Y HOC VIET NAM SO DAC BIET-THANG 11/2010 thoracoscopic surgery in patients clinically
resectable lung tumors", Diagnostic and Theurapic Endoscopy 2 : 1 5 1 - 1 5 5
Todd L. Demmy, David P. Mason, Scott J.
Swanson (2001), " Lung cancer: Diagnistic and Treatment", Video-Assisted Thoracic Surgery, Landes Bioscience: 7 1 - 9 9
Shaw JP, Dembitzer FR, Wisnivesky JP, Litle VR, Weiser TS, Yun J, Chin C, Swanson SJ (2008), "Video-assisted thoracoscopic lobectomy: state of the art and future directions", Ann Thorac ft£g,Feb;85(2):S705-9
Anthony PC. Yim (2001) "Video-assisted lobectomy: Indication and Technique", Heart. Lung and Circulation 10: 33 - 34
8. Congregado M, Merchan RJ, Gallardo G, Ayarra J, Loscertales J (2008), "Video- assisted thoracic surgery (VATS) lobectomy:
13 years' experience", Surg Endosc.
Aug;22(8): 1852-7. Epub 2007 Dec 20.
9. Wan IY, Thung KH, Hsin MK, Underwood MJ, Yim AP (2008), "Video- assisted thoracic surgery major lung resection can be safely taught to frainees", Ann Thorac
•Sz/rg. Feb:85(2):416-9.
10. Demmy TL, Nwogu C (2008), "Is video- assisted thoracic surgery lobectomy better?
Quality of life considerations", Ann Thorac Sure. Feb:85f2i:S719-28.
OANH GIA KET QUA BaOC DAU AP DUNG PHAU THUAT NOI SOI LONG NGlJC TAI BENH VIEN DA
N A N GThan Trong Vu*, Bui Chin*, Ho Ai Yen*, Tran Ngoc Thanh*,
TOM TAT
Phau thuat ngi soi long ngUc thUc sU da trd thanh cuoc each mang trong nganh phau thuat long ngUc hien dai. Benh Vien Oa Nang bat dau ap dung phlu thuat ngi soi long ngUc tCr dau nam 2009.
Muc tieu nghien cu'u: Danh gia bieu qua phau thuat ngi soi long ngUc tai Benh Vien Oa Ning.
061 tu'dng va phu'dng phap nghien cu'u:
62 benh nhan dUdc phau thuat ngi soi long ngUc tii thang 1 nam 2009 den thang 8 nam 2010.
phUdng phap nghien cu'u tien cu'u, md ta cat ngang.
Ket qua nghien ciTu: 62 benh nhan tud'i tCr 6 Jiang den 81 tudi, nam (79,03%), nu- (20,97%).
98,39% benh nhan dugc thUc hien phau thuat thanh cdng, 1,61% benb nhan chuyen sang md ngUc, bien cbiing nhe vdi ty le cho phep, khdng cd tai bien trong md', khdng cd tu" vong.
Ket luan: phau thuat ngi soi long ngUc tai Benh Vien Oa Ning hieu qua, an toan.
ABSTRACT
EVALUTE THE INITIAL RESULTS FROM APPLICATION OF THE VIDEO ASSISTED THORACOSCOPIC SURGERY AT THE DA
NANG HOSPITAL
Introduction: The video assisted thoracoscopic surgery (VATS) is really a revolution of modern thoracic surgery. The Da
CHUYlN DE: PHAU THUAT TiM MACH VA LONG NGUC VIET NAM Nang hospital has applied the VATS from
01/2009.
Objectives: To evalute the effect of the VATS at the Da Nang hospital.
Patients and Methods: All patients had been operated by VATS at the Da Nang hospital from 01/2009 to 08/2010. Methods: Prospective, descriptive study.
Results: From 01/2009 to 08/2010, there were 62 patients to be operated by VATS at the Da Nang hospital. Overall, thoracoscopy was successful in 61 cases (98,39%). Conversion to formal thoracotomy was required in 1 case (1,61%) secondary to complex desease. No mortality, no morbidity, acceptable complication rate.
Conclusions: The VATS at the Da Nang hospital was effective, safe surgery.
I. DAT VAN OE
Phau thuat ldng nguc da dugc bidt tu lau.
Day la mdt phau thuat ldn, gay dau nhidu nhat, thdi gian hdi phuc keo dai trude khi benh nhan cd the hoat ddng binh thudng va trd lai lam viec (4)(5).
