D o t b a n g d a o m o t circ
D a y la p h u o n g p h a p da u tien d u g c sir d u n g t r o n g c a c k y t h ua t noi soi. N h u tat ca c ac chi d in h d u n g d a o m ot c u c, no c o the g a y tai bi en d o sir d u n g di en ( n h u ton t h u a n g he tieu hod, nieu qu a) . T u y n h i e n d a y la m o t ky t h u a t h u y hoai nen k h o n g the’ k h d n g c h e c a c ton t h u a n g voi trung: ne u n h u d a o m o t c uc c h a m phai m a c h m a u voi t r un g no c o the h u y hoai h o a n t o a n p h a n xa c u a voi. Vi 2 ye u to n ay m a ky thuat na y trd n e n k h o n g h o a n h a o va t u a n g ddi n g u y h i e m, vi va y k h o n g n e n sir d u n g m a c du ti le t h a n h c o n g k h a c a o (ti le that bai la 0 ,3 5 tren 100 t r u d n g hgp).
D o t b a n g d a o hai circ
D o t k h o n g c h u a du, m u o n sir d u n g p h u o n g p h a p n a y t h a n h c o n g c a n k e t h g p ky t huat cdt voi, se ft g a y ton t h u a n g voi. Khi dot c a n pha i b a o t o a n m a c treo voi. Bien churng rat ft. D o la m o t p h u o n g p h a p h o a n c h i n h , ft d u g c s u d u n g d P h a p n h u n g lai d u g c sir d u n g d M y (ti le that bai 1 , 1 / 1 0 0 0 ) ( h i n h 35 x e m d phu ban).
D o t nh iet
K y t huat na y da d u g c S e m m pha t trien. P h u o n g p h a p dot n h i e t c o the d u g c sir d u n g de triet san voi. N o d u n g nhiet do 120 - 1 4 0 ° C t r o n g 2 0 g ia y . Ti le that bai rat thap 0 , 2 1 / 1 0 0 0 .
V o n g Y o o n
K y thuat n a y d o Y o o n m o ta va o n a m 1972. P h u o n g p h a p n a y d u o c n hi eu n g ud i biet d e n va s u d u n g r o ng rai. P h u o n g p h a p n a y d u n g m o t v o n g Silicon c o d u d n g k in h n goa i 3, 6 m m va d u d n g k inh t ro n g 1,0 m m , v o n g n a y d u o c dat b i n g m ot d u n g cu da c biet, c a c h s u n g tu c u n g 3 c m va siet c h a t mo t d o a n voi tu 1 toi 1,5 c m. Khi dat v o n g c a n lira c h o n ky, dat v u o n g g o c vdi e o vdi b a ng c a c h trai dai m a c treo voi t ru ng n h d di d o n g tu c u n g b i n g c a n n a n g (hinh 39). N h u n g tai bien c h i n h c u a p h u o n g p h a p na y la lam dut voi khi dat vong. N g u d i ta c o the t r an h d u o c tai bien na y b i n g c a c h t h uc hi en nhe n h a n g va tu tur. T u y nh ie n , mot so voi q u a d a y va phu nd n e n k h o n g dat v o n g d uoc . T r o n g t r u d n g h o p c i t voi, n g u d i ta dat 2 v o n g d 2 dau c i t . Ne u dat v o n g k h o n g d u n g , vdi k h o n g bi t i c h o a n toan. D i e u do giai t hich ti le that bai t h a y ddi tir 1 toi 1 6 / 1 0 0 0 tuy the o tinh trang b e nh n h a n va k inh n g h i e m c u a k y t hu at vien.
K e p voi
Co 2 loai kep, k e p H u l k a va C l e m e n t . K y t huat n a y da d u o c t h u c h i e n tu 1972. P h u o n g p h a p n a y ft ga y ton t h u a n g va tien h a n h d i n h a d u n g cu c h u y e n biet, va d u a n g va o tren k h d p mu . Chu y d u y n h a t lam s ao t o a n bo e o voi d t ro n g k ep t ru dc khi b a m kep. Ty le that bai dudi 5 / 1 0 0 0 ddi vdi k e p H u lk a , 0 ,9 - 4 , 9 / 1 0 0 0 ddi vdi k ep Filshie.
Ky t h u a t
B i t da u b i n g noi soi kinh dien K y t huat thdt voi trufng
C h i d j n h
Can phai phan biet 2 trudng hop khac nhau: chi dinh do y te va triet san tu nguyen. Chi dinh y te t h u d n g ga p nha t t rong t r u d n g h o p c o c h d n g chi d i n h c o thai tuyet ddi. T r o n g t r u d n g h o p n ay c an phai tha o luan g i u a b e n h n h a n vdi c a c n ha c h u y e n m o n c o lien q u a n .
T r u d n g h o p triet san tu n g u y e n , c a n phai t h a m k h a o c a c ye u td: - Tuoi n g u d i vg
- So c o n
- K h a n a n g d u n g h a y k h o n g d u n g d u g c c a c bien p h a p t r a n h thai - T a m ly 2 vg c h o n g , ban de n van de triet san k h o n g hoi p h u c
O c a c n u d e t r ong the gidi t h u 3 triet san voi va t h i t o n g d i n tinh la t r o n g n h o m triet s an t u n g u y e n .
V- KET LUAN
Noi c h un g triet san q u a noi soi la ky thuat an toan, co hieu q u a va d o n gian. T uy vay n h u tat c a c ac p h i u thuat khac no co 1 so tai bien, tai bien nh e va nang. Co n hieu n g h i e n c u u q u o c gia va q u o c te d u a ra ket luan r a n g triet s an vdi trurng la m ot p h u o n g p h a p d a n g tin cay , ty le tai bien tu 1-2% t h a p h a n ti le m d b u n g la 5 - 1 0 % .
