Y H p c T P . H o C h i M i n h " T a p 1 8 * S o 1 * 2 0 1 4 N g h i e n c u u Y h p c
30 70 UNG THU" TUI MAT TAI BV BINH DAN
Van tdn*, Duang Vdn Hdi*, Nguyin Cao Cuong*, Bdi Mgnli Con*, Hoang Danh Tail*
TOMTAT
Dgt van de: Ung thu tdi mat co tiin lugng xaii, a phuang toy, ti li sohg 5 ndm la tii 5 ddi 38%. Ung thu tid mat dieng hdng thie5 tiong ung thu tidi hod, thidniggap a nie, trdi 65 tuoi. Ung thu tiii mat c6 lidi he viem kinh nidi, md sdi mat Id nguydi nlidn chinii, chiein 75 cim 90% trudng hgp. O My, ngucri bj soi mat vd vian kiidi nien bi ung thu 7 Ian han ngiedi kliong bi soi mat vd khong vidn.
Muc tieu: Nghidi dm ung thu tiii mat lie ldm sdng vd kB. qud dieu tri.
Dm tugng vd Phuang phdp: U Iwi neu nhimg tnrdng hgp ung thu tiii mat tie tiidng 7 ndm 2006 ddi hit thdng 12 nam 2009. 80 TH ung thu tiii mat trong so'7456 TH cat tiii mat vidn dugc tim thay. Trong so 80 TH CO nam 40, nit 40, tiim trung binh 55. Co 10 TH co soi tiii mgt, chiem ti le 12,5.
Kei qua: Ve lam sdng: Nhom thu nhdi: Benli nhan dau lisp, thbdi tlioang co sot. Co khi viem tui mat cap liay kinh niin, thdnh tui mat ddy. Sau mo, tren hinh anh mo budu nidi thmf u, nlwm ndy co 33 TH. Nhdm thie lid: u sa dugc a hg sudn plidi, xam lah gan, clidi ep dudng mat gay vdng da tac mat, rdwm ndy co 47 TH. Trdi siiu dm hay CT, thuy thdnh tiii mat ddy mgt cho, thdnh tiii mat khong deu hay u lan bung ra trong long tui mat vd xdm Imgan, diedng mat nhdm thu hai
Ve phau thugt: Co 33 TH md'ngi soi vd 47 TH md'md, tioiig thai gian do, cd 300 TH polip tui mat, Hdu hit diegc md'ngi soi, chi co STH moma. Nhfeng TH mongisoigpm w u kliu ti-u trong tiii mat, khdng thay hgdi.
Nhieng TH momd gom coudddn lan ra khdi thdnh tdi mat tidi cdt tui mat ma rong, nhu cdt tui mat md 4 TH, cdt tui mat, md OMC DL 29 TH, cat tiii mat, cat gan 6 TH, cat tui mat, cat ohg mat dm, im ohg mat chit, dan luu Kehr, 2 TH, cdt tui mat, cat otig mat dm-nol mat mgt 3 TH, cdt tiii mat- noi vi tidng 3 TH,..., nao hgch. 42 TH nam vien tien 10 ngdy. 1 TH tie vong, nam znen 35 ngdy do do mgt-rugt ddn ddi suy kiet. Trong theo doi nhieng TH Tl, co 31 TH, theo doi trung binh 2 nam, S5% TH con sohg; nhieng TH pliau thuat md rong, theo doi dugc 21 TH, 45 % cxm sohg. (^ 18 TH md'lgi vi n^t mat hay nghet mgt. Hod tii vdi 5FU vd cisplatin nlimig Ididng theliegng gid k& qua.
Kit ludn: Ung thu tiii mat Id ung thu ndng, c5» de phdng klii cat tiii mat noi soi, ddc bid Id nhiaig TH da bi bieh diieng nhu vidn tiii mat cap, apxe tiii mat, tiii mat Iwqi tie, VPM mat, cdt tiii mat md tdiong dty ldm zmng rdi tebdo ung thu Khi budu a T2, ndi mo'md, cat hii mat nga iigdi tan goc, cdt cdc bo phan an lan. Tidi lugng khoi u T3 thudng xdu.
