Y Hpc VlgT NAM THANG 4 - SO 2/2012 Trung tam Phong chdng HIV/AIDS tinh Cao
Bing (2010), Bao cao T6ng ket cdng tic Phong chong HIV/AIDS nBm 2006. 2007. 2008.
2009 vd 2010. Cao Bang.
Trung tam Phong chong HIV/AIDS tinh Sdn La (2010), Bao cao T6ng ket cdng tdc Phong
chSng HIV/AiDS nam 2006, 2007. 2008. 2009 vd 2010. Son La.
Trung tam Phong chdng HIV/AIDS tinh Lal Chau (2010), Bdo cdo T6ng k^t cdng tdc Phdng chdng HiV/AIDS ndm 2006, 2007, 2008.
2009 vd 2010. Lai ChSu.
NGHIEN CQU TAG DUNG KHONG MONG MUON VA BIEN CHlhJG TRONG HOA XA DONG THOn DIEU TRj UNG THlT HA HONG - THANH QUAN GIAI DOAN III, IVA,B (MO)
T 6 M TAT
Qua nghien ctitJ 60 benh nhan UTHH-TQ giai doan in-IVB khong phau thuat dupc ve tac dyng khong mong muon va bien chirng cua ptiac do hoa xa tri dong thdi chung toi nhan thay:
1. Tac dung khong mong muon cua phac do dp III, IV gom: giam bach cau 5%; bach a u hat 3,3%; viem da 56,6% (do IV 3,3%); viem niem mac hong mieng 23,3% (do in); kho nuot 8,3%; nuot dau 6,7%.
2. Bien chCrhg muon tren thi/c quan dp I I I 38,6%, cao hon hin xa tri ddn thuan nhUng chap nhan dUPc.
SUMMARY
Study on Sides effects and complications in concurrent chemoradiotherapy treatment of hypopharynx cancer patients stage IIMVB
A group of 60 unresectable hypopharynx cancer patients stage lll-IVB v^ere studied to determined unexpected results and complications of concurrent chemoradiotherapy. There were some findings as follow:
1. Sides effects Included' leucopenia 5%;
neutropenia 3.3%; skin burning 56.6% (degree IV 3.3%); dysphagia 8.3% and odinophagia 6.7%
2, Late complicationof eosophagus degree III was 38.6% as much higer as definitive radiation but that outcom was acceptable.
I.
OAT VA'No f
Ung t h u ha hong-thanh quan (LJTHH-TQ) la mpt benh phd bien trong cac UT dau - c d chi sau UT vdm mui hpng. Phau thuat la phUdng phap dieu trj chinh cho benh khi 6 GD mupn (lll-IVB) nhung de lai hau qua nang ne do phai eSt bo toan bp c d quan, dSc biet trong eae trudng hpp khdng eon m d diidc (khoang 25%)
* B&nhvi&nK
Phan bifn khoa hge: PGS.TS. Nguyin Thj Vinh Ha
B u i C o n g T o a n * , N g o T h a n h T u n g * tien lupng benh thudng xau. Hipn nay hoa - XT ddng thdi da trd thanh phac do thay the cho xa trj ddn thuan. Tuy nhien, nhung tac dung phu ci3a hoa trj va bien chilfng cOa xa trj con nSng ne nen ehi ap dung dupc tren BN the trang cdn tdt, cd chilfc nang tu:y' xUdng va gan, than binh thudng. Chfnh vi vay, chung tdi mudn tidn hanh de tai nay nham danh gia tac dung khdng mong mudn cCia hda tri va bien chifng ci!ia XT gia tdc dong thdi tren nhdm bdnh nhSn nay.
