Y HOC VIET NAM THANG 5 • SO 2/2015 nghiem FFN vdi nhau de tien doan de non thi
cac gia trj tren lan lu'dt la 67%, 8 1 % , 3 6 % , 94%. Sl/ khac nhau ve ket qua nghien ciTu cd the do rndc lay tuoi thai la de non ciia 2 nghien ciru la khae nhau. Nghien ciTu cua chung tdi chpn 38 tuan mdi ia dii thang [SJnhu'ng tac gia Schmitz chpn 35 tuan la du thang nen trong nghien cu'u ciia Schmitz FFN cd dp dae hieu va gia tri ehan doan am tinh cao hdn.
V. KET L U A N
Xet nghiem FFN la mpt xet nghiem dang tin cay va cd gia trj cao trong tien lu'dng de non. Dp nhay, dp dac hieu, gia trj ehan doan du'dng tinh, gia trj chan doan am tfnh de chan doan chuyen da de non trong vdng 7 ngay lan lu'dt la 100%, 64j,3%, 16,7% va 100%. Cac gia tri tu'dng td de chan doan chuyen da de non lan lu'dt la 3 5 % ; 75%; 58,3% va 83,3%. Neu du'dc ap dung rpng rai vao thdc hanh lam sang xet nghiem FFN se giup tranh cho nhap vIen va dieu tn thudc giam CO cho nhu'ng tru'dng hdp khdng can t h i e t
Ldi dm dn: Nghien ciru nay du'dc thi/c hien bSng kinh phi ho t r d tir nhiem vy nghj dinh ttiu"
"Hdp tac nghien ciru mpt so yeu t d nguy cd, dd
phdng va dieu trj de non d thai phu tai khu vUc phi'a bac Viet Nam". Xin chan thanh cam dn Hoc vien Quan y, Benh vien Phu san Trung u'dng da giup dd va tao dieu kien trong suot thdi gian ngiiien ciTu.
TAI LI^U T H A M KHAO
1. Bo Y t e , Hu'dng dan chuan qua: gia ve cac dich vu Cham SDC sut khoe sinh san. 2003. Tr: 127-128.
2. Nguyin Manh Tri (2004). Nghien cud vedpdai CO t& cung trong thdi ky thai nghen va y ngfila tien iudng doa de non. luan an tien sy y hoc.
3. lams, J.D., et al., (19*96). The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal i^edicine Unit Network N Engl J Med,. 334(9): 567-72, 4. Kiefer, D.G. and A.M. Vinbileos (2008), TJa
Utility of Fetal Fibronectin In the Prediction and Prevention of Spontaneous Preterm Birth. Reviews in Obstetrics and Gynecology. 1(3):106-112.
5. Sanchez-Ramos, L , et a)., (2009). Fetal fibronectin as a short-term predictor of pretenn birth in symptomatic patients: a meta-analyas.
Obstet Gynecol. 114(3):631-40.
DANH GIA KET QUA PHAU THUAT UNG THU* GIAP TRANG TAI BENH VIEN DAI HOC Y H A NOI
T 6 M TAT
Myic tieu: Danh gia ket qua sdm phau thuat L/FTG tai Benh vi?n Dai hoc Y Ha Npl.Doi tu'Ong va phu'dng phap: 70 benh nhan chan doan UTTG dUdc dieu trj tai Benh vien Dal hpc Y Ha Noi tu' thang 01/2012 den thang C)5/20i4. PhUdng phap nghien ciTu mo ta. Ket qua: Cat tuyen giap toan bd 81,43%; vet hgch cd 50%, vet hach cd 1 ben 38,57%; ung thU the nhil 91,43%; giai doan T l 41,43%, T4 35,71%, NO 51,43%, NI 48,57%; giai doan I 70%; thdi gian nSm vien 6-10 ngay 82,86%; khan tieng trong 24h dau 11,43%, 72 h 7,14%, tuan <fiu 4,29%, sau 1 thang
* Khoa Ung bddu va CSGN - Benh vien DH YHa Noi
** Benh vien ung bddu Nghe An Chiu trach nhiem chinh: Le Van Quang Email; [email protected] Dt: 0913035195 Ngay nhan bai: 3/3/2015
Ngay phan blen khoa hoc: 2/4/2015 Ngay duyet bai: 13/4/2015
hk Van Quang*, Tr^n VSn Th6ng**, Hoang Manh Thang*, Nguyen Xuan Hau*
1,43%; cdn tetany sau 24h dau 1,43%, 72h 25,71%, sau 1 tuan 10%; ket qua dieu tn tdt sau tuan dau 85,71%, sau 1 thang 98,57%. Ket luan: phau tiiujt la phUdng phap diieu trj chfnh trong benh ung thugiap trang, tuy nhien phau thuat cung gay ra cac tai bien, bien chirng nhung vdi ty le thap va thu'dng phuc hoi hoan toan sau mpt thang.
