BO GI~O DUC V~ D~O TAO TRUONG DAI HOC Y DU''''QC C~N THO LE KIM THOA BO Y T~ NGHI~N C~U DAC DIEM L~M S~NG, PH~N DO D~NH GI K~T QU~ DI~U TRI SA SINH DUC B~NG PH~U THU4T CAT TU'''' CUNG NG~ ~M DAO PHUONG PH~P[.]
BO BO GI~O DUC V~ D~O TAO Y T~ TRUONG DAI HOC Y DU'QC C~N THO LE KIM THOA NGHI~N C~U DAC DIEM L~M S~NG, PH~N DO D~NH GI K~T QU~ DI~U TRI SA SINH DUC B~NG PH~U THU4T CAT TU' CUNG NG~ ~M DAO PHUONG PH~P CROSSEN Chuyen ng~nh: SAN PHU KHOA M? s6: 62.72.0\ • • s LUAN AN CHUYEN KH A CAP Nguoi huong d~n khoa hoe: G S T S PHAM VAN LINH BS.CKII NGUYEN THI C~n Tho, n~m HUE t L~I CAM DOAN Toi xin cam doan to~n b~ c~ng trinh nghi~n cu c~a ti l~ trung thuc, duoc the hi~n nghi~m t~c, khong vi pham y d~c v~ k~t qua~ nghi~n c~u c~a t~i chua ting dug c~ng b~ true d~y Tc L~ gi lu@n n KIM THOA I I LOI C~M ON D~ ho~n th~nh chuong trinh hoc v~ lu~n ~n n~y, t~i xin bay t~ long bi~t on s~u s~c d~n: - GS.TS Pham Vin Linh, hi~u tru~ng Truong Dai Hoc Y Duoc C~n Tho Th~y d~ nhi~t tinh d~n v~ gip d6 t6i ho~n th~nh lu~n ~n - Xin ch~an th~nh cm on BS.CKII Nguy~n Thi Hu~ d hu~ng d~n v~ g~p y cho t~i s a ch~a lu~n ~n - Xin ch~n th~nh cm on: PGS.TS Dim Van Curong PGS.TS Pham Van N~ng PGS.TS Nguy~n Van Lam PGS.TS Nguy~n Van Qui BS.CKII V6 Dong Hai TS.BS VO Huynh Trang da dong g~p y ki~n quy b~u v~ tao di~u ki~n cho t~i ho~n th~nh lu~n ~n - Xin ch~n th~nh c~m on Ban Ch nhi~m v~ c~c gi~ng vi~n B m~n San Truong Dai Hoc Y Dugc C~n Tho - C~m on BGD, Phong K~ Hoach Tng Hop, khoa S~n, khoa Gay me h~i src B~nh vin Da Khoa Vinh Long d~ tao di~u kin cho t~i hoc t~p su~t th~i gian qua - Ch~n th~nh cam on gia dinh v~ ban b~ d~ gip d~, d~ng vi~n t~i ho~n th~nh chuong trinh hoc Can Tho, ng~y th~ng n~m Le Kim Thoa 1j MUC LUC Trang ph bia Loi cam doan Loi c m on Mc Iuc Danh muc c~c ky hi~u, c c ch~ vi~t tit D~i chi~u c~c thu@t ng~ Anh - Vi~t Danh muc c~c bang Danh muc cc hinh v~ D4T VAN DE Muc teu n l gh , 1en cuu : Chuong : TONG QUAN TAI L IE U Ga a.1 p h"' ,, ' ' h" au tur cung va san c ?U Gi~i ph~u tr cung Gi~i ph~u san ch~u nt 1.2 Khai ni�m v� sa sinh d1,1c ········· 1.3.Nguy~n nh~n, co ch~ sa sinh dc a a Nguyen nhan Ca ch@ L , s > ha: d6 ± A an va yeu to am sang va p ± en quan 10 ' , Lam sang - 10 I 1.4.2 Phan d9 12 ' Y~u t~ lien quan I 15 , \1.5 Tinh hinh m~c b~nh m~c b~nh sa t?ng ch?u 16 � Ty I� mac b�nh sa t?ng c h ? u • · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · : · · · · · · · · · · · · · · · · · · · · Ty l& ph~u thu~t sa tang c h @ u I t Di�u ttj 18 iv N6i khoa ; 18 1.6.2 DiSu tti bfulg phiu thu?t 20 Churong 2: D I TUONG V~ PHUONG