NGHIEN Cl)U OAC DIEM L A M S A N G CUA UNG THIT HA HONG
T 6 M TAT
Ung thu h^ hgng Id mdt u dc tinh xuit phdt td Idp biiu md Malpighi cOa nidm mgc do phi vung hg hgng. Ung thu hg hgng chiim khdng 5 - 6 % tmng ting si dc logi ung thu.
Mgc tidu: Md ti ddc diim Idm sdng, hinh thdi tin thuang qua ndi soi.
Dii tugng vd phuang phdp nghiin cdu: Md ti tifng ca. can thiip, tiin edu trin 62 bdnh nhdn dugc diiu tri tai w$n Tai-Mui-Hgng Tmng Lfong.
Kit qui vd bdn ludn: Thdi gian xuit hiin b$nh 1-6 thdng 49/62 (79%,). < 1 thdng 5/62 (8.1%,). > 6 thdng 8/62 (12.9%,). Rii loan nudt 62/62 (100%o), hach cS 27/62 (43.5%,). khdn tiing 22/62 (35.5%), dau tai 11/62 (17.7%,), khd thd thanh quin 9/62 (14,5%). U chO yiu xuit phdt td xoang Id 57/62 (91,9%o). Thi sdi g$p nhiiu nhit 42/ 62 (67.7%,). Md binh hgc, 100%o ung thU ti bdo viy (SCO), dd md hgc ll. III.
Kit luan: Hini) thdi sdi gdp nhiiu nhit 67.7%o, rii loan nudt 100%o.
Tir khda: Ung thu, ha hgng, CT scaner.
SUMMARY
Hypopharyngeal cancers involve a tumor that is relatively mom silent than other head and neck cancer tumom.
Objective: Describe the clinical and CT scan featums.
Materials and methd: A pmspective study fmm a series of 62 patients am diagnosed of the Hypopharyngeal cancers and have opemted.
Results and discusion: The time between initial symptom and dianogsis is one to six months 79%,.
Symptoms: dysphagia 100%o. hoarseness 35.5%,, otalgia 17.7%,, laryngeal stndor 14.5%o, metastasis the lymph node in the neck 43.5%,. The sit initial of the pyrifonn sinus 91.9%o.
Conclusion: The form uleerlamtive and infiltmte 67.7%o,theSCC100%o.
Keywords: Cancer, hypopharyngeal, CTscan.
DAT VAN D ^
^Ung thu ha hong la mdt u ae tinh xuat phat tU Idp bilu md Malpighi cCia niem mac bao phQ vung ha hong. Ung thU vung ha hpng - thanh quan ehiem khoang 5 - 6% trong tdng sfi eac loai ung thU ndi ehung, difng thif hai trong cde ung thu viing dau cd, sau ung thu vdm [1,9]. 6 Phap ung thu ha hong chilm khoing 12,15% trong tong sd eac ung thu cCia dudng an, dudng thd tren va ehiem 1 % trong tdng sfi e i c loai ung thua4]. 6 My ung thu ha hpng chiem khoang 5 - 10% trong tdng sfi dc ung thu dudng tieu hda tren, khoang 0,5% trong tong sd eac khdi u ac tfnh, khoing 24% eae tnidng hpp viing ha hpng, thanh quan, hang
NGUYEN QUOC DUNG, BUI DI^U B$nh vi^n K
N G U Y £ N DiNH P H O C
B4nh vl^n Tai Mdi Hgng Trung uang
nam sfi ca m i e mdi la 1,22/100.000 nam gidi[5,6,8]. 6 Anh, sfi ca m i c mdi lafl/100.000 nam gidi[6,7]. Hach d trong ung thu ha hpng Hiudng xuit hien sdm, anh hudng d i n tifin lupng. Di tai Nghien ciifu dae diem Iam sang ung thu ha hpng qua 62 benh nhdn gap tai vien Tai - MOi - Hpng t n j n g L/dng, n h i m mue tidu: Mo ta dae d i l m l i m sang, hinh thai tdn thuong qua nfii soi.
