TAP CHI Y HOC VIET HAM TAP 459 - THANG 10 - SO 2 - 2017 - HFS cac mire dp chiem ty le cao d nhdm ed
tien sir dieu tri hda chat tru'dc dd.
TAI LIEU T H A M KHAO
1, Nguyin Chan Hung va Cs (2013). Xuat do ung thu' thanh gho Hp Chi Minh: ket qua tir ghi nhan ung thu" quan the 2007-2011. Tap chf ung thu" hoe Viet Nam, tap 4, 19-27.
z. Pham Nhijr Hiep, Le Loc va Cs (2006) Phau Thuat noi soi tro'ng dieu tri ung thu' dai-tri/c trang benh vien Trung u'dng Hue, Tap chi y hoc Viet Nam- so dac biet, 28-30.
3. Nguyen Chan Hung (1986) Unp thU dai trang-tJiTc trang va hau mon, Ung thU hoc lam sang, tru'dng dai hpc y du'dc Ho Chi Minh, tap 2,167-181.
4. Nguyen Quang Thai (2003), Nghien ciru ^ia tn mot so phu'dng phap chan doan va ket qua song 5
nSm sau dieu tri phau thuat ung thu" dai trang, Luan an tien sT y hoc. Hoc Vien Quan Y, Ha Noi.
. Sargent DJ, Wieand HS, Haller DG, Gray R, Benedetti JK, Buyse M, Labian R, Seitz JF, O'Callaghan O, Francini G, Grothey A, O'Connell M, Catalano PJ, Blanke CD, Kerr D, Green E, Wolmark N, Andre T, Goldberg RM, De Gramont A, (2005) Diease- free survival versus overall survival as a primary end poit for adjuvant colon cancer studies: individual patient data from 20.898 patients on 18 randomized trials, J Clin Oncol, 23(34), 8664-85670.
. Vukasin P,Ortega AE, Greene FL, Steele GD, Simons A3, Anthone G3, Weston LA, Beart RW Jr.(1996) Wound recurrnce following laparoscopic colon cancer resection. Result of the American Society of Colon and Rectal Surgeons Laparoscopic Registry, Dis Colon Rectum 1996 Oct; 39; 3-20.
TIM HIEU NHU'NG YEU TO LIEN QUAN DEN KET QUA DIEU TRI S6l NIEU Q U A N 1 / 3 DU-ffl QUA NOI SOI T A N SOI NGU-ffC DONG
BANG HOLMIUM LASER
TOM TAT
Day la mot mghien ciTu cat ngang mo ta, du'dc BiiTc hi|n tir thang 1/2014 den thang 9/2016 tai Benh vien Da Mioa Nong nghjep. Doi tu'dng nghien ciru la 69 benh nhan du'dc chan doan la sdi nieu quan 1/3 dudl va du'dc dieu trj theo phu'dng phap tan soi npi soi ngu'de dong bang Holmium laser. Ket qua nghien ciTu cho thay tan sdi thanh cong 98,6%, that bai 1,4%;
thcfi gian tan trung binh la 38,25; soi cang nhieu vien ket qua tan sdi cang giam, su" khac biet nay cd y nghia thong ke vdi p=0,048; tinh trang nieu'quan cang cd nhieu ton thu'dng phdi hdp ket qua tan sdi cang kem, p=0,046.
SUMMARY
FIND OUT ABOUT FACTORS RELATED TO THE OUTCOME OF URETERAL STONES 1 / 3 BELOW USING ENDOSCOPIC RETROGRADE LnHOTRIPSY W I T H HOLMIUM LASER This IS a eross-sectional descriptive study, conducted from January 2014 to September 2016 at the General Hospital of Agriculture. Study subjects were 69 patients diagnosed ureteral stones 1/3 below using endoscopic retrograde lithotripsy with Holmium laser. Research results show that 985% of successful gravel, 1.4% failure; Average canopy time is 38.25; As the number of stones increased, the difference was
*Benh vien Da khoa Nong nghiep Chju trach nhiem chinh: Nguyen Dinh Lam Email: [email protected] Ngay nhan bai: 19.8.2017 Ngay phan bien khoa hoc: 4.10.2017 Ngay duyet bai: 16.10.2017
Nguyen Dinh Lam*, Ha Hfru Tung*
stabstically significant with p = 0.048; The worse the ureteral morbidity, the lower the cumulative morbidity, p = 0,046.
