NGHIEN CU'U KHOA HOC I
DANH GIA HIEU QUA LTNG DUNG GHEP CUNG MAC DONG KHO TRONG PHAU THUAT OAT VAN AHMED
Phgm Thi Thiiy Tien*, Trang Thanh Nghiep*, Tran Cong Togi*
TOM TAT
Muc tieu: ddnh gid tinh an todn vd hiiu qud sir dung manh ghep cung mac ddng kho trong phdu thugt ddt van Ahmed.
FhiroTig phap nghien ciru: can thiep Idm sdng tien cuu. Binh nhdn gdm tri em vd ngudi ldn co chi dinh dugc phdu thudt ddt van Ahmed vd ghep cung mac ddng kho tgi Binh viin Mdt TPHCM tir 2009 ••2010 Ghi nhgn thdi gian tieu manh ghep vd edc biin chimg eiia ghep cung mge nhu dellen gidc mac, phdn img logi mdnh ghep, nhiim triing mdnh ghep, dd dng van.
Ket qua: cd 76 mdt (40 mdt ciia ngudi ldn vd 36 cua tre em) dugc ghep ciing mac ddng khd pha ten van Ahmed vdi thdi gian theo doi trung binh 14,84 ±6,21 thdng (6 - 29 thdng). Thdi gian tieu mdnh ghep 7.29
± 1,44 thang (5-14 thdng). Ngoai trir dellen gidc mgc gap trong mdt truang hgp, con cdc bien chung khdc nhu nhiim triing, phdn dng logi mdnh ghep, do ong van khong xdy ra.
Ket luan: cung mgc ddng khd dung ngp lot vd co the sic dung an todn nhu mdnh ghep phu len dng ddn liru trong phdu thudt dgt van ddn luu Ahmed.
Tir khoa: gidcdm, cung mac ddng khd, van ddn luu Ahmed.
I.DATVANDE
Phau thuat dat van Ahmed dugc chi dinh trong cac truang hpp gloeom tai phat kho dieu trj, gloeom tan mach, gloeom tre em,... Van Ahmed gom hai phan: than van va ong van. Sau khi co dinh than van Ahmed vao thanh ciing mac a vi tri ciing do, phau thuat vien se cat ngan dau ong van dua vao tien phong va khau phii mgt lap mang ngoai tim len than ong silicon, khau ket mac. Theo cac bao cao nghien ciiu, phau thuat vien co the tao vat cung mac ty than ho^c diing mang ngoai tim, mang
cung. Cling mac tuai che phii ong van nham bao ve va tranh do ong van [5,7].
Tao vat cung mac tu than co uu diem han che hien tuong phan iing thai loai manh ghep nguoi cho sau phau thuat, trong tham my hon vi benh nhan co ciing mau cung mac ciia minh, ciing nhu tranh nhung benh truyen nhiem khac do manh ghep dong loai gay ra. Tuy nhien, ciing mac benh nhan gloeom thuang mong, nhat la a tre em co viing ria giac ciing mac hi dan hoac nguai bi can thi co ciing mac eye sau mong, thi tao vat ty than co the gay do
* Khoa Gidcdm, Benh viin Mdt TP HCM
I NGHIEN CUtJ KHOA HOC
ciing mac [4]. Do do, viec sir dung mgt manh gh^p khac phu len ong silicon dugc ua chugng hon nham giir nguyen ciing mac cua benh nhan.
Freedman (1987) mo ta dau iicn sir dyng manh ghep ciing mac phii ien ong dan luu Molteno vai ket qua thanh cong tot. Brandt (1993) bao cao sir dung chat lieu manh ghep la mang cirng dong kho [2]. Tir do, hang loat chat li?u khac dupc dua vao sir dung nhu mang ngoai tim, can co, gidc mac [7], mangoi [I].
