TAP CHl Y HQC V | | T HAM TAP 465 - THAHG 4 - S 6 2 - 2018
DIEU TRI HEP BAO QUI DAU BANG KY THUAT CAT VONG XO,
BAO T O N BAO QUI DAU
Nguyen Vift Hoa\ Vu H^ng Tu^n^'^
6 My, ty ie cat bo bao quy dau sd sinh giam tiy 90% eua nhuYig nam 50, xuong con 60 - 70%
cua nhij'ng nam 80 thupe the ky tru'dc, nhu'ng gan day ty le nay thay doi tif 65 - 82% tiiy theo tirtig nam. O cae nUcfe Chau Au, Chau A, Trung va Nam My, ty le cat bo bao quy dau thap. O nu'dc Anh, t^- le nay giam tu" 30% eua nam 19^10 xuong con 6% vao nam 1975. Tu" sau chien tranh Nam - Bac Trieu tien (nhOTig nam 50 cua the ky tru'dc), Han quoe la nu'dc duy nhat 6 Chau A thi/c hien rong rai ky thuat nay, vdi ty le 90%
d hpc sinli trung hgc [ 1 ] .
Ve mat ngoai khoa, chung ta chi djnh eat bao qui dau eho eac tru'dng hdp hep bao qui dau benh ly. Hep bao quy dau benh ly thdc sd dddc dac tru'ng bang lo cua bao quy dau bj xd, mau trang, hoa eutig, khong the lam lo quy ^ u va ranh quy dau khi keo bao quy dau ve phi'a goc du'dng vat. Bdi nhieu nghien cu'u gan day da cho thay bao qui dau co nhieu chu'c ning nhii: bao ve qui dau va io tieu, kha nang mien djch, nhay cam va su" ki'eh thi'ch tinh due, che pliu du'dng vat khi cu'dng, chu'c nang sinh due [6]. Oac biet trong phau thuat tao hinh, bao qui dau con Ja mot chat lieu rat tot de tao hinh nieu dao nhutig tru'dng hdp^^chan thu'dng nieu dao, thieu doan nieu dao bam sinh hoac bi hep nieu dao do cac nguyen nhan khac nhau [6].
Hien nay van edn ed nhiJng quan diem khac nhau ve ehi djnh cung nhu' phu'dng phap mo, trong dd phau thuat eat bd gan het bao qui dau ia pho bien [3]. Vdi quan niem mpi bp phan trong ed the deu cd nhiJng chu'c nang sinli ly cua nd nen can dddc bao ve toi da neu ed the du'dc.
TiJ nhieu nam nay tai ktioa phau thuat Nhi va tre sd sinh - Benh vien Viet Du'c chung toi van siJ dung ky thuat eat vdng xd va bao ton bao qui dau.. Mue dich cua ky thuat n ^ la giai quyet du'dc hep bao qui dau nhu'ng van bao ton bao qui dau vdi eac chu'c nang cua nd. Chung toi thi/e hien nghien cu'u nay nham danh gia ket qua dieu tn cua phu'dng phap nay.
II. DOI TUpNG VA PHLTONG PHAP NGHIEN COtt 2.1 e d i tu'dng nghien cuTu: Bao gom 75 benh nhan hep bao qui dau cd vdng xd du'dc mo theo cung mpt ky thuat tai khoa phau thuat nhi va tre sd sinh - Benh vien Viet Du'c td 1/1/2017 den 30/12/2017.
T O M TAT
Muc tieu: 1*16 ta ky thuat cat vong xd bao ton bao qui dau de dieu tri hep bao qui dSu. Ddi tUUng va phddng phap nghien cut/: Mdta hen ciiu 75'tre mo hep bao qui dau c6 vong xo mo theo^ky thuat cat vong xd bao ton bao qui ^ u tai khoa phau thuat nhi - benh vien V i ^ Du'c trong nam 2017. Ket qua: Thdi gian mo trung binh ia 25,6 phut, thdi gian nSm vien trung binh ia 1,4 ngay, thong thu'dng ia ra vB trong ngay. Ty ie bien ehijtig sau mo ia chay mau 1,3%. Ket qua 100% khong^ eo hep bao ciui dau tai phat Kei luin: Ky thuat cat vong xO, bao ton bao qui dau ia mot ky thuat dem lai su' hai long ve tham my. Ky thuat don gian nhuVig eung can su' can tlian, ty my, chuyen khoa.
