Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
- Ket qua that trT noi do 1, II, 111 bang 3.
phuong phap bin vong cao su t6t (96.5%).
Bien chirng nhe nhang. Cac trieu chirng co nang nhu chay mau, dau rat viing hau mon,
loi ra ngoai dugc cai thien ro ret. 4.
TAI LIEU THAM KHAO.
1. Nguyen Xuan Hung, "(\ic plurong plidp 5.
phdu thudt cat trT" Hau mon hoc lap 2 (2002), Tr: 49-54. Nha xuat lian ^' hoc.
2. Pham Thi Thu Ho, "Chan dodn va dieu tri benh trV Benh hoc noi khoa lap (2009), Tr:
40-48. Nha xuat ban ^' hoc. 6.
Nguyen IVIsinh Nham, "Dieu tri mot sd liC')ih ihdiig thudng viing hdii man hang thu thudt. phdu thudi" (2004), Tr: 45-49, Nha xuat ban Y hoc.
Armstrong (2002), "DN- Vcs- Hamonic
.scalpel hcrmorrhoidcclomy 500 ci)ii,scculi\c cases Dis. Col. Reel, 45:354-9.
David j , Kecrney MD, "(Icncral approach to Gastrointestinal Diseases- Current diagnosis and treatment in (lastroenterology I'rintie Hail intcnialional, INC USA 1996.P 293-307.
Harrison's Principles. Janssen LWM,
"(\msen sus hae morihoids -Ned- Genees "
Kd 1994.
HiNH ANH NOI SOI VA MO BENH HOC BENH UNG THU DA DAY
• • • • •
TAI BENH VIEN VIET TIEP HAI PHONG TLT 7/2010 - 6/2011
Le Van Thieu*
TOM TAT
Ung thu da day la benh ly ac tinh ciia te bao da day, la benh hay gap d nu'dc ta va mot so nu'dc tren the gidi, ti le mac cd sU khac nhau giu'a cac vung mien. Npi soi ket hdp sinh thiet la tieu chuan vang chan doan ung thu" da day. Muc tieu: Mo ta hinh anh npi soi va mo benh hoc benh ung thu" da day tai benh vien Viet Tiep Hai Phong. Do! lu'dng va phu'dng phap nghien cuTu: mo ta cat ngang. Ket qua:
nghien cuU 155 benh nhan ung thU da day, chiing toi thay: gap nhieu d lira tuoi 40 -69 (78,83%). Ti le nam (54,84%), nff (45,16%). Vj trf khoi u gap nhieu nhat d hang vj va bd cong nhd (65,80%) Ki'ch thu'dc khoi u phan Idn > 3cm (96,77%), be mat sui (65,80%), loet (30,32%), lan tran (3,87%). Ung thu' bieu mo tuyen la chii yeu (96,77%), ung thu' loai sarcom (3,22%). Ket luan: Ung thu' da day gap chii yeu d lira tuoi 50 - 59, nam gap nhieu hdn nij'. Vj tri u thu'dng gap d bd cong
* Benh vien Hitu nghi Viet Tiep, Hai Phong
nhd va hang vi. Phan Idn ung thu" da day la ung thu' bieu mo tuyen.
ABSTRACT
PICTURE ENDOSCOPIC ANH HISTOPATHOLOGY CANCER STOMACH AT VIET TIEP HAI PHONG
HOSPITAL FROM 7/2010 - 6 / 2 0 1 1
Backgound: Stomach cancer is a malignant disease of the stomach cells, a common disease in our country and some countries in the world, the incidence of differences between regions. Endoscopy with biopsy is the gold standard diagnosis of stomach cancer.
Objectives: Describe the endoscopic images and histologic gastric cancer at Viet Tiep Hai Phong hospital. Methods: descriptive cross-sectional.
Results: study 155 patients with gastric cancer, we found: see more at age 40 -69 (78.83%). The rate of male (54.84%) and female (45.16%). Position of the
25
HOI NGHI KHOA HOC BENH VIEN HUTU NGH! VIET TIER H A I PHONG LAN THLf 37 tumor having the most curvature in the antrum and
small (65.80%) Tumor size mostly > 3 cm (96.77%), Increased surface (65.80%), ulcers (30.32 %), spread (3.87%). Cancer is mainly adenocarcinoma (96.77%), sarcoma cancer types (3.22%). Conclusions:
Stomach cancer have mostly aged 50 to 59, men were more women. Common tumor location in the small cun/ature and antrum. Most gastric cancer is adenocarcinoma cancer.
