1

TIT NIU HC NHI

19N-05 KT QU IU TR CONG DNG VT MING NIU
O NG THP
Phm Ngc Thch*, L Tn Sn**
TM TT
Mc ch: Chng ti gii thiu tt cong dng vt ming niu o ng thp, cch x tr v kt qu
iu tr ca d tt ny.
i tng v phng php nghin cu: Trong thi gian t 3/2012- 3/2015 ti bnh vin Nhi ng 2
c 359 bnh nhn ming niu o ng thp th gia v th sau c iu tr, trong c 248 trng hp
c chn on trc m cong dng vt chim t l 69%(248/359). Nu lm thng dng vt vn bo tn
sn niu o s c phu thut to hnh niu o theo k thut Snodgrass; cc trng hp lm thng dng
vt phi ct sn niu o s c lm phu thut th 1. Sau khi bc tch da thn dng vt ra khi thn dng
vt (degloving) lc ny dng vt s c lm test cng nhn to nh gi c cong dng vt hay khng
v mc ; nu dng vt cong s c tin hnh lm k thut Nesbit khu gp mt lng, trong trng hp
dng vt vn cong s tch sn niu o theo k thut Mollard; sau cng nu dng vt cn cong s ct sn
niu o. Tui phu thut t 12 thng tui n 15 tui. y l mt nghin cu tin cu m t.
Kt qu: C 359 bnh nhn ming niu o ng thp th gia v th sau c phu thut, tui trung v
l 3; trong c 248 trng hp cong dng vt chim t l 69% (248/359). Trong 359 trng hp phu
thut lm thng dng vt c 81 trng hp phi ct sn niu o v 278 trng hp gi c sn niu o.
Vi mc ch bo tn sn niu o sau khi lm thng dng vt trin khai k thut Snodgrass t l t
c 77,4% (278/359). Trong 278 trng hp gi sn niu o v c trin khai k thut to hnh niu o
Snodgrass c 166 trng hp degloving l dng vt thng sau test cng, cn li 112 trng hp bao gm
85 trng hp dng k thut Nesbit v 27 trng hp dng k thut Nesbit v Mollard. C 11 trng hp
cong ti pht chim t l bin chng chung 9,8% (11/112) sau t nht 6 thng theo di; tt c trng hp ti
pht ny u mc nh nh hn 15 v thuc nhm ch lm k thut Nesbit n thun: 2 bnh nhn ti
pht c phu thut li lm thng dng vt kt hp v r tiu, 3 bnh nhn phu thut li kt hp chnh
chuyn v dng vt bu v 6 bnh nhn cn li khng can thip g. T l bin chng ca nhm ch lm Nesbit
12,9%(11/85) cao hn 0%(0/27) ca nhm kt hp k thut Nesbit v Mollard (p < 0,05). Trong nhm 81
bnh nhn lm thng dng vt bng ct sn niu o (3 trng hp s dng km k thut mnh ghp b, 5
trng hp km k thut Nesbit) c 2 trng hp ti pht cong mc nh chim t l 2,4% (2/81) (c 2
trng hp ti pht u nhm ch ct sn niu o). C 2 trng hp ti pht u c gii quyt bng k
tht Nesbit phu thut th 2. T l ti pht cong dng vt ca nhm bo tn sn niu o 9,8% (11/112)
cao hn nhm ct sn niu o 2,4% (2/81) (p < 0.05).
Kt lun: T l lm thng dng vt bo tn sn niu o trin khai k thut Snodgrass chim t l
77,4% (278/359). T l cong dng vt ti pht nhm bo tn sn niu o (Nesbit v Nesbit kt hp
Mollard) trin khai k thut Snodgrass 9,8% (11/112) cao hn nhm ct sn niu o 2,4% (2/81)
(p<0,05). Tuy nhin nu lm thng dng vt- bo tn sn niu o vi s kt hp k thut Nesbit v k
thut Mollard 0%(0/27) th t l ti pht thp hn so vi ch s dng k thut Nesbit n thun
12,9%(11/85) (p < 0,05).
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T kha: Cong dng vt.

