Y HOC VIET NAM THAHG 4 - S O 2/2015
PHAU THUAT CAT TUI MAT NOI SOI TRONG DIEU TR|
VIEM TUI MAT CAP CT NGU'O'I CAO TUOI
T6IVI TAT
O^t van de: Hien nay, phau Hiuat cat tiii mat npi soi la phddng phap dieu tn dddcjda chpn ijong dieu trj viem tiji mat cap do soi. Tuoi cao la mpt trong nhffng yeu to nguy cd gay ra cac bien chu'ng va t d vong trong c3t tui m i t npi soi. Muc tieu cua nghien cdu nay nh&m danh gia k€t qua eiia phau thuat cat tui mSt npi soi trong dieu tri viem tiii mat cap d ngudi cao tuoi.
Phuttng phap: Td thang 5/2012 thang 12/2012, cd 55 b^nh nhan tit 60 Uioi ti-d len md cat tiii mat npi soi trong viem tui mat cap tai Khoa Ngoai tong quat B^nh vien da khoa trung udng Can J h d . tien edu mo tS b'm hilu v§ tudi, gidi, ehi djnh md, ty le chuyen mo md, ket qua.
Ket q u i : B§nh nhan nam gSp 13 (23,6%), niJ' g$p 42 (76,4%). Benh phoi hdp hay gap nhft gom b^nh tdng huylt ap, thieu mau co tim va dai thao dddng. Chi dinh mo tin/dc 72 gid 52,7%, chi dinh md sau 72 gid 47^3%. Ty le chuyen mo md 18,18%. Ket qui t6t 84,4%. Ty le blen diuhg 5,45%. Thdi gian nim vien trung binh 5,55 ngay. Khong cd t d vong.
K€t lu$n: Phau thu|t cat till mat npi soi trong dieu trj viem^ tui mat cap an toan va hieu qua d benh nhSn cao tuoi.
SUMMARY
LAPAROSCOPIC CHOLECYSTECTOMY I N THE TREATMENT OF ACUTE CHOLECYSTITIS FOR ELDERLY PATIENTS
Introduction: Nowadays, Laparoscopic cholecystectomy is the treatment of choice for acute cholecystitis from cholelithiasis. Old age is one of the critkal factisrs causing the complication and mortality In laparoscopic cholecystectomy. The aim of this study was ti3 evaluate the result of laparoscopic choleeystectiDmy in the treatment of acute cholecystitis for elderiy patiens.
Methods: The medkal records from 55 patients aged 60 years or older who underwent laparoscopk:
cholecystectomy because of acute cholecystitis, between May 2012 to December 2012 at General surgery's falcuty of Cantfra Central Hospital was analysed. Prxjspective
* Ogl hpe Y Ddpc Can Thd
Chju bach nhiem chi'nh: Ph^m Thanh Suol Email: [email protected] Dt: 0908.659.698 N g d y n h l n b k 23.1.2015
Ngay phan bl^n khoa hoc: 23.2.2015 Ng^y duyet bdi: 3.3.2015
Pham Thanh Suol*, Nguyin Thanh Quan*
study described of age, sex, condition surgery, open surgical conversion rate, results.
Results: The study population of 55 patients comprised 13 males (23.6%) and 42 females (76.4%).
The most common ancillary diseases were hypertension, myocardial ischemia and diabetes.
Specifies the operation before 72 hours was 52.7%, after 72 hours was 47.3%. Open surgical conversion rate 18.18%. The good result was 84.4%. The
Complication rate 5.45%. The average length of hospital stayed 5.55 days. There was no death.
Conclusion: Laparoscopic cholecystectomy is a safe and efeetive treatment of acute cholecystitis for elderly patients.
I. OAT VAN o l
Phau thuat npi soi eSt tui mat da tnif thanh Ida ehpn hang dau trong benh ly tui mat can m6, ehiem 9 0 % tong so cat tui mat hi^n nay [5], [13]. Cat tui mat viem cap d ngddi rao tuoi bang phau thuat npi soi cung ddde thdc hi$n pho blen vdi dp an toan rao [ 3 ] , dii khd khan hdn so vdi khi tui mat khong viem cap do tui mat cang, dinh, phu ne..., thdi gian phau thuat eung keo dai va t i le chuyen mo hd rao hdn. Ngoai ra ngu'di cao tudi cd cac benh npi khoa nhd tSng huyet ap, dai thao dddng... kem theo [6].
