{"id":31209,"date":"2023-05-04T16:24:01","date_gmt":"2023-05-04T09:24:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31209"},"modified":"2023-05-04T16:24:01","modified_gmt":"2023-05-04T09:24:01","slug":"quy-trinh-ercp-can-thiep-dat-stent-duong-mat-tuy","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/quy-trinh-ercp-can-thiep-dat-stent-duong-mat-tuy\/","title":{"rendered":"Quy tr\u00ecnh ERCP can thi\u1ec7p-\u0111\u1eb7t stent \u0111\u01b0\u1eddng m\u1eadt-t\u1ee5y"},"content":{"rendered":"

N\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP) can thi\u1ec7p-\u0111\u1eb7t stent \u0111\u01b0\u1eddng m\u1eadt-t\u1ee5y l\u00e0 k\u1ef9 thu\u1eadt \u0111\u01b0a stent b\u1eb1ng kim lo\u1ea1i ho\u1eb7c b\u1eb1ng nh\u1ef1a qua n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng v\u00e0o \u0111\u01b0\u1eddng m\u1eadt ho\u1eb7c v\u00e0o \u0111\u01b0\u1eddng t\u1ee5y ch\u00ednh qua m\u00e1y n\u1ed9i soi t\u00e1 tr\u00e0ng v\u1edbi m\u1ee5c \u0111\u00edch d\u1eabn l\u01b0u m\u1eadt xu\u1ed1ng t\u00e1 tr\u00e0ng ho\u1eb7c d\u1eabn l\u01b0u d\u1ecbch t\u1ee5y xu\u1ed1ng t\u00e1 tr\u00e0ng qua.<\/span><\/strong><\/p>\n

\"\"<\/p>\n

1. Ch\u1ec9 \u0111\u1ecbnh<\/h2>\n

1.1. \u0110\u1eb7t stent \u0111\u01b0\u1eddng m\u1eadt<\/span><\/b><\/h3>\n

– Ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt<\/a> v\u00f9ng r\u1ed1n gan.<\/span><\/p>\n

– Ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt v\u00f9ng ngo\u00e0i r\u1ed1n gan khi kh\u00f4ng c\u00f2n c\u00f2n kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt.<\/span><\/p>\n

– H\u1eb9p \u0111\u01b0\u1eddng m\u1eadt l\u00e0nh t\u00ednh<\/span><\/p>\n

– R\u00f2 m\u1eadt<\/a> ru\u1ed9t<\/span><\/p>\n

– S\u1ecfi l\u1edbn \u1ed1ng m\u1eadt ch\u1ee7 ch\u01b0a th\u1ec3 l\u1ea5y ngay \u0111\u01b0\u1ee3c<\/span><\/p>\n

– S\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7 nh\u01b0ng ng\u01b0\u1eddi b\u1ec7nh trong t\u00ecnh tr\u1ea1ng n\u1eb7ng kh\u00f4ng cho ph\u00e9p l\u1ea5y s\u1ecfi<\/span><\/p>\n

– Nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng m\u1eadt c\u1ea7n d\u1eabn l\u01b0u<\/span><\/p>\n

1.2. \u0110\u1eb7t stent \u0111\u01b0\u1eddng t\u1ee5y<\/span><\/b><\/h3>\n

– D\u1eabn l\u01b0u d\u1ecbch t\u1ee5y d\u1ef1 ph\u00f2ng vi\u00eam t\u1ee5y c\u1ea5p sau ch\u1ee5p m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng, sau c\u1eaft u<\/span><\/p>\n

b\u00f3ng Vater qua n\u1ed9i soi t\u00e1 tr\u00e0ng.<\/span><\/p>\n

– Vi\u00eam t\u1ee5y m\u1ea1n c\u00f3 t\u1eafc ngh\u1ebdn c\u1ea7n d\u1eabn l\u01b0u \u1ed1ng t\u1ee5y<\/span><\/p>\n

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

– Ng\u01b0\u1eddi b\u1ec7nh m\u1edbi b\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim<\/span><\/p>\n

– B\u1ec7nh l\u00fd tim ph\u1ed5i n\u1eb7ng<\/span><\/p>\n

– D\u1ecb \u1ee9ng v\u1edbi thu\u1ed1c c\u1ea3n quang<\/span><\/p>\n

– R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u1eb7ng<\/span><\/p>\n

– Gi\u1ea3m ti\u1ec3u c\u1ea7u<\/span><\/p>\n

– \u0110ang d\u00f9ng thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u<\/span><\/p>\n

