B! Y T" TR#$NG %&I H'C D#(C H N!I %)NG THU TR KH*O ST TNH
HNH S+ D,NGTHU-C TRONG %I.U TR/UNG TH# %&I TR0C TRNGT&I
B1NH VI1N H2U NGH/ KHO LU3N T-T NGHI1P D#(C S4 H N!I 2014B! Y T"
TR#$NG %&I H'C D#(C H N!I %)NG THU TR KH*O ST TNH HNH S+
D,NGTHU-C TRONG %I.U TR/UNG TH# %&I TR0C TRNGT&I B1NH VI1N
H2U NGH/ KHO LU3N T-T NGHI1P D#(C S4 Ng56i h57ng d8n : 1.TS. Nguy!n
Th" Lin H#$ng2.TS. Hong Th" Minh Hi%nN9i th:c hi;n: 1.B& mn
D#'c Lm SngTr#(ng )*i h+c D#'c H N&i2.B,nh vi,n H-u Ngh" H N!I
2014 L.I C/M 0N L(i 12u tin, ti xin chn thnh by t3 lng knh tr+ng v
bi4t $n su s5c t6i hai ng#(i th2y: TS. Nguy!n Th" Lin H#$ng Tr#7ng
b& mn D#'c LmSngTr#(ng)*ih+cD#'cHN&ivTS.HongTh"MinhHi%n
Tr#7ng khoa D#'c B,nh vi,n H-u Ngh", 1 tr8c ti4p h#6ng d9n, ch:
b;o, t*o 1i%u ki,n v tc FiOm b;nh nhn sM dQng
thuJc.................................................... 53 1.2 VE
F>c FiOm thuJc FiEu trH ung th5 F5Kc sM
dQng................................. 53 1.2.1 V: phc %A %i:u
tr!.................................................................................
53 1.2.2 V: li:u dng, cch dng
.........................................................................
53 1.3Tc dQng khng mong muJn cPa ho trH li;u v cch xM
tr................. 54 2 %E xuRt
...............................................................................................................
54 TI LI1U THAM KH*OPH, L,C Ph8 l8c 1: Phi(u thu th.p thng tin c6a
b#nh nhn nghin c2u. Ph8 l8c 2: Phc %A tiu chu+n theo guideline c6a
NCCN n>m 2014. Ph8 l8c 3: Tiu chu+n %;c tnh trn cc c* quan c6a
WHO. Ph8 l8c 4: BCng hi#u ch?nh li:u cc thu)c. Ph8 l8c 5: Danh sch
b#nh nhn. QUY #?C VI"T T@T 5-FU5-FluorouracilADRAdverse drug
reaction: Tc d8ng khng mong mu)n BNB#nh nhnBSA Body surface area:
Di#n tch b: m4t c* th5 CEACarcino-embryonic AntigenCTComputed
Tomography: ch8p c,t l=p vi tnhEGFREpidermal growth factor
receptor: Y(u t) pht tri5n bi5u bFAPFamilial Adenomatous Polyposis:
H;i ch2ng %a polyp tuy(n c tnh gia %nhFJPFamilial Juvenile Polyps:
H;i ch2ng %a polyp D ng$1i trE NCCNNational Comprehensive Cancer
Network: M&ng l$=i ung th$ qu)c gia NICENational Institute for
Health and Care Excellence: Vi#nNSAIDsNon-steroid anti-inflammatory
drug: Thu)c ch)ng vim khng steroidTDKMMTc d8ng khng mong
mu)nTTMTruy:n tFnh m&chUICCUnion for Internation Cancer
Control: Hi#p h;i ki5m sot ung th$ qu)c t( UTUng th$UT%TTUng th$
%&i tr'c trngVEGFVascular endothelial growth factor: Y(u t)
t>ng tr$Dng n;i m&c m&ch muWHOWorld Health Organization:
T< ch2c y t( th( gi=iDANH M,C CC B*NG STTK hi;uTn bUngTrang
1BCng 1.1Phn lo&i giai %o&n b#nh v tG l# s)ng trn 5 n>m
7 2BCng 1.2L'a ch/n phc %A tiu chu+n theo guideline c6a NCCN n>m
2014 9 3BCng 3.1Phn b) b#nh nhn UT3TT theo khoCng tun22 7BCng
3.5Phn lo&i b#nh nhn theo ch2c n>ng th.n 23 8BCng 3.6Phn
lo&i b#nh nhn theo ch? s) huy(t h/c 23 9BCng 3.7Cc ph$*ng php
%i:u tr! c s7 d8ng ho ch9t 24 10BCng 3.8S) %@t %i:u tr! bHng ho
ch9t 25 11BCng 3.9TIn su9t s7 d8ng cc ho ch9t trong %i:u tr!
