{"id":19113,"date":"2023-04-16T18:23:03","date_gmt":"2023-04-16T11:23:03","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19113"},"modified":"2023-04-17T12:02:33","modified_gmt":"2023-04-17T05:02:33","slug":"ung-thu-dai-truc-trang-chan-doan-theo-huong-dan-cua-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/ung-thu-dai-truc-trang-chan-doan-theo-huong-dan-cua-bo-y-te\/","title":{"rendered":"Ung th\u01b0 \u0111\u1ea1i – tr\u1ef1c tr\u00e0ng: Ch\u1ea9n \u0111o\u00e1n theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

Ung th\u01b0 \u0111\u1ea1i – tr\u1ef1c tr\u00e0ng l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh ung th\u01b0 ph\u1ed5 bi\u1ebfn tr\u00ean th\u1ebf gi\u1edbi. Theo th\u1ed1ng k\u00ea n\u0103m 2012 c\u1ee7a Globocan, ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u0111\u1ee9ng th\u1ee9 3 v\u1ec1 t\u1ef7 l\u1ec7 m\u1eafc (10%) v\u00e0 th\u1ee9 4 v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong (8,5%) do ung th\u01b0.\u00a0Ch\u1ea9n \u0111o\u00e1n ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh quan tr\u1ecdng trong vi\u1ec7c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng.<\/strong><\/p>\n

\"Ung
Ung th\u01b0 \u0111\u1ea1i – tr\u1ef1c tr\u00e0ng l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh ung th\u01b0 ph\u1ed5 bi\u1ebfn tr\u00ean th\u1ebf gi\u1edbi.<\/figcaption><\/figure>\n

1. L\u00e2m s\u00e0ng c\u1ee7a ung th\u01b0 \u0111\u1ea1i – tr\u1ef1c tr\u00e0ng<\/strong><\/h2>\n

1.1. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/h3>\n

– R\u1ed1i lo\u1ea1n l\u01b0u th\u00f4ng ru\u1ed9t, t\u00e1o b\u00f3n ho\u1eb7c \u1ec9a ch\u1ea3y.<\/p>\n

– \u0110i ngo\u00e0i ra nh\u1ea7y m\u00e1u l\u00e0 tri\u1ec7u ch\u1ee9ng hay g\u1eb7p nh\u1ea5t.<\/p>\n

– \u0110au b\u1ee5ng: u \u0111\u1ea1i tr\u00e0ng ph\u1ea3i \u0111au ki\u1ec3u Koernig, u d\u1ea1i tr\u00e0ng tr\u00e1i \u0111au ki\u1ec3u t\u1eafc ru\u1ed9t, u \u0111\u1ea1i tr\u00e0ng sigma \u0111au h\u1ea1 v\u1ecb k\u00e8m \u0111i ngo\u00e0i nhi\u1ec1u l\u1ea7n.<\/p>\n

– Bi\u1ebfn ch\u1ee9ng c\u1ee7a u nh\u01b0 b\u00e1n t\u1eafc, t\u1eafc ru\u1ed9t, th\u1ee7ng u g\u00e2y vi\u00eam ph\u00fac m\u1ea1c.<\/p>\n

– M\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng do di c\u0103n xa: t\u1ef1 s\u1edd\u00a0th\u1ea5y h\u1ea1ch th\u01b0\u1ee3ng \u0111\u00f2n, ch\u01b0\u1edbng b\u1ee5ng.<\/p>\n

1.2. Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/h3>\n

– Kh\u00e1m b\u1ee5ng: c\u00f3 th\u1ec3 s\u1edd\u00a0th\u1ea5y u qua th\u00e0nh b\u1ee5ng ho\u1eb7c qua th\u0103m kh\u00e1m tr\u1ef1c tr\u00e0ng n\u1ebfu u \u1edf tr\u1ef1c tr\u00e0ng, \u1ed1ng h\u1eadu m\u00f4n. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u1ef1 s\u1edd\u00a0th\u1ea5y u.<\/p>\n

– Th\u0103m tr\u1ef1c tr\u00e0ng: c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n kh\u1ed1i u \u1edf tr\u1ef1c tr\u00e0ng th\u1ea5p v\u00e0 tr\u1ef1c tr\u00e0ng gi\u1eefa.<\/p>\n

– Kh\u00e1m to\u00e0n th\u00e2n \u0111\u1ec3 ph\u00e1t hi\u1ec7n di c\u0103n gan, h\u1ea1ch ngo\u1ea1i vi, d\u1ecbch c\u1ed5 tr\u01b0\u1edbng, di c\u0103n bu\u1ed3ng tr\u1ee9ng \u1edf ph\u1ee5 n\u1eef, gi\u00fap \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9\u00a0ti\u1ebfn tri\u1ec3n b\u1ec7nh.<\/p>\n

