{"id":33151,"date":"2022-07-02T05:14:20","date_gmt":"2022-07-01T22:14:20","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=33151"},"modified":"2022-07-03T08:53:10","modified_gmt":"2022-07-03T01:53:10","slug":"nhung-dieu-co-ban-ve-viem-tuy-cap","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/nhung-dieu-co-ban-ve-viem-tuy-cap\/","title":{"rendered":"Nh\u1eefng \u0111i\u1ec1u c\u01a1 b\u1ea3n v\u1ec1 b\u1ec7nh vi\u00eam t\u1ee5y c\u1ea5p – Acute Pancreatitis"},"content":{"rendered":"

<>T\u1ea3i file PDF b\u00e0i vi\u1ebft Vi\u00eam t\u1ee5y c\u1ea5p – Acute Pancreatitis<\/strong> <\/b>t\u1ea1i \u0111\u00e2y<\/a><\/p>\n

<>B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c d\u1ecbch b\u1edfi Tr\u1ea7n Th\u1ecb Thu, Dr. L\u00ea V\u0169 Duy<\/p>\n

GI\u1edaI THI\u1ec6U<\/span><\/h2>\n
<>Tr\u01b0\u1edbc h\u1ebft, c\u00f3 hai giai \u0111o\u1ea1n c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn trong ph\u00e2n lo\u1ea1i c\u1ee7a Atlanta s\u1eeda \u0111\u1ed5i:<\/p>\n
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<>Giai \u0111o\u1ea1n s\u1edbm – tu\u1ea7n \u0111\u1ea7u : Ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111\u1ec3 l\u00ean k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng \u0111\u00e1p \u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng – \u0111i\u1ec1u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy \u0111a t\u1ea1ng.<\/li>\n
<>Giai \u0111o\u1ea1n mu\u1ed9n – sau tu\u1ea7n \u0111\u1ea7u : d\u1ef1a v\u00e0o ti\u00eau chu\u1ea9n v\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc tr\u00ean CLVT k\u1ebft h\u1ee3p v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111\u1ec3 qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n.<\/li>\n<\/ul>\n
<>M\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p \u0111\u01b0\u1ee3c chia l\u00e0m 3 \u0111\u1ed9 d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh :<\/p>\n
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<>Nh\u1eb9: kh\u00f4ng c\u00f3 suy t\u1ea1ng v\u00e0 kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7 ho\u1eb7c to\u00e0n th\u00e2n.<\/li>\n
<>Trung b\u00ecnh: c\u00f3 suy t\u1ea1ng tho\u00e1ng qua k\u00e9o d\u00e0i kh\u00f4ng qu\u00e1 48h v\u00e0\/ho\u1eb7c c\u00f3 bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7.<\/li>\n
<>N\u1eb7ng: suy t\u1ea1ng k\u00e9o d\u00e0i >48h, 15-20% tr\u01b0\u1eddng h\u1ee3p.<\/li>\n<\/ul>\n
<>V\u1ec1 h\u00ecnh th\u00e1i h\u1ecdc, c\u00f3 2 lo\u1ea1i vi\u00eam t\u1ee5y c\u1ea5p:<\/p>\n
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<>Vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 ph\u00f9 n\u1ec1 hay vi\u00eam m\u00f4 k\u1ebd t\u1ee5y.<\/li>\n
<>Vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 ho\u1ea1i t\u1eed:\n
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<>Th\u01b0\u1eddng g\u1eb7p l\u00e0 ho\u1ea1i t\u1eed c\u1ea3 m\u00f4 t\u1ee5y v\u00e0 m\u00f4 quanh t\u1ee5y.<\/li>\n
<>\u00cdt g\u1eb7p h\u01a1n l\u00e0 ch\u1ec9 ho\u1ea1i t\u1eed m\u00f4 quanh t\u1ee5y<\/li>\n
<>Hi\u1ebfm g\u1eb7p ho\u1ea1i t\u1eed nhu m\u00f4 t\u1ee5y \u0111\u01a1n thu\u1ea7n.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
<> $\"\"$ <\/p>\n
<>CHU\u1ea8N \u0110O\u00c1N VI\u00caM T\u1ee4Y C\u1ea4P<\/h2>\n
<>Khi c\u00f3 2\/3 ti\u00eau chu\u1ea9n sau:
\n<>- \u0110au b\u1ee5ng ph\u00f9 h\u1ee3p v\u1edbi vi\u00eam t\u1ee5y c\u1ea5p: kh\u1edfi ph\u00e1t c\u1ea5p t\u00ednh, k\u00e9o d\u00e0i, d\u1eef d\u1ed9i, \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, th\u01b0\u1eddng lan ra sau l\u01b0ng.
\n<>- Enzym amylase ho\u1eb7c lipase t\u0103ng tr\u00ean 3 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean b\u00ecnh th\u01b0\u1eddng.
\n<>- \u0110\u1eb7c tr\u01b0ng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p tr\u00ean CLVT c\u00f3 ti\u00eam thu\u1ed1c c\u1ea3n quang, \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n l\u00e0 MRI, ho\u1eb7c si\u00eau \u00e2m.
\n<>- Ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng d\u1ef1a v\u00e0o d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 men t\u1ee5y, CLVT ch\u1ec9 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi c\u00e1c ti\u00eau ch\u00ed tr\u00ean kh\u00f4ng r\u00f5 r\u00e0ng.<\/p>\n
<> $\"\"$
\n<>Nh\u1eefng h\u00ecnh \u1ea3nh n\u00e0y l\u00e0 c\u1ee7a 1 b\u1ec7nh nh\u00e2n \u0111au b\u1ee5ng d\u1eef d\u1ed9i v\u00f9ng th\u01b0\u1ee3ng v\u1ecb g\u1ee3i \u00fd \u0111\u1ebfn vi\u00eam t\u1ee5y c\u1ea5p. <>Tuy nhi\u00ean men t\u1ee5y \u1edf trong m\u1ee9c b\u00ecnh th\u01b0\u1eddng, v\u00e0 CLVT c\u00f3 ti\u00eam thu\u1ed1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. <>Quan s\u00e1t th\u1ea5y:<\/p>\n
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<>H\u1ea7u h\u1ebft t\u1ee5y b\u00ecnh th\u01b0\u1eddng<\/li>\n
<>Ghi nh\u1eadn h\u00ecnh \u1ea3nh ph\u00f9 n\u1ec1 \u1edf m\u1ecfm m\u00f3c \u0111\u1ea7u t\u1ee5y (m\u0169i t\u00ean xanh)<\/li>\n
<>Ph\u00f9 n\u1ec1 m\u00f4 m\u1ee1 quanh t\u1ee5y (m\u0169i t\u00ean v\u00e0ng), ph\u00f9 h\u1ee3p v\u1edbi vi\u00eam m\u00f4 k\u1ebd t\u1ee5y.<\/li>\n<\/ul>\n