Tai Viet Nam, gia thanh mgt mieng mang ngoai tim (Tutoplast) rat dat, chi su dung cho mol benh nhan va khong co san, Vai mong muon tiet kiem kmh te cho nhiing benh nhan gloeom, chiing toi lien hanh diing cung mac ciia nguai sau khi cat bo nhan cau (do gloeom, chan thuong) da dupc xir ly va dong kho nhu mpt manh ghep che phu ong silicon trong phau thuat dat van Ahmed,
Mac dau, co nhieu uu diem irng dung ghep
ciing m^c trong b^nh Iy nhan c5u nhung no co the anh huong boi qua trinh phan ung mien dich, viem gay hoai tir, ty tieu do khong co mach mau nuoi. Theo cac tai Ii?u y van ma chiing toi co dugc, ciing mac sir dung nhu manh ghep che phu ong van deu la cung mac tuoi; chua co nghien ciiu nao sii dyng ciing mac dong kho. Do vay, chiing toi lien hanh nghien ciru nay nham danh gia hi?u qua va tinh an loan ciia viec sir dyng ghep cung mac dong kho che phu ong van trong phSu thual d5t van Ahmed.
II. PHUONG PHAPNGHIKN CUU Nghien ciru can thiep lam sang lien ciiu. Benh nhan gom ire em va nguoi Ion co chi djnh dat van Ahmed tai khoa Gloeom va khoa Nhi Benh vi^n Mat TP.HCM trong hai nam tir 2009 - 12/2010.
Quy trinh san xuat cung mac dong kho (so d6 I)
Xet nghiem vi sinh am tinh Cat bo nhan t
Lam sach hac mac, c6 dinh bang dung dich Optisol Cung mac ttrai
X u Iy tai ngan hang Mo Cung mac dong kho
Dong goi, luii triJ Ghep Cling mac
Sa do I Quy trinh Idy cdng mgc vd sdn xudt cung mgc dong kho.
NGHIEN CUtJ KHOA HOC;
Tai benh vien Mat TPHCM, benh nhan dupc c^t bo nhan cau muon hien cung m^c can lam tat ca xet nghiem vi sinh gom viem gan sieu vi B (HBsAg), viem gan sieu vi C (HCV), HIV (test Elisa), giang mai (VDRL) cho ket qua am tinh mai chap nhan lay mo. Tat ca benh nhan dong y hien ciing mac cho nghien ciiu khoa hpc deu dugc giai thich lgi ich ciia viec hien mo va dong ky bien ban dong y hien mo.
Cac ciing mac cho deu dugc danh so, luu ho sa.
NhiJng ciing mac ciia mat bi cat bo dupc xir ly ban dau lam sach hac mac ben trong bang dung dich nuoc muoi sinh Iy. Sau do ciing mac dupc co dinh bang dung dich Optisol dugc san xuat tai Bg mon Mo phoi Truang Dai hpc Pham Ngpc Thach (Ngan hang Mo) trong vong 24 gio sau khi lay mat. Tsii day, ciing mac dugc cat nho vai dien tich lOxIOmm, ggi la don vi ciing mac, xii ly vo triing, dong kho, dong goi theo quy trinh cua Hiep hpi ngan hang mo Hoa Ky AATB, cho ma so cung mac, khu triing bang tia biie xa gamma va co the luu tru a nhiet dp phong trong vong nam nam ke tir ngay san xuat.
Quy trinh ghep ciing mac dong kho Tat ca benh nhan co chi djnh dat van dupc giai thich va ky vao bien ban dong y dat van va ghep mo dong loai. Sau khi ciing mac dugc ghep, tem nhan co ma so ciing mac ghep dugc dan vao ho so benh an. Phau thuat vien ky vao phieu bien ban ghep mo, bien ban nay se giii ve Bp mon Mo phoi truong Dai hpc Pham Ngpc Thach luu ho so,
Tieu chuan chpn benh
Benh nhan gom nguoi Ion va tre em dupc phau thuat dat van Ahmed va ghep ciing mac dong kho tai Benh vien Mat TPHCM trong hai nam tir 2009 - 2010 dugc tai kham va theo doi djnh ky it nhat 6 thang.
Tien hanh phau thuat
Benh nhan dupc dat van dSn luu Ahmed theo
quy trinh dat van thuang quy. Sau do, phau thuat vien tien hanh ghep cung mac phu len ong van.
