Y H p c T P . H b C h i M i n h * T a p 1 8 * P h u b a n c u a S b 4 * 2 0 1 4 N g h i e n c i h i Y h p c
NHAN XET KET QUA DIEU TRI SOI THAN KHONG CAN QUANG BANG PHU'ONG PHAP TAN SOI NGOAI CO THE VOI HE THONG DINH VI SIEU AM TAI BENH VIEN NHAN DAN 115
Nguyen Van TriDung', Truang Hoang Minh', Tran Thanh Phong', Tran te Duy Aidt', Le Thj Nghia' T O M T A T
Muc tieu: 1. Xdc dinh ty li dinh vi thdnh cong soi than khong vd kem can quang bdng siiu am. 2. Xdc dinh ty lisqch soi trong dieu tri sdi than Ididng vd kem cmi quang bang phuong phdp tdn soi ngoai co the vdi lie thdiig dmh vi bang siiu dm, sS'Ian tdn, ty lisqch soi, bii bieh, bich diung.
Doi tiwng vd phtamg phdp: Nghiai ahi tien cuu tren 55 berdi nhan co soi than kliong can quang duac xdc dinh bang sieu dm, (^-Scan bung co can quang vd dial hi bang phucmg phdp tdn soi ngodi co tlie trin mdy Piezolith 3000 vdi 2 he tlmtg diidi vi bang sieu dm vd C-arm taibiidi vien NhdiiDdn 115 tie thdng 9/2021 deh 3/2014.
Kit qua: Ty li sqdt soi diung sau 1 lan tdn: 90,9%, sau 2 lan tdn 100%. Khong co tai bieii hoac bim diinig Idn, da socd tieu mdu sau tdn sbi, hH tieu mdu sau 12 gid. Kiwng cd trudng liop ndo diuyai phucmg phdp dieu tri khac. Ty le sach soi gidm khi kich thudc soi tang Cdc ym td'didi hudng bdi lai tdi ty le sach soi bao gom: Mch thudc soi, do can quang soi, do it niedc than.
Kii luan: Dieu tri soi than kim vd kliong can quang bang phuang plidp tdn soi ngodi ca tlie Id phuong phdp dieu tri it xam IMt, ty le thdnh cong cao, it tai biih vd bieii ehung.
TH khoa: soi than khong can quang, tdn soi ngodi ca the.
A B S T R A C T
REMARK ON THE RESULT OF LESS AND NON RADIODENSTTY RENAL STONE TREATMENT BY EXTRACORPOREAL SHOCKWAVE UTHOTRIPSY
WTTH ULTRASONIC POSTTIONING IN 115 PEOPLE'S HOSPTTAL
N g u y e n Van Tri D u n g , T m o n g H o a n g M i n h , T r a n T h a n h P h o n g , Tran Le D u y A n h , Le Thi N g h i a
* Y H o e TP. H o Chi M i n h • Vol. 18 - S u p p l e m e n t of No 4- 2014:91 - 95
Objective: Detennine successful rate of less and none radiodensity kidney stones ultrasonic positioning.
Determine the stone -free rate and the factors related in the treatment of less and none radiodensity kidney stones hyESV^.
Patients and Methods: Study in 55 patimts unth less and none radiodenaty kidney stones is determined by idtrasonography, abdomir^ CT-Scan on the treatment result by ESV/L madiine Piezolith 3000 at 115 People's Hospital from 9/2011 to 3/2014.
Results: The overall of stone -free rate was 90.9% afrer die first ESWL and 100% after the second time No severe atmplication zpas noted, most after ESWL ivith hematuria, and the aid after 12 hours. No case exdvmges other treatmaits. The stone -free rate reduce when the stone size increase. Factors adversely affecting the stone - free rate indude: stone diameter, radiodensity stone and hydronephrosis degree of kidney.
Conclusion: Treatment of less and none radiodensity kidney states by ESWL methods is a good procedure.
* Khoa ngoai m?u - Ghep than BV ND 115
Tdcgia Uen lac. N g u y i n Van Tri Dung DT: 09036244S7 Email: vantridung2000(^yahoo.com
Chuyen De T h ^ Ni?u »
Nghien ciru Y hpc Y Hpc TP. Hb Chi Minh * Tap 18 * Phii ban cua So 4 * 2014 gh success rate, less severe complication.
Keywcn-ds' none radiodensity renal stone, extracorporeal shockioave lithotripsy.