Y e u to n g u y c o la
- Benh to an than: dai t h a o d u d n g , beo, tien s u n h i l m t r u ng tieu k h u n g va p h i u t huat tieu k h u n g .
- Th di gian t h uc hien: sau de, sau n a o ph a thai - Pha u t huat vien k h o n g co k in h n g h i e m noi soi
- K y t hua t noi soi: that voi thuc hi en bdi m o t d u d n g d udi ron h a y g a p b i e n c h u n g h a n d u d n g va o tren k h d p mu 16 lan
Ty le tir v on g t r ong noi soi triet san: k h o n g ga p nhirng c o the g a y roi loan h uy e t d o n g hoc. H a y x e m c h u o n g c ac tai bien t r on g noi soi.
Co thai sau noi soi triet san: Benh nhan co the co thai trong hay ngoai tu c ung. Nhieu nghien curu that bai triet san q ua noi soi tuy theo c ac h thdt voi trurng. - L6i ky t huat
- Thoi gian thu thuat nira sau v on g k inh khi b e nh n h a n da c o thai
- Ky thuat that voi trurng. Co the de lai 1 16 h 6n g, h oac d u o n g d i n t r ong m o lanh s eo da c biet khi dot b a ng da o mo t c u c ha y hai cuc. N eu c o thai t rong n a m dau t h u o n g g ap c o thai t r ong tu c u n g, va g i a m d a n t r on g n h u n g n a m sau, n g u g c lai c h u a ngoai tir c u n g so voi c h u a t r ong tu c u n g tang da n t r o n g nhurng n a m sau. N g u y c o g ay G E U lien q u a n voi t i l n sir n h i l m t r u n g k h u n g c h a u va p h i u t hu at phu khoa.
D e g i a m t h a t bai phai:
- T h u c hi en thu t huat ph a dau d u o n g vao tren k h d p mu. - X a c d i n h voi c h i c chdn.
- T h u c h i e n d u n g tha o tac dat v on g clip ha y vong. - Kie’m tra lai vi trf thdt neu moi thuc hien noi soi.
T h o n g lai voi da triet san: Su pha t trien triet san q u a noi soi d i n d e n v an d l lam t h o n g voi sau noi soi n g a y c a n g tang. Ro r ang triet san q u a noi soi phai la m o t p h u o n g p h a p tot d a m ba o kha n a n g vi p h i u thuat t h o n g voi sau triet s an. N h i e u n g h i e n curu ket luan r i n g p h u o n g p h a p triet san tot n h a t la p h u o n g p h a p lam ton t h u o n g voi n g i n nhat. Hi en na y k e p voi ph a h u y 5- 7 m m , dot d a o hai c u c, dot nhiet g a y ton t h u o n g 1 5 - 2 0 m m , v d n g Y o o n 25 - 5 0 m m . D o t d a o 1 c u c k h o n g ne n d u n g vi no p ha huy ho n 5 0 m m .
L a y v o n g t r a n h thai q u a noi soi
V o n g t r a n h thai la 1 p h u o n g p h a p tranh thai k h a p h o bien d n u o c ta. C o the ga p tai bi en v o n g c h u i q u a c o tu c u n g va o 6 bung.
C h i n d o a n d u v ao lam s a ng c o dau lung, da u bu ng . K h a m lam s a n g k h o n g t h a y d a y v o n g . T h a m d o b u o n g tir c u n g b i n g m o c v o n g k h o n g t h a y v o n g, sieu a m k h o n g t h a y v o n g t ro n g tir c u n g . C h i n d o a n c h i n h xa c d u a va o c h u p b u 6 n g tir c u n g b a n g t h u oc c a n q u a n g . K h o n g tha y v o n g t r o n g b u o n g tir
c u n g , v o n g n g o a i tir c u n g . T r u a c d a y khi c h u a c o noi soi phai lay v o n g q u a m a b u n g n h u n g g a p n hi eu k h o k h a n do p h i u t r u o n g hep, x a c d i n h vi trf v o n g k h o k h a n , do v on g bi m a c noi Ion, ba o boc, v on g di c h u y e n k h o n g c o n n a m t ro n g tieu k h u n g .
T u khi c o noi soi d l d a n g b a o q u a t d u o c toan bo 6 b u n g , x a c d i n h vi trf v o n g d l d a n g , ft g a y s a ng c han .
Co 1 vai t r u d n g h o p v o n g c o n 1 p h an t r on g tir c u n g phai c i t v o n g va rut v o n g ra k h o n g g a y c h a y m a u tir c u n g .
TAI LIEU THAM KHAO
1. Triet san tir n g u y e n m o d un 1, 8 tai lieu h ua n l uye n t o a n d i e n vd sure k h o e sinh san. N h a xu at ba n y hoc 1996.
2. M a u r i c e A n t o i n e Bruha t et coll: Sterilisation t ub a i r e p 169 - 176. C o e l i o s c o p i e o pe r a t oi r e . M E D S I / M c G R A W - H I L L 1989.
CAT TUT CUNG QUA NOI SOI
Vu B d Q u y e t
Ke’ tir khi H a r r y R e i ch m o ta lan da u tien cdt tir c u n g q u a noi soi n a m 1989, d en n a y pha u t huat cdt tir c u n g q u a noi soi da d u o c thuc hien 6 nhi 6u noi tren the gioi. C h u n g toi xin gioi thieu ky thuat cdt tir c u n g h o a n t o a n va b e n h ly lanh tinh q u a noi soi.