Y Hpc TP. Hb Chi Minh * Tap 21 * So 6 * 2017 Nghien cuu Y hoc
^ NHAN XET KET QUA DIEU TRI UNG THU" BANG QUANG TIEN TRIEN BANG P H U O N G PHAP CAT BANG QUANG TOAN BO, TAO HINH BANG QUANG BANG RUOT TAI BENH VIEN QUAN Y175
Nguyen Vi$t Ci^mg*, Nguyen Vdn Khan*
TOMTAT
Muc tiiu: Ddnh gid kii qud buac ddu phdu thu&t cdt bdng quang (BQ) toan bo, tqo hinh BQ bdng ruot theo phucmg phdp Hautmann-Studer diiu tri ung thu BQ tieh trim.
Dot tUf^g vd phucmg phdp nghien cdu: Tim cuu, mo td mt ngang cdc binh nhdn ung thu BQ tim trim duac phau thuqt cdt BQ todn bd, tqo hinh BQ tiruc vi bdng hdi trdng theo phuang phdp Hautman-Studer tai khoa Ngoai Tiii niiu -Benh viin Qu&n y 175 tie 8/2013 - 02/2017.
Kei qud: 15 benh nhan (BN) nam tudi trung binh 58,63 ± 13,25 (45 - 75) ung thu BQ tim triih giai doan T2a - T3b, do dc tinh md hgc Grade 2 (9/15) va Grade 3 (6/15). Thai gian phdu thuat tiling binh: 6g30 phiit ± lg25 phat (5g55 phdt - 8 gia); thai gian rdt dan luu trung birdi: 5,25 ± 3,56 ngdy (4 -14); ngdy dieu tri h&u phau trung binh: 22,45 ± 2,34 ngdy (21 - 26). Cd 15 tihang hap (TH) BQ mai deu hoqt dong tdi vd binh nh&n rdi hdi long ziekeiqud phdu thuqt Tai biih, bim chdng: 3/15 TH co tai bim, bim chdng nhe Ididng phdi can thiep lai (Chdy mdu nhieu: 1/15 TH; Ro nude tim qua dan lieu: 1/15 TH; Suy than cap sau mo: 1/15 TH). Ddnh gid kii qud chung: tdi (12/15); khd (3/15); kem (0/15). Theo doi sau md'(3 - 42 thdng): khong phdt hiin tai phdt tai chd vd di can ung thu.
Kei ludtu Ph&u thuqt cdt BQ todn bo, tqo hinh BQ true vi bang hoi trdng theo phuang phdp Hautmann- Studer diiu tri ung thu BQ tien trim tqi Binh znin Qudn y 175 bu&c dau cho kii qud tdi. BQ m&i hoqt ddng tdi cd zH chiec nang chiea dung, tong xucd vd bdo ve du&ng tim trin.
Td khoa: cdt bang quang todn bg, ung thu bdng quang tim trim, tqo hinh bdng quang bang rudt ABSTRACT
REMARK ON THE OUTCOME IN TREATING ADVANCED BLADDER CANCER BY RADICAL CYSTECTOMY AND ILEAL NEOBLADDER RECONSTRUCTION
AT MILITARY HOSPTTAL 175
Nguyen Viet Cuong, Nguyen Van Khan * Y Hoc TP. Ho Chi Minh * Vol. 21 - No 6 - 2017:77 - 82 Background: Testosterone is essmtialfor the regulation cf erectile physiology. But the relationship between testosterone and erectile dysfuntion (ED) has not hem established
Objectives-Description clinical and paraclinical features, related factors and the relationship among Testosterone, Estradiol and ED.
