^___^_ Tgp chl Tai MQi Hgng Vi$t Nam - Volume (60-26). N°2- April, 2015
SO SANH CAT AMI©AN BANG COBLATION VA PHU'ONG PHAP B 6 C T A C H KINH DIEN
Tran Anh Tuin * T6M TAT
Cat amydan bdng Coblation co nhiiu uu diem nhu hi thdng cdt dot luang cue (bipolar) sic ditng ddu ddt lanh, nhiet do cdt ddt thap nen it tdn thuang md ldnh xung quanh. Muic tiiu: 1. Ddnh gid hieu qud vd cdc uu khuyit diim ciia phucmg phdp cdt amidan bdng Coblation. 2. So sdnh vai phuang phdp bdc tdch kinh diin. Phuffng phdp nghiin cuu : nghiin cuu md td timg ca can thi^p 191 binh nhdn cdt bdng coblator vd 159 binh nhdn bdng phteang phdp bdc tdch, tudi tic 6 din 66 Binh viin Dgi hgc Y Dugc TPHCM Ca s& 2. Binh nhdn dugc gdy mi ngi khi qudn, thai gian phdu thudt dugc tinh tic luc dgt banh mien^ cho din Mc thdo banh mi$ng. ghi nhdn sd lugng mdu mdt trin mdi benh nhdn. Sau md cho khdng sinh, gidm dau. Theo doi tinh trgng binh nhdn sau md dua vdo tdi khdm dinh ky vd trd l&i cdu hoi. Ket qua: lugng mdu mdt trong md: coblation trung binh 6,88ml (l-60ml) bdc tdch trung binh 34,31ml (20-80ml); th&i gianphdu thudt:
coblation trung binh 17,42 phdt (10-45) bdc tdch trung binh 23,97phut (15-55); ty le chdy mdu s&m phdi can thiep : coblation 1,57% (3/191); bdc tdch 1,26 (2/159) ty 1$ chdy mdu mudn sau mdphdi can thiip: coblation 1,05% (2/191); bdc tdch 1,26% (2/159) tinh trgng dau sau mo : coblation ngdy 1 : 3,96, ngdy 2 : 3, ngdy 3 : 3,43, ngdy 4: 2,74, ngdy 5: 2,48, ngdy 6: 2,04, ngdy 7:1,82. Bdc tdch ngdy 1 5,07, ngdy 2: 4,51, ngdy 3: 4,35, ngdy 4: 3,74, ngdy 5: 3,38, nggy 6: 3,05, ngdy 7: 2,84. Th&i gian tr& lgi dn cam binh thuang: coblation 6,59 nggy (3-17), bdc tdch 8,43 (4-15); Thai gian tr& lgi ldm viec binh thu&ng: coblation 6,23 (1-12), bdc tdch 8,26. Kit lugn: cdt amidan bang phuang phdp coblation an todn, hieu qud vai th&i gian cdt nhanh, it mdt mdu trong md, it dau sau md, th&i gian ldnh thuang nhanh vd it chdm soc hgu phdu.
SUMMARY
RESULT OF TONSILLECTOMY BY COBLATION IN COMPARISON WITH CLASSIC DISSECTION METHOD
Tran Anh Tuan ' Tonsillectomied by coblation have many advancements such as bipolar probe systems, cool probes (Plasma Wand), a low temperature molecular disintegration. Objective: to assess the morbidity and efficacy of radiofrequency thermal ablation tonsillectomied (Coblation) in comparison with classic dissection method. Study design and setting : Prospective, randomized, controlled clinical study 191 patients were tonsillectomy by dissection and 159 patients by coblator II system. All of them was under general anesthesis. Operative time was recorded as the number of minute frame insertion of the mouth gag to removal of the mouth gag. Estimated blood loss was recorded for each patient.
