Y HOC V l | T NAM THANG 8 - SO D A C Bl$Ty2013 V. KET LUAN:
Qua nghien ci/u 58 benh nhan sdi than da CO bien chirng suy than tai khoa phau thuat tiet nieu - benh vien 103, chung tdi thay: Nong dp trung binh eiia Hb, so lu'dng HC, gia trj Het giam dan theo mire dp tang ciia nong dp creatinin mau. Co moi tu'dng quan nghjch giu'a nong dp creatinin mau vdi so lu'dng HC (r = - 0,36), nong dp Hb mau (r - 0,4) va gia tri Het (r = - 0,332). Su" tu'dng quan giiJa nong dp Hb va nong do creatinin mau la chat ehe hdn so lu'dng HC va gia tri Het.
TAI LIEU T H A A A K H A O :
1 Vo Tam, Ngd Thiiy Trang, " Nghien ciiu sir tu'dng quan giij^ thieu mau va mirc do suy than 6 benh nhan suy than man", tru'dng dai hoc Y DUOc Hue, Y hpc thi/c hanh (614 + 615) - so 8/2008.
2. Hoing Trung Vinh, "Nghien cuU tinh trang thieu mau is b?nh nhain suy than man tfnh", tap chi Y - Du'dc hoc quan si/ so 1/ 2005.
3. Ph^m Thi Hong Van, Nguyen Xuan Phong,
"Nghien ciTu moi tu'dng quan gii/a chi so smh hoa, huyel hpc vdi mirc dp suy than tai Thai Nguyen", tap chi Y hoc Viet Nam - NSm 2008, thang 10, so 2, Chuyen de Hoi nghj hoa smh y hoc Quoc gia 2008 - Chao mCftig 40 nSm thanh lap tru'dng dai hpc Y Du'dc Thai Nguyen, tap 351, tr. 83-90.
4. Nguyen Van Xang. Mot so chuyen de chan doin, dieu tn benh than. Tai lieu bo tiic cho bac sy phyc vu cho tap huan chuyen nganh npi khoa. Ha Noi, 1996, 36-44.
5. Kazmi WH et all, "L'anemie: Une complication precoce de Unsuffissance renale chronique a.
Journal de la Societe de Nephrologie, 2001, Vol 38(4), pp 803-812.
6. Paganini E.P. Hematologic abnormalities, Handbook of dialysis 2"^ edition, 1994, 444-467.
BirdC DAU NGHIEN CllflJ MOT SO CHI SO NIEU DONG HOC 0 BENH N H A N PHI DAI LANH TiNH TUYEN TIEN LIET CO TRIEU CHUfNG
Le O i n h K h a n h * , Le O i n h O a m * , V o Tru'dng G i a n g * , N g u y i n Tru'dng A n * , N g u y e n Khoa H i m g * , H o a n g Van T i m g * , Tru'dng Van C a n * * TOJVITAT:
Muc tieu: Khao sat mdi tu'dng quan giCTa mgt so : dii so cua nieu dong hoc vdi cac tneu chi/ng lam sang, can lam sang. Odi tu'dng va phu'dng phap: Gom 22 benh nhan nam vao kham tai Khoa Ngoai Tong hdp Benh vien Tru'dng Oat hoc Y Du'dc Hue tir thang
•l/ZOn den thang 4/2013 du'dc chan doan tang smh lanh tfnh tuyen tien liet. Moi benh nhan du'dc do nieu trong do, So nieu dgng hpc va ket qua thu du'dc se doi diieu vdi cac dac diem lam sang, diem so IPSS, QoL , va kfch thu'dc tuyen tien liet, do loi, the tfch nu'dc tieu Kn liTu du'dc do qua sieu am. Ket qua: Qmax trung binh 8,89±6,03ml/s, nhdm Qmax <10ml/s chiem chii yoj (77,3%) nhung khi kiem chimg bang phep do nieu ' Oai hoc YDupc Hue, ** Benh vien Tmng t/dng Hue Phan bi?n khoa hoc: PGS.TS. TrSn Van Hinh
dpng hpc thi chi co 62,5% la co tac nghen thiTc su".
