TAP CHI NGHIEN C l f U Y HOC •
DAC DIEM BENH NHAN DUOC GHEP GIAC MAC TAI BENH VIEN MAT TRUNG UONG TRONG GIAI DOAN 2002 - 2011
Pham Ngoc Ddng, Tru'O'ng Nhu* Han, Le Xuan Cung Benh vien Mit Trung uong Nghien cim duoc thuo hi?n nhim danh gia mdt s6 dac diem b$nh nhan va benh ty giac mac da dugc ghep giac mac tai b$nh vien MBt Trung uong trong giai doan 2002 - 2011 Nghien cuv tren toan bg h6 so benh nhan da ghep giac m^c trong giai doan 2G02 - 2011 Cac so lieu thu thap bao gdm tuoi, giai, nghi nghiep, nai cw tru, benh ly giac mac duoc chi dinh ghep. Trong 10 nam, c6 1016 benh nhan (1049 mit) d^
ghep giac mac. trong do co 58.8% benh nhan nam, din tir 44 tinh thanh trong ca nuoc TuSi benh nhan trung binh la 45,3 Cd 63,8% nguoi duoc ghep lam cdng viec lao ddng chan tay Benh ly giac mac duoc ghep theo thwthwgiam din la viem loet giac mac (53,4%). seo due giac mac (18,3%), loan duong giac m^c bam sinh di truyin (9,4%), ghep lai (6,5%,), benh giac mac bong sau md thuy tmh the (4,1%,), bong giac m^c (4%,) Cac chi dinh it gap han la benh giac mac hinh chop (1,4%), thoai hoa giac mac (0,6%>), ma due giac m^c bam smh (0,5%) va mot vai benh giac mac khac Trong 10 nam, b$nh vien Mat Trung uong da ghep giac mac cho benh nhan a 44 tinh thanh tmng ca nwac. Benh ly giac mac duoc ghep thuong gap nhat la viem loet giac mac Cac benh ly giac mac khong nhiem trimg duoc ghep cd xu huong tang din T u khoa: ghep giac mac, dac di§m benh nhan
I. DAT
V A NBt
Ghep giac mac la mdt trong nhCfng p h l u thuat ghep md duae thue hien sdm n h i t Ngay tif nhifng nam cuoi t h i ky XIX, nhO'ng ca ghep d i u tien da dupc thuc hien d chau Au Tif dd d i n nay, phiu thuat ghep giac mac da cd nhCfng budc tiln dang ke, ca ve ehlt luong va so luang Phlu thuat da dem lai anh sang cho r l t nhilu ngudi bi mCi do benh giSe mae. Hang nam, tai My cd khoang 40 000 ca ghep giac mac [1].
& Viet Nam, p h l u thuat ghep giac mac da dLcocthLfc hien t d nam 1950 Sau do, do hoan canh c h i l n tranh, phau thuat chi d u o c thuc hiSn rai rac vdi sd lupng han e h i . T d nam 2000^. phau thuat ghep giae mac da duac thuc hien' nhilu han va trd thanh p h l u thuat thudng quy trong d i l u tn benh ly giac mac. So
Dia chi lien h€ Pham Ngoc Ddng. Khoa Kit - Giac mac, b$nh vien MBt Trung uong
Email' dong69nam@yahoo com Ngay nhan 7/8/2013 Ngay duoc chap thuan 30/1(3/2013
luang phau thuat gay me ngay cang tang, ciii dmh ghep giac mac cang dLcpc m d rdng iion.
Tuy nhien, ghep giae mac cung v i n chi duac thuc hien d mot sd trung tam Nhan khoa Idn Benh vien M i t Trung Lfong la mot trong nhifng c a s d ed s6 luong ghep giac mac n h i l u nhat trong ca n u d c Chiing tdi thLcc hi^n nghien cdu nay n h i m danh gia dac diem bSnii nhan da ghep giae mac tai benh vien Uk Trung u a n g trong 10 nam 2002 - 2011, tren ca s d do, d l xuat mdt s6 bien phap n h i m nang cao hieu qua d i l u tn b l n g ghep giac mac.
