Tap chl Tai MOI Hpng Vijt Nam - Volume (57-12). N°6- Dec., 2012 ^
fiOl CHltV DAC DIEM LAM SANG
UNG THir HA HQNG Vdl CHVP CT SCAN VA PHAU T H U ^ T
Ting Xudn Thing*, Nguyin QuScBQng**
T6M TAT
Ung thu ha hgng xuat phdi lir ldp biiu mo Malpighi bao phu vitng hg hgng. Nd chi chiim khodng 5-6% so vol ung thu ciia todn ca Ihe. Trilu chirng Ihdm Idng, chdn dodn vd diiu tri mugn. Mfic tilu:) Mo td ddc diim ldm sdng, hinh Ihdi Ion thuimg qua ngi soi vd CT. 2) Ddi chiiu ddc diim ldm sdng. (T v&l phdu thugt. Dii ttrgmg vd PPNC: Md Id timg ca, can thi(-p. lien cuu. gom 62 blnh nhdn gdp tgi blnh viln TMHTlf. Ket qud vd bdn lugn: Ddnh gid Win thuang hg hgng LS vd CLVT chinh xdc 96,7% so vdi phdu thugt. Ddnh gid iSn llutang viing gidp ranh hg hgng, sun, lan lln cao LS, CLVT, PT cd ket qud nhu phdu thugt (p < 0.05). Ddnh gid lan Iran thirc qudn LS vd CLVT kem chinh xdc so vdi phdu thugt (p< 0,05). Kit lufln: CT ddnh gid chinh xdc han tren ldm sdng, dgt 96% so vdi phdu thudt.
Tirkhda : Ung thu. hg hgng, CT scaner
S U M M A R Y
Hypopharyngeal cancers involve a tumor that is relatively more silent than other head and neck cancer tumors. Objective. Describe the clinical and CT scan features. Materials and Methods: .i prospective study fi-om a series of 62 patients diagnosed of Ihe hypopharyngeal cancers operateds. Results and Discusion The comparision the diagnosis Ihe lession in out ofthe hypopharyngeal, and eosophageal on the clinical and CT scan -with the operation is lower exaclely (96%). There is the same ofthe diagnosis the lesion expanded on the base lingual (p<0,05). Conclusion: The exact ofthe diagnosis on Ihe clinical and CT scan is 96%.
Key Words: Cancer hypopharyngeal. CTScan. Peratlon
I p ^ J VAN Dfe ^^^ ^°^ " " 8 * " no> chimg va dung Ihli hai tiong c^c ung thu viing dSu mat cd sau ung Ung thu ha hong la u i c tmh xu&t phdt tCr . , . ,,, j , „ , t u i . , , . . / . ; . • . , . . . , , . thu vom hong [1], O Phdp ung thu ha hpng ldp bieu md Malpighi cua mim mac bao phu ; , „ . . . . . . , , , , " , , , . , ,_ chiem khoang 12,15% tdng sd cac ung thir ha hong. Ung thu vung ha hong va thanh , . , . , . , ^ . .^ ,m
• , ' , . , , , , , , „ , ., cua duong Sn, duong tho tren va chiem 1 * quan chiem khoang 5 - 6 % tiong tong so . „ , . . . . , , , , , -
nong tdng sd c i c loai ung thu [4]. o My ung thit ha hong chiSm khoang 5 - 10% hong
• Dal hpc Y Hi Npi . " „, ' , . , . , , -
"BpnhvifnKHiN«i " " S so <:ac ung thu duong ueu hoa tren, Nhan bai 20/10. Duy« in 30/10/2012
Tap chl Tai MOI Hpng VI j t Nam - Volume (57-12). N°6 - Dec, 2012
khoang 0,5% tiong t6ng so cic khdi u ic tinh, khoang 24% cic trudng hpp viing ha hpng, thanh quan, hang nim sd ca mic mdi la 1,22/100.000 nam gidi [4,6]. 6 Anh, sd ca mdc mdi la 1/100.000 nam gidi [7].
