hepatocellular carcinoma wtth tumor thrombi in porial vein and curative analysis, Zhonghua Waike Zazhi 1999; 37:8-11.
4. bang-He Yu, Nan Li, Shu-Qun Cheng (2011), "The Role of Antiviral Therapy for HBV-Related Hepatocellular Carcinoma", International Journal of Hepatology, 1-8,
5 Llovel JM, Bm C, Bmix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification.
Semm Liver Dis 19(3)'329-338
6, Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sale M, Bru C, Rodes J, Brulx J, Natural history of un- treated nonsurgical hepatocellular carcinoma:
Rationale for the design and evaluation of therapeutic trials.
Hepatology 1999; 29. 62-67
7. M. E, Tublin, G,D Dodd, Richanj L. Baron, "Benign
and Malignant Hortat vein i nramoosis: umm&nmuon oy u i Characteristics", AJR:168, March 1997
8, Minagawa M, Makuuchi M, Takayama T, Ohtomo K Selection criteria for hepatectomy In patients with hepatocellular carcinoma and porial vein tumor thrombus.
Ann Surg 2001; 233: 379-384.
9, Ohkubo T, Yamamolo J, Sugawara Y, Shimada K, Yamasaki S, Makuuchi M, Kosuge T (2000) Surgical resulte for hepatocellular carcinoma with macroscopic portal vein tumor thrombosis. J Am Coll Surg 191(6):657-660.
10, Poon RT, Fan ST, Ng 10, Wong J (2003) Prognosis after hepatic resection for stage IVA hepatocellular carcinoma' a need for reclassification. Ann Surg 237(3): 376-383,
im TRANG VA NHU CJU N H A N LUC Y T^ Oi; PHONG TJNH DAKLAK
T 6 M TAT
Nghidn cwu thwc trgng vd nhu ciu nhdn Iwc y td dw phdng tinh DdklSk dwqc tiin hinh tir thdng 1 din thing 6 nSm 2011. Myc tiiu li dinh gid thi/c trgng vi trin ea sd dd wde tinh nhu ciu cdn bd tmng todn tinh din nSm 2015. Nghidn cuv dwqc thuc hidn theo phwang phip md ti cit ngang. Ddi lu-gng nghiin cOv Id tit ei cin bd chuyin mdn(444 ngwdi) dang cdng tdc tgl cdc ca sd y td dw phdng. Sd lidu thu thdp dwqc qua nghidn ciiv sd sach vd nhin Iwc eua cic ca sd y te vd phdng vin cdn bd- CSn cw vdo Quyit d}nh 255/2006/QD-TTg ngiy 09/11/2006 cua Thu twdng Chlnh phu vi vide phd duydt chiin Iwqc qudc gia vi y ti dw phdng Vidt Nam din nim 2010. dinh hwdng ddn nSm 2020 [7] dd irdc Iwgng nhdn luc. Kit qui cho thiy: Sd CBYTDP tren 10.000 ddn li 2,6; Ty Id bie sp /10.000 din Id 0.9; T} 1$ dwqc sp /10.000 ddn Id 0,3. Cdn bd tmng cip chidm ty 10 58,8%
cao hon dgi hqc vd cao ding (31,3%) vi sau dgi hgc (7.7%). Tdng sd 148 Bic sT (33.3%). tmng dd bdc sy YHDP chidm 1.2%. bic sT hi diiu trj 29.5% vd 1 BS CKti (0,2%) vi 11 thgc sp (2.5%). Cd 90,5% dwqc Idm vide phu hqp vdi chuyin mdn, 94,8% hii Idng vdi cdng vide dang lim, 96.2% CBYT mudn tiip tgc cdng vide dang lim vdi ly do phu hqp cdng vide chlim ty Id 72,1 %.
khdng mudn tiip tqc cdng vide 3,8%. Udc tinh nhu eiu nhdn Iwc Y td dw phdng cho toin tinh din nim 2015 li cin bd sung 300 cin bd tmng binh mdi nSm cin tuyin 60 ngwdn. Tmng dd bic sy mdi ndm cin 18 ngwdi. kp thudt viin XN 12 ngwdi, chuyin mdn khde 30 ngwdi.
