SINH THIET TUYEN TIEN LIET 12 MAU QUA NGA TRlTC TRANG TAI BENH VIEN BINH DAN
Pban Van Hoang', Nguyen Vdn H p c " , N g u y i n Chi Phong*"
TOMTAT , . , . . . Mtfc tieu: Co nhiiu bdo cdo trong y vdn xem sinh thiet 12 mdu la sinh thiet chudn de tarn sodt ung ihu tiin lief tiiyin. Nen chung toi gidi thiiu nhung kinh nghidm ddu tiin khi bdt ddu sinh thiit tiin Hit tu\in 12 mau tgi benh vien chung toi.
Phuangphdp: Co 41 benh nhdn duac chi dinh sinh thiet tien lief tuyen vi PSA cao (> 4 ng/ml) va/lwgc vi thdm fnrc frdng cd bdt ilmcmg. Chiing toi fien hanh smh thiet mdi ben 3 mdu nhu trong sinh fhiet 6 mdu, sau do sinh thiit thim mdi bin 3 mdu ni>a vi phfa ngogi vi cua tien lief tuyin.
Kit qua: Phdt hien duac ung thu trong 9 trudng hap (17.07%), c6 1 truang hap high-grade PIN vd 1 truang hop chdy mdu tntc trdng ddng ki, 1 tnidng hop tiiu mdu ddng ki. Co 15 trudng h^ ndm viin chd din khi co kit qud (7 ngdy), cdc trudng hap cdn lgi nam vi^n 1 ngdy di fheo doi.
Kit lugn: Biin chiing nhiim triing vd biin chimg chdy mdu trong sinh thiit 12 mdu la thdp. Sinh thiet tiin lief tuyin qua tnrc trdng 12 mau Id khd thi trong^ benh vien ciia chiing toi. . _ , Tir khod: Sinh thiit tiin Het tuyin; Sinh ihiif 12 mdu tien Hit tuyen; Sinh thiit 12 mdu lien Hit tuyen qua sieu dm true trdng
A B S T R A C T
TRANSRECTAL EXTENDED 12-CORE PROSTATE BIOPSY AT BINH DAN HOSPITAL
Objective: To show our preliminary experiences over extended 12-core prostate biopsy method in our hospital.
Methods: Tliis study included 41 patients wlw underwent extended 12-core biopsy. Inclusion criteria for prostate biopsy were elevated serum PSA levels (>4.0 ng/ml) and/or suspicious digifal rectal examination (DRE). We acquired 3 cores from each side like sextant biopsy and another 3 additional cores from each side more peripheral than a 6 core.
ResuUs: Cancer was defected in 09 (17.07%), and one case with high- grade PIN. There was one case of strong hematuria (2.43%) and strong rectal bleeding. There were 15 cases who were hospitalized for 7 days for waiting the result, and 26 patients who were hospitalized one day for follow-up.
Conclusion: Our infection and rectal bleeding complications associated with extended 12-core transrectal ultrasound-guided prostate biopsy were low. Extended 12-core prostate biopsy is feasible at our hospital and increases the detection rate of prostate cancer.
Key words: TRUS; Transrectal prostate biopsy; 12 core prostate biopsy: Extended prostate biopsy
G l 6 l T H I t U
Sir dung mdt cdch rdng rai PSA va sinh thiet qua ngd true ttdng lara gia tang t i n s u i t phat Men ung thu tuyen tiln lift d giai dogn sdm""'. K l tii khi Hodge va cs'^' dp dung sinh thilt tuyln tiln lift 6 mau ttong sinh thiet m y l n tien lift tiii phuang phdp nay dugc dp dung ttong mpt thdi gian dai. Tuang ty 6 Viet Nam sinh thiet tuyen tien liet cung bat dau b i n g 6 mdu, n h u tai Trung tam Medic qua nga tdng sinh mdn 6 mau, tai benh vien Binh Dan chung tdi cung bdt ddu sinh thilt 6 mdu qua nga tryc ttdng ke tir nam 2006. Nhung cd nhilu bao cao gdn ddy, sinh thilt 6 mdu khdng dii phdt hien ung thu'", vd khuyen cao nen sinh thiet nhieu mdu hon ma cu t h i la sinh thiet 12 mdu md rpng Idm gia tang sy phdt hien ung thu hay do chinh xdc diem Gleason'^*. N h u Eichler va cs tham khao y vdn dk so sdnh dya tten tieu chi sy gia tang phat hien ung tiiu va nhung b i l n chumg lien quan tdi sinh tiiilt k i t luan rdng khi sinh tiiiet them 6 mdu nfla so vdi 6 m l u truyln thdng lam gia tang ty le phat hien ung thu them 3 1 % va sinh tiiilt nhilu hon 12 mau la khdng cdn thilt, va ty If b i l n chung khdng gia tang khi tdng them mau''".
