PHẪU THUẬT PHACO NHẬP MÔN

A TS NGUYEN HUfU QUOC NGUYEN GS TS TON THI KIM THANH Phau thuot Phoco nhop mon # TS NGUYiN HQU QUOC NGUYEN GS TS TON THj KIM THANH PHAU THUAT PHACO NHAP MON ■ ■ NHA XUAT BAN Y HOC HA NOI - 2004 LOI NOI OAU Hien nay, ky thuat phaco da trd bien phau thuat lay thuy tinh the due dat thuy tinh the nhan tao long bao Tii cac bac si nhan khoa cho den ngiidi dan deu hieu dUdc tmh liu viet cua ky thuat phaco qua cac phiidng tien thong tin nhu td rdi, sach bao, va ttf van cua cac bac si nhan khoa cung nhii truyen mieng tvf ngifdi sang ngtfdi khac V6i ky thuat difdng rach nho tvt 2,5 - mm, khong can khau, it chay mau, thi lUc hoi phuc nhanh, thdi gian liiu lai benh vien ngan tvf tieng den 12 tieng dong ho, ky thuat phaco da noi len dUdc sil vtfdt troi so v6i cac ky thuat khac trvfdc day Toi viet cuon sach chi vdi muc dich la muon cung cap mot so" khai niem va kien thCfc cd ban cua phudng phap phaco den cac bac si nhan khoa m6i vao nghe de lam tU lieu tham khao sd dang ve cac tinh nang ly hoc, cac ky thuat mo, cac thao tac mo, cac cach s i dung thuoc, chat nhay va cac van de lien quan Chac chan ban doc se Wdng ttfdng nhieu dieu m6i la hdn Co nhufng cum tCf Anh ngii chi cac dung cu mo, ky thuat mo, cac chat heu, se dufdc toi giut nguyen van tieng Anh (vi co dich cung khong het y dufdc tham chi' lam toi nghia cau van tieng Viet) Chac chan quyen sach se khong tranh khoi nhiing sai sot Toi xin chan cam dn va don nhan tat ca nhufng ldi gop y cua ban doc Moi chi tiet xin gxli ve theo dia chi: TS.Nguyln Hflu Quoc Nguyen - 60 TrUng Nuf VUdng Da Nang TAC GIA nhutng tl / t ie n g a n h Ng u y e n oi/dc sCrd u n g ■ ■ van Phaco: Chu! viet tac cua Phacoemulsification: Su tan nhuyen thuy tinh the (TTT) Phacotip: dau tip phaco dung de dao ranh va tan nhan Handpiece tip: Tay cam dung de gan dau phacotip I/A tip: Dau rUa hut Cortex: L6p vo TTT ( hay goi la chat nhan) Vac (Vaccum): Luc hut ap luc am U/S tip: Dau tan nhan b&ng nang liidng sieu am (tUdng tU dau phacotip) U/S handpiece: Tay cam tan nhuyen b^ng sieu am (tUdng tU dau handpiecetip) Aspiration orifice: Lo mieng hut cua dau phacotip hoac dau I/A tip Phacoemulsifier: Bo phan tan nhuyen tan nhuyin TTT Handle: Dung cu cam tay Pedal: Ban dap dieu khi; n bang chan Sleeve: Boc nhUa dau phacotip Orifice: Lo hut dau tip Hydroclavage: Tach nhan bang nU6c Hydrodissection: Thuy tach hay tach nhan b&ng nUdc Tach phan thUdng nhan v6i 16p vo thuy tinh the Hydrodelineation: Tach giuta 16p nhan Ooi cting) vdi 16p nhan ngoai(16p thUdng nhan) Hydrodelamination: Tach 16p thUdng nhan vdi 16p nhan Hydrofracture: Tach phan nhan v6i nhan ngoai bang dau Hydrosonic: ket hdp bdm dich CCC: Continuous curvature capsulorhexis -Xe bao hinh tron lien tuc Rhexis: Lo xe bao Sideport: DUdng md tien phong ben phia gid de dUa spatule hoac chopper vao tien phong Spatule: dung cu mo co be mat trdn lang, bang