{"id":24823,"date":"2023-04-19T18:43:02","date_gmt":"2023-04-19T11:43:02","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24823"},"modified":"2023-04-20T17:23:04","modified_gmt":"2023-04-20T10:23:04","slug":"noi-soi-thuc-quan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/noi-soi-thuc-quan\/","title":{"rendered":"Nh\u1eefng h\u00ecnh \u1ea3nh qua n\u1ed9i soi th\u1ef1c qu\u1ea3n"},"content":{"rendered":"

Nh\u1eefng tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111au ng\u1ef1c, nu\u1ed1t \u0111au, nu\u1ed1t kh\u00f3, \u1ee3 chua do r\u1ea5t nhi\u1ec1u nguy\u00ean nh\u00e2n g\u00e2y ra, nh\u1eefng tri\u1ec7u ch\u1ee9ng n\u00e0y kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho m\u1ed9t b\u1ec7nh l\u00fd n\u00e0o \u1edf th\u1ef1c qu\u1ea3n do \u0111\u00f3 n\u1ed9i soi th\u1ef1c qu\u1ea3n<\/a> l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p quan tr\u1ecdng gi\u00fap ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb nh\u1eefng b\u1ec7nh l\u00fd \u1edf th\u1ef1c qu\u1ea3n. N\u1ed9i soi k\u1ebft h\u1ee3p v\u1edbi sinh thi\u1ebft gi\u00fap ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng l\u00e0nh hay \u00e1c t\u00ednh \u1edf th\u1ef1c qu\u1ea3n. N\u1ed9i soi \u0111i\u1ec1u tr\u1ecb g\u1ed3m nong th\u1ef1c qu\u1ea3n, l\u1ea5y d\u1ecb v\u1eadt, c\u1eaft polyp, th\u1eaft c\u00e1c b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/strong><\/p>\n

1. Gi\u1ea3i ph\u1eabu th\u1ef1c qu\u1ea3n b\u00ecnh th\u01b0\u1eddng<\/h2>\n

Th\u1ef1c qu\u1ea3n l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a \u1ed1ng ti\u00eau h\u00f3a n\u1ed1i t\u1eeb mi\u1ec7ng \u0111\u1ebfn d\u1ea1 d\u00e0y, chi\u1ec1u d\u00e0i kho\u1ea3ng 25 cm t\u1eeb c\u1ed5 ngay ph\u00eda d\u01b0\u1edbi ch\u1ed5 c\u01a1 nh\u1eabn h\u1ea7u (t\u01b0\u01a1ng \u1ee9ng v\u1edbi \u0111\u1ed1t s\u1ed1ng c\u1ed5 6) cho \u0111\u1ebfn t\u00e2m v\u1ecb trong \u1ed5 b\u1ee5ng (t\u01b0\u01a1ng \u1ee9ng v\u1edbi \u0111\u1ed1t s\u1ed1ng ng\u1ef1c 11). B\u00ecnh th\u01b0\u1eddng l\u00f2ng th\u1ef1c qu\u1ea3n x\u1eb9p, khi nu\u1ed1t l\u00f2ng th\u1ef1c qu\u1ea3n gi\u00e3n ra kho\u1ea3ng 3cm. Th\u1ef1c qu\u1ea3n \u0111i theo h\u01b0\u1edbng h\u01a1i l\u1ec7ch sang tr\u00e1i v\u00e0 n\u1eb1m sau tim \u0111i v\u00e0o trong \u1ed5 b\u1ee5ng qua l\u1ed5 ho\u00e0nh, l\u1ed5 n\u00e0y xuy\u00ean qua tr\u1ee5c ho\u00e0nh ph\u1ea3i. ngang v\u1edbi \u0111\u1ed1t s\u1ed1ng ng\u1ef1c 4, th\u1ef1c qu\u1ea3n b\u1ecb cung \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00e8 v\u00e0o, do \u0111\u00f3 khi soi th\u1ef1c qu\u1ea3n s\u1ebd th\u1ea5y nh\u1ecbp \u0111\u1eadp c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, v\u1ecb tr\u00ed n\u00e0y c\u00e1ch cung r\u0103ng tr\u00ean kho\u1ea3ng 23 cm, ngay ph\u00eda d\u01b0\u1edbi ch\u1ed5 l\u00f5m c\u1ee7a cung \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 ch\u1ed5 l\u00f5m c\u1ee7a kh\u00ed qu\u1ea3n tr\u00e1i \u0111\u00e8 v\u00e0o th\u1ef1c qu\u1ea3n \u1edf ph\u00eda tr\u01b0\u1edbc tr\u00e1i, ti\u1ebfp theo th\u1ef1c qu\u1ea3n n\u1eb1m s\u00e1t ngay sau th\u1ea5t tr\u00e1i. B\u00ecnh th\u01b0\u1eddng \u0111o\u1ea1n th\u1ef1c qu\u1ea3n trong \u1ed5 b\u1ee5ng d\u00e0i 2 cm. Khi soi th\u1ef1c qu\u1ea3n th\u1ea5y ch\u1ed5 n\u1ed1i gi\u1eefa th\u1ef1c qu\u1ea3n v\u00e0 d\u1ea1 d\u00e0y c\u00e1c cung r\u0103ng tr\u00ean kho\u1ea3ng 38 \u2013 40 cm.<\/p>\n

