Nghiên cứu đặc điểmvà xử trí u xơ tử cung trên sản phụ đẻ tại bệnh viện phụ sản trung ương

B GIO DC V O TO B Y T TRNG I HC Y H NI NH THU HềA NGHIÊN CứU ĐặC ĐIểM Và Xử TRí U XƠ Tử CUNG TRÊN SảN PHụ Đẻ TạI BệNH VIệN PHụ SảN TRUNG ƯƠNG Chuyờn ngnh : Sn ph khoa Mó s : 60720131 LUN VN THC S Y HC Ngi hng dn khoa hc: TS V VN DU H NI - 2016 LI CM N! Trong quỏ trỡnh hc tp, nghiờn cu v hon thnh lun ny tụi ó nhn c rt nhiu s giỳp v nhng chõn tỡnh sõu nng ca quý Thy Cụ, bn bố ng nghip Vi lũng bit n sõu sc, tụi xin chõn thnh cm n: ng y, Ban giỏm hiu, Phũng o to sau i hc, B mụn ph sn Trng i hc Y H Ni ó giỳp v to iu kin tt cho tụi thi gian qua ng y, Ban Giỏm c Bnh vin Ph sn Trung ng, Phũng k hoch tng hp v Phũng nghiờn cu khoa hc Bnh vin Ph sn Trung ng ó to iu kin cho tụi quỏ trỡnh hc v nghiờn cu Tụi xin chõn thnh by t lũng kớnh trng v bit n sõu sc ti: TS V Vn Du l ngi Thy ó dỡu dt, giỳp , to mi iu kin, hng dn tụi sut quỏ trỡnh hc tp, nghiờn cu v hon thnh tt lun ny GS.TS Nguyn Vit Tin Th trng B Y T, Ch nhim B mụn Ph sn Trng i hc Y H Ni, Thy ó nhit tỡnh giỳp , to iu kin cho tụi sut quỏ trỡnh hc tp, nghiờn cu v hon thnh lun Cỏc Phú giỏo s, Tin s hi ng khoa hc thụng qua cng v bo v lun ó úng gúp nhiu ý kin quý bỏu cho tụi quỏ trỡnh nghiờn cu v hon chnh lun tt nghip Cui cựng, tụi xin by t lũng bit n ti B m, anh ch em cựng tt c ngi thõn gia ỡnh, bn bố v ng nghip ó giỳp ng viờn, chia s khú khn vi tụi sut quỏ trỡnh hc v nghiờn cu Xin trõn trng cm n! H Ni, ngy 12 thỏng 11 nm 2016 Tỏc gi lun Nh Thu Hũa LI CAM OAN Tụi l Nh Thu Hũa, Hc viờn cao hc khúa 23 Trng i hc Y H Ni, chuyờn ngnh Sn ph khoa, xin cam oan: õy l lun bn thõn tụi trc tip thc hin di s hng dn ca TS V Vn Du Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp nhn ca c s ni nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, ngy 12 thỏng 11 nm 2016 Tỏc gi lun Nh Thu Hũa CC T VIT TT BV PSTW : Bnh vin Ph sn Trung ng TC : T cung UXTC : U x t cung MC LC DANH MC BNG DANH MC BIU DANH MC HèNH T VN U x t cung (UXTC) l loi u sinh dc hay gp nht ph n tui sinh , chim 10 20% s bnh nhõn n khỏm ph khoa v chim khong 18 20% s ph n trờn 35 tui [1] Bnh cng thng gp nhng ph n khụng sinh hoc sinh ớt [2] la tui sinh , UXTC nh hng n kh nng sinh sn ca ngi ph n nh gõy chm cú thai hoc vụ sinh [1], [2], [3], [4] T l u x t cung thai kỡ gp t 0,5 3,2% theo cỏc nghiờn cu khỏc [5], [6], [7] nh hng ca UXTC lờn thai nghộn v tỏc nh hng ca thai nghộn n UXTC l c nhiu tỏc gi quan tõm v nghiờn cu UXTC cú th khụng gõy bin chng no sut quỏ trỡnh mang thai, nhng cng cú th lm gia tng nguy c cỏc bin chng nguy him cho thai nhi Theo Lopes P, nhng ph n cú UXTC, t l thai kộm phỏt trin l 3,5%, thai cht lu l 1,75% [8] T l sy thai sm UXTC dao ng t 8,5% theo Parker WH [9] Trong quỏ trỡnh chuyn d, UXTC cng lm tng nguy c khú v chy mỏu sau s rau Ngc li, thai nghộn cng nh hng n UXTC nh gõy khú khn chn oỏn cng nh cú th gõy hoi t v xon u X trớ u x t cung ph thuc vo rt nhiu yu t nh: s lng u, kớch thc u, v trớ u, tỡnh trng bnh nhõn Chớnh vỡ vy, phỏc iu tr cho tng trng hp c th cũn nhiu t i vi cỏc thy thuc sn ph khoa Trờn th gii ó cú nhiu nghiờn cu v u x t cung ph n cú thai Ti Vit Nam cng cú mt s nghiờn cu v u x t cung v thai