{"id":24610,"date":"2023-04-19T23:11:14","date_gmt":"2023-04-19T16:11:14","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24610"},"modified":"2023-04-20T11:24:33","modified_gmt":"2023-04-20T04:24:33","slug":"phuong-phap-dan-luu-tui-mat-xuyen-gan-qua-daptgbd","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/phuong-phap-dan-luu-tui-mat-xuyen-gan-qua-daptgbd\/","title":{"rendered":"Ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da(PTGBD)"},"content":{"rendered":"

Vi\u00eam t\u00fai m\u1eadt c\u1ea5p l\u00e0 b\u1ec7nh l\u00fd c\u1ea5p t\u00ednh, g\u00e2y \u0111au b\u1ee5ng nhi\u1ec1u v\u00e0 d\u1eef d\u1ed9i, s\u1ed1t v\u00e0 c\u00f3 th\u1ec3 k\u00e8m theo v\u00e0ng da. Ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da(Percutaneous Transhepatic Gallbladder Drainage – PTGBD) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 \u0111\u01b0a d\u1eabn d\u1ecbch m\u1eadt t\u1eeb t\u00fai m\u1eadt ra ngo\u00e0i c\u01a1 th\u1ec3 th\u00f4ng qua \u1ed1ng d\u1eabn. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn t\u00fai m\u1eadt nh\u01b0 vi\u00eam t\u00fai m\u1eadt c\u1ea5p ho\u1eb7c nhi\u1ec5m tr\u00f9ng n\u1eb7ng quanh t\u00fai m\u1eadt.<\/strong><\/p>\n

\"d\u1eabn
D\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da (PTGBD) ch\u1ec9 \u0111\u1ecbnh cho vi\u00eam t\u00fai m\u1eadt c\u1ea5p m\u1ee9c \u0111\u1ed9 trung b\u00ecnh v\u00e0 n\u1eb7ng<\/figcaption><\/figure>\n

1. Ch\u1ec9 \u0111\u1ecbnh d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da (PTGBD)<\/h2>\n

D\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da (PTGBD) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd t\u00fai m\u1eadt v\u00e0 s\u1ecfi m\u1eadt b\u1eb1ng c\u00e1ch d\u00f9ng \u1ed1ng d\u1eabn \u0111\u1ec3 \u0111\u01b0a d\u1ecbch m\u1eadt t\u1eeb t\u00fai m\u1eadt ra ngo\u00e0i c\u01a1 th\u1ec3 th\u00f4ng qua da. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y th\u01b0\u1eddng ch\u1ec9 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c kh\u00f4ng hi\u1ec7u qu\u1ea3 ho\u1eb7c kh\u00f4ng kh\u1ea3 thi.<\/p>\n

    \n
  • H\u01b0\u1edbng d\u1eabn Tokyo th\u00e1ng 1-2007 (TG07) \u0111\u01b0a ra ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 vi\u00eam t\u00fai m\u1eadt c\u1ea5p. Trong H\u01b0\u1edbng d\u1eabn n\u00e0y d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da (PTGBD) \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho vi\u00eam t\u00fai m\u1eadt c\u1ea5p m\u1ee9c \u0111\u1ed9 trung b\u00ecnh (grade II), v\u00e0 vi\u00eam t\u00fai m\u1eadt c\u1ea5p n\u1eb7ng (grade III)<\/li>\n
  • T\u00fai m\u1eadt l\u1edbn ho\u1eb7c c\u00f3 s\u1ecfi m\u1eadt l\u1edbn, kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt qua n\u1ed9i soi (EGBD).<\/li>\n
  • B\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt v\u00ec c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe kh\u00e1c.<\/li>\n
  • B\u1ec7nh nh\u00e2n mu\u1ed1n ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u00edt \u0111au \u0111\u1edbn v\u00e0 \u00edt bi\u1ebfn ch\u1ee9ng.<\/li>\n<\/ul>\n

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

    C\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da (PTGBD) bao g\u1ed3m:<\/p>\n

      \n
    • T\u00fai m\u1eadt qu\u00e1 nh\u1ecf \u0111\u1ec3 \u0111\u01b0a \u0111\u01b0\u1ee3c \u1ed1ng d\u1eabn qua da.<\/li>\n
    • T\u00ecnh tr\u1ea1ng kh\u00f3 ti\u1ebfp c\u1eadn v\u1ecb tr\u00ed ti\u00eam do m\u1ee1 b\u1ee5ng qu\u00e1 nhi\u1ec1u ho\u1eb7c do v\u1ecb tr\u00ed t\u00fai m\u1eadt kh\u00f4ng ph\u00f9 h\u1ee3p.<\/li>\n
    • B\u1ec7nh nh\u00e2n b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/li>\n
    • B\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111\u00f4ng m\u00e1u ho\u1eb7c ch\u1ea3y m\u00e1u.<\/li>\n
    • B\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 gan nghi\u00eam tr\u1ecdng nh\u01b0 x\u01a1 gan, ung th\u01b0 gan.<\/li>\n<\/ul>\n

