Y HQC VlgT NAM THANG 8 - SO D A C BigT / 2Q13
TAO HINH LAM RONG BANG QUANG QUA NOI SOI 6 BUNG TRONG BANG QUANG CO NHO DO LAO:
KINH NGHIEM QUA 11 TRUdNG HOP DAU TIEN
Nguyen Phiic CSm Hoang', Le Van Hieu Nhan'
T O M TAT:
S a t v a n d e & m u c t i e u : Danh gia ket qua, dp an toan, tinh kha thi ciia phau thuat lam rong bang quang bang hoi trang qua npi soi 6 bung trong bang quang co nho do lao qua 11 tru'dng hdp dau tien.
Boi tu'dng va phu'dng phap: Trong thdi gian tu-1/2005 den het 12/2011, co 11 benh nhan bang quang co nho do lao nieu du'cJc mo tao hinh lam rong bang quang bang hoi trang qua npi soi 6 bung tai khoa Nieu B va Nieu C benh vien Binh Dan. Benh nhan du'dc dieu tn bang thudc khang lao tru'dc mo toi thieu 2 thang. Noi soi 6 bung dung 4 trocar, cat day chang ron giij^, xe phiic mac thanh tru'dc vao khoang tru'dc bang quang, phau tfch nhUng cho dinh quanh bang quang. Cat md bang quang 6 vung chop theo du'dng ngang vong nhe ra mat tru'dc bang quang, dung mpt doan hoi trang dai 15-20cm, dUa ra ngoai cd the qua du'dng md rpng trocar ron 4-5 cm, xe ong rupt va xep ruot kieu Goodwin (cup-patch), khau noi hoi trang-bang quang trong cd the. Danh gia ket qua phau thuat trong thdi ky hau phau va thdi gian sau mo 6 thang.
Ket qua: Co 11 benh nhan: 6 nam va 5 nU vdi tuoi trung binh: 43,45 (27-61). Cd 4 tru'dng hdp (36,4%) CO lao phoi ket hdp, 1 tru'dng hdp lao mao tinh ket hdp ( 9 % ) . Dung tich bang quang trung binh tru'dc mo: 47,3 mL (40-50). Ton thu'dng phoi hdp: hep nieu quan hai ben: 1/11 (9%), hep nieu quan mpt ben phai: 1/11 (9%),
' B^h vi^n Binh Dan
Phan bien khoa lioc: PGS.TS. Do Trirong Thanh
hep nieu quan trai, trao ngu'dc bang quang nieu quan hai ben: 1/11 ( 9 % ) , than mat chiic nang mot ben phai: 1/11 ( 9 % ) , than mat chiic nang mot ben trai: 8/11 (72,7%), trao ngu'dc bang quang nieu quan hai ben: 2/11 (18,2%), trao ngu'dc bang quang nieu quan mpt ben phai: 4/11 (36,4%), trao ngu'dc bang quang nieu quan mpt ben trai: 2/11 (18,2%). Cd 4 / U tru'dng hdp cd creatinin mau tren 120 pmol/l trudc mo (36,4%).
Ky thuat mo phoi hdp vdi lam rpng bang quang:
cam lai nieu quan phai vao bang quang: 6/11 (54,5%), cam lai nieu quan trai vao bang quang:
1/11 (9%), dat thong JJ mot ben: 2/11 (18,2%).
Thdi gian mo trung binh 430 phiit (330-480). Udc lu'dng mau mat trung binh: 480 mL (400-600).
Chuyen mo md: 3/11 tru'dng hpp (27,3%). Nam vien sau mo trung binh: 11,9 ngay (6-20). Bien chimg sau mo: mpt benh nhan bi ban tac rupt ngay hau phau 14, dieu tn bao ton, mpt benh nhan bi hep cho cam nieu quan than dpc nhat vao bang quang ruot phai md nieu quan ra da sau mo 1 thang. Ket qua sau mo 6 thang (10 benh nhan):
dung tich bang quang trung binh (chup bang quang can quang): 252 mL (160-300), khong cd trao ngu'dc bang quang nieu quan tren ca 3 benh nhan co cam lai nieu quan vao bang quang, nu'dc tieu ton luU sau di tieu trung binh: 58 mL (10-80).
Tat ca cac benh nhan cd cai thien trieu chimg di tieu nhieu Ian va dau ha vL Khong cd tru'dng hdp nao son nu'dc tien ban ngay va ban dem.