UT3TT25 12BCng 3.10Cc phc %A ho ch9t trong %i:u tr! UT3TT 26 13BCng
3.11TIn su9t s7 d8ng cc phc %A ho ch9t v=i khng th5 %*n dng26
14BCng 3.12M)i lin quan giBa phc %A %Iu tin v giai %o&n b#nh 27
15BCng 3.13BCng thay %m c khoCng 7.367 b#nh nhn m=i m,c, 4.131
b#nh nhn t7 vong do ung th$ %&i tr'c trng
[6][13].Trongungth$%&itr'ctrng,l'ach/n%i:utr!%Iutintrong%as)cctr$1ng
h@p l ph-u thu.t, nh$ng ho tr! v-n %ng vai tr quan tr/ng trong %i:u
tr! b< tr@, ng>n ch4n ti pht, di c>n hay trong nhBng
tr$1ng h@p kh)i u %&i tr'c trng khng thch h@p %5 ph-u thu.t. Ho
tr! ung th$ ch6 y(u l cc nhm thu)c gy %;c t( bo, khoCng %i:u tr!
hKp v %;c tnh cao, do % vi#c %i:u tr! ho tr! li#u cIn %$@c theo di
v gim st ch4t chL v: li:u dng, cch dng v %;c tnh trong su)t qu trnh
%i:u tr!.B#nh vi#n HBu Ngh! l B#nh vi#n %a khoa h&ng 1 c trch
nhi#m ch>m sc s2c khoE cho cc cn b; trung, cao c9p c6a 3Cng v Nh
n$=c. Trong nhBng n>m gIn %y,
vi#c%i:utr!ungth$%ang%$@cB#nhvi#nr9tquantm,tGl#ungth$%&itr'ctrng
%$@c %i:u tr! D %y kh cao v khoa D$@c B#nh vi#n HBu Ngh! m=i thnh
l.p Phng
phach(thu)c%i:utr!ungth$t.ptrungvothng5/2013.Tuynhin,cho%(nnay,
ch$a c %: ti nghin c2u v khCo st tnh hnh s7 d8ng thu)c %i:u tr! ung
th$ %&i tr'c trng t&i B#nh vi#n HBu Ngh!. V v.y, chng ti
th'c hi#n %: ti: KhUo st tnh hnh sM dQng thuJc trong FiEu trH ung
th5 FGi tr:c trng tGi B;nh vi;n HVu NghH nhHm m8c tiu m tC th'c
tr&ng s7 d8ng thu)c v: cc m4t: -34c %i5m b#nh nhn s7 d8ng
thu)c. -34c%i5mthu)c%i:utr!ungth$%$@cs7d8ng:phc%A%i:utr!;li:udng,
cch dng. -Tc d8ng khng mong mu)n v cch x7 tr. T0 % %: xu9t m;t s)
giCi php gip gp phIn nng cao hi#u quC %i:u tr! ung th$ %&i tr'c
trng. 2 CH#BNG 1: TCNG QUAN 1.1TDng quan vE b;nh ung th5 FGi tr:c
trng1.1.1D"ch t! b,nh ung th# 1*i tr8c trng1.1.1.1D!ch t" b#nh ung
th$ %&i tr'c trng trn th( gi)i Hng n>m theo th)ng k c6a WHO
th c khoCng 9-10 tri#u ng$1i m,c m=i ung
th$vm;tn7atrongs)%ch(tvc>nb#nhny.60%cccaungth$m,cm=ilD chu Phi,
chu , D Trung v Nam MM [20]. Hng n>m s) ng$1i b! ung th$ D chu
t>ngln3-5%[21].Cclo&iungth$%&itr'ctrng,ti:nli#ttuy(nth$1ngg4pDcc
n$=c giu [15].N>m2002,trnth(gi=ickhoCng550.000ng$1im=im,cUT3TTvc
khoCng 278.000 ng$1i t7 vong do UT3TT [2]. N>m 2011, Hi#p h;i
ung th$ Hoa KN
$=ctnhckhoCng141.210ng$1i%$@cch+n%onm,cUT3TTvkhoCng49.380 ng$1i t7
vong do b#nh ny. TG l# ch+n %on UT3TT x(p th2 3 v l nguyn nhn th2 3
