d i l u trj thoai hda khdp gd'i, Luan van tdt nghiep D.B, David S, Chester V.O (2008), The effect of b l e sT, TrUdng Dai hoc Y Ha Npi. • Glucosamin and/or Chondroitin sulfate on the pro-
3. Trodng Dai hoc V Ha Npi (2004), Thoai gression of knee osteoarthritis, Arthritis & Rheuma- khdp, Bai giang benh hpe npi khoa tap 2, nha tism, 58 (10), 31 83 - 3 1 9 1 .
xuat ban Y hpe, 327 - 342. 5. Brandt KD (1994), Osteoarthritis, In Stein J 4. Allen D.S, Helen S, Martha F.F, Dorothy ed Internal Mediein 4 * ed St Louis, Mo. Mo by D.D, Clifton O.B, Crystal L.H, Nora G.S, Tohn year book, Ine, 2489 - 2493.
Summary
THE EFFECT OF GLUSAMIN IN
SUPPORTING TREATMENT KNEE JOINT DEGENERATION
Objective: This research aims to assess the sedative supporting effect and safety of Glusamin in treating knee joint degeneration. Methods: Randomized clinical trial. The study recruited 60 patients with knee joint degeneration, w h i c h included treated and control groups. Results: Glusamin has supporting sedative effect on knee joint degeneration: The 51 days post - therapeutic average points by VAS reduced 3.89 ± 1.46; The 51 days post - therapeutic average points by Lequesne reduced 6.87 ± 2.32, which is higher than the point in the control group (p < 0.01). Glusamin has the rehabilitated effect on motor function of knee joint: The motive field of knee joint after treatment increased 15.40 ± 11.96(°). Glusamin has no side effect on the clinic and some sub - clinical indexes. Conclusion: Glusamin has supporting sedative and rehabilitated motive effect in treating knee joint degeneration. Glusamin has no side effect during 51 days of treatment.
Keywords: Glusamin, knees joint degeneration
KET QUA PHAU THUAT NOI SOI 0 BUNG DIEU TRj BENH PHINH DAI TRANG BAM SINH M O T THI
Vu Thi Hong Anh Trddng Dai hoc Y Difdc Thai Nguyen
Muc tiSu: danh gii kit qua phiu thuit ndi soi 6 bung diiu trj bdnh phinh dai tring bim sinh. Doi tugng va phuang phap nghien ciiu: md ta tien cdu, bdnh nhin dddi 36 thing tuoi, bj bdnh phi dai trang bam sinh cd vj tri vd hach td trdc trang tdi dai trang xich ma ddac phiu thuat ndi soi mot thi tai Benh vien Nhi Trung dang td thing 1/2008 den thing 9/2009. Benh nhan ddac kiem tra dinh gia kha nang dai tien, tinh trang mieng ndi, cac bien chdng sau mo. Kit qua: 64 bSnh nhin bi phi dai tring bam sinh dddc phiu thuit ndi soi mdt thi gom 55 nam va 9 nd, 31/64 bdnh nhin (48,4%o) bi dd da quanh hiu mdn mot thdi gian ngin sau mo, khi ra vien tit ca cic benh nhin diu td dai tien vdi sd lan trdng bmh la 6,5 ± 2,2 lin/ ngay, mot bdnh nhin bj rd mieng ndi sau mo 3 tuan. 54/64 bdnh nhan di ddac kiem tra sau mo vdi tuoi TB li 17 ± 7,8 thing (td 5 - 39 thing), thdi gian theo ddi sau mo trung binh ta 11 ± 5,3 thing, sd lan dai tidn trung binh la 1,9 ± 1,0 lan/
ngiy (td 1 - 5 lan/ ngiy), 45/54 benh nhin dai ti$n phan thanh khudn,18/54 benh nhin thinh thoang bi sdn phin, mde do sdn phin va sd lan dai tien giam dan qua thdi gian theo ddi. Cd 2/5 benh nhin bi viem rudt
sau mS can dieu tri tai vien, khdng cd BN nao bj tao bdn tii phat, hep mieng ndi, va tac rudt do dmh sau mo. Kit luan: bSnh nhan bi phi dai trang bim sinh sau phiu thuit ndi soi 6 bung ha dai trang deu co kha nang td dai ti$n, tinh trang dai tien dan dan trd ve binh thddng khi tre Idn dan len. Ty Id viem ruot sau mo, cic bien chdng sau mo tha'p. Kha nang kiSm soit dai tiSn can tiep tuc ddac theo ddi.
