{"id":31460,"date":"2023-05-04T16:24:52","date_gmt":"2023-05-04T09:24:52","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31460"},"modified":"2023-05-04T16:24:52","modified_gmt":"2023-05-04T09:24:52","slug":"quy-trinh-noi-soi-thuc-quan-da-day-ta-trang-dai-tan-hep","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/quy-trinh-noi-soi-thuc-quan-da-day-ta-trang-dai-tan-hep\/","title":{"rendered":"Quy tr\u00ecnh n\u1ed9i soi th\u1ef1c qu\u1ea3n d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng d\u1ea3i t\u1ea7n h\u1eb9p"},"content":{"rendered":"

N\u1ed9i soi th\u1ef1c qu\u1ea3n d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng d\u1ea3i t\u1ea7n h\u1eb9p l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. K\u1ef9 thu\u1eadt n\u00e0y gi\u00fap gi\u1ea3m thi\u1ec3u r\u1ee7i ro v\u00e0 t\u0103ng hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb, gi\u00fap b\u00e1c s\u0129 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c v\u1ecb tr\u00ed v\u00e0 m\u1ee9c \u0111\u1ed9 b\u1ec7nh l\u00fd, t\u1eeb \u0111\u00f3 gi\u00fap t\u0103ng hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh. Ngo\u00e0i ra, n\u00f3 c\u00f2n gi\u1ea3m thi\u1ec3u r\u1ee7i ro trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch gi\u00fap tr\u00e1nh nh\u1ea7m l\u1eabn v\u1edbi c\u00e1c b\u1ec7nh kh\u00e1c ho\u1eb7c vi\u1ec7c ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra.<\/strong><\/p>\n

\"\"<\/p>\n

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

N\u1ed9i soi th\u1ef1c qu\u1ea3n d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng d\u1ea3i t\u1ea7n h\u1eb9p NBI<\/a> (Narrow Banding Imaging) l\u00e0 m\u1ed9t trong nh\u1eefng k\u1ef9 thu\u1eadt g\u1ea7n \u0111\u00e2y s\u1eed d\u1ee5ng b\u1ed9 l\u1ecdc R\/G\/B filter, s\u1eed d\u1ee5ng lo\u1ea1i \u00e1nh s\u00e1ng \u0111\u01a1n s\u1eafc, trong \u0111\u00f3 nguy\u00ean l\u00fd l\u00e0 s\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng k\u00ednh l\u1ecdc v\u00e0 b\u1ed9 ph\u00e2n t\u00edch x\u1eed tr\u00ed \u00e1nh s\u00e1ng v\u1edbi hai b\u01b0\u1edbc s\u00f3ng 415nm (415 \u00b1 30nm) v\u00e0 540nm (540 \u00b1 30nm). Nh\u1edd k\u1ef9 thu\u1eadt n\u00e0y m\u00e0 cho h\u00ecnh \u1ea3nh c\u00f3 kh\u1ea3 n\u0103ng ph\u00e2n bi\u1ec7t r\u00f5 h\u01a1n v\u1ec1 m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m – \u0111\u1eb7c th\u00f9 c\u1ee5 th\u1ec3 gi\u1eefa t\u1ed5 ch\u1ee9c b\u00ecnh th\u01b0\u1eddng v\u00e0 t\u1ed5 ch\u1ee9c b\u1ec7nh l\u00fd, c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau \u1edf ni\u00eam m\u1ea1c v\u00e0 t\u0103ng \u0111\u1ed9 t\u01b0\u01a1ng ph\u1ea3n tr\u00ean b\u1ec1 m\u1eb7t bi\u1ec3u m\u00f4 c\u1ee7a m\u1ea1ng mao m\u1ea1ch d\u01b0\u1edbi ni\u00eam m\u1ea1c \u0111\u1ec3 \u0111\u01b0a ra h\u00ecnh \u1ea3nh ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c h\u01a1n trong ch\u1ea9n \u0111o\u00e1n b\u1ec7nh l\u00fd th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0y, t\u00e1 tr\u00e0ng<\/span><\/p>\n

