NGOAI KHOA SO D A C BIET 1, 2, 3/2012
KET QUA PHAU THUAT MO DIEU TRI GIAN T I N H MACH TINH TAI BENH VIEN 103
Le Anh Tuan*
T O M TAT
Muc tiiu: Oanh gia ket qua dieu trj gian tTnh mach tinh bang phau thuat md that tTnh mach gian tai Benh vien 103.
Ddi t&dng va ph&dng phap nghien c&u:
Gom cac benh nhan bi gian tinh mach tinh du'dc phau thuat md that tTnh mach gian tiT 7/2010 den 12/2011. Chi dinh phau thuat: cac benh nhan bj gian tinh mach tinh dp I I , I I I cd kem theo: Dau tiic nhieu viing ben, biu dPn thuan, tinh hoan ben benh teo nhd va cd bat thudng tinh dich do. Cac benh nhan dUPc kiem tra sau phau thuat bang kham lam sang, sieu am Doupler va xet nghiem tinh djch do
Ket qua: Cd 41 benh nhan dUpc phau thuat, Uioi tir 13- 40 (trung binh: 24,8) gom cd:
GTMT+Oau tiTc nhieu vung ben, biu dPn thuan:
11 benh nhan, GTMT -^ Teo tinh hoan: 5 benh nhan. GTMT+ Bat thydng tinh djch d d ; 25 benh nhan. Cac benh nhan deu cd cai thien ve trieu chijhg lam sang sau phau thuat, sieu am Doupler 14/21 benh nhan khdng cdn tTnh mach gian, 8/14 benh nhan cd cai thien ve tinh dich dd.
Kit luan: Dieu trj phau thuat gian tinh mach hnh, nhat la tren benh nhan vd sinh nam la mdt chi djnh dieu trj pho bien hien nay tren the gidi va d Viet nam, phau thuat md that tinh mach gian van la mot phu'dng phap ddn gian, it bien chiihg va cd the ap dung d nhieu tuyen y te.
SUMMARY
THE RESULTS OF VARICOCELECTOMY BY OPEN INGUINAL I N 103 HOSPHAL Objective: To evalueted the results of varicocelectomy by open inguinal in 103 Hospital.
* Khoa Tiet nieu - Vien 103
Material and method: All the patients varicocele underwent the open Inguinal varicocelectomy in the department of urology- 103 hospital from July 2010 to December 2011 with the following indications: long-term scrotal pain, abnormal semen parameters and testicular atrophy.
Results: 41 patients was opereted, the age range from 13 to 41 years old (mean: 24,8), 9 5 , 1 % of varicocele was on the left and 4,9%
was on bilateral. Varlcocele+long-term scrotal pain: 11 patients, varicocele+abnormal semen parameters: 25 patients and varicocele+testicular atrophy: 5 patients. Postoerative: 8 3 % % patients in freedom of pain, the diameter of the internal spermatic vein Is smaller than 2mm on ultrasound: 7/21 patients.
Conclusion: Varicocele are common, treatement of varicocele is nesessary. The open Ingullal varicocelectomy is the simple and effective technique.
I. O A T V A N OE
Gian tinh mach tinh la su gian, xoan bat thudng cua tinh mach tinh, la mdt benh lanh tinh, tien trien tir tir nhung gay anh hudng din sinh hoat hang ngay va cd the la nguyen nhan gay vd vinh nam, theo mot sd tac gia, gian tTnh mach tinh chiem khoang g^n mdt ph4n ba cac ca vd sinh nam [ 1,4,6].
Dilu tri phlu thuat cd nhieu phuang phap khac nhau: phau thuat ndi soi that tTnh mach gian, phau thuat md that tTnh mach gian d vimg biu, viing ben...tuy nhien den nay phau thuat md van dupe ap dung rpng rai.
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BAI H6l H6l NGOAI KHOA VN LAN T H J X I I VA HQI NGHj KHOA HOC NGOAI KHOA T 0 A N Q U 6 C _ L A N THCTXIV
Nghien ciiu nay nham danh gia su cai thien trieu chimg cua benh nhan bi gian tTnh mach tinh dupe dieu tri bang phau thuat md that tTnh mach gian d viing ben tai Benh vien 103.
