Y HOC V l | T NAM THANG 5 - SO 1/2015
NGHIEN CU'U U-NG DUNG HUT AP LITC A M VA VAT DA CAN VUNG M O N G TRONG DIEU TRI LOET CUNG CUT MU'C D O NANG (DO III. IV)
Nguyen Van Thanh*, Tran Van Anh**, Nguyen Van Hue**
T 6 M TAT
Ba mUdi mot vat nhanh xuyen dong maeh mong tren va ba mUOi vat da can tai cho cd cuong ngau nhien vung mong da dUpc sir dung de dieu tri eho 60 benh nhan, dUdc chia lam 2 nhdm: nhdm 1 sir dung v^t nhanh xuyen dpng mach mong tr§n cho khuyet hong vung ciing cut cd kich thu'dc dUdng kinh Idn hdn 6 cm v^ nhom 2 sir dung vat da can t^i cho eo cudng ngau nhien cho o loet eo dUdng kinh nhd hdn 6cm.Trong 60 benh nhan nghien ciili cd 20 benh nhan vdi d loet dd I I I , sd benh nhan edn lai dude phan loai dp IV. Tat ea 6 loet ciing cut deu dUpc dieu tn ban dau bSng eSt Ipe va hut ap li/c am tir 3-10 Ian thay foam. Ket qua diSu tn khong ed tru'dng hdp nao bi bien chiTng nang nhu" hoai tii' toan bp vat, chi cd 2 tn/dng hdp cliay mau dudi vat va 1 tn/dng hdp hoai tir */i vat. Theo doi sau mo tCr 5 den 37 thang.
T&khda: vat ngau nhien tai cho viing mdng , vat nhanh xuyen ddng maeh mong tren vung mong, loet cOng cut, hut ap lUc am.
SUMMARY
CLINICAL STUDY OF THE GLUTEAL FASCIOCUTANEOUS FLAPS WITH VACUUM
ASISTED CLOSURE (VAC) FOR SEVERELY DEGREE OF SACRAL PRESSURE
SORE RECONSTRUCTION Thirtyone perforator- sparing and thirty random pattemgluteal faseiocutaneous v\(ere used for cover of pressure sores in 60 patients with age range from 16 to 82 years. 35 patients were paraplegic and 28 patients was ambulatory. Twenty patients were classil^ed as grade 3 and 40 patients as grade 4. All of pressure sores were sacral and were treatmented with vacuum assisted closure therapy, which treatmented range 3-10 period. The random pattern gluteal were used for defected sore with diametre below 6cm and which are over 6em were covered by super lor gluteal artery perforator flaps. There was no major complications such as total flap neaosis. Three cases were complications: 2 blooding under flap and one cas
* Benh vien 115, TP. Ho Chf Minh
* * Vien Bdng Quoc gia
Chju trach nhiem chinh: Nguyen Van Thanh Email: drthanhibcs^omaiLcom Ot: 0903744344 Ngay nhan bai: 5/3/2015
Ng&y ph^n bl§n khoa hpc: 23/3/2015 Ngdy duyet bSi: 25/3/2015
with a half flap necrosis. Mean follow - up period was 18,7 months (range 37-5 months).
Keywords: pressure sores management- fasciocutaneous buttock perforator flaps- random pattern flaps - vacuum assisted closure- superior gluteal artery perforator flaps.
I. OAT
VXN B 1Dieu trj loet ciing cut la van de du'dc quan tam rat nhieu trong lanh viTc tao hinh trong hdn 2 thap nien qua [ 7 ] . Loet ciing cut thUdng gap do ti de va khi nhap vien thu'dng cd bleu hien lam sang nang ne vdi ton thUdng lan sau qua Idp can sau va viem xUdng cung cut, dUdc ph^n loai dp I I I , IV theo phan loai ciia Hoa Ky nam 1989 [5]. Ton thu'dng loet ciing cut lan rpng nhieu ngde ngach, khe ke, nhieu djch tiet nen can du'dc Celt Ipe sach va dieu trj hut ap lUc am nhieu ddt tao nen ton khuyet sach, ft dich tiet, to chu'c hat sach, thu hep vet thu'dng cd hpc chuan bj ddn nhan vat da can vung mong che phii [ 5 ] . Ton thu'dng vdi dudng kinh nhd hdn 6 cm du'dc che phii being cac vat chuyen tai cho cd cudng ngau nhien va cac ton khuyet Idn hdn 6cm( dUdng kinh) du'dc che phii bdl cac vat da can cd cudng mach nudi la nhanh xuyen dong mach mdng tren vdi Uu diem chu ddng nguon cap mau va dien b'ch vat rpng dii che phii eac khuyet hong Idn [ i j .
