VIETNAM MEDICAL JOURNAL H°2 - OCTOBER - 2017 viem gan nhj dau cd tae dung giam dau, cai
thien chirc nang van ddng khdp vai tot hdn nhdm tiem Depo-Medrol. Lieu phap an toan.
TAILIEU THAM KHAO
1. An Tran Ngoc, Viem quanh khdp vai. Benh thap kh6p. Nha xuat ban y hoc, (2002), tr.364-374 2. Tan f>ang Ngoc, Danh gia hieu gua tiem Corticoid
du'di hu'dng daii sieu am trong dieu tn viem quanh klidp vai, Luan van Thac sy y khoa, f)ai hoc Y Ha NOI, (2009)
3. Trong Hoang Cong, Nghj Tran Hong. Oieu tri viem gan nhi,dau bang phiTdng phap tienj, huyet tu'dng giau tieu cau tir than du'di hu'dng dan sieu
am bang thudc chdng viem khong steroid, Tao dii NOI khoa, thang 5 - 2017, tr. 170-178 . LLiknur Sanli, Barnes Morgan et al. Sinde
injection of platelet - rich plasma (PRP) for 5,e treatment of refractory distal biceps tendonitis' long-term results of a prospecbve multicenter cohort study (2016).
. Speed, C.A., Fortnightly review: Corticosteroid injections in tendon lesions. BMI 2001.323f73n9V p. 382-6. ^ '•
. D. Folinais, Echographie de la region scapulaire (initiation): echo-anatomie normale. Technique Semiologie. Cas diniques journal de radioloqie Volume 85, Issu§!9, 2004,Page 1180 . M.C Boissier, Epaule douloureuse: Orientation
Diagnostic. Rev. Part 1993, 43,6 : 21-28
DANH GIA MOT SO TAC DUNG KHONG MONG MUON CUA CAPECITABINE TRONG DIEU TRI UNG THU" DAI TRU'C TRANG
Nguyen Thi Giang Oanh', NguySn Van H i l u ^ Phiim Thi Phirffng^
T O M TAT
Myc tieu: Oanh gia mot so tac dung khong mong muon cua Capecitabme trong dieu tn ung thu" dai tru'c trang va mot so yeu to anh hu'dng. Phu'dng phap nghien cuXi:m6 ta lam sang; 118 benh nhan chan doan ung thd dai tri/c trang cac giai doan 6dac dieu tri phac do hoa chat co Capecitabine. Ket qua: ty te xuat hien cac tac dung khong mong muon thap (n^20%), hay gap nhat la hgi chirng ban tay- ban chan (HFS). Ha bach cau, tieu chay, HFS la nhifng tac dung khong mong mudn chiem ty le cao va co doc tinh do
%: 25,5% (do % 3,4%); 21,1% (do % 3,3%); 48,3%
(do VA 8,4%). Ha bach cau va tieu chay cac mu'c dp gap d nhom diing Capecitabine phoi hdp cao hdn nhom diing Capecitabine ddn thuan. HFS cac miTc do chiem ty le cao d nhdm co tien sir dieu tri hoa chat tru'dc do. Ket luan: Capecitabine la thuoc an toan irng dung trong lam sang dieu tn ung thir.
Tii'khoa: Capecitabine, ung thir dai trire trang, tac dung khong mong muon
SUMMARY
EVALUATING SOME OF THE SIDE EFFECTS OF CAPECITABINE I N THE TREATMENT OF
COLORECTAL CANCER Objective: To evaluate some of the adverse effects of Capecitabine on the treatment of colorectal cancer and its determinants. Research methodology: Clinical description; 118 patients with colorectal cancer diagnosed dunng the chemotherapy
^Vien Yhoc phong xa va Ubddu Quan dol.
^Trddng Dal hgc y HA Ngi
^Benh vien Giao thong van tai Ha Ngl Chiu trach nhiem ehinh: Nguyen Thi Giang Oanh Email: giangoanh8520I5@gmail,com Ngay nhan bai: 6.8.2017 Ngay phan bien khoa hoc: 4.10.2017 Ngay duyet bai: 16.10.2017
regimen had Capecitabine. Results: The incidence of undesirable effects was low (=^20%), the most common of which was hand-foot syndrome (HFS), Hypothyroidism, diarrhea, HFS are highly undesirable effects and have a toxic grade %: 25.5% (grade % 3,4%); 21.1% (grade ¥4 3.3%); 48.3% (grade % 8.4%). Lower leucopenia and diarrhea levels were higher rn the capecitabine group than in the capecitabine group alone. HFS levels are high in tlie pre-treatment group. Conclusion: Capecitabine is a safe drug used in clinical cancer treatment.
