{"id":25288,"date":"2023-04-21T13:10:28","date_gmt":"2023-04-21T06:10:28","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25288"},"modified":"2023-04-21T18:00:43","modified_gmt":"2023-04-21T11:00:43","slug":"quy-trinh-ky-thuat-noi-soi-dai-trang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/quy-trinh-ky-thuat-noi-soi-dai-trang\/","title":{"rendered":"Quy tr\u00ecnh k\u1ef9 thu\u1eadt n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng"},"content":{"rendered":"<p><strong>N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n, \u0111\u01b0a \u0111\u00e8n soi m\u1ec1m t\u1eeb h\u1eadu m\u00f4n \u0111i ng\u01b0\u1ee3c l\u00ean \u0111\u1ebfn manh tr\u00e0ng \u0111\u1ec3 quan s\u00e1t t\u1ed5n th\u01b0\u01a1ng to\u00e0n b\u1ed9 \u0111\u1ea1i tr\u00e0ng. \u0110\u01b0\u1ee3c coi l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 t\u1ea7m so\u00e1t ung th\u01b0 \u0111\u1ea1i tr\u00e0ng, ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 c\u1eaft b\u1ecf nh\u1eefng t\u1ed5n th\u01b0\u01a1ng ti\u1ec1n ung th\u01b0 v\u00e0 c\u00e1c kh\u1ed1i u nh\u1ecf trong \u0111\u01b0\u1eddng ru\u1ed9t tr\u01b0\u1edbc khi xu\u1ea5t hi\u1ec7n nh\u1eefng tri\u1ec7u ch\u1ee9ng.<\/strong><\/p>\n<h2>1. Ch\u1ec9 \u0111\u1ecbnh<\/h2>\n<h3>1.1. Ch\u1ec9 \u0111\u1ecbnh n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng ch\u1ea9n \u0111o\u00e1n<\/h3>\n<ul>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi m\u1eafc ung th\u01b0 \u0111\u1ea1i tr\u00e0ng.<\/li>\n<li>Ti\u00eau ph\u00e2n \u0111en (soi d\u1ea1 d\u00e0y b\u00ecnh th\u01b0\u1eddng).<\/li>\n<li>Thi\u1ebfu m\u00e1u ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n.<\/li>\n<li>X\u00e9t nghi\u1ec7m t\u00ecm m\u00e1u trong ph\u00e2n d\u01b0\u01a1ng t\u00ednh.<\/li>\n<li>Ti\u00eau ch\u1ea3y k\u00e9o d\u00e0i ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n (soi \u0111\u1ec3 sinh thi\u1ebft t\u1eebng \u0111o\u1ea1n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n).<\/li>\n<li>Ti\u00eau ch\u1ea3y c\u1ea5p.<\/li>\n<li>R\u1ed1i lo\u1ea1n \u0111i ti\u00eau.<\/li>\n<li>Ki\u1ec3m tra nh\u1eefng b\u1ea5t th\u01b0\u1eddng kh\u00f4ng r\u00f5 tr\u00ean phim x quang.<\/li>\n<li>\u0110au d\u1ecdc khung \u0111\u1ea1i tr\u00e0ng kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n<\/li>\n<li>Ch\u1ea3y m\u00e1u th\u1ea5p ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n.<\/li>\n<li>Soi ki\u1ec3m tra \u0111\u1ecbnh k\u1ef3 b\u1ec7nh nh\u00e2n c\u00f3 polyp, ung th\u01b0 \u0111\u1ea1i tr\u00e0ng.<\/li>\n<li>B\u1ec7nh t\u00fai th\u1eeba.<\/li>\n<li>C\u00e1c b\u1ec7nh vi\u00eam \u0111\u1ea1i tr\u00e0ng do m\u1ecdi nguy\u00ean nh\u00e2n.<\/li>\n<\/ul>\n<h3>1.2. Ch\u1ec9 \u0111\u1ecbnh soi \u0111\u1ea1i tr\u00e0ng \u0111i\u1ec1u tr\u1ecb<\/h3>\n<ul>\n<li>C\u1eaft polyp<\/li>\n<li>L\u1ea5y d\u1ecb v\u1eadt<\/li>\n<li>C\u1ea7m m\u00e1u<\/li>\n<li>Nong ch\u1ed5 h\u1eb9p<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb xo\u1eafn \u0111\u1ea1i tr\u00e0ng v\u00e0 manh tr\u00e0ng.<\/li>\n<\/ul>\n<h3>1.3. Ch\u1ec9 \u0111\u1ecbnh soi \u0111\u1ea1i tr\u00e0ng theo d\u00f5i<\/h3>\n<ul>\n<li>Sau c\u1eaft polyp, n\u1ebfu polyp l\u00e0nh t\u00ednh, soi ki\u1ec3m tra sau 3 n\u0103m, sau \u0111\u00f3 c\u1ee9 5 n\u0103m m\u1ed9t l\u1ea7n.