Tap cM GAN MAT VIET NAM so 28-2014 31
Danh gia 10 nam hieu qua tan soi qua ducmg ham Kehr trong dieu tri soi dirong mat tai benh vien Binh Dan
Bui Manh Con, Luang Thanh Tiing, Nguyen Due Trung T6M TAT
M^ic dich: Ddnh gia ty le sach sdi sau tan sdi dudng mat qua dudng hdm Kehr d nhung benh nhdn cd sdi sdt dudng mat hong 10 nam tai benh vi?n Bmh Ddn.
Phuong phdp: Cat ngang md ta. Thdi gian 10 nam tai khoa Gan mat benh vien Binh Ddn, 826 benh da dugc tao dudng hdm dng Kehr, den khdm vd dieu tri tai BV Binh Ddn, cd sdi tdn luu hay sdi sdt dudng mat, cdn phdi tdn sdi dieu tri dugc dua vdo mdu nghien ciiu.
K^t qud: tudi frung binh 46,2 ± 9,9; ti le Idy SUMMARY
Purpose: The aim of this study was to esti- mate the ratio of complete clearance of stone after lithotripsy through Kehr-tunnel in patients with remaining stones at Binh Dan hospital in 10 years
Method: A prospective analysis. With the time of 10 years, 826 patients with recurrent or remaining stones in bile duct and must be per- formed lithotripsy treatment at the department of heaptobihary - Binh Dan hispital. These pa- tients were included in the research samples.
Result: Average age: 46,2 ± 8,9; the ratio of
sach sdi 95,9%, trong cdc nguyen nhdn gdy sdt sdi thi tinh trang sdi gan phdi la nguyen nhdn chiem ti le cao nhdt (32,4%), tai bien gap nhieu nhdt Id chdy mdu dudng mat (4,4%); 86,6%
benh nhdn khdng cd rdi loan 1dm sdng ndo sau tdn sdi.
Ket luan: Viec tim mdt phuang phap de dieu tri triet cdn sdi dudng mat la mot cdu hdi dugc dat ra. Tan sdi qua dudng ham Kehr dugc thuc hien sau ldn md md dng mat chii Idy sdi vd ddn luu Kehr, thi 95,9% benh nhdn sach sdi hodn todn thi ddy Id mdt ket qud dang dugc quan tdm.
complete clearance of stones is 95,9%; positions in the right lobe takes lead (32,4%) in the rea- sons for remaining stones after operation, the most common complication is bleeding (4,4%);
and 86,6% of patients have no clinical changing after operation.
Conclusion: Finding method to treat the bile duct stone completely was a question being posed. Lithotripsy through Kehr-tunnel was per- formed after surgery to open the common bile duct which later is drained with the Kehr tube, there are 95,9% of patients are complete clear- ance of stone, this is a deserving attentive result.
l . D A T V A N D E
0 Viet Nam, benh ly gan mat, dac biet la sdi dudng mat la mdt benh ly kha phd bien. Bang nhieu phuang phap ndi khoa va ngoai khoa ciing khd cd thi diSu tri sach sdi dudng mat mdt each hi?tdd [11], [12] Benh thudng gap d nu nhieu hgn nam. Tdn sudt mac sdi mat chung cua dan sd khodng 5-25%, va thay ddi theo tiing dia phuong, qudc gia, chdu luc, ddc diem phong tuc tap quan [1], [3], [7]. Ty I? biSn chiing sau md 3-7%. Ty le hi vong cung khde nhau. chu yeu
do soc nhiem tning va chay mau dudng mat. Ty le sdi sdt d
Phdn bien khoa hpc: GS. Vdn Tdn.
dudng mat sau md theo cac tai lieu khoang 2- 27% ddi vdi sdi dudng mat ndi chung, vd khoang 46-77% vdi cac trudng hgp sdi trong gan. Ty le tai phat sdi sau md lay sdi vao khoang 40-75% [3], [6), [7], [8].
