AP DUNG KY THUAT D 6 T HACH GIAO CAM QUA NOI SOI L 6 N G NGl/C 0^
CHO'A CHU-NG RA M 6 HOI TAY TAI BENH VlfN Npi TltT TRUNG U'ONG
TVin Nggc Luvng
B$nh vi^n N^i tiit Trung uang, Hd N&l
TOM T A T
Tir 10 thdng 5 nfim 2003 din 23 thdng 11 nfim 2005, lai Khoa ngoai Bfnh vi^n nOi Hit trung ucmg, cic tic gli 6i mb cit hach giao cim qua nOi soi i&ng nggc cho 350 bOnti ntiin vdi t^ iO nam nO gin ti/crng 6\rong nhau (54,6% vi 45,4%). Tu6l tmng binh 21,6 tuii (ti> 9- 57 tuii). Trong 66 6a 36 s i Id hpc sinh v i sinh vidn:
231 b$nh nhfin (66,0%). Chu yiu id binh nhfin chira dugc diiu trt gl (92%), C6 3 b^nh nhfin dugc tifim cdn v i n\rdc sOI li> tnrdc, d$c bl$t cd 1 b^nh nhfin m6l tifim cdn di/gc 1 thfing tn/dc U)\ mb. Chi cin djimg 6ng nOI khi quin thOng thu'dng nhu'ng cQng IthAng inh hudng gl din cfic thao tic mfi cdn glim di/gc niiliu tiin vl$n phi. Vdl ky thu9t djt 2 trocar 5mm d vCing nfich mfi trocar d du*l dfinh cho ing kinh soi vfi vdl tu thi ngda, diu cao cfic tfic gii thiy cd nhiiu thuin igi cho viic <36t hach. Trong cic tn/dng hgp dlnh nhiiu thl d$t thdm 1 trocar 5mm d phfa di/dl 6ng kinh sol. Tit c i nhOng b$nh nhfin (14 bdnh nhfin) dinh phii diu di/gc tfich dinh vdi kjr thu$t tich chi khu trii b viing dlnh phii tirong Cmg qufing xirang sudn 2,3 v i di/grc dit hach cd hidu qufi. Khdng cd tO vong, khAng cd biin chung trfin mfiu vfi trfin khi mfing phii. Ty 1$ khA cfi 2 bfin tay cua binh nhfin d^t 100%.
L DAT VAN DE
Tang tiet mb h6i tay Ii m^t b?nh thudng g9P ehiem din 1% dan so. Mo hoi tay thu6ng gap nhat la ting tiet mo hdi is cic noi nhu: bin tay, bin chan, nich, m^t. B^nh thudng giy phien ha frong sinh ho^t hing ngiy, frong eic giao tilp... VI v^y nhieu ngudi bf chung b?nh niy thudng song m$c cim, kh6p minh. Di c6 nhieu phuang phip dieu tri nhung cho tdi nay dieu t4 bing dot h^ch giao cim qua ngi soi l6ng ng\re dugc coi Ii phucmg phip an toin vi ed hi?u qui nhat. Tu thk b?nh nhan khi mo, dudng vio, so luijmg ong frocar, chieu dii cfia dudng mch moi tic gii sii d\mg mgt cich khic nhau nen m5i cich ed uu nhugc diem rieng.
Mfic tiiu cda Di tdi: Ddnh gid ky thugt eat hgch giao cdm qua npi soi long nguc vd icet qud ngay sau mo cua phucmg phdp tgi bfnh vifn npi tiet trung ucmg.
IL PHirOfNG PHAP NGHIEN ClTU 2.1.D6i tirgng nghiSn cihi
B$nh nhan din khim, dieu trj t^I Khoa ngo^i B?nh vi?n n^i tiet vdi ehihig ra m^
h6i tay.
Tieu chuin lo^i tri!i : nhihig b^nh nhan b) cudng giao cim do cudng ning tuyen gi^.
Thdi gian: t^ ngiy 10 tiling 05 nim 2003 din ngiy 23 tiling 11 nim 2005.
2.2. Phinmg phip nghiSn ciru:
Phuang phip nghien elm tien cihi ,ngu6i Tic gii: Tran Ngpc Luang
Dja chi: B$nh vifn NOi tiet trung uong Di^n tiiogi: 0947488666
Email: ngocIuongsiugery{gyahoo.com Ngiy nhgn bii: 16/12/2012 N g i y d i n g b i i : 20/4/2012
Phinbi^nl: GS. TS. Truong Uyen Nmh Cvc Y t l dv phdng - Bg Y te.