V\u1ea5n \u0111\u1ec1 vi\u00eam th\u1ef1c qu\u1ea3n, u th\u1ef1c qu\u1ea3n \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong m\u1ed9t b\u00e0i vi\u1ebft kh\u00e1c<\/p>\n

2. R\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng th\u1ef1c qu\u1ea3n<\/h2>\n

2.1. Co th\u1eaft t\u00e2m v\u1ecb (achalasia)<\/h3>\n
    \n
  • Co th\u1eaft t\u00e2m v\u1ecb l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n b\u1ec7nh l\u00fd do gi\u1ea3m nhu \u0111\u1ed9ng th\u1ef1c qu\u1ea3n v\u00e0 t\u0103ng co b\u00f3p c\u01a1 th\u1eaft th\u1ef1c qu\u1ea3n d\u01b0\u1edbi. Do \u0111\u00f3 kh\u00f3 nu\u1ed1t, th\u1ef1c qu\u1ea3n gi\u00e3n ra kh\u00f4ng h\u1ebft l\u00e0m cho th\u1ee9c \u0103n \u1ee9 \u0111\u1ecdng trong th\u1ef1c qu\u1ea3n.<\/li>\n
  • Khi soi th\u1ea5y th\u1ef1c qu\u1ea3n gi\u00e3n r\u1ed9ng, \u1ee9 \u0111\u1ecdng th\u1ee9c \u0103n, c\u00f3 th\u1ec3 th\u1ea5y sung huy\u1ebft, tr\u1ee3t, lo\u00e9t, l\u00fac m\u1edbi \u0111\u01b0a m\u00e1y soi v\u00e0o th\u1ef1c qu\u1ea3n c\u00f3 th\u1ec3 kh\u00f3, nh\u01b0ng n\u1ebfu nh\u1eb9 nh\u00e0ng \u0111\u1ea9y v\u00e0o th\u00ec d\u1ec5 d\u00e0ng xu\u1ed1ng d\u1ea1 d\u00e0y. N\u1ebfu m\u00e1y soi \u0111\u01b0a qua th\u1ef1c qu\u1ea3n kh\u00f3 ho\u1eb7c kh\u00f4ng th\u1ec3 qua \u0111\u01b0\u1ee3c th\u00ec c\u00f3 th\u1ec3 h\u1eb9p th\u1ef1c qu\u1ea3n do t\u1ed5n th\u01b0\u01a1ng l\u00e0nh hay \u00e1c t\u00ednh. Quan s\u00e1t v\u00f9ng t\u00e2m v\u1ecb b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p soi ng\u01b0\u1ee3c \u0111\u1ec3 lo\u1ea1i tr\u1eeb t\u1ed5n th\u01b0\u01a1ng ung th\u01b0 \u1edf v\u00f9ng n\u00e0y g\u00e2y nu\u1ed1t kh\u00f3. Bi\u1ebfn ch\u1ee9ng c\u1ee7a co th\u1eaft t\u00e2m v\u1ecb k\u00e9o d\u00e0i l\u00e0 ung th\u01b0 th\u1ef1c qu\u1ea3n.<\/li>\n
  • \u0110i\u1ec1u tr\u1ecb b\u1eb1ng nong th\u1ef1c qua n\u1ed9i soi b\u1eb1ng b\u00f3ng ho\u1eb7c b\u1eb1ng d\u1ee5ng c\u1ee5 nong. Ch\u1ec9 \u0111\u1ecbnh ngo\u1ea1i khoa khi nong th\u1ef1c qu\u1ea3n 3 l\u1ea7n th\u1ea5t b\u1ea1i.<\/li>\n<\/ul>\n
    \"N\u1ed9i
    Co th\u1eaft t\u00e2m v\u1ecb<\/figcaption><\/figure>\n

