Nao vit hach b&ng n&i soi trong ung thu tuyin giap Phan Hodng Hi&p, Trin Ngqc LUOng
Nao vet hach bang noi soi trong ung thu tuyen giap
Phan Hoang Hiep, Tr^n Ngoc LUdng
Khoa Di^u fn ky thuat cao - B#nh vien N0i tiet Tnjng tftJng
Ttf khda:
ung thtf tuyen gidp, ngo vdt hgch
Dia ch) lien he:
Phan l-lodng IHi$p, Khoa BT ky thu&t cao - Bdnh vi&n N&l tiit Trung Udng, 215 Ngpc Hoi, Td Hi6p, Thanh Tri.
H a N $ i
Oien thogi: (84)-904211839 Email, [email protected]
Ngky nhan bdi: 27/04/2016, Ngay duyet: 13/05/2016, Ngay chip nhan ddng:
02/06/2016.
Tdm tat
Dgt van di: Phlu thuSt noi soi nao vet hach trong ung thtf tuyS'n gi^p la mdt ky thuat khd, lien quan trtfc tig'p din viec hko ton dSy than kinh thanh qukn quat ngtfdc vk tuyin c^in gidp. Nghign ciiu dtfdc thtfc hi6n de ddnh gid ky thuSt vk hi6u qua ciia phtfdng phdp noi soi khi cat to^n bd tuyg'n gidp kfem nao vet hach khoang Uung tSm (nhdm VI) vk khoang b6n (nhdm II, i n , IV,V).
Phuang phdp nghiin ciiu: 90 b6nh nhan (BN) ung thtf tuyen gidp dtfdc md tif thdng 6 nam 2012 den thang 8 ndm 2015 bdng phSu thuSt n6i soi dtfdng ngtfc- ndch 2 b6n, tao khoang bang bdm khl CO^. Ky thult mi cat toJin b6 tuyen gidp vk nao vet hach theo khoang (khoang trung tam vk khoang ben). Dilu tri h§ trd sau md bdng lot phdng xa.
Kit qud: 90 b6nh nhin ung thtf tuyg^n giap: 26 trtfdng hdp c^t to^n bo tuygn gidp, khong nao v6t hach (ldm skng vk sieu am khong co hach). Cat todn b6 tuyen gidp vd nao vet hach 1 khoang ben dtfdc tien hdnh d 12 trtfdng hdp (13,3%). Nao vet hach khoang trung tam vk 1 khoang bgn 10 trtfdng hdp (11,1%). 8 tnOng hdp c^t todn b6 tuyS^n gidp k6m nao v6t hach 2 idioang bgn va khoang trung tam.
Nao v€t hach khoang trung tam 19 TH (21,1%). Viec nao vet hach cdc khoang dtfdc thtfc hign l^n Itfdt sau khi c^t thiiy raoi ben. Ket qud giii phlu bgnh cudi cilng deu Id ung thtf biet hoa the nhii trong do c6 51 trtfdng hdp (79,7%) da di cdn ra hach, dieu ndy cho thd'y chpc hdt tg" bdo hach dtfdi htfdng din cua sigu Sm c6 do ddc hieu cao (100%), do nhdy 94%. Sau md khong co BN nko ndi khdn hay te tay chdn vinh vign, 3 BN ndi khdn tam thcfi nhulig td't ca deu noi ro sau 1 thdng.
Dieu tri sau md b'dng iot 131, lieu xa trung binh Id 105,5 85,4mCi. 46 BN (51,1%) chi cln dieu tri 1 lan, 39 (43,3%) BN dieu Ui 2 lin vd 5 (5,6%) BN cin thiet phdi dieu tri lin thif 3.
Bdn ludn: Chi dinh nao hach dtfa vdo ldm sdng, sieu dm vd tg' bdo hpc (Sieu dm Id c6ng cu hieu qud de chin doSn hach, chpc tg'bao Id tieu chuan vdng). Ky thuat nOi soi c6 th^ liy het dtfdc td chiJc tuyen gidp, nao v^t dtfdc hach theo chi dinh.
