguyen Thj Thu Ha (2008), nghlen cilU bien ddi i p lue dpng m^ch vinh phdi va thong kiii phdi tren benii nhin xd gan, luan v3n bac si chuyen khoa ri, Hpc vien Quan Y
3. Pham Til Di/Ong, Nguyen The Khanh (2005),
"xet nghiem khi mau", xet nghiem su' dung trong lam sang, Nha xuat ban y hoc.
Pham Thj Thu Tra (2010), Nghien cuti tinh trang khi mau dpng mach (O2, CO2) va chile nSng ho hap d benh nhan xd gan, luSn van thac sy, Dai hoc y Ha Npi.
AJizadet AH , Fatemi SR, Mirzaee V (2006),
"Clinical features of Hepatopulmonary syndrome in cirrhosis patinets", world J Gastroenterology, 12(12): 1954-1956.
Charalabopoulos K, Peschos D, Zoganas L, er al (2007), " Alteration in arterial blood parameters in patient with liver cinliosis and ascites" Int J Med Sci, 4(2): 94- 97.
7. I r e m Pembegul Ylgit, et al (2007), "The Relationship between severity of liver dnliosis and pulmonary funtion test" Dig dis Sd 53:
p.1951 -1956 4.
5.
6.
PHAN TICH YEU TO LIEN QUAN DEN DL CAN HACK UNGTHU-DAITRANG
T 6 M TAT
Nghlen d i l l dul^c thUc hien nhSm danh gia mpt so yeu to lien quan den di cin hach ung thu dal trang.
Mpt b i m chin sau benh nhSn nghign cini dupe chia thinh 2 nhom 98 b^nh nhan d i c i n hach va 98 benh nhSn khdng co di cin h^ch. Kit q u i cho thiy ti le di cin h?eh eao d nhdm b§nh nhin thieu mau (66,3%
so vdi 36,4%, p <0,001), nong do CEA trudc md alO ng/ml (77,8 % so vdi 43,8%, p<6,001), ung thU bleu mo che nhay va khdng blet hda (70,4% so vdi 46,7%, p =0,023), u T4 (85,4% so vdi 40,9%, 40,6% 6 T2, 73, p <0,001); 100% bpnh nhan the tham nhiem cd di can hach ( p<0,001).
Tiykhda; Ung thU dai trang, di cin hach, yeu td lien quan
S U M M A R Y
THE FACTORS ASSOCIATED W I T H LYMPH NODE METASTASIS OF COLON CANCER
• Trudng D?i hpc Y H i Ndi
" B|nh vlen K
Ngudi chju trach nhl^m chinh: Nguyen Thj Thu HUdng Email: [email protected] Dt: 0983136982 Ngiy nhin bai: 13.1.2015
Ngiy phin bien khoa hpc: 20.2.2015 Ngiy duyet bai: 30.2.2015
Nguyen Thu HiroTig*. Le Van Quang*
Nguyin van Hilu*, Dinh Xuan Cfffrng**
The study was done to evaluate some of factors associated with lymph node metastasis of colon cancer. One hundred and ninety-six patients were divided into 2 groups of 98 patients with lymph node metastasis and 98 patients without lymph node metastasis. Result showed a high rate lymph node metastasis in anemia patients (66.3% versus 36.4%, p<0.001), preoperative CEA levels 210 ng/ml (77.8 % versus 43.8%, p <0.001), mucous cardnoma and undifferentiated carcinoma (70.4% versus 46.7%, p
=0.023), T4 tumor stage (85.4% versus 40.9%, 40.6% in T2, T3 respectively, p <.0001); 100%
patients with Infiltration tumor had lymph node metastasis (p <0.001).