    2.2. T\u0103ng co b\u00f3p th\u1ef1c qu\u1ea3n<\/strong>:<\/p>\n

      \n
    • Th\u1ef1c qu\u1ea3n co b\u00f3p nhanh, m\u1ea1nh v\u00e0 k\u00e9o d\u00e0i, t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1 c\u1ee7a c\u01a1 th\u1eaft th\u1ef1c qu\u1ea3n d\u01b0\u1edbi khi nu\u1ed1t v\u00e0 gi\u00e3n ra kh\u00f4ng h\u1ebft.<\/li>\n
    • N\u1ed9i soi th\u1ef1c qu\u1ea3n \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c \u1edf th\u1ef1c qu\u1ea3n.<\/li>\n
    • Th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c.<\/li>\n
    • C\u00f3 th\u1ec3 th\u1ea5y vi\u00eam th\u1ef1c qu\u1ea3n do thu\u1ed1c, do nhi\u1ec5m tr\u00f9ng v\u00e0 ung th\u01b0 th\u1ef1c qu\u1ea3n.<\/li>\n
    • \u0110i\u1ec1u tr\u1ecb: n\u1ed9i khoa v\u1edbi thu\u1ed1c gi\u00e3n c\u01a1 nitrat, an th\u1ea7n, ch\u1ed1ng co th\u1eaft, thu\u1ed1c ch\u1eb9n k\u00eanh can xi. Nong th\u1ef1c qu\u1ea3n qua n\u1ed9i soi ho\u1eb7c ph\u1eabu thu\u1eadt.<\/li>\n<\/ul>\n

      2.3. C\u00e1c r\u1ed1i lo\u1ea1n co b\u00f3p th\u1ef1c qu\u1ea3n kh\u00e1c<\/h3>\n
        \n
      • Gi\u1ea3m nhu \u0111\u1ed9ng th\u1ef1c qu\u1ea3n do b\u1ec7nh l\u00fd to\u00e0n th\u00e2n nh\u01b0 x\u01a1 c\u1ee9ng b\u00ec, collagen.<\/li>\n
      • H\u00ecnh \u1ea3nh n\u1ed9i soi: vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c, h\u1eb9p th\u1ef1c qu\u1ea3n ho\u1eb7c n\u1ea5m th\u1ef1c qu\u1ea3n.<\/li>\n<\/ul>\n

        3. Nh\u1eefng b\u1ec7nh l\u00fd th\u1ef1c qu\u1ea3n kh\u00e1c<\/h2>\n

        3.1. V\u00f2ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n<\/strong> (Mucosal esophageal rings)<\/h3>\n

        V\u00f2ng ni\u00eam m\u1ea1c \u0111\u01b0\u1ee3c bao ph\u1ee7 b\u1edfi l\u1edbp ni\u00eam m\u1ea1c \u1edf v\u1ecb tr\u00ed \u0111\u01b0\u1eddng Z, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 v\u00f2ng Schatzki ho\u1eb7c v\u00f2ng B. H\u00ecnh \u1ea3nh n\u1ed9i soi: v\u00f2ng m\u1ecfng, tr\u00f2n, ho\u1eb7c khuy\u1ebft \u1edf tr\u00ean \u0111\u01b0\u1eddng Z, c\u00f3 th\u1ec3 th\u1ea5y th\u1ee9c \u0103n v\u01b0\u1edbng \u1edf v\u00f2ng ni\u00eam m\u1ea1c ho\u1eb7c ch\u1ea3y m\u00e1u do r\u00e1ch khi m\u00e1y soi \u0111i qua.<\/p>\n

        \u0110i\u1ec1u tr\u1ecb: n\u1ebfu c\u00f3 h\u1eb9p th\u00ec nong qua n\u1ed9i soi.<\/p>\n

        \"N\u1ed9i
        Schatzki ring<\/figcaption><\/figure>\n
        <\/div>\n

        3.2. V\u00f2ng c\u01a1 th\u1ef1c qu\u1ea3n <\/strong>(Muscularesophageal rings)<\/span>C\u00e1c \u0111\u01b0\u1eddng Z v\u00e0i cm, h\u00ecnh d\u1ea1ng thay \u0111\u1ed5i khi th\u1ef1c qu\u1ea3n co b\u00f3p.<\/p>\n

        Ph\u00e2n bi\u1ec7t v\u1edbi v\u00f2ng ni\u00eam m\u1ea1c th\u1ef1c qu\u1ea3n d\u1ef1a v\u00e0o v\u1ecb tr\u00ed, h\u00ecnh d\u1ea1ng, n\u1ebfu l\u00e0 v\u00f2ng ni\u00eam m\u1ea1c s\u1ebd kh\u00f4ng thay \u0111\u1ed5i khi th\u1ef1c qu\u1ea3n co b\u00f3p v\u00e0 th\u1ea5y v\u01b0\u1edbng khi m\u00e1y soi \u0111i qua. \u0110i\u1ec1u tr\u1ecb: n\u1ebfu c\u00f3 h\u1eb9p th\u1ef1c qu\u1ea3n nong qua n\u1ed9i soi.<\/p>\n

