{"id":25096,"date":"2023-04-20T19:01:08","date_gmt":"2023-04-20T12:01:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25096"},"modified":"2023-04-21T11:09:15","modified_gmt":"2023-04-21T04:09:15","slug":"chup-duong-mat-va-cac-ki-thuat-lay-soi-qua-da","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/chup-duong-mat-va-cac-ki-thuat-lay-soi-qua-da\/","title":{"rendered":"Ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt v\u00e0 c\u00e1c k\u0129 thu\u1eadt l\u1ea5y s\u1ecfi qua da."},"content":{"rendered":"<blockquote><p><strong><a href=\"https:\/\/vinmec.com\/vi\/tieu-hoa-gan-mat\/thong-tin-suc-khoe\/cach-lam-giam-con-dau-soi-mat\/\">S\u1ecfi m\u1eadt<\/a>\u00a0l\u00e0 b\u1ec7nh l\u00fd ngo\u1ea1i khoa r\u1ea5t th\u01b0\u1eddng g\u1eb7p \u1edf Vi\u1ec7t Nam. Trong \u0111\u00f3, s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7 chi\u1ebfm kho\u1ea3ng 50-60% t\u1ed5ng c\u00e1c tr\u01b0\u1eddng h\u1ee3p s\u1ecfi m\u1eadt. Hi\u1ec7n nay c\u00f3 3 ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ec3 l\u1ea5y s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt, ph\u1eabu thu\u1eadt (h\u1edf v\u00e0 n\u1ed9i soi), qua n\u1ed9i soi v\u00e0 l\u1ea5y s\u1ecfi qua da. L\u1ea5y s\u1ecfi qua n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP) g\u1ea7n \u0111\u00e2y \u0111\u00e3 tr\u1edf th\u00e0nh \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay, tuy nhi\u00ean c\u00f2n nhi\u1ec1u bi\u1ebfn ch\u1ee9ng v\u00e0 h\u1ea1n ch\u1ebf. Th\u00f4ng th\u01b0\u1eddng th\u1ea5t b\u1ea1i v\u1edbi ERCP s\u1ebd chuy\u1ec3n m\u1ed5 n\u1ed9i soi\/h\u1edf. V\u1edbi s\u1ef1 ra \u0111\u1eddi c\u1ee7a k\u0129 thu\u1eadt ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt v\u00e0 l\u1ea5y s\u1ecfi m\u1eadt qua da, c\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1ea5t b\u1ea1i ERCP c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u00edt x\u00e2m l\u1ea5n so v\u1edbi ph\u1eabu thu\u1eadt.\u00a0<\/strong><\/p><\/blockquote>\n<h2><strong>1. S\u1ecfi m\u1eadt v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb.<\/strong><\/h2>\n<h3><strong>1.1. T\u1ed5ng quan v\u1ec1 s\u1ecfi m\u1eadt.<\/strong><\/h3>\n<p>S\u1ecfi \u0111\u01b0\u1eddng m\u1eadt (bao g\u1ed3m s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7 v\u00e0 \u1ed1ng gan chung) l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh c\u1ee7a t\u1eafc \u0111\u01b0\u1eddng m\u1eadt kh\u00f4ng do u. Nguy\u00ean nh\u00e2n ch\u1ee7 y\u1ebfu l\u00e0 do s\u1ecfi t\u1eeb t\u00fai m\u1eadt di chuy\u1ec3n v\u00e0o \u1ed1ng m\u1eadt ch\u1ee7 v\u00e0 c\u00e1c \u1ed1ng gan. S\u1ecfi m\u1eadt trong gan l\u00e0 s\u1ecfi h\u00ecnh th\u00e0nh trong c\u00e1c \u1ed1ng d\u1eabn m\u1eadt c\u1ee7a gan. \u0110i\u1ec1u tr\u1ecb s\u1ecfi m\u1eadt b\u1eaft bu\u1ed9c khi c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c c\u00e2n nh\u1eafc khi kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng do c\u00f3 th\u1ec3 d\u1eabn t\u1edbi c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 vi\u00eam \u0111\u01b0\u1eddng m\u1eadt, t\u1eafc m\u1eadt (c\u00f3 th\u1ec3 d\u1eabn t\u1edbi x\u01a1 gan do \u1ee9 m\u1eadt) v\u00e0 vi\u00eam t\u1ee5y.