Y H o c T P . H o C h i M i n h * P h u B a n T a p 1 9 * S o 5 * 2015 N g h i e n c i h i Y h p c
KET QUA SOM PHAU THUAT NOI SOI CAT LACH VOI DAO DIEN DON OJC DIEU TRI CAC BENH LY CO CHI DINH CAT LACH 6 TRE EM
Pham Vdn Phu*, Hdn Cdnh Dinh*, Phan Xudn Cdnh*, VoXudn Thanh*, Nguyen Vdn Phien*, Le Bd Thao*, Biii Thien Thjnh*
TOM
TATMuc tieu: Trinh bdy kit qud sam phau thuat noi soi cat lach vai dao diin dan ciec dihi tri cdc benh ly co chi dinh cdt lach a tre em.
Phuang phdp nghien cdu: Tien ed'u mo td cdc truang hap lach Icni henh ly co chi dinh cdt lach a tre em.
PMu thudt noi soi dugc tieh hdnh vai tu the treo Idch, dimg 3 trocar roh 10 mm dimg dqt den soi vd Id'y lach sau cdt, ho'chau trdi 10 mm dedung haemolock neu co vd sau mo'dedat ddn luu hd'ldch, thuang vi 5 mm. Lddi sau khi gidi phong todn bo, duac cho vdo tdi diing keo Ion dua qua Id trocar 10 mm a ho'chau trdi di'cat nho trong tui chim vd sau do dugc la'y ddn qua lo trocar roh. Dqt ddn luu hd'ldch qua 16 trocar 10 mm a ho'chau trdi.
Kei qud: Tie tlidng 10/2008 deii thdng 10/2014 co 8 truang hap duac dugc phdu thuqt, 5 nam; tuoi tie 5-15.
Tai cd cdc truang hgp deu co kit qud toi, xudi viin sau 5 ngdy, khong co tai bieh vd bie'n chieng, tlieo doi deh 1 thdng sau mo deu oh dinh.
Kit ludn: Cat Iddi ngi sot vdi dao dim dan circ o tre emcd tinh kha thi cao, tuy nhiSn so'lieu con it nen cdn nghiSn cuu them nua.
Tit khoa: Noi soi cdt lach.
ABSTRACT
THE THE SOON RESULTS OF LAPAROSCOPIC SPLENECTOMY WITH UNIPOLAR KNIFE FOR DISEASES OF INDICATED SPLENECTOMY IN CHILDREN
P h a m V a n P h u , H a n C a n h D\nh, P h a n X u a n Canh, Vo Xuan T h a n h , N g u y e n Van Phieiv Le Ba Thao, Bui T h i e n Thinh* Y H o c TP. H o Chi M i n h * S u p p l e m e n t of Vol. 19 - N o 5 - 2015:49 - 55 Objective: To presait the soon results of laparoscopic splenectomy zoith unipolar knife for diseases of splenomegaly in children.
Method: Prospective, descriptive. The patiaits zoere applied laparoscopic splenectomy zoith unipolar knife.
Results: From Octorber, 2008- Octorber, 2014, there zoere 8 cases, age. 5-15 years old, aidergoing laparoscopic splenectomy. The soon results loere good, no complication, postoperative folloioed up 4 wedcs zvere stable.
Conclusiotis: Laparoscopic splenectomy in children may be carried out safe and jeasible in provincial
Key words: Laparoscopic splenectomy.
F>AT V A N D E 1991va sau d o d u g c c h a p n h a n la tieu c h u a n v a n g t r o n g p h a u t h u a t cat lach n h a cac u u die'm P h l u t h u a t npi soi cat lach- la p h a u t h u a t cat ^ ^ , ^^^ ^^^^ ,^ ^^^ ^^^ ^ ^ ^ - ^ ^ ^ ^ ^^^
b o lach to b e n h ly h o a n toan b a n g d m m g n o i so.- ^^. ^^^^ ^ ^ ^y^^^^ -^ ^ ^ ^ ^^^ ^ g ^ ^ ^ ,^ ^ d u o c Delaitre 6 Paris t h u c hien Ian ^ u tien n a m
*Benh \ i e n Da khoa tinh Binh Efjnh.
