{"id":1237,"date":"2025-12-14T17:37:33","date_gmt":"2025-12-14T10:37:33","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=1237"},"modified":"2025-12-16T18:21:24","modified_gmt":"2025-12-16T11:21:24","slug":"loi-chan-doan-trong-sieu-am-tuy-tong-quan-toan-dien-dua-tren-ca-benh-va-cac-bai-hoc-kinh-nghiem","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/loi-chan-doan-trong-sieu-am-tuy-tong-quan-toan-dien-dua-tren-ca-benh-va-cac-bai-hoc-kinh-nghiem\/","title":{"rendered":"L\u1ed7i ch\u1ea9n \u0111o\u00e1n trong si\u00eau \u00e2m t\u1ee5y: t\u1ed5ng quan to\u00e0n di\u1ec7n d\u1ef1a tr\u00ean ca b\u1ec7nh v\u00e0 b\u00e0i h\u1ecdc kinh nghi\u1ec7m"},"content":{"rendered":"\n
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https:\/\/pubs.rsna.org\/doi\/10.1148\/rg.250037<\/a><\/p>\n<\/blockquote>\n\n\n\n

T\u00f3m t\u1eaft<\/h3>\n\n\n\n

Si\u00eau \u00e2m l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n quan tr\u1ecdng trong \u0111\u00e1nh gi\u00e1 t\u1ee5y v\u00ec t\u00ednh ch\u1ea5t kh\u00f4ng x\u00e2m l\u1ea5n, kh\u00f4ng s\u1eed d\u1ee5ng tia x\u1ea1, cung c\u1ea5p kh\u1ea3 n\u0103ng t\u1ea1o \u1ea3nh th\u1eddi gian th\u1ef1c v\u00e0 \u0111\u1ed9 ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i. M\u1eb7c d\u00f9 si\u00eau \u00e2m t\u1ee5y r\u1ea5t h\u1eefu \u00edch, ph\u01b0\u01a1ng ph\u00e1p n\u00e0y th\u01b0\u1eddng c\u00f3 hi\u1ec7u qu\u1ea3 h\u1ea1n ch\u1ebf do gi\u1ea3i ph\u1eabu ph\u1ee9c t\u1ea1p c\u1ee7a t\u1ee5y v\u00e0 c\u00e1c c\u1ea5u tr\u00fac quanh t\u1ee5y, \u0111i\u1ec1u n\u00e0y t\u1ea5t y\u1ebfu d\u1eabn \u0111\u1ebfn c\u00e1c l\u1ed7i ch\u1ea9n \u0111o\u00e1n.<\/p>\n\n\n\n

C\u00e1c t\u00e1c gi\u1ea3 t\u00f3m t\u1eaft nh\u1eefng b\u00e0i h\u1ecdc kinh nghi\u1ec7m r\u00fat ra t\u1eeb c\u00e1c quy tr\u00ecnh \u0111\u1ea3m b\u1ea3o ch\u1ea5t l\u01b0\u1ee3ng t\u1ea1i m\u1ed9t trung t\u00e2m ch\u0103m s\u00f3c tuy\u1ebfn cu\u1ed1i c\u00f3 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n l\u1edbn. C\u00e1c l\u1ed7i \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng th\u00e0nh: l\u1ed7i nh\u1eadn th\u1ee9c, l\u1ed7i di\u1ec5n gi\u1ea3i, l\u1ed7i truy\u1ec1n t\u1ea3i th\u00f4ng tin v\u00e0 l\u1ed7i quy tr\u00ecznh. M\u1ed7i lo\u1ea1i l\u1ed7i \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn k\u00e8m theo c\u00e1c nghi\u00ean c\u1ee9u ca b\u1ec7nh chi ti\u1ebft t\u1eeb th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng \u0111\u1ec3 nh\u1ea5n m\u1ea1nh c\u00e1c b\u1eaby th\u01b0\u1eddng g\u1eb7p v\u00e0 t\u00e1c \u0111\u1ed9ng c\u1ee7a ch\u00fang \u0111\u1ed1i v\u1edbi vi\u1ec7c qu\u1ea3n l\u00fd ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n\n\n\n