Phin bi?n 2: PGS.TS. D$ng Due Anh Vi?n v$ smh djch t l Trung uong.
148 T?Lp chi Y hoc dv phbng, T i p XXH, s6 2 (128)
bfnh den duge thim khim, dinh gii vi ghi ch6p theo mgt m^u b^nh in thong nhat.
2.2.1. Khdm l&m sdng vd c^n ldm sdng:
- Xac dinh tu6i, gidi, thdi gian b; b^nh, vung bi bfnh.
- X6t nghifm nong dO FT4 , TSH frong miu dk dinh gii chue ning tuyln giip.
- Ch\ip phoi thing.
- Ghi difn tim db.
- Cic xet nghifm thong thudng de mo.
2.2.2. Ky thugt mo
- Gay mi : toin thin, d?t n^i khi quin.
Su dyng toin bO 6ng ngi khi quin thudng I nfing, lim x?p ph6i tiing bSn.
- Tu till bfnh nhan
Tu the nim ngiia d^u cao ( Semi- Fowler position) va quay nghigng ve phia doi difn.
2.2.3. Vf trid^t trocaC
-1 frocat 5mm khoang Hen sudn 5 dudng nich gifia cho ong kinh soi.
-1 trocat 5mm khoang li£n sudn 3 dudng nich trade eho dyng cy dit.
- Trong trudng hgp neu thay dinh mang phoi n h i ^ thi c6 the dgt them 1 frocar thii 3 d dudi trocar cho ong lfinh soi.
2.2.4. Ky thudt dit
Trong trudng hgp phdi khdng dinh: Xac dmh xuang sudn 2 v i 3 sau khi dua 6ng kinh soi vio, tim dudng di eua day thin kinh giao cim, dot hgch fren dudng di eua day d moi dau xuong sudn. D6t bing cich cit dtit day bang dyng cy dit difn. D^ng thdi neu thay c6 day KUNT thl eiing dot luon. Kiem fra s\r chay mau, neu khdng cd thi lim nd phoi vi nit frocar, khdng cin dSn luu.
Trong trudng hgp Hinh ph6i:
+ Dinh theo kilu ming nhfn: dua dyng cy dot vio thudng Ii dau dot hinh L qua frocar nam d phia fren. Vda dot, vda eat di ve phia
frong ciia dinh phli noi vj tri ciia 2 dau xuang sudn. Dit hach d chS vi tri ciia 2 diu xuong xudn 2, 3. Thdng thudng khdng cin ph4i d$t d ^ Imi ming phli kin.
+ Dlnh theo difn rdng ip sit vio thinh ngyc: frong hrrdng hgp niy phii d§t thdm 1 frocar sl 5 nita. Vi tti djt frocar niy tiiudng d phia dudi frocar cila Ing ldnh soi, nim d quing Hdn sudn tini 6 dudng nich giiia. 6ng hfit vi dyng cy dit thay nhau giiia 2 frocar fren vi dudi Ing kinh soi Tich v^ phia frong cfia dinh phoi. Vda tich, vda dit difn cam miu. Khoing can tich ciing gilng nhu d lo?i dinh kieu m ^ g nhfn. Dit hgch d dau xuang sudn 2, 3. Theo ddi sy thay dli cfia nhift dg bin tay, neu nhift dg ting len li da c6 kit qui. Tuy tinh frgng mi quyet djnh dan Iuu ming phli kin hay khdng.
2.2.5. Theo doi & ddnh gid - Theo ddi frong mo
Dgt difn e\re vao long bin tay, theo doi v i ghi lai s\r thay doi nhift dg trade vi sau dot bSng miy Monitor.
Ghi lai difn tim trade vi sau khi dit ciing bing miy Monitor.
- Theo doi sau m l .
Budi chieu ngay md hay ngay sau mo chup phli thing mdt cich thudng qui, ghi lai difn tim, sii 1^ cic bien ehiing neu ed nhu trin khi, trin miu mang phoi.
Dinh gii kit qui bing cich sd tay bfnh nhin ho$c bio bfnh nhan lim nhiing ddng tic nhu xoa 2 bin tay vio nhau.
IIL KET QUA
3.1. Tfi-10/05/03 den 23/11/05 da mo cho 250 b^nh nhan vdi cic ket qui nhu sau:
- Tuli: nhd nhat 9 hioi, ldn hioi nhat 57 tuoi, trung binh 21,6 tuoi.
