BỆNH NGOẠI KHOA: NHỮNG ĐIỀU CẦN BIẾT

DANH MỤC CHIA SẼ
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  Chắc hẳn đâu đó trong cuộc sống bạn thỉnh thoảng đã từng nghe nói đến những từ “bệnh ngoại khoa”, “phẫu thuật (mổ)”… Mặc dù vậy, chưa chắc ai cũng hiểu biết những bệnh lý nào gọi là “bệnh ngoại khoa”? phương thức điều trị những bệnh này như thế nào? Phẫu thuật (mổ) là gì? Tại sao phải mổ? Bác sĩ nào được phép mổ?…

1. Bệnh ngoại khoa là gì?

  Tất cả các bệnh lý xảy ra là do sự rối loạn hoạt động hay thay đổi cấu trúc của các cơ quan trong cơ thể, và hầu hết chúng cần được điều chỉnh lại bằng thuốc men. Tuy nhiên, có một số bệnh lý cần phải được sửa chữa và điều chỉnh lại nhờ vào sự can thiệp của phẫu thuật, các bệnh lý này được gọi là “bệnh ngoại khoa”.

  “Phẫu thuật” là những kỹ thuật mổ xẻ để lấy bỏ đi hoặc sửa chữa lại những cơ quan trong cơ thể đã bị hư hỏng, với mục đích đưa cơ thể hoạt động trở lại bình thường hoặc gần như bình thường. Thực hiện những kỹ thuật này là những bác sĩ (phẫu thuật viên-PTV) hiểu rõ về cơ thể con người, quá trình bệnh lý và hơn hết là họ đã được huấn luyện thành thục những thao tác như: cột, cắt, xẻ, may… trên những cơ quan của người bệnh.

  “Ngoại khoa” là một nhánh của y học liên quan đến việc điều trị, quản lý và đánh giá một loạt các tình trạng y tế, chẳng hạn như ung thư và ghép tim. Trong một số trường hợp, phẫu thuật cũng có thể được thực hiện cho mục đích thẩm mỹ (ví dụ: căng da mặt, thu nhỏ ngực, v.v.). Vì thế Ngoại khoa là phương pháp điều trị rất hiệu quả và nhanh chóng cho những bệnh lý mà thuốc men không chữa được, nhưng đó cũng là một phương pháp mang nhiều nguy hiểm tiềm ẩn trong quá trình điều trị cho người bệnh.

  Các bác sĩ trực tiếp tham gia phẫu thuật được gọi là “phẫu thuật viên”, và họ sẽ phải được giáo dục toàn diện. Ngoài 6 năm học ở trường đại học y khoa, tiếp đó họ sẽ phải tham gia phụ tá cho các PTV có kinh nghiệm trong việc điều trị và phẫu thuật cho người bệnh ít nhất 2 năm nữa. Sau đó họ sẽ được học chuyên môn sâu trong các lĩnh vực khác nhau về thần kinh, tim mạch, tiêu hóa, hô hấp… Việc đào tạo chuyên môn sẽ phải cần thêm 2 năm nữa hoặc dài hơn tùy vào mong muốn của PTV.

2. Mục tiêu của việc điều trị ngoại khoa

• Đảm bảo người bệnh không phải chịu những đau đớn, khó chịu và quá trình phục hồi không cần thiết.

• Đề xuất kỹ thuật thủ thuật, phẫu thuật phù hợp nhất để điều trị bệnh, hoặc giảm các triệu chứng.

• Làm cho người bệnh hiểu đầy đủ các rủi ro hoặc biến chứng tiềm ẩn của thủ thuật, phẫu thuật.

• Phác thảo một kế hoạch thủ thuật, phẫu thuật cho người bệnh mà PTV sẽ phải thực hiện.

• Theo dõi tiến trình và sự hồi phục của người bệnh, đặc biệt là trong 24 đến 48 giờ đầu tiên sau khi phẫu thuật.

3. Gia đình và người bệnh cần chuẩn bị gì trước khi đi phẫu thuật?

  Khi bác sĩ của bạn thông báo cho bạn hay là bệnh cần thiết phải phẫu thuật thì bạn cần phải chuẩn bị như thế nào?

• Đối với những trường hợp mổ cấp cứu bạn sẽ được chuẩn bị và kiểm tra mọi thứ ngay tại bệnh viện. Bác sĩ sẽ làm xét nghiệm máu để xem các chỉ số hoạt động của gan, thận, các chỉ số về chức năng đông máu và số lượng các tế bào máu. Chụp x-quang tim phổi và điện tâm đồ để xem tim phổi hoạt động bình thường không? nếu cần sẽ được kiểm tra thêm siêu âm tim. Sau đó Bác sĩ gây mê sẽ khám qua để đánh giá công việc gây mê để phẫu thuật. Việc của bạn phải làm là thông báo cho các bác sĩ biết những bệnh lý gì mà mình mắc phải, có đang dùng những thuốc gì không, dị ứng với thuốc gì không? và không quên hỏi kỹ bác sĩ phẫu thuật của mình về tất cả những gì liên quan đến cuộc mổ mà bạn muốn biết thêm. Không được ăn uống gì và bình tâm chờ đợi đến khi vào phòng mổ.