<\/li>\n<li>B\u1ec7nh nh\u00e2n vi\u00eam \u0111\u1ea1i tr\u00e0ng c\u00f3 lo\u1ea1n s\u1ea3n n\u1eb7ng.<\/li>\n<\/ul>\n<h2>2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h2>\n<ul>\n<li>Th\u1ee7ng \u0111\u1ea1i tr\u00e0ng.<\/li>\n<li>Vi\u00eam ph\u00fac m\u1ea1c.<\/li>\n<li>Suy tim<\/li>\n<li>Nh\u1ed1i m\u00e1u c\u01a1 tim c\u1ea5p<\/li>\n<li>M\u1edbi m\u1ed5 \u1edf \u0111\u1ea1i tr\u00e0ng, m\u1ed5 \u1edf ti\u1ec3u khung.<\/li>\n<li>Ph\u00ecnh l\u1edbn \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng.<\/li>\n<li>B\u1ec7nh t\u00fai th\u1eeba c\u1ea5p t\u00ednh.<\/li>\n<li>T\u1eafc m\u1ea1ch ph\u1ed5i.<\/li>\n<li>S\u1ed1c.<\/li>\n<li>B\u1ec7nh nh\u00e2n \u0111ang c\u00f3 thai (3 th\u00e1ng \u0111\u1ea7u v\u00e0 3 th\u00e1ng gi\u1eefa).<\/li>\n<\/ul>\n<h2>3. D\u1ee5ng c\u1ee5<\/h2>\n<ul>\n<li>M\u00e1y soi \u0111\u1ea1i tr\u00e0ng, d\u00e0i 130 \u2013 140 cm l\u00e0 hay d\u00f9ng nh\u1ea5t.<\/li>\n<li>M\u00e1y soi \u0111\u1ea1i tr\u00e0ng d\u00e0i 165 \u2013 180 cm cho ph\u00e9p quan s\u00e1t t\u1ed1t manh tr\u00e0ng trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1ea1i tr\u00e0ng qu\u00e1 d\u00e0i.<\/li>\n<li>M\u00e1y soi \u0111\u1ea1i tr\u00e0ng ng\u1eafn 70 \u2013 110 cm<\/li>\n<\/ul>\n<h3>3.1. C\u00e1c d\u1ee5ng c\u1ee5 \u0111i k\u00e8m<\/h3>\n<ul>\n<li>K\u00ecm sinh thi\u1ebft, d\u00e2y c\u1eaft polyp.<\/li>\n<li>K\u00ecm l\u1ea5y d\u1ecb v\u1eadt.<\/li>\n<li>Kim ti\u00eam c\u1ea7m m\u00e1u.<\/li>\n<li>Thu\u1ed1c nhu\u1ed9m m\u00e0u \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng nh\u1ecf: xanh methylen, indigo carmine \u0111\u1ec3 \u0111\u00e1nh d\u1ea5u ch\u1ed5 polyp \u0111\u00e3 c\u1eaft.<\/li>\n<\/ul>\n<h3>3.2. Chu\u1ea9n b\u1ecb b\u1ec7nh nh\u00e2n<\/h3>\n<h4>3.2.1. Ch\u1ebf \u0111\u1ed9 \u0103n<\/h4>\n<ul>\n<li>Ng\u1eebng c\u00e1c th\u1ee9c \u0103n c\u00f3 ch\u1ee9a s\u1eaft tr\u01b0\u1edbc 3 \u2013 4 ng\u00e0y.<\/li>\n<li>Ng\u1eebng c\u00e1c thu\u1ed1c nhu\u1eadn tr\u00e0ng 1 \u2013 2 ng\u00e0y tr\u01b0\u1edbc soi.<\/li>\n<li>\u0102n ch\u1ebf \u0111\u1ed9 \u0103n kh\u00f4ng c\u00f3 ch\u1ea5t x\u01a1 1 ng\u00e0y<\/li>\n<\/ul>\n<h4>3.2.2. Chu\u1ea9n b\u1ecb \u0111\u1ea1i tr\u00e0ng<\/h4>\n<ul>\n<li>C\u00f3 nhi\u1ec1u c\u00e1ch \u0111\u1ec3 <a href=\"https:\/\/www.vinmec.com\/vi\/tieu-hoa-gan-mat\/thong-tin-suc-khoe\/chuan-bi-truoc-noi-soi-dai-truc-trang\/\">chu\u1ea9n b\u1ecb \u0111\u1ea1i tr\u00e0ng<\/a>, nh\u01b0ng hi\u1ec7n nay \u0111ang dung d\u1ecbch u\u1ed1ng Fortrans l\u00e0 hi\u1ec7u qu\u1ea3 nh\u1ea5t, lo\u1ea1i tr\u1eeb tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n b\u00e1n t\u1eafc th\u00ec ph\u1ea3i \u00e1p d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p th\u1ee5t r\u1eeda nhi\u1ec1u l\u1ea7n (3 l\u00edt n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd ho\u1eb7c n\u01b0\u1edbc \u1ea5m).<\/li>\n<li>D\u00f9ng Fortrans c\u00f3 th\u1ec3 bu\u1ed3n n\u00f4n, n\u00ean d\u00f9ng thu\u1ed1c nh\u00f3m Metoclopramid, domperidon, Mosaprid&#8230;<\/li>\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n t\u00e1o b\u00f3n c\u00f3 th\u1ec3 cho chu\u1ea9n b\u1ecb b\u1eb1ng c\u00e1ch cho d\u00f9ng thu\u1ed1c nhu\u1eadn tr\u00e0ng (Fortrans) trong v\u00e0i ng\u00e0y. Tr\u01b0\u1edbc soi:<\/li>\n<li>N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c kh\u1ed1i l\u01b0\u1ee3ng n\u01b0\u1edbc l\u1edbn, ta c\u00f3 th\u1ec3 \u0111\u1eb7t sond d\u1ea1 d\u00e0y r\u1ed3i b\u01a1m dung d\u1ecbch qua \u0111\u00f3.