KET QUA PHAU THUAT CAT TUI MAT NOI SOI DO POLYP TUI MAT

t Om tAtMyc tiiu: Ddnh gid kdt qud didu tri ph iu thu$t nQi

soi cdt tui m it do Poiip tui m$tDoi twyng vd phircmg phdp nghiin ciru:

Nghiin ciru md td hdi ciru kdt hyp tidn ciru 33 binh nhdn polip tui m it duxyc ph iu thu it cdt tui m$t nQi soi tir thdng 1/2009- 12/2013 t$i B inh v iin HO’U nghj da khoa Nghi An.

K it qud: 33 binh nhdn cd polyp tui m it duxyc m6 c it tui m$t nQi soi, 25 N ir vd 8 Nam theo ty l i 3/1; 27 binh nhdn du&i 50 tudi; 75,8% binh nhdn sdng 6 vung ndng thdn; ndng ddn chidm 81,8%. Cd 22 (66,7%) tnr&ng hcyp polyp dan ddc vd 6 (18,1%) da polyp. Th&i gian ph iu thu it: 46,2 ± 12,9 (30-65); Gidm dau sau md tmng binh 1,8 ± 0,4 (1-3) ngdy; Th&i gian tmng tiin sau md tmng binh 37,2 ± 11,6 (24-72) gi&; Ngdy didu tri sau md tmng binh 3,1 ±0,9 (3-5) ngdy. Kdt qud gidi ph iu binh cd 1 tnr&ng h<yp cacinom tuydn.

Kit lu$n: P hiu th u it ndi soi cdt tui m it do polyp tui m it Id phuong phdp duxyc li/a chQn cho h iu h it polyp tui m it cd chi dinh.

TCr khod: Polip tui m it, cdt tiii m it, ph iu thu it ndisoi.

SUMMARYObjective: Evaluate the results of surgical

treatment by endoscopic cholecystectomy PoiipsMaterial and menthod: Retrospective descriptive

study combined prospective with 33 patients gallbladder polyps surgery laparoscopic cholecystectomy from January 2009 to December 2013 at Nghe An General Friendship Hospital.

Result: 33 patients with gallbladder polyps surgery laparoscopic cholecystectomy, 25 Women and 8 Men at the rate of 3/1; 27 patients under 50 years of age; 75.8% of patients living in mral areas and 81.8% was farmers. There are 22 (66.7%) cases of solitary polyps and 6 (18.1%) polyposis. Average surgery time was 46.2 ± 12.9 (30-65) minute; postoperative analgesia average 1.8 ±0.4 (1-3) days; average flatus postoperative period 37, 2 ± 11.6 (24- 72) hours; Average days of treatment after surgery was 3.1 ± 0.9 (3-5) days. Pathological one cases cacinoma

Conclution: Laparoscopic surgerycholecystectomy due to gallbladder polyps is the method of choice for most gallbladder polyps indicated.

