DIEN DAN Y HOC
Nghien cii'u khoa hpc
Nghien cii'u hieu qua cua phucfng phap choc hut bang kim Wang 3 19 trong noi soi phe quan
chan doan ung thii phe quan tai khoa Ho hap Benh vien Bach Mai
• I • • • Hoang Hdng Thai*
TOM TAT
Bat van 66: ndi soi phi quan, sinh thiit tin thudng phi quan tuy da dat kit qua chin doin cao nhung trong mpt si trudng hdp cdn bd sdt tin thuang. Phuang phip choc hut bang kim trong npi soi phi quan cd thi hi trd cho ky thuat sinh thiit. Muc tieu: nghien cdu hieu qua cua phuang phap choc hut liy benh phim bang kim Wang 319 trong npi soi phi quan d nhdng benh nhin nghi ngd ung thu phi quan. Dii tudng: 68 trudng hop nghi ung thu phi quan nguyen phit diiu trj tai Khoa Hd hip, Benh
vien Bach Mai td 1/1/2002 din 30/12/2003. Phuong ti§n, phirang phap: nghien cdu hdi cdu md ta cat ngang. Npi soi phi quan ing mim vdi 2 ky thuat liy benh phim ding thdi: sinh thiit bang kim vi chac hut bang kim Wang 319 (hang Mill Rose Compagny Ltd. Ohio USA), so sinh kit qua cua hai ky thuat.
Kit qua: sinh thiit phi quan xac djnh ung thu 55 trudng hap vi 13/68 trudng hgp kit qua xet nghiem md hoc im tinh. Choc hdt bang kim Wang 319 d 13 trudng hdp niy phat hien cd ti bao ung thu 9/13 trudng hgp do sinh thiit bd qua (16j8%).
Md benh hoc cua 68 trudng hdp nghien edu: ung thd biiu md vay (ilTBMV) li 22 trudng hgp (32%), UTBM tuyin li 17 trudng hgp (25%), UTBM tibio nhd -12 trudng hgp (19,4%), UTBM tibio Idn - 8 trudng hgp (12%), UTBM viy- tuyin li 7 trudng hgp (10,4%), UTkhdng xip loai -1 trudng hgp (0,7%), U tibio thin kinh - npi tiit 1 trudng hgp (0,7%). Ke't luan: choc hut bang kim Wang 319 cd hieu qua chin doin xic djnh cao hon sinh thiit bang kim trong mpt si tin thudng. Kim di sd dung, khdng cd tai biin.
I. DAT VAN DE
Ung thu phe quan ngay nay II benb ed ty le mac va tu voug cao. Mac du cd rat uhieu phuong phip lay benh pham, chan doln cdn bd sdt nhieu trudrtg hgp. Sy phdi hgp ele ky thuat lay berth phim giiip cho chan doln xlc djnh duge nlng len rat nhieu. Ndi soi phe quan, ket qua ciia sinh thiet phi quan blng kiin dugc coi nhu tieu chuan vang.
* Khoa Ho hip - Berth vi$n Bach Mai
Ky thuat chgc hiit bang kim Wang 319 la rtidt trortg nhirrtl ky thuat hd trg cho sirth thiet phe quirt. Vi vay, churtg tdi dert birth de tai nham muc tieu:
Nghiin cihi hiiu qua cua phUffng phdp chOc hut Idy benh pham bdng kim Wang 319 trong ngi soi phe quan ff nhiing benh nhdn vi lam sdng vd X quang nghi ngd ung thu phi quan.
So 42 (TRahg 67/2009) Y HOC LAM SANG I 4 l
DIENDAN Y HOC
Nghien cii'u khoa h p c
II. DOI T i r p G VA PHirCTNG PHAP
1. Ddi tuOTig nghien cuu: 68 BN UTPQ dugc ngi soi phS quIn va choc hiit bang kim Wang lay berth pham xet nghiem cho chan doln tai Khoa Hd hap, Berth vien Bach Mai tir 1/1/2002 din 31/12/2003.
