yiETTJAH MEDICAL JOURNAL N°2 - DECEMBER - 2016
DANH GlA KET QUA UTWG DUNG MAY CAT NOI THANG TRONG PHAU THUAT CAT DA D A Y UNG THU" PHAN BA DUCfl TAI BENH V I | N K
Pham Van Binh*, Ha Hai Nam*, Nguyen Van T r v d ^
T6M TATMftc Heu: O^nh gia kS: qua (tng dung may cat noi thSng trong phau thuat rat da day ung thu" phan ba dircfi tai benh vien K. Dot tupng va phuVhg phap: 65 b^h nhSn chan doan xac d[nh ung thu* da day 1/3 du^ dutfc phau thuat triet can tai khoa Ngoai Tong hdp Benh vien K, chia lam 2 nhom nglu nhien:
c6 diing may d t n5i va khong dung may, tii"
01/3/2011 a&i 30/9/2011. Phutfng phap nghien cirti can t h i ^ ISm sang ngau nhien co doi chirng. K^
ffi»,'To5i trung binh 57,5; ty le nam/nu' la 1,7/1. 63 BN (96,9%) c6 dau bung thiftJng vj, 22 scf thay khoi tr&i iSm sSng chi&n 33,8%. Tren hinh anh noi soi gSp the loet IS chil yeu (47,7%). Co 34 BN dCing may va 31 BN khfing dung may. Tat ca c5c BN deu phau tfch duljfc hj- 7 h^ch trd len, bung binh la 18 ± 5,9 trong do chil y&j l i nhdm [^au tfch dutfc tir 16 hach trcf len (61,5%). \ f l ^ suf dyng may c3t nS thSng gtup nit ngSn thdi gian mo (104,3 ± 11,9 so vd^ 153,9 ± 16,2 phiA), bao gom ca thcfi glan dong mom ta (1,1
± 0,7 so v * 5,2 ± 1,5 phut) vh thdi gian ISm mi?ng noi : 5,7 ± 2,5 so vdi 24,9 ± 7,1 phtit (p< 0,001).
Thdi gian c6 bung ben, ttidi glan Sn dudng mi^ng, thifl glan nSm vipi oia nhom BN c6 diing mSy deu thSp hdn vdl p tutfng uY>g la 0,001; 0,02 vS 0,026.
BlSh chljrhg sau mo: g$p duy nhat m5t birdng hdp chay mdu mdm tA sau idii ddng mdm bSng may (2,9%). Kit lu$n: Qua nghign diM chiing tti ttiay t u ^ trung blnh cua nghifin dtu \h 57,5 tu6i, nam gidi chi&n 58,5%. S5 lu^ng hpch trung binh vet dul?c \h 18,0. Ty 1^ di can hach \h 46,2%, ttwig do diii yeu la N2. ay dyng m ^ cSt nS ttiSng giup njt ngSn ttidl glan m^ ttldl gian cd trung tt?n, ttidl gian Sn dudng mieng, ttldl gian nSm v i ^ ciia nhdm BN cd dimg may deu thSp hcm so vdl nhom khdng dimg may. Bien chiiYig 3 " ™= « P duy nha mpt ttudng hdp chay miu mom a sau khi ddng mom bang mSy (2,9%)
TUT khia: ung thu dp day, may dtndi thSng SUMMARY
ASSESSMENT OF USING UNEAR CUTTING STAPLER I N GASTRECTOMY FOR DISTAL
GASTRIC CANCER AT K HOSPITAL
*B$faivi4nK
** Hqc Vl$n QuSn Y
Oiju ttidl nhii|m chtnh: Phgm VSn ffinh Email: [email protected]
Ngay nh|n bai: 5.10.2016 Ngay phin bien khoa hoc: 30.11.2016 NgSy duyft bai: 6.12.2016
Objective: Evaiuabon short-term outcomasilto subtotal gastrectomy using stapler of the gaAt cancer patients. Patients and method: 65 gastA rancer pattents were treated by subtotal gaslredB*
at K hospital from 03/2011 to 09/2011. The randomized controlled clinical study. Results; Tie mean age was 57,4; ratio male/female was i.7/1 Stomach pain was the most common s/a^
(96,9%), palpable mass was detected in 22 patOeli (33,8%). Endoscopy showed that peptic ulcere H the most common types (47.7%). 34 patients wt.
