Y HOC V I | T NAM THANG 9 - SO 2/2014 Kan, Luan vSn Thac sT Y hoc, Dai hpc Y Thai 6.
Nguyen, tr. 56 - 57.
4. Blonde L. (2010), "Current antihyperglycemic treatment guidelines and algorithms for patients with type 2 diabetes meliitus", Am.J.Mea, 123(3 7.
SuppI), pp. 12 - 18.
^. Mohamed, Mafauzy (2008), 'An audit on diabetes management in Asian patients treated by specialists" the Diabcare - Asia 1998 - 2003 studies. Volume 24, Number 2, pp. 507 • 514.
Ou H.Y., Cheng J.T., Yu E.H., Wu T J . (2006),
"Metformin increases insulin sensitivity and plasma beta-endorphiin in human subjects", Horm.Metab /?es, 38(2), pp. 106-111.
Roden M., Mariz S., Brazzale A.R., Pacini G.
(2009), "Free fatty acid icinetics during long-term treatment with pioglitazone added to sulfonylurea or metformin in type 2 diabetes", Inter Med,2^S{A), pp. 476 -487.
GIAI P H A U C U O N G M A C H NUOI VAT CO" THANG BUNG Nguyen Van Lam*
T6M TAT
Ccf sd giai piiau ci!ia vat cd thSng bung la cd thing bung, dpng mach thu'dng vj du'di va dpng mach thViJng vj tren. Mye tieu: Mo ta dang dgng mach cap mau cho cd ttiSng bung, xac djnh kich thu'dc cac cuong mach nu6i cd, xac dinh itich thu'dc cd thing bung. Dol tu'dng va phu'dng phap nghien cufu: 30 tieu ban phau tich cd thang bung va mach nuoi tren xac \i6[> formol. Ket qua: 66,7% dpng m?ch thu'dng Vj du'di tach tu" m^t trong DM chau ngoai va tren day Chang ben 1 - 1,5cm, chieu dai dfing mach thu'dng vj du'di la 5,1 ± 1,1cm, du'dng kinh ft-ung binh dpng mach d nguyen uy la 1,8mm. Ket luin; Vat cd thang bung du'dc cap mau tot bdi dpng mach thu'dng vi tren va thu'dng vj du'di, m6t trong hai cuong co the cap mau cho toan bp cd, ca hai cuong deu thich hop cho nS] vi mach.
Tu'kh6a:y^t cd thing bung (VCTB), dpng mach thu'dng vi du'di (DMTVD), dong m?ch thu'dng vi tren (DMTVr).'
S U M M A R Y
ANATOMY OF THE RECTUS A B D O M I N I S MUSCLE FLAP Rectus abdominis muscle flap is based on rectus abdominis muscle, deep inferior epigastric artery and deep supenor epigastric artery. Objectives; to disaibe the typical anatomy and possible variations of the vascular pedicle, to identify the measurement of the vascular pedicle, to identify the measurement of ttie rectus abdominis muscle. Subject and method:
30 specimens of reaus abdominis muscle and vascular pedicle on formalin - fixed cadavers. Results: 66,7%
deep inferior epigastric artery originate from external iliac artery within 1 - 1,5cm proximal to the inguinal
* Tru'dng Oai hpc Y Du'ijc Can Thd Chju trach nhiem chinh: N g u y e n VSn L a m Email:[email protected] Ot: 0913.974.351 Phan bien khoa hpc: GS.TS Le Gia Vinh Ngay nhan bai: 1.8.2014
ligament, the length of the deep infenor epigastric artery is 5,1 ± 1,1cm, the average values of arterial diameter at level of the origin is 1,8mm. Conclusions:
Rectus abdominis muscle flap is well vascularized by the deep infenor epigastric artery and deep superior epigastric artery, one of them can supply blood to the entire muscle, the vascular pedicle is suitable for microvascular anastomosis.
Keywords: Rectus abdominis muscle flap (RAMF), deep inferior epigastric artery (DIEA), deep superior epigastric artery (DSEA).
