phau thuat dm canh sau 15 nam
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8/4/2019 PHAU THUAT DM CANH SAU 15 NAM
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PHU THUT NG MCH CNH
Thay i g qua 15 nm?
F. MANTZ D. THIBAUD
Trung tm Y khoa Orangerie
STRASBOURG
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NGHIN CU SO SNHT 1/01/2006n 31/12/2010
624 BN
662 lt PT
AG AL49 613
4
T1/01/1994n 31/12/1998
631 bnh nhn
705 lt PT
AG AL401 304
1
AG: Gy m ton thn; AL: Gy m cc b
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TIN TRIN CA PHNG PHP
GY M
AG: Gy m ton thn; AL: Gy m cc b
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CH NH HIN NAY CA GY
M TON THN
Gy m cc b tht bi
Yu cu ca BN / tnh trng ca BN
Shunt lp trnh
Hp M cnh ti pht??? (21/34)
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PHN B THEO NAM V N
705 t phuthut
662 t phu thut
Femme: N Homme: Nam
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PHN B THEO TUI V
GII
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CCYU T NGUY
C
HTA traite: tng HA
iu trDIND: T khngph thuc insulinDID: T phthuc insulin
Atteinte coronaire:Bnh mch vnh
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BNH MC
H VNH
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TRIUC
HNG
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CT SCAN NO TRC PHU
THUT ( CCN QUANG)
1994 - 1998
2006 - 2010
13/705 2/662
1,84 % 0,3 %
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KTHUT M
Rimplantation: cm to hnh mch cnhTEA simple:bc tch ni mc n ginTEA+ patch:bc tch ni mc c patch
Autres: cc phng php khc
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PHNG PHP BC TCH
NI MC C PATCH (TEA)
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K THUT CM TO HNH
MCH CNH LN NGC
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BC TCH NI MC VI
NG KHU N GiN
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KTHUT M
Rimplantation: cm to hnh mch cnhTEA simple:bc tch ni mc n ginTEA+ patch:bc tch ni mc c patch
Autres: cc phng php khc
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TiN TRIN K THUT M
THEO KTV
Rimplantation: cm to hnh mch cnhTEA simple:bc tch ni mc n ginTEA+ patch:bc tch ni mc c patch
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CCK
THUTK
HC
1994 -1998
2006 -2010
8 Ghp tnh mch 1
4 Gi 17
Dy chng M cnhtrong.
1
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TO SHUNT M CNH
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A GIC WILLIS
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CCCH NH T SHUNT
1994 1998 2006 - 201020 Theo N 0
23 P tn d < 40 10
35Tht bi vi
test kp47
5 khc 2
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TIN HNH T SHUNT1994 1998 2006 - 2010
1
48
35
Di gy m ton thn 7
52
2Di gy m cc b
(83/705) 11,7% TNG CNG (59/662) 8,9 %
18/83 = 21,6
%
TC NG MCH IBN
11/59 = 18,6
%
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TI HP
1994 1998 2006 - 201022 Ti hp phu thut 34
1/01/1994 et31/12/1998
Ti hp xut hin vc m trong quatrnh nghin cu:
1/01/2006 et31/12/2010
2 % (6/244) sau TEA simple 02,6 % (1/38) sau TEA + patch 0,9 % (1/109)
0,49 % (2/408) Sau to hnh mchcnh
0,93 % (5/535)
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KT QU: KIM SOT SAU M
1994 - 1998 2006 - 2010683 AVV 578
14 Chp mch 0
5 Siu m 72
1 Chp mch Ctscan
21
703/705gestes
TNG CNG 671/662gestes
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KT QU1994 1998 2006 - 2010
0 Nhim trng 0
3
Thuyn tc M cnh trongkhng triu chng ( khng
m)
0
2 Tc M cnh trong c triuchng ( TBMMN) khng
m
0
09/705 = 1,2 % T l ti can thip 15/662 = 2,2 %
2 Tc M cnh trong c triuchng ( TBMMN) m li
0
7 mu t vng c 11
0 Hp tn d 3
0 Bc tch trn shunt 1
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7 tc M cnh sau phu thut
(1994/1988): 1 ghp tnh mch
1 TEA + patch
2 Ti ghp ( mt bnh nhn)
3 TEA n gin
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T l t vong 30 ngy
1994 1998 2006 - 2010
4 (AG) TBMMN 00 Nhi mu 1
1 t t 1
5/705 = 0,7%
2/662 = 0,3%
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Nhi mu sau phu thut
1994 1998 2006 - 20102 (gy m cc b) 0
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Tai bin thong qua sau phu thut
( 6 thng0
2 (
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1994 1998 2006 - 2010
1,4 %
T l t vong 30 j(t vong do minguyn nhn +
TBMMN)
0,9 %
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Cc bin chng thn kinh
ngoi bin (X, XII) > 30 ngy
1994 1998 2006 - 20107/705 7/662
1 % 1 %
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Kt lun :phu thut M cnh hin ti
Gy m cc b lm thng quy
Gy m cc b: hp l ha cc ch nh t shunt
Gy m cc b khng gy ra cc bin chng timmch nh gy m ton thn ngc li gip x tr ttcc vn tim mch tin phu
K thut to hnh mch cnh : khng cn gy tcmch sau m t 2006-2010
Scanner no+ cn quang= ch inh nht thi
Thi iu tr tch cc nu hp tn d sau phuthut: khng xy ra TBMMN khng c t vong doTBMMN trong nghin cu 2006 - 2010
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