D 6 | TUONG VA PHUONG P H A P N G H I E N CCTU 62 bfinh nhan, duoc c h i n d o i n x i c dinh l i ung thu ha hong, cfi k i t qua g i i i p h i u benh ly, dupc chi dinh plilu thuit tai khoa Ung budu B1- Bfinh vien Tai- Mui - Hong TnJng L/Ong, tit thing 0 1 / 2005 den thing 09/
2010.
T h i l t ke nghien c i i u : Mfi t i ti/ng ca cfi can thiep SiJf dung p h i n mem SPSS 13.0. Xijf ly v i phan ti'ch ket q u i theo phuong phap thfing ke y hpc.
Thong so'nghien cUu
Tham kham l i m s i n g , ndi soi, mooter dae diem iam sang, p h i n loai mfi banh hoc, chan doan TNMS.
Oanh gia tdn thuong tnang p h i u thuat. Vj tri, hinh thii, mitc dp xam lan c^a u.
K ^ t QuA NGHJgN C(SU 1. O^c diem chung.
1.1. PhSn bdtheo tuS. gidi.
Tudi tu 40 - 70, chiem 88,7%. Tufii b^ng binh 53,4
± 9,2. Tuoi t h i p n h i t 38,cao nhit 77. Nam chiem 96,8%. Trong 62 benh nhan, cd hai nu" (3,2%), ea hai trong khoing tudi tU 1 - 70.
1.2 Yoj tdnguy ca.
Hdt thudc Ruou dan thuSn Hut Ihudc + mou H/C trdo ngutK
N
<10nam 00 00 05 01 06
1 0 - 2 0 nam 00 00 25 00 25
>20n^m 05 05 17 00 27
(B,6%L
%
(8,6%) (81,0%) (1,8%) 56 N h a n x e t ' T r o n g u n g t h u h a h p n g d a h a u h i t benh n h a n c f i y e u t f i n g u y c d 5 8 / 6 2 ( 9 3 , 5 % ) . T h d i gian tiep x i i e d a p h a n t r e n 1 0 n a m 5 2 / 5 8 ( 8 9 , 7 % ) .
1.3. Chin dodn md b4nh hgc.
Trong nghifin ciru nay 100% benh nhan thudc typ mfi benh hpc la ung thute bao vay.
Bing 2. Phan dp mfi hoe ciia u.
Phan Ioai Odi Ddil Ddili DdiV N
n 00 35 27 00 62
(%)
0056,5 43,5 00 100 Nhan xet: 100% benh nhan thufic typ mfi bfinh hoc
Y HOC THl/C HANH (881) - s 6 10/2013
2, D$c diem lam sdng Z1. Lixto vdo vi&t. Bang 3.
LVdov^ovifin Rfii ioan nudt Khdn li^ng Kh6 thd thanh ouin
HachctS LV(lokhdc(dautai)
N
n 38 4 8 11 1 62
61,3
%
6,5 12,9 17,7 1,6 100 Nhan xet: Da sd benh nhan den khim l i do rdi loan nudt (61,3%), tilp d i n hach ed to (17,7%). Cfi mfit tnidng hdp vao vifin.
2.2. fhdl gian xuit hi^n b$nh. Bang 4.
Thdi gian x u i t hien benh
Th«l gian
< 01 Mng
>01-<03 thing
<03-<06th&ng
> 06 thang Ting
n 05 24 25 08 62
8,1
«
38,7 40,3 12,9 100 Nhan xet: Binh nhan d i n k h i m , da phan trong thdi gian 01- 06 thing, k l tU khi mac benh (79%). Dudi 01 thing cd 05 bdnh nhan (8,1%).
2.3 Cdc tri^u chdng candng khi vdo diiu trf . B a n g 5.
Trieu ChUng CO nSng Rfii ioan nufit
Khdn tifing KhfithdthaniiguSn
Hach Cfi Dau tai
n 62 22 09 27 11
100
%
35,5 14,5 43,5 17,7 N h a n xet: 1 0 0 % b e n h n h a n e d rdi l o a n n u d t C a e t r i i u chUng k h i c t h u d n g g a p la h a c h c d . k h a n tiing,
3. Hinh t h i i ton thuong dudi npi soi Vltrfu nguyin phdt qua ktiSm ndisoL Bang 6.
Vi ttf u nguydn ohst Xoang ie VOnq sau sun nhSn Thanh ha honq sau
N
n 57 04 01 62
91,9
%
6,5 1,6 100 Nhan xet: H i u h i t khdi u x u i t phat tU xoang le 57/62(91,9%).Cae vj tri khic ft gap, 05 trUdng hop.
