Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
KET QUA Bl/6C DAU DIEU TRj T R I BANG PHL/ONG PHAP
SONG CAO TAN TAI PHONG KHAM DA KHOA Dl/ONG AN HAI PHONG
TOM TAT
PhUcfng phap dieu trj tri bang song cao tan m6i dUcJc iiYig dung tren the gidi, ket qua budc dau to ra tien Idi va it dau, it bien chirng hdn va giam du'dc nhieu thdi gian nam vien cho ngUdi benh. Muc tieu:
Danh gia ket qua bu'dc dau trong dieu trj tri bang phu'dng phap song cao tan. D61 tUdng va phiTc^ng phap nghien ciTu: Mo ta cat ngang. Ket qua:
Nghien cifu 90 BN dieu tri tri bang phu'dng phap dien cao tan, chiing toi thay: Dieu tri tri bang song cao tan cho ket qua tot vdi cac loai tri npi, tri ngoai va tri hon hdp. Thdi gian phau thuat ngan: trung binh 20,54 phut, nhanh nhat la 9 phut, cham nhat la 60 phiit.
Tinh trang dau sau mo I't, chii yeu la dau nhe va dau vii^ khi di dai tien (91,11%). Bien chii'ng chay mau sau mo thap (6,66%). Bien chu'ng hep hau mon thap va hep mifc dp nhe (5,55%). Ket luan: Dieu tri tri bang phu'dng phap sdng cao tan cho ket qua tot vdi cac loai tri npi, tri ngoai va tri hon hdp, it dau, it bien chu'ng, giam dUdc nhieu thdi gian nam vien cho ngu'di
benh. f
ABSTRACT
INITIAL RESULTS OF THERAPY TREATMENT METHOD I N HIGH-FREQUENCY AT SIGNAL
CLINIC AN DUONG HAI PHONG
Background: Hemorrhoids treatment method new high-frequency waves are applied in the worid, the initial results proved to be convenient and less pain, fewer complications and reduced hospital time for patients. Objectives: Assess the initial results in the treatment of hemorrhoids by means of high frequency waves. Methods: Describe the cross-sectional Results: The study piles 90 patients treated with high-frequency electrical methods, we find: Treatment
lloang Dsln^ iVljch*, Le Van Thieu*
of hemorrhoids with high frequency waves for good results with all kinds of internal hemorrhoids, external hemorrhoids and hemorrhoids mixture. Shorter surgical time average of 20.54 minutes, the fastest is 9 minutes, at least 60 minutes. Less postoperative pain, mostly mild and moderate pain when defecating (91.11%). Postoperative bleeding complications is low (6.66%). Variable low anal stenosis and mild stenosis (5.55%). Conclusions: Treatment of hemorrhoids by high frequency waves for good results with all kinds of internal hemorrhoids, external hemorrhoids and hemorrhoids mixture, less pain, fewer complications, reduce hospitalization time for patients.
I. DAT VXN OE
TrT la mot benh rat pho bien, ti le mac benh tai cong dong khoang 10-40% dan so [5],[6], benh tuy khong gay nguy hiem den tinh mang nhung lam nguoi benh kho chiu anh hucmg den chat lugng cong viec va cugc song, nhieu khi benh nhan doi hoi phai phau thuat. Voi nhirng trT do I, do II thuong dieu tri noi khoa, nhung voi nhiing trT do III, do IV va trT ngoai thi phau thuat van la phuong phap dieu tri chon loc. Phuong phap dieu tn trT bang song cao tan moi dugc ung dung tren the gioi va da dugc Gupta PJ [6] bao cao to ra tien Igi va it dau, it bien chung hon va giam dugc nhieu thoi gian nam vien cho nguoi benh. Vi vay, chung toi tien hanh nghien cuu de tai nay nham muc tieu:
Danh gia kit qud biro'c dau trong aieu tri tri bang phitffng phdp song cao tan.
* Benh vien Hieu nghi Viet Tiep, Hai Phdng
II. D6\ TUpNG VA PHJONG PHAP NGHIEN CCfU 2.1. Doi tuyng nghien ciiu
Gom 90 bcMih nhan dugc dieu tri tiT bang phuong phap song cao tan tir thiing 5/2010 d6n 7/2011 tai phcMig kham da khoa Duong An - Hai Ph()ng.
