Y HOC VIET NAM THANG 1 - SO 1/2014
C O N G T R I N H N G H I E N C O U
SO SANH CAT TU" CUNG QUA AM DAO V a i CAT TTJ CUNG QUA NQI SOI TRONG U XCT TIT CUNG
T 6 M TAT
Myc tieu: So sanh hai ky thuat cat tir cung qua am dao va cat tiT cung qua npi soi d Benh vien Phu san tmng u'dng. Doi tu'dng: cac ngu'di benh da dUOc thu'c hien cat tiT cung qua am dao va qua noi soi 6 Benh vien Phu san trung u'dng trong 3 nam tir 2006 den het 2008 vi u xd tir cung. Chfnh tac gia ia phau thuat vien thu'c hien tat ca cac triTdng hpp phau thuat nay. Ket qua nghien ciJTu: Giam dau trong cat tiT cung qua am dao chii yeu la giam dau viing bang gay te tiiy sdng, chiem hdn % so tru'dng hop (87,5% so tru'dng hdp). Trong khi v6i phu'Ong phap cat tir cung qua ngi soi bupc phai sir dung phu'dng phap gay me toan than bang noi khf quan. Thdi gian phau thuat trung binh ciia nhom cat tiT cung qua am dao la: 39,3 + 13,7 phut, trong khi thcJi gian phau thuat trung binh ciia nhom cat tir cung qua npi soi la: 60,2 ± 16,3 phiit, mpt 51/ khac biet rat dang ke. Ket luan: Cat tir cung qua am dao la phau thuat nhanh hdn so vdi cat tiT cung qua noi soi. Trong cat tir cung qua am dao, phu'Ong phap giam dau viing bang gay te tiiy song chiem hau het vdi hdn % sd tru'dng hdp.
Tu'khda: cat ti^ cung qua md bung, cat tir cung qua am dao
SUMMARY
VAGINAL HYSTERECTOMY VERSUS UPAROSCOPIC HYSTERECTOMY
FOR UTERINE LEIOMYOMA 48 cases of vaginal hysterectomy and 28 cases of laparoscopic hysterectomy are performed by same surgeon dunng the period 2006-2008 at National Hospital of Gynecology-Obstetrics. The patient's age, parity, anemic level, post-procedural uterine weight are similar in both groups. In the vaginal hysterectomy's group, the mean of procedure length is 39,3 ± 13,7 minutes, much more faster than laparoscopic hysterectomy's group with 60,2 + 16,3 minutes of mean. Loco-regional spinal anesthesia is used very commonly in vaginal hysterectomy's group.
Vaginal hysterectomy will be routinely performed.
Keywords: abdominal hysterectomy, vaginal hysterectomy
• Tnitfng Dai hgc Y Ha Ndl
Phan bign khoa hgc: PGS.TS Le Thj Thanh Van
Ngujen Difc Hinh*
I.
DAT VAN fiEHien nay co 3 con du'dng tiep can de cat tu"
cung: md bung, noi soi va qua am dao. So phu nij' sau 40 tuoi bi chiTng benh u xd tir cung la kha pho bien. Cat ti^ cung van la phu'dng phap chii yeu de dieu tri u xd tir cung d nhiJng phu nO' da CO dii con. Theo thong ke cf Hoa Ki cho thay ty le phu nif bi cat tiT cung la khoang 5,57oo trong so phu nU tir 15 tuoi trd len (nam 2000 den 2004) ^ Trong so cac tru'dng hdp bj eat tiT cung, cd khoang hdn 4 0 % la do nguyen nhan u xd tu"
cung . O Benh vien Phu san trung i/dng, eat tir eung qua npi soi ehiem 14,6%, qua am dao chiem khoang. 20% tong so tru'dng hdp cat tiT cung (2009). 6 Hoa Ki, ti le cat tiT cung qua noi soi ehiem khoang gan 1 1 % va qua am dao khoang 21-22% (2000-2004)'. Nghien ciTu mudn so sanh hai phiTOng phap cat tiT cung qua am dao va qua noi soi.
