IS A.R. etnutnnonal~'itiOI1' 23,

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16

VAl TRO CtJA NGHI~M PHAp KicH THicH J3 HCGTRONG CHAN £loAN CHLrC NANG NQI TIET

CtJA TINH HoAN KHONG XUONG aiu a TRE EMHoang Tit! T/Iliy Yen

Bo mon Nhi, Truong Dai h9C Y Duac Hud

Tom t~tD~t van d~: Nghiern phap kich thich HCG ( test ~hCG) danh gia cac suy giam chirc nang noi ti~t cuatinh hoan. M(I"CdO tang cua testosteron goi y su t6n tai it nh~t co mot tinh hoan a b~t cir vi tri nao trongcothS. Nong do testosteron khong tang hay tang khong du trong truong hop goi Y ch~n dean khong cotinh hoan hay loan san tinh hoan. M\lc tieu : Danh gia clnrc nang ti~t testosterone cua tinh hoan khongxuong biu (THKXB), xac dinh mot s6 nguyen nhan noi ti~t bang beta human chorionic gonadotropin(~hCG). Phuong phap: Phuong phap mo ta theo doi doc 63 benh nhi tinh hoan khong xuong biu, phantich ITIUCdO tang testosteron sau nghiem phap ~hCG. K~t qua: (i) Nhorn dap trng binh tlurong cua tinhhoan sau nghiem phap ~-hCG la 30 cas (47,62%), trong do 8 benh nhi co cac di t?t dirong V?t nho hoac16 tiSu thap kern theo. S benh nhi cua nhorn nay co kich thuoc dirong V?t tang r6 r~t sau nghiern phap,do thi~u enzyme Sa - reductase. 3 benh nhi con lai khong co biSu hien tang kich thuoc dU011g V?t r6 r~tsau nghiern phap, nguyen nhan hay g~p nh~t la do kern nhay earn mot phan voi androgen (incompleteandrogen insensitivity syndrome - PAIS). (ii) Nhorn khong dap irng voi nghiem phap ~-hCG co 3 benhnhi, khong tim th~y tinh hoan tren lam sang va ch~n doan hinh anh (sieu am va MRI bung), nhiern s~cth~XY co SRY (+) duoc ch~n doan khong co tinh hoan. (iii) Nhorn dap irng mot phan voi nghiem phapII!30 cas do da s6 duoc ch~n dean muon sau 2 tu6i. Tuy nhien co 4 cas duoc ch~n dean sorn tnroc Itubi. Ca 4 benh nhi nay d€u co di * 16 tiSu thap hay duong V?t nho, chirng to chirc nang tinh hoan diigiam tir trong giai doan bao thai. R6i loan du true tinh hoan trong thoi ky phoi thai gay ra r6i loan phattri~ngioi tinh cua nam. K~t lu~n : Danh gia chirc nang tiet testosterone cua tinh hoan khong xuong biub~ngnghiern phap kich thich ~-hCG co thS goi y ch~n doan mot s6 nguyen nhan nhu thieu enzyme Sa- reductase, kern nhay earn voi androgen mot phan hay do loan san tinh hoan gay nen.TiI' khoa: Chirc ndng noi (id!, fJ-hCG, tinh hoan khong xuong biu.

AbstractROLE OF P HCG STIMULATION TEST IN THE DIAGNOSIS OF ENDOCRINE FUNCTION

OF UNDESCENDED TESTICLES IN CHILDRENHoang Tlli Tlluy Yen

Dept. of Pediatrics, Hue University of Medicine and Pharmacy

Background: Test ~ hCG was used to stim u late testosterone secretion in order to diagnose any iITIpairmentintesticular endocrine function. Increasing levels of testosterone after administration ofhCG suggest thattherebe at least one viable testicle somewhere in the body, while partial or no hormone response suggestanorchia or testicular dysgenesis. Objective: To diagnose any impairment of testosterone secretion andidentify some endocrine causes of undescended testicle in children. Methods: follow - up study of63 children with undescended testicle to analyse increased levels of testosterone after administrationofhCG test. Results: (i) Normal response after ~-hCG test consists of the 30 cas (47.62%), including8 patients with micropenie or hypospadia. S out of 8 patients with penis size significantly increasedaftertest due to deficiency of the enzyme Sa - reductase while the rests without significant increase inthepenis size is caused by incomplete androgen insensitivity syndrome - PAIS; (ii) No response after