<>Kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng n\u00e0o v\u00e0 ch\u1ea9n \u0111o\u00e1n l\u00e0 vi\u00eam t\u1ee5y c\u1ea5p m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/p>\n
<> $\"\"$ <\/p>\n
<>\u0110\u1eb6C \u0110I\u1ec2M L\u00c2M S\u00c0NG<\/h2>\n
<>Vi\u1ec7c s\u1edbm ph\u00e2n t\u1ea7ng m\u1ee9c \u0111\u1ed9 vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 r\u1ea5t quan tr\u1ecdng:<\/p>\n
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<>Vi\u00eam t\u1ee5y c\u1ea5p nh\u1eb9: kh\u00f4ng c\u00f3 suy t\u1ea1ng, h\u1ea7u h\u1ebft kh\u00f4ng c\u00f3 t\u1ee5 d\u1ecbch v\u00e0 ho\u1ea1i t\u1eed, th\u01b0\u1eddng h\u1ed3i ph\u1ee5c v\u00e0o cu\u1ed1i tu\u1ea7n \u0111\u1ea7u ti\u00ean.<\/li>\n
<>Vi\u00eam t\u1ee5y c\u1ea5p v\u1eeba v\u00e0 n\u1eb7ng: t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c v\u00e0o ph\u1ea3n \u1ee9ng c\u01a1 th\u1ec3 v\u1edbi vi\u00eam t\u1ee5y.\n
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<>\u2018C\u01a1n b\u00e3o Cytokine\u2019, l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a \u0111\u00e1p \u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng(SIRS), l\u00e0m t\u0103ng nguy c\u01a1 suy t\u1ea1ng.<\/li>\n
<>Suy t\u1ea1ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi: suy h\u00f4 h\u1ea5p (gi\u1ea3m pO2), suy th\u1eadn (t\u0103ng creatinin), v\u00e0 suy tu\u1ea7n ho\u00e0n (huy\u1ebft \u00e1p t\u1ee5t).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
<>M\u1ee9c \u0111\u1ed9 thay \u0111\u1ed5i h\u00ecnh th\u00e1i nh\u01b0 ho\u1ea1i t\u1eed v\u00e0 t\u1ee5 d\u1ecbch kh\u00f4ng t\u1ef7 l\u1ec7 thu\u1eadn v\u1edbi m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a suy t\u1ea1ng. <>Tuy nhi\u00ean nhi\u1ec1u b\u1ec7nh nh\u00e2n trong s\u1ed1 n\u00e0y s\u1ebd b\u1ecb vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong t\u0103ng l\u00ean khi ho\u1ea1i t\u1eed b\u1ecb nhi\u1ec5m tr\u00f9ng.<\/p>\n
<> $\"\"$ <\/p>\n
<>PH\u00c2N LO\u1ea0I ATLANTA V\u1ec0 T\u1ee4 D\u1ecaCH TRONG VI\u00caM T\u1ee4Y<\/h2>\n
<>Atlanta 2012 ph\u00e2n lo\u1ea1i t\u1ee5 d\u1ecbch quanh t\u1ee5y trong vi\u00eam t\u1ee5y c\u1ea5p d\u1ef1a v\u00e0o th\u00e0nh ph\u1ea7n, m\u1ee9c \u0111\u1ed9 t\u1ea1o v\u00e1ch v\u00e0 th\u1eddi gian, g\u1ed3m 4 lo\u1ea1i:<\/p>\n
<>V\u1ec1 th\u00e0nh ph\u1ea7n<\/h3>\n
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<>Ch\u1ec9 c\u00f3 d\u1ecbch: g\u1ed3m t\u1ee5 d\u1ecbch c\u1ea5p t\u00ednh quanh t\u1ee5y (APFC) v\u00e0 nang gi\u1ea3 t\u1ee5y (Pseudocyst).<\/li>\n
<>H\u1ed7n h\u1ee3p d\u1ecbch v\u00e0 ch\u1ea5t ho\u1ea1i t\u1eed: g\u1ed3m t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed c\u1ea5p t\u00ednh (ANC) v\u00e0 t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed c\u00f3 v\u1ecf (WON).<\/li>\n<\/ul>\n
<>V\u1ec1 m\u1ee9c \u0111\u1ed9 t\u1ea1o v\u1ecf<\/h3>\n
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<>Kh\u00f4ng c\u00f3 ho\u1eb7c t\u1ea1o v\u1ecf 1 ph\u1ea7n trong APFC v\u00e0 ANC.<\/li>\n
<>T\u1ea1o v\u1ecf ho\u00e0n to\u00e0n trong Pseudocyst v\u00e0 WON.<\/li>\n<\/ul>\n
<>V\u1ec1 th\u1eddi gian<\/h3>\n
<>Trong v\u00f2ng 4 tu\u1ea7n: APFC v\u00e0 ANC. Tr\u00ean 4 tu\u1ea7n: Pseudocyst v\u00e0 WON, c\u1ea7n th\u1eddi gian kho\u1ea3ng 4 tu\u1ea7n \u0111\u1ec3 v\u00e1ch \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh. <>Tr\u00ean CLVT vi\u1ec7c ph\u00e2n bi\u1ec7t APFC v\u00e0 ANC l\u00e0 kh\u00f3 kh\u0103n, nh\u1ea5t l\u00e0 trong tu\u1ea7n \u0111\u1ea7u, n\u00ean thu\u1eadt ng\u1eef \u201ct\u1ee5 d\u1ecbch quanh t\u1ee5y kh\u00f4ng x\u00e1c \u0111\u1ecbnh\u201d th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. <>D\u1ecbch n\u00e0y c\u00f3 th\u1ec3 v\u1eabn v\u00f4 tr\u00f9ng ho\u1eb7c nhi\u1ec5m tr\u00f9ng. Nh\u01b0ng nhi\u1ec5m tr\u00f9ng l\u00e0 hi\u1ebfm trong tu\u1ea7n \u0111\u1ea7u.<\/p>\n
$\"\"$ <\/p>\n
<>B\u1ea3ng n\u00e0y t\u00f3m t\u1eaft ti\u00eau ch\u00ed v\u1ec1 CLVT c\u1ee7a t\u1ee5 d\u1ecbch t\u1ee5y v\u00e0 quanh t\u1ee5y trong vi\u00eam t\u1ee5y c\u1ea5p.
\n<>\u2022 APFC: t\u1ee5 d\u1ecbch quanh t\u1ee5y ch\u1ec9 ch\u1ee9a d\u1ecbch v\u00e0 kh\u00f4ng ho\u1eb7c c\u00f3 1 ph\u1ea7n v\u00e1ch, ch\u00fang ch\u1ec9 quan s\u00e1t \u0111\u01b0\u1ee3c trong 4 tu\u1ea7n \u0111\u1ea7u c\u1ee7a vi\u00eam m\u00f4 k\u1ebd t\u1ee5y v\u00e0 th\u01b0\u1eddng t\u1ef1 tho\u00e1i lui.
\n<>\u2022 ANC: h\u1ed7n h\u1ee3p ch\u1ee9a d\u1ecbch v\u00e0 ch\u1ea5t ho\u1ea1i t\u1eed, ch\u00fang th\u01b0\u1eddng kh\u00f4ng c\u00f3 ho\u1eb7c c\u00f3 1 ph\u1ea7n v\u00e1ch, \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y trong 4 tu\u1ea7n \u0111\u1ea7u c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 ho\u1ea1i t\u1eed.
\n<>\u2022 Pseudosyct: sau 4 tu\u1ea7n c\u1ee7a vi\u00eam m\u00f4 k\u1ebd t\u1ee5y, t\u1ee5 d\u1ecbch n\u00e0y \u0111\u01b0\u1ee3c v\u00e1ch h\u00f3a. Nang gi\u1ea3 t\u1ee5y kh\u00f4ng th\u01b0\u1eddng g\u1eb7p trong vi\u00eam t\u1ee5y c\u1ea5p. H\u1ea7u h\u1ebft t\u1ee5 d\u1ecbch l\u00e2u ng\u00e0y s\u1ebd ch\u1ee9a m\u1ed9t s\u1ed1 ch\u1ea5t ho\u1ea1i t\u1eed.
