CHUYEN OE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
9.
Renin Angiotensin Aldosterone Syst, 2004, 5(3), pp. 102-108.
McNulty M et al, "Collagen type-I degradation is related to arterial stiffness in hypertensive and normotensive subjects", J
Hum Hypertens, 2006 doi:10.1038/sjjhh.1002015.
Nurnberger J, Dammer S, Opazo Saez A, Philipp T, Schafers RF. Diastolic blood pressure is an important determinant of
augmentation index and pulse wave velocity I in young, healthy males. J Hum Hypertens 2003; 17: 153-158.
10. Ngim CA, Abdul Rahman AR, Ibrahim A.
Pulse wave velocity as an index of arterial stiffness: a comparison between newly diagnosed (untreated) hypertensive and normotensive middle-aged Malay men and its relationship with fasting insulin. Acta , Cardiol \999; 54: m-282.
OANH GIA KET QUA OIEU TR| CHUNG TANG TIET MO HOI TAY BANG PHAU THUAT NOI SOI CAT HACH GIAO CAM NGUC
Dang Nguyen Kha*, Biii Dure Phu*
TOM TAT
MUC DICH: Tang tiet mo hoi tay la mpt chu'ng khd chju thu'dng gap, nhat la d nhiing ngu'di tre tudi. Cd nhieu phu'dng phap dieu trj chu'ng tang tiet mo hoi tay ca npi khoa cung nhu' ngoai khoa. Tuy nhien, nhii'ng phu'dng phap nay hoac cho ket qua that thu'dng hoac kha nang ne CO nhieu bien chu'ng. Vdi su" phat trien cua phau thuat npi soi, phau thuat cat hach giao cam ngi/c qua npi soi de dieu trj chiing tang tiet mo hdi tay du'pe thu'c hien hau het d cac nu'dc tren the gidi va tai cac benh vien phau thuat long ngiTc tim mach d nu'dc ta.
OOI TLfpfNG: Gom 62 benh nhan du'pe chan doan mac chiing tang tiet mo hoi tay, cd chi dmh phau thuat, dieu trj tai benh vien Trung u'Png Hue va benh vien tru'dng Dai hpc Y Ddpc Hue tiT thang 1-2006 den thang 5-2008
KET QUA: Trong so 62 benh nhan du'pe phau thuat gom 31 nam va 31 nii, tudi t i i 15 den 43 tudi, trung binh la 23,65 ± 6,33 tudi. Benh gap chu yeu d hpc sinh - sinh vien chiem ty le
66,1%. Da so benh nhan mac chu'ng mo hoi tay tir nhd 83,9%. Vijng tang tiet mo hoi cao nhat ia hai ban tay + hai ban chan, chiem ty le 53,2%.
Phan Idn, benh nhan mac chu'ng tang tiet mo tay miic dp 3 va miic dp 4 (theo KRASNA), chiem ty le lan lu-pt la 61,3% va 32,3%. Bien chu'ng sdm sau phau thuat chu yeu la tran khi du'di da 14,5%, tran djch mang phoi 6,5% va tran khf mang phdi 6,5%. Khong cd bien chu'ng nang sau mo. Ket qua tdt sau md chiem ty le cao nhat 85,5% va khdng cd ket qua xau. Thdi gian hau phau trung binh la 3,7 ± 1,1 ngay, nhanh nhat la 2 ngay, lau nhat la 7 ngay nhanh hdn rat nhieu so vdi md ngi/c thong thu'dng. Sau phau thuat, tinh trang tang tiet mo hdi tay cai thien tdt 6 miic dp 1 (khd hoan toan) hoac miic dp 2 (cai thien ro) lan lu-pt la 64,3% va 28,6% (d thdi diem theo doi tren 6 thang).
KET LUAN: Phau thuat cat hach giao cam ngiTc qua npi soi dieu tri chu'ng tang tiet mo hol tay la phu'dng phap dieu trj cd tfnh hieu qua, an toan va mang tfnh tham my cao.
