TAP CHf YOagc LAM SANG 108 """^P ^^-Sd 1/2017
Hieu qua dieu tri suy tinli macli man tinh clii dit&i bang gay xff bot tai Benh vien Lao khoa Trung irong
The treatment outcomes of foam sclerotherapy of chronic venous mcompetence at National Geriatric Hospital
Nguyen Trung Anh*, Bui Thue Quang *, *Benh vien Lao khoa Trung ucmg Nguyin Quy Phong *, Ph^m ThSng*, **Benh vien Trung uong Qudn doi 108 Pham Nguyen Son**
Tom t ^ t
Muc tieu: 6anh gid hieu qud dieu trj 110 b@nh nhdn suy tTnh mach man tinh chi dUdi bang phuong phdp gay xo bpt tai Benh vien Lao khoa Trung Uong. Ddi tubng vdphuoigphdp: 110 benh nhdn suy tTnh mach man tinh chi dudi tudi trung binh 53,6 +11,9 dUdc dieu tri bang phuong phdp gay xo bpt dUdi hUdng dan si&u dm.
Tat cd benh nhdn d I u ddpc theo doi dieu tri 1 thdng va 3 thang bdng sieu am Duplex, phan dd !dm sdng CEAP, thang diem VCSS vd CIV!Q-20. Phuong phap tien ci2u, md ta cSt ngang vd theo doi d p c Kit qud: Ldm sang cdi thi#n tdt vdi phan dp lam sdng CEAP: C2 giam t d 28,2% cdn 20,0%, 3 gidm t d 42,7% cdn 0%, C4 gidm t d 26,4% cdn 0,9%, C5 gid nguyen 2,7%. Trong khi do CO va CI Ian lupt tang len 2,7% va 73,7%. Thang diem VCSS giam 2,1 diem tdong ddcfng 40,0% va CIVIQ-20 gidm 24,9 diem tUOng dUOng 52,1% sau 3 thdng d i l u tri cd y nghia thdng ke (p<0,001). Ti le gay tac TM hoan toan Id 66,4%, tac mot phan 20,0% va that bai 13,6%. Bien chdng I M O gdm dau dpc TM ddpc dieu trj 44,5% va rdi loan sac t d da 36,4%. Kit ludn: Gay xO bpt la phuong phap d i l u tri hi&u qud, an toan va xam nhdp tdi thieu vdi t! le bien chdng thdp.
TUkhod: Suy tTnh mach man tinh chi dudi, lieu phap gdy xo bpt.
Summary
Objective: To evaluate the treatment results of foam sclerotherapy of 110 patients w i t h chronic venous incompetence (CVI) at National Geriatric Hospital. Subject ond met/jod: 110 patients CVi (mean age 53.6 ± 11.9) were treated by under ultrasound guided foam sclerotherapy. All patients were monitored by evaluating the duplex, the CEAP clinical classification, t h e VCSS and the CIVIQ-20 at 1 month and 3 month follow-up. Result: Significant clinical improvement w i t h t h e change of CEAP clinical classification: C2 decreased from 28.2% t o 20.0%, C3 from 42.7% to 0%, C4 from 26.4% t o 0.9%.
Meanwhile CO and Cl respectively increased t o 2.7% and 73.7%. VCSS decreased 2.1 points representing 50% and C!VIQ-20 decreased 24.9 points representing 58.8% at baseline (vs 18.8 ± 2.0) after 3 months o f treatment significantly (p<0.001). The complete occlusion rate was 66.4%, partial occlusion 20.0% and the fail rate 13.6%. Complications of the treatment include pain along the vein treated 44.5% and hyperpigmentation 70.0%. Conclusion: Foam sclerotherapy is an effective, safe, and minimally invasive endovenous t r e a t m e n t for chronic venous incompetence with a low rate o f complications.
Keywords: Chronic venous incompetence, foam sclerotherapy.