Tickhoa: Ung thu tiii mat A B S T R A C T
CANCER OF THE GALLBLADDER AT BINH DAN HOSPITAL
Van T a n , D u o n g V a n Hai, N g u y e n C a o C u o n g , Bui M a n h Con, H o a n g D a n h T a n
* Y H o c TP. H o C h i M i n h * Vol. 18 - N o 1 - 2014:149 - 1 5 4
Background: Cancer ofthe GB liave bad prognosis. In the ocddental countries, tlie rate of survival 5 years is fixmi 5 to 38%. Cancer of the GB is the ^ digestive cancer, usually met on ^nale over than 65yo Cancer of the GB rdate to dironic infiammation. Clwleq/stis with stones that are the main cause, occupy fiom 75 to 90% of
' Benh vif n Binh Dan
Tdcgia lien lac: GS.Van Tan DT. 3S394747 Email: binhdanhospitaJig'han vnn.vn
Hpi Nghi Khoa Hpc Ky thuat BV. Binh Dan 2014 149
Nghien cuu Y hpc V Hpc TP. Hb Chi M i n h * Tap 18 * So 1 * 2014 cases, hi USA, men who have stone in the biliary system and chronic inflammation, have cancer of the GB 7"' time more tlian men who have iw stone and inflammation of biliary system.
Objective: We study the climcal manifestations and the surgical result ofthe GB cancer.
Patients and Method: It is a poststudy ofthe GB cancer fi-om July 2006 to December 2009.
Result: 80 cases of GB cancer among 7456 cases of LC. In tfie 80 cases, male 40, female 40, and middle age 55. 10 cases have gall stones, the ratio is 12.5. - Group 1: 33 cases, patients liave subcostal pain with fever, dyspepsy mimic as acute or chronic cholecystitis with stones in the gall bladder. Tlie ultrasound not found abnomality, but the pathology found cancel- in the uviU. Group 2: they have cxquise pain of subcostal or RUQ pain, with light jaudice. At examination, we found a subcostal mass. The ultrasound or CT fi)und a thick or inegularity of the gall bladder wall or a mass develop intra lumen of tlie gall bladder. - 33 cases haoe LC and 47 cases, opaied clwlecystedomy, at tlie same time, zoe operate in LC 300 cases of polip ofGB with 5 cases. The cases that tlie LC are done have tumor confine in the CB, and no lymph nodes. The cases tliat cancer develop out ofthe GB wall are extended removal of the GB, in opened diolecystectomy: 4, cholecystectomy - CBD drainage; 29, cholecystedomy - hepatedomy: 6, cholecystedomy - CBD removal, with biliai-y anastomosis; 2, cholecystedomy - CBD removal, biliari-aiterotomy anastomosis; 3, chdecystedomy - gastrointestinal anastomosis: 3. removal of lymph nodes. Tha-e are 42 cases stayed in hospital over 10 days. 1 case died in hospital for 3S''days, 72 yo, due fo fistula, drrhosis and debility. In the follow-up during 2 years, the 33 cases Tl, 85% is still alive. The cases of extended cholecystedomy (47 cases), 45 % is still alive, but there are 18 cases came back to Iwspital because of staiosis of bile trad or small bowel, they must be reoperated. Ahnost cases have chemotlierapy with 5 FU and dsplatinum..
Ccmclusioiv Cancer ofthe GB is a severe disease. As, clinical manifostations, the syndrom is mimic a chronic or acute cholecystitis, except the advanced case that the tumor is in tlie subcostal area. We peiform the LCfor the early cases (Tl). In advanced cases, LC causes seeding tlw cancer cell. So zohm loe found tumor that is T2, the opened cholecystectomy is mandatory, removal nodes, removal the extended viscera and anastomosis. Tiie prognosis is bad in tliese cases.
Keywords: Cancer of gallbladder.
DAT VAN DE ]or)h nien bi ung thu 7 Ian hon nguoi khong bj soi mat va khong viem*^*. Ngoai ra, nhung
^ Ung ta hii mat la ung ta nang, thuang xay ^^^^ ^ ^ ^ ^ . , ^ ^^^^ rtu mat sanh hoa, den voi nguoi cao haoi. Tri, trucmg hop tim thay ^ ^ . ^ ^ ^ ^^ ^^, _j^. ^ ^ ^ ^ trone cat tlii mat noi soi vi SOI gay viem thuong ,.~- . . . , ., , , .. ... ... . ,. ..
