bdng noi soi de khong co trieu chung. Theo chung toi: Neu benh nhdn d do tudi trdn 50, polyp Idn hon 10 mm, polip don doc, khbng co cu6ng, nghdo am thi c6 nguy co cao bi thoai h6a dc tinh. Cdc polyp nho ndn theo dinh ky bdng sidu dm; cdc polyp gdy con dau qudn nguc mdt vd khdng c6 soi kdm theo, gdy khb xu tri cho bdc sy Idm sang nhung neu th iy thuoc tin chdc con dau Id do polyp thi nhung bdnh nhdn ndy se chi djnh m6 cdt tui mdt. NhQng polyp Idn, don ddc hay c6 ph6i hop vdi soi thi c in phai theo d6i nghiem ngdt. Cdt tui mdt phbng ngua trong polyp tui mdt chi duoc thuc hidn khi polyp Idn hon 10mm.

k £t lu a nPolyp tui mdt thudng it bien d6i theo thdi gian.

Nhung polyp Idn thudng dc tinh; C in theo dbi djnh ky cdc polyp nho.N^u polyp khbng Idn nhung gdy nhung con dau qudn gan thi cb chi dmh can thidp phdu thudt. M6 noi soi cdt tui mdt trong trudna hop polyp cb chi dinh m6 Id phdu thudt thich hop nhat.

TAI LIEU THAM KHAO1. Nguyen Tang Mien "Cat tui mdt npi soi dieu trj

Polyp tui mdt", So ddc biet chuyen de ngoai tong quat Y hpc Thanh pho Ho Chi Minh, Hpi nghj Ngoai khoa va phau thudt npi soi toan Quoc nam 2008.

2. Chattopadhyay D, Lochan R, Balubury S, et al(2005). Outcome of gall bladder polypoidal lasions detected by transabdominal ultrasound sacnning a nine year experience, Worl J.Gastroenterol, 14;11 (14): 2171-3.

3. Kar M, Bhattacharyya U, Laha RN, et al (2003)

Haemobilia due to a lasge gall bladder polyp inMed, Assoc 101(9) 554-5 PMID 15168995

4 Khomeriki SG. Orlova luN, II Chenko A et al(2004) Quantitative analysis of morp' Kjical manifestatins of cholesterolosis and co tant pathology of the gall bladder Arkh Pato 15). 12-5 PMID 15575378.

5. Kim DH, Kim SR, Song SY, et al (2003) A Large sibrous polyp of the gall bladder m im ic k im g a polypoid carcinoma J. Gastroenterol, 38(10)1009-12

6. Mainprize KS, Gould SW, Gillbert JM (2000): Sergical manaherment of polypoid lesions of the gall bladder Br.J.Surg, 87(4);414-7.

7. Noton J. Greenberger,Gustave Paumgarlen(2005). Diseases of the gall bladder and bile ducts in Harrion's Principles of intern Med, 16 Edit, Vol.II.1880- 1891

8. Paslawski M, Krupski W, Zlomeniec J (2004); The Value of Ultransound harmonic imaging in the dianosis of the gall bladder cholesterol polyps. Ann Univ. Mariae Curie Sklodowska 59(2): 293-7. PMID 16146095.

9. Persley KM (2005): gall bladder polyps. Curr. Treat. Options Gastroenterol, 8(2): 105-108

10. Terzi C, Sokmen S, Seckin S, (2000),Polupoid lesion of the gall bladder : Report of 100 cases with special raference to operative indications, Surgery,127(6):622-7.

11. Wolpers C (1989), gall bladder polyps and gall bladder stones. Dtsch Med. Wochenscher; 114(49); 1905-12.

NHAN XET KET QUA UffiG DUNG PHAU THUAT NOI SOI TRONG DIEU TRj VIEM PHUC MAC RUOT THflfA TAI KHOA NGOAI BENH VIEN BACH MAI

