DANH GIA KET QUA

Nghien ciru Y hoc Y Hoc TP. Ho Chi Minh * Fhu Ban Tap 19 * So 5 * 201S

DANH GIA KET QUA PHAU THUAT DIEU TRI LO TIEU THAP TAI BENH VIEN DA KHOA TINH BINH DINH

Phan Xuan Cdnh*, Pham Vdn Phd*, Hdn Cdnh Dinh*, Vo Xudn Thdnh*, Nguyin Van Phien*, le Bd Thao*, Bui Thien Thjnh*

T O M T A T

Muc tieu: Ddnh gid ket qud phdu thuqt dicu tri 16 twit thq? tai binh znen da khoa tinh Bhih Dinh.

Phtfong phap nghien ctau Tiat cdu mo td.

Kei qud: Trong thdi gian tir 6/2013 - 6/2015, dning toi cd 32 benh nhan 16 ticu thdp dugc phau thuat (27 ti-udng hgp mo Idn dau vd 02 md'thi 2, 02 ti'ii thita kem liep nieu dqo, 01 do niiu dqo kem hep nieu dqo). Bieii chifng diung sau mo chiing toi Id (12/32 ca) chiein 37,5%. 03 (9,3%>) tnidng hap thim nidu nmi mat bung duang vqt nliimg ngdy dau sau mo'. 01(3,1%) trudng hgp hep niiu dqo duac nong sau mo. 06 trudng ligp do nieu nieu dqo (18,8%) va 02 (6,3%) trudng hgp tui Siiea niiu dqo can phdi mo lai. Ket qua chiing toi dqt tot Id 62,5%, khd Id 12,5%, xm Id 25%.

Kei ludn: Benh vien da Idwa tuyeii tinh co the trim khai phdu thuat 18 tieu thdp zm 02 dieu kiin: bac sy dm:

ddo tqo cdn bdn ve Ngoqi nhi va ditgc trang bi dung cu phdu thuqt

Tit kltoa: Lo tiat thap, tqo hinh niiu dqo, cong dmmg vqt, ro nieu dao, hep niiu dqo.

A B S T R A C T

TO ASSESS THE RESULT OF OPERATION TREATS HYPOSPADIA IN BINH DINH GENERAL HOPSTTAL

P h a n Xuan Canh, P h a m Van Phu, H a n Canh Dinh, Vo Xuan T h a n h , N g u y e n V a n Phien, Le Ba Thao, Bui Thien Thinh • Y H o c TP. H o Chl M i n h * Supplement of Vol. 19 - N o 5 - 2015: n o - H 3 Objective: To assess the result of operation treats hypospadias in Binh Dinh general hospital.

Methods: Prospective study.

Results: From 6/2013 to 6/2015, we had 32 patients with hypospadias zoho zoere operated. There zoere 27 cases, irfio zoere operated the first time, 2 cases were operated the second stage, 2 cases urethral divaiiculum and 1 case urethral fistula combined urethral stawsis. Cj)mmon complications occurcd (12/32 cases) holding 37.5%, 3 cases (93%) had temporary vaitral isdiemia, 1 case urethral stawsis was dilatable after surgery,, 6 cases (18.8%) had fistula, 2 case (6.3%) had urethral diverticulum. Our results had good (62.5%,), fan- (12.5%), bad (25%).

Conclusions: Province gateral hospital could operate hypospadisas zoith two antditions: doctors zoere traiiwd base about pediatiic surgery and surgery equipmait zoas aiough.

Keywords: Hypospadias, urethroplasty, patile curvature, fistula, urethral stawsis.

D A T V A N D E h e u cd t h e n S m tii r a n h q u i c ^ u cho d e n ^ g TL -I - " u J- „ J - . *.. ,. . sinh m d n ) va di«mp zwf CDiip d n h i e u m u c dd"'.

Thuat n g u T l y p o s p a d i s a s " d e cap d e n di tat , = ^„. ' „ ^. . ', .. , . ^ L-- ^- L. - J "I ' • I. • ,^L -• , . ', '-^ ° ^ ^ *hap la dl tat b a m sinh cua d u o n e v^t b a m sinh o d u o n g vat voi hai t h u o n e tdn chinh , , , ' ,. ..

l i . 1^ h-s J-.J n Xi. •• • ^ L- L , . „^ t h u o n g g a p v a co tan suat k h o a n e 1/300 tre trai la: lo nat lech thap so voi vj t n b i n h t h u d n g (16 c o r a '

*B^nh vien da khoa tinh Binh E>irih.

