TAP CHi Y HOC VIJT NAM TAP 452 - T H A N G 3 - S 6 2 • 2017 Benh nhan ed sdi dai du'di chiem 7 4 , 3 % (58
rUdng hdp). Thii thuat doi vdi soi dai du'di bi inh hu'dng bdi yeu to giai phau he ttiong dai be han va nieu quan, dac biet la cae yeu to: goc eo Iai du'di be than, chieu dai dai du'di, do rong eo Iai va chieu cao co dai du'di. Cae yeu to nay lu'dc nghien cijli sau bdi tac gia Elbahnasy[5].
<hi tan sdi dai du'di qua ky thuat nay lam cho 3au ong soi gap, day dan laser d l gay hong cenh thao tac.
£)a so khi da tiep can sdi, chung toi glC' nguyen vj tn' va luon laser qua vo bpc de tan soi.
Day la I d diem dang ke trong cai tien ky thuat :ua diung toi, tien Idi trong qua trinh thao tac.
Khi SLf dung vo bao ve, chung tdi khong bj lac mat soi, khong can rut day dan laser ra ngoai khi thao tac thay doi vi t r i cua dau ong sol de tim sdl. Mae du trong nghien culi eua tac gia Durak, ong cung chi ra rang ong soi co kem theo vo bao ve laser (FlexGuard) trong kenh thao tac thi no larn ,han che gap cua dau ong soi khoang 7 dp (tfr 73 dp xuong 66 dp) va giam toe dp tu'di rCfe tif 0,55ml/giay xuong b,02ml/giay[3]. Tuy nhien, chiing toi van khong thay can t r d nhieu trong thao tac dieu khieu dau ong va chung toi tang toe dp tu'di rife bang bdm nu'dc theo nhu" de nghi cua tac gia.
Qua thi/c te sii dung, chung toi nhan thay van con giO' du'dc chat luUng gan nhu' mdi hoan toan. Vi|c keo dai tuoi thp cua ong soi mem con phu tJiupc vao nhieu yeu t 6 khac ke ca ky nang su" dung thanh thao may. Tat nhien day chi mdi la nhifng ket qua bu'de dau. Chung toi thiet nghT neu vdi ket qua nay, ong soi ed t h ^ tang gap doi
hoac 3 lan sii dung so vdi binh thu'dng, thi eung la mot thuan Idi va gdp phan giam chi phi siia chife dang ke.
V. Kir LUAN
v d bao ve laser cai tien cd t h ^ sii dung du'dc trong npi sol mem nieu quan ngu'dc ddng ma khong gay trd ngai cho cac thao tac so vdi ky thuat thong thu'dng va eo the kieo dai thdi gian SLf dung cua ong soi.
T A I L I | U T H A M KHAO
1 . Phan Tru'dng Bao (2016), "Danh gia vai tro ngi soi mem trong dieu tri sdi thSn", Luan van tien sty hoc, Dai hoc Y Difdc TP HCIwi.
2. Afane J . S., Olweny E. O., Bercowsky E., et al (2000), "Flexible Ureteroscopes: A Single Center Evaluation Of The Durability And Function Of The New Endoscopes Smaller Than 9f', The Joumai of Urology, 164, 1164-1168.
3. Durak E., Hruby G., Mitchell R., e t al (2008),
"Evaluation of a Protective Laser Sheath for Application In Flexible Ureteroscopy", Journal of Endouroiogy, -22(1), 57-59.
4 . Einstein A. (1917), "Zur Quantentheorie da*
Strahlung", Physilcalische Zeifschrm, 18, 121D128.
5. Elbahnasy A. M., d a y m a n R. V., Shalhav A.
L., et al (1998), "Low/er-Pole Caliceal Stone Oearance after Shockwave Lithotripsy, Percutaneous Nephrolithotomy, and Flexible Ureteroscopy Impact of Radiographic Spatial Anatomy", Joumai of En(huroiogy, 12(2), 113-119.
6. Monga M., Best S., Venkatesh R., e t at (2006),
"Durability of Flexible Ureteroscopes: A Randomized, Prospective Study", The Joumai of Urology, 176, 137-141.
7. Whftfi M. D., Moran M. E. (1998), "fatigability of the latest geneationureteropyeloscq:es: WdiardWbifvsl^
Stor^', Joumai Of Endoimslogy, 12(suppi), 182-186.
