Tap chi GAN MAT VIET NAM s6 25-2013
Danh gia hieu qua cua Kim Dom Khang trong dilu tri hS trg sau lay soi bang noi soi mat tuy nguwc dong
Assessing the role of Kim Dom Khang in the paUiative treatment of common bile duct disease after ERCP technique
Lg XUAN THANG, Du'dNG XUAN NHUONG, DAo TRU'ONG GIANG, TRAN VIBT TU, THAI BA C 6
Sumary:
45 patients after having been Endoscopy retro cholangiopancreatography (ERCP) were treated by Kim Dom Khang in 6 months.
Results:
- The clinical symptoms are significantly improved, there is no pts have bile duct obstrustion during the time following - up.
- Serum aminotransferase are decreased.
Bilirubin total and direct also being decrease.
- The rate of intra hepatic bile duct stone Tom t a t :
45 benh nhan diing Kim Dom Khang ngay sau lam ERCP trong vong 6 thang, ket qua theo doi cho thay cac trieu chiing lam sang cai thien ro ret, khong c6 bieu hien ciia tac mat tai phat sau dieu tri ERCP va Kim Dom Khang.
Co su giam men gan GOT, GPT, GGT va Bilirubin sau 6 thang dieu tri.
Soi duong mat trong gan giam xuong tu 44,4% con 35,6%. Soi ong mat chii giam tu 1. Dat van de
Benh soi mat, nhiem tning duong mat la benh kha pho bien va c6 nhieu phuong phap dieu tri nhu: phau thuat, tan soi, diing thuoc tan soi, lay soi qua noi soi... Trong do, npi soi mat tuy ngugc dong (ERCP) la mpt phuang phap dugc ap dung de dieu tri benh ly soi duong mat. Tuy nhien van con mpt ty le sot soi hoac soi tai phat, phai mo di mo lai nhieu Ian, gay tam ly cho phau thuat vien cung nhu benh nhan va gia dinh ho.
Kim Dom Khang la mpt bai thuoc co
after ERCP was 44.4% decrease to 35.6%;
common bile duct stone was 28.9% after ERCP decrease to the rate of 17.8%). All of the patients don't have bile duct obstruction during
6 months of following - up.
- There are several minal adverse reaction, mainly dyspepsia, headache; these symptoms are only occur at the first month of therapy and decrease in the third month and disappear after 6th of therapy.
28,9% xuong 17,8%. Tdt ca benh nhan d k khong CO tac mat sau 6 thang.
Mpt so tac dung khong mong muon gap phai, chii yeu roi loan tieu hoa, dau dau, mat ngii, tang men gan. Tuy nhien chi gap 6 nhirng thang dau sau diing Kim Dom Khang. Cac trieu chiing nay giam dan o thang thii 3 va khong thay xuat hien sau 6 thang theo doi.
truyen, tang cuong van dpng duong mat, hoi phuc chiic nang gan, khang viem, khang khuan nen co hieu qua trong viec du phong tai phat soi.
Muc tieu nghien ciru:
1. Danh gia tdc dung dieu trj ho tra benh soi mat ciia Kim Dom Khang a nhirng benh nhdn sau lam ERCP.
2. Cdc tdc dung khong mong muon gapphdi trong qud trinh sii dung san pham.
Benh vien 103
Phan bien khoa hoc: PGs, Ts Nguyln Nhugc Kim
36 TspchiGANMATVI$TNAMs625-2013
2. Doi t u v n g va phiromg phap nghien cihi 2.1 BMtirt/mg nghien cuu:
45 benh nhan soi 6ng mat chu vJo dieu tri tji Khoa Npi tieu h6a B?nh vi$n 103 tir th^ng 10/2011 din thang 7/2013.
2.2 Phmmgphdp nghien ciru :
Mo ta cat ngang va tien ciiu c6 phan tich 2.3 Chat lifu nghien cihi:_
Kim Dom Khang, mdi hgp 3 vi x 10 vien.