PHAP NGHI~N C U 25 D6i tUQilg 25 D6i tUQilg nghien cuu 25 Tieu chuful ch9n miu 25 Tieu chuful lo:;ii trir 25 Dia di Sm nghien cuu 26 2.2 Phuong phap nghi~n c u a 26 Thi@t k@ nghien cuu 26 2.2.2 Miu nghien cuu 26 2.2.3 Phuong phap ch9n miu 26 2.2.4 N9i dung nghien cuu 26 v~ k thu~t thu th~p 2.2.5 Phuong ph~p s~ l i ~ u 34 l i ~ u 45 cu 45 Chuong 3: K~T QU~ NGHI~N C ~U 46 2.2.6 2.3 dvc Ph~n Dao duc D c va u t6 Ti~n 3.2.2 D�c Di) 2.4 3.3 K~t c~n c qua s~ nhi~n b~nh n lie nh~n nh~n lam dv u t6 lie sa sinh sa sinh dc due, a dc di~m l~m sang, mc d sa uan nh~n sa sinh duc ng c D c uan 55 q hiu thu?t 57 p di~m 1 T u f> i c~a 48 55 Chuong 4: BA.N LU� 4.1 53 sa n 46 sinh q b~nh sinh y@ ly b~nh c~a iSm d sa Ca c~a y@ 3.2.1 c~a c~n cac x~ di~m Ti~n v~ tich b~nh nh~n 6 sa sinh d u c 66 66 Ngh@ nghi�p 67 Nai s6ng 4.2 Ti~n c~n, d~c di~m lam sang, ph~n d~ 67 v~ cc y~u t6 lien q u an 68 Ti~n c n 68 4.2.2 D~c di Sm lam sang 73 Phan d9 sa sinh dl)C 75 4.2.4 Cac ySu t6 lien quan · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 76 4.3 K~t qu~ ph�u thu�t KETLU� : 77 87 KIEN NGHJ · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 88 T~i lieu tham kh~o • T T T DANH MUC CAC TU' VI~ Ti~ng Vi@t dao AD : BN : B~nh nh~n BVDK : Benh vi~n da khoa CTC : C~ t cung ECG : Dien tim Am mac tu cung NMTC i : N PTNS : Ph~u thu~t n~i soi POP : Pelvic organ prolapse SA : Si~u ~m SSD : Sa sinh duc TSM : T~ng sinh m6n TC : T cung Ti~ng Anh AUGS Society : American Urogynecologic ICS ety : International Continence Soci NIH : National Institutes of Health POP-Q tification : Pelvic Organ Prolapse Quan SGS eons : Society of Gynecologic Surg DI CHI~U C C THU~T NG~ ANH- VIET Pelvic organ prolapse Sa tang ch@u Pelvic Organ Prolapse Quantification Ph~n loai sa tang ch~u t International Continence Society Hi~p h~i ki~m so~t ti~u ti~n qu~c American Urogynecologic Society Hip h@i ni~u khoa Hoa Society of Gynecologic Surgeons Hi&p h~i c~c b~c si ph~u thu~t phu khoa Anterior Tru~c, th~nh tru~c Apex Dinh Posterior Sau, th~nh sau Total vaginal length T~ng chi~u d~i ~m dao National Institutes of Health Vien y t~ qu~c gia Ky DANH MUC CAC B~NG Trang Bang Tu6i 46 Bang 3.2 Ngh~ n gh i ~ p .' 