Khoa Noi SOI meu benh vien Binh Dan
" Khoa Nieu C benh vien Binh Dan Khoa Chan doan hinh anh benh vien Binh Dan
Dia chl hen lac: ThS.BS.Phan Van Hoang DT: 0908163791 Email: [email protected]
4 4 8
Tai benh vien Binh Ddn chung ldi da dp dung phuang phdp sinh thiet 6 mau nhu tmyln thdng, qua tham khdo^mdt sd tap chi cung nhu nhung hudng dan tten the gidi su cdn thilt cua phuang phdp sinh thiet 12 mdu qua ngd true trang. Nen chiing tdi manh dan thuc hien phuang phap nay ke tu thang 6 ndm 2009.
B 6 1 Tir<?(NG VA PHirONG PHAP
^f ^ "^hdng 6 nam 2009 din cudi thang 9 nam 2009, cd 41 bfnh nhan dupc chi dmh sinh thilt myln tien lift vi PSA cao bay vi tham ttyc ttdng cd bdt tiiudng.
Khang sinh phdng ngira: khdng sinh ciprofloxacine 500 rag 1 vien sang 1 vien chilu va Flagyl 250 mg 2 vien SMig 2 vien chieu ttudc sinh thif 124 gid. Thut thdo bdng Fleet enema luc 8 gid sang hdm sau.
Tu the benh nhan nam nghieng sang bf n ttdi, gdi co vdo bung. Sii dung may sieu dm Logic 5 Pro Gay te bdng: 4 dng lidocain 2% 2 nil pha loang vdi 5 ml nude cat, thudc td dugc tiem vdo md xung quanh tuyen tien lift bat ddu tir mdm din 2 thuy ben va dac biet nhilu tiiudc te ban vao cho tilp giap gifla tdi tinh va tien Het tuyln.
12 mdu dugc ldy theo md hinh nhu sau
Hinh 1 So* do sinh thilt tuyln tien liet 12 mau qua true trdng Sau sinh thiet bfnh nhan dugc cho ndm vien 1 ngdy de theo ddi cac bien chung cd thf cd KET QUA
Tudi ttung binh Id 70,17, PSA trung binh hudc sinh tiiilt la 33,08 ng/ml (min = 2,45; max= 479,65).
Kfch thudc trung binh ciia tuyen lien lift la: 38,29 gram. Chi djnh vi PSA cao : 40 trudng hop, ttong dd chi dinh vi thdm true ttang cd bat thudng 1 trudng hpp. Chi cd gay tf 35 trudng hgp va cd gay te + tien me 7 trudng hgp. Ty le phat hien ung thu Id; 9 carcinoma . 1 sarcoma vd 1 tnrdng hgp high- grade PIN
Bien chung sau sinh thift: khdng cd Uudng hgp ndo chdy mdu tryc trang dang kf; 1 trudng hpp keo dai 3 ngay vd tieu mdu keo dai: 2 trudng hgp keo dai 2 ngay.
JI
Bieu do 1 Phan bo benh nhdn theo tudi Trong dd ta cd phdn ldn benh nhan dugc chi dinh sinh thift khi PSA > 10
Bang 1 phan bo benh nhan, ung thu va chi so PSA So lugng ung
PSA (ng/ml) So lugng bfnh nban
n i^'
Bill! dd 2 Ty II phan tram cua budu Idn hay nho hoTi 50 gram
i
Bilu do 3 Phdn b l ung thu theo Gleason score BAN LUAN
Sinh thilt tuyln tiln lift qua hudng din sieu am vdn la xet nghiem chuan cho chdn doan sdm ung thu tuyln tiln lift. Sinh thilt 6 mdu theo mat phdng trudc-sau ldn ddu tien dugc gidi thieu bdi Hodge va cs'^'. Tuy nhien cd nhung nghien cuu gan day cho thdy sinh thiet nhu vay vdn chua dii. Nam 1995 Stamey va cs" " de nghi sinh thift van Id 6 mdu nhung nghieng ve phia ngoai biSn cua tuyen tien liet, dl cd nhung mdu han cua viing ngoai vi noi thudng cd ung thu. Tuy nhien ngay cd cd cai tifn nhu vdy nhieu tac gid thdy ve lam sang cdn sdt tdi 34% cdc trudng hop ung thu, va nen lay nhif u mau hem de tang kha nang phat hifn ung thu.