TW khoa: Ung thu giap trang, phlu thuat, bien chu'ng
SUMIVIARY
TO EVALUATE EARLY RESULTS OF THYROID CANCER SURGERY AT HANOI
MEDICAL U N I V E R S I T Y HOSPITAL Objective: To evaluate early results of thyrffld cancer surgery at the Hanoi I^edlcal University Hospital. Subjects and Methods:A retrospective study of 70 thyroid cancer patients were diagnosed and treated at Hanoi Medical University Hospital from 01/2012 to 05/2014. Results: Total thyroidectomy
Y HOC VIET NAM THANG 5 - SO 2/2015
was 81.43%; neck dissection was 50%, of which ipsilateral neck dissection was 38.57%; papillary carcinoma was 91.43%; stage Tl was 41.43%, T4(35.71%), NO (51.43%), Nl(48.57%); stage I was 70%; hospitalization from 6 tolO days was 82.86%;
dysphonia in the first 24 hours was 11.43%, in the first 72 h (7.14%), dysphonia in the first week was 4.29%, after 1 month was 1.43%; hypocalcemia after the first 24 hours was 1.43%, 72 hours was 25.71%, after 1 week was 10%. The no event surgical results after the first week was 85.71% and 98.57%
after 1 month. Conclusions: Thyroid cancer surgery is safe, however there were some surgical complications but the rate is low
Keywords: thyTo\i^ cancer, surgery, complication.
I.OATVANDE
Ung thu" tuyen giap (UTTG) la ung thu' phd bien nhat cua he ndi tiet, chiem tdi 90% va ty le tir vong chiem 63% trong tong so td vong do ung thu' tuyen npi tiet. Tren the gidi cung nhu" d Viet Nam, UTTG chi chiem 1-2% trong tat ca cac loai ung thu'. UTTG thu'dng bieu hien bang khdi u giap d giai doan sdm hay chiJa iiach cd di can ddn ddc, hoac mdt ung thd bleu hien rd tren lam sang vdi day dii tinh chat ac ti'nh. Viec chan doan ung thu* giap trang tu'dng ddi de d^ng diTa vao lam sang va can lam sang nhu* sieu am vung c6,te bao hoc khdi u. I^ac dii phau thuat la phu'dng phap ddng vai trd quyet djnh, cac phu'dng phap khac chi cd vai trd dieu tri bd trd_jnhu'ng cd nhieu quan diem khac nhau ve piiau thuat doi vdi UTTG, cd tac gia cat gan toan bd tuyen giap khi ung thu dang d giai doan sdm roi theo doi, cd tac gia chii tru'dng cat thiiy va eo giap cd ung thu' va vet hach cimg ben, cd tac gia khuyen nen cSt toan bd tuyen giap cd hoac khdng kem theo vet hach cd, sau dd cdn dieu tri bd trd bang I131ngay ca khi chu'a cd di can xa.
Tiiy theo phu'dng phap phau thuat ma ty le cae blen chirng khac nhau. O Viet Nam, da cd nhieu cdng trinh nghien cu\i ve UTTG ndi chung nhu'ng cac cong trinh nghien culj ve danh gia ket qua sdm phau thuat nhu" ty le cac tai bien, bien chirng trong va sau phau thuat van cdn han che.