Tdc gid hen he- BS Ph^m Van Phii, DT: 0914004337, Email: [email protected].
Nghien cmi \ hpc Y Hpc TP. Ho Chi M i n h * Phu Ban Tap 19 * So 5 * 20^
diem na>' cang co y nghia hon voi cac benh nhan nhi(i"-"-nt.
Nho cac tien bo ve may moc trang thiet bi dung cu phuc vu mo npi soi nhu dao cat sieu am, dao han mach, Ligasure, cac clip cap mach mau, ban tay ho trp viec cat lach bSng phau thuat npi soi se fhuan lpi hon rat nhfeu khi giai phong cac mach mau va hien da dupc ung dung rpng rai a cac tnmg tam lon tren the gjoi ciing nhu 6 Viet Nam, tuy nhien cac dung cu nay rat dat tienf^Aio^.
Tai mpt so benh Wen tuyeh tinh voi nhung dan may noi soi trang bi toi thieu vdi dao di^n don cut thi vi?c xu ly cac mach mau cuong lach CO dam bao khong, sau khi cat lach viec lay lach ra ngoai nhu the nao de dat yeu to tham my ? Noi chung la tai cac benh vien chi trang bi dan may mo npi soi voi trang bi toi thieu thi \^ec cat lach npi soi co kha thi khong ?
TlT nam 2008 khoa Ngoai Tong hpp Benh vi?n da khoa tinh Binh E>inh bat dau trien khai ung dung cat lach npi soi \'ai dao dien don cyc.
De tai nham bao cao ket qua som cat lach bSng phau thuat npi soi dieu tri cac benh ly co chi dinh cat lach o tre em.
Mye tieu nghien cuu
Danh gia ket qua som phau thuat npi soi cat lach voi dao di^n don cue dieu tri cac b^nh ly co chi dinh cat lach 6 tre em.
DOITirONG-mi/ONGraAPNGHIENaJlJ Doi tirong
Tieu chuah chgn benh
Cac benh nhi duoc phSu thuat noi soi ck lach voi dao dien don cue.
Cac benh nhi lach lon benh Iy co chi dinh cat lach.
Tieu chuan loai trit
Cac benh nhi khong dii dieu kien gay me npi khi quan, khong dii dieu kien de tien hanh phlu thuat npi soi.
Cac benh nhi co lach Ion khong lo voi duong
kinh lach lon nhat > 20 cm.
Dia diem
Khoa Ngoai Tong hpp, Benh vien da khoj tinh Binh E)inh.
Thai gian
Thang 10 nam 2008 den thang 10 nam 2014 Phmmg phap
Thiei ke'nghien cihi | Tien cuu, mo ta.
Cdc bttac tieii hdnh
Hoi chain voi cac bac sy Nhi khoa va Huyet hpc voi cac trucmg hpp benh nhi lach Ion b?nh ly va CO chi dinh cat lach.
Chuaii bi cac xet nghiem tien phau thirong qui, Ien lich mo phien.
Benh nhan dupc gay me npi khi quan, nita nghieng phai khoang 600. D|t trocar ron cho den soi va 2 trocar thao tac duoi ba suon trai (5 mm) va ho ch^u trai (10 mm) de co the dimg dip hole Hemolock va sau mo dupc dung de dat ong dan luu ho lach.
