{"id":21886,"date":"2023-04-17T11:24:36","date_gmt":"2023-04-17T04:24:36","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21886"},"modified":"2023-04-17T16:52:19","modified_gmt":"2023-04-17T09:52:19","slug":"nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/","title":{"rendered":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf"},"content":{"rendered":"<p><strong>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong cao. N\u1eafm \u0111\u01b0\u1ee3c nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb HCC gi\u00fap cho c\u00e1c chuy\u00ean gia y t\u1ebf c\u00f3 th\u1ec3 t\u1ed1i \u01b0u h\u00f3a ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n.<\/strong><\/p>\n<figure id=\"attachment_22478\" aria-describedby=\"caption-attachment-22478\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-22478 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1285939854-612x612-1-300x252.jpg\" alt=\"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t\" width=\"300\" height=\"252\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1285939854-612x612-1-300x252.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1285939854-612x612-1.jpg 612w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-22478\" class=\"wp-caption-text\">N\u1eafm \u0111\u01b0\u1ee3c nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan r\u1ea5t quan tr\u1ecdng gi\u00fap \u0111i\u1ec1u tr\u1ecb b\u1ec7nh hi\u1ec7u qu\u1ea3<\/figcaption><\/figure>\n<h2><b>1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb HCC<\/b><\/h2>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb (c\u00e1c) kh\u1ed1i HCC \u1edf giai \u0111o\u1ea1n c\u00f2n kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd n\u1ec1n t\u1ea3ng hay y\u1ebfu t\u1ed1 nguy c\u01a1 (vi\u00eam gan si\u00eau vi B ho\u1eb7c C, x\u01a1 gan&#8230;).<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa k\u1ebft h\u1ee3p ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 \u1edf giai \u0111o\u1ea1n mu\u1ed9n.<\/p>\n<h2><b>2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng HCC<\/b><\/h2>\n<h3>2.1. Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf ph\u1ea7n gan c\u00f3 mang kh\u1ed1i u (ph\u1eabu thu\u1eadt c\u1eaft gan)<\/h3>\n<p>Ph\u1eabu thu\u1eadt c\u1eaft gan \u0111\u01b0\u1ee3c coi l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 \u0111\u1ed1i v\u1edbi HCC v\u00e0 an to\u00e0n ngay c\u1ea3 \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 x\u01a1 gan. Tuy nhi\u00ean, ch\u01b0a c\u00f3 \u0111\u1ed3ng thu\u1eadn tr\u00ean th\u1ebf gi\u1edbi v\u1ec1 t\u00ecnh tr\u1ea1ng u v\u00e0 m\u1ee9c \u0111\u1ed9 b\u1ea3o t\u1ed3n ch\u1ee9c n\u0103ng gan \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 s\u1ed1ng c\u00f2n ph\u00f9 h\u1ee3p khi ch\u1ec9 \u0111\u1ecbnh c\u1eaft gan. EASL, ESMO v\u00e0 AASLD ch\u1ec9 \u0111\u1ec1 xu\u1ea5t ph\u1eabu thu\u1eadt c\u1eaft gan cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 c\u00f3 m\u1ed9t kh\u1ed1i u \u0111\u01a1n \u0111\u1ed9c, ch\u1ee9c n\u0103ng gan l\u00e0 Child-Pugh A v\u00e0kh\u00f4ng c\u00f3 t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda. Trong khi \u0111\u00f3, APASL l\u1ea1i \u0111\u1ec1 xu\u1ea5t ph\u1eabu thu\u1eadt c\u1eaft gan cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 c\u00f3 nhi\u1ec1u u, ch\u1ee9c n\u0103ng gan Child-Pugh A v\u00e0 B, v\u00e0 c\u00f3 th\u1ec3 c\u1ea3 khi c\u00f3 x\u00e2m nh\u1eadp m\u1ea1ch m\u00e1u \u0111\u1ea1i th\u1ec3 (nh\u01b0 c\u00f3 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch c\u1eeda) hay di c\u0103n ngo\u00e0i gan m\u00e0 c\u00f3 th\u1ec3 l\u1ea5y b\u1ecf \u0111\u01b0\u1ee3c khi ph\u1eabu thu\u1eadt c\u1eaft gan.