{"id":22937,"date":"2023-04-21T11:05:25","date_gmt":"2023-04-21T04:05:25","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22937"},"modified":"2023-04-21T12:35:19","modified_gmt":"2023-04-21T05:35:19","slug":"xo-gan-benh-sinh-phan-giai-doan-va-tien-luong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/xo-gan-benh-sinh-phan-giai-doan-va-tien-luong\/","title":{"rendered":"X\u01a1 gan: B\u1ec7nh sinh, ph\u00e2n giai \u0111o\u1ea1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng"},"content":{"rendered":"<p><strong>X\u01a1 gan l\u00e0 m\u1ed9t b\u1ec7nh gan m\u1ea1n t\u00ednh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1 h\u1ee7y ti\u1ebfn tri\u1ec3n c\u1ee7a t\u1ebf b\u00e0o gan v\u00e0 thay th\u1ebf ch\u00fang b\u1eb1ng m\u00f4 s\u1eb9o. S\u1ef1 x\u01a1 h\u00f3a nhu m\u00f4 gan c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy gi\u1ea3m ch\u1ee9c n\u0103ng gan, ch\u1eb3ng h\u1ea1n nh\u01b0 gi\u1ea3m kh\u1ea3 n\u0103ng l\u1ecdc \u0111\u1ed9c t\u1ed1 kh\u1ecfi m\u00e1u, s\u1ea3n xu\u1ea5t m\u1eadt v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c ch\u1ee9c n\u0103ng trao \u0111\u1ed5i ch\u1ea5t quan tr\u1ecdng kh\u00e1c. X\u01a1 gan l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u00f3 di\u1ec5n ti\u1ebfn \u0111a d\u1ea1ng, nhi\u1ec1u giai \u0111o\u1ea1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a m\u1ed7i giai \u0111o\u1ea1n c\u0169ng r\u1ea5t kh\u00e1c nhau.<\/strong><\/p>\n<h2>1. Sinh b\u1ec7nh h\u1ecdc c\u1ee7a x\u01a1 gan<\/h2>\n<p>X\u01a1 gan l\u00e0 m\u1ed9t b\u1ec7nh gan m\u1ea1n t\u00ednh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1 h\u1ee7y ti\u1ebfn tri\u1ec3n c\u1ee7a t\u1ebf b\u00e0o gan v\u00e0 thay th\u1ebf ch\u00fang b\u1eb1ng m\u00f4 s\u1eb9o. S\u1ef1 x\u01a1 h\u00f3a, \u00a0nhu m\u00f4 gan c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy gi\u1ea3m ch\u1ee9c n\u0103ng gan, ch\u1eb3ng h\u1ea1n nh\u01b0 gi\u1ea3m kh\u1ea3 n\u0103ng l\u1ecdc \u0111\u1ed9c t\u1ed1 kh\u1ecfi m\u00e1u, s\u1ea3n xu\u1ea5t m\u1eadt v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c ch\u1ee9c n\u0103ng trao \u0111\u1ed5i ch\u1ea5t quan tr\u1ecdng kh\u00e1c. X\u01a1 gan l\u00e0 k\u1ebft c\u1ee5c chung c\u1ee7a r\u1ea5t nhi\u1ec1u b\u1ec7nh gan m\u1ea1n t\u00ednh kh\u00e1c nhau, \u0111\u1eb7c tr\u01b0ng v\u1ec1 m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a x\u01a1 gan l\u00e0 s\u1ef1 thay th\u1ebf c\u1ea5u tr\u00fac nhu m\u00f4 gan b\u00ecnh th\u01b0\u1eddng b\u1eb1ng m\u00f4 s\u1ee3i. S\u1ef1 h\u00f3a s\u1ee3i n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00edch th\u00edch t\u1eeb nhi\u1ec1u y\u1ebfu t\u1ed1 kh\u00e1c nhau v\u00e0 c\u00f3 s\u1ef1 tham gia c\u1ee7a r\u1ea5t nhi\u1ec1u lo\u1ea1i t\u1ebf b\u00e0o \u1edf nhu m\u00f4 gan. Trong \u0111\u00f3, quan tr\u1ecdng nh\u1ea5t l\u00e0 vai tr\u00f2 c\u1ee7a c\u00e1c t\u1ebf b\u00e0o h\u00ecnh sao (stellate cell). C\u00e1c t\u1ebf b\u00e0o n\u00e0y c\u00f3 v\u1ecb tr\u00ed m\u00f4 h\u1ecdc b\u00ecnh th\u01b0\u1eddng l\u00e0 n\u1eb1m ngo\u00e0i c\u00e1c mao m\u1ea1ch d\u1ea1ng xoang, n\u1eb1m trong kho\u1ea3ng Disse gi\u1eefa c\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 gan v\u00e0 