II. D 6 | TU-ONG V A PHU'aNG PHAP
Nghien cifu hdi CLKU d u a c thuc hien tai benh .vien M i t Trung u-ang trong nam 2012 T i t ca cac hd s a ghep giac mac tif ngay 1 thang 1 nam 2002 d i n het ngay 31 thang 12 nam 2011 duac tim lai de t h i n g ke s6 heu
Cac thdng tin thu thap bao gdm mdt so dSc diem xa hpi hoc eua ngu-di d u a c ghdp, bao gdm tuoi, gidi, n g h i nghiep, nai c u trii, b^nh ly giac mac d a a c chi dmh ghep
TCNCYH 85 (5) - 2013
Xu" ly s 6 lieu: d u p c x u ly b l n g p h l n m i m SPSS 16.0,
Dao di>c n g h i e n CIPU
de tai nghidn c d u da d u a c Hpi ddng dao difC nghien c u u Y hoc benh vien Mat Trung uang cho phep thae hi0n.
III.
K£T QUATrong giai dogn 2002 - 2011, tai bdnh viSn M i t Trung u a n g da cd 1016 b&nh nhan duac ghdp giac mae (1049 m i t ) , trong dd so b6nh nhan nam la 597 (58,8%), s6 benh nhan nO- la 419 (41,2%) TUOI trung binh cua b$nh nhan 3upc ghdp la 45,3 (dao ddng tif 1 d i n 89), So b^nh nhan ed tuoi tir 19 den 60 tuoi la 741 bdnh nhan chiem 72,9%
180 160 140 120 '100
Mat ghep
T J J P CHI NGHIEN CUU Y HOC Ngudi duac ghdp d i n tif 44 trong tong sd 63 tinh thanh trong ca nudc (ea 3 mien Bic, Trung, Nam) Nhifng tinh ddng dan han thi sd luang ca ghep giac mac nhilu han nhu Ha Ndi cd 231 benh nhan, Thanh Hda cd 107 bdnh nhan, Nghe An 73 benh nhan Nhifng t!nh d m i l n Nam nhu thanh pho Hd Chi Mmh, Binh Duong, Binh Phudc... Tay Nguydn nhu Kon Tum, B i c Lie...; m i l n nui nhu Ha Giang, Cao Blng d i u cd bdnh nhan d u p c ghdp giac mac .
N g h i nghiep cua benh nhan duae ghep:
Trong s6 1016 benh nfian du-pc ghep, cd 103 (10,1%) la hpc sinh, sinh vien; 648 ( 63,8%) ngu'di lao dOng chan tay; lao ddng tri dc la 68 (6,7%); gia va hau tri 197 (19,4%).
So mat du'ac ghep giac mac trong 10 nam du'ac the hidn trong bieu dd 1.
40 . 20
0 2002
Thdi gian
2003 2004 2005 2006 2007 2008 2009 2010 2011
Bleu d d 1. S6 lu'o'ng ca ghep giac mac theo nam
So lu'ong mat d a a c ghdp giac mge tang dan theo thdi gian va dat cao nhat vao nam 2008 vdi I t c a la 170 m i t d a a c ghdp giac mae •
B^nh ly cua b§nh nhdn da ghep giac mac
Lo6t giac mac va seo dye giac mac la bdnh ly d a a c chi dinh ghep giac mac do nhieu nhit, s6 aang ghdp cua 2 b$nh 1^ nay tang dan theo thdi gian.
