TAP CHi Y HOC VIET NAM TijiP 459 - THANG 10 - SO 2 - 2017 tre binh thydng sy khac biet co y nghia thong ke
vdi p<0,05. Dieu nay phan anh rang tre t y ky cd cac van de ve giac ngii nhieu hdn so vdi nhdm tre binh thydng. Nhan dinh nay eung da dydc Souder va CS (2009) dya ra qua khao sat bang CSHQ d tre t y ky va tre binh thydng [6].
Paula Krakovrfiak va CS (2008) khi so sanh 303 tre TK vdi 163 tre BT cho thay 53% tre TK CO it nhat 1 roi loan GN, trong khi ty le nay la 32% d tre BT (p<0,001), trong do 2 van de thydng g l p la kho vao giac ngii va thirc giac trong dem [7]. Chiing toi cung nhan thay 81,2%
tre TK CO it nhat 1 trong cac van de ve GN trong do bleu hien hay gap nhat la tre khd vao giac ngii, 6 4 , 1 % tre t y ky khong ngii dydc sau 20 phut len giydng, 45,2% tre TK thydng xuyen thire day trong dem,15,4% tre thire day sdm hdn dy dinh so vao buoi sang cao hdn so vdi nhom tr^ BT vdi cac ti le tydng irng la 2 9 . 1 % ; 2 3 , 1 % va 4,3%. Ngoai ra, bieu hien hanh vi chong ddi tryde khi di ngii, kich thieh cir dp"q nhieu khi ngii hay can eac giai dieu nhip nhang va gan bd vdi do vat dac biet de vao giac ngii d tre TK cao hdn rd ret so vdi nhom tre BT. Ti le bleu hien cae van de ve GN cua tre TK trong nghien ciru ciia chiing toi eung tydng t y nhy 1 so nghien cu'u khac tren the gidi nhy nghien euii eiia Souder la 66% [6] hay Liu X 2006 la 40-80% [3]. Tuy nhien ti le nay eao hdn nghien eiru eua Tran Thj I^gpe Hoi 2014 (45,6%), nhyng cac van de ve giac ngii cita tre t y ky dydc tae gia nay neu len ehii yeu d dau giac ngu (83,3%), giu'a giac (13,9%), cuoi giac (2,9%) eung tydng t y vdi ket qua nghien cii'u eua chiing toi [4].
V. K ^ lUfyN
Ty le tre t y ky gap cac van de ve giac ngii
chiem t / le kha cao 81,2%. Vdi bieu hien chinh la cac van de khd vao giac ngii, thydng xuyen thirc day trong dem, thirc day sdm, tong thdi gian ngii ngan... Day la van de can dUde quan tam, hd trd de nang cao chat lydng cupe song va hieu qua can thiep dieu tri, nham giup tre t y ky hoa nhap epng dong tot hdn.
Ld^i cam ffn: Chung toi xin chan thanh cam dn khoa Tam Benh, benh vien Nhi Trung t/dng da ho trd giup dd ehiing toi trong qua trinh nghien eiru.
TAI LIEU T H A M KHAO
1. American Psychiatric Association. (1994).
Diagnostic and Stabstical Manual of Mental Disorders, Fourth Edition (DSM-IV), 58-63.276-279 2. Moran J.S. (2014). Prevalence of Autism
Spectrum Disorder among children aged 8 years- Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States 2010. Centers ibr Disease Control and Prevention. 63(2) J. Liu X, Hubbard JA, Fabes RA, Adam JB.
(2006) Sleep disturbances and correlates of children with autism spectrum disorders. Child Psychiatry Hum £'ei';3?:179-91.
4. Tran Thj Ngoc Hoi (2014) Dac diem lam sang roi loan hanh vi d tre td try va nhan xet ket qua dieu tri bang Risperidone Luan van thac sy y hoc a. Owens (2000) The Children's Sleep Habits
Questionnaire (CSHQ); Psychometric Properties of A Survey Instrument for School-Aged Children.
SLEEP, Vol. 23, No. 8
o. Souders MC; Mason TBA; Valladares 0 et al (2009). Sleep behaviors and sleep quality in children with autism spectrum disorders. SLEEP
;32(12):1566-1578.
/ . Paula Krakowiak, Beth Goodlin-Jones, Irva Hertz-Picciotto et al (2008). Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: a populationbased study. J Sleep Res. June ; 17(2):
197-206.
