CVv253V39S82014148.pdf

Tgp CHl V - Diroc HOC OUBN sy s6 8-2014

NGHIEN CCrU KET QUA BIEU TRj VIEM PHUC MAC R U O T T H C T A

BANG P H A U T H U A T NOI SOI 6 BUNG TAI BENH VI$N QUAN Y 103

Bili Tuin Anh'; Nguyen Vu Quang' TOM T A T

NghiSn cyu kit qua dieu trj bing phiu thult npi soi (PTNS) eho 42 b|nh nhSn (BN) vi6m phiic mac rudt thya (VPMRT) tgl Khoa Phiu thult Bung, Bdnh vl|n QuSn y 103, cho thiy: aSj IS phugng phSp dilu tri an toSn vi hi|u qua Khdng cd tai biln trong m l vi Ml veng phlu thujt 9,5% biln Chung nhilm khuan chSn trocar Thdi gian mo trung binh: 79,8 ± 24,1 phOl TJ 16 chuyin mo md: 14,3%. BN nhanh phgc hli sau m l , rtit ngin thdi gian nlm vi|n (trung blnh 6,3

± 1,8 nggy). 95,9% BN phuc hli v|n dOng sdm. Nhu ddng rudt phyc h l i trung binh 41,3 ± 15,5 gid sau ml. Ket qua Chung 90,5% tot; 9,5% trung blnh, khdng cd kit qui xlu.

* Tir khda: ViSm phiic mgc ruOt thira; PhSu thult npi sol I bgng.

RESULTS TREATMENT OF APPENDICULAR PERITONITIS BY LAPAROSCOPIC SURGERY AT 103 HOSPITAL

SUMMARY

By studying 42 patients with appendicular peritonitis treated by laparoscopic surgery at Department of Abdominal Surgery, Hospital 103, we found that laparoscopic surgery for treatment of appendicular peritonitis Is safe and effective. There weren't serious complications and mortality The rate of infectious trocar's incision was about 9.5%. The average operating time: 79.8 ± 24.1 minutes. 14.3% of the cases were converted to open surgery. Patients could recover rapidly with shod hospital stay. The postoperative recovery Is fast and shorten hospital stay The rate of earty mobilization recovery was about 95.9%. Mean time of peristalsis recovery.

41.3 ± 155 hours. The period of postoperative hospital stay: 6.3 ± 1.8 days. The general outcomes:

90.5% good, 9.5% medium and 0% bad.

* Key words: Appendicular pentonitis; Peritoneal laparoscopy.

BAT VAN OE giam thieu biln ehO'ng. Tuy nhiln, ylgc Vilm phOc mac mpt thya l l biln chung "'"9 dung phiu thugt n i y chya dygc Ip nlng, k h i p h i biln cOa vilm rapt thOa eip. '''•'"9 rgng r l i .

Vi v|y^ vile dieu trj gap khdng it khd khan. Nghiin cyu nay nham; Gop phan dinh Phiu thult n l i soi cd tinh xim nhgp t l i gii vai trd eua PTNS trong diiu tn VPMRT thilu vdi yu dilm I I : It dau, nhanh h l i phyc, thdng qua cic kit qua sdm.

' Binh vien Quin y 103

Ngmtriphin hii (Corresponding): Nguyin VO Quang (nguyenvuquang2211@gmaii.com) Ngiy nhin bin 20/06/2014; Ngiy phin bl^n dinh gii bii bio: 15/09/2014

Ngiy bii bio dupv ding: 24/09/2014 148

Tiff CHi V - DUOC HOC QURN SU sS 8-2014

BOI TUONG VA PHUONG P H A P N G H l i N cCru 1. Ddi t i r g n g nghien CIFU.

42 BN VPMRT, dyge PTNS tgi Khea Phiu thult Byng, Bgnh vign Quin y 103 tir thing 5 - 2009 den 5 - 2011.

* Tiiu chuin chpn BN:

- BN dyge c h i n dean qua m l noi soi l l VPMRT.

- Quy trinh ky thugt m l thing nhit.

- H i s g nghiin eyu d i y du.

* Tiiu chuin io^i trir:

- BN khdng dyge x i e <flnh trong m l npi soi I I VPMRT.

- Ho sg nghien eyu khlng d i y dO.

- Co h i s g b l n h I n ghi chip khlng diy dO.

2. P h y g n g p h i p n g h i i n cO>u.

* Thiit ki nghien ciru: hoi cOu, md ta e i t ngang, khdng d l i ehirng.