c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 mao m\u1ea1ch d\u1ea1ng xoang. C\u00e1c t\u1ed5n th\u01b0\u01a1ng nh\u1ea5t \u0111\u1ecbnh hay c\u00e1c t\u1ed5n th\u01b0\u01a1ng t\u00edch l\u0169y c\u00f3 th\u1ec3 l\u00e0m k\u00edch ho\u1ea1t c\u00e1c t\u1ebf b\u00e0o n\u00e0y, l\u00e0m c\u00e1c t\u1ebf b\u00e0o n\u00e0y bi\u1ec7t h\u00f3a th\u00e0nh c\u00e1c \u00a0nguy\u00ean b\u00e0o s\u1ee3i c\u01a1 (myofibroblast). C\u00e1c t\u1ebf b\u00e0o sau khi bi\u1ec7t h\u00f3a c\u00f3 kh\u1ea3 n\u0103ng t\u1ed5ng h\u1ee3p c\u00e1c protein b\u1ec7nh l\u00fd v\u00e0o kho\u1ea3ng Disse. S\u1edbm nh\u1ea5t l\u00e0 s\u1ef1 t\u1ed5ng h\u1ee3p fibronectin v\u00e0 sau \u0111\u00f3 l\u00e0 collagen type 1. S\u1ef1 l\u1eafng \u0111\u1ecdng c\u1ee7a c\u00e1c protein n\u00e0y ti\u1ebfp t\u1ee5c k\u00edch ho\u1ea1t c\u00e1c t\u1ebf b\u00e0o sao v\u00e0 l\u00e0m thay \u0111\u1ed5i c\u1ea5u tr\u00fac c\u1ee7a c\u00e1c m\u1ea1ch m\u00e1u b\u00ean trong gan.<\/p>\n<p>M\u1ed9t s\u1ed1 t\u1ebf b\u00e0o kh\u00e1c c\u0169ng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c x\u01a1 h\u00f3a c\u1ee7a nhu m\u00f4 gan. V\u00ed d\u1ee5 nh\u01b0 c\u00e1c t\u1ebf nguy\u00ean b\u00e0o s\u1ee3i (fibroblast) \u1edf h\u1ec7 c\u1eeda. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, \u0111\u1eb7c bi\u1ec7t trong c\u00e1c t\u1ed5n th\u01b0\u01a1ng h\u1ec7 c\u1eeda do t\u1eafc m\u1eadt nh\u01b0 trong x\u01a1 gan m\u1eadt nguy\u00ean ph\u00e1t, c\u00e1c nguy\u00ean b\u00e0o s\u1ee3i n\u00e0y c\u00f3 th\u1ec3 chuy\u1ec3n d\u1ea1ng th\u00e0nh c\u00e1c nguy\u00ean b\u00e0o s\u1ee3i c\u01a1 v\u00e0 tham gia v\u00e0o qu\u00e1 tr\u00ecnh g\u00e2y x\u01a1 h\u00f3a nhu m\u00f4 gan. C\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 gan c\u0169ng c\u00f3 vai tr\u00f2 nh\u1ea5t \u0111\u1ecbnh. T\u1ed5n th\u01b0\u01a1ng l\u00ean c\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 gan, ngo\u00e0i c\u00e1c \u0111\u00e1p \u1ee9ng nh\u01b0 ch\u1ebf theo ch\u01b0\u01a1ng tr\u00ecnh, ho\u1ea1i t\u1eed, c\u00e1c t\u1ebf b\u00e0o n\u00e0y c\u00f2n c\u00f3 th\u1ec3 ti\u1ebft c\u00e1c h\u00f3a ch\u1ea5t trung gian g\u00e2y k\u00edch ho\u1ea1t c\u00e1c t\u1ebf b\u00e0o h\u00ecnh sao.<\/p>\n<h2>2. C\u00e1c giai \u0111o\u1ea1n c\u1ee7a x\u01a1 gan<\/h2>\n<p>Di\u1ec5n ti\u1ebfn c\u1ee7a x\u01a1 gan th\u00f4ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c chia l\u00e0m hai giai \u0111o\u1ea1n ch\u00ednh l\u00e0 x\u01a1 gan c\u00f2n b\u00f9 (compensated) v\u00e0 x\u01a1 gan m\u1ea5t b\u00f9 (decompensated). X\u01a1 gan \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 m\u1ea5t b\u00f9 khi c\u00f3 s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u \u1edf c\u00e1c v\u1ecb tr\u00ed gi\u00e3n c\u1ee7a t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n, b\u00e1ng b\u1ee5ng, b\u1ec7nh n\u00e3o gan hay ung th\u01b0 t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 gan (hepatocellular carcinoma &#8211; HCC). V\u1ec1 ph\u01b0\u01a1ng di\u1ec7n l\u00e2m s\u00e0ng, c\u00f3 th\u1ec3 chia x\u01a1 gan th\u00e0nh 04 giai \u0111o\u1ea1n:<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n 1: X\u01a1 gan nh\u01b0ng ch\u01b0a c\u00f3 xu\u1ea5t hi\u1ec7n c\u1ee7a b\u00e1ng b\u1ee5ng