Y Hoc TP. Hb Chi Minh * Tap 20 * So 4 * 2016 N g h i e n cmi Y hoc
NGHIEN CLfU DAC DEM LAM SANG, CAN LAM SANG SOI NIEU SAU GHEP THAN
Truang Hodng Minh*, Trdn Tharih Phong*, Trdn Hdi Phong*, Bui Duy Luqt*, Do Anh Ddc*, Trdn Le Duy Anh*, Li Dinh Him*, Truong Sy Vinh*, Nguyin Vdn Tri Dung*, Nguyen Phuoc Hdi*,
Trdn Phuc Hoa * Hd Thi Minh Chdu *, Nguyen Thi Nghia *, Nguyen Nggc Anh *, Phan Vdn Bdu * Muc tieu: Trinh bdy dqc diim lam sdng, can sdng sdi nieu tren birih nhdn ghep than dugc theo doi tgi benh zriin Nh&n D&n 115.
Benh rdian vd phuang phdp: hoi cuu moid cac tne&ng hap lam sdng
Ket qua vd bdn luan: cd 2 tru&ng hap (TH) soi niiu (ti li 1,69%). cd2ld nam, turn trung binh:39,5 turn, nguyin nh&n gay sdi do hep chd ndi nieu qudn (NQ) vdo bdng quang (BQ). Cd2TH dugc tdn sdi ndi sot ngugc ddng thdnh cdng.vd cam lai NQ vdo BQ theo Leadbeter - Politano thdnh cdng.
Kei ludn: Ti li soi niiu sau ghep than thdp, nguyen nh&n do hep vd dj vgt du&ng tiii niiu. Ngi soi nieu qudn ngugc ddng ohg cieng vd niem v&i laser tdn soi la phuang tiin an todn vd hiiu qud.
Tie khda: Soi nieu, ghip th&n.
ABSTRACT
STUDY CLINICAL AND PARACLINICAL CHARACTERISTICS OF UROLTTHLASIS IN RENAL TRANSPLANTATION
Truong Hoang Minh, Tran Thanh Phong, Tran Hai Phong, Bui Duy Luat, Do Anh Ehic, Tran Le Duy Anh, Le Dinh Hieu, Tmong Sy Vinh, Nguyen Van Tri Dung, Nguyen Phuoc Hai, Tran Phuc Hoa, Ho Thi Minh Chau, Nguyen Thi Nghia, Nguyen Ngoc Anh, Fhan Van Bau
* Y Hoc TP, Ho Chi Minh * Vol. 20 - No 4 - 2016: 63 - 67 Objectives: To report clinical and paradinical characteristics of urolithiasis in renal transplantation at 115 people's hospital
Patients and Methods- We conduded a retrospeetizje these patients of renal transplantation at 115 people's
Results: 2 cases of the ureteral calculi (1,69%), 2 males, the mean age 39,5y, These causes of calculi are stenose in the anastomosis uravesical and foreign body in the tract urinary. To succeed with the treatment zvith transurethral lithotripsy in 2 cases and the reimplantation uraoesical zoith Leadbeter -Politano technique.
Ccmclusions: the inddence of calculi in the transplanted kidney is low, these causes are stenose andfordgn body in the tract urinaire. The treatment with transurethral lithotripsy arc safe and effective.
Keywords: Lithiasis urinaire, renal transplantation.
DAT V A N DE rdhx khoa muon va thoi gian mac benh trung binh la 18 thang'^'. Khi soi nieu xuat hien, dac S6i nieu htah thanh tten benh nhan ghep ^^^^ ^^ ^^ ^ be than va nieu quan (NQ) than than la hiem, ti le soi moi nam tai Hoa ky la ^ . ^g ^^^^ ^^^ ^^^ j g , 3^^ ^ ^ ^^ ^ 104/100.0(W 6 benh nhan ehep than, va nu mac , > i_-^ i_ j " i, - - > j - -
• ^ &. 1^ .^1, va iiu Ilia.. huong ughicm trong den chuc nang cua than nhieu hon nam^^. Soi nieu la m,ot bien chiing
* Bfnh vi?n nhan dan 115.
