Giới thiệu các phương pháp điều trị sỏi thận ít sang chấn

DIENDAN Y HOC

Chuyen de trong thang

Gidi thieu cac phucfng phap

dieu trj soi than it sang chan

Nguyin Minh Tuan*

Sdi tiit nieu da thiy d nhUng xae udp Ai Cap cd dai tU nam 4800 trudc cdng nguyen [10], [11]. Ty

le mac benh sdi tiit nieu dao dong tU 2- 3%, thay ddi tuy theo tCing vung dia ly va hay tai phat vdi ty

le khoang 10% sau 1 nam; 35% sau 5 nam; 50% sau 10 nam [10], [11].

Vdi nhung thanh tuu vuat bac trong cae tinh vuc: chin doan hinh anh, cong nghe va trang thiit bi ndi soi,

dung cu pha sdi, tU nam 1980 trd lai day mot loat eac phuong phap diSu tri sdi than khdng sang chin (non-inva￾sive) hoac it sang chin (mini-invasive) da ra ddi va ngay cang hoan thien [6] Cac phudng phap chu yiu diSu

trj sdi than it sang chin hien tai bao gdm: liy sdi than qua da (percutaneous nephrolithotomy - PCNL), tan soi

than qua npi soi nieu quan ngugc ddng (retrograde transureteral nephrolithotripsy), liy sdi than bang phiu thuat

npi soi trong hoac sau phuc mac (transperitoneally or retroperitoneally laparoscopic pyelolithotomy). Chung tdi

xin gidi thieu mpt each tdng quan vd cac phudng phap nay nhu sau.

Lay sdi than qua da

Lieh sir

Nam 1976, Fernstrom va Johanson thdng bao

trudng hgp dau tien lay sdi than qua da thdng qua

dan Itru than da dugc dat trudc dd. Nam 1979,

Smith cac ddng nghiep da md ta thii thuat tad

dudng vao he tiet nieu qua da nhu II mdt thii thuat

ngi soi nieu vl dng da thdng bio 5 trudng hgp dieu

trj sdi than va nieu quan bang dudng dan luu than

xuyen da. Suphit trien vl eli tien cic dung cu phi

sdi bang dien thuy luc, sieu am, xung boi va laser

da nhanh chdng lam cho viec lay sdi qua da vdi

nhiing vien sdi Idn trd nen de dang ban [12]. Ky

tbuat nly dugc ua chudng ban md md nhd giam

dugc ty le tai bien - bien ehiing, it dau ddn sau md

va thdi gian hdi phuc nhanh ban.

Chi djnh va chong chrdjnh

Chi dinh

Tat el ele loai sdi than, ndi cbung deu cd the

dugc lay bang dudng qua da. Tuy nhien, tuy theo

kich thude sdi, ky nang ei!ia phau thuat vien ma eac

* Khoa Ngoai - Benh vien Bach Mai

phuong phip dieu tri khae cd the duge ua thich

hon [13]. Chi dinh PCNL hien tai bao gdm [6]:

- Sdi trong tui thiia dai than.

- Sdi than kem theo hep khiic ndi nieu quIn -

be than can phii can thiep phau tbuat chinh siia.

- Sdi san hd, ban san hd, sdi than kich tbudc Ion

( > 2,5 cm), sdi than nhieu vien.

- Benh nhan sdi than da tin sdi ngoai co thi

that bai hoac chdng chi djnh tin sdi ngoai eo tbi.

Chdng chi dinh [6]

* Chdng cbi dinh tuyet ddi: benh nhan ed ele

rdi loan ve ddng mlu chua duge diiu tri dn dinh.

* Chong ehi dinh tuong ddi:

- Benh nhan cd nhiem khuan nieu, lao nieu

chua dn dinh.

- Benh nhan ed thai.

- Benh nhan thude nhdm nguy co cao: gia yeu,

nhieu benh ket hgp.

Nbirng benh nhan cd sdi than tren than di dang

(than mdng ngira, than di dang xoay, than lac chd),

di dang cot sdng, hep dai be than, khi chi dinh

PCNL can than trgng.

4 IY HOC LAM SANG So 42 (Thang 07/2009)