{"id":24575,"date":"2023-05-16T00:32:59","date_gmt":"2023-05-15T17:32:59","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24575"},"modified":"2023-05-16T00:32:59","modified_gmt":"2023-05-15T17:32:59","slug":"dieu-tri-co-that-tam-vi-bang-phau-thuat-noi-soi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/16\/dieu-tri-co-that-tam-vi-bang-phau-thuat-noi-soi\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb co th\u1eaft t\u00e2m v\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt n\u1ed9i soi"},"content":{"rendered":"

Co th\u1eaft t\u00e2m v\u1ecb (Achalasia<\/a>)<\/b> l\u00e0 danh t\u1eeb do Von Mickulicz d\u00f9ng l\u1ea7n \u0111\u1ea7u ti\u00ean n\u0103m 1882 \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd c\u1ee7a th\u1ef1c qu\u1ea3n, trong \u0111\u00f3 hi\u1ec7n t\u01b0\u1ee3ng ch\u1ee7 y\u1ebfu l\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng (nhu \u0111\u1ed9ng) b\u00ecnh th\u01b0\u1eddng c\u1ee7a th\u1ef1c qu\u1ea3n v\u00e0 t\u00e2m v\u1ecb: m\u1ea5t ho\u00e0n to\u00e0n co b\u00f3p d\u1ea1ng nhu \u0111\u1ed9ng c\u1ee7a th\u1ef1c qu\u1ea3n v\u00e0 m\u1ea5t s\u1ef1 d\u00e3n n\u1edf \u0111\u1ed3ng b\u1ed9 c\u1ee7a c\u01a1 th\u1eaft t\u00e2m v\u1ecb.<\/strong><\/p>\n

