{"id":24127,"date":"2023-04-18T18:45:10","date_gmt":"2023-04-18T11:45:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24127"},"modified":"2023-04-19T11:31:36","modified_gmt":"2023-04-19T04:31:36","slug":"viem-tui-mat-va-nhung-kho-khan-khi-phau-thuat","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/viem-tui-mat-va-nhung-kho-khan-khi-phau-thuat\/","title":{"rendered":"Vi\u00eam t\u00fai m\u1eadt v\u00e0 nh\u1eefng kh\u00f3 kh\u0103n khi ph\u1eabu thu\u1eadt"},"content":{"rendered":"<p><strong>Xem x\u00e9t tr\u01b0\u1edbc v\u00e0 c\u00f3 hi\u1ec3u bi\u1ebft v\u1ec1 vi\u00eam t\u00fai m\u1eadt gi\u00fap l\u1eadp k\u1ebf ho\u1ea1ch v\u00e0 do \u0111\u00f3, t\u1ea1o ti\u1ec1n \u0111\u1ec1 cho ph\u00e1n \u0111o\u00e1n t\u1ed1t trong ph\u1eabu thu\u1eadt. Vi\u1ec7c c\u00f4ng nh\u1eadn c\u00e1c s\u1eeda \u0111\u1ed5i v\u00e0 chi\u1ebfn l\u01b0\u1ee3c k\u1ef9 thu\u1eadt m\u00e0 ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u01b0 v\u1eady c\u00f3 th\u1ec3 n\u00e2ng cao h\u01a1n n\u1eefa kh\u1ea3 n\u0103ng th\u00e0nh c\u00f4ng c\u1ee7a ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt kh\u00f3.<\/strong><\/p>\n<h2>1. Kh\u00f3 kh\u0103n trong vi\u00eam t\u00fai m\u1eadt c\u1ea5p<\/h2>\n<p>Vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y kh\u00f3 kh\u0103n cho vi\u1ec7c b\u00f3c t\u00e1ch t\u00fai m\u1eadt v\u00e0 chi\u1ebfm 10% trong t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1eaft b\u1ecf t\u00fai m\u1eadt. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 bi\u1ec3u hi\u1ec7n \u0111au dai d\u1eb3ng \u1edf h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, b\u1ea1ch c\u1ea7u (WBC) t\u0103ng cao v\u00e0 k\u1ebft qu\u1ea3 si\u00eau \u00e2m cho th\u1ea5y th\u00e0nh t\u00fai m\u1eadt d\u00e0y l\u00ean (&gt; 3mm), s\u1ecfi m\u1eadt v\u00e0 d\u1ecbch quanh t\u00fai m\u1eadt. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u00fai m\u1eadt c\u1ea5p g\u1ea7n \u0111\u00e2y \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1eadp nh\u1eadt trong <strong>h\u01b0\u1edbng d\u1eabn Tokyo Guideline 2018<\/strong>. Ch\u00fang bao g\u1ed3m:<\/p>\n<ul>\n<li>(A) c\u00e1c d\u1ea5u hi\u1ec7u vi\u00eam t\u1ea1i ch\u1ed7 ho\u1eb7c kh\u1ed1i \u1edf g\u00f3c ph\u1ea7n t\u01b0 ph\u00eda tr\u00ean b\u00ean ph\u1ea3i\/\u0111au<\/li>\n<li>(B) c\u00e1c d\u1ea5u hi\u1ec7u vi\u00eam to\u00e0n th\u00e2n (s\u1ed1t, protein ph\u1ea3n \u1ee9ng C t\u0103ng cao, s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng cao)<\/li>\n<li>(C) c\u00e1c d\u1ea5u hi\u1ec7u h\u00ecnh \u1ea3nh c\u1ee7a vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh.<\/li>\n<\/ul>\n<p>B\u00ean c\u1ea1nh d\u1ea5u hi\u1ec7u Murphy d\u01b0\u01a1ng t\u00ednh khi kh\u00e1m th\u1ef1c th\u1ec3, d\u1ea5u hi\u1ec7u n\u00e0y c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n khi kh\u00e1m si\u00eau \u00e2m.