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Phẫu thuật bắc cầu dạ dày bằng nội soi để điều trị tắc nghẽn lối ra dạ dày có liên quan đến hồi phục nhanh hơn, suôn sẻ hơn và thời gian nằm viện ngắn hơn so với phẫu thuật mở
Tóm tắt
Phẫu thuật bắc cầu dạ dày bằng nội soi nhằm giảm triệu chứng tắc nghẽn lối ra dạ dày (GOO) cho thấy có khả thi và an toàn. Tuy nhiên, dữ liệu so sánh để xác nhận lợi ích của phương pháp nội soi vẫn còn thiếu. Giữa năm 1998 và 2003, 26 bệnh nhân đã trải qua 15 phẫu thuật gastrojejunostomy bằng nội soi (bác sĩ A) và 12 phẫu thuật mở (bác sĩ B) cho tình trạng GOO. Chỉ định phẫu thuật bao gồm các bệnh lý ác tính (n = 17) và lành tính (n = 10). Không có chuyển đổi sang phẫu thuật mở trong nhóm nội soi, và không có tỷ lệ tử vong phẫu thuật xảy ra trong cả hai nhóm. Hai nhóm có sự tương đương về tuổi tác, giới tính, điểm số của Hiệp hội Gây mê Hoa Kỳ (ASA), tần suất phẫu thuật bụng trước đó và bệnh ác tính hoặc lành tính, cũng như loại hình gastrojejunostomy được tiến hành. Không có sự khác biệt giữa nhóm nội soi và nhóm mở về thời gian phẫu thuật (trung vị, 90 so với 111 phút; P = 0,113), và bệnh nhân nhận truyền máu trong phẫu thuật. Tuy nhiên, phẫu thuật nội soi có liên quan đến thời gian truyền dịch tĩnh mạch sau phẫu thuật ngắn hơn đáng kể (60 so với 234 giờ; P = 0,001), giảm đau bằng opiate (49 so với 128 giờ; P = 0,025) và thời gian nằm viện (3 so với 15 ngày; P = 0,005). Biến chứng phẫu thuật xảy ra thường xuyên hơn sau phẫu thuật mở (33% so với 13%; P = 0,219). Phẫu thuật gastrojejunostomy bằng nội soi để điều trị GOO có liên quan đến quá trình hồi phục sau phẫu thuật suôn sẻ và nhanh chóng hơn cũng như thời gian nằm viện ngắn hơn so với phẫu thuật mở. Trong tay các bác sĩ có kinh nghiệm, phương pháp nội soi cho gastrojejunostomy nên trở thành tiêu chuẩn vàng mới.
Từ khóa
#phẫu thuật bắc cầu dạ dày #tắc nghẽn lối ra dạ dày #phẫu thuật nội soi #phẫu thuật mở #hồi phục sau phẫu thuậtTài liệu tham khảo
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