Keywords: Polyps of the gallbladder, cholecystectomy, laparoscopic surgery

OAT VAN OSPolyp tui mdt cdn gpi Id u nhu nifem mac tuyin

mdt, Id m0t dang t6n thuang dang u hodc gid u phdt

NGUYiN VAN HUONG B$nh vien Huu nghj da khoa Ngh$ An

triln trfen b l mdt nifem mac tui mdt. Ti> khi c6 sifeu dm, nhung bfenh ly cua tui mdt duac phdt hifen sdm vd dfe ddng han rdt nhiiu, trong d6 c6 nhung t6n thu’ang dang polyp. Nhung polyp tui mdt thudng khdng c6 trifeu chung vd chdm b iln d6i vdi thdi gian, nhung niu khdng duac theo ddi vd xu ly dung cdch thi su thodi biln thdnh dc tinh sfe r it nguy hilm cho bfenh nhdn vi ung thu tui mdt Id mfet trong nhung ung thu khdng nhung phuc tap v l mdt phdu thudt md tifen luang cung rdt mu mit. O’ Vifet Nam, trong vdi thdp nifen trd lai ddy bfenh ly gan mdt duac phlu thudt cd xu hudng gia tdng. Sau thdnh cdng ca cdt tiii mdt ndi soi ddu tifen trfen th i gidi cua Phippe Mouret (1987), ky thudt ndy dd duac ph i b iln vd phdt triln nhanh chdng, trd thdnh “Tifeu chuin vdng’ trong cdt tui mdt. 0 Vifet Nam, phdu thudt cdt tui mdt nfei soi duac thuc hifen Idn ddu tifen ndm 1992. Tai. Bfenh vifen Huu nghj da khoa Nghfe An, phdu thudt nfei soi duac thuc hifen tu ndm 2002, d l tdi duac thuc hifen nhlm muc tifeu: Md ta ddc diim Idm sdng, cdn Idm sdng cua bfenh ly polyp tui mdt duac phdu thudt ndi soi cdt tui mdt tai Bfenh vifen Huu nghi da khoa Nghfe An vd ddnh gid k it qua cua nhung trudng hap ndy.

DOl TU’CXNG VA PHU’QNG PHAP NGHIEN C im1. Obi tupng nghifen ci>u: 33 trudng hap duac

chin dodn Id polyp tui mdt vd duac m l ndi soi cdt tui mdt tai Bfenh vifen Huu nghi da khoa Nghfe An tu 12009- 12/2013

2. Phirong phdp nghifen cu»u: Nghifen cuu md ta hoi clpu k it hap tiin ci>u.

3. Nhung npi dung nghifen ciru:- Ddc diim bfenh nhdn: tu ii, gidi, nghi nghifep,

nai cu tru- Nhung ddc diim Idm sdng vd cdn Idm sdng:

dau ha sudn phai, sifeu dm cd polyp tui mdt, tinh trang djch mdt vd thdnh tui mdt vd cdc chie s i huyit hpc sinh hod mdu

- Nhung tui mdt sau khi duac phdu thudt dfeu duac md ra xem dai th i, ghi nhdn tinh trang cua nifem mac tui mdt, s i luang polyp, kinh thudc, vj tri cung nhu cd phii hap vdi soi hay khdng. GCri xfet nghifem giai phdu bfenh tui mdt d chb nghi ngd nh it nhu chd cd khli, chd nifem mac ddy, khdng nhdn

K£T QUA NGHIEN CLPU “Qua nghifen clpu 33 trudng hpp cdt tui mdt n |i soi

do polyp tai bfenh vifen Hu-u nghi da khoa Nghfe tu thdng 12009-12/1023 chung tdi thu dupe nhung k it qua sau:

1. Ode d iim nhbm nghifen ciru:Bang 1. Phdn bb bfenh nhdn theo gidi.

Gidi N Ty lfe%Nam 8 24,2NO 25 75,8

Y HOC THyC HANH (905) - SO 2/2014 67

Tan suat xuat hien benh nhan Nu/ Nam la 3/1 nhfen nfey, c6 5 bfenh nhfen cb kfem theo c6 tui mfet.

eng

Tuoi N Ty le%<30 4 12,131-40 16 48,541-50 7 21,2>50 6 18,2

Tuoi trung binh 40,1± 9,9Lua tuoi bi polyp trong nghien cuu thu’O’ng gfep

30-40 (48,5%), trung binh 40,1± 9,9 tuoi.

Oia chi N Ty le%Th^nh thj 5 15,2N&ng thon 25 75,8Mien nui 3 9,1

Da so benh nhfen song o’ vung nong thon (75,8%)

Oia chi N Ty 10%cong chifc, viSn chuc va huu tri 5 15,2

Nong dan 27 81,8hoc sinh- sinh vien 1 3,0

Doi tuong Ife nong dfen chiem 81,8%.2. Nhung dac difem Ifem sang vfe cfen Ifem sfeng:* D iu hieu dau vung ha subn phai fern i, ma h6 cb

28 trudng hap(84,8%), so bfenh nhfen cbn lai chi tinh cb di khfem phfet hien ra co polyp tui mfet.

