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DANH GIA DAC DIEM L A M SANG, CAN LAM S A N G VA KET QUA DIEU TRI PHAU THUAT
CAT TUYEN GIAP QT DENH NHAN UNG THtfTUY^N GlAP THE BI^T HdA
Do Quang Tru'dng*, N g u y i n Quoc B a o * * va CS
T 6 M TAT
137 benh nhan ung thU tuyen gidp (UTTG) th^
biet hoa, du^c phSu thuat c3t todn bO tuyen gidp, gom
24 benh nhan nam (17,5%) va 113 b^nh nhSn nff
(82,5%). Tuoi trung binh cua benh nhan nam Id
42,214,4 vd cua nu" id 39,2 12,5. l(fa tuoi hay mSc
bSnh la 21- 60 tuoi (90,5%). Benh nhdn cd u tuyen
gidp la 100%; b^nh nhan c6 1 u Id 73%; u d 1 thiiy
tuyen giap la 78,8%. Kich thu'dc u tu" 1- 4cm la 84,7%.
U CO mat dp cutig, chdc la 88,3%; u di dpng la 73,0%;
i CO ranh gidi ro Id 92,0%, Di cdn hach c6 Id 48,9%
benh nhdn, h?ch c6 cung ben khoi u Id 92,5%, h?ch
c3 2 ben la 7,5%. Hadi di dpng la 94,1%; hach mlm
la 64,2%; hach cutig, chdc la 35,8%. UTTG the nhu
chiem 81%, UTTG thS nang chim 19%. Ddnh gia ket
qua phau thudt bdng xa hinh vCing tuy^n giap sau mo:
d ^ yeu cau la 96,4%. Cdt tuyen giap tnhn bo, ton
thiftJng can giap Id 2,9% vd than kinh qu^t ngu'pc t^m
thcfi Id 4,3%. CSt giap toan bp co vet hach co, ton
thuttng can giap la 4,5% va than kinh qudt ngu'pc tam
th6i la 6,6%.
SUMAAARY
Remarks on the clinical features, result surgical
treatment tiiyroidectomy in the Differentiated
t h ^ v i d cancer
A total 137 patients Differentiated thyroid cancer
were surgery completion thyroidectomy, 24 men
(17,5%) and 113 women (82,5%). Age men with a
mean is 42,2 14,4 and women is 39,2 12,5* The
patient at the 21- 60 year old were the most frequent
(90,5%). The ari^ng symptoms were appearance of
tumor (100%), patients were one tumor (73%),
patients were tumor in the lobe (78,8%). Size of tumor
1- ton was 84,7%. Tumor solid was 88,3%; mobil
tumor was 73,0%; surround of tumor clear was
92,0%. Metastases to t^rvical nodes was 48,9%. The
node unilateral with tumor was 92,5%. The node
bilateral with tumor was 7,5%. Mobil of tumor was
94,1%; node soft was 64,2%; node solid was 35,8%.
Papillary carcinoma 8 1 % , Follicular carcinoma 19%.
Whole- body scan postoperative; result excilent was
96,4%. Total ttiyroidectomy, injury to the
a
parathyroid gland was 2,9% and recun-ent laryngeal
nen/e was 4,3%. Total thyroidectomy and neck node
dissection iniury to the a parathyroid gland was 4,5%
and recunent laryngeal nerve was 6,0%.
