Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
NGHIEN CLfU OAC DIEM LAM SANG CUA UNG THU TUYEN GIAP
^TOM TAT
Nghien ciiu dUdc tien hanh tren 293 benh . nhan kh6ng phan biet tuoi, gidi, cd benh ly tuyen
giap, du'dc dieu tri ngoai khoa tii' 2003-2008, gom hai nhdm: nhdm ac tfnh : 198 benh nhan, nhdm lanh tinh: 95 benh nhan
Nghien cifu nhan thay:
Ung thu' tuyen giap hay gap d ngu'di tre tir 31-50 (45,4%), ti le nC/nam la 2,2/1.
Cac dac diem lam sang cd y nghTa djnh hu'dng chan doan UTTG gom:
Tud'i (P<0.05); gidi(P<0.0001); Khd thd (P<0.01); khan tieng(P<0,05); Cd u tuyen giap(P<0,0001); Cd u tuyen giap va hach c6(P<0,0001); Cam giac bd cirng c6(P<0,0001);
' mat do bu'du (P<0.000); kich thu'dc (P<0.05);
ranh gidi (P<0.0001); be mat (P<0.05); tinh chat
^ dl dgng (P<0.0001).
^ SUMMARY
^ The stady was implemented in 293 patiens with thyroid diseases, who was operated from 2003 to 2008. There are two groups: malignant:
198 patiens ; benign : 95 patiens
The obtained result has shown that:
Thyroid canser is more common in young age (range 31 - 50): 45.4%, and in women (occuring in a 2 . 1 / 1 ratio).
Clinical symptoms are able to differ between thyroid cancer and other benign thyroid diseases. They include: age (P<0.05); mai or female (P<0.0001); difficulty breathing (P<0.01);
hoarsenness (P<0.05); Thyroid nodules (P<0.0001); Thyroid nodules and lymps nodes in neck (P<0.0001); compression neck (P<0.0001);
* B0nh vi$n HCru Nghi Vi0t Ti$p Hai Phdng
Pham Van Trung*
goiter density (P<0.000); size (P<0.05);
bowndary (P<0.0001); face (P<0.05); mobile (P<0.0001).
I. OAT V A N o f
Theo hiep hdi qudc tc chdng ung thu (Incrnational Union against Cancer: lUAC) thi Ung thu tuyen giap chiem khoang 1% cac loai ung thu. Ung thu ciia he thdng ndi tiet chiem khoang 1.5% tdng sd cac loai ung thu, trong dd chii ydu la ung thu tuyen giap (UTTG) chiem 90% [2].
O Viet Nam, theo tai lieu ciia benh vien K Ha Ndi va trung tam ung bucyu thanh phd Hd Chi Minh ti le mhc UTTG theo tudi la 1,5 - 1,9/100.000 dan, dimg thir 13 trong cac loai ung thu [2],[4]. Theo Parkin, D.M va cdng sir nghien cim vh UTTG tren 5 chau luc (1992) thi tan xuk mhc benh tir 0,5 dhn 10/100.000 dan. Tudi mhc nhi^u tir 45 50. Nir bj nhiSu ban nam 2 4 lan.
Mac dii tuyIn giap nam ngay d vimg cd trudc va ung thu tuyen giap la mdt benh hay gap ciia tuyIn giap nhung kha nang phat bien UTTG qua tham kham lam sang chi chiem khoang 1% tdng sd cac tdn thuang dc tinh ciia tuydn giap. CJ My hang nam cd tren
11.000 benh nhan UTTG, nhung viec phat hien ung thu tuyIn giap trong mdt trieu ngudi dan la 25 - 40%.
Do dac dihm lam sang cua ung thu tuyIn giap d giai doan sdm thudng rat ngheo nan, khdng dac hieu nen UTTG thudng dugc chhn doan d giai doan mugn. Viec didu tri ung thu tuydn giap ciing khdng dam bao dugc tinh
HOI NGHI KHOA HOC BENH VIEN HUfU NGHI VIET TIER HAI PHONG LAN THLf 37 triet dc \a co he thdng \i riit nhicu IrucVng
hcrp ung thu tu\cn giiip bi chiin doiin lan diiu nham \cVi u lanh tinh ciia lu>i'ii giiip.
Xiuit phiit tir nhung \cu ciui tlurc ticn ndi tren, chimg tdi ticn hanh dc tiii: "Nghien ciru dgc diem him sdng cua ung thir tuyen gidp"
nham gdp phan niing cao chat lucrng chiin doan \a dieu tri can hcnh niu.
