Y HOC VltT NAM THANG 6 - SO 1)2014
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NGHIEN ClhJ KET QUA XET NGHIEM TINH DICH DO 6^ BENH NHAN TINH H O A N AN NGITCTI LffN
T6M TAT.
MiJic dfch: Danh gia su* anh hu'dng tdi tinh djch do d benh nhan tinh hoan an ngu'di Idn.
Doi tiTAig va phu'dng phap nghien cuTu: Gom nhiJtig benh nhan tu" 18 tuoi ti-djen, dUtfc chan doan va phau thuat "mA tai khoa Phau Thuat T i ^ Nieu cua benh vien Viet Ou'c tu' thang 1 nam 2011 den het thang 7 nam 2013. Nghien culi tren cac benh nhan co ket qua tinh djch do tru'dc mo. Cac chi so ve the b'ch tinh djch cung nhu" chat luttng tinh djch (so lu'dng va chat liJWng tinh trung) du'dc thu thap va nghien cihj.
K ^ qua nghien cuti: The tfch tinh djch d benh nhan THA hai ben it hdn d benh nhan THA mot ben, SlJ" kh^c biSt CO y nghTa thong ke (p<0,05). The t'ch tinh dich d benh ntian THA mot ben khong anh hu'dng bdi vi trf THA, si/ khac biet khong co y nghla thong ke (p>0,05). Tat ca 31 b?nh nhan THA hai ben (100%) dSu khong co tinh trung, ty le khong cd tinh trung d nhom benh nhan THA mot ben la 22,6% (12 benh nhan), si/ khac biet co y nghTa thong ke ( p<0,05).
M$t dp tinh trung d benh nhan THA mot ben khong ch|u anh hudng bdi vj tri THA, sy" khac biet khong cd y nghia thong ke (p>0,05). Cac chl so chat lu'dng tinh triing (ty le % tinh trCing song, ty I? % tinh tring binh ttiu'dng, ty le % t'nh trung di dpng) d benh nhan THA mpt ben khdng anh hUdng bdi vj tri cua THA (si/ khac b i ^ khong co ^ nghTa thong kg vdi p>0,05).
KSt lu$n: Tinh hOcin in cd anh hu'dng tdi tinh dich di5 a!ia benh nhan, dSc di^t khi b| an ca hai ben. Qua 66, cinh hu'dng xau d^n Idia nang sinh san cua ngudi b|nh. Tuy nhien, khi b^nh nhan chi bj tinh hoan an mpt b§n thi the tfch tinh djch, mat do tinh triing, chat lu'dng tinh trung cd thay doi nhUhg sy khac biet khong cd y nghTa thong ke glO^ cSc vj tri cua tinh hoan an.
S U M M A R Y
SEMEN ANALYSIS I N ADULT CRYPTORCHID PATIENTS Purpose: Evaluate the effect of undescended testes on semen in adult cryptorchid patients
Patients and method: This study was carried out in adult cryptorchid patients operated at Urology department of Viet Due hospital and in v/hom semen analysis was performed pre-operatively during the period from January 2011 to July 2013. All results of semen analysis were collected and analyzed.
Results: Semen volume of patients witii bilateral
*Kh03 PTVetnleu - BV Vi^tDifc Phan bign khoa hgc: PGS.TS Nguyen Ky
Nguyen Quang*
undescended tesfes was less than that of patents with unilateral undescended testis Cp<0.05). Semen volume of patients was not affected by testicular location {p>0.05).
Pi\ 31 patients with bilateral undescended testes were azoospermia, yet the rate of azoospermia in patients with unilateral undescended testis was 22.6% (12 patients);
ttie difference was significant (p<0.05). The spenn concentration in patients with unilateral undescaidal testis were not affected by testicular location (p>0.0^.
Some other characters of spemi in patients with unilateral undescended testis such as survival rate, rate of normal morphology, r^te of mobilization were not affectedly testicular location (p>0.05).