Ng^ nhdn bai: 20/12/2016, ngay chdp nhan Sang: 26/12/2016
Nguaiphan hdi: Nguyin Trung Anh. Email: [email protected] - Benh vi4n Lao khoa Trung uong
JOURNAL OF 108 - CUNICAL MEDICINE AND PHARMACY VoLl2'N''1/2017
I.DatvSnde
Suy tTnh mach man t i n h ehl dUdi Id m d t b i n h t h u d n g gap md cac b i i u hien cCia n d bao g o m eac gian tTnh maeh va n h d n g t h a y ddi cOa da n h d la v i l m da tTnh mach, t d n g sac t d da, x d m d da va l o l t cSng chan man t i n h . Cac dau h i l u va t r i l u chdng cda n d cd lien quan rd vdi t a n g ap lUc tTnh mach [1], [2]. Phdu t h u d t duac xem la p h d d n g phdp dieu t n suy tTnh mach man t i n h t r i l t de cd h i l u qua t u y n h i l n phdi dddc t h d c h i l n d u d i gay m l , t h u d n g gdy dau, cd the cd cac bien chdng do vet thUOng va phdi nghl lam viec vai ngdy. Gay x d bpt dUdi hUdng dan cCia sieu am dieu t n suy gian tTnh mach mang lai cai t h i l n dang ke chat lUpng sdng toan the vd do b i n h trong it nhat 12 thang sau dieu trj. Do vay, chung tdi tien hdnh n g h i l n cdu nay nham muc tieu Ddnh gid hieu qud diiu tri suy tinh mach man tlnh chi dudl cOa phuang phdp gdy xabot tai Benh viin Lda khoa Trung uang.
2. Doi tupng va phuTtfng phap 2.1.D6itddng
Tiiu chuan chon benh nhdn
T i t ca cdc benh nhan cd tieu chuan chan dodn STMMT chi d d d i bang s i l u dm duplex t h e o Hdi TTnh maeh Hoa K^ nam 2011 vd Hdi TTnh mach chau Au 2012 [9] (thdi gian d d n g trao ngupc > 0,5s) va phdn dp ldm sang CEAP C2 den C6. Sd ludng benh nhan:
110 tai phdng can thiep tTnh mach, Benh vien Ldo khoa Trung Udng.
Tieu chudn loai trd
Gdm cd: Huyet khdi tTnh mach sau cap t i n h va/hoac t h u y i n tac phdi, nhiem t r u n g tai v u n g t i e m hoac nhiem trCing toan than nang, b^t d d n g keo dai va ndm l i l t giddng, phu n d cd thai, cho con b u , benh d p n g mach ngoai vi nang va n g u y co tac maeh h u y l t khdi cao.
2.2. Phdc/ngphap Thiet ke nghien cUu
Nghien cdu tien cdu m d td cat ngang va theo ddi dpc t r o n g t h d i gian 3 t h d n g .
Qui trinh nghien cdu
Tat ca cac ddi t u p n g nghien edu dupe hdi b e n h t i m i , lam cac xet nghiem mdu, d d n g mdu c d bdn.
d i l n t a m d o , X-quang t i m p h d i va s i l u d m duplex tTnh m a c h . Ddnh gid lam sdng t h e o phdn d p CEAP ldm sang, tfnh cae t h a n g d i e m VCSS va CIVIQ-20 t r d d c d i e u t r i va sau d i l u t r i 1 t h a n g va 3 t h a n g .
Sieu dm duplex tinh mach
Tham kham b a n g s i l u a m duplex can xac dinh cdc trj sd sau: Thdi gian d o n g t r a o ngupc (gidy), d u d n g kinh (mm), chieu dai (cm) T M suy.
Diiu tri gdy xabgt
Sieu dm lai TM dupe dieu trj trude khi t i e m xd.
