{"id":26794,"date":"2023-04-22T17:56:27","date_gmt":"2023-04-22T10:56:27","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26794"},"modified":"2023-04-22T18:19:49","modified_gmt":"2023-04-22T11:19:49","slug":"ung-thu-vu-giai-doan-1-2-t3n1m0-phac-do-dieu-tri-theo-bo-y-te-p-1","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-1-2-t3n1m0-phac-do-dieu-tri-theo-bo-y-te-p-1\/","title":{"rendered":"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 1, 2, T3N1M0: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf (P.1)"},"content":{"rendered":"<p><strong>Ung th\u01b0 v\u00fa l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf ph\u1ee5 n\u1eef. Vi\u1ec7c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 c\u1ea3i thi\u1ec7n c\u01a1 h\u1ed9i s\u1ed1ng s\u00f3t c\u1ee7a b\u1ec7nh nh\u00e2n. B\u1ed9 Y t\u1ebf Vi\u1ec7t Nam \u0111\u00e3 \u0111\u01b0a ra ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 1, 2 v\u00e0 T3N1M0 nh\u1eb1m h\u01b0\u1edbng d\u1eabn c\u00e1c b\u00e1c s\u0129 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 c\u01a1 h\u1ed9i s\u1ed1ng s\u00f3t t\u1ed1t h\u01a1n. Ph\u1ea7n 1 s\u1ebd bao g\u1ed3m 2 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb l\u00e0 ph\u1eabu thu\u1eadt v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3.<\/strong><\/p>\n<h2>1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 ung th\u01b0 v\u00fa<\/h2>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/ung-thu-vu-dau-hieu-nguyen-nhan-cach-phong-tranh-va-dieu-tri\/\">Ung th\u01b0 v\u00fa (UTV)<\/a> l\u00e0 lo\u1ea1i ung th\u01b0 th\u01b0\u1eddng g\u1eb7p v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong h\u00e0ng \u0111\u1ea7u do ung th\u01b0 \u1edf ph\u1ee5 n\u1eef tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. M\u1ed7i n\u0103m n\u01b0\u1edbc ta c\u00f3 kho\u1ea3ng h\u01a1n 15.230 ph\u1ee5 n\u1eef m\u1edbi m\u1eafc v\u00e0 h\u01a1n 6.100 ng\u01b0\u1eddi t\u1eed vong do UTV. Ung th\u01b0 v\u00fa nam chi\u1ebfm kho\u1ea3ng 1% c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTV. \u0110a s\u1ed1 UTV xu\u1ea5t ph\u00e1t t\u1eeb c\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 c\u1ee7a v\u00fa. B\u1ec7nh Paget c\u1ee7a v\u00fa c\u00f3 th\u1ec3 k\u00e8m theo UTV. Do v\u1eady, khi c\u00f3 th\u00e0nh ph\u1ea7n ung th\u01b0 tr\u00ean Paget v\u00fa c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 UTV th\u00f4ng th\u01b0\u1eddng v\u1edbi giai \u0111o\u1ea1n t\u01b0\u01a1ng \u1ee9ng.<\/p>\n<p>C\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng quan tr\u1ecdng bao g\u1ed3m: k\u00edch th\u01b0\u1edbc u nguy\u00ean ph\u00e1t, s\u1ed1 l\u01b0\u1ee3ng h\u1ea1ch di c\u0103n, th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc, \u0111\u1ed9 m\u00f4 h\u1ecdc, t\u00ecnh tr\u1ea1ng th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft, t\u00ecnh tr\u1ea1ng th\u1ee5 th\u1ec3 y\u1ebfu t\u1ed1 ph\u00e1t tri\u1ec3n bi\u1ec3u b\u00ec ng\u01b0\u1eddi s\u1ed1 2 (human epidermal growth factor receptor-HER2), tu\u1ed5i.