TO khoa: phlu thuat noi sol, phinh dai trang bam sinh
I.
DAT V A N DENam 1995, Georgeson lan dau tien md ta ky thuat npi soi d bpng k i t hpp ha dai trang qua dudng hau mdn mpt thi d i l u tri bfinh PDTBS.
P h l u thuat npi soi vdi nhflng Uu diem vUpt trdi nhU tham m y , it gay cha'n thUdng d phuc mac, quan s i t rd doan vd haeh, doan gian va doan dai trang lanh, sinh thie't lanh trong md de x l e djnh ehan d o l n , thdi gian phuc hdi sau md ngan, giam ty le bie'n ehdng eua p h l u thuat md nhU tac rupt do d i n h , nhiem trung vet m d . PTNS ngay d n g dfldc ap dung phd bie'n de dieu trj benh PDTBS tai mpt so' trung t i m p h l u thuat nhi Idn tren the gidi [ 1 , 4, 5, 10].
Nhieu nghien cdu da md t l mpt so' ke't q u i chfla td't qua theo ddi sau m d nhfl v i e m rupt t l i phaL t l o bdn, sdn p h i n , khdng kiem soat dai tien vdi ty le khac nhau bat ke tdi ap dung phflpng p h l p phau thuat. Tuy n h i e n , so' nghien cflu theo ddi ke't q u i lau dai sau' PTNS chUa n h i l u [3, 7, 8, 9] .
Tai Viet Nam, p h l u thuat npi soi d i l u trj benh PDTBS bat d i u dUdc thflc hien tai Vien Nhi Trung Udng to nam 1997, nhflng den nam 2001 p h l u thuat npi spi mdi dflpc ap dpng nhieu d l d i l u trj benh PDTBS. Tfl dd de'n nay mdi cd bao d o nhan xet ve k i t qua bUde d i u ap dung ky thuat nay trong d i l u trj benh PDTBS [1], k i t q u i theo ddi xa sau md ehUa dUde d l cap tdi. Vi vay, chdng tdi tien hanh d l tai " D i n h gia k i t qua p h l u thuat npi soi d bung d i l u trj benh phinh dai trang bam sinh mpt t h i " vdi muc tieu: Danh gia ket qua theo doi sau phau thuat ngi soi d bung diiu tri benh PDTBS.
II. DOI TUONG vA PHUONG PHAP NGHIEN CLfu
1 . Ddi tOdng nghi6n cOu: b#nh nhan bj benh PDTBS dupe md bang phfldng phap p h l u thuat ndi soi mpt thi tai benh vien Nhi Trung Udng trong thdi gian tfl t h i n g 01/2008 den t h i n g 09/2009.
2. Tieu chuan benh nhan:
- Tudi: Tfl sd sinh de'n 35 t h i n g tudi, ca gidi nam va nO.
- Tieu chuan chan doan: benh nhan cd cac trieu chflng lam sang (cham Ia p h i n su, t l o bon keo dai....) dflpc chup khung dai,trang cd hinh anh dien hinh cua benh PDTBS la ed doan hep, doan ehuyen tiep hinh pheu va doan gian vdi vj trf doan vd hach d trUc trang, dai trang xich ma.
Cd k i t qua sinh thiet trpng md la khdng ed t l bao haeh than kinh d doan hep, khdng dan.
- BN dfldc kiem tra sau md it nhat 2 thing.
3. PhOdng phap nghien cOu: nghien cflu mo t l tie'n eflu.
4. PhOdng phap danh gia Thdi diem danh gia:
- Khi benh nhan ra vien;
- Thdi diem k i t thue nghien eflu (09/2009).
Cae ehi tieu nghien cdu
- Thdi gian d i l u trj sau md, sd lan dai tien khi ra vien.
