So sánh kết quả sớm phẫu thuật cắt trĩ bằng dao siêu âm và dao đốt điện đơn cực theo phương pháp Milligan Morgan

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Tác giả: Duy Tuấn Kiệt Nguyễn, Hữu Chánh Nguyễn, Thanh Việt Phạm, Thị Tuyết Minh Phạm, Minh Đạt Võ, Ngọc Anh Tuấn Vũ

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

Mô tả vật lý: tr.181

Bộ sưu tập: Báo, Tạp chí

ID: 442397

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Đặt vấn đề: Mục tiêu của nghiên cứu nhằm so sánh kết quả sớm phẫu thuật cắt trĩ phương pháp Milligan Morgan bằng dao siêu âm và dao đốt điện đơn cực. Đối tượng và phương pháp nghiên cứu: Nghiên cứu đoàn hệ tiến cứu. Từ tháng 6/2023 đến tháng 8/2023 chúng tôi tiến hành phẫu thuật cắt trĩ theo phương pháp Milligan Morgan bằng dao siêu âm và dao đốt điện đơn cực tại bệnh viện Bình Dân. Kết quả: Trong thời gian 2 tháng, có 30 bệnh nhân được phẫu thuật cắt trĩ theo phương pháp Milligan Morgan bằng dao siêu âm và đốt điện trong mỗi nhóm. Không có sự khác biệt có ý nghĩa thống kê về tuổi (P = 0,50) và giới tính (P = 0,196), nghề nghiệp (P = 0,96), các đặc điểm lâm sàng trước mổ như hct (P= 0,861), thời gian mắc bệnh (P = 0,583), tiền sử điều trị (P = 0,642), yếu tố thuận lợi (P = 0,795), chẩn đoán giữa 2 nhóm (P = 0,947). Thời gian mổ cắt trĩ bằng dao siêu âm ngắn hơn đốt điện 23,40 ± 5,80 phút và 38,17±9,69 phút (P = 0,000), lượng máu mất ít hơn ở nhóm dùng dao siêu âm 11,07 ± 7,26 và 19,50 ± 9,77 (P = 0,000), mức độ đau sau mổ nhiều hơn ở nhóm đốt điện ( P <
0,05). Không có sự khác biệt có ý nghĩa thống kê về biến chứng sau mổ và thời gian nằm viện giữa 2 nhóm sau mổ. Thời gian lành vết thương dài hơn ở nhóm bệnh nhân đốt điện (P = 0,001). Kết luận: So sánh kết quả ban đầu giữa dao siêu âm và dao đốt điện đơn cực dùng để cắt trĩ độ III, IV, hỗn hợp theo phương pháp Milligan - Morgan, chúng tôi nhận thấy kỹ thuật và phương tiện này thực hiện rất dễ dàng, hiệu quả cao và ít biến chứng hơn so với sử dụng dao đốt điện đơn cực. Với các ưu điểm nổi bật nêu trên của dao siêu âm, chúng tôi nhận thấy khi sử dụng dao siêu âm trong phẫu thuật cắt trĩ là rất khả thi và đóng góp hữu hiệu trong điều trị bệnh trĩ tại Việt Nam. Abstract Objective: The objective of the study is to compare the early results of Milligan Morgan hemorrhoidectomy surgery using ultrasound scalpel and monopolar electrocautery. Subjects and Methods: Prospective cohort study. From June 2023 to August 2023, we performed hemorrhoidectomy surgery according to the Milligan Morgan method using an ultrasound scalpel and monopolar electrocautery at Binh Dan hospital. Results: During a 2 - month period, 30 patients underwent hemorrhoidectomy according to the Milligan Morgan method with ultrasound scapel and monopolar electrocautery in each group. There were no statistically significant differences in age (P = 0.50) and gender (P = 0.196), occupation (P = 0.96), and preoperative clinical characteristics such as hct (P = 0.861), duration of disease (P = 0.583), treatment history (P = 0.642), favorable factors (P = 0.795), diagnosis between 2 groups (P = 0.947). Time to hemorrhoidectomy with ultrasound scalpel is shorter than monopolar electrocautery 23.40 ± 5.80 minutes and 38.17 ± 9.69 minutes (P = 0.000), blood loss is less in the group using ultrasound scalpel 11.07 ± 7.26 and 19 ± 9.77 minutes (P = 0.000), the level of postoperative pain was higher in the electrocautery group (P <
0.05). There was no statistically significant difference in postoperative complications and hospital stay between the 2 groups after surgery. Wound healing time was longer in the monopolar electrocautery patient group (P = 0.001). Conclusion: Comparing the initial results between the ultrasonic scalpel and the monopolar electrocautery knife used to cut grade III, IV, mixed hemorrhoids according to the Milligan - Morgan method, we found that this technique and means perform very well, easily, highly effective and less complicated than using monopolar electrocautery knife. With the above outstanding advantages of the ultrasonic scalpel, we find that using the ultrasonic scalpel in hemorrhoidectomy is very feasible and makes an effective contribution to the treatment of hemorrhoids in Vietnam. DOI: 10.59715/pntjmp.3.1.21

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