{"id":31931,"date":"2023-05-05T06:39:43","date_gmt":"2023-05-04T23:39:43","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31931"},"modified":"2023-05-05T20:00:49","modified_gmt":"2023-05-05T13:00:49","slug":"bien-chung-nghiem-trong-cua-ky-thuat-nang-xoang-cua-so-ngoai","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/bien-chung-nghiem-trong-cua-ky-thuat-nang-xoang-cua-so-ngoai\/","title":{"rendered":"Bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng c\u1ee7a k\u1ef9 thu\u1eadt n\u00e2ng xoang c\u1eeda s\u1ed5 ngo\u00e0i."},"content":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y n\u00f3i v\u1ec1 ch\u1ee7 y\u1ebfu hai bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng c\u1ee7a k\u1ef9 thu\u1eadt n\u00e2ng xoang c\u1eeda s\u1ed1 ngo\u00e0i, \u0111\u00f3 l\u00e0 “Th\u1ee7ng m\u00e0ng xoang Schneiderian” v\u00e0 “V\u1ea5n \u0111\u1ec1 ch\u1ea3y m\u00e1u dai d\u1eb3ng sau ph\u1eabu thu\u1eadt”. M\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng sau ph\u1eabu thu\u1eadt ch\u1ee7 y\u1ebfu c\u1ee7a k\u1ef9 thu\u1eadt c\u1eeda s\u1ed5 ngo\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i \u00edt g\u1eb7p. Ch\u00fang g\u1ed3m c\u00f3 nhi\u1ec5m tr\u00f9ng v\u00f9ng gh\u00e9p, vi\u00eam xoang h\u00e0m sau ph\u1eabu thu\u1eadt, \u0111au, v\u00e0 h\u1edf v\u1ebft th\u01b0\u01a1ng c\u0169ng \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp. Nha s\u0129 n\u1eafm r\u00f5 c\u00e1c bi\u1ebfn ch\u1ee9ng \u0111\u1ec3 c\u00f3 k\u1ebf ho\u1ea1ch \u0111\u00e1nh gi\u00e1 v\u00e0 ti\u00ean l\u01b0\u1ee3ng hi\u1ec7u qu\u1ea3 tr\u00ean b\u1ec7nh nh\u00e2n. C\u00f9ng t\u00ecm hi\u1ec3u.<\/strong><\/p>\n

1. Bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng: Th\u1ee7ng m\u00e0ng xoang Schneiderian \u0111\u1ed1i v\u1edbi k\u1ef9 thu\u1eadt n\u00e2ng xoang c\u1eeda s\u1ed5 ngo\u00e0i<\/h2>\n

Th\u1ee7ng m\u00e0ng xoang l\u00e0 bi\u1ebfn ch\u1ee9ng trong ph\u1eabu thu\u1eadt th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a k\u1ef9 thu\u1eadt n\u00e2ng xoang h\u1edf, v\u1edbi t\u1ef7 l\u1ec7 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o n\u1eb1m trong kho\u1ea3ng t\u1eeb 10 \u0111\u1ebfn 56% (H\u00ecnh d\u01b0\u1edbi \u0111\u00e2y).<\/p>\n

\"bien-chung-nghiem-trong-1\"
Th\u1ee7ng m\u00e0ng xoang Schneiderian\u00a0l\u00e0 bi\u1ebfn ch\u1ee9ng trong ph\u1eabu thu\u1eadt th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a k\u1ef9 thu\u1eadt n\u00e2ng xoang h\u1edf, v\u1edbi t\u1ef7 l\u1ec7 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o n\u1eb1m trong kho\u1ea3ng t\u1eeb 10 \u0111\u1ebfn 56%<\/figcaption><\/figure>\n

B\u1eb1ng ch\u1ee9ng trong y v\u0103n cho th\u1ea5y s\u1ef1 t\u1ea1o x\u01b0\u01a1ng gi\u1ea3m \u0111\u00e1ng k\u1ec3 (14.58%) khi m\u00e0ng b\u1ecb th\u1ee7ng, so v\u1edbi nh\u1eefng v\u1ecb tr\u00ed kh\u00f4ng b\u1ecb th\u1ee7ng (33.58%).<\/p>\n

