{"id":19085,"date":"2023-04-12T19:58:00","date_gmt":"2023-04-12T12:58:00","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19085"},"modified":"2023-04-13T09:47:54","modified_gmt":"2023-04-13T02:47:54","slug":"huong-dan-dieu-tri-ung-thu-da-day-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-dieu-tri-ung-thu-da-day-theo-bo-y-te\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y theo B\u1ed9 Y t\u1ebf"},"content":{"rendered":"<p><strong>Ung th\u01b0 d\u1ea1 d\u00e0y (UTDD) l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh ung th\u01b0 (UT) ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean\u00a0 th\u1ebf gi\u1edbi. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y tu\u1ef3 theo giai \u0111o\u1ea1n kh\u1ed1i u v\u00e0 c\u00e1c t\u00ednh ch\u1ea5t k\u00e8m theo.\u00a0<\/strong><\/p>\n<h2>1. \u0110I\u1ec0U TR\u1eca<\/h2>\n<h3>1.1. Nguy\u00ean t\u1eafc chung<\/h3>\n<p><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng v\u00e0 ch\u1ee7 \u0111\u1ea1o trong \u0111i\u1ec1u tr\u1ecb ung\u00a0 th\u01b0 d\u1ea1 d\u00e0y. Ph\u1eabu thu\u1eadt c\u00f3 vai tr\u00f2 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n trong giai \u0111o\u1ea1n s\u1edbm, l\u00e0 ph\u01b0\u01a1ng\u00a0 ph\u00e1p ch\u00ednh trong giai \u0111o\u1ea1n c\u00f2n ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c v\u00e0 l\u00e0 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb tri\u1ec7u\u00a0 ch\u1ee9ng \u1edf giai \u0111o\u1ea1n mu\u1ed9n.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">H\u00f3a tr\u1ecb, x\u1ea1 tr\u1ecb \u0111\u00f3ng vai tr\u00f2 \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3, t\u00e2n b\u1ed5 tr\u1ee3 trong giai \u0111o\u1ea1n c\u00f2n ch\u1ec9 \u0111\u1ecbnh\u00a0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n v\u00e0 vai tr\u00f2 gi\u1ea3m nh\u1eb9, k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng th\u00eam khi b\u1ec7nh \u1edf giai\u00a0 \u0111o\u1ea1n mu\u1ed9n, t\u00e1i ph\u00e1t, di c\u0103n.\u00a0<\/span><\/p>\n<h3><b>1.2. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y c\u1eaft b\u1ecf \u0111\u01b0\u1ee3c theo giai \u0111o\u1ea1n\u00a0<\/b><\/h3>\n<h4><span style=\"font-weight: 400;\">1.2.1. Ung th\u01b0 d\u1ea1 d\u00e0y giai \u0111o\u1ea1n Ia (cTis, cT1aNoMo): c\u1eaft u n\u1ed9i soi\u00a0<\/span><\/h4>\n<p><b><i>A. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p c\u1eaft u n\u1ed9i soi\u00a0<\/i><\/b><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">C\u1eaft ni\u00eam m\u1ea1c n\u1ed9i soi (Endoscopic mucosal resection: EMR)\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">C\u1eaft h\u1ea1 ni\u00eam m\u1ea1c n\u1ed9i soi (Endoscopic submucosal dissection: ESD)\u00a0<\/span><\/li>\n<\/ul>\n<p><b><i>B. Ch\u1ec9 \u0111\u1ecbnh c\u1eaft u qua n\u1ed9i soi\u00a0<\/i><\/b><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Nguy\u00ean l\u00fd ch\u1ec9 \u0111\u1ecbnh: xem x\u00e9t \u0111i\u1ec1u tr\u1ecb \u1edf nh\u1eefng kh\u1ed1i u r\u1ea5t \u00edt c\u00f3 kh\u1ea3 n\u0103ng di c\u0103n h\u1ea1ch\u00a0 v\u00e0 th\u00edch h\u1ee3p cho vi\u1ec7c c\u1eaft t\u1ed5n th\u01b0\u01a1ng th\u00e0nh m\u1ed9t kh\u1ed1i.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">C\u00e1c kh\u1ed1i u c\u00f3 ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i c\u1eaft qua n\u1ed9i soi<\/span>\n<ul>\n<li><span style=\"font-weight: 400;\">&#8211; EMR v\u00e0 ESD \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho kh\u1ed1i u: th\u1ec3 bi\u1ec7t h\u00f3a cao kh\u00f4ng c\u00f3 lo\u00e9t, ch\u1ea9n \u0111o\u00e1n\u00a0 l\u00e2m s\u00e0ng giai \u0111o\u1ea1n T1a v\u00e0 k\u00edch th\u01b0\u1edbc d\u01b0\u1edbi 2cm.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"font-weight: 400;\">C\u00e1c kh\u1ed1i u ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i c\u1eaft qua n\u1ed9i soi (m\u1edf r\u1ed9ng ch\u1ec9 \u0111\u1ecbnh)\u00a0<\/span>\n<ul>\n<li><span style=\"font-weight: 400;\">C\u00e1c kh\u1ed1i u r\u1ea5t \u00edt kh\u1ea3 n\u0103ng di c\u0103n h\u1ea1ch v\u00e0 kh\u00f4ng c\u00f3 x\u00e2m nh\u1eadp m\u1ea1ch b\u1ea1ch huy\u1ebft\u00a0 c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh c\u1eaft u n\u1ed9i soi. Ph\u01b0\u01a1ng ph\u00e1p ESD c\u1eaft r\u1ed9ng r\u00e3i l\u1edbp h\u1ea1 ni\u00eam m\u1ea1c n\u00ean\u00a0 hay \u0111\u01b0\u1ee3c d\u00f9ng h\u01a1n EMR.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">C\u00e1c kh\u1ed1i u \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n T1a v\u00e0:\u00a0<\/span>\n<ul>\n<li><span style=\"font-weight: 400;\">Th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc bi\u1ec7t h\u00f3a cao, kh\u00f4ng c\u00f3 lo\u00e9t, nh\u01b0ng k\u00edch th\u01b0\u1edbc &gt; 2cm <\/span><\/li>\n<li><span style=\"font-weight: 400;\">Th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc bi\u1ec7t h\u00f3a cao, c\u00f3 lo\u00e9t, v\u00e0 \u0111\u01b0\u1eddng k\u00ednh kh\u1ed1i u \u2264 3cm <\/span><\/li>\n<li><span style=\"font-weight: 400;\">Th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc k\u00e9m bi\u1ec7t h\u00f3a, kh\u00f4ng c\u00f3 lo\u00e9t, v\u00e0 \u0111\u01b0\u1eddng k\u00ednh kh\u1ed1i u \u2264 2cm\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><span style=\"font-weight: 400;\">C\u1eaft kh\u1ed1i u qua n\u1ed9i soi\u00a0<\/span>\n<ul>\n<li><span style=\"font-weight: 400;\">B\u1ec7nh ph\u1ea9m c\u1eaft ra c\u1ea7n \u0111\u01b0\u1ee3c ki\u1ec3m tra m\u00f4 b\u1ec7nh h\u1ecdc t\u1ef7 m\u1ec9. Hai y\u1ebfu t\u1ed1 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng c\u1eaft tri\u1ec7t c\u0103n kh\u1ed1i u qua n\u1ed9i soi: lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n kh\u1ed1i u nguy\u00ean ph\u00e1t v\u00e0\u00a0 kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng di c\u0103n h\u1ea1ch.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">C\u1eaft tri\u1ec7t c\u0103n khi: c\u1eaft t\u1ed5n th\u01b0\u01a1ng th\u00e0nh m\u1ed9t kh\u1ed1i, u k\u00edch th\u01b0\u1edbc \u2264 2cm, gi\u1ea3i ph\u1eabu\u00a0 b\u1ec7nh th\u1ec3 bi\u1ec7t h\u00f3a, giai \u0111o\u1ea1n pT1a, di\u1ec7n c\u1eaft chu vi \u00e2m t\u00ednh (HM0), di\u1ec7n c\u1eaft \u0111\u00e1y\u00a0 \u00e2m t\u00ednh (VM0) v\u00e0 ch\u01b0a c\u00f3 x\u00e2m nh\u1eadp m\u1ea1ch b\u1ea1ch huy\u1ebft.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">C\u1eaft tri\u1ec7t c\u0103n cho nh\u1eefng kh\u1ed1i u m\u1edf r\u1ed9ng ch\u1ec9 \u0111\u1ecbnh: c\u1eaft tri\u1ec7t c\u0103n khi\u00a0\u00a0<\/span>\n<ul>\n<li><span style=\"font-weight: 400;\">C\u1eaft u th\u00e0nh m\u1ed9t kh\u1ed1i, di\u1ec7n c\u1eaft chu vi \u00e2m t\u00ednh (HM0), di\u1ec7n c\u1eaft \u0111\u00e1y \u00e2m t\u00ednh\u00a0 (VM0), kh\u00f4ng x\u00e2m l\u1ea5n h\u1ea1ch [ly (-): no lymphatic invasion], kh\u00f4ng x\u00e2m l\u1ea5n\u00a0 m\u1ea1ch [v (-): no venous invasion] v\u00e0\u00a0<\/span>\n<ul>\n<li><span style=\"font-weight: 400;\"> Kh\u1ed1i u &gt; 2cm, gi\u1ea3i ph\u1eabu b\u1ec7nh bi\u1ec7t h\u00f3a cao, pT1a, kh\u00f4ng c\u00f3 lo\u00e9t. b. Kh\u1ed1i u \u0111\u01b0\u1eddng k\u00ednh \u2264 3cm, gi\u1ea3i ph\u1eabu b\u1ec7nh bi\u1ec7t h\u00f3a cao, pT1a, c\u00f3 lo\u00e9t\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> Kh\u1ed1i u \u0111\u01b0\u1eddng k\u00ednh \u2264 2cm, th\u1ec3 gi\u1ea3i ph\u1eabu b\u1ec7nh k\u00e9m bi\u1ec7t h\u00f3a, pT1a, kh\u00f4ng c\u00f3\u00a0 lo\u00e9t\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> Kh\u1ed1i u \u0111\u01b0\u1eddng k\u00ednh \u2264 3cm, th\u1ec3 gi\u1ea3i ph\u1eabu b\u1ec7nh bi\u1ec7t h\u00f3a cao, pT1b.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">V\u00ec c\u00e1c b\u1eb1ng ch\u1ee9ng kh\u00f4ng \u0111\u1ee7 cho c\u00e1c kh\u1ed1i u bi\u1ec7t h\u00f3a cao c\u00f3 \u0111i k\u00e8m v\u1edbi m\u1ed9t s\u1ed1 v\u00f9ng\u00a0 th\u1ec3 gi\u1ea3i ph\u1eabu b\u1ec7nh kh\u00f4ng bi\u1ec7t h\u00f3a, c\u1eaft kh\u1ed1i u qua n\u1ed9i soi kh\u00f4ng \u0111\u01b0\u1ee3c cho l\u00e0 tri\u1ec7t\u00a0 c\u0103n v\u00e0 c\u1ea7n ph\u1ea3i ph\u1eabu thu\u1eadt th\u00eam cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p sau:\u00a0<\/span><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"font-weight: 400;\">C\u00e1c v\u00f9ng carcinoma k\u00e9m bi\u1ec7t h\u00f3a v\u01b0\u1ee3t qu\u00e1 2cm nh\u01b0 tr\u01b0\u1eddng h\u1ee3p (a) \u1edf tr\u00ean.