Ben canh dieu tri sdi dudng mat bang npi khoa diing thudc tan sdi (it hi^u qua va ty I? tai phdt cao). hien nay phau thuat van Id phuang Phan bi?n khoa hgc: GS Van Tan
32 Tap chi GAN MAT VIET NAM s^ 28-2014 phdp chu yeu de dilu tri sdi mat d nudc ta. Van de sdi sdt vd tdi phat sau md la nguyen nhdn chmh khien benh nhan phdi md di md lai nhieu lan. Lay sdi mat sdt qua dudng hdm Kehr dudi quan sat true tiep ciia dng noi soi mem cd the giup tiep can sdi de dang, ke ca sdi ndm sdu trong cdc ha phdn thiiy gan, va dugc ghi nhdn vdi ty le thdnh cdng tir 80-90% [1], [2], [4], [5], [6], [9], [10].
Tan sdi qua dudng hdm Kehr la mdt phuang phap dugc thuc hien rat nhieu tai benh vien Binh Ddn. Day Id mot phuang phap dieu tri nhe nhang vdi benh nhdn nhung ddi hdi trang thiet bi may mdc va ky thudt cua ekip thirc hien (bac sy lay sdi vd ca bac sy gdy me).
Do vay, de danh gid tdng ket lai mdt sd dac diem 1dm sang, can lam sang, cac tai bien vd bien chiing cua phuang phdp ndy qua 10 nam gan day (2003 - 2013), chung tdi tien hanh nghien ciiu nay.
Muc tieu nghien cihi
Ddnh gid mdt sd dac diem ve lam sdng va can lam sdng cdc trudng hgp tan sdi qua dudng ham kehr dieu tri sdi sdt dudng mat tai benh vien Binh Ddn trong 10 nam.
Ddnh gid cac tai bien vd bien chiing cdc trudng hgp tan sdi qua dudng ham kehr dieu tri sdi sdt dudng mat tai benh vien Binh Dan trong 10 nam.
Ddnh gia ket qua sach sdi sdm cac trudng hgp tan sdi qua dudng hdm kehr dieu tri sdi sdt dudng mat tai benh vien Binh Ddn trong 10 nam.
2. DOI TlTQNG VA PHl/ONG PHAP NGHlfeN CUtl
D6i tugng nghien cuu:
Cdc trudng hop, cd dudng ham dng Kehr, cd sdi sdt dudng mat, dugc tan sdi qua dudng ham Kehr tai benh vien Bmh Dan, trong 10 nam (2003- 2013), frudc 6 thdng tai thdi diem nghien ciiu.
Mot so khdi niem:
Sdt sdi thu ddng va sdt sdi chu dgng:
Sdt sdi thu dgng: da cd tien can md sdi dudng mat va trong liic md, bdc sy phau thuat da cd gdng Idy bdt sdi nhung khi kiem tra dudng mat sau md (qua sieu dm, chup hinh dudng mat qua dng Kehr, hay npi soi mat tuy ngugc ddng) thay cdn sdi sdt.
Sdt sdi chu ddng: da xdc dinh cdn sdi trong cugc md nhung khdng the Idy h6t dirge (do dudng mat trong gan hep khd Idy, tinh trang nhilm tning nang, tdng trang benh nhdn khdng cho phep tidp tuc keo ddi cugc phau thudt,...).
Sach sdi hay cdn sdi sau Idy sdi mat sdt qua dudng ham Kehr:
Sach sdi sau Idy sdi mat sdt qua dudng ham Kehr: benh nhdn dugc xdc dinh la da sach sdi trong ldn Idy sdi mat sdt qua dudng hdm Kehr, sau dd qua sieu dm va chup hinh dudng mat ki8m tra trudc khi xudt vien cho kk qua la khdng cdn sdi trong dudng mat.
Cdn sdi sau lay sdi mat sdt qua dudng hdm Kehr: nhiing benh nhdn dugc xac dinh Id cdn sdi trong ldn Idy sdi mat sdt qua dudng hdm Kehr, hoac qua sieu am hoac qua chup hinh dudng mat kiem tra trudc khi xuat vien cho ket qud Id cdn sdi trong dudng mat.