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

N\u1ed9i soi v\u1edbi d\u1ea3i t\u1ea7n h\u1eb9p \u0111\u00e3 t\u1ea1o n\u00ean m\u1ed9t b\u01b0\u1edbc \u0111\u1ed9t ph\u00e1 \u0111\u1ed1i v\u1edbi s\u00e0ng l\u1ecdc v\u00e0 ch\u1ea9n \u0111o\u00e1n ung th\u01b0 \u1ed1ng ti\u00eau h\u00f3a<\/a> tr\u00ean th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0y, t\u00e1 tr\u00e0ng \u1edf giai \u0111o\u1ea1n s\u1edbm v\u00e0 giai \u0111o\u1ea1n r\u1ea5t s\u1edbm, c\u0169ng nh\u01b0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c<\/span><\/p>\n

Ch\u1ec9 \u0111\u1ecbnh cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd b\u1ec7nh l\u00fd th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0y, h\u00e0nh t\u00e1 tr\u00e0ng v\u00e0 t\u00e1 tr\u00e0ng.<\/span><\/p>\n

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

– Nghi ng\u1edd h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p<\/span><\/p>\n

– T\u0103ng huy\u1ebft \u00e1p ch\u01b0a ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c<\/span><\/p>\n

– Nghi ng\u1edd th\u1ee7ng t\u1ea1ng r\u1ed7ng<\/span><\/p>\n

– Nghi ng\u1edd ph\u00ecnh, t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh trong t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh suy tim n\u1eb7ng<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n kh\u00f4ng h\u1ee3p t\u00e1c<\/span><\/p>\n

– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i: t\u1ee5t huy\u1ebft \u00e1p HA t\u00e2m thu < 90mmHg.<\/span><\/p>\n

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

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

– B\u00e1c s\u1ef9: 01 b\u00e1c s\u1ef9 \u0111\u00e3 c\u00f3 ch\u1ee9ng ch\u1ec9 t\u1ed1t nghi\u1ec7p n\u1ed9i soi Ti\u00eau h\u00f3a<\/span><\/p>\n

– \u0110i\u1ec1u d\u01b0\u1ee1ng: 02<\/span><\/p>\n

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

– 01 M\u00e1y n\u1ed9i soi d\u1ea1 d\u00e0y \u0111\u1ed3ng b\u1ed9 c\u00f3 h\u1ec7 th\u1ed1ng NBI: v\u00ed d\u1ee5 h\u1ec7 th\u1ed1ng Olympus EVIS LUCERA SPECTRUM system<\/span><\/p>\n

– 01 K\u00ecm sinh thi\u1ebft.<\/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 m\u00ea v\u00e0 ti\u1ec1n m\u00ea: midazolam 5mg, 2 \u1ed1ng; fantanyl 0,1 mg, 2 \u1ed1ng; propofol, 2 \u1ed1ng .<\/span><\/p>\n

– 05 L\u1ecd \u0111\u1ef1ng b\u1ec7nh ph\u1ea9m<\/span><\/p>\n

– 05 Lam k\u00ednh<\/span><\/p>\n

– 02 b\u01a1m ti\u00eam 20 ml<\/span><\/p>\n

– 06 \u0111\u00f4i g\u0103ng tay<\/span><\/p>\n

– 02 \u00e1o m\u1ed5<\/span><\/p>\n

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

Chu\u1ea9n b\u1ecb ng\u01b0\u1eddi b\u1ec7nh<\/span><\/p>\n

– Gi\u1ea3i th\u00edch Ng\u01b0\u1eddi b\u1ec7nh: m\u1ee5c \u0111\u00edch, tai bi\u1ebfn th\u1ee7 thu\u1eadt.<\/span><\/p>\n

– C\u00e1c Ng\u01b0\u1eddi b\u1ec7nh nguy c\u01a1 cao: tu\u1ed5i > 60, nghi ng\u1edd c\u00f3 b\u1ec7nh l\u00fd tim – ph\u1ed5i m\u1ea1n t\u00ednh c\u1ea7n l\u00e0m th\u00eam x\u00e9t nghi\u1ec7m \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 v\u00e0 X quang tim ph\u1ed5i.<\/span><\/p>\n

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

– Ki\u1ec3m tra kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/span><\/p>\n

– Nh\u1eadn gi\u1ea5y ch\u1ec9 \u0111\u1ecbnh<\/span><\/p>\n

– Gi\u1ea3i th\u00edch Ng\u01b0\u1eddi b\u1ec7nh k\u00fd gi\u1ea5y \u0111\u1ed3ng \u00fd l\u00e0m th\u1ee7 thu\u1eadt<\/span><\/p>\n