Ddo tgo Igi 376 ngwdi, mdi nim cin dio tgo Igi sau dgi hgc 20. dgi hge 25. cao ding 17, kp thudt viin xdt nghidm 3 vi cw nhin y ti cdng cdng fl.
Td' khda: thqe trg,ng. nhu ciu nhin /yc / td dw phdng DAT VAN oe
Trong thdi gian qua hogt dfng y l l dy phdng dd dgt duye nhilu thdnh tyu to ldn trang sy nghifp chdm sdc sue khoi nhfin dfin. Tuy nhifin d n nhieu b i t d p d n duyc gidi quylt td Tmng uong d i n djg phuong md quan trgng nhit Id tiiilu hgt b'lm trgng nguin nhdn Ig'c y tfi dy phdng, ddy Id v i n d l Iryng Idm d n duyc quan tdm giai quyet d l hodn tiidnh t i t hon nhifm vg bao v f vd d d m sdc sdc k h d d o nhdn ddn ti^ng d n g cufe hifin dgi hod vd d n g nghifp hod d i l nudc vd hfi nhfp quic l l .
D O A N PHirdrC T H U O C - Tnrdng Dgi hqc YDwqicHui T R A N THj AAAl ANH - TTYT dw phdng tinh DSklik Tgi llnh D i k L i k , nhdn lyc y t l dy phdng dang g^p nhilu khd khdn nhung d u a duyc nghifin ciru mft cdch d i y du vd todn difn.
D l xdc djnh duyc thuc trgng vd xdy dyng k l hogeh phdt triln nguin nhdn luc y t l dy phdng tinh DikLik diing hudng, chung tdi thyc hifin d l tdi: "Nghifin ci>u Ihuc Irgng vd nhu c l u nhdn lyc y t l dy phdng cua llnh D i k L i k ' vdi d c mgc tifiu:
1. Md ti thwc trgng ngudn nhin iqc ytd hi dwphdng ciia tinh DikLik nSm 2010.
2. Xic djnh nhu ciu nhdn lue y ti dw phdng tinh DikLik din nim 2015.
D 6 I TU-grNG VA P H U - O N G P H A P NGHIEN CLFU 1. D i l t u y n g nghifin ci>u
- Cdn bf dang cdng Idc it nhit 6 thdng Igi d c dan vj hfi y t l du phdng tgl dja bdn tinh D i k L i k ndm 2010.
Thdi gian nghifin cuu t d tiidng 01 ndm 2011 din tiidng 06 ndm 2011
2. Phvong phdp nghifin ci>u Thiit ki nghiin cuv: Md ti dt ngang.
Cfr miu: Tit ci cdn bd ldm c6ng tic chuydn mdn y td dwphdng bao gdm 444 ngudi cd (hdr gian Idm vide 9 nhit 6 thing theo Quyit djnh tiip nh$n din thdi diim nghiin cwu.
Phwang phip thu tfi^p s6 li^
- Phing v i n theo bf cdu h i i . - Quan sdl. thing kfi s i lifu d s i n . Phuvng phip xic djnh nhu ciu
Cfin c d vdo Quylt djnh 255/2006/QD-TTg i _ 09/11/2006 d a Thu tudng Chlnh phii v l vifc phfi du) chiln luye quic gia v l y tfi dy phdng Vift Nam din n"
2010, djnh hudng d i n ndm 2020 [6], [7].
K £ T QUA NGHIEN CCrU
1. Thvc trgng c o c l u cdn b f YTDP/10.000 ddn Bdng 1. Ca c l u CBYT/10.000 df n
Cdnbf CBYT dy phdng
Bdcs9 Oyycs9
Ddn s i 1.733.113 1.733.113 1.733.113
SiCBYT 444 148 48
cmo.ow
S6 CBYTDP tr«n 10.000 dSn [i 2,6 ; Ty 1$ bScsy /10.000 dSn \i 0,9 t h i p horn so ; Ty 1$ dirgrc ff /ICOOO dan Ijl 0,3
Y HQC THVC HANH (815) - SO 4fl012
B f n g 2 . T r l n h d f c f i n b d D6i I u v n g
Sau d^i hgc DH v^ cao
dSng Trunq do
So d i p C f n g
Ttnh S i lircmq
25 74 77 3 179
T y l f i
%
14 41.343 1,7 40
V t f d u p h d n q Huvfin S f lup'ng
9 65 184 7 265
T y l f 3,4
%
24.5 69.4 2,7 60
I h e o t u v ^ n Tdnq sd SA l u c n q
34 139 261 10 444
T y l f 7,7
%
31,3 58.8 2,3 100 Cfn b f Irung cap chif m ty If 58,8% cao hon dgi hpc i cao dang (31,3%) vfi sau d$i hpc (7,7%).