NGHIEN CU'U D A C DIEM SAN PHU NHIEM RUBELLA TRONG THffI KY MANG THAI TAI BENH VIEN PHU S A N TRUNG UffNG
T 6 M TAT
Muc tiiu: Mo ta cac dac diem san phu nhiem rubella b-ong thdi ky mang thai tai Binh vien Phu san
*Benh vien Phu san Trung ddng Chju b-ach nhiem chinh: Nguyen Quang 6ac Email; [email protected] Ngay nhan bai: 20.7.2017 Ngay phan bien khoa hgc: 25.9.2017 Ngay duyet bai: 3.10.2017
Nguyen Quang Bac*
Trung u'dng nam 2011. Phu'dng phap: Nghien ciTu mo ta hoi cyu. Ketqua:T\io\ trung binh ciia san phu nhiem rubella la: 28,3 ± 0,3. So san phu la can bp vien ehye nhieu nhat: 41 san phu (29,9%), nong dan cd 38 san phu (27,7%). San phu cd tien sy mo lay thai chiem 18,2%, san phu co tien sir smh con di dang chiem 2,9 %. San phu chuyen da d tuoi thai dii thang chiem 70,5%. Kit luan: San phu nhiem rubella chit yeu tap trung dp tuoi sinh de, san phu chuyen da chii yeu d tuoi thai dii thang,
Tu'khoa: Rubella, Benh vien Phu san Trung ddng
VIETNAM MEDICAL JOURNAL N°2 - OCTOBER - 2017
SUMMARY
RESEARCH THE CHARACTERISTICS OF PREGNANT WOMEN WHO WAS INFECTED W I T H RUBELLA DURING PREGNANCY AT NATIONAL HOSPITAL OF OBSTETRICS AND
GYNEACOLOGY
Objectives: To describe the characteristics of pregnant women who was infected with Rubella during pregnancy at National hospital of Obstetrics and Gyneacology in 2011. Method. This is a cross sectional study among 137 pregnant women infected with Rubella in NHOG, Results. Mean of age was 28,3 ± 0,3. 41 pahents were government (29,9%), 38 patients were farmer (27,7%). C-section was 18,2 %, baby born with malformation was 2,9%. Term labour was 70,5%. Conclusion, most of pregnant women were in reproductive age and term labour.
Key words: Rubella, National Obstetric and Gynecological Hospital
I. DAT VAN OE
Di tat bam sinh eua thai nhi ta mot trong nhu'ng hau qua nghiem trong nhat ciia tinh trang nhiem vi riit rubella eiia ngydi me trong thdi ky CO thai. Cae nghien ciru tren the gidi da e6ng_bo ty le gay di tat thai nhi cita cae ba me nhiem rubella trong vong 8-10 tuan cua thdi ky mang thai ed the tdi 90%. Tai Viet Nam, nam 2011, trong ca nyde xay ra dai djch rubella. Hang nghin phu nu' mang thai bj nhiem rubella, hdn 2000 phu nu" mang thai bi nhiem rubella den trung tam chan doan tryde sinh Benh vien Phu san Trung ydng t y van, hdn 1000 phu nii' mang thai nhiem rubella bj dinh ehi thai nghen,
V. KET QUA
3.1. Phin bdWoisanphu nhiem rubella Tyl#%
Tai eac nyde tren the gidi da co cac cong trinh nghien ciru ve dj tat bam sinh $ thai nhi ciia cae ba me nhilm rubella trong thdi ky mang thai, nhyng tai Viet Nam ehi co m6t vai nghien eiru ve dj tat Isam sinh tren cac ba me mang thai nhiem rubella. Tuy nhien, cac nghien eiru ve dac diem san phu nhiem rubella trong thdi ky mang thai rat it. Vi vay, chiing toi tien hanh nghien cuti de tai nay: "Nghien ciiU dac diem sin phu nhiim rubella trong thdi ky mang thai tai Binh vien Phu san Trung ddng"
II. OOI TUpWC VA PHUONG PHAP NGHIEN CIJU 2.1. Ddi tu'dng nghien ci^u - Tieu ehuan lya chon doi tydng nghien ciTu;
+ Cac ba me mang thai co cac trieu chiTng lam sang nhy sdt, phat ban va noi hach, tuoi thai nhiem rubella tir 5-18 tuan, cae ba me mang thai nhiem rubella theo dol thai va sinh de tai BVPSTW.