K e t luan: Qua 11 tru'dng hdp dau tien ciia chimg toi cho thay npi soi 6 bung lam rpng bang
HQI NGH! KHOA HQC LAN THJ; VII. Hpr T|£'T NlgU - THAN HQC VI$T NAM (VUNA) quang bSng hoi trang trong bang quang co nho
do iao la kha thi, an toan, cd ket qua gan rat kha quan ve ca chii'c n3ng va hinh the du'dng tieu dong thdi da mang lai cho benh nhan Idl ich cua phau thuat it xam Ian.
Tu" khda: Lao nieu sinh due (LNSD); Hep nieu quan do lao; Bang quang co nh6 do lao.
SUMMARY
LAPAROSCOPIC AUGMENTATION ILEOCVSTOPLASTY FOR TUBERCULOUS CONTRACTED BLADDER: INHIAL EXPERIENCE
Introduction & objective: Assess the outcomes, safety, and the feasibility of laparoscopic augmentation ileocystoplasty for tuberculous (TB) contracted bladder by our first 11 cases.
Patients & method: From January 2005 to December 2011, eleven patients suffering from TB contracted bladder underwent laparoscopic augmentation ileocystoplasty at the Department of Urology B and C of Binh Dan hospital. All patients received antituberculous drugs at least 2 months preoperatively. Four ports were used.
Division of the middle umbilical ligament to enter the prevesical space. The contracted bladder Is dissected off the paravesical adhesions and incised at the dome In a transverse Incision slightly curved to the anterior aspect of the bladder. An ileal loop of 15 - 20 cm was isolated, exteriorized through an extended umbilical port incision of 4 - 5 cm, then detubularized and sutured into a cup-patch according to Goodwin.
Intracorporeal vesico-ileal anastomosis was used to form a neobladder. We assess the operative outcomes in postoperative period and 6 months postoperatively.
Results: There were 11 patients: 6 males and 5 females with mean age: 43.45 (27-61).
Four cases (36.4%) with associated pulmonary tuberculosis, one case (9%) with epidydymal tuberculosis. Preoperative mean bladder
capacity: 47.3 mL mL (40-50). Associated urinary tree deformities: bilateral ureteric strictures: 1/11 (9%), right ureteric stricture: 1/11 (9%), left ureteric stricture, bilateral vesicoureteral reflux (VUR): 1/11 (9%), right non-functioning kidney:
1/11 (9%), left non-functioning kidney: 8/11 (72.7%), bilateral VUR: 2/11 (18.2%), right VUR:
4/11 (36.4%), left VUR: 2/11 (18.2%). Four out of eleven cases (36.4%) had preoperative serum creatinin above 120 pmol/L. Associated operative techniques: right neovesicoureteral reimplantation: 6/11 (54.5%), left neovesicoureteral reimplantation: 1/11 (9%), unilateral placement of a Double-J stent 2/11 (18.2%). Mean operative time: 430 minutes (330-480). Estimated blood loss: 480 mL (400- 600). Conversion to open surgery; 3/11 (27.3%).
Mean postoperative hospital stay: 11.9 days (6- 20). Postoperative morbidity: one patient had bowel semi-occlusion in day 14 post-op which was managed conservatively, one patient had stricture of the neovesicoureteral reimplantation in a solitary functioning kidney one month postop necessitating a cutaneous ureterostomy. Follow- up at 6 months post-op (10 patients): mean bladder capacity (on VCUG): 252 mL (160-300), no VUR detected in all 3 patients having neovesicoureteral reimplantation, mean post- voiding residual urine: 58 mL (10-80). All patients had improvement of day-time and night-time urinary frequency and lower abdominal discomfort and/or pain. No cases of day-time and night-time urinary incontinence documented.
Conclusion: By our 11 initial cases we realize that laparoscopic augmentation ileocystoplasty for TB contracted bladder is feasible, safe, and have satisfactory short-tenn functional and radiological outcomes. It could help to bring in advantages of MIS to our patients.
Keywords: Genitourinary tuberculosis (GUTB); Tuberculous ureteric stricture.
Tuberculous contracted bladder.
