Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
TAI UEU THAM K H A O .
[. Vu Nguyen Khai Ca (2001), Chdn dodn vd dieu tri phdu thuat chdn thirang than, Luan van thac sy y hoc, Dai hoc Y Ha Npi.
I. Hammer.CCSantucci.RA (2003), "Kffect of an institutional policy of nonoperativc treatment of grade 1 to IV renal injuries", J.Urol, 169(5), pp. 1751-3
3. Mazeman E.Debeugny P, Biserte J (1984),
"Les traumatismes fermes du rein a propos de 225 observations ", Ann Urol, pp. 517-526.
MargenthalenJA, Weber.TR, Keller.MS (2002), "Nonoperativc management of blunt renal trauma: A prospective study", American Surgeon, 68(12), pp.1097-1103.
Mansi IM, Alkhiidair W (2009),
"Conservative management with percutaneous intervention of major blunt renal injuries" The American .Journal of Emergency Medicine, Vol 15(7), pp. 633-637..
NHAN XET 2 TRl/ONG HOP THAN MAT CHLfC NANG DIEU TRI
• • • •
BANG CAT THAN NOI SOI TAI BENH VIEN VIET TIEP
• • • • • • •
Nguyen Cong Binh''
TOM TAT
Muc tieu: Nhan xet bUdc dau cat than qua npi soi than mat chirc nang. Phu'dng phap: Tir 2 nam
•2009 den 2 nam 2010. 2 benh nhan co 1 than bi mat chirc nang do benh ly than dUOc cat than no! soi tai Benh vien Viet Tiep Hai Phong. 2 benh nhan niJ": 1 tru'dng hdp than mat chirc nang do soi than, 1 tru'dng hdp than mat chirc nang do hep khiic no! be than nieu quan. Ket qua: Ca hai tru'dng hdp dUdc cat than qua npi soi thanh cong; thdi gian mo: 115 phut va 129 phut, lu'dng mau mat: 120 ml va 90 ml; lu'u thong tieu hoa phuc hoi sau mo 35 gid va 38 gid; ngay nam vien 10 ngay va 7 ngay. Ket luan: phau thuat noi soi cat than an toan, hieu qua cho benh ly than mat chiTc nang lanh tfnh.
ABSTRACT
EVALUATE THE RESULTS 2 PATIENTS OF ' UPAROSCOPIC NEPHRECTOMY FOR NON-
FUNCnONING KIDNEY DISEASES AT HOSPITAL VIET TIEP
^ Benh vien Hiru Nshi Viet Tiep Hdi Phdng
Background: to evaluate the initial results of laparoscopic nephrectomy for non-functioning kidney diseases. Methods: Between Feb 2009 and Feb 2010, the laparoscopic nephrectomy for non-functioning kidney diseases has been performed in 2 patients in Viet Tiep hospital Hai Phong. Age 62 and 57, 2 females. Unilateral non-functioning kidney due to renal calculi: 1, stricture of ureteropelvic junction: 1.
Results: The laparoscopic nephrectomy was successful in 2 patients; surgical time was 115 min and
129 min, blood lost was 120 ml and 90; postoperative bowel circulation was 35 hour and 38 hour; average hospital stay was 10 days and 7 days. Conclusions:
The laparoscopic nephrectomy is a safe and effective aproach for benign non-functioning kidney diseases.
I. OAT V A N o f
Phau thuat ngi soi trong chuyen nganh
t\ht nieu da dugc ung dung tir dSu nhijng nam90. Cho dhn nay, ciing vai su tiln bg cua cac
nganh khoa hgc, dac biet la kha nang tilu
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HOI NGHI KHOA HOC BENH VI^N HLfU NGHI VIET TI^P HAI PHONG LAN THLf 37
hinh hoa cac dung cu ngi soi. Phau thuat ngi soi trong chuyen nganh tiet nieu ngay cang phat trien nhanh chong bai nhung uu diC'iii ciia phuang phap nay, nhu: it xam hai, it gay pha hiiy to chirc, nga>' nam vien ngan...va hi mgt phuang phap diim tri hieu qua doi vai nhieu loai benh ly cua he tiet nieu noi rieng
\a cac chuyen nganh khac noi chung. Truac da>. de loai bo mgt than bi mat chirc nang, cac phau thuat \ ien thuang phai su dung mgt duong mo a \ iing that lung, cat qua nhicu to chirc. Benh nhan dau nhieu, ngay nam vign keo dai. Nhung den nam 1991, dayman da ung dung phuang phap ngi soi dc cat mgt than mat chuc nang.. Ca mo thanh cong, benh nhan da dau ban, thai gian nam vien ngan ban.
Tai Viet Nam, cQng da co mgt so trung tam img dung phuang phap nay de cat than mat chuc nang nhu Benh vien Binh Dan, Viet Due, benh vien Trung uang Hue. Trong thai gian tir 2009 den 2010, chung toi da ung dung phuang phap ngi soi sau phiic mac de dieu tn cho hai benh nhan co than bi mat chuc nang. Doi vai benh nhan, phuang phap nay thuc su hieu qua vi co nhieu uu diem.
