graft ean be epithelized with conjunctival epithelium. Fat resorption can be encountered, especially when preseptal transplantation is done. Conclusion: Dermofat is a valuable autologous material used in oculoplastic surgery.
Keyword: dermograft, oculoplastics
NHAN XET KINH NGHIEM XU" T R I RAU CAI RANG LU'QC 6 THAI PHU
• • • •
Bj RAU TIEN DAO CO SEO MO DE CU TAI BENH VIEN PHU SAN TRUNG U'QNG TRONG 2 NAM 2008 - 2009
Dinh Van Sinh\ Dang Thj Minh Nguyet^
^Bpnh vien Da khoa Nghe An, ^Trwdng Dpi hpc Y Hi Ndi Nhin xet thii dp xir tri rau oil ring luvc (RCRL) a thai phu bj rau tiin dao (RTD) cd spo md de cu (SMDC) tai Benh vipn Phu sin Tmng wang trong 2 nam 2008 - 2009 va cie tai biin thwdng gap. Ddi twang vi phwang phip:
Nghien cim hoi ciru tir 110 trwdng hap rau tiin dao (RTD) cd hd sa vdi tudi thai tir 28 tuin trd len, cd see md de cu, duvc chin doin li RTD qua lim sing vi sieu im, di duvc de tai BVPSTU trong thdi gian tw ngiy 1 thing 1 nim 2008 den ngiy 31 thing 12 nam 2009. Kit qua: Cd 24 tnrdng hvp duvc chin doin RCRL, ty Ip RCRL a thai phu bj RTD cd SMDC chiim 21,8%, ty Ip RCRL d nhdm tudi > 35 chiem ty Ip cao nhit. Diiu tri: Ty le phii cat tir cung bin phan thip, chiim 91,67%, trcng dd cd 2 trwdng hap cat tir cung bin phin thip (BPT) kem that ddng mpch hp vj. Biin chimg tdn thwang tang a viing tiiu khung do RCRL chiim ty le 85,7%, ty Ip phii tmyin mau li 70,8%, trong dd sd trwdng hpp phii tmyin tren 3 dan vj chiem 6%>. Kit luin: Ty Ip phai cit tir cung bin phan thip chiim 91,67%, trong dd cd 2 trwdng hpp cat td cung BPT kem that dpng mpch ha vj. Biin chimg tdn thwang tpng a vung tiiu khung do RCRL chiim ty Ip 85,7%, ty Ip phai tmyin miu li 70,8%, trong dd sd trwdng hap phai tmyin tren 3 dan vj chiim 6%>.
Tu- khoa: rau ti§n d^o, rau cai rang luge
I. DAT
V A NBt
RCRL l i mdt benh ly s i n khoa hiim gap, khoang 1/2000 - 1/7000 ea de mdi nam, nen trude diy it dugc quan t i m v i chin doin d i bj bd sdt.
Tuy nhidn, ty Id RCRL d i dugc ehCrng minh l i ting Idn cd y nghTa thong kd d nhu-ng san phu bj RTD v i sin phu cd tiin su- mo liy thai. Miller DA nhan thay ring RCRL chiim ty Id 9,3% trong so nhirng phu nO- bj RTD. Laura M.R cung nhin thiy r i n ^ ty 16 RCRL cd lien quan tdi RTD v i ting qua cie nim: nim 1952 ed 0,2% RTD cd RCRL, nim 1975 - 1977: 4,09%, nim 1985: 10,1%. tai benh vien Phu san Trung uang theo Nguydn DCre Hinh gap RCRL d 2,9% (1989 - 1990) v i 6,4% ( 1993 - 1994) cie san phu bj RTD ed seo mo de cu, Oiiu trj RCRL rit khd khin, thudng phai eit tu- cung, giy nhieu biin ehCrng ning n i , nhit l i doi vdi nhu-ng phg nu tre tuoi cdn nhu c i u sinh de.
