{"id":24949,"date":"2023-04-21T13:12:34","date_gmt":"2023-04-21T06:12:34","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24949"},"modified":"2023-04-21T18:01:27","modified_gmt":"2023-04-21T11:01:27","slug":"benh-ly-da-day-ta-trang-qua-noi-soi-tieu-hoa","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/benh-ly-da-day-ta-trang-qua-noi-soi-tieu-hoa\/","title":{"rendered":"B\u1ec7nh l\u00fd d\u1ea1 d\u00e0y-t\u00e1 tr\u00e0ng qua n\u1ed9i soi ti\u00eau ho\u00e1"},"content":{"rendered":"

N\u1ed9i soi d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng<\/a> l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd c\u1ee7a \u1ed1ng ti\u00eau h\u00f3a t\u1eeb th\u1ef1c qu\u1ea3n \u0111\u1ebfn DII c\u1ee7a t\u00e1 tr\u00e0ng b\u1eb1ng m\u00e1y n\u1ed9i soi \u1ed1ng m\u1ec1m. Soi d\u1ea1 d\u00e0y \u2013 t\u00e1 tr\u00e0ng nh\u1eb1m ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0y, t\u00e1 tr\u00e0ng.<\/strong><\/p>\n

1. B\u1ec7nh l\u00fd d\u1ea1 d\u00e0y<\/h2>\n

1.1. Vi\u00eam d\u1ea1 d\u00e0y<\/h3>\n

L\u00e0 s\u1ef1 thay \u0111\u1ed5i c\u1ee7a ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y do nhi\u1ec5m khu\u1ea9n, do nu\u00f4i d\u01b0\u1ee1ng, do s\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a t\u1ebf b\u00e0o vi\u00eam v\u00ec nhi\u1ec1u nguy\u00ean nh\u00e2n.<\/p>\n

Nh\u1eefng h\u00ecnh \u1ea3nh c\u1ee7a vi\u00eam ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y: C\u00f3 th\u1ec3 th\u1ea5y \u0111\u00e2y l\u00e0 m\u1ed9t h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c nhi\u1ec1u h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng k\u1ebft h\u1ee3p v\u1edbi nhau. T\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 khu tr\u00fa hay lan t\u1ecfa. H\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng n\u1ed5i b\u1eadt nh\u1ea5t c\u00f3 th\u1ec3 \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9, v\u1eeba hay n\u1eb7ng.<\/p>\n

1.1.1. Ph\u00f9 n\u1ec1 (Edema)<\/h4>\n

Ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y tr\u1eafng, nh\u1ea1t m\u00e0u, loang l\u1ed5. C\u00f3 th\u1ec3 th\u1ea5y nh\u1eefng h\u00ecnh \u0111a gi\u00e1c n\u1ed5i r\u00f5 tr\u00ean ni\u00eam m\u1ea1c, bi\u1ec3u hi\u1ec7n ph\u00f9 n\u1ec1 ni\u00eam m\u1ea1c \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9. C\u00f3 nh\u1eefng v\u00f9ng sung huy\u1ebft \u0111\u1ecf, \u1edf v\u00f9ng n\u00e0y n\u1ebfp ni\u00eam m\u1ea1c th\u00f4 n\u1ed5i r\u00f5, tr\u00ean c\u00f3 nh\u1eefng ch\u1ea5m sung huy\u1ebft \u0111\u1ecf r\u1ef1c, \u0111\u01b0\u1ee3c chia l\u00e0m 3 lo\u1ea1i sau:<\/p>\n

    \n
  1. Lo\u1ea1i sung huy\u1ebft nh\u1eb9: \u0110\u00e1m sung huy\u1ebft \u0111\u1ecf nh\u01b0ng thay \u0111\u1ed5i m\u00e0u s\u1eafc r\u00f5.<\/li>\n
  2. Lo\u1ea1i sung huy\u1ebft trung b\u00ecnh: \u0110\u00e1m sung huy\u1ebft l\u1edbn h\u01a1n, m\u00e0u \u0111\u1ecf r\u1ef1c.<\/li>\n
  3. Lo\u1ea1i sung huy\u1ebft n\u1eb7ng: \u0110\u00e1m sung huy\u1ebft r\u1ed9ng, m\u00e0u \u0111\u1ecf r\u1ef1c<\/li>\n<\/ol>\n

    1.1.2. Vi\u00eam d\u1ea1 d\u00e0y do ch\u1ea5n th\u01b0\u01a1ng<\/em>:<\/h4>\n

    C\u00f3 th\u1ec3 ch\u1ea3y m\u00e1u nhi\u1ec1u ho\u1eb7c ch\u1ea3y m\u00e1u r\u1ec9 r\u1ea3.<\/p>\n

    1.1.3. Vi\u00eam xu\u1ea5t ti\u1ebft (Exudate)<\/h4>\n

    Tr\u00ean ni\u00eam m\u1ea1c c\u00f3 nh\u1eefng m\u1ea3ng m\u00e0u xanh n\u00e2u, v\u00e0ng x\u00e1m, ho\u1eb7c \u0111\u00e1m t\u01a1 huy\u1ebft l\u1eafng \u0111\u1ed9ng, r\u1ea5t kh\u00f3 bong khi r\u1eeda. Vi\u00eam d\u1ea1 d\u00e0y n\u00e0y th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn Helicobacter \u2013 Pylori. <\/em><\/p>\n

