TAI UEU THAM KHAO
1. DANG HANH DE: Thai do xir Ui trong chin thuang ldng nguc. Trong: Cap cuu ngoai khoa tim mach, long ngirc - Nha xuat ban Y hoc. Ha Ngi, 2005, 7-20.
2. DOAN DUY HUNG: Nhan xet tinh hinh tran khi tran mau khoang mang phdi trong 2 nam 2003-2004 tai benh vien Saint Fault Ha noi - Ky yeu hoi nghj khoa hgc Tim mach, long nguc lan thii 1, 2005, 61-66.
3. NGUYEN CONG MINH: Chan thuang ngirc - Nha xuat ban Y hgc. Ha Ngi, 2005, 1-22,54-55,60-78.
4. TRAN QUYET TIEN: Chin doan va dilu tri cap cim vet thuong phdi-mang phoi. Ykhoanet.
5. KERR T.M: Prospective trial of the six hours rule in stab wounds of the chest - Surg. Gynecol & Obstet,1989, 169, 223-5.
6. SIEMENS R. J>OLD H.C,GRAY:
Indication for thoracostomy following penetrating thorax - J.Trauma 1982, 17, 943- 500.
7. THOMAS W. SHIELDS: Chapter 70, Blunt and Penetrating Injuries of the Chest Wall, Pleura, and Lungs - General Thoracic Surgery, 6* edition. Lippincott Williams &
Wilkins, 952-971.
8. SABISTON, SPENCER: Chapter 7, Thoracic Trauma - Surgery of the Chest, 7*
edition. Anne Lenehan.
XtfTRi TON THirONG SEO HEP KHI QUAN VA RO KHI QUAN - THUC QUAN
B A N GNOI KHI QUAN TAN TAN TRlTC TIEP VA KHAU DlTONG DO THlTC QUAN
Vu Hiru Vinh*, Ngo Quoc Hung*, Chau Phu Thi*
TOM TAT
Ddi ti/dng: Bao cao ket quan phau thuat benh nhan bi hep khf quan hoac/ va rd khf quan -thUc quan, bien chifng ciia dat dng ndi khf quan (NKQ), md khf quan (MKQ) keo dai hoac chan thUdng, vet thUdng khi thUc quan.
Phwana phap nahien cdu: Hoi cufu 26 tru'dng hdp hep khf quan hoac/va rd khf quan - thUc quan tudi tii 19 tdi 47 dUdc phau thuat trong 3 nam (tii 7/2007 den thang 7/2010) tai khoa ngoai Ldng ngUc benh vien Chg Ray. Thdi gian tir khi bat dau dugc md khf quan hoac bi chan thUdng/vet thUdng tdi thdi diem dUdc phau thuat la tii 12 thang tdi 5 nam. Tdn thUdng cua cac benh nhan lien quan tdi hau bet cac doan cua khf quan.
• Benh vien Cha Ro}'
Ket qua: PhUdng phap phau thuat la ndi khf quan tan tan va khau dUdng rd thUc quan. Ty le thanh cdng la 23 ca chiem (88,4%). Trong dd, 19 ca (73%) cho ket qua tdt. 2 ca (7,6 %) ket qua kha (mgi cdn khan tieng, mdt cdn hep thUc quan phai nong lai nhieu lan sau md). 2 ca (7,6%) cd ket qua trung binh. 2 ca (8,3%) that bai (mdt ca bung cho ndi khf quan tan tan 2 ngay sau mo, mgt ca hep lai khf quan sau khi ra vien 3 ngay) phai md khf quan lai. Cd 1 ca tLr vong (3,8%).
Ket luan: Site chiia mdt thi seo hep khf quan va rd khf thUc quan bang ndi khf quan tan tan va khau ky dau dudng rd thUc quan la hoan toan kha thi, oo ti le thanh cdng cao va an toan bat ke thdi gian bj tdn thUdng. Ndi khf quan tan - tan cd the ap dung an toan cho mat doan khf quan tdi 4cm.
CHUYEN PE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM Tut khoa: Hep khf quan, rd khf thUc quan.
