NGOAI KHOA S6 3-2011
DANH GIA K^T QUA P H A U T H U A T C A T T O I MAT NOI SOI TAI BfNH VI$N DA KHOA KI^N GIANG
Nguyin Quic Vi$f*, Triin Bfio Long**
T6M TAT
Nghien ciru 432 TH cSt tui m§t n$i sol do sdi v4 polyp tii thang 06/2006 - 12/2010 t?l BVBK Kiem Giang. Ket qua: dd tudi hay g^p tir 41-60 tuoi, 95,50%, nir chigm ty 1$ niiiSu hdn nam gSp 3 IBn. Trieu ctiCTng ISm siing chii y^u 1^ dau HSP, vang mSt vang da chidm ty l | rat thap (1,62%).
7/432 TH polyp trieu chutig chii yeu 1^ dau titc vung HSP va thu'dng v| khdng co TH nao sot Sieu am CO gia tri chan doan chinh xac rat cao (98,12%). Thdl gian mo: 68,5 phut (30-150) so ngay nSm vien:3,7±2,4 (ngay). Tai bidn chung trong mo: 18,06%, phan Idn la thiing tui mat, 0,64% ton thu'dng du'dng mat chinh. Bien chirng sau m6:5,5% g3p hau het la cac nhe dieu tri noi khoa on djnh. 3 TH mo lai: TSc mat ITH va Chay mau 2 TH l<St qua s6ni: Tot: 87,04%; trung binh: 10,42%; kem: 2,54%. Ket qua sau mo 3 th^ng: Tot: 93,63%; trung binh: 6,37%. Khong CD ket qua kem.Khong co benh nhan tir vong.
I. Oi^T V A N OE
B?nli ly cua nii mSt 14 b^nh thutoig g?ip trong ngo?ii khoa. Ty 1$ b?nh soi tui mat 6 cac nu6c Au, My chilm kho^g 5 - 10% dan s6 [14],[15],[18]. 6 Vi$t Nam, theo thong ke a cdc bfnh vi?n a ca 3 miln, cd quan va dan Y cho thay so lugng b?nh nhan phlu thudt cdt tui mdt kha Ion, chiing to soi tui mat co rdt nhik 6 Vi?t Nam [5, [7], [12]
Ndm 1882, Carl Langenbuch lan diu tien th\rc hi|n thanh c6ng truang hgp mo ma
* BVBK Kien Giang ** BV Viet Bui
cat tii mdt diu tien vd ky thuat ndy dugc dp dyng rjng rdi trong ngo?ii khoa trSn khdp thi gidi trong hem m§t thi ky qua [6] Cho din thdnh c6ng cua trudng hgp cdt tiii mat ngi soi diu tien do Philippe Mouret 6 thanh phi Lyon (Phdp) th\rc hi$n ndm 1987, ky thuat phlu thu^t cdt tiii mat ngi soi da dugc phi bien vd triln khai nhanh chong a cdc nu6c Au - My vd lan r$ng ra toan thi gicri. Phau thudt cdt tui mdt ngi soi dugc nghien ciru nhilu va ngdy cang tra nen hodn thien hon dugc c6ng nhdn la "tieu chuan vang" (Gold Standard) trong dieu tri benh ly tui mat [I], [10],[13]
Tai BVDK tinh Kien Giang, tir nam 1997 ky thuat mo npi soi cung da duoc ap dyng, nhung van khong trien khai rong rai dugfc do c6 nhihig kho khan dac thu cua benh vi?n tuyen tinh. Mai den n5m 2006, phau thudt npi soi dugrc ap d\mg thucmg quy tai BVDK Kien Giang cho den nay. Tu nhiing van de neu tren, qua kinh nghiem thuc tien chung toi th\rc hi?n de tai nghien cuu '*BAnh gid kit qua phdu thugt cat tui mat n^i soi tgi BVDK Kiin Giang " nhim muc tieu:
1. Nhgn xet dgc diem b$nh ly cua cdc truang hgp CTMNS tgi BVDK tinh Kien Giang
2. Ddnh gid kit qud ung dung phdu thugt CTMNS tgi BVDK tinh Kiin Giang tic thdng 06/2006-12/2010
32
NGOAI KHOA sd'3-2011 n. BOI TUIJNG VA PHUONG PHAP NGHIEN COU
2.1. Tiiu chuan lira chgn
- Gom tat ca b?nh nhan it mgi lira tuli, da dugc ml edp ciiu vd chuong trinh CTMNS do soi vd polyp tiii mdt tai BVDK tinh Kien Giang tit thdng 06 ndm 2006 din
±dngl2nam2010.