Bang 3. C h l l lup'ng bfic sT dang edng lac YHDP Ch^t lu-png c^n bf
Bicsy sac s9 CK dl/ ph6ng B^csyCKI dy ph6ng BScsy ctiuy6n khoa 2
Ttigc sy
S6 luiyng~ Ty Ifi %
Thdi d f cua CBYT vd'i cdng v i f c dang Mm Bang 4. Su phii hop cdng vific chuyfin mdn vdl bling cfp dupe dfio lao
Sl/ phCi hgrp cdng vific vd'i bdng c i p d u o c ddo t90
C6 phij hgrp Khdng phii h g p S u hii ldng v4 cdng vide
Hdi ldng Khdnq hdi Idnq Mu6n tiip tgc cdnq vide
C6 t y do: PhCi hop Cd c a hOi hoc Ifin
Khde Khfinq Cflng v i f c khdng PhCi hgrp Cflng vi$c khdng dOng chuydn
nqdnh Khde (tidn liromq Ihdp)
Sfl Iuvng 402
42 Sfl l u v n q
421 23 Sfl lucrng
427 308 111 8 17 8 7 2
Ty 1$ (%) 90.5 9.5 T v l $ ( % )
94.8 5.2 T * 1$ (%)
96,2 72.1 26.0 1.9 3,8 47,1 4 1 2 1 1 8 90,5% duoc \dm vi§c phii hpp vdi chuyfin mdn, 94,8%
hdi Idng vdi cdng v i ^ dang lam. 96,2% CBYT mudn liSp tgc cdng vi0c dang l^m. L^ do phCi hgp cdng vi^c chiem iy l i 72,1%. Khdng muon li^p tuc cdng vific 3,8%.
Nhu c^u t u y i n di^ng wi dio tgo CBYTDP d i n 2015
Bang 5. Nhu c^u s6 lupng cAn bd v t l qua c^c nam Tuydn
Tinh Htivdn Tdng cdng
Ndm 2011 25 35 60
Ndm 2012 25 35 60
Ndm 2013 25 35 60
Ndm 2014 26 34 60
Ndm 2015 26 34 60
Tdng cdns 127 173 300 Mdi n g m n g d n h y t l c i n t u y i n t h d m 6 0 C B c h u y i n mdn Y T D P .
B a n q 6 . N h u c l u I r i n h d d C B Y T D P CBYT cdn
luy^n Bdcsv KTVxdl nghidm Chuydn mfln khde T i n g cflng
Ndm 2011 18 12 30 60
Ndm 2012 18 12 30 60
Ndm 2013 18 12 30 60
Ndm 2014 18 12 30 60
Ndm 2015 I S 12 30 60
Tdng cdng 90 60 150 300
DS tuySn diing ca c5u thi m6i nam cSn tuy^n thSm 18 bac sJ, 12 KTV x a nghiim.
BSng 7. Nhu c i u dSo t^o CBYTDP
Bdc ddo t90 Sau d^i
hgc E)ai hgc Cao ddnq Trunq cdo KTV xdt nghidm C N Y T C C
S o cdp Tflng cdnq
Hidn c6
34 137
2 232
29 0 10 444
Cdn ddo t ^ o d l n
2015 100 129 86 0 17 44 0 376
S6 ngu'di ddo t^o Iheo ndm 2011
20 25 17 0 3 6 0 73
2012 20 25 17 0 3 9 0 74
2013 20 25 17 0 3 9 0 74
2014 20 25 17 fl 3 9 0 74
2015 20 29 18 0 5 9 0 61 BAN LUAN
Thvc trgng n g u i n nhfln \wc y t l d y phdng tinh Ddkiak
sd lup'ng c6n bO y l l du phdng theo luydn Irong tinh."
