Y HOC VlgT NAM THANG 3 • SO 1/2013 nghien cffu thi HATT ngay sau dat cd thap hdn
so vdi ngay trffdc dat MTQ, co tlie do khi kh6l me chiing toi dung lieu propofol 2mg/kg trdn bdnh nhan ldn tudi gay nen tut huyet ap.
V. KET LUAN
Sff dung mat na thanh quan Supreme dam bao tliong khi tdt vd c6 hidu qua nhff nhau d ca hai mffc cuff 45 cmHjO va 55 cmHjO trong gay me benh nhan Idn tuoi. T^ le dat
thanh cdng lan dau 95%; thdi gian dat riit mat na thanh quan Supreme 28,8±8,3 gidy, Sp02 diiy tri 98 - 100% khdng bj hd, Vte dat 95% so vdi Vt. Peak, Pmean vd EtCO; trong gidi han binh thffdng. 100% phau thuat vien hdi Idng.
Thong khi qua riit mat na thanh quan Supreme it cd tac dung khdng mong mudn, 100% benh nhan khdng bj khdn tieng, chay mau hau hpng.
ndn hay buon non. Cd 2 bdnh nhan d hai nhdm dau hong 6 gid sau md (3,3%), it cd bien ddi ve tan sd tlm va huyet ap tru'dc thii thuat dat va riit mat na thanh quan Supreme. Gay me bang riit mat na thanh quan Supreme it cd bie'n doi ve tan sd tim va huyet ap ngay ca trudc thCi thuat dat vd riit mat na thanh quan Supreme.
TAI LIEU THAM KHAO
1. Vu van Dung, Nguyin VSn Chffng (2005), "GSy m§ h6i sQc trong phlu thuat d ngudi cao tuoi", Tap chi Y hg TP.Ho Chi Minli, tap 9.
4.. DUdng Anh Khoa (2006), "Oanh gia hieu qua va an toan ciJa phUdng phap diing mask thanh quan Proseal trong gay me mo noi soi 6 bung", Luan van thac sly hoc, Dai hoc Y Ha Noi, o, Nguyin Thj Thu Huyert (2006), "Nghien cCfu mpt
so yeu to phong dau hong va khan tiwig d benh nhan dat mask thanh quan", Luan van tot nghiep bac sT chuyen khoa II, Dai hoc Y Ha Noi.
4 Nguyin Thj Thanh Hudng (2011), "Danh gia hi^u qua va sU an toan cCia mask thanh quan Proseal va Supreme so vdi ong npi khi quan trong gay me phau thuat npi soi cit tCii m|t", Bao cao khoa hoc Hdi nghi gSy m§ trong phiu thuat ndi SOI toan quoc".
5. A.M.Lopez. R.Valero. P.Hurtado, P.Gambu, M.Pons and T. Anglada (2011), "Companson of the LMA Supreme with the LMA Proseal for airway management in patiens anaesthetized in prone position", British Journal of Anaesthesia, 107(2):265-71.
6. Ayman Hussein Kahla et all (2009),
"Comparison of laryngeal mask airway supreme and andotracheal tube in adult patiens undergoing laparoscopic surgery", Am shams journal of anesthesiology, 2(2),73-85, 7. Wei Yo Yao (2012), "The laryngeal mask ainway
Supremed- safety and efficacy dunng gynaecological laparoscopic surgery", SouthAfrJ Anaesth Analg, 18(3):143-147
KET QUA P H A U THUAT UNG THlf DA D A Y SUT DUNG MAY CAT NOI THANG
TAI DENH VIENK
• T O M T A T
Myc tieu: "Danh gia ket qua iiYig dyng maycSt ' noi thSng trong phau thu^t cat doan da day tren benh I nhan ung thu" d? day mgt phan ba du'di"
! Doi tifdng: 65 BN du'dc chan doan la UTDD 1/3 du'di duWc phau thu|t triet cSn tai BVK tff 1/3/2011 t den ngay 30/9/2011, vdi i trong 2 phu'dng phap noi:
, CO sff dung may (34 BN nhom tien cffu) va khong sff ', dung may (31 BN nhom hoi cffu)
' Ket qua: BN du'dc phau tich trung binh la 17,98 ' ± 5,87 (8-37) hach. frung binh moi BN co 2,03 hach I dl can, N2; 21,5%; N 3a : 9,2%. Nhom sff dung may
* Binh vl$n K
Phan bl^n khoa hpc: GS.TSKH Phan Sy An
N g u y e n T u y e t M a i * , Ha Hai N a m * CO thcfl gian mo ng§n hdn (104,26 ± 11,88 so vdi 153,87 ± 16,21phut), thcfi glan dong mom ta trang ngSn hdn (1,10 ± 0,74 so vdi 5,42 ± 1,53 phut) va thdi gian thu'c hien mieng noi ngSn hdn (5,72 ± 2,46 so vdi 24,94 ± 7,12 phyt), (p< 0,001). Lu-dng mau mat trong mo 6 nhom dung may cung it hdn nhom khong diJng may, p = 0,21. Thdi gian co trung tien, thdi gian an du'dng mieng, thdi gian nSm vien cua nhdm BN cd dung may deu ngSn hdn co y nghTa thong kd so vdl nhom khong dung may.