L\u1ed7i nh\u1eadn th\u1ee9c<\/strong> x\u1ea3y ra khi ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n b\u1ecf s\u00f3t c\u00e1c d\u1ea5u hi\u1ec7u b\u1ec7nh l\u00fd k\u00edn \u0111\u00e1o do gi\u1ea3i ph\u1eabu ph\u1ee9c t\u1ea1p. L\u1ed7i di\u1ec5n gi\u1ea3i<\/strong> ph\u00e1t sinh t\u1eeb vi\u1ec7c \u0111\u00e1nh gi\u00e1 sai v\u1ec1 \u00fd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a c\u00e1c b\u1ea5t th\u01b0\u1eddng nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c, trong khi l\u1ed7i truy\u1ec1n t\u1ea3i th\u00f4ng tin<\/strong> b\u1eaft ngu\u1ed3n t\u1eeb vi\u1ec7c trao \u0111\u1ed5i b\u1ec7nh s\u1eed kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 ho\u1eb7c xem x\u00e9t ch\u01b0a t\u1ed1i \u01b0u c\u00e1c k\u1ebft qu\u1ea3 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh tr\u01b0\u1edbc \u0111\u00f3. L\u1ed7i quy tr\u00ecnh<\/strong> ph\u1ea3n \u00e1nh c\u00e1c v\u1ea5n \u0111\u1ec1 h\u1ec7 th\u1ed1ng li\u00ean quan \u0111\u1ebfn giao th\u1ee9c si\u00eau \u00e2m v\u00e0 k\u1ef9 thu\u1eadt qu\u00e9t.<\/p>\n\n\n\n

C\u00e1c t\u00e1c gi\u1ea3 \u1ee7ng h\u1ed9 vi\u1ec7c c\u1ea7n c\u00f3 hi\u1ec3u bi\u1ebft th\u1ea5u \u0111\u00e1o v\u1ec1 h\u00ecnh \u1ea3nh gi\u1ea3i ph\u1eabu si\u00eau \u00e2m t\u1ee5y b\u00ecnh th\u01b0\u1eddng v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3, \u0111\u1ed3ng th\u1eddi nh\u1ea5n m\u1ea1nh t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c \u0111\u1ed1i chi\u1ebfu c\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean si\u00eau \u00e2m v\u1edbi k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh kh\u00e1c \u0111\u1ec3 c\u1ea3i thi\u1ec7n \u0111\u1ed9 ch\u00ednh x\u00e1c ch\u1ea9n \u0111o\u00e1n. H\u1ecd c\u0169ng n\u00eau b\u1eadt s\u1ef1 c\u1ea7n thi\u1ebft ph\u1ea3i s\u1eed d\u1ee5ng \u0111\u1ea7u d\u00f2 si\u00eau \u00e2m \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao, \u00e1p d\u1ee5ng c\u00f4ng ngh\u1ec7 m\u1edbi v\u00e0 th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt kh\u1ea3o s\u00e1t t\u1ec9 m\u1ec9 nh\u01b0 nh\u1eefng chi\u1ebfn l\u01b0\u1ee3c th\u1ef1c t\u1ebf c\u00f3 gi\u00e1 tr\u1ecb \u0111\u1ec3 gi\u1ea3m thi\u1ec3u l\u1ed7i ch\u1ea9n \u0111o\u00e1n.<\/p>\n\n\n\n

Th\u00f4ng qua ph\u00e2n t\u00edch chi ti\u1ebft c\u00e1c ca b\u1ec7nh, b\u00e0i t\u1ed5ng quan n\u00e0y ch\u1ee9ng minh r\u1eb1ng c\u00e1c bi\u1ec7n ph\u00e1p \u0111\u1ea3m b\u1ea3o ch\u1ea5t l\u01b0\u1ee3ng c\u00f3 h\u1ec7 th\u1ed1ng v\u00e0 vi\u1ec7c \u0111\u00e0o t\u1ea1o li\u00ean t\u1ee5c c\u00f3 th\u1ec3 gi\u1ea3m \u0111\u00e1ng k\u1ec3 c\u00e1c l\u1ed7i ch\u1ea9n \u0111o\u00e1n. Nh\u1eefng n\u1ed7 l\u1ef1c n\u00e0y \u0111\u00f3ng vai tr\u00f2 then ch\u1ed1t trong vi\u1ec7c \u0111\u1ea3m b\u1ea3o ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 t\u1ed1i \u01b0u h\u00f3a k\u1ebft c\u1ee5c cho b\u1ec7nh nh\u00e2n.<\/p>\n\n\n