Vi vay chimg tdi tien hanh nghien ciru de tai nay vdi muc tieu Danh gia ket qua sdm phau thuat UTTG tai Benh vien Dai hpe Y Ha Ndi.
II. OOI urplSIG VA PHU'OTMG PHAP NGHIEN CUU 2.1. Ddi tu'dng nghien cii'u
Gom 70 benh nhan chan doan la UTTG du'dc dieu tri phau thuat tai Benh vien Dai hoc Y Ha Npi tir 01/2012 den 05/2014.
* Tieu chui'n chon benh nhin - Chan doan ung thu giap trang bang lam sang, can lam sang va nhat thiet phai cd md benh hpc sau md la ung thu' bieu md tuyen giap - Du'dc dieu trj bang phau thuat lan dau - Cd thdng tin theo ddi sau dieu trj
* Tieu chui'n loal trW - U lanh tfnh tuyen giap trang
- Ung thu" giap trang nhu'ng da phau thuat tai cd sd khac
- Khdng cd ho sd \du tru* day dii.
2.2. Phu'dng phap nghien cihi: nghien ciru md ta
2.3. Phu'dng phap thu thap so lieu Thu thap theo mau benh an in sin,trinh td tien hanh tlieo cac bu'desauday
2.3.1. Cic phWdngjjhip phau thuit - Cae phu'dng phap phau thuat ung thiT tuyen giap: cat thiiy va eo,cat tuyen giap gan toan bp,cat tuyen giap toan bp.
- Doi vdi hach: khdng vet hach,vet hach cd chpn Ipc mpt hoac hai ben
2.3.2. Cic tai biin, bien chuhg trong va sau phau thuit
- Bien chimg sau phau thuat trong 24h dau: chay mau, ndn va budn ndn, khd thd, khan tieng, cdn CO rut ngdn tay, chan^ rd dng ngu'c, tir vong.
- Bien chirng sau phau thuat trdng 72h dau: khd thd,khan tieng,cdn co riit ngdn tay, chan, rd dng ngu'c,nhiem triing vet mo.
- Bien chu'ng sau phau thuat trong tuan dau tien:
khan tieng,cdn co riit ngdn tay, chan, rd dng ngu'c,nhiem triing vet mo^^
- C^c bien chii'ng sau phau thuat 1 thang; khan tieng,cdn co riit ngdn tay, chan,rd dng ngiTc.
III. K f r QUA N G H I I N CU'U,
3.1. Phu'dng phdp phau thuat va giai doan benh - Cic phWdng phip phau thuit vdiu, hach
Bing 3.1: Cac phu'dng phap phau thuat u, hach
SofBN Ty le %
* Cac phu'dng phip phau thuat u glip (n=70) Cat thuv qiap + eo
C3t tuyen giap gan toan bo Cat tuyen qiap toan bo
4 9 57
5,71 12,86 81,13
Y HOC VIET NAM THANG 5 - SO 2/2015
-^ Cac phu'dng phap phau thuat vdi hach Khonq vet hachi
Vet hacii mot ben Vet hacli hai ben
38,57 11,43
V e i lldCII l l d l UKII O I 1 . 1 , T J
Nhan xet; Cat tuyen giap toan bo chiem 81,43%, cat gan toan bp tuyen giap la 12,86% va chi co 5,71% la cat thuy va eo giapTy le vet hach co la 50% trong do vet hach 1 ben la chu yeu gap 38,57%.
- Kit gui mo binh hgc va giai doan sau phiu thuit
LTTTG the nhu chiem da so veil ty le 91,43%. Giai doan T l la 41,43% va T4 la 35,7%, giai doan T2 va T3 deu chlem 11,4%; NO chiem 51,43% va NI chiem 48,57%; giai doan I chlem hdn 70%
3.2. Ket qua dieu trj
=*= Cac ket qua sdm - Binh gia ket qui sau phau thuit
Bleu do 3,1, Sau mpt tuan
Trung binh Xdu
Bli'u do 3,2, Sau mpt thang
1,43% 0%
98.57°/
Trong tuan dau sau phau thuat co 85,71%
ket qua tot va 14,29% la trung binh.
