TAP CHi Y DlfpC Hpc CAN THg - SO 11-12/2018
N G H I E N ClTU D A C D I E M L A M S A N G , C A N L A M S A N G V A D A N H G I A K E T Q U A D I E U TRJ S O I O N G M A T C H U B A N G P H U O N G P H A P N Q I
SOI M A T TUY N G l / a c D O N G Of B E N H N H A N CAO TUOI TAI BENH V l J N D A KHOA TRUNG iTONG C A N T H O N A M 2015 - 2017
Nguyin Nggc Trdn*, Phgm Van Linh Truang Dgi hgc YDuac Can Tha
*Email: bsnguyenngoctran@gmail. com TOM T A T
Dgt vdn de: Soi du&ng mgt Id benh ly rdt phd biin & nuac ta. trong do da sd Id soi a dng mat chu - ong gan chung. Ky thugt lay soi du&ng mgt qua ngi soi mgt tgy ngugc ddng (NSMTND) da gdp phdn diiu tri thdnh cong binh ly sdi dng mat cha (OMC), giup benh nhdn cao tudi trdnh dugc cugcphdu thudt l&n vd th&i gian hdi phuc siic khoe nhanh. Muc tiiu nghiin ctiu: (1) Md ta cdc ddc diim ldm sdng. cgn ldm sdng tren binh nhdn sdi OMC. (2) Ddnh gid kit qud diiu tri so/
OMC bdng phuang phdp NSMTND. Boi lugng vd Phuong phdp nghiin ciiu: Nghien ciiu md td cdt ngang cdc binh nhdn >60 tuoi bi sdi OMC dugc thuc hi$n ngi NSMTND tgi Binh vi$n Ba khoa Trung uang Cdn Tha. Sd liiu dugc thu thgp tir 5/2015 din 5/2017 vd dugc xir ly bdng phdn mim SPSS 18.0. Ket qud: Cd 40 binh nhdn trong nghien ciru v&i tudi trung binh la 73.9±10,90 (nhd nhdt: 60, l&n nhdt- 95); ti le nam:nir la 2:3. Dau thugng v/V 37,5%; dau hg su&n phdi:
62,5%, tam chimg Charcot: 32,5%; bgch cdu tdng: 42,5%; tdng bilirubin: 55%; tdng amylase:
47,5%. Chgp du&ng mgt thdnh cdng 97.5%. Co 3 trirang hgp bj viim tuy cdp sau NSMTND ldy soi vd cd 3 tru&ng hgp deu dn dinh sau 3 hogc 4 ngdy. Ket lugn: NSMTND giup gidi quyit hdu het binh ly mgt tuy khong cdn phdu thugt Ngdy nay viic One dgng ky thugt NSMTND doi v&i nhiing trir&ng hgp soi OMC & nguai cao tudi Idphuangphdp diiu tri mang lgi hiiu qud cao.
Tir khoa: ngi soi mat tuy ngugc ddng, sdi mat, cao tudi.
ABSTRACT
CLINICAL, PARACLINICAL C H A R A C T E R I S T I C S A N D OUTCOME OF BILIARY TRACT STONES E X T R A C T I O N B Y E R C P IN T H E ELDERLY
AT CAN THO CENTRAL G E N E R A L H O S P I T A L IN 2015-2017 Nguyen Ngoc Tran, Pham Van Linh Can Tho University of Medicine and Pharmacy Background: Cholelithiasis is a widespread illness in Viet Nam in which the majority is biliary duct stones (choledocholithiasis). ERCP is a safe and effective method of treatment in elderly patients of cholelithiasis. Objectives: (1) To describe the clinical, paraclinical characteristics of cholelithiasis patients. (2) To evaluate the efficacy of ERCP on biliary tract stone extraction. Materials and methods: A Cross-sectional study in elderly patients (i.e. >60 year-of-age) who suffered from CBD stones and underwent therapeutic ERCP at the Can Tho Central General Hospital Data were collected from May, 2015 to May, 2017 and analyzed by SPSS 18.0. Results: There were 40 patients with the mean age of 73.9±10,90 (60 - 95) and the male-tofemale ratio of 2:3. Epigastric pain: 37.5%, right upper: 62.5%, Charcot's triad: 32.5%, leucocytosis 42.5%, hyperbilirubinemia 55%, hyperamylasemia: 47.5%. The success rate was 97.5%. Three patients had acute pancreatitis after stones extraction by ERCP and they all had been well after 3 and 4 days of conservative treatment Conclusion: ERCP is a safe and effective method of treatment in elderly patient with choledocholithiasis and may avoid undergoing a major operation.