Thanh phan : Moi vien chiia Cao Kim ti6n thao : 150 mg
Cao Hoang ba : 1 5 0 m g Cao Sai h6 : 120 mg CaoUatl<im : lOOmg Cao Di?p ha chau : 60 mg Cao Chi hi : 50 mg Cao Chi xac : 30 mg Cao Nhan trSn : 20 mg 2.4 Xdr ly so lifu:
Theo cac thuat toan thfing ke, sii dung p h k mkn EPI- INFO 6.0 va SPSS 13.0
3. Ket qua nghien ciru va b^n luan S.l. Bac diem dich ticua doi tir^g nghien ciru:
Bang 3.1 Dac diem vi do tuoi cua nhom nghien ciru(n=45) Tuoi
2 0 - 3 0 3 1 - 4 0 4 1 - 5 0 5 1 - 6 0 6 1 - 7 0
>70 Cong
Giai Nam
0 1 3 5 4 1 14
Ni 3 3 3 5 5 12 31
Ty 1? (%) 6,7 8,9 13,3 22,2 20 28,9
100 Nil gap nhiSuhon nam, ti le nii/nam = 2,2/l(phii hgp voi cac tac gia frong nu6c)[5]. Tuoi trung binh la 57,9 (thap nhat 23, cao nhat 85). Theo nghien ciiu ciia Nguyen Cao Cuong ty le nu/nam = 1,75/1 va tuoi trung binh 48,02. Nghien ciiu tai Benh vien 108 tuoi trung binh la 42,2 ± 15,8.
Nghien ciiu ciia Yu Fan Cheng tai Dai Loan: tuoi trung binh 46, nii gap nhieu hon nam. Nghien cihi cua Degenais a Canada tuoi trung binh 68,4 ± 4,6[5].
3.2. Dac diem tien sii- vd trieu chung lam sang:
Bdng 3.2 Dac diem ve tien su benh ciia nhom nghien cuu(n=45) Tien sir
Phau thuat soi mat Giun chui ong mat Con dau quan gan
So luvng (n=45) 11 5 29
Tyin%) 24,4
11,1 64,4
Ve tien sir benh: 11 benh nhan (24,4%) da m6 l4y soi, 29 benh nhan (64,4%) da co con dau quan gan, 5 benh nhan (11,1%) co giun chui 5ng mat.
Theo 1 nghien ciiu truoc day ciia Duong Xuan Nhuong va CS vS ti6n su soi mat is 92 doi tugng benh nhan cao tu6i cho thiy c6 16,3% da phau thuat soi mat; 51,08% co tam chiing Charcot [3].
T9P chi CAN MAT VIST NAM s6 25-2013 37
Bdng 3.3 Bac diem lam sang truac lam ERCP(n=45) CSc trieu chirng
Dau ha suon phai Sot Vang da, tieu vang
Canto
TVirftc ERCP v4 uong thuoc 37 38 36 5
Tyl^(%) 82,2 84,4 80 11,1 Da so benh nhan co cac tri$u chiing cua tam chiing Charcot diSn hinh. Day chinh la ly do khiSn ngiroi b?nh phai den vien dl dilu tri.
Bdng 3.4 Dac diem duang mat truac ERCP:
Dac diem Ong mat chu gian Duong mat trong gan gian Duong mat trong gan co soi Ttii mat co soi
SolVQllg 32 10 20 10
T y l f ( % ) 71,1 22,2 44,4 22,2 Truoc khi lam ERCP, benh nhan dugc sieu am 6 bung, ket qua cho thdy ty le gian 6ng mat chii a cao nhat, chiem 71,1%. Duong mat nong gan gian 22,2%, co soi 44,4% va soi nii mat 22,2%.
Bdng 3.5 Nhdn xet truac vd trong ER CP:
Chi tieu S6i<lcm Soi l-2cm Soi mot vien Soi nhieu vien Soi biin Xac giun Dich mat co mu Dich mat trong
So iu^ng 18 8 18 9 12 5 29 14
Tyie(%) 40 17,8
40 20 26,7 11,1 64,4 31,1
Chi tieu So Iirong Ty le (%) Soi <lcm 18 (40%) Soi l-2cm 8 (17,8%) Soi mpt vien 18 (40%) Soi nhik vien 9 (2*0%) Soi bun 12 (26,7%) Xac giun 5 (11,1%) Dich mat co mii 29 (64,4%) Dich mat trong 14 (31,1 %) Cac benh nhan co soi kich thuoc viia va nho, chiem 57,8%, chii y^u la soi mpt vien, chi8m 40%. Co 9 benh nhan soi nhieu vien (20%). Soi biin 12 benh nhan (26,7%) va 5 truong hgp (11,1%) c6 xac giun trong duong mat. Dich mat co mu 64,4% the hien benh nhan co su nhiem triing duong mat.