Chung tdi thUc hien tren 60 benh nhan tai Khoa Phau thuat tao hinh tham my- Vien bdng quoc gia Le HiJu Trac- Ha Npi va tai Ddn vi Tao hinh tham my - Benh vien Nhan dan 115- thanh pho Ho Chf Minh tCf thang 10/2010 den thang 12/2014. Uu diem va nhu'dc diem trong quy trinh dieu trj loet eiing cut mire dp nang (dp III,IV) se dUdc phan tich va ban luan trong nghien culj cCia Chung toi.
H. 0 0 1 TU'pNG VA PHyCTNG P H A P N G H I I N C O U 2 . 1 . 0 6 1 tu'dng nghiSn cu'u
60 benh nhan nhap vien tai khoa Phau thu^t tao hinh tham my - Vien bdng quoc gia Le Hthj f r a c - Ha Not va Ddn vj tao hinh tham my - benh vien Nhan dan 115 - Thanh pho Ho Chi' Minh tCf thang 10/2010 den thang 12/2014. Tat ca benh nhan deu du'dc chan doan loet cung cut dp i l l ,
Y HOC VIET NAM THANG 5 - SO 1/2015 IV theo phan loai eiia hiep hpi dieu tri loet ti de
Hoa Ky.
2.2. Phu'dng phap nghien cu'u 2.2.1. Nghien cu'u tri lieu hut ap Idc am dieu trj du'dc dau 6loet viing cung cut
ThUc hien ky thuat hiit ap lUe am vdi vat lieu ciia hang Cura VAC, Han quoc bao gom mieng xdp, dng dan, binh hiit, may tao ap lUc am. Cac budc thUe hien hut theo quy trinh da ^yidz xae dinh. Ap lUe hut tir 125-200mmHg, thdi gian thay mieng xdp la 48 gid, tiiy theo tinh trang ton thUdng ma thdi gian dieu trj hut tir 7-21 ngay.
2.2.2. Nghien cii'u li'ng dung vat nhanh xuyen che phu 6 loet da dWdc dieu trf hiit ip lyc am vdi kich thu'dc dWdng kinh dioet
> 6 cm
- Sir dung may sieu am cam tay 8 MHz de gliip xac dinh vj tri nhanh xuyen cap mau cho vat, thiet ke vat nhanh xuyen.
- Tien haiih bde taeh vat nhanh xuyen theo thiet ke la vat V-Y hay vat canh quat.
- Dan lUu ndi eho va nhan vat trong vong 48 gid - Ddng da 1 thi ndi cho vat
- Theo ddi tinh trang tirdi mau cho vat, ehay mau vat, dUdi vat, xoan vat ngay sau mo. Tranh ti de tren vat trong 5-7 ngay dau sau mo.Theo ddi xa sau 3 thang, 6 thang tfnh chat vat; dp mem mai, seo quanh vat, loet tai phat.
2.2.3. Nghien cu'u li'ng dung vat da can tai cho cho oloet cung cut co du'dng kinh 6 loet < 6cm
- Thiet ke Ihay 2 vat chuyen^ kieu IC, vat xoay cudng vat nam d gan trung diem eiia dudng ndi tir mau chuyen Idn xUdng diii den u ngoi. vat chuyen kieu IC ed eudng vat quay xuong dudi,
- Dan lUu ndi cho va nhan vat - Ddng da 1 thi ndi eho vat
- Theo doi vat theo quy trinh gidng vat nhanh xuyen
* Cd sd danh gia ket qua:
Tinh trang song eua vat Su lien seo vet md
Kha nang phuc hoi chu'c nang va tham my eiia viing dUde tai tao.
