.MAM Tiii'./ ''., Y HOC VIET NAM THANG 11 - SO 2/2010
KET QUA DIEU TRj SOI NIEU QUAN 1/3 DlTOTI BANG Kl THUAT NOI SOI TAN SOI NGiraC DONG TljrT2/2008 DEN 4/2010 TAI BENH VIEN VIET TIEP HAI PHONG
s l i : • Le Quang Hung*, Nguyen Cong Binh*, Biii Van Chien*,
; Pf; Nguyen Manh Thing**, Pham Thanh Hai**.
ABTRACT:
Background: The retrospective study was performed on 68 patients who had lower ureteral stones that were treated by lithoclast from December 2008 to April 2010 at Viet Tiep Hospital.
Method: Retrospective study
Results: The stones were completely removed In 59 patients (86,76%), the failure rate is 13,24 % of cases.
Mean hospitalization time was 5 ± 5,1 days The migration of stone into the kidney 7,35 % Ureteral injuries 1,47%
JJ stents were placed in 45,59%
Conclusions: The lithoclast was the treatment of choice for lower ureteral stones at Viet Tiep hospital. : ^ ,
I. OATVANOE
Soi tiet nieu la benh Iy kha phi biln trong dan so. Ty le mac benh soi giao dgng tir 2 - 20% dan si, thay dii tuy theo tung viing va hay tai phat. Soi nieu quan la benh Iy thucmg gap nhit o he tilt neu va nguai Ion tuoi, tuy nhien co thi gap a tre em. Ti le mic soi nieu quan chilm 25-40% trong ting s i benh soi nieu [5]. Trong d6 soi nieu quan 1/3 duoi chiem 70- 75 % cac benh soi nieu quan.
Ngi soi nieu quan dugc Hugh Hampton Young Iam lin diu tien vao nam 1912 [15].
Ben nam 1977 ngi soi nieu quan bang Ing soi Cling dugc Goodman thuc hien [4]. 1989
* B^nft vi$n Vi$t Tiep Hdi Phdng
din 1993 Huffman va Abdel-Razzak nghien ciiu va cai tien dua ra he thing may soi voi 1 hoac 2 kenh Iam viec dugc sii dung cho din nay [6].
Ngay nay voi nhung thanh tuu vugt bac trong cac ITnh vuc: chan doan hinh anh, cong nghe va trang thiet bi ngi soi, dung cu pha soi... mgt loat cac phuang phap dilu tri soi than khong sang chan hoac it sang chin da ra doi va ngay cang hoan thien Iam xu hudng dieu tri can thiep soi nieu quan co sir thay dii dang ke.
Tir nhiing nam 80 chu ylu la m l mo thi ngay nay dieu tri soi nieu quan chii ylu bing cac phuang phap it sang chin bao gIm: Tan soi ngoai co the, liy soi bing phiu thuat ngi soi trong hoac sau phiic mac, tan soi qua ngi soi nieu quan ngugc dong (Retrograde transureteral nephrolithotripsy -URS), tu do mo lay soi chiem mgt vi tri nho va it dugc chi dinh trong can thiep soi nieu quan.
Culi nam 2008 Benh vien Viet Tiep Hai Phong CO du dieu kien trien khai ky thuat ngi soi tan soi nieu quan ngugc dong bang xung hoi vai may tan soi co 1 kenh lam viec, cho den nay chiing toi ciing da dat dugc nhirng ket qua dang ke. De gop phan phuc vu nguoi benh tot ban va co chi dinh chinh xac mang lai hieu qua cao trong dilu tri, chiing toi tiln hanh dl tai: "Nghiin cuu kit qud dieu tri giai dogn s&m binh sdi nieu qudn dogn
HOI NGHj KHOA HOC LAN THtf IV • HOI TIET NIEU - THAN HQC VIET NAM
thdp bdng ki thudt npi soi tdn sdi nguac dong sir dung xung hai tgi binh viin Viet Tiip - Hdi Phong tir 12/2008 din 4/2010"
nham muc dich: '< ' ^ ••••'• .'''.\ ' ' » ' ' ^ ' 1. Danh gia ket qua dieu tri giai doan
sam benh soi nieu quan doan thap bang ky thuat ngi soi tan soi ngugc dong sii dung xung hoi.
