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Y HQC VigT NAM T H A N G 9 - S6' 1/2012

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

hanh de tai ""Danh gia dac diim iam sSng,


can iam sang va leH qua dieu tii phau thuat
cit tuyih giap d benh nhan ung thW tuyen
giSp the biet h6a"y&\ muc tieu: danh gia mot
so dac diem iam sang va can iam sang, i<et qua
phau thuat cat tuyen giap d benh nhan UTTG the
biet hoa.

II. o 6 l TUONG VA PHUdNG PHAP NGHIEN COU


1. Doi tifdng: 137 benh nhan (gom 24
benh nhan nam'va 113 nff) UTTG the bi#t hda
du'dc dieu tri phau thuat cat toan bp tuyen giap
tai Benh vien K va Benh vien Ung buidu Ha Npi tu*
10/2004 den 3/2010.

2. PhWdngphap nghiin cdi/:


- Nghien ciilj cac chi so: tuoi, gidi.
- Tri$u chutig lam sang dau tien cua benh (u
tuyen giap, hach co, nuot vuidng...)
- Dac diem u tuyen giap va hach co, moi lien
quan giu^ cac dac diem lam sang.

* BSnh viSn Ung Budu Ha Noi; ** B?nh vien K


Phin bi$n khoa h^: PGS.TS. Ngo Van Hodng Linh

97

Y H(PC VI$T NAM THANG 9 s g 1/2012


- X& nghidm ti Wo hgc, mo b|nh hipc,
phSn lo<il TT^M v^ glal do^n b^nh.
- C^nh gl^ t& qui phlu thi4t dit tuyn glip
bSng x^ hinh vung tuySn gIdp sau phSu thu$t bSng
" ' I vi dc taSn chCmg phSu thu$t. Kit qui; TH
III. KlT

Q u A VA B A N

Bing3.1:Tu6\
GIAI
Tufii
20
21-40
41-60
>60
C6nq
Tmnq binh

(khSng c6n m& glip trn xa hlnh), d^yiiucau(dx\


s6t 1^1 ril ric m8 glip trSn x? hinh), kiiong ditldin
nhdu md glip tren x? hinh).
5. ;iri>' / / 5<r//^//.- sff ll$u du'dc xu' ly theo
chu'dng trinh phSn mSm EPI-INFO va EXCEL

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

Y HQC V l | T NAM T H A N B 9 s 6 1/2012


UTTG CO dl c i n h?ch co I i 48,9% (67/137), di c i n hach ciing ben vdi u la 92,5% v i hai ben co la
7,5%; hach mem I i 64,2%; di ddng la 9 4 , 1 % . Theo Ernest L M , dl c i n h?ch co hai ben I i 24% [7],
Bing

3.5; Ket q u i choc te bao tai Ithoi u bSnq klm nho


Tyl^'Vo

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

3.7; Ptwin loai qlai doan


Giai doan
SSBN
Ty le %
I
86
62,7
22
16,1
n
29
21,2
ra
137
100
Tonq so
Benh nhin d giai doan I la 62,7%; giai doan I I - I I I Ii 37,3%. Nghien cii^i cua Nguyen Tien
tang, giai doan I I i 19,5%; giai doan I I Ii 65,6% [4]. Nghien cffu ciia Lim LH, glal doan I, I I , III, IV
c6tyl$li56; 11; 31; 2%.
Bing 5 . f t Phan loai mo benh hoc (MBH)
TVI$%
SoBN
Thb$nh
81,0
111
Nhu
19.0
26
Nang
100
137
Tonq conq
IITTG the nhii la 81,0% va the nang la 19%. Nghien ciru ciia Lim L H , the nhd la 78%, the nang
I i 19%, the U y I i 1 % , the khong biet hoa I i 2%.
Bing3.g:M6i
Lam sang

lien quan giua mo benh hoc (MBH) v i qidl, hach CO


Th nanq
The nhu
MBH
SSBN
SSBN
Tyle%
Tyl^Vo

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

Y HQC VI$T NAM THANO 9 S6 1/2012


iSTTG th? nang di cin h?ch cS I i 69,3%; cao hdn thS nhu (44,2%), LTTTG thg nhu gip d b#nh
nhan t r i tuoi hdn thK nang (p < 0,05). Khdng cd si/ khic bi^t ro r^t vS gidi vdl md benh hoc the nhu
v i the nang (p > 0,05).
Bing 3.10; Cic phtfdnq phip diSu tr| phSu thuit
Tyia%
PhuWng phip phiu thuit
51.1
Cit toin bi tuygn glip
Cit toin bO tuv6n qiipt vit hach cS
TSnqsS
I
137
I
100,0
Cit tuyn glip toin b la 51,1%; cit glip cd vit h?ch c8 I i 48,9%. Theo Vu Trung Chtnh, cSt
toin b$ giip I i 29,5%, cSt giip c6 vit hach co Ii 70,5% [3].
Iffdnq, vi tri, kich thffdc u tuySn q i p
SSBN(n=137)
OicdilimkhSlu
Ji\i<o
73,0
100
lu
25,5
35
2u
SSiuVng
2
1,5
i3u
70
51,1
Thiiv Phil
27,7
38
Thiivtril
Vitri
16,8
23
2 thuy
4,4
6
Eo tuvn qiip
8,0
11
S 1cm
84,7
116
1 < u 5 4 cm
Kich thudc
10
7,3
1
> 4 cm
U d mot thiiy I i 78,8% ; d hai thiiy I i 16,8%; cd n$t u I i 73,0% hoic nhiSu u la 2 7 % ; kich thudi

