la do ngodi vi khd qua chung tdi cdn cd thdm cac vj Ihudc cd tac dung ha dJdng huydt, thanh nhiet, tir am va sinh tan trong bai thudc. Vdi kdt qua nay chung ta cd t h l sCf dung bdi thudc nhir id mot giai phap dieu tri bfinh nhdn DTD typ 2 cd hi§u qua va ft doc hai.
5. Ban ve hieu q u i dieu tri theo YHCT Danh gia kdt qua nghidn ciili theo the YHCT trong nghidn cdu thu dUdc: The tieu khat thu'dng tidu cd 11 banh nhan, ket qua tdt + kha cd 10 benh nhan chiem ty 16 90,91%. Thd tieu khat trung tieu cd 7 benh nhan, kdt qua tdt + kha cd 04 benh nhan chidm ty la 57,14%. Thd tiau khat ha tiSu ed 12 benh nhdn, ket qua tdt + kha co 8 benh nhan chidm ty le 50%.
Tidu khat la mot loai benh ngi thu'ang man tfnh.
Difa vao triSu chljfng an, udng va tieu nhieu di phan th^ thanh thUdng tlSu, trung tieu va ha tieu. Benh cd quan hd mat thiet ddn phe, ty, vi va than [3], Chifng tidu khat tuy chia thuong ti§u (phd), trung tieu (vi), ha tiSu (than) ba loal song goc la mot do la am hu, am hif gay dudng cang, Trong ba tang am h i / t h i d than la chi^ yeu. Do dd thd tieu khat ha tieu qua trinh dieu t^inh cham va khd khan hdn. Benh tieu khat do am hi/gay dUOng cang, khi ehQa benh phai thanh nhiet ti/
am. Tam tieu luan ndi "Chira benh tieu khat can bo cai hiram han cua than thiiy, ta cai thUc duong nhiet cua tam hda, trir cai tao nhiet cua trudng vj. giiJp cai hir suy cCia tan djch trong cd the khien cho kinh mach th6ng thoang ma khdng ket dpng. Tan djch sinh ra ma khdng khd can, khf huyet ldi ma khdng sa sut thi bSnh khdi". Vay chCfa tieu khat can bd am sinh tan thanh trir nhiat tfch.
Bai thudc HDT gdm c6 cac vi:
+ Bd am sinh tdn: Khd qua, sinh d!a, cat can, + Thanh nhiSt: Kim ngan hoa, bd cong anh, sinh cam thSo.
Bai thudc tr6n vira cd tac dung nhuan phd, mat vi.
tl/than am:
- Khi bSnh d phd, phe nhiet lam cho chifc nang phd bt rdi loan, khong phan bd dirge tinh vi cua thu'c an di xudng toan than ma di thSng xudng bang quang (than) sinh ra ddi nhieu, nUdc tieu ngpt, bai thudc dieu tri vap phd, thanh nhifet nhuan phd, lam cho phe thuc
hian tdt chtfc nang tri tiet ddng thdi giup than phan thanh giang trpc, ti/than thuy giam hif nhiet lam cho benh khdng nang ldn.
- Khi benh d vj, vj nhiet bdc len lam cho thiifc an khdng bidn thanh tan djch dd dua Idn phd. Vi vay, lam chirc nang cua phe va cOa than cung bi rdi loan. Bai thudc dieu trj vao vi, thanh vi nhiet lam cho vj tdt len bidn thifc an thanh tan dich dUa len phe, tan djch day dO thi giiip phd thUc hien chirc nang tri tiet va than phan thanh giang trpc dugc tdt,
- Khi benh d than, tinh kiet, tan dich bi hao tdn d i n den thUdng than am, lam phd b! tao, vi bj nhiet gay ndn chUfng tieu khat. Bai thudc dieu tri vao than am cho benh khdng lam ton thudng den phe va vi, ddng thdi thuoc cung co tac dung nhuan phe, mat vi de tang cudng sifc chdng dd cCia benh tat, lam cho benh khong nSng len
Chfnh vi vay, bai thuoc tren c6 tac dung d ca ba the thi/dng tieu, trung tieu va ha tieu.