Conclusion: Semen is affected by cryptordiiil condition, especially bilateral cryptorchidism. Tm, patient's reproductive possibility Is also affected, {n patients with unilateral cryptorchidism, semen vdunie, sperm concenti^tion, sperm quality are affected but testicular location doesnt cause a agnificant difTerence,
I. DiCiT V ^ N OE
Tinh hoan an (THA) co nhieu nguy cd tdi aJ the, trong do hai nguy cd nang ne nhat la ung thu* va anh hu'dng tdi tinh djch d3 gay vo sinfi, Tai Viet Nam, da co m p t so nghien cu'u tinh hoan an d tre em. Nhuing cac nghien cull tinh hoan an tren ngu'di Idn khong nhieu, d^c biet la nglii^
CIJXJ ve tinh djch do. Chung toi lam nghlSn ciili nay de danh gia s i / anh hu'dng tdi tinh dich do d benh nhan tinh hoan an nguftl Idn.
IL OOI TU'ONG v A PHU'ONG PHAP NGHIEN cOU Gom nhihig benh nhan tu* 18 tuoi trd len, du'dc chan doan va phau thuat THA tai khoa Phau Thuat Tiet Nieu cua benh vien Viet Du'c lir thang 1 nam 2011 den het thang 7 nam 2013.
Nghien culi tren cac benh nhan co ket qua tinh dich do tru'dc mo. Cac chi so ve the tfch tinh d j * cung nhu* chat lu'dng tinh djch (so lu'dng va ciiat lu'dng tinh trung) du'dc thu th?p va nghien cilU.
IM. KETQUA NGHltNCCrU 3.1. Ket qua the tich tinh dich Co 84 benh nhan du'dc lam xet nghidm til*
djch do trong so 144 benh nhan tinh hoan 5n ngu'di Idn du'dc phau thuat, ket qua the tich tinh djch nhu'trong bang 1.
Y HQC V|£T HAM THAHG 6 • S6' 1/2014
Bina 1: Ket qua Ben THA
Mpt ben Hai ben Tong
the ti'ch tinh dich va so ben THA The tich tinh dich Binh thirdng
37 (68,8%)
9 (29%)
46 (54,8%)
Thap 16 (31,2%)
22 (71%)
38 (45,2%)
Tdng 53 (100%)
31 (100%)
84 (100%) The b'ch tinh dich d binh nhin THA hai bin thap hdn d binh nhin tinh hoin in mot bin, sir khic biit dy nghia thong ki vdl (p < 0,05).
3.2, Ll£n quan glD'a the ta'ch tinh djch va v| tri THA (d BN THA mot b£n)
Trong 97 benh nhan THA mot ben co 53 benh nhan lam xet nghiem tinh djch do, l<et qua the ti'ch tinh d|ch cua benh nhan THA mot ben nhu' bang 2.
Bing 2: KS qua the tfch tinh dich va vi tri THA V j t r i THA
THA cl cao • , THA d thap
Tong
The tich tinh dich Binh thu'cfng
22 81,5%
15 57,7%
37 69,8%
Thap 5 18,5%
11 42,3%
16 30,2%
TSng 27 100%
26 100%
53 100%
The tkh Hnh dich da BN THA mgt bin khong khic nhau giia dc vl tri THA, sii khic biit khdng d y ngia thong ki vdl (p = 0,059 > 0,05)
3.3. Lien quan giii'a m$t df tinh trCing (so iu'dng tinh trCing/lml tinh djch) va s& ben THA C6 84 b$nh nhan iiitfc lam xet nghiem tinh djch do, ket qua xet nghiem mat do tinh triing nhu' trong bing 3.
