± 608,23g. TruPng hpp eP edn ndng dudi 2500gr chilm 19,5% Ty IP tCr vong sa sinh Id 2,1%.
T A I LIEU THAM K H A O
1. Truang Dgi hoe Y Ha Npi - Bp mdn Phy san.
(1999/ Bii giang san phu khoa. Uha xult ban Y hpc, Ha Npi, tr.26-31.
2 Nguyen Hong Phuang (2000). Nghien cuv tinh hinh RTD vi cic yeu td lien quan tai Vidn BVBMTSS tmng 3 nam 1997-2000. Lugn van tot nghiep Thgc sT.
TorPng Dpi hpc Y Ha Ndi.
3. TruPng Dai hpe Y Duac Thdnh pho Hd Chi Minh - Bg mdn Phy san (1996), Bai giing sin phu khoa. Nha xult ban Y hoe. Ha Npi, tr. 405 - 410.
4 Nguyen Bi>c Hinh (1999). So sanh m l lay thai vi RTD d 2 giai dopn 1989-1990 va 1993-1994 tai vipn BVBMTSS. Tap chi Thong tin Y Dwgc, So ddc bi$t chuydn dd Sin phu khoa. 12, tr. 107-111.
5. LP Diem (1985). Tinh hinh m l lly thai tai Benh vipn Phy san Hai Phdng thdng 6/80 - 6/85. Cong trlnh NCKH 5 nam phu sin so sinh vi KHHGO, BVPS Hal phdng, 1. tr. 56-63 .
6. Pham Thu Xanh (2006). Nh$n xet tinh hinh sin phu cd seo md de cu dwgc xi> tri tai BVPSTW trong nam 1995 va 2005. Luan van tdt nghipp BSCK II, Tnjong Dgi hoc Y Hd Npi.
7. NguyPn Thj Thdm (2002). Nghien cuv cac yiu to lien quan den each de d san phu cd seo MLT mgt lin tai Benh vidn Phu san Tmng wong tmng 3 nam 2000-2002.
Lupn vdn tot nghipp thpc sy Y khoa TruPng Dgi hgc Y Ha Npi.
8. Phan TruPng Duypt - D i n h The My (1999) Ldm sang sin phu khoa. Nhd xult ban Y hgc Ha Ngi, 102-
DANH GIA KET QUA DIEU TRI VO BANG QUANG DON THUAN TRONG PHUC MAC B A N G PHAU THUAT NOI SOI 0 BUNG TAI BENH VIEN VIET TIER HAI PHONG
T6M TAT
Myc tieu. Dinh gii kit qui <fiiu tri khiu bing quang v& don thuin trong phuc m$c bdng phiu thudt ndi soi 6 bung. Doi twgng vi phuxmg phip nghidn cO'u: Nghidn cOv hdi ciru 25 tnrdng hgp vd bing quang don thuin trong phuc m$c dwac phiu thudt ndi soi tw thdng 08/2012 din thing 06/2014. Kit qui: Tudi trung binh ta 30,86 tudi. Thinh cdng chiim tp Id 92 %. Thdi gian md trung binh li 110±12 phOt Thdi gian nim vi$n tmng binh Id 7,8 ngiy. 06 3 trwdng hgp kdm tdn thwong rich thanh mac d^i tring Sigma, 2 trwdng hgp kdm vd bdng quang ngodi phOc mgc. 1 trwdng hgp v& khung chdu. Khdng tai biin vd biin ChOng tmng vd sau phiu thuit. Thdi gian rOt thdng nidu dgo - bing quang tmng blnh 9±1,5 ngdy, khdng cd bdnh nhdn ndo can md thong bing quang trdnxwangmusauphiu thudt. Kit lu$n:Phiu thuit ndi soi khiu 16 thung bdng quang li mdt phiu thudt an toan, hiiu qui, it xim lin, cd tinh wu vidt cao ndn dwgc ii/a chgn.
TIP khda: Bdng quang, phiu thudt ndi soi.
SUMMARY
Objectives: to evaluated treatment of traumatic isolated intraperitoneal bladder rupture by lapamscopic surgery. Materials and Methods:
Prospective study was conducted on 25 cases of intraperitoneal bladder rupture post trauma from april 2012 to June 2014 at Viet Tiep Hospital Results: The average age was 30.86 years. The Successesful rate is 92 %. Time operation is : 110±12 mins, gas after 12-36h. Postoperation stay was 7.8 days. There was no intra- or postoperative complications There is 3 cases with a torn at serosa of sigmoid colon, 2 cases
B O I VAN CHIEN Benh vien Vidt Tiep Hii Phdng with the bladder rupture extraperitoneal and one case broken pelvis. There aren't complications during and after surgery. Foley catheter were removed on 9±1.5 days, postoperation without any suprapubic catheter.
