{"id":24136,"date":"2023-04-19T18:36:52","date_gmt":"2023-04-19T11:36:52","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24136"},"modified":"2023-04-20T16:23:37","modified_gmt":"2023-04-20T09:23:37","slug":"nhung-giai-phap-trong-phau-thuat-cat-tui-mat-kho","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/nhung-giai-phap-trong-phau-thuat-cat-tui-mat-kho\/","title":{"rendered":"Nh\u1eefng gi\u1ea3i ph\u00e1p trong ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt kh\u00f3"},"content":{"rendered":"

Ph\u1eabu thu\u1eadt n\u1ed9i soi l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1ed5 bi\u1ebfn nh\u1ea5t \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn trong ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt. Tuy nhi\u00ean n\u1ebfu \u0111i\u1ec1u ki\u1ec7n kh\u00f4ng thu\u1eadn l\u1ee3i, c\u1eaft t\u00fai m\u1eadt kh\u00f3, nh\u1eefng gi\u1ea3i ph\u00e1p k\u1ef9 thu\u1eadt thay th\u1ebf: d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da, d\u1eabn l\u01b0u t\u00fai m\u1eadt v\u00e0 k\u1ebft th\u00fac ph\u1eabu thu\u1eadt, c\u1eaft t\u00fai m\u1eadt b\u00e1n ph\u1ea7n, chuy\u1ec3n m\u1ed5 m\u1edf<\/a> gi\u00fap gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1.<\/strong><\/p>\n

1. Vai tr\u00f2 c\u1ee7a d\u1eabn l\u01b0u t\u00fai m\u1eadt qua da<\/h2>\n

\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n nguy c\u01a1 cao \u0111\u1ed1i v\u1edbi ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf nh\u01b0 d\u1eabn l\u01b0u t\u00fai m\u1eadt qua da n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t. Nh\u01b0 \u0111\u00e3 l\u01b0u \u00fd \u1edf tr\u00ean, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 l\u00e0m t\u0103ng \u0111\u1ed9 kh\u00f3 c\u1ee7a cu\u1ed9c ph\u1eabu thu\u1eadt bao g\u1ed3m: th\u1eddi gian c\u00e1c tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i h\u01a1n 72\u201396 gi\u1edd, s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u l\u1edbn h\u01a1n 18.000\/mm3<\/sup>, s\u1edd th\u1ea5y t\u00fai m\u1eadt, tu\u1ed5i cao v\u00e0 c\u00e1c b\u1ec7nh k\u00e8m theo, v\u00e0 nghi ng\u1edd t\u00fai m\u1eadt b\u1ecb ho\u1ea1i t\u1eed<\/p>\n

Th\u00f4ng th\u01b0\u1eddng, \u1ed1ng \u0111\u01b0\u1ee3c l\u01b0u \u0111\u1ebfn khi ti\u1ebfn h\u00e0nh c\u1eaft b\u1ecf t\u00fai m\u1eadt v\u00ec th\u01b0\u1eddng c\u00f3 s\u1ef1 t\u1eafc ngh\u1ebdn \u0111ang di\u1ec5n ra \u1edf \u1ed1ng t\u00fai m\u1eadt. Do \u0111\u00f3, k\u1ef9 thu\u1eadt n\u00e0y th\u1ef1c hi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng thu\u1eadn l\u1ee3i ph\u1eabu thu\u1eadt ho\u1eb7c ng\u01b0\u1eddi gi\u00e0 c\u00f3 nguy c\u01a1 cao v\u00e0 b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh n\u1eb7ng. C\u1ea7n l\u01b0u \u00fd r\u1eb1ng ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt n\u1ed9i soi sau m\u1edf th\u00f4ng t\u00fai m\u1eadt qua da v\u1eabn l\u00e0 m\u1ed9t ph\u1eabu thu\u1eadt kh\u00f3 v\u1edbi t\u1ef7 l\u1ec7 sai s\u00f3t trong kho\u1ea3ng 9\u201316%.<\/p>\n