Chan doin giai do^n, s\r lan trin rpng nhd npi soi vi CT scan, de cd chi djnh phlu thuit. De tai Nghien cuu die diem lim sing ung thu ha hpng qua 62 bpnh nhan gip t^i bpnh vipn TMHTU, nhim myc tieu sau:
Doi chieu die diem ISm sing vdi CT vi phlu thuat, de riit kinh nghifm cho chan doin va dieu tri.
2. D 6 I TirONG vA PHlTONG PHAP NGHIEN c i r u
2.1.1. Gdm 62 benh nhin duoc chil doan xic dinh li ung thu ha hpng, cd ket qua giai phiu benh ly, dupe chi dinh phiu thuit tai khoa Ung budu Bl- Benh vien Tai Mui Hpng Trung uong, tut thing 01/2005 din thing 09/2010.
2.1.2. Thift ki nghien ciiu: Md ta timg ca, can thidp. Sir dung chuong trinh phin m^m SPSS 13.0 trong dd cic so lieu dupe ma hoa, nhip vio miy, xur ly va phin tich kSt qui theo phuong phip thdng ke y hpc. Cic bich dinh luong md ta dudi dang trung binh (x) va dd lech chuin (SD). Cic bie'n dinh tinh md ti dudi dang ty le %, so sinh ty le SII dung thuit toin khi Xl
2.1.3. Thdng sd nghien ciiru
1. Tham khim npi soi, md ta cic die diem LS, phin lo?i dd md bdnh hpc: chin doin TNMS.
2. Dinh gii tdn thuong tren CLVT: Vi tri khdi u, vi tri u tai xoang le, phin dd T (xim lin cua u), mit dd vi dd ngim thudc.
3. Dinh gii t6n thuong hen PT: Vi tri khfii u, vi tri u tai xoang le, hinh thii khdi u, phin dd T (xim lin ciia u).
4. Ddi chi^u LS -CLVT-PT.
3. K£T QUA
3.1. Ddi chi^u xim lin tai viing ha hpng tren LS - CLVT-PT
Bang 3.1. D6I chi^u xim lin tai vCing ha hong (n=62)
Vj tri bj xim lin Xoang ie
61/62 Thinh sau
ha hong 23/62 Vung sau sun nhan 5/62
LS n 59/61 17/23
5/5
%
96,7 73,9 100
CLVT n 59/61 21/23
2/5
%
96,7
91,3 40
PT n 61/61 23/23
2/5
%
100 100
40
Nhin xet: Vi tri bi xim lin thudng gap hon ca la xoang le (61/61), tie'p de'n li thanh sau ha hpng va viing sau sun nhin.
Danh gia su xim lin 6 vCing niy ciia ba phuong phap LS, CLVT, PT cd su khic biet rd det vdi p < 0,05.CLVT cho ket qua gin vdi PT hon li dinh gii tren LS vdi dd nhiy, dd die hieu, dd chinh xac dat tur 91,3 d«n 100%.
Tap chl Tai MOi Hpng Vipt Nam - Volume (57-12). N°6-Dec, 2012
3.2. Doi chieu xim li'n tai viing Ihanh quSn ciia u trin LS - CLVT-PT Bing 3.2. D6| chiiu xim lin l?l vCing Ihanh quin (N=62)
Thanh mdn
Thuong thanh mdn
Ha thanh mdn Cic sun thanh quan
Vung glip gianh
Diy thanh 22/62 Mdp trudc
4/62 Khoing canh thanh
mdn 55/62 Bing thanh thit
32/62 Thanh thiil
49/62 Ha thanh mdn 6/62
Sun phSu 50/62 Sun nhin
28/62 Nep phSu thanh
thiit
LS n 9/22
3/4 30/55 24/32 36/49 02/6 33/50 8/28 61/61
%
40,9 75 54,5
75 73,5 33,3 66 28,6 100
CLVT n 14/22
3/4 54/55 26/32 42/49 06/6 50/50 28/28 61/61
%
63,6 75 98 81,3 85.7 100 100 100 100
PT n 22/22
4/4 55/55 32/32 49/49 6/6 50/50 28/28 61/61
%
100 100 100 100 100 100 100 100 100 Nhdn xer. Vi tri bi xim lin thucmg ""anh thit. Dinh gii su xim lin d viing gip hon ca la, nep pheu thanh thiet, nay cua ba phuong phip LS, CLVT, PT cd khoang canh thanh mdn, thanh thiet, bing ^V khic biet ro det vdi p < 0,05.