V} trf xuit phSt cua u 6 xoang le dudS n(Si soL Bang 7.
VIHIMu Thdnh tiong Tlidnh ngodi EXnh Ody N
n 37 05 00 15 57
64,9
%
8,8 00 26,3 100 Nhin xet: 6 xoang le, h i u h i t ung thu x u i t phit tU thinh trong v i day 52/57 (91,2%). Trong dfi tiianh trong la vj trf gap nhilu nhat 37/57 (64,9%),
Hinh UiS cua u qua khdm n^ soi. Bang 8.
Hkh Ihdiu n
%
SUi 4?
67,7 Lo«t
01 1,6
Thdm nhifim 09 14,5
H6n hop (sOi,lodt,thdm nhifim)
10 16,1
N 62 100 Nhan xet: T r o n g n g h i f i n ciifu cOa c h d n g tdi, t h e s i i i
g a p n h i e u n h i t 4 2 / 6 2 ( 7 , 7 % ) , rdi d e n t h i h d n h o p v a t h a m n h i l m 1 9 / 2 ( 3 0 , 6 ) . T h e loet g a p ft n h i t 1/62 ( 1 , 6 % ) .
BAN LUAN 1 . 0 | c diem lam sang Lj^dovdovi^
Trong ung thu ha hong, da sfi bdnh nhan d i n kham l i do rfii loan nufit (61,3%), hach eo to (17,7%). Khin tidng,khfi thd eung la \p do khiln bdnh nhin phii di kham ngay, eae trieu chifng nay khi xuat hidn thudng trenh nhan d giai doan T3, T4, do u xam lln,da diy.
Dau tai, gay sut it khi la \p do d i ^ binh nhan tdi kham.do benh nhan khfing cd d i y di^ thfing tin ve bdnh.
ThdS gian xuSit hi$n b$nh
Bdnh nhan d i n kham,da phin la ti'ong thdi gian 01 - 06 thang, ke tU khi xuit hien trieu chimg d i u ti6n(79%). DuwowisOl thing efi ()5 tiudng hpp(8,1%).
Theo Tran HiJU Tuan 60% ngudi bfinh khi d i n kham dahdn 06 thing, ke tU khi xuit hien trieu ehiing d i u tien.
Cdc tri^u chdng candng khi vdo diiu trj Trong nghien eiifu cua chOng tdi, 100% benh nhan cfi rfii loan nudt d c i c mdc dp khic nhau, day la tiieu chiing cd sdm, tien trien tang dan, ludn xuat hien, giai doan dau thudng nhe va khfing lien tyc, bdnh nhan d l bo qua. Hach eo to (43,4%), khan tieng (35,5%), dau tai (17,7%). Khd thd la tridu chUng ft gap nhat (14,5%).
Oau tai lien quan day than kinh tai Idn (day Amord).
Trong rdi loan nudt, ciia chung tdi 100%, Ravindra 100%, Paul 99%. Khan tieng, k i t qua chiing tdi 35,5%
cao hdn ciia Paul 30%, tUdng tUdng kit q u i ci^ia Ravindra 35,6%. Hach eo, kdt qua cQa ehung tdi 27/62 (43,4%)gan gidng ket qua eua Ravindra 45,1%. Kho thd thanh quin, chiing tdi 9/62(14,5%) tUdng tu kit qua eCia Paul 14%, Ravindra 11,8% [4,6], Dau tai 5/6 (8,1%) tuong tuong k i t qua eda Paul 9%, thap hdn eila Ravindra 17,5% [4,6,9],