Tieu chuan lya chgn benb nhart: cle benh nhan dugc thyc hien sirth thiet bang kim va chgc hiit bang kim, xac dinh ung thu qua ket qua md benh hgc-te bio hoc. Hai ky thuat duge tien hinh ddng thdi tren ciing mdt benh nbin khi soi phe quan.
2. Phuxmg phap nghien cihi: nghien ciru hdi ciru md ta. CIc thdng tin dugc khai thIe tir benh In luu trir tai phdng hd so ciia Benh vien Bach Mai theo mau thdug rthat.
Qui tiirth ndi soi phS quan: phuang dert: miy soi phe quirt dng mem ky hieu 0TV-F3 va kim Wang 319, kim sinh thiet. Chuan bi benb nhan, tbudc, cle phuong tien cap cdu, quy tiinh soi phe quan, nhu mgi cuge soi thuong qui. Lay benb pham khi c6 tdn thuong bang hai phuong phap: sinh thiet bang kim sau dd chgc hit tdn thuang bang kim. Theo ddi benh nhan sau soi 24 gid. Benh pham: benb pham dugc xirly, dgc ket qua tai Khoa Giai phau benh, Benb vien Bach Mai.
Xu ly sd lieu: c l c s d lieu thu thap dugc xir ly thdng ke tren phln mdm SPSS 10.05.
III. KET QUA NGHIEN Clhl
68 trudng hgp (TH) tud'i trung binh 62,4 ± 11,4 tudi, thap nhat II 24 tudi, cao nhat 83 tudi. Do tudi 40-70 cd 53 TH (77,9%). Tren 70 tud'i cd 7 TH (5 nam, 2 nir), chidm 10,3%.
Bdng 1. Cdc triiu ehung cff ndng
Trieu chiing Dau nguc Gly siit Ho kban Kb6 tha
n 53 46 44 39
% 77,9 67,6 64,7 57,4
Trieu chiing Ho ra mlu Khan deng Nudt nghen
n 26 17 13
% , 38,2
25 19,1
Nhdn xet: ele trieu ehung dau ugyc, gay siit, ho khan hay gap nhat. Dac biet, cd 26 trudng hgp cd ho mlu (38,2 %). Chen ep day than kinh quit ngugc X cd 17 TH (25%).
Bang 2. Cdc trieu chirng thuc the Trieu chiing
Hoi ciiuTig ba giam
Hoi cliung dong dac Hoi ctiung Pierre-Marie Hoi ehung Pancoast- Tobias
n 41
15 12 9
%
63
22 17,6 13,2
Trieu chiing Hach thuong don
Hoi ehung chen ep tinh mach chii tren Hgi ehung Claude-Bernard- Horner Vu to a nam
n 7 4 1 1
%
10, 3 5,9 1,5 1,5 Nhdn xet: trong 68 trudng hgp nghiert ciru hdi
2. Tren X quang ghi nhan ton thuong (n=68) Phdi phai 43 TH (63,2%), phdi trai: 24 TH (35,3%), c l hai phd'i 1 TH (1,5%).
Hach trurtg that to: 17 TH (26,6 %),
Cd u rd 14TH (21,9%), ndt md don dde 14 TH (21,9%), td'rt thuortg mlrtg phd'i 17 TH (25%), xep phd'i 3 TH (4,7%).
3. Hinh anh tren CT nguc (n=56)
- U phdi rd 18 TH (32,1%), hach to trung thit:
22 TH (39,2%).
- Tran dich mang phdi 12 TH (21,4%), xep phd'i 3 TH (5,3%), uug thu hoai tir 1 TH (1,8%),
chiirtg 3 gilm gap rthieu rthat.
u xam lan thlrth rtgye 1 TH (1,8%). '• ' • 4. Noi soi phe quan
- Chit hep phe quan: 24 TH (35,3%), tham nhiim: 21 TH (30,8%),
- U sili: 14TH (20,5%), de ep tirngoai: 5 TH (7,4%), 5. Vj tri, hinh anh ton thutrng
O phS quan: dinh phii 12 TH (17,6%), dinh trai - 8 TH (11,8%).