SUMMARY
Management of tracheal stenosis and/or tracheoesophageal fistula with direct
tracheal anastomosis and primary esophageal closure
Objective: We evaluated the outcome of the surgical repair for tracheoesophageal fistula and/or tracheal stenosis, which are usually complications of tracheostomy or tracheoesophageal injury.
Methods: From July 2007 to July 2010, twenty-six patients aged from 19 to 47 years old with tracheal stenosis and/or tracheoesophageal fistula were operated. The period from initial tracheostomy to the time of repair surgery ranges from 12 months to 5 years. Any part of the trachea was involved. All cases were repaired by direct end to end tracheal anastomosis and primary esophageal closure.
Result: Successful rate was 23/26 cases (88.4%). In which, 19 cases (73%) have very good results. 2 cases (7.6%) have good result (one with husky voice, one with esophageal stenosis that require dilatation of the esophagus postoperatively). 2 cases (7.6%) has medium result. 2 cases (7.6%) were failed. In one, tracheal anastomosis was ruptured 3 days after repaired operation and in the other, the trachea was restenosis. Tracheostomy was set up again for both. One death, mortality is 0.4%.
Conclusion: Primary repairing long-term post-tracheotomy tracheal stenosis and/or tracheoesophageal fistula is feasible, safe and have high successful rate regardless period of having those injuries. Tracheal missing length up to 4cm in could be repaired safely by direct end to end anastomosis.
Key words: tracheal stenosis, tracheoesophageal fistula
I. OAT VAN OE
Mac dii cac dng ndi khi quan hoac cac dng md khi quan hien dang dugc sir dung co cuff ap luc thap nhung tren thuc te kha nhi^u benh nhan dugc dat dng ndi khi quan hoac rod khi quan lau dai cd hep khi quan hoac/ va do khi quan - thuc quan. Nguyen nhan cd the la ky thuat md khi quan chua dung, thd may lau hoac cd nhiem trimg keo dai vimg md khi quan. Mot nguyen nlian nua cung thudng gay hep khi quan hoac dd khi quan thuc quan la chan thuang hoac bdng hda chat (udng nham hoac cd y).
Nhiing benh nhan nay thudng phai deo dng md khi quan d cd neu cd rd khi quan - thuc quan, cd them mdt dng nudi an d bpg.
Vdi 1 hoac ca 2 dng nay, chat lugng cudc song cua ngudi benh giam rd ret anh hudng khong chi ngudi benh ma ca ngudi than, xa hdi.
Do cd nhieu nguy ca trong phiu thuat phuc hdi cac tdn thuong tren ma nhieu benh nhan chju mang nhiing dng nay trong mot thdi gian kha dai. Nhieu benh nhan da di kham nhieu nai nhung khdng phai co so phau thuat nao cung nhan sira chiia nhiing tdn thuong nay cho ngudi benh.
Ddi vdi phau thuat sdm de sira chiia cac tdn thuong tren, da cd nhieu nghien ciiu cong bd '^' ^' ^" ''' TUy nhien phiu thuat mudn thi cdn it cac bao cao *^''''.
Cac nguyen nhan khac bao gdm chan thuong, vet thuong hoac bdng do hda chat, thudng la do udng hda chit gay ton thuang thuc quan rdi tdi khi quan.
De sira chiia cac tdn thuong dd, cin phai cat bd doan khi quan bi hep, tac hoac biln dang, noi khi quan lai va khau lai dudng rd thuc quan.
II. MUC TIEU NGHIEN CQU
Danh gia ket qua sdm sau phiu thuat hep khi quan va rd khi thuc quan va chirc nang dudng thd, dudng an tu nhien va cac biln
chiing xay ra sau khi dugc tai tao. Danh gia kha nang ndi khi quan tan tan d nhiing tdn thuang cd mat doan khi quan ldn.
