Y Hpc VI$T NAM THANG 2 - s 6 1/2013 Nguyen V. Hung; T.A.T., L.T.T.T., Nguyen T.
Nga, Vu V. Giang, Nguyen V. Ha, Pham L.
Tuan, Tran Quy. Prevalence of and relative factors for nosocomial infections in some hospitals in the north of Vietnam, 2006-2007.
Journal of clinical medicine 6 (2008).
Phuong, D.M. Quality issues in resistance testing and data in Vietnam (Presentation in the 1st GARP's workshop) (2009).
http://wvm.cddep.org/tools/quality_issues_resist ance_testing_and_data_vietnam.
NGHIEN CUU THffI GIAN S 6 N G THEM UNG THIfTRlA; TRANG 1/3 TREN Dime PHAU THUAT NOI SDI TRIET CAN
j6fA TAT
Nghien ciTu thdi gian song them va tinh trang tai phat sau mo ciia 62 benh nhan ung thu tn/c trang 1/3 tren (27 nu', 35 nam, tuoi trung binh 60,17±13,27), dUOc phau thuat npi soi c3t true trang tnet c3n, tai benh vien 108 tir 1/2006 den 12/2012. Oa sd benh nhan d giai doan muon: 54,8% giai doan I I I , 83,9%
khoi u T3, T4 vdi kich thu'dc 4,06±l,59em, 59,6% di c3n hach. Thdi gian phau thuat 108,79± 23,99 phut, hau phau 12,76 ± 6,04 ngay. Khong eo tir vong phau ttiuat, ty le tai bien 1,61%, bien chuhg 8,06%, ehuyen mo md 9,67%. Thdi gian theo doi tmng binh 41,60± 10,80 thang, 14,49% eo tai phat tai cho hoac di can xa, 9,67%
da tir vong. Thcfl gian song tmng binh !a 62,4±3,5thang.
Ty le song tich IDy sau 1, 2, 3, 4, 5 nam la 98,0%;
92,7%; 87,9%; 79,9% va 63,9%. Ung thU tn/c trang 1/3 tren la vi tri thuan lOi de thu'c hien phau thuat c3t tn/c trang npi soi triet can. PhUdng phap eo ty fe thanh cong cao, an toan, khong anh hUdng den ty le tai phat tai cho va kha nSng song sau mo.
*Ti/' khoa: ung thu" tru'c trang 1/3 tren, phau thuat noi soi, thdi gian song them.
ABSTRACT;
Study survival time after laparoscopic radical surgery of upper third rectal cancer
To study survival and recurrence postoperative status of 62 patients with upper third rectal eancer(27 male, 35 female, mean age 60.17 ± 13.27 ), after laparoscopic radical treatment at 108 hospital from 1/2006 to 12/2012. Most patients in advanced stages:
stage III 54,8%, 83.9% tumor T3, T4 with 4.06 ± 1.68 cm size. 59,6% of lymph node metastasis.
Surgical time 108,79 ± 23.99min, postoperative time 11.76 ± 6.04 days. No surgical mortality, incidence rate 1,61%, postoperative complications 8,06%, conversion rate to open surgery 9,67%. Median follow-
* Benh vien TW Quan doi 108; * * Benh vien 103 Phan bien khoa hoc: PGS.TS. Nguyin Van Xuyen
Nguyen Anh T u a n * , Ho^ng VSn A n * * up time 41.6 ± 10.8 months. 14.49% with local recurrence or distant metastases, 9.67% were dead.
Median survival time was 62.4 ± 3.5 months. The cumulative survival rate after 1, 2, 3, 4, and 5 years was 98.0%; 92.7%; 87.9%; 79.9% and 63.9%. Upper third rectal cancer is a favorable position to perfomi laparoscopic radical surgery. The method has a high success rate, safety, does not affect the rate of local recurrence and sun/ival after surgery.
* Key words: Upper third rectal cancer, Laparoscopic Surgery, Survival.
I.
OAT V A No f
Ung thu- tru'c trang (UTTT) la benh ly ac tinh pho bien. UTTT 1/3 tren chiem tren 50 % cac tru'dng hdp UTTT. Day la vi t r i thuan Idi de ap dung phau thuat ngi soi (PTNS) cat tri/c trang tnet can, vdi ty le phau thuat thanh cdng cao hdn cac vj tri khac. ChuS cd cac nghien culi danh gia thcfi gian song va ty le tai phat tai cho ciia UTTT 1/3 tren sau phau thuat triet can. De tai nham nghien aili thdi gian sdng them, tinh trang tai phat sau FTTJS dieu trj triet can LfTTT 1/3 tren va xac djnh mS lien quan vdi mot sd yeu t d tien lu'dng.
