1. Si eu a m
a. Sieu am lieu k h u n g qua thanli hung:
Sieu a m la m o t t h a m k h a m k h d n g g a y n g u y hie’m, c d t he l a m n h i e u lan va c o the th uc hi en d b at cti giai d o a n n a o c u a c h u ky k i n h n g u y e t . N o c h o ket q u a rat tot v i h i n h d a n g , ki ch t h u d c va c a c b i e n d a n g c u a tti c u n g c u n g n h u tinh t r an g c u a b u o n g trting. Sieu a m tieu k h u n g d ac biet c o Uu d i e m d6 c h £n d o a n u x o tti c u n g d ud i t h a n h ma c , di d a n g tti c u n g va c a c b e n h ly c u a b u o n g trting. N g u g c lai, sieu a m ti6u k h u n g q u a t h a n h b u n g lai c o rat ft gia tri t r ong viec d a n h g i a tinh t ra n g c u a n i e m m a c tti c u n g . T r o n g v ie c d a n h gia rdi loan k in h n g u y e t , r o n g k inh, r o n g h uy e t , sieu a m q u a t h a n h b u n g k h o n g phai luc n a o c u n g x a c d i n h d u o c sir n g u y e n ven h a y b e n h ly c u a b u o n g tti c u n g va c u a n i e m m a c tti c u n g .
b. Sieu dm d u o n g am dao:
Sieu am vdi dau do a m d a o c o the x a c d in h d u o c c h f n h x a c tinh t r a n g n i e m m a c tti c u n g va b u o n g tti c u n g n h d dau do 7,5 M H z m a n g u d i ta c d t he dat tiep xu c vdi v u n g c a n n g h i e n ctiu.
N e n lam sieu a m q u a t h a n h b u n g t r u d c de d a n h g i a tinh t r a n g c h u n g c u a tu c u n g va hai p h a n p hu . Sieu a m d u d n g a m d a o rat c d hi eu q u a de l a m b il a n
Khi n g h e n ctiu so s anh hieu q u a chdn d o a n c u a sieu a m d u o n g a m d a o va soi b u o n g tir c u n g , R. C R u d i g o z n ha n t ha y r i n g : noi soi b u o n g tu c u n g co hieu n a n g c h dn d o a n c ac be nh ly 6 b u o n g tu c u n g c a o h o n sieu a m d u o n g dm dao. N g u g c lai, sieu am d u o n g a m d ao lai co k h a n a n g c h dn d o a n b e nh ly d t ha nh tu c u n g tot h o n soi b u o n g tu c u n g .
2. C h u p b u o n g t u c u n g - vdi trurng
C h u p b u o n g tu c u n g la m o t p h u o n g p h a p t h a m do c d tCr rat lau va rat c d hieu qua. N g a y nay, ve m a t ky t hu at p h u o n g p h a p c h u p b u o n g tu c u n g - vdi trting da d ug c tieu c h u a n h oa . Vi e c sir d u n g t h u d c c an q u a n g ho a tan t ro n g n u de da lam gi a m n g u y c o di ting va n a n g c a o hieu q u a chdn d oa n .
C h u p b u o n g tti c u n g - voi trting da c biet d u g c chi d in h t ro n g c a c t r u d n g h g p rong kinh, r o n g h uy e t, ra m a u sau m a n kinh. N o c o the x a c d i n h d u g c h in h d a n g c u a n i e m m a c va b u o n g tti c u n g . Do vay, c o the g i u p c h dn d o a n c a c trudng hgp: u x o tti c u n g , dac biet la u x o dudi n ie m ma c , u x o tti c u n g d a n g ke, polip b u o n g tti c u n g , d inh b u o n g tti c u n g , tti c u n g di d a n g ...
- Cac p h i m c h u p n ie m m a c d u g c thuc hien vao luc mdi b o m t h u d c c an q u a n g vao b u o n g tti c u n g h o a c vao luc t h a o t h u dc k hoi b u o n g tti c u n g la rat co hieu q u a de xac dinh niem mac va cac benh ly c u a niem m a c tti c u n g , vi t h u d c c a n q u a n g d u g c b o m vao vdi khoi l u g n g n h o se t a ch biet d u g c tat c a c a c hinh a nh t r un g tam b u o n g tti c u n g. Hi eu q u a c h dn d o a n c a c t h u o n g ton n h o d b u o n g tti c u n g se g i a m di khi b o m d a y t h u d c c a n q u a n g v a o b u o n g tti c u ng .
C h u p b u o n g tir c u n g t h u d n g d u g c thuc hien vao n g a y thti 8 - 10 c u a c h u ky k in h n gu y e t .
