TAP CHi Y HOC V|£T NAM TAP 454 • THANG 5 - SO 2 - 2017
V. KET L U A N
Dirt rdi da dau thu'dng gap d phu ni? toe dai bi cuon vao may, mo t d dang ehay. Viec chia thanh nhieu kip phau thuat giup rut ngan thdi gian thieu mau, tang kha nang song eiia da dau khi du'dc trong lai. Maeh mau thu'dng du'dc sir dung la dpng maeh thai du'dng nong. Trong lai da dau thanh cong se thu du'dc ket qua tot hdn ve mat giai phau, chiTc nang cung nhu' van de tam ly cho BN so vdi cac phu'dng phap khac.
TAI UEU T H A M KHAO
1. Ngjjyen Hong Ha, Nguyin Bac Hung, (2007),
"Noi lai da dau dut rdi toan bo bang k^ thuat vi phau : nhan 6 tru'dng hdp dau tien tai Viet Nam,"
Yhpc Viet Nam, So 10. Ky 2, 90-95.
2. Cheng k., Zhou S., Jiang K., Wang S., Dong J., e t a l . (1996), "Microsurgical replantation ofthe
avulsed scalp: report of 20 cases," Plast Reconstr Surg 97 (6), 1099-106; discussion 1107-8.
3. Hazani R., Buntic R.F., Brooks D. (2008),
"l^icrosurgical scalp reconstruction after a mountain lion attack," Ann Plast Surg, 61 (3), 265-8.
**. Nahai F., Hurteau J., Vasconez LO. (1978),
"Replantation of an entire scalp and ear by microvascular anastomoses of only 1 artery and 1 vein," Br J Plast Surg 31 (4), 339-42.
a. Sabapatiiy S.R., Venkatramani H., Bharattii R.R., D'Slva J. (2006), 'Technical consaderabons in replantation of total scalp avulsions," Joumal of Plastic, Reconstn/dii^&Aesthett Surgery, 59 (1), 2-10.
6. Ueda K., Nomatsi T., Omiya Y., Tajima S.
(2000), "Replanted scalp recovers normal sensation without nerve anastomosis," Plast ReconstrSurg, 106 (7), 1651-2.
7. Yin J.W., Matsuo 3.M., Hsieh C.H., Yeh M.C, Liao W.C, et al. (2008), "Replantation of total avulsed scalp with microsurgery: experience of eight cases and literature review," J Trauma, 64 (3), 796-802.
DANH GIA KET QUA SIT DUNG VAT DUI TRUaC NGOAl LAM MONG BANG VI P H A U TICH
T O M TAT
Muc tiSu: Danh gia ket ^ua sii' dung vat diii tru'dc ngoai lam mong bang vi phau h'ch trong tao hinh cac khuyet phan mem. Doi tu'dng va phu'dng phap: tir 5/2009 den 3/2015, 41vat dui tru'dc ngoai t y do dUOc lam mong bang ky thuat vi phau tich tren 38 benh nhan cd cac khuyet phan mem viing co mat, ban tay, ban chan. Ket qua: trong 41 vat dupc thi/c hien vi phau b'ch co 27 vat sdng hoan toan, 6 vat thieu du€ng, hoai tiT mep vat; 6 vat hoai tijr mot phan, 2 vat hoai tir hoan toan. Op mong cua vat sau khi lam mdng tir 2,5-5mm va khong phai lam mdng vat thi hai sau do. Ket lu^n: Vat diii tru'dc ngoai dudc lam mong vdi ky thuat vi phau tich la mpt lu^ chpn dang tin cay trong tao hinh cho cac khuyet to chiTc viing dau mat c6, ban tay, ban chan.
Tiir khoa; Vat diii tru'dc ngoai, vi phau tfch.
SUMMARY
EVALUATTON OF USING THE MICRODISSECTED T H I N ANTEROLATERAL
THIGH PERFORATOR FLAPS Objective: To evaluate the result of using the microdissected thin anterolateral thigh flap for the reconstruction of soft tissue defects. Method: from
*Binh vien Trung udng Quan dpi 108 Chju trach nhiem chinh: Nguyen Tai Sdn Email: [email protected] Ngay nhan bai: 22/2/2017 Ngay phan bien khoa hpc: 20/3/2017 Ngay duyet bai: 31/3/2017
Nguyen Vu Hoang*, Nguyin Tai Son*
June 2009 to Inarch 2015, 41 free anterolateral thigh flaps thinned by microdissected method were used for reconstruction in the face, neck, hands, and feet soft tissue defects in 38 patients. Results: 27 flaps completely survived, 6 flaps have marginal necrosis, 6 flaps have partial necrosis, 2 free flaps were totally necrosis. The thickness of microdissected flaps ranged from 2.5 to 5 mm. Conclusions: microdissected technique of the anterolateral tJiigh flap provides reliable solution for preparing thin flaps in the reconstruction of face, neck, hands, and feet defects.