phang Forceps: Kep dung de mo, xe bao Asp (Aspiration): Hut Ampl (Amplitude): Bien Thresh: NgUdng Burst: Pha nhan bang xung sieu am ngan Chopper: Dung cu che nhan TTT Cataract: Thuy tinh the - TTT IOL: Thuy tinh the nhan tao - TTTNT Optic: phan quang hoc cua TTTNT Phaco chop: Ky thuat che nhan TTT Chop and flip: Ky thuat che va bay nhan TTT Stop and chop: Ky thuat diing va che nhan TTT Crack and flip: Ky thuat be va bay nhan TTT Stop, chop, chop and stuff: Ky thuat dufng, che, che va an nhan TTT Step-by-step chop in situ: Ky thuat che nhan TTT tai cho theo tufng bu6c mot Vaccum seal: Hut chat bang chan khong Ky thuat dung dau phacotip vui chat manh nhan de co"dinh manh nhan Contact: num dieu khien Focus: Dieu'chmh tieu cU kinh hien vi p h lu thuat Zoom: Phong to, thu nho phlu trUdng kinh hien vi phiu thuat Sculpting: Dao ranh Removal: Hut nhan va chat nhan khoi mat LjCH Sir PHACO Ba thap ky phat trien Thang 04 nam 1997 la ll ky niem lan t h i 30 “Phaco” ddi, phUdng phap phaco dUdc BS Kelman mo ta dau tien tren Thdi bao Nhan khoa Hoa Ky so thang nam 1967 Trong suot thdi gian do, phUdng phap phaco da co nhufng thay doi dang ke Lich s i phat trien cua phUdng phap dUdc chia thap ky ro ret 1.1 Thap ky thur nhat: (1967 - 1977) goi IA the he ‘Phaco tien ph o n g ” Dau tien, BS Kelman mo ta ky thuat dUa nhan TTT len tien phong va dao ranh, tan nhan thuy tinh the (TTT) t in g manh nho The he phaco dau tien dUa tren nang lifdng la chinh Hut cac manh nhan ddn gian vdi sau tien phong on dinh Dieu se dUdc nh^c d phan cd che bdm hut hoac cai dat che hut Bdi vi “cong viec cua phaco” la tan nhuyen nhan TTT nguyen khoi bang cach s i dung nang lu[...]... chat nhay) Theo Kelman, ky thuat mo ngoai bao bang tay la mot ky thuat hoan chuyen khi dieu kien trong mo° khong cho phep 16 phau thuat vien hoan tat phau thuat bang phiidng phap phaco Ky thuat mo ngoai bao co the manh rieng va la ky thuat di kem de thiic hien phau thuat phaco Tuy nhien, sii tan nhuyen thuy tinh the chiia diidc dung rong rai vao nhiing nam 1980 bdi vi nhieu phau thuat vien chiia hieu diidc... ti le cao cac ca phau thuat co hieu qua ro rang hdn, dac biet la nhiing ket qua tot hdn, nhat la phau thuat diidng rach nho Bay gid cac ban hay tii hoi r in g ban co muon quay lai phau thuat ngoai bao khong? Ban than toi khong biet la mot phau thuat vien da mo thuan thuc ve phaco roi co muon quay lai mo ngoai bao hay khong? Ro rang la ket qua da noi len gia tri cua phau thuat Nhtfng phaco mdi chi la... mot bien chiing trong phau thuat due TTT Bien chiing co the dien ra suot ca thdi gian sau phau thuat Mot dieu hien nhien la, khi hieu qua phau thuat due TTT tang len thi kha nang gap bien chiing la zero Khuynh hudng tien den hieu qua cao hdn khi chung ta nghien ciiu ve phaco Tai sao hau het cac nha nhan khoa bo ra thdi gian va no liic de hoc ve phaco? Tai sao phau thuat vien phaco