M\u1ed9t s\u1ed1 nh\u00f3m \u0111\u00e3 ki\u1ec3m tra k\u1ebft qu\u1ea3 c\u1ee7a th\u1ee7 thu\u1eadt m\u1edf th\u00f4ng t\u00fai m\u1eadt qua da trong vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh. Trong m\u1ed9t nghi\u00ean c\u1ee9u, t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh d\u1ef1a tr\u00ean ti\u00eau ch\u00ed h\u01b0\u1edbng d\u1eabn c\u1ee7a Tokyo \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u1eeb n\u0103m 2001 \u0111\u1ebfn 2010. Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf 150 b\u1ec7nh nh\u00e2n v\u00e0 51 ng\u01b0\u1eddi \u0111\u01b0\u1ee3c d\u1eabn l\u01b0u qua da. B\u1ec7nh nh\u00e2n tr\u1ea3i qua d\u1eabn l\u01b0u qua da th\u00ec tu\u1ed5i l\u1edbn h\u01a1n, c\u00f3 s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng cao h\u01a1n v\u00e0 th\u1eddi gian n\u1eb1m ICU k\u00e9o d\u00e0i h\u01a1n. C\u00e1c bi\u1ebfn ch\u1ee9ng cao h\u01a1n m\u1ed9t ch\u00fat \u1edf nh\u00f3m d\u1eabn l\u01b0u qua da (2,9%so v\u1edbi 1,9%) v\u00e0 t\u00e1i nh\u1eadp vi\u1ec7n c\u0169ng cao h\u01a1n (31,4% so v\u1edbi 13,3%).<\/p>\n

M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c s\u1eed d\u1ee5ng c\u01a1 s\u1edf d\u1eef li\u1ec7u c\u1ee7a Hi\u1ec7p h\u1ed9i y t\u1ebf c\u00e1c Tr\u01b0\u1eddng \u0111\u1ea1i h\u1ecdc cho th\u1ea5y nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh n\u1eb7ng tr\u1ea3i qua th\u1ee7 thu\u1eadt m\u1edf th\u00f4ng t\u00fai m\u1eadt qua da \u0111\u00e3 gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh, \u00edt ph\u1ea3i nh\u1eadp vi\u1ec7n ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t h\u01a1n, th\u1eddi gian n\u1eb1m vi\u1ec7n ng\u1eafn h\u01a1n v\u00e0 chi ph\u00ed th\u1ea5p h\u01a1n so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt n\u1ed9i soi ho\u1eb7c m\u1ed5 h\u1edf.\u00a0T\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh khi \u0111i\u1ec1u tr\u1ecb l\u00e0 8,7% \u1edf nh\u00f3m d\u1eabn l\u01b0u qua da so v\u1edbi 47% \u1edf nh\u00f3m c\u1eaft b\u1ecf t\u00fai m\u1eadt c\u1ea5p c\u1ee9u v\u00e0 bao g\u1ed3m hai l\u1ea7n r\u00f2 r\u1ec9 m\u1eadt c\u1ea7n ph\u1ea3i m\u1ed5 l\u1ea1i sau m\u1ed5 ng\u00e0y th\u1ee9 nh\u1ea5t.<\/p>\n

G\u1ea7n \u0111\u00e2y, Dimou v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 th\u1ef1c hi\u1ec7n ph\u00e2n t\u00edch \u0111i\u1ec3m xu h\u01b0\u1edbng c\u1ee7a nh\u1eefng b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i b\u1ecb vi\u00eam t\u00fai m\u1eadt \u0111\u1ed9 III v\u00e0 \u0111\u1eb7t \u1ed1ng th\u00f4ng m\u1eadt b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng d\u1eef li\u1ec7u c\u1ee7a Medicare t\u1eeb n\u0103m 1996 \u0111\u1ebfn 2010. Trong s\u1ed1 8188 b\u1ec7nh nh\u00e2n vi\u00eam t\u00fai m\u1eadt \u0111\u1ed9 III, 565 (6,4%) \u0111\u00e3 \u0111\u1eb7t \u1ed1ng th\u00f4ng m\u1eadt.<\/p>\n

