Y HOC VIET HAM THANG 6 - SO 1/2015
V. KET LUAN
- Trong benh nhan dj irng thudc, ham lu'dng IgE huyet thanh cao gap nhieu lan chi so binh thu'dng, dac biet loai hinh dj iTng nhanh - Ham lu'dng IgE huyet thanh trong benh nhan dj irng thuoc cd mdi tu'dng quan thuan, chat che vdi mire dp phan huy te bao mast.
TAI LIEU T H A M KHAO
1. Bo Y te (2003), Cac gia tri sinh ngu'di Viet Nam binh thu'dng, thap ky 90- The ky XX, Nxb Y hoc Ha Noi, tr: 79-90
2. Phan Qua ng Doan (2003), "LTng dung phan utig phan huy te bao mast va tieu bach cau dac hieu trong chan doan di ung thuoc", Tap chi Y hgc thirc hanh (4), tr: 17-19.
Pham Le Tuan, Nguyen Van Doan, Pham Manh Hung ( 1 9 9 9 ) , " Nghien ciTu IgE toan phan trong huyet thanh nhan vien y te co tien su"
dl LTng thuoc khang sinh ho Beta-lactam,, Thong tin Y -DUdc (3), tr: 26-29
Baldo B.A, Pham N.H (2002),
"Immunoglobulin E binding determinant on beta- lactam drugs", Curr Opin Allergy Clin Immuno, Aug, 2(4): 297-300.
Lebrec H, Bachot N, Gaspard I et al (1999),
"Mechanisms of drug - induced allergic contact dermatitiss". Cell Biol Toxicol, Feb, 15(1), pp. 57-62.
Parks K.W, Casale T.B (2006), "Anti- immunoglobulin E monoclocal antibody adminisstered with immunotherapy", . Allergy Asthma Proc, Mar-Apr, 27(2), pp. 33-36.
Sadok Y ( 2 0 0 5 ) , "Diagnosis of type I hypersensitivity by laboratory test" Tunis Med, Aug, 83(8), pp. 441-4.
NAO HACH TRONG PHAU THUAT NOI SOI
CAT DAI T R A N G D O U N G THU"
Huynh Thanh Long*, Vu Huy Niing**, V6 Bich D^i Hao*, Tran Quoc Hung*, Nguyen Thanh Nhan*
T6M TAT
D^t vSn de: Phau thuat noi sol cat dai trang dupe thi/c hien dau tien tren the gidi nim 1991 bdi Jacob. Chung toi thi/c hien nghien ciru nay nham danh gia tinh hieu qua ciia cua nao vet hach trong phau thuat ngi soi c3t dai trang do ung thu".
Doi tu'dng va phu'dng phap nghien cihi;
Nghien ciru hoi ciru cac benh nhan du'dc chan doan la carcinom hjyen nguyen phat ciia dai trang va du'dc phlu thuat ngi soi d t dai trang den 12/2012 tai Berih vien Dai hgc YDU^c TPHCM.
Ket qua: Khong cd tru'dng hpp nao dien cat gan va__dien cSt xa con te bao ung thu" ve ca dai the lan vi the, sau khi hoi cir b3ng ghi hinh cijng khong ghi nhan tru'dng hdp nao khong cSt t | n goc mach mau. So lu'png hach trung binh la 11.5.
Ket lu|n: Nao vet hach trong phau thuat npi soi c3t d?i trang do ung thu' la hieu qua.
Tiy khoa: Ung thu dai trang, Phau thuat noi soi cSt dai trang, Nao hach D3.
*Benh vien Nguyen Tn Phu'dng
** Hgc vien Quan Y
Chju trach nhiem chinh: Huynh Thanh Long Email:[email protected] Dt: 0913562056 Ngay nhan bai: 20/3/2015
Ngay phan bien khoa hoc: 08/4/2015 Ngay duyet bai: 16/4/2015
SUMIVIARY
LYPHADENECTOMIE I N LAPAROSCOPIC COLECTOMIE FOR COLON CANCER Background: Laparoscopic Colectomie was first performed by Jacob in 1991. The aim of this study was to investigate the the efectively of Lyphadenectomie in Laparoscopic Colectomie for Colon cancer.