Tiiu chudn lua chpn mdu:
Cac benh nhdn dupc chpn vdo mdu nghien ciiu thda man cdc dieu kien:
Cd sdi sdt dudng mat (sdt sdi thu dpng hay sdt sdi chu ddng).
Cd dat dng Kehr cd ldn (18F trd len, d - dmm).
Ong Kehr da dugc dat it nhat 6 tudn de cd dii thdi gian dudng ham dugc chac chdn.
Cd dieu tri lay sdi mat sdt qua dudng ham Kehr va dugc dieu trj tai khoa gan mat benh vien Binh Dan tir 2003-2013.
Tieu chudn loai trir:
Khi benh nhan khdng thda man mpt trong cac dieu kien tren.
ASA do IV, V.
3- PHlTONG PHAP NGHlflN ClTU: Cat ngang md ta.
Cac budc tien hanh thu thap so Ii?u:
Budc 1: Tdt ca benh nhan thda man tieu chi chpn mau se dugc dua vao mau nghien ciiu.
Budc 2; Tdt cd benh nhan thda man di8u ki^n chgn mau deu dugc dieu Ui vdi ciing mdt phuong phap Idy sdi mat sdt qua dudng hdm dng Kehr.
Budc 3: Danh gia ket qua sdm cua nghien ciiu.
Tap chi GAN MAT VIET NAM so 28-2014 33 Cac b?iih nhan tiep tyc dugc ghi nhan tinh Ket qua dugc trinh bay duoi dang bang, ttang lam sang va sieu am kiSm tra khi tro lai tai Thdng ke mo ta cung cip nhiing diong tin wi kham sau 1,3, 6 thang. s6 lugng, ty le phin tram, s6 trung binh ± dp
PHlTONG PHAP Xif LY VA P H A N lech chuAn.
TICH S6 LIEU: KET QUA
Nhap so lieu bang chucmg trinh Excel. Tong s6 benh nhan 826.
Diing pham mSm SPSS 11.5 va Excel dk Tudi Uung binh: 46,2 ± 8,9. Tudi nho nhit la phan tich s6 lieu 18, tu5i Ion nhit la 108, TI LE N C : NAM = 7:3
Bang 1: Phdn bo theo noi cu tni
Nffi cir trii TPHCM Cac tinh khac T6ng
So lirgng (n) 237 589 826
T y l e ( % ) 28,7 71,3 100 Nhan xet: TPHCM chiem ty le 28,7% , so con lai phan bd rai rac khap cac tinh phia nam.
B^ng 2: Sd Idn da mo soi mat:
S6 l^n ni6 1 lan
2 lin 3 lin 4 lin 5 lin Tdng
So lirong (n) 713
93 15 3 2 826
T y l | ( % ) 86,3 11,3 19 0,3 0,2 100
Nhdn xet: da sd cac benh nhdn da dugc md gan nhat den ldn nhap vien nay khoang 2-3 thang.
sdi dudng mat 1 ldn, cd 2 benh nhdn da md sdi jhoi gian tmng binh bi liic md sdi dudng mat dudng mat 5 ldn chi6m ty le 0,2%. g^n nhdt den ldn nhap vien nay: 81,67 ± 18,72
- Khoang thdi gian tii liic dugc md sdi dudng mat ngay.
Bdng 3: Sdt sdi chd dpng hay thu ddng S6t soi chu d^ng hay
thy d^ng Sdt soi chu dong Sdt soi thu dong
So l u ^ g (n) 273 553
T y l ? ( % ) 33,1 66,9 Nhdn xet: nhom sol soi thu dpng chijm ty le 66,9% (62 trudng hgp).