II. 0 6 1 TUpNG VA PHUONG PHAP NGHIEN CCTU 2 . 1 . D o i t i r p n g : G d m 60 BN UTHH-TQ giai doan lll-IVB khong m d dupc tai Benh vien K t y thang 3/2005 den hel thang 7/2008 dap yng cac tieu chuan sau:
• C o chan doan xac djnh md benh hpc la UT bieu mo vay; dieu tri lan dau; benh GD mupn khdng mo dupc (GD T N M theo AJCC 2002); PS = 1; ehyc nSng gan, than, tuj" xUOng binh thudng;
• T i e u chuan loai taf; BN khdng dap yng cac tieu chuan tren; cd benh ndi khoa nSng phdi hpp.
2.2. P h U d n g p h a p n g h i e n ctJu: Nghien c y u tien eyu mo ta tyng ca can thidp lam sang cd theo ddi dpe khdng ddi c h y n g .
- Xa tri n g o a i : May gia tde SIEMENS (phat tia X nang lupng 6MV va chum Electn^n 9- 12MeV). Tdng lieu xa vao u va hach vCing nguyen phat: 7.000cGy. D y phdng hach 5.000cGy. Phan lieu 200cGy/ngay, 5 ngay/tuan. The tfch XT:
Tnjdng chieu 2 bdn ed doi xyng bao ehijm toan bd u va chuoi hach cd cao, giijia. Mpt tn/dng cd thap to/dc ndi lien ti'nh lieu 6 dp sau 3 em cho
Y HQC VigT HAM THANG 4 - S6 2/2012
ntiQtig hach co thap chua di cSn.
- Ho4 trj: Cisplatin 30mg/m' diSn^tlch da truyen tinh mach ng^y thCf 1 cila moi tuan, trong 6 tuan.
• Danh gia tic dung khdng mong mudn vi bien chifng cOa diSu tn: trSn he tao huyet.
ngoai he tao huyet. h6 tiSu h6a vi c4c biS'n chimg muon do XT theo 5 mi/c do cCia Vifin UT quoc gia Hoa Ky (CTCAE).
Theo ddi sau diSu tn:
+ Tinh trang benh + Tinh trang bi§'n chCmg
III. KET Q U A V& BAN LUAN3.1. Giai doan benh theo T N M Bang 1. Xep giai doan TNIVI.
XCflys6ll$u:
- Xil 1^ s6' iiSu bSng phan mem tin hoc SPSS 15,0,
- Dung phudng phap Kapian- Meier de tinh thdi gian OS, thdi gian DPS.
- PhSn tfch ket qua theo phuonj phap thSng l(S y hpc: sOf dung phuong phap l<iem djnh Log- rani< test (trong phSn tich don ixSn) vi mo hinh hoi qui Cox (trong phSn tich da biSn) nhSm l<hao sat cSc ySu tfi liSn quan dfin t^ le OS vi DPS vii l(hoSng tin c$y 95% (p=0.06).
T T1 T2 T3 T4
N
n
%
n%
n%
n%
n%
N (hach) NO
4 6,7
13 21.7 17 28,3
N l
2 3,3
8 13.3
10 16,7
N2 1 1,7 2 3,3 11 18,3
8 13,3
22 36,7
N3 3 5 3 5 2 3,3
3 5 11 18,3
n 4 6,7
7 11,0
17 28,3 32 53,3
60 100.0
GO ill: 4; GB iVA: 45: GD IVB: 11: khfii u T3, 4 chiem 81,6%; hach N2.3: 55%.
3.2. Mo benh hoc Bang 2. Mo benh hoc
Vj tri u nguyen phat
Ha hpng
Thanh quan
Xoangle Th^nh hong ThUdng thanh mon Thanh mon Khflng phan dinh
n
%
n%
n%
n%
n%
n%
Mure biet hoa (do) Cao
5 8,3
1 1,7 5 8.3 11 18,3
vera 13 21,7 3 5
23 38,3
39 65
Kem 1 1,7 2 3,3
1 1.7 2 3.3
4 6.7 10 16,7
n 19 31,7 5 8,3
1 1,7 3 5 32 53,2
60 100
Tip md hpc vay bidt hoa vya (dp 2) chiem t^ l§ 65 %.
