TAP CHlNGHliN CO'U Y HQC
gered by way an punture approach since 2005 with successful rafio of 90%. In conclusion, brain abscess punture approach in coopporate with radical mastoidetomy was safe, effecfive method.
CT Scan was an important method in diagnosis, treatment brain abscess as well as monitor eom- plieafion of surgery.
Keywords: brain abscess
OAC OI^M LAM SANG VA CAN LAM S A N G BENH N H A N
OI^U TRI U x a TLP CUNG B A N G P H A U THUAT NOI SOI TRONG 5 NAM (2006 - 2010) TAI BENH VIEN PHU S A N TRUNG U'QNG
Phgm Thj Thanh H i l n \ Ddo Thanh Hudng'
^Trwdng Dpi hpc Y Hd Ndi. 'Bdnh vidn Phu sdn Tmng uxmg Nghidn cwu hdi cim md td 281 bdnh nhdn dwgc md bdc nhdn xa qua ndi soi tpi bpnh vidn PSTW tmng 5 ndm (2006-2010) cho thiy sd ca md bdc u qua ndi soi tdng din eOng nhw ty Id thdnh cdng dpt 73.7% (ndm 2006: 57.7%). 84% bdnh nhdn khdng bj rdi lopn kinh nguypt. 69% tmdng hap phdt hipn u qua khdm phi) khoa dnh ky. kieh thwde tw cung twang dwang tw cung cd thai < 8 tuin chiim 47.3%. Tinh trang thiiu miu chiim 9.6% (27 ca).
Tip khod: u x a tir cung, md bdc nhdn x a qua ndi soi
I. DAT
V A Noe
U xa tu cung Id logi khdi u sinh due hay gdp nhit d phg n& trong do tudi sinh de, Id loai u ldnh tinh phdt triln tu ea tu cung. Ty 10 gdp 10 20% sd bOnh nhdn d i n khdm phu khoa. Cd nhilu phuang phdp dilu trj u xa tu cung bao gdm dilu tri ndi khoa, ldm t i c mgch hay dilu tri ngogi khoa nhu phlu thudt bdc u xa tu cung, phiu thudt e l t tu cung.
odi vdi phu n& edn duy tri kha ndng sinh sin vd tuy thudc vdo tinh chit u xa tu cung, tudi, finh trgng bOnh nhdn thi phiu thudt bdc u xa tu cung dugc thgc hiOn bing mOt trong hai phuang phdp md md hodc md ndi soi. VI vdy chQng tdi nghiOn c&u vdi muc fiOu: MO ta ddc dilm ldm sdng vd cdn Idm sdng bOnh nhdn dilu trj u xa tu cung bing phiu thudt ndi soi trong 5 ndm (2006 2010) tgi bOnh viOn Phu san Trung uang.
II. D 6 | TU'gNG VA PHU'ONG PHAP
Tieu c h u l n Iga chgn: T i t ca nh&ng bOnh nhdn ed chi djnh bdc u xa tu cung qua nOi soi dwgc phlu thu$t tgi BVPSTLP t& thdng 1/1/2006-31/12/2010.
TiOu c h u l n lo^i trip: Cde trudng hgp ho sa luu tr& thilu cdc thdng tin c i n thilt.
Phuang phdp nghiOn cii'u: NghiOn ci>u hdi c&u, chon m i u : t i t c l ede hd sa bOnh dn cd chl djnh md ndi soi tgi bOnh viOn Phg san 'Trung uang t u 2006 d i n 2010.
III. KtT QUA
NghiOn cuu ed 281 bOnh dn dugc chi djnh md ndi soi thl 207 trudng hgp phiu thu$t ndi soi thdnh edng, 74 trudng hgp ehuyin mdmd.
, '.
Nam .2006 2007 2008 2009 2010 Tdng
Bang 1 . T y l Md 1
n 15 33 49 49 61 207
0 md npi soi bdc u ngi soi
; ' •
thanh
•
cdng
% 57,7 67,3 69,0 80,3 82,4 73,7
xa
J
tii' cung qua cdc ndm Thit bai
n 11 16 22 12 13 74
chuyin md md
% 42,3 32,7 31,0 19,7 17,6 26,3
Trong thdi gian 5 ndm c&u ed 281 trudng hgp duge chi djnh md ndi soi thl cd 207 trudng hgp phiu thudt nOi sol thdnh cdng chilm 73,7%, 74 trud-ng hgp thit bgi ehuyin md md chilm 26,3 %.