      3. C\u00e1c b\u01b0\u1edbc th\u1ef1c hi\u1ec7n<\/h2>\n

      D\u01b0\u1edbi \u0111\u00e2y l\u00e0 c\u00e1c b\u01b0\u1edbc th\u1ef1c hi\u1ec7n ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da (PTGBD):<\/p>\n

      3.1. Chu\u1ea9n b\u1ecb:<\/h3>\n

      – C\u00e1c d\u1ee5ng c\u1ee5 c\u1ea7n thi\u1ebft bao g\u1ed3m kim 18-G, catheter, dung d\u1ecbch kh\u1eed tr\u00f9ng da, v\u1eadt li\u1ec7u b\u0103ng g\u1ea1c kh\u00f4, g\u0103ng tay, kh\u1ea9u trang v\u00e0 b\u1ea3o v\u1ec7 m\u1eaft.
      \n– Chu\u1ea9n b\u1ecb b\u1ec7nh nh\u00e2n b\u1eb1ng c\u00e1ch \u0111\u1eb7t b\u1ec7nh nh\u00e2n n\u1eb1m nghi\u00eang tr\u00e1i ho\u1eb7c ng\u1ea3 v\u1ec1 b\u00ean tr\u00e1i \u0111\u1ec3 gi\u00fap t\u00fai m\u1eadt di chuy\u1ec3n v\u1ec1 ph\u00eda tr\u01b0\u1edbc v\u00e0 gi\u1ea3m nguy c\u01a1 x\u1ea3y ra ch\u1ea3y m\u00e1u.<\/p>\n

      3.2. Ti\u00eam g\u00e2y t\u00ea t\u1ea1i ch\u1ed7<\/h3>\n

      – Ti\u00eam dung d\u1ecbch g\u00e2y t\u00ea v\u00e0o v\u00f9ng da, m\u00f4 m\u1ec1m xung quanh v\u1ecb tr\u00ed ti\u00eam.
      \n– Th\u1eddi gian \u0111\u1ec3 g\u00e2y t\u00ea l\u00e0 kho\u1ea3ng 10-15 ph\u00fat.<\/p>\n

      3.3. \u0110\u01b0a \u1ed1ng d\u1eabn qua da v\u00e0o t\u00fai m\u1eadt<\/h3>\n

      –\u00a0 D\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m ch\u1ecdc kim xuy\u00ean gan v\u00e0o t\u00fai m\u1eadt qua gi\u01b0\u1eddng t\u00fai m\u1eadt, sau \u0111\u00f3 1 catheter c\u00f3 1 \u0111\u1ea7u u\u1ed1n cong c\u1ee1 t\u1eed 6 \u2013 10 Fr \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00e0o t\u00fai m\u1eadt d\u01b0\u1edbi d\u1eabn \u0111\u01b0\u1eddng c\u1ee7a guidewire (ph\u01b0\u01a1ng ph\u00e1p Seldinger)
      \n– Th\u1ee7 thu\u1eadt ph\u1ea3i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi m\u1ed9t b\u00e1c s\u0129 c\u00f3 kinh nghi\u1ec7m v\u00e0 \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 b\u1edfi m\u00e1y si\u00eau \u00e2m \u0111\u1ec3 gi\u00fap \u0111\u1ecbnh v\u1ecb ch\u00ednh x\u00e1c v\u1ecb tr\u00ed c\u1ee7a t\u00fai m\u1eadt.<\/p>\n

      3.4. Th\u1ef1c hi\u1ec7n d\u1eabn l\u01b0u:<\/h3>\n

      – D\u1ef1a tr\u00ean tr\u1ea1ng th\u00e1i c\u1ee7a t\u00fai m\u1eadt, b\u00e1c s\u0129 c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn \u0111\u1ec3 d\u1eabn l\u01b0u m\u1eadt ngay l\u1eadp t\u1ee9c ho\u1eb7c \u0111\u1ec3 ch\u1edd \u0111\u1ee3i m\u1ed9t th\u1eddi gian ng\u1eafn.<\/p>\n