    1.1.4. Vi\u00eam d\u1ea1 d\u00e0y tr\u1ee3t n\u00f4ng ph\u1eb3ng (Flat erosio)( s\u01b0\u1edbt ph\u1eb3ng)<\/h4>\n

    C\u00f3 1 hay nhi\u1ec1u tr\u1ee5 nh\u1ecf, trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 \u1ed5 ho\u1ea1i t\u1eed (nh\u1eefng t\u1ed5n th\u01b0\u01a1ng ch\u01b0a ph\u00e1 h\u1ee7y l\u1edbp c\u01a1 ni\u00eam d\u1ea1 d\u00e0y), c\u00f3 nh\u1eefng m\u1ea3ng tr\u1eafng x\u00e1m c\u00f3 vi\u1ec1n \u0111\u1ecf ho\u1eb7c kh\u00f4ng c\u00f3 vi\u1ec1n \u0111\u1ecf bao quanh, \u0111\u00e1y \u1ed5 lo\u00e9t tr\u1ee3t, c\u00f3 th\u1ec3 c\u00e1c m\u1ee7 \u0111\u1ecdng s\u00e2u kho\u1ea3ng 1mm. \u1ede h\u00e0nh t\u00e1 tr\u00e0ng nh\u1eefng \u1ed5 lo\u00e9t tr\u1ee3t n\u00f4ng, ph\u1eb3ng k\u1ebft h\u1ee3p v\u1edbi sung huy\u1ebft m\u1ea1nh t\u1ea1o n\u00ean h\u00ecnh \u1ea3nh “x\u00fac x\u00edch”.<\/p>\n

    1.1.5. Vi\u00eam d\u1ea1 d\u00e0y tr\u1ee3t n\u00f4ng l\u1ed3i<\/em> (lo\u00e9t ki\u1ec3u h\u1ea1t \u0111\u1eadu) (Raised erosion) (s\u01b0\u1edbt nh\u00f4 cao)<\/h4>\n

    T\u1ea1o th\u00e0nh d\u00e3y ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng ri\u00eang bi\u1ec7t, \u1ed5 vi\u00eam tr\u1ee3t g\u1ed3 cao, tr\u00ean \u0111\u1ec9nh l\u00f5m.<\/p>\n

    M\u1ee9c \u0111\u1ed9 nh\u1eb9: c\u00f3 1 ho\u1eb7c v\u00e0i n\u1ed1t tr\u1ee3t.<\/p>\n

    M\u1ee9c \u0111\u1ed9 v\u1eeba: c\u00f3 nhi\u1ec1u h\u1ea1t.<\/p>\n

    M\u1ee9c \u0111\u1ed9 n\u1eb7ng: c\u00f3 r\u1ea5t nhi\u1ec1u h\u1ea1t.<\/p>\n

    1.1.6. Vi\u00eam t\u0103ng s\u1ea3n<\/em> (c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c nhi\u1ec1u v\u00e0 to)<\/h4>\n

    N\u1ebfp ni\u00eam m\u1ea1c th\u00f4 d\u00e0y, khi b\u01a1m h\u01a1i c\u0103ng kh\u00f4ng h\u1ebft.<\/p>\n

      \n
    • M\u1ee9c \u0111\u1ed9 nh\u1eb9: N\u1ebfp ni\u00eam m\u1ea1c d\u00e0y < 5mm.<\/li>\n
    • M\u1ee9c \u0111\u1ed9 v\u1eeba: n\u1ebfp ni\u00eam m\u1ea1c d\u00e0y 5 \u2013 10 mm.<\/li>\n
    • M\u1ee9c \u0111\u1ed9 n\u1eb7ng: n\u1ebfp ni\u00eam m\u1ea1c d\u00e0y > 10mm.<\/li>\n<\/ul>\n

      1.1.7. Vi\u00eam teo ni\u00eam m\u1ea1c<\/h4>\n

      Ni\u00eam m\u1ea1c m\u1ecfng, nh\u1eb3n, m\u00e0u v\u00e0ng, c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c th\u01b0a th\u1edbt, nh\u00ecn th\u1ea5y m\u1ea1ch m\u00e1u n\u1ed5i r\u00f5, th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi d\u1ecb s\u1ea3n.<\/p>\n

      1.1.8. Vi\u00eam teo n\u1eb7ng<\/h4>\n

      Khi ch\u01b0a b\u01a1m h\u01a1i c\u0103ng \u0111\u00e3 nh\u00ecn r\u00f5 c\u00e1c m\u1ea1ng l\u01b0\u1edbi m\u1ea1ch m\u00e1u v\u1edbi k\u00edch th\u01b0\u1edbc kh\u00e1c nhau. \u0110\u01b0\u1ee3c chia l\u00e0m 3 m\u1ee9c \u0111\u1ed9:<\/p>\n

        \n
      • M\u1ee9c \u0111\u1ed9 nh\u1eb9: nh\u00ecn th\u1ea5y m\u1ea1ch m\u00e1u r\u00f5.<\/li>\n
      • M\u1ee9c \u0111\u1ed9 v\u1eeba: nh\u00ecn th\u1ea5y m\u1ea1ng l\u01b0\u1edbi m\u1ea1ch m\u00e1u.<\/li>\n
      • M\u1ee9c \u0111\u1ed9 n\u1eb7ng: m\u1ea1ng l\u01b0\u1edbi m\u1ea1ch m\u00e1u n\u1ed5i r\u00f5, cong queo.<\/li>\n<\/ul>\n

        1.1.9. Vi\u00eam d\u1ea1 d\u00e0y ch\u1ea3y m\u00e1u<\/h4>\n

        Ch\u1ea3y m\u00e1u d\u01b0\u1edbi ni\u00eam m\u1ea1c ho\u1eb7c ch\u1ea3y m\u00e1u v\u00e0o d\u1ea1 d\u00e0y.<\/p>\n