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H\u00ecnh 1. Gi\u1ea3i ph\u1eabu t\u1ee5y b\u00ecnh th\u01b0\u1eddng \u1edf ba b\u1ec7nh nh\u00e2n.<\/strong> (A)<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft ngang \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 35 tu\u1ed5i cho th\u1ea5y nhu m\u00f4 t\u1ee5y \u0111\u1ed3ng nh\u1ea5t, kh\u00f4ng nhi\u1ec5m m\u1ee1. \u0110\u1ea7u t\u1ee5y (\u0111\u1ea7u m\u0169i t\u00ean) n\u1eb1m k\u1ec1 s\u00e1t t\u00e1 tr\u00e0ng (m\u0169i t\u00ean d\u00e0i), trong khi c\u1ed5 v\u00e0 th\u00e2n t\u1ee5y (m\u0169i t\u00ean ng\u1eafn) l\u1ea7n l\u01b0\u1ee3t n\u1eb1m ph\u00eda tr\u01b0\u1edbc h\u1ed9i l\u01b0u t\u0129nh m\u1ea1ch c\u1eeda (PVC) v\u00e0 t\u0129nh m\u1ea1ch l\u00e1ch (SV). (B)<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft ngang \u0111u\u00f4i t\u1ee5y (PT) \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 63 tu\u1ed5i, s\u1eed d\u1ee5ng l\u00e1ch (m\u0169i t\u00ean ng\u1eafn) l\u00e0m c\u1eeda s\u1ed5 \u00e2m. \u0110u\u00f4i t\u1ee5y n\u1eb1m gi\u1eefa l\u00e1ch v\u00e0 th\u1eadn (m\u0169i t\u00ean d\u00e0i). T\u0129nh m\u1ea1ch l\u00e1ch (\u0111\u1ea7u m\u0169i t\u00ean) ch\u1ea1y d\u1ecdc theo b\u1edd sau c\u1ee7a \u0111u\u00f4i t\u1ee5y; ph\u1ea7n \u0111u\u00f4i t\u1ee5y n\u00e0y t\u0103ng \u00e2m so v\u1edbi l\u00e1ch do nhi\u1ec5m m\u1ee1. (C)<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft d\u1ecdc \u1edf c\u00f9ng b\u1ec7nh nh\u00e2n trong h\u00ecnh A cho th\u1ea5y m\u1ecfm m\u00f3c (m\u0169i t\u00ean) n\u1eb1m ph\u00eda sau t\u0129nh m\u1ea1ch m\u1ea1c treo tr\u00e0ng tr\u00ean (SMV) v\u00e0 ph\u00eda tr\u01b0\u1edbc t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi (IV). (D)<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft ngang \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 40 tu\u1ed5i cho th\u1ea5y \u1ed1ng t\u1ee5y b\u00ecnh th\u01b0\u1eddng (m\u0169i t\u00ean).<\/p>\n\n\n

