Y Hpc TP. Ho Chi Minh * T^p 14 * Phti b a n ciia So 4 * 2010 Nghien cmi Y |
TINH HINH PHAU T H U A T NQI SOI THAI NGOAI TU" CUNG TAI BENH VIEN NHAN DAN GIA DINH TU" 01/2009 DfeN 04/2010
VdDodnMy Thgnh*, Nguyin Thi Tham*, Le Thi My Hanh*, Nguyin TtiiHSng Vdrt*, Hoang TTii Hdng Nga*, Huynh TJii Thiiy*
TtMlAT
Mac tieu nghien cuu: Ddnh gia tinh hi^u qua cua phuong phdp phdu thudt nqi soi trong chdn dodn va dieu trj thai ngodi tu cung lai khoa phu khoa benh vien Nhdn Don Gia Dmh.
Phmmg phap nghien cvni: Logi hinh nghiSn cuu: bdo c&o hang togi cdc truang hap phdu thudt npi soi thai ngodi tu cung nr 01-01 -2009 din 30-04-2010 igi khoa phu khoa b?nh vi^n Nhan Ddn Gia Dmh
Kk qud: Tong cgng co 158 b^nh nhdn dirpc phdu thudt ngi soi thai ngodi lir cung, 60% trudng h^ thai ngodi tu cung chira m. duac phau thudt kjp thai khdng xdy ra tai bien 70% tntang h^ cd tien cdn hut nifo tluiL 5% cdc truang h(rp CO tien cdn thai ngodi lir cung. Da sd cdc Iruang hop c6 tam chung ldm sdn co dien: tri kinh, dau bipig, rong huyei. Co su khdc biet trong chdn dodn thai ngodi tir cung va i'd chua vo tntac vd sau mo: co 52% tnrdng hgp Ai(K chdn dodn tnrdc md Id thai ngodi tu cung v& lhi sau mo ty le ndy gidm xuong 39% C6 0.6% trudng hgip md n$i sol that bgi phai chuyen md ha. 69,5% cdc truong hop mdu mdt dudi 300ml. Vidi gian mo dudi 45 phut chiem 40%. Da so cdc trudng hqp (96%) su dung mdi lieu khdng sinh d\e phong. Gdn Vi so inediig hop thdi gian ndm vi?n Id tren 4 ngdy (47.77%), khong cd lai bien nao xay ra trong i^i sau piidu thudt.
Ket luffn: Sieu dm ngd dm dgo ket hpp dinh luang ftHCG dd giup chdn dodn sdm thai ngodi tu cung chua vd (60% cdc trudng hop md npi soi thai ngodi tu cung). NQI soi 6 bipig giiip chdn dodn chdc chdn thai ngodi tu cung ddng a vdi irung. Chi cd 0.6% bj thdt bgi v&i phdu thudt npi soi. 96% irudng hop chi su dung mpt liiu khdng sinh dir phdng Khong cd tai biin trong phdu thudt vd hdu phau Tdt ca thong sd trin chung to tinh hi?u qua cua phitang phdp phdu ihugi npi soi thai ngodi tu cung.
TK khda: Npi soi thai ngodi tu cung.
ABSIHACr
ENDOSCOPIC MANAGEMENT OF ECTOPIC PREGNANCY AT NDGD HOSPTTAL FROM 01-2009 TO 04-2010 ,
Vo Doan My Thanh. Nguyen Thi Tham, Hoang Thi Hong Nga. U Thi My Hanh, Huynh Thi Thuy, Nguyen Thi Hong Van • Y Hoc TP. Ho Chi Minh * Vol. 14 • Supplement of No 4 - 2010:43 - 48 Objective: Evaluate the effectiveness and the safety of laparoscopic treamient of ectopic pregnancies.