    \n
  • Th\u1ee7ng r\u1ea5t nh\u1ecf (< 2 mm) c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft \u0111\u01a1n gi\u1ea3n b\u1eb1ng c\u00e1ch g\u1ea5p m\u00e0ng ho\u1eb7c t\u1ea1o c\u1ee5c m\u00e1u \u0111\u00f4ng. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 v\u1eabn th\u00edch s\u1eed d\u1ee5ng m\u00e0ng ti\u00eau collagen \u0111\u1ec3 s\u1eeda ch\u1eefa l\u1ed7 th\u1ee7ng.<\/li>\n
  • Th\u1ee7ng l\u1edbn ph\u1ea3i \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft b\u1eb1ng nh\u1eefng bi\u1ec7n ph\u00e1p c\u1ee5 th\u1ec3.\n
      \n
    • M\u00e0ng xoang b\u1ecb th\u1ee7ng (l\u1edbn h\u01a1n ho\u1eb7c b\u1eb1ng 2 mm) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c che v\u00e0 s\u1eeda ch\u1eefa b\u1eb1ng m\u00e0ng ti\u00eau collagen.<\/li>\n
    • K\u1ef9 thu\u1eadt t\u00fai Loma Linda: m\u00e0ng ti\u00eau l\u1edbn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u1ee7 to\u00e0n b\u1ed9 m\u1eb7t trong c\u1ee7a xoang h\u00e0m, v\u00e0 b\u1edd c\u1ee7a n\u00f3 ph\u1ea3i m\u1edf r\u1ed9ng b\u00ean ngo\u00e0i c\u1eeda s\u1ed5 x\u01b0\u01a1ng. M\u00e0ng ti\u00eau \u0111\u01b0\u1ee3c \u0111\u1eb7t l\u00ean m\u1eb7t ngo\u00e0i \u0111\u1ec3 b\u1ecbt k\u00edn t\u00fai v\u00e0 b\u1ea3o t\u1ec7 t\u1ed1i \u01b0u x\u01b0\u01a1ng gh\u00e9p h\u1ea1t. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ch\u1ed1t \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh m\u00e0ng ti\u00eau trong tr\u01b0\u1eddng h\u1ee3p th\u1ee7ng do k\u1ef9 thu\u1eadt c\u1ee7a s\u1ed5 ngo\u00e0i.<\/li>\n<\/ul>\n<\/li>\n
    • Th\u1ee7ng r\u1ea5t l\u1edbn: T\u1ed1t nh\u1ea5t n\u00ean d\u1eebng ph\u1eabu thu\u1eadt v\u00e0 ph\u1eabu thu\u1eadt tr\u1edf l\u1ea1i sau 3-4 th\u00e1ng \u0111\u1ec3 cho ph\u00e9p l\u00e0nh th\u01b0\u01a1ng t\u1ea1i v\u1ecb tr\u00ed th\u1ee7ng.<\/li>\n<\/ul>\n

      2. V\u1ea5n \u0111\u1ec1 ch\u1ea3y m\u00e1u nhi\u1ec1u<\/h2>\n

      N\u1ebfu ch\u1ea3y m\u00e1u nhi\u1ec1u trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt th\u00ec n\u00ean \u0111\u1eb7t \u00e1p l\u1ef1c tr\u1ef1c ti\u1ebfp l\u00ean \u0111i\u1ec3m ch\u1ea3y m\u00e1u. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ch\u1ea5t co m\u1ea1ch t\u1ea1i ch\u1ed7. V\u00ed d\u1ee5, \u0111\u1eb7t mi\u1ebfng g\u1ea1c \u0111\u00e3 ng\u00e2m xylocaine 2% v\u1edbi 1:50,000 epinephrine trong khoang sau n\u00e2ng xoang \u0111\u1ec3 ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u v\u00e0 gi\u00fap quan s\u00e1t. N\u1ebfu ch\u1ea3y m\u00e1u trong x\u01b0\u01a1ng th\u00ec c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng s\u00e1p c\u1ea7m m\u00e1u x\u01b0\u01a1ng. N\u1ebfu x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c \u0111i\u1ec3m ch\u1ea3y m\u00e1u th\u00ec c\u00f3 th\u1ec3 kh\u00e2u m\u1ea1ch m\u00e1u n\u1eb1m k\u1ebf \u0111i\u1ec3m ch\u1ea3y m\u00e1u. \u0110\u1ed1t \u0111i\u1ec7n c\u0169ng \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t ph\u01b0\u01a1ng \u00e1n kh\u1ea3 thi.<\/p>\n