Afeywony; Anterolateral thigh flap, microdissected.
Le^DkTV^NDE
Mpt trong nhu'ng vat dong mach xuyen du'dc nghien ciru va img dung rpng rai hien nay la vat dill tru'dc ngoai vdi du diem cd cuong mach dai, hang djnh, du'dng kinh mach tu'dng doi Idn cho khoi Iu'dng to chiTc rong va it di chu'ng ndi cho vat. Tuy nhien vat cd nhu'dc diem la kha day doi vdi viing mat, eo, ban tay va mu chan, lam anh hu'dng chu'c nang va tham my sau phau thuat ghep vat. Nam 2002, ky thuat vi phau tich du'dc Kimura de xuat va ap dung lam mdng ehieu day mpt so vat maeh xuyen nhu' vat vat diii tru'dc ngoai, vat mach xuyen thu'dng vj sau du'di, vat mach xuyen dong mach ngiTc lu'ng [7]. Day la phu'dng phap tam mong vat cd bao ton cae mach mau nhd ciia vat to chu'c nhd sir dung kinh hien vi phau thuat. trong bai bao nay cfiiing tdi trinh bay ket qua iTng dung ky thuat vi phau tich cho vat diii tru'dc ngoai trong tao hinh cac khuyet phan mem.
VIETNAM MEDICAL JOURNAL N°2 - MAY - 2017
II. OOI TU'ONG VA PHUaNG PHAP NGHIEN CUU 1 . Doi tu'dng nghien cu'u: 38 benh nhan vdi eae khuyet phan mem tren ed the du'dc tao hinh bang 41 vat dtii tru'dc ngoai tiT do lam mdng bang ky thuat vi phau tich, tai khoa Phau thuat tao hinh, benh vien Xanh Ron Ha Noi, Tir 6/2609'den 12/2015,.
2. Phu'dng phap nghien cu'u: Nghien ciTu tien ciTu, can thiep lam sang khong doi chiTng.
Tiiu chuan l&a chgn benh nhan: ed khuyet phan mem viing dau mat co, ban tay, mu ban chan. Dii su'c khoe phau thuat.
Tiiu chuan loai tr&: bj cac benh cap hoac man tfnh nhu* tim maeh, ho hap, roi loan dong mau..., CO ton thu'dng vimg diii tru'dc ngoai 2 ben. Khong dong y tham gia nghien ciTu.
3. Quy trinh ky thuat: Bde vat du'di can theo phu'dng phap kinh dien ciia Fu Chan Wei.
GiiJ nguyen cuong mach va tien hanh lam mdng III. KET QUA
l.Dac diem Id benh nhan nghien cihi 1.1. Tudi va gidi
Bang l.Tuoi va gidi benh nhan (n= 33)
vat sd cap bang keo Mayo, lay bo Idp mS sau tren can tir ngoai vi (mep vat) vao trung tam vat, de lai dao can mS ban kinh 1-2 em xung quanh cuong mach xuyen.
4. Danh^gia ket qua: Danh gia ket qua gin ngay sau phau thuat va ket qua xa sau 3 thang duS vao su'c song, mau sac cua vat, chirc nang, ttiam my ndi nhan va chia cae miTc dp: \at, kha, kem
-I- Tot; vat da song toan bp, cd mau sac va dp mdng, mem mai, dp chun gian tu'dng thich v^
da viing tao hinh, dam bao mue dich tao hinh, chiTc nang ndi nhan vat du'dc cai thien rd ret.
+ Kha: vat da cd mau sac va dp mong chus that phu hdp vdi da vimg mat co, seo quanh vat phi dai hoac loi.
+ kem: vat xd hda, bien doi mau sac ro rang, khong dam bao yeu cau tham my, chiTc nang ndi nhan vat khong 6.\itic cai thien.