Sau 01 thang co 98,57% co ket qua tot va chi CO 1,43% la ket qua trung binh.
- Sci lu'dng dich qua ong dan lu'u, tlidi gian rdt ong din lu'u vathdi gian nam vien sau phau thuat: So lu'dng djch qua ong dan lulj chu
a T9t
• Trung binh B Xiu
yeu la tii 60-lOOmml, trong do 60-80mml chlem 32,86% va 80-100 mml chlem 54,29%. Ba so BN rut ong dan lull sau PT tir 48-72h chiem 64,29%.
Ty le nam vien sau phau thuat tif 6-10 ngay chiem 82,86%.
« Cic bien chung sau phau thuit tnm \\
24h diu, 72h, tuan dau vi mgt thirig.
Y HOC VIET NAM THANG 5 - SO 2/2015
Banq 3.2. Cac bien chimq sau phau thuat tronq 24h dau, 72h, tuan dau va mot thanq Cac bien chu'ng
Chay mau Non, buon non
Kho tha Khan tienq
Tetany
2 4 h SoBN
1 5 3 8 4
Ti le % 1,43 7,14 4,29 11,43 5,71
7 2 h SoBN
0 0 0 5 18
Ti le % 0 0 0 7,14 25,71
Tu'an dau SoBN
0 0 0 3 7
Ti le%
0 0 0 4,29 10,0
Mot thang SoBN
0 0 0 1 0
Ti le % 0 0 0 1,43
0 Nhin xet: Trong 24h dau gap ehii yeu la khan tieng chiem 11,43%. Trong 72h sau mdgap cac bien chirng ve cdn Tetany va khan tieng vdi ty le lan lu'dt la 25,71%va 7,14%.Trong tuan dBu chi cdn 10% cdn Tetany va 4,29% la khan tieng.
IV. BAN LUAN
4.1. Phu'dng phap phau thuat, giai doan benh
Trong nghien ciru ciia chung tdi cd 81,43%
tru'dng hdp la cat toan bp tuyen giap, ty le cat gan toan bd tuyen giap la 12,86% va clil cd 5,71% la cat thiiy va eo tuyen giap. Ty le nay gan tu'dng du'dng vdi ket qua ciia Chir Quoc Hoan (2013), ty le cat giap toan bp la 85,5% va cd 5% la eat thuy va eo giap. Trong sd 35 BN du'dc vet hach co, ty le vet hach cd mdt ben la 27/35 BN ehiem 77,14% va hai ben la 22,86%.
Ket qua nay tu'dng ty" nghien ciru cua Oinh Xuan Cu'dng, ty le vet hach cd la 62,7%, trong so dd vet hach cd mdt ben la 50,2%, hai ben la 12,5%.
Ket qua md benh hpc sau phau thuat: qua nghien cOru chung tdi thay cd tdi 91,43% la UTTG the nhu, nhii nang va cd 8,57% la the nang va khdng cd tru'dng hdp nao the tiiy hoac the khdng biet hda. Ket qua nay cung tu'dng td cac nghien cirli ciia Nguyen Van Thanh (2000), UTTG the nhii la 81,7%, the nang la 13%.
Nghien ciru ciia Le Van Quang, the nhu cd 79,5% va the nang 16,5%.
Xep loai TT^I^ va giai doan benh: trong nghien cihj ciia chiing tdi, chii yeu gap d giai doan I vdi ty le la 74,29% va ed 14,29% tru'dng hdp d giai doan IV, cac giai doan khac it gap hdn. Ket qua nay phii hdpnghien ciru ciia Le Van Quang, giai doan I la 65,6% va giai doan IV la 4,2%.
4.2. Ke\ qua dieu tri
Thdi gian nam vien sau phau thuat trong nghien ciru ciia chiing tdi chii yeu la 6-10 ngay 82,86% va ed 8,57% nam vien sau phau thuat du'di 6 ngay (benh nhan eat thiiy va eo giap) dac biet cd 1,43% nam vien tren 15 ngay, day la 1 tru'dng hdp cd benh ndi khoa kem theo. Ty le nay cd sy khac biet so vdi nghien ciru ciia Tnnh
Xuan Du'dng (2012) la 6-10 ngay la 35,6% va tir 10- 15 ngay 50,8%.Sd lu'dng djch qua dng dan lulj chii yeu la tir 60-lOOmm!, trong do 60- 80mml ehiem 32,86% va 80- 100 mml chlem 54,29%. -Da sd BN rut dng dan lu'u sau PT tir 48- 72h chiem 64,29%.
