Stent đường mật qua da trong tắc đường mật

Dick khi nghien cipu tren 200 benh nhan so sanh vlt

md phia thai duang va vlt md cung giac mgc da thay

rang phan ipng viem d tiln phdng thip han va cd y

nghTa thdng ke d nhdm md phia thai duang [5].

Theo I.Howard Fine, dudng md phia thai duang liln

lai nhanh chdng, chdp mat binh thudng. Chinh vi nhQ'ng

uu diem ay ma ngay nay cac phlu thugt vien thich dung

dudng md phia.thai duang han.

4.4.4. Ky thuat tach va xoay nhan.

Chung tdi dung kim G24-25, gan vdi bam tiem 3ml

chLPa 1,5-2ml dung djeh ringer laeatte. Dua dau kim

xudng dudi bao va nang nhe nhang, bam tif tif djeh cho

din khi nhin thiy ludng dung djeh chay loang deu qua

bao sau tu' 2- 3 lan. Sau khi nhin rd djeh chay qua bao

sau va thiy nhan ndi len trong bao, ep nhe len bl mat

cua nhan de day djeh trong bao tran ra va de tach hoan

toan nhan ra khdi idp vd bao quanh nd. Dung diu kim

hoac Hook xoay nhan de dam bao chae chin ring nhan

da tach ra khdi vd bao.

Cd trudng hpp nhan chua xoay dupc phai lam Igi

cac budc tach nhan, hoac cd the dung hai dgng eg la

mdc Sinskey dl xoay nhan bang tay, cho tdi khi tach

dupc nhan ra khdi vd bao va ehung tdi phai bam djeh

tach nhan d nhieu vi tri trong Idng bao.

KtT LUAN

Qua nghien cipu 105 benh nhan (137 mat) tudi tu' 40

trd len dupc phlu thugt TTT bing ky thugt Phaeo Bpnh

vien Da khoa tinh Ha Giang nam 2008, chiing tdi rut ra

mpt sd kit lugn sau:

2. Kit qua phlu thuat TTT bing ky thuat Phaco.

Sau md 1 thang cd 94,9% sd benh nhan ed thj lye tif

6/10 -8/10, nhdm thi lue nay cd d thdi dilm 6 thang la

88,3%.

Biln chipng trong md ehi ggp d 2,2% vg la nhQ'ng

bien chifng nhp, ehi cd mpt trudng hpp rach bao sau.

Biln chipng sau md trong tuin diu la phu giac mac

1,46%, VGM khia vdi ty Ip 2,2%), phan u'ng MBD 2,9%.

Phu hoang dilm dgng nang gap 1 thang sau md la 4,4%

va sau md 3 thang la 2,2%. Dye bao sau gap d thdi

dilm 6 thang la 7,3%. Lang dpng t l bao mat lOL d thdi

dilm 3 thang va 6 thang la 3,6%)

- Vdi kit qua dgt dupe nhdm nghien cu'u eug ehung

tdi khing djnh ring Benh vipn Da khoa tinh Ha Giang da

tilp nhgn chuyen giao cdng nghe md phaco thanh edng.

3. D§ xult LPng dung cua phircng phap

NhQ'ng kit qua da dgt dupc trong qua trinh nghien

ciPU ipng dgng, nhdm nghien cipu chung tdi khang djnh

budc diu LPng dyng phlu thugt phaeo tgi Bpnh vien Da

khoa Ha Giang dgt kit qua tdt, dap ipng vdi myc tieu d l

ra.

- Vdi nhQ'ng uu diem neu tren phlu thugt phaeo can

dupc U'ng dyng rpng rai trong toan tinh gdp phin tich

eye vao nhipm vg giai phdng mil loa eua Qudc gia ndi

Chung vd tinh Ha Giang ndi rieng.

STENT DUdNG MAT QUA DA TRONG TAC DlTDTNG MAT

TOM TAT

De tai co muc tieu danh gia kit qua cua kT thuat d^t

stent duvng mat qua da sCr dung gia da kim loai tw na

(GDKLTN) trong benh 11 u khong con chi dinh phau

thu$t, nhan 14 tnrang hop. PhuKyng phap: mo ta tien cuv

(tlf 2008 den 6/2010). Hinh anh duxyng mat tren may

chijp mach DSA dwgc coi la tieu chuan danh gia ket qua

ngay khi lam thu thu$t. Cac chi so chwc nang gan va cac

bien chwng dwgc ghi nh$n. Ket qua: T^o l$p dwgc

duang thong xuong ta trang trong ca 14 trwong hgp (mqt

trwong hgp phai tien hanh thu thuat 2 lan). Thanh cong

vi mat ki thu$t 100%; 6/14 (42%) tnrong hgp chi dan

Iwu duge dwang m$t mqt ben gan do bit tac the Bismuth

III. Hal b$nh nhan co bien chwng nang: nhiim khuan

dwang mat, tran dich mang phoi. 10 b$nh nhan co hinh

anh thoat thu6c vao khoang phue m$c nhwng khong gay

bien chimg tren lam sang. Ket lu$n: Ket qua ban diu

cua ki thu$t dat qua da stent che phu vao du^yng m$t

dang kha quan, hira hen thin vgng.

Cac chCr viet tat: OMC-ong m$t chu. DMC: dwong

m$t chinh; GDKLTN-gia da kim loai tw no (auto￾expanding stent).

Tif khoa: d§t stent duv'ng mat qua da

SUMMARY:

Value of percutaneous self-expandable metallic

stents for biliary obstruction

PURPOSE: To determine the technical results of

using an auto-expanded biliary endoprosthesis to treat

NGUYI N QUOC DUNG

Khoa CDMA benh vien HCfu nghi

malignant biliary obstmction. l\/IATERIALS AND

METHODS: This prospective nonrandomized study

included 14 patients (from 2008-2010) with malignant

obstmction of the pnnciple bile duct, the internal

drainage was performed by using fully covered

endoprostheses. DSA fluoscopic Images were used to

evaluate the immediate results of the technlc.

Procedure- and device-related complications were

recorded. Mean follow-up billmbinemia were calculated.

RESULTS: Successful deployment, correct positioning,

and patency of the device were achieved In all patients

(15 procedures/14 patients). Branch duct obstmction

was observed In six (42%) patients. Grave complications

(pleural effusion and biliary infection)-occurred in two

patients. Laboratory values decreased significantly after

the procedure (P <.001). No endoprosthesis migration

was observed. CONCLUSION: Initial results of

percutaneous treatment of malignant biliary obstructions

with fully covered stents suggest that they are safe and

potentially clinically effective

Keywords.percutaneous self-expandable metallic stents

DAT VAN Dfe

Tac dudng mat chinh (DMC) do u khdng thi phlu

thugt Ig mpt bpnh eanh thudng gap, dgt ra yeu clu dieu

tri trieu chipng bing each dan luu mat.

Cd the din luu dudng mgt da ngoai hoac vao trong

ta trang. Dan luu mat ra ngoai la thu thuat dan gian, re

tiln nhung cd nhupe diem lam mit dich mat, chit lupng

Y HOC THlJC HANH (727) - SO 7/2010