Tiy khda: Hep da qui dau.
SUMMARY
TREATMENT P H I M O S I S W I T H FIBER RING CUTTING TECHNIQUE AND CONSERVATION OF THE CIRCUMCISION
Objective: Description of fiber ring cutting technique and conservation of the circumcision for treatment phimosis. Meterial and methods:
Prospective study- 75 boys treat phimosis with fiber ring at department pediatric in Viet Due hospital in 2017. Result: The average operative time was 25,6 minutes, the average hospitalization was 1,4 days, usually during the day. The complication after surgery:
bleeding 1,3%. 100% of the results not have recurrent phimosis. Conclusion: This technique should be applied to treat all the patients with phimosis that need surgical treatment.
key words: Phimosis.
I. OAT VAN o l
Cat bd bao quy dau la loai thao tae ngoai khoa CO xu"a nhat va van con la van de du'dc tranh luan nhieu nhat eho den tan ngay nay [1].
Ty le cat bd bao quy dau khac nhau tuy tutig viJng dan cu'. Nhin chung tren the gidi, cd khoang 8 0 % nam gidi khong bj cat bd bao quy dau [2]. Ty le cat bd bao quy dau sd sinh b| anh hu'dng bdi cac yeu to: ton giao, XLT sd, tpc ngu'di, cu'dng vj xa hoi - kinh te, thai dp cua ciia me va thay thuoc.
'Khoa phau thuit nhi - ixnh vien Viet Ddc.
^Bd mdn ngoai - trddng dai hgc Y Hi Noi.
Chiu traeh nhiem chinh: Vu Hong Tuan Email: [email protected] Ngay nhan bai: 14.2.2018 Ngay phan bi^n khoa hoc: 30.3.2018 l^lgay duyet b^i: 12.4.2018
VIETMAM MEDICAL JOURNAL M°2 - APRIL - 2018 2.2 Phiftfng phap nghien cihi:
2.2.1 Thiei ke nghien cdU: Nghien CIJXI tien cull.
2.2.2 Md ta ky thuat: Gay me doi vdi tre nhd. Gay te vdi tre tren 10 tuoi, chiu hdp tac: J:e goe du'dng vat, mue dich nham phong be tJian kinh lu'ng du'dng vat gom 2 nhanh di tiJ du'di xu'dng mu, chay dpc d \dng du'dng vat d vi t r i 10 gid va 2 gid. Thuoc te thu'dng diing la Lidocain hoac Xyloeain 0.25%, vj tri gay te d diem 2 gid, 10 gid va to chiTe du'di da quanh goe du'dng vat.
- Danh dau du'dng eat da vdng quanh du'dng vat, thu'dng d trang thai du'dng vat cu'dng.
- Tach niem mac quy dau khdi quy dau, sat khuan lai quy dau.
- Danh gia ham quy dau, se cat tao hinh ham neu ngan.
- Ddng 4 Plnee d 4 gdc (2h, 4h, 8h va lOh).
Rach da bao quy dau vj tri 6 va 12h den du'dng danh dau. Cat vanh xd hep den du'dng danh dau d da ben ngoai.
- Cat bdt niem mae quy dau, thu'dng eat each ranh quy d^u khoang 1cm.
- Kiem tra cam mau ky (dung dao dien ddn CLTC hoae \ddng cdc).
- Lpn bao qui dau ve phia sau va kiem tra do rong eua du'dng eat. Neu chu'a du rong thi cat them cho vu^ du.