NGHIEN CUU MOT SO DAC DIEM GIAI PHAU CHUOI HACH THAN KINH GIAO CAM NGirC TREN x A c U a P VA TRONG P H A U THUAT N C I SOI LONG NGirC DIEU TRI CHU'NG TANG TIET MO HOI TAY NGUYEN PHAT
Nguyfin Van Nam*
TOM TAT
Ogt v f n d e / Phau thu$t npi soi d t TK6C ngi/c la piiLfdng phap co hieu quS de dieu trj chu^hg tang tiet m3^ hoi tay nguyin phat. Nhu'ng co mot so iiau qua khong mong muon xuat hien sau mo. Nghien cihj
*B&ih vien 103 - Hoc vien Quin y.
Chju trach nhiem chinh: Nguyin VIn Nam Email: [email protected] Ngay nhan bai: 9/12/2016 Ngay phan bien khoa hoc: 6/1/2017 Ngay duyet bai: 18/1/2017
niiam mo ta mot so dac diem giai phau cua cliuoi tiian Idnh giao cam ngifc tren va cac day TK ket nS v6i cac day TK ngi/c de tiung cap mot so cx( sd giai phau ilfng dung trong phau thuat cat, hOy TKGC ngyc dilu tri c^ufng ra nhieu mS hoi tay nguyen phat khu tru.' PhLfdng phap: Tien hanh phau tich, do dac, mo ta chuoi TKGC ngLfc 6 30 ben long ngifc xac iTdp ngu'cfi l6n;^M6 ta trong piiau thuat noi soi long ngi/c 276 chuoi TKGC ngUc ciia 138 benh nhan bi chuYig tang tiet mo hoi tay nguyen phat. KSt qua: XS niiln ttiay tren cung Wii chu'a cat ia thanh mang phoi la xu'Ong su'dn 2. Khong the xac dinh chinii xac v| tri cua cac hach TKGC ngifc tren Wii chu^ boc la thanh mang piioi a 100% cac tru'dng hOp. Vi tri thap nhat cua hach sao
hoac hadi T l co the den cung sau cua xu'dng su'dn 2 v d i t y le 3,3% (1/30 ben). Hach T2, T3, T4 oo ty le cao nhat la nam trong khoang lien su'dn tu'tftig \ing.
Nhanh than kinh Kuntz, co ty Ie 56,7%.
TO' khda: Chutig tang Het mo hoi tay nguyen phat, chuoi TKGC, than kinh Kuntz.
S U M M A R Y
STUDY ANATOMY OF THE UPPER T H O R A a C SYMPATHEHC CHAIN APPLIES ON CADAVERS
AND I N THORACOSCOPIC SYMPATHOTOMY SURGERY FOR "THE TREATMENT OF PRIMARY
PALMAR HYPERHIDROSIS Objective: Endoscopic thoradc sympathocotomy was effective for Primary palmar hyperhidrosis, but appear somme side effects after sympathocotomy.
The aim is to dearly delineate the upper thoradc sympathetic chains and neural connections between the chains and the thoradc nen/es, and to provide an anatomical foundation for successful upper thoracic sympathicotomy for treating Primary palmar hypertiidrosis. Methods: 30 upper thoradc sympathetic chains of adult cadavers have been dissected, measured, and mapped; 276 upper thoracic sympathetic chains of 138 patients with Primary palmar hypertiidrosis have been invesGgated under tiie endoscope. Results: If 9ie parietal pleura wasnt dissected yet, ttie uppermost observed rib to be ttie second rib and cant identify the exact anatomical locations of the sympathetic ganglia in all of cases.
Lowemiost location of the stellate ganglion or the fist thoradc sympathetic ganglia was In the second rib with rate was 3,3%. The second to the fourth thoracic sympathetic ganglia were most commonly located in the corresponding intercostal spaces. The inddence of Kuntz nerve was 56,7%.
Key words: Primary palmar hyperhldrosis, Sympathetic chains, Kuntz nerve.
