Bạn đang truy cập: Trang ch? Tin ho?t ??ng

Nh?ng v?n ?? c?p nh?t trong ch?n ?on v ?i?u tr? ngo?i khoa ung th? ph?i nguyn pht ( issues update in diagnosis and surgical treatment primary lung cancer)

PGS.TS ??ng Ng?c Hng; PGS.TS Ng V?n Hong Linh

I .??t v?n ??:

UTPQNP v?n cn l m?t b?nh n?ng . K?t qu? ?i?u tr? ni chung v ?i?u tr? ngo?i khoa ni ring cn h?n ch? . L do l:

+ Ch?n ?on s?m UTPQNP cn kh kh?n nn khi pht hi?n ???c th kho?ng 80% khng cn ch? ??nh m? (do b?nh nhn ??n mu?n , do th?y thu?c khng pht hi?n ???c).
+ Tiu chu?n vng ?? ch?n ?on UTPQNP l tm th?y ???c t? bo ung th?.Tin l??ng b?nh l?i ph? thu?c r?t nhi?u vox?p giai ?o?n (G?)v lo?i t? boung th?.

+ N?u x?p G? UTP cng chnh xc th ph??ng php ?i?u tr? ???c ch?n l?a cho ng??i b?nh cng hi?u qu? v tin l??ng v? s?ng cn cng c gi tr?.

V nh?ng l do trn, ?? gp ph?n nng cao ch?t l??ng ?i?u tr? v tin l??ng UTPQNP, chng ti xin trnh by t?ng h?p nh?ng nghin c?u c?a cc tc gi? n??c ngoi th?i gian g?n ?y.

II. V?n ?? xc ??nh giai ?o?n v ngh?a c?a n:

1. T? l? t? vong thay ??i r?t l?n theo t?ng giai ?o?n ung th?:

Theo cc tc gi?, t? l? t? vong sau 5 n?m cho t?ng giai ?o?n:

+ G? IA : 35%, IB : 60%.

+ G? IIA : 63%, IIB : 70%.

+ G? IIIA :85%, IIIB :95%.

2. H? th?ng x?p lo?i TNM:

. H? th?ng x?p lo?i TNM ???c Hi?p h?i ch?ng ung th? Hoa K? ( AJCC: American Joint Committee Cancer ) v T? ch?c ch?ng ung th? Qu?c t? (UICC: Union Internationale Contre le Cancer, 1997) ch?p nh?n t? 1986, n?m 1997 ? ???c xu?t b?n thnh s? tay, sau ? ???c c?p nh?t

??y ?? h?n vo 2006 ti b?n vo 2009 ( Xu?t b?n l?n th? 7 ):

T (Tumor),N (Node),M (Metastasis).

Cc tc gi? ? l?p thnh cc b?ng ng?n g?n ?? ti?n s? d?ng trong lm sng:

B?ng 1:

Giai ?o?n

Giai ?o?n T

Giai ?o?n N

Giai ?o?n M


Tis ( T?i ch? )


























T1, T2, T3




T1, T2, T3




B?t k? N



B?t k? T

B?t k? N


3. Xc ??nh N ( Node):

3.1. Xc ??nh T v M khng kh.V?i cc d?u hi?u lm sng,ch?pX.quang th??ng, ch?p c?t l?p vi tnh ( CT ), ch?p c?ng h??ng t? (MRI ), siu m ta c?ng c th? ch?n ?on ???c.Xc??nh N (Node) hi?n nay v?n l m?t kh kh?n, cc tc gi? ? ??a ra nh?ng nghin c?u v h??ng d?n sau:

Theo b?n ?? trn th 14 v? tr nhm h?ch lin quan ??n UTPNP:

*Nhm h?ch trung th?t trn:

1. H?ch trung th?t trn cng.

2. H?ch c?nh kh qu?n trn.

3.H?ch tr??c v sau kh qu?n.

4. H?ch c?nh kh qu?n d??i v h?ch c?nh t?nh m?ch Azygos.

Nhm h?ch ? ??ng m?ch ch?

5. H?ch d??i ??ng m?ch ch? t?i c?a s? ch? - ph?.

6. H?ch c?nh ??ng m?ch ch? .

*Nhm h?ch trung th?t d??i:

7. H?ch d??i ng ba kh ph? qu?n .

8. H?ch c?nh th?c qu?n .

9. H?ch ? dy ch?ng ph?i .

*Nhm h?ch r?n ph?i v trong ph?i:

10. H?ch r?n ph?i .

11. H?ch lin thy ph?i .

12. H?ch thy ph?i .

13. H?ch phn thy ph?i .

14. H?ch d??i phn thy ph?i.

*H?ch trung th?t k hi?u l N2, bi?u th? b?ng cc ch? s? t? 1 ??n 9

*Nh?ng h?ch r?n ph?i v trong ph?i k hi?u l N1, bi?u th? b?ng cc ch? s? t? 10 ??n 14, v ??u n?m trong mng ph?i t?ng.

*Theo h? th?ng x?p lo?i hi?n nay, ???ng phn chia h?ch r?n ph?i N1 v h?ch trung th?t N2 l ???ng gi?i h?n c?a mng ph?i trung th?t.

3.2. ngh?a c? vi?c xc ??nh N2:

H?ch N1 l h?ch r?n ph?i v trong ph?i, nn khi ph?u thu?t ung th? ph?i khng kh kh?n ?? chng tavt h?ch.Kh kh?n l c xc ??nh ???c h?ch N2 hay khng? V ngh?a c?a n nh? th? nao? .

Theo tc gi?: Michael J. Weyant (2009); Raja M. Flores (2010):

-Di c?n c?a ung th? thy trn ph?i ph?i v tri vo trung th?t khi ? xc ??nh ???c c N2:

- Di c?n c?a ung th? thy gi?a v thy d??i ph?i ph?i v thy d??i ph?i tri vo trung th?t khi ? xc ??nh ???c c N2:

- Nh? v?y c ngh?a l:Khi ? c h?ch di c?n vo trung th?t (N2), n?u ung th? ? thy nao? ph?i nao? Th chng s? di c?n vo nhm h?ch no c?a trung th?t v t? l? di c?n l bao nhiu ph?n tr?m.