Methods: - Types of research case series report through retrospective studvfrom medical records of cases of ectopic pregnancies treated by laparoscopic surgery in our hospiialfrom January 2009 to April 2010
ResuUs: - Unruptured ectop^ pregnancies coiisliluied for ihe majority (60%) of laparoscopic surgery • 70% of cases had a history of surgical abortion. - 5% of cases had a historv of previous ectopic pregnancy • Most frequent symptoms presented were missed periods, abdominal pam and viginal bleeding - Only 1 case (0.6%) failed IO laparoscopic procedure and had to do open surgerv. • Blood loss less than 300ml in 69% of cases. - Operating Umeless than 45 minutes m 40% of cases. - One dose of prophylactic aniibioties in 96% of cases - In over half of cases n54%, the hospitalization time was 3 davs or more - There was no sureical
complication on our smdy ' * Conslusion- (!) Transvaginal ultrasound combined nth quantitative P-HCC helped to diagnose e
* Khoa San phu khoa- Benh vien Nhdn Dan Gia Djnh
Dia ch, liin l„: BS. V5 Doan M, Thanh BT. 0913.742 711 £ ™ „ . htbachmy,[email protected] '"'^•"'f'"'P''P''Sn'»'l''l'Mj.(2,0„ly,caset0.6%nail,diolapa,„.copicproc,durel3iNoaccidem
or c,mp,canon recorded dunng and afier operauon. (4) The„ re^bs LonLLt.. J ' a Z e 7 Z 2 safely- of laparoscopic melhodfor ilie Ireamiem o/eclopic pregnancies.
Keywoids: Endoscopic eaopic pregnancv D^TVANDt
Tltat ngoai at cung ,a benh ly ph„ Ithoa c6 M gSy „i vong nja benh nhin djn beri, vijn tti. hoac kh6„g dttgc
Hpi Nghi PhSu Thuat Npi Soi BV. NhSn Dan Gia D i n h - N a m 2010 43
Y Hpc TP. Ho Chi M i n h * Tap 14 * Phu b a n o i a So 4 * 2010 Nghien cuu Y hpc
chan do5n va dieu iri kip thdi. Xgay nay. diai ngoai lu cung cd the dupe chdn dodn sdm trudc 7 tudn vd kinh nhd: dinh lupng PHCG. djnh lupng progesteime. sieu am ddu dd am d^o. rod npi soi didn dodn.
Khoa phg benh vi^n Nhan Dan Gia Djnh ap dyng k>' ihuai md npi S(» chdn doan \'a dieu tri diai ngoai nr cung lu nam 2009 dSn nay. Thdng ke cac ca diai ngoai tu cung dupe md n ^ soi mmg dwi gian qua nhdm ddnh gid tinh hieu qua cua phuung j A ^ nay ucmg chdn doan vd dieu tri diai ngoai tii cung t?ii khoa rfiu khoa b^nh vien Nhan Dan Gia Dinh.
Danh gia tmh hieu qua cua phuong (rfi^ phlu thudi ndi soi nwig chSn doan vk dieu in diai ngoai nr cung tai khoa phy khoa b?nh vien Nhdn D5n Gia Dinh.
BOnLgNG-IHR^GIHiPNGHIENCLtJ Doi tuqog ngfaien cuu
Tieu chuSn chpn mSu
Bao gom cac benh nhan diai neoai ni cung dupe n
3Qrt)4/2010 theo cac neu diudn: I npi soi tai benh vien Nhan Dan Gia Dinh tir 01/01/2009 den E>upc chdn doan fliai ngoai ni cung chua vd. hode thai ngoai tu cung n mdu ho^c vd nhung chua shock.
Chan dodn nghi ngd thai ngodi ni cung.
Benh nhan ddng ;y md npi soi Tieu chudn lop trir
B^nh nhdn chdng chi dinh chung cua phdu thudt ndi soi Thai ngoai tu cung vd co shock.
Phirong phap nghifn cihi Logi hinh nghien cuu
Bao edo hang lo^i ca.
Thu Ih^ ditkiin
Dir kien dugc thu th|p qua hoi cuu hd so c ^ ca md npi soi thai ngodi ni cung tir 01A)l/2009 den 30^)4/2010 tai benh vi?n Nhan Dan Gia Dinh.
