{"id":31462,"date":"2023-05-04T16:24:59","date_gmt":"2023-05-04T09:24:59","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31462"},"modified":"2023-05-04T16:24:59","modified_gmt":"2023-05-04T09:24:59","slug":"quy-trinh-noi-soi-dai-trang-dai-tan-hep","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/quy-trinh-noi-soi-dai-trang-dai-tan-hep\/","title":{"rendered":"Quy tr\u00ecnh n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng d\u1ea3i t\u1ea7n h\u1eb9p"},"content":{"rendered":"

N\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng d\u1ea3i t\u1ea7n h\u1eb9p (NBI<\/a>) 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 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng.<\/span><\/strong><\/p>\n

\"\"<\/p>\n

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

N\u1ed9i soi v\u1edbi d\u1ea3i t\u1ea7n h\u1eb9p (Narrow Banding Imaging – NBI) \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 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/a> \u1edf giai \u0111o\u1ea1n s\u1edbm v\u00e0 giai \u0111o\u1ea1n r\u1ea5t s\u1edbm v\u00e0 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 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/span><\/p>\n

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

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

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

3.1. 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

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

– 01 M\u00e1y n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng \u0111\u1ed3ng b\u1ed9 c\u00f3 h\u1ec7 th\u1ed1ng NBI<\/span><\/p>\n

– Chu\u1ea9n b\u1ecb d\u00e2y soi s\u1eb5n s\u00e0ng, \u0111\u1ea3m b\u1ea3o d\u00e2y soi \u0111\u01b0\u1ee3c ti\u1ec7t tr\u00f9ng s\u1ea1ch v\u00e0 kh\u00f4ng h\u1ecfng h\u00f3c.<\/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: 2 \u1ed1ng midazolam 5mg; 2 \u1ed1ng fantanyl \u00a00,1 mg; 2 \u1ed1ng propofol.<\/span><\/p>\n

– 01 K\u00ecm sinh thi\u1ebft<\/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 \u00c1o m\u1ed5<\/span><\/p>\n

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

Ng\u01b0\u1eddi b\u1ec7nh t\u1ed1i h\u00f4m tr\u01b0\u1edbc khi soi \u0103n ch\u00e1o. Ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng Fortran 3 g\u00f3i pha v\u1edbi 3 l\u00edt n\u01b0\u1edbc trong v\u00f2ng 2 ti\u1ebfng tr\u01b0\u1edbc khi n\u1ed9i soi 6gi\u1edd. Sau khi \u0111i v\u1ec7 sinh s\u1ea1ch s\u1ebd n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng. N\u1ebfu Ng\u01b0\u1eddi b\u1ec7nh t\u00e1o b\u00f3n, cho Ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng thu\u1ed1c nhu\u1eadn tr\u00e0ng Folax x 3 g\u00f3i\/ng\u00e0y trong 3 ng\u00e0y.<\/span><\/p>\n

H\u01b0\u1edbng d\u1eabn Ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng thu\u1ed1c l\u00e0m s\u1ea1ch \u0111\u1ea1i tr\u00e0ng ho\u1eb7c li\u00ean h\u1ec7 n\u01a1i th\u1ee5t th\u00e1o l\u00e0m s\u1ea1ch \u0111\u1ea1i tr\u00e0ng n\u1ebfu Ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c.<\/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

3.4. 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 b\u1ec7nh nh\u00e2n k\u00fd gi\u1ea5y \u0111\u1ed3ng \u00fd l\u00e0m th\u1ee7 thu\u1eadt<\/span><\/p>\n

4. 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 thay qu\u1ea7n.<\/span><\/p>\n

– 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 l\u00ean c\u00e1ng th\u1ee7 thu\u1eadt \u0111\u00fang t\u01b0 th\u1ebf<\/span><\/p>\n

– \u0110i\u1ec1u d\u01b0\u1ee1ng 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 ni\u00eam m\u1ea1c tr\u1ef1c tr\u00e0ng v\u00e0 to\u00e0n b\u1ed9 \u0111\u1ea1i tr\u00e0ng, \u0111\u1ec3 ch\u1ebf \u0111\u1ed9 NBI quan s\u00e1t k\u1ef9 c\u00e1c t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd. Ph\u00e2n bi\u1ec7t t\u1ed5n th\u01b0\u01a1ng \u1edf ch\u1ebf \u0111\u1ed9 NBI d\u1ef1a tr\u00ean thay \u0111\u1ed5i m\u1ea1ng l\u01b0\u1edbi mao m\u1ea1ch (CP: capillary pattern), t\u00f9y thu\u1ed9c v\u00e0o thay \u0111\u1ed5i c\u1ea5u m\u1ea1ng l\u01b0\u1edbi mao m\u1ea1ch, k\u00edch th\u01b0\u1edbc m\u1ea1ch m\u00e1u m\u00e0 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c c\u00e1c t\u1ed5n th\u01b0\u01a1ng. \u0110\u00e1nh gi\u00e1 theo ph\u00e2n lo\u1ea1i CP t\u00edp 1, CP t\u00edp 2, CP t\u00edp 3.<\/span><\/p>\n