LOATVANDE
Ngay nay, phau thuat npi soi long ngi/c cat, dot huy than kinh giao cam ngi/c tren da t r d thanh pht/dng phap dieu tri pho bien cho chCfng tang tiet mo Iioi lay nguyen phat d rat nhieu nu'dc tren the gidi. M3c du dat hieu qua cai thien ra nhieu mo hoi d long ban tay rat cao ttj" 80- 100%. NhuYig cd mot so hau qua khdng mong muon xuat hien sau mo, nhii' ra nhieu mo hoi bij
VIETHAM MEDICAL JOURNAL N''2 - MARCH - 2017
qua mu'c, hoi chuHg Claude Bernard - Horner,}ii nhieu mo hoi tai phat hoac kho long ban tay q u i mu'c, lam anh huSng den ket^ qua a e u t n | Nguyen nhan tai bien trong m o , cac hau qua khong mong mu6n sau mo du'dc c^o la co l i ^ quan den mot so dac diem glal phau cua ehuM hach than kinh giao cam (TKGC) n g u t tren. 1
Tren the gidi, chMa co nhieu tac gia ^nghierit ciiu ve cac dac diem giai phau ciia chuoi hadi(.
TKGC ngye t r i n , dac biet la mo ta dac diem giai phau cua chuoi hach TKGC ngifc ngay trang kill phau thuat noi soi long ngi/c. Trong nude, chu&s CO tac g\k nao nghien cuXi ve van de nay. Xiiat phat tLf nhDtig yeu cau thtfc tien tren, chung toi' tien hanh nghien ciiu de ^ i nay, nham muc tieu^;
£>anh gia mot sd dac diem giai phau cua d)uSi}
TKGC ngut hen xac udp va trong phau thuit na soi long ngdc^ <^ lien quan den kit qua cua phau thuat npi soi long ngiTc dieu tri chutig tang ffis?
mo hoi tay nguyen phat
II. €)6l T U p N G VA PHycnsiG PHAP NGHIEN CU\J
2.1. Ddi tWdng nghien cdti
- Nghien ciili tren xac u-dp: 30 ben long ngut cua 20 xac tfdp ngudi Idn Viet Nam, gom: 17 ben phai, 13 ben trai.
- 276 ben long ngi/c cua 138 benh nhan dutfc phau thuat npl sol long n g u t dot huy TKGC n g u t tren dieu trj chifng tang tiet mo hoi tay nguyen p h a t
2.2. Phifdngphap nghien cuU
•Phu'dng phap nghien cult: Phau tfch kinh dieru
*Quan sat^ xac djnh, mo l a mot so dac diem giai phau chuoi TKGC ngLfc tren khi chuS boc la thanh mang phoi. ^ ^
*£)o va mo ta mot so dac diem giai phau chuoi TKGC ngi/c tren*sau khi da phau tfch chi tiet.
- Trong m o : Mo ta mot so dac d i & n giai phau, chuoi hach TKGC ngi/c tren trang mo.
2.3.Phu'dngphapxu'iysd'liSu:Cac so lieu
nghien culi du'dc xLf ly bang chUdng trinh xii' ly so lieu SPSS 13.0 Ibr Window.III. KET QUA VA BAN LUAN
3.1. Xac dinh cung sau cac xu'dng sifdn tren khi diu^ bdc la thanh mang phdt.
Bang 3 . 1 . Xac ffinh cung sau cac xu'dng su'dn t r e n Cung sau
cac xu'dng su'dn
Cung sau XS 1 Phai Trai Pliai
Doi tu'dng Tren tigu ban xac (n=30) (phai: 17, trai: 13)
SaiUdng(tyle°/ol 0/17 (0,0%) 0/13 (0,0%) 17/17 (100,0%)
Quan sat trong mo (n=276) (phai: 138, trai: 138)
So lu'dng (ty ie % )
0 (0,0%)
0 (0,0%)
138/138 (100,0%)
TAP CHI Y HOC VIET HAM TAP 452 - THANG 3 - SO 2 - 2017
Cunq sau XS 2
Cunq sau XS 3 Cunq sau XS 4
Trai Phai Trai Phai Trai
13/13^100,0%) 17/17(100,0%) . 13/13^100,0%) 17/17 (100,0%) 13/13 (100,0%)
138/138 (100,0%) 138/138 (100,0%) 138/138 (100,0%) 138/138 (100,0%) 138/138 (100,0%)
Cung sau eac xu'dng su'dn tren la moc giai3hau quan trpng nhat de xac djnh chuoi hach IKGC ngLfc'trln va cac thanh piian cua no. Ti!f Jo xac dinh du'dc chinh xac mu'c d6 can thiep rao chuoi hach TKGC ngLfc tren. Ket qua clio thay khong the xac djnh du'dc cung sau xu'dng SLfdn 1 d 100% cac tieu ban, cung sau XS 2 den XS 4 deu xac djnh du'dc d 100% cac Heu ban.
