Y HOC VliT NAM THANG 1 - SO 1/2013 So sanh cac trieu chu'ng lam sang tru'dc va
sau mo thay cd cai thien ro ret dac biet la sau 3- 6 thang (bang 7). Cac trieu chirng ed nang giam dang ke tuy nhien tieng TTT la dau hieu mat di ch$m nhat, sau phau thuat con khoang 20,47%
Bn cdn tieng TTT ngan. Nhan xet nay cting tu'dng t i / vdi cac ket qua ciia khi thay tieng click la dau hieu cai thien ro ret nhat con tieng TTT la dau hieu con ton tai keo dai nhat sau phau thuat.
V. KET LUAN
Qua 114 Bn sa VHL du'dc phau thuat tai benh vien tim Ha noi, chung toi nhan thay cac bieu hien lam sang thu'dng kin dao, khi ton thu'dng mu'c dp nang thu'dng co bieu hien: dau ngi/c, kho t h d , ngat,...Kham tim mach thay tieng click va TTT ngan hoac keo dai. Sau phau thuat, huyet dpng cd thay doi nhieu va can phai sir dung thuoc t r d tim nhieu d nhdm thay van hdn la site van. Trong vong 6 thang sau mo cac trieu chirng lam sang cai thien tot. Can kham va chl dinh phau thuat sdm clio cac Bn sa van do siT phue hoi sau mo lien quan chat che den mire dp suy tim va kha nang bu trif ciia that trai.
T A ) LIEU T H A M K H A O
1. & | n g Hanh De, Ton That Bdch, Nguyen Doan Hong va cs (1998), "Thai do dieu tri ngoai khoa Benh van hai la do thap", Khuyen dto so 8 (1998) cua h& tim mach hoc quct gia Viet nam, Ky yeu toan vSn cac de tai khoa hoc, Dai hoi bm mach hoc quoc gia Viet nam lan thir III, Da lat, tr.106-115 z. Nguyen Van Phan (2006), "Nghien cuU ap dung
phtrong phap sira van ciia Carpentier trong benh hd van hai la", Luan an Tien si Y hoc, chuyen nganh Phau thuat dai cu'dng.
3. Ahmed M. I., Sanagala 1., Denney J., et al.
(2009), "Mitral valve prolapse with a late-systolic regurgitant murmur may be associated with significant hemodynamic consequences", Am J MedSci, 338, (2), pp. 113-115.
4. Guy T. S., Hill A. C. (2012), "Mitral valve prolapse", Annu Rev l^ed, 63, pp. 277-292.
5. Lieng H.L., Enriquez-Sarano M., James B.
(2000), "Oinical oubxme of mitral regurgitation due to flail leaflet", Di\4sion of Cardiovascular Disease and Internal Medidne, 335, (19), pp. 1417-1423.
6. Lisa F.A. (1999), "Prevalence and clinical outcome of mitral valve prolapse", N Engl J Med, 341, pp. 1-7.
7. Sylvain C , Jean-Frangois F., Alain B. (2001),
"Long-Term (29 Years) Results of Reconstructive Surgery in Rheumatic Mitral Valve Insufl^dency", Circulation, 104, pp. 1-13
DAC DIEM LAM SANG. THINH LIAS VA NHI LlHOTNG DO CUA BENH XEP NHI
€)ao T r u n g D u n g * , Le Cong D j n h * *
TOM T A T
Xep nhl la mot loai viem tai gii?a nguy hiem vi co the tien trien tiianh cholesteatoma. Myc tieu: Nghien cicU dSc diem lam sang, thinh lUc va nhi lu'dng do ciia benh xep nhT. Doi tu'dng: 58 benh nhan dUdc chan doan xep nhT, tong sd 74 tai nghien ciru. Phu'dng phap nghien cih/: nghien ciru mo ta tiTng ca. Kit qua: Tuoi trung binh la 34,6 tuoi. Nghe kem la trieu chirng chii yeu chiem 87,9%. 60,8% xep nhi toan bo, 39,2% xep nhi khu trii, xep nhT dp III hay gap nhat.
