- Dat ong thong da day - Khang sinh.
- Nuoi dtfdng dtfdng tlnh mach trong 3, 4 ngay dau. Chu y thang b ln g di$n giai trong mau. Cho an sdm khi co ltfu thong ruot trd lai.
- Theo doi bilirubin mau, mau sic cua phan va xet nghiem Stercobilinogen trong phan sau md de danh gia ket qua md.
6. b i£'n c h it n g
6.1. Bien chumg sdm
- Chay mau trong 8 bung: Thtfdng bi chay mau d v&ng ron gan, hoftc chay mau d v£t md
- Rdi lo$n di$n giai: thtfdng la giam Natri trong mau.
- Ro mat
- Nhiem trung vet mo - Buc vet mo thanh bung - Buc mieng noi mat-ruot
- Viem dudng mat: co the xay ra sdm trong nhiing ngav dau sau mo V&
nhieu thang sau mo. Chi xay ra d nhiing benh nhan co mieng noi ruot vdi ron gan hoac vdi dudng mat ngoai gan ma khong thay d nhiing benh nhan co mieng noi tui mat vdi ron gan. Cac loai vi khuan thUdng gap la vi khuan dudng ruot: grame am, vi khuan ky khi. Dieu tri khang sinh loai Cephalosporine the he 3 ket hdp Aminoside va Metronidazole.
6.2. Turvong sdm sau mo
ThUdng do suy gan hoac bien chting n&ng nhu buc mieng noi mat-ruot, chay mau.
7. TIEN TRIEN VA TIEN Ll/ONG
Neu khong dUdc dieu tri hoac dieu tri khong ket qua thi tien trien n&ng dan:
Xd gan - Tang ap hie tinh mach cUa roi suy gan, thUdng chet luc 1-2 tuoi.
• Cac yeu to len quan tdi ket qua phau thuat:
- Tuoi benh nhan luc mo:
La mot yeu to quan trong, mo d ltia tuoi cang nho thi tien liidng c&ng tot.
Liia tuoi mo co ty le ket qua tot cao la dudi hai thang tuoi. Tren hai thang tuoi, ty le that bai rat cao.
Do vay chan doan teo dudng mat bam sinh phai dUdc coi nhu mot cap ciiu.
phai dUdc chan doan trong tuoi sd sinh va md sdm ngay sau khi co chan doan.
Thdi gian md muon lam miic do xd gan tang va lam giam ty le thanh cong cua phau thuat
- The loai teo dudng mat:
Vdi teo hoan toan dudng mat ngoai gan thi tien lUdng xau, con teo mot ph&n dudng mat ngoai gan thi tien lUdng tot.
- Viem dudng mat sau md:
Xay ra sdm hoac muon sau md. Can phat hien s6m de dieu tri va khi mo nen lam them van chong trao ngUdc.
- Kinh nghiem cua phau thuat vien vdi loai ky thuat md thtfc hien.
8. KET QUA LAU DAI
• Loci i tot:
Luu thong mat xuong ruot tot, het vang da. phan co mau vang, Bilirubin trong mau trd ve gia tri binh thUdng, chilc nang gan dUdc cai thien tot va on dinh.
• Loai trung binh:
Luu thong mat xuong ruot nhung khong hoan toan. Phan co mau vang nhung v in con vang da va Bilirubin trong mau con cao. Chiic nang gan co cai thien nhung khong on dinh.
• That bai:
Van tac mat, khong co mat xuong ruot. Phan van trang. da va cung mac mat v in vang, gan to chic. Tien trien xd gan.
9. VAN DE GHEP GAN
Ba thang sau phau thuat Kasai ma van vang da va ty le bilirubin mau van cao, phan van trang nhu trUdc mo, xet nghiem phan khong co stercobilinogen thi ket qua phiu thuat coi nhu that bai va van de chuan bi ghep gan dUdc dat ra.
Gan ghep thUdng la ha phan thuy II va III va dUdc lay tif ngUdi than thuoc trong gia dinh nhu bo, me...
TAI LIEU THAM KHAO
1. B ern ard. O. Atresie des voies biliaires - Aspects medicaux.
Chirurgie hepato - biliaire de l’enfant.
Sauramps Medical, 1994, Page 65-72.
2. B ettex M, K u ffer F. Sharli. Pathologie du foie et des vo ies biliaires.
Precis de chirurgie infantile.
Masson 1978, p 177-181.
3. G autier.F . Atresie des voies biliaires - Aspects chirurgicaux Chirurgie hepato - biliaire de l’enfant.
Sauramps Medical, 1994, Page 73-84.