- Khau lai da va niem mae bao quy dau bang chi tieu 5/0 hoac 6/0.
- Boi md khang sinh va bang ep lai. Trong tru'dng hdp bao qui dau viem nhieu, xd seo chung toi dat Sonde tieu va rut sau 1 ngay.
III. KET QUA NGHIEN CU'U
jTuoi trung binh la 8,3 tuoi, tre nhd nhat la 5 tudi va Idn nhat la 15 tuoi. Khai thac tien sd thi cd 43 benh nhi (57,3%) da it nhat 1 lan du'dc tach bao qui d i u tai eae cd sd y te.
Thdi gian phau thuat trung binh la 25,6 phut, nhanh nhat la 20 phut va lau nhat la 45 phut.
Thdi gian nam vien trung binh la 1,4 ngay, thong thu'dng benh nhan mo ve trong ngay.
Bien ehiTng sau mo: Mot tru'dng hdp chay niau sau mo chiem ti le 1,3% do cd 1 niit chi bj rach yi trf lOh va ri mau tu' mep da, x d ly bang ep vdi adrenalin pha loang va khong co tru'dng hdp nao nhiem khuan sau mo (thu'dng kham lai sau 7-10 ngay).
Ket qua dieu tri: 100% benh nhan deu khong con hep bao qui dau, bao qui dau Ion len de dang. Kha nang che phu bao qui dau: Che phu toan bp qui dau ed 51 (68%), che phu mdt phan bao qui dau cd 18 benh nhan (24%), ed 6 benh
nhan (8%) bao qui dau sau cat khong ehe phu qui dau. Khong cd tru'dng hdp nao bj mat can ddi da bao qui dau. Tat ca cac gia dtnh b€nh nhan deu hai long vdi ket qua (100%).
IV. BAN LUAN
Hep bao quy dau sinh ly d tre cdn bd (du'di 1 tuoi) khong cd ehi dinh mo cat bd bao quy dau.
Hep bao quy dau benh ly thy'c su" duWc dac tru'ng bang 16 cua bao quy dau bj xd, mau trang, hda eutig, khong the lam ip quy dau va ranh quy dau khi keo bao quy dau ve phia goc du'dng vat Ve md hpc, tinh trang benh ly nay du'dc dSc truYig bang viem quy dau kho tac. Ngu'di ta dio rang hep bao quy dau thu" phat cd the do nliieu ian CO gang keo bao quy dau ve phi'a gdc duUng vat de lam lo quy dau, cac dpng tac nay gay ra ton thu'dng md cua bao quy dau va tao nen seo xd hoac viem bao quy dau man tinh dan den seo xd [6]. Trong nghien cu'u cua ehung toi, ty le tre ft nhat 1 lan du'dc ipn bao qui dau tai cac ed sc( y te la 57,3%. Chung tdi chu'a tim thay eae nghien ciru ndi ve van den nay, tuy nhien d goc nhin chuyen khoa eho rang: sii cd gang Ipn bao qui khi bao cdn hep de lam clio dau bao qui dau tSn thu'dng ehay mau, tre rat dau (dae biet nhij'ng . tnJdng hdp diing Pince tach), sau dd tre se khong eho gia dinh cham sdc cho tre hang ngay, dan den cho ton thu'dng rl mau do tach viem xd hda.
Hep bao quy dau benh ly thu'c su" it gap tru'dc 5 tuoi, ehi gap td 0,6 - 4 % d tre nam 17 tuoi va chiem 0,9% d nam gidi tu" 19 - 31 tuoi [1] [4].
Dieu tri bang eorticoide khdng cd tae dung doi vdi hep bao quy dau benh ly. Tinh trang benh l'^
nay ehi cd the dieu trj bang phau ttiuat cat bo bao quy dau. Theo cac tae gia cac ehong chi dinh eat bd bao quy dau d tre sd sinh bao gom:
Tre de non va tre sd sinh (du'di 1 thang tudi), tat ca cae roi loan dong mau, benh da chay mau, hoae ed tien sit gia dinh ve roi loan ddng mau, neu phan bung ciia bao quy dau ngin hoac khdng cd, bien dang gap gdc d lulig du'dng vat (du'dng vat bi cong veo len phi'a tren), tre bi hypospadias hoac epispadias, du'dng vat nho lun hoac hinh chan vjt [3] [ 7 ] .