Bdng 3.6 Kit qud ERCP:
Dac diem est CO Oddi
Lay het soi Con sot soi Dat stent
S6 llTQllg 45 32 13 1
Tyle(%) 100 71,1 28,9 2,2
38 Tap chi GAN MAT VIET NAM s6 25-2013
Tat ca cac benh nhan dSu iaqic cit CO Oddi trong qui trinh lam, da My ditoc hk soi 32 ca (71,1%); c6 13 ca (28,9%) con sot soi do co soi ducmg mat trong gan va soi bun dirong mat mac du da dugc 13y va boin riia nhilu l4n xong van khong lay het dugc. Co 1 ca dugc dat stent ducmg mat (2,2%) do soi kich thudc to, nhiSu vien khong 1 Sy hk dugc trong ISn lam dau tien, chi cjt got dugc 1 ph4n va ISy dugc 1 vien soi sit ca Oddi. B^nh nhan cao tuoi, khong cho ph6p thai gian gay me keo dai, tiSn hanh dat stent duong mat de giim ap. Lin thii 2 lam ERCP da 18y soi thanh cong
Bdng 3.7 Dac diem lam sang sau 6 thang theo doi:
Ckc trifu chung Dau ha sucm phai Sot
Vang da, tieu vang
1 thing 6 0 3
3 thing 1 0 0
6 thing 0 0 0 Tat ca benh nhan sau lam ERCP va dugc diing Kim Dom Khang ngay deu khong thay xuat hien sot tro lai trong suot 6 thdng theo doi va dieu trj. C6 6 benh nhan (13,3%) con dau ha suon phai am i trong thang thii nhat, giam nhieu sau thang thii 3, khong xuM hi?n sau 6 thang. Co 3 benh nhan (6,7%) con vang da va nuoc tieu vang trong thang dau dieu tri, nhiing trieu chiing nay khong xudt hien sau 3 den 6 thang theo doi.
Bdng 3.8 Hinh dnh sieu dm 6 bung sau 6 thdng theo doi:
Dac diem Co soi ong mat chu Co soi duong mat trong gan Co soi tiii mat Co giun ong mat chii
I thing 13 19 9 0
3 thing 11 17 8 0
6 thing 8 16 8 0
Ty le (%) sau 6 thing 17,8 35,6 17,8 0 Sau 6 thing so lugng benh nhan co soi 5ng mat chu giim xudng, tit 13 (28,9%) xuOng 8 (17,8%); soi duong mat trong gan giam xu6ng tit 20 (44,4%) xudng 16 (35,6%). Do soi trong gan rai xuong ong mat chu, lim s5 benh nhan co soi 6ng mat chu tang len, my nhien thuc tk s6 benh nhan co soi 6ng mat chu da giam hi 13 (28,9%) xu6ng 8 (17,8%). Va khong co biSu hien lam sang ciia tac mat a thing thii 6 sau diSu tn. Sau thii thuat cSt co Oddi, viec soi con sot lai tu roi xuong phii Chang co tic dung thong mat va bao mon soi ctia Kim Dom Khang khiki soi khong to len.
Theo tic gii Trin Nhu Nguyen Phuong vi CS ty le soi tai phit sau ERCP la 5% [6]. Doi chi6u voi ket qui theo doi ciia Doin Thanh Tiing vi CS thiy ty le soi tai phit sau phiu thuat Ii 28,51%
[4]. Co 4 benh nhan co soi nho trong gan biSn mit sau 6 thing dung thu6c va 2 benh nhan khong con soi tui mat, phai chang do tic dung bii thach ciia Kim Dom Khang.