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

– M\u1eddi Ng\u01b0\u1eddi b\u1ec7nh v\u00e0o ph\u00f2ng, h\u01b0\u1edbng d\u1eabn Ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m l\u00ean c\u00e1ng th\u1ee7 thu\u1eadt<\/span><\/p>\n

– M\u1eafc monitor theo d\u00f5i, theo ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129 soi<\/span><\/p>\n

– H\u01b0\u1edbng d\u1eabn Ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m t\u01b0 th\u1ebf nghi\u00eang tr\u00e1i, ch\u00e2n tr\u00ean co, ch\u00e2n d\u01b0\u1edbi du\u1ed7i.<\/span><\/p>\n

Cho ng\u01b0\u1eddi b\u1ec7nh ng\u1eadm canuyl.<\/span><\/p>\n

– \u0110i\u1ec1u d\u01b0\u1ee1ng gi\u1eef canuyl ph\u1ea3i theo d\u00f5i t\u00ecnh tr\u1ea1ng Ng\u01b0\u1eddi b\u1ec7nh, th\u00f4ng b\u00e1o b\u00e1c s\u0129 khi c\u00f3 b\u1ea5t th\u01b0\u1eddng, lu\u00f4n \u0111\u1ed9ng vi\u00ean v\u00e0 h\u01b0\u1edbng d\u1eabn Ng\u01b0\u1eddi b\u1ec7nh h\u1ee3p t\u00e1c \u0111\u1ec3 ti\u1ebfn h\u00e0nh th\u1ee7 thu\u1eadt thu\u1eadn l\u1ee3i.<\/span><\/p>\n

– Th\u00f4ng b\u00e1o cho Ng\u01b0\u1eddi b\u1ec7nh b\u1eaft \u0111\u1ea7u l\u00e0m th\u1ee7 thu\u1eadt, h\u01b0\u1edbng d\u1eabn Ng\u01b0\u1eddi b\u1ec7nh ph\u1ed1i h\u1ee3p trong qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt.<\/span><\/p>\n

– N\u1ed9i soi theo quy tr\u00ecnh chu\u1ea9n quan s\u00e1t th\u1ef1c qu\u1ea3n, ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y h\u00e0nh t\u00e1 tr\u00e0ng v\u00e0 t\u00e1 tr\u00e0ng, \u0111\u1ec3 ch\u1ebf \u0111\u1ed9 NBI quan s\u00e1t k\u1ef9 c\u00e1c t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd. Khi n\u1ed9i soi v\u1edbi ch\u1ebf \u0111\u1ed9 NBI c\u00f3 hai \u0111\u1eb7c \u0111i\u1ec3m c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c ki\u1ec3m tra v\u1edbi ni\u00eam m\u1ea1c c\u1ee7a d\u1ea1 d\u00e0y<\/span><\/p>\n

+ C\u1ea5u tr\u00fac h\u1ec7 vi m\u1ea1ch d\u01b0\u1edbi bi\u1ec3u m\u00f4 (MV: microvascular)<\/span><\/p>\n

B\u00ecnh th\u01b0\u1eddng h\u1ec7 th\u1ed1ng vi m\u1ea1ch d\u01b0\u1edbi bi\u1ec3u m\u00f4 c\u1ee7a ni\u00eam m\u1ea1c th\u00e2n d\u1ea1 d\u00e0y tr\u00f4ng gi\u1ed1ng t\u1ed5 ong, c\u00f9ng c\u00e1c r\u00e3nh h\u1ed9i t\u1ee5 (CV: collecting venules)<\/span><\/p>\n

<\/span><\/p>\n

H\u00ecnh 1. H\u00ecnh \u1ea3nh ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y b\u00ecnh th\u01b0\u1eddng<\/span><\/p>\n

+ C\u1ea5u tr\u00fac vi ni\u00eam m\u1ea1c b\u1ec1 m\u1eb7t (MS: microsurface)<\/span><\/p>\n

