Giới thiệu phẫu thuật cắt đầu tụy tá tràng

DIENDAN Y HOC

Chuyen de trong thang

Gidi thieu phiu thuat

cat dau tuy ta trang

Nguyin Ngoe Bich*

I. NOI DUNG CUA PHAU THUAT

Phau thuat cat dau tuy td trlng II mgt phau

thuat Idn vl phirc tap trong chuySn nganh tiSu hda.

Su phirc tap bdi giai phau dinb khu tai cho va kit

hgp vdi su tham nhiSm cua td chtrc ung thu tdi cle

tang lan can nhat la cic bd mach trong dd c6 bo

mach mac treo trang tren. Han nira cic mieng ndi

tuy-rudt, mat- rugt sau md cd ty IS tai biSn va biSn

chirng cao (20-30%) va tir vong sau md cao (5-

7%). Dac biet cle benh ly ung thu viing diu ttiy

sau phau thuat sdng sau 5 nam cdn thip (10-15%)

nSn khiSn cho cle phau thuat vien e ngai khi thyc

hien loai phau thuat nay .

Ndi dung ciia phau thuat II: cit bd khdi diu

tuy, tiii mat, phan thap cua dng mat chti, mdt phin

da day (hang vj), khung tl trlng vl quai hdng

trlng diu tiSn trong mdt khu giii phiu rit nhiSu

mach mlu nhu phia sau la tTnh mach chii dudi, bo

mach mach treo trang trSn va he tTnh mach cira.

Hinh 1. Sffdd cdc vung cdn cat bd trong

phdu thuat cat ddu tuy - td trdng

KSt hgp nao vet bach cudng gan, tren tuy, mac

treo dai trlng. Sau dd phuc hdi luu thdng vdi 3

mieng ndi: tuy- rugt, mat-rugt va da dly - rugt.

Cat dau tuy tl trang dugc chi djnh cho cic

benh thudng gap sau:

- Ung thu Vater, ung thu phan thap dudng mat,

ung thu dau tuy... nhiSu khi khdng thS xac dinh

dugc dau II nguyen nhan nSn ngudi ta ggi la cac

khdi u viing quanh bdng Vater (Peri Ampullary

Tumors)

- CIc benh ttiy Ilnh tinh nhu viSm tuy man, soi

dau ttry.

- Dac biet cac chan thuang phirc tap dau tuy vl

tl trang.

- CIc u tl trlng (GITS)... ' ' "'"

II - SIT PHAT TRIEN CUA PHAU THUAT

Ngay nay phau thuat cit diu tuy-tl trlng da

dugc phlt trien d muc do cao, nhit II tir nhung

nam 60-80 ctia the ky trudc.

KSt qui theo cic thdng kS trong giai doan diu

thiSn niSn ky nly vdi ty IS tai biSn va biSn chirng

chi cdn 5-7% (trudc day 20-30%), ty IS ttr vong 3

- 5% tham chi tdi 0% d cle trung tam chuyen

khoa. Thdi gian sdng sau md vdi cac benh nhan

ung thu viing quanh bdng Vater sau 5 nam quanh

quan 15-20% la mgt kSt qua rit kha quan vdi sy

phdi hgp ciia phau thuat, gay mS hdi sire vdi cac

bien phip diSu trj bd trg sau phiu thuat. Vdi su

phlt triSn cila phau thuat ndi soi, nhiJng nam gin

day phau thuat trSn da dugc thyc hien tirng phin

qua ngi soi.

DS cd cai nhin vS sy phat triSn ciia loai phiu

thuat trSn chiing tdi xin gidi thieu qui trinh phlt

triSn ciia phau thuat qua cac giai doan, nhiing cai

tiSn qua cic thdi ky va cic quan diem y hgc tung

' Khoa Ngoai - Benh vien Bach Mai

20 IY HOC LAM SANG So 46 (Thang 11/2009)