Method: Retrospective study, we reviewed colon cancer patients who underwent laparoscopic colectomie at UMC from 01/2010 to 12/2012.
Results: The proximal and distal margin were both clear in macroscopic and microscopic. The lymphnode yield was 11.5.
Conclusion: Lyphadenectomie tn Laparoscopic Colectomie for Colon cancer is effective.
Keywords: Colon cancer, Laparoscopic Colectomie, D3 Lyphadenectomie.
I.OATV/(NOE
Hach lympho la du'dng di can chinh ciia UTOT, nao vet het hach viing hay con gpi la nao vet hach trong phau thuat LTTDT can du'dc tien hanh triet de. Xae djnh dung so lu'dng hach viing va so lu'dng hach viing bi di can rat quan trpng trong chan doan chinh xac giai doan benh cung
Y HOC VIET NAM THANG 6 - SO 1/2015 nhu' lap ke hoach dieu tri. Trong phau thuat cat
dai trang do ung thu', toan bp mac treo tu'dng uTig phai du'dc cat bd de bao dam lay dl tat ea cac hach nam trong do.
Phau thuat npi soi cat dai trang du'dc thu'c hien dau tien tren the gidi nam 1991 bdi Jacob, nhO'ng nghien ciru y hpc chu'ng cir mire 6q III da cong nhan Idi ich ciia phau thuat npi soi trong dieu trj ung thu' dai trire trang nhu" giam chan thu'dng phau thuat, giam bien chirng hau phau, thdi gian hoi phyc hoi nhanh, seo mo nhd[3], ti le song eon tu'dng td nhd eae phau thuat mo md kinh dien va dat du'dc nhO'ng ket qua tot ve mat ung thiT hpc, bao dam du'dc cac nguyen tac trong dieu tri ung thu* nhu" la phau thuat each ly khong cham, that maeh mau tan goe, ed the nao vet hach...[4].
Chiing toi thirc hien nghien ciTu nay nham danh gia tinh hieu qua eiia nao vet hach trong phau thuat npi soi cat dai trang do ung thu'.
II. OOI TU'OMG VA PHircrNG PHAP NGHIEN CCTU Doi tiTdng nghien cu'u: cae benh nhan tai benh vien Oai hpe Y Du'dc TPHCM du'dc chan doan la carcinom tuyen nguyen phat cua dai trang va du'dc dieu trj bang phau thuat npi soi cat dai trang tir 01/2010 den 12/2012.
Phu'dng phap nghien ciru: nghien cifu hoi ciru, eat ngang mo ta,
Tieu chuan loai trir:
Khong lien lac du'dc benh nhan.
Khong lay du'dc ho sd benh an.
Benh nhan ed u khac tren khung dai trang hoac dl can xa du'dc phau thuat md rpng.
Benh kem theo: da p6-lip dai tri/c trang, viem loet dai trang.
Theo Hiep hpi Nghien culj Ung thu' dai - trdc trang Nhat Ban, cae hach lympho d dai trang du'dc phan thanh eac nhdm sau:
Nhom 1: gom eac hach tren thanh dai trang hoac canh dai trang d kiioang each khong qua 5 em chieu rpng so vdi dau gan va dau xa ciia khoi u, tinh luon kich thu'dc khoi u.
Nhdm 2: gom cac hach tren thanh dai trang hoac canh dai trang d khoang each tren 5 cm nhu'ng khong qua 10 cm chieu rpng so vdi dau gan hay dau xa ciia khoi u, cac hach trung gian dpc theo dpng mach nuoi du'dng doan rupt cd khoi u.
Nhom 3: gom cac hach chinh d goe eiia dpng mach nuoi duQng doan rupt co khoi u.
