N g h i e n c m i Y h p c i n p e i i . i i u v , . r
PHAU THUAT NOI SOI DIEU TRI UNG THU" DA DAY DOAN XA
Vu NgQC Aidi Tuan*, Dd Minli Hdng**, Vuong Thiia Bdc***
T O M T A T
Ddt van de: Ung thu da ddy Id benh thudng gap Viec dieu tii tir tivdc deh my diu yai Id phau ihuat md cat dq ddy. Phdu thuat noi soi cdt dg ddy du mdi duoc img dung gan ddy nhimg chim pho biai idiieu tai VN.
Muc tieu Ddnh gid Act i^ud sdm dia PTNS cat bdn plidn xa dg day.
Phuang phdp, doi tuang: tien dm, tiong 3 ndm (1/2010-1/2013) tai BV Bhih Ddn TPHCM.
Kei qud: Co 57 binh nhan duac cat bdn pHdn xa daddy kem mo hach vdi tuoi ti^ng binh 54,12 ± 10,9. nam 66,7%, nie 33%, BMI tiung binh Id 21,242 ± 1,92 kg/nf Khong co tu vong hodc chuyen nwmd. Chi co 3 ti^'ong hop nhihn triing vet mo (5,26%) vd 1 tinvang liap (1,75%) ro tuy nhe tu lanh. Chua ghi nhan co tdi phdt sau 6 thdng tlieo doi.
KH luan. PTNS cdt dg ddy Id khd thi, an todn, it bieii ehung.
Tii khoa: PTNS, Ung thu dg ddy doan xa A B S T R A C T
LAPAROSCOPIC GASTRECTOMY IN TREATMENT OF DISTAL GASTRIC (y[RCINOMA Vu Ngoc A n h Tuan, Do M i n h H o a n g , V u o n g T h u a Due
* Y H o e TP. H o Chi M i n h * Vol. 18 - N o 1 - 2014; 34 - 38
Backgroud: Gastric cardnoma has beat a common disease in Asia, including Vietnam. The main treatment is opai surgical gastredomy. Laparoscopic gastrectomy is not so widespread until now, and just be used in a few Vietnamese caiters in recait years.
Purpose: Estimate the early results of laparoscopic gastrectomy
Objectives, Method- Prospective case saies study in Binh Dan hospitdfrom Jan 2010 to Jan. 2013.
Results. There were 57 patients operated with laparoscopic distal gastrectomy arui nodal curettage. Thdr mean age were 54.12 ± 10.9. Male-fanale ratio was 67%-33%. Mean BMI is 21.24 ± 1.92 kg/mK The operative results were: no death, no case tiasfrring to open surgery. There zoere only 1 case of pancreatic fistula (self healed) (1.75%) and 3 cases of wound infiidwn (5.26%).
Conclusion: Laparoscopic gastiedomy is possible, safe, withfew complication.
Keywords: Laparoscopic gastiedomy. distal gastnc carcinoma.
M O D A U - M U C T I E U N G H I E N C U t J ^ ^ h a u A u va ket q u a h r o n g d u o n g v e ti le song T T .1, J J • 1 • "X L - 1 - , , . ^ " ^ ^ ^ ^^ ™° rn6P-iw^-2i-^-25.2632), Tai v i ^ t Nam, U n g t h u da d a y la m o t t r o n e n h u n g b e n h lv i.:^ . , . . - . J , , , .
' ._• I- i . - u - " 1- • i - 1.° .. - *•« . p n a u thuat noi soi eat d a d a y d o u n g t h u da day ac tinh p h o bien. T n r o c day, p h a u thuat dieu t n , . , . , , , „ „ ^ '
4.1, ^ .J' ^ •.!, u - 1,1 ' 1 ' ^ ^'^ " " ^ c ^'^^ h i e n o m o t so t r u n g tamf^'^' u n g t h u da day d u o c thirc m e n b a n g p h u o n g r. „ ^., „, ' ° . . - • 1 • L ^ - - r*- i - u " ., . . VOI m o t so ket q u a khich le n h u n g c h u a ro ret VI p h a p m o m o kinh dien. Gan day, p h a u thuat noi « , , , ' °
^^- •'4. J J- u I, J u-^ .L - - -. so n g h i e n a m con it. D o d o , c h u n e toi tien h a n h SOI cat d a d a y n a o h a c h d u p e chap t h u a n rong rai , -T . , • ° A™Ai.^^„,.^.,r-i,- A ' ^-,- '•,— ." , ' n g l u e n a m n a y n h a m m u c tieu n g h i e n c u u cu o mpt so n u o e C h a u A va mpt vai t r u n g tam Ion J • & •
* DH Y khoa Phgm Ngoc Thach "K h o a Ngoai Tieu hoa BV Binh Dan TP.HCM
" * Bo mon Ngoai, DH Y Duoc TP.HCM
Tdc gid lien lac: PGS. TS. Vuong Thiia Due DT: 0903979725 Email vuongthuaducfdvahoo.com.vn
34 Hpi Nghi Khoa Hpc Ky thuat BV. Binh Dan 2014
Y Hpc TP. Ho Chi Minh * Tap 18 * So 1 * 2014 Nghien cuu Y hpc the la: Xac dinh tinh an toan, ty le tai bieh, bieh
chiing som khi thuc hi§n phau thuat c3t ban phan da day voi npi soi ho trp trong dieu tri ung thu da day.
