Y HOC VIET NAM THANG 11 - SO 2/2010
dugc md bat con. Trong trudng hgp md bat con, phau thuat vien nieu khoa nen cd mat trong cugc md de phdi hgp vdi cac bac sT san khoa nham tranh pham phai bang quang tan
tao trong liic md. nVw ' ' ; ' ' • ' TAI UEU THAM KHAO
/. Akihisa T, Hidehiro K, Masashi M, Katsuya N, Tomohiko K. (2002) Management of Pregnancy and Delivery After Augmentation Cystoplasty. Japanese J Urol 93 (l):39-43 [abstract]
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C. (2002). Pregnancy in patients with spina
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4. Norris JP, Wheeler JS, Norris DM, Rubenstein MA (1995). Augmentation Cystoplasty and Ileal Conduits in Pregnancy.
Int Urogynecol 6: 37 - 40
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6. Shaikh A, Ahsan S, Zaidi Z.(2006).
Pregnancy after augmentatin cystoplasty. J Park Med Assoc 56 (10): 465-467
7. Yamazaki Y, Yago R, Toma H, Onodera J, Nakabayashi M (1997). Pregnancy after augmentation cystoplasty. A case report . Nippon Hinyokika Gakkai Zasshi. 88(6):632- 5 [abstract].
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VI PHAU COT TINH MACH TINH GIAN HAI BEN NGA BEN ~ BIU 0 TRE EM TAI BENH VIEN BINH DAN TUfZOOS DEN 2009
T6MTAT
Muc tieu: khao sat dac diem gian tinh mach tinh d tre em va danh gia hieu qua cua vi phau cot linh mach tinh gian hai ben nga tien biu d be em.
Ddl tu'dng va phu'dng phap nghien cu'u:
Nghien ciru tien ciru md ta lam sang. Odi tUdng la nhu'ng benh nhi tai khoa Nam hgc, benh vien Binh Dan dUdc dieu trj gian tinh mach tinh bang vi phau cot tinh mach tinh gian hai ben nga ben biu, tir 2/2005 den 12/2009. Benh nhan dUdc theo doi tinh trang dau biu, the tich tinh hoan sau md it nhat 3 thang.
IVIai Ba Tien Dung , Nguyen Thanh Nhu '
Ket qua: 21 benh nhi. Tudi trung binh la 14,13 ± 1,72. Ly do vao vien la dau biu (82,5%), nong biu (12,5%), biu to ben trai (5%). Quan sat khi phau thuat ghi nhan cd gian tinh mach tinh hai ben 6 tat ca cac trUdng hdp. Khdng ghi nhan nhiem trimg vet md hay tu rnau biu trong thdi gian hau phau. Theo ddi sau 3 thang khong ghi nhan teo tinh hoan, tran djch tinh mac hay gian tinh mach tinh tai phat. Tat ca benh nhan deu het cam giac dau biu
Ket luan: Gian tinh mach tinh fa benh ly ciia hai ben thirng tinh. Vi phau cot tinh mach tinh
Khoa Nam hoc, benh vien Binh Ddn TP. HCM (Department of Andrology, Binh Dan hospital).
HOI NGHj KHOA HOC LAN T H Q IV • HQI TIET NIEU - THAN HOC VIET NAM
gian hai ben nga ben biu trong dieu tri gian tTnh mach tinh d tre em mang lai hieu qua tdt.
Tu' khoa: gian tinh mach tinh, vl phau cot tfnh mach tinh gian hai ben nga ben - biu.
ABSTRACT
Bilateral scroto-inguinal microscopic varicocelectomy in children at Binb Dan
hospital from 2005 to 2009
Objective: Evaluating the characteristics of varicroele in children and the efficacy of bilateral scroto- inguinal microscopic varicocelectDmy in chiWren.
Methods: Clinical prospective study.
Pediatric patients admitted at Department of Andrology, Binh Dan hospital underwent bilateral scroto-inguinal microscopic varicocelectomy from February 2005 to December 2009. Follow-ups were focused on scrotal pain, hydrocele and testicular volume at least 3 months after surgery.
