Tổng quan về sự hình thành và phát triển can thiệp thần kinh Thành phố Hồ Chí Minh=Overview of the formation and development of neuro

Tổng quan về sự hình thành và phát triển can thiệp thần kinh Thành phố Hồ Chí Minh=Overview of the formation and development of neuro - intervention in Ho Chi Minh City

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Tác giả: Đức Khang Nguyễn, Ngọc Hoa Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.11-22

Bộ sưu tập: Metadata

ID: 245011

Thêm vào giỏ

Can thiệp thần kinh là tên gọi chung của những thủ thuật xâm lấn trên người bệnh để chẩn đoán và điều trị các bệnh lý mạch máu não. Chụp mạch máu não là dùng ống thông và dây dẫn luồn từ động mạch đùi hay động mạch quay chọn lọc vào các mạch máu não bơm thuốc cản quang và thông qua máy chụp mạch máu (DSA) để chẩn đoán các bệnh lý mạch máu (là tiêu chuẩn vàng trong chẩn đoán). Can thiệp mạch máu não là đưa các dụng cụ qua ống thông để điều trị các bệnh lý mạch máu não: dị dạng mạch máu não, rò động tĩnh mạch não, lấy huyết khối điều trị nhồi máu não cấp, tạo hình mạch máu não: nong bằng bóng và đặt stent mạch máu não, tắc các u giàu mạch máu trước phẫu thuật và trong điều trị là kỹ thuật xâm lấn tối thiểu nhưng mang lại hiệu quả tối ưu đối với các bệnh lý mạch máu não. Lịch sử thế giới bắt đầu từ năm 1927 khi Egas Moniz một nhà thần kinh học người Bồ Đào Nha tiêm thuốc cản quang vào động mạch cảnh sau phẫu thuật để chụp mạch máu não, chụp động mạch chẩn đoán càng thông dụng hơn khi kỹ thuật Seldinger được giới thiệu vào năm 1952. Năm 1974, Serbinenko đã báo cáo về việc sử dụng bóng bay có thể tháo rời để điều trị chứng phình động mạch nội sọ. Năm 1975, Gianturco và cộng sự báo cáo về sự phát triển và sử dụng các cuộn dây đầu tiên (coil). Từ đó các dụng cụ của can thiệp thần kinh đã trải qua sự phát triển và cải tiến liên tục. Tại Thành phố Hồ Chí Minh, những trường hợp can thiệp thần kinh đầu tiên được tiến hành vào cuối những năm 1990. Giai đoạn này có Bác sĩ Jack Drouineau và Giáo sư Lampier viện trường Poitier Cộng hòa Pháp sang Bệnh viện Nhân Dân 115 hỗ trợ chúng tôi tiến hành làm can thiệp các bệnh lý dị dạng và dò động tĩnh mạch não cũng như thuyên tắc các u giàu mạch máu vùng đầu mặt cổ. Đến năm 2003 có sự giúp đỡ của Giáo sư Phạm Minh Thông hỗ trợ Bệnh viện Nhân Dân 115 và năm 2004 hỗ trợ Bệnh viện Đại học Y Dược Thành phố Hồ Chí Minh các kỹ thuật can thiệp dị dạng và dò mạch máu não thực hiện thường quy. Năm 2006 Bệnh viện Nhân Dân 115 thực hiện kỹ thuật tiêu sợi huyết đường tĩnh mạch đầu tiên và hai năm sau đó tiến hành tiêu sợi huyết đường động mạch, năm 2009 tiến hành lấy huyết khối bằng dụng cụ Penumbra thế hệ đầu và năm 2012 tiến hành lấy huyết khối bằng Solitaire, sau đó các kỹ thuật thực hiện nhuần nhuyễn: Lấy huyết khối bằng ống hút, bằng stent, kết hợp các kỹ thuật đặc biệt kỹ thuật kết hợp hút + kéo (Solumbra). Với người bệnh đến trước 6 giờ chúng tôi áp dụng các kỹ thuật trên đạt tỉ lệ tái thông mạch máu não rất cao trên 90% và đặc biệt là giúp cho trên 60% các bệnh nhân sau điều trị trở về cuộc sống bình thường (mRS: 0-2), giảm thiểu đáng kể tàn phế và tử vong cho người bệnh nhồi máu não cấp giúp giảm gánh nặng cho người bệnh, gia đình và xã hội. Từ đây chúng tôi đã tiến hành đào tạo cho hàng trăm bác sĩ và chuyển giao cho các bệnh viện ở các tỉnh, thành trên cả nước, cho đến nay chúng tôi đã đào tạo các bác sĩ can thiệp thần kinh cho 52 bệnh viện lớn. Sau 25 năm các kỹ thuật can thiệp thần kinh ở Thành phố Hồ Chí Minh nói riêng và Việt Nam nói chung đã theo kịp trình độ của thế giới về can thiệp thần kinh. Đặc biệt can thiệp nhồi máu não cấp bằng dụng cụ cơ học, áp dụng phần mềm trí tuệ nhân tạo (RAPID.AI) mở rộng cửa sổ can thiệp lấy huyết khối não đến 24 giờ, can thiệp lấy huyết khối đối với các trường hợp nhồi máu diện rộng (ASPECT 3 - 5 điểm) và đang