<\/li>\n<\/ul>\n<h4>3.2.3. C\u00e1ch d\u00f9ng Fortrans<\/h4>\n<ul>\n<li>U\u1ed1ng m\u1ed9t l\u1ea7n 4 l\u00edt n\u01b0\u1edbc trong 2 gi\u1edd tr\u01b0\u1edbc khi soi 6 gi\u1edd (th\u01b0\u1eddng d\u00f9ng cho soi \u0111\u1ea1i tr\u00e0ng bu\u1ed5i chi\u1ec1u).<\/li>\n<li>U\u1ed1ng l\u00e0m 2 l\u1ea7n: 2 l\u00edt n\u01b0\u1edbc bu\u1ed5i t\u1ed1i h\u00f4m tr\u01b0\u1edbc v\u00e0 2 l\u00edt bu\u1ed5i s\u00e1ng ng\u00e0y soi (c\u00e1ch n\u00e0y \u00edt g\u00e2y bu\u1ed3n n\u00f4n, hay d\u00f9ng cho soi bu\u1ed5i s\u00e1ng).<\/li>\n<\/ul>\n<h4>3.2.4. C\u00e1c thu\u1ed1c d\u00f9ng trong soi \u0111\u1ea1i tr\u00e0ng<\/h4>\n<ul>\n<li>Thu\u1ed1c ti\u1ec1n m\u00ea: seduxen 10mg, Hypnovel 2,5 \u2013 5 mg.<\/li>\n<li>Thu\u1ed1c ch\u1ed1ng co th\u1eaft: Buscopan 20 \u2013 40 mg, glucagon 0,5 \u2013 1 mg<\/li>\n<li>Thu\u1ed1c gi\u1ea3m \u0111au: Visceralgin.<\/li>\n<\/ul>\n<h2>4. K\u1ef9 thu\u1eadt soi \u0111\u1ea1i tr\u00e0ng<\/h2>\n<h3>4.1. C\u00e1c nguy\u00ean t\u1eafc chung<\/h3>\n<ul>\n<li>B\u01a1m h\u01a1i v\u1eeba \u0111\u1ee7 v\u00e0 h\u00fat h\u01a1i th\u1eeba \u0111\u1ec3 tr\u00e1nh ch\u01b0\u1edbng h\u01a1i.<\/li>\n<li>\u0110\u01b0a \u0111\u00e8n v\u00e0o nh\u1eb9 nh\u00e0ng khi \u0111\u00e3 nh\u00ecn r\u00f5 \u0111\u01b0\u1eddng.<\/li>\n<li>Ph\u1ea3i r\u00fat b\u1edbt m\u00e1y v\u00e0 l\u00e0m ng\u1eafn l\u1ea1i m\u1ed7i khi c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c.<\/li>\n<li>Kh\u00f4ng \u0111\u1ea9y \u0111\u00e8n khi kh\u00f4ng th\u1ea5y \u0111\u01b0\u1eddng. N\u1ebfu v\u1eabn ph\u1ea3i \u0111\u1ea9y khi \u0111\u00e3 t\u00ecm \u0111\u01b0\u1eddng k\u1ef9 th\u00ec ph\u1ea3i ch\u00fa \u00fd t\u1edbi h\u1ec7 mao m\u1ea1ch c\u1ee7a ni\u00eam m\u1ea1c tr\u01b0\u1edbc \u0111\u1ea7u \u0111\u00e8n. N\u1ebfu ni\u00eam m\u1ea1c ng\u1ea3 m\u00e0u tr\u1eafng l\u00e0 do b\u1ecb qu\u00e1 \u00e9p s\u00e1t, s\u1ebd c\u00f3 nguy c\u01a1 th\u1ee7ng n\u00ean ph\u1ea3i r\u00fat \u0111\u00e8n ra ngay.<\/li>\n<li>C\u00e1c polyp n\u00ean c\u1eaft \u1edf th\u00ec \u0111\u01b0a \u0111\u00e8n v\u00e0o v\u00ec khi r\u00fat \u0111\u00e8n ra c\u00f3 th\u1ec3 kh\u00f4ng t\u00ecm l\u1ea1i \u0111\u01b0\u1ee3c.<\/li>\n<li>Khi kh\u00f3 \u0111\u1ea9u \u0111\u00e8n v\u00e0o ti\u1ebfp th\u00ec ph\u1ea3i thay \u0111\u1ed5i t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n t\u1eeb nghi\u00ean tr\u00e1i sang n\u1eb1m ng\u1eeda, v\u00e0 c\u00f3 khi sang nghi\u00eang ph\u1ea3i.<\/li>\n<li>Khi b\u01a1m h\u01a1i \u00edt ho\u1eb7c \u0111\u1ea1i tr\u00e0ng b\u1ecb co th\u1eaft th\u00ec \u0111\u01b0\u1eddng \u0111i th\u01b0\u1eddng t\u00ecm \u1edf ch\u1ed5 t\u1ee5 h\u1ed9i c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c.<\/li>\n<li>M\u00e1y b\u1ecb cu\u1ed9n khi \u0111\u1ea7u \u0111\u00e8n kh\u00f4ng ti\u1ebfn c\u00f9ng t\u1ed1c \u0111\u1ed9 v\u1edbi th\u00e2n m\u00e1y khi \u0111\u01b0a m\u00e1y v\u00e0o v\u00e0 khi r\u00fat m\u00e1y ra. Th\u00e1o cu\u1ed9n \u0111\u00fang khi \u0111\u1ea7u \u0111\u00e8n ti\u1ebfn l\u00ean, c\u00f2n n\u1ebfu \u0111\u1ea7u \u0111\u00e8n t\u1ee5t ra l\u00e0 kh\u00f4ng \u0111\u00fang, ph\u1ea3i quay \u0111\u00e8n theo chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 v\u00e0 r\u00fat m\u00e1y ra.