Bdng 3.9 Dac diem xet ngh Cac thdng s6
Bilirabin TP Bilirabin TT GPT GOT GGT
TriTffc diing sin pliam 65,9 ± 52,3 34,1 ±36,3 98,6 ±117,8 103,1 ±117,2 371,9 ±344,4
em sinh hoa mau trong qud trinh theo doi:
Sau 01 thing 33,4 ±57,9 15,2 ±27,4 56,3 ±37,1 60,5 ±61,2 220,1± 224,3
Sau 03 thing 33,4 ±57,9 15,2 ±27,4 56,3 ±37,1 60,5 ±61,2 220,1± 224,3
Sau 06 thing 11,2±13,7
5,4 ±7,4 22,1 ± 16,5 43,9 ±55,4 162 ±192,7
Tap chi GAN MAT VIET NAM s6 25-2013
Su bien dpng ve cac xet nghiem sinh hoa tot dan len do tinh trang nhilm khu5n va tSc mat dugc cai thien, phai chang do tac dyng lam giam men gan, nhuan mat cua Kim Dom Khang.
Bdng 3.10 Cdc tdc dung khong mong muon:
IViSu chirng Roi l o ^ tieu hoa Dau dau, mat ngu Tang men gan
Sau 01 thing 6(13,3%)
3(6,7%) 4(8,9%)
Sau 03 thing 0 1 1
Sau 06 thing 0 0 0 Sau 1 thang diing Kim Dom Khang, gap roi loan tieu hoa (13,3%); dau dau, mat ngii (6,7%) va tang men gan (8,9%). Sau 3 thang nhiing trieu chiing nay giam dang ke va sau 6 thang thi khong con gap lai.
4. K e t luan
1. Cac trieu chiing lam sang cai thien ro ret sau khi dimg Kim Dom Khang, khong co benh nhan nao co bieu hien lam sang cua tac mat tai phat. Co su giam men gan GOT, GPT, Biliru- bin.
2. Ty le soi tai phat sau ERCP: soi duong mat trong gan giam xuong tir 20 (44,4%) xuong 16 (35,6%), benh nhan co soi ong mat chu sau 6 thang da giam tii 13 (28,9%) xuong 8
Tai lieu tham khao
1. Hoang Gia Loi. Soi mat. Bai giang Npi Tieu h6a (dai hpc). Nha xuat ban Quan dpi Nhan dan 2011(330-343).
2. Bh XuSn Chuomg Soi mat. Bai giang Benh hpc npi khoa (sau dai hoc). Nha xuat ban Quan doi Nhan dan 2011(18-21).
3. Dirong Xuan Nhirffng, Dang Viet Dung, Mai Hong Bang. Hieu qua ciia npi soi mat tuy nguoc dong trong dieu tri soi ong mat chii a benh nhan cao tuoi tai benh vien 103. Tap chi Y- Dugc hpc quan su so 1 -2012( 100-104).
4. Vu Thi Khanh Van. Nghien ciiu tac dung Ipi mat, khang khuan vua bai thudc Nhan Kim Thang trong dieu tri h6 tra benh soi mat Luan an Tign si Y hpc nam 2000( 1 -9).
5. Diro'ng Xuan Lpc, Hoang Trpng Nhat Phinmg, Ho Van Linh va CS. Hieu qua tan soi dien thiiy luc trong soi mat mo lai. Tap chi
benh nhan (17,8%).
3. Mpt so tac dung khong mong muon, chu yeu la roi loan tieu hoa 13,3%, dau dau mat ngii 6,7%, 8,9% c6 tang men gan; xong nhirng tac dung nay chi xuat hien o nhirng thang dau diing Kim Dom Khang, nhirng thang tiep theo deu giam dan va mat di.
4. Kim Dom Khang an toan trong qua trinh su dung.
Gan mat Viet Natn(44-51).
Tr5n Nhtf Nguyen Phuong, Ho Ngoc Sang, Le Phudc Anh va CS. Dieu tri s6i 6ng mat chu bang npi soi mat tuy nguac dong tai BVTW Hu8 tir 5/2005 den 5/2012. Tap chi Y hoc thuc hanh s6 832+833(41-49) B6 y tS xuat ban.
H6 Dang Quy Dung, Pham H&u Tiing, Tran Dinh Tri va CS. Danh gia tinh hinh npi soi chup mat tuy ngupc dong tai Benh vien Cho RSy nam 2011. Tap chi Y hpc thuc hanh s6 832-1-833(34-40). Bp y te xuSt ban.
La Van Phirong va CS. Danh gia ket qua npi soi mat tuy ngupc dong dieu tri soi ong mat chii tai Benh vien da khoa TU' Can Tho. Tap chi Y hpc thuc hanh s6 832+833(50-55). Bp Y te xuat ban.