Keywords; colon cancer, lymphnode metastasis, association
1. DAT VAN OE
Ung t h u dai trang (tn'DT) la ung thU thudng gap tai Viet Nam, dutig thd' 4 ve ty le mac d ca 2 gidi, n i m 2010 t r i n ca nu'dc cd khoang 5434 ngUdi mdi m i c , trong dd ty le mac ciia nam la 19,0/100.000 d i n va d niJ la 14,7/100.000 dan [1]. Thep ghi n h i n ciia t d ehire y t l t h i gidl, ung t h u dai bare trang cung l i ung t h u phd bien dOrng thii' 3 ve ty I I mac d c i hai gidi, dimg thir
81
Y HOC VIET NAM T H A H G 3 - SO 2/2015
2 ve ty ie tu' vpng, tren 50% trong sd dd la ung thu dal trang. SEER Udc tinh nam 2010 ed khoang 142.570 trudng hdp ung thu dai trUc tring mdi mac trpng dd 51.370 trudng hdp tir vpng [2].
Nguy eP tir vpng cua ung thU dai trang lien quan true tiep. tdi cac yeu td nguy ed dl can.
Benh di can theo 3 con dudng ehinh: lan tran tal elio, theo dudng bach huyet va theo dudng mau, trpng dd bach huyet la con dudng di can ehii yeu (37%) [2]. Giai doan hach di can dupe xic djnh dija vap sd lu'dng hach di cin du'dc phau tich sau md. Thep hi|p hdi ung thU I4y va hilp hdi giai phau benh I4y sd IUdng haeh tdi thieu can phau tich d l xae djnh ehinh xae giai doan benh la 12 h?eh [3].
Ve d i u 01, tai thdi diem chan doan 75% - 80% tu'dng hijp phau thuat cd the ehua khdi benh, hda chat bd trd sau phau thuat vdi ung thu' d;l bang cd dl can h^eh nham blu di|t nhiitig d di cin vi the va lam giam cae ylu td nguy ed t i l phat, duije chiTng minh lam ting thdi gian sdng khdng benh va thdi gian sdng toin bd [4]. Odi vdi ung thu di can h?ch ty II thdi gian sdng toan bd 5 nam la 70,4% trong khi ty l | nay la 90% d nhdm khdng di cin haeh (Theo SEER thdng k l tir 2003-2009) [2].
Nhu vay haeh di can la mdt yeu td tien IUdng xau anh hudng kit qua dieu trj [5]. Vay dau la nhiJUg ylu td anh hudng din tinh trang di cin haeh ciia ung thu dai tring. Hiln nay trin t h i gidi, nghiin euli ve hach dai tring van dang tiip tue duuc bin hinh khdng chi dimg lai d vj tri, tinh chat, sd lu^ng hach, ban dd hach trpng phau thuat, ma cdn mdi liln quan ciia chiing vdi kit qua dieu bi. Trong khi dd tai Vilt Nam eae nghiin edit v l haeh ehu ylu tap trung vao da diy va trtrc trang, nghien eiiti ve haeh dal bang edn han chl, v i chua cd nghlen ciili riing biet dinh gia eae ylu td anh hudng din tinh trang di can haeh. Vi vay
nghien ciru nay dxtdc thi/e hien nham danh gia mpt sd yeu td lien quan anh hudng den tinh trang di can hach ung thu dai trang.
II. DOI -nycyNG vA PHircmG PHAP NGHIEN dm 2.1. Ddi ti/dng
Benh nhan ung thU dai trang dupe phau (huat triet can (cat doan dal tring kit hdp v^
haeh tan goe mach mac treo dai trang) va mo benh hpc sau md khang djnh ung thu bleu m6 (LTTBM) dal tring. Benh nhan sau md dMc phau tich hach, kiem tra md benh hpe it nhat 12 hach de dam bao danh gia giai doan haeh chinh xae Nhiirig benh nhan cd bang ehutig di can xa b|
Ipai khdi nghien ciru.
Nghiin cull hdi citu trin 196 benh nhan ung thu' bleu md dai b-ang dUdc ehia thanh 2 nhom:
98 benh nhan cd di can haeh, 98 benh hilar khdng ed di cin hach, tai binh vien K trimj Udng tir 2005 den 2010.