<\/li>\n<li>\u0110\u1ea1i tr\u00e0ng \u0111\u01b0\u1ee3c quan s\u00e1t k\u1ef9 khi \u0111\u01b0a \u0111\u00e8n v\u00e0o t\u1edbi manh tr\u00e0ng v\u00e0 r\u00fat d\u1ea7n ra. Khi c\u1ea7n thi\u1ebft ph\u1ea3i cho \u0111\u00e8n v\u00e0o l\u1ea1i \u0111\u1ec3 quan s\u00e1t nh\u1eefng v\u00f9ng d\u1ec5 b\u1ecb b\u1ecf s\u00f3t (\u0111\u1eb1ng sau van Bauhin, g\u00f3c ph\u1ea3i, g\u00f3c tr\u00e1i, ch\u1ed5 n\u1ed1i tr\u1ef1c tr\u00e0ng \u2013 \u0111\u1ea1i tr\u00e0ng sigma, \u0111\u1ea1i tr\u00e0ng sigma v\u1edbi \u0111\u1ea1i tr\u00e0ng xu\u1ed1ng).<\/li>\n<\/ul>\n<h3>4.2. K\u1ef9 thu\u1eadt soi<\/h3>\n<p><strong>4.2.1. T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n<\/strong>: n\u1eb1m ng\u1eeda ho\u1eb7c nghi\u00eang tr\u00e1i.<\/p>\n<p><strong>4.2.2. \u1ede t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda<\/strong> th\u00ec d\u1ec5 \u00e1p d\u1ee5ng, d\u1ec5 nh\u00ecn th\u1ea5y \u00e1nh s\u00e1ng qua th\u00e0nh b\u1ee5ng v\u00e0 b\u1ec7nh nh\u00e2n d\u1ec5 ch\u1ecbu h\u01a1n.<\/p>\n<p><strong>4.2.3. C\u00f2n \u1edf t\u01b0 th\u1ebf nghi\u00eang tr\u00e1i<\/strong>: d\u1ec5 \u0111\u01b0a \u0111\u00e8n qua ch\u1ed5 n\u1ed1i tr\u1ef1c tr\u00e0ng \u2013 \u0111\u1ea1i tr\u00e0ng sigma.<\/p>\n<p><strong>4.2.4. B\u01b0\u1edbc \u0111\u1ea7u ti\u00ean<\/strong>: th\u0103m h\u1eadu m\u00f4n, tr\u1ef1c tr\u00e0ng r\u1ed3i \u0111\u01b0a \u0111\u00e8n v\u00e0o sau khi \u0111\u00e3 b\u00f4i tr\u01a1n m\u00e1y b\u1eb1ng m\u1ee1 lidocain ho\u1eb7c silicon<\/p>\n<p><strong>4.2.5. Soi \u0111o\u1ea1n \u0111\u1ea1i tr\u00e0ng <\/strong>\u00edt g\u1eb7p kh\u00f3 kh\u0103n, c\u00f3 th\u1ec3 quan s\u00e1t to\u00e0n b\u1ed9 tr\u1ef1c tr\u00e0ng khi ph\u1ed1i h\u1ee3p quay ng\u01b0\u1ee3c m\u00e1y.<\/p>\n<figure id=\"attachment_25292\" aria-describedby=\"caption-attachment-25292\" style=\"width: 507px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-25292\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/quat-nguoc-soi-truc-trang.png\" alt=\"n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng\" width=\"507\" height=\"345\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/quat-nguoc-soi-truc-trang.png 507w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/quat-nguoc-soi-truc-trang-300x204.png 300w\" sizes=\"(max-width: 507px) 100vw, 507px\" \/><figcaption id=\"caption-attachment-25292\" class=\"wp-caption-text\">Qu\u1eb7t ng\u01b0\u1ee3c \u1ed1ng soi \u0111\u1ec3 quan s\u00e1t tr\u1ef1c tr\u00e0ng<\/figcaption><\/figure>\n<p><strong>4.2.6. Kh\u00f3 kh\u0103n \u0111\u1ea7u ti\u00ean<\/strong> l\u00e0 khi \u0111\u01b0a \u0111\u00e8n qua \u0111\u1ea1i tr\u00e0ng sigma, \u0111o\u1ea1n n\u00e0y \u0111\u1ea1i tr\u00e0ng r\u1ea5t l\u1ecfng l\u1ebbo, d\u1ec3 t\u1ea1o th\u00e0nh cu\u1ed9n ki\u1ec3u \u03b1. Khi \u0111\u1ea9y m\u00e1y, m\u00e1y ti\u1ebfn l\u00ean cao, ra ph\u00eda tr\u01b0\u1edbc tr\u1ef1c tr\u00e0ng, sau \u0111\u00f3 l\u1ea1i v\u00f2ng xu\u1ed1ng v\u00e0 ra sau. Ph\u1ea3i r\u00fat h\u01a1i v\u00e0 quay \u0111\u00e8n theo chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i v\u00e0 h\u00fat h\u01a1i.