Tgp chl Tai MQi Hpng Vi$t Nam - Volume (58-14). N°2 - Apr, 2013
NGHIEN CUtJ DAC DIEM TON THlTOfNG TREN CT SCAN CUA UNG THU* BIEU MO VAY Cf MUI XOANG
Phan Thanh BIT", Li Cong Bjnh*, Tong Xudn Thdng*, Nguyin Binh Phuc*
T6M TAT
Chdn dodn ung thu mUi xoang dua vdo lam sdng. dgc bi^t tren CT scan cho phep xdc dinh Ion thuang lan rpng. phd hiiy xuang Mgc tieu:l) Mo td ton thuang tren CT scan. 2) Ddi chiiu chdn dodn giai dogn trin CT v&i lam sdng cua ung thu bieu mo mQi xoang. Boi tirffng vd phirffng phdp NC: 32 b^nh nhdn chdn dodn xdc dinh UTBMMX. dieu tri tgi benh vien TMH TU'.Nghien cuu md Id timg truang hpp, tien cuu. Nghiin ciru npi soi, CT Scan mm xoang, Ket qud vd bdn lugn: Tren phim CT, hinh dnh ma toan bp mpt bin hoc mui 46,8%, hinh dnh phd huy xuang vdch mUi xoang 53,1 %, phd huy thdnh ngodi xoang hdm 37.5%; phd hiiy sdn d mdt 31.2%; phd va Iran sdng 15.6% vd phd huy vdch trong d mat 21,8%. Ket lugn: Mat dp khdng dong nhdt 68,7%, ngdm thudc cdn quang nhieu 51.3%.
Tir khda: Ung thu mUi xoang, CT scan.
SUMMARY
This article is about a lesion of cancer nasosinusal on the CT scan. Ojective : The description a lesion on the CT scan and comparesion with the clinical of the cancer naso- sinusal Materials and Methods: Case study of 32 patients operateds at Hospital ENT central (2011-2012). Diagnostic clinical,CT scan, histopathologics of HE, PAS and immuno-histopathologic. Results and discussions: the lesion ofunisinusal 46,8%, destory the wall nasosinusal 53.1%, destory the maxillilary sinus 37,5%; destory the floor of the eye 31,2%; destory the floor of the ethmoidal sinus 15.6% and destory the wall of the eye 21,8%. Conclusion Hyper- dence 51,3%, cloudy 68.7%.
Key words: CT scan, sinusonasal Carcinoma
1. DAT VAN DE tdi tien hdnh nghien cuu dl tdi: ^Nghien Ung thu hic mui vd cdc cac xoang ^ ' ^ ^^^ ^^^^ '^« ' * " ^ 5 "•^« <^^*^?« '^"'^
canh mui gap khong nhilu, chi chilm ""« '*"" *'^^" '"^ ' " " ' •^'""'^" ' ^ ^ ^"^
khoang 0,2- 0,8% ting si cac ung thu (UT) ^^^ ^'^"•
noi chung vd khoang 3% cac ung thu vung /. Mo td tdn thuang trin CT scan dau CO. Chan dodn xdc djnh phdi 6 mo benh 2. Ddi chiiu chdn dodn giai dogn tren CT hpc. Chan dodn lan trdn phai dua vdo vao vai Idm sdng cua ung thu biiu mo mui lam sang, ddc biet tren CT scan cho phep xoang.
xac dinh tin thuong Ian rpng, phd huy noTTlfONr VAPHirfTNrPHAPNC xuong. Xuat phdt tir nhung ly do tren, chiing ^- **"^ ^^^^ ^^ PHUONG PHAP NC
2.1. Doi tuong. Gdm cd 32 benh nhdn da ] Dai hoc Y Ha Npi duoc chan dodn xdc djnh Id UTBMMX,
"' B?nh vien Bach Mai Nhan b^i 21.2. Duyet in 5.3.2013
Tap chl Tai Mui Hpng Vi j t Nam - Volume (58-14). N°2 - Apr, 2013 diSu tri tai b$nh vien TMH TU tir 2010-
2012.
2.2. Phirong phap. Nghien ciiu mo ta timg trucmg hop, tien ciiu.
Nghien ciiu lam sang: Npi soi, mo benh hpc thuong quy
CT Scan miii xoang. Chup 2 txr thS coronal, axial va dimg lai sagital, c6 va khong tiem thuocs can quang. Di x&c dinh do ma, mat dp, miic dp phd huy tren phim.