        3.3. M\u00e0ng th\u1ef1c qu\u1ea3n (Esophageal webs)<\/h3>\n

        M\u00e0ng \u0111\u01b0\u1ee3c bao ph\u1ee7 b\u1edfi t\u1ebf b\u00e0o v\u1ea9y, c\u00f3 th\u1ec3 l\u00e0m h\u1eb9p l\u00f2ng th\u1ef1c qu\u1ea3n, th\u01b0\u1eddng \u1edf v\u1ecb tr\u00ed \u0111o\u1ea1n th\u1ef1c qu\u1ea3n c\u1ed5 nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 th\u1ea5y \u1edf b\u1ea5t c\u1ee9 \u0111o\u1ea1n n\u00e0o c\u1ee7a th\u1ef1c qu\u1ea3n, c\u00f3 th\u1ec3 c\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u m\u00e0ng<\/p>\n

          \n
        • N\u1ebfu c\u00f3 k\u1ebft h\u1ee3p v\u1edbi thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng Plummer \u2013 Winson ho\u1eb7c h\u1ed9i ch\u1ee9ng Paterson \u2013 kelly.<\/li>\n
        • C\u00f3 th\u1ec3 ch\u1ea3y m\u00e1u do b\u1ecb th\u1ee7ng nh\u01b0ng kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb.<\/li>\n
        • \u0110i\u1ec1u tr\u1ecb: nong th\u1ef1c qu\u1ea3n qua n\u1ed9i soi n\u1ebfu c\u00f3 nu\u1ed1t kh\u00f3 v\u00e0 nhi\u1ec1u m\u00e0ng.<\/li>\n<\/ul>\n

          3.4. H\u1eb9p th\u1ef1c qu\u1ea3n do ch\u00e8n \u00e9p t\u1eeb ngo\u00e0i v\u00e0o<\/h3>\n

          Nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y ch\u00e8n \u00e9p v\u00e0o th\u1ef1c qu\u1ea3n: t\u1ed5 ch\u1ee9c b\u1ea5t th\u01b0\u1eddng, m\u1ea1ch m\u00e1u, t\u1ed5 ch\u1ee9c ung th\u01b0, gai \u0111\u1ed1t s\u1ed1ng c\u1ed5, tim to, ph\u1ed3ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n ph\u1ea3i, ung th\u01b0 ph\u1ed5i v\u00e0 h\u1ea1ch trung th\u1ea5t.<\/p>\n

          H\u00ecnh \u1ea3nh n\u1ed9i soi: h\u1eb9p l\u00f2ng th\u1ef1c qu\u1ea3n, h\u00ecnh \u1ea3nh x\u00e2m l\u1ea5n c\u1ee7a kh\u1ed1i u v\u00e0o l\u00f2ng th\u1ef1c qu\u1ea3n. \u0110i\u1ec1u tr\u1ecb: kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng khi nong th\u1ef1c qu\u1ea3n qua n\u1ed9i soi.<\/p>\n

          3.5. T\u00fai th\u1eeba th\u1ef1c qu\u1ea3n \u2013 h\u1ecdng (t\u00fai th\u1eeba Zenker)<\/h3>\n

          3.5.1. T\u00fai th\u1eeba Zenker<\/strong>: t\u00fai th\u1eeba \u1edf v\u1ecb tr\u00ed th\u1ef1c qu\u1ea3n \u2013 h\u1ecdng, ch\u1ee5p th\u1ef1c qu\u1ea3n c\u00f3 u\u1ed1ng baryte \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n, kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh soi th\u1ef1c qu\u1ea3n v\u00ec t\u00fai th\u1eeba ngay \u1edf v\u00f9ng nh\u1eabn h\u1ea7u n\u00ean kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c quan n\u1ed9i soi. N\u1ed9i soi ch\u1ec9 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c, ch\u00fa \u00fd bi\u1ebfn ch\u1ee9ng th\u1ee7ng t\u00fai th\u1eeba khi soi.<\/p>\n

          \"N\u1ed9i
          T\u00fai th\u1eeba Zenker<\/figcaption><\/figure>\n

          3.5.2. T\u00fai th\u1eeba \u1edf gi\u1eefa th\u1ef1c qu\u1ea3n<\/h4>\n

          Th\u01b0\u1eddng do vi\u00eam nhi\u1ec5m \u1edf v\u00f9ng trung th\u1ea5t co k\u00e9o sinh ra t\u00fai th\u1eeba, do qu\u00e1 tr\u00ecnh r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng c\u1ee7a th\u1ef1c qu\u1ea3n ho\u1eb7c do b\u1ea9m sinh.<\/p>\n

          Ch\u1ee5p X quang: th\u1ea5y h\u00ecnh \u1ea3nh t\u00fai th\u1eeba, n\u1ed9i soi ch\u1ea9n \u0111o\u00e1n c\u1ea7n ch\u00fa \u00fd bi\u1ebfn ch\u1ee9ng th\u1ee7ng ho\u1eb7c ch\u1ea3y m\u00e1u.<\/p>\n

          \u0110i\u1ec1u tr\u1ecb: ngo\u1ea1i khoa khi c\u00f3 bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u ho\u1eb7c h\u1eb9p.<\/p>\n