<\/p>\n<figure id=\"attachment_25293\" aria-describedby=\"caption-attachment-25293\" style=\"width: 817px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-25293\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-alpha.png\" alt=\"n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng\" width=\"817\" height=\"801\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-alpha.png 817w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-alpha-300x294.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-alpha-768x753.png 768w\" sizes=\"(max-width: 817px) 100vw, 817px\" \/><figcaption id=\"caption-attachment-25293\" class=\"wp-caption-text\">C\u00e1c ki\u1ec3u cu\u1ed9n alpha<\/figcaption><\/figure>\n<p><strong>4.2.7. Cu\u1ed9n ki\u1ec3u omega<\/strong>: \u0111\u00f4i khi \u0111\u01b0a \u0111\u00e8n qua \u0111\u1ea1i tr\u00e0ng sigma d\u1ec5 t\u1ea1o m\u1ed9t g\u00f3c nh\u1ecdn \u1edf ch\u1ed5 n\u1ed1i \u0111\u1ea1i tr\u00e0ng sigma v\u00e0 \u0111\u1ea1i tr\u00e0ng xu\u1ed1ng, ph\u1ea3i thay \u0111\u1ed5i t\u01b0 th\u1ebf h\u00fat h\u01a1i v\u00e0 \u00e9p h\u1ed1 ch\u1eadu tr\u00e1i. B\u00ecnh th\u01b0\u1eddng g\u00f3c l\u00e1ch c\u00e1ch h\u1eadu m\u00f4n 40 \u201370 cm.<\/p>\n<figure id=\"attachment_25291\" aria-describedby=\"caption-attachment-25291\" style=\"width: 438px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-25291\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-omega.png\" alt=\"n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng\" width=\"438\" height=\"330\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-omega.png 438w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-omega-300x226.png 300w\" sizes=\"(max-width: 438px) 100vw, 438px\" \/><figcaption id=\"caption-attachment-25291\" class=\"wp-caption-text\">Cu\u1ed9n ki\u1ec3u Omega<\/figcaption><\/figure>\n<p><strong>4.2.8. G\u00f3c l\u00e1ch \u0111\u00f4i khi cu\u1ed9n ng\u01b0\u1ee3c<\/strong>, kh\u00f3 \u0111\u1ea9y \u0111\u00e8n, ph\u1ea3i r\u00fat \u0111\u00e8n quay ng\u01b0\u1ee3c chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 ho\u1eb7c thay \u0111\u1ed5i t\u01b0 th\u1ebf.<\/p>\n<figure id=\"attachment_25290\" aria-describedby=\"caption-attachment-25290\" style=\"width: 452px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-25290\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-goc-lach.png\" alt=\"n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng\" width=\"452\" height=\"383\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-goc-lach.png 452w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cuon-goc-lach-300x254.png 300w\" sizes=\"(max-width: 452px) 100vw, 452px\" \/><figcaption id=\"caption-attachment-25290\" class=\"wp-caption-text\">\u1ed0ng soi cu\u1ed9n \u0111\u1ea1i tr\u00e0ng g\u00f3c l\u00e1ch<\/figcaption><\/figure>\n<p><strong>4.2.9. Qua \u0111\u1ea1i tr\u00e0ng ngang<\/strong> th\u01b0\u1eddng \u00edt kh\u00f3 kh\u0103n, nh\u01b0ng khi \u0111o\u1ea1n n\u00e0y qu\u00e1 d\u00e0i ph\u1ea3i h\u00fat h\u01a1i v\u00e0 \u00e9p b\u1ee5ng \u1edf \u0111\u1ea1i tr\u00e0ng sigma, \u0111\u1ea1i tr\u00e0ng g\u00f3c l\u00e1ch v\u00e0 gi\u1eefa b\u1ee5ng.<\/p>\n<p><strong>4.2.10. Ph\u1ea3i cho \u0111\u00e8n t\u1edbi manh tr\u00e0ng<\/strong> b\u1eb1ng c\u00e1ch h\u00fat b\u1edbt h\u01a1i \u00e9p v\u00f9ng \u0111\u1ea1i tr\u00e0ng ngang ho\u1eb7c \u0111\u1ea1i tr\u00e0ng sigma ho\u1eb7c \u0111\u1ea1i tr\u00e0ng g\u00f3c l\u00e1ch v\u00e0 thay \u0111\u1ed5i t\u01b0 th\u1ebf.