II. o 6 l TUpNG VA PHaONG P H A P NGHIEN COU 2 . 1 , Odl tu'dng nghien cu'u
Nghien cuTu tren 62 BN UTTT, tuoi trung binh 60,17 ± 13,27 (27-82 tuoi), du'dc PTNS cat tri/c trang tai benh vien VjQO 108, tir 1/2006 den 6/2012 va theo doi den 12/2012.
2.2. Phu'dng phap
BN du'dc Chan doan xac djnh b l n g noi sol, sinh thiet. Chi dinh phau thuat khi chu^ cd dau
Y HQC V l | T NAM T H A N G 2 - SO 1/2013
hieu di can xa va khoi u con kha n3ng cat bo.
Phau thuat du'di gay me npi khi quan, BN nam tu"
the san, sir dung 4 trocart, ap li/c 6 bung 12mmHg. Ogng mach mac treo trang du'di du'dc that cao hoac thap. Mac treo tri/c trang du'dc cat 5 cm each bd du'di khoi u. Bao ton ed that bang mieng noi dai trang tri/c trang vdi may noi EEA 29-31mm. Dieu t n hda chat sau mo theo phac do FUFA hoac FOLFOX 4 . Theo doi ket qua sdm va xa sau md bang hen kham lai benh nhan (BN) 3 thang/lan. Danh gia tinh trang tai phat tai cho bang kham lam sang va cac xet nghiem can lam sang can thiet.
2.3. 'x<i ly thong k6 bang phan mem SPSS 16.0. Cac so sanh cd y nghia thong ke vdi P<0,05.
Tinh t / le song them sau mo bang phu'dng phap Kaplan- l^eier vdi Idem dinh Log-rank.
III. KET QUA NGHIEN CCFU
Da so BN du'dc phau thuat trong giai doan muon. Ty le giai doan I, I I va I I I tu'dng irng la 16,i%; 29,6% va 54,8%; Giai doan Dukes A, B, C: 3,22%, 37,10% va 59,68%. Kich thu'dc trung binh khoi u la 4,06±l,59cm. Ty le khdi u T l , T2, T3, T4 tu'dng irng la: 3,2%; 12,9%; 3 7 , 1 % va
46,8%. BN da CO di can hach ehiem 59,6% trong dd mire N l 17,7% va N2 41,9%.
3 . 1 . Ket qua phau thuat: Thdi gian phau thuat trung binh 108,79 ± 23,99 phiit (50-180 phut). Thdi gian dieu tri trung binh 19,05±7,54 ngay (9-42 ngay). Thdi gian hau phau 12,70 ± 6,04 ngay (6-29 ngay). Khong cd tir vong phau thuat. Ty le tai bien trong mo' 1,61%. Bien chu'ng sau mo 8,06% (Buc mieng noi 4,84%). Ty le chuyen mo md 9,67%, chii yeu do khdi u xam lan rpng (4,84%) va tai bien trong mo (1,61%), 75,80% BN khong phai truyen mau. Thdi gian phue hoi lu'u thong tieu hda 62 ± 15,6 gid.
3.2. Ket qua x a : 90,32% BN du'pc theo doi sau mo. Thdi gian theo doi trung binh 41,60±10,80 thang; 80,64% BN du'dc kham lai tri/c tiep; 14,49%
ed tai phat tai eho hoac di can xa; 9,67% da tir vong. Ket qua thdi gian sdng them toan bp du'dc trinh bay trong bieu do 1. Trong tong sd 62 BN, loai trir 6 BN that lac, 9 BN (14,49%) phat hien tai phat tai cho hoac di can xa, trong dd 6 BN (9,6%) da chet. Sir dung phu'dng phap tinh ty le sdng them tai cac thdi c^em va thiet lap du'dng eong sdng Kaplan- Meier, thdi gian sdng Irung binh la 62,40±3,50 thang. Ty le song tich luy tai thdi diem 1, 2, 3, 4, 5 nam tu'dng iiYig la 98%; 92,70%; 87,90%; 79,90%
va 63,90%.
Survival F u n c t i o n
ThoiBiannghi.ncuu
BilSu ddX .Ty\e song them toan bo
Ty le song them theo giai doan benh difdc trinh bay trong bieu do 2. Giai doan I co 10 BN, that lac 1 BN, tu- vong 1 BN, ty le song them sau 60 thang la 89,06%, thcJi gian song trung binh la 64 tiiang. Glal doan I I co 17 BN,'that lac 1 BN, tiJ vong 1 BN, thdi gian song them 60 thang ia 87,61%, m gian song'trung binh ia 6 1 thang. Giai doan I I I co 35 BN, that iac 4 BN, tir vong 4 BN, thdi gian song trung binh la 52 thang, thcfi gian them tich luy tai cac thdi diem 1, 2, 3, 4, 5 nam tu'dng u'ng 96,70%; 85,70%; 80,60%; 67,20%; va 44,80%.
