Y Hpc TP, Hb CW Minh » Tap 20 * So 4 * 2016 Tong Quan
TONG QUAN VE TINH HINH GHEP TANG TAI BENH VIEN QUAN Y103 Hodng Manh An*, Pham Gia Khanh**, Nguyen Tieh Binh**, Do Tdt Cudng*, Bui VdnManh*
D A T V A N D E
Ghep tang la mot trong nhiing thanh tmi y hgc VI dai nhat ciia the ky XX. Sau ca ghep than thanh cong i ^ u tien tren nguoi tai Hoa Ky (ngay 23/12/1954), cac ky thu|t ghep tgng khac lm\ lugt dirgfc thuc hien thanh cong: g^ep gan (ngay 01/3/1963 tai Colorado-Hoa Ky), ghep tuy (17/12/1966 tai Minesota-Hoa Ky) ghep tim (ngay 02/12/1967 tai Nam Phi), ghep da tang (tim-phoi, than-tuy..)"-^'. Tai Viet Nam ghep than bat dau tix nam 1992 va d&i nay da co tren 10 benh vien trong ca nuoc tirai hanh ghep than, trong do co mpt so benh vien da tien hanh nhieu loai ghep tang khac nhau. Benh vien 103 va Hpc vien Quan y la noi dau tien trong nude thuc hien gjiep cac tang than, gan, tun, tuy-than va da dat dupe mpt so thanh tuu. Bao cao nay nham trinh bay t&ig quan v^ tinh hinh ghep tang tai BVQY 103 trong nhiing nam qua.
KET QUA imJC HIEN CAC KY THUAT GHEP TANG TAI BENH VIEN QUAN Y 103 Tl/ NAM 1992 DEN THANG 5/2015.
Ghep than
De tien hanh ghep than tren nguoi thanh cong, Hpc vien Quan y va Benh vien 103 da cimg cac ca so nghien ciiu khac thuc hien mpt so de tai nghien cihi tniac khi trien khai ghep than tren lam sang. Hai de tai cap nha nuac da trien khai va thuc hien thanh cong, bao gom:
- Nghien cihi mot so khia canh ve ghep than de phyc vu viec ghep th?n tren nguoi do GS.TSKH Pham Manh Hung la chu nhiem de tai.
Ket qua nghien cuu da cho thay tl le benh nhan bi suy than man tinh a cac vimg khac nhau cua Viet Nam dao dong tu- 0,06-0,81% va nhu cau benh nhan can dupe ghep than a cac vimg dupe dieu tra vao khoang 5,5/100.000 nguoi. Ket qua nay la co so de thuc hien va day manh chuang trinh phat trien ky thuat ghep th§n.
4 0 3 0 2 0 1 0
S6 lupng BN
3 4 3 ^ ^ ^ ^ 2 3 ^ ^ ^ n 1992 1995 1998 2001 2004 2007 2010 2013
Bieu do 1. Soluang BN ghep th&n tie 1992-5/2015 (n^l98) - Nghien euu ung dung cong nghe tien tien phuc vu ghep tang tai Viet Nam do GS.TS Pham Gia Khanh la chii nhiem de tai.
Ngoai ra mot so de tai cap Bp Y te, Bp Quoc phong va nhieu de tai ca so da dupe thuc hien trong nhieu nam tiep theo. Tir ket qua cac
* Benh vien 103,
Tdc gid lien lac: PGS. 1 5 . Hoang Mgnh An, DT: 0913283632,
nghien cuu tren d&i thang bet thang 5/2015 BVQY 103 da thuc hien thanh eong 198 ea ghep than til nguoi hien than song va nguoi chet nao.
So luong BN ghep than tang deu va ro ret trong nhung nam gan day (Bieu do 1).
email: [email protected]
Tdng Quan Y Hpc TP. Hb Chi M i n h * T^p 20 * S^ 4 * 2016 Do dgc Ihii la BV quan y nen ti le BN la quan
nhan eao (25,3%) (bang 1).
Phan Ion BN nhan than tir nguoi song hi&i thgn cung huyet th&ig (bang 2).
Nguoi n h ^ riam nhieu hon nu; nguoi hioi:
niJ nhieu ban nam (Bang 3).
Ti le song them ciia than ghep va benh nhan kha eao (Bieu do 2).
