Nghiên cứu đặc điểm chẩn đoán và đánh giá kết quả điều trị phẫu thuật xoắn tinh hoàn tại bệnh viện việt đức

B GIO DC V O TO B Y T TRNG I HC Y H NI - PHM HI TRUNG NGHIÊN CứU ĐặC ĐIểM CHẩN ĐOáN Và ĐáNH GIá KếT QUả ĐIềU TRị phẫu thuật XOắN TINH HOàN TạI BệNH VIệN VIệT ĐứC LUN VN THC S Y HC H NI - 2013 B GIO DC V O TO B Y T TRNG I HC Y H NI - PHM HI TRUNG NGHIÊN CứU ĐặC ĐIểM CHẩN ĐOáN Và ĐáNH GIá KếT QUả ĐIềU TRị phẫu thuật XOắN TINH HOàN TạI BệNH VIệN VIệT ĐứC Chuyờn ngnh: Ngoi khoa Mó s : 60.72.07 LUN VN THC S Y HC Ngi hng dn khoa hc: PGS.TS HONG LONG TS NGUYN QUANG H NI 2013 LI CM N Li u tiờn tụi xin by t lũng kớnh trng v bit n sõu sc nht ti PGS TS Hong Long Phú ch nhim khoa phu thut tit niu ging viờn b mụn Ngoi i hc Y khoa H Ni - Ngi thy ó ht lũng giỳp , ch dy v to mi iu kin cho tụi sut quỏ trỡnh hc v hon thnh lun Tụi xin gi li cm n ti TS Nguyn Quang ó tn tỡnh giỳp v cho tụi ý kin quý bỏu quỏ trỡnh thc hin ti Tụi xin by t lũng cm n sõu sc ti cỏc thy hi ng chm lun ó cho nhng ý kin quý bỏu giỳp tụi hon thnh lun ny mt cỏch tt nht Tụi xin by t lũng cm n n: - Ban giỏm hiu, Phũng o to sau i hc, B mụn Ngoi Trng i hc Y H ni - Ban giỏm c, cỏc khoa phũng: Khoa Phu thut Tit niu, Phũng K hoch tng hp, Th vin, Phũng lu tr h s, phũng khỏm Nam Hc Bnh vin Vit c cựng th cỏc bỏc s, iu dng khoa phu thut tit niu, phũng m Bnh vin Vit c ó tn tỡnh giỳp v to mi iu kin thun li cho tụi sut quỏ trỡnh hc tp, nghiờn cu v hon thin lun - Tụi xin gi li cm n sõu sc ti ng y, ban giỏm c, c bit l lónh o cựng th nhõn viờn khoa Ngoi Bnh vin a khoa tnh Hi Dng ó to mi iu kin, h tr, ng viờn tụi sut qỳa trỡnh cụng tỏc v hc Cui cựng tụi vụ cựng bit n m, v, con, anh ch v hai chỏu, ó luụn ng viờn ng h v l ng lc ln cho tụi cụng vic cng nh cuc sng H ni, ngy thỏng nm 2013 Tỏc gi Phm Hi Trung LI CAM OAN Tụi xin cam oan õy l cụng trỡnh nghiờn cu ca riờng tụi Cỏc kt qu, s liu thu c lun l trung thc v cha c cụng b bt k mt lun no khỏc Tỏc gi lun Phm Hi Trung CC CH VIT TT BA Bnh ỏn BN Bnh nhõn GPB Gii phu bnh FSH Follicle-Stimulating Hormone HCG Human Chrionic Gonadotrophin LH Luteinizing Hormone SA Siờu õm TDF Testis development Factor TH Tinh hon MC LC T VN CHNG 1: TNG QUAN 1.1 Phụi thai hc v mụ hc ca tinh hon 1.1.1 S phỏt trin ca tinh hon 1.1.2 S phỏt trin ca ng sinh tinh 1.1.3 S phỏt trin ca tuyn k 1.1.4 S di chuyn ca tinh hon 1.1.5 Mụ hc tinh hon 1.2 Gii phu, sinh lý tinh hon 1.2.1 Hỡnh th kớch thc tinh hon 1.2.2 Liờn quan gii phu ca tinh hon vi cỏc lp ca bỡu, cỏc phng tin c nh tinh hon 1.2.3 Cu to v liờn quan gii phu ca thng tinh 10 1.2.4 Mch mỏu tinh hon 11 1.2.5 Sinh lý, chc nng tinh hon 12 1.3 Bnh lý xon tinh hon 14 1.3.1 Tn sut 14 1.3.2 Nguyờn nhõn, c ch bnh sinh 14 1.3.3 Din bin v hu qu ca xon tinh hon 15 1.3.4 Phõn loi xon tinh hon 15 1.3.5 Triu chng lõm sng, cn lõm