Gidi tfnii Nam Tong
m
Tudi
< 1 8 3 2 5(13,2»/o) Theo gidi: nam nhieu hdn nff, co 2, va cao tuoi nhat la 60. Lij^a tuoi lao do
1.2. Vj tri ton thWdng^
Bang 2. Vi tn i^huyet honq (n=38) Vi tri Ithuyet iiong
I^at CO Ban tav Mu ban chan
Tong Da so tri/dng dp (94.7%)
18-55 20 12 3 2 ( 8 4 , 2 % )
> 5 5 1 1 ( 2 , 6 % )
Tong so 23(60,5%) 15(39,5%) 3 8 ( 1 0 0 % ] nam va 15 nti'. Theo do tuoi: benh nhan nhd tuoi nhat la 13 ig (tir 18-55) chiem t i le cao nhat d ca 2 gidi (84,2%).
So tru'dng Iidp 15 21 2 3 8
on t h i rdng vung Vat nhd nh
Tv le % 39,5 55,2 5,3 100
at la 28cm'', vat idn nhat la 330 mat CO va ban tay
1.3. Kich th&dc ton th&dng: Dien tich khuyet: nhd nhat 18cm^ Idn nhat 300cm^ trung binh llOcm^. Kich thu'dc: Dai 6- 31cm, rdng 3,5 - 14cm, trung binh 16,9 x 8,3cm.
2. Ket qua p h l u thuat
21. Kldi th&dc vat: Kieh thu'dc vat tu'dng img va rpng hdn kich thu'dc ton thudng khoang 10%.
cm', trung binh la 123cm . Chieu dai vat 7- 33 cm, chieu rong vat 4 - 1 5 cm, trung binh la 17,8 X 9,3cm.
2.2. Bg mong ciia vat: Tru'dc khi lam mdng: 8 - 30mm, trung binh'la 17.1mm. Sau khi lam mdng: 2,5 - 5mm, trung binh la 3,2mm
2.3. Dac diem d&dng di cua mach xuyin
Loai mach xuyen So tru'dng Iidp 1
2 3 Tdng so
21 15 5 4 1
Tv le % 51,2 36,6 12,2 1 0 0
£)a so cac maeh xuyen chay vuong goc vdi mat da, chiem 51,2%.
2.4. Kit qua gan
TAP CHi Y HOC V|£T HAM TAP 454 - THANG 5 - S6' 2 - 2017 Bang 4. Sire song cua vat ( n = 4 1 )
Ket qua So tru'dng hdp Ty le o/o
Sonq hoan toan 65,9
Thieu duQnq niep vat,dau v a t " 9,8
Hoai ttf mot phan vat Hoai t[f hoan toan
19,5 4,9 _ Tong so I -T... I .>«w I Ty le vat song toan bo sau lam mong vat chiem 65,9%, hoai t d mot phan la 12,2% va hoai tiJT toan bp la 4,9%.
Baiig S.Moi lien quan giO'a loai mach xuyen va siTc song ciia vat lani mong (n=41)
Su'c song cua vat Loai mach xuyen Tong so
Vat song hoan toan Vat thieu du'dng mep, c^u vat~
27 Vat hoai ttf mpt phan
Vat hoai tu' hoan toan Tong so
Ty le vat song toan bp cua loai mach xuyen loai mot la cao hdn ca, chiem 18/41 vat va it hdn ea la cita loai mach xuyen 3, khong cd vat lam mong nao song toan bp.
Bang 6. Moi lien quan qiu'a kich thu'dc vat lam mdng va siTc song ciia vat ( n = 4 1 ) Su'c sdng cua vat
Vat sonq hoan toan Vat thieu duSnq mep, dau vat
Vat hoai tu' mot phan Vat hoai tu' hoan toan
t o n g so
Kicll thu'dc vat lam mong (cm')
< 100 10
2 5 2 19
100-199 14 2 1 18
200-300 2 1 3
>300 1
1
Tong sd 27
4 8 2 4 1 Bang 6 eho thay vat cang rpng thi nguy c6 hoai tiT cang eao.
Bang 7. Moi lien quan gjilTa phu'dng piiap xif ly vat va su'c song ciia vat lam mong (n=41)
Su'c song ciia vat
Khong xu' (khong xe, khonggap)
Khong xe vat Gap, cuon
vat Khong^
gap, cupn Phu'dng phap
Xe vat khdng hoan toan
Gap cupn
Khong^
gap, cupn Xe vat hoan toan
G^
Tong
Vgt song hoan toan Vat thiiu du8ng mep, i ^ u vat
Vat hoai tu* mot phan Vat hoai tu' hoan toan
Tong so Bang 8. Bien chuYig (n=41) Bien
chuang Chay Tae tmh mau mach
Ton thu'dng mgch mau Tac mach
xuyen
Ton thu'dng he mach
vat Thieu i^ep, l^ot Toan
duSng dau xa phan bp So vat
Tong
T v l e % 34,1
Nhieu ben chu'ng co the xuat hien cimg tren mot vat, ton thu'dng he maeh vat gay chay mau dan den mau ty, gay chen ep cuong vat dan den tac maeh va hoai tir vat. Hoai tuT vat la bien chiTng mupn, xuat hien sau, do eae bien chiTng ton thu'dng mach mau.