* Dau hieu vang da khbng gfep benh nhfen nfeo.* Cfec dau hieu sinh hoa mfeu vfe huyet hpc khbng

cb su thay doi ro ret.* Hinh anh sieu fern trubc mo 2 Jin deu 100% Ife

cb polyp tui mat

Kich thu’dc polyp N Ty le%< 8 mm 5 15,2

8-10 mm 20 60,6£ 10 mm 8 24,2

Da so cfec polyp cb k'ch thubc £ 10 mm (60,6%)3. Kfet qufe phfeu thuat* Vj tri dfet Trocar: Trong nghien cuu nfey t i t ca

deu thuc hien su dung 3 trocar, khbng cb benh nhfen nfeo phai su dung 4 trocar, khbng cb truang hap nfeo bj tai bien trong mo vfe khbng cb truang hap nfeo chuyen mo mb.

* Phuang phfep cfet tui mfet: 100% truang hap duac cfet tui mfet nguac dbng.

* Thbi gian phfeu thufet: 46,2 ± 12,9 phut ngfen nhat Ife 30 phut, dfei nhat Ife 65 phut.

* Giam dau sau mo: trung binh 1,8 ± 0,4 (1-3) ngfey.

* Thbi gian trung tien sau mo: trung binh 37,2 ±11,6 (24-72) gib.

* Ngfey dieu trj sau mo: trung binh 3,1 ± 0,9 (3-5) ngfey.

S6 Polyp 1 2 >3 TongSo lu’p’ng b§nh

nhSm22 5 6 33

Ty l$% 66,7 15,2 18,1 100

GPB Polip tuy£n CareN 32

Ty l$% 97.0

,en

I y uoo u u v i ly i iy K 1 ,,v*'11 ii

cb 18,1% Ife cb tu 3 polyp tra Ifen. Trong sb 33 benh

Trong sb 33 bfenh nhfen Ifem gifei pnfeu bfenh cb 1 truang hap dan polyp bi ung thu hoa

BAN LUANVbi su phfet hifen qua sieu fern, sb luang tbn

thuang dang polyp cua tui mfet duac phfet hifen Nhung thfei do dieu tri nhung dang tbn thuang nfey v in cbn Ife dieu bfen lufen Terzi [10] thfey phin Ibn cfec tbn thuang dang polyp tui mfet, du la lanh tinh hay fee tinh, thubng la dan doc vfe cb kfet hap vbi sbi trong phan Ibn truang hap, tru nhung polyp cholesterol. Trong 74 truang hap ton thuang dang polyp Ifenh tinh, Terzi cb 39 trubng hap cholesterol, 20 adenomas vfe 15 trubng hap tfeng sfen tuyin (adenomastous hyperplasia) [10]. Mainprize [7], khuyen nhung tbn thuang dang polyp cua tui mfet neu cb trifeu chung hay Ibn han 10 mm thi nfen can thiep phlu thufet. Ofec bifet vbi chup cfet Ibp positron (PET positon emission tomography), ngubi ta hy vong nhiiu trong viec tim nhung thofei hba fee tinh cua polyp, nhb db mfe cb the tien hfenh cfet tui nfei soi mfet sbm nhit cho benh nhfen.

