Nhan mQt trudng hgp chdn doSn nhA'mhen v6i lao nQi m4c khi qu6n " NguydnVdnTho,LCThi TuYAtLan D{c didm IDR v) X-quang phdi tr bQnhnhan ung thu phdi t4ibQnh viQn Pham Ngoc Thach " NguydnVdn Tho,QuangVdn Tr[ 16

HiQu quA cira Broncho-vdom trong phdng ngta nhiSm trimg trong bgnh phdi tic ngh6n man tinh * Le Thi Huy\h Trang,LCThi TuYAtLan

20

Dac di6m n6i soi v) m6 bQnhhqc cria polip da diy * QuhchTrongDrtc Nghi6n cuu phAnbdpolip tuy6h dai - truc

25

45

Phucrngph6p gAy xo h6a mlng phdi bdng Talc qua dng dAn luu nho trong di6:utri trin dich mirng phdi Actinh " Dd.ngThi Bich Nghn,NguydnXufrn Bich Huy€n,Lhm Qu6bDilng, LAVdn Vi6t, Nguy\n ThiT6'Nht

52

So siinh hiQu quA phucrng ph6p bQrJrnhan tu kidm so6t dau v6i Bupivacaine-Fentanyl dudng ngoiri mimg cimg v) Morphine dulng finh mach sau ph5u thuft lcrn virng bung " NguydnVdn Chitng, B:iliNggcUyln Chi, Phan TOnNgocVtt, NguydnAnh Tukh,Nguydn Th! HodiNam, nguydnThi Hdng Vhn Mdi li6n quan gifta lAm sdng vd n6i dQctd trong vi6m duhng mat do s6i " Nguy\n Dirc Thukn,Dd Dinh COng

trirng theo vi tri v) kich thu6c cua polip. " QuachTrongDttc 32

HiQu quA bu6c dA'ucua tu vAh di6'u tri nhAn thrlc-hlnh vi kdt hgp bupropion trong h5 tro cai thudc 16. * LAKh6cBdo KhAo s6t thuc trang hrit thudc 16cria bQnh nhah hO hap bQnhviQn Chq RAY. " LOKhdcBdo,LAVdnVigt,DQuNguydnAnh Thtr

PhSu thuft longo di6\r tri tri d0 3: KOt quA sau 260 trudng hqp " NguydnHiru Thinh,Duong Pha1cHwng, NguydnTrungTln 7l

Denh gi6 mfc d6 xAm lAh vA di cdn h4ch cua ung thu tr.uctr)ng * D5 Trong I{ranh, Vo TAhLong, Trhh Minh Th\ng, NguydnMinh Hdi (Xemtieptrang363)

Y Hgc TP.Hd Chi Minh * Tap 1.2* Phg bAnSd1 'F2008

Nghi6n cftu Y hgc

EAcpdvr NQrsorvA vrOnguHHec cuA poltn DADAy QudchTrgngDftc*

16rr,rrar Muc fiAu: xdcdinh drtcdidmtr\n n1i soi,m6 b|nh hyccrtaPolip da ddyud dOan toin cila phaongphdp cit potipdq dayquandi soi. Phuongphdp: nghi€ncnu ti€h cnu, m6 td cat ngnngdnoc fiAhhdnhtir thing 10/2004- 0412007 tai b(nh aiQnDai hoc Y Dnoc ffAn cdcbQnhnhAndaqc ciit polip dq day qua n6i soiad c6 k6'tqud m6 b€nhhoc phil hqp, Cdcdit kiQnaA'dqcdidmnQi soi,bi{n chirngcila thit thufu,k\lt qudm6 bfnh hocdryc ghi nhQn.S{r dung phin m€rnSPSSddfuu trft ad xh Iy th6ngke.Sh dyng phepkidm2 b€nah xemId c6y nghlath6hgkA khi p 50,05. K{t qurt:cd70 b€nhnhdntrongnghiAncftu adi tu6:itrung binh lh 48 tli. Ti I€ nam:nirlh 1:1,4.Polip dq ddy c6 fh€'gflp6 ffit cd cdca! tri theogidi phducila dq ddy,nhrng thudnggfip nhilt 6 hangai. KIch thnoc trung binh cuapolip ld 6 t 3 mm. Hai dqng m6 bgnhhqc thrdng gqp nhkt Id polip tuy{n 6hg (42,90/')ad polip tdngsdn G0%). Cdcpolip tuy|h thndngc6kich thaocl6n hon nhang kh6ngc6sq khdcbi€to€phkn (59170)trrdng hqp trong nghi€ncau c6 b6'dinhkhu so aoi polip c6bdnchilt khbngphdi mOthn sinh. 84,4o/o polip dq diy don dQc.Khbngc6 bi\h chirngcdt polip quan trong: 1 tradng hqp (L,4%)nghi ngdthilng bit daqc di€u tri bdot6h thdnhc1ngad 10 trudng hqp (L4,3%)c6 trigu chirngdau thaong ai xiy ra sau thit thuQtcdtpolipquanQisoi24 - 48 gid. K{t luQn:Polip tuy{n dq dhy khi ph6'bi\h adkh6phhnbi€tabi cdcpolip khdcdta tr\n hinh inh ndi soi. Xit tri cit polip dq dayquanQi soian todnadkh\ng gliy UiC:"chdrngnghi€mtrqng.