2. Phat hien mgt so tai bien, bien chiing cua ky thuat, each phong ngira va xu tri tai bien.
II. o6l TUdNG VA PHUONG PHAP NGHIEN CUU 1. Doi tugng: Gom 68 truang hgp soi nieu quan 1/3 giiia va 1/3 duai dugc chi dinh
tan soi ngi soi ngugc dong tai BV Viet Tiep - \ HP tu 12/2008 din 4/2010.
2. Phuong phap nghien curu
S" Nhirng benh nhan co soi nieu quan dugc i chi dinh tan soi ngugc dong, kich thuoc soi \
<15mm
Cac xet nghiem chan doan hinh anh: sieu i am he tiet nieu, XQ he tiet nieu khong chuin \ bivaUIV...
Dung cu: dung may ngi soi nieu quan mgt kenh kich thuac 9,5 Fr, Camera, nguin sang, day dan (Guide wire ), rg cap soi, kim gap soi, dau tan gan vai bg phan tao xung j
hai, Stent JJ. <
III. KET QUA NGHIEN CQU 1. Dac diem lam sang:
Bang : Tuoi va giai tinh
'( :»,r<'i' iiC":
Gidi Nam Nu- Tong
So trUdng hdp (n) 30
38 68
Ty le o/o 44,11 55,89 100
X (tuoi) 50,13 ± 15,545 50,74 ± 15,337 50,46± 15,407
Tuoi trung binh 50,46±15,407 tuoi, Ion nhat la 81, nho nhat: 17 tuoi.
2. Vi tri soi:
Vj tri soi Soi 1/3 giO'a Soi 1/3 dudi
Tong
SolUdng
9 59 68
Ti le o/o 15,25 84,75 100
Mau nghien ciiu ciia chiing toi co da so soi nieu quan 1/3 duai chiem ti le 84,75% tuong i duong vai nghien cuu ciia Nguyen Thanh Diic va Do Trung Nam ve vi tri soi [3].
3. Ket qua dieu tri: , ; : , , , , r _•
Ket qua So lUOng
Ti le %
Tot 19 27,94
Kha 40 58,82
That bai 9 13,24
Y HOC VIET NAM THANG 11 -562/2010
IV. BAN LUAN
1. Thoi gian hau phau :
Qua nghien ciiu chiing toi thiy thai gian dieu tri nhanh nhat la 2 ngay, lau nhat la 10 ngay. Trung binh la 5 ± 5,1 ngay, benh nhan ra vien sau 5 ngay. Thai gian nam vien ciia chiing toi con dai ban so vai ket qua nghien ciiu ciia Chau Quy Thuan va Tran Nggc sinh la 3,35 [11]. Vi co so mai trien khai thuc hien kT thuat nen can thai gian de theo doi cac tai bien, bien chiing va cham soc benh nhan. :;-y d:';u.;ft '&'^gT!tn io.%- iS-'-v ^::K
2. Tai bien va bien chung :
Dat nong nieu quan sau tan soi (dat stent JJ) de xu tri ton thuang niem mac nieu quan.
Chiing toi tien hanh dat stent JJ sau tan soi cho 31 benb nhan chiem ti Ie 45,59 %>
thap hon nghien ciin cua Chau Quy Thuan va Trin Nggc Sinh 92,5% [11], 85,7 % Nguyin Thanh Diic va Do Trung Nam [3].
Nghien ciiu cua chiing toi cho thay bien chiing ton thuong niem mac nieu quan chilm ti Ie cao nhat (47,05 %) chii yeu la a miic do nhe, nhiim khuan nieu (8,82%), soi len than (7,35%), chay mau (2,94%)), cac biln chung ton thuong nieu quan nang it gap (thung nieu quan: 1,47 %, diit nieu quan: 0%). Kit qua nghien ciiu cua chiing toi phu hgp vai nghien ciiu ciia cac tac gia khac.
Diit nieu quan 0.5 % Weinberg J J, Ansong K, smith AD [14]. Nguyen nhan thudng do co gap manh soi qua Ian bang rg dormia (rg lay soi). Trong nghien ciiu cua chiing toi chua gap truong hgp nao.