Key words: ERCP, billiary stone, elderly.
TAP CHI Y DirpC Hpc CAN THP - SO 11-12/2018 I. D A T V A N D E
Sdi dng mat chft (OMC) la benh thudng ggp ttong cac bSnh ly gan - mat - tyy va kha phd biSn d Viet Nam ciing nhu cac nude tten thS gidi. Benh cd the gay ra nhiSu bien chftng, nSu khdng chan doan va diSu tti kip thdi cd the tft vong. Sdi nam ttong dudng mat lau dai lam tdn thuong dudng mat, nhu md gan thudng dan den teo h?p dudng mat dS gay ra sdi tai phat, xa teo gan, suy gan. Ke tu khi phuong phap ndi soi mat tuy ngugc ddng (NSMTND) ra ddi vao nam 1968 den nay phuang phap nay ngay cang phat triSn va mang Igi Igi ich to ldn ttong diSu tri benh ly mgt tyy giftp benh nhan ma nhat la bSnh nhan cao tudi ttanh dugc cudc phlu thuat md kinh dien de dieu tri hay dS chdn doan loai trft [10], [13]. O Vipt Nam, tft nam 1993, phuang phap ndi soi mSt tuy ngugc ddng dS dugc thyc hiSn tai cac tnmg tam ldn ve y hpc nhu benh vien Binh Dan, bSnh vien Chg Ray, benh vien Bgch Mai, benh vi?n Viet Dftc, ...va da cho nhftng ket qim dang khich le ttong viec dieu tri sdi dng mat chft tten nhimg benh nhan cao tudi [I]. Tgi b?nh vien Da khoa Tnmg uong can Tha nhihig nam gan day cung da triln khai ap dyng phuang phap ndi soi mat tuy ngugc ddng lay sdi dng mat chft, budc ddu da dgt dugc kit qim nhung chua cd nhilu nghiSn cftu thdng kS cu thS ttSn nhung benh nhan cao tudi. Chftng tdi tien hanh d l tai:
"NghiSn cftu dac diSm lam sang, cgn lam sang va danh gia ket qua diiu tri sdi dng mat chft bang phuong phap ngi soi mat tuy ngugc ddng d benh nhan cao tuoi tai Benh vien Da khoa Trung uong Can Tha nam 2015 - 2017" nham muc dich:
- Md ta cac dac diSm lam sang, can lam sang ttSn bSnh nhan bj sdi dng mat chu.
- Danh gia kit qua i S u trj sdi dng mat chft cfta phuang p h ^ ndi soi mat tuy ngugc ddng.
II. DOI TiTgfNG vA PinroNG PHAP NGHIEN ClTU
2.1. Doi tirgng nghien cftu: Tat ca bSnh nhan tu 60 tudi ttd len nhap vien dugc chan doan xac dinh sdi ong mat chft cd chi dinh ldy sdi dng mat chft bdng phuang phap ngi soi mat tyy ngugc ddng tai BSnh vien Da khoa Trung uong Can Tha 5/2015 dSn 5/2017.
Tieu chudn chon mdu: BSnh nhan >60 tudi va dugc xac lap chdn doan sdi OMC cd chi dinh thyc hien NSMTND lay sdi.
Tieu chudn logi trie: BSnh nhan sdi OMC kem theo benh ly ngi khoa ngng, sau nhdi mau ca tim, bSnh tim - phdi nang, suy hd hdp, rdi loan qim tiinh ddng cdm mau chua dieu chinh, cd benh ly vftng hdu hpng gay tdc, veo cot song ngyc, hep thyc qimn, m6 cat doan dg day ndi kilu Bilttoth II hay Roux-en-Y, benh nhan khdng ddng y tham gia nghien ciru.
2.2. Phirong phap nghiSn cihi
Thiit ki nghien cuu: NghiSn cftu md ta cat ngang.