Xu ly sac xuit thSng ke y hpc.
3. KET QUA
3.1. Mot so dac diem lam sang 3.1.]. Phan bo b^nh nhan theo nhom tudi
Bangl. PhSn bo b^nh nhan theo nh6m tuoi Tuoi
So lu'ong Ty 16 %
20-40 3 9,4
41-60 22 68,8
>60 7 21,8
T6nq so 32 100,0 Tuoi thap nhat trong nghien cuu ndy la 28, cao nhdt la 83 tuoi. Tudi tnmg binh la 57 ±11,2.
3.L2. Phan bo benh nhdn theo gi&i Nam gidi chiem 68,7%, nii 10 chilm 31,3%. Tyle nam/nu la 2,2/1.
3.1.3, Hinh thdi ton thuffng thuc the trong hdc mUi qua ndi soi
Bang 2. Hinh thdi tin thuong khoi u qua n$j soi Hinh thai
S6 luong T9 le %
Thi sui don thuan
24 75,0
Thi siii, k6m polype
8 26,0
N 32 100,0
l$ch vach ngSn sang ben d6i dien 12,5%, kh6i u con khu tni a khe giira 15,6%.
3.2. Dac diem ton thirong tren cat lop vi tinh.
3.2.1. Ton thirong tren phim CT Scan Being 3 T6n thuang xoang trfin phim CT Scan
T6n thuong IVIQi vd xoang sdng don thuin
MQi vd xoang sdng hdm MQi vd xoang sdng, hdm, bu6m
Todn bo hoc mQi vd tat ca cdc xoang SHTB
Tong s6
S6 luong 3 9 5 15 32
791$ % 9,4 28,0 15,6 46,8 100,0 Hinh anh mo toan bp h6c mui 46,8%;
xoang sang don thuin 9,4%. T5n thuong xoang sang va ham 28,0%, sang ham buom mpt ben 15,6%.
Bang 4, Cdc vi tri xuong bi pha huy trfin phim CT Scan(N=32)
Phd huy xuong Vdch mui xoang Sdn 6 mSt Vdch trong 6 mdt Thdnh ngodi xoang ham Thdnh trub-c xoang hdm Vdch ngan mui Vdch sdng bub-m Thdnh sau xoang hdm TrSn sdng
So luong 17 10 7 12
4 4 5 4 5
Ty IS % 53,1 31,2 21.8 37,5 12,5 12,6 15,6 12,5 15,6 Khdi u da chiem toan bd hdc mui 84,4%,
u sui de chay mdu 75%, thdm nhiem, ddy Phd huy vdch miii xoang 53,1%, thanh ngoai xoang hdm 37,5%; san 6 mdt chiem
15
Tjp chl Tai MQl Hpng Vl$t Nam - Volume (58-14). N°2 - Apr., 2013 31,2%; tran sang 15,6% vi thanh trong 6
mat 21,8%.
Bang 5. Mdt 30 vd dO ng4m thu6c cin quang trSn CT Scan (N=32) B5c a i l m trdn CT
Mdt ad (dO m&)
BO ngam thuOc cdn quang
D6ng nh6t KhOng aOng n h i t
N h i l u It KhOng
ngam n 6
26
30 2
0 T y l «
%
18,7
81,3
93,6 6,4
0,0
Mat dp khong ding nhat 68,7%, ngam thulc can quang nhieu 51,3%.
3.2.2. Phdn logi giai dogn benh Bang 6. Phdn logi b§nh theo giai doan S
So luonq Tyl$%
SO
0 0,0
S I 0 0,0
S I I
0 0,0
S III
28 87,5
S IV A 4 12,5
S IVB
0 0,0
Trong nghien cuu nay khong gap cdc BN d giai doan 1 vd 11; giai doan 111 ggp 87,5% con giai doan IVA gdp 12,5%.
4. BAN LUAN
4.1. Ve cac ton thuong tren phim CT Scan cua ung thu mui xoang
Kit qua nghien cuu chua chiing toi cho thdy: Hinh dnh ton thuang md toan bp hdc miii va cdc xoang chiem ty le cao (46,8%);
bieu hien su xam lan phd huy nhieu do khdi u d hoc miii tdi cdc xoang canh miii, xoang
sdng don thu4n cd 3 BN chiem 9,4%. Tin thuong md ca xoang sdng vd ham cd 9 BN chilm 28,0%. Ton thuang md sang ham budm mpt ben cd 5 BN (15,6%).