<\/p>\n<p><strong>C\u00e1c lo\u1ea1i s\u1ecfi m\u1eadt:<\/strong><\/p>\n<ul>\n<li>S\u1ecfi cholesterol: chi\u1ebfm &gt;50% th\u00e0nh ph\u1ea7n l\u00e0 cholesterol, m\u00e0u v\u00e0ng, k\u00edch th\u01b0\u1edbc &lt;2cm. Kh\u00f4ng c\u1ea3n quang, chi\u1ebfm ph\u1ea7n l\u1edbn c\u00e1c s\u1ecfi t\u00fai m\u1eadt.<\/li>\n<li>S\u1ecfi h\u1ed7n h\u1ee3p: m\u00e0u v\u00e0ng v\u00e0 xanh\/\u0111en, c\u1ee9ng, h\u00ecnh th\u00e0nh do \u1ee9 \u0111\u1ed9ng m\u1eadt.<\/li>\n<li>S\u1ecfi s\u1eafc t\u1ed1: c\u00f3 &lt;20% cholesterol, k\u00edch th\u01b0\u1edbc 2 &#8211; 5mm, c\u1ee9ng, nh\u1ecf, b\u1edd kh\u00f4ng \u0111\u1ec1u.<\/li>\n<\/ul>\n<p>S\u1ecfi \u0111\u01b0\u1eddng m\u1eadt bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng b\u1edfi v\u00e0ng da \u0111\u1ed9t ng\u1ed9t (s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7 di \u0111\u1ed9ng c\u00f3 th\u1ec3 g\u00e2y v\u00e0ng da ng\u1eaft qu\u00e3ng), \u0111au h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n; s\u1ed1t n\u1ebfu c\u00f3 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng m\u1eadt.<\/p>\n<h3><strong>1.2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb.<\/strong><\/h3>\n<p>Trong nhi\u1ec1u th\u1eadp k\u1ec9 tr\u01b0\u1edbc, ph\u1eabu thu\u1eadt l\u00e0 l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean trong \u0111i\u1ec1u tr\u1ecb s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt. Tuy nhi\u00ean t\u1ec9 l\u1ec7 t\u1eed vong h\u1eadu ph\u1eabu chi\u1ebfm t\u1edbi 1.3 &#8211; 4% v\u00e0 b\u1ec7nh su\u1ea5t chi\u1ebfm \u0111\u1ebfn 20 &#8211; 40%. V\u1eabn c\u00f3 th\u1ec3 c\u00f2n s\u00f3t s\u1ecfi sau m\u1ed5.<\/p>\n<p>Ph\u1eabu thu\u1eadt n\u1ed9i soi m\u1edf \u0111\u01b0\u1eddng m\u1eadt l\u1ea5y s\u1ecfi l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf m\u1ed5 h\u1edf v\u1edbi \u00edt x\u00e2m l\u1ea5n h\u01a1n, r\u00fat ng\u1eafn th\u1eddi gian ph\u1ee5c h\u1ed3i sau m\u1ed5. Tuy nhi\u00ean b\u1ec7nh su\u1ea5t v\u00e0 t\u1ec9 l\u1ec7 t\u1eed vong c\u0169ng t\u01b0\u01a1ng t\u1ef1, v\u1edbi t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng 86 &#8211; 95% v\u00e0 t\u1ec9 l\u1ec7 bi\u1ebfn ch\u1ee9ng t\u1eeb 5 &#8211; 18%.