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H\u00ecnh 2. C\u00e1c t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n th\u01b0\u1eddng d\u00f9ng trong si\u00eau \u00e2m t\u1ee5y.<\/strong> T\u01b0 th\u1ebf n\u1eb1m ng\u1eeda cho ph\u00e9p \u0111\u00e1nh gi\u00e1 to\u00e0n b\u1ed9 t\u1ee5y tr\u00ean m\u1eb7t c\u1eaft ngang v\u00e0 d\u1ecdc qua c\u1eeda s\u1ed5 d\u01b0\u1edbi m\u0169i \u1ee9c. Vi\u1ec7c \u0111\u1eb7t b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf ch\u1ebfch sau ph\u1ea3i v\u00e0 n\u1eb1m nghi\u00eang ph\u1ea3i cho ph\u00e9p qu\u00e9t \u0111\u1ea7u t\u1ee5y v\u00e0 m\u1ecfm m\u00f3c ho\u1eb7c \u0111u\u00f4i t\u1ee5y, t\u00f9y thu\u1ed9c v\u00e0o vi\u1ec7c \u0111\u1eb7t \u0111\u1ea7u d\u00f2 l\u1ea7n l\u01b0\u1ee3t t\u1ea1i v\u1ecb tr\u00ed d\u01b0\u1edbi m\u0169i \u1ee9c hay v\u00f9ng h\u00f4ng tr\u00e1i. T\u01b0 th\u1ebf ng\u1ed3i c\u00f3 th\u1ec3 gi\u00fap quan s\u00e1t t\u1ee5y t\u1ed1t h\u01a1n khi c\u00e1c c\u00e1ch ti\u1ebfp c\u1eadn tr\u01b0\u1edbc \u0111\u00f3 b\u1ecb h\u1ea1n ch\u1ebf.<\/p>\n\n\n

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H\u00ecnh 3.<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft ngang t\u1ee5y (m\u0169i t\u00ean) thu \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng d\u1ea1 d\u00e0y ch\u1ee9a \u0111\u1ea7y n\u01b0\u1edbc l\u00e0m c\u1eeda s\u1ed5 \u00e2m; ph\u01b0\u01a1ng ph\u00e1p n\u00e0y gi\u00fap t\u0103ng c\u01b0\u1eddng kh\u1ea3 n\u0103ng quan s\u00e1t c\u00e1c t\u1ed5n th\u01b0\u01a1ng nh\u1edd c\u1ea3i thi\u1ec7n s\u1ef1 truy\u1ec1n \u00e2m qua m\u00f4i tr\u01b0\u1eddng d\u1ecbch.<\/p>\n\n\n

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H\u00ecnh 4. T\u1ee5y h\u00ecnh nh\u1eabn \u1edf tr\u1ebb 10 th\u00e1ng tu\u1ed5i nh\u1eadp vi\u1ec7n v\u00ec n\u00f4n.<\/strong> (A)<\/strong> H\u00ecnh si\u00eau \u00e2m c\u1eaft ngang cho th\u1ea5y \u1ed1ng t\u1ee5y (PD) b\u1ecb gi\u00e3n v\u1edbi kh\u00ed trong l\u00f2ng \u1ed1ng (m\u0169i t\u00ean), d\u1ea5u hi\u1ec7u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n. Ph\u1ea7n \u0111\u1ea7u t\u1ee5y to k\u1ebf c\u1eadn (c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean) bao quanh \u0111o\u1ea1n 2 t\u00e1 tr\u00e0ng (D2) \u0111\u00e3 b\u1ecb b\u1ecf s\u00f3t. (B)<\/strong> H\u00ecnh si\u00eau \u00e2m c\u1eaft ngang cho th\u1ea5y \u0111o\u1ea1n g\u1ea7n c\u1ee7a D2 b\u1ecb gi\u00e3n do t\u1eafc ngh\u1ebdn b\u1edfi m\u00f4 t\u1ee5y bao quanh, d\u1ea5u hi\u1ec7u n\u00e0y c\u0169ng b\u1ecb b\u1ecf s\u00f3t. Kh\u00ed trong \u1ed1ng t\u1ee5y lan r\u1ed9ng (m\u0169i t\u00ean) c\u0169ng \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y.<\/p>\n\n\n