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

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

01 b\u00e1c s\u1ef9 chuy\u00ean l\u00e0m NSMTND, 01 k\u1ef9 thu\u1eadt vi\u00ean g\u00e2y m\u00ea, 03 \u0111i\u1ec1u d\u01b0\u1ee1ng trong \u0111\u00f3 c\u00f3 \u0111i\u1ec1u d\u01b0\u1ee1ng ph\u1ea3i s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c m\u00e1y C- Arm.<\/span><\/p>\n

3.2. Ph\u01b0\u01a1ng ti\u1ec7n, thu\u1ed1c, trang thi\u1ebft b\u1ecb v\u00e0 v\u1eadt t\u01b0 ti\u00eau hao<\/span><\/b><\/h3>\n

3.2.1. Ph\u01b0\u01a1ng ti\u1ec7n<\/span><\/i><\/b><\/p>\n

– Ph\u00f2ng n\u1ed9i soi cho ph\u00e9p chi\u1ebfu tia Xquang, c\u00f3 h\u1ec7 th\u1ed1ng oxy.<\/span><\/p>\n

– M\u00e1y t\u0103ng s\u00e1ng xquang (C.Arm).<\/span><\/p>\n

– H\u1ec7 th\u1ed1ng m\u00e1y n\u1ed9i soi t\u00e1 tr\u00e0ng (m\u00e1y n\u1ed9i soi c\u1eeda s\u1ed5 b\u00ean) v\u1edbi k\u00eanh l\u00e0m th\u1ee7 thu\u1eadt c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 4,2mm, canun.<\/span><\/p>\n

– Ngu\u1ed3n c\u1eaft \u0111\u1ed1t.<\/span><\/p>\n

– M\u00e1y theo d\u00f5i lifescope v\u00e0 d\u1ee5ng c\u1ee5 c\u1ea5p c\u1ee9u: m\u1eb7t n\u1ea1, bong b\u00f3p, n\u1ed9i kh\u00ed qu\u1ea3n<\/span><\/p>\n

– \u00c1o ch\u00ec 5 b\u1ed9<\/span><\/p>\n

3.2.2. Thu\u1ed1c<\/span><\/i><\/b><\/p>\n

– Thu\u1ed1c m\u00ea v\u00e0 ti\u1ec1n m\u00ea: midazolam 5mg t\u1eeb 1- 4 \u1ed1ng, fantanyl 0,1 mg t\u1eeb 1-3 \u1ed1ng, propofol 20 ml 1- 4 \u1ed1ng.<\/span><\/p>\n

– Thu\u1ed1c c\u1ea3n quang 50ml (telebrix, xenetix) 1-2 l\u1ecd.<\/span><\/p>\n

3.2.3. Trang thi\u1ebft b\u1ecb v\u00e0 v\u1eadt t\u01b0<\/span><\/i><\/b><\/p>\n

– 01catheter, 02 d\u00e2y d\u1eabn (guidewire), 01 dao c\u1eaft c\u01a1 v\u00f2ng Oddi.<\/span><\/p>\n

– \u1ed0ng \u0111\u1ea9y stent<\/span><\/p>\n

– Stent \u0111\u01b0\u1eddng m\u1eadt: 02 stent kim lo\u1ea1i ho\u1eb7c 02 stent nh\u1ef1a lo\u1ea1i 7- 10 F, 10-12 cm<\/span><\/p>\n

– Stent \u0111\u01b0\u1eddng t\u1ee5y: 01stent nh\u1ef1a 5F- 3 cm<\/span><\/p>\n

– G\u0103ng tay 10 \u0111\u00f4i<\/span><\/p>\n

– \u00c1o m\u1ed5 02<\/span><\/p>\n

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

– Nh\u1ecbn \u0103n tr\u01b0\u1edbc khi l\u00e0m th\u1ee7 thu\u1eadt 8 gi\u1edd<\/span><\/p>\n

