{"id":10489,"date":"2025-06-29T10:00:00","date_gmt":"2025-06-29T03:00:00","guid":{"rendered":"https:\/\/bvndgiadinh.org.vn\/?p=10489"},"modified":"2025-06-27T09:50:09","modified_gmt":"2025-06-27T02:50:09","slug":"noi-soi-cat-tach-duoi-niem-mac-esd-giai-phap-dieu-tri-polyp-tai-phat-tren-nen-seo-tranh-phau-thuat-cat-noi-ruot","status":"publish","type":"post","link":"https:\/\/bvndgiadinh.org.vn\/?p=10489","title":{"rendered":"N\u1ed9i soi c\u1eaft t\u00e1ch d\u01b0\u1edbi ni\u00eam m\u1ea1c (ESD): Gi\u1ea3i ph\u00e1p \u0111i\u1ec1u tr\u1ecb polyp t\u00e1i ph\u00e1t tr\u00ean n\u1ec1n s\u1eb9o, tr\u00e1nh ph\u1eabu thu\u1eadt c\u1eaft n\u1ed1i ru\u1ed9t"},"content":{"rendered":"\n

Trong \u0111i\u1ec1u tr\u1ecb polyp \u0111\u1ea1i tr\u00e0ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng ph\u1ee9c t\u1ea1p c\u00f3 nguy c\u01a1 \u00e1c t\u00ednh, vi\u1ec7c l\u1ef1a ch\u1ecdn \u0111\u00fang ph\u01b0\u01a1ng ph\u00e1p ngay t\u1eeb \u0111\u1ea7u l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t gi\u00fap tr\u00e1nh nguy c\u01a1 t\u00e1i ph\u00e1t, bi\u1ebfn ch\u1ee9ng ho\u1eb7c ph\u1ea3i ph\u1eabu thu\u1eadt c\u1eaft n\u1ed1i ru\u1ed9t v\u1ec1 sau.<\/em><\/strong><\/p>\n\n\n

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\"\"<\/figure><\/div>\n\n\n

T\u1ea1i B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh, c\u00e1c b\u00e1c s\u0129 Khoa N\u1ed9i soi \u2013 Th\u0103m d\u00f2 Ch\u1ee9c n\u0103ng \u0111\u00e3 \u1ee9ng d\u1ee5ng k\u1ef9 thu\u1eadt n\u1ed9i soi c\u1eaft t\u00e1ch d\u01b0\u1edbi ni\u00eam m\u1ea1c (ESD) \u2013 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p n\u1ed9i soi chuy\u00ean s\u00e2u \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng hai tr\u01b0\u1eddng h\u1ee3p polyp ph\u1ee9c t\u1ea1p t\u00e1i ph\u00e1t tr\u00ean n\u1ec1n m\u00f4 s\u1eb9o. Nh\u1edd can thi\u1ec7p k\u1ecbp th\u1eddi v\u00e0 ch\u00ednh x\u00e1c, ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng ph\u1ea3i tr\u1ea3i qua cu\u1ed9c ph\u1eabu thu\u1eadt l\u1edbn, \u0111\u1ed3ng th\u1eddi gi\u1eef \u0111\u01b0\u1ee3c to\u00e0n v\u1eb9n ch\u1ee9c n\u0103ng ti\u00eau h\u00f3a.<\/p>\n\n\n\n

Hai tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec3n h\u00ecnh \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb t\u1ea1i B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh:<\/strong><\/p>\n\n\n\n

    <\/ol>\n\n\n\n

    1. Polyp \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng t\u00e1i ph\u00e1t tr\u00ean n\u1ec1n s\u1eb9o sau h\u01a1n 2 n\u0103m can thi\u1ec7p<\/em><\/strong><\/p>\n\n\n\n