III. PHUONG PHAP NGHIEN CCfU
Hdi ciiu nhiing benh nhan hep khi quan hoac/va rd khi quan, thuc quan, nhirng benh nhan phai deo dng thd nhieu nam dugc phau thuat sira chira bdi cimg mdt nhdm phau thuat vien trong 3 nam (7/2007 - 7/2010) tai khoa phau thuat Ldng Nguc - Benh vien Chg Ray
Phan loai nguyen nhan bao gdm: 1- do dat dng thd (NKQ, MKQ) keo dai, 2- do chan thuang kin, 3- do vet thuong dao dam, 4 - do tdn thuong bdng hda chit thuc quan hoac khi quan, 5- do benh lao.
Vi tri tdn thuang khi quan dugc phan loai theo dinh hudng ngoai khoa dd la dudng md de vao tdn thuang dd. Bao gdm 1/3 tren, 1/3 giira va 1/3 dudi.
Phuang phap phau thuat bao gdm chgn dudng md thich hgp dl cd thi tilp can tdt nhat chd tdn thuong va thuan lgi cho phau thuat. Ddi vdi tdn thuang khi quan 1/3 tren, chung tdi md dudng co trude, dudng md thudng vdng qua Id md khi quan. Ddi vdi tdn thuang khi quan 1/3 dudi va cac phi quan goc, chiing tdi md dudng nguc. Chi rieng tdn
thuong phi quan gdc trai don thuin chiing tdi mdi md nguc trai cdn lai la md nguc phai.
Tdn thuong khi quan 1/3 giiia cd thi md dudng cd hoac nguc, nhung tdt nhit la md dudng cd phdi hgp vdi che xuang ire ban phan hoac toan phin. Doan khi quan tdn thuong dugc cit bd cho tdi phin khi quan cd khau kinh binh thudng va ndi lai tan tan. Dudng dd khi quan thuc quan dugc tach rdi, thuc quan dugc khau lai hai ldp bing chi tu tieu.
Danh gia kit qua: chiing tdi danh gia kit qua phiu thuat theo tot kha trung binh va xiu (that bai). Tir vong khdng nim trong danh gia ket qua, dugc coi nhu la tai biln phau thuat.
• Tdt: benh nhan trd ve cudc sdng binh thudng. An va thd bing dudng tu nhien khdng gap bat ky trd ngai nao.
• Kha: Ket qua chua that hoan hao, vi du cd khan tieng sau md, hep thuc quan sau md ma cd the ndi soi nong dugc ve binh thudng.
• Trung binh: Khdng sira chira hit cac tdn thuong, vi du chi ddng dugc dudng dd khi thuc quan ma khdng thi phuc hoi khi quan do mat doan ldn hoac day thanh am di'nh bit hoan toan.
• Xau: that bai, chd ndi khi quan bi bung ra hoac khi quan bi hep lai sau md, phai md khi quan lai hoac phai md lai.
IV. KET QUA 1. Tuoi:
<20 tud'i 1 3,8%
20-45 tud'l 23 88,4%
45-60 tud'l 2 7,6%
>60 tudi 0 0 2. Gioi:
Nam: 14 (53,8%), Nir: 12 (46,2%) 3. Vj tri ton thuoTig khi quan:
1/3 tren 12 46,1%
1/3 giu'a
26,9%
1/3 dudi, carina va phe quan 26,9%
CHUYEN PE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
Vi tri tdn thuang dugc phan theo dinh hudng ngoai khoa dd la dudng md de cd the tiep can tdt nhat vdi tdn thuang. Trong 7 ca tdn thuong khi quan 1/3 dudi, cd 3 ca tdn thuong khi quan ngay tren carina, 1 tdn thuong phe quan gdc phai, 3 tdn thuang phe quan gdc trai. 2 tdn thuang phe quan gdc trai la seo hep do lao, da dat stent nhieu lan that bai. Mdt ca sau md tdt, mdt ca cd hep lai phai dat stent lai nhung theo ddi tdi nay ket qua tdt khdng phai dat stent lai nhieu lan nhu trude. 2 cdn lai do chan thuong cQ, diit rdi hoan toan phe quan gdc gay xep phdi, viem phdi xep va tdi vdi chiing tdi sau 4-5 thang bi chan thuong. Ve chan thuang gay seo hep, chung tdi chi tinh nhiing ca den mudn cdn tdn thuong phe quan gdc mdi va dugc phau thuat ngay thi kha nhieu va khdng dugc tinh trong nghien ciru nay
Trong 7 ca tdn thuong 1/3 giira cd 1 ca do chan thuang, 1 ca do vet thuang. 2 ca do bdng thuc quan gay hep khi quan va dd khi
thuc quan. Cdn 2 ca la do hep khi quan duoi lo md khi quan (stoma). 1 ca seo hep do lao keo dai toan bd tir cd xudng phe quan g6c phai. Benh nhan nay dugc md 2 lan, lan thii nhat xir ly phe quan gdc phai va khi quan 1/3 giii'a, lan 2 la khi quan cd. Bn phai thd may va nam ICU hon 1 thang va tir vong. Day ciing la trudng hgp tdn thuong khi phe quan dai nhat ma chiing tdi gap, va cQng la ca tir vong duy nhat trong nghien cim nay.
