PHAU THUAT NOI SOI T A C RUOT DO DINH SAU MO
Nguyin An . Nguyin Manh Dung', Le Phong Huy*
TOMTAT
Muc tieu: ddnh gid hiiu qud img dung phdu thudt ndi soi trong diiu fri fac rudt do dinh sau md.
Bdi tugng & phucmgphdp: Tir 01/01/2005 den 31/12/2007 tai khoa cdp cmi binh viin Binh Ddn dp dungpMu thudt ndi soi ga dinh cho 21 binh nhdn tdc rugt do dinh sau mo. Phdn ti'ch kef qud cdc chi so vi thdi gian plidu thudt, biin chimg, thdi gian ndm vien di ddnh gid khd ndng, finh an todn va hiiu qud cua phtrang phdp dieu tri ndy.
Kit qud: trong 21 trudng hop, cd 4 truang hop chuyin md ha do dinh nhiiu, cdn cdt ndi rudf, 5 trudng hap tdc dcm gidn do ddy dinh chi cdn cat ddy dfnh, 8 tivdng hap xodn rugt. Thai gian phdu thudt frung binh 68.1 phiit. biin chirng ehung 14,3% frong do 2 trudng hap viim phuc mgc hdu phdu do thdng kdi frdng phdi mo lai (9,5%), thdi gian ndm viin trung binh 8,7 ngdy .
Kit ludn: Phdu thudt ndi soi diiu fri fdc rudt sau md Id mdt phuang phdp an todn, hiiu qud cho nhihig trudng hop bdn fdc hay tdc ruot cdp khdng qud dinh.
Tir khod: Tdc rudf ndi soi SUMMARY
LAPAROSCOPIC ADHESIOLYSIS FOR POST-OPERATIVE SMALL BOWEL OBSTRUCTION Background: Acute small bowel obstruction has been a relative contra-indication for laparoscopic treafment due fo the potential for bowel distention and the risk of enteric injury. As laparoscopic experience has increased, surgeons have begun to apply minimal access techniques fo the management of post-operative small bowel obstruction.
Materials and methods: From the first of January 2005 to the thirty-first of December 2007, we performed laparoscopic adhesiolysis for 21 patienfs with acute small bowel obstruction due to post- operative adhesion. The results were analysed to assess the feasibility, safety and efficacy of this technique.
Results: Conversion has been made in 4 patients because of dense adhesion. 5 patients had an adhesive band, 8 patienfs lmd volvulus of the small intestine. The mean operative lime was 68.1 minutes. The over all complications were 14.3% including 2 case of post-operative peritonitis because of accidental small intestinal perforation (9.5%). Tlie average length of hospital stay time was 8.7 days.
Conclusions: Laparoscopic adhesiolysis for acute or subacute small bowel obstruction due to post-operative adhesion is safe and efficient in patients without multiple or dense adhesion.
Key word: Laparoscopic adhesiolysis DAT VAN DE
T3c rupt non sau mo la mot cap ctiu ngoai khoa rat pho bien. Dieu tri chCi ylu la can thiep ngoai khoa. Cho den nay phau thuat ma bung kinh dien de g5 dinh la phuang phap dilu tri chfnh ctia t^c ruQt sau mo vi kha nang ga dinh tot va ban che kha nang thiing rupt. Nhieu truong hgp phai ma ruot lam xep hay c3t noi rupt. Tac rugt do dfnh co khi la dfnh rai nhieu, cung co khi chi la mpt day dfnh, mol quai rupt gap goc gay tac. Phau thuat npi soi de g5 dfnh da dtrac mpt s6 tac gia di cap din, nhung din nay no vin dang dugc ban cai. Bao cao nay ciia chiing toi mu6n neu len kha nang, do an toan va chi dinh Clia phucmg phap dieu tri nay.
Muc tigu de tai
Buac dau khao sat ti'nh an toan ciia viec (rng dung ky lhu|t n^i soi 6 bung trong phlu thuat dilu tri tSc rupt do dfnh sau mo tai benh vien Binh Dan.
PHU'ONG P H A P NGHIEN ClTU
Day la nghien ciiu tien cuu m6 ta thyc hien tai khoa Hoi stic cap cuu I trong khoang thai gian du kiln 2 nam tir 01/01/2005 din 31/12/2007.