Nhdm 4: gom cac hach xa hdn nhdm 3 (nhu' cac hach dpc theo dpng mach mac treo trang tren gan nguyen iiy ciia dpng mach dai trang giiJa hoac cac hach canh dong maeh chu bung).
- Cac mu'c do nao hach:
DO: khong nao hach, hoac nao khdng hoan toan hach nhdm 1.
Dl: nao hach nhom 1.
D2: nao hach nhdm 1 va 2.
D3: nao hach nhdm 1, 2 va 3.
- Phau thuat noi soi cat dai trang, nao hach trong nghien cu'u cua chung toi
Trong phau thuat npi soi eat dai trang tai BV Dai hpe Y Du'dc TP HCM, ehiing toi ap dung ki thuat phau tieh tu' Ijong ra va nao hach mii'c D3:
Ddi vdi eat dai trang phai: Phau tich va that tan gdc eiia dpng tinh mach hoi ket trang, that bd mach dai trang phai tan goe neu eo.Trong tru'dng hdp u d dai trang gdc gan, can phai eat dai trang md rpng, ehiing toi that luon nhanh phai ciia dpng mach dai trang glu'a
Ooi vdi cat dai trang trai: Phau ti'ch dpc theo dpng maeh mac treo trang du'di, bpc 16 va that tan goc dpng mach dai trang trai. Phau tieh va that tmh mach mac treo trang du'di, cung tai vj tri nay, that lai dpng mach dai trang trai lan thuT hai. Tiep tue phau tieh dpc theo dpng mach mac treo trang du'di hu'dng ve phia ehan benh nhan, that 1 hay nhieu nhanh dpng mach dai trang chau hong tiiy theo vj tri khoi u. Trong tru'dng hdp u d dai trang gde lach, can phai eat dai trang md rpng, se that luon nhanh trai ciia dpng maeh dai trang giO'a.
Cat dai trang chau hong: Phau tich dpc thep dpng mach mac treo trang du'di, bpc Ip va that tan goc dpng mach dai trang chau hong
Bu'dc ke tiep, phau tich tir ngoai vao di dpng dai trang len dai trang gdc gan, dai trang goc lach, dai trang xuong, dai trang chau hong, phan tren trdc trang ra khdi thanh bung sau.
Cat dai trang ngang. phau tich tir trong ra:
dau tien lat dai trang ngang len, xac djnh bo mach dai trang giffa, phau tieh, kep cpt bd mach dai trang glu'a. Phau tieh tir ngoai vao, dl vao hau cung mac noi, dl dpng mac trep dai trang ngang ra khdi tuy, ta trang, di dpng dai trang goc gan va dai trang goc lach.
Hien nay khong edn khai niem nao hach D4, bdi vi khi ung thd da lan den cac nhdm hach nay thi coi nhu' da di can xa, do dd ket qua phau thuat con it du'dc cai thlen[5].
Y HOC VIET NAM THANG 6 - SO 1/2015 So lieu du'dc thu thap tir ho sd benh an tir
liic mo den sau phlu thuat 1 thang, gpi dien thoai cho benh nhan, xem lai bang ghi hinh du'dc thu lai. So lieu du'dc lu'u tru' va thong ke bang phan mem IBM SPSS 20.0 .
III. KET QUA
Chiing toi theo doi du'dc 235 benh nhan thda tieu chuan chon benh, trong dd co 120 nam (51,1%), 21 nd (48,9%). Tuoi trung binh 57,43
± 14,11 (18-89).
Vj tri u: u d manh trang co 18 tru'dng hdp(7,7%), dai trang len 42 tru'dng hdp (17,9%), dai trang gdc gan 33 tru'dng hdp (14%), dai trang ngang 27 tru'dng hdp (11,5%), dai trang gdc lach 15 tru'dng hdp (6,4%), dai tr^ng xuong 29 tru'dng hdp (12,3%), dai trang chau hong 71 tru'dng hdp (30,2%),
Chuyen mo md ed 12 tru'dng hdp (5.1%) nguyen nhan chii yeu la do u to, xam lan cae cd quan lan can. Trong dd 1 tru'dng hdp lam thung bang quang do u xam lan bang quang.