So v\u1edbi 1689 b\u1ec7nh nh\u00e2n ph\u00f9 h\u1ee3p v\u1edbi xu h\u01b0\u1edbng m\u00e0 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng d\u1eabn l\u01b0u t\u00fai m\u1eadt qua da, h\u1ecd ph\u00e1t hi\u1ec7n ra r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ea3i qua ph\u1eabu thu\u1eadt m\u1edf th\u00f4ng t\u00fai m\u1eadt qua da \u00edt c\u00f3 kh\u1ea3 n\u0103ng ph\u1ea3i c\u1eaft b\u1ecf t\u00fai m\u1eadt h\u01a1n (33,4% so v\u1edbi 64,4%) v\u00e0 th\u1eddi gian s\u1ed1ng 30 ng\u00e0y, 90 ng\u00e0y v\u00e0 2 n\u0103m cao h\u01a1n t\u1ef7 l\u1ec7 t\u00e1i nh\u1eadp vi\u1ec7n v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong trong 30 ng\u00e0y v\u00e0 2 n\u0103m cao h\u01a1n (t\u1ef7 l\u1ec7 r\u1ee7i ro 1,26 v\u00e0 1,19).<\/p>\n

El-Gendi v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 t\u1eeb m\u1ed9t th\u1eed nghi\u1ec7m ti\u1ec1n c\u1ee9u so s\u00e1nh c\u1eaft b\u1ecf t\u00fai m\u1eadt kh\u1ea9n c\u1ea5p v\u1edbi c\u1eaft b\u1ecf t\u00fai m\u1eadt n\u1ed9i soi tr\u00ec ho\u00e3n 6 tu\u1ea7n sau ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt t\u00e2n sinh qua da \u1edf b\u1ec7nh nh\u00e2n vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u1ed9 II. Vi\u00eam t\u00fai m\u1eadt \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft nhanh ch\u00f3ng b\u1eb1ng c\u1ea3 hai ph\u01b0\u01a1ng ph\u00e1p. Nh\u00f3m c\u1eaft t\u00fai m\u1eadt n\u1ed9i soi s\u1edbm c\u00f3 t\u1ef7 l\u1ec7 chuy\u1ec3n \u0111\u1ed5i cao h\u01a1n (24% so v\u1edbi 2,7%), th\u1eddi gian m\u1ed5 d\u00e0i h\u01a1n, m\u1ea5t m\u00e1u nhi\u1ec1u h\u01a1n v\u00e0 th\u1eddi gian n\u1eb1m vi\u1ec7n sau m\u1ed5 l\u00e2u h\u01a1n so v\u1edbi nh\u00f3m c\u1eaft t\u00fai m\u1eadt qua da.<\/p>\n

C\u00e1c bi\u1ebfn ch\u1ee9ng sau ph\u1eabu thu\u1eadt c\u0169ng ph\u1ed5 bi\u1ebfn h\u01a1n \u0111\u00e1ng k\u1ec3 \u1edf nh\u00f3m c\u1eaft b\u1ecf t\u00fai m\u1eadt s\u1edbm (26,7% so v\u1edbi 2,7%), bao g\u1ed3m t\u0103ng t\u1ef7 l\u1ec7 r\u00f2 r\u1ec9 m\u1eadt (10,7%). K\u1ebft h\u1ee3p l\u1ea1i v\u1edbi nhau, nh\u1eefng nghi\u00ean c\u1ee9u n\u00e0y s\u1ebd g\u1ee3i \u00fd r\u1eb1ng vi\u1ec7c \u0111\u1eb7t \u1ed1ng th\u00f4ng t\u00fai m\u1eadt qua da s\u1ebd c\u1ea3i thi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ph\u00f9 h\u1ee3p.<\/p>\n