Xir ly dir iden
Dir kien diKxr nhap bang phdn mfm Excel va xu ly bing phdn mem SPSS.
Tieu chuan danh g ^ thitiih coog
Khong xay ra lai bien hay bien chiing trong cuoc md. trong thdi gian hdu phlu.
K£T QUA NGHIEN cut:
Tai b?nh vi?n Nhdn Dan Gia Djnh tii 01/2009 din 04/2010 chung tra ^ nh^n cd 158 Uudng hprp md npi soi diai ngoai tii cung tren 510 Huong hpp md thai ngoai tu cung, chiem ty le 30,98%.
D^c diem chung Tudi Bdngl:
Tu6i 16-19 20-24 25-34
= 35
Soca 10 37 57 54
T y l f % 6.3.^%
23.41%
36.06%
34.20%
Nhdn xet • nhdm tudi thuimg gjp n S6l&nsanh
Bdng 2
11 la 25-34 tudi. Cdc ca Ben 25 tudi chiem 70.28%.
SJ lan sanh Chua sanh lan ndo
SanhOlIan Sanh 02 lan Sanh tren 03 lan
Soca 46 53 38 21
Tylc%
29.12%
3334%
24,10%
13.24%
Hpi Nghi P h a u T h u a t Npi Spi BV. N h a n Dan Gia D i n h - Nam 2010
Y Hpc TP. Ho Chi Minh * Tap 14 * Phu ban ciia So 4 * 2 Nghien ctru Y hoc
Nhdn xet: Nhdm (E c6 01 Idn sanh duem Ij- le cao nhdL Tien can ngo hdi thai
So lan nao hiif thai Chua nao hdt thai Cd tien cdn nao hut thai
Soca 50 100
T y l | % 31,65%
64,29%
Nhdn xet: Nhdm cd tien ciin n^o hdt diai cd ty le cao.
Ti^ cdn thai ngodi turcung
Benh nhan cd lien can thai ngodi tu cung cd 8 ca chiem t\ le 5,06%.
Trif u chimg lam sang Tri^tt chung
Tre kinh. dau bung, nmg huyet sd ihdy khdi canh tu cung Bdng 4:
Tri^u chihig ISm s^ng Tre kmh Dau bung Rong huyet So Ihay khdi canh cu cung
Sica
157 140 119 34Tylf%
99,36%
88.60%
7532%
21.51%
Nhdn xet: iri?u chiing Irl kinh Id nieu chiing thudng gap nhat, diii den la trieu chimg dau bung, (t khi so duoc khdi canh tu cung.
Cbijc do tui ciing sau BdngS
Ch^c do tii ding sau Khdng chpc dd Chpc dd ra mdu khdng ddng
Oipc dd khdng ra mdu Soca
90 58 10
Tyle%
56.96%
36,71%
6,33%
•Nhdnxef da so cdc ca thai ngodi ni cung dugc md npi soi khdng chpc dd tui ciing sau.
Ty le chpc dd am tfnh gia la 6%.
Trifu cbin% c&a lam sang Bjnh lirpng pHCG
- Cd 82 ca khdng dinh lupng. 76 ca cd djnh lupng - Trong 76 ca cd djnh lupng. ghi nh{in ket qud nhu sau- Bmg 6:
Djnh Iu9i« PHCG (mUI/ml) Dudi 1000 Tir 1000-1500
Tren 1500
S^ca 25 23 28
Tylf % 32,89%
30,26%
36,85%
" xet: nhdm b?nh nhan cd djoh lupng pHCG uen 1500mUI/ml chiim cy le cao bon (36,85%).
Nhom benh nhan cd dmh lupng pHCG 1000 -1500mUI/ml cd ty le t h ^ hon (30,26%).
Nhu vdy t> le phan bd khd ddng deu o 3 nhdm.