+ Tre sd sinh dydc lay mau tTnh mach xet nghiem khang the IgG va IgM.
+ Ho sd benh an day dii cac thong tin can nghien cuXi.
- Tieu chuan loanrir:
+ Tre sd sinh khong dydc lay mau tinh mach xet nghiem IgG va IgM.
+ Ho Sd khong day dii cac thong tin can nghien ciru.
2.2. Phu'dng phap nghiin aiU: La mot nghien ciru mo ta hoi ciTu cac dac diem san phu nhiem rubella trong thdi ky mang thai. Tir thang 1-12 nam 2011, cd 137 san phu de tai BVPSTW, trong dd co 2 trydng hdp de song thai.
40
30
20 15
5 0
35,8 35,8
4.4
^
. . „ . 19,6
•r^ 4,4
^=1__
0.39 >=40 Nh6m tuSi
Bleu do 1: Phan bo san phu theo nhdm tuoi
Nhan xet: Nhom tuoi tir 20-24 va nhom tuoi 25-29 co 49 san phu moi nhom, chiem 35,8*.
Khong co san phu nhilm rubella chuyen da de d nhom tuoi > 40. Tuoi trung binh ciJa san phu nhiew rubella ia: 28,3 ± 0,3.
TAP CHi Y HOC VIET NAM TAP 459 - THAHG 10 - S O 2 - 2017 3.2. Phin bo nghe nghiep ciia sin phu nhiem rubella
l l ^^ I \J I |«J ^h ito ^ ^.
Bieu dd 2: Nghi nghiip cua sin phu
Nhin xet: So san phu la can bo vien chu'c nhieu nhat: 41 san phu (29,9%). Nong dan cd 38 san phu (27,7%). Nhan vien y te co 3 san phu chiem 2,2% va hoc sinh, sinh vien la 4 san phu ehi&n 2,9%.
3.3. Dae diem ve tien sut khoa eua sin phu Nhin xet: Co 25 san phu co tien sir mo lay thai chiem 18,2%.
3.4. Dae diem ve tien siy con dl dang Bing 3.1. Ty le sin phu co tien sii sinh
con dl dang
Tien su* thai d|
dang Co Khonq
Tong
So lu'dnq
4 133 137
Ty le % 2,9 97,1
100 Bleii dd 3: Phan boty Ii sin phu cd tien su"
mdi lay thai
Nhan xet: Co 4 san phu ed tien sir sinh con di dang chiem 2,9 %.
7. Tudi
Ty S O 7 0 e o s o - t o 3 Q 2 0 l O o
i itaisinphu e 16 -yi.
^ 2 8 huyen
^
2 9 - 3
I
Bieii dd 4: Tudi thai ehuyen da
Nhan xdt: San phu chuyen da d tuoi thai dii thang cd t / le cao nhat: 98 trydng hdp chiem 70,5%1 Cd 2 trydng hdp thai gia thang chiem 1,4%, khong cd san phu nao ehuyen da d tuoi thai dydi 28 tuan.
IV. BANLUi?iN
Tuoi cua doi tydng nghien ciiu nhd nhat la 17 tuoi, cao nhat la 39 tuoi, tap trung nhieu vao nhom 20-29 tuoi (71,6%), trong do nhdm tuoi 20-24 chiem 35,8%, nhdm tuoi tir 25-29 ehiem 35,8%. Tuoi trung binh cua doi tu'dng nghien cuXi la 28,3±0,3. Da so cac benh nhan cdn tre, tnang dp tuoi sinh de, mang thai lan dau hay lan 2.
Oo tudi trcing nghien cu\i nay cao hdn do tuoi
trung binh trong nghien cu'u ciia Hoang Thj Thanh Thiiy vdi tuoi trung binh la 26,1±0,2, nhdm tuoi tir 20-29 tuoi cao nhat chiem 81,4%.
Theo Nguyen Quang Bae (2009), phu nu' mang thai nhiem rubella ed do tuoi tir 25-34 chiem 80%, tir 20-24 chiem 15%, tren 35 tuoi la 5%. • Ooi tydng nghien ciru ciia chiing toi co do tuoi thap hdn so vdi nghien eiru ciia Nguyen Quang Bac. Nghien ciili cita ehung toi chi bao gom
VIETNAM MEDICAL JOURNAL N°2 • OCTOBER - 2017 nhii'ng san phu ehuyen da de tai Benh vien Phu
San Trung ydng ma tryde do da cd tien sir nhiem rubella va tiep tuc theo doi thai nghen, khong bao gom nhO'ng tliai phu nhiem rubella da dydc chan doan, sang loe tryde sinh va da eo ehi dinh dinh ehi thai nghen.