Hi y ti dw phdng tinh DikLik cd 444 CB chuydn mdn.
so vdi dinh biin CBYTDP theo thdng tw lidn tjch 08 BNV-BYT li 591 - 712 nhw vdy toin tinh cdn thidu tir 147 - 268 biin chd. Tinh trgng sd Iwqng CBYTDP thiiu trim trgng, thip so vdi ci nwdc [2]. [8] vi cdng khd khdn han cho tuyin huydn sau khi thwc hign nghj dinh 172 cua Chinh phu [5], nguydn nhin li sw phdi hqp giCra trung tim y ti vd bdnh vidn ngdy cdng hgn che han, khdng ho trq cdng tdc chuyen mdn lin nhau. Vi viy bidn chi tmng tim y td khdng du ngwdi de dim dwang cdng tic phdng dich.
Tnnh ^ vi ca ciu nguon nhin Iwc YTDP: Ty lfi CBYT cd Irinh dd d^i hpc vd sau dgi hpc ehilm 39,2%, trinh dd Imng d p 58,3% ehilm ty Ifi eao nhll, Irinh do so c^p van cdn chiem 2,5%. Qua ph^n Uch co c l u v i Irinh dd cdn bd y l l du phdng cho Ihly ddi tuong tmng e l p ehilm nhilu nhai 58,3 % Irong dd bao gom: Y s^, dieu duong vd nu hd sinh. Hifin nay cin bd trlnh dd sau dgi hpc h$ du phdng trong linh chiem I j Ifi 7,7%, khdng cd Irinh dd tiln 59. Nlu so vdi cde linh Irong khu vuc vi ca nude thi Irinh do cdn bd ngdnh y t l tinh D i k L i k edn nhilu hgn c h i . Cdn bfi y t l du phdng ehu yeu duoc ddo Igo tir h$ dilu Irj, sau dd chuyin sang cdng Idc hfi du phdng, ddy ciing Id linh Irgng chung cua ca nud^. Trinh dd difiu du&ng, nii' hd sinh phan Idn Id tmng d p , nhung khi chuyin sang hfi y l l du phdng ddy Id ngudn luc d l i ddo d l ddo tgo k9 IhudI vidn vd ci> nhdn y te cdng cdng, nlu ede Irudng cao ding, dgi hpc cd md ngdnh dao Igo cho h i vua hpc vua ldm [3]. Kj? IhudI vidn x i l nghi$m cdn thip 11,3% so vdi s l lupng d c don vj hfi du phdng trong todn linh, Iheo quy djnh Ihdng l u lidn bd 08 BNV- BYT, CO d u k? IhudI vifin xfil nghi|m phai chilm 20%
bifin ehl chuydn mdn.
Sw phO hqp cdng vide chuyin mdn vdi bing eip dwqc dio tgo: Cd 90,5% p kidn eho la phu hap vdi ehuydn mdn theo bang cdp dwqc ddo tgo vd cd 9,5% p kiin cho li khdng phO hqp, cd 94,8% hai ldng vdi cdng vide minh dang ldm, 5,2% khdng hdi ldng. Nhw vdy tmng vide phin edng nhigm vq ein Iwu p din bing eip chuyin mdn.
Y Hpc m y c HANH {SIS) - s o 4/2012
Nhu c l u t u y i n vd ddo tgo CBYTDP giai dogn 2011-2015
Tdng bifin c h i d n thu Ihdm cho h$ du phdng todn tinh Id 300 ngudi (27 ngud'i nghi huu + 108 ngudi tuyin llnh + 165 luydn huyfin). Tinh d i n 2015, mfii ndm ngdnh y t l d n luyen mdi 60 CBYT cho d c don vj du phdng.