PQ gde phai: 9TH(13,2%), gde trii: 6 TH (8,8%).
PQ dly phai: 14 TH (20,6%), dly trii: 11 TH (16,2%).
PQ thuy giira: 4 TH (5,9%).
4 2 IY HOC LAM SANG SO 42 (Thang 07/2009)
DIEN DAN Y HOC
Nghien cifu khoa hoc
Bdng 3. Hiiu qua ciia cdc ky thudt Idy benh phdin trong khi soi (ii=68)
^ ^ ^ T o n thmnig Ky thuat ^ ^ - ^ Sinh thiet PQ
Choc hiJt bang kim Wang 319
Chai phe quan
U r o (n-14)
12 9 10
Chit hep (n=24)
21 14 6
Tham nhiem (n=21) 18
7 8
De ep tirngoai
(n=5) 1 3 1
Khong thay ton thuxmg (n=4)
3 0 2
Tong so
55 33 27
Sinh thiet phe quan thay te bao ung thu 55/68 TH, cd 13 TH khdng thly tg bio ung thu nhung chgc hiit bang kim Wartg tbay tdrt thuortg ung thu d 9/13 TH.
Nhdn xet: ve tdng the, ket qua sinh thiet phe quan tim thay tdn thuang ung thu cao hon so vdi chgc hiit bang kim Wartg. Trortg sd 13 trudng hgp sinh thiet cho ket qua am tinh, choc hiit bang kim Wang thay tdn thuang ung thu d 9/13 trudng hgp.
6. Cac typ md benh hoc
Urtg thu bieu uid tS bao vay - 22 TH (32, 3%), ung thu bieu md tuyen - 17 TH (25%).
Ung thu bie'u md tg bao nhd - 12 TH (17,6%), ung thu bieu md td bao Idn -8 TH (11,8%).
Urtg thu bieu md te bao vay - tuyen 7 TH (10,3%), ung thu khdng xgp loai - 1TH(1,5%).
U te bao than kinh - ndi tiet - 1 TH (1,5%).
IV. BAN LUAN
Tren 68 TH mac KPQ cd chgc hiit bang kim Wang lay benb pham chart doln ehung tdi thly:
tudi tir 40 dSn 70 tudi gap nhiSu: 53TH (77,6%).
Tudi trurtg binh 62,4 + 11,4. Ty le nam/nir = 7/1.
Sd lugng cd do tudi tren 40 gap tuang tu nhu nhieu nghienctm[I], [2], [3], [4].
Bieu hien lam sang cua 68 BN nghien cuu:
Tren 50% sd TH d giai doan' ung thu xam rthap vdi trieu ehung dau ngyc 53 TH (77,9%), gly siit 46 TH (67, 6%), ho khau keo dii 44 TH (64,7%), khd thd 39 TH (57,4%), tuortg ty rtbu mdt sd rtghien cuu [1],[2]. Ngoai ra, ehung tdi cdn thay trieu ehung bo ra mau 26 TH (38,2%), khIn tiSng 17 TH (25%), nudt nghen 13 TH (19,1%), hach thugng ddn 7 TH (10,3%), chen ep tinh mach chii tren 4 TH (5,9%). Qua cac trieu cbung ghi nhart dugc d tren cho thay gart mot nira sd trudng hgp rtghiert cuu ciia ehiing tdi da d giai doart rtang .
Can lam sang
Cd 56 /68 TH dugc chup CT ngyc: gin 50% sd TH da cd xam nhap ung thu vao bach trung thit.
Theo phan loai TNM cua To' chirc Y li Thi gidi:
50% sd trudrtg hgp rtghiert ciiu cua chiing tdi da ed tdrt thuang hach trung that va d giai doan N2 [3], [5], [7], [8].