SUMMARY
THE OUTCOME OF CHORDEE CORRECTION IN HYPOSPADIAS
Pham Ngoc Thach, Le Tan Son
Purpose: We present the etiology, management and evaluation of the surgical results of chordee with
hypospadias remaining on the urethral plate and usethe Snodgrass technique.
Patients and methods: During the period from 3/2012 - 3/2015, the Children's Hospital 2 had 278
patients with proximal hypospadias who underwent correction of chordee and urethroplasty with the
Snodgrass technique; 81 patients underwent the first stage repair. All patients who had chordee with
hypospadias received a test before and after surgery to assess the curvature of the penis. Penis straightening
techniques in the group of Snodgrass techniques included Nesbit accompanied by Mollard; penis straightening
techniques in the group of stage 1 repair received resection of urethral plate. Patients were ages from 12
months to 15 years old (mean age 5,8); this is a descriptive prospective study.
Results: 77.4% (278/359) of patients required the urethral plate in order to use Snodgrass technique.
Among the 278 patients who underwent the surgery using Snodgrass technique, 112 patients receiving the
surgery also received the Nesbit technique; 85 patients received the Nesbit technique only and 27 patients had
a combination of the Nesbit technique and Mollard technique. There were 11 cases of recurrent chordee with a
complication rate of 9.8% (11/112) after 6 months of follow-up; all these recurrent chordee cases were mild and
received the Nesbit technique only: 2 patients with recurrent chordee to straighten the penis combined with
closing of the urethral fistula; 3 patients with combined peno-scrotal transposition correction; 6 remaining
patients required no intervention. Complication rate of the group receiving Nesbit technique was 12.9%
(11/85) higher than 0% (0/27) of the group with the combination of Nesbit technique and Mollard technique
(p <0.05). Among 81 patients who underwent the first stage repair with urethral transection (3 cases using
dermal graft techniques, 5 with Nesbit) 2 cases had mild recurrent chordee 2.4% (2/81) Relapse rates with
recurrent chordee in urethral plate conservation group was 9.8% (11/112) higher than the group with urethral
plate transection by 2.4% (2/81) (p < 0.05)
Conclusions: The ratio treatment that still remain the urethral plate in order to use Snodgrass technique
is 77.4% (278/359). The rate of recurrent chordee at conservation group urethral platefor complication rate of
the group underwent Nesbit technique was 12.9% (11/85) higher than 0% (0/27) of the group with the
combination of Nesbit technique and Mollard technique (p < 0.05). However, if straightening with urethral
plate conservation with a combination of technical Nesbit and Mollard 0% (0/27), had lower recurring rates
compared to just using simple techniques Nesbit 12, 9% (11/85) (p < 0.05).
Keyword: Chordee.
* Khoa Niu bnh vin Nhi ng 2 ** B mn Ngoi Nhi, HYD TPHCM
Tc gi lin lc: Bs Phm Ngc Thch T: 0902 187 095 E-mail: dr.thachpham@yahoo.fr
 3

15N-05 IU TR MING NIU O NG THP THEO K

THUT CUN NG TI CH C RCH SN NIU O
Phm Ngc Thch*, L Tn Sn**
TM TT
Mc tiu: nh gi kt qu iu tr ming niu o ng thp th gia v th sau theo k thut cun ng
ti ch c rch sn niu o (Snodgrass) ti Bnh vin Nhi ng 2.
Phng php nghin cu: Nghin cu tin cu m t khng i chng t thng 3/2012 n thng
3/2015, cc trng hp ming niu o ng thp th gia v th sau c chn on trc m, sau khi
degloving v c bo tn sn niu o trin khai c k thut Snodgrass s c a vo nghin cu; cc
trng hp ct sn niu o lm phu thut th 1, hoc sn niu o nh thiu sn to hnh niu o theo k
thut Onlay flaps s b loi khi nghin cu. K thut to hnh niu o theo Snodgrass khu niu o mt
hoc hai lp, c tng cng khu th xp hay khng; khu ph niu o tn to bng mnh m di bao qui
u hoc mnh tinh mc.
Kt qu: C 359 trng hp ming niu o ng thp th gia v th sau trong thi gian trn c a
vo nghin cu, tui trung v l 2 tui; th gia chim 196 trng hp v th sau chim 163 trng hp. Sau
khi lm thng dng vt 81 trng hp b loi khi nghin cu; cn li 278 bnh nhn c phu thut to
hnh niu o theo k thut Snodgrass; c 112 trng hp c lm thng dng vt vi k thut Nesbit
khu gp mt lng dng vt, trong c 27 trng hp kt hp vi k thut tch sn niu o ca Mollard.
Bin chng lu di xy ra 65 trng hp cn phi phu thut li (27 trng hp th gia v 38 trng hp
th sau) chim t l bin chng chung 23,3% (65/278) trong r niu o 41 trng hp (14,7%), tt ming
niu o 18 trng hp (6,4%) v hp ming niu o 6 trng hp (2,1%) trong c 2 ca hp ming niu
o km r niu o. T l bin chng ming niu o ng thp th gia 15,9% (27/169) thp hn bin
chng ming niu o ng thp th sau 34,8% (38/109) (p < 0,05). Thi gian theo di t 6 thng n 36
thng.
Kt lun: Bin chng chung ca k thut Snodgrass cho ming niu o ng thp th gia v th sau l
23,3%. T l bin chng ny chp nhn c so vi cc k thut khc; u im ni bt ca k thut th hin
s n gin v tnh thm m cao.
T kha: ming niu o ng thp th sau, to hnh niu o
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SUMMARY
TUBULARISED INCISED PLATE TECHNIQUE FOR HYPOSPADIAS REPAIR
Pham Ngoc Thach, Le Tan Son
Objective: To describe the results in using Snodgrass technique for middle and posterior hypospadias at
the Children hospital number 2.
Methods: Prospective descriptive study, from March 2012 to March 2015 primary repairs were carried
out on 278 boys with proximal hypospadias. After degloving the penile skin, tunica albuginea plication was
used to correct residual ventral curvature in 112 boys. The method of urethroplasty was adapted from that
described by Snodgrass. The key step of the TIP repair is a midline incision of the urethral plate; a preputial
dartos flap or a tunica vaginalis flap are used to cover the neourethra. An 8Fr Foley is used as a urethral tent
and remove from 10 to 14 days after surgery. The follow-up time is 6 - 36 months.
Results: Mean age 2 years, tunica albuginea plication was used to correct penile curvature in 112 of the
patients. The overall complication rates were 23.3%; 41 urethrocutaneous fistulas (14.7%), 18 metal
regressions (4%) and 6 meatal stenosis (2.1%). The meatal stenosis was managed by meatoplasty. Posterior
hypospadias were more complication rates than middle hypospadias (p < 0.05).
Conclusions: Postoperative complications rate could be accepted, the results in using Snodgrass
technique for posterior hypospadias is good.
Keywords: posterior hypospadias, urethroplasty
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15N-06 NH GI KT QU PHU THUT IU TR