II. 061 TUONG VA PHJONG PHAP NGHIEN CCOJ
2.L Ddi tugng nghien cuu:
Gdm 293 hcnh nhiin khdng phiin hict tudi, gicVi. cd benh ly tu\cn giiip, ducrc dieu tri ngoai khoa tir 2003-2008, gdm hai nhdm:
Nhdm dc tinh: 198 benh nhan, cd chin doan giiii phau benh sau md la ung thutuySn giiip.
Nhdm Idnh tinh: 95 benh nhan, co chim doan giai phau benh .sau md khdng phai la ung thu tuyen giiip
2.2. Phmrng phap nghien ciiru:
Nghien ciru theo phuang phap mo ta ciil ngang.
So simh cac dac diem lam sang ciia hai nhdm nghien cim nham tim ra nhimg dac diem khiic bigt giira UTTG va cac benh ly limb tinh ciia tuyen giap.
Phdn loai md benh hc)c (MBH), Phan loai giai doan theo UlCC \ii VK'C nam 1997.
Xu ly so lieu bang EPl INFO 6.04
I. KET QUA NGHIEN COU
Bang 3.1. Phan bd benh nhan theo nhdm tudi
Nhom tuoi 10-20
21-30 31-40 41-50 51-60
>61 Cgng Trung binh
So sanh
Nhom lanh tinh Sd lu'dng
2 8 16 17 28 24 95
Ti le (O/o) 2,1 8,4 16,8 17,9 29, 25,3 100,0 50,4 ± 13,6
Nhom ac tinh So lu'dng
5 25 44 46 40 38 198
Ti le (O/o) 2,5 12,6 22,2 23,2 20,2 19,2 100,0 46,9 ± 14,9
p < 0.05
Cong So lu'dng
7 33 60 63 68 62 293
Ti le (O/o) 2,4 11,3 20,5 21,5 23,2 21,2 100,0 48,1 ± 14,6
Nhdn xet: Ung thu tuyen giap cd thh gap a mgi lira tudi.
Thn su^t phan bd ung thu tuydn giap theo lira tudi kha rgng, benh nhan nhd nhit la 13 tudi va gia nhat 79 tudi.
Bang 3.2. Phan bd benh tuy6n giap d lira tudi < 50 va > 50
Tuoi Chan doan GPB
Lanh tinh Ac tinh Cong
<50t 43 (45.2%) 120 (60.6%) 163
> 50t 52 (54.8%) 78 (39.4%) 130
Cgng 95 198 293
p < 0.05
Ti le UTTG d lira tudi <50 g k gap ddi lira tudi > 50 (60.6% so vdi 39.4%).
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011 Bang 3.3. Lien
Nhom tuoi 1 0 - 2 0 21 30 31 40 41 50 5 1 - 6 0
> 6 1 Cong
quan nhom tuoi vdi tai phat Benh nhan
n 5 25 44 46 40 38 198
o/o 2,5 12,6 22,2 23,2 20,2 19,2 100,0
Tai phat n
1 5 7 9 3 5 30
%
0,50 2,52 3,51 4,54 1,51 2,52 15,10
di can, tii' vong (n Di can n
1 1 5 1 6 1 15
%
0,5 0,5 2,5 0,5 3,0 0,5 7,5
= 198) Tit vong n
1 2 0 3 13
7 26
%
0,5 1,0 0 1,5 6,6 3,5 13,1
• — - » - —-—* 1 1 1 1 1 1:
Giira nhdm tudi \a tai phat. di can. tir \ong cd tuang quan thuan rdt chat che p <0.05, (r=
0.781). Ti le tai phat cao virxk a nhdm tudi 41-50 (4.34" o). Ti lc di can cao d nhdm tuoi 51-60 (3%). Ti le tir vong cao d Uioi 51-60 (6.6%). Ti le tai phat, di can, tii' vong ciia cac nhom tu6i khac nhau thi khac nhau.
Gioi NQ' Nam Cgng
Bang ; 3.4. Phan b6 benh nhan nghien cuu theo gidi tinh Nhom lanh tinh
So lu'dng 89
6 95
Ti le (O/o) 93,7
6,3 100,0
Nhom ac tinh SdlUdng
136 62 198
Ti le (O/o) 68,7
31,3 100,0
Cong Sd lu'dng
225 68 293
Ti le (O/o) 76,8 23,2 100,0 p = 0,0000; OR = 6,75
Nhdn xet: Benh tuyen giap d hai gidi khac nhau, vdi p < 0.0001. Ti le benh lanh va ac tinh khac nhau p < 0.05. Ti le UTTG d nu: cao han nam hai lan (2.2/1).