          3.5.3. T\u00fai th\u1eeba tr\u00ean c\u01a1 ho\u00e0nh<\/h4>\n

          T\u00fai th\u1eeba li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng c\u1ee7a th\u1ef1c qu\u1ea3n \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u01a1 th\u1eaft th\u1ef1c qu\u1ea3n<\/p>\n

          H\u00ecnh \u1ea3nh ch\u1ee5p x quang th\u1ef1c qu\u1ea3n th\u1ea5y t\u00fai th\u1eeba c\u00f3 mi\u1ec7ng r\u1ed9ng ngay \u1edf ph\u00eda tr\u00ean h\u00ecnh “m\u1ecf chim” c\u1ee7a b\u1ec7nh co th\u1eaft t\u00e2m v\u1ecb.<\/p>\n

          3.5.4. Gi\u1ea3 t\u00fai th\u1eeba<\/h4>\n

          Gi\u1ea3 t\u00fai th\u1eeba c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf, c\u00f3 ngay tr\u00ean th\u00e0nh c\u1ee7a th\u1ef1c qu\u1ea3n n\u00ean r\u1ea5t r\u00f5 khi ch\u1ee5p x quang th\u1ef1c qu\u1ea3n. H\u00ecnh \u1ea3nh n\u1ed9i soi th\u1ea5y t\u00fai th\u1eeba nh\u1ecf. T\u00fai th\u1eeba c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn h\u1eb9p th\u1ef1c qu\u1ea3n, n\u1ea5m th\u1ef1c qu\u1ea3n ho\u1eb7c vi\u00eam th\u1ef1c qu\u1ea3n tr\u00e0o ng\u01b0\u1ee3c. Kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u<\/p>\n

          3.6. \u1ee8 \u0111\u1ecdng glycogen<\/h3>\n

          \u1ee8 \u0111\u1ecdng glycogen l\u00e0 m\u1ed9t b\u1ec7nh l\u00e0nh t\u00ednh.<\/p>\n

          H\u00ecnh \u1ea3nh n\u1ed9i soi: m\u1ea3ng tr\u1eafng, h\u1ea1t tr\u1eafng tr\u00f2n, h\u00ecnh oval, nh\u1eb3n, th\u01b0\u1eddng \u1edf \u0111o\u1ea1n d\u01b0\u1edbi th\u1ef1c qu\u1ea3n, k\u00edch th\u01b0\u1edbc nh\u1ecf h\u01a1n 5mm, \u0111\u00f4i khi 1,5 cm. N\u1ebfu lan r\u1ed9ng t\u1ea1o th\u00e0nh m\u1ea3ng l\u1edbn, kh\u00f4ng c\u00f3 ph\u00f9 n\u1ec1 ho\u1eb7c sung huy\u1ebft. C\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi b\u1ea1ch s\u1ea3n, n\u1ea5m ho\u1eb7c ung th\u01b0 s\u1edbm.<\/p>\n

          3.7. Tuy\u1ebfn nh\u1eddn l\u1ea1c ch\u1ed7: r\u1ea5t hi\u1ebfm g\u1eb7p<\/h3>\n

          H\u00ecnh \u1ea3nh n\u1ed9i soi: m\u1ea3ng v\u00e0ng, x\u00e1m, h\u00ecnh tr\u00f2n ho\u1eb7c oval. K\u00edch th\u01b0\u1edbc 1 \u2013 5 mm, \u0111\u00f4i khi v\u00e0i cm, c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi polyp \u1ee9 glycogen, l\u00e0nh t\u00ednh v\u00e0 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb.<\/p>\n

          4. Gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n<\/h2>\n

          Gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n (TMTQ) l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda, th\u01b0\u1eddng kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng g\u00ec, ho\u1eb7c c\u00f3 ch\u1ea3y m\u00e1u do v\u1ee1 TMTQ. N\u1ed9i soi gi\u00fap ch\u1ea9n \u0111o\u00e1n gi\u00e3n TMTQ v\u00e0 bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u do v\u1ee1 gi\u00e3n TMTQ, ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y ch\u1ea3y m\u00e1u kh\u00e1c.<\/p>\n

          H\u00ecnh \u1ea3nh gi\u00e3n TMTQ qua n\u1ed9i soi: theo ph\u00e2n lo\u1ea1i c\u1ee7a H\u1ed9i n\u1ed9i soi Nh\u1eadt B\u1ea3n<\/p>\n

            \n
          • \u0110\u1ed9 1: t\u0129nh m\u1ea1ch c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf, th\u1eb3ng bi\u1ebfn m\u1ea5t khi b\u01a1m h\u01a1i c\u0103ng.<\/li>\n
          • \u0110\u1ed9 2: t\u0129nh m\u1ea1ch c\u00f3 \u0111\u01b0\u1eddng k\u00ednh nh\u1ecf h\u01a1n 5mm, ngo\u1eb1n ngo\u00e8o v\u00e0 chi\u1ebfm d\u01b0\u1edbi 1\/3 kh\u1ea9u k\u00ednh th\u1ef1c qu\u1ea3n.<\/li>\n
          • \u00a0\u0110\u1ed9 3: t\u0129nh m\u1ea1ch c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn h\u01a1n 5mm v\u00e0 chi\u1ebfm tr\u00ean 1\/3 kh\u1ea9u k\u00ednh c\u1ee7a th\u1ef1c qu\u1ea3n.<\/li>\n<\/ul>\n