    Ng\u01b0\u1eddi b\u1ec7nh N.V.T, 45 tu\u1ed5i, \u0111\u01b0\u1ee3c n\u1ed9i soi ki\u1ec3m tra sau h\u01a1n 2 n\u0103m k\u1ec3 t\u1eeb l\u1ea7n can thi\u1ec7p polyp tr\u01b0\u1edbc \u0111\u00f3 t\u1ea1i \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng. N\u1ed9i soi ghi nh\u1eadn t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng polyp kh\u00f4ng cu\u1ed1ng, m\u1ed9t s\u1ed1 v\u00f9ng c\u00f3 c\u1ea5u tr\u00fac m\u1ea1ch m\u00e1u b\u1ec1 m\u1eb7t kh\u00f4ng \u0111\u1ec1u, k\u00edch th\u01b0\u1edbc 20 mm tr\u00ean n\u1ec1n s\u1eb9o c\u1eaft polyp. CT scan b\u1ee5ng ch\u1eadu: T\u1ed5n th\u01b0\u01a1ng d\u1ea1ng polyp \u1edf \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng, k\u00edch th\u01b0\u1edbc 17 x 20 mm, n\u1ebfu l\u00e0 K th\u00ec giai \u0111o\u1ea1n T2-3N0Mx. T\u00ecnh tr\u1ea1ng x\u01a1 h\u00f3a d\u01b0\u1edbi ni\u00eam m\u1ea1c c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c m\u1ee9c \u0111\u1ed9 x\u00e2m l\u1ea5n s\u00e2u c\u1ee7a t\u1ed5n th\u01b0\u01a1ng. Do v\u1eady, c\u00e1c b\u00e1c s\u0129 \u0111\u00e3 th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt ESD l\u1ea5y tr\u1ecdn t\u1ed5n th\u01b0\u01a1ng, kh\u00f4ng c\u1ea7n ph\u1eabu thu\u1eadt. K\u1ebft qu\u1ea3 m\u00f4 h\u1ecdc: U tuy\u1ebfn \u1ed1ng ngh\u1ecbch s\u1ea3n \u0111\u1ed9 cao, b\u1edd di\u1ec7n c\u1eaft kh\u00f4ng t\u1ebf b\u00e0o u.<\/p>\n\n\n\n

    \n
    \"\"
    (A) Polyp \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng sau nhu\u1ed9m Indigocarmine t\u00e1i ph\u00e1t tr\u00ean n\u1ec1n s\u1eb9o (m\u0169i t\u00ean)<\/figcaption><\/figure>\n\n\n\n
    \"\"
    (B) Nhi\u1ec1u d\u1ea3i x\u01a1 d\u00ednh d\u01b0\u1edbi ni\u00eam m\u1ea1c. B\u00f3c t\u00e1ch t\u1eebng ph\u1ea7n m\u00f4 x\u01a1<\/figcaption><\/figure>\n\n\n\n
    \"\"
    (C) Di\u1ec7n c\u1eaft sau l\u1ea5y tr\u1ecdn polyp<\/figcaption><\/figure>\n<\/figure>\n\n\n\n

    2. Polyp tr\u1ef1c tr\u00e0ng t\u00e1i ph\u00e1t s\u1edbm tr\u00ean n\u1ec1n s\u1eb9o sau c\u1eaft carcin\u00f4m tuy\u1ebfn d\u1ea1ng nh\u1ea7y<\/em><\/strong><\/p>\n\n\n\n

