1. Ngi hng dn:PGS. TS. L N TH HA HIP TS. V HU VNH Hc vin: NG QUC HNG 2. T VN U trung tht l mt khi nim rt bao qut v cc bnh trung tht, bao gm tt c cc khi u lnh tnh hoc c tnh, bm sinh hoc mc phi, cc khi u tin pht hoc th pht [1] C rt nhiu phng tin chn on hnh nh gip xc nh v tr, mc xm ln ca u trong trung tht [2]1. Malcolm M. DeCamp et al (1991), The Mediastinum, Glenns thoracic and cardiovascular surgery sixth edition, pp. 643 63 2. AJ Cohen, Primary cysts and tumors of the mediastinum, The Annals of Thoracic Surgery; 51: 378 384 3. T VN T l c tnh u trong trung tht gia tng trong thp k cuica th k XX [1] Gn y, PET-CT c vai tr rt ln trong vic tm sot v nh giai on ung th. Tuy nhin, PET-CT c th dng tnh trong mt s bnh nhim trng hoc ang c tnh trng vim nhim km theo [2]1. Bacha EA (1998), Surgery for invasive primary mediastinal tumors, The Annals of Thoracic Surgery; 66: 234 239 2. Kubota K, Yamada S, Kondo T, Et al (1996): PET imaging of primary mediastinal tumours. Br J Cancer; 73: 882-886 4. T VN V vy, trong iu tr u trong trung tht trit th phi cc kt qu gii phu bnh ca khi uL Nguyn Quyn, Nguyn Hoi Nam (2009), Nghin cu vai tr ni soi lng ngc sinh thit cc khi u trung tht. Y hc tp H Ch Minh. Vol.13 No.1, p9-13 5. CC PHNG PHP LY MU 1. Ni soi ph qun sinh thit xuyn thnh 2. Sinh thit qua ni soi thc qun di hng dn siu m 3. Sinh thit bng kim xuyn thnh ngc 4. M trung tht trc5. Ni soi lng ngc chn on 6. Ni soi trung tht 7. M ngc sinh thit 1. Reemtsen B.L. and Wood D.E. (2005), Endoscopic Diagnosis of Thoracic Disease, In: Sellke F.W., Del Nido P.J., Swanson S.J., Sabiston &Spencer surgery of the chest. 7th ed. Vol. 1, Elsevier Saunders, p.5964 2. Ruediger Hoerbelt and Helmuth Grimm, The value of a noninvasive diagnostic approach to mediastinal massAnn Thorac Surg 2003; 75: 1086 1090. 3. Sellke F. (2005), Invasive modality, Sabiston & Spencer Surgery of the Chest, 7th edition, Saunders 6. Ni soi ph qun Nm 1897 Killian thnh cng trong vic gp xng ln t ph qun ca ngi [1] Nm 1970, s xut hin ng soi ph qun ng mm ca Ikeda [2]1. Al-Naaman et al (1974), Primary mediastinal tumors, Thorax 29: pp 475 481 2. Mc Elvein (1991), Bronchscopy, Glenns thoracic and cardiovascular surgery: pp 169 - 180 7. Ni soi ph qun Sinh thit xuyn vch qua ni soi kh ph qun bng ngni soi mm [1] Sinh thit qua ni soi di hng dn siu m [2]1. Reemtsen B.L. and Wood D.E. (2005), Endoscopic Diagnosis of Thoracic Disease, In: Sellke F.W., Del Nido P.J., Swanson S.J., Sabiston &Spencer surgery of the chest. 7th ed. Vol. 1, Elsevier Saunders, p.59-64 2. Yasufuku K. et al (2011), A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer, J Thorac Cardiovasc Surg, 142(6): p. 1393-400. 8. Ni soi kh ph qun bng ng ni soi mm Ch nh: Sinh thit nhng hch cnh kh qun ln nh nhm hch di carina, sau kh qun, quanh kh qun v rn phi. Sinh thit nhu m phi bng cch y ng soi mm vo tn n ph qun tn cng sinh thit nhu m phiNgun: Reemtsen B.L. and Wood D.E. (2005), Endoscopic Diagnosis of Thoracic Disease 9. Ni soi kh ph qun bng ng ni soi mmS H THNGHCH TRUNG THTAJCC, 7th edition (2009), lung cancer staging 10. Ni soi kh ph qun bng ng ni soi mm Bin chng *: Chy mu trong lng kh ph qun (>=30ml) Trn kh mng phi. Trn kh trung tht.