PCHlYDUqCLAM SANG 108 Tap 12-566/2017
[ghien cmi mot so yeu to anh hirong d£n kit qua giam rong luong khoi u co tron tu cung sau nut dong mach tu ung vol hat nhua PVA
tudy of some factors effect to the results of treatment uterine fibroma y uterine artery embolization with PVA
guyen XuSn Hien, Fham Minh Thong Benh vien Bgch Mai
i m t S t
Muc tiiu: Tim hieu mpt sd yeu to nhu vj tri u, kieh thude, tang sinh maeh, kieh thudc hat PVA dung nut mach... c d l n h hudng den mde dp g i l m kfch thudc khdi u cotron tdcung. Do/tt/pngvophuongp/)dp:Td 1/2007 den 9/2010 vdi 108 benh nhan dUoc dieu trj u eo tron tdcung bang nut ddng mach t d cung vdi hat nhua PVA tai Khoa Chan d o l n hlnh I n h , Benh vien Bach Mai. Duac theo doi lam sang bang bp eau hdi; kieh thudc, the tieh khdi u bang sieu am va sau 6 thang nOt maeh. Kitqud: 108 benh nhan (tudi trung binh 39,4) vdi 129 khdi u co tron t d cung (trpng lupng u trung binh trudc nut maeh la 67,3cm^). Sau 6 t h i n g nut mach thay: U dUdl niem mac cd ket q u i t h l n h cong cao hon u trong t h l n h v l u dudi thanh mac la 2,1 l l n (p<0,05; OR = 2,1 va 95% Cl = 1,7 - 6,1). U tang sinh mach cd ket qua thanh eong cao hon khdi u tang sinh mach it v l vda I I 2,08 lan (p<0,05; OR = 2,1 va 95% Cl = 1,7 - 6,1). U dUdi niem mac g i l m trpng lUpng hon u trong thanh va u dUcfi thanh mac la 18,1% (p<0,05). U t i n g sinh mach nhieu g i l m trpng lupng nhieu hOn khdi u tang sinh mach vda va it la 17,7% (p<0,05). Kit ludn: Cae khdi u ed tang sinh mach hay n l m dudi niem mac tdcung dap dng tdt khi dieu tn bang niit dpng maeh.
Tdkhda: Nut dpng mach tdcung, hat nhua PVA, u cO tron t d cung.
i m m a r y
Objective: Analyse some factors that effected to the results of uterine fibroids treatment by uterine artery embolization. Subject and method: Analyzed 108 patients (mean age 39.4) has 129 tumors with symtomatic uterine fibroids undergoing uterine artery embolization by PVA at the Radiology Department in Bach Mai Hospital from January 2007 to September 2010. Afer treatment, follow up the symptoms with questionaire, size and volume of fibroids by ultrasound at 6 months. Result: After 6 months of procedure, submucosal leiomyoma volume was 18.1% more reduction than intramural and subserosal leiomyoma (p<0.05; OR = 2.1 and 95% Cl = 1.7 - 6.1). Uterine fibroma hypervaseulaire volume was 17.7% more reduction than hypovasculaire (p<0.05; OR = 2.1 and 95% Cl = 1.7 - 6.1). Conclusion: The volume reduction of uterine leiomyoma after uterine artery embolization by PVA was better in sumucosal leiomyoma, hypervaseulaire.
Keywords: Uterine artery embolization, PVA, uterine fibroid.
