IV. Kết quả phẫu thuật: 1.Tỷ lệ tử vong:
7. Tỷ lệ mổ lại và biến chứng sau phẫu thuật TPHĐR:
7.2. Cỏc biến chứng sau phẫu thuật sửa toàn bộ TPHĐR
Biến chứng chủ yếu sau phẫu thuật sửa toàn bộ TPHĐR là tổn thương đường dẫn truyền phải đặt mỏy tạo nhịp. Tựy theo từng nghiờn cứu mà tỷ lệ
bệnh nhõn phải đặt mỏy tạo nhịp tim sau phẫu thuật dao động từ 1.7-6.9% [3], [10],[12],[23],[44],[71],[79].
Đột tử là một trong những biến chứng đó được ghi nhận sau phẫu thuật sửa toàn bộ TPHĐR. Theo nghiờn cứu của bệnh viện Mayo, đột tử sau phẫu thuật sửa toàn bộ chiếm tỷ lệ tới 73% cỏc trường hợp tử vong muộn sau phẫu thuật. Cỏc yếu tố nguy cơ tiờn lượng đột tử bao gồm tuổi phẫu thuật muộn, loạn nhịp thất xuất hiện trong và sau mổ và tổn thương đường dẫn truyền cần đặt mỏy tạo nhịp sau mổ. Do nghiờn cứu được tiến hành trong những năm của thập kỷ 70 và 80 nờn kết quả nghiờn cứu khụng thể ỏp dụng cho thời điểm hiện tại, tuy nhiờn nguyờn nhõn chớnh yếu liờn quan tới đột tử sau phẫu thuật cú lẽ cú liờn quan chặt chẽ tới loạn nhịp tim sau mổ [67].
Phỏt triển tinh thần và vận động sau phẫu thuật tim bẩm sinh là mối quan tõm đỏng kể của cỏc nghiờn cứu hiện nay. Vấn đề này cú lẽ liờn quan chủ yếu tới việc sử dụng mỏy tim phổi nhõn tạo và cỏc chế độ chạy mỏy tim phổi nhõn tạo. Cỏc bệnh nhõn sau phẫu thuật sửa toàn bộ TPHĐR cũng khụng nằm ngoài sự liờn quan này. Việc theo dừi và nghiờn cứu lõu dài về sự phỏt triển tinh thần, vận động và phỏt triển trớ tuệ sau phẫu thuật là hoàn toàn cần thiết.
V. Kết luận:
Bệnh lý TPHĐR với cỏc thương tổn đa dạng, phức tạp đũi hỏi ỏp dụng nhiều phương phỏp phẫu thuật khỏc nhau và nhiều kỹ thuật sửa chữa riờng biệt nhằm đạt được mục đớch phẫu thuật sửa chữa hai thất. Kết quả phẫu thuật điều trị bệnh lý tim bẩm sinh phức tạp này ngày càng được cải thiện với sự tiến bộ về chẩn đoỏn, gõy mờ và hồi sức sau phẫu thuật. Tuy vậy, đối với những trường hợp phức tạp cú phối hợp nhiều tổn thương giải phẫu khú, kết quả sống cũn sau phẫu thuật và tỷ lệ mổ lại vẫn cũn cần được cải thiện.
Để tiến hành phẫu thuật sửa chữa hai thất tại Việt Nam thành cụng, cần cú sự phối hợp chặt chẽ giữa chẩn đoỏn và phẫu thuật, xỏc định rừ ràng phương
phỏp phẫu thuật tối ưu, cỏc thương tổn phối hợp cần giải quyết trong mổ, trước khi tiến hành điều trị.
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