{"id":30217,"date":"2023-05-04T17:19:16","date_gmt":"2023-05-04T10:19:16","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30217"},"modified":"2023-05-15T14:08:56","modified_gmt":"2023-05-15T07:08:56","slug":"cap-the-dich","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/cap-the-dich\/","title":{"rendered":"Th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch trong gh\u00e9p th\u1eadn: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p th\u1ea3i gh\u00e9p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong gh\u00e9p th\u1eadn, trong \u0111\u00f3 m\u00e1u c\u1ee7a ng\u01b0\u1eddi cho gh\u00e9p \u0111\u01b0\u1ee3c l\u1ecdc \u0111\u1ec3 lo\u1ea1i b\u1ecf t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch, sau \u0111\u00f3 \u0111\u01b0\u1ee3c truy\u1ec1n sang ng\u01b0\u1eddi b\u1ec7nh. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y gi\u00fap tr\u00e1nh s\u1ef1 ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch v\u00e0 gi\u1ea3m nguy c\u01a1 t\u1eeb ch\u1ed1i gh\u00e9p. Tuy nhi\u00ean, ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u0169ng c\u00f3 nh\u1eefng r\u1ee7i ro, bao g\u1ed3m nguy c\u01a1 l\u00e2y nhi\u1ec5m v\u00e0 ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng. \u0110\u1ec3 gi\u1ea3m thi\u1ec3u nh\u1eefng r\u1ee7i ro n\u00e0y, c\u00e1c b\u00e1c s\u0129 th\u01b0\u1eddng theo d\u00f5i ch\u1eb7t ch\u1ebd b\u1ec7nh nh\u00e2n v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/strong><\/p>\n

1. Th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch<\/strong><\/h1>\n

1.1 Ch\u1ea9n \u0111o\u00e1n th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch<\/strong><\/h3>\n

– L\u00e2m s\u00e0ng c\u1ee7a th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch th\u01b0\u1eddng l\u00e0 t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng, g\u1eb7p trong 2 t\u00ecnh hu\u1ed1ng:<\/p>\n

    \n
  • Th\u1eadn gh\u00e9p tr\u00ec ho\u00e3n ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n kh\u00e1ng th\u1ec3 l\u01b0u h\u00e0nh \u0111\u1eb7c hi\u1ec7u ch\u1ed1ng l\u1ea1i ng\u01b0\u1eddi cho \u1edf th\u1eddi \u0111i\u1ec3m gh\u00e9p (d\u00f9 hi\u1ec7u gi\u00e1 kh\u00e1ng th\u1ec3 th\u1ea5p), v\u00e0<\/li>\n
  • Th\u1ea3i gh\u00e9p c\u1ea5p s\u1edbm v\u00e0 n\u1eb7ng (hay th\u1ea3i gh\u00e9p c\u1ea5p gia t\u1ed1c). Tuy nhi\u00ean, c\u00e1c \u0111\u1ee3t th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf c\u00e1c t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng kh\u00e1c nhau, v\u00e0o c\u00e1c th\u1eddi \u0111i\u1ec3m kh\u00e1c nhau, \u0111\u00f4i khi mu\u1ed9n sau gh\u00e9p, do kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb UCMD, trong qu\u00e1 tr\u00ecnh gi\u1ea3m li\u1ec1u thu\u1ed1c UCMD, ho\u1eb7c khi \u0111i\u1ec1u tr\u1ecb v\u1edbi interferon\u03b1 \u1edf b\u1ec7nh nhi\u1ec5m virus vi\u00eam gan C. V\u00ec th\u1ebf, c\u1ea7n ngh\u0129 t\u1edbi th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn gh\u00e9p c\u1ea5p \u1edf b\u1ea5t k\u1ef3 th\u1eddi \u0111i\u1ec3m n\u00e0o sau gh\u00e9p, \u0111\u1eb7c bi\u1ec7t khi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn gh\u00e9p n\u1eb7ng.<\/li>\n<\/ul>\n

    – Ch\u1ea9n \u0111o\u00e1n th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 sau<\/strong>:<\/p>\n

    + R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn gh\u00e9p<\/p>\n

    + Hi\u1ec7n di\u1ec7n kh\u00e1ng th\u1ec3 l\u01b0u h\u00e0nh \u0111\u1eb7c hi\u1ec7u ch\u1ed1ng l\u1ea1i ng\u01b0\u1eddi cho, th\u01b0\u1eddng l\u00e0 ch\u1ed1ng l\u1ea1i kh\u00e1ng nguy\u00ean HLA c\u1ee7a ng\u01b0\u1eddi cho<\/p>\n

