TCNCYH 69 (4) - 2010
4. Jonathan Marrale, Matthew C. Morrissey and Fares S. Haddad (2007): "A literature review of autograft and allograft anterior cruciate ligament reconstruction". Knee Surg Sports Traumatol Arthrose 15: 690 - 704.
5. Luis Sierra Suarez and John C. Richmond (2007): "Overview of procurement processing and sterilization of soft tissue allografts for sports medi- cine". Sports Med Arthrose Rev; 15: 1 06 - 113.
6. Margit Pavelka, Jurgen Roth (2004):
"Collagen and elastic fibres". Functional
ultrastructure: An atlas of tissue biology and pathology. Springer, 250 - 252.
7. P. Kannus (2000): "Structure of tendon connective tissue". Scand J Med Sci Sports 2000:
10: 312 - 320.
8. Peter Fratzl (2008): "Tendon and ligament:
Structure, mechanical behaviour and biological function". Collagen: Structures and mechanics.
Springer, 269 - 284.
9. S. M . Belkoff and R. C. Haut (1992):
"Microstructurally Based Mddel .Analysis of Gamma irradiatien tenden albgrafts". J Orthop Res, Vol. 10, No. 3.
Summary
EVALUATION ON THE ULTRASTRUCTURE OF GAMMA IRRADIATED ALLOGRAFT TENDON
Objective: Evaluate the ultrastructure of Gamma irradiated allograft tendon. Methods: 6 Gamma irradiated deep frozentendon samples and 1 non - irradiated tendon sample. Evaluate the ultrastructure by scanning microscope and electron transmission microscope with 10000 to 50000 times magnification.
Results: There are some damages of irradiated tendon with scanning microscope. The ultrastructure is the same among irradiated and non - irradiated tendon sample w i t h electron transmission microscope.
Conclusion: Gamma irradiation with 25 kGrays dose cause damage to the ultrastructure of collagen fibre but mainly the branchs between the bundles.
Keywords: ultrastructure. Gamma irradiation, collagen i
BIEN CHL/NG vA KET QUA CUA PHAU THUAT
NOI ONG MAT CHU - TA TRANG TRONG BENH LY SOI DL/CfNG MAT
Nguyen Van Tong TrUdng Dai hge Y - Dugc Can Tha Sdi mat la mot benh phd bien moi nai, phau thuat ndi dng mat chu - Ta trang vin cd vi tri Irons xd ly sdi dudng m$t cap cdu. Muc tieu: (1) danh gia cac bien chUng cua phau thuat ndi dng mat chu -ta trane. Doi tagng va phaang phap nghien cdu: hoi cUu md ta cat ngang 64 trUdng hgp ndi d'ng mat chu - Ta trane tai benh Vien Da khoa Trung uang Can Tha td nam 1999 den 2004. Ket qua va ket luan: hep mieng ndi (9,37%o), xa gan (l,56%o), ap xe gan dUdng mat (l,56%o), td vong sau 5 nam 8 trudng hgp (9,19%),
TCr khoa: ndi dng mat chu - ta trang •sn
88
TCNCYH 69 (4) - 2010
I. DAT VAN DE
Sdi mat la mpt benh phd bien mpi nPi, 6 cac nddc dang phat trien cung nhU d cac nUdc phat trien.
Phlu thuat ndi dng mat chu - ta trang (OMC - TT) v i n ed vj trf trong xd ly sdi dddng mat, dac biet la trong cap cdu [2], va d cac benh vien tuyen tinh trong dieu kien cdn thieu cac phifpng tien ky thuat hien dai.
Cac phUPng phap d i n lUu mat - rupt dUpe sd dung nham giai toa sU tac nghen dUdng mat, trong cac trUdng hpp hep doan cudi d'ng mat chu, hoae cho cac trifdng hdp nhU sdi trdng gan khdng the lay het, sdi dUdng mat md nhieu l l n , sdi mat tai phat . ^ . . . [ 1 , 4 ] . Chung tdi thdc hien nghien edu nay vdi muc tieu:
Danh gia cae bien chdng ciia phau thuat ndi dng mat chu ta trang.
