TAP CHJ Y HOC VigT NAM Tifl.P 451 - THAHG 2-SO 1-2D17
la sieu am la nhij'ng tham do cd gia trj trong han doan sdm viem l i i y cap d tre e m .
TAI L l | U THAIVI KHAO
L Simild Mv Saito N., Naritaka N., et al. (2015).
Scoring system for the [ffediction of severe acute pancreatitis in children: Pediafrint 57(1): p. 113-8.
Z. Benifla M.,Weizman Z. (2003). Acute pancreatjbs in chiidhood: analysis of literature 6ztB.jain Gasboenterol. 37(2): p. 169-72.
3. Kandula I^Lowe M. E. (2008). Etiology and outcome of acute pancreatitis in infants and toddlers.7/^/afr: 152(1): p. 106-10,110 e l . 4. Sanchez-Ramirez C. A, Larrosa-Haro A,
Flores-MartJnez 5, e t ai. (2007). Acute and
recurrent pancreatitis in children: etiological factors. Acta Paediab-. 96(4): p. 534-7.
5. Tran Thi Thanh Tam, Tang Le Chau Ngpc, (2007)/ bac di^m viem luy cap d tre em d benh vien nhi d^ng 1 vk b§nh vien nhi dSng 2. Y hoc
TP. Ho Chi Minh. 1 1 : p. 143-147.^
6. Pham Thj Minh Khoa, Nguyen Gia Khanh (2008)/ Nghien cu'u dac diem lam sang, can lam sang va dieu trj viem tuy ctp d tre, Luan an tien si yhoc, Tru&ng Oai hoc Y Ha Noi, Ha NSi.
7. Park A. 2, Latif S. U, Ahmad M. U., et al.
(2010). A comparison of presentation and management trends in acute pancreatitis between infants/toddlers and older children. J >
Gasboenteroi Nuf. 51(2): p. 167-70.
DAC DIEM LAM SANG, CAN L A M SANG TAC DONG MACH PHOI 6" BENH NHAN DOT cAP BENH PHOI TAC N G H £ N MAN TINH
T O M T A T
Muc tieu: Mo ts d|c diem lim sang, can lam sang TDMP 6 benh nhan dot cap COPD. Phu'dng phip: Nghien a ^ md ta cat ngang 21 benh nhan
"TOMP 6 benh nhSn dot cifp COPD tai Tmng tam Ho Hap- Benh vien Bach Mai. K i t qua: Tuoi trung binh:
68,8 ± 9,86. Dot cap COPD nang: 90,5% va 90,5% c6 2 2 dot cap. Kho tiid: 100%, tfm moi va dau chi:
90,5%, dau ngu'c: 8 1 % , phiJ: 61,9%, ddm mCi:
57,1%, sot: 38,1%. Dien dm: nhip nhanh xoang (90,5%), dau hieu S1Q3T3 (14,2%); (2) Khf mau: pH
> 7,45 (52,4%); PaC02 < 35 mmHg (15%), Pa02 <
80 mmHg (30%); (3) C3t Idp vi tinh da day dong mach phoi: gian phe nang (85,7%), gian phe qiian (81%), viem phoi (75,2%), tran dich mang phoi
^2,4%), xep phoi (47,6%). Ket luan: Trieu diutig lam sang TDMP diong lap vdi dot cap COPD, co the g|p cac bat thu'dng tren dien tim, khf m l u , cac ton thiftJng phS tren cat Idp vi ti'iih dong mach phoi.
WAAoa.'TDMP, dot dip COPD.
SUMMARY
CLINICAL A N D PARACLINICAL CHARACTERISnCS OF PULMONARY EMBOUSM I N CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS
'Benh inen €a Idioa Hai Dudng 'Bg mon H5is&e cSp cut/ - Dai hge YHa Ngi
^Bg mdn Ngi - Dai hoc Y Hi Ngi
^Tning tam Hd Hap - Binh viBn Bach Mai.
