{"id":23851,"date":"2023-04-18T19:00:33","date_gmt":"2023-04-18T12:00:33","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=23851"},"modified":"2023-04-19T11:23:51","modified_gmt":"2023-04-19T04:23:51","slug":"quy-trinh-phau-thuat-cat-tui-mat-noi-soi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/quy-trinh-phau-thuat-cat-tui-mat-noi-soi\/","title":{"rendered":"Quy tr\u00ecnh ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt n\u1ed9i soi"},"content":{"rendered":"

Ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt n\u1ed9i soi l\u00e0 ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt, m\u1ed9t c\u01a1 quan h\u00ecnh qu\u1ea3 l\u00ea n\u1eb1m b\u00ean d\u01b0\u1edbi gan. T<\/b>h\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong c\u00e1c ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb s\u1ecfi t\u00fai m\u1eadt, polyp t\u00fai m\u1eadt v\u00e0 ung th\u01b0 t\u00fai m\u1eadt. Phillipe Mouret th\u1ef1c hi\u1ec7n l\u1ea7n \u0111\u1ea7u ti\u00ean v\u00e0o n\u0103m 1987 t\u1ea1i Lyon – Ph\u00e1p v\u00e0 \u1edf Vi\u1ec7t Nam v\u00e0o n\u0103m 1992. Ng\u00e0y nay, ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt n\u1ed9i soi \u0111\u01b0\u1ee3c ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i, l\u00e0 m\u1ed9t ph\u1eabu thu\u1eadt \u00edt x\u00e2m l\u1ea5n, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 xu\u1ea5t vi\u1ec7n v\u00e0 ph\u1ee5c h\u1ed3i s\u1edbm sau m\u1ed5.<\/strong><\/p>\n

1. Ch\u1ec9 \u0111\u1ecbnh<\/h2>\n

– S\u1ecfi t\u00fai m\u1eadt c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c k\u00edch th\u01b0\u1edbc l\u1edbn.
\n– Vi\u00eam t\u00fai m\u1eadt
\n– Polyp t\u00fai m\u1eadt c\u00f3 tri\u1ec7u ch\u1ee9ng, \u0111a polyp ho\u1eb7c polyp c\u00f3 k\u00edch th\u01b0\u1edbc > 1cm.<\/p>\n

2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h2>\n

– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a ph\u1eabu thu\u1eadt n\u1ed9i soi \u1ed5 b\u1ee5ng n\u00f3i chung: ti\u1ec1n s\u1eed m\u1ed5 b\u1ee5ng, kh\u00f4ng th\u1ec3 b\u01a1m CO2 khoang \u1ed5 b\u1ee5ng (do suy tim, b\u1ec7nh h\u00f4 h\u1ea5p\u2026)
\n– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a ph\u1eabu thu\u1eadt \u1ed5 b\u1ee5ng n\u00f3i chung: r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u1eb7ng, b\u1ec7nh l\u00fd tim m\u1ea1ch h\u00f4 h\u1ea5p kh\u00f4ng cho ph\u00e9p th\u1ef1c hi\u1ec7n g\u00e2y m\u00ea to\u00e0n th\u00e2n.<\/p>\n