Y HQC VigT NAM T H A N G 2 • s 6 1/2013
Bleu do 2. Ty le sdng them theo giai doan benh
Ty le song them theo mire dp xam lan thanh tru'c trang du'dc trinh bay trong bieu do 3. Cd 2 BN khdi U xam lan den Idp du'di niem mac thanh tri/c trang (Tl), ty le sdng them sau 60 thang la 100%.
Co 8 BN khdi U xam lan den Idp cd (f2), that lac 1, tir vong 1 BN thdi gian sdng them sau 60 thang la 87,50%, thdi gian sdng trung tiinh la 64 thang. Cd 23 BN khdi u xam lan den thanh mac (T3), that lac 1 BN, thdi gian sdng them sau 60 thang la 75%, thdi gian sdng them trung-binh la 62 thang, da tiif vong 1 BN. Cd 29 BN khdi u xam lan vu'dt thanh mae(T4), that lac 1 BN, thdi gian sdng trung binh la 49 thang, thdi gian sdng them sau 12, 24, 36, 48, 60 thang tu'dng irng la 95,70%; 85,20%; 73%;
73%; 36,75%, da tir vong 4 BN.
Bleu do 3. Ty le sdng them theo mire dp xam lan thanh tru'c trang
Ty le sdng theo mire do di can hach du'dc trinh bay trong bieu do 3. Nhdm chuS c6 di can hacii (NO): 25 BN, that lae 2, tir vong 1 BN, thdi gian song trung binh 69,2 thang, thdi gian song them sau 60 thang la 95,83%. Nhdm di can hach Nl: 11 BN, that lac 1 BN, tir vong 1 BN, thdi gian sdng trung binh 49,8 thang, thdi gian sdng them sau 60 thang la 87%. Nhdm di can hach N2: 26 BN, that lac 3, tir vong 4 BN thdi gian sdng trung binh 42,81 thang, thdi gian sdng them sau 60 thang la 32,50%. SLT khac nhau ve ty le sdng them sau md giii'a eac nhom khac nhau la cd y nghta thong ke vdi liiem djnh log Rank : x 2=22,62, bac td do 2, P= 0,000
Bii'u do 4. Ty le song theo mu'c dp di can hach
Y HOC VIET NAM THANG 2 - SOI/2013
*' Tai phat tai cho va di can xa xay ra d 9 BN (14,49%) trong do 1 BN tai phat tai mieng noi dutfc nhap vien cat lai tru'c trang, bao ton cd that, I'BN tai phat tai dai trang ngang du'dc mo cat dai trang, 1 BN di can gan ddn thuan, 2 BN CO hach 6 bung, 4 BN cd dich d bung. Hau het BN khi tai phat tai cho hoac di can xa deu ed tinh trang djch trong 6 bung.
IV. BAN LUAN
Trong nghien ciTu, cd 90,32% BN du'dc theo doi sau mo vdi thdi gian tiieo doi trung binh 41,60±10,80 thang. Thdi gian sdng trung binh 52,40±3,50 thang, vdi giai doan I I 62 thang, giai doan I I I 54 thang, khdi u T2 64 thang, T3 62 thang, T4 49 thang, NO 69 thang, N l 55 thang va N2 50 thang. Ty le sdng tich luy tai thdi diem 1 nam, 2 nam, 3 nam, 4 nam, 5 nam la 9 8 % ; 92,70%; 87,90%; 79,90% va 63,90%. Ket qua nay la tu'dng td vdi nhieu bao cao trong nu'dc va tren the gidi va khdng cd sy khac biet vdi cac nghien cii'u ve phau thuat cat tri/c trang bang phu'dng phap kinh dien [1] [2] [3] [ 4 ] .
Cd 2 yeu t d chii yeu anh hu'dng tdi thdi gian song sau md ia: giai doan benh va ky thuat mo.
BN du'dc md d giai doan mudn, dae biet la cac khoi u T4, da cd di can hach cd nguy cd tai phat tai cho eao[5] [ 6 ] . Nghien ciru cho thay: khoi u f l cd ty le sdng them sau 36 thang la 100%, ngu'dc lai, khoi u T4 ehi cd thdi gian sdng trung binh 39 thang. Khdi u T4 ed tien lu'dng rat xau.
