CHUYSN BJ: H(>I NGHI KHKT CAC TINH VUNG DUY^N HAI BAC B 6 LAN T H O WHAT
OANH GIA KET QUA DIEU TRj P H A U THUAT UNG THir DAI TRANG TAI BENH VIEN VIET TIEP
Phan Thj Tuy^f Lan*, Trjnh Hong Son**, Nguyen Minh Tuin*
NguySn Thdi Binh*, Trjnh Vict Thong*, Cao Minh Tifp*, Pham VSn Thirong**'
S U M M A R Y
Retrospective descriptive analysis of 29 coion carcinoma patients, operated in Digestive surgery Dept of Viet tiep Hospital from 01/2012 ta 12/2012.
Mean age was 63.72±2.66, ratio of male and female was 1,23. Abdominal pain, the most common symptom, occupied 82,8% of cases.
51.7% patients had the CEA level > 5 ng/ml before surgery. The current histological grade was adenocarcinoma (89.7 % ) . Radical colonic resection v»as critically surgical procedure with hemicolectomy. About complications, leakage of anastomosis happened in 3,4% of operated patients.
I. OAT VXN o f
Ung thu dai trang la benh ly thuong gap tren the gioi cung nhu tai Viet Nam. Theo Parkin DM (2002), tfnh chung tren toan thi giai ung thu dai - true trang dung hang thii ba, sau ung thu ph6i va ung thu vu [11]. Ghi nhan cua benh vien K Ha Npi, giai doan 1988 - 1992, ti le mSc benh la 13.3/100 000 dan, tu6i trung binh la 40 - 60 tu6i [4].
Phau thuat van la bien phap hieu qua nhat va dupc lua chon diu tien trong iiiu tri ung thu dai trang dac biet la 6 giai doan sirni.
Voi mong mu6n gop phin vao viec chin doan va iiiu tri phau thuat ung thu dai trang tai benh vi$n Huu nghi Viet Tiep, chung toi tien hanh de tai nay voi hai muc tieu:
• Benl, vien Vifl Tifp: • • Bfnh vifn Vifl Biic
* * • Ben hoc YHaiphong
I Nhdn xet vi dgc diem ldm sang, c^
ldm sang ciia ung thif dgi Irdng ikt^c diiu trj phduthudt
2. Danh gid kit qud sam diku Iri phdu Ihugt ung thu dgi trdng
II. OOI TUONG VA PHUONG P H A P NGHIEN CUU
1. Doi ttrong v& phirong phap Nghien ciiu h6i ciiu mo ta tren 29 benh nhan dugc chan doan sau mo la ung thu d?i trang duac dieu tri tai khoa Phau thuat tieu hoa benh vien Him nghi Viet Tiep trong nam 2011
2. Cac chi tieu nghien cihi;
. Tuoi, gioi . Dau hi?u co nang
Vi tri ton thuong trong soi dai tning, CEA, chyp CT scanner 6 bung ,^
. Hoan canh mo: mo phien, mi cip ciiu . Phucmg phap phau thuat:
- Khi chtra co bien chiing:
Phiu thuat tri$t ii: cat nila dai phii-trai nao vet hach, cat doan dai trang sigma nao vet hach, cat doan dai trang ngang nao vet hach.
Phau thuat tam thai: cat doan dai trang, noi tat, lam HMNT vinh viin truoc u
- Khi CO bijn chiing:
Tdc ruot:
* Doi voi UTDT phai:
+ Cat nira dai trang phai va n6i ngay.
+ Noi tat hoi - dai trang ngang: Khi the trang b$nh nhan xiu, u khong con kha nSng
208
Y HOC V I J T NAM T H A N G 5 - S6' B>j^C BlgT/2013
cit bo hoac dS co di can phuc mac hoac di can nhieu nai.
* Doi v6i UTDT trai: Cat dai trang trai hai thi, bao gom cac ky thugt sau:
- Lam HMNT truac kh6i u. Sau 2 - 3 tuSn mb lai cSt d?i trang va noi ngay khi dai trang da dugc chuan bi tot.
- cat dgi trang trai cap cuxi va dua hai
"^u dai trang ra lam HMNT. Viec phuc hoi luu thong tigu hoa du(;K: thuc hien 6 lan mo sau.
Viem phuc mgc do thung dgi trdng:
* V6i UTDT phai: Cat dai trang phai, dua hai dku ruot ra ngoai lam HMNT.
* Voi UTDT trai:
- Thung tgi cho khoi u: Cat dai trang lay hit khdi u va cho thiing, dua hai dau ruot ra i^oai lam HMNT.