Nhom benh nhan co chirc nang co bdp bang quang yeu chiem 42,9%, binh thUdng la 35,7% va manh la 21,4%. Co 17,65% benh nhan bang quang khong on dmh. Co moi tu'dng quan thuan trung binh giiTa BOOI - IPSS, BOOI - the tich TTL. Tu'dng quan thap giCTa BOOI - QoL, BOOI - do loi tuyen tien het vao bang quang. Tu'dng quan nghjch cao giiJa BOOI va Qmax, Ket luan: Xet nghiem nieu dong hoc cung cap nhieu thong tin quan trpng giup danh gia tinh trang tac nghen du'dng tieu du'di do tang sinh lanh tinh tuyen ti'en liet.
TO" khoa: Nieu dong hgc, tang sinh lanh tinh tuyen tien Hit
269
HQI NGHj KHOA HpC L A N T H Q VII. Hpl TlfeT NI$U - T H A N HQC VI$T NAM (VUNA) SUMMARY:
INITIAL STUDY OF SOME OF URODYNAMIC INDEXES IN BENIGN PROSTATIC HYPERPLASIA PATIENTS WITH LUTS Objectives; To describe clinical and subclinical features of symptomatic benign prostatic hyperplasia, same time, survey correlation of some os urodynamic indexes with clinical and subclinical symptoms.
Material and methods: 22 BPH patients with LUTS were examined in General Surgery Department in Hue University Hospital from 4/2012 to 4/2013. They were measured uroflowmetry, urodynamic indexes and the results obtained wilt be compared with the dinical features, IPSS score, QoL score and prostate volume, intravesical prostatic protrusion, post-void residual unne volume. Results: Qmax average 8.89 ± 6.03mi/s, Qmax <10mi/s dominated (77.3%), but when evaluate by measurement uroynamic, only 62.5% is real obstruction. Group of patients with bladder contractility function weak 42.9%, normal 35.7% and strong 21.4%. There are 17.65% patients have instability bladder. Moderate correlation between BOOI- IPSS, BOOI- prostate volume. Low correlation between BOOI-QoL, BOOI intravesical prostatic protrusion. High correlation between BOOI and Qmax.
Conclusion: urodynamic test provides important informations for assessing the situation bladder outlet obstruction due to benign prostatic hyperplasia.
Keywords: tjenign prostatic hyperplasia.
urodynamic.
I. O A T V A ' N OE:
Tang sinh lanh tfnh tuyen tien liet la benh ly thu'dng gap d nam gidi Idn tuoi. Oo chen ep vao vung CO bang quang nen se gay nen tinh trang tac nghen du'dng tieu du'di ma bieu hien tren lam sang la cac trieu chirng tieu khd, bf tieu... gay anh hu'dng den chat lu'dng cuoc song [ 1 0 ] .
Dieu trj tang sinh lanh tfnh tuyen tien liet gom c6 theo ddi, ndi khoa va ngoai khoa [14], Trong do dieu trj phau thuat cat nhan tang sinh lanh tinh tuyen tien liet noi soi qua nieu dao la phu'dng phap dUdc sir dung nhieu nhat va day
van du'dc coi la "tieu chuan vang" [13, 14]. Tuy nhien trong khuynh hu'dng hien nay, dieu tri noi khoa dang chiem uli the.
Oe danh gia mu'c dp tac nghen du'dng Heu du'di cung nhu' chu'c nang ciia bang quang trang tang sinh lanh tfnh tuyen tien liet, gdp phan phan tfch tinh trang benh nhan de cd chi djnh dieu tn, ngu'di ta da su* dung phu'dng phap tham do nieu dgng hpc [ 2 ] .
Tren the gidi khao sat nay khong con mdi, tuy nhien 6 Viet nam hien nay van con it nghien ciru lien quan du'dc cong bo.