- Co diy dli hi so va cdc dO li?u chan doan truoc ml, each thirc phau thujt, ket qud gidi phau b$nh, theo dai va ddnh gid kit qud sau mo.
2.2. Tieu chuan lofi trir - Soi dudng mat chinh phoi hgp - Ung thu tiii mat
- Khong xip b?nh nhdn vdo doi tugng nghien cim khi b$nh dn khong dii dif li$u tren.
2.3. Thiet kl ngien cihi
Nghiin cim theo phuong phdp: mo td cdt ngang
- Giai doan 1: Nghiin cihi hoi cihi. Thu th^p sl Ii$u tai phong luu trii hi so BVDK tinh Kiln Giang cua 367 binh an dd dugc ml CTMNS dat du da li|u n/c tit 06/2006 din 03/2010.
Giai doan 2: Nghiin cihi tiln cihi gom 65 TH tdt cd cac BN nay dugc quan sdt, m6 ta thu thap so li|u thong qua vile true
tiep khdm b|nh, tham gia dilu trj, chdm soc va theo doi b|nh nhan, ddnh gia kit qua sdm sau ml tir 04/2010 din 12/2010 .
- Phuong phdp chgn c8 mau: Ldy mau todn bg.
-I- Dja dilm: Khoa ngoai - B|nh viin Da khoa Kiln Giang
+ Thdi gian: Tir thdng 06/2006 din thdng 12/2010
- Cdc thdng tin phuc vy nghien ciru dugc thu thap theo mau benh dn nghien ciru. Xir ly va thu thap so Ii|u theo phuong phdp thing ke y hgc sit dung phdn mim SPSS 15.0 vdi P< 0,05 thi sy khac bi|t cd y nghTa thing ke
III. KET QuA NGHIEN COU
Til thang 06/2006 din 12/2010, cd 432 b?nh nhdn dugc CTMNS da chgn vao id nghiin ciiu, kit qud nghiin ciiu nhu sau:
-I- Tuoi: Trung binh: 55,6 ± 12 (thdp nhdt Id 22, cao nhdt 80).
- Do tuoi 4 1 - 6 0 chilm nhilu nhdt (56,71 %)
+ Gidi: nam: 121/432 (28%), NQ:
311/432 (72.%), (p<0,05)
^ D$c diem lam sdng
Bang 3.1 Cdc triiu chimg Trieu churng
Dau HSP Sot
Vanq da, vanq mdt Kem dn , roi loan tieu hda.
Tui mat to Phan iinq HSP
N=432 408 / 432
94/432 7/432 45 / 432 69 / 432 164 / 432
%
94,50 21,76 1,62 10,42 15,97 37,96
33
NGOAI KHOA S6'3-2011 -1- Ddc dilm siiu dm
Bdng 3.2 D l i chilu hinh dnh siiu dm trudc m l vd t i n thuong trong m l Hlnh inh SA
Cd sol tui mat Thanh till mat day > 3mm Polyp till mat Till mdt cdnq to TM teo nhd
Hinh inh SA tru'dc mS
426 173 12 95 8
TSn thu'dng b^nh ly trong md
418 150 7 119
10
0 9 chinh xac f»/o) 98,12 86,71 58,34 79,83 80
+ Chi djnh mo Biiu do 3.1 Chin doAn tru6c m6
n \ T M man dn soi
• SoiT.M D \ ' T \ 1 ciip do soi D Polyp T M
• \ T M m:in tinh liliong soi
Ty Ie %
+ ThM gian mo
Bang 3.3 Thai gian md Thdl gian m6
<60' 61' - 90' 91' - 120'
> 120' Tonq sd
N = 4 3 2 207 154 53 18 432
%
47,92 36,64 12,29 3,15 100%
-1- Tai biln trong m l
Bang 3.4 Cdc tai biln trong mo Loai tai bien
Thiinq tiii mat
S o c a 50 / 432
%
11,57
NGOAI KHOA so 3-2011 Chay mau > 100ml
Ton thtfanq dudnq mat Thiinq ta tranq
Tonq
22 / 432 4/432 2/432 78 /432
S,09'>>'!A>
0,93 ' 0,47 18,06%
+ Bien chung sau mo
Bang 3.5 Cdc bien chiing sau mo Loai bien chihig
Tu mau du'di qan Chay mau Ap xe ton du Nhiem triinq lo troca Tdc mat sau md Tonq cdnq
N=432 7 3 2 10
2 24
TvIS 1,60 0,68 0,46 2,30 0,46 5,5 H Ngay nSm vien
Bang 3.6 Thin gian n3m vien Ngiy nim vien (ngay)
< 2 3 - 4 5 - 6 7 - 8
> 9 Trung binh
N-432 77 273
50 12 20
Ty le »/o 17,82 63,20 11,57 2,80 4,61 3,7±2,4 (nqay)
Biiu do 3.2. Kit qud sdm Bilu do 3.3 Kit qud sau 3 thang
NGOAI KHOA S6 3-2011 IV. BAN LUAN
4.1. Tuoi: Tren 432 BN thupc nghien cuu n^y, tuoi trung binh I& 56,6 ± 12 (tuoi th^p l^ 24 tuoi, cao nhat Ik 80 tuoi). Dp tuoi tir 41 - 60 chiem ty I? cao nhat (56,71%).
