Y HQC VI$T N A M T H A N G I -561/2012 Theo thdi gian theo doi sau phau thuat,
tong diem chat lu'dng cuoc song cua cac benh nhan tang dan.
Cac yeu to anh hi/dng den chat lu'dng cuoc song cua benh nhan bu'du giap ddn thuan sau phau thuat la tuoi va tinh trang seo.
TAI LIEU THAM KHAO
1. Dang Ngoc Hung (2002), Nghien cuV dinh gia kit qua xa sau phau thuat tuyen giap, De tai cap Bp Quoc phong, Hoc vien Quan y. Ha Npi.
2. Le Huy Lieu (2003), "Benh bu'du co ddn thuan", Bach khoa thW benh hoc, Tap 1, Trung tam quoc gia bien soan tt/ dien bach khoa Viet Nam, Ha Npi, tr. 96-101.'
4.
6.
7.
ThAi Hong Quang (2001), Benh nqi tiet, Nha xui't ban Y hpc.
Kfeu Trung Thanh (2002), Danh gia kit qua xa sau phau thuat cStgan hoan toan tuyen giap dieu trj benh bu'du giap Ian toa nhiem doc, Luan an Tien si Y hoc, Hpc vien Quan y.
Dagan T., Bedrin L., Horowitz Z. et al.
(2004), "Quality of life of well-differentiated thyroid carcinoma patients", J. Laryngoi. Otol.,
118(7):537-42.
Huang S. M., Lee C. H., Chien L. Y. et al.
(2004), "Postoperative quality of life among patients with thyroid cancer", J. Adv. Nurs., 47(5):492-9.
Ware 3. E., Sherbourne CD. (1992), The MOS 36-item short form health survey (SF-36), Medical Care, 30, 473-483.
GIAN NAO THAT CAP TINH DO CHAY MAU HO SAU TRONG CHAN THlATNG SO NAO
Nguyen The Hao*
TOM T A T
Muc dichr. Oanh gia nhiJYig yeu to lien quan vdi gian nao that cap tinh do ton thu'dng ho sau trong chan thu'dng sp nao (CTSN) va nhan xet ve thai dp xCr tn. Phu'dng phap-. Nghien cu'u hoi cu'u 41 benh nhan gian nao that do ton thu'dng ho sau trong CTSN, tai Benh vien Viet-Oi/c, tiT 1/2008-7/2011. Ketquar. Ti le nu'/nam: 1/7, tuoi trung binh 32,6. Co 26,8% la mau tu NMC; 41,5% CO mau tu trong nao va dap nao;
19,5% mau tu DMC; 70,7% phoi hdp ton thu'dng tren leu; do day khoi mau tu >3cm chiem 78%; tat ca benh nhan deu co bat thu'dng be day; 58,5% co xoa nao that 4. Ket luanr. Cac yeu to nguy cd cua gian nao that la mau tu trong nao va dap nao, khoi mau tu day >3cm, be day va nao that 4 bj xoa. Chi dmh mo dan (u'u nao that tuy theo loai ton thu'dng. Mau tu NMC khong can thiet dan lu'u nao that. Cac ton thu'dng khac deu can dan lu'u nao that ra ngoai.
SUMMARY
Acute hydrocephalus in posterior fossa injuries after cranio-cerebral trauma
Objective. To evaluate factors involving acute hydrocephalus in posterior fossa injuries, and assess managements for these hydrocephalus. Methods.
Retrospective study of 41 patients with acute hydrocephalus in posterior fossa injuries treated at Viet-Duc hospital from 1/2008 to 7/2011. Results.
female/male: 1/7, mean age 32,6. Main lesions of
* Benh vien Viet-Dik:, Ha Ngi
Phan bien khoa hoc: PGS.JS. Ha Kim Trung
6
posterior fossa: 26,8% extradural hematomas;
intracerebeilar hematomas and contusions 41,5%;
subdural hematomas 19,5%; associated supratentorial lesions 70,7%; bilateral hematomas 63,4%. Thickness of hematoma >3cm 78%; all patients show dtemal anormalities; effaced 4* ventricule in 58,5%.
Conclusion: The risk factors of acute hydrocephalus consist of intracerebeilar hematomas and contusions, thickness of hematoma > 3cm, not visualized cisterns, and 4* ventricule effaced. External ventricular drainage depends on lesion. In case of extradural hematomas, derivation is unnecessary. Othenwise, drainage is really effective.