used auto suture stapler and 31 patients wen not The least dissected lymph nodes was 7 and Bt average was 18 ± 5,9 (8-37), almost cases had more ttian 16 lymph nodes. Using stapler helped to decrease the operating time (104.3 ± 11.9 vs 153,9
± 16.2 minutes, p<0.001), as well 3s the Btne rf having postoperative gas (p=0.001)," ttie Stue rf feeding by mouth (p=Q.02) and hrepltel durattn (p=D.026). The rate of postoperaH\ffi compllcattons was very low. Conclusion: In this study, ttie nm age was 57,4, ratio male/female was l.7l\.~%
average dissected lymph nodes were 18,0 and tit rate of patients having posittve lymph node wu 46.2%. Using auto suture stapler reduced opeiatitij ttme and the hospital duration, PostoperaHw complication was very low
Key words: gasb-lc cancer, auto suture stapters I.OjCkTV^NO^
Ung thu- Ida day hi§n la ung thu* pho bighlii 4 t r i n toan the gidl, d ca 2 gia, va 1^ nguyin nhSn tir vong do ung thu* dii^g thii" 2 (ti*) 700,000 ca tiJ" vong moi nSm tren toan thg giffl.
Oieu trj UTDD chu yeu bSng phau thuat trongj vet h?ch CO val tro rat quan trong, cac phutfns phap khac nhu" hoa chat, tia xa, mien dichffli) vai tro b6 trd. Tren the gidl, hien co rat lihUel tien trong phu'dng phap c3t da day vh phuc W
\\iu thong da day-ruot, trong dd c6 phutJng ph^
cat va khau noi may, giiip nang cao hi?u t^
dieu tri. Vi vay, chung toi tign hanh nghl&j , #
nay v6i 2 muc t i i u : * l.€anh gla icet qua Ottg dung m^y c ^
thing trong phau thuSt cSt do^n d? day t^m Ngoai Tong hdp - B$nh vien K ' 2
2.Xep loai gial doan hach tmng benh im sau phau thuit ung thw da ddy 1/3 du&t^B' vi4nK. ' - II. 061 TU-QNG VA PHirONG PHAP NGHIEN CDV 64
YHOC Vier NAM TAP 44S-THAMB12-S02-2IHIi
* t | •
(AHpK OS tU0ig nghien ahi: 65 benh nhan ung l, HSlsffi-.
* « * , ^ 1 S t o o ^ » ™ « i i , a , - ,. * " " W * " ' » ^ "!- 22 BN 06 sft thay mass
. : 5 S f ? « T v l " A N L S n p , s o i « a p t h e k = e t . c h u y . - u , c h ^ 4 7 , 7 % ,
Dunn mau fn— '>A\ FVIJA— JJCZ T6ng thcfi gian ITTO fphut)
Thcfi gian dong mom te (phiit) Thfn nian lam mlAnn « ^ V_i..'j.\
Ttid gian lam mieng n6i (phi'it)
liftfnq mau mat (ml)
Dung may ( n = 3 4 )
104,3 ± 11,9
1,1 ± 0,7
W ± 2.526,2 ± 10,2
sttdsr
wise
* "^^ *" uuiiy may o
" ^ ngSn thdfi glan mo (104,3 ± 11,9 so'va753,'9 IIB? * '^'^ '''^"''' ' ' ^ som ca thfti glan dong mom , „ ; S . " " " ' t^'l * " - ' so " * 5/1 ± 1.5 phut) va
— ' thai glao thut hiSn mieng noi (5,7 ± 2,5 so vfti 2 4 , 9 M l phut), sir lihac biet nay la co y nghia t h o n ^ ( p < 0,001). Luang mau mSt trang mo
Khonq dimg mav (n= 31) 153,9 ± 16.2
5,4 ± 1.5 24,4 ± 7.1 36,8 ± 15.4
: 0,001
;M^2^fA^ss^^ ssyjz^'s^ifr^^nt^"
. ' T « ^ «",Bj ..lay, VUI l^ct qud lOUg EnOI gian phau thuat dia nhom dung may la 166,4 phut. Co sir khac biet ve thcfi glan phlu thujt gius nghien diu da chung toi va nghiSn ohi cda cac tac gla nu'dc ngoai chii yeu do nghien cihi cua Chung toi thut hien tren nhutig bSnh nhan duBc phau thuat md bung, con cac tac gia trSn•W" ItTiS^r '•'-• '-1-JS ™ " . " ^ ' ' ^ " S ™ 'ddc phSi thuat mft bung con cac tic oB frin
i« rS7irsVZc"SS"nr.hirc^^i s ? ^ r n 5 ^ i i ; s l S H ?