C& mdu vd phuang phdp chon mdu: 40 benh nhan >60 tuoi thda tieu chuan chpn mdu dugc dua vao nghien cftu ttong khoang thdi gian tu 5/2015 - 5/2017.
Phuangphdp thu thdp mdu: Kham, ghi nhan cac trieu chung lam sang, dgc kit qua sieu am, cac ket qua xet n ^ S m mau. Sau khi thyc hiSn NSMTND, theo ddi sinh hieu, tinh ttgng dau bung, xuat huySt tiSu hda, amylase mau, sieu am bung kiem tta sau ldy sdi va danh gia kit qim diSu tri din khi xudt vien.
P/n«wg/'^xi>/;5 JO'/ifM-SdUpu dugc xft U vft phan tich bdng phdn mem SPSS 18.0.
Noi dung nghiin cuu: Chia nhdm tudi thanh cac nhdm tft 60 dSn 69 tudi, tft 70 den 79 tudi, tft 80 din 89 tudi va tft 90 tudi ttd ISn. Ghi nhan tiin su sdi OMC, benh ndi khoa kem theo, cac ttieu chftng dau bung, sot, vang da ruSm vft cac kit qua c ^ lam sang AST, ALT, bilirubin mau, amylase may, siSu am. Khi thyc hien NSMTND, ghi n h ^ dac diim 185
TAP CHI Y Dl/pC Hpc CXN THg - S6 11-12/2018
giai phau ta ttang, sdi OMC (sd lugng, kich thudc), dudng mat, phuang phap cdt co Oddi, phuang phap ldy sdi (tan sdi hay khdng tan soi), kSt qua lay sdi va cac tai biin va biin chftng sau lay sdi (thftng, chay mau, viem tuy cdp, nhiSm trftng).
H I . K E T Q U A N G H I E N C U t J 3.1. Bac diSm chung ciia mau nghiSn cuu Bang 1. Phan bd benh nhan sdi dng mat chu theo tuoi
Nhom tuoi 60 - 69 tu6i 70 - 79 tu6i 80 - 89 tu6i
>90 tuoi T6ng c^ng
n 15 11 11 3 40
37,5
%
27,5 27,5 7,5 100 Tudi trung binh ttong nghiSn cftu la 73,9±10,9;
Benh nhan cao tudi nhat ttong nghien cftu la 95 tudi.
Bang 2. Phan bd b?nh nhan sdi ong mat chft theo tien sft
bao gdm 40% nam va 60% nft.
Tien su lay soi OMC Phau thuat ducmg mat Npi soi MTND Chua lay soi
n 13 5 5
%
32,5 12,5 12,5 13/40 benh nlmn cd tien sft lay sdi bang phlu thugt dudng mat la 32,5% ttong khi ty IS benh nhan da dugc lam ngi soi MTND ldy sdi OMC la 12,5%.
Bang 3. Phan bd cac benh ndi khoa mgn tinh di kem Cac benh npi khoa di kem
Tang huyet ap B?nh dpng mach vanh Dai thao duong tip 2
Benh ph6i man tinh (hen, COPD, lao) Tai bien mach man nao cii Rung nhi / ngoai tam thu that Suy than man
Co n 16 9 8 2 3 1 2
%
40 22,520 5 7,5 2,5 5
Khong n 24 31 32 38 37 39 38
60
%
77,5 80 95 92,5 97,5 95 Tang huySt ap, benh ddng mach vanh va dai thao dudng tip 2 la 3 benh r phdi hgp chilin ty le cao nhdt ldn lugt la 40%, 22,5% va 20%.
3.2. Dac diSm lam sang va can lam sang ciia sdi ong mat chft Bang 4. Benh canh lam sang sdi dng mat chft
B^nh canh lam sang Dau hg sudn phai Dau thuong vi Sdt vang da Tam chftng Charcot
n 25 15 22 17 13
•*"•"'
6 2 p
37,5 J
" i
42,5 • 32,5 • 186
TAP CHI Y DUpC Hpc CAN THg - SO 11-12/2018
Da sd cac benh nhan dlu dau d hg sudn phai, sdt nhung vang da khdng nhiSu.
