{"id":21854,"date":"2023-04-16T17:46:35","date_gmt":"2023-04-16T10:46:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21854"},"modified":"2023-04-17T14:12:13","modified_gmt":"2023-04-17T07:12:13","slug":"xet-nghiem-can-lam-sang-cua-ung-thu-bieu-mo-te-bao-gan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/xet-nghiem-can-lam-sang-cua-ung-thu-bieu-mo-te-bao-gan\/","title":{"rendered":"X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan"},"content":{"rendered":"<p><strong><a href=\"https:\/\/www.vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/tim-hieu-ve-ung-thu-gan-nguyen-phat\/\">Ung th\u01b0<\/a> bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan l\u00e0 lo\u1ea1i ung th\u01b0 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong li\u00ean quan \u0111\u1ebfn ung th\u01b0 t\u1ea1i Vi\u1ec7t Nam theo \u01b0\u1edbc t\u00ednh c\u1ee7a T\u1ed5 ch\u1ee9c Ghi nh\u1eadn Ung th\u01b0 to\u00e0n c\u1ea7u (GLOBOCAN) n\u0103m 2018. C\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng gi\u00fap ph\u00e1t hi\u1ec7n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan s\u1edbm v\u00e0 h\u1ed7 tr\u1ee3 cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh hi\u1ec7u qu\u1ea3.<\/strong><\/p>\n<figure id=\"attachment_22369\" aria-describedby=\"caption-attachment-22369\" style=\"width: 292px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-22369 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1283030881-612x612-1-292x300.jpg\" alt=\"C\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng gi\u00fap ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan s\u1edbm v\u00e0 h\u1ed7 tr\u1ee3 cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh h i\u1ec7u qu\u1ea3.\" width=\"292\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1283030881-612x612-1-292x300.jpg 292w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1283030881-612x612-1.jpg 596w\" sizes=\"(max-width: 292px) 100vw, 292px\" \/><figcaption id=\"caption-attachment-22369\" class=\"wp-caption-text\">X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng gi\u00fap h\u1ed7 tr\u1ee3 cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan hi\u1ec7u qu\u1ea3.<\/figcaption><\/figure>\n<h2>1. C\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng c\u1ea7n l\u00e0m<\/h2>\n<p>+ C\u00f4ng th\u1ee9c m\u00e1u, ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u to\u00e0n b\u1ed9, \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n<p>+ Ch\u1ee9c n\u0103ng gan th\u1eadn: ALT, AST, Bilirubin, Albumin, Ure, Creatinin m\u00e1u.<\/p>\n<p>+ C\u00e1c x\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch v\u1ec1 virus vi\u00eam gan B, C: HBsAg, AntiHCV<\/p>\n<p>+ Ch\u1ec9 d\u1ea5u sinh h\u1ecdc c\u1ee7a ung th\u01b0 bi\u1ec3u mo t\u1ebf b\u00e0o gan: AFP, AFP-L3, PIVKA II (DCP).<\/p>\n<p>+ C\u00e1c ch\u1ec9 d\u1ea5u ung th\u01b0 kh\u00e1c (n\u1ebfu c\u1ea7n): CEA, CA 19.9, PSA, CA 12.5, \u2026<\/p>\n<p>+ X quang ph\u1ed5i th\u1eb3ng.<\/p>\n<p>+ Si\u00eau \u00e2m Doppler m\u1ea1ch m\u00e1u gan.<\/p>\n<p>+ CT scan b\u1ee5ng c\u00f3 c\u1ea3n quang (v\u00e0 MRI b\u1ee5ng c\u00f3 t\u01b0\u01a1ng ph\u1ea3n t\u1eeb n\u1ebfu c\u1ea7n).<\/p>\n<h2><b>2. