KINH NGHIEM PHAU THUAT OIEU TRJ MO HOI TAY QUA NOI SOI LONG NGUC
Van Tan, Ho Nam, Tran Van Quyen, Hoang Danh Tain, Nguyin Ngoc Binh, Ho Huynh Long, Ho Khanh Diic, Nguyin Ba Minh Nhat va CS (*)
TOMTAT
U'dt ban tay do mo hdi la hgi chirng thudng gap d ngUdi lao dgng tre, gay trd ngai lao ddng hoc tap va giao tiep,
Dieu trj hieu qua nhat la cat than kinh giao cam (TKGC) ngUc. Ngay nay khong cdn ai xit dung mo md
Ve NSLN, lo trocar vao ngUc tren dUdng nach giu'a d ngUdi benh nam nghieng. Neu mudn thiic hien phau thuat ben kia thi phai xoay ngUdi benh. Vdi ky thuat nay, phai md 2 lan 6 1 ngUdi benh.
Cat bo doan TKGC tir sUdn 2 den sUdn 4 thu'dng gay do mo hdi bii trir (MHBT) cao, la mot bien chu'ng rat khd dieu tri. Nhieu bao cao cho thay ket qua khd ban tay dat tren 98% nhUng ti le dd MHBT cd the len den 70%.
Muc tieu: - NC cai tien the nam va dUdng vao ngUc de cd the tham sat va cat TKGC ngUc 2 ben d 1 the nam trong 1 lan md.
- NC cai tien phau thuat de cd the giam tiet MHBT.
Phu'dng phap va doi tu'dng:
- Cai tien the nam, dUdng mo :
- NgUdi benh nam sap hay nam ngiTa sau khi gay me vdi thdng NKQ cho xep phd'i tiing ben.
- Soi va md qua 2 lo roi 1 Id' vao ngUc tren dirdng nach sau (nam sap) hay nach trUdc (nam ngii^)
- Cai tien PP phau thuat: cat diit ngang TKGC tren sUdn 2 va 3 thay vi cat bd ca doan than kinh.
- Trang thiet bj: May ngi soi Olympus va Storz vdi camera 0, trocar ngan khdng van 10
mm hay 5 mm.
- Benh nban: 3616 BN bj Udt ban tay do MH, gay trd ngai lao dgng, hgc tap, sinh hoat, giao tiep, yeu cau dUdc dieu tri tai BV Binh Dan tir thang 8 nam 1996 den thang 6 nam 2010.
2 nhdm benh dUgc dieu tn theo 2 PP phau thuat d 2 thdi ky khac nhau:
1- Nhdm 1 mo vdi the nam nghieng, lo vao tren dUdng nach giiTa, ca doan TKGC 2-3- 4 phai cat bd.
2- Nhdm 2, nam sap hay nam ngira, lo vao tren dUdng nach sau hay nach giiia, chi cat dirt ngang TKGC tren cac sUdn 2 va 3 hay chi tren sUdn 2.
Ti le nam/nCr 3/2, tud'i trung binh 25, hdn Vi den tir cac tinh. Hau het la hgc sinh, sinh vien va cdng nhan. Ca 2 nhdm khdng cd sU khac biet ve tud'i tac, nam niT, nghe nghiep va cac dac diem lam sang, can lam sang.
Kit qua: Nhdm 1 cd 102 va nhdm 2 cd 3514. Trir 1 BN khdng the thUc hien phau thuat vi khdng dat dugc dng ngi khi quan de gay me va 14 BN chi cat dUdc TKGC 1 ben vi ben kia phdi dinh nhieu vao la thanh, ket qua phau thuat dat dugc nhu sau:
- Ti le khd ban tay sau md d nhdm 1 la 97,3%, nhdm 2 la 96.8%. SU khac biet khdng co y nghla thdng ke.
- Ti le do' MHBT d cac ndi khac tren cd the 6 nhdm 1: 41%, d nhdm 2: 24 %. SU khac biet cd y nghla thdng ke
- Ti le do mo hdi bii trir nhieu gay nhieu phien phirc d nhdm 1 la 4 %, 6 nhdm 2 la 0 %.