Trong sb 33 bfenh nhfen cb polyp tui mfet cua chung tbi, sb luang Nu vfe Nam cb ty lfe Ife 3/1, khi mfe nhieu gia thuyit cho rfeng khbng cb su khfec nhau v i ty Ife NO vfe Nam mfec polyp, nghifen cuu cua Nguyin Tang mifen, vbi 120 ca duac phfeu thufet cfet tui mfet do polyp tui mat cb ty le Nu vfe Nam Ife tuang duang nhau [1]. Bfenh nhfen dubi 50 tubi chiem 91,8%, nghien cuu cua Nguyfen Tfeng mifen thi db tubi dubi 50 chiem 73.3% [1], H iu h it bfenh nhfen sbng b nbng thon vfe mien nui (84,9%) vfe 81,8% sb bfenh nhfen Ife ngubi nbng dfen. Co 8 polyp dubng kinh Ibn han 10 mm (chiim 24.2%). Cfec polyp hofec dan dbc, hofec da polyp, hofec k it hap vbi soi Cb 5 trubng hap polyp cb kfem sbi. Cb 22 trubng hap (66,7%) chi cb 1 polyp vfe 6 trubng hap (18,1%) > 3 polyp, 1 trubng hap dan polyp thofei hba thfenh fee tinh, trubng hap nfey Ife bfenh nhfen nu tren 45 tuoi, giai phiu bfenh dang carcinoma tuyin.

Ngubi ta dung thufet ngu ‘hiperplastic cholecystosis' de chi su tfeng tn/dng thfei qufe cua cfec thfenh phin tb chuc binh thubmg cua tui mfet. Adenomiomatosis’ d i chi su tfeng sinh Ifenh tinh cua nifem mac b i mfet mbi hinh thfenh dang tuyin, cfec xoang ngoai thfenh, cfec chb hep ngang hay cfec hinh thfenh nbt b dfey (dang adenoma hay adenomioma) cbn ‘cholecystosis’ Ife nhung tich tu b it thudng cua lipit, dfec biet Ife cholesteryl esters trong nhung thuc bfeo d Idp lamina propria cua thfenh tui mfet, mfe trong th i Ian toa ngubi ta gpi dudi tfen ‘tui mfet qufe dfeu tfey’ vi nifem mac tui mfet db vfe dfey Ifen, trong th i khu trii thi dang nfey tao nfen nhung polyp cholesterol dan

68 Y HOC THtyC HANH (905> - SO 2/2014

dbc hay da polyp cholesterol g in d thdnh tui mdt.Phin Idn nhQng polyp cua tui mdt thudng Idnh

tinh vd khbng thay d ii nhiiu qua thdi gian. Nhd sifeu dm, polyp duoc phdt hifen mfet cdch tinh cd. Tuy nhifen nhQng polyp c in duac theo dbi dinh ky vdi si6u dm. D ii vbi nhung bfenh nhdn dau qudn gan vd cb nhOng polyp nho tui mdt md khbng cb sbi mdt gdy cho thiy thubc xi> tri khb khdn.

Vifec phdt hifen polyp nhiiu khi khbng dfe. Dbi vdi nhQng polyp cholesterol cua tui mdt, Paslawski [8] khuyfen nfen chpn sifeu dm ‘Harmonic mode’ vi chit luang hinh dnh sfe tbt hon, thdnh tui mdt se rb han vd hinh dnh polyp sfe rb rang han thi se do chinh xdc kich thudc polyp. Vdi ‘Standard mode’ n iu cb mdt cb ddc duac tim th iy trong tui mfet thi dbi vbi nhung bfenh nhdn ndy polyp khb duac phdt hifen. Vbi harmonic mode su hifen difen cua bun mdt se duac loai tru* vd Idm cho sy" ddnh gid cua polyp de ddng han. Do db, khbng nhung polyp duac phdt hifen md sb luang polyp duac phdt hifen cung cao han trong standard mode.