Bang 5. Dac diSm vS sinh hda va cdng thftc mau cfta sdi dng mat chu Dac diem xet nghiem mau
So lugfng b^ich cSu tang Bilirubin mau tnfc tiSp tang Men AST tang Men ALT tang Amylase mau tang
n 17 25 21 21 19
%
42,5 62,5 52,5 52,5 47,5 Sd lugng bach cau, amylase mau da sd dSu khdng tang ttong khi cac xet nghiem khac nhu AST, ALT, bilirubin mau deu tang.
3.3. Ket qua lay soi ^ng m^t chu bdng ngi soi m^t tiJiy ngirgc dong Bang 6. Ket qim chup dudng mat
chyp duong mat Thanh cong That bai
n 39 1
97,5
%
2,5 Cd I trudng hgp khdng chup dugc dudng mat (2,5%) do may ndi soi khdng tiep can dugc vdi ta ttang.
Bang 7. KJ thu^t cat ca vdng Oddi Cat ca vong Oddi Cat chuan
Cat truoc
n 33 6
%
84,6 15,4 Phuong phap cat ca vdng Oddi kieu cat chan chiSm ty IS cao nhat (84,6%) Bang 8. Dac diSm sdi ong mat chft tten man tang sang
Mirc do dan OMC
So lupng soi
Kich thuoc soi
<15mm 15-20mm
>20mm 1 vien 2 vien
>3 vien
<10mm 10-20mm
>2Dmm
n 25 10 4 21 12 6 13 18 8
64,1
%
25,6 10,3 53,8 30,8 15,4 33,3 46,2 20,5 Dudng kinh OMC tiimg bmh la 14,4±5,24mm, (ldn nhat la 30nun, nhd nhat la 8mm). Cd 21/39 BN cd 1 viSn sdi (53,8%), Dudng kinh sdi tinng binh la 13,7±5,69nim.
Dudng kinh sdi nhd nhat la 5mm va dudng kinh sdi ldn nhat la 25Tmn Bang 9. Phuang phap lay sdi dng mgt chft
Phuong phap lay soi C6 tan soi
Khdng CO tan soi
n 10 29
74,4
%
25,6 Co 74,4% benh nhan khdng can phai tan sdi qua ndi soi trudc khi lay sdi.
187
Ti«lP CHi Y DUgC HQC CAN THO - S6 11-12/2018 Bang 10. Tai biin va biin chftng cfta ndi soi mat tuy ngugc ddng ldy sdi
Tai bien va bien chftng 1 ^ ^ mau dudng mat B|l^te tuy cap
{TMi l«
n 0 3 0
% ]
0 7,70 BiSn chftng viem tyy cap dugc ghi nhan d 3 tin-dng hop (7,7%). Trong nghiSn cftu 'cima ghi nhan trudng hgp nao chay mau dudng mat va thftng tft ttang.
IV, BAN LUAN
4.1. Bgc diem chung cua mau nghiSn cuu
Trong nghien cftu ciia chftng tdi, do tudi trung binh la 73,9±10,9 tudi va da sd gap d benh nhan cd do tudi ttong nhdm tft 60-69 tudi phft hgp kit qua cfta cac tac gia ttong nude [2], [11]. Sy phan bd gidi tinh cua bSnh nhan cftng khdng cd su khac biet gi vdi cac nghiSn ciiu trudc day vdi phdn Idn benh nhan la nu [5], [7], [9]. Da sd benh nhan sinh sdng d ndng thdn (70%) va lam nghi ndng (75%) nSn cung dS dang bi nhiSm trung, ky sinh trftng nhdt qua cdng vi?c lln thdi quen an udng, do dd nguy ca bj sdi OMC ciing cao hon [6]. cac bpnh ndi khoa phdi hgp thudng gap nhdt la tang huyet ap, benh mgch vanh va dai thao dudng tip 2. Tiin sft ldy sdi OMC bdng can thiSp NSMTND la 12,5%, thdp hon nhilu so vdi 45,3% ttong nghien cftu cfta Duong Ximn Nhuong [8] chftng td vi^c ap dyng NSMTND lay sdi cdn tuong ddi chua phd biSn.