- Thdi gian mo va sd lo trocar vao ngUc
CHUYEN DE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM giam d nhdm 2, tir 2 den cdn 1 lo so vdi nhdm 1,
3 Id.
- 6 nhdm 1 cd 1 BN, d nhdm 2 cd 5 BN phai dan lUu mang phdi trong 24 gid. Tat ca deu khdng dimg khang sinh va chi cd 1 BN bi nhiem triing vet md d nhdm 2. Tat ca deu dUdc chup phdi kiem tra ngay sau md, dUdc xuat vien ngay hdm sau. Khdng cd bien chu'ng can can thiep phau thuat lai trong va sau mo.
- Trong theo ddi tir 3 thang den 15 nam, trung binh la 60 thang tren 80% BN, chi cd 9 BN d nhdm 2 va 1 BN d nhdm 1 tai phat mdt hoac ca 2 ben va 7 BN da md lai (NS) vdi ket qua rat tdt.
Ban luan: O trong nUdc, Nguyen ThUdng Xuan da dieu trj cbiing benh nay bang each cat bd TKGC qua md ngUc hay chich nUdc sdi de pha hiiy bach TKGC.
6 nUdc ngoai, NSLN de dieu trj chirng Udt ban tay do MH da dUdc bao cao nhieu trong cac hoi nghj NS va ket qua lam khd ban tay la tir 95 den 100% nhUng ti le dd MHBT thi khdng khac phuc dUdc. Nghien ciTu ciia chiing tdi da dat dUdc ti le khd ban tay nhU hg nhUng ti le dd MHBT d nhu'ng ndi khac ciia cd the giam rat dang ke.
Rieng ve the nam sap ciia benh nhan de md 2 ben 1 lan dUdc Hann bao cao lan dau tai hgi nghi NS Au-A Istanbul nam 1997. Tac gia da thiic hien 9 TH vdi dng thdng NKQ 1 ndng va phai bdm CO2 de lam xep phdi. Vi sd lieu qua ft nen tac gia chi ket luan la tien ldi nhd md 2 ngUc vdi 1 the nam. Sau Hdi nghi, chung tdi da irng dung the nam nay nhUng lai dimg dng NKQ 2 ndng, thdng khi chgn Ipc nen khdng can bdm CO2 va chi diing 2 trocar thay vi 3 trocar nhU Hann va da dat dugc cac ket qua nhu y mudn.
Tir nam 2004, chiing tdi cai tien the nam, cho BN nam ngii'a va vao ngUc chi 1 Id, vdi dung cu cai tien.
Kit luan: Qua NSLN, benh nhan nam ngCTa, vdi mpt lo vao 7mm tren dUdng nach giu'a, phau thuat cat dirt ngang TKGC ngiic tren cac sUdn 2 ' va 3 cd the thUc hien 6Mc gan 100%; hieu qua
khd ban tay rat cao, ft gay BC, khdng do MHB nang, tai phat trong dai han thap.
Tdkhoa], Phau thuat dieu tri mo hdi tay
SUMMARY
EXPERIENCE OF PALMAR HYPERHYDROSIS TREATMENT BY THORACOSCOPIC
SYMPATHECTOMY
Standard Thoracic Sympathectomy (IS) involves removal of the sympathetic nerve (SN) with thoracic ganglia 2, 3 and 4. This is the standard approach for palmar hyperhydrosis (PH), Raynaud's phenomena, Buerger's disease and causalgia.
There are many surgical approaches and techniques for TS:
By these procedures, many reports show/ed over 95% of the wet hand having been cured, though a high compensary sweating (CSw) rate, from 21 to 70% was reported.
Purpose: We study the modifed technique of TS to treat the PH for getting 2 aims:
- To practice the bilateral thoracoscopic sympathectomy with 1 patient position.
- To reduce the rate of CSw.
Method: 1- As approach, patient is in prone at first and in supine since 2004.
2- As treatment, only the SN on T2 or on T2 and T3 is transected without removal.
The Olympus and Storz laparoscopic system are used with short, valveless trocars: 10 or 7 and 5 mm.
A double lumen tracheal intubation is applied for selective each side lung collapse
The results are randomized with a group operated by lateral position with the SN from T2 to T4 removed.
Patients: From August 1996 to June 2010, in 3616 patients operated (besides 1 case that we can't intubate and 14 cases, the SN of one side can't be cut because dense adhesions), there are:
-102 patients of group 1: the SN from T2 to T4 V(/as dissected and removed. Patients were on the right then on left lateral decubitus with a 3 ports procedure.
- 3514 patients of group I I : the SN on T2 and T3 were transected without removed.