    + Hi\u1ec7n di\u1ec7n t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc chuy\u00ean bi\u1ec7t \u1edf m\u1eabu sinh thi\u1ebft th\u1eadn<\/p>\n

    + L\u1eafng \u0111\u1ecdng lan t\u1ecfa C4d \u1edf mao m\u1ea1ch quanh \u1ed1ng th\u1eadn<\/p>\n

    \"\"
    \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Ngu\u1ed3n: Vinmec<\/strong><\/figcaption><\/figure>\n

    1.2. \u0110i\u1ec1u tr\u1ecb <\/strong>th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch<\/strong><\/h3>\n

    – Th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb corticosteroid v\u00e0 huy\u1ebft thanh kh\u00e1ng b\u1ea1ch c\u1ea7u lympho<\/strong>. C\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb m\u1edbi bao g\u1ed3m vi\u1ec7c k\u1ebft h\u1ee3p trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng (ho\u1eb7c d\u00f9ng huy\u1ebft t\u01b0\u01a1ng tinh ch\u1ebf ho\u1eb7c h\u1ea5p ph\u1ee5 mi\u1ec5n d\u1ecbch), globulin mi\u1ec5n d\u1ecbch \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (IV Ig) v\u00e0 rituximab, nh\u1eb1m m\u1ee5c \u0111\u00edch:<\/p>\n

    + Ng\u0103n ng\u1eeba t\u1ed5n th\u01b0\u01a1ng m\u00f4 g\u00e2y ra do c\u00e1c ch\u1ea5t trung gian th\u1ec3 d\u1ecbch (kh\u00e1ng th\u1ec3, b\u1ed5 th\u1ec3)<\/p>\n

    + Ng\u0103n ng\u1eeba s\u1ef1 h\u00ecnh th\u00e0nh kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1eadn gh\u00e9p<\/p>\n

    + \u1ee8c ch\u1ebf ng\u1eafn h\u1ea1n v\u00e0 d\u00e0i h\u1ea1n c\u00e1c \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch th\u1ec3 d\u1ecbch v\u00e0 t\u1ebf b\u00e0o<\/p>\n

    – Trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng, d\u00f9ng huy\u1ebft t\u01b0\u01a1ng tinh ch\u1ebf ho\u1eb7c h\u1ea5p ph\u1ee5 mi\u1ec5n d\u1ecbch:<\/strong><\/p>\n

    + C\u00e1c k\u1ef9 thu\u1eadt tinh l\u1ecdc huy\u1ebft t\u01b0\u01a1ng ngo\u00e0i c\u01a1 th\u1ec3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c lo\u1ea1i b\u1ecf kh\u00e1ng th\u1ec3 v\u00e0 1 s\u1ed1 ch\u1ea5t trung gian vi\u00eam. Trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n m\u1ed7i ng\u00e0y hay c\u00e1ch ng\u00e0y, v\u00e0 s\u1ed1 l\u1ea7n trao \u0111\u1ed5i t\u00f9y thu\u1ed9c \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n (5-10 l\u1ea7n n\u1ebfu di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng thu\u1eadn l\u1ee3i). Th\u1ec3 t\u00edch m\u1ed7i l\u1ea7n trao \u0111\u1ed5i dao \u0111\u1ed9ng t\u1eeb 1 \u0111\u1ebfn 1.5 l\u00edt v\u00e0 dung d\u1ecbch thay th\u1ebf l\u00e0 albumin 5%, dung d\u1ecbch tinh th\u1ec3 ho\u1eb7c dung d\u1ecbch mu\u1ed1i sinh l\u00fd (NaCl 9\u2030). S\u1eed d\u1ee5ng IV Ig, \u1edf cu\u1ed1i li\u1ec7u tr\u00ecnh trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng, li\u1ec1u 0,4-2 g\/kg, ho\u1eb7c \u1edf cu\u1ed1i m\u1ed7i l\u1ea7n trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng.<\/p>\n

