T C N C Y H Phg trUdng 80 (3B) - 2012
experience viiith 200 cases. T h e Journal of 12, Narmada P. Gupta, Rajiv Goel, Ashok Urology 160: 1265 - 1 2 6 9 , K, Hemal (2004). Should retroperitoneoscopic 11, Joseph J . Delpizzo, Stephen S. nephrectomy be the standard of care for Jacobs, Bishoff Jl (2003). Pleural Injury ' " = " ' 9 " nonfunctioning kidneys? An outcome During Laparoscopic Renal Surgery: Early analysis based on experience with 449 cases Recognition and Management. The Joumal of ' " ^ ^'l^"' ^''"°^- ^ h e Jounial of Urology Urology 1 6 9 : 4 1 - 4 4 . 172: 1411 -1 413.
summary
O U T C O M E S OF RETROPERITONEOSCOPIC NEPHRECTOMY FOR NON FUNCTIONING KIDNEYS
The first retroperitoneoscopic nephrectomy (RPN) was done by Gaur in 1993 for treatment the nonfunctioning kidney The study evaluate the safety efficacy and our experiences to expand the use of this technique surgical for the treatment of nonfunctioning diseases of the kidney 35 patients underwent RPN between January 2006 and September 2011 at Viet Due Hospital including 7 males and 23 females who had age ranged from 17 to 78 years (mean 46.8 ± 17.77). RPN indication included: 55.7% non functioning hydronephrosis, 11.4% hypertensive atrophy kidney. 2.9% renal polycystic disease and 20%
duplex kidney and ureter anomalies. We used 4 trocars lor 65.7% cases and 3 trocars for 34.3%. Average time of operation was 124.6 ± 36 minutes. Mean volume blood loss occupies 73.9 ± 39.1 ml. The RPN was difficult in 25.7% relating to the inflammatory renal conditions and obese patients with one converted case. 88.6% RPN was successful. The rate of per and post operative complications was 2.86% and 5,72%
respectively. The mean duration of hospitalization was 5.3 ± 1.7 days (range 2 - 12 days).
Key words: Nonfunctioning kidney, nephrectomy, retroperitoneoscopic surgery
PHAU THUAT NOI SOI OAT CATHETER b BUNG
Di. THAM PHAN PHilC MAC
Pham Viet H a ' , Nguyen Ngoc Bich^, Tran Hu'u V i n h ' , Tran H i l u Hoc^
I" Binh vien B^ch Mai, « Tnriing Dai hpc YHa Npi
Tham phin phuc mac li mpt phuang phip diiu tri nhung benh nhin suy than giai doan cuoi cd hiiu qui. Phiu thuit mo nil sol dat catheter thim phin phuc mac ti mpt phuang phip an toin, dit dupe chinh xic vi tri cua catheter vi It biin chung. Nghien ciyu dupe thuc hien nhim md ta ky thuit vi kit qui cua phau thuit. Kit qui nghiin cim cho thay dd tuii trung binh ciia doi tuxyng nghien cuv ii 44 tuoi: thdi gian mo tmng binh khoing 37 phCif Khong c6 biin chimg ngay vi sau 24 gia sau mi. Cd 02 benh nhin N tic vi di chuyin diu catheter sau 01 thing va 03 benh nhin bi nhiem trung cho duang ra ciia catheter. Phau thuit dat catheter i bpng ndi soi li mpt phuang phip dat catheter chinh xic vao till cung viing tiiu khung
TCNCYH Phy trUdng 80 (3B) - 2012
vi cd tl ti tic catheter ca hpc thip. Tuy nhidn, nhOng blin chirng xa nhw viim phiic m^c, rd vit m6 cir) duxyc nghiin ciiv thim.
TIP khoa: Tham phan phuc mgc, suy thgn I. OAT V A N £)£
Suy thOn mgn l i bOnh khi p h i biln.