Sau khi bam hoi, tham do 6 byng va go dmh neii CO de tiep can cue duoi lach, dung dao dien don cue cat day chang lach dai trang, hoanh d^
trang, ha dai trang goc lach, ma tiii cung hau cung mac noi dong thai voi cat mach vi mac m de vao hau cung mac noi. CSt day ching vi ladi cimg cac dpng mach vi ngan tir cue duoi len cip:
tren lach, thay ro duoi tuy va cuong lach, mcr phuc mac thanh sau bpc Ig dong mach va liih mgch lach. E)ua lach sang phai, c3t day chimg lach - than, hoanh - lach tir duoi len ti^n, ladi chi con Ii§n quan den duoi tuy. Phlu tich cuong lach, xir ly dpng mach va tinh mach lach bJi^
bupc chi hoac Hemolock, trong qua trinh phau tich lach tiiy theo vj tri phlu ti'ch ma co the tgo them thuan lpi bing each sir dung linh hoat cac tu the ciia ban mo de hS trp them nhu nang cao dau, nghieng them sang phai. Benh phain dirge cho vao tlii nilon, dimg keo lon dua vao 6 bung qua 16 trocar 10 mm 6 ho chgu trai cat lach tiong hii thanh cac manh nho, hiit het mau. Din luu
i \
Chuyen D e Ngo^i NW
Y Hoc TP. H o Chi Minh * Phu Ban Tap 19 * So 5 * 2015 Nghien cun Y hpc ho lach bang ong chat deo qua 16 trocar 10 mm o
ho ch§u trai. Bom nia hiit sach dich trong 6 bung va dua tui dung lach ra 16 ti-ocar ron da dupc banh rong, dung pince cap bop nat cac mau lach va lay dan ra ngoai qua 16 trocar ron.
Sau mo: Theo doi cac bien diung, sir dung khang sinh, cham soc vet mo, nit dan luu 6 bung khi kho dich.
Bdnh gid kei qud
Bangl: Cdc dac diem ldm sdng va can ldm sdng:
Dua vao tinh trang benh nhan trong va sau mo, cac tai bi&i va bieh chiing ket qua sau mo, KETQUA
Tir tiiang 10/ 2008 ~ 10/2014 tai khoa Ngoai T6ng hpp Benh vien da khoa tinh Binh Dinh co 8 benh nhan cat lach noi soi duoc mo cimg mpt nhom phau thuat vien, trong do Nam: 5, nil: 3;
Tuoi: tir 5 - 1 5 , thuong gap nhat: 8 tuoi.
ChSn doan hinh anh Lach Ion, giam teu ciu,
hgi chung gia Cushing
Lach Icrn, thieu mau Huy^t do, tuy dogiam 3 dong
Lach Ion, thieu mau
Lach Ion, thieu mau Sieu am, CT-scanner
Lach Ion, thi^u mau Thi^u mau. Thabssemie
Lach Ion, thieu mau Sieu am, CT-scanner Huyetdo, tuy do giam 3 dong Lich Ion, thieu mau Sieu am, CT-scanner Huyet 6b, tuy do giam 3 dong Lach Ion, thieu mau Sieu am, CT-scanner Huyetd6, tuy do giam 3 dong Nhdtt xet: Tat ca b?nh nhan deu co tinh trang
thie'u mau va lach lon 6" cac muc dp khac nhau.
Bdng 2: Chan dodn.
Chin doan tnroc mi Giam tieu cku vo can
Cud-ng lach Thalassemie
SdliPpng 1 4 3
T7I?%
12,5 50,0 37,5 BdngS
Lach I6nd9
II ill IV IV III IV IV IV
Ddc diem bmh hgc, thai ^ ThoH
gian m6(
phut) 100 120 120 150 120 120 150 120
Rut dng d i n i u v saumS (ngay) 3 3 3 3 3 3 3 3
Sd trocar
3 3 3 3 3 3 3 3
ian mo', kil qud:
sau mo (ngay) 5 5 5 5 5 5 5 5
K i t qua
Tot Tot Tot Tot Tot Tot Tot Tot Nhdn xet. Da so trucmg hpp la lach lon do HI, IV.
Tat ca cac lach sau khi cat xong dupc cho vao hii cii dimg keo lon dua qua lo b-ocar 10 mm o ho chau trai ck thanh manh, bop nat va lay qua Io trocar ron.
