CHUYEN D^: H6| NGH! KHKT CAC TINH VUNG DUY^N HAI BAC B<) U N THQ NHAT
DANH GIA KET QUA DIEU TRj TAN SOI NIEU QUAN NOI SOI NGOaC DONG DANG MAY TAN LASER
Bui v a n Chien
T 6 M TAT
MIJC dfch de tar. Danh gia ket qua dieu tri soi nieu quan bSng pliLfOrlg phap tan soi ngu'dc dong, nguon tan laser.
So lieu va phWdng phap: Nghien ciTu tien CLTU, mo ta 141 tru'dng htfp tan soi nieu quart bSng npi soi ngu'dc dong vdi may tan laser tu' thang 1/2012 den thang 1/2013 tai Benh vien Viet Tiep, Hai phong.
Kit quit. Thdl gian tan soi trung binh 25,3 phut. Thdi gian hau phau trung binh 3,15 ngay.
Ty le thanh cong 131/141 tru'dng hdp (93%). 4 tru'dng hdp phai ket hdp ESWL, 4 tru'dng hdp chuyen mo md. Nieu quan 1/3 tren tan thanh cong 38/42 tru'dng hdp. Nieu quan 1/3 du'di tan thanh cdng 66/69 tru'dng hdp.
Ket luan: Viec siV dung nguon tan laser trong tan sdi nieu quan mang lai hieu qua cao, ft bien chu'ng, co the ap dung tot vdi soi nieu quan tren cao, ki'ch thu'dc soi Idn cd mat do chac
SUMMARY
EVALUATE THE RESULT OF URETER STONE TREATMENT BY LASER LITHOTRIPSY
Purpose: To evaluate the result of ureter stone treatment by laser lithotripsy.
Materials and Method. A total of 141 ureter stone patient underwented laser lythotripsy from Jannuary 2012 to Jannuary 2013 at Viet tiep hospital, HP
Results: the mean duration of the procedure is 25,3 minute. The mean post-op hospital is 3,15 days. The stone-free rate 93%, combination with ESWL in 4 cases. 4 cases must be treated by open- operation.
* ^ ? " ^ v/^« Viet Tiep Hdi Phong
Conclusion: The initial result of lase lithotripsy for ureter stone has hight result
I.
OAT V X N OESdi tiet nieu la benh ly kha pho bi^n trer the gidfi cung nhu a Vi?t Nam, trong do soi ni?u quan chiem 25-30% [1]. Phan Ion soi nieu quan do soi tir than roi xuong chiSni 80% cac truoTig hop. Soi ni|u quan khi gay tac duong nieu la loai soi gay anh hudng lon nhat den than hon bat cu loai sdi nao d than, nhanh chong gay suy than, giSn than.
Dieu trj npi khoa chi ap dung doi voi nhung soi nho < 4mm, churc nang than cfe tot. Tuy nhien doi voi nhihig sdi ldn hon, hinh thu goc canh hoac viem dinh thi dieu bi noi khoa khong co kel qua
Hien nay cung vcri su phat trien ciia cag dung cu npi soi, cac phuong phap d i l u t r j ^ it xam lan ngay cang ap dung rpng rai nhii phau thuat noi soi sau phiic mgc lay soi, ta^
soi qua da hoac npi soi nguoc dong lay sdi nieu quan su dung may tan xung hoi ho|c laser. Moi phucmg phap deu co nhfing mi nhuac digm, trong do tan soi npi soi ngugc.
dong bang may tan Laser la phucmg | | a | moi giiip xir tri hieu qua soi d tat ca cic vim!i ciia nieu quan.
Trong thdi gian tir thang 1/2012 d&i thang 1/2013 tai Khoa ngoai tilt nieu- Benh vien Viet Tiep, chung toi da thuc hien 141 i trudng hcfp tan sdi nieu quan npi soi nguM ddng bang nguon tan laser va thuc hien nghien ciiu nay n h i m muc tieu: DdnhpaU^
qud phdu thugt noi soi tan soi neu qudn bai^
mdy tdn Laser.
YHOC VlfT NAM THANG 5 - SO OAC BlfT/2013
II. odi TU0NG VA PHUONG PHAP NGHfEN CUU 1. BSI tUffng nghien cuu: G6m 141 trudng hpp sdi nieu quan dupc di6u tri bang phuang phap npi soi tan soi ngupc ddng su dung ngudn tan laser tai Khoa Ngoai tiet
^ni?u, Benh vien Vi?t Ti$p - Hai phdng tu 'thang 1/2010 d^n thang 6/2011.
