K^T LUAN
Qua nghien cflu 112 benh nhdn vidm gan sieu vi B man ngoai trti tai benh vien Qudn Thfl Dflc chflng tfli nhdn thay nhu sau:
TJ le viem gan sieu vi HBeAg (+) (51%), tUOng duong HBeAg (-) (49%) (p > 0,05), tudi bat dau dieu tri tmng binh 38, nam uu the hon nfl", xd gan ehiem 28%,
Tai thdi didm 24 t u i n vd 48 tuan, tp Id HBVDNA dudi ngUPng phdt hien d trdn d^i tupng HBeAg (+) d nhdm Lamivudine (70% vd 75%), adefovir (71% vd 71%), tenofovir (83% vd 93%). p>0,05. TJ Id mat HBeAg va/hoac dao huydt thanh HBeAg ehiem 20% 5 nhdm lamivudine, 29% d nhdm adefovir vd 24% d nhdm tenofovir, p>0,05.
Tai thdi d i l m 24 va 48 tuan, tJ Id HBVDNA dUdi ngudng phat hidn d tren ddi tUOng HBeAg (-) d nhdm Lamivudine (67% vd 78%), adefovir (50% vd 50%), tenofovir (88% vd 94%), p<0,05.
TAI LI^U THAM K H A O
1. Pham Thj Le Hoa, Phan Vinh Thp (2008), Ddc diem vidm gan sidu vi B man tinh HBeAg (-) trdn benh nhdn n6i tni tai benh vien benh Nhiet Ddi. Tap chi Y Hoc TP. H 6 Chi Minh* Tap 12' Phu ban sd 1" 2008.
2. Dienstag JL et al - Histological outcome during long-term lamivudine therapy - Gastroenterology 2003:124: 105-117
3. Hadziyannis, S. and D. Vassilopoulos, Hepatitis B e antigen-negative chronic hepatitis B. Hepatology, 2001, 34: p. 617-624.
4. Goldstein ST Zhou F, HadterSC, Bell BP, Mast EE, Margolis HS. A mathematical model to
estimate global hepatiiis B disease burden and vaccination impact. Int J Epidemiol 2005;34:1329-39.
5. Llaw YF, Leung N, Guam R, et al - Asian - Pacific Consensus Statement on the IVlanagement of Chronic hepatitis B: 2005 Update - Liver Intemational 2005;25:472-489. 3
6. LIndh M et al - Hepatitis B virus DNA levels, precore mutations, genotypes and histological activity in chronic hepatitis B - J Viral Hepat 2000;7:258-267.
7. Snow - Lampart A et al - Lack of tenofovir DF (TDF) resistance mutations in treatment-na#ve and treatment-experienced subjects with chronic HBV infection following 48 weeks of TDF monotherapy - Program and abstracts of the Conference Hepatitis B and C vims Resistance lo Antivims Therapies;Feb 14 - 16, 2008;Paris,France. Poster 4.
8. Summers J, smolec JM, Snyder R (1978). Avims similar to human hepatitis and hepatoma in woodchucks.
Proc nati Acer sd USA. 75:4533-7.
9. Yim HJ, Lof AS - Natural history of chronic hepatitis B vims infection: what we knew in 1981 and what we know in 2005 - Hepatology 2006;43:S173-S181.
KET QUA DIEU TRI THOAT Vj BEN BANG KY THUAT LICHTENSTEIN VA NOI SOI NGOAI PHUC MAC
LE QUOC PHONG, LE MANH HA Benh viin Trung UOng Hue
TRAN V l f r HUNG - Benh viin Huu nghj Viet Nam Cu Ba - Ding Hdi NGUYEN QUANG BO - Trudng Dai hgc Y DUpt Hud
T 6 M TAT
Dit vin di: Thoat vi ben li binh lp thudng gip^
trong khoa ngoai tieu hda, diiu tri thoat vf ben bing kp thuat Uchtenstein vi ndi soi ngoii phOc mac (TEP) dugc Ong dung khip nai trin thi gidi.
Bii tugng vi phuang phap nghiin cOu: Nghiin cOu tiin cOu, gdm 198 benh nhan 219 thoit vi ben mi bing ky thuat Lichtenstein vi TEP.