    Ng\u01b0\u1eddi b\u1ec7nh N.V.C, 51 tu\u1ed5i, v\u1eeba \u0111\u01b0\u1ee3c n\u1ed9i soi c\u1eaft polyp carcin\u00f4m tuy\u1ebfn d\u1ea1ng nh\u1ea7y (Haggit \u0111\u1ed9 4) c\u00e1ch \u0111\u00e2y 6 tu\u1ea7n. Qua n\u1ed9i soi ph\u00e1t hi\u1ec7n \u1edf tr\u1ef1c tr\u00e0ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng polyp d\u1ea1ng 0-IIa, m\u1ed9t s\u1ed1 v\u00f9ng c\u00f3 c\u1ea5u tr\u00fac m\u1ea1ch m\u00e1u b\u1ec1 m\u1eb7t kh\u00f4ng \u0111\u1ec1u, k\u00edch th\u01b0\u1edbc 10 mm tr\u00ean n\u1ec1n s\u1eb9o g\u00e2y co k\u00e9o c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c xung quanh, d\u1eabn \u0111\u1ebfn kh\u00f3 l\u1ea5y tr\u1ecdn t\u1ed5n th\u01b0\u01a1ng b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p c\u1eaft truy\u1ec1n th\u1ed1ng. Ch\u00fang t\u00f4i ch\u1ecdn k\u1ef9 thu\u1eadt ESD v\u00e0 l\u1ea5y tr\u1ecdn t\u1ed5n th\u01b0\u01a1ng th\u00e0nh c\u00f4ng. M\u00f4 h\u1ecdc: U tuy\u1ebfn \u1ed1ng ngh\u1ecbch s\u1ea3n \u0111\u1ed9 cao, b\u1edd di\u1ec7n c\u1eaft kh\u00f4ng t\u1ebf b\u00e0o u.<\/p>\n\n\n\n

    \n
    \"\"
    (A) Polyp tr\u1ef1c tr\u00e0ng t\u00e1i ph\u00e1t tr\u00ean n\u1ec1n s\u1eb9o, co k\u00e9o n\u1ebfp ni\u00eam m\u1ea1c xung quanh (m\u0169i t\u00ean)<\/figcaption><\/figure>\n\n\n\n
    \"\"
    (B) Nhi\u1ec1u d\u1ea3i x\u01a1 d\u00ednh l\u1edbp c\u01a1. B\u00f3c t\u00e1ch t\u1eebng ph\u1ea7n m\u00f4 x\u01a1<\/figcaption><\/figure>\n\n\n\n
    \"\"
    (C) Di\u1ec7n c\u1eaft sau l\u1ea5y tr\u1ecdn polyp<\/figcaption><\/figure>\n<\/figure>\n\n\n\n


    <\/strong>L\u1ea5y tr\u1ecdn polyp ngay l\u1ea7n \u0111\u1ea7u \u2013 Gi\u1ea3m t\u1ed1i \u0111a nguy c\u01a1 t\u00e1i ph\u00e1t<\/strong><\/p>\n\n\n\n

    Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, n\u1ebfu polyp kh\u00f4ng \u0111\u01b0\u1ee3c c\u1eaft tri\u1ec7t \u0111\u1ec3 ngay t\u1eeb l\u1ea7n \u0111\u1ea7u ti\u00ean, nguy c\u01a1 t\u00e1i ph\u00e1t l\u00e0 r\u1ea5t cao. C\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1ecdc l\u1ea1i th\u01b0\u1eddng ph\u00e1t tri\u1ec3n tr\u00ean n\u1ec1n m\u00f4 s\u1eb9o x\u01a1 h\u00f3a \u2013 \u0111i\u1ec1u n\u00e0y khi\u1ebfn vi\u1ec7c x\u1eed l\u00fd tr\u1edf n\u00ean ph\u1ee9c t\u1ea1p v\u00e0 d\u1ec5 g\u00e2y bi\u1ebfn ch\u1ee9ng h\u01a1n. V\u00ec th\u1ebf, v\u1edbi nh\u1eefng polyp c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn, h\u00ecnh d\u1ea1ng b\u1ea5t th\u01b0\u1eddng ho\u1eb7c n\u1eb1m \u1edf v\u1ecb tr\u00ed kh\u00f3, vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p c\u1eaft t\u1ed1i \u01b0u ngay t\u1eeb \u0111\u1ea7u \u2013 nh\u01b0 ESD \u2013 l\u00e0 \u0111i\u1ec1u h\u1ebft s\u1ee9c c\u1ea7n thi\u1ebft.<\/p>\n\n\n\n