34 Tap chi GAN MAT VIET NAM s^ 28-2014 B ^ g 4: Trieu chdng lam sdng chinh:
IVi^u chvng Mo ho hoac khdng
Tam chiing Charcot (Dau + sot + vang da) Chi CO dau Chi CO sot Dau + vang da Tdng
$6 lirgrng (n) 742
18 54 5 7 826
Tyl?(%)
89,8 2,2 6,5 0,6 0,9 100
Nhdn xet: khdng tri?u chiing hoac chi cam giac ma hd chiem ty le 89,8% (742 trudng hgp), chi cd 18 benh nhdn la cd tam chiing Charcot (chiem ty le 2,2%).
Bang 5: Vi tri sdi sdt dudng mat duoc phdt hien qua kit hpp siiu dm vd X-quang duang mat
Vi tri soi sot Gan trai Gan phai Can trai + phai Gan trai + ngoai gan
Gan phai + ngoai gan Ca 3 vj tri (gan phai, gan trai, ngoai gan) Ngoai gan (sdi sot d ong gan chung va dng mat chu) Tong
So lugng (n) 17 28 57 142 119
87 376 826
T y l | ( % ) 2,1 3,4 6,9 17,2 14,4 10,5 45,5 100
Nhdn xet: qua ket hgp ca sieu am va X-quang, sdi mat sot g ngoai gan chigm 45,5%, trong luc soi mat sot trong gan hoac trong gan ket hgp ngoai gan chiSm 54,5% .
Tap chf GAN MAT VIET NAM s6 28-2014 Bdng 6: Phdn loai tinh trang lam sdng benh nhdn truac mo (theo ASA)
Phan loai theo ASA Lo^i I
Loain Tong
So Iir9lig (n) 647 179 826
Ty H (%) 78,3 21,7 100
Nhdn xet: 179 trudng hgp (21,7%) cd benh toan than nhung nhe, khdng gidi ban hoat ddng thd luc.
Bang 7; Ty li sd ldn lay sdi mat sdt qua duang hdm Kehr Sh lan liy soi
1 lin 2 lin 3 lin 4 lin 5 lin 6 lin Tdng
So lugng (n) 184 397 181 39 18 7 826
T y l | ( % ) 22,3 48,1 21,9 4,7 2,2 0,8 100 Nhdn xet: Sd lan Idy sdi trung binh: 2,3 ± 0,9 ldn. It nhdt 1 ldn, nhieu nhdt Id 6 ldn Idy sdi.
Thdi gian lay sdi sdi sdt dudng mat: Thdi gian mdt ldn Idy sdi sdt dudng mat ngan Thdi gian trung binh mgt ldn lay sdi sdt nhdt 25 phiit, ddi nhdt nhat: 90 phiit.
dudng mat la: 54 ± 23 phiit.
Bdng 8: Kit qud ve each thuc Idy sdi sdt dudng mat Cich thirc lay
Chi dimg ro lay soi T6n sdi dien thiiy lire + dUng rp lay soi Tdng
So Ivtqng (n) 154 672 826
Ty If (%) 18,7 81,3 100
Nhgn xet: cac trucmg hgp co ket hgp tan sdi dien thuy Itic va lay sdi bang rp cd 672 trudng hgp, chiem ty If 81,3%.
36 Tap cM GAN MAT VIET NAM sd 28-2014 Bing 9: Kiiu xung trong TSBTL
Kiiu xung trong TSDTL Kieu xung A
Ki8u xung B
KiSu xung A va ki8u xung B Tdng
S6 luwng (n) 549
57 66 672
T y l f ( % ) 81,7
8,5 9,8 100 Nhdn xet: Kidu xung A dugc sir dung nhilu 549 tnrong hgp chiem ty le 81,7%
Bing 10: Cucmg dp trong TSBTL
Cirimg ao trong TSDTL cip 1
cip 1 va 2
Tdng
So liroTig (n) 587
85 672
Ty 1| (%) 87,4 12,8 100
Nhdn xet: Cudng do trong tdn sdi dien thiiy lire thudng dugc diing la d cdp 1, chidm ty le 87,4%.