Trong 68 trudng hgp dugc soi phe quan: cd u rd trong long khi phe quan khoang 10 dert 20 % sd TH.
Tdrt thuang dtrdi dang tham rthiem, si^ii loet niem mac chiem uu the. Tdrt thirong nhu vay, sinh thiet khd lay dtrgc benb pham, ty le chi dat 80% [4],[5]. Vdi nhung hcin che eiia kim khi sirth thiet, choc hut bang kim de lay benh pham da chan doln them dugc 9 TH trong sd 13 trudng hgp sinh thiet cho ket qui am dnh.
Dasgupta A [6] sinh thiet ehi dat dugc 65%, chgc hut bang kim chan doln ung thu phe quan dat ket qua tdi 96%. Day II uu diem ciia ky thuat chgc hut bang kim Wang 319 [3],[5],[6],L8].^
Chgc hut lay benh pham bang kim Wartg 319.
Tren 68 TH dugc chgc hut bang kim Wang 319: 33/68 trudng hgp cd te b i o ung thu (48,5%). Sinh thiet phe quan cho ket qua md benb hoc thay tdn thuong ung thu d 55 trudrtg hgp vl am tinh d 13 trudrtg hgp. Trong 13 trudng hgp sinh thiet cho ket qua am tinh, chgc hiit bartg kim Wartg 319 x l c dirth ung thu them 9/13 trudng hgp (13,2%).
Choc hut bang kim Waug 319 thay tdrt thuang ung thu trong cac tdn thuang: phu nS tham nhiim, de ep phe quan td ngoai vao. Nhung ton thuaug nhu vay sinh thiet bang kim da bd sdt chan doan.
Hieu qua chan doln ciia chgc hiit bang kim Wang 319 so vdi sirth thiet bartg kim sinh thiet da dugc nhieu nghien ciru nhart xet [4], [5],[6],[8].
Trert 68 trudng hgp xlc dinh chan doan la ung thu phe quart, trong do UTBM te bao vay 22
So 42 (Thang 07/2009) Y HOC LAM SANG I 4 3
DIENDAN YHOC
Nghien cii'u khoa hpc
truang hgp (32%), UTBM tuySrt 17 trudrtg hgp (25%), UTBM tS bao rthd 12 trudrtg hgp (19,4%), UTBM tS bio Idn 8 trudng bgp (12%), UTBM ti bao vay-tuySn 7 trudng hgp (10,4%). Ung thu khdng xip loai 1 trudng bgp (1,5%). U te bao than kinb - ngi ti&t 1 trudng hgp (1,5%). Ty le, thanh phan ele loai te bao ung thu trong nghien cuu ciia chiing'tdi khdng khac biet vdi ele nghien ciru trudc day [1],[2],[4],[8].
V. KET LUAN
Nghien cuu 68 benh nban dugc chan doan ung thu phe quIn, dieu tn ndi tru tai Khoa Hd hap, Bgnh vien Bach Mai tu 1/1/2002 din 30/12/2003 chiing tdi cd ket luan sau.:
1. Dac difi'm ehung: nam nhieu ban rtir (rtam/nir = 7/1), tap trung chii yeu tir tudi 40-70, chiem 77,6%.
2t Noi soi phe quan: hinb thii va vj tri tdn thuong phe quan
Ndi soi phe quIn cd u ro 14 TH (%), chit hep phe quan 35,5%, tham nhiem niem mac 25,5%, de ep tu ngoai 6,3%.T6n thuong phe quirt thiiy treu eua hai phdi gap nhieu nhat, cbii yeu d beu phai
Choc hut bartg kim Wang 319:
- Cho ket qui cao hon sinh thiet phe quan ddi vdi cic tdn thuong phii ne chiit hep, de ep phe quan tir ngoai. ^
- Nang do nhay ciia chan doln len them 19%
so vdi sinh thiet phe quirt.