Mng 3.5. Lien quan giiia gidi tinh vdi tai phat, di can, tir vong (n = 198)
Benh nhan
Gidi n %
Tai phat Di can
n % n %
Td vong
n o/o
m
136 68,7 21 10,6 3,5 11 ^ 5 .Nam 62 31,3 4,5 4,0 15 7,6
Cdng 198 100 30 15,1 15 7,5 26 13,1
Nhdn xet: Khdng cd sir lien quan giira gidi tinh vdi tinh trang tai phat, di can va ti le tir vong cua cac benh nhan UTTG, (p > 0.05).
Bang.3.6. Di§u kien phat hien
Dieu kien phat hien
Vd tinh Dhat hien Kham suTc khoe
Nhom lanh tinh
Sd lu'dng 85
9
Tile
89,5 9,5
Nhom ac tinh Sd
lu'dng 186
8
Tile
(O/o)
93,9 4,0
Cdng Sd
lu'dng 271
17
Tile ( % ) 92,5 5,8
Hpl NGH! KHOA HOC BENH VigN HUfU NGHj VIET TIEP H A I PHONG LAN THLf 37 NgUdI khac phat hien
Cdng
1 95
1,0 100/0
P ' 0-05 4 198
2,0 100,0
5 293
1,7 100,0
Bsing 3.7.
Thdi gian
<1 tliang 1-6 thang
>6-12 thang
>12 thang -3 nam
>3-5 nam
>5-10 nam
> 10 nam Cdng
Ihdi )ii;iii lir khi phiil hiC'u den khi ( Nhom lanh tinh
n 1 13
5 6 13 25 32 95
o/o 1,1 13,7
5,3.., 6,3 13,7 26,3 33,7 100
luge dieu tri Nhom ac tinh
n 6 30 14 33 30 49 36 198
o/o 3^0 15,2
7,1 16^7 15^2 24,7 18,2 100
So sanh n
7 43 19 39 43 74 68 293
o/o 2,4 14,7 6,5 13,3 14,7 25,3 23,2 100,0
Nhdn .\et: Giira thdi gian mac benh ciia hai nhdm lanh tinh \ ii ac tinh cd mdi tuong quan thuan rat chat che \di p <0.05, r = 0.773. thdi gian mac benh cao nhat cua nhdm tinh la >10 nam (33.7%), ciia nhdm ac tinh la > 5-10 nam (25.3%).
Tinh chat u
Bang 3.8. T i n Nhom lanh tfnh
n (%)
1 chat u Nhom n
ac tinh (%)
So sanh
P OR
Mat do:
. Cirng . Chac . Mem . < 1cm . 1- <3 cm . 3 - <5 cm . > 5cm . Rd rang . Khong rd rang
11 82 2
11,6 86,3 2,1
150 48
0 Kich thudc:
7 65 20 3
7,4 68,4 21,1 3,2
3 118
57 20 Ranh gidi:
60 35
63,2 36,8
56 142
75,8 24,2
1,5 59,6 28,8 10,1 28,3 71,7
0,0000
0,005
0,000 4,35 Be mat khdi u:
.Nhan . Go ghe . Di ddng .Di ddng kem
12 83
12,6 87,4
13 185 Tinh chat di ddng:
88 7
92,6 7,4
81 117
6,6 93,4 40,9 59,1
0,016
0,000 18,2
Oac diem tuyen cd u: •
--
1
• ^
• ~
^
»
1
1 1
I
s
YHO . Lan toa
. The nhan . The hon hdp
C VIET NAM THANG 1 0 - SO DAC BIET/2011 0
1 94
0 1,1 98,9
8 15 175
4,0 7,6 88,4
0,008 Phan dd budu:
. O d i .OdII
. Od III .OdIV
.OdV . To nhanh
. To cham
0 6 59 28 2
0 6,3 62,1 29,5 2,1 Mu'c dd tien 4
91
4,2 95,8 Hach vunq . Cd hach
. Khdng cd hach
1 94
1,1 98,9
1 31 128
30 8
0,5 15,7 64,6 15,2 4,0
0,015
trien:
91 107
46,0 54,0 cd
70 128
35,4 64,6 Sd lUtfnq u:
. Mdt u . Hai u trd len
19 76
20,0 80,0
48 150
24,2 75,8
0,000
0,000
0,418
19,34
51,4
0,78
^ Nhan xet: Cac dac didm cua u tuyIn giap nhu : mat do, kich thudc, ranh gidi, hh mat, tinh chat di ddng, dac diem cua thuy tuyIn giap chua u, muc do tiln tridn, tinh trang hach cd trong deu khac nhau cd y nghia giira hai nhdm vdi p < 0,001.