\n<>\u2022 WON: Sau 4 tu\u1ea7n, h\u1ea7u h\u1ebft t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed \u0111\u01b0\u1ee3c v\u00e1ch h\u00f3a v\u00e0 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ho\u1ea1i t\u1eed c\u00f3 v\u1ecf ( Walled- off necrosis).<\/p>\n\n\n\n\n
<>T\u1ee5 d\u1ecbch quanh t\u1ee5y c\u1ea5p t\u00ednh (APFC)<\/p>\n
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<>< 4 tu\u1ea7n<\/li>\n
<>Trong vi\u00eam m\u00f4 k\u1ebd t\u1ee5y<\/li>\n
<>\u0110\u1eadm \u0111\u1ed9 d\u1ecbch \u0111\u1ed3ng nh\u1ea5t<\/li>\n
<>Kh\u00f4ng c\u00f3 v\u00e1ch r\u00f5 r\u00e0ng<\/li>\n
<>G\u1ea7n k\u1ec1 v\u1edbi t\u1ee5y<\/li>\n
<>Gi\u1edbi h\u1ea1n b\u1edfi b\u1ec1 m\u1eb7t c\u00e2n ho\u1eb7c c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu b\u00ecnh th\u01b0\u1eddng<\/li>\n<\/ul>\n<\/td>\n
T\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed c\u1ea5p t\u00ednh (ANC)<\/p>\n
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< 4 tu\u1ea7n<\/li>\n
Trong vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed<\/li>\n
D\u1ecbch kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t<\/li>\n
Kh\u00f4ng c\u00f3 v\u00e1ch r\u00f5 r\u00e0ng<\/li>\n
Trong ho\u1eb7c ngo\u00e0i t\u1ee5y<\/li>\n<\/ul>\n
<\/td>\n<\/tr>\n
Nang gi\u1ea3 t\u1ee5y (Pseudocyst)<\/p>\n
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4 tu\u1ea7n<\/li>\n
Trong vi\u00eam m\u00f4 k\u1ebd t\u1ee5y<\/li>\n
\u0110\u1eadm \u0111\u1ed9 d\u1ecbch \u0111\u1ed3ng nh\u1ea5t<\/li>\n
C\u00f3 v\u00e1ch r\u00f5 r\u00e0ng<\/li>\n
G\u1ea7n k\u1ec1 v\u1edbi t\u1ee5y<\/li>\n
Kh\u00f4ng ch\u1ee9a th\u00e0nh ph\u1ea7n \u0111\u1eb7c.<\/li>\n<\/ul>\n<\/td>\n
Ho\u1ea1i t\u1eed t\u1ea1o v\u00e1ch (WON)<\/p>\n
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> 4 tu\u1ea7n<\/li>\n
Trong vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed<\/li>\n
D\u1ecbch kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t<\/li>\n
C\u00f3 v\u00e1ch r\u00f5 r\u00e0ng<\/li>\n
Trong ho\u1eb7c ngo\u00e0i tuy\u1ebfn t\u1ee5y<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
CTSI (CT severity index)<\/h2>\n
Ch\u1ec9 s\u1ed1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p tr\u00ean CT (CTSI- CT several index) = thang \u0111i\u1ec3m Balthazar( 0-4 \u0111i\u1ec3m) + \u0111i\u1ec3m ho\u1ea1i t\u1eed t\u1ee5y (0-6 \u0111i\u1ec3m).<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
CT several index (CTSI)<\/td>\n<\/tr>\n
T\u1ee5y vi\u00eam <\/strong><\/td>\n \u0110i\u1ec3m<\/strong><\/td>\n<\/tr>\n
T\u1ee5y b\u00ecnh th\u01b0\u1eddng<\/td>\n 0<\/td>\n<\/tr>\n
T\u1ee5y t\u0103ng k\u00edch th\u01b0\u1edbc<\/td>\n 1<\/td>\n<\/tr>\n
Vi\u00eam quanh t\u1ee5y<\/td>\n 2<\/td>\n<\/tr>\n
1 \u1ed5 t\u1ee5 d\u1ecbch quanh t\u1ee5y<\/td>\n 3<\/td>\n<\/tr>\n
\u2265 2 \u1ed5 d\u1ecbch quanh t\u1ee5y<\/td>\n 4<\/td>\n<\/tr>\n
Ho\u1ea1i t\u1eed t\u1ee5y <\/strong><\/td>\n <\/td>\n<\/tr>\n
Kh\u00f4ng ho\u1ea1i t\u1eed<\/td>\n 0<\/td>\n<\/tr>\n
< 30%<\/td>\n 2<\/td>\n<\/tr>\n
30-50%<\/td>\n 4<\/td>\n<\/tr>\n
> 50%<\/td>\n 6<\/td>\n<\/tr>\n
T\u1ed5ng \u0111i\u1ec3m: <\/strong><\/td>\n 10<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
CH\u1ea8N \u0110O\u00c1N H\u00ccNH \u1ea2NH<\/h2>\n
CLVT l\u00e0 ph\u01b0\u01a1ng th\u1ee9c \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n, ph\u00e2n lo\u1ea1i vi\u00eam t\u1ee5y c\u1ea5p v\u00e0 bi\u1ebfn ch\u1ee9ng. Do ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p th\u01b0\u1eddng d\u1ef1a tr\u00ean l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m, ch\u1ee5p CLVT giai \u0111o\u1ea1n s\u1edbm ch\u1ec9 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi ch\u1ea9n \u0111o\u00e1n ch\u01b0a ch\u1eafc ch\u1eafn ho\u1eb7c khi nghi ng\u1edd bi\u1ebfn ch\u1ee9ng s\u1edbm nh\u01b0 th\u1ee7ng ru\u1ed9t hay thi\u1ebfu m\u00e1u ru\u1ed9t. Ch\u1ee5p CLVT giai \u0111o\u1ea1n s\u1edbm c\u00f3 th\u1ec3 g\u00e2y sai l\u1ea7m v\u1ec1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a vi\u00eam t\u1ee5y, v\u00ec n\u00f3 \u0111\u00e1nh gi\u00e1 th\u1ea5p s\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 l\u01b0\u1ee3ng ho\u1ea1i t\u1eed. H\u00ecnh \u1ea3nh t\u1ee5y ng\u1ea5m thu\u1ed1c b\u00ecnh th\u01b0\u1eddng v\u00e0o ng\u00e0y th\u1ee9 nh\u1ea5t. Khi t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n t\u1ed3i t\u1ec7 h\u01a1n, CLVT l\u1ea7n th\u1ee9 2 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0o ng\u00e0y th\u1ee9 3. \u0110i\u1ec3m l\u01b0u \u00fd l\u00e0 h\u1ea7u nh\u01b0 th\u00e2n v\u00e0 \u0111u\u00f4i t\u1ee5y kh\u00f4ng ng\u1ea5m thu\u1ed1c, ch\u1ec9 ra l\u00e0 vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed (m\u0169i t\u00ean). H\u00ecnh \u1ea3nh CLVT ban \u0111\u1ea7u kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u00fang m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a vi\u00eam t\u1ee5y, BN n\u00e0y \u0111\u00e3 ch\u1ebft v\u00e0o ng\u00e0y th\u1ee9 5 do SIRS n\u1eb7ng v\u00e0 suy \u0111a t\u1ea1ng.<\/p>\n
$\"\"$ <\/p>\n
VI\u00caM M\u00d4 K\u1ebc T\u1ee4Y (Interstitial pancreatitis)<\/h2>\n
V\u1ec1 h\u00ecnh th\u00e1i c\u00f3 2 lo\u1ea1i vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 vi\u00eam m\u00f4 k\u1ebd hay vi\u00eam t\u1ee5y ph\u00f9 n\u1ec1, v\u00e0 vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed. \u0110\u00e2y l\u00e0 v\u00ed d\u1ee5 v\u1ec1 vi\u00eam m\u00f4 k\u1ebd t\u1ee5y.<\/p>\n
\n
T\u1ee5y ng\u1ea5m thu\u1ed1c b\u00ecnh th\u01b0\u1eddng v\u00e0 ch\u1ec9 c\u00f3 th\u00e2m nhi\u1ec5m m\u1ee1 xung quanh<\/li>\n