DdlTUgNG-FMJ'CiNG PHAP NGHIEN CUU Doi ttrong nghien cmi
Bfnh nhan dupe chan doan la ung thu da day 1/3 dudi dupe phlu thuat eat da day voi npi soi h6 trp boi mpt nhom phau thuat vien tai b?nh vien Binh Dan TP HCM tix 1/2010- 01/2013.
Tieu chuan chpn mau
Cac b|nh nhan co ung thu da day 61/3 duoi Buou chi han che d da day, chua co di can gan va phuc mac.
Tieu chuan Ioai trii
B?nh nhan khong dong y tham gia nghien cuu.
Nhiing bfnh nhan co bfnh ly kem theo chong chi dinh voi phau thuat npi soi.
Phuong phap nghien cuu
Nghien cuu tien euu, mo ta hang loat ca, khong nhom chiing.
Co mau: dupe tinh la n > 31.
Ky thudt mo
N90 vet hach theo huong dan cua Hpi Ung Thu Nhat Ban GGCAp. Chung toi thue hifn nao h?ch kieii Dl+a (Dl + nhom hach 7), Dl+p (D1+ nhom hach 7,8,9) va D2.
Ki4u vet hach DD D l D1 +
D2
Nhom hach edn vet Vet it hOTi D l 1.3,4sb.4d,5,6,7
D U 8 a , 9 D1+8a,9,l1p,12a
est ta trang duoi mon \i khoang 1 - 2 cm bang stapler Echelon Flex 60.
Cat da day tren u, noi vi trang kieu Billroth U dupe thuc hien ngoai 6 bung qua mpt duong mo bpng 5 em o thuong vj.
KET QUA NGHIEN CUXJ
Tai bfnh vien Binh Dan Tp Ho Chi Minh tu
1/2010 - 01/2013, chiing toi eo 57 benh nhan ung thu da day dupe phau thu^t npi soi eat ban phan da day va ket qua nghien cuu nhu sau:
Tuoi, gioi
Cac benh nhan dupe phau thuat tap trung 6 lira tuoi 50-59 tuoi chiem ti le 43,9%. Tuoi nho nhat 32, Ion nhat 78, hrung binh 54,12 ± 10,909.
Gioi nam chiem da so voi 38 bfnh nhan (66,7%), ti If nam: nii = 66,7: 33,3 = 2 1 .
Bdngl: Phdn botheo khoang tuoi Khoang tu6i
3 0 - 3 9 4 0 - 4 9 5 0 - 5 9 6 0 - 6 9 7 0 - 7 9 Tong cpng
S o B N 8 9 25 11 4 57
T i l ? % 14%
15,8%
43.9%
19,3%
7%
100%
Li do nhap vif n
Phan Ion benh nhan nh$p vien dieu tri vol ly do dau thupng vi (chiem ti If 47,4%).
Bdng 2: Li do nhap vien Ly do nhap v i f n
D a u t h i f p n g vi Cham tieu Ndn ra mau TiBu phan den
61 Tong cpng
S o B N 27
9 6 7 8 57
T i l f 4 7 , 4 % 15,8%
10,5%
12,3%
14%
1 0 0 %
Chi so khoi ca the (BMI) va ASA Phan Ion bfnh nhan co can nang binh thuong, chi CO 1 benh nhan beo phi va 10 bfnh nhan thua can. Da phan bfnh nhan trong nghien ciiu nay co chi so ASA la II, chiem ti le 57,9% (33 bfnh nhan), ASA I co 13 bfnh nhan va ASA HI CO 11 benh nhan.