STT
1 2 3 4 5 6 7 8 9 10
Trieu chu'ng lam sang
Khd thd
Khan tieng tang dan Cam giac bd chat viing cd Cd u tuyen giap
Cd hach cd va bu'du giap Mat dd ciing
Be mat bu'du go ghe Dinh vdi md xung quanh Ranh gidi khdng rd Di ddng kem
Lanh tinh n
(95) 5 7 17 92 1 11 83 5 35 7
o/o 5,3 7,4 17,9 96,8 1,1 11,6 87,4 5,3 36,8
7,4
Ac tinh n
(198) 34 33 131 152 50 150 185 71 142 117
o/o 17,2 16,7 66,2 76,8 25,3 75,8 93,4 35,9 71,7 59,1
P 0,009 0,030 0,000 0,000 0,000 0,0000
0,016 0,000 0,000 0,000
OR 3,73 2,52 8,97 0,11 31,76 23,86 2,06 10,70
4,35 18,20 Bang 3.10. Chan c
Mo benh hoc UTTG the nhii UTTG the nanq
oan md benh hgc sau md (nhdm ung thu n = 198) So benh nhan
134 23
Tile o/o 67,6 11,6
HOI NGHI KHOA HOC BENH VI^N HUfU NGH! VI$T TI$P H A I PHONG LAN THLf 37 PHAN III: CAN LAM SANG
DANH GIA BiraC DAU DIEU TRI UNG THlf BIEU MO GAN BANG NUT MACH CHON LOC
Bui Hoang Tli*
TOM TAT
Cac tac gia da nghien ciTu tren 19 benh nhan ung thU bieu m6 gan. Tong sd lan thUc hien niit hoa chat tren cac benh nhan la 24 lan.
Ket qua nhUsau:
Kich thudc ciia cac khdi u giam trong 1 thang va cd xu hudng tang len sau 3 thang.
Viec cung cap mau cho khdi u giam sau khi niit hda chat va phu thudc vao SLi lang dgng lipiodol trong u.
AFP giam sau khi niit hda chat
- Hgi chiihg thuyen tac sau nut mach: 2-7 ngay Tinh trang lam sang du'dc cai thien sau khi nut hda chat
ABSTRACT
The authors have reseached on 19 patients, who was suffered from HCC. All patients was done with TACE 24 times. The results is as follow:
The size of the tumors are reduced in 1 month and tendency increasing in 3 months.
The blood supply for the tumors are reduced after TACE and it depends on lipiodol deposition intra tumors.
AFP level is reduced after TACE
After embolization syndrome is in 2-7 days Clinical condition is improved after TACE
I.
OAT V A N OEUng thu gan nguyen phat la loai ung thu phd biln dung thu 5 the gidi, hang nSm cd ban 500.000 ca dugc chdn doan mdi [12].
Tai Viet Nam, theo Pham Hoang Anh va cdng sir [3], thi ung thu bieu md td bao gan
dirng hang thir 3 d nam gidi va dimg hang thir 6 d nu: gidi.
Ung thu gan nguyen phat thudng gap tren nen xa gan, it khi gap tren gan lanh. Theo thong kc d nude ngoai thi ty le ung thu gan tren xogan chiem khoang 2/3 sd ca ung thu gan cdn d Viet Nam, ty le nay len den 90% [4]
Nguyen nhan gay ung thu gan cho den nay van chua dugc xac dinh mdt each ro rang. Ngudi ta chi thay cac yeu td thuan lgi dan den ung thu gan nguyen phat la: nhiem virus viem gan B, C (HBV. HOC), nghien rugu, mdt sd ddc td gay ung thu nhu Anfatoxin. Nhu'ng yeu td nay dan den xo gan va cudi ciing la ung thu gan [4].
Ung thu gan la mdt ung thu cd tinh chat ac tinh cao, neu khdng dugc dieu tri thi thoi gian sdng ciia benh nhan (BN) chi khoang 6 den 7 thang. Den na>. cd nhieu phuomg phap de dilu tri cho loai ung thu nay. Da co nhieu cdng trinh trong va ngoai nude nghien cmi ve phucmg phap nut mach cd sir dung hoa chat nhu niit mach bang Lipiodol xa Doxorubicin, Cisplatin, Adriamycin... nhung viec danh gia vc phuang phap nay \ an cdn nhieu tranh cai.