Bdng 11: Vi tri sdi sdt khi lay sdi mat qua dudng hdm Kehr
Vi tri sdi sdt Gan trai Gan phai
Gan trai + phai Gan trai + ngoai gan Gan phai + ngoai gan Ca 3 vi tri (gan phai, gan trai,
ngoai gan) Ngoai gan (sdi sdt d dng gan
chung va ong mat chii) Tdng
S6 lirgng (n) 39 24 91 176 132 129 235 826
T y l | ( % ) 4,8 2,9 11,0 21,3 16,0 15,6 28,4 100
Nhan xet: Sdi dugc phat hien khi liy soi qua duong him Kehr, soi sdt a ngoai gan chiSm 28,4%, trong luc sdi trong gan hoac trong gan ket hgp ngoai gan chiSm 71,6%.
Tap chi GAN MAT VIET NAM sd 28-2014 37 Bang 12: Ket qud thdnh cong sach soi mat sau thuc hien phucmgphdp lay soi sot dudng mat qua duang ham Kehr
Ket qua sach sdi hay cdn soi Sach sdi
Cdn sdi Tdng
So liTQDg (n) 792
34 826
Tylf(%) 95,9
4,1 100
Ty le thdnh cdng sach sdi mat sau thuc hien phuang phdp Idy sdi mat sdt qua dudng hdm Kehr Id 95,9%. Ddy chinh la ket qud sdm cua phuang phap.
Bang 13: Tdng thoi gian ndm viin
Thdi gian nam vien
< 15 ngay
> 15 ngay Tdng
So liroug (n) 542 284 826
Ty le (%) 65,6 34,4 100
Tdng ngdy nam vien: 16,1 ± 11,7 ngdy, thdi Nhan xet: benh nhdn nam vien < 15 ngay gian nam it nhdt: 4 ngay, thdi gian nam lau nhat: chiem ty le 65,6%, benh nhdn nam> 15 ngay cd
100 ngay. chidm ty Ie 34,4%.
Bang 14: Nguyen nhdn khdng lay hit sdi sdt duong mat
Nguyen nhan Benh nhan khd thd- Sp02 giam, ST chenh xudng
Cdn sdi gan phai Con sdi gan trai Cdn sdi gan phai + trai Hep dudng m^t Uong gan phai Hep dudng m^t trong gan trai Tdng
So llTQTlg (n) 1 11 5 6 7 4 34
Ty If (%) 3 4 324 14,7 17,6 20,1 11,8 100
38 Tap cU GAN MAT VIET NAM so 28-2014 Nhdn xet:
I benh nhan co sdi sot duong mat gan trai, ttong khi dang thuc Men lay sdi mat sot qua dudng him kehr, benh nhan thiy khd thd nhe, cam giac nang g nguc, SpOj giam, dien tam dd c6 ST chenh xudng, nen benh nhan nay dugc ngung viec liy sdi, cdn mpt it sdi sot a gan trai nhung khdng anh hudng nhidu ddn su luu thdng dudng mat. Benh nhan dugc chuydn ddn phong hoi siic theo ddi va tmh trang trd vd binh thudng sau 1 ngay Benh nhan dugc hpi chin, dugc sieu am va chup Unh dudng mat kiem tra va xuit vien, tiep tuc dugc theo ddi.
II benh nhan cdn sdi gan phai d ha phan thuy VH, Vm, 5 benh nhan cdn sdi gan trai d cac ha phan thuy II, III va 6 benh nhan cdn sdi gan phai -I- trai d cac ha phan thuy II, VI, VII, VIII. Cac benh nhan nay diu cdn sdi sdt nim a cac vi tri sau hong gan, ong soi khdng the tiep can de liy sdi.
7 benh nhan cd hep dudng mat va cd sdi sdt gan phai nim d ha phan thuy VI, VII, VIII, 4 benh nhan cd hep dudng mat va cd sdi sdt gan phai nam d ha phan thdy II, III.