Afeyiwarefr; Capecitabine, colorectal cancer, side effects I. OAT VAN OE
Ung thu' (UT) dai tru'c trang la mot trong nhu'ng benh ung thu' thu'dng gap d nu'dc phat trien, la ung thu" gay tir vong ddhg hang thiJ 3 sau UT phdi va UT vii. Theo ghi nhan xuat do ung thu" toan cau nam 2012, UT dai tru'c trang dirng hang thir 3 d nam (10%) va thir 2 d nU (9,2%). Tai Viet Nam, UT dai tru'c trang du'ng hang thir tu' d nam vdi xuat do la 11,5/100.000 va hang thii' sau d nd vdi xuat dp la 9/100.000 [1]. Vdi sir ra ddi ciia Capeeltabine(Xeloda)- mot tien ehat eua 5FU da du'dc ehi djnh rong rai trong UT dai triTc trang khi dieu tri bd treJ, tri^u chu'ng. Tuy nhien, chu'a ed mot nghien eihj nao danh gia ve tac dung khdng mong mudn cua Capecitabine mot each day dii. Vi vay, chiing toi tien hanh de tai: ^^Danh gia mot so tac dung khong mong mudn ciia Capecitabine trong dieu tri ung thd dai tru'c trang"r\ham muc tieu; Oanh gia mot so tac dijng khong mong mudn cua phac do CO Capecitabine khi dung trong dieu trj UTdai tru'c trang va mot sd yeu tdanh hu'dng.
II. DOI TUONG VA PHUONG PHAP NGHIEN COU 132
TAP CHi Y HOC VlgT HAM TAP 459 - THANG 10 • SO 2 - 2017 - Ddi tu'dng g o m l l S benh nhan UTDTTT
dude chan doan xac dinh bang giai phau benh, sir dung hda chat phac do ed Capecitabine tai Benh vien Oai hoc Y Ha Noi tir 2012 den 4/2017.
- Phu'dng pliap nghien eiru: md ta lam sang hoi eiru ket hdp tien ciru.
- Cdmau: thuan tien.
- Xir ly sd lieu bang phan mem SPSS 16.0 III. KET QUA NGHIEN CLTU
"^^Mot so dac diem chung cua nhom nghien cu'u: Trong thdi gian nghien cirtj ed 118
benh nhan ung thu' dai trdc trang dii dieu kien lu^ chon vao nghien ciTu gom: Nam 54 tru'dng hdp (45,8%), nu' 64 tru'dng hdp (54,2%). Tuoi trung binh 63±11,2 tudi (dao dong tir 29 - 84).
Cd 84 tru'dng hdp diing caepeeitabine ddn thuan (71,2%) va 34 tru'dng hdp diing phoi hdp vdi Oxahplatin (28,8%).
Trong 118 benh nhan nghien cu'u ty le eac giai doan 2 cd yeu t d nguy ed eao, giai doan 3, giai doan 4, giai doan tai phat - di can tu'dng img (39,8%; 21,2%; 25,4%; 13,6%).
*Oac diem benh nhan theo vj tri u va v| tri tai phat, di can Bang 1: Phan bo benh nhan theo vi tri u
So BN Tv le % Vi tri u nguyen phat(n
OT phai 28 UT nqanq 6 BT trai 9
£)T Sigma 26 Tru'c trang 48
Nhieu vi tri 1 Vi tri tai phat, dican(r
Tai DT 3 Gan 18
Phoi 4 Cd quan l<hac 8 Nhieu cd quan 13
= 1 1 8 )
= 4 6 )
23,7 5,1 7,6 22 40,7
0,8 6,5 39,1
8,7 17,2 28,3 UTOT chiem" ty ie cao 58,5%, UTTT 40,7%. Trong dd UTDT sigma va UTOT phai (45,7%). Di can gan ehiem ty le cao nhat (39,1%), di can nhieu phoi (8,7%).
*Tac dung khong mong muon(TDKMM) ciia Capecitabine.
Bang 2: TDKMM tren he tao mau, gan, thin, da,niem mac, he tieu hoa
HST Bach cau Tieu cau Gan Than Tieu chay
Tao bon Dau T.Vi Viem mienq
Non HFS BocTK Ty Ig benh nh
Ty le ( % )
eoo
85,6%
74,6%
81,4%
82,2%
82,2%
78,8%
95,8%
90,7%
95,8%
97,5%
51,7%
91,5%
an khong xuat hien
C o l 9,3%
13,6%
11,9%
14,4%
16,9%
9,3%
3,4%
6,8%
2,5%
0,8%
22%
6,8%
tac dung khong rr Do 2
4,2%
8,5%
5 , 1 % 3,4%
0,8%
8,5%
0,85%
2,5%
1,7%
0,8%
17,8%
1,7%
ong muon chie 0 6 3 0,8%
3,4%
0%
0%
0%
2,5%
0%
0%
0%
0,8%
7,6%
0%
m ty le cao(
Bo 4 0%
0%
1,7%
0%
0%
0,8%
0%
0%
0%
0%
0,8%
0%
: 80%). Ty IS TDKMM do V4 gom: ha bach cau (3,4%); Tieu chay(3,3%); HFSC8,4%).
