{"id":29689,"date":"2023-04-30T13:21:08","date_gmt":"2023-04-30T06:21:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29689"},"modified":"2023-04-30T13:21:08","modified_gmt":"2023-04-30T06:21:08","slug":"ung-dung-phuong-phap-thd-dieu-tri-benh-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/30\/ung-dung-phuong-phap-thd-dieu-tri-benh-tri\/","title":{"rendered":"\u1ee8ng d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p THD \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tr\u0129"},"content":{"rendered":"

Ph\u01b0\u01a1ng ph\u00e1p kh\u00e2u treo v\u00e0 tri\u1ec7t m\u1ea1ch tr\u0129 THD l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb<\/a> b\u1ec7nh tr\u0129 kh\u00f4ng c\u1ea7n ph\u1eabu thu\u1eadt. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y s\u1eed d\u1ee5ng m\u1ed9t thi\u1ebft b\u1ecb \u0111\u1eb7c bi\u1ec7t \u0111\u1ec3 tri\u1ec7t m\u1ea1ch c\u00e1c \u0111\u1ed9ng m\u1ea1ch tr\u0129 v\u00e0 kh\u00e2u treo l\u1ea1i c\u00e1c m\u00f4 xung quanh v\u00f9ng tr\u0129 \u0111\u1ec3 gi\u1eef ch\u00fang \u1edf v\u1ecb tr\u00ed b\u00ecnh th\u01b0\u1eddng. Vi\u1ec7c s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c quy\u1ebft \u0111\u1ecbnh b\u1edfi b\u00e1c s\u0129 chuy\u00ean khoa v\u00e0 b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i th\u1ea3o lu\u1eadn k\u1ef9 v\u1edbi b\u00e1c s\u0129 \u0111\u1ec3 hi\u1ec3u r\u00f5 c\u00e1c l\u1ee3i \u00edch v\u00e0 h\u1ea1n ch\u1ebf c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y.<\/strong><\/p>\n

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H\u00ecnh \u1ea3nh tr\u0129 qua m\u00f4 h\u00ecnh gi\u1ea3i ph\u1eabu<\/figcaption><\/figure>\n

1. Ph\u01b0\u01a1ng ph\u00e1p THD l\u00e0 g\u00ec?<\/b><\/h2>\n

Kh\u00e2u treo tri\u1ec7t m\u1ea1ch tr\u0129 d\u1ef1a tr\u00ean nguy\u00ean t\u1eafc l\u00e0m gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn b\u00fai tr\u0129 \u0111\u1ec3 thu nh\u1ecf th\u1ec3 t\u00edch kh\u1ed1i tr\u0129 v\u00e0 treo b\u00fai tr\u0129 l\u00ean \u1ed1ng h\u1eadu m\u00f4n b\u1eb1ng c\u00e1c m\u0169i kh\u00e2u tay kh\u00e2u x\u1ebfp n\u1ebfp ni\u00eam m\u1ea1c tr\u00ean \u0111\u01b0\u1eddng l\u01b0\u1ee3c 2-3 cm. Ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt kh\u00e2u treo k\u00e9m hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi tr\u0129 h\u1ed7n h\u1ee3p c\u00f3 th\u00e0nh ph\u1ea7n tr\u0129 ngo\u1ea1i ph\u00ecnh gi\u00e3n qu\u00e1 l\u1edbn so v\u1edbi th\u00e0nh ph\u1ea7n tr\u0129 n\u1ed9i.<\/p>\n