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/b><\/h2>\n<h3>2.1. Si\u00eau \u00e2m<\/h3>\n<p><i>a. Si\u00eau \u00e2m 2D v\u00e0 si\u00eau \u00e2m Doppler m\u1ea1ch m\u00e1u gan<\/i><\/p>\n<p>Si\u00eau \u00e2m 2D v\u00e0 si\u00eau \u00e2m Doppler thu\u1eadn ti\u1ec7n v\u00e0 c\u00f3 chi ph\u00ed th\u1ea5p n\u00ean l\u00e0 c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 t\u1ea7m so\u00e1t v\u00e0 theo d\u00f5i \u0111i\u1ec1u tr\u1ecb UTBMTBG, nh\u01b0ng kh\u00f4ng d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n UTBMTBG. Si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 h\u00ecnh d\u1ea1ng, v\u1ecb tr\u00ed, s\u1ed1 l\u01b0\u1ee3ng, k\u00edch th\u01b0\u1edbc kh\u1ed1i u gan, t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd gan n\u1ec1n, t\u00ecnh tr\u1ea1ng d\u1ecbch \u1ed5 b\u1ee5ng v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111i k\u00e8m trong \u1ed5 b\u1ee5ng. Si\u00eau \u00e2m Doppler m\u1ea1ch m\u00e1u gan cho ph\u00e9p \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng c\u1ea5p m\u00e1u c\u1ee7a kh\u1ed1i u, t\u00ecnh tr\u1ea1ng kh\u1ed1i u x\u00e2m l\u1ea5n v\u00e0 di c\u0103n v\u00e0o c\u00e1c m\u1ea1ch m\u00e1u l\u00e2n c\u1eadn, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi.<\/p>\n<p>H\u1ec7 th\u1ed1ng D\u1eef li\u1ec7u v\u00e0 B\u00e1o c\u00e1o h\u00ecnh \u1ea3nh Gan (The Liver Imaging Reporting And Data System &#8211; LI-RADS) khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng si\u00eau \u00e2m kh\u00f4ng ti\u00eam ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n \u0111\u1ec3 t\u1ea7m so\u00e1t v\u00e0 theo d\u00f5i UTBMTBG \u1edf c\u00e1c b\u1ec7nh nh\u00e2n x\u01a1 gan v\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 cao kh\u00e1c.<\/p>\n<p><i>b. Si\u00eau \u00e2m c\u00f3 ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n (contrast-enhanced ultrasound &#8211; CEUS)<\/i><\/p>\n<p>Nh\u1eefng thay \u0111\u1ed5i ch\u00ednh trong qu\u00e1 tr\u00ecnh sinh UTBMTBG bao g\u1ed3m s\u1ef1 h\u00ecnh th\u00e0nh m\u1ea1ch, thay \u0111\u1ed5i t\u1ebf b\u00e0o gan, gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a t\u1ebf b\u00e0o Kupffer, trong \u0111\u00f3 s\u1ef1 thay \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng c\u1ee7a c\u00e1c n\u1ed1t, bao g\u1ed3m t\u0103ng l\u01b0u l\u01b0\u1ee3ng \u0111\u1ed9ng m\u1ea1ch v\u00e0 gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng t\u0129nh m\u1ea1ch c\u1eeda, l\u00e0 thay \u0111\u1ed5i quan tr\u1ecdng nh\u1ea5t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n UTBMTBG. M\u1eadt \u0111\u1ed9 t\u1ebf b\u00e0o Kupffer gi\u1ea3m c\u00f9ng v\u1edbi s\u1ef1 gi\u1ea3m bi\u1ec7t h\u00f3a c\u1ee7a n\u1ed1t x\u01a1 gan. C\u00e1c vi b\u00f3ng kh\u00ed trong CEUS \u0111\u01b0\u1ee3c th\u1ef1c b\u00e0o b\u1edfi c\u00e1c t\u1ebf b\u00e0o Kupffer, n\u00ean h\u00ecnh \u1ea3nh t\u1ebf b\u00e0o Kupffer c\u00f3 th\u1ec3 quan s\u00e1t \u0111\u01b0\u1ee3c, c\u00e1c kh\u1ed1i u \u00e1c t\u00ednh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n bi\u1ec7t v\u1edbi v\u00f9ng gan quanh u do ch\u00fang ch\u1ee9a \u00edt ho\u1eb7c kh\u00f4ng ch\u1ee9a t\u1ebf b\u00e0o Kupffer.