Results: 21 children. Average age was 14,13 ± 1.72. The chief complaints were scrotal pain (82.5%), hot scrotum (12.5%), enlarged left scrotum (5%). Varicocele on both sides were observed in all cases. No wound infection or scrotal hematoma were recorded in postoperative period. Testicular atrophy, hydrocele or recurrence were not found at 3-month check-up.
Scrotal pain was subsided in all patients.
Conclusions: Varicocele is a bilateral disease. Bilateral scroto-inguinal microscopic varicocelectomy in children had good efficacy.
Key-v/ords: microscopic varicocelectomy, varicocele.
I. OAT V A ' N o f
Gian tinh mach tinh (GTMT) la tinh trang benh ly bieu hien gian va xoan thanh
timg dam rdi ciia tinh mach tinh trong thimg | tinh '. Benh nay cd the gap sau 10 tudi. Ngay ] cang cd nhieu tac gia day la benh ly cua hai <
ben thimg tinh. Theo Trussell (2003) '° ty le | GTMT hai ben dugc ghi nhan la 77,5%, Gat i (2004) • ciing ghi nhan tinh trang GTMT hai j ben la 80,8%. Nguyen Thanh Nhu ^ cung ghi j nhan benh ly GTMT la benh ciia hai ben : thimg tinh.
Tai Viet Nam, viec dieu tri GTMT da dugc thuc hien tai cac benh vien. Tuy nhien, ^ chiing tdi chua ghi nhan viec ap dung vi phlu trong dieu tri GTMT d cac benh nhi. Do vay, chiing tdi tien hanh nghien ciiu de tai nay nham khao sat dac diem GTMT d tre em va \ danh gia hieu qua vi phau cdt tlrih mach tinh ;
gian d tre em. ]
II. odi TUONG VA PHUONG PHAP NGHIEN COU j
Tat ca cac trudng hgp dieu tri GTMT a i
tre em cd ap dung ky thuat vi phau da dugc j
tien hanh phau tai Khoa Nam hgc - Benh I
vien Binh Dan tir thang 02 nam 2005 den !
thang 12 nam 2009. Nghien ciiu tien ciiu mo 1
ta lam sang. Dich te hgc lam sang ghi nhan \
tudi, noi cu tni, tien sir benh, thdi gian khdi \
phat trieu chimg, ly do kham benh. Kham !
lam sang ghi nhan miic do GTMT, ben bi j
GTMT, the tich tinh hoan. Xet nghiem noi j
tiet bao gdm FSH, LH, testosterone. Sieu am j
Doppler ben biu. Phau thuat dugc thuc hien \
bdi cac bac sT khoa Nam Hgc benh vien Binh \
Dan. Ghi nhan phuang phap phau thuat: so I
dudng md, cac bien chimg. Benh nhan dugc \
tai kham sau 1 thang, 3 thang, 6 thang ve tinh j
trang dau biu, dau vet md, thi tich tinh hoan, \
gian tinh mach tinh tai phat hay khdng. j
Y HOC VIET NAM THANG 11 - 5 0 2/2010
III. KET QUA
Trong thdi gian nghien ciiu, chiing tdi da tien hanh phlu thuat GTMT vdi ky thuat vi phau cho 24 benh nhi. Tudi trung binh: 14,13±1,72 tuoi (10-15).
Ly do nhap vien: 82,5% la dau biu, 12,5%) nang d biu, 5%> biu to.
The tich tinh hoan phai la 8,86 ± 1,96 cc, trai 8,24 ± 1,79 cc.
Ket qua kham lam sang GTMT (bang 2):
Bdng 1. Miic do GTMT khi kham lam sang.