<\/p>\n<p>Nh\u1eefng th\u00e1ch th\u1ee9c k\u1ef9 thu\u1eadt c\u1ee7a vi\u00eam t\u00fai m\u1eadt c\u1ea5p ch\u1ee7 y\u1ebfu li\u00ean quan \u0111\u1ebfn qu\u00e1 tr\u00ecnh vi\u00eam x\u1ea3y ra. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nghi\u00eam tr\u1ecdng h\u01a1n, m\u1ed9t t\u00fai m\u1ea1c n\u1ed1i c\u00f3 th\u1ec3 bao b\u1ecdc t\u00fai m\u1eadt v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn kh\u00f3 nh\u00ecn th\u1ea5y t\u00fai m\u1eadt v\u00e0 t\u0103ng ch\u1ea3y m\u00e1u trong ph\u1eabu thu\u1eadt. C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c c\u1ee7a vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh bao g\u1ed3m t\u00fai m\u1eadt ho\u1ea1i t\u1eed, vi\u00eam t\u00fai m\u1eadt kh\u00ed th\u1ee7ng v\u00e0 \u00e1p xe th\u1ee7ng. Do qu\u00e1 tr\u00ecnh vi\u00eam c\u1ea5p t\u00ednh, h\u00ecnh \u1ea3nh c\u1ee7a \u0111\u1ea1i tr\u00e0ng v\u00e0 t\u00e1 tr\u00e0ng c\u00f3 th\u1ec3 b\u1ecb che khu\u1ea5t, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng ru\u1ed9t. T\u00ecnh tr\u1ea1ng vi\u00eam d\u00ednh \u1edf tam gi\u00e1c gan m\u1eadt c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn kh\u00f3 b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch gan v\u00e0 \u1ed1ng m\u1eadt ch\u1ee7. C\u0169ng c\u00f3 th\u1ec3 c\u00f3 s\u1ef1 vi\u00eam d\u00ednh t\u00fai m\u1eadt v\u00e0o gi\u01b0\u1eddng t\u00fai m\u1eadt.<\/p>\n<p>C\u00e1c d\u1ea1ng gi\u1ea3i ph\u1eabu kh\u00e1c nhau \u1ed1ng m\u1eadt k\u1ebft h\u1ee3p v\u1edbi c\u00e1c t\u00ecnh hu\u1ed1ng vi\u00eam nhi\u1ec5m n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng th\u00eam nguy c\u01a1 c\u1ee7a c\u00e1c th\u1ee7 thu\u1eadt n\u00e0y. Ph\u00f2ng ng\u1eeba nh\u1eefng t\u00ecnh hu\u1ed1ng n\u00e0y t\u1ed1t nh\u1ea5t b\u1eb1ng c\u00e1ch can thi\u1ec7p s\u1edbm trong vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh v\u1edbi m\u1ee5c ti\u00eau can thi\u1ec7p trong v\u00f2ng 72 gi\u1edd k\u1ec3 t\u1eeb khi c\u00f3 tri\u1ec7u ch\u1ee9ng. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng can thi\u1ec7p s\u1edbm c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c xu\u1ea5t vi\u1ec7n s\u1edbm h\u01a1n, v\u1ebft m\u1ed5 \u00edt bi\u1ebfn ch\u1ee9ng h\u01a1n v\u00e0 chi ph\u00ed ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe th\u1ea5p h\u01a1n.<\/p>\n<p><strong>K\u1ef9 thu\u1eadt:<\/strong><\/p>\n<ul>\n<li>M\u1ed9t s\u1ed1 \u0111i\u1ec1u ch\u1ec9nh ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh. Khi c\u00e1c Trocar \u0111\u01b0\u1ee3c \u0111\u1eb7t, b\u01b0\u1edbc \u0111\u1ea7u ti\u00ean l\u00e0 xem x\u00e9t vi\u1ec7c ch\u1ecdc h\u00fat t\u00fai m\u1eadt b\u1eb1ng d\u1ee5ng c\u1ee5 kim h\u00fat \u0111\u1ec3 cho ph\u00e9p t\u00fai m\u1eadt \u0111\u01b0\u1ee3c l\u1ea5y ra d\u1ec5 d\u00e0ng h\u01a1n. Ngo\u00e0i ra, b\u01b0\u1edbc n\u00e0y l\u00e0m gi\u1ea3m nguy c\u01a1 th\u1ee7ng l\u00e0m m\u1eadt v\u00e0 s\u1ecfi tr\u00e0n ra ngo\u00e0i, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m cho vi\u1ec7c b\u00f3c t\u00e1ch sau \u0111\u00f3 tr\u1edf n\u00ean kh\u00f3 kh\u0103n h\u01a1n.