ABSTRACT THE ENDOSCOPrc AND HISTOPATHOLOGICAL CHARACTERIST/CSOF GASTRICPOLYPS QuadrTrongDuc * Y Hoc TP.Ho Cl:f Minh * Vol. 12- Supplementof No 1 - 2008:20 -25 Aims: to determine theendoscopic andpathological characteristics of gastricpolyps. Methoils: A prospectiae, cross-sectional study was conducted from Oct 2004 to Apr 2007on patients who underwentgastricpolypectomyat the UniuersityMedicalCenter.Endoscopic andpathological findings as well as polypectomy complications wererecorded.SPSSsoftwarewas usedto storeand analyzedata.A testwasconsidered of significance if p < 0,05. Results:Therewere70 patientswith the ffieanageof 48 t 13.Male:femaleratio was L:1..4.Gastric polyp couldbefound in any sitesbut most commonlyin the antrum. The two mostcommonforms were tubular adenoma(42.9'/")and hyperplasticpolyp (30%). Gastricadenomas were usually biggerin size compared with non-neoplastic polyps.Howeaer,their distributionwas not significantlydffirent from the others.84.4%(5917Uof caseshadsinglepolyp.Regardingto thecomplications of gastricpolypectomy, there TDas onepatient(1.4%)suspected perforation, of closed uthowas successfully managed without operation, and thereweretenotherpatients(14.3%)withbothersome epigastric painafterpolypectomy. Conclusions:Gastricadenomas nre commonand dfficult to dffirentiatefrom othergastricpolypsby endoscopic alone. Gastric polypectomy is a safeprocedurewithout majorcomplications. findings

x Dai hqc Y Dugc TP. HCM

20

HQi nghi Khoa hgc C6ng nghQTudi tr€ l!i^nthv20 - ngAy 1010t12008

Nghi6n criu Y hgc

* Y Hqc TP.Hd Chi Minh * Tap 12* Phs bin Sd1 2008

p+rvANPfi

Ti6u chudnloai tru

Polip d4 dly lh mQt chah do6n thinh thodng vAn gap tuy xuA't dQ lJr6ng thucmg xuy6n nhu bQnhvi6m lo6t da d)y - tA trdng vh ung thu da dAy. Cdc nghiOn cuu tr6n th6'gioi tfp trung nhie'u v)o polip dai - trUc trAng do con dudrng hinh thenh ung thu li6n quan chat ch6 voi polip tuy6h o vi tri nhy, trong khi o da dny thi d4i da sd c6c trudrng hqP ung thu li6n quan d6h H' pylori, vi6m teo da d)y v) chuy6h sAnruQt.Tuy vfy, polip o da d)y c&ng c6 ti6m ndng h6a 6c tuong tr,t nhu polip o vi tri khdc tr6n duorngti6u h6a. Nguy co 6c tinh cao nhA'tlh o dang polip tuyOn,ddc biQtvoi polip tuy6h c6 kich thudc 16rn vh o nguoi ldn tudio. C6c nghiOn cuu tr6n thd gioi con cho thAy ngay cAmQt sdpolip ting san cflng c6 khA ning kbm c6c d nghich sAnvir ung Kha ndng h6a 6c khi thu khu tni trOnPoliP(23'4)' theo d6i polip da d)y chi6m khoang 1',3o/"cic trudrnghcvp(n.Vl viy, dang bQnhly niry cAhdugc quan tAm dring muc hcrn vA c6 th6i d0 xu tri thich hqp ddngdn ngta nguy co ung thu h6a v6' sau.Do xuat d0 polip da dny gap kh6ng thudrng xuy6n n6n kinh nghiQmv6'd4ng bQnhli nAy cdn roi rag khu tru o mQt sd it ca lAm sirrg gAP o timg c6 nhan. Y vdn trong nudc hiQn chua c6 b6o c6on)o v6'dic didm bQnhly n)y' Chring t6i thUc hiQn nghiOn ciru nAy nhim x6c dinh dac di6m nQi soi,bAn chA'tm6 bQnhhqcvir nhimg tai bi6h cua thu thudt c5t polip da d)y qua nQisoi.