DAT VAN DE.
Tan soi ngoai co the la mot phuang phap it gay sang chan dugc ap dung kha rong rai trong nhiing nam gan day nham lam vo soi tir ngoai CO the ma khong phai can thiep phau thugt. Dua tren nguyen ly song xung dpng tap trung vao mpt tieu diem {vien soi) voi mot ap luc cao lam vo vun soi thanh nhting vien nho sau do bai tiet ra ngoai theo duong tu nhien.
Hien nay da co rat nhieu loai may tan soi ngoai CO the ra doi cua nhieu nuoc khae nhau tren the gioi nhu My, Phap, Due, Trung Quoc,.,.Da so cac may chi co mpt he thong dinh vi bang X-quang (C-arm). Soi can quang se CO dp Cling cao, tan kho vo, ty le thanh cong thap hon so voi soi khong can quang. Voi soi than can quang, viec dinh vi soi bang C-arm {da so cac benh vien dang sii dung) de tan soi de dang. Doi voi soi than khong can quang, hf thong C-arm khong dinh vi soi dupe do do khong the tan soi ngoai co the dupe, Nhung truang hop nay chi co may tan soi voi he thong dinh vi bang sieu am moi co the dinh vi dupe de tan.
Hien nay benh vien Nhan Dan 115 dupe trang bi he thong tan soi ngoai co the Piezolith 3000 do Diic san xuat voi 2 he ihong dmh vi sieu am va C-arm, Do do ehung toi thuc hien de tai nay nham muc tieu:
Xac dinh ty le dinh vi thanh cong soi than khong va kem can quang bang sieu am,
Xac dinh ty le tan soi ngoai co the thanh cong eua soi than khong va kem can quang dupe dpih vi bang sieu am, so Ian tan, ty le sach soi, tai high, bien ehung.
DOITL/ONG-PHU'ONGFHAPNGHIENCUtJ Doi hrpng nghien cmi
Gom 55 benh nhan (BN) co soi than khong va kem can quang duoc xac dinh bang sieu am
va CTscan bung co can quang va dupe dieu tri bang phuong phap tan soi ngoai ea the tai phong tan soi Benh vien Nhan Dan 115 thang 09/2011 den thang 3/2014.
Tieu chuan chon beidi
Soi than kich thuoc £ 2 cm, so Iupng khong qua 2 vien, khong eo benh ly roi loan dong mau, khong CO nhiem trimg nieu hien dien. Soi khong can quang tren X-quang ho|c can quang kem ma he thong dinh vi C-arm khong thuc hien dupe, Tieu chuan loat trie
Nhimg truong hpp chong ehi dinh tan soi ngoai eo the^ soi can quang ma co the dinh vi bang C-arm.
Phirong phap nghien cmi Loai hinh nghien ciiu
Tien cuu, mo ta.
Phuang tien nghien ciiu
May tan soi Piezolith 3000, san xuat tgi Due, he thong dinh vi X-Quang va sieu am, nguon phat song xung.
Npi dungnghien ciiu
- Nghien ciiu cac dac diem ehung ciia BN ve tuoi, gioi... Dae diem h | tiet nieu: chuc nang than, muc do chuong nuac, cac di dang .. .Hinh thai soi: vi tri, kich thuoc, so Iupng, muc dp can quang,...
- Cac BN dupe Iam cac xet nghiem tien phau, chup than thuoc tinh mach (UIV), chyp he nieu khong chuan bi (KUB), sieu am bung - nieu, chup CTscan bung eo can quang, tan soi ngoai eo the eo giam dau bang Efferalgan Ig truyen tinh maeh va mobic 15mg long tiem maeh, nam theo d5i tai khoa 12 gio sau tan, hen tai kham sau 4 tuan.
- Ket qua dieu tri; ty 1? het soi sau 1 thang, 2 thang, phai sii dung cac thu thu$t bo sung va chuyen phuong phap dieu tri, tai bien - bien ehung...
Chuyen D e T h | n Nieu
V
^Kf^^mist^Km'Y Hpc TP. Hb Chi Minh * Tap 18 * Phu ban cua Sb 4 * 2014 Nghien cmi Y hpc
Xulysolieu
Bang phan mem SPSS 13.0 va excel.
