{"id":31415,"date":"2023-05-04T16:23:00","date_gmt":"2023-05-04T09:23:00","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31415"},"modified":"2023-05-04T16:23:00","modified_gmt":"2023-05-04T09:23:00","slug":"ung-dung-ercp-trong-lay-soi-giun-duong-mat","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/ung-dung-ercp-trong-lay-soi-giun-duong-mat\/","title":{"rendered":"\u1ee8ng d\u1ee5ng ERCP trong l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt"},"content":{"rendered":"

N\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP) can thi\u1ec7p – l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt l\u00e0 ti\u1ebfn h\u00e0nh n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng c\u00f3 c\u1eaft c\u01a1 v\u00f2ng Oddi v\u1edbi m\u1ee5c \u0111\u00edch \u0111\u1ec3 l\u1ea5y s\u1ecfi ho\u1eb7c giun \u1ed1ng m\u1eadt ch\u1ee7. ERCP l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt can thi\u1ec7p an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3. Tuy nhi\u00ean, nh\u01b0 v\u1edbi b\u1ea5t k\u1ef3 th\u1ee7 thu\u1eadt n\u00e0o, n\u00f3 c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 xu\u1ea5t huy\u1ebft, nhi\u1ec5m tr\u00f9ng v\u00e0 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng m\u1eadt t\u1ee5y. Do \u0111\u00f3, tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n ERCP, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n v\u00e0 ki\u1ec3m tra k\u1ef9 l\u01b0\u1ee1ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o r\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0y l\u00e0 ph\u00f9 h\u1ee3p v\u00e0 an to\u00e0n cho h\u1ecd.<\/span><\/strong><\/p>\n

\"\"<\/p>\n

1. Ch\u1ec9 \u0111\u1ecbnh ERCP trong l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt<\/h2>\n

– L\u1ea5y s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7<\/a><\/span><\/p>\n

– L\u1ea5y giun trong \u1ed1ng m\u1eadt ch\u1ee7<\/span><\/p>\n

2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh <\/span><\/b>ERCP trong l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt<\/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

1 b\u00e1c s\u1ef9 chuy\u00ean l\u00e0m NSMTND, 1 k\u1ef9 thu\u1eadt vi\u00ean g\u00e2y m\u00ea, 3 \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, v\u1eadt t\u01b0 y t\u1ebf<\/span><\/b><\/h3>\n

3.2.1. Ph\u01b0\u01a1ng ti\u1ec7n<\/span><\/i><\/b><\/h4>\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

– B\u1ed9 nghi\u1ec1n s\u1ecfi<\/span><\/p>\n

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

– Thu\u1ed1c v\u00e0 trang thi\u1ebft b\u1ecb v\u1eadt t\u01b0 ti\u00eau hao<\/span><\/p>\n

3.2.2. Thu\u1ed1c<\/span><\/i><\/b><\/h4>\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. V\u1eadt t\u01b0<\/span><\/i><\/b><\/h4>\n

+ 01catheter, 02 guidewire, 01 dao c\u1eaft c\u01a1 v\u00f2ng Oddi, 01 b\u00f3ng l\u1ea5y s\u1ecfi, 01 r\u1ecd l\u1ea5y s\u1ecfi, 01 r\u1ecd t\u00e1n s\u1ecfi.<\/span><\/p>\n

+ Stent \u0111\u01b0\u1eddng m\u1eadt: 02 stent nh\u1ef1a<\/span><\/p>\n

+ Stent \u0111\u01b0\u1eddng t\u1ee5y: 01<\/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 ERCP l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt<\/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><\/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

4.3.1. \u0110\u01b0a m\u00e1y xu\u1ed1ng t\u00e1 tr\u00e0ng<\/span><\/i><\/b><\/h4>\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. \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 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

4.3.5. C\u1eaft c\u01a1 v\u00f2ng Oddi \u0111\u01b0\u1eddng m\u1eadt<\/span><\/i><\/b><\/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 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.<\/span><\/p>\n

– C\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh c\u1eaft c\u01a1 v\u00f2ng Oddi t\u1ed1i \u0111a t\u1edbi m\u0169 c\u1ee7a papilla<\/span><\/p>\n

4.3.6. Nong c\u01a1 v\u00f2ng Oddi<\/span><\/i><\/b><\/p>\n

Trong tr\u01b0\u1eddng h\u1ee3p s\u1ecfi nh\u1ecf ho\u1eb7c giun trong \u1ed1ng m\u1eadt ch\u1ee7 c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n c\u1eaft c\u01a1 v\u00f2ng Oddi m\u00e0 ch\u1ec9 c\u1ea7n ti\u1ebfn h\u00e0nh d\u00f9ng b\u00f3ng nong c\u01a1 v\u00f2ng Oddi \u0111\u1ec3 l\u1ea5y s\u1ecfi ho\u1eb7c giun (k\u1ef9 thu\u1eadt n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng can thi\u1ec7p nong \u0111\u01b0\u1eddng m\u1eadt b\u1eb1ng b\u00f3ng).<\/span><\/p>\n

4.3.7. L\u1ea5y s\u1ecfi v\u00e0 giun \u1ed1ng m\u1eadt ch\u1ee7<\/span><\/i><\/b><\/p>\n

T\u00f9y theo k\u00edch th\u01b0\u1edbc c\u1ee7a s\u1ecfi m\u00e0 ti\u1ebfn h\u00e0nh l\u1ea5y b\u1eb1ng c\u00e1c d\u1ee5ng c\u1ee5 kh\u00e1c nhau.<\/span><\/p>\n