THD (Transanal Hemorrhoidal Dearterilization) l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt kh\u00e2u th\u1eaft \u0111\u1ed9ng m\u1ea1ch tr\u0129 v\u00e0 kh\u00e2u treo b\u00fai tr\u0129 d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a \u0111\u1ea7u d\u00f2 si\u00eau \u00e2m Doppler. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng l\u1ea7n \u0111\u1ea7u ti\u00ean n\u0103m 1995 do b\u00e1c s\u1ef9 Morinaga ng\u01b0\u1eddi Nh\u1eadt. THD l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt ti\u00ean ti\u1ebfn, kh\u00f4ng \u0111au, hi\u1ec7u qu\u1ea3, \u0111\u01a1n gi\u1ea3n, \u00edt tai bi\u1ebfn, h\u1eadu ph\u1eabu \u0111\u01a1n gi\u1ea3n, th\u1eddi gian n\u1eb1m vi\u1ec7n ng\u1eafn v\u00e0 chi ph\u00ed th\u1ea5p. \u0110\u1ebfn nay THD \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng t\u1ea1i Vi\u1ec7t Nam.<\/p>\n

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

– Tr\u0129 n\u1ed9i \u0111\u1ed9 3, \u0111\u1ed9 4, tr\u0129 v\u00f2ng.<\/p>\n

– Tr\u0129 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c th\u1ea5t b\u1ea1i c\u00f2n sa v\u00e0 ch\u1ea3y m\u00e1u.<\/p>\n

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

– Tr\u0129 h\u1ed7n h\u1ee3p m\u00e0 th\u00e0nh ph\u1ea7n tr\u0129 ngo\u1ea1i to d\u00e3n n\u1edf, tr\u0129 huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch, tr\u0129 ngo\u1ea1i ph\u00ecnh to.<\/p>\n

– H\u1eadu m\u00f4n vi\u00eam nhi\u1ec5m.<\/p>\n

– H\u1eb9p h\u1eadu m\u00f4n, kh\u00f4ng \u0111\u1eb7t \u0111\u01b0\u1ee3c \u1ed1ng nong h\u1eadu m\u00f4n.<\/p>\n

– B\u1ec7nh r\u1ed1i lo\u1ea1n v\u1ec1 \u0111\u00f4ng m\u00e1u, b\u1ec7nh to\u00e0n th\u00e2n \u1edf giai \u0111o\u1ea1n c\u1ea5p, suy gi\u1ea3m mi\u1ec5n d\u1ecbch HIV d\u01b0\u01a1ng t\u00ednh; ch\u1ec9 \u0111i\u1ec1u tr\u1ecb tr\u0129 khi c\u00e1c b\u1ec7nh ph\u1ed1i h\u1ee3p \u0111\u00e3 \u1ed5n \u0111\u1ecbnh.<\/p>\n

4. Chu\u1ea9n b\u1ecb<\/b><\/h2>\n

4.1. Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n:<\/h3>\n

Ph\u1eabu thu\u1eadt vi\u00ean ti\u00eau h\u00f3a hay ngo\u1ea1i chung \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o chuy\u00ean s\u00e2u ho\u1eb7c c\u00f3 ch\u1ee9ng ch\u1ec9 v\u1ec1 ph\u1eabu thu\u1eadt v\u00f9ng h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng – t\u1ea7ng sinh m\u00f4n.<\/p>\n

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

M\u00e1y THD: M\u00e1y tri\u1ec7t m\u1ea1ch tr\u0129 v\u1edbi \u0111\u1ea7u d\u00f2 si\u00eau \u00e2m Doppler m\u1ea1ch.<\/p>\n

5. C\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh<\/b><\/h2>\n

5.1. T\u01b0 th\u1ebf<\/b>:<\/h3>\n

S\u1ea3n khoa<\/p>\n

5.2. V\u00f4 c\u1ea3m<\/b>:<\/h3>\n

G\u00e2y m\u00ea to\u00e0n th\u00e2n<\/p>\n

5.3. K\u0129 thu\u1eadt<\/b><\/h3>\n

5.3.1. Nong h\u1eadu m\u00f4n, b\u1ed9c l\u1ed9 c\u00e1c b\u00fai tr\u0129<\/h4>\n

\u0110\u1eb7t 9 panh t\u1ea1i 3 v\u1ecb tr\u00ed: 3h, 8h, 11h; theo h\u00e0ng: \u1edf m\u00e9p h\u1eadu m\u00f4n, tr\u00ean \u0111\u01b0\u1eddng l\u01b0\u1ee3c v\u00e0 g\u1ed1c b\u00fai tr\u0129 t\u1ea1o n\u00ean tam gi\u00e1c tr\u00ecnh b\u00e0y.<\/i><\/p>\n

