Nhdn dp khdng dieu chinh chu y i u dang E vd dgng F. Ngyyc Igi nhdn dp t h i p < 5mmHg lgi xdy ra 2 m i l d nhdm D khdm Idm sdng t h i y seidel (+).
Tyang t u , Mandal AK khi nghiOn c d u seo bpng dang E cOng t h i y nhdn dp khdng dieu chinh [11].
Sd dT nhy vdy vl khoang djch trOn eung mgc dyyc bao bpc bdi d c md ed dO phan dm cao. Seo ndy thydng khdng ed khe dydi k i t mac. Cdc md cung mgc vd k i t mac khdng d y y c phdn biOl rd rdng, thdm chi cd t h i dinh lai (todn bd thdnh sgo ddy Igi), dydng thdy dich dydi vat cdng mgc vd Id md bd thudng r i t manh.
Sgo F (dgt) khdng cd chdc ndng lyu thdng thuy djch vl thdnh ddy trong dd k i t mac vd cdng mgc dinh vdo nhau. Dudng thuy djch dyOi vgt cdng mac thydng khdng nhin thiy mdc du Id md bO cd t h i nhln duyc.
Theo Zhang Yi (2008), d c bpng d chdc nSng thi nhdn dp duyc d i l u chinh (14,3±3.6 mmHg); cdc bpng.
khOng cd chdc nSng ed NA tmng binh cao han (22.9± 3,2 mmHg) vdi p<0,001 [4],
Minh chdng cho nhdn djnh tren, Nakano N (2010) dd ddng OCT d l theo ddi t i l n t r i l n 48 sgo bpng I d t u i n thd 2 d i n thdng 6 sau md c i t bO cd ddng MMC eho ring nhdm cd thdnh sgo phdn dm t h i p phan dnh llOn k i t md Idng leo ( d u tnic nhilu t i n g nhieu Idp d y y c phdn djnh), Ideh biet md dudi k i t mgc vd nhilu nang thi sau 6 Ihdng cd chdc ndng tdt i"''T
K£T LUAN
Sau phdu thudt d t bO cdng gidc mac d dp MMC.
khdm tren sinh h i l n vi vd b i n g OCT d i u cho t h i y chd y i u edc m i l cd sgo bpng tda lan (66,7%) vd dgng nang (30%). Tuang dng vdi sgo bpng tda Ign vd bpng dgng nang nhdn dp eOng ha tdt han (nhdn dp d i i u chinh tuyOt ddi chi cd d 2 nhdm ndy). Nguyc Igi nhdm seo bao Tenon vd sgo det nhdn dp khdng (Slu chinh. Cdc sgo cd dSc d i l m chd yeu H2 vd H3, E2 vd E3 vd sgo vO mgch. Chi d hai m i l .(6.7%) x u l l hiOn Seidel sau 1 t u i n . Nhy vdy, d t bO dp MMC d o k i t qua sgo bpng t h i m tuang ddi dn ^ n h v l hinh thdi vd chdc ndng tdt sau 6 Ihdng theo ddi.
T A I Lieu THAM K H A O
1. Kitazawa Y. Yamamoto T (1996). Surgery for refractory glaucoma. Australian and New Zealand Joumal of Ophthalmology. 24(4), 327-332.
2. Greenfield DS, Uebmann J.M, Jee J et al (1998), Late-onset bleb leaks atter glaucoma filtering surgery, 116 (4), 443-7.
3. Cantor LB. Mantravadi A, WuDunn D et al (2003), Morphologic classification of filtering blebs after glaucoma filtration surgery: the Indiana Bleb Appearance Grading Scale, J Glaucoma. 12, pp 266-271.
4. Zhang Yi, WU Qiang, Zhang Min, Song Bel-wen et al (2008), "Evaluating subconjunctival bleb function after trabeculectomy using slit-lamp optical coherence tomography and ultrasound biomicroscopy". Chin Med J, 121(14), 1274-1279.
5. Mahdy RA, Waled M.N. Salah M.A et al (2010). A freeze-dried (lyophilized) amniotic membrane transplantation with mitomycin C and trabeculectomy for pediatric glaucoma, Cutaneous and Ocular T(X(icology, 29(3), 164-170.
6. Anand N, Arora S, Clowes M (2006), Mitomycin C augmented glaucoma surgery: evolution of filtering bleb avascularity. transconjunctival oozing and leaks, Br Ophthalmol, 92,175-180.
7. Megevand G.S, Salmon J.F. Raoul P et al(1995).
The effect of reducing the exposure time of mitomycin C in glaucoma filtering surgery. Ophthalmology, 102(1). 84 -90.
8. Memioud A. Salmon J.F et al (1993).
Trabeculectomy with mitomydn C for refractory glaucoma in Blacks, Am J Ophthalmology, 116, 72 - 78.
9. You YA, Gu YS. Fang CT et al (2002), Long-tenn effects of simultaneos subconjuncUval and subscleral mitomycin C application in repeat trabeculectomy, J Glaucoma, 11(2), 110-8.
10. Harish C A . Deepali S, Ramanjit S (2001):
Assessing the role of subconjunctival versus intrascleral application of Mitomycin-C in high-risk trabeculectomies, Indian joumal of Ophaimology.AQ (,2), 9^-95.
