Y HOC VIET NAM THANG 6 • s61/2014
DANH GIA KET QUA DIEU TRI LIET THAN KINH QUAY CAO THEO PHU'aNG PHAP BOYES TAI BENH VIEN VIET DU'C
T 6 M TAT
Md dau: Liet than kinh quay cao thudng gap trong tam sdng, viec chuyen gan theo phu'dng phap Boyes la cSn thigt. MMC tieu: Danh gia ket qua phau thuat chuyen gan dieu trj liet than kinh quay cao theo phuong phdp chuyen gan Boyes. 051 lu'png va phuUng phip nghien cihii Nghien cutJ hoi ciiU tren 32 BN 11^ than 'kinh quay dupc phau thuat chuyen gan theo phuong phdp Boyes tai benh vien Viet Ou'c. Ket qui nghign c ^ i dp tuoi trung binh la 28, Ty le nam/nif & 5.4, 31/32 BN liet than kinh tru'dc mo, KS qui phau thuat dat rat tot vi tot li 82.1%. Phiic hoi chifc nSng llSn quan ch3t che tdi ket qud phlu thuat.
Ket lu$n; Phau thuat chuyen gan theo ky thu|t Boyes cho kSt qui t5t doi vdi dieu tri Het than kinh quay.
Tiy khia; U^t than kinh quay cao, ky thu|t Boyes, chuydn gin
SUMMARY
Introduction; High level radial nen/e paralysis is quiet common in clinical, Boyes method tendon transfer is necessary. Objective; To assess the results of Boyes method tendon transfer surgery for radial nerve paralysis. Patients and methods;
retrospective study 32 patients undenvent tendon transfer for radial nen/e paralysis with Boyes technique in Viet Due University Hospital. Results; average age is 28, male/female ratio is 5.4, surgical results achieved very good and good are 82.1%.
Itehabilitation Is closely related to surgical results.
Conclusion: Tendon transfer with Boyes technique Is useful for radial nerve paralysis treatment.
Keywonis: radial nerve paralysis, Boyes technique, tendon transfer
LD/^TVANDI
U^t than kinh quay cao la ton thu'dng thu'dng gSp, nguyen nhan chi'nh la do chan thu'dng, die bl?t trong gay than xu'dng canh tay. Theo nhieu nghiin cull, ty 1$ ton thu'dng than kinh quay trong gay thin xutdng cinh tay tif 1,8% den 16%
* Binh viin Viit Due
"TnltlngDalHocYHiN6l '-Binh viin tinh Thanh Hoi
Phin biin khoa hfc: PGS.TS Trjnh VSn Tufn
Tran Manh Hiing*, Tran Trung Diing**, Nguyen Xuan Thiiy**, Hoang Van***
[1], 10% den 20% ton thUdng than kinh quay la khong hoi phuc.
Liet than kinh quay cao ta mpt tpn thudng dan den tan tat nghiem trpng ve chifc ning ban tay, anh hu'dng Idn tdi sinh hpat va lap dpng ciia ngu'di benh. Ngudi benh khdng thedupi dot I cic ngon tay va dang dupi ngon cai, mat duoi chu dpng cp tay, lam anh hudng nghiem trpng den ciiu'c nang am nam va lam giam lUc bdp ban tay. DP vay phau thuat chuyen gan trong tiet than kinh quay khong hpl phuc la can thiet.
Vi vay nghiin cilu "Oanh gia kit qui dieu tri phau thuat liet than kinh quay cap thep phu'dng phap Bpyes tai benh vien hiJu nghj Vl|t Oifc"
thuc hlln vdi 2 niuc Ueu: Banh gii kit gui phiu ihu$t chuyin gin Oieu trf li$t thin liinh quay cao theo phidng phip chuyin gin Boyes.
II. BOI urcjNG VA PHirONG PHAP NGHISN COTJ - Nghien ci^u m6 t i cit ngang 32 BN Jlet than kinh quay cap khpng hpi phuc dude phau thuit chuyen gan thee phUdng phap ciia Bpyes t?i Benh vien Viet Oifc tif nim 2008 den nim 2013.