S? ?? ?nh s? h?ch:

S? ?? 1: S? ?? 2:

3.3. Xc ??nh N2 b?ng cc ph??ng php no?

Theo cc tc gi?, gi tr? c?a t?ng ph??ng php ???c ?nh gi d??i ?y:

3.3.1. X quang ng?c (T & N ):

+ V? tr u.

+ Bi?t kch th??c kh?i u, ?nh gi m?c ?? lan t?a c?a u theo ( T ).

+ Xc ??nh s? ph ??i c?a h?ch ( N ), nh?ng khng ch?c ch?n.

+ So snh v?i cc phim tr??c ?? ?nh gi s? ti?n tri?n c?a kh?i u.

+ C th? nh?n bi?t s? xm l?n c?a u vo thnh ng?c, trung th?t.

+ C th? xc ??nh Bng m? di c?n ph?i ??i bn, di c?n x??ng, no (kh chnh xc, ch? r ? G/? Mu?n).

+ Kh kh?n xc ??nh h?ch trung th?t (N2)

3.3.2. Ch?p c?t l?p ?i?n ton (CTScan):

- ??nh v? chnh xc kh?i u theo chi?u su.

- Lin quan v?i rnh lin thy.

- Nh?n bi?t s? ? kh trong ph?i gip phn bi?t tnh ch?t c tnh c?a kh?i u:

+ D?ng lnh tnh: B? t??ng ??i trn, vi ha, gi?i h?n r ( th?i gian nh ?i > 500 ngy).

+ c tnh: B? khng ??u, ?a cung, l?i lm, tia m?t tr?i, khng vi ha ( ti?n tri?n c?a kh?i u nhanh).

- CT scan xc ??nh ???c u di c?n h?ch trung th?t # 8% cho nh?ng h?ch 20 mm. M?t s? tc gi? ?nh gi CT scan: (JW Lewis ,1996; De Leyn P & cs, 2007):

+ ?? nh?y: 57% - 84,4%.

+ ?? chuyn: 52% - 81,1%.

+ Tin ?on d??ng: 56% - 68,7%.

+ Tin ?an m: 83% - 92,9%.

C?ng theo nh?ng tc gi? trn, xc ??nh G? UTPNP b?ng CT Scan ch? c # 45,4% l cho k?t qu? ph h?p trong m?, #10,7% xc ??nh ???c di c?n gan, ph?i, th??ng th?n v # 12,5% cho x??ng, h?ch ? b?ng. ?i ??n k?t lu?n: CT Scan khng ?? kh? n?ng xc ??nh G/? TNM ( ??c bi?t l N) trong UTPNP.

3.3.3. Ch?p c?ng h??ng t?(MRI):

- C hi?u qu? t??ng ???ng CT Scan.

- Xc ??nh di c?n xa vo gan, th??ng th?n ngang nhau.

- Xc ??nh di c?n no: MRI h?n h?n CT Scan.

- Xc ??nh di c?n x??ng: MRI c?ng nh?y nh?ng khng b?ng X? hnh x??ng.

- Xc ??nh N kh kh?n v khng chnh xc.

3.3.4. Ch?p c?t l?p tn x? Positron (PET: Positron Emission Tomography):

- PET Scan v?i ??ng v? phng x? 18-fluorodeoxyglucose (FDG) k? thu?t m?i ?? ?nh gi G/? UTPQNP v nh?ng kh?i u c tnh khc. C kh? n?ng nh?n bi?t ???c nh?ng kh?i u, nh?ng h?ch di c?n s?m:

+ D? li?u ?em l?i c?a PET gip ch r?t l?n trong trong ch?n ?on UTPNP.

+ Khi kh?i u pht sng trn PET th 90 95% l ung th?.

+ N?u u < 10 mm v khng th?y trn PET th ch? kho?ng 5% c? h?i l c tnh.

+ ?? nh?y v ?? chuyn # 90%.

+ K?t h?p PET v?i CT Scan c ?? nh?y ngang b?ng v?i Ph?u Thu?t khi TB h?c c?a h?ch l c tnh do di c?n ( Eichfeld U v cs, 2005 ).

- Tuy nhin PET hi?n nay trn th? gi?i v trong n??c ch?a th?nh hnh v gi thnh c?a phim ch?p kh cao. PET c?ng khng ph?i l Tiu chu?n vng trong ch?n ?on ung th?.

3.3.4. N?i soi trung th?t(NSTT):

- NSTT v?n l m?t Tiu chu?n vng xc ??nh G/? h?ch trung th?t (Carlens E, 1959).

- ? M? hi?n nay v?n th?nh hnh.

- NSTT xc ??nh ???c cc nhm h?ch: 2R, 2L, 4R, 4L; h?ch tr??c KQ: 1, 3.

- Nh?ng h?ch khng th? sinh thi?t ???c: h?ch d??i ng ba KPQ: 7; h?ch TT d??i: 8, 9; h?ch ? c?a s? Ph? - Ch? v h?ch TT tr??c ? v? tr: 5, 6. (Landreneau RJ, 1993).

- ?? nh?y # 80 85%, theo Hammoud ZT, 1999: ?? nh?y # 43 57% v m tnh gi? # 5,5 8%.

- S? d? c m tnh gi? l v v? tr h?ch khng th? v?i t?i ???c b?ng NSTT ( Cc nhm h?ch 5, 6, 7, 8, 9 ).

3.3.5. N?i soi ph? qu?n(NSPQ):

NSPQ th?c hi?n STXTPQ an ton, t bi?n ch?ng:

- Dng th??ng xuyn ?? xc ??nh nh?ng h?ch d??i ng ba KPQ.

- Nh?ng h?ch c?nh KQ, ST c kh kh?n h?n do khng th? t?o ???c gc ?? ?? l?n gi?a thnh KPQ v kim ch?c.