gy t7 vong D cC nam v nB (sau ung th$ ti:n li#t tuy(n v ung th$
phm1994l7,5/100000dnv%(nn>m2003t&ikhu v'c H N;i l
12,9/100.000 dn. [12] Theo bo co c6a B#nh vi#n Ung b$=u H N;i
n>m 2000, UT3TT chi(m m;t tG l# %ng quan tm, D H N;i l 13,3%, D
HA Ch Minh l 14,8% trn tm 2010, tG l# m=i m,c D Vi#t Nam l
22,1/100.000, D nB l 17,5/100.000 [5]. Theo s) li#u cng b) c6a
T< ch2c Nghin c2u ung th$ Qu)c t(, D Vi#t Nam mJi n>m c
khoCng 7.367 b#nh nhn m=i m,c, 4.131 b#nh nhn t7 vong do UT3TT . TG
l# m,cvt7vongdoUT3TT%2ngv!trth24DcCnamvnB(sauungth$ph(quCn S phn
u)ng m9t cn %)i: giu ch9t bo, th!t %;ng v.t, t ch9t x*, vitamin, cc
vi ch9t dinh d$Png sL t>ng nguy c* UT3TT, do t>ng ti(t acid
m.t, cc ch9t lm 2c ch( qu trnh bi#t ho t( bo nim m&c ru;t, %Ang
th1i lm giCm tc d8ng c6a ch9t x* trong vi#c g,n, c) %!nh, bi ti(t
cc ch9t gy ung th$ ra ngoi theo phn. [2][5][11] -Thu)c l, r$@u: l
nguyn nhn lm t>ng nguy c* UT3TT. [19]
-Y(ut)nguyc*khc:b#nhvim%$1ngru;t,b#nhvim%&itr'ctrngchCy mu,
b#nh Crohn, ti:n s7 gia %nh ... [5][11][17] 4 1.1.3ChMn 1on
1.1.3.1Ch-n %on lm sng -Tri#u ch2ng c* n>ng: trong UT3TT, tri#u
ch2ng xu9t hi#n %Iu tin l %&i ti#n phn c mu ho4c nhy mu. Bi5u
hi#n khc l chCy mu h.u mn, mu chCy ra h.u mn t' nhin hay khi %i
%&i ti#n. Khi b#nh ti(n tri5n D giai %o&n mu;n h*n, th$1ng
th5
hi#nh;ich2ngtr'ctrngvh;ich2ngr)ilo&ntiuho:%i%&iti#nnhi:ulIntrong
ngy, khng ra phn m ch? ra ch9t nhy, ho4c phn c l-n mu. [6][11] H;i
ch2ng to bn bn t,c ru;t, t,c ru;t th$1ng g4p D UT %&i trng tri.
[5][6]
3aub8ngv=ic*n%auqu4nb8ng,%aub8ngkmtheomt%&iti#n,%&iti#ngiC
th$1ng xu9t hi#n mu;n khi kh)i u % c kch th$=c l=n. [11] -Tri#u
ch2ng ton thn
+Thi(umu:b#nhnhnb!m9tmudochCymutr'ctrngkodi,daxanh,nim m&c
nh@t, xt nghi#m th9y giCm hAng cIu, huy(t s,c t) + GIy st: b#nh nhn
c th5 gIy st 5-10kg trong vng 2-4 thng. + Suy nh$@c: b#nh ti(n
tri5n lu lm suy mn. [11][29] -Tri#u ch2ng th'c th5:
+Khmb8ng:Dgiai%o&nmu;ncth5s1,ch&mnhBngkh)i2%/ngphnvngh)
ch.u tri, khi u to, cht hKp sL gy bn t,c ru;t ho4c t,c ru;t.
[5][11] + Th>m %&i, tr'c trng: l th>m khm %Iu tin khi
nghi ng1 ung th$ %&i tr'c trng, c th5 pht hi#n %(n 70% UT tr'c
trng D %o&n th9p v giBa [6][21]. 1.1.3.2Ch-n %on b.ng n/i soi -
Soi tr'c trng )ng c2ng. [11][29] - Soi %&i trng bHng )ng soi
m:m. [11] - N;i soi %&i trng. [5][29] 1.1.3.3Ch-n %on b.ng hnh
0nh Bao gAm: -Siu m b8ng. -Siu m n;i tr'c trng. -Ch+n %on X-quang.