After operation, all of patients took antibiotics (Augmentine) and analgesic (Efferalgan). All patients were asked to fill out a postoperative diary. Results: The amount of blood lost
* Dai hpc Y Duoc TPHCM
Tjp chl Tai MOi Hpng Vi#t Nam - Volume (60-26). N°2- April, 201S
during surgery: the coblation average 6,88ml (l-60ml) dissection average 34,31ml (20- 80ml): Surgery time: coblation average 17.42 minutes (10-45) dissection average 23.97 minutes (15-55); the rate of bleeding early intervention: coblation 1.57% (3/191): dissection 1.26 (2/159) ratio late postoperative bleeding intervention: coblation 1.05% (2/191);
dissection of 1.26% (2/159) Median postoperative pain scores: coblation day 1: 3.96, day 2:
3 days 3: 3.43, 4: 2.74, day 5: 2.48, day 6: 2,04, day 7:1.82 day I 5.07 dissection, day2:
4.51, day 3: 4.35 4: 3.74, day 5: 3.38, day 6: 3.05, day 7: 2.84 Time back to eating normally: coblation 6.59 days (3-17), dissection 8.43 (4-15); Time to return to normal: 6.23 coblation (1-12), dissection 8.26. Conclusion : tonsillectomy by Coblation is a safety and effect method with time of surgery is short, decrease in blood lost, less pain after operation, faster healing and reduced postoperative care.
1. BAT VANDE
Cdt amidan. Id phau thuat thong thudng trong tai mui hgng. Co nhieu phuong phap cdt amidan khac nhau dang duoc dp dung nhung tai bien do cdt amidan vln la mpt trong nhftng tai bifn thuong gap phdi trong th\rc hanh tai miii hpng. Nhihig ban chl chinh do Id : dau sau mo nhif u vd keo ddi, chay mdu trong va sau mo con nhilu, doi khi dua dfn tir vong.
1.1. Lich si^ cdc phirong phap cat amidan:
1. Boe tach bang dao: co thl xem la phuong phdp tieu chuin trong cdt amidan. Hifn c6 18,7% so ca cat amidan sir dung ky thudt ndy (Walner 2007). N6 co uu diem it chdy mdu sau m6, mo ldnh xung quanh dupc ton trpng, nhung lupng mdt mdu trong m6 con kha nhieu.
2. Dao difn don C\TC: it mat mdu, phdu thudt nhanh, nhung nhiet dp cat d6t cao (400°C-600°C), thiu nhiet sau (2cm) nen gay ton thuong mo xung quanh khd nhieu, ldm bfnh nhan rat dau sau ml. Ty If chay mdu mupn cao nen ngdy nay ti le sir dung phuong phap nay dang giam
din (54,9% so vcri cdeh nay 5 nam la 65,2% (Walner 2007).
3. Dao ml sieu am (Harmonic scalpel): it gay dau sau mo hon so vcri dao dien nhung thai gian cdt Idu hon va ty le chay mdu mupn cao hon, su ldnh thucmg ciing chdm hon (Haegner va cfng su 2002, Willging va cpng su 2003). Ty If so dung phuang phdp nay hifn nay Id 0,9%
(Wahier 2007).
4. Laser: gay ton thucmg mo do nhift nhieu tir do gdy dau nhilu sau ml. Trong 5 ndm tra 1^ day tai My khong con sir dung phucmg phdp nay niia. (Walner 2007)
5. Microdebrider : it gay dau sau mo, hoi phuc nhanh (Charles M. Mixson, l/SD va cfng su 2007) tuy nhifn no gay chay mau nhilu, doi khi dii dpi Hifn nay chi CO 0,9% ca cat A tai My sii dung kJ thuat nay (Walner 2007).
6. Coblation: nhilu nghien cu:u cho thay cat amidan bang Coblator it dau, it mit mau, mau hli phyc vd ty If chdy mdu mu6«
thip. Cdcb day 5 ndm moi chi co 2,7%
ca cit amidan sii dung kj' thuit Coblation, theo thoi gian ky thuat naj dupc su dung ngay cdng nhilu va nay co
Tgp chf Tai Mui Hpng Vi^t Nam - Volume (60-26). N°2- April, 2015
16% so ca cat amidan tai My su dung ky thuEit Coblation (Walner 2007).
Cac nha khoa hpc tren thl gidi van khfing ngung tim kigm nhung phircmg phap moi nham dat hi^u qua phSu thuat cao hon va giam thieu cac bien chimg.
Tren the gjoi dt amidan bSng Coblator ducrc ap dung tir 1998 buoc diu cho k^t qua rat kha quan so vcri cac phuong phap cat amidan kinh dien.
