Thông báo trường hợp biến chứng mất đoạn niệu quản 1/3 trên do thắt tĩnh mạch tinh qua nội soi ổ bụng

Chung liSn quan din khau nhu trdi chi khau. Id ndt

ehi, hay l$ch lOL say khi dirt ehi.

NhO'ng thuan Ip'i khac cua ky thuat nay la nhanh

va d l thye hi$n. Ky thuat nay logi bd vide khd sw

dyng ehl Prolene 10-0 d l khau cang lOL, thdi gian

ein thilt d l bao dam dinh tam tot trudc khi vui chi, va

thdi gian cin thilt d l khSu vgt cung mgc va ddng kit

mgc, do dd thdi gian toan bO phiu thuSt giam dang

k l. COng d l dang han va khdng cin nhilu ky nang

phiu thuat vdi kep diu 25 d l bit va bdc Id ra ngoai

cang lOL. Keo fibrin chi mit 20 giay d l cd tac dyng d

giudng cung mgc, va nd giup dinh kit va elm mau.

Keo fibrin cung giiip ddng chat, va theo thdi gian khi

fibrin thoai biln, nhu'ng kit dinh phiu thuat bit diu

xay ra d giudng eung mgc.

• Keo fibrin ma chung tdi su dyng thi bit hogt vims

va dup'c kilm tra khang nguyen virus vdi PCR; do

dd, ca hOi truyin nhiim thi thip. Nhung vdi nhO'ng

chiit suit tu md, v l m§t ly thuylt ludn cd kha nSng

truyin nhiem, do dd nfin thdng bao cho bSnh nhin

trude. Mac du sii' dyng keo fibrin trong nhan khoa

chua ehinh quy, nhung nd d§ duac sir dung thanh

cdng d mit. Nd dup'c sCe dyng nhilu d mit nhu trong

Id hoang dilm toan bd chilu dly, dudng md dye thuy

tinh thi, thung giae mgc, va thung bao thuy tinh the

chin thuang. Nd eung dup'c sir dyng d l ddng tam

thdi vgt cung mgc sau phiu thuat elt bd ciing mgc d

nhO'ng mit nhan ap thip, ddng Id dd kit mgc, ghdp

kit mgc va ghdp mang di.

Gabor va cdng sy da gidi thi$u cd djnh lOL cung

mgc khdng khau bing each d?t cang lOL trong

dudng him cung mgc. Ky thu$t cua chung tdi khac

vdi nhu'ng phu'ang phap khdng khau khae bing each

sir dyng keo fibrin, iam tang ty 1$ dinh'kit vdi elm

mau. Chung tdi cQng sw dyng vgt cung mgc nhu

trong cd djng lOL cung mgc cd khau thdng thu'dng.

COng khdng cd tang nguy ca nhilm trung n^i nhan

tham nh$p qua dyang ham khi keo fibrin han dinh

vgt. Khdng ed vi6m ndi nhSn do keo tr6n nhu'ng b$nh

nhan eua chung tdi ' i tit ca 12 mit diu trong d cae

lin h$u phiu. An eung mgc d mit phiu thuat eho

thIy khdn-i ed sy thay ddi nao v l vj tri tryc cua lOL.

Sau 1 tha.ig theo ddi, chung tdi khdng tim thIy cd sy

l$ch tam lOL hay bit ky biln chung nao khac d 12

mitphSuthu$t. ,,,,,.' , , , .n -.1 -.O'.it.

Tdm tat:

Ogt lOL ed dinh hgu phdnq khdng khau vdi keo fibrin

thich hp'p eho nhO'ng mit thieu hay mat bao sau, va cd

the thye hien du'p'c d l dang vdi nh&ng logi lOL va

nhO'ng dyng ey vdi thdi gian phau thuat riit ngln. Tuy

nhien can phai theo doi lau dii hon de phan quyet kit

qua giai phau va chirc nang lau dai ciia phuang phap.