Chiing toi nghien cu'u de tai nay nham muc tieu khao sat moi tu'dng quan giu^ trieu chifng lam sang, sieu am vdi mot so chi so nieu dong hpc qua dd mong muon gdp them cac thong so de danh gia tjenh nhan.
II. o d ) T U 0 N 6 VA PHJONG P H A P NGHtEN COU:
2 . 1 . Doi tu'dng nghien cu'u: 22 benh nhan nam vao kham tai Khoa Ngoai Tong hdp Benh vien Tru'dng Oai hpc Y Du'dc Hue tir tiiang 4/2012 den thang 4/2013 du'dc chan doan tang sinh lanh ttnh tuyen tien liet dira vao trieu chuttg lam sang, sieu am.
Loai trir cac tru'dng hdp: Benh nhan co tinh trang bi tieu cap khdng dap img dieu trj npi khoa, ung thu' tuyen tien liet, hep nieu dao, cd sdi bang quang kem theo, cd tien sir phau thuat dieu trj tSng sin lanh tfnh tuyen tien liet hay co phau thuat tren bang quang tru'dc dd hoac dang cd nhiem triing du'dng tieu.
2.2. Phu'tfng p h a p nghien cufu: Nghien ciru tien ciTu mo ta.
Ghi nhan cac d3c diem lam sang, danli gia trinh trang benh theo bang diem IPSS, QoL. Sieu am do kfch thu'dc tuyen tien liet, dp loi vao bang quang, the tich nu'dc tieu tdn lu'u.
Benh nhan se du'dc do nieu dong do deghi nhan cac thong so Qmax, Qave, va do nieu dong hpc bang may nieu dpng hpc da kenh hang
270
Y HOC VlfiT NAM THANG 8 - SO DAC BIET/2013 aborie de ghi nhan ap life cd detrusor, ap liTc 6
iung, ap lu'c bang quang qua do tfnh chi so tac ighen du'dng tieu du'di (BOOI) va chi so kha iang co bdp bang quang ( B Q ) du'dc tinh theo mq thirc sau [12].
BOOI = Pdet Qma^ - 2 Q m a x BCI = Pdet Qmax + 5 Q m a x
Cac thong sd tren du'dc doi chieu vdi trieu chimg lam sang, diem so IPSS, QoL, hinh thai tuyen den liet va the tfch nu'dc tieu ton lull tren sieu am, hinh thai tuyen tien liet va bang quang trong mo.
Cac sd lieu du'dc tong hdp va xii ly bang phan mem SPSS 18.0.
III. KET QUA NGHIEN COU:
Trong so 22 t)enh nhan, chiing tdi do nieu dpng hpc du'dc 14 benh nhan.
Tuoi trung binh ciia t)enh nhan la 75,41 ± 7,87 tuoi.
Ly do vao vien do roi loan tieu tien la 68,2%, bf tieu 31,8%. Cd 7 benh nhan bl tieu vao vien du'dc dat sonde tieu, nhu'ng benh nhan nay sau khi dieu trj npi khoa bang thuoc chen Oi deu tieu lai du'dc sau khi rut sonde. Thdi gian lu'u sonde tieu trung binh 2,86±1,22 ngay.
f. 3.1. Trieu chuCng l a m sang va diem so IPSS, QoL
Bangl:J\i le cac tneu chirng cd nang Trif u chi>ng c a nang
Tieu kho Tieu v^u Tilu khonq het Tieu nq^t quanq TiSutSl Tieu qap Tieu dem Oau ttjc ha VI
N 22 22 16 17 17 10 21 12
Ti le % 100,0%
100,0%
72,7%
77,3%
77,3%
45,5%.
95,5%
54,5%
QoL trung binh: 4,45±1,14, 5 9 , 1 % benh nhan xep vao mirc dp nSng, 40,9% cd mirc dp trung binh.
