- Phdu thuat vien d u n g ben trai b e nh n ha n.
- Nguo i phu thu" nhat d u n g ben phai be nh n ha n dieu khi6n c a m e r a .
Nguoi phu t h u hai ngoi g i ua hai c h a n b e nh n h a n de dieu k h i e n c a n n a n g tu c ung.
IV- KY THUAT
1. Vi tri t r o c a r t
- 1 trocart 1 1mm 6 n g a y sat ron de’ dat o n g soi.
- 2 trocart 6 m m 6 hai ben ho c h a u , n g a y tren x u o n g m u ( 6 hai d a u c u a d u d n g P f en n e n s t i e l k e o dai ra) de d u a d u n g cu: kep, d a o d i e n , o'ng hut, k e o ...
2. Ph du t h u a t noi soi b a o ton ( H i n h 24 - 25 6 phu b an va h in h 26)
Ky thuat noi soi bao ton chira ngoai tu cung duoc tien hanh trinh tu nhu sau: - Neu co c h a y m a u thi hut va rura 6 b u ng .
- D u n g q ue g a y va ke p k h o n g g a y c h a n t h u o n g de’ b o c lo k hoi c h u a , d a n h gia tinh t ra ng vdi trurng ben ddi dien.
I lin h 26: Ky Ihudt lay kho i chua bao Ion vdi tru n g D a y c h a n g tr e n tr e o v o i trd n g K h o i chJa o' hang vai trJ n g ~~ y Buong trJ n g N i e u q u a n
- D u n g k ep k h o n g g ay c h a n t h u o n g d u a trocart 6 m m c u n g b en kho'i c h u a , c a p voi t ru n g 6 ga n k ho i c h u a de co' dinh.
- M d voi truTig: d u n g d a o di en m o t c uc d u a q u a tro ca rt doi di en voi kh oi c h u a c a m m a u va m o d o c b o tu do c u a voi t r ung 1cm o vi trf k h o i c h u a , tren c u a khoi c h u a . D a u d a o dien mo t c u c ap nhe n h a n g len b6 m a t c u a voi trufng va phai r a c h ca 3 16p c u a voi trung. C an luu y, d a o d i e n c o the gay b o n g r ong, p h a h u y t h a n h voi trung. Co the d u n g L a s e r t h a y d a o d i e n mo t cuc.
- Ldy to chufc rau thai: d u n g o n g hut v ua hut vua r ua de lay het t6 c h u c rau thai va m a u cuc. C o the d u n g k e p gdp to c h u c rau thai n he n h a n g , t r a n h lam s ang c h a n n i e m m a c voi trung.
- Can x ac di nh c hdc chdn k h o n g c on sot to c h u c rau thai n g a y c a khi voi trufng da xe p x u o n g . D u n g m o t ke p k h o n g c h a n t h u o n g d u a voi trufng q u a vet rach, sau do m o k ep ra de boc lo ben t r ong voi trirng. D u a o n g soi va o ga n de n hin ro ra n g hon.
- K i e m tra c h a y ma u : neu co c h a y m a u 6 m e p rach voi t r u n g h o a c d i e n rau ba m, d u n g da o di en hai c u c c a m m a u o m u c toi thieu, t r a n h l am p h a h u y t hanh voi trung.
- L a y to chufc rau thai ra n go ai o bung: th ay the 1 tr oc a rt 6 m m c u n g ben p h i u thuat vien b a n g 1 trocart 1 1mm. D u n g k e p g a p to c h u c rau thai q u a trocart 11 h oa c hut b a n g o n g hut 10 mm. Ne u t6 c h u c rau thai Ion, cat t h a n h m i e n g n h o h o n lay dan. Co thS d u n g m ot tui n il on lay q u a t h a n h bung.
- Sau c u n g r u a o b u n g m o t c a c h ky c a n g , hut 6 c u n g do sau. C h o b e n h n h a n n dm 6 tu the d a u c a o de m a u va dich d o n g d o n x u o n g c u n g d6.. .