2. Th\u1ee7 t\u1ee5c thay th\u1ebf ho\u1eb7c gi\u1ea3i c\u1ee9u trong t\u00fai m\u1eadt kh\u00f3 kh\u0103n<\/h2>\n

\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang tr\u1ea3i qua ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt v\u00e0 c\u00e1c \u0111i\u1ec1u ki\u1ec7n \u0111\u01b0\u1ee3c coi l\u00e0 qu\u00e1 kh\u00f3 kh\u0103n ho\u1eb7c nguy hi\u1ec3m \u0111\u1ec3 ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf trong tam gi\u00e1c gan m\u1eadt v\u00e0\/ho\u1eb7c khi CVS kh\u00f4ng th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c, n\u00ean xem x\u00e9t m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf ho\u1eb7c gi\u1ea3i c\u1ee9u. M\u1ed9t l\u1ef1a ch\u1ecdn \u0111\u01a1n gi\u1ea3n l\u00e0 \u0111\u1eb7t m\u1ed9t \u1ed1ng th\u00f4ng m\u1eadt ph\u1eabu thu\u1eadt v\u00e0o v\u00e0 k\u1ebft th\u00fac cu\u1ed9c ph\u1eabu thu\u1eadt. \u0110i\u1ec1u n\u00e0y s\u1ebd \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1eb7c bi\u1ec7t n\u1ebfu kh\u00f3 \u0111\u1ec3 b\u1ed9c l\u1ed9 to\u00e0n b\u1ed9 t\u00fai m\u1eadt.<\/p>\n

M\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e3 xem x\u00e9t 41 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u t\u00fai m\u1eadt do d\u00ednh ho\u1eb7c vi\u00eam nghi\u00eam tr\u1ecdng g\u1eb7p ph\u1ea3i khi ph\u1eabu thu\u1eadt. Trong s\u1ed1 n\u00e0y, 33 b\u1ec7nh nh\u00e2n sau \u0111\u00f3 \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf t\u00fai m\u1eadt sau trung b\u00ecnh 60 ng\u00e0y sau khi \u0111\u1eb7t \u1ed1ng. C\u00e1c ca n\u00e0y \u0111\u01b0\u1ee3c m\u1ed5 n\u1ed9i soi ho\u00e0n th\u00e0nh 28 ca, chuy\u1ec3n m\u1ed5 m\u1edf 1 ca v\u00e0 4 ca b\u1eaft \u0111\u1ea7u m\u1ed5 m\u1edf. Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y g\u1ee3i \u00fd r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec1u ki\u1ec7n ph\u1eabu thu\u1eadt kh\u00f4ng thu\u1eadn l\u1ee3i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd th\u00e0nh c\u00f4ng b\u1eb1ng d\u1eabn l\u01b0u \u1ed1ng th\u00f4ng t\u00fai m\u1eadt sau \u0111\u00f3 c\u1eaft b\u1ecf t\u00fai m\u1eadt c\u00e1ch qu\u00e3ng v\u00e0o th\u1eddi \u0111i\u1ec3m thu\u1eadn l\u1ee3i h\u01a1n (\u22652 th\u00e1ng sau) khi t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ea5p t\u00ednh \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft.<\/p>\n