<\/p>\n<p>\u0110\u1ed1i v\u1edbi ERCP, k\u0129 thu\u1eadt n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ea7u ti\u00ean b\u1edfi Kawai v\u00e0 c\u1ed9ng s\u1ef1 n\u0103m 1974. T\u1eeb \u0111\u00f3 k\u0129 thu\u1eadt n\u00e0y \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt v\u1edbi m\u1ed9t s\u1ed1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u00e0 h\u1eb9p c\u01a1 v\u00f2ng Oddi. ERCP c\u00f3 th\u1ec3 g\u00e2y bi\u1ebfn ch\u1ee9ng c\u1ea5p nh\u01b0 ch\u1ea3y m\u00e1u, vi\u00eam t\u1ee5y c\u1ea5p, th\u1ee7ng ru\u1ed9t, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng m\u1eadt. M\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng m\u1ea1n t\u00ednh bao g\u1ed3m: tr\u00e0o ng\u01b0\u1ee3c \u0111\u01b0\u1eddng m\u1eadt &#8211; t\u00e1 tr\u00e0ng v\u00e0 vi\u00eam \u0111\u01b0\u1eddng m\u1eadt, h\u1eb9p b\u00f3ng Vater v\u00e0 t\u1ea1o s\u1ecfi t\u00e1i ph\u00e1t. T\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng t\u1eeb 76 &#8211; 92%. ERCP c\u00f3 m\u1ed9t s\u1ed1 gi\u1edbi h\u1ea1n nh\u01b0:<\/p>\n<ul>\n<li>Kh\u00f4ng ti\u1ebfp c\u1eadn \u0111\u01b0\u1ee3c s\u1ecfi do h\u1eb9p quanh b\u00f3ng Vater, \u0111\u00e3 ph\u1eabu thu\u1eadt d\u1ea1 d\u00e0y tr\u01b0\u1edbc \u0111\u00f3, h\u1eb9p t\u00e1 tr\u00e0ng, \u1ed1ng m\u1eadt ch\u1ee7 h\u00ecnh sigma, s\u1ecfi qu\u00e1 to, s\u1ecfi n\u1eb1m \u1edf \u0111\u01b0\u1eddng m\u1eadt trong gan, s\u1ed1 l\u01b0\u1ee3ng qu\u00e1 nhi\u1ec1u (&gt;10), s\u1ecfi to &gt;15mm.<\/li>\n<li>Nhi\u1ec1u b\u1ec7nh \u0111\u1ed3ng m\u1eafc kh\u00f4ng \u1ed5n \u0111\u1ecbnh, kh\u00f4ng th\u1ec3 g\u00e2y m\u00ea.<\/li>\n<\/ul>\n<p>Trong c\u00e1c t\u00ecnh hu\u1ed1ng tr\u00ean, ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt v\u00e0 l\u1ea5y s\u1ecfi qua da l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf \u0111\u1ec3 x\u1eed tr\u00ed s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt.<\/p>\n<h3><strong>1.3. Ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt qua da xuy\u00ean gan v\u00e0 c\u00e1c c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n kh\u00e1c.<\/strong><\/h3>\n<p>X quang kh\u00f4ng chu\u1ea9n b\u1ecb c\u00f3 gi\u1edbi h\u1ea1n l\u00e0 ch\u1ec9 20% s\u1ecfi m\u1eadt c\u1ea3n quang.<\/p>\n<p>Si\u00eau \u00e2m v\u00e0 ch\u1ee5p MRI m\u1eadt t\u1ee5y: ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n, an to\u00e0n, nh\u01b0ng c\u00f3 th\u1ec3 b\u1ecf s\u00f3t s\u1ecfi.<\/p>\n<p>N\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP): ph\u01b0\u01a1ng ph\u00e1p x\u00e2m l\u1ea5n, v\u1eeba ch\u1ea9n \u0111o\u00e1n v\u1eeba \u0111i\u1ec1u tr\u1ecb. C\u00f3 nguy c\u01a1 tai bi\u1ebfn nh\u01b0 \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean.