Đặc điểm lâm sàng, cận lâm sàng và kết quả sớm trong phẫu thuật nội soi điều trị u lao phổi tại Bệnh viện Bình Dân

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Huỳnh Long Hồ, Bảo Duy Lý, Văn Việt Thành Nguyễn, Công Quyền Trần, Minh Thiện Trần, Hoàng Minh Tín Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

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

Mô tả vật lý: tr.187

Bộ sưu tập: Báo, Tạp chí

ID: 442404

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Tổng quan - mục tiêu nghiên cứu: Đánh giá đặc điểm lâm sàng, cận lâm sàng và kết quả sớm trong Phẫu thuật nội soi hoàn toàn điều trị lao phổi tại Bệnh viện Bình Dân. Đối tượng - Thiết kế nghiên cứu: Hồi cứu cắt ngang, 36 BN phẫu thuật nội soi (PTNS) lồng ngực cắt một thùy phổi hoặc một phần thùy phổi chứa u tại Bệnh viện Bình Dân từ 3/2017 đến 9/2022. Kết quả: Nam giới: 72,5% (26/36), tuổi trung bình: 58 ± 9 tuổi. Tiền căn lao phổi cũ (41,6%), triệu chứng lâm sàng nghèo nàn, đa số là tình cờ phát hiện, BK đàm âm tính 100%. Đặc điểm chụp cắt lớp vi tính ngực: u chiếm 97,1%, tổn thương dạng hang đi kèm chiếm 72,2%, đa số tổn thương ở vùng cao của phổi (66,6% thùy trên, 11,2% thùy giữa, 8,3% phân thùy S6 thùy dưới). Ghi nhận tổn thương: có viền rõ, có tổn thương vệ tinh, có vôi hóa trung tâm và khoảng trống trong u. Kết quả sớm sau PTNS ngực: Không trường hợp tử vong, không trường hợp phải phẫu thuật lần 2, thời gian phẫu thuật trung bình cắt một thùy phổi: 161 ± 31 phút hoặc một phần phổi chứa u: 105 ± 28 phút, lượng máu mất trung bình: 100 ± 44 ml, thời gian rút ống dẫn lưu màng phổi là 77,5 ± 10,4 giờ, thời gian nằm viện 7,5 ± 0,8 ngày, biến chứng xẹp phổi sau mổ 2,7%, viêm phổi hậu phẫu 8,3%, thở máy kéo dài 2,7%, tràn khí dưới da 8,3%. Kết luận: Kết quả CT- scan ngực có giá trị cao trong chẩn đoán tổn thương u lao phổi. Kết quả sớm sau PTNS lồng ngực cắt một thùy phổi hoặc một phần thùy phổi chứa u có kết quả sớm cao, khỏi bệnh, thời gian hậu phẫu ngắn, tỷ lệ biến chứng sau phẫu thuật thấp.Abstract Introduction: Tuberculosis (TB) is one of the oldest diseases causing disease in humans, and the main causative agent is M. tuberculosis. In Vietnam, the TB incidence is high (100 - 299/100,000 people), and it is also one of the countries with the highest burden of MDR-TB. Tuberculosis of the lung is a benign tumor in the lung, but the diagnosis is still difficult
it is difficult to distinguish from malignancies in the lung, and medical treatment shows a high rate of non - response to drugs, so surgical treatment is recommended. Subjects - Study design: 36 cases of total thoracoscopic lobectomy or segmentectomy, the post - operative pathology results were tuberculosis lesions. Using a retrospective study at Binh Dan hospital from March 2017 to September 2022. Main results: The proportion of men accounted for 72.5% (26/36), the average age was 58 ± 9 years. Past history of pulmonary tuberculosis (41,6%), clinical symptoms are poor, most of them are unintentionally discovered lung lesions, sputum smear testing for TB is 100% negative, chest computed tomography (CTscan) showed tumor pattern accounted for 97,1%, accompanying cavernous lesions accounted for 72,2%, most of the lesions were in the high areas of the lung (66,6% upper lobe, 11,2% middle lobe, 8,3% S6 - segment lower lobe), noted recognition of lesions: with clear borders, satellite lesions, central calcified nodules, voids in the tumor. Early results after thoracotomy: No deaths, no second surgery, average surgical time to lobectomy of the lung was 161 ± 31 minutes or 105 ± 28 minutes when performed segmentectomy. Blood loss during surgery was 100 ± 44 ml, time to remove pleural tube was 77,5 ± 10,4 hours, hospital stay was 7,5 ± 0,8 days, postoperative atelectasis complication 2,7%, postoperative pneumonia surgery 8,3%, mechanical ventilation lasting 2,7%, subcutaneous pneumothorax 8,3%. Conclusion: Tuberculoma lesions through chest CT have a high value in the diagnosis. Early results after total thoracoscopic lobectomy showed that the treatment is highly effective, cured, reduced postoperative time, and low postoperative complication rate. DOI: 10.59715/pntjmp.3.1.22

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