I. OjBiT VAN OE
UTTG la benh ac tinh thu'dng gdp, chi^m
90% ung thu' noi tiet va khoang 1 % cac loai ung
th\i. Tan suSt mSc benh hSng ndm la 0,510/100000 dan. Theo md benh hpc UTTG chia 2
the; biet hoa va khong biSt hod. Hien nay, cd
nhieu phu'dng phap dieu tri la; phau thuat, udng
" ' l , chieu xa ngoai, hoa tri lieu vd hormon li|u
phap... Trong dd phau thu$t cdt toan bp tuyen
gidp ddng vai trd quan trpng vd u'u tien hang
dau. U'u diem cua phau thuat cSt tuyen giap Id
de SI/ hap thu ^^^I cua te bao UTTG cdn lai duUc
de dang hdn, lam tdng hieu qua cua " ^ I , thuan
Idi cho theo doi sd tai phdt bang djnh lu'dng ndng
dp thyroglobulin, gidm tai phat tai cho, loai bd 6
ung thu' vi the d thijy giap doi ben, han che dl
can xa, giam ty le tu' vong, lam tang hieu qud
cua xa trj ngoai d benh nhan UTTG khong bat
^^^I va the khdng biet hoa. Tuy nhien, phau thuat
cat todn bp tuyen giap cd bien chutig nhat djnh
nhu" ton thu'dng tuyen can giap va than kinh quat
ngu'dc thanh quan nen anh hu'dng den chat
lu'dng sdng ciia benh nhan. Vi vay,_chung toi tien
97
Q u A VA B A N
Bing3.1:Tu6\
GIAI
Tufii
20
21-40
41-60
>60
C6nq
Tmnq binh
IUAN
va qidl
Nam
SSBN
Ty 1$ %
2
8,4
33,3
8
54,1
13
4,2
1
24
100
42,4 14,4
NB
SSBN
6
53
50
4
113
Ty l /o
5,3
46,9
44,3
3,5
100
39,2 12,5
TSnasS
SSBN
TVI%
8
5,9
61
^ 44,5
63
46,0
5
3,6
137
100
39,7 i 12,8
UTTG g$p d mpl [i/a tuSl. TuSi hay g^p Ii 21- 60 (90,5%), tuoi mic b^nh trung binh I i 39,7
12,8. Nam gidl chlem 17,5% (24/137) v i nif chlem 82,5% (U3/137), ty 1^ nff/nam la 4,7/1 (113/24).
Nghien cuU cua Le Vin Quing, nff gidl chlem 72,1%; nam chlem 27,9%; tuoi 31- 50 chlem 50% [5]
v i Vu Trung Chinh, nff gidl gip 81%, ty 1$ nff/nam I i 4/1, tuoi trung binh Ii 38,6 13,9 [3].
Bing 3.2; Tdeu chffnq lam sanq dau tifin
Tri^u chihig
U tuvfn qlip
K^chco
U tuyen giip + hach co
Nuot vudnq
Tonq so
TvlS<M>
70,8
2,9
24,8
1,5
100
SSBN
97
4
34
2
137
Trieu chuhg u tuyen giap la 70,8%; u tuyen giap cd di cSn hgch co Id 24,8%. Theo Tran Minh
Olj'c benh nhan cd cam giac tu'c, vu'dng, bd didt vung co la 53,4%; ngh^n khi 3n la 38,9%; khan
tieng Id 15,3% [4].
Bing 3.3:0^
Mat dp
Ranh gidi
Bem^tu
Didpng
diem u tuyen q i i o
DJIc diem khSl u
MSm
COhq, chSc
R6
Khonq rB
Nh^n
Goghe
Didong
Khonq dl dOnq
SSBN
16
121
126
11
10
127
100
37
Tvle<Wi
11.7
88.3
92,0
8.0
7.3
92,7
73.0
27.0
inTG CO u cffng, chic la 88,3%, u cd ranh gidi ro la 92,0%, be m$t u ghS ghS I i 92,7%, u dl
d$ng Ii 73,0%. Theo TrSn Minh Offc, b5 m?t u go ghe la 100%, u cffng I i 90,1%; u c6 ranh gkSIroIi
76,3%; u xam Ian trung thSt Ii 12% [4].
