VS Thj Hdng Anh Tap chi KHOA HOC & CONG NGHE 85(09)/2: 77 - 82
KET QUA PHAU THUAT NOI SOI 6 BUNG
DIEU TRI BENH PHINH DAI TRANG
BAIMSINH MOT THI
Vu Thj Hong Anh Tru&ng DH Y Duac - DH Thdi Nguyen
TOM
TATMuc tieu: Danh gia iing dung va ket qua phlu thuat ngi soi (PTNS) 6 bung dilu fri benh phinh dai frang bim sinh (PDTBS).
Doi tu'png va phuong phap: Nghien cun tien cim 76 BN dudi 36 thang tudi, chin doan PDTBS dua vao ket qua sinh thiet tuc thi frong mo, cd vi fri vd hach tir true frang tdi DT xich ma, dugc PTNS mgt thi tai Benh vien Nhi Trung uong tir thang 1/2008 din thang 1/2010.
Kit qua: 76 BN dugc PTNS mgt thi gdm 63 nam va 13 ntr, tudi trung binh la 5,5 ± 0,7thang (tir 16 ngay den 24 thang), frgng lugng trung binh la 5,9 ± 2.2kg, 13 BN cd vi tri vd hach d true frang (17,1%), 63 BN cd vi fri vd hach tdi DT xich ma (82,9%). 76 BN diu dugc dat 3 trocar 5mm va 1 trocar 3mm vdi ap lire bom CO2 bang 1/10 fri sd huyet ap dgng mach BN. Thdi gian phau thuat trung binh 121 phut( tir 80 din 180 phiit), doan ruot cit frung binh 22cm (tir 14 din 40cm). Khdng cd tai bien frong md, khdng cd BN phai chuyen md md. BN dugc an sau md 24 gid, khdng cd tu vong, khdng nhiem friing vet md, 3 BN bi loi mac ndi khi riit din luu, 37 BN cd dd da quanh hau mdn trong thdi gian ngan sau md. Thdi gian nim dieu tri sau md trung binh 5,7 ± I ngay, khi xuat vien cac BN deu tu dai tien. Mgt BN bi rd mieng ndi phai md lai. Cd 52 BN den kiem fra sau md vdi thdi gian theo doi trung binh I6,8± 6,9 thang (tir 3,5 din 29 thang) va tuli trung binh la 22,5 ± 9,5 thang (tir 6 den 50 thang). Sd lan dai tien trung binh la 1,5 ± 0,6 lln/ngay (tir I din 4 lin), 48 BN (92,3%) cd sl lin di ngoai binh thudng. 50 BN (96,2%) di ngoai phan thanh khudn, 8BN (15,4%) thinh thoang bi sdn phan. Cd 5 BN bi viem ruot. Khdng BN nao bi tao bdn tai phat, hep mieng ndi va tac ruot do dinh sau mo.
Ket luan: PTNS 6 bung dieu trj benh PDTBS mgt thi dam bao an toan, tham my, it sang chan hoan toan cd the thuc hien dugc cho BN dudi 36 thang tudi cd vj tri vd hach tir true trang tdi DT xich ma. Sau md BN deu tu dai tien, khong tao bdn, tuy nhien can tiep tuc theo doi lau dai dl danh gia chirc nang kiem soat dai tien.
Til' khda: phdu thudt ngi soi, benh phinh dgi trdng bam sinh DAT VAN DE
Phau thuat ndi soi vdi nhirng uu diem vugt trdi nhu tham my, it gay chan thuong d phuc mac, quan sat rd doan vd hach, doan gian va DT lanh, thdi gian phuc hdi sau md ngan da dugc ap dung trong dieu trj PDTBS tai mdt sd trung tam phau thuat nhi Idn [5, 6, 8].
Nhieu nghien ciru md ta mdt sd ket qua chua tdt qua theo ddi sau md nhu viem rudt tai phat, tao bdn, sdn phan, khdng kiem soat dai tien vdi ty le khac nhau bat ke tdi ap dung phuong phap phau thuat nao. Tuy nhien, nghien ciru theo ddi ket qua lau dai sau PTNS chua nhieu.