Tieu chuan chon BN: TiT noi do II, 111, rV. TrT \ img do 111, IV. Tn ngtuii. ITT hon hap.
Tieu chuan loai trii': Loai trir ciic truong hgp trT trieu chirng, BN phau thuat \ i da thira.
2.2. Phuong phap nghien ciiu; Phuong phap nghien ciru mo ta cat ngang
2.2. L Phuong tien nghien ciru
May dieu tri trT bang song cao tan /,/. II 500 cua cong ty DALISHEN Trung Quoc.
2.2.2. Cac bu'&c tien hdnh phdu thuat Phuong phap \ 6 cam: gay te tai cho.
Nong liiiu mon, phau tich bui trT theo phuong phiip Milligan - Morgan va tien hanh lam dong kho biii trT bimg song cao tan tan so I,7Mh/ - 4Mh/. Thcri gian 1 lan lam dong khi) biii IrT tir 3 den 5 giay, khi nao may phat tin hieu dat yeu cAu lap lai lan thir 2 gan cho da dong kho.
Ihco doi hau phau \a tai kham benh nhiin sau 30 nga> sau phau thuat.
Diinh giii ket qua:
+ Dau sau mo chia thanh 5 mire dg theo Golighcr: Do I - Khong dau; Do II - Dau nhe; Do III - Dau vua; Do IV - Dau nhieu;
Do V - Dau dtr doi.
+ Chay mau sau mo; Bi tieu sau mo.
Khi tai kham nghien cim: tinh trang dau khi di cau, cha\ mau, tinh trang di cau, - Benli nhan nSm nghieng trai hoac nam ngira mire do hep hau mon.
2.3. Xir ly so lieu: So lieu dugc xir ly bang phan mem SPSS 13.0
III. KET QUA NGHIEN CQU
Tuoi
^ ^ ^ ^ ^ Gidi
<20 20-30 30-40 40-50 50-60
>60 Tong
B a n g 1. Phan bo benh nhan theo tuoi \ a gioi Nam
3 (3,33%) 8 (8,88%) 11 (12,22%)
10(11,11) 9(10%) 6 (6,66%) 47 (52,22%)
NO' 1(1,11%) 7 (7,77%) 11 (12,22%) 16(17,77%) 5 (5,55%) 3 (3,33%) 43 (47,77%)
Cpng 4 (4,44%) 15(16,66%) 22 (24,44%) 26 (28,88%) 14 (15.55%) 9 (9,99%) 90 (100%)
Nhan xet: Ket qua bang 1 cho tha> lira tuoi 30-50 chiem ti le cao nhat (53,33%), tuoi nho nhat la 15, tuoi Ion nhat la 89.
Bang 2. Phan loai trT
Loai trT Tri bill Tri vong Tri ngoai Tri hon hdp
long
N 36 11 16 27 90
o/o
40,00 12,22 17,77 30,00 100
Nhan xet: Ti le gap n h i k nh§t la loai trT bui (40%), tiep den la trT hon hgp (30%), ti le thap nhat la trT vong (12,22%).
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
DTNC Thdi gian
Bang 3. Thoi gian mo (phiit)
N 90
T61 thieu Toi da 60
Trung binh 20,54±13,82
Nhan xet: Thai gian m6 t6i thi^u la 9 phiit, toi da la 60 phiit, trung binh la 20,54±13,82.
Bang 4. Phan loai mire do dau theo thcTJ gian sau mo
~~~"—-—-TJidi gian sau mo
Mu'c do dau ~~~~~~-~--__
Dau nhe Dau vCra Dau nang Tong
Ngay thuT nhat 56 (62,22%) 26 (28,88%) 8 (8,88%) 90 (100%)
Ngay thu'hai 70 (85,55%) 17 (18,18%) 3 (3,33%) 90 (100%)
Nhan xet: Hau het benh nhan chi dau nhe \ a dau viia, dau nhe trong 24 gio dau chiem ti le 62,22% va sau 24 gio la 85.55%.