- Thiing dai trang phai do gian:
+ Cat dai trang toan bp hoac gan toan bp, dira hai dau rupt ra ngoai.
+ cat doan dai trang co u dua hai dau rugt ra ngoai va dua doan thung ra ngoai o bung.
1^ Viec lap lai luu thong tieu hoa dugc thuc hien a lan mo sau.
3. Bien chirng sau mo: nhiem trung vet mo, ap xe du, ro tieu hoa, tac rupt sam, suy kiet, tli vong
lit. KET QuA VA BAN LUAN 1. Dac diim chung
Trong nghien cuu ciia chiing toi, nh6m
•'tudi tren 60 chiSm ty le cao nhit 72.4%, ''tuong duang voi Nguyin Van Le ( 75%)[7].
Tu6i trung binh la 63.72±2.66, gkn tuong
duang vai Schiedeck va Nguyin Ho^g Bac [1], Nam gioi chiem 55.17%, nu" gi6i chiem 44.82%, tuong duong vdi Nguyen Van Xuyen [10].
2. Dau hieu cof ndng
Dau hieu co nang thuang gap nhat la dau byng (82.8%), tilp din la dai tien ra mau 31.1 %. Ket qua nay tuong duong voi Huynh Quylt Thing [9]. Nhutig dau hieu ca nang ban dau thuang khong ro rang, mpt b?nh nhan co the bilu hien mpt hoac nhieu trieu chung [9]. Theo Nguyen Van Le, nhieu truang hgp co bilu hien dau hi?u co nang ro rang nhung lai dugc chin doan nham voi mpt so bSnh tieu hoa khac nhu tri, viem dai trang man [7],
3. Dac dilm soi dai trang va xet nghiem CEA
Soi dai trang thuc hien 6 24/29 benh nhan, do co 5 benh nhan dugc chi djnh mo cip cuu ngay khi nhap vien voi chan doan la tac rupt do u dai trang nho cac chan doan hinh anh khac. Vi tri t6n thuong gap nhieu nhit a dai trang sigma (34.1 %), dai trang goc gan 20.6%. Kit qua nay tuong ducmg vai Nguyin Van Le [7].
Xet nghiem CEA tren 5 ng/ml chilm ti le 51.7%. Ket qua nay co khac biet so vai Huynh Quylt Thang (40.8%) [9].Theo Tabbarah H.J, lugng CEA cao truoc m6 tuong hgp vai dp mo hpc cao, giai doan lam sang tri va tinh trang di can xa [12]. Theo Nguyin Chin Hiing, n6ng dp CEA truac m6 tuang hgp voi xep loai Dukes va co y nghia tien lugng [5],
4. Dau hifu tren CT scanner o t 4,1, VitrltSn thu-rngtrln CTd f'Vjlritonthu'tfng
.Bai tranq len
t»ung
bung Vfl kill phdu thudt CT scanner 6 bung
n 2
Tv le °/o 6.9
Phau thuat n 2
Ty le »/o 6.9
CHUYSN tl6: Hpl NGHI KHKT CAC TiNH VUNG DUVew HAI B t e BQ LJJN THP NH<iT
Dai tranq goc qan Dai tranq nqanq Dai tranq qoc lach Dai tranq xuonq Dal tranq slqma Dam quanh ruot thu'a Khonq chup Tonq
5 2 3 5 10
1 1 29
17.2 6.9 10.3 17.2 34.5 3.4 3.4 100
6 2 3 6 10
29
20.7 6.9 ' 10.3 20.7 1 34.5
100
4.2. Boi chieu T, M, NgiHa CTscanner vd sau phau thu$t TNM
T
N
M
T l T2 T3 T4 NO Nl N2 N3 MO Ml
C T s c a n n e r n = 2 7
0 5 17
5 24 3 0 0 25 2
Ty l6»/o 0 18.5
63 18.5 88.9 11.1 0 0 92.6
7.4
Sau phiu thuat n = 27
0 2 19
6 22 4 1 0 25
2
Tyl8%
0 •' 7.4 70.4 22.2 81.5 14.8 3.7 0 92.6
7.4 Co 1 TH CO kSt luan tren CT scanner la
dam quanh rapt thiia, 1 TH khong chyp CT scanner. Con lai la 27 TH iiu xac dinh chinh xac vi tri t6n thuong CT chin doan dung miic do xam lin 24/27 TH, hach 3/5 TH, di can 2/2 TH. Theo ICaren M. do nhay cua CT scanner trong vi?c phat hien ung thu dai trang phu thuoc vao kich thuoc khdi u [13].