2. Hinh thai ton thuong dudi nfii soi.
Vi tri khoi u nguyen phdt qua khSm n(S/ soi Trong nghien cUu eCia ehung tdi. U nguyen phat xuat phat tU xoang le 57/62 (91,1%), Tran HQu Tuan 80% [2], Kirchner 86%, Carpenter 72% [4]. Cac viing khic ft gap cfi 05 tmdng hpp (8,1%), thanh sau ha hpng ed 01 tixTdng hpp(1,6%), vung sau sun nhin 4/62 (6,5%). K i t qua eua ehung tdi eung phii hdp vdi dc tac gia Phap, Canada, Brazil, Bl nhung khae v ^ c i c t i c g i i My, Anh, Phan Lan [6,7,8]. Tai xoang Id My (59%), Anh (60%), Phan Lan (52%) [6,7,8]. Vung sau sun k i t qua ei^a chiing tdi tuong tu eda cac tac gia khac' Canada (7%), My (6%), khic vfii cac t i c g i i Phap (3%), Bl (2%), Anh (35%), Phan Lan (30%), Brazin (0%) [6,7,8]. Thanh sau ha hpng, ket qua eda chiing tdi 1/62 (1,6%),thlp hdn ciia dc tae gia khac:
Phap (7%), Canada (8%), Bi (9%), My (35%), Phin Lan (18%), Anh (5%), gan vdi kdt q u i cOa Brazin(3%) [6,7,8]. Cd su khac nhau v l vj tri xuat phat cOa khdi u:
d bac au va My ung thU viing sau ha hpng ehilm tp Id eao hdn d c i c qudc gia khic, tiong khi do d Anh, Phan Lan u viing sau sun nhin lai cfi ty le eao eao hon d cac
Y HOC TH^rc HANH (881) - S6 10/2013
qufie gia khic. U x u i t phat tU viing sau sun n h i n , thudng xam l l n vao phin sau ciia thanh q u i n (syn phiu, khdp nhin phiu) gfiy Net d i y thanh, k h i n tiing.
6 vj tri niy, u thudng xam l l n v l phia sau bfin cOa xoang Id, xufing dudi lien quan vdi midng thUC quin,kh(
quin.
VI tri xuit phdt cua u d xoang IS
Thinh tiding xoang Ifi 52/57 (91.2%), thanh trong xoang Id gap nhilu nhit 37/57 (64,9%), Tani (65%) [4].
Vj tri thinh bfin, khfii u thudng xfim l l n v i o syn giip,tuyln giip, phin mdm cua c6. Vj tri thinh trong, khdi u thudng xam l l n vao thanh q u i n , khoing canh thanh mdn Vj trf d i y xoang Ifi (d trfin eao), khdi u hay xam l l n v i o thanh thidt, nep hpng thanh thifit, khoang tnfdc Uianh thifit, d i y ludi. K i t q u i cOa chung tfii cOng phij hdp vdi nghifin ciru cCia Seungwon Kim[5]. Vide xac dinh ndi xuit phit cDa u d xoang lg r i t quan ti^png, bdi h i u hdt cac khdi u cCia ha hpng d i u xuit phat d diy, noi ehiing ta cfi t h i thuc hidn p h i u thuit c i t thanh quin - ha hpng b i n phin, khiu cdn nh6[1,7,9],
Hinh thdi cua u qua khdm n^soi Trong nghifin ciiru cGa chung tfii, t h i siji gSp nhidu nhit 42/62 (67.7%). hSn hdp v i t h i m nhiem 19/62 (30,6%), t h i loit ft gap nhit 1/62 (1,6%). Ket qua dia chiing tfii tUdng t u cQa c i c tac nghifin ciiu khic[1, 5,10],
K£T LUAN
1. Thdi gian x u i t hifin bfinh 01 - 06 thang 42/62(79%), dudi 01 t h i n g 5/62(8,1%), tren 06 thang 8/62(12,9%).
2. Trifiu chiimg ed n i n g chfnh: Rdi loan nufit 62/62(100%), hach cfi 27/62(43,5), khin tieng 22/62(35,5%). dau tai 11/62(17,7%), khd thd thanh q u i n 9/62(14.5%).
