Y Hpc TP. Ho Chi Minh * Tap 18 * Sd 1 * 2014 Nghien cihi Y hpe
NGHIEN CLfU TAI BIEN VA BIEN CHL/NG CAT GAN UNG THU"
Van Tan*, Nguyin Cao Cuang*, Bdi Maidt Con*
TOMTAT
Tong quan: Phdu thudt cdt gan ung thu thudng gay biai chirng aio md nguy ca nhai Id xuai huyii vd hon me.
Muc tieu: Nghiai cieu tai bidi vd bien chinig nhimg benh nhan cat gan ti-ong ung thu Dot tucmg vd phuang phdp: La nghiai cuu hdi cieu 151 binh nhdn mo tinidm 2006 ddi 2010.
Kei qud: Trong sd'tidi, ti li nam nii Id 3/1, tudi trung binh Id 52. Child A 129, Child B 22. Md'cat gan Idn la 113, mdu tmyen trung binh trong mold 147ml mdi benh nhdn, thai gian mo tmng binh mdi benh nhdn Id 92 phut. Ndm vien trung binh sau mold 10 ngdy. Tai biai vd bidi diiaig diung la 38,4%, tie vong ehung Id 3%
(xuSi huyii Id 2, hon mi gan Id 3).
Ke't ludn: Nine vqy, tai biai, bidi clidng cdt ung thu gan cao vi gan co binh lien tie trudc (xa gan. viem gan man), tuy nhidi iidi md'cm than, tai bidi, biai c^idig vd tir vong nam trong gidi lian cho phep. N/iiew n^idi cieu tiin Idiap the giai xdc djnli cat gan. neu. cdt dugc, Id didi tri ung thu hidi qua nhai cho din nay.
Tir khoa: biai diung cdt gan ung thu.
ABSTRACT
COMPUCATIONS OF HEPATECTOMY FOR UVER CANCER
Van Tan, Nguyen Cao Cuong, Bui Manh Con
* Y Hoc TP. Ho Chi Minh * Vol. 18 - No 1 - 2014:93 - 99 Backgrcnaui: Hepatectomy fer liva- cancer liave a high.ratio of complications that the high death cases are bleeding and coma.
Objective: Stiidy of complications of liver resedion in cancar
Patient and Method: A retrospedive study of 151 patients operated from 2006 to 2010.
Results: The ratio male/female is 3/1, the middle age, 52. Child A 129, Child B 22. The major liver resection is 113, the transfuse blood average, 147ml/ patient, the average time of surgery/ patient, 93 minutes. Time of hospital stay after operation is 10 days. The operative accidents and complications are '38.41%, tlie death rate is 3%.
Ccmclusicni: So, resection of hepatic cancer have a high complication because there are a preop disease (drrhosis, cdironic hepatitis) of majority of liver, but if the surga-y with caution, we should reduce the complications in a rate that tlie majority authors accepted. Nowaday, the surgery of liver resection feir canca- is still the procedure ofdwice.
Keywords: complications of resection of hepatic cancer
TONC OUAN ^^ S^" duoc mdi nam. Khdng phai cat gan la md tru can tat ca. Cd tnidng hgp cat gan vi xuat Ung thu gan den dieu Iri tai BV Birh Dan huyet do v5, ctt gan de cam mau Co trudng hap kha nhieu, da so co xo gan ket hop, nhung ti le ^ ^ ^ ^ . , . ^ ^^ ^^^ ^^ ^^^.^ ^g. ^ ^ y^_
cat gan duoc hoi hiem, CO khoang 30 truong hop ^^ ^ ^ ^ 5^^ ^^^ ^^^^ ^ ^ ^ ^^^ ^ ^ ^^^^
* Benh ^•ien Binh Dan
Tdc}!id lien Iqc: GS BS. Van Tan DT: 38394747
Hpi Nghi Khoa Hpc Ky thuat BV. Binh Dan 2014
Nghien cmi Y hpc Y Hpc TP. Hb Chi M i n h * Tap 18 * Sd 1 * 2014 cat gan ben kia. Vi tai bien, bieh ehung va tu
vong cat gan rat cao.