nghộn Cỏc tỏc gi ngy cng quan tõm n chn oỏn v x trớ u x t cung thai k cng nh quỏ trỡnh sinh nhm ch ng cú k hoch chm súc, x trớ v phũng trỏnh cỏc bin chng u x t cung gõy vi thai nghộn v ngc li Tuy nhiờn cú nhiu quan im cha thng nht v ny gúp phn nghiờn cu v chn oỏn v iu tr u x t cung ti Vit Nam, chỳng tụi tin hnh ti: Nghiờn cu c im v x trớ u x t cung trờn sn ph ti Bnh vin Ph sn Trung ng vi hai mc tiờu: Mụ t c im lõm sng, cn lõm sng ca cỏc sn ph cú u x t cung ti Bnh vin Ph sn Trung ng Nhn xột v phng phỏp x trớ nhng sn ph u x t cung núi trờn Chng TNG QUAN 1.1 Thay i gii phu ca t cung thi k thai nghộn v chuyn d Trong thi kỡ cú thai v , t cung l b phn thay i nhiu nht ca c th Trng lm t ti niờm mc t cung, hỡnh thnh bỏnh rau, mng rau v lm nờn bung i cha thai nhi Trong chuyn d, c t cung õm o bin thnh ng dn thai Cn co t cung l ng lc ca cuc chuyn d Nhng thay i c th t cung: Thay i v trng lng: cha cú thai, t cung nng 50 60g, vo cui thi kỡ thai nghộn, t cung nng 1000g Thay i v chiu cao: cha cú thai, t cung cao cm, vo cui thi kỡ thai nghộn, t cung cao khong 32 cm Thõn t cung phỏt trin mnh v tng trng lng ch yu vo na u thi kỡ thai nghộn Thay i v mt : cú thai, t cung mm v gim trng lc hn so vi khụng cú thai Thay i v kh nng co búp v co rỳt: cú thai, t cung tng kh nng co búp v co rỳt, d b kớch thớch hn so vi t cung khụng cú thai Thay i on eo t cung: cú thai v quỏ trỡnh chuyn d, eo t cung bin thnh on di t cung, on di t cung khụng cú lp c an Thay i c t cung: chuyn d, c t cung xúa m lm cho t cung thụng vi õm o Vai trũ ca cn co t cung: cn co t cung l ng lc ca cuc chuyn d, lm xúa m c t cung v thnh lp u i S co li ca t cung sau l yu t quan trng nht giỳp cm mỏu din rau bỏm v y sn dch ngoi [1] 1.2 U x t cung 1.2.1 nh ngha U x t cung l u lnh tớnh xut phỏt t c t cung, thng gp ph n tui sinh [1], [5] 1.2.2 Dch t hc Mt s yu t c cp cú liờn quan n dch t ca UXTC: tui, chng tc, s dng ru bia thuc lỏ, mụi trng sng, cỏc bnh lý kốm theo nh tng huyt ỏp, bộo phỡ [10], [11], [12], [13], [14] U x t cung chim 20% ph n trờn 35 tui i vi ph n da mu (nht l ph n da en) t l ny tng t ln [14] Nhỡn chung, bnh u x t cung thng gp la tui 35 50 tui, cũn ph n tui 20 gp khong 3% [15] Ti Cng hũa Phỏp, hn 25% ph n ngoi 30 tui mc mt hay nhiu u x Tuy nhiờn t l ny cũn cao hn nhiu nu tin hnh phỏt hin bng siờu õm [16] 1.2.3 C ch bnh sinh C ch bnh sinh UXTC cũn cha bit rừ rng, iu ny lý gii n cha cú iu tr cn nguyờn [2], [17] Cú nhiu gi thuyt c nờu lờn: - Thuyt v ni tit: vai trũ riờng r ca Estrogen v Progesteron cha c xỏc nh, vai trũ ca chỳng cú th trc tip hay giỏn tip thụng qua cỏc yu t tng trng nh EGF (Epidermal Growth Factor) v IGF (Insulike Growth Factor1) [17] 10 - Thuyt v di truyn: ngi ta tỡm thy cú cỏc ri lon nhim sc th 6, 7, 10, 11, 14 t bo u [17] 1.2.4 Phõn loi u x t cung - Da vo tng quan v trớ gia ng kớnh ngang ln nht ca u x vi c t cung chia lm ba loi [2]: + U x di mc: phỏt trin t c t cung phớa mc t cung, thng cú nhõn to, cú th thnh mt u cú cung gõy xon v hoi t + U x k (u c t cung): phỏt sinh t lp c t cung, thng nhiu nhõn v lm cho t cung to lờn mt cỏch ton b, gõy ri lon kinh nguyt rừ rt, hay gõy sy thai, non + U x di niờm mc: l nhng u x cú ngun gc t lp c nhng phỏt