          \n
        • Ch\u1ea3y m\u00e1u d\u01b0\u1edbi ni\u00eam m\u1ea1c: ch\u1ea5m xu\u1ea5t huy\u1ebft k\u00e8m theo ph\u00f9 n\u1ec1 sung huy\u1ebft.<\/li>\n
        • M\u1ea3ng ch\u1ea3y m\u00e1u: m\u1ea3ng m\u00e0u n\u00e2u h\u1ed3ng ho\u1eb7c nh\u1eefng ch\u1ea5m, v\u1ec7t \u0111en s\u1eabm.<\/li>\n<\/ul>\n

          1.1.10. Vi\u00eam d\u1ea1ng h\u1ea1t<\/h4>\n
            \n
          • M\u1ee9c \u0111\u1ed9 nh\u1eb9: h\u1ea1t nh\u1ecf li ti.<\/li>\n
          • M\u1ee9c \u0111\u1ed9 v\u1eeba: h\u1ea1t to<\/li>\n<\/ul>\n

            1.2. Ph\u00e2n lo\u1ea1i h\u00ecnh \u1ea3nh vi\u00eam ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y theo h\u1ec7 th\u1ed1ng Sydney<\/h3>\n

            1.2.1. Vi\u00eam ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y ph\u00f9 n\u1ec1 sung huy\u1ebft <\/em><\/h4>\n

            Hay g\u1eb7p, c\u00f3 nh\u1eefng h\u00ecnh \u1ea3nh sau:<\/p>\n

              \n
            • L\u00e0 nh\u1eefng \u0111\u00e1m sung huy\u1ebft, tr\u00ean c\u00f3 nh\u1eefng h\u1ea1t nh\u1ecf li ti, ni\u00eam m\u1ea1c m\u1ea5t t\u00ednh ch\u1ea5t nh\u1eb3n b\u00f3ng, \u0111\u00f4i khi th\u1ea5y \u0111\u00e1m xu\u1ea5t ti\u1ebft. Ni\u00eam m\u1ea1c m\u1ee7n v\u00e0 c\u00f3 nh\u1eefng ch\u1ea5m \u0111\u1ecf ch\u1ea1y d\u1ecdc v\u00f9ng hang v\u1ecb t\u1edbi l\u1ed5 m\u00f4n v\u1ecb. Hay g\u1eb7p \u1edf hang v\u1ecb ho\u1eb7c c\u1ea3 \u1edf hang v\u1ecb v\u00e0 th\u00e2n v\u1ecb.<\/li>\n
            • Nguy\u00ean nh\u00e2n do nhi\u1ec5m Helicobacter Pylori<\/em> n\u1eb7ng.<\/li>\n<\/ul>\n

              1.2.2. Vi\u00eam ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y do tr\u00e0o ng\u01b0\u1ee3c d\u1ecbch m\u1eadt<\/h4>\n

              Ni\u00eam m\u1ea1c sung huy\u1ebft \u0111\u1ecf r\u1ef1c, c\u00f3 d\u1ecbch m\u1eadt tr\u00e0o ng\u01b0\u1ee3c qua l\u1ed5 m\u00f4n v\u1ecb. Hay g\u1eb7p tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u1eaft d\u1ea1 d\u00e0y.<\/p>\n

              1.2.3. Vi\u00eam tr\u1ee3t ph\u1eb3ng<\/h4>\n

              – C\u00f3 nhi\u1ec1u v\u1ebft tr\u1ee3t n\u00f4ng ph\u1eb3ng, c\u00f3 m\u00e0ng t\u01a1 huy\u1ebft ph\u1ee7 \u1edf \u0111\u00e1y. C\u00e1c v\u1ebft tr\u1ee3t c\u00f3 th\u1ec3 t\u1ea1o th\u00e0nh m\u1ed9t \u0111\u01b0\u1eddng bao quanh l\u1ed5 m\u00f4n v\u1ecb. Hay g\u1eb7p \u1edf hang v\u1ecb ho\u1eb7c to\u00e0n b\u1ed9 ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y.<\/p>\n

              – Nguy\u00ean nh\u00e2n do d\u00f9ng thu\u1ed1c ch\u1ed1ng vi\u00eam lo\u1ea1i kh\u00f4ng Steroides, Steroides…Do s\u1ed1c ho\u1eb7c do t\u0103ng ur\u00ea m\u00e1u trong suy th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i.<\/p>\n

              1.2.4. Vi\u00eam tr\u1ee3t l\u1ed3i<\/h4>\n

              – Vi\u00eam tr\u1ee3t l\u1ed3i l\u00ean tr\u00ean ni\u00eam m\u1ea1c nh\u01b0 h\u1ea1t \u0111\u1eadu, t\u1eadp trung d\u1ecdc theo c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c.<\/p>\n

              – T\u1ed5n th\u01b0\u01a1ng k\u00e8m theo: th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi vi\u00eam d\u1ea1 d\u00e0y lympho, v\u1edbi \u0111\u1eb7c \u0111i\u1ec3m th\u00e2m nhi\u1ec5m lympho tr\u00ean m\u1eb7t l\u1edbp bi\u1ec3u m\u00f4 ph\u1ee7<\/p>\n

              1.2.5. Vi\u00eam teo ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y<\/h4>\n
                \n
              • Th\u1ea5y c\u00e1c m\u1ea1ch m\u00e1u n\u1ed5i r\u00f5 ngay khi ch\u1ee9a b\u01a1m h\u01a1i, ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y nh\u1ea1t m\u00e0u, c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c teo m\u1ecfng.<\/li>\n
              • T\u1ed5n th\u01b0\u01a1ng k\u00e8m theo: d\u1ecb s\u1ea3n ru\u1ed9t v\u00e0 lo\u1ea1n s\u1ea3n bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u00e1c m\u1ea3ng tr\u1eafng x\u00e1m \u00f3ng \u00e1nh nhi\u1ec1u m\u00e0u. Khi quan s\u00e1t g\u1ea7n th\u1ea5y c\u00f3 nhung mao. C\u00f3 th\u1ec3 g\u1eb7p sau c\u1eaft d\u1ea1 d\u00e0y.<\/li>\n<\/ul>\n

