NHẬN xét tỷ lệ các tổn THƯƠNG cổ tử CUNG,ÂM đạo QUA xét NGHIỆM tế bào học PHỤ KHOA

B GIO DC V O TO B Y T TRNG I HC Y H NI -*** - Lấ XUN QUí Nhận xét tỷ lệ tổn thơng cổ tử cung, âm đạo qua xét nghiệm tế bào học phụ khoa KHểA LUN TT NGHIP BC S A KHOA Ngi hng dn khoa hc: Ths Trn Ngc Minh H NI - 2016 LI CM N Tụi xin chõn thnh cm n Ban giỏm hiu- Trng i hc Y H Ni, Khoa gii phu bnh- Bnh vin i hc Y H Ni, ó to mi iu kin thun li cho tụi quỏ trỡnh hc v hon thnh khúa lun ny Tụi xin chõn trng by t lũng bit n sõu sc n: Ths.BS Trn Ngc Minh, ngi Thy ó tn tỡnh giỳp , hng dn cho tụi sut quỏ trỡnh thc hin khúa lun ny, ng thi ó b sung cho tụi nhng kin thc chuyờn mụn b ớch v kinh nghim quý bỏu v lnh vc chuyờn ngnh tụi hc v nghiờn cu Tụi gi li bit n sõu sc n Cha, M, nhng ngi thõn gia ỡnh, bn bố, ó luụn bờn h tr, c v v ng viờn tụi hon thnh c khúa lun ny H Ni, ngy 11 thỏng nm 2016 Sinh viờn Lờ Xuõn Quý LI CAM OAN Tụi xin cam oan: õy l cụng trỡnh nghiờn cu khoa hc ca riờng tụi Cỏc s liu, kt qu trỡnh by khúa lun l trung thc v cha tng c cụng b bt k cụng trỡnh no khỏc Ngi thc hin khúa lun Sinh viờn Lờ Xuõn Quý MC LC DANH MC T VIT TT - CTC : m o- C t cung ASCUS : Atypical squamous cell of undetermined significance (Tờ bao vy khụng in hỡnh ý ngha khụng xỏc nh) ASC-H : Atypical squamous cells cannot exclude HSIL (T bo vy khụng in hỡnh cha loi tr HSIL) AGUS : Atypical glandular cells of undetermined significance (T bo biu mụ tuyn khụng in hỡnh ý ngha khụng xỏc nh) ASR : Age Standardized incidence rate (T l mc chun theo tui) CIN : Cervical intraepithelial neoplasia (Tõn sn ni biờu mụ cụ t cung) CI : Confidence interval (Khong tin cy) CTC : C t cung DSV : D sn vy H : c hiu G.V : G.Vaginalis HPV : Human Papilloma Virus (vi rỳt gõy u nhỳ ngi) HSIL : High-grade squamous intraepithelial lesion (Tụn thng ni biờu mụ vy ụ cao) IARC : International Agency for Research on Cancer (Hip hi nghiờn cu ung th quc t) KH : Khụng c hiu LSIL : Low-grade squamous intraepithelial lesion (Tụn thng ni biờu mụ vy ụ thõp) SCJ : Cervical squamocolumnar junction (Vung tiờp giap vy tr) SIL : Squamous intraepithelial lesion (Tụn thng ni biờu mụ vy) TBH : T bo hc T-Z : Transformation zone (Vung chuyờn tiờp) T.V : Trichomonas vaginalis UT : Ung th UTCTC : Ung th c t cung WHO : World Health Organization (T chc y t th gii) DANH MC BNG DANH MC HèNH DANH MC T VIT TT - CTC ASCUS : m o- C t cung : Atypical squamous cell of undetermined significance (Tờ bao vy khụng in hỡnh ý ngha khụng xỏc nh) ASC-H : Atypical squamous cells cannot exclude HSIL (T bo vy khụng in hỡnh cha loi tr HSIL) AGUS : Atypical glandular cells of undetermined significance (T bo biu mụ tuyn khụng in hỡnh ý ngha khụng xỏc nh) ASR : Age Standardized incidence rate (T l mc chun theo tui ) CIN : Cervical intraepithelial neoplasia (Tõn sn ni biờu mụ cụ t cung) CI : Confidence interval ( Khong tin cy ) CTC : C t cung DSV : D sn vy H : c hiu G.V HPV : G.Vaginalis : Human Papilloma Virus (vi rỳt gõy u nhỳ ngi) HSIL : High-grade squamous intraepithelial lesion (Tụn thng ni biờu mụ vy ụ cao) IARC : International Agency for Research on Cancer ( Hip hi nghiờn cu ung th