62 Tap chi GAN MAT VIET NAM so 32-2015
Ket qua cat gan ndi soi dika tri ung thv gan
Result of laparoscopic hepatectomy for hepatocellular carcinoma
Nguyen Cuong Thinh*, Nguyen Anh Tudn*, Le Vdn Thdnh* Do Tudn Anh**, Luang Cong Chdnh***, VU Van Quang*
Tom tat
Muc dich: Nghien cihi nay nham bao cao ket qua som cat gan noi soi dieu tri ung thu gan.
Doi tirgng va phirong phap: Cac benh nhan rao cat gan npi soi dieu tri ung thu gan tir thang 01/2011 - 08/2014 tai Benh vien TUQD 108 va Benh vien Viet Dire. Nghien cuu can thiep lam sang khong doi chung.
Kit qua: C6 67 BN, tu6i trung bmh 50.0 ± 13.9, ty le nam/nii la 2.9/1. Churc nang gan phan loai Child A (95.5%), Child B (4.5%). Vi tri u
(tren phun chup CLVT) 6 HPT 2,3 (49.2%), HPT 6 (38.8%).Kh6iudandpcc6kt<5cm (61.2%), kt >5cm (31.3%), da khoi u kt < 3cm (7.5%).
KhIi u CO kich thu6c trung binh 4.73 ± L71cm.
Thoi gian m6 trung bmh 108.4 ±34.8 phiit. Lupng mau mat hung bmh 396.1 ± 351.8 ml, C6 14BN (24.6%) phai truyen mau trong mo, 10 BN (14.9%) chuySn mo mo, ty le bien chimg 14.0%, khong CO tir vong sau mo.
Ket lu^n : Phau thuat cat gan npi soi dieu tri ung thu gan la phau thuat an toan, co tinh kha thi, buoc dau cho ket qu^ tot.
Abstract
Objective: The aim of this study to report ini- tial result of laparoscopic hepatectomy for hepa- tocellular carcinoma.
Subject and Methods: All patients who un- derwent laparoscopic liver resection to treatment liver cancer from 01/2011-08/2014 m 108 Mili- tary central hospital and Viet Due hospital.
Prospective intervention study.
Results: From 1/2011 to 8/2014, we have 67 patients who underwent laparoscopic hepatec- tomy for hver cancer. Mean age was 50.0±13.9, die ratio men to women was 2.9/1. Preserved liver function Child-Pugh Class A:95.5%, Child B:
4.5%. On abdominal CTscan, the tumor located
in segment 2,3 (49.2%), in segment 6 (38.8%).
Solitary tumor size <5cm diameter (61.2%), >5cm diameter (31.3%). Multiple tumor< 3cm (7.5%).
Mean tumor size was 4.73±1.71cm. Mean opera- tion time was 108.4±34.8 mmutes. Mean blood loss was 396.1±351.8 ml. 14 cases have to blood transfusion intraoperative(24.6%). 10 patients have to convert open operation (14.9%). Compli- cations occurred in 8 patients(14.0%), no mortal- ities.
Conclusions: Laparoscopic liver resection for liver cancer is a safe, feasible and good initial re- sult.
Keyword: Laparscopic hepatectomy, cat gan
X. Dat van de
Ung thu gan (UTG) la loai ung thu pho biSn, benh dung hang thu 5 trong cac benh ung thu pho bi^n nhit tren th^ gidi. Khoang 90% cac truong hpp UTG xay ra 6 nhiing nguoi mac benh gan man tinh. Phuong phap dieu tn dupc coi la co ban
va hieu qua la cat gan. Trong thoi gian gan dSy, cung voi sir bimg no ciaa phau thuat ngi soi, cac chuong trinh sang Ipc UTG co nhieu hieu qua, nhieu khoi u gan dupc ph^t hiSn 6 giai doan som din toi viec ap dimg phau thuat npi soi trong dieu tri UTG. Da co nhiSu nghien cuu chung minh
>= BVTU'QD 108, ** BV Viet Dire, *** BVDK Nong Nghiep
Tap chi GAN MAT VIET NAM s^ 32-2015 duac tmh kha thi va an toan ciia ky thuat. Uhu hit
cac nghien cuu deu th4y ring: phhx thuat cat gan npi soi dieu tri UTG la phau thuat an toan, cd tinh kha thi, cho ket qua tot tren co so dap img dupc cac tieu chuan lua chon benh nhan phii hpp. Muc dich cua nghien cuu nay nham bao cao ket qua som cat gan npi soi dieu tri ung thu gan.