Co 40 tru'dng hdp u d giai doan T4 (17%), 195 tru'dng hdp u d giai doan T3(87%)
Trong nghien culi ciia ehiing toi, khong ed tordng hdp nao dien eat gan va dien cat xa con te bao ung tliu' ve ca dai the lan vi the, sau khi hoi cir bSng ghi hinh cung khong ghi nhan tru'dng hdp nao eat khong tan goe mach mau. So lu'dng hach nao vet du'dc trung binh la 11.5, khi phau b'ch ed 48 tru'dng lidp cd hach den nhdm 3 (20.4%), 98 tru'dng hdp ed hach den nhdm 2 (37.8%), 185 truidng hdp ed hach den nhdm 1 (70.6%).
IV. BAN lU^U
Trong sir tranh luan vB tinh an toan ve ung thu* hpc, mpt cau hdi Idn nhat du'dc dat ra la lieu phau thuat npi soi cd dat du'dc tinh triet can tu'dng du'dng vdi mo md hay khong, tranh du'dc s;/ phat tan te bao ung thu' vao khoang phuc mac hoac trong Idng doan rupt ke can cOng nhu' bao dam tinh an toan eiia dien eat gan, dien eat xa, mii'c dp nao vet hach, so lu'dng hach, dam bao du'dc ky thuat "cpt cao" (high ligation) tai goc dpng mach, Ap dyng nhuTig tieu chuan danh gia dai the va vi the benh pham nhieu tac gia da chutig minh du'dc phau thuat npi soi cat dai trang hoan toan cd the dap irng du'dc nhu'ng yeu cau tren va eho ket qua tu'dng du'dng vdi mo md. Phan tieh gop 2071 ngu'di benh ung thu* trye trang ciia Aziz va cs khong cd sir khac biet glQ^
mo npi spi va mo md ve an toan eiia bd cat hay
so lu'dng hach lympho thu du'dc[6]. Trong phan tich gop 1536 ngu'di benh ung thu' dai trirc trang (796 ngu'di mo npi soi va 740 ngu'di mo md), Bonjer va cs [2]:
Sd hac lympho trung binh 11.8 ± 7.4 trong phau thuat npi sol 12.2 ± 7.8 trong md' md
Su' khac biet khdng cd y nghTa thong ke (p=0.40)
Bd cat con mo ung thu"
2.1% CLia nhdm mo md 1.3%CLia nhdm npi soi
Su' khac biet khong c6 y nghTa thong ke (P=0.23)
Trong nghien ciru ciia ehiing toi, khong co tru'dng hdp nao dien eat gan va dien cat xa con te bao ung thu" ve ca dai the lan vl the, so lu'dng hach trung binh la 11,5, ket qua tu'dng du'dng vdi eac tae gia ndi tren.
Nhu'ng bien doi ciia mach mau dai trang phai rat da dang nen trong phau thuat cat dai trang phai do ung thu'va nhat la phau thuat npi soi doi hdi phau thuat vien phai nam vu'ng giai phau mach mau dai trang phai, nhat la hai bo mach hoi dai trang va dai trang phai, Khi phau tich 2 bd mach nay, tTnh mach mac treo trang tren la mdc giai phau quan trpng nhat, tat ea mach mau dai trang ben phai ciia tinh mach mac treo trang tren phai du'dc that tan goe. Do dd, viec nhan djnh dpng maeh hoi dai trang di tru'dc hay sau tTnh mach mac treo trang tren giiip phau thuat vien chii dpng trong phau ti'ch tan goe bd mach nay, Trong tru'dng hdp dpng mach hoi dai trang bat cheo tru'dc tinh maeh mac treo trang tren, khi do can phai phau tieh sang ben trai bd mach nay. Ve giai phau dpng maeh dai trang phai, tren phu'dng dien phau thuat npi soi, ehi khi nao dpng maeh nay xuat phat trut tiep tir dpng mach mac treo trang tren mdi du'dc gpi la dpng mach dai trang phai. Mpt nghien cdo nam 2012 ciia Nguyen Hoang Bac[l] va cpng sir cho thay dpng maeh hoi dai trang hien dien trong tat ca cac tru'dng hdp va ed 36% tru'dng hdp bat cheo phia tru'dc tTnh mach mac treo trang tren, dpng mach dai trang phai xuat phat tri/c tiep tir dpng mach mac treo trang tren trong 38% tru'dng hdp,
Tu'dng ty nhy vay trong phau thuat npi soi eat dai trang trai, eat dai trang chau hong, cat dai tranp ngang, phau thuat vien cam nam vu'ng giai phau ciia cac maeh mau mSc treo trang du'di, dai trang trai, dai tran^ chau hong, dai trang glu'a va nhii'ng thay doi bat thydng ciia chiing.