II. 061 TUONG VA PHUONG PHAP NGHIEN COU
Gdm cac benh nhan bi gian tTnh mach tinh dupe phlu thuat tai Khoa tiet nieu-Vien 103 tif7/2110ddn 12/2011.
Chi dinh phau thuat: cac benh nhan bi gian tinh mach tinh dp II,III cd kem theo:
Dau tire nhieu vimg ben, biu don thuan.
Tinh hoan ben benh teo nhd.
Cd bit thudng tinh dich do.
Phuang phap phliu thuat: Rach da vimg ben, md dng ben, phlu tich thimg tinh, tim
tTnh mach giSn, that, dt tTnh mach gian sat lo ben sau.
Cac benh nhan dupe kiSm tra bang kham lam sang, sieu am Doupler v^ xet nghiem tinh djch dd.
III. KET Q U A
Cd 41 benh nhan bi gian tTnh mach tinh da dupe ph&u thuat.
Tudi tir 13- 40 (trung binh: 24,8) Nghe nghiep: bd dpi: 34 benh nhan (82,9%), hpc sinh, cdng chuc, lao dpng tir do:
07 benh nhan (17,1%).
Ben tTnh mach tinh bi gian: cd 2 benh nhan (4,9%) bi gian tTnh mach tinh ca 2 ben, 39 benh nhan (95,1%) bj gian tTnh mach tinh ben trai don thuan.
Bang 1: Trieu chung lam sang trudc phau thuat
Trieu chu'ng Dau tLTc vunq ben, biu ben bi benh Co i<ti6i phonq phia tren tinh hoan Sci thay bui tTnh mach qian Tinh hoan teo nho hOn ben lanh
So lu'dng 41 41 41 5
T y l £ 100%
100%
100%
12%
Da sd cac benh nhan dupe phau thuat deu cd trieu chimg lam sang tuong ddi rd rang.
Bang 2: Chi dinh phau thuat
Chi dinh GTMT+Dau ttTc nhieu vunq ben, biu GTf^T+Teo tinh hoan
GTf^T+ Bat thLTcfnq tinh dich do Conq
So lu'dng 11
5 25 41
T v I e 26,9%
1 2 , 1 % 61%
100%
Tat ca benh nhan deu dugc mo ben trai.
S6 lugng tmh mach tinh bi gian:
1 tinh mach gian: 29 (70,7%) 2 trnh mach gian: 12 (29,3%)
BiSn chiing sau ra6: co 1 benh nhan bi nhilm trimg thay bang hang ngay.
. ei mo chi can diing khang sinh va
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NGOAI KHOA S6BACBI£T 1,2,3/2012 Bang 3: Cai thien trieu chung lam sang sau md Trieu chu'ng
Dau tiVc vijnq ben, biu Khoi phonq tren biu Scf thay bui tTnh mach gian viing biu
Khong doi 07 (17%) 03 (7,3%) 03 (7,3%)
Giam 34(83%) 38 (92,7%) 38(92,7%)
Cong 41(100%) 41(100%) 41(100%)
Sieu am Doupler mau: dupe thyc hien tren 21 benh nhan sau md tir 3-6 thang.
07 benh nhan cdn tTnh mach gian <
2inm.
14 benh nhan khdng cdn tTnh mach gian.
Xet nghiem tinh dich dd: thuc Men d 14 b?nh nhan:
Cai thien vk tinh dich dd: 8 benh nhan Khdng cai thien: 6 benh nhan.
(Cae benh nhan khac khdng xet nghiem tinh dich dd do cac ly do khac nhau nhu:benh nhan chuyen don vj cdng tac, benh nhan khdng hpp tac...)
IV. BAN LUJsiN
Mdt sd tac gia cho rang md md van la phucmg phap thdng dung vi khdng can gay me, khong xay ra cac tai bien bien chung nhu md ndi soi: tdn thuang ruot, tdn thuang mach mau, dinh ruot sau mo...[1,6].
Cho d6n nay nhidu tac gia da ch^p nhan 3 phuong phap diSu tri gian tinh mach tinh cd ket qua gin tuong duong nhau la md md, md ndi soi va lam t4c mach. Tai Benh vien 103 chiing tdi thudmg ap dung 2 phuong phap la md md va ndi soi sau phiic mac that tTnh mach tinh gian, Cung nhu da sd cac tac gia khac, khi phlu thuat md that tTnh mach tinh gian phai ludn chii y bao tdn ddng mach tinh [4,7].
