Y HOC Vlir HAM Tap 449-THANG 1 2 - S d l . M t S Krouse J.H. (2008). Management of the patient
with rhinitis. Managing the allergic padent, Elsevier, Philadenphia, 73-101.
Moral V.P. (2010). Rhinitis. J Investig Allergol Oin Immunol., 10{Suppl. l ) , 37-42.
Semino E. (2011). Les rtiinites dironk}ues diifidtes- Revue Francaise dASergohgie, 51, S2-S6.
Wilson K.F., Specter M.E., Orlandi R.R.
(2011). Types of Rhinitis. Otolaryngol an NAm.
44, 549-559.
Bousquet J. et aL (2003). Important research quesbons in allergy and related diseases;
nonallergk: rhinitis: a GA2LEN paper. Alleigy, 63, 842-SS3.
Scadding G.K., Church M.K. (2006). Rhinitis.
AHergy Bsevier, Philadenphia, 55-76.
NHAN XET flAC DIEM DI CAN HACH TREN CT SCAN, PET-CT DOI CHIEU VO'I TON THITOTVC MO BENH HOC
TRONG UNG THU" PHOI KHONG TE B A O NHO
T b M T A T
B o n i n g thdi gian lir 01/2014 dSn 03/2016, tal khoa
^ ^ H thuat long nguc - Tim mach, Benh vien (Juan y 103 da OHI hinh phlu thuSt d t thiiy, nao vet hach cho 29 tn/dng hop ung thu phoi khong te bao nho hiol tmng binh 58,62 vdl 93,10% la nam gidi. Trang d6 c6 28 benh nhan cSt 1 thiiy phoi (96,55%), 1 b ^ h nhin cSt 2 thiiy phoi (3,45%). Phan loai md benh hpc:
ung thu bi&i mo biy^n 62,07%, ung thu bleu mo le bio vay 21,14%, ung thU bleu m6 kem biSt hda 10,34%, ung thu bieu md te bio sing 3,45%. Chan doin 6u8c mo chi 3,45% tni«ng hop xie dinh ro hach tren CT scan. 29 b/dng hop deu dudc ghl nh|n'c6 h?ch bong md, bong do hach so 10 chiem ti le cao nhat (21 tufing hop, 72,4%), bep den hach so 4 va hach s6 9 vdi lin luOl l i 24,1% v i 20,4%. Mo benh hpc hach sau md cd 8 tnidng hop (27,59%) co di d n hach, bong s5 niy phii hop vdi PET- CT l i 75%, di d n hadl so 4 chiem ty I? cao nhat vdi 50%.
Tir khda: Ung thu phoi khong te bio nho, hach SUMMARY
CHARACTERISTICS OF LYMPH NODE METASTASIS USING CT SCAN DIAGNOSIS
AND PET-CI I N COMPARISON WITH HISTOPATHOLOGICAL I N PATIENTS WITH
NON-SMAU CELL LUNG CANCER Within 01/2014 - 03/2016, 29 patients who were diagnosed with the non-small oell lung cancer disease, and underwent lobectomy surgery at cardiothoraac 'Bil^, viin 103-HOCmen Quany
Chiu trich nhi§m chinh: Nguyen Tnidng Giang Email: [email protected] Ngiy nhSn bii: 18/9/2016 Ngiy phin biin Wioa hpc: 12/10/2016 Ngiy duyet bii: 05/11/2016
Nguyen Tru-dng Giang*, Nguyin Ngjc Trung*, Nguyen Van Nam*
department of 103 Militarv hospital. The mean age was 58,62; 93.10% was male; lobectomy surgery was perfonned on 28 pabents (95,55%), bilobectomy surgery was implemented on 1 patient (3,45%).
Histopathological analysis; adenocaranoma (62,07%) squamous cell caranoma (24,14%), undifferenliatBd pulmonary carcinoma (10,34%), dear cell carcinoma (3,45 %). Pre-operabve CT Scan diagnosis Identified the lymph node metastasis with the low percentage of 3,45%, while 100% being detennlned during the operation. In which lymph node groups 10,4, 9 make up 72,42%, 17,24%, 10,34% respectively The histopathological analysis identified lymph node metastasis in 8 cases (27,59%). These cases were correlated with PET- CT 75%, tile highest percentage of 50% was lymph node metastasis in group 4.