Patients were on prone with a 2 ports or in supine with 1 port procedure
The middle age, 25, the gender rate male/female, 3/2, the occupations (almost are students and young workers), the histor/ of disease, the clinical and paraclinical characteristics of 2 groups are almost the same.
Results: The rate of wet hand cured were 97.5% in the group I and 96.8 % in the group I I . The CSw of the group I is 4 1 % with 4 %, severe sweating and of the group I I , the rate, only 24%
and none having had severe sweating. As complications, one side pneumothorax must be drained within 24 hours in 1 case of the group 1 and 5 cases of the group I I . Port infection in 1 case of the group I I . The other intra and post operative complications as long lasting thoracic pain, mild dypnea, local lung contusion or torn are seldom.
The operative time and the ports are reduced in the group I I , (2 ports or 1 port) in comparlsion with group I (3 ports). There are any technical difficulties in group II in comparlsion with group I.
In the follow-up from 3 months to 15 years, (60 months average) of more than 80% of cases;
there are only 1 case of group I and 9 cases of group II that the PH recurs in one side. 7 cases reoperated, got good results.
Dicussion: In Viet Nam, besides the sympathetectomy by thoracotomy, some authors have had treated the PH by injection of hot water into the thoracic SN but they got uncertain results.
Until now, many authors reported high CSw after TS. In our study, by transecting in place of removing the SN, the CSw reduced a lot.
About approach, Hann reported 9 cases operated with the posterior approach the first time in the Euro-Asian Congress of Endoscopic Surgery, Istanbul 1997. For getting lung collapse, he used single lumen tracheal intubation with CO2 inflation. We use double lumen tracheal intubation to create room by selective lung collapse, so the surgical procedure can be practiced easily. The procedure is more modified since 2004 that we can practice the TS with one port on patient in supine.
Conclusion: With posterior approach (patients in prone) or anterior approach (patients in supine), we can practice the TS (almost of patients) of both thoracic cavities in one operation with one port 7mm.
The transection of sympathetic nerve on the T2 or on T2 and T3 is sufficient to cure 96.8% of wet hands and can reduce a lot of the CSw. Recurrence of wet hand after the procedure is seldom in long-term follow-up.
I. TONG QUAN
NSLN de dieu tri cac benh trong ldng nguc ngay cang phat trien. Nhiing nam sau nay, hau het cac phau thuat trong long nguc deu cd the thuc hien qua NS [9,10].
Ci benh vien chiing tdi, phau thuat cac bd phan d trong ldng nguc qua NS dugc thuc hien tir nam 1996, 3 nam sau khi iing dung NS d bung de dieu tri [9].
NSLN cat bd mdt so doan TKGC dd
dieu tri chiing udt ban tay do md hdi, chiing
Raynaud, benh Buerger da dugc iing dung
nhieu nai tren the gidi. Ngay nay, khdng cdn
ai md nguc de cat TKGC nhu trude. Vdi
nhiing the nam va dudng md cho dung cu
vao, vdi nhirng PP phau thuat khac nhau nhu
cat bd cac doan TKGC tren cac sudn 2,3, cat
nhanh TKGC hau hach, dot buy TKGC tren
sudn 2 hay ca tren sudn 3 hay chi kep than
TKGC deu dat ket qua lam khd ban tay gan
gidng nhau, ngoai trir ti le dd MHB sau md.
CHUYEN DE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
Dd MHB nhu vay, neu it thi khdng may khd chiu nhung neu nhieu thi that rac rdi vi tuy ban tay thi khd nhung cac noi khac tren than, sudt ngay bi dam udt. Sira chira bien chiing nay hinh nhu bat kha thi.
Muc tieu: Chiing tdi nghien ciiu cai tien PP phau thuat qua NSLN de dieu tri chiing udt ban tay do MH nham lam cho phau thuat don gian, de phd bien va nham giam ti le dd MHB.
Phutmg phap: La tien cuu cd ddi chiing.
Benh nhan: 3616 BN dugc ck TKGC nguc qua NSLN de dieu tri chiing udt ban tay do md hdi, gay trd ngai lao ddng, di§u tri tai BV Binh Dan tir thang 8 nam 1996 d^n thang hdt thang 6/2010 (hinh 1). Ty le nam/nii la 3/2, tudi trung binh 25, ban 50%
benh den tir cac tinh. Da sd la hgc sinh, sinh vien va ngudi lao ddng tre, cd benh sir dd m6 hdi ca 2 tay tir nhd.
