d p Ojnh nghia va sinh ly bgnh". Ky yiu bdo do khoa hgc. Hpi tim mgch TP HCM
3, Dgng Van Phudc, Truong Quang Binh (2006),
"Sinh ly benh dgng mach vdnh" Nhd xult bdn y hpc TP HoChiMinh, 49-83,
4 Dgng Vgn Phudc, Vfl Thdnh Nhdn (2006-2010),
"Dau thit ngyc khdng 6n djnh vd nhdi mdu co tim khdng cd ST chdnh lgn", Khuyin cio hpi Tim mgch hgc Vipt Nam chin doin vi diiu tq, 107-181
5. De Lemos JA, Morrow DA, Bentley JH, Omiand T, Sabatine MS, McCabe CH, Hall C, Cannon CP, Braunwald E, (2001), "The prognostie value of B-Type natriuretic peptide in patients with acute coronary syndromes" The New England Joumai of Medicine, 345 1014-1021
6. Drew E. Fenton D, (2008), "Myocardial infarction
" In Medicine come, 327
7. Dumaine RL, Gibson CM , Gelfand EV, et al (2004), "For the TlMl study group. Association of glomerular filtration rate on presentation with subsequent mortality in non ST -segment elevation acute coronary syndrome observation in 13 307 pateints m five TlMl trial". European Heart Joumai,
8. Galvani M, Ottani F, Oltrona L, et al (2004), "N-
terminal probrain natriuretic peptide on admission has prognosis value across the whole speetnum of acute coronary syndrome". Circulation, 110. 128-134.
9, Killip T (1976), "Treatment of myocardial infarction in a coronary eare unit. A two year expenence with 250 patients" Am J Cardiol, 20: 457-464.181
10 Kragelund C, Granning B, Kober L et al. (2005),
"N-Terminal Pro-B-Type Natnuretic Peptide and Long- Term Mortality in Stable Coronary Heart Disease". The New England Joumai of Medicine, 666-675.
11. Omiand T, et al (2002), "NT-proBNP and long term mortality in acute coronary syndromes". CImulation, 106:2913-2918
12 Pfisler R, Schneider CA (2004), "Natriuretic peptide BNP and N-terminal probrain natriuretk: peptide:
establesshed laboratory markers in elincal practice or just perspective" Clinical chimica Acta. 349, 25-38
13 Phgm Nguydn Vinh (2006), "Bgnh hpc tim mgch" Nhd xuit bdn y hoc TPHCM, 77-138.
14. Trdn Thanh Tudn, Dpng Vgn Phudc (2008),
"Vai trd cua NT-proBNP trong tien luyng ngin hgnwhoi mau CO tim d p " Lupn vdn BS Npi trO chuydn ngdnh HQI tdng quit. TP.HCM
DANH GIA KET QUA DIEU TRj TON THU0NG OA DO XA TRj VUNG AM HO B A N G PHirONG PHAP CHUYEN VAT DA
N G U Y E N V A N TUYEN - Bpnh vien K
TOM T A T :
Muc tieu nghien cdu: Ddnh gid kit qud diiu tn tdn thwang da do xa tri vung dm hp bing phwang phap chuySn vgt da.
Ddi twgng nghien cwu 21 bdnh nhdn cd tdn thwang viem, loet da do xa tri vung im hP
Phwang phdp nghidn cww Md ti hdt cdu.
Phwong phip tien hanh Cit bo vung da ton thwang do xg tri tgi im hp, tao hinh bdng vgt da diy hinh chd Z mpt trong dui. Kit qui: Liin sgo todn bd li 66.6%, Itin sgo mpt phin. phii chdm sdc vit thwang 33.3% 100 % bpnh nhdn ra vipn hit vidm, lodt, chdy dich, dau vung dm hd
Kit luin Cd thi dp dung phwang phip ehuyin vat da hinh chw Z di dieu In bpnh nhin tdn thwang da do xa tri viing dm ho
Tw khda: xa tn vung dm hg, chuyin vgt da SUMMARY
Object-Evaluate the local flap - plasty surgery result of skin injury after radiation therary of vulva cancer
Subject 21 patiens with inflamation and ulceration at local vulva skin affer radiotherapy.