Bing3;Uenc BSnTHA
Mpt ben Hai ben Tong
uan giu^ so ben rHA va mai do tinh trung Mat dQ tinh triing Binh thu'dng
26 49,1%
0 0%
26 31%
ThSp 15 28,3%
0 0%
15 17,9%
Khong CO tinh trCing 12 22,6%
31 100%
43 51,1%
Tfing 53 100%
31 100%
84 100%
Trong 144 benh nhin nghien ciJu thi co 84 benh nhan du'dc lam tinh djch do, chiing toi thay co su' Idiic bl$t ve mat do tinh triing is benh nhan Tinh hoan Ithong xuong biu mot ben va cl benh nhan Tinh hoin khong xuong biu hai ben co y nghla thong ke vdi (p < 0,05; F=0,747 gan 1), co 31 (100%) b|nh nhan THA hai ben du'dc lim xet nghiem tinh dich do thi tat ca deu khong co tinh triing, con 153 b|nh nhan Tinh hoin khong xuong blu mot ben co 12 (22,64%) benh nhan khong co Inh b-ilng.
3.4. Ll£n quan v| tri THA v i ni$t dp tinh trCing (A BN THA mpt ben)
C6 53 b?nh nhin THA mpt ben duBc lim xet nghiem tinh djch do, ket qui xet nghiem mat dp tinh trving cOa b?nh nhin THA mpt ben du'Bc trinh biy trong bing 4.
Y HOC VIET NAM THANG G - s61/2014' Bing 4: Vj trf THA va mat do tinh triirig (6 BN THA mot ben)
^ Mardn I _, . .. ... I I ... -Binh ttiu'dng Thap Khong CO tinh trung Tong
THA cl cao 17
(63%)
6 (22,2%)
4 (14,8%)
27 (100%)
THA cl thap 9
(34,6%) 9
(34,6%) (30,8%)
26 ((100%))
Tong 26
(49,1%)
15 (28,3%)
12 (22,6%)
53 (100%) Trong 97 benh nhin THA mat ben cd 53 benh nhan dddc lam tinh dich do. Chung toi thay khong c6 sd khic biet d y nghia thdng ke ve mat do tinh trung giia cac vi tri THA d binh nhin Tinh hoan khong xudng biu mgt bin vdi (p= 0,112>0,65), d the la do benh nhin dn mgt ben tinh hoin linh.
3.5, Uen quan giii^ ty le phan t r i m tinh triing song va vj tri THA d b^nh nhan THA m6t bin Co 53 benh nhan THA mpt ben du'dc lim xet nghiem tinh djch do, ket qui xet nghiem ty I? phan trim tinh tnj'ng song ciia benh nhin THA mpt ben nhu' trong bing 5.
BingS: Ket qui b> le phan tram tirih triing song cua BN THA mpt ben
Binh thu'dng Thap Kh6ng co tinh triing Tong
THA 6 cao 16
59,3%
7 25,9%
4 14,8%
27 100%
THA a thap 11
42,3%
6 23,1%
9 34,6%
26 100%
•53"
100%
Tong 27
51%
13
24,5% 13
24,5%
- I 3170 I ^n,3V0 I ^n,3"/0 I 1UU70 Si khac biet khong co y nghia thong ki ve ty le b'nh trung song glib cac vi tn THA dBNTHAm^
bin, vdl(p=0,234 > 0,05)
3.6. Liin quan giii'a ty i$ (°/<i) tinh triing binh thu'dng va v| tri THA d b^nh nhin THA mpt b i n
Ket qui xet nghiem ty le (%) tinh triing binh thu'dng cua 53 benh nhin THA mdt bin dutfc tinh biy trong bing 6.
