Cac khuynh huong dieu tri soi tiet nieu.

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Cac khuynh huong dieu tri soi tiet nieu

Trong thoi gian vua qua, cac tien bo vuot bac cua ky thuat chan doan hinh anh, dung cu noi soi va tan soi ngoai co the da tao nen mot cuoc cach mang trong dieu tri soi tiet nieu. Hien nay, bang cac phuong tien can thiep xam hai toi thieu, phau thuat vien co the dieu tri benh ly soi rat hieu qua. Uu diem cua phau thuat xam hai toi thieu la it dau sau mo, so ngay nam vien hau phau va thoi gian phuc hoi suc khoe cua benh nhan rut ngan dang ke..

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Cac khuynh huong dieu tri soi tiet nieu.

Cac phuong tien dieu tri soi tiet nieu

May tan soi bang song chan dong (SWL - shock wave  lithotripsy): SWL xuat hien tu thap nien 1980 va hien dang la phuong tien duoc lua chon hang dau trong dieu tri soi tiet nieu do tinh hieu qua va an toan. Song chan dong la nhung song ap luc bien do nang luong cao, duoc truyen qua cac moi truong  nuoc hoac mo mem ma it bi giam cuong do. Khi song cham vao mat truoc cua vien soi, do su khac biet  ve tro khang, be mat cua soi se sinh ra mot luc ep lon hon rat nhieu so voi luc cang be mat cua vien soi. Luc ep nay lam be mat cua soi vo ra. Khi song chan dong tiep tuc di den mat sau cua vien soi, mot phan nang luong se doi tro lai va tiep tuc lam vo mat sau cua soi. Cac song chan dong duoc lap di lap lai lien tuc lam vien soi vo thanh nhieu manh vun. Nhung manh vun duoi 2 mm se tu troi ra ngoai theo dong nuoc tieu.

Moi SWL deu gom 4 bo phan chinh: nguon tao song chan dong, bo phan hoi tu song, moi truong  truyen song va dung cu dinh vi soi. Co 3 loai nguon tao song: thuy dien luc (electrohydraulic), ap dien (piezoelectric) va dien tu truong (electromagnetic).

Lay soi than qua da (PCNL - percutaneous nephrostolithotomy): nam 1976, lan dau tien tren the

gioi, Fernstrom va Johansson tien hanh tao mot “duong ham” di tu be mat da xuyen qua cac lop can co, vao dai be than de lay soi cho 3 benh nhan. Su kien nay mo ra mot “chan troi moi” cho viec dieu tri soi than.

Trong PCNL, duong ham vao than thich hop la yeu to quyet dinh  thanh cong  cua phau thuat. Da so cac phau thuat vien lua chon duong vao than tu dai duoi hoac dai giua, mat sau cua than va nam duoi xuong suon 12. Duong ham vao than duoc nong dan tu 8 den 30 Fr (10 mm). Sau do mot nong nhua 30 Fr duoc dua vao be than de tien hanh soi than bang may soi cung hoac soi mem.

Nhung vien soi kich thuoc  duoi 1 cm co the gap tron ra ngoai. Neu kich thuoc  soi lon hon, phai dung dung cu tan soi noi soi.

Doi voi soi than kich thuoc  lon nen tan soi bang dung cu sieu am. Uu diem cua dung cu nay la trong qua trinh tan soi co the hut duoc soi vun. Tuy nhien mot so soi acid uric, soi calcium oxalat monohydrat hoac soi cystin rat cung, khi tan soi can ket hop them cac loai dung cu khac.

Noi soi nieu quan (URS - Ureteroscopy): su xuat hien cua may soi nieu quan da lam thay doi tinh hinh dieu tri soi nieu quan. Nho nhung tien bo trong cong nghe  che tao soi quang, cac may soi nieu quan ban cung (semi-rigid) hien nay tuy co kich thuoc  nho (tu 6,9 - 8,5 Fr) nhung kenh thao tac cua may kha lon (2,4 - 4,0 Fr) cho phep tiep can soi de dang va co the tan soi bang nhieu loai dung cu khac nhau. Ngoai ra, voi may soi nieu quan mem va dung cu tan soi holmium laser, phau thuat vien co the dieu tri hau het cac vien soi o doan nieu quan tren, ke ca mot so soi than.