Thing ke d Phip ty 10 mdi mic suy thOn mgn giai dogn cuoi l i 120 trudng hpp/1 tnOu din/I nim, d My va Nhgt l i khoing 300 truang hpp /I trlOu din/1 nOm. 0 ViOt Nam theo Trin Vin Chit cd khoing 40,4% ting s l bOnh nhin tgi khoa thOn bOnh viOn Bgch Mai bj suy thOn mgn, theo Nguyin Nguyen Khbi nim 2009 thl eb khoang 6 tnOu chilm khoing 6,73% dan s l bOnh nhan suy Ihgn mgn.
Thim phan phiic mgc hay cbn gpi l i Ipc ming byng d i dupe xic nhgn 10 mOt phuong phip dilu trj thay t h l thgn cb higu qua vdi uu diem l i bOnh nhan suy thgn mgn cb thl sinh hogt, lam vigc tuang doi binh thudng tgi gia dinh v i xa hpi ma khbng bj phy thupc vao bgnh viOn nhu doi vdi Ipc miu bing chgy thgn nhin tgo ViOc dgt catheter vio khoang ming byng la mpt bude quan trpng trong qui trinh thim phan phuc mgc. Phuang phip phau IhuOt m l md dot catheter la phuang phip da dupe su dyng tu nhilu nim nay nhung nhilu nghiOn cuu tren thl gidi d i cho thiy phuang phip nay cd nhieu biln ehung nhu tic catheter, viem phiic mgc, nhiem trung vet mo... Gin day vdi nhung tien bp eua phau thuOt nOi soi ngiy cing ed nhilu bgnh nhin dupe thyc hiOn dgt catheter I byng nOi soi vdi uu diem higu qua, an toan v i l i phuang phap it xim lin doi vdi ngudi bgnh, mgc dti vgy d ViOt Nam hiOn van chua eb bio cio cy t h l nio ve ky thuOt cung nhu kit qu^ cy the v l phuang phip phau thugt n i y Bio cio nay cua chiing tdi nhim myc tiOu mb t i ky thuOt va dinh gii ket qua cCia phuang phip phau thugt npi soi dgt catheter I byng de tham phin phuc mgc.
II. D6\ TU'tp'NG VA PHU'aNG PHAP 1. Doi lu'p'ng nghien ciPu:
40 bOnh nhin dup'e dOt catheter I byng bing phuang phip nbi soi tii' thing 1 nim 2010 din thing 08 nam 2011 tgi khoa ngogi bOnh viOn Bgeh Mai
2. Phuang phap nghien cuu:
NghiOn eu'u dupe tiln hinh theo phuang phap mb la hli cdu trOn tit c i ho sa bgnh an cua bOnh nhin dugrc phiu thuOt.
Mb t i phiu thugt BOnh nhan dupe gay mO toin thin, nim ngua. 03 trocar dupe d|t thed cie bude sau
Trocar 1: Chiing tbi thudng su dyng trocar 5 mm dgt d vj tri ngay dudi ron. Bam COj vao I byng vdi i p lye l(y 12 d i n 14 mmHg va du'a camera dudng kinh 5 mm qua trocar nay dl quan sit v i danh g i i I byng.
Trocar 2: Dgt trocar 10 mm ngang ron trOn dudng gi&a ddn trii d l dua catheter qua trocar niy vao I byng.
Trocar 3: l i trocar 5 mm dup'C dOt d viing hg vj dudng giua ngay trOn xuang mu.Oua trocar niy chiing tbi su dyng kgp phau tich de dot diu catheter vio dung liii cung Douglas va kOo nut chi buOe vao catheter c l djnh catheter vio thanh byng.
Sau khi da dgt catheter dung vj tri khSu cuff 1 vdi phuc mgc.
Dung dui cong tgo dudng him v i kit nil catheter vdi tui djch d l kiem tra dbng chay vio ra. Sau khi kilm tra xong catheter dupe dOy nip kin cb heparin trong Ibng catheter va se dupcsi^
dyng d l thim phin phuc mge sau 02 tuin.
