Nghiên cứu ứng dụng phẫu thuật nội soi 1 lỗ điều trị các u tuyến thượng thận lành tính

B GIO DC O TO B Y T TRNG I HC Y H NI ễN QUANG PHểNG NGHIÊN CứU ứNG DụNG PHẫU THUậT NộI SOI MộT Lỗ ĐIềU TRị CáC U TUYếN THƯợNG THậN LàNH TíNH LUN N TIN S Y HC H NI - 2017 B GIO DC O TO B Y T TRNG I HC Y H NI ễN QUANG PHểNG NGHIÊN CứU ứNG DụNG PHẫU THUậT NộI SOI MộT Lỗ ĐIềU TRị CáC U TUYếN THƯợNG THậN LàNH TíNH Chuyờn ngnh: Ngoi tiờu húa Mó s: 62720125 LUN N TIN S Y HC Ngi hng dn khoa hc: GS.TS Trn Bỡnh Giang PGS.TS Nguyn c Tin H NI - 2017 LI CAM OAN Tụi l ễn Quang Phúng, nghiờn cu sinh khúa 31 trng i hc Y H Ni, chuyờn ngnh Ngoi tiờu húa, xin cam oan: õy l lun ỏn bn thõn tụi trc tip thc hin di s hng dn ca: - GS.TS Trn Bỡnh Giang - PGS.TS Nguyn c Tin Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp thun ca c s ni nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni ngy thỏng nm 2017 Ngi vit ễn Quang Phúng CC CH VIT TT ACTH : Adreno-Cortico-Trophine-Hormone (Húc mụn kớch thớch v thng thn) ASA : American Sociaty of Anesthesiologist (Hip hi gõy mờ Hoa K) BN : Bnh nhõn BMI : Body Mass Index (Ch s c th) BV : Bnh vin CHA : Chn oỏn hỡnh nh CHT : Cng hng t CLVT : Ct lp vi tớnh CRH : Corticotropin Releasing Hormone (Hocmon gii phúng ACTH) CS : Cng s M : ng mch MCB : ng mch ch bng MTT : ng mch thng thn T : ỏi thỏo ng FSH : Follicle Stimulating Hormone (Hormon kớch thớch nang noón) GPB : Gii phu bnh HA : Huyt ỏp HC : Hi chng HS : H s LA : Laparoscopic adrenalectomy (Phu thut ni soi tuyn thng thn) LH : Luteinizing Hormone (Hocmon kớch thớch hong th) LN : Ln nht NN : Nh nht NPUC : Nghim phỏp c ch NT : Nc tiu P : Phi Pheo : Pheochromocytome (U ty thng thn) SA : Siờu õm SPA-A : Single port access adrenalectomy (Phu thut ni soi l tuyn thng thn) T : Trỏi TB : Trung bỡnh TKGC : Thn kinh giao cm TM : Tnh mch TMCD : Tnh mch ch di TMGPG : Tnh mch gan phi gia TMHD : Tnh mch honh di TMTT : Tnh mch thng thn TMTTC : Tnh mch thng thn chớnh TMTTP : Tnh mch thng thn ph TTT : Tuyn thng thn UIV : Urograhie Intra Veineuse (Chp niu tnh mch) XN : Xột nghim MC LC T VN .1 Chng TNG QUAN .3 1.1 Mụ hc .3 1.1.1 V thng thn 1.1.2 Ty thng thn 1.1.3 V ngoi .5 1.2 Cu to gii phu tuyn thng thn 1.2.1 Hỡnh th ngoi, v trớ liờn quan 1.2.2 Phõn b mch mỏu v thn kinh .11 1.2.3 Bch huyt v thn kinh 17 1.3 Sinh lý tuyn thng thn 17 1.3.1 V thng thn 17 1.3.2 Ty thng thn 18 1.4 Cỏc bnh lý, hi chng u TTT 19 1.4.1 Hi chng Cushing tng tit cortisol 19 1.4.2 Hi chng tng tit aldosterone nguyờn phỏt: Hi chng Conn 21 1.4.3 Hi chng tng tit androgene (Apert-Gallais) 22 1.4.4 U tu thng thn (Pheochromocytome) .23 1.4.5 U TTT thn phỏt hin ngu nhiờn (incidentalome) [39] 25 1.5 Cỏc phng phỏp thm dũ u TTT 29 1.5.1 Thm hỡnh th .29 1.5.2 Thm chc nng 32 1.5.3 Cỏc nghim phỏp chõn oỏn u TTT 33 1.6 Cỏc phng phỏp