trin dn vo bung t cung, i lp niờm mc lờn, cú to chim ton b bung t cung U x di niờm mc ụi cú cung, cú th thũ ngoi c t cung gõy nhim khun v chy mỏu - So vi v trớ gii phu ca t cung, UXTC c chia lm loi: + U x thõn t cung + U x eo t cung + U x c t cung 1.2.5 V trớ, s lng, kớch thc ca u x V trớ u x t cung thay i tựy theo cỏc phn khỏc ca t cung V trớ thng gp nht l thõn t cung chim 96%, eo t cung 3%, cũn u x c t cung rt him gp, ch chim khong 1% [18] V s lng: Devivo A v cng s thy mt u x n c c phỏt hin l 88% cỏc trng hp v nhiu u x c phỏt hin 12% cỏc trng hp [16] Vitale SG v cng s thy tn s gp u x n c cao gp 2,8 ln loi nhiu u x [2] 31 Tarnawa E, Sullivan S, Underwood P, et al (2011), Severe hypercalcemia associated with uterine leiomyoma in pregnancy, Obstet Gynecol, 117:473 32 Daniel S, Koren G, Lunenfeld E, et al (2014), Fetal exposure to nonsteroidal anti-inflammatory drugs and spontaneous abortions, CMAJ, 186:E177 33 Ciavattini A, Clemente N, Delli Carpini G, et al (2015), Number and size of uterine fibroids and obstetric outcomes, J Matern Fetal Neonatal, 28:484 34 Casini ML, Rossi F, Agostini R, Unfer V (2006), Effects of the position of fibroids on fertility Gynecol Endocrinol, 22:106 109 35 Coronado GD, Marshall LM, Schwartz SM (2000), Complications in pregnancy, labor, and delivery with uterine leiomyomas: a populationbased study, Obstet Gynecol, 95:764 769 36 Rice JP, Kay HH, Mahony BS (1989), The clinical significance of uterine leiomyomas in pregnancy, Am J Obstet Gynecol, 160:1212 1216 37 Chen YH, Lin HC, Chen SF, Lin HC (2009), Increased risk of preterm births among women with uterine leiomyoma: a nationwide populationbased study, Hum Reprod, 24:3049 38 Gyamfi-Bannerman C, Gilbert S, Landon MB, et al (2012), Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment, Obstet Gynecol, 120:1332 39 Michels KA, Velez Edwards DR, Baird DD, et al (2014), Uterine leiomyomata and cesarean birth risk: a prospective cohort with standardized imaging, Ann Epidemiol, 24:122 40 Vergani P, Locatelli A, Ghidini A, et al (2007), Large uterine leiomyomata and risk of cesarean delivery, Obstet Gynecol, 109:410 41 Anita, K., M Seema and P Richa (2007), Cesarean myomectomy, J Obstet Gynecol., 57: 128 130 42 Hammoud AO, Asaad R, Berman J, Treadwell MC, Blackwell S, et al (2006), Volume change of uterine myomas during pregnancy: myomas really grow?, J Minim Invasive Gynecol 13: 386 390 43 Neiger R, Sonek JD, Croom CS, Ventolini G (2006), Pregnancy-related changes in the size of uterine leiomyomas., J Reprod Med, 51: 671 674 44 Laughlin, S.K., Baird, D.D., Savitz, D.A., Herring, A.H., Hartmann, K.E (2009), Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study, Obstet Gynecol, 113:630635 45 Laubach M, Breugelmans M, Leyder M, et al (2011), Nonsurgical treatment of pyomyoma in the postpartum period, Surg Infect (Larchmt), 12:65 46 Nguyn c Vy, Nguyn c Hinh (2005), ỏnh giỏ hiu qu, an ton v kh nng chp nhn thuc Trinh N Hong Cung iu tr u x t cung, ti nghiờn cu cp B, nghim thu thỏng nm 2005 47 Pron G, Mocarski E, Bennett J, et al (2005), Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial, Obstet Gynecol, 105:67 76 48 Liu WM, Wang