Day 1^ dp tuoi lao dpng, d6ng vai tro chu chot trong gia dinh. LOra tuoi cua BN m^
chiing toi g$p trong b?nh ly s6i va polyp tiii m^t dupc mo cat tui mat npi soi cung tuong t\r -vdi nghien cuu ciia mpt so t^c gi^ if nudc ta da thdng bSo nhu: Do Kim Scm la 54,7%
[12] Doan Ngpc Giao, Nguyen Duy Duyen la 56,6% [3]
4.2. Gidi: NiJ gap 3 Ian nam
Theo Lawrence,W.Way [20] npi tilt to cua nO tuoi man kinh nong d0 estrogen lam s\r bao hoa cholesterol trong m?tt va progesterol lam giam kha nang co bop tui mat dan din u meit de hinh thanh soi tui mat, viem tiii mlit vi v^y gap 6 nG nhieu han nam.
Yeu to phu nQ mac benh soi TM tang hon nam la do sinh de lam thay doi kich t6 niJ
4.3. Lam sang
Dau HSP: Trieu chiing dau HSP (94,50%) tuong duong voi nghien cuu cua Cao Vi?t Dung (95%) [5] va Collet (94,6%) [22]. Theo thong ke ciia nhieu tac gia, dau HSP thucmg CO ty 1^ dao dpng tu 88 - 100%.
[6]. [13], [22], Dau nhieu do soi di chuyin, nhit la khi BN v£in dpng hoac lao dpng n§ng nlu dupc nghi ngoi va dung thuoc giam co that thi het dau. Doi khi BN dupc nghi ngoi, dimg thudc giam co that nhung tinh trang dau van khong dd va kem theo c6 s6t nen vao vi?n de dieu tn. Doi voi BN co tiln sur viem tiii mgt cip do soi ket co tiii mat thi khi phau thu^t phai het siic than trpng
D6i vdi dau do polyp tiii m$t, benh nhan CO cam giac dau viing hsi sudn phai ho^ic
thupng vi, cam gidc diy b\ing, k^m an, an thiy kh6 tieu it khi kem theo s6t do do de nham tudng vdi b?nh ly da day - ta trang
D0c diem dau trong nhom n/c chiing toi la dau am i, dau tire viing thuang vi, co lien quan din bira an ho§c khong. Vi dau viing thupng vj tren r6n nen s6 b/n dupc kham va chdn doan la dau dg day - ta trang, dieu tri khong kit qua. Sau do mdi dupc phat hi?n la polyp tui mgt.Trong b?nh polyp tui mat chiing toi khong gSp trudng hpp nao sot
- Phan ling ha sudn phai gap tren 164 BN chilm ty 1? 37,96% (bang 3.1) tri?u chumg nay thudng xuat hi^n sau dau tir vai gid den vai ngay gap trong nhimg trudng hpp viem tiii mat do soi va viem tiii mat cap khong soi, soi k^t co tui mat va nhChig BN dS CO nhieu Ian dau trong tien sir. Trieu chung nay c6 the kem theo vdi nong sot, ret run va sieu am xac dinh tiii mat co soi, thanh tiii mgt viem day, dich quanh tiii mat. Nhihig trudng hpp nhu vay khi phau thuat thudng gap kho khan. Nhieu tac gia cimg nhgn dinh tuong tir nhu: Nguy6n Hoang Bac [2] Nguyen Cudng Thinh [13], Van Tan [14]. chiing toi gap 5 trudng hpp phai chuyen mo hd (se ban ky 6 tai bien trong mo)
- S6t: Chilm ty 1? 21,76% cao hon so vdi ty I? cua Cao Vi?t Dung (2006): 3,3% [5 ] tuong duong vdi D ^ g Thanh Dong (2009) [6]. Sot thudng xuat hipn sau khi dau HSP;
Co 5 trudng hpp s6t ndng, s6t ret trudc khi dau, 5 trudng hpp nay deu bj viem tiii mgt cap. ca 5 trudng hpp nay ddu dupc mo sau khi dieu trj khang sinh, het sot, dd dau. Khi m6 thay tiii mSt viem day, mac ndi dinh vao tiii m$t, gd dinh, chay mau tir thanh tiii mat tuong ddi nhilu. Cupc md kho khan, ca 5 trudng hpp thdi gian md diu keo dai > 90'.