I.
OAT VAN OETon thu'dng trong chan thu'dng so nao (CTSN) d vi trf ho sau cd the gSp mau tu ngoai mang cuTng (NMC), mau tu duTdi mang ciitig (DI^C), mau tu trong tieu nao, dap nao tieu nao, chay mau than nao, chay mau du'di mang nhen va chay mau nao that tu*. Mot trong nhuTig hau qua cua nhOtig ton thu'dng nay cd the gay ra gian nao that, nguyen nhan chu yeu la can trd lu'u thong dich nao tuy do chay mau do phu nao, do tang ap li/c npi so d ho sau. Day la nhiJng tru'dng hdp gian nao that cap tinh, lam tang manh hdn ap lu'c noi sp, nen dien bien thu'dng nhanh va benh nhan d trong tinh trang nang.
Y HOC VIET NAM T H A N G 1 - SO 1/2012
chup cat Idp vi tinh sp nao. Viec dieu trj la giai quyet nguyen nhan lay mau tu va nao dap neu.
cd chi djnh md, va dan lu'u nao that ra ngoai. Ket qua dieu tn phu thupc vao nhii'ng ton thu'dng do CTSN va SI/ khan tru'dng trong chan doan va dieu tn. Tuy nhien, trong thi/c te lam sang, tru'dc nhu'ng khoi mau tu Idn va dap nao d ho sau, cd the phdi hdp vdi ton thu'dng dap nao d vung tran, doi khi bd sdt tinh trang gian nao that cap tinh, va thai dp xiy tri khong de dang quyet djnh chien lu'dc can thiep nhu' the nao? Vi vay, chung toi thi/c hien nghien culi nay nham danh gia nhii'ng yeu to lien quan vdi gian nao that cap tinh trong ton thu'dng ho sau do CTSN va nhan xet ve thai dp xu' trf doi vdi gian nao that loai nay.
II. 061TUONG VA PHirONG P H A P NGHIEN COU 1. Doi tu'dng nghien cu'u
Gom 41 benh nhan gian nao that cap tinh do td'n thu'dng d viing ho sau trong CTSN kin, dieu tn tai Benh vien Viet-Oirc, tCr 1/2008- 7/2011. Tieu chuan chan doan gian nao that cap tinh la benh nhan du'dc chup CLVT sp nao trong
vdng 3 ngay dau sau chan thu'dng, va cd chi sd hai nhan dudi vu'dt qua gidi han binh thu'dng. Chi sd hai nhan dudi la ti sd giu'a khoang each cua hai nhan dudi va khoang each mat trong cua hai ban xu'dng sp d ngang mCTc. Chi sd nay thay doi theo tuoi, binh thu'dng la: 0,16 (<36 tuoi); 0,17 (36-45 tuoi); 0,18 (46-55 tuoi); 0,19 (56-65 tuoi); 0,2 (>65 tuoi). Tieu chuan chpn benh nhan la tat ca nhu'ng benh nhan cd gian nao that cap tinh cd ton thu'dng do chan thu'dng d Pid sau.
Loai khdi nghien cu'u nhu'ng chay mau ho sau do tai bien mach mau nao, hay do u nao chay mau.
2. Phu'dng phap nghien cu'u
Nghien cu'u hoi cu'u, di/a tren ho sd lu'u trO' tai Benh vien Viet-OLrc. Cac chi tieu nghien cu'u bao gom: tud'i, gidi, thdi gian tif khi tai nan den khi chup CLVT, ton thuttng tren chup CLVT, danh gia cac yeu to lien quan vdi gian nao that nhu' vj trf td'n thu'dng, khdi lu'dng mau tu, tinh trang Chen ep nao that 4, chi djnh can thiep, ket qua dieu trj. Ket qua du'dc danh gia d thdi diem xa sau md toi thieu la 3 thang va theo thang diem ket qua Glasgow outcome scale.
III. KET QUA NGHIEN CCfU
1. Tuoi va gidi: Tud'i thay doi tif 7-58 tud'i, trung binh 32,6 tud'i. Ti le nam/nu' la 7/1.
2. Thdi gian tu" khi chan thu'dng den khi chup CLVT: Cd 32 benh nhan du'dc chup CLVT Ian dau trong vdng 24 gid sau chan thu'dng va 9 benh nhan chup CLVT sau 24 gid.