Y HQC VI$T HAM T H A N G 4 • SO 2/2012
3.3. Chip hinh dieu tri cua benh nhin NC Bang 3. Chap hanh dieu tri
So lan truyen Cisplatin
Chap hanh th6i gian tia
2 3 4 5 6 Dung (50-60 ngay) Gian doan (> 60 ngay)
n 1 1 5 7 46 42 18
%
1,7 1,7 8,3 11,6 76,7 70 30
76,7% BN tham gia truyen dCi 6 chu ky
tuan Cisplatin theo phac do 100% BN nang lieu hach cd sau bang chum electron an toan va XT du lieu; 30% bi gian doan thdi gian XT (> 60 ngay).
Do ap dung 2 phuong thyc dieu tri phdi hpp. t^ le tae dung khdng mong muon cung tang so vdi sd lieu NC cOa cac tac gia trudc day khi XTDT. Hau het cac NC cho thay mdt \^
le thap cda viec chap hanh phac do, qua dd anh hudng tryc tiep den ket qua dieu trj vi lien quan den tdng lieu thudc dupc sif dung. NC ciia Lau [1] sijf dyng cisplatin lieu thap, tdng
lieu 160mg/m^ nhUng eh? c6 54% BN tham gia dCi; cac tac gia sau nay sy dung cisplatin lieu eao nhu Ai-Sarraf, Herchen Horn [2], (lOOmg/m^ truyen cac ngay 1, 22, 43 cOa qua trinh XT) eung cho ty le truyen dO lieu ehl ty 55% den 75%. Thdi gian XT cung la yeu td dupc quan tam vi lidn quan den vide tai lap sd lupng te bao u ma din ddn de gay khang, hau qua la that bai trong dieu tri. V! vay viec sSn sdc BN tnJdc, trong va sau dieu trj la yeu to cue ky quan U'png. NC dat 76,7% thyc hien truyen dO lieu cisplatin, 100% xa dCi lieu tuy nhien cd tdi 30% BN bi gian doan keo dai ngay XT.
3.4. Danh gia cac tac dung khong mong muon Tren he tao huyet vd chCfc ndng gan, thdn
BC BCH Hem TC GOT GPT Ure Creatinin
B o i n 7 11 29 6 4 7 1 3
11,7
%
18,3 48,3 10,0 6,7 11,7 1,7 5,0
0 6 2 n 16 4 8
26,7
%
6,7 13,3
0 6 3 n 2 2
3.3
%
3.3 Bo 4 n
1
%
1.7
Ha BC dp 3 va 4 la 5%; ha BCH dp 3 la 3,3%; giam Hem dp 2 la 13.3%. anh hudng tren gan, than 6 dp 1 vdi ti Id thap.
Phae dd mang lai t | \6 tac dung khdng mong mudn thap hdn nhieu so vdi NC eda cac tac gia nu6c ngoai vdi t9 le cac dde tfnh dp 3. 4 thap va chap nhan dupc, dae biet khdng cd ddc ti'nh dp 2 trdn gan, than. NC Lau hda XT
vdi cisplatin lieu thap tuan 1 va 5 cd tdi 47%
BN phai nam vien sSn sdc vi anh hudng dde
ti'nh, Ngd Thanh Tung vdi phac do tUOng ty
eung gap 2 tnJdng hpp id vong vl suy tdy va
suy gan. T^ le dpc ti'nh dp 3, 4 trong NC phdi
Y Hpc VigT NAM THANG 4 • s 6 2/2012
hop XT vdl cisplatin lieu cao eda Adelstein r^t
cao 77%, Arlene 82%, Herchenhorn: 5,3% trdn he tao huyet. 7% trdn thSn va 45% cdn nudi
3.5. Ngoai he tao huyet
BJing 5. Anh hudng ngoai hd tao huydt
dudng. T^ Id dpc tfnh cang cao khi XT phdi hpp vdl phac dd da hda trj. Taylor [3] thay dde tfnh di kdm sd BN phSi nhap vidn.