Tai Viet Nam cho toi nay chua co mot nghien ciiu chuyen sau nao ve viec su dung ky thuat nay tren nguoi Viet Nam.
Benh vien DHYD TPHCM ap dyng ky thuat cat amidan bing Coblator tir nam 2004. Sau mgt thoi gian thirc hien vdi nhieu phuong phap khac nhau, toi nhan thay Coblator co mpt so uu diem hon so voi cac phucmg phap thucmg qui khac. De xac dinh ghi nhan tren, tdi tiSn hanh nghien cuu "so sanh cit amidan bing phuong phap coblation va phuong phap bdc tach kinh dien "
1.2. Nguyen ly phau thuat coblation Tu nam 1998, tren the gioi da dua vao ap dung mot phuong phap phau thuat mdi goi la phirong phap Coblation. Vg nguyen tac thi phlu thuat Coblation cung la mot dang phau thu^ fien ludng cue nen vh nguyen ly hoat dpng CO ban giong nhu cac phuong phap phau tiiuat dien tnioc day, nhung do he tiidi^ Coblation cd su dimg diu dot lanh (dung nudfc Imi thong trong dien cue de lam mat va lam moi trudng dem truyen dan nhiet) nen dien ^ va nhiet dp cit ddt cua chung kha thip (40-70''C) t£r do giam thiSu dupc hien tupng tdn thucmg md lanh xung
quanh do nhi?t va dien. Co che hoat dgng dd la nuoc trong diSn cue se t ^ mpt ldp djch nam giua di?n cyc va md, qua trung gian ldp dich nay dudi tac dung cua dien truong. C4c nguyen tu trong Idp dich nay bien doi th^mh cac ion (su ion hda) tao thanh mgt lop plasma
H^t tich di&n trong lop plasma dupc gia tdc duoi tac dyng cua dien trudng va dat dupc du nang lupng dh be gay ciu ndi phan ttr cua te bao.
Nhi^t dp cdt cda phuffng phdp coblation thip hffn binh thir&ng la do:
1. Dong dien khdng true tiep qua mo trong qua trinh phau thuat, hau het nSng lupng dupc tieu thy trong ldp plasma Ah ion hda ldp dich nay. Sau dd nhung ion nay moi cdng pha md nen giam thieu dupc lupng nhiet vao md.
2. Sy luu thdng cua nudc trong dien cue lam h^ nhi?t do cua dien cyc va lam lanh mo xung quanh dien cue, ddng thoi nuoc Iam giam trd khang cua md (the tich nudc tai noi dot cd anh hudng den tro khang cua mo, trd khang cua md khd se cao hon rad ng^m nudc ) tro khang md thap cho phep tao ra nSng lupng cue dai ddi vdi 1 the ti'ch cat ldn hon.
2. e 6 l TirONG VA PHlTONG PHAP VA VAT Ll£U NGHIEN CtTU 2.1. Doi tvgmg nghien cmi
191 b?nh nhan cat amidan bang coblator va 159 benh nhan cit amidan bang phucmg phap bdc tach.
Tgp cht Tai MQi Hpng Vigt Nam - Volume (6Q-26). N°2- April, 2015
Tieu chuan ch^n b^nh
Tudi, gidi, chilu cao, can n|ng ; khdng phan biSt
• Tmh trang sue khde dap img cho vi?c ph§uthi4t, gayme.
Cd it nhat mgt trong cac chi dinh dudi day:
+ Nhiem trur^ amidan tir ba lan trd len trong mgt nam du da dieu tri ngi khoa thich hpp.
+ Amidan qua phat gay the dudng thd, khd nudt, rdi loan giac ngiu
+ Viem amidan mgn tinh gay tho hdi ma khdng dap ung voi dieu tri ngi khoa.
+ Amidan qua phat mdt bfin nghi u buou.
• Tieu chuin loai tru : Cac benh ly vl ddng mau, thieu mau, cac benh man tinh: lao, tilu dudng, benh tun, viem amidan d p tmh, cd nhilu ylu td nguy CO khi g^y md, hay cd cac benh ly khdng kiem soat dupc
• Vdt li^u nghien cuu:
• H? th6ng Coblator II (My) bao gdm : than may chinh, hS th6ng kiem soM c4p nuoc, di$n cyc EvacTO.