Trong nghien cihi cdc ung thu vung dau CO ndi chung, cdc ung thu mui xoang ndi rieng, chin doan hinh anh d6ng vai tro het siic quan trpng, ddc biet Id phuong phdp chyp phim vimg tdn thuong. So vdi phim XQ kinh dien, phim CT Scan cd nhilu uu diim. Hai tu thi chup thudng dung dl ddnh gid muc dp lan trdn cua ung thu mui xoang la tu thi Axial vd tu the Coronal. Tu thi Coronal cho phep ddnh gid tdt ve cdc t6n thuang trong xoang, cdc moc gidi phau nhu manh sang, bd trong vd bd dudi ciia 6 mat, Clia cac xoang, dac biet Id xoang sang va xoang ham. Tu the nay rat quan trpng trong ung thu mui xoang, cho phep ddnh gia sir xam Idn, de day ciia u vdo cdc thdnh 6 mdt, thdnh ngoai hoc mui, nen sp, khdu cdi la cdc hudng lan co ban ciia loai ung thu nay.
Cdc Idp cdt theo tu the ndy can dupe lay tu bd trudc xoang trdn den bd sau cua xoang budm vdi tu the chup benh nhdn ngiia co toi da. Trong ung thu miii xoang, tu the Axial cung co mpt vai trd quan trpng nhat Id doi vdi cdc ton thuang lan theo chieu trudc sau: cdc tdn thuang lan ra mat trudc xoang hdm hay phia sau xoang budm, xoang sang. Them niia, trong cdc trudng hpp benh nhan khong thi ngua dau hit cd nhu truong hpp benh nhan cd ddt dng npi khi quan, benh nhan cd di tat d dot song, ciing nhu co tin thuang c6t song co ... vi^c chup bdng tu the Axial sau do co thi dung
Tap chf Tai MQI Hpng Vi$t Nam - Volume (58-14), N°2 - A p r . 2013
hinh lai tu thi Coronal neu cdn. Cac hinh dnh tren phim c6 thi cho thdy u tu khi cdn rat nhd, nhd do ta cd the chan dodn benh d giai doan sdm. Khi u da phat trien, tren phim giiip ddnh gid chinh xac vi tri u cdn khu tni d mdt xoang hay da lan tran sang cdc CO quan ke can, nhat la khi chua co cdc trieu chumg bien dang d mdt hay co cdc trieu chiing tren 1dm sdng. Md ung thu xam Idn chi de day cdc thdnh xuong hay da dn mon, phd huy cdc thanh xuong ciia xoang (vach mui xoang, thanh trudc, thdnh sau, thdnh ngodi, thanh trong xoang hdm, xuong gidy, sdn d mat, trdn sang...). Nhung tdn thuong ndy thudng khdng ro tren phim XQ thong thudng d giai doan sdm. Tren phim ciing giiip ddnh gia hinh dnh pha vd mpt hay nhieu vach xuang cua cung mot benh nhan. Tren phim ciing co the quan sat dupe su thdm nhiem, xdm lan cua u vao cac tl chiic xung quanh nhu ho chan budm ham, 6 mdt, xoang budm, vdo nao. Ti le benh nhan ung thu mui xoang cd chup phim CT Scan tang nhanh. Thdi ky 1991 - 1996 ti le benh nhdn ung thu mui xoang c6 chup phim CT Scan khoang 17 %, thdi ky 1996 - 2001 ti le ndy khodng gdn 43% vd hien nay tdt cd cdc benh nhdn ung thu mui xoang deu chup phim CT Scan. Trong nghien cuu nay, khi phan tich cac hinh dnh tren phim CT Scan cho thay: Hinh dnh phd buy xuong trong ung thu mui xoang nhilu nhat Id vdch miii xoang vdi 17 BN chilm 53,1%, phd huy thdnh ngodi xoang ham chilm 37,5%;
10 BN CO hinh dnh bi phd hiiy san d mdt chilm 31,2%; pha vo trdn sang chilm
15,6% va pha huy vdch trong d mdt chilm 21,8%. Hdu het cdc u deu cd dp ngdm thudc tot nhung ty trpng khong ddng nhdt 1^ chilm da si (68,7%). Ket qud nghien ciiu Clia chiing toi ciing tuong t\r nhu ket qua nghien cuu ciia Phiing Quang Tuan [6].