Hien tai. van chua cd su thdng nhat ve phuang phap chudn ciing nhu viec su dung cac chdt nut mach. Theo nghien cuu cua Calogero Camma va cdng su [6], Takayasu K va cs (1987) [13], Ryder S D (2003) [U], Nhdm nghien cuu va dieu tri ung thu gan cua Phap [8], Douglas E [7] thi sir dung hoa chat chdng ung thu trong nut mach hoa chat khdng mang lai hieu qua ban so vdi viec
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
hdng sir dung boa chdt chdng ung thu Vai
•d ciia Lipodol sieu Idng la chdt gay hoai tir hdi u, ndu dua dugc dng thdng vao sat [hanh mach nudi u thi thdi gian dh khdi u cd uan hoan bang he se dai ban. Vi va\ chiing oi tien hanh de tai nay nham muc tieu :
Ddnh gid ket qud sdm budc dau cua ihuang phdp nut mgch chgn Igc trong dieu ri ung thu hieu md tc bdo gan nguyen phdt.
Neu mot so iru nhugc diem cua phirong ihdp nay.
I. o6l TaONG VA PHUONG PHAP NGHIEN CCfU 2.1. Doi tuoTig nghien cuu
Ddi tugng nghien ciru la 19 BN dugc :han doan la UTBMTBG dugc gidi thieu den dioa Chan doan hinh anh Benh \ien Hiru ighi Viet Tiep de dieu tri nut mach tir thang 1/2008 ddn thang 7/2011. BN dugc tien hanh
;ac xet nghiem trudc chup nhu xet nghiem ve linh anh (Sieu am, sieu am mau, CLVT). cac
\.it nghiem Ne sinh hoa: AFP. men gan, Bilimbin, prothrombin, dudng mau va Creatinin nau, cd the cd ket qua chgc hut te bao gan.
2.1.1. Tieu chudn lira chgn BN: Nhimg BN dugc chdn doan la UTBMTBG bdng te bao igc hoac nhung BN dugc chan doan xac dinh rd Ten cac phuang tien chan doan hinh anh.
Thd trang chung ciia BN cdn' tdt.
Khdng cd huydt khdi than tinh mach cira loac dao chidu ddng chay tmh mach cira.
Khdng cd cd trudng nhieu.
'• Prothrombin > 50%.
f 2.1.2. Tieu chudn logi trir
^ Nhiing BN da cd can thiep trudc dd nhu -)hau thuat, tiem con, ddt sdng cao tdn, da nut nach gan. Cd benh khac phdi hgp: Suy than, -iuytim...
- Cd tidn sir di img lod. Xa gan giai doan
^:hild-Pugh B, C.
Ciic BN ung thu bieu md tc bao gan the lan toa.
2.2. Phuong phap nghien ciiu 2.2.7. Phuong phdp nghien cuu:
Nghien ciru md ta, tien ciru.
2.2.2. Phirang tien nghien cuu :
Ma> sicu iim mau ALOKA SSD 1400, GI- LOGIC 500; May chup CLVT Hitachi 8 dii); Mil) chup mach sd hda xda nen mdt binh dien. Thudc can quang Palmiray 370 mg
\a Xcnctix 300 mg. Cac xct nghiem khac sinh hda mau.
2.2.3. Cdc budc tien hdnh
Khai thac benh canh lam sang, tien sir, nghien ciru hd sa benh an ciia BN. Xem xet cac xet nghiem ciia BN vc cac chi sd danh gia chuc nang gan, cac xet nghiem AFP, te bao hgc (neu cd)
Tien hanh thii thuat
Thu thap hd sa benh an luu trii bao gdm dll lieu lam sang, can lam sang, ket qua dieu tri sau 1. 3 thang.
Xir ly sd lieu: theo phan mem thdng ke EPI-INFO 6.04.
III. KET QUA NGHIEN CQU VA BAN LUAN 3.L So lieu cua BN truoc nut
3.1.1. Tudi: S6 lugng trong nhom nghien curu cua chiing toi gom 19 BN. Do tudi trung binh la: 59,12-14,5 tudi. BN it tudi nhdt ciia chung tdi la 30 tudi. Nhieu nhdt la 89 tudi. Wh do tudi thudng gap chung tdi nhan thdy ciing phii hgp vdi mdt sd tac gia trong va ngoai nude.
3.1.2. Gi&i: Nam gidi chiem 100% so cac BN trong dd tai nghien cuu ciia chung tdi. Didu nay cung phii hgp vdi cac tac gia khac nhu Le Anh Tudn [2], Nguyen Duy Trinh [3], Munemasu [10].