- t l l u chuan iM'a chon benh nhin + Benh nhan dUdc chan dpan liet than kinh quay cao khpng hpl phuc
+ Benh nhan dUdc phau thuat chuyen gin theo phUdng phap BOYES
+ Day dil ho sd benh an - Quy trinh nghien cifu:
+ BN dUdc chan doin Uet than kinh quay cao khong hoi phuc, nguyen nhan, cd clii chan thUdng, chup XCJ
+ Phau thuat: BN dUpc gay te dim roi, duoi miu v i garo cinh tay; bpc lp va chuyen gin gap nong ngon III cho gan duoi chung cac ngon, gan gap nong ngon IV cho gin duoi ngpn cii v i duoi rieng ngon trOj gin gap oS tay quay cho gin dang dii va duoi ngan ngon cil, gin al sap trdn dip gan dupl co tay quay ngin va co tay quay dai [ 2 ] ; thao garo, bdm rua v i dong vet thUdng;
dit ming bpt CBT tU the 6 tuan + Tip PHCN theo bai tip + Dinh gii kit qui
+ Bien dp van dpng cic khdp thep bing phan ipai kit qui cua Chu'inard [3]
Y HOC VIET NAM THANG 6 • SO 1t2of9
Mii'c d6 Rat tot Tot
Tb Xau
Co tay Duoi
>50°
25°- 50°
<25°
Gap
>30'' 10°- 30°
<10°
Ngon tay Duoi bin ngpn
<10"
10- 25"
>25°
Gap dau ngpn tdl nep qan tay
0 0- 1.25 cm
>1.25cm
Ngon cai Dang
>40»
30°- 40°
<30°
Duoi khdp lien dot
<0°
0°- 15°
>15°
Khonq thay doi so vdi trUdc mofKhonq cai thien) Cich thifc xep loai:
Neu CO 5 hdac 6 muc cung mpt mifc thi ket qui dUdc xep d mifc dc.
Neu 2 hpac >2 muc 6 cac mifc khic nhau thi kit qui xip d mifc thap hdn.
- Xiif ly sS Iilu bang thu$t tpin thing ke y sinh hpc c6 sif dung phan mem SPSS 16.0
III. K S T Q U A NGHIEN CO'U
CP 27 nam (84.4%), 5 nii' (15.6%), ty I I nam/nif la 5.4. Dp tupl trung binh la 28 tupi, thap
nhat la 17 va cac nhat l;a 50 tuci, BN tap trung cl tupl 20-40 tuoi chiem 78.1%. Co 18 BN liet sag khau noi TK that bai (56.2%), 14 BN do gay xu'dng canh tay, trong do 13 BN lilt TK truSc kN KHX. Vi tri ton thu'dng than kinh quay 1/3 glQa a 17 BN, 1/3 dudi CO 15 BN.Cp 31/32 BN duljt chuyen gan sau lilt TK 6 thing.