Ket qud phlu thuSt an todn. It bien chtfng, sd liu dieu tri iot phdng xa sau md it.
Laparoscopic neck on iymphadenectomy for thyroid cancer
Phan Hoang Hiep, Iran Ngoc Luong
National Hospital of Endocrinology
Tap chf phau thu?t n§i soi va nfii soi Vigt Nam (2016) Sfi 2 - Tap 6; 14 - 20
Phan Hodng Hidp, Trin Ngqc LUOng Nao vdt hach bang noi soi trong ung (hU tuyin gidp
Abstract
Introduction: Laparoscopic lymphadenectomy in thyroid carcinoma is difficult technique relative to protection of recurrent nerve and parathyroid. Aims of research are evaluated technique and result of centrai (group VI) and lateral compartment (group II, III, IV, V) dissection by laparoscopy in thyroid cancer.
Material and Methods: 90 thyroid cancer patients were performed laparoscopic total thyroidectomy and lymphadenectomy with axillary approach from June, 2012 to August, 2015 and radioactive iodine (RAI) treatment postoperation.
Results: 90 thyroid cancer patients: 26 patients were performed laparoscopic total thyroidectomy (without lymph node detected on ultrasound). Total thyroidectomy and ipsilateral neck dissection group II, III, IV were performed in 12 patients (13.3%), Total thyroidectomy and ipsilateral neck lymphadenectomy group II, UI, IV, VI were per- formed in 10 patients (11.1%). 8 cases were performed total thyroidectomy and bilateral neck lymphadenectomy in group II, III, IV, VI. Ipsilateral central neck lymphadenectomy were performed on 19 cases (21.1 %). Pathology results were PTC, 51 cases with metastasis lymph node (79.7%). Final needle aspiration (FNA) lymph nodes un- der ultrasound is high specific (100%) and sensitive (94%). Postoperative complications: No case with permanent hoarseness and hypoparathyroidism. 3 cases with temporary hoarseness, recovered after 3 months. RAI treatment:
mean dose: 105,5 85,4mCi. 46 cases (51,1%) were performed 1 time, 39 cases (43,3%) had 2 times vd 5 cases had 3 times (5,6%).
Discussion: Indication for neck lymphadenectomy is depends on ultrasound and FNA results. Laparoscopy tech- nique can remove all thyroid tissues, neck lymphadenectomy in indication. Results are safe with low complication and low RAI treatment.
Keyword: thyroid cancer, lymphadenectomy.
Phau thuSt n6i soi de d i l u tri ung thtf tuyen gidp mdi dtfdc thtfc hien d m3t sd* trung tam tren thg" gidi.
Chi dinh cua p h i u thudt Id cdc ung thtf tuy^n giap giai doan sdm, kich thtfdc nhSn ung thtf nho hdn 4 cm, trong bao gidp (T1,T2 vd N0,N1 v^ MO). Kh6 khdn nhat trong p h i u thuEt ndi soi ndy Id chi dinh nao vgt hach khi ndo vd ky thudt nao vet hach. Hign nay tren the gidi c3c tdc giS chi lay nhffng hach d khoang trung t i m khi phdt hidn thay trtfdc md. C i c t i c g i i Nhdt Ban, Hdn Qud^c... tfu tien cho viec cit todn bp tuyen gidp, c6n nao vgt hach tiiy thupc vdo kinh nghiem m6i phau thulit vien .
Tai Benh vign Npi ti^t Trung tfdng, chdng toi x i c dinh hach tnrdc rad bSng sigu i m , CT vd chpc te bdo hach dtfdi htfdng d i n cfla sigu am. Dilng ky t h u i t ndi soi dt todn bO tuyg^n g i i p v i nao vgt hach theo nhdm. Muc dich ci3a nghign clhi n h i m : D i n h g i i chi dinh vd ky thudt cfla phtfdng phdp n6i soi di nao vgt hach cd trong ung thtf tuyen g i i p .