3. Chu\u1ea9n b\u1ecb<\/h2>\n

3.1. Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n:\u00a0<\/strong>Ph\u1eabu thu\u1eadt vi\u00ean chuy\u00ean khoa Ngo\u1ea1i ti\u00eau ho\u00e1 – Gan m\u1eadt
\n3.2. Ph\u01b0\u01a1ng ti\u1ec7n:<\/strong>
\n– B\u00e0n m\u1ed5 c\u00f3 th\u1ec3 d\u1ea1ng ch\u00e2n, quay c\u00e1c chi\u1ec1u.
\n– Gi\u00e0n m\u00e1y m\u1ed5 n\u1ed9i soi: ngu\u1ed3n s\u00e1ng, m\u00e1y b\u01a1m kh\u00ed, kh\u00ed CO2, m\u00e0n h\u00ecnh, dao \u0111i\u1ec7n (\u0111\u01a1n c\u1ef1c v\u00e0 l\u01b0\u1ee1ng c\u1ef1c).
\n– B\u1ed9 d\u1ee5ng c\u1ee5 m\u1ed5 n\u1ed9i soi: 04 trocar (02 trocar 10mm; 02 trocar 5mm); banh c\u00f3 r\u0103ng – kh\u00f4ng r\u0103ng; m\u00f3c \u0111\u1ed1t \u0111i\u1ec7n; k\u00ecm c\u1eb7p clip; k\u00ecm c\u1eb7p kim; k\u00e9o; \u1ed1ng k\u00ednh 90o<\/sup> ho\u1eb7c 45o<\/sup>.
\n3.3. Ng\u01b0\u1eddi b\u1ec7nh:<\/strong>
\n– C\u00e1c x\u00e9t nghi\u1ec7m c\u01a1 b\u1ea3n ph\u1ee5c v\u1ee5 cu\u1ed9c m\u1ed5, l\u01b0u \u00fd ti\u1ec1n s\u1eed \u0111au, s\u1ed1t, v\u00e0ng da l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7 k\u00e8m theo.
\n– C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng gan.
\n– Si\u00eau \u00e2m \u1ed5 b\u1ee5ng t\u1ed1i thi\u1ec3u hai l\u1ea7n kh\u1eb3ng \u0111\u1ecbnh kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng \u1edf \u0111\u01b0\u1eddng m\u1eadt ch\u00ednh.
\n3.4. H\u1ed3 s\u01a1 b\u1ec7nh \u00e1n:<\/strong>
\n– Ho\u00e0n th\u00e0nh c\u00e1c th\u1ee7 t\u1ee5c h\u00e0nh ch\u00ednh theo quy \u0111\u1ecbnh: b\u1ec7nh \u00e1n chi ti\u1ebft, bi\u00ean b\u1ea3n h\u1ed9i ch\u1ea9n, bi\u00ean b\u1ea3n kh\u00e1m tr\u01b0\u1edbc khi g\u00e2y m\u00ea, gi\u1ea5y cam \u0111oan \u0111\u1ed3ng \u00fd ph\u1eabu thu\u1eadt.<\/p>\n

4. C\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh<\/h2>\n

4.1. Ki\u1ec3m tra h\u1ed3 s\u01a1:<\/strong> T\u00ean tu\u1ed5i ng\u01b0\u1eddi b\u1ec7nh, ch\u1ea9n \u0111o\u00e1n, ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/p>\n