Ket luan: Sff dung may cat noi thSng la phu'dng phap ddn gian, an toan, nhanh chdng.
Y Hpc VlgT NAM THANG 3 • S 6 1 /2013 SUMMARY
EVALUATION OF THE EFFICACY OF USING THE LINEAR CUTTER STAPLER I N GASTRECTOMY
Purpose: To evaluate the efficacy of using the linear cutter stapler in subtotal gastrectomy of patients with 1/3 lower gastric cancer.
Materials and methods: 65 patients diagnosed 1/3 lower gastric cancer had radical surgery in the Nation Cancer Hospital from March l " 2011 to September 30"' 2011, divided into groups with two different methods: using the linear cutter stapler (34 patients in the prospective study group) and no using It (31 patients in the retrospective study group) in stomach operation.
Results: The average number of lymph node dissection and their metastasis m each patient is 17,98
± 5,87 (8-13) and 2,03 respectively, including N2:
21,5%, N3a: 9,2%. The group using the linear cutter stapler has a shorter total operation time than the other group (104,26 ± 11,88 minutes compared with 153,87 ± 16,21 minutes). Time for closunng the duodenal stump and implementing the gastrointestinal anastomosis of this group are also reduced (1,10 ± 0,74 mm compared with 5,42 ± 1,53 mm; 5,72 ± 2,46 compared with 24,94 ± 7,12 mm), (p<0,001). The blood loss dunng surgery of the linear cutter stapler group IS less than the group without equipment, p = 0,21, Watting time to have flatulence, to eat by mouth, length of hospitai stay after operatbn of the using equipment gnsup is significantly shorter than the other,
Condusion: Using the linear cutter stapler in subtotal gastrectomy is a simple, fast and safe method.
I.
OAT VANof
May cat noi thang da dffdc ffng dung trong cac phau thuat cat da day, dong mom ta trang va mom hong trang,,, da dffdc thffc hien tai nhieu nu'dc tren the gldi. Phffdng phap nay giup rut ngan thdi gian mo, thdi gian co nhu dpng rugt va thdi gian nam vien, giam mat mau trong va sau mo [7].
Tai^Benh vien K, tff dau nam 2007, khoa Ngoai Tong hdp da bk dau sff dung may cSt noi thang trong phau thuat mo md cat da day cho benh nhan ung thff da day con kha n5ng phau thuat. Ket qua nghien cffu bffdc dau tren IS benh nhan co sff dung may cat noi thang cho thay phu'dng^ phap nay giup lam giam dang ke thdi gian phau thuat. khong co trffdng hdp nao xay ra tai bien va bien chffng sau mo. Tuy'nhien,
van c5n cd nhffng nghien cffu vdi so Iffdng ldn hdn va danh gla day du hdn cac tal bien va bien chutig khl sff dyng may cat noi thang da day va oi doi chieu vdi cac benh nhan c i t noi bang tay truj^n thong. Vi vay chung toi tien hanh de tai nay nhSm muc dich "Danh gia ket qua ffng dung nnay cSt nS thing trong phau thuat cat doan da day tren benh nhan ung thff da day mgt phan ba dffdi".
II. o d t TUONG VA PHUONG P H A P NGHIEN CCTU 1 . D o i tu'cfng n g h i e n cu'u
Bao gom nhffng benh nhan dffdc chan doan la UTDD 1/3 dffdi, dieu t n bang phau thuat t r i ^ can tai khoa Ngoai tong hdp BVK tff 1/3/2011 den ngay 3 0 / 9 / 2 0 1 1 , du'dc xac chan bing mfi benh hpc, dffdc chia lam 2 nhdm: cd sff dung may (nhdm tien cffu) va khong sff dung may (nhdm hoi cffu).