I. DAT VAN OE
Sdi tiet nieu la mot benh pho bien, thu'dng gap, chiem ty le 2-3% dan sd. Trong dd sdi nieu quan chiem 28 - 40% trong eac benh sdi tiet nieu [1],[2]. Viet Nam la mdt nu'dc ed nhieu benh nhan bi sdi tiet nieu. t h e o Ngd Gia Hy pinan Idn sdi nieu quan la do sdi than rdi xudng (80%), cdn lai ia sdi sinh ra tai cho do di dang, hep nieu quan. Sdi nieu quan khi bit tac nieu quan se gay ra nhu'ng bien chu'ng nguy hiem (ii' nu'dc, d mil dai - be than), neu khdng du'dc dieu tri sdm ed the dan tdi nhiem khuan, vd nieu, suy than, tham ehi tir vong.
Tir cuoi the ky XX ed nhieu phu'dng phap can thiep sdi nieu quan It sang chan ra ddi da va dang du'dc ap dung de dieu tri sdi nieu quan nhu": tan sdi ngoai ed the, md noi soi lay sdi ngoai phiic mac , tan sdi nieu quan ndi soi ngu'de ddng bang xung hdi hoac bang Holmium Laser vdi dng kinh ndi soi ban cirng hoac dng mem, phu'dng phap nay dang ngay cang chiem du the va du'dc ap dung pho bien vi nd cd rat nhieu ulj diem tan dung cac Id tir nhien, tham my do khdng 6e lai seo, benh nhan it dau sau thu thuat, thdi gian nam vien ngan, han che du'dc toi da cac tai bien va bien chu'ng vi trong qua trinh tan sdi du'dc quan sat tru'c tiep.
Tru'dc l<hl cd tan sdi nieu quan bang Holmium
VIETNAM MEDICAL JOURNAL N°2 - OCTOBER - 2017 Laser thi tai Benh vien da khoa Ndng nghiep da
sd cae tru'dng iidp sdi nieu quan deu ehi dinh md' md, md ndi soi ngoai phuc mac lay sdi hoac tan sdi ngoai ed the. TiJ- nam 2012, khoa Ngoai tdng hdp trien khai ky thuat tan sdi nieu quan npi soi b^ng Holmium Laser. Xuat phat tir thu'c te tai Benh vien, ehung toi tien hanh de tai vdi^muc tieu "Xac dinh mot sd yeu to liin quan den ket qua dieu tri soi niiu quan 1/3 dddi qua noi soi tan sol ngddc ddng bang Holmium Lasei"
II. €01 TUONG VA PHLTOfNG PHAP NGHIEN CLTU 2 . 1 . Ddi tu'dng n g h i e n cii'u: Benh nhan du'dc chan doan la sdi nieu quan 1/3 du'di va du'dc dieu tri theo phu'dng phap tan sdi ndi soi ngu'de ddng bang Holmium Laser tai Benh vien Oa khoa Ndng nghiep tir thang 01/2014 den thang 09/2016
- Tieu chuan chpn benh nhan + Benh nhan tiT I's tuoi trd len.
-I- Sdi nieu quan 1/3 du'di cd kich thu'dc tir 5mm den 2dmm.
+ Chu'c nang than binh thu'dng, cdn bai tiet nu'dc tieu dii ap liTc de day cac vun sdi xuong bang quang.
-I- Khdng cd dau hieu hep, dj dang hoac tae nghen du'dng bai tiet nirdc tieu phia du'di vien sdi dinh tan.
+ Khdng ed nhiem khuan tiet nieu nang.
