{"id":5660,"date":"2024-05-03T15:22:29","date_gmt":"2024-05-03T08:22:29","guid":{"rendered":"https:\/\/bvndgiadinh.org.vn\/?p=5660"},"modified":"2024-05-03T15:22:30","modified_gmt":"2024-05-03T08:22:30","slug":"phau-thuat-thanh-cong-cho-nguoi-benh-95-tuoi-co-buou-co-khong-lo-chen-ep-khi-quan","status":"publish","type":"post","link":"https:\/\/bvndgiadinh.org.vn\/?p=5660","title":{"rendered":"PH\u1eaaU THU\u1eacT TH\u00c0NH C\u00d4NG CHO NG\u01af\u1edcI B\u1ec6NH 95 TU\u1ed4I C\u00d3 B\u01af\u1edaU C\u1ed4 KH\u1ed4NG L\u1ed2 CH\u00c8N \u00c9P KH\u00cd QU\u1ea2N"},"content":{"rendered":"\n

C\u00e1c b\u00e1c s\u0129 khoa Ngo\u1ea1i L\u1ed3ng ng\u1ef1c m\u1ea1ch m\u00e1u b\u01b0\u1edbu c\u1ed5, B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh v\u1eeba th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt th\u00e0nh c\u00f4ng cho c\u1ee5 b\u00e0 95 tu\u1ed5i c\u00f3 kh\u1ed1i b\u01b0\u1edbu c\u1ed5 l\u1edbn g\u00e2y h\u1eb9p kh\u00ed qu\u1ea3n g\u00e2y kh\u00f3 th\u1edf.<\/strong><\/p>\n\n\n\n

\u0110\u00f3 l\u00e0 tr\u01b0\u1eddng h\u1ee3p c\u1ee7a c\u1ee5 b\u00e0 T.T.H, s\u1ed1ng t\u1ea1i G\u00f2 V\u1ea5p, c\u00e1ch \u0111\u00e2y h\u01a1n 40 n\u0103m ng\u01b0\u1eddi b\u1ec7nh \u0111i kh\u00e1m \u0111\u00e3 ph\u00e1t hi\u1ec7n b\u01b0\u1edbu c\u1ed5 nh\u01b0ng do k\u00edch th\u01b0\u1edbc nh\u1ecf n\u00ean b\u00e0 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb. Kho\u1ea3ng th\u1eddi gian g\u1ea7n \u0111\u00e2y b\u00e0 th\u01b0\u1eddng xuy\u00ean c\u00f3 c\u1ea3m gi\u00e1c kh\u00f3 th\u1edf n\u00ean \u0111\u1ebfn b\u1ec7nh vi\u1ec7n kh\u00e1m v\u00e0 \u0111\u01b0\u1ee3c chuy\u1ec3n v\u00e0o khoa Ngo\u1ea1i L\u1ed3ng ng\u1ef1c m\u1ea1ch m\u00e1u b\u01b0\u1edbu c\u1ed5 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n

T\u1ea1i khoa, b\u00e1c s\u0129 \u0111\u00e1nh gi\u00e1 b\u01b0\u1edbu c\u1ed5 to bi\u1ebfn d\u1ea1ng v\u00f9ng c\u1ed5, c\u00f3 kh\u1ea3 n\u0103ng ch\u00e8n \u00e9p v\u00e0o c\u00e1c c\u1ea5u tr\u00fac xung quanh nh\u1ea5t l\u00e0 kh\u00ed qu\u1ea3n v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng th\u00f2ng trung th\u1ea5t n\u00ean cho ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p CT scan c\u1ed5 ng\u1ef1c c\u00f3 c\u1ea3n quang, k\u1ebft qu\u1ea3 ghi nh\u1eadn b\u01b0\u1edbu gi\u00e1p to ch\u00e8n \u00e9p g\u00e2y h\u1eb9p kh\u00ed qu\u1ea3n c\u1ed5, ch\u1ed7 h\u1eb9p nh\u1ea5t k\u00edch th\u01b0\u1edbc #4mm k\u00e9o d\u00e0i m\u1ed9t \u0111o\u1ea1n 11mm.<\/p>\n\n\n\n

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H\u00ecnh \u1ea3nh ng\u01b0\u1eddi b\u1ec7nh tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, b\u01b0\u1edbu c\u1ed5 to<\/em><\/figcaption><\/figure><\/div>\n\n\n\n