146
TCNCYH Phy trUdng 80 (3B) - 2012
Hinh anh catheter dup'e dgt vao tiii cung vj tri trocar va dudng ra catheter III. K^T QUA
Trong 40 bOnh nhan dupe phiu thugt dgt catheter I byng npi soi thi cb 22 bgnh nhan nam chilm 55% v i 18 bgnh nhin ntf chilm 45%. dp tuli trung binh la 44,6 ± 13,5 tuoi thip nhit 17 tuoi v i cao nhat la 82 tuoi. Thdi gian trung binh thyc hiOn phiu thugt la 37,5 ± 4,1 phiit vdi ca thyc hign nhanh nhat ehi mit 25 phut, ca keo dai nhat la 50 phiit.
Cae biln chung ngogi khoa trong 24 gid diu sau m l -Thung tgng rbng; khdng cd trudng hpp nio - Chay mau trong I byng: khdng cb trudng hpp nao - Chay miu vlt mo; khdng gap trudng hpp nao - Tic catheter khdng ggp sau 24h diu sau mo Cic biln chung ngogi khoa sau theo doi 01 thing
-Tie va di lech catheter: gap 02 tordng hp-p chiem 5% do mgc nil Idn quan v i do tyt nut buOc ed dinh catheter vao thinh byng tarde; djch vio tdt nhung djch ra yOu hoge tie hoan toin.
Cac nguyen nhan gay t i c catheter nhu do nut fibrin, cac tang chen ep, xoin vgn catheter:
khong ggp tordng hap nao.
- Thoai V! bgn va thoit vi thinhiiyng: khdng gap trudng hp'p nao - Tic rupt va thung tang rbng khdng gap trudng hpp nao y kien bgnh nhan
- 07 bgnh nhin thay hai Ibng vdi phau thugt
- 28 bgnh nhan thay day I i phau thugt chip nhOn dupe va catheter dung ngp tot -05 bgnh nhan khbng thiy hii long vdi phiu thugt
TCNCYH Phg truong 80 (3B) - 2012 Bang 1. O^c d l l m cua nhom ni Tuoi
Gldl
Thcyl gian phSu lhu$t Thd'i gian nam vi0n sau phlu thu^t ChSy mdu trong 1 bgng Chay mSu vlt m l Tic catheter Djch rd quanh vlt m l Viem phuc mac Thung tang ring Thoat vj ben, thoSt vj vlt m l Tic mOt sau m l
Nhilm tnjng ch§n catheter vA dudrng him Bang 2,
\ , , ^ BN
Y kiln ^ \
Hal long Chap nh|n du{?c Khong thl chju dup'c Tong
ghlen ciju va biln chu'ng cua phau thult Tmng binh 44,6 ±13,5
Nam: 22, nO': 18
TO' 25 ain 40 phiit, tmng binh 37,5 ± 4,1 phut Trung binh 1 ngdy
0 tnj'iiyng h{?p 0 2 (5%) 0 2 (5%) 0 0 0 3 (7,5%) Ykien benh nhan
n
7 28 5 4 0
%
17,5 70 12,5 100 IV BAN LUAN
Lya chpn phuang phip, ky thuOt dOt catheter I byng cb y nghTa quan trpng vi nd anh hudng din chdc ning,thdi gian su dyng, biln chung cua catheter eung nhu la ehit lup'ng cupc song cua ngudi bOnh sau nay.Vi vgy phau thugt dgt catheter I byng can dupe coi trpng nhu mpt can thigp phiu thugt thyc thy, can dupe quan tim va ddi hbi sy ehu y nhu cic logi phlu thugt khic [4,5]. Phiu thugt dOt catheter Ipc ming byng qua npi soi o byng da dupe nhieu phau thugt vien thyc hiOn v i cho
thiy l i mbt phuang phip hiOu qui, an toan, it xam lin d i i vdi ngudi bgnh [1,2,3,4,7,8]. John Cablree eho rang su dyng gay tO tai eho thi tot han cho bgnh nhan suy thgn (4) nhung chiing toi cho la nOn giy me toan than l i an toin han vl bgnh nhin suy thOn thudng cd eao huylt ap, cin gay me toin than d l kilm soit huylt ap v i dudng thd tot han. Hossein Ashegh va Stephen P va cpng sy cung nhiOu t i c gia khac cung cd quan dilm nhu chCing tbi [3,7,10].