Tuy vdy, sy ddnh gid thyc ch it cua mfet tbn thuang trong tui mdt cung khbng phai Id dan gian. Chattopadhyay [2] trong 23 bfenh nhdn duac chin dodn bdng sifeu dm byng xuyfen thdnh trubc mb (transabdominal ultrasound scanning) Id tbn thuang dang polyp cua tui mdt, nhung sau khi c it tui mdt thi thiy cb 12 trudng hap id sbi, 7 polyp cholesterol, 3

V i kha ndng thodi hba dc tinh cua polyp thi nhO-ng polyp cb dudng kinh Idn han 10mm, dan dbc khbng cb cubng, nghfeo dm thudng gdn vdi nguy ca dc tinh cao, nfen nhung bfenh nhdn vdi polyp Idn, dan dbc hay cb sbi tui mat can phai theo dbi sdt sao sifeu dm. Theo Persley [8] ngodi y iu tb kich thudc cbn y iu t i tuii tdc, nhat Id nhung bfenh nhdn Idn han 50 tuoi. Kar [3] cb 1 bfenh nhan 61 tuoi nbn ra mdu vd phdn den tu 10 ndm. Sifeu dm phdt hien tui mdt cb dang polyp 5.5x4 cm gdn vdi tui mdt bdng mbt cuing nho. Gidi phdu bfenh Id mot polyp cb nhung tifeu diim carcinoma tai chb. Kim [5] tim th iy dang polyp xa vd cho ring su phdn bifet giua polyp Idnh tinh vd polyp carcinoma r it khb khi polyp Idn han 10 mm dudng kinh. Trong 26 trudng hap polyp dc tinh cua Terzi [10] cb din 88% polyp cb dudng kinh Idn han 10 mm. Vi thi, Norton [7] cho rdng cdt tui mdt duac chi

carcinom tuyin d trong polyp vd 1 binh thudng. Tdc gia cho rdng phin Idn t in thuang dang polyp d tui mdt bfenh ly thdt su Id sbi. Cho nfen, trudng hap polyp Idn han 10 mm trfen sifeu dm nen Idm nfen sifeu dm cdt ngang hay sifeu dm nbi soi (cross-sectional +/-EUS) trudc khi phdu thuat. D iiu ndy giup ta cb mpt hudng xu tri thich hap cho bfenh nhdn vd trdnh duac su b it ngd vdi k it qua giai phdu bfenh. Wolpers C [11]. Theo doi 689 bfenh nhdn trong db cb 181 bfenh nhdn cb polyp tui mdt trong 32 ndm bdng X Quang, it nh it 2 Ian T it ca d iu khbng cb sbi luc dau. Sau thdi gian theo dbi trung binh 9.5 ndm thi sbi tui mdt xu it hifen 18% trudng hap (24% sdc tb mat, 30% cholesterol dan doc vd 46% nhiiu sbi) du cb hay khbng cb polyp tui mdt. Khbng cb bdng chung ndo chung tb cb su biin d ii tu polyp sang sbi. Cb su tich tu cholesterol esters trong nhung t i bdo bot d Idp dudi nifem 95% polyp tui mdt Id polyp cholesterol vd se bj m it din. Khomeriki [4] nghifen cuu hinh th i cua 345 tui mdt duac cdt bb th iy cb 173 tui mdt bj cholesterolosis (73.8% cholesterolosis, 18.5% da polyp, 8.7% dang polyp). T in s i ngang nhau giua nam nu, nhung d nam cb dang polyp vd nu cb dang ludi. Thdn tui mdt Id nai bj t in thuang chinh. K it hap giua cholesterolosis vd sbi Id 87.3% (151 ca), 19% adenomyomatosis (33 ca). Cb 47 trudng hap pclyp cholesterol md 30 la da polyp. Kinh cd thay d ii tu 2-17 mm.

djnh d bfenh nhdn cb trifeu chung cung nhu khbng cb trifeu chung, Idn han 50 tuoi, polyp Idn han 10 mm hay k it hap vdi sbi hay polypldn d in Ifen trong nhung lin sifeu dm hang loat.