dynhgn bdi: 17/3/2017, ngdy chdp nhgn ddng- 27/4/2017
vaiphdn hoi: Nguyin Xudn Hiin, Email- ngochienduyiocbm@,gmail-com - Benh vi^n Bgch Mai
JOURNAL OF 108 - CLINICAL MEDICINE A N D PHARMACY VoM2-N%/20i7
I . D a t v a n d e
Dieu trj u eo tron t d cung (UCTTC) bang phuong phap nut ddng mach t d cung (E)MTC) ddpe thde hien t d nam 1995 [1]. Vat lieu nut maeh cd nhieu loai trong do cd hat nhda Polyvinyl aneohol (PVA) cd gia t h l n h re, sin cd vdi nhieu kich cd khlc nhau. Tren the gidi da cd mdt sd nghien cdu don bien anh hudng tdi mdc dp g i l m trpng lUpng khdi u nhd JB Spice va cdng su nghien cdu ve vj tri cOa khdi UCTTC anh hudng den mdc dp g i l m trpng Idpng khdi u sau nut ddng maeh t d eung [2] hay Jha v l cdng sU nghien cdu ve mde dp tang sinh maeh eua khoi u cd anh hddng den mdc dp giam trpng Idpng khdi u sau nut mach [5]. Tai Viet Nam chda cd nghien cdu nao ve van de nly, vdi mong mudn tim hieu sau ve ele yeu t d I n h hudng den mdc dp giam trpng ldpng khdi u sau nut mach theo don bien v l da bien, chung tdi mong mudn dupe thde hien de tai
"Nghien cdu mdt sd yeu to I n h hddng den giam trpng luong khdi u co tron t d cung sau nut ddng mach t d eung vdi hat nhua PVA" dupe tien hanh vdi muc tieu:
Phdn tich mdt so yiu td lien quan din mdc dd gidm trgng IdOng khdi u co tran td cung sau nut dong mgch tdcung.
2. Ddi tupng va phUtfng phap 2.1.DditUMg
Vdi 129 khdi u co tron t d cung ddpc nut ddng maeh t d eung dieu trj bang PVA t d t h i n g 1 n l m 2007 den thang 9 nam 2010 tai Benh vien Baeh Mai.
3. Ket qud
3.1. Dgc diem khoi u ca tran td cung trUdc ndt mgch 3.1.1. Ddc diem vi vi triu trin siiu dm 2D
2.2. Phuang phdp
Nghien cdu can thiep, md ta hdi edu.
Tieu ehuan chpn: Tat ca eac khdi u eo tron td eung cd gay ra cac dau hieu l l m sang nhU; Oau bung, rong kinh, kich thudc u Idn nhlt dudi 10cm, benh nhan (BN) cd the ed 1 hole nhieu khdi u.
Tieu ehuan loai t r d : Khdi u ed cudng nam dirdi thanh mac h o l e u cd kfeh thude tren 5cm nam di/*
niem mac, dang ed viem nhiem kem theo...
Phdong tien nghien cdu: MIy si^u I m Doppler mau AlokarSSD 5000.
Cae bien sd nghien cdu; Vj tri khdi u, kichthi/dc khdi u, mde dp tang sinh mach ehup maeh (DSA), trpng IdOng khoi u dUpe ti'nh bang: D l i x rong xcao X 0,52em^ hay gam. Thdi diem ddpc theo doi sau 6 t h i n g nut ddng mach t d cung.
Ket qua dieu trj se ed hai gia trj Thanh c6ng' hay'That bai".
That bai: Trpng Idpng khdi u g i l m so vdi trifiJc dieu trj dudi 25% dupc cho I I khdng thlnh edng.
T h l n h edng; Trong lUpng khdi u giam so vdi trude dleu tri tren 25% dUdc cho la thanh cong va khdng phai phau thuat cat khdi u hay eat bd tiJcung.
Xd ly sd theo phan mem SPSS 16.0, STATA 16.0 va STATICA 5.0, phan tich hdi quy da bien logistic va test Wileoxon; chi sd nguy co (OR) t d do rut ra nhan xet. Ket q u i kiem djnh 6ugc danh gia la ed y nghia thdng ke vdi g i l trj p<0,05.
9,8%
44.5'' ° ^ ^ ^ ^ ^ | ^ B | _
• Dircn mem mac
• Trong c(7 ti> cung D Oirai thanh mfc
B i e u d o 1 . D a e d i e m vi t r i u t r e n s i e u a m
CHlYDUOC LAM SANG 108 Tap 12-So 6/2017
N/idnxef:Trong so 129 khoi u dirpc nghien cutu thl co 59 l<hoi u nam 6 di/6i niem mac chiem 45,7%, sd u n duai thanh mac chiem 9,8% con iai 44,5% ia i<h6i u nam trong thanh t i l cung.
3.1.2. Bac diem ve cau tnic u tren sieu dm 2D
:^J) 1% 15,4%
54,5%
• Tdng dm
• Giam dm n HSnhcrpdm
Bieu do 2. Dac diem cau true u tren sieu am
Nhdn xet: Trong sd 129 khoi u ddoc nghien edu thl sd u giam I m ehiem 54,5% (70 khdi u), sau dd den )i u hon hop am chiem 30,1%, cdn lai I I khdi u t i n g I m ehiem 15,4%.
