PH U THU T NG M CH C NH Thay i g qua 15 n m?

F. MANTZ Trung tm Y khoa Orangerie STRASBOURG

D. THIBAUD

NGHIN C U SO SNH
T 1/01/1994 n 31/12/1998 T 1/01/2006 n 31/12/2010

631 b nh nhn 705 l t PT AG 401 1 AL 304

624 BN 662 l t PT AG 49 4 AL 613

AG: Gy m ton thn; AL: Gy m c c b

TI N TRI N C A PH GY M

NG PHP

AG: Gy m ton thn; AL: Gy m c c b

CH

NH HI N NAY C A GY M TON THN

Gy m c c b th t b i Yu c u c a BN / tnh tr ng c a BN Shunt l p trnh H p M c nh ti pht??? (21/34)

PHN B

THEO NAM V N

705

t ph u thu t Femme: N

662 Homme: Nam

t ph u thu t

PHN B

THEO TU I V GI I

CC Y U T
HTA traite: t ng HA i u tr DIND: T khng ph thu c insulin DID: T ph thu c insulin Atteinte coronaire: B nh m ch vnh

NGUY C

B NH M CH VNH

TRI U CH NG

CT SCAN NO TR C PH U THU T ( C C N QUANG)

1994 - 1998 13/705 2006 - 2010

2/662

1,84 %

0,3 %

K THU T M

Rimplantation: c m t o hnh m ch c nh TEA simple: bc tch n i m c n gi n TEA+ patch: bc tch n i m c c patch Autres: cc ph ng php khc

PH NG PHP BC TCH N I M C C PATCH (TEA)

K THU T C M T O HNH M CH C NH L N NG C

BC TCH N I M C V I NG KHU N Gi N

K THU T M

Rimplantation: c m t o hnh m ch c nh TEA simple: bc tch n i m c n gi n TEA+ patch: bc tch n i m c c patch Autres: cc ph ng php khc

Ti N TRI N K THU T M THEO KTV

Rimplantation: c m t o hnh m ch c nh TEA simple: bc tch n i m c n gi n TEA+ patch: bc tch n i m c c patch

CC K THU T KHC
1994 1998 8 4 Ghp t nh m ch Gi Dy ch ng M c nh trong. 2006 2010 1 17 1

T O SHUNT M C NH

A GIC WILLIS

CC CH
1994 1998
20 23 35 5

NH
Theo N P t n d < 40 Th t b i v i test k p khc

T SHUNT
2006 - 2010
0 10 47 2

TI N HNH
1994 1998
48
1

T SHUNT
2006 - 2010
7
2

D i gy m ton thn D i gy m c c b

35 (83/705) 11,7

52

T NG C NG

(59/662) 8,9 %

% 18/83 = 21,6 T C NG M CH BN I 11/59 = 18,6

TI H P
1994 1998
22
1/01/1994 et 31/12/1998

2006 - 2010
Ti h p ph u thu t Ti h p xu t hi n v c m trong qua trnh nghin c u: sau TEA simple sau TEA + patch Sau t o hnh m ch c nh 34
1/01/2006 et 31/12/2010

2 % (6/244) 2,6 % (1/38) 0,49 % (2/408)

0 0,9 % (1/109) 0,93 % (5/535)

K T QU : KI M SOT SAU M
1994 - 1998
683 14 5 1 703/705 gestes AVV Ch p m ch Siu m Ch p m ch Ct scan T NG C NG

2006 - 2010
578 0 72 21 671/662 gestes

K T QU
1994 1998 0 3 2 Nhi m trng Thuyn t c M c nh trong khng tri u ch ng ( khng m ) T c M c nh trong c tri u ch ng ( TBMMN) khng m T l ti can thi p T c M c nh trong c tri u ch ng ( TBMMN) m l i mu t vng c H pt nd Bc tch trn shunt 2006 - 2010 0 0 0

09/705 = 1,2 % 2 7 0 0

15/662 = 2,2 % 0 11 3 1

7 t c M c nh sau ph u thu t (1994/1988):

1 ghp t nh m ch 1 TEA + patch 2 Ti ghp ( m t b nh nhn) 3 TEA n gi n

T l t vong
30 ngy

1994 1998
4 (AG) 0 1 TBMMN Nh i mu tt

2006 - 2010
0 1 1

5/705 = 0,7 %

2/662 = 0,3 %

Nh i mu sau ph u thu t
1994 1998
2 (gy m c c b )

2006 - 2010
0

Tai bi n thong qua sau ph u thu t

(< 30 ngy sau ph u thu t)
(vi gi n vi ngy)

1994 1998
12/705

2006 - 2010
6/662

1,7 %

0,9 %

T vong do b nh l TK
1994 1998 4 3 2 (<6 thng) 1,27 % TBMMN v t vong TBMMN khng ti n tri n> 6 thng 2006 - 2010 0 0

TBMMN h i ph c 4 (< 3 thng) 0,60 %

1994 1998

2006 - 2010

1,4 %

T l t vong 30 j (t vong do m i nguyn nhn + TBMMN)

0,9 %

Cc bi n ch ng th n kinh ngo i bin (X, XII) > 30 ngy

1994 1998
7/705

2006 - 2010
7/662

1%

1%

K t lu n :
ph u thu t M c nh hi n t i Gy m c c b lm th ng quy Gy m c c b : h p l ha cc ch nh t shunt Gy m c c b khng gy ra cc bi n ch ng tim m ch nh gy m ton thn ng c l i gip x tr t t cc v n tim m ch ti n ph u K thut t o hnh m ch c nh : khng cn gy t c m ch sau m t 2006-2010 Scanner no+ c n quang= ch inh nh t th i Thi i u tr tch c c n u h p t n d sau ph u thu t: khng x y ra TBMMN khng c t vong do TBMMN trong nghin c u 2006 - 2010