                1.2.6. Vi\u00eam ni\u00eam m\u1ea1c ch\u1ea3y m\u00e1u<\/h4>\n

                Nh\u1eefng ch\u1ea5m ch\u1ea3y m\u00e1u nh\u1ecf m\u00e0u \u0111\u1ecf, ho\u1eb7c m\u00e0u n\u00e2u s\u1eabm. Nh\u1eefng m\u00e0u \u0111en tr\u00ean ni\u00eam m\u1ea1c ph\u00f9 n\u1ec1 v\u00e0 c\u00f3 th\u1ec3 th\u1ea5y m\u00e1u trong d\u1ea1 d\u00e0y.<\/p>\n

                1.2.7. Vi\u00eam ni\u00eam m\u1ea1c ph\u00ec \u0111\u1ea1i<\/h4>\n

                N\u1ebfp ni\u00eam m\u1ea1c th\u00f4 to, c\u00e1c ni\u00eam m\u1ea1c ch\u1ed3ng l\u00ean nhau, tr\u00ean \u0111\u1ec9nh c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c c\u00f3 tr\u1ee3t n\u00f4ng.<\/p>\n

                  \n
                • B\u1ec7nh Menetrie: nhi\u1ec1u nh\u1ea7y ph\u1ee7 l\u00ean c\u00e1c l\u1edbp ni\u00eam m\u1ea1c th\u00f4, to, \u0111\u1ec9nh c\u1ee7a c\u00e1c l\u1edbp ni\u00eam m\u1ea1c tr\u00f4ng gi\u1ed1ng nh\u01b0 polyp.<\/li>\n
                • U d\u1ea1 d\u00e0y b\u00e0i ti\u1ebft gastrin: ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y v\u00f9ng th\u00e2n v\u1ecb n\u1ed5i r\u00f5 d\u1ec5 th\u1ea5y, ti\u1ebft nhi\u1ec1u d\u1ecbch trong.<\/li>\n
                • Vi\u00eam d\u1ea1 d\u00e0y t\u0103ng ti\u1ebft: c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c th\u00f4 to, m\u00e0u s\u1eafc kh\u00f4ng \u0111\u1ec1u, m\u1ea5t t\u00ednh ch\u1ea5t nh\u1eb5n, b\u00f3ng, c\u00f3 nhi\u1ec1u d\u1ecbch nh\u1ea7y.<\/li>\n<\/ul>\n

                  \"H\u00ecnh<\/p>\n

                  \"H\u00ecnh
                  A: B\u00ecnh th\u01b0\u1eddng; B: vi\u00eam ni\u00eam m\u1ea1c; C: vi\u00eam t\u0103ng s\u1ea3n; D; chuy\u1ec3n s\u1ea3n<\/figcaption><\/figure>\n

                  1.3. D\u1ecb s\u1ea3n d\u1ea1 d\u00e0y<\/h3>\n

                  C\u00f3 3 t\u00edp d\u1ecb s\u1ea3n: d\u1ecb s\u1ea3n ru\u1ed9t v\u00e0 m\u00f4n v\u1ecb th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi vi\u00eam teo ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y.<\/p>\n

                  1.3.1. D\u1ecb s\u1ea3n ru\u1ed9t<\/strong>: th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn ung th\u01b0 d\u1ea1 d\u00e0y. Ni\u00eam m\u1ea1c c\u00f3 c\u1ea5u tr\u00fac nhung mao \u0111\u1ea7u ti\u00ean l\u00e0 nh\u1eefng \u0111\u00e1m \u1edf hang v\u1ecb.<\/p>\n

                  1.3.2. D\u1ecb s\u1ea3n m\u00f4n v\u1ecb<\/strong>: ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y gi\u1ed1ng ni\u00eam m\u1ea1c b\u00ecnh th\u01b0\u1eddng c\u1ee7a m\u00f4n v\u1ecb. \u0110\u1ea7u ti\u00ean xu\u1ea5t hi\u1ec7n \u1edf v\u00f9ng th\u00e2n v\u1ecb s\u00e1t v\u1edbi ph\u1ea7n hang v\u1ecb.<\/p>\n

                  1.3.3. D\u1ecb s\u1ea3n l\u00f4ng<\/strong>: c\u00f3 c\u1ea5u tr\u00fac l\u00f4ng mao m\u00e0 b\u00ecnh th\u01b0\u1eddng kh\u00f4ng th\u1ea5y \u1edf \u1ed1ng ti\u00eau h\u00f3a, ngay c\u1ea3 tr\u01b0\u1eddng h\u1ee3p lo\u1ea1n s\u1ea3n \u1edf d\u1ea1 d\u00e0y. Lo\u1ea1i d\u1ecb s\u1ea3n n\u00e0y th\u1ea5y tr\u00ean b\u1ec7nh nh\u00e2n lo\u00e9t d\u1ea1 d\u00e0y, lo\u1ea1n s\u1ea3n d\u1ea1 d\u00e0y v\u00e0 ung th\u01b0 d\u1ea1 d\u00e0y. D\u1ecb s\u1ea3n \u1edf l\u1edbp bi\u1ec3u m\u00f4 ph\u1ee7 c\u00e1ch xa t\u1ed5n th\u01b0\u01a1ng ch\u00ednh, k\u1ebft h\u1ee3p v\u1edbi vi\u00eam d\u1ea1 d\u00e0y m\u1ea1n t\u00ednh v\u1eeba.<\/p>\n