Hinh 2
Hinh 3 Hinh 4
Trang thiit bl: Chiing tdi sti dung may cua hang Olympus va Storz vdi nhimg Trocar ngan khdng van, mdt Camera 0 do, 10mm, va 1 cay cit-ddt Smm, cd khi phai diing them mdt dung cu dd ep phoi va mdt keo ck cd ciing kich thudc la Smm (hinh 3).
Tir nam 2004, mdt dung cu cai tidn tu chd (hinh 4) dugc xir dung dd ck ddt TKGC qua cimg lo 7mm vdi 1 camera Smm va 1 probe 2mm
Gay me vdi dng thdng ndi khi quan 2 : ndng (hinh 2) cho da sd cac TH, dk cd th8 ; cho xep phdi timg ben. Ndu khdng dat dugc NKQ 2 ndng thi dimg dng NKQ 1 ndng, gay me cho xep phdi khdng qua S phiit, BS PT ; thao tac nhanh, chinh xac ciing cat dugc \ TKGC nguc. Ndu cSn, gay me khdng th6 cho \ ngung thd keo dai, chiing tdi xir dung them { cay ep phdi. Chung tdi chua xir dung trocar !
cd van va bom CO2. i
BS phdu thudt: Tir nam 1996 ddn hdt trong khoa LN-MM BV Binh Dan ddu cd thd nam 1997, chi cd 1 BS phau thuat thuc hien md dugc vdi phuang phap nay.
nhung sau nam 2000, hku nhu tit ca cac BS
Hinh 5 Hinh 6
Tu the benh nhdn: 102 benh nhan nhdm 1, md d thd nami nghieng (hinh 5) va 3514 nhdm 2, mo d the nam sap (hinh 6) hay nam ngira (hinh 7 & 8)
Hinh 7 Hinh 8
Mdi ngudi benh deu dugc lam 1 benh an theo mau nghien ciiu. Mac dau d 2 thdi diem khac nhau, giiia 2 nhdm khdng cd su khac biet cd y nghia ve thdng ke tren tudi tac, gidi tinh, nghe nghiep cung nhu cac dac diem lam sang, can lam sang va tien can.
Dudng vdo nguc: Ld vao cua ngudn sang va cay cat ddt nam tren dudng nach giira, nam nghieng d nhdm 1 (hinh 9) va tren dudng nach sau, nam sap (hinh 6) hay nach giira, nam ngua (hinli 7 & 8), nhdm 2.
Hinh 9 Hinh 10
CHUYEN DE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
Phdu thudt: Ci nhdm 1, cat bd cac doan TKGC hi sudn 2 ddn sudn 4 (hinh 10); d nhdm 2, ddt buy ma khdng cat bd TKGC tren sudn 2 hay ca tren sudn 3 (hinh 11), vdi 2 lo vao (hinh 12) roi 1 lo vao (hinh 13).
Hinh 11 Hinh 12 Hinh 13
Khdng dan luu xoang mang phdi sau md d ca 2 nhdm (hinh 12 va 13).
Chup phdi kiem tra khi benh tTnh.
Kit qud vd nhan xet [33]:
1- Sd BN den dieu tri ngay cang nhieu:
Nam 1995 1996 1997 1998 1999 2000
Tdng
SdBN 0 2 101 75 84 148
Nam 2001 2002 2003 2004 2005
1/1/2006-30/6/2006 1/7/2006-30/6/2007 1/7/2007-30/6/2008 1/7/2008-30/6/2009 1/7/2009-30/6/2010
SdBN 166 206 314 348 328 233 483 449 351 328
36162- The ndm vd ket qud:
- Nam nghieng: 102 BN, cat bd TKGC xong mdt ben phai xoay benh nhan de cat ben kia.
- Nam sap hay nam ngira: 3514 BN, khdng phai ddi tu the ngudi benh, nen khdng can thay do vai, ao md va gang.
3- Sd dogn TKGC phdi cdt bd hay cdt diet vd ket qud :
- cat bd ca doan TKGC tren cac sudn 2, 3 va 4: 101 BN. 1 TH khdng thuc hien dugc vi khdng dat dng thdng ndi khi quan dugc.
• Ket qua ban tay khd hoan toan: i 97,5%
• Dd MHB nai khac la 41%, dd MHB j nang: 4%.