I. OAT
VXNof
Ung thu da di\\ la benh ly ac tinh ciia Ic bao da day. khi bi kich thich ciia cac tac nhan sinh ung thu, le bao tang .sinh mot ciich vo han do, \o to chirc khong luan theo ciic co che kiem soat \c phat triC-n ciia ca the. Ung thu da day la benh hay gap a nuac ta va mot so nuac tren the giai, ti le mac co su khac nhau giira cac viing mien, la mot trong nhQng ung thu hay gap nhat ciia ong tieu hoa.Tuoi mac ung thu da day thuang gap la 50-60 tuoi, tuoi cang cao, cang tang kha nang mac ung thu da day. Nam mac nhieu han niJ, vai ty le 1,5/2. Co mot so benh dugc coi nhu tinh trang tien ung thu da day nhu: loet da day, khoi u lanh tinh da day (cac polyp u tuyen da day CO the ung thu hoa), viem teo niem mac da day lam tang nguy ca ung thu gap 4-3 lan.
Noi soi kcl hgp sinh thilt la tieu chuan vang cliiin doan ung thu da day. 6 Hai Phong, nghien ciru ve van de nay chua co nhieu, vi vay chiing loi lien hanh nghien ciru de tai nay nham muc lieu:
Mo ta hinh anh npi soi vd mo benh hgc benh ung thir da day tai benh vien Viet Ti^p Hai Phong.
II. DOI TUONG VA PHUONG PHAP NGHIEN COU
2.1. Doi tuong nghien ciiu
Fat ca cac benh nhan dugc chan doan xac dinh ung Ihir da day tai phong noi soi lieu hoa benh \icn Viet Tiep Hai Phong tir thang 7/2010 den thang 6/2011.
2.2. P h u o n g phap nghien c i i u
2.2.1. Thiet ki nghien ciiu: Nghien cuu mo ta cat ngang.
2.2.2. Cac chi tieu nghien ciru Tuoi
Giai
Hinh anh noi soi: mo ta vi tri, kich thuac, tinh chat be mat cua khoi u
Ket qua mo benh hgc.
2.2.3. Xir ly sd lieu: BSng phuomg phap thong ke \ hgc sir dung phan mem SPSS 13.0
I. KET QUA NGHIEN ClTU 3.1. Dac diem tuoi, gidi
Bang 1. Dac diem tuoi ciia nhom BN nghien ciai
Tuoi
< 3 0 30-39 40-49 50-59 60-69
> 7 0 Tong
n 5 9 40 47 29 25 155
Ti le o/o 3,22 5,80 25,80 30,32 18,70 16,12 100
Nhan xet: Phan Ion ung thu da day gap tuoi > 40 chiem 90.96%.
26
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
Bang 2. Dac diem giai ciia nhom BN nghien cii'u
Gidi Nam Nij- Tong
85 70 155
Ti le % 54,84 45,16 100
Nhan xet: Ung thu da da> gap a giai nam (54.84%) iihi^u han giai nir (45,16%).
3.2. Hinh anh noi soi
B a n g V i t r i
Tam - phinh vi Than v| - bd cong Idn Bd cong nho
Hang vi
Tien mo vi mon vi Tong
3. V i t r i k h o i u tren h i n h anh noi soi n
15 17 61 41 21 155
Ti le % 9,67 10,96 32,35 26,45 13,54 100
Nhan xet: Khoi u da da>- gap a ba cong nho chiem ti le cao nhat (32,35%), ti le gap thap nhat la tam - phinh \i (9,67%).
Bang 4.
Kich thu'dc
< 3cm 3 - 5cm
> 5cm Tong
Kich thuac khoi u tren hinh anh noi soi n
5 127
23 155
Ti le % 3,22 81,93 14,83 100 Nhan xet: Phan Ion khoi u da day co kich thuac > 5cm chiem ti le 81,93%.
Bang 5. Tinh chat be mat khoi u tren hinh anh noi soi
Tinh chat be mat cua khoi u Sui
Loet Lan tran
Tong
n 102
47 6 155
Ti le % 65,80 30,32 3,87 100
Nhan xet: chiing toi gap chu yeu la khoi u co be mat siii chiem ti le (65,80%).
3.3. Dac diem mo benh hoc
• • • B a n g 6. Phan loai Phan loai mo benh hoc
Unq thu bieu mo tuyen ong Unq thu' bieu mo te bao nhan
Unq thu' bieu mo te bao vay Unq thu' bieu mo tuyen vay
m o benh hgc ciia ung n
105 19 11 9
thu da day
Ti le % 67,74 12,25 7,09 5,80
27
HOI NGH! KHOA HOC BENH VIEN H O U NGHj VIET TIER H A I PHONG LAN THL/37^
Ung thu' bieu mo kem biet hoa 6 Ung thu* loai sarcom
Tong
5 155
3,87 3,22 100
Nhan \cl: Phdn lan chiing loi ^ap ung Ihu da day dang ung thu bieu mo tuyen ong (67,74"o), ung ihu loai sarcom chiC-ni ti Ic ihap nhal (3,22%).