Bang 5. Phan loai muc do dau ngay thu nhat theo nhom tuoi
^^"^^-^MuTc do dau Nhom tuoi ^^~~~---.^
< 20 20-30 30-40 40-50 50-60
> 6 0 Tong
Dau nhe 3 (3,33%) 9 (9,99%) 17 (18,88%) 12 (13,33%) 9 (10,00%) 6 (6,66%) 56 (62,22%)
Dau viTa 1 (1,11%) 5 (5,55%) 4 (4,44%) 10 (11,11%)
4 (4,44%) 2 (2,22%) 26 (28,88%)
Dau nhfeu 0 1 (1,11%) 1 (1,11%) 4 (4,44%) 1 (1,11%) 1 (1,11%) 8 (8,88%)
Nhan xet: Muc do dau trong ngay sau mo khong co sir khac biet co y nghTa thong ke giira cac nhom tuoi vai p > 0.05.
Bang 6. Phan loai mire do dau ngay thu hai theo nhom tuoi
^^-^.^Itirc do dau Nhom tuoi ^^~~~----.._
< 2 0 20-30 30-40 40-50 50-60
> 6 0 Tonq
Dau nhe 4 (4,44%) 12 (13,33%) 19 (21,11%) 16 (17,77%) 12 (13,33%) 7 (7,77%) 70 (77,77%)
Dau viTa 0 3 (3,33%) 3 (3,33%) 8 (8,88%) 2 (2,22%) 1 (1,11%) 17 (18,88%)
Dau nhieu 0 0 0 2 (2,22%)
0 1 (1,11%) 3 (3,33%)
Nhan xet: Muc do dau ngay thu 2 sau mo khong co su khac biet co y nghTa thong ke giira cac nhom tuoi voi p > 0.05.
Bang 7. Phan loai mire do dau theo loai IrT (nija> I, nyay 2) luTc do dau
Tri noi Tri ngoai Tri hon hdp
Tri vong Tong
Dau nhe Dau vUa
Loai tri ^^^^_^ Ngay 1 Ngay 2 Ngay 1 Ngay 2
25(27,77%) 30(33,33%) 2(2,22%) 1(1,11%) 0
7(7,77"/o) 9(10,00%) ^ _J_i^,'^:^/o± lIiJ-i%J_ J {LIAIM 10(11,11%) 14(15,55%) lOqixll^I—-J(5^^g%) 2(2,22%) 14(15,55%) 17(18,88%) 13X14^%) 11(12,22%) 5(5,55%) 56(62,22%) I 70(77/77%) 26(28,88"/o) J 17(18,88%) I 8(8,88%)
Nhan \ct: Mire do dau sau mo iheo loai trT a ngay thir nhat va ngay thir hai c6 sir khac biet CO y nghTa thong ke \ivi p < O.O.S.
Biing S. Tinh trang cha> miiu sau mo
Dau nhieu Ngay 1 j Ngay 2
i(iAl%.
2(2,22%) 3(3,33%i
Mu'c do chay mau Khong chay mau
Mau dinh phan Chay mau tiTng giot Chay mau thanh dong
Tong
Sau N
69 15 6 0 90
mo
o/o 76,66 16,66 6,66
0 100
Nhan xet: Ket qua bang 9 cho thiiy phan Ion BN sau mo tiT di ngoai khong chay mau hoac mau dinh phan sau khi di dai tien (93,33%).
Bang 9. Ket qua tai kham sau 1 thang
Chi tieu nghien cu'u Dau khi di cau
Hep hau mon Sa 16 niem mac tri Da thCra
Co 1 (1,11%) 2 (2,22%)
0 3 (3,33%)
Khong 89 (98,88%) 88 (97,77%) 90(100^"'o) 87 (96,66%)
Nhan xet: Sau mo I thang chi co 1 benh nhiin con dau nhe khi di ciui, 2 benh nhan (2,22%) hep ong hau mon mire do nhe dugc dieu tri bang nong hau mon.
Bang 10: Tinh trang roi loan ticu tit;n sau mo (RLTT)
Gidi
RLTT
Nam Nu'
Tong
Co 5 (5,55%)
0 5 (5,55%)
Khong 42 (46,66%) 43 (47,77%) 87 (96,66%)
Nhan xet: c6 5 benh nhan bi nam bi bi tieu ngay thu nhat sau mo, trieu chung nay het ngay khi benh nhan dugc chuom nong viing bang quang.