KET QUA PHAU THUAT NQI SOI DIEU TBI VIEM TUI MAT CAP DO SOI TAI BENH VIEN DA KHOA TINH KHANH HOA
TRUONG DiNH KHOI. D 6 HOAI K^, NGO THE LAM, CAO VIET DUNG Benh vi^n Da khoa tinh Khdnh Hoi
T 6 M T A T ^
Ddt van de: Vidm tOi m$t cip do sdi Id bdnh dp cuv ngogi khoa thw&ng gdp. Phiu thuit ndi soi dt tOi mdt da dw^ chi dinh rgng rii cho cdc bdnh ly sdi tOi mdt. Tuy nhidn ddi v&i vidm tOi mdt cip do sdi. md ndi soi m&i bw&c diu dwac irng dgng tai Bdnh vidn da khoa tinh Khdnh Hod. Muc tidu nghidn cdu: ddnh gid kit qud dieu tri. tinh hidu qui, tinh an todn cDng nhw tinh khd thi cua phiu thudt ndi soi dt tOi mit ddi v&i vidm tOi mdt cip do sdi. Doi tuvng vd phuxmg phdp nghidn cOv: tiin cuv, md td. 31 tnrdng h<?p vidm tui mdt cip do sdi dwgv phiu thudt ndi soi dt tOI mdt tgi
Bdnh vidn da khoa Snh Khdnh Hda f d 01/2013 din 05/2014. Kit qui: Tudi tmng binh 53.42±15,36 tudi.
Nam 32,3%, nw 67.7%, ty Id nam:n(r Id 1:2,1. Vidm tOi mat cip dd I chiim 87,1%, dd II 12.9%. Thdi gian tmng binh tw lOc nhdp vidn ddn iOc md Id 3.22±1,63 ngdy. Th&i gian phiu thudt tmng binh 78,23±24,75 phOt. Th&i gian nim vien tmng binh 8,55±2,45 ngdy.
Sg- khic bidt vd th&i gian khdng cd ]? nghJa giOa dO / I'd dp //. Chuyin md hdc6 1/31 tnrdng /jpp (3.23%). Biin chimg sdm sau md cd 1/31 tnrdng hop (3,23%).
Khdng cd tir vong. Chwa ghi nhdn bidn chimg mudn.
Kit lu^n: Phau thudt ndi soi dt tul mdt hidu qud, an
Y HOC THirc H A N H (937) - SO 10/2014
todn vd khi thi trong Ong dung didu tri vidm tOi mdt cip do sdi tgi Bgnh vidn da khoa tfnh Khdnh Hda.
TO' khda: Vidm tui m$t cip, phau thugt ndi sol.
SUMMARY
OUTCOME OF EARLY LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CALCULOUS CHOLECYSTITIS IN KHANH HOA GENERAL HOSPITAL
Objectives: Acute calculous cholecystitis is one of most common reasons for emergency admisson in surgical pmctice. Laparoscopic cholecystectomy is becoming popular for the treatment of calculous galMadder disease. This approach Is recentiy indicated for the definib/e treatment of acute calculous cholecystitis in Khanh Hoa General Hospital. The purpose of this study was to evaluate the eariy outcomes, the safety and the feasibility of eariy laparoscopic cholecystetomy for acute calculous cho/ecysW/s. Methods: The study was performed in 31 patients who had been diagnosed with acute calculous cholecystitis and eariy operated by laparoscopic approach between January 2013 and Mai 2014 in Khanh Hoa General Hospital. The study design is obsen/ationai and prospective. Results: The average age was 53.42 ± 15.36 y.o. 32.3% male. 67.7%
female, male: female ratio was 1:2,1. The grade I of acute cholecystitis accounted for 87.1% and grade II for 12.9%. The average time from the admission to hospital until cholecystectomy was 3.22 ± 1.63 days.
The average time of operation was 78.23 ± 24.75 minutes. The average length of total hospital stay was 8.55 ± 2.45 days. There was no significant difference of these times between grade I and grade II groups.
The conversion rate was 1/31 (3.23%). The eariy postoperative complication rate was 1/31 (3.23%).
There was no death. Any late postoperative complication was noted. Conclusions: Eariy laparoscopic chdecystectomy is a safe, effective and teasible procedure for the treatment of acute calculous cholecystitis in Khanh Hoa General Hospital.
Keywords: Laparoscopic cholecystectomy, acute calculous cholecystitis.