      3.5. Ho\u00e0n t\u1ea5t th\u1ee7 t\u1ee5c:<\/h3>\n

      – Sau khi d\u1eabn l\u01b0u m\u1eadt, catheter s\u1ebd \u0111\u01b0\u1ee3c g\u1eafn v\u00e0o da b\u1eb1ng b\u0103ng g\u1ea1c v\u00e0 b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u01b0\u1ee3c quan s\u00e1t trong m\u1ed9t th\u1eddi gian ng\u1eafn.
      \n– B\u1ec7nh nh\u00e2n s\u1ebd \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn v\u1ec1 c\u00e1ch ch\u0103m s\u00f3c v\u00e0 thay \u0111\u1ed5i b\u0103ng g\u1ea1c t\u1ea1i v\u1ecb tr\u00ed ti\u00eam \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 nhi\u1ec5m tr\u00f9ng v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c.<\/p>\n

      Trong qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n PTGBD, b\u00e1c s\u0129 s\u1ebd c\u1ea7n tu\u00e2n th\u1ee7 c\u00e1c quy tr\u00ecnh kh\u1ea9n c\u1ea5p n\u1ebfu x\u1ea3y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 nhi\u1ec5m tr\u00f9ng, ch\u1ea3y m\u00e1u ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan l\u00e2n c\u1eadn.<\/p>\n

      4. \u01afu \u0111i\u1ec3m c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da(PTGBD)<\/h2>\n

      Ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da (PTGBD) c\u00f3 nhi\u1ec1u \u01b0u \u0111i\u1ec3m, bao g\u1ed3m:<\/p>\n

        \n
      • Ph\u01b0\u01a1ng ph\u00e1p PTGBD l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng y\u00eau c\u1ea7u ph\u1eabu thu\u1eadt l\u1edbn, gi\u00fap gi\u1ea3m \u0111au cho c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n
      • Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 \u0111\u1ed9 an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 cao, gi\u00fap gi\u1ea3m nguy c\u01a1 x\u1ea3y ra nhi\u1ec5m tr\u00f9ng, ch\u1ea3y m\u00e1u v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c so v\u1edbi ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt truy\u1ec1n th\u1ed1ng.<\/li>\n
      • PTGBD c\u00f3 kh\u1ea3 n\u0103ng gi\u00fap gi\u1ea3m \u00e1p l\u1ef1c trong t\u00fai m\u1eadt v\u00e0 gi\u1ea3m t\u00ecnh tr\u1ea1ng vi\u00eam t\u00fai m\u1eadt, gi\u00fap b\u1ec7nh nh\u00e2n gi\u1ea3m \u0111au v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/li>\n
      • Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nhanh ch\u00f3ng v\u00e0 d\u1ec5 d\u00e0ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea5p c\u1ee9u.<\/li>\n
      • PTGBD c\u00f3 kh\u1ea3 n\u0103ng t\u00e1i s\u1eed d\u1ee5ng, gi\u00fap ti\u1ebft ki\u1ec7m chi ph\u00ed v\u00e0 n\u00e2ng cao hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/li>\n
      • Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 l\u1ea5y m\u1eabu m\u1eadt \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh l\u00fd c\u1ee7a gan v\u00e0 t\u00fai m\u1eadt.<\/li>\n<\/ul>\n

        Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng v\u00e0 quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u01b0a ra sau khi \u0111\u00e3 xem x\u00e9t k\u1ef9 l\u01b0\u1ee1ng t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c r\u1ee7i ro v\u00e0 l\u1ee3i \u00edch c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y.<\/p>\n

        T\u00f3m l\u1ea1i, quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u01b0a ra sau khi \u0111\u00e3 xem x\u00e9t k\u1ef9 l\u01b0\u1ee1ng t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c r\u1ee7i ro v\u00e0 l\u1ee3i \u00edch c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n v\u00e0 h\u01b0\u1edbng d\u1eabn v\u1ec1 c\u00e1ch ch\u0103m s\u00f3c sau \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra.<\/p>\n","protected":false},"excerpt":{"rendered":"

        Vi\u00eam t\u00fai m\u1eadt c\u1ea5p l\u00e0 b\u1ec7nh l\u00fd c\u1ea5p t\u00ednh, g\u00e2y \u0111au b\u1ee5ng nhi\u1ec1u v\u00e0 d\u1eef d\u1ed9i, s\u1ed1t v\u00e0 c\u00f3 th\u1ec3 k\u00e8m theo v\u00e0ng da. Ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da(Percutaneous Transhepatic Gallbladder Drainage – PTGBD) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 \u0111\u01b0a d\u1eabn d\u1ecbch m\u1eadt t\u1eeb t\u00fai m\u1eadt ra ngo\u00e0i […]<\/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":[3],"yoast_head":"\nPh\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da(PTGBD) - Vinmec<\/title>\n<meta name=\"description\" content=\"Ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da(Percutaneous Transhepatic Gallbladder Drainage - PTGBD) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 ...\" \/>\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=\"Ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da(PTGBD) - 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