<\/p>\n<p>Ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt xuy\u00ean gan qua da (PTC), c\u0169ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1p x\u00e2m l\u1ea5n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n theo tr\u00ecnh t\u1ef1 g\u00e2y m\u00ea, sau \u0111\u00f3 g\u00e2y t\u00ea t\u1ea1i ch\u1ed7. D\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a m\u00e1y si\u00eau \u00e2m, m\u1ed9t kim nh\u1ecf d\u00e0i \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o gi\u1eefa hai x\u01b0\u01a1ng s\u01b0\u1eddn v\u00e0o gan v\u00e0 d\u00f2 t\u00ecm \u0111\u01b0\u1eddng m\u1eadt. Khi \u0111\u1ea7u kim \u0111\u00e3 n\u1eb1m trong \u0111\u01b0\u1eddng m\u1eadt, b\u00e1c s\u0129 s\u1ebd ti\u00eam thu\u1ed1c c\u1ea3n quang, thu\u1ed1c s\u1ebd ch\u1ea3y v\u00e0o c\u00e1c \u1ed1ng d\u1eabn m\u1eadt v\u00e0 ti\u1ebfn h\u00e0nh ch\u1ee5p X-quang \u0111\u01b0\u1eddng m\u1eadt trong gan x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed t\u1eafc m\u1eadt.<\/p>\n<p>Ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt xuy\u00ean qua da (PTC) th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi:<\/p>\n<ul>\n<li>Nh\u1eefng ng\u01b0\u1eddi c\u00f3 tri\u1ec7u ch\u1ee9ng t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng m\u1eadt nh\u01b0 s\u1ed1t, \u0111au h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, v\u00e0ng da v\u00e0 m\u1eaft nh\u01b0ng kh\u00f4ng th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c th\u1ee7 thu\u1eadt\u00a0<a title=\"n\u1ed9i soi\" href=\"https:\/\/medlatec.vn\/tin-tuc\/bo-tui-3-phuong-phap-noi-soi-da-day-khong-dau-it-nguoi-biet-s67-n14616\">n\u1ed9i soi<\/a>\u00a0m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP).<\/li>\n<li>Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ea5t th\u01b0\u1eddng \u1edf th\u1ef1c qu\u1ea3n, ru\u1ed9t non ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed ph\u1eabu thu\u1eadt l\u00e0m thay \u0111\u1ed5i gi\u1ea3i ph\u1eabu \u1edf b\u1ee5ng (v\u00ed d\u1ee5 ph\u1eabu thu\u1eadt d\u1ea1 d\u00e0y) khi\u1ebfn cho vi\u1ec7c th\u1ef1c hi\u1ec7n n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng kh\u00f4ng th\u00e0nh c\u00f4ng.<\/li>\n<li>C\u00e1c ch\u1ec9 \u0111\u1ecbnh kh\u00e1c c\u1ee7a PTC bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb r\u00f2 r\u1ec9 d\u1ecbch m\u1eadt sau ph\u1eabu thu\u1eadt ho\u1eb7c sa \u0111\u01b0\u1eddng m\u1eadt do ch\u1ea5n th\u01b0\u01a1ng.<\/li>\n<\/ul>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh PTC:<\/p>\n<ul>\n<li>Ph\u1ee5 n\u1eef c\u00f3 thai ho\u1eb7c nghi ng\u1edd c\u00f3 thai.<\/li>\n<li>R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, \u0111ang d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng acenocoumarol, Plavix.<\/li>\n<\/ul>\n<p>PTC c\u00f3 th\u1ec3 \u0111\u1ec3 l\u1ea1i m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng: nh\u01b0 nhi\u1ec5m tr\u00f9ng huy\u1ebft, ch\u1ea3y m\u00e1u, r\u00f2 r\u1ec9 \u0111\u01b0\u1eddng m\u1eadt, vi\u00eam ph\u00fac m\u1ea1c, tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, ch\u1ea3y m\u00e1u ph\u00fac m\u1ea1c.<\/p>\n<h2><strong>2. Ph\u01b0\u01a1ng ph\u00e1p l\u1ea5y s\u1ecfi qua da xuy\u00ean gan.