N G H I E N cilu KET QUA PHAU THUAT NOI SOI VIEM PHUC MAC RUOT THUTA TRE EM TAI BENH VIEN NHI THANH HOA
TOM TAT
Muc dich: Nghien edu kit qui phiu thuat ndi soi viem phue mac mdt thda tre em tai Benh vien Nhi Thanh Hda.
Bii tugng va phuang phSp nghiSn cdu: 60 benh nhi bj viem phue mae mdt thda duac phiu thuSt ndi soi tai Binh vien Nhi fhanti Hda td 01/2011 din 12/2011.
Kit qui:
ThSnh cdng cd 54/60 (90%) tn/dng hgp, 06/60 (10%) trudng hop chuyin momd.
Ket qua cCia PTNS: Tot 49/54 (90,7%); Tmng binh:
4/54 (7.4%,); xiu^ 1/54 (1.8%,).
Thdi gian phSu thuat: 74.1+24,2 phut.
Thdi gian dau sau phSu thuat tmng binh: 3 ngay Thdi gian Hit rudtsau phiu thuat ngan: 3 ngay.
Tbdi gian hau phSu tmng binh 7 ngay.
Nhiim trung trocar 3,3(%) chi dn dieu tri ndi khoa.
Ap xe ton du 1/60 (1.7%,) diiu bi ndi khoa.
lie mdt sau mophaiphSu thuat lai 0/60 (0%).
Tdkhda: Viem phdc mae rudt thda, tre em.
SUMMARY
Aim: The main objective of this study was to determine the result of endoscopic for peritonitis appendicitis at children.
Patients and methods: From January 2011 to December 2011, at Thanh Hoa children HospitaL The case-control study includes 60 patients with peritonitis appendicitis were treated by endoscopic.
Result:
Sucess in 54 patients (90%).
The failure mte was 10%.
Mean time ofopemtion was 74.1 ± 24.2 mins.
Mean Bower movement is 3 days.
Mean hospitalization time was 7 days.
Keywords: Endoscopic for peritonitis appendicitis, children.
DATVXNDE
Viem njpt thiia (VRT) Id mpt c ^ cflu ngogi khoa thuflng gap nhat, Viem rupt [hiia the dien hlnh thudng d l chan doan va xfl tri ddn gian, ket qua didu tn tdt.
The khdng dien hlnh chan doan kho vl trieu chflng lam sdng rat da dgng thay ddi theo lii^ tudi, thay ddi theo tflng the lam sang, ma ta c6 the nhdm_vd[ nhidu loai benh khac, neu khong xd Ij- kip thdi d l d i n tdi viem phflc mac rupt thya, de Igi nhflrng bien chflmg nhieu khi khd khae phuc, biam chi d i n tdi tfl vong [1], [2], [3].
Viem phflc mac do viem rupt thfla la mpt bidn ehflng nang hay gap tren lam sang, tJ le vieni phflc mae rudt t h i ^ dao ddng tfl 11- 20 % b tre em van cdn kha cao [4], [5].
Tai Benh Vien Nhi Thanh Hoa PTNS da dupc ap dung tfl nam 2008. Tuy nhien, dieu tri VPM do VRT cf b-e em hau nhfl chua ed edng b'inh nghien eflU nao dUde thuc hien de danh gia day dfl, de so sanh vdi eac
BUI V A N CHie'N - B^nh viin Vi$t Tigp Hai Phdng N G U Y E N DANH THONG - Benh vi$n Nhi Thanh Hoa
tac gia trong va ngoai nU6e. Lieu phlu thuat npi sol dieu trj VPMRT d tre em tai Benh Vien Nhi Thanh Hda cd an toan va hieu qua hay khong? Xuat phat t d thyc td dd chflng toi tidn hanh nghien eflU de tai "Nghiin cdu kit qui phau thuat ndi soi viem phOc mac mdt thda tri em tai Benh vien Nhi Thanh Hda tdngay 01- 01-2011din ngSy 30 -12-2011".