\"\"<\/p>\n

1. T\u1ed5ng quan b\u1ec7nh co th\u1eaft t\u00e2m v\u1ecb<\/b><\/h2>\n

B\u1ec7nh co th\u1eaft t\u00e2m v\u1ecb \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm nh\u1ea5t trong nh\u1eefng b\u1ec7nh l\u00fd th\u1ef1c qu\u1ea3n. Thomas Villis (1674) l\u00e0 ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1ec7nh tr\u00ean nh\u1eefng ng\u01b0\u1eddi \u0111\u00e0n \u00f4ng \u1edf Oxford m\u1eafc b\u1ec7nh nu\u1ed1t kh\u00f3 v\u00e0 n\u00f4n o\u1eb9 li\u00ean t\u1ee5c do s\u1ef1 \u0111\u00f3ng ch\u1eb7t c\u1ee7a c\u01a1 th\u1ef1c qu\u1ea3n. Sau \u0111\u00f3 Purton (1921) l\u1ea7n \u0111\u1ea7u ti\u00ean t\u00ecm th\u1ea5y v\u00e0 m\u00f4 t\u1ea3 b\u1ec7nh tr\u00ean t\u1eed thi 6,8. M\u1ea5y ch\u1ee5c n\u0103m qua, b\u1ec7nh co th\u1eaft t\u00e2m v\u1ecb \u0111\u00e3 \u0111\u01b0\u1ee3c nhi\u1ec1u nh\u00e0 nghi\u00ean c\u1ee9u y h\u1ecdc tr\u00ean th\u1ebf gi\u1edbi \u0111\u1ec3 t\u00e2m nghi\u00ean c\u1ee9u v\u1ec1 gi\u1ea3i ph\u1eabu b\u1ec7nh, sinh l\u00fd b\u1ec7nh c\u0169ng nh\u01b0 t\u00ecm ki\u1ebfm nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb. Tuy v\u1eady nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf b\u1ec7nh sinh v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh ch\u1eafc ch\u1eafn, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb c\u0169ng c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c nhau, c\u00f3 th\u1ec3 t\u00f3m t\u1eaft th\u00e0nh 2 lo\u1ea1i:<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa: nong th\u1ef1c qu\u1ea3n b\u1eb1ng nh\u1eefng d\u1ee5ng c\u1ee5 \u0111\u1eb7c bi\u1ec7t (\u1ed1ng nong th\u1ee7y ng\u00e2n, n\u01b0\u1edbc, h\u01a1i v\u00e0 \u1ed1ng nong Savary). K\u1ebft qu\u1ea3 n\u00f3i chung ch\u1ec9 t\u1ea1m th\u1eddi v\u00e0 th\u01b0\u1eddng ph\u1ea3i nong l\u1ea1i nhi\u1ec1u l\u1ea7n.<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i khoa: t\u1eeb \u0111\u1ea7u th\u1ebf k\u1ef7 20 cho \u0111\u1ebfn nay, nhi\u1ec1u ph\u1eabu thu\u1eadt \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng, c\u00e1c ph\u1eabu thu\u1eadt c\u0169ng kh\u00f4ng ng\u1eebng \u0111\u01b0\u1ee3c c\u1ea3i ti\u1ebfn. Trong \u0111\u00f3, ph\u1eabu thu\u1eadt Heller (m\u1edf c\u01a1 th\u1ef1c qu\u1ea3n-t\u00e2m v\u1ecb ngo\u00e0i ni\u00eam m\u1ea1c) l\u00e0 ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i, cho k\u1ebft qu\u1ea3 s\u1edbm ngay sau m\u1ed5 t\u1ed1t. Ng\u01b0\u1eddi b\u1ec7nh h\u1ebft ngh\u1eb9n ho\u00e0n to\u00e0n, c\u00f3 th\u1ec3 cho u\u1ed1ng ngay bu\u1ed5i t\u1ed1i h\u00f4m \u0111\u00f3. Tuy nhi\u00ean ph\u1eabu thu\u1eadt n\u00e0y c\u00f3 nh\u01b0\u1ee3c \u0111i\u1ec3m l\u00e0 c\u00f3 th\u1ec3 g\u00e2y hi\u1ec7n t\u01b0\u1ee3ng tr\u00e0o ng\u01b0\u1ee3c t\u1eeb d\u1ea1 d\u00e0y l\u00ean th\u1ef1c qu\u1ea3n m\u00e0 h\u1eadu qu\u1ea3 l\u00e2u d\u00e0i s\u1ebd d\u1eabn \u0111\u1ebfn vi\u00eam th\u1ef1c qu\u1ea3n. \u0110\u1ec3 gi\u1ea3m b\u1edbt h\u1eadu qu\u1ea3 tr\u00ean \u0111\u00e3 c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p t\u1ea1o van th\u1ef1c qu\u1ea3n ch\u1ed1ng tr\u00e0o ng\u01b0\u1ee3c \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng. Trong \u0111\u00f3 ph\u01b0\u01a1ng ph\u00e1p t\u1ea1o van to\u00e0n b\u1ed9 c\u1ee7a Nissen v\u00e0 c\u1ea3i ti\u1ebfn c\u1ee7a h\u1ecdc tr\u00f2 \u00f4ng l\u00e0 Rossetti \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh qua th\u1ef1c t\u1ebf l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p c\u00f3 hi\u1ec7u qu\u1ea3.<\/p>\n

T\u1ea1i Vi\u1ec7t Nam, ph\u1eabu thu\u1eadt Heller-Nissen kinh \u0111i\u1ec3n \u0111\u00e3 \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb CTTV \u1edf b\u1ec7nh Vi\u1ec7t \u0110\u1ee9c t\u1eeb n\u0103m 1986.<\/p>\n

T\u1eeb n\u0103m 1992 – 1993 ph\u1eabu thu\u1eadt soi \u1ed5 b\u1ee5ng \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau, trong \u0111\u00f3 c\u00f3 CTTV.<\/p>\n

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

– Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ch\u1ea9n \u0111o\u00e1n co th\u1eaft t\u00e2m v\u1ecb v\u1edbi x\u00e9t nghi\u1ec7m, Xquang, soi th\u1ef1c qu\u1ea3n d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng.<\/p>\n