3. Chuy\u1ec3n sang c\u1eaft t\u00fai m\u1eadt m\u1edf<\/h2>\n

C\u00e1ch ti\u1ebfp c\u1eadn th\u00f4ng th\u01b0\u1eddng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f3 kh\u0103n trong \u0111\u00f3 kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c ti\u1ebfn \u0111\u1ed9, kh\u00f4ng th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c CVS ho\u1eb7c c\u00f3 lo ng\u1ea1i v\u1ec1 ch\u1ea5n th\u01b0\u01a1ng theo truy\u1ec1n th\u1ed1ng l\u00e0 chuy\u1ec3n sang ph\u1eabu thu\u1eadt m\u1edf. Tuy nhi\u00ean, chuy\u1ec3n \u0111\u1ed5i sang th\u1ee7 thu\u1eadt m\u1edf kh\u00f4ng b\u1ea3o v\u1ec7 ch\u1ed1ng l\u1ea1i t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng m\u1eadt ti\u1ec1m \u1ea9n, v\u00e0 quy\u1ebft \u0111\u1ecbnh chuy\u1ec3n \u0111\u1ed5i n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a ra trong b\u1ed1i c\u1ea3nh kinh nghi\u1ec7m c\u1ee7a b\u00e1c s\u0129 ph\u1eabu thu\u1eadt \u0111\u00f3 v\u1edbi th\u1ee7 thu\u1eadt m\u1edf. Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m c\u1ee7a B\u1ec9 tr\u00ean 1089 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh b\u1edfi 53 b\u00e1c s\u0129 ph\u1eabu thu\u1eadt kh\u00e1c nhau, chuy\u1ec3n sang m\u1ed5 h\u1edf x\u1ea3y ra \u1edf 116 b\u1ec7nh nh\u00e2n (11,7%). T\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng \u0111\u01b0\u1eddng m\u1eadt l\u00e0 13,7% trong nh\u00f3m n\u00e0y (16 b\u1ec7nh nh\u00e2n), trong \u0111\u00f3 c\u00f3 7 tr\u01b0\u1eddng h\u1ee3p l\u00e0 t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng m\u1eadt n\u1eb7ng (6,0%). ba trong s\u1ed1 nh\u1eefng v\u1ebft th\u01b0\u01a1ng n\u00e0y \u0111\u00e3 ph\u00e1t sinh sau khi chuy\u1ec3n \u0111\u1ed5i th\u00e0nh m\u1edf. Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y l\u00e0m n\u1ed5i b\u1eadt kh\u1ea3 n\u0103ng t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng m\u1eadt \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao. Do \u0111\u00f3, chuy\u1ec3n \u0111\u1ed5i sang ho\u1ea1t \u0111\u1ed9ng m\u1edf c\u00f3 th\u1ec3 kh\u00f4ng ph\u1ea3i l\u00e0 t\u00f9y ch\u1ecdn m\u1eb7c \u0111\u1ecbnh t\u1ed1t nh\u1ea5t trong tr\u01b0\u1eddng h\u1ee3p kh\u00f3 kh\u0103n. Thay v\u00e0o \u0111\u00f3, n\u1ebfu chuy\u00ean m\u00f4n ph\u00f9 h\u1ee3p kh\u00f4ng c\u00f3 s\u1eb5n cho ph\u1eabu thu\u1eadt m\u1edf (v\u00ed d\u1ee5, thi\u1ebfu kinh nghi\u1ec7m v\u1edbi ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt m\u1edf), th\u00ec ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt b\u00e1n ph\u1ea7n n\u1ed9i soi \u1ed5 b\u1ee5ng c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t c\u00e1ch ti\u1ebfp c\u1eadn t\u1ed1t h\u01a1n, ho\u1eb7c ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 k\u1ebft th\u00fac th\u1ee7 thu\u1eadt v\u00e0 chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u00f3 \u0111\u1ebfn m\u1ed9t trung t\u00e2m c\u00f3 chuy\u00ean m\u00f4n ph\u00f9 h\u1ee3p. Ch\u1eafc ch\u1eafn, m\u1ed9t ngo\u1ea1i l\u1ec7 l\u00e0 trong tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u n\u1eb7ng kh\u00f4ng th\u1ec3 ki\u1ec3m so\u00e1t b\u1eb1ng n\u1ed9i soi \u1ed5 b\u1ee5ng, trong \u0111\u00f3 chuy\u1ec3n ngay sang ph\u1eabu thu\u1eadt m\u1edf \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