Key words: Non-small cell lung cancer, lymph node LOAT VAN oS
Ung thu- phoi chiem ty le cao va 11 nguyen nhan gay tii' vong hang dau trong t i t c l cac loai benh ung ttU. Tren the gidi trong sd khoing n,J tt'eu m/dng hop ung ttu mdi mac duHc chan doin hing nam, ung thtf phoi nguyen p h i l chtem 1,61 Weu tru'dng hdp (12,7%), vdl 1,38 trieu tru'dng hdp bJ vong. f a i Viet Nam, ung thU phoi nguyen p h l l cd xual dd cao, dac biet d nam gidl, vdi ly le 24,6 benh nhln/10(i.000 dan lai khu vut TMnh pho Ho Chi Minh v l 38,8 benh nhan/100.000 dan tai khu vu'c H I Ndi. Tir n'lm 2005 - 2006, trang 93.719 tn/dng hop til vong do ung ttir trong dd cd 22.209 do ung IhU phoi.
[l]» [3], [6].
O a s o cac bi/dng hop ung thU phoi du'dc phat hien is giai doan mudn khdng cdn khi naiig dieu tt tt'el de. Theo hau het d c I I I lieu thong ke bung va ngoai nu'dc thi chi cd khoing 15-
VIETNAM MEDICAL JOURMAL N l - DECEMBER - 2016
^/1
20% benh nhan ung thu" phoi du«c phat hien d giai dogn con co kha nang p h l u thuat dieii trj triet de. Phat hien sdm, dian doan chmh xac giai doan va lyS chon phuWng phap dieu tn toi u\i gop phan nhin nhan ro hdn biit tranh toan canh ve ung thu" phoi.
Cac^ nghien cijTj ve ung thu" phoi da du'dc thu'c hien nhieu cf cac trung tam Idn trong va - Benh ngoai nu'dc, tuy nhien cac ket qua nghien cuXi dac diem:
danh gia ve tinh trang di can hach ron phoi va ' + Tuoi, gidi tning that 6oi chieu vdi chup CT scan va dac biet ' "
la PET- c r midc mo va ket qua mo benh hoc h|ch ^sau mo con r S khac nhau. Vi vay, chuiig toi tien hanh nghien cihj nay nham muc dfch:
danh gia tinh trang di can hach so sanh giu^ ket qua chup c r Scan, PFT-CT' va ton thu'dng mo benh hoc trang ung thu" phoi te bao khong nho.
Benh nhan ung thu* phoi khong te bao nho duyc dieu tri bang phau thuat tai Khoa phau thuat Tim mach- Long ngut, Benh vien Quan Y 103, thdi gian tur 01/2014 den 03/2016.
2.2. Phu'tfng phap nghfen c i h i _ -JTiiet ke nghien ciiu: nghien cihj tien cu^
mo ta cat ngang.
Benh nhan ung thu* phoi dudc danh gia cac
II. Q6\ TUQNG VA PHI/ONG PHAP NGHIEN cCfU 2 . 1 . fidl tu'dng nghien c t h i
Ml. K f r QUA N G H l l N CO'U Bang 3 . 1 ; Tuoi va gidl mM Knk I _ 1—
+ Cac trieu chirtig lam sang.
+ Cac xet nghiem; CT scan, PET- CT danh gia: vi^tri khoi u, kfch thu'dc khoi u (cm), hach ran phoi, hach trung that
- Tat ca cac benh nhan dudc danh gia giai doan, xet chi dinh phau thuat, chuan bi m6 theo quy trinh thong nhat.
- So lu'dng hach cy the trang mo.
-1^6 benh hpc khffl u va hach sau mo.