Nhung, vai phau thuat vien mai \hn dhu irng dung phuang phap nay con co mgt so kho khan do kha nang thao tac vai dung cu ngi soi ban che. Vi vay, chiing toi thuc hien dh tai nay vai muc dich:
Nhan xet mgt so kinh nghiem vd kit qud cua phuang phdp ngi soi cdt than mat chirc ndng.
II. 061TU9NG VA PHUONG P H A P NGHIEN COU
2.1. Doi tiroTig nghien cii-u:
Tir thang 2/2009 dhn thang 2/2010. 2 benh nhan than mk chuc nang mgt ben do benh ly lanh tinh dugc thuc hien cat than noi
soi tai khoa tiet nieu benh vien Viet Tiep Hai Phong.
2.2. Phu'crng phap nghien cihi:
2.2.1. Chi dinh phau thuat: Nhirng benh nhan co than bi mat chirc nang lanh tinh nhir;
mat chirc nang do hep cho noi be than- nieu quan, cao huyet ap do than teo, than mk chirc nang do soi.
2.2.2. Chong chi dinh cho nhimg truong hgp da co can thiep ngoai khoa vao 6 bung, dang CO nhiem khuan.
2.2.3. Ca hai benh nhan deu dugc lam cac xct nghiem ca ban, sieu am he tiet nieu, chup than thuoc, chup cat lop he tiet nieu, lam xa hinh danh gia chirc nang than.
2.2.4. Phuang phap phau thuat:
Rach da canh ron mgt duong 2 cm.
Tach to chirc duoi da, can, mo phiic mac. Dat 1 Trocar 10 \ao khoang phuc mac. Qua trocar nay, bom khi CO2 vao trong a bung, Tiep theo dat tiep 1 trocar 5 \a 1 trocar 10 vao trong 6 bung ILI\ theo than can cat d ben phai hay trai ma dat \i tri troca phii hgp.
Dua camera vao qua trocar 10 de quan sat, danh gia tinh trang 6 bung. Boc tach ha mac told dc di vao khoang sau phiic mac.
Boc tach lop mo quanh than. Tim va tach nieu quan ra khoi lop mo quanh than, kep cat nieu quan, khau bugc dau duoi nieu quan.
Boc tach dan len tren giai phong cuong than, bgc 16 ro tinh mach \ a dgng mach than. Vi khong CO dung cu kep cuong than (hemolock), chiing toi mo rong 1 lo troca, luon chi vicryl 1/0 quanh cuong than buoc.
cat than, cho than vao tiii nilon va dua ra ngoai qua 16 mo trocar 10 mo rong hiit va lau sach h6 than. Dan luu h6 than. Lam xep 6 bung. Khau lai cac 16 dat trocar.
Cac benh nhan deu dugc ghi chep ti nil tren h6 so, benh an: chan doan, xet nghiem, thoi gian mo, thoi gian bom khi CO2 vao
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Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
tioang phuc mac, lugng mau mk, thoi gian Thu6c giam dau sau m6: 1 ong p nhu dgng ruot tro lai, thai gian hau phau, Vontaren. Thoi gian nhu dgng ruot tro lai: 35 5 ngay dimg thu6c giam dau sau m6... gio. Riit dan luu sau 48 gia. Thai gian nam
vien: 10 ngay.
I. KET QUA Benh dn 2:
3.1. Dac diem lam sang: So trocar su' dung: 4. Ap lire bom khi Benh dn 1: nu, 57 tuoi. Trieu chimg dau CO: \ao khoang phuc mac 12 mmHg. Thai ung that lung ben phai nhilu nam. gian phau thuat: 129 phiit, lugng mau mat:
N6ng do creatinine: 105 |imol/l. Sieu am 90 ml
hat hien thay co soi a than phai. kich thuoc Thu6c giam dau sau mo: 1 ong ian 2,5 cm x 7,2 cm. nhu m6 than 0,6 cm. Vontaren. Thoi gian nhu dgng ruot tro lai: 38
Chup than thu6c: ben trai tilt thuoc binh gia- Rut dan luu sau 48 gio. Thai gian nam tiuong, ben phai khong tilt thuoc sau 120 vien: 7 ngay
ihut.