      L\u00ean k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb c\u1ea9n th\u1eadn v\u00e0 \u0111\u1ea7y \u0111\u1ee7 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt n\u00f3i chung s\u1ebd l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 c\u1ee7a lo\u1ea1i bi\u1ebfn ch\u1ee9ng n\u00e0y. V\u00ed d\u1ee5, s\u1eed d\u1ee5ng CBCT s\u1ebd gi\u00fap x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c c\u00e1c m\u1ea1ch m\u00e1u \u1edf v\u00f9ng l\u00e2n c\u1eadn \u0111\u1ec3 c\u00f3 th\u1ec3 tr\u00e1nh ch\u00fang trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt.<\/p>\n

      3. M\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng kh\u00e1c<\/h2>\n

      Nh\u1eefng bi\u1ebfn ch\u1ee9ng sau ph\u1eabu thu\u1eadt ch\u1ee7 y\u1ebfu c\u1ee7a k\u1ef9 thu\u1eadt c\u1eeda s\u1ed5 ngo\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i \u00edt g\u1eb7p. Ch\u00fang g\u1ed3m c\u00f3 nhi\u1ec5m tr\u00f9ng v\u00f9ng gh\u00e9p, vi\u00eam xoang h\u00e0m sau ph\u1eabu thu\u1eadt, \u0111au, v\u00e0 h\u1edf v\u1ebft th\u01b0\u01a1ng.<\/p>\n