Bang 15: Tai bien trong luc My sdi sdt dudmg mat
Cac tai bien Chay mau dudng mat do tan soi Ong npi soi lam thung dudng ham ong Kehr
Benh nhan khd thd -Sp02 giam, ST chenh xuong
Sd lugng (n) 36
6 1
Tyl?(%) 4,4 0,7 0,1
Nhdn xet: cdc tai bidn dugc ghi nhan la chay mau dudng mat do tdn sdi, dng npi soi lam ±ung dudng ham dng Kehr, Sp02 giam, ST chenh xudng.
Bang 16: Cdc rdi loan lam sdng sau lay sdi mat sdt qua dudng hdm Kehr Cac roi loan
Dau nhieu phai diing giam dau sdt
Chay mau chan dudng ham Kehr Khdng
Tdng
So luffng (n) 71 23 17 715 826
Ty If (%) , 16,6
2,8 2 86,6
100
Nhdn xet: da sd cac trudng hgp lay sdi mat sdt qua dudng hdm Kehr d^u on dinh (715 trudng hgp, chiem ty le 86,6%). Chi 13,4% trudng hgp cd rdi loan lam sdng sau Idy sdi mat sdt qua dudng hdm Kehr nhu dau nhieu phdi diing giam dau, sdt, vd chay mau chan dudng hdm Kehr.
Tap chi GAN MAT VIET NAM sd 28-2014 39
Anh I.4.: RutdngKehr[Vo Vdn T- 77 tuoi. MSNV: 209/20133- hinh chup tai benh vien Binh Ddn, 24-03-10]
Anh 1.5.: Lay soi qua dudng hdm KehrfVo Vdn T- 77 tuoi, MSNV- 209/20133 - benh vifn Binh Ddn. 24-03-10]
40 Tap chi GAN MAT VIET NAM sd 28-2014
Anh 1.6.: Dung ro Idy sdi qua duong hdm Kehr [Vo Vdn T - 77 tuoi, MSNV: 209/20133 - hinh chup tai benh vien Binh Ddn, ngdy 24-03-10]
Anh 1.7.: Tdn sdi dien thuy luc [Vo Vdn T - 77 tuoi, MSNV: 209/20133 - hinh chup tai benh vien Binh Ddn, ngdy 24-03-10]
Tap chi GAN MAT VIET NAM so 28-2014 41 BANLU.^
Cung nhu tmh ph6 bien cua benh, sdi dudng mat chinh (soi trong gan, soi dng gan phdi vd trdi, sdi ong gan chimg, sdi ong mat chu) cd the gap a mpi dg tudi, tu 20-80 tuoi va trung bmh khodng 45 - 55 tudi [6]. Tdn sd mac benh sdi mat cao nhdt d dg tuoi 60 -70 [1]. Tdng sd benh nhan 826. Tuoi tnmg binh: 46,2 + 8,9. Tudi nhd Dh4t Id 18, tudi ldn nhdt la 108.
Ti 1? nam : nii = 3 : 7 ndi len tinh uu thi vd gidi nil ciia b$nh va phu hgp vdi ti le ciia nhieu cupc nghien ciiu truac [3, 6, 8, 10].Gia thiet dat ra dugc chip nhgn Id: ndi ti§t td nii (Oestrogen) 1dm tang choeiesterol trong dich mat, mat khac progesterol 1dm gidm kha nang co hdp cua tiii mat din den s\r li tr? d tiii mat lam tang nguy ca tao sdi. Ve phdn bd theo nai cu tru hdu het phdn bo tai cdc tinh phia nam va thdnh phd Hd Chi Mmh.
86,3% bSnh nhdn da cd 1 ldn md sdi dudng mat tiudc dd, 11,3% cd tidn cdn md sdi dudng mdt 2 l^n, cd 2 b?nh nhdn md den 5 lan vd khodng thdi gian tii liic md sdi dudng mat gdn nhdt d6n ldn nh^p vi?n ndy khodng 2 - 3 thang.
Di^u ndy cho thdy sdi dudng mat Id mdt b?nh ly rit khd dieu hi triet de vd de tai phdt.