Bing 6; Ket qui xet nqhiem ty le (%) tinh triing binh thudng d BN THA mdt ben
^ TiflSTTllinhthii'rInn'l ^ " ^ T 77-. '. 1 I T T binh thu'dng Biiih thu'dng
~ Z I —
77,8%
Thap Khong CO
tinh triing Tong
THA d cao 2
7,4%
4
14,8% ^21
100%
THA d thap 15
57,7% 2
7,7%
9
34,6% 100%
Tong 36
68%
4
7,5% 13
24,5%
53 100%
Ty li (%) tinh bing song dbenh nhin THA mdt bin khong inh hu'dng bdi vim'cua THA, si khic li^
khdng cd y nghia thdng ke vdl (p=0,234 > 0,05)
3.7. Lien quan giCa t^ le (%) tinh trCrng dl dpng va vi tri THA d BN THA m$t b i n Ket qua xet nghiem ty le (%) tinh triing dl dong d 53 benh nhan THA mot ben nhu' trong bing 7;
Bing 7; Ket qui ty le (%) tinh triing dl dpng d BN THA mpt ben
I L ^ l ^ ^ I Binh thu'dng I ThUp I Khdng co tinh triing I TSng '
THAdcao 16
59,3%
7
25,9% 4
14,8% 27
100%
THA d thap 10
38,5% 7
26,9% 9
34,6% 26
100%
Tong 26
49,1% 14
26,4% 13
24,5% 53
100%
T'y li (%) tinh trung dl dgng cua binh nhin THA mdt bin khdng phu thuoc vao vl tri THA, simHc blit khong d y nghia thong ki vdl (p=0,193>0,05)
T Hpc VIET NAM THANG 6 - S010014
IV. BAN LUAN
^ Tinh hoan an fTHA) cd nhieu nguy ca tdi cd the, trong do hai nguy cO nang ne nhat la ung thU va anh hudng tdi tinh dicli do gay vo sinh. Ve nguyen tac, phau thuat ha tinh hoin du'dc tten hinh cing sdm cang tot, cang giam cac nguy cp neu tren. Khi phau thuat ha tinh hoin xuong blu dupc den hanh d nam gidi tuoi tru'dng thinh, chiing toi nhin thay cic tinh hoan an thu'dng cd kich thu'dc nhd hPn binh thu'dng, nhu md thu'dng mem nhao. Trong nghien ciru ciia Anne Suskind v i cpng sU (My, 2007) d cac tre cd tinh hpan an, du'dng kfnh ciia cic ong sinh tinh nhd hPn, mifc dp xd hoa tinh hoan cung cao hdn d nhiihg tre ldn hdn 1 tuoi so vdl tre nhd hdn 1 tuoi. Cac ket qui niy cho thay cd sir thay dol cd y nghla vg mo hpc ciia cac ttnh hoan an va cd the inh hudng tdl ttnh triing, giy vo sinh. Cic nghlSn ciJu khac tlm thay sif xd hda to chifc gliiS cac ong sinh ttnh, xd diy thanh ong sinh Unh d nhiirig difa tre difdc phau thuit mupn.
Neu benh nhan chi bi an tinh hpin mpt ben thi van CO khi nang cd cdn. Tuy nhien, cd nhleu nil rojidn do cd nguy cd bj ung thu' ben tinh hoin an va nhleu nguy cd khic. Tai Trung tim Nam hpc - B^nh vien Viet Difc, chiing tdl cung Sa_ gip tttfdng hdp benh nhin cd tinh hoin an mpt bin, tinh hoin ben kia nim trpng blu nhtfng Chang may bj xoin hoac chan thu'dng nen phil cit ttnh hoin. Nhu' viy, nguy cd vd sinh dol vdl benh nhin niy rat ldn.
Neu bpnh nhin b| an ttnh hoin hai ben thi nguy cd vo sinh rat cao. Nhifng ngu'di niy ttiu'dng cd ket qui xet nghiem tinh djch do khdng cd ttnh triing. Tham'chf, cd nhutig ngu'di cdn khSng the quan he tinh due du'dc do thieu hut njl tiet to tram trpng. The trang nhiilig nam glil niy thu'dng ySu dupl, inh hu'dng rat Idn den oipc song, sinh hoat v i tam sinh jy nqu'di benh.
Ngoil ra, ngu'di bl tinh hoan an con cd the bj phoi hjp them cac dj t i t bam sinh khac nhu' lo dai lech thap, thoat vj b?n,... Nhiu di t^t bam sinh lam t ^ g nguy cd vo sinh hdn cho ngudi benh.
Trong nghien citu, the h'ch tinh djch d benh nhin THA hai ben ft hdn d b?nh nhin THA mpt bSn, Slf khic biet cd y nghia thpng k i (p<0,05').
