{"id":3361,"date":"2023-04-10T11:01:12","date_gmt":"2023-04-10T04:01:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=3361"},"modified":"2023-04-10T14:53:47","modified_gmt":"2023-04-10T07:53:47","slug":"gia-tri-chan-doan-cac-dau-hieu-tren-sieu-am","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/gia-tri-chan-doan-cac-dau-hieu-tren-sieu-am\/","title":{"rendered":"\u0110\u00e1nh gi\u00e1 h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay d\u1ef1a tr\u00ean si\u00eau \u00e2m th\u1ea7n kinh gi\u1eefa"},"content":{"rendered":"

S\u1eed d\u1ee5ng si\u00eau \u00e2m t\u1eeb c\u00e1c gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n d\u1ea5u hi\u1ec7u ho\u1eb7c c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u00f3 th\u1ec3 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 thay \u0111\u1ed5i h\u00ecnh th\u00e1i c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa qua khu v\u1ef1c \u1ed1ng c\u1ed5 tay, tuy nhi\u00ean si\u00eau \u00e2m c\u00f3 \u01b0u \u0111i\u1ec3m v\u01b0\u1ee3t tr\u1ed9i nh\u01b0 r\u1ebb ti\u1ec1n, c\u01a1 \u0111\u1ed9ng v\u00e0 cho ch\u1ea5t l\u01b0\u1ee3ng th\u0103m kh\u00e1m v\u1edbi \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n ng\u00e0y c\u00f9ng v\u1edbi th\u0103m kh\u00e1m l\u00e2m s\u00e0ng c\u1ee7a b\u00e1c s\u0129 l\u00e2m s\u00e0ng ho\u1eb7c ph\u1ed1i h\u1ee3p \u0111\u1ed3ng th\u1eddi v\u1edbi b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh. C\u00f9ng v\u1edbi \u0111i\u1ec7n sinh l\u00fd th\u1ea7n kinh, si\u00eau \u00e2m th\u1ea7n kinh \u0111\u00e3 tr\u1edf th\u00e0nh 1 y\u1ebfu t\u1ed1quan tr\u1ecdng<\/strong><\/p>\n

1) D\u1ea5u hi\u1ec7u ph\u00f9 d\u00e2y th\u1ea7n kinh v\u00e0 d\u1ea5u hi\u1ec7u Notch<\/span><\/h2>\n

C\u00e1c d\u1ea5u hi\u1ec7u n\u00e0y tr\u00ean si\u00eau \u00e2m \u00edt c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n v\u00ec ph\u1ee5 thu\u1ed9c v\u00e0o ch\u1ee7 quan c\u1ee7a ng\u01b0\u1eddi l\u00e0m. C\u00e1c d\u1ea5u hi\u1ec7u ch\u1ec9 mang t\u00ednh ch\u1ea5t \u0111\u1ecbnh t\u00ednh ch\u1ee9 kh\u00f4ng \u0111o l\u01b0\u1eddng \u0111\u01b0\u1ee3c m\u1ed9t c\u00e1ch c\u1ee5 th\u1ec3. Theo c\u00e1c t\u00e1c gi\u1ea3 Ahmad v\u00e0 c\u1ed9ng s\u1ef1, d\u1ea5u hi\u1ec7u d\u00e2y th\u1ea7n kinh ph\u00f9 n\u1ec1, gi\u1ea3m \u00e2m c\u00f3 \u0111\u1ed9 nh\u1ea1y 91% trong ch\u1ea9n \u0111o\u00e1n HCOCT<\/span><\/p>\n

2) D\u1ea5u hi\u1ec7u di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa trong si\u00eau \u00e2m<\/span><\/h2>\n

Di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa l\u00e0 d\u1ea5u hi\u1ec7u c\u00f3 gi\u00e1 tr\u1ecb nh\u1ea5t v\u00e0 \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t trong ch\u1ea9n \u0111o\u00e1n HCOCT. B\u00ean c\u1ea1nh gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n, \u0111o di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa theo m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 c\u00f2n c\u00f3 gi\u00e1 tr\u1ecb ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT<\/a> v\u00e0 theo d\u00f5i hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