Ngiy nay, do ty Id mo lay thai ting Idn, dong nghTa vdi bdnh nhin bj rau t i i n dao cd v i t mo de
cu ngiy cing ting len, nhiiu tie gia d i nghien cu-u sy lien quan giii-a benh nhin bj RTD ed SMDC vdi RCRL [1, 3, 8]. Vdi sy tiin bd vugt bic eua chin doin hinh anh, die biet l i sieu i m thi vide chin doin RCRL d thai phu bj RTD cd SMDC khdng phai khd. Tuy nhien, ky thuit mo liy thai d RTD ed SMDC thudng khd khin han do dinh RCRL v i nguy ed tai biin cho thai phu cao. Mdt ciu hdi dugc dit ra l i cie nhi san khoa cin dua ra cich xu- tri nhu t h i nio ddi vdi nhii-ng benh nhin bj RCRL d i nhim giam nhu-ng tai biin v i biin chu-ng cho me v i con. Vi viy, ehung tdi thye hien nghien eCru niy vdi muc tidu:
Nhin xdt thii dp xu- tri RCRL d thai phu bj RTD cd SMDC.
Nhu-ng tai biin thudng gap cua RCRL d thai phu bj RTD cd SMDC.
II.
D 6 ITU'QNG VA PHU'QNG
P H A P I.Ddi tu'ang1.1. Tieu chuan Iwa chon
Cie san phu cd ho sa vd-i tuoi thai tCr 28 tuan trd len, ed see m i de eu, dugc chan dpin l i RTD qua lim sing v i sieu i m , da dugc de tai BVPSTU"
trpng thdi gian tCr ngay 1 thing 1 nam 2008 d i n ngiy 31 thing 12 nim 2009. Cd hd sa vdi d i y du cie thdng tin can nghien cCru.
1.2. Tieu chuan loai trw
Cie san phu bj RTD ed seo mo de cQ nhung ho sa benh i n eua hp khdng day du eic thdng tin can ehp nghien cu-u.
+ Khdng ghi rd the l i m sing RTD, khdng ed sieu i m chin doin.
+ Cie san phu dugc chan doin trude sinh la RTD tren v i t mo de eu nhung sau sinh khdng phai RTD nhu: Rau bong non, rau bim mang, de non khdng phai do RTD.
Cie san phu ed tuoi thai dudi 28 tuin ...
1.3. Tieu chuin chin doan
Ouge the hien rd trong hd sa benh i n .
Diu hidu l i m sing v i hinh anh sidu im de chin doin.
Nhii-ng bdnh nhin dugc chin doin hoi cu-u sau sinh l i RTD ed SMDC.
2. Phipang phap
Chung tdi su- dung phuang phip nghien cu-u md ta hoi cCru, ed mau nghidn cu-u trong 2 nim dugc chpn l i m i u ngiu nhidn khdng xie suit trong khoang thdi gian tCr ngay 1 thing 1 nim 2008 den 31 thing 12 n i m 2009.
3. Xip ly sd lieu
Xu- ly bing phin m i m SPSS 11.5
III. K^T QUA
Ty Id RCRL d thai phu bj RTD ed SMDC Bang 1. Ty le RTD va RTD co SMDC
- » _ _ ^ ^ Nam Rau t i i n dao ^ Rau c i i ring luge
Rau tiin dao/seo mo de eu Tong so
Tyld
2008 6 45 51 11,76%)
2009 18 41 59 43,9%
Tdng s6 24 86 110 21,8%
Nhin xdt Ty Id RCRL trong 2 nim chiim 21,8% trong dd nim 2008 chiim 11,76% v i nim 2009 chiim ty Id 43,9%
Xip tri RCRL
Bang 2. Cac phu'ang phap c i m mau trong mo RTD
Phipang phap c i m mau Khdng ean thidp gi thdm
Chdn gae tam huyit thanh i m Khiu mui BIynch
Khiu mui ehu' X tai dien rau bim
Co 1 0 0 1
RCRL Khong
33 3
1 7
% % 30,3
2,8 0,9 7,3 Thit ddng mach
tu- cung
Dan thuan 12 11,0
Khiu mui ehCi- X 27 25,7 37,8
Mui BIynch Cit tu- cung bin Dan thuan
phan thip Thit ddng mach ha vj Tong $6
0 19
2 24
2 1 0 85
1,8 18,4
1,8 100
9 0 9
^U,zl
Nhin xdt Ty Id phai eit tu- cung bin phan thap doi vdi nhCi-ng trudng hgp RCRL l i 87,5% (21/24). Cd mOt trudng hgp RCRL Ipai RBC khdng phai ean thiep gi.