The tich Hnh dich d benh nhin THA mpt ben khing inh hu'drtg bdi vj tri THA, sif khic biet Idling cd y nghla thSng k i ( p>0,05).
Tinh triing duBc tap ra d mil tnfdng cd nhiit dy thSp hdn nhlit dp cd the 1- 2°C, cd Dartos ciia blu CO giin Hi dieu chinh nhlit dp che phii hpp.
Khi ndng cd Dartos gian ra con khi lanh thi co ial.
Cho nin neu Hnh hoin khdng nim d blu, te bio ddng Hnh bl huy hpal nhit l i khi ttnh hoan nim
trong 6 bung hay ngudi thirdng xuyin lam viic d nhiet dp cao cung bi inh hudng den sinh sin Hnh triing, nen ty l i vo sinh cao hdn binh thu'dng.
Qua nghiin cutj ciia chung toi thay ring tat ca 31 binh nhan THA hai ben (100%) deu khdng cd Hnh Hung, ty i i khdng cd ttnh biing d nhdm benh nhan THA mpt ben la 22,6% (12 benh nhan),'sir khac biet cd y nghTa thong k i (p<0,d5).
Chung toi cung thay rang mat dp Hnh triing d binh nhin THA mpt ben khong chiu inh hu'dng bdi vi trf THA, sy lihac biit khong cd y nghla thong ke (p>0,05).
Theo Li Ngpc Tir (1995), tj le khong co Hnh hiJng d benh nhin Hnh hoin an mot ben l i 20- 25%, d benh nhin Hnh hoin an hai bin l i 60- 80%.
Cic chi so chat li/dng tinh triing (ty l i % Mnh triing song, ty l i % Urih triing binh thu'dng, ty l i
% Hnh Hiing dl dpng) d binh nhin THA mdt bin khdng inh hu'dng bdi vj tri ciia THA (sU khic blit khdng cd y nghTa ttiong k i vdl p>0,05).
V. KET LUAN
Tinh hoin an cd inh hu'dng tdl Hnh djch do ciia binh nhan, die diet khi bj an c i hai bin.
Qua dd, inh hu'dng xau din kha ning sinh sin CLia ngu'di benh. Tuy nhiin, khi binh nhin chi bj Hnh hpin ari mpt bin thi the tich Hnh dich, mit dp Hnh triing, chat lu'dng ttnh triing cd thay dol nhu'ng sif khac blit khong cd y nghTa thong k i gliiS cac vj tri cua tinh hoin an.
TAI L | | U THAIVI K H A O
1. Luciano A.F. and Frandsco J.B.S. (2014):
Testicijlar migration chronology: do the right and the left testes migrate at the same time? Analysis of 164 human fetuses. BJU Int 2014; 113: 650-653 2. Douglas A. Husmann (2002): "Oyptorchidism",
Clinical pediatric urology, p 1125 - 1248.
3. Thai Lan Thu', Hoing Vin HCing (1993), 'Nhjn xet bu'dc dau ve tfnh chat ISm sang, dieu trj vi giai phau benh iy ciia Hnh hoan khong xuong blu trong mudi nSm 1981-1990, Ngoai khoa Hig'c hinh y dupc hqic Viet Nam, XXIII, H 27-32.
4. Israel Franco (2002), "EvaiuaHon and management of impalpable tesHs*, Clinical pediatic urology, p 1155-1170.
5. Steven G. Doclmo.MD (2000), The undescended testide. Diagnosis and management", Amerian Family Physidan, p 2037-2044.
6. Rakesh P.P., Thomas F.K., Dale S.H. et al.
(2005), Testicular microlitiiiasis and antisperm antibodies following testicular biopsy in boys with cryptorchidism, 1 Urol., 174: 2008-2010.
7. Le Ngpc TCf (1995), "Tinh hoan khong xu6ng biu", Benh hoc tiet ni?u, NXB Y hoc, H 570-576.