Tham lu|in:

Rach bao sau, mat bao sau, lech thuy tinh the, rdt

thuy tinh the hoac thuy tinh thi nhan tgo vao khoang

djch kinh,... la nhUng bien chipng, nhu'ng van de khd

khan va phii'c tgp dgt ra cho phiu thugt vien trong viee

xu" tri va phyc hdi thj lye eho benh nhan.

Vdi viee phat trien va hd trp cua phau thugt elt dich

kinh, tryc vdt thuy tinh the ciing vdi ky thugt dgt kinh npi

nhan 1 thi hay thu- phat vdi chf ed djnh cang vao eung

mgc da giai quylt du'pc van de tren. Nhu'ng day la ky

thugt phice tgp ddi hdi nhieu ky nang va thdi gian phau

thugt, Cling vdi nhieu sang chan them cho nhan cau nen

cung gay khdng it khd khan cho phau thugt vien.

Ky thugt dgt kinh npi nhan thii' phat hgu phdng ed

djnh cang ciing mgc khdng khau vdi sy trp giiip eiia keo

fibrin ciia cac tac gia tren da giiip du-a mpt hu'dng giai

quyet mdi ve ky thugt cho cac ptiau thugt vien chpn lya.

Ky thuat nay mdi du'pc thye hien 2 nam, nen can du'p'c

thye hien mpt each hoan chinh va can thdi gian theo ddi

lau dai de cd the danh gia du'p'c ket qua. Nhu'ng vdi

nhO'ng u'u diem ma nhdm tac gia du'a ra khi so sanh vdi

ky thuat cd djnh cang bing chi vao ciing mgc cho thIy

day la mpt ky thugt can du-pe quan tam va cd the tien

thanh nghien ciru tren thCfc te nhim gdp phin tim ra mpt

ky thuat hieu qua, dan gian cho phau thugt vi&n.

Toi dang tien hanh thye hien cac thao tac ve ky

thugt ddi vdi ky thuat mdi nay tren mit heo tgi phdng

WETLAB benh vien mit thanh phd nhim thuan thye hda

eae thao tac trudc khi cd the tien I anh tr§n mit bpnh

nhan. Qua thye hien tren mit heo, toimhgn thIy, thao

tac dung kep qua lo ciing mgc de bit cang thuy tinh the

nhan tgo dua ra ngoai la thao tac duy nhat rndi va hai

gay khd khSn chiit it cho phau thugt vien, edn nhOng

thao tac khac thi cae phiu thuat vien ed thi d l dang

thuc hipn dupe, thdi gian thuc hipn riit ngln han so vdl

ky thugt cd djnh trudc dSy.

Tdm Igi, day la mpt ky thugt mdi d n dupe quan tam

va theo ddi lau dai.

THONG BAO TRlldNG H0P BIEN CHUlNG MAT DOAN NIEU QUAN 1/3 TREN

DO THAT TfNH MACH TINH QUA NOI isOl 0 BUNG

TRjNH HONG SON, TRA N CHJ THANH

DAT VA'N Di

Biin chifng tdn thUdng nieu quan thudng gap do

cac can thiep phiu thuat san phu khoa va viing tieu

khung. Ton thUdng nieu quan gap 0,5% - 1% trong

cac phiu thuat viinq khung chau [1], tuy nhien^vdi bat

CLf ean thiep nao sau phue mac nhu: npi soi d bung,

cat dai trang, cat u sau phue mac... deu cd the gay

tdn thUdng mat doan nieu cyan. Trong nghien cifu

cua B. I. Chung ty le hep dai hoac mat doan nieu

quan do bien chifng sau phau thuat eao nhat 44,2%

(n=52) [6].

Nhan mdt trudng hpp mat doan nieu quan dai b

1/3 tren sau phau thuat soi d bung sau phuc mac that

tTnh mach thi/ng tinh, chiing tdi de cap van de nay vdi

Y HOC THUC HANH (741) - SO 11/2010 11