3. Cac typ m6 bihh hoc: UTBM vay virt II typ ung thu hay gap v l vi tri dhi trong cle typ ung thu phe quirt. Urtg thu phi quIn hdn hgp ti bao cd xu hudng tang.
TAI LIEU THAM KHAO
7. Ddng Khac Hung (1995), "Nghiin cm vS Idm sdng, X quang phdi chudn vd mdt sd ky thuat xdin nhap de chdn dodn ung thu phdi nguyin phdt", Luan dn phd tien si khoa hgc Ydugc, Dgi hoc Y Hd Noi.
2. Hoang Hdng Thdi (2001), "Quy trinh ngi soi phe quan", Tdi lieu dao tao mdt sd ehuyin di vi hd hdp, Hd Ndi, tr 264 - 310.
3. Nguyen Vughg, Nguyen Nggc Hdng vd cs (1998) Chdn dodn md binh hgc trudc phdu thudt ung thu phi quan phdi" phu trucmg Y hgcViit Nam. Chuyin di gidi phdu binh Y phdp. Hd Ndi, trang 1-3.
4. Atul c.Mehta, Mani s.kavuru. (1989), "Transbronchial needle aspiration for histology specimens, Chest 96, pp:1228 -1232.
5. Cetinkaya E,Yildiz. P (2004),"Diagnostic value of transbronchial needle aspiration by Wang 22 gauge cytology needle intrathoracic lymphadenopathy".
Chest.pp 527 531.
6. dasgupta a., join p., minaio.a.(1999), "Utility of trans- bronchial needle aspiration in the diagnosis of endo- bronchial lesions. Chest, May 115 (5), pp.1237-1241.
7.Lundgren R., Bergman F, Angstrom T.(l983), "compar- ison of transbronchial fine needle aspiration biopsy, aspiration of broncliial secretion, broncliial washing, brush biopsy and forceps biopsy in the diagnosis of lung cancer, eurj .respir dis, 64, pp. 378 -385.
8. Wang K.P, Harrow E. M.( 1997), "Transbronchial needle aspiration, a decade of experience, Technic of fiberoptic bronchoscopy, Philadelphia, pp.85 -92.
SUMMARY
DIAGNOSTIC VALUE OF TRANSBRONCHIAL NEEDLE ASPIRATION BY WANG NEEDLE IN D I A G N O S I S OF LUNG CANCER
Background: Bronchoscopy and forcep biosy is a "Gold standard" for diagnosis of lung cancer but some time have a false negative result. Transbronchial Needle Aspiration technique with Wang 319 is ah effective procedure to obtain a specimens. Objective: studying effectiveness Of the transbronchial needle aspiration for diagnosis of lung cancer by Wang 319 and a comparison betwen two technics of biopsy (byforcep and by Wang needle aspiration). Subject: 68 patients at Respiratory Department of Bach mai Hospital (Jan./2002 - Dec./2003), who had suspision of malignant disease on clinical examination, chest radiography, bronchoscopy, histologic and cytologic specimens were malignancy.
Material and method Transbronchial needle aspiration Using Wang 319 needle (Mill Rose coinp Ltd.
Ohio USA). Desriptive cros-sectional retrospetive. Result: On 68 patients with diagnosis of lung can- cer Forcep biopsy was negative in 9 patients, but was positive by Wang 319 needle. The histology of all patients were; squamous cell carcinoma: 22 (32%) patients; adenocarcinoma: 17 (25%) patients, smdil cell carcinoma: 8 (19.4%) patients; large cell carcinoina:7 (12%) patients, adeno-squamous cell carcinoma; 10.2 % and 1 neuroendocarcinoma (1.5%), unknow origin carcinoma: 1 patient (1.5%). Conclusion: Transbronchial Needle Aspiration technique with Wang 319 is a safe, effective procedure to obtain a specimens for diagnosis of bronchogenic carcinoma.
4 4 IY Hoc LAW SANG SO 42 (Thang 07/2009)