Ciing m^c dupe ngam trong dung djch nuoc muoi sinh Iy 20 phiit truoc khi su dyng. Sau do, ciing mac dupc cat nho Iai khoang 4x7mm sao cho vira phii len ong silicon ciia van Ahmed. Khau dinh ciing m?c ghep vao ciing mac benh nhan bang 3-4 moi chi rai nylon 9/0 hoac 10/0. Dau moi chi duoi cung mac ghep. Khau phii vat ket mac len. Neu ma ket mac ciing do, khau tenon - ket mac hai lap bang vicryl 8/0; neu ma ket mac ria Ihi khau dinh hai goc tenon va ket mac vao ria giac ciing mac bang nylon 10/0 va phan ket mac xung quanh khau kin bang chi vicryl 8/0, Thuoc sau phau thuat gom khang sinh va khang viem steroid nho tai cho.
Tieu chuan danh gia
Benh nhan da dupc phau thuat dat van Ahmed CO ghep ciing mac dong kho, dugc tai kham va theo doi dinh ky moi thang trong 6 thang dau, moi 2 thang va moi 3 thang sau do. Cac thong so ve nhan chiing hpc, cac bien chiing nhu dellen giac mac, phan ling loai manh ghep, nhiem triing manh ghep, manh ghep mong, tieu manh ghep gay nho ong van nam ben duai va tieu manh ghep gay do ong van deu dugc ghi nhan.
Thong ke, xu* ly so lieu
Nhap, -K^ii Iy va phan tich so lieu bang phan mem SPSS for Window 16.0. Bien so dinh Iuong dupc trinh bay bang so trung binh ± do lech chuan. Moi lien quan giiia hai bien dinh lupng dupc kiem dinh bang Student test. Cac test co y nghTa thong ke khi p < 0,05.
III. KET QUA
Chiing toi tien hanh ghep ciing mac cho 76 mat ciia 71 benh nhan dii tieu chuan theo doi it nhat sau thang sau phau thuat, Co 66 benh nhan ghep cung mac mgt mat va 5 benh nhan (mpt ngucri Ion va bon tre eAi) ghep ciing mac hai mat (bang 1). Duong
MGHIEN c u l i KHOA HOC
nhir giai ntt 42/71 (59,2%) chijm uu thS h m trong ke (p= 0,10). Ngoai ra, sir khac biet giai tinh giiia benh gloeom duoe dat van va ghep cijng mae dong hai nhorn tre em va nguai lom eung khong eo y kho nhung su khac biet nay khong co y nghta thong nghTa thong ke (p=0,75).
Bang 1. Bac mSm benh nhan ghep cung m(ic Mng kho phu lin mg van Ahmed
Sac dilm Su benh nhSn
- Tre em - Ngiroi ion So mat
- Tre em - Nguai ion Gioi
- Tre em nam - Tre em nO - Ngiroi Ion nam - Nguai Ion nu
Tu5i trung binh (nam) - Tre em
(day) - NgucTi Icni
So luvng (%) 71 32(45,1) 39 (54,9) 76 36 (47,4) 40 (52,6)
13 19 16 23
28,60 ± 24,44 7,60 ± 4 , 9 5
(1-16) 47,00 ±19,16
(16-80)
DSc diem TliM gian theo d6i (thing)
- Tr6 em (day) - Nguoi ldn
Chdn doan
- Gloeom tai phat/ POAG, PACG - Giocom sau \ky the thuy tinh - Giocom thli phat/ ICE - Giocom tan mach - Giocom do VMBD - Giocom tai phat/glocom bam sinh - Giocom tre em thu phat do cac hoi
chung tai mat
So lifffng (%) 14,84 ±6,21 16,19 ±7,34 (6-29) 13,62 ±4,74
(6-21)
14(18,4) 12(15,8) 5 (6,6) 14(18,4) 2(2,6) 22 (28,9)
7(9,2)
Tuoi trung binh ciia tre em liic phau thuat 7,60
± 4,95 nam (1-16 tuoi) va ciia nguai Ion la 47,00 ± 19,16 nam (16-80 tuoi).
Thai gian theo doi trung binh 14,84 ± 6,21 thang (6-29 thang). Khong co khac biet c6 y nghTa thong ke ve thai gian theo doi giira hai nhom tre em va ngucri Ion,
Bdng 2. Bac diem mdnh ghep cdng mgc dong kho tgi lan khdm cuoi ciing Thai gian trung binh lieu cung mac dong kho la 7,29 ± 1,44 thang (5-14 thang), trong do nhom tre em vai thai gian 6,92 ±1,61 thang va nhom nguoi Ion la 7,68 ± 1,12 thing {bang 2). Su khac bietv^
thgi gian tieu ciing mac giUa hai nhom co y nghia thdng ke vai p - 0,02 (S05).