4.2. Bgc diem ISm sang va cgn lam sang cua soi ong mgt chu
v l b^nh canh lam sang, ttong nghiSn ciiu ghi nhan 25 bSnh nhan dau hg sudn phai (62,5%) va 15 bSnh nhan (37,5%) chi cd trieu chftng dau thugng vi khi vao vien tirong ddng vdi bao cao cfta Quftch Trgng Dftc [3]. Khi danh gia ve cudng do can dau, cd 42,5%
benh nhan cd cudng dp dau it (vdi 0 din 2 diim theo thang diem dau NRS). Diiu nay cd nghia la mac du chdn doan tdm soat sdi OMC ttong cdng ddng la can thiet nhung se rat khd khan nlu chi dya vao trieu chftng dau hg sudn phai va cudng dd con dau cfta benh nhan dgc biet d benh nhan Idn tudi. Cd din 45% bSnh nhan khdng cd bilu hien sot, chi dugc phat hi^n nhiem trftng dudng mat khi tim d nhiem trftng va 55% benh nhgn bieu hien sdt vdi cac mftc dp sdt khac nhau. Benh nhan cd tam chftng Charcot diSn hinh la 32,5% va tham kham lam sang se giftp chdn doan cac trudng hgp nay tuang ddng vdi kit qua cfta Nguyen Hoang Khai (30%) [7]. Do do, cac dac diim lam sang chi cdn cd gia tti ggi y sft dung can lam sang dS chudn doan phft hgp nhdt la ttong bdi canh y hpc chftng eft dang ngay cang phat trien nhu hien nay.
v l dac diim lam sang, nghiSn cftu ghi nhan 42,5% bSnh nhan cd bgch cau tang dugc chia thanh cftc mftc dd tang bgch cau khac nhau. KSt qua cfta chftng tdi thap ban so vdi nghiSn cthi cfta La Van Phft (64,5%) [9] va Dao Xuan Cudng (72%) [2] la do cac tac gia La Van Phft va Dao Xuan Cudng dlu kMo sat ttSn tdt ca cac benh nhan khdng phai la ngudi ldn tudi nen sy dap ftng cfta bgch cau d ngudi tre mgnh ban. Trong nghiSn cftu, chftng tdi ghi nhan da sd cac xet nghiSm AST, ALT, bilirubin tryc tiSp, amylase mau dSu tang trudc thft thuat va sau khi lam ngi soi MTND lay sdi tlmnh cdng, cac chi sd imy deu ttd vS binh thudng. Qua siSu am, chftng tdi ghi nhan 100% benh nhan cd gian dudng m§t.
Sieu am byng nhgy khi danh gia gian dudng mat, thudng cd kem theo sdi dudng mat.
D u d i ^ mat cd dudng kinh binh thudng qua sieu am cd gia tti tiSn doan am tuih sdi dudng mat khoang 95% sau khi danh gia lai qua ndi soi MTND [13].
188
TAP CHi Y Dl/pC Hpc CAN THg - S6 11-12/2018 4.3. Ket qua lay soi ong mat chu bang noi soi mgt tijy ngu-gc dong
Trong 40 benh nhan, chftng tdi thdng dudng mgt thanh cdng d 39/40 benh nhan (97,5%). Ket qua ciing phft hgp vdi cac tac gia ttong va ngoai nude [3], [4], [5], [12].
