{"id":31453,"date":"2023-05-04T16:25:46","date_gmt":"2023-05-04T09:25:46","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31453"},"modified":"2023-05-04T16:25:46","modified_gmt":"2023-05-04T09:25:46","slug":"cap-nhap-phuong-phap-cat-polyp-ong-tieu-hoa-qua-noi-soi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/cap-nhap-phuong-phap-cat-polyp-ong-tieu-hoa-qua-noi-soi\/","title":{"rendered":"C\u1eadp nh\u1eadp ph\u01b0\u01a1ng ph\u00e1p c\u1eaft polyp \u1ed1ng ti\u00eau h\u00f3a qua n\u1ed9i soi"},"content":{"rendered":"

C\u1eaft polyp qua n\u1ed9i soi l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, th\u01b0\u1eddng l\u00e0 c\u1eaft poyp \u1edf tr\u1ef1c tr\u00e0ng, \u0111\u1ea1i tr\u00e0ng. Polyp d\u1ea1 d\u00e0y h\u00e0nh t\u00e1 tr\u00e0ng \u00edt g\u1eb7p h\u01a1n. K\u1ef9 thu\u1eadt c\u1eaft polyp c\u00f2n c\u00f3 \u00fd ngh\u0129a ng\u0103n ng\u1eeba bi\u1ebfn ch\u1ee9ng ung th\u01b0 h\u00f3a c\u1ee7a c\u00e1c polyps n\u00e0y.<\/span><\/strong><\/p>\n

\"\"<\/p>\n

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

N\u1ed9i soi \u1ed1ng ti\u00eau h\u00f3a ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng polyp <1cm.<\/span><\/p>\n

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

– R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u c\u1ea7m m\u00e1u.<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh \u0111ang d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng.<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh n\u1ed9i soi d\u1ea1 d\u00e0y<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh soi \u0111\u1ea1i tr\u00e0ng\u00a0<\/a><\/span><\/p>\n

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

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

– 01 B\u00e1c s\u0129 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o v\u1ec1 n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea5p ch\u1ee9ng ch\u1ec9 n\u1ed9i soi<\/span><\/p>\n

– 02 \u0111i\u1ec1u d\u01b0\u1ee1ng<\/span><\/p>\n

3.2. Ph\u01b0\u01a1ng ti\u1ec7n<\/span><\/b><\/h3>\n

– 01 m\u00e1y n\u1ed9i soi d\u1ea1 d\u00e0y, \u0111\u1ea1i tr\u00e0ng \u1ed1ng m\u1ec1m c\u00f3 k\u00eanh ho\u1ea1t \u0111\u1ed9ng l\u1edbn ho\u1eb7c c\u00f3 2 k\u00eanh ho\u1ea1t \u0111\u1ed9ng<\/span><\/p>\n

– Th\u00f2ng l\u1ecdng c\u1eaft polyp b\u1eb1ng nhi\u1ec7t \u0111i\u1ec7n v\u1edbi k\u00edch th\u01b0\u1edbc kh\u00e1c nhau v\u00e0 c\u00e1c lo\u1ea1i d\u00e2y kh\u00e1c nhau.<\/span><\/p>\n

– Tay n\u1eafm \u0111i\u1ec1u khi\u1ec3n<\/span><\/p>\n

– C\u00e1c k\u00ecm nhi\u1ec7t<\/span><\/p>\n

– Kim g\u1eafp polyp ra ngo\u00e0i<\/span><\/p>\n

– L\u01b0\u1edbi \u0111\u1ef1ng polyp<\/span><\/p>\n

– D\u1ee5ng c\u1ee5 c\u1ea7m m\u00e1u: cllip, \u0111\u1ea7u d\u00f2 nhi\u1ec7t, m\u00e1y APC<\/span><\/p>\n

– Catheter \u0111\u1ec3 b\u01a1m ch\u1ea5t nhu\u1ed9m m\u00e1u khi c\u1ea7n<\/span><\/p>\n