Tai Viet Nam, PTNS dilu trj PDTBS bit dau dugc thuc hien tai Vien Nhi Trung uong tir
Emad; [email protected]
nam 1997, den nam 2001 PTNS mdi dugc ap dung nhieu de dieu trj PDTBS. Tir dd den nay mdi cd bao cao nhan xet ve ket qua budc dau ap dung ky thuat nay trong dieu trj benh PDTBS [2], ket qua theo ddi xa sau md chua dugc de cap tdi. Vi vay, chiing tdi tien hanh de tai "Ket qua PTNS d bung dieu frj benh phinh dai trang bam sinh mdt thi" vdi muc tieu:
/. Ddnh gid img dung PTNS d bung dieu tri benh PDTBS
2. Ddnh gid ket qud theo ddi sau phdu thudt ndi soi d bung dieu tri benh PDTBS DOI TUONG VA PHUONG P H A P NGHIEN CLTU.
Doi tuong nghien ciru: Benh nhan bi PDTBS dugc PTNS mdt thi tai Benh vien Nhi Trung uong.
* Tieu chuan chon benh nhan: .
77
Vii Thj Hdng Anh Tap chi KHOA HOC & CONG NGHE 85(09)/2: 77 - 82 - Tudi; Tir sa sinh den 36 thang tudi, ca nam
va nir.
- Tieu chuan chgn: Benh nhan cd vj tri doan vd hach d true trang, DT xich ma. Cd ket qua sinh thiet trong md la khdng cd te bao hach than kinh d doan hep.
- Tieu chuan loai trir; Da md d nai khac that bai, md nhieu thi, bj benh PDTBS dang cd cac bien chung viem rudt, tac rudt, viem phuc mac.
Cd cac chdng chi djnh cua PTNS nhu rdi loan ddng mau, benh tim bam sinh nang vv...
Phuo'ng phap nghien ciru: La nghien ciru md ta tien ciru.
Phuang phap phau thuat trong nghien ciru
* Chuan bj benh nhan: Thut thao DT sach trudc md. Khang sinh tmh mach trudc md (cephalosporine the he thir 3, genlamycin), truyen Metronidazol trong md.
* Ky thuat mo: BN nam ngua cd ddn dudi mdng sat den ria hau mdn, nam theo chieu ngang ban md. Phau thuat vien chinh, ngudi phu md dirng phia dau BN. BN dugc phau thuat theo ky thuat cua Georgeson.
Cac chi tieu nghien cihi: Gidi, tudi (liic phau thuat), vj tri vd hach. Vj tri dat frocar, ap lire bom hai CO,. Thdi gian phau thuat, chieu dai doan rudt cat, tai bien frong md, bien chirng sau md. Thdi gian nam vien sau md, sd lan dai tien khi ra vien. Thdi gian theo ddi sau md, sd lan dai tien/ ngay, sdn phan, do dac cua phan, sir dung thudc hay cac bien phap can thiep khi di dai tien. Tinh frang mieng ndi, cac bien chung xuat hien frong thdi gian theo ddi.
Cach danh gia:
- Phdng van true tiep bd (me) benh nhan - Sdn phan la tinh trang day it phan ra quIn ngoai nhirng lan dai tien.
Khdng sdn phan.
Hiem khi sdn phan; Trung binh sdn < 2 lan/ tuan.
Thinh thoang sdn phan: Sdn phan 3- 4 lin/ tuan.
Thudng xuyen sdn phan; Ngay nao cung bj sdn phan.
- Do dac ciia phan; Phan khudn, phan nhao, luc thanh khudn luc khdng.
- Kham true tiep benh nhan danh gia tinh trang mieng ndi.
Mieng noi mem mai, gd manh, san siii, vdng xa.
Mieng noi khdng hep: Khi kiem tra hau mdn neu Igt que nong hau mdn sd 11 hoac 12 ddi vdi benh nhan tren 12 thang tudi, Igt que nong so 10 doi vdi benh nhan < 12 thang tudi.
Mieng ndi hep khi khdng dat tieu chuan tren.
- Viem rudt sau md khi benh nhan cd cac trieu chiing sau: la phan long miii thdi kham, bung chudng, sdi bung, cd the sdt hoac khdng sdt.