Tap chi Y hpc dy phong. Tap XXH, s^ 2 (128)
Bing 1. Phin b i gIM Unh
S6 b9nh nhfln T } l » %
Nam 191 54,6
NO 159 45.4
Ting 350 100
Nghi nghidp.
Bing 2. Phin b6 nghi nghifp
S6 b^nh nhfin TylS%
HS.SV 231 66,0
Giio vltn 7 2,0
Ki toin-NWP
16 4,6
Khic 96 27,4
Ting 350 100
D i di^u tri.
Bing 3. Diiu trf trudge
s i b$nh nhfin T } I S %
Thuic ddng y 25 7,1
Tiim cin- mrin sil 3 0,9
C h i » aitu tr|
322 92,0
Ting 350 100
V&ng bj bfnh.
Bing S. VCing b| b^nh
S i b$nh nhfin T>IS%
2 tay don thuin 159 45,4
2 tay + noi khfic (chfin, nfich...) 191 54,6
Ting 350 100
T?ip chi Y hpc dv phdng, T$p XXH, s g 2 (128)
- Ben dit: 100% c i 2 ben.
- Dhih ming phoi: d 14 bfnh nhin frong dd cd 2 bfnh nhan dhih ei hai ben, 12 bfnh nhan ehi ed dinh b6n phii. Tit ci s l bfnh nhin deu bdc tich vi dit dugc, frong dd c6 4 bfnh nhan dgt din Iuu ldn ming phli).
- Cd 346 bfnh nhSn (98,8%) la vifn sau 1 ngay; 4 bfnh nhan d$t dan Iuu; 1 bfnh nhin ra vien sau 3 ngiy, 2 bfnh nhan sau 4 ngiy, 1 bfnh nhin sau 5 ngiy.
IV. BAN LUAN 4.1. S i c dilm lam sing.
Trong so 350 bfnh nhin cfia chfing tdi ed 191 nam, 159 nii vdi tuli nhd nhit Ii 9 tuli , ldn nhat li 57 t u l i , trung binh 21,6 tuli, dieu niy eung phfi hgp vdi kit qui cfia eic tie gii khie (3,5,7). MJc dfi bfnh cd till g§p d 1% din so nhung trong so 350 bfnh nhan trong dd hge sinh, sinh vien l i 231 bfnh nhin chilm 66% . Ra nhieu mo hdi d tay Ii chung bfnh gay nhieu can trd khi vilt, giiy hay bj nhoi ...ddng thdi day eiing la lua tuoi niy nd them nhieu moi quan hf vdi cic bgn ciing liia, ra nhieu mo hdi tay Iam eho nhimg bfnh nhan niy nggi ngfing, mien cudng phii nim tay, bit tay ngudi khic.
Chihh \d the so Iugng bfnh nhan den khim chfi yeu li hgc sinh v i sinh vien v i din phSu thugt vio 3 thing h^ nhilu hon cic thing khie.
Ve thdi gian b; bfnh, tat ci s l bfnh nhan cfia ehung toi (100%) diu hi ehiing bfnh niy tu Ific nhd. Theo Christer Drott frong sl 850 bfnh nhan mo till ed 62% bfnh cd tfi nhd, 33% xuit hifn tii khi dly thi, ehi ed 5% bfnh bat dau d tuoi thanh nien.
Vfing bi bfnh g ^ d 2 bin tay dan thuan li 159 bfnh nhin chilm t^ If 45,4% vi hai tay ket hgp vdi nhimg ncri khie eung gan hrong duong chilm tf If 54,6%. Bj bfnh d 2 bin tay Ii 1^ do chlnh bfnh nhan di khim vi chiia bfnh.
4.2. Tu thl bfnh nhSn v i Ing n$i khi quin.
Toin bd s l bfnh nhin cfia chfing tdi d nghien cfiu niy diu duge d$t hoin toin d tu the ngfia dau eao. Vdi tu the niy cho den hifn nay chfing toi eho Ii thugn lgi vi ed hifu qui nhit.
Nd trinh duge eic nhugc dilm ciia tu thl nim sip hay nim nghidng mi d thdi ky diu chfing tdi sd dyng vl vifc phii thay doi tu the bfnh nhin vi phii thay toan io khi ml ben dli difn.