quc t) KH LSIL : Khụng c hiu : Low-grade squamous intraepithelial lesion (Tụn thng ni biờu mụ vy ụ thõp) SCJ SIL : Cervical squamocolumnar junction (Vung tiờp giap vy tr) : Squamous intraepithelial lesion (Tụn thng ni biờu mụ vy) TBH T-Z : T bo hc : Transformation zone (Vung chuyờn tiờp) T.V : Trichomonas vaginalis 10 UT UTCTC : Ung th : Ung th c t cung WHO: World Health Organization (T chc y t th gii) 77 sng lc t bo hc, Y hc Vit Nam (tp 173 s 7), Chuyờn bnh 27 ung th, Tng hi y dc hc Vit Nam, tr 110-112 Ha Th Giang (2008),Nghiờn cu phỏt hin nhim virus gõy u nhỳ ngi viờm v tõn sn c t cung qua xột nghiờm t bo hc, mụ bnh hc, PCR, Lun thc s y hc, Trng i hc Y 28 H Ni Ngụ Thu Thoa, Lờ ỡnh Roanh v CS (1993), Khỏm phỏt hin bnh ph khoa v vỳ n cụng nhõn viờn chc mt s xớ nghiờp v hm m, Tp y hc Vit Nam (S 173), tr 110- 29 112 Ch ỡnh Ngha (2001), Phỏt hin cỏc tn thng viờm c t cung õm o qua sng lc t bo hc, Lun tt nghip bỏc s y khoa 30 H Ni Nguyn Thu Hng (2008), Mt s c im t bo hc CTC- viờm, tn thng tin ung th v ung th i chiu vi mụ 31 bnh hc, Chuyờn tin s, Trng i hc Y H Ni Nguyn Vng, Trnh Quang Din, Trn Vn Hp, Lờ ỡnh Hũe, Lờ Trung Th, Nguyn Thỳy Hng, ng Vn Dng, Trn c Hng, Bựi Th M Hnh v CS (2000), Phỏt hin sm ung th c t cung qua sng lc t bo hc, ti cp Nh nc, B KH & CN, 32 Tng hi y dc hc Vit Nam Nguyn Th Thanh H (2000), T bo hc mt s trng hp viờm c t cung-õm o, Lun tt nghip bỏc s y khoa, Trng i hc Y H 33 Ni Ngụ Hong Qu (2008), Nghiờn cu t l viờm nhim õm o-c t cung qua sng lc t bo hc ti mt s cng ng H Ni, Lun 34 thc s y hc, Trng i hc Y H Ni Lờ Th Kim Trõm (2005), Xỏc nh cn nguyờn vi khun v ký sinh trựng gõy viờm nhim ng sinh dc di ph n n khỏm ti 78 bnh vin ph sn Trung ng nm 2005, Luõn thc s y hc, 35 Trng i hc Y H Ni Lander D.V et al (2004), Predictive value of the clinical diagnosis of lower genital tract infection in women, Am J Obstet Gynecol 190 (4), p 36 1004 Bowden F.T (2000), Trichomonas vaginalis epidemiology: Parameterising and analyzing a model of treatment intervention, 37 Sexually transmitted 76, p 248-256 Mary Frances Cotch, Joseph G.P., Robert P.N (1997), Trichomonas vaginalis associated with low birth weight and preterm delivery, STD, 38 July, Vol 24 (No 6), p.353-360 Nguyn Thanh Bỡnh (2015), Xỏc nh giỏ tr v tớnh kh thi ca phng phỏp quan sỏt vi acid acetic (VIA) sng lc ung th c t cung ti Bc Ninh v Cn Th, mt s yu t liờn quan n ung 39 th c t cung, Lun tin s y hc, Trng i hc Y H Ni Nguyn Th Thm (2008), Nghiờn cu t l tn thng ni biu mụ c t cung qua sng lc t bo hc ph khoa ti mt s cng ng, 40 Lun thc s y hc, Trng i hc Y H Ni Dng Th Thu Lan (2012), Nghiờn cu tỡnh hỡnh viờm c t cung v tn thng tin ung th qua sng lc t bo hc mt s a 41 phng, Lun thc s y hc, Trng i hc Y H Ni Dhaubhadel P (2008), "Early Detection of Precursors of Cervical Cancer with Cervical Cytology and Visual Inspection of Cervix 42 with Acetic Acid", J Nepal Med Assoc, 47(170), pp 71-76 Henry MR., Powers CN.,Geisinger KR., at al., (1998), Current Issues in Womens Health and Cytopathology, ASCP Educationnal 43 Course The Omni Rosen Hotel Orlando Florda, P 4-7 Trnh Quang Din (1997), Gúp phn nghiờn cu mt s yu t nguy