3. Ch\u1ed1ng ch\u1ec9\u00a0 \u0111\u1ecbnh<\/b><\/h2>\n

– Th\u1ec3 tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh qu\u00e1 y\u1ebfu kh\u00f4ng ch\u1ecbu \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt.<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh gi\u00e0 y\u1ebfu, c\u00f3 nhi\u1ec1u b\u1ec7nh ph\u1ed1i h\u1ee3p.<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh ung th\u01b0 th\u1ef1c qu\u1ea3n.<\/p>\n

– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a ph\u1eabu thu\u1eadt n\u1ed9i soi:<\/p>\n

    \n
  • Ti\u1ec1n s\u1eed m\u1ed5 vi\u00eam ph\u00fac m\u1ea1c, t\u1eafc ru\u1ed9t.<\/li>\n
  • C\u1ed5 tr\u01b0\u1edbng t\u1ef1 do ho\u1eb7c c\u1ed5 tr\u01b0\u1edbng khu tr\u00fa.<\/li>\n
  • Tho\u00e1t v\u1ecb th\u00e0nh b\u1ee5ng, tho\u00e1t v\u1ecb r\u1ed1n. o Nhi\u1ec5m khu\u1ea9n t\u1ea1i ch\u1ed7 th\u00e0nh b\u1ee5ng o B\u1ec7nh l\u00fd r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/li>\n<\/ul>\n

    – Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh b\u01a1m h\u01a1i ph\u00fac m\u1ea1c: B\u1ec7nh m\u1ea1ch v\u00e0nh, b\u1ec7nh van tim, b\u1ec7nh t\u00e2m ph\u1ebf m\u00e3n.<\/p>\n

    4. Quy tr\u00ecnh<\/h2>\n

    4.1. T\u01b0 th\u1ebf:<\/b><\/h3>\n

    Ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m ng\u1eeda, \u0111\u1eb7t \u1ed1ng th\u00f4ng d\u1ea1 d\u00e0y tr\u01b0\u1edbc m\u1ed5. Ng\u01b0\u1eddi b\u1ec7nh n\u0103m \u1edf t\u01b0 th\u1ebf \u0111\u1ea7u cao ch\u00e2n th\u1ea5p m\u1ed9t g\u00f3c 30 \u0111\u1ed9 so v\u1edbi m\u1eb7t ph\u1eb3ng n\u1eb1m ngang. Hai ch\u00e2n d\u1ea1ng m\u1ed9t g\u00f3c 90 \u0111\u1ed9.<\/p>\n

    4.2. V\u00f4 c\u1ea3m:<\/b><\/h3>\n

    G\u00e2y m\u00ea n\u1ed9i kh\u00ed qu\u1ea3n.<\/p>\n

    4.3. K\u1ef9 thu\u1eadt:<\/b><\/h3>\n

    Th\u00ec I: Ph\u1eabu thu\u1eadt Heller<\/b><\/p>\n

    – D\u00f9ng que g\u1ea1t n\u00e2ng d\u00e2y ch\u1eb1ng tr\u00f2n v\u00e0 m\u1eb7t d\u01b0\u1edbi gan tr\u00e1i l\u00ean \u0111\u1ec3 b\u1ed9c l\u1ed9 m\u1eb7t tr\u01b0\u1edbc d\u1ea1 d\u00e0y c\u00f9ng v\u1edbi t\u00e2m v\u1ecb v\u00e0 th\u1ef1c qu\u1ea3n b\u1ee5ng<\/p>\n

    – M\u1edf ph\u00fac m\u1ea1c m\u1eb7t tr\u01b0\u1edbc tr\u01b0\u1edbc th\u1ef1c qu\u1ea3n b\u1ee5ng ch\u1ed7 d\u00ednh v\u00e0o ch\u00e2n c\u01a1 ho\u00e0nh \u0111\u1ec3 b\u1ed9c l\u1ed9 \u0111o\u1ea1n th\u1ef1c qu\u1ea3n b\u1ee5ng tr\u00ean m\u1ed9t \u0111o\u1ea1n d\u00e0i 5 cm t\u1eeb t\u00e2m v\u1ecb. M\u1edf ph\u00fac m\u1ea1c ngang su\u1ed1t chi\u1ec1u r\u1ed9ng c\u1ee7a m\u1eb7t tr\u01b0\u1edbc t\u00e2m v\u1ecb \u0111\u1ec3 l\u1ed9 l\u1edbp c\u01a1.<\/p>\n