Trong nghiSn cuu niy chfing tdi cimg sfi dyng duy nhit Ing ndi khi quin thdng thudng 1 ndng. Vdi Ing ndi khi quin 1 ndng chiing tdi tiiiy phli vin x?p dfi dl ed till tiln hinh dit dyoc hgch. Ing ndi khi quin I ndng tiinh duge nhugc diem rat Idn cfia ong 2 ndng( ong Caraell) Ii rit dit, khd d$t vi phii thay dli Igi ong I ndng sau khi ml d thdi gian hli tinh.
Vdi tu thl ngfia diu cao, mgt quay ve phia ben doi difn ehung tdi thay rat phfi hgp vdi vifc sfi dyng ong ngi khi quin 1 ndng.
43. Ky tbu§t mo
Chfing tdi sfi dyng 2 frocar logi 5nini,vdi 216 vio d vfing nich. Vdi logi frocar 5mm chimg tdi thay ring rat de ding eho vife dua trocar vio frong long ngyc vl khiu kinh cfia nd hi. Bfnh nhan tdi ehfia churng ra nhilu mo hdi tay thudng d liia tuli hgc sinh, cdn It tuoi. VI vgy cic khoang Udn sudn d nhilu bfnh nhan cdn h?p, nlu dua frocar log! lOmm vio ddi khi khd khan vi dau eho tii sau khi mo.
Nhiing vit rgch da nhd de dua frocar nhd vio thudng cung khdng gay dau sau mo. Neu sau mo bfnh nhin c6 kdu dau thl chfing tdi thudng thiy dau d vfing sau lung nai tuong ling vdi vfing da dit hgch.
Vj tri chgc frocar: chgc trocar diu tien d vj tri khoang lidn sudn 5 dudng nich gifta cho Ing kinh soi. Sau khi dua ong kinh soi vio quan sit neu khdng cd dinh, phoi x ^ tit thl ehimg tdi d$t tilp 1 frocar nfia cho dyng cy dit d khoang lien sudn 3 hay 4 d dudng nich trudc ngay dudi tim ca ngyc Idn. Vdi vi tri cfia Ing Tgp chi Y hpc du phdng, T^lp XXH, s^ 2 (128)
151
khih soi vi dyng cy dit niy chfing tfli thiy rit tifn lgi. 6ng kinh soi tfi dudi Idn ditih phli, dyng ey dit Igi di thing vio hi phia frSn tdi viing dit mi khdng chgm vio bit cit bO p h ^ nio, vl nai niy phli x?p nhilu nhit, tgo dilu kifn cho vifc dit tiiin kmh rit dl ding.
Trong tradng hgp phli dhih vio thinh ngyc theo kilu ming nhfn thl nhiing dii xa dlnh thudng vit tfi phli din thinh ngyc thinh timg chiim cd thl dugc nhin rit rd dudi Ing kinh soi nhu nhihig diy ehing miu fring nhung minh. Trong nhthig trudng hgp niy thl thudng phli cd xQp nhung khdng hoin toin. Vifc bdc tich dl di din vfing dit thudng don giin. Chi can dualdau dit hinh L vio qua frocar phia tren li dfi dl dit vi cit cie sgi xo dlnh niy. Vdi vife dit vi cit cho nhiing sgi xo dinh kieu niy thudng khdng gay chiy miu. Khi din vihig dit d diu xuang sudn 2,3 thi diy thin kinh giao eim ciing nhin rit rd dudi Ing kinh soi. Vifc dit diy thin kinh niy cung tuong ty nhu frong tradng hgp khdng duih.
Trong tradng hgp dinh nhieu nghia Ii phoi dinh sit vio thinh ngyc: day Ii nhimg trudng hgp khd thudng khdng phit hifn dugc trade ml vdi nhiing phuang tifn chyp phli thdng thudng hay sieu Sm. Tien sfi frin djch hay chan thuang phoi eu chi mang tfnh chat ggi f. Trong so 14 bfnh nhan cfia chfing tdi cd dinh phli nhilu thi cd 2 bfnh nhan dlnh c i hai bdn, edn 12 bfnh nhan ehl i^^nh d ben phii.
