Kết quả sớm phẫu thuật nội soi lồng ngực điều trị tràn khí màng phổi tự phát tái phát

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Đình Dương Hoàng, Quang Khánh Huỳnh, Như Hưng Việt 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.160

Bộ sưu tập: Metadata

ID: 339322

Thêm vào giỏ Liên kết toàn văn

- Đặt vấn đề: Dù có nhiều phương pháp điều trị tràn khí màng phổi tự phát, tỷ lệ tái phát tràn khí màng phổi còn cao. Phương pháp điều trị kinh điển là mở ngực, tuy nhiên, phương pháp này có nhiều hạn chế. Với những ưu điểm, phẫu thuật nội soi lồng ngực đã trở thành phương pháp chủ yếu. Trong nghiên cứu này, chúng tôi đánh giá kết quả sớm của phẫu thuật nội soi lồng ngực điều trị bệnh nhân tràn khí màng phổi tự phát tái phát.- Đối tượng - Phương pháp: Hồi cứu, mô tả, loạt ca từ 03/2018 đến 03/2021 tại bệnh viện Nhân Dân Gia Định.- Kết quả: Với 51 bệnh nhân được phẫu thuật, nam gấp 4,6 lần nữ, 20 - 39 tuổi, có thói quen hút thuốc lá và chỉ ở nam (67,3%), thể trạng bình thường (55,1%). Tràn khí màng phổi càng nhiều lần, thời gian giữa hai lần tràn khí càng ngắn. Đau ngực là triệu chứng hay gặp (84,3%), khởi phát không liên quan gắng sức. 100% bệnh nhân có bóng, kén khí (ghi nhận trong phẫu thuật nội soi lồng ngực)
80,4% có bóng, kén khí tập trung ở thùy trên, 2 % ở thùy giữa, 7,8% ở thùy dưới và có 9,8% có bóng, kén khí rải rác các thùy phổi. Bóng, kén khí ≤ 2 cm chiếm 39,2%
bóng, kén khí >
2 cm chiếm 60,8%. Số lượng bóng, kén khí ≤ 3 chiếm 74,5%
số lượng >
3 bóng khí chiếm 25,5%. Cắt lớp vi tính lồng ngực phát hiện 82,4 % (42/51) trường hợp bóng, kén khí. Thời gian phẫu thuật nội soi lồng ngực trung bình 73,3 ± 16,9 phút
bệnh nhân được rút dẫn lưu màng phổi đặt sau phẫu thuật trong vòng 48h (88,2%). Thời gian nằm viện sau phẫu thuật ngắn (4,39 ± 1,28 ngày), không ghi nhận tai biến trong lúc mổ, hậu phẫu không có bệnh nhân nào xảy ra biến chứng. Sau xuất viện 1 tháng các bệnh nhân đều không có tình trạng tràn khí màng phổi tái phát.- Kết luận: Điều trị tràn khí màng phổi tự phát tái phát bằng phẫu thuật nội soi lồng ngực cần được chú trọng. Nên can thiệp phẫu thuật nội soi lồng ngực sớm đối với bệnh nhân tràn khí màng phổi tái phát để tránh tình trạng viêm dính màng phổi, sẽ gây khó khăn cho phẫu thuật cũng như kéo dài thời gian hậu phẫu.Abstract- Introduction: Although there are many methods to treat spontaneous pneumothorax, rates ofrecurrence pneumothorax are still high. Aclassic treatment is thoracotomy. However, this treatment has many limitations. Where as, thoracoscopic surgeryhas many advantages and has become the main treatment. In this study, we evaluated short - term results of thoracoscopic surgery in patients with recurrent spontaneous pneumothorax.- Materials - Methods: Aretrospectivestudy of patients who were operated thoracoscopic pulmonary blebectomy from March 2018 to March 2021 at Nhan Dan Gia Dinh Hospital.- Results: There were 51 patients in our study. The number of male was 4.6 times higher than that of female. The range of age was 20 - 39 years old. Smoking was a habit and in the male only (67.3%). The normal body accounted for 55.1%. The more frequently pneumothoraxoccured, the shorter intervals between two pneumothoraxwere. Chest pain was common (84.3%) and exertion did not cause recurrent pneumothorax. 100% of the patients had bullae and blebs. With bullae and blebs, 80.4% were in the upper lobes, 2% werein the middle lobes, 7.8% were in the lower lobes and 9.8% were in the all lung lobes. The bullae, blebs ≤ 2 cm occupied 39.2%)
the bullae, blebs >
2 cmstood at 60.8%. The bullae, blebs ≤ 3 reached 74.5% while those >
3 constitued 25.5%. Computed tomography of the thorax detected 82.4% (42/51) bullae, blebs. The average surgical time was 73.3 ± 16.9 minutes
the pleural drainage were removed after 48 hours (88.2%). The postoperative time was short (4.39 ± 1.28 days. No accidents and postoperative complicationswas recorded. After 1 month, the patients did not have recurrent pneumothorax.- Conclusions: Treatment of recurrent spontaneous pneumothorax by thoracoscopic surgery should be focused. Thoracoscopic surgery isearly recommended for recurrent spontaneous pneumothorax to avoid pleural adhesions, which would make operation difficult as well as prolong the postoperative period. DOI: 10.59715/pntjmp.1.2.18

1. Đọc trực tuyến

1. Đọc trực tuyến

Tạo bộ sưu tập với mã QR