    – Ti\u1ebfn h\u00e0nh m\u1edf d\u1ecdc l\u1edbp c\u01a1 m\u1eb7t tr\u01b0\u1edbc t\u00e2m v\u1ecb: s\u1eed d\u1ee5ng m\u1ed9t k\u1eb9p kh\u00f4ng ch\u1ea5n th\u01b0\u01a1ng k\u00e9o m\u1eb7t tr\u01b0\u1edbc ph\u00ecnh v\u1ecb l\u1edbn ch\u1ed7 s\u00e1t t\u00e2m v\u1ecb xu\u1ed1ng d\u01b0\u1edbi sang tr\u00e1i \u0111\u1ec3 c\u0103ng m\u1eb7t tr\u01b0\u1edbc t\u00e2m v\u1ecb. Ph\u1eabu t\u00edch gi\u1ea3i ph\u00f3ng m\u1ea1ch m\u00e1u ch\u1ea1y tr\u01b0\u1edbc t\u00e2m v\u1ecb c\u00f3 th\u1ec3 v\u1edbi k\u00e9o hay dao \u0111\u1ed1t \u0111i\u1ec7n m\u00f3c sau \u0111\u00f3 k\u1eb9p 2 clip \u1edf hai ph\u00eda v\u00e0 c\u1eaft \u1edf gi\u1eefa. C\u00e1c m\u1ea1ch m\u00e1u nh\u1ecf kh\u00e1c \u1edf tr\u00ean ho\u1eb7c d\u01b0\u1edbi c\u00f3 th\u1ec3 \u0111\u1ed1t \u0111i\u1ec7n c\u1ea7m m\u00e1u ho\u1eb7c k\u1eb9p clip t\u00f9y theo.<\/p>\n

    – \u0110\u01b0\u1eddng m\u1edf c\u01a1 b\u1eaft \u0111\u1ea7u tr\u00ean th\u1ef1c qu\u1ea3n, \u1edf ngay b\u00ean tr\u00e1i c\u1ee7a d\u00e2y th\u1ea7n kinh X tr\u01b0\u1edbc. M\u1edf m\u1ed9t \u0111i\u1ec3m \u1edf gi\u1eefa m\u1eb7t tr\u01b0\u1edbc th\u1ef1c qu\u1ea3n tr\u00ean t\u00e2m v\u1ecb sau \u0111\u00f3 d\u00f9ng k\u00e9o hay m\u00f3c \u0111\u1ec3 ph\u1eabu t\u00edch t\u1eebng l\u1edbp c\u01a1 c\u1ee7a th\u1ef1c qu\u1ea3n cho t\u1edbi l\u1edbp d\u01b0\u1edbi ni\u00eam m\u1ea1c th\u00ec d\u1eebng l\u1ea1i. Sau \u0111\u00f3 ti\u1ebfp t\u1ee5c ph\u1eabu t\u00edch \u0111i l\u00ean tr\u00ean cho t\u1edbi khi \u0111o\u1ea1n m\u1edf c\u01a1 th\u1ef1c qu\u1ea3n tr\u00ean t\u00e2m v\u1ecb d\u00e0i kho\u1ea3ng 4 cm. Trong khi ph\u1eabu t\u00edch, \u0111i t\u1eebng l\u1edbp gi\u1ea3i ph\u00f3ng t\u1eebng \u00edt m\u1ed9t, c\u1eaft hay \u0111\u1ed1t \u0111i\u1ec7n khi \u0111\u00e3 nh\u00ecn r\u00f5 trong t\u1ed5 ch\u1ee9c \u0111\u1ecbnh c\u1eaft kh\u00f4ng c\u00f3 m\u1ea1ch m\u00e1u hay ni\u00eam m\u1ea1c. Sau \u0111\u00f3 quay xu\u1ed1ng m\u1edf qua t\u00e2m v\u1ecb xu\u1ed1ng ph\u00eda m\u1eb7t tr\u01b0\u1edbc d\u1ea1 d\u00e0y kho\u1ea3ng 2 cm sao cho to\u00e0n b\u1ed9 \u0111\u01b0\u1eddng m\u1edf c\u01a1 d\u00e0i kho\u1ea3ng 6 cm<\/p>\n

