{"id":26723,"date":"2023-04-22T19:08:11","date_gmt":"2023-04-22T12:08:11","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26723"},"modified":"2023-04-22T19:08:11","modified_gmt":"2023-04-22T12:08:11","slug":"dieu-tri-dong-kinh-khang-thuoc-bang-phuong-phap-phau-thuat","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/dieu-tri-dong-kinh-khang-thuoc-bang-phuong-phap-phau-thuat\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh kh\u00e1ng thu\u1ed1c b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt"},"content":{"rendered":"

\u0110\u1ed9ng kinh kh\u00e1ng thu\u1ed1c<\/a> l\u00e0 s\u1ef1 th\u1ea5t b\u1ea1i trong vi\u1ec7c duy tr\u00ec c\u1eaft c\u01a1n c\u1ee7a hai l\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng \u0111\u1ed9ng kinh th\u00edch h\u1ee3p. Ph\u1eabu thu\u1eadt l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh kh\u00e1ng thu\u1ed1c. C\u00e1c lo\u1ea1i ph\u1eabu thu\u1eadt bao g\u1ed3m: ph\u1eabu thu\u1eadt ch\u1eefa kh\u1ecfi (c\u1eaft b\u1ecf v\u00f9ng sinh \u0111\u1ed9ng kinh ban \u0111\u1ea7u – epileptic onset zone (ZE)) v\u00e0 c\u00e1c ph\u1eabu thu\u1eadt gi\u1ea3m nh\u1eb9 \u0111\u1ed9ng kinh (g\u1ed3m c\u1eaft b\u1ecf m\u1ed9t ph\u1ea7n v\u00f9ng sinh \u0111\u1ed9ng kinh ban \u0111\u1ea7u, c\u1eaft th\u1ec3 chai, c\u1eaft b\u00e1n c\u1ea7u ch\u1ee9c n\u0103ng, c\u1eaft b\u00e1n c\u1ea7u gi\u1ea3i ph\u1eabu, k\u00edch th\u00edch d\u00e2y X, v\u00e0 c\u00e1c k\u00edch th\u00edch s\u00e2u \u1edf n\u00e3o).<\/strong><\/p>\n

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H\u00ecnh \u1ea3nh ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ed9ng kinh<\/figcaption><\/figure>\n

1. Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh<\/b><\/h2>\n

– \u0110\u1ed9ng kinh c\u00f3 1 \u1ed5 sinh \u0111\u1ed9ng kinh: lo\u1ea1n s\u1ea3n v\u1ecf n\u00e3o, u m\u00e1u th\u1ec3 hang, u n\u00e3o\u2026 Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf v\u00f9ng sinh \u0111\u1ed9ng kinh.<\/p>\n

– \u0110\u1ed9ng kinh kh\u00e1ng thu\u1ed1c \u1edf tr\u1ebb em m\u00e0 kh\u00f4ng t\u00ecm th\u1ea5y \u1ed5 sinh \u0111\u1ed9ng kinh, ho\u1eb7c \u0111\u1ed9ng kinh c\u00f3 nhi\u1ec1u v\u00f9ng sinh \u0111\u1ed9ng kinh. Ph\u1eabu thu\u1eadt nh\u1eb1m \u0111i\u1ec1u tr\u1ecb gi\u1ea3m nh\u1eb9 t\u1ea7n s\u1ed1 c\u0169ng nh\u01b0 c\u01b0\u1eddng \u0111\u1ed9 c\u01a1n, v\u00e0 gi\u1ea3m li\u1ec1u thu\u1ed1c \u0111ang d\u00f9ng.<\/p>\n

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

– \u0110\u1ed9ng kinh c\u00f3 t\u1ed5n th\u01b0\u01a1ng lan t\u1ecfa hai b\u00e1n c\u1ea7u.<\/p>\n

– \u0110\u1ed9ng kinh ch\u01b0a \u0111\u1ea1t ti\u00eau chu\u1ea9n kh\u00e1ng thu\u1ed1c: d\u00f9ng \u0111\u00fang thu\u1ed1c, \u0111\u00fang li\u1ec1u, \u00edt nh\u1ea5t 2 lo\u1ea1i thu\u1ed1c, \u00edt nh\u1ea5t 2 n\u0103m.<\/p>\n

– Ch\u1ea9n \u0111o\u00e1n sai c\u01a1n \u0111\u1ed9ng kinh (ng\u01b0\u1eddi b\u1ec7nh bi\u1ec3u hi\u1ec7n t\u00e2m th\u1ea7n).<\/p>\n