- Kh6ng do'ng1i cit polip qua nQi soi - Kh6ng c6 rdi lo4n d6ng cA'mm6u chua di6u chinh dugc v) / hoac dang su dgng Aspirin vir c6cthu6'ckh6ng d6ng. C6 ket quA kh6ng phir hqp vdi polip da ddy. CAch thrlc tidn hAnh: Su dlmg m6y nQi soi Olympus EXERA GIF 160.CAcbQnhnhAn d6h nQi soi ti6u h6a tr6n vir ph6t hiQn polip da ddy qua nQi soi dugc giAi thich tinh hrnh bQnh vcri bQnh nhAn v) nguoi nhe. Ne'u thAn nhAn vir bQnh nhAn d6hg y ttu tieh h)nh thu thuat cft polip qua nQi soi. Chirng t6i chi ydu cA'ux6t nghiQm d6ng cdm m6u khi polip >10mm hoic bQnh nhan c6 ti6h su rdi 1o4nd6ng cA'mm6u. V
NGHIn{ ruUoxc PI{APvA Pd TLIqNTG CUU Phuong ph6p ti6n cuu, m6 tA cXt ngang ti6h hAnh tai BV Dai Hqc Y Dusc fJ 1U2004 0412007. Ti6u chudn nhdn bQnh C6c bOnhnhAn d6h khdm vir dugc chi dinh nOi soi ti6u h6a tr6n t4i bQnhvi€n Dai Hgc Y Duqc. C6 tdn thucrng dang polip tr6n nQi soi ti6u h6a trdn. - Ddng f thUc hiQn thu thuat c5t polip qua n6i soi.

HCM.

PhAn tich vi xft lj' thdng k€: C6c dtt liQu duqc luu trCr v) xu l1i bing phah mOm SPSS (phi6n ban13.0,SPSSInc, Chicago,Ill) . Su dung c6c ph6p dem tah suat dd m6 tA cdc ti lQ,trung binh. St dung phuong ph6p phAn tich phucng sai ANOVA mQt y6'u td dd so s6nh tudi, kich thu6c giira nh6m polip tuy6h v2rc6cpolip kh6c. Su dsng y2 d€ so sdnh sq kh6c bi€t vd vi tri polip, d4ng cu6'ng v) bQnh ly duong ti6u h6a tr6n phdi hqp. Thuc hiQn ph6p kiem 2 b6n vA xem ld c61zngtria th6'ngke khi p < 0,05.

H6i nghi Khoa hqc C6ng nghQtudi tr6ldn thit 20 - ngiy 10/01./2008

2l

Y Hgc TP.Hd Chi Minh * Tap 12* phs brin Sd1 * 2008

rdrruAN C670 bQnhnhan thoa mdn ti6u chuAhnhfn bQnhvi lo4i tru. Tudi trung binh cua bQnhnhAn lA: 48 + 13.Su khdc biOtld,t6lg c6 f nghia thdng kO gifta tudi vi gicri cua nh6m benh nhan bi polip tuy6h vi polip c6 ban chat kh6ng phAi m6 tAn sinh. Ti lQnam:nir li1.:1.,4. V6'mat nQi soi, polip da diy c6 thd g{p d tat cA ciic vi tri theo giAi phAu cua d4 dAy, nhmg ti l0 gap nhi6'u nhat h o vtng hang vi. Dai da sd trucmg hqrp chfng t6i gap li c5 polip da dAy don dQc;15,6yotrudrnghqrpcdn lai c6 d6hg thoi nhie'u polip. Kfch thu6c trung binh cua polip l) 6+3 mm voi hcrr phAn nira sdtnrdrng hqp polip c6 kich thu6cS5mm. Polip ldrn nhat gdp trong nghiOn crlu nAy c6 kich thu6c 15mm. Da sd polip da dAy o dang kh6ng cudng. Tdn thu
Nghi6n crlu Y hgc

