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Nhdnxdt bu6c dAuvO gi|tri criasi€udm nQisoi trongchAndoanc6ckh6i u 6ngti6u h6at4i B€nhvi6nE HANgi. Initial comments on thevalueof endoscopic ultrasonography in thediagnosis of gastrointestinaltumorsat Hanoi E centralhospital. Vil H6ngAnh,Dd Nguyil lnh, NguydnThu!,Wnh cttnidm macquan6i soi6ngmcmdiAutrf polypkh6ngcuongil4i - tryc trdng. Evaluatethefeasibility of endoscopicmucosalresectionin'the treatmentof

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colorectal.

NguydnTq Quyet,QudchTrpngDuc, NguydnTht)yOanh S

KCtqui bu6c dAudi6utri b6ophi bing phucrngph6p
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patients Nguydn Ngpc Thdnh,Nguydn Hdi Nam, LA Quang Nhdn, Nguydn Thuy Oanh 4

D6nh gi6 hiQuqud bu6c dAucira nQi soi c6 d6i rlnh sdnghep (NBI) trong chAn do6n t6n thucrngthuc quin do trdo ngugc da ddy thr,rcqu6n. Initial ffictiveness evaluationofnarrow band imaging (NBI) in the diagnosis of reflux esophagitis. Duong Xudn Nhuong, Ddo Trudng Giang, LAXudn Thdng,NS,lyA" Vdn Huiin

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D6nh girl tinh hinh nQi soi chup m4t tqy nguoc dong t4i BQnhvi6n Chq RAy n d m2 0 1 1 . Remarks on endoscopicretrograde cholangiopancreatographyat Cho Ray Hospital. nA Oang Quy Dilng, Pham Hiru Tilng, Trin Dinh Trl, Ng6 Phtrong Minh Thuqn, Trdn C6ng Trryc, Trdn Quiic Wnh

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Thetreatmentofthe commonbile duct (CBD)stonesbyERCPat Hue Central Hospital. TrdnNhu Nguy€nPhuong,HA NgpcSang,LAPhudcAnh,NguydnVdnDuy &cs DAnhgi6 k6t qu6nQisoi mflttuy ngqqc ddngtrong diAutri soi 6ng m4t chtr tai BQnhvi6nDa khoaTrunguongCdnTho. Therole of ERCP in the treatmentof commonbile duct stonesat Can Tho CentralGeneralHospital. La VdnPhrong vd cQngs1r C{p nhatdiAutri soi ducrngmdttronggan. Updateon themanagement of intrahepaticstones. Trdn VdnHuy, Trdn QuangTrung