Dac diem
Thai gian tieu ciing mac (thang) (day)
Tinh chat manh ghep ciing mac (so mat, %) Mong
Tieu nhung khong gay nho 6ng van Tieu gay nho ong van - Con nguyen
Ca hai nhom n-76 7,29 ± 1,44
(5-14)
8 (10,5) 50 (65,8) 17(22,4) 01(1,3)
Nh6m tre em n=36 6,92 ± 1 , 6 1
(5-14)
7(19,4) 23 (63,9)
6 (16,7) 0
Nhom ngircri Ifrn 11=40 7,68 ±1,12
(6-12)
1 (2,5) 27 (67,5) 11(27,5) 01 (2,5)
28 Nhan khoa Viet Nam (So 31 - 2013)
NGHIEN C I A J KHOA HC
Phan tich Kapplan-Maiyer kha nSng s6ng tich luy ciia manh ghep chi con 39,9% sau 8 thang va 6,1%
sau 10 thang (bieu do 1),
Thvi gian theo doi sau ghep cung mac dong kho (thang)
Bieu do 1. Phdn tich Kaplan-Melyer khd ndng song tich luy cua mdnh ghep cung mgc ddng kho trong phdu thugt dgt van Ahmed.
Hien tuang tieu cung mac gay nho ong van xay ra a nguai lan 11/40 (27,5%) nhieu han so vai tre em chi gap 6/36 (16,7%) tuy nhien chua dii y nghia thong ke (p=0,25). Mot trucmg hgp benh nhan dugc dat van va ghep ciing mac ca hai mat voi thai gian theo doi mat phai la 9 thang va trai la 12 thang thi ghi nhan rang ciing mac ghep tieu hoan toan gay nho ong van a mat phai va ciing mac con nguyen a mat trai,
Ngoai dac diem manh ghep ciing mac dong kho con nguyen (hinh 1,2), mong di (hinh 3), tieu
nhung khong gay nho ong van (hinh 4), manh ghep ciing mac co riit (hinh 5), ciing mac tieu gay nho ong van ben duai (hinh 6), chiing toi chua ghi nhan truong hgp nao do ong van do tan manh ghep. Bien chung tren giac mac la dellen giac mac gap mgt truang hgp.
Hinh anh chup cat ngang ong van bang may chup cat lap ban phan truac (AS-OCT) de khao sat Cling mac dong kho sau ghep 3 ihang va 12 thang (hinh 7,8).
Hinh 1. Hdu phdu ngdy thu nhdt cua binh nhdn nam bi gidcdm gid trdc bao ddphdu thudt cdt be cung mgc vd Idy the thuy tinh. Ciing mgc ddng khd cd dinh lin dng van. ben tren phu kit mge.
Hinh 1. Hai thdng sau phdu thiiu! cua cung benh nhdn, kit mgc bdt sung huyet, mdnh ghep cung
mgc eon nguyen che phu dng van ben dudi
INGHIEN CUU KHOA HOC
Efli-g-ns-a.
Hinh 3. Sdii llidii^ sau phdu ihudi, ciing mgc ddng khd mong ddn nhung vdn khdng Id dnii van.
Khdng cd hien tmrng phan irng kel mgc.
Hinh 5. ilicn tugng ciing mgc ddng khd co nil lgi sau khi ghep sdu thdng a binh nhdn nir hi
gidcdm fan mach.
r
Hinh 4. Mdt ndm sau phdu thudt, bong van hogt dgng tdl. Ciing mgc ddng khd tieu hit, md xa
lhay thi ddn mdnh ghep ciing mgc che phu hodn todn dng van hen dual.
Hinh 6. Hdu phdu bd}- thdng cua benh nhdn nir bl gidcdm thir phdt do hdi chimg Cogan Reese. COng Ciing mac ghep tan hodn todn cho thdy mdt phdn ong
van ndm ben dirdi kit mgc nhimg khdng gdy do.
Hinh 7. Hinh anh chup cdt ngang bdng AS-OCT ctia ong van sau khi ^liep cirng mac ddng khd ba thdng. Ldp kcl mgc (2) ngoai cirng vd mdnh ghep
ciing mac (i) phii len tren dng van (I).