\"C\u1eaft
\n4.2. Ki\u1ec3m tra ng\u01b0\u1eddi b\u1ec7nh:<\/strong> \u0110\u00fang ng\u01b0\u1eddi (t\u00ean, tu\u1ed5i,\u2026), \u0111\u00fang b\u1ec7nh.
\n4.3. Th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt:<\/strong>
\n4.3.1. T\u01b0 th\u1ebf:<\/em>
\n– Ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m ng\u1eeda, 2 ch\u00e2n c\u00f3 th\u1ec3 kh\u00e9p ho\u1eb7c d\u1ea1ng 90\u00b0, tay ph\u1ea3i kh\u00e9p, tay tr\u00e1i d\u1ea1ng 90\u00b0. M\u00e0n h\u00ecnh \u0111\u1eb7t \u1edf ph\u00eda \u0111\u1ea7u b\u00ean tay ph\u1ea3i ng\u01b0\u1eddi b\u1ec7nh.
\n– Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n \u0111\u1ee9ng b\u00ean tr\u00e1i ng\u01b0\u1eddi b\u1ec7nh, ng\u01b0\u1eddi ph\u1ee5 c\u1ea7m camera \u0111\u1ee9ng ph\u00eda d\u01b0\u1edbi ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n ho\u1eb7c gi\u1eefa 2 ch\u00e2n, d\u1ee5ng c\u1ee5 vi\u00ean \u0111\u1ee9ng ph\u00eda d\u01b0\u1edbi.
\n4.3.2. V\u00f4 c\u1ea3m:<\/em>
\n– M\u00ea n\u1ed9i kh\u00ed qu\u1ea3n.
\n– C\u00f3 \u0111\u1eb7t \u1ed1ng th\u00f4ng d\u1ea1 d\u00e0y, kh\u00f4ng c\u1ea7n \u0111\u1eb7t \u1ed1ng th\u00f4ng b\u00e0ng quang.
\n4.3.3. K\u1ef9 thu\u1eadt:<\/em>
\n– M\u1edf b\u1ee5ng theo k\u1ef9 thu\u1eadt mini-open \u1edf d\u01b0\u1edbi r\u1ed1n \u0111\u1ec3 \u0111\u1eb7t trocar 10mm. B\u01a1m h\u01a1i \u1ed5 b\u1ee5ng, duy tr\u00ec \u00e1p l\u1ef1c trong \u1ed5 b\u1ee5ng 10 – 12 mmHg.
\n– \u0110\u01b0a camera quan s\u00e1t, l\u1ef1a ch\u1ecdn v\u1ecb tr\u00ed \u0111\u1eb7t c\u00e1c trocar ti\u1ebfp theo: trocar 10mm d\u01b0\u1edbi m\u0169i \u1ee9c; trocar 5mm \u1edf b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng to ngang b\u00ean ph\u1ea3i r\u1ed1n; trocar 5mm \u1edf d\u01b0\u1edbi b\u1edd s\u01b0\u1eddn ph\u1ea3i \u0111\u01b0\u1eddng n\u00e1ch gi\u1eefa.
\n– Ch\u1ec9nh b\u00e0n t\u01b0 th\u1ebf \u0111\u1ea7u cao, nghi\u00eang tr\u00e1i t\u1ed1i \u0111a.
\n– D\u00f9ng banh c\u00f3 r\u0103ng \u0111\u01b0a qua l\u1ed7 trocar d\u01b0\u1edbi s\u01b0\u1eddn c\u1ea7m v\u00e0o \u0111\u00e1y t\u00fai m\u1eadt \u0111\u1ea9y l\u00ean tr\u00ean v\u00e0 sang ph\u1ea3i t\u1ed1i \u0111a \u0111\u1ec3 b\u1ed9c l\u1ed9 v\u00f9ng c\u1ed5 t\u00fai m\u1eadt v\u00e0 cu\u1ed1ng gan.
\n– D\u00f9ng banh kh\u00f4ng r\u0103ng \u0111\u01b0a qua l\u1ed7 trocar b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng c\u1ea7m v\u00e0o ph\u1ec5u t\u00fai m\u1eadt, quan s\u00e1t xem c\u00f3 b\u1ea5t th\u01b0\u1eddng \u1ed1ng m\u1eadt ch\u1ee7 (c\u00f3 gi\u00e3n kh\u00f4ng), \u1ed1ng c\u1ed5 t\u00fai m\u1eadt (c\u00f3 gi\u00e3n kh\u00f4ng).
\n– D\u00f9ng m\u00f3c dao \u0111i\u1ec7n ph\u1eabu t\u00edch v\u00e0o tam gi\u00e1c Calot \u1edf m\u1eb7t sau v\u00e0 m\u1eb7t tr\u01b0\u1edbc, b\u1ed9c l\u1ed9 \u0111\u01b0\u1ee3c \u0111\u1ed9ng m\u1ea1ch t\u00fai m\u1eadt, \u1ed1ng c\u1ed5 t\u00fai m\u1eadt.
\n– C\u1eb7p clip v\u00e0o \u0111\u1ed9ng m\u1ea1ch t\u00fai m\u1eadt v\u00e0 \u1ed1ng c\u1ed5 t\u00fai m\u1eadt, ph\u1ea3i nh\u00ecn r\u00f5 \u1ed1ng gan chung khi c\u1eb7p, d\u00f9ng k\u00e9o c\u1eaft \u0111\u1ed9ng m\u1ea1ch t\u00fai m\u1eadt v\u00e0 \u1ed1ng c\u1ed5 t\u00fai m\u1eadt. D\u00f9ng m\u00f3c \u0111i\u1ec7n gi\u1ea3i ph\u00f3ng gi\u01b0\u1eddng t\u00fai m\u1eadt t\u1ec9 m\u1ec9, c\u1ea7m m\u00e1u gi\u01b0\u1eddng t\u00fai m\u1eadt.
\n– Cho t\u00fai m\u1eadt v\u00e0o t\u00fai nylon, lau s\u1ea1ch \u1ed5 b\u1ee5ng, c\u1ea7m m\u00e1u k\u1ef9. Tr\u01b0\u1eddng h\u1ee3p vi\u00eam nhi\u1ec5m, d\u1ecbch m\u1eadt \u0111\u1ee5c b\u1ea9n c\u00f3 th\u1ee7ng t\u00fai m\u1eadt n\u00ean \u0111\u1eb7t d\u1eabn l\u01b0u d\u01b0\u1edbi gan v\u00e0 \u0111\u01b0a v\u00e0o \u1edf l\u1ed7 trocar d\u01b0\u1edbi s\u01b0\u1eddn ph\u1ea3i.
\n– L\u1ea5y t\u00fai m\u1eadt qua l\u1ed7 trocar r\u1ed1n, \u0111\u00f3ng c\u00e1c l\u1ed7 trocar b\u1eb1ng ch\u1ec9 ti\u00eau.<\/p>\n

5. Theo d\u00f5i sau ph\u1eabu thu\u1eadt<\/h2>\n