phu thut u TTT .35 1.6.1 Phng phỏp m kinh in (m m) .35 1.6.2 Cỏc phng phỏp phu thut ni soi u TTT 39 1.7 Nhng cụng trỡnh nghiờn cu v bnh lý v iu tr phu thut u tuyn thng thn 43 1.7.1 Th gii 43 1.7.2 Vit Nam 44 1.7.3 Phu thut ct u TTT ni soi l 45 1.7.4 Cỏc bin phỏp cm mỏu m 46 Chng 48 I TNG V PHNG PHP NGHIấN CU 48 2.1 i tng nghiờn cu .48 2.1.1 Tiờu chuõn la chn 48 2.1.2 Tiờu chuõn loi tr 48 2.2 Phng phỏp nghiờn cu 49 2.3 Thit k nghiờn cu 49 2.3.1 C mu nghiờn cu 49 2.3.2 Cỏc bc tin hnh nghiờn cu .50 2.3.3 Phng phỏp thu thp s liu 51 2.4 Quy trỡnh phu thut u TTT qua PTNS l 57 2.4.1 Phng tin, Dng c: 57 (nhúm nghiờn cu) 59 2.4.2 Phng phỏp vụ cm: .59 2.4.3 Mụ t k thut 60 2.5 Phng phỏp x lý s liu .66 2.6 o c nghiờn cu: 66 Chng 67 KT QU NGHIấN CU .67 3.1 S liu tng quỏt .67 3.1.1 S lng bnh nhõn 67 3.1.2 Thụng tin chung v i tng nghiờn cu 67 3.2 c im lõm sng, cn lõm sng ca u TTT c ng dng PTNS l 68 3.2.1 Tin s bnh 68 3.2.2 c dim lõm sng 68 3.2.3 Bnh hc, v trớ v kớch thc u TTT 71 3.2.4 c im chõn oỏn hỡnh nh u TTT 73 3.2.5 Gii phu bnh 74 3.2.6 c im ni tit u TTT 74 3.2.7 Cn lõm sng khỏc 75 3.3 ng dng PTNS l iu tr u TTT .76 3.3.1 Nguy c phu thut 76 3.3.2 ng dng phu thut .76 3.4 Kt qu PTNS l iu tr u TTT 80 3.4.1 T l ct u v ton b tuyn thng thn 80 3.4.2 Cỏc tai bin m .80 3.4.3 Thi gian m 81 3.5 Bin chng sau PTNS l iu tr u TTT 83 3.6 Kt qu iu tr sau phu thut .85 3.6.1 Thi gian dựng thuc gim au .85 3.6.2 Thi gian trung tin 86 3.6.3 Thi gian dựng thuc khỏng sinh 87 3.6.4 Thi gian nm vin 87 3.7 Khỏm li sau m .88 Chng 91 BN LUN 91 4.1 c im dch t hc mu nghiờn cu 91 4.1.1 V tui: 91 4.1.2 V Gii 92 4.2 Bn lun v c im lõm sng, cn lõm sng cỏc u TTT c ng dng PTNS l ti bnh vin Vit c 93 4.2.1 c im lõm sng cỏc u TTT c ng dng PTNS l 94 4.2.2 c im ca siờu õm v chp ct lp vi tớnh u tuyn thng thn lnh tớnh c ng dng PTNS l 100 4.2.3 Xột nghim sinh húa c hiu v khụng c hiu .103 4.2.4 Cỏc xột nghim cn lõm sng khỏc 106 4.3 Bn lun v ng dng v kt qu ca PTNS mt l ng qua phỳc mc iu tr cỏc u tuyn thng thn 106 4.3.1 Bn lun v phu thut ni soi thụng thng v PTNS mt l 106 4.3.2 ng dng phu thut ni soi mt l .108 4.3.3 Chõn oỏn: 111 4.3.4 Gõy mờ: 112 4.3.5 K thut PTNS l 112 4.3.6 K thut m ni soi l phỳc mc ct u tuyn thng thn .116 4.3.6.2 ng m v s lng trocart: 116 4.3.7 Thi gian m 124 4.3.8 Tai bin m v t l chuyn m m 132 Laparoendoscopic single site (LESS) adrenalectomy: technique and outcomes World J Urol, 2012;30: 597604 74 Shi TP, Zhang X, Ma X, Li HZ, Zhu J, Wang BJ, Gao JP, Cai W, Dong J (2011) Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: a matched-paircomparison with the gold standard Surg Endosc; 25: 2117 2124 75 Yuge K, Miyajima A, Hasegawa M, Miyazaki Y, Maeda T, Takeda T, Takeda A, Miyashita K, Kurihara I, Shibata H, Kikuchi E, Oya M (2010) Initial experience of transumbilical