Materials and methods: Data were colleded in 36 patients from September 2015 to April 2016 at Can Tho Cmtial Hospital. ED was evaluated by using the 5-item Intemational Index of Erectile Function (UEF). Total Testosterone (TT), Estradiol (E2) were titrated
Result: The mean age was 40,06 ± 11,08. The assodation between age and chronic diseases (p = 0,007, 95%
CL 3,3-19,07), psychogmic ED (p = 0,021, 95% CI -18,5 to -1,57). TT level showed no significant correlation with ED (r = -0,231, p = 0,175). E2 leoel was significant correlated with ED (r = -0,371, p = 0,026)
* Khoa Ngoai Tiet ni^u Benh vien Quan Y175
Tdc gia lien Iqc: TS. Nguyin Vi^t Cuong DT: 0903704056 E-mail: [email protected]
N g h i e n c i ^ Y hpc Y Hpc T P . H b Chi M i n h * T a p 21 * So 6 * 2017
Conclusion: TT is not assodated with ED. History of psychobiology ofpatimtis important far evaluating and treating ED.
Key words: Erectile dysfunction, total testosterone, estradiol.
phuang phap Hautmann-Studer tai khoa tiet D A T V A N D E
Ung thu bang quang (UTBQ) la mgt benh tiiuong gap, dung hang thii 2 trong cac benh ly ung fhu duong nieu sau img fhu tuyoi tien Uet, nam gap nhieu hon nii voi ti le 3,8:lt^>.
Phau tiiuat cat BQ toan bo (tan goc) bao gom BQ, tuym tien Met va tui tinh 6 nam ho?c tu cung va phan phu 6 nii duac coi la phuong phap dieu tri chu&i cho nhiing TH UTBQ te bao chuyen tiep da xam laoi lop co (UTBQ tien trioi) hoac co nguy CO tioi trial cao*^'.
Phlu tiiu|t de chuyen luu nuoc tieu la mpt buac ke tiep bat buoc sau cat BQ toan bp. Cac phuong phap chuyoi luu nuoc tieu co tiie la chuyen luu khong kiem soat (dua 2 nieu quan ra da, chuyen luu nuoc tieu ra da qua doan hoi trang), co kiem soat mot phan (noi 2 nieu quan vao dai trang sigma hoac true trang, v.v.) va chuyoi luu nuoc tieu co kiem soat bang each tao hinh BQ tan tao dung vi tri (BQ true vi). Viec lira chpn phuang phap chuyen luu phu fhupc nhieu yeu to: giai doan boih, vi tri u, tong tiang chimg cua benh nhan, nang luc cua co so y te, v.v..
Trong dieu kien cho phep, tao Wnh BQ true vi la phuong phap dieu tri mang lai chat lupng song tot nhat cho nguoi benh*^. Tai khoa Ngoai Tiet nieu ~ Benh vien Quan y 175, chiing toi da trien khai ky thuat cat BQ toan bp, tao hinh BQ bang rupt tCf thang 8/2013. De gop phan phat trioi mpt ky thuat dupe coi la phuc tap trong chuyen nganh Tiet nieu, chiing toi Hen hanh nghien cuu de tai tren voi muc tieu: Ddnh gid fcet qud buac ddu phau thuqt cdt BQ todn bd, tqo hinh BQ bdng ruot theo phuang phap Hautmann-Studer dieu tri ung thu BQ tim trien.
D6lTl/qNG-PHU'0NGPHAPNGHIENCUtJ Doi t u g n g
Gom cac benh nhan (BN) UTBQ duoc phSu thuat cat BQ toan bg, tao hinh BQ true vi theo
nieu Benh vien 175 - Bp Quoc phong tir thang 8 nam 2013 doi fhang 2 nam 2017.
Cac benh nhan dupe kham lam sang, lam cac xet nghiem thuong qui danh gia tong tiang chung, sieu am, chup CT. Scan he nieu, npi soi sinh thief u chsn doan xac dinh UTBQ va danh gia giai doan benh tru6c phau thuat.
Chi diiih
UTBQ xam \sn lop co nhung chua eo biwi hien xam lah ra ngoai BQ (T2a doi T3b).
