Tinh khi thi vd ket qui budc diu phau thu&t n&i soi cat todn b& da ddy diiu (rj NguySn Hodng Bac \
Tmh kha thi va ket qua budc dau phau thuat noi soi cat toan bo da day dieu trj ung thu da day
Nguyen Hoang Bgc, Vo Duy Long, Nguygn Vu Tuan Anh, Nguyen Viet Hai, H6 Le Minh Qudc, Tong Pham Quang Trung
Benh vi#n Dai hoc Y Duoc TPHCM
TiJ khda:
Cat to^n b& da day, c i t da day noi soi, ung t h U d a d ^ y
Qja chi lien he:
Nguyen HoSng B i c , Benh vi&n Bai hoc Y DUQC TPHCt^
215 Hfing B&ng, q u | n 5, TPHCM Dign thoai, 0903669955 Email, [email protected]
Ngdy nh&n bai: 15/04/2016, Ngdy duy&t: 13/05/2016, Ngay chap nhan dang:
02/06/2016.
Torn tat
D^t vdn di: Phlu thuit noi sol cat ban phin diTdi da diy didu tri ung thif da day da du'dc chu'ng minh higu qui. Tuy nhien, dii vdi c i t toin bo da diy v i nao hach D2 bang phlu thuit noi soi con nhilu tranh cai v l mat ky thuit, cich thUc hien mieng noi v i kg't q u i vi mat ung thU hoc.
Phuong phdp nghiin cdu: Nghign ciJu 40 trUffng hdp carcinoma tuyen 1/3 giiia v i 1/3 trgn da diy du'dc phlu thuit ngi soi c i t toin bo da diy v i nao hach D2 tai Bgnh vign Dai hoc Y dUOc TPHCM tir 1/2010 d^n 2/2016. Dinh gii tinh kha thi v i cac ke't qui sdm sau mo.
Kit qud: Khgng c6 trUffng hdp n i o chuydn md m6. Thfti gian mi trung binh 248 phut. LiTdng m i u mi't trung bmh l i 46,3 ml. So IiTdng hach nao vgt dUdc trung binh l i 29,4 hach. Thdi gian nam vign sau md li 8,2 ngay. Co 2 trtfdng hdp tai big'n trong md bao gdm 1 tru'dng hdp rich dng m | t chu va I tnrdng hdp tdn thUdng dgng mach lich; 1 trUdng hdp hiin chiJng chiy man sau md 3 ngiy, Khong cd tnrcfng hdp n i o r6 mieng ndi sau md.
Bdn luqn: Phau thuit n6i soi cat toin bo da d i y v i nao hach D2 dieu tn ung thU da diy k h i thi v i an toan.
Evaluation of the feasibility and initial results of laparoscopic total gastrectomy treating gastric carcinoma
Nguyen Hoang Bac, Vo Duy Long, Nguyen Vu Tuan Anh, Nguyen Viet Hai, Ho Le Minh Quoc, Tong Pham Quang Trung
University Medical Center of Ho Chi Minh city
Abstract
Introduction: Laparoscopic subtotal gastrectomy with lymphadenectomy for gastric cancer is emerging in Viet Nam as the technique that may benefit for patients. But the controversy surrounding laparoscopic total gastrectomy involves whether the feasibility, performing the anastomosis and oncologic features results.
Material and Methods: Analysing the results of 40 patients with gastric cancer who was performed laparoscopic
Tap chi ph§u thuat npi soi va n0! soi Vi§t Nam (2016) So 2 - T^p 6: 44 -
Nguyen Hodng Bac va c&ng sq Tinh kha thi va kit qua bUdc dau phiu thuat not soi cat todn bd da day dieu tri..
total gasttectomy and lymphadenectomy D2 between Jan 2010 and Feb 2016 at Umversity Medical Center in Ho Chi Mmh city assessed early outcomes.
Results- No patient have to be converted to laparotomy. The mean blood loss was 46,3 ml and average operating time was 248 minutes, averaged number of retrieved lymph nodes were 29,4. The postoperation hospital stay was 8,2 days. There were 2 cases with intraoperative complications: 1 case had injuried common bile duct, the other had mjuried splenic artery. There was 1 case with postoperative haemorrhage. There were no fistula case.
Discussion. Laparoscopic total gastrectomy with D2 lymphadenectomy is feasible and safe.