Ta't ca cac truong hpp deu dupc dat dan luu ho lach qua 16 trocar 10 mm a ho chau tiai.
Ket qua hinh anh vi the; cac mau lach deu co hinh anh cuong lach.
Kh6ng CO til vong, trong va sau mo khong co tai bioT, bien chiing.
Tat ca cac benh nhi theo doi trong 1 thang sau mo deu on dmh co xet nghiem cong thiic mau trong gioi h ^ binh thuong khong co chi dinh truyen mau.
BANLUAN
Chi dinh phau thuat cat lach npi soi do benh Iy huyet hpc nhu xua't huye't giam tieu cau huyet khoi, giam heu cau tu mien trong do chu yeu la xuat huyet giam tieu cau v6 can, cuong lach, thieii mau huye't tan , hien nay da co nhieu tac gia cat lach npi soi trong cac truang hpp benh ly ac tinh tuy nhien van con nhieu ban cai, chiing t6i kh6ng truang hpp nao co benh mau ac tmh.
Cac benh nhan vao vien vi thieu mau, lach Ion va tien sir co truyen mau it nhat la 1 fan. Co 1 benh nhan xuat huyet giam tieu cau v6 can da dupc dieu tri corticoide lau ngay gay hpi chiing
Nghien ctru Y hoc \ Hoc TP. Hb Chi Minh * Phu Ban Tap 19 * So 5 * 2015 gia Cushing con lai la benh nhan cuong lach va
Thalassemie.
Ve kich tiiuoc lach cac benh nhan aia chiing t6i da so la lach Ion dp IV, chi co I tniong hpp lach lon dp IL Tir 2007 den 2009, Nguyin thanh Liem cat lach noi soi cho 14 benh nhi xuat huyet giam tieu cau, hong a u nho hinh (su, thieu mau tu mien, Nguyen Hoang B^c cat ladi cho cac b#nh nhan xuat huyet giam tieu diu v6 can cho ket qua sau mo rat tot^"'.
Theo Habermalz cat lach npi soi dupc chi dinh cho cac lach lon (lach co d < 15 cm), voi lach khong 16 (d > 20 cm) thi nen phau thuat npi soi voi ban tay ho trp. Voi cac truang hpp tang ap CLia do xo gan can can nhac cat lach npi soi nhu 1 chong chi djnh.
Ve ky thu4t
Chiing toi dat tu the benh nhan nam nghieng phai khoang 60", vao 6 bpng bang 3 trocar, r5n cho den soi, ho chau trai 10 mm de CO the dimg clip ho^c hemolock. Phau b'ch thuang bat dau 6 cue duoi, cue tren, vao hau cung mac noi xir ly dpng mach lach roi Snh mach lach. Trong qua trinh phau tich lach thuang chiing toi thay doi them tu the ban mo de tao dupc phau truong toi uu.
Habermalz voi tu the nam ngira co the de dang di vao h|u cung mac noi de den cuong lach nhung se kho kh5n khi cit cac day ching lach cung nhu xir ly cac mach mau 6 m^t lung va sau lach. Vdi tu the nam nghieng hay " ky tfiuat treo lach" cua Delaitre \'iec cat cac day ching lach se thuan lpi hon, cung co the nghieng ban 900 se de phau b'ch cuong lach hon, kiem soat tot duoi tuy nen thoi gian mo se nit ngan va co the ap dyng cho lach khong lo"-*>. Thoi gjan mo tmng binh cua chiing toi la 125 phiit (100- 150 phiit), Nguyin Hoang Bic 90 phiit (50-140 phut), Nguyen Tan Cuong 186 phiit Nguyin Thanh Liem 100 phiit cho tfiay viec phau thuat npi soi cit lach vai dao di?n dan cue tuy thoi gian mo co dai ban so voi Nguyen Thanh Liem va Nguyen Hoang Bic nhung kh6ng dang ke'"-^"'.