Ung thu tui mdt Id loai ung thu cb db dc tinh cao nfen ty Ife ung thu tui mdt song trfen 5 ndm Id r it thip.Nhu vay, nhung bfenh nhdn trfen 50 tu ii cb polyp Idn han 10 mm, dang dan, polyp khbng cb cuing, nghfeo dm trfen sifeu dm d iu cb kha ndng thodi hba thdnh ung thu cao. NhQng polyp dan dbc dfe thodi hba thdnh dc tinh dan da polyp. Nhung polyp nho nfen theo dbi djnh ky vdi sifeu dm. Nhung bfenh nhdn cb can dau qudn gan vd polyp tui mdt md khbng cb sbi tui mdt, nhung n iu th iy thu ic qua quyit rdng chinh polyp Id nguin g ic cua can dau qudn gan db thi nhung bfenh nhdn ndy nen duac cdt tui mdt. Nhung polyp Idn han 10 mm d iu nfen cdt bb tui mdt

Bdng 8: Ddc diim GPB polyp cua cdc tdc giaTdc gia Cholesterol Adenoma Adenomyotatous

hyperplasiaTubular

polypCarcinoid Carcinom

tuyinSoi

Chattopadhyay(n=23)

7 3 12

Mainprize(n=11)

7 2 1 1

Terzi(n=100)

39 20 15 26

Nguyfen Tdng Mien (n=120)

0 117 0 1 2 18

NguySn VSn Huong (n=33)

0 32 0 0 0 1

Y HOC THVC HANH (905) - SO 2/2014 69

bdng noi soi de khong co trieu chung. Theo chung toi: Neu benh nhdn d do tudi trdn 50, polyp Idn hon 10 mm, polip don doc, khbng co cu6ng, nghdo am thi c6 nguy co cao bi thoai h6a dc tinh. Cdc polyp nho ndn theo dinh ky bdng sidu dm; cdc polyp gdy con dau qudn nguc mdt vd khdng c6 soi kdm theo, gdy khb xu tri cho bdc sy Idm sang nhung neu th iy thuoc tin chdc con dau Id do polyp thi nhung bdnh nhdn ndy se chi djnh m6 cdt tui mdt. NhQng polyp Idn, don ddc hay c6 ph6i hop vdi soi thi c in phai theo d6i nghiem ngdt. Cdt tui mdt phbng ngua trong polyp tui mdt chi duoc thuc hidn khi polyp Idn hon 10mm.

k £t lu a nPolyp tui mdt thudng it bien d6i theo thdi gian.

Nhung polyp Idn thudng dc tinh; C in theo dbi djnh ky cdc polyp nho.N^u polyp khbng Idn nhung gdy nhung con dau qudn gan thi cb chi dmh can thidp phdu thudt. M6 noi soi cdt tui mdt trong trudna hop polyp cb chi dinh m6 Id phdu thudt thich hop nhat.

TAI LIEU THAM KHAO1. Nguyen Tang Mien "Cat tui mdt npi soi dieu trj

Polyp tui mdt", So ddc biet chuyen de ngoai tong quat Y hpc Thanh pho Ho Chi Minh, Hpi nghj Ngoai khoa va phau thudt npi soi toan Quoc nam 2008.

2. Chattopadhyay D, Lochan R, Balubury S, et al(2005). Outcome of gall bladder polypoidal lasions detected by transabdominal ultrasound sacnning a nine year experience, Worl J.Gastroenterol, 14;11 (14): 2171-3.

3. Kar M, Bhattacharyya U, Laha RN, et al (2003)

Haemobilia due to a lasge gall bladder polyp inMed, Assoc 101(9) 554-5 PMID 15168995

4 Khomeriki SG. Orlova luN, II Chenko A et al(2004) Quantitative analysis of morp' Kjical manifestatins of cholesterolosis and co tant pathology of the gall bladder Arkh Pato 15). 12-5 PMID 15575378.

5. Kim DH, Kim SR, Song SY, et al (2003) A Large sibrous polyp of the gall bladder m im ic k im g a polypoid carcinoma J. Gastroenterol, 38(10)1009-12

6. Mainprize KS, Gould SW, Gillbert JM (2000): Sergical manaherment of polypoid lesions of the gall bladder Br.J.Surg, 87(4);414-7.