Chfing tdi chua bilt rd dugc nguydn nhin tgi sao, nhung qua hli eiiu Igi bing vife hdi ngudi nhi hay bfnh nhan thl thay ed 2 bfnh nhin trin dich ming phli tii nhd. Bfnh nhin khdng cd khd thd, phim chyp phoi thing hoin toin binh thudng. Ngoii ra c6 m$t bfnh nhan bi ngi d§p thinh ngyc xuing v§t cung cich dd khoing 10 nim nhtmg khdng ed gay xuang sudn v i khdng phii xu 1^ gl. Thdi dilm dd bfnh nhin chi dfing thuoc giim dau vi theo ddi. D$c bift trong s l 3 bfnh nhan dugc tidm cin v i nudc sfli tfi trudc,
chfing tdi cd I bfnh nhan nam ra mo hdi d 2 bin tay rit nhilu nhung khi soi vio frong long ngyc thiy rat dlnh, toin bd vfing thinh ngyc sau vi d phia dlnh thiy phfi mgng nhu dang frong thdi ky vifm nhilm n$ng. Chfing tdi vin tiln hinh dit hgch dugc bhih thudng, kit qui 2 tay khd.
Sau m l khai thie 1^1 tiln sfi mdi bilt bfnh nh^
mdi dugc tifim cin tgi mflt bfnh vifn d Hi n^i I thing trade khi m l nhtmg bfnh nhin giiu.
Trong nhihig trudog hgp dlnh nhilu thl sau khi chgc kim baui khi, khi bam khi chfing tdi thiy ring chi s l ip lye khi cimg ed tinh ehit ggi f din mOt tinh trgng dlnh phli. Thdng thudng d bfnh nhin khflng dbh till sau khi d$t diu day bam khi vio thl ip Ige d frong khoang ming phoi bao gid cung tyt xudng d ip Ivrc im 1- 2minHg roi sau dd ip l\rc niy ting len din dan. 6 frong tradng hgp niy khi chgc frocar phii thin frgng vi hudng dau frocar len phia dinh phli vi phii cim giic duge bang tay sau khi frocar vugt qua thinh ngyc.Trong nhimg tradng hgp dinh nhieu thl ehi so ip Igc cao ngay dau tien d mue khoing dg 10 - I2minHg m$c dfi da nim d frong khoang ming phoi. Dua ong kinh soi vio dl quan sit v i dit tiep tyc trocar thfi hai dudi sy giim sit cfia ong kinh soi. Neu dlnh ngay cho dau cfia ong kinh soi thl ed thl dfing ngay diu Ing kinh niy tich, vin cho dlnh de tim mpt cho d$t tiep trocar khic vio. Vj tri cho trocar niy thudng d phia tien cfia ong ldnh soi. Sau dd tilp tyc d$t tilp trocar thfi 3 d dudi vi tri cfia ong kinh soi. Vdi vifc d$t them 1 frocar niia cho Ing hfit chfing tdi thiy rit thu^
Igi eho qui trinh tich cho phoi dlnh de di len ve phia dhih phli. Trong qui ttinh tieh phli thflng thudng ed miu chiy hay ri ra tfi thinh ngyc nhung cd thl dot cim miu hoin toin dugc bing dao difn. Khi din dinh phli vfing khoing xuang sudn 2, 3 do cd miu chiy ebo nen khflng nhhi rd duge diy tiiin kmh. Dfing Ing hfit dl hfit sgch miu, nlu van chua nhin rd thi rfia bing dung djch muli ding tiuong 0,9%.
152 T9P chi Y hgc dv phdng, T$p XXH. s6 2 (128)
Vdi cich niy chfing tdi bOc lg duge rat ro diy thin kmh vi tiln hinh dot mflt cich ttiuin Igi.
Theo Hoing Ting Bhih frong nhiing ttirdng hgp dhih nhilu till tic gii md khoang lidn sudn rgng ban dfing ngdn tay tich trade sau dd mdi dua frocar vao vi xic dinh dau xuang sudn 2,3 bang kim chgc tu phia sau lung. Chung tdi thiy cich niy cimg rit phfie tgp vi cung khd thyc hifn frong khi ml khi bfnh nhin di giy mS nam d frSn bin mo. Sau khi dot xong chfing tdi cung theo ddi sy thay dli cfia nhift db bin tay, neu nhift dp bin tay ting len Ii vife dit day thin kmh di cd hifu qui. Tu^* tinh frgng cfia long ngyc sau khi tich dinh ma d$t din luu hay khdng. Tit ci s l bfnh nhan cd dhib phli nhilu deu duge gd dinh vi dit diy thin kinh cd hifu qui frong dd chi ed 4 tradng hgp phii d$t din luu ming phfli kin. Tit ci 100% sl bfnh nhan dugc tich dinh vi dot bach bang cich niy tay diu khd sau ml. Din luu thudng duge rfit vao ngiy thit 2 sau mo.
