VIEM TUI MAT CAP & MAN TNH

BS NGUYEN TAN CNG Khoa bo mon Ngoai Tong Quat Benh vien Ch Ray

NHAC LAI

SINH LY & GIAI PHAU

-dch tui mat co ac gap 5-20 lan dch OMC tng ng mat t gan tiet ra 12 gi
-Thanh phan: muoi mat (50%)cholesterol- lecithin- nc- ien giaibilirubin - Ong tui mat 1-8cm

CN AU QUAN MAT

TAM GIAC SMALL (hnh thanh soi tui mat )

Ong tui mat

Song song 20%

Goc nhon 70%

Xoan 10%

TAM GIAC GAN MAT

VIEM TUI MAT

- 95% VTM do soi - 80% n gii - 70% khong trieu chng (barbara) Sau 5 nam 10% co trieu chng (Mc Sherry) Sau 15 nam 18% co trieu chng (Ransohoff) - Soi TM co trieu chng nhng t choi mo (150 BN Thuy ien) Sau 2 nam 27% mo cap cu STM CO TRIEU CHNG CAN PHAI MO STM KHONG TRIEU CHNG KHONG CAN MO (TR BN TIEU NG HOAC BENH VAN TIM CAN PT)

SOI TUI MAT

Phng Tay 10% dan so
75 tuoi N 35% Nam 20% Viet Nam ?

SOI TUI MAT MO TAI BV

C s BV
Viet c

Thi iem
1978-82

Soi TM n thuan/ Soi ng mat

30/597

T le %
5

Hau Giang
TrngVng Tien Giang Bnh Dan Ch Ray

1987-90
1986-90 1988-90 1992-96 1980-89 1993-95

34/267
28/163 50/148 1464/2747 70/709 278/565

12,7
17 33,8 65,4 9,9 49,2

VIEM TUI MAT CAP

la tnh trang viem cap cua TM do tac nghen ong TM Nguyen nhan - 95% do soi tui mat - 5% do nhiem trung (thng han, nhiem trung huyet) tac ong TM (do ung th, x hoa, gap goc ) hep c vong Oddi chan thng Thng ton - VTM sung huyet - VTM mu - VTM hoai t

VIEM TUI MAT CAP

TRIEU CHNG LAM SANG
Giai oan 1 au cn TV + oi Giai oan 2 au HSP lien tuc Sot - tang bach cau e khang thanh bung Giai oan 3 Phan ng thanh bung

Co cng - nhiem doc

Giai oan 4 Thung TM (48-72 gi) VPM khu tru & toan the

TRIEU CHNG LAM SANG

VIEM TUI MAT CAP

CHAN OAN LAM SANG - Tien s au quan mat - Trieu chng nhiem trung - Hiem khi vang da (tr khi b HC Mirizzi) CAN LAM SANG - Bach cau tang - Amylase tang nhe - X quang ngc bung 10-15% thay soi - Sieu am chan oan chnh xac 90-95% STM

VIEM TUI MAT CAP

Sieu am

Thc te sau mo

VIEM TUI MAT CAP

CHAN OAN PHAN BIET 95% lam vi 6 benh
Loet da day ta trang

Benh ong mach vanh

Viem tuy cap Viem ruot tha Viem phan phu

Cn au quan than

BIEN CHNG
Hoai t tui mat
am quanh tui mat Tham mat phuc mac Viem phuc mac mat (thung TM ) Viem phuc mac mat Tham mat phuc mac

Viem ng mat

VIEM TUI MAT CAP

NGUYEN TAC la mot cap cu ngoai khoa tr hoan , BN nen c theo doi tai khoa Ngoai. IEU TR

Noi khoa: Giai oan 1 va 2

- Nhn an & at ong thong mui-da day (tranh kch thch tui mat va tuy) - Truyen dch bang ng tnh mach

- Dung thuoc c che than kinh X (nh Atropin, propantheline) e giam tiet acid, giam co that c vong Oddi va giam co bop cua tui mat
- Theo doi sat sao tnh trang benh nhan, bao gom(1) theo doi cong thc bach cau moi 6 gi, (2) o nhiet o moi 2 gi, (3) kham bung lai moi 2-3 gi bi cung mot thay thuoc hoac nhieu thay thuoc trong cung nhom trc cap cu.