-Diachi lien h~: Hoang Thi Thuy Yen, email: thuyyenhoangthitdiyahoo.com- Ngay nhdn bai: 101612013 * Ngay a6ng y dang: 221712013 * Ngay:xuat ban: 271812013

Tap chi Y Dune hoc - Truong Dai hoc Y DU'Q'c Hu~ - S6 16 35

~-hCG test includes 3 patients whose testicles were not found by clinical examination and MRI andchromosome is XY,SRY (+), they were diagnosed with anorchidia; (iii) Partial response group contains30 cas mostly diagnosed late after 2 years. However, 4 out of them were diagnosed early before I yearwith micropenie or hypospadia as a result of the testicular function insufficiency in fetal or early life.Testicular dysgenesis in fetus causes disorder of male sexual development. Conclusion: More functionalassessment of undescended testicle testosterone by ~ hCG stimulation test may suggest a diagnosis ofcauses such as deffiency of enzyme 5a - reductase, incomplete androgen insensitivity syndrome - PAISor in part caused by testicular dysgenesis.Key words: fJ hCG, endocrine junction, undesended testicles.

l.D~TVA.NDETinh hoan khong xuong biu (THKXB) hay con

goi la tinh hoan ~n, la thuat ngtr duoc dung trongcac tnrong hop tinh hoan khong 6 trong biu dodung lai b~t thuong tren duong di chuyen xuong nr6 bung, hoac do tinh hoan I1;1Cch6 nam 6 vi tri b~tthirong ngoai dirong di chuyen binh thuong, hoactinh hoan dao dong co th~ di dong xuong biu 6 vitri binh thirong r6i co th~ di chuyen len tren ngaysau do. Day la di t~t hay g~p o' tre em. Nguyen nhancua THKXB khong chi la can tro co hoc cua daychang va 6ng ben lam han che SI! di chuyen cuatinh hoan hoac d~n d~n tinh hoan lac ch6 6 vi tri b~tthuong, ma con do r6i 101;1ncau tao tinh hoan nhunhom 101;1nsan tinh hoan, hay cac nguyen nhan noi

ti~t do r6i 101;1ntong hop, thi~u hut enzym hay thuth~ ti~p nhan hormon androgen [3], [4].

Nghiern phap kich thich ~-hCG (test ~hCG) danhgia kha nang dap irng cua t~ bao Leydid tinh hoan,bang kich thich keo dai tang san xuat testosteron.Nong d<)testosteron tang cao chung to co hien dientinh hoan o' b~t cir vi tri nao cua co th~. Nong d<)testosteron khong tang hay tang khong du trongtnrong hQV goi Y ch~n doan khong co tinh hoanhay 101;1nsan tinh hoan. 6 Viet Nam, ph~u thuatdira tinh hoan xuong biu v~n la phuong phap di~utrj chinh y~u cho cac tnrong hop THKXB. Di~u tringoai khoa trong nhi~u tnrong hQV la phuong phapduy nhat, t:Y I~ thanh cong cao. Tuy nhien phuongphap nay khong danh gia duoc clurc nang ti~ttestosteron cua THKXB, do d~ khong dinh huongduoc nguyen nhan do 101;1nsan tinh hoan hay cac

b~t thuong noi ti~t khac co th~ d~n d~n vo sinh 'v~sau, du benh nhan co duoc ph~u thuat som. Chinhvi vay, nghien ciru nay tim hi~lI cac loi di~m cuanghiern phap kich thich hCG nhftm dinh huongch~n dean nguyen nhan n<)i ti~t cua THKXB.

Muc tieu nghien ciru: Danh gia chtrc ruing Iii!testosterone cua tinh hoan khong xuong biu, xac

36

dinh 1119ts6 nguyen nhdn noi tiit bJng beta humanchorionic gonadotropin (fJ hCG).