Trpng 32 BN dUdc phau thuat cp 28 BN khim lai, cac BN deu dUdc dinh gii kit qua sau 6 thing thu du'dc ket qui:
3.1. Chu'c ning duoi co tay
ing 1. Ket qua dupi cc tay (n Kit qua Rat tct >50°
Tpt:25°- 50°
Trunq binh <25°
Xau Tpng SP
=28)
So binh nhan 16 10 2 0 28
Ty 16%
57,2%
35,7%
7,1%
0%
100%
Nh0n xit: Ket qui rat tPt la 26/28 benh nhan chilm ty le 92.9%
3.2. Chifc ning duoi cic ngin I I I I I IV V Bang 2. Kit qui duel khdp ban ngpn (n=28)
Ket qua RattPt<10°
Tpt 10°- 25°
Trung binh >25"
XlT
Tpng SP
Sd benh nhan
Nh$n xet: Ket qua tot va rat tot chiem ty le 92, 3.3. Chu'c nang duoi ngon cai
Bangs. Kit qui duoi ngon caifn=28) Ket qua
Rat tct <0°
Tpt 0°- 1 5 ^ Trunq binh >15"
Xau TPhjjSP
So benh nhan
28 Nh$n xit; Ket qui tot va rat tPt chiem ty le cap 96,'
3,4. Chu'c ning d^ng ng6n cil Bang 4. Kit qua dang ngpn cil (n=28)
Ket qua Rattpt>40""
So benh nhan
Tyle
7,1%
0%
100%
Tyle 75%
21,4%
3,6
Tyli 64,3%
n y v . «t^T NAM THANG 6 - SO 1/2014
Tet 30°- 40°
Trunq binh <30°
Xau Tonq SO
8 2 0 28
28,6%
7,1%
0 100%
Nhan xet: Kit qua tot va rat tot chiem ty le 92,9%
3.5. Danh gii theo bang diem Chuinard Bang5. Ket qua theo bang diem Chulnard (n=28)
Ket qua Rat tot
Tot Trung binh"
Xau Tpng SP
So benh nhin
28
Tyie 46,4' 35,7%
17,9%
100%
Nh$n xit; Ket qui rat tot cd 13/28 BN (46,4%), tot co 10/28 BN (35,7%). Trpng 28/32 trudng hdp benh nhan den kham lai khong tru'dng hdp nap gip phai blln chiJng nhU: Nhiem triing, mcl khiu long leo, dut moi noi, dinh gin cd.
IV. BAN LUAN
4.1. Djch te ii$t than kinh quay cao - Trong nghien cifu cua chung tcl BN lilt than kinh quay cap cc dp tupi trung binh li_^28 tupl, tip chung d nhdm tupi 20 - 40 tuSi chilm 78.1%, gap chii yiu d nam gidi 27/32 BN. Kit qua niy tifdng tg' kit qua ciia cic tic gia trong v i ngpal nu'dc.
- Trong 32 BN liet than kinh quay cp 18 tru'dng hpp ll|t TK khpng hoi phuc sau khiu noi that b^l, 13 tru'dng hdp dp gay xtfdng, 1 tru'dng hdp sau KHX . Vj trf ten thu'dng 100% 6 1/3 glOa va 1/3 dudi ndi than kinh quay dl sat xddng v i dan ra nong; kit qui niy phii hdp vdl cac nghien cull tic gii khac.
4.2. Ket qui phiu thu$t
Bien dp van ding khdp cc tay thu dUdc 26/28 BN dat kit qui tct va rat tPt, 2/28 BN dat kit qua trung binh. Ket qui ciia chiing tci d?t tifdng tsf nhu kit qui tot va rat tot cua Vo vin Chau la 12/14 BN, Hoang Vinh PHuc 13/15 BN, Chulnard l i 21/21 BN. J<et qua cho thay viec s*
d^ng cd sap tron chuyen gin cho 2 gan duoi co tay dat kit qui tot.
Ket qui chuyen gin gap nong ngon III chp gin duoi chung cic ngdn dat kit qui rat tot va tot l i 26/28 BN. Kit qui nay tu'dng tif kit qur tet vi rit tot ciia cic tic gia Vo Van Chiu 14/14 BN, Ll M?nh Sdn 26/30 BN, Hpang Vinh Phuc 14/15 BN, Chulnarei l i 21/21 BN. Nhif vay viec sif dung cd gap ncng ngpn III chuyen cho cd duoi chunp cic ngdn gliip giif l?l gin gap co tay tru dat ket qui tet mi khing inh hu'dng tdl vl?c gap ciia ngin III v i khcng inh huSng tdl true cp tay.