Y hgcThgc hinh - S6tlz + S:l

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cAr NIEM MAceuANgrsor 6r.rcmEmolEurR! poLyp cu6ttoDAr- TRr./c xnOruc rRANG Nguy€nTq Quy2t,QudchTrgngD*c, Nguy€nThily Oanh Dai hoc Y DwqcfP. UA Ch{Minh T6mtit tvt0 dAu: Polyp lon, khdng cul5ngchdnrQngo d4i - tryc trirngld c6ct6n thucrngc6 nguy co ung thu cao.DiAutri kinh di€nld k! thuatcit polyp.Nhi6unghidnciru ctrathti gi6i v€ tcyttruat c6t niem m?c quanQisoi 6ng mAmdiAutri polyp kh6ngcu6ngvi ung thu sdmd4i-tryctring cho ktit qudt6t. Tai BV D4i hgc Y Dugc dd bu6c dAu6p dgngk! thu4tc6t ni€m mac di0u tri polyp khdngcu5ngt14itryc trdngcho k6t qudt6t, mo ra tri6n vgng c6 th€ xri trf dugc c6ct6n thuongndy bing cilchcanthiQpnQisoi it xAm6n. Mgc ti6u: Erinhgirl higu qudphuongph6p cit ni0m mac quanQisoi di6u tri polyp kh6ngcu6ngvd ung thu sdm dai - truc trdng.D6i tuqng - phuong phrip nghiOncrfru:D6i tuqng: tilt ch c6ctrudnghqp bQnhnhdnc6 polyp chdn rQngkhdngcu6ngo d4i - trgc trdng d6n kh6mvd nQisoi di6u tri t?i KhoaNQi soi - BV Dai ph6p:h6i cr?u,m6 t6. K6t qui: ttl hqcY Duoc TP HCM, ddngy thamgia nghi6ncr?u;Phucyng thrlng 11/200S.d6n th6ng l0l20ll c6 1l trudng hqp polyp t14i-tryc trdngduoc thUc-hidnthir thuQtcit ni6m m4cquanQisoi d4i trdng.Ea s6t6n thucrngo d4i trangSigmoid(3 trucrnghqp) vd tryc tring (5 truonghgrp).C6ctdn thucrngc6 ducrngkinh tt 1,5- 3cm.Thri thuatdugc thgc hi6n an todn,c6t trgn ducr. c t6n thuongvd kh6ngc6 bi6n chimg.Ktit qudgi6i ph6ubCnhlf t6t polypny6n ci ld 6ng;d0 loansin vria (6 trucrnghgp),lo4n sannhg(2 trucrnghqp) vd loan sdn phapcit ni6m mac quanQisoi di6utri cho I I trudrng naneQ trucmghqp). K6t lu$n: Phucrng' hqp polyp kh6ngcu6ngd d4i-tryctring dugcthgc hiQnan todn,hiQuqud. Tir kh6a: Polyp,Cit ni6mmacquan6i soi d4itrang. Abstract EVALUATE THE FEASIBILITY OF ENDOSCOPICMUCOSAL RESECTION IN THE TREATMENT OF POLYPSOF COLORECTAL NguyenTaQuyet,QuachTrongDuc, NguyenThuyOanh ^ HCM City University,ofMedicineandPharmacy Background:Largesessileand flat polypsof colorectalis high risk leisionsfor cancer;it tend to invasiveto layersof colorectalwall. The classicaltreatmentof colorectalpolypsis surgicalresection.Recently,Endoscopicmucosalresectionis a promisingtherapeutic optionfor removalsuperficialcarcinomas or largesessileandflat polyps.Webegunto dothismethodfrom 2008asa minimalinvasivemethodto treatmentfor largesessileandflat polypsof colorectal. Objectives:evaluatethe feasiblyof endoscopic mucosalresectionin polypeandearlycancer of colorectal.Method: Patientswas olderthan 18 ys, colonicendoscopy diagnoseare large sessileandflat polyps; in Endoscopic department, UniversityMedicalCenter;Retrospective, casesserial.Result:from 2008,Novemberto 2011,October;therehave1l casesin this study to endoscopic mucosalresection. Leisionswerelocatedin Sigmoidcolon(3cases) andrectum(5 cases). Diameterof leisionsis 1,5 3cm.Procedure werecompleteremovalof the leision,not Y hgcThgc hinh - S6SgZ+ aSS

15

complication.The histologic assessment were adenomatouspolyps, inclusemoderated-grade (6 dysplasia cases),low-gradedysplasia(3case)andhigh-gradedysplasia(2case).Conclusion: endoscopicmucosalresectionis minimal invasivemethod for large sessileand flat polyps of colorectalwith safely,feasibly. Keyword: Polyps;Endoscopicmucosalresection.