Bdng 2. Tudi bfnh nhan
Nhdm tudi %
<20 21 - 3 0 ' 3 1 - 4 0
3 63 149
1,1 22,4 53,0
<0,05
>40 66 23,5
Tdng 281 100
Tudi thlp nhit trong nghiOn c&u la 20 tudi, cao nhit Id 56 tudi.
Tudi sinh de (21- 40) chilm 78,4%, "Nhdm tudi tu > 40 cd 66 trudng hgp chilm 23,5 %. Sg khde blot cd y nghTa thdng kO vdi p < 0,05.
Bang 3. TiOn sii* phu khoa Tien sii'
TriOu eh&ng ed rdi logn kinh nguyOt
OT ndi trudc khi vdo vien
KhOng rdi logn kinh nguyOt Rdi logn kinh nguyOt <3 thdng Rdi logn kinh nguyOt 3-6 thdng Rdi logn kinh nguyOt >6 thdng Cd
236 29
5 11 32
84 10,3
1,8 3,9 11,4
KhOng 249
281
88,6 100
TAP CHl NGHliN CO'U Y HQC
Bang 3 eho thiy: TriOu eh&ng rdi logn kinh nguyOt: da sd bOnh nhdn (236 trudng hgp) khOn ed rdi logn kinh nguyOt, chilm ty 10 84%. Cd 45 trudng hgp ed rdi logn kinh nguyOt chilm ty 101
%. Trong dd ed 10,3% bOnh nhdn cd rdi logn kinh nguyOt < 3 thdng,
Oilu trj nOi khoa trudc khi vdo viOn: 88,6 % chua dugc dilu trj trudc khi vdo viOn.
Bdng 4. Ly do vdo vl^n
Trifu chii'ng
%Phdt hiOn qua khdm phu khoa Rdi logn kinh nguyOt
Oau hg vj Tg sd thiy u
194 31
2 53
69,0 11,0 0,7 18,9
<0,05
Bl ddi, bl dgi fiOn 0.4
Tdng 281 100
Phdt hiOn qua khdm phu khoa Id ly do vdo viOn gdp nhilu nhit (69 %), filp dd Id rdi logn kinh nguyOt (11 %) vd dau ha vj (0,7 %). Sg khde biOt cd y nghTa thdng kO vdi p < 0,05,
ndy cQng tuang tg ede edng bd khde [3; 5]
IV. BAN LUAN
NghiOn c&u ed 281 trudng hgp duge ehi djnh md ndi soi thl cd 207 trudng hgp phiu thudt nOi soi thdnh edng chilm 73,7%, 26,3%
thit bgi dugc chuyin md md.
Qua bang 1 eho thiy ty 10 md ndi soi bdc nhdn xa tdng din qua cde ndm, t& ndm 2006 cd 26 trudng hgp md nOi soi nhung chl thdnh edng ed 57.7%. Oin 2010 sd ca md ndi soi d§
tdng lOn tdi 74 ea vd ty 10 thdnh edng 82,4%.
Dgt dugc ty 10 ndy eh&ng td trlnh dO tay nghi thiy thudc ngdy cdng cao. phlu thudt ndi soi ngdy dwgc dp dgng rdng trong nhilu ehuyOn ngdnh. trong dd ed chuyOn ngdnh phg khoa.
Nhd vdy bOnh nhdn chdng hdi phgc, thdi gian nim viOn dwgc rut ngin.
Ddc dilm ciia ddi tugng nghiOn cii'u
*Tudi: Tudi eiia ddi tugng nghiOn c&u thlp nhit Id 20 tudi. eao nhit 56 tudi, tdp trung nhilu vdo nhdm tudi dudi 40 (76%). Tudi trung binh eua ddi tugng nghiOn c&u Id 35,7 ± 7.0. DO tudi eiia ngudi bOnh trong nghiOn c&u
- Tiln sii" phi^ khoa
* Tridu chdng rdi lo^n kinh nguydt:
Theo kit qui bing 4 ed 236 ngudi bdnh khdng ed rdi logn kinh nguyOt. chilm ty 16 84%. Cd 45 trudng hgp (16%) cd rdi logn kinh nguyOt trong dd ehu ylu Id rdi logn kinh nguyOt dudi 3 thdng (10,3%).