1.3. Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n<\/h3>\n

– H\u1ea1ch th\u01b0\u1ee3ng \u0111\u00f2n (th\u01b0\u1eddng g\u1eb7p b\u00ean tr\u00e1i)<\/p>\n

– Thi\u1ebfu m\u00e1u<\/p>\n

– G\u1ea7y s\u00fat: ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 g\u1ea7y s\u00fat 5-10kg\u00a0trong v\u00f2ng 2-4 th\u00e1ng.<\/p>\n

– Suy nh\u01b0\u1ee3c: b\u1ec7nh ti\u1ebfn tri\u1ec3n l\u00e2u l\u00e0m suy m\u00f2n.<\/p>\n

2. C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h2>\n

2.1. N\u1ed9i soi<\/h3>\n

Soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u1ed1ng m\u1ec1m l\u00e0 ph\u01b0\u01a1ng ph\u00e1p quan tr\u1ecdng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, cho bi\u1ebft v\u1ecb tr\u00ed, \u0111\u1eb7c \u0111i\u1ec3m kh\u1ed1i u v\u00e0 b\u1ea9m sinh thi\u1ebft.<\/p>\n

2.2. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/h3>\n

– Ch\u1ee5p X-quang ch\u1ee5p b\u1ee5ng kh\u00f4ng chu\u1ea9n b\u1ecb: \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u1ea5p c\u1ee9u ho\u1eb7c khi c\u00f3 bi\u1ebfn ch\u1ee9ng t\u1eafc ru\u1ed9t ho\u1eb7c th\u1ee7ng ru\u1ed9t.<\/p>\n

– Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh: \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng u \u0111\u1ea1i tr\u1ef1c tr\u00e0ng v\u00e0 di c\u0103n xa. Vai tr\u00f2 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 si\u00eau \u00e2m nh\u01b0ng \u0111\u1ed9 nh\u1ea1y cao h\u01a1n.<\/p>\n

– Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb: c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng trong ch\u1ea9n \u0111o\u00e1n di c\u0103n gan v\u00e0 \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng t\u1ea1i ch\u1ed7.<\/p>\n

– Si\u00eau \u00e2m: \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng t\u1ea1i gan v\u00e0 to\u00e0n b\u1ed9 \u1ed5 b\u1ee5ng, tuy nhi\u00ean \u0111\u1ed9 nh\u1ea1y kh\u00f4ng b\u1eb1ng ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh. Si\u00eau \u00e2m qua n\u1ed9i tr\u1ef1c tr\u00e0ng: l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p c\u00f3 gi\u00e1 tr\u1ecb \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c x\u00e2m l\u1ea5n ung th\u01b0 tr\u1ef1c tr\u00e0ng v\u00e0 di c\u0103n h\u1ea1ch m\u1ea1c treo tr\u1ef1c tr\u00e0ng.<\/p>\n

2.3. Y h\u1ecdc h\u1ea1t nh\u00e2n<\/h3>\n

– Ch\u1ee5p h\u00ecnh ph\u00f3ng x\u1ea1 kh\u1ed1i u \u0111\u1eb7c hi\u1ec7u (ch\u1ee5p h\u00ecnh mi\u1ec5n d\u1ecbch ph\u00f3ng x\u1ea1- Radioimmunoscintigraphy: RIS). S\u1eed d\u1ee5ng c\u00e1c kh\u00e1ng th\u1ec3\u00a0\u0111\u01a1n d\u00f2ng \u0111\u00e1nh d\u1ea5u ph\u00f3ng x\u1ea1 ch\u1ee5p SPECT gi\u00fap ph\u00e1t hi\u1ec7n u nguy\u00ean ph\u00e1t v\u00e0 t\u1ed5n th\u01b0\u01a1ng di c\u0103n.<\/p>\n

– Ch\u1ee5p h\u00ecnh kh\u1ed1i u theo nguy\u00ean t\u1eafc chuy\u1ec3n h\u00f3a (PET, PET\/CT, PET\/MRI) v\u1edbi F18-FDG ph\u00e1t hi\u1ec7n u nguy\u00ean ph\u00e1t, di c\u0103n h\u1ea1ch, di c\u0103n xa, gi\u00fap \u0111\u00e1nh gi\u00e1\u00a0ch\u00ednh x\u00e1c giai \u0111o\u1ea1n b\u1ec7nh, m\u00f4 ph\u1ecfng l\u1eadp k\u1ebf ho\u1ea1ch x\u1ea1 tr\u1ecb (v\u1edbi ung th\u01b0 tr\u1ef1c tr\u00e0ng).<\/p>\n

– Ch\u1ee5p x\u1ea1 h\u00ecnh, SPECT x\u01b0\u01a1ng v\u1edbi Tc99m-MDP gi\u00fap ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng di c\u0103n x\u01b0\u01a1ng<\/p>\n

