Mô hình tổ chức ghép gan, thận từ người cho chết não

78,57% trudng hyp cd u to tren 4 cm. Tuong ty, Suman

Mallik, et al. (2010) qua quan sat 47 bgnh nhan ung thu

tuyln dudi ham thiy kich thudc u tren 4 em ehilm

61,7%. Rieng Scott M. Kaszuba, et al. (2007) nghien

cuu 87 bOnh nhan tu 1970 din 2003 thiy kit qua la u

cd kich thudc Idn hon 4 em chilm 54,02% trong tdng sd

eae trudng hyp. Theo Neil Bhattaeharyya (2004) [8] thi

kich thude u thudng gap la 2,9 cm (tu 2.72 din 3,09

em). Qua dd eho thiy u thudng phat trien nhanh, to.

Kich thudc cua u cung la ylu to quan trpng trong vipc

lap k l hogch dilu tri. Theo P.M. Speight (2009) [10] ung

thu bilu md tuyln dudi ham cd kich thudx; u tren 4 em

thi nen ed dilu tri bd tiie kem theo, dudi 4 em thi khdng

cin can thigp them sau phiu thugt.

Tinh di dpng eua u la mpt trong nhu'ng yeu td gdp

phin quan trpng trong viec phan bigt gitra u ac va

lanh.Ton thuong ac tinh thudng cd tinh chit cung, dinh

md xung quanh, gay di dpng khp khi thay thude tham

kham lam sang. Tuy nhien, trong Tihdm benh nhan eua

chung tdi (bang 7) cd din 52,94% sd trudng hyp la di

dpng de, chi ed 3 trudng hyp (8,82%) la khdng di dpng.

Nhu vgy, kit qua nay eho thiy dti ban chit cua tdn

thuong la xam lln, tuy nhien nd thudng bilu hign di dpng

de dang vdi md xung quanh, va cung phti hyp vdi kit

tuan eua nhilu tac gia da bao eao tren y van [1, 4, 5].

Ranh gidi hay bd tdn thuong va tinh chit da tuong

ung trSn u la hai dau higu d n dupe khao sat d n thgn

khi kham lam sang. Nd la dac dilm phan anh su xam

lln tgi cho cua thuong tdn. Ung thu bilu md tuyln dudi

ham la logi u ae tinh, ed kha nang xam lln va di can xa,

tuv ilinen, kit qua nghien cuu d bieu dd 3 va bieu dd 4

cho thiy ti le ranh gidi u khdng ro va tham nhiem da tai

chd kha thip (28,12% va 9,09%). Nhieu khao sat tren

thi gidi cuing cho thiy u bilu md ae tinh tuyln dudi ham

thudng ed dae diem lam sang gidng vdi u lanh tinh va

ed nhieu trudng hyp duyc chin doan xae dinh ehi khi

ed kit qua giai phiu bpnh [2]. Kham lam sang, quan sat

d n thgn eae diu hi$u, trigu chung eua bgnh la yeu td

quan trpng, d n thilt giup xae djnh va lap k l hogch dieu

tri u bilu md ae tinh tuyln dudi ham m$t each hyp ly.

KtT LUAN

Nghian cuu d$c dilm lam sang cua 34 b$nh nhan u

bilu md ac tinh tuyln dudi ham tgi Vi$n Rang Ham M$t

Qudc Gia, chiing tdi nJt ra duyc kit luin nhu sau:

B$nh cd thi g$p d ca nam va nu, thudng trung ni§n.

Da sd chi bilu hi$n sung gd tuyln dud+ ham (58,82%),

thdi gian khdi phat dudi 12 thang (76,48%). Bpnh

thudng khdng dau (73,53%), kich thude u to tren 3 cm

(70,59%), di dpng d i (52,94%), da sd ed ranh gidi ro

(71,88%) va da phu tren u binh thudng (90,91%).