Oiju tradi nhiem diinh: Nguyen Quang DOi
&nail: [email protected]}m Ngay nhan bai: 29.10.2016 Ngay phan bien Idioa hpc: 9.01.2017 Ngay duyet b^i: 18.01.2017
NguySn Quang B v i , Ho^ng Bui H a i , Hoang Hong Thai^, Chu Tlii Hanh'*
Objective: To describe the dinicai, paradinical characteristics of pulmonary embolism in patients with COPD exacerbation. MeQiods: Cross-sectional descriptive study of 21 pulmonary embolism patients with COPD exacerfciation at the Respiratory Center of Bach Mai Hospitai. Results: The mean age: 68.8 ± 9.85. Often severe COPD exacerbations: 90.5% and 90.5% had > 2 episodes of exacerbation. Dyspnea (100%), purple lips and extremities (90.5%), chest pain (81%), edema (61.9%), pumlent sputum (57.1%), fever { 38.1%). (1) ECG: sinus tachycardia (90.5%), S1Q3T3 signs (14.2%), (2) blood gas: pH >
7.45 (52.4%), PaCOz < 35 mmHg (15%), PaO; < 80 mm Hg (30%); (3) CT-PA: Emphysema (85.7%), bronchiectasis (81%), pneumonia (76.2%), pleural effusion (52.4%), atelectasis (47.6%). Conclusions: • Clinical symptoms of pulmonary embolism overiap with those in ttie COPD exacerbation, may present many abnormalities on ECG, on blood gas, and on CT-PA.
Keywords: ftjimonary embolism, COPD exacerbation.
I. DAT VAN o l
TTiuyen tac huyet khoi tanh mach (TTHKTM) bao gom huyet khoi tmh mach sau (HKTMS) va tac^dong mach phoi (TDMP). Li nguyen nhan pho bien dulig hang tJiLf ba tnang so cac benh ly tim mach vdi ty le mdi mSc hang nam ioo - 200/100.000 dan. Ghi nhan tai 6 quoc gia thuoc lien hiep chau Au (2004), hdn 317.000 (tren din so 454,4 trieu nguifi) tru'dng hdp td vong lien quan den TTHICTM. Trong so liay co 34% tu*
vong dot ngot, 59% tLT vong la hau qua cCia TDMP khong du^c chan doan trong suot cuoc ddi, chi 7% TDMP dutfc chan doan dung tru'dc tu* vong. Trieu chiiVig cua TDMP thay doi rong.
VIETNAM MEDICAL JOURHAL N°1 • FEBRUARY - 2017 CO the bieu hien kho thd dot ngot, dau ngu'c kieu
mang phoi va ho. Tuy nhien, nhieu tru'dng hdp TDMP ldn cac trieu chu'ng Iai nhe, thSm chi khong trieu chiiYig [1]. Mot so yeu to nguy cd gay TDMP da du'dc ghi nhan, trong do COPD la yeu to nguy cd, chu yeu d cac tru'dng hdp ddt cap COPD nhap vi|n [2]. Hdn 30% ddt cap COPD kh6ng xac d'inh du'dc nguyen nhan ro rang. Hai phan tich gop ghi nhan ty le hien mac TDMP trong ddt cap COPD ti^ 16 - 20% [3]. Phat hien TDMP trong ddt cap COPD cd y nghTa lam sang quan trong vi ty le tu' vong dac biet cao, tuy nhien chan doan TDMP d benh nhan ddt cap COPD la mot thd thach vi su* chong lap cac trieu chCrtig. Nghien culi mo tu" thi ghi nhan ti le mdi mac TDMP d benh nhan COPD tu" 28 - 51%
nhu'ng khong du'dc chan doan tru'dc tu" vong [4].
Chung toi tien hanh nghien cub de tai nay nham rriuc deu mo ta dae diem iam sang, can iam sang TDi^P d benh nhan ddt cap COPD.
II. DOI TUPNG VA PHUONG PHAP NGHIEN COU DOI tu'cfng: Com 21 benh nhan du'dc chan doan xac djiih TDMP d benh"nhan ddt cap COPD, dieu trj npi trO tai Trung tam Ho Hap - Benh vien lit. KET QUA NGHIEN CO'U
l.Dac diem chung
Bang 1. Bac diem chung cua dg? tu'dng nghien cii'u
Bach Mai tij" thang 5 nam 2015 dgn thang 5 nam 2016. Thoa man cac tieu diuan lu^ chpn va loai tru' sau:
Tieu chuan chpn doj tu'dng nghiSn cihi:
Benh nhan du'dc chan doan xac djnh ddt dip COPD theo hu'dng dan cua GOLD; co ket qua xet nghiem D-dimer > Img/I FEU; du'dc chyp CLVT 64 day dong mach phoi co tiem thuoc can quang (Ct-PA) theo quy trinh cilia khoa Chan doan hinti anh - Benh vien Bach Mai. Ket qua chup CT-PA cd hinh anh huyet khoi trong dong mach phoi.