O cac nude chau A, ung thu gan trong quan ehung cao, nhat la d doi tuong bi nhiem sieu vi B. Nhiem sieu vi C thudng gap d eae nude Tay Au nhung cung thay nhieu d Nhaf^'.
Dieu quan trong la benh duo'c phat hien tre, gan bj suy vi xo hay viem man, md hoa nen dieu tri khdng may hieu quai^'. Trong cac phuong phap dieu tn, cd phuong phap cat u gan trir can hay ghep gan la hieu qua nhat nhung cac phuong phap tren duoc chi dinh d mdt so it trudng hop, khoang 25 den 30%. O nude ta, Tdn That Timg, ngudi dau tien da mo e5t gan hang tram trudng hgp tu thap ky SC*-^'.
Khdng ke nhimg tnjong hop ghep gan, ehung tdi thong ke phan tich nhiing tai bien, bien chiing va tir vong lien he den xo gan hay khdng, viem gan man va hau qua ciia ehung, hau tim ra phuong phap phdng ngira de tranh nhiing hau qua.
c i t gan duoe de cap tir 1800, nhung den nam 1952, Lortat Jacob mdi ndi deh cSt gan theo giai phau hoc, dua tren phan bo maeh mau, dtrdng mat timg thuy va timg phan thuy. Tir vong con rat eao. Mai den thap ky 70, tir vong vin con tren 10%<^'^i. Nhd tien bd ky thuat va cham sdc chu phau, trong 2 th|p ky sau da din den tit vong dudi 5%, tham chi cd noi bao cao chi l-2%w. Nhd ha huyet ap tinh maeh trung tam <
7cm 0H2, benh nJm the Trendelenburg, da giam duoc bien ehung chay mau, nhung bieh ehung ndi ehung thi con rat eao tdi 45%. Ngoai bien chiing chay mau, bien chiing rd mat, bieh chiing suy gan dan den suy da tang, bien ehung nhiem trimg rdi dieh bang...
Ngay nay, rngt so benh vien Idn da thir md ndi soi nhung u gan gidi han hoac nhd, nhung chua phan ti'ch nhimg tai bi&i va bien chimg.
M\ic tieu nghien cuu
Chiing tdi nghien ciru tai bien, bien chiing lien h? den xo gan hoac khdng, viem gan man, hau qua va tim each khSc phuc.
PHU'ONG HIAP-DOI lUiONG NGHIEN CUtJ - Ddi tuang: Nhiing benh nhan ung thu gan, cd eat gan til 2006 den 2010 tai BV Binh Dan
- Phuang phdp: Chiing tdi ghi nhan nhiing yeu to dan den bieh chiing va phan tich nhiing tai bien, bien chiing lien he den xa gan hoac khdng xo gan va hau qua. Chiing tdi tim each khic phuc cac tai bien va bi&i chiing hau giam ti le tir vong.
N h u n g yeu to dan deh tai bien va bien chiing
Trong thdi gian hi 2006 den 2010, cd 151 trudng hgp eat gan, tudi tir 16 den 78, tudi trung binh 52, nam gap 3 nii, da sd lam nghe don gian nhu lam mdng, chan nudi, lam cdng, cdng ehiic Chiic ndng gan
J1: Chung tdi dua vdo
Y e u t d Mattoartph^n trong
mau (mg/dl Mbumin trong mau (g/dl Prothrombin lime (tang/
giay) Ascile Hon me
1
<2
>3,5 1-3 Khong Khong
2 2-3 2,8-3,5
4-6 Nhe Nh?
3
>3
<2,8
>6 Vi>a Nang
Nhu vay, trong nhdm benh nhan cua chiing tdi cd Child A 5 - 6 diem: 129 trudng hop. Child B 7 - 9 diem: 22 trudng hop, ALT ti-ong mau 26%
cao, 74 % binh thudng
Child B nhiing yeu td gay chay mau trong md va sau mo, roi hdn me gan.