22,3% b§nh nhdn dupc tdn sdi qua dudng him Kehr 1 ldn vd 4 8 , 1 % benh nhdn dugc tan sdi 2 ldn. Sd ldn tan sdi trung binh la 2,3 ± 0,9 lan. Nhieu nhdt la 6 ldn. DiSu ndy cd the dugc gidi thich: [6]
Thdng thudng, thu thudt tdn sdi mdi ldn keo ddi khodng 1 gid, neu keo dai ban se cd nhiing b4tlgi
>- Ap l\rc dudng mat tang trong liic ndi soi do phdi bom nudc vdo dudng mat, neu keo dai se gdy lanh run vd sdt.
>- B?nh nhdn tilp nhdn mot lugng nudc qua nhieu tir dudng mat do dpng tdc npi soi bam vao.
Do v^y, cdc trudng hgp cd nhieu sdi thi nen tdn sdi nhilu lan, trdnh cd gdng tdn hit trong 1 lan, se gdy nguy hiim cho b?nh nhdn, nhdt. Tuy nhien, nlu tan sdi nhilu lan se lam tang thdi gian
nam vien benh nhdn, anh hudng den tdm ly ngudi benh, dnh hudng nhiing ngudi than phdi cham sdc benh nhdn, vd tang vien phi.
Chup X-Quang dudng mat qua dudng hdm Kehr vd mdt sd trudng hgp cd ket hgp sieu dm, cho ket qud sdi sdt ngodi gan chiem den 45,5%.
Trong luc do, ket qua qua npi soi liic tdn sdi ghi nhdn Id 28,4%, phdn ldn sdi sdt la trong gan hoac trong gan ket hgp ngodi gan. Ket qud tren cho thdy, ndi soi liic tan sdi cho ket qua chinh xdc va hgp ly ban. Sdt sdi chu yeu xdy ra d nhiing trudng hgp phau thuat sdi dudng mat cd kem sdi trong gan. Sdi trong gan rdt de bi bd sdt hoac khdng the lay bet dugc vi sdi thudng nam rdi rac hay cd khi nam day nghet cd dng mat ha phdn thuy sau trong gan. Nhieu trudng hgp dng mat lai bi viem nhiem keo dai, tdi di tdi lai, td chiic xa phdt trien lam hep Idng dng mat gay rdt nhilu khd khan cho viec Idy sdi. Sdi d vj tri trong gan khd lay la nguyen nhan quan trpng chu chdt nhdt trong sdt sdi dudng mat.
Tai thdi dilm xudt vien, chiing tdi thu nhdn dugc kit qua:Sach sdi: 95,9%, ket qua nay dugc xem nhu ty le thanh cdng chinh cua chiing tdi khi tan sdi qua dudng hdm Kehr d nhiing benh nhdn cd sdi dudng mat.
K E T LUAN
Viec tim mdt phuang phap de dieu tri triet de sdi dudng mat Id mdt cau hdi dugc dat ra. Vdi nhirng ldn tdn sdi qua dudng ham Kehr dugc thuc hien sau lan md dau md dng mat chii Idy sdi vd ddn luu Kehr, thi 95,9% benh nhdn tdn sdi va sach sdi hoan todn thi day la mdt kel qua dang dugc quan tam.
Tai lieu t h a m khao
1. Nguyen Cao Cuong, Tran Thif n Hoa Khao sat tinh hinh mdc benh sdi mat 6 ngudi tren 50 tuoi tai thanh pho Ho Chi Minh.
2. Nguyen Dinh Hoi, Ton That Bach: Nghien curu ung dyng tien bg khoa hpc cong ngh? trong chan doan va dieu tn sdm b?nh s6i mat. De lai khoa hgc
42 Tap chi GAN MAT VIET NAM so 28-2014 cap nha nudc. Chucmg trinh khoa hgc va cong ngh6 phvic vu cham soc va bao ve siic khoe cdng dong.
3. Fh^m Khue: Phlu thuat d ngudi gia. Benh hgc hioi gia ( 1993) (Tr 366-373).
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