3. U ha hong chD y l u x u i t phit ti^ xoang le 57/62(91.9%).
4. Hinh tiiai eiJa u: T h i silt gap nhieu nhat 42/62(7,7%).
5. Md bfinh hoc: 100% ung thU bieu md td bio vay (SCC), dfi mfi hpc II, III.
KHA NANG KIEM SOAT DUfiTNG HUYET SAU AN CUA SAN P H £ M TRA CO SUA TREN BENH N H A N DAI THAO D O O N G H P 2
TOM T A T
Nghidn cdu can thidp ttf ddi chdng nhim ddnh gia khi ndng kiim sdt tdng dudng huyit sau Sn da trd ed sua (Euphorbia hirta L) da dugc bin hdnh trdn 15 dnh nhdn dai thdo dudng type 2 tai thdnh pho Ha Long, Quing Ninh. Tiin hdnh tmng 2 ngdy khdc nhau:
ngay thd nhit ddi tugng chi udng 150 ml nudc tring vd Sn mdt beta dn vdi ting ndng lugng 250 Kcai, ngdy thd 2 (dch ngay thd nhat 7 ngdy) binh nhdn udng sin phim trd cd sOa (30 gmmAin/bdnh nhdn) vd dn bda dn gidng nhu ngdy thd 1. Dudng huyit dugc xde dinh tniOe dn vd sau dn 15, 30, 60. vd 120 phut. Kit qui cho thiy ndng dd dudng huyit sau dn eda ngdy udng trd ed sOa dd giim xudng thip han so vdi ngdy khdng udng tra cd stja. Tgi thdi diim 15 phut vd 30 phut sau dn, ndng dd dudng huyit da ngdy udng trd cd sOa dd giim mdt dch cd y nghTa thdng kd so vdi ngdy chdng (8.94 so vdi 10.63 mmol/L tai 15 phut; p<0.001). Didn tieh dudi dudng eong da ngdy udng tra cd sOa cung ed xu hudng thip han so vdi ngay ehUng (496.6 so vdi 586.7 mmol/L.gid: p=0,17). Vdi khi ndng han chi tdng dudng huyit sau dn. trd ed sda (liiu tmng binh 30 gmm cd sQa/lin thd nghidm) cd khi ndng kiim sdt dudng huyit sau dn trin benh nhan ddi thdo dudng type 2. Chinh vi vay, sin phim trd cd sua cfi thi dugc xem-la sin pham tiim ndng tmng vide hi trg phdng tri benh dai thdo dudng.
Td khoa: cd sda (Euphorbia hirta L.). dai thdo dudng type 2, dudng huyit sau dn
TRUONG H O A N G K I ^ N
Chi cyc An toSn V$ sinh Th{it: ph&n Quang Ninh PH( N G Q C QUVeN, TRUONG TUYfiT MAI, W ^ Dinh dUGng Qudc gia
SUMMARY
The study in the reducing in postpmndial glyeemia of Co Sua tea (Euphorbia hirta L) in 15 type 2 diabetic patients vras carried out in Ha Long, Quang Ninh.
Them are 2 days to do the experiments: td first day.
patients wem given 150 ml of water with eating the meal (250 kcal); then the second day (affer the first day is 7 days), all these 15 patients wem given 150 ml of Co Sua tea (30g dried Co Sua/patient) and eating the same meal. The blood glucose levels wem determined at initial time and at 15, 30. 60 and 120 min affer eating the meal Resulting, incmase of the postpmndial blood glucose level of subjects on the Co Sua day was significantly lower than that of the water contml day.
Significant diffemnces of blod g/ucose inemrments at 15 min and 30 mm was established dtween the i^
Sua day and the eontrr^ day (8.94 so vs. 10.63 mmol/L at 15 min; p<0.001). Them was a light diffemnce on the blod glucose lAUCs between each meal with and without Co Sua (496.6 vs. 586.7 mmol/L.hr. p=0.17).
The msults of the pmsent study suggest Co Sua tea to have a potential capacity in controlling the post pmndial blod giucose level in diabetic patients.
Themfom. Co Sua tea might be used as a fi;nc/rona/
fod forpmventing diabetic patients.
Keywords: Co Sua tea (Euphortjia hirta L); type 2 diabetic bents, postpmndial blod glucose.
Y HOC THVC HANH (881) - s6 10/2013