Bien chii'ng RCRL
Bang 3. Sd dan vj miu phai truyin va RCRL
Dan V
0
1 - 2
>3
Tong
- - ^ ^ T i n h chit 'j mau~-^^.^^
RCRL Cd
7 8,5%
8 57,1%
9 64,3%
24 21,8%
Khdng 75 91,5%
6 42,9%
5 35,7%
86 78,2%
Tdng
82 74,6
14 12,7%
14 12,7%
110 100%
OR
14,29
19,29
95%CI
3,17 ^ 64,54
4,20 : 91,68
Nhan xet: Ty Id phai truyin mau cua benh nhan bj RCRL la 70.8% (17/24), trong dd benh nhin phai truyin 3 dan vj miu trd len chiim 52,9% (9/17).
Nguy ca phai truyin 1 2 dan vj mau d benh nhan bj RCRL tang gip 14,29 lin so vdi benh nhan khdng cd RCRL ( OR = 14,29; 95%CI = 3.17 - 64,54) va nguy ca phai truyin > 3 dan vj miu d benh nhin bj RCRL ting gip 19,29 lin so vdi benh nhan khdng cd RCRL (OR = 19,29; 95% CI = 4,20 - 91,68).
Bang 4. Phan bd giO'a tdn thu'ang tang va RCRL
"~~~~---^J^n thu'ang Loai rau^^"~~--~^,.^^
Rau cii rang luge Rau dim xuyen Rau bim chat Khdng Tong so
Rich bang quang
1 5 0 0 6
Rich ca tip cung
1 0 0 0 1
Rudt 0 0 0 0 0
Khdng tdn thu'ang
10 5 7 86
Tdng 12
5 7 86 110 Cd 7 trudng hgp ton thuang bang quang va rich ca tu- cung do RCRL chiim ty Id 29.17% (7/24) Trong dd cd 6 trudng hgp ton thuang bing quang chiem 25% (6/24), bao gdm 5 trudng hgp do RDX v i 1 trudng hgp RCRL.
- Khdng cd trudng hgp nio ton thuang rudt va tu mau.
vira cit TCBPT v i vira thit OMHV. Ty le cit
IV. BAN LUAN
Ty le RCRL d- thai phu bj RTD cd SMDC Ty le RCRL trong 2 nam l i 21,8%, ty Id nay thay doi qua eic nim, nam 2008 l i 11,76% v i nim 2009 ty Id niy l i 43,9%.