TAP CHI NGHIEN C l f U Y HOC •
SO 70 6 0 50 40
• ^ ^ ^ - ' - ^ S ^ J ^ - ^ a , ^ , , . , ^
Loet GM
S e o G M
Loan dadng GM Ghep lai
Benh GM bpng sau md TTT
2002 2003 2004 2005 2006 2007 2008 2009' 2010 2011 Nam B i l u d d 2. Sd lipang ca ghep theo nam cua 5 nhdm chi djnh thu'O'ng gap
* GM- giac mac; TTT. thuy tinh thi
Benh ly gidc mac d a a c ghep theo thif ta giam dan la viem loet giae mac (53,4%), seo due giac mac (18,3% vdi 76,9% la seo do loet giae mac), loan d a d n g giac mac b i m smh di t r u y l n (9,4%), gh^p lai (6,5%), benh giac mae bong sau mo thuy tmh the (4,1%), bdng giac mac (4%) Cac chi dmh it gap hon la benh giac mac hinh chdp (1,4%), thoai hda giac mac (0,6%), m d due giac mgC bam smh (0,5%) va mdt vai chi dinh it gap khac
IV. BAN LUAN
Benh nhan d a a c ghep giac mac tre n h i t la 1 tuoi. Ngadi cao tudj nhat difoe ghep a tuoi 89 Nhom b^nh nhan tuoi tif 19 d i n 60 hay gap nhat, cd 741 benh nhan c h i l m 72,9%. Tai benh vien M i t Trung a a n g , p h l u thuat ghep giac mac da daoe thu'c hien d t i t ca cac lifa tuoi, n h i m dem lai thi lac cho benh nhan Tuy nhien, ghep giac mac tren tre em la mdt thach thifC ldn vi rat khd kham, cham sdc cho tre trong vd sau ghep, nguy c a b i l n chifng cung cao hon nhilu d ngadi Idn [2]
Bo tuoi trung binh trong sd benh nhan daac ghep d nhdm nghien edu la 45,3 tuoi.
Nhdm tuoi hay gap n h i t la 46 tuoi. 0 cac nadc nha Trung Qudc, Malaysia, Pakistan, tuoi trung binh dape ghep trong khoang 40 -
50 tuoi [3; 4] Tai My, nghien cifu cua Fans vS edng s a trong 5 nam (2001 - 2005) cd 1162 ca' ghep giae mac, benh nhan cd dd tuoi trung binh la 62,5 [5], cao hon so vdi cac nifdc khae. & n a d c phat trien va cd s6 laang benh nhan d a a c ghep giac mac n h i l u nha My, tuoi trung binh ciTa ngadi d a a c ghep cao hon o cac n a d c dang phat tndn, d i l u dd chifng to benh iy giac mae c l n ghep d cac nadc nay gap a nhdm tuoi tre han. Bay la mdt ganh nang cho xa hpi cting n h a gia dinh ngifdi benh, ddi hdi phai cd giai phap de lam gtam ^ benh ly can phai ghep, eung nha tang kha nang ghep giac mac de phuc hdi thi lac cho ngadi benh
N g h i nghiep cac bdnh nhan daac gh6p, giac mac ehii yeu la lao dpng chan tay, chiem,
TCNCYH 85 (5) - 2013
• TAP CHI NGHIEN CU'U Y HOC 63,8%. Bay la nhu'ng doi taang cd d i l u kien
kinh te xa hdi thap AL Towerki cung t h i y ring benh nhan ghep giac mac thadng a nhdm cd dieu kien kinh te thap hon. Day la mdt trong nhdng han che ddi vdi k i t qua ghep giac mac vi nhdm benh nhdn nay thadng it tuan thu che dd dieu tri va theo doi sau ghep ban so vdi cac nhdm benh nhan khac [6]
Bdnh nhan ghep giae mae trong thdi gian qua den tir 44 tinh thanh trong ca nadc. Mac dii ddng a dia ban Ha Npi, sd lapng ghep giae mae hang nam cdn it, nhang vdi ta each la benh vien chuydn khoa d i u nganh, benh vien M i t Trung aang da ghep giac mac cho benh nhan cua 44 tren t i n g s6 63 tinh thanh trong ca nadc B i l u dd the hidn sa binh d i n g trong sa h i p can vdi phlu thuat ghdp giac mac cua benh nhan d nadc ta