3. Ton thu'dng nguyen phat d ho sau Ton thu'dng nguyen phat
Mau tu NMC
Mau tu trong nao va dap nao Mau tu DMC
Chay mau du'di nhen Chay mau than nao
So benh nhan 11 17 8 3 2
Ti le % 26,8%
41,5%
19,5%
7,3%
4,9%
4. Ton thu'dng phdi hdp tren feu tieu nao: trong 41 ca td'n thu'dng sp nao ho sau cd 29 benh nhan (70,7%) cd phdi hdp ton thu'dng tren leu tieu nao, trong do ton thu'dng thu'dng gap tren leu la mau tu trong
0 va dap nao 12/29 benh nhan (4 Ton thu'dng phdi
hdp tren Teu Ton thu'dng ho sau
Mau tu NMC
Mau tu trong nao Va dap nao Mau tu DMC
Chay mau du'di nhen Chay mau than nao Tong sd benh nhan
1,4%) va mau tu NMC 7/29 Mau tu
NMC"
6 1
7
Mau tu DMC dap nao
5 4 2 1 12
) benh nhan ( Mau tu
trong nao
1 1 1 3
24,1%).
Chay mau du'di nhen
2 1 1 4
Chay mau nao that
1 1 1
3
Y HQC Viei NAM THANG 1 - S6'1/2012
5. Cac yeu to lien quan vdi gian nao that d ton thu'dng ho sau trong CTSN Yeu to lien quan vdi gian nao that
Mau tu ho sau: 1 ben 2 ben
Do day mau tu ho sau: < 3 cm
> 3cm Tinh trang be day: Bi ^p
Bi xoa Chen ep nao that 4: Bi ep
Bi x6a
So b$nh nhan 15 26 9 32 27 14 17 24
Tl 1% o/o 36,6%
63,4%
22%
78%
65,8%
34,2%
41,5%
58,5%
6. Thai dp xu' trf doi vdi benh nhan gian nao that cd ton thu'dng ho sau trong CTSN: Cd 2 benh nhan (4,9%) d tinh tranq qua n§ng, khdng con chi djnh md', con lai 14 benh nhan (34,1%) mo lay mau tu ddn thuan, 16 benh nhan (39%) md lay mau tu phdi hdp dan lu'u n|o that ra ngoai, 9 benh nhan j|22%) chi md dan lu'u nao that ra ngoai ddn thuan.
7. Ket qua dieu trj d nhUng benh nhan td'n thu'dng ho sau do chan thu'dn^g cd gian nao that:
18 benh nhan (43,9%) cd ket qua tdt^, 8 benh nhan ket qua trung binh (19,5%), 15 benh nlian ket qua xau (36,6%).
IV. BAN LUAN
1. Yeu to lien quan vdi gian nao that cap tinh do ton thu'dng ho sau trong CTSN
Ton thu'dng ho sau trong CTSN khdng phai It gap, theo y van tren the gidi loai ton thu'dng nay chiem khoang 2,9-6% tong sd CTSN [l]/[3],[6]. Cung nhu' cac td'n thu'dng khac trong CTSN, trong nghien cu'u cua chung tdi, phan Idn benh nhan la nam, ttipi tre va trung nien, (tud'i trung binh la 32,6). Ton thu'dng ho saudo CTSN rat da dang,tronq dd mau tu NMC la td'n thu'dng thu'dng gap nhat Ll]/[2],[5]. Cac ton thu'dng khac bao gom: mau tu trong nao va dap nao, mau tu DMC, chay mau nao that, chay mau du'di mang nhen, chay mau than nao. Tuy nhien khdng phai tat ca cac tru'dng hdp deu gay ra gian nao that cap tfnh. Trong nghien cu'u cua Karasawa va cpng si/ [5] thi chi 22,6% benh nhan ton thu'dng ho sau do CTSN cd gian nao that phoi hdp. Trong dd, hai loai thu'dng ton chi'nh gay gian nao that la mau tu NMC va mau tu trong nao phdi hdp dap nao. Theo D'Avella va cpng SI/ [3] thi 15,8% chay mau tieu nao do clian thu'dng cd plan nao that. Trong nghien cu'u cua Karasawa ca cpng si/ [5J thi 36% mau tu NMC ho sau cd gian nao that, Trong 41 benh nhan nghien cu'u cua chung tdi, ti le mau tu trong nao va dap nao cd gian nao that chiem tcfi 41,5%; mau tu NMC chjem 26,8%; mau tu DMC chiem 19,5%; cac ton thu'dng khac chiem 12,2%. Mac du mau tu NMC chiem ti le cao nhat trong cac ton thu'dng d ho sau do CTSN, nhu'ng ti le CO gian nao that (26,8%) thap hdn mau tu 8