Xac d j n h vd danh dau vj t r i chpc kim, hUdng dua kim vao T M , xac d j n h t h e t i c h va n d n g d p b p t phu thudc vao d u d n g kinh, loai T M h i l n dupe t i e m theo khuyen cao ciia Hpi TTnh maeh chau A u 2012. Tien hanh tao b p t gay x d . Sat khuan, chpc TM dUdi h u d n g dan cCia s i l u a m bang kim b u d m hoac bdng k i m ludn. Kiem tra vj tri cda k i m x e m da chac chan vdo t r o n g Idng T M . Sau d o t i e m chat gay x d bpt vao idng TM d d d i h d d n g dan cCia s i l u a m . Sau khi t i l m h i t thudc, chen tai vj t r i quai T M bang tay hoac dau d d sieu am d l t h u d c t a p t r u n g Ian vdo he TM ndng, t r d n h v d o T M sau han che b i l n c h d n g .
Rut kim, sat khuan vd d u n g b d n g v d khuan bdng chat lai vj t r i chpc kim. Di tat dp lUc (23 - 32mmHg) sau dieu trj gay x d b p t hang ngay t r o n g 3 tudn.
Theo doi binh nhdn
B i n h nhdn dupe hen khdm lai sau 1 t h a n g vd 3 t h a n g vdi danh gia phan d p lam sang CEAP, thang d i l m VCSS, CIVIQ-20 va sieu dm duplex TM de do dupe kinh T M , xac d j n h d d n g chdy vd DTN.
2.3. XCtl^sd liiu
T i t cd cae sd lieu n g h i e n c d u dupe x d ly vd phan tich t h e o t h u d t t o a n t h d n g ke y hpc t r l n may tinh bang chUdng t r i n h p h ^ n m e m SPSS 20.0.
3. Ket quit
3.1. Dac diem chung
3.1.1. Tuoi vd gidi
Tudi t r u n g binh cCia n h d m n g h i l n cdu la 53,6 ± 11,9, n d gidi chiem d u t h e so vdi nam gidi (79,1%
vs 20,9%).
TAPCHrVDirOCUMSANGlOS Tap 12-561/2017
Bing 1. Sac diem chung cAa nhom nghien clhl
Cdc dac diem
Nam
Nil
Tuoi trung binh Chieu cao (m) C3n nang {i<g) BMI (Icg/m^)
Chung cd 2 nhom
34 24,3%
106 75,7%
54,4 ±12,3 1,59 ±0,06
56,8 ± 7,3 21,8±4,1
Nhom gSyxo (n = 110)
23 20,9%
87 79,1%
53,6 ± 1 1 , 9 1,58 ±0,06 56,8 ±7,3 21,8 ±4,5
Nhom Laser (n = 30)
11 36,7%
19 63,3%
57,3 ±13,5 1,61 ± 0 , 0 6 56,7 ± 7 , 3 21,8±2,2
P
<0,01
>0,05
>0,05
>0,05
>0,05
3.1.2. Cdc yeu to nguy ca
Bdng 2. Cac ylu td nguy ctf cOa suy tinh mach man tinh chi difdi
Cac y^u t6 nguy co Cong viec ddng I3u
Ti^nsCf gia dinh
Qua can 23 <BMI <30 Beo phi BMI >30 Nufcol - 2 con
N(Jfc6>3con
n = 110 95 (36,4%) 36 (32,7%)
40 (36,8%) 2(1,8%)
22 (25,3%) (74,7%)
3.2. The tich vd nong dd bpt dieu tri
Cd 110 TM hien dupe dieu tn bang gay xd bpt, trong dd 104 TMHL vd 6 TMHB. Chieu dai trung binh cda TMHL dupe dilu tri la 20,0 ± 2,3cm vd TMHB Id 17,2 ± 2,6cm. Thi tfch bpt trung binh di^ng trong mdi thd thuat Id 7,1 ± 2,2ml (tdi da 15ml va tdi thieu 3,0mi) va ndng dp bpt trung binh la 1,9 ± 0,5% (tdi da 3,0% vd tdi thieu 0,5%).