- Phu'cfng phap xu- ly so tieu: so lieu dudc xiJ ly tren phan m i m SPSS 16.0
Gioiitanh Nam
Jong
29
Tulii nho n"hl 36
55
Tuoi !6n nhat Tu6i t r u n g binh
58.59
58,62Tuoi trung binh cho ca nam va nO' la 58 62 "-^-^ ' h ^ ^ " S 5 " v t 6 3 ' ? u S i ' ? / l l 'Zl'fS-^l;,^" " ' ° ' •"'' ^ ° ' " « ' • - ' « ^ " '^ " ™ 3 « ' « 2 trudng
Bang 3.2; CT « a n Idnq ngu'c c6 thuoc r j n n i i » n „ t>3c diem C T s r a n 1 cjs'ua.
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"niiiy tren (P) TTlLly giii^ (P) Thiiy dudi (P)
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Thily dudi 0 0 Thiiy tren + gIDs (p)Thiiy dudi+giu^ (p) Thiiy tren + dudi (T) Hach ron phoi Hach trunq that
So bgnh nhan
4 10 10 3 2
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TYre%
13,79 34,48 34,48 10,34 6,91 37,93 0 24,14 27,59 10,34 0 0 0
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YHOCVieTKAMTac4W.Tl<AMG12-s6l.?lllB Bang 3,3: K a qua d i u p PET-CT
SSBN Boi chieu md benh hoc va hach
U thiiy t r S n ( P )
25
U thiiy
du'di (P) U thy tren (T)
U t h u y dUSifT)
1 25
Dican hach nhdm N l
100
Di can hach nhom N2
50
1
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SoBN
.0 I 3,4 I 0 I 24,1 I 10,3 I 3^4 I 13 7 3,4 20,4 72.4" TT^
10 I 11 I 12
Bang 3.5: Phu'dng phap phau thuat ' Phu'dna Dhan nh^ii thuaf T '
PhU'ang phap phau t h u i t Cll 1 thiiy phoi Cat 2 thiiy phdi Cit loin fad 1 ben p h ^
So benh nhan
28 Ty le °/o
96,55
0 3,45
•ri^^^sssssssfes-
Kgt qua md bgnh hgc Ung thu jjieu mo tuyen Ung thu bleu md te bio vay Ung thubieii md kem biet hria l i n n t h i r h i o n n.n ,a k^.. ^.f Ung thu bleu mo te bao sanij
SoBN
IS
62,07%
24,14
-y-a " . . . >jn.M i i m 1.C uau aantj 1
10,34
3,45Moi« so » oenh nhan xlc dinh cd di c a i h i S chiem 27,59%, thi dl can h a r t l d ^ S t S l I IV. B A N LUiBlN
4 . 1 . e$c diSm cCIa ung t h u phoi duac diiu ttj b i n g phSu thu$t
""9, ftf phSl khdng le bio nhd II benh ly khi HiuWig gip, trong thdi gian 26 thing qua tai Khoa phau thuit Long ngu'c v i Tim mach, benh vlfn Quan Y 103 chung tdl Ben hinh phau thuat cit thiiy cho 29 b«nh nhin. Trieu chimg lam sang chii yeu 11 ho khan (23 budng hdp 79,31%) v i dau lu'e ngu'c (21 frudng hdp^
72,41%). Hai trilu chiJtig niy cao hdn cic tac gla khic la 32,7% v l 20% [5].
b f ^^'^ "''=" Pli^t Wen linh cd dl kham su'c khjie chiem ly le cao (4 tru'dng hdp, 13,79%) Bieu nay wang du'dng vdl cac nghien cijli ciia a c tac gia khic [2), [6]. Nhiivig khoi u phll hien lmh Cd thuong nhd, d gial doan I. K?t qua niy hoan loan phii hdp giai doan benh sau mo vdi 18 benh nhan glal doan IA va IB chiem 62,07%
Ty le nam gia/nif gidi cua chung loi la 13,5/1, cao hdn d c tie gll khac [1],[41. Bleu nay CO the duBc gill thich mot phan do chung toi I - l."^- r*". ' ^ t " 1"^" "?'• " « " cung CO SU' chenh lech dang ke giii^ nam gidi v i ni? gidi
4.2. w tri ton thu'Ong va hach tren CT- scan long ngu'c
... .„:'W
VIETNAM MEDICAL JOURNAL N ^ - DECEiwaeK -:
Ton thudng nam d ben phdi phai nhieu hdn 18 trudng hdp chiem 62,07%. Trong do thiiy b^n chiem ty le cao vdi 11/18 Irudng hdp, 61,11%. Nhan dinh n i y cung giong mot so t i c g l l khic [7]. Tuy nhien cho den nay van chu^ ly gill du'dc tai sao ung thU phdi d phdi phai chiem ty le cao hdn phdi t r i i . Do cau lao ve g i l l phau hoc, nen vdl nhifng khoi u ben phoi phai viec phau thuat callhuy dieu fri ung thtf de hdn phdi tril. Trong phlu thuat cat thiiy, khd nhat I I cat thiiy tren phoi trai, neu khdng can than se l l m ton IhUdng nhlnh dong mach cila IhCiy dudi phdi trai, g l y hoai til hole mat chii'c nang thiiy dudl.