n . Doi t u ^ g va phirong p h a p l.DoituQfng:
67 BN ung thu gan dupc chi dinh cat gan npi soi tai BV T L T Q D 108 va BV Viet Dire, tu thang 1/2011- 8/2014, CO giai phau benh sau mo, co benh an ghi chep day dii.
2. Phirong phap
2.1. Thi^t k^ Dghien cihi: Nghien ciru can thiep Iam sang khong doi chiing.
2.2. N$i dung nghien cihi 2.2.1. Chi dinh cat gan npi soi - The trang chung ciia benh nhan - Chiic nang gan
- Vi tri khoi u
- Kich thuoc va so lupng u 2.2.2. Ket qua phiu thuat
- Loai cat gan: theo phan loai Brisbane nam 2 0 0 0 .
- Loai ky thuat cat gan npi soi: theo huong din d6ng thuan qudc t l Louisville 2008 [12]: ky thuat npi soi hoan toan, ky thuat npi soi ket hpp.
- K i t qua trong va sau mo dupc ghi nhan: thai gian mo, luong mau mat, tai bien, ty le chuyen m6 md, biSn chung (phan Ioai bi6n chiing theo Clavien-Dindo [7]: Dp I-cd bien chiing nhung khdng cSn can thiep gi ngoai trir thudc giam dau, ha sdt, khang sinh. Do II- bidn chiing cSn phai didu tri bing thudc. Dp HI- bidn chiing cin dupc phSu thuat, npi soi hoac Iam chan doan hinh anh can thiep. Dp IV- bidn chiing cd the gay chet nguoi, can dupc cham soc dac bidt hoac dieu tri hdi sire tich cue. Dp V- benh nhan tii vong), thdi gian nam vien.
2.3 Xif ly sd !i?u: sd lieu dupc xir ly theo chuang frinh SPSS 20.
III. Ket qua 1. Dac diem chung Ll.TXioi
Trong thdi gian tu thang 1/2011-8/2014 co 67 BN ung thu gan dugc chi dinh cat gan ndi soi, tudi trung binh 50.0±13.9 (13-73 tudi). BN frong dp tudi 40-59 chidm ty Ie cao 59.7%.
1.2. G i ^
Nam: 50 BN (74.6%), n i r : 17 BN (25.4%).
Ty le nam/nii la 2.9/1.
2. Chi dinh phau thuat 2.1. The trang chung benh nhan
• 0 diem
• 1 diem B 2 diem Bieu do 3.1: Diem the trgng chung cua benh nhdn
Nhan xet: BN trong nhdm nghien ciiu cd thang diem the trang < 2 chiem ty le 100%, trong do, ty le BN hoat dpng bmh thudng (0 didm) 50 BN (74,6%), BN cd thang diem 1 diem va 2 diem chidm 16,4% va 9,0%.
2.2. Chiic nang gan
4.5%
• Child A
• Child 8
Bieu do 3.2: Phdn logi chirc ndng gan theo ChUd-Pugh.
Nhan xet: BN dupc lira chpn trong nghien ciiu chu y§u cd chirc nang gan tdt, 64 BN dupc phan loai Child- Pugh A chi8m ty le 95,5%, 03 BN Child-Pugh B (4,5%).
2.3. Vj hi khoiu
Tap cht GAN MAT VIET NAM so 32-2015 Bang 3.1: Vi tri khdi u gan
Vi tri khoi u HPT 2,3
HPT 6 HPT 7 HPTl/4b/5/5-6
Tong
Sieu am SoBN
33 28 01 1/2/2/0
(05) 67
Ty le % 49,2 41,8 1,5 7,5 100
CLVT S 6 B N
33 26 02 1/3/1/1
(06) 67
T y l e % 49,2 38,8 3,0 9,0 100
D&i chi^u trong mo S o B N
33 24 02 1/3/1/3
(08) 67
T y l ? % 49,2 35,8 3,0 12,0 100 Nhan xet: Vi tri khdi uctha. phan thiiy 2,3 va ha phan thiiy 6 chiem ty le cao tren sieu am, chup CLVT va ddi chieu trong md. Khdi u d ha phan thiiy 1,4b,5,5-6,7 cd ty le thap hon.