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

Bang 3.14; Cac yeu to tien Iffdno xau


YSu t S tien lu'dng xSu
So benh nhan
Ty le %
C61 ySu to
57
41,6
Co 2 yeu to
52
38,0
Co 3 yeu to
18
13,1
C6 4 yeu to
10
7,3
T6ngs6
137
100
Yeu to tien lu'dng xau: tuoi <15 hoac >45 tuoi, tien sif tia xa dau cd, u 2 thuy giap, u > 4 cm, u
pha v9 vd bao tuyen giap, di cSn hach c6, di cdn xa. Benh nhan cd 1 yeu to tien lu'dng xau la 41,6%; od 2
yeu to la 58,4%. Theo Vu Trung Chfnh, cd 1 yeu td tien luHng xau la 15,9%, cd > 2 la 84,1% [3].
Bang 3.15: B'\Sr\ chiTng phau thuat
T6n thu'cfng than kinh tam
Phu'dng p h i p phau t h u ^ t
Suy c$n giap t^m thdi
thdi
(attuygngidp(n = 70)
2 (2,9%)
3 (4,3%)
C5tTGc6veth9Ch(n = 67)
" I
3(4,5%)
I
4 (6,0%)
Cat tuyen giap, suy can giap t^m thdi la 2,9% va ton thu'dng than kinh quat ngu'dc tam thdi la
4,3%. N^u cat tuyen giap ket hdp vet h^ch co, suy can giap tam thdi la 4,5% va ton thu'dng than kinh
quat nguWc tam thdi la 6,0%. Theo Nguyen Tien Lang, suy can giap tam thdi do cat tuyen giap toan
bp Id 3 % va cat tuyen giap kem vet h?ch co la 14,9%; ton thu'dng day than kinh quat ngu'dc tam thdi
do cdt tuyen giap la 7,4% va cat tuyen giap kem vet hach co la 19,5% [ 4 ] .
B a n g 3.16: Ket qua phau thudt
SS b^nh nhan
Tvle%
Kaqua
96,4
Dat yeu rau
132
Khong tfat y i u c3u
Tdng so
137
Phau thuat dat yeu cau la 96,4%. Theo Vij Trung Chinh, ket qua tot va dat yeu cau la 97,4% [3].
IV. KlT LUiBhN
UTTG gap d nu* nhieu hdn nam, ty le
nff/nam la 4 , 7 / 1 . Benh nhan cd 1 u giap la 7 3 % ,
u 1 thijy tuyen giap la 78,8%. Kich thu'dc u tir 14 cm la 84,7%. Mat do u chac la 88,3%. U di
dong Id 73,0%. U cd ranh gidi ro la 92,0%. Di
can hach co la 48,9%, hach co cung ben khoi u
la 92,5%, hach co 2 ben la 7,5%. Hach di dong
la 9 4 , 1 % ; hach mem la 64,2%; hach cuhg, chac
Id 35,8%. LTTTG the nhu la 8 1 % va the nang Id
19%. Phau thuat dat yeu cau la 96,4%. Cat
tuyen giap suy can giap tam thdi Id 2,9% va tdn
thudng than kinh quat ngu'dc tam thdi la 4,3%.
d t tuyen giap ket hdp vet hach cd, suy can giap
tam thdi Id 4,5% va ton thu'dng than kinh quat
ngudc tam thc^ la 6,0%.

TAI LIEU THAM K H A O


1. va Trung Chinh (2002), Nghien cuV ip dyng
phui}g phap dieu hi ung did giap tr^ng the biet
Acs bSng cSt bo tuyen giap toan bd icet hpp I-

131, Luan van Thac sy Y hoc, Tru'dng dai hpc Y


Ha Noi.
Tran Minh Oufc (2002), Nghien culi dian doan va
^oj trf ngoai Idioa ung diu"tu\n giap, Uian van Tien
s? Y hoc, Hpc vien Quan Y.
3. Tran Trpng Kiem (2008), Nghien cuU phau
thuat cSt bo tuyen giap ic^ hop iode phdng xa
131 dieu trj ung thU tuyen giap die biet hoa, Luan
v3n Tien sy Y hpc, Hpc vien Quan Y.
4 Nguyen Tien Lang (2008), Banh gia phau
thuat cat toan bp tuyen giap phoi hdp 1-131 dieu
td ung diu" tuyen giap thebiit hoa, Luan van tot
nghiep BSCK I I , Tru'dng da! hpc Y Ha Noi.
5. Le Van Quang (2002), "Nhan xet 6lc d\&m lam
sang va cac phu'dng phap diSu tri ung thu" tuyen
giap tai Bgnh vien K tir ndm 1992 - 2000", Tap chi
y/7PQ so (431), tr. 323-326.
6. Le Vdn Xuan (2000), "Vai tro chpc hut bdng kim
nho trang chan doan tudc mo trong 126 truSng hdp
hat giap", Tap chi Y hpc thanh f^Ho QiiMinh, tap
4,'tr.203-213,
7. Ernest L.M. (2004), "Management of papillary
and follicular thyroid cancer". Endocrine Surgery,
pp. 157-182.

2.