Kit qua: Uchtenstein: tuSi tmng binh: 69±11, thoit vi nguyin phat 87,9%, thoit vj tii phit 12,1%, tu mau vit md 2,1 %. tu dich vit mi 0.7%>, nhiim tmng vet m6 0.7%. tile tii phit 1.8%,. TEP: tuii trung binh 59±19.
thoit vj nguyen phit 92.3%. thoat vj tii phit 7,7%,, tu mau vit mo 3%, tu dich vit mo 11 %, nhiim trung vet m60%, chuyin mihh 7,7%,. tlii tii phit 1,4%o.
Kit luin: Diiu tri thoat vi ben bang tam ludi nhin tao polypropylene bang ky ttiuit Lichtenstein vi ndi soi hoin toin ngoii phuc mac li phiu thuit^ cd gii tri va hiiu qui. thdi gian phiu thuit ngin. tl le cac bien chiing vi tii phit thip.
Tit khda: Thoit vj ben; Lichtenstein, ndi soi ngoii phOc mac
SUMMARY
Background: Inguinal hernia is a common disease in genemi surgery, it was tmated by Uchtenstein tension-free hemioplasty and total extmperitoneal (TEP) procedum. It is also application in the woridwide.
Study objectives: The msults of use polypmpylene mesh by Lichtenstein and TEP for inguinal hemia.
Materials and method: Prospective study of 198 patients with 219 inguinal hernias hemioplasty by Lichtenstein and TEP ftom June 2009 to November 2012 in Hue Central Hospital.
Results: Lichtenstein: the mean age 69 ± 11, primary hemia 87.9%, mcurrence hemia 12.1%,, hematoma 2.1 %, semma 0.7%, wound Infection 0.7%, mcurrence mte 1.8%o. TEP: the mean age 59 ± 19.
primary hemia 92,3%,, recurrent hemia 7.7%o.
hematoma 3%>. seroma 11%,, wound infection 0%>, conversion 7.7%, mcurmncemte 14%.
Conclusions: Uchtenstein tension-fme hemioplasty and TEP for inguinal hemia am valuable and effective, shorter surgical time, low complications post-operation and low recurrence rate.
Keywords: inguinal hernia; Lichtenstein, TEP
Y HOC THUC H A N H (878) - SO 8/2013
DAT VA'N
Dg
Thoat vj ben la benh IJ thudng gdp, dupe thUC hidn trong phlu thudt tieu hda, nhit la d ngUdi gia. Thoat vj ben xay ra 11 trudng hpp tren 10.000 ddn tudi tfl 16-24 vd 200 trudng hpp tren 75 tudi. Thoat vj ben chilm 15% d nam. Mdi ndm. phdu thuat thodt vi ben d P h i n Lan 11.000. Hd Lan 33.000. Anh hOn 80,000, My hOn 800.000. Tai Phap, phSu thudt thoat vj ben m6i ndm Id 100.000 tnidng hpp. Bdt ky nd luc ndo Idm giam duoc 1% tl Id tdl thi giam dupc 1000 tnJdng hpp phliu thudt thoat vj ben tai phat moi ndm [4].
Thodt vj ben duoe i^lu tri bang edc kp thudt cd d i l n sfl dung md tU thdn de khdu che lai d i l m y l u cfla thanh bung nhu: Bassini. Shouldiee. Mc Vay. Nyhus, Beriiner... Ti Id tdi phat v i n cdn kha cao, d MJ ti Id tai phdt Id 10-20%, d chdu Au Id 10-30%, d Dflc Id 14,7%, tai Thuy Dien va Dan mach la 16%. Nghidn cflu nhilu tmng tdm cho thd'y ti le tai phat cfla phuong phdp.
Shouldiee 6,1%, Bassini 8,6%, Mc Vay 11,2. Welsh vd Alexander da phdu thudt 207.635 tmdng hpp thoat vj ben bang ky thudt Shouldiee vdi ti id tdi phat 1 % . d viet Nam phlu thudt thoat vj ben, Bfli Dflc Phfl nhilu ky thuat ti le tai phat 19% [4], Nguyin Vdn Lieu ky thuat Shouldiee ti le tai phat 1.3% [2]. Ngd Viet Tuan ky thuat Berliner, ti Id tai phat la 3.8% [3].