SUMMARY
EVALUATE RESULTS VIDEO-ASSISTED THORACIC SURGERY FOR PALMAR
HYPERHIDROSIS
Background: Hyperhldrosis is frequently present in younger patient, making a lot of problem in life.
Various The existing non-operative therapeutic options or the traditional open surgical techniques seldom give sufficient relief or have many mortality or life- threatening complications. Today, with the development of endoscopy, video-assisted thoracoscopic surgery for palmar hyperhldrosis is now widely accepted as the approach of choice In VietNam and the World
Objective: Evaluate results video-assisted thoracic surgery for palmar hyperhldrosis from Jan 2006 to May 2008 at Hue central hospital and Hue medical university hospital
Methods: Prospective, described study
Results: From Jan 2006 to May 2008, a total of 62 patients with hyperhldrosis palmaris underwent video-assisted thoracoscopic surgery. There were 31 males and 31 females with a mean age of 23,65 ± 6,33 years old. The most of patient is adolescents in high schools and colleges 66,1%. The prevalence palmar hyperhldrosis is highest among teenage and young adults 83,9%. In our study, the hands sweat in combination with the feet mainly 53,2%. Most cases involve as degree 3 and 4 of KRASNA (61,3% and 32,3%). Surgical complications were minimal: 4 cases of pneumothorax (6,5%), 4 cases of hemothorax (6,5%). The good result after operation is 85,5%, There was no severe accidents or complications after procedure. The duration of postoperative traetment is 3,7 ± 1,1 days (much shorter than standard thoracotomy). After procedure, situation of palmar hyperhldrosis is better improvement at degree 1 or 2 of KRASNA
Conclusions: video-assisted thoracic surgery is an effident, safe, cometic and minimally invasive surgical method for the treatment of palmar hyperhldrosis
I. DAT VAN OE:
Tang tiet md hdi tay la mdt chiing thudng gap, nhat la d nhiing ngudi tre tudi.
Chiing nay tuy khdng gay nguy hilm chdt ngudi nhung nd mang lai cho ngudi benh rSt nhieu khd chiu va phien toai trong cudc sdng [5], [12], [8], [9].
Ve nguyen nhan cd hai loai chiing tang tiet md hdi. Tang tiet md hdi nguyen phat thuang xay ra bit ki thdi dilm nao cua ddi sdng, thudng do cudng giao cam gay ra.
Tang tiet md hdi thu phat xuSt hien theo sau mpt loai benh, thudng gap nhSt la benh tilu dudng, cudng giap, lao phdi hay cac benh rdi loan ve npi tiet v.v... [5].
Theo Lin Chih Lung, tang tilt md hdi tay nguyen phat gap thudng xuyen a cac nudc chau A. d Dai Loan, ty le ngudi tre mic chung benh nay vao khoang 0,3%. Trong dd, mac benh do cd tien sti ve gia dinh chiem khoang 12,5 %. Theo tac gia Andar, tai Israel ty le ngudi mac chiing benh nay trong gidi tre tir 1-2 ngudi tren 1.000 dan [5]. Cdn a Viet Nam, theo Tran Ngpc Luang [2], ty le ngudi mac chung tang tiet md hdi chiem khoang 1% dan sd, trong do chiing tang tiet md hdi tay la hay gap nhat.
Viec chan doan chiing tang tiet md hdi tay khdng khd vi day la trieu chiing gay phien ha cho benh nhan. Tuy nhien, d nhiing ngudi bi tang tiet md hdi tay thii phat de tim ra nguyen nhan can phai thuc hien nhiing xet nghiem chuyen biet [1].
Cd nhilu phucmg phap dieu tri chiing tang tiet md hdi tay ca npi khoa (nhu dCing cac thudc iic che kenh calci, thudc iic che p giao cam, thuoc khang tilt md hdi tai cho...), ciing nhu ngoai khoa (cat hach than kinh giao cam nguc bang md nguc nhd hai ben, huy than kinh giao cam nguc bang tiem huyet thanh ndng...). Tuy nhien, nhiing phuang
CHUYEN OE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
phap nay hoac cho kit qua thdt thudng hoac • kha nang nl cd nhilu bien chiing [5].