36
NGOAI KHOA so 3-2011 - Vang da; Gap 7 trudng hop, chilm ty
1? l,62%.Trong 7 trudng hpp vang da, khi md chiing tdi thdy: 6 trudng hop c6 sdi lo ket cd tiii mat chen vao dng gan dng gan chung gdy vang da (Trudng hpp nay chiing tdi cdt tiii mgt xudi dong ). 1 trudng hpp co sdi tren gan, sieu am 2 lan khdng phat hi^n ra. Sau md cat tiii mat 3 ngay, benh nhan xudt hien vang da tang dan, sieu am ki6m tra cd sdi k?t phdn thdp OMC, chiing tdi thuc hien ldy sdi OMC qua ERCP (se ban ky d phdn tai biln trong md).
Theo Do Kim Son, sdi tiii mat it khi gay vang da, vang da chiem ty Ie 11% trong viem tui mat cap, bieu hien su li mat do nhiem triing dudng mat [12], vang da c6 thi xuat hien khi hii mgt cang to hoac sdi cd TM de vao OMC, dng gan. Vang da ciing cd thi xuat hien khi sac td mgt ngam vao mau qua cac chd tdn thuong niem mac TM hoac viem ca Oddi (gap trong 25% trudng hpp) [18].
4.4. Sieu am 6 bung.
Sieu am trudc md cd sdi hii mat 426 trudng hpp (bang 3.2). Tdn thuang trong md 418 benh nhan cd sdi tui mat. Dp chinh xac dgt 98,12%. Ddi chidu giO'a sieu am trudc md va tdn thuong trong md, ndi chung dp chinh xac cua sieu am trong sdi tiii mat cd the cho miic dp chdn doan dua vao dang tin tudng.
Tiii mat cang to: 95/119 TH, do chinh xac dgt 79.83%
Tiii mat teo nhd: 8/10, dp chinh xac dgt 80%
Dp day thanh tiii mgt > 3mm; 173/150 TH, dp chinh xac dgt 86,71%
Theo Dgng Van TSm va Nguyen Dinh Hdi [15]. Dp chinh xac ciia sieu am cd sdi tiii mgt la 83,3%.Tui mat to: 88,8%. Dp day thanh tiii mgt cd dp chfnh xde la: 86,1%.
Theo Hoang Viet Diing: do chinh xac sieu am cd sdi TM dgt: 98%; tui mat cang dp chinh xac: 58,7%; TM teo nhd: 55,6%; thanh TM day dp chinh xde dgt; 96,6% [4 ].6]
Sieu am la phuong tiSn chdn doan sdi TM cd dp chinh xac cao. La loai thSm dd can lam sang it xam hai, c6 gia thanh r6. Chiing tdi chii truang sieu am trudc md it nhdt 2 idn de danh gia tinh trang tiii mat va cac td chiic quanh tiii mat
4.5. Chi djnh mo
Theo (bilu dd: 3.1) cho thdy 71,06%
benh nhan chan doan trudc md viem tiii mat man tinh do sdi, sdi tui mat dan thudn la 22,89%, cdn lai mdt sd nhd la viem tui mat cap, man tinh khdng sdi, va polyp tiii mat.