DAT V A N Dt
Viem tdi mdt c i p do sdl Id mpt bOnh d p cdu tiOu hda thudng ggp. 90% trydng hyp viOm tui mOt cap Id do sdi gdy t i c nghen dng tdi mdt. ViOm tdi mdt d p se din den cdc b i l n chdng: hogi I d hoOc thung tui mdt, dp xe I byng, viOm phdc mac vd d t h i d i n d i n t d vong. Theo Kimura vd cs, ty 10 t d vong vd ly 10 b i l n chdng cua viOm tdi mOt c i p l i n l y y t Id 0-10% vd 7- 26%. 20% vJOm tdi m$t d p khdng ddp dng iSOu trj nOi khoa. Do dd, d n phai can thiOp sdm nhy d i n luu tgm thdi hodc md cap cdu e i l tui mdt [ 6 j Phiu thuOt d t tdi mdt Id phyang phdp dieu lr\ triOl d l viOm tdi mOt c i p do sdi. Ca mo hd d l tdi mat d i u tiOn d y y e Langenbuch bdo cdo ndm 1882. Trudc fldy, md hd cdt tdi mOt Id phyang phdp d u y c lya chpn trong d i l u trj viOm tdi mdt d p . D i n thdp niOn 1980, khi bdc sy Philippe Mouret thyc hien ca d t tdi
mOt ndi soi d i u lien tgi Phdp. d t tdi mdt nOi soi da d y y c xem Id tidu d u i n vdng trong d i l u tri bOnh ly sdi tdi mgL Nhilu p h i u thudt viOn dd thyc hiOn phdu Uiudt nOi sol d t tdi mdt ddi vdi d viOm tdi mdt d p . Nhilu nghien edu dd so sdnh hai phyang phdp md hd vd md ndi sol ddi vdi vidm tdi mat d p , nhyng d i n nay v i n d n nhiiu tranh cai v l quan diem. Nhdng ndm g i n ddy. p h i u thudt ndi soi da phdt triln v y y t bOe vd trd thdnh phyang phdp p h i u lhu$t s d dyng Irong d i l u tri sdm viOm tdi mdt c i p do d i n h i m g i i m thdi gian n i m vign^ eOng nhu ty 10 b i l n chdng trong md vd ty Id ehuyin md hd dS duyc d i thiOn r i t nhieu [8].
Tai BOnh vlOn da khoa tinh Khdnh Hod. p h i u thugt nOi sol d t tdi mdt ddi vdi sdi tdi mOt chua cd biln chdng dd d y y e dng dyng t d nhdng ndm 2000.
Tuy nhiOn ddi vdi viem tui mOt d p do sdl, chdng 101 mdi budc d i u thye hiOn md ndi soi d t tdi mdt sdm.
D l ddnh gid bydc d i u k i t qua d i l u trj. tinh hlOu qua.
tinh an todn cung nhy tinh kha thi cda p h l u thudt ndi soi sdm trong d i i u trj viem tdi mOt d p do sdi, chiing tdi tien hdnh nghiOn cdu "Kit qui phiu thudt npi soi dieu tii vidm tui m^t cap do s6i tai Bdnh vi^n Da khoa tinh Khdnh Hoa".
D O I TU'O'NG VA PHU'aNG PHAP NGHIEN CO'U Ddi t y y n g nghien c d u
Cdc bOnh nhdn d u y c c h i n dodn viem tdi mdt d p do sdi vd d y y c phdu Viudt nOi sol c i i tdi mdt lgi Khoa Ngogi tdng qudt BOnh vign da khoa linh Khdnh Hda t d thdng 1/2013 den Ihdng 4/2014.
Tidu chuin chgn b^nh: ViOm tdi mat dd 1, II ed ehl djnh rnd d t tdi mdt sdm sau khi da d i l u trj ndi khoa tieh cyc ban d i u . Chdng tdi sd dyng Phdc dd Tokyo TG13 d l ddnh gid mdc dd n^ng cda viem tui mOj d p . Benh nhdn khdng cd chdng chi djnh eua phdu thudt ndi sol.
Danh gid mdc dd n$ng cda viOm tdi mdt d p theo Phdc dd Tokyo TG13:
- DO III (ndng): viOm tdi mdt kOm theo rdi logn ca quan/hO thdng sau:
+ rdi loan tim mgch: tyt huyit dp d n h i try Dopamin ^ 5 pg/kg/phdt hodc d n hd try Norepinephrine
+ rdi loan tiiin kinh: giam In gidc + rdi loan hd h i p : Pa02/Fi02 < 300
+ rdi logn chdc ndng thdn: thilu nieu. Creatinine mdu > 2.0mg/dl
+ rdi logn chdc ndng gan: PT-INR > 1,5 + rdi loan vO mdu: lieu d u < 100.000/mm3 - Dp 11 (tmng binh): viem tdi mat d p kOm theo d c y i u td sau:
+ Bgch d u > 18.000/mm3
+ s d t h i y khdi hodc p h i n dng thdnh bung hg sudn phai
+ dau > 72h
+ ed d e b i l n chdng tgi chd nhy viOm md tdi mOt, dp xe Idi mgt, dp xe gan, viOm phuc mgc mOl, phd n l tdi mdt
- Dd I (nhe): viem tdi mgt khdng kOm theo d e y i u td ndng cda dd II, III. ViOm tdi mdt nhe vdi nguy ca p h i u thudt t h i p .
y HO^ HUC HANH (937) - s610/2014
Tidu chuSn loai inr. Vigm tiji m$t cSp do sdi mtJc ao III. B$nh nhan' cd c4c t>#nh If tim m?ch, hd h4p nang khdng cd chi dinh nOi soi.
P h v a n g phdp nghign C(PU li/ld td, ti6n ciru.
CSc thdng s6 nghidn ci>u: tu6i, gi6i, mO'C dd n$n^, t h « gian tCf ICic nh§p vi$n il4n liic m6, t h i i gian mo, thdri gian n i m vi$n. t n j * n g hyp mat m i u > 200ml, ty tg chuyin md h i , b i l n chi>ng sau mo.