        \n
      • Nhi\u1ec5m tr\u00f9ng v\u00f9ng gh\u00e9p:<\/strong>\u00a0T\u1ef7 l\u1ec7 trung b\u00ecnh \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong m\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng l\u00e0 2.9%. Nguy c\u01a1 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1ee3c ghi nh\u1eadn th\u01b0\u1eddng xuy\u00ean h\u01a1n khi x\u1ea3y ra th\u1ee7ng m\u00e0ng trong ph\u1eabu thu\u1eadt. Nhi\u1ec5m tr\u00f9ng v\u00f9ng gh\u00e9p th\u01b0\u1eddng \u0111\u01b0\u1ee3c ghi nh\u1eadn sau ph\u1eabu thu\u1eadt 3-7 ng\u00e0y. Nhi\u1ec5m tr\u00f9ng v\u00f9ng gh\u00e9p l\u00e0 m\u1ed9t t\u00ecnh hu\u1ed1ng nguy hi\u1ec3m b\u1edfi v\u00ec nhi\u1ec5m tr\u00f9ng c\u00f3 th\u1ec3 l\u00e2y lan sang nh\u1eefng v\u00f9ng kh\u00e1c, ch\u1eb3ng h\u1ea1n nh\u01b0 \u1ed5 m\u1eaft ho\u1eb7c th\u1eadm ch\u00ed l\u00e0 n\u00e3o b\u1ed9. Bi\u1ebfn ch\u1ee9ng n\u00e0y \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng li\u1ec7u ph\u00e1p kh\u00e1ng sinh. Testori v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 \u0111\u1ec1 ngh\u1ecb k\u1ebft h\u1ee3p Augmentin v\u1edbi metronidazole ho\u1eb7c levofloxacin. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, ngo\u00e0i li\u1ec7u ph\u00e1p kh\u00e1ng sinh, c\u00f3 th\u1ec3 c\u1ea7n d\u1eabn l\u01b0u, l\u00e0m s\u1ea1ch v\u1ecb tr\u00ed ph\u1eabu thu\u1eadt, ho\u1eb7c l\u1ea5y v\u1eadt li\u1ec7u gh\u00e9p ra. \u0110\u1ec3 ph\u00f2ng ng\u1eeba nhi\u1ec5m tr\u00f9ng, kh\u00e1ng sinh ph\u00f2ng ng\u1eeba v\u00e0 sau ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. Augmentin (amoxicillin\/clavulanate) l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn. Metronidazole k\u1ebft h\u1ee3p clarithromycin \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 thu\u1ed1c thay th\u1ebf \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u1ecb \u1ee9ng penicillin.<\/li>\n
      • Vi\u00eam xoang h\u00e0m sau ph\u1eabu thu\u1eadt:<\/strong> Bi\u1ebfn ch\u1ee9ng n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi t\u1ef7 l\u1ec7 1%. M\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a Timmenga v\u00e0 c\u1ed9ng s\u1ef1 cho th\u1ea5y vi\u00eam xoang sau ph\u1eabu thu\u1eadt x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n l\u1ec7ch v\u00e1ch ng\u0103n ho\u1eb7c cu\u1ed1n qu\u00e1 l\u1edbn. Vi\u00eam xoang nh\u1eb9 s\u1ebd \u0111\u00e1p \u1ee9ng v\u1edbi ch\u1ea5t th\u00f4ng m\u0169i nh\u01b0 oxymetazoline. N\u1ebfu nguy\u00ean nh\u00e2n do vi\u00eam k\u1ebft h\u1ee3p nhi\u1ec5m tr\u00f9ng, th\u00ec li\u1ec7u ph\u00e1p kh\u00e1ng sinh v\u00e0 kh\u00e1ng vi\u00eam c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3.<\/li>\n
      • \u0110au nhi\u1ec1u:<\/strong> C\u00f3 th\u1ec3 t\u0103ng li\u1ec1u gi\u1ea3m \u0111au. Ibuprofen 400-800 mg (3 l\u1ea7n\/ng\u00e0y ho\u1eb7c n\u1ebfu c\u1ea7n) hay acetaminophen c\u00f3 codeine #3 (m\u1ed7i 6 gi\u1edd ho\u1eb7c n\u1ebfu c\u1ea7n) th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u00ea cho b\u1ec7nh nh\u00e2n.<\/li>\n
      • H\u1edf v\u1ebft th\u01b0\u01a1ng:<\/strong> \u0110\u00e2y c\u0169ng l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng hi\u1ebfm g\u1eb7p (3%). N\u00f3 th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn \u0111\u01b0\u1eddng r\u1ea1ch n\u1eb1m l\u1ec7ch trong qu\u00e1 nhi\u1ec1u, g\u00e2y gi\u1ea3m cung c\u1ea5p m\u00e1u cho v\u1ea1t.<\/li>\n
      • Implant \u0111i v\u00e0o xoang:<\/strong> T\u1ef7 l\u1ec7 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o tr\u00ean l\u00e2m s\u00e0ng l\u00e0 4%. Thi\u1ebfu \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh khi \u0111\u1eb7t implant ho\u1eb7c m\u1ea5t \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh s\u01a1 kh\u1edfi s\u1edbm \u0111\u01b0\u1ee3c xem l\u00e0 c\u00e1c nguy\u00ean nh\u00e2n ch\u00ednh. M\u1ed9t lo\u1ea1t ca t\u00ecm hi\u1ec3u nh\u1eefng nguy\u00ean nh\u00e2n c\u1ee7a bi\u1ebfn ch\u1ee9ng n\u00e0y cho th\u1ea5y n\u00f3 c\u00f3 th\u1ec3 l\u00e0 do l\u1ef1a nhai qu\u00e1 m\u1ee9c ho\u1eb7c v\u1eb7n implant s\u1edbm, kh\u00f4ng n\u00e9n ch\u1eb7t v\u1eadt li\u1ec7u gh\u00e9p ho\u1eb7c ti\u00eau v\u1eadt li\u1ec7u gh\u00e9p s\u1edbm, ho\u1eb7c th\u1eadm ch\u00ed li\u00ean quan \u0111\u1ebfn th\u1ee7ng m\u00e0ng xoang. Th\u1ef1c t\u1ebf, implant c\u00f3 th\u1ec3 b\u1ecb h\u00fat v\u00e0o trong xoang qua l\u1ed7 th\u1ee7ng do \u00e1p l\u1ef1c \u00e2m b\u00ean trong xoang.<\/li>\n<\/ul>\n

        Ngu\u1ed3n t\u00e0i li\u1ec7u: Clinical Cases in Implant Dentistry, First Edition – Published 2017 by John Wiley & Sons, Inc.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

        B\u00e0i vi\u1ebft n\u00e0y n\u00f3i v\u1ec1 ch\u1ee7 y\u1ebfu hai bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng c\u1ee7a k\u1ef9 thu\u1eadt n\u00e2ng xoang c\u1eeda s\u1ed1 ngo\u00e0i, \u0111\u00f3 l\u00e0 “Th\u1ee7ng m\u00e0ng xoang Schneiderian” v\u00e0 “V\u1ea5n \u0111\u1ec1 ch\u1ea3y m\u00e1u dai d\u1eb3ng sau ph\u1eabu thu\u1eadt”. M\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng sau ph\u1eabu thu\u1eadt ch\u1ee7 y\u1ebfu c\u1ee7a k\u1ef9 thu\u1eadt c\u1eeda s\u1ed5 ngo\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i \u00edt g\u1eb7p. 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