OI^M K^T THAI (2006-2010)

TAP CHl NGHIEN CiW Y HQC

uterine leiomypmas J Reprod Med, 48 (10). myomectomy Przegi Lek. 61 (2), 65-69 792 - 779, , . s e i n e r a , P., A r i s i o , R., Decko, A et a

5. Ferrari M.M., Berlanda N., IMezzopane (.jgg^j Laparoscopic myomectomy indications et al (2000). identifying the indications fpr g^^^gj^g, technique and compiicatipns. Hum laparoscopycaily assisted vaginal hysterec- Rgpprt 12 1 9 2 7 - 1 9 3 0

tpmy. a prpspective, randpmized comparison

«-ith abdominal hysterectomy in patients with 8. Sinha R, Hegde A, Mahajan C, Dube) symtomalic uterine fibrpids Br J Obstet Gune- N, S u n d a r a m M (2008). Laparpscopic myo col 107 620 - 625 mectomy do size, number, and location of the 6. Jedrzejczak P, Pawelezyk L, Grewling myomas form limiting factors for iaparoscopk K, et al (2004). Ability to conceive and the myomectomy J Minim Invasive Gynecol, IS course of pregnancy in women after laparoscopic (3), 292 - 300

Summary

LAPAROSCOPIC MYOMECTOMY AT THE NATIONAL HOSPITAL FOR OBSTETRIC AND GYNECOLOGY IN

FIVE YEARS (2006-2010)

The retrospective study described 281 patients of laparoscopic myomectomy in 5 years (2006-2010) in the National Hospital for Obstetric and Gynecology shows the success rate was 73 7%, pregnancy rate to 55.76% of the patients expected The average surgical time 75 ± 36 minutes And depending on size, location and weight of uterine fibroids On the average 2 54 ± 1-21 days after surgery 83 6% of patients in hospital no more than 3 days

Key w o r k s : laparoscopic m y o m e c t o m y

M O I LIEN QUAN GILPA CHU'C NANG THAN C O A THAI PHU VA THO'I OI^M K^T THUC THAI NGHEN

D d Gia Tuy^n Trudng Dgi hgc Y Hd Alpi Chuc ndng thdn cua thai phg vd tinh trgng thai nghdn cd moi lidn quan mgt thiet vdi nhau. chuc nang thgn cua mg cung dnh hudng tdi dien biin cua thai nhi cu thi Id thai diim dinh chi thai nghen. Nghidn cuv nham ddnh gia chdc ndng thgn d bdnh nhdn cd thai diiu trj tgi khoa Thdn -Tiit nidu bdnh vign Bgcti Wai w tim hiiu mii lien quan giua chuc ndng thdn cua thai phu va thdn aim kit thuc thai nghdn. Kit qud cho ttiay ty Ig suy thdn cua thai phg Id 23,4%. Ty Id smh tnidc 38 tuin) chiim 80,2%, ty Id tre sing Id 70%. Tmng nhdm tre sdng cdn ndng tmng binh Id 2111 4 ± 761.1 (g). Cd mdi tuang quan tuyen tinh nghich giua ctii^

nang than cOa mg vd thdi diim dinh cht thai ngiidn (p < 0.05). Kit ludn Mg suy thgn cang ngng ttidi d/lf"

phai dinh chi thai nghen cdng sdm.

Tu- khoa: chu-c nang t h | n , thai ngh^n

78 TCNCYH 79 (2) - 2012

1. OAT

V A N

Dt

N h i l u nghidn euu trdn t h i gidi cho t h i y s u suy giam chQ-c ndng th^n dd Idm giam mdt cdch ddng ke c a hbi cb thai, SM" phdt t r i l n bInh thudng ciia thai nhi vd s u thdnh cbng cQa qud trlnh thai nghdn [5] Khbng nhu-ng t h i , khi eb thai s u thay ddi v l giai phdu, sinh ly k h i l n bb phdn Thdn - T i l t nidu cd t h i x u l t hidn bdnh ly hode Idm n$ng hon cdc bdnh ly dd cb s i n [6].