– Ra y l\u1ec7nh ch\u1ee5p \u1ea3nh minh h\u1ecda t\u1ed5n th\u01b0\u01a1ng, y l\u1ec7nh l\u00e0m x\u00e9t nghi\u1ec7m 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.<\/span><\/p>\n

– H\u01b0\u1edbng d\u1eabn Ng\u01b0\u1eddi b\u1ec7nh b\u1ed5 sung th\u00eam phi\u1ebfu x\u00e9t nghi\u1ec7m, 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

5. 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

6. X\u1eed tr\u00ed tai bi\u1ebfn<\/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, m\u1ea1ch ch\u1eadm ho\u1eb7c ng\u1eebng tim trong khi l\u00e0m th\u1ee7 thu\u1eadt, ghi v\u00e0o phi\u1ebfu tr\u1ea3 k\u1ebft qu\u1ea3 ho\u1eb7c cho Ng\u01b0\u1eddi b\u1ec7nh nh\u1eadp vi\u1ec7n x\u1eed tr\u00ed ti\u1ebfp t\u00f9y thu\u1ed9c t\u1eebng bi\u1ebfn ch\u1ee9ng.<\/span><\/p>\n

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

H\u00ecnh 1.\u00a0 A l\u00e0 h\u00ecnh \u1ea3nh polyp tr\u1ef1c tr\u00e0ng \u0111\u01b0\u1eddng k\u00fdnh 20 mm v\u1edbi m\u00e1y n\u1ed9i soi\u00a0 th\u00f4ng th\u01b0\u1eddng. B s\u1eed d\u1ee5ng m\u00e1y n\u1ed9i soi c\u00f3 NBI c\u00e1c m\u1ea1ch m\u00e1u n\u1ed5i r\u00f5 v\u00e0 c\u00e1c\u00a0 m\u00e0u n\u00e2u t\u1ed1i \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ung th\u01b0 trong l\u1edbp ni\u00eam m\u1ea1c<\/span><\/p>\n

T\u00f3m l\u1ea1i, n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng v\u1edbi d\u1ea3i t\u1ea7n h\u1eb9p (Narrow Banding Imaging – NBI) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p h\u00ecnh \u1ea3nh y t\u1ebf \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ki\u1ec3m tra \u0111\u1ea1i tr\u00e0ng. N\u00f3 s\u1eed d\u1ee5ng \u00e1nh s\u00e1ng v\u1edbi d\u1ea3i t\u1ea7n h\u1eb9p \u0111\u1ec3 gi\u00fap nh\u00ecn r\u00f5 h\u01a1n c\u00e1c m\u00f4 b\u00ean trong \u0111\u1ea1i tr\u00e0ng v\u00e0 ph\u00e1t hi\u1ec7n c\u00e1c kh\u1ed1i u ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng. N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng v\u1edbi d\u1ea3i t\u1ea7n h\u1eb9p (NBI) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p h\u00ecnh \u1ea3nh ti\u00ean ti\u1ebfn v\u00e0 c\u00f3 nhi\u1ec1u \u01b0u \u0111i\u1ec3m gi\u00fap n\u00e2ng cao kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n s\u1edbm ung th\u01b0 \u0111\u1ea1i tr\u00e0ng v\u00e0 gi\u1ea3m thi\u1ec3u nh\u1eefng r\u1ee7i ro v\u00e0 tai bi\u1ebfn cho b\u1ec7nh nh\u00e2n.<\/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. Pp273-295<\/span><\/p>\n

2. Jonathan Cohen (2007).\u00a0<\/span><\/b>Comprehensive Atlas of High Resolution Endoscopy and Narrowband Imaging. Blackwell publishing. Pp 123-149.<\/span><\/p>\n

3. Fabian Emura, Yutaka Saito, Hiroaki Ikematsu(2008).\u00a0<\/span><\/b>Narrow-band imaging optical chromocolonoscopy: Advantages and limitations. World J Gastroenterol August 21;14(31): 4867-4872.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

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