Tao hinh thay the thtfc quan bang cac ky thuat sau:
- Bang dai trang ngang biet lap: Dai trang dUa len theo dtfdng dtfdi da ngoai xUdng tic (hien nay rat it lam), theo dtfdng sau xtfdng tic roi noi mot diu vdi thtfc quan d cd con mot dau noi vdi mat trUdc da day, hoac theo dtfdng qua trung that. DUa dai trang qua trung that la sinh ly nhat nhUng ky thuat md phtic tap hdn.
- Bang mot quai hoi - dai trang biet lap.
- Bang mot quai hoi trang co cuo'ng mach va noi mach vi phiu.
- Bang bd cong ldn cua da day (ky thuat Graviliu).
- Bang dUa da day len ngtfc: ky thuat nay khong thtfc hien d tre em.
11. SAU MO
ThUdng rut noi khi quan sdm khi benh nhan da ttf thd. De ong noi khi quan lau la dieu kien thuan ldi tang nguy cd benh mem sun khi quan. Hut cac cha't xuat tie't d mieng-hong.
Tu the benh nhan v ln nen d tu the diu cao de tranh nguy cd trao ngtfdc tti da day len.
Nuoi dtfdng: bang dtfdng tinh mach trong 1-3 ngay diu.
Bdm stia qua sonde da day de nuoi dtfdng bat diu tti ngay thti 1, 2 sau md vdi so' ltfdng tang din.
Khang sinh: dung khang sinh loai Cephalosporin the he 3.
Theo doi than nhiet, sti dung long a'p neu co.
Co md thong da day khong ?
Mot so' tac gia chu trtfdng md thong da day mot cach he thong de dtfa sonde xuong hong trang cho an.
Mot so' tac gia khac lai chu trtfdng khong md thong da day ma chi dat ong thong qua mui, mieng no'i thtfc quan vao da day de cho an.
Chung toi tha'y md thong da day cung co nhting bien chting cua no va dat ong thong qua mui, mieng noi vao da day de bdm stia nuoi dtfdng la bien phap ddn gian nhtfng hieu qua va khong bien chting, nen dtfdc ap dung.
12. b i£'n chltng s a u m o m q t t h i
Noi thtic quan va cit-khau dtfdng rd.
12.1. Bien chtimg sdm
- Thdng khf k£m gfiy xep phoi, dieu tri bang thd may.
- Viem phoi: difsu tri bing khang sinh.
- Ro mieng no'i: thtfdng xay ra sau mo 5-8 ngay. Bieu hien bang dau hieu ho hap va nhiem khuan. Chup can quang thuc quan xac dinh dtfdng ro.
Neu ro nho, dat sonde qua mieng no'i thtfc quan de hut. dat lai dan ltfu ngtfc de hut lien tuc, md thong da day cho an, hut chat xuat tiet d mieng. hong. Ket qua dieu tri thtfdng tot, het ro nhtfng co nguy cd bi tai phat lai ro khi thtfc quan va hep mieng noi.
Neu buc mieng noi, mo lai de dong kin dau dtfdi thtfc quan va dtfa dau tren thtfc quan ra da d co. Md thong da day de nuoi dtfdng. Thi mo sau tao hinh thtfc quan.
12.2. Bien chumg muon 12.2.1. Hep mieng noi
Trtfdc het soi, nong mieng noi, neu khong ket qua thi mo lai de cat cho hep va noi lai thtfc quan.
12.2.2. Luong trao nguqtc da day - thuc quan: cung co the xay ra sdm.
Nguyen nhan cd the do lam thtfdng ton day than kinh phe vi trong md hoac cd the do phiu tich keo doan thtfc quan phia dtfdi len no'i vdi thtfc quan d iu tren.
Thtfdng xay ra sau md the benh teo thtfc quan m& khoang cach giiia hai diu thtfc quan xa nhau va cd ro diu dtfdi thtfc quan vdi khi quan.
• Chan doan: bang chup thtfc quan - da day, sieu am, soi thtfc quan v& do do pH d dich trao ngtfdc len thtfc quan.
• Dieu tri: trtfdc het la dieu tri noi khoa bang ttf the sau an, thuoc giam tiet acid d dich da day, thuoc bang boc bao ve niem mac thtfc quan va thuoc giam nguy cd trao ngtfdc.