PH, Tang WL, et al (2006), Uterine artery ligation for treatment of pregnant women with uterine leiomyomas who are undergoing cesarean section, Fertil Steril, 86:423 428 49 Ravina J.H (2000), Pregnancy after embolisation of uterine myoma: report of 12 cases, Fertil steril, P.1241 1243 50 Awoleke JO (2013), Myomectomy during Caesarean Birth in FibroidEndemic, Low-Resource Settings, Obstet Gynecol Int, 520834 doi: 10.1155/2013/520834 51 Celal K, Hỹlya C (2011), The evaluation of myomectomies performed during cesarean section in our clinic, Niger Med J, 52(3):186 188 52 Hassiakos D, Christopoulos P, Vitoratos N, Xarchoulakou E, Vaggos G, Papadias K (2006), Myomectomy during cesarean section: a safe procedure?, Ann N Y Acad Sci, 1092: 408 13 53 Lờ Th Thu H (2015), Kt qu lõm sng nhng trng hp m ly thai kt hp búc u x t cung to thnh sau ti bnh vin T D, Y hc Vit Nam thỏng 12, s 33 39 PHIU BNH N THU THP S LIU PHN HNH CHNH S bnh ỏn: S th H v tờn: Tui: Ngy vo vin: Ngy Ni sinh sng:Thnh th Nụng thụn B TIN S BNH NI KHOA C TIN S SN KHOA S ln : Cha non Sy thai D TIN S PH KHOA: Vụ sinh Cha ngoi t cung Phu thut t cung: Cha phu thut M Phu thut vựng tiu khung: A Cú t: vin Khụng ln ln Thai lu > ln Búc nhõn x TRIU CHNG LM SNG UXTC Thi im phỏt hin u: Trc cú thai Trong thai k Trong m Khi kim soỏt t cung 11 Tui thai: tun 12 iu tr ni khoa trc vo vin: Cú Khụng 13 Thi gian iu tr: Thuc iu tr: E 10 F 14 TRIU CHNG CN LM SNG Siờu õm: S lng UXTC: V trớ UXTC Di niờm mc Di mc ỏy Thõn Eo Nhiu U k Kớch thc UXTC: < cm 10 cm >10 cm C 15 G 16 H 17 18 19 Xột nghim mỏu: Hb: Hng cu: Hematocrit: Bch cu: CCH THC : ng õm o M ly thai CC THễNG TIN THU C KHI NG M O Trng lng s sinh: Can thip: Kim soỏt t cung Búc rau nhõn to Forcep Giỏc hỳt Tai bin: Chy mỏu sau Rau cm tự CC THễNG TIN THU C KHI PHU THUT Chn oỏn trc m: V trớ ca UXTC: S lng UXTC:Kớch thc UXTC: Chn oỏn sau m: Trng lng s sinh: X trớ UXTC: Búc u Ct t cung bỏn phn Ct t cung hon ton Khụng x trớ 26 Tai bin m Tn thng h niu: Bng quang Niu qun Tn thng h tiờu hoỏ: Rut non i trng X trớ: Chy mỏu Khỏc 27 Tai bin sau m 28 Chn oỏn gii phu bnh - U c trn lnh tớnh: Thoỏi húa Khụng thoỏi húa - U lc ni mc t cung - Dng u khỏc (Ghi rừ.) 29 iu tr sau m - Khỏng sinh d phũng Khỏng sinh iu tr - Tng co: Oxytocin Oxytocin + Ergometrin Oxytocin + Duratocin I 20 21 22 23 24 25 CNG HềA X HI CH NGHA VIT NAM c lp T Hnh phỳc GIY CHNG NHN Phũng nghiờn cu khoa hc v phỏt trin cụng ngh Bnh vin Ph sn Trung ng chng nhn Lun Thc s y hc ca Bỏc s Nh Thu Hũa vi tờn ti: Nghiờn cu c im v x trớ u x t cung trờn sn ph ti Bnh vin Ph sn Trung ng c thc hin ti Bnh vin Ph sn Trung ng nm t 1/1/2014 n 31/12/2015 Cỏc s liu nghiờn cu c ly t cỏc bnh ỏn ca 272 sn ph cú tiờu chun, l cỏc bnh ỏn ca bnh nhõn cú u x t cung ti bnh vin PSTW nm t 1/1/2014 n 31/12/2015, cha y cỏc thụng tin cn thit cho nghiờn cu, thuc quyn qun lý ca Bnh vin v Phũng Nghiờn cu khoa hc H Ni, ngy thỏng nm 2016 XC NHN CA THY HNG DN KHOA HC BNH VIN PH SN TRUNG NG TL GIM C TRNG PHềNG NCKH & PTCN TS V Vn Du TS Quan H DANH SCH BNH NHN NGHIấN CU STT Mó BA 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 3536079 73732002 58297051 52704004 26321021 85480079 73331002 15230001 