Khong ttie xac djnh dude xuUng stfcfri 1 vi day la XS dSe biet, ngan va cong nhat, nam eheeh, co 2 mat tien va dudi, bd trang mdng kho xac dinh hdn mat trong cac XS khac.
Nhu' vay, XuWng su'dn nhin thay tren d i n g khi chu^ cat la thanh mang phoi la xu'dng su'dn 2, Ket qua cua ehung tor phu hdp vdi nhan xet cua Kopelman D. [4] theo tac gia nay, cd nhieu phau thuat vien khong chu y den van de nay, hp cho rang XS nhin thay tren ciJng la XS 1, neu nhu"
vay se xae djnh sai vi t n cac thanh phan cua diuoi hac^ TKGC ngi/c tren, va mifc dp can thiep thifc SLf se bj thap hcJn dii dinh cxia cae phau thuat viSn nay mot m u t , khi do SLf so sanh giife cac t^c gia ve mu'c dp can thiep khong con chfnh )ac.
3.Z Xac dinh vltn cic hach TKGCngu'c tren khi chua bdc la thinh mangphSi.
Bang 3.2. Xac dinh ro v i t r i cac hach t h a n Idnh giao cam ngu'c t r e n
Hach ( b e n )
H a c h T l HachT2 HachT3 Hach T 4
Phai Trai Phai Trai Phai Trai Phai Trai
Doi tu'dng T r e n t i e u ban xac ( n = 3 0 )
( p h a i : 1 7 , t r a i : 1 3 ] So lu'dng ( t y l e ° / o )
0/17 (0,0) 0/13 (0,0) 0/17 (0,0) 0/13 (0,0) 0/17 (0,0) 0/13 (0,0) 0/17 (0,0) 0/13 (0,0)
Quan sat trong m o ( n = 2 7 6 } ( p h a i : 1 3 8 , t r a i : 1 3 8 )
So lu'dng ( t y ie °/o) 0/138 (0,0) 0/138 (0,0) 0/138(0,0) 0/138 (0,0) 0 / 1 3 8 i 0 j P ) 0/138 (0,0)
0/138(0,0) 0/138 (0,0) Theo ket qua cua chung toi cho thay, d tren
100% cae tieu ban xae ciing nhu" t a t ca cac ben long ngi/c quan sat trong mo, deu khong the xac dinh chfnh xac vj trf cac hach TKGC.
Nhtf vay, trong FTNSLN vdi ky thuat chi cat ngang TKGC tren cae XS ma khong cat la thanh mang phoi va phau ts'eh ro rang chuoi hach TKGC ngifc, m^c dij co ong soi vdi dp phong dai Idn va
cd kha nang tiep can sat vdi chuoi TKGC ngu'c tren thi cung khong l^e xae djnh chfnh xac vj t n cac hach TKGC. NhUng tac gia cho rang cd the xac djnh du'dc vi trf hacii TKGC trong khi PTNSLN, theo chung t o i , ed le vi trf ma hp xac dinh la hach TKGC thi thtfc su" do chi la vj trf ma chuoi hach TKGC chay tren dau sau eac xu'dng su'dn tren, nen nho cao hdn eac doan khac.
3.3. JTiSC dinh vi tri cac hach TKGC ngu'c tren khi da bdc la thanh mang phoi va phiu tich chi tiit (tien xac)
Bang 3.3. Vy tri hach T 1 , T 2 , T3^ T 4 so yd! cac IfS t r e n va du'di tu'dng iJ'ng.
Nam de len XS du'di Bd du'di
XS t r e n Giu'a KLS Bd t r e n XS du'di
20,0% (6/30)
60,0% (18/30) 16,7% (5/30) 3,3% (1/30) 10% (3/30)
76,7% (23/30)10% (3/30) 3,3% (1/30) T3 3,3% (1/30) 63,3% (19/30)
2 6 , 7 % (8/30) 6,7% (2/30)T4 3,3% (1/30) 50% (15/30)
1 ^ qua nghien cuXi cua chung tai ciing d i o thay:
- Gidi han thap nhat cua hach sao hoac hach Tl ia nam tren XS 2.