30
Y HOC Vl^T NAM THANG 8 - S6 D A C Bl^T / 2013 I- O^T VAN OE
Bang quang co nhd la di chung bi^n the dudng tieu it gap trong lao nieu-sinh due vdi ti le g5p khoang 7,2% [8], trong nhung nam qua da dugc rao tao hinh lam rpng bang hoi trang qua mo md vdi ket qua trung binh [6].
Trong trao luu phau thuat it xam hai trong phau thuat tao hinh dudng tieu, mpt sd tac gia nude ngdai da bao cao mpt so trudng hpp thuc hien qua npi soi d bung [3,4,10]. Bai vilt nay bao cao l^i 11 trudng hpfp dau tien tao hinh lam rpng bang quang bang hoi trang qua npi soi da dupe thuc hien trong thdi gian vira qua.
II- o d i TUONG VA PHUONG PHAP NGHIEN COU
1. Doi tu'pTig nghien ciru: Benh nhan lao nieu dupe chan doan bang quang co nhd do lao nieu dupe mo tao hinh lam rpng bang hoi trang qua npi soi 6 bung tfii Khoa Nieu B va Nieu C benh vien Binh Dan trong thdi gian tir 1/2005 ddn 12/2011.
2. Phu'O'ng phap nghien ciru 2.1. Xet nghiem chan doan lao niiu 2.1.1.Xet nghiem mrac tieu: Tai benh vipn Binh Dan thirc hien phoi hop thudng quy c^ ba xet nghipm: (1) Tim true khuan khang acid-con (AFB) true tiep bang nhudm Ziehl. (2) Phan ung PCR nude ti^u (IS6110- PCR) tim M tuberculosis. (3) Cay nude tieu tren moi trudng Lowenstein-Jensen tim M.tuberculosis hay M nontuberculosis.
2.1.2. Xet nghiem lao chung: VS, IDR, X quang phoi ± Vi khuan kh^ng acid-con trong dam
2 1.3. Chan doan hinh anh: chan doan biSn chung bien the dudng tieu.
Sieu am (Hinh l.A): xem dp ir nude than, nieu quan; hinh dang, dung tich bang quang.
Chup he nieu cd tiem can quang (UIV) (Hinh l.B.C); xem dp li nude than nieu quan, chiic nang than, hinh the va dung tich bang quang.
Hinh 1. A. Sieu am: hinh anh than u nude. B. UIV: Than P mat chuc nang, bang quang co nhd. C. UIV: Than T mdt chuc nang, bang quang eo nhd
Chup ni?u d^o-bang quang ngupc ddng (Hinh 2.A): xem dung tich, hinh the bang quang:
"thimble bladder", trao ngugc bang quang-nieu quan.
CT/MSCT (Hinh 2 B.C): xem toan thS he nieu v^ chuc nang va hinh thi, dac biet la chiic
HQI NGH! KHOA HQC L A N THCrVII, HQI TI^T NlgU - T H A N HQC VigT NAM (VUNA)_
H i n h 2. A . C h u p bang quang nieu dan nguac d(m^: bang quang co n h u . true ngugc hai ben.
l i . C. ( ' r / M S C I : hai than Li nuxVc. cluVc nang g i a m
2 I -1 A'<j/ .soi haiii!, ijiuin^ ( l l i n l i 3): x c n i n i i c n g nieu q u a n . d u n g t i c h bang q u a n g , chu y cu hep CO hun^ (jiuin^ kluhiy. '^
Hinh 3. A. Niem mac bang quang "nhu nhung".
B. C6 bang quang. C. Mieng nieu quan chit hep 2.2. Chi dinh mo tao hinh
Khi dung tich bang quang < 100 mL se mo tao hinh lam rpng bang quang. Neu cd hep cd bang quang: xe rpng eo bang quang qua npi soi trudc. Hpp nlpu quan sat bang quang: cam lai nieu quan vao bang quang rupt. Trao ngugc bang quang - nieu quan (VUR) tir dp III trd len se cSm lai nipu quan vao bang quang rupt. Chi cam lai nieu quan khi chiic nSng than lien hp cdn bao ton.
Vet mo cii viing byng khong la chong chi dinh ciia npi soi. Benh nhan dugc dieu tri bang thudc khang lao trudc md tao hinh toi thiiu 2 thang tdn cong (2SRHZ/ 6HE)
2.3. Ky thuat mo (Hinh 4, 5) Ngi soi d byng trong phuc mac diing 4 trocar, dat d viing ron va hai ben ho chau.
Seo mo cU vimg bung khong la chong chi dinh npi soi.