laparoendoscopic single-site surgery ofpartial adrenalectomy in patient with aldosterone-producing adenoma BMC Urol 2010 Nov 23;10:19 76 Annibale D A et al (2004) The da Vinci robot in right adrenalectomy: considerations on technique Surg Laparosc Endosc Percutan Tech 14: 3841 77 Hubens G, Coveliers H, Balliu L, Ruppert M, Vaneerdeweg W (2003) A performance study comparing manual and robotically assisted laparoscopic surgery using the da Vinci system Surg Endosc 17: 15951599 78 Beninca G, Garrone C, Rebecchi F, Giaccone C, Morino M (2003) Robot-assisted laparoscopic surgery Prelimary results at our center Chir Ital 55: 321331 79 Ianc Bennett and Mark Ray (2002) Hand-Assisted Laparoscopic Adrenalectomy: An alternative minimal invasive surgical technique for the adrenal gland ANZ J Surg.; 72: 801805 80 Smith C D, Weber C J., Amerson R A (1999), Laparoscopic Adrenalectomy: New gold standard, Wordl J.Surg, N0 23, pp 389 396 81 Brunt (2006), Minimal access adrenal surgery, Surg Endosc, N0 20, pp 351361 82 Jeong BC, Park YH, Han DH, Kim HH (2009) Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: amatched casecontrol study J Endourol 2009 Dec;23(12):1957-60 83 Lin VC, Tsai YC, Chung SD et al (2012) A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors Surg Endosc 2012 Apr;26(4):1135-9 84 Kassasseya A, Irani N et Rouffet F (1999), Les accidents électriques en coelioscopie, Ann Chir, Vol 53, N0 1, pp 49- 56 85 Copeland P M (1984), The incidentlly discovered adrenal mass, Ann Surg, N0 199, pp 116-122 86 Valeri A et al (2002), The influence of new technologié on laparoscopic adrenalectomy, Surg Endos, N0 16, pp 1274-1279 87 Dindo D, Demartines N, Clavien PA (2004) Classification of Surgical complications: a new proposal with evaluation in a cohort of 6336 patients with results of a survey Ann Surg, 240:205-213 88 Zollinger's Atlas of Surgical Operations Plate 148-149 89 Kwak HN, Kim JH, Yun JS, et al (2011) Conventional laparoscopic adrenalectomy versus laparoscopic adrenalectomy through mono port Surg Laparosc Endosc Percutan Tech; 21: 439-442 90 Walz MK, Groeben H, Alesina PF (2010) Single-access retroperitoneoscopic adrenalectomy (SARA) versus conventional retroperitoneoscopic adrenalectomy (CORA): a case-control study World J Surg 34(6): 1386-1390 91 Tunca F, Senyurek YG, Terzioglu T, et al (2012) Single-incision laparoscopic adrenalectomy Surg Endosc; 26: 3640 92 Trn Bỡnh Giang et al (2013) Single-incision laparoscopic adrenalectomy at Viet Duc University Hospital Asian J Endosc Surg, (2013) 3338 93 Wang L, Liu B, Wu Z, et al (2012) Comparison of single-surgeon series of transperitoneal laparoendoscopic single-site surgery and standard laparoscopic adrenalectomy Urology; 79:577583 94 Sasaki A, Nitta H, Otsuka K et