* Townsend P. (2007), Lung cancer, Sabiston Textbook of Surgery, 18th edition, Saunders 11. Ni soi kh ph qun bng ng ni soi mm Hiu qu: nhy, c hiu, gi tr d ondng, gi tr d on m v chnh xc chn on ln lt l 66.6%, 100%, 100%, 65%, v 79.4%[1] Chc ht sinh thit hch trung tht qua kh ph qun c ci thin nhiu nh c thc hin ni soi di hng dn ca siu m [2] Hn ch: khng sinh thit c nhm hch quanh thc qun v ca s trung tht [3] 1. 2.3.Ngun: Abeloff M. (2004), Bronchoscopic Techniques Including Transbronchial Needle Aspiration BiopsyReemtsen B.L. and Wood D.E. (2005), Endoscopic Diagnosis of Thoracic Disease, In: Sellke F.W., Del Nido P.J., Swanson S.J., Sabiston &Spencer surgery of the chest. 7th ed. Vol. 1, Elsevier Saunders, p.59-64 Yasufuku K. et al (2011), A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer, J Thorac Cardiovasc Surg, 142(6): p. 1393-400. Cumming C.W., Haughey B., Thomas J., (2005), Flexible Fiberoptic bronchoscopy, Otolaryngology: Head and neck Surgery, 4th edition, Mosby 12. Sinh thit qua ni soi thc qun di hng dn siu m Ch nh [1]- Nhng thng tn thuc thc qun, trung tht quanh thc qun. - nh gi giai on trong ung th phi, thc qun . Bin chng: - Chy mu, c bit l nhng trng hp c tng p tnh mch ca. - Nhim trng trung tht. - Trn kh mng phi. - Nguy c gieo rc t bo ung th rt him. Kt qu: nhy l 90% [2]Ngun: Mason P. (2005), Techniques for obtaining mediastinal tissue, Murray & Nadel's Textbook of Respiratory Medicine, 4th edition, Saunders1. Mason P. (2005), Techniques for obtaining mediastinal tissue, Murray & Nadel's Textbook of Respiratory Medicine, 4th edition, Saunders 2. Vilmann P. (2006), Endoscopic ultrasound-guided fine needle aspiration biopsy: equipment and technique, Journal Gastroenterol Hepatol, pp.1646-55 13. Sinh thit bng kim xuyn thnh ngc Nm 1885, Menetrier ln utin chn on ung th phi [1] Ti M nm 1930, Martin v Ellis thy bnh phm thu c khi s dng kim 18G lm xt nghim t bo hc [2] 1960 ph bin trn th gii Nay thng c tin hnh di s hng dn ca siu m, chp CLT, hay di mn hunh quang tng sng [3]Ngun: Sellke F., (2005), Invasive modality, Surgery of the Chest1. Sellke F. (2005), Invasive modality, Sabiston & Spencer Surgery of the Chest, 7th edition, Saunders 2. Mason P. (2005), Techniques for obtaining mediastinal tissue, Murray & Nadel's Textbook of Respiratory Medicine, 4th edition, Saunders 3. Priola A., Priola S., Cataldi A. et al (2008), CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures, La Radiologia medica,113, pp.315 14. Sinh thit bng kim xuyn thnh ngc Bin chng:*T l trn kh mng phi c ghi nhn l 5-57% Theo Woolf tai bin chy mu c 8,4% trng hp khc ra mu lng trung bnh Kt qu:**Priola A. v cng s thy nhy v chuyn bit trong chn on ung th ln lt l 83,6% v 100%* Mason P. (2005), Techniques for obtaining mediastinal tissue, Murray & Nadel's Textbook of Respiratory Medicine, 4th edition, Saunders ** Priola A., Priola S., Cataldi A. et al (2008), CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures, La Radiologia medica,113, pp.315 15. M trung tht trc MC Neil v Chamberlain m t nm 1966, rch m ngccnh c tri di khong 8 cm, thng ct sn sn th 2 ca khoang lng ngc. Hin nay phng php ny t lm do c ni soi lng ngc v sinh thit xuyn thnh ngc di hng dn ca CLT. [1] Ch nh - U trung tht trc c kch thc qu to, xm ln nhiu, khng th iu tr bng cch ct trn u c [2]. - nh gi h thng hch vng ca s trung tht, v tr thng b di cn ca ung th thy trn phi [3]. 