Conclusion: Treatment of traumatic isolated intraperitoneal bladder rupture by laparoscopic is safe and effective.
Keywords: Bladder, laparoscopic surgery.
DAT VAN De
Bdng quang dupe khung xuang ehpu bao vp n&n khi eP c h i n thuang viing bung, bdng quang Id tang It bj ton thuang nhat. Tuy vay. khi bdng quang P trang thdi cdng d l y . vPi mpt lye tac ddng trye tiep hodc gidn t i l p bang quang r l t d l vp vdo trong phiic mpc [9]. Bpnh nhan thuPng vdo vipn vpl benh canh eiia da c h i n thuang lam cho cdc tripu chii-ng eua vd bdng quang bj ehe l i p . Vi vay, c h i n dodn thuPng chpm. ^ l u trj chii yeu bdng mo mo'.
Tuy nhlPn vPi s y phdt then ciia phdu thudt npi soi hipn nay, dde biet Id phdu thupt npi soi t i l t nieu, khau bdng quang vP qua npi soi 6 byng da dpt dupe nhO'ng k i t qua t i t . Dd cd nhilu bdi bdo trong vd ngodi nuPe ve c h i n dodn vd d i l u trj vd" bdng quang bang p h i u thuat npi soi eho k i t qud r l t tot. Ddy Id mot p h i u thuat hipu qua. it xdm hpi, eP t h i kiem sodt duac ton thuang cdc tpng khac kdm theo ma khdng bo sdt t i n thuang.
Tpi Vipt Nam. NguyPn Tang MlPn Id nguPi d i u tiPn khdu bdng quang vd' b i n g npi soi vdo nam 2004 [11]. TO' ndm 2008. Bpnh vipn Vipt Tipp Hai Phdng eung dS dp dung ky thupt khau bdng quang qua npi soi 6 byng, nhung chua ed 6e tdi nghiPn euu hp thing ndo. Chinh vi v$y chiing tPi t i l n hdnh nghiPn
y HOC THVt HANH (948) - SO 1/2015
ciru ndy nhdm mye tieu 'Danh gii kit qua dieu tri vd bdng quang don thuin trong phdc mac bang l^tSu thudt ndi soi 6 bung ".
D 6 | TUVNG v A PHU'aNG PHAP NGHIEN CLPU 1. DPI lu'p'ng
T i t ca cdc bpnh nhan nhdp vien tai Bpnh vipn Vipt TiPp Hdi Phdng t u thdng 08/2012 d i n thdng 06/2014 dupe c h i n dodn vP bang quang, eP huyet dpng I n dmh
TiPu ehuIn loai trCr: Huyet dpng khPnq I n djnh sau hli sii-e, vidm phiic mac, nhilm khuan huylt, chin thuang sp nao eP tri giac khong on dmh. cd t i l n su phiu thupt I byng tai-Pe dP.
2. Phuang phap nghien ciru: Md ta cdt ngang hoi CO'U.
3. Phuang phdp phdu thudt Hdi sue truPc m l vd gdy mP ndi khi quan.
Bpnh nhdn n i m ngua, e l djnh 2 chdn, d i u thap, ddt thing tilu.
Phiu thudt vien chinh dung bdn trdi. phy dung b&n phai.
Troea 10 mm d i u tiPn dpt trPn rIn.
Hai troea 5 mm dat 2 bPn h i ehpu tpi ehd giao nhau oia ba ngodi ea thing to 2 ben vai duPng ngang n l i hai gai ehpu truPe trPn.
Bam CO2 vPi dp lyc I byng 12-13 cmHsO.
Hiit speh djch, mdu I bung, quan sdt todn bd I byng phdt hidn t i n thuang p h l i hpp.
Kiem tra todn bp Idng bdng quang d l phdt hIPn vP bdng quang ngodl phOe mpc kPm theo.
Bdt troea 5mm trpn xuang mu xuyen thdnh truPe bdng quang, sau dd dua sonde htit nhPt s l 8 khdu vdi sonde Foley 18F. kPo Foley vao trong de ddn luu bdng quang nhu'ng tnj'Png hpp v p phi>e tpp.