2. Phu'dng p h a p n g h i e n c u ' u :
* T h i e t k e n g h i e n c u ' u : la nghien cffu can thiep lam sang cd doi chffng
* M a u n g h i e n c u l i :
* Cac bu'dc t i e n h a n h n g h i e n c f f u : Nhom hoi cffu: Ghi nhan mpt so dac diem lam sang va can lam sang. So Iffdng hach phau tich dffdc va so Iffdng hach di can theo phan loai TNM mdi cua AJCC 2010 [ l ] : T 6 n g thdl glan phlu thuat, thdi gian dong m o m ta trang, thdi gian lam mieng noi da day rupt, thdi gian co trung tien, thdi gian bat dau an dffdng mieng, thdi gian nam vien, Iffdng mau mat trong mo, tai bien trong mo (chay mau, rach buc mdm ta trang, mieng noi), bien chffng sdm sau mo (chay mau, viem phuc mac, ap xe ton dff,..).
Vdi nhdm tien cffu: Cach thffc tien hanh cupc mo: tffdng tff cac ca phau thuat cat da day ban phan va vet hach triet can thong thffdng.
Tuy nhien, cd hai thi phau thuat dffdc thffc hien bSng may cat nol thang Linear cutter: c i t va dong mdm ta trang; thffc hien mieng nol da day - rupt va ddng bdt mom da day. Sau dd ghi nhSn cac thong tin nhff nhom hoi cffu.
3. Xu" l y so li^u: sff dung thuat toan thong ke nhff test ANOVA khi so sanh cac gia trj trung binh, test x^ khl so sanh cac t y Ie nghien dia (khoang tin cay 9 5 % ) . So sanh kliac biet co y nghia thong ke khi p<0,05.
Y HQC VlgT NAM THANG 3 - SO 1/2013
III. KIT QUA
1. Mot SO dac tru^g ca nhan ciia doi tuTcfng nghi&n cu'u
Qua nghien cffu 65 benh nhan UTDD 1/3 dffdi dffdc phau thuat tai khoa Ngoai benh vien K tff 1/3/2011 den 30/9/2011 dffdc chia lam 2 nhdm nghien cffu: nhdm cd sff dung may cat noi thing (34 benh nhan) va khong diJng may cit noi thang (31 benh nhan). Trong do, tuol trung binh cua cac benh nhan la 57,46 ± 9,2 tuoi. Vdi tuol benh nhan nho nhat la 30 tuol va benh nhan cao tuoi nhat la 77 tuol. Da so benh nhan la nam gidi chlem ty le 58,5%, cdn lai la nff gidi vdi ty le 41,5%.
Bang 1 . So lu'dnq hach p h l u tfch So lu'dnq hach phSu tich
<7 hach 7-15 hach
> 16 hach Trunq binh
So benh nhan 0 25 40
Tv l« »/o 0 38,5 61,5 17,98 ± 5,87 hach
Ket qua: SN deu du'dc phau ti'ch trung binh la 17,98 ± 5,87 (8-37) hach, tren 16 hach (61,5%), it nhat; 8 hach. Nhieu nhat: 37 hach
Bang 2, Phan ioai hach di can Phan Ioai hach di c3n NO (Chua dl can hach) Nl (Di cSn 1-2 hach) N2 (Di cSn 3-6 hach) N3a (Dl cin 7-15 hach) N3b (Di can > 16 hach) Tong
So benh nhan 35 10 14 6 0 65
Ty le % 53,8 15,5 21,5 9,2 0 100
NhSnxet'Trung binh 2 hach di can, N2: 21,5%; N 3a: 9,2%. Trung binh: 2,03 hach; it nhat: 0 hach. Nhieu nhat: 13 hach
2. So sanh ket qua dieu trj UTDD bang phau thuat dung may cat nm thang va khong dung may
Bang 3. Thdi gian phau thuat va Iffdng mau mattrpng mo
Phau thu^tTong thdi gian mo (phut) Thdi gian dong mom ta trang (phut) Thdl gian thu'c hien mieng noi (phutl LUdnq mau mat (ml)
Dung may ( n= 34) 104,26 ± 11,88
1,10 ± 0,74 5,72 ± 2,46 26,18 ± 10,15
Khong dung may (n=
31) 153,87 ± 16,21
5,42 ± 1,53 24,94 ± 7,12 36,77 ± 15,36
P O<0,001 p<0,001 O<0,001 0>0,05
Nhan xet: Nhdm sff dung may cat noi thang cd thdi gian mo' ngan hdn (104,26 ± 11,88 so vdi 153,87 '± 16,21phut), thdi gian ddng mdm ta trang ngan hdn (1,10 ± 0,74 so vdi 5,42 ± 1,53 phut) va thdi gian thffc hien mieng noi ngan hdn (5,72 ± 2,46 so vdi 24,94 ± 7,12 phut), (p< 0,001). Lffdng mau mat trong mo d nhdm diJng may cung it hdn nhdm khong dung may, p = 0,21.