c6 ban chdt ld m6 ting sinh trong nghi6n cfu n)y 1Akich thu6c cua polip: voi kich thu6c polip cAngldn thi x6c suA'tgip polip tuy6h s6 tdng lOn &i6'ud0'3). V6'tai bi6h cua di6'u tri bing nQi soi: chring t6i kh6ng c6 trudrng hqp nAo chAy m6u dang kd vir c6 triQu .ht*g xuflt huy6t tr6n lAm sAng sau cdt polip. MQt sdtruong hqp c6 ru6m mdu nhe chAnvOt c6t polip vA dusc xu tri ti6ir bing dung dA'u thdng lgng voi ddng di-6n d6ng cAm miiu ti6ir dat hiQu quA cA'mm6u tdt tru6c khi ngtmg ttru thudt ndn chring t6i kh6ng x6ir v)o nh6m c6 tai bieh xuAt huy6t. C6 1 trucmg hqp 0,4%) polip kh6ng cudng chAnrQngducrrg kinh 1"2mm o ving hang vi nghi ngd thung bit ho4c c6 bong xuy6n thenh gAy ra kich thich phric m4c voi bi6'u hiQn voi benh nhen dau bgng nhie'u sau khi cft polip. Ki6m tra phim X quang bung kh6ng chuAhbf kh6ng thdy li6m hoi ducyiholnh. BQnh nhAn dugc nim theo d6i 1 ngiy sau thi dn dinh, giAm dau, bLmg m6m vi du-o. c ctro xuAt viQn v) tdi khdm 4 tuen sau trong tinh trEng dn dinh. C6 10 trudrng hqp 94,3%) bQnhnhAn c6 triQu chimg dau qu{n thugng vi xAy ra sau cfit pohp 2L 48gio voi cuong d$ tdng hcm so vcyitru6c ktri cXt polip vA giAm dAh sau d6. insL: L: Ddc Dqcdi&n didmnQisoicuapolipdq Dqcali6mnQisoi N Yo Vitripolip T6mvi 2 2,9 E D5yvi 7,1 ThAnvi 19 27,1 Hangvi 44 62,9 56luEng 1 59 84,4 polip 24 I 11,4 >10 3 4,2 Kichthudc Kichthudctrungbinh 6+3mm polip <5 mm 57,1 40 6-9 mm 27,2 19 15,7 11 >10 mm Cu6ngpolip C.6cu6ng 12 17,1 Kh6ngcu6ng 58 82,9 TOnthuong Vi6mTQ trdonguEc 1 1,4 ph6ihEp Vi6md9 diy 59 84,5 tr€nnOisoi Lo6tdq ddy z 2,8 Loett6 trdng 3 4,2 Binhthuong 5 7,1

v

)',

HQinghi Khoa hqc C6ngngh0Tudi tr6lii^nthir 20- ngiy 70101/200g

Y Hsc TP.Hd Chi Minh * Tap 1.2* Phs bin sd 1 * 2008

Nghi6n ct?uY hgc

BANLUAN

r Polyptuy6n

lo1"ryq11a. ]

TAmvi

D6y V

HangV

Th6nV

crtapolip dqday BiAhd6^1:Phanb6'dlnhkhu

20

iit"*.*tr PoLyqlhac

15

l

10 c

0 BT

VDD

GERD LDD

LTT

BiAhdo^2: B€nhl,! duongti€uh6afiAnph6ihqp

<=smm

6-9mm

>=10mm

Bidu dd 3: Phdnb6'kichthaocpolipdqdaytheobdn chfftm6b€nhhoc ciapolipdqddy mOb2nhhqc 2:Cdctip mo M6 bgnh hgc