<\/strong><\/h2>\n<p>Tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c l\u00e0m x\u00e9t nhi\u1ec7m th\u01b0\u1eddng quy: c\u00f4ng th\u1ee9c m\u00e1u, \u0111\u00f4ng m\u00e1u v\u00e0 ch\u1ee9c n\u0103ng gan.<\/p>\n<p>B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u0111\u00ea tr\u00e1nh nhi\u1ec5m tr\u00f9ng: th\u01b0\u1eddng d\u00f9ng cephalosporin.<\/p>\n<p>\u0110\u1ea7u ti\u00ean, k\u0129 thu\u1eadt PTC \u0111\u01b0\u1ee3c th\u1ef1c hi\u00ean b\u1eb1ng vi\u1ec7c \u0111\u01b0a \u1ed1ng d\u1eabn v\u00e0o \u1ed1ng m\u1eadt th\u00f9y gan ph\u1ea3i ho\u1eb7c tr\u00e1i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u1ec1 \u0111\u01b0\u1eddng m\u1eadt, k\u00edch th\u01b0\u1edbc, v\u1ecb tr\u00ed, s\u1ed1 l\u01b0\u1ee3ng s\u1ecfi. Sau khi lu\u1ed3ng th\u00e0nh c\u00f4ng d\u00e2y d\u1eabn v\u00e0o \u0111\u01b0\u1eddng m\u1eadt, \u1ed1ng m\u1eadt s\u1ebd \u0111\u01b0\u1ee3c nong d\u00e3n b\u1eb1ng b\u00f3ng, c\u01a1 th\u1eaft Oddi c\u0169ng \u0111\u01b0\u1ee3c nong d\u00e3n \u0111\u1ec3 th\u00f4ng t\u1edbi t\u00e1 tr\u00e0ng ho\u1eb7c h\u1ed7ng tr\u00e0ng. S\u1ecfi sau \u0111\u00f3 \u0111\u01b0\u1ee3c \u0111\u1ea9y t\u1eeb \u0111\u01b0\u1eddng m\u1eadt v\u00e0o t\u00e1 tr\u00e0ng b\u1eb1ng Fogarty balloon catheter. N\u1ebfu l\u1ea5y s\u1ecfi kh\u00f4ng th\u00e0nh c\u00f4ng, c\u00f3 th\u1ec3 l\u1eadp l\u1ea1i nong t\u00e1 tr\u00e0ng r\u1ed3i thao t\u00e1c l\u1ea1i. \u0110\u1ec3 gi\u1ea3m nguy c\u01a1 vi\u00eam t\u1ee5y c\u1ea5p, \u0111\u01b0\u1eddng m\u1eadt nhi\u1ec1u s\u1ecfi c\u1ea7n \u0111\u1ea9y l\u1ea7n l\u01b0\u1ee3t t\u1eebng vi\u00ean m\u1ed9t. V\u1edbi s\u1ecfi &gt;15mm, c\u00f3 th\u1ec3 t\u00e1n c\u01a1 h\u1ecdc tr\u01b0\u1edbc khi \u0111\u1ea9y ra t\u00e1 tr\u00e0ng. \u0110\u1eb7t d\u1eabn l\u01b0u \u0111\u01b0\u1eddng m\u1eadt th\u01b0\u1eddng quy gi\u00fap gi\u1ea3m bi\u1ebfn ch\u1ee9ng vi\u00eam t\u1ee5y c\u1ea5p v\u00e0 \u1ee9 \u0111\u1ecdng m\u1eadt.<\/p>\n<p>V\u1edbi s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt trong gan, c\u1ea7n ch\u1ecdn \u0111\u01b0\u1eddng v\u00e0o \u0111\u01b0\u1eddng m\u1eadt th\u00edch h\u1ee3p, s\u1ecfi \u0111\u01b0\u1ee3c \u0111\u1ea9y t\u1eeb \u1ed1ng m\u1eadt trong gan ra \u0111\u01b0\u1eddng m\u1eadt ngo\u00e0i gan r\u1ed3i \u0111\u1ea9y v\u00e0o t\u00e1 tr\u00e0ng. Tuy nhi\u00ean, s\u1ecfi trong gan c\u00f3 m\u1ed9t s\u1ed1 h\u1ea1n ch\u1ebf nh\u01b0 kh\u00f3 ti\u1ebfp c\u1eadn s\u1ecfi, s\u1ecfi to, qu\u00e1 nhi\u1ec1u s\u1ecfi d\u1eabn t\u1edbi t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng th\u1ea5p h\u01a1n s\u1ecfi m\u1eadt ngo\u00e0i gan 61.5 &#8211; 94% v\u00e0 t\u1ec9 l\u1ec7 s\u00f3t ho\u1eb7c t\u00e1i ph\u00e1t s\u1ecfi t\u1edbi 21 &#8211; 62%.