2.4. Kich thudc va sd lupng u Bdng 3.2: Kich thuac vd so luang u
Dac diem kh6i u U don doc CO kt <3cm
U don dpc kt 3-5cni U don dpc kt >5cm Nhieu u (<3u, <3cni)
Tong
Sieu am SoBN
09 31 23 04 67
Ty le % 13,4 46,3 34,3 6,0 100
Chup CLVT S o B N
10 31 21 05 67
Ty le % 14,9 46,3 31,3 7,5 100
Doi chieu trong mo S6BN
04 37 21 05 67
T y l e % 6,0 55,2 31,3 7,5 100 Nhdn xet: Tren hinh anh sieu am, chup CLVT
va ddi chieu trong md, khdi u don ddc chiem ty le tir 92,5% - 94,0%. Nhidu khdi u chi chi6m ty le thip 6,0% - 7,5%.
- Kich thudc tnmg binh khdi u qua sieu am:
4,57±1,62 (1,0-8,7) cm, chup CLVT: 4,73±1,71 (l,6-ll,0)cm va ddi chieu trong md: 4,67±1,51 Bdng 3.3: Loai cat gan
(1,5-11,0) cm.
Khdng cd sy khac biet giua kich thudc tnn^
binh khdi u qua sieu am, chup CLVT va ddi chieu hong md (T-test, p=0,58, p=0,67 va p-0,94).
3. Ket qua phau thuat 3.1. Loai cat gan
Loai cat gan Cat gan Ion
CiX gan nho
Tong
Cat gan trai HPT5-6-7
HPT3 HPT6 Thiiy gan trai (HPT2,3) Phan thuy sau HPT6 HPT7 Cat gan khong dien hinh
(HPTl/3/4b/5/6)
SSBN 01 01 01 07 26
08 07
01 13 (01/01/02/01/08)
57
Ty le % 1,8 1,8 1,8 12,3 45,6 14,0 22,8 i
s 100 ,
T a p chi GAN M A T V!ET NAM so 32-2015
Nhan xet: Trong nghien cihi, so BN phau thuat npi soi thanh cong la 57/67 (85,1%), trong do chii yeu la cat gan nho (96,4%), cat gan Ion chi chiem ty le 3,6%. Trong cM gan nho, cit thiiy gan trai chiem ty le cao 45.6" n. c^t phan thuy sau (14,0%), cat gan khong dien hinh (22,8%), c4t ha phan thuy gan (HPT3, HPT6) CO tyle thap 14,1%.
3.2. Loai ky thuat cat gan npi soi Bdng 3.4: Ket qua trong mo
Bieu do 3.3: Loai ky thuat npi soi
Not SOI lipan NoisoiketlK>p
Ky thuat noi soi hoan toan duac thuc hien 53/57 BN (93%), ky thuat npi soi kit hpp 4/57 BN (7%).
3.3. Ket qua trong mo
Chi so Thai gian mo trung binh (phut) Luong mau mat tmng binh (ml) So BN phai tmyen mau (n,%) The tich mau tmng binh phai tmyen (ml) Tai bien trong mo (n,%)
Chuyen mo ma (n,%) Tu vong (n,%)
Ket qua 108,4 ±34,2 (50-210) 396,1 ±351,8 (30-2000)
14 (24,6) 770,0 ±340,6 (350-1750)
05 (7,5) 10 (14,9)
0 Nhgn xet: Thai gian mo trung binh trong
nghien cuu 108,4±34,2 phut, ngan nh4t la 50 phut, thoi gian mo dai nhat 210 phiit. Luang mau mat trung binh: 396,1 ±351,8 (30-2000) ml. Ty le tmy^n mau trong mo: 24,6%. The tich mau trung Bdng 3.5: Bien chiing sau mo
binh phai tmyen 770,0 ± 340,6 (350-1750) ml. Tai bien trong mo g ^ o 05 BN (7,5%), ty le chuyen mo ma 14,9%, khong co tii vong trong mo.
