chda b$nh npi tru, ngoai trii tai mpt s6 benh vien trung treng - Ha N0i va de xult cac giai phap khlc phuc tinh trgng qua tai"
3. BO Y te. "Bao cao kiem tra b$nh vien nam 2006".
Cue Quan ly Kham chda b#nh.
4. Drew B Richardson. Increase in patient mortality at 10 days associated with emergency department overcrowding. MJA2006; 184 (5): 213-216.
5. Bp Y te - Benh vien K (2009) "Bao cao ve thyc trang
qua tai tai B§nh vien K va cac bien phap giai quyet"
6. Bf> Y te - Chi thj s6 01/2002/CT-BYT ngay 11 thang 3 nam 2002 cua Bd trudng Bd Y te ve viec dly m?nh cdng tac phdng chong ung thu trong cac cu sd y ti. "Quy hoach phat trien mang ludi phdng chong ung thu tai Viet Nam giai do?n 2009 - 2020".
7. Tran Tan Tram (1997). "Khao sat nguy£n nhan qua tai tai benh vien Nhi dong I va de xult hirdng giai quyet".
Bao cao khoa hpc B#nh vien.
KET QUA DIEU TRJ BENH PHING DAI TRANG BAM SINH BANG PHAU THUAT QUA DUTJNG HAU MON MOT THI BUI BUG HAU, NGUYEN THANH LIEM,
TRAN ANH QUYNH, VU H6NG ANH Khoa Ngoai - Benh vien Nhi Trung uong TOM TAT
Muc dich: Muc dich cua nghien cdu nay la trinh bay kinh nghidm va nhung ket qua budc diu ung dung ky thudt Soave cai tien bang phau thuat qua dudng hau mdn trong dieu tri bdnh phinh dai trang bSm sinh (PDTBS). Bdi tUdng vd phuang phap nghien cdu: Td thang 2-2003 den thang 12-2007, 132 benh nhan (104 nam, 28 nCt) bi bdnh PBTBS da dUOc phau thuat bang dudng qua hdu mdn mCit thi. Tuoi td 15 ngay den 36 thang. Phau thudt duac thuc hidn qua Id hau mdn. Doan dai trang vd hach vd dai trdng lanh duoc xac dinh ngay trong khi md bing sinh thiet tut thi. Doan dai trang benh ly duac cit bd dd lai dng thanh ca cda dng hau mdn true trang ngin 2cm td trdn dddng rdng luoc. Midng ndi giua dai trang lanh vdi dng hau mdn duoc thuc hidn mdt thi trdn dudng luoc 1cm. Ket qua: Trong nghidn cdu nay cho thSy doan dai trang vd hach 6 true trdng 71 trudng hap, 6 sigma 44 vd dai tdi dai trdng xuong 17. Thdi gian mo trung binh 107 phut. Khdng cd td vong va bien chdng phiu thudt. Mdt mau trong m6 rdi It, cd mdt trudng hdp bi A mau midng ndi ddi hdi phai truyen mau va tu dm d ngay thd hai sau md. Thdi gian nim vien trung binh 5,53 ngay. Td't ci bdnh nhdn deu tu dai tidn duoc khi xuSt vien. Theo ddi sau md duac 80 (60,6) bdnh nhan. Thdi gian theo ddi ngin nhdt 4 thang, dai nhdt 63 thang, trung binh 34,7 thang. 47 (58,7%) bdnh nhan dai tien chu ddng 1-2 lin trong ngay, 28 (35%) bdnh nhan dai tidn 3- 4 lin/ngdy, 4(5%) bdnh nhan dai tidn trdn 4 lin/ngay, 1(1,3%) bdnh nhan van tao bdn dai ding. Vidm rudt sau md xiy ra d 7(8%,) bdnh nhan. Tit ca bdnh nhan theo ddi dUdc deu khdng cd rdi loan ve tidu tidn. Kha nang cuong duang vat deu tot d 63 bdnh nhan nam theo ddi duac. Ket luan: phiu thudt mdt thi qua dudng hdu mdn dd diiu trj bdnh PDTBS Id phudng phap an toan, cd hidu qui cao.