<\/p>\n<figure id=\"attachment_24676\" aria-describedby=\"caption-attachment-24676\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-24676\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/unnamed-1-2136-1645583322-300x170.jpg\" alt=\"minh-hoa-ung-thu-vu-o-phu-nu\" width=\"300\" height=\"170\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/unnamed-1-2136-1645583322-300x170.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/unnamed-1-2136-1645583322-1024x579.jpg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/unnamed-1-2136-1645583322-768x434.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/unnamed-1-2136-1645583322-1536x869.jpg 1536w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/unnamed-1-2136-1645583322.jpg 1600w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-24676\" class=\"wp-caption-text\">Ung th\u01b0 v\u00fa l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong do ung th\u01b0 \u1edf ph\u1ee5 n\u1eef<\/figcaption><\/figure>\n<h2>2. Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 1, 2 v\u00e0 T3N1M0 l\u00e0 g\u00ec?<\/h2>\n<p>Giai \u0111o\u1ea1n 1, 2 v\u00e0 T3N1M0 \u0111\u1ec1u l\u00e0 c\u00e1c giai \u0111o\u1ea1n c\u1ee7a ung th\u01b0 v\u00fa, nh\u01b0ng c\u00f3 nh\u1eefng kh\u00e1c bi\u1ec7t v\u1ec1 k\u00edch th\u01b0\u1edbc c\u1ee7a kh\u1ed1i u v\u00e0 s\u1ef1 lan r\u1ed9ng c\u1ee7a b\u1ec7nh.<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n 1: \u0110\u00e2y l\u00e0 giai \u0111o\u1ea1n s\u1edbm nh\u1ea5t c\u1ee7a ung th\u01b0 v\u00fa, khi kh\u1ed1i u c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf, ch\u01b0a c\u00f3 d\u1ea5u hi\u1ec7u di c\u0103n. T\u1ea1i giai \u0111o\u1ea1n n\u00e0y, kh\u1ed1i u th\u01b0\u1eddng nh\u1ecf h\u01a1n 2 cm v\u00e0 ch\u01b0a lan sang c\u00e1c m\u1ea1ch m\u00e1u v\u00e0 m\u1ea1ch lymph.<\/li>\n<li>Giai \u0111o\u1ea1n 2: \u1ede giai \u0111o\u1ea1n n\u00e0y, kh\u1ed1i u \u0111\u00e3 l\u1edbn h\u01a1n so v\u1edbi giai \u0111o\u1ea1n I, t\u1eeb 2 \u0111\u1ebfn 5 cm v\u00e0 c\u00f3 th\u1ec3 \u0111\u00e3 lan sang c\u00e1c h\u1ea1ch n\u00e1ch l\u00e2n c\u1eadn. Tuy nhi\u00ean, v\u1eabn ch\u01b0a c\u00f3 d\u1ea5u hi\u1ec7u di c\u0103n \u0111\u1ebfn c\u00e1c c\u01a1 quan \u1edf xa trong c\u01a1 th\u1ec3.<\/li>\n<li>T3N1M0: \u0110\u00e2y l\u00e0 m\u1ed9t d\u1ea1ng c\u1ee7a ung th\u01b0 v\u00fa \u1edf giai \u0111o\u1ea1n 3, khi kh\u1ed1i u \u0111\u00e3 l\u1edbn h\u01a1n, t\u1eeb 5 \u0111\u1ebfn 7cm v\u00e0 lan r\u1ed9ng sang 1 \u0111\u1ebfn 3 h\u1ea1ch n\u00e1ch (N1). Tuy nhi\u00ean, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u ung th\u01b0 di c\u0103n (M0).