UTBQ chua xam lafri den lop ca nhung co nguy eo tien trien cao: mo hpc dp ac tinh cao (grad 3), nhieu vi tri, tai phat nhieu Ian, ung thir BQ dang nhiem ciing (in situ), that bai voi dieu tri h6 tro chong tai phat (hoa Ueu phap va/ hoac mien dich Ueu phap).
Chong chi dinh
UTBQ giai doan mupn da xam lan ra ngoai BQ (T4a, T4b), eo di can hach va/ hoac di can xa (NI, Ml).
UTBQ ma khoi u nam o vimg co BQ hoac nieu dao tien Uet tuyoi.
BN gia yeu, nhieu benh ket hgp, tong tiang khong eho phep tioi hanh phau thuat PhxHmg p h d p n g h i e n ciiu Thiet ke'nghien cdu
Tien ciiu co can thiep, mo ta cSt ngang hang lo?t ca, khong nhom chiing.
Cdc chi tieu nghien cdu
Dac dion BN: Tuoi, giai, mpt so trieu chiing lam sang, tien su phau fhuat va dieu trj ho tr?
chong tai phat, benh kef hpp.
Dae diem u: Vi tri, so lupng, kieh thuoc, giai doan va dp ac tinh mo hgc.
Dac diem he nieu phia tren u: Miic dp if nuoc cila than va lueu quan, chiic nang than.
Y H p c T P . H b C h i M i n h * T a p 21 * So 6 * 2017 N g h i e n c u u Y hpc
Kii qud phau thu&t
Then gian p h l u thuat, nhiing kho khan khi tieh hanh phau thuat, tai bioi gap phai, nguyen nhan va each khae phuc.
Thong ke ngay dieu tri hau phlu, thoi gian nit cac dan luu, eae bioi chiing sdm sau phau tiiu?t.
Ket qua theo doi sau phau thuat: tinh trang tai phat u tai cho hoac di can, nude tieu ton luu, cac bioi chiing xa, miic dp hai long ciia nguoi benh.
Kii qud chung ciia phau thuqt duac ddnh gid theo 3 miec
Tot: phau thuat tioi hanh fhuan lm, hau phau dien bien on dinh, khong co tai bien - bieh chiing, BQ tan tao hoat dgng tot, nguoi benh hai long.
Kha: phiu fhuat co tai bioi - bien chiing nhung khong Ion, khong phai can thiep 1^, BQ tan tao hoat dpng tot, nguoi b^nh hai long.
Kem: p h i u fhuat co tai bien - bioi ehiing n|ng phai can thiep lai, BQ fan tao khong hoat dpng phai chuyen luu nude tieu ra da, ngudi b&ih khong hai long,
Ky thuatmovd phuangphap vo cam Chudn bi tneac movd vo cam
Benh nhan dupe lam cac xet nghiem tien phau va chan doan xac dinh, danh gia giai doan benh: diup cat Idp vi tinh hoae cong hudng t£r vimg bung - chau, npi soi sinh thiet, v.v..
Chuan bi rupt trudc mo: uong khang sinh duong ruot trudc mb 5 ngay, sii d i ^ g fhuoc lam sach rupt (Fortrans, Heet Phosphosoda) trude mb 3 ngay.
Tu van ky ve nhiing u u diem va cac tai bien, bioi chiing co the xay ra trong va sau phau thuat.
Vo cam trong mb bang gay me npi khi quan, giam dau sau mo qua catheter dat ngoai mang ciing.
Ky thudt
BN nam ngiia, sat trimg rgng vung mo va dat thong tieu tiong mo. Rach da dudng trang giua dudi ron tdi sat xuong mu, bgc 16 mat trude BQ va danh gia so bg miic do xam lah ciia u thong qua miic dp di dpng ciia BQ.
Tioi hanh boc tach va cat BQ toan bp theo kieu ngupc dong hoac xuoi dong. Kian tia cam mau ky vung ho chau, khau cae moi chi Vicryl 3/0 chd quanh mom eat nieu dao tai cac vi tri l l h , l h , 3 h , 5 h , 7 h v a 9 h .