3.4. Ket qua sam sau mo 3.4.1. Bien chung sau mo
Bien chijng Suy gan
Chay mau Romat Tran dich MP Co chuong 6 dong dich NK vet mo
Phan loai bien chung theo Clavicn-Dindo do 1/ii/iii/rv/v
SoBN 0 02 01 06 04 01 03 05/09/03/0/0
Ty le % 0 3.5 1,8 10,5 7,0 1,8 5,3 29,4/52.917,6/0/0 BiSn chOtng sau m6 xay ra a 08 BN (14,0%) trong do: tran dich mang ph6i (10,5%), c6 chuong (7,0%), chay mau (3,5%), to mat (1,8%). Khong co truong hop nao bi suy gan sau m6. Phan loai bi6n chung theo Clavien -Dindo chu yeu gap do II chiem ty le 52,9%.
66 Tap chi GAN MAT VIET NAM s^ 32-2015 3.4.2. Thai gian nam vien sau mo Thai gian nam vien trung bmh sau mo la 7,7 ± 2,9 (3-21) ngay.
IV. Ban Iuan 1. Dac diem chung 1.1. 'moi
Phiu thuat cat gan npi soi dieu tri UTG duac chi dinh cho 67 BN co tu6i trung bmh 50.0±13.9 (13-73 tuoi). BN a do tu6i 40-59 chiSm ty le cao 59.7%. Nam giai 50 BN (74.6%), nir giai 17 BN (25.4%). Ty 16 nam/nii la 2.9/1. Tu6i m5c benh cua benh nhan UTG thay doi theo nhieu nghien ciiu. Cac nghien curu dupc thuc hien tu tnrac den nay a cac vung dich te khac nhau cho thay tin suat UTG cung khac nhau. Tuoi thirdng lien quan nghich vai vung luu hanh benh va thay doi theo benh nguyen. CS Viet Nam, UTG thuang gap a Ilia tu6i 50 - 60 tuoi, voi dp tuoi trung binh 50 - 55 tu6i
1.2. Gidi
Ket qua nghien ciiu cho thiy khong co sir khac biet ve gioi so voi hau het cac nghien ciiu: Theo Nguyin Cuong Thinh (2009), ty le nam/nii; 2.1/1.
Nguyin Sao Trung (2004), ty le nam/nii: 3.0/1.
Sarpel.U (2009),ty le nam/nii: 3/1 [17], Theo s6 lieu ciia Globocan(2002)[15] , ty le nam/nii 6 Dong Nam A va Viet Nam nkm trong khoang 2.2/1 dSn 4.3/1.
2. Chi dinh phiu thuat 2.1. The trang chung b^nh nhSn BN h-ong nghien ciiu dupc lira chpn dira theo phan loai giai doan cua BCLC. KSt qua NC cho thay: BN co thang diem the trang < 2 chiem ty le 100%, trong do BN c6 the trang tdt, hoat dpng binh thuang (74,6%). Ket qua NC ciing tuang tir kk qua cua Chen.H.Y [3], Tranchart.H [19]: ty le BN CO thang di6m th§ frang < 2 tu 86,6%-100%.
2.1. Chih: nang gan
- Chiic nang gan dupe xem la ySu t6 quan trpng nhat, quyet dinh ty le bien chiing va tix vong sau phau thuat cat gan. Phau thuat cSt gan duoc chi dinh cho nhiing benh nhan c6 chiic nang gan a miic dp A theo phan loai Child- Pugh. Trong
truong hpp cat gan khong diln hinh a vung ngoai vi ciia gan, mpt so tic gia dl nghi cat gan npi soi cho nhiing benh nhan dupc phan loai Child B [9].
- Ket qua nghien cuu cho thay: BN dupc phan loai Child A chiim ty 1? 95.5%, Child B (4.5%).