6 nddc ta hien nay, sd phat trien cac viing, mien ed khae nhau, phau thuat npi soi trong viem till mat cap, dac biet la viem tui mat cap d ngddi rao tudi cung chi mdi bat dau d mpt so benh vien Idn va cung ft c&ng trinh nghien ciid de tai nay. Xuat phat t d thdc te tren, chiing toi nghien ciru de tai nay nham muc dich danh gla ket qua eat tui mat npi soi trong dieu trj viem till mat cap d ngddi rao tuoi.
II. DOI TU'QNG VA PHU'ONG PHAP N G H I I N CO'U Ooi tu'dng: 55 benh nhan viem tui mat cap do sdi, tudi tren 60, 6iidc cat tui mat npi soi t^i Khoa Ngoai TQ BVDKTU" Can Thd, trong thdi gian t d thang 05/2012 - 12/2012.
Phu'dng phap: Tien ciTu md ta ho sd ciia eae benh nhan tim hieu ve tuoi, gidl, chi djnh mo, ty le chuyen mo m d , ket qua.
YHp^. lET NAM THANG 4 - SO 2/2015 Ml. K i r QUA
3.1. Tuoi va gidi Bang 1: Tuoi va gidi
Nhom tudi 60-69 70-79
>80 Tonq so
N i i Benh nhan
23 14 5 42
Ty le (%) 54,76 33,33 11,91 100
N a m Benh nhan
11 1 1 13
Ty le (%) 84,62
7,69 7,69 100
Tong so Benh nhan
34 15 6 55
Ty le (%) 61,82 27,27 10.91 100 Bang 1 cho thay lir:a tuoi gap nhieu la tir 60-69 (61, 82%), ti le nii gap nhieu hdn nam 42 (76,-I 3.1. B jnh iy kgt hdp Bing 2: Benh iy Item theo 3.2. Chi djnh mo Bing 3: Thdi diem md
B$nh Ii kem theo N I Ty le "/o I Thdi diem mo N Ty le % Tang huylt ap
Thieu mau cd tim Dai thao dudng
Vilm qan Loet da day - ta trang
46 83,6 Md trudc 72 gid 29 52,7
30,9 1,8 12,7
Mo sau 72 gid 26 Tdng cdng 55
_4Zi
100
Bang 2 cho thay benh ly phoi gap nhleu nhat ia tang huyet ap 46 (83,6%), sau dd la benh thieu mau cd tim 17 (30,9%).
Bing 3: Trong 55 benh nhan phau thuat co 29 benh nhan chi dinh mo trwdc 72 gid, con 26 benh nhan chi dinh mo sau 72 gid.
3.3. Ket qua
- Ty le chuyen mo md 10 benh nhan (18,18%) - Kit qua tot 84,4%. Bien chirng sau mo 5 benh nhan (11,1%): 4 b|nh nhan tu dich dudi gan (8,9%), 1 benh nhan rd m|t (2,2%).
- Thdi gian nam vien sau mo tiding binh la 5,55 ngay IV. BAN LUAN
Kit qua nghien cilU cho thay lira tuoi gap nhieu la tir 60-69 (61,82%), tudi trung binh ia 68,47. So lieu nay phii hpp vdi nghlln ciru ciia Hoang Viet bung tuoi 60 -69 chiim 47,9%, tuoi ti'ung binh la 70,17 [1], [7], Nguyen Van Bang tuoi 50-70 chiim 72,10% [1], Nguyen Tan Cuflng tir 60 tuoi trd lln khoang 47%^ [2].
Nguyen Van NghTa ty le vilm tiii mat d tuoi 61- 80 la 20,06% [6].
Mpt so tac gia cho rang tuoi cang cao thi dp bao hda cholesterpi trpng dich m$t cang tang, kha nSng cp bdp ciia tiii mat lai giam di do dd lam tSng nguy cd tao sdi gay viem tiii mat [15], O i u nay dUdc glal thich la d nhihig ngudi cd tuoi SI/ CO bdp till mat giam dan din ir dpng mat gay tSc dng tiii mat, mat khac d ngUdi cao tudi viem tui mat cd tlie xuat hien do rdl loan tuan hoan mau (b|nh tSng huyet ap, dai dudng, xd vuS mach mau, vilm nut quanh dpng mach...) lam tSc mach mau gay hpai tir thanh tiii mat.
cdn d phu nil' cd thai thi do bj de ep lam thay ddi vj tri ciia tiii mat, dupng mat [14].