157415003 50583001 22671008 66567002 62847001 27127005 74072051 4389067 6163023 11063024 66805009 66805002 9287039 58321001 150577003 4838044 65508002 69225002 17370005 52249051 28405008 34130062 28011005 6405052 78973051 303088 H V Tờn Trng Th Thanh H Trn Th nh T Nguyn Thanh M Nguyn Th Hng A Nguyn Th V Nguyn Th H Nguyn Th N Nguyn Th L Phan Qunh H Trn Th H Phan Th H o Th Thu L Thõn T Ng Trn Thanh T Nguyn Th T Bựi Th T Nguyn Th H Nguyn Th M Phm Th Q Bựi Th H Nguyn Th Thu H ng Minh H ng Th H Trn Thanh P Dng Th X Hong Minh T Nguyn Th V Nguyn Th T Nguyn Th Kim C Trn Th Mai P Bựi Th T Th Kim O Nguyn Th Tuyt M Nguyn Thỳy H Nm sinh 1984 1975 1988 1978 1981 1984 1988 1979 1987 1980 1988 1982 1982 1985 1989 1978 1982 1986 1985 1981 1983 1987 1984 1977 1970 1988 1986 1987 1972 1978 1988 1977 197 1985 Ngy vo vin 4-11-14 28-12-13 2-1-14 28-12-13 24-12-13 30-12-13 2-1-14 8-1-14 10-1-14 10-1-14 13-1-14 16-1-14 15-1-14 20-1-14 25-1-14 4-2-14 25-1-14 5-2-14 11-2-14 10-2-14 6-3-14 4-3-14 8-3-14 9-3-14 18-2-14 14-3-14 14-3-14 24-2-14 12-3-14 12-3-14 25-3-14 31-3-14 28-3-14 24-3-14 Ngy vin 8-11-14 1-11-14 6-1-14 1-1-14 4-1-14 4-1-14 6-1-14 11-1-14 13-1-14 15-1-14 18-1-14 20-1-14 19-1-14 26-1-14 30-1-14 7-2-14 29-1-14 11-2-14 15-2-14 14-2-14 10-3-14 6-3-14 18-3-14 12-3-14 22-2-14 18-3-14 18-3-14 4-3-14 17-3-14 17-3-14 29-3-14 4-4-14 1-4-14 28-3-14 STT Mó BA H V Tờn 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 27059005 5001044 30013008 158978003 30969021 67428001 769103 86379002 4934500 32484021 29263005 92316051 28104008 81943002 26827021 70710004 38607004 80502001 67809051 2754008 2974022 50828004 168960003 6366079 75472002 35243062 84322051 93030051 995073 159652003 59141004 52967900 87425051 9991079 168794003 171582003 62355004 Hong Minh C Nguyn Th Bớch L V Th H Nguyn Th Minh P Lự Th Thỳy N Hong Th N Trn Th Thu H H Th Th Lờ T Trn Th Thanh T Nguyn Th Hong O Bựi Th Kim T Lờ Th D Lờ Anh T V Th Thanh T Phựng Th T Nguyn Th Hng K V Th T Nguyn Th Thanh B Nguyn Th Phng L ng Th M Hong Tuyt M Nguyn Th Vng A Nguyn Giang A Nguyn Th Kim T T Th Thu H Nguyn Th Thựy L H Mai H Nguyn Th Thu T V Th Tuyt A Trn Th N Trn Th T Hong Th Thu P Hong Th L Luyn Th Thuy N V Th H Ngụ Th Ngc H Nm sinh 1981 1976 1980 1971 1988 1974 1973 1986 1987 1984 1978 1982 1983 1982 1982 1984 1977 1990 1980 1984 1978 1973 1976 1982 1978 1978 1982 1980 1989 1990 1969 1975 1983 1980 1979 1979 1989 Ngy vo vin 26-3-14 8-4-14 25-4-14 23-4-14 16-4-14 8-5-14 5-5-14 10-6-14 8-4-14 16-5-14 5-6-14 2-6-14 26-5-14 12-5-14 14-6-14 6-11-14 5-11-14 3-11-14 3-11-14 13-6-14 25-5-14 15-6-14 15-7-14 25-7-14 24-4-14 19-6-14 19-6-14 8-7-14 14-7-14 15-7-14 16-7-14 25-4-14 20-11-14 2-12-14 26-8-14 15-8-14 20-8-14 Ngy vin 30-3-14 12-4-14 29-4-14 27-4-14 20-4-14 12-5-14 9-5-14 13-6-14 14-4-14 21-5-14 9-6-14 7-6-14 30-5-14 16-5-14 18-6-14 10-11-14 10-11-14 7-11-14 7-11-14 17-6-14 30-5-14 19-6-14 19-7-14 29-7-14 29-4-14 23-6-14 23-6-14 12-7-14 17-7-14 18-7-14 20-7-14 29-9-14 24-11-14 7-12-14 30-8-14 20-8-14 24-8-14 STT Mó BA H V Tờn 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 7032001 30495005 25515062 100965051 173349003 10124079 9826023 73277004 95970051 87950051 101982051 