- Tieu chuan loai truT benh nlian + Sdi nieu quan kich thu'dc >20mm (tu'dng doi) -»- Benh nhan mac eac benh dang tien trien nhi/suy gan, suy than, cae benh tieu du'dng, tim mach, rdi loan ddng mau, lao nieu quan, ung thu' + Benh nhan dang dieu tri benh rdi loan ddng mau hole su'dung Heparin, Aspirin,...
-I- Benh nhan cd di tat, nhat la di tat tiet nieu khdng cd kha nang dat du'dc may.
2.2. Oja d i e m va t h d i g i a n n g h i e n cu'u:
- Dia diem: Benh vien £)a khoa Ndng nghiep.
Ha Npi
- Thdi gian nghien ciru: tir thang 01/2014 den 09/2016
2.3. Phu'dng phap n g h i e n c i h i : Nghien cu'u cat n g a n g , m o t a
2.4. Cd m a u n g h i e n cu'u: Tat ca eac benh nhan du'dc chan doan la sdi nieu quan 1/3 du'di va du'dc dieu tri theo phu'dng phap tan sdi noi soi ngu'de ddng bang Holmium Laser tai Benh vi§n Oa khoa Ndng nghiep tir thang 01/2014 den thang 09/2016
2.5. Ky t h u a t t h u va xuT ly so lieu Thu t h a p so l i e u : Moi benh nhan nghien cii'u du'dc ghi nhan cac chi tieu nghien cu'u bang mot
m l u benh an dam bao ti'nh thdng nhat, khadi quan, chmh xac
Xu" ly so l i e u : Cac sd lieu du'dc kiem tra va xd ly khi thu du'dc, Phan tieh so lieu bang chu'dng trinh SPSS 16.0.
III. KET QUA NGHIEN COU 3 . 1 . Ket q u a t a n soi
Bang 3.1. Tinh trang nieu quan nhan dinh qua ngl sol.
T i n h t r a n g n i e u q u a n Phu re rem mac 16 neu qiBn, neu quan
Polyp nieu quan Xd, hep 16 nieu quan, nieu quan
Gap khuc nieu quan Nieu quan binh thudnq
T o n g
n i.1 4 11 1 36 69
24;7
%
5,8 15,9 If'' 52,2 100 Nhan xet Tinh trang nieu quan nhan dinh qua ndi soi nieu quan cd 36 BN (52,2%) NQ binh thu'dng, 17 BN (24,6%) cd phii ne niem mac l5 nieu guan va nieu quan, 11 BN (15,9%) co xcf, hep lo nieu quan va nieu quan, 4 BN ed polyp nieu quan (5,8%) va 1 BN gap khiie nieu quan ehiem 1,4%.
Bing 3.2. Thdi glan tin sol Thcfi g i a n ( p h u t )
< 30 phut 30-60phut
>60 phut T o n g
n 23 31 15 69
33,3%
%
44,9%
21,8%
100%
Trung binh 38,25±17,73 phut, cao nhat 170 phiit, thap nhat 8 phiit
Nhan xet: Thdi gian tan sdi 30 - 60 phiit cao nhat 31 BN ehiem 44,9%. Trung binh 38,25±17,73.i phut, eao nhat 170 phiit, thap nhat 8 phiit.
Bing 3.3. Su'dung dng thong nieu quan Loai o n g t h o n g
l^odelaqe (plastic) Sonde J3 Kh6nq dat
T o n g
n 41 26 2 69
•A 59,4%
37,7%
2,9%
100%
Nhan xet: Hau het cac tru'dng hap Suae ait ong thong nieu quan la sonde plastic co 41 BN (59,4%), CO 26 BN (37,7%) dat sonde M, c6«
BN (2,9%) Ithong du'dc dat ong thong nieu quan!
Bang 3.4. Tai bien va bien chufng Tai bien va Bien chtfng I BN I %
Chay mau Sot cao sau tan Thiing nieu quan
T o n g so 69
13,1%.
10,1% 2,9% 100% Nhan xet Co 9 BN (13,1%) chay mau do tan va co 7 BN (10,1%) sot cao sau tan, c o | . tru'flng hdp (2,9%) thung nieu quan gay thoat nu'dc tieu ra ngoai.