TOM TATDat vin d i: Vidm phuc mac mdt thira l i mdt b iin

chung n ing cua vidm mdt thira c ip . P h iu th u it ndi soi d iiu tri vidm phuc mac mdt thira dd duxyc ung dung kh i phd b iin , tuy vdy v in c in tiip tuc d inh g iiv i tinh an toan va hidu qui. Doi tinmg, phirong phip: 64 bdnh nh in vidm phuc mac mdt thira, duxyc ph iu th u it ndi soi t$i Bdnh vidn tir th ing 1 n im 2010 d in th ing 1 n im 2013. Nghidn ciru hdi ciru md t i c it ngang. K it qui: Ty Id chuyin md l i 11,9%, thdn gian m6 tmng binh 75,4 ± 27,5 phut, thdi gian cd tmng tien tmng binh 45,3 ± 20,4 gib, ty id b iin chimg chung l i 18,92 % (tic mdt s&m, ip xe tdn dir, nhidm khuin chin trocar lin luxyt l i 2,7%; 2,7%; 13,52%). Thai gian n im vi$n sau md tmng binh l i 6,5 ± 1,3 ngiy. K it lu$n: P hiu th u it ndi soi trong d iiu tri vidm phuc mac mdt thira an to in, hidu qui.

Tir khda: Vidm phuc mac mdt thira. P h iu thu it ndi soi.

SUMMARYBackground: Appendicular peritonitis is a serious

complication o f appendicitis. Laparoscopic procedure had been applied routinely, but it is still in need to

TRAN HUTU VINH va CS

measure the efficiency and safety o f laparoscopic surgery in treating appendicular peritonitis. Patients and methods: Retrospective, from 1-2010 to 1-2013 at hospital, 64 cases of appendular peritonitis have been treated by laparoscopic approach. Results: Conversion rate was 11.9%. Mean operative time was 75.4 ± 27.5 minutes, mean time of flatus passage was 45.3 ± 20.4 hours. Overall complication rate was 18.92% (trocar site infection, postoperative intra-abdominal abscess and early intestinal obstmction were 13.52%, 2 7% and 2.7% respectively). Mean hospital stay was 6.5 ± 1.3 days. Conclusion: Laparoscopic surgery is safe and efficient option in appendicular peritonitis

Keywords: Appendicular peritonitis Laparoscopic.

DAT VAN 0£Viem phuc mac rubt thCra (VPMRT) Id bi£n chung

ndng, hay gdp cua vidm rubt thira c£p Nguydn nhdn do viem rubt thira c ip khbng duac ch in dodn vd xu tri kip thdi, vd mu vdo 6 bgng gdy vidm phuc mac vd d in den nhidm dbc todn thdn ndng thdm chi ddn d&n tu vong.

70 Y HOC THUC HANH (905) - SO 2/2014

VPMRT Id mdt thd vifem phuc mgc thu phdt, nen nguyfen t ic didu tri Id phiu thudt cdng sdm cdng tot Phiu thudt nhdm muc dich cdt rudt thua (giai quyet nguyfen nhdn), rua vd ddn luu d bung. Trong vdi thdp mfen trcr Igi ddy vdi su- phdt tridn mgnh me cua phdu thudt ndi soi, phiu thudt nOi soi didu tri vifem phiic mac ruOt thua dd duac dp dung. Nhd nhung uu vifet cua n6 so vdi m6 md: bfenh nhdn it dau sau m6, giam ddng kd nhidm khuin vdt md, giam ngdy ndm diiu tri sau md, hifeu qud cua phdu thudt ndi soi didu tri viem phuc mac rudt thua dang d in duac khdng dinh.

Od cd nhidu bdo cdo cho thay khdng c6 su khdc bifet vd ty Ife tai bidn, bidn chung sau m6 giua mo ndi soi vd m6 md. Gdp phin nho nghifen cuu de khdng dinh tinh an todn vd hifeu qua cua phdu thudt nfei soi trong didu tri vifem phuc mac rudt thua chung tdi tien hdnh nghien cuu dd tdi ndy vdi muc tieu: Dinh g ii ket qu i ung dung ph§u thuit ndi soi trong diSu tri c ic taring hop VPMRT tgi khoa Ngoai b$nh vien Bach Mai.