                  1.4. Lo\u00e9t d\u1ea1 d\u00e0y<\/h3>\n

                  Lo\u00e9t d\u1ea1 d\u00e0y hay g\u1eb7p \u1edf b\u1edd cong nh\u1ecf nh\u1ea5t l\u00e0 ch\u1ed5 n\u1ed1i gi\u1eefa ph\u1ea7n hang v\u1ecb v\u00e0 ph\u1ea7n th\u00e2n v\u1ecb, ho\u1eb7c \u1edf ph\u00eda tr\u00ean g\u00f3c b\u1edd cong nh\u1ecf, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p \u1edf b\u1ea5t c\u1ee9 v\u1ecb tr\u00ed n\u00e0o trong d\u1ea1 d\u00e0y.<\/p>\n

                  Ph\u00e2n lo\u1ea1i \u1ed5 lo\u00e9t:<\/p>\n

                  1.4.1. Lo\u00e9t mi\u1ec7ng n\u1ed1i<\/strong>: th\u01b0\u1eddng th\u1ea5y sau c\u1eaft d\u1ea1 d\u00e0y do lo\u00e9t h\u00e0nh t\u00e1 tr\u00e0ng.<\/p>\n

                  1.4.2. Lo\u00e9t ki\u1ec3u \u0111\u01b0\u1eddng h\u1ea7m<\/strong>: \u1ed5 lo\u00e9t ch\u1ea1y d\u1ecdc theo b\u1edd cong nh\u1ecf t\u1eeb t\u00e2m v\u1ecb t\u1edbi g\u00f3c b\u1edd cong nh\u1ecf.<\/p>\n

                  1.4.3. Lo\u00e9t do Stress<\/strong>: \u1ed5 lo\u00e9t do b\u1ecfng, do s\u1ed1c ngo\u1ea1i khoa, do ch\u1ea5n th\u01b0\u01a1ng, s\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch.<\/p>\n

                    \n
                  • \u1ed4 lo\u00e9t Cushing li\u00ean quan t\u1edbi vi\u1ec7c t\u0103ng \u00e1p l\u1ef1c trong th\u1eadn.<\/li>\n
                  • \u1ed4 lo\u00e9t Curling x\u1ea3y ra khi b\u1ec7nh nh\u00e2n b\u1ecb b\u1ecfng n\u1eb7ng.<\/li>\n<\/ul>\n

                    1.4.4. Lo\u00e9t m\u1ea1n t\u00ednh:<\/strong> th\u01b0\u1eddng c\u00f3 1 \u1ed5, b\u1edd ph\u1eb3ng, \u0111\u00e1y s\u1ea1ch. N\u1ebfu c\u00f3 nhi\u1ec1u \u1ed5 lo\u00e9t ho\u1eb7c \u1ed5 lo\u00e9t r\u1ed9ng l\u00e0 do d\u00f9ng thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng Steroides.<\/p>\n

                    C\u00e1c giai \u0111o\u1ea1n c\u1ee7a \u1ed5 lo\u00e9t:<\/p>\n

                    \u1ed4 lo\u00e9t ho\u1ea1t \u0111\u1ed9ng (A): <\/em><\/h4>\n
                      \n
                    • A 1: \u1ed4 lo\u00e9t c\u00f3 th\u00e0nh th\u1eb3ng \u0111\u1ee9ng, b\u1edd cao, kh\u00f4ng \u0111\u1ec1u, \u0111\u00e1y tr\u00f2n nh\u1eb3n, s\u1ea1ch ho\u1eb7c c\u00f3 ch\u1ea5t xu\u1ea5t ti\u1ebft \u0111\u1ecdng. Ni\u00eam m\u1ea1c xung quanh \u1ed5 lo\u00e9t m\u1ec1m, ph\u00f9 n\u1ec1 sung huy\u1ebft, nh\u00f4 cao, ni\u00eam m\u1ea1c \u1edf xa \u1ed5 lo\u00e9t c\u00f3 th\u1ec3 b\u1ecb vi\u00eam teo, c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c gi\u1ea3m. N\u1ebfu c\u00f3 th\u00ec c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c b\u1ecb co k\u00e9o v\u1ec1 ph\u00eda \u1ed5 lo\u00e9t s\u00e1t t\u1edbi t\u1eadn b\u1edd \u1ed5 lo\u00e9t.<\/li>\n
                    • A 2: \u1ed4 lo\u00e9t tr\u1edf n\u00ean n\u00f4ng h\u01a1n, nh\u1ecf h\u01a1n, c\u00f3 h\u00ecnh b\u1ea7u d\u1ee5c. T\u1ed5 ch\u1ee9c h\u1ea1t b\u1eaft \u0111\u1ea7u thay th\u1ebf cho t\u1ed5 ch\u1ee9c ho\u1ea1i t\u1eed.<\/li>\n<\/ul>\n

                      L\u00e0nh \u1ed5 lo\u00e9t (H) <\/em><\/h4>\n
                        \n
                      • H 1: Ni\u00eam m\u1ea1c xung quanh \u1ed5 lo\u00e9t b\u1edbt ph\u00f9 n\u1ec1 sung huy\u1ebft, \u0111\u00e1y \u1ed5 lo\u00e9t nh\u1ecf h\u01a1n, t\u1ed5 ch\u1ee9c h\u1ea1t d\u1ea7n d\u1ea7n thay th\u1ebf to\u00e0n b\u1ed9 t\u1ed5 ch\u1ee9c ho\u1ea1i t\u1eed.<\/li>\n
                      • H 2: T\u1ed5 ch\u1ee9c c\u1ee7a ni\u00eam m\u1ea1c \u0111\u01b0\u1ee3c t\u00e1i t\u1ea1o, \u1ed5 lo\u00e9t nh\u1ecf h\u01a1n n\u1eefa, ho\u1eb7c ph\u1eb3ng, ho\u1eb7c ch\u1ec9 c\u00f2n m\u1ed9t khe nh\u1ecf. C\u00e1c n\u1ebfp ni\u00eam m\u1ea1c \u0111\u1ee1 ph\u00f9 n\u1ec1 nhi\u1ec1u, t\u1ea1o th\u00e0nh nh\u1eefng n\u1ebfp nh\u0103n nheo xung quanh \u1ed5 lo\u00e9t.<\/li>\n<\/ul>\n