• Bg phau thuat bdc tach amidan tieu chu^
Xu ly sd liSu bing phln mim SPSS 15 2.2. Phu-ong phap nghien cihi:
2.2.1. Thiit ki nghiin cdu : nghien ciru md ta tung ca can thiep.
2.2.2. Cdc bu&c tiin h^nh cho tdng nhdm nghiin citu:
Danh gia tinh tr^ng benh nhan trird^c mo:
+ Danh gia lam sang : danh gia tinh tr^g 2 amidan. chia dg qua phat ciia amidan theo 4 dO cua Brodsky + Danh gia cSn ISm sang cac xet
nghidm tiln phlu
+ Phuong phap vd cam . gay rae toan than ducmg npi khi quan
Phu-ong ph^p phSu thu^t: Coblator ho|c bdc tach
NguySn tac chung trong cat amidan + Bdc tach cit amidan ra khdi hd cirng
voi vd bao
+ Bao ton try trudc, try sau
+ elm mau bing c§t chi (bdc tach) hoac dot di?n (Coblator)
Ky thu^t cit amidan
1. Ky thuat cit amidan bing Coblator Md miSi^ benh nhSn bing banh mi?ng David's
Tach cue dudi amidan khdi hd : c^p khli amidan, keo vao trong va len tren sao cho bpc Id ranh gioi gifia cue dudi amidan va nen hd amidan ro nhat. Ap nhe mat di?n cue vao vi tri cln cat, tach cit giiia bao amidan va nen hd amidan
• Tach amidan ra khdi try tmdc : dirng go diu di^n cue cit tao 1 dudng rach tren dudng ranh gidi nay. Ludn dien cue ^iia try trudfc va khoi amidan tu duoi Ien, ma!
dien cue hudng ve phia amidaa neu amidan an sdu trong try truoe ngudi phy dimg ven try v^n try trudc ra ngoM dS hoc Id dudng cat ro hon.
Tach cyc tren amidan ra khdi hd : Ck din Bn cue tren dl giai phdng cyc tret amidan ra khdi hd. Khi cit d vung nay df tranh dau hiit cua dien cue hut lam t6i
Tap chl Tai MQi Hpng Vigt Nam - Volume (60-26) N''2- April, 2015
thuong luoi ga, ngudi phy cung cd the dimg ven tru ven luoi ga sang ben ddi di$n.
Tach amidan ra khdi nin hd va try sau : Cat tach bao amidan ra khdi nSn hd, din ve phia try sau. Cudi cung la giai phdng try sau. Ddt cam mau neu cd.
• Kiem tra va elm mau
2. Ky thuat cat amidan bang bdc tach:
• Tach amidan khdi cac try : kep giiia khdi amidan, keo nhe xudng dudi va vao trong, dung dao s6 12 cat nidm mac dpc ranh gidi giua amidan va try trudc khoang l-2cm, dimg cdy bdc tach tach dgc xudng het nep cudng amidan dd tach amidan ra khdi try trudc.
• Dua bdc tach di len het cyc tren roi xoay dm vdng cyc tren amidan Uen tyc xudng dudi de tach amidan ra khdi try sau.
- Bdc tach amidan ra khdi hd : Dimg cay bdc tach diy dan khdi amidan xudng phia cue dudi cho tdi cudng dudi amidan.
• Cat cudng amidan, lay amidan ra ngoai:
ludn thdng lpng tdi sat chan cudng amidan, bdp tir tir thong long de eit cudng amidan
• Cat mdt mpt mau td chirc cdn lai d nen hd amydan de thir md benh hgc tien cac tdn thuong va phan ung ciia md lanh sau phlu thuat.
• Kidm tra va cam mau : Kep, cdt bang i chi chromic 1/0.
3. Cham soc hau phau :
Khang sinh va giam dau sau md : 'Augmentine va efferalgan vdi Heu lupng I tuy theo tudi va c&i nang tiong 1 tuin.