DQl TU’Q’NG VA PHU’O’NG PHAP NGHIEN CUHJ1. Odi tu’ang nghien cuu: Gom 64 bfenh nhdn

(BN), trong dd nam Id 37 BN (57,8%), nu Id 27 BN (42,2%) vdi tudi trung binh Id 36,7±19,6 (11-89). Duac chin dodn Id VPMRT vd dd duac dp dung phiu thudt ndi soi. Thdi gian tu thdng 1 ndm 2010 ddn thdng 1 ndm 2013. Loai tru cdc trudng hap cd chi dinh mo md ngay tu dau. Nhung BN chong chi dinh vdi gdy mfe noi khi quan vd cd bam hai o bung.

2. Phuang phdp nghien cuu: Hoi cuu, md ta cdt ngang. Ghi nhdn ddc diem Idm sdng cua VPMRT, gid trj cua n$i soi trong chin doan VPMRT. Ddnh gid ket qud phdu thudt.

3. Ky thudt md: Bfenh nhdn duac gdy me noi khi quan, 1 trocar 10mm duac ddt a canh dudi r6n Idm cdng camera, 1 trocar 10mm man sudn trdi, 1 trocar 5mm hg vi. Kidm tra ddnh gid ton thuang o bung, rudt thua, cdt rudt thua (kep goc ruot thua bdng hemolock hodc khdu). Rua 6 bung bdng nude muoi sinh ly im , cd thd pha bethadine loang Idm tdng hifeu qua tudi rua. Tuy tinh trang o bung cd thd ddt mot, hai hodc ba ddn luu.Thudc khdng sinh duac dung trudc md, trong vd sau md thudng duac dung khoang 5-7 ngdy sau md, phdi hap 2 khdng sinh Sulperazon vd Dalacin C. Giam dau sau md thudng dung Morphin kdt hap paracetamol.

k £t q u a1. B$c d iim Idm sang1.1. Thdi gian birthBdng 1: Thdi gian bfenh (tu khi dau bung tdi khi

duac md)Th6i qian S6 bfenh nhdn Ty Ife %s 24 gid 12 18,75

>24 - 72 aid 37 57,82>72 qid 15 23,43T6nq 64 100

Nhdn xfet: Thdi gian bfenh trong khoang 24-72 gid chiim nhiiu nh it (57,82%). Thdi gian bfenh trung binh cua nhdm nghifen cuu Id 45,7 ± 25,5 gid.

1.2. Cic tri$u chimg lim sing: (Bang 2)

Trifeu chimci lam sang So bfenh nhan Ty Ife %Dau viinq ho chau phai 61 95,3

Sot 59 92,1Bi trunq dai tifen 55 85,9Non, buon non 31 48,4

Phan irnq niia bunq phai 59 92,1Cam imq phuc mac bung 16 25,0

Tham tryc trdnq dau 48 75,0Bach cdu tang 57 89,0

Sifeu Sm 6 bung c6 dich 48_ i. . . . 75,0

phan ung nua bung phai la nhung trifeu chung chinh Ian luot chiem ty Ife Id 95,3%, 92,1%, 85,9% va 92,1%

2. Kfet qua phdu thuat2.1. Phuryng phip phau thuat: Cdt RT noi soi

trong o bung: 51 TH (79,6%). Cdt RT ngoai o bung: 5 TH (7,8%). Rua o bung - d in luu: 58 TH (90,6%). Ty Ife chuyen md md: 12,5% (trong sd 8 trudng hap chuyen md md cd 1 trudng hap do tai bien thung rudt non, 3 TH hoai tu gdc ruot thua, 4 trudng hap cdn lai do cdc quai ruot chudng).

2.2. Th&i gian phau thuat

Thdyi gian phau thuat (phut) S6 bfenh nhan Ty Ife %< 60 4 7,15

60-120 48 85,70> 120 4 7,15Tong----. . . . j- 56 100

phut, trong dd thdi gian md tu 60-120 phut chiem 85,7%.