KET LUAN
1. Bai thudc HDT co tac dung tdt tren benh nhan DTD typ 2 cd mitc dUdng huydt trong gidi han tit 7 mmol/l-13 mmol/l.
- Bai thudc co tac dung lam giam Glucose mau, HbAlc va Cholesterol trong qua trinh dieu trj.
- Bai thudc c6 tac dung cai thien tdt cac tri§u chifng lam sang dac biet la cac trieu chirng khd hpng, them an, tieu vang.
- Bai thudc CO tac dung tdt tren the tieu khat thugng tidu va tieu khat trung tiSu cua YHCT
2. Trong qua trinh nghien ciru chua thay tac dung phu cua thudc,
TAI LIEU THAM K H A O
1. Ta van Binh (2007), NhCfng nguyen ly nen tang benh dai dudng - iang glucose mau, NXB Y hpc.
2. Bp mon Noi TrUdng Dai hpc Y Ha Npi (2005),
"Bdnh dai dudng", Benh hoc noi khoa sau dai hoc, tr.214-229, NXBYhpc,^
3. Bo mon Y hpc CO truyen Hpc vien Quan y (2011).
Benh hoc noi khoa y hpc cd tnjydn, tr.312-321, NXB Quan doi nhan dan.
TAI PHAT, Dl CAN SAU DIEU TRj UNG THIf TUYEN GIAP
DAO VAN TU - Khoa noi 2 - Benh vien K LE V A N QUANG - Trudng Dai hgc Y Hd Nqi
T6M TAT
Myc tiiu: Nhdn xdt t^ Id tdi phdt. di cdn sau diiu bj ung thu gidp trang va eac yeu to lien quan. Ddi fufng vd phuang phdp: Gom 218 benh nhdn duac chin dodn Id ung tbu tuyin gidp nguydn phdt, duoc diiu trj t^i Bdnh vidn K td tiiang 1/1995 den thang 12/1999. Phuang phdp nghidn cdu md ta hdi cdu. Ket qui: Tdi phdt u 12%, tdi phdt bach 15%. ThS nhu va nhOnang 8,6% tdi phdt u va 16.1% tai phdt hach; thi nang tuang dng Id 15.6% vd 9,4%; thi khdng biet hda
va the tdy tai phat cao. Tdi phat u d giai doan II vdi 18,8%. giai doan III la 16.7% va giai doan I chiem t^
Id thap. Giai doan IH tai phdt bach 33.3%. giai doan II la 31.3%. Tai phat chij yeu gdp trong 24 thang. doi vdi u la 65% (trong dd tai phat trong ndm dau la 45%) va doi vdi bach la 61.3%. Di cdn xa hay gdp d tbi khdng biet bda vdl 50% cac trudng hap, d thi nang la 15,6%. Trong so cac vi tri di cdn. di cdn phii gdp vdi fj? Id cao nhat vdi 78.6%. di cdn xuang 14.% vd di cdn gan it g$p. Thdi gian di cdn thudng xuit hidn trong 2
T H O C THVC HANH (924) - S6 7/2014
ndm diu vdi 50%. Kit ludn: The nhu va nang it tdi phdt, thi tQy va the kbdng biet bda cd ti le tdi phat cao. Di can xa hay gdp d the khdng biet hda vdi 50%
tnidng hgp.
Tir khoi: Ung tbu gidp, tdi phat, dican.
SUMMARY
RECURRENT AND/OR METASTASES AFTER THYROID CANCER INITIAL TREATMENT Objective: To evaluate the rate of recurrence, metastases after initial treatment of thyroid cancer and prognostic factors. Patients and Methods:
Clinical records of 218 thyroid cancer patients, treated by surgery at K hospital from 1/1995 to 12/1999. Were investigated in this prospective study.