4. Danh gia ket qua : gidng nhau cho ca hai phuomg phap
- ThM gian phau thu^t : tinh tu luc bat dau d^t banh midng cho din khi hoan tat phlu thuat va thao banh midng.
- Lwgng man mat: Ihd ti'ch dung dich mau trong binh trii di thl tieh dich truydn da Cam giac dau sau mo : dua vao bang ty danh gia cua benh nhan theo bang thang dau mau. Chia miic dp dau tir 0 (khdng dau) din 10 (dau tgt eimg)
Muc dd ton thirong mo tanh xung quanh : giai phau bdnh nen hd amidan
~ T;y le chay man sdm sau mo : chay mau lai tiong vdng 24 gid sau md. BChdng tinh trudng hpp chay it, ty elm.
Ty le chay man muon sau mo chay mau sau 24 gid sau md. Khdng tinh trudng hpp chay it, ty cam.
- Gia mac ho md : ghi nhan tai mdi lan benh nhan tai kham
Ngay bat dan an com va tro lai lam 3. KET QUA
191 bdnh nhan nhdm Coblator va 159 bdnh nhan nhdm cat bdc tach dap iing dii tidu chuan dua vao nhdm nghien ciiu.
3.1. Ph^n bo theo tuoi:
Tudi trung binh ciia nhdm Coblator la 29,10 (6-62). cua nhdm bdc tach la 29,25 (7-66).
Su khac biet vd tudi giua cac nhdm khdng cd y nghla thdng ke, P>0,05
Phan bd tudi tiong ca hai nhdm tap trung d lira tudi 16-40.
27
T;p chl Tai MOi Hpng Vi#t Nam - Volume (60-26). N°2- April. 2016
3.2. Pban bo tbeo giM :
Trong cd hai nhom nam dSu niiieu hon na voi ty le # 6:4
Khong CO sir khdc bift ve phai gi&a cdc nhom P>0,05
DSc tinh mau cho thdy Idiong co sv Ididc biet ve tuoi vd gioi giua cdc nhom 3.3. Chi dinh phSu thudt
Chi dinh cdt amidan thucmg gjp nhdt do la viem amidan man tdi di tai Igi > 3 Idn/nam (78-78,6%), Viem amidan qud plidt gay nu6t vuong (8,2-8,9%) vd Viem amidan hoc mu gay h6i nii§ng (3,8-4,7%).
3.4. ThM gian phSu thu|t:
Nhom cdt bdng Coblator : 17,42 phiit (10 - 45) bdng boe tach: 23,97 phiit (15 - 55)
So sdnh ket qud cho thdy thai gian cat amidan bdng Coblator nhanh hon bdng b6c tdch 14 6,55 phut. s\i khac bi?t co i nghia thdng ke (P<0,05)
3.5. Luvng mau m4t trong mS : Nh6m cdt bdng Coblator : 6,88 ml (1 - 60 ml) bang hoc tach: 34,31 ml (20 - 80 ml) So sdnh kit qud cho thay^ lugng mdu mdt trun| binh trong m6 cit bdng Coblator it hem bdng hoc tach la 27,43ml. sir khac biet CO y nghia th6ng kS (P<0,05) 3.6. Danh gid cam giac dau :
Bdng 3.16a Mi^c do dau sau cSt amidan coblator Coblator
MO'C do dau TB
N l
3,96 N2
3,00 N3
3,43 N4
2,74 N6
2,48 N6
2,04 NT
1,82 N8
1,41 N9
1,07 NIO
0,8
Boe tach
MljcdO dauTB
Nl
5,07
Bdng 3.16b nixc dp dau sau cdt amidan b6c tdch N2
4,51 N3
4,35 N4
3,74 N5
3,38 N6
3.05 N7
2,84 N8
2,43 N9
2,24 N10
2,09
Trong dd: Nl,..., NIO: Ngay thir nhit,..., ngay thu mudi sau md Nhdm cat amidan bang bdc tach miic
dp dau cao nhat la ngay dau tien sau md sau do giam dan. Nhdm Coblator, cd sy giam dau vao ngay thir 2 nhimg tang len vao thur 3 sau do giam din.