Vi tri & kich thuoc cua sang thuong Sang thuong m 6 tien mon vi tiong 15 trudng hpp, 6 hang vi la 42 truong hop. Kieh thuoc trung binh ciia sang thuong la: 2,807 + 1,1369 cm.
CT Scan bung
Co 43/57 tiuong hop (75,4%) dupe lam CT Scan, thi eo 15 truong hpp (26,3%) di can hach.
Hpi Nghj Khoa Hpc Ky thu?t BV. Binh Dan 2014
w
Nghien ciru Y hpc Dang vi the ciia sang thuong
Theo ghi nhan cua chiing toi, tat ea cae truong hop deu la carcinoma tuyen, tiong do eo 14 truong hpp biet hoa cao, 16 truong hpp biet hoa viia va 26 truong hop biet hoa kem.
Loai phau thuat
Chiing toi thuc hien nao hach theo huong dan Clia Hpi Ung thu Nhat Ban (JGCA). Trong nghien ciiu nay, da so bfnh nhan duoc thuc hifn n^o vet hach D2 (chiem ti If 64.91%), 10 trudng hpp nao hach Dl + a va 10 trudng hpp nao hach Dl +p.
Thoi gian phau thu?t
Thai gian phau thuat tiong nghien cuu ngan nhat la 130 phiit, dai nhat la 270 phiit, trung binh la 207,12 ± 32,99 phiit. Vdi phep kiem ANOVA F
= 99,605; R = 0,887 cho thay anh huong co y nghia cua kieu nao hach doi voi thdi gian mo (p=
0,001). Vdi phep kiem ANOVA F = 7,901; R = 0,504, cho thay BMI anh hudng ed y nghia len thdi gian phlu thuat (p = 0,003).
Bdng 3: Thdi gian phau thuat theo kieu ngo hgdi
Y Hpc TP. Hb Chi Minh * Tap 18 * So 1 * 2014 Giai doan ung thu danh gia sau phau thuat
Phan Idn benh nhan d giai doan Hb va Ilia.
So hach di can trung binh dupe xae dinh sau mo qua giai phau benh la 2,1 ± 1,7 hach.
Bdng 5. Giai doqn sau pliau thudt khi co kei qud gidi 'jhdu benh
h^ch D1+a Dl +p D2
Th^i gian ngin nhat 130 phut 175 phut 200 phut
Thoi gian toi da 169 phut 205 phiit 270 phut
Thoi gian trung binh 152,50 phut 188,70 phut 226,95 phut
OQ l#ch chuin 11,664 8,883 17,534 Bo cit tren u & kieu noi
M^t ck tiling binh tren u la 6,12 ± 0,908 cm, (5-10 cm), 100% khong co te bao ung thu d mat eSt. Tat ca cac trudng hpp trong nghien ciiu nay dupe tai lap Iim thong da day rupt theo phuang phap Billorth D.
So h^ch dupe n^o
So' hach tiling binh: 27.39 ± 7.907, (it nhat: 14, nhieu nhat- 45).
Bdng 4: Tong sdhqch duoc ngo Sd h^ch 6ipqic n^o
10-19 20-29
^ 3 0
SdBN 14 19 24
Til^
24,6%
33,3%
42,1%
TNM sau md la lb lla lib Ilia lllb Tong cpng
SdBN 2 1 10 15 2 7 2 57
Til9 3,5%
1,75%
17,5%
26,31%
47,44%
3,5%
100%
Tai bien trong mo
Chiing toi khong gap tai bien nao trong khi md va ciing khong eo tiudng hpp nao phai chuyen mo mo do gap khd khan tiong khi mo.
Lupng mau mat tiung binh tiong nghien cihi la 89,1 ± 30,6 ml (it nhat la 40 ml va nhieu nhat la 200 ml).
H | u phau
Thdi gian trung tifn Ian c^u sau mo la 3,2 ± 0,8 ngay. Thdi gian trung binh bfnh nhan nam dieu tri sau khi phau thuat la 7,07 ± 0,8 ngay. Sau md, chiing toi chl cd 3 trudng hpp nhiem trung vet mo^ chiem ti Ie 5,26% va 1 trudng hpp (1,75%) rd tyy nhe tu lanh. Khong eo cac bien chiing khae va khdng cd tir vong.
Co 49/54 trudng hop dupe theo ddi chua thay tai phat (qua soi da day va CT Scan bpng).
BAN LUAN BMI
Trong nghien cuu oia chiing tdi, BMI trung binh la 21,242 ± 1,92 kg/m^.