[5][11] S 1.1.3.4 Ch1t ch2 %i3m kh*i u: CEA (Carcino-Embryonic
Antigen) 3ylkhngnguynungth$bi5umphi-m;ttrongnhBngch9tch?%i5m
chnhc6aUT3TT.NhBngnghinc2uchoth9yhml$@ngCEAtronghuy(tthanh ng$1i
bnh th$1ng c gi=i h&n cao nh9t l 5 ng/ml. Trong UT3TT c s'
t$*ng quan giBa tG l# CEA v giai %o&n b#nh. CEA c gi tr! %nh gi
hi#u quC %i:u tr! b#nh. 3i:u
tr!b#nhck(tquCkhiCEAtrDv:bnhth$1ngsau6tuIn.Qngd8ngl=nnh9tc6a CEA l
%5 theo di ti pht, di c>n sau %i:u tr!. TG l# CEA t>ng cao
bi5u hi#n b#nh ti pht ho4c di c>n. Tuy nhin, CEA cRng t>ng
trong m;t s) tr$1ng h@p khc (b#nh lS gan m.t tuT,
htthu)cl...).Nh$ngngaycCkhitcgitr!ch+n%on,CEAcRngnn%$@cxt nghi#m
cho t9t cC cc b#nh nhn b! UT3TT, %5 lm c* sD cho vi#c theo di v %nh
gi tin l$@ng sau ny. [4] 1.1.4Cc giai 1o*n b,nh Ngy nay, ng$1i ta
s7 d8ng 2 h# th)ng phn lo&i chnh l: Phn lo&i Dukes v h#
th)ng phn lo&i TNM 1.1.4.1Phn lo&i Dukes N>m 1932, Dukes
chia ung th$ tr'c trng lm 3 giai %o&n A, B, C.-Giai %o&n
A:ung th$ xm l9n t=i l=p c* gi=i h&n D thnh tr'c trng, ch$a di
c>n h&ch.-Giai %o&n B: ung th$ xm l9n thanh m&c %(n
t< ch2c xung quanh nh$ng ch$a di c>n h&ch. -Giai %o&n
C: c di c>n h&ch. [6][11] N>m 1935, giai %o&n Dukes C
%$@c chia thnh C1 (di c>n h&ch vng) v C2 (di c>n h&ch
xa). N>m1949,KirklinvCSphnchiaDukesAthnhgiai%o&nAm=i(ch?gi=i
h&n trong l=p nim m&c) v giai %o&n B1 (%(n nh$ng ch$a
qu l=p c*),
%m1949,Dukesbocov:giai%o&n4lgiai%o&nb#nhv$@tqugi=ih&n
ph-u thu.t c,t bU; n>m 1963 Turnbull v CS g/i giai %o&n 4 ny
l giai %o&n D.N>m 1954, Astler v Coller ti(p t8c lm chi ti(t
h*n phn lo&i Dukes. [11] 6 1.1.4.2H# th*ng phn lo&i TNM
Hi#n nay h# th)ng phn lo&i TNM %$@c s7 d8ng r;ng ri v ph<
bi(n nh9t v c th5 p d8ng v=i nhi:u lo&i ung th$ v c8 th5 h*n cc
h# th)ng phn lo&i tr$=c. Phn loGi TNM trong ung th5 FGi tr:c
trng theo UICC 2010 [11] T: U nguyn pht. Tis: Ung th$ t&i chJ,
ch$a ph vP mng %y, khu tr D nim m&c. T1: U xm l9n l=p d$=i nim.
T2: U xm l9n l=p c*. T3: Kh)i u xm l9n qua l=p c* t=i thanh
m&c. T4: U xm l9n qua thanh m&c %(n t< ch2c xung quanh
%&i tr'c trng. T4a: U xm l9n xuyn qua phc m&c t&ng.
T4b: U xm l9n tr'c ti(p ho4c dnh vo cc t< ch2c, t&ng ln c.n.