<\/p>\n<p><strong>4.2.11. \u0110\u1ec3 qua van Bauhin<\/strong>: h\u01b0\u1edbng \u0111\u1ea7u \u0111\u00e8n xu\u1ed1ng s\u00e2u h\u01a1n v\u1ecb tr\u00ed c\u1ee7a van, sau \u0111\u00f3 b\u01a1m c\u0103ng manh tr\u00e0ng, r\u1ed3i r\u00fat \u0111\u00e8n l\u00ean t\u1edbi m\u00e9p d\u01b0\u1edbi van. B\u01a1m h\u01a1i c\u0103ng \u0111\u1ec3 m\u1edf l\u1ed5 van v\u00e0 \u0111\u1ea9y \u0111\u00e8n v\u00e0o, h\u1ed3i tr\u00e0ng d\u1ec5 nh\u1eadn bi\u1ebft v\u00ec h\u00ecnh \u1ea3nh ni\u00eam m\u1ea1c h\u01a1i l\u1ea7n s\u1ea7n.<\/p>\n<p><strong>4.2.12. Nh\u1eefng kh\u00f3 kh\u0103n<\/strong> trong soi \u0111\u1ea1i tr\u00e0ng c\u00f3 th\u1ec3 do m\u1ed9t trong n\u0103m nguy\u00ean nh\u00e2n:<\/p>\n<ul>\n<li>Sau khi ph\u1eabu thu\u1eadt \u1edf ti\u1ec3u khung ho\u1eb7c m\u1ed5 \u0111\u1ea1i tr\u00e0ng.<\/li>\n<li>Vi\u00eam t\u00fai th\u1eeba<\/li>\n<li>B\u1ea5t th\u01b0\u1eddng v\u1ec1 gi\u1ea3i ph\u1eabu: \u0111\u1ea1i tr\u00e0ng qu\u00e1 d\u00e0i.<\/li>\n<li>\u1ede c\u00e1c b\u1ec7nh nh\u00e2n qu\u00e1 b\u00e9o, kh\u00f3 \u00e9p b\u1ee5ng ho\u1eb7c \u00e9p kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3.<\/li>\n<li>Nh\u1eefng b\u1ec7nh nh\u00e2n g\u1ea7y, b\u00e9.<\/li>\n<\/ul>\n<h2>5. C\u00e1c bi\u1ebfn ch\u1ee9ng soi \u0111\u1ea1i tr\u00e0ng<\/h2>\n<h3><strong>5.1. Th\u1ee7ng \u0111\u1ea1i tr\u00e0ng<\/strong>:<\/h3>\n<p>Hay g\u1eb7p nh\u1ea5t 0,14 \u2013 0,2%<\/p>\n<ul>\n<li>Nguy\u00ean nh\u00e2n: Hay li\u00ean quan t\u1edbi d\u00ednh sau m\u1ed5, t\u00fai th\u1eeba vi\u00eam n\u1eb7ng, vi\u00eam lo\u00e9t n\u1eb7ng, h\u1eb9p \u0111\u1ea1i tr\u00e0ng, b\u00e1c s\u0129 \u00edt kinh nghi\u1ec7m.<\/li>\n<li>V\u1ecb tr\u00ed hay th\u1ee7ng: \u0111\u1ea1i tr\u00e0ng sigma.<\/li>\n<li>Th\u1ee7ng c\u00f3 th\u1ec3 do:<\/li>\n<\/ul>\n<p>+ \u0110\u01b0a \u0111\u00e8n kh\u00f4ng \u0111\u00fang h\u01b0\u1edbng.<\/p>\n<p>+ \u0110\u1ee9t d\u00e2y d\u00ednh.<\/p>\n<p>+ B\u01a1m h\u01a1i ph\u1ed1i h\u1ee3p v\u1edbi \u00e9p t\u1eeb ngo\u00e0i v\u00e0o ch\u1ed5 \u0111\u1ea1i tr\u00e0ng b\u1ec7nh l\u00fd.<\/p>\n<p>+ Th\u1ee7ng t\u00fai th\u1eeba do b\u01a1m h\u01a1i qu\u00e1 c\u0103ng.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb ngo\u1ea1i khoa l\u00e0 ch\u00ednh.<\/p>\n<ul>\n<li>Tr\u1eeb tr\u01b0\u1eddng h\u1ee3p th\u1ee7ng diastatic, ta c\u00f3 th\u1ec3 gi\u1eef \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, nh\u01b0ng ch\u1ec9 trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1ea1i tr\u00e0ng chu\u1ea9n b\u1ecb r\u1ea5t s\u1ea1ch: \u0111i\u1ec1u tr\u1ecb b\u1eb1ng h\u00fat s\u1ea1ch d\u1ecbch, kh\u00e1ng sinh, nu\u00f4i d\u01b0\u1ee1ng b\u1eb1ng truy\u1ec1n, n\u1ebfu theo d\u00f5i c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng: s\u1ed1t, co c\u1ee9ng b\u1ee5ng, b\u1ea1ch c\u1ea7u cao th\u00ec ph\u1ea3i chuy\u1ec3n x\u1eed l\u00fd ngo\u1ea1i khoa.<\/li>\n<\/ul>\n<h3>5.2. Nhi\u1ec5m khu\u1ea9n huy\u1ebft<\/h3>\n<p>C\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao: b\u1ec7nh nh\u00e2n thay van nh\u00e2n t\u1ea1o, b\u1ec7nh nh\u00e2n c\u00f3 suy gi\u1ea3m mi\u1ec5n d\u1ecbch, x\u01a1 gan c\u1ed5 tr\u01b0\u1edbng.<\/p>\n<h3>5.3. Ch\u01b0\u1edbng h\u01a1i n\u1eb7ng<\/h3>\n<ul>\n<li>Do b\u01a1m h\u01a1i nhi\u1ec1u, \u0111\u1ec3 \u0111\u1ec1 ph\u00f2ng th\u1ee7ng ph\u1ea3i ch\u1ee5p kh\u00f4ng chu\u1ea9n b\u1ecb.<\/li>\n<li>H\u00fat h\u1ebft h\u01a1i.