– \u0110\u1ed1i v\u1edbi s\u1ecfi k\u00edch th\u01b0\u1edbc d\u01b0\u1edbi 8 mm c\u00f3 th\u1ec3 l\u1ea5y s\u1ecfi b\u1eb1ng r\u1ecd th\u01b0\u1eddng kh\u00f4ng c\u1ea7n t\u00e1n s\u1ecfi.<\/span><\/p>\n

– S\u1ecfi m\u1eadt t\u1eeb 8 \u0111\u1ebfn d\u01b0\u1edbi 10 mm c\u00f3 th\u1ebf l\u1ea5y b\u1eb1ng r\u1ecd th\u01b0\u1eddng n\u1ebfu c\u01a1 v\u00f2ng Oddi \u0111\u01b0\u1ee3c c\u1eaft t\u1ed1i \u0111a. Trong tr\u01b0\u1eddng h\u1ee3p n\u1ebfu c\u01a1 v\u00f2ng Oddi kh\u00f4ng \u0111\u01b0\u1ee3c c\u1eaft t\u1ed1i \u0111a, c\u1ea7n d\u00f9ng b\u1ed9 t\u1eddi \u0111\u1ec3 t\u00e1n s\u1ecfi, sau \u0111\u00f3 l\u1ea5y s\u1ecfi \u0111\u00e3 t\u00e1n b\u1eb1ng r\u1ecd th\u01b0\u1eddng v\u00e0 cu\u1ed1i c\u00f9ng d\u00f9ng b\u00f3ng \u0111\u1ec3 l\u1ea5y ph\u1ea7n c\u1eb7n s\u1ecfi c\u00f2n l\u1ea1i.<\/span><\/p>\n

– S\u1ecfi m\u1eadt t\u1eeb 10 – 20 mm c\u1ea7n d\u00f9ng b\u1ed9 t\u1eddi \u0111\u1ec3 t\u00e1n s\u1ecfi, sau \u0111\u00f3 l\u1ea5y s\u1ecfi \u0111\u00e3 t\u00e1n b\u1eb1ng r\u1ecd th\u01b0\u1eddng v\u00e0 cu\u1ed1i c\u00f9ng d\u00f9ng b\u00f3ng \u0111\u1ec3 l\u1ea5y ph\u1ea7n c\u1eb7n s\u1ecfi c\u00f2n l\u1ea1i.<\/span><\/p>\n

– N\u1ebfu s\u1ecfi l\u1edbn \u1ed1ng m\u1eadt ch\u1ee7 m\u00e0 kh\u00f4ng l\u1ea5y \u0111\u01b0\u1ee3c ngay, th\u00ec \u0111\u1eb7t 2 stent v\u00e0o \u1ed1ng m\u1eadt ch\u1ee7 sau 3 th\u00e1ng \u0111\u1ec3 s\u1ecfi m\u1ec1m ra v\u00e0 nh\u1ecf l\u1ea1i khi \u0111\u00f3 c\u00f3 th\u1ec3 l\u1ea5y s\u1ecfi th\u00ec 2.<\/span><\/p>\n

– \u0110\u1ed1i v\u1edbi giun c\u00f3 th\u1ec3 c\u1eaft c\u01a1 oddi v\u00e0 d\u00f9ng r\u1ecd th\u01b0\u1eddng ho\u1eb7c b\u00f3ng \u0111\u1ec3 l\u1ea5y giun gi\u1ed1ng nh\u01b0 v\u01a1i l\u1ea5y s\u1ecfi nh\u1ecf d\u01b0\u1edbi 8 mm.<\/span><\/p>\n

– Trong tr\u01b0\u1eddng h\u1ee3p ti\u1ebfn h\u00e0nh th\u1ee7 thu\u1eadt l\u00e2u ho\u1eb7c c\u00f3 nguy c\u01a1 cao vi\u00eam t\u1ee5y sau l\u1ea5y s\u1ecfi c\u1ea7n \u0111\u1eb7t stent \u0111\u01b0\u1eddng t\u1ee5y d\u1ef1 ph\u00f2ng.<\/span><\/p>\n

5. Theo d\u00f5i sau <\/b>ERCP l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt<\/h2>\n

– 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.<\/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\u00eam 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 khoang sau ph\u00fac m\u1ea1c.<\/span><\/p>\n

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

– 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 v\u00f2ng 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

– Ch\u1ea3y m\u00e1u do c\u1eaft c\u01a1 v\u00f2ng 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 – l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt l\u00e0 ti\u1ebfn h\u00e0nh n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng c\u00f3 c\u1eaft c\u01a1 v\u00f2ng Oddi v\u1edbi m\u1ee5c \u0111\u00edch \u0111\u1ec3 l\u1ea5y s\u1ecfi ho\u1eb7c giun \u1ed1ng m\u1eadt ch\u1ee7. ERCP l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt can thi\u1ec7p an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3. Tuy nhi\u00ean, nh\u01b0 […]<\/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":"\n\u1ee8ng d\u1ee5ng ERCP trong l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt - Vinmec<\/title>\n<meta name=\"description\" content=\"N\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP) can thi\u1ec7p - l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt l\u00e0 ti\u1ebfn h\u00e0nh n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng c\u00f3 c\u1eaft c\u01a1 v\u00f2ng Oddi ...\" \/>\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=\"\u1ee8ng d\u1ee5ng ERCP trong l\u1ea5y s\u1ecfi, giun \u0111\u01b0\u1eddng m\u1eadt - Vinmec\" \/>\n<meta property=\"og:description\" content=\"N\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP) can thi\u1ec7p - 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