94,6% tren thi'nh lu'c do co bieu hien nghe kem. ABG d xep nhT toan bo la 31,8 dB va co xu hudng tang len 6 giai doan III-IV; d xep nhl khu tru la 27,1 dB va khong CO SLT khac biet giO^ cac giai doan. 86,5% cac trUdng hop nhl do dang B va C. Kei luan: Nghe kem la trieu diiihg hay gap nhat. Npi soi tai de chan doan va phan giai
* Khoa Tai Mui Hong Benh vien Bach Mai
* * Bo mon Tai Mui Hong tru'dng dai hoc Y Ha Noi PhanbiSn khoa hoc: PGS.TS. Lipo-ng Thj Minh Hu-cng
doan xep nhT. Can do thinh li/c va nhi lutJng de danh gia anh hudng cua xep nhitcii chii'c nang tai giiJa.
Tiy khoa: xep nhi, tui co keo, thinh lu'c do, nhi lu'dng do.
SUMMARY
CLINICAL, AUDIOMETRY AND TYMPANOMETRY OF TYMPANIC ATELECTASIS Background: Tympanic atelectasis is a form of dangerous otitis media because it can develop into cholesteatoma. Objectives: To study clinical, audiometnc and tympanometric presentations in tympanic atelectasis. Patients and methods:
Descriptive case study. 58 patients (74 ears) were induded based on their otoscopic appearance, audiometric and tympanometric findings. Results:
Y HQC VigT NAM THANG 1 - S6 1/2D13 Mean age was 34,6 years. Hearing loss was the most
complained symptom in fifty-one (87,9%) of the patients. Of the 74 ears, forty-five (60,8%) were total and twenty-nine (39,2%) were localised atelectasis.
Grade I I I was the most common grade found.
Audiometry reveals hearing loss in seventy (94,6%) of the ears, ABG was 31,8 dB in total atelectasis and more severe in grade III-IV; in localised ones was 27,1 dB and shows no difference among grades. Sixty-four (86,5%) of the tympanometries were type B and C according to Jerger. Conclusions: Hearing loss was the most common symptom. Otoendoscopy was used for diagnosis and staging. Audiometry and tympanometry were used for evaluation of middle ear function affected by this disease.
Key words: tympanic atelectasis, retraction pocket, audiometry, tympanometry.
\.
DAT VANo f
Xep nhi la tinh trang mang nhT bj co lorn ve phia trong, lam giam the tich horn tai. Bleu hien co lom cd the d mot phan ciia mang nhT (xep nhT khu trii) hay toan bo mang nhT (xep nhT toan bp).
Xep nhT khu trii thu'dng d mang chiing va gdc phan tu" sau tren eiia mang cang, do dac diem giai phau ciia mang nhT d eac vi tri nay. Xep nhT tien trien qua nhieu giai doan va co eac bieu hien lam sang va thinh hoc khac nhau. Theo cac nghien cu'u [5] [6] ehf co 10 - 2 0 % xep nhT bieu hien d giai doan dau. Theo l^agnan va Bremond [7] cd khoang 3 0 % xep nhT tien trien thanh cholesteatoma, vi vay trong phan loai viem tai hien nay da xep xep nhT vao nhom viem tai giu'a
man tinh nguy hiem. Viec chan doan, theo doi cac giai doan ciia xep nhT de du'a ra^phi/dng phap dieu tri phii hdp la rat can thiet nham ngan ngifa cac bien chirng co the xay ra.
M^JC tiiu: Nghien cuV die diem lam sang, thinh life do va nhi lu'dng do cua benh xep nhl II. o d l T U 0 N G VA PHUONG P H A P NGHIEN COU
2.1. Ddi tu'0ig nghien cUV:
58 benh nhan du'dc chan doan xep nhi tai khoa Tai Mui Hong benh vien Bach Mai tir thang 01/2010 den thang 10/2012 (42 xep nhT mpt ben, 16 xep nhT hai ben). Nhu" vay tong so tai benh nghien ciru la 74 tai gom 45 xep nhT toan bp va 29 till CO keo.
Tieu ehuan lu'a chpn: ho sd benh an day du, cd hinh anh ndi soi tai, cd ket qua do thinh lire va nhT lu'dng.
2.2. Phu'dng phap nghien cthi. Nghien cii'u mo ta tirng tru'dng hdp.
Cac chi so va tieu chi nghien ciTu: tuoi va gidi, trieu chiTng cd nang, phan loai xep nhi va giai doan xep nhT theo Sade, phan loai nghe kem va chi so khoang each du'dng khi - du'dng xi/dng (ABG) d 4 tan sd 0 , 5 - 1 - 2 - 4 kHz, phan loai nhi lu'dng do theo Jerger.
Phu'dng tien nghien ciili: bp npi soi tai mui hong cd chup anh, may do thfnh luC, may do nhT lu^ng.