Mien nhiem
Dac biet la gan tiep tuc viem (viem cap tinh), de gay bien chiing.
HBsAg (+): 71/115 = 61,74%
HBC {+): 4/115 = 3,48%
Markers: Khdng anh hudng den tien lugng.
AFP (+): 67/91 =73,26%
CEA (+): 9/91 =9,89%
CA 19,9:15/91 = 16,48%
Hpi Nghi Khoa Hpc Ky thuat BV. Binh Dan 2014
Y Hpc TP. Hd Chi Minh * Tap 18 * Sd 1 * 2014 Nghien cihi Y hpc Cdtgan
Cat gan Idn, nhieu thuy, rat xay ra chay mau trong md va sau md va suy gan.
^an^T: 151 tiirdng hap est 1 thuy
C S t 2 t t i u y C ^ S t h u y C l t 4 t h u y C a t s thuy Cat gan Irai C^t gan gii>a C ^ gan phai
38 73 24 15 1
44 (trong do c6 4 tarcmg h g p cat gan trai, chich c6n tuy?t 36i hay 5FU vao gan phai)
8
99 (trong do, c6 2 trudng hgrp cat gan phai, chich c6n tuy#t d6i gan trai) 14 t n / o n g hgrp cat gan do ung thir gan tai p h a t 13 tm-ong hop Child-Pugh A, 1 tnrong
hgp Child-Pugh B, co 2 t a w n g hpp di c i n ngoai gan, t r ^ dai trang ngang; kh6i u la t 0 1
sin 3; gan phai co 10, gan trai co 4; kich thiroc ti> 1,5cm den 7 cm.
Mdu SU dung
Bdng 3: Sie dung cdng nhieu thi bidi diieng cdng idng
1 boc mau 2 b Q c m a u S b g c m a u 4 b Q c m a u S b g c m a u
6 19x2 6x3 3x4 3x5
= 1 500 ml 1
= 9.500 ml
= 4.500 ml
= 3.000 ml
= 3.750 ml
Tong: 69 bpc mau = 22250 mJ/151 benh nhan
= 147 ml/ mdi ngirdi.
Day la mau sir dung trong liic mo, d hoi sue cd the su dung them, nhat la trudng hgp ung thu gan vd.
Thai gian mo
Bdng 4- Rdt dnh hudng dai tinh tiang h'di tinh.
nhung Ididng dnh hitmig ddi bidi diicng
T h a i g i a n 50 phut 50-100 p*iut 100-150 phut 150-200 phut 200-250 phut T i n q c^ng
TriFOTig h o p 13 64 30 6 3 118
Thdi gian mo trung binh mdi ngudi phiit.
la 92
Bdng 5: Mo ndi soi chua tlidy dnh hudng deh bidi chimg, mac du mo Ididng nhanh, didi quan trgng la mo trit can. ty le tdi phdt.
MSNS
Chuyen N a s o i
BN 14 6 8
TGTB 180' 90' 168'
K.thu>6>c
< 5 c m 5-6 cm 4-5cm
Phan t h i i y T r i i 3 phai 11 P h a i / 6 , 7 Trai 3.
phai 5 Mo buou U hien: 6,
U a c 8 U hien 4,
U a c 2 U hi^n 5,
U a c 3
2 trudng hgp cat khdng het budu, 1 tnidng hgp AFP con cao.
Mo budu
Chua thay anh hudng den bien chiing.
Khdng tiiay de cap den loai lamellar HCC, nhung cd 2 trudng hgp te bao sang va 7 te bao phat trien..
Bdng 6
HCC bi#t hoa cao HCC bj#t hoa vi>a HCC biet hoa kem HCC t l bao sang HCC p h i t tnen CA te b i o d u o n g mat
52 39 5 2 7 6
Tdng so ung thu gan ngu3'en phat 105, trudng hgp la ung ttiu dudng mat trong gan.
CA tuy^n di can U tuyen gan l i n h tinh U mach mau lanh tinh U viem mo hat
U l a o Apxe kho X c g a n phi dai
M i t k i t qua
1 10 6 8 2 1 4 6
Kich thuac khoi u
Rat quan trpng, dac biet la lan ra nhieu thiiy, cat khd, rat anh hudng den bien chiing.