Cac thuoc thtfdng dtfdc dung nhtf: Motilium, Prepulsit, Gaviscon, Phosphalugen ...
Motilium cd tac dung gay tang co that d vung thtfc quan tam vi va md rong cd mon vi, tang co bop vung hang vi da day de day thtfc an trong da day xuong ta trang.
Gaviscon vao trong da day thi tan ra va noi len tren be mat cua dich da day.
Khi dich da day trao ngtfdc len thtfc quan thi Gaviscon len theo va trang-boc niem mac thtfc quan nen bao ve dtfdc niem mac tranh lo6t.
• Chi dinh dieu tri ngoai khoa khi:
- Dieu tri noi khong ket qua.
- Viem thtfc quan lien tuc ton tai, nguy cd cao gay h§p mieng noi.
- Cd benh mem sun khi quan phoi hdp.
Md de tao van eho'ng trao ngtfdc da day- th^c quan. T$o van theo ky thu$t Nissen hoac Tupper hoac Thai.
12.2.3. MSm sun khi quan
Bieu hien bang xep vong sun khi quan d thi thd ra. Hay gap khi teo thtfc quan co ro khf thtfc quan va rat hiem gap khi teo thtfc quan khong co ro khi thtfc- quan.
Nguyen nhan gay benh co the do stf chen ep bdi tui cung tren thtfc quan dan to, do ro dich da day qua lo ro, do lo ro lam gian doan ldp xd chun d thanh thtfc quan. Sun khi quan mem thtfdng khu tru.
12.2.4. Rd khi - thi/c quan t4i phat
Ro khi - thtfc quan tai phat sau md it gap. Nguyen nhan do nhilm trung ngay cho mieng noi va cho khi quan dtfdc khau.
Benh bieu hien bang da'u hieu viem phoi lien tuc, co the co ho, sac khi bu.
C hin doan bang soi thtfc quan, soi va chup khi phe quan can quang. Dieu tri bang phiu thuat.
13. TIEN LlfONG
Phu thuoc vao can nang, mtfc do viem phoi, cac di tat khac phoi hdp va mtfc do nang nhe cua di tat. Theo mot thong ke thi:
- Neu can nang > 2500g, khong viem phoi, khong di tat phoi hdp, cl the benh co the noi thtfc quan ngay dtfdc thi ty le song sau md dat tdi 90%.
- Neu can nang ttf 2000g - 2500g, viem phoi nhe, co di tat nhe phoi hdp thi ty le song sau md vao khoang 70%.
- Neu can n$ng < 2000g, co di tat nang kem viem phoi nang thi ty le song sau md chi dat khoang 20%.
TAI LIEU THAM KHAO
1. T ra n Ngoc Bich. Teo thtfc quan va da di tat.
Hoi thao khoa hoc “Sang loc va chin doan trtfdc sinh”.
Trtfdng Dai hoc Y Ha Noi-Benh vien Phu San Ttf Du Thanh pho Ho Chi Minh. Ha Noi 4/2004.
2. Nguyen Thanh Cong, Tran Ngoc Bich, Nguyin Thanh Liem. Ket qua dieu tri teo thtfc quan tai Vien Nhi Ha Noi 1997- 1999.
Nhi khoa (Ky yeu cong trinh nghien ctfu khoa hoc) n&m 2000, tr 532 - 537.
3. Bargy. F. Atr6sie de l'oesophage.
Chirungie digestive de l'enfant. Doin 6diteurs, 1990. p 117 -134.
4. Bettex M, Kuffer F. Sharli. Atr6sie de l'oesophage.
Precis de chirurgie infantile.
Masson 1978, p 87 - 91
5. Carroll M. Harmon, Arnold G Coran.: Congenital Anomalies of the Esophagus,.
Pediatric surgery - 5 th ed/edited by James A-O’ Neill, Jr...
Mosby- Years book, In C, 1998, p 941 - 967.
6. Jaubert de Beaujeu.M.: Atresie de l’oesophage Techniques de chirurgie pediatrique
Masson, 1978, p 176-186
7. Sellier. N., Kalifa G. Bennet. J: Exploration radiologique et chirurgie digestive le l'enfant.
Chirurgie digestive de l'enfant. Doin editeurs, 1990. p 3 - 18.