– Ch\u1ee5p x\u1ea1 h\u00ecnh, SPECT gan v\u1edbi Tc99m-SC gi\u00fap ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng di c\u0103n gan.<\/p>\n

2.4. X\u00e9t nghi\u1ec7m sinh h\u00f3a – huy\u1ebft h\u1ecdc<\/h3>\n

– X\u00e9t nghi\u1ec7m CEA, CA 19-9, ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c \u0111\u1ec3 theo d\u00f5i v\u00e0 ch\u1ea9n \u0111o\u00e1n ung th\u01b0 t\u00e1i ph\u00e1t, di c\u0103n sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– X\u00e9t nghi\u1ec7m huy\u1ebft h\u1ecdc v\u00e0 h\u00f3a sinh m\u00e1u: \u0111\u00e1nh gi\u00e1 to\u00e0n tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

2.5. M\u00f4 b\u1ec7nh h\u1ecdc<\/h3>\n

Ung th\u01b0 \u0111\u1ea1i tr\u00e0ng \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n, \u0111\u00e1nh gi\u00e1 giai \u0111o\u1ea1n m\u00f4 b\u1ec7nh h\u1ecdc bao g\u1ed3m:<\/p>\n

– \u0110\u1ed9 m\u00f4 h\u1ecdc<\/p>\n

– Giai \u0111o\u1ea1n T<\/p>\n

– S\u1ed1\u00a0l\u01b0\u1ee3ng h\u1ea1ch v\u00e9t \u0111\u01b0\u1ee3c v\u00e0 s\u1ed1 h\u1ea1ch d\u01b0\u01a1ng t\u00ednh<\/p>\n

– Di\u1ec7n c\u1eaft tr\u00ean, di\u1ec7n c\u1eaft d\u01b0\u1edbi v\u00e0 di\u1ec7n c\u1eaft xung quanh u<\/p>\n

– S\u1ef1 x\u00e2m l\u1ea5n th\u1ea7n kinh m\u1ea1ch m\u00e1u<\/p>\n

– S\u1ef1 x\u00e2m l\u1ea5n m\u1ea1ch b\u1ea1ch huy\u1ebft<\/p>\n

– Nh\u00e2n ung th\u01b0 m\u1ea1c treo ngo\u00e0i h\u1ea1ch<\/p>\n

– \u0110\u00e1nh gi\u00e1 di c\u0103n h\u1ea1ch<\/p>\n

– S\u1ed1 l\u01b0\u1ee3ng h\u1ea1ch v\u00e9t \u0111\u01b0\u1ee3c t\u1ed1i thi\u1ec3u 12 h\u1ea1ch \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o x\u1ebfp lo\u1ea1i giai \u0111o\u1ea1n ch\u00ednh x\u00e1c.<\/p>\n

– Sinh thi\u1ebft h\u1ea1ch c\u1eeda nh\u1eb1m ph\u00e1t hi\u1ec7n di c\u0103n h\u1ea1ch ch\u00ednh x\u00e1c h\u01a1n nh\u1edd k\u0129 thu\u1eadt h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc.<\/p>\n

– \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111\u1ea1i tr\u00e0ng giai \u0111o\u1ea1n II \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 \u1edf giai \u0111o\u1ea1n n\u00e0y hay kh\u00f4ng c\u1ea7n x\u00e9t nghi\u1ec7m MSI (PCR) ho\u1eb7c MMR (ph\u01b0\u01a1ng ph\u00e1p h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch). V\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y n\u1ebfu dMMR ho\u1eb7c MSI-H c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i khi h\u00f3a tr\u1ecb b\u1ed5 tr\u1ee3 v\u1edbi 5-FU.<\/p>\n

Ph\u00e2n t\u00edch gene:<\/strong>\u00a0\u0110\u1ed1i v\u1edbi ung th\u01b0 \u0111\u1ea1i tr\u00e0ng di c\u0103n, n\u00ean \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m \u0111\u1ed9t bi\u1ebfn gen KRAS, NRAS v\u00e0 BRAF nh\u1eb1m m\u1ee5c \u0111\u00edch ti\u00ean l\u01b0\u1ee3ng v\u00e0 s\u1eed d\u1ee5ng \u0111i\u1ec1u tr\u1ecb \u0111\u00edch.<\/p>\n

a) \u0110\u1ea1i th\u1ec3: Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng c\u00f3 th\u1ec3 c\u00f3 d\u1ea1ng s\u00f9i, th\u00e2m nhi\u1ec5m v\u00e0 lo\u00e9t.\u00a0V\u1ec1 m\u1eb7t \u0111\u1ea1i th\u1ec3 t\u00f9y thu\u1ed9c v\u00e0o 3 t\u00ednh ch\u1ea5t: kh\u1ed1i u, u s\u00f9i, u s\u00f9i lo\u00e9t, v\u00f2ng nh\u1eabn.<\/p>\n

b) Vi th\u1ec3:<\/p>\n

– Nh\u1eefng ung th\u01b0 kh\u00f4ng ph\u1ea3i bi\u1ec3u m\u00f4 (u lympho kh\u00f4ng Hodgkin, u carcinoid, ung th\u01b0 m\u00f4 li\u00ean k\u1ebft) chi\u1ebfm kho\u1ea3ng 5% c\u00e1c ung th\u01b0 m\u00f4 \u0111\u1ea1i tr\u00e0ng.<\/p>\n