2. DOl TU<}NG vA PHUONG pHAP NGHIEN CUu2.1. D6i tU'<;mg nghien ciruBenh nhi tir I - 15 tu6i duoc chan doan tinh

hoan khong xuong biu tai Khoa Nhi Than - N<)iTi~t - Th~n Kinh Benh vien Trung irong Hu~,

Tieu chuin chon b~nh nhan:+ Tieu chudn chdn doan tinh hoan khong

xuong biu- Lam sang: Kharn khong thay tinh hoan a .

trong biu I ben hoac 2 ben, co th~ sa thay tinhhoan (6 16 ben nong, gifra 6ng ben, 16 ben sau)hoac khong sa thay tinh hoan

- Sieu am: Xac dinh vi tri tinh hoan ~n, do th~tich tinh hoan ~n trong nhirng tnrong hop tinhhoan khong so' thay.

Tieu chuin loai trir+ Benh nhan dil day thiT~t ca nhung benh nhan khong tuan thu li~u.

trinh dieu tri: thuoc, thoi gian di~u trio2.2. Phuong phap nghien ciruPhuong phap mo ta theo d6i doc 63 benh nhi

tinh 'llOan khong xuong biu, phan tich rmrc d<)tang testosteron sau nghiern phap ~hCG.

2.3. Cac buoc ti~n hanh:- Kham lam sang xac dinh :+ Tinh hoan ~n I hay 2 ben,+ Cac di t~t ph6'i hQV 0' nhorn tinh hoan ~112ben:.:. L6· ti~u .th~p: 16 tieu nftl'l16 ph~n mat bung

duong v~t; , ..:. Duong v~t nh6: chi~u dai dlI011g v~t < -2SD

bieu d6 theo tu6i (10)- Xet nghiem: Caryotyp, SRY: sieu am bung,

MRI bung n~u sieu am khong thay tinh hoan.- Phac d6 di~u tri n<)i khoa tinh hoan ~11tai

Khoa Nhi Than-Noi tier- Th~n kinh Benh vienTrung uong Hu~:

Tap chi Y DU'Q'choc - Truong f)~ihoc Y Duo'c Hu~ - S6 16

+T'x 71~n

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nd MRI andoup containsiefore Iyearor early life.e functional(jiagnosis ofme-PAIS

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+ Thu6c sir dung: Pregnyl 1500 UI/6ng cua

hang Organon+ LiSu sir dung :

Tre < I tu6i : 500 dun vi/I:lnTre 1- 10 tu6i : 1000 don vi Il:lnTre > 10 tu6i 1500 dun vi/I.1n

+ T~t ca benh nhi diroc tiern thuoc I l.1n/2 ngay

x 71~n tiern.+ Dinh hrong nong dO testosterone (ng/ml)

mroc nghiem phap phCG (T) va 24 gio sau miiitiem cu6i cung'(T2)

- Dap irng ti~t testosteron nghiem phap kichthich hCG

+ Dap irng ti~t binh thuong:

T/TJ > 50 l.1n ± tang kich thuoc diroug V?t,tinh hoan.

+ Dap irng tiet mot phan:T2> T1 va T/T

J< 50 l.1n

+ Khong dap ung hoan toan:T

Jgiarn th~p va T2 khong thay d6i so voi T

J

2.3. Thiri gian va dia di~m nghien ciru

Nghien ciru duoc ti~n hanh tu nam 2008 d~n2012 tai Khoa Nhi Than - NOi tiet - Th~n kinh,Benh vien Trung uong Hu~.

2.4. Xu Iy sa li~u: Xir Iy s6 lieu bang phirongphap thong ke y hoc : Medcalc®lO.O va MicosoftExcell 2007.

3.KETQuABang 3.1. Tu6i ch~n dean

Nh6m tu6i 56 b~nh nhan (n) Ty I~ (%)

0-1 15 23,81

2-6 31 49,21

7 - 12 16 25,39

>12 1 1,59

T6ng c9n9 63 100

Bang 3.2. Phan b6 theo hinh thai THKXB

56 b~nh nhan (n) TY I~ (%)