Siu&m
Cd 07 ca khdng sieu am. chiem tj' 1? 4%, 151 ca cd sieu am chiem ty 1? 96%.
xet 151 cacd sieu dm kei qua nhu sau:
NQI nvfc tie cung Bang 7:
Npi mac tu cung (mm) EhrdiStmn Tren 8 mm
Soca 37 104
T y l l % 26.2 73,8
Hpi Nghi Phau Thuat Npi Spi BV. Nhan Dan Gia Dinh - Nam 2010 45
Y Hpc TP. H o Chi M i n h * T a p 14 * P h u b a n cua So 4 * 2010 Nghien cmi Y hpc
Cd 10 ca khdng do npi mac tu cung.
C^ 141 ca do Dpi mac tir cung.
Nhdn xet: cac ca do npi mac tu cung > 8mm chiem t>' le cao nhat 73.8%.
Cd khdi cgnh tu cung
107 ca sieu am cd khdi cgnh hi cung dat 70.86%
Dich tui cung Dich tui cilng / sieu am
C6 Khong
S^ca 115 36
T y l c % 76.16 23,84
Nhdn xit: da s6 cdc tmdng hpp diai ngoai tu cung jJidt hien cd djch tui ciing Uen sieu dm So sanh dilo doan trud'c va sau mo
^mg 9: Chdn dodn tnrdc vd sau md:
Chan dodn tnrdc ID6 Thai ngoai ni cung v6 83 ca (52,5%)
Tliai ngodi tir cung chua vd 75 ca (47J%)
Chin doan sau m5 Thai ngoai tu cung vd 62 ca (39.3%)
Thai ngoai tir cung chua vd 95 ca (60%)
Thai trong tii cung
1 ca (0.7%)
Nhdn xet: cd su khdc biet giua ly le thai ngoai tii cung vd va chua vo trong chdn dodn trudc md va sau md.
Chdn dodn sau md: thai ngoai Di cung vd thap hon thai ngoai Oi cung chira vd.
K^t qua giai phlu b|nh
Phil hpp vdi thai d tai vdi 157 ca chiem tj' le 99,37%.
Khdng phii hpp vdi thai d tai vdi 1 ca chidm ty le 0,63% (ca nay chan dodn sau md la nang hodng die ttiai ky vd.
diai Uong ni cung.
Xii tn': cdt Ipc md nghi nang hodng ttig vo va ngo Idng ni cung.
Kdl qua gidi phdu b ^ : thai d budng ming.
Nhdn xet: 99% cdc tnrcmg hop thai ngoai tii cung d dng din tning diu duoc chdn dodn chmh xdc qua ndi soi d byng.
D^c diem ciia cu8c mo n$i soi
Md ngi soi thit bai phai diuydn md ho cd 1 uudng hpp do d btfng dihh vi viem nhilm cii, chi&m ty le 0,6%.
Ky thu& mo
cit tai vdi cd 157cachiemtyl$ 100%.
Thdiffanmo
Trong 158 ca duoc chi djnh md ndi soi cd 1' ca mo bung. Trong 157 ca md cdn lai dugc ghi nhdn nhu sau:
Bang 10 Tbdi gian md (phdt)
<30 Tu30den<45 Tir 45 den < 60 Tir 60 den 120
Soca 7 57 91 2
T>'1|%
4.46%
36.30%
57.59%
1.65%
Nhdn xit: da sd cuOc md keo dai tu 45 phdt den 60 phuL TTidi ^an md ming binh la 47 phdl/ca.
Luang mdu mh Oirdc mo Bang 11
LaOBg mau mat tronf 8 b\ing (ml)
0 0-<300
Soca 15 108
T y l | % 9J%
65%
Hpi N g h i Phau Thual Npi Spi BV. N h a n D a n Gia D i n h - Nam 2010
46Y HPC TP. HP Chi Minh * Tap 14 * Phu ban ciia So 4 * 2 Nghien cuu Yhj
>300 34
Z]
Nhdn xet: Uime mau n ^ dudi 300ni] chiem ty 1? cao nhai 69%.