• 3 Id vao long nguc moi ben: 10mm,
Smm, Smm. ;
• Thdi gian md trung binh la 20 phut, \ khdng ke thdi gian gay me
• Cd 2 BN chi cat dugc 1 ben vi ben \ kia phdi dinh nhieu vao thanh nguc.
• 1 BN phai dan luu xoang mang phoi \
24 gid vi bi tran khi lugng trung binh. I
- Cat diit TKGC tren sudn 2 hay tren 2 vatrensudn3: 3514 BN
• Cd 14 BN chi cat dugc 1 ben, ben kia ph6i dinh nhieu vao thanh nguc.
• Ket qua la ban tay khd hoan toan: 96.8%,
• Dd MHB d nhirng nai khac tren ca thi: 24%, khdng cd BN nao dd MHBT nhidu phai than phien.
• Khoan 2 lo (10 mm, 5 mm) hay 1 Id (7mm) vao ldng nguc moi ben.
• Thdi gian md trung binh la 10 phiit, khong ke thdi gian gay me
Nhu vay, trir mdt sd it TH phdi dinh nhieu vao thanh nguc 1 ben hay ca 2 ben, phau thuat NSLN khdng thuc hien dugc day du, thao tac phau thuat khdng gap khd khan d ca 2 vi tri nam cua ngudi benh, ket qua khd ban tay sau md d ca 2 nhdm khac nhau khdng CO y nghia thdng ke: 96.8% va 97.5%, Dd MHB giam rd ret cd y nghia d nhdm 2 so vdi nhom 1, 24% so vdi 4\% va dd MHB nang d nhom 2 khdng gap TH nao so vdi nhdm 1 la 4%, thdi gian md a nhdm 2 chi bang V2 nhdm 1.
d ca 2 nhdm, khdng diing khang sinh, thuoc giam dau chi cho 1-2 lieu ngay sau md.
Tat ca deu dugc xuat vien ngay hdm sau.
Ngoai cac TH phai dan luu mang phdi, 1 TH bj nhiem trung Id trocar d nach (md vdi the BN nam ngiJa), nhiing bien chiing khac nhu dau tiic nguc, khd thd nhe deu khdng dang ke.
4- Ket qud dieu tri:
Theo ddi trung binh la 60 thang (ngan nhat la 3 thang va dai nhat la 10 nam), ngoai van de dd MHB, khdng ai than phien ve mdt thay ddi nao khac tren ca the. Cd 9 BN tai phat d nhdm 2, 1 BN tai phat d nhdm 1; 7 BN da md lai, khi md thay cdn 1 sgi than kinh giao cam phu. Gay me va phau thuat lan 2 cung nhu lan ddu. Kdt qua tiic thdi rit tdt, 2 BN cdn lai dang theo ddi va se md lai sau 3 thang, ndu tinh trang udt ban tay vdn cdn.
I I . BAN LUAN
The nam ngira cd nhieu thuan lgi ban the nam nghieng trong md cat TKGC nguc do cd the tham sat va cat TKGC ben nay rdi ben kia ma khdng xoay trd benh nhan, rira, sat triing lai da, khdng thay dd vai va dung cu phau thuat. Khdng cd TH nao phai chuyen tir the nam ngiia qua the nam nghieng dd mo trong nhdm benh nghien ciiu 2.
De dieu tri chiing udt ban tay do md hdi, NSLN cat bd doan TKGC tir sudn 2 den sudn 4 tir cudi nam 1996 iing dung tai BV Binh Dan. Tren 99% BN, phlu thuat thuc hien dugc, ban tay khd tiic thdi sau md.
Trong theo ddi, ket qua khd ban tay dat 97.5% nhung dd MHBT d cac nai khac qua cao, gay phien ha rat nhieu cho ngudi benh, nhat la mgt sd BN bi do MHBT qua nhidu [9,10] budc phai cai tien phuang phap md.
Thay vi cat bd ca doan, TKGC tren sudn 2 hay ca tren sudn 3 chi dugc cat ngang. Vdi phau thuat cai tien tren, ket qua khd ban tay tlie thdi va lau dai khdng khac d nhdm 1 nhung ty le dd MHBT giam rat dang ke.