            5. Tho\u00e1t v\u1ecb ho\u00e0nh v\u00e0 b\u1ec7nh l\u00fd th\u1ef1c qu\u1ea3n do nguy\u00ean nh\u00e2n \u1edf d\u1ea1 d\u00e0y<\/h2>\n

            5.1. Tho\u00e1t v\u1ecb ho\u00e0nh<\/strong>:<\/p>\n

            L\u00e0 m\u1ed9t ph\u1ea7n d\u1ea1 d\u00e0y tr\u01b0\u1ee3t qua l\u1ed5 ho\u00e0nh chui v\u00e0o l\u1ed3ng ng\u1ef1c, khi ch\u1ed5 n\u1ed1i gi\u1eefa th\u1ef1c qu\u1ea3n v\u00e0 d\u1ea1 d\u00e0y cao h\u01a1n l\u1ed5 ho\u00e0nh l\u1edbn h\u01a1n 2 cm.\u00a0 Tho\u00e1t v\u1ecb ho\u00e0nh chia l\u00e0m 2 lo\u1ea1i l\u00e0 tho\u00e1t v\u1ecb tr\u01b0\u1ee3t v\u00e0 tho\u00e1t v\u1ecb khe.<\/p>\n

            5.1.1. Tho\u00e1t v\u1ecb tr\u01b0\u1ee3t<\/h4>\n

            Tho\u00e1t v\u1ecb tr\u01b0\u1ee3t l\u00e0 ch\u1ed5 n\u1ed1i d\u1ea1 d\u00e0y \u2013 th\u1ef1c qu\u1ea3n v\u00e0 m\u1ed9t ph\u1ea7n d\u1ea1 d\u00e0y b\u1ecb \u0111\u1ea9y l\u00ean ph\u00eda sau trung th\u1ea5t nh\u01b0ng d\u1ea1 d\u00e0y kh\u00f4ng c\u00f3 thay \u0111\u1ed5i tr\u1ee5c.<\/p>\n

            H\u00ecnh \u1ea3nh n\u1ed9i soi c\u1ee7a tho\u00e1t v\u1ecb ho\u00e0nh tr\u01b0\u1ee3t khi soi ng\u01b0\u1ee3c th\u1ea5y v\u00f9ng khuy\u1ebft \u1edf \u0111\u00e1y d\u1ea1 d\u00e0y \u0111\u00f3 l\u00e0 v\u00f9ng c\u01a1 ho\u00e0nh, ph\u00eda tr\u00ean ch\u1ed5 khuy\u1ebft l\u00e0 ph\u1ea7n \u0111\u00e1y d\u1ea1 d\u00e0y \u1edf trong l\u1ed3ng ng\u1ef1c.<\/p>\n

            H\u00ecnh \u1ea3nh tho\u00e1t v\u1ecb ho\u00e0nh tr\u01b0\u1ee3t khi ch\u1ee5p x quang l\u1ed3ng ng\u1ef1c nghi\u00eang th\u1ea5y kh\u1ed1i \u0111\u1ecdng thu\u1ed1c v\u1edbi m\u1ee9c h\u01a1i \u1edf tr\u00ean.<\/p>\n

            Tho\u00e1t v\u1ecb ho\u00e0nh tr\u01b0\u1ee3t th\u01b0\u1eddng kh\u00f4ng g\u00e2y tri\u1ec7u ch\u1ee9ng n\u1ebfu c\u00f3 tr\u00e0o ng\u01b0\u1ee3c th\u1ef1c qu\u1ea3n s\u1ebd c\u00f3 \u1ee3 n\u00f3ng, \u0111au ng\u1ef1c.<\/p>\n