Result: The incidence of recurrent tumors 12%, recurrent nodes 15%. In the group papillary and follicular variant of papillary carcinoma: 8.6% of recurrent tumor, 16.1% recurrent lymph node: the correlative rate in the group of follicular: 15.6% and 9.4%; anaplastic and medullary carcinoma group has high recurrence rate compare with other group. The recurrent tumor rate of stage II 18.8%. Stage UI 16.7% and stage I is lower. The recurrent lymph node rate of stage III 33.3%. stage II 31.3%. The recunent almost seen in 24 month, for the tumor 65% (in which the recurrent in the first year is 45%) and for the node 61.3%. The incidence metastatic rate of the anaplastic group (50%) was higher than follicular group (15.6%). Lung metastases seen as the most common site the rate was 78.6%. bone metastase 14% and hepatic metastase was less unexpected.
50% metastases appeared in 2 years after treadment Conclusions: The anaplastic group has a higher recurrence rate compare with the papillary and follicular group. Distant metastasis was common in the anaplastic group with the incidence was 50%.
Keywords: Thyroid cancer, recurrent, meta stasis.
OAT VAN DE
Tren the gidi cung nhi/ d Viet Nam, ung thu tuyen giap chl chidm 1-2% trpng tat ea cae loai ung thu nhung chiem den 90% ung thu" cua cac tuyen ndi tiet.
Viet Nam, theo Nguyen Ba Diic (2000), ti le mac ung thu tuyen giap cl nQ xep thir 12 trong cac loai ung thir ndi chung vdi tl le 2,3/100 000 dan, va d nam xep hang thif 13 vdi ti le 1,3/100.000 dan. Ung thu giap trang chia lam hai nhdm khac nhau ve lam sang, phu'Ong phap dieu trj va tien li/gng, dd la ung thif tuyen giap the biet hda va ung thU tuyen giap the khdng biet hoa, Ung thir tuyen giap the biet hoa tien trien cham, benh nhan thu'dng den vien d giai doan chira di cSn xa, u tai chd va hach di cdn cdn co the cdt bo du'gc va tien lu'gng tdt. Ung thi/tuydn giap the khdng biet hoa tidn trien nhanh. benh nhan thu'dng den vien khi khoi u va hach da xam lan rong, khdng cat bo duge, di can xa sdm va tien lugng xau, Trong dieu tri ung thU tuyen giap. phau thuat ddng vai trd quan trong nhat ed tinh chat quyet dinh den ket qua dieu tri, tuy nhien mire do rong cua phau thuat thi cd thay ddi tiiy thudc vao giai doan. tuoi cua benh nhan.
Sau p h l u thuat cd the dieu trj bd trd bang I"' vS homion thay the vira cd tac dung bo xung hormon vUa cd tac dung duy tri benh on dinh lau dai. Xa trj co vai tro bd trg ddi vdi ung thU tuyen giap khdng bi&t hda va ung thU tuyen giap the tiiy, Hda chat toan than hien tai chUa chirng to dUOc vai trd trong dieu tn ung thu bieu mo tuyen giap. 6 Viet Nam da co nhieu nghien cifu ve ung thu giap trang, trong do cd nghien cifu vd sdng them, cd de cap den van de tai phat va di can, nhung chUa phan tfch chi tidt cac yeu tdanh^
hudng tdi van de nay, Vi nhCfng If do nhu tren chiing^
tdi thUc hien de tai nghien cUu nay nham muc tieu:
"Nhdn xet /j? Id tai phat, di cdn sau dieu tri ung thi gidp trang va cac yeu to lien quan".
DOI Tl/ONG VA PHI/ONG PHAP NGHIEN CLftJ 1. Dd'i tirdng nghien c u u : Gom cac benh nhSitf.
dugc chan doan la ung thU tuyen giap nguyen phatt' dUdc dieu tri tai Benh vien K tU thang 1/1995 ddi thang 12/1999,_^
* Tieu chuan chgn benh nhan:
+ Chan doan ung thU bieu mo tuyen giap blng benh hoc,
+ Dugc phau thuat tai Benh vien K.
+ Chua qua can thiep d tuyen trudc.
+ 06 ho Sd lull trU day du.
* Tieu chuan loai trCn
+ Ho so khdng day du, that lac hd so.