KET QUA NGHIEN CUV
Chung toi thuc hien 55 truong hpp soi tfian khong va kem can quang dupe xae dinh soi b&ig sieu am va CTscan bung co can quang voi cac dac diem nhu sau:
Dac diem benh nhan.
- Tuoi himg binh: 38,68 ± 9,8, nho nhat 22, Ion nhat 68
- Nam: 34, nij 21 Bdng 1: Dac diem soi
D^c d i l m s o i
Vi tri soi
Kich thiro'c SOI
quang soi
Nhom dai tren Nhom i3ai giOa Nhom dai dirbi Phiit: tap*
< 1 0 m m 1 1 - 1 5 m m
> 15 m m 1 vien 2 v i § n Soi kem can quang SOI khong can quang
S o B N 13 31 9 2 17 22 16 53 2 7 48
Tyle%
23,6 56,2 16,2 4.0 31 40 29 96 4 12,7 87,3
*Phuc tap: > 2mSn soi, ndm cung nhom dai hay khac klidc nhom dai tlidn.
Da s6 cac BN soi nam nhom dai giua chiem 56,2%.
Da so soi CO kich thuoe tu 10-15mm.
Phan Ion la soi don dpc.
- Da so la soi khong can quang.
Ket qua ehung tan soi than ngoai co the Bdng 2: Kit qud tdn sbi ehung (Sau 2 thdng)
K i t qua H i t soi sau 1 l^n fan H i t s d i 5 a u 2 l i n t S n C h u v i n phirang phap
S 6 B N 50
5 0
T y l e { % ) 90,9
100 0
Nhan xet:
Ty le het soi ehung sau 2 Ian tan 100%; khong CO benh nhan nao thuc Men cac ky thuat bo sung.
Cae truong hpp that bai: co 2 truang hop soi phiic tap va la kem can quang. Co 3 truong hpp vi tri soi nam dai duoi va than co u nuoc va 1 truong hpp soi kem can quang.
Ket qua tan soi theo dac diem he nieu va soi
Bdng 3: KH qud hil sbi theo Mdi thudc (sau 1 Ian tdn)
<kt q u a ^ " " ~ ~ - - » . ^ H i t soi Con sdi
Cong
£ 1 0 m m S o B N
17 0 17
T y l ? 31
0 31
> 1 1 m m S6BN
33 5 38
T y l # 60 9 69
ISIhan xet: Da s5tan soi thanh cong trong Ian tan dau tien, 5 truang hpp eon soi gom 2 tnrong hpp soi phuc tap va 3 truong hpp soi dai duoi, Bdng 4: Ket qud hei soi theo tinh chat sbi co can quang/kem can quang (sau 1 lan tdn)
« t q u i " " " " - - ^ ^ Met sol Con SOI Cong
Kem Can quang S o B N
4 3 7
T y l # 57 43 100
K h o n g can q u a n g S d B N
46 2
T y l e 96
4
Nhan xet: Soi khong can quang co ty le thanh cong cao hon soi kem can quang p=0,033.
Bdng 5: Kit qud hei sbi theo mice do ve nude than
M t p c d o K i t qua Met 501 Con soi Cong
K h o n g w S o B N
42 1 43
n u v c T y l 9
98 2 100
C o L r n i P o v S o B N
S 4 12
T y l e 67 33 100
Nhan xet: Ty le sach soi theo do u nuoe eiia than khae biet eo y nghia thong ke (pO,04).
BAN LUAN Ket qua dieu tri
Nghien cihi 55 benh nhan co soi than kem va khong can quang, da so soi nam 6 nhom dai giua, phan Ion kich thude tir ll-15mm, dupe dieu tri bang phuang phap tan soi ngoai co the bang may Piezolith 3000 voi 2 he thong dinh vi sieu am va C-arm tai benh vien Nhan Dan 115.
Chuyen De Than Ni?u
Nghien cihi Y hpc Y Hpc TP. Hb Chi M i n h * Tap 18 * Phu ban ciia Sb 4 * 2014 -100% benh nhan dupe xac dinh soi kem va
khong can quang deu dupe chiing toi dinh vi thanh cong bang sieu am.