N\u0103m 2012, hi\u1ec7p h\u1ed9i \u0111i\u1ec7n th\u1ea7n kinh c\u01a1 c\u1ee7a Hoa K\u1ef3 (AANEM) do t\u00e1c gi\u1ea3 Cartwright v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 t\u1ed5ng h\u1ee3p nghi\u00ean c\u1ee9u 67 b\u00e0i b\u00e1o full text (t\u1eeb n\u0103m 1990-2011) v\u00e0 \u0111\u01b0a ra guideline v\u1ec1 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n si\u00eau \u00e2m trong HCOCT d\u1ef1a tr\u00ean c\u00e1c d\u1eef li\u1ec7u c\u1ee7a 67 b\u00e0i b\u00e1o [38], C\u00e1c t\u00e1c gi\u1ea3 ph\u00e2n lo\u1ea1i c\u00e1c b\u00e0i b\u00e1o th\u00e0nh 4 nh\u00f3m trong \u0111\u00f3 nh\u00f3m 1 v\u00e0 nh\u00f3m 2 g\u1ed3m c\u00e1c nghi\u00ean c\u1ee9u thu\u1ea7n t\u1eadp s\u1eed d\u1ee5ng c\u00f9ng ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n (l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n c\u01a1), \u0111o \u0111\u1ea1c s\u1ed1 li\u1ec7u tr\u00ean d\u00e2y th\u1ea7n kinh gi\u1eefa v\u00e0 \u0111\u01b0a ra gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n.<\/span><\/p>\n

K\u1ebft lu\u1eadn r\u00fat ra t\u1eeb nh\u00f3m 1 v\u00e0 2: di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u0111o \u1edf \u0111\u1ea7u g\u1ea7n c\u1ee7a \u1ed1ng c\u1ed5 tay (ngang m\u1ee9c x\u01b0\u01a1ng thuy\u1ec1n v\u00e0 x\u01b0\u01a1ng \u0111\u1eadu) v\u00e0 gi\u00e1 tr\u1ecb Delta S (hi\u1ec7u s\u1ed1 ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf \u0111\u1ea7u g\u1ea7n c\u1ee7a \u00f4ng c\u00f3 tay v\u00e0 \u1edf \u0111o\u1ea1n ngang c\u01a1 s\u1ea5p) \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n. Di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u0111o tr\u1ef1c ti\u1ebfp \u1edf \u0111\u1ea7u g\u1ea7n \u1ed1ng c\u1ed5 tay dao \u0111\u1ed9ng t\u1eeb 8.5 – 12 mm2 c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n v\u1edbi \u0111\u1ed9 nh\u1ea1y dao \u0111\u1ed9ng t\u1eeb 65% t\u1edbi 97% [30, 39], \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u dao \u0111\u1ed9ng t\u1eeb 72,7-98% [27, 30], C\u00e1c t\u00e1c gi\u1ea3 \u0111\u1ec1u ch\u1ecdn ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n HCOCT d\u1ef1a tr\u00ean c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n c\u01a1. Ch\u1ec9 c\u00f3 Nakamichi v\u00e0 Tachibana s\u1eed d\u1ee5ng ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n HCOCT d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng, \u0111o di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf 3 v\u1ecb tr\u00ed. K\u1ebft qu\u1ea3 di\u1ec7n t\u00edch c\u1eaft ngang b\u1ea3ng 12mm2 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n [40].<\/span><\/p>\n

\"B\u1ea3ng
B\u1ea3ng 1: \u0110\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a d\u1ea5u hi\u1ec7u si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n HCOCT<\/figcaption><\/figure>\n