- Thdi gian theo ddi sau mo, sd l l n dai tign/
ngay, sdn phan, dp dae cda phan, tinh trang soi bung, thdi gian bj dd da quanh hau mon, sfl dung thude hay eae bien phap can thiep khi di dai tien.
Tinh trang mieng nd'i, cae bien ehdng xuat hien trong thdi gian theo ddi.
Cach danh gia:
- Phdng van trflc tiep bd'(me) benh nhi ve tinh trang dai tien cua BN nhfl so' l l n dai tien/ngay, dp dac cua phan, tinh trang sdi bung, thdi gian bj dd da quanh hau mdn, sd dung thude hay d c bidn p h l p can thiep khi di dai tien.
- Sdn phan dUde d i n h g i l khi benh nhi > 4 thing tudi, sau md > 2 t h i n g . Sdn phan la tinh trang day it phan ra quan ngoai nhflng lan dai tien.
+ Khdng sdn phan.
-(- Hiem khi sdn phan: trung binh sdn < 2 lan/tuan.
+ Thinh thoing sdn phan: sdn phan 3 - 4 lan/tuan.
+ Thudng xuyen sdn phan: Ngay nao cung bj son phan.
- Dp dac cda phan: phan thanh khudn, khdng thanh khudn, lue thanh khudn lue khdng thanh khudn.
- Thdi gian dd da quanh hau mdn sau md: tinh theo t u i n .
- Kham trflc tiep benh n h i n danh gia tinh trang mieng nd'i.
+ Mieng ndi mem mai, gd manh, san sui, vdng xP.
-f Mieng ndi khdng hep: Khi kiem tra hau mdn nlu Ipt que nong hau mdn sd 11 hoae 1 2 dd'i vdi benh nhan tren 12 t h i n g tudi, ipt .que nong sd 10
Bang 1. So lan dai tien va
dd'i vdi benh nhan > 12 t h i n g tudi.
+ Mieng ndi hep khi khdng dat tieu ehuan tren.
" - Viem rupt sau md khi benh nhan ed d c trieu chdng sau: ia phan long mui thdi kham, bung chudng, sdi bung, cd the sd't hoae khdng sdt.
- Ghi nhan d c b i l n chflng khi benh nhan nam dieu trj tai vien hoae tdi kham lai.
5. Phoong phap thu thap va xuf ly sd lieu: d c so' lieu dupe thu thap theo m l u benh I n dupe xfl
• ly theo phflpng phap thd'ng ke y hpe tren phan mem SPSS.
III. KET QUA
Trong thdi gian nghien cflu tO t h i n g 1/2008 den t h i n g 9/2009 ed 64 BN bj benh PDTB dflpc PTNS mpt thi gdm 55 nam va 9 nfl, tudi trung binh khi p h l u thuat la 5,5 ± 0,8 t h i n g (tfl 16 ngay den 24 thang tudi), trpng lUdng trung binh luc md I I 5,9 ± 2,3 kg. Thdi gian d i l u trj trung binh sau md la 5,9 ± 0,9 ngay, khi ra vien tat c l d e benh nhi deu tfl dai tien dfldc vdi sd l l n dai tien trung binh 6,5 ± 2,2 lan/ ngay (tfl 1 - 12 lan). Cd 54/64BN (84,4%) da dfldc kiem tra sau m d ' v d i tudi TB la 17 ± 7,8 t h i n g (tfl 5 - 39 t h i n g ) , thdi gian theo ddi sau md TB la 11 ± 5,3 t h i n g (tfl 2 - 20 t h i n g ) , sd l l n dai tien TB la 1,9 ± 1,0 lan/
ngayftfl 1 den 5 lan/ ngay). Sd l l n dai tien/ ngay g i l m d i n qua thdi gian theo ddi sau md (bangl).
thai gian theo doi sau md
Thdi gian TD (Thang)
< 3 4 - 6 7 - 12
> 12 Tdng epng
1 0 3 5 9 . 17(31,5%)
So lan 1 - 2
2 4 13 10 29(53,7%)
dai tien 3 - 4
1 2 1 2 5(11,1%)
> 4 1 1 0 0 2(3,7%) Trong 54 BN cd 18 BN thinh thoang bj sdn phin, mifc do sdn phan giam din qua thdi gian theo doi (bang 2) .