CT Scanner: than trai binh thuong, than IV. BAN LUAN
ihai ngam thuoc kem. Cat than qua ngi soi dugc chi dinh cho Xa hinh than: chiic nang than phai duai 7,5%. nhirng truong hgp than mat chirc nang. Co Chan doan: Than mat chuc nang do soi nhieu phuang phap chgn lira de tiep can than, han Duong vao khoang sau phiic mac c6 thuan
Benh dn 2: nii, 62 tu6i. Trieu chung dau lgi vao true tiep than, thai gian giai phong oing that lung ben phai nhilu nam. than nhanh. Kh6ng co nguy co t6n thuang N6ng do creatinine: 102 pmol/1. Sieu am cac tang trong 6 bung. Tuy nhien, do phau
;6 li nuoc 6 bl than phai, kich thuoc than truong hep, dac biet voi nhimg than li nuac, 10,3 cm X 15,1 cm, nhu m6 than 0,4 cm. cang lam cho khoang sau phiic mac hep hon,
Chup than thuoc: ben trai tilt thu6c binh vi vay, kha nang thao tac cac dung cu ngi soi huong, ben phai bai tilt rk cham, thu6c kho khan, anh sang thuomg ban chi do cac diong xu6ng dugc nieu quan. dung cu che khuat, kh6 khan dac biet cho cac
Ct-scaner: than trai binh thuong. Than phau thuat vien moi thuc hien lin dhu, chua )hai la mgt tui nuoc, nieu quan kh6ng co co nhilu kinh nghiem. Ngugc lai, duong vao lUoc tilu qtia 6 bung c6 diem thuan lgi, do la khoang
Xa hinh than: chirc nang than phai duoi tu nhien c6 sEn, vi vay, kh6ng phai tao
; 2%. khoang nhu duong vao sau phiic mac. Phdu Chhn dom: Than mk chiirc nang do hep truong rong rai hon, viec thuc hien cac thao
;ho nli bl than-nieu quan. tac tren dung cu ngi soi thuan tien hon. Tuy 3.2. Ket qua phau thuat: nhien cdn than trgng vi de bi ton thuang cac Benh dnh tang trong 6 bung.
S6 trocar sir dung: 4. Ap lire bom khi Chiing toi thuc hien phau thuat cat than
"O2 vao khoang phiic mac 12 mmHg. Thoi qua ngi soi cung nhu tat ca cac tac gia khac.
;ian phiu thuat: 115 phiit, lugng mau mk: Do khong co hemolock chung t6i phai khau 20 ml bugc dgng mach va tinh mach than bang chi vicryl qua ch6 mo rong lo troca 10. Trong hai
241
HOI NGHI KHOA HOC B^NH VlgN HUfU NGHI VI^T Tlfep HAI PHONG LAN THLf 37 truong hgp, kh6ng co truang hgp nao bi chiiy
mau do bugc dgng, tinh mach than khong chat. Qua cho mo rgng 16 troca 10 lay than ra ngoai. Lugng mau mat trong m6 ciia hai truang hgp la kh6ng dang ke: Truang hgp dau tien mat 120 ml mau \i\ truang hgp thir hai mat 90 ml mau trong khi mo. I rong hai truong hgp, chiing toi thay, vice phau tich
\'ao than co soi lau nay kho khan hon vi dinh.
Qua trinh dieu tri hau phau ca hai truong hgp deu thuan lgi, thai gian phuc h6i luu th6ng ruot ngan 35 gia va 38 gio. Tinh trang dau sau mo it, cii hai trucrng hgp chi phai sir dung thu6c giam dau ngay trong ngay dau tien sau m6.
V. KET LUAN
Phau thuat ngi soi 6 bung trong chuyen nganh tiet nieu ngay cang tro len ph6 bien.
Qua 2 truong hgp ung dung phau thuat ngi soi cat than mat chuc nang tai benh vien Viet Tiep Hai Phong. Chiing t6i nhan thay day la loai phau thuat it xam hai, an toan va hieu qua cho benh nhan mac benh ly than mat chuc nang. Phau thuat ngi soi co the thay the dugc cho phiu thuat mor co dien de dieu tri mgt so truong hgp than mat chirc nang.
TAI UEU THAM K H A O .
1. Nguyen Phiic Cam Hoang, Vfi Chuyen (2006). Cat than ngi soi ; phiic mac trong than mat chuc nang bgnh ly lanh tinh: Kinh nghiem band qua 24 truong hgp. Tap chi Y hoc V Nam, tap 319, thang 2/2006.
2. dayman RV, Kavoussi LR, Soper ^ Dierks SM, Meretyk S, Darcy MD al. Laparoscopic nephrectomy: init case report. J Urol 1991;146:278-82.
3. Doublet .ID (2000). Nephrecton lomboscopiquc. Encyclopedic Medic Chirurgicale (Editions Scientifiques Medicales Else\ier SAS, Paris, to droits reserves). Techniques chirurgical
Urologie, 41 -036-B, 2000, 6 p.
4. Ramsay L. Kuo et al (200:
Laparoscopic Simple Nephrectom Transperitoneal and Retroperitone Approaches, Essential Urolog Laparoscopy, Humana Press Inc. Totow New Jcrse\.
5 Rassweiler J, Fornara P, Weber U Laparoscopic nephrectomy: Tl experience of the laparoscopy group the German Urologie Association. In: J(
Urol (1998). Vol. 160 pp. 18-21
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