Op tuoi trung binh trong nghien ciru ciia chiing toi thap hdn trong nghien cu'u eiia Onakewhor JU, Chiwuzie 2 ve phu nd mang thai nhiem rubella tai Nigeria nam 2011 vdi tuoi trung binh la 30±4,8. Nguyen nhan co the do d Nigeria dp tuoi lap gia dinh muon hdn hoac dp tuoi sinh de keo dai hdn nen dp tuoi trung binh cao hdn.
Cae san phu nam trong nhom doi tydng eua nghien eiru co dii eac nganh, nghe, trong do can bp vien chirc chiem t / le eao 29,9%. Nhdm nay bao gom rat nhieu nghe nghiep khae nhau nhy cong an, phong vien, giao vien, ke toan, nhan vien van phong, bp dpi... Nhom doi tydng ed nghe nghiep lam rupng chiem ty le 27,7%, Nhy vay la trong nghien cii'u ciia chiing toi, chi rieng doi tydng lam nghe nong nghiep da chiem tdi 27,7%. Ket qua nay rat khae so vdi nghien ciTu cita Hoang Thj Thanh Thiiy ve tinh hinh dinh ehi thai nghen vi nhiem rubella tai Benh vien Phu San Trung ydng trong 5 thang dau nam 2011:
nhom can bp vien chdc chiem 19,0% va lam ruong chiem 13,5%. Sd khac biet nay hoan toan phii hdp vi trong nhdm can bo vien chu'c, tiiy thuge vdi tinh chat ciia tiing nganh nghe, ed nganh phai tiep xiic vdi nhieu ngydi, lam viee d ndi ddng ngydi nen kha nang bj lay nhiem eao.
Ooi tydng trong nhdm nay hau het deu la nhu'ng ngydi cd trinh dp cao dang va dai hpc trd len, c6 nhii'ng hieu biet nhat dinh, sinh song tai nhutig viing do thj, dydc tiep xitc vdi nhieu nguon thong tin nen phat hien benh va di kham sdm, do dd nhifng doi tydng dydc chan doan tryde sinh va dinh ehi thai nghen eao. Trong nghien ciru cua chung toi nhom lam ruong ehiem ty le cao 27,7%. Oieu nay dydc ly giai la do nhu'ng ngydi lam nghe nong nghiep, phan ldn trong so hp it dydc tiep xuc vdi nhii'ng thong tin dai Chung, nhij'ng liien thire ve benh cdn chda day etti. Hp sinh song d nhu'ng viing nong thon ndi rjl^og Judi y te chya phat trien, ngydi dan ehu^
qaan jtlim i u n g mifc den sire khoe sinh san nen viec phat taen benh va dydc t y van tryde sinh rat han chS. Oieu nay dan den nhutig thai phu bj nhiem rubella khong du'dc kham va lam sang lpc tryde sinh rat thap. Hp tiep tuc duy tri thai ky cho den chuyen da sinh ma khong y thire dydc nguy cd cho thai. Hoac do mot sd viing nong
thon tin ngydng va phong tue tap quan van con bj rang bupc^ khong cho phep pha thai nen ty le san phu nhiem rubella theo doi thai den chuyen da trong nhdm lam nong nhiep eao nhat.
Co 25 san phu co tien sir mo de cu chiem 18,2%, nhd hdn nhieu so vdi nhom khong co tien sir mo de chiem 81,8% vdi p< 0,001, trong do 19 san phu mo lay thai trong lan chuyen da nay, 5 san phu sinh thydng va 1 san phu k^
thiic ehuyen da bang foreep. Nhy vay tien sir mo de eu CO anh hydng den each xdiri ehuyen da.
Trong tong sd 69 san phij ket thuc chuyen da bang mo lay thai, co 19 san phu co tien sir m6 cu vdi p<0,05.