<\/p>\n<p>H\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh c\u1ee7a UTBMTBG tr\u00ean CEUS l\u00e0 ng\u1ea5m thu\u1ed1c m\u1ea1nh th\u00ec \u0111\u1ed9ng m\u1ea1ch (arterial phase hyperenhancement &#8211; APHE) v\u00e0 th\u1ea3i thu\u1ed1c nh\u1eb9 sau 60 gi\u00e2y. CEUS c\u00f3 \u0111\u1ed9 nh\u1ea1y cao \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u00ecnh tr\u1ea1ng gi\u1ea3m quang th\u00ec \u0111\u1ed9ng m\u1ea1ch v\u00e0 th\u1ec3 hi\u1ec7n t\u1ed1t h\u01a1n d\u1ea5u hi\u1ec7u \u201cth\u1ea3i thu\u1ed1c\u201d nhanh (di\u1ec5n ra s\u1edbm, t\u1ea1i th\u1eddi \u0111i\u1ec3m 55-60 gi\u00e2y) \u0111\u1ed1i v\u1edbi b\u1ec7nh \u00e1c t\u00ednh kh\u00f4ng ph\u1ea3i UTBMTBG v\u00e0 \u201cth\u1ea3i thu\u1ed1c\u201d r\u1ea5t mu\u1ed9n (sau 60 gi\u00e2y) \u0111\u1ed1i v\u1edbi UTBMTBG. CEUS kh\u00f4ng c\u00f3 b\u1ee9c x\u1ea1 ion h\u00f3a v\u00e0 c\u00e1c ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n c\u1ee7a CEUS kh\u00f4ng g\u00e2y \u0111\u1ed9c cho th\u1eadn.<\/p>\n<p>CEUS c\u00f3 ph\u00e2n \u0111\u1ed9 theo LI-RADS (Ph\u1ee5 l\u1ee5c 1) \u0111\u01b0\u1ee3c Hi\u1ec7p h\u1ed9i Nghi\u00ean c\u1ee9u B\u1ec7nh gan ch\u00e2u \u00c1 Th\u00e1i B\u00ecnh D\u01b0\u01a1ng (APASL) v\u00e0 H\u1ed9i Ung th\u01b0 N\u1ed9i khoa ch\u00e2u \u00c2u (ESMO) khuy\u1ebfn c\u00e1o d\u00f9ng trong ch\u1ea9n \u0111o\u00e1n UTBMTBG nh\u01b0ng ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u1ed3ng thu\u1eadn \u0111\u01b0a v\u00e0o c\u00e1c h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n UTBMTBG kh\u00e1c tr\u00ean th\u1ebf gi\u1edbi do kh\u00f3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt trong gan v\u1edbi UTBMTBG trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p. B\u00ean c\u1ea1nh \u0111\u00f3, v\u1eabn ph\u1ea3i ch\u1ec9 \u0111\u1ecbnh CT v\u00e0\/ho\u1eb7c MRI \u0111\u1ed9ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh giai \u0111o\u1ea1n b\u1ec7nh tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb.<\/p>\n<h3>2.2. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT) v\u00e0 c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI)<\/h3>\n<p>H\u00ecnh \u1ea3nh h\u1ecdc \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n v\u00e0 trong vi\u1ec7c \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb UTBMTBG nh\u1edd v\u00e0o vi\u1ec7c m\u00f4 t\u1ea3 \u0111\u1ea7y \u0111\u1ee7 h\u00ecnh th\u00e1i gan v\u00e0 n\u00eau l\u00ean \u0111\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc t\u01b0\u1edbi m\u00e1u gan. T\u1ed5n th\u01b0\u01a1ng UTBMTBG c\u00f3 s\u1ef1 thay \u0111\u1ed5i \u0111i\u1ec3n h\u00ecnh l\u00e0 t\u0103ng ngu\u1ed3n c\u1ea5p m\u00e1u t\u1eeb \u0111\u1ed9ng m\u1ea1ch v\u00e0 gi\u1ea3m ngu\u1ed3n c\u1ea5p m\u00e1u t\u1eeb t\u0129nh m\u1ea1ch c\u1eeda.<\/p>\n<p>\u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n UTBMTBG, c\u1ea7n c\u00f3 CT \u0111a d\u00e3y \u0111\u1ea7u d\u00f2 ch\u1ee5p \u0111\u1ee7 4 th\u00ec v\u00e0\/ho\u1eb7c MRI \u0111\u1ed9ng c\u00f3 th\u00ec \u0111\u1ed9ng m\u1ea1ch tr\u1ec5, th\u00ec t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 th\u00ec mu\u1ed9n (kho\u1ea3ng 3-5 ph\u00fat sau khi ti\u00eam ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n t\u1eeb). CT \u0111\u1ed9ng v\u00e0 MRI \u0111\u1ed9ng cho ph\u00e9p \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 ph\u00e2n b\u1ed1 m\u1ea1ch m\u00e1u t\u1ea1i kh\u1ed1i u, v\u1edbi h\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh c\u1ee7a UTBMTBG l\u00e0 ng\u1ea5m thu\u1ed1c m\u1ea1nh \u1edf th\u00ec \u0111\u1ed9ng m\u1ea1ch v\u00e0 th\u1ea3i thu\u1ed1c \u1edf th\u00ec t\u0129nh m\u1ea1ch c\u1eeda v\u00e0\/ho\u1eb7c \u1edf th\u00ec mu\u1ed9n.