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Th\u00e0nh ph\u1ea7n k\u00e9m bi\u1ec7t h\u00f3a \u0111\u00e3 x\u00e2m nh\u1eadp l\u1edbp h\u1ea1 ni\u00eam m\u1ea1c nh\u01b0 tr\u01b0\u1eddng h\u1ee3p (b) \u1edf tr\u00ean. Ho\u1eb7c di\u1ec7n c\u1eaft d\u01b0\u01a1ng t\u00ednh.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">N\u1ebfu th\u00e0nh ph\u1ea7n carcinoma k\u00e9m bi\u1ec7t h\u00f3a \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf tr\u00ean (b) nh\u01b0ng kh\u00f4ng\u00a0 chi\u1ebfm \u01b0u th\u1ebf, nguy c\u01a1 di c\u0103n h\u1ea1ch \u0111\u01b0\u1ee3c \u01b0\u1edbc t\u00ednh l\u00e0 th\u1ea5p th\u00ec ph\u01b0\u01a1ng ph\u00e1p c\u1eaft qua\u00a0 n\u1ed9i soi \u0111\u01b0\u1ee3c coi nh\u01b0 l\u00e0 tri\u1ec7t c\u0103n.\u00a0<\/span><\/p>\n<p><b><i>C. \u0110i\u1ec1u tr\u1ecb sau khi c\u1eaft u qua n\u1ed9i soi\u00a0<\/i><\/b><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb sau c\u1eaft tri\u1ec7t c\u0103n: Theo d\u00f5i b\u1eb1ng n\u1ed9i soi \u0111\u1ecbnh k\u1ef3 2 th\u00e1ng\/ l\u1ea7n. * Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd v\u1eabn c\u00f2n t\u1ed5n th\u01b0\u01a1ng c\u1ea7n c\u00e2n nh\u1eafc c\u1eaft d\u1ea1 d\u00e0y tri\u1ec7t c\u0103n.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb sau c\u1eaft tri\u1ec7t c\u0103n cho nh\u1eefng kh\u1ed1i u \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng ch\u1ec9 \u0111\u1ecbnh: &#8211; Theo d\u00f5i ng\u01b0\u1eddi b\u1ec7nh b\u1eb1ng si\u00eau \u00e2m ho\u1eb7c ch\u1ee5p CLVT k\u1ebft h\u1ee3p v\u1edbi n\u1ed9i soi \u0111\u1ecbnh k\u1ef3\u00a0<\/span>\n<ul>\n<li><span style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb vi khu\u1ea9n Helicobacter Pylori (HP). Tuy nhi\u00ean m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho\u00a0 th\u1ea5y \u0111i\u1ec1u tr\u1ecb HP kh\u00f4ng l\u00e0m thay \u0111\u1ed5i t\u1ef7 l\u1ec7 xu\u1ea5t hi\u1ec7n ung th\u01b0 d\u1ea1 d\u00e0y.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h4><span style=\"font-weight: 400;\">1.2.2. Ung th\u01b0 d\u1ea1 d\u00e0y giai \u0111o\u1ea1n Ib-III\u00a0<\/span><\/h4>\n<p><strong><i> Ph\u1eabu thu\u1eadt\u00a0<\/i><\/strong><\/p>\n<p><strong><i>A<\/i>. <i>Nguy\u00ean t\u1eafc ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n:\u00a0<\/i><\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt c\u1eaft d\u1ea1 d\u00e0y ti\u00eau chu\u1ea9n th\u1ef1c hi\u1ec7n v\u1edbi m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n bao\u00a0 g\u1ed3m ph\u1eabu thu\u1eadt c\u1eaft \u00edt nh\u1ea5t 2\/3 d\u1ea1 d\u00e0y v\u00e0 n\u1ea1o v\u00e9t h\u1ea1ch D2 (s\u1ed1 l\u01b0\u1ee3ng h\u1ea1ch v\u00e9t\u00a0 \u0111\u01b0\u1ee3c t\u1ed1i thi\u1ec3u \u226515 h\u1ea1ch).\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt c\u1eaft d\u1ea1 d\u00e0y kh\u00f4ng ti\u00eau chu\u1ea9n: c\u1eaft d\u1ea1 d\u00e0y v\u00e0\/ho\u1eb7c v\u00e9t h\u1ea1ch t\u00f9y thu\u1ed9c\u00a0 v\u00e0o giai \u0111o\u1ea1n v\u00e0 v\u1ecb tr\u00ed kh\u1ed1i u.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt bi\u1ebfn \u0111\u1ed5i: c\u1eaft d\u1ea1 d\u00e0y v\u00e0 v\u00e9t h\u1ea1ch D1 ho\u1eb7c D1+ \u00edt h\u01a1n so v\u1edbi c\u1eaft d\u1ea1 d\u00e0y\u00a0 ti\u00eau chu\u1ea9n.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt c\u1eaft d\u1ea1 d\u00e0y m\u1edf r\u1ed9ng: bao g\u1ed3m c\u1eaft d\u1ea1 d\u00e0y k\u00e8m c\u00e1c t\u1ea1ng x\u00e2m l\u1ea5n v\u00e0 v\u00e9t\u00a0 h\u1ea1ch D2+\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Di\u1ec7n c\u1eaft: \u0111\u1ea3m b\u1ea3o kh\u00f4ng c\u00f2n t\u1ebf b\u00e0o ung th\u01b0 \u1edf di\u1ec7n c\u1eaft tr\u00ean v\u00e0 d\u01b0\u1edbi: gi\u1edbi h\u1ea1n\u00a0 tr\u00ean c\u00e1ch kh\u1ed1i u t\u1ed1i thi\u1ec3u 6cm, gi\u1edbi h\u1ea1n d\u01b0\u1edbi qua m\u00f4n v\u1ecb 2cm. Trong tr\u01b0\u1eddng h\u1ee3p\u00a0 kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c di\u1ec7n c\u1eaft \u0111\u1ee7 xa, c\u1ea7n l\u00e0m t\u1ee9c th\u00ec di\u1ec7n c\u1eaft. V\u1edbi nh\u1eefng kh\u1ed1i u x\u00e2m\u00a0 l\u1ea5n th\u1ef1c qu\u1ea3n, kh\u00f4ng c\u1ea7n thi\u1ebft \u0111\u1ea3m b\u1ea3o di\u1ec7n c\u1eaft xa u m\u00e0 c\u1ea7n l\u00e0m sinh thi\u1ebft t\u1ee9c\u00a0 th\u00ec di\u1ec7n c\u1eaft \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o di\u1ec7n c\u1eaft R0.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u, t\u1eafc ru\u1ed9t trong giai \u0111o\u1ea1n mu\u1ed9n.\u00a0<\/span><\/li>\n<\/ul>\n<p><strong><i>B. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p c\u1eaft d\u1ea1 d\u00e0y\u00a0<\/i><\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">C\u1eaft to\u00e0n b\u1ed9 d\u1ea1 d\u00e0y: c\u1eaft to\u00e0n b\u1ed9 d\u1ea1 d\u00e0y bao g\u1ed3m c\u1ea3 m\u00f4n v\u1ecb v\u00e0 t\u00e2m v\u1ecb. &#8211; C\u1eaft g\u1ea7n to\u00e0n b\u1ed9 d\u1ea1 d\u00e0y: \u0111\u1ea3m b\u1ea3o theo nguy\u00ean t\u1eafc ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n.\u00a0<\/span><\/li>\n<\/ul>\n<p><strong><i>C. V\u00e9t h\u1ea1ch trong ph\u1eabu thu\u1eadt ung th\u01b0 d\u1ea1 d\u00e0y\u00a0<\/i><\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">V\u00e9t h\u1ea1ch D0: V\u00e9t c\u00e1c nh\u00f3m h\u1ea1ch \u00edt h\u01a1n D1\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">V\u00e9t h\u1ea1ch D1: V\u00e9t c\u00e1c nh\u00f3m h\u1ea1ch t\u1eeb nh\u00f3m 1 \u0111\u1ebfn nh\u00f3m 7\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">V\u00e9t h\u1ea1ch D1+: V\u00e9t h\u1ea1ch D1 + c\u00e1c nh\u00f3m h\u1ea1ch 8a, 9, 11p\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">V\u00e9t h\u1ea1ch D2: bao g\u1ed3m v\u00e9t h\u1ea1ch D1 + c\u00e1c nh\u00f3m h\u1ea1ch 8a, 9,11d, 12a <\/span><\/li>\n<\/ul>\n<p><strong><i>D. Ch\u1ec9 \u0111\u1ecbnh v\u00e9t h\u1ea1ch theo giai \u0111o\u1ea1n\u00a0<\/i><\/strong><\/p>\n<p><span style=\"font-weight: 400;\">V\u1ec1 nguy\u00ean t\u1eafc: v\u1edbi kh\u1ed1i u giai \u0111o\u1ea1n T1N0M0 ch\u1ec9 \u0111\u1ecbnh v\u00e9t h\u1ea1ch D1 ho\u1eb7c D1+. V\u1edbi\u00a0 kh\u1ed1i u giai \u0111o\u1ea1n cN+ ho\u1eb7c T2-T4 ch\u1ec9 \u0111\u1ecbnh v\u00e9t h\u1ea1ch D2. V\u00e9t h\u1ea1ch D2 ch\u1ec9 \u0111\u1ecbnh n\u1ebfu\u00a0 trong m\u1ed5 c\u00f3 h\u1ea1ch nghi ng\u1edd di c\u0103n\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">* V\u00e9t h\u1ea1ch D1: \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho kh\u1ed1i u giai \u0111o\u1ea1n T1a (nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng\u00a0 c\u00f3 ch\u1ec9 \u0111\u1ecbnh l\u00e0m EMR\/ESD), v\u00e0 cho nh\u1eefng kh\u1ed1i u giai \u0111o\u1ea1n cT1bN0 c\u00f3 gi\u1ea3i ph\u1eabu\u00a0 b\u1ec7nh th\u1ec3 bi\u1ec7t ho\u00e1 v\u00e0 kh\u1ed1i u nh\u1ecf h\u01a1n 1,5cm.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">* V\u00e9t h\u1ea1ch D1+: \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho giai \u0111o\u1ea1n cT1N0 ngo\u00e0i nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 \u0111\u1ecbnh v\u00e9t h\u1ea1ch D1 \u1edf tr\u00ean.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">* V\u00e9t h\u1ea1ch D2: \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u1eefng kh\u1ed1i u t\u1eeb T2-T4 v\u00e0 cT1N+ c\u00f3 kh\u1ea3 n\u0103ng\u00a0 ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n. Vai tr\u00f2 c\u1ee7a c\u1eaft l\u00e1ch c\u00f9ng v\u1edbi v\u00e9t h\u1ea1ch tri\u1ec7t c\u0103n nh\u00f3m 10,11 v\u1eabn\u00a0 c\u00f2n nhi\u1ec1u tranh lu\u1eadn, v\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng JCOG 0110 v\u1ec1 v\u00e9t h\u1ea1ch\u00a0 tri\u1ec7t c\u0103n nh\u00f3m 10, 11 k\u00e8m theo b\u1ea3o t\u1ed3n l\u00e1ch mang l\u1ea1i k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u1eaft l\u00e1ch\u00a0 k\u00e8m theo. Nh\u1eefng kh\u1ed1i u T2-T4 c\u00f3 x\u00e2m l\u1ea5n ph\u00ecnh v\u1ecb, b\u1edd cong l\u1edbn ho\u1eb7c x\u00e2m l\u1ea5n l\u00e1ch\u00a0 th\u00ec ch\u1ec9 \u0111\u1ecbnh c\u1eaft l\u00e1ch k\u00e8m theo v\u00e9t h\u1ea1ch tri\u1ec7t c\u0103n nh\u00f3m 10.