2.2. Phan tich sd lieu
Danh gii anh hudng mdt sd ylu td: hiol, gidl, tinh trang thieu mau, ndng dp CEA tnidc phau thuat, kich thu'dc u, hinh inh dai the, mi benh hpc, mu'c dp u xam lan thinh dai trang vdi tinh trang di can haeh.Sd li|u dUde xir ly bSng phan mem SPSS 16.0. So sinh, kiem djnh sir khae biet glQa cic bien djnh tinh giiia 2 nhom bang test x2, eae so sanh ed y nghTa thdng kfi khi p <0,05.
2.3. D^o du'c nghlen CU'U
l^ghien eiru nay thUe hien dUde sir dong y eiia hdi ddng y dire benh vien, dUde su* ddng y eiia benh nhin.
Cac thdng tin ve kit qua nghiin cull cua benh nhan du'dc giii' kin. Kit qui nghien ciili phuc vu chp edng tic eham sdc su'c khne cua nhan dan ddng thdi nghiin edli khdng anh hudng tdi qui trinh dieu trj ciia ngu'di benh.
iii.KfrQuA
196 benh nhan UTDT dude chia thanh 2 nhdm: 98 ed di can hach v i 98 khdng ed di cin haeh Bing 1: Liln quan giiia tudi, gidi v i tinh trang thilu miu vdi tinh trang di can hach
Tudi
<40Dl can hgch 59,3
Khong di cin hach
40,7 0,3
Y HOC Vl|T NAM THANG 3 • SO 2g015
Gidi Tiileu mau
>40 Nam Nu' Cd Khdng
82 51 47 59 39
48,5 48,1 52,2 66,3 36,4
87 55 43 30 68
51,5 51,9
47,8 0,56
< 0,001 Nh$nxet:
-1^ Ie di can haeh d nhom tuoi <40, >40, gidi nam va nCi' khong cd su* khae biet.
- 66,3% benh nhan thieu mau ed di can haeh so vdi 36,4% d nhdm khong thieu mau, sir khae biet 03 '^ nghTa thdng ke vdi p<0,001.
^ / i f f Z ' L i l n quan Mdng do CEA
tru'dc md
< 10 nq/ml
> 10 nq/ml
qlDa ndnq dd CEA trUde md vdi tinh b-anq di can haeh Dl cin h^ch
n 70 28
43,8
%
77,8
Khdng dl can hach n
90 8
56,2
%
22,2 P
< 0,001
^064; Caitinoembryonie Antigen- Khang nguyen bieu md ph&) Nli$n xit: Tl,8% b|nh nhan cd nong dp CEA> 10 ng/ml sp vdi 43,8% d nhdm < Ing/ml, s^ khae bl|t cd y nghTa vdi p<0,001.
Bing 3: Uen quan kich thu'dc u, hinh inh dai t h i u, the md benh hpc, miit dp u xim lin vdl tinh bang di cin haeh
Kich thu'dc u Hinh anh d^i the u dal tring
Md b|nh hpc Miitcddu
x i m l i n thanh dai
tranq
< 5
>5 The sill The Ipet Sui loet Tham nhiem UTBI4 tuyIn UTBM che nhay va khdng biet
hda T2 T3 T4
Dlcin h^ch n 23 75 59 8 26 5 79 19 9 .54 35
48,9
%
50,3 70,2 61,5 26,3 100 46,7 70,4 40,9 40,6 85,4
Khdng dl can hach n
23 75 25 5 68 0 90 8 13 79 6
51,1
%
49,7 29,8 38,5 72,3 0 53,3 29,6 59,1 59,4 14,6
P 1
< 0,001
0,023
< 0,001
- Ty i i dl cin haeh d nhdm u tren v i dudi 5 em khdng cd sir khae biet.
- 100% the tham nhiem, 70,2% the sui, 61,5% the loet cd di can haeh, sU khic bllt ed y nghTa thdng k l vdi p<0,001.
- 70,4% b|nh nhin UTBM che nhay va khdng bl|t hda ed di cin h?eh so vdi 46,7% LiTBM tuyIn, p= 0,023.