Tieu chuS'n loai truT: Dang dijng cac Ioal thuoc chong dong, dang cd lu'di igc tmh mach chu du'di, nhiJng benh nhan cd chlin thu'dng mdi hoac cac can thiep phau thuat vung ch$u, khdp hang, khdp goi, co cac benh ly ung thu" da biet.
Thiet ke nghien cuti: Nghien cu\j mo ta cat ngang, tien culj.
Xu" ly so lieu bang phan mem SPSS 16,0 va cac thu$t toan th5ng ke y hpc.
Dao dijTc nghlSn cCtu: Tat ca benh nhan deu ky cam VBL dong y tham gia nghiSn culJ, so IiSu nghien ciJu du'dc bao mat va chi phuc vu cho muc dich nghien culi va diSu trj.
Oac diem chung Tuoi (X ± SD) Gifli (Nam/Nin ( %) Hilt thuoc (c6/kh6nq) ( %)
So bao-nam (X ± SD) So ddt cap nam tru'dc {X ± SD)
So ddt cap nam tru'dc (%) Phan loai Anttionisen (%)
mMRC (%)
Phan nhdm GOLD (%)
Cac benh dong mac (%)
JMh$n xet: Juoi trung binh 68,8 ± 9,86
n = 68,8 ± 9,86
16/5 17/4 36,94 ± 10,92
2,43 ± 0,75
< 1
> 2 Typ 2 Typ 3
< 1
> 2 Nhdm A NhomB NhdmC Nhom D • Bai thao du'dnq Tanq huyet ap
Suy tim Suy vanh
Ac tinh 50-86); nam gap nhigu hdn
21
5 0 - 8 6 76,2/23,8
81/19 22-55 1 - 4
9,5 90,5 9,5 90,5
19 81 0 4,8 4,8 90,4 42,9 76,2 52,4 33,3 4,8 nu'; da so co hut thuoc; gap pho blen dot cap COPD nang, nhieu ddt cap, nhieu trieu chutig. Oai thao du'dng, tang huyet ap, suy tim ia cac benh dong mac thu'dng gap.
2. e^c diem ISm sang
142
TAP CHi Y HOC VIET NAM TAP 451 T H A N G 2 -SOI Bang 2. Bac diem lim sang
Sac di€m ISm sang Ran am, no
Khd thd Ri rao phe nanq qiam
Tfm moi, (Ku chi Ran rit, ngay .',. Dau nqu'c .11\ Co iteo cd ho hap i '-.. '-- Lonq ngu'c hinh thCtnq ' ' ' " • Gan to, tTnh mach co noi
Phu Khac ddm due
Sot
2017
n = 21
• 21 21 20 19 19 17 15 14 14 13 12 8
Vo 100 100 95,2 90,5 90,5 81 71,4 66,7 66,7 61,9 57,1 38,1 Nh$n xet: Dau ngi/c, Ichd thd, tieng ran d phdi, tfm moi- dau chi la cac trieu chu'ng gap pho ien. Mpt so tru'dng hdp bieu hien tinh trang suy tim phai.