5.3.2. Kh\u00e2u treo tri\u1ec7t m\u1ea1ch t\u1eebng b\u00fai tr\u0129:<\/h4>\n

Th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u \u1edf b\u00fai 3h.<\/p>\n

\u0110\u1eb7t van Hill – Ferguson (van b\u00e1n nguy\u1ec7t che ph\u1ea7n c\u00f2n l\u1ea1i c\u1ee7a \u1ed1ng h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng \u0111\u1ec3 b\u1ed9c r\u00f5 b\u00fai tr\u0129 s\u1ebd kh\u00e2u tri\u1ec7t m\u1ea1ch).<\/p>\n

N\u1ebfu s\u1eed d\u1ee5ng m\u00e1y THD, d\u00f9ng \u0111\u1ea7u d\u00f2 Doppler gi\u00fap x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed b\u00f3 m\u1ea1ch tr\u01b0\u1edbc khi kh\u00e2u v\u00e0 ki\u1ec3m tra t\u00ednh ch\u1ea5t tri\u1ec7t m\u1ea1ch sau khi kh\u00e2u treo.<\/p>\n

Nguy\u00ean t\u1eafc chung l\u00e0 kh\u00e2u ch\u1eef X ho\u1eb7c ch\u1eef I ch\u1ec9 l\u1ea5y l\u1edbp ni\u00eam m\u1ea1c v\u00e0 l\u1edbp d\u01b0\u1edbi ni\u00eam, nh\u1eb1m tri\u1ec7t m\u1ea1ch m\u00e1u \u0111\u1ebfn cung c\u1ea5p cho c\u00e1c \u0111\u00e1m r\u1ed1i tr\u0129 v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c ph\u1ea7n ni\u00eam m\u1ea1c b\u1ecb sa tr\u01b0\u1ee3t ra ngo\u00e0i. M\u0169i kh\u00e2u c\u00e1ch \u0111\u01b0\u1eddng l\u01b0\u1ee3c 1,5 – 2 cm, s\u00e2u \u0111\u1ebfn l\u1edbp d\u01b0\u1edbi ni\u00eam m\u1ea1c v\u00e0 c\u00f3 th\u1ec3 l\u1ea5y m\u1ed9t ph\u1ea7n c\u01a1 th\u1eaft trong, sau \u0111\u00f3 kh\u00e2u t\u0103ng c\u01b0\u1eddng v\u00e0o c\u00e1c kho\u1ea3ng gi\u1eefa c\u1ee7a c\u00e1c m\u0169i ch\u00ednh, th\u01b0\u1eddng kho\u1ea3ng 8 m\u0169i. M\u0169i kh\u00e2u cu\u1ed1i tr\u00ean \u0111\u01b0\u1eddng l\u01b0\u1ee3c 5 mm (v\u00f9ng kh\u00f4ng \u0111au). Sau khi k\u1ebft th\u00fac c\u00e1c m\u0169i kh\u00e2u v\u00f2ng, ph\u1ea7n th\u1eeba c\u1ee7a ni\u00eam m\u1ea1c tr\u1ef1c tr\u00e0ng v\u00e0 \u1ed1ng h\u1eadu m\u00f4n ph\u00eda tr\u00ean \u0111\u01b0\u1ee3c kh\u00e2u c\u1ed9t v\u00e0o n\u1ebfp kh\u00e2u ph\u00eda d\u01b0\u1edbi \u0111\u1ec3 gi\u00fap k\u00e9o c\u00e1c b\u00fai tr\u0129 v\u00e0o s\u00e2u trong \u1ed1ng h\u1eadu m\u00f4n h\u01a1n.<\/p>\n