+ Cac trudng hdp dugc chan doan la ung thj tuyen giap nhifng khdng cd ket qua mo benh hpc,
+ Cac trudng hop ung thu noi khac di can tdi tuy^r giap.
+ Trudng hgp da phau thuat d tuyen trUdc, hoSc nhifng benh nhan cu tU trU6c nam 1995 den dieu trj tiep vi tai phat. di cSn.
2. PhUdng phap nghien cijfu: PhUong phap nghien ciru mo ta hoi cifu
KET QUA 1. Tai phat u, hach
Bang 1: Tai phat u, hach theo md benh hoc
' Loai tai phat Tai ptiat u Tai ptiat tiach ' Tai pttat u theo
MBH Nhu, nhu nanq
Nanq Tijy Khonq biel hoa
* Tai phat hach theo MBH Nhu, nhu nanq
Nang Tuv Khong biet hoa
Tai So BN
?6 33
15 5 1 5
28 3 0 2
phat T}ie
%
12 15
8,6 15,6 50 50
16,1 9,4 0 20
Khonq tai phat So BN 192 185
159 27 1 5
146 29
2
a
T } I 6
%
88 85
91,4 84,4 .50 50
83 9 90 6 100 80
Tdnq So BN 218 218
174 32 2 10
174 32 2 10
Tiit
%
100
too
IM 101
too
100too m
100
too
Nhan xet Tai phat u gap trong do co 8 trUdng hop tai
12%, phal
tai phat hach 15%, ca u va hach. The
Y HOC THUC HANH i '724) - s6 7/2014
nhu; vd nhit nang 8,6% tdi phat u vd 16.1% t^i phdt h^ch; thi nang tuOng (a\g \d 15.6% vd 9,4%; thi khdng bi$t h6a vd thi tOy tdi phdt cao.
BSng 2: Dffi chiSu giai doan bgnh vd tdi phat u 66\
yH una thif t h l bi^t h6a
G U l o n l GU doan II GUilDanlN
TS SS BN 16 3 1
phai Tin
»,/ %
1S,8 16,/
KhOnqlAillli^
So BN 172 13 5
T } I 6
%
91,3 81,2 83.3
T6nq SS BN 184 16 6
T } l §
%
100 100 100 N h $ n x d t T d i p h d t g d p chO y e u d g i a i d o a n II v d i 18,8%, giai d o a n III I d 1 6 , 7 % v a g i a i d o a n I c h i ^ m t ^ IfithSp.
Bang 3 : 0 6 i c h i € u g i a i d o a n b e n h v d t a i p h d t h a c h dgi vfli u n g t h u t h l b i $ t h o a
.-,
GiaidoanI GUdoanll GU doan III
Tii BN 24 5 2
phit
Tflf
%
13 31,3 33.3
Kliang tSi phat S<
BN 160 11 4
TJIS 8/
%
68,7 66,7
T6nfl
Si
BN 184 16 6
T } l § 100
%
100 100 hSn x d t : d g i a i d o a n III h a y g d p t d i p h d t h a c h v d i t ^ 16 3 3 , 3 % , t i ^ p d ^ n I d g i a i d o a n II v d i 3 1 , 3 % .
B d n g 4 : T h d i g i a n t d i p h d t d6\ v d i u n g t h i / t h ^ biSt h6a
''Hicn gian tdi phdt u(n=20)
< 12 thing 13-24 M n o
> 24 thing ' T M o l a n t i l Phil hach (n=31)
< 12 thing 13-24 thing
> 24 thing
S5BN 9 4 7 13 6 12
T * I 6 % 45 20 35 41,9 19,4 38,7 Nh$n x d t : T d i p h d t chO y ^ u g d p t r o n g 2 4 t h d n g , dfil v d i u Id 6 5 % ( t r o n g d 6 t d i p h a t t r o n g n d m d i u i d 4 5 % ) v d dtfi v d i h a c h I d 6 1 , 3 % (chO y ^ u Id n d m 6iu ti6n_vfli41,9%).