3.1.3. Ddc diem trgng IdOng u tren siiu dm 2D
Bdng 1 . Dac diem trong lUorng u
Trong lUtfng u (gam)
50 5 0 - s l O O 100-S150 150-< 200 200
Tong
So lircrng U I
53 26 15 6 8 108
U2 16 1
17
U3 4
4
Tong
73 27 15 6 8 129
T y l e %
56,6 20,9 11,6 4,7 6,2 100 Nhdn xet: Qua bang tren ehung toi thay u dUdi 50 gam ehiem 56,6%, khdi u cd trpng lupng dddi 100 va 1 50 gam chiem 20,9%. Trpng lupng trung blnh u (TLTBU) trddc nut mach la 67,3 ± 60,3 gam, trong do u 3 nhat la 0,69 gam va Idn nhat la 294,5 gam.
3.2. Phdn tich dan bien mot sdyeu to dnh hddng den ket qud dieu tri sau 6 thdng nut mgch 3.2.1. Vitri khdi u
Bang 2 . Mdc do giSm trong Idong khoi u theo vj tri u sau 6 thang dieu tri
ldi niem mac 3ng CO, ducfi thanh mac
Sou
51 78
TLTBU (gam) Trir6c nut
53,1 66
Sau nut 7,4 21,1
T$ le giam
('%)
86,1 68
P
<0,05 Nhdn xet: Ty le giam trpng ldpng cua khdi u dddi niem mac nhieu hOn u trong thanh t d cung va dddi i h mae la 18,1 % vdi p<0,05.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.l2-N°6/2(ll7
3.2.2. Kich thddc khdi u trddc d hai nhdm kich thddc < 5cm vd > 5cm
Bdng 3. Mdc do gidm trong lUOng giuTa hai nhom u sau 6 thang dieu tri
Kich thudc u
<5cm
>5cm
Sou
82 47
TLTBU (gam) Tri/crc nut
20,4 124,1
Sau nut 4,5 35,4
Tyle g i i m (%)
78
71,4 1 P
>o,os Whdn xet. TJ le g i l m trpng ldpng khdi u eOa hai nhom u cd ki'chthudc nho hOn hole b i n g 5em va tr&n Sem cd sd khae biet nhung khdng ed y nghla thdng ke vdi p>0,05.
3.2.3. Cdu trde dm khdi u
BIng 4. Mdc do giam trong lugng khoi u sau 6 thang nut mach gida cac nhom cau true am khoi u tren si^u dm
Am khoi u
Giam am(i) Tang am^) Hon hop{3)
So u
66 24 39
TLTBU (gam) Truorc nut
45,1 64,5 67,9
Sau nijt 9,0 29,1 18,9
T ^ l e g i i m ( % )
80 54,9 72,2
P
Plui<0,OS PiMl>0,05 Pl«i>0,!15 Whdnxef; Mdc dp g i l m trpng Idpng cua khdi UCTTC sau 6 t h i n g nut mach d n h d m u g i l m am nhieu hon nhdm u tang am la 25,1% vdi p<0,05.
3.2.4. Mdc do tdng sinh mgch khdi u tren chup mgch mdu
BIng 5. Mdc do g i l m trong IdOng khoi u gida hai nhom tang sinh mach nhieu va nhom tang sinh macti viia va it sau 6 thang nut mach
Tang sinh mach
Nhilu VUa va it
Sou
43 86
TLTBU (gam) TrUdrc nut
86,3 46,4
Sau nut 15,0 16,1
Ty le giam (%)
83 65,3
<0,05
Nhan xet: MUc dp giSm trong luong cCia kh6\ u tang sinh mach nhieu nhieu hon nhom tang sinll mac^
vito va it ia 17,7% vdi p<0,05.
3.2.5. Kich thi/dc hat PVA dung nijt mgch
Bing 6. IVIuTc do g i i m trong IUtfng Ichoi u theo kich thi/dc hat si]rdung sau 6 t h i n g nijt mach
Kich thu«c hat PVA (|im) TLTBU (gam)
T y l ^ g i i m ( % )
Nhgn xet: Mute do giSm trong iuong Midi u cua nhom u dung hat nho nhieu hon nhom u dung list*
17,5% vai p<0,05.