<\/p>\n<p>MRI c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n nh\u1eefng kh\u1ed1i u c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf, nh\u1ea5t l\u00e0 c\u00e1c kh\u1ed1i u &lt; 2cm, d\u1ef1a v\u00e0o s\u1ef1 kh\u1ea3o s\u00e1t tr\u00ean nhi\u1ec1u chu\u1ed7i xung, \u0111\u1eb7c bi\u1ec7t l\u00e0 MRI \u0111\u1ed9ng v\u00e0 chu\u1ed7i xung khu\u1ebfch t\u00e1n r\u1ea5t nh\u1ea1y trong ch\u1ea9n \u0111o\u00e1n. MRI cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t r\u1ea5t t\u1ed1t gi\u1eefa UTBMTBG v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng khu tr\u00fa kh\u00e1c trong gan nh\u01b0 u m\u00e1u, u tuy\u1ebfn (adenoma), t\u0103ng sinh d\u1ea1ng n\u1ed1t khu tr\u00fa (focal nodular hyperplasia-FNH), di c\u0103n gan ho\u1eb7c n\u1ed1t t\u00e2n t\u1ea1o trong x\u01a1 gan. Trong h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n UTBMTBG, MRI \u0111\u1ec1u c\u00f3 \u0111\u1ed9 nh\u1ea1y cao h\u01a1n CT v\u1edbi \u0111\u1ed9 chuy\u00ean bi\u1ec7t t\u1eeb 85% \u0111\u1ebfn 100%, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng nh\u1ecf. C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y khuy\u1ebfn c\u00e1o ch\u1ee5p MRI v\u1edbi ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n t\u1eeb gan-m\u1eadt gadoxetate disodium (Gd-EOB-DTPA-gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid) c\u00f3 \u0111\u1ed9 nh\u1ea1y cao h\u01a1n CT \u0111\u1ed9ng v\u00e0 MRI s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n t\u1eeb kh\u00e1c.<\/p>\n<p>H\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh c\u1ee7a UTBMTBG tr\u00ean CT\/MRI l\u00e0 gi\u1ea3m \u0111\u1eadm \u0111\u1ed9 \u1edf th\u00ec ch\u01b0a ti\u00eam thu\u1ed1c, ng\u1ea5m thu\u1ed1c m\u1ea1nh \u1edf th\u00ec \u0111\u1ed9ng m\u1ea1ch (arterial phase hyperenhancement &#8211; APHE) v\u00e0 th\u1ea3i thu\u1ed1c (wash-out) \u1edf th\u00ec t\u0129nh m\u1ea1ch c\u1eeda hay th\u00ec mu\u1ed9n.<\/p>\n<p>Ngo\u00e0i gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n, CT\/MRI c\u00f2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 theo d\u00f5i v\u00e0 \u0111\u00e1nh gi\u00e1 sau \u0111i\u1ec1u tr\u1ecb UTBMTBG. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ph\u00e2n \u0111\u1ed9 theo LI-RADS (Ph\u1ee5 l\u1ee5c 2 v\u00e0 3) \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>C\u00e1c t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd l\u00e0 UTBMTBG n\u1ebfu c\u00f3 ng\u1ea5m lipiodol t\u1ea1i t\u1ed5n th\u01b0\u01a1ng sau khi l\u00e0m N\u00fat m\u1ea1ch h\u00f3a ch\u1ea5t (TACE) th\u00ec \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 UTBMTBG.<\/p>\n<h3>2.3. PET v\u00e0 PET\/CT<\/h3>\n<p>Ch\u1ec9 c\u00f3 kho\u1ea3ng 40% c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG c\u00f3 h\u1ea5p thu Fluorodeoxyglucose F-18 (<sup>18<\/sup>F) khi ch\u1ee5p PET v\u00e0 PET\/CT, v\u00e0h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG bi\u1ec7t h\u00f3a cao \u0111\u1ec1u cho k\u1ebft qu\u1ea3 \u00e2m t\u00ednh khi ch\u1ee5p PET v\u00e0 PET\/CT. Tuy nhi\u00ean, PET v\u00e0 PET\/CT r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng di c\u0103n ngo\u00e0i gan c\u1ee7a UTBMTBG, nh\u1ea5t l\u00e0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ea5y t\u1ed5n th\u01b0\u01a1ng UTBMTBG m\u1edbi hay ti\u1ebfn tri\u1ec3n t\u1ea1i gan sau khi \u0111i\u1ec1u tr\u1ecb. Ngo\u00e0i ra c\u00f3 th\u1ec3 ch\u1ee5p PET\/CT v\u1edbi <sup>11<\/sup>C-Choline \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng t\u1ea1i gan, ngo\u00e0i gan t\u1ed1t h\u01a1n\u00a0<sup>18<\/sup>F.