Hinh 8. Hinh dnh cirng mgc ddng khd mong di sou hdu phdu 12 thdng. Kit mgc (2) cdn nguyen ven, ldp cung mgc ddng khd (3) tieu di di lgi mdt mang
mdng phli len tren dng van (1). Ciing mgc ghep hod nhap vdi md quanh dng khdng de lgi khoang
trdng ndo vd giup cd dinh dng van
NGHIEN C(tU KHOA HOC I
Mac dil tren lam sang quan sat thay manh ghep cung mac dong kho tieu hoan toan lam 6ng van co the nhin thay ben duai ket mac nhimg tren hinh anh AS-OCT van con mot lap ciing mac mong phu Ien ong van (hinh 8).
rV. BAN LUAN
Trong nhiing tb^p nien vira qua, nhieu loai mo va nhu'ng chat tong hgp dugc su dung nh^n tai tao cau true thanh nhan cau ciing nhu on djnh truang luc thanh nhan cau. Cac loai mo sinh hgc bao g6m mo tu than, mo dong lo^i (ciing mac, can ca diii, mang xuang, mang niem mac mieng, mang cirng, mang ngoai tim nguai) va mo di lo?i nhu mang ngoai tim ciia heo [5], bo [7].
Ghep cung mac dugc sii dung rgng rai trong phau thuat nhan khoa. Manh ghep cung mac chii yeu diing de phii cac bi san ho hoc mat sau cat bo nhan cau hoac phu ciing mac bi ton thuang nhu chan thucmg thiing ciing mac, nhuyen ciing mac sau mo mgng, viem khop dang thap. Nhirng irng dung khac cua manh ghep ciing mac la tai tao cau tnic vat cung mac trong cat be ciing mac co bien chiing, phoi hgp trong phau thuat that dai mo bong vong mac, t?io hinh mi mat trong phau thuat quam phiic tap hoac dung de phii Ien van dan luu trong phau thuat giocom.
Cling m^c dong lo^i dugc xii ly va luu giii theo ba dang: dong lanh, c6 dinh bang ethanol (con) va dong kho. Cung mac dong lanh dugc ngam trong dung dich khang sinh (gentamycin), luu trG a -20''C va co the sir dung trong vong ba thang. Cung mac co dinh trong dung dich con ethanol va dugc de o nhiet do phong trong vong mot nam. Tuy nhien, mo ciing mac sau khi ngam dung dich con bi co cung lai rat kho thao tac trong liic phSu thuat.
D^ng thu ba la cung mac dii tieu chuan chgn mau dugc tien hanh dong kho vai cac buoc de
loai bo viriit gay b?nh truyen nhiem nhu HIV, cac tac nhan virul khac. Ciing mac dugc xu Iy vo triing bang tia gamma 0,015 xlO* Gy nhSm loai bo cac yeu to vi khuan va nam [2]. Sau khi xii Iy vi sinh, ciing mge se dugc lam mat nuac, dong kho va luu trii- vo trimg a nhiet do phong trong vong nam nam [4].
Ghep ciing mac co nhieu uu diem noi bat han cac loai mo khac vi dac tinh chac, dai, mem, de thao tac. Ciing mac co dg cong tu nhien cho phep phau thuat vien co the be cong theo mat nguai nhan. Khi sir dung, ngam ciing mac dong kho trong dung dich nuac muoi sinh ly trong 15-30 phiit de Cling mac trcf ve hinh dang liic ban dau.
Theo ly thuyet, ciing mac dong kho sau khi xir ly lay di cac kich thich cua khang nguyen gay phan ling trung gian te bao nen giiip manh ghep giam phan ung mien djch loai ghep ciia nguai nhan [4], Dieu thuan lgi va quan trgng khac la ciing mac dong kho co the tu san xuat va co san trong ngan hang Mo tai TP.HCM. Vcri cac dae tinh iru viet tren, chiing toi quyet djnh sir dung ciing mac dong kho de phii len ong silicon cho benh nhan dat van dan luu Ahmed.
