Tap cM GAN MAT V I 6 T NAM so 30-2014 55
Danh gia k^t qua ph§u thuat l4y soi dng mat chu ndi soi dihu tri soi du'trag mat tai Benh vien Hihi nghi da khoa Nghe An
Nguyen Van Huang*. LeAnhXudn*. Nguyen Huy Todn*
Abstract:
Subiects: Evaluation the results of laparoscopic choiedochotomies to management principal bile duct stones together with endoscopic lithotripsy and lithotiipsy through tunnels Kehr.
Methods: Retrospective descriptive study combined a prospective of 113 patients of biliary stones or gallstones have accompanying operative laparoscopy remove the stones from January 2009 to December 2013 in Nghe an General Friendship Hospital.
Results: The total number of 113 patients with 38 male (33,6%), 75 women (66,4%);
mean age 48 ± 15,5 (15-87). 69,9% were open surgical taken stones of common bile duct and drainage Kehr; open surgical taken stones of
common bile duct and drainage Kehr accompa- nied cholecystectomy by 19,5%; Open common bile duct and sewing common bile duct 5,3%; rate to open surgery was 5,3%. Surgical time: 85 ± 3,7 minutes (50-150 minutes); Complications after surgery was 7,2% with 2 cases of postoperative bleeding, 1 case of bile leakage, 2 cases of residual abscess, 3 cases of wound mfection. Lithotiipsy through the Umnel Kehr is 53,1%, of which 24%
had lithotripsy or more 3 times and a maximum of 6 times with 1,8%).
Conclusions: Surgery laparoscopic with the open taken stones of common bile duct together with hthotripsy through tunnels Kehr achieve good results in the treatment of gallstone disease with rate stones clearance 92.7%, surgical comphcations and postoperative lower.
T6m t§t:
Mtfc tieu: Danh gid ket qua phau thuat md dng mat chu (OMC) npi soi trong dieu tri sdi dudng mat kem tan sdi qua dudng h i m Kehr.
Phuang phdp: Nghien ciiu hdi ciiu, ket hgp tign cihi 113 benh nhan dugc chin doan sdi dudng mat chinh bao gdm sdi dng mat chii, sdi dng gan chung, sdi dudng mat ti-ong gan, cd hay khdng sdi tui mat kem theo dupe phlu thuat ndi soi l i y sdi tai bgnh vien HNDK Nghe An tii 01/01/2010 ddn 31/12/2013
Kit qua: Tdng sd 113 BN vdi 38 nam (33,6%), 75 nu (66,4%); dp tudi tiimg binh 48
± 15,5 (15- 87) tudi. P h i u thuat md OMC liy sdi, dan luu Kehr vdi ty 1? 69,9%; M d OMC + Dan luu Kehr + c i t tiii mat 19,5%; Md OMC + khau kin OMC 5,3%; chuyen md m d 5,3%.
Thdi gian p h i u thuSt 85 ± 3,7 phiit (50 - 150 phiit). Biln chiing sau phau thuat la 7,2% vdi 2 BN chay mau sau mo miic dp nh?, 1 BN rd mat, 2 BN ap xe t^n du, 3 BN nhilm tning vk md.
Tan sdi qua dudng ham Kehr la 53,1%, trong dd 24%> phai tan sdi tu 3 lan trd len va 1,8% phai tan sdi 6 lan .
Kit luan: Phau thuat md dng mat chu npi soi lay sdi kem tan sdi qua dudng ham Kehr dat ket qua tdt trong dieu tri benh ly sdi mat vdi ti le sach sdi 92,7%, tai bien trong md va sau md thap
Tff k h o a : Phau thuat npi soi, sdi dng mat chu, sdi tui mat.
Keyword: Laparoscopic surgery, bile duct stones, gallbladder stones.
1. Bat van de
Sdi mat d ^^et Nam thudng la sdi s i c td m^t va sdi hon hpp lien quan den n h i l m ky sinh trung, nhiem trimg dudng mat, hep dudng mat.
Dieu tri sdi dudng mat dupe thuc hien tir nhiing nam dau cua t h i ky XX vdi nguyen t i c dugc Kehr dua ra la: m d bung, md dng mat chu lay sdi, dat dng dan luu Kehr, cat tiii mat neu cd sdi.