Bdng7
D u o n g kinh 2 cm D u o n g kinh 2 — 3 cm D u o n g kinh 3 - 4 cm D u o n g kinh 4 - 5 cm D u c m g kinh 5 — 6 cm Duicng kinh 6 - 7 cm D u o n g kinh 7 - 8 cm D u o n g kinh 8 ~ 9 cm D u f f n g kinh 9 - 10 c m D u f f n g kinh > 10 cm
4 T H 4 T H 24 TH 16 TH 15 TM 9 T H 7 T H S T H 14 T H 12 TH
Hpi Nghi Khoa Hoc Ky thuat BV. Binh D i n 2014
Nghien cixu Y hoc Y Hpc TP. Hd Chi Minh * Tap 18 * So 1 * 2014
Ung thu gan vo
T 3
Suy gan, suy than truac va sau mo Xo gan, Viem gan man 107/151 = 70,8 Suy than sau mo 23/151 -15,23%
KET QUA NGHIEN O J t J
Tai bieii Bangs
R i c h ccr hoanh X u i t huyet mo lai Ro dich b i n g mo lai
S 6 T H 2/151 3/151 1/151
Tt> v o n g 0 2 0
Bien chimg Bdng 9
- NhiSm tfung vet mo - Dau v^t m6 sau mo 5 ngay
- Ro d|ch bang - 0|ch bang
- Ro mat - Apxe d u o i hoanh - Tg mat d u o i t i o i n h
- Vang da - S6t > 38 dp C
- Bung v l t mh - Vi6m tuy cap - Vifem phw - T r i n d|ch mang phoi
- T i l u g i t - T i l u m i u - Lach to - Hon m^ gan
Tong
S 6 T H 13/151 6/151 3/151 8/151 2/151 1/151 1/151 5/151 7/151 1/151 1/151 2/151 2/151 1/151 1/151 2/151 2/151 58/151 = 38,41%
Ti> vong 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 5 (3%)
Tifvang
Tu vong la 5, chiem b le 3%.
1- 207/02390: Hoang L. 69 hadi, K gan T 2-3-4 vd, XH ngi. C3t gan Idn. ngay 2/2/07. TV 4/2/07.
2- 207/06908: Nguyen B., 76 hioi, K gan 8 + xo gan. Cat 8, ngay 26/4/07, sdc mat mau, RLDM.
Gan xo teo. khdng md Iai, TV ngay 28/4/07 3- 207/15051: Ta Quang Ph., 67 tudi, K gan 6- 7, sdi m§t, c3t 5-6-7, cat TM. C5t gan Idn, ngay 13/8/07 sau md vang da tang dan, suy than va TV ngaj' 28/8/07 do suy gan
4- 209/11992: Tran Huy H. 58 tiioi, K gan
phai, est 5-6-7-8, din luu ngay 1/8/09. Sau mo dich bang roi rd dich bang, da vang ngay cang nang, suy than phai lpc mau, nhiem trung dich bang. TV ngay 15/8/09.
5- 210/04011: Hoang Thanh H, 69 tudi, K gan phai, cat gan P DL 24/3/2010. XH mo lai 24/3/2010, TV 31/3/2010. Ly do: cii gan Idn, chay mau, md 1^ cham, soc mat mau keo dai va TV.
Suy gan sau md gay tu vong 3 TH tu so 2 den so 4, va xuat huyet cd 2 trudng hpp: sd 1 va so 5.
Nhimg trudng hop suy gan gom cd cac trieu ehung sau:
1- Vang da tang dan, bilirubin mau > 5mg/ dl
= 100umoI/I
2- Ascite nhieu: 500 ml/ngay trong 7 ngay.
3- Rdi loan ddng mau: PT > 24", % PT < 50%
4- Hdn me gan
Trudng hpp so 1 va so 5 xuat huyet m|it gan cat, can thiep cham, rdi loan ddng mau vi xa gan.