– Ngu\u1ed3n c\u1eaft \u0111i\u1ec7n: s\u1eed d\u1ee5ng d\u00f2ng \u0111i\u1ec7n xoay chi\u1ec1u v\u1edbi t\u1ea7n s\u1ed1 cao tr\u00ean 106 chu k\u1ef3\/gi\u00e2y. V\u1edbi t\u1ea7n s\u1ed1 n\u00e0y kh\u00f4ng g\u00e2y ra \u0111i\u1ec7n gi\u1eadt, kh\u00f4ng k\u00edch th\u00edch s\u1ee3i th\u1ea7n kinh c\u01a1 n\u00ean kh\u00f4ng g\u00e2y rung th\u1ea5t. Ngu\u1ed3n c\u1eaft c\u00f3 nhi\u1ec1u c\u00f4ng su\u1ea5t kh\u00e1c nhau. \u0110\u1ec3 c\u1eaft polyp th\u01b0\u1eddng d\u00f9ng c\u00f4ng su\u1ea5t 175w.<\/span><\/p>\n

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

Ph\u1ea3i l\u00e0m s\u1ea1ch v\u00f9ng polyp c\u1ea7n c\u1eaft.<\/span><\/p>\n

N\u1ebfu l\u00e0 polyp \u1edf th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0\u0111i\u1ec1u d\u01b0\u1ee1ng tr\u00e0ng: Ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i nh\u1ecbn \u0103n tr\u01b0\u1edbc \u0111\u00f3 \u00edt nh\u1ea5t 6 gi\u1edd.<\/span><\/p>\n

N\u1ebfu l\u00e0 polyp \u1edf \u0111\u1ea1i tr\u00e0ng: chu\u1ea9n b\u1ecb gi\u1ed1ng soi \u0111\u1ea1i tr\u00e0ng.<\/span><\/p>\n

N\u1ebfu l\u00e0 polyp \u1edf tr\u1ef1c tr\u00e0ng: ph\u1ea3i th\u1ee5t th\u00e1o s\u1ea1ch ph\u00e2n.<\/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><\/h3>\n

Ki\u1ec3m tra x\u00e9t nghi\u1ec7m Nh\u00f3m m\u00e1u<\/span><\/p>\n

C\u00f4ng th\u1ee9c m\u00e1u Ti\u1ec3u c\u1ea7u >50G\/l<\/span><\/p>\n

\u0110\u00f4ng m\u00e1u c\u01a1 b\u1ea3n PT>60%<\/span><\/p>\n

X\u00e9t nghi\u1ec7m HIV, HbsAg, Anti HCV<\/span><\/p>\n

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

Ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 \u0111\u01b0\u1ee3c l\u00e0m s\u1ea1ch v\u00f9ng polyp c\u1ea7n c\u1eaft<\/span><\/p>\n

\u0110\u00e3 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch \u0111\u1ea7y \u0111\u1ee7 v\u1ec1 qu\u00e1 tr\u00ecnh l\u00e0m k\u1ef9 thu\u1eadt v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra<\/span><\/p>\n

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

4.3.1. Lo\u1ea1i polyp c\u00f3 cu\u1ed1ng<\/span><\/i><\/b><\/h4>\n

– \u0110\u01b0a th\u00f2ng l\u1ecdng \u0111\u1ebfn v\u1ecb tr\u00ed polyp, m\u1edf th\u00f2ng l\u1ecdng \u00f4m l\u1ea5y \u0111\u1ea7u polyp r\u1ed3i t\u1ee5t xu\u1ed1ng \u00f4m l\u1ea5y cu\u1ed1ng polyp. \u0110\u1ea9y v\u1ecf ngo\u00e0i c\u1ee7a th\u00f2ng l\u1ecdng s\u00e1t v\u1edbi cu\u1ed1ng c\u1ee7a polyp.<\/span><\/p>\n

– Th\u1eaft t\u1eeb t\u1eeb th\u00f2ng l\u1ecdng cho \u0111\u1ebfn khi c\u00f3 c\u1ea3m gi\u00e1c ch\u1eb7t tay r\u1ed3i k\u00e9o nh\u1eb9 \u0111\u1ea7u polyp l\u00ean.<\/span><\/p>\n