* Kit qua gan:
• Tot: Vat song hoan toan, tinh chat vat tot, vet md lien seo tot, khong viem dd, cat chi sau 10- 14 ngay, khong can thiep phau thuat gi khac.
Chirc nang tham my vung m d tot, khong blen dang viing mdng.
• VCra: Vat thieu du'dng, xuat hien phdng niTdc tren be mat hoac hoai tu' 1 phan vat, cd hoac khong ghep da bo sung. Hoac vat bj hoai tii Idp da nhu'ng edn Idp can, liic nay vat cd dang can md, phai ghep da len Idp can vat, vet md nhiem khuan gay toac. Van ddng viing md cd cai thien nhUng Jthd khan.
- X a u : Vat bj hoai t i r tren 1/3 dien tfch den hoai tir toan bp, phai cat bd hoac thay the bang phUdng phap dieu trj khac. Chirc nang van dong viing md khong cai thien.
III. KET QUA NGHIEN CLTU 3.-1. Ket qua trj lieu h u t ap liTc a m
Bang J ; T i n h trang toan than va tai cho o loet Ngay
TriT chii'ng
Tru'dc hut Sau 7 ngay Sau 1 4 ngay
Sot CO hoac khong Khdng Khong
D a u ,
tijrc Khdng Khdng Khdng
D j u n g Khdng Djch tiet nhieu, cd the kem
theo dich mu, miii hdi
Khdng Khong
Dich tiet
Viem ne quanh d loet, cd the lan ra vung da lanh
xung quanh.
Djch tiet giam,
khdng cd dich mu Djch tiet rat ft
Viem ne Viem ne het Viem ne het, vet thUdng sacK tao dieu
kien cho TCH phat trien.
Khdng cd
Ton thUdng sach, ed to ehire
hat.
TCH d d , sach, day d loet phu kin bang TCH, nhieu trudng hdp TCH phat trien lap
day be mat 6 loet.
Ria d loet ed d§u hieu bieu md. 0 loet thu hep cd tfnh chat cd hpc, to chirc hat che
phii ed ban day o loet.
tiet giam nhieu, nhieu t r u i n g hdp da thay Thu hep
VT Thu hep rat it
Nhan xet: Sau trj lieu VAC 7 ngay o loet het viem ne, djch xuat hien to chu'c hat.
Y HOC VIET NAM THANG 5 - SO 1/2015
3.2. Ket qua dii^u trj che phu 6 loet cung cut bang vat nhanh xuyen:
gg/Tg 2 ; Hinh thu'c sir dung vat Hinh thu'c su* dung
Vat V- Y Vat canh quat (propeller)
Tong so
So lu'dng 6 25 31
Ty le (%) 19.35 80.65 100
Nhan xet: So lUdng vat chuyen theo kieu canh quat ehiem Uu the trong nghien cu'u, ti le tUdng iTng vdi nghien ciru eiia Tran Van Anh (2011)[ ]
Bang 3:T\S(Sv\g quan giffa sd lUdng nhanh xuyen va sd lupng vat sir dung So nhanh xuyen
So lu'dng vat 1<I le (%)
1nhanh 2 6.44
2 nhanh 14 45,16
3 nhanh 12 38.70
4nhanh 3 9.70 Nhan xet: Sd lUdng nhanh xuyen trong mdi cudng mach nudi vat du'dc quan sat va xae dinh bang may sieu am cam tay xuat hien vdi 2 nhanh vdi ti le cao nhat la 44,44%.