Vai su phat trien cua phau thuat npi soi, phSu thuat cat hach giao cam nguc qua npi soi dl dilu tri chiing tang tiet md hdi tay dupc thuc hien hdu hit d cac nudc tren the gidi va tai cac benh vien phau thuat long nguc tim mach d nudc ta. ^^
Nghien ciiu nay nham muc dich nghien ciiu mpt sd dac diem lam sang, can lam sang chiing tang tiet md hdi tay va danh gia ket qua dilu tri chiing tang tiet md hdi tay bang phau thuat cdt hach giao cam nguc npi soi da ap dung tai Benh vien Trung uang Hul va Benh vien Trudng Dai hpc Y Dupc Hul tir thang 1-2006 din thang 5-2008.
I I I . KET QUA NGHIEN CUtJ:
1. Dac diem chung:
I I . DOI Tl/QNG VA PHl/QNG PHAP NGHIEN cCrU:
1. Doi tirong nghien ciru: Gdm 62 benh nhan dupc chan doan mac chiing tang tilt m6 hdi tay, cd chi dinh phau thuat, dieu tri tai benh vien Trung uang Hue va benh vi?n trudng Dai hpc Y Dupc Hul tii thang 1-2006 din thang 5-2008.
2. Phirong phap nghien cmi: Tiln ciiu, md ta. Ghi nhan dac diem benh ly, danh gia ket qua phau thuat, ghi nhan diln biln sau md, luc benh nhan ra vien va cac dpt tdi kham 1 thang, 3 thang va tren 6 thang
Bang 1: Dac diem chung
Tudi trung binh Gidi tinh Nqhe nqhiep
23,65 + 6,33 (15 tu6i-43 tudi) Nam 31(50%), nu- 31(50%)
Hoc sinh, sinh vien chiem ty le cao nhat 66,1%
2. Dac diem Iam sang:
Bang 2: Thdi gian phat hien benh Thdi gian bj benh
Bi tu" nhd Mdi mac
Tong
So benh nhan 52 10 62
Ty le (o/o) 83,9 16,1 100
Phan Ion benh nhan mac chiing tang tilt md hdi tay tii khi cdn nhd chilm ty le 83,9%.
Bang 3: Vung tang tilt md hdi Vung tang tiet
Hai ban tay Hai tay + hai chan Hai tay + hai nach Tay + chan + nach
So benh nhan 24 33 0 5
Ty 1? (o/o) 38,7 53,2 0 8,1
Vving tang tilt md hdi chilm ty le cao nhdt la hai ban tay + hai ban chan, chilm ty le 53,2%. Tilp theo la vung hai ban tay dom thudn 38,7%.
Bang 4: Dp dm udt va chdt lupng cupc sdng
Mure do
Miic dp 1 Miic dp 2 Miic do 3 Miic dp 4 Tong
Do am u'dt So benh nhan
0 4 38 20 62
Ty le ( % ) 0 6,5 61,3 32,3 100
Chat lu'dng cudc song So benh nhan
0 19 35 8 62
Ty le (o/o) 0 30,6 56,5 12,9 100
Nhdm bpnh nhan mac chiing tang tiet mo tay miic dp 3 va miic dp 4 chiem ty le cao nhat lan lugrt la 61,3% va 32,3%.
Ddi vdi chdt luprng cupc sdng, nhdm miic dp 2 va miic dp 3 chilm ty le cao nhdt ldn lupt Id 30,6% va 56,5%.
Sir khac biet vl ty le giiia cac miic dp ciia dp dm udt va chdt luprng cupc sdng benh nhan mSc chiing tSng tiet mo hoi tay cd y nghia thdng ke (p < 0,05).