° ^ ^ *' -' _ ° bien thanh ung thu. Ung thu tui mat con la tir som, hau het duQC phat hien a giai doan tre, co p^jj (E™.R,f™,„™™™.f™<i,_
tien luong xau. O phuong Tay, ung thu tui mat,
ti le song 5 nam la tu 5 de^n 38%e>.i,«„. m hanh ^ * * ^'^' '^°'' ' ^ khu tru 6 fhanh tui thay, CO nhieu truong hpp khong cStbo duoc khi ""9'' ^^°'° ^ ^ "^ ^''^ ^y ' ^ ' ^ '^^ ""^
lim thay. Moi day, nho phlu taat tien bo, P''*" ' ^ '^ "^ *"'"' ^^ ^'«" "="•'•""' nhung truong h<7p img thu con khu tru, tien Myc tieu
lu<?ng mo khaO,'"."-'!"). Chiing toi nghien cuu ve dac diem lam sang, 6 My, ung thu hii mat diing hang thii 5 c|n Iam sang va kel qua dieu tri ung thu hii mil Irong ung Ihu heu hoa, thuemg gap 6 nu, tren 65 tai benh vi|n Binh Dan.
luoi. Ung thu hii mat co lien he den viem kinh p n U O N G PHAP VA D 6 I Tl/qJNG nien, ma soi mat la nguyen nhan chinh, chiem 75
den 90% truong hop. Nguoi bi soi mat va viem La hoi aiu nhung ca ung thu liii mat tir
Y Hpc TP. Hb Chi Minh * Tap 18 * Sb 1 * 2014 Nghien cuu Y hpc thang 7 nam 2006 den het thang 12 nam 2009.
KETQUA
Trong suot thai gian hon 3 nam ruoi, chiing toi tim dupe 80 ca ung thu tui mgt, 10 truong hgp CO soi trong tui mat, ti le la 12,5°o, 1 tmong hpp soi trong gan trai va phai. Trong luc do co 300 truong hpp polip tui mat, co 48 ca co soi, ti le 16%, mo mo la 5 trudng hpp.
D | c diem lam sang Tudi vd phdi Bdngl
T u i i
< 3 9 4 0 - 5 9 6 0 - 7 9
> 7 9 Tfing
N a m 10 17 11 2 40
NiP 2 21 12 5 40
T o n g 12 38 23 7 80
80 ca ung thu tui mat trong so 7456 TH cat tlii mat viem, chi&n ti le 1%. Trong so 80 TH co nam 40, nii 40, tuoi trung binh 55. Nam tuoi tre nhieu, Nu tuoi gia nhieu.
Ldm sdng Bdng 2
D i u hieu Phat hi#n t'nh ccr khi cat TM/NS
MStky V i n g da Vang niem
e a u HSP Khoi u HSP Khoi u thinyng vi
S d c a 32 42 22 17 62 4 3 04
Dinh b^nh
Dua vao SA va CTscan.
Bdng 3
S A 8 0 T H
C T 1 0 T H
KhSng th^y bat thirong, tn> soi Kh6i b ^ thirong 6" giuong tiii m$t, soi
Thanh tiii mat day b i t t h u w i g Khonq thay b ^ thirong, tn> soi Thanh tui mat khong deu Kh6i t h i y tui mat, xam lan cac bo phan lan
can
30%
4 0 % 3 0 % 10%
4 5 % 2 2 %
Cac hmh anh tren cho thay tiii mat bi ung tiiu khong cSt IJO duoc.
Ket qua phau thuat Bdng 4
P h l u t t ) u # t M o N S Mo m o Tong
S o T H 33 47 80
BC 1 T i le % 0 6 6
0 12.76 12,76
- Phau thuat npi soi: Tat ca co 33 TH, khong hi bien chiing va hi vong.
Do la nhiing TH co u khu tni trong tiii m^ti khong thay hach. Trong thoi gian do, co 300 TH p>olip tlii mat, hau het dupe mo noi soi, chi co 5 TH mo mo, co 2 truong hpp ung thu.
- Phau thuat mo mo (Bang 5): Co 47 TH, bi&i Chung la 6 (12,76%).
Bdng 5
P h a u ttiuat C i t ban phan tui mgt - DL Cat tui mat + nao h?ch - mcr OMC-
DL C i t tui mat + c4t gan. nao hactvDL
OMC C i t T M + nao hgch. c i t OMC-noi m a
mot c i t tui mat + n6i m i t mot-noi vi trang
C i t tui mat + d t OMC-DL ong gan Tong cpng
S o T H 2 31 6 5 3 1 47
BC 1 3 1 1 0 0 6 (12,76%)
TV 0 0 0 1 0 0 1 (1.3)
Nhiing TH mo mo gom c6 u da an lan ra khoi ihanh tiii mat nen cat hii mat mo rpn^ nhu cat ban phan tiii mat 2, cat hii mat+ nao hach-mP OMC DL 31 TH, cat hii mat+cit gan, nsio hach, DL OMC 6, cit hii mat+nao hach, cJt OMC niat- rupt 5, cat hii mat - noi vi trang 3, cat hii mat cat OMC, DL ong gan. Bien chiing la 6 (12,76%).