Kh\u00f4ng c\u00f3 t\u1ee5 d\u1ecbch v\u00e0 ho\u1ea1i t\u1eed nhu m\u00f4 t\u1ee5y<\/li>\n<\/ul>\n
CTSI: 2 \u0111i\u1ec3m<\/p>\n
$\"\"$ <\/p>\n
\u0110\u00e2y l\u00e0 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p kh\u00e1c vi\u00eam m\u00f4 k\u1ebd t\u1ee5y kh\u00f4ng k\u00e8m theo ho\u1ea1i t\u1eed. T\u1ee5y ph\u00f9 n\u1ec1 v\u00e0 vi\u00eam quanh t\u1ee5y. Kh\u00f4ng k\u00e8m theo ho\u1ea1i t\u1eed quanh t\u1ee5y.<\/p>\n
$\"\"$ <\/p>\n
<>VI\u00caM T\u1ee4Y HO\u1ea0I T\u1eec <>(Necrotizing pancreatitis)<\/h2>\n
Ho\u1ea1i t\u1eed nhu m\u00f4 t\u1ee5y hay m\u00f4 quanh t\u1ee5y x\u1ea3y ra 10-15% tr\u01b0\u1eddng h\u1ee3p, n\u00f3 \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng k\u00e9o d\u00e0i, t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng v\u00e0 t\u1eed vong cao. C\u00f3 3 lo\u1ea1i vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed:<\/p>\n
\n
Ho\u1ea1i t\u1eed c\u1ea3 nhu m\u00f4 t\u1ee5y v\u00e0 m\u00f4 quanh t\u1ee5y (th\u01b0\u1eddng g\u1eb7p).<\/li>\n
Ho\u1ea1i t\u1eed ch\u1ec9 s\u1ea3y ra \u1edf m\u00f4 quanh t\u1ee5y m\u00e0 kh\u00f4ng ho\u1ea1i t\u1eed nhu m\u00f4 t\u1ee5y (\u00edt g\u1eb7p).<\/li>\n
Ho\u1ea1i t\u1eed ch\u1ec9 \u1edf nhu m\u00f4 t\u1ee5y m\u00e0 kh\u00f4ng ho\u1ea1i t\u1eed m\u00f4 xung quanh (r\u1ea5t hi\u1ebfm).<\/li>\n<\/ol>\n
\n
Ho\u1ea1i t\u1eed nhu m\u00f4 c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n tr\u00ean CLVT c\u00f3 ti\u00eam thu\u1ed1c c\u1ea3n quang sau \u2a7e<\/li>\n
Ho\u1ea1i t\u1eed m\u00f4 xung quanh t\u1ee5y c\u00f3 th\u1ec3 kh\u00f3 ch\u1ea9n \u0111o\u00e1n, nh\u01b0ng nghi ng\u1edd khi c\u00f3 nh\u1eefng \u1ed5 t\u1ee5 d\u1ecbch kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t tr\u00ean CLVT.<\/li>\n<\/ul>\n
H\u00ecnh \u1ea3nh CLVT cho th\u1ea5y vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed<\/p>\n
\n
C\u1ea3 th\u00e2n v\u00e0 \u0111u\u00f4i t\u1ee5y kh\u00f4ng ng\u1ea5m thu\u1ed1c, trong khi \u0111\u1ea7u t\u1ee5y ng\u1ea5m thu\u1ed1c b\u00ecnh th\u01b0\u1eddng.<\/li>\n
Ho\u1ea1i t\u1eed tr\u00ean 50% nhu m\u00f4 t\u1ee5y v\u00e0 c\u00f3 \u00edt nh\u1ea5t 2 \u1ed5 t\u1ee5 d\u1ecbch<\/li>\n<\/ul>\n
CTSI: 4+6= 10 \u0111i\u1ec3m<\/p>\n
$\"\"$ <\/p>\n
MRI<\/h2>\n
MRI c\u00f3 gi\u00e1 tr\u1ecb h\u01a1n CLVT trong vi\u1ec7c ph\u00e2n bi\u1ec7t d\u1ecbch v\u00e0 ch\u1ea5t ho\u1ea1i t\u1eed. \u0110\u00e2y l\u00e0 h\u00ecnh \u1ea3nh CLVT c\u1ee7a 1 b\u1ec7nh nh\u00e2n c\u00f3 v\u00e0i \u1ed5 d\u1ecbch \u0111\u1ed3ng nh\u1ea5t quanh t\u1ee5y. Nh\u1eefng \u1ed5 d\u1ecbch n\u00e0y c\u00f3 t\u00edn hi\u1ec7u \u0111\u1ed3ng nh\u1ea5t tr\u00ean T2W x\u00f3a m\u1ee1, \u0111\u1ea7y \u0111\u1ee7 v\u00e1ch v\u00e0 ch\u1eafc ch\u1eafn l\u00e0 d\u1ecbch ( nang gi\u1ea3 t\u1ee5y).<\/p>\n
$\"\"$ <\/p>\n
B\u1ec7nh nh\u00e2n n\u00e0y b\u1ecb vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 ho\u1ea1i t\u1eed kh\u1edfi ph\u00e1t 2 th\u00e1ng tr\u01b0\u1edbc. Tr\u00ean CLVT ch\u1ec9 ra t\u1ee5 d\u1ecbch quanh t\u1ee5y \u0111\u1ed3ng nh\u1ea5t \u1edf v\u1ecb tr\u00ed gi\u1eefa c\u1ee7a \u0111\u1ea1i tr\u00e0ng ngang (m\u0169i t\u00ean). Tr\u00ean xung T2W-MRI ch\u1ec9 ra d\u1ecbch c\u00f3 c\u01b0\u1eddng \u0111\u1ed9 t\u00edn hi\u1ec7u th\u1ea5p (m\u0169i t\u00ean) v\u00ec \u0111\u00e2y l\u00e0 ho\u1ea1i t\u1eed m\u00f4 m\u1ee1 quanh t\u1ee5y. B\u1ec7nh nh\u00e2n kh\u00f4ng s\u1ed1t v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng. Tr\u01b0\u1eddng h\u1ee3p n\u00e0y, n\u1ed9i soi d\u1eabn l\u01b0u hay d\u1eabn l\u01b0u qua da \u00edt gi\u00e1 tr\u1ecb nh\u01b0ng l\u1ea1i l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng.<\/p>\n
$\"\"$ <\/p>\n
<>T\u1ee4 D\u1ecaCH QUANH T\u1ee4Y<\/h2>\n
T\u1ee5 d\u1ecbch quanh t\u1ee5y c\u1ea5p t\u00ednh (APFC)<\/h3>\n
T\u1ee5 d\u1ecbch trong \u1ed5 b\u1ee5ng v\u00e0 t\u1ee5 d\u1ecbch m\u00f4 ho\u1ea1i t\u1eed th\u01b0\u1eddng g\u1eb7p trong vi\u00eam t\u1ee5y c\u1ea5p. T\u1ee5 d\u1ecbch n\u00e0y h\u00ecnh th\u00e0nh s\u1edbm trong vi\u00eam t\u1ee5y c\u1ea5p. Giai \u0111o\u1ea1n \u0111\u1ea7u, t\u1ee5 d\u1ecbch n\u00e0y ch\u01b0a c\u00f3 v\u00e1ch hay t\u1ea1o v\u1ecf<\/p>\n
V\u1ecb tr\u00ed hay g\u1eb7p c\u1ee7a t\u1ee5 d\u1ecbch:<\/p>\n
\n
H\u1eadu cung m\u1ea1c n\u1ed1i<\/li>\n
Khoang c\u1ea1nh th\u1eadn tr\u01b0\u1edbc v\u00e0 sau<\/li>\n
R\u00e3nh \u0111\u1ea1i tr\u00e0ng ngang<\/li>\n
M\u1ea1c treo ru\u1ed9t non<\/li>\n<\/ul>\n
T\u1ee5 d\u1ecbch l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a s\u1ef1 gi\u1ea3i ph\u00f3ng c\u00e1c enzym t\u1ee5y ho\u1ea1t h\u00f3a l\u00e0m ho\u1ea1i t\u1eed m\u00f4 xung quanh t\u1ee5y. \u0110i\u1ec1u n\u00e0y gi\u1ea3i th\u00edch 1 s\u1ed1 \u1ed5 d\u1ecbch l\u1ea1i ch\u1ee9a c\u00e1c m\u1ea3nh ho\u1ea1i t\u1eed.<\/p>\n
Kho\u1ea3ng 50% t\u1ee5 d\u1ecbch n\u00e0y t\u1ef1 tho\u00e1i lui (v\u1ec1 h\u00ecnh d\u1ea1ng). Kho\u1ea3ng 50% c\u00f2n l\u1ea1i ho\u1eb7c \u1ed5n d\u1ecbnh ho\u1eb7c t\u0103ng l\u00ean v\u00e0 t\u1ea1o v\u1ecf. Ch\u00fang c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i v\u00f4 tr\u00f9ng ho\u1eb7c s\u1ebd nhi\u1ec5m tr\u00f9ng. $\"\"$ <\/p>\n
<>T\u1ee4 D\u1ecaCH HO\u1ea0I T\u1eec C\u1ea4P T\u00cdNH <>(Acute necrotic collection-ANC<>)<\/h3>\n
Tr\u00ean h\u00ecnh \u1ea3nh:<\/p>\n
\n
Ho\u1ea1i t\u1eed nhu m\u00f4 t\u1ee5y<\/li>\n
T\u1ee5 d\u1ecbch kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t m\u00f4 quanh t\u1ee5y.<\/li>\n
Kh\u00f4ng c\u00f3 v\u00e1ch.<\/li>\n<\/ul>\n
=> c\u00f3 th\u1ec3 k\u1ebft lu\u1eadn t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed c\u1ea5p t\u00ednh – ANC<\/p>\n