3 5: D l c d n x a t h e o m o b $ n h h o c
Nho, nhQ nang Nang
TSy Khing biit h6a
Di can xa SS BN 4 5 0 5
T } I 8 2,3
%
1,S,6 0 50
Khitnc SS BN 170 27
7 5
di can xa T J I 6 % 97.7 84,4 100 50
Tdng SS BN 174 32 2 10
T } I 6 100
%
100 100 too
N h $ n x d t : D l c d n x a h a y g 9 p d t h ^ k h o n g b i ^ t h o a V * 6 0 % c 4 c tnJSng h o p , d t h e n a n g 14 1 5 , 6 % .
Bdng 6: V i trf v 4 t h d i g i a n x u a t h i e n d i c 3 n x a ' V I H d i c i n x a l n = 1 4 )
Phdi
xum Gan
" I M gian xua h l ^ n d i c i n x a (n=14)
<12lhin<i 13^4 thing
>24 thing
SoBN 11
2 1
5 2 7
T i l 8 % 78,6 14,3 7,1
35,7 14,3 50
Nhan xdt: Trong sd cdc vi tarf di cdn. di cdn phdi gdp vdi t^ le cao nhat vdi 78,6%, di cdn xuong 14.%
vd di cdn gan it gdp. Thdi gian di cdn UiUdng xudt hidn trong 2 ndm dau vdi 50%.
BAN LUAN
Trong dieu tn ung thU. hai bdn khodn de ndng len bdnh nhan vd t h i y thu6c dd Id nguy ca tdi phdt va di cdn xa. tdi phdt chifa gay cho t}dnh nhan chet ngay nhifhg gdp khd khdn cho nhQng lan dieu tri tiep theo va lam bdnh nhan chan nan. Di cdn xa Id ti^n trien khd khdn mau chdng dan din kit cue Id cdi ch^t. Ddi vdi ung tha giap trang, mdc dCi Id loai benh cd tien liAing tdt ngay cd khi da c6 di cdn xa, nhung di cdn xa van la nguyen nhdn gdy chet chQ y^u.
Ve thifc chat, tdi phdt Id si/ phat trien trd lai cDa t^
bdo u cdn sdt lai hodc nhQng u nhd c h i ^ loai bd diJdc hodn toan. Do dd. theo chOng toi de giam 6 Id tdi phat tai cho, can tien hdnh d i l u tri Uieo phdc d6 dda ra mdt each chdt che. Trong nghidn cdU cOa chiing tdi.
tdi phat u sau dieu bi gdp vdi t^ Id 12%, nghien cQu cQa Dodn HiXi Nghj (1995) nhdn xet trdn hd so bdnh dn, tai phat u gdp vdi t? le 20%, cao hOn nghien cflu cOa chtjng tdi. Sd di kit qua cOa chflng tdi cd thap hon Id do chflng tdi khdng tfnh nhflng tnidng hop tdi phat sau d i l u trj d tuyen tnJdc hodc dieu tri tnJdc ndm 1995 den vi tdi phat, di cdn. Tt Id tdi phat hach vd di cdn xa theo Dodn HOu Nghi Id 5,7% cd tii^p hfln nghidn cflu c^a chflng tdi (15%), cd le do chCing tdi gfli thfl thdm dd vd mdi bdnh nhdn din khdm lai ndn sd trfli^ng hdp phdt hign duOc nhilu hon so vdi ghi nhdn tit hd so bdnh an. Nghidn cflu cOa Lee (2013), trdn 3305 bdnh nhan ung thfl tuyln gidp t h l bidt hod, t^ Id tai phdt tai chd Id 3,4% vd t^ Id di cdn xa Id 7,2%.