- Ghi nhan cac bien chung khi benh nhan nam dieu trj tai vien hoac tdi kham lai.
Phuong phap thu thap va xir ly so lieu: Cac sd lieu dugc thu thap theo mau benh an dugc ma hoa va xir ly tren phan mem SPSS.
KET QUA
76 BN gdm 63 nam (82,9%) va 13 ntr (17,1%), tudi TB luc mo la 5,5 ± 0,7 thang (16 ngay ^ 24 thang), 19 BN dugc md a tudi sasinh.
Bang 1. Tudi benh nhan Iiic phlu thuat Tuli (thang) S6 benh nhan Ty le (%)
< 1 19 25,0 2 - 6 37 48,6 7 - 1 2 10 13,2
> I 2 10 13,2
Tdng 76 100
Trgng lugng TB luc mo la 5,9 ± 2.2 kg(2,3kg - 11kg), 13 BN vd hach d true trang (17,1%), 63 BN vd hach tdi DT xich ma (82,9%).Tat ca cac BN deu dugc dat 3 trocar 5mm va 1 trocar 3mm vdi ap lire born CO2 bing 1/10 trj sd huyet ap dgng mach BN. Thdi gian phau thuat TB 121 phut (80 - 180 phut), doan rudt cat trung binh 22cm (14 H- 40cm). Khdng cd tai bien trong mo, khdng cd BN phai chuyen md md.
BN dugc an sau mo 24 gid, khong cd tir vong, khdng nhiem triing vet mo, 3 BN bj Idi mac ndi khi rut dan luu, 37 BN cd do da quanh hau mdn (26 BN < 3 thang tudi). Thdi gian nim vien sau mo TB 5,7 ± 1 ngay, khi xuat vien cac BN deu tu dai tien trung binh la 6,67
± 2,1 lan/ ngay.
va Thj Hdng Anh Tap chi KHOA HOC & CONG NGHE 85(09)/2: 77 - 82
* Ket qua theo doi sau mo :
Cd 52 BN den kiem tra sau md vdi thdi gian theo ddi TB 16,8± 6,9 thang (tir 3,5 din 29 thang). Tuoi TB la 22,5 ± 9,5 thang (tir 6 den 50 thang). Sd lan dai tien trung binh la 1,5 ± 0,6 lan/ngay (tir 1 den 4 lan), sd lan dai tien giam dan qua thdi gian theo ddi.
Bang 2. Thdi gian phau thuat va chieu dai doan rudt cat
Chieu dai doan
ruot cat(cm)
10-20 21-30
>30 Tdng Bang 3.
Thdi
< 9 0 1 4 0
Thdi gian phau thuat (phut)
91-120 121-150 24 2 23 16 2 0
>150 0 3 1 5(6,5%) 49(64,5%) 18(23,7%) 4(5,3%) Sd lan dai tien va thdi gian theo doi
Sd lan dai tien/ ngay
saumd
gian theo doi
sau md (thang)
<4 4-12 13-24
>24
llln
2 3 16
6
1 - 2 lan
4 2 15
0
3 - 4lln
0 2 2 0
Tdng cgng
6 7 33
6 Tong
cdng 27(52%) 21(40,3%) 4(7,7%) 52 48 BN (92,3%) cd sd lan di ngoai binh thudng.
Trong 52 BN cd 8 BN (15,4%) thinh thoang bj sdn pban, muc do sdn phan giam dan qua thdi gian theo ddi (bang 4 ) .
Bang 4. Tinh trang sdn phan va thdi gian theo doi sau md
Thdi gian (Thang)
Sdn phan Khdng
sdn Hiem Thinh thoang
<4 4- 12 13-24
>24
4 3 20
4 Tong
cgng 31(59,6%) 13(25%) 8(15,4%) Cd 3 BN (5,8%) tren 36 thang tudi cdn sdn phan sau mo. 50/52BN (96,2%) di ngoai phan thanh khudn. 47/52 BN kham thay mieng ndi mim mai khdng hep hoac da xda het. 4 BN thay mieng noi gd manh, khdng hep, 1 trudng hgp mieng ndi hai san.
* Bien chirng sau mo:
- Khdng cd BN nao bj nhiem triing vet md.
Khdng cd trudng hgp nao tir vong.