N\u0103m 2012, m\u1ed9t nghi\u00ean c\u1ee9u c\u1ed9ng g\u1ed9p \u0111\u00e1nh gi\u00e1 vai tr\u00f2 c\u1ee7a si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n HCOCT trong m\u1ed9t th\u1eadp k\u1ef7 qua (2000 – 2009) \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi t\u00e1c gi\u1ea3 ng\u01b0\u1eddi Ph\u00e1p Alexis Descatha v\u00e0 c\u1ed9ng s\u1ef1 [7], Nghi\u00ean c\u1ee9u n\u00e0y \u0111\u00e0 t\u1ed5ng h\u1ee3p k\u1ebft qu\u1ea3 c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ea1t chu\u1ea9n c\u1ee7a kh\u1eafp c\u00e1c ch\u00e2u l\u1ee5c (Ch\u00e2u M\u1ef9, ch\u00e2u \u00c2u, ch\u00e2u \u00c1, Trung \u0110\u00f4ng); tr\u00ean 8 qu\u1ed1c gia (13 nghi\u00ean c\u1ee9u), \u0111\u01b0a ra k\u1ebft lu\u1eadn v\u1ec1 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n HCOCT. Theo k\u1ebft lu\u1eadn n\u00e0y, di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa (CSA) trong kho\u00e1ng 9,5-10,5 mm2 c\u00f3 \u0111\u1ed9 nh\u1ea1y l\u00e0 84% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 78%; CSA t\u1eeb 7,0-8,5 mnr \u0111\u1ed9 nh\u1ea1y l\u00e0 94% v\u00e0 CSA t\u1eeb 11,5-13mm2 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 97%.<\/span><\/p>\n

\"B\u1ea3ng
B\u1ea3ng 3: \u0110\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a si\u00eau \u00e2m trong ch\u1ea9n \u0111o\u00e1n HCOCT<\/figcaption><\/figure>\n

Gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a d\u1ea5u hi\u1ec7u \u0111o di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u dao \u0111\u1ed9ng l\u1edbn b\u1edfi v\u00ec c\u00e1c t\u00e1c gi\u1ea3 s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u kh\u00e1c nhau, c\u00e1ch \u0111o kh\u00e1c nhau v\u00e0 s\u1eed d\u1ee5ng ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n HCOCT c\u00f9ng kh\u00e1c nhau. V\u00ed d\u1ee5, ph\u1ea7n l\u1edbn c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ec1u \u0111o di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf v\u1ecb tr\u00ed ngang x\u01b0\u01a1ng \u0111\u1eadu, m\u1ed9t s\u1ed5 kh\u00e1c l\u1ea1i \u0111o \u1edf v\u1ecb tr\u00ed kh\u1edbp quay – tr\u1ee5 xa, kh\u1edbp quay – c\u1ed5 tay, n\u1ebfp g\u1ea5p c\u1ed5 tay, trong \u1ed1ng c\u1ed5 tay, m\u00f3c c\u1ee7a x\u01b0\u01a1ng m\u00f3c, v\u00e0 c\u1ea1nh m\u1ea1c gi\u1eef g\u00e2n g\u1ea5p \u0111\u1ea7u xa. Ti\u00eau chu\u1ea9n \u0111\u1ed1i chi\u1ebfu c\u0169ng thay \u0111\u1ed5i t\u00f9y theo nghi\u00ean c\u1ee9u: ph\u1ea7n l\u1edbn c\u00e1c nghi\u00ean c\u1ee9u s\u1eed d\u1ee5ng l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n c\u01a1 l\u00e0m ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n, m\u1ed9t s\u1ed1 nghi\u00ean c\u1eedu ch\u1ec9 s\u1eed d\u1ee5ng l\u00e2m s\u00e0ng l\u00e0m ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n. Tuy nhi\u00ean gi\u00e1 tr\u1ecb \u0111i\u1ec7n c\u01a1 \u0111\u01b0a v\u00e0o ch\u1ea9n \u0111o\u00e1n \u1edf m\u1ed7i nghi\u00ean c\u1ee9u c\u0169ng kh\u00e1c nhau.<\/span><\/p>\n

Ngo\u00e0i gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay, \u0111o di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa c\u00f9ng c\u00f3 vai tr\u00f2 trong ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT. Tuy nhi\u00ean k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u c\u0169ng \u0111\u01b0a ra c\u00e1c \u00fd ki\u1ebfn tr\u00e1i chi\u1ec1u nhau.<\/span><\/p>\n