So sanh vdi ty le benh nhan cd tien sir mo de eu trong nghien ciTu cua Hoang Thj Thanh Thuy la 13,3% ty le trong nghien eifu ciia chung toi cao hdn. Oay la mot khd khan cho san phu va thay thuoc trong theo doi va xd tri chuyen dsi vi nhij'ng san phu ed tien sir mo de cu oo nguy ed v9 tir cung, niit seo mo eu va kha nang phai can thiep mo lay that trong lan chuyen da nay eao hdn.
Trong tong so 139 san phu dydc chon la doi tydng nghien ciru, chi co 4 san phu co ti§n sir sinh eon bat thydng chiem 2,9%. Ty le nay thap hdn rat nhieu so vdi nhdm khong co tien sii'sinh con di dang ehiem 9 7 , 1 % p<0,001. So sanh vdi nghien ciru ciia Phan Thanh Hai, ty le thai phu cd thai nhi dj dang trong lan mang thai dau tien ehiem 16,9%. Nhy vay la ty le trong nghien ctfu cua chiing toi rat tliap, lien quan khong eo y nghTa thdng ke den tinh trang tre bi rubella bam sinh sau sinh vdi p>0,05.
Trong nghien ciru ciia chiing toi, san phu chuyen da d tuoi thai dii thang cd ty le eao nhat:
98 trydng hdp chiem 70,5%. San phu ehuyen da d tuoi thai tCf 29-37 tuan chiem 28,1%. Co 2 trydng hdp thai gia thang ehiem 1,4%. Khong co san phu nao ehuyen da d tuoi thai dydi 28 tuan.
V. KET L U A N
San phu nhiem rubella chu yeu tap trung do tuoi sinh de, san phu chuyen da chu yeu cl tuoi thai dii thang.
TAI LIEU T H A M KHAO
1. M, De Santis, A,F, Straface, A, Caruso.
(2006), "Rubella infection in pregnancy, Reproductive Toxicology, 21, pp. 390-398.
2. Hoang Thi Thanh Thuy {Z011\ Nghien cuV tinh hinh dinh ehi thai nghen vi nhiem nibella ^i Benh vien Phu san Trung ddng 6 thing dau nam 2011, Luan v3n tot nghiep not tru, Tmicfng Oai hoc Y Ha Noi, 48-54. , . . 3. Nguyen Quang Bac (2012). NghiSn ctAi m
TAP CHi Y HOC VIET NAM TAP 459 • THANG 10 - SO 2 - 2017 trang nhiem rubella d phu nit mang thai ed nguy
cd va hgi chu'ng rubella bam sinh tai Benh vien Phu san Trung udng, luan an tien sT y hgc, Tru'dng Dai hoc Y Ha Npi
4. Onakewhor JU, Chiwuzie 3 (2011).
Seroprevalanee survey of rubella infection in pregnancy at the University of Benin Teaching
Hospital, Benin City, Nigeria. Niger J Clin Pract , 2011Apr-3un;14(2): 140-5,
. Phan Thanh Hai (200S). Nghien ciili mptsdlydo,^
danh gia hieu qua cua Misoprostol trong pha thai tu 17 den 22 tuan tai Benh vien Phu San Thing ddng nam 2008, luan van tot nghiep bac sT chuyen khoa cap II, Tru'dng Dai hpc Y Ha Ngi, 57-58.
DANH GIA KET QUA DIEU TRI BO TRQ* UNG THU* VU GIAI DOAN IMIIA BANG P H A C Dib 4AC - 4D
TOM TAT
Myc tieu: Oanh gia ket qua dieu tri bo try va mot so doc tinh ciia phac do 4AC - 4D d benh nhan ung thiT vii glai doan ITIIIA. Doi lu'Ong va phu'dng phap nghien cuti: Nghien cii^j mo ta hoi CLTU C6 theo doi doc ^32 benh nhan ung thy vii giai doan IHIIA duUc phlu thuat triet can va dieu tri bo trd bang phae ilo4AC - 4D tei Beiih vien K t y thang 01/2013 den thang 08/2017. Ket qua: Tuoi mac benh trung binh la 47,5 ± 7,6, hay ^Sp nhat 40 - 49 chi^m 53,1%. Vi tri u vii 'A tren ngoai la 71,9%. UTBM tlie ong xam nhap (84,4%), do mo hoc 2 chiem chii yeu (71,9%). ER, PR, HER2 dUOng tinh tyong img la: 53,1%; 50%;
56,2%. Giai doan benh IIA, IIB, IIIA la: 43,8%; 25%;
31,3%. Ty le song them khong benh va song them toan bo 1, 2, 3 nam la: 100%; 91,4%; 86,9% va 100%; 95,5%; 95,5%. Doc tinh tren he huyet hoc la ha bach cau trung tinh do 1, 2 (43,8%), ha do 3 (12,5%), do 4 (6,2%); giarh huyet sac to chii yeu do 1 (71,9%), do 2 (3,1%), khong co dp 3, 4. Khong gap ha tieu cau va suy than. Tang men gan dp 1 la 31,2%, do 2 la 15,6%, tang men gan do 3 (3,1%), khong cd ta'ng men gan do 4. Ket luan: Phac do 4AC - 4D trong dieu tri bo trd UTV giai doan IHIIA mang lai ty le song them cao va dgc tinh chap nhan du'dc.