II. DOI TUONG v A PHUONG
P H A PNGHIEN CL/U
1. Dd^i tupng nghien cu'u
Nhdng hd so cua benh nhan difdc md lay sdi ndi OMC - TT tai benh vien da khoa Trung Udng Can Thd td nam 1 999 - 2004.
Tieu chuan loai trd: nhdng trUdng hdp ndi mat rupt khdng p h l i nd'i d'ng mat chu - ta trang.
2. Phuong phap nghien ciifu:
- Nghien edu ddpc tien hanh theo phUOng phap hdi cdu md ta cat ngang.
- Xd ly sd lieu bang p h I n mem SPSS 11.5.
III. KET QuA
Trong 1096 benh nhan dUpc md lay sdi dUdng mat tai Benh vien da Khoa Trung L/dng Can Thd td thang 1/1999 - thang 1/2004 cd 64 trUdng hdp ndi OMC - TT, trdng dd cd 24 benh nhan nam (37,5%) va 40 benh nhan nd (62,5%).
Bang 1. Phan bd Nhom tudi
3 0 - 3 9 4 0 - 4 9 5 0 - 5 9 6 0 - 69
> 70
ty is theo nhdm tudi n
6 12 9 18 19
(%) (9,37) (18,75) (14,10) (28,10) (29,68)
1 . Bien chu'ng
Bang 2. Phan bd bien chdng sdm Bien chiing TrUdng hpp Nhiem trung vet md 14/64
Dd mat 1/64
% 23,80
1,56
Bang 3. Cac bien chdng mugn
Bien chu'ng n Hep mieng ndi 6/64
Xdgan 1/64 Ap xe gan dddng mat 1/64
(%) (9,37) (1,56) (1.56)
2. Ket qua dieu trj Tieu chuan danh gia :
- Tdt: khdng cd lan nhap vien dieu trj; Khdng cd dau HSP - T V ; An udng binh thddng; Kiem tra xet nghiem , sieu am , trong gidi ban binh thddng.
- Trung binh: cd l l n vao vien dieu trj; Cd dieu trj npi khdi; Cac xet nghiem chUa ve binh thudng
- Xau: phai nhap vien d i i u trj n h i i u lan; Con dau lien tuc, sdt... Cac xet nghiem bieu hien benh ly; Cd bie'n chdng c i n phai can thiep thu thuat, phau thuat va td vong.
Bang 4. Ket qua dieu tri sdm Tinh trang ra vien
Tdt Trung binh
Xau
TrUcfng hpp 41 20 3
% (64) (31) (5)
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TCNCYH 69 (4) - 2010
Ket qua theo ddi 5 nam ed 8 trUdng hgp td vong chiem ty le 9,19%o.
IV. BAN LUAN
1 . Cac bien chufng cua ndi OMC - TT
Viem dudng mat ngUpc dong: la bien chdng thddng gap, ly le n h i i m trung ngdpc ddng khac
nhau tuy theo thdng ke cua tdng tac gia.
Theo thdng ke Hu'/nh Quyet Thang va cpng sU n h i i m trung dUdng mat ngUpc ddng sau ndi OMC - T T la 12,8% [6].
Theo Dd Trpng H a i , ty le n h i i m trung dUdng mat ngifpc ddng la 1 6,6% [3].
VUdng Hung va N g u y i n Ngpc Bich then ddi 132 trUdng hpp ndi mat rupt cd ty le n h i i m trung ngifpc ddng la 21,3% [5].
Vu Manh ghi nhan !•/ le n h i i m trung dddng mat sau nd'i mat rupt la 25,8%.
NgUpc lai, tac gia nUdc ngoai thi ty le n h i i m trdng dddng mat ngUde ddng lai tha'p.