trong nao va dap nao (41,5%). Nghien cOfU cua chung tdi chi ra rSng mau tu trong nao va dap nao d ho sau la mot yeu to ngu^ cd gay nen giSn nao that cap tinh. Op day khoi mau tu ho sau cung da du'dc cac tac gia de cap den, vdi nhu^g khdi mau tu trong tieu nao cd ki'ch thu'dc>3cm co nguy cd cua gian nao that [3],[4], Trong nghien cu'u cua Karasawa va cpng si/ [5] thi mau tu NMC day tren 15mm la cd nguy cd cua gian nab that, Chung tdi nhan thay 78% benh nhan gian nao that trong nghien cu'ujcd khdi mau tu day tren 3cm, Sy bat thu'dng be day quanh cau nao gap trong tat ca benh nhan cua chung tdi, trong dd 65,8% benh nhan bj ep va 34,2% bj xda hoan toan, va 58,5% benh nhan khdng cdn thay nao that 4 tren chup cLVT, Xda be day va nao that 4 cd the lam caii trd IU\J thong djch nao tuy. Theo Karasawa va cpng si/|5] thi day la nguyen nhan quan trpng gay gian nao that.
2. Thai do xuT tri gian nao that do die ton thu'dng ho sau tron^ CTSN.
Cac tac gia deu thong nhat rang Jchi ton thu'dng ho sau do CTSN co gian nao 5iat la co chi djnh md hoac lay mau tu va/hoac daii IU\J nao that ra ngoai. Van de dat ra la khi md lam nhiJng gi? Va chien lu'dc can thiep nhu' the nao.
Odi vdi tat ca cac ton thu'dng nriau tu d ho sau neu cd chi djnh md (nhu' mau tu NMC, maujtu trong nao va dap nao Idn, mau tu DMC) thi can phai can thiep cap cu'u lay mau tu. Trong tru'dng hdp mau tu trong nao va dap nao, hay mau tji DMC thi tnidc het can dan li/u nao that ra ngoai sau dd md lay mau tu dong thdi trong mot till md. Theo D'Avella va cpng si/ [3] nen dat dan luti nao that ra ngoai cho nhffng benh nlian co gian nao that do chay mau tieu nad^sau CTSN.
Chung tdi cd 39% benh nhan vula dan IU\J nao
that ra ngoai vCra md lay mau tu va dap nao d ho
sau. Tat ca nhu'ng benh nhan nay deii cd mau tu
trong nao, dap nao hay mau tu DMC. Theo
Karasawa ca cpng si/ [5j[ thi doi vdi mau tu trong
nao, dap tieu nao can dong thdi yiia dan liiXi nao
that ra ngoai viTa lay mau tu nao dap. Cungjheo
cac tac gia nay khi lay mau tu trong tieu nao co
the lam giam du'dc si/ tac nghen cua nao that va
cai thien sur cheh ep len than nao, nhu'ng hien
tu'dng gian nao that khdng phai ludn ludn du'dc
cai thien va DNT khdng phai ludn luon lull thong
Y HOC VIET NAM T H A N G 1 - SO 1/2012
tot sau \ai mau tu va nao dap ddn thuan, bdi vi ca^nao that 4 va cpng sylvius cdn bj chen ep bdi hien tu'dng phu tieu nao va mau trong nao that.
Trong cac tru'dng hdp mau tu NMC hd sau cd gian nao that thi hau het cac tac gia cho rang chi can thiep md lay mau tu NMC ddn thuan, khdng can dan lu'u nao that ra ngoai [2],[5]. Chung tdi cho rang cung khdng nen dan lu'u nao that cho cac tru'dng hdp gian nao that do mau tu NMC hd sau. Thi/c te nghien cu'u cua chung tdi cho thay 34,1% benh nhan chi md lay mau tu ddn thuan va tat ca deu la mau tu NMC hd sau va khdng cd ket qua xau d nhu'ng benh nay. Doi vdi cac tru'dng hdp gian nao that do cac ton thu'dng hd sau ma nhii'ng td'n thu'dng^nay khdng cd chi djnh md de lay bo, thi can dan lu'u nao that, 22%
b|nh nhan trong nghien ci/u cua chung tdi chi dan lu'u nao that ra ngoai ddn thuan, Chung tdi cho rang, dan lull nao that se lam giam du'dc ap li/c npi sp, cai thien du'dc ddng mau nao, va tao cd hpi song tot hdn cho benh nhan.