Smith va cong su [7] so sanh sir dung cac chat lieu manh ghep khac nhau bao gom ciing mac tuoi (23 mat), mang cung (18 mat) va mang ngoai tim (23 mat) diing de phii Ien ong van dan Iiru trong giocom ket luan rang khong chat lieu nao co uu the tieu manh ghep nhanh hem vcri thcrl gian theo doi toi thieu la 24 thang. Nghien ciiu ghi nhan co ba trucmg hgp bi do ong van xay ra cho ca ba loai chat lieu can phai dugc phau thuat lai, Hien tugng mong dan manh ghep lam ong van nho len duai ket mac con nguyen chiem 22-26% cho ca ba chat lieu.
Ket qua cua chiing toi ghi nhan tren lam sang co 17/76 (22,4%i) cung mac tieu lam nho ong van nam ben duai ket mac con nguyen. Bang phuang phap chup c4t lap phan truoc nhan cau (AS-OCT) cat
I NGHIEN c u l l KHOA HOC
ngang ong van tai vj tri ghep ciing mac, chung toi nhan thay rang ciing mac van ton tai mgt lap mong phli ben tren ong silicon. Ngoai ra, chiing toi khong ghi nhan truang hgp nao do ong van. Can thdi gian theo doi lau dai hon de danh gia day dii bien chirng do ong van.
Lama va cgng sir [3] bao cao hai ca do ong van sau bon va nam thang dugc ghep phii mang ngoai tim, ma hai benh nhan nay khong co yeu to benh ly tai nhan cau hay toan than kem theo. Dua tren cac tong quan ghi nhan, gia thuyet dugc dua ra nham giai thich viec tan manh ghep la do qua Irinh phan irng mien dich. Phan iing mien dich qua trung gian te bao, mac dau it gap, thai gian xay ra lau han va lam mong dan manh ghep (hinh 5). Phan irng mien dich khong qua trung gian te bao neu xay ra vai toe do cao lam ciing mac se hi tan rat nhanh trudc sau thang [7]. Neu qua trinh tao xa cua cac te bao sgi chua hoan thanh bao bgc quanh ong van (thudng sau sau thang) se de lai ong van nam tro ngay ben dudi ket mac gay Ig ong van lau dan cd the gay do ong van.
Trong mot nghien cuu khac cua Raviv [6], khoang 11% manh ghep mang ngoai tim mdng dan trong vdng muoi thang theo doi. Theo nghien ciru ciia chiing toi thi thdi gian tieu ciing mac xay ra vao
giiia thang thii bay. Thdi gian tieu ciing m?c a tre em xay ra sdm, theo chiing toi gia thuyet, co the do qua trinh phan ung mien dich xay ra mgnh mg d tre em han ngudi Idn. Tuy nhien, qua trinh tgo mo sgi d nhdm tuoi tre em nay ciing nhieu va nhanh hem nen hien tugng tieu ciing mac gay nho ong van it gap han ngudi ldn.
Chiing toi van chua giai thich dugc mgt trudng hgp ghep ciing mac tren hai mat ciing mgt benh nhan (ngudi Idn) ma mgt ben mat ciing mac tan hoan toan va mgt ben ciing mac cdn nguyen v?n, mac dau benh nhan nay khong bi benh Iy nhan cau d ca hai mat ciing nhu benh loan than.
Mgt trudng hgp hi dellen giac mac do ciing mac ghep qua day va dugc khau gan ket mac ria. Benh nhan nay cd kem theo benh ly kho giac mac nen dua den tinh trang viem giac mac sgi. Chiing toi phai su dung nudc mat nhan tao nhd, thuoc ma lien tuc ciing vdi giam lieu khang viem corticoid thi tinh trang sgi giac mac giam dan. Dong thdi, ciing mac ghep mdng dan theo thdi gian lam dellen giac mac bien mat va benh nhan khong cdn cam giac com xdn nua. Riit kinh nghiem chiing toi thudng lang mdng bdt chieu day ciing mac dong kho neu manh ghep qua day va dinh manh ghep each ria khoang I-2mm tranh bien chirng dellen giac mac.
Bdng 3. So siinh uu diem vd nhuffc diem cda cung mgc dong kho vdi mdng ngoai tim
\fu diem
Nhuffc diem
Ciing mac dong khu - An toan ve mien dich, vi smh.
- Co sSn, tien dung
- Thdi han sir dung 5 nam, bao quan nhiet do phong.
- Re, kinh te.
- De tliao tac
- Dp day khac nhau, kho xuyen kim.
- Khong tham my.