TAP CHi Y HOC VIET NAM TAP 459 - THANG 10 - s 6 2 - 2017
Bang 3.S. Thdi gian dieu tri sau tan Thcfi qian hau phau
< 2 nqay 3-5 nqay
> 5 nqay Tonq
BN 6 45 18 69
%
8,7%
65,2%
2 6 , 1 % 100%
Trung binh 4,84± 3,36, cao nhat 17 ngay, thap nhat 01 ngay
Nhan xet: Thdi gian nam vien 3-5 ngay 45 BN ehiem 65,2%, nam vien lau nhat la 17 ngay, ngan nhat la 1 ngay. Trung binh 4,84±3,36 ngay.
Bang 3.6. Ket qua tan soi (mu'c do) Tan soi thanh cong
Tot 52 (75,4%)
Trung binh
14 (20,3%)
Kem 2 (2,9%)
That bai
1 (1,4%)
Tong 69 (100%) Nhan xet: Tan soi thanh cong chung la 68 BN trohg dd ket qua tot la 52 BN (75,4%), trung binh 14 BN (20,3%), kem 2 BN chiem 2,9%.
Ttiat bai 1 BN (1,4%).
3.2. Mot so yeu to lien quan den ket qua tan soi Bang 3.7. Lien quan sd lu'dng soi va ket qua tan So iuong
Tot
Thanh cong
Trung binh That bai Tong
52(81,2%) 11(17,2%) 0(0%) 1(1,6%) 64(100%)
2 vien 0(0%) 2(66,7%) 1(33,3%) 0(0%) 3(100%)
> 3 vien 0(0%) 1(50%) 1(50%) 0(0%) 2(100%)
p [ 0,048 ^ ^ , Nhan xet: Chung toi thay rang tat ca nhu'ng benh nhan CO > 2 vien soi deu co ket qua trung binh va kem, p<0,05.
Bang 3.8. Lien quan tinh trang nieu quan va kei qua tan Tinh trang NQ
Nieu quan binh thi/dnq Phu ne niem mac !6 nieu quan,
nieu quan Polyp nieu quan Xd, hep 16 nieu quan, nieu quan
Gap khuc nieu quan P
Thanh cong Tot
3 3 ( 9 1 , 7 % ) 15 (88,2%)
1(25%) 3(27,3%)
0(0%)
Trung binh 3 ( 8 , 3 % )
2 (11,8) 3(75%) 6(54,5%)
0(0%) Kem 0 ( 0 % )
0 (0%) 0(0%) 1(9,1%) 1(100%)
That bai 0 ( 0 % )
0 (0%) 0(0%) 1(9,1%)
0(0%) l o n g 3 6 ( 1 0 0 % )
17 (100%) 4 ( 1 0 0 % ) _ 11(100%) 1(100%) 0,046
Nh$n xet: Trong tru'dng hdp nieu quan binh thuftng cd 33/36 BN (91,7%) dat ket qua tdt./olyp nieu quan cd 25% dat ket qua tdt, xd hep lo nieu quan va nieu quan ed 27,3% dat ket qua tdt.