Bdng 10
Nam vien
< = 10 ngay
> 10—15 ngay
> 15 ngay Trung binh
Ngay 95 44 11 10
TO vong 3 2 0 5
BAN LUAN
Theo Nguyen Cudng Thinh va CS**' ve " Ket qua 156 TH cit gan brong HCC tii 5/2007 den 10/2011 tai khoa phlu thuat tieu hoa 108, thi tai bien va bien chiing la 22,1% va tu vong la 0,64%.
Tai bien, bien chiing gom cd chay mau sau mo 0,64%, d dpng dich 5,7%, rd mat 2,5%, b-an didi MP 7,6%, CO chudng 5,1%, tdn thuang TM chii dudi 0,64% (TH nay TV). Cat gan tirai 32,6%, cat gan phai 23%. 83,3% benh nhan cd benh ly man tinh, 100% Child -Pugh A. Thdi gian md tiimg binh 112-1- 21,2 phut, lupng mau mat trung binh 300+- 232ml. Thdi gian nam vien trung binh la 12 +^ 3,5 ngay.
Theo Le Ldc va CS (nghe bao eao), tren 1200 TH ung thu gan den dieu tri tix 1995 den 2010, d
Hoi Nghi Khoa Hpc Ky thu^t BV. Binh Dan 2014
Y Hpc TP. Hb Chi Minh * Tip 18 * Sd 1 * 2014 Nghien cmi Y hpc benh \'ien Trung uang Hue thi bien chiing quan
tTOTig nha't la chay mau sau mo, roi d a i suy gan gay tu vtmg nhieu nhat Trudng hpp chay mau sau md, o n phai md lai gap, tic gia nhan m^aih.
Theo Van Tan, tii nam 2000 d&i nam 2006f^, cd 1134 ung thu gan den nhap \'ien dieu tri tai benh \'ien Binh Dan, so tren cd 244 trudng hpp dupe md, da so theo cau tnic giai phiu va md cat gan Idn, thai gjan mo trung binh la 110 phiit, lupng mau mat trung binh la 200ml, tfidi gian nam vien trung binh la 10 ngay. Chiic nang gan Child A hay B. Tai bien va bien chiing nang la XH la 7 trudng hgp do xo gan gay RLDM hay khau diua tot can thiep kip thdi, ciiu song dupe 4. Suy gan la 5 tat ca trong nhdm cd xo gan va suy gan man, nhiing benh nhan nay sau md bi vang da dan, cd dich bang va suy than dan den suy da tang va tii vong 5. Nhung bien chiing khac phan Idn nam trong nhdm ung thu gan vd (31 trudng hpp).
Trong nghien ciiu lan nay, tai bien va bien chiing cd 38.41% (Bang 11), quan trpng nhat van !a xuat huyet sau md d nhung trudng hpp md Idn (3 trudng hpp), tru trudng hpp ung diu gan vd, cd xo gan, mac dii chiic nang gan con bii; ke den la suy gan (3 trudng hpp), bat dau la vang da, nhat la nhiing trudng hpp cd ALT trude mo cao, cd viem gan sieu vi B, cd AFP cao. I>ac biet la trudng hpp xo gan Child B, thudng bi dich bang va tran dich mang phdi sau md (11 trudng hpp). Nhimg trudng hpp viem gan man, cat gan Idn ciing thudng bi tran dich mang phdi ben phai. Cdn rd mat, tu mat dudi hoanh thudng do cat gan Idn ma khdng dan luu mat (3 trudng hop).
Theo Jamagin, Ann Surg 2002. MSKCC New York, 1991-2001, 1.803 patients. Tac gia nhaii manh d&i suy gan nang sau mo.