Bang 4, Ket qua scim sau phau thu Ket qua sdm sau phau thuat
Thdi qian co trunq tien (nqav) Thdl qian an lonq dUdnq mienq (nqay) Thdi qian nSm vien (nqay)It
Dung may ( n = 3 4 ) 2,88 ± 0,46 5,28 ± 0,64 7,31 ± 0,80
Khong dung may ( n = 3 1 ) 3,32 ± 0,48 5,94 ± 0,96 8,07 ± 1,75
P p<0,001
p<0,05 p<0.05
Nhan x4t: t\\ii\ gian cd trung tien, thdl gian an dffdng mieng, thdi gian nam vien ciia nhdm BN cd dung may deu ngan hdn cd nghTa thong ke so vdi nhdm khong dung may.
IV. BAN LUJC^N
1. So lu'ang hach phau tfch: tat ca cac BN deu dffdc phau tfch kiem tra tff 7 hach trd len, trung binh la 17,98 ± 5,87 (8-37) trong dd
chu yeu la nhdm phau tfch dffdc tren 16 hach
(61,5%). Ket qua nay cQng tffdng dffdng tac
gia Trinh Hong Sdn (2001) vdl 18,58 hach khi
phau thuat ung thff da day vet hach DII [6],
Y HQC VlgT NAM THANG 3 - SO 1/2013 2, P h a n l o a i l i a c h d i c a n : ap dung phan
loai giai doan TNM mcli trong UTDD theo AJCC 2010, Chung toi gap ty le hach di cSn (46,2%) thap hdn so vdi cac tac gia khac, trong do chu yeu la hach N2, trong khi cac nghien cCru deu cho thay giai doan N l la nhieu hdn ca. Dieu
nay co the do trong nghien CUXJ nay ty le ung thu" da day sdm cao hdn so vdl cac tac gia khac (bang 5). Hdn nO'a, theo phan loal mdi ciJa WCC 2010 thi dl c5n 1-2 hach xep la N l , con dl can tir 3-6 hach da la N2, trong khi theo phan loai cu thi di can 1-6 hach dUdc xep la N l . Bang 5: Ket qua cua mot so tac qia khac
Tac qia Biii Anh Tuyet (2003) r n Trinh Hong Sfln (2001) [61 Le Minh Ouang (2002) [31 NC (2011)
pNO 34,4%
19,28%
44,4%
53,8%
p N l 44,8%
52,94%
31,6%
15,5%
pN2 20,8%
21,24%
24%
21,5%
pN3 0 6,54%
0 9,2%
3. T h d i g l a n p h S u t h u a t v d I f f d n g mciu m a t t r o n g mol: viec sff dung may c3t ndi thSng giup rut ngan thdi gian mo (104,26 ± 11,88 so vdi 153,87 ± 16,21phut), bao gom ca thdi gian ddng mdm ta trang (1,10 ± 0,74 so vdi 5,42 ± 1,53 phut )va thdi gian thffc hien mieng noi (5,72
± 2,46 so vdl 24,94 ± 7,12 phut), sff khac biet nay la cd y nghia thong ke (p<0,001). Lffdng mau mat trong mo d nhdm diing may cung it hdn nhdm khong dung may, tuy nhien p = 0,21.
Ket qua cua chung tdi cd sff khac biet so vdi nghien cffu cua Dong-Heon Kim vdi thdi gian mo trung binh la 172,6 phut [ 7 ] . Cd sff khac biet nay chil yeu do nghien cffu ciia chiing toi la phau thuat md bung, cdn cac tac gia tren nghien ciTu phau thuat noi soi. Tuy nhien, cac tac gia deu dffa ra mpt nhan dinh rang sff dung may cat nol thang trong phau thuat UTDD se giup cuoc mo dien ra nhanh chdng, an toan va cd tlie thay the cho phu'dng phap cat nol bang tay truyen thong
4. Ket q u a s d m s a u p h a u t h u a t : thdi gian cd trung tien, thdi gian an dffdng mieng, thdi gian nam vien ciia nhdm BN cd diing may deu thap hdn cd nghia thong ke so vdi nhdm khong diing may. Nghien cffu ciia Nguyen VSn Hieu cho thay thdi gian cd trung tien ciia BN ditng may la 3 ngay, va Yoon Young Choi la 2,6 ngay; cdn thdi gian nam vien ciia Dong-Heon Kim la 11,2 ngay, Yoon Young Choi 7,9 ngay [ 7 ] .
