So sánh kết quả phẫu thuật nội soi cắt túi mật cấp cứu và phẫu thuật nội soi cắt túi mật sau dẫn lưu túi mật trong viêm túi mật cấp do sỏi độ II tại Bệnh viện Bình Dân

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Tác giả: Anh Dũng Nguyễn, Cao Cương Nguyễn, Hoàng Nhựt Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.106

Bộ sưu tập: Báo, Tạp chí

ID: 339316

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- Đặt vấn đề: Nhóm bệnh nhân viêm túi mật cấp do sỏi phân độ II theo Hướng dẫn Tokyo năm 2018 chưa có sự thống nhất ở các tác giả cho việc chỉ định phẫu thuật nội soi cắt túi mật cấp cứu hoặc dẫn lưu túi mật xuyên gan qua da. PTNS cắt túi mật cấp cứu có gì khác biệt với PTNS cắt túi mật sau dẫn lưu túi mật (DLTM) về tỉ lệ thành công, tai biến, biến chứng, thời gian nằm viện…?- Mục tiêu nghiên cứu: So sánh kết quả sau mổ giữa phẫu thuật nội soi cấp cứu cắt túi mật và phẫu thuật nội soi cắt túi mật sau dẫn lưu túi mật trong viêm túi mật cấp do sỏi độ II.- Đối tượng - Phương pháp nghiên cứu: Gồm những bệnh nhân được chẩn đoán viêm túi mật cấp do sỏi phân độ II được PTNS cắt túi mật trong cấp cứu hay PTNS trì hoãn sau DLTM, tại bệnh viện Bình Dân. Nghiên cứu cắt ngang. Cỡ mẫu tối thiểu cho nhóm mổ cấp cứu (nhóm 2) và mổ trì hoãn sau DLTM (nhóm 1) là 32 bệnh nhân cho mỗi nhóm. Chọn mẫu ngẫu nhiên đơn thuần được: 36 bệnh nhân (BN) thuộc nhóm 1 và 35 BN thuộc nhóm 2.- Kết quả: (trong bảng)- Kết luận: Nhóm PTNS cấp cứu có kết quả phẫu thuật tốt hơn nhóm PTNS trì hoãn sau dẫn lưu túi mật trên BN viêm túi mật cấp độ II (p = 0,023).Tuy nhiên, phương pháp PTGBD phối hợp với PTNS trì hoãn là cần thiết trên những BN có nhiều bệnh nền, tiền căn phẫu thuật ổ bụng, ASA ≥ 3 hoặc CCI ≥ 6.Abstract- Backgroud: In the group of patients with acute gallstone cholecystitis grade II according to the 2018 Tokyo Guidelines, there was no consensus among the authors for the indications for emergency laparoscopic cholecystectomy or percutaneous transhepatic gallbladder drainage (PTGBD). What are the differences between emergency laparoscopic cholecystectomy and laparoscopic cholecystectomy after PTGBD in terms of success rate, complications, hospital stay...?- Objective: Comparison of postoperative outcomes between emergency laparoscopic cholecystectomy and laparoscopic cholecystectomy after PTGBD in acute gallstone cholecystitis grade II.- Methods: Cross - sectional study. We observed 36 patients underwent laparoscopic cholecystectomy after PTGBD and 35 patients underwent emergency laparoscopic cholecystectomyfrom 01/2020 to 01/2021 at Binh Dan Hospital.- Result: 36 patients underwent laparoscopic cholecystectomy after PTGBD had an average admission time before surgery of 6.81 ± 3.25 days, an average surgical time of 104.58 ± 23.40 minutes
the rate of intraoperative complications (bleeding, perforation of the gallbladder) was 38.89%
early complications after surgery (infectious fluid collection) was 30.56%
the mean postoperative stay was 5.5 ± 2.06 days. 35 patients underwent emergency laparoscopic cholecystectomyhad an average admission time before surgery of 13 ± 11.03 hours, an average surgical time of 82.57 ± 33.68 minutes
the rate of intraoperative complications (bleeding, perforation of the gallbladder) was 17.14%
early complications after surgery (infectious fluid collection) was 11.43%
the mean postoperative stay was 4.43 ± 2.15 days.- Conclusion: The emergency laparoscopic group had better surgical results than the delayed laparoscopic after PTGBD group (p = 0.023). However, the method of PTGBD combined with delayed laparoscopy is necessary in patients with multiple diseases, a history of abdominal surgery, ASA ≥ 3 or CCI ≥ 6. DOI: 10.59715/pntjmp.1.2.12

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