Nhieu ky thugt npi soi o byng dgt catheter dS dupe mb ta v i thyc hign bdi nhu'ng dyng cy
148
T C N C Y H Phy trUdng 80 (3B) - 2012
dupe thiet ke chuyen bigt d khoa ngogi chiing tbi chi s u dyng nhu'ng dyng cy n h u dyng cy mb ndi soi 6 byng t h u d n g quy n h u nhO'ng p h i u thugt npi sol I byng k h i e . Npi soi o byng eho phep nhin rd va dgt catheter diing vj tri d n u la tOl ciing bang quang t u cung, d nam la tiii cung bang quang tryc trang. Vigc dgt sau d i u catheter v i o tui ciing ed t h l gay ra dau viing hg vi nhu bao eao cCia Stephen P va cpng s y [10]
nhung chung tdi khdng thay t r u d n g h p p nao.
B i l n chung t i c catheter 6 byng sau khi dgt ndi soi, Crabtree bao eao eb 12.5% [4], chiing tbi cb 2 bgnh nhan l i e catheter la do mac noi Idn d i n q u i n vao phai mo Igi d l g d mgc noi. Nhieu nghien e u u cua Crabtree va Ogunc [3,7] eho thay khdng cd t r u a n g h p p nao t i e catheter neu cd them thu thugt khau co d[nh mgc noi Idn vao thanh byng khbng cho mgc n i l Idn di chuyen xuong viing lieu khung.
Mpt so bao cao ed eat mgc noi Idn nhung van cb ti le n h i t djnh t i c catheter [2,3,7,9]
Viem phuc mac; nguyen nhan do n h i l m vi khuin hogc nam vi catheter lam thdng o byng vdi mdi t r u d n g bOn ngoai. Hossein Ashegh thay cd khoang 2,5% t r u d n g h o p viem phiic mac [3], Mark la 5,26% [6], Stephen va cdng sy la 6,5%, Po-Jen Yang la 7,9% [10]. Chimg tbi thay cb 02 t r u d n g h p p (chiem 5%) viem phiic mac sau mo dieu tri khang sinh khbng cb higu qua phai lay bb catheter Bien chu'ng xay ra do benh nhan khdng dam bao cac nguyen t i c vd khuan khi t h y c hien qua trinh tham phan.
N h i l m triing chan catheter chung tbi gap 03 tnj'dng hap chiem 7,5%,Po-Jen Yang gap 11,8% trudng hp'p n h u n g Abdullah Igi khbng gap trudng h p p n i o [1].Bien chung n i y t h u d n g gay khb chiu cho n g u d i bOnh n h u n g dieu trj bang khang sinh loan than, s i t k h u i n tgi cho thl cb higu qua.
Rd djch d chan catheter; Kent khdng ggp trud'ng h p p nao [5], Markus gap 21,74% [7], Ahmed gap 22,2% [2]. Ti Ig gap bien chirng nay d cac bao cao khac la tii' 2 den 28%
[3,6,9]. Ro r i n g day la bien chii'ng hay ggp chu yeu ciia p h i u thugt npi soi do thi khau cuff 1 vao phuc mac I h u d n g khd khan. Chiing tdi khbng cd trudng h p p nao vi hau h i t d thi nay chung Ibi deu rgch rpng da chd dua trocar 10 mm d l ed phau t r u d n g khau cuff 1 vao phiic mgc du'p'c tdt h a n .
