Nhân hai trường hợp vỡ tử cung trong thời kỳ mang thai mà nguyên nhân là do sau mổ chửa đoạn kẽ tử cung qua nội soi chỉ dùng dao điện đốt đơn thuần

NHAN/'HAI TRU&NG HOP Vd TIT CUNG TRONG THOI KY MANG THAI MA NGUYEN NHAN

LA DO SAU MO CHUTA DOAN KE TUT CUNG QUA NOI SOI CHI DUNG DAO DIEN DOT DON THUAN

TOM TAT:

Chda ngoai td cung d doan ke chiem 1,2% trong

tong so chda ngoai td cung, chda ngoai td cung ma

cd Hen quan tri/c tiep den vd tCr cung trong thdi ky

mang thai la rat hiem gip va cung chua cd tat Heu

nao ghi nhan ve nhOng trudng hop nhu vay. Viec

chan doan va quan ly benh nhan nay trong thdi ky

mang thai la rat khd khin, hau nha khong ai nghT tdi.

Chi dinh mo khi cd nhiJng biiu hien bat thadng thi

deu vi nhdng ly do khac.

Tdkhda: ChCfa ngoai tCtcung

SUMMARY:

About two uterine rupture cases in pregnancy

period because of a Interstitial fallopian tube

gestation, treatment by laparoscopy procedure

using only electrotome

Interstitial section gestation occupies 1.2% in total

ectopic gestation cases. There is no report about the

relation between extra- uterine fertilization and uterine

rupture due to its rare appearance. It's very difficult to

prognosis and diagnosis these situations during

pregnancy period of woman. And the operation is

often recommended by different causes.

Keywords: ectopic gestation

DAT VAN oi:

Chiia ngoai ti^ cung la mot benh thi/dng gap trong

d p cifu san khoa ehCi yeu la chii'a cl vdi trifng (tubal)

chiem ty le la 97,72%, va ty le chCfa d ke tCr

eung(interstitial) chiem khoang 1,2% trong tdng sd

ehCfa ngoai tir cung, neu cd tien SIJT md chiJa ngoai tCr

cung thi ty le chifa ngoai tur cung lan sau tren benh

nhan dd la 50%, ke ca khi triet san bang ddt nhiet vdi

trirng qua npi soi thi ty le chCfa ngoai tur cung tai vdi

trimg triet san la 11%. Nhifng cd tien sir md ehCra

ngoai tif cung cu ma gay nen vd tir cung trong thdi

gian mang thai sau d6 thi chUa cd tai lieu nao ghi

nhdn. Trong ndm 2009 tai benh vien phu san Hai

Phdng, chiing toi da gdp 2 trifdng hdp v3 tif cung

trong thdi ky mang thai, vdi muc dich cung cap thong

tin, bydc dau tim hieu nguyen nhan lien quan, cung

nhu mpt sd giai phap khae phuc de eae ddng nghiep

nJt kinh nghiem, cung trao ddi, ban luan gdp phan

ldm sang td them mpt nguyen nhan ti/dng chifng

chdng he cd lien quan gi vdi nhau, nhUng tren thyc te

da gdp phai tai benh vien phu san Hai Phong.

B£NHAN:

1. Benh nhan thiir nha't: Bui Thi Thanh Th 28 tudi

Nghe nghiep; Noi trd

Oia chi 36 to 6 cam lo 2 Hung VUdng, Hai Phong

Vdo vien 6h ngay 30 thang 9 ndm 2009

Ly do vdo vien: Thai lan 2, 34 tuan - ngdi ngUdc

doa de non

NGUYEN VAN HOC

Tien sir san khoa; lay chdng nam 23 tudi, de

thirdng nam 2005 con 2600gr sdng, hut thai 3 lan. Md

npi soi chira ngoai tir cung ben phai lan 1 vao thang 2

nam 2008, md npi soi chijra ngoai tCr cung doan ke

ben phai lan 2 vao thang 10 nam 2008 (ea 2 lan deu

diing dao dien ddt khdi chira, khong khau).

Kham khi vao vien: Toan trang tinh tao, tiep xiie

tdt, mach 80 lan/phiit, HA 110/80 mmHg, nhiet dp

370C, can nang 70 kg, tim, phdi binh thu'dng

Kham san cao tiJ" cung 25 cm cdn eo thUa nhe, tim

thai 145 I/phut, tham trong cd tir cung Ipt ngdn tay

chae, di cdn, ngoi ngiTde hoan toan.

Xet nghiem mau ngay 30 thang 10, hdng eau 3

trieu900/mm3, bach cau 6000/ mm3, Hb 11,5 g/dL,

HOT 34,8%, nhdm mau B. Xet nghiem sinh hoa ure

huyet 2,3mmol/ L, glucoza 6,3mmol/ L, creatinin 57

mmol/ L, axit uric 280 mmol/ L, GOT 23U/L, GPT

24U/L, HIV am tinh, HbsAg am tinh, xet nghiem ni/dc

tieu binh thu'dng.

Sieu am mpt thai ngoi ngi/de 34 tuan, lUOng dinh

86em, tim thai 150 lan/ phiit, di binh thudng.

Benh nhan di/pc dua vao benh phdng theo doi va

dieu tri giam eo bang Sabutamon truyen va an than

trong 4 ngay. Thay cdn eo giam, dau it hdn da chuyen

dung giam co sang Papaverin x 4 dng / ngay(thdi

gian nam theo doi la 7 ngay).

Oen 8 gid, ngay 7/10 benh nhan xuat hien dau

bung kem theo di ngoai phan Idng. Kham toan trang

tinh tao, tiep xuc tdt, mach 85 lan/phiit, huyet ap

110/80 mmHg, nhiet dp 370C, kham san cdn co tir

cung 30 giay each nhau 3phiit 30 giay, tim thai 145

l/phut, tham trong ed tif cung md 2 cm, di v3 hoan

toan, ngoi ngi/dc hoan toan. Benh nhan di/de ehi dinh

md lue 8g30 phiit vi thai lan 2, 34 tuan, ngdi ngifdc di

vd sdm.

Vao d bung ed khoang 400 ml mau loang va

300gr mau cue, rach ngang doan dirdi lay chan ra

mdt nhi gai 2400 gram, ap ga 1 phiit 9 diem, 5 phiit

10 diem, day rau dai 50 em, lay rau kiem tra tai gdc

simg phai tCr eung(ch6 md ehCTa ngoai tCr cung eu) vd

dang ehay mau, vet rach gpn difdng kinh 3cm, ddng

ed tCr cung va khau lai chd v9 bang 2 mui chi; x cam

mau.Trong md truyen 250 ml mau B. Xet nghiem mau

sau md ngay 8 thang 10, hdng cau 2.550.000/ mm3,

bach cau 12.000/ mm3, Hb 7,7g/dl, HOT 22,8%.

Khang sinh dimg phdi hdp 2 loai. Hau phau sau 7

ngay dn dinh cho xuat vien ngay 17/10, me va con

deu binh thudng.

2. Benh nhan thiir 2: Nguyen Thi Th. 23 tudi

Nghe nghiep; npi trp

Dia chi An LU, Thuy Nguyen, Hai Phdng

Vao vien; 20 gid 50 phiit ngay 30 thang 12 ndm

^ HOC THUC HANH (755) - S6 3/2011 85