Oiiu trj: Trong 109 benh nhin bj RTD cd SMDC phai mo liy thai thi chung tdi thiy ty Id cit tu- cung do RCRL-ROX l i 100%, trong dd cd mdt trudng hgp vCra eit TCBPT vCra thit DMTC. Cd 6 trudng hgp rau bim chit, cam miu bing eit TCBPT Ti 4 trudng hgp, trong dd cd mdt
TCBPT trong RCRL la 87,5% ( 21/24). Nhu viy, cich xu- tri ddi vdi thai phu bj RTD cd SMDC d nhCrng benh nhin cd RCRL thi chu yeu vin l i mo liy thai sau dd kem theo cit TCPPT. Cd mdt trudng hgp nghi rau bim chat, bdc rau khd khan, khdng chay mau, ngudi phiu thuat vien quyet dinh bao tdn tu- cung va theo ddi sau phiu thuit, sau 5 ngiy'kiem tra tren sieu i m khdng thiy hinh anh sdt rau v i benh nhin ra vien. ChCing tdi nhan thiy ring doi vdi nhii-ng trudng hgp RCRL bdc rau khd khan, khdng thiy chay miu tren nhirng thai phu tre
tuoi cdn mong mudn cd eon thi vide lya chpn c i t tu- eung hay bap ton ngudi phau thuit vien c i n c i n nhic. Niu lya chpn phuang phip baa t i n tu- cung thi cin trao doi vdi ngudi nha benh nhin nhu-ng tinh huong ed the xay ra va theo ddi s i t trude khi cho benh nhin ra vien. De giam mit miu trong RCRL thi ngoii vide dCrt khoit trong lua chpn bao ton hay eit tu- cung, mdt sd t i e gia [2,4,7,9] khuyen nen c i t TCBPT trong mo liy thai vdi RCRL, vide eit tu- cung phai dugc thye hien mdt cich ty mi d i giam sy mit mau, ngudi phau thuit vien cin thin trpng d i khdng lim thuang tang lin can. Mit miu trong RCRL l i bien ehCrng rit nang, de doa den tinh mang eua thai phu, de giam lugng m i t mau trong q u i trinh phau thuat, mdt sd t i c gia da dua ra nhCrng phuang phip mdi nhim muc dich han chi nhCrng biin ehCrng xay din vdi thai phu.
Oa so eic bio cio trong dd ky thuat nut ddng mach chiu trong bing bdng trong thdi gian c i t tu- eung bin phin thip [5, 6]. Bdng dugc bam khdng khi lien tue khdng dudi 20 phut khi thye hien cit tu- cung v i cho thiy ring giam dugc sy mat miu v i lim cho phau trudng dugc khd, tao thuan Igi cho phiu thuit vien thye hidn eic dpng tie d i ding.
Tuy nhien, khi thye hien ky thuat nut mach thi cin thao luin vdi benh nhan nhCrng biin chu-ng cd t h i xay ra, vi khi thuc hidn nhCrng ky thuit niy cd t h i gip nhung biin chCrng nghiem trpng ed t h i xay ra nhu huyit khdi v i tie mach...
Hien nay ky thuit mo liy thai hiu hit dugc mo ngang doan dudi tu- cung, trong nghien cCru eua ehung tdi ed 4 trudng hgp mo thin tu- cung liy thai, trong dd cd 2 ea la RCRL. Theo suy luin cua ehung tdi, thi se cd sy lien quan giCra vj tri rau bim cua RTD d mat trude v i mat sau tu- cung, loai RTD v i RCRL tren cie benh nhin ed seo mo de eu. Vide rach dpc thin tu- cung se tranh di v i o binh rau v i trinh dugc m i t mau v i vide liy thai se de ding han.
Biin chii'ng
Ty Id phai truyin miu eua benh nhin bj RCRL l i 70,8% (15/24), trong dd benh nhin phai truyen 3 dan vj miu trd len chiem 52.9% (9/17). Nguy ea phai truyin 1 - 2 dan vj mau d benh nhin bj RCRL ting gip 14.29 Ign so vdi benh nhin khdng cd RCRL (OR = 14,29; 95%CI = 3,17 - 64,54) v i nguy ea phai truyin > 3 dan vj mau d benh nhin bj
RCRL tang g i p 19,29 l i n so vdi benh nhin khdng ed RCRL (OR = 19,29; 95% CI = 4,20 - 91,68).
Nhu viy, nhCrng benh nhin bj RTD ed SMDC/
RCRL thi nhu c i u truyin mau cao han so vdi benh nhin khdng cd RCRL. Trude eude phiu thuat, ngudi phiu thuit vien c i n dy tru miu d i giam nhu-ng tai biin cho me v i eon.