sng 16 1.3.6 Chn oỏn xỏc nh xon tinh hon 19 1.3.7 Chn oỏn phõn bit xon tinh hon 19 1.4 iu tr xon tinh hon 20 1.5 Tỡnh hỡnh nghiờn cu v chn oỏn v iu tr xon tinh hon v ngoi nc 20 CHNG 2: I TNG V PHNG PHP NGHIấN CU 22 2.1 i tng nghiờn cu 22 2.1.1 Tiờu chun la chn bnh nhõn 22 2.1.2 Tiờu chun loi tr 22 2.1.3 C mu nghiờn cu 22 2.2 Phng phỏp nghiờn cu 23 2.2.1 Phng phỏp nghiờn cu 23 2.2.2 Cỏc bc tin hnh nghiờn cu 23 2.2.3 K thut m 24 2.3 Cỏc ch tiờu nghiờn cu 27 2.3.1 Nghiờn cu c im lõm sng 27 2.3.2 Nghiờn cu c im cn lõm sng 29 2.3.3 ỏnh giỏ tn thng tinh hon m 30 2.3.4 ỏnh giỏ cỏc yu t liờn quan 30 2.3.5 ỏnh giỏ kt qu theo dừi sau phu thut 30 2.3.6 ỏnh giỏ theo dừi xa 31 2.4 o c nghiờn cu 31 2.5 X lý s liu 31 CHNG 3: KT QU NGHIấN CU 32 3.1 c im lõm sng, cn lõm sng 32 3.1.1 Phõn b theo tui bnh nhõn 32 3.1.2 Thi gian n khỏm 33 3.1.3 Thi im phỏt bnh 33 3.1.4 Cỏc nguyờn nhõn n khỏm mun 34 3.1.5 Phõn b bnh theo yu t nguy c 35 3.1.6 Phõn b bnh theo 35 3.1.7 Cỏc triu chng lõm sng 36 3.1.8 Du hiu Prehn v phn x c bỡu 37 3.1.9 Kt qu siờu õm Doppler mch thng tinh 38 3.1.10 Bờn tinh hon xon 38 3.1.11 Phõn b bnh theo nhúm mỏu 39 3.1.12 Kt qu xột nghim bch cu mỏu 40 3.1.13 Kt qu gii phu bnh 40 3.1.14 S vũng xon thng tinh 40 3.1.15 ỏnh giỏ tn thng m 41 3.2 Kt qu iu tr phu thut 41 3.2.1 Kt qu phu thut chung 41 3.2.2 Kt qu phu thut theo thi gian nghiờn cu 42 3.3 Cỏc yu t liờn quan 43 3.3.1 Liờn quan gia thi gian n khỏm v kt qu phu thut 43 3.3.2 Liờn quan gia s vũng xon thng tinh v kt qu phu thut 44 3.3.3 Liờn quan gia tn thng i th v kt qu phu thut 44 3.4 Kt qu theo dừi sm sau m 45 3.4.1 Thi gian nm vin sau phu thut 45 3.4.2 Tai bin v bin chng sau phu thut 45 3.4.3 Kt qu siờu õm sau m thỏo xon tinh hon 46 3.5 Kt qu theo dừi xa sau thỏo xon 46 3.5.1 Thi gian theo dừi sau phu thut 46 3.5.2 Kt qu khỏm lõm sng sau m 47 3.5.3 Kt qu xột nghim Testosterone v tinh dch sau m 48 3.5.4 Liờn quan gia thi im phu thut v kớch thc tinh hon bo tn 49 3.5.5 Liờn quan gia thi im phu thut vi kt qu tinh dch 50 CHNG 4: BN LUN 51 4.1 Tui bnh nhõn 51 4.2 Thi gian n khỏm 52 4.3 c im lõm sng 54 4.4 Cỏc yu t liờn quan ca xon tinh hon 56 4.4.1 Cỏc yu t nguy c 56 4.4.2 S liờn quan theo nm 57 4.4.3 Cỏc yu t liờn quan khỏc 58 4.5 Vai trũ ca siờu õm Doppler chn oỏn sm xon tinh hon 59 4.6 ỏnh giỏ tỡnh trng tn thng tinh hon m 61 4.7 Kt qu iu tr 63 4.8 Kt qu theo dừi sau m 64 4.8.1 Kt qu theo dừi sau m 64 4.8.2 Kt qu theo dừi xa sau m 64 KT LUN 67 KIN NGH 69 TI LIU THAM KHO PH LC DANH MC BNG Bng 3.1 Thi gian n khỏm 33 Bng 3.2 Cỏc nguyờn nhõn n khỏm mun 34 Bng 3.3 Cỏc yu t nguy c ca xon tinh hon 35 Bng 3.4 Cỏc triu chng lõm sng 36 Bng 3.5 Du hiu Prehn 37 Bng 3.6 Phn x c bỡu 37 Bng 3.7 Bờn tinh hon xon 38 Bng 3.8 Phõn b bnh theo nhúm mỏu 39 Bng 3.9 Kt qu xột nghim bch cu mỏu 40 Bng 