12 ca tdn thuong khi quan 1/3 tren d8u do di chiing cua md khi quan keo dai. T6n thuang hep hoac diit rdi hoan toan khi quan tren Id md khi quan.
Dd thuc quan thudng d vi tri cd, co 1 trudng hgp dd d nen cd, gay khd khan cho viec khau dudng dd, benh nhan nay sau co hep thuc quan, phai nong 3 lan thi an uong dugc binh thudng. Trong 20 trudng hgp hep khi quan cd 6 trudng hgp cd dd khi thuc quan, mdt trudng hgp chi cd dd khi thuc quan ma khdng cd hep khi quan.
Rd thUc quan phdi hdp hep khf quan Rd thUc quan khdng cd hep khf quan
4. Nguyen nhan ton thuong:
Oat dng NKQ keo dai 15
57,6%
Chan thu'dng 4 15,3%
Vet thu'dng 1 3,8%
Hoa chat 2 7,6%
Lao 4 15,3%
5. Chieu dai khi quan mat doan:
Trong 26 ca cd 25 ca cd phau thuat khi quan, 1 ca chi cd dd khi thuc quan ma khdng co hep khi quan, 1 ca cd hep khi quan va dd khi thuc quan nhung chi dugc chi dinh phiu thuat ddng dudng dd khi thuc quan, khdng phau thuat khi quan do tdn thuong dinh day thanh am bit dudng thd phia trong mieng. Trong 23 ca cd hep khi quan, do dai doan khi quan mat doan sau khi da cat bd phan khi quan tdn thuong tdi phan cd khau kinh binh thudng hoac chap nhan duac trude khi ndi tan tan nhu sau:
< 2 cm 4 15,3%
2-4 cm 18 69,2%
4-5 cm 2 7,6%
> 5 c m 2 7,6%
Trong 2 trudng hgp mit doan > 5cm, 1 la trudng hgp thit bai, bung mieng ndi khi quan 3 ngay sau mo. Trudng hgp nay dugc phau thuat 2 lin thit bai d mdt ca sd khac trude khi din voi chiing tdi. Trudng hgp thti 2 la ca seo hep do lao keo dai tir cd tdi phi quan gdc phai. Ca nay tir vong sau 2 lin phiu thuat va hon 1 thang thd may d ICU.
6. Chieu dai mieng ro thuc quan:
2,5cm ±0,5 cm
7. Thdi gian tu khi tdn thirotig toi khi dugc phau thuat:
6 -12 thang 1- 2 nam 11
3-5 nam Tren 5 nam Tong sd
26
Tat ca deu la di chiing chan thuang, vet thuong hoac do md kW quan keo dai, hoac seo hep do lao da dugc dat stent nhieu lan that bai. Nhiing tdn thuang la cii, lau ngay, anh hudng tdi chat lugng cudc sdng ciia ngudi benh. Nhieu trudng hgp neu khdng phau thuat se tir vong do bit dudng thd hoac viem phdi nang. Phiu thuat nhirng trudng hgp nay thudng khd do dinh.
