Tap chfTai MQi Hpng Vidt Nam - Volume (57-9). N°3 - July, 2012
BirdC DAU NGHIEN ClTU iTNG DVNG DAO PLASMA TRONG PHAU THUAT NAO VA TAI KHOA TAI MUI HQNG
BENH VIEN DAI HQC Y HA N Q I
Cao Minh Thanh*, Phgm Huy Tan*, DdBd Hung*
T6M TAT
Mftc tieu : 1. ddnh gid th&i gian phdu thugt ngo VA khi .sir dung dao Plasma di ngo VA. 2. Ddnh gid biin chimg chdy mdu sau ngo VA bdng dao Plasma Phuang phdp nghien ciiru:Tiin ciiu timg ca co can thiip Ket qud nghiin ciru :100% binh nhdn ngo VA dan thudn bdng dao Plasma cd th&i gian phdu thudt ngdn 20-40 phut 100% BN ngo VA dan thudn hogc phdi hgp v&i cdc phdu thugt khdc khong xdy ra bien chimg chdy mdu sau phdu thugt. Kit lugn : SU dung dao Plasma trong phdu thugt ngo VA da m& ra mgt hu&ng m&i trong phdu thudt ngo VA nhdm muc tiiu riit ngdn th&i gian phdu thudt vd ldm gidm biin chimg chdy mdu sau phdu thudt.
Tit khda : Ngo VA, Dao Plasma
SUMMARY
Objectives: 1. evaluate the surgery time when to use a Plasma knife to remove VA. 2.
Assess bleeding complications after remove VA with a Plasma knife. Research Method: A descriptive cases study with intervention. Results: 100% remove VA patients with a Plasma knife pure have short time surgery (20-40 minutes average). 100% of remove VA patients with curettage alone or in combination with other surgical procedure have no bleeding complications occur after surgery. Conclusion: Plasma knife using in remove VA surgery and has opened a new direction in VA surgery. It aims to shorten the surgical time and reduce bleeding complications after surgery.
Key Words: Plasma knife
1. DAT VAN BE gian lao ddng eua bd me. Khi viem VA tdi Td chiic amidan vung vdm mui hpng didn nhidu lin hay vidm VA gdy cdc bidn hay cdn gpi la VA, td chiic VA cd tu khi tre chung ldn can ciing nhu eac bidn chdng xa mdi sinh ra va phdt tridn ldn nhdt khi trd 6 tW vifc didu tri ngo td chuc VA dupe ddt ra tuoi va bidn mdt hoan todn d tudi 20.Vidm - Phiu thudt nao VA Id phdu thudt co ban VA la mdt trong nhiing bfnh ly thudng gdp vd la mdt trong nhihig phdu thudt ddu tay nhdt d trd em, bfnh hay tai phdt va gay tidu cua cdc bdc sy tai mui hpng nhung cung la tdn nhidu tidn eua ciia gia dinh vd mdt thdi phlu thugt gay ty If bidn chdng nhidu nhdt.
* Blnh vifn D^ii hoc Y Ha Nfi Nhan hk\ 20/6/2012. Duyet in 30/6/2012
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Tgp chl Tai Mui Hpng Vidt Nam - Volume (57-9). N°3 - July. 2012
Phau thugt ngo VA cd the gay nhihig bien chung nhu: chdy mdu , nhiem trCing. bdng, tdi phdt... do cd nhieu bi^n chiing nhu v^y nen cdc phuong phdp nao VA nguy cdng dupe cdi tien de gidm thieu toi da nhiing bien chiing cd the xdy ra.