1. Ahmad U.S. and Blum M.G. (2009), Invasive diagnostic procedures. In: Shields T.W., Locicero J.L., Reed C.E. and Feins R.H., General thoracic surgery, Philadelphia, Lippincott Williams & Wilkins, p. 301312 2. Fang W.T., Xu M.Y., Chen G. et al (2007), Minimally invasive approaches for histological diagnosis of anterior mediastinal masses, Chinese Medical Journal, Volume 120 (8), pp. 675-679 3. Sagawa M., Sato M., Sakurada A. (2002), A Prospective Trial of Systematic Nodal Dissection for Lung Cancer by Video-Assisted Thoracic Surgery: Can It Be Perfect?, Ann Thorac Surg, (73), pp. 900-904 16. M trung tht trc Bin chng:- Tn thng mch mu, thn kinh him gp. - Rch mng phi t xy ra [1]. - T l t vong l 0% -0,3%, t l tai bin 1% n 2,3% [2] - Nhim trng. Kt qu: nhy ca phng php ny l 91% 1. 2.Fang W.T., Xu M.Y., Chen G. et al (2007), Minimally invasive approaches for histological diagnosis of anterior mediastinal masses, Chinese Medical Journal, Volume 120 (8), pp. 675-679 Abdel Rahman M. Abdel Rahman, Standard Cervical Mediastinoscopy in the Diagnosis ofMediastinal MassesJournal of the Egyptian Nat. Cancer Inst., Vol. 15, No. 3, September: 253-258, 2003 17. Phu thut ni soi lng ngc Jacobaeus thc hin ti Stockholm -Thy in t nhng nm 1910 1920. [1]. Thp nin 80 vi s ng dng ca ngun sng cc mnh, h thng cp quang gip cho hnh nh r nt, h thng knh Hopkins, x l nh k thut s ghi hnh ng truyn hnh nh ra mn hnh video cho nn cc thng tn trong lng ngc c pht hin rt r rng qua ni soi lng ngc. [1] Tin hnh thc hin cc th thut v phu thut cc thng tn nh ct b hoc sinh thit lm chn on. [2]Ngun: Landrenaeau RJ (1992), Video-assisted thoracic surgery, Ann Thorac Surg 54: 800 - 8071. Luis Marcelo Inaco Cirino, Diagnosis and treatment of mediastinal tumors by thoracoscopy, Chest 2000; 117: 1787 1792 2. L Nguyn Quyn, Nguyn Hoi Nam (2009). Nghin cu vai tr ni soi lng ngc sinh thit cc khi u trung tht. Y hc tp H Ch Minh. Vol.13 No.1, p9-13 18. Phu thut ni soi lng ngc Ch nh- Sinh thit cc hch nhm 5, 6, hch cc nhm 8,9 v hch s 7 mc thp [1]. - Sinh thit cc khi u trung tht cha r bn cht [1]. - nh gi mng phi v nhng bt thng ca nhu m phi [2]. Chng ch nh [3] - Dy dnh mng phi. - Khng chu c gy m mt phi. - C bnh ni khoa qu nng. PTNS lng ngc c u th hn phng php m trung tht. Thm st cc thng tn trong lng ngc trc khi m ngc gip nh gi c kh nng ct c khi u v trnh c nhng trng hp m ngc khng cn thit. 1. 2. 3.Townsend P. (2007), Lung cancer, Sabiston Textbook of Surgery, 18th edition, Saunders R. Duane Davis, The Mediastinum, Surgery of the chest 1996, pp.576 610 Ahmad U.S. and Blum M.G. (2009), Invasive diagnostic procedures. In: Shields T.W., Locicero J.L., Reed C.E. and Feins R.H., General thoracic surgery, Philadelphia, Lippincott Williams & Wilkins, p. 301312. 19. Phu thut ni soi lng ngc Mt s bin chng thng gp: [*].Chy mu II. Trn kh mng phi III. Bin chng khc nh tn thng ng ngc, gieo rc t bo ung th, ri lon nhp tim, xp phi, au v d cm vt m... I.