N: H&ch vng. N0: Ch$a di c>n h&ch vng. N1: Di c>n 1-3
h&ch vng. N1a: Di c>n 1 h&ch. N1b: Di c>n 2-3
h&ch. N1c: Ch9t l,ng %/ng c6a u D l=p d$=i thanh m&c,
m&c treo ru;t, m quanh %&i tr'c trng (khng phCi phc
m&c) m khng c di c>n h&ch vng. N2: Di c>n t0 4
h&ch vng trD ln. N2a: Di c>n 4-6 h&ch. N2b: Di c>n t0
7 h&ch trD ln. M: Di c>n xa. M0: ch$a di c>n. M1: C di
c>n xa. M1a: Di c>n 1 c* quan ho4c 1 v! tr. M1b: Di c>n
h*n 1 c* quan ho4c h*n 1 v! tr ho4c di c>n phc m&c. 7 BUng
1.1: Phn loGi giai FoGn b;nh [11][26][33] "#$#
%&'()*+,-./01023/4 5 6&33/4 uTisNuNuAA 1T1NuNuAB1 T2NuNuAB1
2ATSNuNuBB2 2BT4aNuNuBBS 2CT4NuNuB SAT1-T2N1N1cNuCC1 T1N2aNuC
STS-4aN1N1cNuCC2 T2-SN2aNuC T1-2N2bNuC SCT4aN2aNuCCS TS-4aN2bNuC
T4bN1-2NuC 4AT bt kyN bt kyN1aB 4BT bt kyN bt kyN1bB 1.2%iEu trH
ung th5 FGi tr:c trng 1.2.1Nguyn t5c chungC nhi:u ph$*ng php %i:u
tr! UT nh$ng tun theo 2 nguyn t,c c* bCn: -
Ph)ih@ptrong%i:utr!:Ungth$lb#nhlSc6at(bovtn hay t&m th1i. [2]
1.2.2Ph9u thun cho nhBng UT m< %$@c v ph-u thu.t t&m th1i
nh$ mD thng 8 %&i trng cho nhBng UT mu;n. Trong m;t s) tr$1ng
h@p %4c bi#t nh$ UT ti pht, UT c di c>n, v-n c th5 ch? %!nh
m< tri#t c>n [11]. Ngy nay, %i:u tr! ph-u thu.t UT3TT %ang
thay %ng c$1ng %i:u tr! bCo tAn v %i:u tr! ph)i h@p v=i x&
tr!, ho tr!, mi"n d!ch, li#u php nh,m trng %ch. [5] 1.2.3X* tr"-Ch?
%!nh: x& tr! %$@c ch? %!nh trong cc tr$1ng h@p UT tr'c trng
trung bnh v %o&n th9p, khi tn v x& tr! t&m th1i.
[11][14] + X& tr! tri#t c>n: X& tr! ti:n ph-u gip thu
nhU kch th$=c u, lm tn:pd8ngchoungth$%&itr'ctrngkhngmng c$1ng
mi"n d!ch. 3)i v=i b#nh nhn b! giCm b&ch cIu h&t %; 3 v %;
4, ng0ng truy:n ho ch9t, nn %$@c dng kch thch b&ch cIu h&t
nh$ Fulgrastim 300mcg/1,2ml tim d$=i da ho4c truy:n tFnh m&ch,
ngy 1 l/, th$1ng tim 2-3 ngy v khng sinh ph< r;ng %5 d' phng
nhi"m khu+n. [10] -GiCm dng hAng cIu:+ Erythropoietin c th5 %$@c
dng %5 phng thi(u mu D b#nh nhn tr$=c khi %i:u tr! ho ch9t D b#nh
nhn c HGB ngmi#ng.3i:utr!tri#uch2ng,scmi#ngsaukhi>nvtr$=ckhi%i
ng6bHngClorhexidin.N(ulotv%auti(ntri5nthdnghJnh@p Diphenylhydramin,
Antacid, Vitamin E v Xylocain. [10] + M#t mUi, chn >n: Nng cao
th5 tr&ng bHng Amigold, Lipovenous,... [2] !Cc tc d8ng khng
mong mu)n khc -D! 2ng. -Shock phCn v#. -R8ng tc, x&m da.
-T>ng glucose huy(t. 16 -Gy lJ th6ng, p xe. [40] 1.3Theo di sau
FiEu trHSaukhik(tthc%i:utr!,b#nhnhn%$@ckhm%!nhkN3thng1lIntrong3
n>m %Iu, 6 thng 1 lIn trong 2 n>m ti(p theo. 3!nh l$@ng CEA,
ch8p X quang th$1ng quy lAng ng'c, cng th2c mu, xt nghi#m mu trong
phn, ch2c n>ng gan, th.n nn %$@c lm D cc lIn khm %!nh kN.