GTMT
Khdng D d l Do 2 Do 3
Biu phai n
8 5 5 6
% 33,33 20,83 20,83 25%
Biu trai n
0 4 10 10
% 0 16,66 41,67 41,67
Cd 6 trudng hgp GTMT nang ca hai ben. Sieu am Doppler biu: GTMT trai 79,2%, GTMT hai ben 20,8%). Quan sat khi phau thuat ghi nhan cd hien tugng gian tinh mach tinh hai ben d tat ca cac trudng hgp. Chirng tdi tien hanh so sanh gia tri chan doan GTMT bang kham lam sang, sieu am Doppler biu va quan sat khi phau thuat (bang 2):
Bdng 2: So sanh lam sang, sieu am va quan sat khi phau thuat.
Khdng ghi nhan Co GTMT
Tinh hoan va thuTng tinh phai Lam sang
33,33 66,67%
Sieu am 79,2%
20,8%
Quan sat 0%
100%
Tinh hoan va thieng tinh trai Lam sang
0 100%
Sieu am 20,8%
79,2%
Quan sat 0%
100%
Theo ddi hau phau khdng ghi nhan cac bien chiing tu mau biu, nhiem trimg vet md, gian tinh mach tinh tai phat, dau biu keo dai, teo tinh hoan.
) . - . 1 . ,
IV. BANLUAN
1. Tuoi benh nhan
Trong nghien eim ciia chiing tdi, tudi benh nhi nhd nhat la 10 tudi va ldn nhat la 15 tuoi. Theo Riedmiller*, GTMT thudng khdng xay ra d tre dudi 10 tudi va khi tre day thi t4n suk GTMT khoang 15 - 20%), tuong duang d ngudi nam trudng thanh. O nhiing tre GTMT nang, ghi nhan 20%o cac trudng hgp lien quan din vd sinh khi trudng thanh, tinh hoan giam sinh tinh . . ,,,, -.^
2. Ly do nhap vien
GTMT thudng khdng cd trieu chiing.
trieu chiing thudng gap nhat la dau biu . Trong nghien ciiu ciia chiing tdi, trieu chiing dau chiem 82,5%o trudng hgp. Trieu chung ndng biu chiem 12,5%, cd le lien quan den sir tang nhiet do biu do li dgng mau tinh mach.
Biu to do GTMT do 3 gap trong 5% benh
nhan ciia nghien ciiu nay. Biu to thudng do
cha me benh nhi phat hien, ddi khi nham
tudng vdi thoat vi ben. Cayan' ciing ghi nhan
ty le tuang tu trong nghien eim va dua ra
hinh anh nhiiTig biii giun d biu trong nhiing
trudng hgp GTMT nang.
HOI NGHI KHOA HOC LAN THLT IV • HQI TIET NIEU - THAN HOC VIET NAM
3. Bien phap chan doan xac dinh GTMT
Theo cac tac gia Riedmiller^ Cayan' thi kham lam sang la phuang phap chinh de kham va phat hien GTMT. Trong nghien ciiu nay, sieu am Doppler biu chi phat hien dugc 79,2% GTMT ben trai va khdng ghi nhan GTMT ben phai. Tuy nhien khi tien hanh phlu thuat, chimg tdi khao sat hai ben va ghi nhan tat ca deu cd GTMT hai ben. Trong nghie'" au cua Mai Ba Tien Diing'', khao sat do nhay cua sieu am 81,5%) va do dac hieu la 59,6%. Theo Dhabuwata \ 40% nhimg benh nhan vd sinh nam khdng cd dau hieu cua gian tinh mach tren sieu am nhung lam sang cho thay cd gian tinh mach tinh d do 1 va do 2.
Do vay, sieu am Doppler biu chi mang tinh tham khao trong chan doan GTMT .
