Đánh giá hiệu quả của phương pháp tán sỏi qua đường hầm Kehr trong điều trị triệt để sỏi đường mật ở người lớn tuổi

DAN H GIA HIEU QUA CUA PHimNG PHAP TAN SGI QUA DU^ G HAM KEHR

TRONG DIEU TRI TRIET DE SOI DU6N G MAT 0 NGOftl LQTN TUOI

BUI MANH CdN - B$nh vi$n Binh Din, TP. Hd Chf Minh

NGUYEN VA N XUV^ N - Hgc vi$n Quin Y

NGUYI N OQ C TRUNG - D?/ hpc Y khoa Ph^m Nggc Th^ch

TOM TAT

Muc dich: Danh gia t^ le sach sol sau tan sol

dudng mat qua dudng ham Kehr d nhCfng benh nhan

ldn tudi.

Phuong phap: Tien cdu cit ngang phan tich. Thdi

gian td ngay 01/2008 den 03/2010 tai khoa Gan mat

benh vien Binh Dan, 90 benh nhan > 60 tuoi, da dugc

tao dudng ham dng Kehr, den kham va dieu tri tai BV

Binh Dan, cd sol tdn luu hay sol sdt dudng mat, can

phai tan sol dieu tri dugc dua vao mau nghien edu.

Sau dd eac benh nhan se dugc theo doi sau 6 thing

dd xae dinh hieu qua dieu tri.

Kei qui: Tudi trung binh: 74,2 ± 8,9, nO/nam: 7:3.

Solan tan soi: 1,5 ±0,9 lan. T^ le sach sol cao sau tan

soi qua dudng ham Kehr d nhdm ngoai gan, thap han

d nhdng nhdm ed sol trong gan ket hgp, thap nhat d

nhom gan trai + ngoai gan va nhdm sot soi a ca 3 vi tri

(p<0,05). Sd lugng sol cang nhieu thi kha ning cdn sol

sau tan soi cang cao (p<0,05). Kich thudc sol cang Idn

thi kha ning cdn sol sau tan sol cang cao (p<0,05). T^

le thanh cdng cCia tan sol qua dudng ham Kehr d

nhutig benh nhan tren 60 tudi la 81,8%,.

Kei luin: Ddi vdi nhiing ngudi Idn tudi, viee tim mdt

phuong phap de dieu tri triet ein sol dudng mat la mot

cau hdl dugc dit ra. Tan sol qua dudng ham Kehr dugc

thuc hien sau lan md ma dng mat chd lay sol va dan

luu Kehr, thi 81,8%, benh nhan sach sol hoan toan thi

day la mdt ket qua dang dugc quan tam.

Tir khoa: dudng ham Kehr, benh nhan Idn tudi,

tin sol.

SUMMARY

Purpose: The aim of this study was to estimate

the ratio of complete clearance of stone after

lithotripsy treatment performed through a T- tube tract

in elder'y patients.

Method: A prospective analysis. From 01/2008 to

03/2010, 90 patients over 60 years old, were

performed Kehr tube, examined and were treated at

Binh Dan hospital. They had recurrent or retain

stones in bile duct and must be performed lithotripsy

treatment. These patients were included in the

research samples. After that, patients would be

followed in 6 months to determine the effectiveness of

the treatment

Result: Average age: 74.2 ± 8.9; the ratio of

female/male: 7/3. The number of performance of

lithotripsy: 1.5 ± 0.9. The rate of complete clearance

of stone was highest with lithotripsy at extrahepatic

group; and lower with stone in combined interhepatic

group; and lowest in left + outside liver group and

retained stones in 3 positions groups (p<0.05). The

more number of stones was in liver, the more ability

of retained stones after performed with lithotripsy

(p<0.05). The larger stone size was, the more ability

of retained stones after performed with lithotripsy

(p<0.05). Success rate of complete clearance of

stone through Kehr tube of patients over 60 years old

was 81.1%

Conclusion: In elderly people, finding method to

treat the bile duct stone completely was a question

being posed. Lithotripsy through Kehr tube was

performed after surgery to open common bile duct

and drained with Kehr tube, there are 5 •'.'/% of

patients are complete clearance of stone, this is a

deserving attentive result.

Keywords: stone, T- tube tract, elderly patients.

OAT VAN DE

6 Viet Nam, benh ly gan mat, dae biet la sdi mat

la mpt benh rat can dupe quan tam do tfnh phd bien

eua nd (chie'm mot vj tri dang ke trong cap cifu ngoai

khoa sau cap ciiu viem rupt thUa cap va trong cac

trudng hpp md chUdng trinh) va khd dieu trj triet de,

can nhieu phUdng phap dieu trj ca npi khoa va phau

thuat. Benh thUdng gap d nOf nhieu hon nam. 6,3% la

tan sua't mac sdi mat d ngUdi > 50 tudi tai thanh phd

Hd Chi Minh, trong dd sdi tui mat chiem da sd [1].

Tan sua't mac sdi mat chung cua dan sd khoang 5 -

25%, va thay ddi theo tifng dja phUdng, qudc gia,

chau luc, dac diem phong tue tap quan. Ty le bien

chirng sau md 3 - 7%. Ty le tif vong thay ddi, chu yeu

do sdc nhilm triing va chay mau dudng mat. Ty le sdi

sdt dudng mat sau md theo cac tai lieu khoang 2 -

27% ddi vdi sdi dUdng mat ndi chung, va khoang 46 -

77% vdi eac trUdng hpp sdi trong gan. Ty le tai phat

sdi sau md lay sdi vao khoang 40 - 75%. [2, 6, 8]

Md dng mat ehu la'y sdi va dan luu dudng mat

bang dng Kehr, sau dd tie'p tue dUpc tan sdi qua

dudng ham Kehr, dupe xem nhU la mpt phUdng phap

dieu trj triet de, nhe nhang sdi dudng mat, dUdc ghi

nhan vdi ty le thanh cong (lam sach sdi hoan) tif 80 -

90%. Do vay, day ed phai la phuong phap thich hpp

de dieu tri sdi dudng mat d nhufng benh nhan Idn tudi,

mpt ddi tupng cd nhieu yeu td nguy co do nhCfng bidn

ddi sinh ly tudi cao va nha't la do nhiJrng benh man

tfnh kem theo [3, 5, 7, 9]. Chung toi danh gia ty le

sach sdi sau tan sdi dudng mat qua dudng ham Kehr

d nhOrrig benh nhan nay.

104 Y HOC THUC HANH (741) - SO 11/2010