Viec flng dung tdm ludi nhan tao de tdng cudng thanh sau dng ben, da dupc sfl dung rpng rai bang ky thuat hd va noi soi la "tieu chuan vang" dieu tri thoat vi ben. Nam 1989, Lichtenstein va cong sUda bao cao ky thuat tao hinh khong pay eang tren 1.000 trudng hpp vdl bien chflng tdi thieu va khong cd tai phat sau 1-5 nam theo doi. Nam 1992, nhdm cfla Lichtenstein da tdng ket 3.019 tm'cJng hop cua nam trung tam vdi ti Id tai phat la 0,2%. Nam 1995, nhdm 72 phlu thuat vien thUc hien theo ky thuat Lichtenstein v6i 16.000 trUdng hdp cho thd'y ti le tai phat <0,5% vd nhiim tmng 0,6%.
Nghien cflU cfla Ramshaw va cong su 300 (TAPP) va 300 (TEP), tl le tdl phat 2% (TAPP) va 0,3% (TEP). Ky thuat Lichtenstein dupc dp dung phd bien nhd tinh ddn gian, kmh te va hieu qua. Ky thudt noi soi hoan toan ngoai phflc mac, xam nhap tdi thieu. tham my, hdi phuc nhanh, thdi gian trd lai lao dong sdm.
Viec sfl dung tam ludi nhan tao dieu tn thoat vi ben bdng ky thuat Lichtenstein va noi soi ngoai phflc mac, nhiJng nam gan day eho ke't qua kha quan, phuc hdi sinh hoat ca nhan sdm Nhung, van con mdi me d Viet Nam va chua ed nhieu cong trinh nghien cflu. Do dd chflng tdl thuc hien de tai "Ket qua diiu tri thoat vi ben bing kp thuat Uchtenstein vi ndi soi ngoii plioc mac"
vdi muc dich:
- Nghien cflu ve dac diem benh nhan thoat vi ben, ludl, gidl. VI Iri, phan loai Ihoat vi.
- Ket qua flng dung tarn ludi nhdn tao dieu tn thoat VI ben bang ky Ihuat Lichtenstein va npi soi ngoai phuc mac.
DOI TUONG VA PHUONG PHAP NGHIEN CLftJ 1. Doi tupng nghien cflu.
Gom 198 benh nhan thoat vi ben vdi 219 lan p h l u thuat tai khoa ngoai lieu hoa va ngoai nhi ca'p cflu bung benh vien trung uong Hue tfl 6,2009 den 11.2012.
Nhdm Lichtenstein 125 bdnh nhan vdi 141 thodt vj ban, nhdm TEP 73 bdnh nhdn vdi 78 thoat vj ben vd 6 ph3i chuyin md hd.
2. Phuong phdp nghien ciiiu.
- Nghidn cflu Idm sang, tien cCfu md tli cd can thidp, khdng so sanh vd theo doi dpc.
- Nghidn cflu ddc diem bdnh nhdn thodt vl ben: tudi, gidi, vj trf, phdn loai thodt vj ben.
- t i d u chuin c h i n doan thodt vj ben^ kham lam sdng trudc md vd k i t hpp t i n thuong dai the Iflc md, d l xdc djnh loai thodt vj ben gdm: trut tilp. gian tilp va phdi hipp.
3. t i e u chu^n chpn b^nh nhan.
- Tudi >20 nhdm TEP va tudi >40 nhom Lichtenstein, thodt vj ben thudng bao g6m: thoat vj ben phSi, thodt vi ben trdi, thodt vj ben hai ben, thoat vj ben tdi phdt.
4. Chl djnh.
- Thoat vj ben mdt ben hodc hai ben khong c6 biln chflng, thodt vj ben tdl phat.
- Chi dinh ddt t i m ludl nhdn tao cho benh nhdn thoat vj ben dd HIA, IIIB vd IV theo phan loai ci^a Nyhus.