- Ba trudng hgp bj ldi mac ndi ra ngoai khi rut dng dan luu, da dugc gay te tai chd, dua mac ndi vao d bung va khau lai thanh bung.
Cd 37/76BN(48,6%) bj dd da quanh hau mdn mdt thdi gian ngan sau md, thdi gian dd da keo dai trung binh 3 tuan.
- Mdt BN bj rd mieng ndi sau md 3 tuan.
- Cd 5/52BN(9,6%) bj viem rudt sau md, 2 BN can dieu trj tai vien.
- Khdng cd BN nao bi tao bdn tai phat, hep mieng ndi va tac rudt do dinh sau md.
- Tat ca cac BN dugc theo ddi deu khdng cd rdi loan tieu tien, 45 BN nam deu cd kha nang cuong duong vat.
Ban luan :
Trong nghien ciru, cd 56/76 BN (73,7%) phau thuat dudi 7 thang, 10 BN phau thuat luc tren 12 thang tudi, trung binh tudi phan thuat la 5,5 ± 0,7 thang. Ket qua nay cao hon nghien ciiu ciia Georgeson la 2,5 thang va Jona la 7 tuan [6, 8]. PTNS d tudi nhd cd mdt sd uu diem dang ke la: DT gian it, mach mau mac treo nhd, viec giai phdng DT va cam mau mac treo kha thuan lgi. Cd 19 BN dugc md d giai doan so sinh, BN nhd nhat la 16 ngay tudi, ket qua nay phii hgp vdi mdt sd tac gia khac.
Trong nghien ciru nay cung nhu mdt sd nghien ciru khac khdng gap tai bien, bien chung trong md cho BN ke ca d do tudi sa sinh. Ddi vdi BN tren 12 thang tudi, DT gian to, phan u dgng nhieu, can phai chuan bj DT that sach trudc md. Mdt sd nghien ciru da PTNS cho BN d Ida tudi Idn hon nhung gap nhieu bien chirng ban nhu rd mieng ndi, viem rudt sdm sau md [3, 7, 10].
63/76 BN (82,9%) cd vj fri vd hach tdi DT xich ma dugc PTTMS. Cung gidng nhu cac nghien ciru kliac, chi djnh PTNS la phii hgp khi vj tri vd bach tdi DT xich ma. Tat ca cac BN deu dugc dat 4 trocar nhu ky thuat md ta.
Vdi vj tri dat trocar nay thi viec sinh thiet, giai phdng true trang, DT xich ma va DT xudng thuan lgi. Thuc te 70 - 80% cac trudng hgp cd
79
va Thi Hdng Anh Tap chi KHOA HOC & CONG NGHE 85(09)/2: 77 - 82 vj fri vd hach d true trang va DT xich ma. Neu
vd hach cao hon, can phai giai phdng DT gdc lach, DT ngang thi vj tri dat trocar nay khdng thuan lgi cho phau tich. Trong PT qua dudng hau mdn, se gap khd khan khi giai phdng mac freo 1/3 tren DT xich ma va tinh toan du cung mach cap mau cho mieng ndi [1].
BN cd trgng lugng 2,3 kg den 11kg, thanh bung mdng, dac biet la tre so sinh, do vay viec ap dung ky thuat dat frocar theo phuong phap md da tranh dugc tai bien d thi dat frocar. Ap lire bom hai CO2 khdng qua 1/10 trj sd huyet ap tdi da cua BN, khdng thay cd tai bien lien quan den bom hai CO2. Tuy vay trong phau thuat cd liic phai phdi hgp nang thanh bung bang chinh trocar de tang them khdng gian cho qua trinh phau tich.
Ky thuat sinh thiet ca dai true frang qua ndi soi khdng khd khan. Tuy nhien cd 3 trudng hgp bj thiing niem mac, cd the do tinh trang viem rudt trudc md gay dinh ldp thanh ca vdi Idp dudi niem mac. Ld thiing dugc khau kin bang chi PDS 5/0. Sau md BN khdng cd bien chiing gi. Chung tdi thay PTNS la ky thuat cho phep chu ddng tinh toan mach mau, vi vay mieng ndi khdng bj cang, phau tich true trang xudng sau nen khi phau tich d thi hau mdn de dang hon la khi phau tich qua dudng hau mdn don thuan. Quan sat rat rd cac tang d tieu khung vi vay da khdng lam tdn thuong cac thanh phan nay trong qua trinh phau tich dac biet la dng dan tinh.