BS.CKII. Tr\u1ea7n Nh\u01b0 H\u01b0ng Vi\u1ec7t – Tr\u01b0\u1edfng khoa Ngo\u1ea1i L\u1ed3ng ng\u1ef1c m\u1ea1ch m\u00e1u b\u01b0\u1edbu c\u1ed5 cho bi\u1ebft: \u201cNg\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 l\u1edbn tu\u1ed5i, c\u00f3 nhi\u1ec1u b\u1ec7nh l\u00fd n\u1ec1n nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, suy tim n\u00ean nguy c\u01a1 \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n r\u1ea5t kh\u00f3 trong qu\u00e1 tr\u00ecnh g\u00e2y m\u00ea v\u00e0 nguy c\u01a1 ph\u1eabu thu\u1eadt r\u1ea5t cao, B\u00ean c\u1ea1nh \u0111\u00f3 b\u01b0\u1edbu gi\u00e1p \u0111a nh\u00e2n 2 th\u00f9y to, v\u00f4i h\u00f3a, ch\u00e8n \u00e9p b\u00f3p d\u1eb9t kh\u00ed qu\u1ea3n v\u00e0 th\u00f2ng 1 ph\u1ea7n xu\u1ed1ng trung th\u1ea5t s\u1ebd g\u00e2y kh\u00f3 kh\u0103n cho qu\u00e1 tr\u00ecnh b\u00f3c t\u00e1ch b\u01b0\u1edbu, b\u1ea3o t\u1ed3n nh\u1eefng c\u1ea5u tr\u00fac quan tr\u1ecdng l\u00e2n c\u1eadn nh\u01b0 th\u1ea7n kinh qu\u1eb7t ng\u01b0\u1ee3c thanh qu\u1ea3n, kh\u00ed qu\u1ea3n v\u00e0 m\u1ea1ch m\u00e1u l\u1edbn. \u00cakip \u0111\u00e3 m\u1eddi h\u1ed9i ch\u1ea9n li\u00ean chuy\u00ean khoa: G\u00e2y m\u00ea h\u1ed3i s\u1ee9c, Tai m\u0169i h\u1ecdng, N\u1ed9i H\u00f4 h\u1ea5p, N\u1ed9i Tim m\u1ea1ch v\u00e0 N\u1ed9i Ti\u1ebft th\u1eadn \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 th\u1ed1ng nh\u1ea5t ph\u01b0\u01a1ng \u00e1n ph\u1eabu thu\u1eadt t\u1ed1i \u01b0u nh\u1ea5t.\u201d<\/em><\/p>\n\n\n\n

S\u00e1ng ng\u00e0y 23\/04\/2024, \u00eakip b\u00e1c s\u0129 khoa Ngo\u1ea1i l\u1ed3ng ng\u1ef1c m\u1ea1ch m\u00e1u b\u01b0\u1edbu c\u1ed5 \u0111\u00e3 ph\u1ed1i h\u1ee3p c\u00f9ng khoa G\u00e2y m\u00ea H\u1ed3i s\u1ee9c ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf b\u01b0\u1edbu c\u1ed5 cho ng\u01b0\u1eddi b\u1ec7nh. V\u1edbi kinh nghi\u1ec7m v\u00e0 chuy\u00ean m\u00f4n cao, c\u00e1c b\u00e1c s\u0129 khoa G\u00e2y m\u00ea H\u1ed3i s\u1ee9c \u0111\u00e3 \u0111\u1eb7t th\u00e0nh c\u00f4ng \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n cho c\u1ee5 b\u00e0, \u0111\u1ed3ng th\u1eddi, c\u00e1c ph\u1eabu thu\u1eadt vi\u00ean \u0111\u00e3 kh\u00e9o l\u00e9o lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n 2 th\u00f9y tuy\u1ebfn gi\u00e1p v\u1edbi k\u00edch th\u01b0\u1edbc b\u00ean ph\u1ea3i l\u00e0 13x6x6cm<\/em> v\u00e0 b\u00ean tr\u00e1i l\u00e0 9x6x5cm<\/em>, b\u1ea3o t\u1ed3n \u0111\u01b0\u1ee3c c\u00e1c c\u1ea5u tr\u00fac quan tr\u1ecdng l\u00e2n c\u1eadn m\u00e0 kh\u00f4ng \u0111\u1ec3 x\u1ea3y ra ch\u1ea3y m\u00e1u.<\/p>\n\n\n\n

