T9P chi GAN MAT VIET NAM so 21-2012 81
Nghien cmi dac diem Iam sang, can lam sang
va danh gia ket qua som u viing duoi tuy duwc phau thuSt t^i benh vien Binh Ddn TP.HCM
Study of clinical, subclinical characteristics and estimate primary results of tumors of pancreatic tail were treated at Binh Dan hospital
BOi M A N H C O N , L 6 Q U A N G N G H I A , N G U Y £ N THANH LifiM*, NGUYgN HAi DANG, NouYfiN DO'c TRUNG**
Summary
Purpose: Stiuly of clinical, subclinical char- acteristics and estimate primary results oj tumors of pancreatic tail were surgeried at Binh Dan hospital Method: Retrospective study, case series. There were 30patiens, were diagnosed tumor at tail of pancreas. They examined and were treated by surgery at Binh Dan hospital from 04/2009 to 04/2012.
Patients were observed after 1,3 months.
Result: Mean age of patients were 44,82 ± 18,4years old (range from 17 to 82 ) . Most oj patients in study were female, female: male = 5:2. 8 cases live in HCM city (28,6%), the rest distributed scattered atsounthem and central provinces. 21 cases (75%) went to the hospital because ofunclearance abdominalgia at vague digastric and left lower quadrant, weight loss.
Ultrasound result showed 21 case, were surg- gested cancer, CT-scan showed 17 cases, were surggested cancer also. But in fact that, there were 11 cancer cases, which were identified by pathologist and all these II cases were in doubt cancer group. ASA Clinical status, patients were in group I or group II. 20 cases were oepen surger (71,4%), %), 5 cases oj laparoscopic were transferred open surgery (19.9%) and 3 cases of laparoscopic surgery
(10.7%). There were 10 cases of surgical pan- creatic tail, which are mostly benign tumors (9/10). There were 10 cases of pancreatic tail with surgical splenectomy, the ratio of tumor is the same as cancer. There are 3 case with too big pancreatic cyst, but it was benign, it cannot be cut. There were 5 cases with malignant tumor, invaded to sorrounding tissue, it cannot be cut (stage 111, IV), so it were biospied to get pathology result. The mean operating time was 98,21 minutes. There were no catactrophe in operating, and confusion in postoperative were small, such as surgical pain, fever and wound infection. All patients underwent surgery and biopsy for histopathologic results. 27 (96,4%) cases were exocrine tumors. Only 1 case was endocrine tumor (insulinoma). In the exocrine tumors, 11 cases of malignancies including cancer of pancreatic pipeline (8) and malig- nant transformation of mucous cysts (3). All patients discharged with stable condition.
Conclusion: Tumors of pancreas was a disease with high incidence of malignancy, however, whether benign or malignant tumor pancreatic tail, if detected early and treated promptly, the prognosis patients is very positive.
*Benh vien Binh Dan
*fiai hpc Y khoa Phgm Nggc Thgch
82 T^p chi r. , • . [ I T NAM so 21-2012
Tdm tat
Muc dich: Nghien cuu die diem lam sing, cgn lim sing vi dinh gii kit qui sdm u vdng dudi tuy dugc phiu thuit tgi b^nh vi?n Blnh Din TPHCM. Phtrffngphdp: Nghien cdu hdi cuu, md ta hing logt ca (case series), gdm 30 b?nh nhin, dugc chin doin Ii u vdng dudi tyy din khim vi dugc dilu ttj phau thuit tgi b^nh vi$n Binh Dan h> 04/2009 den 04/2012. Cic b?nh nhin tilp tyc dugc theo ddi sau 1,3 thing. Kel qua: Tudi trung binh: 44,82 ± 18,4.
Tuoi nhd nhit li 17, tudi Idn nhit li 82. NCi gidi chiem phin Idn, nu/nam = 5:2. TPHCM chilm ty 28,6% (8 trudng hgp), sd cdn Igi phan bo rii ric khip cic tinh miln nam, mien trung.
21 trudng hgp chilm 75% tdng so b$nh nhan den khim vi cic trieu chung dau byng am 1 mo ho vung thugng vj vi hg sudn trii, syt can.. Kit qui sieu am ghi nhin cd 21 trudng hgp nghi ung diu, CT-Scan ghi nhin cd 17 trudng hgp nghi ung thu, trong khi thuc te cd II trudng hgp ung thu dugc xic djnh theo kit qui giii phau b?nh vi ci 11 trudng hgp niy deu nim trong nhdm nghi ung thu. Tinh ttang Iim sing theo AS A, cic benh nhan diu d nhdm I hoac II.
20 ttirdng hgp dugc phau thuit hd (71,4%), 5 trudng hgp phiu thugt ngi soi chuyen md hd
(19,9%) vi 3 trudng hgp dugc phau thugt ngi soi (10,7%). Cd 10 tttrdng hgjj dugc phlu thugt cit dudi tyy, trong dd da phin li u linh tinh (9/10). Cd 10 trudng hgp dugc phau thuat cit dudi tyy k6m cit lich, ttong dd u linh tinh vi u ic tinh chilm ty 1$ ngang nhau. Cd 3 trudng hgp nang tyy linh tinh nhung qui to, khdng the cit dugc. Cd 5 trudng hgp u ic tinh, in lan md xung quanh khdng thi cit dugc (giai dogn III, IV), nen chi sinh thilt de liy kit qui giii phau b«nh ly. Thdi gian m^ trung blnh li 98,21 phut Khdng cd tai biln trong khi md vi cic r6i logn lam sing sau md it, chu ylu li dau vlt md, sot vi nhiem trung vet m6. Tit ci b?nh nhin deu dugc phau thuit vi sinh thilt dl cd kit qui giii phau b?nh. Trong dd cd 27 trudng hgp li u ngogi tilt cua tyy chiem 96,4%. Chi cd I trudng hgp li u ndi tilt (insulinoma). Trong u ngogi tilt cd 11 trudng hgp u ic tuih bao gom ung thu tuyln dng tyy (8) vi nang djch nhay hda ic (3). Tit ci b?nh nhin xuat vi?n vdi tinh ttgng on. Ket lu^n: U tyy li ragt b?nh ly cd ty 1$ ic tinh cao, tuy nhien, du li u linh tinh hay ic tinh vung dudi tuy, neu dugc phit hien sdm vi dilu Irj phau thugt kjp thai thi tien lugng b$nh nhan cQng rit khi quan.