Khdu vat b i n g chi Vicyl 2.0 mat truPc hay d* dinh bdng quang den giua vet thuang. Sau dd e l dinh bdng quang vdo thanh byng truPe.
Ddt d i n luu tiil Cling Douglas, nit khi khdng cdn ra djch.
DOt sonde nipu dao - bdng quang sau 9 ngdy K£T QUA vA BAN LUAN
1. T u l i vd giP'i: NghiPn ei>u eiia ehiing tPI ed 25 tnrPng hap va bdng quang trong phue mac do ehIn thuang. trong dp 24 bpnh nhan nam, mot benh nhdn t^. Tuli tnjng blnh Id 30,86 tuoi.
2. NguyPn nhdn chdn t h u a n g : VP bdng quang trong phiic mac thuang gpp trong nhO'ng tnjpng hpp viing hp vj bi ddp vdo vpt eO'ng trong tai npn giao ttidng, trong t h i thao hay lao dpng, hoac bj vdt eO'ng il^p vdo khi bdng quang dang cdng tieu [3][10][11].
Chiing tPi gpp 20 truPng hpp do TNGT. 3 truPng hpp do chai the thao, 2 truang hpp bj vpt eung ddp vdo byng duPi.
3. Ldm sdng Tripu . chi>ng
Tyip
Oau I Ti^u do I Tiku khd, I Sonde tiPu cd byng | | bl tilu | mdu
mdt tieu nhung khdng t i l u duac, t i l u do qua sonde nipu dao bang quang [10]. Nam 2000, nghien euu eiia Nouri eP 1 benh nhdn nhpp viPn sau 24 glP bi tai nan, khdng eP dau hieu phan ijng thanh bung, duac d i l u trj qua nPl soi 6 bung thdnh cdng. Ndm 2003.
ZiadP cQng ed mdt truang hpp VBQTPM nhap vien ngay thu 4 eua benh, khdng cd d i u hipu viPm phiic mac, benh nhdn duac noi soi chan dodn sau dP chuyin m l ma.
Dau byng Id triPu ehO'ng hay gpp n h i t t i l u mdu eung thuPng xuat hipn ngay tO d i u nhung s l lupng nuac t i l u it d i n . Dpt thdng tieu cd mdu vd lupng nuac tieu it Id d i u hipu e l n luu y. MPt s6 truPng hpp Chung tdi dat ra nhilu nuae t i l u nguyen nhdn Id do thdng tieu dat vdo 6 bung, qua c h i vP bdng quang
Cdn Idm sdng:
Djch 6 bung
VP bSng quang
X quang (thulc trong 6
bgng)
CT scanner (v& bang quang)
C h i n dodn vP bdng quang dya vdo trieu ehijng ldm sdng thuPng gdP- dau hp vj. r l i lopn t i l u tipn,
100% j 60%(15/25) j 88%(22/25) j 100%
T i t ca ede bpnh nhdn d i u siPu am t h i y djeh I byng, thay mIt lien tuc a thdnh bdng quang Id 60%.
CP 22 truPng hpp t h i y eP thodt thude cdn quang vdo obung, 3 truPng hpp khdng thay, nguyPn nhdn Id do Id thiing duac qual rudt bit lai. nuPc bam va thuoc can quang khdng du dp lye de day ra ngoai, 3 bpnh nhan nay da dupe chyp CT scanner thay cd vP bdng quang. Theo Hodng Van Tiing, c h i n dodn va bdng quang b i n g siPu dm Id 48%, gpi ^ c h i n dodn Id 36%.
Trong nghiPn ci>u ciia ehOng tPi t i t ca cdc bpnh nhdn d i u dupe c h i n dodn xac c^nh truac khi phau thuat.
Dieu tn phdu thupt la bat bupe, khau ehP vP bdng quang, d i n luu bdng quang trPn xuang mu, ddn luu 6 bpng Nhung phai dCing duPng mo rat ddi va dii rdng mai cd the quan sat dupe ede tpng khdc trong o bung, dieu nay se trd' IPn ndng n l nhat la khi khdng CO t i n thuang kem theo [1,2,4,5.6.7.8]. D l i vai cdc benh nhan eP huyet dpng I n djnh thi npi soi I byng uu vipt han ed. It xdm l l n , phye h l i nhanh n h i t cho benh nhdn, cd the quan sdt h i t ede tpng trpng o byng vd cd ty Ip t u vong It han phuang phdp mo md kinh dien [7]. Ngodi ra cPn eo t h i trdnh md byng trong 63
% ede truPng hap, tdng hon khi eP cde ton thuang lien quan.