Tuy vay, sot sdi sau mo va sdi mat tai phdt cdn
* B?nh vi4n da khoa Ngh^ An
f Phdn bi?n khoa hqc: PGS, TS Pham Duy Hien
Tap chi GAN MAT VIET NAM so 30-2014 rit cao do nhieu ylu td nhu nhiem tning dudng mat tai dien, hep dudng mat, sdi trong gan va thiSu ap dung nhiing bien phap phat hien sdi trudc, trong va sau md. Dieu tri sot sdi va sdi mat tai phat la mot phiu thuat khd khan do viem dinh nhilu va bien ddi giai phau vung cudng gan.
Nam 1990, thi gidi bat dau ap dung phau thuSt ndi soi de dieu tri sdi dudng mat chinh.
Vdi su phat trien ciia thiet bi phau thuat ndi soi Jacobs, Frankhin va cac tac gia khac da chiing minh su an toan va hieu qua cua phau thuat n^i soi dieu tri sdi dng mat chu, mang lai nhieu ket qua to Idn nhu: hau phau nhe nhang, it dau sau md, nit ngan thdi gian nam vien, it viem dinh vung cudng gan... Tai Viet nam, nam 2000, phau thu^t npi soi lay sdi dng mat chu dat dng dan luu Kehr dugc tien hanh.
Tai B?nh Vien Huu Nghi Da khoa Nghe An, tir nam 2010 chung tdi da thuc hien phau thuat md dng mat chu lay sdi, dan luu Kehr ndi soi va tan sdi ngi soi qua dudng ham Kehr ap dung dieu tri benh nhan sdi dudng mat chinh dan thuan hoac ket hgp sdi trong gan.
Vi v$y, chung tdi tien hanh nghien ciiu dl tai nay: nhim muc dich: Danh gid tinh khd thi, an todn, hieu qud cua phau thuat noi soi dieu tri soi ong mat chu vd tdn soi noi soi qua duang ham Kehr
2, Bdi tuang vd phuang phdp nghiin ciiu 2.1. Doi tirgng nghien cihi
113 BN dugc chan doan sdi dudng mat chinh bao gdm sdi dng mat chu, sdi dng gan chung, sdi dudng mat trong gan, cd hay khdng sdi tiii mat kem theo dugc phau thuat ndi soi liy sdi kem theo tan sdi qua dudng him Kehr tai benh vien HNDK Nghe An tu 01/01/2010 din 31/12/2013.
2.2. Phirong phap nghien cmi:
* Thiet ke nghien cuu: Nghien ciiu md ta hdi cuu ket hgp tien ciiu.
* Cdc buac tien hanh nghien cuu - Nghien cuu cac diu hieu lam sang, can lam sang trudc phau thuat
- Nghien ciiu ky thuat phiu thuat ndi soi md dng mat chii lay sdi, dat dng din luu Kehr. trong dieu tri sdi OMC dan thuin hoac sdi OMC phoi hgp sdi dudng mat trong gan va/ hoac sdi tui mat; sdi OMC cd the kem theo sdi dudng miit trong gan d benh nhan da lay sdi qua npi soi ta trang that bai; sdi OMC cd the kem theo soi dudng mat trong gan d benh nhan nhilm khuin dudng mat hoac viem tuy cap da dugc dieu tri dn dinh; sdi OMC cd the kem theo sdi dudng mat trong gan d cac benh nhan cd cac benh phoi hgp nhung cd chi dinh md ndi soi.
Nghien cihi ky thuat npi soi tan sdi qua dudng ham Kehr. Sau md dat Kehr 6ng mat chu tir 3-5 tuan, dudng ham Kehr da dupe hinh thanh chac chan, sir dung dng sdi mem cd dudng kinh ngoai 5mm, dieu khiln dugc theo 4 hudng cong len, xudng, sang phai, trai dua qua dudng ham Kehr vao dng mat chu va dudng mat trong gan de lay sdi. Tren dng soi mem cd mdt kenh dung cu 2 mm cho phep dan nude va dua cac dung cu nhu day tan sdi, rp vao de lay sdi.
- Danh gia kit qua: phan loai kit qua theo 3 miic: tdt, trung binh va xiu.
+ Ket qua tdt: Benh nhan hoan to^n khoe manh, khdng cd trieu chiing gi; SiSu am gan mat: Khdng cd sdi dudng mat; Benh nhan dugc nit dng din luu him Kehr khi da chic chan khdng cdn sdi.
+ Kit quk trung binh: Sieu am hit sdi; C6 bien chiing sau md nhung dilu hi npi khoa khoi.
+ Ket qua xau: Cd bien chiing nang sau ml dieu tri ndi khoa khdng kit qua; ho|c sieu am con sdi dudng mat nhung khdng thi tilp can sdi de tan sdi hoac do cac biln chiing cua ky thuat.