B i ^ chiing toan bp: 1350 tiic 74,87°o, trong dd:
B i ^ c h i m g Gan/Mat - Nghet T M o i a do
cue mau - Viem Sitimg mat
9 3
Bien e h u n g Nieu s i n h due - Bien d i i m g Da
day-ruol - t j e t r u o t 109
B i 6 n chLPnq Gan/M^t - Apxe quanh gan
- Suy gan nang - Ro mat/Mat u dong
110 99 47
Bi6n C h u n g Nieu s i n h d u e - NT d u o n g ni#u - S u y t h i n n i n g
- B i b e u 72 41 23
B i e n c h i i n g p h o i - T r i n dich MP (Tneu chirng)
- Viem ph6i - Nghet njot - XIH tieu hoa - Viem dai trang
- X ^ p phoi - T h u n g ta t r i n g - Suy ho hap nang
- Thung dai trang - T r a n khi MP - Thuyen tac D M phoi
154 54 27 21 16 4 5 2 4 3 1 32 16 Bien e h u n g Tlm-maeh
- Loan nhip -Dvr - C H F - Dau r>guc/MI -EXrngtim
- S t r ( * e TIA - V i ^ m i n g tim t r i n dich
83 24 19 13 8 7 3
B i ^ c h i m g khac -hTTvetrnd - NT huy^t/ vi tnjng
v i o m i u - Sot chua ro N/N
- X u t t huyet - Delirium - H o v§t m6
94 39 33 18 12 10
Theo Jeack D, Bachelier P, Oussoultzoglou E, Weber J-Q Wolf P 1990- 2002: Cat gan 1467 trudng hpp. Bien chiing gom cd: - Ascite: 22- 35%, - Suy gan: 4,9-19%. Tu vong la 10,6%.
Iheo Poon, Ann Surg 2004>: Hong Kong, 1989-2003, 1222 ca, tac gia nhan manh den xuat huyet va suy gan nang sau md.
Bien chiing nhdm 1 gom 402 trudng hpp la 55.72% va bi&i chiing nhdm 2 gom 820 trudng hop la 29,63%.
B4n chimg ngoai khoa
Nhom 1.
1 (n -402) - Ro mat -Apxe trong tiurw
- XH sau mo - NfT vet mo - Bing manh bmg
24 22 9 34 7 - ^tohet ruot ' 1
-Romot 2
. Bien diuTw noi khoa ' -Suy gan - NT dich barig
20 2 - XH din vo TM thirc 1
%
55 72 6 5 5 2 2 B3 1 7 0,2 0 5 50 0 5 G2
Nhom II, (n = 820) 14 11 11 81 9 1 0 27 4 1
%
29 53 1 7 1 3 1 3 99 1 1 0,1
0 P
<0 001
<oooi!
0298 0 428 . 0 352 0.550 1 0 108 ,
1 1
33 0 5 0 1
0151 1000 1 1 000
1
Hpi Nghi Khoa Hpc Ky thuat BV. Binh Dan 2014
Nghien ctru Y hpc Y Hoc TP. Ho Chi M i n h * Tap 18 * So 1 * 2014^
BUn Chung ngoa) khoa -XMbeldadayMa
trang - Viem phe qijai>f)h6i
- Tran dicli MP. din chgctiut -ViemmuMP - T r ^ l t f i i M P Tdng
Nhoml, 5 41 40 1 5
%
1.2 10.2 4.0 0.2 1.2 224
» i 6 m II, 7 44 23 1 9
%
0,9 5.4 2.6 0,1 1,1 243
P 0,422 0,004 0,001 1,000 0,782
Nguyen Quang Nghia, nam 2011, bao cao tai BV Dai hoe Y, neu len 1 TH tir vong do hdn me gan va nhan manh sau mo, ngudi bi suy gan, la bien ehiing dang chii y nhat gay hi vong eao, nhung trieu ehung sau:
Vang da tang dan: bilirubin mau > 5mg/dl - lOOumol/L khdng tSe m | t khdng hoai huyet.
Ascite nhieu: SOOml/ngay trong 7 ngay.
Rdi loan ddng mau: PT > 24", %PT< 50%.
Hdn me gan.