2. Phuffng pitdp ngltiin ciru: Nghien Cliu tien ciiu md ta.
2.1. Chpn binh nhdn:
- Sdi nieu quan 6 tat ca cac vi tri.
- Chiic nang than cdn tdt - Khong cd di dang nieu quan.
2.2. Pltuffngphdp thirc hiin:
•3 - Dyng cu:
+ Ong soi nieu quan ciing ciia hang Karl 'Stoz 9,5Fr.
+ Nang lupng Homium laser ciia hang Dai Hoa- Trung Qudc
+ Spi day truyen Laser 200)a.m + Nguon sang, camera, man hinh.
-Qua trinh tan sdi:
+ Dat dng soi mem theo Guide wire ludn trong ong soi len ni^u quan.
+ Khi phat hien sdi, dua day truyen laser qua kenh hoat dpng cua dng soi va din hanh tan sdi thanh nhung manh nhd < 3mm, gip cac sdi vun hoac bom riia lay het manh sdi.
+ Dat thong JJ nieu quan - b£ than cho tat ca cac benh nhan sau tan sdi.
- Kiem tra ket qua:
+ Chup phim XQ va sieu am ngay sau tan sdi.
+ Hen benh nhan kham lai sau 1 thang.
IIL KiT QU^ NGHIEN CClU /. Dgc diim ldm sdng:
- Tudi: Tudi trung binh 41,52 (tir 21 - 65 tudi).
- Gidi: Nam 78 (55,3%). nu 63 (44,7%).
- Tri?u chiing khi vao vien:
Da sd cac benh nhan den kham vi con dau quan than di8n hinh 69 BN (48,9%), 45 TH (31,9%) dSn kham vi dau that lung, 27 TH (19,2%) sieu am tinh cd phat hien sdi.
2. Ddc diim can idm sdng:
-Vitri sdi:
Bang 1: Vi tri soi Vi tri soi fNieu auan 1/3 tren
Nieu quan 1/3 qiO'a Nieu quan 1/3 du'di Tdnq
So benli nhan 42 30 69 141
Ty le (°/o) 29,8 21,3 48,9 100
- Kich thuac soi:
Bane 2; Kich thuoc soi Kicli tilirdc soi
<10 mm 10-15 mm
>15 mm Td'ng
So benh nhan 21 81 39 141
Ty le (%) 14,9 57,4 27,7 100
CHUYEN DJ: HQI NGH| KHKT CAC TJNH VONG DUVfiN HAI BAC BQ LAN THtf NHAT
- D$m d$ cdn quang ciia sdi so vdi cpt song:
Bang 3: Dam dp ckn quang cua sdi Oam do can quang cua vien
sol so v6i cot sSng Ldn hon
BInq it hdn Khonq thay soi
Tong
S6 benh nhan
45 57 33 6 47
Ty 1^%
31,9 40,4
23,4 r
4,3 100
3. Ket qud tdn sdi:
- Thdi gian tan sdi trung binh 25,5 phiit (17 -70 phut).
- Thdi gian hau phau trung binh 3,15 (2-5 ngay). - 1 noi gian tan soi trung Di:
- Thdi gian hau phau trung - Tan sdi thanh cdng:
Bing 4: Tan sdi thanh cong lien quan iin vi tri sdi.
Vi tri soi Nieu quan 1/3 tren Nieu guan 1/3 giii'a Nieu quan 1/3 dudi Tonq so
So bdnh nhan t^n soi 42 30 69 141
So benh nh3n thanh conq 38 27 66 41
4, Bien chtmg:
- Nhiem khudn nieu: 15 benh nhan (10,6%) - Dai mau: 12 benh nhan (8,5%) IV. BAN LUAN
Hien nay, cung vdi su phat triSn ciia phau thuat npi soi va cac dung cu npi soi hi$n dai, benh nhSn sdi nieu quan cd rat nhiju su chon lira trong viec didu tri, rit it trutag h(;rp phai mo md My sdi. Phuong phap chii yeu hien t?i la sit dung npi soi nguoc ddng vdi cac the he may tan xung hoi hoic laser mang I?i hi^u qua cao, dSy d6u la nhttng phuong phap dieu tli it xam lin, it tdn thucmg ni$u quan.
Phuang phap tdn xung hoi da dupc trang bl cho nhieu benh vien cd uu didm gia thanh thap, chi phi diu tu it tdn kem, tuy nhien vi?c sii dung dng soi ciing han chi hieu qua trong
vi?c tan sdi cr vj tri ni?u quan 1/3 tren, ciing voi dd ngudn tan xung hod sS gSp khd kMn ddi vdi nhung sdi cd kich thudc lon vii mat dp ran chic.