Chijng tdi si> dung phSn m i m th6ng kd MedCalc version 12.3.0.0, phdp thi} x2, phdp thCf Anova. Sij' k h i c biOt cd 4 nghTa th6ng kd khi p < 0,05.
K£T QUA
TCF thdng 1(2013 d i n thSng 5/2014, chOng tdi 85 phau thu$t nOi soi c i t ttji mat sdm doi vd'i 31 b$nh nhan viSm tlii mat c^p do sdi. K i t qua d?t d\sqc nht/ sau:
T u l i : l*n nhat: 85 t u l i , nhd nhit: 25 t u i i , tmng binh: 63,42±15,36 t u l i .
Gi*l: nam 32,3%, nO' 67,7%. Ty 1$ nam: nO IS 1:2,1.
Bang 1. Mu'c d l nang cua vidm tOi mat d p theo Phac d i Tokyo TG-i 3
Mdc dd ndng B d i DO 2 Bd3 Tdng cdng
N 27 4 0 31
87.1
%
12.9 0 100 Bdng 2. Mdc dd ndng cda viOm tdi mdt theo gidi
Nam Nii'
Tdng cpng 27(67,1%) 90 2
4 (12,9%) Ting cOng 10(32,3%) 21 (67,7%) 31 (100%) Sy kiidc blOt v l mdc dO ndng cda viOm Idi mdt d p khdng cd d y nghTa gida nam vd nd.
Thdi gian t d Idc bOnh nhdn nhdp vlOn cho d i n Idc duyc phau thudt ndi soi d t tdi mdt t d 1 d i n 7 ngdy, tmng binh 3,22±1,63 ngdy. Nhdm bOnh nhdn do 2 duyc md sdm han nhdm bOnh nhdn dd 1, tuy nhien sy khdc biOt ndy khdng cd y nghTa thdng kO,
Thdi gian md n g i n nhit: 40 phdt ddi nhit. 150 phdt, tmng binh: 78,23±24,75 phdL Thdi gian md tmng binh ddi vdi nhdm dO 1 vd nhdm dO 2 tuang t y nhau, khOng d sy khde biOt d y nghTa.
Thdi gian n i m viOn n g i n nhit: 5 ngdy, ddi nhit:
14 ngdy, trung binh' 8,55±2,45 ngdy. Nhdm bgnh nhdn dO 2 n i m viOn Idu han nhdm dO 1, tuy nhidn su khdc biOt khOng cd y nghTa thdng ke.
Bang 3. So sanh ve thdi gian gida 2 nhdm bOnh nhdn dp 1 vd dp 2
Mdc dO n$ng
Bdi Bd2 Gid tri p khi so sdnh thdi gian giO-a nhdm dO 1
vd nhdm dd 2 Thdi gian trung binh td luc nhdp viOn den luc m l
(nqdy) 3,29 2,75
p = 0.54 Thdi gian
md trung binh (phiit)
79.26 71.25
p = 0,555 Thdi gian nim viOn trung binh (ngSy)
8.26 10.50
p = 0,037
Chuyin md hd: d 1 trydng hyp (3.23%). ^BOnh nhdn ndy d viOm tdi mOt d p dp 2. Ly do chuyen md hd Id do tam gidc Calot bdc tdeh qud khd khdn, nguy ea t i n thyang dydng mdt chinh.
Biln chdng sau md: d 1 trudng hyp (3,23%) p h i i md Igi sau m l 2 gid vi ehodng do c h i y mdu d byng. BOnh nhdn d y y c md Igi thi phdt hiOn t h i y clip ddng mgch tdt mdt bj bung ra ngodi.
Sd trydng hyp cd l y y n g mdu m i t trong md >
200ml Id 4 trydng hyp (12,9%).
D i n luu 6 byng eO 12 trydng hyp (38,7 %), vj tri d i n lyu Id gam gan. Thdi oian rdt dng d i n luu trung binh khodng 3 ngdy sau md.
Thdi gian bOnh nhdn tmng tidn Igi tmng binh t d 1 d i n 2 ngdy sau md.
Chdng tdi chya ghi nhOn bien chdng mudn sau md, dau vdng tdi m$t sau md d t tdi mOt khi bOnh nhdn tdi khdm sau 1 thdng.
B A N LUAN
Ddi vdi sdi tdi mdt khdng cd b i l n ehdna, phlu lhu$t ndi soi Id phyong phdp d y y c lya chpn de d t tdi mOt.