Thdi gian phau thuat TB 121 phiit. So vdi mdt sd tac gia khac thdi gian phau thuat ciia chiing tdi ngan hon. Ciing tai Benh vien Nhi Trung uong, trong thdi gian 2002-2004 thdi gian phau thuat trung binh la 140 phut. Nhu vay, khi PT frd thanh thudng qui se nit ngln thdi gian phau thuat, tuy cd lau hon so vdi PT qua dudng hau mdn don thuan[l, 4].
Ket qud sdm sau mo:
Sau PTNS, BN phuc hdi nhanh. Thdi gian cd hai va phan qua ong thdng trung binh 8,86 ± 2,8 gid. Khdng gap trudng hgp nao bj buc mieng ndi, nhiem triing vet mo, viem rudt sdm sau md. Ket qua nay phii hgp vdi cac nghien ciru khac[6, 8].
Cd benh nhan bj Idi mac noi Idn ra ngoai khi rut dng din luu. Chiing tdi nhan thiy nhirng ; BN nay cd Id dat troca rdng, khi dat dan luu ', chi cd djnh din luu ma khdng khau hep bdt Id dat troca, sau khi rut kinh nghiem khdng cd benh nhan nao bj ldi mac ndi nira.
Thdi gian nam vien sau md TB la 5,7 ngay, so vdi Georgeson la 4 ngay va Jona la 2- 3 ngay[6, 8]. Sd dT thdi gian nam vien keo dai vi BN cua chung tdi tir khap cac tinh cua mien BIC ve dieu trj, nhieu benh nhan d vimg sau nen khdng the cho BN ra vien sdm dugc vi gia dinh BN va thay thudc khdng yen tam.
Tuy nhien, qua theo doi chung tdi khdng ghi nhan thay bien chimg gi, nhu vay cd the cho BN ra vien sdm han neu trong qua trinh hau phau khdng cd gi dac biet.
Khi ra vien cac BN tir dai tien TB la 6,67 lan/
ngay (1-^12 lan). Vi phan Idn cac BN dugc phau thuat d liia tudi bii me, ddng thdi bj cat mat doan DT nen sau md BN di dai tien nhieu lan la tat yeu. 37 BN bj do da quanh hau mdn trudc khi ra vien trong do cd 26 BN dudi 3 thang tudi. Cd the do anh hudng ciia do PH • cua phan da gay nen tdn thuang nay. Nhiing BN nay dugc bdi ma Penexillin quanh hau mdn de giam bdt tdn thuong da quanh hau mdn. Mgt sd tac gia cho biet do da quanh hau mdn se giam dan khi sd lan dai tien cua BN
giam xudng [3, 5, 7]. ; Ket qud theo doi xa sau mo:
Cd 52/76BN (68,4%) den kiem tra sau md cd ! tuoi TB 22,5 ± 9,5 thang (6 - 50 thang), thdi : gian theo ddiTB la 16,8 ± 6,9 thang (3,5 - 29 | thang), so lan dai tien TB la 1,5 Ian/ngay(l | lan ^ 4 lan). Ddi vdi tre binh thudng, khi Idn ! len sd Ian dai tien/ngay giam xuong. Qua theo \ ddi chiing tdi nhan thay sd lan dai tien/ ngay • giam dan qua thdi gian theo doi sau md (bang 3). Tuy nhien, 2 BN sau mo tren 12 thang nhung dai tien 3 den 4 lan/ngay, khi hdi cha me BN chiing tdi thay dd la nhiing tre khdng dugc ngdi bd khi dai tien hoac ia dim, vi khdng dai tien het phan trong DT nen fre di nhieu lan. Khi cha me BN dugc tu van ve each tao thdi quen dai tien dung gid cho tre thi tinh trang nay dugc cai thien. Phan Idn cac
Vu Thj Hdng Anh Tap chi KHOA HOC & CONG NGHE 85(09)/2: 77 - 82 tac gia deu thay sd lan dai tien giam dan qua
thdi gian theo ddi. Sau md, BN dai tien tir 5 den 8 lan/ ngay, trong vdng 3 thang dau sau md sd lan dai tien giam xudng cdn 3-5 lan/
ngay. Tir luc 3 thang cho tdi 1 nam sd lan dai tien tir 2-3 lan / ngay. Xu hudng dai tien duy tri 2 lan / ngay trong nam tiep theo [3].