    + C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng trong li\u1ec7u tr\u00ecnh trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng, c\u00e2n nh\u1eafc d\u00f9ng tacrolimus \u0111\u1ec3 thay th\u1ebf cho cyclosporin. C\u00e1c huy\u1ebft thanh \u0111a d\u00f2ng kh\u00e1ng b\u1ea1ch c\u1ea7u lympho \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 th\u00e0nh ph\u1ea7n th\u1ea3i gh\u00e9p t\u1ebf b\u00e0o \u0111i k\u00e8m v\u1edbi th\u1ea3i gh\u00e9p th\u1ec3 d\u1ecbch. Rituximab c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong ch\u1ec9 \u0111\u1ecbnh n\u00e0y, b\u1eb1ng c\u00e1ch k\u1ebft h\u1ee3p v\u1edbi trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng v\u00e0\/ho\u1eb7c IV Ig.<\/p>\n

    + Trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1ng \u0111\u1ed1i an to\u00e0n, \u00edt bi\u1ebfn ch\u1ee9ng, nh\u1ea5t l\u00e0 bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

    – IV Ig<\/strong>:<\/p>\n

    + IV Ig k\u1ebft h\u1ee3p v\u1edbi c\u00e1c kh\u00e1ng th\u1ec3 kh\u00e1ng HLA ng\u0103n ng\u1eeba s\u1ef1 g\u1eafn k\u1ebft c\u1ee7a c\u00e1c kh\u00e1ng th\u1ec3 n\u00e0y tr\u00ean c\u00e1c ph\u00e2n t\u1eed HLA \u1edf b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o, gi\u00fap \u0111i\u1ec1u tr\u1ecb th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch. IV Ig c\u0169ng c\u1ed1 \u0111\u1ecbnh tr\u00ean c\u00e1c immunoglobulin \u1edf b\u1ec1 m\u1eb7t lympho B l\u00e0m gi\u1ea3m t\u1ed5ng h\u1ee3p immunoglobulin b\u1edfi lympho B, v\u00e0 th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh ch\u1ebft l\u1eadp tr\u00ecnh c\u1ee7a c\u00e1c t\u1ebf b\u00e0o n\u00e0y. C\u00e1c c\u01a1 ch\u1ebf n\u00e0y gi\u1ea3i th\u00edch l\u1ee3i \u00edch c\u1ee7a IV Ig trong c\u00e1c ph\u00e1c \u0111\u1ed3 kh\u1eed m\u1eabn c\u1ea3m tr\u01b0\u1edbc gh\u00e9p, c\u0169ng nh\u01b0 kh\u00f4ng c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng tr\u1edf l\u1ea1i n\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3 sau c\u00e1c \u0111\u1ee3t trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng \u0111i k\u00e8m v\u1edbi s\u1eed d\u1ee5ng IV Ig.<\/p>\n

    + IV Ig d\u00f9ng \u0111\u01a1n thu\u1ea7n li\u1ec1u cao c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c d\u1ef1 ph\u00f2ng v\u00e0 \u0111\u1ea3o ng\u01b0\u1ee3c c\u00e1c \u0111\u1ee3t th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch, k\u1ebft h\u1ee3p trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng v\u00e0 IV Ig hi\u1ec7u qu\u1ea3 h\u01a1n. Trao \u0111\u1ed5i huy\u1ebft t\u01b0\u01a1ng o\u1ea1i b\u1ecf kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u ch\u1ed1ng l\u1ea1i ng\u01b0\u1eddi cho gi\u1ea3m n\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3 nhanh h\u01a1n v\u00e0 d\u1ec5 ki\u1ec3m so\u00e1t h\u01a1n so v\u1edbi IV Ig \u0111\u01a1n thu\u1ea7n li\u1ec1u cao.<\/p>\n