    Polyp t\u00e1i ph\u00e1t tr\u00ean n\u1ec1n s\u1eb9o \u2013 Th\u00e1ch th\u1ee9c l\u1edbn, d\u1ec5 ph\u1ea3i m\u1ed5<\/strong><\/p>\n\n\n\n

    T\u1ed5n th\u01b0\u01a1ng t\u00e1i ph\u00e1t sau can thi\u1ec7p c\u0169 th\u01b0\u1eddng \u0111i k\u00e8m t\u00ecnh tr\u1ea1ng x\u01a1 d\u00ednh m\u1ea1nh. Qu\u00e1 tr\u00ecnh b\u00f3c t\u00e1ch tr\u1edf n\u00ean kh\u00f3 kh\u0103n, nguy c\u01a1 th\u1ee7ng ru\u1ed9t t\u0103ng cao n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c x\u1eed l\u00fd \u0111\u00fang k\u1ef9 thu\u1eadt. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 bu\u1ed9c ph\u1ea3i ph\u1eabu thu\u1eadt c\u1eaft n\u1ed1i ru\u1ed9t \u2013 m\u1ed9t cu\u1ed9c m\u1ed5 l\u1edbn \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn s\u1ee9c kh\u1ecfe v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng.<\/p>\n\n\n\n

    ESD \u2013 Gi\u1ea3i ph\u00e1p t\u1ed1i \u01b0u, tr\u00e1nh ph\u1eabu thu\u1eadt, b\u1ea3o to\u00e0n ru\u1ed9t<\/strong><\/p>\n\n\n\n

    K\u1ef9 thu\u1eadt ESD cho ph\u00e9p b\u00e1c s\u0129 b\u00f3c t\u00e1ch ch\u00ednh x\u00e1c l\u1edbp d\u01b0\u1edbi ni\u00eam m\u1ea1c, l\u1ea5y tr\u1ecdn t\u1ed5n th\u01b0\u01a1ng k\u1ec3 c\u1ea3 khi c\u00f3 x\u01a1 h\u00f3a ho\u1eb7c \u0111\u00e3 t\u1eebng can thi\u1ec7p tr\u01b0\u1edbc. D\u00f9 \u0111\u00e2y l\u00e0 th\u1ee7 thu\u1eadt kh\u00f3, \u0111\u00f2i h\u1ecfi tay ngh\u1ec1 cao v\u00e0 kinh nghi\u1ec7m, nh\u01b0ng ESD mang l\u1ea1i hi\u1ec7u qu\u1ea3 v\u01b0\u1ee3t tr\u1ed9i trong b\u1ea3o t\u1ed3n ch\u1ee9c n\u0103ng ru\u1ed9t, r\u00fat ng\u1eafn th\u1eddi gian h\u1ed3i ph\u1ee5c v\u00e0 tr\u00e1nh \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt cho ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n\n\n\n

    Trong \u0111i\u1ec1u tr\u1ecb polyp \u0111\u1ea1i tr\u00e0ng, vi\u1ec7c can thi\u1ec7p \u0111\u00fang ngay t\u1eeb \u0111\u1ea7u c\u00f3 \u00fd ngh\u0129a quy\u1ebft \u0111\u1ecbnh trong vi\u1ec7c h\u1ea1n ch\u1ebf t\u00e1i ph\u00e1t v\u00e0 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m. \u0110\u1eb7c bi\u1ec7t, v\u1edbi nh\u1eefng t\u1ed5n th\u01b0\u01a1ng t\u00e1i ph\u00e1t tr\u00ean n\u1ec1n m\u00f4 s\u1eb9o \u2013 v\u1ed1n ti\u1ec1m \u1ea9n nhi\u1ec1u r\u1ee7i ro \u2013 c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 c\u1ea9n tr\u1ecdng v\u00e0 x\u1eed tr\u00ed b\u1edfi c\u00e1c b\u00e1c s\u0129 c\u00f3 chuy\u00ean m\u00f4n s\u00e2u nh\u1eb1m tr\u00e1nh ph\u1ea3i can thi\u1ec7p b\u1eb1ng ph\u1eabu thu\u1eadt c\u1eaft n\u1ed1i ru\u1ed9t.<\/p>\n\n\n\n