Trong nhdng nSm tnj'dc ddy khi phdu thudt nOi soi mdi b i t d i u phdt triln, viOm tdi mat d p do d i Id mpt trong nhdng chdng chi djnh cda phyang phdp it xdm Iln ndy. T d dd ed r i t nhidu nghien cdu cOng nhu tdi IiOu d l cdp v l v i n d l chi flnh p h i u thuOt nOi soi ddi vdi ViOm 101 mdi d p vd k i t luOn ring md ndi sol hodn todn k h i thi vd an todn trong d\hu trj vidm tdi mdt d p . Tuy nhlOn, viec khing djnh an todn vd hlOu qua chi dyyc d c tdc gia d l d P flin viOm tdi mOt duyc md frong vdng 72h t d khi d triOu (^dng. Cdn ddi vdi tmdng hyp viOm tdi mdt dd d i l n t i l n trOn 72h thi d c quan d i l m d i l u tri vdn chya r5 rdng. Mdt sd quan iSim tnj'dc ddy dng hd viOc d i i u trj ndi khoa sau dd se phlu thudt nOi soi d t tdi m$t mudn sau 9-12 t u i n . Tuy nhiOn, trOn 20% trydng hyp bgnh khdng ddp dng dilu trj nOi khoa vd 30% d c tm-dng hyp bOnh nhan nhdp viOn trd Igi do viOm tdi mdt Idi phdt trong vdng 3 thdng sau xuit vien [3]. Ty 10 b i l n chdng cda phdu thudt nOi SOI d l tdi mdt trong viOm tdi mgt cap khoing 9-15%. ty 10 ndy cOng tyang duang md hd theo Kitano S. vd cs.
Ty 10 tdn thyang dydng mdt khoing 0,7-1.3% [10]. VI vOy mdt d tdc gia khuyin d o nOn chyp hinh dydng mdt trong md cat tdi mOt npi soi ddi vdi viem tul mOt c i p d l hgn che b i l n c^dng ndy. Ddi vdi bOnh nhdn nguy ca cao, benh nhdn gid yeu, bOnh nhdn viem tdi m$t mdc dd 3 theo T G I 3, d c tdc g i i khuyin cdo nOn d i n luu tdi mOt qua da vd dieu tq nOi Khoa tieh cyc.
Md d t tdi mat se d y y e thye hien mudn khi bOnh nhdn dd 6idjnh sau 6-12 t u i n . t n j ' d n g hyp ddn lyu tdi mdt qua da dau tien d y y c bdo d o ndm 1984, phuang phdp ndy da phdt huy tinh higu qua vd an todn ddi vdi bOnh nhdn viem tdi mOt nSng vdi ty 10 thdnh d n g g i n 100%. Phuang phdp ndy edn d y y c sd dyng vdi myc dich c h i n dodn. Theo Yusoff I.F. vd cs, ty 10 thdnh d n g cua d i n luu tdi mdt qua da khoing 75-90% [10].
Trong nghiOn cdu cda chOng tOi, d c bOnh nhdn dyyc mo trong khoang t d 1 d i n 7 ngdy sau khi nhdp viOn, tmng binh 3,22±1,63 ngdy Nhdm viOm tui mOt d p dd 2 duyc md sdm han nhdm dd 1 (2,75 ngdy so vdi 3,29 ngdy). D i l u ndy eung hap ly vi viOm tdi mOl
Y HOC THUC HANH (937) - S6 10/2014
dd 2 d n duyc md sdm han d l trdnh cdc biln ehdng n$ng n l nhy thdng Idi mdt, vlOm phdc mac. Tuy nhiOn sy khdc biOt ndy khdng ed y nghTa Uidng kO (p = 0,54).
Md d t tdi mdt sdm doi vdi viOm tdi mdt d p eOng Id vin dO tranh iuOn gida nhiiu tdc g i i . Tuy nhidn, theo quan d i l m hiOn nay cung nhy phdc dd Tokyo T G I 3, m l d l tdi mdt sdm trong l i n nhdp vign Id quan d i l m dyyc nhidu tdc g i i ling hO. Phuang phdp phdu thudt ufu tiOn Id md nOi soi.
Td khi p h i u thudt ndi soi d t tdi mdt d y y c thyc hlOn l i n dau tidn d i u thdp niOn 1980 vd sau dd duyc ling dyng Irong d i l u trj vidm tdi mOt d p vdo Ihdp nlOn 1990, thdi gian ehl djnh md d t tdi mdt nOi soi diOu tn viOm tdi mdt d p do sdi luOn Id v i n de tranh luOn gida nhilu tdc g i i . MOt sd tdc gid khuyin cdo nOn d i l u tri nOi khoa sau dO m l d t tui mOt mudn sau 6 t u i n trd ton. Mpt bdo d o Cochrane trOn 5 nghien cdu ngdu nhidn. so sdnh nhdm md ndi soi sdm (trong vdng 7 ngdy) vd md mudn (> 6 tuin), eho t h i y ty 10 b i l n chdng tdn thyang dydng mOl d nhdm md sdm Id 0,64% nhung thdi gian nam viOn d nhdm md sdm ngin han den 4 ngdy so vdi nhdm md mudn. khdng d sy khde biet v i ^ 10 bien ehdng sau md cQng nhy ty 10 chuyin md hd [6]. Theo Lacaine vd cs, phdu thudt ddi vdi vidm Idi mOt c i p c i n thye hiOn d n g sdm d n g tdt, phyang phdp yu tiOn lya chpn Id p h i u thudt ndi soi tni*
nhdng trudng hyp ehdng chi djnh md nOi sol, bOnh nhdn d n duyc dieu tii khdng sinh tm'dc md [5]. Theo BmgOre C vd Slim K., ty 10 chuyin md h d ddi vdi nhdm md sdm t h i p han so vdi nhdm md nguOl vd nOn md trong vdng 5-6 ngdy I d khi b i t d i u cd trlOu chdng Idm sdng [5]. Araujo-Teixeira J,P, vd cs cho ring ty 10 chuyin mo md cdng eao n l u thdi gian t d Idc nhdp vidn cho d i n Idc p h l u thudt kdo ddi tren 4 ngdy, do dd md d n g sdm d t h i d n g tdt [3]. Theo nghlOn cdu d a Osman Y. vd cs, m l sdm khdng d s y khdc blOt v l m$t bien chdng hoOc thdi gian md so vdi md nguOl (sau 9-12 t u i n khi dd ^ l u trj ndi khoa trong dyt nhdp viOn d i u tiOn), nhung md sdm lgi Idm g i i m thdi gian nim vign cQng nhy vign phi so vdi md ngudi. MOt ly do cdc tdc gia khuyin d o nOn m l s d m j d kha ndng bdc tdch tam gidc Calot trong md sdm dO han so vdi md ngudi, ty Ig ehuyin md h d cda nhdm md sdm vd m l mudn tuang dng Id 17,6% so vdi 25,7%. Ly do giai thich cho ty 10 chuyin md h d d bOnh nhdn md sau 5 tuin cao han md sdm la vung tam gidc Calot bj dinh.