v\u00e0 gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/li>\n<li>Giai \u0111o\u1ea1n 2: X\u01a1 gan v\u1edbi s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a c\u00e1c gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n nh\u01b0ng kh\u00f4ng ch\u1ea3y m\u00e1u, kh\u00f4ng c\u00f3 b\u00e1ng b\u1ee5ng<\/li>\n<li>Giai \u0111o\u1ea1n 3: X\u01a1 gan c\u00f3 b\u1ee5ng b\u00e1ng, c\u00f3 th\u1ec3 k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m theo c\u00e1c gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/li>\n<li>Giai \u0111o\u1ea1n 4: X\u01a1 gan c\u00f3 ch\u1ea3y m\u00e1u t\u1ea1i c\u00e1c v\u1ecb tr\u00ed gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 b\u00e1ng b\u1ee5ng\n<p><figure style=\"width: 509px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"r48jcc pT0Scc iPVvYb\" src=\"https:\/\/vinmec-prod.s3.amazonaws.com\/images\/20200130_151453_689583_noi-soi.max-1800x1800.png\" alt=\"Minh-hoa-gian-tinh-mach-thuc-quan-trong-xo-gan\" width=\"509\" height=\"395\" \/><figcaption class=\"wp-caption-text\">Gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n trong x\u01a1 gan<\/figcaption><\/figure><\/li>\n<\/ul>\n<p>Theo h\u1ec7 th\u1ed1ng ph\u00e2n giai \u0111o\u1ea1n n\u00e0y, giai \u0111o\u1ea1n 1 v\u00e0 2 t\u01b0\u01a1ng \u1ee9ng v\u1edbi x\u01a1 gan c\u00f2n b\u00f9; giai \u0111o\u1ea1n 3 v\u00e0 4 t\u01b0\u01a1ng \u1ee9ng v\u1edbi x\u01a1 gan m\u1ea5t b\u00f9.<\/p>\n<h2>3. Ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n x\u01a1 gan<\/h2>\n<p>Nguy\u00ean nh\u00e2n g\u00e2y ch\u1ebft \u1edf c\u00e1c b\u1ec7nh nh\u00e2n x\u01a1 gan m\u1ea5t b\u00f9 th\u01b0\u1eddng ch\u00ednh l\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a b\u1ec7nh l\u00fd x\u01a1 gan v\u00e0 suy c\u00e1c c\u01a1 quan kh\u00e1c ngo\u00e0i gan. C\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn t\u0103ng \u00e1p l\u1ef1c h\u1ec7 t\u0129nh m\u1ea1ch c\u1eeda, HCC hay nhi\u1ec5m tr\u00f9ng l\u00e0 c\u00e1c nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u. C\u00f2n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n x\u01a1 gan c\u00f2n b\u00f9 th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn bi\u1ebfn c\u1ed1 tim m\u1ea1ch; \u0111\u1ed9t qu\u1ef5 v\u00e0 b\u1ec7nh th\u1eadn.<\/p>\n<p>Theo s\u1ed1 li\u1ec7u th\u1ed1ng k\u00ea t\u1eeb m\u1ed9t s\u1ed1 b\u00e1o c\u00e1o t\u1ea1i Hoa K\u1ef3, x\u01a1 gan l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ch\u1ebft \u0111\u1ee9ng h\u00e0ng th\u1ee9 3 \u1edf nh\u00f3m d\u00e2n s\u1ed1 t\u1eeb 45 \u0111\u1ebfn 64 tu\u1ed5i. So v\u1edbi d\u00e2n s\u1ed1 chung, b\u1ec7nh nh\u00e2n x\u01a1 gan giai \u0111o\u1ea1n c\u00f2n b\u00f9 c\u00f3 nguy c\u01a1 t\u1eed vong t\u0103ng g\u1ea5p 5 l\u1ea7n d\u00e2n s\u1ed1 chung v\u00e0 nguy c\u01a1 g\u1ea5p 10 l\u1ea7n n\u1ebfu r\u01a1i v\u00e0o giai \u0111o\u1ea1n m\u1ea5t b\u00f9. B\u00ecnh qu\u00e2n tri\u1ec3n v\u1ecdng s\u1ed1ng c\u1ee7a m\u1ed9t b\u1ec7nh nh\u00e2n x\u01a1 gan c\u00f2n b\u00f9 l\u00e0 9-12 n\u0103m v\u00e0 gi\u1ea3m ch\u1ec9 c\u00f2n 2 n\u0103m khi ti\u1ebfn tri\u1ec3n v\u00e0o giai \u0111o\u1ea1n m\u1ea5t b\u00f9.