4.1. Benh ly ket hop
6 ngudi cao tud'i, thudng cd nhieu benh kit hdp, nghien cdu ciia chiing tdi thay cd 54 benh nlian (chiem 98,18%) hien tai hoac trong tien sii mac cac benh kem theo va lien quan, trong dd cd nhung trUdng hdp mac tir 1 din 2 tham chi 3 benh kit hop do vay nguy cd sau mo la rat rao.
Nghien ciru ciia Nguyen Van Hai trong 66 benh nhan cd 22 benh nhan cd 1 hay nhieu benh ndi khoa di kem [4]. Nghien ciili ciia Ha Van Quyet, Hoang Viet Dung trong 119 benh nhan thi cd 77 benh nhan [7]. Cac benh mIc kit hdp cd lan so rao la tang huyet ap (83,6%); dai thao dudng (29,1%); thilu mau cd tim (30,9%). Kit qua nay cho thay ty le mac cac benh phdi hdp rao hdn so vdi nhdm ngUdI tre tudi va cung phii hdp vdi nhiing nghien cu'u trong nUdc khi thong ke cac benh phoi hop trong phau thuat sdi mat ndi cliung va md cat till mat tren nhiiiig benh nhan rao tudi ndi rieng.'
4.2. Chi djnh mo
Trong 55 benh nhan cua chiing tdi cd 29 benh nhan dUdc phau thuat cat tui mat ndi soi trudc 72 gid ke tir khi nhap vien chiim 52,7% va 26 benh nhan phau thuat ndi sol sau 72 gid (47,3%). Nghien cii'u ciia Ha Van Quyet, Hdang
- J T '
Y HOC VIET NAM THANG 4 - s o 2/2015
Viet Dung [7] d 119 benh nhan (bao gom 105 benh nhan ddpc phau thuat npi soi cd 5 benh nlian chuyen mo md va 14 benh nhan mo md t d dau) thi ty le mo cap edu chiem da so. Theo Nguyen Van NghTa trong 139 benh nhan cd 79 benh nhan ddde phau thuat eat tiii mat npi soi trdde 72 gid ke t d khi nhap vien ehiem 56,8% va 60 benh nhan phau thuat sau 72 gid (43,2%) [6]. Theo H. Lau va cs cat tui mat qua npi soi an toan va hieu qua hdn so vdi cat tui mat ed tri hoan, tac gia de nghi nen thdc hien trong 72 gid dau ke tu' khi cd trieu chdng dau tien [12].
V. Kfr QuA
Chung toi cd 10 trddng hdp chuyen md md (18,18%) trong dd cd 3 trudng hpp (khong cd tiSn sd mo trddc) do chay mau khd khdng che qua npi soi (5,5%),^ cd 5 trddng hpp (cd 1 trifdng hpp cd seo mo d tren va dddi rdn do mo thiing da day) di'nh nhieu d tam giae gan mat (9,1%) va eo 2 trddng hdp (khong ed tien sd mo trddc) cau true giai phau khong ro rang (3,6%).
Ty le phau thuat npi soi cua chung tdi thanh cong' la 45 trddng hdp (81,82%). Nghien edu cua Nguyen Van Hai, Nguyen Tuan chuyen mo md la 5 benh nhan ( d 66 benh nhan) chiem ty le 7.6% va cd 12 trddng hdp (18,2%) eat till mat t d day [5]. Nghien eiilj eiia Nguyen Van Nghia cd 6 trddng hdp chuyen mo md (4,32%) trong dd cd 3 trudng hdp do chay mau khd khdng che qua npi S(^ (2,16%) va 3 trddng hpp dinh nhieu d tam giSc gan mat. Ty le phau thuat ndi sol thanh cdng ia 133 b-dclng hdp (95,68%) [6], Ket qua nay tudng dong vdi nghien cdu ciia chiing toi.
Trong 55 benh nhan cua chung toi, cd 7 truSng hp^ (12,7%) dfnh nhieu d vimg tani giae gan mat nen chiing toi chii dpng chuyen mo md, o6n 3 trddng hpp chay mau Ichi phau tich cat tui mSt t d day do ngai ton thddng dudng mat chfnh.