Nghien cftu cung ghi nhgn 1 trudng hgp khdng thi thdng dudng mat (2,5%) do bSnh nhan cd tiSn sft phdu thugt d hanh ta trang lam biin dgng hanh ta ttang, khi bdt ddu thyc hien ndi soi MTND k j thuat viSn khdng thi dua dng ndi soi xudng dugc ta ttang D2 d l tiin hanh thdng nftm vft trudng hgp nay chung tdi chuyen md. Phuong phap cat ca vdng Oddi tiieo k j thugt cat chuan dugc diing nhilu nhdt (84,6%) do la phuang phap don gian, dao cat ludn dugc din dudng bdi dng thdng. Trong 39 trudng hgp thdng vdo dudng mat thanh cdng, sd benh nhan c6 1 viSn sdi la 53,8% tuong ddng vdi cac tac gia ttong nude [9]. Sd lugng sdi cang nhieu thi thdi gian lay sdi cang keo dai. Dudng kinh sdi tnmg binh la I3,7±5,69mm. Chien luge ldy sdi cdn tfty thudc rat nhilu vao dudng kinh cfta OMC doan dudi sdi va giai phlu ciia viing nhft tft Idn. Tat ca cac bpnh nhan ttong nghiSn cftu dSu dugc lay sdi thanh cdng, 74,4% benh nhan khdng cdn plmi tan sdi. 100% benh nhan cd dudng mat thdng thoang sau khi bom rfta. Ty IS thanh cdng cfta chftng tdi cao vi mdt phdn do ca mlu chua dft ldn va mgt phan do chftng tdi chi ldy mlu d bSnh nhan cd sdi dng mgt chft, cdn cac tac gia khac thi lay ca mau d sdi dng gan. Thdi gian tnmg binh lam NSMTND ldy sdi la 45,l±3I,I9phftt. Thdi gian trung binh cfta chung tdi dfti hem so vdi cfta tac gia Ta Van Nggc Dftc vi tac gia chia lam nhilu ldn NSMTND ldy sdi, mdi ldn khoang 15-25 phftt nhdm giftp bpnh nhan mau hdi phuc hon, it biSn chftng do gay me hon vi da sd benh nhan deu cd tudi cao. Nghien cftu ^hi nhan 3 trudng hgp viSm tyy cap sau NSMTND (7,7%) tucmg ddng vdi bao cao cfta Hd Van Han la 6% [5]. Trong nghiSn cftu khdng gap trudng hgp clmy mau, thung ta ttang hay thftng dng m^t chft sau NSMTND.
Chftng tdi theo ddi cftc ddu hieu lam sang va cfn lam sang sau thu thugt ghi nhgn: thdi gian dft dieu kien xuat vien sdm nhat la 2 ngay, cham nhat la 6 ngay, thdi gian tnmg binh imm vien la 2,5±0,89 ngay. Thdng thudng, sau khi lam NSMTND, benh nhan se phuc hdi rat nhanh va cd thS xudt vi?n sau 48 gid. Van de hdi sftc va dieu tri ndi khoa tich cue trudc 24 gid cung gdp phdn lam giam ty I^ tft vong sau can thiep NSMTND lay sdi.
V. K E T L U A N
Cac benh nhan sdi dng m$t chft cd tam chftng Charcot chiem 32,5%. Mftc dp tang bgch cdu cfta bSnh nhdn cung tu tang nhe (25%) din vfta (12,5%) va tang cao chi 5%. Da sd cac benh nhan deu tang amylase mau, bilirubin tryc tiSp, men gan AST, ALT. Chyp dudng mat thanh cdng la 97,5%. Ldy sdi thdt bgi la 2,5% do khdng the dua dng ndi soi xudng tdi ta ttang D2. 100% benh nhan cd dudng mgt thdng tdt sau khi bom rfta. Bien chftng viSm tyy cdp chiSm 7,7% dap ftng tdt vdi diSu tti va amylase mau ttd lai sau 3 ngay theo ddi. Ngay ndm vipn sau thu thugt tnmg bmh la 2,5±0,89 ngay. Chung tdi ghi nhan nhimg diSm uu viet cfta ndi soi mat tuy ngugc ddng so vdi cac phuang phap ldy sdi diig mat chu khac la: benh nhan khdng cd vet seo d bung, sdi 6ng mSt chft dugc lay sach neu dft phuong tien va cd the dugc lam nhilu ldn ma khdng d l seo lam hep dng m^t, thdi gian hdi phyc rdt nhanh so vdi cac phuang phap khac.
T A I L I E U T H A M K H A O
1. LS Quang Qudc Anh (2012), "Vai ttd cua ERCP ttong b^nh ly dirdng mat", Tgp chi Y hgc thuc hdnh, sd 821, tt. 130-134.
TAP CHf Y Dl/pC Hpc CAN THg - s6 11-12/2018
2. Dao Xuan Cudng (2015), "Dinh gia hieu qua cua ky thuat ndi soi mat-tyy ngugc dong ttong diiu tri cap cftu sdi dudng mat cd bien chftng", Tgp chi Y hgc Thdnh phd Hd Chi MnA, tgp 19, tr. 22-27.
3. Quach Trpng Dftc (2014), "HiSu qua ciia npi soi mgt tyy ngugc ddng vdi gay me npi khi quan ttong diiu tti sdi dng mat chu d ngudi cao tudi", Tgp chi Y hoc Thdnh phd Hd Chi Mn;i,tapl8,tt.4i8-423.