II. OOI Tl/ONG VA PHU'aNG PHAP NGHIEN CU'U 2 . 1 . Tieu chuan chon doi tu'dng nghien cirU Tat ea ngu'di benti da du'dc chfnh tac gia thi/c hien cat tir cung qua am dao va qua npi soi tai Benh vien Phu san trung u'dng trong khoang thdi gian 3 nam (2006-2008) deu du'dc chon li/a vao nghien ciTu nay. Chf dinh phau thuat ciia ca hai nhom nay deu la u xd tir cung. Co tong so 48 ngu'di benh du'dc cat tir cung qua am dao va 28 ngu'di benh du'dc cat tir cung qua npi soi dii tieu chuan de du'a vao nghien ciTu.
2.2. Tieu chuan loai trCr'
Nhii'ng ngu'di benh du'dc cat tir cung qua md bung. NhiJng ngu'di benh du'dc cat tiT cung qua md bung hay qua am dao nhu'ng do phau thuat vien khac thu'c hien hay do chf dinh khong phai ia u xd Cir cung,
2.3. Phu'dng phap nghien cuTu Nghien eiTu mo t a e a t ngang, NhiJng ngu'di benh nay du'Oc hoi chan de thong nhat chf djnh phau thuat va thong nhat chon lu'a loai hinh phau thuat la cat tir cung qua am dao hay qua noi soi.
Chinh tac gia Ja ngddi thu'c hien toan bp cac tru'dng hdp phau thuat nay. Cac thong tin di/dc ghi chep day dii.
y HOC VIET NAM THANG 1 • SO 1/2014
III. KET QUA NGHIEN ciru
Nghien citu du'dc tien lianli tren 28 ngirdi benh difdc cat tiJ cung qua npi soi va 48 ngu'di^benh diTdc cat tit cung qua am dao tai Benli vien Phu San Trung u'dng, trong khoang thdi gian 3 nam tir 2006 den het 2008.
3.1. Tuoi ngu'di benli Bang J;Tuoi cija ngu'di benh
Tuoi
< 4 0 4 0 - 4 4 4 5 - 4 9
> 5 0 Tuoi trung binh Gia tri nho nhat Gia tri Idn nhat
Cat tit cung qua a m dao n
2 8 28 10 48
2,5
%
7,3 56,1 34,1 100 4 6 , 8 + 3,7 tudi
37 57
Cat t i r cunq qua npi soi n
0 6 15 7 28
%
021,4 53,6 25 100 4 7 , 1 ± 3,6 tuoi
41 54
Kit qua cho thay khong co si/ khac biet dang ke ve tuoi giu'a nhom ngudi benh du'dc cat tty cung qua am dao va nhom du'dc cat tu'cung qua ngi sol
3.2. Tien siJTsan khoa gaffgZ'So lan da de
1 lan 2 lan 3 lan
> 4 ^n
Cat 111* cung qua a m dao n
8 36
2 2 48
16,7
%
74,9 4,2 4,2 100
C^t tiy cunq qua noi soi n
5 18 2 3 28
17,9
%
64,3 7,1 10,7 100
Nhom ngu'di benh da de 2 lan chtem ti le cao nhat trong td'ng nhom, 74,9% trong nhom cat tu' cung qua am dao va 64,3% trong nhom cat t& cung qua ngi soi, Ca hai nhdm deu khong cd ngu'di benh nao chu^ de.
3.3. Mu'c do thieu mau
Bang 3:\jSi^nq hemoqiobin tronq mau (tru'dc phau thuat) Nong do hemoglobin (g°/o)
Trunq binh Gia tn nho nhat Gia tri Idn nhat
Cat tit cung qua a m dao 114,1 + 23,6 q %
43 143
Cat tir cung qua noi soi 114,4 ± 17,6 q %
70 139 Bang4:So lu'dng hong cau (tru'dc phau thuat)
So lu'dng hong cau Gia trj trung binh
Gia tri toi thieu Gia tri toi da
c i t tCr cung qua a m dao 4,3 ± 0,5 trieu/mm^
2,3 trieu/mm^
5,5 trieu/mm^
Cat tuT cung qua noi soi 4,3 ± 0,6 trieu/mm-'
3,4 trieu/mm^
6,1 trieu/mm^
So lu'dng hong cau, nong dp hemoglobin d hai nhdm ngudi benh khong khac nhau. Tuy nhien, ngu'di benh bi thiiu mau nhieu nhat lai rdi vao nhom trong nhdm cat !& cung qua am dao, thiiu mau nang hdn so vdi nhdm cat tiT cung qua md bung (hemoglobin 43 g% so vdi 70 g%, 2,3 trleu/mn^ so v&
3,4 trieu/mm^).