Tac gia Ibrahim Dagher [5] nghien ciiu 163 truong hpp cat gan npi soi dieu tri UTG, ty 1$
Child A (92.5%), Child B (6.6%). Theo Hong- Yaw Chen [3] qua 116 tr° Yong nghien ciiu tir 81- 100%.
2.1 Vj tri khoi u
- Cac truong hpp co khoi u nam o vi tri HPT truac-ben ciia gan (HPT 2,3,4b,5,6- con duac gpi la HPT npi soi). Voi nhirng khoi u a vi tri nay, cat gan khong dien hinh, cat ha phan thuy gan hay cat thiiy gan trai la chi dinh tot nhat cho phau thuat CGNS. Vai tro cua phau thuat npi soi voi cac ton thuang thupc HPT 7,8 va 1 la chua dupc xac dinh, tham chi con duac coi la viing khong phau thuat ngi soi vi kho khan ve ky thuat va han che truong mo.
Kit qua NC cho thdy: vi tri khdi u d HPT 2,3 chiem ty le 49,2% tren ca sieu am, chup CLVT va doi chieu trong mo. Khoi u a HPT 6 (41,8%) qua sieu am, 38,8% tren chup CLVT va 35,8% qua dii chieu trong mo. Khoi u d HPT 1,4b,5,5-6,7 chiim ty le 9,0%; 12,0% va 15,0% tuang ling tren sieu am, chy.p CLVT va ddi chieu trong md.
Nghien ciiu cua Cherqui (2000) [4] ciing cho kit qua tuong tir: khdi u d HPT 2,3 (46,7%), khdi u HPT 6,7 (23,3%), HPT 4b,5 (30%). Nghien curu cua Pulitano.C (2008) [16]: khdi u d gan trai (82,5%) h-ong do: khdi u d HPT 2,3 (63,6%), khdi u dgan phai (17,5%).
2.2. Kich thu^c \k so lirgng u
Phau thuat npi soi cat gan dupc chi dinh cho nhiing benh nhan dap ling dupc tieu chuan Milan(
khdi u don ddc kt<5cm, hoac <3u,kt u<3cm)[12].
Tieu chuan nay cung dupc hau het cac tac gia thdng nhit [3,5,9], Phau thuat CGNS khdng nen chi dinh cho cac tdn thuang ldn d trong nhu md gan vi di ddng khdi u khd khan, nguy ca vo khdi u va khd dam bao dupc nguydn tic ttong ung thu.
Tuy nhien, mot sd tac gia khdng tuan thu theo tieu
Tap chi GAN MAT VIET NAM s^ 32-2015 67 chuan nay. Tac gia E.Vibert(Phap-2006)[8] bao
cao CGNS thanh cdng cho BN ung thu gan cd khoiu 17cm.
Ket qua NC cho thiy: khdi u co kich thuac <
5cm chiim ty le 59,7%, 61,2% va 61,2% tren sieu am, chup CLVT va ddi chilu trong md. Kich thudc > 5cm chiem ty le 34,3% tren sieu am, 31,3% h-en chup CLVT va 31,3% ddi chilu trong md. Ty le BN cd nhieu khdi u, kich thudc u < 3cm tuong ling la 6,0%, 7,5% va 7,5% tren sieu am.
chup CLVT va ddi chieu trong md.
Kich thudc hung bmh khdi u qua sieu am la 4,57±l,62cm (l,0-8,7cm), tren chup CLVT la 4,73± 1,71 cm (1,6-11,0cm) va ddi chilu trong md la 4,67±l,51cm (l,5-ll,0cm). Khdng co sir khac biet giiia kich thirdc tmng binh khdi u do dupc qua sieu am, chup CLVT va ddi chieu trong md vcfi p-0,58, p=0,67 va p=0,94.