Cat day chang ron giGa, xe phiic mgc thanh trudc vao khoang trudc bang quang.
Phau tich quanh bang quang, tach nhihig cho dinh quanh bang quang thudng gap trong lao nieu. Cat md bang quang d chop theo duang ngang vdng nhe ra mat trudc bang quang [10].
Cd lap mpt doan hoi trang dai 15-20cm, dua ra ngoai ca the qua dudng md rpng trocar ron dai 4-5 cm, xe ong rupt, xep rupt kieu Goodwin (cup-patch). Neu can cam lai nieu quan thi dem dau nieu quan ra ngoai ca the cam lai vao bang quang ruot theo ky thuat LeDuc. Dua doan hoi trang da xkp hinh chu:
U ngugc vao hi trong ca thi, khau ndi hoi trang-bang quang, thudng khau ndi tir mat sau ra mat trudc, diing mQi khau vat.
32
Y HOC VIET NAM THANG 8 - SO DAC BIET / 2013
lat 4 trocar. C. Cat md bang quang. D.E. IChau nni hoi irang-bang quang, F, Phau thuat hoan thanh
Hinh 5. A. Doan hoi trang dem ra ngoai co the. B.C. Doan rudt cd lap, xe dng va khau xep hinh U ngugc. D. Khau ndi rudt-bang quang trong co the
2.4. Danh giS ket qua thdi ky hSu phau v^ tai kham sau mo 6 thang.
Tong phan tich nude tieu. Chiic nSng than: US, creatinin mau, ion dd/mau, du trit kiem.
SiSu am bung: cd cai thien li nude than, do lupng nude tieu ton luu sau khi di tieu.
Chup UIV ho5c MSCT cd tiem thuoc cSn quang, chup bang quang ngugc chieu.
xem hinh thS dung tich bang quang sau mo.
Ill- KET QUA NGHIEN COXJ
Tir 1/2005 din 12/2011 cd 11 benh nhSn dugc md tao hinh lam rgng bang quang bSng hdi trang qua ngi soi d bung:
1. Benh nhan. Tuoi trung binh: 43,45 (27-61); Gidi: 6 nam (54,5%), 5 nG (45,5%)
- Benh lao ket hgp: 4 trudng hgp lao phoi (36,4%), 1 tnidng hpp lao mao tinh (9%)
- Chiic nang than trudc mo: 4/11 trudng hgp ed creatinin/mau > 120 jamol/L (36,4%)
HQI NGHj KHOA HQC L A N T H Q VII. HQI TlgY NigU - T H A N HQC VigT NAM (VUNA)
2. Bien the dudng tiet nifu trirdc mo.
2.1. Dung tich bang quang trung binh trudc md: 47,3 mL (40-50)
2.2. T6n thuong dudng tilt ni^u tren phoi hgp
- Hpp nipu qudn 2 ben: 1/11 (9%) - Hpp ni^u qudn 1 ben P: 1/11 (9%) - Hpp ni?u qu^ T, VUR 2 ben: 1/11 (9%) - Th$n mkt chiic nang 1 ben P: 1/11 (9%); Than mat chirc nang 1 bSn T: 8/11 (72,7%)
- VUR 2 ben: 2/11 (18,2%); VUR I ben P: 4/11 (36,4%); VUR 1 ben T: 2/11 (18,2%)
3. Ky thuat mo ket hpp
- cam lai nipu quan P: 6/11 (54,5%) - cam lai nipu quan T: 1 / U (9%) - Dat thdng JJ mpt ben: 2/11 (18,2%) 4. Thong so cugc mo
Thdi gian md trung binh: 430 phiit (330-480)
- Lugng mau mat trung binh: 480 mL (400-600)
- Chuyin md md: 3/11 TH (27,3%) - Nam vipn sau md trung binh: 11,9 ngay (6-20)
- Bien chiing sau md: I bpnh nhan bi ban tac rupt ngay h$u phau 14, dieu tri bao ton; 1 benh nhan bi hpp cho cam nipu quan than doe nhat vao bang quang rupt phai md nieu quan ra da sau md 1 thdng.