Bdng 6: Chi so'BMI cua ehung toi vd cdc tdc gid khac Tac gia
J H Lee'^"' Pughese'"' KYSong'""
Joo Ho Lee'^''' Fukunaqa'"'
R y u « Chung toi
SiBM 24 7 0 4 4 106 391 347 57
BMI 24,60
28,8 23,1 24,3 2 3 23.9 21,242
Hgi Nghi Khoa Hpc Ky thuat BV. Binh Dan 2014
Y Hpc TP. Ho Chi Minh * Tap 18 * So 1 * 2014 Nghien cmi Y hpc Hyuk Joo Leef'^i da dua ra nhiin xet rSng c6
su khae biet ve thdi gian phSu tiiuat giiia nhdm cd chi sd BMI < 25 kg/m^ va BMI > 25 kg/m^
Hirokazu Noshiro'^ nhan thay thdi gian phau thuat dai hon tiong nhdm bfnh nhan cd BMI >
25. K Yasuda™> va cpng su cung cho ket qua tuong tu. Chiing toi nhan thay, chi so BMI lam keo dai thdi gian phSu thuat Trong ng^en aiu Clia minh, Fukunaga'*' da ghi nhan co 8 tnrdng hpp bfnh nhan beo phi vdi chi so BMI tiong khoang tu 30 - 35,6 kg/m-, cd nhieu khd khan khi nao vet hach tien tuy lam keo dai thdi gian phlu thuat.
Loai phau thuat
Theo phien ban 3 oia JGCA, vdi ung thu da day, cac hach tii 1 - 1 2 va 14v dupe xem la hach vimg, di can tdi bat ki hach nao khac dupe xem la di can xa. Ben c^inh dd, tiong phien ban nay, cae nha phlu thuat Nhat Ban ding dua ra hudng dan ngo vet hgch cho nhimg ung thu d phan xa Clia da day<"J, qua do chiing tdi thay rang Dl + a ehinh la Dl, Dl + p chinh la Dl + aia phien ban mdi. Trong hudng dan lan nay, vifc nao vet hach 14v la khong can thiet tiong nao hach D2. Chiing tdi hoan toan tan thanh vifc khdng nao vet hach 14v nay vi kha nang lam tang them tai bieh phau thuat.
Bdng 7: Kiiu ngo hadi ciia chiing toi vd cdc tdc gid khde
hon), kieu nao hach va kinh nghiem oia phau thuat vien.
8: Thdi gian phdu thuat trung bhih
Tac gia Keun Won Ryu'"''"
Sang II Hwang'"' Chiltara Kunisaki'"'
Fukunaga""
ChOng toi SdBN
347 45 130 391 57
Ki^u n^io h D l + a
5 122 350 10
Di +p 150
14
10
?ch D2 95 26 8 41 37 Thoi gian phau thuat
Cac tac gia tien the gidii'"^' deu ddng y rang thdi gian phSu thuat phu thupc vao the tiang bfnh nhan, vao cac dung cp phau thuat npi soi (dao cit sieu am giiip phau thuat nhanh cam mau td't, tiang thiet bi phau thu^t npi noi diing chuMV man hinh rd, sang gnip phau thuat nhanh
Tac gia
J H Lee'^"' Joo Ho Lee""
Fukunaga'^' Zhao'^^' K Y Song'-*'
Kitano'^*"
Hayashi'*' Huscher^"' Sang II Hwang""
Uyama''"' Ryu'"*
Tneu Tn^u Du'ong'^' Pugliese'"' ChikaraKunisalti'^"
Pham OLPC Huan''*' Tanimura''"'
Chiing tdi
So b^nh nhan
24 106 391 346 44 14 30 30 45 5 347
31 70 130 94 235 57
Thd'i gian phiu Uiu^t trung binh (phut)
319 285,8
239 211 264 227 378 196 255,5 392 270 264,0 235 262,6
206 236 207,12 Bien ehung phau thuat
Theo Ryu tien 347 bfnh nhan ung thu giai doan sdm, cd ti le bien chiing trong mo la 2,6%, bien ehung sdm la 6,1% va bien ehung mupn la 2,9%, thudng gap la chay mau. Theo Bo'^', ti If bieh chiing trong md' la 5% chii yeu la chay mau phai ehuyen mo md, bien chiing sau md la 7% tiong do rd mom ta tiang la thudng gap nhat (2.3%). Fukunaga thyc hifn phau thuat ndi soi cat da day nao hach tien 391 bfnh nhan, thi ti If bien chiing sau phau thuat la 4,6%; tiong dd chiem ti If cao nhat la ro tuy (7 bfnh nhan). Chiing toi cd 1 trudng hpp rd tuy (1,8%), ty le nay thap han so vdi Ryui-*). Viec rd tuy co the li giai la do tiong qua trinh nao hach doan tien tuy, ehiing tdi lam ton thuong tuy ma khong phat hien.