Trong 109 bdnh nhin bj RTD cd SMDC dugc phau thuit liy thai, cd 6 trudng hgp ton thuang bing quang (6,4%o), mdt trudng hgp rich ea tu- cung (0,9%o), 92,7%) khdng thiy ton thuang.
Trong ton thuang bing quang thi cd 5 trudng hgp dorau dam xuyen, mdt trudng hgp thai 38 tuan nhip vien, sieu i m RTOTT, ngdi ngugc (khdng phat hien RCRL tren sieu im) Hb trude mo la 116 g/l, seo mo dudng ngang trdn vd. Benh nhin d i dugc phiu thuit liy thai vdi dudng rach ngang doan dudi tu- cung liy ra mdt bd nang 3000g, apgar phut thCr nhit 9 diim, phut thu- 5 la 10 diim. Bdc rau khd khin, rau bim chit tu- cung, chl djnh c i t tu- cung ban phin thap, ton thuang day bing quang, khau phuc hdi bing quang, truyin 2 dan vj miu, Hb sau mo 97g/l, hinh anh giai phiu benh RCRL. Chan doan sau mo l i thai 38 tuin RTOTT cd SMDC, RCRL. Qua benh nhin nay Chung tdi thiy ring, tai biin doi vdi benh nhan RTD cd SMDC khd ludng trude dugc, benh nhan vio vien khdng ed d i u hidu bio trude, khdng phat hien ra RCRL.
Nhu vay, v i n d i dat ra la lim t h i nio de giam dugc tdi da eic tai biin cua thai phu bj RTD co SMDC? Theo chung tdi, nhu'ng benh nhin bi RTD ed SMDC phai ed mdt chiin luge chin doin va dieu trj. Ngiy nay, vdi su tien bd eua chin doan hinh anh thi vide phit hien ra RCRL khdng phai la khd khin. Trude khi mo cin chuin bj ky nhu chpn phiu thuat vien cd kinh nghiem, dy trii miu v i cac ky thuit hd trg khic. Ngudi phiu thuit vidn trong khi mo cin than trpng, tCr ton. Vdi nhu-ng trudng hgp 6 bung dinh c i n bdc tich v i bdc 10 bang quang tot, khi ed chin doin RCRL sau khi liy thai nen c i t tu- cung b i n phin thip, khdng eo bdc rau nhim trinh m i t m i u cho benh nhin. NhO-ng trudng hgp khdng ed RCRL thi nen bdc rau nhe nhing de giam tai bien cho me.
ChCing tdi thiy ring, vdi benh nhin bj RTD c6
SMDC ludn cd nhii-ng diin bien phu-c tap, ed nhung tai bien m i ngudi phiu thuit vien khd trinh khoi niu khdng cd kinh nghiem. Cin hdi chin vdi cac bic sy giy me, hoi sCre sa sinh v i can thiep mach niu cin thiit nhim muc dich giam toi thieu nhOng tai biin cho me v i eon. Mdt dieu cung khdng kdm phin quan trpng l i cin giai thich cho bdnh nhin nhu-ng tai bien ed t h i xay ra v i khi su- dung cie ky thuit can thiep mach cin cd sy ddng y cua benh nhin.
V. K^T LUAN
Ty Id phai eit tu- cung bin phin thip doi vdi nhCrng trudng hgp RCRL l i 87,5% (21/24).
Ty Id khdng phai can thiep gi vdi benh nhan bj RTD cd SMOC/RCRL l i 4,2%.
Ty le phai truyin miu eua benh nhin bj RCRL l i 70.8% ( 15/24), trong dd benh nhin phai truyin 3 dan vj miu trd len chiim 52.9%) (9/17).
Ty le ton thuang bing quang do RCRL d thai phu bj RTD cd SMDC l i 25%). Trong dd ton thuang bing quang do rau dim xuyen chiim ty Id 100%.