3.2. Sieu a m
Bang 2: Oanh gia ket qua qua sieu am bung Thong s6
Th4 tich TTL (ml) V nu'*c tilu l6n ii^u (ml) DOi«iTTLvSoBQ(mm)
n 22 14 10
Trung binh 53,11115,67 34,14±33,08 18,30±9,15
3.3. Ket qua nieu dong do Bang 3; Nhom Qmax
Gia trj (ml/s) 0 - < 5 6-<10 10-<15 215 Tonq
n 6 11 2 3 22
27,3
%
50,0 9.1 13,6 100,0 Qmax trung binh 8,89±6,03ml/s, Qave trung binh 3,72±2,01mt/s.
3.4. Ket qua n i e u dpng hpc Bang 4: Nguyen nhan khdnq do du'dc NDH Ly do khong thu'c hi?n au'p'c NDH Khonq dgt diFiyc onq thonq ND May bl l5i
B§nh nhan khonq h(?p tac Tonq
n 2 1 2 5
%
40.0 20.0 40,0 100,0 Bangs;Ap \ic cd detrusor
T
Pdet buon tieu ' ^ 4 0 ' Pdet dl tieu
13 76,6
>40 .4 ; 23^_
<60 _ 10 _ 68,8 I >60 7 _ _ 4 1 , 2
Totai _ J _ J 7 _ LJOO.O
, Biem IPSS; 2S,68±8,65, 72,7% benh nhan ro trieu chirng nang (20-35 diem), 27,3% trung binh (8-19 diem), khong co benh nhan nao mu'c do nhe.
Bang ff; Tinh tranq ba D9C di^m banq quang Banq quanq on dinh Banq quang khonq on dinh T6nq
nq quanq n 14 3 17
83,35
%
17,65 100 Co 17,65% benh nhan bang quang khong on dinh, va 17,65% benh nhan co tieu ri trong giai doan do day.
Hpl NGHI KHOA HpC LAN THIJ VII, HQI T|6T N | | U - THAN HpC VIST NAM (VUNA)
_ .. /.. , i , - V ^ , - - . . , ' •
'i""^- ,jaiu>.Ji>i», . _ .
1 . JI .
Ji—' •• -
„ . . '
". :.
Hinh 1: Bieu do NOH bang quang khong on dinh (benh nhan Vd Ph, 83 tuoi)
g 7; BOOI va BCI theo nho nBOOI
BCI
>40 20-40
<20
<100 100-150
>150 Tonq
n 8 3 3 6 5 3 14
»/o 57,1 21,4 21,4 42,9 35,7 21,4 100,0
Ket qua nieu dong hgc cho thay nhom benh nhan co tac nghen du'cfng tieu du'di chiem ty ie ( nhat 57,1%, nhom nghi ngd va khong tac nghen bang nhau 21,4%, Nhom benh nhan co kha nang bop bang quang yeu 42,9%, binh thu'dng 35,7% va manh 21,4% (Bang 7).
3.5. Moi tu'dng quan
Bleu do 1; (a) Tu'dng quan giu'a BOOI va IPSS; (b) Tu'dng quan giffa BOOI va QoL; (c)Ti(ifng quan giifa BOOI va Qmax,
Co moi tu'dng quan thuan trung binh giSa BOOI va IPSS (r=0,46); thap giu'a BOOI va QoL
(r=0,347); Tifdng quan nghjch cao giu'a BOOI va Qmax (r=-0,661)
Y HQC VigT NAM THANG 8 - s 6 B A C BlgT/2013
Bieu do 2: (a) Tu'dng quan giiJa BOOI va the tich TTL; (b) Tu'dng quan giu^ BOOI va dp loi tuyen tien Net vao bang quang.
Co mdi tu'dng quan trung binh giiJa BOOI va the ti'ch TTL (r = 0,566); va thap giiJa BOOI va dp loi tuyen tien liet vao bang quang {r = 0,29)
IV. BAN LUAN:
Ket qua bu'dc dau cua nghien CLTU thu du'dc do tuoi trung binh ciia benh nhan la 75,41 ± 7,87, da sd nam trong nhdm 70 - 79 tuoi (50%).