<\/p>\n<h3>2.4. C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c<\/h3>\n<p>&#8211; X\u1ea1 h\u00ecnh x\u01b0\u01a1ng b\u1eb1ng m\u00e1y SPECT, SPECT\/CT v\u1edbi\u00a0<sup>99m<\/sup>Tc-MDP \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng di c\u0103n x\u01b0\u01a1ng, ch\u1ea9n \u0111o\u00e1n giai \u0111o\u1ea1n b\u1ec7nh tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb, theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, \u0111\u00e1nh gi\u00e1 t\u00e1i ph\u00e1t v\u00e0 di c\u0103n.<\/p>\n<p>&#8211; X\u1ea1 h\u00ecnh th\u1eadn ch\u1ee9c n\u0103ng b\u1eb1ng m\u00e1y SPECT, SPECT\/CT v\u1edbi\u00a0<sup>99m<\/sup>Tc-DTPA \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb v\u00e0 sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>&#8211; X\u1ea1 h\u00ecnh &#8211; SPECT gan v\u1edbi\u00a0<sup>99m<\/sup>Tc-Sulfure Colloid: h\u00ecnh \u1ea3nh kh\u1ed1i cho\u00e1n ch\u1ed7 trong gan, \u00e1p d\u1ee5ng trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p.<\/p>\n<p>&#8211; X\u1ea1 h\u00ecnh gan m\u1eadt trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p<\/p>\n<h2><b><span lang=\"FR\">3. C\u00e1c marker ung th\u01b0\u00a0<\/span><\/b><\/h2>\n<h3><span lang=\"FR\">3.1. Alpha-fetoprotein (AFP)<\/span><\/h3>\n<p><span lang=\"FR\">Vai tr\u00f2 c\u1ee7a AFP trong ch\u1ea9n \u0111o\u00e1n UTBMTBG ch\u01b0a r\u00f5 r\u00e0ng. AFP c\u00f3 th\u1ec3 t\u0103ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam gan ho\u1ea1t \u0111\u1ed9ng v\u00e0 x\u01a1 gan, v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m \u0111i khi \u0111i\u1ec1u tr\u1ecb c\u00e1c t\u00ecnh tr\u1ea1ng vi\u00eam gan b\u1eb1ng c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb HBV v\u00e0 HCV. Ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng c\u1ee7a AFP th\u01b0\u1eddng l\u00e0 20 ng\/ml, ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a AFP l\u00e0 400 ng\/ml. AFP c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi si\u00eau \u00e2m \u0111\u1ec3 t\u1ea7m so\u00e1t UTBMTBG tr\u00ean c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng nguy c\u01a1.<\/span><\/p>\n<h3>3.2. Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3)<\/h3>\n<p>AFP-L3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t s\u1ef1 gia t\u0103ng AFP trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p u l\u00e0nh t\u00ednh \u1edf gan. Ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng c\u1ee7a AFP-L3 l\u00e0 5%.<\/p>\n<h3>3.3. Prothrombin induced by vitamin K absence-II (PIVKA II) hay c\u00f2n g\u1ecdi l\u00e0 Des- gamma-carboxyprothrombin (DCP)<\/h3>\n<p>PIVKA II l\u00e0 m\u1ed9t prothombin b\u1ea5t th\u01b0\u1eddng, t\u0103ng trong huy\u1ebft thanh c\u1ee7a c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG. Ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng c\u1ee7a PIVKA II l\u00e0 40 mAU\/ml.<\/p>\n<h3>3.4. M\u1ed9t s\u1ed1 d\u1ea5u \u1ea5n sinh h\u1ecdc kh\u00e1c trong huy\u1ebft thanh<\/h3>\n<p>C\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc kh\u00e1c nh\u01b0 Glypican-3 (GPC3), Golgi protein 73 (GP73), Osteopontin, circulating cell free DNA, v\u00e0 c\u00e1c microRNA ch\u01b0a c\u00f3 vai tr\u00f2 r\u00f5 r\u00e0ng v\u1ec1 chuy\u00ean m\u00f4n l\u1eabn hi\u1ec7u qu\u1ea3 v\u1ec1 kinh t\u1ebf.