Method, retrospective-descnption. Removing all area skin injured after radiation, applied local Z - plasty flap surgery at the femeral inferior
Result: there were 66 6% patiens with total mcover of scar, sub total recover of scar and wound
cam after surgery was 33.3% .All patiens discharged from hospital were very good condition without vulva area inflamtion, ulceration and pain.
Conclusion: The local Z- plasty flap surgery method could apply on therapy for skin injury after local mdiation therary of vulva cancer
Keywords, skin injury, vulva cancer DAT V A N OE:
Ung thu am hg la bgnh It gdp chiem 3 -5 % cac ung thu_phi,i khoa, Tai Vigt nam ung thu am hg tuy \d bgnh dg phat hign, xong bgnh nhan thudng den kham va dieu trj d giai dogn mudn (giai doan 1I,III,1V).
Do vSy, nhidu benh nhan phai dp dung phuong phip xa tn bd sung sau md. Xa tri tai chd duye ehi djnh khi dien d t dm hd edeh bd tdn Ihuong ung thu ^ 8 mm, xdm l l n sdu tren 5 mm hoae xSm l l n mao mach, bach huydt. Lieu xg cdn dat tdi da la 55 gy [1]. Xa trj cd tac dung iam giam tai phat tai vCing trong ung thu' am hg, xong trong mdt sd trudng hyp gay bien Chung dai d i n g nhu viem, loet, dau keo dai lam anh hudng tdi e h l l luyng cudc sdng cua bdnh nhdn 0^
khac phgc Unh trang nay, ehiing tdi tien hanh phiu thual e l t bd viing da ton thuung do xg tri lai am hd, lao hinh lai b i n g phuong phdp chuyen vat da ddy, Nghien c&u eua chung tdi cd muc tieu id "Ddnh gia ket qua dieu tri ldn thuong da do xa trj vCing dm ho bang phuong phdp chuyen vat da".
DOI TU'aNG, PHU'aNG P H A P NGHIEN ClfU:
V HQC THV'C HANH (872) - SO 6/2013
2.1. Ddi t u o n g nghien cii'u: 21 bgnh nhdn cd ldn Ihuong viSm, loet da do xa tri viing dm hd cd cae tigu chuin sau.
- Ld nhung bgnh nhdn ung thu am hd (cd c h i n dodn xdc dirih b i n g md benh hpc) da duye didu Irj phlu thugt eat am hd vd vdt hgeh bgn hai b6n, sau dd duye didu trj xg tri bd sung vao vimg dm hd lidu 55gy
±xatri hgeh ben 50 gy.
- Bdnh nhdn khdng ed tdi phdt tai ehd (xdc d|nh qua sinh thiet viing da tdn thuong).
2.2. Phuong phdp nghien cu>u: Md la hdi e&u.
2.3. Phuung phap phdu thugt:
- Bdnh nhdn duye gdy tS tuy sdng hodc gdy md, - Benh nhdn duyc e l t bd viing ldn Ihuong da do xa tri vting dm hg tdi sdt Idp c u . Gidi han trong Id mem mac am dgo, gidi hgn ngodi Id bd eua tdn thuong.
Hinhl Vgt da hinh chO'2
Chuyen vgt da hinh chu Z d mat trong diii (hlnh 1), Vat da duuc l l y den hdt ldp md dudi da Cudng vat cd chieu rdng t u 10-15 cm, eao 8-10 cm.