tang tii 15% 1985... Phau thuat vien ap dung phiidng phap phaco vi nhiing ly do sau: - Sii ra ddi cua TTTNT mem da cho phep phau thuat vien s i dung diidng mo phaco ma khong phai rach rong, day la diem noi bat dau tien - Xe bao cho phep tan nhuyen nhan TTT an toan hdn, ddn gian hdn theo chiidng trinh cai dat san - Cac kieu dung cu va phiidng phap phau thuat cho phep phau thuat vien ap dung nhiing ldi diem noi bat cua phaco. .. phau thuat diidng rach nho That vay, chac chan rang cac p h lu thuat vien se co kinh nghiem va thoa man vdi phau thuat TTT, mang lai cho benh nhan nhiing ket qua chiia tung cd vdi nhiing ky thuat nay 14 NGUYEN LY,7 CAU TAO m VA HOAT ■ DONG • c Cja p h a c o 1 Phaco la gi ? Phaco la mot ky thuat can thiep diidc bac si Charles Kelman gicii thieu vao nhiing nam 1960 Muc tieu cua ong la thiic hien ky thuat. .. nhan cho den khi vien canh cua phau thuat nhan khoa dat diidc nhiing ket qua dang ke vdi phiidng phap cai tien nay Trong suot nhiing nam 70, phiidng phap pho bien nhat la lay thuy tinh the trong bao bang ciic lanh va dieu chinh thi liic bSng kinh gong Phaco lam thay doi moi nguyen tac Triidc het, phaco gidi thieu khai niem ve vi phau thuat (dung kinh hien vi phau thuat) Phau thuat diidc thiic hien qua... g tay (phaco trong long bao vdi ky thuat tach vo nhan) - Diidng mo nho khong khau dan den ket qua tot ve giai ph lu va chiic nang, thdi gian mo ng&n, giam loan thi sau mo Ngay nay, benh nhan ddi hoi phau thuat phai chac chan hdn va phau thuat vien phai x i ky tot hdn de mang lai nhiing ket qua hoan hao vdi ky thuat phaco va diidng mo nhd tii lien, khong gay loan thi Do chi can gay te nen phau thuat. .. thiic hien qua diidng mo nhd Tuy nhien mot so" bien chiing cua phiidng phap nay to ra tram trong hdn nen mot so" phau thuat vien quay lai vdi phau thuat ngoai bao Tuy nhien, phaco la mot trong nhiing ky thuat ldn va diidc nhieu phau thuat vien thiia nhan dan vi no cd nhieu ldi diem hdn han cac ky thuat co dien nhii : - Diidng rach nhd lam vet mo lien nhanh, giam loan thi sau mo, it xep tien phong sau mo,... lo au va giam gia thanh phau thuat Phaco la mot trong nhiing phiidng phap mang lai ket qua cao Tuy nhien, cac phau thuat vien can tich luy kinh Jighiem, PTPCNM 17 phai nam ro cac nguyen ly dong hoc, ky thuat ve ca ly thuyet va thuc hanh Xe bao hinh tron lien tuc (CCC) dong vai tro quan trong trong viec phat trien phaco That vay, xe bao la biidc dau tien de tien den ky thuat phaco trong bao hien nay,... diidc trinh bay trong phan ky thuat phaco trong long bao 2 Cac nguyen tac vat ly hoc cua phacoemulsification De hieu diidc cac hien tUdng dien ra trong qua trinh phacoemulsification, dieu quan trong nhat la cac phau thuat vien phai co kien thiic ve 2 van de cd ban : 1 - Dong hoc dong chay trong he thong kin : ch in g han nhii tien phong 2 - C h ic nang cua cac bo phan phaco 2.1 Dong hoc dong chay Dong