JOURNALOF108-CLINICALMEDICINEANDPHARMACY Vol.l2-N"4/2017j
Danh gia kit qua biro^c dSu phSu thuat noi soi c5t thiiy phoi tai Benh vien Quan y 103
Evaluate the results of thoracoscopie surgery lobectomy at the 103
Military Hospital j
Nguyen Tririrag Giang, Nguyen Ngoc Trung, Benhvien Quany m Nguyen Van Nam
4
Muc tiiu: Danh gia sii an toan, hieu qua cua phau thuat cat thuy phdi ndi soi tai Benh vi§n Quan y 103. Do/ tugng vd phuang phdp: 21 benh nhan dupe phau t h u l t cat thiiy phdi ndi soi tU 5/2016 den 2/2017. Phuong phap nghien cUu md ta lam sang, tien cUu, khdng ddi ehUng. Ket qud; 21 b^nh nhan tuoi t U 4 0 - 7 2 t u d i , nam (18 benh nhan = 85,7%), nU (3 benh nhan = 14,3%). 90,47% benh nhan dupc thifc hien phau t h u l t ndi soi ho^n toan, 9,52% benh nhan chuyen sang ndi soi hd trp, bien chUng nhe vdi t^ le 9,52%, khdng cd tai bien trong md, khdng cd tU vong. Kit ludn: Phau t h u l t cat thuy phdi ndi soi dieu tii mdt sd b$nh ly phdi tai Benh vien QuIn y 103 hieu q u i , an toan, t i le bien chUng thap.
Tdkhda: Phau t h u l t ndi soi cat thiiy phoi, ket q u i phau thuat ndi soi cat thuy phdi.
Summary
Objective: To evaluate the effect and the safety of the thoracoscopie surgery lobeaomy at the 103 Military Hospital. Subject and method: 21 patients had been operated by thoracoscopie surgery lobectomy at the 103 Military Hospital from May 2016 to February 2017. Method: Prospective, descriptive. Result There v^rere 21 patients to be operated by thoracoscopie lobectomy at the 103 Military Hospital. Overall, thoracoscopy w/as successful in 19/21 cases (90.47%). Conversion to minimal thoracotomy was required in 2 cases (9.52%) secondary to bleeding. No mortality, no morbidity, acceptable complication rate (9.52%). Conclusion: The thoracoscopie lobectomy at the 103 Military Hospital was effective, safe.
/feyivords: Thoracoscopie surgery lobectomy, the result of thoracoscopie lobectomy.
1. Oat van de ciia thap nien 1980, ndi soi Idng ngiic thUc sU trd lai Ndi soi long ngue dUPe thue hien dau tien bdi ^^^'' ^ ^ ^ " 9 ^ ^ ' " ^ ^<^' ^^' *'"° * ^ ^ *^' ^ ^ ^ ' ^^"^ " ^ ' ™- Jaeobaeus n I m 1910 b i n g dng soi cifng tai Benh vien ^ ^ " ^°' P^^" ^^"^* " ^ ' '°^ ' ° " 9 ngifc da va dang co Serafimerla sarettet d Stockholm. Su ra ddi cua he "^^""^ ^"^^^ ^^^^ ^"^"^ ^ ^ ^ ^^'=- ^ ^ " "^"^ ^^^^' 7 thdng may quay camera cue nhd vao nhUng nam d i u ^^^^ P^°' ' ' ^ " ^ p h i u t h u l t ndi sol Idng ngUe lan dau
tien dupe thUe hien thanh edng [3], [7], [9].