4. Lua chgn phuong phap phau thuat Muc tieu cua dieu tri GTMT la het trieu chiing dau va du phdng hiem mudn sau nay cho benh nhi. X quang can thiep lam tac mach cd ti le bien chimg chung la 6%) nhu thung mach mau, thuyen tac mach . Phau thuat cot tinh mach tinh nga sau phiic mac cd ti le tai phat cao. Phau thuat ndi soi d bung cd ti le thanh cdng tuang tu phau thuat nga sau phiic mac; tuy nhien ndi soi d bung lai tdn kem nhieu va bien phau thuat dieu tri GTMT tir ngoai phiic mac thanh phau thuat qua phiic mac vdi nguy ca tdn thuang rudt va cac tang trong d bung^. Phau thuat nga ben vdi dung cu vi phau cd ti le tai phat thap han va bao tdn dugc ddng mach tinh, bach mach; bat lgi la dau vimg ben sau md. Phau thuat nga dudi ben cd iihirng thuan lgi tuong tu nhu phlu thuat nga ben va it dau han do khdng cat ca, tuy nhien kho cdt het tinh mach do cac tinh
mach phan nhilu nhanh nhd, va dd dd di ton \ thuang cac ddng mach ^.
Chiing tdi chgn phuang phap vi phau | thuat cdt tmh mach tinh gian. Kinh liip x3.0 j cd hieu qua tuong duang kinh hien vi phau \ thuat vi chi can bdc tach cac mach mau trong thimg tinh chii khdng can khau ndi. Cung \ nhu Goldstein ^, chiing tdi khdng ghi nhan i bien chiing sdm hau phau, ciing nhu cac bien j chiing tre nhu teo tinh hoan, gian tinh mach \ tinh tai phat, tran dich tinh mac.
V. KET LUAN
Cling nhu d ngudi ldn, GTMT d tre em ; la benh ly cua ca hai ben thimg tinh - tinh i hoan chii khdng phai chi ben trai. Kham lam I sang cd gia tri chan doan cao ban sieu am { Doppler biu. Vi phlu thuat cdt tinh mach tinh gian nga ben - biu hai ben dap iing cac yeu cau: khdng de GTMT tdn tai hay tai phat, khdng lam hu hai cac ddng mach tinh, bach | mach va than kinh.
TAI LIEU THAM KHAO
1. Cayan S (2002). Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the \ testicular volume: using the Prader \ orchidometer versus ultrasonography. Urol j Int; 69(4):293-296.
2. Chiou RK, Anderson JC, Wobig RK, Rosinsky DE, Matamoros A Jr, Chen WS, j Taylor RJ (1997). Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical ; examination. Urology; 50(6):953-956. j 3. Dhabuwala CB, Kumar AB, Kerkar PD, I
Bhutawala A, Pierce J (1989). Patterns of I Doppler recordings and its relationship to i
Y HOC VIET NAM THANG 11 - SO 2/2010
varicocele in infertile men. Int J Androl;
12(6): 430-438.
4. Mai Ba Tien Dung, Nguyen Thanh Nhu- (2008). Vai tro cua sieu am Doppler trong chan doan gian tTnh mach tinh. Y hgc thirc hanh, s6 631+632, 110-113.
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6. Goldstein M., Gilbert BR, Dicker AP (1992). Microsurgical inguinal varicocelectomy with delivery of the testis:
an artery and lymphatic sparing technique. J Urol; 148(6): 1808-1811.
7. Nguyen Thanh Nhu-, Tran Chung Thuy, Mai Ba Tien Dung (2010). Vi phau thuat cot tTnh mach tinh gian hai ben nga ben-biu: hieu
qua dieu tri trong hiem muon nam. Y hoc TP.
H6 Chi Minh, tap 14, phu ban cua s6 2,43-47.
8. Riedmiller H, Gerharz E, Hoebeke P, Kocvara R, Nijman R, Radmayr C, Stein R (2009). Guidelines on paediatric urology.
European Association of Urology, European Society for Paediatric Urology; 23-25.
9. Sandlow JI,Winfield HN, Goldstein M (2007). Surgery of The Scrotum and Seminal Vesicles. In Campbell -Walsh Urology, 9"' Ed, Saunders-Elsevier, Philadelphia, 1098-' i?8.
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35(1):115-118.
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