c gõy tõn sn ni biu mụ c t cung, Y hc Thnh ph H Chớ Minh, Chuyờn Gii phu bnh, tr.84-87 79 44 Nguyn Thỳy Hng (2007), Virus u nhỳ ngi (HPV) v ung th c t cung S c bit chuyờn virus sinh u nhỳ ngi v mi liờn quan c bit vi ung th t cung, Y hc Vit Nam (thỏng 45 1/2007), tr 138-149 Nguyn Vng, Nguyn Vn Phi, Trn Vn Hp v cng s (1995), Chn oỏn t bo hc cỏc tn thng ni biu mụ vy v ung th c t cung, Y hc Vit Nam (s 192), Tng hi y dc hc Vit 46 Nam, tr 34-35 Bennedet J.L., Anderson G.H (1992), A comprehensive program for cervical cancer detection and management, Am J Obstet Gynec; 47 1992, 166, p.1254-1259 Engel S.H.,Nyongo A., Temmernan M., Quint W.G., Van Marck E., Eylenbosch W.J (1992), Cervical cancer screening and detection of genital HPV infection and Chlamydial infection, Clin, Obstet, 48 Gynecol, p.26-188 May (De) R.C (2005), The Pap test, Joshua Weikersheimer 49 Publishers, ASCP Cao Th Kim Chỳc (2009), Tỡnh hỡnh nhim human papilloma virus (HPV) trờn bnh nhõn n khỏm bnh lõy qua ng tỡnh dc ti bnh viờn da liu H Ni (1/2008-10/2008), Lun thc s y hc, 50 Trng i hc Y H Ni Nguyn Trng Hiu, Nguyn Th Thựy (2004), Tn s nhim HPV ph n TP H Chớ Minh, Thi s Y Dc hc (s 9), tr 51 195-198 V Th Nhung v CS (2007), Kho sỏt tỡnh hỡnh nhim cỏc typ HPVowr ph n thnh ph H Chớ Minh bng k thut sinh hc phõn t, Bỏo cỏo ti hi tho ỏnh giỏ nhu cu xõy dng chng trỡnh phũng chng ung th c t cung ti Vit Nam, B Y t, WHO 80 52 Eileen F Dunne; Elizabeth R Unger, Maya Stemberg; et al (2207), Prevalence of HPV Inf ection Among females in the United States, 53 Jama, p 813-819 Trnh Quang Din (1997), Phỏt hin cỏc d sn, lon sn v ung th c t cung bng phng phỏp t bo hc, Lun ỏn Phú tin s Y 54 dc hc, Trng i hc Y H Ni Nguyn Th Chi, o Trung Dng, Nguyn Vng v cỏc tỏc gi (2001), Chn oỏn TBH ASCUS phỏt hin sm UTCTC, 55 Tp Y hc Vit Nam, C GPB-YP 2001 thỏng 10, tr 16-17 Nguyn Vng v CS (2000), Phỏt hin sm UTCTC qua sng lc t bo hc (t 1992-1999), ti cp nh nc Tng hi Y dc 56 hc Vit Nam Lawley T.B v CS (1995), The significance of moderate and severe inflamation on class I Papanicolaou smear, J Obs & Gyne December 1995 No Vol 76 pp.997-1005 81 PH LC HèNH NH CC TN THNG TRấN PHIN -CTC nh 1: Viờm khụng c hiu mc nh (PAP x 40) nh 2: Viờm khụng c hiu mc va (PAP x 40) 82 nh 3: Viờm khụng c hiu mc nng (PAP x 40) nh 4: Viờm G.Vaginalis (PAP x 100) 83 nh 5: Viờm nm Candida (PAP x 40) nh 6: Tn thng ni biu mụ vy thp (LSIL) (PAP x 200) 84 nh 7: T bo vy khụng in hỡnh ý ngha khụng xỏc nh (ASCUS) (PAP x200) 85 nh 8: Tn thng ni biu mụ vy thp (LSIL), t bo nhim HPV (PAP x100) nh 9: Tn thng ni biu mụ vy cao (HSIL) (PAP x400) nh 10: Ung th biu mụ vy (PAPx400) 86 PH LC HèNH NH CC TN THNG TRấN PHIN -CTC nh 1: Viờm khụng c hiu mc nh (PAP x 40) 87 nh 2: Viờm khụng c hiu mc va (PAP x 40) nh 3: Viờm khụng c hiu mc nng (PAP x 40) 88 nh 4: Viờm G.Vaginalis (PAP x 100) 89 nh 5: Viờm nm Candida (PAP x 40) nh 6: Tn thng ni biu mụ vy thp (LSIL) (PAP x 200) nh 7: T bo vy khụng in hỡnh ý ngha khụng xỏc nh (ASCUS) 90 (PAP x200) nh 8: Tn thng ni biu mụ vy thp (LSIL), t bo nhim HPV (PAP x100) 91 nh 9: Tn thng ni biu mụ vy cao (HSIL) (PAP x400) nh 10: Ung th biu mụ vy (PAPx400)