Nao vet hach chau 2 ben.
Co lap mpt doan hoi trang khoang 60 cm co cuong mach nuoi, noi rupt tan - tan. Sii dung doan hoi tiang mdi co lap tao hinh BQ mdi kieu Hautmann - Studer.
Hitdi 1. Ky thuqt too hinh bang quang bang rudt theo Hautmann. Ngudn: trich iheo Ddo Quang Odnh'"
Cam 2 Tueu quan vao BQ mdi kieu true tiep tren nong day hiit ddm 8F, dua 2 dau qua BQ mdi ra ngoai. Noi BQ ^ n tao vdi mom nieu dao, md BQ tan tao ra da va daf fhong tieu luu.
Daf d i n luu hb chau 2 ben, dong bung 2 lop.
Ngihien cuu Y hpc Y H p c TP. H b Chi M i n h * T a p 21 * Sb 6 * 2017
Cham soc hau ph&u
BN dugc nuoi dudng tot bang dudng finh mach va dudng an khi da trung tien.
Theo doi sat tinh tiang chay mau, nhiem khuah, luu thong rupt va )d ro nude tieu.
Theo doi va cham soc cac ong dan luu: 72 gid sau mo bom nia BQ mdi moi ngay, nit cac ong din luu ho chau sau khi het dich 24 gid, nit nong nieu quan 10 - 12 ngay sau md, nit thdng tieu luu sau mo 2 tuan va rut dan luu BQ tren xuong mu sau mo 3 hian.
BN dupe tai kham theo hen sau 1 thang, hoa tri bang phac do ket hop Gemdtabine va Cisplatin, sau do hen tai kham moi 3 thang:
kham lam sang, sieu am, chup CT. Scan hoae PET/CT. Scan theo doi tinh tiang tai phat u.
Xii li solieu
Cac so Ueu dupe xii ly bang phan mem SPSS 16.0.
KETQUA Dac &im berih nhan
Tuoi trung binh: 58,63 ± 13,25 (nho nhat 45;
ldn nhat 75).
Gidi:15A5BNIanam.
Ly do nhap vien do tieu mau: 13A5 BN.
Tien sii can fliiep phau thuat u: mo md cat u: 1A5 BN; npi soi cat u nhieu Ian va hoa tri:
2/15 BN.
Bdng 1: Giai doqn phdt trien cita u Giai do^n u
T2a T2b T3a T3b COng
SoBN 2 4 6 3 15
•ni?(%) 13,3 26.7 40,0 20,0 100 N h ^ xefc Da so BN den benh vien khi benh da d giai doan T3a, T3b (60,0%).
Do mo hgc: grad 2: 9A5 BN; grad 3: 6/15 BN.
Di can hach chau: 1/15 BN phat hien co hach chau trong mo va ket qua giai phlu benh xac nhan ung thu di can.
Chiic nang than va miic dp li nude: 15/15 BN chiic nang than tot tren UW; 3A5 BN than li nude 1 ben.
Ket q u a p h a u thuat
Thdi gian phlu thu?t trung binh: 6 gid 30 phut ± 1 gid 25 p h u t dai nhat 8 gid; ngan nhat 5 gid 55 phiit.
Thdi gian nit het dan luu ho chau trung birih: 5,25 ± 3,56 ngay; ngan nhat 4 ngay; dai nhat 14 ngay.
Ngay dieu tri hau phau trung binh: 22,45 + 2,34 ngay; ngan nhat 21 ngay; dai nhat 26 ngay.
Tai bien, bien chihig:
Chay mau nhieu trong mo: 1/15 TH.
Xi ro nude tieu qua dan luu keo dai: 1/15 TH.
Suy fh|n cap sau mo: 1A5 TH.