3. Chu\u1ea9n b\u1ecb\u00a0<\/b><\/h2>\n

3.1. Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n<\/b><\/h3>\n

–\u00a0K\u00edp m\u1ed5:<\/b><\/p>\n

+ B\u00e1c s\u1ef9: 1 ph\u1eabu thu\u1eadt vi\u00ean ch\u00ednh + 2 b\u00e1c s\u1ef9 ph\u1ee5 m\u1ed5<\/p>\n

+ \u0110i\u1ec1u d\u01b0\u1ee1ng: 2 \u0111i\u1ec1u d\u01b0\u1ee1ng: 1 \u0111i\u1ec1u d\u01b0\u1ee1ng d\u1ee5ng c\u1ee5 (chu\u1ea9n b\u1ecb v\u00e0 tr\u1ee3 gi\u00fap d\u1ee5ng c\u1ee5 ph\u1eabu thu\u1eadt) + 1 \u0111i\u1ec1u d\u01b0\u1ee1ng ch\u1ea1y ngo\u00e0i ph\u1ee5c v\u1ee5 cho ca m\u1ed5.<\/p>\n

M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t: C\u1ea7n l\u00e0m \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 b\u1ec1 m\u1eb7t v\u1ecf n\u00e3o trong m\u1ed5, th\u00ec c\u1ea7n th\u00eam 1 b\u00e1c s\u0129 n\u1ed9i th\u1ea7n kinh \u0111\u1ec3 \u0111\u1ecdc \u0111i\u1ec7n n\u00e3o, v\u00e0 1 \u0111i\u1ec1u d\u01b0\u1ee1ng k\u1ef9 thu\u1eadt \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 \u0111\u1ec3 th\u1ef1c hi\u1ec7n ghi \u0111i\u1ec7n n\u00e3o trong m\u1ed5.<\/p>\n

–\u00a0K\u00edp g\u00e2y m\u00ea:\u00a0<\/b>1 b\u00e1c s\u1ef9 g\u00e2y m\u00ea + 1 \u0111i\u1ec1u d\u01b0\u1ee1ng ph\u1ee5 m\u00ea<\/p>\n

3.2. Ph\u01b0\u01a1ng ti\u1ec7n:<\/b><\/h3>\n

+ Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c m\u00ea n\u1ed9i kh\u00ed qu\u1ea3n, n\u00ean ph\u00f2ng m\u1ed5 ph\u1ea3i \u0111\u1ea3m b\u1ea3o \u0111\u1ee7 trang thi\u1ebft b\u1ecb \u0111\u1ec3 ti\u1ebfn h\u00e0nh m\u00ea n\u1ed9i kh\u00ed qu\u1ea3n<\/p>\n

+ B\u1ed9 d\u1ee5ng c\u1ee5 m\u1edf s\u1ecd th\u00f4ng th\u01b0\u1eddng<\/p>\n

+ K\u00ednh vi ph\u1eabu, h\u1ec7 th\u1ed1ng \u0111\u1ecbnh v\u1ecb th\u1ea7n kinh, dao h\u00fat si\u00eau \u00e2m<\/p>\n

+ M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t: \u0111i\u1ec7n c\u1ef1c b\u1ec1 m\u1eb7t v\u1ecf n\u00e3o, m\u00e1y ghi \u0111i\u1ec7n n\u00e3o trong m\u1ed5<\/p>\n

+ V\u1eadt t\u01b0 ti\u00eau hao:<\/p>\n

100 g\u1ea1c con; 20 g\u00f3i b\u00f4ng s\u1ecd; 5 s\u1ee3i ch\u1ec9 prolen 4.0; 5 s\u1ee3i ch\u1ec9 prolen 5.0; 5 s\u1ee3i ch\u1ec9 vicryl 2.0 (3.0 \u0111\u1ed1i v\u1edbi tr\u1ebb em); 1 g\u00f3i c\u1ea9m m\u00e1u surgicel; 1 g\u00f3i spongen; 2 g\u00f3i s\u00e1p s\u1ecd<\/p>\n

Keo sinh h\u1ecdc v\u00e0 c\u00e1c mi\u1ebfng v\u00e1 m\u00e0ng c\u1ee9ng nh\u00e2n t\u1ea1o<\/p>\n

Ch\u1ea5t li\u1ec7u c\u1ea7m m\u00e1u Floseal<\/p>\n

B\u1ed9 d\u1eabn l\u01b0u n\u00e3o th\u1ea5t ra ngo\u00e0i (trong tr\u01b0\u1eddng h\u1ee3p c\u1ea7n d\u1eabn l\u01b0u n\u00e3o th\u1ea5t ra ngo\u00e0i nh\u01b0 ph\u1eabu thu\u1eadt c\u1eaft b\u00e1n c\u1ea7u ch\u1ee9c n\u0103ng)<\/p>\n