Bang 4: Bien chu'ng gan sau mo
~~B)aich(l'ng K l S u v a t ^ ^ Vat V- Y Vat canh quat
Ti le (%)
Chay mau vat
1 1/25
Chay mau nen vat
1 1 2/25
Xoan vat
1 1/25
Chen ep vat
1 1/25
Hoai tii mep vat
2 2/25
Hoai tiy
> vj vat Tyle 1/6
Nhan xet: ^mh trang chay mau tai vat, nen ton thUdng xuat hien thap va dUdc phat hien sdm tranh hoai tiy toan bp vat.
Bang5:Tm\\ trang vat sau mo
~ ^ ^ ^ ^ Ket qua V?t ^ ^ ^ ^ ^ _
Vat V-Y Vat canh quat
Tong so T'/le
Tot 6 18 27 87.09
Vira 0 4 4 12.01
Xau 0 0 0 0 Bang g/Theo doi tinh trang vat sau 6 thang
Vat V-Y Vat Canh quat
Tong sd
Lien seo tot Vat mem mai Loet tai phat
N/t0n xet: Sau 6 thang so tru'dng hdp theo doi dUde la 25 va qua danh gia ca 3 tieu chf tren deu dat ket qua tot. Tinh trang ndi cho vat: 100% 6\X<ic ddng kin 1 thi va lien ky dau.
3.3. Ket qua nghien cu'u vat da can tai cho co cuong ngau nhien ga/Tg/.'Hinh thire su'dung vat
Hinh thu'c su' dung Vat chuyen Dufourmentel Vat chuyen dang IC Vat xoay 1 ben Vat xoay 2 ben
TSng so
So lu'dng 4 21
4 1 30
Ty le (%) 13,33
70 13,33
3,34
100
Y HOC VIET NAM THANG 5 - SO 1/2015
Bang 3:J\icSnq quan glu'a kfeu vat Kieu vat
TB dien tfch ton khuyet (cm)
Vat kieu Dufourmentel
28,75
va trunq binh Vat kieu IC 41,10
<ich thudc ton khuyet Vat xoay 1 ben
32,75
Vat xoay 2 bSn 54 Bang P/Tinh trang vat (ket qua gan)
--JCetqua gan Kieu vat ^~~~""~~~~-~-_
Dufourmentel Vatic Vat xoay 1 ben Vat xoay 2 ben
Ti le (%)
Tot 4 20
3 1 93,33
vera 1 1 6,67
Xau Tong so
4 21
4 1 30 ffa/jff iO;Tinh tranq vat fket qua xc
^ ^ ^ ^ ^ < e t qua xa Kieu v?t ~ ^ ~ - ^ ^ _ _
Dufourmentel Vatic Vat xoay 1 ben Vat xoay 2 ben
Tonq so eo doi xa d&cic 16/30 tr&c
Tot 2/16 10/16
12/16 fng hdp do beni
)
vera 2/16 1/16 1/16 4/16 nhan bi iiet khong
Xau Ti le (%) 12,5
75 6,25 6,25 100 tai kham theo thi/mdiduVc, do be nhan d vung sau vung xa cua cac tinh mien trung, mien nui phia bac khong du dieu kien tai kham va den tan ndi de tai kham.
Benh an minh hoa 1:
Benh nhan Lai HUu D., nam, 23 tuoi, (ngay vao vien 28/3/2012, ngay xuat vien 10/5/2012, sd benh an 1190). Benh nhan bj tai nan giao thong, ehan thUdng sp nao each nhap vien 02 thang da 6\S<:iz dieu trj phau thuat sp nao, hau phau dieu trj bi loet ciing cut hdn 01 thang da dieu tri tai benh vien tinh Bac Ninh khdng dd nen chuyen dieu trj d Vien Bdng quoc gia. Vao Vien Bdng, tri giac theo thang diem Glassgow 10 diem; Id md, an qua sonde, dap irng Idi ndi, van ddng cham, dap li'ng dau tot. 6 loet viing ciing cut cd kich thUdc 6x9 em, ed nhieu djch hdi, hoai tir be mat, nhiSu ngdc ngach, chUa viem xUdng cung cut Tien hanh cat Ipe hoai tir, dat hut ap lUc am 7 ddt cho nen vat tot, to chirc hat dd, het phii ne d mep vat, djch tiet trong, lUdng ft khdng hdi, kfeh thUde khuyet hong thu hep edn 5x7 em Chung tdi tien hanh thiet vat cd cuong ngau nhien tai cho kieu IC che phii khuyet hong, Theo doi sau md on djnh, khdng cd bien chutig, vat da song tot. Sau 1 nam benh nhan di lai, sinh hoat binh thu'dng, seo lien tot, vat da mem mai.