4. Tg Van Ngpc Dftc (2010), "Ket qua ldy sdi dudng mat qua ngi soi mat tyy ngugc dong ttong4 nam tgi BV Binh Dan", Tgp chi Yhgc Thdnh phd Hd Chi Minh, tgp 14, tt. 388.
5. Hd Van Han (2010), "Can thiep diiu tti qua npi soi mgt-tuy ngugc dong", Tgp chi Yhgc ThdnhphdHd Chi Minh, tap 14, tt. 67-73.
6. Nguyen Dinh Hdi (2012), "Dich te hpc benh sdi on%mM!\ Sdi du&ng mgt, Nha xuat ban Y hpc, tt. 45-55.
7. Nguyen Hoang Khai (2012), "Dac diem lam sang, cgn lam sang tten nhung b?nh nhan soi ong mat chu dugc dieu ttj bang phuang phap npi soi m|t tuy ngugc ddng tgi vien 103", Tgp chi Yhgc thuc hdnh, sd 855, tt. 137-138.
8. Duong Xuan Nhuong (2015), "Hi?u qua, tinh an toan cua npi soi mat tuy ngugc dong dieu tri sdi ong mgt chu d ngudi cao tuoi tgi bSnh vi?n QuSn Y 103", Hdi nghi khoa hoc Ngi A/)oo toan gudc/on iY", Tgp chi Npi khoa Viet Nam sd dgc bi^t,tt. 315-319.
9. La Van Phu (2015), "Jte? qud sam diiu tri soi duang mgt chinh bdng phdu thugt ngi soi tgi Binh vi4n Da Khoa Thdnh Phd Cdn Th(f\ De tai nghien cftu cSp thanh phd 2015.
I O.Nguyen Khanh Trgch (2009), "Sy phat ttiln ndi soi ttong b^nh Iy gan mat-gid tti cua no ttong chan doan-dieu tti tac mgt", Binh hgc ngi khoa tgp 1, Nha xuat ban Y hpc, tt. 70-80.
II .Nguyen Quang Trung (2012), "Nghien ciru ddc diem ldm sdng, can ldm sdng vd thdi do xu tri soi duang mgt chinh a ngu&i cao tudr, Luan in tiSn sf y hpc.
12.ASGE Guideline (2012), "Complications of ERCP", Gastrointestinal Endoscopy, Vol 75, No.3,pp.467-473.
13.ASGE Guideline (2010), "The role of endoscopy in the evaluation of suspected choledocholithiasis", Gastrointestinal Endoscopy, Vol 71.
H.Lee YT (2008), "Choledocholithiasis", ERCP, Elsevier Saunders, pp. 222.
(Ngdy nhgn bdi: 15/11/2017 - Ngdy duy$t ddng: 08/01/2018)
D A N H G I A KET QUA DIEU T R | C H A N THlTONG XOANG H A M TAI B f N H VIEN DA KHOA T R U N G l/OTVG C A N T H O N A M 2015-2017
Mai Vo Kim Thanh *, Duang Hitu Nghj Truang Bgi hgc Y Dugc Cdn Tho
*Email: [email protected] TOM T A T
Dgt vdn de: Chdn thuang xoang hdm khd phd biin, v&i nhiiu hinh thdi vd muc dg tdn thuang khdc nhau Chan dodn vd diiu trj chdn thuang xoang hdm cdn phdi kfp th&i vd dung dan, nhdm ddm bdo gidi phdu, chuc ndng vd thdm my cho b^nh nhdn. Mgc tiiu nghiin ciiu: Md td dgc diem ldm sdng, hinh dnh hgc vd ket qud diiu tri chdn thuang xoang hdm tgi Binh viin Da Khoa Trung Uang Can Tha. Boi tugng vd phuang phdp nghien cuu: Nghien cint mo td cdt ngang 66 truang hgp chdn thuang xoang hdm diiu tri ldn ddu dugc phdu thudt ndn chinh qua tiin dinh lgi mdi tir thdng 9/2015 den thdng 6/2017 tgi BVDKTVCdn Tha. Ket qud: Co 66 binh nhdn (nam gdp 5 ldn nii, tuoi trimg binh 30,65 tuoi). Triiu chirng ca ndng chu yiu la dau chdi vd dau nhiic tgi