N

Poliptuy6n6ng Poliptuy6n6ngnhungmao Poliptuyennhungmao

30

Poliptdng sdn

21

Poliptuy6nd6yvi Tdngsdnh6ctuy6nkhutrt Polipthi6uni6n T6ngcQng

7 8

1 1

2 70

%

42,9 1,4 1,4 30 10 11,4 2,9 100

K6t quA nghi6n cuu ctia chring t6i c6 nhi6u di6m tuong d6hg voi nghiOn cLru cria Muehdorfer vir cQngsu lhm tai Duc nim 2001(6). Nghi6n cuu nly cfrng cho thffy polip da diy thucrrg gap o nit (nam:nCt= 1:1,4),tfp trung o ving hang vi $7%), kd deh h thAn vi (31,2o/o), tAm vi (5%) v) d6y vi (2,8"/').Dang phd bi6h nhAt tr6n nQi soi cfrng h d4ng kh6ng cu6'ng Theo y vin th0- gtor, t lQ ung thu chi6m 73,4o/o. h6a cua polip da dly thay ddi tuy bAn chA'tm6 hgc cria polip: khoAng 2,1% ddi vcri polip ting ddi sAn,5o/"ddi vcri polip tuy6h dng vA 28,5-40o/" pn6(&e). Do vfy xdc dinh voi polip tuy6h.h*g ban chAtm6 bQnhhqc rA'tquan trgng vi d6ng vai trd quyOt dinh thei d0 xu tri vA theo d6i benh nhAn sau niry. K6t quA nghiOn crlu cua chfng t6i cho thA'y2 dang polip d4 diy thuong gap nhat h polip tuydh dng vir polip tdng san. Tuy vfy chu.g tdi nhan thA'y rA1 1Jr6 phAn biQt polip tuy6h vcri cdc polip khdc dr,tatr6n hinh Anh nQi soi don thuAh ngo4i tru y6'u td gqt f h polip tuy6h thucmg c6 kich thu6c l6n. Nghi6n crlu cua Muehdorfer cho thA'y polip tuy6h thuong d dang kh6ng cudng v) ni€m m4c b0'mit tron liing trong khi c6cpolip kh6c kh6ng c6 ban chat h m6 tAn sinh thudrngc6 bdmat trqt, xuA't huy6tto);tu/ nhi6n theo hudrng dAn thuc h)nh lAm sirng ndm 2006 cha HQi NQi Soi Ti6u H6a Mf thi vAn kh6ng thd xiic dinh chic chin duqc dang m6 hgc cua polip da dAy dga tr6n hinh anh nQi soi vi cAhphAi cft hoac sinh thi6t tdn thucrrg nghi ngd polip d6'x6c dinh ban chAt m6 bQnhhoc(4.Muehdorfer so sdnh gi6 trf chAh dodn m6 bQnh hqc dua tr6n mAu m6 sinh thi6t polip bing k6m voi bQnhphA'mtro.npolip dugc c6t qua nQi soi(o).CAc mAu bQnh phdm trong nghiOn cuu nly dugc cit rAt ki m5i 4pm. Nghi6n cuu cho thfy k6t quA m6 bQnh hqc kh6ng tuong hqp trong 2L truong hqP (9,5%). C6 13truong hqrp(5,9%)sai 10chnghiOmtrgng: 7 k6t quA dqa tr6n sinh thi6t li polip kh6ng tAn sinh trong khi k6t quA khi cit trqn polip lA polip tuy6h vir ung thu; 6 trucmg hqp k6t quA dga tr6n