Trong nghien cuu ciia chiing toi, hdu het b?nh nhan den kham d gia doan mupn, da lan tran nen rdt khd ddnh gid chinh xdc vi tri nguyen phat.
4.3. Ve chan doan giai doan
Trong nghien ciiu ciia chung toi, chi co 5 trudng hap u con khu tni d khe giira, 23 trudng hpp u lan tran todn bp hoc miii, thdm nhilm vao vdch ngan va 4 trudng hpp lan rpng ra cdc xoang. Nhu vdy, xep giai doan theo kich thudc u, co: 5 trudng hop d T2; 23 trudng hpp d T3 vd 4 trudng hop d T4. Ting hpp cac yeu to tren, chiing toi co 87,5% so benh nhdn d giai doan III va 12,5% sd benh nhan d giai doan IV A, khong gap benh nhdn ndo d giai doan 1 va II. Kit qud Clia chiing toi ciing phii hpp vdi ket qud nghien cuu cila mpt so tac gid nhu Le Van Bich, Pham Khanh Hod [1], Vu Cong True [7], Popovic 17] va Greene FL [10], theo cac tdc gid nay, si benh nhan ung thu miii xoang d giai doan T3, T4 chiem 83%. Nhung trudng hop u cdn khu tni it gap, thudng chi vo tinh phdt hien dupe khi benh nhdn dupe chan dodn Id viem da xoang man tinh vd dupe md xoang de gidi quylt vdn dl dan luu nhung do co hinh anh tin thuong nghi ngd ung thu va 1dm chan dodn MBH xac dinh.
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Tgp chl Tai MQi Hpng Vi$t Nam - Volume (58-14). N°2 - A p r . 2013
5. KET LUAN
Tren phim CT, hinh anh md todn bp mpt ben hoc miii 46,8%, hinh dnh phd hiiy xuong vdch miii xoang 53,1%, phd huy thdnh ngodi xoang hdm 3 7,5%; phd hiiy sdn I mdt 31,2%; phd vd trdn sdng 15,6% vd phd hiiy vdch trong d mdt 21,8%.
TAI LIEU THAM KHAO 1. Le Van Bich, Pham Khanh Hoa (1969),
"Nghien cuu tren 60 u dc tinh sdng hdm g^p tai khoa TMH benh vien Bach mai tir 1960 -1968", Npi san TMH sd 12.
trang 73 - 79.
2. Nguyen Manh Cudng (1978), "Nhiing bieu hien Idm sang, to chirc benh hpc, dien quang ciia 52 trudng hpp ung thu bieu mo khdi sdng ham", Lugn vdn tot nghiep chuyen khoa IL
3. Tran Thi Hpp (1996), "Gdp phan chdn dodn va dieu tri ung thu sang ham. Nhdn xet qua 174 ca ung thu sdng ham tai vien TMH va Vien K Ha Ndi" Ludn dn chimin khoa II (Chuyen nganh ung thu).
4. Nguyen Cdng Thanh (1991), "Mdt sd nhan xet ve ung thu sang ham tai Vien Tai Mui Hpng tir 1986 - 1990", Lugn vdn tot nghiep bdc sy npi tru benh vien.
5. Le Trung Thp, Biii Thj My* Hanh, Nguyen Cdnh Hipp (2011), Ddc diim ung thu sang hdm, Y hpc Thdnh pho Hd Chi Minh, so 2, phy bdn tap 15,29-35.
6. Phiing Quang Tu4n (2009), Nghien cuu d^c diim lam sdng, chan dodn hinh dnh vd md bpnh hpc cua ung thu sang ham.
Ludn vdn Thgc sT. Dai hpc Y Hd Npi.
7. Vu Cdng Tryc (1996), " Gdp phdn tim hilu dich te hpc, chan dodn ung thu sang hdm vd mpt so tdc nhan sinh benh lien quan", Ludn vdn tot nghiep Thgc sp y hpc.
8. American Joint Committee on Cancer (2005), AJCC Cancer Staging Atlas.
Springer
9. John C Sok, Francesca M CoppeUi, Suhi M Thomas et al (2012), Mutant Epidermal Growth Factor Receptor (EGFRvIll) Contributes to Head and Neck Cancer Growth and Resistance to EGFR Targeting. Clinical Cancer Research, 18(21).
10. Shailaja Kalyankrishna and Jennifer R.
Grandis (2006), Epidermal Growth Factor Receptor Biology in Head and Neck Cancer. American Society of Clinical Oncology.