3. Ket qua phiu thu^t 3.1. Loai cat gan . Bdng 4.1: Loai cat gan theo mdt sd tac gia tren the gioi
Tac gia (nam) K& qua NC (2014) Zhen(2010) Yoon(2009) Belli (2009) Lai (2009) Santambrogio (2009) Chen (2008) Dagher (2008) Cherqui (2006) Kaneko (2005)
Quoc tich Viet Nam Trung Quoc Han Quoc Y Hong Kong Y Dai Loan Phap Phap Nhat Ban
Co mau 57 29 69 54 30 22 116 32 27 30
Loai cat gan Ldn (n,%)
2(3.6) 0(0) 9(13) 3(5.6) 1(3.3) 0(0) 19(16.4)
4(12.5) 1(3.7) 0(0)
Nho (n,%) 55 (96.4) 29 (100) 60 (87) 51 (94.4) 29 (96.7) 22 (100) 97 (83.6) 28 (87.5) 26 (96.3) 30 (100) Cac nghien ciiu bang 4 cho thay: cat gan nhd
chiim ty le cao tCr 83.6- 100%, cat gan ldn tu 0- 16.4%.
Kit qua nghien ciiu cho thay: loai cat gan dupc thirc hien chu ydu la cit gan nhd (96,4%) trong do: cit thiiy gan trai 45,6%, cit phan thiiy sau 14,0%, cit HPT 3 (1,8%), cit HPT 6 (12,3%), cit gan khdng diln hinh 22,8%. Cat gan Ion chiim (3,6%) trong do: cit gan trai (1,8%), cit HPT 5-6-7 (1,8%).
3.2 Loai ky thuat ndi soi.
Cd 3 ky thuat ndi soi cit gan la: ndi soi hoan toan, ndi soi voi ban tay trp giiip va ndi soi ket hpp. Ky thuat ndi soi hoan toan duoc thuc hien d hiu hit cac nghien curu, dac biet la d Chau Au [1], [5], [6], [13], trong khi ky thuat ndi soi vdi ban tay trp giiip dirpc mdt sd tac gia d My, Nhat,
Trung Qudc, Dai Loan su dung [10], Ket qua NC cho thay: ky thuat ndi soi hoan toan dupc thuc hien vai ty le 93,0%, ndi soi kit hop 7,0%. Chiing tdi sii dung ky thuat ndi soi ket hpp trong tmdng hap kiem soat chay mau d thi cat nhu md gan gap kho khan. Voi mdt dudng md nhd (6-8cm) d dudi sudn phai hay dudng trang giiia dudi miii lic viia de lay benh phim, vua giiip cam mau hieu qua hon.
Nghien ciiu cua Dagher.I [5] cho thiy: loai ky thuat npi soi hoan toan dupc thuc hien voi ty le 95,1%, npi soi vdi ban tay trp giup 4,9%.
Nghien cuu cua Kof&on A.J [14] qua 300 tnrdng hop CGNS cho kit qua nhu sau: ky thuat ndi soi hoan toan dupc thuc hien vai ty le 80,3%, ndi soi vdi ban tay trp giiip 10,7%, ndi soi ket hpp 9%.
3.3. Ket qua trong md
68 T^p chi GAN MAT VIET NAM sd 32-2015
Bang 4.2: Ket qud trong mo CGNS theo mot so tdc gid tren the giai
Tac gi^
Zhen Yoon Belli Sasaki Lai Sarpel Santambrogio Dagher Cherqui Kaneko
S6 BN 29 69 54 37 30 20 22 32 27 30
Tgian mo (phut)
120 280,9
167 195 139,4
161 199 231 240 182
Mat mau (ml)
164 808,3
297 103 200 183
-
461 338 (n=21)
>1000 (n=6) 350
Truyen mau trong mo
0 23 (33%)
6(11%) 3 (10%)
-
1 (5%)
-
5 (16%) 5 (19%)
Chuyen mo ma 3 (10.3%)
5 (7.2%)
-
1 3 (13.6%)-
3 (9.3%) 7(25.9%)
1 Nguon: Chung.C.D [2]
- Kit qua nghien ciiu bang 4.2 cho thay: thdi gian md trung binh tii 120-280.9 phiit, luang mau mat trung binh 103-808-3ml, ty le BN phai tmyen mau trong md 0-33%, chuyen md md tii 7.2- 25.9%.