Tdc gid lien lgc: Bs. Truong Hoang Minh DT: 0903982107 Email, [email protected]
63
N g h i e n cihi Y hoc Y Hpc TP. H b C h i M i n h * T a p 20 * So 4 2016 ghep ma nguoi benh khong dau vl mang luoi
ttwn kinh ciia than ghep da bi gian doan. Dieu tri soi nieu ve nguyen tic cung tuong tu nhu dieu tri soi t r ^ benh nhan thuong, tuy nhien nguy eo nhiem trung va suy Ihan caoW. Benh vien Nhan Dan (BVND) 115 da thuc hien ghep t h ^ tiJ 2004 den nay tro thanh phlu Ihuat thuong quy. Ngoai cac benh nhan ghep tai BVND 115 thi chung t6i con nhan theo doi cac berth nhan ghep tu noi khac hoac tu nuoc ngoai tra' ve. Qua iheo doi chiing toi ghi nhan 2 truong hgp s6i nieu sau ghep than va da dieu trj thanh cong. Chung toi trinh bay dac di&i lam sang va can lam sang ciia 2 truong hgp soi va nit ra kinh nghiem buoc dau dieu tri soi nieu tren b^nh nhan ghep than tai BVND 115.
DOITl/CWG-FHUtlNGPEiAPNGHIENaJtJ Doi hcong nghien ciiu
Tat ca cac benh nhan dugc theo doi hau ghep tai benh vien Nhan Dan 115 tu thang 2 nam 2004 cho deh thang 5 nam 2015.
P h u o n g p h a p n g ^ e n cmi Thiei ke'nghien cdu
Hoi ciiu mo ta cac truong hgp lam sang Phmmg tien nghien ciiu
L|p benh an nghien cuu, dii lieu dugc sir ly theo phan mem SPSS 16.0 va MicroSoft Office Excel 2007. So lieu dugc su ly theo nguyen tic thong ke y hoc voi bieu djnh lugng p) va bieu dinh tinh (ti Ie %), khac biet dugc xem co y ngha thong ke khi gia trj p< 0,05. Trinh bay duoi dar^
bang, bieu.
KET Q U A VA BAN LUAN
Qua theo doi 119 truong hgp theo doi ghep ttian ttf thang 2 nam 2004 den thang 5 nam 2015, CO 2 truong hgp phat hien soi nieu chian ti % 1,69% voi cac dac diem sau:
Thong so Ho v^ ten Tuoi Gi6i Ngtie nghiep Nguyen nhan suy than ma
Thdr gian ghep than Xet nghi§m PTH triro'c ghep
Quan h§ cho-nh#n Noi gh^p Vi tri ^ thin ghep Phunng phap cam meu quan
Thuoc iJc chi miin djch Trieu chiJng ISm sSng
Can lam sang
\fltris6i Oi^utii
BNsd1 0oan Trac V
42 tu6i Nam Cong nhan vien ViSm ^A c4u than
3 nam KhOng r5 Cling huyet thong
Viet nam Liy thSn phai ghep a ho diau trai
Lich - Gregoir Neoral.Ceiicept, Prednisoion Thi^u nieu, tiKC nhe ho diSu trSi noi 3at than
gh6p BUN: 29 mg/dL, Creatinine. 1.93mg/dL
CRP: 6,21 mgA Cydo^xinne/mau. 81.4 ng/ml.
