{"id":31458,"date":"2023-05-04T16:24:31","date_gmt":"2023-05-04T09:24:31","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31458"},"modified":"2023-05-04T16:24:31","modified_gmt":"2023-05-04T09:24:31","slug":"noi-soi-can-thiep-tiem-histoacryl-bui-gian-tinh-mach-phinh-vi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/noi-soi-can-thiep-tiem-histoacryl-bui-gian-tinh-mach-phinh-vi\/","title":{"rendered":"N\u1ed9i soi can thi\u1ec7p-ti\u00eam Histoacryl b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb"},"content":{"rendered":"

N\u1ed9i soi can thi\u1ec7p-ti\u00eam Histoacryl b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ti\u00ean ti\u1ebfn trong vi\u1ec7c ch\u1eefa tr\u1ecb c\u00e1c b\u1ec7nh v\u1ec1 gi\u00e3n t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb, gi\u00fap gi\u1ea3m thi\u1ec3u nguy c\u01a1 nhi\u1ec5m tr\u00f9ng v\u00e0 ti\u1ebft ki\u1ec7m th\u1eddi gian cho b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, c\u1ea7n \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng c\u00e1c h\u1ea1n ch\u1ebf v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng.<\/strong><\/p>\n

\"\"<\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng<\/span><\/b><\/h2>\n

N- butyl-2-cyanoacrylate (histoacryl) l\u00e0 m\u1ed9t h\u1ee3p ch\u1ea5t polyme. Qu\u00e1 tr\u00ecnh polyme h\u00f3a di\u1ec5n ra khi ch\u1ea5t n\u00e0y ti\u1ebfp x\u00fac v\u1edbi n\u01b0\u1edbc t\u1ea1o th\u00e0nh ch\u1ea5t \u0111\u00f4ng c\u1ee9ng v\u00e0 b\u00e1m ch\u1eafc v\u00e0o b\u1ea5t c\u1ee9 b\u1ec1 m\u1eb7t n\u00e0o m\u00e0 n\u00f3 ti\u1ebfp x\u00fac. Ch\u00ednh v\u00ec v\u1eady ti\u00eam histoacryl v\u00e0o trong l\u00f2ng c\u1ee7a t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb khi ti\u1ebfp xuc v\u1edbi m\u00e1u trong l\u00f2ng m\u1ea1ch qu\u00e1 tr\u00ecnh polyme s\u1ebd di\u1ec5n ra v\u00e0 t\u1ea1o th\u00e0nh ch\u1ea5t \u0111\u00f4ng c\u1ee9ng t\u1ea1i b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb sau \u0111\u00f3 qu\u00e1 tr\u00ecnh huy\u1ebft kh\u1ed1i s\u1ebd di\u1ec5n ra v\u00e0 l\u00e0m r\u1ee5ng b\u00fai gi\u00e3n v\u00e0o trong l\u00f2ng d\u1ea1 d\u00e0y.<\/span><\/p>\n

V\u00e0o n\u0103m 1986 l\u1ea7n \u0111\u1ea7u ti\u00ean t\u00e1c gi\u1ea3 Soehendra v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 s\u1eed d\u1ee5ng histoacryl \u0111\u1ec3 ti\u00eam c\u1ea7m m\u00e1u c\u1ea5p c\u1ee9u v\u1edd t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb \u1edf ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan v\u00e0 d\u1ef1 ph\u00f2ng xu\u1ea5t huy\u1ebft t\u00e1i ph\u00e1t do v\u1ee1 t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb.<\/span><\/p>\n

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

– Ti\u00eam x\u01a1 v\u00e0o t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb c\u1ea5p c\u1ee9u khi c\u00f3 v\u1ee1 t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb do t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda.<\/a><\/span><\/p>\n

– Ti\u00eam x\u01a1 t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb \u0111\u1ec3 ph\u00f2ng ch\u1ea3y m\u00e1u.<\/span><\/p>\n

3. 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: Vi\u1ec7c s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra nguy c\u01a1 nhi\u1ec5m tr\u00f9ng v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c, do \u0111\u00f3 kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng cho 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: N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd tim ph\u1ed5i n\u1eb7ng, vi\u1ec7c ti\u00eam ch\u1ea5t k\u1ebft d\u00ednh c\u00f3 th\u1ec3 g\u00e2y ra nguy c\u01a1 suy tim ho\u1eb7c suy h\u00f4 h\u1ea5p.<\/span><\/p>\n

– R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u1eb7ng: N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u1eb7ng, vi\u1ec7c s\u1eed d\u1ee5ng N\u1ed9i soi can thi\u1ec7p-ti\u00eam Histoacryl b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb c\u00f3 th\u1ec3 g\u00e2y ra nguy c\u01a1 nhi\u1ec5m tr\u00f9ng ho\u1eb7c c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111\u00f4ng m\u00e1u.<\/span><\/p>\n