Ghep gidc mac cho cac benh nhan d cac tinh xa Ha Ndi cung la mdt trd ngai, iam han che ket qua ghep giac mac COng nha sau ghdp cac md tang khac, bdnh nhan ghep giac mac phai dOng thude ehdng thai ghep, c l n , daac theo ddi de phat hien cac b i l n chdng : Vdi cac benh nhan d xa Ha Ndi, viee theo ddi I sau mo r l t khd khan Khi cd thai ghdp gidc , mac, nhCfng benh nhan d xa Ha Ndi cd the m i t vai ngay mdi den kham va d i l u tri d a o c B i l u nay iam m i t di "thdi gian vang" de d i l u tn thai ghep giac mac, VI vay, de nang eao k i t qua phau thuat, c l n phai xay dang mang ladi va dao tgo cac bac sy nhan khoa de ho cd the theo ddi va d i l u tn bdnh nhan sau ghep giac mac tr^n pham vi ca n a d c Nhd mang ladi nay, bdnh nhan sau ghep giac mac se d a o c cham sdc va dieu tn tot han
Vi6m loet giae mac va seo due giac mac la 2 chi dmh chinh cua ghep giac mae tai benh vi$n Mat Trung a o n g trong 10 nam qua K i t qua nay taong ta vdi m0t so nghidn edu cua cac nadc trong khu v y c va cac nadc dang
phat tnen khac Xie L va cdng sa, bao cao chi dmh chinh cua ghep giac mac xuydn trong nghien cdu tai Trung Qudc la viem loet giac mac (49%), t i l p theo la seo due giae mac (16%), benh giac mac hinh chdp (13%), benh giac mac bong (7%i), ghep lai (5%), va loan dadng giac mac di truyln (4%) Tac gia nhan t h i y r i n g ghep giac mac do viem loet giac mac ed xu hadng giam d i n va cd sa gia tang cua cac chi d[nh benh giac mac hinh chdp va benh giac mac bong [3]
Tai Israrel, Yahalom nghien cicu cac tradng hop ghep giac mac trong 40 nam -(1961 - 2000) vdi 1681 ca ghep. Trong giai doan 1961 - 1 9 7 0 , n h i l m triing giac mac la chi dmh ghep chinh, c h i l m 37,0% Vdi thai gian, ehi dinh nay ngay cang giam, daac thay t h i b l n g cac chi dmh khac nha benh giac mac chop, bdnh gidc mac bong, ghep lai B i n nhCpng nam 1990 - 2000, n h i l m trimg giac mac chi cdn c h i l m 6,5% trong tdng sd cac chi dmh ghep giac mac [7] Tai A rap Xe ut, mdt nghien cifu v l tinh hinh gh6p trong 20 nam tif 1983 - 2002 cho t h i y r i n g giai doan d i u 1983 1987 chi dmh ghep giae mac chinh la seo giac mae (52%), bdnh giac mae bong sau mo thuy tinh the (13,5%), benh giac mac chdp chi c h i l m 7,6% Nhang giai dogn t d 1998 -2002, bdnh giac mac hinh chdp iai la ehi dmh chinh cua ghep giac mac (40,2%) B i l u nay daoc giai thich la do sa eai thien v l cac d i l u kien kmh t l xa hdi va su gia tang dan sd [6] Chi dinh ghep giac mae xuyen tai Canada t d 1986 - 1995 la benh giac mac bong (28,5%), ghep lai (22,4%). benh giac mac hinh chdp (10%), loan dadng Fuchs (4%), viem loet giac mac (3,7%) va seo due giae mac (2.8%) [8] Nghien cifu 1200 ca ghep giac mac tif 2001- 2010 a Bde, Wang J va cdng sa nhan thay bdnh giac mac hinh chdp Id chi dmh hang d i u (25,5%).
tiep d i n la loan dadng giac mac (21,2%), cac
27
TAP CHl NGHIEN CU'U Y HOC • chi dinh do seo giac mac va loet giac mac g'lp it han, vdi fy ie taong ifng la 14,4% va 13%.
c a c tac gia nhan t h i y cd s y gia tang cd y nghTa thdng ke cua benh giac mae hinh chdp, loan dadng Fuchs va sa giam ed y nghTa thong k& ciia chi dinh ghdp giae mac do seo due giac mac [9].