3. ket qua xet nghiem Bang 3. Ket qui xit nghiem
Xet nqhiem 1 n = 21
MiSn dich D-dimer {mg/l FEU)
Fibrinogen (q/l) T^TT-hs (nq/ml) Pro-BNP (pmol/l)
5,3 ± 4,79 4,01 ± 1,48 0,05 ± 0,05 374 ± 4,18
0,82 -17,95 1,6-7,5 0,003 - 0,242
6,44 - 1614 Khi mau
pH
PaC02(mmHg)
PaOz (mmHg) HCO,-
SaO;
7,43 ± 0,09
<7,35 7,35 - 7,45
>7,45 47,5 ± 18,5
<35 35-45
>45 74,9 ± 23,5
>B0
<80 30,9 ± 7,14 94,3 ± 3,29
7,19-7,57 19 28,6 52,4 2 5 - 8 7
15 45 40 27 - 138
70 30 17-47,5 88,8 - 99,9 fiien tim
Nhip nhanh xoanq Sonq P phe
Suy vanh Block nhanh phai ST chenh len dVl-V4 i S103T3
Nqoai tam thu that Runq nhT
19 12 7 7 5 3 2 1 Nhin xit. (1) khi mau: pH > 7,45 (52,4%), PaCOz < 35 mmHg (1 2) Bien tim: Nhip nhanh xoang (90,5%), dau hieu S1Q3T3 gap 14,2%
4. Chin doan hinh anh
Bing 4. Ket qui chan doan hinh anh Chan doan hinh anh
Gian phe nanq Ken khi Viem phdi
X quang n = 21
11 3 13
52,4
%
14,3 61,9
90,5 57,1 33,3 33,3 23,8 14,2 9,5 4,8 )%),, Pa02 < 80 mmHg (30%
MSCT n = 21
18 13 16
85,7
%
61,9 76,2
) •
J
143
I
VIETNAM MEDICAL JOURNAL N°1 • FEBRUARY - 2017
U phoi Tdn thu'dnq md ke Tran khi manq phdi Tran dich manq phdi Gian phe quan Xd hoa CO keo
Xep phdi Tim hinh qiot nu'dc
Bdnq tim to Vdm hoanh cao mot ben
1 2 2 6 9 11
8 12 12 3
4,8 9,5 9,5 28,6 42,9 52,4 38,1 57,1 57,1 14,3
1 17 2 11 17 15 10
- - -
4,8 81 9,5 52,4 81 71,4 47,6
- -
Nhin xet: Cac ton thu'dng phoi thu'dng gap la gian phe nang, gian phe quan, viem phoi, tdn
-
thu'dng mo ke, xd hda co keo. Mdt sd tdn thu'dng bj bo sdt tren x quang thirdng quy.
iV. BAN LUAN
4.1 0 | c di€m Chung cua nhom nghiSn cdfu: Ddt cap la mpt bien co quan trpng trong diln tien cua COPD vi anh hu'dng tieu cu'c d^n chat lu'dng cudc song, anh hu'dng den trieu chulig va chlJc nang phoi mat nhieu tu3n de hoi phuc, d^y nhanh tdc dp suy giam chu'e nang phdi, chi phi tdn kem. TiJ' vong tai benh vien d b|nh nhan ddt cap COPD cd tang CO2 mau gay toan ho hap chiem khoang 10%, khoang 40%
sau 1 nam d nhu'ng benh nhan can thong khf nhan tao, ti^ vong do tat ca cac nguyen nhan sau 3 nam khoang 49%. Mpt sd tru'dng hdp cd xu hu'dng xuat hiin nhieu ddt cap va ddt cap nang, trong khi dd mpt so khac thi khdng. Nhifng ghi nhin > 2 ddt cap moi nam du'dc xic djnh la ddt cap thu'dng xuyen, mpt kilu liinh xuat hien dn djnh theo thdi gian [4]. Ket qua nghien cuXi d Bang 1 cho thay binh nhan thu'dng d nhdm tuSi cao, da so co hut thudc, chu yeu gap ddt cap n§ng, benh nhin cd nhieu ddt cap, nhiiu trieu chuTig, mpt sd binh dong mac gap phd bien niiu' daj thao du'dng, tang huyet ap, suy tim. Cac dac diem nay thu'dng thay d binh nhan ddt cSp COPD nhap vien, r§it khd de phin biit do ban than COPD hay do cac trieu chifng cua cac binh dBng mac trong dd co TOMP.
4.2 Dac diem lam sang: Ket qua Bang 2 cho thay cac trieu chu'ng lam sang thu'dng gip gom ho khac ddm, dau ngu'c, khd thd, tfm mdi va dau chi, tinh trang co that phe quan. Mdt s3 truSng hdp bieu hien cac dau hieu cua su)i tim phai nhu' phii, gan td, tinh mach cd ndi. Nhihig dac diem nay bleu hiin tinh trang mat bii trong ddt cap cua COPD. Bdt cap COPD gay tang nguy cd TTHKTM, hai phan tfch meta cho thay ty le TDMP trong ddt cap la 16 - 20% [3]. Do cd si}
chong lap cac triiu chu'ng, viic phan biet cac triiu chiJng cua ddt cap COPD vdi TBMP die biet khd khan. Cac hu'dng dan hien nay deu ihuySn cao dinh hu'dng chan doan TBMP duS tren danh
gia nguy aJ lam sang va xet nghiim D-dimer. Mot nguy cd iam sang thap (duS tren thang a&n Welis hoac Geneva) ka hdp D-dimer am tfnh cho pliep loai trir TDMP [1].