<\/li>\n<\/ul>\n<p>Vi\u1ec7c x\u00e1c \u0111\u1ecbnh giai \u0111o\u1ea1n c\u1ee7a ung th\u01b0 v\u00fa r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 \u0111o\u00e1n t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, \u0111\u1ec3 ch\u00ednh x\u00e1c x\u00e1c \u0111\u1ecbnh giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh, c\u1ea7n ph\u1ea3i th\u1ef1c hi\u1ec7n nhi\u1ec1u x\u00e9t nghi\u1ec7m v\u00e0 ki\u1ec3m tra b\u1ed5 sung.<\/p>\n<h2>3. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 1, 2 v\u00e0 T3N1M0<\/h2>\n<p>Theo ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 1, 2 v\u00e0 T3N1M0 c\u1ee7a b\u1ed9 Y t\u1ebf, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p bao g\u1ed3m:<\/p>\n<ul>\n<li>Ph\u1eabu thu\u1eadt<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3<\/li>\n<li>H\u00f3a tr\u1ecb v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00edch b\u1ed5 tr\u1ee3<\/li>\n<li>X\u1ea1 tr\u1ecb b\u1ed5 tr\u1ee3<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft b\u1ed5 tr\u1ee3<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 v\u1edbi thu\u1ed1c t\u00e1i t\u1ea1o x\u01b0\u01a1ng<\/li>\n<\/ul>\n<p>Trong ph\u1ea7n 1, b\u00e0i vi\u1ebft s\u1ebd \u0111\u1ec1 c\u1eadp 2 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb l\u00e0 ph\u1eabu thu\u1eadt v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3. 4\u00a0ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00f2n l\u1ea1i s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u1edf <a href=\"http:\/\/noithathoaphat.in\/ctv\/wp-admin\/post.php?post=26804&amp;action=edit\">ph\u1ea7n 2<\/a>.<\/p>\n<h3>3.1. Ph\u1eabu thu\u1eadt<\/h3>\n<ul>\n<li>Ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n (c\u1eaft r\u1ed9ng u v\u00e0 v\u00e9t h\u1ea1ch n\u00e1ch) n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 nhu c\u1ea7u. C\u1ea7n ki\u1ec3m tra di\u1ec7n c\u1eaft khi ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n. N\u1ebfu di\u1ec7n c\u1eaft d\u01b0\u01a1ng t\u00ednh, c\u1ea7n c\u1eaft l\u1ea1i. \u0110\u1eb7t clip gi\u01b0\u1eddng u \u0111\u1ec3 l\u1eadp k\u1ebf ho\u1ea1ch x\u1ea1 tr\u1ecb ch\u00ednh x\u00e1c. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTV \u0111a \u1ed5, UTV trong 6 th\u00e1ng \u0111\u1ea7u th\u1eddi k\u1ef3 mang thai, c\u00f3 h\u00ecnh \u1ea3nh vi canxi h\u00f3a lan t\u1ecfa tr\u00ean phim ch\u1ee5p x-quang v\u00fa, \u0111\u00e3 \u0111\u01b0\u1ee3c x\u1ea1 tr\u1ecb v\u00e0o ng\u1ef1c\/di\u1ec7n v\u00fa tr\u01b0\u1edbc \u0111\u00f3 ho\u1eb7c di\u1ec7n c\u1eaft d\u01b0\u01a1ng t\u00ednh dai d\u1eb3ng m\u1eb7c d\u00f9 \u0111\u00e3 c\u1eaft l\u1ea1i. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p u l\u1edbn (so v\u1edbi k\u00edch th\u01b0\u1edbc v\u00fa), b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh h\u1ec7 th\u1ed1ng, u n\u1eb1m d\u01b0\u1edbi n\u00fam v\u00fa.