TAI
LIEU THAM
KHAQ1. Nguyin DiPC Hinh (1999). So sinh mo lay thai vi RTD d giai doan 1989-1990 v i 1993-1994 tai BVBMTSS". Tap chi thdng tin y dugc, so die bietchuydn d i San phu khoa (12/1999), 107-111.
2. Eller, AG, Porter, TF, Soisson, P, Silver,
RM. (2009). Optimal management strategies for placenta accreta. BJOG; 116: 648.
3. Federiksen M.C, Glassengerg R, Stika CS (1999). Placenta previa: A 22-year analysis. Am J Obstet Gynecol. June, 180 (9ptl), 1432 - 7.
4. Grosvenor, A, Silver, R, Porter, TF, Zempolich, K, (2007). Optimal Management of
Placenta Accreta. Am J Obste Gynecol; 195. Abstr No. 238. S 82.
5. Hong, TM, Tseng, HS, Lee, RC, et al, (2004). Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage.
Clin Radiol 59: 96.
6. Ojala, K, Perala, J, Kariniemi, J, et al (2005). Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage. Acta Obstet Gynecol Scand 84:1075.
7. Oyelese, Y, Smulian, JC, (2006). Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 107: 927.
8. Taylor V.M, Kramer M.D, Vaughan T. Let al (1994). Placenta previa and prior cesarean delivery. How strong is the association? Obstet Gynecol 84(1), 55-57.
9. Wing D.A, Paul R.H, Millar L.K (1996).
Management of the systematic placenta previa. A random controlled trial of inpatient versus outpatient expect management, AM. J. Obstet Gynecol, October, 175 (4plt), 806 - 1 1 .
Summary
DIAGNOSIS AND TREATMENT ATTITUDES PLACENTA ACCRETE AT PLACENTA PREVIA AFTER A PRIOR PREGNANCY
DELIVERED BY CESAREAN
Reviews diagnosis and treatment attitudes placenta accrete at placenta previa after a prior pregnancy delivered by cesarean in the National Hospital of Obstetrics for 2 years from 2008 to 2009 and common hazards. Subjects and research method: Non-probability retrospective research on 110 cases placenta previa after a prior pregnancy delivered by cesarean in the National Hospital of Obstetrics for two years from 2008 to 2009 including 24 cases placenta accreta. Results: 24 cases diagnosed placenta accreta, placenta accreta rate in women with plaeeta accreta have accounted for 21.8% pregnancy delivered by cesarean, placenta accreta rate in the age group over 35 accounted for the highest. Treatment: hysterectomy rate to sell low accounting for 91.67%o of which 2 cases Peripartum hysterectomy with Hypogastric artery ligation. Organ damage due to complications placenta accreta percentage 85.7%, the rate is 70.8% of blood transfusions in which the number of eases transmitted to the three units accounted for 6%. Conclusion: Hysterectomy rate to sell low accounting for 91.67%) of which 2 eases Peripartum hysterectomy with Hysterectomy
artery ligation. Organ damage due to complicatipns placenta accreta percentage 85.7%), the rate is 70.8%
cf bippd transfusions in which the number of cases transmitted to the three units accounted for 6%.
Keywords: placenta accrete, placenta previa
HIEU QUADI^U TRj CUA VIEN NEN TADIMAX
TREN BENH NHAN PHJ DAI LANH
T I N H T U Y ^ NTIEN LIET
• • •
TAI BENH VIEN LAO KHOA TRUNG U'QNG
Nguyin Viit Thanh, Pham Thing Bpnh vipn Lap khpa Tmng uxyng
Nghidn ciru tiin hdnh tai benh vien Lao khoa trung wong, bdnh nhdn phi dai Idnh tinh tuyin tiin li§t (PDTTL) duxyc diiu trj bdng vien ndn Tadimax vdi thdnh phin chinh Id chiit xuit cua Id cdy trinh nCehodng cung. Muc tidu: (1) Ddnh gid hieu qua diiu trj phi dai Idnh tfnh tuyin tiin lidt bdng vidn ndn Tadimax,(2) Ddnh gid tde dung khdng mong mudn cua thude. Ddi twgng vd phwong phdp: Phwong phdp nghien ciru can thiep thu' nghidm Idm sdng md khdng nhdm ddi chwng, 53 benh nhdn bj PDTTL dwgc diiu tri bdng thude trong 2 thdng. Kit qud: 92% bdnh nhdn kit qua diiu tri tdt vd khd; 7,5% bdnh nhdn kit qud kem. Cdc tic dung khdng mong mudn cua thude: chdng mat nhe 5,7%. Kit ludn: Ddy Id loai thude diiu trj cd hieu qui v^
an todn.