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011 IV. BAN LUAN
Thoi gian m6: Kk qua bang 3 cho thSy thai gian m6 trurig binh ciia chiing toi la 20,54 phut, lau nhat la 60 phiit, nhanh nhk la 9 phiit. So voi cac phuong phap phau thuat khac thi thcri gian mo ciia chiing toi ngdn hon nhi^u nhu phau thuat Longo cai tii}n ciia l.c Quang Nhan [4], va ngan tirong cUrong \6i ket qua cat trT bang song cao tdn ciia tac gia Le Dinh Van [5]. Nhu \a>, din co tht^ dugc xem nhu la im diem ciia phuong phap dieu tri trT bang song cao tan.
Dau la \ an de Ion sau mo cat trT. Chinh vi van de sg dau ma nhieu ngui^i benh tir choi mo cat trT, dau la cam giac chii quan cua BN nen kho danh gia mot each khach quan cuong do dau. Chiing toi dura theo phan do dau ciia Goligher cho ket qua sau:
+ Trong nga}' dau sau mo tat ca cac BN deu dau trong do chii yeu la dau nhe \ a dau vira (91,11%), co 8 BN chiem 8,88% dau nhieu.
+ Sang ngay thir 2 thi co 85,55% s6 BN CO dau nhe. Ket qua nghien cuu ciia chiing toi ciing phii hgp voi ket qua nghien cuu ciia Le Dinh Van [5]; ket qua nghien cuu ciia Trieu Trieu Duong thay dau nhieu sau mo trT bang phuong phap Milligan - Morgan len den 95,5% [1]. Day ciing co the la mot uu diem nira ciia phuong phap dieu tri trT bang phuong phap s6ng cao tan. De dieu tri giam dau chiing toi chi can diing Efferalgan vien uong da du khong che dugc cam giac dau ciia BN. Muc do dau phu thuoc nhieu vao ky thuat mo va nguang chiu dau cua moi BN.
Neu so voi cac phuong phap mo trT khac thay cac tac gia thuang phai dung nhOng nhom giam dau manh nhu morphin, khang viem non-steroid [1],[2],[7].
- Chay mau sau mo: Theo ket qua nghien cuu cua cua Jai Bikhchandani [7], trong nghien cuu so sanh mo trT bang phuong phap Longo va Milligan - Morgan co ti le chay mau tir 2 - 4%, co BN phai truyen mau. Ket
qua nghien ciru ciia cluing toi (bang 9) cho thay CO 6 BN chitMn li le 6,66% co chay mau tirng giot sau mo (thuirng vao ngay thir 4 den thir 7 sau mo), nhfrng BN nay chiing toi chi can dieu tri noi khoa bang cac thuoc cam niiui, co mach va thuoc iiim mem phan la BN dii Oil dinh, khong co truirng hgp nao phai lru>cn miiu. Ket qua nghien ciru ciia chiing toi ciing phii hgp \6i ket qua nghien cim cua L.c Di nil Vein [4|.
Roi loan tiC'u tien: day la bien chirng thuirng gap sau ciic can thicp hay phau thuat Ming chau hiing. Theo tac gia Nguyen Dinh lloi [2], bi ticu con lien quan den phuong phap \6 cam. Ket qua nghien ciru cua chiing toi CO 5,55% BN co roi loan tieu tien sau mo, thap hon ti le roi loan ticu tien bang phuong phap gay te tai cho ciia Nguyen Xuan Huyen [3] la 30,09% va khau treo trT ciia Le Quang Nhan [4] la 23%. Co thi ti le r6i loan tilu tien sau mo trT bang song cao tan thap (5,55%) trong nghien ciru ciia chiing toi la ket qua ciia phuong phap vo cam va vi BN dau it. Day co the la mot uu diem nira ciia mo trT bang song cao tan.
- Theo nghien cuu ciia nhieu tac gia cho rang bien chirng sau mo trT rat thap neu lam diing ky thuat. Cac BN trong nghien cuu ciia chiing toi chi tai kham dugc 1 lan sau mo khoang 30 ngay, so lan tai kham it va chua dai nhung ket qua cho thay sau 30 ngay sau mo benh nhan het dau khi di dai tien la 98,88%. Co 5 BN bi hep hau mon mire do nhe chi can nong de dieu tri. Ket qua nay cUng phii hgp voi ket qua cua mot so tac gia khac [2],[5]'.