Theo Terrier va cpng sU trong 224 trifdng hpp ndi OMC - TT td 1957 - 1978 ty le n h i i m trdng ngUflc ddng nang la 6 % [8].
Theo sd lieu thdng ke cua chung tdi cd 46/64 trddng hpp chiem ty le 71,9%; cd n h i i m trung
ngifpc ddng.
Nhin chung van de n h i i m trung ngUpc ddng sau nd'i OMC - TT la van d i dang quan tam, tren thdc te da cd ky thuat chdng trao ngdpc de phdng ngda n h i i m trdng ngdpc ddng [1].
Hep mieng ndi la bien chdng xay ra d bat cd p h l u thuat ndi mat rupt nao. Da'u hieu n h i i m trung dudng mat ngUpc ddng sau md tai dien nhieu lan the hien bang dau hieu sdt lanh run, dau thUpng vj va ha sUdn phai la nhdng gpi y cho npi soi va sieu am de chan doan viem, hep mieng ndi .
Theo tac gia nddc ngoai, ty le hep mieng ndi:
H .Bismuth 4 , 2 % [9]; Leborgne 1 3%;
Theo tac gia Viet Nam thi ty le hep mieng ndi:
Vu Manh 12,9%; VUdng Hung & N g u y i n Ngpc Bich 4%;
Thee sd lieu thdng ke cda chung tdi trong 5 nam cd 6/64 trddng hdp tac mieng ndi chiem ty le 9,37%. Trong dd 3 trUdng hpp phau thuat lai ndi theo phuong phap Rouxen Y, 3 trUdng hdp can thiep bang ERCP. ,^
Ap xe gan do sdi mat trong gan
N h i i m trung mat keo dai kem sdi trong gan tao CO hpi hinh thanh ap xe dddng mat hoae n h i i m trung mat rat nang [4].
Theo Fong - Fu - Chou, M D va cdng sU [7] theo ddi 9,5 nam vdi 483 benh nhan thay \y le ap xe gan sau md la 3 , 1 % nhUng ngUdc lai ap xe gan do sdi trong gan rat cao 33,4%.
Chung tdi cd 01/64 trUdng hdp ap xe gan trai do sdi trong gan sau ndi OMC - TT, ap xe gan sau md mat ft ddpc y van trong va ngoai nUde nhae den VI cd le ty le tha'p.
Sdi trong gan vdi ndi OMC - TT
N h i i u tac gia trong nddc da ap dung eae phdong phap ndi OMC - T T va phddng phap ndi mat rupt trong va ngoai gan hoae bang sang tao ciia minh nham khac phuc va dieu trj sdi trong gan nhdng cho den nay, qua n h i i u hpi nghj ngoai khoa trong va ngoai nUdc van d i nay v i n la nan giai.
Ty le sdi trong gan d Viet Nam rat cao tiJy thdng ke cda n h i i u tac gia [2, 3, 4, 5]. Viee chon phuong phap nd'i mat rupt nham muc dfch tao lull thdng dudng mat va hy vong sdi trong gan rdi xudng ta trang, cai thien tfnh trang tac mat.
Td vong sau 5 nam theo ddi d nhdm benh chdng tdi la 8 trUdng hdp, ngdai 2 trUdng hdp khnng ddng y p h l u thuat (xin v i ) , 6 trUdng hdp cdn lai td vong do ngoai van d i benh ly sdi mat cdn cd nhdng benh ly phdi hdp, tudi gia...
Ngay nay vdi sU tien bp cda khoa hpc ky thuat.
90
TCNCYH 69 (4) - 2010
n h i i u phUdng tien chan doan mdi ra ddi, nhieu phddng phap d i i u trj mdi xuat hien, hda hen tddng lai tdt hon cho benh ly sdi trong gan d nddc ta.
