VIEM RUOT THUTA 0 TRE EM
8. VIEM PHUC MAC RUOT THLfA
Viem ruot thtfa cap thung gay viem phuc mac khu tru (apxe) ho&c viem phuc mac toan the.
Ti le ruot thtia viem thung gay bien chting gap tti 25 - 47% cua tong so viem ruot thtia va chiem ty le khoang 60-70 % d ltia tuoi dtfdi 5 tuoi.
8.1. Lam sang
Benh nhan thtfdng tdi kham khi da c6 trieu chting tren hai ho&c ba ngay (80
% cac trtfdng hdp), nhieu benh nhan da dung khang sinh, thuoc giam dau trtfdc khi di kham d kenh vien.
8.1.1. Toan than va c a nang
Benh nhan thtfdng sot cao, dau bung vung ho" chau phai hoac toan bo o bung. Co roi loan tieu hoa nhtf non, bi trung dai tien, ia long. Co the co dau hieu dai buot, dai rat. Tuy theo mtfc do benh ma benh nhan co the d tinh trang nhiem trung, nhilm doc nang, co dau hieu mat ntfdc, toan trang suy sup.
8.1.2. K him thuc the
• Vdi Apxe ruot thiia:
N&n d ho' chau phai co mot khoi mem - dau. Khoi nay co the sat vdi ai chau trtfdc tren, mao chau hoac tach biet, n&m d ho' chau phai hoac dtfdi ron ben phai.
Vung ho chau phai cd phan tfng, con cac vung bung khac cd the nSn con mem.
Tham trtfc trang: cd the sd thay mot kho'i d thanh ben phai trtfc trang va dau.
• Vdi viem phuc mac toan the:
Bung chtfdng, nan cd cam ting phuc mac. Nan v ln tha'y dau nhieu nhat d vung ho' chau phai.
8.2. X quang
Vdi ap xe ruot thifa: cd the tha'y hinh mtic ntfdc - hdi d vung ho' chau phai hoac canh ho' chau phai, hinh md d vung ho' chau phai. ằ
Vdi viem phuc mac toan the: cd hinh md do cd dich trong o bung, cd hinh mtic ntfdc hdi, ma't dtfdng vien phuc mac ben phai.
8.3. Sieu am
Tha'y dtfdc hinh anh khd'i ap xe, rudt thtia viem da hoai ttf. Cd dich trong o bung.
Hinti15.4. Ap xe rudt thifa
8.4. Choc do o bung
Choc do o dp xe ruot thiia: nen thuc hien dudi hudng d&n cua sieu am. Choc do de chan doan va dieu tri.
8.5. Xet nghiem
Cong thtic mau, Hematocrit, dien giai do, Ure...
8.6. Chan doan
8.6.1. Chan dodn ap xe rugt thifa ho&c viSm phuc m$c to&n t h i Dua lam sang va can lam sang.
8.6.2. Chan do An ph&n bi$t
- Viem phuc mac tien phat do Ph£ cau hoac do nhilm trting mau.
- Hoi chting than hu.
- Viem phuc mac mat.
- Viem rudt hoai tti d tre nho - ldn.
- Viem tuy ca'p hoai tti - xu&'t huy£t.
- Xo&n rudt ho^i tti.
- Viem phuc mac sau ch^m thudng bung.
- Lao phuc mac.
9. DIEU TRj: la cap ctiu ngoai khoa.
9.1. Viem ruot thtia
- Gay me noi khi quan
- DUdng md: Mac Burney ho^c dudng ngang theo nep byng dudi d hd chau phai. Vdi dudng md ngang nay, sau khi rach qua 16p da tiep tuc tach cac ldp cd nhu vdi dudng md Mac Burney ho$c theo bd ngoai cd thdng to phai de vao 6 bung.
- Cat ruOt thtia va kiem tra co tui thtia Mecken thi cat bo.
- Khang sinh du phong.
- Truyen djch trong mpt, hai ngay d£u sau md va cho an sdm.
9.2. Vidm phuc mac ruot thtia
- Chua’n bi trudc md: tu£ theo thd tr^ng b^nh nh&n mb c6 dilu tri trtfdc md Bdi phu nUdc, di#n giai.
- Gay me noi khi quan.
- Khang sinh: Trtfdc - trong - sau mo (Metronidazone + Aminoglycose + cephalosporin).
9.2.1. Ap xe ruot thua
/ •
- Ap xe khu tru - gi6i han ro d ho" chau phai, sat gai ch&u trtfdc tren.
(thtfdng d tre ldn).
- D&n ltfu o ap xe ngoai o bung. Nen lam choc do dtfdi htfdng d&n cua sieu am.
- Ap xe trong o bung, d tieu khung va d tre bu me: Mo nhtf viem phuc mac to&n the.
9.2.2. Vi§m phuc mac to i n the - Dtfdng mo du rong:
+ Ntfa tren va dtfdi ron khi viem phuc mac toan the.
+ Bd ngoai cd thfing to phai: khi viem phuc mac khu tru d ho" chau phai.
- Xtf tri thtfdng ton:
+ C&t ruot thtia.
+ Rtfa 6 bung b&ng dung dich NaCl 0,9%, co the pha dung dich Betadine ty 1$ 1%.
+ D in ltfu o bung, cung c6 thi khdng d in ltfu o bung neu l&m sach va th&m kho o bung.
9.3. N§i to i o bung
- Cho viem ruot thtfa c&p : D<? chan doan khi nghi ngd v& c&t ruot thiia qua ndi soi. Neu noi soi khong thay viem ruot thtfa thi khong nen c&t bo ruot thtfa.
- Cho viem phuc mac rudt thtfa: c&t ruot thiia, hut mu, rtfa 6’ bung.
10. Bidn churng sau mo
• Nhiim triing:
- Vet md’.
- Trong 6 bung: &p xe b hd' ch&u phai, d mac treo rudt, b tui cting Douglas.
- Rd manh tr&ng.
Mdt trong nhiing nguyen nhan gay nhilm triing, ro manh trang 1& tut nut chi bu§c d goc ruQt thiia ho&c khdng c&t h6't rudt thtia viem.
• Chdy mdu:
Trong 6 b\mg do tyt w it chi budc m^ch b mac treo ru6t thtia v& chay- ty mau d v&t m6.
• T&c ru$t sau mS: T4c ru$t 06 th i xay ra sdm ho&c mupn
TAI LIEU THAM KHAO
1. A lvarad ov A.: A practical score for the early diagnosis of acute appendicitis.
Ann. Emerg.. 1986. 15 : 557-564.
2. Bargy F. : Appendicite aigue et peritonite.
Chirurgie digestive de l’enfant. Doin editeurs, 1990. pp.516-532.
3. Canty T.G., Collins D., Losasso B., Lynch F.y Brown C Laparoscopic appendectomy for simple and perforated appendicitis in children: the procedure of choice ?
J. Pediatr. Surg., 2000. 35 (11), pp. 1582 - 1585 . 4. Hoang Cong Dac.: Viem ruot thvra cap.
Benh hoc ngoai khoa, Nxb Y hoc, 1999,1, tr.119-134.
5. Kathryn D. Anderson, Robert L. ParryjAppendicitis.
Pediatric Surgegy. - 5 th ed/ edited by James A. O’ Neil, Jr...
Mosby 1998, volume 1, pp. 1369-1379.
6. Phan Thanh Luang, Trdn Ngoc Bich, Vu Huy Nung~ Nghien cvfu dac diem lam sang, can lam sang va giai phiu benh ly cua viem ruot thiia cap d tre em.
Ngoai Khoa, 2003, 2: 27 - 32.