IV. BAN LUAN
Qua nghien ciru 155 bcMih nhan ung ihu da da> chiing toi co mgl so ban luan nlur sau:
Dac diem tuoi, giiri ciia nhom hcnh nhan nghien ciru: nhom luoi gap nhieu nhal 50 - 59 (30,32%), liC-p dC-n la nhom luoi 40 - 49 (25.80"o), nhom lu6i 60 - 69 (18,70%), nhom tuoi > 70 (I6,12"i)), li le gap thtip nhSl la nhom tuoi < 30 (3,22%), lucSi ihap nhil la 18, tuoi cao nhat la 95. Vc giai chiing loi thaN nam co 85/155 BN chicMii ii Ic (54,84%) cao hom nij (45,16%), ti le nam/nu' la 1.21.
Ket qua nghien ciru ciia cac tac gia khac cung CO ti le tuang tu ket qua nghien ciru ciia chiingt6i[l], [3],[4].
Hinh anh noi soi: Vi tri khoi u trong da day chung toi thay gap nhieu nhat a bir cong nho chiem ti le (32,35%), ke din la hang vi (26.45%), tiln mon vi mon vi (13.54%), than \i ba cong lan (10,96%), thdp nhSt la tam - phinh vi (9,67%). Khi lam noi soi chung toi thay rang mac dii ton thuang loci viing tam - phinh vi va than vi it gap nhung khi gap ton thuang loet viing nu) thi nguy ca ac tinh rat cao. Kich thuac khoi u tren noi soi chiing toi thay rang phhn lan khi benh nhan din kham kh6i u da lan > 3cm (96,77%) trong do u co kich thuac > 5cm chiem ti Ic
14,83%, ti le gap khoi ac tinh < 3cm la rill th4p (3,22%), trong s6 nay co 1 benh nhan 6 loet tien mo vi kich thuac 0,7cm khi sinh thiet lam mo benh hgc da co te bao ung thu.
Tinh chat be mat ciia khoi u tren noi soi chiing toi thay rang phhn lan khdi u co bl mat siii chilm ti le (65,80%), tilp din la thi loet (30,32%), th^p nhat la the lan tran (3,87%).
Dac diem mo benh hgc: khi nghien ciru mo benh hgc cua 155 benh nhan ung thu da
day chiing loi ihay chiem li le cao nhat la ung Ihu bii-u mo luycn co 150/155 benh nhan chilm li Ic (96,77%), cim lai la ung thu loai sarcom (ung thu khong bieu mo) chiem ti le (3,22%). Trong ung thu bieu mo tuyen gap nhieu nhat la ung thu bieu mo tuyen ong (67,74%), tiep den la ung bieu mo te bao nhan (12,25%), ung ihu bieu mo le bao vay (7,09%), ung thu bilu mo tuyin vay (5,80%).
ung Ihu bieu mo kem biet hoa (3.87%).
V. KET LUAN
Tir ket qua nghien ciru 155 benh nhan ung thu da day chiing toi ait ra ket luan nhu sau:
Ung thu da da\ gap chii \eu a lira tuoi 50 - 59, nam gap nhieu han nu".
\'i tri u thucrng gap a ba cong nho va hang \i (65.80"o). bl mat u siii (65.80%).
Phan Idn ung ihu da day la ung thu bieu mo luycn (96.77" o).
TAI LIEU THAM KHAO.
1. Nguyen Ngoc Himg, Nguyen Van Tuyen, Nguyen Van Binh (2007), "Phan logi mo h(,h]h hoc ung thu da ddy' \ hoc Thanh pho Ho Chi Minh, tap II, s6 3, tr: 57-60.
2. Hosokawn O, Watanabe K, Hatorri M et al (200J), "Detection of gastric cancer by repeat endoscopy within a short time after negative exatnination" Endoscopy 2001; 33:
pp; 301-5.
3. Liu \ , Uemura N, Xiao XD et al (2005),
"Agreement between endoscopic and histological gastric atrophy scores", J.
Gastroenterol. 2005; 40: pp: 123-7.
4. Suzuki H, Iwasaki E, Hibi T (2009),
"Helicobacter pylori and gastric cancer", Gastric cancer 2009; 12: pp: 79-87.
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