3.3. Doi chieu lan tran ngoai viing thanh quan ha hpng tren LS - CLVT- PT Bang 3.3. Dinh gli su lan trin ngoil vung thanh quin - ha hpng cOa u
V| UI
Lin trdn Hong mt0ng
Lan rdng ngoil vung cd v i vung thuc quan
Thinh bin hong mling 1/62 Oiy lual
1/62 Tn/dc thanh thiet 11/62
Sun glip 17/62 Mling thuc quan
13/62
LS n 1/1 1/1 11/11
1/17 0/13
%
100 100 100 5,9 00
CLVT n 1/1 1/1 11/11 17/17 10/13
%
100 100 100 100 76,9
PT n 1/1 1/1 11/11 17/17 13/13
%
100 100 100 100 100
Nhdn xet: Khi u lan len tren thi '"y^" S'^P- ""idng thuc quan thi rit khd duoc phat hien bing ca ba phuong phip '^^'^ 8'* ''*"8 LS. CLVT cho ke't qui gin cho ket qua nhu nhau. Nhung sun giip, S'^"S " * ^ - ^anh gii su xim lin 6 vimg
Tap chl Tai MOI Hpng Vijt Nam - Volume (57-12). N°6 - Dec., 2012 nay ciia ba phuong phip LS, CLVT, PT cd
su khic Met rd det vdi p < 0,05.
4 . B A N L U ^
4.1. Dinh gii xam l^n t^i h^ hpng qua d6i chilu LS - CLVT-PT
Vi tri hi xim ISn thudng gip hon ca li xoang le, nep phdu thanh thiet, khoang canh thanh mdn, thanh thiet, thanh thit. 6 xoang le, CO 61/62 (98,4%) trudng hpp bi xim li'n, LS vi CLVT phit hien 59/61 (96,7%), PT xac nhin co 61/61(100%) bi xim lin, 01 trudng hpp khdng thiy xim lin xoang le cd u xuit phat til thanh sau hpng. Cd 02 trudng hpp khdng phit hien dupe trtn LS va CLVT , dd 14 02 trudng hpp khdi u xuit phit tur thinh sau hpng vi sun nhin giai doan Tl th^ thim nhiem, rit khd phat hien tren LS va CLVT. Di^u nay la hoan toan phi hpp, bdi hiu bet benh nhin nghien cuu cua chiing tdi cd khdi u xuit phit tir xoang le 57/62 (91,9%). Kft qua nay cung phi hpp vdi nghien cihi ciia Xuc Ying Deng (100%), Millipn, Saleh vi cpng su (100%) [7]. Su khic biet nay cd y nghia thd'ng ke vdi p < 0,05.
Thanh sau ha hpng, cd 5/62 (8%) mrdng hpp phat hien cd xim lin, CLVT va PT xac dinh cd 2/5 (40%), sil khic biet niy co y nghia thd'ng ke vdi p< 0,05. Viing sau sun nhin cd 23/62 (37%) bi xim lin, LS 17/23 (73,9%) trudng hpp, CLVT 21/23 (91,3%) vi PT 23/23 (100%) tru&ng hpp. So vdi PT cd 02 ca CLVT khdng phit hien dupe, dd nhiy 91,3%, nhung ddi chie'u vdi LS flu nd phit hien dupe fliem 04 trudng hpp. Kft qua niy cung phi hpp vdi nghien cdu cua
Xue - Ying Deng [9] 100%. Diy la viing phin m^m niem mac de bi phCl ni, il dpng, xo hda, che lip, di diy vi viy, CLVT cd th^
cho kft qua im tinh gia, duong tinh gia, Wenig vi CS, Becker, Aspestrand vi CS, Nowak vi CS, Prehn vi CS, Thabet va CS [7], dd chinh xic 80 - 85%. p < 0,05.
4..2. Doi chieu xim li'n tai viing thanh quan cua u tren LS - CLVT-PT 4.2.1, Thanh m«n
Diy thanh co 22/62 (35,5%) trudng hpp bi xim li'n, LS phat hien 9/22 (40,9%) trudng hpp. CLVT xic dinh cd 14/22 (63,6%), kft qua niy cung phii hpp vdi nghien ciiu ciia Xue - Ying Deng (62%).