C h u p b u o n g tti c u n g - voi trting co m ot n h u g c d i e m sau:
+ C a c h in h a nh phi dai n i e m m a c tti c u n g t h u d n g k h o n g phu h g p vdi h inh a nh m d hoc. Do vay c an phai x ac d in h c h i n h x a c tdn t h u o n g ve m a t m o hoc.
+ T r o n g t h a m do c ac rdi loan kinh n gu y e t , p h u o n g p h a p c h u p b u o n g tti c u n g - voi trting co ty le d u o n g tinh gia c a o h o n so vdi soi b u o n g tir c u n g va sieu a m q u a a m dao.
+ C h u p b u o n g tir c u n g k h o n g ne n chi dinh t ro n g c ac kh oi u tieu k h u n g , vi no k h o n g x ac d inh d u g c hinh d a n g ben n g o a i c u a tti c u n g . C h d n g chi d inh ciia p h u o n g p h a p c h u p tir c u n g - voi trting:
- Co thai
- V i e m n h i e m phu k h o a - Bang ki nh n hi eu
- 0 n h u n g b e n h n h a n c o ti6n sir v i e m p h a n phu, c a n dieu tri k h a n g sinh b a o vay t r ud c va sau khi lam thu thuat.
3. Soi b u o n g t u c u n g
- Soi b u o n g tir c u n g la p h u o n g p h a p k h o n g n h u n g g i u p c h d n d o a n c a c be n h ly b u o n g tir c u n g rat c o hieu q u a m a c o n c o the xir trf d u o c m o t s6 ton t h u o n g b e n h ly c u a b u o n g tir c u ng.
- V6 m a t p h u o n g tien, c o hai loai d u n g cu soi b u o n g tir c u n g : o n g soi c u n g vdi c a c ki ch c d k h a c n h a u va o n g soi m6 m.
Vdi su- p h o c a p c u a o n g soi m 6 m b u o n g tir c u n g da lam c h o p h u o n g p h a p t h a m do n a y t ro ne n t h u a n loi h o n voi c a c Uu di em: d o n g ia n, de t h u c h i e n n h a n h c h o n g va k h o n g g a y n g u y hiem.
- V e chi di nh b a o g o m soi b u o n g tir c u n g c h a n d o a n va soi b u o n g tir c u n g didu tri.
+ Soi b u o n g tir c u n g c h a n d o a n la mo t t h a m d o d u o c c h i d i n h c h o c a c t r u on g h o p r o n g ki nh , r o n g huye t, ra m a u sau m a n k i n h , t r o n g c a c t r u d n g h o p vo sinh, s ay thai lien tiep, x a c n h a n vi trf h o a c lay b o d u n g cu t ra n h thai t r on g b u o n g tir c u n g .
+ Soi b u o n g tir c u n g c o the q u a n sat d u o c toan bo n i e m m a c tir c u n g , q u a do c o the l am s inh thiet c h fn h x a c c a c vi trf ton t h u o n g . D o v a y soi b u o n g tir c u n g la c hi d i n h de c h dn d o a n t ro n g c a c t r u o n g h o p r o n g k inh, r o n g h u y e t , ra m a u sau m a n kinh. D a c biet soi b u o n g tir c u n g g iu p c h dn d o a n x a c d i n h va c h dn d o a n s d m u n g t h u va c a c t 6n t h u o n g tien u ng t h u c u a n i e m m a c b u o n g tir c u n g , c a c t r u d n g h o p q u a s an, t eo ni e m m a c tir c u n g , c a c u x o d ud i n i e m m a c , po li p b u o n g tir c u n g ... T r o n g c a c t r u d n g h o p vo sinh, soi b u o n g tir c u n g g i u p c h d n d o a n x a c d in h dfnh b u o n g tir c u n g , v a c h n g a n b u o n g tir c u n g .
- N g o a i m u c d i n h c h dn d o a n , soi b u o n g tir c u n g c o the didu tri d u o c m o t so ton t h u o n g b e n h ly ciia b u o n g tir c u n g nhu: cdt p olip, t a c h d i c h b u o n g tir c u n g , dat c a t h e t e r v ao voi t r un g, cdt v a c h n g a n b u o n g tir c u n g , cdt u x o n h o dudi n i e m m a c. . .
- C ac c h d n g c hi d i n h c h f n h ciia soi b u o n g tir c u n g la c d thai, v i e m n h i d m bo p h a n s inh due.
Soi b u o n g tir c u n g c d t he t h u c h i e n d u o c d n g a y giai d o a n d a n g c h a y m a u . N e u soi t r o n g m d i t r u d n g di ch ( d e x t r a n 70, g l y c i n e 1 , 5%, m a n i t o l sorbitol. ..) . Bo m h o p b u o n g tir c u n g b dng C 0 2 t r o n g c a c t r u d n g h o p n a y c d the g ay bi en c h ti ng tdc m a c h hcri va c u n g k h o x a c d i n h ton t h u o n g vi c o m a u d b u o n g tir c u n g .