Trong nghien cffu, chiing tdi chi gap duy nhat mpt trffdng hdp chay mau mdm ta trang sau khi da ddng mdm ta trang bang may, chiem ty le 2,9% trong nhdm 6\fdc phau thuat b§ng may, khong cd benh nhan nao cd bien chffng rach hay buc mdm ta trang, rach buc mieng noi.
Tuy nhien sff khac biet giffa hai nhdm khdng cd y nghia thong ke vdi p > 0,05. Nguyen nhan ciia tai bien nay xuat phat tff he thong mach mau
nuoi dffdng phong phu cua da day va ta trang, thanh ciia doan ta trang dffdc cat tffdng doi day, do vay khi sff dung bang dinh ghim kich c3 nho (1,5mm chieu cao, chieu dai 55mm), mdm ta trang dffdc ddng khi do day ciia md va chieu cao khl ddng ciia hang dinh la bat can xirng, dan tdi ri mau tai chan dinh ghim. Tai bien nay cd the phdng tranh 6[idc tuy thupc danh gia trong mo ciia phau thuat vien ve do day, do dai ciia mo can cat hoac noi vdi chieu cao va chieu dai bang dinh ghim de Iffa chpn sao cho phu hdp nhat
Trong nghien cffu cua chimg tdl, khdng gap bat cff trffdng hdp nao xay ra bien chffng sdm sau mo (chay mau, viem phuc mac, ap xe t3n dff..) d ca hai nhdm benh nhan. Ket qua nay tffdng tff vdi cac nghien ciTu ciia cac tac gia nffdc ngoai [ 7 ] . Khi so sanh vdl nhffng nghien ciJli trong nffdc phau thuat bSng phffdng phap truyen thong, chimg tdi nhan thay cac tac gia thffdng gap nhutig ty le bien chihig nhat dinh: rd mieng noi chiem 0,98% trong nghien cffu ciia Trjnh Hong Sdn [ 6 ] , 0 , 8 % trong nghien citu ciia Bo Offc Van 1,2%, trong nghien cffli ciia Pham Duy Hien, ty le rd mdm ta trang trong nghien cuff ciia Le Minh Quang la 0,6%, nghien cuU ciia Bo Diit Van la 0,9%, cua Pham Duy Hien la 0,64% [2], [3], [ 5 ] . Cd the do trffdc day, phffdng tien kini chi khdng dffdc tot, gay me hoi sffc con han che nen cac ty le nay thffdng gap hdn. Ben canh do, sff ra ddi cac the he may cat noi thang va cat ncS dang vdng cung mang lai Uiem sff Iffa chpn cho cac phau thuat vien de han che bdt cac bien chffng, dSc biet trong phau thuat noi soi [7].
V. KET I U A N
Sff dung may cat noi thang la phffdng phap ddn gian, an toan, nhanh chdng, cd the ap dung
70
Y HQC VlgT NAM THANG 3 - SO 1/2013 cho phau thuat ung thff da day phan ba tren,
giffa, dffdi. Oac biet khi phau thuat cho benh nhan gia, yeu, cd benh ly man tinh kem theo, ddi hdi cuoc mo phai hoan thanh cang sdm cang tot.
Tuy nhien can l u ^ chpn loai may, kich cd bang dinh ghim phii hdp vdl d d day md can cat va nol.
T A I U E U THAM K H A O
1, Bui Anh Tuyet (2003), "Nhan xet dSc di^m I5m sang, hinh anh noi soi va mo bfnh hoc cua ung thu" da day dieu tri tai b^h vien K tff thang 9/2002-6/2003 ", T^ chi Ung thif 2003. tri20-129
2, o5 Du'c VSn (1993), "Dieu tn phau thuat ung thu' da day tai benh vi^n Viet Dffc tff 1970 den 1992 ", Y fwc VietNam, 7, 173; tr 45-50
Le Minh Quang (2002), " Nghien ciai Qhz diem lam sang, mo b^nh hpc va ket qua dieu trj phau thuat ung thu* bieu mo tuyen da day tai benh vi^n k 1995-1999", Tap chl Ung tfiU2002, tr 87-99/
Pham Duy Hien - Nguyin Xuan Kien (2000), "Nhan xet tai bien va bien chuhg oia phau thuat dieu bi ung thu' dada/', Yhoc thut hanh thing 6, \i,l^i&.