Y HOC VIET NAM THANG 1 • SO 1/2014
3.4. Phu'dng phap giam dau trong mo fla/Tg 5/Phu'dng phap qiam dau trong phau thuat
Te tuy song Noi khi quan
Cat t i t cung qua a m dao n
42 6 48
87,5
%
12,5 100
Cat tir cunq qua noi soi n
0 28 28
%
0100 100
Nhom cat tu" cung qua am dao co din 87,5% so tru'dng hdp du'dc giam dau vung bang gay te tuy song. Trong khi nhdm cat tu' cung qua ngi soi chi cd giam dau toan than bang gay me noi khi quan dWdc ap dung cho mgi tru'dng hdp.
3.5. Trong lu'dng cua tu' cung sau phau thuat Bang6:TxQX\q lu'dng tu'cung sau_phau thuat
Trong lu'dng tu'cung sau phau t h u a t ( g ) Gia trj trung binh Gia tri toi thieu Gia tri toi da
Cat tur cung qua C i t tuT cung qua nor am dao soi 251 ± 81,2
100 530
251,5 ± 94,3 100 520
Trgng lu'dng tu" cung sau phau thuat la nhu' nhau d ca hai nhom cat tif cung qua am dao va cat tit cung qua ngi soi.
3.6. Th6i gian phau t h u a t va thdi gian nam vien Bang 7:Thiii qian phau thuat
Thdi gian phau t h u a t ( p h u t ) Gia tri trung binh
Gia tri toi thieu Gia tn toi da
Cat tu' cung qua a m dao 39,3 ± 13,7
20 100
C M tu" cung qua m d bung 60,2 ± 16,3
30 100 Bang S:Jhd\ qian nam vien
Thdi gian nam vien ( n g a y ) Gia trj trung binh
Gia trj toi thieu Gia tri toi da
Cat tu' cung qua a m dao 6,3 ± 4,2
3 28
Cat tir cung qua m d bung 6,6 ± 4,3
3 19
Thdi gian phau thuat trung binh ngan hdn ro ret d nhdm ngu'di benh cat tu' cung qua am dao (39,3 phut) so vdi nhdm cat tu' cung qua noi sol (60,2 phut). Thdi gian nam vien khong khac nhau giij'a hai nhom (6,3 ngay vdi nhdm cat tt^ cung qua am dao va 6,6 ngay vdi nhom cat tiY cung qua md bung).
3.7. Tai bien cua phau t h u a t
Nhdm 48 tru'dng hdp cat tir cung qua am dao CO 1 tru'dng hop b\ chay mau trong buoc phai md bung de khau cam mau.
Nhdm 28 tru'dng hdp cat tiT cung qua npi soi khong cd tru'dng hdp nao bj bien chirng nang.
IV. BAN LUAN
Ngirdi benh d hai nhdm cat tiT cung qua am dao va cat tiT cung qua ngi soi giong nhau ve dp tuoi, so lan 6a de, mirc dp thieu mau, trong ludng tir cung sau phau thuat, Nghien ciTu cua tac gia Do Minh Thjnh cho biet trpng lu'dng trung binh ciia tiT cung khi cat qua am dao la 255,4 ±
96,9 gam^. Thdi gian nam vien ciia nhom cat tir cung qua am dao va nhom eat tiT cung qua npi soi khong khac nhau,
Qua nghien ciru nho nay, ndi len mpt so die'm cho phep so sanh phu'dng phap cat tir cung qua am dao vdi phu'dng phap cat tir cung qua noi soi.
Thdi gian phau thuat trung binh ciia nhom cat tiT cung qua am dao la; 39,3 ± 13,7 phiit, trong khi thdi gian phau thuat trung binh ciia nhdm cat tir cung qua noi soi la: 60,2 ± 16,3 phiit, mot SLT khac biet rat dang ke, Phau thuat cat tiT cung qua am dao nhanh hdn nhieu so vdi phau thuat cat tir cung qua npi soi. Day la mot u'u the dang ke ciia
Y HOC VIET NAM THANG 1 • SO 1/2014 phau thuat eat tir cung qua am dao so vdi phau
thuat cat tiT cung qua noi soi.