3. D^c diim phau thuat:
Bang 5: Tu the phiu thuat Tu-the
Tu" the nam sap Tu" the nam nghieng
Tong
So benh nhan 17 45 62
Ty le (o/o) 27,4 72,6 100
Nhdm bpnh nhan thuc hien phau thuat d tu the nam nghieng chiem ty If cao nhat 72,6%
Bang 6: Ky thuat pha huy hach giao cam Ky thuat dot
Cat chuoi hach Dot chuoi hach
Tong
So benh nhan 45 17 62
Tyle(o/o) 72,6 27,4 100
Ty lp phau thuat cdt chudi hach chilm ty le cao nhdt 72,6%, tilp theo la phau thuat ddt chuoi hach 27,4%.
CHUYEN OE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
Bang 7: Vi tri ddt hay cdt chudi hach giao cam
Vj tri hach xii tri T2
T 2 - T 3 T2 - T3 - T4
Tong
So benh nhan 0 45 17 62
Ty le (o/o) 0 72,6 27,4 100
Ty le phiu thuat ddt (hay cat) d vi tri hach T2 - T3 chiem ty le cao nhat 72,6%.
4. Danh gia ket qua som sau phau thuat:
Bang 8: ket qua sdm sau phau thuat
Bien chu'ng sdm trong va ngay sau phau thuat
Tran khi mang phdi Tran mau mang phdi
Xep phdi Suy ho hap Tran khf du'di da Nhilm trung vet md
Tong
So benh nhan 4 4 1 0 9 0 18
Ty le (O/o) 6,5 6,5 1,6 0 14,5
0 29
Trong cac bien chiing ngay sau md, tran khi dudi da chiem ty le cao nhdt 14,5%», tiep theo la tran khi va tran mau mang phdi 6,5%.
Bang 9: Dat dan luu nguc sau md
Dat dan luTu ngu'e sau mo Ben phai
Ben trai Ca hai ben
Tong
So benh nhan 1 1 2 4
Ty le (O/o) 1,6 1,6 3,2 6,5
Cd hai benh nhan phai dat dan luu nguc hai ben, chilm ty le cao nhdt 3,2%.
Bang 10: Danh gia ket qua sau md
Ket qua sau mo Tdt Trung binh
Xau Tong
So benh nhan 53
9 0 62
Ty le (o/o) 85,5 14,5 0 100
Ket qua tdt sau md chiem ty le cao nhat 85,5% va khdng cd ket qua xau.
Sd ngay nam vien sau md trung binh 3,7 ± 1,1 ngay, nhanh nhat la 2 ngay, lau nhdt la 7 ngay.
Bang 11: Bien chiing sdm sau phau thuat
^"•^^....^^ Tholi gian theo doi (thang)
Bien chu'ng ^~~"^-^^^
Oau giao cam Kho tay
Hpi chu'ng Claude Bernard-Horner Chu'ng tang tiet mo hoi miji vj
Tai phat
1 (N=62)
n 1 1 0 0 0
o/o 1,6 1,6 0 0 0
3 (N=44)
n 1 0 0 0 0
o/o 2,3 0 0 0 0
6 (N=28)
n 0 0 0 0 0
o/o 0 0 0 0 0
> 6 (N=28)
n 0 0 0 0 2
o/o 0 0 0 0 7,1
Bang 12: Miic dp tang tiet md hdi sau phau thuat
\v..^ Thdi gian (thang)
Mii'c do ^ ^ ^ ^ D p i
Do 2 06 3 06 4
1 (N=62) n 47 15 0 0
o/o 75,8 24,2 0 0
3 (N=44) n 27 17 0 0
o/o 61,4 38,6 0 0
6 (N=28) n 18 10 0 0
o/o 64,3 35,7 0 0
> 6 (N=28) n 18
8 0 2
o/o 64,3 28,6 0 7,1 Miic dp 1 (khd hoan toan) chiem ty le cao nhat d cac mdc tai kham theo thdi gian: 75,8%) 6 thang thii nhdt, 61,4% d thang thii 3, 64,3% d thang thu 6 va sau 6 thang.
CHUYEN OE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
Miic dp 2 chilm ty le cao thii hai lan lupt la 24,5%, 38,6%, 35,7%, 28,6% theo cac m6c thdi gian tai kham.