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">* V\u00e9t h\u1ea1ch D2+: nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 di c\u0103n h\u1ea1ch ch\u1ee7 b\u1ee5ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb h\u00f3a ch\u1ea5t\u00a0 t\u00e2n b\u1ed5 tr\u1ee3 sau \u0111\u00f3 ph\u1eabu thu\u1eadt c\u1eaft d\u1ea1 d\u00e0y k\u00e8m v\u00e9t h\u1ea1ch D2+ (h\u1ea1ch ch\u1ee7 b\u1ee5ng).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">V\u00e9t h\u1ea1ch D2 + v\u00e9t h\u1ea1ch nh\u00f3m 14v (h\u1ea1ch g\u1ed1c t\u0129nh m\u1ea1ch m\u1ea1c treo tr\u00e0ng tr\u00ean) \u1edf ng\u01b0\u1eddi\u00a0 b\u1ec7nh c\u00f3 di c\u0103n h\u1ea1ch nh\u00f3m 6.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Di c\u0103n h\u1ea1ch nh\u00f3m 13 coi nh\u01b0 di c\u0103n xa. Tuy nhi\u00ean, v\u00e9t h\u1ea1ch D2+ nh\u00f3m h\u1ea1ch 13\u00a0 tri\u1ec7t c\u0103n \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 kh\u1ed1i u x\u00e2m l\u1ea5n t\u00e1 tr\u00e0ng.\u00a0<\/span><\/p>\n<p><strong><i>E. M\u1ed9t s\u1ed1 v\u1ea5n \u0111\u1ec1 kh\u00e1c\u00a0\u00a0<\/i><\/strong><\/p>\n<p><i><span style=\"font-weight: 400;\">B\u1ea3o t\u1ed3n th\u1ea7n kinh ph\u1ebf v\u1ecb\u00a0<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400;\">Trong ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n nh\u00e1nh gan c\u1ee7a th\u1ea7n kinh ph\u1ebf v\u1ecb tr\u01b0\u1edbc v\u00e0\/ho\u1eb7c nh\u00e1nh t\u1ea1ng\u00a0 c\u1ee7a th\u1ea7n kinh ph\u1ebf v\u1ecb sau l\u00e0m t\u0103ng ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng do l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 s\u1ecfi t\u00fai\u00a0 m\u1eadt, ti\u00eau ch\u1ea3y ho\u1eb7c gi\u1ea3m c\u00e2n n\u1eb7ng sau ph\u1eabu thu\u1eadt.\u00a0\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400;\">C\u1eaft m\u1ea1c n\u1ed1i l\u1edbn\u00a0<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400;\">C\u1eaft m\u1ea1c n\u1ed1i l\u1edbn th\u01b0\u1eddng c\u1eaft c\u00f9ng v\u1edbi d\u1ea1 d\u00e0y cho nh\u1eefng kh\u1ed1i u T3, T4. V\u1edbi kh\u1ed1i u\u00a0 giai \u0111o\u1ea1n T1\/T2 c\u00f3 th\u1ec3 \u0111\u1ec3 l\u1ea1i m\u1ea1c n\u1ed1i l\u1edbn, c\u1eaft d\u1ecdc theo b\u1edd ngo\u00e0i c\u1ee7a cung m\u1ea1ch b\u1edd cong l\u1edbn.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400;\">C\u1eaft k\u00e8m c\u01a1 quan b\u1ecb x\u00e2m l\u1ea5n\u00a0<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400;\">V\u1edbi kh\u1ed1i u x\u00e2m l\u1ea5n c\u01a1 quan l\u00e2n c\u1eadn c\u00f3 th\u1ec3 c\u1eaft k\u00e8m theo (gan, l\u00e1ch, t\u1ee5y\u2026) \u0111\u1ec3 \u0111\u1ea3m\u00a0 b\u1ea3o di\u1ec7n c\u1eaft R0.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt n\u1ed9i soi\u00a0<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400;\">N\u0103m 2014, h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1ee7a \u1ee6y ban ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1ee7a Nh\u1eadt b\u1ea3n \u0111\u1ec1 xu\u1ea5t\u00a0 ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft b\u00e1n ph\u1ea7n xa c\u1ee7a d\u1ea1 d\u00e0y.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">T\u00f3m l\u1ea1i, ph\u1eabu thu\u1eadt b\u1ec7nh ung th\u01b0 d\u1ea1 d\u00e0y, c\u00f3 th\u1ec3:\u00a0<\/span><\/p>\n<ol>\n<li><span style=\"font-weight: 400;\"> Th\u0103m d\u00f2 sinh thi\u1ebft (m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c tr\u01b0\u1edbc m\u1ed5 nh\u01b0ng\u00a0 m\u1ed5 ra c\u00f3 di c\u0103n xa hay m\u1ed9t s\u1ed1 kh\u00f4ng \u0111\u00e1nh gi\u00e1 giai \u0111o\u1ea1n tr\u01b0\u1edbc m\u1ed5 b\u1eb1ng c\u1eaft\u00a0 l\u1edbp n\u00ean th\u0103m d\u00f2 sinh thi\u1ebft b\u1eb1ng n\u1ed9i soi ho\u1eb7c m\u1ed5 m\u1edf)\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> M\u1edf th\u00f4ng h\u1ed7ng tr\u00e0ng trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 h\u1eb9p m\u00f4n v\u1ecb nh\u01b0ng t\u00ecnh tr\u1ea1ng\u00a0 kh\u00f4ng cho ph\u00e9p n\u1ed1i v\u1ecb tr\u00e0ng ho\u1eb7c c\u1eaft d\u1ea1 d\u00e0y kh\u00f4ng tri\u1ec7t c\u0103n (d\u1eabn l\u01b0u ngo\u00e0i).\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> D\u1eabn l\u01b0u l\u1ed7 th\u1ee7ng do ung th\u01b0 \u2013 ph\u1eabu thu\u1eadt Newman (d\u1eabn l\u01b0u ngo\u00e0i).\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> N\u1ed1i v\u1ecb &#8211; tr\u00e0ng ho\u1eb7c n\u1ed1i t\u1eaft ru\u1ed9t \u2013 ru\u1ed9t trong tr\u01b0\u1eddng h\u1ee3p h\u1eb9p m\u00f4n v\u1ecb ho\u1eb7c h\u1eb9p\u00a0 c\u00e1c quai ru\u1ed9t do ung th\u01b0 di c\u0103n x\u00e2m l\u1ea5n (d\u1eabn l\u01b0u trong).<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> C\u1eaft \u0111o\u1ea1n d\u1ea1 d\u00e0y, m\u1ea1c n\u1ed1i l\u1edbn (c\u1eaft 3\/4, 4\/5\u2026) v\u00e0 n\u1ea1o v\u00e9t h\u1ea1ch: c\u00f3 th\u1ec3 tri\u1ec7t \u0111\u1ec3 ho\u1eb7c kh\u00f4ng tri\u1ec7t \u0111\u1ec3 (giai \u0111o\u1ea1n III, IV c\u00f3 bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u, th\u1ee7ng, h\u1eb9p)\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> C\u1eaft to\u00e0n b\u1ed9 d\u1ea1 d\u00e0y, m\u1ea1c n\u1ed1i l\u1edbn v\u00e0 n\u1ea1o v\u00e9t h\u1ea1ch: c\u00f3 th\u1ec3 tri\u1ec7t \u0111\u1ec3 ho\u1eb7c kh\u00f4ng\u00a0 tri\u1ec7t \u0111\u1ec3 (giai \u0111o\u1ea1n III, IV c\u00f3 bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u, th\u1ee7ng, h\u1eb9p).\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> C\u1eaft \u0111o\u1ea1n ho\u1eb7c to\u00e0n b\u1ed9 d\u1ea1 d\u00e0y k\u00e8m c\u1eaft t\u1ea1ng l\u00e2n c\u1eadn (gan, \u0111o\u1ea1n \u0111\u1ea1i tr\u00e0ng, l\u00e1ch\u00a0 v\u00e0 \u0111u\u00f4i t\u1ee5y\u2026.), m\u1ea1c n\u1ed1i l\u1edbn, n\u1ea1o v\u00e9t h\u1ea1ch: C\u00f3 th\u1ec3 tri\u1ec7t \u0111\u1ec3 ho\u1eb7c kh\u00f4ng tri\u1ec7t\u00a0 \u0111\u1ec3. C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1eaft d\u1ea1 d\u00e0y c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m c\u1eaft t\u1ea1ng l\u00e2n c\u1eadn d\u00f9 ph\u1eabu\u00a0 thu\u1eadt v\u1eabn kh\u00f4ng tri\u1ec7t \u0111\u1ec3 l\u00e0 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 th\u1ee7ng, h\u1eb9p hay ch\u1ea3y m\u00e1u).\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> C\u1eaft u qua n\u1ed9i soi \u1ed1ng m\u1ec1m trong tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 d\u1ea1 d\u00e0y s\u1edbm.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> C\u1eaft d\u1ea1 d\u00e0y h\u00ecnh ch\u00eam trong tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 giai \u0111o\u1ea1n s\u1edbm m\u00e0 kh\u00f4ng c\u00f3\u00a0 \u0111i\u1ec1u ki\u1ec7n c\u1eaft u qua n\u1ed9i soi \u1ed1ng m\u1ec1m.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> L\u00ed do c\u1ea7n n\u1ea1o v\u00e9t h\u1ea1ch trong ung th\u01b0 bi\u1ec3u m\u00f4 d\u1ea1 d\u00e0y: Th\u1ee9 nh\u1ea5t l\u00e0 h\u1ea1ch b\u1ea1ch\u00a0 huy\u1ebft l\u00e0 con \u0111\u01b0\u1eddng di c\u0103n ch\u00ednh c\u1ee7a ung th\u01b0 d\u1ea1 d\u00e0y. Th\u1ee9 hai l\u00e0 n\u1ea1o v\u00e9t h\u1ea1ch\u00a0 l\u00e0m cho ph\u1eabu thu\u1eadt tr\u1edf n\u00ean tri\u1ec7t \u0111\u1ec3 h\u01a1n. Th\u1ee9 ba l\u00e0 n\u1ea1o v\u00e9t h\u1ea1ch gi\u00fap \u0111\u00e1nh gi\u00e1\u00a0 ch\u00ednh x\u00e1c giai \u0111o\u1ea1n b\u1ec7nh v\u00e0 ti\u00ean l\u01b0\u1ee3ng. Th\u1ee9 t\u01b0 l\u00e0 c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng di c\u0103n nh\u1ea3y\u00a0 c\u00f3c trong ung th\u01b0 d\u1ea1 d\u00e0y (kh\u00f4ng di c\u0103n h\u1ea1ch ch\u1eb7ng 1 nh\u01b0ng di c\u0103n h\u1ea1ch\u00a0 ch\u1eb7ng 2 ho\u1eb7c ch\u1eb7ng 3).