HOI NGHI KHOA HOC BENH VIEN H Q U NGHI VI§T TIEP H A I PHONG L A N THLf 37
KET QUA TAO HINH BANG QUANG Mdl
B A N GHOI TRANG QUA 8 TRJONG HOP TAI BENH VIEN VIET TIEP HAI PHONG
Pham Van Yen* Nguyen Cong Binh*
TOM TAT
Ung thu bieu mo bang quang la loai ung thU thudng gSp nhat 6 nam gidi. Tieu chuan cho vict dieu tri la cat khoi u va dan dong nUdc lieu.
Tir giii'a thang 1 nSm 2002 va thang 12 nSm 2004, chung toi da phau thuat tao hinh bang quang cho 8 benh nhan nam ung thU bang quang bSng ky thuat Carney I I .
Trong nghien ciTu nay, chiing toi mo ta ve cac tinh chat ve chiTc nSng va sU hoat dong ciia bang quang dUdc tao hinh, cu the la chiing toi tao hinh bang quang mdi b§ng hoi trang ap dung ky thuat Camey I I .
SUMMARY
Carcinoma of the urinary bladder is the most commonly encountered cancer in males. The standard treatment for the invasive tumor is radical cystectomy and urinary diversion.
Between Jan 2002 and Dec 2004, 8 male patients with urinary bladder cancer underwent cystoprostatectomy and orthotopic urine diversion.
Ileum was used in 8 patients utilizing Camey II procedure.
In this study, we describe about the funtional and urodynamic properties of the most commonly used for reconstruction of neoplader, namely the ileum applying the Camey II technique.
I.
OAT VAN OEPhau thuat cat bang quang va sir dung quai ruot de tao hinh bang quang moi trong dieu trj ung thu bang quang da dugc thuc hien nhieu nuac tren the gioi tir nhirng nam dau the ky 20, co nhieu phuang phap khac nhau de tao hinh bang quang nhu cua Camey,
* Benh vien Hitu Nghj Viel Tiep Hdi Phong
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SUidcr, llautmann, koch... Trong nuoc vien Vicl Dire, benh vien Binh Dan sir dung chii yen ky thuat Camey, mgt so benh vien khac diing ky thuat Studcr... Tu nam 2002 Benh vien Viet Tiep Ilai Phong chung toi su dung ky Ihuat cat loan bg bang quang ciing luyen tien licl roi sau do dung doan hoi trang tao hinh bang quang theo phuomg phap Camey cai tien (Camc> 11). Qua 8 truang hap dat kel qua tot. riit ngan thai gian phau thuat, giam ly lc bien chirng do nuoc tieu sau mo, giam chi phi phau thuat va thai gian dieu trj.,,
II. so' UEU VA P H U O N G PHAP NGHIEN CQU
2.1. So lieu; Tir thang 1 2005 - 12/2007.
8 benh nhan nam ung thu bang quang giai doan muon., chua co di can hach dugc phau thu^t cat bang quang \ a tao hinh bang quang theo kynhuat Camc> cai tien.
2.2. Ky thuat mo; Benh nhan nam ngita, hoi gap ngang \iing hong lung; gay me noi khi quan.
Phdu thuat gom hai thi chinh:
J. 2.L C 'at bd hang quang:
Rach da duong giiia duoi ron vong qua ron 2-r^cm. bgc lo khoang Retzius \a khoang ben phai \ a tri canh bang quang, vao bo mach chau, nao \el hach chau theo tieu chu5n 2 ben, lam xet nghiem GPB tire thoi.
Neu kht qua am tinli thi nhn hanh ck bang quang.
Boc 16 cat bo 6ng dan tinh phai va trai, bgc 16 va ck nieu quan den sat tan bang quang, mom cat nieu quan co ket qua GPB tire thai am tinh.
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
Phau tich mat sau bang quang, mo can Denonvilliers, boc tach theo mat sau tui tinh den tan co bang quang
Phau tich mat truoc bang quang den vung c6 bang quang tien liet tuyen.
- cat lan lugt 2 canh ciia bang quang den tan c6 bang quang - tien liet tuyen
cat bo tien liet tuyen duoi co bang quang, de lai dau trong nieu dao. Mom cat bang quang lam sinh thiet tuc thoi am tinh.
2.2.2. Tao hinh hang quang:
Chuan bi doan ruot non klioang 60 - 70cm, each goc h6i manh trang 15 - 20cm.
Tai lap luu th6ng ruot theo kieu noi tan tan.
Doan ruot da chgn de tao hinh dugc xe doc, khau ghp thanh 4 phan deu nhau tao thanh hinh W bang chi Vicryl 4.0. Sau do noi phan thdp nhal ciia quai ruot da gap nay vao nieu dao luycn tien liet (thong thuong chiing toi khau 8 miji chi roi).
cam 2 nieu quan vao dau gan ciia doan ruot \c dugc khau gap W. dat thong nong nieu quan, dan luu bang quang bang sonde pezzer. Dat ong thong tieu. Dan luu 6 mo.
Hinh 1. Doan ruot xe dugc khau ghp W va noi phdn thdp nhat vao nieu dao 2.2.3. Sdn soc hau phdu Hau phau ngay
thu 3, bom rira bang quang hang ngay vai nuac mu6i sinh ly khoang 300 - 500ml moi lin, muc dich ihy sach chat nhhy ciia ruot tiet ra tranh tac sonde nieu dao bang quang. Bom rira dugc thuc hien den khi rut sonde tilu va sonde dan luu bang quang thuong vao ngay thu 15 sau m6, rut 2 sonde nieu quan vao ngay thu 12 sau mo.