8. Ket qua phau thuat;
Tdt 19 73%
Kha 2 7,6%
Trung binh 2 7,6%
That bai 2 7,6%
Tu' vong 1 3,8%
Tot: 19 trudng hgp (73%) benh nhan trd ve cudc sdng binh thirong, bd dugc dng md khi quan va dng nudi an d bung, ndi soi sau md cho thay khi quan hoan toan thdng thoang, khdng chit hep. Thuc quan lien tdt, ngudi benh an tu nhien
Khd: 2 trudng hgp (9.5%). Mdt benh nhan bi khan tieng sau phau thuat, mdt bi hep thuc quan sau phau thuat, phai nong 3 lan sau do mdi an udng dugc.
Trung binh: 2 trudng hgp (4.8%). Mdt chi ddng dugc dudng dd khi - thuc quan, cdn khi quan do soi thay day thanh bien dang, dinh chat bit hoan toan dudng thd d mieng, phau thuat dugc chi dinh chi ddng dudng dd thyrc quan - khi quan, khdng can thiep vao khi quan. Mgt la seo hep dang nhuyen phe quan gdc trai da dugc dat stent nhieu lan nhung stent ludn bi trugt xudng dudi phai phdi hgp vdi phiu thuat ghep de xuong sudn vao phe quan trai (do bs Phap thuc hien d mgt benh vien ban). Sau dd phdi trai cam
hoan toan va viem nang, chiing tdi phai phau thuat liy bd stent, lay bd manh xuong sudn ghep ngoai, cat ngan phe quan gdc trai. Sau md, phe quan gdc trai hep lai, dugc dat stent va stent dn dinh, tdt, khdng trugt niia.
Kem: 2 trudng hgp (9.5%)), 1 benh nhan bi dirt rdi cho ndi khi quan sau 3 ngay phiu thuat, phai md khi quan lai, 1 trudng hgp sau phiu thuat bi hep lai
Tir vong: 1 trudng hgp. Day la trudng hgp seo hep do lao keo dai tir cd xudng tdi phi quan gdc phai. Bn khd thd nang, dugc phau thuat 2 thi, lin 1 cit bd seo hep phi quan gdc phai, tai tao carina nhung bn cdn doan hep d cd ddi hdi phau thuat lan 2 d cd.
Khi quan mit doan ldn, bn thd may lau ngay d ICU va tir vong.
V. BAN LUAN
Fhlu thuat khi quan va ndi khi quan tan tan da dugc dl cap tir lau. Tuy nhien khi quan la ca quan duy nhat, cd chieu dai nhat
CHUYEN PE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
dinh (khoang 12 cm vdi khoang 1 8 - 2 2 vdng sun) va tdi nay van chua cd vat lieu thay the nen phau thuat khi quan an chiia nhieu nguy ca. Van de quan trgng la vi tri tdn thuong va do dai cua doan khi quan bi mat doan sau khi cat bd phan khi quan bi tdn thuong. Belsey nam 1950 da tuyen bd nhiing mat doan khi quan > 2cm la khdng the ndi tan tan true tiep dugc '". Chinh vi vay phau thuat khi quan nhat la d vi tri khd tiep can nhu 1/3 giii'a va cd mat doan ldn > 2cm van dugc danh gia la phau thuat khd.
Tdn thuong 1/3 tren khi quan thudng do dat dng keo dai hoac do hit hoac udng phai hda chat. Seo hep hoac/va rd khi quan thuc quan lam cho khd cd the riit dng md khi quan. De dng cang lau, miic do hep va rd cang nang. Vdi loai tdn thuong nay chiing tdi ludn md dudng cd ngang qua va bao gdm Id md khi quan (stoma)
Tdn thuong khi quan 1/3 gitia thudng gap do chan thuong, vet thuong hoac hep dudi chd md khi quan de lau, nd ciing thudng phdi hgp vdi rd khi thuc quan nhu ddi vdi tdn thuong 1/3 tren. Day la vi tri rat khd tiep can neu chi md d cd hoac md nguc phai. Vdi dudng md cd thi tdn thuang d qua thap va vdi dudng md nguc phai thi tdn thuang lai d qua cao. Vdi nhung dudng md nay van cd the tiep can tdn thuong dugc nhung khd khan va cd the khdng xir ly het doan tdn thuong can thiet, de gay hep tai phat. Dudng thich hgp nhat la phdi hgp md cd vdi che xuong ire ban phan hoac toan phan, khi quan dugc tiep can qua viec md mang tim va tach re tmh mach chu tren va phan len cua quai ddng
mach chu. Tuy nhien dudng md nay phiic tap I hon va cin cd kinh nghiem phau thuat.