47 Bang 3.3 Noi sinh s6ng 47 Bang Ly v~o vi~n :: 48 Bang 3.5 Tin c~n b~nh n~i kh o a 49 Bang Ti~n cin ph&u thu?it B~ng Ti~n c~n b~nh phu kh o a 50 Bang S61:ln sanh Bang 3.9 Kho~ng c~ch sanh 50 51 Bang C~ch thc s a nh 52 B~ng 1 Sang ch~n t~ng sinh m~n lc s anh 52 Bang Dau, n~ng bung d u ~ i a 53 B~ng Su xu~t hi~n c~a kh~i sa 53 B~ng Tri~u chng r~i loan ti~u t i ~ n 54 B~ng Trieu chng r~i loan ti~u h a 54 Bang D B~ng Li~n quan gi~a ph~n d SSD v~ tu i a Li~n d@ Bang 3.18 B~ng 3.19 B~ng 3.20 Bang 3.21 ang 3.22 sa sinh d\lC Li~n Li~n quan quan quan Phuong 55 gi~a gi~a ph~n gi~a ph~p phan ph~n v~ cam d$ SSD SSD v~ v~ ngh~ s6 l~n 55 nghip 56 s an h 56 T S M 57 57 as so so o.do a 58 d6 SSD v~ ph~u tin c~n thu@t r~ch B Th~i gian ph~u thu@t B~ng 3.23 Luong mu m~t ph~u t h u ~ t 58 Bang 3.24 Cc tai bi~n ph~u th u ~ t 59 Ix B~ng 3.25 Th~i gian ti~u ti~n sau rt ~ng thong t i ~ u 59 B~ng 3.26 Th~i gian trung ti~n sau ph~u thu~t 60 B~ng 3.27 Th~i gian dau sau ph~u th u ~ t 60 B~ng 3.28 Khng sinh di~u tri sau ph~u t h u ~ t B~ng 3.29 C~c bi~n chng sau ph~u thu~t • • B~ng C~c tri~u ch~ng c~i thi~n sau ph~u thu~t 62 Bang 3 Thai gian nim vi�n 62 B~ng Tinh trang c~i thi~n tri~u chng ti~t ni~u ti kh m 63 Bang 3.33 Tinh trang c~i thi~n tri~u chng ti~u h a t~i kh am 63 Bang Su l~nh v~t t h u on g 64 B~ng Bi~n ching v~ tri~u ch'mng bt thuong t~i kh ~ m 64 B~ng Dinh gi~ k~t qu~ ph~u th u ~ t 65 62 Neuman M, Lavy Y (2007) Conservation of the prolapsed uterus is a valid option: medium term results of a prospective comparative study with the posterior intravaginal slingoplasty operation Int Urogynecol J Pelvic Floor Dysfunct 18(8):889-893 63 Nguyen JK, Lind Lumbosacral LR, spine Choe and JY, McK.indsey F, pelvic inlet changes Sinow R, associated Bhatia NN with eplvic organ prolsape Obstet Gynecol 0 ; : 3 - 64 Nygaard I., Disorders, Menefee A.S., Berek Novak's & Wall L.L (2007), Gynecology, Lower 14th Urinary Edition, Tract Lippincott william & Wilkins, pp 849-896 65 Ottesen M., Sorensen M., Kehlet H., Ottensen B (2003), "Short convalescence after vaginal prolapse surgery'', Acta - Obstet - Gynecol Scand 66 Pakbaz M., Mogren hysterectomy for I., Lofgren uterovaginal M (2009), prolapse, Outcomes BMC of Women's vaginal heath, DOI: , l 186/1472-6874-9-9 67 Pessary treatment for pelvic organ prolapse and health-related quality of life a review, Int Urogynecol J 1 Jun; 22(6): 637 -640 68 Peter Petros (2007) Pelvic floor: function, disfuntion and management according to the integral theory Spinger medizin verlag;l 69 Powes C.A medicine, 70 Rinne KM, (2006), Diabetes Mellitus, Harrison's principle o f Internal 16" Edition, chapter 323, pp - Kirkinen PP What predisposes young women to genital prolapse? Eur J Obstet Gynecol Reprod Biol 1999; 84:23-5 71 Rortveit , G v~ c~ng su (2007), Symptomatic Pelvic Organ Prolapse: Prevalence and Risk Factors in a Population-Based, Racially Diverse Cohort, The American Collede o f