BingZ KaauasdmsauohSuUtuit ihdl glan co trunq tien fnqay)
Thdi qian an duting mieng (nqav) TTOI gian nam vien (noavT
DCing miy ( n = 3 4 )
2,9 ± 0.5 5,3 ± 0.6
7,3 ± 0.8Kliong citing mdy ( n = 3 1 ) 3,2 ± 0.5
5,9 ± 1.0 8.1 ± 1.8
< 0,001
0,020,026
TJ . . l " ' " ! - . ™ •"?" ™ ' " tiie phong ttanh duoc khi phau tfiuat vien lua chpn Mng dinh ghim phu hdp vdi mom ta b^ng.Trong nghien cuU cua diijng toi, khong gSp bat cU^hTiBng hdp nao xay ra bien chutig sdm sau mo (chay mau, viem phuc mac, ap xe t5n du'...) d ca hai nhom benh nhan. Kft qua nav j i i ,. ^^ Ol=" 00 ttung H|n, Uifti gian an duSng
.« "'7"^' •" S'^" ™"' ^'^" °J3 "''oni BN CO dCing
•^K mtfi dSu thgp hdn so vdl nhdm khong ding
* ^ miy. NghiSn cfti cila Nguyen VSn Hieu cho Uiay
» » UlBI gian co ttung tien cua BN diing m^y la 3 m ngSy, cOa Fujila.T Vs 2,4 ngay vS Yoon Young
»" nhien s^r kh^c bl?t gliia hal nhom diJng m i y ^ H & S le i 6 ^ A ^ i 2 S , ^ l l f ^ " i f - ' ' ' " ? ' °^
^^ kheng dung-h^y B khong cd y nghTa'tt^ng' 11 T t i l l ^ ^ ^ ^ ^ ^ ' ^ ' ^ Z
yiETHAy MEDICAL JOURNAL N'^ - DECEMBER - 2016
Van la 0,9%, ciia f ^ m Duy Hien la 0,64% [2], chan) da han che cac blen chiitig nay. L..
[3], [5]. Cd the do tiudc d i y , phutJng tien kim do^sir ra ddi cac the he may cat noi gliip d._
chi khfing duWc lot, gay me hoi siit con han che phau thuat vien co nhieu lua chon hdn d ^ l nen cac ty l | nay Uiudng gap hdn. Ngay nay, che bdt cac bien chutig.
kim chi tfit lidn (kim lien chi, kim khong sang 3. X^ glal aoan hach sau phau thuit tm>D Bing 3: Sff lddng hach phiu tich
Sg Iuyng hach phau tkft T V I j %
.7-15 hach 38,5
> 16 hach
61,5
Trung blnh; 18,0 ± 5 , 9 ft nhSt: 8 hach Nhieu nhSt; 3 7 hach Bang 3 dio tfiay tat ca cac BN deu dudc phau b'ch kiem tra tCr 7 hach trft len, trung binh la Ifc 5,9, trong dd chu yeu la nhdm phau tich duwc tir 16 hach trd ISn (61,5%). K ^ qua nay ding Is' duOng t i c gla Trinh Hong Son (2001) vdl 18,6 hach khi phau thuat ung thu' da day vet hach D2 [61
Bing 4. Phin loai hach dl can Phan toai hach di cSn NO (Chua dl can hach)
NKDIcSn 1-2 hach) N2(Dlcgn3-6hach1 N3a ( Dl can 7-15 hachl N 3 b ( D l d l n a l 6 h a c h )
SoBN
Trung binh: 2,03 hach T i c g l i BUI Anh T u v a (2003) r n Trlnh Hang Stfn (2001) [61 l a MInh Quang (20021 [3]
H i H i l Nam (2011)
it nhat: Q hach
T y l S % 53,8
21,5
pNO 34,4%
19,28%
44,4%
53,8%
p N l
Nhieu nhat: 13 hach 44,8%
52,94%
31,6%
15,5%
pN2 20,8%
21,24%
24%
21,5%
PN3
6,54%
9,2%
„ °^™J? • * ? * ^ ' ' * ' ^ **^ P''*" ' ° ' ' Slai Tai bISn va blen chutig'! ch gap duy nhj.