<\/li>\n<\/ul>\n<figure id=\"attachment_24139\" aria-describedby=\"caption-attachment-24139\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-24139\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/vtm-300x186.png\" alt=\"Ch\u1ecdc h\u00fat t\u00fai m\u1eadt c\u0103ng \u1edf vi\u00eam t\u00fai m\u1eadt\" width=\"300\" height=\"186\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/vtm-300x186.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/vtm.png 641w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-24139\" class=\"wp-caption-text\">Ch\u1ecdc h\u00fat t\u00fai m\u1eadt c\u0103ng \u1edf b\u1ec7nh nh\u00e2n vi\u00eam t\u00fai m\u1eadt<\/figcaption><\/figure>\n<ul>\n<li>N\u1ebfu d\u00ednh m\u1ea1c n\u1ed1i l\u1edbn, ph\u1ea3i b\u00f3c t\u00e1ch kh\u1ecfi t\u00fai m\u1eadt. N\u1ebfu s\u1ecfi k\u1eb9t \u1edf c\u1ed5 t\u00fai m\u1eadt, c\u00f3 th\u1ec3 d\u00f9ng Grasper \u0111\u1ec3 c\u1ea7m n\u1eafm v\u00e0 \u0111\u1ea9y t\u00fai m\u1eadt v\u1ec1 ph\u00eda sau \u0111\u1ec3 thu\u1eadn ti\u1ec7n cho vi\u1ec7c b\u1ed9c l\u1ed9.<\/li>\n<li>H\u00ecnh \u1ea3nh trong ph\u1eabu thu\u1eadt v\u1edbi ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt th\u00f4ng th\u01b0\u1eddng, si\u00eau \u00e2m n\u1ed9i soi \u1ed5 b\u1ee5ng quan tr\u1ecdng trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f3 v\u00e0 \u0111\u1ec3 x\u00e1c minh gi\u1ea3i ph\u1eabu tr\u01b0\u1edbc khi k\u1eb9p ho\u1eb7c c\u1eaft b\u1ea5t k\u1ef3 c\u1ea5u tr\u00fac n\u00e0o.<\/li>\n<li>Cu\u1ed1i c\u00f9ng, c\u00e1c m\u1eb7t ph\u1eb3ng m\u00f4 ph\u00f9 n\u1ec1 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng t\u1ea1o kh\u00f3i li\u00ean quan \u0111\u1ebfn dao \u0111\u01a1n c\u1ef1c, trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00f3, s\u1eed d\u1ee5ng Harmonic c\u00f3 th\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho vi\u1ec7c b\u00f3c t\u00e1ch t\u00fai m\u1eadt t\u1eeb gi\u01b0\u1eddng. Tuy nhi\u00ean, ng\u01b0\u1eddi ta n\u00ean th\u1eadn tr\u1ecdng v\u1edbi ph\u01b0\u01a1ng ph\u00e1p n\u00e0y v\u00ec \u1ed1ng m\u1eadt v\u00e0 \u0111\u1ed9ng m\u1ea1ch gan v\u1eabn c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng khi qu\u00e1 tr\u00ecnh b\u00f3c t\u00e1ch ti\u1ebfn t\u1edbi tam gi\u00e1c gan m\u1eadt do s\u1ef1 d\u00ednh \u1edf khu v\u1ef1c n\u00e0y.<\/li>\n<\/ul>\n<h2>2. Kh\u00f3 kh\u0103n trong vi\u00eam t\u00fai m\u1eadt m\u1ea1n<\/h2>\n<p>Vi\u00eam t\u00fai m\u1eadt m\u1ea1n t\u00ednh n\u1eb7ng v\u1edbi t\u00fai m\u1eadt co r\u00fat c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn bi\u1ebfn d\u1ea1ng \u0111\u00e1ng k\u1ec3 gi\u1ea3i ph\u1eabu \u0111\u01b0\u1eddng m\u1eadt. S\u1ef1 co th\u1eaft c\u1ee7a t\u00fai m\u1eadt v\u1edbi th\u00e0nh t\u00fai m\u1eadt d\u00e0y m\u00e3n t\u00ednh c\u0169ng c\u00f3 th\u1ec3 g\u00e2y kh\u00f3 kh\u0103n trong vi\u1ec7c n\u1eafm v\u00e0 b\u1ed9c l\u1ed9 t\u00fai m\u1eadt. C\u00e1c m\u1eb7t ph\u1eb3ng m\u00f4 c\u00f3 th\u1ec3 kh\u00f4ng c\u00f2n r\u00f5 r\u00e0ng trong nh\u1eefng t\u00ecnh hu\u1ed1ng n\u00e0y do s\u1ef1 k\u1ebft h\u1ee3p vi\u00eam \u0111\u01b0\u1eddng m\u1eadt x\u1ea3y ra.