\u00a0<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">N\u1ea1o v\u00e9t h\u1ea1ch D1, D2, D3, D4 d\u1ef1a v\u00e0o b\u1ea3ng sau \u0111\u00e2y c\u1ee7a t\u00e1c gi\u1ea3 Kodama (Nh\u1eadt b\u1ea3n)\u00a0<\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td><span style=\"font-weight: 400;\">V\u1ecb tr\u00ed\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">D1\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">D2\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">D3\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">D4<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Ung th\u01b0 1\/3 tr\u00ean\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">1,2,3,4\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">5,6,7,8,9,10,11\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">12,13,14\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">15,16<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Ung th\u01b0 1\/3 gi\u1eefa\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">3,4,5,6,1\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">4,8,9,11,2,10\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">12,13,14\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">15,16<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Ung th\u01b0 1\/3 d\u01b0\u1edbi\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">3,4,5,6\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">1,2,7,9\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">11,12,13,14,2,10\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">15,16<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">To\u00e0n b\u1ed9 d\u1ea1 d\u00e0y\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">1,2,3,4,5,6\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">7,8,9,10,11,12\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">13,14\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">15.16<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<figure id=\"attachment_19086\" aria-describedby=\"caption-attachment-19086\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-19086 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/gastric-lymph-300x225.png\" alt=\"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y\" width=\"300\" height=\"225\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/gastric-lymph-300x225.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/gastric-lymph.png 483w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-19086\" class=\"wp-caption-text\">V\u1ecb tr\u00ed c\u00e1c nh\u00f3m h\u1ea1ch<\/figcaption><\/figure>\n<p><span style=\"font-weight: 400;\">Trong \u0111\u00f3 nh\u00f3m 1: C\u00e1c h\u1ea1ch \u1edf b\u00ean ph\u1ea3i t\u00e2m v\u1ecb. Nh\u00f3m 2: C\u00e1c h\u1ea1ch b\u00ean tr\u00e1i t\u00e2m v\u1ecb.\u00a0 Nh\u00f3m 3: C\u00e1c h\u1ea1ch d\u1ecdc theo b\u1edd cong nh\u1ecf. Nh\u00f3m 4: C\u00e1c h\u1ea1ch d\u1ecdc theo b\u1edd cong l\u1edbn\u00a0 (4sa: V\u1ecb ng\u1eafn, 4sb: V\u1ecb m\u1ea1c n\u1ed1i tr\u00e1i). Nh\u00f3m 5: C\u00e1c h\u1ea1ch tr\u00ean m\u00f4n v\u1ecb. Nh\u00f3m 6: C\u00e1c\u00a0 h\u1ea1ch d\u01b0\u1edbi m\u00f4n v\u1ecb. Nh\u00f3m 7: C\u00e1c h\u1ea1ch d\u1ecdc theo \u0111\u1ed9ng m\u1ea1ch v\u1ecb tr\u00e1i. Nh\u00f3m 8: C\u00e1c\u00a0 h\u1ea1ch d\u1ecdc theo \u0111\u1ed9ng m\u1ea1ch gan chung. Nh\u00f3m 9: C\u00e1c h\u1ea1ch d\u1ecdc theo \u0111\u1ed9ng m\u1ea1ch th\u00e2n\u00a0 t\u1ea1ng. Nh\u00f3m 10: C\u00e1c h\u1ea1ch t\u1ea1i r\u1ed1n l\u00e1ch. Nh\u00f3m 11: C\u00e1c h\u1ea1ch d\u1ecdc theo \u0111\u1ed9ng m\u1ea1ch\u00a0 l\u00e1ch. Nh\u00f3m 12: C\u00e1c h\u1ea1ch trong d\u00e2y ch\u1eb1ng gan t\u00e1 tr\u00e0ng, cu\u1ed1ng gan. Nh\u00f3m 13: C\u00e1c\u00a0 h\u1ea1ch m\u1eb7t sau \u0111\u1ea7u t\u1ee5y. Nh\u00f3m 14: C\u00e1c h\u1ea1ch d\u1ecdc m\u1ea1ch m\u1ea1c treo tr\u00e0ng tr\u00ean. Nh\u00f3m 15:\u00a0 C\u00e1c h\u1ea1ch d\u1ecdc theo c\u00e1c m\u1ea1ch m\u00e1u \u0111\u1ea1i tr\u00e0ng gi\u1eefa. Nh\u00f3m 16: C\u00e1c h\u1ea1ch d\u1ecdc \u0111\u1ed9ng\u00a0 m\u1ea1ch ch\u1ee7.<\/span><\/p>\n<p><strong><i> X\u1ea1 tr\u1ecb\u00a0<\/i><\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">X\u1ea1 tr\u1ecb \u0111\u01a1n thu\u1ea7n ch\u1ee7 y\u1ebfu \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng nh\u01b0 h\u1eb9p m\u00f4n v\u1ecb, ch\u1ea3y m\u00e1u&#8230;\u00a0 <\/span><\/li>\n<li><span style=\"font-weight: 400;\">X\u1ea1 tr\u1ecb ph\u1ed1i h\u1ee3p v\u1edbi ho\u00e1 tr\u1ecb trong \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3, t\u00e2n b\u1ed5 tr\u1ee3.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<p><strong><i> H\u00f3a &#8211; x\u1ea1 tr\u1ecb k\u1ebft h\u1ee3p\u00a0<\/i><\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">H\u00f3a x\u1ea1 tr\u1ecb \u0111\u1ed3ng th\u1eddi b\u1ed5 tr\u1ee3 sau m\u1ed5 ph\u1ed1i h\u1ee3p v\u1edbi 5-FU (fluorouracil) \u0111\u01b0\u1ee3c\u00a0 khuy\u1ebfn c\u00e1o cho nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh giai \u0111o\u1ea1n t\u1eeb IB tr\u1edf \u0111i.\u00a0\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">H\u00f3a x\u1ea1 tr\u1ecb \u0111\u1ed3ng th\u1eddi c\u00f2n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c UTDD t\u1ea1i ch\u1ed7 kh\u00f4ng c\u1eaft b\u1ecf \u0111\u01b0\u1ee3c ho\u1eb7c th\u1ec3 tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng cho ph\u00e9p ph\u1eabu thu\u1eadt. Khi \u0111\u00f3, m\u1ee5c \u0111\u00edch\u00a0 \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 l\u00e0 tri\u1ec7t c\u0103n hay t\u1ea1m th\u1eddi t\u00f9y theo t\u1eebng t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">H\u00f3a x\u1ea1 tr\u1ecb b\u1ed5 tr\u1ee3 sau ph\u1eabu thu\u1eadt trong tr\u01b0\u1eddng h\u1ee3p di\u1ec7n c\u1eaft sau ph\u1eabu thu\u1eadt c\u00f2n t\u1ebf b\u00e0o u tr\u00ean vi th\u1ec3 (R1) ho\u1eb7c tr\u00ean \u0111\u1ea1i th\u1ec3 (R2). Nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c c\u1eaft d\u1ea1 d\u00e0y\u00a0 kh\u00f4ng tri\u1ec7t \u0111\u1ec3 hay c\u00f3 di\u1ec7n c\u1eaft d\u01b0\u01a1ng t\u00ednh c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p \u0111a\u00a0 m\u00f4 th\u1ee9c sau m\u1ed5 m\u1ed9t c\u00e1ch ph\u00f9 h\u1ee3p.\u00a0<\/span><\/li>\n<\/ul>\n<p><strong><i> H\u00f3a tr\u1ecb\u00a0<\/i><\/strong><\/p>\n<p><span style=\"font-weight: 400;\">\u2b9a <\/span><b>H\u00f3a tr\u1ecb tr\u01b0\u1edbc m\u1ed5 (h\u00f3a tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3)<\/b><b>\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400;\">M\u1ee5c ti\u00eau:\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Gi\u1ea3m giai \u0111o\u1ea1n (k\u00edch th\u01b0\u1edbc v\u00e0 s\u1ef1 x\u00e2m l\u1ea5n c\u1ee7a u, gi\u1ea3m di c\u0103n h\u1ea1ch), t\u0103ng kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n R0.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Gi\u1ea3m vi di c\u0103n tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, gi\u1ea3m t\u1ec9 l\u1ec7 t\u00e1i ph\u00e1t t\u1ea1i ch\u1ed7 v\u00e0 di c\u0103n xa, c\u1ea3i thi\u1ec7n\u00a0 th\u1eddi gian s\u1ed1ng th\u00eam to\u00e0n b\u1ed9.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u0110\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c \u0111\u1ed9 nh\u1ea1y v\u1edbi h\u00f3a ch\u1ea5t.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">L\u1ef1a ch\u1ecdn ng\u01b0\u1eddi b\u1ec7nh:\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p UTDD ti\u1ebfn tri\u1ec3n t\u1ea1i ch\u1ed7 c\u00f2n kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">B\u1ec7nh \u1edf giai \u0111o\u1ea1n ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c nh\u01b0ng ch\u01b0a c\u00f3 kh\u1ea3 n\u0103ng m\u1ed5 ngay (th\u1ec3 tr\u1ea1ng,\u00a0 b\u1ec7nh to\u00e0n th\u00e2n, kinh t\u1ebf\u2026)\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">C\u00e1c h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh \u0111i\u1ec1u tr\u1ecb c\u1ee7a NCCN v\u00e0 ESMO \u0111\u00e3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o\u00a0 v\u1ec1 \u0111i\u1ec1u tr\u1ecb h\u00f3a ch\u1ea5t tr\u01b0\u1edbc m\u1ed5 cho c\u00e1c ng\u01b0\u1eddi b\u1ec7nh UTDD ti\u1ebfn tri\u1ec3n t\u1ea1i ch\u1ed7. C\u00e1c\u00a0 ph\u00e1c \u0111\u1ed3 bao g\u1ed3m ECF v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 (ECX, EOX\u2026) ho\u1eb7c g\u1ea7n \u0111\u00e2y nh\u1ea5t l\u00e0\u00a0 ph\u00e1c \u0111\u1ed3 FLOT.