Phan Idn benh nhan deu d ndng thdn chiem 81,8%, dieu nay thu'dng lien quan den kinh te, mifc dp nhan thu'c lam cho benh nhan thu'dng vao kham mudn, t)enh thu'dng d giai doan nang.
Ty le benh nhan du'dc phau thuat 68,2%, dieu tr;
noi thap 31,8%.
Ly do vao vien chu yeu la do rdi loan tieu tien chiem 68,2% va day cung la trieu chu'ng chinh cua benh khien benh nhan vao vien, trieu chu'ng bi tieu ft gap hdn chiem 31,8%.
Danh gia ket qua cua sieu am tuyen tien liet qua nga bung cho thay cd moi tu'dng quan thap dp loi cua tuyen tien liet vao bang quang vdi Qmax, BOOI (p>0,05, r=0,289). Khdng cd si/
i(iiac biet giij'a gia t n trung binh dp loi vao bang quang vdi Qmax va BOOI (p>0,05).
¥ Cac chi so cua phep do nieu ddng do thu te Qmax trung binh 8,89±6,03ml/s, Qmax
<10ml/s chiem chu yeu (77,3%). So vdi Nguyen
"Hoang Ou'c Qmax trung binh la 7,5ml/s, Qmax <
lOml/s chiem 6 7 , 1 % [ 4 ] . Qmax <10ml/s la cd
tac nghen du'dng tieu du'di, nhutig khi kiem chu'ng bang phep do nieu dpng hpc thi trong nhdm Qmax <10ml/s chi cd 62,5% la cd tac nghen thu'c SLT, theo Nguyen Oao Thuan la 68%, con Paul Abrams la 88%. Oieu nay cho thay viec do nieu ddng dd giup cho chung ta cd du'dc nh&ng thong so mang tfnh chat gdi y. Chung tdi cho rang dieu nay cd the la ban than d ngu'di Idn tuoi thi Qmax da thap hdn binh thu'dng. Cho nen viec danh gia ro rang la can phai ket hdp nhieu yeu td.
Trong so 22 benh nhan, chung toi do du'dc 17 benh nhan chiem 77,27%, 5 benh nhan khdng do du'dc chiem 22,73%. Ngoai nguyen nhan chu yeu tLT benh nhan cdn co ca nguyen nhan do loi ky t h u a t Phan Idn nguyen nhan khdng do du'dc la do tuyen tien liet Idn chen ep vao nieu dao lam khd dat ong thong nieu dao.
Ket qua nieu dpng hpc cho thay nhdm benh nhan cd tac nghen du'dng tieu du'di chiem ty le cao nhat 5 7 , 1 % , nhdm nghi ngd va khdng tac nghen bang nhau 21,4%. Nhdm benh nhan cd kha nang co bdp bang quang yeu 42,9%, binh thu'dng 35,7% va manh 21,4%. Trong nhdm nghien cu'u cd 17,65% benh nhan bang quang
273
Hpl NGHI KHOA HQC L A N T H I J VII, H p l TlgT NI$U - THAN HpC VI$T NAM (VUNA) khong on djnh, va 17,65% b^nh nhan cd tieu ri
trong giai doan do day.
Co moi tu'dng quan thuan trung binh giite BOOI - IPSS, BOOI - the tfch TTL. Tu'dng quan thap giu'a BOOI - QoL, BOOI - do loi tuyen tIen liet vao bang quang. Tu'dng quan nghich cao giu^ BOOI va Qmax.
Trong nhom c6 chi so BOOI tSc nghen 100%
CO tuyen tien iiet Idn thuy giiJa, 7 5 % Idn toan bp.
Tuy nhien khong co moi lien quan giffa hinh thai u tuyen tien liet vdi chi so BOOI (p>0,05).
V. KET LUAN:
Chi cd 62,5% benh nhan la cd t3c nghen thi/c SI/ dia tren cac thong so nieu dong hgc d nhom benh nhan co Qmax <10ml/s tren nieu dong do.