Vi tri tdn thuong khi quan 1/3 duoi, j carina va phe quan gdc thudng la do chan j thuang. Nhiing tdn thuang nay khdng dugc) chu y dung mirc trong lan nhap vien dSu ; (ngay khi bi chan thuang). Sau mdt thdi gian, J nhiing tdn thuong nay trd thanh van de, khd tha \ dH dgi vdi chan thuong khi quan va xep ph6i hoan toan vdi tdn thuong phe quan gdc ben phfii xep. Benh nhan tdi kham va dugc phat hien t6n thuong. Thu'dng thi cac phe quan gdc hep nang hoac diit rdi. Khi quan thi cd the hep 1,2 hoac 3 chd nhu mdt tm'dng hgp ma chiing tdi da gap, Dudng tiep can tdt nhat la md nguc phai cho nhiing tdn thuang khi quan, carina va phe quan gdc phai. Tdn thuong phe quan gdc trai don thuan thi nen md nguc trai.
Seo hep khi phe quan do lao cd the d hk ky vi tri nao ciia khi phe quan. Seo hep do lao thudng phdi hgp vdi nhuyen khi phe quan nen neu chi cat doan seo hep khdng thi phan j khi quan nhuyen van gay khd thd, ddi h6i j phai dat stent lai. Thudng phai cat ca doan j khi phe quan bi nhuyen thi ket qua phau thuat | mdi tdt, khdng phai dat stent lai.
Mat doan khi quan ldn la mdt van de quan trgng trong phiu thuat. Tuyen bd ciia Belsey da khdng cdn phii hgp do nhiing tiln bg \ cua phau thuat va gay me hdi siic. Khi gap diu;
hoan toan, khi quan cd gan nhu nim hoan toan;
Uong nguc va neu cd bdc tach tot, khi quan nguc;
ciing cd the dua len cd kha nhilu. Bdc tach them \ hai phe quan gdc thi kha nang di ddng cua khi j quan nguc cang ldn. Xe mang tim dudi rdn phoij cung cd the gdp phan keo khi quan len tren them '\
dugc tdi gan 1cm.
A. Vdi khi quan cd: cd thi ndi tan tan cho doan mat dai tdi 4 cm. Ndu bdc tach vao ldng nguc cd thi them 1,5 cm
B. Vdi khi quan nguc: cho phep tdi 3 cm. Neu bdc tach phi quan goc 2 ben va dac biet la phe quan goc trai thi them dugc 2,5cm.
Trong nhdm tdn thuang mudn, mat doan ldn thudng hay gap, thach thiic cho viec ndi tan tan. Trong nghien ctiu nay, tdn thuong mat doan phd bien tii' 2-4 cm, khdng phai la van de ldn cho ndi tan. Trudng hgp mat doan lon hon can than trgng, bdc tach du hon, dat mui khau gan nhau hon , can cd 2- 3 m mdi anchor (mdi dinh keo) va thdi gian khau gap dau can de lau hon. Trudng hgp bung mdi noi ciia chiing tdi tuy la mat doan ldn nhung ciing mdt phan do cat mdi khau gap dau sdm vao ngay thir 2 sau md. Nhirng trudng hgp sau chiing tdi de tdi 4 - 6 ngay cho ket qua tot han.