Trong theo ddi, udt ban tay tai phat d nhdm 2 chi cd 0.0028% (9 BN)
Mdi day, cac tac gia Saudi Arabia bao
cao chi cat ngang nhu phuang phap cua
chung tdi hay chi kep TKGC tren sudn sd 2
nhu PP cua cac tac gia Dai Loan cQng dat
dugc ket qua khd ban tay vdi ty le cao
[3,5,6]. Khi bi do MHBT qua nhieu, cac tac
gia Dai Loan da NS lay bd clip. Kao [5] thi
de nghi cat TKGC tren ca hai sudn 2 va 3
nhung, de giam ti le do MHBT, tnrdc khi cat
TKGC phai thir xem chiing dd mdi hdi tay
ciia ngudi benh dap ling vdi phong be bao
nhieu doan TKGC de cat cho vira du. Ciing
de giam ti le dd MHBT, Witmoser de nghi
chi cat TKGC d doan hau hach sd 2 hay cat
TKGC 3-4. Trong Hdi nghi Tim mach ldng
CHUYEN DE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
nguc chau A tai Bac Kinh, bao cao dimg vi phau khau lai TKGC didu tri dd MHBT nhidu dat dugc KQ ban dau khich le.
Cac tac gia Do Thai va Dai Loan [8] da bao cao thuc hien cat TKGC trong cac hdi nghi NS thd gidi, khuyen cao mudn ket qua lam khd tay dat ket qua cao thi can luu y la phai cat nhanh Kuntz [4] Ngoai bidn chimg do MHBT, vdi 1302 BN, cac tac gia Dai Loan bao cao tran khi hay ca tran khi-tran mau la nhimg bien chimg hay gap nhung chi dan luu long nguc trong 24 gid la dieu tri hieu qua hau het cac trudng hgp. Hg ciing bao cao 2 BN hi ngung tim trong liic md rihimg hdi site dugc, khdng bi du chiing. Dau vet md va nhiing bien chung khac sau md thi khdng dang ke.
Gossot va CS d Phap da bao cao mgt NC tidn cim 940 ISn NSLN cat TKGC cho 500 BN bi udt ban tay do md hdi nam 2001, da bj nhiing BC sau: 1 BN bi rach TM dudi ddn phai, chuyen md hd de khau, 2 rach dng nguc phai md nguc trong hau phau de xir tri, 5.3%
chay mau trong liic md tir 300-600 ml, 1.3%
tran khi-tran mau ldng nguc lugng nhieu phai dan luu, 0.4% bi HC Homer, 2% dau nguc keo dai sau md.
Cac tac gia Nhat, nam 2004 da bao cao kinh nghiem ve nhieu TH cat than kinh giao cam chi bang 1 camera 2.5 ly cd gan probe cat-ddt dien, sau md khdng de lai seo van dat dugc ket qua rat tdt.
O BV Binh Dan, chiing tdi da khdi sir NC dieu tri chiing dd md hdi nach va md hdi chan bang each cat TKGC so 4 va chong dau khdng chiu ndi cac tang trong d bung do ung thu tuy, da day bang each cit TKGC tir tren sudn 5 den ca hoanh. Rieng ve benh Buerger, hdi chiing Raynaud va Causalgia, hang chuc TH da dugc NSLN cat TKGC (thudng la 1 ben) dat ket qua giam dau kha tdt.
Vi mudn cit TKGC mdt lan d ca 2 16ng ' nguc, khdng phai xoay trd BN, tranh duoc ; xao trdn vd huyet ddng hgc cho ngudi benh, i tranh gay khd cho ngudi gay me va tranh ! thay ddi dd vai, dung cu md cho ngudi lam i dung cu nen tir nam 1998, chiing tdi da m6 ! tren ngudi benh nam sap voi 2 Id vao nguc j va tir nam 2004, chiing tdi da md tren nguoi i benh nam ngira, dau cao vdi 1 Id vao nguc i 7mm (camera Smm, cay cat ddt 1.5mm) Tuy j nhien vdi 1 Id vao, phau thuat cd the gap trd I ngai khi phdi khdng xep du vi dinh hay do i dng thdng NKQ chua dat diing va nhit la khi | can cat ddt cac doan TKGC thap hon. Mac i du chua gap bien chiing nang can them nhiSu i trocar hay phai chuyen md md nhung chiing \ tdi ludn chuan bi san cac dung cu can thi6t i
khi can den la cd ngay. ;
. . . j
I I I . KET LUAN
Do sir mat can bang ve chiic nang h?
TKGC gay ra, chimg tang tiet md hdi d tay khdng cd nguy ca thuc the nhung lam cho \ chicc nang ban tay giam va anh hudng den 1 tam ly khdng it nen phau thuat cat TKGC 1^ j can thiet.