V. KET LUAN
Dieu tri trT bang song cao tan cho ket qua tot voi cac loai trT.
Thoi gian phau thuat ngan: trung binh 20,54 phiit, nhanh nhii la 9 phiit, cham nhat la 60 phut.
Tinh trang dau sau mo it, chii yen la dau nhe vii dau vira khi di dai ticMi (91,11 % ) .
Bien chirng chiiy mim sau mo thap (6,66%).
Bien chirng hep hau mon thap va hep mire do nhe (5,55%).
TAI LIEU THAM KHAO.
1. Trieu Trieu Duong vii cs (2006), ' Ket qua dieu tri benh trT do III vd Jl' hang phdu thudt Longo so sdiih vdi phuong phdp Milligan Morgan tai h('nh vien Trung Uong qudn ddi 108" Tap chi ^' Duoc hoc qiiiin sir .so 2/2006, tr: 87-92.
2. Nguyen Dinh Hoi va cs (2002), "Ket qud cat trT bang dao laser so vdi dao thudng", Ngoai khoa so 3/2002, tr: 29-33.
3. Nguyen Xuan Huyen (1999), "Mot so nhan xet ve gay te tai cho trong mo trf, Ngoai khoa so 4/1999.
7.
Le Quang Nhan, Nguyen Thiiy Oanh (2004), "Ddnh gid ket qud budc dau dieu trf tri ndi do 11 J. JV hang phdu thudt Longo cat lien" Tap chi Y hpc TP Ho Chi Minh, tap 8, phu han si) 1/2006, Ir: 2 2 6 - 2 3 1 .
li- Dinh Van (2006), "Ket qud budc dau dieu trj h('idi tri hang sdng cao tdn ", Tap chi Y hoc tinrc hanh so 559/2006, tr: 53-58.
(iupta P.I (2002), "Novel technicque:
radio/rec/uencv coagulation - a treatment alternative lor early - stage hemorhoids McdCicnMed, 2002:4.
Jai Bikhchandani (2005), "Randomized controlled trail to compare the early and mid - term resultceof stopped versus open hemorrhoidectomy" The American Journal of .Surgery 189/2005, p: 56-60.
OAC OIEM LAM SANG, HINH ANH NOI SOI VA MO BENH HOC QUA 141 BENH NHAN POLYP LANH TINH OAI TRl/C TRANG
TAI BENH VIEN TINH Hl/NG YEN
TOM ikl
Polyp dai trUc trang la benh hay g3p tren the gidi Cling nhu" b Viet Nam, la nguyen nhan chii yeu gay ung thu (Jai tri/c trang. Mijc dich: Mo ta d§c diem lam sang, hinh anh npi soi, mo benh hoc ciia polyp dai trUc trang tai benh vien da khoa tinh Hung Yen n3m 2009- 2010. 061 lu'dng va phu'dng phap nghien cuTu:
Nghien cifu mo ta cSt ngang. Ket qua: Nghien ciru 141 benh nhan co polyp lanh tfnh dai trUc trang chiing toi thay: Trieu chu'ng thudng gap la dau bung doc khung dai trang (30,9%). Polyp gSp moi vj tri trong khung dai trang trong do gap nhieu nhat 6 trUc trang
Tran Cong Khanh', Le VSn Thi^u^
(51,7%), dai trang sigma (33,3%). Polyp thUdng gSp la polyp ddn doc (90,8%). Polyp co kich thu'dc vuci gSp nhieu nhat (75,2%). GSp polyp co cuong va khong cuong la ngang nhau. Hinh thai polyp g3p nhieu nhat la nhSn (86,0%). Mau s5c polyp g8p nhieu nhat la polyp mau hong (73%). Da so gSp polyp t§ng san (46,8%), polyp tuyen (31,9%), polyp loan san (21,3%). Ket luan: Polyp gSp chii yeu d trUc trang va dai trang sigma. Thudng gap polyp ddn doc, co kich thudc vira, be mat nhln, mau hong. Da so gap polyp tang san va polyp tuyen.
'BVDa khoa tinh Hung Yen, ^BV Viet Tiep Hai Phong
