Chi dinh c h i n h c u a p h i u thuat q u a soi b u o n g tti c u n g la: c i t p o l y p , c i t u x o dudi noi m a c tti c u n g , c i t v ac h n g a n, dieu tri di nh b u o n g tti c u n g .
Ky thuat phu t h uo c va o tting chi di nh. T u y n h i e n c d m o t n g u y e n t i c lu d n phai ghi nhd, do la c i t m o d thi k e o d u n g cu, k h o n g c at d thi d i y d u n g cu. D o n g tac n a y c h o p h e p k i e m s oat d l d a n g d u n g cu d t r o n g l o n g b u d n g tti cun g.
Soi b u o n g tti c u n g da g iup c h o n g u d i thay t h u d c di tti c h o m d m a m d en c h o nhin t ha y c ac t h a m do, th ao tac c u a m i n h d t r on g b u o n g tti c u n g
TAI LIEU THAM KHAO
1. Bruhat M A . , M a g e G., P o u l y JL. , M a n h e s . , C an i s M . , W a t t i e z A. - C o e l i o s c o p i e o p er a t o r i e - M E D S I / M c G R A W - H I L L , 1989
2. Blanc B., Boubli L - E n d o s c o p i e ut e ri ne - e d i t io n p r a de l , 1996.
3. G l o w a c z o w e r E., R ai g aj ., W a t t i z A . , C ani s M., Bru ha t M A - M i s e e n pl a ce de la c o e l i o s c o p i e . 4. W a t t i e z A., B ot chor is hv il i R.- M at e ri e l et t e c h n i q u e s de ba se de la c o e l i o c h i r u r g i e . 5. M e n c a g l i a L., W a t t i e z A- M a n u a l o f g y n e c o l o g i c a l l a p a r o s c o p i c s u r g e r y , 1998. 6. L a n s a c J., B od y G., M a g n i n G - C h i r u r g i e par voie c o i e l i s c o p i q u e , L a p r a t i q u e c h i r u r g i c a l e en g y n e c o l o g i e - o b s t e t r i q u e , M a s s o n , 1998, 161. 7. Q u e r l e u D.- C o e l i o s c o p i e d i a g n o s t i q u e et o p e r a t o i r e . T e c h n i q u e s c h i r u r g i c a l e s en g y n e c o l o g i e , M a s s s o n 1995, 29. i t
TAI BIEN TRONG SOI BUdNG TUT CUNG
L e T h i P h u o n g L a n
Soi buong tu cung (BTC) la mot ky thuat moi, co gia tri trong tham do c h i n doa n va dieu tri cac ton thuong lanh tinh d buong tu cung va mot phan voi trurng.
Soi b u o n g tu c u n g n g a y c a n g d u o c su- d u n g r o n g rai. N h u n g q u y d i n h n h a m g ia m c a c tai bien c i n d u o c ton tr on g. Ph a n ldn c a c tai bien t r o ng soi b u d n g tu c u n g la do sir thieu k inh n g h i e m c u a ng ud i ph au t huat vien. D e g i a m tai bien Hoi Soi b u o n g tu c u n g C hau Au da p h an loai tu de d e n k h o n h u sau: 1. Ph a u t huat tdi t hi e u : sinh thiet n i e m m a c tu c u n g , cat p o l i p n h d va n o n g c h d n g dinh d o n gian.
2. P h i u t huat t ru n g binh: dat o n g t h o n g voi t r un g , triet san
3. P h i u t huat ldn: boc ta ch n h a n xo, n a o dot n i e m m a c tu c u n g , c i t v a c h n g a n , g d dfnh r o ng
T ai bi en c u a soi b u o n g t u c u n g 1. T ai bi en khi tien h a n h thu t h u a t
1.1. Rach co t u cu n g :
* P h o n g tai bien:
- Can ki en n h i n khi tien h a nh n o n g c o tu c u n g , vdi o n g n o n g t a n g d a n so. - Su d u n g t h u d c lam m e m va m d co tu c u n g: c y t o t e c ( P r o s t a g l a n d i n e E l )
dat t rudc khi tien h a nh thu t hua t 2 gid. Li eu: 100 - 2 0 0 p g , ket q u a g a y m d c o tir c u n g 8 0 % . T a c d u n g phu: b u o n non, n o n, m i n ngura, t a n g h u y e t a p nen k h o n g d u n g c h o b e n h n h a n c a o h u y e t ap.
1.2. T h u n g t u cun g : gap khi nong co tu cu ng va khi d a ng tien ha nh p h i u thuat. Tuy tdn t hu on g ma hudng xir trf la dieu tri noi vdi Id t h u n g nhd, don gian hoac m d b un g khau Id thun g tham chi' cat tu c ung neu can.