<\/p>\n<p>X\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam t\u00fai m\u1eadt m\u00e3n t\u00ednh \u0111\u1ec3 s\u1eb5n s\u00e0ng \u0111\u1ed1i ph\u00f3 v\u1edbi nh\u1eefng th\u00e1ch th\u1ee9c trong ph\u1eabu thu\u1eadt. Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 xu h\u01b0\u1edbng \u0111\u00e3 c\u00f3 nhi\u1ec1u c\u01a1n \u0111au qu\u1eb7n m\u1eadt tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 l\u1edbn tu\u1ed5i h\u01a1n v\u00e0 gi\u1edbi t\u00ednh nam.<\/p>\n<figure id=\"attachment_24168\" aria-describedby=\"caption-attachment-24168\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-24168 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/vtmm-300x259.png\" alt=\"Vi\u00eam t\u00fai m\u1eadt\" width=\"300\" height=\"259\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/vtmm-300x259.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/vtmm.png 478w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-24168\" class=\"wp-caption-text\">Vi\u00eam t\u00fai m\u1eadt m\u1ea1n<\/figcaption><\/figure>\n<h2>3. H\u1ed9i ch\u1ee9ng Mirizzi<\/h2>\n<p>H\u1ed9i ch\u1ee9ng Mirizzi \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 t\u1eafc ngh\u1ebdn b\u00ean ngo\u00e0i c\u1ee7a \u1ed1ng gan chung do m\u1ed9t vi\u00ean s\u1ecfi l\u1edbn k\u1eb9t \u1edf c\u1ed5 t\u00fai m\u1eadt. T\u1ef7 l\u1ec7 m\u1eafc h\u1ed9i ch\u1ee9ng Mirizzi th\u1ea5p, x\u1ea3y ra \u1edf 2,7% trong s\u1ed1 t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n tr\u1ea3i qua ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt. C\u00f3 hai lo\u1ea1i ph\u1ee5 ch\u00ednh: lo\u1ea1i I trong \u0111\u00f3 c\u00f3 t\u1eafc ngh\u1ebdn t\u1eeb b\u00ean ngo\u00e0i ho\u1eb7c ch\u00e8n \u00e9p v\u00e0o \u1ed1ng m\u1eadt ch\u1ee7 do s\u1ecfi m\u1eadt l\u1edbn v\u00e0 lo\u1ea1i II trong \u0111\u00f3 c\u00f3 l\u1ed7 r\u00f2 gi\u1eefa c\u1ed5 t\u00fai m\u1eadt v\u00e0 \u1ed1ng m\u1eadt do s\u1ecfi l\u1edbn. Vi\u1ec7c nh\u1eadn bi\u1ebft h\u1ed9i ch\u1ee9ng Mirizzi tr\u01b0\u1edbc ph\u1eabu thu\u1eadt l\u00e0 ch\u00eca kh\u00f3a v\u00ec s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a l\u1ed7 r\u00f2 \u0111\u00f2i h\u1ecfi ph\u1eabu thu\u1eadt c\u1eaft gan-h\u1ed7ng tr\u00e0ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi m\u1ed9t b\u00e1c s\u0129 ph\u1eabu thu\u1eadt gan m\u1eadt tu\u1ef5. Nh\u1eadn bi\u1ebft s\u1edbm li\u00ean quan \u0111\u1ebfn vi\u1ec7c x\u00e1c \u0111\u1ecbnh m\u1ed9t vi\u00ean s\u1ecfi l\u1edbn \u1edf c\u1ed5 t\u00fai m\u1eadt v\u1edbi\u00a0 b\u1eb1ng ch\u1ee9ng v\u1ec1 m\u1ed9t \u1ed1ng gan chung gi\u00e3n tr\u00ean h\u00ecnh \u1ea3nh k\u1ebft h\u1ee3p v\u1edbi c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan t\u0103ng cao.