ThS.BS Nguy\u1ec5n Th\u1ecb C\u1ea9m \u2013 Khoa Ngo\u1ea1i L\u1ed3ng ng\u1ef1c m\u1ea1ch m\u00e1u b\u01b0\u1edbu c\u1ed5 cho bi\u1ebft th\u00eam: \u201cNg\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n c\u0103n c\u01b0\u1eddng gi\u00e1p \u0111ang \u0111i\u1ec1u tr\u1ecb \u1ed5n \u0111\u1ecbnh v\u1edbi Thyrozol, ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p \u0111\u00e3 v\u1ec1 gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng v\u00e0 ph\u1ea3i s\u1eed d\u1ee5ng Lugol 1% u\u1ed1ng ng\u00e0y 2 l\u1ea7n trong v\u00f2ng 7 ng\u00e0y \u0111\u1ec3 gi\u00fap gi\u1ea3m ch\u1ea3y m\u00e1u trong m\u1ed5. Ng\u01b0\u1eddi b\u1ec7nh l\u1edbn tu\u1ed5i v\u1edbi b\u1ec7nh l\u00fd n\u1ec1n c\u00f9ng u k\u00edch th\u01b0\u1edbc l\u1edbn l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c v\u1edbi c\u00e1c b\u00e1c s\u1ef9. Ekip ph\u1ea3i ph\u1ed1i h\u1ee3p nhi\u1ec1u chuy\u00ean khoa, n\u1ed9i khoa, ngo\u1ea1i khoa kh\u00e1c nhau \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n cho ng\u01b0\u1eddi b\u1ec7nh tr\u01b0\u1edbc, trong v\u00e0 sau ph\u1eabu thu\u1eadt\u201d.<\/em><\/p>\n\n\n\n

Ca ph\u1eabu thu\u1eadt k\u1ebft th\u00fac thu\u1eadn l\u1ee3i th\u00e0nh c\u00f4ng, ch\u1ec9 sau \u0111\u00f3 1 ng\u00e0y ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 chuy\u1ec3n xu\u1ed1ng khoa Ngo\u1ea1i L\u1ed3ng ng\u1ef1c m\u1ea1ch m\u00e1u b\u01b0\u1edbu c\u1ed5 theo d\u00f5i. Sau m\u1ed5, c\u1ee5 b\u00e0 n\u00f3i chuy\u1ec7n \u0111\u01b0\u1ee3c to r\u00f5, kh\u00f4ng t\u00ea tay, v\u1ebft m\u1ed5 kh\u00f4, d\u1eabn l\u01b0u v\u1ebft m\u1ed5 ra \u00edt d\u1ecbch \u0111\u1ecf s\u1eadm, \u0111\u01b0\u1ee3c r\u00fat d\u1eabn l\u01b0u v\u00e0 xu\u1ea5t vi\u1ec7n chi\u1ec1u c\u00f9ng ng\u00e0y.<\/p>\n\n\n\n

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H\u00ecnh \u1ea3nh kh\u1ed1i u \u0111\u01b0\u1ee3c l\u1ea5y sau ph\u1eabu thu\u1eadt<\/em><\/figcaption><\/figure><\/div>\n\n\n\n
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H\u00ecnh \u1ea3nh ng\u01b0\u1eddi b\u1ec7nh sau ph\u1eabu thu\u1eadt 1 ng\u00e0y<\/em><\/figcaption><\/figure><\/div>\n\n\n\n
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H\u00ecnh \u1ea3nh ng\u01b0\u1eddi b\u1ec7nh t\u00e1i kh\u00e1m<\/em><\/figcaption><\/figure><\/div>\n\n\n\n

\u0110a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u01b0\u1edbu gi\u00e1p th\u00f2ng l\u00e0 l\u00e0nh t\u00ednh, ch\u1ec9 c\u00f3 3-6 % l\u00e0 \u00e1c t\u00ednh. C\u00f3 hai nguy\u00ean nh\u00e2n g\u00e2y b\u01b0\u1edbu gi\u00e1p th\u00f2ng: do s\u1ef1 l\u1edbn d\u1ea7n v\u00e0 di chuy\u1ec3n xu\u1ed1ng trung th\u1ea5t c\u1ee7a b\u01b0\u1edbu gi\u00e1p (th\u1ee9 ph\u00e1t), hay b\u01b0\u1edbu gi\u00e1p l\u1ea1c ch\u1ed7, n\u1eb1m ho\u00e0n to\u00e0n trong l\u1ed3ng ng\u1ef1c v\u00e0 kh\u00f4ng li\u00ean quan v\u1edbi c\u1ea5u tr\u00fac tuy\u1ebfn gi\u00e1p v\u00f9ng c\u1ed5, c\u00f2n g\u1ecdi l\u00e0 b\u01b0\u1edbu gi\u00e1p ch\u00ecm th\u1eadt s\u1ef1 trong trung th\u1ea5t (nguy\u00ean ph\u00e1t).<\/p>\n\n\n\n