9167079 173439003 91434002 93480051 7987079 11556079 33613022 98804002 16224061 89626051 38719008 77584002 58278004 67032051 80997051 15924025 89996002 56943004 28949021 13060079 36427001 26737022 105086051 190601003 47885062 135573051 Phựng Th H Lờ Th H Lờ Th H Phan Y L Lờ Th Thanh H ng Th Mai H Dng Th T Nguyn Th L inh Th Thu G Trng Hunh Kim N Nguyn Th Hi Q Trn Th Thu D Trn Th L Ngụ Chung T Mai Cm T Lờ Hng A Nguyn Th Hng T u Th Hi L Nguyn Th L Bựi Thanh T T Th Thu T Nguyn Th nh D Nguyn Th H Chu Th Thanh H T Th Thỳy V Lờ Th Hong H Trn Th Hng T Nguyn H P Lu Th H Nguyn Thanh H Doón Th Phng M Khng Th H Nguyn Th N Trn Thu T Nguyn Kim Hng H Nguyn Thu H Nguyn Th P Nm sinh 1987 1983 1988 1978 1976 1977 1979 1989 1985 1982 1976 1979 1981 1979 1984 1986 1971 1988 1974 1982 1979 1980 1991 1983 1985 1977 1985 1984 1978 1980 1973 1979 1987 1986 1989 1974 1977 Ngy vo vin 24-8-14 8-8-14 10-8-14 6-8-14 4-8-14 29-9-14 27-12-14 20-12-14 22-7-14 16-6-14 1-11-14 29-10-14 3-11-14 10-11-14 25-12-14 28-11-14 23-12-14 25-11-14 11-12-14 23-8-14 13-11-14 29-12-14 21-9-14 18-9-14 4-9-14 7-9-14 25-8-14 12-9-14 9-9-14 11-9-14 8-3-15 9-2-15 8-2-15 1-3-15 7-3-15 26-1-15 28-1-15 Ngy vin 28-8-14 12-8-14 14-8-14 8-8-14 7-8-14 3-10-14 31-12-14 30-12-14 25-7-14 20-6-6-14 6-11-14 3-11-14 7-11-14 14-11-14 28-12-14 2-12-14 29-12-14 15-12-14 15-12-14 5-9-14 17-11-14 2-1-14 25-9-14 22-9-14 7-9-14 10-9-14 28-8-14 16-9-14 13-9-14 15-9-14 12-3-15 13-5-15 12-2-115 5-2-15 11-3-15 30-1-15 2-2-15 Lờ Th H V Th A Th H Nguyn M H V Th K Nguyn Th Phng O Lờ Th Thanh M Lu Th Hng Ló Th Minh T Nguyn Th Bớch H Lờ Th Ngc H Nguyn Th Thu T Phm Th H H Th T Nguyn Hng D Phm Th Tuyt N Nguyn L T Nguyn Th K Tng Th Hong G Nguyn Th S Lờ Th H Th Kim O Phm Phng L Lờ Thu H Th H Phm Th T m Th Thy C Nguyn Th Ngc B Nm sinh 1977 1981 1986 1982 1977 1981 1979 1974 1977 1980 1982 1983 1986 1983 1980 1979 1981 1976 1977 1972 1976 1990 1988 1987 1976 1977 1978 1979 Ngy vo vin 8-2-15 9-2-15 24-1-15 19-1-15 21-1-15 18-1-15 10-1-15 8-1-15 8-1-15 2-1-15 2-4-15 16-4-15 18-4-15 13-4-15 9-4-15 14-4-15 15-4-15 26-3-15 8-4-15 7-4-15 8-4-15 8-3-15 7-3-15 30-3-15 27-3-15 14-2-15 28-3-15 16-3-15 Ngy vin 12-2-15 13-2-15 28-1-15 23-1-15 25-1-15 22-1-15 14-1-15 13-1-15 12-1-15 6-1-15 5-4-15 20-4-15 22-4-15 17-4-15 13-4-15 18-4-15 17-4-15 21-4-15 12-4-15 11-4-15 13-4-15 12-3-15 12-3-15 3-4-15 31-3-15 18-2-15 31-3-15 18-3-15 Lờ Th X 1978 27-3-15 31-3-15 Lờ Th Vit H Nguyn Th H Nguyn Th Thỳy L Trn Th N Th H Lờ Th H Nguyn Thỳy D 1982 1981 1973 1982 1977 1975 1981 18-3-15 27-3-15 25-10-15 2-9-15 12-10-15 16-10-15 9-10-15 21-3-15 31-3-15 29-10-15 5-9-15 15-10-15 26-10-15 13-10-15 STT Mó BA H V Tờn 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 37773002 74596004 74313001 41096008 129921051 125997051 11303079 37138008 35180008 17018003 111548051 35025005 141793051 39757005 40496008 121171051 193775003 46068021 135402051 39078005 102726002 139761051 123089051 38596005 11806023 55841062 136004051 49719052 418660700 118279051 190266003 93521002 40424062 16410002 39237021 31663022 137 138 139 140 141 142 143 144 STT Mó BA 145 146 147 148 149 150 108740051 34136005 874088 51183052 10193081 1500011442 