Chiing tdi thdng nhat vdi y kien ciia Mahamad SF (2001) [21]. Chi dinh cdt tiii mat ngi soi cung gidng cat tiii mat md, do la : viem tiii mat man tinh do sdi, hoac khdng sdi, polyp tiii mat, viem tiii mat cap.
Theo nghien ciiu cua Nguyen Cudng Thinh (2004) [13] co cdu benh ly trong cdt tiii mgt ndi soi bao gdm viem tiii mat mgn tinh do sdi la 87,0%, viem tiii mgt mgn tinh khdng sdi la 1,1% polyp tiii mat la 4,1%, viem tiii mat cap la 5%
4.6. Thdi gian mo; ngan nhat la 30 phut, dai nhdt 150 phiit, himg binh 68,5 phut (bang 3.3). Thdi gian md cua chiing tdi tuong duong vdi thdi gian md ciia Tran Binh Giang (68 phiit) [7], nhilu hon cua Nguyin Cudng Thjnh (51,4 phiit) [13]. Va nhilu hon cua Muhammad S.P(2001)ia60phut[21].
Theo chiing Tdi thdi gian md nhanh hay chgm cdn phu thudc vao mpt sd yeu td sau:
- Bdt thudng dng cd tiii mat va ddng mgch tiii mat
- Tinh h-ang tdn thuong tiii mat.
37
NGOAI KHOA S6 3-2011 - Kinh nghidm ciia phSu thu^t vien va
kip md
- Dieu ki?n trang bj may mdc va dyng cy PTNS
4.7. Tai bien trong ni6: Mo cfit ttii mdt bang phuang phap n0i soi din nay da dupc cac nha phdu thugt trdn the gidi cdng nhgn la m§t phuong phap phau thugt uu vi?t. Tuy nhien nd khdng thi thay the hoan toan cho phau thu^t md kinh diin va van cd t^" I§ tai bien nhdt djnh. Trong nghien cuu ndy, tai bien g$p nhilu la thiing tiii mat (11,57%), chay mau > lOOcc la 5,09% (bang 3.4).; Tdn thuong dudng m^t 0,93%; Thimg ta trang 0,47
Cd 4 trudng hpp tai biln tdn thuong OMC (bang 3.4). Chilm ty le 0,93%, ty 1?
nay tuang duong vdi nghien cuu ciia Nguyen Thanh Long (0,9%) [11] cua Van Tdn (0,83%) [14] va nhieu hon cua Nguyen Dinh Hoi (0,6%) [10 ] Daniel la 0,6%
- Mpt trudng hpp viem tiii mat do sdi, thanh tiii mat va vung tam giac Calot viem day dinh nhieu. Khi phau tich vimg co tui mat dinh, chay mau. Khdng nhan dinh rd mdc giai phau. Phau tich 60 phiit khdng xac dinh dupc dng tiii mat. Trong khi phSu tich, chiing tdi da nham OMC la dng tiii mgt nen da c|p clip va cat ddi OMC ma khdng bilt, cupc mo keo dai 130 phiit.
Hgu phau ngay thir 2 b?nh nhan trung ti?n, an uong cham tieu, tir ngay thir 3 xudt hi?n vang da tang ddn. Sieu am phat hi^n mdt mpt dogn OMC.
B?nh nhan dupc chuyin len B?nh vi^n Chp Ray vao ngay thir 5. Sau do BV Chp Rdy md Igi dl sua chita tdn thuong dudng mat bang each ndi mat rupt kilu Roux - en -
Y .Theo m0t s6 tac gia thuong t6n nay thu^c t6n thuang dudng mat nhom C [17], [19]
- Hai trudng hpp tiln sii da md sdi dng m^t chu va I viem tiii mat cap do sdi. Ca 3 trudng hpp nay viing tam giac gan mat viSm ddy dinh nhieu nen khi thao tac co tiii mat da lam thung ong mat chu, Theo mpt sd tac gia thuong ton nay thupc tdn thucmg dudng mdt nhdm B [17],[19]. ChOng tdi phat hi?n ngay trong mo va chuyen md md kilm tra them, gd dinh + d$t Kehr vao noi ton thuang khau Igi ong mgt chu. Sau mo benh nhan dn dinh va dupc xudt vi^n vao ngay thu 10. Theo y van ty 1$ ton thuang dudng mgt d nhihig b^nh nhan cat tiii mat md dao dpng tir 0,2% - 0,5%, ty 1? nay dao dpng tir 0,2% - 3% d nhihig b$nh nhan phau thugt cat hii mgt ndi soi [16]
4.8. Bien chirng sau mo:
Theo ket qua thu dupc d (bang 3.5): co 24 trudng hpp bien chiing sau md chilm 5,5%.Ti 1? nay cao hon so vdi ket qua nghien cim cua Nguyen Cudng Thinh (2006) la 2,5% [13], thdp hon kit qua nghidn cihi cua Tir Dire Hien, Nguyen Hoang Bdc (2006) la 6,3% [8], tuang duong vdi ket qua nghien ciiu dupc cdng bd ciia Delair (1992) la 3,4%.