Sdn phan thudng thay d BN sau md chu'a PDTBS, miic do sdn phan tiiy thudc vao do dac cua phan, tinh trang ca that hau mdn..., tan suat sdn phan se giam khi tre Idn len va dai tien phan cd khudn. Trong nghien ciiu nay, cd 59,6% khdng cdn sdn phan den thdi diem danh gia. Chi cd 7/50 BN dai tien phan thanh khudn thinh thoang bj sdn pban, phan Idn nhirng BN nay phau thuat chua dugc mdt nam. Theo Resecorla va cdng su, 12% BN dudi nam tudi cdn sdn phan, ti le nay giam xuong cdn 6% trong do tudi 10-15, khdng cdn trudng hgp khdng kiem soat dai tien khi tren 15 tuoi [10]. Trong nghien ciru nay, chi cd 5,8% BN tren 36 thang tudi cd sdn phan, day la kit qua dang dugc ghi nhan. Tudi BN cdn nhd, can phai tiep tuc theo ddi de danh gia kha nang kilm soat dai tien vi day la mdt trong nhung tieu chi quan trgng danh gia chat lugng cudc sdng BN sau md chua PDTBS.
Tao bdn la van de thudng gap ciia BN sau phlu thuat ha DT. Tao bdn thudng xuat hien trong thdi gian ngan va cai thien ciing vdi thdi gian. Ti le tao bdn tir 5-20% tiiy theo tac gia [4, 9]. Nghien ciru nay khdng gap BN nao bj tao bdn sau md, ket qua nay dem lai sir hai ldng cho gia dinh benh nhan vi phan Idn trudc md BN den vien vi tao bdn.
Bien chdng sau mo:
Viem rudt la biln chung thudng gap sau md, ty le viem rudt sau md khac nhau tir I2%- 34% [7, 10]. Khoang 50% so ca tir vong lien quan true tiep tdi PDTBS do viem rudt. 5BN (9,6%) bj viem rudt, trong dd 3 BN dieu trj ngoai tru, chi cd 2 BN dieu trj tai vien vdi khang sinh Cephalosporin, metronidazole va thut thao, sau 4 den 6 ngay BN dugc ra vien.
Sau khi ra vien, cha me BN dugc tu vln ky ve biln chiing viem rudt va each nong hau mdn lam xep hai trong DT khi chudng bung hoac bat thudng ve phan.
Mdt BN bj rd mieng ndi, dugc dan luu hdi trang nhung khdng ket qua va phai phau thuat lai de ha DT. Khi phan tich chiing tdi nhan thay BN 21 thang tuoi, bj tao bdn keo dai, Idng DT khdng dugc thut sach nhu cac benh nhan khac, khi md phan DT ndi vdi dng hau mdn tuong ddi gian, cd the day la li do gay rd mieng ndi sau md. Trong trudng hgp nay neu khau ndi va de mdm thira se an toan cho BN, tranh dugc rd mieng ndi.
Khdng BN nao bj tic rudt sau md, day cting la mdt uu diem vugt trdi cua PTNS so PT kinh dien. Khdng cd hep mieng ndi. khdng cd BN bj roi loan tieu tien, cac BN nam deu cd bieu hien cudng duong. Ket qua nay phii hgp vdi nhieu nghien ciru khac [7, 10].
Ket luan: PTNS 6 bung dilu trj benh PDTBS mdt thi cd the ap dung cho BN dudi 36 thang tudi cd vj tri vd hach tir true trang tdi DT xich ma dam bao an toan, tham my, it sang chan, hdi phuc sau md nhanh. Sau md BN deu tu dai tien, khdng cdn tao bdn, tuy nhien BN can dugc theo ddi tiep de danh gia chirc nang kiem soat dai tien.