3.3. Hieu qua dieu tri gdy xd bgt 3.3.1. Bdp i^g ldm sdng
Phdn dp !am sang CEAP
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N°1/2017
Bang 3 . Phan do lam sang CEAP trilolc va sau g a y x o b o t Thcri gian
CO Cl C2 C3 C4 C5 C6
Trirdc can thiep 0(0%) 0(0%) 31 (28,2%) 47(42,7%) 29 (26,4%) 3 (2,7%)
0(0%)
Sau 1 thang 1 (0,9%) 43(39,1%) 17(15,5%) 17(15,5%) 29 (26,4%) 3 (2,7%)
0(0%)
Sau 3 thang 3 (2,7%) 82 (74,5%) 22 (20,0%) 0(0%) 0(0%) 3 (2,7%)
0(0%) Sau 3 t h a n g , phan S6 C3 va C4 da t r d ve bSng 0, d u y chi co C5 van giO n g u y e n . B a y c u n g chi'nh la diem han c h ^ danh gia d o cai t h i e n cda benh bSng phSn do lam sang CEAP,
Thang Hem VCSS vd aVQ-20
Thang diem lam sang VCSS va t h a n g diem CIVIQ-20 cai thiSn t o t sau can t h i e p gay x o b p t 6 cac thdi diem 1 t h a n g va 3 t h a n g co y nghia t h o n g ke (p<0,001).
Bang 4 Thdi gian TnJ6c can thiep Sau 1 thang Sau 3 thang
. Thay ddi thang diem VCSS VCSS
5,2 ±1,2 3,6 ±1,3 3,1 ± 1 , 2
Khac b i M
-1,6 -2,1
va CiViQ-20 trifdc v a sau dieu trj P
<0,001
<0,001
CiVIQ-20 47,8 ± 1 0 , 6 27,8 ± 1 0 , 5 22,9 ± 5 , 1
Khic biet
-20,0 -24,9
P ,
<0,001
<0,001
3.3.2. Thdnh edng gidi phau vd huyet dong
Sau 3 thang d i l u trj gdy x o bpt, t i le tac hoan toan ci!ia T M nghTa Id k h d n g cd d d n g chdy c h i l m 66,4%. Ti I I tac m d t phan nghTa la cd d d n g chay n h d n g DTN < 0,5s Id 20% vd t i le t h a t bai (DTN > 0,5s) la 13,6%.
Bang 5. D i f d n g I d n h T M v a d o n g t r a o ngi/tfc t r d d c v a sau d i l u t r j Thcri gian
Trucfc can t h i f p Sau can thiep 1 thang Sau can thiep 3 thang
eKTIVI(cm) 5,7 ± 1 , 6 4,7+1,4 4,1 ± 1 , 4
Khong co dong chdy 0(0%) 73 (66,4%) 73 (66,4%)
DTN <0,5s 0(0%) 14(12,7%) 22(20,0%)
DTN >0,5s 30(100%) 23 (20,9%) 15(13,6%) 3.3.3. Bien chC^g
Trong 110 b i n h nhdn dddc gdy x d b p t dieu t n suy tTnh mach m a n tfnh chi dudi, c h u n g t o i khdng gap cac bien chdng nang n h d h u y l t khdi TM sau, t h u y e n tac phdi, d o t quL Cd 2 b i l n chdng gap t r o n g nghien eiJ^ d d la dau dpc TM dUpc gdy xo b p t va rdi loan s a c t d da.
TAP CHf Y DUdc U M SANG 108 Tap 12-S6 1/2017
4 . Ban ludn
4.1. Ddc diem chung
Ti le mac benh suy tTnh mach gia t a n g t h e o t u d i , do d d cac t o n t h d o n g t h d n h tTnh mach t h u d n g dupe eao bdo nhieu h o n d tTnh mach ngUdi cao t u d i . Capitao LM vd cs (1993) ghi nhan n h d m t u d i t h u d n g mdc STMMT nhieu nhat la 55 - 64 t u d i , d d n g t h d i nhan manh t u d i la yeu t d quan t r p n g dnh h u d n g den t y f l mac b i n h . Tudi t r u n g b i n h ciia BN suy T M man tfnh t r o n g nghien cdu cua Blaise va cs nam 2010 la 53 va cua T. Beckitt va cs (2011) la 55 [2] . Tudi trung binh cda BN nghien cdu cda chOng t d i la 53,6 ± 11,9. Cac yeu t d nguy ca ldm sdng cua b e n h STMMT chi dddi dupe d l cap den bao g d m t u d i , gidi, nghe n g h i l p d d n g Idu, t i l n sd gia dinh, sd Ian sinh con d n d v a thda can, beo phi.