al (2013) Laparoendoscopic single site adrenalectomy: initial results of cosmetic satisfaction and the potential for postoperative pain reduction BMC Urol 13(1): 21 95 Masanori Hasegawa, Akira Miyajima, Masahiro et al (2013) Visceral Fat Is Correlated With Prolonged Operative Time in Laparoendoscopic Single-site Adrenalectomy and Laparoscopic Adrenalectomy, Urology 82 (6) 1312-1319 96 Akira Miyajima, Seiya Hattori, Takahiro Maeda, Masanori Hasegawa, et al (2012) Transumbilical approach for laparo-endoscopic single-site adrenalectomy: Initial experience and short-term outcome, International Journal of Urology 19, 331335 97 Zhang X, Shi TP, Li HZ et al (2011) Laparoendoscopic Single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments: initial experience and short-term outcome J Urol 185(2): 401-406 98 Linhui Wang, Chen Cai, Bing Liu, et al (2013) Perioperative Outcomes and Cosmesis Analysis of Patients Undergoing Laparoendoscopic Single - site Adrenalectomy: A Comparison of Transumbilical, Transperitoneal Subcostal, and Retroperitoneal Subcostal Approaches, Urology 82 (2) 358-365 99 Vidal O, Astudillo E, Valentini M, et al (2012) Single-incision transperitoneal laparoscopic left adrenalectomy World J Surg; 36: 1395 1399 100 Hu Q.Y, Gou C, Sun K et al (2013) A systematic review and metaanalysis of current evidence comparing laparoendoscopic single-site adrenalectomy and conventional laparoscopic adrenalectomy J Endourol 27(6): 676-683 101 ng Vn Chung (1971), Bnh hc ni khoa, tr 37-45 102 Nguyn Thuyờn (1972), trng hp phộochomocytome, Tp y hc Vit Nam, 57, s 4, tr 5-11 103 Mai Th Trch, Nguyn Thy Khuờ (2004), Ni tit hc i cng, Nh xut bn y hc, tr 213-270 104 Ilias I, Pacak K (2004), Current approaches and recommended algorithm for the diagnostic localization of pheochromocytoma, J Clin Endocrinol Metab, N0 89, pp 47991 105 Sheps.S G et al (1990), recents developments in the diagnosis and treatement of pheochromocytoma, Mayo, Clin, Proc, N0 65, pp 88-95 106 Brunaud L A et al (2005), Les problemes diagnostiques du pheochromocytome, Annales de chirurgie, N0 130, pp 267272 107 Lờ Ngc T (1996), Mt s nhn xột v cỏc u tuyn thng thn, Tp y hc Vit Nam, 208, s 9, tr 64-66 108 Pannier I et al (1999), Pheochromocytoma, E.M.C, 10-015-B-50, 4P 109 Aron C D (1981), Cushing/ s syndrome: problem in diagnosis Medcine (bantimor), N0 60, pp 25-35 110 Boggan J E e al (1983), Transsphenoidal micrsurgical management of Cushing s disease: report of 100 cases" J Neuro Surg, N0 59, pp 195-200 111 Martino P (1993), The role of echography in the diagnosis of adrenal masses, Arch Ital Urol Androl, Vol 65, N04, pp 337-340 112 Ross E et al (1966), Cushing/s syndrome: disganosis criteria, Quaterly J Med, N0 138, pp 149-191 113 Lynnette K, Nieman MD, Ioannis