Nghien cuu chuyen gan^ap npng ngpn IV vio gin dupl ngpn cai va dupi rieng ngpn I! dat kit qua tet v i rat tet l i 27/28 BN khpng khac bl|t vdl kit qui ciia cic tic gia khic. Kit qua chp
thay viec chuyen gan gap npng ngpn IV khpng chi cho k3; qua tet ma giiip ngdn I vi n hoat dpng dpc tap vdi 3 ngon con lai giup dim bio cliifc nang Hnh t l cua ban tay, day la uU diem cua phau thuat Boyes so vdi cac phu'dng phip khac. ^
Viec chuyen gin gap ce tay quay CP jan duSi ngin va dang dai ngcn I dat kit qui tpt vi rat tPt la 26/28 BN. Kit qur niy tUdng tul nhU kit qui ciia cac tie gia trong v i ngoai nude. Kit
Nghien cull chuyen gan theo phUdng phap Boyes thep nghien ciJli chua chiing tcl thep kit qua thep phan Ipai ciia Chulnard dat rat tet 13/28 BN, tet 10/28 BN, trung binh 5/28 BN. Kit qui nay tu'dng tU kit qui ciia 1.1 Manh Sdn 14/30 BN rat tet, iO/ 30 BN tet; Chulnard rit tSt 10/21 Bn, tet 6/21 BN. Kit qui chp thay vl|c chuyen gan thep phutfng phip Bpyes cil thl|n ding k l chifc nang ciia bin tay gliip BN cc t h i lap dpng va sinh hpat dUdc tet.
V. KET LUAN
Nghiin cifu phau thuit chuyen gin 32 BN thep phudng phap Boyes thu dUdc kit luan sau - Liet than kinh quay cao thudng gip d nam gidi 27/32 BN, tuoi trung binh la 28,100% BN dp tSn thUdng than kinh quay d 1/3 pIDa va dudi, 31/32 BN do lilt than kinh tru'dc phau thuit.
- Kit qui phau thuat dat rat tet 13/28 BN, tet 10/28 BN, trung binh 5/28 BN, kit qui niy lien quan chat che vdl phuc hoi chifc ning.
TAILIIUTHAMKHAO
1. Green DP (2006) Operative Hand surgery, 6" Ed.
Elsevier Churchill Livingstone, Philadelphia, Chapter 33.
2. Boyes JH (1960) Tendon b'ansfers fOr radial palsy. Bull Hosp Joint Dis 21, 97- 105.
Y HOC VIET NAM T H A H G 6 - SO 1/2014 Chuinard RG, Boyes 3H, Stark HH, Ashworth
CR (1978) Tendon transfers for radial nerve palsy: Use of superficialis tendons for digital extension. J Hand Surg 3, 560- 570.
Vo Van Chau, N g u y i n Duy ^Lu^t(2000}
Chuyen gan as phuc hoi df dong duoi ban tay ya ngon tay de dieu tri het than kinh quay. Phau thuat tao hinh, tap V I . 5 5 1 , 33- 35.
Hoang Vinh Phuc (2005) Danh gia ket qua dieu tri di chuYig liet than kinh quay cao bang phu'cfng phap phau thuat chuyen gan theo Iselin tat benh vien 103 .Luan van thac sT y hoc, 37- 46 Le Manh ScAi (2005) Danh gia ket qua phau thuat chuyen gan ciia Boyes dieu tri liet than Wnh quay tai benh vien Viet DLTC. Luan van thac sT y hoc, 35- 50
DANH GIA KET QUA PHAU THUAT NOI SOI
SAU PHtrC MAC CAT THAN BENH LY MAT CHU'C NANG L A N H TINH
T6M TAT
M^c tieu: Oanh gia ket qua ph§u thuat npi soi cSt than sau phuc mac dno nhutig tru'dng hdp benh ly than mit chu'c nang l^hh tfnh t?i benh vien TWQD 108.