Y HOC VIET NAM THANG 6 - SO 1/2015
- Cac dang chia nhanh DM MTTD. Theo tac gia Lu'u Long Phung [7]
Dang 1: Dang V: 31.3%
La 3 nhanh dpng machdai trang trai, dpng mach dai trang chau hong va dpng mach trye trang tren co chung diem xuat phat ty dpng mach mac treo trang du'di.
CB
%
• ' V ^
>o.
^ / • 7
/7a/T^2/DangY21.9%
La 2 nhanh dpng mach dai trang trai va dpng mach dai trang chau hong cd than chung ciing do trye tiep vao dpng maeh mac treo trang dydi.
CB
% • /
'V/- Jo
^r>
D^ng3: Dang SS tO.6%
Dpng mach dai trang chau hong co than chung vdi dong mach try'c trang tren va khong co nhanh nao xuat phat chung vdi dong mach dai trang trai.
CB
•V;-
fo
.<>
&^
Jy>
CB
Dang 4: Dang Kh 6.2%
Dang Idiuyet dong mach dai trang trai ia khi boc tach dpc theo dong mach mac treo trang du'di khong phat hien du'dc nhanh dpng mach dau tien nao thoa dieu kien dpng mach dai trang trai, ma chi co nhutig nhanh dpng mach chay hul5ng sang trai den dai trang chau hong va trirc trang.
% - y
Jo
^r>
Hinh 1: Cac dang chia nhanh dpng mach mac treo trang du'di [7]
CB: Di^ chu bung, MTTD: BM mac beo trang dudi, DTT: DM dai trang trai, DTCH: DM dai trang chau hong, ITT: DM trut trang trin.
Y HOC VIET HAM THANG 6 - SO 1 /2015
V. KET LUAN
Qua bu'dc dau nghien ciru, chiing toi nhan thay nao vet hach trong phau thuat npi soi cat dai trang do ung thu* la hieu qua. Tuy nhien, de nhan djnh nay du'dc chinh xac va cd the so sanh du'dc vdi nghien cyu ciia cac tac gia nu'de ngoai can co nhutig nghien cyu tien cyu vdi sd lu'dng mau Idn, nghien cyu da trung tam va can hoan thien cac quy trinh chan doan tru'dc m6( chup CY Scan bung de danh gia di can hach), ky thuat m6(ky thuat cat toan bp mac treo dai trang: CME).
TAI L l | U THAIVI KHAO
1 Nguyin Hoang Bac, Nguyen Hu'u Thinh (2012), "Khao Sat Cac Dang Mach Mau Dai Trang Phai Qua Phau Thuat Noi Soi Cat Oai Trang Phai". Tap Chi Phau Thuat Noi Soi Va Noi Soi Viet Nam,2,Tr.ll9-121.
2 Bonjer Hj, Hop Wjc, Nelson H (2007),
"Laparoscopically Assisted Vs Opened Colectomy
For Colon Cancer: A Meta Analysis". Arch Surg (204), 439 - 446.
Hana Alhomoud, Oscar Falcon (2012),
"Laparoscopic Assisted Vs Open Surgery For Colon Cancer". V/orld Journal Of Laparoscopic Surgery, 5(3), P. 128-130.