Ngay nay, nhieu trung tam tren the gidi da ap ^1 Ngdy nhdn bar 9/3/2017. ngdy chdp nhdn ddng: 23/3/2017 d u n g ky t h u l t n l y . Tai Vi^t Nam, p h l u t h u l t n6i SOI Ngirai phdn hoi- Nguyin Vdn Nam. long ngUc dUpe dUa vao Ip dung tU nam 1996. Tuy Email, [email protected] vien Qudny 103 nhien, ve m a t ky t h u a t thl cCing COn chUa dlftfC 98
' TAP CHlY DLfCfC LAM SANG 108 Tap12-S64/2017
thdng nhat v l ele eh! dinh I p dung cung I I van de , tranh luan nhieu, nhat la trong phau t h u l t c i t thiiy phdi dieu trj ung t h u phdi [2], [8], [10]. Xuat p h l t tif thuc tien tren, chung tdi thUe hien nghien eUu nham muc tieu Ddnh gid tinh khd thi, an todn vd ket qud budc ddu phdu thudt ngi sol ldng ngUc cdt thuy phoi tgi Binh viin Qudny 103.
2. Ooi tuong va phUdng phdp 2.1. Doi tdang
21 benh nhan dUpc phau t h u l t ndi soi hoan t o l n eat thiiy phdi tai Khoa P h l u t h u l t Ldng ngUc - Tim maeh - Benh vien Quan y 103 tU 5/2016 den 02/2017.
2.2. Phddng phdp
Nghien citu md t l , tien cUu, khdng ddi ehUng.
2.3. Quy trinh phiu thudt va chdm sdc sau m6 Chi dinh phau thudt ngi soi hodn todn cat thuy phoi Benh n h i n dii dieu kien de phau t h u l t Idng nguc, chju dung dUpc g l y me mpt phdi, khdng cd benh ly mang phdi v l phau thuat khoang m I n g phdi trude dd.
B&nh phdi lanh tinh: Dan phe quan, ken khi phdi Idn, mpt sd u phdi lanh tfnh benh phdi bam sinh nhu; Phdi biet l i p .
Ung t h u phdi nguyen p h l t : Giai doan I, II, u kfch thudc < 6cm.
Chuyen ngi soi ho trg hoac mo md
Khi mang phdi dinh nhieu, phau tieh mach m l u khd khan h o l e khi ed e h l y m l u khd cd kha nang cam m l u bang ndi soi hoan t o l n .
Vd cam: Gay me toan t h i n , thdng khi chpn Ipe mdt ben phdi bang dng ndi khi q u I n hai ndng.
TU the benh nhan: Nam nghleng 90 dp, ddn gdi dudi b d sudn.
W tri kip phau thudt vd mdn hlnh ngi soi Phau thuat vien ehmh: Ben p h l i benh nhan.
P h l u t h u l t vien phu 1: B d i dien phau t h u l t vien chfnh.
Phau thuat viSn phu 2: Cung ben phau thuat vien ehi'nh.
Ky thuat vien dung cu: Ben trai phau t h u l t vien phu 1.
Vj t r i m i n hinh m I y ndi soi: Cd 2 m i n hinh m I y ndi soi d hai ben ban mo de eho phau t h u l t vien ehinh v l phau t h u l t vien phu 1 quan sat, gdc k h o i n g 1 5 - 3 0 dp.
Cdc budc phau thuat
Trocar 10mm, thudng dupc d I t d vi tri KLS Vli h o l e VIM dudng n i e h gitfa dung de dUa camera d i n h g i l tdn thUdng.
Trocar 12mm d khoang lien sUdn 6 h o l e 7 dudng nIeh sau de dUa dung eu ven phdi.
1 vet m d k h o i n g 3 - 5cm khoang lien sUdn 4 h o l e 5 dudng naeh trudc de thao t i c va phau tfch rdn phdi.
Cle nhanh ddng mach, tTnh maeh phdi v l phe q u I n dupe eat b i n g stapler.
Tien h l n h vet hach theo he thong neu ket q u i m d benh ciia khdi u I I ung thU ( d i n h g i l dUa tren ket q u i sinh thiet xuyen thanh ngUc trUde md h o l e tiifc thi trong md).
Benh pham duoc eho vao t i i l , lay ra khdi Idng nguc.
Kiem tra, p h l t hien c l e diem e h l y mau, khau hoac ddt cam mau. Rira sach khoang m I n g phdi bang nude mudi am dang trupng va d i n h g i l t i n h trang nd phdi, kiem tra c l e vi t r i dd khf de khau t i n g eUdng.
€>at dng dan lUu khoang m I n g phdi.