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2b9a <\/span><b>H\u00f3a tr\u1ecb sau ph\u1eabu thu\u1eadt (h\u00f3a tr\u1ecb b\u1ed5 tr\u1ee3)<\/b><b>\u00a0<\/b><\/p>\n<p><i><span style=\"font-weight: 400;\">M\u1ee5c ti\u00eau:\u00a0<\/span><\/i><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Di\u1ec7t c\u00e1c t\u1ebf b\u00e0o ung th\u01b0 c\u00f2n s\u00f3t l\u1ea1i.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t, c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng th\u00eam.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400;\">Ch\u1ec9 \u0111\u1ecbnh:<\/span><\/i><i><span style=\"font-weight: 400;\">\u00a0<\/span><\/i><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Ng\u01b0\u1eddi b\u1ec7nh ung th\u01b0 d\u1ea1 d\u00e0y giai \u0111o\u1ea1n II-III, \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n v\u00e9t h\u1ea1ch\u00a0 D2, di\u1ec7n c\u1eaft kh\u00f4ng c\u00f2n t\u1ebf b\u00e0o UT.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">H\u00f3a tr\u1ecb sau ph\u1eabu thu\u1eadt gi\u00fap ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 cao \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c b\u1edfi\u00a0 c\u00e1c y\u1ebfu t\u1ed1 b\u1ec7nh l\u00fd v\u00e0 nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh nguy c\u01a1 th\u1ea5p s\u1ebd tr\u00e1nh \u0111\u01b0\u1ee3c c\u00e1c r\u1ee7i ro \u0111\u1ed9c\u00a0<\/span><span style=\"font-weight: 400;\">t\u00ednh c\u1ee7a h\u00f3a tr\u1ecb tr\u01b0\u1edbc do s\u1ef1 \u0111\u00e1nh gi\u00e1 giai \u0111o\u1ea1n kh\u00f4ng ch\u00ednh x\u00e1c. Ngo\u00e0i ra, do ph\u1eabu\u00a0 thu\u1eadt l\u00e0 ph\u01b0\u01a1ng th\u1ee9c \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 nh\u1ea5t, khi \u0111\u00e3 c\u1eaft b\u1ecf \u0111\u01b0\u1ee3c u nguy\u00ean ph\u00e1t s\u1ebd gi\u1ea3m nguy c\u01a1 kh\u00f4ng c\u00f2n c\u01a1 h\u1ed9i ph\u1eabu thu\u1eadt cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u00f3a tr\u1ecb tr\u01b0\u1edbc\u00a0 kh\u00f4ng hi\u1ec7u qu\u1ea3.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">T\u00f9y theo t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng nguy\u00ean ph\u00e1t v\u00e0 m\u1ee9c \u0111\u1ed9 di c\u0103n h\u1ea1ch m\u00e0 ph\u00e1c \u0111\u1ed3 thay\u00a0 \u0111\u1ed5i c\u00f3 th\u1ec3 bao g\u1ed3m ECF ho\u1eb7c c\u00e1c bi\u1ebfn th\u1ec3 hay k\u1ebft h\u1ee3p oxaliplatin v\u1edbi capecitabine\u00a0 v\u00e0\/ ho\u1eb7c TS-1 \u1edf c\u00e1c ng\u01b0\u1eddi b\u1ec7nh ch\u00e2u \u00c1.\u00a0<\/span><\/p>\n<p><b>1.3. UTDD giai \u0111o\u1ea1n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n <\/b><\/p>\n<p><span style=\"font-weight: 400;\">Ch\u1ec9 \u0111\u1ecbnh:\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Ung th\u01b0 d\u1ea1 d\u00e0y giai \u0111o\u1ea1n mu\u1ed9n c\u00f3 di c\u0103n xa nhi\u1ec1u t\u1ea1ng; di c\u0103n ph\u00fac m\u1ea1c; t\u00ecnh\u00a0 tr\u1ea1ng to\u00e0n th\u00e2n kh\u00f4ng cho ph\u00e9p ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt ho\u1eb7c kh\u00f4ng ch\u1ea5p nh\u1eadn ph\u01b0\u01a1ng ph\u00e1p\u00a0 \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt.\u00a0<\/span><\/li>\n<\/ul>\n<h4><span style=\"font-weight: 400;\">1.3.1. Ph\u1eabu thu\u1eadt tri\u1ec7u ch\u1ee9ng\u00a0<\/span><\/h4>\n<p><span style=\"font-weight: 400;\">\u1ede nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh UTDD giai \u0111o\u1ea1n di c\u0103n xa c\u00f3 bi\u1ec3u hi\u1ec7n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a\u00a0 ho\u1eb7c h\u1eb9p m\u00f4n v\u1ecb c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh c\u1eaft d\u1ea1 d\u00e0y tri\u1ec7u ch\u1ee9ng ho\u1eb7c n\u1ed1i v\u1ecb tr\u00e0ng t\u00f9y thu\u1ed9c\u00a0 v\u00e0o kh\u1ea3 n\u0103ng c\u1eaft b\u1ecf kh\u1ed1i u nguy\u00ean ph\u00e1t v\u00e0 c\u00e1c nguy c\u01a1 c\u1ee7a ph\u1eabu thu\u1eadt. N\u1ed1i v\u1ecb tr\u00e0ng\u00a0 b\u00e1n ph\u1ea7n d\u1ea1 d\u00e0y \u0111\u1ea3m b\u1ea3o ch\u1ee9c n\u0103ng t\u1ed1t h\u01a1n so v\u1edbi n\u1ed1i v\u1ecb tr\u00e0ng \u0111\u01a1n thu\u1ea7n.\u00a0<\/span><\/p>\n<h4><span style=\"font-weight: 400;\">1.3.2. H\u00f3a tr\u1ecb\u00a0<\/span><\/h4>\n<p><span style=\"font-weight: 400;\">M\u1ee5c \u0111\u00edch:\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng, c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng cho ng\u01b0\u1eddi b\u1ec7nh. <\/span><\/li>\n<li><span style=\"font-weight: 400;\">K\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng th\u00eam kh\u00f4ng ti\u1ebfn tri\u1ec3n, th\u1eddi gian s\u1ed1ng to\u00e0n b\u1ed9.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u2219 <\/span><b><i>Vai tr\u00f2 c\u1ee7a h\u00f3a tr\u1ecb trong UTDD giai \u0111o\u1ea1n mu\u1ed9n\u00a0\u00a0<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400;\">K\u1ebft qu\u1ea3 t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u th\u1eed nghi\u1ec7m g\u1ea7n \u0111\u00e2y cho th\u1ea5y nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh UTDD\u00a0 giai \u0111o\u1ea1n mu\u1ed9n kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n m\u00e0 c\u00f3 th\u1ec3 dung n\u1ea1p \u0111\u01b0\u1ee3c\u00a0 h\u00f3a tr\u1ecb s\u1ebd \u0111\u1ea1t \u0111\u01b0\u1ee3c l\u1ee3i \u00edch d\u00f9 nh\u1ecf nh\u01b0ng r\u00f5 r\u00e0ng v\u1ec1 th\u1eddi gian s\u1ed1ng so v\u1edbi ch\u1ec9 ch\u0103m\u00a0 s\u00f3c gi\u1ea3m nh\u1eb9 \u0111\u01a1n thu\u1ea7n.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2219 <\/span><b><i>\u0110\u01a1n h\u00f3a ch\u1ea5t trong \u0111i\u1ec1u tr\u1ecb UTDD\u00a0<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400;\">M\u1ed9t s\u1ed1 h\u00f3a ch\u1ea5t \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y bao g\u1ed3m: 5- fluorouracil, Capecitabine, TS-1, Cisplatin, Carboplatin, Oxaliplatin, Docetaxel,\u00a0 Paclitaxel, Doxorubicin, Epirubicin, Irinotecan, trifluridine ph\u1ed1i h\u1ee3p tipiracil,..<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2219 <\/span><b><i>\u0110i\u1ec1u tr\u1ecb \u0111\u01a1n h\u00f3a ch\u1ea5t so v\u1edbi \u0111a h\u00f3a ch\u1ea5t\u00a0<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400;\">\u0110\u00e3 c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u1ec3 ph\u00e1t tri\u1ec3n c\u00e1c c\u00f4ng th\u1ee9c ph\u1ed1i h\u1ee3p hi\u1ec7u qu\u1ea3 h\u01a1n cho b\u1ec7nh\u00a0 UTDD di c\u0103n b\u1eb1ng c\u00e1ch k\u1ebft h\u1ee3p c\u00e1c lo\u1ea1i thu\u1ed1c. C\u00e1c th\u1eed nghi\u1ec7m cho th\u1ea5y t\u1ef7 l\u1ec7 \u0111\u00e1p\u00a0 \u1ee9ng cao h\u01a1n v\u1edbi c\u00e1c ph\u00e1c \u0111\u1ed3 \u0111\u01a1n ch\u1ea5t. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng 30%- 50%. C\u00e1c ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p cho th\u1ea5y c\u00e1c ph\u1ed1i h\u1ee3p h\u00f3a tr\u1ecb \u0111em l\u1ea1i l\u1ee3i \u00edch s\u1ed1ng c\u00f2n\u00a0 khi\u00eam t\u1ed1n nh\u01b0ng c\u00f3 \u00fd ngh\u0129a khi so s\u00e1nh v\u1edbi \u0111\u01a1n h\u00f3a tr\u1ecb.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">T\u1eeb k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, ECF, DCF v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 hi\u1ec7n \u0111\u01b0\u1ee3c\u00a0 xem l\u00e0 ph\u00e1c \u0111\u1ed3 chu\u1ea9n trong \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc m\u1ed9t. C\u00e1c d\u1eef li\u1ec7u t\u1eeb th\u1eed nghi\u1ec7m REAL-2\u00a0 g\u1ee3i \u00fd r\u1eb1ng c\u00e1c k\u1ebft qu\u1ea3 l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng khi thay th\u1ebf capecitabine cho 5-FU truy\u1ec1n, v\u00e0\u00a0 thay th\u1ebf oxaliplatin cho cisplatin trong ph\u00e1c \u0111\u1ed3 ECF.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">C\u00f3 5 nh\u00f3m t\u00e1c nh\u00e2n h\u00f3a ch\u1ea5t c\u00f3 ho\u1ea1t t\u00ednh trong UTDD v\u1edbi t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng l\u00e0 10-25%,\u00a0 th\u1eddi gian \u0111\u00e1p \u1ee9ng trung b\u00ecnh t\u01b0\u01a1ng \u0111\u1ed1i ng\u1eafn bao g\u1ed3m fluorouracil, cisplatin,\u00a0 docetaxel v\u00e0 \u00edt s\u1eed d\u1ee5ng h\u01a1n l\u00e0 paclitaxel, epirubicin v\u00e0 irinotecan l\u00e0 c\u00e1c th\u00e0nh ph\u1ea7n\u00a0 ch\u00ednh trong c\u00e1c ph\u00e1c \u0111\u1ed3. G\u1ea7n \u0111\u00e2y th\u00ec oxaliplatin v\u00e0 capecitabine c\u0169ng \u0111\u01b0\u1ee3c d\u00f9ng\u00a0 nhi\u1ec1u trong \u0111i\u1ec1u tr\u1ecb \u0111a h\u00f3a ch\u1ea5t.