– \u0110\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch<\/span><\/p>\n

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

Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c l\u00e0m h\u1ed3 s\u01a1 v\u00e0o vi\u1ec7n \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa, \u0111\u00e3 \u0111\u01b0\u1ee3c l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m c\u01a1 b\u1ea3n, nh\u01b0: ch\u1ee9c n\u0103ng gan, th\u1eadn, nh\u00f3m m\u00e1u, \u0111\u00f4ng m\u00e1u c\u01a1 b\u1ea3n, ch\u1ee9c n\u0103ng t\u1ee5y, c\u00e1c marker virut, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3<\/span><\/p>\n

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

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

\u0110\u1ec3 \u0111\u1ea3m b\u1ea3o c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh ti\u1ec1n m\u00ea ho\u1eb7c g\u00e2y m\u00ea, \u0111\u1ea3m b\u1ea3o c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh th\u1ee7 thu\u1eadt g\u00e2y ch\u1ea3y m\u00e1u.<\/span><\/p>\n

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

\u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng s\u1ed1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n tr\u01b0\u1edbc khi l\u00e0m th\u1ee7 thu\u1eadt, \u0111\u00e3 tu\u00e2n th\u1ee7 nh\u1ecbn \u0103n tr\u01b0\u1edbc \u0111\u00f3.<\/span><\/p>\n

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

Sau khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ti\u1ec1n m\u00ea ho\u1eb7c g\u00e2y m\u00ea, s\u1ebd ti\u1ebfn h\u00e0nh th\u1ee7 thu\u1eadt:<\/span><\/p>\n

4.3.1. \u0110\u01b0a m\u00e1y xu\u1ed1ng t\u00e1 tr\u00e0ng<\/span><\/i><\/b><\/p>\n

– M\u00e1y n\u1ed9i soi qua th\u1ef1c qu\u1ea3n “b\u00e1n m\u00f9”, do \u0111\u00f3 kh\u00f4ng quan s\u00e1t \u0111\u01b0\u1ee3c to\u00e0n b\u1ed9 th\u1ef1c qu\u1ea3n.<\/span><\/p>\n

– M\u00e1y n\u1ed9i soi v\u00e0o d\u1ea1 d\u00e0y: \u0110\u01b0a \u0111\u1ea7u d\u00e2y n\u1ed9i soi qua th\u00e2n v\u1ecb v\u00e0 hang v\u1ecb \u0111\u1ec3 \u0111\u1ebfn l\u1ed7 m\u00f4n v\u1ecb r\u1ed3i v\u00e0o h\u00e0nh t\u00e1 tr\u00e0ng.<\/span><\/p>\n

– M\u00e1y qua g\u1ed1i tr\u00ean t\u00e1 tr\u00e0ng v\u00e0o \u0111o\u1ea1n II t\u00e1 tr\u00e0ng: Quay \u0111\u1ea7u m\u00e1y soi l\u00ean tr\u00ean \u1edf v\u1ecb tr\u00ed trung gian v\u00e0 \u0111\u1ea9y m\u00e1y v\u00e0o \u0111o\u1ea1n II t\u00e1 tr\u00e0ng. Quay m\u00e1y 90<\/span>0\u00a0<\/span>sang b\u00ean ph\u1ea3i v\u1edbi \u0111\u1ea7u m\u00e1y quay sang ph\u1ea3i v\u00e0 l\u00ean tr\u00ean s\u1ebd nh\u00ecn th\u1ea5y ph\u1ea7n gi\u1eefa c\u1ee7a \u0111o\u1ea1n II t\u00e1 tr\u00e0ng v\u00e0 papilla. R\u00fat m\u00e1y ra \u0111\u1ec3 m\u00e1y \u0111i d\u1ecdc theo g\u00f3c b\u1edd cong nh\u1ecf v\u00e0 n\u1eb1m trong d\u1ea1 d\u00e0y \u0111o\u1ea1n ng\u1eafn nh\u1ea5t kho\u1ea3ng 60-70 cm c\u00e1ch cung r\u0103ng tr\u00ean. Th\u01b0\u1eddng \u0111\u1ec3 \u1ed1ng soi \u1edf v\u1ecb tr\u00ed ng\u1eafn nh\u1ea5t cho ph\u00e9p quan s\u00e1t tr\u1ef1c di\u1ec7n v\u1edbi papilla \u0111\u1ec3 lu\u1ed3n catheter v\u00e0o papilla \u0111\u01b0\u1ee3c thu\u1eadn l\u1ee3i.<\/span><\/p>\n