Nhdm benh nhan cd tac nghen du'dng tieu du'di chiem ty le cao nhat 5 7 , 1 % , nhdm nghi ngd va khong tac nghen bang nhau chiem 21,4%.
Nhom benh nhan cd chijrc nang co bdp bang quang yeu chiem 42,9%, binh thu'dng la 3 5 , 7 % va manh la 21,4%. Cd 17,65% benh nhan bang quang khong dn dmh,
Co moi tu'dng quan thuan trung binh giiia BOOI - IPSS, BOOI - the ti'ch TTL. Tu'dng quan thap giOs BOOI - QoL, BOOI - do loi tuyen tien liet vao bang quang. Tu'dng quan nghich cao giiJa BOOI va Qmax.
TAI LIEU T H A M K H A O :
1 Nguyen Tru'dng An (2008), "Danh gia k i t qua phau thuat cat u lanh tinh tuyen tien iiet bSng npi soi qua nieu dao". Tap chi Y hoc TP Ho Chi Minh, 12(4), tr. 187-192,
2. N g u y i n Van An (2003), "Dai cu-Ong ve cac phep do nieu dong hoc -, Tap chi Y hpc TP Ho Chi Minh 7(2), tr, 68-74,
3. I r a n Bile Hoe (1996), "Ket qua dieu tra dich t l hpc u xo tuyen tien lilt". Tap chi Y hoc Quan su' 2 tr, 69-74, ' '
-•. Nguyen Hoang Ou'c (2003), Su thay iJoi ciia men d6ng do sau cSt dot npi soi budu ianh tien iiet tuyen, Luan v3n tot nghiep Bac si npi tnj, Oai iigc Y DUpc TP Ho Chi Minh,
5. Le Oinh Khanh (2003), "SU thay doi m^t so dii s6 ni?u dpng hpc d benh nhan u xd tien liet tuyai' Tap chi Y hpc Vipt Nam, 11, tr, 13-19, 6. Tran Ngpc K h ^ n h , Le Oinh Khanh (2007),
"Bu'dc dau uhg dung phep dp nieu dpng do trong Chan doan benh ly dUdng beu dudt", Tap dliy iioc thi/c hanh, (568), tr, 471-474,
7. N g u y i n 0 ? o Thuan (2004), Vai tro phep Jo ap luc - nieu dong trong tien doan ket qua cSt dot noi soi budu l^nh tien liet tuyen, Luan vIn tot ngtiKp Bac sT npi trlj, D j i hpc Y DUpc TP Hp Chi Itinil, 8. Du'dng Quang Tn', Vu Le Chuyen, Nguyen S ^
Thuan (2004), "Vai trp phep dp ap IUC - nieu dong trong chain doan t3c nghen dudng tieu di/cfl do budu ianh tuyen tien lieT, Tap chf Y hpc TP Ho Oil Minh, 8(2), tr, 174-179,
9. Abrams PH, Griffiths D,(1979), Tlie assessmenttf prostatic obstruction from urodynamic measurements and from residual unne", Br J Urol 51, PP129-134, 10. Abrams PH (1999), "Bladder outlet obstnicticil
Index, bladder contractility Index and bladder voiding effiaency: TTiree simple indices to define bladder voiding function", Brit,J,Urol, vol 84, pp, 14-15,
11. American Urological Association (2010), "AUA guideline on the management of benign prostatic hyperplasia", American Urological Assodation Education and Research, pp, 1-34,
12. Griffiths DJ, Hofner K, van Maslrigl R, et al (1997), "Standardisation of temiinology in lower unnary tract function: pressure flow studies cf voiding, urethral resistance and urettiial obstruction", Neurourol Urodyn, 6, pp, 1-18, 13. Paul Abrams, MD, FRCS (2006), "Urodynamic
techniques", Urodynamics, Spnnger London Lid, Third edition, pp, 17-116,
14. Victor w , NitB, MD (2005), "Pressure «o«
urodynamic studies: The gold standani f«
diagnosing bladder outlet obstruction". Reviews in urology, vol 7, pp, 14-21.
