Nhận xét một số đặc điểm lâm sàng, cận lâm sàng và kết quả phẫu thuật ung thư trực tràng cao giai đoạn II III tại bệnh viện ung bướu hà nội

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Nhận xét một số đặc điểm lâm sàng, cận lâm sàng và kết quả phẫu thuật ung thư trực tràng cao giai đoạn II   III tại bệnh viện ung bướu hà nội

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1 B GIO DC V O TO TRNG I HC Y H NI B Y T HONG TI MNH NHậN XéT MộT Số ĐặC ĐIểM LÂM SàNG, CậN LÂM SàNG KếT QUả PHẫU THUậT UNG THƯ TRựC TRàNG CAO GIAI ĐOạN II-III TạI BệNH VIệN UNG BƯớU NộI Chuyờn ngnh : Ung th Mó s : 60720149 LUN VN THC S Y HC Ngi hng dn khoa hc: PGS TS Lấ CHNH I H NI - 2016 LI CM N Tụi xin by t lũng bit n sõu sc ti: ng y, Ban giỏm hiu Trng i hc Y H Ni, Phũng o to Sau i hc, B mụn Ung th, cỏc phũng ban ca nh trng ó to iu kin giỳp tụi quỏ trỡnh hc v hon thnh lun Vi tm lũng chõn thnh tụi xin by t lũng bit n sõu sc ti: - PGS TS Lờ Chớnh i Trng i hc Y H Ni, ó trc tip hng dn khoa hc, tn tõm, tn lc mang ht nhit huyt ca mỡnh ging dy, giỳp , ch bo cho tụi nhng kinh nghim quý bỏu nht quỏ trỡnh hc tp, nghiờn cu tụi hon thnh lun v chng trỡnh hc Tụi xin by t lũng bit n ti: - Cỏc Thy Cụ hi ng chm lun Thc s, Trng i hc Y H Ni, nhng Thy Cụ ó úng gúp cho tụi nhiu ý kin quý bỏu tụi hon thnh lun ny - Ban Giỏm c, Khoa Ngoi Tng Hp v cỏc ng nghip Bnh vin Ung bu H Ni ó to iu kin thun li cho tụi sut quỏ trỡnh nghiờn cu ti vin - Cỏc Thy Cụ B mụn Ung th - Trng i hc Y H Ni ó to iu kin thun li cho tụi sut quỏ trỡnh hc Cui cựng tụi xin c trõn trng bit n, v gi nhng tỡnh cm yờu quý nht ti cha, m, v, gỏi v nhng ngi thõn gia ỡnh tụi, bn bố, ng nghip ó luụn bờn tụi giỳp , ng viờn, khớch l tụi quỏ trỡnh hc v hon thnh lun ny H Ni, ngy29 thỏng12 nm 2016 Hong Ti Mnh LI CAM OAN Tụi l Hong Ti Mnh, hc viờn Cao hc Ung th khúa 23 - Trng i hc Y H Ni, xin cam oan: õy l lun bn thõn tụi trc tip thc hin ti Bnh vin Ung bu H Ni di s hng dn ca PGS.TS Lờ Chớnh i Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp thun ca c s ni nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, Ngy 29 thỏng 12 nm 2016 Hc viờn Hong Ti Mnh NHNG CH VIT TT TRONG LUN VN AJCC BN CHA CEA CLS CLVT CT - Scanner G GPB HMNT M MRI N PET - CT PT PTNS SANS T TL TSM UTTT UTTT American Joint Committe on Cancer (Liờn hip u ban ung th Hoa K) Bnh nhõn Chn oỏn hỡnh nh Carcino Embryonic Antigen (cht ch im u) Cn lõm sng Ct lp vi tớnh Computed Tomography Scanner (Chp ct lp vi tớnh) Giai on Gii phu bnh Hu mụn nhõn to Metastasis (Di cn) Magnetic Resonance Imaging (Cng hng t) Node (Hch) Positron Emission Tomograpgy - Computed Tomography Scanner Phu thut Phu thut ni soi Siờu õm ni soi Tumor (Khi u) T l Tng sinh mụn Ung th i trc trng Ung th trc trng MC LC 5 DANH MC BNG DANH MC BIU DANH MC HèNH T VN Ung th trc trng (UTTT) l mt s cỏc bnh ung th thng gp thi gian gn õy v chim gn mt phn ba bnh lý ung th i trc trng (UTTT) T l mc v t vong UTTT trờn th gii ngy cng gia tng Theo t chc y t th gii nm 2008 th gii cú khong 1,2 triu trng hp UTTT mi mc v 608.700 trng hp UTTT t vong M nm 2012 t l t vong UTTT chim gn 9% cỏc bnh ung th v 40.290 bnh nhõn UTTT mi mc T l mc UTTT cng thay i theo v trớ a lý: c, New Zealand, chõu u, Bc M cú t l cao nht, chõu Phi, Nam l nhng ni cú t l mc thp nht [1],[2],[3] Ti Vit Nam theo ghi nhn ca Hi Ung th H Ni giai on 20082010, UTTT cú t l mc chun theo tui vi n l 13,7/100.000 dõn, nam l 17,1/100.000 dõn [4] i vi UTTT cao, ỏnh giỏ triu chng v thm khỏm lõm sng khú khn hn so vi UTTT thp v trung bỡnh (nh thm trc trng, cỏc triu chng mút rn, i tin mỏu) UTTT cao nu phỏt hin sm giai on I ch cn iu tr phu thut, giai on II - III sau phu thut cú th phi iu tr húa cht b tr Giai on IV thỡ vai trũ ca húa tr l ch yu, phu thut thng mang tớnh iu tr triu chng, tm thi Hin