I. Doi tucmg nghien cuu Tieu chuan chgn benh nhan
Benh vien Binh Dan
Dia chl lien lac. BS CKD Nguyen An DT: 0913605701 Email: [email protected]
-I- Nhung tnrang hgp t^c ruot sau mo co chi dinh phau thuat vai tien lugng dfnh dan gian vf du nhu nhung tnrcmg hgp co tien can mo rupt thira, mo bat con,...
-•• Nhiing truang hgp ban tic rugt co tien can dieu tri bao ton nhieu lan vai tien lupng dfnh dan gian.
Tieu chuan loai trir
-(- Khong chgn nhiing trucmg hgp c6 tien can mo viem phiic mac, ap xe, m6 dilu tri ung thu,...
+ Tac rupt do cac thuang ton ciia dai trang.
+ Benh nhan c6 kem theo nhung benh ve ho hap, tim mach,... cd chong chi dinh bam CO? 6 bung.
2. Phuang tien va dung cu
May va dung cu ngi soi cua Storz san xuat.
3. Cac buac tien hanh
Kham benh, chan doan, Iam benh an mau.
Hoi siic tfch cue, boi hoan dich- dien giai, hiit dich rugt bang thong mui da day, cho khang sinh du phong.
Tien hanh phau thuat n^i soi.
Theo doi h§u phau.
Ghi nhan cac thong tin can nghien cuu.
Thu thap, xur ly so lieu.
4. Ky thuat mo noi soi
Phau tiiuat ho ma mgt lo nho 1cm a vi trf khong co seo mo, d6i dien vai seo, dat troca 10mm bam hai 6 bung va dkt camera tham sat.
Danh gia thuong ton, neu thdy dfnh nhieu, dfnh dai trang, tiin lugng m6 khd khan hoac cd bien chiing nhu xoan rupt hoai tii,... thi chuyen sang m6 ha.
Neu th§y thuang t6n cd the xii tri qua npi soi dugc thi dat them 2 troca 5 hay 10mm t^o thanh v6ng cung quanh thuang ton cin xii tn, dua dung cu vao tiln hanh thao tkc go dfnh, cit day dfnh, thao xoan,...
Neu rugt chudng nhieu can trd thao tac co the dat them troca 5nim dua dung cu ri quat vao ven rupt.
Trong ItJC mo, neu cd tai bien dan gian nhu rach thanh mac nhieu, bong rupt, thiing rugt lo nho,... CO the khau qua noi soi. Neu thiing rupt 16 to gay trao phan nhieu vko 6 bung thi chuyen sang mo ha.
5. Cac thong tin can nghien cuu Tuoi benh nhan.
Gioi.
Tong trang.
Benh kem theo.
Tien can phau thuat.
Thai gian phau thuat ngi soi.
Loai thuang ton :dfnh, day dfnh, xoan rupt, thoat vi vet mo,...
Cach xii trf thuemg tdn: ga dfnh, cat day dfnh, thao xoan, phuc hoi thanh bung,...
Tai bien trong liic mo: rach thanh mac, bong rupt do dot, chay mau mac treo, thCing rupt,...
Cach xii tn' tai biln: khau cho rach, thiing, ddt cam mau,...
So trudng hgp chuyen sang md hd, ly do.
Bien ehung hau phau gan; thiing rupt, tac rupt, chay mau,...
Thai gian cd trung tien Iai.
Thai gian nam vien.
KET QUA
Trong tiidi gian 3 nam, tir 01/01/2005 den/12/2007 chiing tdi da tiiuc hi?n 21 tnrdng hgp phau tiiu^l npi soi dieu tac rugt do dfnh sau mo §dm co 11 nam va 10 nii.
Tudi thip nhll la 20, ldn nhit la 82, tudi trung binh la 43.
201
Cac benh nhan cd tneu_ chimg dau quan byng, bf trung dai tien, phim X quang cd myc nude hai rugt non. Cac xet nghiem tien phlu ghi nhan 2 trudng hgp thilu nang vanh Irong dd cd 1 benh nhan cd them ngoai tam thu that, 1 trudng hgp cd block phan nhanh trai trudc. Cac truong hgp nay khdng dilu tri ngi gi them.
Cd 1 trudng hgp thieu mau chua ro nguygn nhan (hdng ciu 2.600.000nuiim"\ Het 22%, Hb 8g/di) benh nhan dugc truyen mau dua Het len 27% sau do phau thuat.
S6 lugng bach ciu cua hau hit henh nhan diu cao tren 10.000/mm"\ chi cd 4 benh nhan cd bach ciu dudi lO.OOO/mm^. So lugng bach cau tiiip nhit la 6.300/inm^. cao nhit la 25.900/mm\ trung binh
14.447/nim^.