Ilias, MD, DSc (2005), Evaluation and treatment of Cushings syndrome, The American Journal of Medicine, N0 118, pp 1340-1346 114 Trung Quõn (1995), Gúp phn chn oỏn v iu tr hi chng Cushing, Lun ỏn Phú tin s khoa hc Y - Dc H Ni 115 Bruce S., Stephan H, Energie sources: bipolar, hamonic and other, http:/www.sages.org/01program/syllabi/ho l/ho l.ht 116 Dudley N E and Harrison B J (1999), Comparison of posterior versus transperitoneal laparoscopic adrenalectomy, Br Surg, N0 86, pp 656-660 117 Aron C D (1987), Cushing/s syndrome: current concept in diagnosis and treatement, Compr - Ther,N0 13, pp 37-44 118 William E; Grizzle (1988), Pathology of adrenal grands, Seminas in Roentgenology, N0 23, pp 323-331 119 Plotz C M et al (1952), The natural history of Cushing/ s syndrome, Am J Med, N0 13, pp 597-614 120 Carpenter P C (1988), Diagnostic evolutin of Cushing/ s syndrome, Endo Metab Clin North Am, 17, 445, 72 121 Hau Liu, MD, MBA, MPH and Lawrence Crapo, MD, PhD (2005), Update on the Diagnosis of Cushing Syndrome, The Endocrinologist Volume 15, Number 3, May/June 122 Marco Boscaro et al (2001), Cushing/s syndrome, Lancet, N0 357, pp 783-91 123 Benjaminn J.T et al (2004), Laparoscopic adrenalectomy for pheochromocytoma: with caution, ANZ J Surg, N0 74, pp 429433 124 MarcosL F et al (2004), Laparoscopic Surgery for Pheochromocytoma, European Urology, N0 45, pp 226-23 125 Portnoi L.M; Kalinin A.P (1994), Radiodianostic prblems in adrenal diseases, Ter Arkh, N0 66, pp 12: 63-67 126 Ngc Giao (1999), Nghiờn cu giỏ tr ca siờu õm chn oỏn bnh u tuyn thng thn, Lun tt nghip bỏc s ni trỳ cỏc Bnh vin trng i hc y H ni 127 Nguyn Duy Hu, Nguyn ỡnh Minh, Nguyn c Tin (2004), Chp ct lp vi tớnh chn oỏn u tuyn thng thn nhõn 102 bnh nhõn, Y hc thc hnh: Cụng trỡnh nghiờn cu khoa hc, Hi ngh ngoi khoa ton quc, tr 590-594 128 Findling JW, Raff H (2001), Diagnosis and differential diagnosis of Cushings syndrome, Endocrinol Metab Clin North Am, N0 30, pp 729-747 129 Nieman LK 2002, Diagnostic tests for Cushings syndrome, Ann N Y Acad Sci, N0 970, pp 112-118 130 Christine F K M.D et al (1998), Laparoscopic versus Open Posterior Adrenalectomy: Comparison of Acute-phase Response and Wound Healing in the Cushingoid Porcine Model, World J Surg N0 22, pp 613620 131 Chrousos G et al (1985), Diffirential Diagnostic evolutin of Cushing/s syndrome, Ann, Intern, Med, N0 7, pp 102-346 132 Young U F (2003), Primery aldosteronism changing concepts in diagnosis and treatement, Endocrinology, N0 144, pp 2208-13 133 Wheeler M H (2003), Diagnosis and management of primery aldosteronism, World J Surg, N0 27, pp 627-631 134 Nguyn Nh Bng, Nguyn Phỳc Cng (1973), Nhn xột gii phu bnh hai trng hp hi chng Conn, Ngoi khoa, 1, s 2, tr 111-117 135 Harris D A et al (2003), Review of surgical