4.3.2. T\u00ecm Papilla<\/span><\/i><\/b><\/p>\n

Cho ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m h\u01a1i s\u1ea5p s\u1ebd nh\u00ecn th\u1ea5y tr\u1ef1c di\u1ec7n papilla n\u1eb1m \u1edf \u0111o\u1ea1n DII<\/span>I\u00a0<\/span>t\u00e1 tr\u00e0ng c\u00f3 h\u00ecnh d\u00e1ng v\u00e0 k\u00edch th\u01b0\u1edbc kh\u00e1c nhau. Papilla c\u00f3 m\u1ea7u h\u1ed3ng s\u1eabm h\u01a1n m\u00e0u h\u1ed3ng c\u1ee7a ni\u00eam m\u1ea1c t\u00e1 tr\u00e0ng, ph\u00eda tr\u00ean c\u00f3 n\u1ebfp ni\u00eam m\u1ea1c to tr\u00f9m l\u00ean tr\u00ean papilla g\u1ecdi l\u00e0 m\u0169 papilla, ph\u00eda d\u01b0\u1edbi c\u00f3 nh\u1eefng n\u1ebfp ni\u00eam m\u1ea1c ch\u1ea1y d\u1ecdc h\u1ed9i t\u1ee5 v\u00e0o papilla, \u1edf \u0111\u1ec9nh Papilla c\u00f3 l\u1ed7 ti\u1ebft m\u1eadt, c\u00f3 k\u00edch th\u01b0\u1edbc to nh\u1ecf kh\u00e1c nhau, qua l\u1ed7 n\u00e0y c\u00f3 th\u1ec3 th\u1ea5y d\u1ecbch m\u1eadt ch\u1ea3y v\u00e0o t\u00e1 tr\u00e0ng.<\/span><\/p>\n

4.3.3. Lu\u1ed3n Catheter v\u00e0o papilla \u0111\u1ec3 b\u01a1m thu\u1ed1c c\u1ea3n quang<\/span><\/i><\/b><\/p>\n

Vi\u1ec7c th\u00e0nh c\u00f4ng c\u1ee7a th\u1ee7 thu\u1eadt n\u00e0y t\u00f9y theo kinh nghi\u1ec7m c\u1ee7a ng\u01b0\u1eddi l\u00e0m th\u1ee7 thu\u1eadt, t\u00f9y theo h\u00ecnh d\u1ea1ng v\u00e0 t\u1ed5n th\u01b0\u01a1ng \u1edf papilla. \u0110\u1ec3 \u0111\u1ea7u catheter \u0111\u1ed1i di\u1ec7n v\u1edbi papilla, \u0111\u1ea9y t\u1eeb t\u1eeb v\u00e0o v\u00e0 h\u01b0\u1edbng l\u00ean v\u1ecb tr\u00ed 11gi\u1edd theo h\u01b0\u1edbng c\u1ee7a \u0111\u01b0\u1eddng m\u1eadt ch\u00ednh, \u0111\u1ec3 v\u00e0o \u0111\u01b0\u1eddng t\u1ee5y, h\u01b0\u1edbng catheter v\u00e0o v\u1ecb tr\u00ed 1gi\u1edd theo h\u01b0\u1edbng c\u1ee7a \u1ed1ng tu\u1ef5. \u0110\u01b0a s\u00e2u catheter v\u00e0o 3 – 5 cm \u0111\u1ec3 ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt. T\u1ed1t nh\u1ea5t l\u00e0 \u0111\u1ea7u catheter n\u1eb1m s\u00e2u v\u00e0o \u0111\u01b0\u1eddng m\u1eadt \u1edf ng\u00e3 3 \u0111\u01b0\u1eddng m\u1eadt (\u0111i qua ch\u1ed7 \u0111\u1ed5 c\u1ee7a t\u00fai m\u1eadt v\u00e0o \u1ed1ng m\u1eadt ch\u1ee7). Khi b\u01a1m thu\u1ed1c, thu\u1ed1c s\u1ebd t\u1ecfa \u0111\u1ec1u v\u00e0o \u0111\u01b0\u1eddng m\u1eadt.<\/span><\/p>\n

4.3.4. B\u01a1m thu\u1ed1c ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt ho\u1eb7c ch\u1ee5p \u0111\u01b0\u1eddng t\u1ee5y<\/span><\/i><\/b><\/p>\n