Keyword: total gastrectomy, laparoscopic gastrectomy, gastric cancer
Dat viin de
Ung thtf da d i y l i mgt trong nhSng benh ly ac tinh thirdng gap nhi^t cua dtfffng tigu hoa [1], P h i u t h u i t cat da day va nao hach rgng rai l i lUa chon dau tign trong dieu t n triet d e .
N i m 1994, Kitano [5] b i o c i o iin d i u tign vi p h i u thuat ngi soi (PTNS) h§ trd cat ban phan du'di da day dieu tri ung thif da d i y giai doan sdm. Kd tti do, nhieu nghien ciJu [14] da chting minh PTNS cat b i n p h t n difdi da day cho ke't q u i ttfdng tuf so vdi md md v l mat ung thtf hoc. Hdn ni?a, cting vdi q u i trinh phat trien cua ky t h u i t ciing nhu dung cu p h i u thuit, PTNS cat b i n p h i n du5i da d i y d i n drfdc ap dung rong r i i v i i p dung cho c i nhiJng trUdng hdp ung thif da d i y giai doan tig'n tridn [14].
M i c du PTNS cat t o i n bd da day d i difdc b a o c i o l i n a i u tif nam 1995 [3], nhtfng v i n chtfa dtfdc c h i p t h u i n rpng rai nhtf PTNS cat b i n phan dtfdi da d i y . Nguyen nhin chlnh la do ky thu^t phau thuit khd khan, d i e biet l i khi thtfc hien migng nd'i thtfc q u i n - hong t r i n g cung nhtf n a o hach D2 tieu chu^n. Cho de'n nay, tren thg' gidi cung da cd v i i nghign ctfu ve van de n i y nhtfng sd ltfdng b e n h n h i n (BN) cl moi nghien cu'u cdn it [2][11][13], ke't q u i btfdc dau cho thi'y PTNS cat t o i n b6 da d i y k h i thi v i an t o i n , nhtfng kg't quk \ku d i i vd m a t ung thtf hoc chtfa dtfdc de c i p nhieu. Tai Vigt Nam, chi cd v i i nghien ctfu [6][12] d i n h g i i ve p h i u t h u i t md cat t o i n bd da day do ung thtf, chtfa cd nghien cd'u n i o ve PTNS cat t o i n bd da d i y . VI v i y , chiing tdi thtfc Men nghien ciJu n i y nham d i n h g i i tinh k h i thi v i an t o i n cda PTNS cat t o i n bo da d i y , nao hach D2
trong dieu tri ung thtf da d i y Ddi tUcing va phu'dng phap nghien cHu Phtfdng p h i p n g h i g n ctfu: tie'n ctfu, can thigp l i m sang
Do'i ttftfng nghign ctfu: NhiJng BN dtfdc chan doan carcmdm tuyg'n 1/3 trgn hoac 1/3 giffa da d i y CO chi dinh c i t t o i n bg da day trigt de dtfdc PTNS cat t o i n bd da d i y va nao hach D2 tai khoa Khoa Ngoai Tigu hda Bgnh vien Dai hoc Y Dtfdc TPHCM ttf thing 1/2010 dg'n t h i n g 2/2016. Khdng c6 BN n i o dtfdc hda va xa tri trtfdc p h l u thuit.
BN dtfdc p h i n lich c i c yeu td' bao g6m: mdi, gidi tinh, vi tri u, kich thtfdc u, giai doan theo TMN, thcfi gian p h i u thuit, phtfdng thiJc l i m migng ndi thtfc q u i n - hdng trang, ltfdng m i u mit, sd' hach nao v e t dtfdc, thdi gian trung tien va thdi gian nam vien. Cac tai bie'n trong md cung nhtf bie'n chlJng sau mo dtfdc ghi n h i n . Til vong do phau thuit dtfdc tinh trong vdng 30 ngay sau p h i u thuit.
Phi/ifng p h a p p h i u t h u a t
BN nam ngu'a vdi 2 c h i n dang, p h i u thuit vign chinh dtfng bgn p h i i , p h i u thuit vien phu diJng bgn trii v i ngtfdi c l m camera dtfng giiJa 2 c h i n BN. B i n dung cu v i dung cu vign dtfng ben p h i i hoac ben t r i i phau thuit vign chinh.
Chiing tdi dung 5 trocar, vdi, 1 trocar 10mm dtfdi rd'n cho kinh soi, 1 trocar 12mm d diim giao nhau giffa bd n g o i i cd thang bung p h i i va dtfSng ngang qua rdn dd p h i u tich va dat stapler v i 3 trocar 5mm dtfdi stfdn p h i i , dtfdi stfdn trii va hdng t r i i nhtf hinh.