Ngdy nay dao phau thuat Id cdc ludi dao phat ra xung dgng sdng radio, nhift hoc hoi cac md mem thdng qua nhifut Joule vd ho quang difn chinh vi dieu nay md vifc cdt vd ddng difn cam mdu gay nen mpt viing rpng bi bdng nhift. Tuy nhien, khdng giong nhu hau het cac tdn so vd tuyen dya trdn sdn pham phau thudt sii dyng dgng sdng difn dp lidn tuc de cdt md, Generator PULSAR vdt tu xung phdng didn plasma qua trung gian dien thdng qua PlasmaBIade. Bdi vi ndng luong tan sd vd tuydn dugc cung cap thdng qua cdc xung ngdn thdng qua mpt difn cue cdt cdch difn cao, PlasmaBIade cdt tai nhidt dp trung binh thdp hem nhidu so vdi dao difn thdng thudng, va cd the thdp den 50 °C. Vdi muc dich dd nen chung tdi tien hdnh nghien ciiu dd tdi:
"Bu&c ddu nghien ciru ung dung dao Plasma trong phdu thugt ngo VA "
2. D 6 I Tl/gfNG VA PHlTOfNG PHAP NGHIEN Ciru
2.1. Doi tirgrng nghien ciru
Bfnh nhdn dupe chdn dodn viem VA va cd chi dinh phau thugt ngo VA tu thang 2 /2012 ddn thdng 5/2012
Tidu chudn lira chpn :Dupc khdm npi
soi tai mQi hpng ch4n dodn viem VA Dupe phSu thu^t ngo VA bdng dao Plasma Dugc theo ddi sau phSu thu^t
Tieu chuAn loai tru :Khdng cd hlnh dnh ndi soi VA Khdng cd day du cdc tidu chuan trdn Khdng dupe theo ddi sau phau thudt Bfnh nhan ho^c ngudi nhd bfnh nhan khdng dong y tham gia nghien ciiu.
2.2. Phuorng phdp nghien cihi - Md hlnh nghien cdu : tien cuu timg ca ed can thifp
- Phuong tifn nghien ciiu :
Mdy npi soi tai miii hpng vdi Optic 2.7mm logi 0°
Dao Plasma : PEAK PlasmaBIade TnA - Xu ly sd lifu bdng phdn mem SPSS 13.0 3. KET QUA NGHIEN ClTU
3.1. Ddc di^m chuDg Tudi va gidi
Nam NO
1-5 4 3
6-10 5 6
>10 3 0 Nhdn xdt: theo ket qua nghien ciiu thi viem VA cd chi dinh phau thuat g|Lp chii yeu d lua tudi < 10 tudi 18/21 ca chiem ty If 85.7%, ty If Nam/Nit khdng cd s\r khac bift vd mdt thdng ke. Bfnh nhan nhd tudi nhdt la 3 tudi, ldn tudi nh^t la 23 tuoi, tudi tnmg binh la 8 tudi.
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Tap chf Tai MQi Hpng Vidt Nam - Volume (57-9). N°3 - July, 2012
3.2. Ddnh gid d$ qud phat ciia VA qua ngi soi
BOI B6II 04 III
n 2 9 10
%
9.5 42.9 47,6 Nhan xet: Theo ket qud nghidn cdu thi cdc trudng hpp dupe phau thugt ngo VA chu yeu la cdc trudng hgp cd td chuc VA qud phdt che kin 2/3 den todn bd cua miii sau , VA qud phdt dp I chi chidm 2/21 ca chidm 9.5%.
3.3. Thdi gian phau thuat
< 20 phiit 2 1 - 4 0
>40
N 0 10
0
%
0 100
0 Nhdn xet :theo kdt qud nghien cuu thi trong 10 ca dugc ngo VA don thudn bang dao Plasma thi thdi gian phau thugt ngan clii tir 20 ddn 40 phut . khdng cd trudng hgp ndo thdi gian ngo qud 40 phut.
3.4. Bi^n chung chay man ngay dau ngo VA
c6 KhSng
N 0 21
%
0 100 Nhgn xet : theo kdt qud nghien ciiu thi tdt ca cdc bfnh nhan dugc nao VA don thudn hoac ngo VA ket hgp vdi cac phiu
thudt khac cd su dung dao Plasma ddu khdng ed bi^n chiing chdy mdu sau phau thudt.
3.5. Bien chirng chdy mdu sau ngdy dau
C6 Khfing
N 0 21
%
0 100 Nhan xet : Theo ket qud nghien cdu thi trong tat ca cdc bfnh nhan dugc nao VA don thuan hodc cd phdi hcrp vdi cdc phau thugt khac thi khdng cd trudng hgp ndo hi bidn chdng chdy mau trong tudn ddu sau ngo.
