Mt s loi dn lu trong ngoi tit niu

1. Dn lu h m - Bao gm : + Dn lu h thn + Dn lu cnh niu qun + Dn lu khoang Retzius a. Mc ch : + Dn lu nc tiu, dch tit, mu, m ra ngoi. + Theo di tnh trng chy mu trong h m. - Cn t dn lu h thn v : + T chc quanh thn l t chc m lng lo, d nhim khun v khi nhim khun th d lan rng. + Nhu m thn gin, khi khu khng c tht qu cht nn d h vt m. + p lc trong i b thn cao, d x r ra ngoi. Mt khc sau m, nhu ng ca b thn niu qun cha c tt, d gy niu. + Nc tiu l mi trng thun li cho vi khun pht trin. Vi khun ng tit niu thng l loi Gram(-), khi nhim khun thng nng. b. Ch nh : tt c cc phu thut vo thn, hoc niu qun, bng quang. c. Loi sonde : Foley hoc Pezzer d. V tr : trn ng nch gia, cch mo chu 3cm. e. Rt dn lu : + Thi gian : sau 3 4 ngy + iu kin rt : Dn lu ht dch. Ton thn : khng st, bng mm, trung tin c Ti ch : h thn khng sng n, cng g, sng nng. - Cch rt : + Rt 1 th. + rt 2 th : khi dn lu qu 72h m lng dch ra cha ht hn, bnh nhn ht trng bng, khng st. Th 1 : ct mi ch c nh, rt dn lu ra 3 cm, c nh li. Ct ng dn lu cch mp da khong 1cm. Nu dn lu chy nhiu dch th thay ngay dn lu mi. Nu khng chuyn sang th 2 sau 24h. Th 2 : rt nt dn lu. 2. Dn lu b thn qua nhu m thn - C nhiu kiu dn lu b thn + Dn lu qua nhu m thn + Dn lu b thn niu qun qua nhu m thn (dng ng dy truyn) + Dn lu b thn niu qun qua da

+ Dn lu b thn qua niu qun bng sonde JJ a. Mc ch + Gim p trong i b thn + Dn lu mu, trnh gy mu cc trong b thn + Lm nng trong phu thut to hnh b thn, niu qun b. Ch nh : + Thn to, niu, m. + M si thn phc tp, do st si. + M to hnh i b thn. + Chn thng, vt thng thn c khu bo tn thn. + Phu thut m nhu m thn nhiu ch, nguy c chy mu th pht cao. + Nguyn nhn no gy bt tc niu qun nhng cha iu kin gii quyt nguyn nhn. c. Loi sonde : Pezzer, Malecot, Foley, ng dy truyn. d. V tr t : + Thng qua nhm i gia hoc t ch nhu m thn dy nht + V tr trn thnh bng : qua ng nch gia, i chiu thng gc vi dn lu bn trong. e. Rt dn lu : + Sau 12 15 ngy. Nu l m to hnh : sau 3 tun. + iu kin rt Nc tiu trong Bnh nhn khng st Vt m kh Vng h thn khng cng n, sng nng Lu thng b thn niu qun tt - nh gi lu thng niu qun : + Kp th sonde. Nu sau 24h bnh nhn i tiu qua niu o bnh thng, khng st, khng au, bng khng chng -> thng. + Bm 10ml xanh Methylen qua sonde, kp li. Nu bnh nhn i tiu mu xanh ngay -> thng. + Bm thuc cn quang qua sonde, chp X quang, nh gi trc tip s lu thng ng niu. 3. Dn lu bng quang trn xng mu a. Ch nh : + B i m khng th t sonde tiu c. + B i v cn lu sonde trong thi gian di (bnh nhn h lit, u tuyn tin lit lnh tnh giai on III) + M ln vo bng quang (ly si, bc u tuyn tin lit, u bng quang)

+ To hnh c bng quang, to hnh niu o. + Chn thng, vt thng bng quang. b. Loi sonde : Pezzer, Malecot, Foley c. V tr t : + Trong bng quang nn t cng cao cng tt, trnh t gn c bng quang gy kch thch mt tiu cho bnh nhn + Ngoi thnh bng : 1/3 gia ng ni rn v khp mu - Cch t : + M t dn lu : rch ng trng gia di rn, qua cn c thng bng, vn phc mc v x thnh bng quang t dn lu vo. Khu c nh bng Catgut. + Chc dn lu bng kim Troca + Nu lu phi thay sonde nh l 2-3 tun/ln. d. Rt sonde : + Thi gian : tu tng ch nh. + iu kin : kp th, nu bnh nhn t i tt mi rt. - Cch rt : Rt sonde v khu thnh bng quang. sau khi rt dn lu, t 1 thng tiu trong 2-3 ngy, nhm bo m l chc dn lu trn xng mu lin tt.