<\/p>\n<p>M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u1edf \u0110an M\u1ea1ch ch\u1ec9 ra, t\u1ef7 l\u1ec7 s\u1ed1ng sau 1 n\u0103m l\u00e0 80% \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ea3y m\u00e1u c\u00e1c v\u1ecb tr\u00ed gi\u00e3n t\u0129nh m\u1ea1ch, 71% \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u00e1ng b\u1ee5ng, 51% \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3 hai v\u00e0 36% khi b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn ch\u1ee9ng b\u1ec7nh n\u00e3o gan.<\/p>\n<p>Ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh nh\u00e2n x\u01a1 gan kh\u00f4ng ch\u1ec9 ph\u1ee5 thu\u1ed1c c\u00e1c giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh m\u00e0 c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc. M\u1ed9t s\u1ed1 thang \u0111i\u1ec3m d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n x\u01a1 gan nh\u01b0 Child-Turcotte-Pugh (hay th\u01b0\u1eddng g\u1ecdi l\u00e0 Child-Pugh), MELD; \u0111\u1ecbnh l\u01b0\u1ee3ng y\u1ebfu t\u1ed1 von Willebrand, \u0111o ch\u00eanh \u00e1p t\u0129nh m\u1ea1ch gan c\u0169ng c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng. Y\u1ebfu t\u1ed1 von Willebrand &gt; 315% cho th\u1ea5y nguy c\u01a1 m\u1ea5t b\u00f9 cao h\u01a1n. Ch\u00eanh \u00e1p t\u0129nh m\u1ea1ch gan c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng cao nh\u01b0ng l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh x\u00e2m l\u1ea5n v\u00e0 \u0111\u1eaft ti\u1ec1n, ch\u01b0a ph\u00f9 h\u1ee3p d\u00f9ng r\u1ed9ng r\u00e3i trong l\u00e2m s\u00e0ng.<\/p>\n<p>C\u00e1ch t\u00ednh v\u00e0 \u1ee9ng d\u1ee5ng c\u1ee7a c\u00e1c thang \u0111i\u1ec3m nh\u01b0 Child-Pugh v\u00e0 MELD trong ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n x\u01a1 gan \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u trong c\u00e1c b\u00e0i vi\u1ebft ri\u00eang tr\u00ean chuy\u00ean trang <a href=\"https:\/\/vinmecdr.com\/\">https:\/\/vinmecdr.com\/<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>X\u01a1 gan l\u00e0 m\u1ed9t b\u1ec7nh gan m\u1ea1n t\u00ednh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1 h\u1ee7y ti\u1ebfn tri\u1ec3n c\u1ee7a t\u1ebf b\u00e0o gan v\u00e0 thay th\u1ebf ch\u00fang b\u1eb1ng m\u00f4 s\u1eb9o. S\u1ef1 x\u01a1 h\u00f3a nhu m\u00f4 gan c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy gi\u1ea3m ch\u1ee9c n\u0103ng gan, ch\u1eb3ng h\u1ea1n nh\u01b0 gi\u1ea3m kh\u1ea3 n\u0103ng l\u1ecdc \u0111\u1ed9c t\u1ed1 kh\u1ecfi m\u00e1u, s\u1ea3n [&hellip;]<\/p>\n","protected":false},"author":37,"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\u01a1 gan: B\u1ec7nh sinh, ph\u00e2n giai \u0111o\u1ea1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng - Vinmec<\/title>\n<meta name=\"description\" content=\"X\u01a1 gan l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u00f3 di\u1ec5n ti\u1ebfn \u0111a d\u1ea1ng, nhi\u1ec1u giai \u0111o\u1ea1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a m\u1ed7i giai \u0111o\u1ea1n c\u0169ng r\u1ea5t kh\u00e1c nhau.\" \/>\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=\"X\u01a1 gan: B\u1ec7nh sinh, ph\u00e2n giai \u0111o\u1ea1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng - 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