khdng loet tai phat, khong bien dang viing mdng nhieu, seo gian rdng, tfnh tham my khdng cao.
y
Benh an minh hoa 2:
Benh nhan Oo Thanh L., sinh nam 1983, vao
vien ngay 19/08/2014 tai dOn vj Tao hinh -
Tham my- Benh vien Nhan Dan l i s - Tp Ho Chi
Minh, so vao vien 054991/14. Benh nhan bj ton
thu'dng tuy song co sau chan thu'dng gay lilt tiJ
Y HOC VIET NAM THANG 5 - SO 1/2015
chi; vao vien trong tinh trang 6 loet vung ciing cut lan rpng, hoai tir, djch tiet rat hdi, nhieu ngdc ngach. Tien hanh cat Ipe hoai tir, dat hiit ap lUc am 5 ddt, nen d loet sach, it djch tiet, chuyen vat nhanh xuyen ddng maeh mdng tren vdi ki'eh thudc 8x14 em, vat canh quat xoay 180°, che phu het d loet, xuat vien sau 15 ngay Theo doi sau 6 thang vat mem mai khdng loet tai phat
IV. BAN LUAN
Khuyet hong viing cung cut do loet ti de sau khi dUde cat Ipe va hut ap lUc am cd nen it phii ne, djch tiet ft, cd to chirc hat dd thuan Idi cho van de che phu bang eac vat da can tai eho[2][3][5]. Oanh gia ton thUdng khuyet hong viing cung cut d mu'c dp nang (dp III, IV) phii hdp cho chuyen vat che phii khi cd nen khdng con dau hieu viem nhiem, ngdc ngach, thi ki'ch thudc ciia chieu rpng ton khuyet rat du'dc quan tam. Do dien tfch cua vung da lanh con lai ciia vung mdng xung quanh ton khuyet cd du cho v^t tai cho cd cudng ngau nhien. Vi vay trong nghien ciru cua chung tdi khi sir dung vat tai cho cd cudng ngau nhien cho cac ton khuyet cd ki'eh thu'dc chieu rpng nhd hdn 6 cm phii hdp vdi thiet ke cho 1 vat xoay, vat chuyen, hay 2 vat xoay 2 ben mdng. Vat da can viing mong du'dc cap mau phong phu nlid cau true giai phau mach mau ciia cac nhanh xuyen ciia dong mach mdng tren, dudi. Cap mau cho vat dUa tren mang lu'di maeh mau dudi da, nudi can theo dang ngau nhien [4].Lien vet thUdng d bd mep cua vat cham, viem nhiem, dd djch mu trong qua trinh theo ddi sau md trong nghien ciru cua chung tdi do cac vat tai cho su* dung md lan can ton thUdng nen giuS 2 mep vet thu'dng deu bj viem nhiem se khd lanh hdn khi sir dung vat xoay so vdi vat chuyen kieu IC (chuyen md lanh each xa ton
khuyet den che phii ton thUdng)[3]. Sd lUdng nhanh xuyen cung cap eho vat nhanh xuyen ddng maeh mdng tren de che phii cho d loet cLing cut thudng la 2-3 nhanh trong nghien ciru ciia Vu Quang Vinh, Tran Van Anh (2011)[1].
Trong mot sd trUdng hdp chi dUa tren 1 nhanh xuyen eijng cho ket qua nudi song vat rat tdt.[l].