Cac sd lieu du'dc xir If bang chudng trinh SPSS 13.0 theo cac thuat toan thong ke thong thudng.
. KET QUA 3.1. Lam sang:
- Tuoi va gidi:
Tuoi trung binh 34,6 tuoi. Nho nhat 10 tuoi, cao nhat 74 tuoi. Cd 26 nam va 32 nu".
- Trieu chutigcd nang: Jxmzmgmo'i^senh nhan ed the gap mpt hay nhieu trieu chirtig pha hdp.
Bang 3.1. Trieu chu'ng ed nang, Trieu chu'ng
Nqhe kem Utai E)au lu'c tai
So benh nhan ( N = 5 8 ) 51 32 4
T v l e % 87.9 55,2 6,9
Nhan xet: Trong tong so 58 benh nhan nghien ciTu co 51 biidng hdp nghe kem (87,9%), vdi dac diem nghe kem lien tuc, tang dan. U tai la trieu ehutig gap nhieu thir hai, chiem 32/58 tru'dng hdp (55,2%).
- Hinh anh npi soi tai:
Bang 3.2. Phan loai va mire dp xep nhT.
~~~~—~--^,_D9 xep nhi Loai xep ~——._
Toan bo TUI CO keo
Tonq so I 0 0 0
I I 18 5 23
I I I 22 18 40
I V 5 6 11
Tong so tai 45 29 74
•/o 60,8 39,2 100,0
Y HOC VtET NAM THANG 1 - SO 1/2013
Nhan xet: Xep nhT toan bp gap d 45/74 tai (60,8%) va khu tru gap d 29/74 tai (39,2%). Su"
khac biet khong cd y nghTa thong ke (/? > 0.05). Xep nhT dp III gap nhieu nhat trong ca nhdm xep nhT toan bp (22/45 tai) va tiii co keo (18/29 tai). Khong gap tru'dng hdp nao d giai doan xep nhl dp I.
3.2. Can lam sang:
- Phan ioai thinh lu'c do:
Bang 3.3. Phan loai thinh lu'c do.
Lo^i thinh lu'c do Xep nhi toan bo Xep nhT khu tru Tonq so
Binh thu'cfng
3 1 4
Nghe l<em dan truyen
30 25 55
Nghe item hon hap
12 3 15
Tong so tai ( N = 7 4 )
45 29 74
%
60,8 39,2 100,0 Nhan xet: lTor\Q sd 74 tai nghien ciTu ed 4 tai thinh li/c binh thUdng va 70 tai ed bieu hien nghe kem (94,6%); trong sd nay nghe kem dan truyen ed le 55/70 tai (78,6%) va nghe kem hon hdp cd 15/70 tai (21,4%). Su" khac biet nay ed y nghTa thong ke (/? = 0,0001). Ty le nghe kem dan truyen trong nhdm xep nhT toan bp (30/42 tai) va khu trii (25/28 tai) nhieu hdn nghe kem hon hdp tu'dng utig (12/42 tai) va (3/28 tai). SLT khac biet ed y nghTa thong ke [p < 0,0S).
- Mu'c do nghe kem:
Bang 3.4. Mife dp nghe kem tren thinh lu'c do i(N = 70).
Trung binh du'dng xUOng Trung binh du'dng khi
Nghe kem dan truyen (dB) ("1=55)
Nghe kem hon hdp (dB) (n2=15)
Nhan xet: To'n thu'dng he thong truyen am the hien bdi chl sd ABG ciia nhdm nghe kem dan truyen va nghe kem hon hdp la khac nhau nhu'ng khdng c6 y nghTa thong ke (p > 0.05).
Bang3.5. Ddi chieu chi so ABG vdi miTc dp xep nhT (N = 70).
Xep nhT toan bo Xep nhT khu tru
D o l l _(dBI_
25,1 ± 8,2 29,7 ± 3,9
Do i n (dB) 35,5 ± 9,6
Do IV (dB) 37,0 ± 12,6 29,5 ± 10,8 29,8 ± 12,4 Nhan xet: Mu'c dp ton thu'dng he thong truyen am^ co xu hu'dng tang len theo miTc dp nang trong xe'p nhT toan bp. Trong xep nhT khu tru, mife dp ton thu'dng khdng co SLT khac biet giu'a eac giai doan benh.