Khi ddi chiSu vdi PT thi cdn 08 tnrdng hpp CLVT khdng phat hien ra dp nhiy 63,6% phii hpp vdi ket qua ciia Ranvindra [10], De Souza vi cdng su [6], khi chiing ta li'y phiu thuit la tieu chuin vang de ddi chi^u. Ddi chie'u vdi trieu chiing khan tieng tren lim sing ta thiy cd su phii hpp 22 trudng hpp cd trieu chiing nay. Diy cflng li trieu chiing khie'n benh nhin phai di kham benh. Su khac biet nay cd y nghia thd'ng ke vdi p < 0,05.
Mep mrdc cd 4/62 (6,4%), LS va CLVT xac dinh cd 03 tnidng hpp, nhumg khi phiu thuit thiy cd 04 benh nhin cd t6n thuong.
Diy la vi tri giy khan ti^ng sdm. Khi u to nd xim lin, de diy thanh quan vi viy khi kham LS bing ndi soi chiing ta khd danh gii he^
duoc. Khi dd vai trd ciia CLVT danh gii t6n thirong tnrdc m6 la het sdc quan trpng, nd cd dp nhiy, die hieu, chinh xac cao (85 - 88%), Becker va cdng su [37], p < 0,05. Khoang
Tsp chi Tai MQI Hpng Vljt Nam - Volume (57-12). N°6 - Dec, 2012 canh thanh mdn, xim li'n cd 55/62 (88,7%)
trudng hpp. LS dinh gii cd 30/55 (54,5%).
CLVT phit hien 54/55 (98%), Xue - Ying Deng (87,2%), cd mdt trudng hpp khdng phit hien dupe (im tinh gii), kft qui niy gin tuong tuong vdi PT 55/55 (100%), Aspestrrand vi cdng su (100%) [7], Die biet khi u 6 T3,T4 lai cd phii n^ niem mac va ir dpng dich. Vi tri niy CLVT phat hien rit tdt vdi dd nhiy vi dd die hieu, dd chinh xic ril cao (85 - 88%), Becker vi cdng su [7], Su khac biet niy cd y nghia thdng ke vdi p < 0,05.
4.2.2. Thuong Ihanh mdn
Bing flianh thit cd 32/62 (51,6%) trudng hpp bi xim lin, LS phat hien 24/32 (75%) ca, CLVT 26/32 (81,3%) tru&ng hpp, Xue - Ying Deng (72%). Cd 02 ca uen LS khdng phit hien ra nhung lai Uii'y uen CLVT. D.
Tren LS, chiing tdi hay gip u th^ sui, hdn hpp xim lin vi de diy vao bing thanh thit ri't khd dinh gii cac phin bi che lip (budng Morgani, diy thanh, thanh mdn, ha thanh mdn, Ichoang canh thanh mdn). Trong tru&ng hpp dd CLVT rit tdt di phit hien tdn thuang. Ddi chifu vdi PT 32/32 (100%), cd 06 tru&ng hpp (XVT khdng phit hien ra (im tinh gia), do khdng dpc ra hoic nhim vdi cic t6n diuong khic. Dlia nay cung phu hpp vdi nhin xdt cia Zbazen vi cdng su [5], Ranvindra [9] (p < 0,05).
Sun thanh thiet, vi tri hay gip thil 5, cd 49/62 (79%) tru&ng hpp. LS dinh gii cd 36/49 (73,5%) cho ty le thip nhit, bdi u to che lip hoic in siu xudng dudi Idp niem mac, niem mac phi n^ ir dpng khim LS khdng phit hien ra. CLVT 42/49 (85,7%),
Xue - Ying Deng (82%) [7], Bailey (75 - 78%) [8] trong tru&ng hpp niy phit hien tdt hon. Dinh gii xim lin thanh fliiet tien CLVT cho kit qui thip hon so vdi PT 49/49 (100%), nhung lai phit hien dupe 05 trudng hpp mi tren LS khdng dinh gii dupe. CLVT cd kit qui thip hon PT li bdi cd mOt sd trudng hop cho k^t qua im tinh gia (nhim vdi t6n thucmg khic, hoic khdng dpc thiy l6n thucmg). K^t qui cua chting tdi gin gidng vdi hai tic gii tren (p < 0,05).