Ndm 1994, phau thudt npi sol khau bdng quang dd dupe md ta tren the giPi, td ra cd nhieu uu dilm vd ipi ich eho benh nhdn Chiing tdi da khdu thdnh cdng cho 23/25 (92%) bpnh nhan. Trong dP ed 20/25 truang hap bdng quang raeh d vOng chdp. Cd 20 tnj'Png hpp (80%) vet rdch thang, 4 truPng hpp (16%) v i t rdch hinh ehC V, CP 1 tnj'Png hpp rdch phi>e tap nhieu dudng Chieu dai v i t rdch ti> 1-9cm trong do v i t rdch tii- 4-6 cm chilm 70%. CP 64 % trudng hap dang chay mdu ri ra tai mep vet rdch, eo 1 tardng hpp (4%) mdu phun thdnh tia tir vet rdch va 1 trudng hpp (4%) vet rdeh phifc tpp nhilu dudng, ehdy mdu nhieu, 2 trudng hpp ndy phai ehuyin m l md d l SCP II ton thuang.
Trong nghiPn cu'u, ehung tdi t i l n hdnh khdu bdng
Y pni • T H U C H ANH IQdH^ . CA 1 liM e
quang 2 idp bing chi viryl 2.0 vd t i l n hdnh bam cang bdng quang kiem tra. Nhung chd xi rd chung tdi se khdu tdng cudng. Theo hudng ddn eiia Hdi Nipu khoa chdu Au. khdu bang quang mpt Idp hay hai Idp tOy theo thdi quen ciia phdu thudt vipn, tuy nhiPn khau bang quang hai Idp bdng ehi tiPu chdm se dat dd an todn cao nhat [2]. Mdt s l tdc gia cho rang khau hai Idp sP kin vd it xl rP nude tilu [9,5]. Cde tdc gid khde lai quan nipm ehi khdu bdng quang mPt Idp l l y sau ca thanh mac va ca du kin cung vdn thdnh cdng [1].
Cae t i n thuang p h l i hap dupe phdt hipn khi phdu thudt' 3/25 (12%) tnj-dng hap rdch thanh mpc dai trdng di kPm, cd le do ea ehe dung ddp manh, nhung ehua vd. 3 BN nay dd dupe khdu lai thanh mpe dai trdng bdng ehi Vicyl 3.0. 2 tnj'Png hap (8%) eP v d bdng quang ngoai phiic mae mdt trudc, dan gian, nPn dupe khdu lai mpt Idp qua npi soi. 1 trudng hap vd ngdnh ngli mu di kPm.
Thdi gian phdu thupt trung binh la 110±12. Qua npi sol chOng tdi hiit h i t d|ch trong bung, hut speh mdu eye trong bang quang va trong I byng d l trdnh nguy ca t i e I n g d i n luu. Lau speh d bung vd ddt mdt d i n luu till cung Doulas qua chdn Id troea 5mm ben phai ho$e trdi.
Hiit sach nude t i l u vd d i n luu I bung tript d l k i t hpp vdn ddng sdm Id e l n thilt d l gliip bpnh nhdn phye l i l i nhanh. Thdi gian nit sonde nieu dao bdng quang trung binh Id 9±1,5 ngay. Sau rut benh nhan cd t i l u bult rlt trong 1 hope 2 ngdy dau sau dd tieu tipn binh thudng
Sau m l bpnh nhdn it dau, sdm trung tiPn 12-36 tiing nPn cd thdi gian phuc h l i nhanh han, hpn ehe b i l n chdng dinh aidt. Cd 76% trudng hap trung tipn sau 24 gid. Thdi gian hpu phiu tmng binh eiia ehiing tPi Id 7,8 ngdy, nhanh nhit Id 4 ngdy lau nhit Id 15 ngdy, cde trudng hap n i m vipn Idu Id do ed kPm theo vd khung ehpu va v d bang quang ngodi phuc mac Ngin han so vdi T r l n Dinh Phong (2001) Id 14 ngdy.
Khdng cd trudng hpp ndo ed bien chi>ng nhiPm trung chdn troea.