Tap chr phau thugt noi soi vd r\&\ soi Vift Nam (2016} So 2 - TSp 6; 44 - 49
Tfnh khd thi vk kit qud budc d&u phiu thuat ndi soi cit loan bd da day diiu tn.. Nguyin Hoang Bic v;
T
Hinh 1. Vitri trocar
Cic thi phiu thuat:
Quan sit vi dinh gii tdn thtfdng gid'ng nhtf trong md md. Vgn thiiy trii gan bing dung cu ttf chg'.
Phau tich li'y bo toin bd mac noi Idn doc theo dai tring ngang tif dai tring gdc gan cho tdi gan cudng lich, cit b6 li trtfdc raac treo dai trang ngang vi Ii tnrdc bao tuy (ky thuat Bursectomy), thit bd mach vi mac nd'i trii tin gdc de nao hach nhom 4sb.
That cic bd mach vi ngin tan gdc vi nao hach nhdm 10.
That DM VI mac nd'i phii vi DM dtfdi ti tring sit chd phan nhinh cfla DM vi ti trang vi tinh mach vi mac nd'i phii ngay thin Henler d phia trtfdc diu tuy dd lly nhdm hach 6, Phlu tich cat li trtfdc bao tuy cho dg'n bd tren cua DM gan chung.
Cat mac ndi nho ra khdt bd trgn ti tring Dl de lly het nhom hach 5. Xe phiic mac dpc theo dng mit chu. Tir diy, nao hach trtfdc vi sau dng mat chu, dpc DM gan rieng vi tinh mach cO'a (nhdm 12a, d, p).
Thit DM vi ph^i tin gdc, lay toin bd mac nd'i nhd cho dg'n tru hoinh phai.
Cat ti tring dtfdi mdn vi 2cm bing stapler thing.
Nao hach titfcfc vi sau DM gan chung (nhdm 8a vi 8p).
That dpng, finh mach vi trii tin gd'c, nao hach quanh DM thin tang (nhom hach 7, 9). Nao hach doc DM lach de lay nhdm 1 Ip vi lid.
Nao hach nhdm hach I vi nhdm 2, Di ddng thtfc qudn cho ddn ming phdi. C^t cic thin kinh X vi mdt phan tru hoanh trai (de dg ding thtfc hign migng nd'i)
ThiTc hign mieng ndi thtfc quin - hong tring theo Roux en Y bing 2 kie'u nhtf sau:
Kidu 1: Ndi thtfc quin - hdng trang tan bgn bing miy khiu no'i vdng hoic bang tay qua vet md nhd dtfdng giffa tren ron. Qua dtfdng md niy lay bgnh phim vi thufc Mgn migng nd'i hgng tring - hdng trang.
Kieu 2. Ndi thtfc quin - hdng trang ben ben bang miy khiu ndi thang thtfc Men hoin toin qua PTNS.
Sau dd, md rdng vg't md trocar rdn de li'y benh ph^m vi thtfc hien mieng nd'i hdng tring - hdng tring.
Tat ci cic benh phim sau md diu dtfdc phiu tich de li'y het cic hach vi gu:i giii phiu benh.
Hinh 3 Sau ckt Xokn b^ da ddy
Tap chi phSu thu^t noi soi vk f\&\ soi Viel Nam (2016) S6 2 - TSp 6
Nguyin Hoang Bic vk c&ng su Tinh khd thi vd ket qui budc diu phau thu&t nqi soi cat loan bo da ddy di&u tn
Ket quS
Trong thdi gian tif thing 1 nim 2010 den thing 2 nim 2016, tai Khoa Ngoai Tigu hda Benh vien Dai hpc Y Dtfdc TPHCM cd 40 BN thda man cac tigu chuan nghign ctfu dtfdc thtfc hien PTNS cat toin bd da diy vi nao hach D2.
Giai doan dau tff 7/2010 - 12/2013 cd 9 trtfdng hdp
Giai doan sau tff 1/2014 - 2/2016 cd 31 trtfdng hdp.
Tudi trung blnh Ii 56, ldn nhi't Ii 68 tudi, nhd nh^t li 33 tudi, sd' ltfdng BN nam nff ttfdng dtfdng nhau.
Khgng cd trtfdng hdp nio chuydn md md.