- TV l i dl cin hach d nhdm T4 l i 85,4% eao hdn so vdi T2, T3 tu'dng utig la 40,9%, 40,6%, sir khic bl^tcd!^ nghTa vdl p<0,001.
IV. BAN LUAN
Khi dinh gii sy liln quan giiia tudi va khi nSng di cin haeh, chung tdi nhin thay nhdm b^nh nhan tre tudi dudi 40 ty le di cin hach cao hdn 59,3% so vdl 48,5%, tuy nhien sir khic bllt khdng d y nghTa. Cung tu'dng ty' khi SP sanh sir khic bl$t giiia gidi nam va niT, chiing tdi cung
khdng nh$n thay sU khae biet ed y nghTa. Kit qui nay cDng tu'dng dong vdi nhieu nghiin ciru h'ong va ngoai nu^e, khing djnh diy la hai ylu td khdng anh hudng tdi tinh trang di cin hach.
Trong khi dd kit qua nghiin ciili chi ra ring tinh bang thieu mau la yeu td anh huidng tdi tinh bang di can hach, 66,3% binh nhin thieu miu cd di can h;ch trong khi dd ty I I niy l i 36,4% d
Y HOC VIgT NAM T H A H G 3 • s 6 2/2015 nhdm khdng thieu mau, sU khae biet ed y nghTa
thdng ke. Thieu mau trong ung t h u dai trang thudng la do mat mau ri ra tir md u, kem theo dd la thieu cae yeu to vi IUdng do rdi loan tieu hda keo dai, rdi loan hap thu. ,
77,8% benh nhan d nhdm CEA trUdc md >
10 ng/ml ed di can hach, trong khi dd ty le nay chi la 43,8% d nhdm < lOng/ml (p <0,001). Trpng mdt nghien culi danh gia ndng dp CEA trUdc va sau phSu thuat, cac t i e g i i nhan djnh 25,4%
fruSng hdp CEA cap tren 5 ng/ml, sir lien quan glQa ndng dp CEA t r u i k md vdi cd hpac khdng cd dl d n hach rat c h i t c h l , dp nhay 89,2% va gia tn dir bap liaeh dut)ng tinh la 8 0 % [ 6 ] .
Khi danh gia mdi lien quan glQ^ kfch thudc u va tinh trang di c i n haeh, ehung tdi khdng thay ed sd khic bi|t. Vdi nhutig u kich thudc dudi 5cm ty l | di c i n haeh 28,3%, 5-10 cm la 23,5%, b i n 10 cm la 33,3 % v i khdng cd sir l i l n quan glDa kich thudc u va di c i n hach. Da sd, cae nghien cihi trong va n g o i i nUdc ciing chi ra rang kich thudc khdi u khdng cd vai trd tien lu'dng vdi ung t h u dai true trang [ 7 ] .
K i t qua Clio thay 100% benh n h i n the t h i m nhiem, 61,5% the loet cd di can haeh, sir khae bl$t cd y^ nghTa vdi p <0,001. TTie loet v i the tham nhiem l i 2 the benh i c b'nh, kha nang di c i n haeh viing eao hdn cae the khae. Ty I I di can h?ch d nhOhg u the loet la cao n h i t (66,7%) so vdi u t h i sill chi cd 38,5%, sU khae b i | t cd y nghia thdng k l vdl p =0,017. Tuy nhien mdt sd nghiin eiili frong nude v i t r i n the gidl t r i n t h i gidi da that bai bong v i | c chi ra bat ciT sif l i l n quan nao glQa hinh dang u vdi cac yeu t d t i l n lutjng. The tham nhiem dupe coi la ed t i l n luljng xau, nhung dieu n i y la do mdi lien quan giij^ hinh thai n i y vdi s u hien dien ciia cac t l bao nhan va eae loai t l bao khic ed dp md hpc cap [ 7 ] .