xa hda vd tdng sinh m g d mdu nhilu han, do dd Idm tdng nguy ea tai b i l n trong qud trinh bdc tdch. VlOm tdi mOt cap d y y c md trong giai dogn sdm thi thdnh tdi mOt phd ne, bdc Idch nOn phdu tich d l ddng han. Giai dogn phd ne tdi mOt kOo ddi khoing t d 1-7 ngdy t d khi bit ddu vlOm. Osman Y. vd cs de nghj mo Irong k h d n g thdi gian sdm n h i t Id trdn 72h cho d i n 7 ngdy.
Lee A.Y. vd cs hdi cdu 202 tnj'dng hyp md d t tdi mgt ndi soi cho viOm tdi mOl d p bao gdm 3 nhOm: nhdm md trong vdng 72h d i u lidn I d khi cd IriOu chdng, nhdm mo trong vdng 4 ngdy d i n 5 t u i n vd nhdm md sau 5 t u i n . K i t q u i cho t h i y khOng cd s y khdc biOt ve ty 10 chuyen md h d eung nhy tai b i l n gida nhdm md sdm v i nhdm md mudn. Tdc gid k i t ludn md sdm viOm tdi mdt d p do sol hodn todn an todn ddi vdi bOnh
nhdn, Nhilu nghiOn cdu dd k i t luOn md d t tdi mdt sdm ddi vdi vlOm tCii mdt d p gidp giim Ihdi gian n i m viOn. viOn phi. nhanh hdi phuc sau md, g i i m 1} 10 b i l n chdng vd t d vong so vdi phyang phdp d i l u trj ndi khoa kOm d t tdi mOt ngudi. Cdc nghien cdu dd ghi nhdn md sOm d ty 10 chuyin md h d t h i p han md mudn. Theo Lo vd cs, Lai vd cs, md ndi sol Id phyang phdp dyyc lya chpn ddi vdi vlOm tdi mOt d p vd ndn md trong vdng 96 gid t d khi cd triOu chdng idm sdng, Garber vd cs khuyOn nOn md trong vdng 4 ngdy d i u lidn [10]. Tdc g i i Stevens K.A. vd cs nghlOn cdu trOn 253 bOnh nhdn gdm 2 nhOm d t tdi mdt ndi soi ddi vdi vidm tlii mat d p trong vdng 72 gid vd 24 gid vd k i t ludn md sdm Irong vdng 24 old d i u tiOn an lodn han vd 11 biln chdng han (ty 10 biin chdng d nhdm md 24 gid Id 7% so vdi 9% d nhdm md sau 24 gid). Theo Yusoff I.F. vd es. 6 nghlOn cdu n g l u nhidn dd so d n h md sdm vd md mudn (sau 6-8 tuin). cho t h i y ty 10 biln chdng Id nhy nhau gida 2 nhdm, tuy nhiOn md sdm gidp g i i m chi phi vd thdi gian n i m viOn vl d d i n 10-25% bOnh nhdn bj viOm tdi mOt trd lgi sau khi dO (Slu trj nOi khoa b i o t i n . Theo Duncan C B . vd cs, ty 10 tdi phdt viOm tdi mdt d bgnh nhdn khOng diryc d t tdi mdt sdm khoang 20-50% [6]. Theo Saeb-Parsy K. vd cs, ty 10 tdi phdt vd nhdp vlOn trd Igi khoang 5-39% vd viOm tdi mdt d p c i n duyc d t Idi mOl ndi soi d p cdu n l u phiu thudt vlOn kinh nghlOm, an todn, vd giim ty 10 bdnh nhdn p h i i nhdp vign trd lai do viem tdi phdL
Thdi gian md tmng binh d a c^dng tdi Id 78,23±24,75 phdt. Theo V5 Hdng Sd, T r i n ThlOn Tmng ndm 2010, Ihdi gian md trung binh Id 93,3 phdt [2]. Theo Dd Trpng H i i , Phan Anh T u i n (2003) Id 85 phiit [1]. Theo Saet)-Parcy K. vd es Id 75 phdt. Stevens K,A. vd es 95 phdt. Nhy vdy, Ihdi gian phiu thudt cda ehOng tdi ngan han mdt chdt so vdi d c tdc gia.