2.3. Th&i gian trung tien: (Bang 4)Thdi gian c6 trung tifen So bfenh nhan Ty Ife %

s 24 gicr 5 8,92>24 - 48 gidr 29 51,58>48 - 72 gib1 22 39,30

Tong 56 100Nhan xfet: Thdi gian cd trung tifen trung binh

43,5±22,4 aid.2.4. Bien chung s&m sau mo cua 56 BN phau

Bien chi/ng sdm sau mo So bfenh nhan (56) Ty Ife %Nhifem khuan chan trocar 5 8,9

Ap xe ton dLf 2 3,57Tdc ruot sdm sau mo 2 3,57

Tong 9 16,06%Nhan xfet: Cd 2 trudng hap bien chung dp xe du

vd ro tifeu hoa lam keo ddi thdi gian ndm didu trj, 5 trudng hap nhifem khuan chdn trocar (Id rdn) duac hudng ddn thay bdng tai nhd. 2 TH tdc rudt sau md vao ngay thu 5 vd 7 duac md md ga dinh, lau rua d bung vi rat nhieu gia mac.

Thdi gian nim vifen sau mo So bfenh nhan Ty Ife %< 5 ngdy 3 5,355-7 ngdy 48 85,7> 7 ngay 5 8,95

Tong 56 100

la 6,5 ± 1,3 ngay.

Y HOC THUC HANH (905) - SO 2/2014 71

3. K it qua chung: Ty lb tot 46 BN (82,14%), trung binh 6 BN (10,71), x iu 4 BN (7,15%).

BAN LUAN1. Trieu chirng lam sbng: Viem phuc mac ruot

thua la mot bien chu’ng nguy hiem cua viem ruot thua cip, tuy nhien vide chan dobn v in gap mot so khb khbn do diin biin benh khb ludng, ISm sbng khbng diin hinh, d i nhim vbi cbc bbnh khbc. Trong ngnibn cuu cb 8 trudng hp,p tu khi xu it hibn trieu chu’ng tbi khi phiu thu^t trong vbng 24 gib rubt thua da vb (12,5%). Cung cb nhiiu tru’bng hop tu khi xu it hibn tribu chu’ng tbi khi vbo vibn Id ngdy thu 3 cua benh nhung tribu chu’ng Ibm sdng khbng d iin hinh (12 BN), bbnh nhbn vdo vibn vbi chan dobn s it chu’a rb nguyen nhbn hobc nhiim khuin nhiim dbc bn uing (7 BN). Vi vby, khi dung trubc mbt trubng hop benh nhbn dau bung luon phai nghi tbi viem rubt thua c ip d i trbnh bb sbt t in thuong. Trong nhbm nghibn cuu ghi nhbn: ty le BN dau hb chbu phai chiim 95,3%, dau bung khdi d iu cb th i xu it hibn canh rbn hobc vung thu&ng vj sau khu tru ta HCP, tinh ch it dau khi thi dpt ngdt khi thi dau bm i, libn tyc vb tbng din. Mbt s i trubng hpp biiu hibn dau giam di sau vbi gib dau tbng trb lai vb xu it hien nhung tribu chung cua bbnh canh VPM tobn th i, hobc cb phan ung nua byng phai. Cbc tbc gia cung ghi nhbn tribu chung dau lb thubng gbp nhit. Ty lb nby cua Nguybn Cubng Thjnh ghi nhbn lb 96,3%.

- Hbi chung nhiim trung: trong nhbm nghibn cuu ghi nhbn 92,1% BN cb s it cao, 89% cb chi s i bach cau tbng cao. Muc db nhibm trung nhiim dbc phy thubc vbo th i VPMRT, phu thubc vbo th i trang cua BN. Ty lb nby cua nghibn cuu khbng cb su khac bibt so vbi k it qua cua cac tbc gia. Theo Nguyin Cubng Thjnh ghi nhbn ty lb nby tuo’ng ung lb 93,8% vb 90,1%.

- Tribu chung thuc th i thubng gbp nh it lb phan ung vung h i chbu phai. Trong nhbm nghibn cuu ghi nhan ty lb nby lb 92,1% so vb-i k it qua dup’c ghi nhbn cua Nguyin Cubng Thjnh lb 93,8%, vb cbc tbc gia khbc khbng th iy cb su khbc biet.