Nu^cti4u' HC' 200/uL Leukocytes' 25/uL PT>H: binh thu^nq Soi a VI tri cim NQ vao BQ -Tin soi nieu quan bang npi soi m^m. Ghi nhgn h?p vj tri d m NQ vao BQ, ti4n hanh nong bang dung cij nong NQ vS dat thOng JJ
loai 3thang
Sau njt JJ 6 thanq tfiSn Cr ni/dc tro lai.Ure vS
BNsd2 Pham Ta ThSnh V
37 tuoi
Nam ^ CSng nhan viwi |
KhSng t^ i 12 nam
Kh6ng rd Khong ciJng huyet thong
Trung quoc Liy thin trai ghep 6* t\6 diau phai
Lich - Gr6goir Prograf, Cellcept Prednisoion
<h5ng tri&u chieng, phat hiSn nhfr sieu §m dfiii ky th$n g h ^ i> nude
BUN 30,8 mg/DI
Creatinine: 0,98 mg/dL fl CRP: 1.74 mgfl M Nuwctieu.HC: 50/Ut, W
BC (-) PTH: binh thuwnq Soi 616 NQ va soi trong BQ Tin SOI nOi soi 6ng cimg laser, kh6ng flat JJ
Ghi nhSn vien soi a 16 NQ bam vao soi cfii khau NQ v6i BQ, tiln hinh cit vd rtit dii. Nfifin
soi d- BQ CO nhan chi.
1
Y Hoc TP. H o Chi Minh * Tap 20 * So 4 * 2016 Nghien curu Y hoc
Thdng s6
Kit qua Thdt gian theo doi sau dilu tii soi
B N s 6 l creatinin/ mdu tang lai -Cim lai NQ vao BQ theo pp. Leadbeter-
Politano Ure vd creatinin/ mSu v l binh thu'dng Sieu am th^n ghep hit if nuoc sau 2 thdng
3 thdng
BNs62
Ure vd creatmin/mdu binh thyo-ng. Sieu am than ghep binh thu'dng
2 thang Mot so hinh anh chah doan soi nieu thuc
hien tren 2 benh nhan nay:
Benh nhan so 1
Hinh anh sieu dm than ghep Hinh dnh soi trin CT-Scan
mum
Hinh dnh soi niiu qudn va bdng quang trin phim X-quang
Nghien ciiu Y hpc Y Hpc TP. Ho Chi Minh * Tap 20 * So 4 * 2016
BAN LUAN Ti 1^ soi
Soi nieu eo ti Ie thap, thep doi cac benh nhan ghep than qua 11 nam chiing toi ghi nh|in dugc 2 truang hgp (1,69%). Ket qUet a i a chiing toi tuong dong tae gia Yuan HJ et al (2015) la l,2%<^Wk OcereUo E et al (2014) la 10%(i).
Nguyen nhan s6i
Soi nieu 6 benh nhan ghep than nguyen nhan thu6ng la da yeu to, nhung truong hgp bi soi nieu som sau ghep than thi 50% truong hgp soi da CO tir truoc. Tuy nhien, viec tao soi co the la do benh ly soi 6 nguoi nhan ket hgp voi nhiing bat thuong chuyen hoa d benh nhan ghep thgn, nhiing benh Iy nhiem trimg nieu, nhung di vat duong tiet nieu va viec su- dung thuoc lie che mien dich'^'. Cac truong hgp soi trong nghien cim aia chiing toi deu do nguyen nhan be tac co hoc va dj vat gay nen, rat liec chiing toi khong thuc hien dugc xet nghiem phan chat soi.
Chan doan
Benh nhan ghep than, mang than kinh cam giac da bi gian doan, thuang khi than it nuoc nhieu co the b&nh nh§n c ^ giac tiic nang vung than ghep ma khong co trieu chiing con dau quan than^. Thuong bieu hien Ihieu nieu hoae vo nieu khi s6i c6 be tac duong tiet nieu. Theo doi dinh ky vol sieu Sm tong quat than ghep va thir xet nghiem chiic nang than dugc dat ra thuong quy.Chiip CT- Scan de chah doan chinh xac soi, xa Wnh than danh gia chiic nang va nguyen nhan be tac ducmg tiet nieu. Cac truong hgp soi trong nghien cuu cua chiing toi deu 6 vi tri cam NQ vao BQ tac gia Cicerello E va cs ghi nhan 10 truong hgp soi nieu sau ghep than thi 7 trudng hgp (TH) la soi than va 3 TH la soi NQ'^' Dieu tri
Lua chgn phuong phap it xam hai la uu tien trong dieu trj soi nieu tren benh nhan ghep than.