Van de bao quy d i u qua dai: da cua bao quy dau bj viem ammoniac ciia nu'dc tieu, cd the dan den da bi day va bao quy dau do thu'dng duUc gpi ta "bao quy dau qua dai". Dd la mot each got ten khdng chinh xac va cd the dan den eat bo bao quy dau mot each khdng can thiet. Neu so ngu'di nay vdi ngu'di khac, thi ki'eh thu'dc eua bao quy dau it thay doi, vi vay khong cd bao quy dSu
TAP CHi Y HOC V|6T NAM TAP 465 - THANG 4-SO 2-2018 qua dai mpt each thdc s\i. Mac du khi nhin, bao
quy dau ed ve kha dai, nhu'ng khi keo bao quy dau ve phia gdc du'dng vat, van bpc Ip du'dc
toan bd quy dau va ranh quy dau. Tat ca cac tru'dng hdp nay deu khong cd cht djnh mo eat bd bao quy d^u.
H/nh 1: Hep bao qui dau cd vdng xd Nam 2008, Tran Ngpc Bich [5] d u ^ ra mot ky
thuat ehi eat bd vdng da niem mac bao qui dau hep ddn thuan bang each bao ton Idp to chu'c du'di da niem mac ma chi bdc bd Idp da-niem mac d u ^ vao kinli nghiem phau tich bdc tach lay vac niem mae bao qui dau t i / do tao hinh nieu dao khi mo dj tat lo dai lech thap. Theo tac gia uli diem cua ky thuat nay la d l thdc hien, neu phau tich ehinh xae thi khi mo hau nhu' khdng ri mau va vi chi cat bd ddn thuan vdng da-niem mac hep nen van bao ton nguyen ven Idp to chu'c dirdi da cd mach mau va than kinli. Do vay, sau mo it nguy cd nhiem khuan va phu ne, vet khau se mau lanh, seo nhd va mem mai. Ky thuat nay ddi hdi p h l u tiiuat vien phai phau b'eh ti mi de cat bd di vdng xd bao qui dau. Ky thuat cua Chung tdi thy'c hien ciing tu'dng td tuy nhien ehung tdi co gang ddn gian hda phau ttiuat va thdi gian mo trung binh ciia chiing tdi 25,6 phut cung tu'dng du'dng ciia tac gia (thdi gian phau thuat trung binh ciia Tran Ngpc Bich la 26 phut), l ^ thuat nay ket hdp tao hinh ham qui dau cho nhuTig tii/dng hdp ngan ham qui dau, dieu nay lam du'dng vat sau mo se dai hdn va ttiam my hdn.
Rach bao quy dau d mat lu'ng rat it khi du'dc khuyen dung vl ket qua khdng du'dc hoan hao ve phu'dng dien tham my. NhuTig, thu thuat nay td ra ed ich d nam gidi eao tudi, cd nhieu benh ly phirc tap phoi hdp nhu" viem quy dau - bao quy dau nang hoac hep bao quy dau ban phan tai phat, ... Tao hinh bao quy dau bang each rach da bao quy dau mdt each han che theo chieu dpc, khau lat da theo chieu ngang. Tao hinh bao quy dau chi nen ap dung cho cac benh nhan bj hep bao quy dau ban phan, ma khdng phai la hep bao quy dau benh ly.