CHlY Dl/OC LAM SANG 108 Tap 12-Sd 6/2017
3.3. Phdn tich da bien hdi quy logistic mot sdyeu tSdnh hUdng den kit qui dieu tri u ca tran tit cung }g nut dgng mgch t&cung
Bang 7. Phan tich da bien cac y^u to anh hddng den muTc do giilm trpng IdOng khdi u sau 6 thang nut mach
Cac bien
ch thudc u trudc nut
t r i u
mg sinh mach
»hatPVA
£ 5 c m
> 5 c m Dudi niem mac Trong thanh, dudi thanh mac Giim am Tang, hon hdp am Nhieu VUa, it
< SOOtJm
> 500pm
Ket q u i dieu tri Thanh cong
73 35 46
62 61 47 39 69 61 47
That bai 10 11 5 16 5 16 4 17
5 16
OR(95%CI)
0,43(0,17-1,12)
2,1 (1,7-6,1)
1,2(0,4-3,5)
2,08(1,15-6,6)
1,2(0,4-3,5) P 0,08
0,02
0,06
0,02
0,06 Nhdn xet:
Khoi u dudi niem mac ed ty ie t h l n h cdng trong nut mach Idn hon 2,1 lan khdi u nam trong thanh v l ffi niem thanh mae vdi p=0,02(OR^2,1;95%Cl = 1,7-6,1) vdi dieu kien cae yeu t d cdn lai la nhd nhau.
Khdi u cd mdc dp tang sinh maeh nhieu cd ty le thanh cdng nhieu hon 2,08 lan khdi u cd tang sinh mach a vda vdi p=0,02 (OR = 2,08; 95% Cl = 1,15 - 6,6) vdi c l e yeu t d cdn lai 11 nhd nhau.
Janluan
Mpt SO yeu t o I n h hddng den ket q u i dieu trj 16 t h i n g nut mach:
4.1. Vj tri cOa khoi u
Theo BIng 2 nhdng khdi u nam dddi niem mac m trpng Idpng hdn nhdng khdi u nam dddi thanh c v l trong t h l n h t d cung 18,1% vdi p<0,05 va o BIng 6 nhdng khdi u dddi niem mac cd ty- le nh cdng eao hon nhdm u trong thanh v l dddi nh mach co y nghTa thong ke vdi (OR = 2,1; 95%
= 1 , 7 - 6 , 1 ) v a p=0,02. Theo Nguyen X u I n Hien v l im Minh Thdng (2010} nghien cdu tr^n 100 benh in thay u dddi niem mae g i l m trpng Idpng hon u i g CO va dudi thanh mach I I 33,2% v l 44,7%
0,05) [7].
Theo nghien cdu n l m 2002 eua James B Spies va g sd [2] tren 200 benh nhan eung thay rang u
dudi niem mac g i l m trpng lupng u nhanh hon nhdm dddi thanh mae va trong t h l n h t d eung la 30 - 40%
(p=0,03) tai thdi diem theo ddi 3 t h i n g sau nutDMTC.
Nhu v l y , ddi vdi nhdng khdi UCTTC dddi niem mac cd tien lupng tdt khi dieu trj b i n g phdong p h i p ntit BMTC, theo kinh nghiem cCia chiing toi nen chpn nhdng khdi u nay cd dddng kfnh s Sem.
4.2. Cdu true dm cua khdi u
Theo BIng 4 thi ta thay eau true am cua khdi u trudc nut mach eung cd g i l trj de tien Idpng ket q u i dieu trj UCTTC bang nut €)MTC. Trong nghien cdu nay nhom u g i l m am g i l m trpng Idpng trung binh 80% sau 6 t h i n g dieu trj so vdi 54,9% cCia nhdm t i n g I m vdi p<0,05. Diiu nay ed the hieu ddpc la do trong cau true khdi u g i l m am eo ehda nhieu te bao CO TC hon t d chdc xa nen khi tae ngudn mach nudi dudng khoi u nay se hoai t d v a tieu nhanh hon khdi u tang I m co chda nhieu te bao xo v l t d ehde lien 75
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N''6/2017
ket. Nhdng trong phan tieh da bien (BIng 6) thl cau tnic I m CLia khdi u khdng I n h hddng den ty' le thanh edng eOa phUOng phap vdi OR = 1,2; 95% Cl = 0,4 - 3,5 v l p=0,06. Theo Nguyen XuIn Hien va Pham
Minh Thdng (2010) nghien cdu tren 100 bgnh nhan thay u giam am giam trpng lupng hon u tang am la 25,1%(p=0,02)[7].