– V\u1ec1 m\u1eb7t m\u00f4 h\u1ecdc 80% tr\u01b0\u1eddng h\u1ee3p\u00a0l\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 tuy\u1ebfn typ Liberkhunier, 10-20% l\u00e0\u00a0u d\u1ea1ng nh\u1ea7y.<\/p>\n

– S\u1ef1 x\u00e2m l\u1ea5n c\u1ee7a kh\u1ed1i u th\u00f4ng th\u01b0\u1eddng l\u00e0 theo chi\u1ec1u s\u00e2u c\u1ee7a th\u00e0nh \u0111\u1ea1i tr\u00e0ng r\u1ed3i di c\u0103n \u0111\u1ebfn c\u00e1c chu\u1ed7i h\u1ea1ch b\u1ea1ch huy\u1ebft v\u00e0 sau c\u00f9ng l\u00e0 c\u00e1c c\u01a1 quan l\u00e2n c\u1eadn, ch\u1ee7 y\u1ebfu l\u00e0 gan.<\/p>\n

– Ph\u00e2n \u0111\u1ed9 trong ung th\u01b0 \u0111\u1ea1i – tr\u1ef1c tr\u00e0ng ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o ph\u00e2n \u0111\u1ed9 theo T\u1ed5 ch\u1ee9c Y t\u1ebf th\u1ebf\u00a0gi\u1edbi v\u00e0 American Joint Committee on Cancer (AJCC).<\/p>\n

c) M\u1ee9c \u0111\u1ed9 bi\u1ec7t h\u00f3a c\u1ee7a t\u1ebf b\u00e0o ung th\u01b0 trong ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh grade 1-4.<\/p>\n

– Grade 1: bi\u1ec7t h\u00f3a t\u1ed1t<\/p>\n

– Grade 2: bi\u1ec7t h\u00f3a trung b\u00ecnh<\/p>\n

– Grade 3: bi\u1ec7t h\u00f3a k\u00e9m<\/p>\n

– Grade 4: kh\u00f4ng bi\u1ec7t h\u00f3a<\/p>\n

d) X\u00e9t nghi\u1ec7m gen: KRAS, NRAS, BRAF v\u00e0 MSI.<\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh ung th\u01b0 \u0111\u1ea1i – tr\u1ef1c tr\u00e0ng<\/strong><\/h2>\n

– L\u00e2m s\u00e0ng.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng ph\u00e1t hi\u1ec7n qua n\u1ed9i soi.<\/p>\n

– H\u00ecnh \u1ea3nh h\u1ecdc (si\u00eau \u00e2m, CT, MRI, SPECT, PET\/CT \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 giai \u0111o\u1ea1n).<\/p>\n

– M\u00f4 b\u1ec7nh h\u1ecdc: l\u00e0 ph\u01b0\u01a1ng ph\u00e1p quy\u1ebft \u0111\u1ecbnh nh\u1ea5t \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh b\u1ec7nh ung th\u01b0.<\/p>\n

4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t ung th\u01b0 \u0111\u1ea1i – tr\u1ef1c tr\u00e0ng<\/strong><\/h2>\n

– B\u1ec7nh Crohn<\/p>\n

– Vi\u00eam lo\u00e9t \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n

– Lao manh tr\u00e0ng<\/p>\n

– U lympho bi\u1ec3u hi\u1ec7n \u1edf \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n

– GIST \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n

– M\u1ed9t s\u1ed1 ung th\u01b0 kh\u00e1c x\u00e2m l\u1ea5n \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n

– C\u00e1c kh\u1ed1i u l\u00e0nh c\u1ee7a \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n

–\u00a0Ung th\u01b0 \u1ed1ng h\u1eadu m\u00f4n<\/p>\n

5. Ch\u1ea9n \u0111o\u00e1n giai \u0111o\u1ea1n ung th\u01b0 \u0111\u1ea1i – tr\u1ef1c tr\u00e0ng<\/strong><\/h2>\n

\u0110\u00e1nh gi\u00e1 giai \u0111o\u1ea1n theo h\u1ec7 th\u1ed1ng TNM (Union for International Cancer Control UICC\/AJCC n\u0103m 2010)<\/p>\n

Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng s\u1edbm gi\u00fap gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n