[6][33] Nn soi %&i trng hng n>m trong 3 n>m %Iu, ti(p
theo soi %!nh kN 3 n>m/lIn n(u 3 lIn soi %Iu khng pht hi#n c
polyp. Ch8p c,t l=p vi tnh lAng ng'c, < b8ng. Khng nh9t thi(t
phCi ti(n hnh %!nh kN tr0 khi nghi ng1 tri#u ch2ng ti pht ho4c hm
l$@ng CEA t>ng cao. [33]
Nhnchungcckh)iu%&itrngtinl$@ngt)th*nDtr'ctrngdot?l#ph-u thu.t
tri#t c>n cao h*n. So v=i cc ung th$ khc D %$1ng tiu ho (VD:
d& dy, th'c quCn, gan, tuT, ...), ung th$ %&i tr'c trng c
tin l$@ng t)t h*n cC. [6] 17 CH#BNG 2: %-I T#(NG V PH#BNG PHP NGHIN
CIU 2.1%Ji t5Kng nghin cLu
3)it$@ngnghinc2ulb#nhnc6ab#nhnhnungth$%&itr'ctrng%$@c%i:utr!
n;i tr t&i B#nh vi#n HBu Ngh! n>m 2013 (t0 thng 1 n>m
2013 %(n h(t thng 12 n>m 2013) 2.1.1Tiu chuMn l8a ch+n- B#nh nhn
%$@c ch+n %on xc %!nh l ung th$ %&i tr'c trng. - B#nh nhn %$@c
%i:u tr! ho ch9t %@t %Iu tin trong n>m 2013.2.1.2Tiu chuMn lo*i
trN- B#nh nhn b! ung th$ %&i tr'c trng vo vi#n khng phCi %5
%i:u tr! ho ch9t.- B#nh nhn mang thai, t7 vong. 2.1.3Th(i gian
nghin cIu T0 thng 2/2014 %(n thng 4/2014. 2.2Ph59ng php nghin cLu
2.2.1Thi4t k4 nghin cIu
Nghinc2uhAic2ukhngcanthi#ptrnccb#nhnthoCmntiuchu+nl'ach/n, lo&i
tr0. 2.2.2Cch ch+n m9u - Thu th.p thng tin, s) li#u t0 b#nh n c6a
b#nh nhn ung th$ %&i tr'c trng %$@c l$u trB t&i phng l$u
trB b#nh n c6a B#nh vi#n HBu
Ngh!-MJilInvovi#nb#nhnhn%[email protected];tb#nhn.MJib#nhncth5theodi1
haynhi:u%@t%i:utr!hoch9ttuNtheoth1igiannHmvi#nc6ab#nhnhn.B#nhn
c6ab#nhnhnungth$%&itr'ctrngl$utrBt&iphngl$utrBb#nhn%$@cmho
bHng m b#nh n C18, C19, C20.- Do %, chng ti khCo st ton b; b#nh n
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c6aNICE[35].Theo1tn nn ch? %!nh ny l ph [email protected] nghin c2u c6a
chng ti, c 6 b#nh nhn (24,0%) %$@c thay %n trong vi#c ch?nh
li:u m;t cch chnh xc.Trong qu trnh %i:u tr!, c m;t tG l# l=n b#nh
nhn (72,0%) %$@c thay %m 2013, chng ti rt ra m;t s) k(t lu.n
sau: 1.1VE F>c FiOm b;nh nhn sM dQng thuJc -3;tun Hi(u (2010),
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%!nh, kE thuCt v k(t qu0 sau m= cFt n*i kG %;u %i+u tr! ung th$
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Ch Minh. 14.Mai Tr/ng Khoa, Nguy"n Xun K7 (2012), M/t s* ti(n b/ v+
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(http:benhvienk.comtin-tuc-chung-fiont-vi4216-khong-the-va-co-the-tiong-nen-y-hoc-the-gioi,
truy cp lIn cu)i ngy 10/5/2014) 48.www.meuicine.oig.ukENC
(https:www.meuicines.oig.ukemcmeuicine17S67SPCEloxatin+S+mg+ml+concentiate+foi+solution+foi+infusionhttps:www.meuicines.oig.ukemcmeuicine2844uXPILCapecitabine+1Sumg+%26+Suumg+Tablets,
truy c.p lIn cu)i ngy 10/5/2014) PH, L,C 1: PHI"U THU TH3P THNG TIN
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P1935Nam11066/5/201321/5/2013 1259030298Ph&m 32c