Trong nhung ndm gan ddy ty Id bdnh nhdn mang thai m l c cdc bdnh v l th$n tdng Idn mdt cdch ddng k l . Trong db sd bdnh nhdn cb suy thdn cQng tdng f6n. Theo s y tham khdo eua ChQng tdi hi§n tgi ed rat ft nghidn edu v l v l n de ndy. Chinh vi v^y, nghidn cQ'u ndy d u a c t i l n hdnh n h l m : "Nghidn cu'u mdi lidn quan giu-a chdc ndng thdn cua thai phy vd thdi diem k i t thQc thai nghdn" vdi muc tieu:

1. Ddnh gid chQ'c nang thdn d bdnh nhdn cd thai d i l u tri tai khoa Thdn - T i l t ni$u bSnh vien Bach Mai

2. Tim hieu mdi lidn quan giQ-a chQc ndng thdn cua thai phu va thdi gian ket thQc thai nghdn.

III. K i T QUA

TAP CHi NGHIEN CO'U Y HQC

II. D6\ TU'P'NG VA PHU-ONG PHAP

1. Ddi typ'ng

64 bdnh nhdn cb thai vd dudc c h i n dodn xde dinh cb bdnh th^n - t i l t nidu, dua vdo tidu c h u i n c h i n dodn eua tdng bdnh vd n l m d i l u trj ndi tru tgi khoa Th§n - T i l t n i | u bdnh vi$n Bgch Mai. B$nh nhdn d u a c c h i n dodn vd xdc djnh cb thai bdng cde phuang phdp ehdn dodn thai nghdn.

2. Phu'ang phdp

Phuang phdp nghidn cdu: t i l n cdu tO-ng ca Idm sdng. T i t ca nhu-ng bdnh nhdn du tidu c h u i n nghidn c u u d u o c khdm vd theo dbi theo mOt m l u bdnh dn nghidn cQ-u- ve thdi gian mang thai, ddnh gid chuc ndng thdn, theo ddi d thdl d i l m k i t thQc thai nghdn.

Cde xdt nghidm d u a c Idm tai khoa Sinh hod, Huyet hoc, cua b?nh vidn Bpch Mai trong qud trinh dieu tri tai benh vi6n.

Cdc sd lidu nghien cQ-u tren duae x u ly tren mdy vi tinh vdi phdn mem SPSS 15.0.

1. Dac d i l m tudi thai d thdi d i l m phat hi§n benh

Bang 1 . Tudi thai trung binh d t h a i d i l m phat hign benh

B§nh

Thd'i gian

So b#nh nhan (n) Tudi thai trung binh (tudn)

B$nh e l u than Bdnh thdn khdc

Nhdm nghign cii'u 27,4 ± 8,3

2. Dac d i l m k i t thuc thai ky va can nang cua tre

T/ong nghidn euu ndy cb 9 thai phy dd phai dinh chi thai nghdn trudc 38 tuan do thai luu hode tre t u vong chu sinh do vdy chi cb 41 tre cdn sdng d thdi d i l m nghidn edu ed t h i khao sdt d u o c cdn ndng luc sinh chidm ty Id 14%.

TCNCYH 79 (2) - 2012

TAP CHi N G H I S N CU'U Y HQC

Bang 2. PhSn b6 tuSn sinh vi cSn njing luc sinh cila thai nhi Tuin sinh (tuSn) CSn n^ng luc sinh (g) Tu^n ^ ^ ^

< 38 tu^n

£ 36 tu^n T6ng s6

^ S6 tri (n) 41

9 50

Trung binh 31,7 ±0,8 39,3 ±0,3

S6 Ui (n) 32

9 41

Trung binh 1675,0 ± 738,4 2766,6 ± 708.9

P

<0,06

Cdn n9ng cua tre sinh sau 38 tuin Idn han cb y nghTa thdng kd vdi cdn n^ng cua tre smh dLrt 38 tuin (p < 0,05).