- Kh? n?ng STXTPQ vo u kh kh?n h?n ( Ranes J.L, 2003; Tan B.B v cs, 2003 ).

- T? l? thnh cng # 90%, ?? nh?y 75%. Trong nhm h?ch N2, N3 t? l? m tnh gi? 25%.

3.3.6. Sinh thi?t xuyn thnh ng?c (STXTN) d??i h??ng d?n c?a ch?p c?t l?p vi tnh (CLVT) :

Sinh thi?t xuyn thnh ng?c l m?t trong cc bi?n php l?y b?nh ph?m ch?n ?on. ? n??c ta k? thu?t STXTN ht b?ng kim nh? ? ???c ti?n hnh t? nh?ng n?m 1980 d?a trn phim ph?i th?ng-nghing. Khi xu?t hi?n my ch?p c?t l?p vi tnh, m?t s? n?i ? s? d?ng ?? h??ng d?n sinh thi?t ph?i ht b?ng kim nh? . Tuy nhin, b?nh ph?m th??ng ch? cho php lm xt nghi?m t? bo h?c. G?n ?y c m?t s? tc gi? trong n??c th?c hi?n k? thu?t sinh thi?t b?ng kim Tru cut. Trong k? thu?t ny b?nh ph?m l?y ???c l m?nh sinh thi?t c?t. Nh? v?y, ngoi xt nghi?m t? bo h?c cn c th? xt nghi?m m b?nh h?c, ?y l xt nghi?m r?t quan tr?ng cho vi?c ?nh gi t?n th??ng, ??c bi?t l phn lo?i tp ung th?. Tuy nhin STXTN v?n cn nhi?u h?n ch? v c nh?ng ch? ??nh, ch?ng ch? ??nh c?a n:

- Kch th??c h?ch TT ph?i > 1,5 cm.

*?? nh?y # 90%, m tnh gi? t? 20 50%.

*Kh?i u ? ph?i ch?c sinh thi?t d? h?n v c ?? nh?y cao h?n.

*Ngy nay ?ng d?ng nhi?u v PP ? c kim ch?c ST chuyn d?ng v c PP nhu?m b?nh ph?m m?i ( LIU).

- Ch? ??nh:

+ C kh?i u ? ph?i v trung th?t. Cc t?n th??ng nhi?m trng ph?i ch?a r c?n nguyn, km hay khng ?p ?ng ?i?u tr? ban ??u.

+ ?? phn bi?t cc t?n th??ng gi? u ph?i, nh?ng tr??ng h?p trn d?ch khu tr, d?ch rnh lin thy, u mng ph?i, b?nh l vng TT.

+ STXTN xc ??nh c TB UT di c?n vo h?ch TT chnh xc > 90%. Kho?ng 10% trn kh mng ph?i ph?i ??t d?n l?u.

+ Tr??ng h?p nghi c tnh, nh?ng khng c ch? ??nh ph?u thu?t, n?u khng ST th khng c c? s? ch?n ?on.

- Ch?ng ch? ??nh:

+ Ch?ng ch? ??nh tuy?t ??i khi nghi ng? nang sn, u mu.

+ Ch?ng ch? ??nh c?a ph?u thu?t.

+ BN c r?i lo?n ?ng mu, khng h?p tc, ch?c n?ng HH h?n ch?, kh ph? th?ng n?ng, t?ng AL?MP n?ng, ? PT c?t ph?i.

3.3.7. N?i soi ph? qu?n d??i h??ng d?n c?a Siu m sinh thi?t h?ch Lympho Trung th?t:

- Cerfolio R.J (2007) NC trong 3 n?m ( 2003 2006) v?i 288 BN c 112 BN c h?ch N2 t?i h?ch s? 5, 6. Tc gi? k?t lu?n:

+ S ch?c ST qua NSTQ ST h?ch N2 t?i h?ch s? 5, 6 khng chnh xc b?ng PTNSLN.

+ K? thu?t ny th??ng dng xc ??nh h?ch Dy ch?ng ph?i d??i, d??i ng ba KPQ.

+ Nh?ng h?ch ? pha tr??c bn KQ th??ng kh l?y m?u, nh?ng r?t th??ng g?p trong UTP.

+ ?? nh?y # 90%, m tnh gi? 23%.

3.3.8. Ph?u thu?t n?i soi l?ng ng?c v?i tr? gip c?a Video(Video assisted thoracic surgery) xc ??nh G/? UTPQNP l m?t h??ng ?i m?i gp ph?n quan tr?ng trong ch?n ?on v ?i?u tr? UTPQNP:

*PTNSLN sinh thi?t kh?i u ph?i ngo?i bin m cc ph??ng ti?n ch?n ?on khc khng xc ??nh ???c:

- Kh? n?ng ST ???c UTP ??t t?i 91,43%, th?t b?i l 8,57%.

- Cho ch?n ?on phn bi?t nhanh gi?a u lnh v c ( km theo sinh thi?t t?c th).

- PTNSLN xc ??nh chnh xc 100% tnh tr?ng c?a khoang mng ph?i: d?ch mng ph?i, tnh tr?ng mng ph?i t?ng, mng ph?i thnh, ??c bi?t l n?t v? tinh trong khoang mng ph?i.

* PTNSLN xc ??nh G/? UTPQNP:

- ?nh gi chnh xc m?c ?? ti?n tri?n, xm l?n c?a u nguyn pht ra mng ph?i t?ng (T2 4) m m?t s? ph??ng ti?n ch?n ?on khc khng xc ??nh ???c.

- Gip ST chnh xc t? 76,9 88,9% h?ch r?n ph?i v ST chnh xc t? 78,6 85,7% h?ch TT m lm sng v CT Scan khng ch?n ?on ???c, qua ? ?nh gi di c?n h?ch N1, N2 chnh xc h?n.

- Gip xc ??nh chnh xc 100% cc t?n th??ng nh? di c?n mng ph?i thnh, mng ph?i t?ng m cc ph??ng ti?n ch?n ?on hnh ?nh khng th? nhn th?y ???c,qua ? h?n ch? m? ng?c cho nh?ng BN khng c ch? ??nh ph?u thu?t.