* Cic chl tieu theo ddi, dinh gii:

- Treng mo:

+ So lygng, vj tri dgt trocar.

+ Thdj gian p h i u thugt: tinh tO' thdi dilm d | t trocar d i n khi k i t thOe p h i u thult.

+ S l lygng, vj tri d i n lyu p byng.

+ Ty l | chuyin me md.

- Sau m l :

•'• Thdi gian t i p v | n d|ng: thdi diem BN t y ngli d l y dyge.

* Thdi gian h l i phyc nhu dgng rupt:

thdi diem ed trung t i l n . + Thdi gian nam vign sau m l .

+ Bien ehyng sdm sau m l : nhilm k h u i n vet trocar, I p x e I byng, ehay m l u . . .

* Dinh gii kit qui chung:

Phin logi k i t qua phlu thult: tit: phlu thult an tpIn khong ed tai biln, biln chyng sdm sau m l ; trung binh: cd ele biln chOng nhg, dilu tri ngi khga khdi v l xuit vi|n;

x i u : cd b i l n ehirng phai m l Igi h o | o t y veng.

K i T QUA NGHliN COU VA BAN LUAN 1. C h u y i n m l m g .

- Ty Ig ehuyin m l md: 14,3% (7 BN).

* Nguyin nhin chuyen mo md.

Rupt trygng nhilu, hgn c h l trydng mo: 2 BN (28,6%); vet mo oO dinh: 1 BN (14,3%); b|e ip rupt thu'a khd khan: 4 BN (57,1%).

Wullstein C (2001) [8] g l p ty l | chuyen m l m g 7,6%; cua Lin H (2006) [6] I I 8,79%; Andreas K (2006) [4] 4,8%.

Nguyin nhin chuyen mo md chO y l u do dinh, rupt qua trydng, ddi khi ed the do u rugt thya.

2. Sd l y g n g , vj tri trgcar.

Sang 1:

S6 LUONG, VI TRi TROCAR

So Iiriyng trocar

Vi tri trocar thira

3 trocar 4 trocar T6ng Ha»l H i chju

trai T6ng

Sd BENH NHAN

41 1 42 34 8 42

T t i e

%

97,6 2,4 100 81 19 100

149

TRP CHl V - D U y HOC QURN SU S6" 8-2014 Hiu hit d o trygng hgp ehi sy dung 3 trocar. Mgt s l t i c g i i thdng b l e r i t it trydng hgp dgt them trocar thir 4, chOng toi phai I p dyng tinh hulng n i y ehe 1 BN.

Clo vj tri trocar thir 1, thir 2 tygng irng I I : egnh rln, mgng sydn trai. Trocar thO 3 ed t h i d h i chau t r i i hole hg vj.

3. Thai gian p h i u t h u | t .

< 60 phOt: 3 BN (7,2%); 6 0 - 1 2 0 phOt:

35 BN (83,3%); > 120 phut: 4 BN (9,5%).

Thdi gian phlu thu|t I I 4 5 - 1 8 0 phut, trung binh: 79,8 ± 24,1 phOt; tygng t y k i t qui cOa Dd Minh Dgi, Iviguyin Hoing Bio [1].

4. Lau ru'a 6 bung.

Tit ca BN d l u dygc rira I bgng qua nil soi. s l lygng djch rya: 500 - 12.000 ml, trung binh 2.300 ± 2.300 mi. Lygng djch rOa nhilu hay it tuy thulc v i e tinh trgng bin cOa I bung. M|t s l t i e gia khdng rya I bung cho t i t c l BN: ty Ig rya I byng eua Dygng Mgnh HOng la: 78,8%

[2), 21,2% ehi lau v l hOt djch.

5. Sd lugng d i n l y u .

100% BN d l u dygc d i n lyu I byng.

Trong dd, 61,9% (26 BN) d l t 1 d i n lyu Douglas qua h i ch|u phai; 33,3% (14 BN) d|t d i n Iyy Douglas v l dygi gan;

4,8% dyge dat 3 d i n lyu (Douglas, dydi gan, h i Ileh). S l lygng d i n lyu tOy thu|e vie tinh trang b i n eua I bung.

6. Phyc h i i sau m l . - Tgp vgn d|ng:

57,1% BN ngli dgy tgi giygng trpng 24 gid d i u sau m l ; 38,1% treng 24 - 48 gid v l 4,1% sau 48 gid.

