Viêm mỏm cụt dạ dày sau phẫu thuật triệt căn ung thư dạ dày cực dưới

VIEM MOM CUT DA DAY SAU PHA U THUAT TRIET CAN UNG THlT DA DAY CUC DUAI

OANG VIN H DUNG, TRliU TRIEU DUONG - B$nh viin TlfQD 108

NGUYI N VA N XUYEN - Benh vien Quin Y103

TOMTAT :

Sau phiu thuit diiu trj triet can ung thw da diy cgc

dwai, benh nhan chju dung nhiiu biin chimg va chat

lwang song bj de dga bdi cac biin chwng nay. Mgt trong

nhCrng biin chimg thwdng gap va cd the khac phue

dwoc la viem mdm cut da day. Doi twgng va phwang

phap nghien ciru: nghien ciru tiin ciru lam sing cd can

thiep dwa tren ddi twgng nghien ciru la bgnh nhan ung

thw da day cgc dwdi, dwgc diiu tri trigt can tai benh vign

TUQDIOS tir thing 1 nam 2006 den thing 6 nam 2009.

Ket qua: 109 benh nhan dii tieu chuan va dwgc chgn

vao trong nghien ewu. Trong dd, nhdm I (bgnh nhan

dwgc phue hoi Iwu thdng kiiu Billroth II) bao gom: 51

trwdng hap vi nhdm II (bgnh nhan dwac phue hdi Iwu

thdng kiiu Rgux en Y) bao gom: 58 benh nhan. Ty 1$

nam/nu':70/39; dd tuoi tmng binh mac benh d

nam:49,96; a ri0':53,83. Ty le benh nhan cd trio ngwgc

dich mat a nhdm I: 94,1%; nhdm II: 0% (khie blgt cd y

nghia, P<0,001). T^ le phat hign viem dai thi mdm cut

da day d nhdm I: 70,6%o, nhdm II: 17,2%,(khac bigt cd y

nghTa, P<0,001).^Ty le benh nhan nhiem HP d nhdm I:

62,7%; nhdm ll:~93,1%o(khic biet cd y nghTa, P<0,001).

Mirc dg viem vi thi theo phin loai Updated- Sydney

System d nhdm II chii yeu la ning, trong khi nhdm I

viem vi thi mirc do nhe chiim wu thi(khac blgt cd y

nghia, P<0,001). Kit luan: viem mdm cut da diy chii a

nhdm benh nhan trio ngwgc li do yiu to dich mat, tuy

vi a nhdm khdng trio ngwgc la do yiu to vi khuin

Helicobacter Pylori. Tuy nhien, do han chi ca mau va

thdi gian theo ddi nen chung tdi tiep tue nghien ciru

them di lam sang td hien twang viem mdm cut da day.

Tw khda: phiu thuat diiu trj triet can ung thw da day

cue dwdi, viem mdm cut da day

SUMMARY

GASTRIC STUMP INFLAMMATION IN THE PATIENTS

WHO HAVE UNDERGONE DISTAL SUBTOTAL

GASTRECTOMY FOR CANCER.

Patients who have undergone gastrectomy have to

cope with many postoperative complications. The most

frequent complications is gastic remnant inflammation

badly influencing the quality of life of patient In order to

understand thoughfully the nature of this situation, we

carry out this study with hope that patient have a quality

of life so far so good. Patients and method: patients

who have undergone subtotal gestrectomy in the 108

Miilitary Central Hospital from Jan.2006 to June, 2009.

Results and discussion: 109 patients (Femal: 70,

Male: 39; Aged mean for them were 49.96 and 53.83

respectively). Group I (gastrectomized Billroth II

procedure): 51 cases; Group II (gastrectomized Rgux en

Y procedure): 58 cases). Macro inflammation occure in

70.6%, for group I and 17.2%o for group II. Bile reflux in

group I, II was 94.7% and 0%o respectlvlly. Micro

inflammation was serious degree for group II and mild

for group I. Analysing these results lead to conclusion

that the main factor for patient belong to group I, group II

are bile reflux and Helicobacter Pylori respectively.

Key words: Gastric remnant inflammation.

DAT VA N oe

Viem mdm cgt da ddy Id tinh trang bpnh ly khd pho

biln vd gdy anh hudng xau di n chat lupng sdng ciia

benh nhdn. Trong nhirng ndm gan day, tren the gidi noi

ehung vd tai Viet Nam ndi rieng, phau thudt _eat ban

phan da day Id su lya chpn uu tien trong phiu thuat

dilu tri triet cdn ung thu dp ddy eye dudi nen cdc bpnh

ly lien quan di n mdm cut da ddy cung tuong doi pho

biin. Mdt trong nhung van d i benh ly lien quan den

mdm cpt dp ddy dupc nhilu su quan tdm nhat Id viem

mdm cut da ddy.

Benh nguyen cua hien tupng viem mdm cut dg day

da gdy nhieu tranh ludn vd chua'thue su thuylt phye

ede nhd lam sang trong edng tde dilu tri.

Vdi ly do tren, chung tdi tiin hdnh nghien eifu van di

ndy nhdm gdp phan Idm rd hien tupng viem mdm cyt da

ddy tren bpnh nhdn dd dugc phau thudt triet edn ung

thu da ddy cue dudi.

0 6 l TU'O'NG vA PHU'ONG PHAP NGHIEN CLfU

Doi twgng nghien ciru: bpnh nhdn ung thu dg day

cue dudi, dugc phau thupt tript edn vd phge hoi theo

mpt trong hai phuong phdp (Billroth II: nhdm I, Roux en

Y: nhdm II). Benh nhdn thupc ddi tupng nghien cieu

khdng phdn bipt tudi, gidi, nghi nghipp. Tdt ca bpnh

nhdn ndy di u do mpt nhdm phdu thudt vien thyc hipn tqii

benh vipn TL^QDIob tir thdng 1 nam 2006 din thang 6

nam 2009.

Phwong phap nghien cii'u: nghien cifu tiln cifu, co

can thiep ldm sdng.

Benh nhdn dupc phdn nhdm dya tren co sd khach

quan bang cdch ddnh sd ehan le theo thif tu vdo vipn.

Nhdm I, sd le, benh nhdn dugc phue hdi luu thdng mom

cgt dg ddy-hong trdng theo phuong phdp Billroth 11 trudc

dai trdng ngang (hinh 1); nhdm II, sd chan, benh nhan

dupe phue hdi luu thdng mdm cgt da ddy-hdng trdng

theo phuong phdp Roux en Y, trude dai trdng ngang

(hinh 2).

J,—

Billroth I

Hinh 1

Roux en Y

Hinh 2

50cm

Benh nhan dupc tdi khdm o thdng thif 6, sau mo.

Npi dung tdi khdm bao gdm: ndi soi dudng tieu hda tren

bing dng mim d i ddnh gid tdn thuong dai the theo tieu^

62

A

Y HOC THl/C HANH (727) - SO 7/2010