Ngoai ra tit ca cac xet nghiem khac deu khdng cd gi bit thuong.
Cd 2 tnrdng hgp benh nhan cd tien can md 3 lan, 5 trucmg hgp da mo 2 lan, sd con lai md 1 13n.
Cd 5 trudng hgp benh nhan cd tien can ban tac rugt dap ung dieu tri bao tdn trong dd co 1 tnrong hgp ban tic rugt 2 lan.
Tien can md:
L5? do md Viim ruot thira Viem phiic mac rudt thira Dam quanh rudt thira rac mot do dfnh XoSn rudt do dfnh rac rupt do thoat vi nghet Mo da day Md bat con Thai ngoai tOr cung U nang budng trimg U xa tit cung Md thong tai vdi
Sd tnrang hgp 8 2 1 2 1 1 3 1 1 1 2 1 Vj tri seo md cu:
Vitri Mc Blimey Ducmg gi&a dudi rdn Dudng giiia tren rdn Dudng Pfannelstiel
Sd irudng hop 11
5 3 2 Thuang ton phat hien trong Thuang tdn
DSy dfnh dan thuan Dfnh dan thuan Dfnh & day dfnh Kokn rugt do day dfnh Xoan rudt do dfnh Dfnh kem thoat vj vet md Dfnh, xoan kem cac thuang ton Ididc
liic phau thuat:
So trudng hap 3 3 3 4 3 2 3
C6 2 tnrong hgp rugt dfnh vao tiii thoat vi vet md cii, dugc gd dfnh va may lai thanh byng qua nOi soi.
C6 4 tnrdng hop chuyen sang md hd do:
1 trudng hgp cd tiln cSn md dam quanh rugt thira tnrdc dd 1 thang, rupt dinh nhilu viing hd chau phai, gd dfnh qua ndi soi khd khan de rich thanh co manh trang, hdi trang nen chuyin md hd lai dudng Mc Bumey gd dfnh va may lai thanh co bi rach.
1 tnrdng hgp ngoai dfnh con cd ldng hdi trang phai md hd c5t do^n hoi tring. Benh nhan nay hi nhiem trung vet mo hau phSu ngay thii 6 gay bung thanh bung hau phlu ngay thir 7, dugc mo tham sat may Iai thanh bung. Benh on xuat vien vao ngay thii 18.
1 yudng hop tic do day dfnh kem viSm hoai ttr tiii thira Meckel, viem rupt thira thii phat, dugc md hd cat doan rugt co tiii thira, cit rudt thira, cit day dfnh.
202
1 tnrdng hgp bj thoat \'i Id bit trai dfnh chae khdng giai phdng rudt bang dung cu ndi soi dugc phai md hd gd dfnh rugt va khau dap d5y chang rgng tii cung vao 16 bit.
Co 2 trudng hgp viem phiic mac hau phau do ihung hdi trang phai md lai:
1 tnrdng hop md ngay hau phlu thu hai, thiing h6i trang dugc may lai 16 thiing va din liru.
H|u phlu ngay thir 11 benh nhSn bj dd cho thiing vlt md phai md lai cit bd 30cm hdi yang.
Benh nhan dn xuat vien vao ngay thii 26.
1 tnrdng hgp md ngay hau phau thir ba, thiing hdi trang 2 Id each nhau 10cm dugc may lai cac 16 thiing, rira bung va dan luu. B^nh nhan 6n xuat vifn vao ngay thir 17.
Ca 3 trudng trudng hgp md lai cd s6 ngay nam vien dai nhat.
Ngo^ ra kh6ng cd trudng hgp nao bj tai bien thung rupt do dam yoca hay thiing rudt do dung cu, do ddt di?n phat hien yong Iiic md. Khong cd tnrdng hgp nao hoai tir rugt do xoin, khdng cd nhiem triing vit mo ngi soi. Khdng trudng hgp nao tu vong.