KETLUAN
Phau thuat npi soi eat ban phan da day tiong dieu tri ung thu da day la an toan (hi vong 0%), it tai bien va bien chiing (Ty le tai bien va bien chiing sdm 7%, chii yeii la nhiem trung vet mo va 1 trudng hpp rd tuy tiJ het).
Hpi Nghi Khoa Hpc Ky thu^t BV. Binh Dan 2014
Nghien cuu Y hpc TAI LIEU THAM KHAO
1 Bo T, Zhibong P. P a w u Y, et aL (2009). •General complications followmg iapaiosoc^c-asasted gastiectomy and analysis of techniques lo manage ihan" Surg Endosc, 23(8), 1860-1865
2 Do Vin Trang. Tnnh. Hwig Scm.va cs. {2009). "Ky fliu^t nao vet h^ich D2 bang phlu thu?t ngi soi tnmg d)eu In ung thu da day viuighangmonvi" YhocIhrchinh,Z6ii-Si5 3 Fukunaga T. Hiki \ ' . TcAunaga M. et a t (2009), "Left-aded
approach for suprapanaeatic l y i r ^ node dissection in laparoscopy-assisted di-4al gastiectomv without duodenal transection". Gas/nr Canar. 12(2), 106-112.
4 Guzman EA. Pigaza A. Lee B, et al. (2009), Totally laparoscopic gastnc resection with extended lymphadenectomy for gastnc adenocarcinoma" Ann Surg OnaJ. 16(8), 2218-2223,
5 Hayashi H, Ochjai T, Shimada H, G u i ^ Y (2005), 'Pn>^>ective randomized study of open versus laparoscopy-asasted distal gastrectomy ivith extrapengastric lymph node dissechon for early gastnc cancer" Surg Endose. 19(9). 1172-U76 6 Huscher CG, Mingoh A, Sgarzinj G, et aL (2005),
'laparoscopic versus open subtotal gastrectomy for distal gastnc cancer five-year results of a randomized prospiecbve tnal" Am Surg. 241 (2). 232-237.
7 Hwang SH, P a * do J, ]ee YS, et al- (2009), "Actual 3-year survival after laparoscopy-assisted gastrectom\' for gastric cancer" Arch Surg. 144(6), 559-564, discussion 565 8 Hwang, SI, Kim HO, Yoo CH, et al. (3X19), 'Laparosospic-
assisted distal gastrectomy versus open distal gastrectomy for advanced gastnc cancer" Surg Endive. 23(6), 1252-1258 9 Hyung W], Song C, Cheong j a Choi SH, Noh SH (2007>
"Factors influencing operation time of laparoscopy-assisted distal subtotal gastrectomy analyas of cor\secuti\'e 100 ii-ufaal ca.scs" £nr/SiirsOiiro/,33(3).314-319.
ju. Japanese Gastnc Cancer Assoaation (2011), 'Japanse dassificabon of gastnc caranoma. 3rd English edition" Cosine Cnnnr, 14(2), 1DM12
11. Japanese Gastnc Cancer Association (2011), Tapanese gastnc cancer treatment guidelines 2010 (ver 3)". Gastnc Cannr, 14(2), 113-123,
li. Kim, M. C , Jung, G J, Kim. H R (2007), "Morbidity and mortality of laparoscopy-asisted gastrectomy with extraperigastnc lymph node dissechon for gastnc cancer". Dig DM Sn, 52(2), 543^548
13. Kitano S, Shiraishi N, F^u K, Yasuda K, et al (2002), "A randomized controlled tnal companng open vs laparoscopy- assisted distal gastrectomy (or the treatmait of ear!5' gastnc cancer an mtenm report' Si«sfrv. 131(1 Suppl),S306-311.
14 Kuni:>ak] C -Makino H, Takagawa R, et aL (2009), "Eifican,' of laparoscopy-assisted distal gastrectomy tor gastric cancer in thedderlv" S u ^ EriAisr, 23(2), 377-383
15. Lee HJ, Kim HH, Kim M C Ryu SY, Kim W, el al (2009), 'The impact of a high body mass index on lapaioscopy asasted ga-sta-ctomy for gastnc cancer". Surg Bulox. 23<11), 2473-2479.