Cd 9.5% cdc trudng hgp nong d byng chua cd n Lupng mdu mdi trung tnnh 224 ml Khdngsinh
Bang 12:
Khar^sinh Du|rfiong
Soca
!51
T y U ^
Nhan xet: cdc cugc md ndi soi thai ngoai tu cung rdt it su dyng khdng sinh dieu Uj.
Thdi gian ndm vi^
Thin gian (ngdy) 2 3 4 5 6
Soca 2 68 75 10 2
Ty le % 1.27%
43,31%
47.77%
6,37%
1,28%
Nhdnxef thin gian nam vi^n uen 4 ngdy chiem ty 1? cao nhdt Thdi gian ndm vi?n mmg buih Id 3,6 ngdy/ca.
Tai biai ph&u thu^
Tdn thuong mgch mdu , tran khi, nhilm Hung, chay mdu thii phdt sau md, thiing rudt, thiing bdng quang khdng xudt hien uong 157 ca md npi soi diai ngoai ni cung tai b^nh vi^n Nhan Ddn Gia Dinh.
BANLUAN
Ty 1? dial ngodi tu cung chua vd chi^m da s6 (60%). Tdt cd cdc mrong hpp diu dugc phdu thudt kjp thdi vd khdng xay ra tai bien. Dieu ndy cho thdy thai ngoai tii cung hoan todn cd diS dupe chdn dodn vd didu tq sdm, ft dnh hudng xdu din siic khde ciia ngudi [rfiy nii.
Tudi diudng gdp la 25-30 tudi. gdp 6 lan so vdi lua tudi tu 16-19 ludi. Kei qua n^icn clhi phii hpp vdi nghien ciiu ciia benh vien Tii Du va mpt sd nghien cuu o nude ngodi"^'. Cd le khi tudi cang cao dii ty le viem nhilm viing cl^u ciing tang ien dua ddn hdu qua diai ngodi lu cung. Dg tudi til 16 din 19 tudi il cd thai hon so vcri dp tudi 25 den 30 tuoL
Khodng 70% cdc uudng hgp dd cd sanh tdi thilu I Idn Tuy nhien 30% mrong hgp cdn lai la chua sanh. Day Id van de cung can phdi d^l ra cho viec phau tfiudl bao tdn tai vdi, de duy tri khd ndng sanh dd cho ngudi phu nii.
ve lien cdn nao hut thai, chung tdi ghi nhdn khoang 70% cdc Uudng hpp diai ngoai tii cung cd tien cdn njo hiil diai.Ddy Id con sd ddng quan tam. Kit qua ndy phii hpp voi nghiSn ciiu cua Le Anh Tuan''" thuc hien tai Ha Ngi, khi thuc hifn 1 nghien ciiu benh chung da cho ihay nguy co bj thai ngoai oi cung p a tdng 2,3 Idn Uen nhdm cd lien can n^o hui thai, vi con sd nay la tir 3-5 Idn trong nghien cuu T? Thi Thanh Thiiy diuc hien tai benh vi?n Td Dfi vd benh vien Hung Vuong vdo ndm 1 9 % ' . Cd IS n^o hiit thai dua den finh trang viem nhiem npi mac Hi cung vd lai vdi lam tdn Ihuong vd dl l^i s ^ tren lop bilu md ciia tai vdi, dua den h^p khdu kinh vd ngdn can khdng cho tning thu tinh di chuyin vao budng tu cung. Nhu vdy ming se ldm td vd phdt triln d tai vdi. Nghien ciiu cua LeVin'^' th(rc hien lai MJ cho thdy nguy co thai ngoai ni cung gia ldng theo sd 1^ n?o hut thai (aOR=l,3 doi vdi 1 Idn hiit ngo vd aOR=2,0 ddi vdi > 2 Idn hdi nao).