Nh? v?y:Trong 8 ph??ng php xc ??nh giai ?o?n v tp TB UTPQNP th ph??ng phpPh?u thu?t n?i soi l?ng ng?c v?i tr? gip c?a Video (Video assisted thoracic surgery) l ?u ?i?m h?n c? m?t h??ng ?i m?i gp ph?n quan tr?ng trong ch?n ?on v ?i?u tr? UTPQNP.Ph??ng php ny hi?n nay c tnh kh? thi ? Vi?t Nam v h?u h?t cc c? s? ph?u thu?t trong c? n??c ??u ???c trang b? my ph?u thu?t n?i soi.

IV. Ch? ??nh ?i?u tr? ngo?i khoa UTPQNP:

?? ch? ??nh ?i?u tr? UTPQNP, cc tc gi? ??u th?ng nh?t d?a vo:

- Tp m b?nh h?c.
- Giai ?o?n ung th?.

- ?nh gi ch?c n?ng c?a b?nh nhn.

1. Tp m b?nh h?c:

Hi?n nay ??u th?ng nh?t ch? ??nh ph?u thu?t UTPQNP tp t? bo l?n. Tp t? bo nh? ch?ng ch? ??nh ph?u thu?t v lo?i ny:

- Tin l??ng x?u.

- ? g?n ph? qu?n l?n.

- Lan r?ng trong trung th?t.

- S?m di c?n r?ng trong l?ng ng?c.

  1. Giai ?o?n ung th?:

UTPQNP tp t? bo l?n [Non- Small Cell Lung Cancer (NSCLC)]:


(Giai ?o?n)


(M t?)

Treatment Options

(Chi?n thu?t ?i?u tr?)

I a : T1 No Mo

I b : T2 No Mo

Tumor of any size is found only in the lung

(kh?i u b?t k? kch th??c, ch? khu tr ? ph?i )

Surgery (Ph?u thu?t)

II a : T1 N1 Mo

II b : T2 N1 Mo

T3 No Mo

Tumor has spread to lymph nodes associated

with the lung

(Kh?i u ? pht tri?n lan r?ng ??n h?ch Lympho trong ph?i)

Surgery (Ph?u thu?t)

III a :

T3 N1 Mo

T1,2,3 N3 Mo

Tumor has spread to the lymph nodes in the tracheal area, including chest wall and

diaphragm (Kh?i u pht tri?n r?ng t?i h?ch Lympho khu v?c kh qu?n, g?m c? thnh ng?c v c? honh)


followed by radiation

or surgery

(?i?u tr? ho ch?t

sau x? tr? ho?c sau

ph?u thu?t)

III b :

T1,2,3 N3 Mo

T4 N B?t k? Mo

Tumor has spread to the lymph nodes on the opposite lung or in the neck (Kh?i u pht tri?n

lan r?ng t?i h?ch ? ph?i ??i bn ho?c h?ch vng c?)

Combination of chemotherapy and radiation (K?t h?p ho tr? v x? tr?)

IV :

T B?t k? N B?t k? M1

Tumor has spread beyond the chest

(Kh?i u ? lan ra ngoi ng?c)

Chemotherapy and/or palliative

(maintenance) care

(Ho tr? ho?c

gi?m ?au)

3. ?nh gi ch?c n?ng c?a b?nh nhn:

?nh gi:

- PFT ( pulmonary function test) : ( FVC ( forced vital capacity) and FEV1 ( forced expiratory volume in one second) Dung tch s?ng th? g?ng s?c (FVC) v Th? tch th? ra g?ng s?c trong giy ??u tin (FEV1)

+ FEV1 and DLCO ( carbon monoxide diffusion in the lung).

- Ventilation and perfusion scans (scan thng kh v t??i mu).

- Cardiopulmonary exercise testing (VO2max) (Test tim ph?i g?ng s?c).

- Arterial blood gas sampling (Sa02)(?o kh mu ??ng m?ch).

- ?nh gi theo ch? s? Karnofski (IK).

Nh? v?y ch? ??nh m? ???c tm t?t nh? sau:

-UTPQNP tp t? bo l?n [Non- Small Cell Lung Cancer (NSCLC)].

- Giai ?o?n: I,II, v IIIA.

- IK > 70%.

- Cc xt nghi?m c?n lm sng cho php.

Ph??ng php ph?u thu?t:

- C?t phn thy, c?t thy ph?i ho?c c?t b? m?t l ph?i + L?y b? h?ch di c?n theo giai ?o?n b?nh .


1. Jemal A , Siegel R , Ward E et al.Cancer statistics, 2006. Cancer J Clin 2006 ; 56 : 106 30

  1. . Thun MJ , Jemal A .How much of the decrease in cancer death in the United States is attributable to reductions in tobacco smoking? Tobacco Control 2006 ; 15 : 345 7 .
  2. Lee DJ , Fleming LE , Leblanc WG et al.Occupation and lungcancer mortality in a nationally representative U.S. Cohort: The National Health Interview Survey (NHIS). J Occup Environ Med 2006 ; 48 : 823 32 .
  3. Kvale PA .Chronic cough due to lung tumors: ACCP evidence-based clinical practice guidelines. Chest 2006 ; 129 :147 53S .
  4. Martins SJ , Pereira JR .Clinical factors and prognosis in non-small cell lung cancer. Am J Clin Oncol 1999 ; 22 : 453 7 .
  5. Tai P , Yu E , Jones K et al.Syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients with limited stage small cell lung cancer. Lung Cancer 2006 ; 53 : 211 15 .
  6. Gupta N , Graeber G , Bishop H .Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small ( 3

cm) lymph node lesions. Chest 2000 ; 117 : 773 8 .

  1. Witte B , Wolf M , Huertgen M , Toomes H .Video-assisted mediastinoscopic surgery: clinical feasibility and accuracy of mediastinal lymph node staging. Ann Thorac Surg 2006 ; 82 :

1821 7 .