16 Lee J H Han HS (2005), "A prospective randarazed study companng open vs laparoscopy-asasted distal gastrectomy in eariy gastnc cancer eariy results". Surg Endosc. 19(2), 168-173 17 L e e H i YomCK,HanHSi2009( Xompanson of long-lenn
outcomes of laparoscopy-assisted and i^jen distal g^lrectomy tor eariv gastnc cancer" Surg Endox. 23(8), 1759-1763
18- Lee J, Kun IV (2009), "T-ong-tenn oubromes after laparoscopy- as£dsted gastrectomy for advanced gastnc cancer anali-as of consecutive 106 expenences" / Surg Oncol, 100(8), 693^*98 19. Nguven Minh Hai (2006), "Dafh gia ban dau ve phau ftni^t
cat da day n?o h^eh qua npi sot ho tip" Y tor timnh p/w'Ho CW Mmk Chuyen dijMu tbuStnoifm. 10(4), 109-113 zu Noshiro H, Shimizu S, Nagai E, et al (2003), 'Lapaiosoopy-
assLsled distal gastrectomy for eariy gastnc canca: LS il ba»eficjal for patients of heavier waght?". Ann Surg. 238(5), 6Sfr685
-^1 Pak KH, H>Ting WJ, Son T, el aL (2012), "Long-tenn oncologic outcomes of 714 consecutive laparosct^ic gastrectomies for gastric cancer, results from the 7.year expenertce of a angle uislitute". Surg Endosc, 26(1), 130-136.
22 Ph?m Due Huan, Tnnh Hong Son, Do Van Trang va cs. (2012),
"Ket qua phau thuat c^t do^n d? day n^o vel h^ch D2 npi sd".
Tap chi phau Ihuat noi soi iw nm H'I Wt Sam. 2(1), 29 • 33 23 Pugbese R, Maggiom D, Sansonna F, et al (2010), 'Subtotal
gastrectomv with D2 dissection by minimally invaave surgery for distal adCTiocaronoma of the stomach; results and 5-year survival" Siir^EHdosc, 24(10), 2594-2602 24 Ryu KW, Kun YW, Lee JH, Xam BH, Kook M C Choi U, et al
(2008), 'Surgical complications and the risk factois of laparoscopy-assisted distal gastrectomy m early gastric cancer" Ann Surg Oncol, 15(6), 1625-1631
25 Song ], Lee, HJ, Cho GS, et al. (2010), "Recunrence following laparoscopy-assisted gastrectomy for gastnc cancer a multicerter retrospective analysis of 1,417 patients", Ann Surg Oncol, 17(7), 1777-1786,
26, Song KY, Kim SN, Park CH (2008), 'laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects" Surg Endosc, 22(3), 655-659
27 Tanimura S, Higashmo M, Fukunaga Y, et al, (2005), 'Laparoscopic distal gastrectomy with regional lymph node dissection for gastnc cancer" Surg Endosc, 19(9), 1177-1181.
38 Trieu Tneu Duong (2008). "Nghien o h i ky thugt cat d? day, vet hach D2 bang phau thu?t npi soi tgi b?nh v)?n 108". YHfic TP H5 Chi Mmh, 12 (4), 204 - 208
29 Uyama 1, Su^oka A, Matsui H, et a! (2000), "Laparcscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach" Gastric Cancer, 3(1), 50-55
30 Yasuda K, Iromata M, SHraishi N, et al (20D4), 'Laparoscopy- assisted distal gastrectomy for eariy gastnc cancff m obese and nonobese patients" Surg Etutosc, 18(8), 1253-1256.
J l Zliao Y, Yu F, Hao Y, Qian F, Tang B, Shi Y, et al, (2011),
"Comparison of outcomes for laparoscoptcally assisted and open radical distal gastrectomy with lymphadenectomy for advanced gastnc cancer" Sury Endnsr, 25(9), 2960-2966 .sz Ziqiang W, Feng Q, Z h m i n C, et al (2006), "Companson of
laparoscopically assisted and open radical distal gastrectomy vnth extended UTnphadenectomy for gastnc cancer management". Surg Endosc, 20(11), 1738-1748
Ngdy nbgii bdi bdo: 16/10/2013 Ngay phdn bien nlidn xet bdi bdo.
Ngdy bdi bdo dugc ddng
n/12/2013 20/02/2014
Hoi Nghi Khoa Hpc Ky thuat BV. Binh Dan 2014