<\/li>\n<li>Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa v\u00e0 v\u00e9t h\u1ea1ch n\u00e1ch (c\u1eaft tuy\u1ebfn v\u00fa tri\u1ec7t c\u0103n bi\u1ebfn \u0111\u1ed5i), m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 c\u1eaft tuy\u1ebfn v\u00fa ti\u1ebft ki\u1ec7m da (skin-sparing mastectomy), c\u1eaft tuy\u1ebfn v\u00fa c\u00f3 b\u1ea3o t\u1ed3n n\u00fam v\u00fa (nipple sparing mastectomy) n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/li>\n<li>V\u00e9t h\u1ea1ch n\u00e1ch l\u00e0 th\u1ee7 thu\u1eadt th\u01b0\u1eddng quy. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ea5y di c\u0103n h\u1ea1ch n\u00e1ch tr\u00ean l\u00e2m s\u00e0ng, ch\u1ec9 c\u1ea7n v\u00e9t ch\u1eb7ng 1 v\u00e0 2. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p khi v\u00e9t th\u1ea5y di c\u0103n h\u1ea1ch \u1edf ch\u1eb7ng 1 v\u00e0 2 n\u00ean v\u00e9t ti\u1ebfp \u1edf ch\u1eb7ng 3.<\/li>\n<li>C\u00e1c tr\u01b0\u1eddng h\u1ee3p N0 tr\u00ean l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 sinh thi\u1ebft h\u1ea1ch c\u1eeda (h\u1ea1ch g\u00e1c). N\u1ebfu tr\u00ean l\u00e2m s\u00e0ng nghi ng\u1edd h\u1ea1ch d\u01b0\u01a1ng t\u00ednh c\u1ea7n ch\u1ecdc h\u00fat kim nh\u1ecf ho\u1eb7c sinh thi\u1ebft kim, n\u1ebfu h\u1ea1ch \u00e2m t\u00ednh m\u1edbi sinh thi\u1ebft h\u1ea1ch c\u1eeda. H\u1ea1ch c\u1eeda c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p nhu\u1ed9m m\u00e0u (b\u1eb1ng xanh methylene ho\u1eb7c isosulfan) ho\u1eb7c \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1 99mTc ho\u1eb7c k\u1ebft h\u1ee3p c\u1ea3 nhu\u1ed9m m\u00e0u v\u00e0 \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1. Khi t\u00ecm \u0111\u01b0\u1ee3c h\u1ea1ch c\u1eeda, ti\u1ebfn h\u00e0nh sinh thi\u1ebft h\u1ea1ch n\u00e0y. N\u1ebfu h\u1ea1ch \u00e2m t\u00ednh khi sinh th\u1ebft t\u1ee9c th\u00ec, c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n v\u00e9t h\u1ea1ch n\u00e1ch. N\u1ebfu h\u1ea1ch c\u1eeda d\u01b0\u01a1ng t\u00ednh s\u1ebd v\u00e9t h\u1ea1ch n\u00e1ch th\u01b0\u1eddng quy.<\/li>\n<li>\u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa c\u00f3 th\u1ec3 xem x\u00e9t ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o tuy\u1ebfn v\u00fa n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nhu c\u1ea7u v\u00e0 v\u1ec1 m\u1eb7t ung th\u01b0 h\u1ecdc kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t li\u1ec7u ngo\u1ea1i lai ho\u1eb7c c\u00e1c v\u1ea1t da c\u01a1 t\u1ef1 th\u00e2n ho\u1eb7c k\u1ebft h\u1ee3p c\u1ea3 hai. T\u00e1i t\u1ea1o tuy\u1ebfn v\u00fa c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh ngay trong khi c\u1eaft tuy\u1ebfn v\u00fa ho\u1eb7c v\u00e0o th\u1eddi \u0111i\u1ec3m n\u00e0o \u0111\u00f3 sau khi ho\u00e0n th\u00e0nh \u0111i\u1ec1u tr\u1ecb. Ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 \u0111\u1eb7t t\u00fai gi\u00e3n m\u00f4 tr\u01b0\u1edbc, sau \u0111\u00f3 m\u1edbi \u0111\u1eb7t m\u00f4 v\u00fa nh\u00e2n t\u1ea1o. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n c\u00f3 th\u1ec3 c\u1eaft tuy\u1ebfn v\u00fa ti\u1ebft ki\u1ec7m da, t\u1ea1o h\u00ecnh ngay ho\u1eb7c c\u1ea5y t\u00fai gi\u00e3n m\u00f4 t\u1ea1m tr\u01b0\u1edbc x\u1ea1 tr\u1ecb. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n, m\u00f4 v\u00fa b\u1ecb khuy\u1ebft, c\u00f3 th\u1ec3 l\u1ea5p ch\u1ed7 khuy\u1ebft b\u1eb1ng v\u1ea1t da (c\u00f3 m\u00f4 m\u1ee1 d\u00e0y v\u00e0 m\u1ea1ch nu\u00f4i).<\/li>\n<li>Ngo\u00e0i ra, ng\u01b0\u1eddi ta c\u0169ng c\u1ea7n ph\u1eabu thu\u1eadt s\u1eeda v\u00fa \u0111\u1ed1i b\u00ean \u0111\u1ec3 cho c\u00e2n \u0111\u1ed1i v\u1edbi b\u00ean v\u00fa b\u1ecb b\u1ec7nh \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1ea1o h\u00ecnh b\u1eb1ng v\u1ea1t t\u1ef1 th\u00e2n c\u00f3 th\u1ec3 c\u1ea7n ph\u1eabu thu\u1eadt s\u1eeda l\u1ea1i t\u1ea1i v\u00fa \u0111\u01b0\u1ee3c t\u1ea1o h\u00ecnh v\u00e0 t\u1ea1i n\u01a1i l\u1ea5y v\u1ea1t da c\u01a1.<\/li>\n<li>Ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o v\u00fa t\u1ee9c th\u00ec, t\u00e1i t\u1ea1o qu\u1ea7ng v\u00fa v\u00e0 n\u00fam v\u00fa ho\u1eb7c x\u0103m qu\u1ea7ng v\u00fa c\u0169ng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 \u0111\u1ea1t s\u1ef1 ho\u00e0n m\u1ef9.<\/li>\n<\/ul>\n<h3>3.2. \u0110i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3<\/h3>\n<ul>\n<li>V\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh c\u00f3 th\u1ec3 m\u1ed5 \u0111\u01b0\u1ee3c khi m\u1edbi ch\u1ea9n \u0111o\u00e1n, \u0111\u1ee7 ti\u00eau chu\u1ea9n b\u1ea3o t\u1ed3n v\u00fa v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 nhu c\u1ea7u b\u1ea3o t\u1ed3n ngo\u1ea1i tr\u1eeb v\u1ea5n \u0111\u1ec1 u l\u1edbn c\u1ea7n \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n tr\u01b0\u1edbc m\u1ed5 v\u1edbi c\u00e1c ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb nh\u01b0 \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3. N\u1ebfu c\u00f3 th\u1ec3, n\u00ean \u0111\u00e1nh d\u1ea5u (b\u1eb1ng clip) ranh gi\u1edbi u tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a ch\u1ee5p X-quang tuy\u1ebfn v\u00fa ho\u1eb7c si\u00eau \u00e2m tuy\u1ebfn v\u00fa.<\/li>\n<li>N\u1ebfu kh\u1ed1i u \u0111\u00e1p \u1ee9ng v\u1edbi ho\u00e1 tr\u1ecb, xem x\u00e9t \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n khi \u0111\u1ee7 ti\u00eau chu\u1ea9n. Vi\u1ec7c sinh thi\u1ebft h\u1ea1ch c\u1eeda c\u0169ng \u0111\u01b0\u1ee3c \u0111\u1eb7t ra khi h\u1ea1ch \u00e2m t\u00ednh c\u1ea3 tr\u01b0\u1edbc v\u00e0 sau \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 (cN0 v\u00e0 ycN0). C\u00e1c tr\u01b0\u1eddng h\u1ee3p ban \u0111\u1ea7u h\u1ea1ch d\u01b0\u01a1ng t\u00ednh (\u2265cN1) nh\u01b0ng chuy\u1ec3n sang \u00e2m t\u00ednh sau \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 (ycN0), ch\u1ec9 sinh thi\u1ebft h\u1ea1ch c\u1eeda \u1edf m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p r\u1ea5t ch\u1ecdn l\u1ecdc.<\/li>\n<li>N\u1ebfu sau ho\u00e1 tr\u1ecb, kh\u1ed1i u kh\u00f4ng \u0111\u00e1p \u1ee9ng ho\u1eb7c b\u1ec7nh ti\u1ebfn tri\u1ec3n, c\u1ea7n ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa, v\u00e9t h\u1ea1ch n\u00e1ch.