    – Sau khi k\u1ebft th\u00fac m\u1edf c\u01a1 ng\u01b0\u1eddi g\u00e2y m\u00ea b\u01a1m ph\u1ed3ng d\u1ea1 d\u00e0y qua \u1ed1ng th\u00f4ng \u0111\u1ec3 ki\u1ec3m tra qua \u1ed1ng soi trong \u1ed5 b\u1ee5ng xem c\u00f2n s\u1ee3i c\u01a1 n\u00e0o ch\u01b0a c\u1eaft \u0111\u1ee9t h\u1ebft, m\u1eb7t tr\u01b0\u1edbc th\u1ef1c qu\u1ea3n v\u00e0 t\u00e2m v\u1ecb ch\u1eafc ch\u1eafn ch\u1ec9 c\u00f2n l\u1edbp ni\u00eam m\u1ea1c v\u00e0 kh\u00f4ng c\u00f3 l\u1ed7 th\u1ee7ng<\/p>\n

    Sau khi ki\u1ec3m tra xong h\u00fat kh\u00ed \u0111\u1ec3 d\u1ea1 d\u00e0y x\u1eb9p l\u1ea1i.<\/p>\n

    – Sinh thi\u1ebft c\u01a1 th\u1ef1c qu\u1ea3n: Sau khi m\u1edf c\u01a1, ch\u00fang t\u00f4i c\u1eaft l\u1ea5y m\u1ed9t m\u1eabu c\u01a1 nh\u1ecf \u1edf v\u00f9ng t\u00e2m v\u1ecb ch\u1ed7 m\u1edf c\u01a1 \u0111\u1ec3 l\u00e0m sinh thi\u1ebft.<\/p>\n

    Th\u00ec II: Ph\u1eabu thu\u1eadt Nissen – Rossetti<\/b><\/p>\n

    – D\u00f9ng k\u00e9o ho\u1eb7c \u0111\u1ed1t \u0111i\u1ec7n h\u00ecnh m\u00f3c \u0111\u1ec3 m\u1edf m\u1ea1c n\u1ed1i nh\u1ecf d\u1ecdc theo b\u1edd cong nh\u1ecf c\u1ee7a d\u1ea1 d\u00e0y cho t\u1edbi s\u00e1t c\u1ed9t tr\u1ee5 ho\u00e0nh ph\u1ea3i. Ch\u00fa \u00fd kh\u00f4ng l\u00e0m t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh X, nh\u1ea5t l\u00e0 nh\u00e1nh ch\u00e2n ng\u1ed7ng.<\/p>\n