Phau thuat ndi soi da thuc sir trd thanh mdt cudc each mang trong nganh phau thuat.
Nhung budc phat tridn cua thap nien 1980 vd ndi soi d bung da thdi thiic cac nha ngoai khoa ldng nguc phai khing dinh vai trd ciia phuorng phap nay trong chan doan va didu fri benh ly phoi va trung thdt (4). Tir khi Hans Christian Jacobaeus gidi thieu ky thuat ndi soi mang phdi vao nam 1910, phlu thuat ndi soi long nguc (PTNSLN) da phat trien manh me. Nam 1993, Kirby d My va Walker d Anh da thyc hien cat thuy phoi dl didu tri ung thu phdi qua ndi soi long nguc (5).
Nam 1996, PTNSLN cit thin kinh giao cam nguc dilu tri benh tang tilt md hdi tay, viem tac ddng mach man tinh chi tren d benh vien Binh Dan, benh vien Chg Ray (5). Din
nay da cd nhieu benh vien fren ca nudc thuc hien dugc PTNSLN va ap dung vao nhilu benh ly khac nhau.
Nam 2009, Benh Vien Da Ning friln khai PTNSLN de chan doan va dilu tri cac benh ly phdi, mang phdi va trung thit. Vi vay, chiing tdi thuc hien nghien cuu: "Kit qua budc dau ap dung phlu thuat ngi soi ldng nguc tai Benh Vien Da Ning" nhim muc tieu:
Danh gia hieu qua phau thuat ndi soi ldng nguc tai Benh Vien Da Ning
I I . DOI TU'O'NG VA PHU'ONG PHAP NGHIEN CLTU
2.1 Doi tvomg nghien cihi
Tat ca cac benh nhan dugc PTNSLN tir 01/2009 din 8/2010 tai khoa ngoai Tilt Ni?u - Ldng Ngyc Benh vien Da Ning.
* Tieu chuan chgn benh
- Tat ca cac benh nhan dugc PTNSLN vdi muc dich chin doan hay dilu tri tai B?nh Vien Da Nang.
* Tieu chuan loai trir
- Benh nhan cd chong chi dinh PTNSLN theo ly thuylt (4)(5):
-I- Day dinh mang phdi toan bg.
+ Tdn thuong khdng cd kha nang cit b6 dugc.
+ Benh nhan khdng cd kha nSng chju dyng thdng khi mgt ben phdi dugc.
+ Rdi loan ddng mau khd dieu chinh.
+ Huyit dgng hgc khong 6n dinh.
+ Nhdi mau ca tim mod.
- Benh nhan khong ddng y tham gia nghien cuu.
2.2 Phirong phap nghien ciru Nghien cuu tien cuu, mo ta.
* Phuong tien va dung cu phau thuat:
dan may va bd dung cy phau thuat ngi soi tdng quat.
Y HOC VIET NAM SO DAC BIET-THANG 11/2010
* Vd cam: gay me ndi khi quan, cd may theo ddi do bao hda oxy mau.
* Phuong phap phlu thuat: tiiy theo tung loai benh ma each dat tu thi, sd lugng trocart vao khoang mang phdi, ky thuat mo khac nhau.
Nghien cuu mdt sd dac dilm chung:
tuoi, gidi tinh, phan loai benh.
Nghien cuu muc dich PT>^SLN: chin doan hay dieu tri.
Nghien cuu mdt sd dac dilm ky thuat md:
+ Tu the benh nhan.
+ Sd trocart vao khoang mang phdi.
Nghien cuu cac dac diem sau md:
+ Van de dau hau phau: thdi gian dung thuoc giam dau dang tiem.
+ Thdi gjan tir khi phau thuat den khi ra vien.
+ Danh gia hieu qua PTNSLN: ty le thanh cdng, chuyen md nguc, tai bien trong md, bien chimg sau md, tir vong.
* Xir ly sd lieu: Phuang phap thdng ke thdng thudng bang Excel 2003.
I I I . KET QUA NGHIEN CLTU
Tir thang 1 nam 2009 din thang 8 nam 2010, chiing tdi da thyc hien 62 trudng hgp md ndi soi ldng nguc.
3.L Tuoi: nhd nhat: 6 thang, ldn nhit:
81 tudi.
32. Gioi: Nam: 49 (79,03%), nir 13 (20,97%).
3.3. Phan loai benh phau thuat
Bang 1: Phan loai benh phau thuat.