Chiing tdi g§p 2 trudng hpp chay mau tii d0ng mgch tui mgt chiem ty Id 0,46%. B$nh nhan md cat tiii mgt, tiii mat bj viem dinh.
Qua trinh md dien bien thuan Ipi. Sau mot ngay b?nh nhan bidu hi?n dau tiic dudi sudn phai, day byng, da niem mgc nhgt mau.
Mgch, huyet ap 6n djnh, xet nghidm hdng cau va HST giam nh$, sieu am d bung thay 1 khoi djch, mat dp khdng ddng nhat, ranh gidi khdng rd rang, nam d vung hd tiii mat. Benh nhan dupc chan doan chay mau d byng sau mb va md Iai vao ngay thii 2. Khi md kiem
38
NGOAI KHOA so 3-2011 tra thdy cd mdu ciic vd mau ichong ddng vCmg
dudi gan. Hut bom rua ldy hit mau cue, Icilm tra thdy mdu ri ra tir mdm cdt dgng mach tiii mat do hi tut 1 ciip, cdn 1 clip bj idng, gdy ri mdu. Chung tdi xii ly bugc lai dgng mach bdng chi Vicryl 4/o.
Mot sd tdc gia cho rang, nguyen nhdn quan trQng gdy tut clip cgp dqng mgch let do edp khong diing ky thugt. Clip phai cap vudng goc vai true dQng mgch, tructc khi edp phai nhin thdy 2 ddu dia clip de trdnh cgp vdo cdc to chiic xung quanh, phdi cgp 2 clip song song v&i nhau khdng dugc chdng cheo hogc lech goc. Khi cdt dgng mgch, khdng cdt qud gdn clip, neu mdm cdt dgng mgch con Igi qud ngdn nen huge them mgt nut chi tdng cudng [7], [8].
4.9. Ngay ndm vi^n
Thdi gian ndm vi?n trung binh la 3,7 ± 2,4 ngdy. Trong dd 17,82% ra vien trong 2 ngdy sau phau thuat, 63,20% ra vien sau 3 - 4 ngay (bdng 3.6).
Kit qud nghien ciiu nay ciing phu hgp vdi Tir Diic Hiin vd NguySn Hoang Bdc [8]
Id 3,65 ngay, Nguyen Dinh Hdi Id 3 ngdy [9].
Nghien cdu ciia Karayiannakis (2007) thdi gian ndm vidn la 3,1 ± 2.1 ngay, cua Montri (1994) Id 1,7 ± 2,4 ngay dli vdi ml ngi soi vd 5,6 ± 3.6 ddi vdi ml md [9].[16], [21]
Mdt dilu dl nhan thdy Id thdi gian ndm vi?n d benh nhdn ml ngi sgi ngdn hon vdi thdi gian ndm vien ml md. Thdi gian nam vi$n ngdn ldm gidm bdt chi phi dilu hi cho benh nhdn vira tdng hieu qua su dung giudng benh
4.10. Kit qua sdm sau mo:
Ddnh gid kit qud sdm chung tdi dvta vdo mgt sl chi tieu trong thdi gian ndm vi?n sau
md nhu: Mdc do dau sau md, thdi gian trung dfn, cdc bien chiing vd ket qud xii tri cdc bien chung.
Trong nghien ciiu nay cd 376 benh nhdn dat kit qud tit chilm ty le 87,04%, tuong duong vdi ket qud cua Nguyen Duy Duyen (2005) 87,04. Kit qud trung binh chilm ty 1?
10,42%. Kit qud kdm chilm ty ie 2,54%.