Obstricians and Gynecologists, Vol 109 (6), pp 13 - 72 Sayer T, Lim J, Gauld JM et al (2012) Medium-term clinical outcomes following surgical repair for vaginal prolapse with tension-free mesh and vaginal support device Int Urogynecol J 23(4):487-493 73 Shah AD, Kohli N, Rajan SS, Hoyte L (2008), The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA Int Urogynecol J Pelvic Floor Dysfunct 19(3):421-428 ' 74 Shek KL, Dietz HP Intrapartum risk factors oflevator trauma Br J Obstet Gynaecol ; 1 : - Shirish S S , Salvi V (2003), Complications, morbidity and mortality of caginal Vaginal hysterectomy, Hysterectomy, Routledge Taylor & Francis, pp.341-354 76 Smith FJ, Holman undergoing CD, surgery Moorin for pelvic RE, Tsokos organ N prolapse Lifetime Obstet risk of Gynecol ; 1 : 6- 0 77 Sprung J and et al (2006), Pain relief and functional status after vaginal hysterectomy: intrathecal versus general anesthesia, Can.! Anesth, Vol 53 (7), pp.690- 700 78 Structural anatomy of the posterior pelvic compartment as it relates to rectocele, Volume , Issue 4, Pages 815-823 79 Swift SE, Tate SB, Nicholas J (2003), Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ discussion 7-9 prolapse? Am J Obstet Gynecol 189(2):372 377, 80 Ulrich D, Guzman Rojas R, Dietz HP, Mann K, Trutnovsk:y G Use of a visual analog scale for evaluation of bother from pelvic organ prolapse Ultrasound Obstet Gynecol 2014;43:693-97 World Journal of Urology August 2012, Volume 30, Issue 4, pp 437-443 Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction 82 Wu JM, Hundley prevalence AF, of pelvic Fulton floor RG, Myers disorders in ER US (2009) women: Forecasting 2010 to the 2050 Obstet Gynecol 114(6):1278-1283 Young N, Kamisan Atan I, Dietz H Obesity: How much does it matter for female pelvic organ prolapse? In: RCOG World Congress Brisbane: RCOG, 84 Zyczynski HM, outcomes Carey MP, Smith AR et al (2010) One-year clinical after prolapse surgery with nonanchored mesh and vaginal support device Am J Obstet Gynecol 203(6):587el-587e8 PHI~U THU THAP TH~NG TIN De tinh chung c~a d~i tuong • inh- a= - Ho v~ t ~ n : N m si1 - Dia tinh chi: A p - Nghe S¢ - S6 xa di�n huy�n thol;li rung, □ Lam N i tro □ Bun b~n Nghe~ □ nh~n Ma vao N = b nh la SO Vien' vi~n kh~c : = s Vao ' «gay €] '" ven: mo: v~o M t kh6i n loa s~ ng~y nm vi~n sau m ~ : vi~n: sa ngo~i dai □ v i ~ n : □ Ia n ' - Ng~y - Ly I~m vuon nht - Ng~y R6i nghi~p: Cong - &: 1- tu ~ i : ~m R6i loan ti~u ti~n dao ti~n □ LJ Ly khac - Ti~n c~n + N~i khoa: Mc bnh L B~nh ph~i COPD L Khong m~c b~nh □ B~nh tim