B\u1ed9 d\u1eabn l\u01b0u k\u00edn \u0111\u1eb7t d\u01b0\u1edbi da<\/p>\n

3.3. Ng\u01b0\u1eddi b\u1ec7nh:<\/b><\/h3>\n

Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c c\u1ea1o t\u00f3c s\u1ea1ch s\u1ebd, v\u1ec7 sinh v\u00f9ng m\u1ed5<\/p>\n

3.4. H\u1ed3 s\u01a1 b\u1ec7nh \u00e1n:<\/b><\/h3>\n

– \u0110\u1ee7 th\u1ee7 t\u1ee5c h\u00e0nh ch\u00ednh<\/p>\n

– Ph\u1ea7n chuy\u00ean m\u00f4n: c\u1ee5 th\u1ec3, \u0111\u1ee7 c\u00e1c tri\u1ec7u ch\u1ee9ng, di\u1ec5n bi\u1ebfn, ti\u1ec1n s\u1eed, c\u00e1c phim ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb, \u0111i\u1ec7n n\u00e3o \u0111\u1ed3, ch\u1ee5p PET (n\u1ebfu c\u00f3), test \u0111\u00e1nh gi\u00e1 nh\u1eadn th\u1ee9c t\u00e2m th\u1ea7n, c\u00e1c x\u00e9t nghi\u1ec7m ph\u1ee5c v\u1ee5 ph\u1eabu thu\u1eadt. Ch\u1ec9 \u0111\u1ecbnh m\u1ed5, gi\u1ea3i th\u00edch r\u00f5 gia \u0111\u00ecnh v\u00e0 vi\u1ebft cam k\u1ebft m\u1ed5.<\/p>\n

4. Ti\u1ebfn h\u00e0nh <\/b>ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh<\/b><\/h2>\n

4.1. Ki\u1ec3m tra h\u1ed3 s\u01a1: <\/b><\/h3>\n

10 ph\u00fat \u0111\u1ea3m b\u1ea3o \u0111\u1ee7 c\u00e1c th\u1ee7 t\u1ee5c v\u00e0 \u0111\u1ec1 m\u1ee5c<\/p>\n

4.2. Ki\u1ec3m tra ng\u01b0\u1eddi b\u1ec7nh: <\/b><\/h3>\n

\u0110\u00fang t\u00ean, tu\u1ed5i, chu\u1ea9n b\u1ecb m\u1ed5: 10 ph\u00fat (c\u1ea1o t\u00f3c, l\u00e0m v\u1ec7 sinh\u2026).<\/p>\n

4.3. Th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt:<\/b><\/h3>\n

– G\u00e2y m\u00ea n\u1ed9i kh\u00ed qu\u1ea3n<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m ng\u1eeda ho\u1eb7c nghi\u00eang \u0111\u1ea7u t\u00f9y k\u1ef9 thu\u1eadt m\u1ed5, v\u1ecb tr\u00ed m\u1ed5<\/p>\n

– N\u1eafp \u0111\u1eb7t h\u1ec7 th\u1ed1ng \u0111\u1ecbnh v\u1ecb th\u1ea7n kinh<\/p>\n

– R\u1ea1ch da<\/p>\n

– B\u00f3c t\u00e1ch c\u00e2n c\u01a1, b\u1ed9c l\u1ed9 x\u01b0\u01a1ng s\u1ecd<\/p>\n

– Khoan x\u01b0\u01a1ng s\u1ecd, m\u1edf n\u1eafp s\u1ecd (t\u00f9y thu\u1ed9c v\u1ecb tr\u00ed c\u1eaft \u1ed5 \u0111\u1ed9ng kinh)<\/p>\n

– M\u1edf m\u00e0ng c\u1ee9ng, h\u00fat d\u1ecbch n\u00e3o t\u1ee7y \u0111\u1ec3 l\u00e0m x\u1eb9p n\u00e3o<\/p>\n

– T\u00f9y thu\u1ed9c ch\u1ec9 \u0111\u1ecbnh m\u00e0:<\/p>\n

+ C\u1eaft c\u1ef1c th\u00e1i d\u01b0\u01a1ng + c\u1eaft h\u1ed3i h\u1ea3i m\u00e3: trong \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh th\u00f9y th\u00e1i d\u01b0\u01a1ng<\/p>\n

+ C\u1eaft v\u1ecf n\u00e3o lo\u1ea1n s\u1ea3n<\/p>\n

+ C\u1eaft \u1ed5 t\u1ed5n th\u01b0\u01a1ng sinh \u0111\u1ed9ng kinh<\/p>\n

+ C\u1eaft b\u00e1n c\u1ea7u ch\u1ee9c n\u0103ng<\/p>\n

+ C\u1eaft th\u1ec3 chai (2\/3 tr\u01b0\u1edbc ho\u1eb7c to\u00e0n b\u1ed9)<\/p>\n