4.11. Ket qud sau ml 3 thdng.
Chung tdi dua vdo mgt sl yeu td:
- Mlic dg cdi thi?n cac tridu chdng ldm sdng.
- Thdi gian phuc hii sdc khoe.
- Cdc biln chdng mugn.
Trong nghi6n ciiu cd 432 benh nhdn, sau ba thdng chung tdi khdm Igi dugc 282 benh nhan (cliilm ty II 65,28%). Nhdn thdng tin qua dign thoai cd 75 b?nh nhdn (chilm ty Ig 17,36 %). Nhan thdng tin qua thu trd ldi 67 bgnh nhdn (chilm ty le 15,51%). Mdt liSn lac 8 benh nhdn (chilm ty 16 1,85 %).
Kit qud tit dat 93,63%
Kit qda trung binh dat 6,37%.
Khdng cd ket qud kem.
V. KET LUAN
Qua nghidn ciiu ddnh gia kit qua PTNS cdt tiii mdt tvr nam 2006 din nay vd kit qud phau thuat 432 bgnh nhdn ml CTMNS t?i Bgnh vien Da khoa tinh Kien Giang. Chung tdi nit ta mgt sl kit lujn sau:
1. Ddc diem bf nh ly (sdi, polip) tdi m|t Lam sdng:
Bgnh ly (sdi, polyp) tui mlit hay gdp d Ilia tuli tir 55,6 ± 12. Gidi. Nil chilm t^ le:
72%, Nam: 28%. Nghl nghidp tieu thuang (tu do) chilm ty le cao nhdt 63,42%
- Sdi tui mat cd cac ddc dilm ldm sdng:
Dau HSP ttifu chiing hay gdp (94,50%);
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NGOAI KHOA S6 3-2011 phdn ling thdnh bung vung HSP (37,96%); TAI sot (21,76%); vdng mdt, vdng da chilm tJ' 1| 1.
thdp nhat (1,62%).
- Polyp tui mat it gdp hem sdi tui m^t (7/432 bgnh nhdn), cd ddc dilm lam sdng dau am i, dau tuc vung thuong vj, khdng cd 2.
trudng hgp ndo bj sot.
Cin ldm sdng: 98,12% sieu dm cd gid trj chan dodn chinh xde vl sdi tui mat, tin thuong hay gdp hong mo Id 96,76(%) cd sdi 3.
tui mdt, tin thuang gidi phSu b$nh phi bien la 95,60 (%) Id viem tui mgt m^n tinh do sdi.
2. Ket qud dng dyng phSu thu|t CTIV1NS
Thdi gian phSu thuat trung binh 68,5 4.
phut,
- Thdi gian ndm vign sau ml la 3,7 ± 2,4 ngdy
- Tai bien trong mo: 18,06%, phdn idn Id thung tui mat: 11,57%, tai bien thung ta trdng 5.
id: 0,47%, tin thuang OMC la: 0, 93% , chdy mdu trong ml id: 5,09%. Khdng gdp cdc tai bien tdn thuang mach mdu idn, tdn thuang cdc tang trong thi chgc troca.
- Bien chiing sau md 5,5%. Trong dd tdc 6.
mat cap sau mo Id: 0,46%, chdy mdu sau mo la 0,46%, dp xe tin du la: 0,68%.
Ket qua phau thu^t dieu trj.
- Ket qud sdm: Tdt: 87,04%; trung binh:
10,42%; kem: 2,54%.
- Ket qud sau ml 3 thdng: Tdt: 93,63%; 7.
trung binh: 6,37%. Khdng cd kit qud kdm.
- Khdng cd bgnh nhdn tir vong.
Phau thujt CTMNS id mgt phuong phdp 8.
phau thuit cd nhilu im diem, cd thi dp dyng r0ng rdi d cdc Bgnh vign tuyin tinh,huygn khi cd du cac dilu kign nhu phau thudt vien vd trang thiet bj
u i u THAM KHAO.
Nguyin Hodng Bdc (2005) "PhSu thudt ngi soi diiu trj sdi duang mat", httD;//www.ctu.cu./workshp....23.S.200 5
Nguyin Hodng BSc , Biii An Th?