– Ki\u1ec3m tra xem ni\u00eam m\u1ea1c th\u00e0nh \u1ed1ng ti\u00eau h\u00f3a c\u00f3 chui v\u00e0o trong th\u00f2ng l\u1ecdng hay kh\u00f4ng. N\u1ebfu c\u00f3 ni\u00eam m\u1ea1c n\u1eb1m trong th\u00f2ng l\u1ecdng ph\u1ea3i \u0111\u1ec3 th\u00f2ng l\u1ecdng ra kh\u1ecfi v\u1ecf catheter r\u1ed3i m\u1edf th\u00f2ng l\u1ecdng ra v\u00e0 nh\u1ea5c th\u00f2ng l\u1ecdng ra kh\u1ecfi \u0111\u1ea7u polyp. Th\u1eaft l\u1ea1i polyp.<\/span><\/p>\n

– C\u0169ng c\u00f3 th\u1ec3 \u0111\u1ea9y v\u1ecf catheter c\u1ee7a th\u00f2ng l\u1ecdng v\u01b0\u1ee3t l\u00ean v\u1ecb tr\u00ed c\u1ee7a \u0111\u1ea7u polyp r\u1ed3i m\u1edf th\u00f2ng l\u1ecdng ra tr\u00f9m v\u00e0o \u0111\u1ea7u polyp.<\/span><\/p>\n

– Ngu\u1ed3n c\u1eaft \u0111i\u1ec7n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong v\u00f2ng 2-3 gi\u00e2y, xen k\u1ebd gi\u1eefa pha c\u1ea7m m\u00e1u v\u00e0 pha c\u1eaft. Trong khi th\u00f2ng l\u1ecdng s\u1ebd t\u1eeb t\u1eeb th\u1eaft ch\u1eb7t l\u1ea1i cho \u0111\u1ebfn khi polyp b\u1ecb c\u1eaft r\u1eddi ho\u00e0n to\u00e0n.<\/span><\/p>\n

– L\u1ea5y polyp ra ngo\u00e0i \u0111\u1ec3 x\u00e9t nghi\u1ec7m m\u00f4 b\u1ec7nh h\u1ecdc.<\/span><\/p>\n

– D\u00f9ng th\u00f2ng l\u1ecdng k\u00e9o polyp ra ngo\u00e0i.<\/span><\/p>\n

– D\u00f9ng k\u00ecm k\u1eb9p g\u1eafp polyp r\u1ed3i k\u00e9o n\u00f3 ra ngo\u00e0i.<\/span><\/p>\n

– H\u00fat \u00e1p l\u1ef1c cao \u0111\u1ec3 polyp d\u00ednh ch\u1eb7t v\u00e0o \u0111\u1ea7u \u0111\u00e8n soi v\u00e0 k\u00e9o ra ngo\u00e0i c\u00f9ng m\u00e1y soi.<\/span><\/p>\n

– N\u1ebfu polyp c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf c\u00f3 th\u1ec3 h\u00fat polyp v\u00e0 h\u1ee9ng b\u1eb1ng l\u01b0\u1edbi m\u00e0 kh\u00f4ng c\u1ea7n ph\u1ea3i r\u00fat m\u00e1y soi.<\/span><\/p>\n

– Ph\u1ea3i ghi r\u00f5 v\u1ecb tr\u00ed c\u1ee7a polyp v\u00e0o gi\u1ea5y x\u00e9t nghi\u1ec7m m\u00f4 b\u1ec7nh h\u1ecdc.<\/span><\/p>\n