Ji so sanh viec phau tich lach duong truoc va duong sau ben tac gia thay rang duong sau ben hieu qua \a an toan hon duong truoc voi cac lachc6d<30cm<^i.
Machado sir dwig dung cu bpc lp ran lach theo 3 goc lam tang dp an toan khi xir ly cuong lach nhat la khi duoi tuy dinh chac vao cac m?ch mau ron lach'"'.
Hien nay cac tuyen tinh chu yeu la su dung dao dien don ciic, loai dao nay co cac han che nhu : Cac may phat dien tiep dat co the gay ra nhiing ton thuong tai ch6 ke tiep nhau thuong o nhimg vimg nhu tay hoac chan. Nguyen nhan la do dong di?n luon tim kiem con duong de tro ve dat nen bat cii vat kim loai nao tiep xiic ngau nhien voi b^nh nhan, nhu la cai gja kim loai de treo dich truyen hoac de dung monitor theo doi bgnh nhan, ban mo co the xem nhu la 1 dien cue hap dan dong dien va lam tr#ch huong tro ve ciia dong di?n. Dong di?n nay se tgp trung va lam bong benh nhan t^ cho noi ma dong di?n tiep xiic vdi vat kun loai de co ging tiioat ra khoi CO tiie. Do dd, xay ra hien tupng phlu thuat vien dang dimg dao mo dien 6 vimg byng ma benh nhan bi chay bdng dien d tay hoac chan va cac dao nay van thudng dupc sir dung d cac benh vi?n tuyen huy?n, tinh. Phlu thuat npi soi dimg dao mo' don cue cd the Iam tang them cac nguy CO nhu: tiep xiic tryc tiep: dieu nay cd the dan den ton thuang nghiem trpng tren b|nh nhan ma khong ludng trudc dupc. Phlu thu|t vien co y t30 tiep xiic true tiep: cham dau dao dien dang hoat dpng vao dung cu khac de cam mach mau nhd hay chd dang chay mau hoac ddi khi phlu thuat vien vo y chgm dau dao dien dang hoat dpng vao dung cu khac d ngoai phlu trudng;
tiep xiic dien dung; xay ra khi 2 vat dan di^n dupc tach rieng bdi 1 ldp each dien ne'u ldp each dien tren dung cu npi soi bj tide, ch6 bi trdc ldp each dien cang nhd, dong dien tap trung cang cao, gay ra ton thuong cang nghiem trpng hogc nguy CO chay no trong phdng mo, chay bdng tgi ch6: khi su dung h^ thong may phat tiep dat Khi dien cue thu hoi tiep xuc khong tot vdi co the
Chuyen De Ngo^i Nhi
Y Hpc TP. Hb Chi Minh * P h u Ban T a p 19 * So 5 * 2015 Nghien cun Y hpc benh nhan chay bdng cd tiie xay ra tai eho dien
cue thu hbi. Cac may hien nay deu ed he thong theo ddi de bao dam su tiep xiie ciia dien cue thu hbi vdi benh nhan.
Dao di^n chiing tdi sir dung trong mo la don cue thuong se eo nlueu nguy co hon khi mo so vdl cac loai dao khac nhu dao sieu am, han mach, ligasure do dd thdi gian mo se lau hon, viec lip dat tiiiet bi can tijan tfiu chgt che tiieo quy trinh hudng dan tranh xay ra tai bien ve dien, khi phau tich chiing tdi phai di timg mau nhd, cam mau ky, cac mgch mau khoang 2 mm trd len phai bu^c chi, han che kep clip kim Ioai vi CO the cham dien khi bdc tach hep hoac bi tupe.
Ket qua la tat ca cac trudng hop aia chiing tpi deu cd ket qua to't khdng cd tai bien, bien chung trong va sau mo.
Neu sir dung dao sieu am, staper mach npi soi, stapler GIA se kiem soat mach tot hon, giam mat mau va md nhanh hon. Dao han mach, ligasure, dao sieu am sir dung rat tot cho cac mach den 7mm nen rat an toan, giam thdi gian mo.