5. Ket qua sau mo tao hinh 6 thang (10 BN, vi 1 BN phai mo lai md nipu quan ra da) - Dung tich bang quang tao hinh: 252 mL (160-300)
- Khdng cd trao ngugc tren ca 6 bpnh nhan cd cam lai nipu quan cdn lai.
- Nude tieu ton luru sau khi di tieu: 58 mL (10-80)
- Tat ca bpnh nhan cai thien trieu chiing tieu nhieu lan/dau ha vi
Khdng cd trudng hgp nao son nude tieu ban ngay-^ogc ban dem.
IV- BAN LUJEkN
1. Tinh huong xay den: biln chimg bang quang co nhd cd the xay den sau khi ngung dieu tri khang lao (di chunp hay ngay trong thdi gian diing thuoc lao tdn cdng (xa hoa cdp do lanh s?o [9]). Trong loat nay, chung tdi thay cd 3/11 trudng hgp xay ra trong thdi gian dieu tri lao tan cong. Bac si Tilt ni^u trong qua trinh theo ddi benh nhan nen chu y dien bien cd phan cap tinh nay.
2. Chi dinh tao hinh lam rpng bang quang [1|: khi dung tich bang quang chi cdn 30 - 150 mL. Lam bang quang thay thi nli thang (orthotopic neobladder) khi dung tich bang quang < 30 mL va dung da day khi co suy t h ^ , dimg dai trang sigma va hdi manh trang khi can cam lai nieu quan vao bang quang tan tao. Can giir lai phan bang quang lanh cang nhieu cang tdt vi phan nay cd vai trd trong tong xuat nuoc tieu.
Chdng chi dinh: Suy than khong phai la chong chi dinh. Chi chdng chi dinh khi dp thanh thai creatinin < 15mL/phut. Cac tac gia dung manh ghep da day khi cd suy thaji.
Trong loat nay cd 4/11 trudng hgp (36,4%) cd suy t h ^ nhp.
Trong loat nay chiing tdi khdng g3p trudng hgp nao phai xe rgng cd bang quang vi hpp cd bang quang. Trong nhieu nam qua tai Khoa-Bp mdn Tiet nipu bpnh vien Binh Dan da giai quyet di chung nay bang tao hinh lam rgng bang quang dimg hdi trang qua mo ma [6]. Tham khao y van tbky cd rdt it hai bao goc ve chii de nay.
3. Kinh nghifm taio hinh b^ng quang bing ruot tai benh vien Binh DSn la dung manh ghep hoi trang vi: (I) Ky thuat tuong ddi dorn gian, de thuc hien (2) U"ng dung
34
Y HQC VIET NAM T H A N G 8 - S 6 D A C BigT / 2013
trong phau thuat npi soi dung hdi trang thuan tien khi chgn doan rupt va dem rudt ra ngoai CO thS (3) Cd rat it roi loan nudc-dipn gidi khi theo doi lau dai [7] (4) Khi can cam lai nieu quan, ky thu$t Le Due da dugc chimg minh la mang \^\ ket qua tdt [2].
Cach cat md bang quang co nhd la mot chi tiet ky thuat can luru y: chiing tdi theo ky thuat cua benh vien Cleveland [10]: cat md bang quang d chdp theo duang ngang vong nh? ra mat truac bang quang. Uu diem: ky thuat nay giiip thi khau ndi rupt-bang quang de dang, nhat la d mat sau. Trong phau thuat npi soi 6 byng, chiing tdi thay khong cdn thiit khau ndi rupt hoan toan trong co the vi ky thuat phiic tgp va lam thdi gian md keo dai.
4. Khi nao can cam lai nieu quan vao bang quang rupt? Chiing tdi chu truang chi cam 1^ nieu quan khi cd hep nieu quan, trao ngugc bang quang-nieu quan nang (tir dp III) (7/11 trudng hgp). Neu hep nieu quan nhe chi cin dat thdng JJ luu 3 thang (2/11 trudng hgp), neu trao ngugc nhe chi can lam rgng bang quang (2/11 trudng hgp). Can luu y khi mpt than mat chiic nang thi khdng cam lai nipu quan ben dd niJa va day la trudng hgp phau thuat nguy ca cao vi tao hinh tren benh
nhan than dpc nhat chiic nSng (9/11 trudng hgp).