Ngay thli 7 sau md cd 88,5% BN nhdm Coblator hdt dau hoac dau it (miic d§
3 tid xuong) so vdi 66% BN nhdm bdc tach
Tap chl Tai MQi Hong Vi^t Nam - Volume (60-26). N''2- April, 2015
3.7. Ty IS chay mau sfrm can phai can thidp:
Nhdm cit bang Coblator 1,57%) (3/191). Nhdm cit b k g bdc tach : l,26%o (2/159)
Ty Ie chay mau sdm trong nhdm cat bdc tach hcri thap ban nhdm cat bang Coblator nhxmg su khac bidt khdng cd y nghia thdng kd.
3.8. Ty le chay mau muda can phai can thiep:
Nhdm Coblator: 1,05% (2/191). Thdi gian trung bmh: 6,5 ngay
Nhdm bdc tach: l,88%i (3/159). Thai gian trung binh: 9 ngay
Ty Id chay mau mudn tiong nhdm cat bdc tach cao hem va mupn hem nhdm cat Coblator
3.9. Tinh trang bong gja m^c:
Bang 3.19 Tinh trang bong gia mac
Ngay thi>7 Ngdy thiH4
NgSy thi>21
Nh6m Coblator Si BN 79 156 191
TylS
%
41,4 81,7 100
Nhom b6c tdch So BN 34 84 166
TylS%
21,4 52,8 98,1
Ngay hdt gia mac trung binh trong nhdm Coblator (12,06) ngin hon nhdm bdc tach (14,82)
T>' Id bdnh nhdn het gia mac cua nhdm cit bang Coblator vao ngay thii 7 (41,4%) nhidu hem nhdm cit bdc tach (21,4%)
Ty le b?nh nhan hdt gia mac cua nhdm cit bang Coblator vao ngay thii 14 (81,7%) nhieu hon nhdm cit bdc tach (52,8%)
Dieu nay chiing td tidn tridn lanh thucmg hd md cua nhdm cit bing Coblator nhanh hon nhdm cat bang bdc tach gan 3 ngay
3.10. Tmh trang an u^og sinh ho^t sau cit amidan:
Thdi gian bdnh nhan nhdm Coblator bat diu an com tid lai : trung binh la 6,59 ngay (3-17) so vdi bdc tach la 8,43 (4-15) 3.11. Tinh tr^ng sinh ho^t:
Ngay tid lai lam vide, hpc tap nhu chd dp binh thudng trudc khi cit: trung binh la 6,23 ngay (1-12) so vdi bdc tach la 8,26 3.12. Tuih tr^ng tdn thircmg md lanh xung quanh
Nhdm Coblator: 100% mdu thu khdng cd tdn thuang do nhiet, ria didn cat khdng hi hoai tii ddng
Nhdm bdc tach: 100%o mlu thu giii giai phau bdnh ly khdng b: hoai tu ddng do nhiet, Cd hidn tupng vidm phu nd md co ndn hd amidan sau md.
Tap chl Tai MQi Hpng Vl$t Nam - Volume (60-26). N''2- April, 2015
BAI HOC Y DUOC TP.HCM Mis*: YI 1970/2001
BO MON aiki PHAU B$NH
XET NCHlf M GlAl P H I U Bf NH
Hp vS t e n : LUU TH| H 6 A Tuoi; 28 GiUi: NI
Dja chl: - N g h d n g h i t p : Chifii dodn tAm sftng; Vifm amidan
ChStb^ohph^ni: NJnh^amidaii Bdc sT chl dinh: BST^j^n C H A N BoAfI G l A l P H I U B ^ N H
« Q « l t h £ : MSd#OJan.
• V l t h £ :
Niu th^ g&m mdsdnid, mdc(}I&iihtinbkim th^m nhSptebaovi^m rri^n tinb.
BSa difn cit kfadng c6 ho^ ti ddng.
Benh vipn: DaiHoc Y Oirdc-cdsdn Ngay: 06AJ6/2007
Tgp cht Tai MOi Hong Vi$t Nam - Volume (60-26). N''2-April, 2015
BAI HOC y DUOC TP.HCM Ma stf: Y9299/2007 BO MdN GlAl PHAU B^NH
XET NGHlf M GlAl P H I U B f NH
Ho va l & i : CHUNG T H | DUYEN T u ^ i : 28 G i d i : na
^. Dfa d d : - Nghe n g h i e p : C h f n dodn Utn s i n g : \ri£ro amidan
Qi£t bSnh f^m : NJn Ul'aniidan sau khi c ^
fiJC^chldillh: BSTulii B S n h v i ^ n : E)?iHocYDU9c-cds5n Ngiy: lOflSQOO?