Benh phau thuat Tang tiet mo hoi tay
U trung that Not ddn doc d phd'i
Tran khi mang phoi do v9 ken khi 6 phoi Mau dong mang phoi do chan thUdng
Tran mau mang phd'i do vet thUdng thau ngUc Benh Buerger chi tren
Mil mang phoi
Ken khi khong lo d phoi U manq phoi thanh
Tong
So lu'dng ( n ) 25
4 5 16
5 1 1 2 2 1 62
Tang tilt md hdi tay: 25 benh nhan, tran khi mang phdi do va ken khi: 16 benh nhan 3.4. Muc dich ciia PTNSLN
Bang 2: Myc dich PTNSLN
Benh phau thuat Tang tiet mo hdi tay
0 trunq that Not ddn ddc d phdi
Tran khi mana phd'i do v9 ken khi Mau ddng manq phd'i do chan thUdng
No! soi chan doan 0
2 5 0 0
No! soi dieu tri 25
2 0 16
5
CHUYEN DE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM Tran mau mang phoi do bi dam
Benh Buerger chi tren Mil mang phd'i Ken khf khdng Id U mang phd'i
Tdng 7 (11,29%) 55 (88,71%)
Ndi soi chan doan: 11,29%), ndi soi dieu tri: 88,71%).
3.5 Tu the benh nhan
Bang 3: Tu the benh nhan.
TU the benh nhan Ngii'a
Nghieng 30°- 40°
Nghieng 90°
Sap nhe Tdng
So lu'dng ( n ) 26
3 32
1 62
Ty le phan tram ( % ) 41,94
4,83 51,62
1,61 100
Ngira: 41,94%, Nghieng 90°: 51,62%.
3.6 So trqcart vao khoang mang phoi
Bang 4: Sd trocart vao khoang mang phdi Benh phau thuat
Tang tiet mo hdi tay Buerger
U trunq that Ndt ddn dpc d phdi
Tran khi mang phd'i do v9 ken khi d phd'i Mau ddng mang phd'i
Tran mau mang phd'i do vet thUdng ngUc Mil manq phd'i
Ken khi khdnq lo d phd'i U manq phdi
Tdnq
2 trocart 25
1 0 0 0 0 0 0 0 0
26 41,94%
3 trocart 0 0 3 5 16
5 1 2 2 1
35 56,45%
4 trocart 0 0 1 0 0 0 0 0 0 0
1 1,61%
Ba trocart: 56,45%. Hai trocan: 41,94%.
Y HOC VIET NAM SO DAC BIET — THANG 11 /2010
3.7. Hieu qua ciia P T N S L N
Bang 5: Hieu qua PTNSLN Hieu qua PTNSLN
Thanh cdng Chuyen md hd Tai bien trong md Bien chu'ng sau md Tu' vong
Sd lUdnq ( n ) 61
1 0 2 0
Ty le phan tram ( % ) 98,39%
1,61%
0%
3,22%
0%
Thanh cdng: 98,39%, chuyen md hd: 1,61%.
3.8. Dat ong dan Imi: 61 trudng hgp md thanh cdng.
Bang 6: Van de dat dng dan luu ngyc.
Benh phau thuat Tanq tiet mo hdi tay
Benh Buerger U trunq that Not ddn doc 6 phoi
Tran khf manq phoi do v9 ken khf Mau ddnq manq phoi
Tran mau mang phd'i do bi dam Ken khf Idn 6 phoi
Mil mang phoi U mang phd'i
Tong
Dan lu'u mang phd'i 0
0 4 5 16
5 1 2 1 1
35 57,38%
Khong d i n lu'u mang phoi 25
1 0 0 0 0 0 0 0 0
26 42,62%
Dan luu mang phdi: 57,38%), khdng din luu mang phoi: 42,62%).
3.9. Thoi gian diing thuoc giam dau dang tiem (61 benh nhan).
Ngan nhat: 1 ngay.
Dai nhit: 3 ngay.
Trung binh: 1,85 ± 0,78 ngay.
3.10. Thoi gian tu* khi mo den khi ra vi?n.
Ngin nhit: 1 ngay.
Dai nhit: 12 ngay.
Trung binh: 4,48 ± 2,99 ngay
IV. BAN LUAN
4.L Mot so dac diem chung:
Da sd benh nhan la nam gidi (79,03%)).
PTNSLN cd thi dugc ap dyng d mgi liia tudi.