5. Kinh nghiem cua cac tac gia.
Kerr va cs. [5] bao cao 12 trudng hpp mo md vdi ket qua "rat tdt". Tuy nhien, dng chii truang cUt hit viing chop bang quang nham cai thien tripu chiing tieu nhieu Ian va lam giam lugng nude tieu ton luu. Neu cd trao ngugc bang quang nieu quan, dng khuyen cao diing hoi trang vdi cam lai nipu quan vao dau gan ciia quai rupt, dau xa quai rupt ndi vdi tam giae-cd bdng quang. Ket qua: benh nhan di tieu moi 2-6 gid, 1 trudng hpp cdn tieu nhieu Ian, 2 trudng hgp cd lugng nude tieu ton luu quan trpng, 1 trudng hgp cd bien chumg ha Kali/mau.
Ngo Gia Hy va es. [6] bao cap 8 trudng hgp: 7 trudng hgp cd ket qua 'trung binh', 1 trudng hgp tir vong do nhiem trimg huyet.
Tac gia cho rang phau thuat tao hinh chi lam dd phdn nao rdi loan di tieu. Phau thuat da lam giam bdt hoac loai bo nude tieu tdn luu vdi ti le thanh cong la 50%.
6. Trong lo^t 11 tru-frng hop nay.
1 trudng hgp bien chimg nang sau md:
hep cho cdm nieu qudn/thgn doc 1 vao bang quang rudt gay thieu nieu sau nit thdng JJ sau md 1 thang, phai md lai md nieu quan ra da.
Hinh 6. BN Le Thi M., SN 1955. Hinh 7. BN Luang Thai S., SN 1947.
H Q I NSHI KHOA HQC U N THCf VII, H Q I TrgT NlgU - THAN HQC VigT NAM (VUNA)
Ket qud sau m6 6 thang: Dung tich bang quang t^o hinh dgt gan binh thu6ng: 252 mL.
Can luu y r3ng theo th6i gian, dung tich bang quang rupt c6 Idiuynh hu6ng tang dan [2].
K^t qu^ cam l^i ni$u q u ^ : 1 tni6ng hpfp h?p cho cam I^i (nSu tren) phii md ni?u qudn ra da, 6 truimg hijp c6n Iji deu Ichong c6 trio ngu(prc bing quang ni^u quin. Lupfng nude tieu tin lini li chap nhjin du^c (10-80 mL), Tri?u chiing co nSng cii thi?n han: b?nh nhan di tieu moi 2-4 gift (ban ngiy), tieu dSm 2 -3 lin/dem, het dau ha vi vi tieu gip.
T& ca bSnh nhan khong co s6n nuac tieu ca ban ngay vi ban dem,
Trong 3 truang hgfp chuyen mo md: 2 tru6rng h(?p l i nhfing ca d^u tien chua co kinh nghiem, 1 trufirng h9p do mo viem dinh nhigu xung quanh bing quang; 1 trucmg hap kho nhung npi soi thinh cong: b|nh nhan dirge mo md khau bing quang, ma bing quang ra da tu trudc khi mo tgo hinh do va bing quang t\r nhien (Hinh 6),
BASS ^msms^K'tBi^^i^^^Km c ^ ^ H D
Hinh 8. BN Dinh Thi Tr„ SN 1949. A. MSCT truoc m6. B. MSCT sau m6. C. Chup bang quang truac m6. D, Chyp bing quang sau m6
V- KET LUJBIN
Qua 11 truong hijtp diu ti5n cua chiing toi cho thay ngi soi 6 byng lam rgng bing quang bing h6i tring trong bing quang co nh6 do lao li khi thi, an t6an, c6 k^t qui gin khi quan vi ci chiic ning va hinh th^ dudng tiju. cin tiap tyc cdng trinh vdi thdi gian theo dai lau dai hem chiic nang ciia bang quang tjo hinh vdi loat b$nh nhin Idn han.
TAI LIEU THAM K H A O
1. Cek M., Lenk S., Naber K.G., Bishop M.
C, Johansen T.E.B., Botto H.,Grabe M., Lobel B., Redorta J. P., Tenke P.: EAU
Guidelines for the management of
genitourinaTy tuberculosis, European Urology, 48, 2005, 353-62.
Dao Quang Oanh, Vu Van Ty, Nguyen Tuan Vinh, Nguyen Van An, Nguyen Phuc Cam Hoang (Abstract): Long term follow- up of bladder substitution: Function of neobladder and continent pouch of 113 patients performed at Binh Dan hospital, HCM city, Vietnam, Indian Journal of Urology, Vol.24, Supp.2 10/2008, 9* Asian Congress of Urology, New Dehli.