Hinh 2 Vgt da sau che phu
- Khau vat da che phu viing tdn thuung da duoc lay bd (hinh 2)
K E T Q U A V A B A N L U A N :
Trong didu tri ung thu am hd, didu In ngogi khoa giO" vai trd quyet dinh, Phau thugt gdm 2 p h i n Cat bo am hd - Vet hach ben, haeh chdu hai ben T u y j d b&nh dd phdt hien, c h i n dodn Xong da sd BN den vi&n trong giai doan tuong ddi mugn (II, III, IV) [ ] Do vay didu tri phlu thuat ggp nhidu khd ngan do una thu' xdm l l n rgng, di cdn haeh Xa trj bd sung sau md tai vLing am hd duoc chi djnh khi dien e l t each ria khdi u £ 8 mm, u xdm l l n sdu qua 5 mm, ed xdm l l n mao mach, bgch huyet. Lieu xg tai viing la 55gy. Xa tri bd sung viing hach ben duuc chi dinh khi cd di cSn
haeh, lidu xg 45 - 50 gy, Tuy vgy, viing am hp sau khi d t bd cd cdu triic gldl p h l u ph&c tap, khd tlnh loan lieu luung xa tn. Mgt sd Irudng hop sau xa tn gay tdn Ihuong da kdo ddi nhu vidm, lodt, chay dich. dau, didu tri ngi khoa khdng ed kdt qua. Bien ch&ng nay thudng xdy ra d thdi gian 3 - 5 sau didu trj 6' nh&ng bgnh nhdn ndy chiing tdl tidn hanh d t bd viing da tdn thuong, tgo hlnh lai b i n g vat da hinh ehu Z mdt trong diii VI la vimg da md va xg trj nen id eh&c tgi viing am hd thudng xu e&ng. It tudi mdu, ndn nguy co khdng hdn vet thuong eao.
- Trong 21 bgnh nhdn duoc phlu thugt cd kdt qua nhu sau
+ Ket qua tdt, L i l n s?o todn bd 14/21 benh nhdn (66,6%).
+ Kdt qua trung binh: 7/21 bgnh nhdn (33,3%), Lidn seo trdn bd mdt da, mdt phan td ehue da khdng lidn vdo CO vung an hd, phai chdm sdc vet thuong, sau dd Idnh vdt thuung 3 benh nhdn (14,3%) Vat da hoai l u mgt phdn d phia ria, phai d t loc vd khSu lgi' 4 bdnh nhdn (19%).
- Khdng cd bgnh nhdn ndo hoai t u todn bg vgt da Cdc benh nhdn nay khi ra vign ddu cai thien ve ehat luong cugc song, hdt vigm, lo6t, ehay dieh, dau viing dm hd
Hinh 3 Benh nhan Nguyen Th| L 56T K E T LUAN:
Qua 21 bdnh nhdn trong nghien euu, chOng tdi thay rang cd thd ap dung phuong phap chuyen vat da ddy hinh chu Z d l dieu tn cac bgnh nhdn tdn thuong da viing dm hd do xa In Phdu thuat cd kdt qua tuong ddi tdt, ehat luung cude sdng cija bgnh nhan duoc cai thien
TAI LIEU THAM KHAO
1, Nguyen Bd Due (2007)," Chan dodn va dieu tn benh ung thu" Nhi xuat bdn Y hoc, trang 352 - 361
2 Clifford R Wheeless, Jr. MD (1997), " Wide local excision of the Vulva, with primary closure or Z- plasly flap". Atlas of pelvic surgery
3 De Vita VT (2006), "Carcinoma of the vulva", Cancer Pnnciples and practice of Oncology
A Faul CM, Fekins RM, et al (1997), "Adjuvant radiation for vulva carcinoma: improved local control", Int Radiat Oncol, pp 381 - 386.
5 Jhingran A, Levenback C, Katz A, et al (2003),
"Radiation therapy for vulva carcinoma: predictors of vulva recurrence" Rad/a( Oncol Biol Phys. 57, pp 193 -197.
Y HOC THV'C HANH (872) - SO 6/2013