T^ khoa: ung thd vii giai doan II-IIIA, phac do 4AC-4D.
SUMMARY
EFFICACY AND TOXICITY OF ADJUVANT 4AC-4D I N PATIENTS W I T H STAGE I I - I I I A
BREAST CANCER
Purpose: Toacssess adjuvant result and toxicity of 4AC-4D regimen in patients with stage II-IIIA breast cancer. Patients and methods: 32 patients with stage II-IIIA postoperativebreast cancer treated byadjuvant 4AC - 4D regimen at National Cancer Hospital. Results: Theaverage age was47,5 ± 7,6 years; the most commonage wasfrom 40 to 49 years
^Binh vi$n Ung Bddu Nghe An
^Bd mon Ung thd Trddng Dai hpc y Ha Noi Chju b^ch nhiem ehinh: Le Thi Sydng Email: [email protected] Ngay nhan bai: 12.8.2017 Ngay phan bien khoa hpc: 29.9.2017 Ngay duyet bai: 6.10.2017
Le Thi Suong', Le Van Quang^
old (53,1%). The most common location of breast tumor was uoper outsidequarter (71,9%). The invasive ductal carcinoma was most common (84,4%), mainly grade 2 (71,9%). Disease free survival rate and overall survivalrate at 1, 2 and 3 years follow-up were 100%; 91,4%; 85,9% and 100%; 95,5%; 95,5%, respectively. Most common side effects afterS cycles were qrade 1 or 2, rarelv arade 3 or 4toxicities. Grade 1, 2 of hematoloqic toxicitv included: neutropenia (43,8%), anemia (75%), andnoneuphrotoxic and thrombocytopenia were observed.Grade 3 of neutropenia (12,5%). qrade 4 (6,2%).Grade 1 heoatotoxicitv was seen m 31.2%. qrade 2 (15,6%) and qrade 3 (3,1%), but no grade 4 hepatotoxicity was observed. Conclusion: 4AC-4Dregimenresults a high survival rate in the setting of postoperative patients with stagell-IIIA breast cancer, with an acceptable overall toxicity profile.
Keywords: Stage II-IIIAbreast cancer, 4AC - 'ID regimen.
I. OAT VAN OE
Ung t h y vii (UTV) la loai ung thy pho bien nhat d phu nff nhieu nyde tren the gidi. Theo hiep hpi ung thy My yde tinh co khoang 234.190 ngydi My dydc chan doan UTV xam nhap va khoang 40.730 chet vi benh tai My trong nam 2015. Tai Viet Nam, UTV ciing dirng hang dau trong cac loai ung t h y cita phu nu". Theo ghi nhan ung t h y tai Ha Npi giai doan 2001-2004 ty le mac UTV ehuan theo tuoi la 29,7/100.000 dan va d thanh phd Ho Chi Minh ty le nay la 19,1/100.000 dan.
Mac dii CO khoang hdn 90% UTV dydc phat hien d giai doan sdm con kha nang phau thuat dydc nhyng nghien ciru cung da ehi ra rang ed hdn 50% chet vi benh neu chi phau thuat ddn thuan trong 30 nam theo ddi. Vi vay dieu trj bo trd sau phau thuat dydc ehi dinh eho giai doan nay nham muc dich tieu diet nhutig vi di can giiip cai thien thdi gian song them khong benh va thdi gian song them toan bp. Oieu tri bo trd cho UTV giai doan sdm bao gom hoa chat va lieu phap npi tiet, dieu trj dich Her-2, xa tri khi co chi djnh. Tir nam 1976 den nay da co rat nhieu thif