3 hian sau, 40 TH deu co dieu tri t>6 hic bang hoa chat 5 HJ va dsplatin, chua co TH nao dieu tri biing tia xa, hieu qua khong xac dinh dupe
- Thai gian nam \ien. 42 TH tren 10 ngay.
Thoi gian nam vien trung binh mo NS la 4 ngay, mo mo la 8 ngay. Thoi gian nam vien dai nhat aia mo npi soi la 12 ngay, con mo mo la 35 ngay.
1 TH til vong, nam \'ien 35 ngay do do mat- rupt dan den suy kiet. Ca nay la nam 72 tuoi, bi ung thu hii mat an lan OMC. BS phau thuat mo mo, cat hii mat cat OMC - noi mat - rupt bi xi
Hpi Nghi Khoa Hpc Ky thuat BV. Binh Dan 2014 151
Nghien ctru Y hpc Y Hpc TP. Ho Chi Minh * Tap 18 * So 1 * 2014 ngay thii 5 sau mo, mo lai, bi do mat tiep. TV o
ngay thii 35 sau mo do do nipt xo gan va suy kiet (1,25%).
- Mo buou: hau het la Adenocarcinoma.
Bdng 6: Giai doqn bddf^
Giai doan 0 1 11 IIIA IIIB IVA [VB T 6 n g s 6
Giai doan TNM Tis (NOMO)
T1NOM0 T2NfflWlO T3NOM0 T1-3N1M0 T4NO-1M0 BitkyTbatkyNMI
Soca 2 10 12 14 15 10 17 80
Theo doi
Nhung TH Tl, mo NS, chiing toi co 31 TH, theo d5i trung dupe 2 nam, 85% (26) TH con song, 54% (14) TH tai phat 1 TH nghet mieng noi khong phai tai phat. Tat ca deu duoc mo lai: 6 TH noi lai mat rupt 2 TH noi vi trang, 6 TH mo ong gan ra da. Khong co TH nao di can do npi soi.
Nhung TH phau thuat mo rpng, theo doi duoc 21 TH trong 2 nam, 45% (9) con song. Tat ca deu tai phat. Co 18 TH mo lai vi nghet mat hay nghet rupt tiong do co 10 TH mo tham sat 5 TH noi lai mat rupt, 2 TH noi vi tiang, 1 TH mo ong gan ra da.
Nhu vay, sau 2 nam ti le song sot la 35 (44%), ti le song khong tai phat la 26 (32,5%).
- Hoa tri: Chiing toi cho hoa tri bang 5FU va muoi platine, hieu qua khong dupe kiem chiing.
BAN LUAN
Ung thu tui mat chiem ti \% hon 1% (80 TH/7456 ca cat bo tlii mat). Ti le nay gan bang so vol nuoc ngoai nhu 6 My ti I# la 1% voi nhung TH cat tlii mat ke hoaehP*. Ti le ung thu hii mat cao 6 An va Hoi quoc. Tuoi trung binh 6 My la 65, o Viet Nam la 55. 6 My nu' nhieu hon nam 2 deh 3 Ian, la ung thu hiem, diing hang thii 5 tiong ung thu tieu hoa. Tuoi trung binh 6 Viet Nam tre hon o My, 6 My tuoi trung binh la 65 O My 40% tneu chiing giong nhu viem tiii mat
kinh nien, 6 mot so khac, tri?u chiing giong nhu viem tlii mat cap tinh, co the co con dau ngan ket hop voi oi miia, sot va dau ha suon phai. Ngoai ra con co trieu chiing nghpt duong mat cap, mat ky va ha suon phai ah dau thuong xay ra. Co khi khong CO trieu chiing ung thu, chi an khong ngon, mat ky va khong vang da, nhung xuat huyet tieu hoa va nghet d^i day, Nhu vay rat lam lan vol viem tiii mat kinh nien, ung thu tuy, viem tiii mat cap, soi trong duong mat hay co tiiJ mat bi nghet lam cho tiii mat li nu6c<*™^ Retot™
Dinh b^nh kho, do lan Ipn voi viem hii mat cap tinh do soi ket co. Nguoi bi soi m^t co ti Ie ung thu hii mat cao gap 7 lan khong co soi. 6 tiianh pho Ho Chi Minh, nguoi co soi hii m|t bi ung thu gap 2 Ian nguoi khong soi. Tiii mat co hinh anh sanh hoa hay polip Ion 1 cm cung thuong bi ung thu. Tren hinh anh sieu am, thay thanh hii mat khong deu, thanh hii mat day mot cho, hay u Ion bung ra trong tui mat tii trong thanh. CT scan co the danh gia giai dogn khoi u nhu u xam lah phiic mac, di can gan, xam lan hach vimg. Khi u sa dupe 6 hg suon phai xam lah gan, u chen ep duong mat gay vang da tSc mat thi da qua tr^-^'*.