I. OAT VAN OE
Viec nghien cu'u cac vat to chufc dap uTig cho nhu cau phau thuat tao hinh cung ngay cang phat trien. Vat cd thang bung la mot trong so nhij'ng vat ra 6ii\ tu'dng doi muon, song kha nang ap dung cua no het su'c phong phu: Vat cd thang byng dung phuc hoi nhu'ng ton khuyet phan mem d thanh ngu'c, thanh bung va nhieu vj tri khac trong cd the, Cd sd giai phau cua vat la cd thang bung va he mach cap mau cho no. Tuy nhien moi tac gia co each mo ta khac nhau tuy each tiep can nghien cu'u. Chung toi "Nghien cu'u giai phau cuong mach nuoi vat cd thang bung"
nham muc tieu:
1. Mo ta dang dpng mach cap mau cho cd thang bung.
2. Xac dinh kich thu'dc cac cuong mach nuoi cd 3. Xac djnh kfch thu'dc cd thang bung.
II. OOI iKsam VA PHi/cmG PHAP NGHIEN COXJ
2 . 1 . Ooi tu'cfna nghien cu'u
30 tieu ban phau tich cd thang bung va mach nuoi tren 15 xac u'dp formol tai bo mon dial Phau, Tru'dng Dai Hpc Y Du'dc CSn Thd.
2.2. Phu'cfng phap nghiSn cu^u
Y HOC VlfT NAM THAHG 9 • SO 2/2014
Phau tich xac bang cac dung cu phau tich
thong thUftng; do dac cac Icich thu'dc cd thang bung; nhan xet cac dang dpng mach cap mau clio aJ; do dac cac kich thu'dc cac mach mau; ghi nhan lai hinh anh nghien cCTu; ve lai sd do_cac daiig dong mach cap mau cho cd; lu'u ho sd nghien ciJu; cac so do du'dc xir I'/ thong ke vdi su"
trd giup cua phan mem excel 2007.
III. KET QUA NGHIEN Ciru
3.1. Cac dang dong mach cap mau cho c0 thSng bi^ng
Cac dong mach thiTdng vi du'di deu tach tif dong macli chau ngoai, doi dien nguyen uy dong mach mil chau sau va d mu'c tren day Chang ben gidng nhu' mo ta kinh dien, vdi 4 dang nguyen iiy: dang A 23,3% dong mach tach tir mat trong dpng mach chau ngoai, tren day chang ben 0 - 1cm; dang B 66,7% dpng mach tach tir mat trong dpng mach chau ngoai, tren day chang ben 1 - 1,5cm; dang C 6,7% dpng mach tach tir mat trong dong mach chau ngoai, tren day chang ben 1,5 - 2cm; dang D 3,3% tach tir mat tru'dc dpng mach chau ngoai, tren day chang ben 2cm.
Hinh 1. Sd do cac dang nguyen iiy dpng mach thu'dng vi du'di
D M chaa ogoaiA B
Hau het cac dpng mach thu'dng vj du'di la mpt than chinh vap cd rSI dl len tan ciing vdi dpng mach thu'dng vj trSn d khoang giii'a mui ire - ron, vdi 4 kieu phan chia va tan ciing: dang A 79,9%
OM dl len la mpt than chinh va tan ciing d
C D
khoang giife mui uTc - ron; dang B 6,7% OM dl len la mpt than chinh va tan ciing d sat bd sUSn;
dang C 6,7% OM dl len la mpt than chinh va tan ciing d ngang ron; dang D 6,7% DM chia hai nhanh d du'di ron.
Hinh Z Sd do cac dang dpng mach thu'dng vi du'di vao cd thang bung
» M I ; 1 I ;^; 1
tbwvng ^i fA B C D
Dgng mach thudng vi tren cd 3 dang tin ciing: 86,6% tin ciing d khoing giiia mOi ifc - ron; 6,7%
tin ciing d ngang ron; 6,7% tin ciing d ngay du'di bd sddn.
3.2. Kich thu'dc cac cuong mach nudi cO Bing 1. Kich thu'dc cac cuong mach nuoi cd thang bung
Donq mach thu'dng vl du'di Tinh mach thu'dng vl dUdI Dong mach thu'dng vl tren Tinh mach thu'dnq vi tren
Chieu dai 5,1 ± 1,1cm 2,8 ± 0,8cm -
Cu'dng kinh 1,8 ± 0,5mm 1,6mm 0,7 ± 0,2nnm
0,5mm
Y HOC VI|T NAM THANG 9 - SO 2/2014
3.3. Kich thu'dc cd thang bung Bang 2. Kich thu'dc cd thang bung
Dai (cm) 30,5 ± 1,6cm
Rong (cm) Bd su'dn
5,1 ± 0,6cm
Ngang ron 4,3 ± 0,5cm
Giu'a ron - mu 3,8 ± 0,4cm
Day (mm) 3,9 ± 0,5mm IV. BAN LUAN
Ket qua nghien cu'u cho thay cuong mach nuoi cd thang bung co nhieu bien doi (ve nguyen uy, phan chia va tan cung), nhu^g ty le cua so tru'dng hdp co nhieu bien ddi khong nhieu. Hdn nu^, ngay ca khi co nhijrig bien doi nhu" vay, van CO the phau tich tim cuong mach du'a trSn cac moc giai phau. Do dong mach thu'dng vi du'di tach ti!r (mat trong hogc mat tru'dc) dong mach chau ngoai, doi dien nguyen uy dong mach mu chau sSu, nen viec phau ti'ch tim dpng mach thu'dng vj du'di kha de dang. Khong nhu'ng the, tru'dc khi 2 tmh mach tan cung bdi mot than chung thi thu'dng noi vdi nhau, nhanh noi thu'dng vat ngang qua mat tru'dc dong mach va kep dong mach d giuS, dieu nay tao dieu kien cho viec lay cuong mach du'dc thuan ldi.