Theo c\u00e1c t\u00e1c gi\u1ea3 Medany (2004); Padual (2008) v\u00e0 Y.S. Karadag (2009), si\u00eau \u00e2m \u0111o di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa c\u00f3 vai tr\u00f2 trong ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay<\/a> [41,42]. Nh\u01b0ng theo m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 kh\u00e1c Kaymak (2008); Mondelli (2009); Mhoon (2012) v\u00e0 Visser 2008…, si\u00eau \u00e2m kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng cua h\u1ed9i ch\u1ee9ng n\u00e0y.<\/span><\/p>\n

Miedany ti\u1ebfn h\u00e0nh nghi\u00ean c\u1ee9u b\u1ec7nh ch\u1ee9ng g\u1ed3m 78 nh\u00f3m b\u1ec7nh v\u00e0 78 nh\u00f3m ch\u1ee9ng, \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng b\u00e0ng thang \u0111i\u1ec3m Boston, si\u00eau \u00e2m \u0111o di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa \u1edf \u0111\u1ea7u g\u1ea7n v\u00e0 trong \u1ed1ng c\u1ed5 tay, \u0111i\u1ec7n c\u01a1 ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay. K\u1ebft qu\u1ea3, gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n d\u1ea5u hi\u1ec7u c\u1ee7a si\u00eau \u00e2m l\u00e0 10,03mm2, t\u1ec9 s\u1ed1 d\u1eb9t l\u00e0 0,3. \u0110o di\u1ec7n t\u00edch c\u1eaft ngang th\u00e2n kinh gi\u1eefa ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay, ph\u00e2n l\u00e0m ba m\u1ee9c \u0111\u1ed9 nh\u1eb9, trung b\u00ecnh, n\u1eb7ng v\u1edbi di\u1ec7n t\u00edch th\u1ea7n kinh gi\u1eefa t\u01b0\u01a1ng \u1ee9ng 10-13mm2; 13-15mm2 v\u00e0 tr\u00ean 15mm2. T\u00e1c gi\u1ea3 th\u1ea5y c\u00f3 m\u1ed1i li\u00ean quan ch\u1eb7t ch\u1ebd gi\u1eefa si\u00eau \u00e2m v\u00e0 \u0111i\u1ec7n c\u01a1 trong ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay [41].<\/span><\/p>\n

Padua – L v\u00e0 c\u1ed9ng s\u1ef1 (2008) \u0111\u00e3 nghi\u00ean c\u1ee9u m\u1ed1i li\u00ean quan gi\u1eefa l\u00e2m s\u00e0ng, test kh\u00e1m th\u1ea7n kinh, \u0111i\u1ec7n c\u01a1 v\u00e0 si\u00eau \u00e2m tr\u00ean 54 b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng \u1ed0ng c\u1ed5 tay. K\u1ebft qu\u1ea3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n di\u1ec7n t\u00edch \u0111\u1ea7u g\u1ea7n d\u00e2y th\u1ea7n kinh gi\u1eefa l\u00e0 10mm2. C\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng tr\u00ean l\u00e2m s\u00e0ng. N\u1ebfu nh\u01b0 test kh\u00e1m l\u00e2m s\u00e0ng \u00e2m t\u00ednh c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng si\u00eau \u00e2m \u0111\u1ec3 ph\u00e1t hi\u1ec7n nh\u1eefng b\u1ea5t th\u01b0\u1eddng m\u00e0 c\u00e1c test th\u1ea7n kinh kh\u00f4ng th\u1ea5y do t\u1ed5n th\u01b0\u01a1ng k\u00edn \u0111\u00e1o [42],<\/span><\/p>\n

