M o t ng ud i phu ng oi g i ua 2 c h a n b e nh n ha n de ddy va b oc lo tir c u n g c h o ph au t hua t vien.
T r u d c het k i e m tra toan bo o b u n g , gan, lach, ruot, m a c noi ldn, tir c u n g , p h a n phu, nieu q u a n , tui c u n g D o u g l a s.
1- D o t va c a t c u o n g m a c h p h a n p h u : (hinh 37, 38 x e m d phu b an )
Tir c u n g d u o c ddy ve mo t phfa ddi dien. D u n g d a o di en hai c u c d o t va cat voi trting, d a y c h d n g tron, d a y c h d n g tir c u n g - b u o n g trting. P h u c m a c d u o c cdt th dn g dti ng s o n g s ong vdi c a n h ciia tir c u n g . Ne u cat c a p h a n p h u thi dot va cdt d a y c h d n g thdt l u n g b u o n g trting trud c roi cdt da y c h a n g tron. D o t va cdt d a y c h a n g t ron thi k h o n g cdt q u a ga n tir c u n g , ne n de’ lai p h a n d a y c h a n g tron d tti c u n g tti 1,5 - 2 c m vi hai ly do:
+ D e k e o ve p h ia ddi dien, do do boc lo r5 ra n g c u o n g m a c h tti c u n g . + C a m m a u d a y c h d n g tron de de d a n g vi do la n goa i c h o p h a n n h a n h tan c u n g ciia d o n g m a c h tir c u n g .
C ac b u d c t ren c o the cdt b dn g d a o m o sieu am, d u n g clip h o a c k h a u de’ c a m m a u . T i e p d o ddy d a y d a y c h a n g r o ng n go ai d o n g m a c h tir c u n g va c a m m a u bdn g d a o d i e n hai cuc.
2- Hoc t a c h tui c u n g tir c u n g - b a n g q u a n g :
D a t tui c u n g d vi trf t ru ng gian. d a y tir c u n g len c a o toi da. P h u c m a c tir c u n g - b a n g q u a n g d u o c gdp len b a n g pin ce c o m a u roi cat sau khi c a m m a u bdn g d a o hai c u c. D d y tui c u n g tti c u n g - b a n g q u a n g b d n g c a c h dot va cdt tat c a c a c dai xo, ddy b a n g q u a n g x u o n g tan t r i c u n g t r u d c a m d a o . D o t c a m m a u c a n g ga n ve phi a tir c u n g c a n g tot de’ t r a n h hoa i tir g a y d o b a n g q u a n g .
Co the’ b o m 2 0 0 - 3 0 0 ml h u ye t t ha nh pha xa nh M e t h y l e n e va o b a n g q u a n g da nhin de d a n g khi boc tach, tra nh t h u o n g tdn b a n g q u a n g .
3- D o t va c at d o n g m a c h tur c u n g :
Nguoi phu ddy tu c u n g toi d a v i phfa doi dien. Mot n g u o i phu d u n g p i n c e co ma u keo da u c u a da y c h d n g tron v i phi a doi dien de b o c lo r5 r a n g d o n g m a c h tu c u n g . D o t va cdt dan da n it to c h u c la trudc va sau c u a d a y c h d n g rong. D o t va cdt la tru dc den tan tui c u n g b a n g q u a n g - tu c u n g va la sau tdi da y c h dn g tu c u n g - c u n g. D o t d o n g m a c h tu c u n g n h i e u ldn bdng d a o hai cuc roi cat ft mot. Co the: d u n g clips h o a c k ha u d o n g m a c h tu c u n g ( x e m hinh 39 d phu ban).
4- D o t va cat bo m a c h co tu c u n g - a m dao:
Du n g da o dien hai c uc dot va cdt m a c h m a u c o tu c u n g - dm d a o d t r o n g lop
can. Roi d u n g keo p ha u tTnh t h a n g goc x u o n g tan tui c u n g b e n dm d a o roi v on g ra sau tdi d ay c h a n g tu c u n g - c u ng.
5- D o t va cat d a y c h i n g tu c u n g - c u n g :
Sau khi cat p h uc m a c d tui c u n g sau, dot va cdt d a y c h d n g tu c u n g - c u n g bdng da o dien hai cu c. T r u d c khi cdt d a y c h d n g n a y phai d a m b a o la true trang da d u o c da y ra xa. T r u d n g h o p tui c u n g D o u g l a s d a y h o a c lac noi m a c tu c u n g phai p ha u tTnh giai p h o n g tui c u n g D o u g l a s va ddy true t r a n g x u o n g .
6- M d am dao:
Ng u di phu x o a y phdn van di d o n g c u a van H o u r c a b i e ddy tdi d a tui c u n g trudc len. d u n g m o c m ot c uc m d tui c u n g trudc . N e n m d n u a tui c u n g t ru dc roi vong ra be n va sau. N g u d i phu ddy van H o u r c a b i e t h e o m o c m o t c u c, luon luon cat tren van. K e o tu c u n g ra n go ai t h e o van H o u r c a b i e .
Nhet mot tam b on g to d dm dao de ngan k ho n g c ho thoat C 0 2 q u a dm dao. C am mau bo sung m o m cdt bdng da o hai cuc. K h a u d on g m o m dm dao bdng hai mui chur X chi Vicryl so 0. K h o n g can phai phu phuc mac. T r o ng tru dn g h o p kho khan co the cdt not m o m cdt q ua d ud n g dm dao (xem hinh 4 0 d phu ban).
7- K i em tra rura o b u n g :
R u a 6 b u n g bdng h u y e t t h a nh dm, lay het m a u c u c. C a m m a u ky b d n g d a o hai cuc. K i e m tra b a n g q u a n g , nieu q u a n. T r u d n g h o p m o k h o k h a n h a y ng hi n g d tdn t h u o n g b a n g q u a n g thi b o m 2 0 0 - 3 0 0 ml h u y e t t h a n h lan x a n h m e t h y l e n vao b a n g q u a n g de k i e m tra. k h o n g c an dan luu d b u n g .
D u n g k h d n g sinh d u p h o n g .
TAI LIEU THAM KHAO
C. C h a p r o n , JB D u b u i s o n - H y s t e r e c t o m i e totale p o u r p a t h o l o g i e s b e n i g n e s - T e c h n i q u e s c o e l i o c h i r u r g i c a l e s et i n d i c a t i o n s . E n c y c l M e d C h i r T e c h n i q u e s c h i r u r g i c a l e s - u r o l o g i e - g y n e c o l o g i e , 41 - 6 5 5 , 1 9 9 5
LASER VA DAO MO SIEU AM TRONG PHAU THUAT NOI SOI
N g u y e n D u e H i n h
Ti en bo n h a n h c h o n g c u a ky t huat da g o p ph an thuc ddy ky t hu at phdu t huat noi soi phat trien. Phat m i n h laser va sieu am da d u o c ap d u n g v a o t r on g phdu thuat noi soi 6 bun g. N a m 1979, m ot so tac gia P h a p ( B ru ha t va c o n g sir o C l e r m o n t F e r r a n d ) lan dau tien sir d u n g laser vao pha u t hua t noi soi. Sau do vai n a m , ky thuat na y da d u o c pho bien rat r o ng rai dac biet la 6 My.
LASER ( L ig ht A m p l i f i c a t i o n o f S ti mu lat ed E m i s s i o n o f R a d i a t i o n )