Doi tUdng va phi/dng phap nghien cdu Dd^i tiring
90 b€nh nhdn (BN) dtfdc c h i n dodn l i ung thtf tuye'n gidp, dtfdc phdu thuat noi soi c i t t o i n bd tuyg'n g i i p v i nao vet hach tii t h i n g 6 ndm 2012 d^n t h i n g 8 ndm 2015, tai Benh vi6n Ndi tie't Trung tfdng.
Phiftfng p h a p nghi&n ctfu: Nghign cu'u tig'n ciJu, m6 tk theo doi doc kh6ng dd'i chtfng.
K h i m Idm sdng, c i n l i r a s i n g : Ltfa chpn BN dtfa trgn p h i n ioai TNM (Itfa chon BN cf giai doan T l , T2 v i N0,N1 v i M O ) .
Ky thuit md:
Dtfdng v i o : Dtfdng ngtfc-nich 2 ben: 1 trocar iOmm d giffa hom nich cho ong kinh soi, 1 trocar Smm d ng^p l^n ranh Delta ngtfc, 1 trocar Smm 5 quing ndm va (vi tri 2 gid vdi bgn phii, 10 gid vdi bgn trii)
Tao khoang: Bdc t i c h titn da tff ngtfc len ngang sun g i i p vdi viec su" dung bdm khi COj
Dung cu c i t dd't: Dao c i t do't sidu i m (Harmonic Scalpel).
Tgp chf p h i u thudt n^i soi vh n&i soi Vi$t Nam (2016) S6 2 • TSp 6; 14 - 20
Nao vet hach bang n&i soi trong ung (hu tuyin gidp Phan Hokng Hi&p, Tran Ngqc Luang
Ong kinh soi: cat tuyen giip vdi o'ng kinh soi 0", nao vgt hach khoang trung tdm vd khoang ben bing d'ng kinh soi 30".
Nao vet hach: Khoang trung tdm: Tdch ddy thin kinh qudt ngtfdc dpc theo dtfdng di cua day tff cho dd vio cd xuong dtfdi. Lay toan bp hach nira canh hay trgn khi quin. Chii y khdng ldm tdn thtfdng tuye'n
cdn giip. Khoang bin: Tach bit dtu tff bd ngoai b6 ddn cua cd tfc-don-chura, tich 16n tren dpc theo bd ndy. Tdch cd vai mdng, tdch tinh mach cinh trong.
Lay toan bp hach cilng td chtfc md theo cic nhom tff dtfdi him tdi hi tren ddn. Chu •^: khong lira tdn thtfdng tmh mach cinh trong.
Hinh 1 Ngo hach khoang trung lam Kmh 2 Nao hach khoang b§n
Kinh 3 Sau khl ngo hach
Trong md: Chiy miu, thdi gian m^, chuyen md md.
Sau md (6 thdng): Noi khin, t6 tay chin tam thdi vd vTnh vien, rd dtfdng chd'p.
Dinh gid so' lan vi lieu dieu tri iot phdng xa.
Kg't qua nghign ctfu
Tudi: Nho nhat 8, ldn nhlit 44 tudi, trung binh 26 9,2 tudi
Thdi gian mac benh; sdm nha't 1 thing, Idu nhit 72 thing, trung binh 18,1 14,9 thang
Phdn loai TNM vd giai doan bgnh: Kh^i u Tl 20,5% T2 chig'm chfl y^u 79,5%, T3 vi T4:0%, hach Nl: 64 BN chig'm71,1%.