5. Phuong phdp vo cam.
- Nhdm Lichtenstein: gdy td tuy sdng, gdy me ndi khf quan.
- Nhdm TEP: gdy md ndi khi quan.
6. Ky thuat d|it tam ludi nhan tao hd va noi soi.
- Ky thudt Lichtenstein: DUdng rach da song song vdi day chang ben, boc lp vd xCf IJ Ifli thoat vj, phuc hdi thdnh sau ong ben bang ddt tam ludi nhan tao Mesh polypropylene 5x10 cm khdu cdn, eddjnh tam ludi chl prolene 2.0. ehi vicryl 2.0, khau da chi Nylon 3.0 [5], [10],
- Ky thudt TEP: Ddt 3 troearts doc dudng gifla dudi rdn: trocart 10mm ngay dUdi rdn, bdm co^ dp luc 10- 12mmHg va tao khoang ngodi phflc mac bang dau Optic. Sau dd Sit troacart 5mm thfl nhat d vj tri tmng diem cua rdn vd xuong mu. trocart 5mm thfl 2 ngay tren xuong mu. P h l u tieh bdc Id khoang Retzius.
khoang Bognss, ddy chang Cooper, ddng mach thupng vj dudi. thflng tmh va tfli thodt vj. Ddi vdi tui thoat vj tnJC liep phdu tich day vao khoang phflc mac, tfli thoat vj gian tie'p phdu tich ra khdi thCmg tinh vd cd djnh lai. Oat tam ludi nhan tao Mesh polypropylene 7,5x15 cm che phfl toan bd Id ed lupe. cd djnh tam ludi vao day chang Cooper va thanh bung, xa khi cOj vd khdu edn cd chi vicryl 2.0 va may da chi Nylon 3.0 [6], [7]. [8].
7. Ket qua sau phdu t h u a t 7.1. Kit qua st^ sau phiu thu0t:
Ghi nhdn nhflng tai bien va bien chflng do gay me vd do phdu thudt:
- Thuong tdn mach mau. thUdng ton than kinh.
thuong tdn ong d i n tmh.
- Tu dich vet md, tu mau vflng md, tu mau viing ben-biu, nhilm triJng vet md, sUng vung biu. viem tinh hoan. teo tmh hodn, tran djch mang tinh hoan.
7.2. Kei qua theo ddi liu dii:
Phuong phap theo ddi:
Y HOC THirc HANH (878) - S6 8/2013
- Benh nhan den kham djnh kJ theo hen va dien thoai mdi bdnh nhan den kham true tilp tai khoa phdng,
- Gien thoai true tiep lien lac vdi benh nhdn d l thu Ihap thdng tin,
8. XuT ly so' lieu.
Theo phuong phdp thdng ke y hoc. Excel 2007 vd SPSS 15.0 for Window.
K i T QUA t^GHlgN COU
Bang 1: Tuoi, gidi vd phdn toai tfiodt vj ben
TuS Nam/NO TlioStvimOtben Thodt vi hai bdn Thodtvinguy6nphSt
TlioatviUipliit T i i o d t v i g i d n t i ^ ThoStvitrucMp Tliodtviphtiihop
Uchtenstein (N=125, n=141) 69.4±11.5 (40-92)
123/2 109(872%) 16 (12,8%) 124 (87,9%) 17 (12,1%) 74(52,5%) 40 (28,4%) 27 (19,1%)
TEP(N=73, n=78) 59±19 (20-78)
72/1 68 (93,2%)
5 (6,8%) 72 (92,3%) 6(7,7%) 37 (47,4%) 27 (34,6%) 14 (18,0%) B a n g 2: P a c d i e m g a y m e
Dac dilm g3y[h6 ASA
I
Piiumg phSp vfi cam NCi khi quan TetOysgng
Lichtenstein (N=125,n=141)
91 (72,8%) 32(25,6%) 2(1,a%) 13 ((10,4%) 112(89,6%)
TEP(N=73, n=78) 61 (83,6%) 12(16,4%) 0(0%) 73 (100%)