$\"\"$ <\/p>\n
To\u00e0n b\u1ed9 t\u1ee5y ng\u1ea5m thu\u1ed1c b\u00ecnh th\u01b0\u1eddng. T\u1ee5 d\u1ecbch l\u1edbn quanh t\u1ee5y, bao g\u1ed3m c\u1ea3 th\u00e0nh ph\u1ea7n l\u1ecfng v\u00e0 \u0111\u1eb7c tr\u00ean CLVT. C\u00f3 \u00edt nh\u1ea5t 2 \u1ed5 t\u1ee5 d\u1ecbch, nh\u01b0ng nhu m\u00f4 t\u1ee5y kh\u00f4ng b\u1ecb ho\u1ea1i t\u1eed. V\u00e0o ng\u00e0y th\u1ee9 18, t\u1ee5 d\u1ecbch quanh t\u1ee5y t\u0103ng v\u00e0 h\u00ecnh th\u00e0nh v\u00e1ch kh\u00f4ng ho\u00e0n to\u00e0n. V\u00e0o ng\u00e0y th\u1ee9 5 s\u1ef1 t\u1ee5 d\u1ecbch n\u00e0y c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n l\u00e0 t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed c\u1ea5p t\u00ednh. V\u00e0o ng\u00e0y th\u1ee9 18, s\u1ef1 xu\u1ea5t hi\u1ec7n v\u00e1ch kh\u00f4ng ho\u00e0n to\u00e0n nh\u01b0ng c\u00f3 th\u1ec3 gi\u1ea3 \u0111\u1ecbnh r\u1eb1ng m\u1ed9t v\u00e0i ng\u00e0y n\u1eefa s\u1ebd t\u1ea1o th\u00e0nh ho\u1ea1i t\u1eed c\u00f3 v\u00e1ch ho\u00e0n ch\u1ec9nh.<\/p>\n
$\"\"$ <\/p>\n
N\u1ebfu t\u1ee5 d\u1ecbch t\u1ed3n t\u1ea1i dai d\u1eb3ng ho\u1eb7c ph\u00e1t tri\u1ec3n th\u00eam, c\u00f3 th\u1ec3 do ho\u1ea1i t\u1eed m\u00f4 m\u1ee1. B\u1edfi v\u00ec ch\u1ea5t b\u00e9o kh\u00f4ng t\u0103ng quang tr\u00ean CLVT, n\u00ean ch\u1ea9n \u0111o\u00e1n ho\u1ea1i t\u1eed m\u1ee1 c\u00f3 th\u1ec3 g\u1eb7p kh\u00f3 kh\u0103n. Ho\u1ea1i t\u1eed c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n tr\u00ean MRI, nh\u01b0ng ch\u1ec9 n\u00ean th\u1ef1c hi\u1ec7n khi c\u00f3 \u0111\u1ecbnh h\u01b0\u1edbng t\u1eeb l\u00e2m s\u00e0ng.<\/p>\n
<>NANG GI\u1ea2 T\u1ee4Y (pseudocyst<>)<\/h3>\n
B\u1ec7nh nh\u00e2n h\u1eb9p m\u00f4n v\u1ecb 2 th\u00e1ng sau vi\u00eam t\u1ee5y c\u1ea5p. C\u00f3 1 \u1ed5 d\u1ecbch ranh gi\u1edbi r\u00f5 \u1edf h\u1eadu cung m\u1ea1c n\u1ed1i, ch\u1ed7 ti\u1ebfp gi\u00e1p d\u1ea1 d\u00e0y v\u00e0 t\u1ee5y. B\u1ec7nh nh\u00e2n kh\u00f4ng s\u1ed1t. \u1ed4 d\u1ecbch n\u00e0y \u0111\u01b0\u1ee3c d\u1eabn l\u01b0u th\u00e0nh c\u00f4ng qua da, d\u1ecbch trong v\u00e0 n\u1ed3ng \u0111\u1ed9 amylase cao, v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft. \u0110\u00e2y l\u00e0 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p nang gi\u1ea3 t\u1ee5y th\u1ef1c s\u1ef1.<\/p>\n
$\"\"$ <\/p>\n
Nang gi\u1ea3 t\u1ee5y l\u00e0 s\u1ef1 t\u1ee5 d\u1ecbch v\u1edbi m\u1ed9t v\u1ecf x\u01a1 ho\u00e0n ch\u1ec9nh. Ch\u1ea9n \u0111o\u00e1n trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 ph\u00f9 n\u1ec1, kh\u00f4ng k\u00e8m theo h\u1ecdai t\u1eed. C\u00f3 th\u1ec3 th\u00f4ng v\u1edbi \u1ed1ng t\u1ee5y. Th\u1eddi gian >= 4 tu\u1ea7n. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t bao g\u1ed3m: WON, gi\u1ea3 ph\u00ecnh m\u1ea1ch v\u00e0 1 kh\u1ed1i u nang. Hay g\u1eb7p trong h\u1eadu cung m\u1ea1c n\u1ed1i. H\u1ea7u h\u1ebft c\u00e1c \u1ed5 t\u1ee5 d\u1ecbch t\u1ed3n t\u1ea1i sau 4 tu\u1ea7n l\u00e0 WON, nang gi\u1ea3 t\u1ee5y th\u1ef1c s\u1ef1 kh\u00f4ng ph\u1ed5 bi\u1ebfn v\u00ec ph\u1ea7n l\u1edbn d\u1ecbch quanh t\u1ee5y c\u1ea5p t\u00ednh t\u1ef1 ti\u00eau tan trong v\u00f2ng 4 tu\u1ea7n.<\/p>\n
<>T\u1ee4 D\u1ecaCH HO\u1ea0I T\u1eec C\u00d3 V\u1ece <>( Walled-off necrosis- WON<>)<\/h3>\n
Ch\u1ec9 d\u1ef1a v\u00e0o CLVT \u0111\u00f4i khi kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c t\u1ee5 d\u1ecbch \u0111\u01a1n thu\u1ea7n hay d\u1ecbch k\u00e8m theo m\u00f4 ho\u1ea1i t\u1eed. Do v\u1eady, \u0111\u00f4i khi m\u00f4 t\u1ea3 \u201ct\u1ee5 d\u1ecbch kh\u00f4ng x\u00e1c \u0111\u1ecbnh\u201d l\u00e0 t\u1ed1t nh\u1ea5t. Nh\u1eefng h\u00ecnh \u1ea3nh n\u00e0y l\u00e0 c\u1ee7a 1 b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p. H\u00ecnh \u1ea3nh ph\u00eda tr\u00ean l\u00e0 t\u1ee5 d\u1ecbch quanh \u0111\u1ea7u t\u1ee5y \u1edf khoang c\u1ea1nh th\u1eadn tr\u01b0\u1edbc b\u00ean ph\u1ea3i. \u1ede giai \u0111o\u1ea1n n\u00e0y kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c gi\u1eefa APFC v\u00e0 ANC<\/p>\n
$\"\"$ <\/p>\n
CLVT theo d\u00f5i, \u1ed5 t\u1ee5 d\u1ecbch t\u0103ng l\u00ean v\u1ec1 k\u00edch th\u01b0\u1edbc, l\u00e0 nang d\u1ecbch \u0111\u01a1n thu\u1ea7n v\u1edbi v\u1ecf m\u1ecfng, ng\u1ea5m thu\u1ed1c. C\u00f3 th\u1ec3 l\u00e0 nang gi\u1ea3 t\u1ee5y ho\u1eb7c WON, c\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng nhi\u1ec5m tr\u00f9ng. B\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng nhi\u1ec5m tr\u00f9ng v\u00e0 d\u1eabn l\u01b0u qua da \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. Sau d\u1eabn l\u01b0u, \u1ed5 t\u1ee5 d\u1ecbch kh\u00f4ng gi\u1ea3m v\u1ec1 k\u00edch th\u01b0\u1edbc. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt v\u00e0 \u1ed5 d\u1ecbch \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y bao g\u1ed3m c\u00e1c m\u1ea3nh ho\u1ea1i t\u1eed, c\u00e1i kh\u00f4ng nh\u00ecn nh\u1eadn \u0111\u01b0\u1ee3c tr\u00ean CT, do \u0111\u00f3 \u0111\u00e2y l\u00e0 ho\u1ea1i t\u1eed c\u00f3 v\u00e1ch ch\u1ee9 kh\u00f4ng ph\u1ea3i l\u00e0 nang gi\u1ea3 t\u1ee5y. M\u1ea3nh ho\u1ea1i t\u1eed n\u00e0y qu\u00e1 nh\u1edbt \u0111\u1ec3 d\u1eabn l\u01b0u th\u00e0nh c\u00f4ng qua da.<\/p>\n