MING NIU O NG THP TI BNH VIN K TNH
BNH NH
Phan Xun Cnh*, Phm Vn Ph*, Hn Cnh nh*,
V Xun Thnh*, Nguyn Vn Phin*, L B Thao*, Bi Thin Thnh*
TM TT
Mc tiu: nh gi kt qu phu thut iu tr ming niu o ng thp (MNT) ti bnh vin a
khoa tnh Bnh nh.

Phng php nghin cu: Tin cu m t

Kt qu: Trong thi gian t 6/2013 - 6/2015, chng ti c 32 bnh nhn MNT c phu thut (27
trng hp m ln u v 02 m th 2, 02 ti tha km hp niu o, 01 r niu o ln km hp niu o).
Bin chng chung sau m chng ti l (12/32 ca) chim 37,5%. 03 (9,3%) trng hp thiu mu nui mt
bng dng vt nhng ngy u sau m. 01 (3,1%) trng hp hp niu o c nong sau m. 06 trng
hp d niu o (18,8%) v 02 (6,3%) trng hp ti tha niu o cn phi m li. Kt qu chng ti t
Tt l 62,5%, Kh l 12,5%, Xu l 25%.

Kt lun: Bnh vin a khoa tuyn tnh c th trin khai phu thut MNT vi 02 iu kin: bc s
c o to cn bn v Niu nhi v c trang b dng c phu thut

T kha: MNT, to hnh niu o, cong dng vt, r niu o, hp niu o

ABSTRACT
TO ASSESS THE OPERATION RESULT TREATS HYPOSPADIAS IN BINH DINH GENERAL
HOPSITAL
Phan Xuan Canh, Pham Van Phu, Han Canh Dinh, Vo Xuan Thanh, Nguyen Van Phien, Le Ba Thao, Bui Thien Thinh
Objective: To assess the operation result treats hypospadias in Binh Dinh general hospital.

Methods: prospective study

Results: From 6/2013 to 6/2015, we had 32 patients with hypospadias who were operated. There were 27
cases, who were operated the first time, 2 cases were operated the second stage, 2 cases urethral diverticulum
combine urethral stenosis, 1 case urethral fistula. Common complications occured (12/32 case) holding 37.5%,
3 cases (9.3%) had temporary ventral ischemia, 1 case urethral stenosis was dilatable after surgery, 6 cases
(18.8%) had fistula, 2 case (6.3%) had urethral diverticulum. Our results had good (62.5%), fair (12.5%), bad
(25%).

Conclusions: Province general hospital could operate hypospadisas with two conditions: doctors were
trained base about urology pediatric surgery and surgery equipment was enough.