* Thu thap vd xir ly so lieu: Theo chuang trmhSPSS 16.0.
3. Kit qud nghiin cuu
Tir 01/2010- 12/2013, 113 bpnh nhan sdi dudng mat chinh dugc chi dinh PTNS md dng mat chu lay sdi va tan sdi ndi soi qua dudng him Kehr, gom 38 nam (33,6%)), 75 nir (66,4%)); do tiidi trung bmh 48 ± 15,5 (15- 87) tudi.
Tap chi GAN MAT VIET NAM so 30-2014 Bang 1. Dac diem lam sdng, can Idm sdng
D^c diem lam sang, c^n Um sang Con dau quan gan
sat tten 38»C Da, cung mac mat vang Gan to
Tiii mgt to
Tien su co tam chiing Charcot TiSn sir phau thuat 6 bung Tri|u chirng c^in lam s^ng Bach ciu tang > 10 G/l Billirubin TP > 40 |imol/l SGOT>40U/1 SOFT > 40 U/l Ty le Prothrgmbin > 70%
Amylase > 200 U/l
BN 112 76 75 26 45 68 02
54 61 65 62 82 7
Ty 16 % 99,1 67,3 66,4 23 40,2 60,2 1,8
47,8 54 57,3 54,9 72,6 6,2
- Trieu chiing lam sang: can dau quan gan - Trieu chiing can lam sang: ty le SGOT, chilm ty IS cao nhit 99,1% SGPT tang lin luot la 57,3% va 54,9%
Bang 2, Chan doan truac mo vi tri soi dua vao sieu dm vd CT scanner duong mat.
V| tri soi Soi OMC don thu4n Soi OMC + Soi tui mat
Soi OMC +
Soi OMC + Soi tui mat +
Soi gan trai Soi gan phai Soi gan trai + phai Soi gan trai Sgi gan phai Soi gan trai + phai
BN 35 11 25 15 16 5 3 3
Tylf%
31 9,7 22,1 13,3 14,1 4,4 2,7 2,7 - Soi OMC don thuin 31%; soi OMC + Soi va soi OMC, soi trong gan kem soi tui mat tiii mat 9,7%, s6i OMC kem soi trong gan 49,5% chiSm 9,8%.
58 Tap clil GAN MAT VIET NAM s6'30-2014 Bang 3. Phucmg phdp phau thuat
PhttoTig phap
M o OMC + khau kin OMC Mo OMC + din lira Kehr M g OMC + D i n luu Kehr + cat hii mat
Chuyen mo mg
BN
6 79 22 6
Ty 1$ %
5,3 69,9 19,5 5,3
- Phiu thuat mo OMC liy sgi, din luu Kehr -Thgi gian phiu thuat: 85 ± 31.7 phiit (50 - vol tyl$ 69,9% 150 phiit)
Bang 4. Tai bien trong mo
Tai bi^n trong md Ton thuong ruot (ta trang, dai trang,...)
Ton thuong gan Ton thuong mach mau Ion Ton thuong tang do dat Trocart
BN 1 0 0 0
Tj-16 %
0,9 0 0 0 Co 1 trudng hgp hi tdn thuang rach thanh ca ta trang.
Bang 5. Nguyen nhan chuyen mo ma
Nguyen nhan
Dinh nhieu kho vao OMC Hep phin thip OMC Rach ta trang Chay mau
BN 5 0 0 I
TJ- If % 4,4
0 0 0,9 Ty 1? chuyen mo mo la 5 Bn (5,3%)
Tap chi GAN MAT VlfeT NAM s6' 30-2014 59 Bang 6. Bien chung sau phau thudt
Biin chihlg Chay mau sau tan soi ViSm phiic mac sau mo R6mat
Nhilm trung vet mo Ap xe ton du
BN 2 0 1 3 2
Ty If % 1,8
0 0,9 2,7 1,8 - Chay mau sau tan sdi 1,8%; nhilm trimg vet md 2,7%; Ap xe tdn du 1,8%.
Bang 7. So lan tdn soi qua du&ng ham Kehr
S6 lan tan soi Khong tan
l l i n 2 lan 3 lin 4 lin 5 lin 6 lan
BN 53 23 10 13 9 3 2
Tylf%
46,9 20,3 8,8 11,5
8 2,7 1,8
- Sau m6 3 tuan, nhiing BN con sot soi chii him Kehr. Co toi 24% b$nh nhan phai tan soi tir dgng; hoac sieu am, chvip Kehr phat hien cdn 3 lin trg len. S6 lin tan soi t6i da la 6 lin voi sdi, chiing toi se tiSn hanh tan soi qua duong 1,8%.