    K\u1ef9 thu\u1eadt n\u1ed9i soi c\u1eaft t\u00e1ch d\u01b0\u1edbi ni\u00eam m\u1ea1c (ESD) \u0111\u00e3 ch\u1ee9ng minh l\u00e0 gi\u1ea3i ph\u00e1p t\u1ed1i \u01b0u trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ph\u1ee9c t\u1ea1p n\u00e0y. Kh\u00f4ng ch\u1ec9 gi\u00fap lo\u1ea1i b\u1ecf tri\u1ec7t \u0111\u1ec3 t\u1ed5n th\u01b0\u01a1ng, ESD c\u00f2n mang l\u1ea1i l\u1ee3i \u00edch v\u01b0\u1ee3t tr\u1ed9i trong vi\u1ec7c b\u1ea3o t\u1ed3n ru\u1ed9t, tr\u00e1nh ph\u1eabu thu\u1eadt v\u00e0 n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng cho ng\u01b0\u1eddi b\u1ec7nh v\u1ec1 l\u00e2u d\u00e0i.<\/p>\n\n\n\n

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

    Trong \u0111i\u1ec1u tr\u1ecb polyp \u0111\u1ea1i tr\u00e0ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng ph\u1ee9c t\u1ea1p c\u00f3 nguy c\u01a1 \u00e1c t\u00ednh, vi\u1ec7c l\u1ef1a ch\u1ecdn \u0111\u00fang ph\u01b0\u01a1ng ph\u00e1p ngay t\u1eeb \u0111\u1ea7u l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t gi\u00fap tr\u00e1nh nguy c\u01a1 t\u00e1i ph\u00e1t, bi\u1ebfn ch\u1ee9ng ho\u1eb7c ph\u1ea3i ph\u1eabu thu\u1eadt c\u1eaft n\u1ed1i ru\u1ed9t v\u1ec1 sau. T\u1ea1i B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n 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Kh\u00e1nh Nh\u1eadt","author_link":"https:\/\/bvndgiadinh.org.vn\/?author=5"},"uagb_comment_info":0,"uagb_excerpt":"Trong \u0111i\u1ec1u tr\u1ecb polyp \u0111\u1ea1i tr\u00e0ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng ph\u1ee9c t\u1ea1p c\u00f3 nguy c\u01a1 \u00e1c t\u00ednh, vi\u1ec7c l\u1ef1a ch\u1ecdn \u0111\u00fang ph\u01b0\u01a1ng ph\u00e1p ngay t\u1eeb \u0111\u1ea7u l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t gi\u00fap tr\u00e1nh nguy c\u01a1 t\u00e1i ph\u00e1t, bi\u1ebfn ch\u1ee9ng ho\u1eb7c ph\u1ea3i ph\u1eabu thu\u1eadt c\u1eaft n\u1ed1i ru\u1ed9t v\u1ec1 sau. T\u1ea1i B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n…","_links":{"self":[{"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=\/wp\/v2\/posts\/10489","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=10489"}],"version-history":[{"count":1,"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=\/wp\/v2\/posts\/10489\/revisions"}],"predecessor-version":[{"id":10500,"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=\/wp\/v2\/posts\/10489\/revisions\/10500"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=\/wp\/v2\/media\/10498"}],"wp:attachment":[{"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=10489"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=10489"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bvndgiadinh.org.vn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=10489"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}