Tit khoa: Dai trang, phinh dai trang bam sinh (PBTBS), dudng qua hau mdn. SUMMARY OBJECTIVE: The aim of this study was to describe the experience and to present the initial results in the treatment of Hirschsprung disease (HD) by applying modified Soave procedure through Transanal approach. METHODS: Between February 2003 and December
2007, 132 patients (104 males, 28 females) underwent primary endorectal colon pull-through procedure (Transanal approach) for HD. Ages ranged from 15 days to 36 months. The operation was pedormed through the anus. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies obtained intraoperation. We left a short rectal seromuscular sleeve 2cm from the dentate line.
RESULTS: The aganglionic segment was located in the rectum in 71 patients, in the sigmoid colon in 44 patients, in the left colon in 17 patients. The median operating time was 107 minutes. There were no operative complications or deaths. There was minimal blood loss during surgery. There was one anastomose minimal bleeding that is stopped spontaneously on the 2nd day after surgery and required blood transfusion. The median hospital stay was 5,53 days. Spontaneous defaecation occurred in all patients before discharge.
Follow-up obtained in 80 infants (60.6%,). The duration of follow-up ranged from 4 to 63 months (averaged, 34.7 months). Forty-seven patients had 1 to 2 stools per day (58.7%>). Twenty-eight patients had 3 to 4 stools per day (35%). Four patients had more than 4 stools per day (5%). One patient had persistent constipation (1.3%). Enterocolitis occurred in 7 patients (8.7%). Intermittent urinary didn't occur in all. Erectile function, evaluated by infant's parent, was presented in all 63 males who was followed up.
CONCLUSION: One-stage transanal approach is a safe and effective procedure for HD.
Keywords: colon, Hirschsprung disease, transanal approach.
OAT VAN Di
Cho den nay nhieu ky thuat md va dudng md da dddc sir dung de dieu tri benh PBTBS. Cac ky thuat kinh dien qua dudng bung da dupe sd dung trong nhieu nam [11,12], Gan day, nhieu dddng md nhu phau thuat qua dudng hau mdn (HM), phiu thuat qua dudng sau true trang (STT), phiu thuat ndi soi (NS) cung da dddc ap dung rdng rai [1,2,3,4,5,6,7,8,9,10] va dang dan dan thay the nhung dddng md kinh dien qua bung. Td nam dddng HM ddpc ap dung bdi de la Torre Mondragon va 1998, sau khi ky thuat co ban nhat cua phau thuat qua
Y HOC THUC HANH (739) - SO 10/2010 77
Ortega Salgado [1], no dang ngay cang dddc ap dung rpng rai hdn de dieu trj benh PDTBS. Phau thuat qua dddng HM dddc chung toi ap dung lan dau tien nSm 2000 de dieu tri benh PDTBS, va td 2001 ky thuat nay da ddoc ap dung mpt each co he thdng de dieu trj benh PDTBS tai benh vien Nhi trung ddng.
Muc dich cua nghien cdu nay la nham trinh bay kinh nghiem va nhdng ket qua budc dau dng dung ky thuat Soave cai tien bang dddng qua hau mdn trong dieu trj benh PDTBS tai benh vien Nhi trung ddng.
DOI TUONG VA PHUONG PHAP NGHIEN CUU 1. Ddi tupng nghien cUu
Bao gdm tat ca benh nhan bj benh PDTBS dUdc md bang phau thuat Soave cai tien qua dddng HM, td thang 2-2003 den thang 12-2007, tai Benh vien nhi TW. Tieu chuan chpn de chi djnh md cho ky thuat nay bao gdm:
tudi, gidi, nhdng trddng hdp cd doan vd hach d trdc trang va trdc trang xich-ma ma dai trang phia tren doan vd hach khong gian to qua. Chan doan benh ddpc xac djnh bang sinh thiet trdc trang trong md.
2. Phuong phap nghien cdu
La phddng phap mo ta tien cdu. Tat ca benh nhan dddc nghien cdu theo mdt mau benh an thdng nha't. Cac thong tin nghien cdu bao gdm tudi, gidi, bieu hien lam sang, vj tri vd hach tren phim chup dai trang, vj tri vd hach trong md, phddng phap phau thuat, thai gian md, chieu dai doan cat bo, bien chdng va tdvong sau md.