K t T LUAN
Dieu tri v d bdng quang trong phiie mac bdng phau thudt npi soi 6 bung Id phuang phdp an todn, hipu qua, it xdm l l n , hpu phdu dan gian, bpnh nhdn phye
h l i nhanh sau m l . ^ Chdn dodn ehinh xde, chi dinh hap li^ dau t u mdy
mdc dyng cy, nang cao ky ndng cua phdu thupt vien d l dem iai k i t qua t i t han.
TAI Lieu THAM K H A O
1 Appeltans BMG, Schapmans S, Willemsen PJA, Verbruggen PJEM, Denis U (1998). Case report:
Urinary bladder rupture, laparoscopic repair. Bnstish Joumal of Urology; 81 (5), 764-765.
2.Badrinath RK, Michael PP. Robert RB (2004).
Vesical trauma and Hemorrhage; Glenn's Urologic Surgery, Sixth edition, Lippincott Williams & Wilkins Company; Section III, Bladder, chapter 27:212-9.
S.Cottam D. Angus LD, Shaftan GW Goreckl PJ (2002), Diagnostic and therapeutic laparoscopy for trauma: a technique of safe and systematic exploration:
Surg Laparosc Endosc Percutan Tech.; 12:195-8.
4.Choi YB, Lim KS (2003). Therapeutic laparoscopy for abdominal trauma. Surg Endosc; 17:421- 427. Lynch D, Martinez-Pineiro L. Plas E, Serafetinidis E. Turken L, Hohenfellner M (2006). Bladder trauma. Guidelines on Urological Trauma. Eumpean Association of Urology Guidelines, 2006 Edition: 31-35.
5.Corriere JN. Sandler CM (1986). Management of the ruptured bladder: seven years of experience with 111 cases. J Trauma: 26: 830-3
6.Corriere JN. Sandler CM (1999) Bladder rupture from external trauma: diagnosis and management.
Worid J Urol:-1784-89.
7.Cottam D. Goreeki PJ. Cun/elo M, Shaftan GW (2001) Laparoscopic repair of traumatic perforation of the urinary bladder. Surg Endosc. Dec; 15 (12): 1488-9.
8.Durand X. Chapuls O, Dellgne E, Jancovici R (2004). Ruptures traumatiques vpsicale et il^ale associees. Pmgresen Umlogie, 14:1216-1218.
9.Ngd Gia Hy (1988). Thuang tieh bpng ddi. Cap cuu Ni$u Khoa tap 1; Chuang 5:129-154.
lO.Ngd Gia Hy (1980), Vd bgng dai. Nipu hpc t$p I.
NXB Y hgc.15. Nouri M, Tligui M. Monsaint H. Thibault P (2000). Rupture spontanea intraperitonPale de la vessie traitee par coelioscopie. Pmgres en Umlogie ; 10, 595- 596.
11. Nguyen Tang Midn (2005), Phiu thuat npi soi - npi soi can thipp tpi BV Hodn My 2002-2005.: Tap san Hpi thao khoa hgc Tim mach can thipp & Phiu thudt ngi soi, trang 1-7.
DANH GIA KET QUA TAO HINH DAY CHANG CHEO TRUAC QUA NOI SOI VGTI KY THUAT HAI DO D A N G G A N HAMSTRING TAI DENH VIEN VIET DUTC Tl)r2011 - 2012
TOM T A T
Ddt van de: Nghidn ciru dinh gid kit qui tgo hinh diy ching chdo trwdc khdp gdi ky thuat hai bd qua ndi SOL IVIyc tieu nghidn cuv: 1) Dinh gii kit qui (90 hinh diy chdng chdo trwdc qua ndi soi vdi ky thudt hai bd bing gin Hamstring. 2) Xic dinh mdt sd
TRANTRUNGDUNG, Truxmg D?i Hgc Y Hd N^i L i T H A N H HUNG, Benh vidn Hgp Lyx: Thanh Hoi
yiu td inh hwdng din kit qui sau phdu thudt. Doi tux^g vi phuxmg phip nghidn cO'u: nghidn cim hdi ciru 39 bdnh nhan dwgc tgo hinh diy ching chdo tnrdc khdp gdi qua ndi soi tai Bdnh vidn Vidt DOc tir 2011 din 2012. Kit qui nghidn cO'u: Tp Id tdt vi rit tdt id 94.6%, nghidm phip ngin kdo tnrdc vi
V HOC THl/C HANH (948) - SO 1/2015