De giam tai bieh, can cat gan can th?n, eoi ehung nhung bat thudng mach mau, luu y co hoanh va cae bp phan lan can; cam mau ky, budc cac mach Idn, ke ca dudng mat, neii can thi khau bupc, bupc ho^c dot cac mach mau nhd hay bom thudc lam bit long mgeh. Lam the nao de phau tiudng khd, trudc khi ddng bung. Sau md^ neu chay mau ra dan luu kha nhieu tW phai md lai sdm diing de b?nh nhan b; sdc, truyen mau nhKU dan den rdi loan ddng mau roi mdi md".
Sau day la bang so sanh:
Xudl huyit Romgl Apxe quanhi
gan TD mang pt)6i
hfTvilmO Hdnme/suy gan B, chimg Chung la
NC Janargin (2002)
1%
2,8%
6,1%
8,5%
5.2%
5,5%
74,8%
N C Poon (2004) Nh 1/2.2%
6%
5,5%
4%
8.3%
5.0%
55,7%
Nh 11/1.3%
1,7%
1,3%
2.8%
99%
3,3%
29,6%
Van Tan (2010)
1,3%
0,7%
0,7%
1,3%
8.6%
2,0%
38,4%
Ng,C.
Tliinh 0,64%
2.5%
5,7 dich 7,6
•) 9
22,1
Bien eao theo Janargin (ke het BC ndi, ngoai), bien chiing trung binh theo Poon va Van Tan.
bien ehiing thap Nguyen Cudng Thinh.
De giam nhiing bien chiing, can phai cd chi djnh md rd, Tham sat gan trong liic mo de danh
gia phan gan chua lai. Md tni can hay md" tam.
Trong md tgm nhu ung thu vd cd the cat khdi u de cam mau, trudng hpp ung thu Idn cd nhieu u ve tinh, can md de lay g'an het u^ cho hoa tri cd hi?u qua.
Trong md trir can, cat gan theo giai phau tung thuy, tung h? phan thuy, dieu can la lay het budu, ke ca hach neu cd, khdng dupe lam cho mpt phan md lanh hoai tii do mach mau bi cat gay suy gan sau md. Phan gan chua phai duac 1/3 gan lanh, khdng xo hay viem, khdng cd budu.
Cam mau ky, khdng de mau chay sau md".
Trong md, nhat la nhiing trudng hpp cd xa gan, truyen nhieu mau se gay roi loan ddng mau va suy gan. Khd nhS't la xo gan ma phai cat gan Idn, trong trudng hop tren can phai quyet dinh \d suy gan se xay ra neu cat nhieu ha phan thuy nhat la gan phai, tha lam TOCE hay chich con va budc ddng mgch gan.
Trudng hop nhiing khoi u d nhiing ha phan thuy cat khd, neu eat khdng bao dam thi chich con hay dot dien cao tan (RFA).
Sau md phai theo ddi sat khi cat gan Idn nhu maeh (<100), huyet ap (binh thudng), nhi?t dp, nhip thd (<25 l/phiit) tren monitor, nude tieu mdi gid (>40ml/gid) trong 12-24 gid dau. Ong dan luu ra mau, mat, dich bang bao nhieu; tinh trgng tinh hay la mo. Chup hinh phdi, sieu am bung xem cd dich khdng. Ngay hom sau, do lupng mgt trong mau, ALT, thudng thi len cao nhung mat khdng bao gid len cao qua 2,5mg/lit. Neu xuat huyet, thi phai mo lai ngay dung de soc hay roi logn ddng mau, ke ea trudng hpp cd xo gan, truyen mau nhieu. Neu tran dich mang phdi nhi"eu gay khd thd thi phai xuyen thieh nit dich hay dan luu. Neu benh lo mo vdi mat trong mau cao dan hi 2,5mg/lit thi phai xem lai albumin de truyen them, xem NH3, xem creatinine, potassium trong mau de sii tri kip thdi, ran thi phai loc mau. Neu nhiet cao > 39 dp thi xem Iai khang sinh cho cd dii khdng, la md sach nhiem, chi can 1 loai khang sinh pho rdng la dii. Trudng
98 Hpi Nghi Khoa Hgc Ky thuat BV. Binh Dan 2014
Y Hoc TP. Hb Chi Minh * Tap 18 * Sd 1 * 2014 Nghien ciru Y hpc hop bi suy gan tu tir nhu mgt trong mau cao
dan, benh ban dau tinh roi den lo mo, vang da ngay cang tang, khdng muon an cd khi di, nude tieu it dan la tnidng hop suy gan nang. Hay eoi chiing tmh trang ehung cua ngudi b^nh. Cd Idii nhd hoi siic tot, nhd lpc mau, nhd cho albumin, nhd cho thuoc thuc day chuyen hoa tebao gan, gan sinh san lai, ngudi benh bdt vang, than hoat ddng trd lai, albumin trong mau du, muon an, dan dan gan phuc hoi.