Ngoai ra, dau hi?u nghi ngo co thi la s\i day len ciia thanh dai trang. Theo tac gia, ty le phat hien khdi u khi chup CT scanner la 75%
[13]. Vice xac djnh hach di cSn tren CT scanner tuong d6i kho khan vi h^ich chi duoc xac dirih khi duong kinh tren 10 mm va co the nham voi hach viem. Kha nang chan doan di can tang tren CT la 90%, tang di can hay gap nhAt la gan [13] [14]. Con trong nghien cuu cua chung toi, tang di can la 210
thanh bung va ruot non. NhOng su khac biet nay la do so benh nhan nguyen ciJru cua chung toi con chua du Ion.
5. Ket qua dieu tri phau tbu^t Trong nghien cuu ciia chiing toi, tat ca b?nh nhan deu dugfc phau thugt triet de.
Trong do co 8/29 TH du^c m6 cip ciiu, trong do 7 TH do t3c ruot, 1 TH do ap xe quanh u.
I TH phai phau thu^t tam thoi (lam hau mon nhan tao tren u, dugc cit u, vet hach v^ dong HMNT thi hai), 7 TH dugc cat doan dai trang mang u - lam hau mon nhan tao va dong l?i thi hai. Theo nghien ciiu cua Ph?m Nta Hiep, CO 10.8% phai lam hju mon nhan tao tam thai, 13.8% dugc cat dai trang va lin hau mon nhan tao [3].
Bien chung sau mo gap nhieu nhat la nhiem tning \it mb (24.1%). 7 TH co nhiem
Y HQC VlgT NAM THANG 5 - s6 OAC BieT/2013
triing vet mo deu la nhiing benh nhan dugc liam HMNT. Bien chiing nang la ro tieu h6a va suy ki?t chilm t>' 1? thlp (3.4%). Biln chiing ro tieu hoa va suy kiet xuat hipn a hai benh nhan tuoi cao va co dai thdo duong k6m theo. Theo Trjnh Hong Son [8]va Nguyen Xuan Hung [6], ty le ro tieu h6a la 3.3%, ti lp nay thay dli tir 0.2% den 4 % theo cac tac gia khac [4] [15].
Ve phan loai vi the, ung thu bieu mfi tuy^n g9p nhieu nhat (89.7%), trong d6 10.3% la ung thu bieu mo tuyen nhay, 6.9%
la ung thu bieu mo tuyen vay. So sdnh ve ty 1? ung thu bieu mo tuyen vol cac tac gia trong va ngoai nuoc thi ket qua cua chiing toi la tuong duong. Nguyen Dai Binh 9 3 % : [2], Nguyen Van HiSu 8 8 % [4], Trinh Hfing i Son 93% [8].
Ve phan chia giai doan benh theo TMN,
; chung toi gap nhieu nhat la giai doan II
; (69%), chi CO 6.9% 6 giai doan IV. Phan chia : theo Dukes, chiem da sfi la Dukes B (75.9%).
'_ Ket qua nay gan tuong duong vcri Chenhan - 'shiang,60%DukesB[15].
V. KETLUAN
Qua nghien cuu 29 benh nhSn ung thu dai trang ducrc dieu tri phau thuat tai khoa phau thimt tieu hoa benh vien Hiiu Nghi Viet Tiep, chiing tfii nit ra dugc mpt vai ket luan sau
Nhom tuoi tren 60 chiem da so (72.4%), cao nhat la 84 tufii, thip nhdt la 21 tufii. Nam gicri chiem ty 1$ 55.17%, nu giai chiem ty 1?
44.82%. Dau hieu hay gap nhat la dau bung (82.8%).
Vi tri u hay gap nhat la a dai trang sigma (34.1%).Thip nhat la u o dai trang len (6.9%) t- Tang CEA tren 5 ng/ml chiem ty le
51.7%.
CT chan doan diing miic dfi xam lan 24/27 TH, hach 3/5 TH, di can 2/2 TH k
Tat ca benh nhan deu dugc phau thuat tri?t dS, CO 8 TH dugc phhi thuat 2 thi
Ung thu bieu mo tuyen chiem da sfi v6i ty 1? 89.7%.
Da phdn bfnh nhdn 6 giai do^n Dukes B (75.9%), CO 6.9% 6 giai doan Dukes D.
Bien chiing sau mfi chiem ty 1? cao nhat la nhiem triing vet mo (24.1%).
TAI UEU THAM K H A O
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211.
CHUY£N pg: HQI NGH( KHKT CAC TINH VDNG DUYfeN HAI BAC BQ LAN THlf NHJJT
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