T~ng HA L Ti~u du~ng [ Khac + Ngoai khoa: C6 LI Khong San khoa: C6 L Khong Phu khoa: C6 L Khong Ti~n c~n ph~u thu~t ngoai khoa: El L Phu thu~t gi + San khoa: Para S~ l~n sanh 1-2 1~n [ 3-4 1~n 5-6l~n [ > l~n Kho~ng c~ch c~c l~n sanh: C~ch sanh: Sanh thuong □ n m n~m [ n m L >3nm [ Sanh kh~ L Ket vai L Sanh gi~c h t E Sanh forseps □ □ L C~c ton thuong du~ng sinh due luc sanh: + Ph khoa: Viem AD R~ch t~ng sinh mon khong phuc hi [ R~ch t~ng sinh m~n c~ phuc hi L Khong r~ch L M~c bnh Viem CTC B�nh ly khac Khong m~c b~nh C L D Viem TCPP _ Man kinh: Chua m~n kinh □ [ Tu6i man kinh: De di~m l~m sang - Dau n~ng bung du~i: Mc d@ nhi~u C6 D Khong Trung binh D - S xu~t hi~n c~a kh~i sa: [ Dau it L Thu~ng xuy~n C D~y l~n duoc E - Tri~u chng r~i loan ti~u ti ~ n : C6 Khi g~ng s~c T~0 b6n L a Ti~ukh6 Ti~u khong h~t L C6 Khong Tieu kh6 DJ [ Khong Tiu khng tu ch~ ging sic: S6n ti~u - C~c tri~u ch~ng r~i loan ti~u h~a: L Khong d~y len duoc L Ti~u nhi~u l~n [ L Tieu khong h~tu Tri�u chung khac: - Kh~m lam s~ng tong qu~t: ] M a c h : ( l ~ n/ p ) Huy~t ~ p : ( m mH g ) Nhi p th ~: ( l ~n/ p ) N h i @ t d : ( c ) Cao:(m) Can n ~ n g : ( k g ) h p : H6 - Kham Am lam s~ng Tu~n h o ~ n : B M I : · Ti~t n i ~ u : s~n: hi): Am TSM: d�o: Tu cung: CTC: I Ph~n d@: K~t D6 D62 [ D63 D D64 [ L qua i~u t r t : l- Th~i di~m bit d ~ u : T h ~ i u m§.t: ~ < Lu9n!?i ma I- - Tai bin ph~u Ch~y T~n 00 ml thu@t: □ 100 C6 m~u thuong trc dim trang -2 0 j ; Sit the: l m □ 200-50 Th~i l m E gian □ > m T~n £ Thuong C6 thuong BQ-NQ ~n kh~c : l□ m [ [J L t E ~ 500 Khong L - Tai bi~n v~ bi~n ch~ng sau ph~u thu@t : ] k~t Khong L L Nhi~m tr~ng v~t m~ L Nhim tr~ng ti~u Lit ru@t, tic rut L Ch~y m~u, tu mu [ Kh ~ c · 8 · · · ] [Th~i gian phuc h~i sc kh~e sau m~: i Ng~y I Ng~y Ng~y Ng~y Mach HA Nhi&t d6 Dau Tieu ti~n Trungti~n Dich AD Vet may T6ngtrang Sau rt thong ti~u Ngay Ng~y Ngay ' ' - Khang s1'nh sau mo: - Tinh trang c~i thi~n c~c tri~u chng sau m~: C6 + Ti~t ni~u: + Tieu h~a: □ H~t □ C6 □ H~t □ Gi~m Khong □ Khong □ □ Gi~m □ - K~t qu~ di~u trj: T6t E (Khong tai bi~n ho~c bi~n ch~ng v~ sau m~, th~i gian n~m vi~n ti€u ti~u tr nhi~n, - ng~y, djch AD kh6ng b~t thu~ng, khong nhi~m tr~ng v~t may) Trung binh (C~ tai bi~n ho~c bpi~n ch~ng v~ sau m~ dugc x~ tri kip th~i, th~i gian 'n~m vi~n 7- 14 ng~y, ti~u ti~u t nhi~n, djch AD kh~ng b~t thuong, khong nhi~m tr~ng vet may) Khi6ng t~t vi~n > l - I [1 (C~ tai bi~n ho~c bi~n ch~ng v~ sau ph~u thu~t, th~i gian n~m 14 ngay, ~n u~ng k~m, suy ki~t ho~c t vong) ching b~t thu~ng sau ph~u thu@t: Cic tri~u C6 L Khong LI Tiet m