Mot so tac gia cho rang gidi han cat TKGC an toan, tranh difdc hdi chu'ng Hornner sau mo la khong qua bd tren xu'dng su'dn 2 [ 7 ] . Nhutig
33,3% (10/30) 13,4% (4/30)
trong nghien c u ^ eua chung toi va mot so tac gia khac nhu" Chung I . H. [ 2 ] , Singh B. gap mot ty le hach sao hoac T l nam tren xu'dng su'dn 2, mac du chi la cifc du'di chu' khong phai phan hach chinh nhu'ng khi cat huy TKGC tren xu'dng sifdn 2 van cd nguy cd xuat hien hoi chuYig HornnerVIETNAM MEDICAL JOURNAL N"; - MARCH - 2017
sau mo do lann ton thu'dng hach sao. Nhu' vay,
gidi han cat an toan Ichong ton thu'dng hach sao phai la tren XS 3.
- Vi tri cac hach T2, T3, n thudng nam trong
khoang lien sudn tu'dng uhg, v6i t^ le tu'dng iJ'ngla 76,7% (23/30), 63,3% (19/30), va 50%
(25/50). Cac hach nay nam de len xu'dng su'dn du'di vdi ty le tuHng iJng la 3,3% (1/30), 6,7%
(2/30) va 13,4% (4/30). Khong cd hach nao nam tren cac xu'dng su'dn tu'dng iJng. Theo l<et qua nay, c6 the thay hach d vj tri cao hdn thi cd ty le nam tnong khoang lien su'dn tu'dng iJ'ng cao hdn, va ty le nam de len xu'dng su'dn du'di thap hdn hach d vi trf thap hdn. Nhu' vay, cd the thay ai djch chuyen xuong du^i cua cac hach so vdi cac xu'dng su'dn tu'dng utig, l<et qua nay ciia chung toi phCi hdp vdi l<et qua ciia Zhang B.
- Khi cat ngang TKGC ngUc tren cac xWdng
sudn thi thanh phan bi cat, huy chu yeu la cac than TKGC ch& khong phai la cac hach TKGC, chigSp mot ty le rat thSp la hach TKGC nhuhg a hdn mot mut.
Ra nhieu mo hoi bii qua miJc^la h|u qi khong mong muon sau mo gay nhieu phien to nhat cho benh nhan sau cat, dot huy TKG ngu'c. Nguyen nhan cua hau qua nay cd lie quan chat che vdi cac mu'c dp va pham vi ca thiSp vao chuoi hach TKGC ngu'c tren. Da va viec xac djnh chinii xac v| tri cac XS tren, vi :t cac hach TKGC, tCf dd xac djnh chfnh xac mii dp, pliam vi can thiep vao chuoi hachjn<GC_,ngu trln cd vai tro dac biet quan trpng de giam ty ( va mu'c dp ra nhieu mo hdi bu. Mot so nghi|
cull iam sang gan day, da khang djnh khi de ngang TKGC tren XS 3 va XS 4, tiJc la gidi ha tren va du'di hach T3 (can CLT vao ket qua nghig cull ve vj tri iiach T3 cua chung toi) thi cd ke qua kha quan nhat: Dat hieu qua giam tiet mi hoi d long ban tay, dong thdi giam du'dc ty le ca hau qua khong mong muon.
3.4, Uen quan glui chuoi hach TKGC ngu'c tren vdi cac tinh mach lien su'dti tren.
Bang 3.4. Vj tri chuSi hach TKGC ng^'c so vdi cac tinh mach lien su'dn tren d cac xu'dni su'dn tu'dng IJ'ng.