Tap chi phau thu^t noi soi v^ noi soi Viet Nam (2016) S6 2 - T d p 6; 14 • 20
Phan Hoang Hi&p, Tran Ngqc LUOng
Bdng 1 KSt qud siSu Sm hach
Nao vdt hach lying n&i soi trong ung thu tuyin giap
Khong co hgch 1 khoang ben 2 khoang b§n Khoang 1 khoang ben 2 khoang bfen Tdng sfi tmng tam va khoang vk khoang
tmng tdm tmng tdm
So benh nhdn 26 12 T i ' l e % 28,9 13,3
15 10
Bdng 2. Ket qud choc te bdo hach bdng kim nho
Ket qua chipc hiit hach Duong ti'nh KhSng xac dmh Tfing sfi
Sfi b^nh nhdn 48 16 64
T f l# (%) 75 25 100
Bdng 3. Ket qud gidi phau benh ciia hach
Loai ung ttiu Hach di cdn Hach khong di can Tfing so
So benh nhan 51 13 64
T i ' i ^ % 79,7 20,3 100
Khdng cd trtfdng hdp chuyen md md Kh6ng CO rd di^ng chd'p
Khong CO trtfdng hdp nao te tay chdn hay ndi khdn vinh viln
Cd 3 trtfdng hdp khdn tig'ng tam thdi vd sau 3 thing thi hoi phuc hodn toan.
s i n g 5 So lan diSu tn lot phong xa
s e lan xa So benh nhdn TJ Ig %
1 l^n 46 51.1 2 ISn 39 43,3
BSng 4 Cach thJc phdu thual
Cdch thtic phSu thuat S6tmangh(;lp Ty le % Cat todn bfi tuyfin giap (TBTG) 26 28.9 Cat TBTG + ngo tiach Wioang tmng tdm 19 21,1 Cdt TBTG + ngo hach 1 khoang b6n 12 13,3 Cdt TBTG -t- nao hach 2 khoang bSn 15 16,7 Cat TBTG • 1 khoang ben + T Tdm 10 11.1 Cat TBTG + 2 khoang bSn + T Tkm 8 8,9 Tfing
Thdi gian md: Nhanh nhit 80 phiit, Idu nhat 160 phiit, trung binh 98,7 20 phflt.
Bien chiJng
Khong cd trtfdng hdp ndo chiy mdu sau md
Tdng hiu xa: it nhi't 29,9 mCi, nhieu nhit 450 mCi, trung binh 105,5 15,4 mCi.
Chi dinh nao vet h^ch co: Hach di can trong ung thtf tuye'n giip thi bigt hoa c6 thi diiu tri bing lot phdng xa. Ky thuit nao vet hach vung cd li rapt ky thuat kho ngay ci trong phdu thudt md. Hen quan trtfc tiep d6'n bd cinh, khi quin vi thifc quin. Ton thtfdng diy than kinh thanh quin quat ngtfdc vd tuyg'n can gidp Id de raac phii. Chinh ly do tren nen cic phau thudt vign khong dtfa ra chi dinh nao vet hach mot cdch hg thd'ng, md phu thudc kinh nghiem vd quan diem ciia mdi phau thuat vien. Hi6n tai co hai trtfdng phii: Cdc tac gii khdng ddng y vgt hach cho rang: di cdn hach vung cd khdng lam tdng ty 16
Tap chi phau thudt noi soi va n&\ soi ViSt Nam (2016) Sfi 2 - Tap 6; 14 - 20
Nao v^t hach bang n&i sol (rong ung thu tuyin giap Phan Hodng Hiep, Trin Ngoc Luong
ttf vong vi cdc big^n chtfng, chtfa thiy md^i quan he giffa di can hach vffng cd vdi thdi gian sd'ng thgm d bgnh nhin UTTG the biet hoa sau phiu thuit. Mdt khac, hach viing cd khong dtfdc xdp vdo cic thgng so ddnh gid ye'u to' tien ltfdng trong phdn loai nguy cd (gdm tudi, kich thtfdc u, mtfc dp xam li'n ciia u ra ngoai vo tuyg'n giip, mtfc do cit tuye'n gidp trigt di, di can xa)[4]
Cdc tdc gii ddng ^ nao vet hach trong ung thtf tuye^n gidp de nghi nen nao vgt hach cd nhdm VI (hach trung tim) mdt cich he thd'ng vl ty lg di cdn hach cao (45%), lim giim ty le tdi phit vi tdng higu qui dieu tri. Matthew L.W (2012) cho rang: nao vet hach trung tim (nhdm VI) kg't hdp cat toan bp tuye'n gidp se tang nguy cd tdn thtfdng tuyg'n cin gidp vd than kinh quat ngtfdc so vdi cit tuyg'n giap ddn thuin nhiftig giim ty 16 tdi phdt d BN UTTG thg' nhu. Theo Martin J.S. (2014), tic gii md md vdi UTTG thd nhli ngn nao vet hach khoang trung tdm (nhdm VI), co the nao vet hach khoang ben khi khdm thS^y hach di cdn dpc theo mdng canh, nao vgt hach se han chg' tii phdt.