Esposito so sanh mo md eat lach vdi mo npi soi cho thay thdi gian md npi soi lau hon (170 phiit so vdi 100 phut), ngay nam vien ngan han.
Hasan cat lach npi soi giam nhiem khuan vet mo, ap xe dudi hoanh, nhiem khuan phoi, giam thdi gian dieu tri phye hbi nhanh honC>.
Theo Lee, Nguyen Tan Cuong vdi nhimg phlu thuat vi§n ehua cd kinh nghiem hoac lach ldn khong Io nen trieh khai cat lach npi soi vdi ban tay tro giiip trudc sau dd mdi trieh khai cit laeh hoan toan bing npi soi. Cac trudng hpp chiing tdi deu phau thuat thanh cdng khi sir dvng 3 trocar, 2 tioear 10 mm d ron va hong trai, 1 trocar 5 mm d dudi sudn trai nhd ap dung ky thuat treo lach va liinh hogt thay doi tu the ban md' de tao khoang phau trudng thuan lpi. Theo Hasan da so tae gia sir dung 5 trocar, Park dimg 4 ti-ocarP>.
De' lay lach ra ngoai thudng la cho vao tiii eat nhd, bdp nat \a lay qua 16 trocar ron nhu chiing
toi va da so tac gia hoae ed the lay lach qua dudng rach Pf annenstiel hoac dimg dao sieu am hoac dimg Morcellator de nghien lach*^.
Cac bien chung cat lach npi soi Trong 8 trudng hop cit lach ndi soi chiing tdi chua gap tai bien, bien chiing nao vi chiing tdi phau tich timg it mpt tao phau trudng that tdt cam mau ky.
Thdi gian nam vien sau md ciia chiing tdi ed dai hon cac tac gia khae vi chiing toi muon sir dung khang sinh sau md du 5 ngay nham tranh cac nguy ca nhiem khuan do suy giam mien dich sau cat lach.
Theo nghien ciru oia Targarona ti le chuyen md md 7,4%, bien chiing 18%. Cac bien chiing hay gap nhu tiioat vi Id tioear, thiing tang, viem tuy, rd tuy, tac rudt viem phd'i, huyet khoi, sot lach phu, chay mau 6 bung, chay mau Id tioear, nhiem khuan(">. Nguyen Thanh Liem cd 2/12 trudng hpp chuyen md md do chay mau, Nguyen Hoang BSc cd 7/18 trudng hpp chay mau duoc xir ly thanh cdng bang each them trocar cpt chi, dimg stapler*^. PHan ldn cac bien chung nay theo chiing tdi ed the tianh dupc neu kiern tra benh nhan trudc mo ky, toan dien, trong md can bpc Id rd rang phau fa'ch caii than va khdng ngan nggi chuy&l md md neu thay cudc md khdng thuan lpi.
KETLUAN
Phau thuat npi soi eat lach benh ly vdi dao dien don cue dupc tien hanh tien 8 benh nhi dat ket qua tdt. Dieu nay cho thay eat lach npi soi d tie em ed the duac tien hanh vdi 3 trocar vdi ky tiiuat treo lach va Iinh hoat thay ddi tu the ban mo de tao phlu trudng thuan led. Khi sir dung dao dien don cue can ludn tuan thii quy trinh de dam bao an toan ve dien, viee cam mau can chinh xac, chac chan, ket hpp vdi bude ehi va cd the sir dung them hemolock de xu Iy bd mach laeh. Lach sau khi cat cd the qua 16 trocar ron bang each cat nhd lach tiong bao va lay dan qua rdn. Ket qua nay cung ehiing td d eac tuyen tinh vdi dan may npi soi duoc tiang bi toi thieu phau
Nghien cuu Y hoc Y Hpc TP. Hb Chi Minh * Phu- Ban Tap 19 * Sb 5 * 2015 thuat cat lach npi soi cd the dupc tien hanh o cac
b|nh nhi, tuy nhien de tai vdi sd' lupng b#nh nhan edn it do dd can cd nghien ciiu vdi so lupng nhieu hon niia.