H\u00ecnh \u1ea3nh CLVT c\u1ee7a 1 b\u1ec7nh nh\u00e2n v\u00e0o ng\u00e0y th\u1ee9 40 c\u1ee7a vi\u00eam t\u1ee5y. B\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 ho\u1ea1i t\u1eed trung t\u00e2m tuy\u1ebfn t\u1ee5y v\u00e0 hi\u1ec7n t\u1ea1i c\u00f3 s\u1ed1t. H\u00ecnh \u1ea3nh CT ch\u1ec9 ra \u1ed5 t\u1ee5 d\u1ecbch c\u00f3 t\u1ef7 tr\u1ecdng t\u01b0\u01a1ng t\u1ef1 nang gi\u00e1 t\u1ee5y, ngo\u1ea1i tr\u1eeb v\u1ecb tr\u00ed n\u1eb1m trong t\u1ee5y. T\u1ee5 d\u1ecbch \u0111\u1ed3ng nh\u1ea5t v\u00e0 c\u00f3 ranh gi\u1edbi r\u00f5 r\u00e0ng v\u1edbi 1 v\u00e1ch m\u1ecfng ti\u1ebfp gi\u00e1p v\u1edbi d\u1ea1 d\u00e0y. B\u00f3c t\u00e1ch qua n\u1ed9i soi, \u1ed5 d\u1ecbch n\u00e0y bao g\u1ed3m d\u1ecbch v\u00e0 t\u1ed5 ch\u1ee9c ho\u1ea1i t\u1eed, \u0111\u01b0\u1ee3c l\u1ea5y ra kh\u1ecfi t\u1ee5y. M\u1eb7c d\u00f9 \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh tr\u01b0\u1eddng h\u1ee3p n\u00e0y t\u01b0\u01a1ng t\u1ef1 nh\u01b0 nang gi\u1ea3 t\u1ee5y nh\u01b0ng n\u00f3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 ho\u1ea1i t\u1eed c\u00f3 v\u1ecf nhi\u1ec5m tr\u00f9ng.<\/p>\n
$\"\"$ <\/p>\n
\u1ede \u0111\u00e2y ch\u00fang ta quan s\u00e1t \u0111\u01b0\u1ee3c \u1ed5 t\u1ee5 d\u1ecbch \u0111\u1ed3ng nh\u1ea5t c\u1ee7a t\u1ee5y v\u00e0 quanh t\u1ee5y, c\u00f3 ranh gi\u1edbi r\u00f5 v\u1edbi 1 v\u00e1ch ng\u1ea5m thu\u1ed1c, v\u00e0o ng\u00e0y th\u1ee9 25 c\u1ee7a \u0111\u1ee3t vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 ho\u1ea1i t\u1eed. B\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1t v\u00e0 suy \u0111a t\u1ea1ng. V\u00ec v\u1eady \u1ed5 t\u1ee5 d\u1ecbch ngh\u0129 \u0111\u1ebfn t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed c\u00f3 v\u1ecf nhi\u1ec5m tr\u00f9ng ch\u1ee9 kh\u00f4ng ph\u1ea3i l\u00e0 nang gi\u1ea3 t\u1ee5y. Khi ph\u1eabu thu\u1eadt, \u1ed5 d\u1ecbch n\u00e0y bao g\u1ed3m c\u00e1c t\u1ed5 ch\u1ee9c ho\u1ea1i t\u1eed v\u00e0 ch\u00fang kh\u00f4ng quan s\u00e1t \u0111\u01b0\u1ee3c tr\u00ean CLVT.<\/p>\n
$\"\"$ <\/p>\n
<>HO\u1ea0I T\u1eec NHI\u1ec4M TR\u00d9NG <>(Infected necrosis)<\/h3>\n
Ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng l\u00e0:<\/p>\n
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Nhi\u1ec5m tr\u00f9ng m\u00f4 t\u1ee5y ho\u1ea1i t\u1eed ho\u1eb7c m\u00f4 m\u1ee1 quanh t\u1ee5y. V\u00ed d\u1ee5: ANC hay WON nhi\u1ec5m tr\u00f9ng, ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 t\u1ea1o v\u1ecf.<\/li>\n
Th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n t\u1eeb tu\u1ea7n th\u1ee9 2-4, hi\u1ebfm khi \u1edf tu\u1ea7n \u0111\u1ea7u ti\u00ean<\/li>\n
L\u00e0 bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7 n\u1eb7ng n\u1ec1 nh\u1ea5t c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 ho\u1ea1i t\u1eed.<\/li>\n
L\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y t\u1eed vong cho b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 ho\u1ea1i t\u1eed.<\/li>\n
Ch\u1ea9n \u0111o\u00e1n khi th\u1ea5y c\u00e1c b\u00f3ng kh\u00ed tr\u00ean CLVT ho\u1eb7c khi FNA c\u1ea5y khu\u1ea9n d\u01b0\u01a1ng t\u00ednh.<\/li>\n<\/ul>\n
Tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 m\u1ed9t v\u00ed d\u1ee5 cho ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng:<\/p>\n
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Ng\u00e0y th\u1ee9 1, T\u1ee5y ng\u1ea5m thu\u1ed1c \u0111\u1ed3ng nh\u1ea5t v\u00e0 n\u00f3 gi\u1ed1ng nh\u01b0 vi\u00eam m\u00f4 k\u1ebd t\u1ee5y m\u1ee9c \u0111\u1ed9 nh\u1eb9.<\/li>\n
Ng\u00e0y th\u1ee9 3, t\u1ee5y kh\u00f4ng ng\u1ea5m thu\u1ed1c ph\u00f9 h\u1ee3p v\u1edbi ho\u1ea1i t\u1eed. Ho\u1ea1i t\u1eed ch\u1ec9 bao g\u1ed3m m\u00f4 quanh t\u1ee5y, v\u00ec v\u1eady \u0111\u00e2y l\u00e0 t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed c\u1ea5p t\u00ednh (ANC).<\/li>\n
Ng\u00e0y th\u1ee9 17, c\u00f3 c\u00e1c b\u00f3ng kh\u00ed trong t\u1ed5 ch\u1ee9c ho\u1ea1i t\u1eed, ph\u00f9 h\u1ee3p v\u1edbi nhi\u1ec5m tr\u00f9ng ho\u1ea1i t\u1eed nhu m\u00f4 t\u1ee5y v\u00e0 m\u00f4 quanh t\u1ee5y. C\u00f3 1 v\u00e1ch quanh \u1ed5 d\u1ecbch.<\/li>\n<\/ul>\n
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Thu\u1eadt ng\u1eef \u00e1p xe t\u1ee5y kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00ec 1 \u1ed5 t\u1ee5 d\u1ecbch m\u1ee7 m\u00e0 kh\u00f4ng k\u00e8m theo m\u00f4 ho\u1ea1i t\u1eed l\u00e0 c\u1ef1c k\u00ec hi\u1ebfm trong vi\u00eam t\u1ee5y c\u1ea5p.<\/p>\n
\u1ede b\u1ec7nh nh\u00e2n n\u00e0y t\u1ee5y ng\u1ea5m thu\u1ed1c b\u00ecnh th\u01b0\u1eddng, t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t xung quanh t\u1ee5y v\u1edbi t\u1ef7 tr\u1ecdng c\u1ee7a d\u1ecbch v\u00e0 m\u1ee1. 2 tu\u1ea7n sau \u0111\u00f3, c\u00f3 kh\u00ed trong \u1ed5 d\u1ecbch quanh t\u1ee5y, ph\u00f9 h\u1ee3p v\u1edbi ANC nhi\u1ec5m tr\u00f9ng. B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt, b\u00e1c s\u0129 \u0111\u00e3 l\u1ea5y ra m\u1ed9t l\u01b0\u1ee3ng l\u1edbn m\u00f4 ho\u1ea1i t\u1eed,v\u00e0 \u01b0\u1edbc t\u00ednh \u0111\u00e3 c\u1eaft b\u1ecf h\u01a1n 90% tuy\u1ebfn t\u1ee5y.<\/p>\n
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\u0110\u00e1ng ch\u00fa \u00fd, CLVT \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n 6 th\u00e1ng sau ph\u1eabu thu\u1eadt cho th\u1ea5y tuy\u1ebfn t\u1ee5y b\u00ecnh th\u01b0\u1eddng. \u0110i\u1ec1u n\u00e0y ch\u1ec9 ra r\u1eb1ng trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt, \u0111\u00f4i khi kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t gi\u1eefa m\u00f4 t\u1ee5y ho\u1ea1i t\u1eed v\u00e0 ho\u1ea1i t\u1eed m\u00f4 quanh t\u1ee5y.<\/p>\n
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<>NH\u1eeeNG H\u1ea0N CH\u1ebe C\u1ee6A C\u0110HA<\/p>\n