Ve ky thudt: Chiing tdi dp dung phuang phap gay te bf mat tien liet tuyen dudi hudng dan sifu am, ban ddu chdng tdi chua hoan loan tin tudng phuang phdp vd cam nay nen chdng tdi cdn cd gdy me Ug giup. ve sau chdng toi khdng can trg gidp cua gay me nfla. Chiing tdi dung vd kim sinh thift nho (18 G. 20 cm) bam thudc te tir mdm, den bf mat tiln lift tuyln, vung ddy va bam nhieu thudc tf tai vj tn' ndi ciia tui tinh va day, each gay te nay chdng tdi dp dung theo cac tac gia qudc tf'''.
Ve each lay raau, ddi vdi mdi ben chung tdi ldy 3 mau dau nhu each lay 6 mdu nhung thdng thudng, sau do xoay ddu do sieu am ye phia ngoai bien ciia tuyln tiln lift. Trudc khi lay mdu chdng tdi thyc hifn tham kham thudng qui bang ngdn tay, sau do kham sieu dm tiln lift tuyen.
Ve kfch thudc ciia myfn tifn lift cua chdng tdi chilm tdi 85% cac trudng hgp nhd han 50 gram. Kich thudc cd dnh hudng dfn kit qud sinh thilt, Brawer va cs'^* kha nang phat hifn gidm ddng kl khi kich thudc cda tuyln tiln lift > 55.5 gram. Trong mot nghien cuu khac cd sy gidm cd y nghia khi sinh thiet 6 mdu khi b'ch thudc tuyen tifn lift Idn'^', chdng han Djavan va cs ndi ring nlu sinh thilt 6 mdu cho budu cd kfch thudc ldn hem 45 gram, trong trudng hgp dd nlu sinh tiiilt ldn ddu dm tinh thi ndn sinh thilt lai'^'.
Vf chi djnh sinh thilt cua chung tdi da phdn Id do PSA cao, chi cd 1 trudng hgp la do tiiam ttuc ttang CO bdt tiiudng. Dieu nay phan dnh cd thi do cdc bac sT nieu cua bfnh vifn cbung tdi bd qua thdi quen tham ttuc ttdng d benh nhan nghi ngd ung tiiu tuyln tiin lift, ma dieu nay Id bdt bupc. Thdm chi gia trj cua tham tryc Uang cdn cao hon gid Ui PSA cao dl ma chi dinh bfnh nhan di sinh thilt tuyln tiln lift.
Nhung may man chdng tdi phat hifn dupc 1 ttudng hgp sarcoma khi PSA = 2,45ng/ml d benh nhdn 26 450
tudi tham true trang cd bdt thudng.
Ve gia tri cua PSA, tiieo budng ddn nam 2009 cua hdi nieu khoa Hoa ky'^* tiii khdng cdn khai niem moc gia tii PSA la an toan ma trudc kia la 0,4 hodc 6,2 ng/ml. Thilt nghi dl cho viec chi djnh dugc dung dan chung ta nen cap nhdt thudng xuyen vd lien tuc nhflng quan difm mdi nhung quan nif m mdi ve ung thu tuyen tiln lift
K£TLU4^N
Trong nghien cuu ciia chiing tdi budc ddu ddnh gia tinh khd tbi ciia phucmg phap sinh thilt 12 mau so vdi ttudc day 6 mdu don thudn cbi Id vf mat 1^ thudt. Chiing tdi ttidy sinh thilt 12 mdu khd thi, dau ft va chdp nhdn dugc vdi each gdy te bf mp tuyln tiln lift qua sieu dm. It tai biln biln chirng vd khdng khdc_^so ydi sinh thift 6 mdu. Theo khuyin cdo cua cdc tdc gid qudc te ve nhung uu diem vd tinh khd thi vf mgt ky thudt theo each lam ciia chdng tdi, chdng tdi khuyin cdo nen sinh thilt 12 mau mdt each thudng qui cho bfnh nhdn Viet nam.
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