Tap chi GAN MAT VIET NAM so 30-2014 4. Ban ludn
Sdi dudng mat chinh la benh ly ngoai khoa ngay cang pho bien va can dudng can thiep ngoai khoa. Hien nay, dieu trj sdi dudng mat chinh vin cdn ban cai trong viec lira chgn phuang thiic tiep can va lay sdi, dac biet trong trudng hgp sdi dudng mat chinh ket hgp vdi sdi tiii mat hay sdi dudng mat trong gan. Chan doan sdi dudng mat thudng khdng khd khan vi hien nay cac phuang tien chan doan hd trg cd do nhay va dac hieu cao. Tat ca cac BN trong nghien ciiu deu dugc sieu am chan doan it nhat 2 lan va cd 32 BN dupe hd trg chan doan bdi MSCT
* Sdi mat cd the gap mgi liia tudi nhung nhieu nhat tap trung do tudi tu 40-70 [3], [7] nii thudng gap han nam. Vdi 113 BN sdi dudng mat chinh dugc chi dinh PTNS md dng mat chu lay sdi va tan sdi npi soi qua dudng him Kehr cua chiing tdi gdm 38 nam (33,6%), 75 nii (66,4%); dp tiidi trung bmh 48 ± 15,5 (15- 87) tudi. Nghien cuu ciia Ducmg Xuan Loc, tudi trung binh la 53,8 (thap nhat la 22, cao nhit la 84, Nam / Nil la 75,9%) [4].
* Lam sang va can lam sang: Da sd benh nhan den vi can dau quan gan, cd tam chiing Charcot va tinh trang nhiem tning, sinh hda mau bieu hien tinh trang nhiem trung va tic mat vdi bilirubin, men gan, bach ciu tang. BN chiing tdi vao vi?n vdi 99,1 % vi dau quan gan, 67,3 % sdt , 60,2 % vang da vdi cung mac mit vang, kit qua nay phii hop vdi nghien cim vdi cac tac gia [1]. [3], [4]. De chuin bi tdt cho cudc md, tit ca benh nhan cd bieu hien nhiem tning dudng mat, sdt, vang da deu dupe chung tdi dilu tin khang smh, vitamin Kl, nang cao thi trang.
* Chi dinh phau thuat: Chimg tdi chi dinh PTNS d giai doan diu cho sdi OMC don thuin;
khi thanh thao vl ky thuat chiing tdi tiiln khai den PTNS cho OMC kem theo cd sdi tiii mat;
sau dd trien khai PTNS den sdi OMC va sdi dng gan dugc chan doan va dinh vi bdi sieu am va MSCT. Ket qua nghien ciiu cho thiy: Soi OMC don thuan 31%; sdi OMC + Sdi tiii mat 9,7%;
sdi OMC k^m sdi trong gan 49,5%»; sdi OMC, sdi trong gan kem sdi tui mat 9,8%. Budc dau nghien ciiu chimg tdi ciing chua thuc hien c5c trudng hop sdi OMC chu tdi phat ho^c BN c6 vet md cG tren rdn; nghien ciiu cua chung tdi co 2 BN (1,8%) CO tiln sii phiu thuat d bung. Tuy nhien mdt sd tac gia khac th\rc hi|n cac nghiSn ciiu PTNS sdi dng mat chii tai phat, sdi dng mSt chu CO vet md cii tren rdn deu cho ket qua kh4 quan [1], [4], [5]. Cd 7 BN vao vi^n vdi bilu hien viem tuy cap do sdi OMC, chiing tdi da tiln hanh PTNS liy sdi OMC va cho kit qua tdt.
* Ve ky thuat: chiing tdi md dgc hoac ngang tuy theo dudng kinh OMC doan tren ta trang khoang 1cm. Giai doan dau chiing tdi md OMC bang dao lanh nhung ve sau chiing tdi md OMC bang dao ddt vdi nhiing OMC dan 1,5 cm. Sau do dung kim Mirizzi dl gap sdi qua Id trocar 5mm d thugng vi va sonde platic 8Fr dl siic rtta dudng mat sau dd dung ndi soi mem de tam soat sdi. Cd nhieu tac gia de xuat md dpc OMC [2]
nhung theo chiing tdi trong trudng hgp OMC dan it se gay hep dudng m^t khi khau, nen mo rieng Idp phiic mac trudc khi md OMC dl co thi quan sat ky khi khau lai OMC tranh rd mat sau md.
