Nhận xét đặc điểm biến chứng sớm sau mổ Basedow tái phát sau phẫu thuật

'- NHA N XET DA C DIEM BIEN CHUfUGSOTM

SAU Mfi BASEDOW TAI PHAT SAU PHAU THUAT

TOMTAT ^'*'^ ' •

Trong thdi gian tif 7/1999 ddn 10/2008, 690 binh

nhan Basedow dugc chin doin vi dieu tri ngoai khoa

tai khoa phau thuit Idng nguc - Benh vien 103, trong

dd cd 595 benh nhin phau thuat lan diu vi 95 benh

nhan tii phit sau phiu thuit.

Ket qua bien chdng sdm sau md ddi vdi Basedow

tai phit sau phiu thuat:

Tl le bien chimg sau md chung d nhdm md tai

phit la 11,6%, nhieu hdn so vdi nhdm md lin dau

(5,2%)^ (P = 0,02024).

Bien chdng suy hd hdp cip tinh sau md d nhdm

md tii phit (5,3%,) nhieu han nhdm md lan dau

(1.2%) (P= 0,01597).

Bien chdng tdn thuang than kinh quit ngugc

(TKQN) sau md d nhdm md til phat (3,2%), nhieu

han nhdm mdlan dau (0,7%) (P= 0,04623).

- Cac bien chifng chay miu, tetani va cudng giip

kich phat khac nhau khdng co y nghTa thdng ke so vdi

nhdm md lan dau.

TCr khoi: Benh Basedow, cudng giip tai phit sau

phau thuat, phau thuat budu giap tii phit.

SUMMARY

From 7/1999 den 10/2008, 690 patients of Graves'

disease were treated in thoracic surgery department

- Military hospital N 103. 95 patients relapse of

hyperthyroidism referred for secondary surgery were

compared to tht, 595 patients who underwent primary

bilate'-al surgery.

The eariy postoperative complications of the

secondary surgery group were:The morbidity rate

was 11.6%, higher than cases of primary thyroid

rssection for bilateral disease, with 5.3%, acute

respiratory failure, 3.2%> transient recurrent laryngeal

nerve palsy. These results were higher than those

from cases of primary thyroid resection for bilateral

disease.

The postoperative complications such as

hemorrhage, hypoparathyroidism and thyrotoxic crisis

were similar cases of primary thyroid resection.

Keywords: Graves'disease, relapse of

hyperthyroidism after subtotalthyroidectomy, reoperation.

DAT VAN OE

Benh Basedow la mpt benh kha phd bien d nude

ta eung nhU tren the gidi. Tai nUde ta , theo Le Huy

Lieu, benh chiem 45,8% sd benh nhan ndi tiet va

2,6% eac benh ndi khoa tai benh vien Bach Mai. Tai

Chau AU ti le.mac benh hang nam la 20/100.000 dan,

tai My ti le khoang 40/100.000 dan. [1], [2].

Dieu trj ngoai khoa hien nay cd nhieu Uu diem:

thdi gian dieu trj ngan, ti le khdi benh cao va ben

vOrng, hieu qua kinh te cao, ap dung dupe cho nhOmg

NGUY§N NGQC TRUNG - B$nh vl^n 103

NGd VA N HOAN G LIN H - B$nh vi$n 103

trudng hpp dieu trj npi khoa khong khdi hoac khdng

the SLf dung dUpc thudc khang giap tdng hpp hoac iod

phdng xa. Tuy nhien dieu trj ngoai khoa vin con ed

mpt sd bien chifng, hien nay bien chifrig tai phat van

eon chiem mpt ti le nha't dinh. Lua chpn phuong phap

dieu tri phii hop ddi vdi Basedow tai phat sau phiu

thuat van cdn la va'n de dupe nghien cifu.

Vdi sU tien bd trong ITnh vUc phiu thuat tuyen

giap, tl le tai bien va bien chifng phau thuat da giam

dang ke. Mpt sd tac gia hien nay da khuyen khich lUa

chpn dieu tri ngoai khoa trong dieu tri Basedow tai

phat sau phiu thuat. Tuy nhien, cac nghien cifu cho

rang phiu thuat tai phat khd khan do sU tham nhiem

eua td ehOre xd va tUdng quan giai phiu thay ddi do

seo md cu, mat khac ddi vdi cUdng giap cdn tang sinh

manh mach mau tai tuyen giap va td chijrc xung

quanh tuy en. [3], [4], [5].

Xua't phat tU nhufng dac diem neu tren, chiing toi

tien hanh nghien cifu nham muc tieu: danh gia, nhan

xet dac diem bien chilmg sau md ddi vdi cac benh

nhan Basedow tai phat sau phiu thuat.

OOI Tl/pNG vA PHLfONG PHA P NGHIS N CLfU:

Cae benh nhan BGLTND tai phat sau phiu thuat

dupe chan doan va dieu trj phiu thuat tai Benh vien

103 (Hpc vien quan y) trong thdi gian tif thang 7/1999

den thang 10/2008. Tdng sd 95 trUdng hpp. Dc lam ro

hOn eae dae diem chan doan va dieu trj cija cae benh

nhan Basedow tai phat sau phau thuat chiing tdi dUa

vao nhdm nghien cOru 595 benh nhan Basedow dUde

md lan dau cung trong thdi gian ndi tren tai Benh vien

103 (Hpc vien quan y). Cac benh nhan nghien ciiru

deu cd chan doan xae djnh benh Basedow bang xet

nghiem md benh hpc sau md.

Cae sd lieu dUpc thu thap va xiir ly bang bd

chuong trinh phan mem Epi Info 2002 chuyen diing

trong thdng ke y hpc, dupe thiet ke bdi Trung tam

kiem soat benh tat cija Hoa Ky (CDC).

KET QUA NGHIEN CLfU

Bang 3.1. Bien chifng chay mau sau md:

Chiy mdu vdt md

Khdng cd bidn

chimg

Cd bidn chirnq

Cdng

Nhdm bdnh nhdn

Md tdi phat

91 (95,8%)

4 (4,2%)

95(100%)

Md lan dau

585 (98,3%)

10(1,7%)

595(100%)

P

0,1134

Nhan xet: Bien chifng chay mau sau mo cl nhdm

md tai phat la 4,2%, nhdm md lan dau la 1,7%. Ti le

bieri chimg chay mau sau md d nhdm md tai phat

nhieu hon so vdi nhdm md lan dau, tuy nhien khac

nhau khdng cd y nghla thdng ke vdi P= 0,1134.

120 Y HOC THUC HANH (741) - s 6 11/2010