Hinh 1 . Sigu am trUde va sau nut maeh cCia UCTTC g i l m I m (BN Hocing Thi Minh L 43T ma BA C53/67) A:Trddc mit maeh u g i l m am vdi p = 51,9 gam
B: Sau nut maeh 6 t h i n g sieu am khdng thay u 4.3. Kich thudc khoi u trUdc ndt mgch
Theo BIng 3 chiing tdi thay su g i l m trpng lupng eCia khdi UCTTC sau khi nut DMTC cua hai nhdm khdi u cd kieh thude Idn hon 5cm va kich thudc nhd hon hole bang 5cm sau nut mach 6 t h i n g khdng cd y nghla thdng ke (p>0,05), dieu nay phu hpp vdi nghien cdu cOa Seiji Isonishi va edng sU [3] nghien cdu tren 43 benh n h i n ddpc nOt ddng mach t d cung de dieu trj u eo tron t d eung thay kfeh suthay ddi kieh thddc khdi UCTTC sau niit DMTC eCia hai nhdm u cd kfch thddc tren 6,5em va dddi 6,5cm khdng cd y nghla thdng ke (p^0,1}. Theo Nguyen X u I n Hien v l Pham Minh Thdng (2010) nghidn edu tren 100 benh nhan thay kich thude khdi u dudi 10cm khdng I n h hudng den ket q u i dieu tri [7],
Theo Smeets va cpng sd [4] nam 2010 nghien cdu tren 71 benh n h i n niitOMTC dd dieu trj UCTTC t d nam 2000 den 2005 thay rang nhdm u cd kfch thude dudi lOem va tren 10cm cd X$ le g i l m trpng ldpng la 86% va 87% vdi p>0,05.
4.4. Mdc do tang sinh mgch cua khoi u Trong 129 khdi UCTTC nghien edu, ehung tdi thay rang cac khdi u cd t i n g sinh mach m l u nhieu tren ehup maeh so vdi nhdng khdi u tang sinh maeh
vda va it thl mdc dp g i l m trpng lupng khdi u sau 6 t h i n g nut DMTC cCia nhdm t i n g sinh mach nhieu so vdi nhdm tang sinh mach vda v l ft I I 17,7% vcfi p<0,05. Theo BIng 7 thay nhdm t i n g sinh mach nhieu cd ty le thanh cdng cao hon nhdm tang sinh mach it va vda I I 2,08 lan (OR = 2,08; 95% Cl = 1,15 - 6,6) v l p=0,02. Theo Seiji va cdng su thi nhdm ed tang sinh maeh g i l m trong lupng khdi u nhieu hon nhom khdng t i n g sinh mach vdi p<0,05 [3], cung vdi k^t q u i tuong t d , theo Jha v l cpng su nghien cilu tren 125 khdi u sau 3 t h i n g nut maeh thay nhdm co tang sinh maeh g i l m trpng lupng u nhieu hon nhom khdng tang sinh mach la 35% vdi p<0,05 [5]. Dieu nay ed nghta rang nhdng khdi u giau maeh se cd ket qua dieu trj tdt hPn nhdng khdi u khdng t i n g sinh mach vi khdi u t i n g sinh maeh thi thddng kem theo nhieu te b l o CO hon la te b l o xo nen sau khi niit mach chiing se tidu nhanh hon eac te bao xO.
4.S. Kich thudc hat sCfdung nut mgch Trong nghien cdu nay chiing tdi cung de cap den kfeh thddc cCia hat PVA dupc sd dung de nOt dpng mach t d cung, theo Bang 6 chiing tdi thay mdc dp g i l m trpng luong khoi UCTTC sau 6 thang niit mach cua nhdm dung hat cd dudi 500pm nhieu hon nhdm dung hat ed kfch thddc tren 500pm la
76
T*^P CHf Y DdOC LAM SANG 108 Tapl2-S6 6/2017
17,5% vdi p<0,05. Dieu nay ed the dupe g i l i thfch I I do hat ed kfeh thddc nhd se di sau v I o khdi u nen lam eho khdi u se thieu m l u nhidu dan den hoat t d nhieu hon dung hat to. Nhdng phan tfch da bien eho thay kich thude hat sd dung khong I n h hudng den t^ le thanh cdng vdi OR = 1,2; 95% Cl = 0,4 - 3,5
v l p=0,06. Theo Bilhlm (2011) nghidn cdu tren 108 benh n h i n chia lam hai nhdm diJng hat t d 350 - 500pm v l 500 - 700pm, t i e g i l thay sau 6 t h i n g niit maeh ket q u i eua hai nhdm nay la n h d nhau [6].