            5.1.2. Tho\u00e1t v\u1ecb ho\u00e0nh khe<\/h4>\n

            L\u00e0 tho\u00e1t v\u1ecb nh\u01b0ng ch\u1ed7 n\u1ed1i c\u1ee7a th\u1ef1c qu\u1ea3n v\u00e0 d\u1ea1 d\u00e0y v\u1eabn \u1edf v\u1ecb tr\u00ed b\u00ecnh th\u01b0\u1eddng, \u0111\u00e1y d\u1ea1 d\u00e0y chui v\u00e0o l\u1ed3ng ng\u1ef1c v\u00e0 xo\u1eafn v\u1eb7n, th\u01b0\u1eddng n\u1eb1m d\u1ecdc theo th\u1ef1c qu\u1ea3n. N\u1ebfu l\u1ed5 tho\u00e1t v\u1ecb to th\u00ec c\u00f3 th\u1ec3 to\u00e0n b\u1ed9 d\u1ea1 d\u00e0y chui v\u00e0o l\u1ed3ng ng\u1ef1c t\u1ea1o ra h\u00ecnh l\u1ed9n ng\u01b0\u1ee3c g\u00e2y h\u1eb9p th\u1ef1c qu\u1ea3n v\u00e0 d\u1ea1 d\u00e0y. N\u1ebfu h\u1ec7 th\u1ed1ng nu\u00f4i d\u01b0\u1ee1ng d\u1ea1 d\u00e0y b\u1ecb \u00e9p th\u00ec c\u00f3 th\u1ec3 th\u1ee7ng d\u1ea1 d\u00e0y, X quang trong tr\u01b0\u1eddng h\u1ee3p tho\u00e1t v\u1ecb nhi\u1ec1u th\u1ea5y to\u00e0n b\u1ed9 d\u1ea1 d\u00e0y n\u1eb1m trong l\u1ed3ng ng\u1ef1c \u1edf v\u1ecb tr\u00ed \u0111\u1ea3o ng\u01b0\u1ee3c, th\u00e2n d\u1ea1 d\u00e0y v\u00e0 hang v\u1ecb ho\u00e0n to\u00e0n \u1edf trong l\u1ed3ng ng\u1ef1c kh\u00f4ng c\u00f3 m\u1ee9c n\u01b0\u1edbc v\u00e0 h\u01a1i.<\/p>\n

            \u0110\u1ec3 \u0111\u1ec1 ph\u00f2ng bi\u1ebfn ch\u1ee9ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa ngay n\u1ebfu ph\u00e1t hi\u1ec7n tho\u00e1t v\u1ecb ho\u00e0nh.<\/p>\n

            6. Lo\u00e9t th\u1ef1c qu\u1ea3n<\/h2>\n

            6.1. Lo\u00e9t c\u1ea5p t\u00ednh<\/strong>: Lo\u00e9t c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 do thu\u1ed1c, do h\u00f3a ch\u1ea5t, do vi khu\u1ea9n, virus…<\/p>\n

            6.2. Lo\u00e9t m\u1ea1n t\u00ednh<\/strong>: th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd tr\u00e0o ng\u01b0\u1ee3c th\u1ef1c qu\u1ea3n, t\u1ed5n th\u01b0\u01a1ng lo\u00e9t \u1edf tr\u00ean \u0111\u01b0\u1eddng Z v\u00e0 \u0111o\u1ea1n d\u01b0\u1edbi th\u1ef1c qu\u1ea3n, \u1ed5 lo\u00e9t s\u00e2u, bi\u1ebfn ch\u1ee9ng h\u1eb9p, th\u1ee7ng ho\u1eb7c ch\u1ea3y m\u00e1u v\u00e0 ung th\u01b0 h\u00f3a.<\/p>\n

            7. D\u1ecb v\u1eadt th\u1ef1c qu\u1ea3n<\/h2>\n

            Th\u1ef1c qu\u1ea3n l\u00e0 \u0111o\u1ea1n \u1ed1ng ti\u00eau h\u00e1o c\u00f3 \u0111\u01b0\u1eddng k\u00ednh nh\u1ecf nh\u1ea5t, c\u00f3 3 ch\u1ed5 h\u1eb9p m\u00e0 d\u1ecb v\u1eadt hay m\u1eafc: v\u00f9ng c\u01a1 nh\u1eabn – h\u1ea7u c\u00e1ch cung r\u0103ng tr\u00ean 15 cm, v\u00f9ng gi\u1eefa \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 kh\u00ed qu\u1ea3n tr\u00e1i c\u00e1ch cung r\u0103ng tr\u00ean 25cm v\u00e0 v\u00f9ng c\u01a1 th\u1eaft th\u1ef1c qu\u1ea3n d\u01b0\u1edbi c\u00e1ch cung r\u0103ng tr\u00ean 38 – 40cm. Tr\u1ebb em hay b\u1ecb m\u1eafc d\u1ecb v\u1eadt \u1edf 1\/3 tr\u00ean th\u1ef1c qu\u1ea3n, d\u1ecb v\u1eadt th\u01b0\u1eddng l\u00e0 \u0111\u1ed3ng xu, n\u1eafp chai l\u1ecd ho\u1eb7c \u0111\u1ed3 ch\u01a1i. Ng\u01b0\u1eddi l\u1edbn hay b\u1ecb m\u1eafc d\u1ecb v\u1eadt \u1edf 1\/3 d\u01b0\u1edbi th\u1ef1c qu\u1ea3n, d\u1ecb v\u1eadt th\u01b0\u1eddng l\u00e0 th\u1ee9c \u0103n nh\u01b0 x\u01b0\u01a1ng, th\u1ecbt, m\u0103ng kh\u00f4. D\u1ecb v\u1eadt th\u1ef1c qu\u1ea3n g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng v\u00e0 c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong, bi\u1ebfn ch\u1ee9ng vi\u00eam trung th\u1ea5t, r\u00f2 th\u1ef1c qu\u1ea3n \u2013 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, \u00e1p xe ph\u1ed5i, d\u1ecb v\u1eadt th\u1ef1c qu\u1ea3n c\u1ea7n \u0111\u01b0\u1ee3c l\u1ea5y ra s\u1edbm qua n\u1ed9i soi v\u00ec d\u1ecb v\u1eadt \u1edf th\u1ef1c qu\u1ea3n \u00edt c\u00f3 kh\u1ea3 n\u0103ng t\u1ef1 xu\u1ed1ng d\u1ea1 d\u00e0y do ph\u00f9 n\u1ec1 v\u00e0 sung huy\u1ebft t\u1ea1i ch\u1ed5.<\/p>\n