3. Mdt sd chi sd c^n lam sdng chung

3.1. Kit qui m^t so chi s6 xdt nghidm sinh hda

Bang 3. Mpt sd chi sd x^t nghiem can Idm sang Dac diem chung

Ur6 mau (mmol/i) Creatinin mSu (pmpl/l) Acid uric (mmol/l) Albumin miu (g/l) Protein mau to^n ph^n (g/i) Protein nieu 24h (g/24h)

3.2. Ty li suy than cua nhom benh nhan nghien cifu

Bang 4. Ty le suy than cua nh6m benh ChtJ'c nang th^n B^nh

B$nh cau thSn B0nh than khSc B$nh c^u th^n B^nh th^n khdc T^ng sd

n 14

1 32 17

Gid trj trung binh 10.1 ±9,9 136,6 ±185,7 372,45 ± 223,51

27.9 ±6,8 59,8 ±10,4

9,0±11,1

nhan nghien cu>u

% Cong 93,3

g7 16(23,4%) 65,3

^j 49 (76.6%)

64 (100%)

''

.„

4

W!

Ty \i bSnh nhSn suy than 23.4%,nhbm b^nh ly cau than cao hon hin so v*! nhpm benh 111*

khSc (93,3% vol 6.7%).

4. Mdi lien quan giira chii'C ndng than vi thin di4m kh thiic thai nghen

Ce mpi tifong quan tuyen tinh nghich giu'a n6ng 66 ure. creatinin mdu cua me vi thdi dien dinh chi thai nghin (bieu d6 1).

80 TCNCYH 79 (2) -21

- TiflkP CHi N G H I £ N C O ' U Y H Q C

Bieu dd 1 . T u o n g quan giu>a ndng d d creatinin mdu cua me vd thdi d i l m dinh chf thai nghen

IV. BAN LUAN

D$c d i l m k i t thiic thai nghen vd can nang cua trd

Tai thdi d i l m k i t thQc nghidn c d u ed 50 thai phu dd sinh con, 14 thai phu chua d i n ngdy sinh, qud trinh mang thai d n h u n g phu nQ- ndy v l n dn dinh, tudi thai ddi n h l t Id 36 t u i n

Vdi nhung ^ a i phu dd sinh trudc 38 tuan vd cdn ndng IQc sinh eua nhO-ng tre ndy d l u dudi 2500(g). Nguydn nhdn Id do ty Id thai phu de non hode phai dinh ehi thai nghdn sdm trudc 38 tuan trong nghidn eO-u Id r l t cao (66%). K i t thQc thai ky d tuoi thai cdng nhd, cdn ndng cua tre s o sinh cdng thap. Tre non thdng, thap cdn cb nguy c a tu- vong eao han tre du thdng. Trong nghidn c u u ndy, ty Id thai chet luu vd t u vong Id 14% trong db sd tre t u vong ehu sinh d l u Id trd d u a c de non. K i t qua tren phu hp-p vdi cac nghidn eO-u trdn t h i gidi.

Nghidn cuu eua Okundaye (1998) trdn 184 thai phy m l c benh th$n dang loc mdu thay rang ty Id de non la 51,3%, ty Id t u vong chu sinh Id 2,8% cao han h i n nhdng phy nQ- khdng m l c bdnh [7]. Tuy nhidn, ty Id thai phu- phai dung cudc mang thai t r u d c 38 tuan trong

nghidn cQ-u ndy eao hon nghidn cuu cua tde gia D6 Th| Lidu (1998), d 35 bdnh nhdn nghidn cdu ty Id de non, say thai Id 17,2%, thai luu Id 17,2%. Didu dd eho t h i y sau 10 ndm ty 16 ede bien chung cho thai nhi d nhung bd me m l c benh th^n khbng h i giam xudng mdc dQ dd ed r l t nhieu t i l n bd trong vide phdt hien vd d i l u tri b&nh [1].

Met diem can chQ y Id tlnh trang edn ndng cua thai nhd han so.vdi tudi thai. Nghidn cuu eua tac gia Db Thj Lieu (1998) cho t h i y ty Id thai de 60 thdng nhung_ nho hon tudi thai Id 8,6%, cdn ndng eua nhung tre ndy chi t u 2000 - 2100(g) [1]. Dieu db dat ra edu hbi: Cb nguy CO thai kdm phdt t r i l n trong tu' cung d nhu-ng phy nQ' mdc bdnh thdn - t i l t mdu? Trong nghidn euu cua Katz (1980) ty Id tre du thdng nhung cdn n^ng nhd hon tudi thai Id 24,3%, cao hon nhieu ty Id dd d nhO-ng phy nd binh thudng [7].

Chu'C nang t h | n cua nhdm bdnh nhan nghign cQ'u.