Phan b'ch mdi lidn quan giij^ ti Id tdi phdt u theo md bdnh hoc, t h i y trong ung thfl t h l nhO cd 8,6% tdi phdt, th^ nang 16.7%, ddc bilt ung thfl t h l khdng bidt hod 50% tnrdng hop tdi phdt. Ddi vdi ung thfl t h l bidt hod, chflng toi ddi chieu t^ Id tdi phdt u vdi giai doan bdnh, d giai doan II gdp nhilu nhdt, t i l p d i n giai doan III'. Ddi vdi hach. t^ Id tdi phdt cung gdp d i d y l u d giai doan II, III. Ung thfl gidp trang Id loai bdnh t i l n triln cham, do vdy thdi gian tdi phdt cung chdm. Theo cdc nghidn cflu trdn the gidi, cd 2 khodng tdi phdt hay gdp dd Id khodng 2 ndm d i u sau d i l u trj vd khoang thfl hai Id 5 ndm sau d i l u trj. Bdi vdy, sau d i l u tri c i n phSl khdm lai theo djnh ky cho bdnh nhdn d l phdt hidn tai phdt kjp thdi vd c6 hfldng xii li^ dflng. Nghidn ciiu cOa chung tdi, tat ca cac trfldng hc^ tdi phdt u vd/hodc hach theo ddi dflOc cung d l u x u i t hidn trong 2 ndm dau sau dieu trj. Trong nghidn cflU cQa chflng tdi, do sd IflOng bdnli nhdn nghidn cfAj cdn chu^
nhilu do vdy chflng tdi khdng phdn tich t9 Id tdi phdt theo tflng phuong phdp d i l u trj phau thudt, phUOng phdp d i l u trj bd tro sau phSu thudt. tdi phdt theo tudi, kfch thudc u hodc sfl xdm l i n vd bao tuyln gidp. Tuy nhidn theo cdc nghidn cflu, d t u l i gid, u xdm l i n vd bao tuyln giap, kfch thfldc u Idn thi tJ Id tdi phdt cao hfln, khoSng thdi gian giQa d i l u trj ban d l u vd tdi phdt Id ngSn hfln. Nghidn cflU ciia chflng tdi tl 1$ di cdn xa
V Hpc THUC HANH (924) - SO 7/2014
sau lan dieu tri dau tidn cd 14 bdnh nhdn trong so benh nhan theo ddi, chiem 6,4%. Trong do the nang cd 15,6 % di cdn xa, the khdng biet hoa cd 50%
tn/dng hop di cdn xa, Vj tri di cdn xa, di cdn phdi chiem 78,6%, di cdn xfldng va gan chiem mot ty le thap. Theo y vdn, vi trf di cdn xa hay gdp Irong ung thfl giap trang la phdi chiem khoang 90%. Thdi gian xuat hien di cdn xa, thay co tdi 50% xuat hidn trong ndm dau.
KET LUAN
Tai phdt u gdp 12%, tai phat hach 15%; the nhfl vd nang co ty le tdi phat tha'p, the tOy va the khong biet hda tJ le tdi phdt cao; giai doan III hay gdp tdi phdt hach vdi ty le 33,3%. tiep dd'n la giai doan II vdi 31,3%;
tai phat chii y l u gdp trong 24 thang, dd'i vdi u la 65%
(trong dd tai phat trong ndm dau la 45%) va ddi vdi hach la 61,3% (chij yeu la ndm dau tien vdi 41,9%) Di cdn xa hay gdp d the khdng biet hda vdi 50% cac tn/dng hop, d tiie nang Id 15,6%; trong so cac v| tri dl cdn, di cdn phoi gdp vdi ty le cao nhat vdi 78,6%, di cdn xfldng 14,% va di cdn gan ft gdp; thdi gian di cdn thfldng xuat hien trong 2 ndm dau vdi 50%.
TAI LIEU THAM K H A O
1. Max P, Freddie B, Feriy J. (2008). Cancer Statistic 2008. GLOBOCAN Cancer J Clin 2008, p:
74-108.
2. Mazzaferri EL, Jhiang SM. (1994). Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer, Am J Med.
J994; c 97. p: 418-428.
3. Dinh Xuan Cfldng (2004). Nghien citu ddc diem idm sang, can lam sang vd mot sd yeu td tien \iS3r\g ung thfl tuye'n gidp tai Benh vien K. Ludn van tdt nghiep thac sy. Trfldng Dai hoc Y Ha Noi.
4. Nguyen Ba Dflc (1999). Ung thfl tuyen giap.
Hudng din thuc hanh, chan doan va dieu tn ung thu, NXB Y hoc, tr 135-149.
