I- DA! CU'CTNG
2. Dieu tri phau thuat
M u c dfch: p ha h u y tat ca ton t h u a n g , bao ton c h u c n a n g c a c c a q u a n . K h o khan:
- L a c noi m a c tir c u n g q u a n on c h u n g to b e nh d a n g tien tri en c o ton t h u a n g k h o n g dien h'mh k h o n g tim het d u g c nen bo sot, di eu tri k h o n g triet de.
- Dfnh q u a nhi6u, b oc ta ch kho.
- T r o n g t r u o n g h g p v ie m tien trien n h i e u m a c h m a u , g a y c h a y m a u khi phdu thuat k h o n g lay d u g c het tdn t h u a n g .
T r o n g p h i u t huat de c h a n d o a n c hf nh xa c ton t h u a n g phai g o d fnh. h u t het dich d o n g tui c u n g D o u g l a s , nhin d u g c toan bo 3 b u o n g trirng, c h o c d o n a n g b u o n g trirng de t'lm o lac noi m a c tir c u n g t r on g b u o n g tr ung.
K h o n g c o be nh c a n h c h u n g ciia lac noi m a c tir c u n g t r o n g soi 6 b u n g bai hinh thai da d a n g ve vi trf c u n g n h u m u c do ton t h u a n g . Co the d a n h gia ton t h u a n g th eo hi ep hoi vo sinh M y ( A FS- 1985) b a n g (3).
Bang 3: Phan loai lac noi ma c tiir c u ng then hicp hoi Sinh san My
(A m erica n Fertility Society)
< l c m 1 -3 cm > 3 c m PM N 1 2 4 S 2 4 6 Lac N M T C BT-T N 1 2 4 S 4 16 2 0 BT-P N 1 2 4 S 4 16 2 0
Tui c u n g m o t phan toan bo
D o u g l a s 4 4 0 <1/3 1/3 - 2/3 >2/3 BT-P M 1 2 4 D 4 8 16 Day BT-T M 1 2 4 c h i n g D 4 8 16 d inh V T - P M 1 2 4 D 4* 8* 16 V T - T M D 1 2 4 4* 8* 16
C a c m u c d o lac noi m a c tur c u n g
1. N he 1 de n 5 2. T r u n g binh 6 den 15 3. N a n g 16 de n 30 4. Rat n a n g > 4 0 N: n o n g S: sau
M: m o n g D: d a y
*: V T h o a n to an bi c h e 16 d i e m
Giai doan I Giai doan II
Giai doan III Giai doan III vira
Giai doan III nang Giai doan IV
H in h 34: ton th u a n g lac noi mac t u c u n g tren so do c o qua n sinh du e nu.
T h u t h u a t :
- G o d in h h o a n toan.
D o t p ha c a c o lac noi m a c tir c u n g b i n g d a o di en m o t c u c h ay hai c u c h o a d a o L as er . Cdt r o n g ton t h u o n g d a m b a o k h o n g tai p ha t , lay t6 c h u c giri gi; p h i u b e nh . T r u a c khi cdt to c h u c phdi g a d i n h b oc lo to c h u c x u n g q u a n tot. K y t hu at cdt n u o c c h o p h e p lay to chiirc lac noi m a c tir c u n g a
- Nieu q u a n , nai c o m a c h m a u 16n m a k h o n g lam ton t h u a n g . D u n g d u n g dich R i n g e r L a c t a c h o a c m uo i d i n g t r u o n g tiem n g a y d u a i v u n g lac noi ma c tu c u n g de tao lop dich ba o ve, roi d u n g k e o cat khoi lac noi m a c tti c u n g , d u n g d a o dien c a m m a u neu can.
- Boc tach n a n g b u o n g trting neu tcm t h u a n g n h o h a n 2 c m co the dot h o a c boc tach. Ne u khoi u lac noi m a c tu c u n g h a n 2 c m t r u a c het phai g o dinh, hut het di ch m a u de p h o n g c a y t6 chtic lac noi m a c tu c u n g va o tieu k h u n g . Hu t rura vai lan tien h a n h lay het vo n a n g tra nh tai phat. Chu y ki e m tra ky p h a t hien c a c t6n t h u a n g k h a c da c biet ton t h u a n g dc t m h kern theo. D u n g d ao hai c u c h oa c L a s e r dot het t uye n be n t ro n g n a ng . - Ta o hinh lai voi trting.
- To n t h u a n g lac noi m a c tu c u n g a c u n g do D o u g l a s c o the c a p moi sau c 6 tti c u n g h o a c dat o n g n o n g true t ra ng neu c a n de ho tro.
Soi o b u n g c h o p h e p lam tat ca thu thuat. N h u n g phai m 6 b u n g t ro n g t r u o n g h op gap tai bien, lac noi m a c tu c u n g n hi eu g ay d inh n a n g , o lac noi m a c tu c u n g d a n g tien trien c h a y m a u noi soi k h o n g xti trf d ug c. Tai bien n h u t r ong p h i u t huat noi soi c h u n g .
Ket h gp dieu tri noi k h o a va ngoai khoa: c o the d u n g noi k h o a phoi h g p t ru a c ha y sau p hdu t huat de g ia m yeu to vie m dinh d i d a n g khi phdu thuat, dieu tri n h u n g o lac noi m a c tti c u n g non k h o n g t'lm ra.
T ai pha t:
D u g c dinh n g h i a la khoi khi b e nh n h a n diSu tri vo sinh c o thai, het d a u , ma t 6 lac noi m a c tti c u n g be n ngoai nhin th ay d ug c. Tai ph at khi b e n h n h a n d en k h a m vi vo sinh thti phat, dau t r a lai, tha y 6 lac noi m a c tti c u n g d a n g tien trien h a y p h a t hi en u n a n g b u o n g trting d a n g lac noi m a c tti c u n g .
IV- KET LUAN
La c noi m a c tti c u n g la mo t b e n h hien n a y n g u y e n n h a n va c a c h e b e n h sinh c h u a hi eu ro nen dieu tri c o n n hi eu k h o k ha n, c h u a c o phde do di eu tri t uy et doi t h o n g nhat. Sau diSu tri lai de tai phat.
Phdu t huat noi soi vai n hi eu uu d i e m hien na v da t r a t h a nh m ot p h a u thuat k h o n g the’ t hieu d u g c t ro ng c hdn d o a n va dieu tri triet de dat ket q u a cao. Q u a noi soi kie m tra ta c o the nhin lai ket qua dieu tri vao n h u n g thai gian sau. D i e u tri noi k h o a t r u a c vd sau m d tuy t h u o c vao b e n h c a n h 1dm s a n g ba n dau vao mtic do t h u o n g t6n va ket q u a phdu t huat .
TAI LIEU THAM KHAO1. A n d r e w S. C o o k a nd J o h n A. R o ck ( 1 9 9 5 ) D i a g n o s i s o f E n d o m e t r i o s i s :