4.3.2. Lo\u1ea1i polyp kh\u00f4ng cu\u1ed1ng<\/span><\/i><\/b><\/h4>\n

– C\u1ea7n t\u1ea1o ra m\u1ed9t cu\u1ed1ng cho polyp: D\u00f9ng dung d\u1ecbch Adrenalin 1\/10.000 ti\u00eam d\u01b0\u1edbi ni\u00eam m\u1ea1c \u0111\u1ec3 \u0111\u1ea9y polyp l\u00ean, sau khi tr\u00f9m th\u00f2ng l\u1ecdng qua \u0111\u1ea7u polyp th\u00ec th\u1eaft t\u1eeb t\u1eeb th\u00f2ng l\u1ecdng \u0111\u1ec3 chu vi c\u1ee7a th\u00f2ng l\u1ecdng nh\u1ecf h\u01a1n \u0111\u1ea7u c\u1ee7a polyp- th\u00f2ng l\u1ecdng s\u1ebd kh\u00f4ng b\u1ecb t\u1ee5t ra kh\u1ecfi polyp. Sau \u0111\u00f3 k\u00e9o th\u00f2ng l\u1ecdng l\u00ean ph\u00eda \u0111\u1ea7u c\u1ee7a polyp sao cho l\u00e0m t\u00e1ch l\u1edbp ni\u00eam m\u1ea1c ra kh\u1ecfi l\u1edbp c\u01a1 ni\u00eam s\u1ebd l\u00e0m gi\u1ea3m nguy c\u01a1 th\u1ee7ng.<\/span><\/p>\n

Ho\u1eb7c ph\u1ea3i c\u1eaft polyp l\u00e0m nhi\u1ec1u m\u1ea3nh nh\u1ecf<\/span><\/p>\n

– Sau khi t\u1ea1o \u0111\u01b0\u1ee3c cu\u1ed1ng polyp r\u1ed3i, l\u1ea5y polyp nh\u01b0 ph\u1ea7n tr\u00ean.<\/span><\/p>\n

Polyp nh\u1ecf l\u00e0 nh\u1eefng polyp c\u00f3 \u0111\u01b0\u1eddng k\u00ednh <6mm, c\u00f3 th\u1ec3 c\u1eaft polyp b\u1eb1ng k\u00ecm sinh thi\u1ebft l\u1ea1nh. Ng\u00e0y nay h\u1ea1n ch\u1ebf d\u00f9ng k\u00ecm sinh thi\u1ebft n\u00f3ng do nguy c\u01a1 d\u1ec5 g\u00e2y th\u1ee7ng.<\/span><\/p>\n

D\u00f9ng k\u00ecm k\u1eb9p v\u00e0o polyp r\u1ed3i t\u1ea1o cu\u1ed1ng gi\u1ea3 cho polyp b\u1eb1ng c\u00e1ch nh\u1ea5c k\u00ecm k\u00e9o polyp l\u00ean cao ra xa ni\u00eam m\u1ea1c v\u00e0 \u0111\u1ed1t \u0111i\u1ec7n trong v\u00e0i gi\u00e2y cho \u0111\u1ebfn khi m\u00e0u c\u1ee7a \u0111\u1ec9nh polyp chuy\u1ec3n sang m\u00e0u tr\u1eafng \u0111\u1ee5c gi\u1ed1ng h\u00ecnh \u1ea3nh \u0111\u00e1m tuy\u1ebft ph\u1ee7 tr\u00ean \u0111\u1ec9nh n\u00fai sau \u0111\u00f3 d\u1ee9t m\u1ea1nh m\u1ea3nh polyp cho \u0111\u1ebfn khi n\u00f3 r\u1eddi ra.<\/span><\/p>\n

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

5.1. Theo d\u00f5i ngay sau c\u1eaft<\/span><\/b><\/h3>\n

Ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m n\u1ed9i tr\u00fa t\u1ea1i b\u1ec7nh vi\u1ec7n trong 24 gi\u1edd<\/span><\/p>\n

D\u1eb7n ng\u01b0\u1eddi b\u1ec7nh c\u00e1c tri\u1ec7u ch\u1ee9ng b\u00e1o \u0111\u1ed9ng: \u0111au b\u1ee5ng \u0111i ngo\u00e0i ra m\u00e1u<\/span><\/p>\n

5.2. Theo d\u00f5i l\u00e2u d\u00e0i<\/span><\/b>: <\/span><\/h3>\n

T\u00f9y theo m\u00f4 b\u1ec7nh h\u1ecdc m\u00e0 c\u00f3 k\u1ebf ho\u1ea1ch theo d\u00f5i th\u00edch h\u1ee3p \u0111\u1ec3 ki\u1ec3m tra.<\/span><\/p>\n