  1. . Kuzdzal J , Zielinski M , Papla B et al.The transcervical extended mediastinal lymphadenectomy versus cervical mediastinoscopy in non-small cell lung cancer staging. Eur J Cardiothorac Surg 2007 ; 31 : 88 94 .
  2. Zielinski M .Transcervical extended mediastinal lymphadenectomy: results of staging in two hundred fifty-six patients with non-small cell lung cancer . J Thorac Oncol 2007 ; 2 : 370 2 .
  3. Inoue M , Sawabata N , Takeda S et al.Results of surgical intervention for P-stage III A (N2) non-small cell lung cancer: acceptable prognosis predicted by complete resection in

patients with single N2 disease with primary tumor in the upper lobe. J Thorac Cardiovasc Surg 2004 ; 127 : 1100 6 .

  1. . Brynitz S , Struve-Christensen E , Borgeskov S , Bertelsen S .Transcarinal mediastinal needle biopsy compared with mediastinoscopy. J Thorac Cardiovasc Surg 1985 ; 90 : 21 4 .
  2. Cropp AJ , DiMarco AF , Lankerani M .False-positive transbronchial needle aspiration in bronchogenic carcinoma. Chest 1984 ; 85 : 696 7 .
  3. Annema JT , Versteegh MI , Maud Veseli M et al.Endoscopic ultrasound added to mediastinoscopy for preoperative staging of patients with lung cancer. JAMA 2005 ; 294 : 931 6 15.Scott WJ , Schwabe JL , Gupta NC et al. Positron emission tomography of lung tumors and mediastinal lymph nodes using [18F]fluorodeoxyglucose. The members of the PET-Lung Tumor Study Group. Ann Thorac Surg 1994 ; 58 : 698 703 .
  4. Michael J. Weyant. Raja M. Flores.VATS lobectomy for earny stage lung cancer.Ann Thorac Surg 2008; 80:268-74.
  5. McKenna RJ Jr, Wolf RK, Brenner M, Fischel RJ, Wurnig P.Is lobectomy by video-assisted thoracic surgery an adequate cancer operation?Ann Thorac Surg 1998;66:1903-8.
  6. Walker WS, Codispoti M, Soon SY, Stamenkovic S, Carnochan F, Pugh G.Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma.Eur J Cardiothorac Surg 2003;23:397-402.

19. Michael J. Weyant, Raja M. Flores.VATS MEdiastinal Nodal Dissection .www.ctsnet.orgPublication Date: 6-Sep-2005 .Last Modified: 26-Oct-2005.

backrop 1

Ngy 13 thng 6 n?m 2013 , t?i b?nh vi?n h?u ngh? Vi?t ??c ? tt? ch?c h?i kh?o ph?u thu?t tim m?ch chuyn ?? lc ??ng m?ch ch? v vim n?i tm m?c nhi?m khu?n, ??n tham gia h?i ngh? g?m cc chuyn gia hng ??u c? n??c v? ph?u thu?t tim m?ch ??t bi?t c s? tham gia chuyn gia Baldev S. Sekhon, M.D., FACS v? ph?u thu?t tim ng??i l?n v ??ng m?ch ch? (?n ??).

PGS Nguy?n Ti?n Quy?t c m?t v ?nh gi cao vi?c t? ch?c h?i ngh? ny v pht bi?u t?i h?i ngh? v? t?m quan trong vi?c c?p nh?t lin t?c ki?n th?c tin ti?n c?a th? gi?i trong ?i?u tr? ph?u thu?t t?i Vi?t nam ni chung v Vi?t ??c ni chung, ??t bi?t tnh chuyn mn ha su, nh? nh?ng c?p nh?t v? l?nh v?c ?i?u tr? v ph?u thu?t m b?nh vi?n Vi?t ??c ? c nh?ng l?nh v?c ngang t?m th? gi?i v khu v?c ???c b?n b qu?c t? ?nh gi cao.

H?i ngh? ? nghe 05 bi bo co v xem trnh di?n ph?u thu?t live surgery mang tnh ?o t?o c?p nh?t v nghin c?u t?ng k?t th?c ti?n chuyn ?? v? ph?u thu?t lc ??ng m?ch ch?, vim n?i tm m?ch nhi?m khu?n c?a cc chuyn gia trong v ngoi n??c, nhi?u tham lu?n ? ???c trao ??i t?i h?i ngh? r?t si n?i v h?u ch, V?i cc k?t qu? ph?u thu?t b?nh l lc ??ng m?ch ch? v vim n?i tm m?c nhi?m khu?n trong n??c ???c cc chuyn gia ?nh gi r?t cao v ?n t??ng.


T?p ch Tim m?ch v Y h?c Tr?c tuy?n

Journal of the American Society of Echocardiography

Webcardio (ti?ng Php)