<\/p>\n<figure id=\"attachment_25701\" aria-describedby=\"caption-attachment-25701\" style=\"width: 788px\" class=\"wp-caption alignnone\"><img decoding=\"async\" loading=\"lazy\" class=\" wp-image-25701\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/10-1055-s-0041-1731373-i001296-1-300x78.jpg\" alt=\"\" width=\"788\" height=\"205\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/10-1055-s-0041-1731373-i001296-1-300x78.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/10-1055-s-0041-1731373-i001296-1-768x199.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/10-1055-s-0041-1731373-i001296-1.jpg 800w\" sizes=\"(max-width: 788px) 100vw, 788px\" \/><figcaption id=\"caption-attachment-25701\" class=\"wp-caption-text\">K\u0129 thu\u1eadt l\u1ea5y s\u1ecfi qua da. H\u00ecnh a. PTC cho th\u1ea5y 2 s\u1ecfi to \u1edf \u0111o\u1ea1n xa \u1ed1ng m\u1eadt ch\u1ee7, b. guide wire \u0111\u01b0\u1ee3c lu\u1ed3n v\u00e0o \u0111\u01b0\u1eddng m\u1eadt v\u00e0 c\u01a1 Oddi \u0111\u01b0\u1ee3c nong b\u1eb1ng b\u00f3ng, c. S\u1ecfi \u0111\u01b0\u1ee3c \u0111\u1ea9y v\u00e0o t\u00e1 tr\u00e0ng b\u1eb1ng b\u00f3ng Fogarty, d. Ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt sau th\u1ee7 thu\u1eadt cho th\u1ea5y h\u1ebft s\u1ecfi. Ngu\u1ed3n: Semin Intervent Radiol. 2021 Aug; 38(3): 348\u2013355.<\/figcaption><\/figure>\n<h2><strong>3. Ph\u01b0\u01a1ng ph\u00e1p l\u1ea5y s\u1ecfi qua da th\u00f4ng qua \u1ed1ng T.<\/strong><\/h2>\n<p>\u1ed0ng d\u1eabn l\u01b0u T th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng sau khi m\u1edf \u1ed1ng m\u1eadt ch\u1ee7, gi\u1ea3i \u00e1p \u0111\u01b0\u1eddng m\u1eadt, ng\u0103n ng\u1eeba \u1ee9 m\u1eadt v\u00e0 r\u00f2 m\u1eadt. Th\u00f4ng qua \u1ed1ng T ta c\u00f2n c\u00f3 th\u1ec3 ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt v\u00e0 l\u1ea5y s\u1ecfi c\u00f2n s\u00f3t.<\/p>\n<p>\u0110\u1ec3 l\u1ea5y s\u1ecfi m\u1eadt qua \u1ed1ng d\u1eabn l\u01b0u, tr\u01b0\u1edbc ti\u00ean ta c\u1ea7n x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed, s\u1ed1 l\u01b0\u1ee3ng, k\u00edch th\u01b0\u1edbc s\u1ecfi m\u1eadt th\u00f4ng qua ch\u1ee5p c\u1ea3n quang \u0111\u01b0\u1eddng m\u1eadt. Ch\u1ea5t c\u1ea3n quang \u0111\u01b0\u1ee3c b\u01a1m v\u00e0o \u1ed1ng T\u00a0 trong \u0111i\u1ec1u ki\u1ec7n v\u00f4 tr\u00f9ng v\u00e0 v\u00f4 c\u1ea3m. Khi \u0111\u00f3 v\u1ecb tr\u00ed, k\u00edch th\u01b0\u1edbc vi\u00ean s\u1ecfi \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. Sau \u0111\u00f3 2 guide wire s\u1ebd \u0111\u01b0\u1ee3c lu\u1ed3n v\u00e0o \u1ed1ng T, m\u1ed9t s\u1ee3i lu\u1ed3n v\u00e0o \u0111\u01b0\u1eddng m\u1eadt trong gan. Ti\u1ebfp theo, ng\u01b0\u1eddi ta lu\u1ed3n m\u1ed9t \u1ed1ng d\u1eabn b\u00ean ngo\u00e0i guidewire, sau \u0111\u00f3 c\u01a1 th\u1eaft s\u1ebd \u0111\u01b0\u1ee3c nong d\u00e3n b\u1eb1ng b\u00f3ng th\u00edch h\u1ee3p. Sau khi ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt, s\u1ecfi s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ea9y v\u00e0o t\u00e1 tr\u00e0ng b\u1eb1ng Fogarty balloon catheter. K\u1ebft th\u00fac th\u1ee7 thu\u1eadt, \u1ed1ng d\u1eabn v\u00e0 guidewire \u0111\u01b0\u1ee3c r\u00fat ra ngo\u00e0i.