Giam dau trong cat tir cung qua am dao chii yeu la giam dau viing bang gay te tuy song, chiem hdn % so tru'dng hdp {87,5% so tru'dng hdp). Trong khi vdi phu'dng phap cat tir cung qua ndi soi buoc phai sir dung phu'dng phap gay me toan than bang ndi khi quan. Day cung la mpt u'u the dang ke ciia phau thuat cat tir cung qua am dao so vdi phau thuat cat tiT cung qua ngi sot.
Vdi tirng cd sd y te, phu'dng phap cat tir cung du'Oc ap dung pho bien phu thugc vao nhieu yeu to, trong do co yeu to khong lien quan den chuyen mon. 0 6 la tru'dng phai, dd la sd thich cua thay thuoc. Cat tiT cung qua am dao luon du'dc chiTng minh co nhieu u'u diem noi trpi hdn so vdi cat tir cung qua ngi soi. Mac dii vay, cd ndi cat tir cung qua am dao chiem den 98,4%
(Kovac) ^ nhu'ng cung co nOi cat tir cung qua am dao chf chiem mot tl le vo ciing khiem ton la 7,4% (Dicker)".
V. KET LUAN
Qua nghien ciTu nay cho thay mpt so UXJ the noi trgi ciia phu'Ong phap cat tir cung qua am dao so vdi phu'dng phap cat tir cung qua ngi soi tren cd sd hai nhom khong cd SLT khac biet ve
tuoi ngu'di benh, chi djnh phau thuat, so lan de, trgng lu'dng td cung sau phau thuat. Cat tu'cung qua am dao la phau thuat nhanh hdn so vdi c3t tir cung qua ngi soi. Trong cat tir cung qua am dao, phu'dng phap giam dau viing bang gay te tiiy song chiem hau het vdi hdn Vi so tru'dng hdp. Nghien ciTu nay khong de cap den khia canh chl phj ciia ngu'di benh va chi phi trang bi, dung cu phau thuat.
TAI LIEU T H A M K H A O
1. Whiteman MK, Hillis SD, Jamieson DJ, et al;
inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol 2008;198:34.
2. Do Minh Thinh: Danh gia phau thuat cat tiT cung du'dng am dao tai Benh vien Phu San Trung iTcfng 2003-2007. Luan van tot nghiep bac sT chuyen khoa 2. Tru'dng Oai hpc Y Ha Noi.
3. Kovac SR: Clinical opinion: Guidelines for hysterectomy. Am J Obstet Gynecol, 2004;
191:635-640,
4. Dicker RC, Greenspan JR, Strauss LT, et al;
Complication of abdominal and vaginal hysterectomy among women of reproductive age in the United States: The collaborahve review of stenlization. Am J Obstet Gynecol, 1982; 144:841-848.
PHAN TICH TU'O'NG QUAN GIU'A MITC DONG vA MU'C HU'aNG COA BAO HIEM Y TE VIET NAM GIAI DOAN 2009-2012
T O M TAT
Phan tfch tu'dng quan giti'a mu'c dong va miTc hu'dng bao hiem y te du'a tren so lieu thiT cap cua bao hiem xa hgi giai doan 2009-2012. Phu'Ong phap: Phan tfch tu'dng quan, tfnh toe do tang tru'dng binh quan ciia miTc dong va miTc hu'dng BHYT, tfnh he so tu'dng quan (r). Ket qua; MiTc hu'dng bao hiem y te thap hdn so vdi mirc dong.
MiTc dong va miTc hu'dng deu co xu hu'dng tang tir 2009 den 2012 nhu'ng toe do binh quan eiia
* Dal Hoc Thai Nguyen
Phan bien khoa hgc: PGS.TS Nguy&n Khanh Doanh
Pham Hong Hai* vies mirc dong tang nhanh hdn miTc hu'dng nen toe dp binh quan ciia ket du' tang nhanh tir 2009 den 2012, dat gan 13 nghin ti dong.
TtT khoa: MiTc dong, mirc hu'dng, toe do binh quan, tu'dng quan
S U M M A R Y
ANALYSIS CORREUVTIONS BETWEEN THE PAYMENT A N D BENEFIT OF VIETNAM
HEALTH INSURANCE I N PERIOD FROM 2009 TO 2012 Analysis of the correlation between the level of payment and benefit of health insurance based