Thdi gian (Thang)
Bang 2. Tinh trang son phan va thdi gian theo doi sau mo
Son phan
Khong son Hiem
< 3 4 - 6 7 . 12
> 12
0 2 9 13
1 3 5 3
Tdng cdng 24 (44,4%) 1 2 (22,3%)
Thinh thoang 3 5 5 5 1 8 (33,3%)
45/54BN dai tien phin thanh khudn, khi benh nhin Idn len do die cua phin din trd vi binh thifdng (bang 3).
Bang 3. Tinh trang phan va tudi benh nhan
Tuoi i BN (Thang)
<
7 - 13
>
6 12 - 24
24
Tinh chat phan
Co khuon Khong CO khudn Luc cd luc khong 1
11 26 7
Tdng cdng 45(83,3%) 2(3,7%) 7(1 3%)
Cd 50/54 BN khi k h l m tha'y mieng nd'i m l m mai khdng hep hoac da xda h i t . 4 benh n h i n tha'y mieng ndi gd m l n h , khdng hpp.
Bie'n chOng sau md:
- Khdng cd trudng hdp nao tfl vong.
- Khdng gap trfldng hdp nao bi n h i l m trung v i t md.
- Ba trfldng hdp bj Idi mac nd'i ra ngoai khi rut d'ng dan Iflu, da dfldc gay te tai chd, dfla mac nd'i vao d bung va khau lai thanh bung. Cd 31/64BN (48,4%) bj dd da quanh hau mdn mpt thdi gian ngan sau m d , thdi gian dd da keo dai trung binh 3 tuan.
- Mpt BN bj rd mieng nd'i sau md 3 t u i n . - Cd 5BN (9,2%) bi viem rupt sau md, 2 BN e i n dieu tri tai vien.
- Khdng ed BN nao bi tao bdn tai phat, hep mieng ndi, va t i e rupt do dinh sau md
- Tat e l eac BN dUdc theo ddi d i u khdng ed
rdi loan tieu tien, 45 BN nam deu cd k h i nang eUdng dfldng vat.
IV. B A N LUAN
P h l u thuat npi soi vdi nhflng flu diem vUdttrgi nhU: tham my, ft gay cha'n thUdng d phuc mac, sinh t h i l t lanh de chan doan chfnh xac trong md trUde khi giai phdng mac treo, thdi gian phuc hdi sau md ngan.
Ket qua sdm sau md:
Trong nghien edu nay, thdi gian nam dieu tri sau md trung binh la 5,9 ngay, so vdi mpt sd tie g i l Georgeson la 4 ngay va Joria la 2 - 3 ngay [4, 5]. Sd dT cd k i t q u i nay vi BN cua chung tdi X(l khap cac tinh cua m i l n Bac ve d i l u tri, nhieu benh nhan d vung sau nen khdng the eho BN ra vien sdm dUde vi gia dinh BN va thay thudc khdng yen tam. Tuy nhien, qua theo ddi chung toi khdng ghi nhan tha'y bien chflng gi, k i t q u i nay gidp cae p h l u thuat vien cd the q u y l t djnh cho BN ra vien sdm hdn.
Cd 3 trfldng hdp bj Idi mac ndi ldn ra ngdai khi rdt d'ng d i n luU. Chdng tdi nhan tha'y day la 3 trfldng hdp ed Id dat troea rpng, khi dat d'ng d i n Iflu chung tdi ehi cd' djnh d i n Iflu ma khdng khau hep bdt thanh bung lai. Sau khi rut kinh nghiem nay khdng cd BN nao bj Idi mac nd'i khi rut d'ng d i n lUu.
Khi ra vien tat ca d e benh n h i n d i u tfl dai t i l n vdi so' l l n trung binh la 6,5 l l n / n g l y (tO 1 den 12 l l n ) . Vi phan Idn d c BN cua chdng tdi dupe phau thuat d Ida tudi bd me, ddng thdi bi e l t mat doan dai trang nen sau md BN di dai tien nhilu l l n la ta't y l u . 31 BN bj dd da quanh hau mdn trUde khi ra vien trong dd cd 20 BN dfldi 3 thang tudi. Cd le do I n h hfldng eua dp PH cua phan da gay nen tdn thUdng nay. Nhflng BN nay sau dd dUde bdi md Penexillin quanh hau mdn vdi hy vpng g i l m bdt tdn thUdng da quanh hau mdn.