h S , ^ j r , ^ ? J , ^ l ^ K : ^ ' ™ ' ^ ' 5 . * " > ' = " " ' * *'i"9'*ch,bucm6mla,rachbucml$ngn5l. • S i n K n ^ s ^ h « " ' ^ " r , ^ * " * ° ? ' " ^- ^ ' " " » ? " "^ch trong b?nh phjm m,
^^y^^hh%^^ht^.Vmi«ncisti&ia phlu thu$t ung thtf da d i y
SSn^i^tal^thfdi^iXrxH l*.i:ti«,.*-^*^" (?v.*)4^^".?"«
N l , cftn dl can tir 3-6 had! dS l i N2, b o i ^ khi tfieo phSn k>?i cu till dl can 1-6 hadi dutJc xSp l i N l . I V . K f r i u A N
1. K»qui Ong dgng miy cSt ndl thing Irong phiu thuftdttofn Of lOy
Vl^c sijf dgng may c i t nSI ttiSng gliip: nit 1 ^ 2 1 ? ' ™ ! " S i * ' 98m ca tfKfl gian ddng mdm l i tting va ttxjl glan tiiui hien ml^ng nS, X , ° ? S » ' i ' ™ ! ^ ^ ' ' ^ 9lan an dirdng
^ S ^ ^ l l i i l * " ' ' ^ ^ nhOT BN cd diing / ^ . . S ^ M p hdn so vdl nhdm khfing dung may ( V k h i c bl«t niy l i cd y nghb ttiong ke)
. . - — . , .^ ..wb., Ul u j i i \-,u,t-rt,y Uiap HUM sw . cac tac gla khac, trong do chu yeu l i hach N2.
TAIUIUTHAMKHAO
1. Bill Anh Tuytt (2003), -Nhjn x«l djc di&l Itn sang, hinh anh n^l sol v i mo b^h hpc oia ung tW da dSy dBu trj t;l b?nh vl^n K tir thSng S/ioB- 61^^", iu^nv^n thac spy khoa, trn-75.
i. 0 6 BiTc VSn (1993), " B i u tfj phlu thujt u f thu' d? dSy tsi b#nh vISn Vl|t Diit tii 1970 4 * 1992 ".rhpcm Nam, >, 173; tt 45-50 3. U MInh Quang (2002), • NghlSn olU djc
Bm sing, m6 b|nh hpc v i kft qui dSu h i , thuit ung thtf bleu mo biyft da diy tal benh ^ X-ws-imr, Lufn vsnuac^rhati Hi hft
*. NguySn Vin Hifu v i cs (2009), - B u * ' nghien aiu iing dgng miy c i t n6l t h i n g '
YHPC VIET MAMTAP449-THAHG12-SO2.201fi phau thuat iJieu trj ung ttiu" da day", De tai nghien
ahi <^p af sol, Benh vien K Ha fidl.
Ph?m Ihiy Hien - Nguygn Xuan Kien (2000) Nhan xet tai bien va bien chifrig cua phau thuat dreu tii ung thiT da day", Yhoc thuH hanh thing 6, tr.24-26.
6. Tnnh Hmig 5(Ai (2001), "NghiSn ahi nao vet hach trong ffieu tri frfiau thuat ung thiT da" day", Luan an Ti&iaYhqc, Bai hoc Y Ha Ngl.
I. AJCC (2010), -Cancer Staging Handbook", From we AKX: Cancer Paging Manual, / * edition.
Springs, 149-152.