Bang 13 Miic dp hai long cua benh nhan sau phiu thuat
^"^^^^ Thdi gian (thang)
Mufc do ^ ^ ^ ^ ^
Reft hai long Hai long Chap nhan du'pe
Khong hai long
1 (N=62) n 12 45 3 2
o/o 19,4 72,6 4,8 3,2
3 (N=44) n 3 35
4 2
o/o 6,8 79,5
9,1 4,5
6 (N=28) n 3 21
2 2
o/o 10,7
75 7,1 7,1
> 6 (N=28) n 3 21
2 2
o/o 10,7
75 7,1 7,1
Miic dp hai long chiem ty le cao nhat d cac mdc thdi gian tai kham, lan lupt la 72,6% d thang 1, 79,5% d thang thii 3, va 75% d thang thii 6 va tren 6 thang.
Bang 14: Danh gia chiing tang tiet bd sau phiu thuat
^ \ W t r i Mii'c do ^ \ ^ ^
it Trung binh
Nhieu
Mat n 1 2 1
% 1,6 3,2 1,6
Than minh n
12 28 17
% 19,4 45,2 27,4
Nach n 4 9 2
% 6,5 14,5
3,2
Chi du'di n
2 13
5
% 3,2 21 8,1
Vi tri tang tiet bu chiem ty le cao nhat la than minh: miic dp it 19,4%, miic dp trung binh 45,2% va muc dp nhilu 27,4%.
IV. BAN LUAN:
- Theo Nguyen Van Nam va cdng su [6], chiing tang tiet md hdi tay nguyen phat thudng xuat hien d liia tudi nhd, nhung yeu cau biic thiet can dieu tri triet de lai la d liia tudi thanh thieu nien. Day chinh la liia tudi bat dau su dung ddi ban tay de lao dpng, hpc tap va giao tiep. Ngoai ra, theo Haider Aamir, Nowell Solish, chiing tang tilt md hdi nguyen phat thudng giam di ddi vdi liia tudi tren 50. Nhiing ly do tren gdp phdn ly giai vi sao tudi trung binh ciia nhirng benh nhan mdc
chiing tang tilt md hdi tay din phau thu$t Id Ilia tuoi thanh thieu nien.Tuang tu nhu tuoi, nhu cdu phiu thuat chiing tang tilt mo hoi tay cung phu thupc vao nghe nghiep. Nghe nghiep nao can su dung nhieu den doi bdn tay thi nhu cau can dilu tri cang ldn do nhOng philn phiic va can trd trong cdng vi?c ma chiing tang tiet md hoi tay mang lai. Dieu do ly giai vi sao hpc sinh - sinh vien la doi tuprng tim den phiu thuat nhieu nhdt do hp c6 nhu cdu Sli dung thudmg xuyen ddi ban tay de hpc tap va giao tilp
- Trong nghien cuu nay cd 38,7% benh nhan mac chung tang tilt md hdi tay dan thuan, sd benh nhan cdn lai diu kem theo tang tiet md hdi d cac nai khac, nhat la hai tay ket hop vdi hai chan chilm 53,2%, tay Icit hpp chan va nach chilm 8,1%. Ket qua nghien cuu cua Nguyen Van Nam va cdng su [7] dua ra ty le 6,3% benh nhan mac chumg tang tiet md hdi d tay dem thuan, 72,9% tang tilt mo hdi tay ket hpp vdi tang tiet md hdi chan, 2,1% tang tiet md hdi tay ket hop vdi tang tiet md hdi nach va tang tiet md hdi toan than chiem 18,8%. Trong nghien ciiu ciia Yuan-Rong Tu va cdng su, chiing tang tiet mo hoi d tay dan thuan chiem 30,1%, tang tilt md hdi tay ket hprp vdi tang tiet md hdi chan 42,1%, tang tiet md hdi tay ket hop vdi tang tiet md hdi chan va nach la 7,65%, tang tilt md hdi tay ket hap nach la 15,65%, va tdng tiet md hdi a cac vj tri khac chiem 4,42%. Theo tac gia, ddi vdi chiing tang tiet mo hdi, viing tang tiet md hdi chu yeu la d tay, chan va nach vi mat dp cac tuyen md hdi a cac vdng nay cao han cac vung khac.