<\/p>\n<p>Nh\u01b0 v\u1eady, tr\u00ean l\u00e2m s\u00e0ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb s\u1ecfi m\u1eadt, \u0111\u1ea7u ti\u00ean ng\u01b0\u1eddi ta s\u1eed d\u1ee5ng k\u0129 thu\u1eadt l\u1ea5y s\u1ecfi qua ERCP, n\u1ebfu k\u0129 thu\u1eadt n\u00e0y th\u1ea5t b\u1ea1i, l\u1ea5y s\u1ecfi qua da xuy\u00ean gan ho\u1eb7c th\u00f4ng qua \u1ed1ng T l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh ph\u1eabu thu\u1eadt.<\/p>\n<p><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o:\u00a0<\/strong><\/p>\n<p>Ozcan N, Riaz A, Kahriman G. Percutaneous Management of Biliary Stones. Semin Intervent Radiol. 2021 Aug;38(3):348-355.<\/p>\n<p>Shin JS, Shim HJ, Kwak BK, Yoon HK. Biliary stone removal through the percutaneous transhepatic biliary drainage route, focusing on the balloon sphincteroplasty flushing technique: a single center study with 916 patients. Jpn J Radiol. 2017 Aug;35(8):440-447.<\/p>\n<div id=\"disease-detail\">\n<div id=\"sticky-wrapper\" class=\"sticky-wrapper\">\n<nav class=\"sticky-nav smooth-scroll-link\">\n<div class=\"container\">\n<div class=\"inner\"><\/div>\n<\/div>\n<\/nav>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>S\u1ecfi m\u1eadt\u00a0l\u00e0 b\u1ec7nh l\u00fd ngo\u1ea1i khoa r\u1ea5t th\u01b0\u1eddng g\u1eb7p \u1edf Vi\u1ec7t Nam. Trong \u0111\u00f3, s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7 chi\u1ebfm kho\u1ea3ng 50-60% t\u1ed5ng c\u00e1c tr\u01b0\u1eddng h\u1ee3p s\u1ecfi m\u1eadt. Hi\u1ec7n nay c\u00f3 3 ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ec3 l\u1ea5y s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt, ph\u1eabu thu\u1eadt (h\u1edf v\u00e0 n\u1ed9i soi), qua n\u1ed9i soi v\u00e0 l\u1ea5y s\u1ecfi qua da. L\u1ea5y s\u1ecfi qua [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt v\u00e0 c\u00e1c k\u0129 thu\u1eadt l\u1ea5y s\u1ecfi qua da. - Vinmec<\/title>\n<meta name=\"description\" content=\"ERCP hi\u1ec7n nay l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay s\u1ecfi m\u1eadt tuy c\u00f2n bi\u1ebfn ch\u1ee9ng v\u00e0 h\u1ea1n ch\u1ebf. Khi th\u1ea5t b\u1ea1i ERCP, l\u1ea5y s\u1ecfi qua da l\u00e0 th\u1ee7 thu\u1eadt \u00edt x\u00e2m l\u1ea5n thay th\u1ebf.\" \/>\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=\"Ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt v\u00e0 c\u00e1c k\u0129 thu\u1eadt l\u1ea5y s\u1ecfi qua da. - Vinmec\" \/>\n<meta property=\"og:description\" content=\"ERCP hi\u1ec7n nay l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay s\u1ecfi m\u1eadt tuy c\u00f2n bi\u1ebfn ch\u1ee9ng v\u00e0 h\u1ea1n ch\u1ebf. 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