Chi cd 3,45% tnidng hdp xac dinh rd ring cd hach trung that va hach ran phdi tren CTscan long ngUc cd Hem thuoc d n quang. Hau het d c frudng hdp odn Ial deu khd khin frong viec xac djnh hach fren CTscan. Kel qua nghien ciru ciia Chung tdl thap hdn so vdi nghien ciilj ciia Chung Giang Bdng v i Do Kim Que 85,4% hach ran phoi v i 47,2% hach trung that [1]. Cd the do nhdm benh nhan cua chung tdi cd den 62,07% giai doan IA va IB, cdn cua He g i i 70,3% glal doan IIIA v i niB nen viec xac djnh hach fren CT scan l i khic nhau. Theo Le Sy Sam v i CS thi ki'ch thirdc khdi u d n g ldn thi ly le di d n hach d n g cao[4].
4.3. Ve di c i n h^ch trSn PET- CT doi chi€u vdi m d benh hach sau mo.
Ci 4 tru'dng hdp chup PET- CT dUdc x l c djnh cd di d n h?ch , frong dd 2 frudng hop di d n hach nhdm N l , 2 tnfdng hdp di d n hach nhdm N2. Boi chleu vdi md b^nii hach sau mo thi nhdm N l phii hdp 100%, cdn nhdm N2 chi phu h((p 50%. Ro l i n g viec x l c dinh dl d n hach tren PET- CT cd Uu the hOn h i n tren CT scan.
Tuy nhien do gla thinh cao nen chi co 4 benh nhan dulJc chup PET- CT nen chua the xac dinh duHc quy luat dl d n nhdm hach cu thi.
4.4. N ; o v d t h^ch t r o n g mo doi chieu vdi k a qua md b | n h h^ch
^Trong dieu tr| ung t h u ndl chung, ung Ihu phoi khdng le bio nhd ndl rieng, nao vet hach 11 cdng viec quan frpng thii' 2 sau phau thuit d l rong i i l khdi u. Nd cd g l l tri bong viec loai bd tdi da le bao ung thU ra khdi cO the beiih nlian, xac dlnh^chinh xac glal doan, giiip cho qua trlnh dilu tti ho b o h i u phau va tiln lulling benh.Tal d 29 j ? n h nhin cua chiing tdi deu duOc nao vet hach, ttons do hach so 10 chiem ty le tao nhat 21 fru'dng hep, 72,4%, dep den hadi so 4 v l hach
50 9 vdi lan iUiJt l i 2 4 , 1 % v i 20,4%. Doi chi§u vdl md benh hach sau m d chi cd 8 frudng hdp, 27,59% o5 dl d n hach, trong dd dl d n hach so 4 chiem 4 tru'dng lidp, 50%, hach so 10 l i 2 Irudng hdp, 25%, hach so 2 v i hach sd 9 cd 1 tnrdng hdp, 12,5%.
Trong so 8 tru'dng hOp xac dinh cd di d n hach, thi cd 2 tru'dng hdp thiiy trdn phli di d n hach so 4, 2 Irudng hop thiiy ben t r i l dl d n hach sd 10, thiiy dudi p h l i : 1 frudng hdp di d n hach sd 2, 1 trudng hdp di d n hach so 4, 1 tn/dng hdp di d n hach so 10 v i 1 friidng hdp di can hach so 9. Nhan dinh n i y mpt phan phu hdp vdi^dac diem di d n hach bach hiiyet ciia ung ttiu phoi [1], (7], tuy nhien do so lieu cdn it, d n dUdc nghien ciJli them.