TriOu eh&ng rong kinh, rong huylt Id ni^t diu hiOu Idm sdng ggi y eua u xa tu cung giiip thiy thude luu y d l ehln dodn sdm. Ttr 6b giup eho viOc theo ddi, dilu trj ndi khoa hay phiu thudt dgt kit qua tdt ban.
- Diiu trj ndi khoa trudc khi vio vidn: Dieu trj nOi khoa trudc md giiip giam kieh thu'dc khdi u xa, u xa khu trQ dk bdc tdch d l ddng han. Thdi gian phiu thudt nhanh han vd b$nti nhdn ed thl duge phiu thuOt bing nOi soi.
Tuy nhiOn trong nghiOn c&u ndy 88.6% bOnh
nhdn ehua dugc dilu trj. Chf cd 32 bOnh nhSn
(11,4%) duge dilu trj trudc khi phlu thu^t
(Progesfin, Zoladex, trinh n& hodng cung..)
Qua ddy eho thiy ngudi bOnh ehua du'O'c
khdm phu khoa djnh ky mOt cdch cd hO thdng nOn ty 10 phdt hiOn u vd dugc dilu trj nOi khoa trudc khi md edn thlp. Tai BVPSTW. bOnh nhan u xa tu cung cd 46,1% rdi logn kinh nguyOt va 87,5 % chua dugc dilu trj nOi khoa trudc md [4].
* Tiin sw phiu thuit 6 bung: Trong sd 281 trudng hgp bOnh nhdn duge ehi djnh phiu thudt ndi soi bdc u xa tu cung ed 253 trudng hgp ehua cd filn su phiu thudt d bgng chilm 90%. 28 trudng hgp ed filn su phiu thudt d bung chilm 10% (3 ca md VRT, 15 trudng hgp md de vd 6 ea md ndi soi vd sinh, 4 ca md u bdng tr&ng). Nh&ng ngudi bOnh ndy trong vd sau phiu thudt khdng bj biln eh&ng gl.
Tidn sw v6 sinh: 84 trudng hgp vO sinh I hoac vd sinh II ed u xa tu cung duge ehi djnh bdc u bing phiu thudt ndi sol vd thdm dd 2 vdi tu cung chilm 37.2 %.
Ly do vao vien
Kit qua bang 4 eho thiy: ly do vdo viOn d nhdm ngudi bOnh phat hien dugc u qua kham phu khoa cd ty 10 eao nhit 75%, tilp do la rdi loan kinh nguyOt (rong kinh, rong huylt) 13.7%, dauhg vj 9,8%, tg sd thiy u 1%, bi tilu 0,5%.
sd ngudi bOnh khdm phg khoa phdt hiOn dugc u chilm ty 10 cao Id do nh&ng trudng hgp ndy duge khdm djnh ky va phdt hiOn.
Cde bOnh nhan edn lgi cd nh&ng triOu ch&ng bao trudc nhu rong kinh, dau hg vj Id nh&ng d i u hiOu Idm sang ggi y d l khdm vd ehln doan sdm u xa*tu cung glQp cho viOc dilu trj thanh cdng
TInh trang thilu mdu khi vdo vien
Qua nghiOn cuu eho thiy khi vao viOn ed 91.3% trudng hgp khdng thilu mdu (Hb >
llg/dl). Cd 1 trudng hgp thilu mdu ndng-. Sg khde biOt ed y nghTa thdng kO vdi p < 0.001.
Khdng ed trudng hgp ndo phai truyin mdu trong vd sau md.
Theo Dubuisson, J.B vd eOng sg dd nghiOn c&u trOn 332 bOnh nhdn ed It nhit mOt u xa duge phiu thudt ndi soi bdc u xa tu cung t&
1/1991 d i n 12/2003 cd huylt sic td trung binh 106 ± 8,6 g/dl, khdng cd trudng hgp ndo phil truyin mdu, khdng ed biln eh&ng trim trpng ndo xay ra trong cudc phiu thudt.
So sdnh vdi nghiOn c&u eua Nguyin Thj Phuang Loan (2004), trong sd nh&ng ngudi bOnh u xa tu cung dugc xu tri bing phiu thudt thl sd ngudi bOnh khdng thilu mdu 62,8%, sd ngudi bOnh thilu mdu 37,2%, trong dd 8,5% sd ngudi bOnh thilu mdu ndng.