IV. BAN LUAN
4 . 1 . Ky thuat va ket qua tan soi: Ket qua va thdi gian tan sdi phu thudc rat Idn vao ky nang va kinh nghiem cua phau thuat vien ve kha nang dat ong soi tiep can sdi, tinh trang ni?u quan, sd ly phan mem du'di sdi, sd lu'dng, ban chat va vi trf ciia sdi; ngoai ra, cdn phu thudc vao do bam dinh cua sdi vdi nieu quan. Theo bang 3.1, cd 4 BN cd polyp du'di sdi, chimg J:di tan dung kha nang cat va khi hda cac md mem cua Holmium Laser de cat polyp thanh cdng ca 4 tru'dng hdp nay de boe id sdi. Khi tan sdi bang Laser thi polyp va sd bam dinh ciia nieu quan lai la mot thuan Idl ciia ky thuat nay, vdi kha nang cat va khi hda md mem mdt each nhanh chdng de cat polyp sdi du'dc bdc Id rd, ldi dung kha nang bam di'nh cua sdi vao thanh nieu quan de tan sdi. Khi tan chimg tdi tan sdi thanh nhieu diem nhd tren be mat vien sdi, khdng nen tan vd
ngay ma ldi dung su' cd dinh cua sdi de tan vun eac manh vd ra khi dd bdm nu'dc cac manh nay khdng chay len than. Khi sdi vd het nieu quan thdng thi (5a'y day d i n du'dng vu'dt qua sdi de ed dinh khdng cho eac manh cdn lai chay len than rdi tiep tuc tan tdi khi het sdi. Vdi sdi xii^si thi mire do bam di'nh vao nieu quan nhieu hdn sdi trdn nhan. Theo nghien ciTu eiia chiing tdi, cd 4 tru'dng hdp sdi cd polyp nieu quan khi tan sdi dat ket qua thanh cdng la 100%.
Viec tiep xiic eiia dau day Laser vdi be mat vien sdi ddi hdi phai ehinh xac va tinh te, khi tan phai quan sat ro du'dc dau sdi quang va kiem soat qua trinh tan tren man hinh. Khi cd bui sdi hoac mau hay nu'dc tieu due lam md phau tru'dng thi phai bdm nu'dc riTa vdi ap li/c vira phai tdi khi quan sat rd phau tru'dng mdi tiep tue tan. Nhieu tac gia khuyen khi sdi trdn dl ddng nen dat dormia len tren sdi rdi mdi tan; tuy nhien theo chiing tdi thi khdng nen, vi nang lu'idng laser ed the cat dirt co rp hoac day dormia khi dd se rat khd khan de lay dormia ra ngoai nieu quan.
VIETNAM MEDICAL JOURNAL N°2 - OCTOBER - 2017
Thdi gian tan sdi: Theo ket qua nghien eiru eiia cihiing tdi (Bang 3.2) thdi glan tan sdi 30 - 60 phut cd ty le cao nhat 31 BN chiem 44,9%.
Trung binh 38,25±17,73 phut, cao nhat 170 phut, thap nhat 8 phut, so vdi Du'dng Van Trung (2007) thdi gian tan trung binh la 48,1 phut [4], Nguyen Hoang Dii'e (2008) thdi gian tan trung b i n h l a 2 7 , 3 ± l l , 8 p h u t [ 3 ] .
Dat ong thong nieu quan sau tan: Hau het e^c tru'dng hdp du'dc dat Modelage cd 41 BN (59,4%), cd 26 BN (37,7%) dat sonde JJ, cd 2 BN (2,9%) khdng du'dc dat ong thdng nieu quan la do tai bien chay mau trong qua_ trinh phlu thuat chiing tdi khdng the tim du'dc Id nieu quan.
Ty le dat JJ ciia ehung tdi thap hdn eac tac gia khac la do ehii yeu chiing tdi gap sdi sat thanh bang quang, thdi gian tan nhanh, it lam tdn thu'dng nieu quan.
Cac tai bien va bien chu'ng sdm cua tan sol nieu quan noi soi: Tan sdi nieu quan ndi soi bang Laser la mot can thiep it xam hai, tuy nhien cae tai bien va bien chuYig van xay ra ehiem tir 2%-20% [6]. Cae bien chirng thu'djig gap ciia npi soi tan sdi la: chay mau, nhiem khuan tiet nieu, ton thu'dng nieu quan nhu' bdng, thiing, rach hoac dut nieu quan. Tiiy theo mire dp nang nhe eiia bien chimg hoac tai bien ma cd each dieu tri khac nhau nhu": dieu tri ndi khoa bao ton hoac md md de xd ly.