Ky thuat md: Benh nhan nim tuthe san khoa (co the khdng treo chan neu benh nhan qua nhd). Bat dau rach vdng quanh niem mac cua dng hau mdn ngay tren dddng Iddc khoang 0,5-1cm. Phau tich Idp niem mac len tren (khoang 6-8cm) phia tieu khung tdi nep gap phuc mac tieu khung, se thay Idp thanh cd thanh trddc trdc trang Ion xuo'ng, cat dpc md mot Id nhd qua Idp thanh cd nay de vao d phuc mac, rdi cat vdng quanh dng thanh cd giai phdng hoan toan trdc trang, dng thanh cd trdc trang dddc cat sda de lai mpt phan dng thanh cd (kdp) dai 2cm tinh td dddng Iddc. Tiep tuc phau tich mac treo xich-ma keo trdc trang va xich-ma ra ngoai qua dng hau mon.
Tien hanh sinh thiet lanh d 2 vj tri chd dai trang hep va chd dan de xac djnh chan doan. Cat bo doan dai trang vd hach va doan dai trang gian ngoai d bung. Ndi dai trang lanh vdi dng hau mdn each dddng rang Iddc khoang 0,5-1 cm. Ndi 1 thi, cd the de mom thda dai trang neu dddng kinh dai trang va dng hau mon qua chenh lech hoSc cd nhdng yeu to lam anh hddng tdi sd an toan cua mieng ndi. Bat 1 xong Folley vao dai trang qua mieng ndi de Idu khoang 4 ngay. Ket thuc phiu thuat. 12 gid sau md cho tre udng nddc, cho an sda ngay thd hai sau md. Xuat vien ngay thd td hoac thd nam sau md. Bat dau nong mieng ndi td tuan thd 3 sau md, nong mot thang lien tuc. Dat Ijch kham djnh ky 3-6 thang mot lan trong 3 nam. Trong thdi gian nghien cdu td thang 2-2003 den KET QUA NGHIEN CUll thang 12-2007, 132 benh nhan (104 nam, 28 nd) bi benh PDTBS da dddc phau thuat bang dddng qua hau mdn mdt thi. Tudi td 15 ngay den 36 thang (bang 1). So benh nhan cd doan vd hach d trdc trang 71, d dai trang sigma 44, d dai trang trdi 17 (bang 2). Chieu dai doan dai trang cat bd ngan nhat 10cm, dai nhat 35cm (bang 3).
Bang 1: Phan bd tudi theo thang
Tuoi Sd luong %
< 12 107 81
13-24 17 12,9
>24 8 6,1
Tdng sd 132 100
Bang 2: Vj tri doan vd hach
Vi tri doan vo hach So luong %
True trang 71 53,8
Dai tdi sigma 44 33,3
Dai tdi dai trang trai 17 12,9
Tdng sd 132 100
Bang 3: Chieu dai doan dai trang cat bo Chieu dai doan cat bo (cm) Sd luong %
10-20 64 48,5
21-30 55 41,7
>30 13 9,8
Tdng sd 132 100
Thdi gian md ngan nha't 50 phdt, dai nha't 240 phut, trung binh 107 phut. Khdng cd td vong trong va sau md.
Mat mau trong md rat it, cd mpt trddng hpp ri mau mieng ndi da td ngdng chay sau tryen mau d ngay thd hai sau md. Trong 132 trddng hdp cd 23 trddng hop phai chuyen md dddng bung (ket hpp vdi NS hoac md bung nhd) do cang ddng mach mac treo dai trdng sigma, do doan vd hach dai va cd mpt trddng hdp do cd khdi u phan to trong dai trang sigma. Thdi gian nam vien sau md trung binh 5,53 ngay. Tat ca mpi benh nhan deu tddai tien tot khi xuat vien.