V. KET LUAN
Qua khao sat va nghien cdu 64 trddng hpp nd'i OMC - TT tai benh vien Da khoa Can Tho td thang 1/1999 - thang 1/1004 eho phep chdng tdi ket luan nhUsau:
Ty le benh nhan md OMC - TT giam theo hang nam.
Lam sang va can lam sang da hd trp gidp chan doan, d i i u trj, can thiep thu thuat, phau thuat kjp thdi. Tuy nhien v i ket qua lau dai nhieu van de ddpc dat ra la: giai quyet cac bie'n chdng nhd nhiem trung dddng mat ngUde ddng. Sdi tro^ng gan, hep mieng ndi, ap xe gan dUdng mat va van d i Idn nha't la chat lUpng cupc sdng. Ty le td vong 9 , 1 % cd lien quan tdi tudi cao benh nang kem theo .
T A I LIEU THAM K H A O
1. Nguyin Ngpc Bich (1993), "Nghien cdu ky thuat tao van chdng trao ngdpc tren thdc nghiem va ket qua ap dung tren benh nhan bj nhiem trung dudng mat ngUpe ddng sau khi da ndi mat rupt kieu Roux en Y". Luan an phd tien sT Y hpc.
Ha Npi.
2. Doan HO'u Dong (1994), " M p t vai nhan xet ve phau thuat sdi mat trong 12 nam (1983 -
1994 ) tai khoa ngoai benh vien Saint - Paul Ha
N d i " . Luan an bac sT cheyen khoa cap II. Dai hpc Y Ha Npi.
3. D6 Trpng Hai (1991), " P h l u thuat ndi mat rupt trong benh ly sdi mat. Ap xe gan amips va sdi^
dudng mat". Hpi thao ngoai khoa Dai Hoc Y Dupc thanh p h d Hd Chf M i n h 6 - 8/06/1991, C i n Tho, tr 2 4 0 - 2 4 7 .
4. Nguyin Dinh Hoi (1997), "Benh sdi dUdng mat d Viet N a m " . Y hpc thanh phd' Ho Chf M i n h , tap I s d 3 , tr 105 - 116.
5. VUdng HCing, Nguyin Ngpc Bich (1992),
"Tinh hinh phau thuat d benh vien Bach Mai (1980 - 1991)". Tap chf Y hpc thifc hanh, sd 5, 2 6 - 2 8 .
6. Huynh Quyet Thang (2002), "Nghien cdu dieu trj phau thuat cap cdu sdi dUdng mat tai Benh vien Da Khoa C i n Tho". Luan an tien sT Y hpc. Dai hpc Y Ha Npi.
7. Fong - fu Chou et al (1997), "Single and multiple pyogenic liver abscess: Clinical course ,etiology, Results of treatment". Werld jdurnal of surgery. May, Vol. 2 1 , N''4, 384 - 389.
8. Marvin L, Gliedman, Micheal S. Gold (1985), "Choledochoduodenostomy. Maingot's Abdominal Operation". 8th Edition; Tone II, 1909 - 1923.
9. Bismuth H ,Hepp J (1969), "Le traitement chirurgical de la lithiase intra hepatique", Entretien de bichat chirurgie, 69 - 72. '
Summary
THE COMPLICATIONS OF OPERATION OF CHOLEDOCHO - DUODENOSTOMY
Cholelithiasis is not uncommon, choledoeho - duodenestdmy is still performed in some situations of emergency operation. Objectives: To estimate the complications of operations of choledoeho - duodenostomy. To tell the result of intervention. Methods: Retrospective, cross - sectional research of 64 eases of choledoeho - duodenostomy done in Cantho central general hospital from 1999 to 2004. Result and conclusion: Stenosis of anastomosis is 9.37%; hepatic cirrhosis: 1.56%; cholangitis abscess: 1.56%;
death after 5 years of operation: 9.19%. ^^,., ..^ , , , , , , . . . • - ; ,.,j,i Keywords: Choledoeho - duodenostomy ; . , , : 0
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