Benh vien cung da va dang ap dung ky thuat npi soi lay th$n de hoan chinh quy trinh l ^ thuat lay than tot nhait
Bdng 1: Ddi tuang BN duac ghep th&n 56i brang BN
Qudn nhdn Dan Ngirdi nuftK ngo^i
Tfing s6
3d lirong BN SO 145 03 198
ni6(%) 25,3 73,2 01,5 100
Bang 2. Quan hi huyei thdng giiea ngu&i Men zm nhdn than (n=198)
Quan h$
tigtrin hi&n s6nq ciing huyet thong Ngyfri hien s6ng kh6ng cCing huy§t thfing
Ngu^ h i ^ chit n3o
7il|(%) 70.7 25,8 03,5 Bdng 3. Tudi vd gidi ngu&i nhdn th&n vd hiin thdn
Tu6ivd gi6i
Nhin Hien
MCrctudi Tlllp n h « 14 21
Cao nhit 65 67
Tnjng binh 35,0t10,3 43,3*11,1
Gi6i Nam(%) 153(77,3) 77(38,9)
Nlj(%) 45(22,7) I21(61,1;
-Ti le song cua than ghep I -Ti le song cua BN i
20
1 nam 5 nam 10 nam
Bim do 2. Kii qud sau ghep th&n (giai doqn sau ndm 2000) Ghep gan
Sau thanh cong ciaa chuong trinh ghep than, tir nhung nam 2000 Hpc vien Quan y va Benh vien 103 da quyet tam trien khai ghep gan tren nguoi. De thue hien quyet tam nay hai d& tai cap nha nuoc do GS.TS Pham Gia Khanh chu tri da dong thoi dupr trien khai:
- Nghien ciiu ghep gan thuc nghiem tren Ipn
- Nghien o h i mpt so khia canh ve ghep gan
de phuc vu ghep gan tren ngUoi
Ngay 31/01/2004 ea ghep mpt phan gan cho mpt benh nhi 9 tuoi tir nguoi song hien gan (bo cho con) da ^ a n h c6ng voi su giup do ky thu|t ciia chuyen gia Nhat Ban va su h6 tro cua cac benh vien Ion trong ca nuoc. Sau ghep gan benh nhan khoe manh, phat tri&i tot, tiep tue hpc t$p binh thuong. Hien nay sau hon 11 nam, benh nhan van khoe manh, chat lupng song tot va dang hpc tai tnrong Trung cap Quan y.
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Y Hpc TP. H o Chi Minh * T?p 20 * S£» 4 * 2016 Tong Quan Hien nay Berth vien da ghep gan dupe 2
tnrdng hop.
Ghep tint
Tir nam 2005 cac don vi trong Hpc vien Quan y va Benh vien 103 da tri&i khai eae de tai nghien euu nham tiep tuc thuc hien ghep tim tren nguoi. Hai de tai cap nha nuoc da dupe thuc hien bao gom:
- Nghien cuu ghep tim thuc nghiem va ghep tim tren nguoi do PC^.TS Dang Ngpc Himg lam chii nhiem de tai (2007).
- Nghien ciiu ghep tim tir ngudi hien chet nao do GS.TS Nguyen Tirai Binh lam chii nhiem (2010).
Ngay 17/6/2010 ca ^ e p tim ^ u tien tren nguoi tai Viet Nam tiJ nguoi hian chet nao cho mpt benh nhan bi benh co tim the gian da thanh eong voi su giup do ciia chuyen gia Dai Loan.
Su thanh cong cua 1^ thuat gan, ghep tim tai Hoc vien Quan y da khuyoi khich va thiic day cac benh vien trong nuoc tien hanh mpt so ea ghep gan va ghep tim khac thanh cong, mo ra mpt giai doan moi cho chuyen nganh ghep tang 6 Viet Nam.
Mac dii ket qua ghep tim con han che, benh nhan tu vong sau 2 nam nroi do bi thai ghep man, suy tim nang nhung buoc dau dning toi da CO dupe mpt so kinh nghiem trong tuyen chpn benh nhan, to chiic ghep tim va theo doi sau ghep.
Ghep dong thai tuy-th^n
Ke thira kinh nghiem tir eae iiy thuat ghep t h ^ , gan v^ ghep tim da thanh cong tnroc d6, B&ih vien Quan y 103 da tiep tuc nghien cihi tri&i khai gjiep tuy/dong thoi tuy-than tren nguoi. De tai cap Nha nuoc "Nghien ciiu ghep dong thoi tuy-than tir nguoi hien chet nao" do PGS.TS Hoang Manh An ehii tri da thanh cong.
Ngay 01/3/2014 ca ghep da tang dong thoi (tuy - than) cho mpt benh nhan bi dai thao dutmg typ 1 da dupe tfiuc hien thanh cong do cac kip thay thuoc ciia Benh vien thuc hien khong co su trp
giiip cua chuyen gia trong va ngoai nuoc. Den nay benh nhan da ghep tuy-than dupe 15 thang, khoe manh, chiic nang cac tang ghep binh thudng. Day la su thanh cong danh dau buoc chuyoi bieh quan trpng ciia ky thuat ghep tang tai Benh vien Quan y 103.
HLTdNG PHAT IRIEN KY THUAT GHEP TANGTAIBVQYlOSlHOIGIANTOil Nhung thuan loi co ban
- Luat "Hioi, lay, ghep mo, bp phan ca the ngudi va hiai, 1% xac" da co hieu lue phap luat va dang dupe thuc Ihi.
- Ky thuat ghep than tir ngudi h i e i song da tro thanh thudng quy. Benh vien da co mpt so kinh nghiem budc dau trong ghep cac tang tir ngudi cho chet nao.