Di can hach la mot yeu t d tien lu'dng dpc lap.
Nhom chu^ cd di can hach c6 thdi gian sdng trung binh 59,2 thang, ngu'dc lai, nhdm di can hach N l cd thdi gian sdng trung binh 39,8 thang va nhom di can hach N2 chi ed thdi gian song
trung binh 32,81 thang. Ty le sdng giiJa cac nhdm theo mite di can hach khac nhau cd y nghia thdng ke (x2=22,62, bae tu" do 2, P=0,000). So lu'dng hach di can cung la mdt yeu t d tien lu'dng. Theo Corman i^.L, ty le sdng sau 5 nam khi chu'a di can hach dat 90- 95%, trong khi ed dl can hach ehi edn 55%: di can 1 hach 45%, di can 4 hach 20% va di can >8 hach la 1 1 % . Nghien eiru eiia Beahrs O.H eho thay, neu di can 1 hach, ty le song 5 nam la 33%, di can 6 hach ty le nay cdn lai 10%, edn neu di can 16 hach thi khdng BN nao sdng 5 nam. Chiing tdi chii tru'dng tap trung vao nhdm hach dpc ddng mach mac treo trang du'di.
Ve ky thuat md, tir khi Heald (1979) di/a ra khai niem mdi ve cat toan bp i^TTT, ky thuat da nhanh ehdng du'dc chap nhan rpng rai va trd thanh ky thuat chuan cho phau thuat UTTT.
Nhieu tac gia khac cung da chiing minh ed the ton tai nhu'ng o ung thu' trong MTTT. Trong 10%-20% tru'dng hpp, eac 6 di can ung thu' cd the tim thay d vi tri thap hdn bd khdi u. Mat khac, ngu'di ta lai ehu^ bao gid tim thay cac o di can ung thu' d MTTT du'di 4 cm so vdi du'di bd khdi u tri/c trang. Vi vay, mdt khoang each an toan vdi MTTT 5 cm each bd du'di_khdi u la dii de dam bao tinh chat triet can eiia phau thuat. Nhu' vay, phau thuat cat bd toan bp MTTT khdng can thiet vcfi nhu'ng khdi u d 1/3 tren, trong tru'dng hpp do chi can cat MTTT 5 cm each bd du'di khdi u la dii. Cac tac gia deu thira nhan day la mpt viec ddi h d i s i / ti mi cdng phu trong phau tich va thdi gian mo se keo dai. PTNS eho phep quan sat MTTT mdt each ro rang nhat va phau tich vdi dao dien cu'dng dp thap trong khoang md lien ket Idng leo giiJa Idp can chau tang va can chau thanh.
V. Kit LUAN
Ung thV tri/c trang 1/3 tren la vj tri thuan Idi ^ de thi/c hien phau thuat cat tru'c trang npi soi triet can. Phu'dng phap cd t / le thanh cdng cao, an toan, khdng anh hu'dng den ty le tai phat tai cho va kha nang sdng sau md.
TAI LIEU THAM K H A O '^
1. Nguyen Minh An (2007), Nghien cdu ehi dmh va danh gia ket qua sdm sau dieu tri ung thU tn/c trang bang phau thuat npi soi tai benh vien 108. ^ Luin van thac sy y hgc. Hoc vien quan y.
2. Nguyen Hoang Bac, f>d Minh D^i^ Le Quan Anh Tuan, Ung Van Viet (2003), "Phau thuat npi soi
cat dai tru'c trang", Hpi nghi chuyen de hau mon-dai tru'c trang, TP. Ho Chi Minh, tr. 160-72.
Nguyen Minh Hai, Lam Viet Trung, Ho Cao Vu (2003), "Phau thuat cat toan bp mac treo true trang va bao ton than kinh tU dgng vung chau trong ung thU trUc trang thap". Hoi nghi chuyen de hau mon - dai tn/c trang, TP (Ho Chi Minh, tr.240-50.
Phan Anh Hoang (2006),"Nghien ciTu chi djnh, ky thuat va ket qua sdm sau mo cat noi ky dau dieu tri ung thu' trUc trang doan giiJa", Luan an tien sy Y khoa. Hpc vien quan y.
Heald R.J. (2002), 'The importance of TME", International colorectal disease symposium 2002, Hong Kong, pp. 10.