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2219 <\/span><b><i>C\u00e1c ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p\u00a0<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <\/span><b><i>Cisplatin-Fluoropyrimidine (CF): <\/i><\/b><span style=\"font-weight: 400;\">l\u00e0 m\u1ed9t trong nh\u1eefng ph\u00e1c \u0111\u1ed3 \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng\u00a0 r\u1ed9ng r\u00e3i.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Cisplatin k\u1ebft h\u1ee3p v\u1edbi c\u00e1c fluoropyrimidine d\u1ea1ng u\u1ed1ng &#8211; do m\u1ed1i nguy c\u01a1 ti\u1ec1m n\u0103ng <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">v\u00e0 s\u1ef1 b\u1ea5t ti\u1ec7n khi d\u00f9ng 5-FU truy\u1ec1n li\u00ean t\u1ee5c. C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 n\u1ed7 l\u1ef1c thay th\u1ebf <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">b\u1eb1ng c\u00e1c d\u1eabn xu\u1ea5t fluoropyrimidine \u0111\u01b0\u1eddng u\u1ed1ng nh\u01b0 uracil-ftorafur (UFT), <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">capecitabine v\u00e0 TS-1.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <\/span><b><i>Docetaxel, Cisplatin v\u00e0 Fluoropyrimidine (DCF): <\/i><\/b><span style=\"font-weight: 400;\">k\u1ebft qu\u1ea3 c\u1ee7a th\u1eed nghi\u1ec7m ng\u1eabu\u00a0 nhi\u00ean so s\u00e1nh ph\u1ed1i h\u1ee3p DCF v\u1edbi CF (th\u1eed nghi\u1ec7m TAX325) cho th\u1ea5y ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p 3 thu\u1ed1c c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n m\u1eb7c d\u00f9 \u0111\u1ed9c t\u00ednh t\u01b0\u01a1ng \u1ee9ng c\u0169ng t\u0103ng \u0111\u00e1ng k\u1ec3.\u00a0 Tuy nhi\u00ean, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong do \u0111i\u1ec1u tr\u1ecb.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <\/span><b><i>Docetaxel k\u1ebft h\u1ee3p capecitabine &#8211; <\/i><\/b><span style=\"font-weight: 400;\">cho t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng trong kho\u1ea3ng 39-46%. Th\u1eddi\u00a0 gian b\u1ec7nh kh\u00f4ng ti\u1ebfn tri\u1ec3n trung b\u00ecnh l\u00e0 4,2-6,1 th\u00e1ng, th\u1eddi gian s\u1ed1ng th\u00eam to\u00e0n\u00a0 b\u1ed9 trung b\u00ecnh l\u00e0 8,4-15,8 th\u00e1ng.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <\/span><b><i>Irinotecan v\u1edbi Fluoropyrimidine-Leucovorin (FOLFIRI): <\/i><\/b><span style=\"font-weight: 400;\">M\u1ed9t th\u1eed nghi\u1ec7m\u00a0 phase III \u0111\u00e3 so s\u00e1nh IF (irinotecan-fluorouracil) v\u00e0 CF cho th\u1ea5y hi\u1ec7u qu\u1ea3 kh\u00f4ng\u00a0 k\u00e9m h\u01a1n. Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t trong t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng to\u00e0n b\u1ed9 (31,8% v\u1edbi IF v\u00e0\u00a0 25,8% v\u1edbi CF), th\u1eddi gian t\u1edbi khi b\u1ec7nh ti\u1ebfn tri\u1ec3n (5 th\u00e1ng v\u1edbi IF v\u00e0 4,2 th\u00e1ng v\u1edbi\u00a0 CF) c\u0169ng nh\u01b0 th\u1eddi gian s\u1ed1ng to\u00e0n b\u1ed9 (9 th\u00e1ng v\u1edbi IF v\u00e0 8,7 th\u00e1ng v\u1edbi CF). \u0110\u1ed9c\u00a0 t\u00ednh \u1edf nh\u00f3m IF th\u1ea5p h\u01a1n, \u0111\u1eb7c bi\u1ec7t t\u1ef7 l\u1ec7 s\u1ed1t h\u1ea1 b\u1ea1ch c\u1ea7u. K\u1ebft lu\u1eadn \u0111\u01b0\u1ee3c \u0111\u01b0a ra l\u00e0\u00a0 IF kh\u00f4ng k\u00e9m h\u01a1n CF m\u00e0 c\u00f3 v\u1ebb \u00edt \u0111\u1ed9c t\u00ednh h\u01a1n.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <\/span><b><i>Epirubicin, Cisplatin, v\u00e0 Fluoropyrimidine (ECF): <\/i><\/b><span style=\"font-weight: 400;\">ph\u00e1c \u0111\u1ed3 3 thu\u1ed1c epirubicin,\u00a0 cisplatin v\u00e0 fluorouracil (ECF) \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u. Hai th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean\u00a0 phase III \u0111\u00e3 so s\u00e1nh ECF v\u1edbi m\u1ed9t ph\u1ed1i h\u1ee3p kh\u00f4ng c\u00f3 cisplatin (FAMTX) hay\u00a0 kh\u00f4ng c\u00f3 anthracycline (MCF). Trong nghi\u00ean c\u1ee9u \u0111\u1ea7u ti\u00ean, ECF hi\u1ec7u qu\u1ea3 h\u01a1n\u00a0 FAMTX c\u1ea3 v\u1ec1 t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng v\u00e0 th\u1eddi gian s\u1ed1ng trung b\u00ecnh (8,7 th\u00e1ng so v\u1edbi 6,1\u00a0 th\u00e1ng). Th\u1eed nghi\u1ec7m th\u1ee9 hai so s\u00e1nh ECF v\u1edbi MCF \u1edf 574 ng\u01b0\u1eddi b\u1ec7nh, t\u1ef7 l\u1ec7 \u0111\u00e1p\u00a0 \u1ee9ng to\u00e0n b\u1ed9 l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng \u1edf 2 nh\u00f3m nh\u01b0ng th\u1eddi gian s\u1ed1ng trung b\u00ecnh \u1edf nh\u00f3m ECF cao h\u01a1n \u0111\u00f4i ch\u00fat (9,4 so v\u1edbi 8,7 th\u00e1ng), \u0111\u1ed9c t\u00ednh dung n\u1ea1p \u0111\u01b0\u1ee3c d\u00f9 \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng g\u1eb7p nhi\u1ec1u h\u01a1n \u1edf nh\u00f3m MCF.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <\/span><b><i>Cisplatin v\u00e0 Irinotecan (IC): <\/i><\/b><span style=\"font-weight: 400;\">trong m\u1ed9t th\u1eed nghi\u1ec7m phase II, t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng \u0111\u1ea1t\u00a0 \u0111\u01b0\u1ee3c kh\u00e1 v\u00e0 \u0111\u1ed9c t\u00ednh dung n\u1ea1p \u0111\u01b0\u1ee3c.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <\/span><b><i>Ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p Oxaliplatin: <\/i><\/b><span style=\"font-weight: 400;\">m\u1ed9t s\u1ed1 ch\u1ebf \u0111\u1ed9 ph\u1ed1i h\u1ee3p kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c\u00a0 nghi\u00ean c\u1ee9u bao g\u1ed3m FOLFOX, EOF, XELOX [CAPOX], TS-1 v\u1edbi oxaliplatin.\u00a0 T\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng trong kho\u1ea3ng t\u1eeb 40%-67%, th\u1eddi gian s\u1ed1ng trung b\u00ecnh t\u1eeb 8-15\u00a0 th\u00e1ng.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; <\/span><b><i>Ph\u00e1c \u0111\u1ed3 c\u00f3 TS-1: <\/i><\/b><span style=\"font-weight: 400;\">k\u1ebft h\u1ee3p TS-1 v\u1edbi irinotecan cho \u0111\u00e1p \u1ee9ng to\u00e0n b\u1ed9 l\u00e0 47,7% v\u00e0\u00a0 v\u1edbi nh\u00f3m ch\u01b0a \u0111\u01b0\u1ee3c h\u00f3a tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 l\u00e0 59%. Trung v\u1ecb s\u1ed1ng th\u00eam to\u00e0n b\u1ed9 l\u00e0 272\u00a0 ng\u00e0y v\u00e0 v\u1edbi nh\u00f3m h\u00f3a tr\u1ecb l\u1ea7n \u0111\u1ea7u l\u00e0 322 ng\u00e0y. K\u1ebft h\u1ee3p TS-1 v\u1edbi Docetaxel cho\u00a0 \u0111\u00e1p \u1ee9ng to\u00e0n b\u1ed9 v\u00e0 trung v\u1ecb s\u1ed1ng th\u00eam t\u0103ng l\u00ean.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0Ph\u00e1c \u0111\u1ed3 TS-1 k\u1ebft h\u1ee3p Cisplatin ch\u1ec9 \u0111\u1ecbnh cho UTDD ti\u1ebfn xa, di c\u0103n.<\/span><\/p>\n<h4><span style=\"font-weight: 400;\">1.3.3. \u0110i\u1ec1u tr\u1ecb sinh h\u1ecdc\u00a0<\/span><\/h4>\n<p><i><span style=\"font-weight: 400;\">Y\u1ebfu t\u1ed1 c\u00f3 \u0111\u00edch l\u00e0 EGFR: <\/span><\/i><span style=\"font-weight: 400;\">kho\u1ea3ng 25% UT d\u1ea1 d\u00e0y giai \u0111o\u1ea1n mu\u1ed9n c\u00f3 b\u1ed9c l\u1ed9 y\u1ebfu t\u1ed1\u00a0 <\/span><span style=\"font-weight: 400;\">ph\u00e1t tri\u1ec3n bi\u1ec3u m\u00f4 lo\u1ea1i t\u00fdp II EGFR (Her 2\/neu), c\u00f3 t\u1ef7 l\u1ec7 t\u01b0\u01a1ng t\u1ef1 trong UT v\u00fa, hay <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">x\u1ea3y ra \u1edf t\u00fdp ru\u1ed9t h\u01a1n t\u00fdp lan t\u1ecfa. <\/span><i><span style=\"font-weight: 400;\">Trastuzumab: <\/span><\/i><span style=\"font-weight: 400;\">l\u00e0 m\u1ed9t kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng t\u00e1i t\u1ed5 <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">h\u1ee3p ADN g\u1eafn ch\u1ecdn l\u1ecdc c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb ng\u01b0\u1eddi, t\u00e1c \u0111\u1ed9ng ch\u1ecdn l\u1ecdc l\u00ean ngo\u1ea1i b\u00e0o th\u1ee5 <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">th\u1ec3 2 c\u1ee7a y\u1ebfu t\u1ed1 ph\u00e1t tri\u1ec3n bi\u1ec3u m\u00f4 ng\u01b0\u1eddi (HER2). \u1ee8c ch\u1ebf s\u1ef1 t\u0103ng sinh c\u00e1c t\u1ebf b\u00e0o <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">kh\u1ed1i u ng\u01b0\u1eddi c\u00f3 bi\u1ec3u hi\u1ec7n qu\u00e1 m\u1ee9c HER2. Thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong ung th\u01b0 d\u1ea1 <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">d\u00e0y lo\u1ea1i bi\u1ec3u m\u00f4 tuy\u1ebfn giai \u0111o\u1ea1n di c\u0103n xa ho\u1eb7c ti\u1ebfn tri\u1ec3n t\u1ea1i v\u00f9ng kh\u00f4ng ph\u1eabu thu\u1eadt <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">\u0111\u01b0\u1ee3c; t\u00e1i ph\u00e1t v\u00e0 HER2 (+++) tr\u00ean ph\u01b0\u01a1ng ph\u00e1p nhu\u1ed9m h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch (IHC: <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">Immunohistochemistry) ho\u1eb7c HER2 (++) tr\u00ean IHC nh\u01b0ng d\u01b0\u01a1ng t\u00ednh (+) tr\u00ean <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">ph\u01b0\u01a1ng ph\u00e1p lai hu\u1ef3nh quang t\u1ea1i ch\u1ed7 (FISH: Fluorescence In Situ Hybridization).