Thdi gian n i m vlOn trung binh trong nghlOn cdu cda chdng tdi Id 8,55±2,45 ngdy, Nhdm bdnh nhdn viOm Idi mdt dO II cd Ihdi gian n i m viOn Imng binh Idu han nhdm dO I (10,5 ngdy so vdi 8,26 ngdy). Tuy nhiOn s y khde blOt ndy khdng cd y nghTa thdng kO (p = 0,087). Thdi gian n i m vlOn trong nghlOn cdu d a d c tdc g i i khdc: Dd Trpng Hal: 4,3 ngdy, VG Hdng Sd: 4,2 ngdy, Lee A.Y. vd cs: 3,1±3,8 ngdy, Araujo-Teixeira J.P. vd cs: 5±3 ngdy, Bareelo M, vd cs: 8.32±4,98 ngdy [1, 2, 3, 4]. Nhy vdy, thdi gian n i m viOn tmng binh cda ede bOnh nhdn trong nghien cdu cda chdng tOi ddi han cdc Idc gia, d t h i do phdu thuOt ndi soi d t tdi m$t bydc d i u dyyc dp dyng trong d i l u trj viOm tdi mdt d p do sdi lgi bdnh viOn nOn chdng tdi gid benh nhdn trong thdi gian hdu phiu ddi han d i chdm sdc bOnh nhdn vd theo dOi d c biln chdng.
Trong nghiOn cdu cda chdng tOi. ehi cd 1 trydng hap (3.23%) ehuyin md h d vi vung tam gide gan mdt ddy dinh, tdng sinh mach mdu nOn bdc tdch qud khd khdn vd nguy ca tdn thuang d y d n g mOt. Trydng hyp ndy d viem tdi mOt mdc dd 2 theo T G I 3. Vd Hdng S d vd T r i n ThiOn Trung nghiOn cdu trOn 396 trydng hyp, ty 10 chuyin md h d Id 0,8% [2]. Theo Garcia P.C. vd cs. ty 10 chuyin md h d Id 5% [8]. Ty 10 chuyin md h d cda chdng tdi cdng tyang t y d c tdc gia, Nhieu nghiOn cdu da ddnh gid tinh kha Ihi cda
Y HOC THUC H A N H (937) - s 6 10/2014
md ndi sol ddi vdi viem tui mOt d p . ly 10 chuyen md hd dao ddng t d 0,5 d i n 28% tuy bdo cdo. Nguydn nhdn chuyin md hd do vdng tam gide Calot vidm, phd n l , dinh. Idm sai lech d c mdc giai p h l u , gdy khd khdn eho viOc phdu tich. Theo y van.^ty 10 chuyin md h d eao han d benh nhdn nam. tudi trOn 65, phdu thugl mudn. vdch tdi mdt ddy trOn 5mm vd kinh nghiem hgn c h i cOa p h l u thugt vien. Ddi vdi vidm tdi mat elp. cde tdc g i i khuyin cdo nen ed trang thiet bi md nOi soi tdt, nen dung camera 30° vd ndn giam dp tdi mat ngay khi b i t d i u p h l u t l t ^ [10].
Trong nghien edu cda chdng tdi ehi d 1 benh nhdn (3,23%) phai md Igi sau mo 2 gid v! ehodng do chay mdu d byng. BOnh nhdn d y y c md Igi thi phdt hign thiy clip ddng mgch tdi mat bj bung ra ngodi K l t d sau trudng hyp ndy, chdng tdi dd sd dung clip Hem-O-lock thay cho clip kim logi binh thydng trong md viem tui mdt npi soi. Theo Vd Hdng San, T r i n Thien Tmng (2010), ty Ig b i l n chdng chung trang md nOi sol d l tdi mdt do viOm tdi mat cap Id 17,1%, trong dd chay mdu ddng mach tdi mdt c6 3/396 trydng hyp (0,8%) [2]. Theo Dd Trpng Hai, Phan Anh Tuan (2003), ^ 10 b i l n chdng td 7,3% [1]. Theo Kawaguchi K. vd cs (2013) 3,3% [9]. Ty Id b i l n ehdng trong nghien cdu cda chdng tdi tuang t y cdc tdc gia.
Chdng tdi tdi khdm bdnh nhdn sau x u i t vien 1 thang vd theo ddi sau 3 thdng, chya ghi nhOn trydng hyp b i l n chdng muOn ndo.
Bdnh nhdn eua chdng tdi khi nhdp viOn d y y e d i l u tri khdng sinh, bd nude diOn giai, nhin dn udng vd dinh dudng qua dydng tTnh mgch ngogi biOn. Khdng sinh s d dyng thudng Id Cephalosporine I h l hO III k i t hyp vdi Metronidazole, Thdi gian s d dung khdng sinh khoang 7 ngdy. Theo BmgOre C vd Slim K., mpt nghiOn edu so sdnh nhdm ehi dung khdng sinh trong md vdi nhOm cd s d dyng khdng sinh 7 ngdy da cho thiy nhdm sd dyng khdng sinh 7 ngdy ed nhilu yu dilm nhy trdnh kha ndng khdng thude cda vi khuin [5]. Fuks D. vd cs (2013) khuyin cdo nOn dieu tri khdng sinh mdt ede hO thdng doi vdi moi trudng hap viem tdi mOt d p vd y u lien khdng sinh dydng mot vd t h i i qua dydng mat [7].