Bien chu'ng chay mau: Tat ca cae benh nhan tan sdi bang Laser, sau tan deu du'dc d | t sonde Foley 16fr. Thdng thu'dng khi nu'dc tieu trong benh nhan du'dc riit thdng tieu tru'dc khi ra vien, neu nu'dc tie'u cd mau thi du'dc luO sonde (cd mau cue trong bang quang se bdm riTa) khi het mau mdi rut thdng tieu. Oa so cae benh nhan sau tan sdi deu cd dai mau nhe va se td het, chi eoi la bien chu'ng neu dai mau dai the keo dai tren 24 gid hoac chay mau nhieu phai truyen mau, dimg cac bien phap can thiep de a m mau. Bien chirng chay mau eiia chiing tdi ehiem 13,1%, tat ea eac tru'dng hdp nay chi ran diing thudc, khdng ed tru'dng hdp nao phai can thiep phau thuat, cdn Phan Tru'dng Bao (2009) gap 8,87% cd chay mau sau tan [5].
Bien chu'ng n h i l m khuan tiet nieu: Nhiem Idiuan tiet nieu xay ra sau tan sdl,_ thu'dng do BN khdng du'dc kiem soat nhiem khuan tru'dc khi tan va cdng tdc vd khuan trong tan sdi. Nghien ciTu ciia chung toi sot cao sau tan gap 7 tru'dng hdp chiem^lO,l% {Bang 3.4). Trong dd ed 5 tru'dng hdp cat sot sau 2 ngay dieu trj, 1 tru'dng hdp edn lai sot den ngay thir 3 chung toi chuyen hdi sire tfch cu'c du'dc cho XN vi sinh nu'dc tieu, nudi cay
vi khuan. Ket qua nudi cay khdng cd nhiem khuan huyet, tru'dng hdp nay chiing tdi dieu tn sau 7 ngay BN het sot,_cho BN xuat vien. Nhu' vay, de han che nhiem khuan thi cdng tac vd khuan trang qua trinh lan giii' vai trd quan trpng, dong thdi phai kiem soat tdt nhiem khuan tru'dc khi tan.
Bien chu'ng thung nieu quan: Khi tan sol kem theo cat polyp hoac nong NQ hay sdi bam dinh nhieu thi nguy ed thiing nieu quan cang eao, vi khi anh sang Laser tiep xuc tru'c hep len thanh nieu quan khoang 2 giay la ed the gay thiing NQ. Nghien cu'u cua chiing tdi gap 2 tru'dng hdp (2,9%) thiing NQ (Bang 3.16),'ca 2 deu du'dc dat JJ va khdng phai can thiep lai.
Thdi gian hau phau: Thdi gian hau phlu ngan, BN dd dau nhieu, binh phuc nhanh la u\i diem eiia tan sdi ndi soi. Theo nghien cu\j cua chiing tdi (Bang 3.5), thdi gian nam vien 3-5 ngay 45 BN chiem 65,2%, nam vien lau nhat la 17 ngay, ngan nhat la 1 ngay. Trung binh 4,84±3,35 ngay. So vdi cac tae gia ngay hau phau eiia chung toi dai hdn vi sau tan benh nhan ed sot hoac chay mau ehimg tdi deu dieu tri khi het sot hoac het chay mau mdi cho ra vien.
Danh gia ket qua:
- Ket qua chung: Theo Nguyen Hoang Su'c (2008) t / le thanh cdng chung la 76,3% [3], Vu Le Chuyen (2005) thanh cdng ehung la 85,71%
[8], Phan Tru'dng Bao (2009) thanh cdng 96,8%
[5], cdn cua chiing tdi thanh cdng chung la 98,5%, that bai la 1,4%
- Mire dp ket qua tan: theo nghien ciTu eiia ehung toi (Bang 3.18) ket qua tdt la 52 BN (75,4%), trung binh 14 BN (20,3%), kem 2 BN ehiem 2,9%. That bai 1 BN (1,4%). Theo Du'dng Van Trung (2007) ed 66,7% dat ket qua tot (sach sdi ngay sau khi tan) [4], Nguyin Hoang Dii'e ty le sach sdi sau khi tan la 63,9% [3].