DOI TUONG VA PHUONG PHAP N G H | £ N CCTU Ddi tu^ng nghien cflu
Nghien eflu dude thyc hien ci nhflng bdnh nhan tre em viem phflc mac rupt thu^ dupe dieu trj bang phlu thuat noi soi tai Benh vien Nhi Thanh Hda tfl thang 01/2011 den thang 12 nam 2011.
Nhflng benh nhan nay hd so dupc ghi chep theo m l u thdng nhat cd day dfl cac dd lieu chan doan trudc md, each UiflC phlu thuat. ket qua theo ddi va danh gia ket qua sau mo
T i f ^ chuan lua chgn:
- Cac tnidng tidp VPMRT b tre em dUdi 16 tudi.
- Dupc phlu biuat npi soi dieu bi VPMRT do VRT, - Co kdt qua giai phlu benh ly la VPM do VRT.
- Cd du hd sd benh an trude, trong va sau mo.
Tieu chuin loai trd:
- VRT b tre em khdng ed VPM.
- Phlu biuat md.
- Khong cd ket qua phlu thuat benh ly.
- Khdng dfl hd so benh an.
- Khdng dupc theo doi va danh gia sau md.
- Benh nhan viem phflc mgc do eae nguyen nhan khac
- cac benh nhan chdng ch? dinh phlu thuat npi soi PhUdng phap nghien cuTu: Nghien cflu mo ta hdi eflu va ben cflu.
KET QUA VA BAN LUAN
Co 60 benh nhan bj VPMRT dUde p h l u thuat, trong dd co 54 benh nhan dupc phlu thuat hoan toan bang npi sot, 06 benh nhan dang tfl PTNS ehuyen sang md md.
Tinh trang d bung (n =60)
Phan ldn benh nhan dupc phau thuat tinh trang d bung da cd dich mfl va gia mac. Dieh mfl" 12/60 (20%);
mfl. 43/60 (71,6%); gia mao 50/60 (83,3%).
Tinh trang mot thfla (n =60)
Hau het njpt thfla bj thflng d dau va than, gdc ruot thfla binh thudng, khong cd tnidng hpp nao la khong tim tha^ mdt thya trong phau thuat.
Chan doan trong p h l u thuat
Trong sd 60 ca VPMRT ehflng toi phlu thuat ndi soi cd 49/60 (81,6%) benh nhan viem phflc mac toan thie.
Y HOC THUC HANH (963) - S6 5/2015
PhUdng phap cat rudt thCra noi soi
^ Trong sd 60 bdnh nhan dUdc phlu thuat VPMRT, ehi cd sd lupng nhd benh nhan 3/60 (ehiem 05%) phai gap tinh hudng khd khan den mflt phai eat rupt thfla ngudc dong.
Ky thuat xur ly gdc RT trong PTNS
Trong sd 54 benh nhan dUpc phlu thuat hoan toan bang npi soi: Cd 45/54 benh nhan dUpe eat RT hoan toan trong o bung dUdc kep Clip gdc RT (chiem 83,3%), ed 9/54 benh nhan (16.7%) dupe eat RT ngo_ai d bung thi gdc RT dude khdu, bupc nhU trong phlu thuat kinh dien, Khong co tru'dng hop nao phai d i n luu gdc RT.
Xur l y o bung
Trong phlu thuat md dd xfl ly VPMRT, theo Bfli SJ Hien, Nguyin Huy Dan nen d i n tuu d bung 100% [6], trong phau thuat noi soi co can thiet phai d i n luu hay khong"'
Nghien cfl\j thdjig ke eho thay cd 88,8% benh nhan dupe tudi rfla va d i n luu 6 bung. Co 11,1 % benh nhan dupe tudi riJi^ d bung saeh ktiong can d i n luu. Ty le dat d i n luu trong ngtiien cflu eua ehflng tdi ed cao hdn so vdi mot sd tac gia khac' Arnold P (15%), Aaron M (16%), Wojciech Koriacki (12%) [7], [8], [13].
Thdi gian tien hanh phau thuat ngi soi Thcli qian PT (phot)
<60 61-90 91-120
>120 T6ngs6
S6 bgnh nhan 28 16 8 2 54
TJI6%
51,8 29,6 14,8 3,7 100 Thdi gian tnjng binh de bdn hanh mot ca phau thuat: 74^1 + 24,2 phut.
