1. N g u y e n ly c h u n g
- C ho n loc b e nh nhan: u n a n g lanh tfnh c o d u o n g kfnh < 10cm, k h o n g dfnh vao c ac t ang x u n g q u a n g .
- G a y me noi khf q u a n .
- D at t h o n g b a ng q u a n g b i n g o n g t h o n g Fole y.
- Co k h a n a n g tien h a nh mc> b u n g n g a y lap tire neu c an thiet. - Co kinh n g h i e m m o noi soi.
- L u o n lam te ba o dich 6 c u n g do D o u g l a s.
2 Hoc u t r o n g o b u n g ( x e m hi nh 21 a p hu b a n va h in h 22)
Ky thuat n a y d u o c Bruhat va c a c c o n g sir m o ta n a m 1989 va J o h n s m o ta n a m 1991. N gu oi ta goi la ky t huat b oc vo b u o n g trufng: b oc bo n a n g b u o n g trting de lai p h an b u o n g trufng lanh. Co hai ky thuat:
- Do i vdi n a n g n h o thi de n g u y e n n a n g va boc tach nang.
- Ddi vdi n a n g ldn thi c h o c hut n a n g trudc khi boc n a ng . D u n g tr oc a rt 6 m m c h o c vao c h o k h o n g c d m a c h m a u c a c h xa m a c treo vdi trun g, hut r ua het to c h u c d t ro ng n a n g rdi boc na ng.
- K y thuat boc nang: c d d inh vd n a ng b i n g mo t kim c d m a u , d u n g k e o cdt vo n a ng dai 1cm, sau 1 - 2 m m . d un g 2 kim co ma u ke o 2 m e p vd n a n g n g u g c n ha u. H o a c d u n g 1 kim co m a u c a p vao vd n a ng, mo t kim k h o n g c d ma u k ep vao n a n g va keo n g u g c n h au de boc tach n a n g khoi p h a n vd b u d n g t r ung lanh. Neu c h a y m a u d u n g d a o dien hai c uc de c a m m a u .
- Ph a n b u d n g t ru n g c o n lai d u g c rua va c a m m a u ky va c d the de n g u y e n h oa c k h au b a n g 1 - 2 mui vicryl c h u X, h o a c b a n g clip.
- L a y u b a n g tui q u a Id c h o c trocart 1 0 m m h oa c rach r o n g t h a n h b u n g d mo t lo c h o c trocart, h oa c cd the m d c u n g do sau de lay u.
- R u a lai tieu k h u n g b a n g h uye t t hanh m a n d a n g t ruong. D o m o t it d u n g dich R i n g e r lactat vao o b un g de g i a m n g u y c o dfnh sau mo.
3. Hoc u n a n g q u a t h a n h b u n g
Dd i vdi c a c n a n g d a c n h u n a ng bi, t e r a t o m e lanh tinh, n a n g to ta c d the ra ch m ot d u d n g n gd n d t h a n h bung, d u n g k im ke o u q u a t ha nh b u n g dudi s u kiem soat c ua noi soi rdi tien hanh boc u d ngoai thanh bung. Cam ma u va khau phuc hoi lai phan b u d n g trung lanh rdi dua bu dn g trung vao lai trong o bung.
4 C a t b u o n g trirng h a y cat p h a n phu ( xe m hinh 23 d phu ban)
Khi u n a n g c h i e m het b u d n g t ru ng h a y d phu iiur da m a n kinh, da u tien d u n g d a o di en hai c u c dot c a m m a u rdi cdt da y c h d n g that l ung b u d n g trufng, h o a c k h a u b uoc , h o a c d u n g clip. T i ep do dot va cdt da y c h d n g tur c u n g b u d n g t r un g rdi d e n m a c treo vdi trung. Ne u b e nh n h an k h o n g c o n n g u y e n v g n g de thi cat c a vdi trung.
L a y u b a n g tui q u a t ha nh b u n g h o a c lay u q u a tui c u n g sau am dao.
5. U n a n g b u d n g trirng d a n g lac noi m a c t u c u n g
T i nh c h a t c u a n a n g b u d n g trurng d a n g lac noi m a c tu c u n g la vd rat m o n g , d t
vd, k h o b oc t ach. C h o c hut rura ky, rdi d u n g da o di en l u o n g c u c, h o a c l aser C 0 2 dot ki tat c a c a c t h a n h c u a vd na ng.
6. Hien chirng
- C h a y m a u .
- C h a n t h u o n g c a c d a n g k ha c. - D a u b u n g va a b c e s b u o n g trurng.
TAI LIEU THAM KHAO
1. Alain J . M . A n d e b e r t - L a p a r o s c o p i c O v a r i an S ur g e r y a n d O v a r i a n T o r si on . E n d o s c o p i c Su rg er y for G y n e c o l o g i s t s 1993. 134 - 141.
2. Pierre - C h i r u r g i e par voie c o e l i o s c o p i q u e . La p ra t i q u e c h i r u r g i c a l e en G y n e c o l o g i e O b s t e t r i q u e . 1998. 161 - 185. 3. G a b o r T. K o v a c s - E n d o s c o p i c Surgical A p p r o a c h to the t r e a t m e n t o f A n o v u l a t i o n d ue to p o l y c y s t i c O v a r y S y n d r o m e - O v a r i a n Dri ll i ng . E n d o s c o p i c s u r g e r y for g y n e c o l o g i s t s 1993. 147 - 153. 4. L a c h l a n de C r e s p i g u y - L a p a r o s c p i c O v a r i a n Su rg er y: P r e o p e r a t i v e D i a g n o s i s a nd I m a g i n g . E n d o c o s p i c S u r ge r y for G y n a e c o l o g i s t s 1993. 122 - 1 3 7 .
OIEU TRI CHUTA NGOAI TUT CUNG BANG PHAU THUAT NOI SOI■ • •
D o T h i N g o c L a n
D i eu tri noi soi bao ton chira n goai tu c u n g d u o c M a n h e s va B ruha t m o ta, ket q u a dau tien d u o c c o n g bo vao n a m 1977. V e sau, m o t so tac gia k h a c (Semn 1977, D u b u i s s o n 1987) da m o ta ky t huat cat bo voi c h u n g t rong c h u a ngo ai tu c u n g . N g a y nay, p h i u t hua t noi soi la m ot p h u o n g p h a p rat d uo c Ua c h u o n g t ro n g di£u tri c h u a n goa i tu c u n g 6 c a c n u 6 c p h a t trien. O Viet N a m , dieu tri b i n g c h u a ngoai tu c u n g b i n g phdu t huat noi soi da d u o c ap d u n g 6 b e n h vien Tu1 Du tu" n a m 1993. Tai Vi en Bao ve Ba m e va Tre so sinh, c h u n g toi ap d u n g p h u o n g p h a p n a y tir 1/1998 va d a tro t h a nh chi d in h c h in h c h o dieu tri c h u a ngoai tu c u ng.