Seo duo giac mac la chT dmh ghep n h i l u thif hai vdi 192 m i t , e h i l m 18,3% Nguyen nhan gay seo due giac mac chu y l u la do viem loet giac mac (74%), seo due giac mae do c h i n thaang (13.5%) va mdt so nguyen nhan khac (12,5%) Tai Malaysia, Reddy va CS nghien edu va daa ra k i t luan seo due giae mac do vifem loet giae mae va c h i n thaang la chi dmh ghep n h i l u thd 2 ( c h i l m 20%) [4], Seo due giac mac d a o c bao cao la chi dmh ghep nhilu nhat trong cac nghien cifu d mpt s6 nadc nha d A rap Xe iit (52%) [6];
An Bo (28,1%) [10],
Vdi nhdm nghien cdu, 76,9% sd benh nhan cd seo giac mac d a o c ghep la seo sau loet giac mac Do vay, tdng sd cac tradng hop daoc ghep cd hen quan den viem loet giac mac se r l t cao, vdi 712 m i t c h i l m 67,9% s6 mat daoc ghep
Nha vay, CO c l u benh ly giac mac d a o c ehi dmh ghep d eac n a d c d giai doan dang phat trien chu y l u la benh n h i l m trung, Khi d i l u kien kmh te xa hdi phat t n I n hon, ehi dmh ghep chinh la eac benh khdng n h i l m triing va ghep lai Chi dmh ghep giac mac do viem loet giae mac va seo due giac mae la nhdng ch?
dmh hang d i u a n a d c ta cung nha mdt s6 nadc dang phat t r i l n da gian t i l p phan anh md hinh benh tat ve giac mac chu y l u la benh n h i l m trung. Do vay, viec d a phdng c h i n thaang va viem loet giac mac n h i l m trung, phat hien sdm-va d i l u tn kip thdi viem loet giac mac se han c h i d a o c sd m i t phai ghep giac mac . nhO'ng m i t ma cho dii d a a c ghep
tot thi hen laong phuc hdi thi lyc cung khdng kha quan
Loan d a a n g giac mac bam smh di truyln la chi dinh ghep nhieu t h d 3 trong tong sd cac ehi dinh ghep (99 m i t c h i l m 9,4%). Trong s6 benh ly loan d a d n g giac mac, loan dadng ddm, loan d a d n g l a d i la 2 hinh thai hay gap n h i t cd ty le l l n laat la 57,6%. va 20,2%.
Bue manh ghep cd 68 mat, c h i l m 6,5% la ehi dmh nhieu thd t a cua ghep giac mac Ty le chi djnh ghep iai t a o n g d a a n g vdi mot so nghien c d u d New Zealand (8,7%) [11], Ma- laysia (9,6%) [4]. Cimg vdi thdi gian, khi s6 phau thuat ghep hang nam tang len, se xult hien them n h i l u tradng hap t h i t bai ghep, s6 tradng hap ghep lai se cang tang nha d cac n a d c phat t r i l n .
Ghep giac mac do benh giac mac bong sau mo the thiiy hnh cd 43 m i t , c h i l m 4,1%.
O cac n a d c khac, ty le ghep nay cao hon n h i l u : Thai Lan la (28,9%) [12], Malaysia (28,8%) [4]- V d i sd laong phau thuat mo due thuy tmh the d n a d c ta ngay cang tang, s6 benh nhdn b; benh giac mac bong sau mo eCing se tang cao han.
V . K ^ T L U A N
P h l n Idn ngadi d a p c ghep la nhdng ngadi dang d tuoi lap ddng, lam cac cdng viec;, lao ddng chan tay, d a o c ghep giac mac de dieu tri loet giac mae n h i i m triing.
Giam ty le ngadi bi viem loet giac mac n h i l m triing thi se lam giam dang ke s6 ngadi c l n phai ghep giac mac, cQng nha e6 the s d dung ngudn giae mac hiem hoi de ghep cai thien thi lac cho cac nhdm benh giac mac khdc
Ghep giac mac de d i l u tn cac benh khong n h i l m trimg nha seo due giae mac, lo^n dadng giae mae b i m smh di truyen, b0nh giac mac bong, ghep lai cd xu h a d n g tang dan.
