KET QUA CAT BAI TRANG QUA NOI SOI 6 BUNG
Nguyen Phiic M i n h ' , Dd Minh Hung*, Nguyen Manh Dung", Holng VTnh Chiic*, Le Quang NghTa*
TOM TAT
Myc tieu nghien cuu: Danh gii ket qui dieu tri ung thu dai trang bang phlu thuat npi soi.
Doi tumig va phircmg phap: Hdi cuu 60 benh nhin duge phau thuat dieu tri ung thu dai trang tai khoa Ngoai 4, benh vien Binh Dan.
Ket qua: Trong 2 nam, chung tdi phau thuat dugc 32 benh nban nam va 28 nii, tudi trung binh 11 55. Co 60 trudng hgp cat dai tring gdm: 20 ea cat dai trang phai, 5 ca cit dai tring ngang, 5 ca cit dai trang trai, 30 ca cit dai trang chau hdng. Ti le chuyen md md la 16,7% (10 ca). Cac bien ehung xay ra 11 nhiem trung vet md (9 ca), viem phuc mac do xi mieng ndi (3 ca), 1 tu vong.
Ket luan: Phau thuat ndi soi cat doan dai tring trong dilu tri ung thu dai trang la mpt ky thuat kha thi vl an loan.
Tir khod; Ung thu dgi trdng/phdu thudt noi soi
ABSTRACT
LAPAROSCOPIC SURGERY FOR COLON CANCER AT BINH DAN HOSPITAL
Objective: Evaluation of laparoscopic surgery in the treatment of colon cancer.
Patients and methods: We review data from 60 patients underwent laparoscopic assisted colectomies for cancer from 01/09/2007 to 31/08/2009 at Binh Dan Hospital.
Results: There are 32 males and 28 females with mean age was 55. There were 60 cases of colectomies, including: 20 cases of right colectomies, 5 cases of transversal colectomies, 5 cases of left colectomies and 25 cases of sigmoidectomies. The conversion to open surgery were 16.7% (10 cases). 9 cases had wound infection, 5 cases had postoperative peritonitis due to anastomotic leakage, mortality was found in 1 case.
Conclusion: Laparoscopic assisted colectomy is technically feasible and safe.
Key words: Colon cancer/Laparoscopic surgery
Tong quan
Nhieu cdng trinh nghiSn cuu trong v l ngoai nude gan day cho thay phau thuat cat dai trang ndi soi, ngdai cac im diem ciia mdt phau thuat it xam hai nhu vet md nhd, it dau, thdi gian phuc hdi sdm cdn cd ket qua tucmg ty md md ve mat ung thu hpc.
Phau thuat ndi soi dieu tri ung thu dai trang da dugc ap dung rdng rai tai cac trung tam phlu thuat trong nude, trong do cd Benh vien Binh Dan.Chiing tdi thyc hien nghien ciiu nay nhim dinh gia ket qua dat dugc sau khi ap dung phlu thuat cat dai trang ndi soi dieu tri ung thu dai trang.
PHlTONG PHAP NGHIEN CUtJ Thiet ke nghien cuu: hdi cuu, md ta
Thdi gian nghien cuu: 2 nam, tu 01/09/2007 den 31/08/2009 Dia diem nghien cuu: khoa Ngoai tdng quit 4, benh vien Binh Dan
Tieu chuin chpn benh: cic benh nhin bj ung thu dai Irang dugc chan ddan va xac dinh vi tri u
^ Dai hpc Y Dupc TPHCM
* Benh vi^n Binh Dan
Dja chi lien l?c: BS.CKl.Nguyln Manh Dung DT: 0913911974
2 4 5
qua ndi soi, x quang khung dai trang dugc md ndi soi chuong trinh Thu thap sd lieu va xir ly bang phan mem SPSS 13.0.
KETQUA
Trong thcri gian nghien cuu, cd 60 benh nhan dugc phlu thuat gdm 32 nam v l 28 nir, tudi tmng binh la 55.