Cac thdng so ghi nhan dugc rhoi gian
ihau thuit (phiit) :6 trung tien (gia) :ho an lai (ngay) dilng thu6c giam 3au (ngly) iSm vien (ngay)
Ngan nhat
30 5 1 2 4
Dai nhat 150
96 5 8 26
Trung binh 68.1 47,8 3 4,7 8.7 BAN L U . ^
Tac rugt do dfnh sau md la mgi cap ciru ngoai khoa thuemg gap. Dfnh sau md la hau qua ciia bit cii cugc md byng nao, dinh phu thugc vko benh ly, sang thuang yong 6 bung, tfch chit can thiep ciia cupc md. Dfnh thdng thudng chi xay ra d rudt non. Mdt phan nho cac trudng hgp dfnh gay nen tic ru§t. Trong dieu trj tac rugt sau md, neu dieu tri bao tdn khdng hieu qua, bfnh nhan phai dugc md de giai quyet tic rupt, tSng them nguy co tic rudt sau md Uong tuang Iai. Ngay c^ khi dieu tri bao tdn tic rupt sau m6 cd cai thi?n, nguy co tic rupt vin deo bam b?nh nhan. Da cd rit nhilu trudng hgp b?nh nhan nhap vien rkt nhiiu lan de diiu trj bao ton ban tic rugt sau mo.
Phau thual npi soi 6 bung la mpt kJ thuat ft gay thuang ton cho phuc mac thanh, giam nguy co dfnh rugt sau m6. hien dang dugc nhieu tac gia ap dung de phlu thuat dieu tri cho tic mot do dfnh sau md. Nhieu nghien ciiu gan day da chiing minh sy hinh thanh dfnh sau phlu thuat npi soi ft hon m6 hd kinh dien. Ng^y nay hau het cac phau thuat byng cd the thyc hi?n qua ndi soi da lam giam nguy ca tic mgt do dfnh sau md. Trudc day bung co vet mo cii la chong chi dinh tuong d6i cCia ngi soi. Din din khi kinh nghidm nOi soi tfch luy khd nhiSu, chiing ta md r^ng chi dinh phau thuat npi soi cho ca nhung benh nhan cd vet md bung cu. Hau hit phau thuat vien ngi soi diu trai qua vai ISn gd mdt it rudt hoac mac ndi dfnh de bOc 16 thuang tdn trong lan md nay. Nhu vay, hau het phau thuat vien ngi soi deu cd the go dfnh mgt va viec md rdng chi dmh phau thi4t ndi soi cho tic mdt do dfnh la nim trong tam tay Clia chiing ta. Van di khd khan la trong tac mdt, root chudng se lam khoang ydng thao tac bi han chi, ngay tir khi dua troca vao da cd kha nang gay tdn thuang mpt. Rupt chudng thanh mgt mdng, cac dyng cy npi soi de lam tdn tiiuong rugt.
Chgn lya thdi diem mo ciing rSt quan trgng ddi vdi phau thuat ndi soi, Trudc diy khi phlu thu^t md kinh dien la chpn lua duy nhat de gd dinh dieu tri lie mgt thi chi dinh md rai ch^l che. Do tfnh chit nang ne ciia cupc md md, do tam I^f ngai mo di md lai ciia benh nhan. Khi phau thuat npi soi dugc ap dung cho benh nhkn, vira de chan doan nguyen nhan dau bung cap vira phdi hgp dieu yj, thi benh nhan de dang chap nhan cugc mo han, chi dinh dugc md rdng hon. Nhieu tmdng hgp ban tic, hay tac mgt th^t su, dieu tri ngi khoa qua khdi. nhtmg tai di tai lai nhieu Ian, npi soi chan doan giiip xac djnh nguyen nhan va vj trf tic. Gd dfnh yong tmdng hgp nay thuan lgi ban vi cac quai mgt kh6ng chudng nhiSu, khoang trdng thao tac rdng, quai rudt khdng dan mdng, khdng phii ne, nguy ca thiing mpt ft han. Tuy nhiSn niu vi lo ngai de lau mpt chudng nhieu ma chi dinh mo sdm qua thi se m6 ca nhiing tmdng hgp c6 the dieu trj bao tdn hi$u qua. Chiing tdi nghi chiing tdi can liep tuc Iam them nghiSn ctiu chup ehudi phim X quang vdi thuoc can quang tan trong nude yen nhiing benh nhan tic rudl do dfnh sau md de cho chi dinh thdi diem can tiiiep phlu thuat npi soi chfnh xac hon.