Bien chiing thiing nieu quan co ti le thay doi theo tung tac gia tir 2-17%) Trong nghien ciiu ciia chiing toi co 1/68 truang hgp (1,47%) thung nieu quan phai m l ma
Long nieu quan say ra khi nieu quan co U hoac polyp nieu quan tien phat hoac co hep nieu quan do can thiep nieu quan tir truac.
Chiing toi khong gap truang hgp nao co tai bien long nieu quan. . ^ ..::•.,.
Chay mau: do chan thuang nieu quan trong qua trinh ngi soi chiem 0,5% theo Sosa RE , Bagley DH , Huffman JL [9]. Chiing toi gap 2/68 benh nhan (2,94 % ) co biln chiing chay mau chi a miic do nhe, bet dai mau sau
2 ngay. .' •• •
Nhiem trung nieu thii phat sau soi chiem 1,3 % Sosa RE , Bagley DH Huffman JL [9].
Nghien ciiu cua chiing toi co 6/68 benh nhan (8,82 %) CO bien chiing nhiem khuan nieu (sot keo dai, cay nuac tieu co vi khuan mgc) cao ban nghien ciiu cua cac tac gia khac vai sot la 1,97% Duong Van Trung, Nguyen Van Oai, Le Nggc Tir, Nguyen Bim Trilu [13] ; sot 4,8% Vii Le Chuyen, VQ Van Ty, Nguyen Minh Quang, Do Anh Toan [2].
Ton thuang niem mac nieu quan gay chay mau, hep nieu quan sau nay la mgt bien chiing hay gap, khac phuc bang dat stent jj, catheter nieu quan Bejamin JC , Donaldson PJ , Hill JT [1]. Chiing toi gap 30/68 benh nhan (44,11 %) bi ton thuang niem mac nieu quan nieu quan. ,
Trong qua trinh tan, soi co the di chuyen len doan nieu quan phia tren hoac len than.
Xu tri: chuyen mo ma hoac mo ngi soi sau phiic mac. Chiing toi gap 5 truang hgp soi di chuyen len than (7,35 %>) ti le con kha cao so vai nghien ciiu ciia cac tac gia khac. Do may tan soi chi co mgt kenh lam viec nen viec co dinh soi de tan nhat la trong nhimg truong hgp nieu quan gian se gap nhieu kho khan.
Soi c6 the chui ra khoi nieu quan khi
HOI NGHI KHOA HOC LAN THtf IV • HQI TIET NIEU - THAN HOC VIET NAM
phiic mac vai ti Ie 0,5 - 2,3 % trong tong so cac truang hgp dugc ngi soi tan soi nieu quan [10]. Chiing toi khong gap truang hgp nao soi chui ra khoi nieu quan khi thung hoac
dut nieu quan. '•
Hoai tu nieu quan do ton thuang mat niem mac lan hoac do chan thuang nieu quan nang va tren dien rgng [7]. Nghien ciin cua chiing toi chua gap truang hgp nao hoai tii nieu quan.
Hep nieu quan chilm 0 - 35%) thay doi tiiy theo cac nghien ciiu do ngi soi ngugc dong liy soi ra hoac do dat stents ti de len nieu quan gay thieu mau cue bg va gay hep [3]. Nghien ciiu cua chiing toi co 2/68 benh nhan sau tan co hep nieu quan (2,94 %)
Kit qua dilu tri ciia chiing toi co 86,76%) ting s i benh nhan .dugc tan het soi, thap hon so voi 95,4%) Nguyen Thanh Diic, Do Trung Nam & cs [3] co thi do chua co nhieu kinh nghiem trong giai doan dau trien khai ky thuat cung voi may tan soi chi co 1 kenh lam viec nen hieu qua chua dugc nhu mong muon.
V. KET LUAN
Qua 68 benh nhan dugc tan soi ngi soi bang xung hoi voi may tan soi co 1 kenh lam viec tai BV Viet Tiep tu 12/2008 - 4/2010 chiing toi riit ra cac ket luan sau :
Voi soi nieu quan 1/3 duoi thi ngi soi ngugc dong tan soi bang xung hoi la phuang phap dugc uu tien lira chgn. Kit qua nghien ciiu cua chiing toi co ti Ie thanh cong la 86,76%, ti le thit bai la 13,24%.