0(0%) B a n g 3; B i e n chilTig t r a n g m d
Bi^n c h ^ tmng md ChSy mdu dCng mach thirong V! dutf Thung phuc mac Chuyin phuong phap Tdn thucnq dnq dan bnh
Lichtenstein (N=125, n=141)
1 (0,7%) 0 0 0
TEP(N=73, n=78) 1 (1,3%) 12 (15,4%) 6(7,7%)
0(0%) B a n g 4 : B i e n c l i l ^ g
Biln ChOng sau md ChSv mdu vlt md
BItilu Tu dic^ vUnq md Tu mdu vUnq md Tu mdu vunq ben-biu
Nhi§m tnJnq vet m l Sunq vOnq biu Tran did! mdnq tinh hodn
s a u m o Lichtenstein (N=125,n=141)
1 (0,7%) S (6,4%) 1 (0,7%) 3 (2,1%) 3 (2,1%) 1 (0,7%) 1 (0,7%) 1 (0,7%)
TEP' (N=67, n=72) 0(0%) 5(6,9%) 8(11%) 3(3%) 2(2,7%)
0(0%) 1(1,4%) 1(1,4%) B a n g 5: T h d i g i a n m d , n a m v i e n , v a
Thdi gian Thcrt gian m6 (phOt) Thdi gian nam vifn (ngSy)
Thdi gian lid lai lao dflng Lichtenstein (N=125.n=141)
56±18,5 (30-120) 5,6±1,4(3"12)
22,5±6,7 (10-40)
t r d lai lao d d n g TEP'{N=67,
n=72) 59,5±t3 (45-135) 5,3 ±1,6 (3-9)
15,4±6,6 (7-35)
B a n g 6: K e t q u a s a u 2 n d m KSt quS sau 2 ndm
Dau kto ddi Trdn djch mdng tinh hodn
t e o linh hodn Tdi phai
Lichtenstein TEP* (N=67, (N=125, n=14t) I n=72)
2(1,6%) 1 (0,8%) 1 (0.8%) 2(1,8%)
2 (2,7%) 0(0%) 1 (1,4%) T E P " : e d 6 t n J d n g h p p c h u y d n m d h o , bi loai ra k h d i n h d m T E P t h e o d o i s a u m d .
N : s d b e n h n h a n . n: s d t h o a t vi b e n . BAN LUAN
1. Ve tuoi.
Qua c6ng trinh nghidn cCfu ndy, chCing toi da phdu thual 219 trudng hop thoat vj ben, phdu thudt bang phuong phap ddt tdm ludi nhdn tao polypropylene tai benh vien trung uong Hud, cho thay: Nhom Lichtenstein 125 bdnh nhdn vdi 141 thodt vj ben tudi tmng binh 69±11 thdp nhat Id 40 vd Idn nhdt la 92 tudi.
Nhdm TEP 73 benh nhdn vdi 78 thoat vj ben tudi tmng binh 59±19 (20-78).
Theo Nguydn Vdn Lidu tudi tmng binh Id 54,16±27.36, thap nhd't la 40 vd ldn nhdt la 91 tudi.
Theo Ngo Viet Tuan tudi trung binh Id 61.67±13,12, thap nhat la 40 va ldn nhd't la 90 tudi. Nhan thay rang:
tudi Idn nhd't gan tUOng dUdng nhau. tuy nhien tudi tmng binh nhien cdU nay cao hon so vdi tac gia Nguydn Van Lilu va Ngo Viet Tuan [2]. [4].
Nghien cCfu eOa Gianelta E tudi tmng blnh la 74.
thap nhat la 66, ldn nhat la 93. Nghien CLTU ctJa Gol<alp A ludi tmng binh nhom Lichtenstein 45 (18-60), nhom TEP 47 (18-59).
2. Vj t r i , phan loai, phan d p thoat vj b e n , kich t h u d c ta'm ludi.
Qua 198 benh nhdn vdi 219 trUdng hdp thoat vi ben, ehiing tdi deu dua vao tham khdm lam sang, vi tri thoat vi. Nhom Lichtenstien: thoat vi mot ben 109 (87.2%) va thoat vi 2 ben 16 (12.8%). Nhom TEP:
thoat Vj mot ben 68 (93.2%) va thoat vi 2 ben 5 (6.8%).