4.2. The tich vd ndng dp bpt ddng cho moi thd thudt
Chung t d i da gay x d b p t d l dieu trj cho 110 benh nhdn STMMT bao g d m cd 104 TMHL (94,5%) va 6 TMHB (5,5%). Chieu dai t r u n g binh cua TMHL dUpc gay xd bpt 20,0 ± 2,3em vdi d d d n g kinh t r u n g b i n h TMHL tren gdi Id 5,7 ± 1,5mm vd TMHL dUdi gdi la 5,1 ± 1,3mm. C h i l u ddi t r u n g binh cCia TMHB dddc gay x o b p t la 17,2 ± 2,6cm vdi d d d n g kinh t r u n g binh 6,7 ± 2,0mm. NhU vdy, TMHB dupc gay x o b p t tuy cd c h i l u dai t r u n g binh ngan hdn n h d n g d d d n g kfnh trung binh lai Idn hdn do TMHB d m d t sd b i n h nhan dieu trj gidn rat Idn, t d i da den 9,8mm. Kfch thudc nay la phu hpp cho chi djnh dieu t n gdy x d bpt [6] vd cung t u o n g d d n g vdi m o t sd tac gia khde t r l n t h e gidi. D u d n g kinh t r u n g binh cua TM hien
\dn t r o n g nghien cdu cua Yamaki vd cs (2009) Id 6,7mm [10] va cua Rabe va cs (2008) la 7,6mm [8].
De dat dupe hieu qud gay xo b p t t d i da chung t6i da sd d u n g ndng dp polidocanoi va t h e tfch b p t dCing cho t d n g thO t h u a t dda vao loai TM dupe can thiep, dudng kfnh vd c h i l u dai doan TM dupe can t h i l p theo h d d n g dan cua Hdi tTnh mach chau Au 2012 [9]. The tich bpt t r u n g binh dUng cho moi t h u thudt dieu t n TMHL Id 7,1 ± 2,2ml (3,0 - 15,0ml) vd
TMHB la 4,8 ± 2,2ml (3,0 - 9,0mi). The tfch b p t s d d u n g dao d p n g t h e o cdc tac gid khac nhau t h e o d d gidn va chieu ddi cda d o a n TM d d p c d i e u t n . Ket qua n g h i e n cdu cda c h u n g t d i ve t h e tich b p t t r u n g b i n h cho m o t Ian d i l u t r i tdcflig t U vdi ket qu3 cua m o t sd tde gid. O'Hare (2008) va cs gay x d cho 165 BN, t h i tfch b p t s d d u n g t r u n g b i n h la 8 m l ( t d 2 - 14ml).
Figueiredo va cs da d d n g t h i tfch b p t t d i da Id 10ml [5]. Rabe vd cs (2008) khi d a n h gia tfnh an t o a n va h i l u qua cua phUdng phap gdy x o b p t cho 106 T M h i l n Idn, t h e tfch b p t chi duac d u n g k h d n g qud 5 m l m d i Ian [8].
T>iudc d d d c d d n g di gdy x p t r o n g nghien c d u cua chung t d i la Polidocanoi. Thudc t h u d n g dupe san xuat d n d n g d p t d i da la 3% va day cQng Id n d n g dp t h u d c t d i da t h e o k h u y i n cao [9]. Ndng dp t h u d c lam gia t a n g b i l n c h d n g cda d i l u t n gay x o . M o t t h d n g h i e m mCi ddi da t r u n g t d m cua Blaise va cs (2010) sau 3 nam t h e o ddi t h a y rang hieu qud gdy tac T M d 2 n h d m Polidocanoi 1 % va Polidocanoi 3% la n h d nhau, n h u n g n h d m Polidocanoi 3% cd 9% bien chdng tai eho, cdn n h d m s d d u n g Polidocanoi l % c d 6% b i l n chdng tai chd [2]. Ndng d p t r u n g b i n h cda Polidocanoi d u n g cho dieu trj TMHL la 1,9 ± 0,5%
(tdi t h i l u 0,5% va t d i da 3,0%) va TMHB la 1,0 ± 0,5%
(tdi t h i e u 0,5% va t d i da 2,0%).