Bang 9. Plian loai ket qua gan (n=41) Ket qua
Tot Kha Kem Tong so
So tru'dng hdp 27
7 7 4 1
Ty le % 66 17 17 100
VIETNAM MEDICAL JOURNAL N°2 - MAY • 2017
2.5. Ket qua x a : Chiing toi thiTe hien kiem tra du'dc 29/38 benh nhan sau mo, it nhat la 3 thang, nhieu nhat la 5 nam. 9 benh nhan khong ed ket qua xa gom: 5 tru'dng hdp that bai chuyen phu'dng phap khac, 4 benh nhan khong den de kiem tra lai
Bang 10. Phan loai ket qua xa ( n = 2 9 ) Ket qua
Tot Kha Kem Tdng sd
1 Sd tru'dng hdp 24
5 0
1 29
Tv le % 82,8 17,2 0 100 IV. BAN LUAN
Trong nghien ciru cua chung toi tat ca 38 benh nhan ton thu'dng vung dau mat co, ban tay, mu ban chan, vdi cac nguyen nhan va hinh thai lam sang da dang va phiTc tap, kieh thu'dc ton thu'dng phan Idn tren 100 em^, can chat lieu cd kfch thu'dc Idn, dp day thich hdp de phii hay diTng hinh lai v i l ^ phai dam bao yeu cau chiTc nang va tham my vimg mat. Kich thu'dc tdn thu'dng Idn nhat ma chiing toi tao hinh la tren benh nhan ung thU te bao day viing mat, vat du'dc lay vdi kich thu'dc 330 em^ (kich thu'dc 33 x 10 cm), kich thu'dc vat nho nhat la 28 cm^ (kich thu'dc 7 x 4cm), dieu nay cho thay tinh linh hoat cua vat dill tru'dc ngoai, Kimura [7] cung co nhan xet tu'dng tiT.
Qua 38 tru'dng hdp lam sang vdi 41 vat co su"
dung ky thuat lam mdng vat vl p h l u tich thi cd 27 vat song hoan toan, 4 vat thieu duQng mep vat, 2 vat hoai tiT mep vat, 1 vat hoai tii dau xa, 5 vat hoai tiT mpt phan, 2 vat hoai tu" toan bp vdi do mong eiia vat tiT 2,5-5mm. Nhu' vay co tdi 14/41 vat cd bien chiTng ve hoai tu" vat eao hdn khi so sanh ket qua lam mong vat diii tru'dc ngoai vi phau tich vdi cac tac gia khae Kimura nam 2003 [7], lam mong vat vi phau ti'ch cho 15 vat dui tru^dc ngoai (co 6 vat mach xuyen loai 2 va 3), ket qua cd 2/15 vat lioai tii mpt phan va den nam 2006, ky thuat lam mong vat du'dc hoan thien hdn nen ty le tai bien giam, chi 1/io v | t hoai tir dBu xa d vat kich thu'dc Idn 3 3 x l l c m , dp mdng vat sau khi lam mong la 3-5mm. Yang, chi cd 1/18 vat bj thieu du'dng dau xa vdi dp mong 3-7mm, Yang khong co du" lieu ve loai mach xuyen. Tac gia Xie S lam mdng vi phau tich cho 12 vat vdi 6 vat cd mach xuyen loai 1, 2 vat mach xuyen ioai 2 va 4 vat mach xuyen loai 3, chi cd mpt vat thieu dddng dau xa vdi dp mdng ciia vat tir 3,25- 6mm. Hai tru'dng hdp hoai tiT mpt phan (hoai tiT mot dao da ciia vat chimeric) deu do vat du'dc gap cupn de tao hinh, gay chen ep tSc mach xuyen. Nhu" vay con con 8/14 vat cd bien chiTng do ton thu'dng he mach vat,lien quan