H\u00ecnh \u1ea3nh c\u00f3 th\u1ec3 th\u01b0\u1eddng xuy\u00ean kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c t\u1ee5 d\u1ecbch v\u00f4 tr\u00f9ng v\u00e0 nhi\u1ec5m tr\u00f9ng, khi ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng ch\u1ec9 40% xu\u1ea5t hi\u1ec7n kh\u00ed trong \u1ed5 ho\u1ea1i t\u1eed. CLVT c\u00f3 th\u1ec3 kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c gi\u1eefa d\u1ecbch \u0111\u01a1n thu\u1ea7n v\u00e0 d\u1ecbch k\u00e8m theo c\u00e1c m\u1ea3nh v\u1ee5n ho\u1ea1i t\u1eed, MRI th\u00ec \u01b0u vi\u1ec7t h\u01a1n.<\/p><\/blockquote>\n
<>HO\u1ea0I T\u1eec TRUNG T\u00c2M TUY\u1ebeN T\u1ee4Y <>(central gland necrosis)<\/h3>\n
L\u00e0 1 d\u1ea1ng \u0111\u1eb7c bi\u1ec7t c\u1ee7a vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed, \u0111\u1ea1i di\u1ec7n l\u00e0 ho\u1ea1i t\u1eed to\u00e0n b\u1ed9 b\u1ec1 d\u00e0y gi\u1eefa \u0111\u1ea7u v\u00e0 \u0111u\u00f4i t\u1ee5y v\u00e0 lu\u00f4n c\u00f3 s\u1ef1 gi\u00e1n \u0111o\u1ea1n \u1ed1ng t\u1ee5y. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn t\u1ee5 d\u1ecbch dai d\u1eb3ng khi \u0111u\u00f4i t\u1ee5y v\u1eabn c\u00f3 kh\u1ea3 n\u0103ng ti\u1ebft d\u1ecbch. \u1ed4 t\u1ee5 d\u1ecbch \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi d\u1eabn l\u01b0u d\u1ecbch qua n\u1ed9i soi hay qua da. \u0110i\u1ec1u tr\u1ecb d\u1ee9t \u0111i\u1ec3m l\u00e0 y\u00eau c\u1ea7u c\u1eaft to\u00e0n b\u1ed9 tuy\u1ebfn t\u1ee5y \u1edf xa ho\u1eb7c d\u1eabn l\u01b0u l\u00e2u d\u00e0i.<\/p>\n
Ho\u1ea1i t\u1eed trung t\u00e2m t\u1ee5y v\u1edbi t\u1ee5 d\u1ecbch l\u1edbn \u1edf khoang sau ph\u00fac m\u1ea1c b\u00ean tr\u00e1i v\u00e0 h\u1eadu cung m\u1ea1c n\u1ed1i.<\/p>\n
$\"\"$ <\/p>\n
<>D\u1ef0 B\u00c1O PANCODE<\/h2>\n
<>L\u00e0 h\u1ec7 th\u1ed1ng m\u00f4 t\u1ea3 vi\u00eam t\u1ee5y c\u1ea5p v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a n\u00f3.<\/p>\n
<>PANcreatic nonenhancement (T\u1ee5y kh\u00f4ng ng\u1ea5m thu\u1ed1c)<\/h3>\n
<>Kh\u00f4ng ghi nh\u1eadn thi\u1ebfu m\u00e1u t\u1ee5y, t\u1ee5y ng\u1ea5m thu\u1ed1c \u0111\u1ed3ng nh\u1ea5t.<>Thi\u1ebfu m\u00e1u t\u1ee5y<\/p>\n
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<>V\u1ecb tr\u00ed: \u0111\u1ea7u, c\u1ed5, th\u00e2n, \u0111u\u00f4i.<\/li>\n
<>M\u1ee9c \u0111\u1ed9: <30%, 30-50%, >50%<\/li>\n
<>M\u1ea3ng ho\u1eb7c to\u00e0n b\u1ed9 b\u1ec1 d\u00e0y<\/li>\n<\/ul>\n
<> Collections (t\u1ee5 d\u1ecbch)<\/h2>\n
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<>Kh\u00f4ng c\u00f3 \u1ed5 t\u1ee5 d\u1ecbch, t\u1ee5y ph\u00f9 n\u1ec1 t\u0103ng k\u00edch th\u01b0\u1edbc, th\u00e2m nhi\u1ec5m m\u1ee1 xung quanh.<\/li>\n
<>C\u00f3 1 ho\u1eb7c nhi\u1ec1u h\u01a1n 1 \u1ed5 t\u1ee5 d\u1ecbch quanh t\u1ee5y.<\/li>\n<\/ul>\n
<>Description (m\u00f4 t\u1ea3)<\/h2>\n
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T\u1ee5 d\u1ecbch quanh t\u1ee5y<\/b>\n
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<>V\u1ecb tr\u00ed gi\u1ea3i ph\u1eabu, h\u00ecnh d\u1ea1ng v\u00e0 k\u00edch th\u01b0\u1edbc t\u1ed1i \u0111a \u1ed5 d\u1ecbch.<\/li>\n
<>T\u1ef7 tr\u1ecdng d\u1ecbch.<\/li>\n
<>M\u1ee9c \u0111\u1ed9 t\u1ea1o v\u1ecf.<\/li>\n
<>S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c \u1ed5 t\u1ee5 kh\u00ed.<\/li>\n<\/ul>\n<\/li>\n
C\u00e1c bi\u1ebfn ch\u1ee9ng ngo\u00e0i t\u1ee5y<\/b>\n
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<>H\u1eb9p m\u00f4n v\u1ecb, nh\u1ed3i m\u00e1u ru\u1ed9t, t\u1eafc ru\u1ed9t.<\/li>\n
<>Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch, t\u0103ng \u00e1p t\u0129nh m\u1ea1ch c\u1eeda, gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch.<\/li>\n
<>Vi\u00eam t\u00fai m\u1eadt, vi\u00eam \u0111\u01b0\u1eddng m\u1eadt.<\/li>\n
<>T\u1ed5n th\u01b0\u01a1ng k\u1ebft h\u1ee3p gan, l\u00e1ch, th\u1eadn.<\/li>\n
<>C\u1ed5 tr\u01b0\u1edbng, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
CAN THI\u1ec6P<\/h2>\n
<>Qu\u1ea3n l\u00fd vi\u00eam t\u1ee5y c\u1ea5p ph\u1ea3i r\u1ea5t th\u1eadn tr\u1ecdng. <>Trong 2 tu\u1ea7n \u0111\u1ea7u, b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng v\u00e0 suy \u0111a t\u1ea1ng c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u. <>Can thi\u1ec7p c\u1ea7n ph\u1ea3i tr\u00ec ho\u00e3n c\u00e0ng l\u00e2u c\u00e0ng t\u1ed1t. <>Nhi\u1ec1u \u1ed5 t\u1ee5 d\u1ecbch s\u1ebd v\u00f4 tr\u00f9ng ho\u1eb7c h\u1ea5p thu theo th\u1eddi gian. <>\u0110\u1ec3 ph\u00e2n lo\u1ea1i c\u00e1c \u1ed5 t\u1ee5 d\u1ecbch c\u1ea7n th\u1eddi gian 4 tu\u1ea7n.<\/p>\n\n\n\n\n
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Qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p<\/b><\/p>\n<\/td>\n<\/tr>\n
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<>Ti\u1ebfp c\u1eadn m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng.<\/li>\n
<>Gi\u1ea3m \u0111au t\u1ed1t.<\/li>\n
<>D\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch v\u00e0 nu\u00f4i \u0103n qua ru\u1ed9t s\u1edbm.<\/li>\n
<>Kh\u00f4ng d\u00f9ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng.<\/li>\n
<>Tr\u01b0\u1eddng h\u1ee3p suy t\u1ea1ng=> ICU.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
<>FNA V\u00c0 D\u1eaaN L\u01afU<\/h2>\n
<>Khi t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n x\u1ea5u \u0111i, b\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1t, c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh ch\u1ecdc h\u00fat kim nh\u1ecf (FNA) \u0111\u1ec3 ph\u00e2n bi\u1ec7t t\u1ee5 d\u1ecbch v\u00f4 tr\u00f9ng v\u00e0 nhi\u1ec5m tr\u00f9ng.<\/p>\n
<>Nh\u1eefng ch\u00fa \u00fd trong FNA:<\/h3>\n
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<>Kh\u00f4ng th\u1ef1c hi\u1ec7n FNA trong giai \u0111o\u1ea1n s\u1edbm.<\/li>\n
<>Kh\u00f4ng \u0111i qua d\u1ea1 d\u00e0y .<\/li>\n