Chia: ndng BQ tdn tqo
Thai gjan theo doi dai nhat 42 thang, ngan nhat 3 tiiang (3 BN chup PET/CT. Scan d cac thang thii 42, 36 va 24) ket qua diua eo BN nao tai phat ung fhu, diiic nang BQ tan tao tren cac mat nhu sau:
Dung tich BQ tan tao sau 3 ftiang: 15/15 BN CO dung tich BQ tan tao tren 300 ml.
Nude tieu ton Imi < 50 ml: 14A5 TH; 50 -100 ml: 1/15 TH.
Thdi gian giua 2 Ian di tieu > 2 gjd: 15A5 TH Kha nang Idem soat nude tioi: 14/15 BN deu CO kha nang Idem soat tdt ca ngay va dem sau 3 fhang phau fhuat; 1/15 BN cd tioi son ve dem.
Kha nang bao ve dudng tieu tien: 15A5 BN deu CO chiie nang than tot tren UIV hoac CT.
Scan, khong eo hien tudng tiao ngupc BQ - nieu quan. 3/15 BN li nude than mpt ben trude mb het li nude sau 3 thang.
Su hai long cua ngudi benh: 15/15 BN deu rat hai long ve hoat dpng eiia BQ tan tao.
Kei qud chung cua phdu Utudt
15/15 BN deu eo ket qua phau fhuat tot ho?c kha tdt.
Y H p c TP. H b Chi M i n h * T^p 21 * Sb 6 * 2017 N g h i e n cu*u Y hpc
Bang 2:Ketquachunxcua Ket qua cliung
Tot Kha Kem COng
phau thudt S6BN
12 3 0 15
•nie(%) 80,0 20,0 0 100 B A N L U A N
D^c di^m b e n h n h a n
Cac BN tiong nghi&i cihi eiia ehiing toi eo tuoi trung binh 58,63 ± 13,25 (nho nhat: 45; ldn nhat 75), toan bg !a nam gidi va d o i nhap vien vdi ly do tieu mau la chti yeu (13A5 BN). Cae TH con lai tinh cd phat hien u khi di kham benh khac (1A5TH) hoae khi npi soi cat U tuyoi tien Uet (1/15 TH). Phau fhuat cat BQ toan bp, tao hinh BQ bang rupt khong dugc khuyoi khich tien hanh tren nhimg boih nhan gia yeu (> 70 tudi), nhieu benh ket hpp vi day la phau fhuat rat phiie tap, thdi gian mb va dieu fri hau phau keo dai, nhieu tai bien - bioi chiing. Tuy nhien, mgt sb tac gia nhu Lee (2004), SouUe (2002) van chii truong cat BQ toan bp, tao hinh BQ bang rupt tien nhirng benh nhan kho: tuoi tren 70, da xa trj, tien sii eat BQ ban phan, v.v.**'®. Trong nghien ciiu ciia chung toi co 2 BN tuoi tien 70 nhung tong tiang cdn tot, cac benh ket hpp tiong
^ m Idem soaf nen chung toi van tioi hanh phau thuat Trong nghien ciiu cua Dao Quang Oanh (2008), hibi fanng binh 57,43 +12,98 (22 - 79)0).
Da sb cae benh nhan (13/15 TH) d o i nhap vien trong giai doan benh da tioi trien va duac chi dinh cat BQ toan bp ngay tiong lan dau nhap vien sau khi ed kef qua ngi soi cat u sinh thiet.
Cac TH con lai n h i p vi?n khi UTBQ chua xam lan Idp CO, cat u npi soi 3 lan, hoa tri Ueu bang bcrm Mitomycin C vao BQ nhung ung fhu van tien trioi xam laii Idp ea nen phai chi dinh eat BQ toan bg. Cac BN trong nghien cuu ciia chung toi deu c6 dp ac tinh mo hpc grad 2 (9/15 BN) hogc grad 3 (6/15 BN). B#nh nhan UTBQ d Viet Nam thudng d o i vien trong giai doan tie ciia benh do khdng co dieu ki?n kham siic khoa dinh ky, y thiic ve viec can phat hien benh sdm diua cao. Trong nghien cihi co tdi 9/15 BN (60%) da d
gjai doan T3a va T3b, cac TH con lai d gi£ii doan T2avaT2b.