+ C\u1eaft li\u00ean k\u1ebft v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i v\u1edbi hamartoma ho\u1eb7c l\u1ea5y b\u1ecf hamartoma<\/p>\n

C\u1ea7m m\u00e1u: b\u1eb1ng dao \u0111\u1ed1t l\u01b0\u1ee1ng c\u1ef1c v\u00e0 ch\u1ea5t c\u1ea7m m\u00e1u Floseal<\/p>\n

\u0110\u00f3ng m\u00e0ng c\u1ee9ng: c\u00f3 th\u1ec3 c\u1ea7n d\u00f9ng mi\u1ebfng v\u00e1 m\u00e0ng c\u1ee9ng nh\u00e2n t\u1ea1o, c\u00e2n th\u00e1i d\u01b0\u01a1ng, c\u00e2n \u0111\u00f9i (t\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p)<\/p>\n

C\u1ed1 \u0111\u1ecbnh x\u01b0\u01a1ng s\u1ecd<\/p>\n

\u0110\u00f3ng v\u1ebft m\u1ed5: c\u00e2n, c\u01a1, d\u01b0\u1edbi da, da<\/p>\n

5. Theo d\u00f5i v\u00e0 x\u1eed tr\u00ed tai bi\u1ebfn\u00a0<\/b><\/h2>\n

5.1. Theo d\u00f5i<\/b><\/h3>\n

– Sau m\u1ed5 ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i t\u1ea1i ph\u00f2ng h\u1ed3i t\u1ec9nh sau m\u1ed5 \u0111\u1ec3 cai m\u00e1y, r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh ngay sau m\u1ed5<\/p>\n

– Theo d\u00f5i ch\u1ea3y m\u00e1u v\u1ebft m\u1ed5, t\u00ecnh tr\u1ea1ng tri gi\u00e1c, c\u01a1n co gi\u1eadt<\/p>\n

5.2. X\u1eed tr\u00ed tai bi\u1ebfn<\/b><\/h3>\n

– Ch\u1ea3y m\u00e1u: t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 ch\u1ea3y m\u00e1u nhi\u1ec1u hay \u00edt m\u00e0 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i ho\u1eb7c m\u1ed5 l\u1ea1i \u0111\u1ec3 c\u1ea7m m\u00e1u<\/p>\n

– Gi\u00e3n n\u00e3o th\u1ea5t: d\u1eabn l\u01b0u n\u00e3o th\u1ea5t ra ngo\u00e0i<\/p>\n

– D\u00f2 d\u1ecbch n\u00e3o t\u1ee7y qua v\u1ebft m\u1ed5: ch\u1ecdc d\u1eabn l\u01b0u d\u1ecbch n\u00e3o t\u1ee7y \u1edf th\u1eaft l\u01b0ng \u0111\u1ec3 gi\u1ea3m \u00e1p v\u00e0 d\u00f9ng thu\u1ed1c ho\u1eb7c m\u1ed5 l\u1ea1i \u0111\u1ec3 \u0111\u00f3ng ch\u1ed7 h\u1edf m\u00e0ng c\u1ee9ng<\/p>\n

– Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh: l\u00e0 t\u00ecnh tr\u1ea1ng \u0111\u1ed9ng kinh li\u00ean t\u1ee5c, ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng th\u1edf, huy\u1ebft \u00e1p, ho\u1eb7c c\u00f3 th\u1ec3 ph\u1ea3i d\u00f9ng thu\u1ed1c an th\u1ea7n \u0111\u1ec3 ki\u1ec3m so\u00e1t tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh.<\/p>\n

T\u00f3m l\u1ea1i, \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh kh\u00e1ng thu\u1ed1c b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c kh\u00f4ng hi\u1ec7u qu\u1ea3. Do \u0111\u00f3, vi\u1ec7c \u00e1p d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh kh\u00e1ng thu\u1ed1c c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng v\u00e0 th\u1ef1c hi\u1ec7n d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a c\u00e1c chuy\u00ean gia y t\u1ebf c\u00f3 kinh nghi\u1ec7m \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

\u0110\u1ed9ng kinh kh\u00e1ng thu\u1ed1c l\u00e0 s\u1ef1 th\u1ea5t b\u1ea1i trong vi\u1ec7c duy tr\u00ec c\u1eaft c\u01a1n c\u1ee7a hai l\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng \u0111\u1ed9ng kinh th\u00edch h\u1ee3p. Ph\u1eabu thu\u1eadt l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh kh\u00e1ng thu\u1ed1c. 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