Da Khfl midng M^'t vi gi6c Kho nuot Nufl't dau Viem n/m mieng Non Bu6n nfln ia chSy Rung t6c
O 9 I n 3 2 3 7 5 2 3 8 1 2
%
53.3 5 11,7
8,3 3,3 5 13,3
1,7 3,3
B 9 2 n 23 57 57 48 50 43 4 4
"/.
38,3 95 95 80 83,3 71,7 6.7 6,7
D 9 3 N 32 1 5 6 14
53,3
%
1,7 8,3 8,3 23,3
So 4 n 2
1 3,3
%
1,7
Viem da dp 3 chiem 53%. dd 4 3.3%; khd nuot, nudt dau dp 3 la 8.3%; viem niem mac mieng dp 3 la 23.3%, dp 4: 1,7%; ndn va budn ndn ehl d dp 1 va 2.
Dpc tinh lam dieu trj gian doan, anh hudng den tdng sd ngay dieu trj. Tae dung khdng mong mudn cda hoa - XT cao hon nhieu so vdi XTDT dupe thdng ke bdi Nguyen Tien Quang va Ngd Thanh Tung. Viem loet da vung XT, viem loet niem mac mieng, khd tuyen nudc bpt.
3.6, Bien chumg mupn
mdt vj giac... 6 XTDT chi d dp 1.2 vdi t^ le thap. Cd anh hudng dp 3 cCia hoa-XT trdn da vd nidm mae midng nhung chap nhan dupc, ngoai ra t^" Id cua dp 1. 2 cao gan gap ddi khi so vdi XTDT. Cae NC cda eac tac gia nddc ngodi it ghi nhan ehi tiet ty le cac dpc tinh nay ma ehl ghi nhan sd BN phai san sdc npi tni nhu nhan xdt eda Taylor.
Da IVIo dudi da Tuyen nudc bot TQ Thuc quan
0 6 1 n 42 25 34 21 20
73,7
%
43,9 59,6 36,8 35,1
O 9 2 n 15 32 23 36 15
26,3
%
56,1 30,4 63,2 26,3
B 9 3 n
22
%
38,6
Bien chiJng muon bS6 ] vi 2. Bien chCrng
thtfc quan do 3: 38,6%,
Qua theo doi thSy ty le cac bifin chumg muon cOa dieu trj bao gom dii nhu XTDT nhtmg v6i cac t^ ie gSp cao hdn hJn. Cac NC XTDT cila Nguyen Tien Quang, Ngo Thanh TCing cho thfiy tj' le cac bien ohiJng mufin chO yfiu cl do 1, cac bifin chCfng 6 do 2 t^ le < 20%
trong khi kfi't qua NC nSy ghi nhan cac t^ le bien ChiJng dfi 2 cao hon nhifiu. bac bifit vdi tuyfin nirdc bot cao gfip 2 lan. Leed va Alan cung ghi nhan bifin chifng cao ciia tuyen nUdc bpt, tuy nhifin, tac gia cho biet c6 su phijc h6i.
Bifin chijfng kho nufil do hep mieng thiJc qu5n
cDa NC tuong dfii cao chifim 38,6% b dfi 3, cao
han kfit qua cCia Wanter va Lee (21%), de giai
Y Hpe VIET NAM THANG 4 - SO 2/2012 quyet cac tac gia phai tien hanh nong mieng
thyc quan. D e han ehe bien chyng nay rat can den ky thuat XT nya chum tia, vi mieng thyc quan chfnh la diem giao nhau cda trudng chidu cho u va hach phia trdn vdi trudng hach cd thap ben du6i.
V. KET LUAN
Qua nghien cyu chung toi nhan thay:
1. Chi cd 76,7% BN truyen du 6 chu ky tuan Cisplatin theo phac do
2. Tac dung phu tren he tao huyet gom: Ha BC dp 3 va 4 ia 5%; ha BCH dp 3 la 3,3%; giam Hem dp 2 la 13,3%. anh hUdng tren gan, than d dp 1 vdl ti le thap.