<\/p>\n<figure id=\"attachment_24163\" aria-describedby=\"caption-attachment-24163\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-24163 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Mirizzi-syndrome-300x224.jpg\" alt=\"C\u1eaft t\u00fai m\u1eadt kh\u00f3 vi\u00eam t\u00fai m\u1eadt\" width=\"300\" height=\"224\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Mirizzi-syndrome-300x224.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Mirizzi-syndrome-1024x764.jpg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Mirizzi-syndrome-768x573.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Mirizzi-syndrome.jpg 1500w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-24163\" class=\"wp-caption-text\">H\u1ed9i ch\u1ee9ng Mirizzi<\/figcaption><\/figure>\n<p>Ch\u1ee5p m\u1eadt t\u1ee5y c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRCP) ho\u1eb7c <a href=\"https:\/\/vinmec.com\/vi\/tieu-hoa-gan-mat\/thong-tin-suc-khoe\/noi-soi-mat-tuy-nguoc-dong-duoc-thuc-hien-nhu-nao\/\">ch\u1ee5p m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng qua n\u1ed9i soi<\/a> (ERCP) c\u00f3 th\u1ec3 h\u1eefu \u00edch trong vi\u1ec7c thi\u1ebft l\u1eadp ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc ph\u1eabu thu\u1eadt v\u00e0 n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i n\u1ebfu c\u00f3 lo ng\u1ea1i v\u1ec1 l\u1ed7 r\u00f2.<\/p>\n<figure id=\"attachment_24167\" aria-describedby=\"caption-attachment-24167\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-24167\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/mirizzi-300x214.png\" alt=\"Vi\u00eam t\u00fai m\u1eadt\" width=\"300\" height=\"214\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/mirizzi-300x214.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/mirizzi.png 642w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-24167\" class=\"wp-caption-text\">H\u1ed9i ch\u1ee9ng Mirizzi v\u1edbi l\u1ed7 r\u00f2 t\u00fai m\u1eadt (GB) v\u00e0 t\u00e1 tr\u00e0ng (D)<\/figcaption><\/figure>\n<p>M\u1eb7c d\u00f9 t\u00fai m\u1eadt Mirizzi kh\u00f4ng c\u00f3 l\u1ed7 r\u00f2 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p n\u1ed9i soi, nh\u01b0ng \u0111\u00e2y th\u01b0\u1eddng l\u00e0 m\u1ed9t quy tr\u00ecnh kh\u00f3 kh\u0103n h\u01a1n v\u1edbi nguy c\u01a1 chuy\u1ec3n sang ph\u1eabu thu\u1eadt m\u1edf cao h\u01a1n. C\u00f3 th\u1ec3 kh\u00f4ng \u0111\u1ea3m b\u1ea3o m\u1eb7t ph\u1eb3ng b\u00f3c t\u00e1ch an to\u00e0n do t\u00ecnh tr\u1ea1ng vi\u00eam m\u00e3n t\u00ednh che l\u1ea5p gi\u1ea3i ph\u1eabu \u0111\u01b0\u1eddng m\u1eadt. M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p c\u1ee7a m\u01b0\u1eddi nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng t\u1ef7 l\u1ec7 chuy\u1ec3n \u0111\u1ed5i m\u1ed5 m\u1edf trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p m\u1eafc h\u1ed9i ch\u1ee9ng Mirizzi l\u00e0 41%. T\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng l\u00e0 20% v\u00e0 ph\u1eabu thu\u1eadt l\u1ea1i l\u00e0 6%. N\u1ebfu kh\u00f4ng th\u1ec3 b\u1ed9c l\u1ed9 CVS, n\u00ean xem x\u00e9t c\u1eaft t\u00fai m\u1eadt b\u00e1n ph\u1ea7n.