Mo buou ehinh la adenocarcinoma. Ban dau phat tiien tiong long tiii m§t tir niem mac, roi di can hach den cuong gan, gan va cac bp phin 6 gan. O giai doan OB moi co hach duong tinh.
Khi dinh l>enh dupe, 25% truong hpp ung thu con nam trong thanh tiii mat 35% eo ket hpp voi di can hach vimg hay xam lah cac tgng lan can va 40% da di can xaH'i3.i5,i7,20),
Di can theo kinh dien, hi hach tai cho, den hach duong mat roi gan va cac bp phan lan can cho nen phai nao hach duong mat doc OMC va ron gan. Xam lah gan bang each di can tnic tiep tii giuong tiii mat theo duong mach mau, bgch huyet he cua hay di can xa theo duong mau.
Phau thuat khi khoi u con tiong tiii mat tiu dua vao giai doan benh<^. B?nh nhan ma khcS u eon nam trong niem mgc hay dudi mem (Tia)
Y Hpc TP. Ho Chi Minh * Tap 18 * So 1 * 2014 Nghien cuu Y hpc
hay khoi u nam tiong co (Tib), song qua 5 nam la 100% den 85%, do cit bo tiii mat mo"-^. O t hii mat qua npi soi co the lam roi vai te bao ung tiiu ti-ong 6 bung va 6 port site, ke ca khi khoi u con a Tl chi tu 26 deh 36%fi8i. Neu ck tiii mat npi soi thi nen ehuyen mo va khoet luon 16 tioca'^"^\ Tai BV chiing toi, 6 cac truong hpp Tl, T2 cac BS thuang c^t qua npi soic^'^. Tren nguyen t^c, truong hop T2, T3 phai mo lai ma, hay mo mo ngay tii dau.
Theo kinh dien, neii u a T2 va T3 thi phai c5t tlii mat mo rong, nao hgch, dan luu OMC hay noi mat ruot Roux-Y. Khi ung thu hii mat xam lah gan thi phai cat gan qua 2 cm. Neu khoi u to, thi nen cat gan theo giai phau hpc"^'''"-"^ Khi khoi u xam lan duong mat, mgch mau gay vang da, khi khoi khong the cat bo duoc thi nho npi soi hay dat stent qua da, sieu am huong dan.
Con chong dau thi co the cat TKGC nguc qua npi soi hay chich lidocain qua thanh bung vao dam roi giao cam than kinh tangi->.
Doi voi hoa tii thi chiing toi co dieu tri voi 5FU va cisplatinum nhung khong chiing minh dupe ket qua, con xa tri thi chiing toi chua sii dung.
Benh nhan bi ung thu tiii mat 6 niem mgc hay 6 lamina propria (Tai), tien lupng rat tot nhung dinh benh rat kho; khi khoi u vao tiong CO (Tib), ti le song qua 10 nam khong khac khi cat tlii mat don thuan hay ngo hgch. Khi khoi u T2, ngo hach tiii can tien lupng tot hon khong ngo hgch. Song 5 nam 50-60% so voi 17- 19% mo binh thuongf^'^J. Klii khoi khong eat bo dupe nguai benh chi song duoe tii 1 den 3 thang. Noi ehung song qua 5 nam cho toan nhom it hon 15%<->.
KET LUAN
Ung thu tui mgt la ung thu ngng.
Kin den som, tiieu chiing giong nhu viem hii mat cap hay man. Khi den mupn da co khoi u 6 HSP gay tiieu chiing chen ep duong mat hay dican gan.