- Nhl lu'dng do:
Mu'c do xep
Loai nhl do D o l l
Do III
eaiv
Tonq so
A 2 0 0 2
As 0 3 1 4
AD 4 0 0 4
B 7 19 6 32
C 10 18 4 32
Tong so 23 40 11 74 Nhan xet: Trong xep nhT chii yeu gap nhT lu'dng do dang B va C, chiem 64/74 tru'dng hdp. O timg mire dp xep dp I I , III, IV, ti le nhT lu'dng do dang B va C cung nhieu hdn dang A. Ti le nay ed xu hu'dng tang len khi mu'c dp xep tang len.
ly. BAN LUAN
4.1. Bac diem lam sang
Tuoi trung binh ciia cac benh nhan trong nghien cii'u la 34,6 tuoi, thap nhat la 10 tuoi, cao nhat la 74 tuoi. Nghien ciru ciia Tos va cpng sd tren 327 tre tif liic sinh ra den khi 16 tuoi cho thay ti le xep nhT tang dan theo lira tuoi: 0,5% d
5 tuoi, 2,5% d 7 tuoi, 4,2% d 16 tuoi [4]. Nghien ciru khac cua Tos va Poulsen cho thay d cac tre bi viem tai giiJa (i dich, ty le tui co keo thu'dng nhT la khoang 34% sau 3-8 nam [5]. Mac dii cd che benh sinh ciia xep nhT chu'a du'dc lam sang to, tuy nhien roi loan ehire nang vol nhT lam giam ap ii/c horn nhT gay eo keo mang nhT va si/ cd mat ciia cae enzym nhU hyaluroniase,... trong
Y HQC VIET NAM THANG 1 - s 6 1/2013 qua trinh viem tai giu'a gay ton thu'dng Idp sdi
mang nhT du'dc cho la ddng vai tro trung tam.
Day la cae van de thu'dng gSp d tre em va gay ra cac hau qua du'dc the hien d cac dp tuoi Idn hdn sau nay [ 3 ] .
Li do khien cho benh nhan phai di kham chii yeu la nghe kem, chiem 8 7 , 9 % cac tru'dng hdp.
Theo Morris, tir xep nhT dp I I trd di tinh trang co keo eiia mang nhT da gay can t r d den hoat dpng ddn bay ciia he thong xu'dng con, mac dii anh hu'dng nay it bleu hien trieu chirng nen ed the bj bo qua. Dac biet tir dp I I I t r d di, khi mang nhT da cham hay dinh vao thanh trong hdm tai, phan dien tich mang nhT rung dpng hieu qua giam di thi bieu hien nghe kem se ro ret hdn [ 6 ] . Tuy nhien, d mot sd tru'dng hdp ke ea xep nhT dp IV, mac dii xu'dng bua va xu'dng de da bi tieu huy mpt phan nhutig phan mang nhT co keo tiep xuc trUc tiep tren chom xu'dng ban dap con nguyen ven va di dpng tot thi sire nghe benh nhan lai gan nhu" binh thu'dng.
Nghien ciTu cho thay khong ed si/ khac biet ve ty le xep nhT toan bo va tui eo keo. Mire dp xep hay gap nhat la dp I I I cho thay benh thu'dng du'dc chan doan khi ton thu'dng thu'c the da d mire dp nang. Tinh trang nay ed the do d giai doan dau cua benh trieu chu'ng md nhat nen de bd qua, mat khac khong phai luc nao mire dp nghe kem cung tu'dng xirng vdi ton thu'dng thi/c the d tai, cd tru'dng hdp nghe kem nhe nhu'ng ton thu'dng thi/c the tai mang nhT va chuoi xu'dng eon lai nang, can du'dc phau thuat. Dieu nay la rat quan trpng trong kham va tu" van cho benh nhan vi theo Magnan va Bremond eo khoang 3 0 % xep nhT tien trien thanh cholesteatoma, dac biet trong dieu kien d Viet Nam benh nhan chu'a cd thdi quen va dieu kien di kham djnh ki nen kho theo doi du'dc tien trien eiia benh.
4.2. Thinh lu'c do:
Trong benh xep nhT tinh trang mang nhT bi eo keo ve phia trong hdm nhT lam giam the tich horn nhT, cau triie mang nhT bj thay doi, chuoi xu'dng con bi can trd di dong hay bj tieu mon deu dan den suy giam chirc nang truyen am ciia tai giu'a. Da sd cae tru'dng hdp (94,6%) tai benh trong nghien ciru deu bieu hien nghe kem tren thinh lu'c dd d eac mire dp khac nhau. Nghien ciru cho thay xep nhT toan bp va khu trii cd ABG d tu'dng t/ng 31,8 va 27,1 dB. Theo chiing nghe kem la do hau qua mpt so yeu to sau:
- Mang nhT eo keo cham vao nganh xudng xu'dng de lam can t r d hoat dpng ddn bay ciia
chuoi xu'dng con.