Nghien cilu eua Amid P. K. Lichtenstein I. L vdi m i u 5000 gdm. thoat v| 1 ben chie'm 7 3 % va thoat vj 2 ben chiem 2 7 % [5].
Ket hpp danh gia ton thuong giai phdu trong khi md. Nhom Lichtenstein: thoat vi ben gian tiep 74 (52,5%), thoat vi ben true tie'p 40 (28,4%), thoat vi ben the phdi hop 27 (19,1%). Nhdm TEP: thoat vi ben gian tiep 37 (47,4%), thoat vi ben true tiep 27 (34,6%), thoat V! ben the phdi hop 14(18,0%).
Bang 1, Ket qua phan loai thoat vi ben eua cac tac gia
TSc gi^
Nguyin Van Lilu [2]
Amid P. K [5]
Frey M.D [9]
SakoralasG.H[15]
Chung tdi (Lichtenstein) ChOnq Bi (TEP)
Thoai vi qiSn tilp 72,22%
44%
47,4%
55%
52,5%
47,4%
ThoStvi true bip 16,20%
43,1%
36,4%
30%
28,4%
34,6%
Thoat V!
phShop 11,58%
12.5%
16,1%
15%
19,1%
18,0%
N g h i e n eCfu n a y , n h d m L i c h t e n s t e i n c h ' d j n h d u n g td'm ludi n h a n t a o p o l y p r o p y l e n e c h o c a c b e n h n h a n t u d i > 4 0 , n h d m T E P dUOc c h i d m h b e n h n h a n > 2 0
Y HOC THUC HANH (878) - SO 8/2013
tudi, ket hpp danh gia thuong tdn phdn dd theo Nyhus:
IIIA, IIIB, iv. Chl djnh diJng tdm ludi nlidn tgo trong nhiJng trudng hpp cd nguy co cao nhu: thoat vj tdi phdt, thoat vj Idn vd phdfc lap hodc benh nhdn cd cdu tnic vung ben bj suy ydu. Nhdm Lichtenstein, siJrdung tdm ludl polypropylene vdi kich thude 5x10 cm chidm 100%. Nhdm ndi soi hodn todn ngodi phde mac sCr dung tam lUdi polypropylene vdi kieh thudc 7,5x15 cm chidm 100% cQa hdng BjBraun.
3. Kd't quk sdm sau m^.
Nghidn cCru ndy, ti Id chuydn ddi tH md ndi soi hodn todn ngodi phCic mac sang md hd 7,7%. L^ do:
chay mau ddng mach thupng vj dudi khdng cdm mdu dupc, phCic mac mdng, khidm khuydt rdng, dinh nhidu khdng bde taeh dupc khoang ngodi phue mac. Nghidn CIJTU cija Eker tl Id chuydn md hd 6,6% [7]. Nghidn cCru cDaBrandt-Kerkhof A t l l d e h u y d n m d h d 6 , 1 % [6]. So vdi hai tdc gta ndy thi tl id chuydn md hd eOa chdng tdi cao hon.
Nghien ciHi cCia chdng tdi, bidn chdng sau md bSng ky thudt Lichtenstein: chliy mdu vet md 0,7%, tu djch vung md 0,7%, tu mau vung md 2.1%, tu mdu vCing ben-biu 2,1%, nhiem trung vet md 0,7%, sung viJng biu 0,7%, trdn dich mdng tinh hodn 0.7% vd bang ky thudt TEP. chay mau vet md 0%, tu djch viJng mo 1 1 % , tu mdu viJng md 3%, tu mau vung ben-biu 2,7%, nhi§m trung vet md 0%. sung viJng biu 1.4%. tran djch mdng tinh hoan 1,4%.
Nghien cdu ciia Ekiund A va eong su, 706 Lichtenstein va 665 TEP, bidn ehdng sau mo. Nhdm Lichtenstein. tu mau 1,4%. Nhdm TEP: tu mau 1,5%.