Chung 'toi CO mgt BN ehi dupe phat hien da di can hach chSu tiong liie md, cac xet nghiem ve chan doan hinh anh trudc mo khfing phat hien dugc. Benh nhan sau md dupe fheo doi sat, chi dinh hoa tri sdm va ket qua kiem tia sau 24 thang tien PET/CT. Sean khong thay dau hieu tai phat va di can ung thu.
Ket q u a p h a u thuat
Phau fhuat cat BQ toan bp, tao hinh BQ bang ruot dieu fri UTBQ tieh trioi la mpt phau fhuat ldn, thdi gian phau thuat keo dai, cham soc hau phau phiic tap va nhieu nguy co xay ra tai bien, bien ehiing. Cae tai bien, bioi chiing co the g | p bao gom: chay mau trong va sau md, nhiem khuan vet mo, nhiem khuan dudng tiet nieu, nhiem khuan huyet, ap xe ton luu, tac rupt sdm hoac mupn, xi ro nude tieu (mi^ng noi khong kin, BQ tan tao bi hd, dinh dudng khong dam bao hoac tac cac ong dan luu), hep mieng nieu quan, hpp co BQ, hep nieu dao, tieu khong kian soat (5 - 10%), rdi loan cuong duong (20 - 50%), tiao ngugc BQ - nieu quan, v.v.'^'^l,
BdngS. Ty le tai biih, biih chihig cua mot so'tdc gid'
Tac gia Ramon Studer Sltinner Mever Steven Campos-Femandes
Sevin Odo Queno 0^n/i
S6BK 93 100 126 104 166 87 124 113
Tir vong 1,1%
0%
1,6%
0%
0%
4,6%
5%
0,88%
BC som 7,5%
11,1%
23%
23,5%
30,1%
34%
16,81%
BC muOn 17,2%
2,4%
13,6%
37,4%
33,6%
20.6%
11,5%
Mo lai 3,2% 15,7%
3,9% 9,6% 4,2% 14% 2,65«
Trong nghi&i ciiu ciia chiing tbi fhdi gian p h l u fhuat trung binh: 6 gid 30 phiif ± 1 gid 25 phiif (5 gid 55 phiif - 8 gjd); Thdi gian nit het dan luu hb chau frung binh: 5,25 ± 3,56 ngay (4 - 14);
Ngay dieu tri h$u phiu trung binh: 22,45 ± 2,34 ngay (21- 26). BQ tan tgo hoat dpng tot tren cac m|t: diiia dung (15/15 TH dung tich BQ > 300 ml; thdi gian giiia 2 Ian di tieu > 2 gid), tong xuat (14/15 TH nude tieu ^ n luu < 50 ml; 14/15 TH kiem soat nude tieu tot ea ngay va dem, chi co 1 TH tieu son ve dem), bao ve dudng tieu tren
Nghidn c i ^ Y hpc Y Hpc TP. Hb Chi Minh * T^p 21 * Sb 6 * 2017
(than het li nude sau mo va khong co trao ngupc BQ - nieu quan), tat ca b?nh nhan deu rat hai long ve ket qua phlu thuat Chiing toi chua gap eae tai bien, bioi chiing ldn can phai can thiep lai, 1 TH ro nude tieu qua dan luu keo dai 14 ngay nhung sau do tu het do mieng noi khong kin, 1 TH chay mau nhieu tiong mo (khoang 2000 ml) do u mat trudc dang nhiem ciing va da xam lah ra ngoai BQ (T3b), 1 TH suy tiian cap sau mo keo dai 1 tuan nghi do tac mach than sau phlu fhuat ldn vimg chau dupe dieu tri npi khoa bang fhuoc Ipi tieu, chong dong kef qua tot Danh gia chung ket qua phau thuat 12A5 TH ket qua tdt, 3/15 TH kef qua kha, khdng co TH