Ji.5. Bac diem m o benh hoc ung thir phoi khdng t § bao nho du'dc diieu t r j b i n g phau t h u ^ t
Ung t h u bieu md luyen chiem ly le cao vudt frpi (18 trudng hdp, 62,07%), tiep dgn ung thir bleu md te b i o v i y (7 tru'dng hdp, 24,14%). Ket qua nay hoin t o i n phii hdp vdi d c nghien ciJu ciia d c t i c g i i trong va ngoii nUdc [2],[4].
V. KIT LUAN
- Tuol trung blnh 58,62 vdl 93,10% la nam gidl. Trong do cd 28 benh nhin d l 1 thiiy phS (96,55%), 1 benh nhan d t 2 thiiy phdi (3,45%)i
• Phan loai mo benh hpc: ung thit bleu M6 tuyen 62,07%, ung thtf bleu md le bio viy 21,14%, ung thtf bilu md kem biel hda 10,34%, ung thtf bleu md te bao sing 3,45%,
- Chan doin frudc mo chi 3,45% Irudng hdp xac d|nh ro hach tren CT scan. 29 Itfdng h((p deu dtfdc ghi nhjn cd hach trong mo, trong dd hach so 10 chiem ti le cao nhat (21 ttfdng hdp, 72,4%), tiep den hach so 4 v l hach s3 9 vdl lan Itfpt la 24,1% v i 20,4%. Md benh hoc hach sau mo cd 8 trtfdng hOp (27,59%) cd dl d n hach, trong sd nay phii hdp vdl PET- CT I I 75%, dl d n hach sd 4 chi«m ty le cao nhat vdi 50%.
TAIUIUTHAMKHAO
1. Chung Giang Oong, Do Kim Que (2007). Oii Of cua CTscan tmng chin doin dian hach cua uns thd phoi nguyen phat, Tap ch( y hoc Tp HB Oil Minh. Tap 11. Phu ban dia SS 1.
2. Nguyin Hoii Nam (1996). Mft so nhin xit vi hinh thil gial phau benh ly qua « tmdng hiB ung thd phil duKmS tai binh viin ChdiSy.m, thai hoc, t|p 6, so 2, fr:25-26.
Y HOC WET NAM Tap 449 - THAHG 12 - S01 - 2016 3. Nguyen Hoai Nam (2003). Nghien dJtU tmh thai
glal phau benh va lam sang aJa ung ttiU pha dupe dieu tri bSng phau diuat Tap chf y hoc Tp Ho Chi Minh. Tap 7. Phu ban ixe So 1.
4. Le Sy Sam, So Kim Que (2007). Kich thuik khm up lien quan vdl nguy aJ di can hadi va ty IS song con trong ung thW phoi ichong te bao nhojap chf y hpc Tp Ho Chf Minh. Tap 11. Phu ban oia So 1.
Brodericit SR, Patterson GA.(2013}.
Perfonnance (^ integrated positron emission tomogtaphy/atmputed tomography for mediastinal nodal staging in non-smail cell lung candnoma. TTiorac Surg Qin. May;23C2): 193-8 dor: 10.1016/j.thorsurg.2013.01.014. Epub 2013 Feb 19. fteview.
6. Clioi CH, Kim MY, Hwang HJ, Lee JB, Kim WS.(2015). Advmced adenocaranoma of the lung: mmpanson of CT charact&istics of patients witfj anaplastk: lymphoma kinase gene rearrangement and those mth ^mi&mai gmwth
^dor recsfOor mutation. Radiology.
Apr;275Cl):2^-9. doi: 10.114S/radiol.l4140848.
Epub 2015 Jan 7.