Thdi gian bj dd da quanh hau mdn trung binh la 3 tuan, theo nghien cdu cua mot sd t i e g i l , dd da quanh hau mdn se giam d i n theo thdi gian khi sd lan dai tien cua BN g i l m xudng, k i t q u i sdm sau md tUdng tfl nhfl e l c nghien eflu khae.
Kit qua theo doi xa sau md:
Cd 54/64 BN (84,4%) da dflpc kiem tra sau md vdi tudi TB la 1 7 ± 7,8 t h i n g (tfl 5 - 39 t h i n g ) , thdi gian theo ddi sau md TB la 11 ± 5,3 thang (tfl 2 - 20 thang), so' lan dai tien TB la 1,9 lan/ ngay (tfl 1 - 5 lln/ngay). Ddi vdi tre binh thudng khi Idn len, sd l l n dai t i e n / ngay giam xud'ng. Qua theo ddi chdng tdi nhan tha'y so' lan dai tien/ngay giam dan qua thdi gian theo ddi sau md (bangl). Tuy nhien, ed mpt so' tre Idn nhUng dai tien 3 - 4 l l n / ngay, khi hdi cha me BN ehung tdi thay dd la nhflng ngay tre khdng dflpc xi dai tien hoae ia dun, vi khdng dai tien h i t phan trong dai trang nen trong ngay dd tre di nhieu l l n . Khi cha me BN dflpc tfl va'n v l each tao thdi quen dai tien dung gid cho trd thi tinh trang nay dflde d i thien.
P h i n Idn eac tac g i l d i u thay sd lan dai tien
giam dan qua thdi gian theo ddi. Sau md, BN dai tien td 5 - 8 lan/ ngay, trong vdng 3 t h i n g dau sau md sd lan dai tien g i l m xud'ng cdn 3 - 5 l l n / ngay. Tfl luc 3 t h i n g cho tdi 1 nam so' l l n dai tien tfl 2 - 3 l l n / ngay. Xu hUdng dai tien duy tri 2 lan/
ngay trong nam, tiep theo [2].
Sdn phan la bieu hien thfldng thay d BN sau md chOa PDTBS, tuy nhien mde dp sdn phan tuy thupe vao dp dac eua phan, tinh trang cd that hau mdn..., tan suit sdn p h i n se g i l m khi tre Idn len va dai tien phan cd khudn. Trong nghien cflu nay, cd 4 4 , 4 % khdng cdn sdn phan den thdi diem danh g i l . Chi cd 10 trong 45 BN dai tien phan thanh khudn thinh thoang bj sdn phan. Theo Re- secorla va cpng sfl, 12% BN dfldi nam tudi edn sdn phan, ty le nay giam xudng cdn 6% trong dp tudi 10 - 15, khdng edn trfldng hdp khdng kiem Sdit dai tien khi tren 15 tudi [9]. Trong nghien cflu nay vi tudi BN cdn nhd do vay can tiep tuc theo ddi de d i n h gia kha nang k i l m scat dai tien.
Tao bdn la van de thudng gap cua BN sau phau thuat ha dai trang. Tao bdn thudng xuat hien trong thdi gian ngan va d i thien cung vdi thdi gian. Ty le tao bdn tfl 5 - 2 0 % tuy theo tac g i l [3, 7]. Tuy nhien, trong nghien eflu nay ehung tdi khdng gap trUdng hpp nao, k i t qua nay dem lai sfl hai Idng cho gia dinh benh nhan vi p h i n Idn trflde md BN den vien vi tao bdn.
