Thông báo lâm sàng trường hợp ghép gan toàn bộ từ người cho chết não

'' 21h30 BN trong tinh trang me sdu Glasgows 3

diem,mat hit cac phan xg, huyet dp 145/IOOmmHg c6

dting vdn mach , testmat nao Idn III kit qua (+), dipn

nao dd thay dudng thing, sieu am chyp mgch mat hodn

todn edc tin hipu DM ndo. Sau khi du'pc chan dodn chet

ndo, giai thieh tinh trpng bpnh nhdn eho gia dinh, dupc

gia dinh BN ddng y cho tang. BN du'pc tien hdnh phau

thuat lay da tang theo md hinh da dinh sdn. 6/ benh

nhdn ndy thyc hipn lay 2 than vd gan. 2 than dirpc ghep

cho 2 BN: nam 38 tudi vd 22 tudi suy than man cting

nhdm mdu A. Tiln triln phau thugt dn dinh vd ra vipn

sau 12 ngdy.

BAN LUAN

Phau thudt lay tang ttr ngu'di cho chet ndo du-pc

thyc hipn ttr nhtrng nam 1960 tai edc nu'dc chdu Au vd

My. Cy Vipt Nam day Id lan dau tien bpnh vipn Viet Dtre

thyc hipn lay tang ttr ngirdi cho chit ndo. Vdi ba benh

nhdn chet ndo hiin tang, ehiing tdi da thyc hipn thdnh

cong 6 trudng hpp ghep than vd mpt tru'dng hpp ghep

gan. Oe ed du'pc thanh cdng nay chiing tdi xin du-a ra

mpt sd kinh nghipm ban dau trong thyc hipn Idy tpng vd

ghep tpng ttr ngudi cho chit ndo. Oiiu dau tien vd quan

trpng nhat dd Id nhdm Bdc s7 Gdy me-Hdi sire thyc hipn

dieu tri vd ddnh gia bpnh nhdn chit ndo. Odng thdi ed

edc phuong tipn chan dodn chit ndo. Nhdm nay d bpnh

vipn chiing tdi da nghien ciru chan doan vd dieu tri eho

50 bpnh nhan du'pc xdc djnh chit nao. Ba bpnh nhdn

hiin tang ndy du'pc chan dodn xdc dinh chit ndo vdi

cde tieu chuan rd rdng Id bdng chirng d l thuylt phyc

ngu'di nhd bpnh nhdn cung nhu' cdc ddng nghipp trong

nhom ghep.

Nhdm chuan bj bpnh nhdn nhdn va dilu tri sau ghep.

Ghep thpn ttr ngirdi cho chit ndo ed nhilu nguy eo biln

chirng hon ttr ngudi cho sdng vi tpng ghep dirpc nudi

du'dng kem tren bpnh nhdn mat dilu phdi ttr than kinh

trung u'ong [6]. Ghep dirpc thyc hipn trong dilu kipn

cap ciru nen cd nhtrng tieu chuan khdng dpt du'pc nhir

thyc hipn ghep cd chuan bi. Trong sd 6 bpnh nhdn ghep

cua chiing tdi cd mpt benh nhan ghep khdng cting nhdm

mdu, tuy nhien van dam bao phan irng cheo am tinh.

Mpt iru dilm nya giiip eho thyc hipn lay tpng du'pc

nhanh chdng khi cd chan dodn chit nao la xet nghipm

mien djch nhu': djnh nhdm HLA, phan irng cheo diu

thyc hipn tren mau mdu ciia ngirdi cho va ngirdi nhpn,

khdng can phai lay hach [5]. Thir ba cdc nhdm thyc hien

lay tang, bao quan tgng, ghep tang thyc hipn dung theo

trinh ty da thdng nhat ttr tru'dc. Thir tu' la nhom dieu

phdi theo doi dilu hanh cac nhdm ghep va lien Igc vd

giai quylt cdc van de vdi gia dinh ngirdi eho tang.

K £T LUAN.

fvlo hinh Idy tgng d l ghep ttr ngu'di cho chit ndo md

bpnh vien chung tdi thyc hien da irng dyng nhieu tiln bo

trong ITnh vyc ghep tang: Lay da phii tgng, tang dupe

bao quan lanh trong vd ngoai eo thi, thdi gian thieu mdu

ndng ngdn.