Vi6c phit hign hach la ri't quan trpng khSng chi mang tinh chat chan dodn mk cdn dtfa vio do de vet hach, ty le hach dtfdng tinh sau md chie'm ty le 93,2%, md'i ttfdng quan giffa hach sd tha'y tren lim sing va ke't qui md benh hpc cho tha'y 95,2%
hach sd thi'y tren lim sing cd di can thifc stf, chi cd 4,8% khong di can. Theo Miccoli, doi ttfdng ltfa chon cua dng li giai doan NO vi Nl do vdy viec nao vet hach chi dd'i vdi giai doan Nl chiem 10% vi cdc hach chii yg'u nam d khoang trung tdm (Nhdm VI), tJ le di can trong so' nhffng BN dtfdc nao vgt hach li 3S% [5]
Trong nghign ctfu niy, dd'i ttfdng Itfa chpn cia chiing tSi Id nhffng BN d giai doan 1 vi 2 ttfdng tfng vdi phin loai TNM li T1,T2 va N0,N1 vi MO. Xdc dinh CO hach vd vi tri, kich thtfdc hach chiing tdi dtfa tren khira vi cic xet nghiem hinh inh dd chin doan: tren sigu ira dtfa vdo cic yg'u to' cd bin: kich thtfdc, hinh dang, cd'u tnic xoang hach, hoai tur, vdi hda. Hach linh tinh khong hing dinh vd kich thtfdc, hinh elip vdi ty lg chilu ddi /chieu cao >2, cau tnic
xoang hach ro vi vo hach cin dd^i, xoang hach Id ciu tnic tdng am nim d vCing rd'n hach di vio trung tdm, cic hach ic tinh bieu hien trgn hinh inh sigu Sm vdi dac diem hinh trdn, ty le chieu dai/cao thtfdng nhd hdn 2, mit ciu tnic xoang hach binh thtfdng, tham nhiera cac u nho trong hach, c6 the hoai tu" nang, hoai ttf dong, vi voi hda, hach di cdn thtfdng gap d nhdm III vd nhdm IV sau de'n Id nhdm VI, cac nhdm khac it gap.
Hach trgn sigu am cd kich thtfdc >5mm chiing tdi chgc lg' bdo dtfdi htfdng din ciia sigu dm. Trong so' 64 TH cd hach thi cd 48 TH chpc te bdo Id hach dl cdn (75%), 16 trtfdng hdp im tinh. Td't ci 64 BN ndy chiing tdi deu nao vgt hach theo khoang khi cd hach thu6c bd't kd 1 nhdm nao trong khoang dd (Khoang trung tim: Nhdm hach VI, Khoang bgn cd nhdm hach n,III,IV vd V). Vdi chi dinh nao vet hach theo khoang nhtf tren, nghien ctfu cho thay phau thuit npi soi vdi o'ng kinh 30° cho phep quan sit dtfdc 5 vi trf siu cua gdc dtfdi him, d mdt sau cua cd tfc ddn chum vd tinh mach canh trong nen vigc nao vgt hach thtfc hign thuin ldi. K^t qui giii phau bgnh cho thi'y ci 48 trtfdng hdp chpc tg' bao di c5n la dung (100%), trong so' 16 TH choc te bdo la Sm tinh thi giii phau benh phdt hign thgm 3 TH cd tg'bdodicdn.Diluniy chiing tdi nhan thay sieu Sm li ky thuit chin doin hinh inh diu tay giiip phit hign cic hach viing cd, ket qui chpc tg' bio dtfdi htfdng din cua sieu im c6 dd ddc higu 100%, Chl dinh nao vet hach trong ung thtf tuyg'n gidp li cdc hach phat hien thi'y tren ISm sing vd cdc hach
> Smm trgn sigu im.