<>\u0110\u1ea3m b\u1ea3o kh\u00f4ng ph\u1ea3i gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch.<\/li>\n<\/ul>\n
<>Suy ngh\u0129 \u2013 l\u00ean k\u1ebf ho\u1ea1ch tr\u01b0\u1edbc:<\/h3>\n
\n
<>M\u1ee7 -> \u0111\u1eb7t d\u1eabn l\u01b0u.<\/li>\n
<>Kh\u00f4ng x\u00e1c \u0111\u1ecbnh r\u00f5 -> nhu\u1ed9m gram, c\u1ea5y khu\u1ea9n.<\/li>\n
<>Kh\u00f4ng c\u00f3 d\u1ecbch -> c\u00f3 th\u1ec3 l\u00e0 ph\u1ea7n \u0111\u1eb7c ho\u1ea1i t\u1eed -> b\u01a1m n\u01b0\u1edbc mu\u1ed1i -> nu\u00f4i c\u1ea5y.<\/li>\n<\/ul>\n
Ch\u00fa \u00fd trong d\u1eabn l\u01b0u<\/h3>\n
Ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1ee5 d\u1ecbch quanh t\u1ee5y. N\u00ean \u0111\u00e1nh gi\u00e1 \u0111\u1ea7y \u0111\u1ee7 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng, x\u00e9t nghi\u1ec7m v\u00e0 h\u00ecnh \u1ea3nh. Kh\u00f4ng d\u1eabn l\u01b0u trong giai \u0111o\u1ea1n s\u1edbm. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn cho ti\u1ebfp c\u1eadn ph\u1eabu thu\u1eadt.<\/p>\n
$\"\"$ <\/p>\n
T\u1ee5 d\u1ecbch quanh t\u1ee5y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfp c\u1eadn tr\u1ef1c ti\u1ebfp (m\u0169i t\u00ean \u0111\u1ecf), qua d\u1ea1 d\u00e0y (m\u0169i t\u00ean xanh l\u00e1), qua th\u00e0nh b\u1ee5ng (m\u0169i t\u00ean xanh d\u01b0\u01a1ng), nh\u01b0ng \u0111\u01b0\u1eddng ti\u1ebfp c\u1eadn \u01b0u ti\u00ean l\u00e0 khoang sau ph\u00fac m\u1ea1c(m\u0169i t\u00ean v\u00e0ng) v\u1edbi \u01b0u \u0111i\u1ec3m sau:<\/p>\n
\n
C\u00f9ng khoang v\u1edbi t\u1ee5y.<\/li>\n
H\u1ea1n ch\u1ebf nhi\u1ec5m tr\u00f9ng t\u1eeb ru\u1ed9t.<\/li>\n
Do tr\u1ecdng l\u1ef1c.<\/li>\n
D\u1eabn l\u01b0u song song v\u1edbi gi\u01b0\u1eddng t\u1ee5y.<\/li>\n
\u0110\u01b0\u1eddng \u0111i c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn cho ph\u1eabu thu\u1eadt t\u1ed1i thi\u1ec3u.<\/li>\n<\/ul>\n
$\"\"$ <\/p>\n
<>CAN THI\u1ec6P PH\u1eaaU THU\u1eacT<\/h2>\n
<>C\u00e1c khuy\u1ebfn c\u00e1o 2013 c\u1ee7a IAP\/APA<\/h3>\n
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<> Ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p trong vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed:<\/li>\n<\/ol>\n
<> – L\u00e2m s\u00e0ng nghi ng\u1edd ho\u1eb7c c\u00f3 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m tr\u00f9ng ho\u1ea1i t\u1eed.<\/p>\n
<> – Suy t\u1ea1ng li\u00ean t\u1ee5c v\u00e0i tu\u1ea7n sau kh\u1edfi b\u1ec7nh m\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng.<\/p>\n
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<> Ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p trong vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed v\u00f4 tr\u00f9ng l\u00e0:<\/li>\n<\/ol>\n
<> – Xu\u1ea5t hi\u1ec7n t\u1eafc ngh\u1ebdn d\u1ea1 d\u00e0y, ru\u1ed9t, \u0111\u01b0\u1eddng m\u1eadt do hi\u1ec7u \u1ee9ng kh\u1ed1i c\u1ee7a t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed c\u00f3 v\u1ecf ( ngh\u0129a l\u00e0 >4-8 tu\u1ea7n sau vi\u00eam t\u1ee5y c\u1ea5p).<\/p>\n
<> – C\u00e1c d\u1ea5u hi\u1ec7u suy nh\u01b0\u1ee3c k\u00e9o d\u00e0i tr\u00ean b\u1ec7nh nh\u00e2n WON m\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng (ngh\u0129a l\u00e0 > 8 tu\u1ea7n sau vi\u00eam t\u1ee5y c\u1ea5p).<\/p>\n
<> – D\u1ea5u hi\u1ec7u \u1ed1ng t\u1ee5y b\u1ecb gi\u00e1n \u0111o\u1ea1n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i (\u0111au, t\u1eafc ngh\u1ebdn,\u2026) c\u1ee7a WON.<\/p>\n
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<> \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed \u0111\u01b0\u1ee3c ch\u1ee9ng minh ho\u1eb7c nghi ng\u1edd c\u00f3 nhi\u1ec5m tr\u00f9ng, can thi\u1ec7p x\u00e2m l\u1ea5n t\u1ed1t nh\u1ea5t l\u00e0 4 tu\u1ea7n sau kh\u1edfi ph\u00e1t khi \u1ed5 d\u1ecbch \u0111\u00e3 \u0111\u01b0\u1ee3c v\u00e1ch h\u00f3a.<\/li>\n
<> Chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p t\u1ed1i \u01b0u cho b\u1ec7nh nh\u00e2n nghi ng\u1edd ho\u1eb7c x\u00e1c \u0111\u1ecbnh vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng l\u00e0 d\u00e3n l\u01b0u qua da hay qua n\u1ed9i soi, sau \u0111\u00f3, n\u1ebfu c\u1ea7n c\u1eaft b\u1ecf ho\u1ea1i t\u1eed qua n\u1ed9i soi ho\u1eb7c ph\u1eabu thu\u1eadt.<\/li>\n<\/ol>\n
$\"\"$ <\/p>\n
Ngu\u1ed3n tham kh\u1ea3o<\/h2>\n
Interventional Radiology Department – <\/span><\/i>No.103 Hospital: <\/span><\/i>https:\/\/radiologyassistant.nl\/<\/span><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"
<>T\u1ea3i file PDF b\u00e0i vi\u1ebft Vi\u00eam t\u1ee5y c\u1ea5p – Acute Pancreatitis t\u1ea1i \u0111\u00e2y <>B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c d\u1ecbch b\u1edfi Tr\u1ea7n Th\u1ecb Thu, Dr. L\u00ea V\u0169 Duy GI\u1edaI THI\u1ec6U <>Tr\u01b0\u1edbc h\u1ebft, c\u00f3 hai giai \u0111o\u1ea1n c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn trong ph\u00e2n lo\u1ea1i c\u1ee7a Atlanta s\u1eeda \u0111\u1ed5i: <>Giai \u0111o\u1ea1n s\u1edbm – tu\u1ea7n \u0111\u1ea7u : […]\n","protected":false},"author":1,"featured_media":33180,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-33151","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33151","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=33151"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33151\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/33180"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=33151"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=33151"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=33151"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}