Bien chdng sau md:
Viem rupt la b i l n chflng thfldng gap sau md, ty le viem rupt sau md khac nhau gifla cac bao d o tfl 12 - 3 4 % [5, 10]. Khoang 5 0 % sd ca tfl vong lien quan trflc t i l p tdi PDTBS do viem rupt. Chung tdi gap 5BN (9,2%) bi viem rupt, trong dd 3 BN d i l u trj ngoai trd, chi cd 2 BN d i l u tri tai vien vdi khang sinh Cephalosporin , metronidazole va thut thao, sau 4 - 6 ngay BN dUpe ra vien. Bd me eae BN eua ehung tdi sau khi ra vien dUpe tU van rat ky ve b i l n ehdng viem rupt cd the gap va each ncng hau mdn de lam xep bdt hdi trong dai trang
khi cd ehfldng bpng hoac cd bat thudng v l phan.
Mpt BN bj rd mieng ndi sau md 3 tuan, BN da dupc dan lUu hdi trang nhUng khong k i t q u i va phai p h l u thuat lai dUdng bung de ha dai trang.
Khi phan tich ehdng toi nhan thay BN 21 thang tudi, bj tao bdn keo dai, Idng dai trang khdng dupe thpt sach nhu d c benh nhan khae, khi md p h i n dai trang ndi vdi dng hau mdn tUdng ddi gian, cd the day la ly do gay rd mieng ndi sau md.
Theo chung tdi, trong nhflng trUdng hdp nay neu k h i u ndi va de mdm thfla se an toan eho benh nhan, t r l n h dflde bien chflng rd mieng ndi.
Khdng cd benh nhan nao bj tac rupt sau md, day cung la mot UU diem vflpt trdi cda PTNS so vdi d c p h l u thuat kinh dien.
C I c BN dfldc theo ddi d i u khdng cd rdi loan tieu tien, d e BN nam d i u cd bieu hien eUdng dfldng nhfl tre binh thfldng. K i t qua nay cung phu hpp vdi d e nghien cflu khac.
V . K E T L U A N
Benh nhan bj PDTBS sau PTNS d bung ha dai trang deu cd k h i nang tfl dai tien, tinh trang dai tien d i n d i n trd v l binh thfldng khi tre Idn dan len. T'y- le viem rupt sau md, d e b i l n chdng sau md thap. K h i nang k i l m soat dai tien e i n t i l p tuc dupe theo ddi.
T A I L I E U T H A M K H A O
1. Nguyin Thanh Liem, Bui DOc Hau (2005), D i l u trj benh phinh dai trang bam sinh bang p h l u thuat npi soi: Kinh nghiem vdi 113 trUdng hpp, Y hpe thflc hanh, (506), 11 9.
2. Erdek M., Wilt E. (1994), Hirschsprung's disease: one institution's ten year experience and long - term follow - up, Am Surg, 60, 625 - 628.
3. Essam A., Elhalabi A., Hashish M. et al (2004), Transanal one - stage Endorectal pull - through for Hirschsprung's disease : A multi- center Study, J Pediatr Surg, 39 (3), 345 - 351.
4. Gorgeson K.E., Robertson D.J. (2004), Laparoscopic - assisted approachs for , the definitive surgery for Hirschsprung's disease.
Semen Pediartr Surg, 1 3 (4), 256 - 262.
5. Ikeda K., Goto S. (1984), Diagnosis and treatment of Hirschsprung's disease in Japan.
An analysis of 1628 patients, Ann Surg 199, 400 - 405.
6. )ona J.D. (2005), Laparoscopic Pull - through for Hirschsprung's disease in infants, J Indian Asso Pediatr Surg, 1 0 (1), 28 - 30.
7. Mohamed I.S., Robert A.D., Drongowski
| . N . et al. (2007), Are the long - term results of the Transanal pull - through equal to those of the transabdominal pull - through? A comparision of the approaches for Hirschsprung's disease, J Pediatr Surg, 42, 41 - 47.
8. Moore S.W., Millar A.J., Cywes S. (1994), Long - term clinical, manometrie, and histological evaluation of obstructive symtoms in the postoperative Hirschsprung's patienL J Pediatr Surg, 29, 1 06 - 1 1 1 .
9. Rescoria F., Morrision A., Engles D. et al.
(1992), Hirschsprung's disease. Evaluation of Mortality and long - term function in 260 cases.
Arch Surg, 127, 9 3 4 - 9 4 1 .