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H\u00ecnh 5. B\u1ecf s\u00f3t b\u1ec7nh l\u00fd \u00e1c t\u00ednh \u1edf \u0111\u1ea7u v\u00e0 th\u00e2n t\u1ee5y, v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u h\u00ecnh \u1ea3nh th\u1ee9 ph\u00e1t, \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 67 tu\u1ed5i.<\/strong> (A)<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft ngang t\u01b0 th\u1ebf ch\u1ebfch sau ph\u1ea3i cho th\u1ea5y m\u1ed9t v\u00f9ng l\u1ed3i b\u1edd kh\u00f4ng r\u00f5 gi\u1edbi h\u1ea1n \u1edf \u0111\u1ea7u v\u00e0 th\u00e2n t\u1ee5y (c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean) k\u00e8m theo teo \u0111u\u00f4i t\u1ee5y (m\u0169i t\u00ean), \u0111\u00e2y l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u b\u1ed5 tr\u1ee3 quan tr\u1ecdng c\u1ee7a b\u1ec7nh l\u00fd \u00e1c t\u00ednh ti\u1ec1m \u1ea9n. M\u1eb7c d\u00f9 gi\u00e3n \u1ed1ng t\u1ee5y th\u01b0\u1eddng g\u1eb7p \u0111i k\u00e8m v\u1edbi teo ph\u1ea7n xa trong c\u00e1c b\u1ec7nh l\u00fd \u00e1c t\u00ednh, nh\u01b0ng d\u1ea5u hi\u1ec7u n\u00e0y kh\u00f4ng r\u00f5 r\u00e0ng trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y. (B)<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft ngang t\u01b0 th\u1ebf ch\u1ebfch sau ph\u1ea3i cho th\u1ea5y huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch l\u00e1ch (m\u0169i t\u00ean), m\u1ed9t ph\u00e1t hi\u1ec7n b\u1ecb b\u1ecf s\u00f3t kh\u00e1c li\u00ean quan \u0111\u1ebfn s\u1ef1 x\u00e2m l\u1ea5n c\u1ee7a kh\u1ed1i u, v\u00e0 teo \u0111u\u00f4i t\u1ee5y (m\u0169i t\u00ean). (C)<\/strong> H\u00ecnh \u1ea3nh CT c\u1eaft ngang th\u00ec t\u0129nh m\u1ea1ch c\u1eeda gi\u00fap x\u00e1c nh\u1eadn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh l\u00fd \u00e1c t\u00ednh nguy\u00ean ph\u00e1t k\u00e8m huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch l\u00e1ch (c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean) v\u00e0 teo \u0111u\u00f4i t\u1ee5y (m\u0169i t\u00ean). C\u00e1c n\u1ed1t di c\u0103n gan c\u0169ng hi\u1ec7n di\u1ec7n (kh\u00f4ng \u0111\u01b0\u1ee3c hi\u1ec3n th\u1ecb).<\/p>\n\n\n

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H\u00ecnh 6. U t\u00e2n sinh d\u1ea1ng nang \u1edf m\u1ecfm m\u00f3c t\u1ee5y c\u1ee7a m\u1ed9t b\u1ec7nh nh\u00e2n 77 tu\u1ed5i.<\/strong> (A)<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft d\u1ecdc m\u1ecfm m\u00f3c cho th\u1ea5y m\u1ed9t kh\u1ed1i u d\u1ea1ng nang (m\u0169i t\u00ean d\u00e0i) l\u1edbn h\u01a1n 3 cm, n\u1eb1m s\u00e2u h\u01a1n so v\u1edbi t\u0129nh m\u1ea1ch m\u1ea1c treo tr\u00e0ng tr\u00ean (SMV) (m\u0169i t\u00ean ng\u1eafn). Kh\u1ed1i u gi\u1ea3m \u00e2m v\u00e0 c\u00f3 b\u1edd kh\u00f4ng r\u00f5 n\u00e9t do c\u00e1c th\u00f4ng s\u1ed1 h\u00ecnh \u1ea3nh ch\u01b0a t\u1ed1i \u01b0u, bao g\u1ed3m \u0111\u1ed9 s\u00e2u qu\u00e1 l\u1edbn v\u00e0 v\u1ecb tr\u00ed v\u00f9ng h\u1ed9i t\u1ee5 (\u0111\u1ea7u m\u0169i t\u00ean), d\u1eabn \u0111\u1ebfn b\u1ecf s\u00f3t ch\u1ea9n \u0111o\u00e1n. (B)<\/strong> C\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m \u1edf ch\u1ebf \u0111\u1ed9 chia \u0111\u00f4i m\u00e0n h\u00ecnh c\u1eaft ngang (tr\u00e1i) v\u00e0 c\u1eaft d\u1ecdc (ph\u1ea3i) c\u1ee7a m\u1ecfm m\u00f3c cho th\u1ea5y kh\u1ed1i u d\u1ea1ng nang hi\u1ec7n r\u00f5 (c\u00e1c m\u0169i t\u00ean d\u00e0i) n\u1eb1m s\u00e2u h\u01a1n SMV (m\u0169i t\u00ean ng\u1eafn) sau khi t\u1ed1i \u01b0u h\u00f3a k\u1ef9 thu\u1eadt, bao g\u1ed3m gi\u1ea3m \u0111\u1ed9 s\u00e2u, \u0111i\u1ec1u ch\u1ec9nh l\u1ea1i v\u1ecb tr\u00ed v\u00f9ng h\u1ed9i t\u1ee5 (c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean), \u0111\u1ed9 l\u1ee3i (gain) ph\u00f9 h\u1ee3p \u0111\u1ec3 gi\u1ea3m \u1ea3nh gi\u1ea3, v\u00e0 c\u1ea3i thi\u1ec7n s\u1ef1 ti\u1ebfp x\u00fac c\u1ee7a \u0111\u1ea7u d\u00f2.<\/p>\n\n\n