- Berth vien co nguon nhan luc va dpi ngii BS chuyen khoa ^t^ eo dii cac trang thiet bi can thiet CO the dpc lap tiai hanh ghep cac tang.
- IXrpe su quan tam ciia Bo Quoc phong, Bp Y te va su hop tac cua cac co sd y te trong va ngoai nude.
Nhimg fhach thuc
- Thieu nguon tang ghep de duy tri va phat trien cac ky thuat da dat dupe
- Benh vien dang trong giai doan dupe xay dung mdi hoan toan nen trong vai nam tdi se rat khd khan cho viec thuc hien ky thuat ciing nhu CO sd vat chat, ha ^ g cho viee tjuan ly, dieu tri benh nhan sau ghep.
- Benh vi§n chua xay dung dirpc he thong dang ky chd ghep chinh thiie dat chuan dap ling yeu cau ciia y hpc hien dai
Huong phat trien trong nhung nam t6i - Duy tri thudng xuyen, tang cudng chat lupng ciia ky thuat ghep than da co tai Benh vien, hoan thien 1;^ thuat lay than npi soi.
- Phdi hpp vdi cac co quan, to chiic xa hpi day manh cong tac van dpng hioi tang de tang nguon tang ghep dac biet tir ngudi chet nao; tiep
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Tong Quan Y Hpc TP. Ho Chi M i n h * Tap 20 * So 4 * 2016 tuc van dpng hien tang hi ngudi song tr&i co sd
dung phap luat hien hanh.
- Xay dung tot he thong du Heu ciia benh nhan chd ghep
- Tang cudng hpp lac vdi cac co sd y te va trung tam ghep tang ca trong va ngoai nude.
Mpt so kien nghi nham ihuc day gjiep tang tai Viet N a m
De thiic dliy chuyen nganh ghep tang trong nude phat trien manh me va ben viing chung toi kioi nghi can lam tot cac van de sau:
- Qiinh phii va Bo Y te can cd them cac van ban dudi lu^t de hudng dan cu the hon viec {hue hien "Luat hi&i, lay ghep md tang..."
- Sau khi thanh lap Hpi Ghep tang Viet Nam, can tang cudng vai tro ciia Hpi trong viec:
+ La cau noi giao luu phap ly, chuyen mon ky thuat vdi cac eo quan, to ehiic, tnmg tam ghep trong va ngoai nude
+ Xay dung cac hudng dan dieu tri cho diuyen nganh ghep tang thong nhat trong ca nude.
+ Hd trp cac don vi/trung tam ghep tang dao tao ngudn nhan luc ca trong va ngoai nude.
- C ^ them tieng ndi cua cac chinh khach trong cac chuong trinh ghep tang; su vao cupc manh me, thudng xuyen ciia eae phuong tien tiiong tin dai chiing...
- Bp Y te va Hpi van dpng hioi tang, Hpi ghep tang Viet Nam can cd chiai lupc quoc gia ve giao due hioi tang, vdi su tham gja ciia toan xa hpi trong dd ndng cot la nganh y te, nhiing
ngudi diing dau cac tdn giao ehinh va eae Hoi nghe nghiep eiia nganh y te.
- Chinh phu, Bp Y te can cd ehinh sach ton vinh va cd mi dai phii hpp ddi vdi ngudi song hien tang va th3n nhan ngudi chet nao da hioi t?ng.
(Hien tgi nhteu ngudi song hien than, gan tai BVQY103 chua duac ca quan BHXH dia phuong cap the BHYT theo luat dinh).
KET LUAN
Trong nhiing nSm qua BVQY 103 da dat dupe mdt so thanh tim ve ghep tang, dac biet ve ghep than. Tuy nhien van de thieii nguon tang ghep dang la van de ehinh can trd su phat trien ben viing ciia cac trung tam ghep tang trong ca nude. Viec tiep can voi cac thdng tin khoa hoc ve hioi va ghep tang ciia cdng dong cdn nhieu ban che, dac biet ve hi&i tang tix ngirdi chet nao, trong khi day la nguon tang cd tiem nang rat ldn. Thieu tang ghep dang tao ra mot thi trudng ngam mdi gidi mua, ban tang rat phiic tap, nguy CO nii ro phap ly khdng ehi voi xa hpi ndi chung ma cdn ddi vdi can bd, nhan vien y te ndi rieng, De chuyen nganh ghep tang phat trien manh me va ben vung can cd su ddng gdp ciia toan xa hpi trong dd nong cot la nganh y te, phap luat, bao hiem xa hpi...
TAI U E U THAM KHAO
1 Kakaei F va Ni3teghbalian S. (2011) "Pancteas-Kidn^
Transplantation". In Undwstanding-the-coin(dexites-<rf- kidney-traniplantalion. Chapter 19, p p . 387-406 2. Mollis P. (2011) ' l a d n e y TrarsplanlatioiT: Prindple and
Practice, 2011.
3 N o n n a n Df (2005), "Primer on Organ Transplantation", Saunders Company.