Sau khi nghien ciiu cai tidn lien tuc the j nam va cac cdng doan phau thuat cho thay ] the nam ngiia vdi phau thuat cit diit TKGC j tren cac sudn 2-3 qua 1 Id nhd tren dudng;
nach giiia la phlu thuat dl thuc hien lam kho 1 ban tay dai ban 96.8% va khdng bj MHB nang. j
Tai lieu tham Ichao:
1. Gossot D. et al (2003): Long-term results ofj endoscopic thoracic sympathectomy fori hyperhldrosis for upper limbs hyperhydrosis, | Ann Thorac Surg 75:1075,2003.
2. Haan J. et al (1997): Posterior approach ofj the bilateral thoracoscopic sympathectomy-:
Euro-Asian congress of endoscopic surgery -j
Istanbul, Turkey, 17-21 June 1997. j
Lee IS. et al (1997): Surface temperature changes of thoracoscopic t2-sympathetic block by clipping in palmar hyperhidrosis-
Euro-Asian congress of endoscopic surgery - 7.
Istanbul, Turkey, 17-21 June 1997.
Chung I et al (2002): Anatomic variations of the T2 nerve root (Kuntz) and their 8.
application for sympathectomy. Thorac Cardiovasc Surg 123:498, 2002
Kao MC (2001):YATs sympathectomy with intraoperative monitoring of palmar skin temperature for PH. Ann Thorac Surg 9.
72:1801,2001.
Lin TS et al (2001): Pitfalls and complication avoidance associated with
fransthoracic endoscopic sympathectomy for PH (analysis of 2200 cases): Intern J Surg invest 2:377,2001.
Mack P. et al (1993): Thoracoscopic sympathectomy - manual of basic operative thoracic surgery, 1993.
Shachor D. et al (1997): Endoscopic transthoracic sympathectomy in the treatment of PH: a review of 1000 patients- Euro-Asian congress of endoscopic surgery- Istanbul, Turkey, 17-21 June 1997.
Leao LEV et al (2003): Role of VATs sympathectomy in the treatment of PH. Sao Paulo Med J 121:191,2003
PHAU THUAT NOI SOI CAT THAN KINH GIAO CAM NGUC N4 OIEU TRJ
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TANG TIET MO HOI TAY - MOT SO KET QUA BUdC OAU
Phan Quoc Hiing*, Nguyen Dinh Long Hai*
TOM TAT:
Muc tieu: danh gia hieu qua cua cat than kinh giao ngUc N4 ddi vdi benh nhan tang tiet mo hoi tay, mii'c do tang tiet mo hdi bii trii" va sU hai long cua benh nhan.
Phu'dng phap: tir thang 5 nam 2009 den thang 4 nam 2010, 45 benh nhan tang tiet mo hoi tay dugc phau thuat ngi soi cat giao cam ngiic N4 hai ben tai khoa phau thuat Long ngUc benh vien Chd Ray, thanh pho Ho Chi Minh.
Banh gia ket qua dieu tn, tang tiet md hdi bii trir, sU hai Idng ciia benh nhan bang each tra Idi bang cau hdi qua dien thoai.
Kit qua: 45 benb nhan cd 20 nam, 25 ni?.
Bo tudi til" 14 - 45 tudi. Vj tri: tay 10/45, tay va nach 14/45, tay va chan 14/45, tay va chan va nach 7/45. Phau thuat qua 1 ngd vao 43/45,
phau thuat 2 ngd vao 2/45 do phd'i dinh. Thdi gian phau thuat trung binh la 31.1 phut (20 - 50 phiit). Ket qua phau thuat: tay 44/45 thanh cdng, 1/45 that bai. 16/21 trUdng hdp cd cai thien hoac bet ra mo hdi chan, 20/21 trUdng hgp nach khd hay cai thien. Tang tiet md hdi bii trir 13/45, trong do 8/13: nhe, 5/13: trung binh. SU hai Idng ciia benh nhan doi vdi phau thuat:
22/45 rat hai Idng, 23/45 hai Idng, khdng cd trUdng hdp nao lay lam tiee vi da phau thuat.
Kit luan: phau thuat ngi soi cat than kinh giao cam ngUc N4 dieu trj tang tiet mo hdi tay cd ket qua tdt, mii'c do hai Idng ciia benh nhan cao, tang tiet mo hdi bii trir it.