Bing 3.4; t>ic diem hach c6
09c dim hg chcS
Vitri
MatdO
Di dpng
98
CiJng ben
Hal ben
Cling, chic
Mem
Di donq
Khonq di dpnq
S5bnhnh8n
62
5
24
43
63
4
Tyle%
92.5
7.5
35.8
64.2
94.1
5.9
putfnq b'nh
78,1
Am tfnh q]F"
21,9
COng
^ , eSI chiSu l<a qua chpc te bao vdl mo benh hoc sau phau thuat, ty ie du'dng tinh I i 7 8 , 1 % va am
tinh g i i I i 21,9%. Nghien diu ciia Le V i n Xuan, dp nhay I i 100%, dp d i e hieu I i 9 8 % , gia tri d u
doan dffdng tinh I i 9 3 % , gia tri dff doan am tinh I i 100%, do chinh x i c la 9 8 % [ 6 ] .
B g / l g 3 . f f ; Phan ioai TNM
P h i n leal TNM
SSBN
Ty 1$ /o
Tl
8
5,8
T2
69
50,4
Khoi u
T3
20
14,6
T4
40
29,2
NO
70
51,1
Hach
Nl
67
48,9
MO
137
DicSn
100
Khoi u d T J la 50,4%. T , I i 29,2%. Di c i n hach co I i 48,9% ; u CO the x i m Ian v i o to chffc Idii
quan, thu'c quan, cd... Nghien cffu cua Ernest L.M, u x i m Ian to chffc: c d I i 5 3 % , l<hi quan la 37%,
than Idnh thanh q u i n la 47%, t h u t q u i n la 2 1 % , tiianh quan la 12%, xam Ian vi tri Idiic I i 30% [7]. Nghien
oju cua Nguyen Tien Ling, u d T ; v i T3 I i 6 5 , 1 % v i T , I i 15,9%; di can hach co la 59,4% [4].
Bing
Gidi
Hach CO
Tuoi trung binh
Nam
Nff
NO
Nl
19
92
62
49
17,1
82,9
55,8
44,2
39,7 12,9
5
21
8
18
19,2
80,8
30,7
69,3
44,7 11,9
P
>0,05
<0,05
<0,05
991
Bing 3.11:55
1< u < 4 cm Ii 84,7%. Theo Le Vin Quing, u d 1 thiiy Ii 80,5%; u d 2 thiiy glip Ii 16,2%; u t?l eo
Ii 3,3% [5]. Tlieo Karl Y.B, u 1 thiiy la 71%, u 2 thiiy la 19%, u <1 cm la 23,9%, u tff 1 - 4 an la
29,8%, u > 4 cm I i 46,3%.
Bing 3.12: Ohc diem hach CO
So b$nh n h i n
Tyl$%
D i e diem hach co
70
51.1
Khonq CO hach
8.8
12
Ihadi
So lu'dng
6.6
9
2 hach
46
33.6
i 3 hach
1
1.5
< 1 cm
64
l-2cm
95,5
Kich tfiudc
3,0
2
> 2cni
B?nh nhan khong cd hach co I i 5 1 , 1 % . Co 1 - 2 h?ch I i 15,4%, co a 3 hach I i 33,6%. Kich thu8c
hach CO < 2 cm la 9 7 % .
Bing3.13;\l\
tri hach co di cin
SS lu'dng ( n = 137 )
VI tri nhdm hach
I
4
37
II
III
43
IV
33
V
18
VI
29
VII
2
T4li<Mi
2.9
27.0
31.4
24,1
13.1
21.2
1.5
Dl cin nhdm hach cinh la 82,5% (nhom II la 27,0%; III I i 31,4%; IV I i 24,1%), it gip di cin
hach nhdm I (2,9%). Tlieo Iran Trong Kiem, di cin h?ch cinh I i 85,3% (nhdm I I la 32,0%; nhom III
la 33,6%; nhom IV la 19,7%), nhdm I i i 0,8%, nhdm V Ii 15,6%, nhdm VI la 6,6% [3].
Y Hpc V | T N A M T H A N G 9 s6 1/2012
2.