Kadar v\u00e0 c\u1ed9ng (2009) s\u1ef1 nghi\u00ean c\u1ee9u m\u1ed1i li\u00ean quan gi\u1eefa di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa, \u0111i\u1ec7n c\u01a1 v\u00e0 thang \u0111i\u1ec3m BCTQ. Thang \u0111i\u1ec3m BCTQ ph\u00e2n \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT th\u00e0nh 5 m\u1ee9c \u0111\u1ed9. Nh\u1eb9: 1,1-2; trung b\u00ecnh: 2,1-3; n\u1eb7ng: 3,1-4; r\u1ea5t n\u1eb7ng 4,1\u00ad-5. Si\u00eau \u00e2m ph\u00e2n \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT theo Migdaly. \u0110i\u1ec7n c\u01a1 ph\u00e2n \u0111\u1ed9 n\u1eb7ng theo Padua L. K\u1ebft qu\u1ea3 cho th\u1ea5y c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa v\u00e0 \u0111i\u1ec7n c\u01a1 trong ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a HOT (k0619). C\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa v\u1edbi thang \u0111i\u1ec3m VAS (p=0,017) v\u00e0 thang \u0111i\u1ec3m BCTQ (p=0,021). T\u00f3m t\u1ea1i, di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa ph\u1ea3n \u00e1nh m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh gi\u1ed1ng nh\u01b0 b\u1ee9c tranh ph\u1ea3n \u00e1nh c\u1ee7a l\u00e2m s\u00e0ng [43].<\/span><\/p>\n

Kaymak v\u00e0 c\u1ed9ng s\u1ef1 (2008) nghi\u00ean c\u1ee9u \u0111i\u1ec7n c\u01a1 v\u00e0 si\u00eau \u00e2m d\u1ef1 \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT tr\u00ean 34 nh\u00f3m b\u1ec7nh v\u00e0 38 nh\u00f3m ch\u1eedng. L\u00e2m s\u00e0ng \u0111\u00e1nh gi\u00e1 b\u1edfi thang \u0111i\u1ec3m B\u1ecc, si\u00eau \u00e2m \u0111o di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh \u1edf ngang x\u01b0\u01a1ng \u0111\u1eadu v\u00e0 t\u1ec9 s\u1ed1 d\u1eb9t d\u00e2y th\u1ea7n kinh. T\u00e1c gi\u1ea3 \u0111\u01b0a ra m\u1ed9t s\u1ed1 k\u1ebft lu\u1eadn nh\u01b0 sau; c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng theo thang \u0111i\u1ec3m B\u1ecc v\u00e0 th\u1eddi gian ti\u1ec1m c\u1ea3m gi\u00e1c c\u0169ng nh\u01b0 m\u1ed1i li\u00ean quan gi\u1eefa thang \u0111i\u1ec3m BCTQ v\u1ec1 v\u1eadn \u0111\u1ed9ng v\u00e0 th\u1eddi gian ti\u1ec1m v\u1eadn \u0111\u1ed9ng. Kh\u00f4ng c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa si\u00eau \u00e2m v\u00e0 thang \u0111i\u1ec3m BCTQ. Tuy nhi\u00ean c\u00f3 th\u1ec3 d\u00f9ng si\u00eau \u00e2m \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n c\u00f3 hay kh\u00f4ng c\u00f3 HCOCT [44].<\/span><\/p>\n

Mhoon v\u00e0 c\u1ed9ng s\u1ef1 (2012) nghi\u00ean c\u1ee9u so s\u00e1nh di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa, t\u1ef7 s\u1ed1 ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch \u0111\u1ea7u g\u1ea7n v\u00e0 \u0111i\u1ec7n t\u00edch ngang c\u01a1 s\u1ea5p (c\u00e1ch \u0111\u1ea7u g\u1ea7n 12cm) v\u1edbi l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n c\u01a1 tr\u00ean 100 b\u1ec7nh nh\u00e2n v\u00e0 25 nh\u00f3m ch\u1ee9ng. K\u1ebft qu\u1ea3 v\u1edbi di\u1ec7n t\u00edch d\u00e2y th\u1ea7n kinh 9mm2, \u0111\u1ed9 nh\u1ea1y l\u00e0 99%; t\u1ef7 s\u1ed1 ch\u00eanh l\u1ec7ch di\u1ec7n t\u00edch l\u00e0 1,4 c\u00f3 \u0111\u1ed9 nh\u1ea1y l\u00e0 97%. Si\u00eau \u00e2m kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT. C\u1ea7n xem x\u00e9t l\u00e0m \u0111i\u1ec7n c\u01a1 trong tr\u01b0\u1eddng h\u1ee3p di\u1ec7n t\u00edch th\u1ea7n kinh gi\u1eefa <\/span> 8mm2 [45].<\/span><\/p>\n