4. C\u1eaft b\u1ecf t\u00fai m\u1eadt b\u00e1n ph\u1ea7n<\/h2>\n

Trong nh\u1eefng \u0111i\u1ec1u ki\u1ec7n c\u00f3 th\u1ec3 ti\u1ebfp c\u1eadn tam gi\u00e1c gan m\u1eadt nh\u01b0ng kh\u00f4ng th\u1ec3 b\u00f3c t\u00e1ch an to\u00e0n, n\u00ean c\u00e2n nh\u1eafc th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt b\u00e1n ph\u1ea7n. G\u1ea7n \u0111\u00e2y, nh\u00f3m c\u1ee7a ch\u00fang t\u00f4i \u0111\u00e3 c\u1ed1 g\u1eafng ti\u00eau chu\u1ea9n h\u00f3a danh ph\u00e1p xung quanh c\u1eaft b\u1ecf t\u00fai m\u1eadt b\u00e1n ph\u1ea7n th\u00e0nh hai lo\u1ea1i ph\u1ee5: l\u00e0m th\u1ee7ng ho\u1eb7c t\u00e1i t\u1ea1o. Trong th\u1ee7 thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt l\u00e0m th\u1ee7ng, c\u1ed5 t\u00fai m\u1eadt \u0111\u01b0\u1ee3c \u0111\u1ec3 m\u1edf v\u00e0 \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u t\u00fai m\u1eadt. Trong lo\u1ea1i t\u00e1i t\u1ea1o, c\u1ed5 c\u1ee7a t\u00fai m\u1eadt \u0111\u01b0\u1ee3c ghim ho\u1eb7c kh\u00e2u k\u00edn \u0111\u1ec3 l\u1ea1i ph\u1ea7n c\u00f2n l\u1ea1i \u0111\u00f3ng k\u00edn.<\/p>\n

C\u00e1c nguy\u00ean t\u1eafc c\u1ee7a ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt b\u00e1n ph\u1ea7n bao g\u1ed3m m\u1edf t\u00fai m\u1eadt ph\u00eda tr\u00ean tam gi\u00e1c gan m\u1eadt v\u00e0 \u0111\u1ec3 l\u1ea1i m\u1ed9t \u201ct\u1ea5m ch\u1eafn\u201d ho\u1eb7c v\u00f2ng b\u00edt \u1edf c\u1ed5 t\u00fai m\u1eadt \u0111\u1ec3 b\u1ea3o v\u1ec7 c\u00e1c c\u1ea5u tr\u00fac \u0111\u01b0\u1eddng m\u1eadt. T\u1ea5t c\u1ea3 s\u1ecfi ph\u1ea3i \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf v\u00e0 m\u1eb7t tr\u01b0\u1edbc v\u00e0 hai b\u00ean c\u1ee7a t\u00fai m\u1eadt \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf \u0111\u1ec3 l\u1ea1i th\u00e0nh sau, m\u1eb7c d\u00f9 ng\u01b0\u1eddi ta c\u0169ng c\u00f3 th\u1ec3 c\u1eaft b\u1ecf ho\u00e0n to\u00e0n th\u00e0nh sau c\u1ee7a t\u00fai m\u1eadt. N\u1ebfu c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y l\u1ed7 \u1ed1ng t\u00fai m\u1eadt, ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua \u1ed1ng t\u00fai m\u1eadt. N\u00f3 c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c kh\u00e2u tr\u1ef1c ti\u1ebfp. M\u1ed9t \u1ed1ng d\u1eabn l\u01b0u n\u00ean \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00ec nguy c\u01a1 r\u00f2 r\u1ec9 m\u1eadt.<\/p>\n

\"C\u1eaft
C\u1eaft t\u00fai m\u1eadt b\u00e1n ph\u1ea7n v\u1edbi m\u1ed9t k\u1eb9p (m\u0169i t\u00ean) \u1edf v\u1ecb tr\u00ed c\u1ed5 t\u00fai m\u1eadt ( v\u00f9ng khoanh tr\u00f2n)<\/figcaption><\/figure>\n