203
Trong tmdng hgp mdt chudng nhieu, thdng mui dsi day thudng chi hiit dugc dich tir mdt trao len da day trong nhung trudng hgp tic cao hoac toan bd mdt chudng nhilu. Sii dyng thdng Miller Abot se hieu qua han trong dieu tri tic mdt. De bdt chudng rudt t^o dilu kien dl dang cho phau thuat ngi soi, cac phlu thuat vien Nhat thudng sii dung mdt loai thdng gpi la Ileus tube dai 3 m dat qua miii xudng den rudt non hiit mdt xep rat hieu qua""*'^'^*. Chung tdi chi c6 thdng miii da day nen chiing tdi chpn benh can than, chi chpn nhiing benh nhan byng chudng it hoac vira, co tiln sir phau thuat nhe nhang viing bung dudi nhu md ragt thira, md bat con, cac phlu thuat yen phin phy,... nhirng tmdng hgp dy doan dfnh dan gian. Chiing tdi khong chf dinh m6 cho nhiing benh nhin tmdc do md vi nguyen nhan ac tfnh, viem phiic mac,... nhiing tmdng hgp du doan dfnh phOc lap cin gd dfnh nhieu hay phai cat noi rapt.
T6n thuang tang do dat yocar dau tien cd ti le cao hon d nhiing benh nhan co vet md cii. Chung ldi khdng gap trudng hgp nao. Chiing ldi dting ky thu^t md cCia Hasson va chgn vi tri xa vet mo cu de yanh tai bien nay. Theo quan diem cua chiing ldi neu dat yocar kfn hay dat kim Veress eye ky nguy hiem vi cac quai mgt dfnh len thanh byng, cac quai mgt liet va chudng hoi. Cac yocar sau cung phai dat het siic can than vi khoang yong hep, mgt chudng cang va viem phii ne rat de ihung. Cac quai mol thudng dfnh 16n thanh byng, che lap viing thanh bung lanh, Iam khd xac dinh vi Iri dat cac yocar sau.
Kh6ng cd trudng hgp tai bien do dat trocar trong Id nghien ciiu nay.
Dung cu phau thuat yong md tic rapt phai thfch hgp de tranh nguy ca thiing hay rach thanh mac mgt. Khi mpt dan cang, viem, phii ne thi dung cu phai mem mai, dau til, cac rang khdng gay sang chan. Can cd 2 kep cam nam mgt danh cho ngi soi, dung cu bdc tach dau tii, kep ddt luong cue v.v...
Khi can tham sat mdt, tranh nam tryc tiep vao thanh mdt, c3m nim d mac treo sat bd mac yeo rapt, thdm sat ngugc lir duai len, cam giii nhiing quai mdt khdng chudng lan den cho tac nghen, sau khi giai quyet nguyen nhan tic nghen, di chuyen dung cu tir gdc hdi manh yang tdi gdc Treitz de yanh bd sdt tdn thuong. De an loan cho phuang phap phau thuat nay thi phau thual vien phai co dii kinh nghiem, phau U'ch an loan, kheo leo, biet khau qua ndi soi.
Theo cac lac gia khac thi sd lugng bach ciu tang la chi dilm cho nguy co cd the hoai tu mdt.
Trong Id nghien ciiu ciia chiing toi hau hit benh nhan diu cd s6 lugng bach ciu tang tren 10.000/mra' va cd vai tmdng hgp tang rit cao yen 20.000/mm^ luy nhien khi npi soi vao thi khong thiy bilu hi?n ctiaho^ii tOrrudt.
Tac ragt co khi do dinh rat nhieu, cung cd khi rat don gian chi la mgt sgi day dfnh chen ngang gSy tac hogc xoan rapt, phau thuat ngi soi chi cin cat day dinh la giai phdng dugc rudt, thao dugc xoin.
Tuy nhien chiing la cung khdng nen chii quan vdi nhiing day dfnh don gian nay, nhit la yong tmdn^
hgp xoin, day dfnh rit sat rugt. Nlu chi dung keo cit day dinh thi co thi chay mau, nlu dot thi cd thi cham bdng mdt. De han che khd khan tren, ehung toi diing gac ngi soi khd nhet vao giiia day dinh va mgt rdi dung ddt dien ludng cue ddt day dfnh. Trong nhihig tmdng hgp qua dfnh, phlu tnrdng kh6ng rd rang, cac quai mdt chiing hcri nhieu, thanh mgt viem dl gay thung thi chuyin sang md hd la chgn lua mang Iai sy an toan cho benh nhan. Phlu thuat ndi soi Itic nay cd vai yd chin doan va chgn lya dudng md thfch hgp cho mdt phlu thuat kinh diln.