4.3 Ket qua xet nghiem: Ket qua dutlc dii ra d Bang 3. 6 nhihig benh nhan nghi ngS TBMP, cac xet nghiem nhu' khf mau ddng mach, cac peptide bai natri (BNP, pro-BNP, NT- proBNP), troponin, D-dimer, dien Hm, chup X quang ngirc nen du'dc thu'c hiin. Cac xet nghiem nay tuy khdng nhay va khdng dac hieu cho chan ddan TBi»IP nhung cd the giup iio trd chan doan va tien lu'dng. Xet nghiem D-dimer cd vai trd djc biit quan trong, neu ket qua D-dimer am tirih ket hdp vdi kha nang iam sang thap hoac trung binh cd the giup ioai trir TBMP mpt each an loan ma khdng can tien hanh them bit ky mpt th5m dd hinh anh nao [5]. Cd nhieu bien ddi tren dien tim lien quan den TBMP. Nhung 10 - 25% TBMP cd hinh anh dien tim hoan toan binh thuSng.
Phat hien ndi tieng nhat la dau hieu S1Q3T3, nhjp tim nhanh xoang la dau hiiu gap phd bien nhat. I>1pt so diu hiiu tren dien tim gdi y mifc dS tien trien cua t i n h hoac hoac xuat hiin cac bien chifng: dien the QRS thaii, bleck rihanh pliai (hoan toan hoSc khdng hoan toan), ST chenh ien d chuyen dao VI va thu'dng la bieu hiin co soc tim, cac roi loan nhjp nhT, md hinh gia nhoi mau (pseudoinfarcHon) (sdng Q sau) d cac chuySn d?d DIII- aVF, do?n ST thay ddi d cac chuyen dao tn/dc Hm trai [6]. PaOi thap d mot so benh nhan^nghi ngd TDMP cap da du'dc ghi nhan o5 gia W ho trd trong danh gia chan doan. Tuy nhien, TBMP cap CD the cd PaOj binh thu'dng.
4.4 Ket qua chan doan hinh anh: Kit qua du'dc chi ra d Bang 4. Mpt sd tdn thu'dng phoi cl binh nhan TBMP cd the gap nhu' viim phdi, gian phe quan, gian p h i nang, ken khf, tran djch mang phdi, bdng Hm to, cao vdm hoanh mot ben. Kit qua nghien cifu cDa chung tdi cho thSy X quang thu'dng quy bd sdt mpt so tdn thuttng
144
TAP CHi Y HOC Vl|T NAM TAP 451 - T H A N G 2 - S01 - 2017
phoi SO vdi CT-PA. Cac dau hieu X quang cua TDMP cap bao gom giam tu'di mau khu t r u , sung h u y ^ ben phoi bj ton thu'dng, gian cac dong mach ron phoi, vom hoanh cao mot ben, gian than dpng mach phoi, tran dich mang phoi, xep phoi, va tham nhiem phoi. £)6i khi gap cac ton thu'dng dang hang. X quang ngiTc t h i n g khdng giup chan doan xac djnh TDMP nhuYig co the ho trd loai tru* mot so b4nh cd bieu hien lam sang giong TDMP, chang han tran khi mang phoi, gay yaidng sudn. Hien nay, ky thuat chup CT-PA giup chan doan xac djnh TDMP va danh gia mu'c do nang TDI^IP, cac ton thu'dng phoi di kem [ 7 ] .
V. Kfr LUAN
Tac dong m a d i phoi thu'dng gap d ddt cap COPD nang, d benh nhSn tiSn su" c6 nhieu ddt cap, nhieu trieu chutig. Cac trieu ehufng lam sang gap pho bien gom dau ngu'c, kho t h d , ho khac ddm, tim moi va dau chi. K^t qua khi mau dong j j a c h cd the binh thu'dng, mot so tru'dng hdp cd 3 ^ ho hap. Nhjp nhanh xoang la dau hieu phd Dien tren dien t i m , dau hieu S1Q3T3 gSp t j ' Ie thap (14,2%). Cac ton thu'dng phoi pho bien tren CT-PA gom gian phe quan, viem phoi, tran djch mSng phoi.
TAI L l | U T H A M KHAO
Belohlavek J, Dytrych V, Unhart A. (2013).
"Pulmonary enbolism, part I: ^idemiotogy, risk fadrws and risk sbBtificadon, pathophyaok^, dinicai presentation, diagnosis and nonthrombotk; pulmmary embolism.". B(panCardid, 18(2): 129-138.
