phau thuat dm canh sau 15 nam

8/4/2019 PHAU THUAT DM CANH SAU 15 NAM

1/32

PHU THUT NG MCH CNH

Thay i g qua 15 nm?

F. MANTZ D. THIBAUD

Trung tm Y khoa Orangerie

STRASBOURG


2/32

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


3/32

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)


5/32

PHN B THEO NAM V N

705 t phuthut

662 t phu thut

Femme: N Homme: Nam


6/32

PHN B THEO TUI V

GII


7/32

CCYU T NGUY

C

HTA traite: tng HA

iu trDIND: T khngph thuc insulinDID: T phthuc insulin

Atteinte coronaire:Bnh mch vnh


8/32

BNH MC

H VNH


9/32

TRIUC

HNG


10/32

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


12/32

PHNG PHP BC TCH

NI MC C PATCH (TEA)


13/32

K THUT CM TO HNH

MCH CNH LN NGC


14/32

BC TCH NI MC VI

NG KHU N GiN


15/32

KTHUT M


Autres: cc phng php khc


16/32

TiN TRIN K THUT M

THEO KTV



17/32

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


19/32

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


21/32

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


24/32

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 (


30/32

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

phau thuat dm canh sau 15 nam

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