P1935Nam127327/5/201310/6/2013 12613010612VR Xun
Q1933Nam22161/10/20137/10/2013 12713010612VR Xun
Q1933Nam245528/10/20131/11/2013 12813010612VR Xun
Q1933Nam260018/11/201322/11/2013 12913010612VR Xun
Q1933Nam27719/12/201313/12/2013 13012005020Bi Ng/c
S1940Nam154A17/1/201321/1/2013 13112005020Bi Ng/c
S1940Nam52828/2/20135/3/2013 13212005020Bi Ng/c
S1940Nam7744/4/20139/4/2013 13312005020Bi Ng/c
S1940Nam10009/5/201315/5/2013 13412005020Bi Ng/c
S1940Nam13026/6/201311/6/2013 1359010226Bi Xun
T1945Nam71612/3/20131/4/2013 1369010226Bi Xun
T1945Nam93522/4/201329/4/2013 1379010226Bi Xun
T1945Nam10554/5/201316/5/2013 1389010226Bi Xun
T1945Nam115017/5/201327/5/2013 1399010226Bi Xun
T1945Nam131031/5/201311/6/2013 1409010226Bi Xun
T1945Nam144818/6/201325/6/2013 1419010226Bi Xun
T1945Nam189931/7/201310/8/2013 1429010226Bi Xun
T1945Nam189911/8/201326/8/2013 1439010226Bi Xun
T1945Nam218427/8/201315/9/2013 1449010226Bi Xun
T1945Nam218416/9/201329/9/2013 1459024630L Thnh
T1940Nam218210/9/201330/9/2013 1469024630L Thnh
T1940Nam242110/10/201329/10/2013 1479024630L Thnh
T1940Nam27763/12/201313/12/2013 1489026217L V>n
T1945Nam285221/11/201314/12/2013 1499026217L V>n
T1945Nam292916/12/201328/12/2013 15011000977Nguy"n 3,c
T1945Nam13724/6/201320/6/2013 15111000977Nguy"n 3,c
T1945Nam149826/6/201311/7/2013 15211000977Nguy"n 3,c
T1945Nam172012/7/20136/8/2013 15310017514Nguy"n HBu
T1934Nam10889/5/201320/5/2013 15410017514Nguy"n HBu
T1934Nam118923/5/20133/6/2013 15510017514Nguy"n HBu
T1934Nam136313/6/201321/6/2013 15610017514Nguy"n HBu
T1934Nam172725/6/20131/7/2013 15710017514Nguy"n HBu
T1934Nam172726/6/201319/7/2013 15810017514Nguy"n HBu
T1934Nam190026/7/20132/8/2013 15910017514Nguy"n HBu
T1934Nam19003/8/201326/8/2013 16010017514Nguy"n HBu
T1934Nam21904/9/201311/9/2013 16110017514Nguy"n HBu
T1934Nam219012/9/201325/9/2013 16210017514Nguy"n HBu
T1934Nam249316/10/201324/10/2013 16310017514Nguy"n HBu
T1934Nam249325/10/20138/11/2013 16412016455TrIn Th!
T1951NB54024/1/20134/2/2013 16512016455TrIn Th!
T1951NB5398/2/20135/3/2013 16612016455TrIn Th!
T1951NB5398/2/20135/3/2013 16712016455TrIn Th!
T1951NB77111/3/201319/3/2013 16812016455TrIn Th!
T1951NB71325/3/20132/4/2013 16912016455TrIn Th!
T1951NB8138/4/201315/4/2013 17012016455TrIn Th!
T1951NB96622/4/20133/5/2013 17112016455TrIn Th!
T1951NB115720/5/201327/5/2013 17212016455TrIn Th!
T1951NB12743/6/201310/6/2013 17312016455TrIn Th!
T1951NB139917/6/201324/6/2013 17412016455TrIn Th!
T1951NB277420/11/20136/12/2013 17512016455TrIn Th!
T1951NB293311/12/201327/12/2013 176130142183J Ng/c
X1944NB278728/11/201313/12/2013 177130142183J Ng/c
X1944NB289020/12/201326/12/2013 XC NH3N CdA B1NH VI1N