(1998) " T6n thuang duang mdi chinh trong cdt lui mdt ngi soi ", ngoai khoa (33,6)Tr38- 45
Nguyin Duy Duyen, Dodn nggc Giao (2005) ^*Mgl sd nhgn xel qua 118 trucmg hgp cdt tui mat ngi soi tgi Binh Vien Viit Tiip", Y hgc thyc hdnh (sl 9/2005) Tr - 23
Hodng Vi|t Dflng (2006) "Nghiim cim ddc diim ldm sdng, can ldm sdng vd kit qud diiu Iri phdu thugt viem tiii mat a nguai cao ludi'\ Luan vdn thac sT Y hgc- Trudng Dai hgc Y Ha Ngi.
Cao Vigt Dung (2006) "Kit qua cdt tui mat ngi soi d bung tgi khoa ngogi long qudi Binh Viin tinh khanh Hoa", Tap chi Y hgc Viet Nam- thdng 2/2006 tr 148-156
D|ng Thinh Dong (2009), "Md ta dgc diem ldm sdng, can ldm sang vd kit qua phdu thugt ngi soi cdt tdi mgt cap cwu do viem tui mgt cap", Luan vdn tdt nghidp Bdc Sl chuyen khoa cap II, Trudng Dai hgcYHdNgi
Trin Binh Giang (2003) VAdM thugt ngi soi d bung", Nhd xudt bdn Y hgc 2003 .Tr 144-156
Tit' Dd-c Kiln, Nguyin Hodng Bdc (2006) "Phdu thugt ngi soi cit tii mat trin b4nh nhdn cd vit md bttng cii", Y hgc Vigt Nam sd djc biet thdng 2/2006- Tr 150
40
NGOAI KHOA SO 3-2011 9. Nguyin Dinh Hii (2002) "NhOng tiin
bg trong chdn dodn vd diiu Iri soi mat"
Nggai khoa (sl 5), Tr . 5-6
10. Nguyen Dinh Hoi, Ton Thit Bdch (2005)" Nghien cuu itng dung khoa hoc cdng nghi trong chdn dodn vd diiu tri binh soi mat", De tai khoa hgc edp Nhd nudc. Tr. 1- 17
11. Nguyen Thanh Long, Do Kim Son (2003) "Nghiin cicu nguyin nhdn vd phuang phdp xii ly tai biin vd biin chimg cua cdt tui mgt ngi soi tgi Binh viin Viet Due", Ngoai khoa (sl 3). Tr 9-13 12. Do Kim San (1998) " Nhiing ling dung
cua phdu thudt ndi soi tgi Binh viin Viit Dire. Kit qud vd trien vgng" Ngoai khoa tap 23 (sl 6). phdn 2 ndm 1998 13. Nguyin Cuitng Thinh (2006) "Kit qud
cdt ttii mat ndi soi tgi Benh viin Trung uang Qudn 3di 108", Y hgc Viet Nam (tap 304) Tr98.
14. van Tin (2006) "Tiin bg trong cdt tui mat qua noi soi d byng tgi binh viin Binh Ddn", Tap chi Y hgc Viet Nam, (sd 2), Tr 137
15. D|ng Tam, Nguyin Dinh Hoi (1991)
"Viem tiii mat edp ddi chiiu ldm sang vd tin thuang", Hgi thdo ngoai khoa Cdn Tho, Hdu Giang Tr 99-104
16. Asagra JS et al (2001) "Is there a place for laparoscopy in management of poslchelecysteclomy biliary injuries, W,J.
Surg,25:10,pp 1331
17. Bisgaard T., Klarskov B., Trap R., et al (2001), "Microlaparoscopic vs conventional laparoscopic cholecystectomy", Surg. Endosc, Voll6,
pp. 458-464
18. Cheah W. K., Lenzi J.E., So J.B.Y., et al (2001), "Randomized trial of needlescopic versus laparoscopic cholecystectomy", British Joumal of Surgery, Voi 88, Issue 1, Page 45-47.
19. Karl A. Zuker (1991), "Converting open in laparoscopic cholecystectomy", Vol 7, pp 45-49 Quality Medical publishing, INC
20. LAWRENCE W. WAY, M.D.(1987)
"Pigment Gallstones Form as a Composite of Bacterial Microcolonies and Pigment Solids", Vol.206 * No.3, pp 242-249.
21. Muhammad S.P (2001), "Laparoscopic cholecystectomy". Surgical Laparoscopy, No. 10, pp 121-131.
22. Perisat j. collet. Dand BeUiard R et al (1992), "Laparoscopic cholecystectomy the state of art, A report of 700 case"
world J Surg (16. 1074), pp 82.
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