5. Doan Hflu Nghj (1995). Mdt so nhan xet ve tai phat vd di cdn ung thfl qua ghi nhdn 1992-1994 tai Benh vien K. Y hoe tbuc hanh, Chuyen san ung thu hoc 11/1995, tr 105-109.
6. National Comprehensive Cancer Network (2013). NCCN Practice Guidelines for Thymid Cancer
KET QUA SOTM CUA PHAU THUAT KHAU TREO TRIET MACH TRONG DIEU TR! RENH TRf SA VONG TAI BENH VIEN DAI HOC Y DUUC CAN THO
DOAN HUTU CANH, PHAM V A N N A N G Bp mon Ngoai, TrUdng Bai hoc Y Duac Can Tha
TOM TAT
Dat van di: Didu tri benh tri sa vdng ddi khi vdn cdn la mdt thach thCfc doi vdi eac bac sJ ngoai khoa tidu boa. Nham danh gid kit qua cua phau thuat khau treo tridt mach trong diiu tri bdnh tri sa vdng, cbOng tdi thuc hien nghien citu nay vdi 2 muc tidu: 1/ Xae dinh ddc diem Idm sang, can lam sang cOa benh nhdn tri sa vdng. 2/ Ddnh gid ket qua sdm cOa phiu thudt khdu treo tridt mach trisa vong.
Phuong phap nghien cuu: Md ta cit ngang vdi 42 bdnh nhdn tri sa vdng dugc dieu tri_ bang phau thudt khdu treo triet mach tai Benb vien Dai hoc Y Dugc Cin Tha, tCl25/7/2013 'din 30/4/2014.
Kit qua: Trong 42 benh nhdn, cd 57.1% Id nam, 42,9% la nfl. Tuoi tmng binh la 46,6 tuoi. Cd 61,9%
benh nhdn cd trisa vdng dd 3, 38,1% trf sa vdng dd 4, 23,8% benh nhan cd trf kem theo cac thuong ton . kbac. Phin ldn benh nhan duac phdu thudt khau treo triet mach dan thuan (81%). cdn 19% duac xCf tri cdc thuang ton kem theo. Sau phdu thudt 24 gid. cd 9.5%
benh nhdn dau nhiiu, 7,1% chay mdu it. 7,1%bitieu va 19% cdn cam giac mdt rdn. Sau phdu thudt 1 tuin, cd 1 benh nhdn vdn con cam giac dau vCfa va cdn bi tieu. cd 1 benh nhan chay mau can phai can thiep.
Sau 4 tuan tbi khdng ghi nhan bien chifng.
Kit lu$n: Phdu thuat khdu treo triet mach cd hieu qui trong didu tn benh tri sa vdng, fj? Id biin chCtng thap.
Tdkhda: Trisa vdng. khau treo triet mach.
SUMMARY
Introduction: Management of circumferential hemorrhoids is still a challenge to young gastrointestinal surgeons. The two aims of this study was to determine the clinical features, investigations of circumferential hemorrhoids and eariy results of ligation-anopexy of circumferential hemorrhoids.
Methods: This sectional, descriptive study included 42 patients who had circumferential hemorrhoids and underwent ligation-anopexy In Can Tho University Hospital of Medicine and Pharmacy from 25/7/2013 to 30/4/2014. Results: There were 57.1% male, 42.9%
female with mean age 46.6 years. 61.9% patients had third-degree and 38.1% fourth-degree circumferential hemorrhoids, and 23,8% patients had other lesions such as anal fissure, anal polyp. Majority of patients underwent simple ligation-anopexy (81%) and the remainder underwent combined procedures (19%).
One-day postoperative complications included severe pain (9.5%), mild bleeding (7.1%), urinary retention (7.1%) and tenemus 19%. After 1 week, one patient still had pain and urinary retention and another patient had severe bleeding required surgical intervention. And after 4 weeks, no complication recorded. Conclusions: Ligation-anopexy is effective in treatment of circumferential hemorrhoids with few and acceptable complications.
Keywords: Ligation-anopexy. circumferential bemoirhoids.
Y HOC THUC HANH (924). s d 7/2014