Cac tai biln da gap voi ti Ie thip: soi len than 7,35%, thiing nieu quan 7,47%), hep nieu quan sau tan soi 2,94%o, chay mau 2,94%o.
Biln chiing t i n thuang niem mac nieu i quan co ti Ie cao (44,11%) nhung chi cin xu ] tri bing each dat stent JJ nieu quan va nit j
som trong vong mgt tuan. j Khong gap cac bien chiing diit nieu !
quan, long nieu quan, chay mau nang. | Qua ket qua nghien ciru chiing toi nhan
thay ngi soi tan soi ngugc dong bang xung hoi dieu tri soi nieu quan doan 1/3 dudi la phuang phap dieu tri co hieu qua cao, an toan, it tai bien, tiet kiem kinh phi, vi vay co the trien khai rgng rai hon a cac benh vien tuyen tinh. -^mm^ u-.'^-^ te
TAI U E U THAM K H A O \
1. Bejamin JC, Donaldson PJ , Hill JT. j Ureteric perforation after i ureteroscopy.Conservatrice management.
Urology 29: 623-624, 1987. j 2. Vu Le Chuyen, Vu Van Ty, Nguyin Minh
Quang, Do Anh Toan. Noi soi ngugc dong tan soi bing xung hai soi nieu quan doan lung: Kit qua tir 49 truong hgp soi nieu quan doan lung dugc tan soi noi soi ngugc dong tai khoa nieu benh vien Binh Dan. YHgc Vi?t Nam, tap 319, 2/2006, 254-261.
3. Nguyen Thanh Due, Do Trung Nam & cs.
Kit qua tan soi nieu quan bang xung hai qua npi soi tai benh vien 175, YHoc TP. Ho Chi Minh * Tap 12 * Phu bdn cua Sd 4, 2008.
4. Goodman TM. Ureteroscopy with pediatric cystoscope in dull. Urology 9:394, 1977) \ 5. Ngo Gia Hy - Nieu Hoc. Tap V- phdu thuat
nieu qudn. Tr 56-57.
6. Huffman JL. Experience the 8,5 French compact rigid ureteroscope. Semin Urol 7:3,
1989 1
Y HOC VIET NAM THANG 11 - SO 2/2010
7. Lytton B, Weiss RM, Green DF, complication of ureteral endoscopy, Urol 137: 649-653, 1987.
8. Park J, Siegel C, Moll M, Konnak J.
Retrograde ureteral intussusception, J Uro 151: 997-998, 1994 '•,
9. Sosa RE , Bagley DH , Huffman JL.
Complication of ureteroscopy. Philadenphia:
WB Saunders, 1988 pp 159-168
10. Stackl W, Marberger M. Late complications of the management of ureteral calculi with the uretenorenoscope J Urol 136: 386-389. 1986.
11. Chau Quy Thuan, Tran Ngoc Sinh. Ket qua tan soi nieu quan noi soi bang may tan xung hai tai benh vien Chg Ray. Y Hoc TP.
Hd Chi Minh, Tap 9, phu bdn cua sd 1, tr:
83-86,2005. :. - - r . -; > O /
12. Du-cng Van Trung, Le Ngoc Tir, Nguyen Biru Trieu. Ket qua tan soi nieu quan noi soi ngugc dong cho 1519 benh nhan tai benh vien Buu Dien Ha Noi. Y Hoc thuc hdnh, 2004, 141 :497-500
13. Duong Van Trung, Nguyen Van Oai, Le Ngoc Tir, Nguyen Biru Trieu. Mgt vai nhan xet qua 1014 benh nhan tan soi noi soi tai benh vifn Buu Dien. Y Hoc thuc hdnh sd 2 /2003. 26-28
14. Weinberg JJ, Ansong K, Smith AD . Complication of ureteroroscopy in relation to experience : Report of survey and author experience. J Urol 137: 384-385, 1987.
15. Young HH, Mc Kay RW. Congenital valvular obstruction of the prostatic urethra.
Urg Gynecol obstet 48 :509 1929.
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