- Dien tich rung dpng hieu qua cua mang nhT giam do phan mang nhT co keo cham va dinh vao u nho, cac ngoc ngach ciia tai giiJa,... Mat khac d phan mang nhT xep Idp sdi bi tieu hay mat tinh djnh hu'dng cua cac sdi collagen dan den giam kha nSng dan truyen am thanh [ 6 ] .
- Ap It/c am trong hdm tai gay can trd hoat dpng ciia toan bp he thong mang nhT - chuoi xu'dng con.
Khi ddi chieu chi sd ABG d nhom xep nhT- toan bp thi ABG d dp I I I va IV giam nhieu hdn trong dp I I . Dieu nay theo chiing toi do dien tfch rung dpng hieu qua eiia mang nhT va the tfch hdm nhT d do I I I va IV giam nhieu nen anh hu'dng den chiTc nang truyen am tai giiJa nhieu hdn d dp I I .
Trong khi dd d nhdm xep nhT khu b i j , chiing toi nhan thay khong cd su" khac biet ve trung binh ABG d xep nhT dp I I , I I I , IV. Dieu nay cd the la do:
- Doi vdi till co keo thu'dng nhT, phan dp co keo chii yeu di/a tren tinh trang tieu mon cua tu'dng thu'dng nhT va kha nang kiem soat day tui.
- Ddi vdi tiii CO keo sau tren, phan dien tfch rung dpng hieu qua ciia mang nhT va the tich hom nhT bj giam it hdn so vdi xep nhT toan bp.
Tuy nhien trong nghien cuXi cung gap mot sd tru'dng hdp trung binh ABG khong tu'dng utig vdi ton thu'dng tai giu'a. Dae biet 6 mpt so tru'dng hdp_xep nhT dp I I I va IV cd ^ n thudng gian doan chuoi xu'dng eon, phan mang nhT co keo tiep xiic tru'c tiep len xu'dng ban dap nen bieu hien ton thu'dng chirc nang truyen am-fren thinh lu'c do lai khdng nang nhu' ton ttiutfng thi/c the khi npi soi tai.
4.3. Nhl lifdng dd: C^c nghien cub cho thay rang trong tai giti^ luon ton tai xu hu'dng tu"
nhien hinh thanh ap li/c am do hoat dpng trao doi va hap thu khf ciia niem mac tai giiJa. Qua trinh nay du'dc can bang bdi hoat dpng md lea vol khi nuot, ngap. Q cae tai bj xep nhT, kha nang can bang ap li/c qua hoat dpng dong md loa vol giam ro ret so vdi tai binh thu'dng [ 2 ] . Mat khac hoat dpng hap thu khi d niem mac hdm tei bj viem tang len khong du'dc bii dap dii bdi hoat dong ddng md binh thu'dng ciia loa voi ciing lam cho ap li/c am trong tai giu'a tSng len [2],
Trong nghien ciru nay dang nhT do gap chu yeu la dang B va C, chiem 86,5% cac tru'dng hdp. Dieu nay cung phii hdp vdi gia thuyet benh sinh ciia xep nhT la su" hinh thanh ap lu'c am trong hom tai do hau qua rdi loan c h u t nang voi nhT va su* giam van dpng ciia he thong mang nhT
Y HOC VIET NAM THANG 1 - SO 1/2013 - chuoi xu'dng con. Chiing toi nhan thay ti le nhT
lu'dng do dang B va C tang len d xep nhT dp I I I va IV so vdi do I I . Tuy nhien do nghien ciru eon han che ve so lu'dng nen chiing toi chu'a du'a ra moi tu'dng quan giii'a rni/c ap li/c am trong hom tai vdi timg mu'c dp xep nhT toan bd va khu trii.
Van de can du'dc lam sang to d nhu'ng nghien cu'u tiep theo.