Dai trangj20 (33.4%) phai
Vitri
Dai trangjS (8.4%) ngang
Dai trlng(5 (8.4%) trai
Dai trang 30(41.8%) shau hdng
i l l
13 pT3 pT4
Phuong phip phau thuat
"at dai trang phai Cit dai trang ngang Cit dai trang trai Cat dai trang ehau hdng
20 5 5 30 Thdi gian md trung binh 165 phiit
Khdng cdn t^ bao ung thu d dien cit trong tat ca cac trudng hgp . 10 trudng hpp (16,7%) chuyen md md
Bien chung:
Nhiem trung vet md: 9 U^dng hgp (30%) Bung thanh bung : 2 trudng hgp (3,33%) Tu dich: 1 trucmg hgp (1,66%)
Xi mieng ndi: 3 trudng hgp (5%), 1 trudng hgp tir vong.
BAN LUAN
Cho d6n nay, vai trd eua phau thuat ndi soi dieu tri ung thu dai trang da duge cdng nhan, nhieu nghien cuu nglu nhien cd nhdm chung so sanh giiia md ndi soi va md md sau thdi gian theo ddi ngin ban v l dai ban da ehung minh cic uu diem nay'^'^'^'^'.
Ve mat ky thuat, chung tdi six dung phucmg phap phlu ti'ch tii trong ra ngoai, cat mach mau dai tring trudc, tucmg tu cic tic gii kblc'^"^*. Viec bdc tich v l cat mac treo da sd dugc thyc hien bing dao dot don cue, mdt sd trudng hgp cd su dung dao cat ddt sieu am thi cd rut ngan dugc thdi gian md hon. Sau khi doan dai trang chira budu dupc di ddng, chiing tdi md bung dudng nhd dua dai trang ra ngoai cat va khau ndi lai bing tay. Diy ciing la lya chpn cua hau het cic phau thuat vien khi md cat dai trang ndi soi vi cd the tiet Idem chi phi cho benh nhan.
Mdt van de can ban luan d day niJa 11 sau khi dat muc tieu lly budu, viee tii lap luu thdng dai trang bao gid cung gap phai nguy co xi mieng ndi, la mdt bien chung nghiem trpng de dpa linh mang benh nhan. Chiing tdi cd 3 tru'dng hgp xi mieng ndi, chiem ti le 5% va deu phai md lai nhung chi 2 trudng hgp qua khdi. Ti le xi mieng ndi dai tring rit khic nhau giua cic nghien cuu vi sy khic biet ve phac dd dieu tri, vi tri giai doan u, ky thu^t md...vl dao ddng tir 3 den 24%"'^'. Cae trieu chung sdm cua xi mieng ndi thudng ma hd, khdng dac hieu, khi cd trieu chung rd rang thi da mudn, hon niJa tim ly ngai can thiep lai cua phlu thuat vien cung la mpt yeu td gop phan chin doin tre.
Ngoai trir cic trudng hgp xi mieng ndi hau phlu, thi nhung kel qua dat dugc trong md nhu tai bien trong md thap, khdng cd trudng hgp nao cin truyen mau do mat mau, dien ell khdng cd te bao ung thu, ti le bien ehung khac tuang ty cac ket qui nghien cuu khac va tuang ty nhu 246
phuang phap md md'^**'"' cho thiy phlu thuat ndi soi cd the ap dung thudng quy cho ung thu dai trang,
Ti le chuyen md md cao vi chung tdi gap cic trudng hgp budu qua to, khdng bao dim nguyen tic phau tich rdng rai khi md ndi soi, vl day 11 dieu Urong tu mdt sd cac nghign cuu khac*^'.
Ti le nhilm trung vet md cao cd the do viec che chan vet md nhd tbanh bung chua ky ludng cung nhu vet md bi phai nhiem lau khi thuc hien khau noi bing tay.
KET LUAN
Phau thuat ndi soi cd thi thyc hien an loan yong dieu tri ung thu dai trang. Khong cd tai bien bien chung trong md nhung can chu y bien chung xi mieng ndi trong nhihig ngay hau phau.
Cin cd nghien ctm lau dai hem dinh gia ty le tii phit va thdi gian sdng cdn ciia benh nhan.
TAI L l £ U THAM KHAO
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10 Regadas, F. S., Rodrigues, L. V., Nicodemo, A. M., Siebra, J. A., Furtado, D. C. &
Regadas, S. M. (1998). Complications in laparoscopic colorectal resection: main types and prevention. Surg Laparosc Endosc, 8(3), 189-192.
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