Tinh hoan an 48 76,19

Tinh hoan lac cha 7 11,11

Tinh hoan dao dong 5 7,94

Kh6ng tim thay tinh hoan 3 4,76

63 100

Bang 3 3 Phan b6 theo hlnh thai tinh hoan ~n..Hinh thai tinh hoan ~n

56 b~nh nhan TY I~ (%)n

Mot ben 25 52,08

Hai ben 23 47,92

T6ng C9n9 48 100Bang 3.4. Cac di tat phoi hop voi THA. ca 2 ben

D] t~t ph6i hQ'p 56 b~nh nhan (n) TY I~ (%)

La dai thap 4 33,33

DU'O'ngvat nh6 7 58,33

Ca 2 di tat tren 1 8,34

T6ng 12 100

Tapchi Y OU"<.>"c hoc - Truong Dl;Ii hoc Y OU"Q"c Hu~ - S6 16 37

Bang 3.5. Chirc nang ti~t testosterone sau nghiem phap ~-hCGCh(Vc nang ti~t testosterone

Nh6m tu6i Sinh thlJ'ang Giarn mot phan Kh6ng dap (vng pn

n % n % n %0- 1 15 11 73,33 4 26,67 0 02-6 31 16 51,61 13 41,94 2 6,45 < 0,05

7 - 12 16 3 18,75 12 75,00 1 6,25>12 1 0 0 1 100 0 0

Tong cong 63 30 47,62 30 47,62 3 4,76 100

Bang 3.6. Chirc nang ti~t testosterone saLt nghiern phap ~-hCG theo hinh thai THKXB

HTTHKXS Sinh thlJ'angGiarn Kh6ng

X2,PnmQt phan dap (vng

THA Mot ben 25 18 7 048

Hai ben 23 8 15 0

Tinh hoan lac cha 7 1 6 0X2 =74,3

P <0,0001Tinh hoan dao dong 5 3 2 0

Kh6ng tlrn thay tinh hoan 3 0 0 3

63 30 30 3

Bang 3.7. Clurc nang ti~t testosterone sau nghiern phap ~-hCG theo hinh thai THA.

THA (N =48) Sinh thlJ'ang Giarn mot phan Kh6ng dap (vngMot ben (n =25) 18 7 0 X2= 5,27Hai ben (n =23) 8 15 0 P < 0,05

Tong so 26 22 0

Bang 3.8. Chirc nang ti~t testosterone cua nhorn THA. 2 ben kern dj t~t

OJt~t ph6i hopCh(Vc nang ti~t testosterone

nGiarn mot phanSinh thlJ'ang Kh6ng dap (vng

La dai thap 4 3 (75%) 1( 25%) 0Duong vat nhe 7 5(71,43) 2 (28,57) 0cs 2 di tat 1 0 1 (100) 0Tong 12 8 4 0

Bang 3.9. SI! di chuyen cua tinh hoan §n theo hinh thai THA.

THA (N =48) Xu6ng hoan toan Xu6ng kh6ng Kh6ng xu6nghoan toan

Mot ben (N =25) 4 9 12X2=0,69

Hai ben (N =23) 3 11 9P >0,05

Tong so 7 20 21

Bang 3.10. Su di chuyen cua s6 tinh hoan §n sau nghiern phap ~-hCGOi chuyen cua s6 tinh hoan ~n se tinh hoan TY I~ (%)

Xuong hoan toan 10 14,08

Xuong kh6ng hoan toan 31 43,66

KhOng xuong 30 42,26

T6ng s6 71 100

38 Tap chi Y OU'Q'c hoc - Truong ~::,i!~y-= Y OU"Q"c Hu~ - S6 16

4. BAN4.1.Ban

chan doday la d"

tinh hoacac t~ b's6 IUQ"n

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4.BANLU~N4.1. Tu6i ch~n doan va hinh thai THKXBBang 3. I cho th~y s6 benh nhan THKXB duoc