Theo ddi sau md duac 80 (60,6%) benh nhan. Thdi gian theo ddi ngan nha't 4 thang, dai nha't 63 thang ( trung binh 34,7 thang). 47(58,7%) benh nhan cd 1-2 lan dai tien / ngay. 28(35%) benh nhan cd 3-4 lan dai tien/ngay. 4(5%) dai ten > 4 lan ngay. 1(1,3%) benh nhan vln tdn tai tao bdn giai ding. 7(8,7%) viem rupt sau md. Tieu tien binh thudng d tat ca benh nhan. Qua hoi bd me benh nhan, kha nang cuang dddng vat vao budi sang deu cd d 63 benh nhan nam theo ddi dddc.
BAN LUAN
Dddng md bung de dieu trj benh PDTBS ia dddng phiu thuat quy ddc. Tuy nhien, nhieu dddng md khac nhd dddng qua HM, dddng STT va NS cung da dddc sd dung [1,2,4,5,7,8], Dddng qua HM cd nhieu du diem quan trpng hdn sa vdi dddng md quy ddc. Mac du, dddng qua HM khdng bpc Id that rd rang dng HM, trdc trang va vung tieu khung, nhdng neu phau tich chinh xac sat thanh trdc trang se it gay tdn thddng tdi cac tang xung quanh. Dddng qua HM tranh ddpc cac bien chdng nhu thoat vi thanh bung, tac rupt lien quan tdi md bung.
Benh nhan hdi phuc nhanh va it dau.
Ky thuat cua chung toi khac mpt vai chi tiet nhd so vdi ky thuat cd ban ma tac gia de la Torre Mondragen va Ortega Salgado da md ta nam 1998 [1], khac d chd: dng niem mac duac phau tich len cao tdi nep gap phuc mac tieu khung. Ldp thanh ca cua thanh trudc true trang Ipn xuo'ng, cat dpc md mpt Id nho tai chd dng thanh cd Ipn xuo'ng ndy de vao tieu khung, roi cat vdng quanh Idp thanh cd de giai phdng hoan toan true trang. dng thanh
78 Y HOC THUC. HANH (739) - SO 10/2010
cd dude cat sda de lai kdp dai 2cm tinh til dddng Iddc, phau tich nhd vay se han che gay sang chan cho cac co quan can ke. Ngoai ra, mieng noi gida dai trang lanh vdi dng hau mdn dddc thdc hien gan gidng ky thuat Soave, cd cai tien hdn mieng ndi thdng thddng la cd 1cm dng thanh cd cua kdp phu ngoai mieng ndi. Chung toi tin rang vdi ky thuat ndi nay, mieng ndi ddpc cung cap mau tot va giam nguy cd ro mieng ndi. Kdp de lai ngan cd the tranh ddoc hien tdpng tao bdn dai dang ton tai sau mo, ma hien tddng nay thlnh thoang van thay con ton tai trong phddng phap Soave cd* dien.
Trong nghien cdu ndy, dddng qua HM da dddc dp dung thanh cong, khdng nhdng cho the loai cd doan vd hach dai d trdc trdng ma con cho ca loai cd doan vo hach dai tdi sigma. Cd 23 trddng hdp da phai phdi hdp vdi dddng bung do mpt so trddng hdp b| cang mach mac treo, mpt sd trddng hpp khac cd doan vd hach dai qua sigma vd mpt trddng hdp do sigma gian to cd chda khdi u phan. Sau md, tat cd benh nhan deu dai tien dddc binh thddng. Theo ddi lau dai la can thiet de danh gia chdc nang, dac biet la chdc nang dai tien. Qua ket qua nghien cdu cua chung toi cho thay, phiu thuat theo phddng phap Soave cai tien, blng dddng qua HM la mpt trpng nhdng phddng phap phiu thuat cd hieu qua tot, an toan cd the dddc Ida chpn de dieu tri benh PDTBS vdi chieu dai doan vo hach d ca trdc trang vd sigma. Phiu thuat npi soi can dddc phdi hdp khi ha dai trang bang dddng qua HM ddn thuan gap khd khan.
KET LUAN
Ket qua thu ddpc td 132 benh nhan bj benh PDTBS dddc phiu thuat theo phdPng phap Soave cai tien blng dddng qua HM cho thay day la mpt phdang phap phiu thuat an toan, cd the khau ndi mpt thi neu cd du kien an toan cho mieng ndi. Phiu thuat cd the thdc hien ddpc d
tuyen chda cd dieu kien ky thuat cao, nhdng phai la ndi cd khoa phau thuat nhi va cd phiu thuat vien giau kinh nghiem ve benh PDTBS.