4.2.3. Ha Ihanh mdn
Ha thanh mdn, cd 6/62 (9,7%) trudng hpp dinh gii ed tdn thucmg, LS phit hien cd 2/6 (33,3%), CLVT va PT xic dinh cd 6/6 (100%). Dd nhiy, dd die hieu, dd chinh xic cua CLVT so vdi PT dat 100%. Cd su khic biet giOa LS vdi CLVT vi PT li bdi khi khdi u con nhd, thanh quan khdng bi xim lin de diy chung ta dinh gii ha thanh mdn rit de, nhung khi u to (T3,T4) ttii viec phit hien tdn Uiuong li rit khd. CLVT giiip chiing ta dinh gii tdn thuong ving nay lit tdt. K^t qua cua chdng tdi tuong duong vdi Aspestrand vi CS [7] p< 0,05
4J.4. Cic sun thanh quan
Sun pheu. cd 50/62 (80,6%) tru&ng hpp.
Kft qua tren CLVT, PT li nhu nhau50/50 (100%), Xue - Ying Deng (74%). (XVT giup chung ta dinh gii duoc tdn thuong d vi tri niy li't tdt. Theo Zbazen vi cdng su [5] CLVT dinh gii tdn ttiuong siin rift tfit nd cd dd nhiy cao (46 - 91%) va dd die hieu (80- 91%). (p < 0,05). Sun nhin, ving nim d vi tri siu. li thinh trudc cua mieng thuc quin, dupe bao phu bdi Idp niem mac
Tap chl Tai MGI Hpng Viet Nam - Volume (57-12). N°6 - Dec., 2012 rit khd dinh gia tdn thudng hen LS. Tdn
fliuong sun nhin cd 28/62 (45,1%), LS 8/28 (28,6%), CLVT 28/28 (100%), FT 28/28 (100%). Dieu niy cho chiing ta thiy ring CLVT danh gii tdn thuong sun rit Idt vdi dd nhiy, dd die hieu, dd chinh xic dat 100% so vdi phiu thuit la tieu chuin vang trong XAC dinh tdn thucmg, ke't qua niy ciing phi hpp vdi nghien cijii cua Roychowdhury va cdng su (100%) [7], Ranvindra 87 - 95% [8).
4.2.5. Vung giip ranh
Vi tri nep pheu thanh thiet, cd 61/62 (98,4%) tru&ng hpp bi xim lin, 01 tru&ng hpp khdng hi xim lin cd u d giai doan Tl, xuit phat l i flianh sau hpng. Ket qua tren LS, CLVT, PT li nhu nhau (p < 0,05).
4.3. Danh gia su xim li'n, lan Iran ngoai ving thanh quan - ha hong ciia u Ircn LS - CLVT- PT
43.1. Xim lan, lan Iran len Iren Thanh ben hpng mieng cd 01/62 (1,6%) tru&ng hpp, ca ba phuong phip diu cho ket qua nhu nhau. Diy li vi tri de dinh gii tren LS khi u d vi tri nay tiic la benh da d giai doan T4, rit khd khin cho dieu tri vi tien lupng benh ril xi'u vdi p > 0,05. Diy luai, cd 1/62 (1,6%) tru&ng hpp danh gia cd xim lin, LS, CLVT vi PT cho kit qua nhu nhau, p> 0,05. Khoang trudc thanh thiet(hd ludi thanh thiet), cd 11/62 (17,7%) danh gii cd tdn thuong, LS, CLVT va PT cd kfit qua nhu nhau, p> 0,05. Diy li ving de dinh gii tren LS.