0 . £ _ _ ^ r.'. lA fan i,-,^ ^^i> *iaii fhst, hn! fhi'rnfj han tltu- hAn fhi
HaBC
Ts dtri hoa chat Chu'a dtrj
29,4%
1 phac do 15,8%
>2 phac do 14,3%
P > 0,05
each dung Ddn thuan 17,9%
Phoi hdp 4 4 , 1 % P < 0,05
% lieu dung theo lieu chuan
<85%
5,9%
85% - 9 0 % 20%
>90%
34,4%
P > 0,05
VIETNAM MEDICAL JOURNAL N°2 - OCTOBER -2017 Tieu
chay HFS
24,7% 1 5,3% 1 21,4%
P > 0,05 43,5% 1 47,4% 1 78,6%
P < 0,05
15,5% 1 35,3%
P < 0,05 53,6% 1 35,3%
P > 0,05
29,4% 17,5% 1 21.3%
P > 0,05 35,3% 50% 1 50.8*
P > 0,05 Ty le ha bach eau va t / le xuat hien ddc tinh tieu chay d nhdm diing Capecitabine phoi hdp cac hdn ed y nghTa so vdi nhdm diing Capecitabine ddn thuan. HFS gap d nhdm cd tien sir dieu tri tren 2 phac dd chiem ty le cao (78,6%).
IV. BAN VJfyN
Thong ke cho thay tuoi trung binh ciia nhdm nghien cihj la 63 (dao ddng tir 29-84). Dieu nay phu hdp vdi nhieu tac gia nhan xet; ty le mac ung thu" dai trdc trang tang sau tuo'i 35[2][3].
Tuy nhien tuoi trung binh ciia nhdm nghien ciru eao hdn so vdi nhieu nghien cdu khac do trong nhdm nghien eiru bao gom benh nhan giai doan tai phat, di can.
Ty le nam: nu" trong nghien ciru la 0,84/1, khdng phii hdp vdi nghien ciTu eua nhieu tae gia thay ty le UTDTT gap d nam nhieu hdn nu", ty le nam/nii' eiia cae tae gia: 1,32-1,68[4][5]. Cd the do ed mau nghien ciru chu'a dii Idn va trong pham vi hep.
*Dac diem benh hoc cua nhom nghien cii'u: Bang 1 cho thay vj tri nguyen phat thu'dng gap nhat theo thir tu' la: tru'c trang (40,7%), OT phai (23,7%), OT Sigma (22%), OT trai (7,6%), OT ngang (5,1%). Oa so cae tae gia cho rang DTP va DT sigma la 2 vj tri hay gap. Nghien eiru ve ung thu' dai trang Denis JA va cdng sd (2014) nhan thay u d OT sigma (35%), va OT phai (34%), OT ngang (10%), DT trai (7%)[6].
Trong nghien ciTu cd 46 tru'dng hdp d giai doan mudn, vi tri' tai phat di can hay gap nhat gan (39,1%). Cae nghien cdu deu dong y gan la vi tri di can hay gap nhat trong UTDTT. Nghien eiru ciia Nguyin Thu Hu'dng va cdng su' (2008) tren 34 benh nhan: di can gan (29,5%), hach thu'dng ddn (17,7%), phdi (14,7%).
^Tac dung khong mong muon cua Capecitabine: Bang 2 cho thay khi su* dung Capecitabine ty le khong xuat hien TDKMM chiem ty le eao (^ 80%). TDKMM do V4 ghi nhan du'dc: gjam HST 0,8%; ddng bach eau 3,4%;
ddng tieu cau 1,7%; tieu chay 3,4%; hdi chirng ban tay- chan 8,4%. Theo ghi nhan cua nha san xuat giam HST dp % 3 , 1 % , giam bach cau hat dp % 0,3%, giam tieu cau dp % 2%, tieu chay dp 3/4 13%, hoi chirng ban tay-ban chan dd % 17%. Nhu- vay, TDKMM do 3/4 tren he tao huyet eiia nghien cu'u khdng cd sir khac biet vdi ghi nhan ciia nha san xuat. TDKMM nhu' tieu chay, hdi chirng ban tay-ban chan thap hdn so vdi ghi nhan nha san xuat.