Soi b u o n g tti c u n g c o the k h o n g t h uc hi en d u o c t r o n g t r u d n g h o p chft h e p c o tir c u n g , kh oi u d c o tti c u n g k h o n g c h o o n g soi q u a d u o c .
Soi b u o n g tir c u n g t h u d n g g ay ft bi en c hting. T u y n h i e n , c o the g a p m o t so bien cht in g nhu: bi en c h t i n g c u a ga y me , hoi cht in g tai h a p thu n u d e , tdc m a c h khf, n h i d m trirng, r a c h c o tti c u n g , t h u g tti c u n g ...
Vdi c ac uu die m n h u vay, trong tuong lai, soi b u o n g tti c u n g se trd t h a nh m o t p hu on g p ha p du gc lira c h o n h a ng dau de tham do c ac be nh ly b u o n g tti c u ng .
Sinh thiet n ie m m a c tir c u n g co hai m u c dich: - D a n h gia tinh t ra ng h o r m o n sinh due.
- X a c d inh tinh t rang q u a san h o a c u n g t h u n i e m ma c tu c u n g .
Sinh thiet n i e m m a c tu c u n g co the thuc hi en b i n g p h u o n g p h a p n a o b u o n g tti c u n g kinh di en h oa c b i n g c a c loai o n g hut k h a c nhu: o n g hut N o v a k , o n g hut K a r m a n , d u n g cu C o r n i e r ... Sinh k hi et n ie m m a c tu c u n g la m o t ky t huat md. D d i vdi m u c dich d a n h gia tinh tra ng h o r m o n sinh d u e thi c d the d ua vao ket q u a sinh thiet n i e m m a c tir c u n g , n h u n g ddi vdi m u c d i c h x ac dinh tinh t ra n g q u a san h oa c u n g t h u n i e m m a c tu c u n g thi s inh thiet n i e m ma c tu c u n g chi c o g ia tri khi no c h o ket q u a d u o n g tinh. C a c ton t h u o n g nho c u a n i e m m a c tu c u n g n h u polip, q u a san khu tru d m ot v u n g n i e m m a c co the bi bo q ua . N a o sinh thiet n i e m m a c k h o n g the tdi d u o c c a c tdn t h u o n g sau h on (u x o dudi n ie m m a c ...). Sinh thiet n i e m m a c tu c u n g la mot t ha m do d o n gian. T u y nhi en, c u n g co the co bien c h ti ng n hu: t h u n g tti c u ng , c h a y m a u , n hi dm trung, dinh b u o n g tti c u n g ...
4. Si nh thiet n i e m m a c tur c u n g
TAI LIEU THAM KHAO
1. Blanc, L. Boubli:. H i e r a c h i e des e x p l o r a t i o n s p a r a c l i n i q u e s de la c av it e uterine, E n d o s c o p i e Uterine. E d i t i o n Pradel 1996, 7 - 1 2 .
2. Blanc, L. B oubli, C . d' Er co le : H y s t e r o s a l p i n g o g r a p h i e , E n c y c l o p e d i c M e d i c o - C h i r u r g i c a l e . E d i t i o n T e c h n i q u e s , Paris 1992, 6 8 A1°. 3. L a n s a c , P. L e c o m t e : G y n e c o l o g i e p o u r le p r a c ti ci e n. S im e p - Paris 1994. 26 - 44. 4. Levi - U l t r a s o n o g r a p h i e en g y n e c o l o g i e , E n c y c l o p e d i e M e d i c o C h i r u r g i c a l e . E d i t i o n T e c h n i q u e s , Paris 1992, 6 9 A1°.
5. R a f ae l F. Valle: O p e r a t i v e H y s t e r o s c o p y . Sciarra - G y n e c o l o g y and O b s t e t r i c s . L i p p i n c o t t - R av e n, N e w Y o r k 1996. V o l u m 1 C h a p t e r 35. 6. Al vi n M. Siegle, H a n s J. L i n d e m a n : H y s t e r o s c o p y p r i n c i p l e s a n d
KY THUAT SOI BUONG TUT CUNG
Nguyen Ditc Hinh
Soi b u o n g t u c u n g c o the n h d m m u c dfch c h a n d o a n h a y di eu tri h o a c c a hai. H ie n n ay c o h a y ky t hua t soi b u o n g t u c u n g: soi o n g c u n g va soi m 6 m . C h u n g toi chi c o d u n g cu soi o n g c u n g c u a h a n g Karl Storz.