Mgt sd nghien ciru cho biet ty le bien chu'ng ciia cat bd bao quy dau d tre sd sinh la tir 0,2 - 0,6%, trong khi cac nghien cu'u khac ch! ra ty le
bien chu'ng nay la tir 1,5 - 10% [1], [7]. Cac bien chiTng thu'dng gap nhat la chay mau, nhiem khuan, hep lo ngoai nieu dao, loet phanh ciia bao quy d i u va dinh bao quy dau. Chay mau la bien chirng thu'dng gap nhat, vdt ty le tir 0 - 35% [7]. Da sd la chay mau it va khdng cd hau qua lam sang. Nhu'ng ehay mau rat nhieu, de dpa tinh mang ngu'di benh eo the gap d cae tru'dng hdp cd roi ioan ddng mau. Trong nghien CLTU eiia chiing toi ty le chay mau la 1,3% la thap so vdi cac tac gia khae [7].
Trong nghien cu'u eiia chung tdi vdi 100% gia dinh hai Idng ve ket qua sau md, khdng cd benh nhi hep tat phat, khong ed tru'dng hdp nao bi mat can dot bao qui dau, ty le 92% benh nhi van giii' du'dc bao qui dau la rat ty tu'dng. Dam bao du'dc chirc nang sinh ly cua bao qui dau va bao tdn toi da bao qui dau la mdt chat lieu tdt khi ed nhu cau tao hinh nieu dao sau nay.
V. K ^ LUAN
Hep bao qui dau la mdt benh ly pho bien va phu'dng phap dieu trj thi khdng qua phiTc tap.
Chi djnh ngoai khoa chi djnh cho nhOYig tru'dng hdp hep benh ly. Sd cham sdc bao qui dau khdng dung each gdp phan tang nguy ed mac benh. Da cd nhieu ky thuat md dieu trj hep bao qui dau, moi ky thuat ed nhu'ng du va nhu'dc diem khac nhau. Ky thuat cat vdng xd hep bao ton bao qui dau mang den tinh tham my, sy' hai Idng cho benh nhi. Ky thuat ddn gian tuy nhien cung can sy can than, ty my.
TAI UEU T H A M KHAO
1. Dunsmuir WD, Gordon EM (1999) The history of drcumcision. BJUIntSZ [Suppl 1], 1 - 2 . 2. Babu R, Harrison SK, Hutton KA (2004)
Ballooning of the foresldn and physiological phimosis: is there any objective evidence of obstructed voiding. BJUInt, 94, 384 - 387.
3. Larke N, Thomas SL, Dos Santos Silva I , et
VIETNAM MEDICAL JOURNAL N''2 - APRIL - 2018 al. (2011). "Male drcumcision and human
papillomavirus infection in men: a systematic review and meta - analysis". 3. Infect. Dis. 204 (9), 1575 -1390.
•*. Ashfield JE, Nickel KR, Siemens DR et al (2003) Treatment of phimosis with topical steroids in 194 children. J Urol, 169.1106 - 1108.
5. Tran Ngoc Bich (2008). "Ky thuat cat bo vong
that bao qui dau chij'a hep bao qui dau (de xuat mot ky thuat md)", Y hoc TP Ho Chi Minh, 12, tr 445-450
. Cuckow P (2006). Phimosis and buried penis, Pediatric Surgery, pp 557-568.
. Kaplan GW (1983). Complications of Circumcision, Urologic Clinics of North America/
10, pp 543-549.
NGHIEN CmJ THU' KICH ITNG DA, NIEM MAC VA KHA NANG LAM LANH VET THiraNG COA BAI THUOC VLI
DANG CON THUOC TREN THITC NGHIEM
L8 Thi Minh Nguyet*, Pham Ba Tuyen*, Tran Trong Duffng**
I. OAT VAN OE
Viem ldi la ton thu'dng viem cap tinh hay man tinh xay ra d t d chiTc phan mem xung quanh rang. Ton thu'dng chi khu tru d ldi (bd, nhu liji, ldi dinh) ma khdng anh hu'dng den xu'dng o rang. TuT xu'a trong dan gian ed nhti'ng bai thuoc chda dau rang viem ldi nhu' vd duoi ngam riTdu de ngam, nu'dc sae ngai cu'u sue mieng, nu'dc sac vd cay sao den, cay dai, dieu tri viem ldi va mpt so san pham dieu trj viem ldi bang che pham thuoe YHCT du'di dang tan bpt boi tai cho, thudc cham tai cho nhu" Eupolin, Sindolor, BT9B, RK94, lu'dng dien hu'dng...