Tinh mach lien su'dn tren Chuoi hach TKGC
Nam trong Nam trudc delen NSm ngoai Khong ro
Trong mo Xac(n=30)
Trong mo(n=138)
Xac Trong mo
(n=138) Xac(n=30)
Trong m6(n=138) Xac (n=30)
Ben phai Tren XS 2
- -
-
17/17(100
%)
138(100%)
-
Tren XS 3
- -
9(6,5%)
-
99(71,7%) 17/17(100
%)
30 (21,7%)
-
TrenXS4
- -
30(21,7%)
;/17(29,4%
103(74,6%) 12/17(70,6
%)
5(3,6%)
-
Ben trai Tren XS 2
- -
-
13/13(100
%)
13^8(100%:
-
Tren XS 3
- -
5(3,6%)
-
57(41,3%) 13/13(100
%)
76(55,1%)
-
TrenXS4
-
35(25,4%) 3/13(23.1%;
66(47,8%!
10/13(76,9!
%) 1
37(26,8%)|
K
K€t qua ci!ia chung toi nhan thay: Tu" mu'c xu'dng su'dn 2 den xu'dng su'dn 4, Chuoi hach TKGC ngifc cd ty le nam ngoai TMLS tren cao hdn d xuUng su'dn mu'c tren, ty le nam tru'dc de len TMLS tren cao hdn d xu'dng su'dn mu'c du'di.
Khong cd tru'dng hdp nao nam trong TML5 tren.
lOii thifc hien 1^ thuat cat ngang TKGC tren cac xu'dng su'dn, neu trong tru'dng hdp chuoi hach TKGC ngi/c tren nam tru'dc de len TMLS tren d doan ran cat, chung toi sCf dung kim phau
tfeh dau cong (Kelly) kep ngang hoac diling mo (Hook) luon du'di chuoi hach TKGC d vj trf dini cat, hdi nhac len tach TKGC khoi xu'dng sudn d' chcic chan da kep hoac moc ten toan bp chie day cua TKGC, keo ra ngoai/ hoac vao trong d chuoi hach TKGC ngi/c tach khdi TMLS tren, sa do dot dien lam dut chuoi hachTKGC ngu'c tren"
3.S. TV le nhanh than kinh no: thim tie XS 2 (than kinh Kuntz) khi chu'a bdc I thanh mang phd/.
Bang 3.5. Nh^nh than kinh noi thSm tren XS 2 ' — ^ . ^ ^ 0 1 tiTdng
Ben ~ ~ ~ ^ ^ Phai
Trai
Tr€n tieu ban xac (n=30) 15 (50%)
9 (30%)
Quan sat trong m3 (n=276) 89 (32,2%) 71 (25,7%)
'1
4
0,0511
0,6a
TAP CHi Y HOC VIET NAM TAP 452 - THANG 3 - SO 2 - 2017 Ket qua cua chung toi cho thay: Tren tieu ban
BC, ty le gap nhanh than kinh Kuntz la 24/30 ben :hiem 80%. Quan sat trong mo, ty le nhanh nay )en phai la 89/276 ben chiem 32,2% va ben trai la '1/276 ben chi&n 25,7%, tong hai ben la 57,9%.
So sanh d tiJtig b^n, t y le nhanh than kinh nay if tren tieu ban xac va quan sat trang mo, s i / khac )iet khdng co y nghla thong ke vdi p > 0,05.
3.6. Dac diem nhanh tiian kinh ndi them trin XS 2 (tiian lanh Kuntz) khi da bdc la th^nh mang phdi (tren xac).
- a 17/30 ben (56,7%) cd nhanh TX Kuntz, trong dd ben phai co 12/17 ben (70,6%) va ben trai CO 5/13 b^n (38,5%)_.
- Du'dng kinh eua nhanh TK Kuntz trung binh la 0,84 ± 0,37mm, nho nhift la 0,5mm va Idn n h ^ la 1,5mm.
- Khoang each trung binh den chuoi hach TKGC tren XS 2 la 10,35 ± 4,95, ngan nhat la 2 mm va dai nhat la 18,5mm.
Do vay, de de phdng tang tiet nhieu mo hoi tai phat thi phai tim va eat nhanh TK Kuntz nam treri, cung sau xu'dng su'dn 2. Pham vl tim cac nhanh nay la trong khoang 20 mm t i f chuoi hach TKGC ra phia ngoai.
JV.KFT LUAN
-XS nhin thay tren cung khi chuci cat la thanh mang phoi la xu'dng su'dn 2.
-Khong the xac djnh chinh xac vj t r i cOa cac h?ch TKGC ngi/c tren khi chu^ boc la thanh mang phoi d 100% cac tnfdng hdp.