Da s d cac trudng hpp p h l u thugt chi can thdi gian tdi da la 60 phflt, nhung tn s d trung binh lgi eao hdn, chflng td nhflng tn/dng hdp edn lai ed dp chenh lech thdi gian tUdng ddi ldn, day ed thd \a nhung b"Udng hdp kho cat rupt thfl^ va mat thdi gian tudi rfl^a o bung.
Lien quan giu^ tinh tr^ng VPM rudt thda vdf thdi gian PT ngi soi:
Sy khac biet giua thdi gian phlu thuat tnjng binh efla nhdm I vdi nhdm ll la co y nghla thdng ke (vdi p <
0,05).
Sy khac biet do chi ra rang, thdi gian phlu thuat npi SOI CO phu thupe rd ret vao tinh trang viem phflc mge rupt thfla.
Lien quan giua vj tri giai phSu cua rudt thCa vdi thdi gian PTNS:
Su khae biet gifla thdi gian phlu thugt trung binh cfla nhdm I vdi nhdm ll ta khong ed y nghTa bidng ke (vdi p > 0,05). Dieu nay chflng td rang, khi mot thfla viem da gay tinh trang viem phflc mac thl viec bm mPt thus cat khdng cd sy khae bidt so vdi vj tri mot thfla,
Thdi gian liet rupt sau phau thuat npi soi Thdi gian liet rudt sau p h l u thuat la thdi gian dupc tinh tfl khi benh nhan dugc phlu thuat xong t6i khi benh nhan ed trung tien trd lgi, Ket qua thdng kd eho thay thdi gian Net ruot trung binh la 3 ngay (tfl 1 den 5 ngay).
Nhidu tae gia nghien cflfu so sanh giijia phlu biuat noi sol va md mb nhan xet rang sy hdi phyc nhu dpng rupt sau PTNS trong VPMRT ngan hdn so vdi phlu biuat md [10]. Trong nghien cflru cfla ehflng tdi nhan thdy thdi gian c6 nhu dpng rupt trd lgi khdng khac so vdi benh nhan dUpc md mcl theo k j thugt kinh dien trong y van.
Thdi gian rflt dng dan luu sau phau thu|t npi soi
Trong 54 benh nhan dUdc PT_hoan toan bang nfil soi ed 50 benh nhan dUdc dat d i n luu 6 bung. Thdi gian trung blnh rflt dng d i n luu sau phlu thuat npi soi la: 3,0 ngay (tfl ngay thy nhat den ngay thfl sau).
Thdi gian n i m vien
Thdi gian nam vien trung blnh sau phlu thuat la 7 ngay (ty ngay thuT tU den ngay thfl mudi tam); benh nhan cd sd ngay nam vien 6 ngay chidm da so 22/54 (40,7%).
Ket qua giai phau benh ly* rupt thfl^ nhdm PTNS Co 54/54 (100%) benh^nhan PTNS trong nghien cflu dupe chan doan giai p h l u benh la Viem phflc mac do viem rupt thfla, trong dd VRT thflng chiem 68,5% va VRT hoai t^ chiem 31,5%.
Bidn chflng sdm sau p h l u thuat noi soi Cd 3 bidn chflng gap phai la nhilm trung Id trocar (5,5%) va bien chflng d dpng djch, ap xe ton du (3.7%). Cae bidn chflng nay chi can didu tri npi khoa bang khang sinh, khPng phai can thiep phlu thuat
Ket qua phu hpp vdi cae tac gia khac: Richards va cpng sU dUa ra thong bao p h l u thuat npi soi cho ket qua tdt vdi sd bidn ehflng sdt, thdi gian nam vien ngan va ft tdn kem hdn so vdi mo md [14], [15]. Chin va cpng su thay rang phlu thuat ndi soi ta an toan va hieu qua ddi vdi VPMRT [9].
Bien chOfng mugn sau PTNS Kit qui Dinh,tacnjfltsaum6dLrocdieutrin6i khoa
Dinh, tac ruot sau md, phii phSu Itiuat lai 6n dinh TUvonq Tdnq sd
SdBN 4 1 49 0 54
7,4
%
1,8 907 0 Nhin vao bang'4.28 cho tha'y:Ket qua PTNS loai tdt:
m
49/54 (90,7%); Tmng binh, 4/54 (7,4%); xdu: 1/54 (1,8%).