Nghien ciru ciia ehung tdi thu nhan du'dc, ty le benh nhan ha calei mau sau mo 18/70 tru'dng hdp chiem 25,71%. Theo Pisanu va CS ty le ha calei mau cao nhat sau 24h la 29,5%.
Khdng ed tai bien phau thuat nao xay ra trong nghien cuXi ciia chiing tdi. Trong 24h dau sau phau thuat cd 1 tru'dng hdp chay mau da du'dc xd tri mo cap ciTu cam mau. Ty le khan tieng chlem 11,43% va cd 7,14% la buon ndn va ndn, ty le gap cdn Tetany va khd thd gan tu'dng du'dng nhau va khdng cd tru'dng hdp nao bj rd dng ngiTc va tir vong sau md.. Trong 72h dau sau md chiing tdi gap chii yeu la edn Tetany vdi ty ie la 25,71% va khan tieng tam thdi la 7,14%, khdng cdn xuat hien cac bien chuYig khac do phau thuat va ciia thudc gay me gay ra. Mpt tuan dau sau phau thuat trong nghien ciru cua chimg tdi chi cdn gap cac bien chu'ng ve cdn Tetany va khan tieng vdi ty le lan lu'dt la 10% va 4,29%. Trong mdt thang sau phau thuat chiing tdi ehi gap duy nhat 1 tru'dng hdp 1,43% cd khan tieng.Ty le gap bien chirng ve day than kinh quat ngu'dc gap cao nhat la sau phau thuat trong 24h dau 11,43%. Ket qua nghien cu'u ciia chung tdi cd phan thap hdn so vdi Nguyen Qudc Bao (2010) ia 13%.
Nhu' vay, vdi nhu'ng ket qua da dat du'dc d tren chimg tdi cd 98,57% dat ket qua tdt va cd 1,43% la trung binh va khdng cd tru'dng hdp nao cd ket qua xau trong 01 thang sau phau thuat trong nghien ciru cua chung tdi.
Y HOC VIET NAM THANG 5 - SO 2/2015
V. KET LUAN
Qua nghien eiru 70 benh nhan UTTG da du'dc kham va dieu trj tai Benh vien Tru'dng Oai hoc Y Ha ndi tir thang 01/2012 tdi thang 05/2014, chiing tdi du'a ra nhii'ng ket luan sau:
- Thdi gian nam vien trung binh la tir^S-lO ngay (82,86%); Sd lu'dng dich qua dng dan lu'u chii yeu tir 60-lOOmml; Thdj gian rut dng dan lull thu'dng Ja 48-72h sau phau thuat
- Ty le ha calei mau cao nhat trong vdng 3 ngay dau sau phau thuat vdi ty le la 25,71%.
- Cac bien ehirng chii yeu trong ngay dau la khan tieng tam thdi 11,43%, budn ndn va ndn 7,14%, cdn Tetany la 5 , 7 1 % ; Cac bien ehirng gap chii yeu trong 72h sau phau thuat la khan t i l n g 7,14% va cdn Tetany 2 5 , 7 1 % ; Cac bien chiTng trong tuan dau la cdn tetany chiem 10%
va khan- tieng 4,29%; Sau 01 thang chi cdn gap 1 tru'dng hdp khan tieng.
- Ket qua dieu t n trong 01 tuan cd 8 5 , 7 1 % tdt va 14,29% trung binh; Ket qua dieu trj trong 01 thang cd 98,57% tot va 1,43% trung binh.
TAI LIEU T H A M KHAO
1. American Cancer Society (2011). Thyroid Ca ncer. /7/e.-//M'M'M/. cancer. org/Cancer/ThvroidCanc er/DetailedGuide/thyroid'Cancer-keystatistlcs (Accessed on August 29, 2011).