Ngoai ra, trung tam kiem soat tiet md hdi d viing dudi ddi cua cac viing nay khac biet hoan toan so vdi trung tam kiem soat tiet md hoi d vung dudi ddi cua cac vung ca the cdn lai, do la kha nang dap ung vdi cac kich thich cam xiic nhu lo lang, xau hd, so hai nhung lai khdng dap iing vdi cac kich thich nhiet. Trong khi do, dieu quan trpng la cac kich thich cam xuc lai ddng vai trd chinh ddi vdi chiing tang tiet md hdi tay nguyen phat.Nhirng kit qua nghien ciiu tren cho thay chiing tang tilt md hdi tay nguyen phat thudng it khi xay ra dan thuan, ma thudng kit hpp vdi tang tilt md hdi d cac vung khac, c\i thi vung ban chan va nach la hay gap nhdt.
Ly do chinh khien benh nhan den benh vien de phau thuat theo ket qua nghien ciiu cua tdi cung nhu cua cac tac gia khac la miic dp tang tiet md hdi tay nhieu hoac rat nhieu.
Ban ve chat luong cupc sdng cua benh nhan ta thay: tru'dc phau thuat, tat ca cac benh nhan deu bi anh hudng xau ve mat tam ly, khd khan trong giao tiep.... tuy theo tung muc dp khac nhau. Mac du vay, ta thay cd su khac biet ve ty le gida miic dp am udt va chat lupng cupc sdng cua benh nhan trude md trong nghien ciiu cua tdi va cua cac tac gia khac. Nguyen nhan cua su khac biet nay la do viec xac dinh cac miic dp anh hudng cua chiing tang tiet md hdi ddi vdi hoat dpng sdng tiiy thudc vao su danh gia chu quan cua timg benh nhan ma khdng phu thudc vao miic dp ra md hdi tay nhieu hay it.
- Ve phuang dien phau thuat, theo nghien ciiu cua cac tac gia Manuel Doblas va cdng sir. Van Tan va Hd Nam, Nguyen Van Nam va cdng su [10], [7], [6], nhirng uu diem ma phuang phap phau thuat theo tu the nam nghieng dem lai la: khoang lien sudn gian rpng thuan lpi cho viec dua dung cu phiu thuat vao thao tac, hudng phau thuat true tiep den than kinh giao cam, cac dung cu cd gdc ca dpng ldn thuan lpi cho viec phiu thuat. Tuy nhien, phuang phap nay ciing cd mpt sd nhupc diem la phai thay ddi tu the, chuan bi lai do vai, thdi gian md keo dai do mdt nhilu thdi gian de chuan bi lai benh nhan. Trong khi dd, phuang phap phiu thuat theo tu the nam sap khac phuc dupc nhiing nhupc diem cua phuang phap phau thuat theo tu thi ndm nghieng, do la phiu thuat cd thi dupc tien hanh ca hai ben, thdi gian md ngdn han vi khdng cdn chuan bi lai benh nhan. Mac du vay, phuang phap phiu thuat theo tu thi nam sap cung bpc Id mpt so nhupc diem nhu: hudng phau thuat khdng
CHUYEN OE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
true tilp vao hach than kinh giao cam do dd khd quan sat, khd thao tac; khi thay ddi benh nhan tu tu the nam ngua sang tu the nam sap de lam xe dich dng ndi khi quan nen lam mat dp chinh xac viec thdng khi chpn Ipc tung ben phdi. Nhu vay, moi tu the phau thuat deu CO uu diem va nhupc di3m rieng. Viec lira chpn tu the phau thuat tuy thudc vao thdi quen va sd thich cua tung phau thuat vien.