5.3.3. Th\u1ef1c hi\u1ec7n t\u01b0\u01a1ng t\u1ef1 v\u1edbi c\u00e1c b\u00fai tr\u0129 \u1edf c\u00e1c v\u1ecb tr\u00ed c\u00f2n l\u1ea1i (8h v\u00e0 11 gi\u1edd).<\/h4>\n

Sau khi kh\u00e2u treo tri\u1ec7t m\u1ea1ch 3 b\u00fai tr\u0129 ch\u00ednh, ki\u1ec3m tra l\u1ea1i c\u00e1c v\u1ecb tr\u00ed kh\u00e2u, c\u1ea7m m\u00e1u b\u1eb1ng \u0111\u1ed1t \u0111i\u1ec7n ho\u1eb7c kh\u00e2u n\u1ebfu c\u1ea7n. N\u1ebfu s\u1eed d\u1ee5ng m\u00e1y THD c\u00f3 \u0111\u1ea7u d\u00f2 Doppler, d\u00f9ng \u0111\u1ea7u d\u00f2 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed b\u00f3 m\u1ea1ch tr\u01b0\u1edbc khi kh\u00e2u v\u00e0 ki\u1ec3m tra t\u00ednh ch\u1ea5t tri\u1ec7t m\u1ea1ch sau khi kh\u00e2u treo.<\/p>\n

5.3.4. C\u00f3 th\u1ec3 c\u1eaft s\u1eeda da th\u1eeba h\u1eadu m\u00f4n t\u1ed1i thi\u1ec3u.<\/h4>\n

5.3.5. Ki\u1ec3m tra l\u1ea1i v\u1ebft m\u1ed5:<\/h4>\n

C\u1ea7m m\u00e1u t\u1ed1t, \u1ed1ng h\u1eadu m\u00f4n kh\u00f4ng b\u1ecb h\u1eb9p (\u0111\u00fat l\u1ecdt d\u1ec5 d\u00e0ng ng\u00f3n tr\u1ecf). C\u00f3 th\u1ec3 \u0111\u1eb7t m\u1ed9t mi\u1ebfng b\u0103ng c\u00f3 t\u00e1c d\u1ee5ng c\u1ea7m m\u00e1u nh\u01b0 lo\u1ea1i surgicel hay spongel \u00e9p nh\u1eb9 l\u00ean v\u1ebft m\u1ed5. B\u0103ng m\u1ee1 v\u1edbi betadine.<\/p>\n

6. Theo d\u00f5i<\/b><\/h2>\n

(xem b\u00e0i nguy\u00ean t\u1eafc chung ph\u1eabu thu\u1eadt v\u00f9ng h\u1eadu m\u00f4n – tr\u1ef1c tr\u00e0ng)<\/p>\n

– Th\u01b0\u1eddng cho kh\u00e1ng sinh, thu\u1ed1c gi\u1ea3m \u0111au 3 – 5 ng\u00e0y lo\u1ea1i metronidazol, paracetamol. Ng\u00e0y \u0111\u1ea7u d\u00f9ng \u0111\u01b0\u1eddng ti\u00eam, t\u1eeb ng\u00e0y th\u1ee9 2 d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng. U\u1ed1ng th\u00eam thu\u1ed1c nhu\u1eadn tr\u00e0ng, tr\u00e1nh t\u00e1o b\u00f3n \u0111\u1ecdng ph\u00e2n trong tr\u1ef1c tr\u00e0ng g\u00e2y k\u00edch th\u00edch \u0111\u1ea1i ti\u1ec7n, g\u00e2y \u0111au k\u00e9o d\u00e0i. Thu\u1ed1c tr\u1ecb tr\u0129: Daflon 0,5g.<\/p>\n