C H ^ N D Q A N G l A l P H A U B $ N H
* B«itM:
Mia mfl n h i
MSa tfaA ^Im mfl c0 vfin v i md lito k ^ Irnih thudng.
Rh (fiSn c& kfaflng H hoai td ddng.
4. BANLUAN
4.1. Ky thuat c^t it chay mau vk it ton thuvng mo lanh xung quanh : didn cue
Coblator kha Ion so vdi dao dien don cue do dd khi cat amidan, bd mat cua didn cue dupc ap d\mg vao vung md amidan bd di cdn dau tiln cua dien cue nam trdn dudng
Tgp chl Tai Mui Hpng Vi$t Nam - Volume (60-26). N°2- April. 2015
du tinh rach nhu thd se trMi tdn thucmg ddn tru. Khi ddt chm mau dung didm xa nhit cua diu ddt ap vao didm can ddt. Da phin nhiing tmong hpp gay tdn thucmg sau va ch4y mau nhi^u la do chung ta da dap pedal cat trong khi ddt. Do dd vide d6t bang gd tan cua dien cyc vua giup phau thuat vidn ddt didm ehinh xac va khdng gay tdn thuong md sSu nhat la khi dap nham.
Trong khi cat, ludn ludn ap bd mat didn c\rc vao hudng md amidan bd di, kep hcri eang vung md can cat. Sau khi dot cim mau xong, lam trung hd md chd 1-2 phut xem cd didm nao chay mdu lai thi ddt 4.2. Nhirng ini dilm ciia h^ thong Coblator khi cat amidan
Do dac didm ciu tao cua he thdng Coblator : di?n cue, he thdng cap nudc va hut nudc nam ngay tren didn cue ndn khi thao tac phiu thuSt vidn hoan toan chu ddng, khdng phu thupc vao sir phdi hpp nhip nhang cua ngudi phu ta
Do dac didm cua he thdng Coblator lam vi?c trong mdi tnidng nude la mdi trudng ludn gap khi phau thuat ndn khdng can phai Iam khd phau tnrdng nhu tnrdng hpp dao dien don cue tu do ciing rut ngin dupc thdi gian phiu thuat.
Nhiet dp cat ddt t h ^ (40-85''C) nen md khdng bi tdn thuong.
4.3. Thoi gian phau thuat : 17±4,2 phtit.
Nhanh hon phucmg phap bdc tach trong nghien cuu cua tdi (23,97±5,592) mdt each cd y nghia {phep kidm student, P<0,05). Thi cit cua 2 phuong phap gin nhu nhau, phuong phap bdc tach lau hom vi them giai
doEm cim mdu (c^t chi). Viec rut ngan thcd gian phau thu§t eung lam cho benh nhSn dd mat mau va it t6n thuong nhidt va didn d&i ho md hem.
4.4. Lu-png m&u mat trong mo : 6,8S±
6,68 ml. it hon phuong phap bdc tach mot each cd y nghia (phep kiem student, P<0,05)
Phuong phap Coblator it gay mit mau hon vi day la mpt phuong phap phSu thuat didn, viia eat vira cam mau.
4.5. Mii-c d$ dau sau md :
So sanh ba phuong phap Coblator, bdc tach trong n ^ e n cihi nay va phuong ph^
cat amidan bang bipolar cua M.S. Timms tiu phucmg phap Coblator it gay dau nhit, va dau i^an ngay nhit. nhidu ngbien cuu cung cho thiy cat amidan bang Coblator it dau va mau hdi phuc hon dao dien don cue (Alvin Kah Leong Tan 2006 ; Parsons 2006; R. H.
Temple 2001 ; M. S. Timms, 2002; Stoker 2004 Maj daniel j 2004). Chung it dau hon c4 dao md am (Parsons 2006). So vdi phuong phap bdc tach thi eit bang Coblator it dau hon, lanh thuong nhanh hon va ty Id chay mau mudn thip hon (Belloso 2003) ho^c tuong duong (Philpott 2004).