J. A. Rennie, C.-C. Lin, A. E. P.
Cameron cung cho rang mdi phau thuat vien deu cd nhung ky thuat md ua thich khac nhau va tin rang chung thich hop vdi kha nang thuc hanh cua hp nhat. M.Hashmonai, A.Assalia, va D.Kopelman tdng hop tu 33 bao cao cua Medline thuc hien tu nam 1974-
1999 ve ky thuat ddt hay cat chuoi hach giao cam dieu tri chiing tang tiet md hdi tay da rut ra mpt sd nhan xet nhu sau: ky thuat ddt chudi hach giao cam thuc hien de dang han, thdi gian md ngan han, trong trudng hop that bai viec md lai cd the thuc hien dupc va cd the thanh cdng. Ngupc lai, ky thuat cat chudi hach giao cam lai cho ket qua cao hem vi cho phep xac dinh dupc chuoi hach giao cam ngay trong md nhd phuang phap sinh thiet lanh, nhung lai ddi hdi ky thuat cao han, de bien chiing han, vi du nhu hpi chiing Homer.
Mpt trong nhimg ca che de giai thich ty le hdi chiing Homer cao khi thuc hien ky thuat cat chudi hach giao cam la do sir co keo qua miic chudi hach giao cam trong qua trinh cat.
Ddi vdi phau thuat cat hach giao cam qua npi soi nguc hau het khdng can thiet phai dat din luu mang phdi sau md, trir nhiing trudng hpp xay ra bien chiing nhu tran khi, tran mau mang phdi... hoac nhirng trudng hop cdn theo ddi cac bien chiing sau md.
- So sanh ket qua nghien ciiu cua tdi va cua cac tac gia khac, sd ngay ndm vien sau md trung binh tir 1-7 ngay, ngdn han rdt
nhieu so vdi md nguc thdng thudng, trung binh td 10-12 ngay. Ket qua nay cho thSy phau thuat ndi soi cat hach giao cam nguc nit ngan dupc dang ke sd ngay nam vien sau m6 so vdi phau thuat md nguc cat hach giao cam. Theo Chih-Lung Lin, phiu thuat ck hach cam nguc qua npi soi cho kit qua tit hon so vdi phau thuat md nguc cdt hach giao cam d cac diem: mau lanh vet thuang, riit ngan thdi gian md va thdi gian nam vien sau md.
Theo S.Erak [9] va cdng sir, nguyen nhan that bai cua phau thuat chilm khoang 7%. Mpt sd nguyen nhan gay ra su thdt bai cua phau thuat dupc xac dinh la do su tai phan bd cac dudng dan truyen cua thdn kinh giao cam, khi cat hoac dot khdng hoan toan hach T2 hoac T3 vi da xac dinh sai vi tri chudi hach, hoac khdng ddt hoan toan cac sgi day than kinh Kuntz - cac day than kinh giao cam phu thudng chay dpc theo than chinh cua chudi hach giao cam, trong khi cac phau thuat vien thudng chi chu y ddt hoac cat cac spi day than kinh Kuntz d gan cac vj tri co xuang sudn 2 hoac 3 ma thdi. Cdn theo C.
Drott va cdng sir [8], cdt hoac dot khong hoan toan chudi hach than kinh giao cam do hai nguyen nhan chinh la cd mpt sy bat thudng ve cac nhanh than kinh giao cam hoac khd xac dinh rd chuoi hach giao cam a nhiing benh nhan cd ldp md dudi mang phoi qua day.
v l chiing tang tilt bii, theo Peter B.
Licht, nguyen nhan cua sir khac nhau giiia cac ket qua nghien ciiu ve chiing tang tiet bii la do bi anh hudng bdi nhieu yeu td nhu hoi benh nhan, thdi gian theo ddi, yeu td dia ly, mdi trudng lam viec, dp am, nhiet dp va mua.
Ngoai ra, M. van't Riet va Takeo Fujita con cho rang cac ket qua cua chung tang tiet bii khac nhau sau phau thuat cung lien quan den
gidi han pha huy chuoi hach giao cam.