V. KET LUAN
Qua 350 bfnh nhan dugc phau thugt dflt hgch giao cim bing ndi soi ldng ngyc chfing tdi rfit ra mgt so ket luan sau:
1- Phiu thugt dit hgch giao cim qua npi soi long ngyc cd the thyc hifn dugc de dang vi an toin.
2- Tu thl tit nhit hifn nay Ii bfnh nhin nam ngfia, diu cao, quay sang hdn ddi difn vi ehi can su dyng dng npi khi quin 1 ndng binh thudng.
3- Sfi dyng 2 frocar Ioai nhd Srrnn, frong tradng hgp dfnh nhieu thl dgt them frocar 5mm thu 3 cho Ing hut vdi ky thugt tich chi can tieh khoing phiu tmdng ldn phia tten frong cfia dfahphli.
4- Khdng cd bien chung trin khl vi trin miu ming phoi. Ty- If khfl tay ngay dr 100% so bfnh nhin.
TAI LIEU THAM KHAO
1. Nguyen Nggc Bich, Trin Hilu Hge, Ngd vin Dang vi cs. Phau thu^t ndi soi dift hgch giao cim dieu tq bfnh ra nhilu ml hdi tay, nich, m$t (kit qui fren 350 tradng hgp).
Ky ylu tdm tit cic dl tii khoa hgc. Dgi hfi hfi ngogi khoa Vift nam lin thfi XI, Hi NOi 2004,Tr.7
2. Hoing Ting Binh. D$t tii till bfnh nhan frong ml n$i soi cit hgch giao cim ngyc dilu tri chung ra ml hdi tay. Y hpe thyc hinh. s l 6, 2005, 89-92
3. Nguyen Hoii Nam. Nhiing cii tiln frong dieu tri chfing ting tilt mo hfli tay bing phau thuit ndi soi ling ngyc. Tgp san bfi nghi nfi soi vi phau thugt npi soi Dgi hpe Y dugc tiiinh phi Ho chi Mmh,2004,407- 417 4. VanTin. Kit qui dieu tri phau thuat udt mo hdi tay do mo hdi qua ngi soi long nguc cii tiln. Tgp sau hdi nghi ngi soi vi phau thugt nfi soi Dai hgc Y dugc thinh pho Hd ehi Mmh, 2004, 50-54
5. Le Quoe Vlft vies. Cat hgch giao cim ngyc qua npi soi 1 lo frong dieu tri chimg tang tiet md hfli tay. Tgp san hfli nghi ngi soi va phau thuat ngi soi Dgi hge Y duge thinh phd Ho chi Mmh, 2004, 395-398.
6. Cheah.W.K: Needlescopic thoracic sympathectomy. 2nd Advanced needlescopic surgery workshop.May 2000.
7. Chen HJ, Liang CL et al. associated change in plantar temperature and sweatmg after fransthoracic endoscopic T2-3 sympathectomy for palmar hyperhldrosis.J Neurosurg 2001JuI;95(l Suppl):58-63.
(Abstract).
8. Fakushima H. Endoscopic thoracic sympathectomy for palmar,axillary and plantar hyperhidrosis:intermediate - term resuIts.Surg Laparose Peeutan Tech 2002 Oct;10(5):338-339.
Tap chi Y hpc dy phong, T§p XXH, s6 2 (128)
153
THORACIS ENDOSCOPIC SYMPATHECTOMY FOR TREATMENT OF PALMAR HYPERHIDROSIS AT NATIONAL HOSPITAL OF ENDOCRINOLOGY
TVan Ngoc Luong
National Hospital of Endocrinology, Hanoi FromlO May 2003 to 23 November 2005, at Surgical Department of National Hospital Of Endocrinology, The authors have performed the endoscopic sympathectomy for 350 patients who were suffered from palmar hyperhidrois. The ratio male/femal was equal, 54,6% and 45,4 % respectively. The mean age was 21,6 years old( range: 9-57). Most of patients were students( 66,0%). The patients were in Semi- Fowler position with 2 frocars placed in the third and tifth intercostal space.
In the severe pleural adhesion, the third frocar was placed below the port of endoscope. In these cases, the technique of dissection was performed only at the superior pleural area.
The normal endofracheal tube( single tube) was used for all of patients.
Results: The were no mortality and no conversion to open surgery. There were not the complication such as the pneumothorax and pleural effusion. Dry limbs were immediately achieved in all patients after surgery(100%).
154 Tap chi Y hpc di; phdng, T^p XXH, so 2 (128)