Vl vi tri thtfdng tdn: Cd 7 BN (17,5%) thtfdng tdn a tim vi, 3 BN (7,5%) 6 phinh vi vi 30 BN (75%) d thin vi. Phin chia theo 3 phin da diy thi cd 24 trtfdng h<?p (60%) thtfdng tdn d 1/3 trdn da diy vi 16 trtfdng hdp (40%) 6 1/3 giffa da diy.
Cd 7 BN (17,5%) dtfdc nd'i thtfc quin - hdng tring tan - ben b^ng khiu ndi tay, 20 BN (50%) bing miy khiu nd'i vdng qua vg't md nhd giffa tren rd'n vi 13 BN (32,5%) cdn lai dtfdc nd'i thtfc quin - hdng tring bgn - bgn b^ng miy khiu nd'i thing thtfc hign hoin toin qua PTNS.
Cd 10 trtfdng hdp (25%) thtfdng tdn d giai doan T3 vi 30 trtfdng hdp (75%) d giai doan T4a.
Sd hach nao v6t dtfdc trung blnh li 29,4 hach (12 - 42). Cd 28 BN (70%) hach cd di can.
Dd bidt hda te' bio sau md gdm: 2 BN (5%) biet hda ro, 12 BN (30%) biet hda vffa, 16 BN (40%) biet hda kgm vi 10 BN (25%) te bio nhin.
Cd 2 BN phii c^t lich kdm theo do cd nhi^u hach viing rdn lich nghi di cin.
Mdt so' die diem khic:
Bkng 1 Cac d|c diem phau thuat khac
O t c diem Trung binh Nhd nhat Ldn nhat Kfch thudc u (cm) 6,5
Luang mau mat (ml) 46.3 Thdi gian mo (phut) 248 KhoSng cdch bd c i f 4,1 tren Idi u (cm)
Thdi gian cd tmng 2,2 tien (ngay)
Thdigian n§mvi$n 8,2 (ngiiy)
Khdng cd trtfdng hdp nao cdn te' bio ic tinh d bd cat tren.
Tit ck BN diu dtfdc ddng mom ta tring b^ng may cat thing, bang dan miu xanh dtfdng. Khdng cd trtfdng hdp nio xi, rd mdm ti tring sau md.
Cd 2 trtfdng hdp (5%) xiy ra tai bie'n trong md:
Trtfdng hdp thtf nhi't bi thung mat trtfdc d'ng mit chu 1 cm trong qui trinh nao hach rd'n gan. BN niy dtfdc phit hign trong md vi nong dng mit chu, dat dng dan Itfu Kehr 14Fr vio dng mit chii, tit ci dtfdc thtfc hien hoin toin bang phau thuat ndi soi.
Sau 3 thing dtfdc rdt d'ng Kehr vi chtfa thi'y hep dtfdng mat.
Tnrcfng hdp thtf hai chiy miu nhiiu trong Mc phlu lich nao hach nhdm 1 Id vi 10, cd lim rich DM lach gan rdn lich, mit miu trong md khoang 200 ml nen quyet dinh cit lich, cSng bang phau thuat npi soi.
Bien chiJng sau md cd 1 BN (2,5%) chiy miu trong d bung vio ngay hau phau thtf 3, dtfdc PTNS tham sat Iai, nhiftig khdng tim thay vi tri chiy miu.
BN niy dtfdc xui't vien sau do vio ngiy hiu phiu thff 14.
Khdng cd trtfdng hdp nio hue xi mieng ndi thtfc quin hdng trang, hdng tring - hdng trang hay nhidm khuan vet mo.
Tap chf p h i u thu^t n&\ soi vd n&\ so) Vifit Nam ( 2 0 1 6 ) 5 6 2 - Tap 6; 44 - 49
Tinh kha thi vd kil qui budc diu phiu thudt noi soi cat taan b& da day diiu tri — Nguyin Hodng Bic v.
Ban luan
Ung thtf da d i y Ii benh ly i c tinh thtfdng gap [1].