TrcMig 16 nghien cim ciia chiing tdi cd 2 tmdng hgp lai bien thung h6i yang gay viem phiic mac h|u phau phai ind l^i. Tmdng hgp tiiir rihii thuang tdn phat hien trong lin md ndi soi tic mgt la dfnh hdi trang vao vlt md Mc Burney do md ragt thira each day 13 nam. Trong qua trinh gd dinh chiing tdi khdng phat hien dau hifu gi ciia thimg mdt (sau khi gd dfnh chiing toi thudng cho dung dich sinh ly vao de rua sach mau phong ngira tao day dfnh sau nay ding thdi dl kilm ya xem mgt cd bi thung khong). Bfnh nhan cd bieu hien vifim phuc mac hau phlu ngay thii hai, chiing tdi md hd lai thiy thiing 1 Id hdi yang khdng phai d vi yf chiing tdi gd dfnh. Chung tdi nghi ngd cd ihl rugt thiing do chgm dung cy dot dien. Sau ca md nay, liic chiing tdi chuin bi dung cu ndi soi dl md cho mgt trudng hgp benh khac thi phat hien mol dung cu ngi soi cd vlt yiy lop bao nhua each difn tren than each diu dung cu khoang 10cm 16 Idp vd kim Ioai ben dudi, cd kha nang vlt yiy nay cd ihl cham ragt va gSy bdng thiing ragt Uorig yudng hgp md tac mdt ngi soi trade do ciia chting tdi. Rtit kinh nghiem, chiing tdi thudng xuyen kiem tra U'nh nguyen ven cua dung cu npi soi trong liic lip rap trade khi md dl han che tai bien. Tmdng hgp thii hai khi ndi soi phat lac rapt do day dfnh chen ngang, dugc cit day dfnh, phlu thuat dugc thyc hien nhanh nhii chi trong vdng 30 phiit. Tuy nhien hau phlu ngay thu ba benh nhan cd bieu hien viem phiic mac, dupc md hd lai phat hien 2 Id thiing d hdi yang each nhau 10cm.
Chiing tdi nghi co ihl do day dinh qua sat mdt nen khi cat dot cham mgt nhu chiing tdi da de cap d yen. Ti le tai bien thung radi ciia chiing toi ciing gan bang cac tac gia khac'^" ^'.
Chiing ldi khdng hi tai biln thung mgt do chgc troca do chiing tdi chgn vi iri dua yoca dau tien d xa seo md cii, dung kJ thuat Hassen md hd 16 nhd de dua vd troca khdng cd ndng sic nhgn vao. Nlu vet md cii khdng di ngang r6n, chiing tdi dat troca dau lien d rdn do vi tri nay de vao bung nhat. Nlu vet md cii di ngang ron, chiing ldi thudng dat troca dau tien d h6ng yai bang each md l5 nhd gidng nhu mo mdt thira hd nho. Vi tri nay se vao bung kho khan hon iihit la d nhiing benh nhin cd lop md day. Cd the vi vay ma cd tac gia chpn vi in vao yoca diu tien d rdn cho lat ca cac yudng hgp kl ca khi vet m6 cu di ngang rdn va tac gia nay da gap tai bien chgc troca thiing mgt'^'. Chiing tdi nghT neu may man khdng chgc tning root thi vj tn troca d rdn nay qua sat chd dfnh khdng the dua dng soi vao quan sdt duoc gi, cang khdng the dua dung cu vao phau li'ch ^ dugc.
Thdi gian phau thuat trang binh ciia chiing tdi la 68,1 phiit, thdi gian cd trang lien lai sdm sau 47,8 gid, benh nhan an iai sdm sau trang binh 3 ngay, thu6c giam dau sir dung ft trong khoang 4,7 ngay, thdi gian nam vien ngin 8,7 ngay se cdn ngin ban neu khong bi tai bien, biln chiing gi. Khdng cd tmdng hgp nao tir vong. Theo ddi hau phau khdng co trudng htpfp nao bj lie mgt hay ban tic rapt lai phat.
KETLUAN
Phau thuat ndi soi dieu yi tic rapt non sau m6 la phuong phap dieu yi an loan va hieu qua, dem lai lgi feh cho benh nhSn. Neu chi djnh chat che, cho ti le thanh c6ng cao. Trong tic mgt ban cSp giiip md rpng chi dinh phau thuat, phau thuat dem lai ket qua tdt dep cho benh nhan. Khi kinh nghiem phlu thual vien tang cao thi ket qua ciia phuong phap dieu yi nay si cai thien chat lugng dieu tri va phan nao phong ngira dugc nguy co tic mgt tai phat.
TAI Ll£U THAM KHAO
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