TAI LIEU THAM KHAO
1. De la Torre Mondragon L, Ortega Salgado JA.
Transanal endorectal pull-through fpr Hirschsprung's disease. J Pediatr Surg 1998;33:1283-1286.
2. De la Torre-Mondragon L, Ortega-Salgado JA.
Transanal versus open endorectal pull-through for Hirschsprung's disease. J Pediatr Surg 2000;35:1630-2.
3. Elhalaby EA, Hashish A, Elbarbary MM, et al.
Transanal one stage endorectal pull-through for Hirschsprung's disease: a multicenter study. J Pediatr Surg 2004;39:345-51.
4. Georgeson KT, Fuenfer MM, Hardin WD. Primary Laparoscopic pull-through for Hirschsprung's disease in infants and children. J Pediatr Surg 1995;30:1017-22.
5. Hedlund H. Posterior sagittal resection for rectal aganglionosis preliminary results of a new approach. J Pediatr Surg 1997;32:1717-20.
6. Langer JC, Durrant AC, de la Torre-Mondragon L, et al. One-stage transanal Soave pull-through for Hirschsprung's disease: multi-center experience with 141 children. Ann Surg 2003;238:583-5.
7. Nguyen Thanh Liem*, Bui Due Hau, Hoang Thanh Son. Modified Soave procedure through the posterior sagittal approach for Hirschsprung's disease. J Pediatr Surg 2005;40:547-550.
8. Nguyen T. Liem, Bui D. Hau. Primary Laparoscopic Endorectal Colon pull-through for Hirschsprung's disease: Early results of 61 cases. Asian Surg 2006;29(3):173-5.
KHAO SAT CAC KIEU TE BAO TRAN CUA XOANG TRAN DUA TREN MS-CT16 TREN 125 TRUONG HOP
NGUYEN TRIEU VIET
Bp mdn Tai Mui Hong- DH Y Dope Can Tho TOM TAT:
Viec nghien cuu khao sat cac kieu tS bao tran cua xoang tran da duoc thuc hien boi nhidu tac gia ngoai nude nhu Han DM. (n=404)... , tuy nhien trong nude vdn chua cd nhidu nghien cuu vd van dd nay. Trong nghien cuu nay chung tdi thuc hien viec khao sat cac kiiu td bao tran cua xoang tran tren 125 benh nhan (250 ben) dua tren MS-CT 16.
Phuong phap nghien cuu la md ta cat ngang tren loat benh nhan, each thuc chon mdu thuan tien. Cac trudng hop nay duoc chup MSCT 16 vung diu tai tao du 3 tu thi la axial, coronal va sagital. Cac ket qua thu dupe la: ti le xuat hien te bao tran la 76/250 (30.4%), trong dd kieu I 49/250 (19.6%), kieu II 221250 (3.8%), kieu III 5/250 (2%,), kieu IV 0/250. Ket qua cho thiy ti /e xuat hien cac te bao tran, va cac kieu te bao tran la kha da dang niu khdng duoc danh gia chinh xac trudc phau thuat cd the dan den viec khdng phai phiu thuat vao vi tri xoang tran mong mudn. Tir khda: xoang tran, MS-CT 16.
SUMMARY:
An analysis of frontal cells depending on MSCT 16 on 125 cases
Many foreign authors (such as Han DM. (n=404)...) have done the studies to investigate the types of the frontal cells based on MSCT 16, but domestic authors have not done frequently. In this study we investigate the types of frontal cells of 125 cases (250 sides). The study method is a cross-sectional description in serial cases.
These cases have been done MSCT 16 in head region with the remodeling in three positions including axial, coronal, sagital position. The results include: the presentation of frontal cells 76/250 (30.4%), type I 49/250 (19.6%), type II 22/250 (8.8%), type III 5/250 (2%), type IV 0/250. The results express the variable formations of frontal cells, and types of frontal cells.
Keywords: frontal cells, MSCT 16
DAT VAN DE -Khi khao sat xoang tran va ngach tran, ngudi ta ghi