    + T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a IV Ig ch\u1ee7 y\u1ebfu \u1edf b\u1ec7nh nh\u00e2n m\u1eabn c\u1ea3m cao trong c\u00e1c ph\u00e1c \u0111\u1ed3 kh\u1eed m\u1eabn c\u1ea3m tr\u01b0\u1edbc gh\u00e9p. \u0110a s\u1ed1 l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u1eb9 (nh\u1ee9c \u0111\u1ea7u, l\u1ea1nh run, bu\u1ed3n n\u00f4n, \u0111au kh\u1edbp, \u0111au l\u01b0ng, t\u0103ng huy\u1ebft \u00e1p), x\u1ea3y ra \u1edf 30 ph\u00fat \u0111\u1ea7u ti\u00ean truy\u1ec1n t\u0129nh m\u1ea1ch, bi\u1ebfn m\u1ea5t khi ng\u01b0ng truy\u1ec1n t\u1ea1m th\u1eddi ho\u1eb7c gi\u1ea3m t\u1ed1c \u0111\u1ed9 truy\u1ec1n. Vi\u00eam m\u00e0ng n\u00e3o b\u1ea1ch c\u1ea7u x\u1ea3y ra sau v\u00e0i ng\u00e0y d\u00f9ng IV Ig, t\u1ef1 kh\u1ecfi, hi\u1ebfm g\u1eb7p. C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7 c\u00f3 th\u1ec3 x\u1ea3y ra, c\u01a1 ch\u1ebf c\u00f3 th\u1ec3 do s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c kh\u00e1ng th\u1ec3 IgG kh\u00e1ng IgA c\u00f3 trong huy\u1ebft thanh ng\u01b0\u1eddi nh\u1eadn IV Ig. 4 t\u00e1c d\u1ee5ng ph\u1ee5 n\u1eb7ng c\u1ea7n \u0111\u01b0\u1ee3c l\u01b0u \u00fd: l\u00e2y nhi\u1ec5m c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh, t\u00e1n huy\u1ebft c\u1ea5p, suy th\u1eadn c\u1ea5p v\u00e0 huy\u1ebft kh\u1ed1i c\u1ea5p t\u00ednh.<\/p>\n

    Rituximab<\/strong> l\u00e0 kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng kh\u00e1ng CD20, l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng lympho B CD19 v\u00e0 CD20 l\u01b0u h\u00e0nh, do \u0111\u00f3, ng\u0103n ng\u1eeba s\u1ef1 t\u1ed5ng h\u1ee3p kh\u00e1ng th\u1ec3, d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch. S\u1eed d\u1ee5ng rituximab \u0111i k\u00e8m v\u1edbi nguy c\u01a1 nhi\u1ec5m tr\u00f9ng.<\/p>\n

    2. Ph\u00e2n lo\u1ea1i gi\u1ea3i ph\u1eabu b\u1ec7nh h\u1ecdc th\u1eadn gh\u00e9p Banff 97 – C\u1eadp nh\u1eadt Banff 09 (g\u1ed3m nhi\u1ec1u th\u1ec3, bao g\u1ed3m c\u1ea3 <\/strong>th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch)<\/strong><\/h2>\n

    2.1. B\u00ecnh th\u01b0\u1eddng<\/strong><\/h3>\n

    2.2. C\u00e1c thay \u0111\u1ed5i m\u00f4 h\u1ecdc th\u1eadn gh\u00e9p qua trung gian kh\u00e1ng th\u1ec3<\/strong><\/h3>\n

    Do hi\u1ec7n di\u1ec7n kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u ch\u1ed1ng l\u1ea1i ng\u01b0\u1eddi cho, C4d +, v\u00e0 t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc th\u1eadn gh\u00e9p<\/p>\n

    C4d+ kh\u00f4ng k\u00e8m t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc c\u1ee7a th\u1ea3i gh\u00e9p c\u1ea5p:<\/p>\n

    C4d+, hi\u1ec7n di\u1ec7n kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u ch\u1ed1ng l\u1ea1i ng\u01b0\u1eddi cho, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ee7a th\u1ea3i gh\u00e9p t\u1ebf b\u00e0o ho\u1eb7c th\u1ec3 d\u1ecbch c\u1ea5p ho\u1eb7c m\u1ea1n t\u00ednh (ngh\u0129a l\u00e0 g0, cg0, ptc0, kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh nhi\u1ec1u l\u1edbp \u1edf m\u00e0ng \u0111\u00e1y mao m\u1ea1ch quanh \u1ed1ng th\u1eadn, kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh vi\u00eam t\u1ed1i thi\u1ec3u t\u01b0\u01a1ng t\u1ef1 nh\u01b0 ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p). Tr\u01b0\u1eddng h\u1ee3p c\u00f3 c\u00e1c thay \u0111\u1ed5i gi\u00e1p bi\u00ean \u0111i k\u00e8m \u0111\u01b0\u1ee3c xem l\u00e0 \u2018ch\u01b0a r\u00f5 \u00fd ngh\u0129a\u2019.<\/p>\n

    Th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch:<\/strong><\/p>\n

    C4d+, hi\u1ec7n di\u1ec7n kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u ch\u1ed1ng l\u1ea1i ng\u01b0\u1eddi cho, t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc c\u1ea5p t\u00ednh<\/p>\n