– N\u1ed3ng \u0111\u1ed9 thu\u1ed1c c\u1ea3n quang: thu\u1ed1c c\u1ea3n quang \u0111\u01b0\u1ee3c pha lo\u00e3ng v\u1edbi n\u01b0\u1edbc c\u1ea5t v\u1edbi t\u1ec9 l\u1ec7 50%.<\/span><\/p>\n

– S\u1ed1 l\u01b0\u1ee3ng thu\u1ed1c c\u1ea3n quang: t\u1eeb 30ml – 100ml, tu theo m\u1ee9c \u0111\u1ed9 gi\u00e3n \u0111\u01b0\u1eddng m\u1eadt. Khi ch\u1ee5p \u0111\u01b0\u1eddng tu\u1ef5 kh\u00f4ng n\u00ean b\u01a1m nhi\u1ec1u thu\u1ed1c c\u1ea3n quang, v\u00ec n\u1ebfu b\u01a1m nhi\u1ec1u s\u1ebd l\u00e0m t\u0103ng \u00e1p l\u1ef1c \u0111\u01b0\u1eddng tu\u1ef5 g\u00e2y bi\u1ebfn ch\u1ee9ng vi\u00eam tu\u1ef5.<\/span><\/p>\n

– Ch\u1ee5p \u0111\u01b0\u1eddng t\u1ee5y b\u1eb1ng 5-10 ml thu\u1ed1c c\u1ea3n quang.<\/span><\/p>\n

4.3.5. \u0110\u1eb7t stent \u0111\u01b0\u1eddng m\u1eadt trong tr\u01b0\u1eddng h\u1ee3p h\u1eb9p t\u1ea1i r\u1ed1n gan<\/span><\/i><\/b><\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u1ea7n \u0111\u1eb7t 2 stent v\u00e0o 2 nh\u00e1nh gan ph\u1ea3i v\u00e0 tr\u00e1i.<\/span><\/p>\n

– \u0110\u01b0a guidewire v\u00e0o qua catheter sau khi ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt l\u00ean nh\u00e1nh gan ph\u1ea3i sau \u0111\u00f3 r\u00fat catheter ra, \u0111\u01b0a dao c\u1eaft v\u00e0o theo d\u00e2y d\u1eabn. Ti\u1ebfn h\u00e0nh c\u1eaft c\u01a1 v\u00f2ng Oddi. \u0110\u1ec3 d\u00e2y d\u1eabn l\u1ea1i trong \u0111\u01b0\u1eddng m\u1eadt gan ph\u1ea3i, r\u00fat dao c\u1eaft ra.<\/span><\/p>\n

– \u0110\u01b0a catheter l\u00ean gan tr\u00e1i ho\u1eb7c s\u1eed d\u1ee5ng ch\u00ednh dao c\u1eaft \u0111\u01b0a l\u00ean gan tr\u00e1i, r\u1ed3i \u0111\u01b0a d\u00e2y d\u1eabn v\u00e0o qua catheter ho\u1eb7c dao c\u1eaft l\u00ean gan tr\u00e1i.<\/span><\/p>\n

– Sau khi ti\u1ebfn h\u00e0nh \u0111\u1eb7t \u0111\u01b0\u1ee3c hai d\u00e2y d\u1eabn v\u00e0o hai \u0111\u01b0\u1eddng trong gan tr\u00e1i v\u00e0 gan ph\u1ea3i, ti\u1ebfn h\u00e0nh l\u1ea7n l\u01b0\u1ee3t \u0111\u1eb7t stent gan ph\u1ea3i v\u00e0 gan tr\u00e1i.<\/span><\/p>\n

– \u0110\u1eb7t stent ch\u1ee7 y\u1ebfu d\u00f9ng ph\u1ed1i h\u1ee3p d\u00f9ng \u1ed1ng \u0111\u1ea9y stent v\u00e0 n\u1eaby elevator.<\/span><\/p>\n

4.3.6. \u0110\u1eb7t stent \u0111\u01b0\u1eddng m\u1eadt trong tr\u01b0\u1eddng h\u1ee3p h\u1eb9p t\u1ea1i \u1ed1ng m\u1eadt ch\u1ee7<\/span><\/i><\/b><\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u1ea7n \u0111\u1eb7t 1 stent v\u00e0o nh\u00e1nh gan ph\u1ea3i.<\/span><\/p>\n