10. Wang N.L., Lee H.C., Yeh M.L. et al.
(2004), Experience with primary laparoseopy - assited endorectal pull - through through for Hirschsprung's disease, Pediatr surg Int, 20 (2), 1 1 8 - 1 2 2 .
Summary
PRIMARY LAPAROSCOPIC - ASSISTED ENDORECTAL COLON PULL - THROUGH FOR HIRSCHSPRUNG'S DISEASE: MEDIUM TERM RESULTS
Objective: To evaluate the feasibility and medium term results of primary laparoscopic endorectal colon pull - through for Hirschsprung's disease in infants. Method: Prospective review of the infants with Hirschsprung's disease treated by primary laparoscopic endorectal colon pull - through proceduee from January 2008 to August 2009 was carried out according to Georgeson's technique. These patients were evaluated with regard to age, position and length of the aganglionic segmenL intraoperative details, postoperative functional results or complications and medium term functional outcomes. Results: Sixty four patients (55 boys and 9 grirls) underwent a curative surgery with average age 5.5 ± 0.8 months (range, 16 days to 24 months). Mean postoperative stay was 5.9 ± 0.9 days (range, 4 to 9 days). Thirty one patients had temporary perianal excoriation (20 patients were < 3 months of age), no death. Spontaneous defecation was achieved in all patients before discharge. Anatomotic leakage occurred in one patient (three weeks after operated) requiring redo pull - through after enterostomy. 54 patients were followed - up at 17 ± 7.8 months of mean age. Mean follow - up period was 1T± 5.3 months (range, 2 to 20 months), mean time of defecation was 1.9 ± 1 (range,1 to 5), normal defecation was noted in 44 of 54 (81.4%), 45/54 (83.3%) patients had normal stool consistency. Oceasionnal spiling occurred in 18 (33.3%).
Recurrent episodes of enterocolitis occurred in 5 of those patients, three of w h i c h improved without hospitalization. Recurrent constipation, anatomotic stricture, tight sphincter, adhesive bowel obstruction Vi/as not noted in any patient. Conclusion: Spontaneous defication was achieved in all patients after primary laparoscopic - assisted endorectal colon pull - through for Hirschsprung's disease. Low rate posoperative complication. These patients need continuing follow - up.
Keyword: Laparoscopic, Hirschsprung's disease
HIEU QUA CUA VI VIEM SO I TREN MO HINH THL/C NGHIEM VIEM TEO NIEM MAC DA DAY MAN TINH
• • •
Nguyin Thj Thu Ha Trifdng Dai hoc Y Ha Ndi
Viem teo niem mac da diy man tinh (Chronic Atropic Gastritis, CAG) la mot benh thddng gap, khd diiu tri trong dudng tieu hda, cd nguy cd cao din tdi ung thd da day. Muc tieu: md ta sd thay doi hinh anh md binh hoc da day, dinh gia sd thay ddi yeu td viem trong huydt thanh tren chudt cdng bj bdnh CAG ddac dieu trj bang Vi viem sd I. Doi tugng va phuang phap nghien cdu: 60 con chudt cdng chuan SD, tao md hinh CAC trong 20 tuin, ngiu nhien chia 6 nhdm: md hinh, chdng, Vi viem so I lieu cao, trung binh, tha'p vi Weimeisu. Sau qui trlnh diiu trj lay mau chudt, ly tim lay huyet thanh, dung phuang phip phdng xa miin dich do luang Interleukin - 10 (IL - Ifi) va yeu td hoai td khdi u - a (TNF - a) trong huyet thanh, dong thdi tien hanh quan sit hinh thii hoc da day. Ket luan: vj viem sd I cai thien hinh anh ton thdang md benh hoc cua viim teo niem mac da day man tinh trdn chudt. So vdi nhdm md hinh thi cic nhdm diiu trj bang Vj viem sd I Hiu trung binh, thi'p vi dieu tri bang Weimeisu deu cd him luang TNF - a trong hdyet thanh giam thi'p, qua dd giup lim giam mde dd ton thdang cua niem mac da day.
TO khoa: Vj viem sd I, viem teo nigm mac da day, TNF - a