B\u00ean c\u1ea1nh gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u00e1c d\u1ea5u hi\u1ec7u si\u00eau \u00e2m v\u00e0 ph\u00e2n \u0111\u1ed9 n\u1eb7ng c\u1ee7a HCOCT, \u0111o di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa c\u00f2n c\u00f3 gi\u00e1 tr\u1ecb theo d\u00f5i v\u00e0 ti\u00ean l\u01b0\u1ee3ng sau ph\u1eabu thu\u1eadt. N\u0103m 2008, Mondelli v\u00e0 c\u1ed9ng s\u1ef1 \u0111o di\u1ec7n t\u00edch \u0111\u1ea7u v\u00e0o \u1ed1ng c\u00f4 tay, \u0111i\u1ec7n c\u01a1 ph\u00e2n \u0111\u1ed9 n\u1eb7ng, s\u1eed d\u1ee5ng thang \u0111i\u1ec3m Boston \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc v\u00e0 sau ph\u1eabu thu\u1eadt 1 th\u00e1ng v\u00e0 6 th\u00e1ng. C\u00e1c t\u00e1c gi\u1ea3 th\u1ea5y r\u1eb1ng gi\u1ea3m di\u1ec7n t\u00edch c\u1eaft ngang th\u1ea7n kinh gi\u1eefa 1mm2 c\u00f3 m\u1ed1i li\u00ean quan v\u1edbi ph\u00e2n \u0111\u1ed9 n\u1eb7ng tr\u00ean l\u00e2m s\u00e0ng.<\/span><\/p>\n

N\u0103m 2015, Ei Miedany v\u00e0 c\u1ed9ng s\u1ef1 nghi\u00ean c\u1ee9u v\u1ec1 thang \u0111i\u1ec3m Doppler, d\u1ea5u hi\u1ec7u di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa, ti s\u1ed1 d\u1eb9t, ph\u00e2n \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111i\u1ec7n c\u01a1 theo Bland v\u00e0 ph\u00e2n \u0111\u1ed9 n\u1eb7ng theo l\u00e2m s\u00e0ng t\u1ea1i th\u1eddi \u0111i\u1ec3m sau ph\u1eabu thu\u1eadt 1 tu\u1ea7n, 1 th\u00e1ng v\u00e0 6 th\u00e1ng. C\u00e1c t\u00e1c gi\u1ea3 \u0111\u01b0a ra k\u1ebft lu\u1eadn: v\u1edbi di\u1ec7n t\u00edch c\u1eaft ngang > 14mm2 v\u00e0 t\u1ec9 s\u1ed1 d\u1eb9t > 2,8, ti\u00ean l\u01b0\u1ee3ng sau ph\u1eabu thu\u1eadt 6 th\u00e1ng c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng k\u00e9m. N\u1ebfu di\u1ec7n t\u00edch c\u1eaft ngang < 14mm2 v\u00e0 thang \u0111i\u1ec3m Doppler > 2, c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng t\u1ed1t sau 6 th\u00e1ng. C\u00e1c t\u00e1c gi\u1ea3 c\u0169ng k\u1ebft lu\u1eadn r\u1eb1ng si\u00eau \u00e2m kh\u00f4ng chi \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb m\u00e0 c\u00f2n l\u00e0 m\u1ed9t marquer quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb. C\u00e1c t\u00e1c gi\u1ea3 khuy\u1ec3n c\u00e1o \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n trong tr\u01b0\u1eddng h\u1ee3p thang \u0111i\u1ec3m Doppler cao v\u00e0 di\u1ec7n t\u00edch c\u1eaft ngang th\u1ea7n kinh gi\u1eefa nh\u1ecf. Xem x\u00e9t ph\u1eabu thu\u1eadt trong tr\u01b0\u1eddng h\u1ee3p t\u1ec9 s\u1ed1 d\u1eb9t cao v\u00e0 di\u1ec7n t\u00edch c\u1eaft ngang th\u1ea7n kinh gi\u1eefa l\u1edbn.<\/span><\/p>\n