Kuhry E, Schwenk W , Gaupset R, Romild U, Bonjer J (2008 Oct), "Long-Term Outcome Of Laparoscopic Surgery For Colorectal Cancer: A Cochrane Systematic Review Of Randomised Controlled Trials". Cancer Treat Rev, 34(6), Pp.498-504.
Nccn Guideline Version 2.2012 (2012), "Colon Cancer". National Comprehensive Cancer Network, 1 - 1 0 1 .
Omez Aziz., Vasilis Constantinides (2006),
"Laparoscopic Versus Open Surgery For Rectal Cancer: A M eta-Ana lysis". Anals Of Surgical Onlcology, 13(3), Pp. 413-424.
Lu'u Long Phung ( 2 0 1 4 ) , "Cac Dang Chia Nhanh Dong Mach Mac Treo Trang Dirdl Nhan Oinh Trong Phau ThuSt Ndi Sol Cat Oai Trirc Trang". Luan Van Thac Si Y Hoc. Dai Hoc Y Du'cJc Tp, Ho Chi Minh.
DANH GIA KET QUA DIEU TRI SEO CO KEO MI TREN BANG VAT DA DAO T H A I DU(yNG C H A N NUOI TO CHU'C DU'6'1 DA
Vu Ngoc Lara*
T O M TAT
Myc dich: Tong ket nhOVig dac diem lam sang seo CO keo mi tren va danh gia hieu qua ciia viec sir dung vat da dao chan nuoi to chirc du'di da viing thai du'dng trong tao hinh phyc hoi khuyet hong mi tren sau cat seo, du'a ra nhiJng uli nhupc diem ciia vat.
Goi tu'dng va phu'dng phap nghien cu'u: 32 binh nhan seo co keo mi tren dieu trj bang vat da dao chan nu6i to chirc du'di da viing thai du'dng, nghien ciftj tien ciftj.
Ket qua! Nguyen nhan ton thu'dng do di chu'ng viem nhiem chiem phan ldn (19/32), sau dd la do vet thu-png (8/32) va di chutig xa trj (5/32). Kich thu'dc ton khuyet sau cat bd seo trung binh la 3,7 cm2; kich thu'dc vat trung binh 4,5 cm2; 27/32 vat tao hinh song toan bp, ket qua gan 21/32 benh nhan dat tot, ket
* Khoa Phau thuat tao hinh-ham mat, BVTWQO108 Chju trach nhiem chinh: Vu Ngpc Lam Email: [email protected] Ot: 0913372489 Ngay nhan bai: 2/4/2015
Ngay phan bien khoa hoc: 15/4/2015 Ngay duyet bai: 17/4/2015
qua xa tot 15/18 benh nhan. Cd 2 vat hoai tiT toan bp, 3 tru'dng hop hoai tir 1 phan chii yeu tren so benh nhan di chutig xa tri.
Ket luan: Seo co keo mi tren chir yeu do di chu'ng viem nhiem va vet thu'dng, kich thu'dc khuyet da sau cat ton thu'dng trung binh la 3,7 cm2; kich thu'dc vat trung binh 4,5 cm2 . Sir dung vat da dao chan nuoi to chu'c du'di da ddn gian, hieu qua cao, it tai bien.
Tu' khoa: Seo co keo mi tren, vat dao chan nuoi dudi da vung thai du'dng.
S U M M A R Y
ASSESSMENTS OF UPPER EYE L I D CONTRACTILE SCAR TREATMENT USING
TEMPORAL SUBCUTANEOUS PEDICLE I S L A N D CUTANEOUS FLAP Objective: To sum up the clinical characteristics of upper eye lid contractile scars and assess the use of temporal subcutaneous island pedicle cutaneous flaps;
find out the advantages and disadvantages of the flaps.
Patients And Methods: 32 patients with upper eye lid contractile scars used temporal subcutaneous island pedicle cutaneous flaps; prospective study.
40