– Ch\u1ebf \u0111\u1ed9 \u0103n: B\u1eaft \u0111\u1ea7u \u0103n tr\u1edf l\u1ea1i sau m\u1ed5 6 gi\u1edd. Ng\u00e0y \u0111\u1ea7u: \u0103n l\u1ecfng d\u1ec5 ti\u00eau. Nh\u1eefng ng\u00e0y sau \u0103n ch\u1ebf \u0111\u1ed9 \u0103n nhu\u1eadn tr\u00e0ng.<\/p>\n

– S\u0103n s\u00f3c t\u1ea1i ch\u1ed7: Th\u01b0\u1eddng \u0111\u1eb7t vi\u00ean \u0111\u1ea1n tr\u0129 v\u00e0o h\u1eadu m\u00f4n 1 vi\u00ean\/ng\u00e0y. H\u00e0ng ng\u00e0y ng\u00e2m r\u1eeda h\u1eadu m\u00f4n v\u00e0o ch\u1eadu n\u01b0\u1edbc \u1ea5m pha thu\u1ed1c t\u00edm ho\u1eb7c dung d\u1ecbch s\u00e1t tr\u00f9ng nh\u1eb9 2 – 3 l\u1ea7n\/ng\u00e0y. Kh\u00f4ng nh\u00e9t g\u1ea1c h\u1eadu m\u00f4n v\u00e0 kh\u00f4ng c\u1ea7n ch\u0103m s\u00f3c v\u1ebft m\u1ed5 h\u00e0ng ng\u00e0y. C\u00f3 th\u1ec3 ra vi\u1ec7n v\u00e0o ng\u00e0y h\u00f4m sau m\u1ed5.<\/p>\n

7. X\u1eed tr\u00ed tai bi\u1ebfn<\/b><\/h2>\n

Ph\u1eabu thu\u1eadt kh\u00e2u treo tri\u1ec7t m\u1ea1ch tr\u0129 \u0111\u01a1n gi\u1ea3n, \u00edt m\u1ea5t m\u00e1u, \u00edt \u0111au, \u00edt bi\u1ebfn ch\u1ee9ng sau m\u1ed5.<\/p>\n

– Ch\u1ea3y m\u00e1u: C\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n d\u1ea1ng t\u1ee5 m\u00e1u v\u00f9ng kh\u00e2u treo. N\u1ebfu m\u1ee9c \u0111\u1ed9 ch\u1ea3y m\u00e1u nhi\u1ec1u, kh\u00f4ng t\u1ef1 c\u1ea7m c\u1ea7n ki\u1ec3m tra l\u1ea1i v\u1ebft m\u1ed5 \u0111\u1ec3 c\u1ea7m m\u00e1u b\u1eb1ng \u0111\u1ed1t \u0111i\u1ec7n hay kh\u00e2u.<\/p>\n

– \u0110au nhi\u1ec1u: D\u00f9ng thu\u1ed1c gi\u1ea3m \u0111au k\u1ebft h\u1ee3p ng\u00e2m h\u1eadu m\u00f4n n\u01b0\u1edbc \u1ea5m.<\/p>\n

– B\u00ed \u0111\u00e1i: Th\u01b0\u1eddng g\u1eb7p sau g\u00e2y t\u00ea t\u1ee7y s\u1ed1ng, ho\u1eb7c do ng\u01b0\u1eddi b\u1ec7nh \u0111au nhi\u1ec1u c\u0169ng g\u00e2y kh\u00f3 ti\u1ec3u ti\u1ec7n. N\u1ebfu c\u1ea7n thi\u1ebft ph\u1ea3i \u0111\u1eb7t \u1ed1ng th\u00f4ng b\u00e0ng quang.<\/p>\n

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

Ph\u01b0\u01a1ng ph\u00e1p kh\u00e2u treo v\u00e0 tri\u1ec7t m\u1ea1ch tr\u0129 THD l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tr\u0129 kh\u00f4ng c\u1ea7n ph\u1eabu thu\u1eadt. 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