Keywords: hypospadias, urethroplasty, penile curvature, fistula, urethral stenosis

* Bnh vin a khoa tnh Bnh nh - Khoa Ngoi Tng Hp

Tc gi lin h: Ths.BSCKI. Phan Xun Cnh, T: 0979710777, E-mail:

canhbacsy1212@gmail.com
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THN HC NHI
17NHI-04 VIM CU THN TNG SINH MNG NGUYN PHT
TR EM: 8 TRNG HP IU TR TI BNH VIN NHI NG I
Nguyn c Quang*, L Thanh Bnh*, Hunh Thoi Loan*, Trnh nh Th Nguyn*
TM TT
Mc tiu: Nhm nh gi kt qu iu tr cc trng hp vim cu thn tng sinh mng (VCTTSM)
nguyn pht tr em theo phn loi mi da trn min dch hunh quang ti bnh vin Nhi ng I.
Phng php nghin cu: Hi cu, m t lot ca. Tt c cc trng hp c chn on VCTTSM trn
sinh thit thn v khng xc nh c nguyn nhn th pht ca bnh.
Kt qu: T thng 01/2008 n thng 12/2015, c 8 trng hp VCTTSM nguyn pht trong 1332 sinh
thit thn ti bnh vin Nhi ng I: 7 trng hp VCTTSM do phc hp min dch, 1 trng hp bnh thn
C3. Tui trung bnh mc bnh l 9,75 tui (3-13 tui), t l nam/n l 3/5. Cc biu hin lm sng lc chn
on: hi chng thn h + vim thn: 100%, tng huyt p: 100%, tiu mu vi th: 100%, tiu mu i th
37,5%. Gim C3 trong mu c ghi nhn 7/8 (87,5%) trng hp, gim c C3 v C4 trong mu c ghi
nhn 5/8 (62,5%) trng hp. 2/8 (25%) trng hp c gim lc cu thn phng on (eGFR) di 60
mL/pht/1,73 m2. 75% trng hp khng p ng iu tr Prednisone. Cyclosporine kt hp Prednisone cch
ngy gy s lui bnh hon ton 2/5 (40%) trng hp khng steroid. Kt hp iu tr Mycophenolate
mofetil v c ch Calcineurine khng to ra s lui bnh cc trng hp khng Cyclosporine trong khi
Cyclophosphamide truyn tnh mch li gy ra s lui bnh hon ton 50% trng hp. 3/8 (37,5%) bnh
nhn ca chng ti khng vi iu tr thuc c ch min dch v gim lc cu thn di 60 mL/pht/1,73
m2 sau thi gian theo di trung bnh 25 thng (3 71 thng).
Kt lun: VCTTSM nguyn pht tr em vi biu hin lm sng ca hi chng thn h v vim thn
thng km p ng vi cc thuc c ch min dch v c d hu xu.
T kha: Vim cu thn tng sinh mng do phc hp min dch, bnh cu thn C3, c trng lm sng-
gii phu bnh, iu tr, tr em.

ABSTRACT
IDIOPATHIC MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS IN CHILDREN: EIGHT
CASES WERE TREATED AT CHILDENS HOSPITAL I.
Nguyen Duc Quang, Le Thanh Binh, Huynh Thoai Loan, Trinh Dinh The Nguyen
Background: To evaluate the therapeutic results of children with idiopathic membranoproliferative
glomerulonephritis (MPGN) according to a new classification based on immunofluorescent microscopy at
Childrens Hospital I.
Methods: Retrospective, case series report. All patients who had a renal pathology diagnosis of MPGN
without a defined etiology were enrolled in this study.
Results: From January 2008 to December 2015, 8 cases with idiopathic MPGN from 1332 renal biopsies
at Childrens Hospital I were enrolled: 7 cases with immune-complex-mediated MPGN, 1 case with C3
glomerulopathy. Mean age at onset was 9.75 years (3 13 years), male to female ratio was 3/5. Clinical
 7

features at the time of diagnosis encompassed: nephrotic-nephritc syndrome 100%, hypertension 100%,
microscopic hematuria 100%, and gross hematuria 37.5%. Low serum C3 was observed in 7/8 (87.5%) cases,
low both serum C3 and C4 in 5/8 (62.5%) cases. eGFR below 60 mL/min/1.73m2 was observed in 2/8 (25%)
cases. 75% of patients did not respond with Prednisone. Cyclosporine combined with alternate-day Prednisone
induced a complete remission in 2/5 (40%) steroid resistant cases. Mycophenolate mofetil combined with
Calcineurin inhibitors did not create a remission in Cyclosporine resistant patients while monthly
Cyclophosphamide intravenous infusion could induce a complete remission in 50% of these cases. Of our 8
patients, 3 (37.5%) did not respond with immunosuppressive therapies and suffered from a low eGFR under
60 mL/min/1.73m2 after a mean time follow-up of 25 months (3 71 months).
Conclusions: Idiopathic MPGN in children with nephrotic-nephritic syndrome at the time of diagnosis
usually had a poor response with immunosuppressive agents and a poor outcome.
Keywords: immune-complex-mediated membranoproliferative glomerulonephritis, C3 glomerulopathy,
clinicopathological features, treatment, children.
* Bnh vin Nhi ng I.
Tc gi lin lc: ThS. BS. Nguyn c Quang, T: 0908106434, E-mail: drquang73@yahoo.com