Biến chứng chảy máu phải mổ lại sau phẫu thuật Longo

BIEN CHUIMG CHAY MAU PHAI MO LAI SAU PHAU THUAT LONGO

TRINH HONG SON, NGUYEN THANH QUANG

DAT VAN oi

Phlu thuat Longo trong di^u tri trT Id cat vdng

niem mac, dUdi niem mac tn/c trang tren dudng lUdc

3 cm nham keo bui trT va niem mac tare trang sa trd

ve vi tri binh thudng, ddng thdi cat ngudn mau den bui

trT. Tac gia dUa ra y tudng nay va thue hien dau tien la

phlu thuat vien ngUdi y: Antonio Longo nam 1993 [4].

Den nay, phlu thuat nay da dUdc thue hien

thudng quy tai benh vien Viet Dure ciing vdi nhufng

phlu thuat dieu tri trT kinh dien khae.

Ben canh nhufng uu diem nhu an toan, hieu qua,

de thufc hien dac biet it dau sau md va nhanh chdng

dua benh nhan trd ve sinh hoat binh thudng, phlu

thuat Longo cung cd the xay ra cac bien chufng nha't

la bien chufng chay mau sau md. Chay mau sau phlu

thuat Longo ed the trong vdng 72 gid sau md, ciing

cd the chay ri ra nhufng ngay sau.

Nghien curu nay ghi nhan chay mau sau phlu

thuat Longo phai md lai de cam mau tai benh vien

Viet Dure tir 2/2007 de'n 10/2009.

TU LIEU VA PHUONG PHAP NGHIEN CLfU

1. Tulieu.

04 benh nhan chan doan trT dupe md theo

phUdng phap Longo tai benh vien Viet Dire hoac tai

eae benh vien khac cd bien chirng ehay mau phai

md lai tai benh vien Viet Dufc trong thdi gian md tU

2/2007 de'n 10/2009.

2. PhUdng phap.

- Nghien ciru hdi ciru, md ta.

- PhUdng phap thu thap sd lieu: lay sd giao ban

md cap cufu hang ngay cua benh vien, tim nhufng

trudng hdp md lai cap cufu sau phlu thuat Longo, ghi

nhan hp ten benh nhan va ngay vao vien, tra ciru ma

sd va tdi kho hd sd luu truf lay hd sd benh an.

3. Cac chi tieu nghien cUu.

Tat ca benh nhan dUdc thu thap theo 1 benh an

mlu chung, vdi eae dif kien:

- Tudi, gidi 'i

- Ndi md Longo

- Lam sang trUde khi' md lai: tinh trang ia mai)

trudc md, thdi gian md lai (tfnh tir sau phlu thuat

Longo den khi md lai tai benh vien Viet Dufc; ddn vi:

ngay), ghi nhan da md lai tai ndi md Longo, trUde

khi de'n benh vien Viet Dife, tinh trang mach, huyet

ap khi vao vien Viet Dure.

- Nhdm mau va sd luong mau truyen trudc md

- PhUdng phap gay te, gay me, thdi gian md

- Danh gia tdn thUdng trong md va each xif 1;^

- Ket qua sau md: thdi gian nam vien, bien

chufng sau md va tinh trang khi ra vien.

K£'T QUA VA BAN LUAN

Sau phlu thuat Longo da cd nhieu thdng bao

trong Y van md ta cac bien chUng dac biet sau md. Vi

du:

- Nam 1997, Peseatori [6] thdng bao 1 trUdng hpp

rd true trang am dao sau phlu thuat Longo.

- Nam 2000, Molloy va Kingsmore[5] da thdng bao

mpt trudng hpp nhilm triing tieu khung va khoang

sau phiie mac sau phlu thuat Longo.

- Nam 2001, Shalaby va Desoky gap 1 trudng

hdp (tdng sd 100 benh nhan) hep hau mdn sau md 1

nam [8].

- Nam 2002, Rippeti va cdng su [7] thdng bao 1

trudng hdp thiing trUc trang gay tran khi phuc mac va

trung that.

- Nam 2003, Wong va cdng sU [9] lai thdng bao 1

trudng hdp thiing true trang sau phlu thuat Longo

- Nam 2005 cac tac gia an dp nhac lai thdng bao

cua Cipriani va Pesctorri ve 1 trudng hop tac rupt cap

tfnh vi ddng ki'n niem mac true trang[3].

Ngoai ra, cae bien chufng khac cung da dupc neu

trong Y van: dau keo dai hoac dau duf dpi; chay mau

dif dpi; tdn thUdng cd that; hep hau mdn, hep true

trang; sdn phan, la khdng tU chui; tang trUdng iuc co

that; bf tieu; nift ke hau mdn; trT tai phat; bien chufng

tac mach; nhilm triing; tu mau thanti, canh tang sinh

mdn; hdi chufng vach niem mac; buc chd khau, buc

mieng ndi...

Bien chirng chay mau phai md lai la mpt trong

nhufng bien chirng cua phl u thuat Longo. Trong thdi

gian tir 2/2007 den 10/2009 chiing tdi thu thi p dUdc 4

benh nhan dupc md lai sau phl u thuat Longo vdi bien

chufng chay mau dieu tri ndi khdng ket qua. Ket qua

eu the nhu sau:

Bang 1: Tudi, gidi, ma hd so

Hpva

ten

Dinh

XudnH

Nguydn

TidnT

Ndng

VanL

Nguydn

VanM

Gidi

Nam

Nam

Nam

Nam

Tudi

18

44

34

49

Noimd

Longo

Bv Udng bi

BvNam

Thang long

Bv Vidt Dire

BvBac

Thang long

Ngdy m6 lai tai

VidtOirc

27.2.2007

6.32008

7.5.2008

3.10.2009

Masd

184/4832

•I

184/5213

184/1017

2

184/2671

0

Tat cac cac benh nhan deu la nam gidi, tudi tha'p

nha't 18, cao nha't la 49. Cd 1 benh nhan duoc md tai

benh vien Viet Dure, 3 benh nhan dupc chuyen tir cac

benh vien khac tdi.

Y HOC THl/C HANH (751) - S6 2/2011 39