                        Li\u1ec1n s\u1eb9o \u1ed5 lo\u00e9t (S) <\/em><\/h4>\n
                          \n
                        • S 1: Li\u1ec1n s\u1eb9o \u0111\u1ecf: t\u1ed5 ch\u1ee9c x\u01a1 thay th\u1ebf t\u1ea1o th\u00e0nh v\u1ebft s\u1eb9o, b\u1edd \u1ed5 lo\u00e9t, ni\u00eam m\u1ea1c xung quanh \u1ed5 lo\u00e9t c\u00f2n ph\u00f9 nh\u1eb9.<\/li>\n
                        • S 2: Li\u1ec1n s\u1eb9o tr\u1eafng: t\u1ed5 ch\u1ee9c x\u01a1 thay th\u1ebf ho\u00e0n to\u00e0n, ni\u00eam m\u1ea1c xung quanh \u1ed5 lo\u00e9t ho\u00e0n to\u00e0n b\u00ecnh th\u01b0\u1eddng, ch\u1ec9 c\u00f2n l\u1ea1i m\u1ed9t v\u1ebft s\u1eb9o tr\u1eafng.<\/li>\n<\/ul>\n

                          1.5. Polyp d\u1ea1 d\u00e0y<\/h3>\n

                          Polyp d\u1ea1 d\u00e0y l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng qu\u00e1 s\u1ea3n c\u1ee7a l\u1edbp bi\u1ec3u m\u00f4 ph\u1ee7, polyp c\u00f3 cu\u1ed1ng ho\u1eb7c kh\u00f4ng c\u00f3 cu\u1ed1ng, c\u00f3 th\u1ec3 c\u00f3 1 ho\u1eb7c nhi\u1ec1u polyp.<\/p>\n

                          Ph\u00e2n lo\u1ea1i polyp:<\/p>\n

                          1.5.1. Polyp t\u0103ng s\u1ea3n<\/strong>: l\u00e0 lo\u1ea1i hay g\u1eb7p nh\u1ea5t chi\u1ebfm t\u1eeb 70 \u2013 90%, \u0111\u01b0\u1eddng k\u00ednh 1,5 cm. Lo\u1ea1i c\u00f3 nhi\u1ec1u polyp chi\u1ebfm t\u1eeb 20 \u2013 25% m\u1eb7t nh\u1eb3n.<\/p>\n

                          1.5.2. Polyp tuy\u1ebfn<\/strong>: l\u00e0 lo\u1ea1i hay g\u1eb7p sau lo\u1ea1i polyp t\u0103ng s\u1ea3n, th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi ung th\u01b0 d\u1ea1 d\u00e0y v\u00e0 th\u01b0\u1eddng chuy\u1ec3n sang \u00e1c t\u00ednh. Ung th\u01b0 th\u01b0\u1eddng ph\u00e1t tri\u1ec3n tr\u00ean v\u00f9ng c\u00f3 d\u1ecb s\u1ea3n ru\u1ed9t. Tr\u00ean b\u1ec1 m\u1eb7t c\u1ee7a polyp th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u1ee7 b\u1edfi nh\u1eefng h\u1ea1t th\u00f4 to ho\u1eb7c l\u1edbp ni\u00eam m\u1ea1c \u0111\u1ecf kh\u00f4ng b\u00ecnh th\u01b0\u1eddng, tr\u00f4ng nh\u01b0 n\u00fam v\u00fa. C\u00f3 th\u1ec3 th\u1ea5y nh\u1eefng v\u00f9ng lo\u1ea1n s\u1ea3n v\u1edbi l\u1edbp nhung mao \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng polyp l\u1edbn. Polyp tuy\u1ebfn \u0111\u01b0\u1ee3c chia l\u00e0m 3 lo\u1ea1i:<\/p>\n

                            \n
                          • Polyp tuy\u1ebfn \u1ed1ng<\/li>\n
                          • Polyp tuy\u1ebfn nhung mao.<\/li>\n<\/ul>\n

                            1.5.3. Polyp l\u1edbn \u0111\u00e1y d\u1ea1 d\u00e0y<\/strong>: hay g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi trong gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb b\u1ec7nh polyp, kh\u00f4ng c\u00f3 li\u00ean quan \u0111\u1ebfn d\u1ecb s\u1ea3n ru\u1ed9t, ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c vi\u00eam teo nh\u1eb9.<\/p>\n

                            1.5.4. Polyp l\u1edbn<\/strong>: th\u01b0\u1eddng c\u00f3 cu\u1ed1ng v\u00e0 c\u00f3 1 chi\u1ebfc, c\u0169ng c\u00f3 khi c\u00f3 nhi\u1ec1u, k\u00edch th\u01b0\u1edbc t\u1eeb 1,5 \u2013 12 cm, m\u00e0u tr\u1eafng x\u00e1m v\u00e0 ch\u1eafc.<\/p>\n

                            Ph\u00e2n lo\u1ea1i polyp theo ph\u00e2n lo\u1ea1i c\u1ee7a Yamada<\/p>\n

                              \n
                            • Yamada I: polyp nh\u00f4 cao, \u0111\u00e1y r\u1ed9ng.<\/li>\n
                            • Yamada II: polyp l\u1ed3i l\u00ean, \u0111\u00e1y h\u1eb9p h\u01a1n.<\/li>\n
                            • Yamada III: l\u1ed3i l\u00ean, \u0111\u00e1y nh\u1ecf ho\u1eb7c c\u00f3 ch\u00e2n r\u1ed9ng.<\/li>\n
                            • Yamada IV: polyp c\u00f3 ch\u00e2n.<\/li>\n<\/ul>\n