<\/p>\n<p>T\u1ea1i Vi\u1ec7t Nam, ph\u1eabu thu\u1eadt c\u1eaft gan n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p:<\/p>\n<p>&#8211; Ph\u1ea7n gan c\u00f3 kh\u1ed1i u d\u1ef1 ki\u1ebfn c\u1eaft b\u1ecf \u0111\u01b0\u1ee3c (theo gi\u1ea3i ph\u1eabu hay kh\u00f4ng theo gi\u1ea3i ph\u1eabu).<\/p>\n<p>&#8211; Th\u1ec3 t\u00edch gan d\u1ef1 ki\u1ebfn c\u00f2n l\u1ea1i ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n. N\u00ean \u0111o th\u1ec3 t\u00edch gan \u0111\u1ec3 g\u00f3p ph\u1ea7n ra ch\u1ec9 \u0111\u1ecbnh c\u1eaft gan \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p d\u1ef1 ki\u1ebfn c\u1eaft \u2265 50% th\u1ec3 t\u00edch gan.<\/p>\n<p>&#8211; Ch\u1ee9c n\u0103ng gan l\u00e0 Child-Pugh A \u0111\u1ebfn B7 (Ph\u1ee5 l\u1ee5c 4). C\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng gan d\u1ef1a tr\u00ean x\u00e9t nghi\u1ec7m thanh l\u1ecdc Indocyanin green (ICG test) \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 c\u1eaft gan.<\/p>\n<p>&#8211; \u0110i\u1ec3m ho\u1ea1t \u0111\u1ed9ng c\u01a1 th\u1ec3 (Performance Status &#8211; PS) 0-2, kh\u00f4ng c\u00f3 di c\u0103n xa.<\/p>\n<p>N\u00ean xem x\u00e9t ph\u1eabu thu\u1eadt c\u1eaft gan cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch c\u1eeda c\u00f9ng b\u00ean v\u1edbi ph\u1ea7n gan \u0111\u1ecbnh c\u1eaft, c\u0169ng nh\u01b0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1ed5n th\u01b0\u01a1ng di c\u0103n ngo\u00e0i gan (h\u1ea1ch cu\u1ed1ng gan, tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn, di c\u0103n t\u1ea1i m\u1ea1c n\u1ed1i l\u1edbn, \u2026) c\u00f3 th\u1ec3 l\u1ea5y b\u1ecf \u0111\u01b0\u1ee3c khi ph\u1eabu thu\u1eadt c\u1eaft gan.<\/p>\n<h3>2.2. Ph\u1eabu thu\u1eadt gh\u00e9p gan<\/h3>\n<p>Ph\u1eabu thu\u1eadt gh\u00e9p gan l\u00e0 bi\u1ec7n ph\u00e1p duy nh\u1ea5t c\u00f3 th\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb c\u1ea3 HCC l\u1eabn b\u1ec7nh l\u00fd gan n\u1ec1n. Ch\u1ec9 \u0111\u1ecbnh gh\u00e9p gan cho b\u1ec7nh nh\u00e2n HCC t\u00f9y thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1, trong \u0111\u00f3 c\u00f3 c\u00e2n nh\u1eafc t\u1edbi hi\u1ec7u qu\u1ea3 c\u1ee7a ph\u1eabu thu\u1eadt c\u1eaft gan v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 &#8211; t\u1ea1i v\u00f9ng, c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 \u01b0u ti\u00ean so v\u1edbi nhu c\u1ea7u gh\u00e9p gan c\u1ee7a c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i l\u00e0 HCC.<\/p>\n<p>C\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb tr\u00ean th\u1ebf gi\u1edbi \u0111\u1ec1u khuy\u1ebfn c\u00e1o xem Ti\u00eau chu\u1ea9n Milan (ch\u1ec9 c\u00f3 01 u v\u1edbi k\u00edch th\u01b0\u1edbc kh\u1ed1i u kh\u00f4ng qu\u00e1 5cm, hay kh\u00f4ng qu\u00e10 3 u v\u1edbi k\u00edch th\u01b0\u1edbc m\u1ed7i u kh\u00f4ng qu\u00e13cm) l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 gh\u00e9p gan cho HCC, v\u00e0 gh\u00e9p gan l\u00e0 l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p