*Gossot D. et al (1996), Mediastinoscopy vs thoracoscopy for mediastinal biopsy. Results of a prospective nonrandomized study, Chest, 110(5): p. 1328-1331 20. Phu thut ni soi lng ngc Hiu qu ca phng php:Xc nh c bn cht m hc ca cc tn thng trung tht trong phn ln cc nghin cu. PTNS lng ngc phi gy m ni ph qun 2 nng. Mt s nghin cu cho thy thi gian nm vin lu hn so vi ni soi trung tht[1, 2].1. Ahmad U.S. and Blum M.G. (2009), Invasive diagnostic procedures. In: Shields T.W., Locicero J.L., Reed C.E. and Feins R.H., General thoracic surgery, Philadelphia, Lippincott Williams & Wilkins, p. 301312 2. Rendina E.A., et al (1994), Comparative merits of thoracoscopy, mediastinoscopy, and mediastinotomy for mediastinal biopsy. Ann Thorac Surg, 57(4): p. 992-995 21. Ni soi trung tht Ni soi trung tht (NSTT) c gii thiu biCarlens nm 1959 [1] Ngy nay phng php c s dng chn on m bnh ca bnh l u v hch trung tht v nh gi giai on ca ung th phi, NSTT tr thnh tiu chun so snh vi cc phng php chn on bnh trung tht khc. [2]1. Carlens E. (1959), Mediastinoscopy: A Method for inspection and Tissue Biopsy in The Superior Mediastinum, Number 4, Volume 34, pp.343-35 2. Nguyn c Thng v CS (2013), nh gi kt qu ni soi trung tht sinh thit u v hch trung tht ti BVTQ 108, Phu thut ni soi v ni soi Vit Nam, s 1, tp 3, tr. 40 - 45 22. Ni soi trung tht Ch nh 1.Chn on 2.Hch trung tht v u trung tht Xc nh giai on ung th phiiu tr: ct nang TT, u tuyn c...De Leyn P. and Lerut T.(2004), Conventional Mediastinoscopy, Multimedia Manual of Cardiothoracic Surgery, 158, p.1-10. 23. Ni soi trung tht 2RL 4RL Nhm hch cnh khquntrn (2P, 2T) Nhm hch cnh kh qun di (4P,4T) Nhm hch di carina (s 7) Nhm hch ca s ph ch(5 v 6) v rn phi (10) De Leyn P. and Lerut T.(2004), Conventional Mediastinoscopy, Multimedia Manual of Cardiothoracic Surgery, 158, p.1-10.78,95, 6 24. Ni soi trung thtNgun: RAHMAN A (2003), Standard Cervical Mediastinoscopy in the Diagnosis of Mediastinal Masses, Journal of the Egyptian Nat. Cancer Inst., Vol. 15, No. 3, September: 253-258 25. Ni soi trung tht Chng ch inh: [1, 2]- Bnh nhn c chng ch nh gy m tng qut - Nhng thay i gii phu: bnh nhn g qu mc, bu c to thng trung tht, s vi ha din rng hay phnh cung ng mch ch hay ng mch v danh, v m kh qun vnh vin sau phu thut ct thanh qun. -Tng i tin cn x tr vng c ngc, tin cn m xng c hay m vng c, tn thng chn p tnh mch ch trn 1. 2.Abdel Rahman M. Abdel Rahman, Standard Cervical Mediastinoscopy in the Diagnosis ofMediastinal MassesJournal of the Egyptian Nat. Cancer Inst., Vol. 15, No. 3, September: 253-258, 2003 Hammoud Z., Anderson R., Meyers B. et al (1999), The curren role of mediastinoscopy in the evualuation of the thoracic disease, The Journal of Thoracic and Cardiovascular Surgery, (118), pp..894-899 26. Ni soi trung tht(A) soi trung tht trc bi Specht;(B) soi trung tht sau bi Specht;(C) soi trung tht bi Carlens;(D) soi trung tht ng tip cn mi kimOtto T.L., Zaslonka J. and Lukianski M.(1972), Experience with mediastinoscopy, Thorax, 27,p.463-466. 27. Ni soi trung thtDe Leyn P. and Lerut T.(2004), Conventional Mediastinoscopy, Multimedia Manual of Cardiothoracic Surgery, 158, p.1-10. 28. Ni soi trung thtDe Leyn P. and Lerut T.(2004), Conventional Mediastinoscopy, Multimedia Manual of Cardiothoracic Surgery, 158, p.1-10. 29. Ni soi trung thtDe Leyn P. and Lerut T.(2004), Conventional Mediastinoscopy, Multimedia Manual of Cardiothoracic Surgery, 158, p.1-10. 30. Ni soi trung thtCarlens E.(1959), Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum, Dis Chest, 36: p. 343-352. De Leyn P. and Lerut T.(2004), Conventional Mediastinoscopy, Multimedia Manual of Cardiothoracic Surgery, 158, p.1-10. 