Chan doan chit ndo dupc thyc hipn bdng ddnh gid

Idm sang va cac Phu'Ong phap sieu dm Doppler xuyen

sp, chyp dpng mach nao, dipn nao dd.

Phau thudt lay tgng du'pc thyc hien trong tinh trgng

cap ciru. Thdi gian phdu thudt trung binh la 210 phiit. Sd

tgng ghep du-pc lay bao gdm: 6 than va 1 gan. Cac tgng

ndy diu dgt diu dat chdt lupng tdt, khong bj tdn thuong

trong qud trinh lay tgng vd dupe ghep thanh cdng cho 6

bpnh nhdn nhdn thdn va mdt bpnh nhdn nhgn gan.

TAI LIEU THAM KHAO:

1. Bp y t l (2002), Hpi ddng tu' van chuyen mon ghep

tang. Quy trinh ghep than ttr ngu'di sdng clio thgn.

2. Bradley H Collins, Renal Transplantation (Urology),

Updated: Oct 22, 2009.

3. Bendalah K., Bitker MO., Barrou B. (2004),

Aspects organisationnels des prelevements multiorgane

en France. J Chir. 141, No 1 : 5 -10.

4. Lechaux D., Dupont - Bierre E., Boudjema K. et al

(2005), Technique des prelevements multiorganes. EMC,

techniques chimrglcales, 40-090/42-747/43-300.

5. S.John Swansona.e, Iman 0. Hypoliteb, Lawrence

Y. C. Agodoac, D. Scott Batty Jra.e, Paul B. Hshiehd,

David Cruessd, Allan D. Kirke, Thomas G. Petersa.fand

Kevin C. Abbott (2002), Effect of Donor Factors on Early

Graft Survival in Adult Cadaveric Renal Transplantation,

American Joumal of Transplantation, 2002; 2: 68-75.

6. Ulrieh Kunzendorf, Bernd Hohensteina, Martin

Oberbarnseheida, Erika Mullerb, Lutz Rendersa,

Gunther Eugen Schottc and Gerd Offermannb (2002),

Duration of Donor Brain Death and Its Influence on

Kidney Graft Function, American Joumal of

Transplantation; 2: 292-294.

THONG BAO LAM SANG TRUONG HOP GHEP GAN TOAN BO TUTNGU&I CHO CHET NAO

NGUYI N TIEN QUYET, NGUYI N QUANG NGHTA,

TRINH HONG SON, NGUYI N QUOC KINH,

DUONG DCTC HUNG, HA PHAN HAI AN, o6 MANH HUNG

Bpnh vien Hu'u nghi Viet Dire

OAT VAN Ofe

Ghep gan la phdu thudt thay thi mpt phan hay todn

bp gan bj bpnh bdng mpt phan hay todn bp gan Idnh ttr

ngirdi cho. Thomas E. Starzl tpi Denver - Colorado (My)

Id ngudi dau tien thyc hipn ghep gan ndm 1963 [5].

Ghep gan cd 5 lopi hinh chinh vdi 2 ngudn cho tpng chu

ylu la ttr ngirdi cho chet ndo va ngirdi cho sdng. Tai

cde nirdc Chdu Au vd My thi md hinh ghep gan todn bp

diing vj tri chiem da sd > 90% vdi ngudn eho ttr ngirdi

chit (chit ndo hope ngirng tuan hoan), con tgi cdc nude

chau A thi md hinh ghep gan lien quan din ngudi cho

khde chilm da sd. Tgi Vipt Nam da thyc hipn dupe 12

tru'dng hpp ghep gan theo md hinh ttr ngudi cho khde

mgnh (1 ngu'di Idn, 11 tre em). Thang 11/2006 Qudc hpi

khda XI dd thdng qua ludt hiin, lay ghep mo, bp phgn co

thi ngu'di va hiin Idy xac gdm 6 chu'ong, 40 dieu. Luat

ndy quy dinh ve vipc hien Idy ghep mo d co the ngudi

sdng va ngudi chet mat nao, va cdc co sd dupc phep

Y HOC THl/C HANH (755) - SO 3/2011 39