– \u0110\u01b0a d\u00e2y d\u1eabn v\u00e0o qua catheter sau khi ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt, l\u00ean nh\u00e1nh gan sau \u0111\u00f3 r\u00fat catheter ra, \u0111\u01b0a dao c\u1eaft v\u00e0o theo d\u00e2y d\u1eabn. C\u00f3 th\u1ec3 ngay t\u1eeb \u0111\u1ea7u kh\u00f4ng d\u00f9ng catheter m\u00e0 thay v\u00f2a \u0111\u00f3 l\u00e0 d\u00f9ng dao \u0111\u1ec3 \u0111\u01b0a v\u00e0o ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt. Ti\u1ebfn h\u00e0nh c\u1eaft c\u01a1 c\u01a1 v\u00f2ng Oddi.<\/span><\/p>\n

– Ti\u1ebfn h\u00e0nh \u0111\u1eb7t stent gan ph\u1ea3i gi\u1ed1ng nh\u01b0 tr\u00ean<\/span><\/p>\n

4.3.7. \u0110\u1eb7t stents \u0111\u01b0\u1eddng m\u1eadt trong tr\u01b0\u1eddng h\u1ee3p s\u1ecfi l\u1edbn \u1ed1ng m\u1eadt ch\u1ee7<\/span><\/i><\/b><\/p>\n

Tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u00f3 th\u1ec3 \u0111\u1eb7t 2 ho\u1eb7c nhi\u1ec1u stent, k\u1ef9 thu\u1eadt gi\u1ed1ng \u0111\u1eb7t stent nh\u01b0 tr\u00ean nh\u01b0ng \u0111\u1ea7u trong c\u1ee7a stent ch\u1ec9 c\u1ea7n n\u1eb1m \u1edf \u1ed1ng gan chung l\u00e0 \u0111\u1ee7.<\/span><\/p>\n

4.3.8. \u0110\u1eb7t stent \u0111\u01b0\u1eddng t\u1ee5y<\/span><\/i><\/b><\/p>\n

– Sau khi dao c\u1eaft v\u00e0o \u0111\u01b0\u1eddng t\u1ee5y th\u01b0\u1eddng t\u1ea1i v\u1ecb tr\u00ed 1gi\u1edd, \u0111\u01b0a d\u00e2y d\u1eabn v\u00e0o trong \u1ed1ng t\u1ee5y. Ti\u1ebfn h\u00e0nh c\u1eaft papilla. R\u00fat dao c\u1eaft c\u00f2n gi\u1eefa l\u1ea1i d\u00e2y d\u1eabn.<\/span><\/p>\n

– Ti\u1ebfn h\u00e0nh \u0111\u1eb7t stent \u1ed1ng t\u1ee5y nh\u01b0 \u0111\u1ed1i v\u1edbi stent \u0111\u01b0\u1eddng m\u1eadt.<\/span><\/p>\n

5. Theo d\u00f5i<\/span><\/b><\/h2>\n

–\u00a0<\/span>Theo d\u00f5i nh\u1eefng bi\u1ebfn ch\u1ee9ng c\u1ee7a g\u00e2y m\u00ea nh\u01b0 suy h\u00f4 h\u1ea5p, t\u1ee5t huy\u1ebft \u00e1p<\/span><\/p>\n

– Theo d\u00f5i ph\u00e1t hi\u1ec7n vi\u00eam t\u1ee5y c\u1ea5p: \u0111au b\u1ee5ng, t\u00ecnh tr\u1ea1ng \u1ed5 b\u1ee5ng, x\u00e9t nghi\u1ec7m amylase v\u00e0 lipase sau th\u1ee7 thu\u1eadt.<\/span><\/p>\n

– Theo d\u00f5i th\u1ee7ng t\u00e1 tr\u00e0ng: t\u00ecnh tr\u1ea1ng b\u1ee5ng, ch\u1ee5p c\u1eaft l\u1edbp n\u1ebfu th\u1ea5y nghi ng\u1edd th\u1ee7ng ra kgoang sau ph\u00fac m\u1ea1c.<\/span><\/p>\n