Tuy bang thang dau dvra vao cam gi^
chii quan cua bdnh nhan nhung \i hai phuong phap cit amidan trong n ^ & i cihi cua tdi thuc hi?n trong cung mpt didu ki6n (cung ngudi thuc hidn, eung dia didm khdng gian va thoi gian, trang thidt bi, chd dp chSm sdc, va danh gia trdn cung mpt bang thang dau miu) ndn kdt qua nay ed thd so sanh dupc. Hom nu:a so sanh voi miic dp dau sau cit amidan bing Coblator cua Timms va
Tap chl Tai MQi Hpng Vigt Nam - Volume (60-26). N°2- April, 2015
cdng su cho thiy su tuong ddng (miic dd dau a ngay 1 la 4 (1-8); so vdi M.S. Timms la 5 (1-9) cdn ngay thii 7 la 1,8 (0-6) so vdi M.S. Timms la 1,5 (1-6)) nen kdt kdt qua nay cd thd tin eay dupc.
4.6. Bien ehirng sau md :
Ty Id ehay mau mudn can xu tri khi eit amidan bing Coblator chi 1,05% (2/191) tuong duong vdi phuong phap bde tach (1,88%). Ty Id chay mau mupn thap cd the do nhidt dp eit dot eua hd th^ng Coblator thap (<100°C), ndn it gay hoai tu md lanh, it tao vay ndn khdng cd su bong trdc md hoai tii lam hoc Id va tdn thucmg mach mau bdn dudi gay chay mau mupn sau md. Hidn tupng it tdn thuong nhidt va dien, benh nhan it dau sau md se an sdm hon eimg sd Iam vdt thuong mau lanh hon.
4.7. Tai sir dung dau dot de ha chi phi phau thuat:
Dung cu (^dn eye) sau khi su dung dupc ngam bang Cidezyme, riia sach, lau va dd khd sau do ngam vao dung dieh CIDEX OPA (ortho-Phthalaidehyde 0,55%) trong 20 phut, qua thuc td tdi cd thd su dung lai I dupc 5-10 lin ndn chi phi su dung la hoan
toan phu hpp voi ngudi Viet Nam.
5. KET L U ^
Qua nghien eiiu ky thuat cat amidan bang Coblator ed so sanh vdi cae phuong , phap bdc tach kinh didn, tdi rut ra nhung
kdt luIn nhu sau:
i Ckt amidan b^ng coblator
' + Thdi gian phau thuSt ngin (17,42
^phijt)
" + Lupng mau mit trong md it (trung binh 6,88ml)
-I- Khdng tdn thuong thau nhidt sau ddn . cac ciu tnic xung quanh
+ It dau va mau lanh thuong : Phuong phap cit bing coblator cd uu didm hon phuong phap bde tach kinh didn.
+ Bidn chiing chay mau sau md thap so
\m bdc tach kinh didn.
-I- Phuong phap coblation cd thd ap dimg de eat amidan mdt each an toan, it mat mau, it dau sau rad va mau lanh thuong, cd the hgn chd mat mau va giam dau sau md nhidu.
TAI LIEU THAM KHAO
1. Wahier DL,et al, Chicago and Park Ridge, IL Past and present instrument use in pediatric adenotoiaillectomy Otolaryngology-Head and Neck Surgery 2007;137,49-53
2. Timms MS, Temple RH. Coblation tonsillectomy: a double blind randomised controlled study. J Laryngol Otol 2002; 116: 450-452.
3. Temple RH, Timms MS. Paediatric coblation tonsillectomy. Int Pediatr Otorhinolaryngol 2001; 61:195- 8.
4. Belloso A, Chidambaram A, Morar P, et dl. Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 2003;
113:2010-3
5. Tan Alvin Kah Leong, et al. Coblation vs electrocautery tonsillectomy:
Postoperative recovery in adults Otolaryngology-Head and Neck Surgery 2006; 135, 699-703
6. Stoker KE et al: Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: A prospective, controlled single-blind study. Otolaryngol Head Neck Surg 2004; 130:666-675.
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