V. KET LUAN
Cac yeu td nguy cd cua gian nao that cap tfnh do tdn thu'dng hd sau trong CTSN la mau tu trong tieu nao va dap tieu nao, khdi mau tu day tren 3cm, be day bj xda, nao that 4 khdng cdn.
Chi djnh md dan lu'u nao that phu thupc vao ti/ng loai ton thu'dng cu the d hd sau. Vdi nhu'ng tru'dng hdp mau tu NMC khdng can thiet dan lu'u nao that. Cdn cac tdn thu'dng khac deu can dan lu'u nao that ra ngoai,
T A I LIEU THAM K H A O
1. Bor-Seng-Shu. E, Agular.P.H, Almeide Leme.R.J et al (2004), "Epidural hematomas of the posterior cranial fossa", Neurosurg Focus, 16 (2).
2. Bozbuga M, Izgi N, Polat G, (1999) "Posterior fossa epidural hematomas: observations on a series of 73 cases", Neurosurg. Rev 22:34^0.
3. D'Avella D; Servadei F. et als (2002),
"Traumatic intracerebeilar hemorrhage:
Clinicoradiological analysis of 81 patients";
Neurosurgery, vol 50, no. 1.
4. Dirim B.V.; Oruk C; Erdogan N. (2005),
"Traumatic posterior fossa hematomas"; Diagn Interv Radiol 11: 14-18.
5. Karasawa H., Furuya H et als (1997), "Acute hydrocephalus in posterior fossa injury"; J Neurosurg 86: 629-632.
6. Little J.R; Turman D.E.; Ethier R., (1978),
"Cerebellar hemorrhage"; J Neurosurg 48:
575-579.
NGHIEN ClJfU NGUYEN NHAN CHAY MAU TRONG VA SAU MO LAY THAI TAI BENH VIEN PHU SAN TW TRONG 2 GIAI DOAN (1998-1999) VA (2008-2009)
Pham Thj Thanh Hien* va Hoang Van Y e n * * TOM T A T
Nghien ciili hoi cufu md ta ty le chay mau trong va sau md lay thai 24 gid tai BVPSTW trong 2 giai doan (1998-1999 va 2008-2009) cho thay ty le chay mau d giai doan lla 3,1% va giai doan 2: 1,2%.
Nguyen nhan hay gap do dd tCr cung da tang len sau 10 nam tCr 30,54% len 62,14%, con cac nguyen nhan khac nhu" do rau thai (tir 65,27% xuong 35,92%), do ky thuat md (ti/ 8,98% xudng 3,88%), do benh ly ngu'di me (tCr 3,54% xudng 3,39%) giam di.
SUMMARY
Research in to the causes of bleeding during and after caesareanb section at the national Hospital or obsterrics and Gtnecoplogy during the 2 periods (1998 - 1999) and (2008 - 1009)
The retrospective study describing ttie bleeding rate for 24 hours during and after cesarean section at the
National Hospital for Obstetrics and Gynecology (NHCX5) during the 2 periods (1998 - 1999) and (2008 - 2009) has found that the bleeding rate at the first period is 3,1% and for the second period is 1,2%. The main reason due to uterine atony has been inaeasing from 30,54% to 62,14% after 10 years; the other reasons such as by placenta (from 65,27% to 35,92%), by surgical techniques (from 8,98% to 3,88%), by the matemal pathology (from 3,54% to 3,39%) have been reduced
I.
DAT VAN OEMo lay thai ngay cang phat trien vu'dn tdi can thiep vao cac tru'dng hdp thai hghen, benh ly phi/c tap cua ca me va con. Chfnh dieu dd cung mot sd yeu td xa hpi da lam cho ty le md lay thai ngay cang tang tai BVPSTW. Ty le md lay thai 1997 la 34,6% (Vu Cdpg Khanh) [1], nam 2005 la 39,71% (Pham Thu Xanh) [6]. Ty le nay cdn
* Dal hoc Yhia Ngi; ** Benh vien Phu san Ha Noi Phan bien khoa hoc: PGS.TS. Nguyin Qu6c TuSn