3.10 S vũng xon thng tinh 40 Bng 3.11 ỏnh giỏ tn thng m 41 Bng 3.12 Liờn quan gia thi gian n khỏm v kt qu phu thut 43 Bng 3.13 Liờn quan gia s vũng xon thng tinh v kt qu phu thut 44 Bng 3.14 Liờn quan gia tn thng i th v kt qu phu thut 44 Bng 3.15 Thi gian nm vin sau phu thut 45 Bng 3.16 Tai bin v bin chng sau phu thut 45 Bng 3.17 Kt qu siờu õm sau m thỏo xon tinh hon 46 Bng 3.18 Thi gian theo dừi sau phu thut 46 Bng 3.19 Kt qu khỏm lõm sng nhúm ct b tinh hon sau m 47 Bng 3.20 Kt qu khỏm lõm sng nhúm bo tn tinh hon sau m 47 Bng 3.21 Kt qu testosterone sau m 48 Bng 3.22 Kt qu tinh dch sau m 48 Bng 3.23 Liờn quan gia thi im phu thut v kớch thc tinh hon bo tn 49 Bng 3.24 Liờn quan gia thi im phu thut vi kt qu tinh dch 50 TI LIU THAM KHO Mansbach, J.M., P Forbes, and C Peters, Testicular torsion and risk factors for orchiectomy Archives of pediatrics & adolescent medicine, 2005 159(12): p 1167 Cuckow, P and J Frank, Torsion of the testis BJU international, 2000 86(3): p 349-353 Gatti, J.M and J Patrick Murphy Current management of the acute scrotum in Seminars in pediatric surgery 2007 Elsevier Phm Vn Ho, Nguyn Thnh Nh., Thy gỡ qua cỏc trng hp xon tinh hon iu tr ti khoa Nam hc bnh vin Bỡnh Dõn Y hc Vit Nam, 2010 2(375): p 178 - 180 Phan Ngc Duy Cn, Lờ Cụng Thng, Lờ Tn Sn., Xon tinh hon ti bnh vin Nhi ng I Y hc TPHCM, 2011 4(5): p 201-202 Kớnh., Mụ hc 2002: NXB Y hc p 490 - 509 Hinman, F and P.H Stempen, Atlas of urosurgical anatomy 1993: WB Saunders Philadelphia Kớnh., Phụi thai ngi 1998: NXB Y hc: p 551 - 554 Frank 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A B 3.O AB Glucose Ure Creatinin Albumin Protein HBsAg K SGOT SGPT HIV Bil (TP) Bil (TT ) Nhn xột m E1 S vũng xon: E2 Tỡnh trng tinh hon: Kt qu phu thut: G Ct b tinh hon Bo tn tinh hon Theo dừi sau phu thut H1 Tỡnh trng vt m H2 Khỏm tinh hon H3 Siờu õm Doppler mch tinh hon: Theo dừi xa sau phu thut I1 Thi gian: < th th th 12 th > 12 th I2 Kt qu siờu õm: Mch tinh hon: Tỡnh trng tinh hon: Kớch thc Bỡnh thng Teo nh Khỏc: I3 Xột nghim ni tit t (Testosterone): Bỡnh thng I4 Tinh dch : Bỡnh thng Gim Gim DANH SCH BNH NHN STT H TấN 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 inh Minh c Nguyn Hng Sn Nguyn Thnh Long Nguyn Phi Hng Hong Mnh Tỳ Khỳc Vn Chung Nguyn Anh Dng Phan Hong Phong Trn Quang Hũa Nguyn Vn Vng Bựi Quang Duy ỡnh Long Lờ Quý Hng Trng Khc H Ngụ Xuõn Dng V V Bo Anh Nguyn Phc Hong Minh Trng Vn Tuyờn Trn Thanh Tựng Lng Mnh Tin Nguyn ỡnh Thng Nguyn ỡnh Tựng Nguyn Huy Trung V c Thng V Quang Minh Trn Phỳc Hi Nam Nguyn Cao Chỡ Phm Hiu Tuyn TUI 23 15 15 17 17 22 16 15 15 21 21 19 20 17 23 15 11 18 20 20 16 23 15 19 16th 3,5 63 NGY VO 7/01/10 12/12/10 24/02/10 25/01/10 29/01/10 26/05/10 15/04/10 01/04/10 26/07/10 24/09/10 8/12/10 13/10/10 13/12/10 20/12/10 