Trjnh Hong Sdn (2001), "Nghien ciJXi nao vet hach trong dieu tri phau thuat ung thu' da day", Luan in
Tien si Y hoc, Dai hoc Y Hi Noi
AJCC (2010), "Cancer Staging Handbook", From the AJCC Cancer Staging Manual, f" edition. Springer, 149-152.
Dong-Heon Kim, Tae-Yong Jeon, et al (2009),
"Roux-en-Y Gastrojejunostomy Using Modified Hemi- Double Stapling", Dig Surg, 26(5): 364-368,
TiM HIEU GIA TRj CUA CHOC HUT TE BAO KIM NHO OU^ HO^NG DAN SIEU AM TRONG CHAN DOAN B I I ^ NHAN TUYEN GIAP
Le Cong Omh*, Nguy§n Thj Hoa Hong*
T 6 M TAT
Myc tieu: Oanh gia gia tn ciia phuong phap choc hut ldm nhd du'di hifdng dan ciia sieu am trong chan doan bu'du giap. Doi tu'dng & phu'dng phap nghien cffu: la 55 benh nhan (BN) bu'du nhan giap du'dc choc hilt te bao kim nho du'di ht/dng dan ciia sieu am. Nghien ciTu mo ta cat ngang. Ket qua: ty le lanh tinh 60%, ac tinh 25,5%, nghi ngd ac tinh 5,4%
va 9,1% benh pham khong thoa dang. Xet nghiem nay CO dp nhay 88,9 %, do d5c hieu 96,9 %, gia tn dUdng tinh 94 % va gia tn i m tinh 93,9%, Ket luan: chpc hilt kim nhd dUdi hu'dng dan ciia sieu am la la xet nghiem te bao hoc ddn gian, re tien, khong nguy hiem, co do chinh xac cao trong chan doan budu giap.
Tff khoa: bffdu giap, hu'dng dan ciia sieu am.
SUMMARY
VALUE OF ULTRASOUD-GUIDED FINE-NEEDLE ASPIRATION I N THE MANAGEMENT OF
THYROID NODULES.
Objective: Assess the value of Ultrasound- guided Fine-Needle Aspiration (US-FNA) in the management of thyroid nodules. Patients &
methods: 55 patients suffering of thyroid nodules undenivent US-FNA. Prospective cohort study.
Results: Benign lesion w/ere 60%, malignant lesion:
25,5%, suspicious for malignancy: 5,4%, samling
•*• Khoa Tai Mui Hgng Benh vien Bach Mai Phin bi^n khoa hgc: PGS.TS. Nguyin Dtnh Phuc
error: 9,1%. The sensitivity were 88,9%, specificity:
96,9%, Positive predictive value: 94%, Negative predictive value: 93,9%. Conclusion: US-FNA is simple method, safe, inexpensive, highly diagnostic accuracy in the management of thyroid nodules,
Keyvtford: thyroid noduie, ultrasound guided I. DATVANDE
Bffdu nhan tuyen giap (BNTG) la benh ly kha thffdng gap, ty le phat hien qua kham lam sang la khoang 4 % - 8 % dan so, 1 0 % - 4 1 % qua sieu am va 50% tren tieu ban md benh hgc trong kham nghiem tff thi I 3 [ [ 5 ] . Dang Iffu y la cd khoang 4-5% bffdu giap la ac tinh va cac bleu hien lam sang ciia loai nay cung khong cd su' khac biet nhieu so vdi bffdu lanh tinh. Tren lam sang bffdu giap bieu hien cac trieu chffng ngheo nan hoac hoan toan khdng cd trieu chffng. Trong chan doan dieu quan trong nhat la xac djnh ban chat ciia bu'du la lanh hay ac tinh de tff dd du'a ra phffdng phap dieu tri thich hdp. Hien nay cd rat nhieu phffdng phap hien dai dyidc ap dung nhff: sieu am, chup CL\n", cgng hffdng tff, y hpc hat nhan... Odi vdi xet nghiem te bao hpc, chpc hi^t kim nhd (CHKN) la Iffa chgn hang dau cua cac thay thuoc trong chan doan. Day la bien