Phu'dng phap: 125 b|nh nhan than mat chu'c n3ng mpt ben do benh ly t h | n lanh ti'nh du'dc cat than npi sol sau phiic mac ti^ 3/2009 den 06/20i3 tgi khoa Tiet Nieu, benh vien TWQD 108; tuoi trung binh 53,7 (29 den 85). Trong do ti I? nam/nu' la 44/81. 25 tniitng hdp th|n mat chu'c nSng do soi than (20%), 75 do soi ni|u quan (60%), 17 do hep khuc ncfi be ttian nl§u quan (13,6%), va 8 b^nh nhan than mat chik n3ng do hep nieu guan (6,4%).
K€t qua: Phau thu|t n$i soi thanh cong 97/125 benh nhan (77,6%); thdi gian mo dung binh 131,5 ± 51,6 phut (70 - 330), lu'dng mau mat tmng binh 30,7 ml (10 - 120); chuyen ^m6 md 28/125 benh nhan (22,4%), tai bien trong mo chCi yeu \h chay mau 7 benh nhan (5,6%), ran Ial la rach phuc m?c va tran khi du'di da. LutJ thong tieu hoa phuc hoi sau n\6 2,5 ngay; ngay nSm vi?n trung binh 5,7 ± 1,6 ngay (3 - 11), bien chiJtig chay mau sau mo 2 b§nh nhan (1,6%).
Ket lu$n: phau thuat npi soi cSt th$n dudng sau phuc mac an toan, hieu qua cho b#nh ly than mat chiJc nSng lanh tfnh.
TO' khoa: phau thuat npi sol cSt thSn sau phuc mac, benh ly than mat chiJc nSng lanh ti'nh.
SUIVIMARY
RESULTS OF RETROPERITONEAL LAPAROSCOPIC NEPHRECTOMY FOR BENIGN N O N - F U N C H O N I N G
IQDNEY DISEASES
Background: We evaluate the results of retroperitoneal laparoscopic nephrectomy In the treatement of benign non-functioning kidney diseases in 108 Central Military Hospital.
* B$nh vl$n n/QD 108
Phan bi$n khoa hgc: GS.TS BuTu Trfen
Methods: Between March 2009 and June 2013, the retroperitoneal laparoscopic nephrectomy for unilateral benign non-functioning kidney diseases hss been performed in 125 patients. Mean age was 53.7 (29 - 85), 44 men (35.2%) and 81 women (64,8%).
Non-fijnctioning kidneys were cause by renal calculi in 25 cases (20%), ureteral calculi in 75 cases (60%), ureteropelvic junction stricture in 17 cases (13.6%), and 8 patients with ureteral stricture after cesarean section (6.4%).
Results: The retroperitoneal laparoscopic nephrectomy was successful in 97/125 patients (77.6%); operation time was 131.5 ± 51.6 min (70- 330), blood lost was 30.7 ml (10 - 120); open conversion In 28/125 patients (22,4%). The main intraoperative complication is haemorrhage in 7 cases (5.6%); bowel function restored after 2.5 days;
hospital stay was 5.7 ± 1.6 days (3 - 11) and postoperative bleeding In 2 case (2.06%).
Conclusion: Retroperitoneal laparoscopic nephrectomy for benign non-functioning kidney diseases has emerged as a safe and effective alternative to open surgery.
Keywords: Retroperitoneal laparoscopic nephrectomy, benign non-fijnctionIng kidney diseases.
I.OATVXNDI
Phau tfiuat noi soi sau phuc mgc (NSSPH) trong tiet nieu da phat trien ntianii ciiong tHrdau thap icy 90, cho den nay, la mot piiu'dng p i i ^ dieu tri iiieu qua dol vcti niiieu t>enh ly phiik tap cua he tiet nieu.
NSm 1991, Ciayman [ 3 ] tien hanh triTdng hdp phau thuat NSSPI^I cSt than qua du'dng sau piiuc mac dau tien tr§n benh nhSn c6 u thSn 3 cm. Day la dau moc quan trong trong si/ pifat trien cua NSSPM dieu tri b f n h iy du'dng t i S ni§u, cho thay mot cd quan Idch thu'dc ldn (nhu* than)