Bien chung sau 1 tuan. Nhdm Lichtenstein gdm: tu mau 12,9%, tu dieh 0,8%, nhidm tmng nong/viem bang quang 0,7%. Nhdm TEP gdm: tu mau 10,5%, tu djch 0,9%, nhiem trdng ndng/viem bang quang 1,4% [8].
Nghien cljfu eua Neumayer L va cdng sif, bien chi:ing sau md. Nhdm Lichtenstein: tu mau hodc tu djeh 23,6%, viem tinh hoan 1,1%, nhiem trung vet mo 1,4%, dau than kinh 3,6%. Nhdm TEP' nhiem taing dudng tieu 1%, tu mau hode tu djch 16,4%, viem tinh hoan 1,4%, nhiem trung vet md 1%, dau than kmh 4,2%.
Cac nghien edu, hau hdt ed cac bien chdng thudng gdp nhu: tu djch, tu mau, viem tinh hoan, dau sau mo, mdi nghien cdu cd ti le khac nhau. E)di chieu ke't qua nghien cdu cda Neumayer L va Ekiund A cho thd'y. ket qua nghien cdu nay tuong ddi kha quan hOn, tl Id eac bien chdng sau md thap [8].
Bien chdng do vd cam- bi tieu Lichtenstein 6,4%, TEP 6.9%. Nghien edu cda Ekiund A, nhdm Lichtenstein. bi tieu 7,5% va nhdm TEP: bi tieu 4,2%
[8J. Nghien edu eCia Neumayer L, nhdm Lichtenstein' bi tieu 2,2% va nhdm TEP: bi tieu 2.8%. Chung tdi dung phuong phap chudm ndng hodc xoa bdp vung tren XUdng mu cho benh nhdn tieu khd va ddt sonde tieu cho benh nhan bi tieu. De khac phuc trinh trang bi tieu sau md, Finlay va cpng sU da neu len duOe tam quan trong cija viee van ddng sdm d nhiJfng benh nhdn hau phlu md thoat vi ben. 6 n g khdng djnh, day la bien phap td't nhat de tranh d dpng nude tieu sau md.
6. Ket quS theo doi sau 2 nam.
Nghien cdu ndy, kdt qua trong thdi gian theo doi sau 2 ndm. Nhdm Lichtenstein: dau keo ddi sau md 1,6%, tran dich mdng tinh hodn 0,8%, teo tinh hoan 0,8%, tdi phdt 1,8%. Nhdm TEP: dau keo ddi sau md 1,4%, trdn dich mdng tinh hoan 2,7%, teo tinh hoan 0%, tai phdt 1,4%.
Nghidn cdu so sdnh cda Neumayer L va cdng sir, bidn chdng Idu ddi: nhdm Lichtenstein: vidm tinh hoan hodc cd v i n dd vd tinh hodn 2,2%, nhidm trting 0,6%, dau thdn kinh hodc dau khac 14,3%, tile tdi phat 4,9%.
Nhdm ndi soi: vidm tinh hoan hoac cd vdn dd vd tinh hodn 1,9%, nhiSm toing 0,4%, dau thdn kinh hodc dau khde 9,8%, ti td tai phdt 10,1%.
Cdc tde glS vSn dd cdp ddn vdi tl Id thap nhu: tran djch mdng tinh hodn chidm 0,7% vd 1%. Teo t'nh hodn: md Idn ddu hidm gdp ehlem 0,1%, b bdnh nhan md thodt vj tdi phdt len Sen 0,9%. Tdc gia Bdi DOt:
Phu, tl Id teo tinh hodn Id 3,8%. Ta Xudn Sdn, ti le teo tinh hodn Id 4,94% [2], [3].
Kg'T L U A N
Didu tri thodt vj ben bang tam ludi nhdn tao polypropylene bang ky thudt Lichtenstein vd ndi soi hodn todn ngodi phdc mae Id phdu thuat cd gia tii va hieu qua, tuong ddi an todn, dat hieu qua cao, thdi gian phdu thudt ngan, t! Id cdc bidn chdng vd tdi phat thdp.
Ky thuat npi soi hoan toan ngoai phuc mac, tham my, hdi phuc ntianh, thdi gian trd lai lao ddng sdm.
TAi LI$U THAM K H A O
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