B\u01b0\u1edbu gi\u00e1p th\u00f2ng trung th\u1ea5t chi\u1ebfm t\u1ef7 l\u1ec7 nh\u1ecf (3 \u2013 20%) trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u01b0\u1edbu gi\u00e1p. Kh\u00f4ng ch\u1ec9 x\u00e2m l\u1ea5n hai th\u00f9y gi\u00e1p, th\u1ef1c qu\u1ea3n v\u00e0 kh\u00ed qu\u1ea3n, lo\u1ea1i b\u01b0\u1edbu n\u00e0y c\u00f2n th\u00f2ng xu\u1ed1ng l\u1ed3ng ng\u1ef1c, ch\u00e8n \u00e9p c\u00e1c m\u1ea1ch m\u00e1u quan tr\u1ecdng g\u00e2y tri\u1ec7u ch\u1ee9ng t\u1ee9c ng\u1ef1c, kh\u00f3 th\u1edf, kh\u00e0n gi\u1ecdng, nu\u1ed1t ngh\u1eb9n, th\u1eadm ch\u00ed l\u00e0 h\u1ed9i ch\u1ee9ng t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean. \u0110\u1ec3 tr\u00e1nh \u0111\u1ec3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p b\u01b0\u1edbu to, vi\u1ec7c si\u00eau \u00e2m tuy\u1ebfn gi\u00e1p nh\u1eb1m t\u1ea7m so\u00e1t ph\u00e1t hi\u1ec7n nh\u00e2n gi\u00e1p l\u00e0 r\u1ea5t quan tr\u1ecdng. C\u00e1c b\u1ea5t th\u01b0\u1eddng c\u1ee7a tuy\u1ebfn gi\u00e1p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n qua kh\u00e1m b\u1ec7nh ho\u1eb7c ph\u00e1t hi\u1ec7n s\u1edbm qua kh\u00e1m s\u1ee9c kh\u1ecfe \u0111\u1ecbnh k\u1ef3.Sau \u0111\u00f3 b\u00e1c s\u0129 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng m\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 b\u1ec7nh b\u01b0\u1edbu c\u1ed5 nh\u01b0: X\u00e9t nghi\u1ec7m m\u00e1u ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p, Si\u00eau \u00e2m tuy\u1ebfn gi\u00e1p, \u0110o h\u1ea5p th\u1ee5 i-\u1ed1t ph\u00f3ng x\u1ea1, Ch\u1ee5p CT ho\u1eb7c MRI (ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb) tuy\u1ebfn gi\u00e1p\u2026<\/p>\n\n\n\n

V\u00ec v\u1eady, khi ph\u00e1t hi\u1ec7n c\u00f3 kh\u1ed1i u v\u00f9ng c\u1ed5 ng\u01b0\u1eddi b\u1ec7nh n\u00ean \u0111\u1ebfn b\u1ec7nh vi\u1ec7n c\u00f3 chuy\u00ean khoa ung b\u01b0\u1edbu \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00f3 h\u01b0\u1edbng x\u1eed tr\u00ed c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb s\u1edbm, tr\u00e1nh tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec3 b\u01b0\u1edbu qu\u00e1 l\u1edbn, \u0103n s\u00e2u v\u00e0o trong l\u1ed3ng ng\u1ef1c s\u1ebd g\u00e2y nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m, nh\u01b0 ch\u00e8n \u00e9p kh\u00ed qu\u1ea3n, th\u1ef1c qu\u1ea3n, m\u1ea1ch m\u00e1u th\u1ea7n kinh, ung th\u01b0 ho\u00e1\u2026<\/p>\n","protected":false},"excerpt":{"rendered":"

C\u00e1c b\u00e1c s\u0129 khoa Ngo\u1ea1i L\u1ed3ng ng\u1ef1c m\u1ea1ch m\u00e1u b\u01b0\u1edbu c\u1ed5, B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh v\u1eeba th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt th\u00e0nh c\u00f4ng cho c\u1ee5 b\u00e0 95 tu\u1ed5i c\u00f3 kh\u1ed1i b\u01b0\u1edbu c\u1ed5 l\u1edbn g\u00e2y h\u1eb9p kh\u00ed qu\u1ea3n g\u00e2y kh\u00f3 th\u1edf. \u0110\u00f3 l\u00e0 tr\u01b0\u1eddng h\u1ee3p c\u1ee7a c\u1ee5 b\u00e0 T.T.H, s\u1ed1ng t\u1ea1i G\u00f2 V\u1ea5p, c\u00e1ch \u0111\u00e2y 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