7. Noton J. Greenberger,Gustave Paumgarlen(2005). Diseases of the gall bladder and bile ducts in Harrion's Principles of intern Med, 16 Edit, Vol.II.1880- 1891

8. Paslawski M, Krupski W, Zlomeniec J (2004); The Value of Ultransound harmonic imaging in the dianosis of the gall bladder cholesterol polyps. Ann Univ. Mariae Curie Sklodowska 59(2): 293-7. PMID 16146095.

9. Persley KM (2005): gall bladder polyps. Curr. Treat. Options Gastroenterol, 8(2): 105-108

10. Terzi C, Sokmen S, Seckin S, (2000),Polupoid lesion of the gall bladder : Report of 100 cases with special raference to operative indications, Surgery,127(6):622-7.

11. Wolpers C (1989), gall bladder polyps and gall bladder stones. Dtsch Med. Wochenscher; 114(49); 1905-12.

NHAN XET KET QUA UffiG DUNG PHAU THUAT NOI SOI TRONG DIEU TRj VIEM PHUC MAC RUOT THflfA TAI KHOA NGOAI BENH VIEN BACH MAI

TOM TATDat vin d i: Vidm phuc mac mdt thira l i mdt b iin

chung n ing cua vidm mdt thira c ip . P h iu th u it ndi soi d iiu tri vidm phuc mac mdt thira dd duxyc ung dung kh i phd b iin , tuy vdy v in c in tiip tuc d inh g iiv i tinh an toan va hidu qui. Doi tinmg, phirong phip: 64 bdnh nh in vidm phuc mac mdt thira, duxyc ph iu th u it ndi soi t$i Bdnh vidn tir th ing 1 n im 2010 d in th ing 1 n im 2013. Nghidn ciru hdi ciru md t i c it ngang. K it qui: Ty Id chuyin md l i 11,9%, thdn gian m6 tmng binh 75,4 ± 27,5 phut, thdi gian cd tmng tien tmng binh 45,3 ± 20,4 gib, ty id b iin chimg chung l i 18,92 % (tic mdt s&m, ip xe tdn dir, nhidm khuin chin trocar lin luxyt l i 2,7%; 2,7%; 13,52%). Thai gian n im vi$n sau md tmng binh l i 6,5 ± 1,3 ngiy. K it lu$n: P hiu th u it ndi soi trong d iiu tri vidm phuc mac mdt thira an to in, hidu qui.

Tir khda: Vidm phuc mac mdt thira. P h iu thu it ndi soi.

SUMMARYBackground: Appendicular peritonitis is a serious

complication o f appendicitis. Laparoscopic procedure had been applied routinely, but it is still in need to

TRAN HUTU VINH va CS

measure the efficiency and safety o f laparoscopic surgery in treating appendicular peritonitis. Patients and methods: Retrospective, from 1-2010 to 1-2013 at hospital, 64 cases of appendular peritonitis have been treated by laparoscopic approach. Results: Conversion rate was 11.9%. Mean operative time was 75.4 ± 27.5 minutes, mean time of flatus passage was 45.3 ± 20.4 hours. Overall complication rate was 18.92% (trocar site infection, postoperative intra-abdominal abscess and early intestinal obstmction were 13.52%, 2 7% and 2.7% respectively). Mean hospital stay was 6.5 ± 1.3 days. Conclusion: Laparoscopic surgery is safe and efficient option in appendicular peritonitis

Keywords: Appendicular peritonitis Laparoscopic.

DAT VAN 0£Viem phuc mac rubt thCra (VPMRT) Id bi£n chung

ndng, hay gdp cua vidm rubt thira c£p Nguydn nhdn do viem rubt thira c ip khbng duac ch in dodn vd xu tri kip thdi, vd mu vdo 6 bgng gdy vidm phuc mac vd d in den nhidm dbc todn thdn ndng thdm chi ddn d&n tu vong.

70 Y HOC THUC HANH (905) - SO 2/2014