- Cbc xbt nghibn cbn Ibm sbng: Sibu bm lb phupng phubp chin dobn hinh anh d i thuc hibn nhat vb cb ty lb dp chuin vb do chinh xbc cao. Ty le BN cb djch trong i bung vbi cbc muc do khbc nhau chiim 75% tren k it qua sieu am. Cbc tbc gia cung nghi nhbn sibu bm cb djch trong i bung lb d iu hibu cb gib trj trong chin dobn VPMRT, va cac tbc gia khuyen ring trong cbc truang hpp cbn nghi ngd thi nbn khbm Ibm sbng vb sieu bm nhiiu Ian d i so sbnh, khi cbc tribu chung Ibm sbng vb djch trong o bgng qua sibu bm tbng hon so vdi trubc thi nbn mo.

2. D iiu trj ph lu thuat ndi soi: D iiu tri vibm phuc mac rudt thua du tiin hbnh phiu thubt ndi soi hay m i mb’ thi nhibm vy ca ban v in lb c it rudt thua (giai quyit nguybn nhbn), rua vb d in luu o byng. Cung giing nhu cbt rudt thua trong cbc trubng hap vibm rudt thua c ip chua cb b iin chung, chung tdi thudng d6t c im mbu mge treo rudt thua bing dao d it dibn dan cuc. G ic rudt thua duac kep bbng hemolock,

nhung trudng hap g ic rudt thua to chung g ic bbng moi chi Roeder Nhung truang K ; goc ruot thua bj hogi tu chung tdi t iin hbnh khbu vui Co 3 TH khbu ndi soi th it bgi chung tdi phai mo mb' vb dbt d in luu manh trbng qua g ic rudt thua

Vibe quan trpng nh it trong phiu thudt dieu trj viem phuc mge rudt thua lb rua sach dien mu trong i bung, dby lb cdng vibe ddi hdi ky nbng vb kinh nghibm phiu thubt. Vi trong tinh trang vibm phuc mac, cbc quai rudt non phu n i chudng hai vb djch, Ibm han ch i trudng m i, d ing thdi r i t d i gby tin thuang cbc tgng trong i byng khi thao tbc. Cf dbv chung tdi dung nude m uii sinh ly im tudi rua i bung, cd th i pha thbm bethadine lobng vbo nude muii d i tbng hibu qua Ibm sach i bung D iiu quan trpng khi rua lb phai bdc Id duac cbc vi tri cd nguy ca dong djch mu, dbc bibt trong nhung trudng hap b$nh nhbn d in mudn, cbc quai rudt db cd xu hudng dinh vbo nhau. Trong nhung trudng hap nby c in th iit phai tbch tung quai rudt ra. Khdng nbn c i liy h it gib mge trong nhung trudng hap bbm ch ic do cd nguy ca chay mbu, t in thuana rudt. Vibe tudi rua duac tiin hbnh tung vung cua i byng tdi khi djch rua trong la duac. Cd tbc gia cho ring khdng nbn rua qub nhiiu nude vb khdng rua ra xa vung rudt thua niu khdng th iy djch mu vi sa djch mu se Ian ra nhQng vung khdng cd t in thuang. Theo quan d iim chung tdi tiin hbnh rua i byng rdng rbi bdc Id h it cbc vj tri cd th i dpng djch, djch rua se duac d in luu h it khi bbnh nhbn ngii dby, tbp vbn ddng. Trong thuc t i chung tdi th iy ring kha nbng vb hibu qua cua vibe tudi rua i bung qua npi soi cdn cao han so vdi m i md. Diiu nby duac nhiiu tbc gia d ing thubn han. V in d i d$t d in luu sau m i: cdn cd nhung y k iin cho ring khdng c in th iit vi dby lb dj vat gby chay mbu vb dinh sau m i. Chung tdi cung quan d iim vdn nhiiu tbc gib khbc lb dbt d in luu cho t i t cb cbc trudng hap sau khi tudi rua i byng vb rut khi BN cd nhu ddng rudt vb khdng chay djch. Theo ghi nhbn cua cbc tbc aia: trong VPM cd su m it cbn bbng giOa t i i t djch vb hap thu djch cua lb phuc mac, qub trinh t i i t djch tbng trong khi qub trinh h ip thu djch giam.