ch§n doan sorn tnroc I tu6i chi~m tY I~ 23,81 %,day la oQ tu6i t6t nh~t duoc khuyen cao O~ oi~u tritinh hoan ~n tnroc khi co sir thoai tri~n v~ s6 IUQ"ngcac t~ bao m~m xay ra a tinh hoan ~n. Tuy nhien56 IUQ'ng benh nhan trong nhorn nay kha thap,trong khi 00 nhom benh nhan trong oQ tu6i 7 - 12chiem tY I~ 25,39% va co I benh nhan (1,59%) cotubi oi~u tri tren 12 tuoi. f)i~u nay cho th~y thuc t~THKXB v~n con la mot di t?t barn sinh chua duocdanh gia dung tinh dp thi~t o~ chan doan va oi~utri sorn cua cac b?c cha me cling nhir th~y thuoclam sang. K~t qua nghien ciru nay cua chung t6icling tuong tir voi Nguyen Thi An (2000) taiBenh vien Nhi Trung uong [I]. Nguyen Ti~n Van(2009), tai khoa ngoai, Benh vien Trung uong Hu~cling ghi nhan s6 benh nhan :s 2 tuoi chi chi~m tYI~ 15,6% [2]. Theo bang 3.2. trong 63 benh nhanTHKXB, nhorn tinh hoan ~n co tY I~ cao nh~t76,19%, tinh hoan lac ch6 co tY I~ II, II %, nhomtinh hoan dao dong 10 xo la 7,49%, co 3/63 benhnhan kh6ng tim th~y tinh hoan.

4.2. Dinh hutrng ch~n doan IDqt sa nguyennhan THKXB theo chirc nang ti~t testosteronciia b~nh nhi THKXB

4.2.1. Drip trng binh thuong vui nghiim pluip

ucoTheo bang 3.5 nhom dap irng binh thuong

cua tinh hoan sau nghiem phap ~-hCG la 30 cas(47,62%), clurng to co sir t6n tai cua tinh hoan vaclnrc nang ti~t testosterone cua tinh hoan con duocdam bao v~ mat chirc nang ti~t testosteron. Ty I~dap ung nghiern phap giam d~n theo OQ tuoi, caonhfit benh nhi nho hon 2 tu6i co 73,33%, nhom nr2- 6 tubi la 51,61 % rnac du nhom nay co s6 IUQ"ngIonnhfit (31/63), va nhorn tu6i 7- 12 tuoi la 18,75%.Nghien ciru nay co mot benh nhi 14 tu6i co tinhhoan dao dong nhung dap irng mot phan clurngto co sir giarn chirc nang ti~t testosterone CLIatinhhoan ~n bj giarn r6 ret. Di~u nay cling phu hop voidi~nbi~n trang sinh Iy b~nh THKXB. Khi tu6i cangtlingthi tinh tr?ng thoai tri~n t~ bao m~m, s6 IU'Q'ngt~ bao Leydid bi suy giam nhi~u do 00 W oap trngv6"ikieh thich ~-hCG (ban ch~t gi6ng LH) bi suygiam vi V?y n6ng oQ testosterone bi anh Imang.

81mh gia oap trng v6"i nghi~m phap ~-hCG theohinh thai tinh hoan kh6ng xu6ng bill. Bang 3.6 cho

T~p chi Y DU'Q'chQc - Truo'ng f)~ihQc Y DU'Q'cHu~ - S6 16

th~y dap ung voi nghiern phap cua cac nhom tinhhoan kh6ng xuong biu co sir khac biet co y nghiathong ke p< 0,05. Phan tich dap ung v6"i nghiernphap theo 48 cas tinh hoan §n, trong 06 co 25 castinh hoan ~n I ben va 23 tinh hoan ~n 2 ben, co sirkhac bier co y nghia thong ke theo hinh thai tinhhoan ~n (Bang 3.7). Cac k~t qua nay cho thay vitri tinh hoan kh6ng xuong biu anh huong r6 reto~n clurc nang ti~t testosteronn cua tinh hoan.Trong bai bao nay chira phan tich duoc vi trigiai ph~u cu th~ cua tinh hoan ~n theo dap irngvoi nghiern phap,

Nghien ciru oa danh gia chirc nang ti~ttestosteron cua nhorn tinh hoan ~n 2 ben kern di t?tphoi hop la 16 ti~u thap va / hoac duong V?t nho,MQt s6 truong hop THKXB 2 ben co chirc nangti~t testosteron binh thuong, nhung co cac di t?tk~t hop goi Y dinh huong mot s6 nguyen nhan nQitiet cua nghien ciru nay diroc trinh bay sau day.