D l tuydn dung ea d u thi m5l ndm d n mdi 16 bdc s9, 12 KTV xfit nghiim. Cdng tdc ddo tgo Igi, theo co d u 30% CBYTDP trfin dgi hoe, 60% CBYTDP dgi hgc. 20%
cao ding. 10% cu nhdn y l l cfing cdng, 25% bdc sy, 15% KTV xdt nghifim. D l d i m bdo c h l l luong d n bd [1], nhu d n ddo Igo Igl hdng ndm d l i vdl d c trlnh dd nhu sau' Sau dgi hpc d n ddo tgo 20 ngud'i. dgi hoc ddo tgo 25 ngudi, Cao ding ddo tgo 17 ngud'i, k? thudt vifin xfil nghifim ddo Igo 3 ngudi, ci> nhdn y l l cfing cdng ddo Igo 8 ngudi. Ddi vdi TTYT du phdng luydn tinh d n xdy dung co d u chuyfin mdn nhu sau: Djch t l hpc d n 5 bdc s9 chuydn khoa dich l l hpe trong dd cd 1 tiln sy hodc 1 Ihge sy. Chuyfin ngdnh vi sinh d n cd 2 bdc s9 trong dd cd 1 Ihgc sy. 2-3 tmng d p ky lhu§t. Chuyfin ngdnh ddng vdt vd cdn tnjng, mdi chuyfin ngdnh d n 1 bdc sy vd 1 trung d p ky thu$t. Mdi Irudng, vfi sinh lao dfing vd bfinh nghi nghifip, mfii chuydn ngdnh 1 dgi hpc vd 1-2 Irung d p ky Ihufit. Vfi sinh an todn thuc phim vd c h l l dfic hda hoc 2 d n bd dgi hpc, 2 trung d p ky IhudI cho d c chuyfin ngdnh sdl rdt, dinh dud'ng, an todn Ihuc phim, an todn lao ddng, bfinh nghi nghifip vd mdi trudng. Trong k l hogeh cung ct vd phdi triln y l l luyin huyfin, trong dd d Irung ldm y l l Idm cdng Ide phdng ehing djch bfinh, nlu khdng cd k l hogeh ddo tgo vd chlnh sdch su dyng hop ly. thi se khdng diH nguin nhdn luc de hogi dong. se tiep lue khd tuyfin nhdn luc mdi cung nhu keo dai llnh Irgng chdy mdu c h l l xdm. Ddi vdi luyin xd y sT d|nh hudng y hpc du phdng Id logi hinh phu hop nhll, hifin nay nhifiu tinh trudng trung d p y l l , cao ding y t l dang ddo Igo y sT djnh hudng chuyfin khoa y hQC du phdng [4].
KET L U A N
Thi,pc trgng ngudn nhdn \ifc
S l d n bfi y t l du phdng/10.000 ddn Id 2,6; trong dd ty le bdc sy /10.000 ddn Id 0,9; ty Ifi duoc sy /10.000 ddn la 0,3. Cdn bd trung d p chilm ty lfi 58,8% eao hon dgi hpc vd cao ding (31,3%) vd sau dgi hpe (7,7%). Ting
sd d 148 Bdc sf (33,3%), Irong dd bdc s? y hqc dy phdng chilm 1.2%, bdc sT h$ d i l u Irj 29,5%, 1 bdc sT chuyfin khoa 2 (0,2%) vd 11 Ihgc sy (2,5%). Cd 90,5%
cdn bfi dwqc Idm vific phii hop vdi chuyfin mdn, 94,8%
hdi Idng vdi cdng vific dang ldm. 96,2% d n bd muln tilp lyc d n g vific dang Idm. Ly do phii hqp d n g vific chilm ty Id 72,1 %. Khdng mudn l i l p Igc d n g vific 3,8%.
Nhu c l u nhdn l^pc tir 2011-2015
Nhu d u nhdn lye Y t l d y phdng d i n ndm 2015 d n 300 ngudi trung blnh mdi ndm can tuyin 60 ngudi.
Trong dd bdc sy mdi ndm d n 18 ngudi, ky Ihufit vifin xfit nghifim d n 12 ngudl, chuydn mdn khde 30 ngud'i.
Ddo tgo Igi 376 ngudi, mdi ndm d n ddo tgo Igi sau dgi hpc 20, dgi hoc 25, cao ding 17, ky thudt vifin xfit nghifim 3, ci> nhdn y t l cdng cdng 6.
