U nội tiết tuyến tiêu hóa: hiếm gặp nhưng nguy hiểm

U noi tiet tuyen

tieu hoa: hiem gap

nhiing nguy hiem

U te bao idn cOa tuydn tieu hoa (dang than kinh noi tiet).

Ngay nay bg may tieu hoa cung dflpc xem nhfl

la mpt CO quan npi tiet bdi nd co nhieu te' bao

than kinh ndi tiet nam phan bd doc theo ong

tieu hda. NhCftig te bao nay co the bi ung thfl hda gay

nen cac loai u than kinh - npi tiet, trong do hay gap

nhat la u carcinoid. Ty le m&c cac khd'i u nay tuy khong

nhieu, nhflng chan doan khd khan, tien Iflpng de dat,

bieu hien lam sang chii yeu la nhflng con bflng mat kem

theo rdi loan tieu hda. Benh dflpc md ta dau tien nam

1838, nhflng mai den nam 1907, Obemdofger mdi dung

thuat ngfl carcinoid de chi loai benh ly nay.

Benh ly dien hinh la u carcinoid tien phat d dfldng

tieu hoa nha't la d rupt thda, doan cuoi hoi trang va

trflc trang. Cac vi tri khac ciia dfldng tieu hda cd the

gap la dai trang, da day va tui thfla Meckel

Phan ldn u carcinoid dflpc phat hien tinh cd qua

phau thuat, do mo tfl thi, hoac doi khi qua npi soi.

Trong giai doan sdm u carcinoid thfldng cM cd nhflng

bieu hien trieu chflng mo ho do dd dl bi bd sdt.

Cac tneu chflng nhfl phflng dd mat, di phan long,

dau bung chi xuat hien vao giai doan mupn khi u da di

can vao gan, hach mac treo, hoac vao cac cO quan khac.

Trieu chflng chinh thfldng gap cua u carcinoid

bao gom:

• Phflng do d mat, cd, trflde ngflc: thfldng khdi

phat khi bi stress, sau udng rflpu, va hoac la sau an

hoac khi dung cac thud'c gidng epinephrin. Tuy nhien,

bieu hien nay khac nhau tiiy theo vi tri khd'i u. Vdi u

-o BS. NGUYEN BACH DANG

carcinoid tfl phe' quan trieu chu^g lam sang thudng

ram rp, con phflng ndng dd mat nang va keo dai kem

dd'u hidu phu mat, bon chon lo lang, run va kich thich,

chay nfldc mat, dd mo hoi, chay nfldc bpt, budn ndn,

non, sot va tidu chay dfl dpi. U carcinoid tfl da day

chi cd trieu chdng phflng dd mat vdi cac mang hdng

ban, cd khi ke't tu thanh tflng dam.

• Bilu hidn hay gap thfl hai la tieu chay, day Id

trieu chflng gay ra do tang tie't, do kem hd'p thu vd

tang nhu dpng rupt. Tieu chay cd the don thuan hay

ke't hpp vdi bieu hien phflng dd mat.

• Ngoai ra cd the gap mpt so' bieu hien khac nhfl

chudt rut d chan, dau bung cd the kem theo ban tdc

rupt, xO hda van tim, loet da day ta trang, cac bilu

hien ciia benh thie'u vitamin PP.

Sfl xuat hien cac trieu chflng lam sang cd the

khong dong bo theo thfl tfl thdi gian, trieu chflng

phflng dd mat cd the xua't hien kem hoac khdng vdi

trieu chflng tieu chay.

Benh chi dflpc gpi y chan doan khi ed cOn phflng

dd mat, kem tieu chay va cac trieu chflng vl hd hap.

Chan doan dflOng tinh can dfla vao cac xet nghidm

dac hieu vdi sfl hien didn cua cac chat danh dau cua u

carcinoid kem vdi hinh anh khd'i u qua chup cdt ldp ti

trpng, cung cd the xa hinh bang thu thi somatostatin

giup dinh vi khd'i u carcinoid.

Vdi cac u carcinoid cd dfldng kinh tren 2cm, dfic

biet nam d doan rupt gifla thfldng cd di can. Cdc vi

tri di can thfldng gap la: hach mac treo, gan, mang

bung, doi khi di can xa nhfl d phoi, xflOng, da, budng

trflng, nao, trung tha't va lach.

Che' dp dieu tri can thich hpp cho tflng moi b§nh

nhan dua vao kich thfldc khd'i u, vi tri khd'i u vd mflc

dp cac trieu chflng tren lam sang.

Dieu tri chu yeu la phdu thuat cdt khd'i u, ldm tdc

mach di vao khdi u, xa tri lidu khu tru tren khd'i u,

hda tri lieu chd'ng ung thfl va flc che' tang tie't chu ylu

la diing corticoid.

Ben canh dd tuy theo cac bieu hidn khdc nhau ma

dung them cac thudc dieu tri trieu chflng.

Hda tri ligu chi dflpc dp dung cho nhflng trfldng

hpp cac tridu chflng hodc khd'i u khdng cai thidn khi

dieu tri bdng octreotid, hoac trong nhflng trfldng hop

chflc ndng tim bi anh hfldng bdi u carcinoid. 3^

THUOC & S0C KHOE so 504 (15.7.2014)