TCNCYH 85 (5) - 2013
• TAP CHI NGHIEN CLPU Y HQC
Lo-j cam en
Nhdm nghien c d u xin chan thanh cam an to lau trCf hd sa benh an. benh vien M i t Trung uong da tao d i l u kien thuan ipi cho chung tdi thyc hien nghidn cdu nay
TAI LIEU THAM KHAO
1. Eye bank asociation of America (2010). 2009 eye banking statistical report
2. Zaidman GW (2002). Pediatric Kerato- plasty, chapter 23 in Corneal Transplantation, chapter 23 in Corneal Transplantation Jaypee Brother Medical publishers Ltd, New Dehi, India, 201 -205,
3. Xie L, Song Z, Zhao J , Shi W, Wang F (2007). Indicahons for penetrating keratoplasty in north china Cornea, 26, 1070-1073
4. Reddy S C, Tajunisah I (2007). Indica- tions for penetrating keratoplasty in west Ma- laysia, International journal of opthamology, 7 (6), 24 - 28
a. Paris R G, Federico C, Ayres B D et al (2008). Indications for Penetrating Kerato- plasty and Associated Procedures, 2001 2005 Eye & Contact Lens. 34(4), 2 1 1 - 2 1 4 .
5. Al-Towerki AE, Gonnah ES, Rajhi AA, Wagoner MD (2004). Changing Indications for Corneal Transplantation at King Khaled Eye
Specialist Hospital (1983 - 2002) Corneal, 23, 584 - 588
7. Yahalom C, Mechoulam H, Solomon A et al (2005). Forty Years of Changing Indica- tions in Penetrating keratoplasty in Israel. Cor- nea, 24, 256 - 258-
8. Liu E, Slomovic AR (1997). Indications for penetrating keratoplasty in Canada, 1986 - 1995 Cornea, 16(4), 4 1 4 - 4 1 9
9. Wang J , Shirra F, Seitz B, Szentmary N (2012). Changing indication for penetrating keratoplasty in Homburg/Saar from 2001 to 2010-histopathology of 1,200 corneal but- tons Graefes Arch Clin Exp Opthalmol, 251 (3), 797 - 802
10. Dandona L, Ragu K, Janarthanan IVl, et al (1997). Indications for penetrating keratoplasty in India. BR. J, Opthalmol, 81(9), 726 - 731
1 1 . Edwards M, Clover GM, Brookes N (2002). Indications for Corneal Transplantation in New Zeland 1991 - 1999 Corneal, 21(2), 1 5 2 - 1 5 5 ,
12. Chaidaroom W, Ausayakhun S, Ngamtiphakron S, Prasisilp J (2003). Clini- cal indication for penetrating keraroplasty in Maharaj Nakorn Chiang Mai Hospital, 1996 - 1999 J M e d ^ s o c r / 7 a / , 86, 20611
Summary
CHARACTERISTICS OF CORNEAL TRANSPLANTED PATIENTS IN VIETNAM NATIONAL INSTITUTE OF OPHTHALMOLOGY OVER
PERIOD OF 10 YEARS (2002 - 2011)
Our study was to evaluate the characteristic of corneal transplanted patients treated at the Vietnam National Institute of Ophthalmology (VNIO) for over a penod of 10 years Medical records pf corneal transplanted patients from 2002 to 2011 were reviewed The following parame-
29
TAP CHI NGHIEN CU'U Y HQC
ters were collected and analyzed, age, gender, job, living 'place, the original corneal pathology for which the graft was indicated During the 10 years period, 1016 patients (1049 eyes) under went corneal transplantation at the VNIO These patients came from 44 provinces throughout Vietnam.
The means age was 45 3 year old; 63 8% of them were labor workers Common corneal patholo- gies Consisted of infectious corneal ulcers (53.4%i), corneal scar (18 3%), corneal dystrophy (9-4%), failure graft (6,5%), pseudoaphakic bullous keratopathy (4 1%), and corneal burn (4%).
The less common pathologies were keratoconus (1 4%), corneal degeneration (0.6%i), congenital corneal opacity (0.5%) and some other diseases. During the 10 year penod, VNIO have per- formed corneal graft for patients from 44 provinces The most common indicabon for corneal graft IS infectious corneal ulcer The non-mfeehous grafted disease is slowly increasing.
Key w o r d : Corneal t r a n s p l a n t a t i o n
TCNCYH 85 (5)-2013