Nghien ciru cua Johannes Schmidt kit luan khoang 50% trudng hop cd hien tupng tang tiet bii se bien mat sau 6 thang, nen khi xay ra hien tupng tang tilt bu, dilu ddu tien phau thuat vien phai lam la giai thich rd cho benh nhan. Ciing theo tac gia mdt dieu chac chan la hien tupng tang tiet bu se giam khi khdng pha huy hach T2. Cdn theo Yang Jie va cdng sy thi hien tuong tang tiet bu la do sir rdi loan cua he than kinh giao cam sau phau thuat.
Cung phan hdi giira he than kinh giao cam va vimg dudi ddi bi pha huy gay mat can bang dilu hoa su tiet md hdi trong ca the. Bao ve nhirng tin hieu feedback tdi vung dudi ddi la chia khoa de tranh hien tuong tang tiet md hoi bu.
V. KET LUAN:
Tang tiet md hdi tay la mpt chiing thudng gap, nhat la d nhirng ngudi tre tudi.
Chiing nay tuy khdng gay nguy hiem chet ngudi nhung nd mang lai cho ngudi benh rat nhieu khd chiu va phien toai trong cudc sdng.
Hi?n nay, phiu thuat cat hach giao cam qua npi soi nguc dieu tri chiing tang tiet md hdi tay la mpt phiu thuat an toan va thuan lpi, hau phiu dan gian, khdng cd cac bien chiing nSng nl cua phiu thuat md nguc ma ket qua lai tdt.
TAI LIEU THAM KHAO
1. Huynh Quang Khanh, Nguyen Cong Minh, Hoang Van Thiep, Dong Lvu Ba (2006), "Phdu thuat npi soi cat hach than kinh giao cam ngirc vdi gay me noi khi quan thudng, ndm ngira va sir dung 1 ngo vao", Y hqc Thdnh pho Ho Chi Minh, tap 10, Phu bangs! l,tr.280-287.
2. Trdn Ngoc Lirong (2004), "Ket qua budc dau qua 131 trudng hgp dot hach giao cam noi soi qua long ngirc de chOa chiing ra md hoi tay", Tgp chi thong tin y duac hgc, so 9, tr. 33-37.
3. Nguyin Hoai Nam (2006), "Cac budc phat trien cua phau thuat noi soi long nguc", Yhoc Thdnh pho Ho Chi Minh, tap 10, s6 2, tr. 65- 71.
4. Nguyen Hoai Nam, Tran Nhir Hurng Viet (2003), "Danh gia ket qua phau thuat noi soi long ngyc", Y hgc Thdnh pho Ho chi Minh, Tap 7, Phu ban cua Sd 1, tr. 36-40.
5. Nguyen Hoai Nam (2003), "Nhung cai tien trong dieu trj chung tang tiet mo hoi tay bang phau thuat noi soi long ngyc", Y hoc thdnh pho Ho Chi Minh, so 7, tr. 31-35.
6. Nguyen Van Nam, fiang Ngoc Hiing, Ngo Van Hoang Linh (2006), "Nhan xet ket qua budc dau dieu trj chirng tang tiet mo hoi tay bang phau thuat npi soi cat hach giao cam ngyc", Tgp chi Y hoc Viet Nam, so dac biet, tr. 429-435.
7. Van Tan, Ho Nam va CS (2006), "NhCtng tien bp trong phau thuat dieu trj udt ban tay qua npi soi long ngyc tai Benh vien Binh Dan", Yhoc Thdnh phd Hd Chi Minh, tap 10, Phu bangs! l,tr. 288-296.
8. Nguyen Thwcmg Xuan (2002), "Benh tang tiet mo hoi". Hoc vi^n qudn Y, tr. 217-223.
9. Cheung J. (2002), "Disorders of sweat glands: hyperhldrosis: unapproved treatments". Climes in Dermatology, Volume 20, Issue 6, November-December, Pages 638-642.
10. Doblas M. (2004), "Posterior Bilateral Thoracodorsal Sympathectomy: Surgical Technique", Ann Vase Surg, 18: 766-769.