T A I LIEU THAM K H A O
[1]. Bill Dire Hau (2006), "Nghien cim img dung phlu thuat mgt thi qua dudng hau mdn de dilu frj benh phinh DT bam sinh", Lugn vdn tdt nghiep bac sy chuyen khoa cdp 11, Hd ndi.
[2]. Nguyen Thanh Liem, Biii Dire Hau (2005),
"Dilu tri benh phinh DT bam sinh bang PTNS:
Kinh nghiem vdi 113 trudng hgp", Y hgc thirc hdnh, 506,fr 119.
[3]. Erdek M., Wih E. (1994), "Hirschsprung's disease: one institution's ten year experience and long- term follow- up". Am Surg, 60, pp. 625-628.
[4]. Essam A., Elhalabi A., Hashish M. et al (2004), "Transanal one- stage Endorectal pull- through for Hirschsprung's disease : A multicenter Smdy", J Pediatr Surg 39 (3), pp. 345-351.
[5]. Ghirardo V., Betalli P., Mognato G. et al.
(2007), "Laparotomic versus laparoscopic Duhamel pull-through for Hirschsprung disease in infants and children", J Laparoendosc Adv Surg Tech A. 17(1), pp.
[6]. Gorgeson K.E., Robertson D.J. (2004),
"Laparoscopic-assisted approachs for the definitive surgery for Hirschsprung's disease".
Semen Pediartr Surg 13 (4), pp. 256-262.
81
va Thj Hdng Anh Tap chi KHOA HOC & CONG NGHE 85(09)/2: 77 - 82 [7].Ikeda K., Goto S. (1984), "Diagnosis and the approaches for Hirschsprung's disease", J treatment of Hirschsprung's disease in Japan. Pediatr Surg, 42, pp. 4\-41.
An analysis of 1628 patients", Ann Surg 199, [10].Rescorla P., Morrision A., Engles D. et al.
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SUMMARY
RESULTS OF LAPAROSCOPIC SURGERY FOR TREATMENT OF CONGENITAL COLON ANEURYSM
Vu Thi Hong Anh*
College of Medicine and Pharmacy - TNU Purpose: To evaluate the feasibility and medium term results of primary laparoscopic endorectal colon pull-through for Hirschsprung's disease in infants.
Material and method: Prospective review ofthe infants with Hirschsprung's disease treated by primary laparoscopic endorectal colon pull-through proceduce from January 2008 to January 2010 was carried out according to Georgeson's technique. We left a short rectal seromuscular sleeve 2cm from dentate line. These patients were evaluated with regard to age, position and length ofthe aganglionic segment, intraoperative details, postoperative complications and medium term functional outcomes.
Results: Seventy six patients (63 boys and 13 grirls) underwent a curative surgery with average age 5.5±0.7 months ( range, 16 days to 24 months). The aganglionic segment was located in the rectum in 13 patients, in the sigmoid colon in 63 patients (82,9%). The mean operating time was 121 minutes (range, 80 to 180 minutes), the average length of resected bowel was 22 ± 5.4 cm(range, 14 to 40 cm), there was no infraoperative complication, no patient required conversion, no death. Mean postoperative stay was 5.7 ± 1 days (range, 4 to 9 days), oral intake were started 24 hours after operation. Thirty seven patients had temporary perianal excoriation (26 patients were < 3 months of age). 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. 52 patients were followed-up at 22.5 ± 9.5 months of mean age. Mean follow-up time was 16.8 ± 6.9 months(range, 3.5 to 29 months), mean time of defecation was 1.5
± 0.6 (range, 1 to 4), normal defecation was noted in 47 of 52 (91.4%), 50/52 (96.2%) patients had normal stool consistency. Occasional soiling occurred in 8 (15.4%). Recurrent episodes of enterocolitis occurred in 5 of those patients (9.6%), three of which improved without hospitalization. Recurrent constipation, anatomotic stricture, tight sphincter, adhesive bowel obsfruction was not noted in any patient.
Conclusion: Primary laparoscopic - assisted endorectal colon pull-through is a safe and an effective for Hirschsprung's disease in infants. The patient need continuing follow-up.
Key words.- Laparoscopic, Hirschsprung's disease.
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