<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400;\">Y\u1ebfu t\u1ed1 c\u00f3 \u0111\u00edch l\u00e0 VEGF: <\/span><\/i><span style=\"font-weight: 400;\">vi\u1ec7c t\u0103ng y\u1ebfu t\u1ed1 ph\u00e1t tri\u1ec3n n\u1ed9i m\u1ea1ch m\u00e1u li\u00ean quan \u0111\u1ebfn\u00a0 <\/span><span style=\"font-weight: 400;\">ti\u00ean l\u01b0\u1ee3ng x\u1ea5u trong UT d\u1ea1 d\u00e0y giai \u0111o\u1ea1n c\u00f3 th\u1ec3 m\u1ed5 \u0111\u01b0\u1ee3c, b\u1edfi v\u00ec khi y\u1ebfu t\u1ed1 ph\u00e1t <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">tri\u1ec3n n\u1ed9i m\u1ea1ch t\u0103ng l\u00ean, th\u00ec nhi\u1ec1u m\u1ea1ch m\u00e1u t\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh, do v\u1eady u s\u1ebd <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">ph\u00e1t tri\u1ec3n nhanh h\u01a1n, m\u1ea1nh h\u01a1n. <\/span><i><span style=\"font-weight: 400;\">Ramucirumab <\/span><\/i><span style=\"font-weight: 400;\">l\u00e0 m\u1ed9t kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng t\u00e1i t\u1ed5 <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">h\u1ee3p c\u1ee7a l\u1edbp IgG1 g\u1eafn v\u1edbi c\u00e1c VEGFR-2, ng\u0103n ch\u1eb7n k\u00edch ho\u1ea1t th\u1ee5 th\u1ec3. Thu\u1ed1c \u0111\u01b0\u1ee3c <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng \u0111\u01a1n tr\u1ecb li\u1ec7u ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi paclitaxel b\u01b0\u1edbc hai ung th\u01b0 d\u1ea1 d\u00e0y <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">lo\u1ea1i bi\u1ec3u m\u00f4 tuy\u1ebfn giai \u0111o\u1ea1n di c\u0103n xa, ti\u1ebfn tri\u1ec3n t\u1ea1i v\u00f9ng kh\u00f4ng ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">ho\u1eb7c th\u1ea5t b\u1ea1i sau m\u1ed9t ph\u00e1c \u0111\u1ed3 c\u00f3 5-FU ho\u1eb7c platin (b\u01b0\u1edbc 2 v\u00e0 c\u00e1c b\u01b0\u1edbc ti\u1ebfp theo).<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400;\">Pembrolizumab: <\/span><\/i><span style=\"font-weight: 400;\">l\u00e0 kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng g\u1eafn tr\u1ef1c ti\u1ebfp v\u00e0o th\u1ee5 th\u1ec3 PD1 v\u00e0 \u0111\u01b0\u1ee3c FDA\u00a0 <\/span><span style=\"font-weight: 400;\">ch\u1ea5p thu\u1eadn trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y, \u0111o\u1ea1n n\u1ed1i d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n v\u00e0 th\u1ef1c qu\u1ea3n <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">giai \u0111o\u1ea1n ti\u1ebfn xa c\u00f3 bi\u1ec3u hi\u1ec7n b\u1ed9c l\u1ed9 MSI cao ho\u1eb7c sai l\u1ea7m s\u1eeda ch\u1eefa gh\u00e9p c\u1eb7p <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">dMMR sau th\u1ea5t b\u1ea1i h\u00f3a tr\u1ecb b\u01b0\u1edbc 1 ho\u1eb7c tr\u01b0\u1eddng h\u1ee3p PD-L1 d\u01b0\u01a1ng t\u00ednh (ch\u1ec9 s\u1ed1 CPS <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">\u22651) trong tr\u01b0\u1eddng h\u1ee3p sau \u00edt nh\u1ea5t 2 li\u1ec7u ph\u00e1p h\u00f3a tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3. <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<h4><span style=\"font-weight: 400;\">1.3.4. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y giai \u0111o\u1ea1n di c\u0103n m\u1ed9t s\u1ed1 v\u1ecb tr\u00ed \u0111\u1eb7c bi\u1ec7t\u00a0<\/span><\/h4>\n<ul>\n<li><span style=\"font-weight: 400;\">Di c\u0103n x\u01b0\u01a1ng: x\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i 30Gy trong 10 bu\u1ed5i ho\u1eb7c 40Gy trong 20 bu\u1ed5i\u00a0 ho\u1eb7c 20Gy trong 5 bu\u1ed5i ho\u1eb7c x\u1ea1 tr\u1ecb chi\u1ebfu trong (P-32, Strontium-89 ho\u1eb7c\u00a0 Samarium-153).<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Di c\u0103n n\u00e3o: x\u1ea1 ph\u1eabu b\u1eb1ng dao gamma li\u1ec1u 16-24Gy n\u1ebfu kh\u00f4ng qu\u00e1 3 t\u1ed5n th\u01b0\u01a1ng,\u00a0 \u0111\u01b0\u1eddng k\u00ednh m\u1ed7i t\u1ed5n th\u01b0\u01a1ng \u22645cm. Ho\u1eb7c x\u1ea1 tr\u1ecb to\u00e0n n\u00e3o 30Gy trong 10 bu\u1ed5i,\u00a0 36Gy trong 20 bu\u1ed5i &#8230;\u00a0<\/span><\/li>\n<\/ul>\n<h4><span style=\"font-weight: 400;\">1.3.5. Dinh d\u01b0\u1ee1ng- ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9:\u00a0<\/span><\/h4>\n<p><b><i><span style=\"font-weight: 400;\">\u2219 <\/span>Dinh d\u01b0\u1ee1ng:<\/i><\/b><b><i>\u00a0<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400;\">Ung th\u01b0 d\u1ea1 d\u00e0y ngo\u00e0i g\u00e2y \u1ea3nh h\u01b0\u1edfng h\u1ea5p thu dinh d\u01b0\u1ee1ng c\u00f2n b\u1ecb ch\u00ednh b\u1ec7nh l\u00fd ung\u00a0 <\/span><span style=\"font-weight: 400;\">th\u01b0 g\u00e2y suy m\u00f2n c\u01a1 th\u1ec3. V\u00ec v\u1eady, v\u1ea5n \u0111\u1ec1 t\u0103ng c\u01b0\u1eddng dinh d\u01b0\u1ee1ng, n\u00e2ng cao th\u1ec3 tr\u1ea1ng <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">ng\u01b0\u1eddi b\u1ec7nh tr\u01b0\u1edbc, sau ph\u1eabu thu\u1eadt v\u00e0 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y b\u1ed5 tr\u1ee3 c\u0169ng nh\u01b0 ch\u0103m <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">s\u00f3c giai \u0111o\u1ea1n mu\u1ed9n l\u00e0 h\u1ebft s\u1ee9c c\u1ea7n thi\u1ebft. C\u1ea7n t\u0103ng c\u01b0\u1eddng ch\u1ebf \u0111\u1ed9 \u0103n gi\u00e0u n\u0103ng l\u01b0\u1ee3ng, <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">b\u1ed5 sung vi ch\u1ea5t qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 c\u1ea3 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch nh\u01b0 truy\u1ec1n c\u00e1c dung <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">d\u1ecbch acid amin, lipid, c\u00e1c ch\u1ebf ph\u1ea9m ch\u1ee9a c\u1ea3 dinh d\u01b0\u1ee1ng v\u00e0 \u0111i\u1ec7n gi\u1ea3i nh\u01b0 c\u00e1c ch\u1ebf <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">ph\u1ea9m t\u00fai 2 ng\u0103n, 3 ng\u0103n: Kabiven, nutriplex, combilipid, \u2026<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400;\">Dinh d\u01b0\u1ee1ng sau ph\u1eabu thu\u1eadt c\u1eaft d\u1ea1 d\u00e0y\u00a0<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400;\">T\u0103ng d\u1ea7n theo t\u1eebng ng\u00e0y \u0111\u01b0\u1ee3c s\u1ed1 l\u01b0\u1ee3ng 2000ml. \u0102n nhi\u1ec1u b\u1eefa, m\u1ed7i b\u1eefa (\u2265 6\u00a0 b\u1eefa, 200-300ml\/b\u1eefa), m\u1ed7i ng\u1ee5m v\u1eeba ph\u1ea3i, 30-50ml \u0111\u1ec3 nu\u1ed1t, \u0103n ch\u1eadm, khi th\u1ea5y no\u00a0 ngh\u1ec9 10 ph\u00fat ti\u1ebfp t\u1ee5c \u0103n cho \u0111\u1ebfn h\u1ebft su\u1ea5t \u0103n (45-60 ph\u00fat\/ b\u1eefa).