Trong nghibn clpu ty lb chuyin m i md lb 8 BN (12,5%), tuy nhibn phai hieu rbng chuyin m i md khdng phai lb th it bai cua phbu thubt. T it cb 8 trudng hap chuyin m i md d iu khdi b£nh vb ra vibn, do s i luang it nbn chung tdi khdng cd so sbnh thing ketrona nghien cuu nby. Chuyin m i ma d dby chi lb thay doi ebeh thuc phbu thubt vi n iu c i Ibm qua ndi soi se kbo dbi cudc m i vb nguy ca xay ra tai biln. Ty lb chuyin m i md r i t khbc nhau tuy tung nghibn cuu: Wullstein C. (2001) cd ty lb chuyin m i ma lb 59/776 (7,6%); Lin H. (2006) lb 8,79%; cua Andreas K.(2006) lb 4,8%.

Cbc b iin chung sau m i hay dugrc nhbc d in lb bp xe t in du sau m i, tg djch sau m6 , nhiim khuin v it m i, it gbp han lb rd manh trbng, tbc rudt sdm. H iu h it cbc tbc gia nh it tri cho ring m i ndi soi Ibm gibm dbng k i ty lb nhibm khuin v it m i so vdi m i md.

72 Y HOC THUC HANH (905) - SO 2/2014

Taqi E. (2007) nghifen ci>u trfen 281 bfenh nhfen th iy ty Ife nhiim khuin v lt m l cua m l nfei soi / m6 ma Ife 1,5% / 9,5% sy khdc nhau c6 y nghla thing kfe (p<0,05) Theo Lin H. (2006) Ife 15,2% a nh6m ndi soi vfe 30,7% dr nh6m m l ma, sy khfec nhau c6 y nghla thing kfe (p<0,05).

Vfei biln chung fep xe tin dy sau m l c6 tfec gia cho ring m l nfei soi Ifem tfeng ty Ife fep xe tin du. Tuy nhifen phin Idm cfec nghifen cuu cho th iy khdng c6 sy khfec nhau cfe y nghfa thing kfe v l ty Ife fep xe tin du giOa nhbm mo nfei soi vfe m l ma. Nghifen cuu cua Wullstein C. (2001) cfe ty Ife nfey a 2 nh6m m l ndi soi vfe m l md lin lyat Ife 4,1% vfe 4,9%, sy khfec nhau khfeng cfe y nghTa thing kfe (p<0.005); k it qua tyang ty nhu1 trong nghifen cuu cua Khalili T.M. (1999) Ife 1% vfe 1,7%.

Trong nghifen ciru cua chung tfei khong gfep trying hap nfeo rfe manh trfeng, cfe 1 try ing hap tfec rufet s im sau m l bfenh nhfen duac dieu tri bao ton thfenh cfeng, ra vifen, mfet tru ing hgp fep xe tin dy sau m l phai m l Igi. Nhifem khuan chfen trocar gfep 5 trying hap (7,8%) chu y iu gfep chfen trocar a rln. Tuy nhifen nhifem khuin chfen trocar sau mo nfei soiv ii nhifem khuin vet mo trong m l ma, hofen toan khfeng anh huong t i i sinh hoat cua bfenh nhan, khflng Idm tfeng ngfey d iiu tri sau m l. Bfenh nhfen dugc cho ra vifen huong dfen thay bfeng a nhfe.

k £t lu anQua nghifen cuu chung toi rut ra k it lufen sau:1. Mfet s i trifeu chu-ng Ifem sfeng chinh: dau bung

chiim 95,2%, hfei chung nhifem trung chiim 92,1%, phan ung vung h i chau phai chiim 93%, o bgng c6 dich trfen sifeu fern chiem 75%. Ty Ife tot 46 BN (82,14%), trung binh 6 BN (10,71), x iu 4 BN (7,15%).