Noi soi o bung hoac noi soi sau phuc mac: nam 1979 va 1992, Wickham va Raboy thuc hien phau thuat lay soi nieu quan noi soi sau phuc mac va noi soi o bung. Phau thuat noi soi sau phuc mac co hieu qua dieu tri soi tuong tu phau thuat noi soi o bung nhung thoi gian phuc hoi cua benh nhan ngan hon. Hien nay, ky thuat  lay soi nay pho bien o cac nuoc dang phat trien  do thieu nhung phuong tien can thiep it xam hai nhu may tan soi ngoai co the, may soi nieu quan mem hoac dung cu tan soi laser.

Mo mo: voi cac phuong tien can thiep xam hai toi thieu hien nay, ty le mo mo lay soi tiet nieu o cac nuoc tien tien chi con tu 1 - 5%.

Cac khuynh huong dieu tri soi tiet nieu

Dieu tri soi than

Soi nho: doi voi soi than kich thuoc  nho thi SWL la phuong tien dieu tri duoc lua chon hang dau, voi ty le sach soi thay doi tu 56 - 91%, tuy thuoc loai may tan soi. Khi SWL that bai thi co chi dinh lay soi qua da. Ty le sach soi cua PCNL kha cao, tu 90 - 95%.

Doi voi soi dai duoi cua than, noi soi than nguoc dong voi ong soi nieu quan mem va tan soi bang holmium laser cho ket qua rat kha quan. Ty le sach soi co the den 95%.

Soi lon: kha nang dieu tri cua SWL rat thap nen PCNL la phuong tien dieu tri toi uu. Ty le sach soi tu 85 - 95%. Tuy thuoc vao vi tri va kich thuoc  cua soi, kha nang sot soi phai noi soi gap soi lan hai hoac phai tan soi ngoai co the ho tro khoang 3 - 35%. Phuong tien dieu tri thu hai  la noi soi than nguoc dong voi ong soi nieu quan mem va tan soi bang holmium laser. Ty le sach soi o lan tan soi dau tien la 76% va o lan thu hai  la 91%.

Vai tro cua mo mo chi con gioi han trong nhung truong hop sau: soi san ho toan bo kich thuoc  lon; da dieu tri bang cac bien phap it xam hai nhung that bai; soi di kem cac bat thuong giai phau cua he tiet nieu; khi than mat chuc nang hoan toan, co chi dinh cat than.

Dieu tri soi nieu quan

Doan 1/3 tren: kha nang dieu tri thanh cong  cua SWL dat gan 100%. Neu soi bam dinh gay tac nghen nieu quan thi co the tiep can tan soi xuoi dong bang duong ham qua da vao dai than tren, hoac tan soi noi soi nguoc dong voi ong soi nieu quan mem.

Doan 1/3 giua: ty le sach soi khi dieu tri bang SWL kha thap, chi khoang 70%. Dieu tri duoc lua chon hang dau la tan soi noi soi voi ong soi nieu quan cung hoac mem. Ty le sach soi dat 80 - 95%.

Chi dinh lay soi noi soi sau phuc mac: soi qua cung, khong the tan soi bang SWL hoac URS; khong the tiep can soi bang may soi nieu quan; khong co cac phuong tien dieu tri it xam hai. Ty le thanh cong  cua phau thuat la 95%. Bien chung thuong gap nhat la hep nieu quan, xay ra o 25 - 30% truong hop.

Doan 1/3 duoi: noi soi nieu quan voi ong soi cung la phuong tien dieu tri duoc lua chon hang dau, voi ty le sach soi tu 90 den 99%. Gan day mot so nghien cuu cho thay ty le sach soi khi dieu tri bang SWL cung rat kha quan, dat gan 85% o lan tan soi dau tien

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Updated: 26/07/2008 | Views: 468 | Comments: 1

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By tam2939, IP: 222.252.*.*, 28/8/2009 15:12 GMT +0700
Cam on bai viet cua quy vi. Vay cho toi hoi o Hanoi dieu tri soi than noi soi sau phuc mac khong? Toi bioi than nam 2001 da di mo tai benh vien Viet Duc Ha noi(Mo phanh). Hien gio lai tai phat lai,di sieu am bsi cho biet kich thuoc 2,5x3cm o dai be than.
Mong nhan duoc su tu van cua cac ban.
Chan thanh cam on!

Ban co y kien gi ve bai viet Cac khuynh huong dieu tri soi tiet nieu nay? Hay goi suy nghi, binh luan, danh gia, loi khuyen ... cua ban ve bai viet Cac khuynh huong dieu tri soi tiet nieu ban tai day.

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