T A I Ll^U THAM K H A O
/. Bd y t l (2006), Chi thi s6 06/2006/CT-BYT, ngiy 14/6/2006 °Vd vide bdo ddm chdt iwqng ddo tgo nhdn Iwc y ti".
2. Bd y t l (2002), Tinh hinh cdn bd y ti ci nudc phdn theo trlnh dd. nidn gidm thdng ki BYT.
3. Bd y t l (2002), Thdng t u s l 05/2004/TT-BYT, ngdy 19/4/2004 hudng d i n luyin sinh ddo Igo cO- nhdn vd Cao ding dilu dudng, Ky Ihufil y hpc hfi vira hoc vira Idm- ndm 2004.
4. Bd y t l (2004), Quin Ip ngudn nhdn luc tmng mgng iwdl y ti dwphdng.
5. Chlnh phu (2004), Nghj quyit sd 172/2004/ND- CP. ngiy 29/9/2004 'Vd vide quy i$nh td chirc eic ca quan chuyin mdn thwqc Oy ban nhdn ddn huydn, qudn, thj xi. thinh phd thudc tinh'.
6. Chinh phu (2006), Quyit d/nh sd 153/2006/QD- TTg, ngiy 30/6/2006 'VN phi duydt quy hogeh tdng the h$ thdng y td Vidt Nam giai Oogn din nim 2010 vi tim nhin den ndm 2020".
7. Chinh phu (2006), Quyit dmh sd 255/2006/QD- TTg, ngiy 09/11/2006 'VN phd duydt chiin Iwqc qudc gia y ti dw phdng Vi$t Nam din nim 2010 vi dinh hwdng din nim 2020'.
8. Tgp chi Y hgc Ihyc hdnh (2007), Thwc trgng ngudn nhdn ii/e vd nhu eiu <Uio tgo kp thuit xdt n0$m tgl cdc Tmng tdm y ti dw phdng tuyin tinh, (ftdn/j phd phia Bic.
KET QUA SANG LOC PHAT HIEN SQlM UNG THUVO VA UNG THIT CO TIT CUNG TAI M O T SO TINH T H A N H GIAI DOAN 2008-2010
T6M TAT
Ung thw vu vi ung thw cd tir cung ii 2 logi ung thw phd bidn nhit d phq nQ- ed ti id mdi mic dwng hing diu d nhidu nwdc trdn thi giin. Qua khim sing igc 70.980 phu nCr tir 35-60 tuSa tgl 7 tinh/thinh trong 3 ndm 2008- 2010 dd phit hidn dwg^ 0,06% ung thw vO (ty Id phdt hidn ung thw vu qua sing Iqc li 59. 2/100.000), tmng dd 21,4% d giai dogn I vd 31,0% d giai dogn ll. 0,02% cie trwdng hqp li ung thw cd tO' cung (tp Id phit hidn ung thw CO tir eung qua sdng Igc gin bang 19,9/100. 000, tmng dd 28,6% d giai dogn I vd 21,4% d giai dogn IL
NGUYEN T U X N Hl/NG, Bd Yti, T R A N V A N T H U A N , Bdnh vidn K Die bidt dd phdt hidn m 3,3% vd 1,3% cie tnrdng hpp LSIL vd HSIL duxyc phdt hl$n di diiu tri kjp thdi ngdn ehdn tidn tridn thinh tdn thwang ung thw CTC sau nay.
Tmng qui trinh thqc hiin td chOc sdng Iqc ehung tdi nh$n thiy dd cdng tdc sdng iqc cd hidu qua cin cd S[F kdt hqp ch$it chd, ddng bd giO^ cdc co quan thwc tiidn.
Mudn dgt Arqc kit qui tdt vi md rdng quy md tmng qud trlnh sing Iqc cin tridn khai vide chuydn giao kp thu$l khdm sdng Iqc phdt hiin sdm ung thw vO, ung thw cd ft>
cung eho eic cin bd tgi dfa phwang cd thd mdi dim bdo tinh bin vung cOa hogt dqng. Cin c6 sw long ghdp hogt
Y HQC THVC HANH (815) - SO 4/2012