Bang 3.8. cho th~y co 8 benh nhi tinh hoan §n2 ben, tuy clnrc nang ti~t binh thuong nhung c6cac di t?t duong V?t nho hoac 16 ti~u th~p kerntheo. Trong 00 co benh nhi 4 thang tuoi, tinh hoan~n hai ben kern di t?t 16 ti~u thap. Nhiern s~c th~cua cac benh nhi nay gioi tinh nam, XV, SRY +.5 benh nhi cua nhom nay co kich thiroc duongvat tang r6 ret sau nghiem phap, chirng to kh6ngco r6i loan nhay earn androgen. Nguyen nhancua nhom benh nhi duong V?t nho va tinh hO<'111~n 2 ben cua cac benh nhi nay tlurong do thieuenzyme 5a - reductase lam giarn tong hop hormonDHT (dihydrotestosterone ) nr testosteron, gay raduong vat nho va tinh hoan kh6ng xuong d~n biutrong giai doan bao thai [9],[ 10]. Khi lam nghiernphap nay do kich thich tang tong hop testosteronlen hang chuc I~n, nen nong oQ DHT cling duoctang tong hop len theo, du co thieu hut nrong 06ienzym 5a - reductase, tang kich thiroc duong V?tsau nghiern phap.

Co 3 benh nhi con lai kh6ng co bi~u hien tangkich thuoc dirong V?t r6 ret sau nghiem phap,nguyen nhan hay g~p nhfit clla cac b~nh nhannay la do kem nh?y eam mQt ph§n v6"i androgencLla th~1 th~, (incomplete androgen insensitivitysyndrome - PAIS

4.2.2. Khong iMp lI'ng va (tfip li'ng giiim mrlpltill1 vui nghi~m p/uip p-HCG.

Khollg co tinh !Joan: Bang 3.6. co 3 b~nh nh ikh6ng tim th~y tinh hO<'111tren lam sang va ch§n

39

doan hinh anh (sieu am va MRI bung), khong cocac di t~t kern theo, nhiern sac th~ XY co SRY (+)khong dap irng voi nghiern phap ~-hCG duocchan doan khong co tinh hoan do 10~1I1san thoi kythai nhi truce 20 tu~n [7]

Loan san tinh hoan: bang 3.5. va 3.6 cho th§ynhom dap irng mot phan voi nghiem phap la 30cas. Ngoai y~u t6 tu6i ch~n doan Ion nhu da trinhbay 6 tren, co 4 cas duoc ch~n doan sorn truceI tu6i va ca 4 cas nay co di t~t 16 ti~u thap hayduong v~t nho (6 bang 3.8) clurng to chirc nangtinh hoan giarn da giam ro trong giai doan baothai do r6i loan du true tinh hoan gay ra voi cacmire do hrong gioi khac nhau cua CO'quan sinh duengoai [6], [7].

4.3. K~t qua di chuyen cua tinh hoan §n saunghiem phap ~-hCG

Bang 3.10 cho th§y s6 tinh hoan ~n xuong biuhoan toan sau nghiern phap la 10 tinh hoan 14,08%.Bang 3.9 cho th§y sir di chuyen cua tinh hoanxuong biu khong pI1\) thuoc tinh hoan ~n mot hayhai ben. Day la nhung tnrong hop di~u tri thanhcong hoan toan v~ phuong dien noi khoa, khongdn phai ph~u thuat, tinh hoan di chuyen xuong vitri giai ph~u binh thuong la trong biu. K~t qua naycua chung toi cling phu hop voi nghien cuu cuanhi~u tac gia khac [I], [3]. Mouriquand P. (2008),k~t qua di~u tri bang ~-hCG co 6 - 75% tinh hoandi chuyen xuong biu [8]. Tuong nr nhir vay, Ritzen