HCC n\u1eb1m trong Ti\u00eau chu\u1ea9n Milan nh\u01b0ng kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 ph\u1eabu thu\u1eadt c\u1eaft gan, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi c\u00f3 x\u01a1 gan m\u1ea5t b\u00f9. C\u00e1c c\u01a1 s\u1edf y t\u1ebf c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc v\u1eadn d\u1ee5ng c\u00e1c ti\u00eau chu\u1ea9n m\u1edf r\u1ed9ng h\u01a1n khi ch\u1ec9 \u0111\u1ecbnh gh\u00e9p gan nh\u01b0ng c\u1ea7n c\u00f3 h\u1ed9i ch\u1ea9n c\u1ee5 th\u1ec3.<\/p>\n<p>C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eafc c\u1ea7u \u0111\u1ec3 l\u00e0m gi\u1ea3m giai \u0111o\u1ea1n HCC tr\u01b0\u1edbc khi xem x\u00e9t gh\u00e9p gan.<\/p>\n<h3>2.3. Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u)<\/h3>\n<p>Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u) c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n b\u1eb1ng s\u00f3ng cao t\u1ea7n (Radiofrequency Ablation-RFA), b\u1eb1ng vi s\u00f3ng (Microwave Ablation-MWA), b\u1eb1ng c\u00e1ch ti\u00eam c\u1ed3n v\u00e0o kh\u1ed1i u (Percutaneous Ethanol Injection-PEI) hay b\u1eb1ng \u0111\u1ed1t l\u1ea1nh (cryoablation) tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3PS 0-2, ch\u1ee9c n\u0103ng gan l\u00e0 Child Pugh A,B, kh\u00f4ng c\u00f3 di c\u0103n xa.<\/p>\n<p>Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u) n\u00ean th\u1ef1c hi\u1ec7n cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p HCC c\u00f3 s\u1ed1 l\u01b0\u1ee3ng u \u2264 3 v\u1edbi k\u00edch th\u01b0\u1edbc u \u2264 3cm, ho\u1eb7c c\u00f3 1 u v\u1edbi k\u00edch th\u01b0\u1edbc u \u2264 5cm, nh\u1ea5t l\u00e0 khi c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 ph\u1eabu thu\u1eadt c\u1eaft gan (do v\u1ecb tr\u00ed u, do t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n). Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u) c\u0169ng \u0111\u01b0\u1ee3c coi l\u00e0 bi\u1ec7n ph\u00e1p thay th\u1ebf cho ph\u1eabu thu\u1eadt c\u1eaft gan trong tr\u01b0\u1eddng h\u1ee3p u c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf \u2264 3cm.<\/p>\n<p>Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u) n\u00ean th\u1ef1c hi\u1ec7n cho c\u00e1c kh\u1ed1i u d\u1ec5 ti\u1ebfp c\u1eadn d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a h\u00ecnh \u1ea3nh h\u1ecdc (si\u00eau \u00e2m, CT scan, MRI). Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 \u0111\u1ecbnh ph\u00e1 h\u1ee7y kh\u1ed1i u k\u00edch th\u01b0\u1edbc &gt; 5cm c\u1ea7n \u0111\u01b0\u1ee3c h\u1ed9i ch\u1ea9n.<\/p>\n<p>Ti\u00eam c\u1ed3n v\u00e0o kh\u1ed1i u ch\u1ec9 n\u00ean th\u1ef1c hi\u1ec7n khi c\u00e1c bi\u1ec7n ph\u00e1p ph\u00e1 h\u1ee7y kh\u1ed1i u (\u0111\u1ed1t u) kh\u00e1c kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c v\u00ec l\u00fd do k\u1ef9 thu\u1eadt, v\u00e0 n\u1ebfu s\u1eed d\u1ee5ng th\u00ec ch\u1ee7 y\u1ebfu l\u00e0 cho u \u2264 2cm.<\/p>\n<p>\u0110\u1ed1i v\u1edbi (c\u00e1c) kh\u1ed1i u ch\u01b0a lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c l\u00e0 HCC, c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p sinh thi\u1ebft v\u00e0 ph\u00e1 h\u1ee7y u t\u1ea1i ch\u1ed7 trong c\u00f9ng m\u1ed9t l\u1ea7n n\u1eb1m vi\u1ec7n.