<\/p>\n<p>Ngu\u1ed3n: The Difficult Cholecystectomy, The SAGES Manual of Biliary Surgery 2020<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Xem x\u00e9t tr\u01b0\u1edbc v\u00e0 c\u00f3 hi\u1ec3u bi\u1ebft v\u1ec1 vi\u00eam t\u00fai m\u1eadt gi\u00fap l\u1eadp k\u1ebf ho\u1ea1ch v\u00e0 do \u0111\u00f3, t\u1ea1o ti\u1ec1n \u0111\u1ec1 cho ph\u00e1n \u0111o\u00e1n t\u1ed1t trong ph\u1eabu thu\u1eadt. Vi\u1ec7c c\u00f4ng nh\u1eadn c\u00e1c s\u1eeda \u0111\u1ed5i v\u00e0 chi\u1ebfn l\u01b0\u1ee3c k\u1ef9 thu\u1eadt m\u00e0 ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u01b0 v\u1eady c\u00f3 th\u1ec3 n\u00e2ng [&hellip;]<\/p>\n","protected":false},"author":15,"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>Vi\u00eam t\u00fai m\u1eadt v\u00e0 nh\u1eefng kh\u00f3 kh\u0103n khi ph\u1eabu thu\u1eadt - Vinmec<\/title>\n<meta name=\"description\" content=\"Hi\u1ec3u bi\u1ebft v\u1ec1 vi\u00eam t\u00fai m\u1eadt cho ph\u00e9p l\u1eadp k\u1ebf ho\u1ea1ch v\u00e0 t\u1ea1o ti\u1ec1n \u0111\u1ec1 cho k\u1ebf ho\u1ea1ch ph\u1eabu thu\u1eadt v\u00e0 c\u00f3 chi\u1ebfn l\u01b0\u1ee3c t\u1ed1t h\u01a1n trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb tr\u00e1nh tai bi\u1ebfn.\" \/>\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=\"Vi\u00eam t\u00fai m\u1eadt v\u00e0 nh\u1eefng kh\u00f3 kh\u0103n khi ph\u1eabu thu\u1eadt - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Hi\u1ec3u bi\u1ebft v\u1ec1 vi\u00eam t\u00fai m\u1eadt cho ph\u00e9p l\u1eadp k\u1ebf ho\u1ea1ch v\u00e0 t\u1ea1o ti\u1ec1n \u0111\u1ec1 cho k\u1ebf ho\u1ea1ch ph\u1eabu thu\u1eadt v\u00e0 c\u00f3 chi\u1ebfn l\u01b0\u1ee3c t\u1ed1t h\u01a1n trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb tr\u00e1nh tai bi\u1ebfn.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/viem-tui-mat-va-nhung-kho-khan-khi-phau-thuat\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-18T11:45:10+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-19T04:31:36+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/vtm-300x186.png\" \/>\n<meta name=\"author\" content=\"Minh Tang Phuong\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Minh Tang Phuong\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/viem-tui-mat-va-nhung-kho-khan-khi-phau-thuat\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/viem-tui-mat-va-nhung-kho-khan-khi-phau-thuat\/\",\"name\":\"Vi\u00eam t\u00fai m\u1eadt v\u00e0 nh\u1eefng kh\u00f3 kh\u0103n khi ph\u1eabu thu\u1eadt - 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