Thdi gian md trung binh trong NC la 108,4±34,8 (50-210) phiit. NC cua Yoon (2010) [20], thai gian md trung binh la 280.9 ± 128.2 phiit. NC cua Dagher (2010) [5] la 180 (60-655) phiit NCciiaTrin Cdng Duy Long (2014) [18] la
112 ±56 (30-345) phut.
Thai gian md thay ddi theo nhieu NC va phu thudc nhieu yeu td nhu lo^i cat gan, vi tri khdi u, tinh trang xo gan kem theo...
Lupng mau mat trong md:
PhEu thuat ndi soi dupc chiing minh la cd lupng mau mat it hon so vai md md d nhilu loai phSu thuat. Trong phau thuat CGNS cung co mdt sd bao cao cho thiy lugng mau mit trong md la tuong duang hoac thap hon so vdi md ma
Ket qua trong NC: luang mau mit trung bmh la 396,1±351,8 ml (30-2000)ml, ty le BN phai tmyen mau trong md (24,6%), thl tich mau trung binh phai huyen cho mdt BN la 770,0±360,5 ml (350-1750 ml).
Nghien ciiu cua Inagaki.H (2009) [11], qua 69 trudng hpp CGNS, lupng mau mat trung bmh la 393 ± 564 ml (5-3,500 ml).
Nghien ciiu cua Yoon (2010) [20], lugng mau mit trung binh ciia nhdm cit gan HPT 2,3,4b,5,6 la 707,3 ± 1056,8ml, ty le BN phai tmyIn mau
trong md la (29,5%). Tinh chung cho nhdm cat gan d HPTl,4a,7,8, luong mau mat trong mo la 808,3 ± 1011,7ml, ty le BN fruyin mau (33,3%).
- Ty le chuyen md md: Nghien curu ciia tac gia Chung.C.D [2] cho tiiay, ty le chuyen mo md tii 7.2-25.9%. Hitoshi Inagaki, Daniel Cherqui thiy ty le nay tu 5-15%. Ty le chuyen md md qua nghien ciiu la 14.9%. Nguyen nhan chuyen sang md md chii yeu la chay mau, vd khdi u va khdi u xam lan, khd phau tich.
3.4. Ket qua s&m sau mo
- Thai gian nam vien trung binh: 7. 7±2.9(3- 21) ngay. Thai gian nam vien tnmg binh qua cac nghien ciru 7.0-9.9±5.6 ngay [5,20]
- Bien chiing sau md
Phiu thuat cat gan ludn c6 ty le bien chiing va hi vong cao hon so vai cac phau thuat khac ciia dudng tieu hda, d^c biet trong trudng hgp xo gan,
Ty le bien chumg sau md CGNS dieu tri UTG dupc ghi nhan hi 5-20%, vdi BN xa gan ty 1? nay la 10-30%.
Ket qua NC cho thSy: khdng c6 hi vong va suy gan sau md. Ty Ip bien chiing sau md la 14% trong dd: chay mau sau md chiem ty 1? 3,5%, rd mat 1,8%, fran dich mang phdi 10,5%, c6 chudng 7,0%, d dpng dich 1,8%, nhilm khuin vit ml 5,3%._
Biin chumg sau md dupc phan loai theo Cla- vien-Dindo (2004) [7] cho kit qua nhu sau: Dp I/II/ni hiong ling vdi 05/09/03 (29,4% / 52,9% / 17,6%), khdng cd do IV va V.
Tap chi GAN MAT VIET NAM s6' 32-2015 69 Nghien cuu cua Tranchart (2010) [19]: dp
mi/in/W/V tuong ling la 3/3/3/0/1 (30%/ 30%/
30% /0%/10%/).
Tac gia Dagher (2010) [5]: dp I/II/nLTV/V tuong ling la 23/7/5/1/2 (60,5% / 18,4% / 13,2%
/ 2,6%/5,2%).
V.Kltln^n
Phau thuat cat gan npi soi dieu tri ung thu gan la phau thuat an toan, co tinh kha thi, huac diiu cho ket qua tot. Chi dinh phu hop voi cac benh nhan co chiic nang gan con tot, kh6i u co kich thuoc trung binh < 5cm, nam a ha phan thiiy 2,3,4b,5,6.
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