- Ty le het soi sau 1 lan tan: 90,9%; sau 2 lan tan la 100%. Theo Y van, soi khong can quang tuong doi mem de tan vo vun do do ket qua nghien ciiu aia ehung toi eo ket qua thanh cong kha cao so vol cac ket qua nghien cuu ciia cae tae gia khae. Tran Van Quoc (2010) va cpng su nghien ciiu ket qua tan soi don doc cue duoi than tren 92 benh nhan cho ket qua ty le saeh soi chimg ia 73,9%"^'. Trong nghien a i u oia Lingeman (1994)(*V ty le sach soi la 74% vol soi ducdlO mm, 56% vdi sdi 10 - 20 mm va chi 33,3%
voi SOI tren 20 mm; theo Abdel (2004): 55% vdi sdi dudi 10 mm, 30,8% vdi soi 10 - 20 mmiii.
Nguyen Van Tri Diing (2013), ty le sach sdi sau tan lan dau 81% va sau ty le sach sdi sau Ian tan thii 2 la 90%™.
- Chiing toi khong ghi nhan dupe nhung tai bien - bieh chiing Idn, giong nhu ket qua cac nghien ciiu khae da so trudng hop benh nhan ed tieu mau sau tan sdi, het tieu mau sau 12 gid.
Khong cd benh nhan nao can can thiep ky thu^t bd sung.
D^c diem sdi va he nieu lien quan tai ket qua dieu tri
- Dae diem sdi va he tiet nieu li&i quan tdi ket qua dieu tri sdi nieu quan da duoc nhieu tae gia de cap. Tuy nhien, viee hen Iupng ket qua dieu tri van edn gap khd khan do khong ed yeii to nao giup tien lupng chinh xac. Chiing toi nhan thay ty le het sdi 6iap hon d cac BN cd sdi kich thudc Idn (> 15mm) va sdi da gay ti nude than.
Theo Motola (1990), kich thude sdi la yeu td dpe lap quan trpng nhat quyet dmh viec lua chpn phuong phap dieu tri thich hpp cho mdt benh nhan sdi th^n. Cac tac gia khac cung nhan dinh:
ty le saeh sdi ehung sau TSNCT trong dieu tri sdi tiian cang giam khi kich thudc tang lerf'^^l Trong nghien ciiu aia Lingeman (1994), ty le sach sdi la 74% vdi sdi dudi 10 mm, 56% vdi sdi 1 0 - 2 0 mm va chi 33,3% vdi sdi tren 20 mm(^';
theo Krishnamurtiiy (2005): 55% vdi sdi dudi 10 mm, 30,8% vdi sdi 10 - 20 mmPi. Nguyen Van Tri Dung (2013) d benh nhan cd kich thudc sdi
>15mm ty le sach sdi dat 72,5% va nhdm sdi gay u nude than ty le sach sdi dat 74%(^''i.
- Ngoai kich thudc sdi, dp can quang cua sdi eiing la yeu td ed Uen quan den ty le saeh sdi, trong nghien ciju ciia chiing tdi eae trudng hop phai tan lan 2 da sd la sdi kem can quang.
Le Dinh Khanh va cpng su (2005) khi nghien a i u TSNCT sdi than kich thudc Idn nhan thay sdi cd dp can quang manh (so vdi dot song L2), dam do khong deu, bd tran lang la nhiing yeu td han che ket qua chungP).
Krishnamurthy MS (2005) nghien cuu ket qua TSNCT dua tren miic do can quang ciia sdi so vdi xuong sudn 12 cimg ben cho ket qua tuong tu: ty le het sdi d nhdm BN ed cdi can quang manh ehi la 60% so vdi 71% d nhdm cd sdi can quang vua va yeu'^>. Can day, Mpt sd tae gia nhu Cheng G (2006)(8), Joshida S (2006)<i'>' eho rang don vi Hounsfield eiia sdi khi chup cat Idp vi tinh la yeu to tien lupng ket qua TSNCT.
- Dd li nude than ciing lien quan deh ty le thanh cdng sdng xung ddng giam cudng dp khi qua moi trudng nude. Ty le thanh cong trong nghien ciiu ciia chiing tdi trong nhdm sdi gay than li nude ciing tuang duong mpt sd nghien ciiu tac gia khac. Nguyen Viet Cudng, Vii Le Chuyen va CS d nhdm sdi than gay li nude viia ty le sach sdi 77,S°U">.
KET LUAN.