3. Bien chung sdm: Viem da dp 3 chiem 53%, dp 4 3,3%; khd nuot, nudt dau 6o 3 la 8,3%; viem niem mac mieng 66 3 la 23,3%, dp 4; 1,7%; ndn va buon ndn chi 6 dp 1 va 2.
4. Bien ehutig mupn thUdng chi gap d dd 1 va 2 phd bien nhat la: Dp 1 tai da (73,7%), Tuyen nUdc bpt (59,6%), md d Udi da (43,9%).
5. Bien ehutig mupn chi gap d thUc quan vdl dp 3 la 38,6%. Bien chyng nay cao hdn han xa tri ddn thuan nhUng chap nhan dupc.
TAI LIEU THAM K H A O
1, Lau WH, Tung SY, et al November 27, 2003, Concurrent Chemotherapy and Radiotherapy for Organ Preservation in Advanced Laryngeal Cancer N Engl J Med 2003; 349:2091-2098 2, Herchen Horn (Dec. 2000). Metallic Nickel and
Certain Nickel Alloys. Cnteria for Listing Agents, Substances or Mixtures in the Report on Carcinogens. U,S, Department of Health and Human Sen/ices, National Toxicology Program
3, Taylor MG (2007). Response to therapy and outcomes in oropharyngeal cancer are associated with biomarkers including human papillomavirus, epidermal growth factor receptor, gender, and smoking, Intemational joumal of radiation oncology, biology, physics 2007;69 (2 SuppI): 8109-11.
DANH GIA TINH ON DjNH CUA TRU GOM SINH HOC TRONG P H A U THUAT THAY THE XOtTNG BAN DAP SAU 2 NAIVI
TOM TAT
Muc tieu: danh gia tfnh dung nap cua cd the, kha nang cai thien sii'c nghe do! vdi tru gom sinh hpc cay ghep tren benh nhan xdp xd tai.
Thiet ke nghien citu: Moi ciiu so sanh ngudng nghe tru'dc va sau phau thuat.
B$nh nhan: Thi/c hien nghien ciJti tren 40 ca xop xd sau phau thuat thay the xUdng ban dap
Can thiep: 28 ca nu' va 12 ca nam dUdc phau thu3t"thay the xu'dng ban dap bang tru gSm sinh hoc.
Danh gia ket qua phau thuat sau 2 nSm Ket qua: Tru gom sinh hpc (BST) da cho thay ti'nh an toan va hieu qua cai thien chu'c nSng nghe, khong co trUdng hdp nao thai giiep. Sau phau thuat ABG < 20 dB chiem t^ le 84,0%.
Ket luSn : Try gom sinh hpc thay the xUdng ban dap cQng dat hieu qua nhu cac tm thay the xUdng ban dap bSng cac chat lieu khac. Khong cd hien tUpng thai ghep, phuc hoi chiic nang nghe ciia tai gii?a sau khi cay ghep tren benh nhan xdp xd tai.
* ep mdn Tai mui hgng- Trudng DH Y Hd Npi Phan bien khoa hgc: PGS.TS. Nguyin Oinh Phiic
Cao Minh Thanh*
SUMMARY
SAFE AND EFFICIENT FOR STAPEDECTOMY WITH IMPLANTATION OF BIOCERAMICSTAPE
PROSTHESIS AFTER FOLLOWING 2 YEARS Objective: To evaluate safe and efficient the postoperative hearing results of Bioceramic stape prosthesis (BST) implanted patients otospongio.
Study design: A retrospective analysis of preoperative and postoperative hearing thresholds.
Patients: we studied 40 cases with otospongio treated by stapes surgery
Intervention: twenty eight women and twelve men had a stapedectomy with bioceramic stape prosthesis. After two years postoperative.
Results: the BSTs showed that it had safe and efficient for improving hearing function, no" case was rejected. In 84,0% of the patients postoperatve air- bone gap was less than 20 dB.
Conclusion: The bioceramic stape prosthesis as well as other matenals. It can be safely and