V. KET LUAN
Qua nghien ciru tren 58 benh nhan xep nhT chiing tdi riit ra du'dc cac ket luan sau:
- Dac diem lam sang: Tuoi trung binh la 34,6 tuoi. Nghe kem la trieu chiTng hay gap nhat chiem 87,9%. Ket qua noi soi tai c6 60,8% xep nhT toan bp, 39,2% xep nhT khu trii. Xep nhT do I I I hay gap nhat.
- Thinh lu'c do: Hau het (94,6%) benh nhan cd nghe kem. ABG d nhdm xep nhT toan bp la 31,8dB va cd xu hu'dng tang len d dp III-IV; d nhdm xep nhT khu tru ABG la 27,ldB va khdng cd su" khac biet giii'a cae giai doan.
- Nhi lu'dng do: NhT do dang B va C la chii yeu (86,5%). Dieu nay chirng to ton thu'dng tai gi&a trong xep nhT chu yeu la hien tu'dng tac voi va giam van dpng ciia he thong mang nhT - chuoi xu'dng con.
T A I U E U T H A M K H A O
1. Nguyen Tan Phong (2006), "Quan diem mi3i trong chan doan, phan loai va dieu tri viem tai glCfe d tre em". Tap chi Tai MUI Hong, sd 1, trang 67-69.
2. Bunne M., Falk B., Magnuson B. et al.
(2000), "Variability of Eustachian tube function:
Comparison of ears with retracted disease and normal middle ears", The Laryngoscope, 110:1389-1395.
3. Daly K., Hunter L., Levine S. et al. (1998),
"Relationships between otitis media sequelea and age", The Laryngoscope, 108' 1306-1310, -,. Djalilian H.R., Paparella M.M. (2000), "The
atelectatic ear". Current opinion in Otolaryngol Head Neck Surg, 8 (5): 369-374.
5. Lancaster J., Srinivasan V. (2002),
"Management of tympanic membrane retraction pockets", Australian Journal of Otolaryngology, 93(2): 147-156.
6. Morris D.P., Bance M., Van Wijhe R.G.
(2004), "Vibration characteristics and function of atelectatic segments m the tympanic membrane m fresh human cadaveric temporal bones", Clin.
Otolaryngol., 29 (2). 133-137.
7. Magnan J., Dubreuil C. Tran Ba Huy P.
(2005), "Les poches de retraction tympaniques et Totite ateiectasique", L'otite chronigue, Societe frangajse d'Oto-rhino-laryngologie et de Chirurgie de la Face et du Cou, 33-67.
NGHIEN CUU BIEN CHUfNG SAU MO PHINH DONG MACH NAO
Nguyen The Hao*, Pham Quynh Trang*
TOM T A T
Myc dich: Danh gia ti le va xac dinh nguyen nhan cac bien chuhg sau mo phinh dpng mach nao. PhuUng phap. Nghien ciru hoi ciru 72 benh nhan co bien chirng sau mo phinh dong mach nao v3 tai Benh vien Viet-Dirc, tir 10/2007 den 10/2012. K€t qua: Tuoi trung binh 47,8. Ti le nO/nam: 1/1,2. Ti le bien chu'ng chung la 17,5%. Bien chu'ng cf nhom benh ntian nang tru'dc mo (do 4-5) la 43,1% cao hdn nhom benh nhan 6 dp 1-2 (26,4%) v6i p<0,05. Khong co sU khac biet ve ti le bien chu'ng sau mo giu'a nhom benh nhan mo sdm va nhom mo cham {p>0,05). Gian nao that sau mo 5,2%. Co that mach 11,9%. Chyp dgng mach nao kiem tra 53,6%, tac mach nao 5,9% va ton dU tiii phinh la 4 , 1 % . Ket luan: 17,5% phau thuat phinh
* Benh vien Viet-Ddc Ha Ngi
Phan bien khoa hoc: PGSTS. Ha Kim Trung
dong mach nao v3 co bien chirng sau mo, co nhu'ng bien chirng ma nguyen nhan la hau qua ciia chay mau dudi nhen gay nen, nhij'ng bien chirng neng biet trong phau thuat phinh mach nao la do ky thuat mo hay dac diem giai phau tiii phinh gay nen, va nhiJng bien chu'ng chung ciia phau thuat than kinh,
Tu" khoa: Phau thuat phinh mach nao, Bien chirng sau mo, Chup mach sau mo.
SUMMARY
ASSESSING POST-OPERATIVE COMPLICATIONS IN ANEURYSMAL MICROSURGERY Objective:To evaluate rate and determine causes of postoperative complications of microsurgical treatment for aneurysms. Methods. Retrospective