5. S\u1ef1 gi\u00fap \u0111\u1ee1 \u0111\u1ed3ng nghi\u1ec7p<\/h2>\n

Cu\u1ed1i c\u00f9ng, m\u1ed9t kh\u00e1i ni\u1ec7m quan tr\u1ecdng trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f3 kh\u0103n l\u00e0 nh\u1edd \u0111\u1ed3ng nghi\u1ec7p gi\u00fap \u0111\u1ee1 n\u1ebfu th\u1ef1c t\u1ebf ho\u1eb7c c\u00f3 th\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c, ngay c\u1ea3 khi \u0111\u00f3 ch\u1ec9 l\u00e0 \u00fd ki\u1ebfn th\u1ee9 hai. C\u00e1ch ti\u1ebfp c\u1eadn nh\u01b0 v\u1eady kh\u00f4ng bao gi\u1edd n\u00ean \u0111\u01b0\u1ee3c coi l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a s\u1ef1 thi\u1ebfu kinh nghi\u1ec7m ho\u1eb7c n\u0103ng l\u1ef1c, m\u00e0 \u0111\u00fang h\u01a1n, \u0111i\u1ec1u n\u00e0y ph\u1ea3n \u00e1nh s\u1ef1 ph\u00e1n \u0111o\u00e1n t\u1ed1t. \u0110\u00e2y c\u0169ng l\u00e0 m\u1ed9t trong nh\u1eefng c\u00e1c nguy\u00ean t\u1eafc c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh C\u1eaft t\u00fai m\u1eadt an to\u00e0n c\u1ee7a Society of American Gastrointestinal and Endoscopic Surgeons <\/em>(SAGES).<\/p>\n

Nh\u1eadn tr\u1ee3 gi\u00fap \u0111\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f3 c\u00f3 th\u1ec3 \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng n\u1ebfu qu\u00e1 tr\u00ecnh b\u00f3c t\u00e1ch b\u1ecb \u0111\u00ecnh tr\u1ec7 ho\u1eb7c kh\u00f4ng th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c quan \u0111i\u1ec3m quan tr\u1ecdng v\u1ec1 an to\u00e0n, gi\u1ea3i ph\u1eabu kh\u00f4ng r\u00f5 r\u00e0ng, c\u00f3 m\u1ed1i lo ng\u1ea1i v\u1ec1 t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng m\u1eadt c\u00f3 th\u1ec3 x\u1ea3y ra ho\u1eb7c c\u00f3 nh\u1eefng \u0111i\u1ec1u ki\u1ec7n kh\u00e1c \u0111\u01b0\u1ee3c coi l\u00e0 kh\u00f3 kh\u0103n.<\/p>\n

Ngu\u1ed3n: The Difficult Cholecystectomy, The SAGES Manual of Biliary Surgery 2020<\/p>\n","protected":false},"excerpt":{"rendered":"

Ph\u1eabu thu\u1eadt n\u1ed9i soi l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1ed5 bi\u1ebfn nh\u1ea5t \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn trong ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt. Tuy nhi\u00ean n\u1ebfu \u0111i\u1ec1u ki\u1ec7n kh\u00f4ng thu\u1eadn l\u1ee3i, c\u1eaft t\u00fai m\u1eadt kh\u00f3, nh\u1eefng gi\u1ea3i ph\u00e1p k\u1ef9 thu\u1eadt thay th\u1ebf: d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da, d\u1eabn l\u01b0u t\u00fai m\u1eadt v\u00e0 k\u1ebft th\u00fac ph\u1eabu thu\u1eadt, […]<\/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":"\nNh\u1eefng gi\u1ea3i ph\u00e1p trong ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt kh\u00f3 - Vinmec<\/title>\n<meta name=\"description\" content=\"Trong tr\u01b0\u1eddng h\u1ee3p c\u1eaft t\u00fai m\u1eadt kh\u00f3, nh\u1eefng gi\u1ea3i ph\u00e1p k\u1ef9 thu\u1eadt thay th\u1ebf: d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da, d\u1eabn l\u01b0u t\u00fai m\u1eadt v\u00e0 k\u1ebft th\u00fac ph\u1eabu thu\u1eadt, c\u1eaft t\u00fai m\u1eadt b\u00e1n ph\u1ea7n, chuy\u1ec3n m\u1ed5 m\u1edf c\u1eaft t\u00fai m\u1eadt gi\u00fap gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1.\" \/>\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=\"Nh\u1eefng gi\u1ea3i ph\u00e1p trong ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt kh\u00f3 - 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