Tiiy theo vi tri soi co the thuc hien nhu: tan soi ngoai CO the, lay soi qua da, tan soi noi soi ngugc
dongii). Ca 2 truong hgp soi trong nghien dm nay chiing toi lua chon tan soi n6i soi ngugc dong vi soi 6 thap. Truong hgp dau tien phai sir dung noi soi mem vi ong cting khong the tiep can soi. Mat khac, nguyen nhan gay soi la do hep tai vj tri khSu NQ vol BQ nen chiing toi ph^
nong NQ sau do moi dua dung cu tan soi de tan.
Tuy nhien, sau nit J) 6 thang tai hep va phai tioi hanh cam Igi NQ vao BQ de giai quyet triSt de nguyen nhan gay soi. Cam lai NQ vao BQ Ian 2 rat kho khan vi dinh, nguy co thieu mau nieu quan. Chiing toi phai di duong bung de phau tich ni|u q u ^ , sau do cam NQ vao BQ thep Leadbeter - Politano.
Truong hgp tan soi thii 2 chiing toi ap dyng ong ngi soi cting vi soi nam ngay 16 NQ tan tao do CO soi chi 16 ra la nguyen nhan gay s6i. Sau tan soi con sgi chi chiing toi nit bo chi qua noi soi. Vien soi bang quang dang tuong tif, sau tan nhan soi la sgi chi va gap ra ngoai. Soi san ho a than nen lay soi qua da, neu nho nen tan soi ngoai co the^'. Chiing toi chua gap TH nao soi than nen chua co kinh nghiem.
Theo doi va phat hien sam soi ni^u Ki&n tra sieu am va thii xet nghiem chik nang than dinh ky giiip phat hien som s6i nieu sau ghep than. Thii nong dp canxi/mau va hong dp PTH/mau giiip som phat hien va ngan ngua hinh thanh soi. Tac gia Cicerello E va cs ghi nh|n CO 5 TH tang canxi va PTH /mau va 3 TH tang trong nuoc tieu*".
KETLUAN
H le soi nieu sau ghep than thap (1,69%), nguyen nhan hinh thanh soi do hep duong tiet nieu (hep vi tri trong ni|u quan v^o bang quang) va do di v$t (chi cham tieu). Dieu trj voi phucmg tien it xam ian (ngi soi tan soi nguoc dong) dat ra truoc hen, tuy nhien voi soi 6 nieu quan than gliep phai sir dung ngi soi mem vi bat thuong giai phau khi cdm NQ vao BQ trong ghep thaa Benh nhan ghep than can phai dugc theo doi hau ghep dinh ky dS' phat hien som bien chiing
Y Hpc T P . H o Chi M i n h * T | p 20 * So 4 * 2016 N g h i e n ciiu Y hpc ni&u khoa trong do sieu am la phuong tien i^u
tay it xam hai.
TAI LIEU THAM KHAO
1 Cicerello E, Merio F, Mangano M, Cova G, Maccatrozzo L.(2014) " Urolithiasis in renal transplantation: diagnosis and m a n a ^ m e n t " , Ardt Ital UnA Androl. Dee 30;86(4) 257-60 2 Klingler H C , Kramer G., Lodde M., M a r t w r ^ M(2002).
"Urohthiasis in allograft k i d n q ^ " . Urdogy ;59:344-348.
3 Kim H , Cheigh J5., H a m H.W.(2001) "Urinary stones following renal transplantation". Korean / Intern Med ;16:118- 1122.
4 Tiselius H.G„ Aiken P., Buck C , Gallucd M., Knoll T , Sanca K., et al,(2008) 'Guidelines on urolithiasis: diagnosis imaging"
EAUguideline^:9-l9.
5 Yuan UJ, Yang DD, Cui YS, Men CP, Gao ZL, Shi L, Wu ]T.(2015} "Minimally mvasive tcealment of renal transplant nephrolith! asi.s". World J Urol. Apr 2
Ngdy nhdn bdi bdo: 12/11/2015 Ngdy phdn bien nhgn xet bdi bdo' 27/11/2015 Ngdy bdi bdo dugc ddng: 15/05/2016
67