phối hợp với các Trung tâm đột quỵ lớn trên thế giới có thể mở rộng cửa sổ tới 30 giờ.Neuro - intervention is the general name for invasive procedures on patients to diagnose and treat cerebrovascular diseases. Cerebral angiography is the use of catheters and guidewires inserted from the femoral artery or radial artery selectively into the cerebral blood vessels, injecting contrast agent and passing through an angiography machine (DSA) to diagnose vascular diseases (the gold standard in diagnosis). Cerebrovascular intervention is the insertion of instruments through catheters to treat cerebrovascular diseases: Cerebral vascular malformations, cerebral arteriovenous fistulas, thrombectomy for acute cerebral infarction, cerebral angioplasty: Balloon angioplasty and stenting of cerebral vessels, occlusion of vascular-rich tumors before surgery and during treatment is a minimally invasive technique but brings optimal results for cerebrovascular diseases. The world history began in 1927 when Egas Moniz, a Portuguese neurologist, injected contrast into the carotid artery after surgery to perform cerebral angiography, diagnostic angiography became more popular when the Seldinger technique was introduced in 1952. In 1974, Serbinenko reported the use of detachable balloons to treat intracranial aneurysms. In 1975, Gianturco et al. reported the development and use of the first coils. Since then, the instruments of neurointervention have undergone continuous development and improvement. In Ho Chi Minh City, the first cases of neurointervention were carried out in the late 1990s. During this period, Dr. Jack Drouineau and Professor Lampier from the Poitier University in the French Republic came to People's Hospital 115 to support us in performing interventions for malformations and cerebral arteriovenous fistulas as well as embolization of vascular tumors in the head and neck area. In 2003, with the help of Professor Pham Minh Thong, People's Hospital 115 supported a d in 2004, supported the University of Medicine and Pharmacy Hospital of Ho Chi Minh City, the techniques of intervention for malformations and cerebral vascular fistulas were routinely performed. In 2006, People's Hospital 115 performed the first intravenous thrombolysis technique and two years later performed arterial thrombolysis. In 2009, thrombectomy was performed using the first generation Penumbra device and in 2012, thrombectomy was performed using Solitaire. After that, the techniques were performed smoothly: thrombectomy using a suction tube, stent, combined with special techniques such as suction + traction (Solumbra). For patients arriving before 6 o'clock, we applied the above techniques to achieve a very high rate of cerebral vascular recanalization of over 90% and especially helped over 60% of patients return to normal life after treatment (mRS: 0-2), significantly reducing disability and death for patients with acute cerebral infarction, helping to reduce the burden on patients, their families and society. From here, we have trained hundreds of doctors and transferred them to hospitals in provinces and cities across the country. Up to now, we have trained neurointerventional doctors for 52 major hospitals. After 25 years, neurointerventional techniques in Ho Chi Minh City in particular and Vietnam in general have caught up with the world's level of neurointerventional intervention. Especially, acute cerebral infarction intervention using mechanical instruments, applying artificial intelligence software (RAPID.AI) to expand the window of cerebral thrombus removal to 24 hours, thrombus removal intervention for cases of large-scale infarction (ASPECT 3-5 points) and are coordinating with major stroke centers in the world to expand the window to 30 hours.

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