V K^T LUAN
P h i u thugt dat catheter I byng qua ndi soi 0 byng la mpt phuo'ng phap cd u u diem nhanh, an toan, giam thieu d u p e cac b i l n chirng ngoai khoa I h u d n g gap n h u t i c , di Igch catheter do quan sal d u p e rb rang o byng, dat va cd dmh d u p e catheter dung vj tri t u dd lam giam ty te phai p h i u thugt Igi hogc rill bd catheter.
T A ! L I E U T H A M K H A O 1.A bdullah Al-Dohayan, MD (1999), Laparoscopic placement of peritoneal dialysis catheter (same day dialysis), Journal of the Society of Laparoendoscopic Surgeons, 3;
327 - 329.
2. Ahmed M AI-Hasemy, Wlohamed I Seleem (2004), Laparoscopic placement of peritoneal dialysis catheter; A preliminary report. Kidney Dis Transpl, 1 5 : 1 4 4 - 1 4 8
3. Hossein Ashegh, Jala! Rezaii, Khali!
Esfandiari (2008), One port Laparoscopic techniquefor placement ofTenckhoff peritoneal dialysis catheters; Report nf seventy-nine procedures, Peritoneal dialysis international, 28; 622 - 625.
4. John H. Crabtree and Arnold FIshman (2000), A Laparoscopic approach under local anesthesia for peritoneal dialysis access".
T C N C Y H Phy trUdng 80 ( 3 8 ) - 2 0 1 2
Peritoneal dialysis international, 20: 757 - 765.
5. Kent Skipper, M D , R i c h a r d D I c k e r m a n , MD, Ernest D u n n , M D (1999), Laparoscopic Placement and revision of peritoneal dialysis catheters. Journal of the Society of Laparoendoscopic Surgeons, 3: 63 - 65
6. Mark J . W r i g h t , K h a l i d B e l ' e e d , B r i a n F.Johnson (1999) Randomized prospective companson of laparoscopic and open peritoneal dialysis catheter insertion, Peritoneal Dialysis International, 19: 372 - 375.
7. M a r k u s D a s c h n e r , Stefan Gfrorer, Otto Mehls (2002),. Laparoscopic Tenckhoff catheter implantation in children. Peritoneal Dialysis International, 22. 22 - 26.
8. M i c h e l e G i a n n a t t a s i o , R o b e r t o L;
R o s a a n d A l b e r t o B a l e s t r a z z i (1999), IHov can videolaparoseopy be used in a peritonea dialysis programme, Nephrology Dialysis Transplantation, 1 4 : 4 0 9 - 4 1 1 .
9.P.Soontraporachal,T.Simapatanaponc (2004), Comparison of open and laparoscopic secure placement of peritoneal dialysis catheter Surgical Endoscopy 19- 137 - 1 3 9
10. S t e p h e n P H a g g e r t y , MD, Tallal M.Zeni, MD (2007) Laparoscopic peritoneal dialysis catheter insertion using a Quinton percutaneous insertion kit. Joumal of the Society of Laparoendoscopic Surgeons, 11;
2 0 8 - 2 1 4 . S u m m a r y
L A P A R O S C O P I C P E R I T O N E A L CATHETER P L A C E M E N T
Peritoneal dialysis is an established and well-known technique for renal replacement therapy in patients with end-stage disease. Laparoscopic peritoneal catheter placement Is efficient, safe and minimally invasive to the patient and is becoming a preferential approach in a growing number of centers.
The aim of this report is to describe our technique and outcomes. The results showed that there were 22 males and 18 females with a mean age of 44 years (range 17-62 years). The mean operating time was 37 minutes (range 25 - 50 minutes). There were no complications dunng the operation and after 24 hours postoperation. Two patients (5%<,) had obstruction and migration of pentoneal dialysis catheter after one month of laparoscopic placement. Three patients (7.5%o) had Infection of exit site. In conclusion, laparoscopic implantation places the catheter accurately in the pelvis and has a lower rate of mechanical obstruction. However the complications of catheter migration, infection of exit site, leakage are the points to a need for further studies.
KeyvhTords: P e r i t o n e a l d i a l y s i s , renal r e p l a c e m e n t
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