                              2. H\u00e0nh t\u00e1 tr\u00e0ng<\/h2>\n

                              2.1. Vi\u00eam h\u00e0nh t\u00e1 tr\u00e0ng<\/h3>\n

                              Ph\u00e2n lo\u1ea1i vi\u00eam h\u00e0nh t\u00e1 tr\u00e0ng:<\/p>\n

                                \n
                              • Vi\u00eam h\u00e0nh t\u00e1 tr\u00e0ng ph\u00f9 n\u1ec1 xu\u1ea5t ti\u1ebft l\u00e0 lo\u1ea1i hay g\u1eb7p nh\u1ea5t, c\u00f3 nh\u1eefng \u0111\u00e1m sung huy\u1ebft, ni\u00eam m\u1ea1c m\u1ea5t t\u00ednh ch\u1ea5t nh\u1eb5n b\u00f3ng.<\/li>\n
                              • Vi\u00eam tr\u1ee3t h\u00e0nh t\u00e1 tr\u00e0ng, c\u00f3 \u00edt ho\u1eb7c nhi\u1ec1u \u1ed5 lo\u00e9t tr\u1ee3t, th\u01b0\u1eddng c\u00f3 fibrin l\u1eafng \u0111\u1ecdng \u1edf \u0111\u00e1y v\u1ebft lo\u00e9t tr\u1ee3t.<\/li>\n
                              • Vi\u00eam h\u00e0nh t\u00e1 tr\u00e0ng ch\u1ea3y m\u00e1u, ni\u00eam m\u1ea1c ph\u00f9 n\u1ec1, c\u00f3 nh\u1eefng ch\u1ea5m ch\u1ea3y m\u00e1u.<\/li>\n
                              • Vi\u00eam h\u00e0nh t\u00e1 tr\u00e0ng d\u1ea1ng h\u1ea1t: c\u00f3 nhi\u1ec1u h\u1ea1t nh\u1ecf, ni\u00eam m\u1ea1c ph\u00f9 n\u1ec1 tr\u00ean c\u00f3 tr\u1ee3t nh\u1ecf.<\/li>\n<\/ul>\n

                                Th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi lo\u00e9t d\u1ea1 d\u00e0y v\u00e0 vi\u00eam th\u1eadn m\u1ea1n.<\/p>\n

                                2.2. Lo\u00e9t h\u00e0nh t\u00e1 tr\u00e0ng<\/h3>\n

                                T\u1ef7 l\u1ec7 lo\u00e9t h\u00e0nh t\u00e1 tr\u00e0ng nhi\u1ec1u h\u01a1n lo\u00e9t d\u1ea1 d\u00e0y, nguy\u00ean nh\u00e2n do t\u0103ng y\u1ebfu t\u1ed1 t\u1ea5n c\u00f4ng h\u01a1n l\u00e0 do gi\u1ea3m y\u1ebfu t\u1ed1 b\u1ea3o v\u1ec7, \u1ed5 lo\u00e9t th\u01b0\u1eddng th\u1ea5y \u1edf m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t sau, c\u00f3 th\u1ec3 ch\u1ec9 c\u00f3 1 \u1ed5 lo\u00e9t ho\u1eb7c nhi\u1ec1u \u1ed5 n\u1ebfu c\u00f3 2 \u1ed5 lo\u00e9t \u0111\u1ed1i di\u1ec7n nhau g\u1ecdi l\u00e0 “Kissing ulcer”.<\/p>\n

                                H\u00ecnh \u1ea3nh lo\u00e9t h\u00e0nh t\u00e1 tr\u00e0ng:<\/p>\n

                                  \n
                                • H\u00e0nh t\u00e1 tr\u00e0ng bi\u1ebfn d\u1ea1ng, do \u1ed5 lo\u00e9t \u0111\u00e3 li\u1ec1n s\u1eb9o.<\/li>\n
                                • C\u00e1c giai \u0111o\u1ea1n c\u1ee7a \u1ed5 lo\u00e9t gi\u1ed1ng nh\u01b0 trong d\u1ea1 d\u00e0y, \u1ed5 lo\u00e9t c\u1ea5p t\u00ednh c\u00f3 b\u1edd ph\u00f9 n\u1ec1 sung huy\u1ebft m\u1ea1nh.<\/li>\n<\/ul>\n

                                  2.3. Ung th\u01b0 h\u00e0nh t\u00e1 tr\u00e0ng<\/h3>\n

                                  Kh\u1ed1i u l\u00e0nh t\u00ednh v\u00e0 \u00e1c t\u00ednh \u1edf h\u00e0nh t\u00e1 tr\u00e0ng r\u1ea5t \u00edt g\u1eb7p. Kh\u1ed1i u \u1edf h\u00e0nh t\u00e1 tr\u00e0ng th\u01b0\u1eddng g\u1eb7p \u1edf v\u1ecb tr\u00ed g\u1ea7n b\u00f3ng Vater. Ung th\u01b0 b\u00f3ng Vater th\u01b0\u1eddng x\u00e2m l\u1ea5n v\u00e0o t\u00e1 tr\u00e0ng.<\/p>\n

                                  \"H\u00ecnh
                                  Ung th\u01b0 h\u00e0nh t\u00e1 tr\u00e0ng<\/figcaption><\/figure>\n