HQi nghi Khoa hgc C6ng nghQtudi tr6ldn thft 20 - ngiy 1010112008

23

Y HQcTP. Hd Chi Minh * Tap 12 * Phg bAn Sd 1 'r 2008 sinh thi6t lA polip tdng sAn rh*g k6t quA cit trgn polip cho thAy c6 nhfrng d ung thu bi6u m6 tuy6h ho{c u carcinoidkhu tni. KOtquA ndy l)m cho nhir nQi soi c6 khuynh hudrngthi6n v6'c6ch xu tri c{t trgn polip qua n6i soi ngay tir dA'uhcyn lh sinh thiOt tru6c vA chd k6t quA m6 bQnh hqc d6'dinh hu6rngxu tri ti6p. Tr6n thUc t6l cho.nh1a cdch thrlc ti6p cfn nho tdt hcyncho bQnh nhAn cbn phAi tuy vAo muc d0 an toAn vd cAm gi6c kh6 driu cho bQnhnhan khi di6'u tri c5t polip da dhy qua n6i soi. Trong nghiOn ctlu cua chring t6i" kh6ng c6 trudrng hqp tai bi6h ndy xAy ra o nh6m polip da d)y c6 kich thu6c{0mm dir kh6ng cAh llm thu nghiQm d6ng cdm m6u (o bQnhnhan kh6ng c6 ti6h su roi lo4n d6ng cA'm mdu vh su dqng thudc kh*g d6ng tru6c d6). Di6u nAy chimg to c{t polip da dAy qua n6i soi khd an toAn cho nh6m bQnhnhAn nAy v) c6 thd thuc hi€n ngay o ldn nQi soi ph6t hiQnpolip. Dai da sd trucyng hqp dilng t6i thqc hi6n dugc nhanh ch6ng thu thudt nAy duoi gAy t6 ho.ngt4i ch6 voi xylocain 10%m) kh6ng gAy lJr6 chiu gr th6m nhi6u cho bQnh nhAn. Ti6h mO th6m v
24

Nghi6n cr?uY hgc

thuft cA\mmAu,2 trudrnghqp phAi truyGh m6u thi c6c trunng hqp khdc deu chi cAh giAi quyOt dn dinh blng phuong ph6p cArmm6u qua nQi soi. Nhu v{y chring t6i cho r}ng th6i d0 thich hqp nhAt dd xu tri polip da ddy 6 nu6c ta 1) c5t qua nQi soi ngay tu dalu, tuy nhi6n cAh luu f l) ddi vcri c6c polip c6 kich thu6c tr6n 10mm thi cAh phAi chuAh bi x6t nghiQm d6ng cA\mmdu cAhthdn, chudn bi day du phucrrg tiQn cArmm6u v) tdt nhat le n6n dugc tieh henh boi mQt nh) nQi soi c6 kinh nghiQm trong xu tri xuAt huy6t ti6u h6a. Di6m han chdmA nghiOncr?unAy chua tra loi dugc lA dAnh gi6 mdi 1i6nquan oia c6c trudrr,g hqp polip da dAy voi tinh trang nhiSm Helicobacterpylori, giira cdc trudrng hqp da polip da diy voi voi bQnhda polip dai trqc trhng c6 tinh chat gia dinh c&ng nhu chua c6 1 k6t quA nghi6n cuu c$t doc theo doi benh nhAn sau cXt polip. CAh c6 th6m nhimg nghidn cr?u moi dd giii d6p rhi*.g cAuhoi cdn dang bi bo ng6 nAy.

rfrruAN Polip da dAy c6 thd gap d bat cf vi trf niro tr6n d4 diy. Polip tuy6h da dAy kh6 phdbiOh vi 1ft6 ph6n biQt voi cdc polip c6 ban chat kh6ng phAi m6 t6n sinh dga tr6n hinh anh nQi soi quy u6c. Xu tri c{t polip da dAy qua nQi soi an toAry kh6ng c6 bi6h chimg nghidm trsng c6 thd ti6h hAnh d rhftng polip 3 L0mm ngay o ldn nQi soi ph6t hiQn ra polip m) kh6ng cAhthu x6t nghiQm chuc ning d6ng cArm mriu (n6ir bQnh nhAn kh6ng dirng khang d6ng ho{c c6 ti6h su r6'i lsan d6ng cA'mm6u). Tuy nhi6n cAh ti6h Mnh thfn trgng voi c6cpolip c6 kich thu6c l6rnhcrt LOmm vA voi da'ydt phuong ti6n cArmm6u qua nQi soi.

TATUEUTFTAMTTTAO 1. ASGE guideline (2005), The role fo endoscopy in the surveillance of premalignant conditions of the upper GI tract. GastrointesEndosc;63(4):573-4. 2. Cristallini EG, Ascani S, Bolis GB (2001), Association between histologic type of polyp and carcinoma in the stomach.GastrointestEndosc;53: 1-5. 3. Daibo M, Itabashi M, Hirota T (1987), Maglinant transformation of gastric hyperplastic polyps. Am J Gastroenterol;82: 101.6-25. 4. Ginsberg GG, Al-Kawas FH, Fleishcher DE et al (1996), Gastric polyps: relationship of size and histology to cacer risk. Am J Gastroenterol;91:774-7.

HQi nghi Khoahgc C6ngnghQTudi tr6ldn thri 20- ngiy 10101,12008