Can de phong khi cit hii mat noi soi, dgc biet
la nhimg ca da bi viem tiii mat kinh nien ha\' cap tinh, apxe hay viem phiic mac khu tni, eSt tiii mat ma khong d e y lam vung rai te bao ung thu.
Khi buou 6 T2, nen mo ma, cat hii mat ngo hach tgn goe, cat cae bp phan an Ian. Tien luong nhirng truong hpp T3 thuong xau.
TAI LIEU THAM KHAO:
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2. Chaii RS, Shad SA (200S) Bauay Sifi.lem. Sabiston Textbook of Surgen-, ISth edit ppl579-I562
3 Cho SY, Park SJ, Km\ SH et al (2010). Analysis between dmieal outcomes of pnmary radical resecbon and second completion radical resection for T2 gallbladder cancer smgle - centerexpenence.Woi(rf;.Si(i534 1572-1578 i Chra SB, Han HJ, Kun CY et al <2009| Inadental gallbladder
cancer diagnosed following laparoscopic choleci'slectomy World J Surg 33.2657-2663.
5 Dixon E. Vdmer CM Jr, Sahajpad A et al (2005), An aggressive surgical ^jpioadi leads to improve survival m patients witf\
gallbladder cancer A 12'year study at a N'orth Amencan eerier ylniisurj241385-394
6 Duong Van Hai, Van Tan (2005) Buoc dau \ ' C su lien he giiia SOI mat va ung thu tui mat TC Y hoc JP HCM. phv ban tap 9. so 4tr 289 297
7 Duong Van Hai, Van Tan (2006)' UT tui t n | t K n h n g h e m 263 TH PT o BV Binh Darv Tap chi KH TH VN: tap 1, s6 3, tr 69-74
8 Fong Y, Jamagin W, Blumgart IH (2000) Gallbladder cancer.
Companson of patiHits presenting inihally for definitive operation with those presenting after pnor noricurahve mterventioa Ann surg 232,557-569,2000
9 Foster JM, Hoshi H, Q b b s JF et al (2007) Gallbladder cancer defining the mdicatiors for primary radical resection and radical re-resechon Aim Surg Oncc^ 14(2} 833-840.
10 Goetze TO, Paolucd V (2008): Benefits of reoperation of T2 and more advanced incidental gallbladder carcmoma:
analvsis of the Gemnan registry. Ann Surg 247(1 )-104-108 11. Kai M Chijiiwa K, Ohucbida J et al (2007): A curah\'e
resection improves the postoperative sur\ival rate even m pahents with advanced gallbladder cancer / Gfl.ifnxn/esl Surg 11(8) 1025-1032
12 Mekeel KL, Heitimmg AW (2007)' Surreal management of gallbladder cancer, a review J (^flroinlest Surg ll(9).n88- 1193
13 Misra .MC Gulena S (2006) Management of gaUbladder cancer found as a suipnse on a resected gaUbladdff speamerL / Surg Oncol 93(8)69(W98.
14. Reddy SK Marroquin CE, Kuo PC el al (2007): Extended hepatic resection for gallbladder cancer. Am J Surg 194(3)'355- 361
15. Shih SP, Schuhck RD, Cameron JL et al (2007) GalWadder cancer the role ol laparoscopy and radical resection Arm furg 245(6)893-901
16. Skora SS, Singh RK (2006) Surreal strate^es m patients with gallbladder cancer, / Surg Oncol 93(8)- 670-681, 17 Toyonaga T, CW|i:wa K, Xakao K et al (2003). Completion
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Nghien cthi Y hpc Y Hgc TP. Ho Chi M i n h * Tap 18 • So 1 * 2014
radical siu^ery after cholecystectomv lor acddentdly undiagnosed gallbladder carcinoma Worid } Surg 27(3):266.
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Van Tan et al (2006): Trocar-site metastasis after L C 2 cases reported. ELSA 2006, 19-21 Oct SeouL ftster 027, Abstract book p 187.
Van Tan. Duong Van Hai (2005) Ung thu tui m a t D ^ di&n, dieu tn va ket qua. 1' hoc Viet Nam, Tap 310, so 5, tr 100- 10835(1)48-51-
Yildimm E. Celen O, Gulben K et al (2005) management of incidental gallbladder caidrra Oi:m;31(l):«-5Z
The surgical la. Eur I Surg
Ngdy nlidn bdi bdo:
Ngdy phdn bien nhan xet bdi bdo:
Ngdy bdi bdo dieac ddng:
31/1012013 02/12/2013 20/02/2014