Trir gid lien lac: Ths.Bs.CKI.Phan Xuan Canh DT: 0979710777 £,«fli7-canhbacsyl212@ginail.mm

*'*' Chuyen De Ngoai Nhi

V Hpc TP. Ho Chi Minh * Phu Ban Tap 19 * So 5 * 2015 Nghien curu Y hpc

sinh sdng ^•*-^^',

Benh khong nguy hiem den tinh mang benh nhi. Tuy nhien, neu khdng duoc dieu tri sdm, khi den tudi di hpc tre se mac cam... dieu nay se anh hudng rat ldn den tam ly va su phat trieh ciia tre. Khi khong dieu tri nam gjdi cd the se khdng cd con do duong vat cong (khdng giao hpp dupc hoac tinh trimg khdng dugc phdng ra ngoai theo duong binh thudng).

Benh vien da khoa tinh Binh Dinh da trieh khai phau thuat dieu tr; Id tieu thap tu nhiing nam 1995. Tuy nhien, thdi gian gan day cd nhieu cai tien mdi trong ky thuat md va dung cu phau thuat (chi khau PDS 7.0, dung cu vi phau, kinh lup phau thuat). Cho nen, ket qua phau thuat dieu tri 16 beu thap cd thay doi theo chieu hudng tdt hon.

Muc tieu nghien cihi

Danh gja ket qua phlu tfiuat dieu tri Id tieii thap tai Benh vien da khoa tinh Binh Dinh DOITl/ONG-PHLrCNG PHAPNGHIEN CUtr Doi tupng

Benh nhan dupc chah doan 16 tieu thap va dupc phau thuat tai BVDK tinh Binh Dinh, trong thdi gian tu thang 6/2013 den thang 6/2015 Phtrong p h a p nghien cuu

Tien cuu md ta Ky thuat m o

Chung t6i ap dung cac phuong phap Duplay, Snodgrass, Duckett (Tubularized Island flap). Tai kham va danh gia ket qua dieu tri: theo ddi tai kham sau xuat vien d cac thdi diem 2 tuan, 1 thang, 3 thang; danh gia ve hinh the duong vat, dong nudc tieu, su hai long a i a than nhan.

Tot: Duong vat thSng khi cuong, khdng dau. Da phan phoi deu, seo dep. Vi tri Id tieu d dinh qui dau. Nieu dao mdi khdng hep: tre tieu tia manh, tia tieu ldn. Gia dinh hoac benh nhi rat hai long.

Kha: Ducmg vat thang khi cuong, khdng

dau. Da phu nieu dao mdi cd hien tupng thieu mau nhung sau dd hoi phuc, seo mo chua dep nhung chap nhan dupc. Id tieu trudc khac quy dau. H?p nieu dao, dong tieu nhd nhung dap ung khi nong nieu dao. Gia dinh hoac benh nhi hai long.

Xaii: Duong vat van con cong seo xau. Rd nieu dao, hep nieu dao, tui thua nieu dao can phai xu li bang phau thuat. Gia dinh berth nhi chua hai ldng<^>.

KET QUA VA BAN LUAN

Trong thdi gian 24 thang, chiing tdi cd 32 benh nhan Id tieu thap dupc phau thuat (27 trudng hpp m6 lan dau va 02 md thi 2, 02 tui thira kem hep nieu dao, 01 dd kem hep nieu dao) Tudi trung binh: 5,6 ± 3,4 tiJoi, (01 - 22 hjoi).

Trong nghien cuu cd ca benh nhan d tudi trudng thanh. Dieu nay la do benh nhan thieii hieu biet ve Id tieu thap, kinh te khd khan nen khi deh tudi trudng thanh mdi den phau thuat duoc.

Benh vien chiing toi chua cd khoa Ngoai Nhi rieng nen van cdn dieu tri chung mpt so benh ngudi trudng thanh nhung cd lien quan deh Ngoai Nhi.

Bdng 1: Phdn loqi 16 tiat thap theo Duckett

N

%

Thetniwc 6 22,2%

The giira 16 59,3%

Th4 sau 5 18,5%

27 100%

Nhan xet Trong 27 benh nhan Id tieu thap md lan dau cua chung tdi the giira chiem nhJeu nhat 59,3%. Theo Le Thuong tfie giua 53,7%«, Nguyen Phi Phong the giiia 57,5%'^J. Theo y van the gidi. Id tieu thap the trudc 50%, the giua 30%, the sau 20%, 6 Viet Nam 16 tieu thap chii yeu d tfie giiia va the sau'*>.