C\u1ea5u tr\u00fac vi ni\u00eam m\u1ea1c b\u1ec1 m\u1eb7t b\u00ecnh th\u01b0\u1eddng c\u1ee7a d\u1ea1 d\u00e0y l\u00e0 c\u00e1c h\u1ed1 nh\u1ecf h\u00ecnh tr\u00f2n ho\u1eb7c h\u00ecnh oval<\/span><\/p>\n

<\/span><\/p>\n

H\u00ecnh 2. C\u1ea5u tr\u00fac vi m\u1ea1ch b\u00ecnh th\u01b0\u1eddng c\u1ee7a hang v\u1ecb d\u1ea1 d\u00e0y d\u01b0\u1edbi \u00e1nh s\u00e1ng th\u01b0\u1eddng v\u00e0 NBI<\/span><\/p>\n

Ra y l\u1ec7nh ch\u1ee5p \u1ea3nh minh h\u1ecda t\u1ed5n th\u01b0\u01a1ng. Ra y l\u1ec7nh l\u00e0m x\u00e9t nghi\u1ec7m test H.pylori ho\u1eb7c sinh thi\u1ebft n\u1ebfu c\u1ea7n.<\/span><\/p>\n

– Theo d\u00f5i to\u00e0n tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh trong to\u00e0n b\u1ed9 qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt<\/span><\/p>\n

– Sau khi k\u1ebft th\u00fac th\u1ee7 thu\u1eadt, \u0111\u00e1nh v\u00e0 in k\u1ebft qu\u1ea3<\/span><\/p>\n

– Sau khi b\u00e1c s\u0129 k\u1ebft th\u00fac qu\u00e1 tr\u00ecnh n\u1ed9i soi, \u0111i\u1ec1u d\u01b0\u1ee1ng ph\u1ea3i gi\u00fap ng\u01b0\u1eddi b\u1ec7nh lau mi\u1ec7ng, \u0111\u1ee1 ng\u01b0\u1eddi b\u1ec7nh d\u1eady v\u00e0 \u0111\u01b0a ng\u01b0\u1eddi b\u1ec7nh ra kh\u1ecfi ph\u00f2ng n\u1ed9i soi t\u1edbi n\u01a1i ng\u1ed3i ch\u1edd<\/span><\/p>\n

– H\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh b\u1ed5 sung th\u00eam phi\u1ebfu x\u00e9t nghi\u1ec7m H.pylori, sinh thi\u1ebft n\u1ebfu c\u1ea7n.<\/span><\/p>\n

– \u0110i\u1ec1u d\u01b0\u1ee1ng r\u1eeda m\u00e1y theo quy tr\u00ecnh k\u1ef9 thu\u1eadt.<\/span><\/p>\n

– Tr\u1ea3 k\u1ebft qu\u1ea3 n\u1ed9i soi cho Ng\u01b0\u1eddi b\u1ec7nh.<\/span><\/p>\n

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

Theo d\u00f5i to\u00e0n tr\u1ea1ng Ng\u01b0\u1eddi b\u1ec7nh trong qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt.<\/span><\/p>\n

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

Ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed tr\u00ed c\u00e1c bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u khi l\u1ea5y b\u1ec7nh ph\u1ea9m, \u0111\u01b0a \u0111\u00e8n soi nh\u1ea7m v\u00e0o kh\u00ed qu\u1ea3n, m\u1ea1ch ch\u1eadm ho\u1eb7c ng\u1eebng tim do c\u01b0\u1eddng ph\u1ebf v\u1ecb, ghi v\u00e0o phi\u1ebfu tr\u1ea3 k\u1ebft qu\u1ea3 ho\u1eb7c cho BN nh\u1eadp vi\u1ec7n x\u1eed tr\u00ed ti\u1ebfp t\u00f9y thu\u1ed9c t\u1eebng bi\u1ebfn ch\u1ee9ng.<\/span><\/p>\n

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

1. H. Niwa. H. Tajiri, M. Nakajima, K Yasuda (2008).\u00a0<\/span><\/b>New Challenges in Gastrointestinal Endoscopy. Springer. pp163-200.<\/span><\/p>\n

2. Jonathan Cohen (2007).\u00a0<\/span><\/b>Comprehensive Atlas of High Resolution Endoscopy and Narrowband Imaging. Blackwell publishing. Pp 83-104.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

N\u1ed9i soi th\u1ef1c qu\u1ea3n d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng d\u1ea3i t\u1ea7n h\u1eb9p l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. 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