6. Tai bi\u1ebfn v\u00e0 x\u1eed tr\u00ed<\/span><\/b><\/h2>\n

–\u00a0<\/b><\/span>H\u00e0ng \u0111\u1ea7u l\u00e0 vi\u00eam t\u1ee5y c\u1ea5p v\u1edbi t\u1ec9 l\u1ec7 kho\u1ea3ng 5%. Nh\u1ecbn \u0103n nu\u00f4i d\u01b0\u1ee1ng t\u0129nh m\u1ea1ch d\u00f9ng kh\u00e1ng sinh n\u1ebfu c\u00f3 bi\u1ec3u hi\u1ec7n nhi\u1ec5m tr\u00f9ng ho\u1eb7c tr\u01b0\u1edbc \u0111\u00f3 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng m\u1eadt.<\/span><\/p>\n

– Th\u1ee7ng t\u00e1 tr\u00e0ng do c\u1eaft c\u01a1 Oddi, hay g\u1eb7p \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u00fai th\u1eeba t\u00e1 tr\u00e0ng, papilla n\u1eb1m c\u1ea1nh ho\u1eb7c trong t\u00fai th\u1eeba. \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt.<\/span><\/p>\n

– Vi\u00eam \u0111\u01b0\u1eddng m\u1eadt, hay x\u1ea3y ra trong tr\u01b0\u1eddng h\u1ee3p t\u1eafc m\u1eadt do ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt m\u00e0 sau n\u1ed9i soi ch\u1ee5p m\u1eadt m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng m\u00e0 kh\u00f4ng \u0111\u1eb7t \u0111\u01b0\u1ee3c stent. D\u00f9ng kh\u00e1ng sinh v\u00e0 d\u1eabn l\u01b0u m\u1eadt qua da trong tr\u01b0\u1eddng h\u1ee3p th\u1ea5t b\u1ea1i d\u1eabn l\u01b0u m\u1eadt qua papilla.<\/span><\/p>\n

– Ch\u1ea3y m\u00e1u do c\u1eaft c\u01a1 Oddi. N\u1ed9i soi c\u1ea7m m\u00e1u<\/span><\/p>\n

– Bi\u1ebfn ch\u1ee9ng li\u00ean quan t\u1edbi g\u00e2y m\u00ea: t\u1ee5t huy\u1ebft \u00e1p, suy h\u00f4 h\u1ea5p, bu\u1ed3n n\u00f4n ho\u1eb7c n\u00f4n. Ti\u1ebfn h\u00e0nh truy\u1ec1n d\u1ecbch, th\u1edf oxy.<\/span><\/p>\n

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

N\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP) can thi\u1ec7p-\u0111\u1eb7t stent \u0111\u01b0\u1eddng m\u1eadt-t\u1ee5y l\u00e0 k\u1ef9 thu\u1eadt \u0111\u01b0a stent b\u1eb1ng kim lo\u1ea1i ho\u1eb7c b\u1eb1ng nh\u1ef1a qua n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng v\u00e0o \u0111\u01b0\u1eddng m\u1eadt ho\u1eb7c v\u00e0o \u0111\u01b0\u1eddng t\u1ee5y ch\u00ednh qua m\u00e1y n\u1ed9i soi t\u00e1 tr\u00e0ng v\u1edbi m\u1ee5c \u0111\u00edch d\u1eabn l\u01b0u m\u1eadt xu\u1ed1ng t\u00e1 tr\u00e0ng ho\u1eb7c d\u1eabn […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[],"yoast_head":"\nQuy tr\u00ecnh ERCP can thi\u1ec7p-\u0111\u1eb7t stent \u0111\u01b0\u1eddng m\u1eadt-t\u1ee5y - Vinmec<\/title>\n<meta name=\"description\" content=\"N\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP) can thi\u1ec7p-\u0111\u1eb7t stent \u0111\u01b0\u1eddng m\u1eadt-t\u1ee5y l\u00e0 k\u1ef9 thu\u1eadt \u0111\u01b0a stent b\u1eb1ng kim lo\u1ea1i ho\u1eb7c b\u1eb1ng nh\u1ef1a qua n\u1ed9i soi ...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Quy tr\u00ecnh ERCP can thi\u1ec7p-\u0111\u1eb7t stent \u0111\u01b0\u1eddng m\u1eadt-t\u1ee5y - 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