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 HER2 d\u01b0\u01a1ng t\u00ednh, n\u00ean k\u1ebft h\u1ee3p h\u00f3a tr\u1ecb v\u1edbi trastuzumab tr\u01b0\u1edbc m\u1ed5. N\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n c\u00e2n nh\u1eafc k\u1ebft h\u1ee3p trastuzumab v\u00e0 pertuzumab v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u1ed1i u &gt;2cm ho\u1eb7c h\u1ea1ch d\u01b0\u01a1ng t\u00ednh. Kh\u00f4ng d\u00f9ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c kh\u00e1ng HER2 v\u1edbi anthracycline. Sau m\u1ed5, ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng kh\u00e1ng HER2 b\u1ed5 tr\u1ee3 (nh\u01b0 tr\u00ecnh b\u00e0y trong m\u1ee5c h\u00f3a tr\u1ecb b\u1ed5 tr\u1ee3).<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft t\u00e2n b\u1ed5 tr\u1ee3 \u0111\u01a1n thu\u1ea7n ho\u1eb7c k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb \u0111\u00edch ch\u1ec9 d\u00e0nh cho m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ec3 h\u00f3a tr\u1ecb, th\u1ec3 l\u00f2ng \u1ed1ng nguy c\u01a1 th\u1ea5p.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 thai kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng h\u00f3a tr\u1ecb trong qu\u00fd \u0111\u1ea7u (3 th\u00e1ng \u0111\u1ea7u) n\u1ebfu gi\u1eef thai, ch\u1ec9 h\u00f3a tr\u1ecb t\u1eeb qu\u00fd th\u1ee9 hai tr\u1edf \u0111i v\u1edbi c\u00e1c thu\u1ed1c \u00edt g\u00e2y h\u1ea1i thai nhi nh\u01b0 doxorubicin, cyclophosphamide, 5 fluorouracil, taxane&#8230; C\u00e1c thu\u1ed1c kh\u00e1ng HER2 v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh trong su\u1ed1t th\u1eddi k\u1ef3 mang thai.<\/li>\n<\/ul>\n<p>Ph\u1ea7n 2 c\u1ee7a b\u00e0i vi\u1ebft v\u1ec1 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 1, 2 v\u00e0 T3N1M0 s\u1ebd bao g\u1ed3m 3 ph\u01b0\u01a1ng ph\u00e1p: h\u00f3a tr\u1ecb v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00edch b\u1ed5 tr\u1ee3, x\u1ea1 tr\u1ecb b\u1ed5 tr\u1ee3 v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft b\u1ed5 tr\u1ee3.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ung th\u01b0 v\u00fa l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf ph\u1ee5 n\u1eef. Vi\u1ec7c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 c\u1ea3i thi\u1ec7n c\u01a1 h\u1ed9i s\u1ed1ng s\u00f3t c\u1ee7a b\u1ec7nh nh\u00e2n. B\u1ed9 Y t\u1ebf Vi\u1ec7t Nam \u0111\u00e3 \u0111\u01b0a ra ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 1, [&hellip;]<\/p>\n","protected":false},"author":43,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 1, 2, T3N1M0: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf (P.1)<\/title>\n<meta name=\"description\" content=\"Ph\u1ea7n 1 c\u1ee7a ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 1, 2, T3N1M0 s\u1ebd bao g\u1ed3m 2 ph\u01b0\u01a1ng ph\u00e1p l\u00e0 ph\u1eabu thu\u1eadt v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, 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