Ch? ??
Ng??i trnh by
S? l?n download
Nguy?n ??c Hi?n
Ph?u thu?t n?i t?nh m?ch ch? trn- ??ng m?ch ph?i thng ra hai h??ng ( BCPS ) t?i Vi?n tim TP HCM : C g m?i ?
Phan Kim Ph??ng
Nguy?n Minh Tr Vin
??ng H?u Danh
Nhn m?t tr??ng h?p ?i?u tr? lot do suy t?nh m?ch chi d??i b?ng ph?u thu?t n?i soi c?t t?nh m?ch xuyn d??i cn
Tr?n Cng Quy?n
Ph?u thut phnh ??ng m?ch ch? ng?c b?ng s? d?ng tu?n hon ngoi c? th?, k?t qu? ph?u thu?t trn 4 b?nh nhn t?i vi?n tim m?ch qu?c gia.
Nguy?n Hong H
Ph?ng d?ng ti quai ??ng m?ch ch? v ??ng m?ch ch? ng?c: b?nh l ngo?i khoa ph?c t?p
?on Qu?c H?ng
Ph?u thu?t ?i?u tr? h?p eo ??ng m?ch ch? t?i B?nh vi?n Nhi Trung ??ng: K?t qu? trung h?n
Nguy?n L Th?nh Tr??ng
Ph?u thu?t n?i soi ton b? ?i?u tr? ph?ng ??ng m?ch ch? b?ng d??i th?n t?i b?nh vi?n Vi?t ??c
Tr?n Bnh Giang
Ti l?p l?u thng ??ng m?ch chy tr??c b?ng ?o?n ghp t?nh m?ch hi?n ??o ng??c xuyn x??ng chy trong b?nh l vim t?c ??ng m?ch chi d??i do ?i tho ???ng
Tr?n Thc Khang
Thu?t ng? - Ch?n ?on - ?i?u tr? U mu v D? t?t M?ch mu
??ng Ng?c Hng
Ti?n b? ?i?u tr? phnh ??ng m?ch ch? b?ng t?i Vi?t Nam
V?n T?n
Ch?n th??ng v x? tr phnh ??ng m?ch ch? b?ng d??i th?n t?i khoa ngo?i l?ng ng?c m?ch mu BVCR
Nguy?n Duy Tn
Bc tch ??ng m?ch c?nh do ch?n th??ng kn
Tr?n Thc Khang
Ch?n th??ng ??ng m?ch th?n ???c ph?u thu?t b?o t?n - thng bo lm sng nhn m?t tr??ng h?p
Nguy?n H?u ??c
?nh gi k?t qu? s?m ph?u thu?t phnh v bc bch ??ng m?ch ch? ng?c ln v quai
Nguy?n Thi An
?i?u tr? ph?u thu?t t?c ??ng m?ch ch? b?ng m?n tnh
?? Kim Qu?
?i?u tr? suy t?nh m?ch nng chi d??i b?ng ph??ng php laser n?i t?nh m?ch v?i laser bn d?n b??c sng 810nm
H? Khnh ??c
?nh gi k?t qu? ?i?u tr? b?nh suy gin t?nh m?ch nng chi d??i
L Quang Th?u
H?p cc nhnh c?a quai ??ng m?ch ch? - ch?n ?on v ?i?u tr? ngo?i khoa
?? Kim Qu?
K?t qu? ?i?u tr? thi?u mu mn tnh chi d??i t?i b?nh vi?n Bnh Dn
Tr?n Cng Quy?n
K? thu?t m? ph?i h?p bc v? n?i m?c ??ng m?ch c?nh trong m? b?c c?u ??ng m?ch vnh
Tr?n Quy?t Ti?n
K?t qu? ??t ?ng ghp n?i m?ch ?i?u tr? phnh ??ng m?ch ch? (?MC)
V?n T?n
Bi?n ch?ng m?ch mu ? ng??i nghi?n ma ty: k?t qu? ?i?u tr? 10 n?m ? B?nh vi?n h?u ngh? Vi?t ??c H N?i
?on Qu?c H?ng
L'intervention de Ross: reste-t-elle une option universelle?
Eisenmann Bernard


H?i th?o tim m?ch Vi?t - M? n?m 2011

Ch? ?? Ng??i trnh by File bo co
Suy tim v?i phn s? t?ng mu cn b: ch?n ?on v ?i?u tr? GS.Daniel D. Borgeson
(Mayo Clinics, USA)
T?i v?
Nh?ng ?i?m m?u ch?t v nh?ng c?m b?y khi ??c ?i?n tm ?? ? b?nh nhn ? ??t my t?o nh?p tim. GS.K.L.Venkatachalam
(Mayo Clinics, USA)
T?i v?
Ti t?o m?ch vnh ? b?nh nhn ?i tho ???ng. GS.Gregory W. Barsness
(Mayo Clinics, USA)
T?i v?
Ch?n ?on cc tnh hu?ng kh trong t?ng p ??ng m?ch ph?i. GS.Micheal D. McGOON
(Mayo Clinics, USA)
T?i v?
CRT cho b?nh nhn suy tim: Khi no v cho ai? GS.Daniel D. Borgeson
(Mayo Clinics, USA)
T?i v?
D? phng tin pht v th? pht b?ng ICD ? b?nh nhn sau nh?i mu c? tim. GS.K.L.Venkatachalam
(Mayo Clinics, USA)
T?i v?
?i?u tr? thu?c t?i ?u cho b?nh nhn nh?i mu c? tim c ?o?n ST chnh ln GS.Malcolm R. Bell
(Mayo Clinics, USA)
T?i v?
?i?u tr? thu?c t?i ?u ? b?nh nhn ???c can thi?p m?ch vnh GS.Gregory W. Barsness
(Mayo Clinics, USA)
T?i v?
?i?u tr? thu?c t?i ?u cho b?nh nhn suy tim GS.Daniel D. Borgeson
(Mayo Clinics, USA)
T?i v?
Ch?n ?on v ?nh gi t?ng p ??ng m?ch ph?i GS.Micheal D. McGOON
(Mayo Clinics, USA)
T?i v?


Theo ch??ng trnh h?p tc qu?c t? gi?a b?nh vi?n Vi?t ??c v?i tr??ng ??i h?c Pari VII v t? ch?c APPCV-ADVASE

t? ngy 09 ??n 12 thng 10 n?m 2011, ?on chuyn gia s? tham gia h?i ch?n, can thi?p m?ch, ph?u thu?t cho b?nh nhn kh, hi?m g?p v ph?c t?p t?i Vi?t nam, k?t h?p v?i h?i th?o trao ??i c?p nh?t ki?n th?c m?i.