Rd khi thuc quan ma khdng cd hep khi quan cung khdng phai la hiem, nhung cd sir khac nhau giiia nhdm dugc phau thuat sdm va mudn. Macchiarini tdng ket kinh nghiem trong 18 nam cd 32 ca rd khi thuc quan dugc phau thuat sdm chi cd 13 ca cd hep khi quan phoi hgp, trong dd 3 ca hep dudi thanh mdn i'a 10 ca hep khi quan *^'. Trong 7 ca rd khi hue quan tdi mudn, chiing tdi chi gap cd 1
^ khdng cd hep khi quan cdn 6 ca cdn lai leu cd hep khi quan.
Khau dudng rd thuc quan thuc chat la ach rdi thuc quan khdi khi quan va khau lai
mat trude thuc quan. Nhieu tac gia khuyen cao nen de mdt it ca hay mang giira thuc quan va khi quan de phdng tai rd nhung trong thuc te chiing tdi khdng ap dung va khdng thay cd rd trd lai.
VI. KET LUAN
Phiu thuat tdn thuong mudn khi quan va rd khi quan - thuc quan la hoan toan kha thi cho du ton thuong d nhiing vi tri phiic tap, doan khi quan tdn thuong ldn va cd rd khi thuc quan. Ket qua phau thuat kha quan, ciiu sdng ngudi benh d nhiing trudng hgp chan thuong cd diit rdi phe quan gdc den mudn.
Tra lai cudc sdng binh thudng cho nhiing cd md khi quan va md dudng tieu hda nudi an dai ngay. Phiu thuat phuc hdi mat doan khi quan khdng cdn gidi ban d mdc 2cm nhu Belsey da timg tuyen bd nam 1950 ma da dugc ndi rdng rat nhieu tuy thudc vao co sd ngoai khoa va kinh nghiem phiu thuat. Ty le thanh cdng d miic 88,4% va ty le tir vong bing 3,8% d nghien cim nay cho thay lgi ich cua viec phiu thuat. Tir nhirng ca that bai, chiing tdi manh dan khuyen cao md xuang ire trong trudng hgp tdn thuang khi quan 1/3 giira va cat bd triet de tdn thuang khi quan
CHUYEN PE: PHAU THUAT TIM MACH VA LONG NGLTC VIET NAM cho tdi khau kinh binh thudng ma khdng sg
mit doan khi quan ldn. Bdc tach rdng rai va phdi hgp cd nguc cho phep ndi tan tan khi quan d miic do mat doan kha ldn.
TAI UEU THAM KHAO
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DANH GIA KET QUA S A M PHAU THUAT U TRUNG THAT
Ngo Quoc Hung*, Chau Phu Thi*, Vu Hfiru VTnh*
TOM TAT
Muc tieu: Danh gia ket qua sdm sau phau thuat u trung that va vai trd CY Scan ngUc
Doi tu'dng va phu'dng phap nghien cu'u:
Hoi ciiu 338 benh nhan dUdc phau thuat cat u trung that 5/2002 den 5/2008 tai Khoa ngoai long ngiic - mach mau benh vien Chd Ray
Ket qua: tud'i trung binh 39,8 ± 16, ty le nam/nu' 1/1. 69,8% u trung that d trung that trUdc, phau thuat cat tron u 75,7%. Ket qua tdt 242 ca (71,6%), trung binh 92 ca (27,2%), xau 4 ca (1,2%).
Ket luan: phau thuat la phUdng phap dieu tri hieu qua u trung that
* Benh vien Chg Rdy
SUMMARY
SURGICAL MANAGEMENT OF MEDIASTINAL j TUMORS AT THE THORACIC AND CARDIOVASCULAR SURGERY DEPARTMENT j
- CHO RAY HOSPITAL j
I
Background: The goal of this work is to j review our series of patients with mediastinal i tumors, to analyse the clinical presentation and j the locations and to evaluate the results of Cfj
Scan and the surgical treatment. | Materials and Methods: A retrospective!
analysis of 338 patients who underwent total or I sub-total resection of a primary mediastinal^
tumor between 5/2002 and 5/2008 was;
performed at the Thoracic And Cardiovascular!