K^T LUAN
c i t tdi mdt ndi soi Id phyang phdp d i l u tri triOl d l VlOm tdi mdt d p do sdi d nhdng bOnh nhdn cd k h i
nSng p h i u thudt vd d n md sdm sau khi bOnh nhdn nhdp vidn d i trdnh b i l n ehdng eung nhy tai biln trong m l . P h l u thudt ndi sol an todn vd hodn todn ed the dp dyng tgi Bgnh vidn da khoa tinh Khdnh Hod trong ffieu tri vidm tui mdt d p do sdi.
T A I LIEIJ THAM K H A O
1. Dd Trpng Hai, Phan Anh T u i n (2003). "Mdc dp an todn vd hiOu qua d a d t tui mdt ndi soi trong vidm tui mgt d p do sdi". Vhgc TPHd Chi Minh, 7(1), 43-48.
2. Vo Hdng Sd. T r i n Thign Trung (2010), "Kit qua phau thuat npi soi dieu tri viem tdi mdt cap do sdi", Y hgc TPHd Chi Minh. 14(2), 96-106.
3. Araujo-Teixeira J.P., Rocha-Reis J.. Costa-Cabral A., Banos H.. Saraiva A.C.. Araujo-Teixeira A.M. (1999),
"Laparoscopie ou laparotomie dans la choldcystite aigue (200 cas). Comparaison des resultats el facteurs prddisposant d la conversion". Chimrgie, 124. pp. 529- 535.
4. Bareelo M., Cmz-Santamaria D.M., Alba-Lopez C, Devesa-Medina M,J.. Diaz-Rubio M., Rey E. (2013),
"Advantages of early cholecystectomy in clinical practice of a terciary care center". Hepatobiliary Pancreat Dis Int, 12. pp. 87-93.
5. Bmgere C . Slim K., Laeaine F. (2003). "Quand et par quelle voie operer une cholecyslite aigud lithiasique?", Annaies de chimrgie, 128. pp. 549-550.
6. Ducan C.B„ Riall T.S. (2012). "Evidence-Based Current Surgical Practice: Calculous Gallbladder Disease". J Gastmintest Surg. 16, pp. 2011 -2025.
7. Fuks D., Cosse C , Regimbeau J.M. (2013),
"Choldcystite aigue lithiasique et antibiolherapie", Joumal de Chimrgie Viscerate, 150, pp. 4-10,
8. Garcia P.O., Tovar J.R., Dehesa A.S,, Amaro A,C., Tabemilla M.D., Fragua R.L, Martin G.H., Molina E.M.. Moreno V.F. (2010), "Acute cholecystitis: is it still justified to delay surgery?', Cirurgia Espanola, 88(2). pp.
92-96.
9. Kawaguchi K., Seo N.. Ohota K., Urayama M., Toya R., Kimura W. (2013), "Early Laparoscopic Cholecystectomy for Acute Cholecystitis in Accordance with the Tokyo Guidelines for the Management of Acute Cholangitis and Cholecystitis", General Med, 2(1), pp. 1-4.
10. Kitano S., Matsumoti T,, Aramaki M., Kawano K.
(2002), "Laparoscopie cholecystectomy for acute cholecystitis", J Hepatobiliary Pancreat Surg, 9, pp. 534- 537.
TINH HINH BENH LAC NOI MAC TIT CUNG 0 THANH BUNG TAI BENH VIEN PHU SAN TRUNG UUNG TUT NAM 2012 - 2014
TOM T A T
Nghidn cOv hdi cOv 28 trwdng hgip Igc ndi mac f d cung d thdnh bung dw(;fc didu tri tai Bdnh vi$n Phg sdn Tmng wong tir 2012 - 2014 v&i mgc tidu: Md td mgt sd d$c diim ca ndng, thwc thd vd kit qui diiu tri LNMTC d thinh bung tai BV Phu sdn Tmng wong tir 1/2012 ddn 6/ 2014. Thidt ki nghien ciru md ta dt ngang hdi cdu. Kit qud: Tudi tmng binh cua cdc ddi
VU BA QUYET - Benh vien Phu san Trung uvng tw<?ng id 30,6. Cd 89% tiin s d md liy thai lin diu.
Th&i gian biiu hidn bdnh tmng binh Id 2,5 ndm. Trigu chimg chinh Id dau bgng vj tri vit mo khi hdnh kinh vd sau dd tt/ sd thiy khdi dwdi vdt mo hodc cgnh vet md thinh bgng. Khdi lac ndi mgc bdn trdi chidm nhidu nhit (60.7%). Kich thw&c khdi u tmng binh Id 3cm.
Tit ca cdc bdnh nhan ddu dux?c phiu thudt dt khdi LNMTC, chi c6 mdt ca tai bidn chiy mdu thinh bgng
Y HOC THUC HANH (937) - s 6 10/2014