B0rvik T, Brsekkan S, Enga K, Sdiinner H, Brodin E, Melbye H, ^ al. (2016). "CX3PD and risk of venous thromboembolism and mortality in a gaieral populatron". Eur Respir J, 47(2): 473-481.
Aleva F, Voets L, Simons S, de Mast Q, van der Ven A, Heijdra Y. (2016). ''Prevalence and Localization of Pulmonary Embolism in Unexplained Acute Bcacerbations of QDPD: A systematic revievi/ and meta-analysis". Chest, Aug 11 (doi: 10.1016/j.chest 2016.07.034).
Andrejak C, Poulet C, Hoguet E, Magots E, Gosset M, Jounieaux V. (2012). ""Prevalence Of Pulmonary Embolism In COPD Patients Hospitalized For An Unesqalained VWieezing COPD Bacerbation".
AmJRespirCrtCateivied, 185; A5862.
Lankeit M, Held M. (2016). "Inddmce of v»)ous thromboembolism in COPD: linking inflammatkin and thrombosis?". Bjr Respir J, 47(2): 369-373.
Boey E, Teo SG, Poh KK. (2015).
"Bectrocardiographic findings in pulmonary embolism". Singapoie Med J, 56(10); 533-537.
Attia N, Seifeldein G, Hasan A, Hasan A.
(2015). "Evaluation of acute pulmonary embolism by sixty-fisur slice multidetector CT angiography: Correlation between obsbucHon index, right ventricular dysfunction and clinical presentation". The ^ypban Journal of Radtoiogy andNudearMedidne, 46(1): 25-32.
DAC DIEM LAM S A N G , CAN LAM S A N G VA PHAN LOAI MO BENH HOC UNG THir BIEU MO TUYEN PHE Q U A N THEO lASLC/ATS/ERC 2 0 1 1 Nguyin Van Tinh\ Ngfi Qu^ Chau^, Nguyin Van Hnug^
TOMTAT^®
Myc tieu: Nghi€n ajli d|c diem lam sang, can llm sang va phan loai mo benh hoc ung tht/ bieu mo tuyen (UTBMT) phg quan tineo lASLC/ATS/ERC 2011.
Doi tu'dng vd phtftifng phap nghign culi: tien cuti mo ta 157 binh nhan UTBMT phe quan dieu tri ^ i Trung t§m H3 Hap - Benh vien B?ch Mai tu"
01/01/2014 den 30/09/2015. Ket qiia: tuoi mSc trung binh 60,2 + 10,2; nam/nD'; 1,9/1; dac di^m ISm sang:
dau ngyt (89,8%), sut can (86,0%), ho khan (61,1%), kho thd (41,4%), ho mau (19,1%); d^c diem can lam sang: CLVT: kich tJii/6c u trung binh 34,4 +18,3 mm, ngoai vi (65,0%), bung tam (35,0%),
'BSnh vi$n 74 Trung udng 'Dal hge YHN, Binh vien Bach Mai Chiu b^ch nhi?m chinh: Nguyen VSn Tinh Email: [email protected] NgaynhSn bai:
Ngay phin bien Idioa hpc:
NgSy duy^t bai:
u d?ng dSc (58,0%). Phan b'p mo benh hpc: diijm nang (51,0%), nhu (13,4%), dac (10,2%), vi nhii (8,9%), lepedic (8,9%), nhay (3,2%), dang keo (2,5%), tE bao sang (1,3%), d|ng tiial (0,6%). Ket lu^n: Trieu chulng lam sang noi b|t: dau ngut, si!it cSn, ho khan, kho thd. CLVT: khdi u hay d ngoai vi, u dang khoi(43,3%), MBH phSn b'p chUm nang chiem cao nhc^, dang thai hiem gip. Co moi l i ^ quan glu^
cac phan b'p MBH vdi vj tri, hinh th^i khcB u.
Tur khoa: Ung tiiiT bieu mo hjy^n, lASLC/ATS/ERC
S U M M A R Y
CLINICAL, LABORATORY CHARACTERISnCS AND HISTOPATHOLOGY CLASSIFICATION OF
LUNG A D E N O C A R a N O M A W I T H lASLC/ATS/ERC 2 0 1 1
Objective: To study clinical, laboratory characteristics and histopathology classification of luno adenocarcinoma with lASLQATS/ERC 2011. Subje- and method: prospective study on 157 patien'
145