2.2.4. Phuang phdp nghien ciru Nghien cuu tien cim; s6 lieu dugc xir ly tren may vi tinh vol phan mhm SPSS 13.0.
III. KET QUA
3.1. Ket qua chung: Tu6i trung binh cua benh nhan: 63,2 ± 8 (nho nhat: 53 tu6i, lan nhat: 82 tu6i). So ngay dieu tri trung binh:
29,07 ± 6,06 (som nhat 19 ngay, muon nhdt 40 ngay)
3.2. Ket qua phau thuat:
Thai gian phau thuat trung binh: 244 phut ± 23 phut (som nhat: 195 phiit, muon nhat 275 phut).
Trong d6: Thoi gian cat bang quang: 90
± 15 phut. Thai gian tao hinh bang quang:
155 ±15 phut
Lugng mau mdt trong mo: khoang 300ml - 350ml; co 6 benh nhan truyk mau trong m6 trung binh 1 don vi (250ml).
Th6 tich bang quang do ngay trong mo:
trung binh 160ml
3.3. Cac bien chihig som sau mo Tac ruot: khong c6
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HOI NGHI KHOA HOC BENH VIEN HLfU NGHI VI^T TIEP H A I PHONG LAN THLf 37
Do nuoc ticu qua chan dan luu bang Nhiem triing vet mo: 1
quang: 3 truong hgp, dugc dat lai sonde ticu Ticu khong tu chii ban dem: 3; T\k sau do het do tu lien; son Ihinh thoang ban ngay: 1
3.4. Ket qua tai kham:
Bang 1. So hcnh nhan dugc tai kham sau mo
Thdi gian (thang) 3
6 12
So benh nhan 8 7 7
Tvie
100%
99%
99%
The lich bang quang moi sau ni6.
+ The lich < 150ml (Khong co benh nhan nao)
+ Tha tich 150 - 300 (co 5 bC'nh nhan) + Thh tich > 300 (co 3 benh nhan)
The tich nuoc tieu t6n du sau khi di tieu a nh6m benh nhan tai kham:
Trung binh 52,6 ± 22,02ml. nhieu nhat 90ml, it nhat 20ml. Co 3 benh nhan tieu khong tu chii ban dem, co 1 benh nhan tieu son thinh thoang ban ngay. Khong c6 benh nhan nao son tieu lien tuc.
IV. BAN LUAN
Ky thuat cat toan bg bang quang tao hinh bang quang moi bang ruot, tieu chuan lira chon de dugc mo la chua co di can hach, mom cat nieu dao tien liet tuyen am tinh.
Doan ruot dugc xe dgc de tao hinh bang quang moi chung t6i khau gap hinh chir W
f \ > f r
n6i phan thap nhat ciia quai ruot vao mom cat ni?u dao bang 8 mui chi roi. Ky thuat nay lam giam dang ke thai gian m6, den nay chung t6i chi con mat khoang 4h30 phiit cho moi truong hgp. Tir d6 lam giam chi phi cho cugc m6, giam mat mau trong m6, benh nhan mau hoi phuc sau mo.
Khong CO truong hgp nao hep mieng n6i nieu dao sau mo, bang quang sau phau thuat C() hinh dang Iron deu, sau 3 thang deu colhe lich tren 300ml. The tich nuac tieu ton du bang quang cung a muc chap nhan dugc trung binh khoang 52,6 ± 22,02ml.
Trong 8 truang hgp phau thuat co 1 benh nhan co bien chimg sam dugc ghi nhan nhu nhiem triing vet mo, dieu trj bang thay bang.
diing khang sinh theo khang sinh do benh on djnh. Tieu khong tu chu ban dem (3 benh nhan) do thai gian dau bang quang chua thich nghi, benh nhan chua tao thoi quen thirc day diing gio trong dem di tieu.
Noi chung sau phau thuat do benh nhan can CO thoi gian de thich nghi voi bang quang moi nen ket qua do t6c do dong tieu tnrac khi ra \ien kh6ng cao chi 9 ± l,5ml/s.
Thuong phai sau 6 thang benh nhan moi co sir thich nghi t6t nhat voi bang quang mod.
V. KET LUAN
cat bang quang tao hinh bang quang ti doan h6i trang theo phuang phap Camey II Bang quang moi co hinh dang tron deu, dung tich lan va the tich t6n du thap.
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Hinh 2. Hinh anh chup bang quang moi
TAI UEU T H A M KHAO.
1. Tran Dii-c Hoe (2003), "Phau thuat cat bo bang quang. cac loai phau tliuat thay the tao hinh ruot non bang quang, manh trang bang quang" Ky thuat ngogi khoa trong tiet nieu, Nha xuat ban y hgc. Ha Ngi, Tr. 617 - 95.
2. Nguyen Ky, Nguyen Bmi Trieu (1993),
"Ket qua dieu tri phau thuat ung thu bang quang trong 10 nam tai benh vien Viet Duc(1982 1991)", Tap san ngogi khoa s63,Tx.l 15.
Nguyen Ky (1997), "Nhan xet va ket qua dieu trj 436 truong hgp ung thu bang quang tai benh vien Viet Dire trong 15 nam tir 1982-1996", Ngogi khoa sd 2: 19- 29.
Dao Quang Oanh, Vu Van Ty, ""Tgo hinh bdng quang bdng rugf\ Y hoc Viet Nam, chuyen de tiet nieu than hoc, so 8- 2005, 756-763.
Hoang Van Tung, Tran Ngoc Khanh, ...cat bang quang giir lai tien liet tuyen va tao hinh bang quang moi bang doan hoi trang theo Studer. Y hgc thuc hdnh, s6 586-2007, 61-65.
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