7. Kudo S, Imai K, Zsliiyama K, Hashimoto M, Saito H, Motoyama S, Sato Y, Takashima S, Murata K, Minamiya Y.(2014). New CT criteria for nodai staging in non-small cell lung cancer. Qin Imaging. Jul-Aug;38{4);'M8-53. doj"
10.1016fl.c6nimag.2014.02.008. Epub 2014 Feb 15
BAC DIEM LAM SANG MON CO RANG COA NHOM RANG NANH VA RANG HAM N H 6
•AT
Myc deu: 1) M6 t l dSc diem lam sang mon co r3ng cita nhom rgng nanh va r^ng ham nho. 2) Nhin xet m§t so yeu to lien quan d^n tdn thuong mon co rSng^Doi tUdng nghien ciiU: 36 b§nh nhan lir 35 tuoi trd len vdi 154 i^ng nanh va nhdm ring ham nho co ton thtfdng mon cd, da den kham va dieu fri tai Khoa Oleu tn Ring ngudl cao tudi, Benh vien Ring Ham M?t Tmng l/dng HI Ndl v i Tnjng tam ky thuat kham chO^ b^nh Ring Him Mil - Nha A7, Tnrdng Oai hoc Y Hi Nji. KitguitTy If mdn CO ilng dcii vdi nhdm tuoi ttf 35-45 luoi la 41,7%, doi vdi nhom tren 45 tuol la 58,3%; 91,4% benh nhan c6 cam giac e buot khi kich thich v i chu^ dieu trj gl frtfdc khi vao vien, 5,7% da s* dung thuoc chdng e buot, 2,9% blnh nhin da dUdc hin bSng Composite, 100% benh nhan khong co tigp xiic vdl hoa chat long; 06 sau bung binh ciia ton thuWng mon c6 i3ng cua ca hai nhom rang la 1,5mm, dO ldng bung binh la 1,8mm, do dil frung binh la' 3,5mm; 100% benh nhSn c6 thoi quen chai rang ngang v i 91,7% sir dung loai ban chal Bng cijng bong do 58,3% c6 thdl glan thay ban dial tren 3 thing lfStlu/n:Ti le min o6 ling tang dan theo tuS va thoi quen dial ring va each sOf dung bin d i i l la mot trong nhOhg yeii to danjaSi tfin thuttng m6n cd ring.
TiyididatToti thuttng mon cfi ring.
'Sinh viin Ring Ham Mjt Tl/Ha Ngi Chju trich nhiem chlnh: Ttan Thi Ngoc "Hiiiy Email: [email protected] Ngay nh|n bil: 18/9/2016 Ngiy phan bi|n khoa hpc: 17/10/2016 Ngiy duyet bil: 5/U/2D16
T r a n T h i Ngpc T h i i y ' , Pham T h a n h H a * SUIVIMARY
THE CUNICAL FEATURES OF NONCARIUOS CERVICAL LESION I N CANINES AND
PREMOLARS
Alms; I . To describe the clinical features of noncanous cervical lesion (NCCL) In canines and premolare. 2. To assess some related lactors of NCCL Subjects; 36 patients aged over 35 years old with 154 canines or premolars which had NCCL, attended Genatnc Dentisby Department, Hanoi National Hospitai of Odonlo-Stomalogy and Advance Dental Care Central Block A7, Hanoi Medical University Results; the prevalence of NCCL among 35-10-45- year-old patients was 41,7 %, over-45-vear-old patients was 58,3 %. 91,4 % patients had sensitive feeling and hadnt been b-eated before going to hospitai, 5,7 % had used anti-sensitivity agents, 2,9 % had the lesions filled with Composite. 100 % hadnt contatt with liquid chemicals. The mean depth of the lesions in both groups were 1,5 mm; the mean width were 1,8 mm, the mean length were 3,5 mm. 100%
of tile patients had horizontal-brushing-habit 91 7 % used hard-bnstie-tooOibnish, 58,3 % changed 'tiielr tootiibmsh in more dian 3 months. Conclusions' The piraalence of NCCl increased wiBi age, bmshing habte and »ie usage of toottibrush were a risk lactots of NCCL
Key work; Noncanous cervical lesion (NCCL).
I.OATVANDI
Cac ton thtfdng to chi?c ciing ciia rang khong do sau Jrong do ton Uiudng mon co ring la benh reit pho bien frong so cac b$nh ly ve rSng mieng, dtfdc xep sau sau rang va viSm quanh