?on chuyn gia Php g?m :

- Jean-Marie Cardon (Nimes)

- Alain Cardon (Rennes)

- Xavier Chauffour ( Toulouse)

- Emmanuel Ostyn (limoges)

- Pierre Desoutter (Paris)

- Pham Thi Minh Thang (Paris)

Ch??ng trnh:

Chi?u ch? nh?t 09/10/2011 :t? 13h45

+ H?i ch?n b?nh nhn

Sng th? 2 10/10/2011:

+ Ph?u thu?t m?ch mu

+ Can thi?p m?ch

+ Trao ??i chuyn mn

Chi?u th? 2 10/10/2011

+ Ph?u thu?t m?ch mu

+ Can thi?p m?ch

+ Trao ??i chuyn mn

Sng th? 3 ngy 11/10/2011

+ Ph?u thu?t m?ch mu

+ Can thi?p m?ch

+ Trao ??i chuyn mn

Chi?u th? 3 ngy 11/10/2011

+ Ph?u thu?t m?ch mu

+ Can thi?p m?ch

+ Trao ??i chuyn mn

Th? 4 sng ngy 12/10/2011

Gi?ng bi h?i ch?n ca kh

t?ng k?t


Chairman of Congress and President of Asian Society for Vascular Surgery,
Shoei-Shen Wang, M.D., Ph.D.
Professor John B. Chang, M.D., FACS, FICA
Founding Chairman, Asian Society for Vascular Surgery
T? ngy 29 thng 9 ??n ngy 02 thng 10 h?i ngh? ph?u thu?t m?ch mu chu l?n th? 12 ???c t? ch?c t?i Trung tm h?i ngh? Qu?c gia- ?i b?c ?i loan,H?i ngh? ???c t? ch?c v?i quy m l?n : H?i ngh? ? t?p trung hng nghn chuyn gia th? gi?i c?ng nh? khu v?c:nhi?u chuyn gia hng ??u ??n t? M?, chu u, Nh?t b?n v Chu , h?n 1000 bo co ???c bo co t?i h?i ngh? :th? hi?n m?t b??c ti?n v??t b?t trong l?nh v?c ?i?u tr? v ph?u thu?t c?ng nh? m?ch can thi?p cc b?nh l ??ng m?ch ch?, t?nh m?ch , van tim...v?i s? tr? gip c?a cc thi?t b? hi?n ??i c?ng nh? nh?ng cng ngh? m?i.
ch??ng trnh c? th? c th? tham kh?o t?i ?y http://asvs2011.com/Daily_Program.php
Vi?t nam ???c hn h?nh m?i bo co v?i 02 bo co, PGS Nguy?n H?u ??c ??i di?n
Nguyen, Huu Uoc(Vietnam)
Total Laparoscopic Infrarenal Abdominal Aortic Aneurysm Treatment
Total Laparoscopic Infrarenal Abdominal Aortic Aneurysm Treatment
Nguyen Huu Uoc, Tran Binh Giang et al., Viet Duc University Hospital (Vietnam)
2Nguyen Huu Uoc, Tran Binh Giang et al., Viet Duc University Hospital (Vietnam)
2.Present Features of Vascular Trauma in Vietnam
Nguyen Huu Uoc, Viet Duc University Hospital (Vietnam)
M?t vinh d? cho Vi?t nam l bi bo co :"Present Features of Vascular Trauma in Vietnam" bo co vin PGS ??c ? ???c ban t? ch?c bnh ch?n "Best presenter Award" v vinh danh trong bu?i Gala dinner ???c t? ch?c t?i khc san W No. 10 Zhongxiao E. Rd., Sec. 5, Taipei, Taiwan (

- HH?i ph?u thu?t m?ch mu chu Asian Society for Vascular Surgery (ASVS), t? ch?c H?i ngh? th??ng nin l?n th? 12 t?i Trung tm h?i ngh? qu?c t? ? Taipei, Taiwan, t? ngy 29 / 9 t?i 2 / 10 n?m 2011.

- Tham d? H?i ngh? g?m cc Ph?u thu?t vin m?ch mu, cc nh Can thi?p m?ch, cc Bc s? n?i m?ch mu, cng nhi?u th?y thu?c khc ho?t ??ng trong l?nh v?c b?nh m?ch mu (siu m, n?i ti?t, ch?n ?on hnh ?nh, y h?c c? s? ), ??n t? h?u h?t cc n??c chu , cng cc chuyn gia ???c m?i t? M?, chu u, v?i h?n 500 Bo co khoa h?c t?ng quan v chuyn ??. ?y l ho?t ??ng n?m trong khun kh? c?a H?i ph?u thu?t m?ch mu th? gi?i cng v?i s? tham gia h? tr? c?a H?i (ISVS International Society for Vascular Surgery).

- Nh? m?i quan h? h?p tc g?n b gi?a B?nh vi?n ??i h?c qu?c gia ?i loan (NTUH) v?i B?nh vi?n H?u ngh? Vi?t ??c, nn cc bc s? m?ch mu ?i loan bi?t kh r v? cc ho?t ??ng ph?u thu?t m?ch mu t?i BV Vi?t ??c. Do v?y, Ban t? ch?c H?i ngh? (12th ASVS) ? m?i PGS.TS. Nguy?n H?u ??c Tr??ng khoa PT tim m?ch v l?ng ng?c c?a BV Vi?t ??c, tham gia bo co t?i H?i ngh? v? ?? ti PT n?i soi ?i?u tr? ph?ng ??ng m?ch ch? b?ng d??i th?n v?i vai tr Bo co vin ???c m?i (Invited Speaker), t?c l H?i ngh? chi tr? ton b? cc chi ph k? c? t? ?i l?i ??n khch s?n v cc chi ph lin quan khc.

- V?i mong mu?n t?n d?ng c? h?i qu?ng b cho chuyn ngnh PT m?ch mu c?a Vi?t Nam, nn bn c?nh bo co ???c m?i, PGS.TS. Nguy?n H?u ??c ? g?i thm 1 bo co t?ng quan v? ??c ?i?m ch?n th??ng v?t th??ng m?ch mu t?i Vi?t Nam, ???c vi?t d?a trn cc s? li?u Bo co khoa h?c c?a BV Vi?t ??c v m?t s? Trung tm PT m?ch mu l?n khc ? H N?i, Hu?, v TP. H? Ch Minh. Ban t? ch?c H?i ngh? ? x?p bo co ny vo 1 bu?i bo co ng?n (Free Paper) v?i th?i gian bo co 6 pht + tr? l?i cu h?i 2 pht.