Trong nghien ciiu ciia chung toi, viec sii dyng ngudn tan laser da khac phiic im nhung nhupc didm tren.
Lua chpn kich thuoc sdi dd tin laser trong nhien ciiu nay khong gJp nhiiu khi khan, vdi 39 trudng hop sdi cd kich thudc
>15mm (27,7%), day la kich thudc soi mii hieu qua tan sdi se khong cao ndu tan bJng may tan xung hoi, chung tdi chi gap 1 tmdng hpp that bai nhung nguyen nhan chii ySu 206
Y HQC VlgT NAM T H A N G 5 - Sti OAC BI$T/2013
khong ph^ do kich thudc ma do vi tri sdi sat b^g quang khdng d^t dupc dng soi m?u quan.
Tan sdi bSng ngudn tan laser hi$u quS ddi vdi ca nhung sdi cd mat d$ rin chic, trong nghien ciiu nay cd tdi 72,3% sdi cd mat do b5ng ho&c ldn hon can quang ciia cpt s6ng. Ket qua nay phu hpp vdi nhieu nghien Cliu cua Duong van Trung [2], Grasso M, ChalikY[3].
I; vh thdi gian tan sdi, trung binh la 25,5 phiit, thdi gian ISu nhat la 70 phiit, qua trinh tan sdi trong nghien ciiu ciia chiing tdi thudng chi gap khd khan trong viec dSt may soi len nieu quan do hep Id nieu quan, do sdi sat Id ni$u quan, nguyen n h ^ n^y lam cho thai gian tan sdi keo dai.
Thdi gian hau p h l u trung binh la 3,15 ngay, lau nhat la 5 ngay, day la trudng hpp benh nhSn cd bien chiing dai mau.
Ket qua tan sdi budc dau cua chiing tdi tiianh cong 131/141 trudng hop (93%) cung tirong tir voi cac tac gia khac nhu Duong Van Tnmg [2], Mulvaney W.P, Beck C. W. [4].
Chiing tdi nhan thay ty le thanh cong cao nhat la nhung sdi nieu quan 1/3 giiia, sdi nieu quan 1/3 tren cd 4 trudng hpp thSt bai (9% ), day la nhihig trudng hpp sdi di chuyen vao trong cac dai than chiing tdi thit bai do co dai tlian hep khdng tidp can dupc sdi da phai ket lipp tan sdi ngoai co the. Vdi sdi nieu quan 1/3 dudi cd 4 trudng hpp chiing tdi phai chuyen md md do sdi nam sat bang quang gay liep 16 nieu quan khdng dat dupc dng soi nieu qu^. Nhung trudng hpp nay cd the xac dinh tnrdc dua tren phim chup nieu do tmh mach.
Qua trinh tdn sdi bing laser ddi hdi dp ' cliinh xac cao, ciing vdi viec lua chpn cudng
dp laser hpp ly giiip cho vi$c tan sdi hieu qua va t r ^ h dupc cac bi^n chiing nhu rd ni$u qu^n, chdy mau ni?u quan...Nghien ciiu cua chiing toi cd 12 trudng hop (8,5%) cd bien chiing dai mau, day la nhung trudng hpp sdi viem dinh, mat dp chic, vi?c tan sdi gay tdn thucmg thanh nieu quan.
V. KET LUAN
Viec sii dung nguon tan laser trong tdn sdi nieu quan mang lai hieu qua cao, it bien chiing, cd the ap dung tdt vdi sdi nieu quan tren cao, kich thudc sdi ldn cd mat dp chic, day la mdt su lua chpn tdt trong vifc dieu tri sdi ni^u quan.
TAI UEU THAM K H A O
1. Tran Quan Anh (2001), "soi ni?u quan", B?nh hpc ngoai khoa tap 2, Nha xuSt ban Y hpc Ha noi, tr 140-145.
2. Diro-ng Van Trung (2010) " Budc d5u tan soi than noi soi ngupc dong bang nang Iugng Laser, Y hgc Vi?t Nam thang 11/2010, tr 577-581.
3. Graso M, Chalik Y. principles and aplications of laser lithotripsi: Experience with the holmium laser lithotrite. J Clin laser Med Sur 1998; 16:3-7
4. MuIvaney,W.P.and Beck,C.W. The laser beam in urology. J Urol I968;99:l 12.
5. Watson GM, Smith NA. Comparison of the pulsed dye and holmium lasers for stone fragmentation: In vitro studies and clinical experience. SPIE vol, 1879 laser in Urology, Gynaecology and general Surgeiy 1993:139-142.
207