Phau thuat nhkm muc dich lam giam trieu chimg lam sang va cai thien chat luong
tinh triing. Theo nghien cuu cua chiing tdi da sd benh nhan: x% cd cai thien cac trieu chung lam sang, tuy nhien van cdn mdt sd benh nhan sau md van chua thoa man: benh nhan vin cam thay dau tuc vimg biu, nhung benh nhan nay khi kiem tra bang sieu am Doupler mau thay cd tTnh mach gian, tuy nhien miic dp nhd hon khi chua phau thuat.
Nhieu phau thuSt vien Tiet nieu. Nam khoa tin rang dieu tri gian tTnh mach tinh dem lai loi ich cho benh nhan vd sinh nam.
Nhieu nghien cim cho thay dieu tri gian tTnh mach tinh khdng nhiing giup ngan ngira suy giam chiic nang ma cdn giiip hdi phuc tdn thuong tinh hoan, thdng qua tang dp di ddng, chat lupng tinh triing... (David 2001, Marcello 2008). Cho den nay, dieu tri gian tTnh mach tinh bang phau thuat tren cac benh nhan vd sinh nam da phat trien nhanh chdng tai nhieu trung tam, benh vien. Cac bac sT Nam khoa va Tiet nieu thucmg cd khuynh hudng dieu tri bang phlu thuat, cac bao cao kdt qua ban dau cung phan nao giiip chimg minh hieu qua cua phuang phap dieu tn nay.
Ngoai ra, dieu tri gian tTnh mach tinh cd chi phi thip, hieu qua va phii hap cho nhieu ddi tuong [1].
Kdt qua ciia chiing tdi cd 8/14 benh nhan cd cai thien tinh dich dd sau md. Agarwal va cs. (2007) chimg minh phuang phap phlu thuat tren ben va vi phau lam tang cd y nghTa thdng ke v6 mat mat dp, do di ddng va hinh thai ciia tinh triing [2]. Al-Kandari nghien
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BAI HOl H 6 | NGOAI KHOA VN LAN THCT XII VA H 6 | NGHI KHOA HOC NGOAI KHOA TOAN Q U 6 C LAN THtf XIV
cuu tren 120 benh nhan cho ihiy ti le tang dp di ddng va mat dp tinh triing ddi vdi phuang phap phau thuat md, ndi soi va vi phau Van luat la 65%, 67%, 76% [3].
V. KE'T LUAN
Gian tTnh mach tinh la mdt benh kha phd bien d nam gidi. Dieu tri phau thuat, nhat la tren benh nhan vd sinh nam la mdt chi dinh dieu tri phd bien hien nay tren the gioi va d Viet nam do chi phi thSp, cd hieu qua...
Cd nhieu phuong phap phau thuat, tuy nhien phau thuat md that tTnh mach gian van la mot phuong phap don gian, it bien chiing va cd the ap dung d nhieu tuyen y te. Tuy nhien phai chii y bao tdn ddng mach tinh va theo ddi benh nhan mdt each cd he thdng.
TAI LIEU T H A M KHAO.
1. Nguyen Thanh Nhir (2006). "Gian tTnh mach thimg tinh. Ly thuyet Nam khoa ca ban". Nhd xuat ban Yhoc, trang 37-44.
2. Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Short RA, Sabanegh E, Marmar JL (2007). "Efficacy of varicocelectomy in improving semen
parameters: new meta-analytical approach". Urology 70, 532-538.
Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA (2007)
"Comparison of outcomes of different varicocelectomy techniques :open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial". Urology 69, 417^20.
Cayan S, Shavakhabov S, Kadioglu A (2009)., "Treahnent of palpable varicocele in infertile men: a meta- analysis to define the best technique". J Androl 30, 33-40.
Dubin L, Amelar RD (1977).
"Varicocelectomy: 986 cases in a twelve- year study". Urology 10, 446^49.
Goldstein M (2002). "Surgical management of male infertility and other scrotal disorder. In Walsh PC et al Eds, Campbell's Urology". W.B Saunders:
1532-1587.
Salem HK, Mostafa T (2009).
"Preserved testicular artery at varicocele repair". Andrologia 41,241-245.
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