GIUN CHUI UNG MAT
Hinh 16.1. Hinh 16.1. Hinh anh xac giun dua trong dtfdng mat
5. D liN BIEN CUA GIUN CHUI ONG MAT
Trtfdc day, giun chui ong mat dtfdc dieu tri noi tren cd sd ly luan: giun chet trong dtfdng mat roi xac giun bi day xuong ta trang theo dong mat chay, hoSc khi giun dang len dtfdng mat mot phan giun d trong ta trang va mot phan d dtfdng mat, khi dung thuoc dan cd Oddi va thuoc ldi mat, ap liic dong mat chay co the day giun xuong ta trang, do vay dieu tri noi co ket qua tot cf mot so trtfdng hdp.
Nhtfng neu da co chan doan sieu am ch&c chan co giun chui ong mat va dfic biet so' ltfdng giun len nhieu thi de dien bien tii nhien kho co the tii khoi, ma dieu tri noi khoa ddn thu&n thtfdng dtfa tdi viem dtfdng m&t do giun vd ap xe gan vdi nhtfng bien chtfng cua no.
5.2. Viem dirdng mat do giun tien trien gay dp xe gan neu khdng dieu trj 5.3. Ap xe gan do giun co the gay cdc bien chumg
Yd dp xe vao:
- Khoang mang tim (khi ap xe gan d thu£ sau trai).
- Khoang mang phoi (khi ap xe d ha phan thu£ VII).
- Nhu m6 phdi (khi ap xe cl ha ph&n thu^ VIII).
- Vao cl bung g&y viem phuc mac toan the ho&c ap xe dtfdi cd ho&nh.
• Viem hocti tit dieting mat ngoai gan gay viem phuc mac m&t
• Viem hoai tit dieting mat trong gan tUfn triin
• Chay mau dieting mat
• Viem chit, hep dieting mat trong va ngoai gan
• Suy kiet, nhiem khuan mau, suy than tit vong 6. DIEU TR|
6.1, Chi djnh dieu trj
6.1.1. Chi dinh dieu trj: noi hay ngoai khoa?
- Chi dinh dieu tri noi khoa:
Benh d giai doan sdm vd khong c6 dieu ki$n lam n§i soi.
Dieu tri b&ng thuoc ldi m&t, t6y giun, thudc ddn cd oddi, khong nen dieu tri khang sinh vi lam m&'t dau hi$u nhi§m khu£n. Nhtfng phai theo d6i ch$t ch§ b$nh nh&n ve;
+ Tien triln cua dau bung
+ Co xu&'t hien hoi chtfng nhilm khulin: sot, bgch c&u cao, m6u l&ng cao + Theo doi sieu am, danh gia tinh trang gan, dtfdng m&t, giun trong dudng m ^t
Neu khong ket qua thi phai dieu tri khang sinh ngay va chi dinh md.
- Chi dinh dieu tri bdng noi soi:
Neu co noi soi thi nen noi soi rut giun khoi dtfdng mat ngay d giai doan sdm va giai doan viem dtfdng mat.
- Chi dinh mo khi:
+ Dieu tri noi khoa hoac noi soi khong ket qua.
+ • Giai doan ap xe gan, da co ho&c chtfa co bien chting.
6.1.2. Chi djnh th&i gian mo: cap ctiu*hay cap ciiu tri hoan?
Vdi viem dtfdng mat do giun hoac ap xe gan do giun, nen co dieu tri noi khoa chuan bi de nang cao thd trang, lam bdt dau hieu viem nhilm, tinh trang toan than on dinh hdn. Chi md c&p ctfu khi ap xe gan co bien chting vd vao khoang mang tim, khoang mang phdi, v&o d bung ho&c chay mau dtfdng mat n&ng
6.2. Dieu trj chu£n bj mo
- Chong nhiem khu£n: khang sinh li§'u cao, phoi hdp lojai khang sinh tac dtfng vdi trtfc khu£n gram am, vi khuan ky khf. Cac khang sinh cd the dung phdi hdp.
+ Nhom cephalosporin th£ h§ 3.
+ Nhom aminoside.
+ Nh6m metronidazole.
- N&ng cao th i tr^ng,
+ Truyen mau: neu thieu mau, dtfa cong thtic mau. Huyet sic to, hong ciu hematocrit.
+ Truyen dam: dtfa protein huyet thanh.
+ Truyln ntfdc, dien giai dtfa d&u hieu m&'t ntfdc va dien giai dd, - Cac sinh to' nhom B.C.
- Tay giun.
- Vitamin K: dtfa ty 1§ prothrombin.
6.3. fHeu trj phiu thu#t 6.3.1. Gay me:n$i khf quan.
6.3.2.Dudng m i: thudng la dtfdng gitfa tren ron.
6.X 3. Nguyin tie trong p hiu thujt - Md tfng n * t theo du£u ngang £ng
- lAy bA gian, tfli. ttani #it&ng mằt.