Trong nghiOn c&u ndy, sd ngudi bOnh thilu mdu cd ty 10 thlp han nhilu vd chi ed 1 trudng hgp thilu mdu ndng [4].
V. K^T LUAN
Ty 10 md ndi soi bdc nhdn xa trong 5 ndm thdnh cOng 73,7%.
84% bOnh nhdn khong cd rdi logn kinh nguyOt.
69 % phat hien u xa qua khdm phu khoa.
Ty 10 thilu mdu chilm 9.6%.
Kich thude tu cung to tuang duang thai <
8 tuin chilm 47,3%.
TAI
LIEU THAM
K H A O1. Chau Thj Xuan Cim (1999). Bdc nhdn xa t& cung qua ndi sol. Chuang trlnh hpc ldp nOl soi khod I, BOnh viOn T& Du.
2. Nguyin Du>c Hinh, Dd Nggc Lan, Vu Bd Quylt (2000). Nhdn xOt v l dp dgng PTNS tgi ViOn BVBMTSS t& ndm 1996 1999. NOi san S i n phu khoa, HOi phg s i n ViOt Nam khod XIV ky hop th& 3, 55 - 58.
3. Nguyin Duy Hung (2008). NghiOn c&u su dung Morcellator trong phiu thudt nOi soi phg khoa tgi bOnh viOn Phg san Trung uang t& 5/2007 d i n 5/2008. Ludn vdn tdt nghiOp bdc sy ehuyOn khoa d p 11, Trudng Dai hoc Y Hd Ndi.
CHl NGHliN CO'U Y HQC
4. Nguyin Thj Phuang Loan (2005) NghiOn c&u finh hlnh xu tri u xa tu cung bing phiu thudt tgi BOnh viOn Phg s i n Trung uang ndm 2004. Ludn vdn tdt nghiOp bdc sy chuyOn khoa d p 11, Trudng Dgi hpc Y Hd NOi.
5. Nguyin Bd My Nhi, Chu Thj Bd vd cdng sg (2004). Tinh hlnh phiu thudt nOl sol tgi bOnh viOn Phg s i n T& DQ t& ndm 1997 2003, HOI nghj ViOt Phdp v l S i n phg khoa vQng Chdu d Thdi Binh Duang lln thu IV, 7 - 20.
6. Nguyin Bd My Nhi (2005), Ddnh gid budc d i u &ng dgng phiu thudt ndi soi trong dilu trj bdc nhdn xa tu cung, NOi san SPK 2005, 115-121,
7. Damiani A, MelgratI L, Marziali M, Sesti F (2003), Gasless laparoscopic
myomectomy, Indlcafions, surgical technique and advantages of a new procedure for removing uterine leiomyomas. J Reprod Med, 48 (10): 792 798.
8. Dubuisson, J.B. and Chapron, C (1996), Laparoscopic myomectomy today. A good teehniqua when correcfiy indicated.
Hum. Report, 1 1 , 9 3 4 - 9 3 5
9. Kirsten Hald MD., Anton Langebrekke MD., Nils Einon Klow MD., Hans Jorgen Noreng MD., Anetii Bugge Berg MD and Olav Istre MD (2004). Laparoscopic occlusion of uterine vessels for the treatment of symptomatic fibroids. Initial experience and comparision to uterine artery embolizasion, Jan Vol 190, 3 7 - 4 3 ,
Summary
CLINICAL FEATURES OF PATIENTS WITH LAPAROSCOPIC MYOMECTOMY IN FIVE YEARS (2006 - 2010) AT THE NATIONAL
HOSPITAL FOR OBSTETRICS AND GYNECOLOGYL
Retrospective study of 281 pafients with laparoscopic myomectomy at the Nafional Hospital for Obstetrics and Gyneeologyl in five years (2006 2010) showed that the success rate of laparoscopic myomectomy increased to 73.7% (2006: 57.7%), 84% of patients had no menstaial disorders, 69% of tumors were detected through roufine pelvic examination, uterine size equivalent to the uterine pregnancies < 8 weeks accounted for 47.3%. Anemia accounted for only 9.6% (27 eases).
Key works: Laparoscopic myomectomy