_ T - NGHIEN CUTJ KET QUA CAN THIEP D 6 N G MACH V A N H QUA DA J | ^ is BENH NHAN BAI THAO BirffNG TYP 2 CO BENH OONG MACH VANH
2S<^MTAT
' * M L .""'^ " ' " i ' ' * * 9'^ * ""= "=" "liSP dSng mach
•linh qua da d bpnh nhSn dii thio ducing typ 2"c6 - ^i?nh dpng m?ch vinh. Phu'dng phip: (^6 t i c3t
^ " Ket .qui: NghiSn tojto henh nhin dil thao CO b|nh d d n B B B v a n h duHc can thilp k i j M u a d a i ^ W l ^ t n r d n g hpp chi dliih fe fi ,. ^ " " " ' " ' ' * 9 mach llln that ',iW,rSS " ' '"'^'''° "* ' ' ' " 9 " ' 5 * " i " ! ! phii J3,3%. KSt qua can thl|p dpng mach vanh qua da:
f >f* ™"h t«ng giai phlu, 86,7% tfiinh clng thu i S f ™ ! ' " i 85% ttianh cong lim Sng. Ty I I can thilp
^ • c o n g llm sang: nhom hep 1 hole 2 nharih liem 100,0% va nhdm 3 nhanh chiem 72,7%
-^..w... *««,„,u va iKiuHi .5 nnann cniem /2,7%, S - T K S ' " ? ' ™ H •"" " " " " 9 A, B va C lan luljt la
» J 0 0 % , 90,6% va 53,8% (p=0,001) v l tfieo dong dliy
; P™ diua c6 khac hl|t <• nghla ttiong ke. Kft lu|n: Can i C * ' ? ' ' ? " * i S n ly I I 53,3%. l<i II can thUp thinh - t ^ f m|t glal phau, ttianh cong ttiii ttiuH Oa ttiinh I.» Wng llm sing lan lupt l i 88,3%, 86,7% v i 85,0%
f ! 5 . J ^ * ^ " * " '^ ' ^ """"^ * 2, can tfillp dpng
!,HllBiach vinh qua da. »p v a ljiii#UMMARY
y ' STUDY OF PERCUTANEOUS CORONARY t m > INTERVENTION RESULTS I N TYPE 2
»)»l DIABETES PATIENTS WITH CORONARY l|ilS* ARTERY DISEASE
Objective: To evaluahve percutaneous coronary nterventlon (PQ) results in type 2 diabetes patients miV™ coronary artery diseases. Methods: Cross-
^ j ^ o n a l descriptive sttldy. Results: A ttital of 60
Tran Vi^t An*, Duvng Van An*
clinical success was 88.3%, 86.7%, 85.0%. ainlcal f f ^ " f 1 ^ results: 1 or 2 branches artery was 100% and 3 brandies artery was 72.7% (p= 0.013), type A, B and C coronary arteries lesion was 100%' 90.6% and 53.8% (p= 0.001) and conttast TIMI flow was not significant. Condusions: Primary p a was ' 53.3%. Angtographtc, procedural, dinical success was 88.3%, 86.7%, 85.0%.
Keyword: type 2 diabetes, percutaneous coronary Intervention.
I.O*TVANB8
^ Trong nhiing nam gan day, dal Uiao duSing ngay cang gia tSng d cac nudc phat trien va dang phat ttien. Khoing 70% til vong ft benh nhan dal ttiao ddftng la do bien chuhg mach mau Idn ttong dd benh mach vanh la chii ySu B?nh dong mach vinh od bien chiilig thuSng g|p v i nguyen nhan gay W vong sdm ft blnh nhan dal thao duftng. Trong do tuSi 40-65, tif vong do benh vanh ft benh nhan dai ttiao dttftng nam gidl gap 3 lan ngufti khong dal ttiao dudng.
ViSc chan doan sdm v i dieu tn kip thdi bSnh mach vanh la mot khuyen cao lufin dUdc d i t r a Cho den nay cd ba phu'dng phap dieu tri benh mach vanh dd la dieu tti noi khoa, can thiep dpng m?ch vanh qua da va phau ttiuat bSc ciu noi m?ch vinh [5], [26]. MSI phu'dng phap cd ttu va nhuBc diem rieng. Can Uiiep dfing m?ch vanh qua daja mpt ttong nhiitig phu'dng phap dieu tti hull hleu, da duac khdi dau tii' ttiap nien 70 cua Ij^tients with t^je 2 diabetes MWB enrolled and PQ
« « r " S „ S S g S . = " a ^ d r . . ^ i ' Y t S i Z i r ^ l ! " ^ "7- ^ \ ^ ? " = E^^P nay t ^ g » r o n a . a . , were PO. Angiographic, t . t c ^ . I I T ^ S n g ^ S ^ ^ n i S * f j ' „ - J ^ ? : „ ^ » .
nen viec danh gla ket qua can Uiiep dong mach vanh qua da d benh nhan dai Uiao dudnq type 2 la ttiat stt can H1I& a r i ^ ' i;HSl-
^^Ihidng Bai hgc YDudc (Sn Tha l(ji*3iiu ttich nhllm chinh: Trin vilt An j^a&nall: [email protected] jrK*l9iy nh|n bai: 8.9.2016 iKjtIgiy phin bl|n khoa hpc: 14.11.2016 irflUgiy duylt bii: 30.11.2016
II. oSlTUHlNG vA PHirCKNG P H 4 P NGHI§N COU 2 . 1 . Doi tu'dng nghien cljru