Cd 5% trudng hpp benh nhan bj thai ngoai iii cung uudc dd. Day la con so khong cao nhung cung ddng phai suy n ^ , vi neu dieu hi tnet de thi s£ anh hirong den khd ndng sanh de cua benh nhdn, ddc biet tren nhiing bfnh nhdn chua du con ho$c chua cd con.
Da sd cdc trudng hgp c& tam chiing Idm sang cd diln la ue kinh, dau byng, rong huylt Trong Y Vdn ghi nhdn ty le nay khoang 50% "^'.
Chi khoang 20% cdc uudng hgp sd dupe khoi c?inh Hi cung, ly le nay hoi thdp hon so vdi Y Vdn (50%)'^' Cd B do k) ndng khdm lam sdng.
56,96% cdc trudng hgp chung tdi chdn dodn thai ngoai tii cung vd khdng cdn choc dd tiii cung sau. Dilu ndy dat dugc la nhd nhiing tiln bp cua sieu dm nga am dao vd djnh lugng pHCG.
Kei qua djnh lupng pHCG cung cd nhilu dilu phai quan tdm. Khodng 36,8% cdc tnrdng hgp c6 miic pHCG>1500mL'I/ml, viec chdn dodn sS dl dang khi si6u dm n ^ dm dao khdng thdy hmh anh tiii diai trong ldng tu cung Khi pHCG o miic 1500mUl/ml thi viec chdn dodn sS khd khdn hon, ddi hoi siSu am phai chinh xdc hon. Chung
Hpi Nghi Phau Thual Npi Soi BV. Nhan Dan Gia Dinh - Nam 2010
Y Hpc TP. Ho Chi Minh * Tap 14 * Phu ban cua So 4 * 2010 Nghien cuu Y hpc
loi ghi nhan khoang 71% ck: trudng hpp diai ngodi tu cung trong n ^ d n cuu cua diiing tdi phat hien dugc khdi qinh tu cung udn sieu dm. Nhu vay vai ud cua sieu am tioog didn dodn sdm thai ngoai tu cung la Uidng dil phti nhfin dugc.
Cdsu khac t»et inxig chdn doan thai ngoai iii cimg vo va chua vd nude mo \ a sau md. Neu trudc md cd 52.5%
iTudng hpp la chdn dodn ttiai ngoai or cung v0 thi sau md ri le nay giam xudng 39%. Dieu nay dugc giai diich Id do trong benh canh thai ngodi ni cung cd tinh tr^ng ri mSuquakta vm, do do sieu am sSco dich d tiii ciing sau (76,16%
theo nghien ciru cua chiing tdi). va khi chpc dd se la mdu khdng ddng (t> le choc dd am tiidi gia la khdng cao, khoang 6% theo ghi nhdn cua chung idi). Se khd [dian biei day la mau chay ra do vd lai vdi hay do ri mini qua loa v£s u&i Iam sang.
Kei qud gidi jrfidu benh st la tieu chudn dl chdn doan chic d ^ diai ngoai tu cung. Tuy nhien ngi soi 6 hung la ueu chudn vang de chan doan. Chung tdi ^ nhan dugc 99% cac tiudng hop thai tai vdi dugc chan dodn bdng ndi soi.
Chi c6 1 ca diai ddng o budng irung vd. bi dian dodn nhdm Id nang hoimg die thai ky vd va diai trraig ni cung. Day la trudng hgp Idid vi Hidi ttiai d budng tning da bj vd sS r ^ khd nhdn dien uen d^i flil.
Npi soi didt bai chi 1 uudng hgp (0,6%) phdi chuyin md bd cfavmg td tinh kha dii ciia npi soi uong dieu ui phlu thu^ thai ngodi tu cung.
Da sd lugng mdu mdt lue md <300ml (69%) dieu nay chitng to diai ngoai ni cung da dugc chdn dodn ngdy cdng sdm hon. Tuy nhieiL gdn 100% cac truong hpp la phdu dmai cdt tai vdi uong khi cd tdi 29% trudng hgp chua cd con, 5% dd c6 tien cdn thai ngoai tu cung. Do dd cdn [rfiai dar vdn dl ddo tao k$ thuat md bao tdn thai ngodi tu cung 6 tai vdi. Tir thang 07/2010 khoa phu BVXDGD da bflt ddu dilu ui bdo tdn tai vdi.