Vat niianh xuyen ddng maeh mdng tren thudng 6Mc cac tac gia nghien ciru thiet ke vdi kich thudc Idn 8x17 cm ciia Hurbungs, Ramkalawan (2012)[6], hay 12x13 em; Yuan- Sheng Tzeng va epng sU ( 2007), Hossam El- din Ali Ismail (2012) vdi vat nhanh xuyen ed ki'ch thudc trung binh 7x7 cm= den 15x13 cm^ cho 5 benh nhan loet ciing cut. Nam 2009 trong bao cao ciia tac gia Yunqin Xu sir dung vat da thuy cd kich thudc tir 12x16 em den 25x30 em de che phu d loet viing ciing cut. Tac gia HAI Heng- lin va epng sU (2013)[7] sir dung vat ed kich thudc trung binh 14x18,2 cm, Vu Quang Vinh, Tran Van Anh (2011) thiet ke va sir dung vat cd chieu dai Idn nhat la 18em va chieu rpng Idn nhat la 12em de che phii khuyet hong md mem viing ciing cut [l].*Trong nghien cu'u ciia chung tdi, vat cd kfeh thUde Idn nhat la 9x17 cm va chieu dai Idn nhat ciia vat la 18 cm va chieu rpng Idn nhat trong eac vat la 10 em. Ndi cho vat deu dUdc ddng 1 thi dBu va qua theo doi tren 6 thang khdng thay xuat hien seo loet hay di chu'ng ciia seo. Khi phau tfch tranh bpc Id rieng biet nhanh xuyen tranh hien tUdng co that mach hay xoan vat khi chuyen vat gay hoai tir vat [ i ] .
Theo ddi va cham sdc hau phau rat quan trpng ddi vdi vat nhanh xuyen ddng mach mdng tren.
Chay mau la blen chutig thudng gap va trong nghien ctili cua chung tdi xay ra 3 trUdng hdp nhUng nhd theo doi ky va xit ly kip thdi nen ft anh hudng den tu'di mau cho vat cua nhanh xuyen.
Trong nghien eiTu ciia chung tdi da sir dung 25 vat canh quat va 6 vat V-Y.Vat V- Y ed Uu diem de bdc tach va phau tich nhanh xuyen cijng nhu ddng ndi cho vat 1 thi dau. Tuy nhien, vat V- Y ddi hdi nhanh xuyen nudi vat phai each xa bd ton khuyet it nhat la 4-5 cm de cd dii dp dai cudng vat khi chuyen don day vat ve phia ton thudng khuyet hong va trong 1 sd trUdng hdp khdng dii dien tieh che phii can phai ket hdp dang vat Pacman ndi dau vat.
V. KET LUAN
Ton thUdng loet cung cut dp III,IV cd dac
diem lan rpng, nhieu ngdc ngach, nhieu dich tiet
hdi dUdc dieu tri ban dau bang hiit ap lUc am
Y HOC VIET NAM THANG 5 - SO 1/2015 tao nen d loet sach, to chu'c hat tot, chuan bi
cho tao hinh che phii tot bang vat da can tai cho cd eudng ngau nhien vdi dUdng kinh < 6cm va sir dung vat nhanh xuyen ddng mach mdng tren che phii cho 6 loet ed dUdng kinh > 6 cm eho ket qua tot. NhU vay quy trinh dieu trj d loet eiing cut dp I I I , IV dUpc thiet lap nhU tren se dem lai ket qua dieu trj tot cho benh nhan.
TAI LIEU T H A M KHAO
1. Tran Van Anh, Vu Quang Vinh va cgng sy"
(2011) "Nghien cuXi irng dung vat da nhanh xuyen dong mach mdng tren trong dieu tr| loet ciing cut do ti de". Tap chi Y hoc tham hoa va Bdng, 208-214.
2. Nguyen Tru'dng Giang (2012): "Oanh gia ket qua eh3m sdc, dieu trj vet thUdng bSng lieu phap
hilt Chan khdng"; Tap chi Y - Dupe hoc quan sif, 50 3-2012; Tr. 32-33.
