Đánh giá kết quả điều trị phẫu thuật tắc ruột sau mổ

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Tác giả: Nguyên Hưng Thái

Ngôn ngữ: Vie

Ký hiệu phân loại: 617 Miscellaneous branches of medicine Surgery

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam) 2023

Mô tả vật lý: 37-41

Bộ sưu tập: Metadata

ID: 409982

Thêm vào giỏ Liên kết toàn văn

Nghiên cứu hồi cứu trên 30 bệnh nhân có tiền sử mổ ung thư đường tiêu hóa được phẫu thuật tắc ruột sau mổ. Mô tả những đặc điểm lâm sàng, cận lâm sàng và đánh giá kết quả phẫu thuật. Đối tượng và phương pháp nghiên cứu: Tất cả những bệnh nhân có tiền sử đã mổ ung thư đường tiêu hóa (ung thư thực quản, dạ dày, đại trực tràng được phẫu thuật điều trị tắc ruột sau mổ (TRSM) tại BV K. Thời gian: 1/2018-12/2018. Kết quả nghiên cứu: Có 30 BN, nam chiếm 76,7%, nữ 23,3%, tuổi TB: 56,0, - Tiền sử: 66,7% mổ bụng 1 lần, 33,3% mổ bụng từ 2 lần trở lên, 66,6% có TS mổ ung thư Đại-trực tràng, 30,0% ung thư dạ dày, 3,4% ung thư thực quản. - Đau bụng cơn 100%, nôn: 86,6%, bí trung tiện 90,0%. Quai ruột nổi 80,0%, rắn bò 36,6%, bụng chướng 90,0%. XQ bụng có mức nước hơi 100% (90% có mức nước hơi ruột non), 96,7% chụp CLVT (93,1% quai ruột giãn, 5 BN có U,1 BN xoắn ruột). - Kết quả chẩn đoán và PT: TRSM do dính 23,5%,do dây chằng 33,3%, do xoắn ruột 16,6%,do ung thư tái phát 16,6%, do bã thức ăn 10,0%. - Không có bệnh nhân TV. - 1 BN rò tiêu hóa điều trị nội, 5 BN nhiễm trùng vết mổ. Kết luận: - Tắc ruột sau mổ ở BN có TS phẫu thuật ung thư đường tiêu hóa chiếm tỷ lệ cao là ung thư đại trực tràng 66,6% (chiếm 20% là PT kiểu Harmann), ung thư dạ dày 30,0%. - Tắc ruột do dính và dây chằng và xoắn ruột chiếm tỷ lệ cao: 22/30 BN (73,3%), tăc ruột do bã thức ăn 10,0%, do ung thư tái phát 16,7%. - 100% là mổ mở, không có BN tử vong, 1 BN rò tiêu hóa điều trị nội khoa. Phẫu thuật nội noi (PTNS) gỡ dính, tháo xoắn, cắt dây chằng có thể thực hiện trong 50,0% số bệnh nhân., Tóm tắt tiếng anh, There were 30 patients of postoperative obstruction were observed in K hospital. The mean age was: 56,0
male 76,7%, femail 23,3%, History feature: There were 66,7% had history of one abdominal surgery, 33,3% had more than 2 abdominal surgery
66,6% were coloreral cancer operation
30,0% were gastric cancer operation. Clinical feature: Abdominal pain 100%, vomissement: 57,7%, Gazless 90,0%, bowel mouvement 80,0%, abdominalfullness: 90,0%. Plain badominal X-Ray: all had air-fluid level (100%),CT Scan were carried out in 96,7%, the sign of intertinal dilatation was 93,1%, one case of bowel anemie due to intertinal torsion and 5 reccurent patients were detected on CT scan. The result of operation: Open surgery were perfomed in all patients. There were 7(23,5%) patients had adhesive intertinal obstruction,10 patients had obstruction on band (33,3%), 5 patients (16,6%) had torsion obstruction, 5 others patients (16,6%) had recurrent obstruction, 3 patients had phytobezoar obtruction. Operation perfomed: all had open surgery including adhesiolysis
band resection and adhesiolysis, intertinal resection (necroses oj bowel due to torsion or band), colon resection, colostomy (recurrence), liberation of phytobezoar. There was no death per and postoperation. Complication: 1 patient had digestive fistulas post adhesiolysis and bypass operation who had medical treatment. - Conclusion: We conclude that: In our study there were 66,6% of patients who had post operative obstruction after colo-rectal cancer operation (20,0% post Harmann procedure), 30,0% of patients after gastric cancr surgery. There were mainly adhesive and/or band and torsion obstruction as high as 73,3%, recurrent cancer obstruction was 16,7%, phytobezoar obtruction post gastrectomy was 10,0%. All the patients had open operation. There was no death per and post operation.1 patient had digestive fistulas treated medical. We find that laparosopic operation could be performed in 50,0% of patients especially who had adhesive, band, torsion, phytobezoar obstruction.

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