K^'T LUAN
- Thanh cdng co 54/60 (90%) tmdng hpp, 06/60 (10%) tmdng hdp chuyen mo md.
- Kdt qua cfla PTNS: Tdt 49/54 (90,7%); Trung binh: 4/54 (7,4%); xau' 1/54 (1,8%),
- Thdi gian phlu thuat: 74,1 + 24,2 phflt, - Thdi gian dau sau p h l u thuat tmng binh: 3 ngay - Thdi gian liet mdt sau p h l u thuat ngan- 3 ngay.
- Thdi gian hau phlu trung binh 7 ngay.
- Nhilm trflng trocar 3,3(%) chi can didu tri npi khoa.
- Ap xe tdn du 1/60 (1,7%) didu tri npi khoa, TAI L l i U THAM KHAO
1. Tran Ngpc Bich, Phan Thanh LUdng (2002), "V/Sm mdt thda tri em". Tap chi Y hpc thuc hanh.
Y HOC THUC HANH (963) - S6 5/2015
2. Bp mPn ngoai TnJdng Dal hoc Y Ha Npi (2002), Binh hpc ngoai khoa.
3. Bp Y te (2004), "Kj? yiu eae cdng trinh NCKH". Tgp chi Y hoc thuc hanh. 491.
4. Hoang CPng Die (1999), "Viim mdt tf)ua", Benh hoc ngoai khoa, Nha xuat ban Y hpc, pp, 119 -135.
5. Dd Minh Dai, Nguyin Hoang Bdc, Nguyin Tan Cudng va CS (2003). "Phiu thuit n& soi diiu tri viim phOe mac rudt thda". Tap ehi Y hoc thuc hanh, 7(1), pp.
22 - 26.
6. Bui Sy Hien, Nguyin Duy Dan (1991), "Xdtri wim phuc mac toin bd do thing rudt thda tai khoa ngoai Viin Quan y 103 tiong nim 1989". Ngoai khoa, (6), pp. 14-17
7. Aaron M, Meriioff G. et al. (2000), "Laparoscopic versus open Appendectomy", Am.J. Surg. 79pp. 375-381.
8. Arnold P, Friedrich Gotz, et al. (1993),
"Laparoscopic appendectomy", Worid.J.Surg. 17(1), pp.
123-125.
9. Miyano G, Okazaki T, Kato Y, (2010), "Open versus laparoscopic treatment for pan-peritonitis secondary to perforated appendicibs in children: a prospecbve analysis." J Laparoendosc Adv Surg Tech A, 20(7), pp.
655-7.
10. Mohammad SM. Aayed AQ. Abdulrahman AB.
(2006). "Laparoscopic Appendectomy Is A Favorable Alternative For Complicated Appendicitis In Children", getaway.ovid.com.
DANH GIA KET QUA DIEU TRj GAY UEN MAU CHUYEN XUtmC DUI
or NGOffl CAO TUOI B A N G THAY KHOTP HANG BAN P H A N BIPOLARTOM TAT
Nghiin cdu kit qua diiu tri thay khdp hang ban phan Bipolar cho 33 benh nhin cao tuii gay kin lien miu chuyin xuang dui tai Benh vien Da khoa tinh Thanh Hda tdthSng 8/2010 din thSng 8/2014. Vdi dSc diim ngudi bSnh: cao tuii (tuoi td 70 - 96) tmng binh 84,5 ± 6.5, gay Hin miu chuyin Al, A2 theo pbSn loai AO, loang xuang tdddl - IU. Phuang phSp dieu tri nSy giOp eho benh nhSn van ddng sdm, phdng trSnh dugc cac biin chdng toSn than vS tai ch6 do nam bit ddng ISu. phuc hdi chdc nSng tot. DSnh giS kit qui xa theo thang diim Merte D' Aubigne - Pastel (30/33 BN): dat rit tot IS 16,7%,. tot 50%>. khS 30%, tmng binh 3.3%, va khdng cd kit qui xiu. Xquang ed 7.0%, mdn 6 di nhung chua thay thing day i di
Tdkhda: Thay khdp Bipolar, Gay lien miu chuyin xuang dui. thay khdp hSng ngudi cao tuoi.