- Tim va md het cac o ap xe d nhu mo be mat gan de lay xac giun va hut h£t mu. Co the cat ha phan thuy doi vdi cac ap xe da vd.
- Lay nUdc mat cay vi khuan va lam khang sinh do.
- Rtia sach dtfdng mat trong va ngoai gan.
- Co chup dtfdng mat trong mo de xac dinh lay het giun va dtfdng mat ltfu thong binh thtfdng,
- Dan ti*ong mat chu b&ng dan ltfu Kehr.
- Dan ltfu d ron gan va canh cho md cac o ap xe.
6.3.4. Mot so chi djnh ky thuat kh ic - Trong chay mau dtfdng mat.
+ That dong mach gan rieng.
+ Cat phan gan ttfdng tfng vdi cho chay mau d dtfdng mat.
- Trong hoai ttf dtfdng mat ngoai gan.
+ Neu hoai tti nho d mat trtfdc, md dtfdng mat cho hoai tti va dat din ltfu Kehr sau khi da lam sach dtfdng mat.
+ Cd the dung mac noi ldn khau che phu phan dtfdng mat hoai tti.
+ Dung mot ph£n day chang tron chuyen xuong tai tao lai ph£n dtfdng mat bi hoai tti neu phan hoai tti d mat trtfdc dtfdng mat ngoai gan.
+ Neu dtfdng mat ngoai gan bi hoai tti nhieu, khdng tai tao lai dtfdc thi cai the cat bo ong mat chu, dtfa 1 quai hong trang len noi vdi ong gan chung theo ky thuat Roux-en-Y.
- Ap xe gan khu tru d mot phan thuy hay d 1 thuy, dtfdng mat vao vung gan do bi chit hep gay dan dtfdng mat phia tren ma khong giai quyet dtfdc yeu to" gay ti dong thi cat gan ha phan thuy hoac phan thuy.
- Ap xe gan vd vao khoang mang tim, khoang mang phoi: mo dan ltfu khoang mang tim, khoang mang phdi ket hdp xti ly ton thtfdng gan va dan ltfu dtfdng mat.
6.4. Dieu trj sau mo - Tiep tuc dieu tri:
+ Khang sinh theo khang sinh do.
+ Hoi stic nang cao the trang.
+ Rtia dtfdng mat qua Kehr neu con ra ntfdc mat due.
+ Chup dtfdng mat qua kehr ttf ngay thti 7 sau mo.
+ Rut Kehr khi dtfdng mat ltfu thdng, het di vat.
- Theo doi ket qua xa:
+ Tay giun theo dinh ky.
+ Theo doi cac bien chting: soi mat, hep dtfdng m$t.
TAI LIEU THAM KHAO
1. Trdn N g oc B ich . Tac dung ldi mat cua Anisomeles - Ovata R.Br tren ngtfdi.
Luan van tot nghiep bac sy chuyen khoa cap I he Noi tru cac benh vien.
Trtfdng Dai hoc Y Ha Noi - 1979.
2. Trdn N goc B ich. Dung day chfing tron tai tao lai phan dtfdng mat ngoai gan bi hoai tti.
Dai hoi thanh lap Hoi Phiu thuat nhi Ha Noi. Thang 4-2000, tr 58-64.
3. CarolLJ., Corcos. V, et Chirinlou - Motlagh. La lithiase intrahepatique.
Maladies des voies biliaires intrahepatiques.
Masson & C,e, editeurs, 1964,Chapitre VIII, p 207 -279
4. H oa n g Bdi Cung, Phiing Tan Cudng, N guyen Xudn Thu. Nhting nhan x6t mdi day ve ap xe gan do giun dua 6 tre em.
Y hoc Viet nam, 1980, 2: 41 - 48
5. N guyen Trinh Ca, N guyen N hu Bdng. Ap xe gan 6 Viet Nam 593 trtfdng hdp. Y hoc Viet Nam 1964, 3: 30 - 47.
6. Gauthier T. Pathologie des voies biliaires extrahepatiques en dehors de l'atr6sie.
Chirurgie digestive de 1’ enfant. Doin Editeurs de Paris 1990, 245-246.
7. N g u yin Thanh Liem, Vu Cong Vinh, L e Thu Phitang, Nguy in X udn Thu. Doi chieu bieu hien lam s&ng, hinh anh sieu am va thtfdng ton trong md cua cac benh nhan bi ap xe gan do giun.
Y hoc thtfc hanh. Ky yeu cong trinh NCKH Vien Bao ve stic khoe tre em 1991-199*5, tr 205 - 211.
8. N guyin D uon g Quang, Nguyen Xudn Thu. Giun chui ong m&t d tre em.
Y hoc Viet nam, 1962, 2: 3-11.
9. N guyen D iton g Q uang, N guyen X udn Thu. C&t gan do ap xe giun dua d tre em.
Y hoc Viet nam, 1963, 4: 29 - 38.
10. Nguyin Duong Quang: Ap xe gan dtfdng m&t.
Bach khoa thtf benh hoc. H& Noi 1991, trang 10-11.