3.6. Thdi gian ndm dieu tri tgi bfnh vien
1 ngay 2ng4y
£ 3 ngay N 4 11 6
%
19 52 4 28 6 Nhdn xet: Theo kdt qud nghidn cuu thi cac trudng hgp dugc phau thugt nao VA don thuan hoac phdi hpp thi thdi gian nam vifn 2ngdy Idphdbidnnhdt 11/21BN.
4. BAN LU^N 4.1. Dgc d em chung
Vidm VA qua phdt cd chi dinh nao VA gap d cd hai gidi vd khdng cd su khdc bidt ve mdt thdng ke. tudi gap nhieu nhat la nhd hon 10 tudi . Didu ndy phu hpp vdi cdc nghien cdu trude day cho rdng VA phdt trien mgnh nhat d tudi thu 6 sau dd thodi trien dan va bien mat hoan todn sau 20 tudi.
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Tap ChfTai Mui Hong Vidt Nam - Volume (57-9). N°3 - July, 2012
4.2. Dp qud phdt ciia to chirc VA Viem VA qud phdt gdy che Itin mdt phkn ho$c hodn todn cua mui sau , theo ket qud nghidn cdu thi chii yeu bfnh nhdn viem VA qud phdt diu d dd II ho^c dO III dicu ndy se gdy ndn nhihig bien chiing cho mui, xoang , tai do to chdc VA qud phdt gdy chdn dp va tdc nghdn.
4.3. Thdi gian phau thuat
Theo ket qua nghien cdu thi thdi gian ngo VA bdng dao Plasma ngdn tat cd cdc tru dng hgp deu chi mat 20 den 40 phut , dieu ndy rat ed y nghia khi trien khai rpng quy trinh phau thudt vi thdi gian md ngdn sd nit ngdn thdi gian gdy md ciing nhu se gidm dugc chi phi cho cupc md, thdi gian md ngdn cijng la mpt tidu ehi quan trpng khi can nhdc sd dung phuong tifn phau thugt.
4.4. Bien chung sau phau thuat nao VA Phdu thuat ngo VA Id mdt thudt eo bdn vd Id phau thudt ddu tay ciia cac bdc sy tai mui hpng nhung cdng la phau thugt hay gay bidn chiing nhdt va bien chung hay g|ip nhdt dd chinh la chay mau trong vd sau ngo VA.
Theo kdt qud nghien ciiu thi khdng cd trudng hgp ndo cd bien chiing chdy mdu trong ngdy ddu sau nao VA ciing nhu khdng ed bidn chung trong tudn ddu vd tudn thd 2 sau nao. Didu ndy cd y nghia rat Idn vi nhu vgy cde bdc sy tai mui hpng sd khdng cdn phdi lo lang nhieu vd bien chiing chdy mdu sau ngo VA khi su dung dao Plasma.
5. KtT LUAN
- Phlu thu^t ngo VA don thuAn vd ngo VA cd ph6i hgp vdi cdc phAu thudt khdc cd su dyng dao Plasma thi thdi gian phhi thudt ngdn chi mii tir 20 d^n 40 phiit.
PhSu thu$t ngo VA bdng dao Plasma khdng gdy bien chimg chdy mdu trong 24 h dau sau nao cung nhu khdng gay bien chiing chdy mdu trong nhihig ngdy theo ddi tiep theo d 100% bfnh nhdn nghien cuu.
TAI L i f u THAM KHAO 1. Quoc Bdo (2008), "Vidm V.A", xem tgi
http://www.benhhoc.coni/content/823- Viem-V.A.html
2. Dr Bryant A (2012), "Advanced Radiofrequency Surgical Technology and Tools". available at http://www.peaksurgical.com/products/
peak-technology/
3. Medtronic (2012), "PEAK PlasmaBIade TnA Dissection Device", available at : httpy/www.medtronic.com/for- healthcare-professionals/products- therapies/ear-nose-throat/sleep- disordered-breathing-products/airvance- system-for-obstruetive-sleep- apnea/related-products-for-sleep- disorders/index.htm#tab3
4. Metronic (2012), "Finally, a precision device for tonsillectomy and adenoidectomy", available at : http ://thiemed .cl/pdf/literatura/peak_pla smablade/Sl l_Ll.pdf
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