management of aldosterone secreting tumours of the adrenal cortex, EJSO, N 6, pp 467 474 136 Tenenbaum F et al (1992), Incidentalomes Surrenaliens, La lettre du cancerologue, Vol 1, N0 5, pp 246-250 137 Agha A, Hornung M, Iesalnieks J et al (2010) Single-incision retroperitoneoscopic adrenalectomy J Endourol 24(11): 1765-1770 138 Chung SD, Huang CY, Wang SM, Tai HC, Tsai YC, Chueh SC (2011) Laparoendoscopic adrenalectomy using a single-site homemade (LESS) single-access retroperitoneal platform and standard laparoscopic instruments Surg Endosc, 25:12511256 139 Koji Yoshimura, M.D., Ph.D., Kazutoshi Okubo, et al (2011), Laparoendoscopic Single-Site Surgery for Left Adrenalectomy: Standardization of Technique Journal Of Endourology Volume 25, Number 6, June 2011 pp 10311035 140 Xiaobin Yuan, MD, Dongwen Wang et al, (2014), Retroperitoneal Laparoendoscopic Single-Site Adrenalectomy for Pheochromocytoma: Our Single Center Experiences Journal Of Endourology Volume 28, Number 2, February 2014 pp 178183 141 Gockel I; W Kneist; A Heintz; J Beyer; T Junginger (2005), Endoscopic adrenalectomy: An analysis of the transperitoneal and retroperitoneal approaches and results of a prospective follow-up study, Surg Endosc, N 19, pp 569573 142 Rubinstein H, Gill IS, Aron M et al (2005) Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy J Urol 174: 442-445 143 Berglund PK, Gill IS, Babineua D et al (2007) A prospective comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy in the extremely obese patient BJU Int 99: 871-874 144 Autorino R, Cadeddu JA, Desai MM et al (2011) Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology; A Critical Analysis of the Literature Eur Urol 59: 26-45 145 Hattori S, Miyajima A, Maeda T et al (2013) Does laparoendoscopic single-site adrenalectomy increase surgical risk in patients with pheochromocytoma Surg Endosc 27(2): 593-598 146 Wang L.Z, Wu M, Li C et al (2013) Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic surgery: a systematic review and meta-analysis of observational studies J Endourol 27(6): 743-50 147 Bonjer.H.J, Kazemier.G, Herder.de.W.W, (1997), Comparision of three tecniques for adrenalectomy, Br J Surg, N0 84, pp 679-682 148 Gagner.M, Pomp A, Heniford B TT, Pharand D, Lacroix A (1997), Laparoscopic Adrenalectomy Lessons Learned From 100 Consecutive Procesdures, Ann Surg, Vol 226, N.3, pp 238-247 149 Kazaryan A M; N S Kuznetsov; A M Shulutko (2004), Evaluation of endoscopic and traditional open approaches to pheochromocytoma, Surg Endosc, N0 18, pp 937941 150 Maccabee D L et al (2003), Transition from open to laparoscopic adrenalectomy, The need for advanced training, Surg Endosc, N0 17, pp 15661569 151 Moăbius E C, Nies, M Rothmund (1999), Surgical treatment of pheochromocytomas