20/12/10 3/11/10 10/11/10 10/1/10 31/8/11 7/4/11 29/12/11 5/4/11 8/5/11 27/3/11 13/3/11 25/6/11 11/11/11 11/11/11 NGY RA 11/01/10 18/12/10 1/03/10 29/10/10 3/02/10 29/05/10 19/04/10 05/04/10 2/08/10 27/09/10 11/12/10 18/10/10 18/12/10 27/12/10 24/12/10 8/11/10 12/11/10 14/1/10 3/9/11 9/4/11 3/1/11 7/4/11 11/5/11 31/3/11 16/3/11 27/6/11 15/11/11 14/11/11 M S HSBA 588 35764 4249 2181 2589 13538 9399 7341 20018 27404 35269 29287 35763 36509 36503 31575 32416 829 25488 8697 39284 8481 11744 7453 6044 17350 33786 33892 29 30 31 32 33 34 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 V Minh Ngc V Vn Tin Nguyn Xuõn Mnh Trng Vn Minh Nguyn Trung Bỏch H Vit Phỏt ỡnh Trng Phm Quang Phỳ Trn c Lõn Xuõn Chin Trnh Vn Cng inh Vn t ng Duuy Nam Phi Cng Nguyn Hu Hũa Hong Tun Anh V Duy Thnh Trn Minh Tun Nguyn Hu Hựng Khỏnh Nguyn Quc Hong Chu Vn Hiu Nguyn Nam Cao T Minh Cng Nguyn Kim Ngc Li Vn M Nguyn Vn Thng Trn Tun Anh Ngụ Vy Mnh Nguyn c Tựng Vừ c Chin Lờ Vn Cụng Phm Ngc Hiu 16 28 17 36 15 21 26 17 16 16 18 18 14 32 27 17 25 22 15 16 16 14 14 32 19 26 20 16 15 28 42 25 13/4/11 14/4/11 28/4/11 18/3/11 23/2/11 9/2/11 26/1/11 11/2/11 14/6/11 21/12/11 27/11/11 16/9/11 29/6/11 19/7/11 4/9/11 5/4/12 30/1/12 16/4/12 28/7/12 9/7/12/ 22/4/12 16/11/12 9/1/12 18/1/12 7/2/12 18/4/12 14/3/12 2/7/12 28/4/12 1/8/12 7/12/12 20/12/12 18/4/11 18/4/11 30/4/11 23/3/11 28/2/11 14/2/11 29/1/11 15/2/11 17/6/11 23/12/11 1/12/11 19/9/11 1/7/11 23/7/11 7/9/11 9/4/12 2/2/12 26/4/12 30/7/12 11/8/12 26/4/12 19/11/12 12/1/12 20/1/12 10/2/12 20/4/12 17/3/12 5/7/12 2/5/12 3/8/12 10/12/12 22/12/12 9184 9337 10891 6628 4275 2975 2224 3199 16140 38363 35574 27287 17883 20271 25830 8775 2057 10159 22732 19248 10819 3665 621 1448 2790 10442 89234 19304 11528 23346 39176 40688 61 62 63 64 65 66 67 68 69 70 Trn Vit Anh Nguyn Vn Lng Chu Quc Sn Trn Ngc Tỳ Nguyn Huy Hiu Nguyn Minh Thnh Nguyn Kim Dng Nguyn Tựng Dng V Vit Qunh Lờ c Anh XC NHN CA GIO VIấN HNG DN 15 32 18 17 15 17 16 15 22 20 18/2/12 26/2/13 20/5/13 22/1/13 19/2/13 15/1/13 10/1/13 30/1/13 1/1/13 14/5/13 21/2/12 4/3/13 24/5/13 28/1/13 21/2/13 17/1/13 12/1/13 1/2/13 4/1/13 18/5/13 3878 5208 15200 2290 4390 1527 1089 305 65 4783 XC NHN CA PHềNG KHTH ... Y T TRNG I HC Y H NI - PHM HI TRUNG NGHIÊN CứU ĐặC ĐIểM CHẩN ĐOáN Và ĐáNH GIá KếT QUả ĐIềU TRị phẫu thuật XOắN TINH HOàN TạI BệNH VIệN VIệT ĐứC Chuyờn ngnh: Ngoi khoa Mó s : 60.72.07 LUN... sinh tinh Gia cỏc ng sinh tinh cú lp t bo k Leydig tit Testosterone - ng dn tinh i t ng sinh tinh n niu o gm cú ng thng, li Haller, nún xut (nm tinh hon) v on ng tinh, thng tinh i t mo tinh qut... thng tinh hon bờn i din cú th gim thiu nu ct b tinh hon xon 1.3.4 Phõn loi xon tinh hon - Xon ngoi tinh mc: ton b tinh hon v tinh mc xon quanh trc dc ca thng tinh, hay gp tr s sinh - Xon tinh