Ty le het sdi sau 1 Ian tan: 90,9%; sau 2 lan tan: 100%. Cac yeii to anh hudng bat lpi den ty le saeh sdi bao gom: kich thudc sdi tren, miic dp can quang ciia sdi, dp li nude ciia than, it gay tai bien va bien chiing. Qua dd chiing ta thay rang sdi than khdng can quang mem, de tan sdi it gay tai bien va bien chiing nhung can cd he thong dinh vi bSng sieu am mdi ed the thuc hien duoc.
do dd dieu tri sdi than bang phuong phap tan sdi
Chuyen De Than Ni^u
Y Hoc TP. Hb Chi Minh * Tap 18 * Phu ban cua Sb 4 * 2014 Nghien cmi Y hpc
ngoai CO the la phuong phap di^u tri it xam lah, it tai bien va bien chiing, tv le thanh cdng cao.
T A I L I E U T H A M K H A O
1 A b d d - Khald: M, Shdr KZ (2004), " Prediction of success rate after ESWL of renal stones - A multivariate analysis mnd^", Scand J Uwl Nephrol, 3S (2), pp 161-7- 2- Cheng G, Xie LD (2006), " Value of Hounsfield unit « i CT in
prediction of stone - tree rate of iipp& uimaiy calculi afta ESWL", Y h o t ^ u a Ti Xue Za 2hi, 86 (4), pp. 276 - a 3 James. E. Lingeman, M.D (1996)," Extracorporeal Shack Wa\'e
Lithotnpsy ", Smith textbook of endourolog\' (1), Oialit>' Medical Publishing, INC, pp. 529 - 695
4 Joshida S, Hayashi T (2006)," Role of volume and Mtenuabon value histognim of uiinaiy stone on noncontrasl hc£ca]
computed tomography as predictor of f r a ^ t y hy ESWL. ", Urotogy,68(l),pp33-7.
5 Knshnamurthy MS, Feruca PG (2005), " Is stone radiodaisit\' a useful parameter for predicting outcome of ESWL for stones
< or = 2 cm.", iii( Bnc 7 Uroi, 31 (1), pp. 3 - 8.
6 Le Dinh Khanh (2002)," Ket qua tan sea ngoai co the dieu hi SOI b S m?u bang n a y M 2 - ESWL - VI t ^ truimg Dai hoc Y khoa Hue ", Tap chi ngoai khoa, Phu tnmng hdi iigfti ngoai khoa quoi gin Viet Nimt lan thu XII, p 307 - 310.
7 LeESnh Khanh (2005), " M p t so yeu to anh huong d & i k S qua dieu tn SOI th^n co kich thuoc 2 0 - 5 0 mm bang may tan soi ngoai CO the MZ - ESWL VI ", V hoc thiK hrnth, 503 (2), p 2 0 - 23
Muslumanoglu AY, Tefekh AH (2006), " Efficacy- of ES\\L for ureteric stones m childr^i ". Iiil Un^ Nephrd. 38 (2), pp. 225 - 9.
Nguyen Thi Thuan (2004), " Danh gia ket qua tan soi ngoai co the' dieu tri soi fli|n - del nieu b i n g may MZ - ESWL - VI tid b?rfi vi^n E".Yhoc IhiK hanh, 491, pp JOG - 510 Nguyen Van Tii D u n ^ Tiuong Hoang M n h va CS (20131 "
Nh^n xet kei qua dieu tri s ^ than b^ng phuong phap tan soi ngoai CO file t?i b?nh vien Nhan Dan 115', YhgcThucHank.
N g u y a i Viet C u o n g Vii Le Qiuyen, N guyen TiOT D?, Le Van H i ^ Nhan (2DDS), "Nhan xet k S qua dieu tri sc^ ni#u quan doan lung b i n g phuong phap tan scd ngoai co the tai b ^ i h v:en binh dan", Y Hoc TP. Ho Chi MaiK 12 ( U p. 330 - 335 Tran Van Quoc, Tran Ngpc S n h (2009), "cac y « i ^ anh huong kei qua tan sen ngoai co the tiong dieu tri sts cue duoi thiin", I J I ^ !>dn fhdir SI y hoc
Wing Saig Leong et al (2000)," In - sihi Extracoiporeal Shock Wave lithotrips}' (ESWL) - the treatment of choice for ureteric caleuh ", IJie fifth Asian congress on Urology, Bapng, china, pp.137-138.
t^gay nhan bai bdo:
Ngd\/ phdn bien nhan xet bai bdo:
Ngdy bai bao duac dang:
08/5/2014 15/5/2014 10/7/2014
Chuyen De Than Ni^u