- Nguyen nhan that bai: Trong nghien cii^J eiia ehung tdi ehi cd 1 BN that bai la do xd hep, khdng xac djnh va du'a may len du'dc nieu quan nen khdng tan du'dc sdi. BN nay du'dc dung khang sinh sau mo, i thang sau du'dc phau thuat lai niem mac bang quang het viem, tim du'dc ]o nieu quan, tiep can du'dc sdi tan thanh cdng v6i ket qua tdt.
4.2. Mot SO yeu to lien quan den tan soi Lien qiian ket qua tan soi vdi so lu'dng soi: Sdi 1 vien cd 64 BN trong dd ket qua tot la 81,2%, ket qua trung binh 11 BN 17,2%, co 1 BN that bai la do khdng tiep can du'dc sdi. Soi 2 vien cd ket qua tot khong ed, ket qua trung binh 66,7%, cdn ket qua kem la 33,3%. Sdi tren 3 vien thi ket qua tdt la 0%, ket qua trung binh
TAP CHi Y HOC VlgT NAM TAP 459 - THAHG 10 - SO 2 - 2017 50%, cdn ket qua kem la 50%. Nhu vay, Chiing
tdi thay rang tat ca nhu'ng benh nhan cd > 2 vien sdi deu cd ket qua trung binh va kem, p=0,048.
Lien quan ket qua t a n sdi vdi tinh trang nieu quan: Chung tdi nhan thay ket qua trung binh cd 3 BN nieu quan binh thu'dng, cd 11 BN nieu quan cd tinh trang bat thu'dng. Ca 2 BN ed ke^t qua kem deu nam trong nhdm nieu quan ed tinh trang bat thu'dng. Tru'dng hdp duy nhat that bai la do xd hep, khdng xac djnh va du'a may len ddric nieu quan nen khdng tan du'dc sdi. Cho thay, tinh trang nieu quan cang cd nhieu tdn thu'dng phdi hdp ket qua tan sdi cang kem, p=0,046.
V. KET lU^N
Tan sdi npi soi ngu'de ddng vdi sdi nieu quan doan 1/3 du'di bang Holmium Laser la phu'dng phap can thiep ft xam hai, an toan va hieu qua.
Tan sdi thanh cdng 98,6%, that bai 1,4%.
Trang tan sdi thanh cdng thi ket qua tot 75,4%, ket qua tmng binh 20,3%, ket qua kem la 2,9%.
Hau het cac tru'dng hdp du'dc dat dng thdng nieu quan la sonde plastic cd 41 BN (59,4%), ed 37,7% dat sonde JJ, cd 2,9% khdng du'dc dat dng thdng nieu quan.
Tai bien va bien chiihg: 13,1% chay mau do tan va cd 10,1% sot eao sau tan, cd 2 tru'dng hdp thung nieu quan gay thoat nu'dc tieu ra ngoai.
Thdi gian tan trung binh la 38,25phut. Thdi gian hau phau trung binh 4,84 ngay.
Sdi cang nhieu vien ket qua tan sdi cang giam. Tinh trang nieu quan cang cd nhieu tdn thu'dng phdi hdp ket qua tan sdi cang kem TAI LIEU T H A M KHAO
1. Tran Quan Anh (2001), Sol nieu quan, Benh hoc ngoai khoa, NXB Y hoc, tr. 140-145.
z. Tran Van Sang (1996), Sol nieu, Bai giang benh hoc ni|u khoa. NXB mui ca mau, tr. 83-130.