TCr khoa: phi d^i lanh tfnh tuyin ti§n Met, tadimax, hoang cung trinh nir
I. OAT VAN D^
Phi dai linh tinh tuyin tiin liet l i mdt benh thudng gap d nam gidi tren 45 tuoi. Ty Id mie benh ting din theo tuoi dat tdi 86%) d ICra tuoi 81 90 [2]. PDTTL giy roi loan tieu tien (RLTT) kich thich v i tie nghen dudng tiiu, eCing eic biin ehCrng lim anh hudng den chit lugng song eua bdnh nhin. Hidn ed nhiiu loai thuoc diiu trj cie roi loan tieu tidn do PDTTL giy ra, trong dd cd chief xuit eua i i eiy trinh nu- hoing cung d i dugc su- nhin din su- dung tCr liu vdi cich s i c l i udng, d i dugc nghien eCru hoat chit v i chu-ng minh ed tie dung trong diiu trj phi dai tuyin" tiin liet [3]. Mdi vidn ndn Tadimax cd eic thinh phin dugc chiit xuit tCr: l i trinh nu hoing cung 2000mg, tri miu 666mg, hoing b i 666mg, ich mau 666mg, dio nhin 83mg, trach ta 830mg, xich thugc 500mg.
Vidn ndn giup BN thuin tien trong viec su- dung thuoc. o i dinh g i i hidu qua, t i c dung khdng mong muin. cua thuoc niy va bo sung them mdt loai thuPC eua Viet Nam trong dieu trj PDTTL, ehung tdi tiin hinh nghidn cu-u de t i i vdi muc tieu: 1. Dinh g i i hi0u qua dieu tri phi dai linh tinh tuyin tien li#t
bing vien nen Tadimax. 2. Dinh gii tie dung khdng mong muon eua thude.
II.
D 6 ITU'QNG VA PHU'QNG
PHAP 1. Odi tu'ang: Nghidn eCru dugc tiin hinh tr§n 53 benh nhin bj PDTTL dugc uong thuoc vidn n6n Tadimax trong 02 thing.Tieu chuin Iwa chon: Cd rdi loan tiiu tien (RLTT) tCr tru'ng binh den nang (thang diim tri$u ChCrng IPSS > = 8); the tich tuyin > 20cm^ Tiiu chuin loai trir: sdi he tiit nieu, u bing quang, ung thu tuyin tien liet, bdnh nhin khdng din khim lai.
2. Phu'ang phap: Thu' nghidm lim sing ma khdng nhdm doi chO-ng, dugc theo ddi v i dinh gii k i t qua trdn mdt sd bdnh nhin ndi tru v i ngogi tru.
3. Phu'ang phap danh gia kit qua
- Dinh g i i mu-e dp RLTT qua thang diim tri$u ehCrng IPSS (Internatipnal prostate symptom score) v i thang diem chit lugng song (quality cf life- QPL) tai thdi diem trude diiu trj v i sau diiu trj 1,2 thing. Thep thang diem IPSS, chia ra lim 3 mi>c dd RLTT: nhe: 0 - 7; trung binh: 8-19; ning: 20 - 35 diem. Theo thang d i i m chat lugng sing (QoL)