<\/li>\n<li>Vasovagal reflex: m\u1ea1ch ch\u1eadm, h\u1ea1 huy\u1ebft \u00e1p, l\u1ea1nh tay ch\u00e2n. \u0110i\u1ec1u tr\u1ecb: atropin<\/li>\n<li>Bi\u1ebfn ch\u1ee9ng li\u00ean quan v\u1edbi ti\u1ec1n m\u00ea<\/li>\n<\/ul>\n<h2>6. Bi\u1ebfn ch\u1ee9ng sau n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng \u0111i\u1ec1u tr\u1ecb<\/h2>\n<p><strong>6.1. Ch\u1ea3y m\u00e1u sau c\u1eaft polyp<\/strong>: 0,7 \u2013 2,24%.<\/p>\n<p><strong>6.2. Th\u1ee7ng \u0111\u1ea1i tr\u00e0ng<\/strong>: khi c\u1eaft c\u00e1c polyp kh\u00f4ng cu\u1ed1ng, c\u1eaft v\u00e0o th\u00e0nh ho\u1eb7c c\u01b0\u1eddng \u0111\u1ed9 \u0111i\u1ec7n m\u1ea1nh l\u00e0m ho\u1ea1i t\u1eed th\u00e0nh.<\/p>\n<h2>7. \u0110\u1ecbnh h\u01b0\u1edbng trong n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng<\/h2>\n<p><strong>\u0110\u1ecbnh h\u01b0\u1edbng theo tr\u1ee5c<\/strong><\/p>\n<ul>\n<li>Mang t\u00ednh ch\u1ea5t t\u01b0\u01a1ng \u0111\u1ed1i n\u1ebfu d\u1ef1c v\u00e0o m\u1ed1c gi\u1ea3i ph\u1eabu.<\/li>\n<li>Chi\u1ec1u d\u00e0i t\u00ednh t\u1eeb h\u1eadu m\u00f4n kh\u00f4ng ch\u00ednh x\u00e1c do \u0111\u1ea1i tr\u00e0ng co gi\u00e3n.<\/li>\n<li>\u0110\u1ecbnh h\u01b0\u1edbng l\u00fac ra d\u1ec5 h\u01a1n l\u00fac v\u00e0o<\/li>\n<li>M\u1ed9t c\u00e1ch t\u01b0\u01a1ng \u0111\u1ed1i, n\u1ebfu ta \u0111\u1ebfn manh tr\u00e0ng l\u00e0 70cm, g\u00f3c gan kho\u1ea3ng 60cm, \u0111\u1ea1i tr\u00e0ng ngang 50cm, g\u00f3c l\u00e1ch 40cm, \u0111\u1ea1i tr\u00e0ng sigma 30cm v\u00e0 tr\u1ef1c tr\u00e0ng 10 \u2013 20 cm.<\/li>\n<li>V\u1edbi nh\u1eefng ng\u01b0\u1eddi c\u00f3 kinh nghi\u1ec7m, t\u1ef7 l\u1ec7 sai kho\u1ea3ng 50 %<\/li>\n<\/ul>\n<h3>7.1. D\u1ef1a v\u00e0o quan s\u00e1t m\u1ed1c gi\u1ea3i ph\u1eabu<\/h3>\n<ul>\n<li>Tr\u1ef1c tr\u00e0ng c\u00f3 3 van Houston \u0111\u1eb7c tr\u01b0ng.<\/li>\n<li>Sigma: ch\u1ed5 g\u1eadp \u0111\u1ea7u ti\u00ean sau khi qua van Houston b\u1ecb g\u1ea5p kh\u00fac nhi\u1ec1u n\u00ean kh\u00f4ng th\u1ec3 quan s\u00e1t to\u00e0n b\u1ed9 l\u00f2ng m\u00e0 ch\u1ec9 th\u1ea5y 1 ph\u1ea7n. Ngo\u00e0i ra c\u00e1c van ru\u1ed9t \u0111\u00e3 l\u00e0 v\u00f2ng tr\u00f2n \u0111\u1ed3ng t\u00e2m ch\u1edb kh\u00f4ng ph\u1ea3i l\u00e0 h\u00ecnh b\u00e1n nguy\u1ec7t nh\u01b0 \u1edf tr\u1ef1c tr\u00e0ng.<\/li>\n<li>\u0110\u1ea1i tr\u00e0ng xu\u1ed1ng th\u1ea5y \u0111\u01b0\u1ee3c to\u00e0n b\u1ed9 l\u00f2ng c\u00f3 d\u1ea1ng nh\u01b0 1 \u1ed1ng tr\u00f2n.<\/li>\n<li>\u0110\u1ea1i tr\u00e0ng g\u00f3c l\u00e1ch: m\u1ed9t ch\u1ed5 g\u1eadp r\u1ea5t g\u1eaft \u1edf kho\u1ea3ng 40 \u2013 70cm, tr\u01b0\u1edbc \u0111\u00f3 th\u01b0\u1eddng c\u00f3 v\u1ebft \u1ea5n c\u1ee7a l\u00e1ch m\u00e0u xanh \u0111\u00e8 v\u00e0o th\u00e0nh \u0111\u1ea1i tr\u00e0ng.<\/li>\n<li>\u0110\u1ea1i tr\u00e0ng ngang: sau khi qua g\u00f3c l\u00e1ch th\u1ea5y \u0111\u01b0\u1ee3c l\u00f2ng \u0111\u1ea1i tr\u00e0ng th\u01b0\u1eddng c\u00f3 h\u00ecnh tam gi\u00e1c.<\/li>\n<li>\u0110\u1ea1i tr\u00e0ng g\u00f3c gan: m\u1ed9t ch\u1ed5 g\u1eadp xu\u1ed1ng sau khi qua \u0111\u1ea1i tr\u00e0ng ngang, th\u01b0\u1eddng c\u00f3 d\u1ea5u \u1ea5n c\u1ee7a gan.<\/li>\n<li>\u0110\u1ea1i tr\u00e0ng l\u00ean: th\u01b0\u1eddng c\u00f3 l\u00f2ng h\u00ecnh tam gi\u00e1c, hay c\u00f3 \u00edt d\u1ecbch v\u00e0ng v\u00e0 c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y manh tr\u00e0ng t\u1eeb xa.