<\/p>\n<h3>2.4. C\u1eaft ngu\u1ed3n m\u00e1u nu\u00f4i kh\u1ed1i u ph\u1ed1i h\u1ee3p v\u1edbi di\u1ec7t t\u1ebf b\u00e0o ung th\u01b0 b\u1eb1ng h\u00f3a ch\u1ea5t<\/h3>\n<p>C\u00f3 c\u00e1c h\u00ecnh th\u1ee9c nh\u01b0:<\/p>\n<p>&#8211; N\u00fat m\u1ea1ch h\u00f3a ch\u1ea5t th\u01b0\u1eddng quy (conventional TransArterial Chemo-Embolization &#8211; cTACE)<\/p>\n<p>&#8211; N\u00fat m\u1ea1ch s\u1eed d\u1ee5ng h\u1ea1t nh\u00fang h\u00f3a ch\u1ea5t (Drug-eluting bead TACE &#8211; DEB-TACE)<\/p>\n<p>TACE \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p HCC m\u00e0 kh\u1ed1i u kh\u00f4ng c\u1eaft \u0111\u01b0\u1ee3c, ho\u1eb7c c\u00f3 nhi\u1ec1u u \u1edf c\u1ea3 hai th\u00f9y, ch\u01b0a c\u00f3 x\u00e2m nh\u1eadp m\u1ea1ch m\u00e1u v\u00e0 ch\u01b0a c\u00f3 di c\u0103n ngo\u00e0i gan, tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 PS 0-2, ch\u1ee9c n\u0103ng gan l\u00e0 Child Pugh A,B. TACE n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ch\u1ecdn l\u1ecdc hay si\u00eau ch\u1ecdn l\u1ecdc \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3, gi\u1ea3m bi\u1ebfn ch\u1ee9ng v\u00e0 gi\u1ea3m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ph\u1ea7n gan l\u00e0nh quanh u.<\/p>\n<p>TACE ch\u1ecdn l\u1ecdc c\u0169ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p u nh\u1ecf nh\u01b0ng kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u1ed1t u \u0111\u01b0\u1ee3c do v\u1ecb tr\u00ed kh\u00f3 hay do c\u00f3 c\u00e1c b\u1ec7nh l\u00fd \u0111i k\u00e8m l\u00e0m t\u0103ng nguy c\u01a1 bi\u1ebfn ch\u1ee9ng.<\/p>\n<p>Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 u \u0111\u00e3 v\u1ee1 ho\u1eb7c c\u00f3 nguy c\u01a1 v\u1ee1 m\u00e0 t\u00ecnh tr\u1ea1ng ch\u1ee9c n\u0103ng gan ho\u1eb7c t\u00ecnh tr\u1ea1ng c\u01a1 th\u1ec3 kh\u00f4ng cho ph\u00e9p l\u00e0m TACE th\u00ec c\u00f3 th\u1ec3 l\u00e0m n\u00fat m\u1ea1ch \u0111\u01a1n thu\u1ea7n (TransArterial Embolization &#8211; TAE) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u1ea1m th\u1eddi.<\/p>\n<p>\u0110\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a TACE c\u1ea7n d\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 s\u1ef1 thay \u0111\u1ed5i c\u1ee7a c\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc c\u0169ng nh\u01b0 c\u1ee7a ch\u1ee9c n\u0103ng gan sau TACE. T\u1ea1i Vi\u1ec7t Nam, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n TACE nhi\u1ec1u l\u1ea7n n\u1ebfu (c\u00e1c) kh\u1ed1i u c\u00f2n ti\u1ebfn tri\u1ec3n ho\u1eb7c xu\u1ea5t hi\u1ec7n u m\u1edbi v\u00e0 t\u00ecnh tr\u1ea1ng ch\u1ee9c n\u0103ng gan v\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 th\u1ec3 cho ph\u00e9p. C\u1ea7n h\u1ed9i ch\u1ea9n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 TACE th\u1ea5t b\u1ea1i hay kh\u00f4ng tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh ng\u01b0ng l\u00e0m TACE ti\u1ebfp t\u1ee5c \u0111\u1ec3 chuy\u1ec3n sang h\u00f3a tr\u1ecb to\u00e0n th\u00e2n.<\/p>\n<h3>2.5. X\u1ea1 tr\u1ecb trong ch\u1ecdn l\u1ecdc (Selective Internal Radiation Therapy &#8211; SIRT)<\/h3>\n<p>S\u1eed d\u1ee5ng h\u1ea1t vi c\u1ea7u ph\u00f3ng x\u1ea1 Ytrium-90 (<sup>90<\/sup>Y) b\u01a1m v\u00e0o \u0111\u1ed9ng m\u1ea1ch nu\u00f4i kh\u1ed1i u gan. C\u00e1c h\u1ea1t vi c\u1ea7u n\u00e0y s\u1ebd \u0111i v\u00e0o c\u00e1c nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch nh\u1ecf kh\u1eafp trong kh\u1ed1i u g\u00e2y t\u1eafc m\u1ea1ch.