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Th\u1ee9c \u0103n ch\u1ebf bi\u1ebfn\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">S\u1eefa, s\u00fap l\u1ecfng: 3-5 ng\u00e0y\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">S\u00fap xay: 3-5 ng\u00e0y\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ch\u00e1o h\u1ea1t: 5-7 ng\u00e0y (n\u00ean n\u1ea5u 50gam = n\u1eeda l\u1ea1ng g\u1ea1o + \u2265 50gam th\u1ecbt + rau) N\u1ebfu \u0103n v\u00e0o dung n\u1ea1p t\u1ed1t th\u00ec chuy\u1ec3n d\u1ea7n c\u00e1ch ch\u1ebf bi\u1ebfn t\u1eeb l\u1ecfng sang \u0111\u1eb7c\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u0102n c\u01a1m t\u1eeb ng\u00e0y 21-30 sau ph\u1eabu thu\u1eadt: \u0103n ch\u1eadm, nhai k\u1ef9, n\u1ea5u nh\u1eeb v\u1edbi rau non, rau\u00a0 m\u1ea7m trong 2 th\u00e1ng \u0111\u1ea7u, h\u1ea1n ch\u1ebf ch\u1ea5t x\u01a1 nhi\u1ec1u: m\u0103ng, rau gi\u00e0\u2026\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">N\u00ean b\u1ed5 sung 200ml qu\u1ea3 ch\u00edn\/ ng\u00e0y (xay, b\u1ecf ch\u1ea5t x\u01a1) v\u00e0 s\u1eefa 2 c\u1ed1c \/ ng\u00e0y. L\u01b0\u1ee3ng th\u1ef1c ph\u1ea9m \u0111\u1ee7 \u0111\u1ec3 \u0103n 01 ng\u00e0y \u0111\u1ea3m b\u1ea3o:\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Th\u1ecbt c\u00e1 c\u00e1c lo\u1ea1i (th\u1ecbt, h\u1ea3i s\u1ea3n, \u0111\u1eadu\u2026 thay \u0111\u1ed5i theo b\u1eefa) \u2265 200 &#8211; 300gam\/ng\u00e0y\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Rau (c\u00e1c lo\u1ea1i thay \u0111\u1ed5i) \u2265 200 gam\/ng\u00e0y\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">G\u1ea1o \u2265 150-200 gam\/ng\u00e0y\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">D\u1ea7u \u0103n \u2265 10-20 gam\/ng\u00e0y\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">S\u1eefa 500ml\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">H\u1ea1n ch\u1ebf c\u00e1c ch\u1ea5t k\u00edch th\u00edch: r\u01b0\u1ee3u, bia, thu\u1ed1c l\u00e1, cafe..\u00a0\u00a0<\/span><\/p>\n<p><b><i><span style=\"font-weight: 400;\">\u2219 <\/span>Ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9:<\/i><\/b><b><i>\u00a0<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400;\">M\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng c\u00e1c ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng c\u00f2n ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb\u00a0 <\/span><span style=\"font-weight: 400;\">b\u1eb1ng ph\u1eabu thu\u1eadt, x\u1ea1 tr\u1ecb hay h\u00f3a tr\u1ecb, h\u1ea1n ch\u1ebf v\u00e0 ki\u1ec3m so\u00e1t t\u1ed1t c\u00e1c nh\u1eefng tri\u1ec7u ch\u1ee9ng <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">g\u00e2y kh\u00f3 ch\u1ecbu, \u0111au \u0111\u1edbn cho ng\u01b0\u1eddi b\u1ec7nh. B\u1eb1ng c\u00e1c bi\u1ec7n ph\u00e1p \u0111\u01a1n gi\u1ea3n, d\u1ec5 th\u1ef1c hi\u1ec7n \u1edf <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">c\u00e1c c\u01a1 s\u1edf y t\u1ebf kh\u00e1c nhau nh\u01b0 d\u00f9ng thu\u1ed1c l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng, d\u00f9ng c\u00e1c thu\u1ed1c <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">ch\u1ed1ng h\u1ee7y x\u01b0\u01a1ng khi c\u00f3 di c\u0103n x\u01b0\u01a1ng, ch\u1ecdc h\u00fat d\u1ecbch \u1ed5 b\u1ee5ng, d\u1ecbch m\u00e0ng ph\u1ed5i\u2026<\/span><\/p>\n<figure id=\"attachment_19088\" aria-describedby=\"caption-attachment-19088\" style=\"width: 273px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-19088 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/so-do-dieu-tri-ung-thu-dd-273x300.png\" alt=\"S\u01a1 \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y\" width=\"273\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/so-do-dieu-tri-ung-thu-dd-273x300.png 273w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/so-do-dieu-tri-ung-thu-dd.png 619w\" sizes=\"(max-width: 273px) 100vw, 273px\" \/><figcaption id=\"caption-attachment-19088\" class=\"wp-caption-text\">S\u01a1 \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y<\/figcaption><\/figure>\n<h2><b>2. THEO D\u00d5I V\u00c0 TI\u00caN L\u01af\u1ee2NG\u00a0<\/b><\/h2>\n<h3><b>2.1. Theo d\u00f5i\u00a0<\/b><\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\">Kh\u00e1m l\u00e2m s\u00e0ng 3-6 th\u00e1ng\/l\u1ea7n trong 2 n\u0103m \u0111\u1ea7u, 6 th\u00e1ng\/l\u1ea7n trong 3 n\u0103m ti\u1ebfp\u00a0 theo. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00e1c (ngu\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 cao, c\u00f3 t\u1ed5n th\u01b0\u01a1ng\u00a0 theo d\u00f5i\u2026) c\u00f3 th\u1ec3 theo d\u00f5i \u0111\u1ecbnh k\u00ec s\u00e1t h\u01a1n 2 th\u00e1ng\/l\u1ea7n.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">X\u00e9t nghi\u1ec7m CEA, CA 72-4, CA 19-9: 3-6 th\u00e1ng\/l\u1ea7n trong 2 n\u0103m \u0111\u1ea7u, 6\u00a0 th\u00e1ng\/l\u1ea7n trong 3-5 n\u0103m.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh (CT, si\u00eau \u00e2m, XQ) ng\u1ef1c\/b\u1ee5ng 3-6 th\u00e1ng\/l\u1ea7n trong 2 n\u0103m\u00a0 \u0111\u1ea7u, 6-12 th\u00e1ng\/l\u1ea7n \u0111\u1ebfn 5 n\u0103m.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ch\u1ee5p PET\/CT: khi nghi ng\u1edd t\u00e1i ph\u00e1t ho\u1eb7c di c\u0103n ho\u1eb7c CEA ho\u1eb7c CA 72-4 ho\u1eb7c\u00a0 CA 19-9 t\u0103ng.\u00a0\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">N\u1ed9i soi d\u1ea1 d\u00e0y 6-12 th\u00e1ng\/l\u1ea7n\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<h3><b>2.2. Ti\u00ean l\u01b0\u1ee3ng\u00a0<\/b><\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\">Th\u1eddi gian s\u1ed1ng th\u00eam 5 n\u0103m t\u1eeb 20-25%.\u00a0\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">C\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh bao g\u1ed3m \u0111\u1ed9 x\u00e2m l\u1ea5n u, di c\u0103n h\u1ea1ch v\u00e0 giai \u0111o\u1ea1n\u00a0 b\u1ec7nh.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 kh\u00e1c c\u0169ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng nh\u01b0: th\u1ec3 gi\u1ea3i ph\u1eabu b\u1ec7nh, \u0111\u1ed9 m\u00f4 h\u1ecdc&#8230;<\/span><\/li>\n<\/ul>\n<p><a class=\"link-in-body\" href=\"https:\/\/www.vinmec.com\/\"><b class=\"link-in-body\">B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/b><\/a>\u00a0\u0111\u00e3 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb g\u00e2y m\u00ea ph\u1eabu thu\u1eadt hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n, g\u00e2y m\u00ea v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn d\u1ea1 d\u00e0y, ti\u00eau h\u00f3a. \u0110\u1ec3 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ea1i vi\u1ec7n, Qu\u00fd kh\u00e1ch vui l\u00f2ng b\u1ea5m s\u1ed1 <a class=\"contact-button link-in-body\" href=\"https:\/\/www.vinmec.com\/vi\/tieu-hoa-gan-mat\/thong-tin-suc-khoe\/chi-dinh-cat-toan-bo-da-day\/?link_type=related_posts#\"><b class=\"link-in-body\">HOTLINE<\/b><\/a>\u00a0ho\u1eb7c \u0111\u1eb7t l\u1ecbch tr\u1ef1c ti\u1ebfp\u00a0<a class=\"appointment-button link-in-body\" href=\"https:\/\/www.vinmec.com\/vi\/tieu-hoa-gan-mat\/thong-tin-suc-khoe\/chi-dinh-cat-toan-bo-da-day\/?link_type=related_posts#\"><b class=\"link-in-body\">T\u1ea0I \u0110\u00c2Y<\/b><\/a>. T\u1ea3i v\u00e0 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ef1 \u0111\u1ed9ng tr\u00ean\u00a0<a class=\"link-in-body\" href=\"https:\/\/www.vinmec.com\/myvinmec\/\" target=\"_blank\" rel=\"noopener\">\u1ee9ng d\u1ee5ng MyVinmec<\/a>\u00a0\u0111\u1ec3 qu\u1ea3n l\u00fd, theo d\u00f5i l\u1ecbch v\u00e0 \u0111\u1eb7t h\u1eb9n m\u1ecdi l\u00fac m\u1ecdi n\u01a1i ngay tr\u00ean \u1ee9ng d\u1ee5ng.<\/p>\n<p>Ngu\u1ed3n: B\u1ed9 Y t\u1ebf. H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ung th\u01b0 d\u1ea1 d\u00e0y (UTDD) l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh ung th\u01b0 (UT) ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean\u00a0 th\u1ebf gi\u1edbi. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y tu\u1ef3 theo giai \u0111o\u1ea1n kh\u1ed1i u v\u00e0 c\u00e1c t\u00ednh ch\u1ea5t k\u00e8m theo.\u00a0 1. \u0110I\u1ec0U TR\u1eca 1.1. Nguy\u00ean t\u1eafc chung Ph\u1eabu thu\u1eadt l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng v\u00e0 [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y theo B\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y nh\u1eb1m m\u1ee5c \u0111\u00edch c\u1eaft tr\u1ecdn kh\u1ed1i u trong c\u00e1c giai \u0111o\u1ea1n c\u00f3 th\u1ec3 c\u1eaft \u0111\u01b0\u1ee3c, \u0111\u1ed3ng th\u1eddi k\u1ebft h\u1ee3p ho\u00e1 x\u1ea1 tr\u1ecb, li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y theo B\u1ed9 Y t\u1ebf - 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