Trong nghiin ciiU eiia chung tdi b/ I I dl can h?ch cap hdn ed y nghia d nhdm ung t h u bleu md che n h i y va khdng b l l t hda (70,4% SP vdi 46,7%, p =0,023). SU b'cli tu chat nhay va sU c h l t i l t ciia nd vao md ke dem thep c i c t l baa i c b'nh la y l u t d glal thich chp sir ae tinh cua ung t h u bleu md che nhay. Nghiin cuXi ciia Kanemitsu txen 2.678 benh n h i n ung t h u dai t r ^ bang sau phau thuat edng cho thay ung thir bleu md che nhay dl c i n h?eh nhilu hdn (48,5%
so vdi 40,3%, p =0,0564). Day cung la yeu t d H l n luidng dpc lap dU bao k i t q u i xau eiia ung t h u dai bVc trang sau phau t h u | t .
Khi d i n h gia tlnh b'?ng di c i n hach vdl mUc dp u x i m lan thanh dal t r i n g , chuhg tdi nhan
thay giai doan u cd lien quan den kha ning di can haeh vdi 85,4% T4 cd di can haeh trong khi dd T3, T2 tUdng irng 40,9%, 40,6%, sU khae biet cd y nghTa thdng ke. Mdt nghien euii khae danh gia mu'c dp u xam lan vdl dl can hach trong ung t h u dai tri/e trang che thay ty le di c i n hach eiia khdi u d glai doan T l , T2, T3 va T4 tudng Ung la 14%; 19,8%, 22,5%, sU khic biet nay cd y nghia vdl p <0,05. On Suzuki cung nhan thay T3-4 ehiem ty ie cao hdn T l - 2 d nhdrti benh n h i n di can hach (78,8% so vdi 21,2%). NhK vay mUc dp u x i m lan thanh dal trang cang Icin thi kha n i n g di can haeh e i n g can, v i la yeu to tien IUdng ed y nghTa dpi vdi mUc do di cin h^ch trong ung t h u dai trang.
V. KET L U A N
Qua nghien ciru chiing tdi riit ra ra mpt sS k i t luan: thieu mau, ndng dp CEA trUdc md, hinh i n h dal the, md benh hpe, mUe dp u xam lan thanh d?i t r i n g l i nhii'ng yeu t d t i l n lUpng di can haeh ung t h u dai trang.
Ldl dm dm Chung tdi xin bay td sU earn On tdi Ban lanh dao va phdng ke hoach tdng hop benh v i | n K da tao mpl d l l u k i l n giiip dd tol hoan thanh nghiin ciiu n i y .
l A l \.\%\i T H A M K H A O
1. Nguyen Ba Disc v i CS (2010). Bao cao sd ll(
kS qua thuc hien du an quoc gia ve phong chSng ung thu gial doan 2008-2010. Tap chi ung thir hoc Viet Nam, Hpi thao quoc gia phong chong ung thu lan thU XV, 21-26.
2. SEER (2010). SEER Stat Fact Sheets: Colon and Rechim.
http://www.seer.cancer.gov/statfacts/html/coloi^
ct.hmil. ; 3. Carolyn Compton (2008). Colon canes.
Abeloff's Clinical Oncology, 4th edition,Chur( ' Livingstone, An Imprint of Elsevier, chapter 81.
4. L.Lombardi (2010). Adjuvant colon cam chemotherapy; where we are and where well go, Cancer treatment reviews 36S3, 34-41.
5. DeVita, Vincent T (2008). Colon cancer.
Prindples 8[ Practice of oncology, 8th Edition, Uppincoti; Williams & Villlklns, Section 12, 1233- 1284.
6. N g u y i n Quang T h i i , C o i n HOli Nghj, Khdng Thj Hiong (2000). Khang nguyin ung thu \m mo_ phdi CEA trong ung thu dai h-ang trUdc v5 sau phau thuat. Tap ehi Thdng tin y duoc, Hpi thio quoc ^ phdng chong ung thu, 94-98.
7. N g u y i n Thanh Tam (20O9). Uen quan giDa hinh anh dal ttie cua khdi u vdi sU dl cSn hadl bong b|nh ly ung Uiu d j i true tring. Tap chi y hpc thuc hanh, 10(679), 66-75.