Ve kich thu'dc, chieu dai va du'dng kinh cuong mach thu'dng vj du'di hoan toan thfch hdp vdi viec noi vi mach khi chuyen vat t\i do tdi cac vung khac ciia cd the. So vdi nghien ciiu cua Le VSn Cu'dng [1] va Nguyen Tran Quynh [3] tren ngu'di Viet Nam, cac so lieu cua chung toi khong cho thay s\i khac biet dang ke.
V. KET lUiBlN
Ket qua nghien CLTU giai phau cac cuong m?ch nuoi vat cd thang bung cho thay vat cd thang byng phu thuoc cuong mach thu'dng vj du'di va thu'dng vj tren, dac biet cuong du'di la tu'dng doi hSng djnh, dai, kich cd kha Idn cho phep su" dung vat du'di nhieu hinh thu'c.
1. Cuong mach thu'dng vj du'di cd dang dien hinh tach tLf mat trong dpng mach chau ngoai, tren day chang ben 1 - 1,5cm, chay thang vao cd va tan het d khoang giu^ mui u'c - ron bang each chia nhieu nhanh nho noi vdi cuong mach thu'dng vj tren. Ben canh dang dien hinh tren, con co cac dang tach tiJr mat tru'dc dong mach chau ngoai
hay tii mat trong dong mach chau ngoai nhu'ng tren day chang ben d mu'c 0 - 1cm hay tren 1,5cm, tan cung d ngang ron hay sat bd su'dn, hay chia hai nganh cung d du'di ron.
2. Chieu dai va du'dng kfnh cac cuong mach:
- Dpng mach thu'dng vi du'di dai 5,1 ± 1,1cm, du'dng kinh 1,8 ± 0,5mm.
- TTnh mach thu'dng vj du'di cd du'dng ki'nh trung binh 1,6mm.
- Dpng mach thu'dng vj tren dai 2,8 ± 0,8cm, du'dng kinh 0,7 ± 0,2mm.
- TTnh mach thu'dng vi tren cd du'dng kinh xap xi 0,5mm.
3. Kich thu'dc cd thang bung
ca thang bung dai 30,5 ± 1,6cm, rong 5,1 ± 0,6cm d bd su'dn, 4,3 ± 0,5cm d ngang ron, 3,8
± 0,4cm d giUa ron - mu va day 3,9 ± 0,5mm.
TAI Ll|U THAIVI KHAO
1 . Le Van Cu'dng (2012), Cac dang va kich thwdc dong mach d ngudi Viet Nam, NXB Y hoc, TP Ho Chi Minli, tr 208 - 209.
2. Nguyen Huy Phan (1999), Ky thuSt vi phau mach mau - than kinh, thiTc nghiem va liYig dung iam sang, Nha xuat ban Khoa Hoc Ky ThuSt, Ha Noi, tr^220 - 227.
3. Nguyen Tran Quynh (2006), Nghien culi qlai phau vat cd thanq bunq tren nqu'dl Viet Nam, Luan van tien sT y hpc, Dai hoc Y Ha Npi, tr 50 - 80.
t . Granzow J.W., Levine J.L. (2006), "Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique", Journal of Plastic, Reconstructive and Aesthetic Surgery, 59, pp: 571-579.
5. Levine J.L (2013), Breast reconstruction - current perspectives and state of the art techniques, InTech, China.
6. Serafin D (1996), "The rectus abdominis flap".
Atlas of microsurgical composite tissue trans - plantation, W.B. Saunders company, Philadelphia - London - Toronto - Montreal - Sydney - Tokyo, pp: 221 • 241.
7. Strauch B, Yu H.L, Chen Z.W, Liebling R (1993), Adas of microvascular surgery: Anatomy and cperative appnoaches, New York, pp: 448 - 461.