4.3.2. Xim li'n, lan rdng ving cd vi ving thuc quan
Sun giip cd 17/62 (27,4%) tru&ng hpp, LS xac nhin cd 1/17 (5,9%), CLVT phit hita 17/17 (100%) ca, PT xac dinh cd 17/17(100%). So vdi PT thi CLVT cho kit qua tuong tuong vdi dd nhiy, dd die hieu, dd chinh xic dat 100%. Diy li ving ri't khd dinh gii tren LS, chinh vi viy mi chi cd 01 trudng hdp dupe phat hita. Ke't qua nay cung phi hpp vdi nghien cdu ciia Xue - Ying Deng [6] 100% p < 0,05. Thuc quan, cd 13/62 (20,9%) hudng hpp bi xim li'n, LS khdng phit hien dupe tru&ng hpp nao, CLVT dinh gii 10/13 (76,9%) ca, PT xic nhin cd 13/13 (100%) tru&ng hpp cd tdn ttiuong. Ket qua tren CLVT cho chiing ta thiy vai trd he'l siic quan trpng cua nd, vdi dd nhiy va dp chinh xac (76,9%) kha cao, tuong duong k€t qua cua Wenig va CS, Becker, Aspestrand vi CS, Nowak va CS, Prehn va CS, Thabet va CS [7], dp chinh xac 80 - 85% vdi p < 0,05. Tuyen giap, khoang trudc sdng, khi quan trong nghien cdu cua chung tdi danh gii khdng cd tru&ng hpp nio. Ca tren LS, CLVT vi FT. Bdi 100% benh nhin trong nghien ciSu cua chung tdi la cd chi dinh phiu thuit. Cac vi tri dd khi danh gii cd xim lin thi u da d giai doan mudn (T4b) khdng con chl dinh phiu thuit.
S. KET LUAN
1. Danh gii tdn thucmg ha hpng LS va CLVT chinh xac 96,7% SP vdi phau thuat.
2.Danh gii tdn thucmg vimg giip ranh
Tap chl Tai MQI Hpng Viet Nam - Volume (57-12). N°6 - Dec., 2012
h? hpng , son, lan cao LS, CLVT, PT cd k^t qui nhu phlu fliuit ( p < 0,05).
3. Dinh gi, lan trin th(rc quin LS v^i CLVT khic vdi phlu thu^t (p< 0,05).
T A I LIfUTHAM K H A O 11. Nguyta Dinh Phuc (2009) : (/«^ r/iic
Ihanh qudn vd hg hgng. Tdng kit 1030 benh nhdn ciia 5./ ndm 1955- 2008 tgi 17(7; Tai Mui Hgng Irung ttong. Tap chi y hpc Viet Nam. Tip 359, sd 2, fliing 07 nim 2009.
12. Trin Hihi Tliin (2003): Ung ttiu ha hpng.
Bdch klioa ihu benh hgc lip HI. Nha xui'l ban Y hpc Ha Ndi. Tr 465- 471 13. Trin Hihi Tudc (1984): Ung ihu hg
hgng- thanh qudn. Nha xuit ban Y hpc Ha Ndi.
14. Bailey Byron J, Randal S Weber (2006): Hypopharyngeal cancer.
Head and neck surgery Otolaryngology. Volum two. 2°' Ed.
Lippmcott company, Philadelphia, USA, pags 1286-1303.
15. Barzan L, Comoretto R (1993).
Hemipharyngectomy and hemilaryngectomy for pyriform sinus cancer: Recontruction with remaining larynx and hypopharynx and with tracheostomy.
Laryngoscope Otolaryngology 103, Pags 82 - 86.
16. Brasnu D (1996): Cancer du hypopharynx. Dans Tran Ba Huy P.
Otprhinplaryngologie. Ellipse. Paris, France, 81 - 9 1 .
17. llpna M. Schmalfiiss (2006):
Neoplasms of the hypopharynxand proximal esophagus. Principles and practice pf head and neck oncology.
MD Martin Dnitz, London and New York. Pags 81 -102.
18. Paul Q mongomery et al (2006):
Tumours of the hypopharynx.
Principles and practice of head and neck oncology. MD Martin Dunitz.
London and New York . Pags 438 - 482.
19. Ravindra uppaluri, John B. Sunwoo (2007): Neoplasms of the hypopharynx and cervical esophagus.
Cumming. Otolaryngology. Head and neck sugery. Chapter 82. Mosby 20. Seungwon Kim et al (2006):
Hypopharyngeal cancer. Head and neck surgery - Otolaryngology. 4°^
Edition. Lippincott Williams &•
wilkins company, Philadelphia, USA, pags 1692-1712.