Theo Irfan Ahmed ti le biln chiing d benh nhan dat Kehr cao ban khau kin ngay thi diu.
Mat dich mat din din mit nude va di^n giai, hoai tir rd mat, viem loet da va viem dudng mat ngugc ddng do sieu vi di tni qua dng Kehr lam cho thdi gian nim vien va phyc hdi cua BN lau ban [6], [10]. Trong nghien cira n^y cd 5,3% BN chiing tdi khau kin OMC. Quylt dinh nay dugc chiing tdi nghien ciiu ky trudc khi thuc hien.
Cac tiirdng hgp dugc chirng tdi kh^u kin OMC:
trudc bet khdng cd nhilm tning dudng mat ( dich mat trong), sdi OMC dan thuin, chic chin khdng cd sdi trong gan (dua tren sieu am kit hgp vdi MSCT), ca Oddi thdng tdt.
* Tai bien trong md va nguyen nhan chuyen md hd: Trong nghien cihi ciia chiing tdi cd 6 BN (5,3%) phai chuyin md hd trong dd 5 BN (4,4%)) dmh qua nhilu vung rdn gan khdng thi
Tap chi GAN MAT VIET NAM so 30-2014 61 phiu tich bdc Id OMC va 1 trudng hop td
thuong dgng mach gan chung do bat thudng giai phiu phai chuyin md md. Theo Qi Wei: ty le chuyin md hd la 3,8% trong 52 trudng hgp;
Nguyen Hoang Bic gap 2/172 trudng hgp chuyen md hd [1]; Duong Xuan Loc gap ty le chuyin md hd: 18/146 (12,33%).
* Thdi gian phau thuat trung binh: 85±31,7 phiit (50 - 150 phiit); Trong thdi gian diu triln khai ky thuat, thdi gian cd thi keo dai len din 150 phut, sau nay thdi gian rut ngan dilu nay phu hgp n h ^ dinh ciia cac tac gia khac. Duong Xuan Lpc,thdi gian phau thuat trung binh: 130 phut(90-230)[4]; Thdi gian nay tuong t\r vdi nghiSn cim cua nhieu tac gia [5], [10].
* Bien chiing sau md chung toan bp trong nghien cim la 7,2%) (8/113 BN). Cac biln chimg ndy chiing tdi tien hanh dieu tri ndi khoa BN dn dinh. Trong dd 2 BN bien chiing chay mau sau md d miic do nhe, chiing tdi da dilu tri ngi khoa bang Transaminase cd ket qua, khdng phai truyen mau, khdng phai phau thuat lai, 1 trudng hgp rd m$t sau md, dieu tri bang phuong phap dat dan luu hiit lien ti^c, khang sinh, nudi dudng.
BN dn dinh, ra vien sau 2 tuan. Cd 3 BN nhiem triing vet md, dieu tii khang sinh, tach mep vet md nhiem tning, thay bang vet md hang ngay.
Sau 5-7 ng^y, td chiic hat mep vet md len dep, khau lai vet md. Cd 2 BN ap xe tdn du sau md dupe chiing tdi dieu tri khang sinh, nang cao the trang, chpc hiit d ap xe dudi hudng dan cua sieu am dat ket qua tdt. Duong Xuan Lpc gap bien chihig sdm sau md 15/128 (11,72%) [4]. Theo ket qua ciia mgt sd tac gia tren the gidi ty 18 nay tij7%-17%[6], [7], [9].
Thdi gian hau phau cho lan PTNS trung binh la 7 ± 1,8 ngay, ngan nhat la 4 ngay, dai nhat la 15 ngay; chi cd 6 trudng hpp liy sdi OMC va khau kin OMC. Nguyin Hoang Bic nhdm PTNS liy sdi OMC va khau kin OMC la 4 ngay, nhdm PTNS liy sdi OMC va din luu Kehr la 9 ngay [1]. Duong Xuan Lpc, thdi gian nam vien tnmg binh 7,6 ngay (5-17) [4].