-Vj trf thap nhat cua hach sao hoac hach T l co the den cung sau eua xu'dng su'dn 2 vdi t / le 3,3% (1/30 ben).
-Hach T2, T3, T4 co ty 1$ cao nhat la nam trong khoang lien su'dn tu'dng dng, vdi ty le 76,7% (23/30 ben), 63,3% (19/30 ben), va 50%
(25/50 ben).
- Chuoi hach TKGC ngifc eo t y le nam ngoai TMLS tren rao hdn d xu'dng su'dn mtfc tren, t / le nam tru'dc de len TMLS tren cao hdn d xu'dng su'dn mu'c du'di. Khong co tru'dng hdp nao nam trong TMLS tren.
. Nhanh than kinh Kuntz:
+ Khi chu^ rat la thanh mang phoi: t / le gap tren xac la 8 0 % va trong mo la 57,9%.
-I- Khi da cat ia thanh mang phoi: co ty ie 56,7% (17/30 ben), trong do ben phai ed 12/17 ben (70,6%) va ben trai cd 5/13 ben (38,5%).
Pham vi tim cac nhanh nay la trong khoang 20 mm tiy chuoi hach TKGC ra phfa ngoai.
TAI LIEU T H A M KHAO
1. AUdnson 3. L, Feeley R. D. (2003), "Sympathotomy instead of s^pathecbomy for palmar hyperhidroas:
minimizing postoperative compCTsatory hyjjerhidroas".
Mayo an ProqTS, pp. 167-172.
2. Chung I . H., Oh C. S., Koh K. S et al. (2002),
"Anatomic variations of the T2 nerve root (including the nen/e of Kuntz) and their implications for sympathectomy", J Thorac Cardiovasc Surg, 123, pp. 498-501
3. Kim D. H., Hong Y. ] . , Hwana J. J., Kim K. D., Lee D. Y. (2008), 'Topographicar consideratkxis under video-scope guidance in the T3,4 levels sympathetic surgery", Et^JCardk^horacSurg, 33, pp. ^6-789.
4. Kopelman D., Hashmonai M. (2008), "The Correlation Between ttie Method of Sympathetic Ablationfbr Palmar Hypertiidrosis and the Occun-ence of Compensatory Hyperhidrosis: A Review", Worid J Surg, 32, pp. 2343-2356.
5. Kuntz A. (1927), "Distribution of the sympathetic rami to me brachial plexus: its relation to sympatJiectomy affecdng the upper extremit/"
ArchSutg, 15, pp. 871-877.
6. Ramsaroop L., Singh B., Moodley ] . , Partab P., Satyapal K, S. (2004), "Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era", din Anat, 17, pp. 294-299.
/ . Sdimidt 3., Bediara F. G., Altmeyer P. and ZimgibI H. (2006), "Bidoscopic thoradc
sympathectomy for severe hyperhidrosis: impad of resbicdve denevation on compensatory sweating", Ann Thorac Surg, 81(3), pp. 1048-1055.
NGHIEN CU'U DAC DIEM LAM S A N G V A KET QUA DIEU TRI PHAU T H U A T DUC THE T H O Y TINH 6* TRE EM
T O M TAT
*B^h vien Mat Da N$ng
Chju tradi nhiem diinh: Nguyin Qudc Dat Email: dodarda^gmaiicom Ngay nhln bai: 8.01.2017 Ngay phan bien khoa hoc: 6.3.2017 Ngay duygt bai: 13.3.2017
Nguyen Quoc Dat*
Nghien cihj tien culi, mo ta, can thiep iam sang vdi 69 mat cua 56 benh nhi < 16 tuoi da dlfOc phlu thuat tai Khoa Nhan nlii B§nh vien Mat Da Nang tCf 06/2014 - 06/2015. TuSi trung binh 8,53 ± 4,50. Do bam sinh 32 mat (46,4%), chan thudng 26 mat (37,7%), benh ly 11 mat (15,9%).
- Thi idc tru^c phau thuat: ST(+)-BBT 36,2%, thi lyt DNT-<1/10 chiem 27,5%, thi lu'c 1/10 - < 3 / l d chiem 30,4%, thj life 3/10-6/10 chiem 5,8%. Ket qua thj life (CO chinh kinh):
31