150000204 25524008 8264041 150002541 150000967 160261051 1500011576 85105004 9777001 150000452 682088 50789052 88130001 193103003 46053008 54764062 66579062 46768606 492003 207422003 107016002 130610051 16701079 139319051 127972051 110735002 194524003 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 Ngụ Th Tuyt M Nguyn Thỳy H Lờ Th Nh H V Th H Lờ Ngc D Nguyn Th T Nm sinh 1983 1983 1978 1976 1991 1976 Ngy vo vin 12-10-15 17-10-15 23-10-15 18-10-15 22-12-15 15-12-15 Ngy vin 17-10-15 21-10-15 26-10-15 23-10-15 26-12-15 21-12-15 Nguyn Th H 1977 9-12-15 14-12-15 Trnh Th Hng H Nguyn Th D 1978 1990 14-12-15 9-12-15 18-12-15 14-12-15 Lờ Hng T 1982 6-12-15 9-12-15 Nguyn Th X 1980 5-12-15 8-12-15 Nguyn Th H Th Thu T Trng Th H Nguyn Minh T 1991 21980 1985 1974 25-11-15 26-11-15 26-11-15 6-11-15 29-11-15 30-11-15 30-11-15 20-11-15 Nguyn Th B 1982 19-11-15 23-11-15 inh Th Bớch T Nguyn Th H Trn Th H Nguyn Th S Nguyn Th Hng H Chu Th Thu H Trn Tuyt M Bựi Th T Trn Th C Nguyn Th Hu A V Th H Nguyn Th L Hong Th M L Nguyn Th Hi A Bựi Thanh L Nguyn Th B Sa Th Võn A 1976 1982 1984 1987 1983 1982 1983 1986 1975 1983 1976 1976 1976 1974 1983 1991 1980 19-11-15 29-10-15 16-10-15 5-10-15 6-10-15 14-7-15 6-7-15 4-7-15 4-7-15 23-6-15 23-6-15 20-6-15 21-7-15 18-8-15 23-7-15 23-7-15 9-6-15 23-11-15 2-11-15 21-10-15 9-10-15 9-10-15 19-7-15 10-7-15 10-7-15 9-7-15 30-6-15 27-6-15 25-6-15 28-7-15 20-8-15 27-7-15 27-7-15 16-6-15 H V Tờn STT Mó BA 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 14680079 13866079 79548004 105276002 611459062 11873024 7880067 20078061 204025003 62815004 13274052 441088008 61563062 21028002 35282005 70072 176286003 676100004 17701003 80760051 62776004 153158051 10245067 14691025 14225044 16726079 87183001 153171051 20001036 39254001 46322008 99129051 31371021 96541051 9123051 41467062 62036004 H V Tờn Nguyn Kim P Trnh H Q Trn Th V Hong Th Thanh T Nguyn Th H Nguyn Vit O Trn Th Hng G Trn Th Qu A Hong Th Ngc A H Th Lan A Nguyn Ngc B Lờ Th Cm T Phm Xuõn T Th H Trn Th M Nguyn Th T Lờ Th Kim D Lờ Th K V Th Thanh N Nguyn Th Võn A Hong Th Y Mai Th L Nguyn Th H Phm Th H Th T Dng Th Thu H Hong Thựy K Nguyn Th A Lờ Th Phng T Nguyn Th G H Minh T Trnh Thu H Hong Hoi T Phm Thi H Nguyn Mai P inh Th H Quỏch Th Q Nm sinh 1985 1980 1978 1983 1983 1975 1982 1982 1978 1975 1987 1983 1982 1987 1983 1982 1975 1980 1981 1989 1978 1988 1977 1986 1982 1980 1979 1986 1979 1988 1987 1978 1985 1979 1989 1982 1981 Ngy vo vin 12-5-15 21-6-14 19-6-14 12-6-14 15-6-14 11-6-14 2-6-14 6-6-14 3-6-14 2-6-14 2-6-14 2-6-14 16-5-14 16-5-14 10-5-14 6-5-14 14-5-14 4-5-14 4-5-14 4-5-14 4-5-14 12-9-15 23-9-15 21-9-15 16-9-15 16-9-15 3-9-15 31-7-15 30-7-15 14-8-15 19-8-15 13-8-15 5-10-14 2-12-14 8-7-14 10-7-14 25-8-14 Ngy vin 16-5-15 24-6-14 23-6-14 15-6-14 19-6-14 17-6-14 5-6-14 10-6-14 6-6-14 6-6-14 6-6-14 4-6-14 22-5-14 20-5-14 16-5-14 17-5-14 17-5-14 9-5-14 8-5-14 7-5-14 8-5-14 16-9-15 28-9-15 25-9-15 21-9-15 18-9-15 6-9-15 5-8-15 10-8-15 20-8-15 21-8-15 17-8-15 7-10-14 5-12-14 10-7-14 11-7-14 26-8-14 STT Mó BA 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 82466002 85432051 41447008 104452051 51078021 45994021 1050088 152088003 