Phương pháp nối thực quản qua đường ngoài màng phổi trong điều trị bệnh teo thực quản bẩm sinh cho trẻ sơ sinh

4. Norman C, Weber A. (1994), Social Health

Insurance: A Guidebook for planning.

5. Qudc hOi khda 12 nudc cOng hda XHCN Vi$t

Nam, Luat BHYT 25/2008/QH12, 2008

6. VO Xuan Phu ^2007), Thyc trgng ehi tra kham

chira b#nh a tuyln y te co sd tai Chi Linh - Hii Duong,

2004-2005 va d l xuit giai phap can thi$p, Luan van

Tiln sy y hpc, Vign Vg sinh djch te TW.

PHUDNG PHAP NO I THU C QUAN QUA omOTNG NGOAI MANG PHOI

TRONG DIEU TRj BENH TEO THUC QUAN BAM SINH CHO TRE SO SINH

NGUYEN THANH CONG, NGUYI N THANH LJ^M,

B^h viSn Nhi Trung oong

T6MTAT

Teo thgc quin bim sinh li mgt di tit cin dwgc phau

thuit s&m ngay tmng thai ky s& sinh. Tmng 5 nam, 2002-

2006, 61 bgnh nhin sa sinh mic teo thgc quan bam sinh

tai Bdnh vign Nhi Tmng wang di dwgc phau thugt ndi thgc

quin qua dwdng ngoii ming phdi. Khdng cd tai bien tmng

giy md, khdng cd tir vong tmng md. Kit qua dgt dwgc cho

thiy v&i phic dd cich thirc phiu thugt cua bgnh vign,

dw&ng ngoii ming phdi trong phau thugt ndi thgc quan

cho tre sa sinh mic teo tht/c quin bim sinh li mdt

dw&ng md an toin, vi khdng khd tht/c hign.

Tir khda: Teo thgc quan bim sinh

SUMMARY

Congenital esophageal atmsia is congenital anomaly

which requires eariy surgical mpair in neonatal period.

During 5 years, 2002-2006, extmpleumi esophageal

anastomosis was done for 61 newboms with congenital

esophageal atmsia in National Hospital of Pediatrics. Them

were no anesthetic complication, no intmopemtive

mortality. The getting msults shows that with Hospital's

protocol, extmpleumi esophageal anastomosis Is a safe

and not complicated procedum for the newboms suffering

from congenital esophageal atmsia.

Keywords: Congenital esophageal atmsia

OAT VAN Dt

Teo thyc quan bim sinh la mpt dj tat ein duyc phiu

thuat sdm ngay trong thoi ky so sinh. Rd migng ndi thyc

quan va dudng rd khi - thyc quan la mpt biln chupng xay

ra sau md vdi ty lg 8-10% [6]. Ol giam ty lg tiT vong khi ed

rd migng ndi thyc quan xay ra, nhieu each thiPC phiu thugt

da duyc nghien CUPU va da duyc thyc hanh. Nam 1936,

Lanman aa dl nghj SUP dgng dudng ngoai mang phdi de tai

tgo sy thdng sudt cua thyc quan. Sau bay nam, nam 1943,

Cameron Haight da tgo hinh thyc quan ngay ky diu

thanh cdng vdi dudng md nay [4]. Tgi Vigt Nam, tur nam

1997, khoa Ngogi - Bgnh vign Nhi Trung uong thdng

nhit sir dgng dudng ngoai mang phdi d l ndi thyc quan

[2]. Chiing tdi lam nghien ciPU nay vdi mgc dich xem Igi

each thupc tiln hanh vi kit qua dem Igi eua phau thugt

ndi thyc quan qua dudng ngoai mang phdi cho cac tre

so sinh mle teo thyc quan bam sinh cua ehiing tdi trong

nhiTng nam qua.

OOl TU'ONG VA PHU'ONG PHAP NGHIEN CLfU

Odi tuyng nghiSn ciPU la bgnh nhan sy sinh cd chin

(Joan teo thyc quan bim sinh, duyc md ndi thyc quan

dudng ngoai mang phdi tgi bgnh vign Nhi Trung yyng

tip thang 12 nam 2001 din thang 12 nam 2006.

Nghi6n CUPU duyc tiln hanh theo phuong phap md ta

tiln CUPU cd phan tich.

Sd ligu duyc xir ly thdng ke bing phin mem SPSS

15.0.

K^T QUA

- Tip thang 12 nam 2001 den thang 12 nam 2006, ed

61 trudng hyp so sinh mie TTQBS duyc md ndi thyc

quan theo dudng ngoai mang phdi.

- 61 trudng hyp cd teo thyc quan kiiu III theo Ladd (kiiu

C theo Gross, kieu 3b theo Vogt va Kluth). Khoang each hai

diu thyc quan xa nhau trung binh la 11,0 ± 6,8 mm.

- Thdi gian phiu thugt ndi thue quan trung binh 80,3

± 26,4 phut: ngan nhit 45 phiit, dai nhit 160 phiit.

- Rach mang phdi cd 4 trudng hyp chilm 6.6%.

- 21 bgnh nhan cd eat doi tTnh mgch don d l bde tach

diu duoi thyc quan.

- Toan bd bgnh nhan duyc cat rdi dudng rd khi -

thyc quan, khau kin dudng rd bing 3-4 mui chi 6.0 mui

rdi.

- Toan bp cac trudng hyp duyc ndi thyc quan tgn -

tgn, mui rdi, ehi 6-0.

- 12 bgnh nhan duyc tiln hdnh dgt din luu khoang

ngodi mang phdi do ed 2 diu thyc quan xa nhau tren 20

mm.

- Khong ed tgi biln gay me, hdi SUPC trong md.

- Khdng ed tir vong trong md.

- Truyln mau sau md: 20 bgnh nhan ehilm 32,8 %.

Nguyen nhan truyen mau:

+ Thiiu mau trude md: 4 bgnh nhan

+ Phiu thugt tieu hda khae kem theo: 4 benh nhan.

+ Dilu trj viem phdi, nhiim triing huyet Keo dai: 12

bgnh nhan.

- Thd may sau md: Cd 36 bgnh nhan thd phai may

sau md (59%). Thdi gian thd may trung binh eua 36

bgnh nhan phai thd may la 130,7 ± 156,3 (gid).

Bang 1: Biln chiTng sau md.

Bien chifng sau mo

Viem phoi

Nhiim triing huyit

Trdn mu mdng phoi phai

Trdn mu mdng phii hai bdn

R6 midng nii TQ + nhiem triing huyet

12

8

4

3

1

19,7

13,1

6,6

4,9

1,6

- Thdi gian taing binh tip khi mo den khi mt sonde mui eho

an la 10,9 ±2,7.

- Khang sinh duyc diing sau md trung binh la 12,2 ±

4,1 ngay.

- Thdi gian trung binh tii' khi md din kh^ ra vign la

14,2 ± 3,6 ngay.

- Ty lg sdng ra vign: 72,1% (44/61) bgnh nhan song

ra vign.

V HOC THVC HANH (751) - S 6 2/2011 117