TAI LIEU THAM KHAO
1 Habermalz B, Saueriand G, Dedcer B. et al (2008) Laparoscopic Splenectomy Hie Chiical Guiddines cf The E u r c ^ a n Associaboii tor Endoscopic Smgov. Suig BidoGC.
22. pp 821-48.
1 Hasan U. Sev'^ B, Mehmet AB, et al (2013) Laparosccpic Splenectomy and Infection. J Microbicd Infecl IHs. Vd. 3,No.l, March, pp-1-2
3 Hdira A. Walker p , Tagge EP, el al (1998). A new tedmique for Laparoscope Splenectomy wHh Massv'dy Enlarged Spleens. The Amencan Surgeon. Dec VoL 64: pp. 1161-64 4 Jl B, Wang Y. Zhang P, et al (2013) Anterior Versus
Posterolateral Approach for ToiaJ Laparoscopic Splenectomv A Comparative Study lntJMedSa.VoLiapp222-229.
5 Lee WF, Wu S C Yong C C et al (2010) Hand-assisted Laparoscopic Splsiectomv - Pidiminary Experaioe m Southem Taiwan. Chang Gung Med J 33; pp.67-72.
6 Machado M A C Makdiss FF, Herman P, et al (2004) Evposure of ^ l e n i c hJum Increases Safety of Laparoscc^c Splenectomy Surg Laparosc Endosc Percutan TecK Vd 14.
Nol,Feb,ppJ!3-5.
7 Nguyen Hoang B i c Hu\Tih Nghia. Le Quan Anh Tuan.
(2003). Ftuu thuft n ^ SOI cit lach dieu bi xuat huyS giam tieu c a u . Y h p c T P H b C h i M n K T s p 7 . S 5 1 . . t r 137-41- 8 Nguyen Ngpc Hirng, Quach Vin Wen, Nguyen Vin Truong
(2008) Cit lach npi SOI Mpl so nhfn xet vv chi dinK ky thuait va b S i chung. Y hpe TP Ho Chi MinK Tjp IZ Phy ban so 4 tr 137-41.
Nguyen Tan Cuong. Biii An Thp, Doan Tioi My, Do Hihi Li^t (2007). Phlu Ihu^t ngi soi cat lach co ban tay ho trp- Mpt so kei qua buoc dau. Y hpc TP Ho Chi M n K Tf p 11. So 1.
Nguyen Thanh Liem (2009) K S qua buoc dau iing dyng p h l u thuft nffl s d c a t l a c h d i e u t r i m p l s o b e n h m a u o t r e a n . H ^ nghl Khoa hpc nhi Viet nam Qn thti VII va H ^ n ^ Ngoai Nhi eac nutic Dong Nam A lan thu IV.
w w w n ^ j otg-vnyShow asp\'camU5&nid=552 RescoHa F] (2005) Laparoscopic Splenedxmiy In F ^ a t r i e Minimal Access Surgay Langer J C Albanese CT Eds.
pp.137-50.
Rescoila FJ (2008) Laparoscopic Splenectomy In; Atlas of Pediatnc Laparoscqmy and Thoracoficopv Holcomb m G W, Georgeson K.E, Eds. pp.121-6
Selim S, Mehmet A, Sabti O et aL (2012). Laparosccpc Spleneetomv fiar splenic O-st Hvdatic Eur J Gen Med 9{suppl l),pp33-5 •
Targarona EM, Espert JJ, Boinbu>' E, et al (2000) Complications of Laparoscopic Splenectomy. Arch Sujg 135(10) pp 1137-40.
Whitman ED, Brunt LM (2003). Laparoscopric splenectomy In:
Laparoscopic Surgery' of the Abdomen. Bruce Mac Fadven eds. pp.238-54
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