TlKri gian md tmng binh 47 phdt. dav ta ccm sd ddng quan lam so vdi md bune hd ciia mpt sd n ^ e n ciiu la 104 [rfiiit"'.
Da sd cdc trudng hpp (96%) chi su dung khdng sinh du phdng lam giam ddng ke dii frfu dicu ui cua benh nhan.
Thoi gian ndm vien; khoang gan phan niia la 4 n ^ y (47.77%). dwt gian ndm vien uung binh la 3,6 ngay/ca. C6 M d n phdi xem xdi lai vi CCHI SO ndy hoi cao, chdng toi can phai dm hieu diem ly do t^i sao. Tuy nhien so vdi thdi gian uung binh cua md hd la 5 n ^ y . ttn day cung la ctni so d ^ g khich le. va chiing td tinh hieu qua. kmh tl ciia phuong phdp. Mpt {fieu ddng mimg la 157 c ^ trudng hpp phlu diupt ngi soi oia chiing t& da khdng c6 tai bien nao xay ra trong vd sau phau thu^L
KETLUAN
( ^ 158cdctriidnghgpphauttiudindisoi tpi benh vien Nhdn Dan Gia Dinh tit thdng 01/2009 din (M/ZO10 chiing toi ghi nhdn dugc cdc ket qua nhu saii:
Sieu am n ^ am d^o kit hpp vdi dinh lugng pHCG da giiip c l ^ dodn sdm thai ngoaini cung 6 giai doan chua vd (60%).
Ngi sold bung gitip chiing tdi chdn dodn chac chdn thai ngoai tii cung ddng d vdi triing (100%).
Qu 0.6% bj thdt b^i vdi phau thu|l ngi soi. Ddy la ctxi so ddng khich le.
96% cdc trudng hgp dii dimg 1 lieu Ididng sinh du phdng.
Khdng lai bien nao dupe giii nhdn trong va sau jriiau thuat Thdi gian ndm vien dudi 3 nga> khoang 45% can phai xem x& Ij do.
Tdt ca cdc thdng sd udn chiing to linh hieu qua v^ kha thi ciia phuong piiaip.
Qt}^ nduen ciiu chdng idi thdy cd nhdng ^'dn de can ddt ra: Idiraig cd trucmg hpp nao dugc pdilu thudt t)ao tdn lai vM (1(X)% cac trudng hpp diu cSt tai vdi). NTiu vgy. ky diuat mo bao tdn tai VM can dirge phdt uien de (luy tri kha ndng sinh de. Dii ti le chdn dodn sau md cd 60% trudng hpp diai ngoai m cung chua vd. nhung chi cd 9.5% uuimg hgp dura cd mdu nong d byng uudc md. Vdn dl d$t ra la cdn md i ^ g hon nira du diiA md.Doi soi chdn dodn ihai ngoai tir cung diua vd, h ^ die tdi da lugng mdu mat tnrdc md va c h ^ nhjto cd ti le md trSng.
TAI LIEU THAM KttAO
1. Beranscm A. etal (1991); Bacioiologic findings widiectc^icpiegnancy. J Reprod Med J6:118.
2. Dorftnan SF, a al (1987): The etidogy of ectopic pregnane). Oin obsta - gyiiecol !987iJ0 (1): 173 3. Job SN, ci al (1993): Risk factors for ectopic pregnane). Results of a ca.se conuol smdy in die Rhcmes -Alpcs
regiwi. Conna;epsIFerta sex 1993A[B-21 (14):307.
4 Le Anh Tuan (1995). Mensuual r^uladon and e c i c ^ pregnancy. Thesis ftjr Master degree on efsdemiokigy Prince of Songkla University - Thailand.
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