<\/p>\n<p>Kh\u1ed1i u s\u1ebd b\u1ecb ti\u00eau di\u1ec7t theo hai c\u01a1 ch\u1ebf: gi\u1ea3m nu\u00f4i d\u01b0\u1ee1ng u v\u00e0 b\u1ee9c x\u1ea1 b\u00eata n\u0103ng l\u01b0\u1ee3ng 0,93MeV \u0111\u01b0\u1ee3c ph\u00e1t ra t\u1eeb \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1\u00a0<sup>90<\/sup>Y g\u1eafn tr\u00ean c\u00e1c h\u1ea1t vi c\u1ea7u s\u1ebd ti\u00eau di\u1ec7t c\u00e1c t\u1ebf b\u00e0o ung th\u01b0 v\u00e0 l\u00e0m gi\u1ea3m th\u1ec3 t\u00edch ho\u1eb7c ti\u00eau ho\u00e0n to\u00e0n kh\u1ed1i u gan m\u00e0 r\u1ea5t \u00edt \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ed5 ch\u1ee9c l\u00e0nh xung quanh.<\/p>\n<p>&#8211; Ch\u1ec9 \u0111\u1ecbnh:<\/p>\n<p>+ HCC kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt, ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt hay b\u1ec7nh nh\u00e2n t\u1eeb ch\u1ed1i ph\u1eabu thu\u1eadt.<\/p>\n<p>+ T\u1ed5ng tr\u1ea1ng c\u00f2n t\u1ed1t ECOG \u2264 1, ch\u1ee9c n\u0103ng gan c\u00f2n b\u00f9 (Child-Pugh A, B)<\/p>\n<p>+ Shunt l\u01b0u th\u00f4ng ho\u1ea1t t\u00ednh ph\u00f3ng x\u1ea1 l\u00ean ph\u1ed5i &lt; 20% tr\u00ean x\u1ea1 h\u00ecnh Tc-99m MAA<\/p>\n<p>+ Ch\u01b0a t\u1eebng x\u1ea1 tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 v\u00e0o gan<\/p>\n<p>&#8211; Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/p>\n<p>+ C\u00f3 lu\u1ed3ng th\u00f4ng \u0111\u1ed9ng m\u1ea1ch gan-ph\u1ed5i (shunt gan-ph\u1ed5i) l\u1edbn (&gt; 20%)<\/p>\n<p>+ X\u01a1 gan m\u1ea5t b\u00f9, b\u1ec7nh n\u00e3o gan<\/p>\n<p>+ Th\u1ec3 tr\u1ea1ng qu\u00e1 y\u1ebfu, d\u1ef1 ki\u1ebfn th\u1eddi gian s\u1ed1ng th\u00eam d\u01b0\u1edbi 3 th\u00e1ng.<\/p>\n<h3>2.6. Truy\u1ec1n ho\u00e1 ch\u1ea5t qua \u0111\u1ed9ng m\u1ea1ch gan (Hepatic Arterial Infusion Chemotherapy &#8211; HAIC)<\/h3>\n<p>Ph\u01b0\u01a1ng ph\u00e1p s\u1eed d\u1ee5ng bu\u1ed3ng truy\u1ec1n v\u00e0 d\u00e2y d\u1eabn \u0111\u1eb7t ch\u1ecdn l\u1ecdc v\u00e0o \u0111\u1ed9ng m\u1ea1ch gan sau khi \u0111\u00e3 n\u00fat t\u1eafc c\u00e1c nh\u00e1nh m\u1ea1ch c\u1ee7a \u0111\u1ed9ng m\u1ea1ch gan c\u1ea5p m\u00e1u cho c\u00e1c t\u1ea1ng kh\u00e1c. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y gi\u00fap \u0111\u01b0a h\u00f3a ch\u1ea5t khu tr\u00fa t\u1ea1i gan n\u00ean gi\u1ea3m c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n so v\u1edbi h\u00f3a tr\u1ecb to\u00e0n th\u00e2n. H\u00f3a ch\u1ea5t th\u01b0\u1eddng d\u00f9ng l\u00e0 t\u1ed5 h\u1ee3p li\u1ec1u th\u1ea5p c\u1ee7a Cisplatin v\u1edbi 5-Fluorouracil (ph\u00e1c \u0111\u1ed3 FP li\u1ec1u th\u1ea5p). Ch\u1ec9 \u0111\u1ecbnh ch\u1ee7 y\u1ebfu cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p HCC giai \u0111o\u1ea1n ti\u1ebfn xa c\u00f3 x\u00e2m l\u1ea5n t\u0129nh m\u1ea1ch c\u1eeda. C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y bao g\u1ed3m: vi\u00eam t\u1eafc m\u1ea1ch, lo\u00e9t d\u1ea1 d\u00e0y ru\u1ed9t do r\u00f2 thu\u1ed1c v\u00e0 nhi\u1ec5m khu\u1ea9n ho\u1eb7c t\u1eafc d\u00e2y truy\u1ec1n.<\/p>\n<h3>2.7. X\u1ea1 tr\u1ecb<\/h3>\n<p>&#8211; X\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i<\/p>\n<p>+ Ch\u1ec9 \u0111\u1ecbnh: x\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i b\u1eb1ng m\u00e1y gia t\u1ed1c c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c. L\u1ef1a ch\u1ecdn tr\u01b0\u1eddng chi\u1ebfu x\u1ea1 ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed, k\u00edch th\u01b0\u1edbc kh\u1ed1i u. Li\u1ec1u x\u1ea1 tr\u1ecb t\u00f9y thu\u1ed9c v\u00e0o th\u1ec3 t\u00edch tr\u01b0\u1eddng chi\u1ebfu, dao \u0111\u1ed9ng t\u1eeb 50-70Gy, ph\u00e2n li\u1ec1u 2Gy\/ng\u00e0y.