188201003 12095044 100594002 44815008 5746067 33585051 51995021 49154008 41057021 37742021 29020022 99558051 8555701 3606081 25811008 68227051 20120008 156740003 77439002 107376051 87131051 107762051 36974008 3779079 100054002 97414004 3016062 20259061 140708051 H V Tờn Phm Th Hng N Phan Thu T Th Thu H Nguyn Th T H Th N Nguyn Hng H o Th Kim O Lờ Th P Nguyn Th X Phựng Th Thu P Nguyn Th H Nguyn Hng D Ngụ Phng D V Th T Lng Th Thanh M Lờ Th H Phm Th L Nguyn Th D Phm Th Hng X Nguyn Th C ng Th H Nguyn Th T Nguyn Th Kim L V Th H Dng Th T Lờ Th Hng N Nguyn Th Nguyn Thu H Lờ Th N Hong Th H Nguyn Th Lc V inh Thỳy G Bựi Th T Lng Th H Nghiờm Th H Nguyn Th L Lờ Th L Nm sinh 1979 1988 1986 1984 1991 1975 1989 1981 1976 1979 1991 1976 1981 1978 1979 1984 1983 1989 1978 1981 1975 1981 1971 1978 1980 1985 1974 1986 1972 1988 1984 1984 1982 1984 1984 1988 1983 Ngy vo vin 9-5-14 14-6-14 10-10-14 1-11-14 17-7-15 3-8-15 25-12-15 19-1-14 3-6-14 17-9-15 22-7-15 28-2-15 10-2-15 19-10-15 7-8-15 18-6-15 1-12-15 10-9-15 12-6-14 6-11-14 24-4-14 24-2-14 22-1-14 10-1-14 8-1-14 17-4-14 5-8-14 19-9-15 31-9-15 15-10-15 10-10-15 30-9-15 3-12-15 22-12-15 4-5-15 27-4-15 16-7-15 Ngy vin 10-5-14 17-6-14 13-10-14 3-11-14 18-7-15 6-8-15 26-12-15 22-1-14 8-6-14 4-10-15 26-7-15 5-3-15 27-3-15 23-10-15 11-8-15 29-6-15 5-12-15 16-9-15 20-6-14 12-11-14 28-4-14 28-2-14 27-1-14 14-1-14 11-1-14 21-4-14 10-8-14 23-9-15 3-10-15 19-10-15 15-10-15 6-10-15 7-12-15 26-12-15 8-5-15 3-5-15 20-7-15 STT Mó BA 252 253 254 255 256 257 258 259 260 261 262 263 264 50197021 8974004 132614051 41960005 48843051 7819023 86153004 157437051 33121005 73773062 22462061 51895021 87066004 150001977 11811045 51960021 91791004 50520021 12436079 45093021 33587021 265 266 267 268 269 270 271 272 Lờ Thanh T Nguyn Th O on Th L Chu Th Thanh H Nguyn Th Bớch T o Th M Tng Th Vit H V Thanh H o Th L Trn Thỳy N Trn Th H Trng Th Võn A H Huyn M Nm sinh 1986 1976 1987 1981 1977 1989 1981 1979 1983 1978 1980 1980 1981 Ngy vo vin 26-6-15 24-8-15 16-3-15 3-7-15 5-2-15 7-4-15 12-6-15 23-10-15 19-6-15 26-11-15 21-11-15 2-7-15 6-7-15 Ngy vin 30-6-15 31-8-15 19-3-15 8-7-15 9-2-15 11-4-15 17-6-15 26-10-15 5-8-15 30-11-15 25-11-15 6-7-15 8-8-15 Nguyn Th D 1988 29-11-15 3-12-15 V Th Thu H Trn Th Thu H Th Mai H Nụng Hong L Ngụ Th Ngc L Hong Th T V Th H 1979 1979 1976 1971 1981 1973 1975 5-9-15 6-8-15 17-8-15 4-7-15 11-12-15 4-3-15 10-6-14 10-9-15 11-8-15 31-8-15 9-7-15 16-12-15 9-3-15 16-6-14 H V Tờn H Ni, ngy thỏng nm 2016 XC NHN CA THY HNG DN KHOA HC BNH VIN PH SN TRUNG NG TL GIM C TRNG PHềNG NCKH & PTCN TS V Vn Du TS Quan H ... phần nghiên c u chẩn đoán đi u trị u xơ tử cung đẻ Việt Nam, tiến hành đề tài: Nghiên c u đặc điểm xử trí u xơ tử cung sản phụ đẻ Bệnh viện Phụ sản Trung ương với hai mục ti u: Mô tả đặc điểm... sàng sản phụ có u xơ tử cung đẻ Bệnh viện Phụ sản Trung ương Nhận xét phương pháp xử trí sản phụ u xơ tử cung nói 8 Chương TỔNG QUAN 1.1 Thay đổi giải ph u tử cung thời kỳ thai nghén chuyển đẻ. .. toàn buồng tử cung U xơ niêm mạc có cuống, thò cổ tử cung gây nhiễm khuẩn chảy m u - So với vị trí giải ph u tử cung, UXTC chia làm loại: + U xơ thân tử cung + U xơ eo tử cung + U xơ cổ tử cung