2.4. Cdc chi tieu
Chi tieu l l m s i n g : Tudi, gidi, thdi gian mac benh, benh ly kem theo.
Chi tieu can lam sang: B o chdc nang hd h i p , X- quang phdi, CT Idng nguc PET-CT, soi phe q u I n , ket q u i sinh thiet xuyen thanh phe q u I n h o l e sinh thiet xuyen thanh ngUe.
Cle ehi tieu phau thuat: Thdi gian md, lUpng m l u mat, lupng m l u truyen trong md, tai bien trong md, chuyen md m d hay ndi soi ho trp, thdi gian t h d
JOURNAL OF 108 - CUNICAL MEDICINE AND PHARMACY Vol.12-N''4/2017
m I y sau md, thdi gian nam hdi sUe, thdi gian nam vien, thdi gian de d i n luu, bien ehUng sau md.
Ket qua sinh thiet tUe thi trong md v l md benh hpc sau md.
2.5. Xdly so lieu
Xif ly sd lieu bang phan mem thdng ke Epl Info 3.3.2.
3. K^t quS
Bang 1 . Tuoi, gidi chi so
Nam NCf
Tong Tuoi trung binh (Tf. ±SD)
So bgnh nhan
18 3 21
Tile 85,7 14,3 100 56,21 ± 9,04 (nt}6 ntiat 40, Idn nhdt 72)
Bdng 2. Vj tri khoi u trSn phim CT scan Idng ngUc Vj tri u phoi
Thuy tren phoi P ThCiy giijfa phdi P Thuy ducfi phoi P ThCiytrenphdiT ThCiydiidi pholT
Tong
n 5 1 6 6 3 21
%
23,8 4,7 28,6 28,6 14,3 100
K^t quS ndi soi Blnh thudng
PQ bi day xep tCi ben ngoai PQ bi chit hep do u sui ben trong
Tong
n 17 2 2 21
%
80,90 9,55 9,55 700
Bang 4. PhUcfng phap m6, thdi gian phSu thu^t
Phifdng phap mo Noi soi ho tro Noi soi hoan toan
Tong So luong ( t i l e % ) 2 (9,5%) 19 (90,5%)
27 (100%)
Thcri gian (phlH),^^H N g i n
nhat 85
105
85 Dai nhat 165
195
795
'^t 3 'iS'
733,7!
± 3 4 , g j | | Nhgn xit Thdi gian phau t h u l t trung binh cilia ndi soi h o l n toan d l i hdn ndi soi ho trp, thdi gian phau thuat dai nhat la 195 phut, ngan nhat la 85 phut ddi vdi p h l u thuat ndi sol hoan toan.
Bang 5. Dac ^ e m kh6i u dcinh gia trong mo Tinh chat u
Co keo mang phoi tang Dinh th^nh nguc Xam lan mang phoi thanh Xam lan thuy lan can Khoi u nSm gpn trong thiiy
T6ng
Kich thUcfc khoi u
n 9 4 1 1 6 27
%
42,9 19,0 4,7 • * • 4,7' 28,5 lOb 3,02 ± 7,67cm (Nhd nhat 1cm, lim
nhAlaScm) Nhdn xet Phau t h u l t ndi soi dugc thue hien tat
e l cle vj tri ciia thuy. Phoi p h l i ehiem Uu the hon (12/20 = 57,1%).
Bang 3. Dac diem noi soi p h e q u i n
Nhdn xit Bac diem u co keo mang phdi tang chi^m t i le gan mpt nUa sd benh n h i n nghien ctfu (45%), eac dae diem khac chiem t i le it.
Nhdn xit Ket q u i ndi soi phe q u I n da sd la blnh thudng (80,95%).
B i n g 6. Tai bien, bien chUnc Tai bien trong mo
Tdn thuong mach m l u Rd khi keo dai sau md Chuyen md ndi soi hd trP Tir vong
Npi soi t h l n h cdng
n 2 2 2 0 19
i
%l
9,5 9,5 9,5 0 90,5 Nhdn xet Ti le ndi soi hoan t o l n la 90,5%.