- Khong dung khang sinh v co the lam lu m cac trieu chng khien chan oan dien bien benh kho khan.
- Neu benh nhan qua cn au, cung nen sap xep mo phien. Khoang 25% benh nhan ieu tr noi se dien bien thanh hoai t hay viem phuc mac can phai mo cap cu.

VIEM TUI MAT CAP

NGOAI KHOA Giai oan 3 va 4 Luc nay co the dung KS pho rong bang ng toan than nhat la BN > 70 tuoi, BN co tieu ng, vang da NOI DUNG MO Thng la mo bung, neu PTV co kinh nghiem co the mo noi soi. 1. BN gia yeu, suy kiet nang, en muon, nhiem oc nang, co benh kem (tieu ng, lao phoi, benh tim mach) va neu tui mat khong viem nang lam th ta ch dan lu tui mat 2. BN tre, the trang tot, mo < 72 gi va TM viem nang (mng mu hay hoai t) th nen cat tui mat

Carrey: t vong do m thong tui mat cao gap 5-10 lan t vong do cat bo tui mat (v benh nhan nang hn)

IEU TR PHAU THUAT

IEU TR PHAU THUAT

IEU TR PHAU THUAT

CAT TUI MAT NOI SOI - Mouret (Lyon- Phap) khi au 3/1987 - Dubois Perissat hoan thien - Reddick Olsen (My) 1988 A Chau 1990 Nhat, Hong Kong, Singapore 1992 Viet Nam (BVCR)

CAT TUI MAT NOI SOI

Thap nien 1960

Ngay nay

CAT TUI MAT NOI SOI

Phau tch vung co TM

Cat TM khoi ging TM

CAT TUI MAT NOI SOI

Lay TM ra qua lo trocar 10mm

IEU TR PHAU THUAT

TIEN LUNG TRC MAT Tot neu cha nhiem trung toan than - Mo cap cu bien chng 20%, t vong 5% - Mo chng trnh bien chng 6%, t vong 0,5% LAU DAI Co the tai phat neu khong cat TM

VIEM TUI MAT MAN TNH

Thng gap hn viem tui mat cap TRIEU CHNG -Cn au quan mat la trieu chng thng gap nhat, xuat hien sau ba an, thng keo dai vai phut, hiem khi au qua 2 gi - Dau Murphy (+) Neu khong co chong ch nh phau thuat th cac benh nhan nay nen c mo phien e cat tui mat, v soi ket co tui mat tai dien nhieu lan se gay x hoa va teo tui mat. BIEN CHNG Viem tuy cap do soi TM t gap, t le thng di 1% so BN co soi tui mat Ro tui mat-ta trang: co the gay tac ruot do soi tui mat qua lo ro ri xuong ruot non.

VIEM TUI MAT MAN TNH

IEU TR ieu tr noi - Giam thieu thc an beo - Dung thuoc c che pho giao cam - An kieng e giam can - Dung acid mat ngoai sinh: CDCA va UDCA - Tan soi ngoai c the - Lam tan soi va lay soi qua da - Lay soi qua noi soi

VIEM TUI MAT MAN TNH

ieu tr phau thuat
Mo cat tui mat kinh ien
Trc 1987, la phng cach ieu tr triet e duy nhat

Mo cat Mo cat tui mat noi soi

- Ngay cang ap dung nhieu hn - My (1993) tren 80% benh nhan STM c cat TM qua noi soi - Tai mot so benh vien TP HCM, t le mo cat TM noi soi cung len en 8090%. -Bien chng cua cat tui mat noi soi la t 1-4% t vong t 0,1-0,3% thi gian nam vien t 1-3 ngay thi gian tr lai lam viec bnh thng la t 5,2 en 10 ngay.