- D u o n g r ac h voi trting de m o, k h o n g c a n kha u.
- Neu c o Tr iton la d u n g cu c o n hi eu c h u c n a n g, d u o c thiet ke d a c biet c h o phuong phap bao ton voi trufng thi phau thuat co the tien hanh thuan loi hon.
3. P h a u t h u a t noi soi c at voi trirng ( H i n h 27)
- D a u tien, hut het m a u , rira o b u n g neu c o c h a y m a u , d a n h g ia t inh t r a n g khoi c h u a v a tinh t ra n g voi t r u ng be n doi dien.
- Cdt bo voi t r u n g c o kh oi c h u a d u o c tien h a n h tu p h a n e o d e n p h a n l oa voi t r un g h o a c n g u g c lai.
- D u n g mo t k e p troc art 6 m m c u n g ben k hoi c h u a k e p c o d i n h voi trufng. c h o tiep g i a p g i u a e o va b o n g de b o c lo d o a n e o voi t ru n g
- D u a da o di en hai c u c q u a tr oc a rt 6 m m b e n doi d i e n voi kh oi chufa, c a m m a u tu eo voi t r un g, vira c a m m a u v u a cdt b i n g k e o d o c t h e o b o m a c t h e o voi tr un g, v ua c a m m a u vira cdt b a n g k e o d o c t h e o b o m a c t h e o voi trufng vS phfa loa voi. C a n da c biet c h u y n h a n h noi g i u a d o n g m a c h b u o n g t r u n g va d o n g m a c h tu c u n g .
- Co mot so tac gia d u n g chi E n d o l o o p , clip h oa c kh au de t ra n h c h a y m a u . - Phan cdt bo d u o c lay ra b i n g c a c h c h o va o tui nilon d u a q u a t h a n h b u n g
h oa c tijrng p h an q u a trocart 1 1mm. - Cuoi c u n g tien h a nh rira sach o b ung. - Mot so k h o k h an gap khi phdu thuat:
Kh oi tu m a u d vdi t r ung ldn, k h o k ha n c h o viec cdt bd, t ro n g t r u d n g h o p n ay nen m d vdi t rung de g i a m the tich ciia vdi trurng, rdi tien h a nh cat vdi t r ung sau.
Mo t so k h o k h a n k h a c la dfnh vdi trirng va b u d n g trirng. N eu di nh n hi eu va da y, k h o n g the g o dfnh d uo c , phai lira c h o n g i u a p hdu t hu at ba o tdn vdi trirng h a y cdt ca b u o n g trirng.
4. D ie u tri noi soi b a n g M e t h o t r e x a t e
M ot so tdc gia n u d e n go ai sir d u n g M e t h o t r e x a t e de dieu tri chira n g oa i tir c u n g q u a noi soi. D u a mot kim c h o c tuy s on g c d 19 q u a t h a n h b u n g va o khoi chira dudi sir g i a m sat ciia noi soi. T i e m vao khoi chira 2 - 5 ml d u n g dich chira 1 0 - 4 0 m g M e t h o t r e x a t e .
V ie c tiem M e t h o t r e x a t e c d the lam ta ng dp luc ben t r ong vdi trirng g a y vo khoi chira n g a y sau khi tiem hoa c t r on g 4 g i d sau.
- C h d n g chi d in h ciia dieu tri na y khi khoi chira bi vd.
- D i e u tri b a n g M e t h o t r e x a t e t h u d n g d u o c chi d in h t ro n g t r u d n g h o p cd c h d n g chi di nh phau thuat noi soi h oa c pha u t huat noi soi k h o k ha n: chira d ke vdi trirng, be o beu, k hoi chira ldn va d inh tieu k h u n g .
- Tai Benh vien Ba me va Tre so sinh c h u n g toi k h o n g dp d u n g p h u o n g p n a p nay.