Laparoscopic or conventional?, Surg Endosc, 13: 3539 152 Seiya Hattori, MD, Akira Miyajima et al (2014) Surgical Outcome of Laparoscopic Surgery, Including Laparoendoscopic Single-Site Surgery, for Retroperitoneal Paraganglioma Compared with Adrenal Pheochromocytoma Journal Of Endourology, Volume 28, Number 6, June 2014 P 686692 153 Cruiz L F (1996), Laparoscopic adrenal surgery, Br Surg, 83: 721-723 154 Imai.T, Kikumori T, Ohiwa M, Mase T (1999), Acase-Controlled study of laparoscopic Compared With Open Lateral Adrenalectomy American", J Surg, N0 178, pp 50-54 155 Barnett C C, Varma DG, El-Naggar AK, et al (2000), Limitations of size as a criterion in the evaluation of adrenal tumors Surgery, N0 128, pp 973983 156 Ikeda Y, H Takami, Y Sasaki, J Takayama, M (2003), Is Laparoscopic Partial or Cortical-Sparing Adrenalectomy Worthwhile?, Eur Surg Vol 35 No, 2: 89-92 157 Ikeda Y et al (2001), Laparoscopic partial or cortical-sparing Adrenalectomy by dividing the adrenal central vein, Surg endosc, N0 15, pp 745-750 158 Martin K, Walz M.D (1998), Subtotal Adrenalectomy by the Posterior Retroperitoneoscopic Approach, World J Surg, N0 22, pp 621627 159 Martin K Walz M.D et al (2004), Partial versus Total Adrenalectomy by the Posterior Retroperitoneoscopic Approach: Early and Long-term Results of 325 Consecutive Procedures in Primary drenal Neoplasia, World J Surg, N0 28, pp 13231329 160 Walz MK, Peitgen K, Diesling D, et al (2004), Partial versus total adrenalectomy by the posterior retroperitoneoscopic approach: early and long-term results of 325 consecutive procedures in primary adrenal neoplasia, World J Surg, N0 28, pp 13231329 161 Lehnert H et al (2002), Benign and malignant phaeochromocytoma, Internist, N0 43, pp 196-209 162 Clellan M et al (2000), Laparoscopic partiel adrenalectomy in patient with hereditary forms of phaeochromocytoma, J Urol,N0 164, pp 14-17 163 Brauckhoff M et al (2003), Functional Results After Endoscopic Subtotal Cortical-Sparing Adrenalectomy, Surg Today, N0 33, pp 342348 164 Yao He, MD, Zhi Chen, MD, Yan-Cheng Luo et al (2014), Laparoendoscopic Single-Site Retroperitoneoscopic Adrenalectomy for Pheochromocytoma Case Selection, Surgical Technique, and ShortTerm Outcome Journal Of Endourology, Volume 28, Number 1, January 2014 pp 5660 MT S HèNH NH MINH HA V trớ trocart u TTT T M phỳc mc thnh sau (nhúm nghiờn cu) bờn T (nhúm nghiờn cu) Phu tớch, kp TMTTC (nhúm nghiờn cu) Kp ng mch thng thn di gii phúng mt sau tuyn (nhúm nghiờn cu) So m bnh nhõn u TTT P (bnh nhõn s 51) So m bnh nhõn u TTT T (bnh nhõn s 71) MU BNH N NGHIấN CU Hnh chớnh - H tờn Tui Nam N - Ngh nghip - a ch: Tel - Ngy vo vin: Ngy vin: - Ngy m: - H s s: Mó bnh ỏn:Mó h s: Tin s trc m - Cao Huyt ỏp: - H Kali mỏu: - Cỏc tin s khỏc (ghi rừ thi gian): Lõm