                                  2.4. Vi\u00eam h\u00e0nh t\u00e1 tr\u00e0ng <\/strong><\/h3>\n

                                  Nguy\u00ean nh\u00e2n l\u00e0 do d\u1ecb s\u1ea3n d\u1ea1 d\u00e0y v\u00e0 Helicobacter pylori<\/em>, ph\u00f9 n\u1ec1, sung huy\u1ebft, tr\u1ee3t.<\/p>\n

                                  2.5. Polyp h\u00e0nh t\u00e1 tr\u00e0ng<\/h3>\n
                                    \n
                                  • Polyp t\u0103ng s\u1ea3n vi\u00eam nhi\u1ec5m: l\u00e0 lo\u1ea1i polyp hay g\u1eb7p nh\u1ea5t, th\u01b0\u1eddng \u1edf h\u00e0nh t\u00e1 tr\u00e0ng v\u00e0 m\u1eb7t sau t\u00e1 tr\u00e0ng, k\u00edch th\u01b0\u1edbc 2 \u2013 6 mm, ni\u00eam m\u1ea1c th\u01b0\u1eddng kh\u00f4ng thay \u0111\u1ed5i ho\u1eb7c ph\u00f9 n\u1ec1, tr\u1ee3t v\u00e0 lo\u00e9t.<\/li>\n
                                  • D\u1ecb s\u1ea3n d\u1ea1 d\u00e0y: th\u01b0\u1eddng \u1edf ngay sau m\u00f4n v\u1ecb ho\u1eb7c th\u00e0nh sau t\u00e1 tr\u00e0ng, th\u01b0\u1eddng c\u00f3 nhi\u1ec1u, t\u1eadp trung th\u00e0nh t\u1eebng \u0111\u00e1m, t\u1eebng m\u1ea3ng, c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf 2 -6 mm h\u01a1i nh\u00f4 cao, kh\u00f3 ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c xung quanh.<\/li>\n
                                  • T\u0103ng s\u1ea3n tuy\u1ebfn Brunner: \u1edf to\u00e0n b\u1ed9 h\u00e0nh t\u00e1 tr\u00e0ng v\u00e0 t\u00e1 tr\u00e0ng, s\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u, k\u00edch th\u01b0\u1edbc nh\u1ecf<\/li>\n
                                  • T\u0103ng s\u1ea3n nang lympho<\/li>\n
                                  • Polyp tuy\u1ebfn<\/li>\n<\/ul>\n

                                    2.6. U d\u01b0\u1edbi ni\u00eam m\u1ea1c t\u00e1 tr\u00e0ng<\/strong>:<\/h3>\n

                                    U c\u01a1, k\u00edch th\u01b0\u1edbc > 1 cm, b\u1ec1 m\u1eb7t c\u00f3 th\u1ec3 vi\u00eam, lo\u00e9t.<\/p>\n

                                    2.7. B\u1ec7nh Sprue \u2013 Crohn v\u00e0 Whipple<\/h3>\n
                                      \n
                                    • B\u1ec7nh Sprue l\u00e0 m\u1ed9t b\u1ec7nh t\u1ef1 mi\u1ec5n, ni\u00eam m\u1ea1c \u0111\u01b0\u1eddng ti\u00eau h\u00f3a b\u1ecb t\u1ed5n th\u01b0\u01a1ng do caroten trong th\u1ee9c \u0103n, d\u1eabn \u0111\u1ebfn k\u00e9m h\u1ea5p thu v\u00e0 ti\u00eau ch\u1ea3y. T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p \u1edf t\u00e1 tr\u00e0ng, c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c b\u1ecb m\u1ea5t nhung mao. H\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng qua n\u1ed9i soi l\u00e0 ni\u00eam m\u1ea1c d\u1ea7y, ph\u00f9 n\u1ec1, m\u1ea5t n\u1ebfp nh\u0103n ho\u1eb7c teo ni\u00eam m\u1ea1c. H\u00ecnh \u1ea3nh n\u1ed9i soi, m\u00f4 b\u1ec7nh h\u1ecdc r\u1ea5t \u0111i\u1ec3n h\u00ecnh. B\u1ec7nh s\u1ebd \u0111\u1ee1 khi \u0103n ch\u1ebf \u0111\u1ed9 kh\u00f4ng c\u00f3 Caroten. Nguy c\u01a1 ung th\u01b0 cao n\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb. – B\u1ec7nh Crohn: kho\u1ea3ng 5% c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u1edf h\u00e0nh t\u00e1 tr\u00e0ng, t\u1ed5n th\u01b0\u01a1ng lo\u00e9t nh\u1ecf, sinh thi\u1ebft ch\u1ea9n \u0111o\u00e1n.<\/li>\n
                                    • B\u1ec7nh Whipple: hi\u1ebfm g\u1eb7p, do t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng to\u00e0n th\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n \u1edf kh\u1edbp, s\u1ee5t c\u00e2n v\u00e0 ti\u00eau ch\u1ea3y. N\u1ed9i soi th\u1ea5y c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c d\u1ea7y l\u00ean, nhung mao to, ph\u00f9 n\u1ec1 \u1edf t\u00e1 tr\u00e0ng v\u00e0 h\u1ed7ng tr\u00e0ng. Sinh thi\u1ebft ch\u1ea9n \u0111o\u00e1n.<\/li>\n<\/ul>\n

                                      \u00a0<\/strong><\/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\u00a0 Churchill Livingstone.<\/li>\n<\/ol>\n

                                        \u00a0<\/strong><\/p>\n

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

                                        N\u1ed9i soi d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd c\u1ee7a \u1ed1ng ti\u00eau h\u00f3a t\u1eeb th\u1ef1c qu\u1ea3n \u0111\u1ebfn DII c\u1ee7a t\u00e1 tr\u00e0ng b\u1eb1ng m\u00e1y n\u1ed9i soi \u1ed1ng m\u1ec1m. 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