SUMMARY
EVALUATION OF TREATMENT INTERTROCHANTERIC FRACTURE IN THE ELDERLY BY JOINT HIP REPLACEMENT BIPOLAR
To study the result of the treatment with joint hip replacement Bipolar for 33 eases intertrochanteric fmcture in elderiy at Thanh Hoa hospital from 8/2010 to 8/2014. Patient characteristic: The average age 84.5 ± 6.5 (70-96). intertrochanteric fmcture type A1. A2 according to AO. have osteoporosis from type l-IU according to Sirjgh. This method treatment help patients are moving earty, preventable complications related to real estate for long, good functional recovery.
Distance scale results according to Merie D'Aubigne - Postel (30/33 patients) reached 16.7%, very good. 50%, good, 30.0%, fairty, averaging 3.3%, and no results bad.
7.0%, X-ray had not yet seen wom aeetabularacetabular trough.
Keywords: Bipolar Joint Replacement, Intertrochanteric fradure. elderiy hip replacement
BAT VAN BE
Gay kin LMC (lien mau chuyen) xuang dfli b rigudi cao tudi la mdt chan biUdng Idn va nang nd, dieu tri kho khan do bnh chat d gay phflc tgp, chdt lupng
LE NGOC HAI, NGUYEN QUANG TRUNG, N G U Y I N DINH THANH XUdng kem (loang xudng), ket hpp nhidu bqrih ly mgn tinh toan bidn. Neu khong dudc dieu tai phau thugt thi de lai nhieu di chflng nang nd tgi cho nhu l^ong tidn xudng, lien lech, cflng khdp hang, Ididp gdi. loet vflng ty de va cac bien chflng toan than nhu viem phdi, bet nieu. suy mdn do nam tau dan den suy kiet rdi tijr vong.
Oieu tn ket xUdng LMC ngudi eao tudi bang cac loai nep DHS. nep vit, dinh Gama tJ le lien xUdng thap. cd nliieu bidn ehflng eham lien xUdng, khdp gia, long dinh, nep, lien lech, hoai tfl chdm iam eho BN khdng van dpng sdm dupe, dau ddn keo dai va nam bat dpng lau dd lai nhieu bien chflng toan than. Tai My, udc b'nh mdi nam CO khoang 200.000 t>enh nhan gay LMC xudng dui, ty le tfl vong len den 15% - 30%. phan ldn b BN hdn 70 tudi, va udc b'nh ehi phi eho dieu tri loai nay khoang 10 ty USD mpt nam [5].
Phlu thuat TKHBP (thay khdp hang ban phan) Bipolar giflp eho cac BN cao tudi gay kin LMC xUdng dfll van dpng sdm, phuc hdi chOc nang tot, cai thien dude diat lupng song, tranh dudc cac di chflng, bien chflng tai chd va toan than, Chung tdi tien hanh nghien cflu de tai nay vdi muc beu: Banh gia kit qua dieu tri gay kin LMC d ngudi cap tuoi bing TKHBP Bipolar vS nhan xet ve chi dinh phau thuat.
DOI TUONG VA PHUONG PHAP NGHIEN CUU 1. Ddi tUdng nghien cUU
- 33 BN 5 70 hjoi khdng phan biet gidi Unh, gay kin LMC XUdng dfli loai A l , A2 theo phan loai AO, dupc do mat dp xuong vflng khdp hang, p h l u thugt TKHBP Bipolar tai Benh vien £>a khoa tinh Thanh Hda tfl thang 8/2010-friang 8/2014.
- Co day dfl hd sd benh an. ed phim chup trudc md, sau md va dUde kiem tra djnh ky theo hen.
- Thay khdp lan dau. d cdi con tdt, khdng bj thoai hoa, khdng bidn dgng.
2. PhUdng phap nghien cflu
- Nghien cflu md ta lam sang cat ngang khdng ddi chflng, hdi cflu va ben cflu.
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