1.Dar vANot

" Edi tugng: tdt ch c6c trucrnghqrpbQnh nhdnc6 polyp chAnrQngkh6ng cu6ngd ct4i - tryc trdng ct6nkh6m vi nQisoi di€u tri tAi KhoaNQisoi - BV Dai hgcY DugcTP HCM, .t d6ngf thamgia nghidncr?u. * Thoi gian: th6ng 1112008d6n th6ng r0l20tl. . ^ i . * Ti6u chuAnchgn bQnh: ngd nQi soi. D6i voi chc polyp l6n, khdng cu6ng o tl4i - trgc trdng vd <1{cbiQt.ld t6n > Benh nhdn dugc ch6ndodnpolyp d4ithuong ung thu sdm dai-truc trdng thudng tryc trd.rng kh6ngcu6ngquanQisoi. tlugc tli€u tri bing ph6u thuft. Do sg ph6t F Nghi ngd 6c tfnh. tri6n cira hinh 6nh hoc vd k! thuft n6i soi, > C6 th6 thgc hign kl thuft cit ni€m mac .: , .2, . ciic tdn thucrngti6n ung thu vd ung thu d4i- hodntodnquan6i soi. truc trdng dugc ph6t hiQn o giai doan s6m. 2.2.Phvongphip nghi0ncrim: Ddy chinh ld co sd cria sg ph6t tritln mQt 0 Nghidncr?undy thgc hiQnbing h6i cr?u, ki thugt moi: cilt ni€m mac di6u tri polyp m6 ti lo4tca. i r r ^ khdng cu6ngvi. ung thu s6m d4i-trpctrdng O MOta ky thuat:saukhi ddxhcdfnhducr. c . A quanQisoi.Ndm 1984,Tada(NhatBdn)b6o t6n thucrngni6m mac, chfng t6i thgc hiQndSnh c6o trudng hqp dAuti6n cit ni6m m4c didu ddu quanh t6n thuong bdng dao diQnxric dinh .,..], tri ung thu s6m da ddy. DAu thap ni6n 90, 'ranh. gicri t6n thuong cdn cdt b6; ding nu6c cflng c6c thc gihNhft Bin rip dgng k! thuat mu6i sinh lf c6 epinephrinepha vcri dung dich ndy chocrict6n thuongungthu sdmd4i-trgc xanh methylen chich vdo lorpdudi ni6m mac trdng; tt d6 k! thu4t ndy dugc nghidncfu d4i+ryc trdng tl€ n6ng lcrpni€m mac l6n khoi . r I ' . d vd ph6 bi6n ngdy cdngrQngrdi, duoc xem lorp ducri ni6m, gi6m nguy co thring vd chiy l ' nhq ld mQtthtrthuQtit xdm l6n trong di6utrf m6u; k! thuat nay cfrngnhdmd.inhgi6 thuong ung thu s6md4i trgc tring (1), (5), (7).Tqi t6n cdn khu tru tAi lop ni€m m4c hay dd xdm ,^ ^ ,, Bgnh vign D4i hoc Y Duoc di nghiOncftu l6n xudng lop co (kh6ngndngduo.c lop ni€m thuc hi6n thdnhcdngkf thuat cit ni6m mac m4cl€n saukhi ddborndungdich).Dungthdng -. I tli€u tr! ung thu s6m da ddy; chringt6i cfing lgng nhiQtthlt vdng quanht6n thucng saud6 <16budc tldu 6p dpng k! thu$t ndy cho c6c thUchien c6t dOt
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cu6ng truc tring c6 tludng kinh 2cm. K! thuflt cdt ni6m mac dugc thpc hi0n thdnh c6ng;bQnhnhdnbi chnym6u mu6n sauthri thu4t vd dugc xri tri cAmmiiu qua ndi soi sau24 gid. - CAcm6u bQnhphdm sau thtr thuat tl6u ,duscgoi ldm x6t nghiQmgi6i ph6u benhli, 3. KEr QUA: Tir thringll l2008di5n th6ngl0l20ll chring ktit qun thu duo.c da sd ld polyp tuyi5n6ng, vta. t6i da thgc hiQnduoc 11trudnghgp c6t ni6m loan sALn Bing 2tDic ttitlmm6 bQnhhqc. mac dai-tryc trdng qua nQi soi; ktit quAnhu sau: D4c tli6m m6 bQnhhgc S6 'Ty le nam/nft:417 lugng i . \ r - mTu6i trung rbinh: 58,5(thdpnhAt26, cao U tuy6n6ng,lo4nsdnnhg 2 go). ntr6t: - Chi dinh nQisoi tla s6 h daubpngk6oddi U tuy6n6ng,lo4nsin vtra 6 (7 trucrnghgrp),vd ti6u ra m6u(4 trucrnghqrp). U tuy6n6ng,lo4nsin ndng - Vi tri tdn thucrng: 2 .

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hgp,chi c6 I truonghqp phii cdtt6n thuong 2 hay nhi€u lAn do kich thudc t6n thuong ^ -.4. ldn 3cm. K6t quAnghiOnctiu criaPhilippe AS vd cQngsp (6) cho th6y kich thudc t6n thuong nho hon 4cm c6 th6 thyc hiQn c6t trgn 1 lAn (l121146trudng h-o.p); cdn l4i 34 truong hgp c6 kich thu6c l6n hon 4cm phAi cEt thinh nhiAuminh. Viqc cit thdnh nhi6uminh c6 th6 gdy kh6 khin trong viQc x6c dinh cit htit t6n thuong,nh6t li nhiing trudng hgp ung thu s6m. Trong 11 trudmghgp cit ni€m m4c cta nghi€ncuu ndy, c6 I trucrnghatpbi6n chimg chiy m6u sauthri thu4t. So srlnhvoi chc tdc gii kh6c: Bing 3: So s6nhbitin chimgcriathi thu4t.