Trong nghien cuu cua chung tdi, tudi nhd nhit la 6 thang tudi, tudi ldn nhit la 81 tudi.
Theo nghien cuu cua tac gia Huynh Quang Khanh (2), tudi nhd nhit la 16, tudi ldn nhit la 77. Ddi vdi trudng hgp benh nhan 6 thang tudi, chimg tdi thyc hien md ndi soi long ngyc dudi sy giiip da cua cac chuyen gia tir Benh Vien Nhi Trung U'ang nhung vdi phan
CHUYEN DE: PHAU THUAT TIM MACH VA tONG NGUC VIET NAM
ldn trang thilt bi phau thuat va gay me hdi siic ciia benh vien chiing tdi. Dieu nay khich le chiing tdi ha thip tudi PTNSLN.
4.2 Dac dilm ky thuat PTNSLN:
. Da sd benh nhan chimg tdi thyc hien phlu thuat vdi ba ngd vao khoang mang phdi. Doi vdi benh tang tiet md hdi tay, viem tic ddng mach man tinh chi tren chiing tdi thyc hien phau thuat vdi hai trocart 5 mm.
Rieng mot trudng hgp khdi u trung that chiing tdi phai dimg ngd vao thii tu de ven tinh mach chu tren.
Theo nghien cuu cua tac gia Nguyen Hoai Nam (4), cac trudng hgp tang tiet md hdi tay dugc thyc hien vdi hai ngd vao (84,52%).
Tac gia Dao Anh Diing (3) thyc hien ddt hach giao cam ngyc dieu tri tang tiet md hdi tay cho 38 benh nhan chi vdi mdt ngo vao.
Chiing tdi thyc hien phau thuat cho benh nhan d nhieu tu the khac nhau. Ddi vdi trudng hgp tang tiet md hdi tay, viem tac ddng mach man tinh chi tren chiing tdi thyc hien phlu thuat cho benh nhan d tu the nam ngua (41,94%). Nguyen Hoai Nam (4) thyc hien md ndi soi ldng ngyc cho benh nhan da sd d tu the nam nghieng cho cac loai benh.
Ddi vdi benh tang tiet md hdi tay, tac gia nay thyc hien ban dau d tu the nam nghieng, nim sap sau dd nam ngira hoan toan. Nhu vay, sd ngd vao khoang mang phdi va tu the benh nhan tuy thudc vao loai benh.
4.3 Hieu qua PTNSLN:
Chiing tdi da thyc hien PTNSLN cho nhieu benli ly ciia phdi, mang phdi, trung that. Myc dich thuc hien nhim chin doan (11,29 % ), dilu tri (88,71%). Ty le mo thanh cdng (98,39%), 1 trudng hgp mu mang phdi phai chuyen sang md ngyc de bdc vd phdi do tdn thuang phiic tap ma chiing tdi khdng danh gia het thuang ton trude md. Day la
trudng hgp ap xe trung that gay tran mu '•
mang phdi hai ben da dugc md ngyc bdc vo * phdi ben phai, thao mil trung thit. Mot 'i trudng hgp bien chimg dd khi keo dai 10 '' ngay sau md cat khau ken khi. Day la fruong i hgp ken khi ldn (6 cm), chimg tdi thuc hien i cat ken khi bang dao ddt dien dan cue va | khau bang tay, cac trudng hgp khac cit ken khi bang dao sieu am sau dd khau bing tay cho ket qua sau md tdt. Nhu vay, bien chimg ' dd khi keo dai sau md se cai thien neu nhu ' thyc hien cat ken khi bang dao sieu am sau ' dd khau bang tay. Mdt trudng hgp nhilm -
trimg vet md dugc dieu tri dn. • PTNSLN nham myc dich chan doan va ^
dieu tri. Chiing tdi thyc hien 7 trudng hgp noi soi chan doan deu cho ket qua ban chat '•
thuang tdn trong do cd hai trudng hgp nit don ddc d phoi cd ket qua u lao. Chung toi ling dung PTNSLN de sinh thiet cho nhOng khdi u khdng the tiep can tir ben ngoai de * chgc xuyen thanh thay vi md ngyc sinh thiet nhu trude day. Theo nghien cuu ciia tac gi4 Huynh Quang Khanh (2), 65 benh nhan mo ndi soi ldng ngyc cd 10 trudng hgp noi soi I chan doan deu cho ket qua chinh xac. Nhu vay, PTNSLN cd hieu qua rat cao trong chan |
doan va dieu trj. s 4.4 Mot so U'U diim cua PTNSLN:
PTNSLN giiip chan doan chinh xac ban j chat thuong tdn cua cac benh ly phdi, mang j phdi, trung that thay vi phai md ngyc sinh ; thiet nhu truac day. Ddi vdi ndt dan doc cua ; phdi cd ban chit lao thi PTNSLN giiip chan ^ doan chinh xac va dieu tri. PTNSLN mang ^ lai tinh tham my cao cho benh nhan.