31. Ni soi trung tht Bin chng : Bin chng thp khong 1%: chy mu tnh mch, do rch cung mch nui hch hoc rch mt nhnh ng mch ph qun. Rch tnh mch n hoc tnh mch v danh. Rch kh qun, rch thc qun him gp nhng rt nguy him c th xy ra vim m trung tht. Trn kh trung tht hoc trn kh mng phi. Tn thng dy thn kinh qut ngc tri trong khi sinh thit hch cnh kh qun di tri hay hch gc kh ph qun triWidstrom A. (1975), Palsy of the recurrent nerve following mediastinoscopy, Chest,67, pp.365-366 32. Ni soi trung tht Kt qu: Ni soi trung tht chn on: phng php xm ln c hiu qu nh gi bn cht m bnh hc ca u v hch trung tht. Abeloff v Detterbeck nhy v chuyn bit l khong 63-86% [1] v 80-85% [2]. Hammoud ghi nhn ni soi trung tht c th thit lp chn on trong 93,6% bnh nhn [3] 1. 2. 3.Abdel Rahman M. Abdel Rahman, Standard Cervical Mediastinoscopy in the Diagnosis ofMediastinal MassesJournal of the Egyptian Nat. Cancer Inst., Vol. 15, No. 3, September: 253-258, 2003 Detterbeck C., DeCamp M., Leslie J. Kohman et al (2003), Invasive Staging, Chest Journal, (123), pp. 167-175 Hammoud Z.T. et al (1999), The current role of mediastinoscopy in the evaluation of thoracic disease, J Thorac Cardiovasc Surg, 118(5): p. 894-899 33. M ngc sinh thit L la chn cui cng. Kho st u v tnh trng khoang mng phi mt cch tondin nht. Tuy nhin, phng php ny c tnh xm ln cao v thng gy au sau m.[1] Hin nay, vi rt nhiu phng php sinh thit chnh xc nn 95% cc trng hp sinh thit khng cn phi m ngc [2]1. 2.Ahmad U.S. and Blum M.G. (2009), Invasive diagnostic procedures. In: Shields T.W., Locicero J.L., Reed C.E. and Feins R.H., General thoracic surgery, Philadelphia, Lippincott Williams & Wilkins, p. 301312. Francois Pons, Videothoracoscopic resection of neurogenic tumors of the superior sulcus using the harmonic scalpel, Ann Thorac Surg 2003; 75: 602 604 34. Kt lun Mc d c nhng pht trin mnh m ca cc phng tinchn on bng hnh nh nh CLT, MRI, PET cc phng php ny gip cho vic chn on u v hch trung tht d dng hn rt nhiu [1], nhng a ra quyt nh iu tr hp l vn cn phi c mt chn on chnh xc v gii phu bnh ca u [2] Nhiu phng php sinh thit u v hch trung tht nhng cho ti nay mi phng php u c nhng u, khuyt im ring ca chng. 1. Ravens A., Bohuslavizki K., Brandt L. et al (2003), Comparison of CT, Positron Emission Tomography, and Endoscopic Ultrasonography With and Without Fine-Needle Aspiration, Chest, 123, pp. 442451 2. L Nguyn Quyn, Nguyn Hoi Nam (2009), Nghin cu vai tr ni soi lng ngc sinh thit cc khi u trung tht. Y hc tp H Ch Minh. Vol.13 No.1, p9-13 35. Kt lun Phng php sinh thit bng kim qua da, qua kh qun, qua thcqun di hng dn ca u d siu m c th sinh thit u chnh xc hn thng cho mu m nh kh t c chnh xc khng cao. Ngc li, phng php m ngc hay m trung tht c th ly c mu m ln cho kt qu m hc chnh xc hn, nhng cc phng php ny li c tnh xm ln cao hn. PTNSLN v NSTT c th gip tip cn sinh thit nhng mu m ln vi mc xm ln t hn PTNSLN i hi phi gy m ni ph qun 2 nng. Nhiu nghin cu chng minh PTNSLN c t l bin chng cao v thi gian nm vin lu hn so vi ni soi trung tht[1, 2]. 1. Ahmad U.S. and Blum M.G. (2009), Invasive diagnostic procedures. In: Shields T.W., Locicero J.L., Reed C.E. and Feins R.H., General thoracic surgery, Philadelphia, Lippincott Williams & Wilkins, p. 301312 2. Rendina E.A., et al (1994), Comparative merits of thoracoscopy, mediastinoscopy, and mediastinotomy for mediastinal biopsy. Ann Thorac Surg, 57(4): p. 992-995