.< . -: ^ '=^^' 'f
D
, ^
HP-- • ,
Hinh 2. Sieu am 2D, mau v l chup mach trude va sau nut mach (BN Dinh Thj L 46T m l BA C55/3). Rong kinh nhieu, p h l i truyen m l u . A, B: Sieu am trudc nut mach khdi u 143 gam, giam I m , tang sinh mach.
C: Chup maeh, tang sinh maeh t d ddng maeh t d cung p h l i . D: Sidu I m sau 4 t h i n g nut mach, khdi u 16 gam, t i n g am, khdng t i n g sinh maeh.
Hinh 3. Sieu I m trude va sau khdi UCTTC hdn hop am (BN Tran Tuyet A 38T ma BA N99/1) A: U 98,6 gam hdn hop I m trdde mit B: U 40,8 gam sau 6 t h i n g niit mach
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.l2-N°6/2017 ,^1
5. Ket luan
Nghien edu tren 108 benh nhan (tudi trung binh la 39,4 + 6,7) vdi 129 khdi u eo tron t d cung (trpng lupng u trung blnh trude nut mach I I 67,3 ± 60,3 gam) tai Khoa Chan d o l n hinh I n h , Benh vien Bach Mai t d t h i n g 1 n l m 2007 den t h i n g 9 nam 2010.
Chiing tdi rut ra mdt sd ket l u i n sau vd mdt sd yeu t d I n h hudng den ket q u i dieu trj sau 6 t h i n g mit mach:
U n l m dudi niem mac cd ket q u i t h l n h cdng cao hon u trong thanh va u dddi thanh mac la 2,1 lan vdi p<0,05; OR = 2,1 va 95% Cl = 1,7 - 6,1.
U tang sinh mach cd ket q u i thanh eong cao hon khdi u t i n g sinh mach it va vda la 2,08 lan vdi p<0,05; OR = 2,08 va 95% Cl ^ 1,15 - 6,6.
U n l m dddi niem mac g i l m trpng Idcmg hon u trong t h l n h va u dddi thanh mac la 18,1 % vdi p<0,05.
U t i n g sinh maeh nhieu g i l m trpng luong nhidu hon khdi u tang sinh maeh vda va it la 17,7% vol" p<0,05.
Tai lieu tham k h i o
1 Ravina, JH et al (1995) Arterial embolisation to treat uterinemyomafa. Lancet 346(8976): 671-672.
2. James BS et al (2002) Leiomyomata treated with uterine artery embolization: Factors associated with successful symptom and imaging outcome.
Radiology 222(1): 45-52.
Seiji I et al (2008) Analysis of prognostic factors for patients with leiomyoma treated with uterine arterial embolization. Americal Journal of Obstretics & Gynecology 198:1 -6.
Smeets AJ et al (2010) Uterine artery embolization in patients with a large fibroid burden: Long-tem clinical and MR follow-up. Cardiovasc Inten/ent Radiol 33(5): 943-948.
Jha, RC et al (2000) Symptomatic fibroieiomyomata:
MR imaging of the uterus before and after uterine arterial embolization. Had'io\ogy 2M:228-235.
Bilhlm T et al (2011) Polyvinyl alcohol particle size for uterine artery embolization: A prospeaive randomized study of initial use of 350 - SOOiim particles versus initial use of 500 - 700pm partides. J Vase Interv Radiol 22(1): 21-27.
Nguyen Xuan Hien va Pham Minh Th6ng (2010) Mdt sdyiu to liin quan din kit qud dieu tri u ca tran tdcung bdng phuang phdp nut dgng mach tif cung.
Y hpc Vi&t Nam, 376, tr. 18-22.