4. G authier. F. Atresie des voies biliaires.
Chirungie digestive de l'enfant.
Doin 6diteurs, 1990. p 225 - 244.
5. Do San Hd. Nghien ciiu dac diem lam sang, can lam sang va ket qua dieu tri teo dudng mat b^m sinh.
Luan an tien si y hoc. Ha noi - 2001.
6. R evillon. Y., Jan.D.: Transplantation hepatique chez l’enfant.
Chirurgie hepato - biliaire de l’enfant.
Sauramps Medical, 1994, Page 189-198.
7. R yoji Ohi, M asaki Nio. The jaundiced infants biliary Atresia and other obstructions.
Pediatric surgery - 5 th ed/ edited by James A-O’ Neill, Jr...
Mosby- Years book, In C, 1998, p 1465 - 1482.
HEP PHi DAI MON VI• ■ ■
Hep phi dai mon vi (HPDMV) la tinh trang phi dai 16p cd cua mon vi gay hep ong mon vi.
1. VAI NET VE UCHSlT
Nam 1648, Fabricius HILDANUS la ngtfdi dau tien bao cao benh nhan bi HPDMV
Nam 1887: HIRCHSPRUNG la ngtfdi dau tien mo ta cac dau hieu lam sang va ton thUdng giai ph iu benh ly. Ong cho r&ng day la benh bam sinh.
Nam 1907: Pierre - FREDET dua ra phUdng phap mo tach cd mon vi ngoai niem mac.
N&m 1911: RAMSTED hoan chinh ky thuat n&y v& phtfdng phap mo mang ten Fredet - Ramsted.
Nam 1912: Lewade mo ta ky thu&t chup da day co can quang de chin doan HPDMV.
N&m 1932: Meiweissen va Sloof mo ta cac hinh anh xquang trong HPDMV N&m 1977: Teele R.L va Smith E.H sti dung sieu am trong chin doan HPDMV.
Nam 1987: B it dau ap dung ky thuat mo tach cd mon vi bln g noi soi.
2. DjCH T§ HOC
• Ty le mac benh:
Ttf 1% t6i 3% (chi tmh cl nhtfng tre con song khi sinh ra).
• Chung toe:
Gap nhieu d ngtfdi da tr&ng d B&c My va Chau Au, it g&p hdn cl Chau My la tinh va Chau A, hiem gap cl ngtfcli da den.
• Gidi:
€ h u yeu la nam gidi. Ty le nam/ntf dao dong ttf 4/1 den 5/1 va thtfdng g&p cl con d iu long (67%).
• Tuoi mac binh:
Chu y£u d sd sinh, hiem g&p d tre 16n.
• MUa mac b$nh: d ca 4 mtfa.
3. CO CHE BENH SINH
Cho tdi nay co nhieu gia thiet khac nhau: do phi dai cd tien phat. do roi loan sU phoi hdp cd. Theo Belding va Kernohan thi do sU giam cac te bao hach d ldp co vong cua mon vi. con Boley va Miller nhan thay do cac te bao hach do chua trUdng thanh. hoac do giam phan bo cua cac sdi than kinh tan cung d ldp cd cua mon vi.
Nam 1960, Lymn gdi y rang: stia dong co the gay nen phu ne niem mac va ldp dudi niem mac. roi dan den phi dai cd mon vi. Markowitz da neu lai gia thiet rang trong mot so it cac trUdng hdp, loet d mon vi gay kich thi'ch niem mac va gay ra co that d mon vi, hang vi roi tti do gay phi dai cd mdn vi va gay hep.
4. GIAI PHAU BENH LY 4.1. Bai the
- Mdn vi cd hinh dang mot u cd dai > 16mm, dtfdng kinh > 15mm, be day ldp cd mdn vi > 4mm.
- Khoi u ch&c, thanh mac binh thtfdng, ranh gidi ro, khoi u nho d&n ve phia da day va khdng cd ranh gidi ro ret gitia ph&n cd benh ly va ph in cd binh thudng. Ve phia ta trang: khoi u cd ranh gidi ro, dtfdc nhan biet do stf thay doi mau sic: mau long lanh cua u cd mon vi va mau hong nhat cua ta trang hoac bang tlnh mach mon vi d trUdc.
4.2. Vi the
- Ldp thanh mac binh thtfdng.
- Phi dai ldp cd gay hep ong mon vi.
- Niem mac ong mon vi binh thtfdng.
5. TRIEU CHLTNG LAM SANG
5.1. Hep mon vj d tre sd sinh va nhu nhi