sng Hi chng Cushing Tng cõn Bộo cc b U m sau gỏy Mt trũn da Rn da Thõm tớm Trng cỏ Rm lụng Gim trớ nh Trm cm-Ri lon nhõn cỏch au u Mt mi Teo c au xng Mt-ri lon kinh nguyt Hi chng Conn Cao huyt ỏp Co rỳt c ỏi nhiu Khỏt nhiu Suy nhc c th Ri lon nhp tim Pheochromoxytome Tng huyt ỏp thng xuyờn Tng huyt ỏp kch phỏt au u Ra m hụi Nhp nhanh lo lng Run chõn tay Mt mi, suy nhc Khú th Thay i th lc Gy sỳt U hch TKGC Cao huyt ỏp au bng Khỏc m vt to Tng huyt ỏp ỏi thỏo ng Cỏc thm dũ cn lõm sng Thm dũ cn Lõm sng in tõm Siờu õm M thn Siờu õm tim XQ phi Siờu õm bng CLVT( CHT) bng Kt qu Dy tht trỏi Bỡnh thng Dy tht trỏi Bỡnh thng Cú U Cú U Hỡnh thỏi, tớnh cht U (ghi rừ kớch thc mm) Hỡnh thỏi, tớnh cht Tớnh cht S Tớnh cht CT, CHT Kớch thc Kớch thc S CT,CHT Nang Hoi t Vụi húa Chy mỏu Hch bng ố y (ghi rừ cq) Xột nghim sinh húa mỏu (ghi rừ kt qu): Xột nghim Bỡnh thng Dopamin Adrenalin Noradrenalin Cortisol Kali Natri Canxi Clo Glucose Chõn oỏn - U TTT Phi: - U ty thng thn: Khụng bỡnh thng U TTT Trỏi: U v thng thn: - U Thng thn khụng ch tit: Nang thng thn: Kt qu Gii phu bnh: Phõn loi trc m theo ASA: ỏnh giỏ m - S lng Trocart: Trocart l Thờm Trocart Tỡnh trng bng: Tỡnh trng U: Thi gian m: - Ct ton b tuyn: Ct chn lc U: Lng mỏu mt m: - Khú khn, tai bin m (ghi rừ): - Chuyn phng phỏp m: Chuyn PTNS TT: M m: Dn lu: Bin chng Trong m Sau m Tng Huyt ỏp Tt Huyt ỏp H ng huyt H Kali mỏu Suy TTT ng dch Nhim khun Khỏc (ghi rừ) iu tr sau m S ngy iu tr khỏng sinh: S ngy dung thuc gim au: S ngy rỳt dn lu: S ngy iu tr sau phu thut: Thi gian trung tin: Khỏm li sau m - Lõm sng Hi chng Cushing Tng cõn Bộo cc b U m sau gỏy Mt trũn da Rn da Thõm tớm Trng cỏ Rm lụng Gim trớ nh Trm cm-Ri lon nhõn cỏch au u Mt mi Teo c au xng Mt-ri lon kinh nguyt m vt to Tng huyt ỏp ỏi thỏo ng Hi chng Conn Cao huyt ỏp Co rỳt c ỏi nhiu Khỏt nhiu Suy nhc c th Ri lon nhp tim Pheochromoxytome Tng huyt ỏp thng xuyờn Tng huyt ỏp kch phỏt au u Ra m hụi Nhp nhanh lo lng Run chõn tay Mt mi, suy nhc Khú th Thay i th lc Gy sỳt U hch TKGC Cao huyt ỏp au bng Khỏc Xột nghim (ghi rừ kt qu s nu cú): ỏnh giỏ s hi lũng vt m: Cú so li: Khụng cú so li: Khỏc (ghi rừ ý kin ngi bnh) 4,6,7,8,11,12,14,15,41,57-65,67,86 1-3,5,9,10,13,16-40,42-56,66,68-85,87-170,172- ... 2 017 B GIO DC O TO B Y T TRNG I HC Y H NI ễN QUANG PHểNG NGHIÊN C U ứNG DụNG PH U THUậT NộI SOI MộT Lỗ ĐI U TRị CáC U TUYếN THƯợNG THậN LàNH TíNH Chuyờn ngnh: Ngoi ti u húa Mó s: 6272 012 5 LUN... phỏp phu thut ni soi u TTT 39 1. 7 Nhng cụng trỡnh nghiờn cu v bnh lý v iu tr phu thut u tuyn thng thn 43 1. 7 .1 Th gii 43 1. 7.2 Vit Nam 44 1. 7.3 Phu thut ct u TTT ni soi l... 10 6 4.3.2 ng dng phu thut ni soi mt l .10 8 4.3.3 Chõn oỏn: 11 1 4.3.4 Gõy mờ: 11 2 4.3.5 K thut PTNS l 11 2 4.3.6 K thut m ni soi l phỳc mc ct u tuyn thng thn .11 6 4.3.6.2