nao ket qua kem. Ket qua theo doi sau md dai nhat 42 thang, ngan nhat 3 thang khong thay bieu hi|n tai phat tai cho va di can ung thu, 3A5 TH dugc chup PET/CT.Scan d cac fhang fhii 42, 36 va 24. Dao Quang Ganh (2008) nghioi ciiu cat BQ toan bg, tao hinh BQ true vi tren 84 BN tai benh vien Binh Dan vdi thdi gian md frung binh 5 gjd 55 phiit, ngay dieu tri hau phlu frung binh 18,3 ngay cho ket qua: tii vong (1/84); tdt (72/83);
tieu khdng ki&n soat ve dem sau 3 thang (24/83), sau 6 thang (5/83); tioi khdng kiem soat ca ngay lln don (l/SS)"^'. Le Due va Camey (1987) cat BQ toan bp, tao Hnh BQ true vi 84 BN, kef qua: fii vong 4/84 TH; ty le kiem soat nude tieu ban ngay khoang 90%; luong mau mat tnmg binh khoang 2500 ml; thdi gian md frung binh 9 gid. Nam 1990, Hautmann va epng su nghien ciiu thyc hien ky thuat tien 113 BN, khong co BN hi vong, ty le kian soat dugc nude tieu 82,1%; 13/113 BN phai can thiep lai ehii yeii do hep ed BQP'.
KETLUAN
Trong thdi gian hr 8/2013 d a i 2/2017 chiing toi da tioi hanh phau fhuat eat BQ toan bp, tao hinh BQ bang rupt theo phuong phap Hautmann-Studer tren 15 benh nhan ung thu BQ tien trioi tai khoa Ngo^ Tiet nieu - Benh vien Quan y 175 vdi kef qua: Cac benh nhan nghien ciiu la nam gidi tuoi trung binh 58,63 ± 13,25 (45 - 75) cd ung fhu BQ giai doan tu T2a -
T3b, do ac tinh mo hpc grad 2 (9/15 TH) va grad 3 (6A5 TH). Thdi gian phau thuat trung binh 6 gid 30 phiit ± 1 gjd 25 phiif (5 gid 55' - 8 g); Thoi gjan nit het dan luu ho diau trung binh: 5,25 ± 3,56 ngay (4 - 14); Ngay dieu trj hau phau trung binh: 22,45 + 2,34 ngay (21 - 26). BQ tan tao hogt dgng tot tien cac m | t diiia dung, tang xuat bao ve dudng tieu tren va kian soat nude tieu, Benh nhan rat hai long ve kef qua phau thuat Ty le tai bioi - bioi chiing chung: 3A5 TH, trong do 1 TH ro nude tieu qua dan luu keo dai sau do tu h&, 1 TH chay mau nhieu trong mo (khoang 2000 ml) do u mat trudc dang nhiem ciing va da xam lah ra ngoai BQ (T3b), 1 TH suy than cap sau mo keo dai 6 ngay nghi do tac mach than sau phlu Ihuat ldn vimg chau. Kef qua chung ciia phau tiiuat tot (12/15 TH), kha (3A5 TH), khdng eo ket qua xau. Kef qua theo doi sau mo (dai nhat 42 thang ngan nhat 3 thang) khong thay tai phat tai cho va di can ung thu.
TAI LIEU THAM KHAO
1 D a o Quang Oanh (2008) Khao sii kS qud phSu Ihuat too Mnli bang quang Ihay Iheimtgruat.lji^ SB iiea si yhoc, V^i\oc\~
DuiTC TP. H 5 O u NfinK
2 Hautmann RE. ^004). Heal neobladder. d a m ' s L&dpjtc SH7jB/y, execution, 82, pp. 638 - 647.
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