TAP CHl Y Daoc LAM SANG 10i Tap 12-Sd 4/2017
Bang 7. Danh gia sau mo
Thdi gian Thdi gian t h d m I y sau md (gid) Thdi gian dat dan lUu mang phdi (ngay) Thdi gian nam vien sau md (ngly)
N g I n nhat 5 3 6
Dai nhat 44
7
16
Trung binh
15,29 + 9,94
5,27 + 2,78
9,84 + 3,27
Bdng 8. Ket q u i mo benh hoc sau mo Ket q u i md b^nh sau mo
Ulao Hamartoma Ap xe phoi UngthUt^baonh6 Ung thu I<h6ng t^ bao nh6
Tong
n 1 1 1 1 17 27
%
4,75 4,75 4,75 4,75 80,95
700 Nhdn xit Binh nhan cd ket q u i g i l i phau benh ly la K phdi khdng te bao nhd chi^m t i le eao (80,95%).
4.1. Mot so ddc diem chung
Phln bd v^ gidi eua binh nhan trong nhdm nghien cu:u:T^le nam, nUlan lupt la 85,7% va 14,3%.
Trong 1100 ea eOa Me Kenna [4], ty le nam, nU lan lupt I I 45,9% v l 54,1%.
C i t thuy phdi ndi sol cd the thuc hien duac d cle benh nhan Idn tudi (BN Idn tudi nhat trong nghidn cufu I I 72 tudi) n^u d i n h gia dUpc ehUe n l n g tim, phdi cho phep, chi djnh nay phii hpp vdi quan diem eiia cae tae g i l khac [2], [5], [10].
Ve vj tri u phdi: U phdi p h l i gap nhieu hPn u phdi trai (12/21 = 57,14%), thiiy tren nhieu hon thiiy dudi v l thiiy giufa.
Ket qua ndi sol phe q u I n ciia da sd benh nhan trong nghien cufu la binh thudng (80,90%), dieu n l y phti hpp vdi chi dinh phau thuat ndi soi trong dieu trj u phdi, dd la ele u phdi ngoai vl.
4.2. Cdc dgc diem cua ky thuat cat thiiy phdi npi soi
Chung tdi thuc hien eat thiiy eho tat ea ele vj t r i thijy eiia phdi trong dd phdi phai ehiem uu the (12/21 = 57,14%). Mc Kenna m d phdi p h l i (59,4%).
Thdi gian phau thuat: Thdi gian phau t h u l t trung binh eua ehiing tdi doi vdi ndi soi ho trp va ndi soi h o l n toan l l n lUpt la 133,57 ± 33,25 phut va 146,25 + 28,69 phut. Ket q u i tUPng tU ele t i c g i l : Sw/anson SJ (130 phut) [7], Tomaszek SC (139 phut) [8], Loseertales J (148 phut) [3]. Phln tich cho thay, thdi gian phau thuat ed su khIe biet theo thuy phdi dugc eat, t i n g dan khi cat thiiy giUa, thiiy dUdi v l thuy tren.
Tai bien trong mo: Cd 02 trudng hop trong q u i trinh phau thuat cd tdn thuong maeh m l u thiiy phdi (01 trudng hop tdn thUPng ddng mach va 01 trudng hpp ton thUPng tinh maeh), da dupe chuyen md ndi soi ho trp de an toan eho benh n h i n (9,52%). Ti le nay thap hon so vdi Amer K (14,7%) [1], nhUng cao hon so vdi Me Kenna RJ (2,5%) [4] va Van Sehil PE (1,6%) [9].
Khdng ed trUdng hpp nao t U v o n g trong mo va trong thdi ky hau phau. Sandra CT [8] phau t h u l t 56 benh n h i n khdng ed trudng hpp n l o t d vong trong m d . Yamamoto K [10] phau thuat eho 502 benh n h i n ghi nhan tir vong sau md la 0,3%. Me Kenna [4]
khdng ed tif vong trong md, ty le tran khi mang phdi I I 5%. Sd lupng phau thuat eiia chung tdi cdn nhd nhung ket qua la d i n g khich le.
