- Loai C: Gay hoan toan cung sau, ton thtfdng m&'t viing ca chieu ngang va chieu doc.
4. CACB |£n CHl/NG DO GAY XUONG CHAU
4.1. Soc do mat mdu: Xtfdng ch&u la ^tfdng ldn nhat trong cd the va la xtfdng xop nen m&'t mau r&'t nhi£u. nen m&'t mau r&'t nhi£u.
- Hoi stic tich cUc sau 1 gid (truyen 2 lit mau) ma huyet ap k h on g k'*n phai md tham do: tdn thtfdng m ach m au ldn sau phuc m ac hay k h o n g 0 Neu do m au chay tti xUdng ra thi that 2 dong m ach chau trong (10% p h lu thuat).
4.2. Bien chtfng tiet nieu: di lech cac nganh cua xtfdng mu se lam ton thUdng bang quang va nieu dao quang va nieu dao
• Dilt nieu dao sau (doan nieu dao tien liet tuyen hay nieu dao m ang) do can day chau gitia giang dtit.
Chan doan dtfa vao: khong thong dai dtfdc, mot dai, danh gia thdi gian cua bai nUdc tieu cuoi cting, tim dau hieu mau d m ieng sao, cau bang quang va tham trtfc trang.
Sieu am cho phep danh gia mtfc day cua bang quang
Dieu tri: M o d in ltfu bang quang, d in ltfu khoang Retzius c&'p ctfu, con nieu dao se ndi thi sau. Neu tinh trang benh nhan on dinh va p h iu thuat vien co kinh nghiem, cho phep khau ndi ngay nieu dao dtft.
• Vd bang quan g: Vd bang quang trong phuc mac thtfdng d dinh cua bang quang
do tang ap ltfc dot ngot. Vd bang quang ngoai phuc mac: hay gap thung m at trtfdc cua bang quang do mot nganh cua xtfdng mu gay dam vao.
Ch^n doan dtfa vao kham bung: dau va c6 phan ting dtfdi roh, khong co c iu bang quang, thong dai: ong thong vao de, khong co ap luc ntfdc tieu va ong thong co mau.
Sieu am bung: co dich ttf do trong o bung, danh gia dUdc tinh trang bang quang Choc do va choc rtia o bung, lay dich thti sinh hoa
Dieu tri: md cap ctfu khau lai cho vd va dan ltfu bang quang de giam ap, dan ltfu khoang Retzius.
4.3. Bien chumg tang rdng
• R ach true trang do cac dau xtfdng gay dam vao
Ch^n doan dtfa vao tham trtfc trang hoac soi trtfc trang
Dieu tri: lam hau mon nhan tao d dai trang xich-ma, xti tri vet thtidng true trang • R ach dm dao do cac dau xtfdng gay dam vao
Chan doan dtfa vao: ra mau am dao, tham am dao (phai tim ky ttfng thanh am dao) hoac soi am dao.
Dieu tri: K hau lai cho rach