Ky thu§t n^o vet h^ch
PhSu thuat ndi soi vdi dtfdng vdo tii ndch, sff dung ong kinh soi 0" khi cat thuy tuyg'n gidp, sau dd thay d'ng kinh soi 30" de cd gdc nhin rdng vl phia dtfdi cdc hach canh khi quan, trgn xtfdng ddn vi sau cd ffc ddn chum. Chung tdi stf dung dao siSu am (harmonic scalpel) thi vigc nao vet hach trd ngn an toin vd higu qui vi dp ndng cua dao nhd hdn rd't nhilu dao dign, dao cd 2 bin ctfc: bin hoat ddng vd bin khdng hoat ddng, khi dd't hay cit thi ludn ddt bin khdng hoat ddng vl phia diy thi viec dd't hay
Tgp chl phdu thugt nfii soi vd noi soi Vi^t Nam (2016) So 2 - Tdp 6; 14 - 20
Phan Hodng Hi&p, Tr&n Ngqc Luang Nao vet hach tiing n&i soi trong ung thu tuyen giip
dt se an todn cho dSy than kinh.
Nqo vet hqch khoang trung tdm
Khoang trung tSm (nhdm hach VI) dtfdc gidi han 2 bgn la hai cd tfc ddn chura, phia sau li mdt trtfdc cua khi quin. Trtfdc khi nao vdt hach khoang ndy, phau thuat vign phii xac dinh rd cd tuyg'n can gidp tai day hay khdng, tich bdc Id dtfdc todn bd diy thin kinh thanh quin dpc theo dtfdng di (bgn trii nam d trtfdc thtfc quin vd bd ben khi quin, ben phii nim d giffa hai khe cua khi quan va thtfc quin. Diing dao sigu im lay todn bd td chtfc md vd cdc hach kem theo. Trtfdc tign phii tich dSy than kinh qudt ngtfdc theo htfdng dtfdng di cua nd tff tren xud^ng dtfdi. Sau dd l(fy bo toin bd cdc nhdm hach tren khi quin va canh bgn khi quin. Hodc vffa liy bd hach vita tdch dSy thin kinh ra dd dim bio an todn cho ddy. Cd the cit hoac khdng cat thgra tuyg'n ffc ne^u trong qui trinh tich xuong phia dtfdi thay nd.
Nqo vet hqch khoang bin
Trong md m6 vigc phlu tich cd tfc ddn chum ra khdi cdc cd ffc giap, ffc mdng vd cd giip mdng theo blnh dien giii phiu, ttf trong ra ngoai vi gdc nhin cua phlu thuat vidn li tff trgn xuong dtfdi. Todn bd raang canh dtfdc bpc Id khi diing vam kgo cd tfc ddn chum ra ngoii, Mc niy he thd'ng hach cd dtfdc bdc Id vdi 3 chudi hach chinh: hach cinh (HIII- IV), hach cd ngang, hach nhdm gai.