NhOhg trddnci hdp nay do chda khong che ddpc mach mau kem vdi tinh trang viem ciia tui mat ngn thddng chay nhleu mau doi khi khj5 kiem scat va la mpt nguyen nhan chuyen md hd (3 b?nh nhan).^Theo £>o Kim Sdn, Nguyen Thanh Long khi mo n€u viee phau tich g3p khd khan nguy cd chSy mau khd cam thi neri chuyen md md ngay va theo tac gia thi viec chuyen md md la ran t h i S vdi nhuhg tnj'dng hdp tren va khdng nen cnl dd la mpt that bai ciia phudng phap npi sol va phau thuat vien.
Ket qua tot 84,4%. Ty le blen chuhg gap 5,45%. Khong cd trddng hdp nao t d vong.
Thdi gian nSm vien trung binh 5,55 ngay, dao ddng t d 3 - 10 ngay. Ket qua thu ddde qua
nghien cdu tu'dng t d ket qua cua Nguyen Van NghTa [ 6 ] , Do Trpng Hai, Phan Anh Tuan [3], Nguyen Van Hai, Nguyin [ 4 ] . Cac tac gla tren deu cho rang phau thuat eat tiii mat npi sol la phddng phap cd nhieu utj viet hdn so vdi mo md trong dieu trj benh nhan Idn tudi bj viem tui mat do sdi.
V I . KET LUAN
Nghien cdu 55 benh nhan Idn tuoi bj viem tui mat cap, ehung toi rut ra mpt sd ket luan sau:
- Ty le benh nhan nam gap 23,6%, nff g3p 76,4%, - Tuoi 60-69: 61,82%, tuoi 70 -79: 27,27%, tif 80 trd len: 10,91%.
- Cac benh phoi hpp thay benh ly tang huyet ap gap nhieu nhat 83,6%, sau do la benh ly thieu mau cd tim 30,9%, dai thao dddng i29,l%, loet da day ta trang 12,7%), viem gan 1,8%.
- Chi djnh md IrudC 72 gid 52,7%, sau 72 gid 47,3%.
- Ty le chuyen mo m d 18,18%.
- Ket qua tdt 84,4%. Ty le bien chuhg 11,1%.
Thdi gian nam vien trung binh 5,55 ngay.
Khong ed trddng hdp nao t d vong,
- Phau thuat cat tui mat npi soi an toan va co hieu qua d benh nhan Idn tuoi.
T A I L I | U T H A M KHAO
1. Nguyen Van Bang (2001^, "Ooi chieu lam sang, giai phau benh qua 233 trddng hpp eSt tiil m^t t^i Benh vien Hud Nghi", Cong tn'nh nghiSn ciiU khoa hoc 1998- 20pl, Nha xuat ban Y hgc, tr 422- 425.
2. Nguyen Tari Cu'dng (1997), Dieu tri sol tyl m$t bang phau thuat cat tiJi m$t qua ngi soi 6 bung, Luan an tien sT khoa hpe Y Ddde, Dai hpe Y D u ^ thanh pho Ho Chf Minh.
3. eS Trpng Hal, Phan Anh T u f n (2003), "l^dc dp an toan va hieu qua eiia cSt tui mat npi sol trong viem tiji mat cap do sdi", Y hoc ttt^nh pho Ho Chi Minh, 7(1), tr. 43 - 47.
4. Nguyen Van Hai, NguySn Tuan (2005), "KS qua ciia cat tui mat npi sot trang viem tOl m$t c3p do sdi", Y hoc dianh pho Hd Chi Minh, 9(2), tr.
109-114.
5. NguySn Dinh Hoi, Nguyen Hoang B^c sh cs (2001), "Cat tiii mat bSng phau thu|t n$i soi'): H9I nghi ngoai khoa Viet Nam, 1, tr7-14.
6. Nguyen Van N g h ^ (201C), D^nh gia kit qua phiu thuat ngi soi dieu bivi&nt& mat cap do sdi t^b^
Mff) da khoa TP(^nVid, Luan vSn tSt nghiep ^^
si chuyen khoa cSp 2, Oai hpc Y Ha Noi.
7. Ha Van Quygt, Hoang Vi^t Dung (2007),
"Nghien cud d^e diem benh If va ket qua dieu til phau thuat viem tui mat d ngddi eao tuoi*, Ngo^l khoa, 4, tr. 40 - 44.