Mang ngoai tim (liitoplast) - An toan ve mien dich, vi sinh.
- Dong nhSt va on dinh chat lugng mo - Thdi h^n sir dung 5 nSm, bao quan nhifit d6
phong.
- De khau.
- Tham my.
- Bk i\hn.
- Khong CO san.
NGHIEN ClAJ KHOA HOC
Cac bien chiing khac nhu phan ung viem loai ghep hay nhiem triing manh ghep chua ghi nhgn trong nghien cuu nay.
Vi day la mo ghep ddng loai (tir ngudi sang ngudi) do dd phu thugc vao ngudi hien tang. Gia d d day dugc ti'nh la chi phi van hanh nhu bao quan, xii ly,...khoang chiing hai tram ngan dong (tuong duang 10 dd la My) cho mgt don vj ciing mac sir dung cho mgt hogc hai b?nh nhan ciing liic. Neu so vdi mang ngoai tim (Tutoplast) cd gia khoang nam trieu dong (hai tram nam muoi do la) cho mgt mieng cd the sii dung cho khoang bdn b?nh nhan ciing mpt luc (bang 3). Tren thuc te khdng cd d^n bon benh nhan dat van trong ciing mdt thdi diem nen van de bao quan vd triing de tai sir dung cho nhirng benh nhan tiep theo khdng the thuc hien dugc.
Manh ghep ciing mgc ddng khd thudng nam d vi tri ciing do thai duang tren hay mui tren nen hi che khuat hdi mi tren va chi 16 ra khi nhin xudng ma thoi do dd khdng gay mat tham my nhieu cho benh nhan d thdi gian dau, sau nay khi ciing mac ghep tieu dan de Iai ket mac trong suot va mau trang ciia ciing mac benh nhan.
V. KET LUAN
Sii dyng ciing mac ddng kho nhu la manh ghep diing de phii len ong van trong phau thugt dat van dan luu Ahmed cho benh nhan gidcdm an toan va hieu qua, Cung mac dong khd cd nhieu uu diem nhu dung ngp tdt, khdng ed phan ung thai loai, khdng bi nhiem triing manh ghep, khong gay do va hieu qua kinh te cao.
TAI LIEU THAM KHAO
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3. LAMA PJ., FECHTNER RD. (1999), "Tube erosion following insertion of glaucoma drainage device with a pericardial patch graft". Arch Ophthalmol. 117, pp.1243-1244.
4. MEHTA JS, FRANKS WA. (2002). 'The
sclera, the prion, and the ophthalmologist". Br J Ophthalmol 86, pp.587-592
5. PINTO LM, REGATIERl CVS, TAVARES IM, RIGUEIRO MP(2004). "Porcine pericardium as glaucoma implant tube coverage - an experimental study", Arq Bras Oftalmol. 71(5), pp.623-628.
6. RAVIV T., GREENFIELD DS., LIEBMANN JM , et al, (1998). "Pericardial patch grafts in glaucoma implant surgery''\ J Glaucoma.
7, pp.27-32.
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I NGHIEN CUtJ KHOA HOC
SUMMARY
DEHYRATED SCLERAL PATCH GRAFT IN AHMED GLAUCOMA VAVLE IMPLANT SURGERY
Objectives: To determine the safety and effectiveness of dehydrated scleral patch grafts in Ahmed valve implantation
Patients and methods: A prospective, clonical trial study was conducted on patients including adults and children who were implanted Ahmed glaucoma valves with ihe use of the dehydrated scleral patch grafts to cover the tubes in HCMC Eye Hospital in 2009-2010. Time for absorption and complications of scleral graft such as dellen formation, graft rejection, graft-related infection, and graft thinning or tube erosion were recorded.
Results: Seventy- six eyes of children and adults were received AVG and covered sdicon tube by dehydrated scleral patch grafts. The mean follow-up time was 14.84 ±6 21 months (6-29 months). It took 7.29 ± 1 44 months for the grafts to be absorbed completely. Besides one case of corneal dellen. no other complications such as graft rejection, graft infection, or tube erosion was observed.
Conclusions; Dehydrated scleral patch grafts appear to be well tolerated and can be used as tube coverage in the implanted glaucoma drainage devices.
Key words: glaucoma, dehydrated sclera, Ahmed drainage implant