Dgc dilm gidng u lanh tinh, am thim, khdng dau, it

bilu hign xam lln tgi chd cua u bieu md lanh tinh tuyln

dudi ham lam eho vige chin doan va djnh hudng dilu tri

bgnh khd khan. Cin khao sat eae trigu chung mpt each

d n thgn, kit hyp vdi nhurng xet nghiem cgn lam sang

thich hyp nhim Igp k l hoach dilu tri cho bgnh nhan.

TAI LIEU THAM KHAO

1. Alexander D." Rapidis, et al. (2004),'Tumors of

the Submandibular Gland: Clinieopathologie Analysis of

23 Patients", J Oral Maxillofac Surg (62). Pp. 1203-1208.

2. Douglas R. G., John D. H., Roderick H.W.Sl,

John Eveson (2009)."Salivary and Lacrimal Glands". In:

Douglas R. Gnepp. Diagnostic Surgical Pathology of the

Head and Neck, 2nd, Saunders- Elsevier Inc,

Philadelphia. Pp. 413-562.

3. F. A. Ito, et al (2005)."Salivary gland tumors in a

Brazilian population: a retrospective study of 496 cases".

Int J Oral Maxillofac Surg (34). Pp. 533-536.

4. Fernando L. Dias, Roberto A. Lima, Claudio R.

Cernea - (2007)."Management of Tumors of the

Submandibular and Sublingual Glands". In: Eugene N.

Myers, Robert L. Ferris. Salivary Gland Disorders,

Springer, New York. Pp. 339-377. '

5. Jae Myoung Noh, Yong Chan Ahn, Heerim Nam,

et al. (2010),"Treatment Results of Major Salivary Gland

Cancer by Surgery with or without Postoperative

Radiation Therapy". Clinical and Experimental

Otodiinolaryngology Vol 3, No. 2. pp. 96-101

6. Li Long-jiang, Li Yi, Wen Yu-ming, et al.

(2008),"Clinical analysis of salivary gland tumor eases in

West China in past 50 years", Oral Oncology (44). Pp.

187-192.

7. Mohammad H. A. (2007),"Salivary Gland Tumors

in an Iranian Population: A Retrospective Study of 130

Cases". J Oral Maxillofac Surg (65). Pp. 2187-2194.

8. Neil Bhattaeharyya (2004),"Survival and

Prognosis for Cancer of the Submandibular Gland". J

0ml Maxillofac Surg (62). Pp. 427-430.

9. Nguyin HO'u Thyi (2002),"Dac dilm lam sang,

md b$nh hpc va kit qua dilu tn ung thu tuyln nudc bpt

chinh", Tgp chi Y Hgc Thac Hinh, sd 5 (423). Trang 36-

38.

MO HINH TO CHUnc GHEP GAN, THAN TUTNGUlOri CHO CHET NAO

DAT VA N 0 £

Gh6p tgng la mdt trong nhO'ng thanh tyu cua y

hpc cudi thi ky XX, ghdp tang cho phdp thay thi mdt

CO quan hoac bd phan cua co thi bi benh bing mpt

tgng khac khde manh. NhO'ng bdnh nhSn bi bfenh

ho$c suy tang giai doan doan cudi cd dugc co hpi

sdng mdt cudc sdng mdi nlu dugc gh6p tang.

NhO'ng ky thu$t gh6p tang dS dat trinh dd rit cao,

theo dSi va dilu trj sau gh6p cd rit nhilu tiin bd...va

NGUYI N TIE N QUY^'T - Bgnh viin hOu nghi Viit DUc

day thyc sy la curu canh duy nhit cho ngudri bSnh

suy tang giai doan cudi. Gh6p th$n, ghdp gan la 2

loai hinh gh6p ra ddi rit sd-m (1954 - than; 1963 -

gan) va hien nay phat trien rit manh m§, dugc phd

bien rpng khip trdn toSn thi gidi.

Tai Viet Nam nhu clu ghdp tang la rit Idn, nhit la

ghdp than va gh6p gan, nhung y hpc khdng dap urng

dugc chu yeu vi thieu ngudn tang. Theo sd li$u Bd Y

te cdng bd nam 2007: sd lugng b§nh nhan vidm th$n

Y HOC THl/C HANH (751) - SO 2/2011 95