Anh hudng cua tlnh trang thai nghdn ddi vdi benh thdn eua ngudi m? se dudC b i l u hidn bdng nhQ'ng thay doi trong h u y l t dp, urd mdu, creatinin mdu vd protein nidu. Nghidn cQ-u cua Katz (1980) thdy r i n g s u suy giam

TCNCYH 79 (2)-2012 81

JfyP CHi NGHIEN CU'U Y HQC • chu'C ndng thdn (bieu hidn blng su thay ddi ndng dd urd mdu vd/ ho$c creatinin mdu) g$p d 16% tdng sd bdnh nhdn, phln Idn trong sd ndy mdc bdnh ly clu thdn. m$c dCi trudc khi cb thai chuc ndng thdn cua hp Id binh thudng (ndng dd creatinin mdu s 1,4mg/dl) vd da sd hdi phuc sau sinh Chi cd 5 bdnh nhdn cd chuc ndng thdn suy gidm nh? vd 5 bdnh nhdn bj suy thdn giai doan cudi, xdy ra sau khi sinh vdi tudn din 8 ndm [3]. Kit qua theo bdng 3 cho thiy ndng dd urS vd creatinin mdu cua bdnh nhdn nghidn cdu dlu cao hon so vdi gidi hgn binh thudng. Ty 16 suy th^n man trong nghidn cQ-u eua ehung tbi Id 23,4%, trong db cb 4 bdnh nhdn suy thdn dd lllb trd Idn (6,2%) vd phai chay thdn nhdn tao cap cuu, chicb mdt benh nhdn trd thdnh suy thdn giai doan eudi va phdi chay thdn nhdn tao chu ky sau khi sinh Ddc bi6t ty Id suy th$n d nhung benh nhdn mdc bdnh ly elu thdn cao han nhieu nhO-ng bdnh nhdn mde bdnh ly thdn khdc (93,3% so vdi 6.7%) Khbng cb b§nh nhdn nao bi suy thdn cap Ket qua tren khdc vdi nghidn cuu cua tdc gia Do Thj Lidu (1998) [1]

Ty Id suy thdn trong nghidn cdu cho thiy cb su tdng Idn eua mdc dd suy thdn trong thdi ki cb thai so vdi tien su cua bdnh nhdn, hode xult hign tlnh trang suy thdn trdn nhu-ng bdnh nhdn chua cd tiln silr suy thdn ttr trudc, chQ ydu d nhO'ng b?nh nhdn mdc bdnh ly elu thdn. Tuy nhi6n mudn ddnh gid thai nghdn dnh hudng din tdc dd suy gidm chu'c ndng thdn trdn nhO-ng bdnh nhdn mlc bdnh thdn nhu thd ndo cdn nhO-ng nghidn cdu sdu han, Tuy nhidn van cin phai quan ly vd theo ddi ehdt che nhQ'ng phy nu' mdc bdnh th$n cb thai, ddc bidt nhung thai phy ed tiln su b$nh thdn tu trudc hode nhQ-ng thai phy mdc bdnh cau thdn de phat hidn sdm cOng nhu phbng trdnh suy thdn xult hidn hode ndng Idn trong

qud trinh mang thai [2; 5; 8].

Mdi lign quan giQ'a chipc ndng thdn cui m? vd'i thdi didm k i t thuc thai nghdn.

Khi nghign cuu v l sy- lidn quan giO-a ndnj dd urd mdu vd creatinin mdu cua nhQ'ng phi, nO- mang thai mdc bgnh thdn vdi tudi thai, ChQng tbi thiy giO-a ede d?i luang trdn cb md tuang quan tuydn tinh nghjch. Chdc ndng thdn suy gidm cdng nhidu (bilu hi$n bdng ndng dd urd vd/hodc creatinin mdu m? cdng cao) thi thdi dilm phai dinh chi thai ngh6n cdng sdm. Trong nghidn euu ndy cb mdt b$nh nhdn ed ndng dd urd mdu Id 45,5 mmol/l, b$nh nhdn ndy dinh chl thai nghdn d tuan thai thi>