Trong phau thuit ndi soi chiing tdi tach bd ngoai bd ddn cua cd tfc ddn chum vd dung kep di tff vi tri trocar ben d^i dien de ndng cd tfc ddn chum Ien. Liic nay todn bd khoang bgn dtfdc bpc Id vd gdc nhin la ttf ngodi vio va tff nen cd nhin lgn. Vdi stf phdng dai vd gdc nhin rpng ciia d'ng kinh soi 30" chiing ta dl ddng bdc tich de ld'y toin bd nhdm hach II, III, IV. Khd'i hach gidi han phia tren ttfdng tfng vdi bd dtfdi cua cd nhi thSn. Gidi han phia dtfdi ttfdng ffng vdi hdi Itm TM Pirogoff. 6 ben trdi cin phai itfu y tdi d'ng ngtfc.
v l dung cu, ngodi d'ng kinh soi 30" vd Itfdi dao sieu Sm chiing tdi stf dung them 1 d'ng hdt, 1 kep Kelly de nang cd tfc ddn chum, tfc giip vi tfc radng.
Viec nSng cd dtfdc thtfc hien bing cich dat thgm 1 troca tff quang vu dd'i dien, dung cu dtfa vio d trocar
ndy se qua loi md cit thily rdi xuyen qua chd bd ngoii cd tfc ddn chum vtfa tich.
Ky thuSt nao vgt hach khoang ben: sau khi tich bd ngodi ciia cd ffc ddn chum vao khoang ben, vtfa phai xic dinh bung dtfdi cua cd vai radng vd ttnh mach cinh trong. Bung dtfdi cua cd vai mdng nim ngay mat trgn ciia tinh mach cinh trong theo htfdng tff dtfdi lgn trgn, tff ngodi vao trong. TTnh mach cinh trong nim d phia ngodi cua dpng mach cinh. Ddng mach cinh Id gidi han trong cua khoang bgn. Trgn bl mdt ciia ttnh mach cinh trong cd rapt sd hach thudc khoang bSn. Vigc nao vet hach dtfdc til^n hinh bing cich ld'y bo hach va ca td chtfc md, liy lan Itfdt cac nhdm hach tff dtfdi nin cd tdi cdc nhdm hach d dtfdi him. Li'y bo ckc td chffc md va hach d cic nhdra tren phia dtfdi ham dtfdi bdng ndi soi chiing tdi thd'y dl hdn md rad vi d'ng kInh soi cd the di vio sSu, xa hdn, phiu trtfdng nhin cung rdng hdn.
Kg't qua phiu thu^t
Trong nghign ctfu vdi 90 BN ung thtf tuyen giip:
26 trtfdng hdp cat todn bd tuydn giip khong nao vgt hach, dSy Id nhffng trtfdng hdp khdng cd hach khi tham khdm ldm sing cung nhtf sigu dm. Cat tokn bd tuyen gidp vd nao vet hach 1 khoang ben Id 12 trtfdng hdp (13,3%). Nao vet hach khoang trung tim va 1 khoang ben 10 trtfdng hdp (11,1%). 8 trtfdng hdp cit todn bo tuyg'n giap nao vet hach 2 khoang bgn vi khoang trung tSm. Nao vlt hach khoang trung tam 19 TH (21,1%). Vigc nao vet hach cdc khoang dtfdc thtfc hign lan Itfdt sau khi cat thily radi bgn.
Kd't qui giii phau benh cud'i cung diu li ung thtf bigt hda the nhu trong do cd 51 trtfdng hdp (79,7%) da di cdn ra hach. Ke't qui ndy cho thi'y chpc hut te bio hach dtfdi htfdng dSn cua sigu am cd dp dac higu cao (100%), dd nhSy 94%.