Trong nghien cuu cua chung tdi, tat ch \ cac benh nhan dugc cat hach giao cam ngirc ' dieu tri tang tiet md hdi tay va viem tac dong : mach man tinh chi tren (Buerger) deu khong = dat din luu ngyc sau md.
Y HOC VIET NAM SO DAC BIET — THANG 11/2010
Thdi gian diing thudc giam dau 1,85 ± 0,78 ngay. Thdi gian dai nhit (3 ngay) la mo u trung that. Theo nghien cuu ciia Nguyen Hoai Nam (4), thdi gian dimg thudc giam dau it nhat la cac trudng hgp tang tilt md hdi tay, viem tic ddng mach chi tren man tinh (1,48 ± 0,72 ngay).
Thdi gian tir khi md den khi ra vien trong nghien cuu cua chiing tdi trung binh la 4,48 ± 2,99 ngay. Nghien cim 52 benh nhan md ndi soi ldng ngyc ciia Weatherford. D.A (7) cd thdi gian nam vien la 5,5 ngay.
Bang 8: Thdi gian nam vien sau md cat hach giao cam ngyc theo cac tac gia:
Tac gia Hoanq Anh Bac va cs (1) n = 146 Oao Anh Dung (3) n = 38 Moya. J (6) n = 36 Chung tdi n = 25
Thdi gian nam vien 90,3% ra vien sau 24 gid
2 ngay 3 ngay 1,12 ± 0,33ngay
Nhu vay, Ket qua nay phan nao cho thay uu diem ve dau sau md dugc cai thien, nit ngan thai gian nam vien, benh nhan hdi phye nhanh, giam chi phi dieu tri cho ngudi benh.
V. KETLUiBlN 3.
Tuy mai bat dau ap dung phau thuat ngi soi ldng nguc tai benh Vien Da Nang trong thdi gian ngin tir thang 1 nam 2009 din thang 8 nam 2010 nhung chiing tdi da thyc 4.
hien ky thuat ngi soi long ngyc phlu thuat cho nhilu benh ly khac nhau cua phdi, mang phoi, trung thit vdi ty le thanh cdng 98,39%, 5.
biln chiing nhe d muc do cho phep. Trong tuong lai, chiing tdi se nghien cuu tinh hieu
qua cho timg b?nh cu thi cua ky thuat nay. 6.
TAI LIEU THAM KHAO
1. Hoang Anh BSc va cong su (2008), "Kit qua dieu trj ra nhieu mo hoi tay, nach bang phlu thuat ngi soi Idng nguc cat than kinh giao cam nguc tai Benh Vien Buu Dien 11 ", 7.
Y hoc Tp. Hd Chi Minh, 12 (4), 256-260.
2. Huynh Quang Khanh va cong sy (2005),
"Vai trd ngi soi long nguc trong chan doan va dilu trj cac b?nh ly phoi, mang phoi ", Y hpc Tp. Ho Chi Minh, 9(1), 43-49.
Dao Anh Dung (2008), "Ket qua dilu trj tang tiet md hdi tay bang noi soi mgt troca vao nguc tai Benh Vien Da Khoa tinh Daklak
" Y hoc Tp. Hd Chi Minh, 12 (4), 261-265.
Nguyen Hoai Nam (2003), "Nhung cai tien ky thuat trong phau thuat ngi soi Idng ngirc", Ngoai khoa, 53 (6), 12-23.
Nguyin Hoai Nam (2006), "Phlu thuat noi soi ldng nguc", Nha xuat ban y hpc, 1 265 - 271.
Moya. J et al (2006), "Results of high bilateral endoscopic thoracic sympathectomy anh sympatholysis in the freatment of primary hyperhldrosis: a study of 1016 procedures". Archives de bronconeumplogia, 42(5), 230-234.
Weatheford. D.A et al (1995),
"Thoracoscopy versus thoracotomy:
indications and advantages". Am surg, 61 (1), 83-86.