Bdng 2: Cong dmmg vqt sau khi deglovc vd gdy cuang nhdn tgo:

N

%

tOiong cong 15 55,6%

Cong < 30°

12 44,4%

27 100%

Nhan xet: Sau khi phau tich va tach da duong vat ve gdc duong vat va gay cuong nhan tao de kiem tra, chung tdi thay 44,4% benh nhan

Chuyen De Ngoai Nhi

Nghien ciru Y hpc Y Hpc TP. Ho Chi Minh * P h u Ban T?p 19 * So 5 * 2015 *

cdn cong duong vat. Chiing tdi ap dung ky thuat chiia cong duong vat theo Baskin va DoDat nhu sau: khau gap bao can lung duong vat d vi tri 12 gid (Nesbit cai tien oia Baskin) cho 09 trudng hpp<", phSu tich the xdp va can Buck 2 ben mang

nieu dao khau phu qua nieu dao 03 trudng hppf^. Chiing tdi khdng gap tnrdng hpp nao cong duong vat nang > 30° trong nhdm benh nhan md Id tieu thap Bn dau nay.

Ky thuat tao hinh nieu

N

%

Snodgras s 21 65,6%

Duptay

7 21.9%

Duckett (Tubulanzed Island

flap) 4 12,5%

32 100

Hinh 1: (a) deglove da dieang vqt ve goc dieang vqt dc chiea cong (b) rqdi sdn nieu dqo ti-ong tqo hhih nieu dqo theo Snodgrass

Bdng 3; Ap dung ky thuat tqo hhdi meu dgo Nhan xet: Chiing tdi chii yeu su dpng dartos flap (md dudi da cd cuong mach mau d bao quy (0u) de che phii nieu dao mdi 75%. Tu khi Retik sir dung dartos flap nhu ldp che phu nieu dao mdi, day trd thanh phuong phap chuah de ngan ngiia rd nieu dao^'^'. Trong nhiing trudng hop md lai hoac md thi 2 chting toi ap dyng theo Snodgrass, Le Tah Son sir dung tunica vaginalis (manh tinh mac bao tinh hoan) de phu nieu dao mdi vi dartos flap da sii dung trudc dcP-^l Sau nay chung tdi tao hinh vat xop mat bung duong vat de phil nieu dgo mdi vira gdp phan dfeu tri cong duong vat t^' vira cd tac dung chong rd nieu dao (cd ket hop vdi phu dartos flap).

Nhan xet: Qiiing tdi chii yeu sir dung 2 ky thuat Snodgrass va Duplay vi cd nhieu uu diem da dupc nhieu tac gia ghi nhan: sir dung mang nieu dao co san vdi nguon mau nudi doi dao, su don gian ciia ky thuat voi nieu dao mdi chi can 1 dudng khau, thdi gian md se ngan hon, thuan lpi cho nhiJng trudng hpp mo lai khi khdng cdn bao quy dau.

Bdng 4: Mo che phii niiu dgo mdi

Mo c tie ptiu ni^u d^o mo-

N

%

Dartos nap

24 75%

Tunica vaginalis

5 15,6%

Dartos flap + v^t x6p m f t bung

3 9,4%

32 100

Hinh 2: (a) Nieu dqo mdi vdi diwn ddi 2,2 cm (b) Phdu tich vqt xop 2 bin gdp phan diiea cong vd phu len niiu dqo mdi (c) Bdng duang vqt sau phdu thuqt

Chuyen De Ngo^i Nhi

V Hpc TP. Hb Chi M i n h * Phu Ban Tap 19 * So 5 * 2013 Nghien cuu Y hpc

Thcri gian mo tnmg binh: 88,6 ± 13,4 phut, ngan nhat 65 phiit, dai nhat 125 phut

Chieu dai doan nieu dao duac tao hinh: 2,89

±0,9 cm (1,2-4,5 cm)

T hoi gian lmi sonde tieu: 7,6 ± 0,8 ngay (6 - 9 ngay)

Bang 5. Bim chirng sau mo:

Biln chu'ng Khong Thi^u mau vat da

Hep nieu dao Do nieu dao Tut thira nieu dao

T6ng

N 20 3 1 6 2 32

62,5%

%

9,3%

3,1%

18,8%

6,3%

100 Nhan xet: Bien chiing chung sau mo cua chiing tdi la (12^2 ca) chiem 37,5%. 03 tiordng hpp thieu mau nudi mat bung duong vat (9,3%) nhiing ngay dau sau md (do qua trinh phau ti'ch lay dartos quy dau xudng phu nieu dao mdi chua tdt), nhung qua tfieo ddi tai kham tu hoi phpc khdng can can thiep. 01 trudng hpp hep ni#u dao (3,1%) dupc nong sau mo. 06 trudng hpp dd nieu nieu dao(18,8%) va 02 trudng hpp tui thira nieu dao (6,3%) can phai mo lai. Ty le bien chiing chung sau md cua chiing tdi ding gidng vdi mdt so benh vien tuyen tinh, Khanh Hda 3i2% <•% Da Ning 33,3%<s'

Bdng 6: Kei qud phdu thuqt.

Kitqua T6t Kha Xau Tong

N 20 4 6 32

62,5%

%

12,5%

25%

100 Nhan xet: Chiing tdi cd 62,5% Tdt, 12,5%, sd trudng hpp Xau la 25%, day la nhihig tiudng hop dd nieu dao, tui thira nieu dao di kem hep nieu dao can phai md lai.

KETLUAN

Benh vien da khoa tuyeh tinh chua cd khoa Ngoai nhi van cd the tri&i khai phau thuat Id tieu thap vdi 02 dieu kien: phau thuat vien duoc dao tao can ban ve Ngoai nhi va dupc trang bi dung cu phau thuat t^y du.

TAI LIEU THAM KHAO

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"> Dodat H, Landty J L (2003)." Spon^oplasty and seperadon of corpora cavernosa for hj'pospadias repair" BJU Intanational 91, pp 528-531.

3 H a y a ^ Y, M z u n o K (2013). " Can spongoplasty prevent 6stiila fonnabon and correct poule curvature in TIP urcthroplast)'for hj'pospadias". Urology 81 (6), pp 1330-1335, 4. Le Tan Son (2002) "Lotieuthap"."BenhhpcvadieulnNgo?i

khoa-Ngo?inhi" NhaxuatbanYhoc,trang211-217.

5 Le Tan Son. (2009). "Dieu tti 16 Beu thap nhung buong h ^ m o lai va mo thi hai theo ky thuat Snodgrass". Y hgc TP Ho Chi MirJi tap 13, phu ban so 1, trang 21S-221 6 Le Thuong, Nguyen Tiianh Ton (2011) "Danh gia ket qua

dieu hi 16 heii thap b a r ^ ky thuat cuon ong tai e t e o b?nh

\'i^ da khoa tinh Khanh Hoa". Y hijc TP Ho ChJ Minh tap 15 phy ban so 3, trang 13S-141

7 Mouriquand P, Delphine D (2010) "Hypospadias". In

"Pediatric Urology" of Gearhart, Rmk, Mouriquand, Saunder Elseviers, p p 526-543

8 Nguyin Phi Phong. Tran Van Tn?ng (2013), "Ket qua buoc (Su dieu m la tieu thap tai benh vien Phu San-Nhi Da Ning"

Yhi?cTP.HoChiMuih tap 17, phu ban so 3, trang 125-128.

9 Nguyen Thanh Liem (2002). "Dj t | t 16 tieu lech thap^'. "Phau Thuat Tiet Nieu Tre Em". Nha xuat ban Y hpc, trang 172 - 195.

lu Ph?in Ngoc Thach, Nguyen Van Quang, (2009). "M6 ta buoc

£ u phau thuat dieu tri tat 16 tieu thap the truoc theo phuong p h a p Duplay-Snodgrass^- V hpc TP H o Chi Minh t4p 13 phv ban so 6, trang 100-105

i l . Retik AB, Mandell] (1994) "Meatal based hypospacfias repair with flie use of a dosal subcutaneous flap to prevert urethrocutaneousfistula" JUrol 1521229-1231 12- Snodgrass W (2012). "Hipo^iadias" In "Urolog}-" of

CampbdL WalsK Saunder Elsevieis, pp 3503-36

Ngdy nlidn bdi bdo:

Ngdy phdn bien nhm xet bai bao:

Ngay bdi bdo duac ddng

01/08/2015 02/08/2015 01/10/2015

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