4.3. Dap dng ldm sdng cda gdy xabot Phdn dp ldm sdng CEAP
Phan dp ldm sang CEAP la m o t edng cu tdcmg ddi d d n gidn giOp ddnh gia d p nang cua STMMT chi d u d i tren ldm sang va d a n h gid dap d t i g dieu t n cua benh. K i t qud sau 3 t h d n g dieu trj dien t i l n t h u a n Ipi. Khdng ed bieu hien ndng len cda ioet T M C6 (0).
D p C2 gidm t d 28,2% cdn 20,0%, C3 giam t d 42,7%
cdn 0%, C4 giam t d 26,4% cdn 0,9%, C5 g i d n g u y e n 2,7%. Trong khi d d CO va C l Ian lupt t a n g len 2,7%
va 73,7%. K i t qua t d Bang 2, sau 3 t h d n g p h a n d p CEAP la CO (3), C l (81), C2 (22), C3 (0), C4 (1), C5 (3), C6 (0). K i t qud nay p h i j h p p vdi n g h i l n c d u cua Coleridge Smith va cs [3], [4]. Phan d p lam sang CEAP t h d c s u h d u ich t r o n g ddnh gia ldm sang b e n h nhdn STMMT vl sU t i l n Ipi vd nhanh g p n cua n d , n h d n g phdn dp nay cung bdc Id khdng it n h d n g
45
JOURNAL OF 108-CLINICAL MEDICINEAND PHARMACY -N 1/2(5
nhuoc diem. Trudc hSt, n6 hoan toan la cac trieu chiing thUc the, phu thuoc hoan toan vao quyet djnh cua bac sT khi tham kham. Them vao do, phan dd lam sang CEAP khi bSnh da co bien chiing nhu loetTM da lanh seo (C5) thi khong t h i het seo ngay ca khi dilu trj gay tac TM thanh cong. VSy nen can CO th6m cac thang diem ho tro cho vi$c danh gia dap ufng dieu tri cCing vdi phan do lam sang CEAP.
Thay doi thang diem VCSS sau dieu tri gay xa
Bilm VCSS trung binh trong nghiSn ciJu cfia chljng toi gi5m 2.1 diem tuong di/ong 40% sau 3
thang dilu trj (p<0,001). Nghi4n cilu Bountouroglou DG va cs (2005), sau can thiep 1 nam
diem VCSS trung binh giSm 4 diem tUOng Ling 80%.
Blaise va cs (2010) da thUc hien tiem xa cho 143 BN, sau 6 thang, diem VCSS trung binh tCi 4,5 xuong con 1,3 diem (giam 3,2 diem tuong dUOng 71%) sau 3 nam theo doi thi chi con 0,8 diem [2J. So dilm gilm trong nghien cuTu cDa chiing toi it hon cac tac gii tren, mot phan vi chung tdi m6i theo doi BN dUOc sau 3 thang va moi chan chi thue hien 1 Ian tiem trong nghien cuU nay.
Thay dot thang diem CtVIQ-20 sau dieu tri gay xa
Trong nghien cilu cOa chung toi, diem CIVIQ-20 trung binh giJm d i n 24,9 dilm tuong duong 52,1%
sau 3 thang dieu tri (p<0,001). Kit qu^ nghien cijfu cCia chung toi tuong tU nhu nghien ciJu cua Francoise P nam 2009 [25] va Blaise S va cs nam 2010 [2] . Qua do cho thay, benh nhan STMMT chi ducfi sau dilu trj bang gay xo, chat luong cuoc song cCia benh nhan da c3i thi&n han va sU cai thien nay tien trien theo thdi gian.