* Ddi vdi nhimg BN cd sdi trong gan phdi hgp, tan sdi qua dudng ham Kehr da dupe cac
tac gia thuc hien rat hieu qua do dd mdt sd tac gia chap nhan sdt sdi chii dpng de md rgng chi dinh PTNS ddi vdi sdi OMC ket hgp vdi sdi trong gan [1] ,[5]. Ddi vdi nhiing BN cd sdi trong gan phdi hpp, md md cung khdng chac chan lay bet sdi, sau do BN ciing phai trai qua tan sdi nhung lai cd nguy ca ciia nhiing bien chiing cua md rad nhu thoat vi vSt md, tac rudt, vdn de tham my... va dac biSt nSu phai md lan 2 vi nguyen nhan benh ly gi do thi chimg ta ciing gap nhieu khd khan so vdi md npi soi lan dau.
Trong nghien ciiu nay, nhirng BN cdn sdt sdi chu dpng hoac sieu am, chup Kehr cdn sdi se dugc tien hanh tdn sdi qua dudng hdm Kehr. Sd BN phai tan sdi sau md chiem ty 16 cao 60 BN (53,1 %) va cd tdi 24 % BN phai tan sdi tii 3 lin trd len, sd lan tan sdi tdi da la 6 lan/ 1 BN la 1,8
%i. Cd 5/60 trudng hgp cdn sdt sdi sau tan sdi chiem 8,3%. Nguyen nhan chu yeu do hep dudng mat nen khdng the dua dng soi vao dugc.
Duong Xuan Ldc, ty le sach sdi la 116/128 BN ( 90,63%) [4]. Trong sd 53 (46,9%) BN khdng tan sdi, cd 4 benh nhan cdn cd sdi dudng mat ti^ong gan nhung bi tut dng din luu Kehr. Cd 1 trudng hpp dng soi mem bi lac dudng dng din luu Kehr dupe phat hien thay dng ndi soi dua qua dudng ham Kehr vao d bung, chiing tdi ngung thu thuat tan sdi, BN dugc dieu tri ndi khoa dn dinh sau dd.
5. Kit lu^n
Phau thuat md dng mat chu ndi soi lay sdi kem tan sdi qua dudng ham Kehr dat ket qua tdt trong dieu tri benh ly sdi mat vdi ti le sach sdi 92,7%, tai bien trong md va sau md la 7,2%, khdng cd tir vong; Thdi gian hau phau trung binh la 7± 1,8 ngay.
Tai lieu tham khao
1. Nguyin Hoang Bic (2007), '"Chi dinh cua phau thudt noi soi trong dieu tri soi duang mat chinh", luan an Tien sT y hgc, Dai hgc Y Dugc TP. Hd Chi Minh.
2. Nguyin Nggc Bich va CS (2012): " Danh gid ket qud Idy soi duang mat qua phau thudt
62 Tap chi GAN MAT VIET NAM s^ 30-2014
npi soi 6 bring" . Tap chi Ngoai Khoa sd 61, ti-.lll-118
3. Trin Trung Hilu, Do Minh Hung, Nguyin Cao Cuong va CS(2010) "phau thudt ngi soi dieu tri soi dng mgt chu", tap chi Y hpc TP HCM tap 14(1), tr374-380.
4. Duong xuan ldc, Pham Nhu Hiep, Le Lgc (2013), "Ma ong mat chu lay soi noi soi: Chi dinh vd kit qud dieu tri" Bao cao hdi nghi phiu thu^t ngi soi va Ngoai khoa Viet Nam, Can Tha nam 2013.
5. Phan Huu Thanh, Pham Nhu Hiep, Le Ldc (2007) "Phau thudt noi soi soi duang mat chinh" tap chi khoa hgc tiSu hda tap II, sd 8 - 2007, ti-ang 475.
6. Waage A, Stromberg. C, "Long-term re- sults from laparoscopic common bile duct ej:- /j/ora/ion ".Surg Endosc (2003) 17: 1181-1185
7. CN Tang, (2006/ "Laparoscopic explo-
ration of the common bile duct: 10-year experi- ence ofl 74 patients from a single centre" .\{QV%
Kong Med J;12:191-19
8. Irfan Ahmed. , Charita Pradban (2008). "
Is a T~ tube necessary after common bile duct exploration". World J Surg, 32, ppl485 - 1488.
9. Jacob M, Vazquez, Frias J.A, and Garcia J.C (2003), "Endoscopic common bile duct ex- ploration", Laparoscopic surgery, 3, pp. 203 - 209.
10. J. Ch. Berthou, (2007) "Evaluation of la- paroscopic treatment of common bile duct stones in a prospective series of 505 patients:
indications and results"S\iig Endosc 21: 1970- 1974
11. Thompson M.H and Tranter S.E (2002),
"All comers policy for laparoscopic exploration of common bile duct", British Joumal of sur- gery, 89, pp. 1608-1612.