den lam mdng vat va thiet ke vat. Bon tru'dng hdp vat thieu du'dng d mep vat va dau vat, trong dd cd hai tru'dng hdp nguyen nhan cd the do vi tri mach xuyen di vao vat khong phii hdp, phan mep vat va dau vat bj thieu dddng ngu'dc chieu dong chay mach mau, cac vat sau do bong thu'dng bi, lien seo thi dau. Ba tru'dng hdp hoai tif mpt phan vat triing vdi dien tich vat lam mong, trong dd co mpt tru'dng iidp bj chay mau d dien lam mdng, gay hematoma chen ep mach xuyen gay tac tinh maeh hoi lull. Nhu" vay co 3/5 tru'dng hdp vat bi hoai tiT mpt phan tu'dng iTng vdi viing lam mdng, eac mang maeh tren can, du'di da va du'di trung bi ciia vat cd the bj ton thu'dng trcing qua trinh vl phau tich, day cung chinh la mpt nhu'dc diem eiia ky thuat can khac phuc. Cae tac gia nghien culi ve k9 thuat lam mong vat diii tru'dc ngoai nhu* Alkureislii [4], Kimura[7] cung cd quan diem tu'dng tiT. Tim hieu them cac yeu to anh hu'dng tdi siTc song ciia vat dill tru'dc ngoai lam mdng chung toi cd mot so nhan xet. Ve kich thu'dc ciia vat lam mong, co 9/14 bien chiTng ve cap mau vat (bang 6) gap cl cac vat CO dien tich lam mdng nhd hdn lOOcm^, nhu" vay khong ed nghia la kfch thu'dc vat lam mong cang Idn thi bien chutig se nhieu hdn. Xet ve moi lien quan giD'a phu'dng phap xif ly vat va siTc song ciia vat lam mong, co 9/14 bien chiilig hoai tir vat cac mu'c dp lien quan d nhihig trirdng hdp gap cupn vat, mach xuyen de bj gap, xoan, Chen ep can trd hoi lulj tinh mach hdn nen CO the ty le bien chiTng cao hdn, dieu nay dong quan diem vdi tac gia Gong [5]. Ket qua xa ehimg toi kiem tra danh gia tren 29 benh nhan, ket qua tot 24/29 benh nhan (82,8%), vat mem mai, mau sac phii hdp vdi ndi nhan vat sau tao hinh, dp day vat mong rat phii hdp va khong phai lam mdng thi hai do vat da du'dc lam mong ngay thi dau vdi ky thuat vi phau tich, tJnh mach dan lu'u mau tot, benh nhan hai long. Tuy ket qua chu'a eao so vdi mpt so tac gia khac su* dung vat diii tru'dc ngoai nhu" Le Diep Linh [1] 9 1 % , Gong [5] 93%, song vdi viec bao ton du'dc he
TAP CHl Y HOC VIET NAM TAP 4S4 - THANG 5 - SO 2 - 2017 thdng maeh mau trong da mpt each toi da ciing
vdi_^viee loai bo Idp m3 thii^ bang ky thuat vi phau tich giiip chiing toi kiem soat mpt each chii dpng ehieu day cua vat da. Trong niiieu tru'dng hdp, khi vat du'dc diing de che phii nhu'ng bp phan dac biet, cac phau thuat tai tao lai bp phan noi tren mat (ciing do mat, mui...) ludn doi hdi cd sir phii hdp ve dp day mong khac nhau tai tCrng diem khac nhau tren ciing mpt vat thi van de kiem soat du'dc dp day theo muc dich tao hinh chi co the thiTc hien du'dc bang ky thuat vi phau tfch.
V. KET LU&N
Vi phau tich la mpt ky thuat dac biet lam tang tfnh linh boat ciia vat diii tru'dc ngoai giiip phau thuat vien chu dpng lam mong vat theo yeu cau phii hdp vdi mue dich tao hinh, nhat la cac khuyet to chire ed hinh dang phu'c tap. Vat diii tru'dc ngoai du'dc lam mdng vdi ky thuat vi phau tfch la mpt lira chpn tin cay, thfch hdp trong tao hinh cac khuyet plian mem co mat, ban tay, ban chan , la cac vj trf tren cd the can eo dp mdng va su" mem mai.
TAI UEU T H A M KHAO
1. Le Diep Linh (2011^ "Nghien culi sir dung vat dui tru'dc ngoai trong dieu tri_ khuyet rong phan mem vtjng CO mat", Luan an tien sy Y hoc, Vien nghien ciTu Kljoa hoc Y di/Oc Lam sang 108, Ha Noi.