2. N g u y i n Quoc Bao (2010). Ung thiT tuyen giap.
Qieu tri phau thuat benh ung thd 2010. Nha xuSt ban y hoc, trang 92-113.
3. Chu' Quoc Hoan (2013). Nhan xet mot so dac diem lam sang, ti le cac nhdm mo benh hoc va ket qua dieu tri ung thu tuyen giap tai benh vien
^.Luan van tot nghiep BSNT, Ha Npi.
4. Dinti Xuan Cu'dng (2004). Nghien ciTu dac diem lam sang, md benh hpc va ket qua dieu tn phau thuat ung thU tuyen giap tai benh vien K. iu^n vin thac si yhoc, Ha Ndi, 33 - 48.
5. Le Van Quang (2002). Nhan xet dac diem lam sang va cac phu'dng phap dieu tri ung thU tuyen giap tai Benh vien K tir nam 1992 - 2000. Tap d\l Yhoc, sd (431), 323 - 326.
6. Vu Trung Chinh (2002). Nghien ciru ap dung phu'Ong phap dieu trj ung thU giap trang the biet hda bang cat bd tuyen giap toan bd ket hdp I - 131. Luan vin thac sly hoc, Ha Npi.
7. Nguyen Van Thcinh (2CJ00). Oac diem giai ph§u b?nh - lam sang ciia ung thu tuyen giap nguySn phat. Y hoc thanh phd HCM, Sd dac biet chuyen de ung budu hpc. Tap 4, sd 4,114 - 1 2 1 .
DAC DIEM NHAN KHAU, XA HOI VA TIEN SIT Sif DUNG MA TUY CUA NGirm NHIEM HIV THAM GIA (PHU'aNG TRINH DIEU TRI NGHIEN CAC
CHAT DANG THUOC PHIEN B A N G THUOC METHADONE Tran Minh Hoang*, Le Minh Giang*, Pham Du-c Manh**
T 6 M TAT
Ngu'di nghien chi'ch ma tiiy nhiem HIV la nhdm cd nguy cd lay truyen HIV cao va la ddi tUdng dich ciia nhieu chudng trinh can thiep dieu trj, dU phong lay nhiem HIV d Viet Nam. Nghien ciTu md ta mgt sd dac diem nhan khau, xa hpi va tien sir si^ dung ma tiiy ciia ngu'di nghien chi'ch ma tuy nhiem HIV tham gia diSu trj Methadone tai Hal Phdng va Tp. Ho Chi Minh. Ket qua nghien ciru cho thay, tai thdi diem bat dau tham gia dieu trj, tudi trung binh ciia benh nhan la 30 tud'i.
*• Tmng tam Nghien cud va Dao tao HIV/AIDS, Tn/dng Dai hoc YHa Noi
** Cue Phong, chdng HIV/AIDS Chiu trach nhiem chinh: Tran Minh Hoang Email: Dt: 0909109481
Ngay nhan bai: 2/3/2015 Ngay phan bien khoa hoc: 30/3/2015 Ngay duyet bai: 2/4/20i5
67% chua tirng ket hdn, cd trinh dp hpc van thap, 40% cd viec lam. Tru'dc khi dieu tn Methadone, dfii tu'dng cd thdi gian sir dung ma tiiy trung binh la 9,2 nim, 43% benh nhan d t p . Ho Chi Minh va 15% b^nh nhan d Hai Phdng da tirng diing chung bdm kim tiem khi tiem chich ma tiiy. Ben canh cung cap djch vu dieu tri Methadone, can tang cu'dng cac djch vu ho trd xa hpi: bao gom dao tao va tao cdng an viec lam cho benh nhan.
TWkhda: HIV/AIDS, Methadone
S U M M A R Y
SOCIO-DEMOGRAPHIC CHARACTERISTICS AND DRUG USE H I S T O R Y AMONG METHADONE MAINTENANCE PATIENTS
WITH HIV/AIDS
HIV-positive drug users are at high risk of HIV infection and are the target group of many HIV/AIDS