3. Dinh Van Thuy (2009) "Loet ti de vung eCing cut" Tap chi Y hoc Tp HCM, phan 13, tr 194-200 4. Le Gia Vinh (1991), "Dac diem phan bo mach
mau cua cd va vat da". Hinh thai hoc ( i ) , tr.2-5 5. De Frazo AJ, Agenta LC, Marks MW, et al
(2001) 'The use of vacuum assisted closure therapy for the treatment of lovt^er extremity wounds with exposed bone". Plast Reconstr Surg;
108(5): 1184-1191.
6. Cilingir Meltem et al (2004) " The gluteal perforator- based flap in repair of pressure sores"
The British Asociation of Plastic surgeons 57, 342-347
7. Hai Hens-lin et al (2013) " Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects" Chinese Medical Journal ;126(9)
KET QUA PHAU THUAT XOAN TINH H O A N CAP 6" TR^ EM Bui Dire Hau*
T6IVI TAT
MMC tieu: Danh gia ket qua dieu tri phau thuat xoSn tinh hoan cap d tre em tai Benh vien Nhi Trung Udng. Ket qua: ty le bao ton tinh hoan trong dieu trj xoSn tinh hoan cap eao (73,8%) va 26,2% phai eat bd tinh hoan do xoSn. Thdi gian dieu tri trung binh 2,93
± 1,302 ngay, da sd nam vien 2-3 ngay (80,3%). Ty le bien ehiitig sau mo ft (3,2%). Theo doi sau md trung binh 3,43 ± 1,69 thang. Kham lai trong thdi gian theo ddi khong cd tn/dng hop nao dau biu. Teo tinh hoan bao ton gap d 4/33 tru'dng hdp (12,12%). Thdi gian den vien kham eang mudn thi kha nang teo tinh hoan bao ton sau phau thuat eang tang cao: den trude 6 gid khong cd trUdng hdp nao ed teo tinh hoan;
tir 7 - 24 gid: 23,5% giam kich thu'dc tinh hoan, sau 24 gid: 100% khdng bao ton dUpe tinh hoan. Ket lu^n: Thdi gian den kham quyet djnh kha nang bao ton tinh hoan. Ty le bao ton tinh hoan d nhdm den kham trUdc 6 gid cao nhat, Oen kham sdm, phlu thuat thao xo3n kip thdi t^ng kha nang bao ton tinh hoan va han che nguy ed viem teo tinh hoan sau thao xoan.
T^ khoa: xo3n tinh hoan cap, tre em, bao ton, teo tinh hoan, eSt bd tinh hoan
* Khoa Ngoai, Benh vien Nhi Tnjng Udng Chju trach nhiem ehinh: Biii Dire Hau Email: [email protected] Dt: 0913522604 Ngay nhan bai: 10/3/2015
Ngay phan bien: 23/3/2015 Ngay duyet b^i: 25/3/2015
S U M M A R Y
OUTCOME OF SURGERY FOR TESTICULAR T O R S I O N I N CHILDREN
Aim: analyze the outcome of surgery for testicular torsion in children at the National hospital of Pediatries. Results: The percentage of conservative surgery in testicular torsion was very high (73.8%), orehideetomy was done in only 26.2% of eases. The average length of treatment was 2,93 ± 1,302 days, the majority of eases had 2-3 days of hospital stay (80,3%). The complication rate was low (3,2%).
Average post-operative following-up time was 3,43 ± 1,69 months, with no recorded case of post-operative scrotal pain. Conservation of necrotic/atrophic testis was done in 4/33 cases (12.12%). The longer the delay in seeking eonsultatton, the higher the rate of testicular necrosis. No case of testicular necrosis was record in the early diagnosed group of patients (less than 6 hours). For those patients diagnosed within 7 to 24 hours, 23.5% had a creased in size testis.
Conservation of testis was not possible in 100% of patients that diagnosed later than 24 hours.
Conclusion: Time of diagnosis is a decisive factor for conservative surgery. Testis was conserved mostiy in patients came in not later than 6 hours. Early consultation and good timing of surgery will increase the chance of conserving testis and lower the incidence of testicular atrophy after detorslon.
Keywords: acute testicular torsion, conservation, testicular necrosis, orehideetomy