2. Nguyen Tai Sjfn (2007), " l/ng dung vat mach xuyen trong phau thuat tao hinh cac khuyet hong phan mem" Tap chi Y du'dc hoc Lam sang 108.2(3), tr.85-90.
3. T r | n Thiet Stfn (2q;ll), " Ung dung Iw thuat vi phau tich trong phau thuat tao hmh', tap chi Nghien ciTu Y hoc. 77 (6), tr 1-6.'
4. AJkureishia LW.T, Shaw-Dunna. J, Rossb .G.
L(2003), "Effects of thinning the anterolateral thigh flap on the blood supply to ttie skin". TTie British Assxiabon ofPiasttSurgecms, 56, pp. 401-408.
5. Gong et al. (2015), "Application of thinned anterolateral thigh flap for the reconstruction of head and neck defects", J Oral Maxillofac Surg, 73, pp. 1410-19.
6. Naohiro Kimura, Kaneshige Satoh, Toshiaki Hasumi, and Takaharu O5tuka(2001), "Clinical Application of the Free Thin Anterolateral Thigh Flap in 31 Consecutive Patients", Plastic and Reconsbvctlve Surgery, 108 (5), pp. 1197-1208.
7. Naohiro Kimura, Kaneshige Satoh,Yoshiaki Ho5aka(2003), "Microdissected Thin Perforrator Flaps: 46 Cases", Plastic and Reconstructive Surgery,n2{7), pp.1875-1885.
cAc YEU TO ANH Hird^NG DEN LIEN VET MO SAU PHAU THUAT FERGUSON DIEU TRI BENH TRi
Phan Sy Thanh Ha*, Tran Minh Dao*, Nguyen Xuan Hung**
T 6 M TAT
D | t van de: Phlu thuat Ferguson thuc hifin tir nam i959, day la cai tien tir phu'Ong phap Milligan - Morgan. Sau khi that goc, cat bjji tri vet mo du'dc khau kin. De tai nay nham tim hieu mpt so yeu to anh hu'dng den lien vet mo sau phau thuat Ferguson dieu tri benh tri. Dol tu'dng va phu'dng phap ^nghien ciru: 190 benh nhan'trt do 3, dp 4 dUOc phau thuat dieo phu'dng phap Ferguson tai Benh vien Viet Du'c.
Thdi gian tir 1/9/2012 den 31/12/2013. Ket qua: Lien vet mo thi dau 82,1%, thi 2 la 17,9%. Co moi tu'dng quan gliJa thdi gian hen vet mo vdi the trt, tinh chat phan lan dai ben dau tien sau mo (p < 0,05J. lthong cd moi tu'dng quan giD^ thdi gian lien vet mo vdi gidi b'nh, tuoi, phan do, so bui tn du'dc cat (p > 0,05). Ket luan: Phau thuat Ferguson dieu tn benh tn co Uu diem an toan, k^ qua dieu tri tot, nhanh lanh vet mo.
*B4nh vl$n 198
**Bpnhvlen Viet Du'c
Chju trach nhiem chinh: Phan Sy Thanh Ha Email; [email protected] Ngay nhan bai: 8/2/2017 Ngay phan bien khoa hoc: 28/2/2017 Ngay duyet bai: 20/3/2017
cham SDC sau mo dcfn gian, benh nhan sdm trd lai sinh hoat va cong viec binh thUdng.
T&khoa: Phau thuat Ferguson, benh tri dp 3, do 4.
SUIVIMARY
FACTORS AFFECTING POSTOPERATIVE WOUND INSTANT FERGUSON
HEMORRHOIDS TREATMENT Purpose: Surgical Ferguson was carried out from 1959, this is the improvement of methods l^illigan - Morgan. After ligation, cut tufts hemorrhoids incision is stitched closed. Subject to learn a number of factors affecting postoperative wound instant Ferguson hemorrhoid treatment. Methods: 190 patients with hemorrhoids grade 3, grade 4 is surgical method Ferguson in Viet Due Hospital, from 1/9/2012 to 12/31/2013. Result: Patients with wound dehiscence was 17.9%. There is a correlation between the time immediately with the old wound, classified hemorrhoids, Finnish nature first postoperative defecabon (p < 0.05). There is no correlation between the time immediately wound with sex, distribution of hemorrhoids, the hemorrhoids are cut tufts (p >
0.05). Conclusions: Surgery Ferguson has advantages heal fast, simple postoperative care, patients soon back to business and work normally.
Keywords: Ferguson technique, hemorrhoids grade 3, grade 4.