1.3. Chay man: do cac tai bien rach cd tu cung, thung tur c ung
1.4. Tai hien do dot dien, laser: du oc sir d ung cat u xo tu cun g, c i t polyp, g d dinh. Do co the truyen nhiet gay tdn t huong ruot. Trieu c hu n g: xuat hien da u bung ngay cang tang sau md 5 ngay. Neu nghi n g d phai soi o b u n g k i e m tra.
D u p h o n g b i n g c a c h chi c i t khi n hi n r5 vi tri d a o c i t .
2. T a i bi en d o d u n g k hi , di ch t r u v e n l am c a n g t u c u n g :
2.1. Tai hien do d u n g k h i
C 0 2 la khi d u o c d u n g t r o ng soi b u o n g tu c u n g . K h f ft d u o c d u n g , t r u t r u d n g hop lay dun g cu tu c ung. Vdi n g u ye n tac phai dieu c hinh ap lire b o m c i n than.
C 0 2 la khi co the hoa tan trong m a u tai n hi et do c o the. V d i luu l u o n g C 0 2 h i p thu vao trong ma u 57 m l/ phu t, p C 0 2 va p H m a u k h o n g t h a y doi. C ac chi s6' na y se thay doi n6'u luu lirong C 0 2 la 4 0 0 m l / p h u t va g a y n g u n g tim vdi luu luo ng 1000 ml/phut.
• T oe do CO 2 dung khi soi buong tif cung khong du o c qua 80 m l Ip hu t vai dp luc khong qua 200 m gH g
2.2. Tai hien do d u n g dich
Cac dich t hu d n g d u n g
- Dich co do n hdt c a o la Uu viet nhat: 3 2 % D e x t r a n 7 0 - Dich co do nh d t thap: G l y c i n e 1.5 %
- Manit ol, Sorbitol
Cac tai bien g i o n g n h u khi t r uy e n dich: t i c m a c h , di urig, do d u n g q u a n h i e u dich do thdi gian p h i u t huat lau, g a y b u o n n on, n o n, da u dau. N a n g c d the gay phu phoi.
• D a c biet
- D e x t r an c d the’ g ay hoi c h u n g q u a m i n D I A R ( D e x t r a n I n d u c e d A n a p h y l a c t i c R e a c t i o n ) , phu te bao, k h o thd, n g u n g thd.
- G l y c i n e 1.5% la m o t acit a m i n k h o n g thiet yeu, ne u t r u y e n vdi d u n g lu on g ldn d i n tdi ta ng c h u y e n h o a a cid a mi n. T a n g c h u y e n h o a acid a mi n than kinh, d i n d e n s uy g i a m d i n t r u y l n t h i n kinh. T d n g dich tr uy en k h d n g d u o c q u a 4 0 0 0 ml. Th d i gi an p h i u t h ua t k h o n g q u a 4 gid. • Phai theo d5i c a n than, do l u o n g di ch va o va ra
3. Tai bi en d o d u n g t h u d c g i a m da u:
Gay te tai chd
- Di urng
- P ha n ung phu c u a t h u d c sir d u n g
C huan bi trudc m o
1- C h u a n bi t ru dc m o la b u d c q u a n trong. T h a m k h a m ky, hoi tien su, n gh ie n c uu ky ho so
2- Thut t h a o tru dc m o
3- C h d n g chi di nh c u a soi b u o n g tu c u n g - N h i l m t rung
- Benh tim va ho hap - Rdi loan c h u y e n h o a - Co thai
- Ra m a u tir c u n g o at - U n g t h u c o tir c u n g
TAI LIEU THAM KHAU
1. Bruno van H e r e n d a e l ( 1 9 9 5 ) H a z a r d a nd D a n g a r o f O p e r a t i v e H y s t e r o s c o p y . In Chis Sutton a n d M. P. D i a m o n d E n d o s c o p i c S u r g e r y for G y n a e c o l o g i s t s , pp 355 - 361. L o n d o n : W . B S a u n d e r s C o m p a n y L T D . 2. T a y l o r PJ a n d G e o o r g e R E ( 1 9 8 4 ) C o m b i n e d l a p a r o s c o p y a n d
h y s t e r o s c o p y in the inv e st i ga ti o n o f infertility. In Si e gl e r A M a n d L i n d e m a n n J 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 P r a c ti c e, pp 2 0 7 - 2 1 0 . Ph il a d e l p h i a : J.B. L i pp in co tt .
3. Siegler A M a n d V a l l e R F ( 1 9 8 8 ) T h e r a p e u t i c h y s t e r o s c o p i c p r o c e d u r e s ' . Ferti lity a n d Sterility 80: 685.
CHI 0|NH VA CHONG chi’ DjNH CUA SOI BUONG TUT CUNG
Vu B d Q u y e t