Sau rad khdng cd BN nio ndi khan hay te tay chdn vmh vien. Dilu ndy khing dinh vdi viec nhin rd cic tuyg'n can gidp trang, vigc stf dung thinh thao dao cit dd^t sigu Sm, chiing tdi da tich tuyg'n can gidp ra khdi tuye'n giip md khdng ldm ton thtfdng vinh viln chiing. Cung nhtf tuyg'n cSn giip, trong qui trinh md chiing tdi chu dpng tach rd dSy thin
Tap chl phau thult nfii soi va nfii soi Vi^t Nam (2016) Sfi 2 - Tdp 6; 14 - 20
Wgo vdt hach bing n&i sal trong ung ihu tuyin gidp Phan Hodng Hi&p, Trin Ngoc Luang
kinh theo dpc dtfdng di ciia nd trtfdc khi cat thily vd li'y hach d khoang trung t i m . Trong qud tiinh bdc t i c h do gat va d i y l i m day t h i n kinh bi kdo cdng ngn cd 3 trtfdng hdp ndi khan tam thdi nhtfng t i t c i deu ndi rd sau 1 thing.
D i l u tri hd trd sau md b i n g iot 131 tai Bgnh vien Trung tfdng Qudn ddi 108 theo mdt quy trinh thong nhi't gitta 2 benh vign. Trong 90 BN den d i l u tri iot phdng xa. L i l u xa trung blnh Id 105,5 85,4mCi. Cd 41 BN (45,6%) chi c i n dieu tri 1 l l n , 39 BN d i l u tri 2 l i n vd 10 BN can thiet p h i i d i l u tri l i n thff 3. Theo nghign clfu cua Khoa Y hpc hat n h i n Benh vign Trung tfdng Qudn ddi 108, trong so' 510 BN dtfdc dieu tri iot phdng xa sau khi c i t t o i n bd tuyg^n gidp thi chi cd 33,3% sd' BN dieu tri 1 ddt thi khdi vd so BN p h i i d i l u tri tren 4 lan Id 13,1%. Nhtf vay so vdi phdu thuSt md trong ung thtf tuyg'n gidp, p h l u thuSt ndi soi ciing cd t h i l i y sach dtfdc td chtfc tuyg^n giip, hach di can vd sd' l l n cin diie't diing iot phdng xa de xoa sach md g i i p sdt cung rat it.
Chi dinh nao hach dtfa vdo ldm sdng, sieu dm v i chpc tg' b i o (Sieu Sm Id cdng cu hieu q u i d l chan
dodn hach, chpc tg bdo dtfdi htfdng d i n cffa sigu dm Id tigu c h u i n v i n g ) . Ky thuit ngi soi cd the li'y he't dtfdc td chtfc tuyg'n gidp, nao vet dtfdc hach theo chi dinh. So' l i n p h i i dieu tri, ltfdng iot phdng xa phai dung It v i nhttng bien chtfng lien quan dg'n phlu thuat vdi tp le ri't t h i p .
Tai lieu tham IthSo
1. Pham thi Minh Bio vk cs (2007), " Nghifin clhi m6t sfi"
ddc dilm ISm sdng vd k^t quk dieu trj ung thtf tuyfi'n gi&p bi^t hoa sau phlu thuSt b^ng I-13I tai Bfinh vien Trung tfdng Quan doi 108", Bdo cdo tdng ket de tai nghifin clhi khoa hgc c3fp Bd quoc ph6ng 2. Bellatone Rocco, Celestino Pio Lombardi et al (2014),
Central neck lymph node removal during minimally in- vasive Video- Assisted thyroidectomy for thyroid carci- noma: A feasible and safe procedure, Joumai of lapar- oendoscopic & advanced surgical techniques. Volume 12 Issue 3- 181-185
3 Matthew LW (2012), PerioperaUve clinical out- comes after robotic thyroidectomy for thyroid car- cinoma a multicenter study, Surgg Endosc, Volume 25(3): 906- 12
4. Miccoli "TNM classification of thyroid carcinoma. ".World J Surg31(5): 879-87.
5 Martin J.S...National Cancer Institute. Retrieved9 June2014
Tgp chi p h i u thu^t nfii soi v^ nfii soi Vi§t Nam (2016) Sfi 2 - T$p 6, 14 - 20