Hinh 2: Tdn thuongtrudc vi saukhi cit ni6mmac 4. BAN LU{N: Cit niCmm4c tli6u tri polyp kh6ng cu6ng vd ung thu sornd4i-trgctrang ld tht thu6t it ^ . l a xdm rlAn ngdycirngdugc 6p dungr6ngrdi; d{c biQtc6 j nghiad6i v6i nhirngbgnhnhdnkyn . l , , , . 1 tu6i c6 nhi6unguy co nOuphdi trAi quaph6u thu4t. Nghidn cuu cria chring t6i c6 7 benh nh6ntr0n60 tu6i, k! thuatclt niem m4ctrong nhimg trucrnghgp ndy g6p phdn ldm giAm , r t nguy co ctraphduthu4t.Nghi6ncr?ucta Kato (3) cfing c6 da sd bqnhnhdnlon tudi, trung binh64,4tu6i. Vi trf t6n thuong da s6 ld o d4i trdng Sigmoid vd tryc trang: 8/11 trudrnghgp (72,7%).Nghi€nctnrcta tdc gihPhilippeAS vd cQngsg(6)vdi c6c trudrnghgp polyp c6 kich thudc. 4cmc6 15126trudarghgrp(58%) , A tdn thuongo trpc trdng.Di€u nAyc6 th6 li6n quand6nxu6t dQcaocta ung thu o d4i trdng ch4uh6ngvir tryc trdng. Chring t6i thyc hiQnk! thu4t c6t trgn t r t6n thuongbangthonglong trong 10truong 18

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K€t quActia chringt6i c6 tf lQchiy m6u kh6 cao; tuy nhiOndo s6 liQu nh6, chi c6 1l truong hop, hon nira t6n thuongc6 kich thu6c vira ph6i, tta s6 nho hon 2cm, nOn t i cdn s6 trudng ho-pnhi6uhon d€ c6 kdt luQn kh6chquan. Mdu bgnhphamsaukhi ciltradAuitugcthri gi6ipheubQnhly, chringtdi c6dastitruorg hgp r\ ^ f, t ld u tuy€n6ng,lo4nsdnviravd n{ng (8 truong hgrp),t16ycflng ld c6ct6n thucrngtiAnung thu n6nthri thuflt cft ni€m m4cdiAutr! c6cpolyp ^ kh6ng cu6ng ciing g6p phAnldm gi6m nguy co ung thu tir c6cpolyp kh6ngcuting.Kh6ng c6 truong hgp ndo ung thu trong nghiOncr?u ndy.Nghi6ncr?ucriaJameel(2)trdn l7 trudmg t ! . hgp cdt ni6m m4cdi6utri polyp khdngcu6ng c6 4 trucrnghqp k6t qudgi6iph6ubQnhlf h u . A A , tuy€n6ng,lo4nsin n{ng, cA4 truonghgrpndy c6 kfch thu6cpolyp # 35mm.C6ctrucrnghgp Y hgcThgc hinh - S.i 832+ 833

nghichsAnvira vd nflngctrachringt6i c6 kich thu6c20 - 30mm.Nhu vfy, du polypco kich thudcndo cflng cAndugc didutri: c6t qua nQi soi hayph6uthuAt. Theo d6i sauthri thuft criachringtdi chi thUc hiQnduqc 5/l I benh nhan,c6c trucmg hgp ndy chuathAyt6i ph6t.

s.KEr LUdN: Quahdi cuu 11trucmghqrpcat ni6m m4c dieu tri polyp khdngcu6ngd dai-tructrdng chringt6i nh{n thdyddyld k! thuft it xdm l6n, an todnvd hiQuqui. Tuy nhi6ncAnthgc hipn v6i sdliQulcrnhondec6 ktit lufn toin diQnvd kV thudtndv. .'t

TAI LIEU THAM KHAO l . Th6i DodnK' (2011)."Ti5ngquan:k! thu4t

cit hortni€m mgcvd cit b6 ha ni6mmacqua nQisoi". Tapchi khoahgcti6uh6aVi€t Nam. T$p6 (23),tr.l52l-31.

(1992)."The careof patientswith colorectal polypsthatcontaininvasiveadenocarcinoma".

Cancer1992:70: 2044-50. 5 . MassimoC.,ThierryP.,SabrinaB., Rosangela 2 . JameelJ. K. A., Pillinger S. H., Moncur F. (2006). " Clinical reviews: Endoscopic P., (2006). "Endoscopicmucosalrestiction mucosal resection".Am J Gastroenterol (EMR) in themanagement of largecolo-rectal .101:653-663. polyps".ColorectalDisease. 8: 497-500 PhilippeA. S., CharlesM., et al (2010). 3 . Kato H., Haga S, et al (2001)."Lifting of "Large endoscopicmucosal resection for leisionsduringEndoscopic MucosalResection colorectaltumorsexceeding4 cm". World J of earlycolorectalcancer:Implicationsfor the Gastroenterol. 16(5):588-595. 1 assessrnent of respectability".Endoscopy.33 Rembacken B. J., GotodaT., Fujii T. (2001). (7):568-73. "Review: EndoscopicMucosal Resection". 4. Kyzer S, BeginLR, GordonPH, MitmakerB. Endoscopy. 33(8):709-l8.

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