– Gi\u1ea3m ti\u1ec3u c\u1ea7u n\u1eb7ng: Vi\u1ec7c s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m ti\u1ec3u c\u1ea7u, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang b\u1ecb gi\u1ea3m ti\u1ec3u c\u1ea7u n\u1eb7ng.<\/span><\/p>\n

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

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

1 b\u00e1c s\u1ef9 chuy\u00ean n\u1ed9i soi ti\u00eau h\u00f3a, 1 k\u1ef9 thu\u1eadt vi\u00ean g\u00e2y m\u00ea, 2 \u0111i\u1ec1u d\u01b0\u1ee1ng.<\/span><\/p>\n

4.2. Ph\u01b0\u01a1ng ti\u1ec7n, thu\u1ed1c v\u1eadt t\u01b0 y t\u1ebf<\/span><\/b><\/h3>\n

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

–\u00a0<\/b><\/span>Ph\u00f2ng n\u1ed9i soi c\u00f3 h\u1ec7 th\u1ed1ng oxy.<\/span><\/p>\n

– H\u1ec7 th\u1ed1ng m\u00e1y n\u1ed9i soi d\u1ea1 d\u00e0y c\u1eeda s\u1ed5 th\u1eb3ng, canun.<\/span><\/p>\n

– M\u00e1y theo d\u00f5i lifescope v\u00e0 d\u1ee5ng c\u1ee5 c\u1ea5p c\u1ee9u: m\u1eb7t n\u1ea1, b\u00f3ng b\u00f3p, n\u1ed9i kh\u00ed qu\u1ea3n<\/span><\/p>\n

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

4.2.2. Thu\u1ed1c v\u00e0 trang thi\u1ebft b\u1ecb v\u1eadt t\u01b0 ti\u00eau hao<\/span><\/i><\/b><\/h4>\n

– Thu\u1ed1c:<\/span><\/p>\n

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

– V\u1eadt t\u01b0:<\/span><\/p>\n

+ Kim ti\u00eam c\u1ea7m m\u00e1u 21 G<\/span><\/p>\n

+ Butyl-2-cyanoacrylate 0,5 ml<\/span><\/p>\n

+ Lipiodol 10 ml<\/span><\/p>\n

+ N\u01b0\u1edbc c\u1ea5t 5 ml<\/span><\/p>\n

+ B\u01a1m ti\u00eam 2ml: 5 b\u01a1m.<\/span><\/p>\n

+ G\u0103ng tay 6 \u0111\u00f4i.<\/span><\/p>\n

+ \u00c1o m\u1ed5 02.<\/span><\/p>\n

4.3. 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

4.4. 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

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

5.1. Ki\u1ec3m tra h\u1ed3 s\u01a1: <\/span><\/b><\/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

5.2. 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

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

– D\u00f9ng m\u1ed9t b\u01a1m ti\u00eam v\u00f4 tr\u00f9ng ho\u00e0n to\u00e0n kh\u00f4 h\u00fat 0,5 ml histoacryl v\u00e0 0,8ml lipiodol sau \u0111\u00f3 l\u1eafc \u0111\u1ec1u.<\/span><\/p>\n

– Tr\u00e1ng kim ti\u00eam b\u1eb1ng lipiodol: b\u1eb1ng c\u00e1ch l\u1ea5y 2 ml lipiodol b\u01a1m v\u00e0o kim ti\u00eam.<\/span><\/p>\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

+ \u0110\u01b0a m\u00e1y n\u1ed9i soi d\u1ea1 d\u00e0y c\u1eeda s\u1ed5 th\u1eb3ng v\u00e0o d\u1ea1 d\u00e0y, qua k\u00eanh sinh thi\u1ebft \u0111\u01b0a kim ti\u00eam c\u1ea7m m\u00e1u.<\/span><\/p>\n

+ Ch\u1ecdn v\u1ecb tr\u00ed b\u1ec1 m\u1eb7t b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch \u0111\u1ec3 ti\u00eam.<\/span><\/p>\n

+ Ti\u1ebfn h\u00e0nh b\u01a1m histoacryl pha v\u1edbi lipiodol v\u00e0o b\u00fai gi\u00e3n, sau \u0111\u00f3 b\u01a1m ti\u00eam 2 ml n\u01b0\u1edbc c\u1ea5t v\u00e0o kim ti\u00eam \u0111\u1ec3 m\u1ee5c \u0111\u00edch \u0111\u1ea9y h\u1ebft ph\u1ea7n thu\u1ed1c c\u00f2n l\u1ea1i trong l\u00f2ng kim v\u00e0o trong b\u00fai gi\u00e3n. \u0110\u1ec3 tr\u00e1nh \u0111\u00f4ng thu\u1ed1c trong \u0111\u1ea7u kim, c\u1ea7n ti\u1ebfn h\u00e0nh b\u01a1m thu\u1ed1c trong th\u1eddi gian 20 gi\u00e2y.<\/span><\/p>\n