* M 6 t so TDKMM v ^ cac yeu to anh hu'dng: Bang 3. cho thay moi lien quan nhiJng tac dung khdng mong muon vdi cac yeu td anh hu'dng:
- Ty le ha bach eau ciia nhdm diing Capecitabine ddn thuan va nhdm diing phoi hop' 17,8% (do 3/4 0%); 4 4 , 1 % (dp V4 11,8%). "SLT khac biet nay ed y nghTa thong ke cho thay if nhdm diing Capecitabine phoi hdp gay ha bach cau nhieu hdn. Phii hdp vdi ghi nhan ei)a riha san xuat (13%), cac doe tinh ed the tang len khi diing Capecitabine phdi hdp vdi hda chat (chu'a loai trir kha nang Capecitabine lam tang dpc tinh eiia hda chat khac).
- Ty le doe tinh tieu chay cae miTc dd eo SLT khac biet cd y nghTa g\da 2 nhdm diing Capecitabine ddn thuan va nhdm phoi hdp vdi Oxaliplatin [15,5%(dd ^A 4,8%); 35,3% (dd % 0)].
Nghien eiru XACT{20il) nghien cdu tren 933 benh nhan sir dung Capecitabine cd ket qua tieu chay mpi mire do 43%. Nghien eiru N016966 (2011) XELOX trong dieu tri bu'dc 1 UTDTT di can thi gap tieu chay eac mire dp la 66%.
- Hdi chirng ban tay- ban chan: gap 48,3%
cd hpi chirng ban tay- ban chan cac mire dp khac nhau. Ty le hpi chu'ng ban tay-ban chan d nhom chu'a cd tien sir dieu trj hda chat,va nhdm eo tien sir dieu tri 1 phac do, > 2 phac do hda ehat:
43,5% (dd % 5,9%); 47,4% (dd 3/4 5,3%);
78,6% (dp 3/4 28,6%). Nhu" vay theo ket qua nghien ciTu thi nhij'ng benh nhan cd tien sddieu tri hda chat thi ty le cd hpi chiing ban tay-ban chan cao hdn. Dieu nay cd the ly giai trong ung thu' du'dng tieu hda thu'dng dieu tri 5FU, cd the tien sir diing 5FU se lam tang ty le cd hdi chirtig ban tay-ban chan. Hien nay, chu^ cd nghien cijfu nao day dii ve van de nay.
V. KET LUJc^N
- Capecitabine la thuoc an toan vdi ty le khong xuat hien TDKMM (80%)
- Ha bach eau, tieu chay, HFS la nhuhg tac dung khdng mong muon chiem ty le cao (xueft hien doe tinh dd ^A) tddng dng: 25,5% (dd % 3,4%);
21,1% (dp 3/4 3,3%); 48,2% (dp 3/4 8,4%).
- Ha bach cau va tieu chay cac miic dp gap cf nhdm diing Capecitabine phoi hdp cao hdn nhom diing Capecitabine ddn thuan.
TAP CHI Y HOC VIET HAM TAP 459 - THANG 10 - SO 2 - 2017 - HFS cac mire dp chiem ty le cao d nhdm ed
tien sir dieu tri hda chat tru'dc dd.
TAI LIEU T H A M KHAO
1, Nguyin Chan Hung va Cs (2013). Xuat do ung thu' thanh gho Hp Chi Minh: ket qua tir ghi nhan ung thu" quan the 2007-2011. Tap chf ung thu" hoe Viet Nam, tap 4, 19-27.
z. Pham Nhijr Hiep, Le Loc va Cs (2006) Phau Thuat noi soi tro'ng dieu tri ung thu' dai-tri/c trang benh vien Trung u'dng Hue, Tap chi y hoc Viet Nam- so dac biet, 28-30.
3. Nguyen Chan Hung (1986) Unp thU dai trang-tJiTc trang va hau mon, Ung thU hoc lam sang, tru'dng dai hpc y du'dc Ho Chi Minh, tap 2,167-181.
4. Nguyen Quang Thai (2003), Nghien ciru ^ia tn mot so phu'dng phap chan doan va ket qua song 5
nSm sau dieu tri phau thuat ung thu" dai trang, Luan an tien sT y hoc. Hoc Vien Quan Y, Ha Noi.