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

6.1. Ch\u1ea3y m\u00e1u<\/span><\/b>:<\/span><\/h3>\n

– Hay g\u1eb7p nh\u1ea5t<\/span><\/p>\n

– X\u1eed tr\u00ed:<\/span><\/p>\n

+ Truy\u1ec1n m\u00e1u v\u00e0 m\u00e1u t\u1ef1 c\u1ea7m.<\/span><\/p>\n

+ \u00c1p d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p c\u1ea7m m\u00e1u qua n\u1ed9i soi<\/span><\/p>\n

+ Ti\u00eam c\u1ea7m m\u00e1u, k\u1eb9p clip<\/span><\/p>\n

+ \u0110\u1ea7u d\u00f2 nhi\u1ec7t<\/span><\/p>\n

+ \u0110\u1ed1t \u0111i\u1ec7n hay m\u00e1y APC.<\/span><\/p>\n

6.2. Th\u1ee7ng<\/span><\/b><\/h3>\n

– \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n: khi \u0111\u1ea1i tr\u00e0ng chu\u1ea9n b\u1ecb s\u1ea1ch, kh\u00e1ng sinh, nu\u00f4i d\u01b0\u1ee1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, h\u00fat d\u1ea1 d\u00e0y li\u00ean t\u1ee5c.<\/span><\/p>\n

– Ph\u1eabu thu\u1eadt s\u1edbm<\/span><\/p>\n

6.3. H\u1ed9i ch\u1ee9ng sau c\u1eaft polyp<\/span><\/b><\/h3>\n

Kh\u00e1ng sinh, nu\u00f4i d\u01b0\u1ee1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 h\u00fat d\u1ea1 d\u00e0y li\u00ean t\u1ee5c.<\/span><\/p>\n

T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/span><\/b><\/p>\n

1<\/span><\/b>.\u00a0Jonathan Cohen. (2007)<\/b>. Colon . 121-164.\u00a0Advanced Digestive Endoscopy.<\/i><\/span><\/p>\n

2<\/span><\/b>.\u00a0Wilcox CM., Munoz-Navas Miguel ., Sung JJY.( 2008)<\/b>. Atlas of clinical gastrointestinal endoscopy.\u00a0Saunders Elsevier.<\/i><\/span><\/p>\n

3. Jerow D., Way MD., Dogulas KR et al ( 2009).\u00a0<\/span><\/b>Colonoscopy. Willey Blackwel<\/span><\/p>\n

4. DanL Longo, AS.Fauci (2010).\u00a0<\/span><\/b>Harrisons Gastroenterology and Hepatology.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

C\u1eaft polyp qua n\u1ed9i soi l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, th\u01b0\u1eddng l\u00e0 c\u1eaft poyp \u1edf tr\u1ef1c tr\u00e0ng, \u0111\u1ea1i tr\u00e0ng. Polyp d\u1ea1 d\u00e0y h\u00e0nh t\u00e1 tr\u00e0ng \u00edt g\u1eb7p h\u01a1n. K\u1ef9 thu\u1eadt c\u1eaft polyp c\u00f2n c\u00f3 \u00fd ngh\u0129a ng\u0103n ng\u1eeba bi\u1ebfn ch\u1ee9ng ung th\u01b0 h\u00f3a c\u1ee7a c\u00e1c polyps n\u00e0y. 1. Ch\u1ec9 \u0111\u1ecbnh N\u1ed9i soi \u1ed1ng ti\u00eau h\u00f3a […]<\/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":"\nC\u1eadp nh\u1eadp ph\u01b0\u01a1ng ph\u00e1p c\u1eaft polyp \u1ed1ng ti\u00eau h\u00f3a qua n\u1ed9i soi<\/title>\n<meta name=\"description\" content=\"C\u1eaft polyp qua n\u1ed9i soi l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, th\u01b0\u1eddng l\u00e0 c\u1eaft poyp \u1edf tr\u1ef1c tr\u00e0ng, \u0111\u1ea1i tr\u00e0ng. Polyp d\u1ea1 d\u00e0y h\u00e0nh t\u00e1 tr\u00e0ng \u00edt g\u1eb7p h\u01a1n. 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