KETLUAN
Can tham sat gan ky trong liic md, cd the diing sieu am neu khdi u nam sau, xem khoi u cd cat bd dupe khdng.
Neu cd gidi hgn rd, phan gan chua lai dii de cat bd phan cd u thi cd chi dinh cat gan tru can.
Neu gidi han khdng ro hay u nhieu thuy, u Idn an qua cac thuv lan can, gan xa hay viem, chiic nang gan tam du hay cao hon mdt it neu gan chua cat thi tuy trudng hpp cat gan khdng trir can ha\' lam TOCE, chich ran tuyet ddi (nen su dung sieu am tai chd).
Khi cat nen cam mau tnidc va can than khdng de chay mau nhieu trong md va chay mau sau md". Neu sau mo chay mau nhieu tfii phai md lai ngay, khdng de den khi cd roi loan ddng mau hay bi soc thi md khdng kip.
Nen dio lam lai chiic nang gan, qua ngay Ihii hai, mat trong mau cd tang nhung khdng qua 2,5g/l, bdt dan qua ngay thii 5. Neu qua
ngay thii 5, vang da tang, chiic nang gan kem dan, bung cd dich bang (cd khi len phdi), gan bi suy that su. Trong trudng hop nay ran theo ddi sat; cho albumin, eho fhuoe lam cho te bao gan sinh san, cho thuoc giam NH3 trong mau, cho di rau nhieu Ian Neii suy than (thieu meu) thi ran cho lpc mau. Giii cho HA binh thudng, mach
^ n binh thudng. He phdng nhiem trung dich bang va suy da tang.
TAI LIEU THAM KHAO
3 Bosdi FX, Ribes J, Qraies R et al (201S): Epidemidogy of HOC CbiUoerdB 9.191-211
-> Fuldier AS^ StetUng RK (2002), Hepatic neoplasms. Computed tomogra;^y and inagnetic resonance i m a ^ n g features. / C3m GrttomltTol 54 463-471
3 H u R H ( 2 0 I l ) Management of H C C surgical aspect Presented DI ininrrsdy m^ad center at HCM city, s^tenAer29* and iCf' 2011.
i Law WY Pnmary HCC In Blumgart LH. Fong y (eds) GOOO), Surgery of fte livrr ayid bHiary tract LonJan, WB Saunderi, ppI423-JiS0-
3 Leridonj R, Crooetti L (20(6): A cntical appraisal of the Bttaatuie on local ablative therapes fcir H C C O m Uver Dn 9301-314.
6 Nguyen Cuimg Thinh, Le van Thanh (2010) Hiau thuat cat
^ n dKu t n Ung thu te bao gan, Yhnc Ip HCM, lap 10. phu bmi 4, tr 395-399.
I Ribero D, Ahdalla EX. n i w n a s MB et al p006)- Lii'erresectic*!
in Ihe trBatmsit of H C C Ixptrt wr milicanceT Aer 6; 567-5;^
S Van Tan \'a CS (2008): Hiau t h u | t dieu tn Ung gan'nguj'en I * a t Sach, nha XB Yhoc Hi Noi. IrSSl-iOS
Ngdy nhan bdi bdo: 31/10/2013 Ngdy phdn bien nhdii xet bdi bdo: 02/12/2013
\gdy bdi bdo dugc dang: 20/02/2014
Hpi Nghi Khoa Hpc Ky thuat BV. Binh Dan 2014