Thanh edng gidi phau va huyet dong cda gdy xabgt
Sau dieu trj gay xo bot Polidocanoi, dudng kinh TM trung binh trong nghien cUu cda chOng toi (Bang 4) giJm 1,0mm tuong dudng 17,5% sau 1 thang dilu trj va giSm 1,6mm tuong dUdng 28,0%
sau 3 thang dieu tri. Kit qua nay cung tuong duong khi so sanh vdi Rabe va cs (2008) gSy xo bot cho 54 TM hiln Idn, sau 3 thang dudng kinh TM hien Idn
each quai 3cm tCf 7,7mm xuor " " «i41 1,9mm = 25%), c4ch quai 25cm " i " i ™ % 5,5mm (giim 1mm = 15%) [8]. '"'*"• ' ' * " <^^
chinh danh gia hieu q u i trong tiem xd la khJ nang;
gay tSc nghen va/ hoac khong con ddng trao ngUff TM chU khong ph5i I i sU thay ddi dUdng kinh TM, Khi mdtTM bj tac hoan toan, td chdc ben trong'lonf mach thay vi cdn ddng chSy va in xep thi da bj ISp tac dly bdi huyet khdi va td chUc xd. I n khdng xep.
Ciing vdi thdi gian, nhufng td chUc nay d i n bj tilu ffl, xo hda, Idng TM co nhd lai va cudi cung bien TM 36.
chi cdn la soi xo nhd dudi da.
Sau 3 thang gay xd bot ti 1$ TM khdng cjii ddng chay cua chiing tdi la 77 (66,4%), DTN s 0,5s la 22 trudng hop (20%) va DTN > 0,5s la 15 trudng hdp (13,6%) (BSng 4). Nhu vay, ti le thanh edng cDa gay xo bpt trong nghien cilu cCia chung tdi sau 3 thang dieu trj IS 66,4% gay tac hoan toan, 20% gay tac m6t phan va 13,6% that bai. Kit q u i nay cung gin xap xl vdi nghien cdu cOa O'Hare va cs (2008) dieu trj gSy xd cho 165 BN, sau 6 thang, ti le thanh edng: Tk hoan toan 74%, tie ban phan 14%, that bai 16% [7).
Thomasset va cs (2010) tiem xo cho 126 BN, sau 3 thang tac hoan toan 79%, tac ban phan 10%, thit bai 6%. Ket qua cOa cac tac giS khac nhu Beckitt v^
cs (2011) t i l m xo cho 235 BN, ti le tie nghen sau 8 tuan la: hoan toan (86,5%), ban phan (12%), that bai (1,5%) [1]. Neu gdp chung ti le gay tac TM hoan toan va khdng hoan toan, thanh edng ciJa dieu trj STMMT chi dudi la 86,4% va that bai la 13,6%.
4.3.7. That bai va bien chiing
Phan tich eae y l u td gSy 4nh hudng d i n that bai cCia phUdng phap gay xd, chung tdi nhan thay chi c6 dudng kinh TM > 7,5mm vdi OR = 6,3 (3,9 -10,0) la ed y nghTa thong ke (p<0,001).
Trong nghiln cOfu cCia chUng tdi chi gap 2 loai
bien ehUng do la dau doc theo TM duge tiem chiem
44,5% va rdi loan sic td da 36,4%. Cae bien chuTig,
khac hau nhu khdng gap. Cd le sd luong benh nhan
Chung tdi khdng nhilu, ky thuat dieu trj dUOc tuan
thO tot nen han chi tdi da eae bien chdng va tac
dung phu.
TAP CHfy Dl/OC U M SANG 108 Tip 12-S61/2017
5. Ket luan
Gay x o b p t la p h d d n g phdp d i l u t n h i l u qud, an todn va x a m nhap t d i t h i l u vdi t i le bien chilftig khdng ddng ke. TI le t h d n h edng cCia gdy x o b p t trong n g h i l n c d u eua chung t d i la 66,4% gdy tde hodn t o a n , 2 0 % gay tde m d t phan.
Tai lieu t h a m khao
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