<\/li>\n<li>Manh tr\u00e0ng: quan s\u00e1t \u0111\u01b0\u1ee3c van h\u1ed3i manh tr\u00e0ng, l\u1ed5 ru\u1ed9t th\u1eeba v\u00e0 ch\u1ed5 t\u1eadn c\u00f9ng c\u1ee7a c\u00e1c th\u1edb c\u01a1 d\u1ecdc.<\/li>\n<\/ul>\n<h3>7.2. D\u1ef1a v\u00e0o quan s\u00e1t \u00e1nh \u0111\u00e8n<\/h3>\n<ul>\n<li>\u00c1nh \u0111\u00e8n \u1edf h\u1ed1 ch\u1eadu tr\u00e1i khi \u1ed1ng soi \u0111\u1ebfn \u0111\u1ea1i tr\u00e0ng sigma.<\/li>\n<li>G\u00f3c gan v\u00e0 g\u00f3c l\u00e1ch th\u01b0\u1eddng cho \u00e1nh \u0111\u00e8n \u1edf h\u1ed1 s\u01b0\u1eddn l\u01b0ng hai b\u00ean. Khi \u00e1nh \u0111\u00e8n \u1edf h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, \u1ed1ng soi th\u01b0\u1eddng \u1edf \u0111\u1ea1i tr\u00e0ng ngang.<\/li>\n<li>\u00c1nh \u0111\u00e8n \u1edf h\u1ed1 ch\u1eadu ph\u1ea3i khi \u1ed1ng soi \u0111\u1ebfn manh tr\u00e0ng.<\/li>\n<li>C\u1ea7n ch\u00fa \u00fd l\u00e0 \u00e1nh \u0111\u00e8n c\u00f3 th\u1ec3 \u1edf h\u1ed1 ch\u1eadu ph\u1ea3i khi \u1ed1ng soi c\u00f2n \u1edf \u0111\u1ea1i tr\u00e0ng sigma.<\/li>\n<\/ul>\n<p>Ngo\u00e0i ra c\u00f3 th\u1ec3 c\u00f3 thay \u0111\u1ed5i n\u1ebfu k\u00e8m theo c\u00e1c d\u1ecb t\u1eadt b\u1ea9m sinh c\u1ee7a \u0111\u1ea1i tr\u00e0ng.<\/p>\n<h3>7.3. D\u1ef1a v\u00e0o m\u00e0n hu\u1ef3nh quang l\u00e0 ch\u00ednh x\u00e1c nh\u1ea5t.<\/h3>\n<p><strong>\u0110\u1ecbnh h\u01b0\u1edbng theo m\u1eb7t c\u1eaft<\/strong><\/p>\n<p>V\u1ecb tr\u00ed tr\u00ean m\u1eb7t c\u1eaft \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh theo b\u1edd m\u1ea1c treo hay b\u1edd t\u1ef1 do.<\/p>\n<ul>\n<li>\u1ede ph\u1ea7n \u0111\u1ea1i tr\u00e0ng di \u0111\u1ed9ng, ho\u00e0n to\u00e0n kh\u00f4ng th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c ch\u00ednh x\u00e1c v\u1ecb tr\u00ed c\u1ee7a t\u1ed5n th\u01b0\u01a1ng.<\/li>\n<li>\u1ede ph\u1ea7n \u0111\u1ea1i tr\u00e0ng c\u1ed1 \u0111\u1ecbnh, c\u00f3 th\u1ec3 \u01b0\u1edbc \u0111\u00f3ab v\u1ecb tr\u00ed d\u1ef1c v\u00e0o c\u00e1c m\u1ed1c c\u1ed1 \u0111\u1ecbnh nh\u01b0 van h\u1ed3i manh tr\u00e0ng hay d\u1ea5u \u1ea5n ng\u00f3n tay t\u1eeb th\u00e0nh b\u1ee5ng tr\u01b0\u1edbc.<\/li>\n<\/ul>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ol>\n<li>N\u1ed9i soi ti\u00eau ho\u00e1. B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/li>\n<li>Abraham H. Dachman, Andrea Laghi (2011), Atlas of Virtual colonscopy. Springer.<\/li>\n<li>Gastrointestinal Endoscopy in practice<\/li>\n<li>Jean Macr Canard (2011), Gastrointestinal Endoscopy in practice. Elsevier Churchill Livingstone.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n, \u0111\u01b0a \u0111\u00e8n soi m\u1ec1m t\u1eeb h\u1eadu m\u00f4n \u0111i ng\u01b0\u1ee3c l\u00ean \u0111\u1ebfn manh tr\u00e0ng \u0111\u1ec3 quan s\u00e1t t\u1ed5n th\u01b0\u01a1ng to\u00e0n b\u1ed9 \u0111\u1ea1i tr\u00e0ng. \u0110\u01b0\u1ee3c coi l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 t\u1ea7m so\u00e1t ung th\u01b0 \u0111\u1ea1i tr\u00e0ng, ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 c\u1eaft b\u1ecf nh\u1eefng t\u1ed5n [&hellip;]<\/p>\n","protected":false},"author":15,"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>Quy tr\u00ecnh k\u1ef9 thu\u1eadt n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng - 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