    – Ti\u1ebfp theo l\u00e0 th\u00ec t\u1ea1o kho\u1ea3ng tr\u1ed1ng sau th\u1ef1c qu\u1ea3n. Sau khi m\u1edf m\u1ea1c n\u1ed1i nh\u1ecf, nh\u1eadn bi\u1ebft c\u1ed9t tr\u1ee5 ho\u00e0nh ph\u1ea3i, m\u1edf m\u1ed9t c\u1eeda s\u1ed5 nh\u1ecf ph\u00fac m\u1ea1c \u1edf m\u1eb7t tr\u01b0\u1edbc c\u1ed9t tr\u1ee5 ho\u00e0nh ph\u1ea3i xu\u1ed1ng ph\u00eda d\u01b0\u1edbi t\u1edbi ch\u00e2n ch\u1eef V n\u01a1i ti\u1ebfp x\u00fac v\u1edbi c\u1ed9t tr\u1ee5 ho\u00e0nh tr\u00e1i th\u00ec ti\u1ebfp t\u1ee5c ph\u1eabu t\u00edch l\u00ean tr\u00ean v\u00e0 sang tr\u00e1i. L\u00fac n\u00e0y m\u1edf v\u00e0o khoang t\u1ed5 ch\u1ee9c l\u1ecfng l\u1ebbo m\u00e0 ph\u00eda sau l\u00e0 m\u1eb7t tr\u01b0\u1edbc c\u1ee7a hai c\u1ed9t tr\u1ee5 ho\u00e0nh c\u00f2n ph\u00eda tr\u01b0\u1edbc tr\u00ean ch\u00ednh l\u00e0 m\u1eb7t sau c\u1ee7a th\u1ef1c qu\u1ea3n. B\u00e1m s\u00e1t m\u1eb7t sau th\u1ef1c qu\u1ea3n, \u0111i d\u1ea7n sang tr\u00e1i t\u1edbi khi nh\u1eadn th\u1ea5y m\u1ed9t l\u1edbp m\u00e0ng m\u1ecfng, qua \u0111\u00f3 nh\u00ecn th\u1ea5y ph\u00ecnh v\u1ecb l\u1edbn c\u1ee7a d\u1ea1 d\u00e0y, hay l\u00e1ch. M\u1edf qua l\u1edbp m\u00e0ng n\u00e0y sang b\u00ean khoang d\u01b0\u1edbi ho\u00e0nh tr\u00e1i. Ti\u1ebfp t\u1ee5c m\u1edf r\u1ed9ng khoang sau th\u1ef1c qu\u1ea3n l\u00ean tr\u00ean v\u00e0 xu\u1ed1ng d\u01b0\u1edbi cho t\u1edbi khi t\u1ea1o \u0111\u01b0\u1ee3c m\u1ed9t \u0111\u01b0\u1eddng h\u1ea7m r\u1ed9ng r\u00e3i cho t\u1edbi khi d\u00f9ng k\u1eb9p ph\u1eabu t\u00edch \u0111\u1ea7u t\u00f9 k\u00e9o th\u1eed nh\u1eb9 nh\u00e0ng th\u1ea5y c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng k\u00e9o ph\u00ecnh v\u1ecb l\u1edbn qua l\u1ed7 h\u1ed5ng n\u00e0y sang b\u00ean ph\u1ea3i m\u00e0 kh\u00f4ng g\u1eb7p tr\u1edf ng\u1ea1i g\u00ec.<\/p>\n