C\u00f3 m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u b\u00e1c b\u1ecf vai tr\u00f2 c\u1ee7a si\u00eau \u00e2m trong ti\u00ean l\u01b0\u1ee3ng sau ph\u1eabu thu\u1eadt. Naranjo v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 c\u00f4ng b\u1ed1 hai b\u00e1o c\u00e1o n\u0103m 2009 v\u00e0 2010 r\u1eb1ng: \u0111o di\u1ec7n t\u00edch c\u1eaft ngang th\u1ea7n kinh gi\u1eefa, t\u1ec9 s\u1ed1 d\u1eb9t, \u0111\u1ed9 khum m\u1ea1c ch\u1eb1ng , \u0111i\u1ec7n c\u01a1 ph\u00e2n \u0111\u1ed9 n\u1eb7ng v\u00e0 thang \u0111i\u1ec3m Boston l\u00e0 c\u0103n c\u1ee9 \u0111\u1ec3 l\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt. Thang \u0111i\u1ec3m Likert \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ebf \u0111\u00e1nh gi\u00e1 sau ph\u1eabu thu\u1eadt 3 th\u00e1ng. C\u1ea3 hai nghi\u00ean c\u1ee9u \u0111\u1ec1u k\u1ebft lu\u1eadn r\u1eb1ng c\u1ea3 \u0111i\u1ec7n c\u01a1 v\u00e0 si\u00eau \u00e2m \u0111\u1ec1u kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o sau ph\u1eabu thu\u1eadt. Trong m\u1ed9t nghi\u00ean c\u1ee9u v\u00e0o n\u0103m 2014, Bland v\u00e0 Rudolf \u0111\u00e3 b\u00e1o c\u00e1o r\u1eb1ng di\u1ec7n t\u00edch c\u1eaft ngang d\u00e2y th\u1ea7n kinh gi\u1eefa kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb t\u1ed1t \u0111\u1ec3 d\u1ef1 b\u00e1o sau ph\u1eabu thu\u1eadt v\u00e0 thay \u0111\u1ed5i \u1edf m\u1ed7i b\u1ec7nh nh\u00e2n c\u0169ng nh\u01b0 \u0111i\u1ec7n c\u01a1 v\u00e0 thang \u0111i\u1ec3m Boston.<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

S\u1eed d\u1ee5ng si\u00eau \u00e2m t\u1eeb c\u00e1c gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n d\u1ea5u hi\u1ec7u ho\u1eb7c c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u00f3 th\u1ec3 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 thay \u0111\u1ed5i h\u00ecnh th\u00e1i c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa qua khu v\u1ef1c \u1ed1ng c\u1ed5 tay, tuy nhi\u00ean si\u00eau \u00e2m c\u00f3 \u01b0u \u0111i\u1ec3m v\u01b0\u1ee3t tr\u1ed9i nh\u01b0 r\u1ebb ti\u1ec1n, c\u01a1 \u0111\u1ed9ng v\u00e0 cho ch\u1ea5t l\u01b0\u1ee3ng […]<\/p>\n","protected":false},"author":54,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[40],"tags":[3],"yoast_head":"\n\u0110\u00e1nh gi\u00e1 h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay d\u1ef1a tr\u00ean si\u00eau \u00e2m th\u1ea7n kinh gi\u1eefa<\/title>\n<meta name=\"description\" content=\"C\u00e1c d\u1ea5u hi\u1ec7u si\u00eau \u00e2m bao g\u1ed3m d\u1ea5u hi\u1ec7u ph\u00f9 d\u00e2y 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