Y Hpc VigT NAM THANG 2 - s 6 1/2013 Martling A., Cedermark B., Johansson H.,
Rutqvist L.E. et al ( 2 0 0 2 ) , "The surgeon as a prognostic factor after the Inroduction of totalmesorectal excision in the treatment of rectal cancer", Br J Surg 2002 Aug, 89(8), pp. 1008-13
Ruillier E., Laurent C , Garrelon J.L., Michel P. Et al ( 1 9 9 8 ) , "Risk factors for anastomotic leakage after resection of rectal cancer", Br J Surg 1998 mar, 85(3), pp. 335-8.
NGHIEN COU KET QUA HdA XA TRj DONG THCTI UNG THlfHA HONG - THANH QUAN GIAI DOAN KHONG mo Dime
T6M TAT
Myc tieu: Danh gia ket qua hoa xa tn tren benh nhan ung thU ha hpng thanh quan giai doan khong mo dUOc tai benh vien K. D61 tu'dng va phu'dng phap:
nghien ciru tien ciru 60 benh nhan, ung thu' ha hpng thanh quan gia! doan khong mo du'pc. Xa tri 70 Gy ket hop cisplatin 30 mg/m2/ 1 Ian/1 tuan x 6 tuan Ket qua: OU'HT 55%, DU'MP 41,7%: 18,3%, th6i gian STKB trung binh 18 thang va STTB trung binh 22 thang. l/dc tinh theo Kaplan-Meier STKB va STTB tai thdi diem 24 thang la 33%. Cac yeu td anh hUcJng den ket qua dieu trj la hoan thanh dii 6 ian hoa trj, xa tri khong gian doan va dat xong da day nuoi dUdng vdi p<0,001. Ket luan: Hoa xa tri dong thdi mang lai hieu qua cao hdn xa tri ddn thuan, can quan tam nuoi du©ng trong qua trinh dieu tri.
Tif khoa: ung thu' ha hong thanh quan, hoa xa tri dong thdi.
SUMMARY
Purpose: to evaluate the effecacy of chemoradiationtherapy in patients with locally advanced inoperable SCC larynx and hypopharynx at K hospital. Patients and Methodes: 60 pts.
Radiotherapy 70 Gy combined with cisplatin 30mg/m2/
weekly x 6 times. Prospective study for event-free (PFS) and overall survival (OS) using an estimated Kaplan-Meyer.
Results: response rate: CR 55%, PR 41,7%.
Medium DFS medium: 18 months, medium OS: 22 months. OS at 2 years; 33%, median survival at 2 years: 33%. Some influence factors on result are enough 6 cycles of cisplatin, no interrupted radiation time and gastrotomosis for feeding with p<0,001.
Conclusion: chemoradiationtherapy is effective for pts with locally advanced inoperable SCC larynx and hypopharynx.
* Benh vien K
Phan bien khoa hgc: PGS.TS. Phan Sy An
Nguyen Tuyet Mai*, Ngo Thanh Tilng*
Key words: larynx and hypopharynx, chemoradiationtherapy
I.
OAT VANof
Ung thir ha hong-thanh quan (UTHH-TQ) la khai niem diing de chi ung thu" (UT) c^a 2 bp phan cCia ccf the, do la ha hpng va thanh quan.
Benh tu'dng ddi pho bien trong cac UT dau - c6 chi sau UT v o m mui hgng[1][4]. B i e u tn bang Hoa - xa tri dong thdi da di/dc thUc hien trong nhieu thO" nghiem lam sang v ^ trd thanh phac do chuan thay the cho xa tri don thuan (XT0T) b cac BN khong mo du'dc[1]. D e tai di/dc tiln hanh nham muc tieu: " Danh gia kit qua cua hoa tn (Cisplatin) vd XT gia toe dong thdi tai Binh vien K tif 2005- 2008"
II. o 6 l TUpNG VA PHUONG P H A P NGHIEN COU 1. D o i t U d n g n g h i e n curu
G o m 60 BN U T H H - T Q giai doan khdng md du'pc tai B e n h vien K tir thang 3/2005 den het thang 7/2008 d a p img cac tieu chuan sau:
BN CO chan doan xac djnh m d benh hgc la UT bieu mo vay; dieu tri lan d a u ; benh GO muon khdng m d dUdc (phan loai GO T N M theo AJCC 2002)[1]; PS = 0 - 1 ; chirc nSng gan, than, Xu^
xu'dng binh thudng;
2. P h i r d n g p h a p n g h i e n c i h i : Nghien ciru tien CLTU m d ta can thiep lam sang c6 theo ddi doc khong ddi c h i m g .
C a c b i r d c t i e n h a n h N C ; X T tir xa bang may gia tdc S I E M E N S , tdng lieu xa vao u va hach viing nguyen phat: 7000cGy. Dir phdng