Kết quả phẫu thuật tạo hình thành bụng bán phần với hỗ trợ nội soi để khâu giãn bao cơ thẳng bụng tại Bệnh viện Đại học Y Dược thành phố Hồ Chí Minh

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Tác giả: Mạnh Đôn Nguyễn, Hiếu Liêm Phạm

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.78

Bộ sưu tập: Metadata

ID: 341769

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Đặt vấn đề: Thay đổi hình dạng vùng bụng sau sanh ảnh hưởng đến đời sống, sinh hoạt hàng ngày của phụ nữ. Phẫu thuật tạo hình thành bụng (THTB) can thiệp bằng cách cắt bớt da thừa, mỡ thừa và củng cố tình trạng chùng giãn cơ thành bụng. Các phương pháp THTB khác nhau tùy theo mức độ dư da, dư mỡ, chùng giãn cơ thành bụng [1]. Chưa có nghiên cứu nào trong nước cho các trường hợp dư da dư mỡ bụng chủ yếu vùng dưới rốn nhưng chùng giãn cơ thành bụng cả trên và dưới rốn, được chỉ định THTB bán phần và củng cố cân cơ thành bụng với nội soi hỗ trợ [2, 3]. Mục tiêu nghiên cứu: Mô tả đặc điểm lâm sàng, siêu âm và kết quả phẫu thuật THTB bán phần với hỗ trợ nội soi để khâu giãn bao cơ thẳng bụng. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả loạt ca, từ 03/2021 đến 11/2022 tại bệnh viện Đại học Y dược TPHCM, 12 trường hợp nữ sau sanh có dư da dư mỡ biến dạng vùng bụng thuộc phân nhóm IIa - IIIa theo Matarasso, được phẫu thuật hút mỡ, THTB bán phần, khâu giãn bao cơ thẳng bụng với hỗ trợ nội soi. Ghi nhận các đặc điểm trước mổ, kết quả trong mổ và sau mổ 1 tháng. Kết quả: Nữ tuổi trung bình 40, đã sanh con, BMI 23.6 kg/m2 dư mỡ trên và dưới rốn, dư da chủ yếu dưới rốn, chùng giãn cơ thành bụng, khoảng giãn cơ thẳng bụng trên rốn rộng 22.2mm và dài 119.6mm, dưới rốn rộng 17.8mm. Bề dày lớp mỡ trên rốn 16.2mm, vùng bụng 16.4mm. Sau phẫu thuật THTB bán phần, hút mỡ, nội soi hỗ trợ kiểm tra đường hầm trên rốn, cầm máu, khâu cân. Nội soi hỗ trợ bóc tách, khâu cân khi đường hầm trên rốn dài trên 10cm. Kết quả sau mổ chiều rộng khoảng giãn cơ thẳng bụng trên rốn 1.9mm
dưới rốn 0.75mm
bề dày mỡ trên rốn 8.6mm, vùng bụng 9.6mm. Vòng eo giảm 4.1cm. Sẹo mổ 20cm. Biến chứng: 4/12 trường hợp dư da đầu sẹo mổ, 3/12 mấp mô trên bề mặt da, 2/12 tụ dịch dưới da. Kết luận: Nội soi hỗ trợ việc khâu gấp bao cơ thẳng bụng trong THTB bán phần.Abstract Introduction: Changing abdominal contour after childbirth affect the life and daily activities of women. Abdominoplasty solves this condition by trimming excess skin and fat and strengthening sagging abdominal muscles. The abdominoplasty procedure vary according to the degree of excess skin, excess fat, and muscle relaxation of the abdominal wall. In Vietnam so far, there has been no study involving subjects with excess skin and belly fat, mainly below the navel and diastasis of the upper and lower abdominal musculofascial structure, who was indicated miniabdominoplasty with endoscopicsupport. Objectives: Describe the clinical and ultrasound characteristics of the abdominal walls and the results of mini abdominoplasty with endoscopic support for rectus abdominis muscle plication. Materials and methods: A descriptive case series study was conducted from March 2021 to November 2022 at the University Medical Center in Ho Chi Minh City. 12 postpartum women with excess skin, excess fat, deformed abdominal area, belonging to groups IIa - IIIa of Matarasso are involved in. Patients were intervened by liposuction surgery, mini abdominoplasty, suture of the rectus abdominis capsule with endoscopic support. Record the preoperative, intraoperative, and postoperative data. Results: 12 female patients, average age 40 years, gave birth, BMI 23.6 kg/m2 excess fat above and below the navel, excess skin mainly below the navel, recti diastasis status: 22.2mm wide upper umbilicus and 119.6mm long, 17.8mm wide below the umbilicus. The thickness of the fat layer above the umbilicus is 16.2mm, the average value of the fat layer of abdomen is 16.4mm. After mini abdominoplasty, additional liposuction, endoscopy supports checking the tunnel above the umbilicus, hemostasis, and suturing
endoscopy also supports for dissection and suture when the upper umbilical tunnel is over 10cm long
we achieve the result: the width of the recti diastasis above the umbilicus is 1.9mm
below umbilicus 0.75mm
Thickness of fat above the umbilicus 8.6mm, average of the abdomen 9.6mm
Waist circumference reduced by 4.1cm
Surgical scar 20cm long. Complications: 4/12 cases of small dog - ear scar, 3/12 contour irregularity, 2/12 liquid accumulation. Conclusion: Endoscopic support facilitates the plicating of the rectus abdominis capsule in mini abdominoplasty. DOI: 10.59715/pntjmp.2.3.9

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