Tai Viet Nam, da so benh n h i n ddn bgnh vien d giai doan mugn do chiing ta chtfa cd chtfdng ttinh t i m soit ung thtf da d i y [6][12]. Trong nghien cffu cua chiing tdi, ta't c i benh n h i n diu n h i p vien d giai doan tidn tridn vdi kich thtfdc thtfdng tdn ldn, trung binh l i 6,5 cm v i 7 5 % c i c trtfdng hdp thtfdng tdn da xam l l n ra ldp thanh mac (T4a),
P h i u t h u i t c i t da d i y la phtfdng thtfc dieu tri ung thtf da day chu ye'u, va PTNS cung nhtf cac phtfdng tign ky thuit phit tri€n nhanh chdng da giiip ich nhieu trong q u i ttinh dieu tri ung thtf da day. Nhffng Idi ich cua PTNS d i dtfdc chffng minh nhtf: rut ngan thdi gian hdi phuc sau md, ltfdng m i u m i t it, it dau sau md, giam nguy cd dinh rudt, v i nhigm khuan vg't md. PTNS c i t b i n p h i n dtfdi da d i y do ung thtf da dtfdc chtfng minh an toan va hieu q u i ve m i t ung thtf hpc. Tuy nhign, tinh k h i thi, an t o i n cung nhtf kg't qua vi mat ung thtf hpc trong PTNS cat t o i n bd da d i y do ung thtf v i n con n h i l u tranh cai [2][3][4]
[7][10].
Ti Ig chuydn md md cua PTNS thtfdng lidn quan dg'n tai Men trong md. Chung tdi gap 2 trtfdng hdp x i y ra tai bien trong md nhMig d i u xu" til thanh cdng b i n g PTNS. Khdng cd tnrdng hdp nao chuyen md md trong nghien cffu cua chiing tdt. Vdi kinh nghigm md mS cat t o i n bd va PTNS c i t b i n p h i n dtfdi da d i y , chiing tdi chtfa chon nhffng bgnh n h i n giai doan T4b trong nghien cffu btfdc d i u n i y nen chtfa gap nhieu khd k h i n trong p h i u thuit. Ti le chuydn rad md cua Pugliese [7] l i 2%. Nguydn n h i n chuydn md md theo da so c i c t i c g i i l i do c h i y mau khdng kiera s o i t dtfdc bang PTNS [4][5][I1].
Thdi gian md trung binh c0a chiing tdi l i 248 phiit, ltfdng m i u m i t trung binh l i 46,3ml, thdi gian cd trung tign trung binh Ii 8,5 ngiy va thdi gian nam vien trung binh l i 8,2 ngay Kg't q u i cua chiing tdi ttfdng ttf nhtf c i c nghien ctfu md md cat t o i n bd da d i y trong ntfdc cua Vo Tan Long [12] trgn 30 benh n h i n thtfc hign nam 2008 vdi thdi gian md trung binh Ii 206 phiit, thdi gian h i u phau trung binh Ii
10,1 ngiy, Cac nghign ctfu phan tich gdp cung cho tha'y thdi gian md, ltfdng m i u mat trong md va thdi gian hdi phuc sau md cung kh6ng k h i c nhau giffa PTNS so vdi md mcf c i t t o i n bd da d i y [2][13].
Tinh an toan cua p h l u t h u i t dtfdc thd Men qua bidn chtfng sau md. Chiing tdi cd 1 trtfdng hdp chiy m i u sau md 3 ngiy v i dtfdc PTNS t h i m s i t lai nhtfng khdng tim tha'y diem c h i y m i u . Nguygn n h i n cd thd do chiy m i u tff tinh mach nhd v i d i ti^ cam, Khdng cd trtfdng hdp nao ro migng ndi v i tOf vong trong 30 n g i y sau rad. Ti le big'n chtfng sau rad md cua Vo Tifn Long [12] l i 6,6% vdi 1 trtfdng hdp rd tuy v i I trtfdng hdp tu dich n h i l m k h u i n . T i c g i i Nguygn Ctfdng Thinh [6] nghien cu'u 208 trtfdng hdp c^t toan bd da d i y , ti Ig bidn chffng Ii 14,4% (30 BN);
trong dd: xi mieng ndi 6 trtfdng hdp, i p xe tdn Itfu 4 trtfdng hdp, rd tuy 3 trtfdng hdp, tran dich mang phdi 6 trtfdng hdp. Ti Id tu" vong 1%. Bie'n chffng sau md cung khdng khac nhau giffa PTNS v i md md trong cac phan tich gdp [2][13]. Nhtf v i y PTNS cat toin bd da d i y an toan.