Elliott S.P., Meng M.V., Haroon P. Anwar H.P., and Stoller M.L: Complete laparoscopic ileal cystoplasty. Urology 59:
2002, pp.939-943.
Gill I.S., Rackley R.R., Meraney A.M., Marcello P.W., Sung G.T.: Laparoscopic 36
Y HQC VigT NAM T H A N G 8 - SQ' PAC BigT / 2013 enterocystoplasty, Urology 55: 178-181,
2000.
Kerr W.K., Gale G.L., Peterson K.S.S.:
Reconstructive surgery for genitourinary tuberculosis, J. Urol, Vol.101, 1969, pp.254- 66.
Ngo Gia Hy, Pham VSn Bui, V6 Thi Hong Lien, Nguyen Phiic Cam Hoang: MQt vai sac thai dac bi^t ciia lao ni$u sinh dye va phau thuat tao hinh dudng tieu. Thai sy Y dv^c hoc. Hoi Y dir<;«: hgc TPHCM (5), 1995,tr.33-35.
Nguyen Phiic cSm Ho^ng, Dao Quang Oaoh, Nguyen VSn An: NhQng thay doi ve sinh hoa va nuac dien giai tren b?nh nhan t^io hinh bpng dai b3ng rupt non. Sinh hogl
KHKTBV Binh Dan (8), 1995-1996, tr.l93- 198.
8. Nguyen Phiic Cam Hoang, Ngo Gia Hy, Pham van Biii, V6 Thj Hong Lien (1990- 1994), Nhan 167 trudng hgp lao ni?u sinh dye dieu trj tai benh vi?n Binh D5n trong 5 nam (1989 - 1994 ). Sinh hoat khoa hpc ky thu?t b?nh vi?n Binh Dan, (7), tr. 293-305.
9. Psihramis K. E. and Donahoe P. K.:
Primary genitourinary tuberculosis: rapid progression and tissue destruction during treatment, y. ^yro/, 135, pp.1033-6,1986.
to. Rackley R.R., Abdelmalak J, and Ross J.
Bladder Augmentation With or Without Urinary Diversion. Operative Urology at the Cleveland Clinic Edited by: A. Novick et al.
© Humana Press Inc., Totowa, NJ, 264-272.
PHAU THUAT NQI SOI MOT CONG SAU PHUC MAC DIEU TR! SOI TIET NIEU TAI BENH VIEN TRUNG LfONG HUE
Le Dinh Khanh', Tran Ngoc Khanh',Ng6 Thanh LieIIl^
Le Lu-ong Vinh , Hoang Van Tiing
TOM TAT:
Muc tieu: danh gia ket qua utig dung phau thuat noi soi mot cong dieu trj soi tiet nieu tai Benh vien Trung LTdng Hue.
fioi tu'dng va phu'dng phap: Nghien CLTU tien cifu mo ta cat ngang du'dc thi/c hien tren 38 benh nhan soi nieu, du'dc diieu t n b i n g phau thuat npi soi mot cong lay soi qua du'dng sau phuc mac tai khoa Ngoai Tong hdp benh vien Trung u'dng Hue tij" thang 06/2012 den thang 06/2013.
Ket qua: Tuoi trung binh 49,42 ± 23,15 (25 - 77 tuoi); 34 tru'dng hdp soi nieu quan, 2 soi be ' DaFhpc Y Duoc Hue
^ Benh vi?n Trung l/ong Hue Phan bi?n khoa hoc: PGS.TS. Trhn VSn Hinh
than, 2 sdi dai than kem soi nieu quan. Thdi gian phau thuat trung binh 59,34±31,13 phut (30 - 105 phut). Thdi gian nam vien trung binh la 5,39
± 2,11 ngay (4 - 12 ngay). Cong noi soi du'dc dSt qua mot lo nho 2,5 cm rach theo du'dng xien hong va chi su' dung dung cu thSng de phau thuat.
Ket luan: Phau thuat noi soi qua mpt cong dieu t n soi tiet nieu la phau thuat an toan, kha thi, ket qua dang khi'ch le, ty le bien chutig chap nhan du'dc.
TlT khoa: phau thuat npi soi mot cong, soi tiet nieu.