3. Nguyen Hoan^ Du'c va Nguyen Tan Cu'dng (2008), "Nghien cdu rut ngan thdi gian nam vien sau tan sol nieu quan doan luiig bang Holmium Laser vdi ong sol cdng." Y hoc thanh pho Ho Chi Minh tap 12*phu ban so 4 nSm 2008.tr 197-200.^
1 . Du'dng Van Trung, Le Ngoc Tu" va Nguyen Birtj Trieu (2007^, " K& qua 'tan sol nieu quan noi SOI ngudc dong bang laser iai binh vien BuU dien /- Ha noi", Tap dii ngoai khoa, '0p 2, tr. 37-42.
d. Phan tru'dng Bao^ Nguyen Tuan Vinh va "Sir dung Holmium Laser trong noi soi tan sdi nieu qiian doan lUng tai benh vien Binh Dan 2009" Tap chiy hoc thanh pho Ho Chi Minh so 4 nam 2009,'tr 488-490. Vu Le Chuyen (2009J, "Sddung Holmium Laser trong ngi soi tan sol nieu quan doan lufig tai benh vien Birih Dan 2009" Tap chiy hor: thanh phd Ho Chi'Mlnh so 4 nam2009, tr 488-490.
6. Danien va Bolton (2000), " Urinary stone disease". Smith' general urology, Lange Medical Books, New York, pp. 291-317.
7. Fernando C va Ramay L. Kuo and Glenn M.
Preminger Delvecchio (2000), " Clinical efficacy of combined lidiodast and liifiovac stone removal dunng
"Urology, vol 164, 40^2, 6/2000.
NHAN XET DIEU TRI ROI LOAN LO AU LAN T 6 A 6^ BENH NHAN TIT 18 TUOI TAI VIEN SU'C K H 6 E TAM THAN - BENH V I £ N BACH MAI
Nguyen Van Dung*
T 6 M TAT
Dgt van d'e: Lo au la cam xuc thu'dng gap nhat ciia con ngu'di vdi nhieu mire do khac nhau. Muc tieu: Nhan xet dieu tn rdi loan lo au lan tda d benh nhan tir 18 tuoi tai Vien sire khoe tam than - Benh Vien Bach Mai. Phu'dng phap: Md ta cat ngang 90 benh nhan du'dc chan doan xac dinh roi loan lo au lan tda theo tieu chuan chan doan ciia ICD 10, tren 18 tuoi, dieu tr| ngi trii tai Vien SiTc khoe TSm than • Benh vien Bach Mai, trong thdi gian tir thang 9/2013 den thang 7/2014. co sir dung mot sd cae trac nghiem tam ly ho trd. So lieu thu thap du'dc ^se diroc xd ly theo phu'dng phap thong ke toan hgc bang phan mem
*Vien sdc khoe tam than- Benh vien Bach MaiChiu trach nhiem ehinh: Nguyen VSn Dung Email: [email protected] Ngay nhan bai: 17.8.2017 Ngay phan bien khoa hoc: 4.10.2017 Ngay duyet b^i: 10.10.2017
SPSS 16.0. Ket qua: Rdi loan lo l u lan tda chiem ty le eao nhat trong cae rdi loan lo au khac tai thdi diem nghien CLTU (50%). Cac trieu chifrig tam than eua roi loan lo au lan toa chiem ty le cao (85,7% - 100%).
Dieu tri roi loan lo au lan tda: gom cd hda dUde tri lieu va tam ly tri lieu, Ngay dieu trj trung binh la 17,4 '±
6,6 ngay. Co 100% benh nhan dUdc diin^ diazepam;
lieu diazepam trung binh la 8 ± 3mg/ngay. Co 92%
benh nhan phoi hdp thudc cac thudc chong tram cam vdi diazepam. Lieu Remeron trung binh la 45 ± 28mg/ngay. Su' thuyen c|iam ciia cac trieu chirng lo au theo ket qua trac nghiem Hamilton. Liie vao vien cd 23,3% benh nhan lo au mire do nhe, 53,3% benh nhan lo au mire do viTa, 23,3% lo au mdc do nang.
Liic ra vien cd 37% benh nhan lo au mire do nhe, 15% benh nhan lo au miTc do vira, khdng con benh nhan lo au mire dp nang. Sir thuyen giam cac tneu chu'ng tram cam theo ket qua trac nghiem Beck. Liie vao vien ed 42% benh nhan tram cam miTc do nhe, 8% benh nhan tram cam miTc do vira. Luc ra vien cd 6,7% benh nhan tram cam mu'c do nhe, khong ed