    \u0110\u1ed9 1: h\u00ecnh \u1ea3nh vi\u00eam t\u1ed1i thi\u1ec3u t\u01b0\u01a1ng t\u1ef1 nh\u01b0 ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p<\/p>\n

    \u0110\u1ed9 2: vi\u00eam mao m\u1ea1ch quanh \u1ed1ng th\u1eadn v\u00e0 ho\u1eb7c vi\u00eam mao m\u1ea1ch c\u1ea7u th\u1eadn (ptc\/g >0) v\u00e0 ho\u1eb7c huy\u1ebft kh\u1ed1i<\/p>\n

    \u0110\u1ed9 3: Vi\u00eam ho\u1eb7c ho\u1ea1i t\u1eed t\u01a1 huy\u1ebft xuy\u00ean th\u00e0nh \u0111\u1ed9ng m\u1ea1ch (v3)<\/p>\n

    Th\u1ea3i gh\u00e9p m\u1ea1n th\u1ec3 d\u1ecbch ho\u1ea1t \u0111\u1ed9ng:<\/strong><\/p>\n

    C4d+, hi\u1ec7n di\u1ec7n kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u ch\u1ed1ng l\u1ea1i ng\u01b0\u1eddi cho, t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc m\u1ea1n t\u00ednh (\u0111\u01b0\u1eddng vi\u1ec1n \u0111\u00f4i \u1edf m\u00e0ng \u0111\u00e1y c\u1ea7u th\u1eadn, v\u00e0\/ho\u1eb7c h\u00ecnh \u1ea3nh nhi\u1ec1u l\u1edbp \u1edf m\u00e0ng \u0111\u00e1y mao m\u1ea1ch quanh \u1ed1ng th\u1eadn, v\u00e0\/ho\u1eb7c x\u01a1 h\u00f3a m\u00f4 k\u1ebd\/teo \u1ed1ng th\u1eadn, v\u00e0\/ho\u1eb7c d\u00e0y x\u01a1 h\u00f3a l\u1edbp n\u1ed9i m\u00f4 \u0111\u1ed9ng m\u1ea1ch)<\/p>\n

    2.3. C\u00e1c thay \u0111\u1ed5i gi\u00e1p bi\u00ean (nghi ng\u1edd c\u00f3 th\u1ea3i gh\u00e9p c\u1ea5p t\u1ebf b\u00e0o)<\/strong><\/h3>\n

    kh\u00f4ng c\u00f3 vi\u00eam n\u1ed9i m\u1ea1c \u0111\u1ed9ng m\u1ea1ch, nh\u01b0ng hi\u1ec7n di\u1ec7n vi\u00eam \u1ed1ng th\u1eadn (t1, t2 ho\u1eb7c t3) v\u00e0 th\u00e2m nhi\u1ec5m vi\u00eam m\u00f4 k\u1ebd t\u1ed1i thi\u1ec3u (i0 ho\u1eb7c i1) ho\u1eb7c th\u00e2m nhi\u1ec5m vi\u00eam m\u00f4 k\u1ebd (i2 ho\u1eb7c i3) v\u00e0 vi\u00eam \u1ed1ng th\u1eadn nh\u1eb9 (t1).<\/p>\n

    2.4. Th\u1ea3i gh\u00e9p qua trung gian t\u1ebf b\u00e0o<\/strong><\/h3>\n

    Th\u1ea3i gh\u00e9p c\u1ea5p t\u1ebf b\u00e0o:<\/strong><\/p>\n

    \u0110\u1ed9 1A: th\u00e2m nhi\u1ec5m vi\u00eam m\u00f4 k\u1ebd trung b\u00ecnh ho\u1eb7c n\u1eb7ng (i2 ho\u1eb7c i3) v\u00e0 vi\u00eam \u1ed1ng th\u1eadn trung b\u00ecnh (t2)<\/p>\n

    1B: th\u00e2m nhi\u1ec5m vi\u00eam m\u00f4 k\u1ebd trung b\u00ecnh ho\u1eb7c n\u1eb7ng (i2 ho\u1eb7c i3) v\u00e0 vi\u00eam \u1ed1ng th\u1eadn n\u1eb7ng (t3)<\/p>\n

    \u0110\u1ed9 2A: vi\u00eam n\u1ed9i m\u1ea1c \u0111\u1ed9ng m\u1ea1ch nh\u1eb9 ho\u1eb7c trung b\u00ecnh (v1)<\/p>\n