nay, iu tr UTTT cú nhiu tin b vt bc vi phng phỏp iu tr a mụ thc L s phi hp ca phu thut, tia x v cỏc phng phỏp ton thõn, ú phu thut úng vai trũ chớnh Ti Bnh vin Ung Bu H Ni bnh nhõn UTTT cao giai on II v III c phu thut ct on i trc trng, vột hch h thng sau ú da vo kt qu mụ bnh hc ch nh húa tr b tr hoc theo dừi thờm Tuy nhiờn cha cú nghiờn cu no v kt qu iu tr iu tr UTTT giai on II-III bng phng phỏp phu thut ti bnh vin Ung bu H Ni Vỡ vy chỳng tụi thc hin ti: "Nhn xột mt s c im lõm sng, cn lõm sng v kt qu phu thut ung th trc trng cao giai on II - III ti bnh vin Ung Bu H Ni" nhm mc tiờu: Nhn xột mt s c im lõm sng, cn lõm sng ca ung th trc trng cao giai on II - III ỏnh giỏ kt qu sm phu thut ung th trc trng cao giai on II - III ti bnh vin Ung Bu H Ni Chng TNG QUAN TI LIU 1.1 DCH T HC UNG TH TRC TRNG Trờn th gii t l mc UTTT chờnh lch ti 10 ln tựy theo cỏc nc Cỏc nc c, New Zealand, Tõy u, Bc M cú t l mc cao nht, Chõu Phi, Trung nam l khu vc cú t l mc thp nht [1],[5] Ti M t l mc UTTT tng lờn t 2% n 3% mi nm vũng 15 nm qua, nm 2012 c tớnh cú 40.290 bnh nhõn UTTT mi mc Theo bỏo cỏo nm 2006 Phỏp cú 36.000 trng hp UTTT mi mc ú UTTT chim 12.600 ca, 16.000 BN t vong UTTT [1] Vit Nam, theo Nguyn Bỏ c, t l mc chun theo tui ca UTTT l 13,7/100.000 dõn i vi n gii v 17,1/100.000 dõn i vi nam gii (giai on 2008 - 2010) [4] 1.2 SINH BNH HC UNG TH TRC TRNG 1.2.1 Sinh bnh hc ung th trc trng Nhng yu t liờn quan n sinh bnh hc UTTT bao gm cỏc yu t dinh dng, thng tn tin ung th v yu t di truyn 1.2.1.1 Yu t dinh dng Ung th i trc trng liờn quan cht ch vi ch n nhiu tht, m ng vt Nhng thc phm cú nhim cỏc hoỏ cht gõy ung th nh benzopyren, nitrosamin cng cú kh nng gõy ung th Ch n ớt cht x, thiu cỏc Vitamin (A, B, C, E) thiu canxi cng lm tng nguy c ung th 1.2.1.2 Cỏc thng tn tin ung th + Viờm i trc trng chy mỏu v bnh Crohn + Polyp i trc trng nh: polyp tuyn, polyp tng sn v polyp lon sn phụi (Hamartomatous polyp) [5],[6] 10 1.2.1.3 Yu t di truyn Yu t di truyn cú vai trũ quan trng sinh bnh UTTT, vi gen sinh ung th v cỏc hi chng di truyn bao gm: bnh a polyp i trc trng gia ỡnh v hi chng UTTT di truyn khụng cú polyp [5] 1.2.1.4 C ch sinh ung th i trc trng C ch sinh UTTT hin ó c sỏng t qua c ch gen sinh ung th Quỏ trỡnh sinh bnh UTTT tri qua nhiu giai on, liờn quan n tn thng nhiu gen sinh ung th tỏc ng ca cỏc yu t gõy ung th Nhng nghiờn cu cũn cho thy, hMSH2 v hMLH1 l nhng gen kim soỏt sa cha ADN, hai gen ny b t bin ó lm cỏc gen sinh ung th b mt bn vng, tr nờn d b t bin cú tỏc ng ca cỏc yu t gõy ung th [7] 1.3 GII PHU TRC TRNG 1.3.1 Gii phu trc trng Hỡnh 1.1 Thit ct dc trc trng (Ngun: theo Frank H Netter [8]) 10 TI LIU THAM KHO Azria D., Becouarn Y., Bosset J et al (2012), "Cancer du Rectum", Chapitre 5, Thộsaurus National de Cancộrologie Digestive, 1- 30 Aỗar H I., and Kuzu M A (2012), "Important points for protection of the autonomic nerves during total mesorectal excision", Dis Colon Rectum, (55), 907-912 Campos F.G., Habr-Gama A., Nahas S.C et al (2012), "Abdominoperineal excision: evolution of a centenary operation", Dis Colon Rectum, (55), 844-853 Nguyn Bỏ c v cng s (2010), Bỏo cỏo s b kt qu thc hin d ỏn quc gia v phũng chng ung th giai on 2008- 2010 Tp Ung th hc Vit nam, 1, 21- 26 Markowitz A.J., and Winawer S.J (1997), Management of colorectal polyps CA, 47(2), 93-112 Lynch P.M (1999), Clinical challenges in management of familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer Cancer, 86(8), 1713-11719 Rosen N (1997), Molecular biology of gastrointestinal cancer, cancer of the gastrointestinal tract, Cancer: principles and practice of oncology, 5th Edition, Lippincott-Raven, 917-980 Frank H Netter (2004), "Trc trng", Atlas gii phu ngi, NXB Y hc, 367 - 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