4.3. Theodoisaumo
Thdi gian dan lUu KMP:Thdi gian dan lUu khoang mang phoi trung binh eiia ele benh n h i n trong nghien eifu eua ehung tdi la 5,27 + 2,78 n g l y ; ngan nhat I I 3 ngay, lau nhat la 14 n g l y do cd bien chUng rd khf keo dai sau md. TTieo Tomaszek [8], dng dan lUu dupe rut sau trung binh 2 ngay ( 1 - 1 2 ngay).
Bien ehUng sau md: Qua ket q u i nghien eUu ehung tdi thay: Ty le bien ehUng sau phau thuat I I 10,52% (02 trudng hpp rd khi keo dai). NhU v l y t i le bien ehUng eiia chung tdi tuong ddng so vdi cac b i o
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e l o khae nhU eiia Loseetales J (12,8%) [3], Solaini L 3.
(11,6%) [6].
Tmh trang dau sau md eiia benh n h i n : Thdi gian dung thudc g i l m dau dang tiem sau md k h o i n g 3 - ^•
4 ngay. B l n h g i l dau ciia benh nhan theo thang diem VAS cho thay hau het ele benh nhan deu dau d mufc dp rat nhe, hau nhu khdng de y (diem VAS ngay thif 5 sau md I I 1 diem).
Thdi gian hau phau eiia ehiing tdi trung binh la 9,84 ± 3,27 ngay. So vdi mdt sd t i e g i l thl thdi gian h l u phau cua chiing tdi d l i hPn nhu Yamamoto K (6,5 ngay) [10], Swanson SJ (6,15 ngly) [7].
5. Ket luan
Benh vien Q u I n y 103 bude dau da I p dung p h l u thuat ndi soi eat thuy phdi dieu trj ele benh phdi hi&u q u i , an toan vdi t i le phau thuat npi soi hoan t o l n I I 90,47%, khdng ed tif vong trong md va trong thdi gian hau phau, t i le bien ehUng sau md t h I p (9,52%).
Tai lieu t h a m khao
1. Amer K, Khan A, Vohra H (2011) Video-assisted thoracic surgery of major pulmonary resections for lung cancer: The Southampton experience. Eur J CardiothoraeSurg 39(2): 173-179.
2. Dziedzic D, Orlowski T (2015) The Role of VATS In Lung Cancer Surgery: Current Status and Prospects for Development. Minim Invasive Surg; 938430.
Loseertales J, Quero VZF, Congregado M et al (2010) Video-assisted thoracic surgery lobectom Results in lung cancer. J Thorae Dis 2(1): 29-35.
4. McKenna RJ, Houck W, Fuller CB (2006) Videiy- assisted thoracic surgery lobectomy: Experlene^ith 1,100 cases. Ann Thorae Surg 81(2): 421-42S discussion 425-426.
5. Mun M, Kohno T (2008) Video-assisted thoradc surgery for clinical stage i lung cancer in octogenarians. Ann Thorae Surg 85(2): 406-411, 6. Solaini L, Pruseiano F, Bagioni P et al (2001) Video-
assisted thoracic surgery major pulmonai^
resections. Present experience. Eur J Cardiothorac
Surg 20(3): 437-442. j 7. Swanson SJ, Herndon JE, D'Amico TA et al (2007)
Video-assisted thoracic surgery lobectomy: Report of CALGB 39802-a prospective, multi-institu^
feasibility study. J Clin Oncol 25(31): 4993-4997 8. Tomaszek SC, Cassivi SD, Shen KR et al (30091
Clinical Outcomes of Video-Assisted Thoracoscopie j Lobectomy. Mayo Clin Proc 84(6): 509-513. I 9. Van SPE, Balduyck B, De WM et al (2013) Surgical
treatment of early-stage non-small-cell lung car)Cii.
EJC11(2):110-122.
10. Yamamoto K, Ohsumi A, Kojima F et al (2010) Long-term survival after video-assisted thoradc surgery lobectomy for primary lung cancer. Ann Thorae Surg 89(2): 353-359.