• Đối với những bệnh không cấp cứu, bạn nên ăn nhẹ vào đêm trước mổ, ngưng các thuốc kháng viêm hay chống đông máu trước mổ khoảng 1 tuần. Có thể tiếp tục uống thuốc tim mạch, tiểu đường nhưng ngưng thuốc trong ngày phẫu thuật. Vào ngày mổ bạn nên nhịn ăn uống hoàn toàn, tắm rửa sạch sẽ, đại tiểu tiện trước khi vào phòng mổ. Trong những trường hợp có bệnh tim mạch như cao huyết áp, thiếu máu cơ tim, bệnh phổi hay tiểu đường chưa ổn định, có thể bác sĩ sẽ cho bạn điều trị nội khoa trước khi quyết định phẫu thuật. Một số bệnh đại trực tràng cần phải rửa ruột hay uống thuốc xổ để làm sạch thì bác sĩ sẽ hướng dẫn thực hiện như thế nào cho nhập viện trước vài ngày.

• Một số bệnh phẫu thuật khác như bướu giáp, sỏi túi mật, thoát vị bẹn…, bác sĩ có thể cho thực hiện các xét nghiệm tầm soát buối sáng và phẫu thuật vào buổi trưa nếu mọi thông số cho phép.

4. Chăm sóc người bệnh sau mổ?

• Khi hồi tỉnh sau mổ, bác sĩ sẽ dùng thuốc để bạn không thấy đau và không bị ói. Bạn nên ngồi dậy sớm và tập đi lại ngay khi có thể (trong vòng 24 giờ đầu), đi vệ sinh và đi quanh giường bệnh, điều này có thể tránh biến chứng sau mổ.

• Nếu không có căn dặn gì đặc biệt, bạn có thể uống nước hay ăn cháo khi thấy đói, ăn uống trở lại bình thường sau 2-3 ngày, xuất viện sau 1 vài ngày. Đau vết mổ sẽ giảm dần mổi ngày và đau nhiều hơn khi vận động, đây là điều bình thường. Khoảng 7 đến 10 ngày bạn không còn cảm giác đau nữa.

• Thông báo với bác sĩ nếu bạn có một trong những dấu hiệu sau: đau bụng hay đau vết thương liên tục và dữ dội, ói và bụng chướng căng, sốt cao – lạnh run, chảy dịch qua vết mổ…

5. Những biến cố có thể xảy ra cho người bệnh trong và sau mổ?

• Khi phải can thiệp ngoại khoa để điều trị bệnh thì có thể xảy ra những biến cố liên quan đến gây mê, phẫu thuật và quá trình lành bệnh sau mổ. Tuy có rất nhiều loại biến chứng có thể xảy ra nhưng tỷ lệ xảy ra lại cực kỳ thấp trên những bệnh nhân khỏe mạnh

• Những biến chứng thường gặp hơn trong và sau phẫu thuật là: chảy máu, nhiễm trùng vết mổ. Ngoài ra phẫu thuật trên đường tiêu hóa còn có thể gặp: liệt ruột, tắc ruột, xì dò miệng nối, viêm phúc mạc….

• Những bệnh nhân có bệnh mãn tính như tim mạch , phổi, tiểu đường … có thể có biến chứng như nhồi máu cơ tim, viêm phổi, tai biến mạch máu não…

• Các nguy cơ phẫu thuật không thể ngăn ngừa hoàn toàn được, tuy nhiên nếu được chú ý theo dõi chi tiết có thể giảm thiểu tác hại do các tai biến này gây ra. Chuẩn bị tốt bệnh nhân trước mổ, điều chỉnh tất cả các rối loạn, phẫu thuật nhanh chóng ít xâm hại, bệnh nhân tập vận động sớm sau mổ sẽ giúp hạn chế tối đa các nguy cơ của phẫu thuật.

6. Phẫu thuật nội soi là gì?

• Phẫu thuật nội soi là kỹ thuật mổ mới được phát triển trong khoảng 30 năm gần đây. Thay vì dùng bàn tay và nhìn trực tiếp vào phẫu trường, phẫu thuật nội soi thực hiện khi bác sĩ nhìn các bộ phận cơ thể gián tiếp qua màn hình bên ngoài nhờ hệ thống truyền hình mini đưa vào bên trong cơ thể và dùng các dụng cụ nhỏ như chiếc đũa để bóc tách, cắt đốt và khâu vá các cơ quan.

• Vì vậy phẫu thuật nội soi không cần đường mổ dài 15 – 20cm, mà chỉ cần 3 – 4 lỗ 1-1,5cm. Người bệnh sẽ ít đau hơn rất nhiều, mau hồi phục và thẩm mỹ. Hơn nữa, phẫu thuật nội soi có thể thực hiện dễ dàng hơn trong một số trường hợp vị trí mổ nằm sâu và phẫu trường được phóng đại nên mổ được thực hiện chính xác hơn.

• Cho đến nay phẫu thuật nội soi đã thay thế dần đến 75 – 80% các trường hợp mổ hở thông thường cho các chuyên khoa ngoại tổng quát – tiêu hóa, tiết niệu, phụ khoa, tai mũi họng, cơ xương khớp, lồng ngực…

• Tham vấn với bác sĩ khoa ngoại để có tư vấn và điều trị tốt nhất cho bệnh tật của bạn.

Nguồn: Hội Ngoại khoa Việt Nam.

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