Ve phtfdng dien ung thtf hoc trong PTNS cat toin bd da d i y , so'hach nao vet dtfdc trong nghidn ctfu nay trung blnh la 29,4 hach, vdi 70% c i c trtfdng hdp cd di c i n hach sau md, khdng cd trtfdng hdp nao con tg' b i o i c tinh d bd c i t tren. Ke't q u i n i y phii hdp theo tidu c h u i n ciia Higp hdi Ung thtf da d i y Nhat B i n v i Hoa Kf vdi sd hach nao vet dtfdc trung binh it nhi't i i 15 hach. Sd' hach nao vet dtfdc trung binh ciia Tanimura [ U ] l i 34 hach v i khdng khac nhau giffa PTNS so vdi md md [2][13]..
PTNS cat t o i n bd da d i y , nao hach D2 l i 1 p h l u thuit khd, doi hdi phau thuat vien p h i i cd kinh nghiera ve PTNS v i mo md cat t o i n bp da d i y . Theo chiing tdi, khd khan nha't d 2 thi p h i u thuit:
nao vdt hach vung rdn l i c h (nhdm 10) v i doc theo D M lich (nhdra 11), v i thi thtfc hign mieng nd'i thtfc q u i n - hdng trang. Ve ky thuat l i m migng nd'i thtfc q u i n - hdng tring, chiing tdi thtfc hign theo 2 kieu l i t i n - bgn va bgn - bgn. Kidu tan - bgn b i n g khSu ndi tay hoac may k h i u ndi vdng CDH 25 qua vg't md nhd dtfdng giffa trgn rdn thtfdng khd hdn, dac bigt d
Tgp chf phau thu^t nfii soi va npi soi Vi§t Nam (2016) 3 6 2 - TSp 6; 44 - 49
Nguyin Hoang Bic va cong sq Tfnh khd (hi vd kit qui budc dau phiu thual n&i soi cat toan bo da day dieu tri
BN CO thinh bung diy md. Kidu nd'i bgn - bgn bang 2 miy khiu nd'i thang vi thtfc hign hoin toan qua PTNS de thtfc hign hdn, mieng nd'i rdng hdn so vdi nd'i tin - ben. Tit ci 2 kieu ndi deu khdng cd bid'n chffng xl rd mieng ndi.
Nam 2011, So va cdng stf [9] thtfc Men PTNS cat toin bd da diy, lim mieng nd'i thtfc quan - hgng tring tan ben bang khiu ndi tay toin bd qua ndi soi.
Tuy nhien, ky thuit niy khd khin, keo dai thdi gian nen chiing tdi chtfa thtfc Men.
Mic du chung tgi thtfc Men phau thuit niy tff nam 2010, nhutig trong 3 nam dau sd' ltfdng it (9 trtfdng hdp). Sau khi cd nMlu kinh nghiem vl PTNS cat bin phin dtfdi da day va nao hach D2, chung tdi thtfc Men nMlu hdn tff nam 2014. Thdi gian theo doi sau md da sd cic trtfdng hdp chtfa dii liu ndn trong ngMgn cffu niy chiing tdi cM danh gia chu ydu ve tinh khi tM vi cic kdt qui sdm. Chung tdi se ngMgn cffu ve thdi gian sdng cdn sau md 6 cac nghien cffu tig'p theo.
Ket luan
Qua 40 trffdng hdp ung thtf da day dtfdc PTNS cat toin bp da diy vi nao hach D2 triet de tai Khoa Ngoai Tidu hda Bgnh vign Dai hpc Y Dtfdc TPHCM, bffdc diu chiing tdi nhin thiy PTNS cat toan bd da day kem nao hach D2 khi thi, an toin vi higu qui.
Tuy nhien, can nghign ctfu thdi gian dii hdn vdi sd miu Idn hdn vi theo ddi liu dai de danh gia ket qui ve mat ung thtf hoc.
Tai lidu tham khSo
1. Global Cancer Facts & Figures 3rd Edition. Atlanta Amencan Cancer Society; 2015
2 Haverkarap L, Weijs TJ, Sluis PC et al (2013). "Lapa- roscopic total gastrectomy versus open total gastrecto- my for cancer a systematic review and meta-analysis", Surg Endosc, 27, pp 1509-1520
3. Huscher CG, Chiodim S, Recher A (1995), "Laparosco- py-assisted gastrectomy for cancer initial experience ".
International Gastnc Cancer Congress.Kyoto, Bologna:
Monduzzi Editors; p 1215-9
4 Jung HS, Seong 10, Han MY (2013), "Short-term out- comes of laparoscopic versus open total gastrectomy: a matched-cohort study". The American Journal of Sur- gery, 206, 346-351
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