            8. Ch\u1ea5n th\u01b0\u01a1ng th\u1ef1c qu\u1ea3n<\/h2>\n

            8.1. R\u00e1ch th\u1ef1c qu\u1ea3n<\/strong> (h\u1ed9i ch\u1ee9ng Mallory \u2013 Weiss) R\u00e1ch th\u1ef1c qu\u1ea3n g\u1ea7n ch\u1ed5 n\u1ed1i gi\u1eefa th\u1ef1c qu\u1ea3n v\u00e0 d\u1ea1 d\u00e0y do \u00e1p l\u1ef1c khoang b\u1ee5ng t\u0103ng \u0111\u1ed9t ng\u1ed9t. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 do n\u00f4n v\u00e0 \u1ee3. Khi soi th\u1ea5y c\u00f3 v\u1ebft r\u00e1ch \u1edf v\u1ecb tr\u00ed 12 gi\u1edd. Ch\u1ea3y m\u00e1u do r\u00e1ch th\u1ef1c qu\u1ea3n c\u00f3 th\u1ec3 t\u1ef1 c\u1ea7m nh\u01b0ng c\u0169ng c\u00f3 khi kh\u00f4ng t\u1ef1 c\u1ea7m v\u00e0 t\u00e1i ph\u00e1t.<\/p>\n

            8.2. H\u1ed9i ch\u1ee9ng Boerhaave<\/h3>\n

            Th\u1ee7ng th\u1ef1c qu\u1ea3n do n\u00f4n qu\u00e1 m\u1ea1nh. V\u1ecb tr\u00ed th\u1ee7ng th\u01b0\u1eddng \u1edf th\u00e0nh sau b\u00ean tr\u00e1i c\u1ee7a th\u1ef1c qu\u1ea3n d\u00e0i v\u00e0i cm. T\u1ef7 l\u1ec7 t\u1eed vong cao n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n s\u1edbm.<\/p>\n

            8.3. T\u1ee5 m\u00e1u th\u1ef1c qu\u1ea3n<\/h3>\n

            Ch\u1ea3y m\u00e1u d\u01b0\u1edbi ni\u00eam m\u1ea1c do b\u1ec7nh m\u00e1u ho\u1eb7c do sau ch\u1ea5n th\u01b0\u01a1ng do n\u00f4n ho\u1eb7c h\u1eaft h\u01a1i m\u1ea1nh. T\u1ee5 m\u00e1u th\u1ef1c qu\u1ea3n th\u01b0\u1eddng th\u1ea5y \u1edf \u0111o\u1ea1n d\u01b0\u1edbi th\u1ef1c qu\u1ea3n nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 lan r\u1ed9ng tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n v\u1ec1 \u0111\u00f4ng m\u00e1u, c\u00f3 th\u1ec3 th\u1ea5y r\u1ea5t nhi\u1ec1u kh\u1ed1i t\u1ee5 m\u00e1u \u1edf th\u1ef1c qu\u1ea3n.<\/p>\n

            Tri\u1ec7u ch\u1ee9ng nu\u1ed1t kh\u00f3, nu\u1ed1t \u0111au, n\u00f4n ra m\u00e1u.<\/p>\n

            Ch\u1ee5p x quang th\u1ef1c qu\u1ea3n c\u00f3 baryte c\u00f3 h\u00ecnh \u1ea3nh nh\u01b0 kh\u1ed1i u d\u01b0\u1edbi ni\u00eam m\u1ea1c t\u1ea1o nh\u1eefng v\u1ebft \u0111\u1ecdng thu\u1ed1c.<\/p>\n

             <\/p>\n

            T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong><\/p>\n

              \n
            1. N\u1ed9i soi ti\u00eau ho\u00e1. B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai.<\/li>\n
            2. Jean Macr Canard (2011), Gastrointestinal Endoscopy in practice. Elsevier Churchill Livingstone.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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