25 vd thai chet Mbt bdnh nhdn khdc eb ndng dd creatinin mdu Id 1041,0 pmol/l phai phd thai d tuan thu 14 vd sau db dugc chay thjn nhdn tao ehu ky, Chdc ndng than cdng suy giam cdng Idm tdng ty Ig dtnh ehi thai nghdn cr nhO'ng tudi thai ebn rat nho, dua din mdt iogt cdc h$u qua ndng nd: Idm giam kha ndng sdng cua thai, tdng t/ ig thai chet luu, ty l^tir vong ehu smh, tdng nguy ca mlc bgnh do si>c dd khdng cua tre de non rat kdm vd ty !§ suy dinh dudng ve sau [4, 5, 8]

V. K£T LUAN

Ty Id suy thdn d thai phy eb bgnh ly thSn tidt nidu chidm 23,4% Sd tre sinh trudc 38 tudn chidm khd eao vdi 80.2%. ty Ig tre song Id 70% Trong nhbm tre sdng cdn ndng trung binh Id 2111,4 ± 761,1(g) Chuc ndng Un suy giam cdng nhilu (bilu hign bdng ndng 30 urg vd/hodc creatinin mdu m? cdng cao) ttil thdi diem phai dinh chi thai nghdn cdng sdm, (p < 0,05),

TAI LIEU THAM K H A O 1. Dd Thj Li§u, Dinh Thj Kim Dung (1998). Nhdn xet tinh hinh bdnh th^n vd thai nghdn d bgnh nhdn dup-c dieu trj tai khoa

TCNCYH 79 (2) - 2012

TAP CHi NGHIEN CO'U Y HQC

T h j n bSnh vien Bach Mai tu' 1993 - 1998.

oang trlnh n g h i i n ciru khpa hpc t j p 2 - b$nh disease. A ten- year survey. Aust NZ J Obstet ViSn Bach Mai. Nh4 xuat ban Y hcc. 42 - 47. Gyneacpl. 3, 21 - 34.

2. Hadd B, Sibai BM (1999). Chronic 6. Lindhelmer IWD, Katz Ai (1991). The hypertension in pregnancy Am J Med, kidney and hypertensipn in pregnancy The 246 - 262. Kidney, edn 4 Edited by Brenner BM. Rector FC.

3. Katz Al, Davison JM, Hayslett JP, Philadelphia WB Saunders Co, 1551 -1596.

Singson E & Lindheimer MD (1980). Preg- 7. Okundaye I, Abrinko P, Hou S (1998).

nancy in women with kidney disease. Kidney Registry of pregnancy in dialysis patients. Am international, Voi 1 8 , 1 9 2 - 2 0 6 J Kidney Dis, 3 1 , 7 6 6 - 7 7 3

4. Kincaid - Smith P, Fairley KF, Sullen 8. Philip J Steer .Mark P Little (2004).

M (1967). Kidney disease and pregnancy. Maternal biopd pressure in pregnancy, birth Medicaljpurnal of Australia, 2, 1155. weight, and perinatal mortality in first births-

5. McKay EV (1963). Pregnancy and renal prpspective study BMJ volume 329 number

Summary

RELATIONSHIP BETWEEN PREGNANT WOMEN WITH RENAL INSUFFICIENCY AND RATES OF PRETERM DELIVERY MOMENT

Renal disease during pregnancy is relatively common in department of nephrology Bachmai hospital Effect of renal disease on course pf pregnancy is unknown A retrospective analysis of 64 pregnant women was earned out in department of nephrology. Pregnant wpmen were analyzed with respect tp degree of renal impairment for the effect of renal disease on course of pregnancy, ccmplicatipns during pregnancy and perinatal putcpme. Outcome of 50 pregnancies was available during the study period 23 4 % patients with impared renal function. Obstetncal compiicatipns included a high frequency pf preterm delivery befpre 38 weeks (80.2%) Overall fetal survival rate was 70%. The mean (SD) birth weight of babies born to mothers with befere 38 weeks' gestatipn was 1675g) and there were 2766g after 38 weeks' gestatien. Mpthers with renal insufficiency have high frequency of preterm delivery In conclusion, pregnant women with renal insufficiency have increased rates of compiicaticns such as high frequency pf preterm delivery.

The birth weight pf babies being delivered by renal insufficiency mothers was lower significantly . compared with stable renal function mpthers .

Keywords; renal insufficiency, preterm delivery

TCNCYH 79 (2) - 2012