Thdi gian phyc h l i nhu dpng rupt (trung tiln):

CIc trydng hgp d l u trung tiln trpng vdng 3 ngiy sau m l . Trang tign trong 24 150

gid d i u , 24 - 48 gid, 48 - 72 gig tygng yng 11,9%; 50% v l 38,1%. Thdi gian trung ti|n trung binh 41,3 ± 15,5 gid. Kit qua cOa D i e Duy Trygng: thgi gian tmng tign 3,35 ngiy.

- Thdi gian n i m vien sau m l : Thgi gian n i m vien cua mpt s l taring hgp bj k l o d l i I I do biln chyng nhilm khuan v l t trocar, tygng dygng vdi kit qua eua Navez B (7 ngay) [7], Do Minh Dgi (6,2 ngiy) [1], Nguyen Cygng Thjnh (7,01 ± 4,2 ngiy) [3].

* Thdi gian nam vipn sau mo:

3 ngiy: 1 BN (2,4%); 4 ngiy: 6 BN (14,3%); 5 ngiy: 8 BN (19,0%); 6 ngay:

8 BN (19,0%); 7 ngay: 10 BN (23,8%);

8 ngiy: 5 BN (11,9%); 9 ngay: 2 BN (4,8%); 10 n g i y : 1 BN (2,4%); 11 ngiy:

1 BN (2,4%).

7. B i l n chirng s d m sau m l . Nhiim khuin Id trgcar: 4 BN (9,5%);

khdng ed biln ehO'ng: 38 BN (90,5%).

Nhilm khuin thydng gap g v l t dgt trocar tai r l n I I vj tri lay rudt thu'a. Vj tri niy khong g i y khd chju eho BN se vdi m l mg.

8. Danh gia k i t qua p h i u thuat.

K i t qua t i t : 38 BN (90,5%); trung binh;

4 BN (9,5%); x i u : 0%.

Kit qua oua Dd Minh Dai: tot 94,5%, trung binh 2,3%, x i u 3 , 1 % [3], Nguyin Cudng Thjnh, Triiu QuIc Dgt: tit 95,06%, tmng binh 2,47%, x i u 2,47% [7].

KET LUAN

Qua nghiin cyu 42 BN VPMRT dygc dilu trj bing PTNS tai Khga Phiu thult Bgng, Bgnh vign Quan y 103 tO' 5 - 2009

TRP CHl V - DUOC HOC QURN SU 50 8-2014 den 5 - 2011, k i t qua che thiy: PTNS

dilu trj VPMRT I I phygng phip higu q u i va an t e l n : khdng ed tai biln trong m l v l to veng, 9,5% biln chirng nhilm khuin l l trocar. Ty l | chuyen m l mg; 14,3%. Thgi gian m l trung binh: 79,8 ± 24 phOt. Phye hoi van d|ng v l nhu dgng rugt sdm. Rut ngan thdi gian n i m vien. K i t qua d i l u trj:

tit: 90,5%; trung binh: 9,5%; x i u 0%.

TAI LliU THAM KHAO 1 DO Minh Dai, Nguyin Hoing Bae, NguySn Tin Cudng. PTNS dieu trj VPMRT.

Tgp chl Y hoc ThSnh phi Ho Chl Minh. 2003, tip 7, phy ban s l 1, tr.95-99.

2. Duang Mpnh Hung. NghiSn cuu irng dgng PTNS trong dilu tri VPMRT Lu|n in Tiin sJ Y hoc. Oal hoc Y Hui. 2009.

3. Nguyin Cudng Thjnh, Triiu Quic Bat PTNS dilu tri VPMRT. Y hpc Vi|t Nam. So dgc bilt thing 2/2006, tr 64-69.

4. Andreas Kinakopouios, [)imithos Tsakayannis, Dimitrios Linos. Laparoscopic management of complicated appendicitis. JSLS 10. 2006, pp.453-466.

5. Ellis H. Appendix. Principles of Surgery.

1986,42, pp.953-977.

6. Lin H.F, Wu J M, Tseng LM, Chen K.H, Huang SH. Lai IR. Laparoscopic versus open appendectomy for perforated appendicitis.

J Gastrointest Surg. 2006, Jun, 10 (6), pp.906- 910.

7. Navez B, Delgadlllo X, Cambler E, RIchir C, Guiot P Laparoscopic approach for acute appendicular peritonitis: Efficacy and safety: a report of 96 consecutive cases.

Surg Laparose Endosc Percutan Tech. 2001, Vol 11 (5), pp.313-316.

8. Wullstein C, Barkhausen S, Gross E Results of laparoscopic vs. conventional appendectomy in complicated appendicitis Dis Colon Rectum. 2001, Nov, 44 (11), pp. 1700-1706

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