<\/p>\n<h3>3.5. K\u1ebft h\u1ee3p c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc trong huy\u1ebft thanh<\/h3>\n<p>S\u1ef1 k\u1ebft h\u1ee3p c\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc AFP, AFP-L3 v\u00e0 PIVKA II trong huy\u1ebft thanh c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n \u0111\u1ed9 nh\u1ea1y trong t\u1ea7m so\u00e1t v\u00e0 ch\u1ea9n \u0111o\u00e1n UTBMTBG m\u00e0 kh\u00f4ng l\u00e0m gi\u1ea3m \u0111i \u0111\u1ed9 chuy\u00ean bi\u1ec7t, do \u0111\u00f3 n\u00ean s\u1eed d\u1ee5ng vi\u1ec7c k\u1ebft h\u1ee3p n\u00e0y trong th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng.<\/p>\n<h2><b>4. Sinh thi\u1ebft gan<\/b><\/h2>\n<p>Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng \u1edf gan kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n d\u01b0\u1edbi \u0111\u00e2y th\u00ec sinh thi\u1ebft gan cho ph\u00e9p x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n UTBMTBG v\u00e0 ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u00e1c t\u00ednh nguy\u00ean ph\u00e1t kh\u00e1c t\u1ea1i gan nh\u01b0 ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt, ung th\u01b0 gan-m\u1eadt k\u1ebft h\u1ee3p, c\u0169ng nh\u01b0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u00e1c t\u00ednh th\u1ee9 ph\u00e1t t\u1ea1i gan c\u00e1c u th\u1ea7n kinh n\u1ed9i ti\u1ebft v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng di c\u0103n t\u1ea1i gan. C\u00e1c nguy c\u01a1 nh\u01b0 ch\u1ea3y m\u00e1u hay gieo r\u1eafc t\u1ebf b\u00e0o ung th\u01b0 \u0111\u1ec1u c\u00f3 t\u1ec9 l\u1ec7 r\u1ea5t th\u1ea5p, c\u00f3 th\u1ec3 x\u1eed tr\u00ed \u0111\u01b0\u1ee3c v\u00e0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn quy\u1ebft \u0111\u1ecbnh l\u00e0m sinh thi\u1ebft gan khi c\u1ea7n thi\u1ebft.<\/p>\n<p>K\u1ebft qu\u1ea3 sinh thi\u1ebft gan c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1ed1i chi\u1ebfu v\u1edbi c\u00e1c d\u1eef li\u1ec7u v\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 ch\u1ec9 d\u1ea5u sinh h\u1ecdc \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh n\u00ean sinh thi\u1ebft l\u1ea1i hay n\u00ean theo d\u00f5i ti\u1ebfp. N\u1ebfu quy\u1ebft \u0111\u1ecbnh theo d\u00f5i ti\u1ebfp th\u00ec n\u00ean \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u1ed5n th\u01b0\u01a1ng b\u1eb1ng h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 ch\u1ec9 d\u1ea5u sinh h\u1ecdc sau 02 th\u00e1ng.<\/p>\n<p>Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n<p><iframe loading=\"lazy\" title=\"C\u00e1c b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf gan v\u00e0 ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng cho ng\u01b0\u1eddi b\u1ec7nh\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/KTilACALZPs?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan l\u00e0 lo\u1ea1i ung th\u01b0 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong li\u00ean quan \u0111\u1ebfn ung th\u01b0 t\u1ea1i Vi\u1ec7t Nam theo \u01b0\u1edbc t\u00ednh c\u1ee7a T\u1ed5 ch\u1ee9c Ghi nh\u1eadn Ung th\u01b0 to\u00e0n c\u1ea7u (GLOBOCAN) n\u0103m 2018. C\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng gi\u00fap ph\u00e1t hi\u1ec7n [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan - Vinmec<\/title>\n<meta name=\"description\" content=\"Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan l\u00e0 lo\u1ea1i ung th\u01b0 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong. 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