<\/p>\n<p>+ Ch\u1ec9 \u0111\u1ecbnh x\u1ea1 tr\u1ecb to\u00e0n gan trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng, li\u1ec1u x\u1ea1 21Gy, ph\u00e2n li\u1ec1u 3Gy\/ng\u00e0y.<\/p>\n<p>+ Ngo\u00e0i ra, c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh x\u1ea1 tr\u1ecb cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p HCC di c\u0103n x\u01b0\u01a1ng, di c\u0103n n\u00e3o, di c\u0103n ph\u1ed5i, di c\u0103n h\u1ea1ch. Th\u1ec3 t\u00edch v\u00e0 li\u1ec1u x\u1ea1 ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed v\u00e0 k\u00edch th\u01b0\u1edbc t\u1ed5n th\u01b0\u01a1ng.<\/p>\n<p>+ M\u00f4 ph\u1ecfng b\u1eb1ng CT, MRI ho\u1eb7c PET\/CT, PET\/MRI.<\/p>\n<p>+ K\u1ef9 thu\u1eadt: c\u00f3 th\u1ec3 d\u00f9ng c\u00e1c k\u1ef9 thu\u1eadt th\u01b0\u1eddng quy 3D, ho\u1eb7c c\u00e1c k\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb ti\u00ean ti\u1ebfn gi\u00fap t\u0103ng hi\u1ec7u qu\u1ea3, \u0111\u1ed9 ch\u00ednh x\u00e1c v\u00e0 gi\u1ea3m thi\u1ec3u t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 x\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn li\u1ec1u (Intensity Modulated Radiation Therapy \u2013 IMRT), x\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn th\u1ec3 t\u00edch (Volumetric Modulated Arc Therapy \u2013 VMAT).<\/p>\n<p>&#8211; X\u1ea1 ph\u1eabu<\/p>\n<p>&#8211; X\u1ea1 ph\u1eabu \u0111\u1ecbnh v\u1ecb th\u00e2n (Stereotatic Body Radiation Therapy &#8211; SBRT)<\/p>\n<p>&#8211; C\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1<\/p>\n<h3>2.8. \u0110i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n<\/h3>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p <a href=\"https:\/\/www.vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/tim-hieu-ve-ung-thu-gan-nguyen-phat\/\">HCC<\/a> ti\u1ebfn tri\u1ec3n, kh\u00f4ng c\u00f2n ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt, n\u00fat m\u1ea1ch, \u0111\u1ed1t u th\u00ec c\u00f3 th\u1ec3 xem x\u00e9t d\u00f9ng \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n: \u0110i\u1ec1u tr\u1ecb \u0111\u00edch v\u00e0 \u0111i\u1ec1u tr\u1ecb mi\u1ec5n d\u1ecbch, h\u00f3a tr\u1ecb to\u00e0n th\u00e2n c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng trong HCC nh\u01b0ng hi\u1ec7u qu\u1ea3 r\u1ea5t h\u1ea1n ch\u1ebf.<\/p>\n<p>Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong cao. N\u1eafm \u0111\u01b0\u1ee3c nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb HCC gi\u00fap cho c\u00e1c chuy\u00ean gia y t\u1ebf c\u00f3 th\u1ec3 t\u1ed1i \u01b0u h\u00f3a ph\u01b0\u01a1ng ph\u00e1p [&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>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf<\/title>\n<meta name=\"description\" content=\"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed ...\" \/>\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=\"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf\" \/>\n<meta property=\"og:description\" content=\"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed ...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-17T04:24:36+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-17T09:52:19+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1285939854-612x612-1-300x252.jpg\" \/>\n<meta name=\"author\" content=\"mitkaka mitkaka\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"mitkaka mitkaka\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/\",\"url\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/\",\"name\":\"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-17T04:24:36+00:00\",\"dateModified\":\"2023-04-17T09:52:19+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/afa83c897f17e0b5f69265f912e0572c\"},\"description\":\"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed ...\",\"breadcrumb\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/afa83c897f17e0b5f69265f912e0572c\",\"name\":\"mitkaka mitkaka\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/0.gravatar.com\/avatar\/f102cd9b17e5dabdddda292eb3a7dd3d?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/0.gravatar.com\/avatar\/f102cd9b17e5dabdddda292eb3a7dd3d?s=96&d=mm&r=g\",\"caption\":\"mitkaka mitkaka\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/mitkaka2009mitkaka2009gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf","description":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed ...","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf","og_description":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed ...","og_url":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/","og_site_name":"Vinmec","article_published_time":"2023-04-17T04:24:36+00:00","article_modified_time":"2023-04-17T09:52:19+00:00","og_image":[{"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1285939854-612x612-1-300x252.jpg"}],"author":"mitkaka mitkaka","twitter_card":"summary_large_image","twitter_misc":{"Written by":"mitkaka mitkaka","Est. reading time":"9 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/","url":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/","name":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-17T04:24:36+00:00","dateModified":"2023-04-17T09:52:19+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/afa83c897f17e0b5f69265f912e0572c"},"description":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed ...","breadcrumb":{"@id":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nguyen-tac-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/afa83c897f17e0b5f69265f912e0572c","name":"mitkaka mitkaka","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/0.gravatar.com\/avatar\/f102cd9b17e5dabdddda292eb3a7dd3d?s=96&d=mm&r=g","contentUrl":"http:\/\/0.gravatar.com\/avatar\/f102cd9b17e5dabdddda292eb3a7dd3d?s=96&d=mm&r=g","caption":"mitkaka mitkaka"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/mitkaka2009mitkaka2009gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/21886"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=21886"}],"version-history":[{"count":6,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/21886\/revisions"}],"predecessor-version":[{"id":23063,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/21886\/revisions\/23063"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=21886"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=21886"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=21886"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}