. Sargent DJ, Wieand HS, Haller DG, Gray R, Benedetti JK, Buyse M, Labian R, Seitz JF, O'Callaghan O, Francini G, Grothey A, O'Connell M, Catalano PJ, Blanke CD, Kerr D, Green E, Wolmark N, Andre T, Goldberg RM, De Gramont A, (2005) Diease- free survival versus overall survival as a primary end poit for adjuvant colon cancer studies: individual patient data from 20.898 patients on 18 randomized trials, J Clin Oncol, 23(34), 8664-85670.
. Vukasin P,Ortega AE, Greene FL, Steele GD, Simons A3, Anthone G3, Weston LA, Beart RW Jr.(1996) Wound recurrnce following laparoscopic colon cancer resection. Result of the American Society of Colon and Rectal Surgeons Laparoscopic Registry, Dis Colon Rectum 1996 Oct; 39; 3-20.
TIM HIEU NHU'NG YEU TO LIEN QUAN DEN KET QUA DIEU TRI S6l NIEU Q U A N 1 / 3 DU-ffl QUA NOI SOI T A N SOI NGU-ffC DONG
BANG HOLMIUM LASER
TOM TAT
Day la mot mghien ciTu cat ngang mo ta, du'dc BiiTc hi|n tir thang 1/2014 den thang 9/2016 tai Benh vien Da Mioa Nong nghjep. Doi tu'dng nghien ciru la 69 benh nhan du'dc chan doan la sdi nieu quan 1/3 dudl va du'dc dieu trj theo phu'dng phap tan soi npi soi ngu'de dong bang Holmium laser. Ket qua nghien ciTu cho thay tan sdi thanh cong 98,6%, that bai 1,4%;
thcfi gian tan trung binh la 38,25; soi cang nhieu vien ket qua tan sdi cang giam, su" khac biet nay cd y nghia thong ke vdi p=0,048; tinh trang nieu'quan cang cd nhieu ton thu'dng phdi hdp ket qua tan sdi cang kem, p=0,046.
SUMMARY
FIND OUT ABOUT FACTORS RELATED TO THE OUTCOME OF URETERAL STONES 1 / 3 BELOW USING ENDOSCOPIC RETROGRADE LnHOTRIPSY W I T H HOLMIUM LASER This IS a eross-sectional descriptive study, conducted from January 2014 to September 2016 at the General Hospital of Agriculture. Study subjects were 69 patients diagnosed ureteral stones 1/3 below using endoscopic retrograde lithotripsy with Holmium laser. Research results show that 985% of successful gravel, 1.4% failure; Average canopy time is 38.25; As the number of stones increased, the difference was
*Benh vien Da khoa Nong nghiep Chju trach nhiem chinh: Nguyen Dinh Lam Email: [email protected] Ngay nhan bai: 19.8.2017 Ngay phan bien khoa hoc: 4.10.2017 Ngay duyet bai: 16.10.2017
Nguyen Dinh Lam*, Ha Hfru Tung*
stabstically significant with p = 0.048; The worse the ureteral morbidity, the lower the cumulative morbidity, p = 0,046.
I. DAT VAN OE
Sdi tiet nieu la mot benh pho bien, thu'dng gap, chiem ty le 2-3% dan sd. Trong dd sdi nieu quan chiem 28 - 40% trong eac benh sdi tiet nieu [1],[2]. Viet Nam la mdt nu'dc ed nhieu benh nhan bi sdi tiet nieu. t h e o Ngd Gia Hy pinan Idn sdi nieu quan la do sdi than rdi xudng (80%), cdn lai ia sdi sinh ra tai cho do di dang, hep nieu quan. Sdi nieu quan khi bit tac nieu quan se gay ra nhu'ng bien chu'ng nguy hiem (ii' nu'dc, d mil dai - be than), neu khdng du'dc dieu tri sdm ed the dan tdi nhiem khuan, vd nieu, suy than, tham ehi tir vong.
Tir cuoi the ky XX ed nhieu phu'dng phap can thiep sdi nieu quan It sang chan ra ddi da va dang du'dc ap dung de dieu tri sdi nieu quan nhu": tan sdi ngoai ed the, md noi soi lay sdi ngoai phiic mac , tan sdi nieu quan ndi soi ngu'de ddng bang xung hdi hoac bang Holmium Laser vdi dng kinh ndi soi ban cirng hoac dng mem, phu'dng phap nay dang ngay cang chiem du the va du'dc ap dung pho bien vi nd cd rat nhieu ulj diem tan dung cac Id tir nhien, tham my do khdng 6e lai seo, benh nhan it dau sau thu thuat, thdi gian nam vien ngan, han che du'dc toi da cac tai bien va bien chu'ng vi trong qua trinh tan sdi du'dc quan sat tru'c tiep.
Tru'dc l<hl cd tan sdi nieu quan bang Holmium