E.M. (2008), cling ghi nhan k~t qua di~u tri thanhcong tinh hoan ~n bang ~-hCG 8 - 60% [I 0]. C~nchu y co nhirng truong hop du tinh hoan xuongbiu ca hai ben nhung chirc nang ti~t testosteronda giam sau nghiem phap (bang 3.6; 3.7; 3.8;3.9; 3.1 0), di~u nay co th~ anh huong d~n phattri~n day thi va clurc nang sinh san v~ sau cua tre.Nhirng benh nhi nay dang duoc theo doi dinh kytai khoa noi ti~t nhi. Do do dn co cac nghien ciru

theo doi doc keo did cho d~n tu6i day thi cua tre d~co k~t luan chinh xac v~ sau.

K~t qua nhirng tinh hoan co di chuyen xuongnhung khong hoan toan, v~ m~t noi khoa thi dayla k~t qua khong thanh cong nhung k~t qua nay lar§t hiru ich vi nhirng tinh hoan ~n nay da diroc lamtang su nroi mau nuoi dU011g,tang th~ tich tinh hoanva di chuyen di xuong mot doan nen khi benh nhanduoc di~u tri ngoai khoa ti~p theo d~ ph~u thuat hatinh hoan xuong c6 dinh o· biu r§t thuan loi, day lauu di~m cua di~u tri noi khoa bang ~-hCG ma cacph~u thuat vien r§t ung hO [9], [10].

5.KETLU~Danh gia clurc nang tiet testosterone cua tinh

hoan khong xuong biu bang nghiem phap kichthich ~-hCG co th~ goi Y ch~n doan mot s6 nguyennhan nhu thieu enzyme 5a - reductase, kern nhayearn voi androgen mot ph~n hay do loan san tinhhoan gay nen.

TAl LI~U TRAM KIIAO

1. Nguyen Thi An (2000), Nghien ciru d~c diem lamsang va hieu qua cua human chorionic gonadotropin(hCG) trong di~u tri tinh hoan kh6ng xuong biu treem, Ludn van thac 51Y hoc, tnrong Dai hoc Y HaNQi, Ha NQi.

2. Nguyen Ti~n Van (2009), Nghien ClJ'U d~c di~mlam sang, can lam sang va k~t qua di~u tri somph~u thuat tinh hoan kh6ng xuong biu (y tre em,Ludn van thac 51 Y hoc, Truong Dai hoc Y duocHu~, D~i hoc Hu~.

3. Le Minh Trac (2008), "Nghien ClI'U phat hien tinhhoan kh6ng xuong biu sau sinh tai benh vien PhuSan Trung U'Ol1g nam 2008", Tap chi y hoc thuchanh s6 ·//2008, tr 27 - 34.

4. Abdullah N A. et al (2007), Birth prevalenceof crytorchidism and hypospadias in northemEngland, 1993 - 2000, Arch Dis Child, 92.

5. Christiansen P. et al (2002), Serum inhibin B, FSH,LH and Testosteron levels before and after humanchorionic gonadotropin stimulation in prepubertalboys with criptorchidism, European Journal of

40

.Endochoronogy, 147, pp. 95 - 101.6. EI Zoghbi S C. et al (2007), Structural analysis

of gubernaculum testis in cryptochid patientssubmitted to treatment with human chorionicgonadotropin, Pediatric Urology, Volume 33 (20),pp.223 - 230.

7. Saenger .P (1995) " Physiology of SexualDetermination and Differentiation ", ClinicalEndocrinology, Blackwell Science, pp . 41 - 68.

8. Mouriquand P. (2008), Undescended testes in children:the peadiatric urologist's point of view, EuropeanJournal of Endocrinolory, 159, pp. 583 - 586.

9. Tekgul S. et al (2012), Cryptorchidism,Micropenis, Guidelines on paediatric-urology.10. Ritzert E M. (2008), Undescended testis: aconsensus on management, European JournalEndocrinology, I59, pp. 87 - 90.

10. Ritzen M, R,L Hintz ( 2007) .. Micropenie ill anewborn. Micropenie at age I year to puberty ".Pratical Algorithms in Pediatric Endocrinology, 2"Edition Editor Z.Hochberg, Karger pp: 34-36.

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