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TAÊNG SINH NOÄI MAÏC TÖÛ CUNGTAÊNG SINH NOÄI MAÏC TÖÛ CUNG
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ÑAÏI CÖÔNGÑAÏI CÖÔNG
Ung thö NMTC: beänh lyù 4th / ung thö phuï nöõ.
Hoa Kyø(2005): 40.880 case môùi maéc/ naêm.
TSNMTC: khoâng ung thö NMTC 3%-29% sau 13 naêm (Kurman)
TSNMTC: baát kyø tuoåi naøo. (TMK-MK 5%-10%). Trieäu chöùng: ra huyeát AÑ baát thöôøng.
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TSNMTC: Taêng sinh caùc tuyeán
(kích thöôùc - hình daïng khoâng ñeàu) Taêng tæ leä tuyeán / moâ ñeäm
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Phaân loaïi: Taêng sinh NMTC ñôn giaûn (ñieån hình/khoâng
ñieån hình) Taêng sinh NMTC phöùc taïp (ñieån hình/khoâng
ñieån hình)
Nguyeân nhaân: cöôøng Estrogen töông ñoái (E/P) Tuoåi daäy thì (voøng kinh khoâng phoùng
noaõn) Maõn kinh (HRT) Tieàn maõn kinh
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Tieán trieån: Töï thoaùi trieån (75%)TSNMTC Ung thö NMTC (25%)Ñieàu trò: Phaãu thuaätBaûo toàn
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Ferenczy-Gelfand (1989) Donald E & cs (2000) MPA 10 mg/ngaøy x 14 /thaùng x 6
thaùng. Hieäp hoäi SPK Ñöùc (2003): MPA 10 mg/ngaøy x 10 / thaùng x 6
thaùng Manee vaø cs (2005): MPA 10mg /ngaøy x 12 /thaùng x 6
thaùng (NST)
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Tieán haønh ñieàu trò Provera 5mg (uoáng) 10mg/ngaøy x 10 /thaùng x 6 thaùng.Taùi khaùm moãi thaùng x 6 thaùngSinh thieát NMTC / 6 thaùng ñieàu trò
ProveraÑaùp öùng ñieàu trò / laâm saøng: Kinh nguyeät: bình thöôøngÑaùp öùng ñieàu trò / beänh lyù:
NMTC bình thöôøng (GPB)
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OÁng huùt Pipelle sinh thieát noäi maïc töû cung
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Ñaùp öùng laâm saøng - ñaùp öùng beänh lyù
Ñaùp öùng LS
Ñaùp öùng beänh lyù
Toång soá
Coù Khoâng
Coù 95(96.94
%)
3(3.06%)
98
Khoâng 2(25.00
%)
6(75.00
%)
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Toång soá 97(91.51
%)
9(8.49%)
106
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So saùnh thôøi gian haønh kinh trung bình / chu kyø
Thôøi gian
haønh kinh
Trung bình SD p
Thaùng 1 5.839 1.41Thaùng 2 5.481 1.14 0.0436*Thaùng 3 4.933 1.22 0.000**Thaùng 4 4.349 1.25 0.000***Thaùng 5 3.854 0.90 0.000****Thaùng 6 3.55 0.82 0.000****
*
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So saùnh löôïng kinh tröôùc – sau / chu kyø ñieàu trò
Löôïng kinh Ít/vöøa Nhieàu PR p KTC 95%
Tröôùc ñieàu trò
45(42.45%)
61(57.55%
)
Thaùng 1
21(19.81%
)
85(80.19%
)0.111 0.000* 0.021-0.361
Thaùng 2
54(50.94%
)
52(49.06%
)1.6 0.000** 0.805-3.280
Thaùng 3
87(82.08%
)
19(17.92%
)9.4 0.000*** 3.755-
30.284
Thaùng 4
94(88.68%
)
12(11.32%
)
13.25 0.000**** 4.880-50.412
Thaùng 5
100(97.09%
)3
(2.91%)28.5 0.000***** 7.536-
241.01
Thaùng 6
99(96.12%
)4
(3.88%)28 0.000*****
*7.397-236.88
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So saùnh beà daøy NMTC tröôùc – sau / ñieàu trò:
NMTCtröôùc
NMTC sau (mm)< 5 5-9 10-14
< 5 4(66.67)
2(33.33)
0(0.00)
5-9 11(33.33)
18(54.55)
4(12.12)
10-14 8(20.00)
21(52.50)
11(27.50)
≥ 15 1(4.00)
15(60.00)
9(36.00)
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Ñaùp öùng ñieàu trò veà maët beänh lyù
Ñaùp öùng ñieàu trò veà maët beänh lyù
Taàn soá(n = 106)
Tyû leä(%)
* Coù ñaùp öùng• NMTC bình thöôøng
* Khoâng ñaùp öùng• TSNMTC ñôn giaûn ñieån hình• TSNMTC phöùc taïp ñieån hình
97
981
91.51
8.497.550.94
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Moät soá nghieân cöùu veà ñieàu trò taêng sinh NMTC baèng progestin
Taùc giaû Loaïi TSNMTC
Thuoác ñieàu trò
Thôøi gian Hieäu
quaûGal – cs. (1986) TSNMTC Megestrol, 20-
40mg/ngaøy lieân tuïc
6-8 tuaàn 90%
Ferenczy - Gelfand (1989)
TSNMTC (ñh)TSNMTC (kñh)
MPA 10mg/ngaøyMPA 20mg/ngaøy
14 ngaøy/thaùng x 6lieân tuïc 6 thaùng
86%50%
Saarikoski – cs. (1980)
TSNMTC (ñh) Norethisterone10mg/ngaøy
10mg/ngaøy x 6 thaùng
90%
Manee – cs. (2005)
TSNMTC (ñh) MPA 10mg/ngaøyNorethisterone 10mg/ngaøyDydrogesteron 20mg/ngaøy
12ngaøy/thaùng x 6
92.5%
BV Huøng Vöông
TSNMTC ñôn giaûn ñieån hình
MPA 10mg 10ngaøy/thaùng x 6
91.5%
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KEÁT LUAÄNKEÁT LUAÄN Taêng sinh NMTC laø beänh lyù
ñöôïc chaån ñoaùn baèng GPB Taêng sinh NMTC ñôn giaûn, ñieån
hình ñieàu trò baèng progestin (provera) ñaït hieäu quaû cao (91,5%).
Caàn ñieàu trò ñuùng möùc vaø theo doõi ñònh kyø nhaèm phaùt hieän sôùm ung thö NMTC.