    – T\u1ea1o van: tr\u01b0\u1edbc h\u1ebft kh\u00e2u b\u1eb1ng m\u1ed9t m\u0169i ch\u1ec9 kh\u00f4ng ti\u00eau (th\u01b0\u1eddng l\u00e0 ch\u1ec9 2.0) kh\u00e9p kho\u1ea3ng gi\u1eefa hai c\u1ed9t tr\u1ee5 ho\u00e0nh. \u0110\u01b0a m\u1ed9t k\u1eb9p kh\u00f4ng ch\u1ea5n th\u01b0\u01a1ng lu\u1ed3n v\u00e0o kho\u1ea3ng tr\u1ed1ng sau th\u1ef1c qu\u1ea3n k\u00e9o nh\u1eb9 nh\u00e0ng m\u1ed9t ph\u1ea7n ph\u00ecnh v\u1ecb l\u1edbn qua m\u1eb7t sau th\u1ef1c qu\u1ea3n sang b\u00ean ph\u1ea3i th\u1ef1c qu\u1ea3n. M\u0169i kh\u00e2u \u0111\u1ea7u ti\u00ean gi\u1eefa ph\u1ea7n ph\u00ecnh v\u1ecb l\u1edbn b\u00ean ph\u1ea3i v\u1edbi m\u1eb7t tr\u01b0\u1edbc c\u1ee7a ph\u00ecnh v\u1ecb l\u1edbn b\u00ean tr\u00e1i th\u1ef1c qu\u1ea3n sao cho ph\u1ea7n ph\u00ecnh v\u1ecb l\u1edbn d\u1ea1 d\u00e0y \u00f4m quanh th\u1ef1c qu\u1ea3n kh\u00f4ng qu\u00e1 ch\u1eadt c\u0169ng kh\u00f4ng qu\u00e1 r\u1ed9ng. Th\u01b0\u1eddng c\u1ea7n kh\u00e2u kho\u1ea3ng 3 – 4 m\u0169i ch\u1ec9 kh\u00f4ng ti\u00eau \u0111\u1ec3 t\u1ea1o ra \u0111\u01b0\u1ee3c \u0111o\u1ea1n \u1ed1ng b\u1eb1ng ph\u00ecnh v\u1ecb l\u1edbn d\u00e0i kho\u1ea3ng 3 – 4 cm b\u1ecdc quanh th\u1ef1c qu\u1ea3n. \u0110\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c \u0111\u1ed9 r\u1ed9ng c\u1ee7a van, \u0111\u1eb7t trong l\u00f2ng th\u1ef1c qu\u1ea3n \u1ed1ng th\u00f4ng c\u00f3 k\u00edch th\u01b0\u1edbc 26 Fr l\u00e0m chu\u1ea9n. Ph\u00eda tr\u00ean van \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh v\u00e0o ch\u00e2n c\u01a1 ho\u00e0nh tr\u00e1i. Ph\u00eda d\u01b0\u1edbi kh\u00e2u m\u1ed9t m\u0169i c\u1ed1 \u0111\u1ecbnh v\u00e0o b\u00ean ph\u1ea3i d\u1ea1 d\u00e0y. Ki\u1ec3m tra to\u00e0n b\u1ed9 \u1ed5 b\u1ee5ng, h\u00fat s\u1ea1ch d\u01b0\u1edbi ho\u00e0nh tr\u00e1i, ph\u1ea3i, th\u00e1o h\u01a1i, r\u00fat c\u00e1c trocar, \u0111\u00f3ng c\u00e1c l\u1ed7.<\/p>\n

    Ngu\u1ed3n tham kh\u1ea3o: V\u0103n b\u1ea3n B\u1ed9 Y t\u1ebf<\/em><\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Co th\u1eaft t\u00e2m v\u1ecb (Achalasia) l\u00e0 danh t\u1eeb do Von Mickulicz d\u00f9ng l\u1ea7n \u0111\u1ea7u ti\u00ean n\u0103m 1882 \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd c\u1ee7a th\u1ef1c qu\u1ea3n, trong \u0111\u00f3 hi\u1ec7n t\u01b0\u1ee3ng ch\u1ee7 y\u1ebfu l\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng (nhu \u0111\u1ed9ng) b\u00ecnh th\u01b0\u1eddng c\u1ee7a th\u1ef1c qu\u1ea3n v\u00e0 t\u00e2m v\u1ecb: m\u1ea5t ho\u00e0n to\u00e0n co b\u00f3p d\u1ea1ng […]<\/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":[],"yoast_head":"\n\u0110i\u1ec1u tr\u1ecb co th\u1eaft t\u00e2m v\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt n\u1ed9i soi - Vinmec<\/title>\n<meta name=\"description\" content=\"Co th\u1eaft t\u00e2m v\u1ecb (Achalasia) l\u00e0 danh t\u1eeb do Von Mickulicz d\u00f9ng l\u1ea7n \u0111\u1ea7u ti\u00ean n\u0103m 1882 \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd c\u1ee7a th\u1ef1c qu\u1ea3n, trong \u0111\u00f3 hi\u1ec7n ...\" \/>\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=\"\u0110i\u1ec1u tr\u1ecb co th\u1eaft t\u00e2m v\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt n\u1ed9i soi - 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