    2B: vi\u00eam n\u1ed9i m\u1ea1c \u0111\u1ed9ng m\u1ea1ch n\u1eb7ng (v2)<\/p>\n

    \u0110\u1ed9 3: vi\u00eam \u0111\u1ed9ng m\u1ea1ch xuy\u00ean th\u00e0nh v\u00e0\/ho\u1eb7c ho\u1ea1i t\u1eed t\u01a1 huy\u1ebft c\u1ee7a l\u1edbp \u00e1o gi\u1eefa th\u00e0nh \u0111\u1ed9ng m\u1ea1ch k\u00e8m th\u00e2m nhi\u1ec5m lympho b\u00e0o (v3)<\/p>\n

    Th\u1ea3i gh\u00e9p m\u1ea1n t\u1ebf b\u00e0o ho\u1ea1t \u0111\u1ed9ng:<\/p>\n

    B\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch th\u1eadn gh\u00e9p m\u1ea1n t\u00ednh (l\u1edbp n\u1ed9i m\u00f4 \u0111\u1ed9ng m\u1ea1ch d\u00e0y, x\u01a1 h\u00f3a k\u00e8m th\u00e2m nhi\u1ec5m lympho b\u00e0o)<\/p>\n

    2.5. X\u01a1 h\u00f3a m\u00f4 k\u1ebd v\u00e0 teo \u1ed1ng th\u1eadn, kh\u00f4ng k\u00e8m bi\u1ec3u hi\u1ec7n m\u00f4 h\u1ecdc c\u1ee7a nguy\u00ean nh\u00e2n chuy\u00ean bi\u1ec7t<\/strong><\/h3>\n

    \u0110\u1ed9 1: x\u01a1 h\u00f3a m\u00f4 k\u1ebd v\u00e0 teo \u1ed1ng th\u1eadn nh\u1eb9 (<25% di\u1ec7n t\u00edch v\u1ecf th\u1eadn)<\/p>\n

    \u0110\u1ed9 2: x\u01a1 h\u00f3a m\u00f4 k\u1ebd v\u00e0 teo \u1ed1ng th\u1eadn nh\u1eb9 (26-50% di\u1ec7n t\u00edch v\u1ecf th\u1eadn)<\/p>\n

    \u0110\u1ed9 3: x\u01a1 h\u00f3a m\u00f4 k\u1ebd v\u00e0 teo \u1ed1ng th\u1eadn nh\u1eb9 (>50% di\u1ec7n t\u00edch v\u1ecf th\u1eadn)<\/p>\n

    2.6. Kh\u00e1c<\/strong><\/h3>\n

    C\u00e1c thay \u0111\u1ed5i m\u00f4 h\u1ecdc kh\u00f4ng \u0111\u01b0\u1ee3c xem l\u00e0 do th\u1ea3i gh\u00e9p c\u1ea5p v\u00e0\/ho\u1eb7c m\u1ea1n t\u00ednh<\/p>\n

    Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh v\u1ec1 th\u1eadn \u2013 ti\u1ebft ni\u1ec7u theo B\u1ed9 Y t\u1ebf 2015<\/p>\n","protected":false},"excerpt":{"rendered":"

    Th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p th\u1ea3i gh\u00e9p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong gh\u00e9p th\u1eadn, trong \u0111\u00f3 m\u00e1u c\u1ee7a ng\u01b0\u1eddi cho gh\u00e9p \u0111\u01b0\u1ee3c l\u1ecdc \u0111\u1ec3 lo\u1ea1i b\u1ecf t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch, sau \u0111\u00f3 \u0111\u01b0\u1ee3c truy\u1ec1n sang ng\u01b0\u1eddi b\u1ec7nh. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y gi\u00fap tr\u00e1nh s\u1ef1 ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch v\u00e0 gi\u1ea3m nguy c\u01a1 t\u1eeb […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[73,33],"tags":[],"yoast_head":"\nTh\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch trong gh\u00e9p th\u1eadn: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/title>\n<meta name=\"description\" content=\"Th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p th\u1ea3i gh\u00e9p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong gh\u00e9p th\u1eadn, trong \u0111\u00f3 m\u00e1u c\u1ee7a ng\u01b0\u1eddi cho gh\u00e9p \u0111\u01b0\u1ee3c l\u1ecdc \u0111\u1ec3 lo\u1ea1i b\u1ecf t\u1ebf b\u00e0o\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta 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