2. Phiu thufet nfei soi trong dieu trj vifem phuc mac rufet thua Ife an tofen vfe dat dyac hieu qua diiu trj. M$c du cfen ti Ife biln chung sau mo nhy: nhifem trung chan trocar (8,9%) dieu nfey khfeng gfey anh hyang tai sinh hogt cua benh nhfen. Ap xe ton dy sau mo Ife 3,57%, tic rufet sfem sau m l Ife 3,57%. Tuy vfey phfeu thu^t nfei soi cfe nhieu uu diem so v i i m l ma: benh nhdn it dau dfen, nhanh phuc hoi, seo m l mang tinh

thlm my cao. Song phau thufet nfei soi trong viem phuc mac ruot thya vdn la phfeu thudt dfei hoi ky ndng vd kinh nghiem cua phdu thuat vien. No c in tiep tuc duac nghien cuu hodn thien vd khdng djnh hieu qua trong qud trinh thyc hdnh lam sdng.

tA i lie u t h a m k h Ao1. Nguyen Hoang Bic, Nguyln Tin Cuing (2004);

“Phlu thudt nfei soi dieu tri viem phuc mge rufet thua”; Y hQC Viet Nam T$p 491; tr:227-30

2. Nguyen Cuing Thinh, Trifeu Quoc 0gt (2006); "Phlu thufet nfei soi dieu tri viem phuc mge rufet thua’’; Y hQC Viet Nam T$p 319; tr.64-69.

3. Agresta F, Ciardo L.F., Mazzarrolo G., et al(2006), “Peritonitis: laparoscopic approach”, World Journal of Emergency Surgery, 1:910.1186/1749-7922- 1-9

4. Albright J.B., Fakhre G.P., Nields W.W., et al(2007), "Incidental appendectomy: 18 year pathologic survey and cost effectiveness in the nonmanaged care setting”, J Am Coll Surg, Voi 205, pp.298-306.

5. Andreas Kiriakopoulos, Dimitrios Tsakayannis, Dimitrios Linos (2006), “Laparoscopic Management of Complicated Appendicitis”, JSLS 10, p. 453-456.

6. Ball C.G., Kortbeek J.G., et al (2004), "Laparoscopic appendectomy for complicated appendicitis an evaluation of postoperative factors", Surg Endosc 18, pp. 969-973.

7. Lin H.F., Wu J.M., Tseng L.M., Chen K.H., HuangS.H., Lai I.R. (2006), “Laparoscopic versus open appendectomy for perforated appendicitis", J Gastrointest Surg., Jun 10(6), p. 906-10.

8. Navez B., Delgadillo X., Cambier E., Richir C., Guiot P. (2001), “Laparoscopic aproach for acute appendicular peritonitis: Efficacy and Safety: a report of 96 consecutive cases”, Surg laparosc Endosc Percutan Tech, voi 11(5), p. 313-316.

9. Taqi E., Al Hadher A., Ryckman J., et al (2008), “Outcome of laparoscopic appendectomy for perforated appendicitis”, J Pediatr Surg., 43(5), p. 893-895.

10. Wullstein C., Barkhausen S., Gross E. (2001), “Results of laparoscopic vs. conventional appendectomy in complicated appendicitis”, Dis Colon Rectum., Nov 44(11), p. 1700-5.

TY LE NHIEM HIV VA KY THI, PHAN BIET DOI XUTVOTI NGlOTl NHIEM HIV CUA CAC NHOM NGUY C(J CAO TAI HA NAM NAM 2013

Dd VAN DUNG, NGUYiN TIEN DUNG, NGUYEN OLTC TRONG

t6 m tAtD i tdi duxyc thi/c hi$n theo phuxyng ph ip nghidn

cun dich t i hq>c md ta v&i didu tra c it ngang trdn co miu 600 ddi tuxyng nghidn chich ma tuy va phu nCr bin d&m t?i tinh H i Nam n im 2013. C6 65,3% ddi tuxyng nhin th iy cd si/ thdng cim , giup do cua cdng ddng ddi v&i ngudi bi nhiim HIV/AIDS, tuy v$y v in cdn 34,3% th iy c6 s i/ xa Unh cua nhCrng ngudi xung quanh; 67,0% nhdm nghidn chich ma tuy v i 63,7%

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Tirkhda: nghidn chich ma tuy, phu niy b in dim .

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