+ \u0110\u1ec3 tr\u00e1nh ch\u1ea3y m\u00e1u t\u1eeb b\u00fai gi\u00e3n sau ti\u00eam, gi\u1eef nguy\u00ean kim trong b\u00fai gi\u00e3n kho\u1ea3ng 20 gi\u00e2y sau \u0111\u00f3 r\u00fat kim ra.<\/span><\/p>\n

+ C\u1ea7n l\u01b0u \u00fd sau khi ti\u00eam histoacryl tr\u00e1nh h\u00fat \u0111\u1ec3 d\u00e2y n\u1ed9i soi kh\u00f4ng b\u1ecb t\u1eafc b\u1edfi histoacryl trong tr\u01b0\u1eddng h\u1ee3p b\u1ecb ch\u1ea3y histoacryl v\u00e0o trong l\u00f2ng d\u1ea1 d\u00e0y.<\/span><\/p>\n

6. 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 ch\u1ea3y m\u00e1u t\u1ea1i b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch ngay sau ti\u00eam: n\u1ebfu c\u00f3 ch\u1ea3y m\u00e1u s\u1ebd x\u1ea3y ra ngay sau khi r\u00fat kim ti\u00eam.<\/span><\/p>\n

– Nhi\u1ec5m khu\u1ea9n sau ti\u00eam.<\/span><\/p>\n

– T\u1eafc m\u1ea1ch xa v\u1ecb tr\u00ed ti\u00eam: t\u1eafc m\u1ea1ch ph\u1ed5i.<\/span><\/p>\n

– Ch\u1ea3y m\u00e1u mu\u1ed9n sau ti\u00eam, th\u01b0\u1eddng x\u1ea3y ra kho\u1ea3ng 4- 6 tu\u1ea7n sau khi ti\u00eam, th\u01b0\u1eddng do lo\u00e9t t\u1ea1i v\u1ecb tr\u00ed ti\u00eam, do to\u00e0n b\u1ed9 histoacryl b\u1ecb \u0111\u1ea9y ra ngo\u00e0i t\u1ea1o \u1ed5 lo\u00e9t.<\/span><\/p>\n

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

– N\u1ebfu nhi\u1ec5m khu\u1ea9n d\u00f9ng kh\u00e1ng sinh.<\/span><\/p>\n

– Ph\u00f2ng ch\u1ea3y m\u00e1u mu\u1ed9n sau ti\u00eam b\u1eb1ng d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf b\u00e0i ti\u1ebft b\u01a1m proton \u0111\u1ec3 gi\u1ea3m b\u00e0i ti\u1ebft ax\u00edt trong 6 tu\u1ea7n sau ti\u00eam.<\/span><\/p>\n

– Ph\u00f2ng t\u1eafc m\u1ea1ch xa b\u1eb1ng c\u00e1ch kh\u00f4ng ti\u00eam qu\u00e1 nhanh histoacryl.<\/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

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

1. B\u1ed9 Y t\u1ebf, Quy tr\u00ecnh k\u1ef9 thu\u1eadt b\u1ec7nh vi\u1ec7n.<\/span><\/p>\n

2. Sivak M. V. Gastroenterologic Endoscopy 1987.<\/span><\/p>\n

3. Kenneth F. Binmoeller, Nib Shoehendra.Gastroenterologic endoscopy. 2004.<\/span><\/p>\n

4. Ginberg G.G. Clinical Gastrointestinal Endoscopy 2005.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

N\u1ed9i soi can thi\u1ec7p-ti\u00eam Histoacryl b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ti\u00ean ti\u1ebfn trong vi\u1ec7c ch\u1eefa tr\u1ecb c\u00e1c b\u1ec7nh v\u1ec1 gi\u00e3n t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb, gi\u00fap gi\u1ea3m thi\u1ec3u nguy c\u01a1 nhi\u1ec5m tr\u00f9ng v\u00e0 ti\u1ebft ki\u1ec7m th\u1eddi gian cho b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, c\u1ea7n \u0111\u00e1nh gi\u00e1 k\u1ef9 […]<\/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":"\nN\u1ed9i soi can thi\u1ec7p-ti\u00eam Histoacryl b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb<\/title>\n<meta name=\"description\" content=\"N\u1ed9i soi can thi\u1ec7p-ti\u00eam Histoacryl b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch ph\u00ecnh v\u1ecb l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ti\u00ean ti\u1ebfn trong vi\u1ec7c ch\u1eefa tr\u1ecb b\u1ec7nh ...\" \/>\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=\"N\u1ed9i soi can 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