- C th? tm l??c cc N?i dung chnh ???c bo co t?i H?i ngh? nh? sau:

o Kho?ng 80 90 % l cc bo co v? Can thi?p n?i m?ch (t? gi?i ph?u, ch?t li?u m?ch nhn t?o, ??n cc k? thu?t ??i v?i cc lo?i m?ch khc nhau), trong ? c r?t nhi?u bo co v? cc l?nh v?c cn nhi?u kh kh?n v m?i m? ??i v?i Vi?t Nam, nh? ?i?u tr? ph?ng ??ng m?ch ch? - ch?u kh, ph?ng ??ng m?ch ch? ng?c, lc ??ng m?ch ch?, h?p ??ng m?ch c?nh, k? thu?t Hybrid

o Cn l?i l cc bo co c?ng kh hay v? cc nghin c?u c? b?n v? b?nh l m?ch mu, cc ph??ng ti?n ch?n ?on b?nh m?ch mu hi?n t?i (MS-CT, IMR), m?t s? lo?i thu?c m?i ?i?u tr? b?nh m?ch mu, cc v?n ?? ch?n th??ng m?ch mu, v b?nh l m?ch mu nhi?m trng.

Cc Bc s? Vi?t Nam c th? tham kh?o tm t?t cc Bo co ny trn trang Web c?a H?i ngh? (12th ASVS 2011, Taipei, Taiwan).

Qua ? c th? th?y r?ng PT m?ch mu Vi?t Nam c nh?ng ?i?m m?nh v? ?i?u tr? c?p c?u m?ch mu ngo?i vi, v cc k? thu?t m? m?ch mu kinh ?i?n. Tuy nhin, chng ta cn r?t nhi?u vi?c ph?i lm ? pha tr??c ?? pht tri?n l?nh v?c Can thi?p n?i m?ch nh?t l ??ng m?ch ch?, ?i?u tr? lc ??ng m?ch ch?, v chu?n ha cc ch? ??nh k? thu?t ch?n ?on v ?i?u tr? cc b?nh l m?ch mu. C nh? v?y th m?i ?u?i k?p s? pht tri?n c?a PT m?ch mu ngang t?m v?i cc n??c trong khu v?c.

- Tuy H?i PT m?ch mu chu cn t ???c bi?t ??n ? Vi?t Nam, v ch? m?i tham d? H?i ngh? l?n ??u tin, song c?ng r?t b?t ng? v vinh d? cho cc Th?y thu?c Vi?t Nam, ? l trong bu?i Gala Diner t?ng k?t H?i ngh?, PGS.TS. Nguy?n H?u ??c ? ???c ??i di?n H?i PT m?ch mu th? gi?i + Ban t? ch?c H?i ngh? + H?i ??ng khoa h?c, nh?t tr trao gi?i th??ng Bo co vin hay nh?t c?a H?i ngh? - cho Bo co v? ??c ?i?m ch?n th??ng v?t th??ng m?ch mu ? Vi?t Nam. Gi?i th??ng ny do H?i PT m?ch mu th? gi?i trao cho Bo co vin hay nh?t c?a H?i ngh? khu v?c (xin g?i km file ch?p Gi?y ch?ng nh?n gi?i th??ng). ?nh h??ng c?a gi?i th??ng ny l kh l?n, v sau ? tc gi? ? nh?n ???c nhi?u l?i m?i bo co vi?t bi t?i nhi?u H?i ngh? v T?p ch m?ch mu c ti?ng c?a chu u v chu , c?ng nh? l?i ?? ngh? ???c sang h?c v? PT n?i soi m?ch mu c?a m?t vi Ph?u thu?t vin c?a Indonesia.


B?nh tim b?m sinh (BTBS) c t?n su?t kho?ng 8/1000 tr? ra ??i cn s?ng. H?u h?t tr? b? BTBS c?n ?i?u tr? ph?u thu?t, m?t s? r?t t d khng ph?u thu?t c th? s?ng t?i tu?i tr??ng thnh. Ph?u thu?t BTBS ??t nhi?u ti?n b? t? cu?i th? k? 20, tuy nhin v?n cn t?n t?i nhi?u v?n ??. H?n n?a, d ???c ph?u thu?t tri?t ??, cc b?nh nhn BTBS v?n c?n ???c ch?m sc v ?i?u tr? b?i bc s? chuyn khoa su?t ??i. Do ? hnh thnh m?t chuyn khoa su: B?nh Tim B?m Sinh ? Ng??i L?n.



Tn bi bo bo co

Dung l??ng


Anterior chest wall approach for video-assisted thyroidectomy using a modified neck skin lifting method


Cardiovascular changes during drainage of pericardial effusion by thoracoscopy


Diagnosis and treatment of mediastinal tumors by thoracoscopy


Diagnostic role of videothoracoscopy in mediastinal diseases


Do bullae indicate a predisposition to recurrent pneumothorax?


Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial


Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial


Mediastinal cysts


Role of videothoracoscopy in chest trauma


Severity of compensatory sweating after thoracoscopic sympathectomy


Spontaneous pneumothorax


Suction versus water seal after thoracoscopy for primary spontaneous pneumothorax: prospective randomized study


The role of thoracoscopy in the management of retained thoracic collections after trauma


Thoracoscopy for empyema and hemothorax


Thyroidectomie endoscopique pour nodules thyroidiens isols endoscopic thyroidectomy for solitary nodules


Total endoscopic thyroidectomy: axillary or anterior chest approach


VATS major pulmonary resection


Video-assisted neck surgery for thyroid and parathyroid diseases


Video-assisted thoracic surgical treatment of initial spontaneous pneumothorax in young patients


Video-Assisted thoracoscopic closure of the delayed bronchial rupture after thoracoscopic resection of mediastinal bronchogenic cyst


Video-assisted thyroidectomy under local anesthesia




2013-09-12 191209

خرید vpn خرید کریو خرید کریو دانلود فیلم خارجی دانلود آهنگ ایرانی دانلود فیلم خرید vpn دانلود فیلم vpn خرید کریو Google