Xuat phat tii nhu cau dieu trj ngay cang ci ma cac nguon thudc ngoai nhap ddi vdi chuye i khoa rang ngay cang dat va khan hiem,lam the nao de dung cac san pham thudc y hpc co truyen v u ^ giam gia thanh dieu trj benh rang mieng, tinh an toan eao nhuTig chat lu'dng dam bao. Chinh vl vay chung tdi nghien eij'u tae dung bai thude chu'a viem ldi V U . De danh gia tac dung CLia bai thudc tren lam sang, bu'dc dau chung tdi nghien cirtj thii' kich u'ng da, niem mac va kha nang lam lanh vet thu'dng cua bai thuoc VLI dang con thuoc tren thd thu'c nghiem, -
J II. OOl TUQNG VA PHITCTNG PHAP N G H I I N ( j | )
*D61 Wdng nghien cdu tren t/wc nghi0m: tho trang nang l,800g - 2000g, khong
phan biet du'c cat. , ^
*Chat lieu nghien cud: Bai thuoc VLi dang con thudc diTdc san xuat tai Khoa Du'dc - Benh vien Y hpc co truyen - Bp Cdng an, dong trong io thiiy ttnh mau sam, da du'dc kiem nghiem dat tieu chuan ed sd. Cong thu'c bai thuoc:
Hoang lien 3g Tetan 3g Dinh hddng 2g Con 55° 5ml TOM TAT
Nghien ciitJ thLf ki'ch iing da, mem mac va kha nana lam lanh vet thu'Ong ciia bai thuoc VLI dang ran thuoc tren Oio thu'c nghiem. Nghien CLTU du'dc tien hanh tren tho trang nang l,800g - 2000g, khong phan biet du'c cai. Nghien C'LTU thii kich iim da va kha nang lam l^nh vet thuUng cua VLI: tien hanh tao vet thu'dng tren da tho, boi VLI vao vet thUdngS lan/ngay trong 3 ngay, so sanh vdi vet thu'dng boi niidc muoi dang tru'dng. Nghien ciili thif kfch il'ng niem mac, boi thuoc ISn niem mac hau mon thd, so sanh vdi boi nu6c muoi sinh ly'. Ket qua nghien euli cho thay Con thuoc VLI khi su' dung vdi lieu cham 3 lan/1 ngay khong gay kich uYig da va niem mac hau mon tho va c6 tae dung lam lanh vet thu'dng.
Tdichoa: VLI, kich thich da, niem mac, lanh vet thu'dng
SUMMARY
STUDY ON SKIN I R R I T A T I O N , MUCOSAL AND POSSIBILITY OF WOUND HEALING OF
V L I PRESCRIPTION DRUGS I N EXPERIMENT Study on the skin irritation, mucosa! and wound healing of VLI drug in experimental rabbit. The study was conducted on white rabbits weighing ISOOg - 2000g, regardless of male. Examination of sidn irritation and wound healing of VLI: wound healing on rabbit skin, VLI applied to the wound 3 times a day for 3 days, compared with isotonic saline wound.
Study on mucosal in-itation, application to rabbit anal mucosa, compared with physiological saline. Research results showed that VLI tablet when used with 3 doses /day did not irritate skin and rabbit anus and wound healing effect.
keyword: VLI, skin irritation, mucosal and wound healing.
*Binh vien Yhoccdbvyen, BdCdngan
**Cuc Y te, Bg Cdng an
Chiu trach nhiem chinh: Tran Trgng DUdng Email: [email protected] Ngay nhan bai: 11/3/2018 Ngay phan bien: 3/4/2018 Ngay duyet bai: 15/4/2018