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H\u00ecnh 7. L\u00e1ch ph\u1ee5 trong t\u1ee5y \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 32 tu\u1ed5i.<\/strong> C\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m chia \u0111\u00f4i m\u00e0n h\u00ecnh c\u1eaft d\u1ecdc (tr\u00e1i) v\u00e0 c\u1eaft ngang (ph\u1ea3i) c\u1ee7a \u0111u\u00f4i t\u1ee5y (m\u0169i t\u00ean) cho th\u1ea5y m\u1ed9t n\u1ed1t \u0111\u1ed3ng \u00e2m (c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean). Vi\u1ec7c t\u1ee5y kh\u00f4ng b\u1ecb nhi\u1ec5m m\u1ee1 khi\u1ebfn n\u1ed1t n\u00e0y tr\u1edf n\u00ean k\u00e9m r\u00f5 r\u00e0ng h\u01a1n v\u00e0 c\u1ea7n \u0111\u1ed1i chi\u1ebfu v\u1edbi CT \u0111\u1ec3 nh\u1eadn di\u1ec7n. Phim CT c\u1eaft ngang \u1edf th\u00ec \u0111\u1ed9ng m\u1ea1ch v\u00e0 th\u00ec t\u0129nh m\u1ea1ch c\u1eeda (H\u00ecnh S3) \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0i n\u0103m tr\u01b0\u1edbc \u0111\u00f3 cho th\u1ea5y m\u1ed9t t\u1ed5n th\u01b0\u01a1ng gi\u1edbi h\u1ea1n r\u00f5 \u1edf \u0111u\u00f4i t\u1ee5y v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m ng\u1ea5m thu\u1ed1c gi\u1ed1ng h\u1ec7t l\u00e1ch, x\u00e1c nh\u1eadn ch\u1ea9n \u0111o\u00e1n kh\u1ea3 d\u0129 l\u00e0 l\u00e1ch ph\u1ee5 trong t\u1ee5y. Vi\u1ec7c xem x\u00e9t h\u1ed3i c\u1ee9u kh\u1ea3o s\u00e1t si\u00eau \u00e2m ban \u0111\u1ea7u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n 8 n\u0103m tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e3 ph\u00e1t hi\u1ec7n c\u00f9ng m\u1ed9t n\u1ed1t \u0111\u1eb3ng \u00e2m trong t\u1ee5y, n\u1ed1t n\u00e0y \u0111\u00e3 b\u1ecb b\u1ecf s\u00f3t nh\u01b0ng sau \u0111\u00f3 \u0111\u01b0\u1ee3c nh\u1eadn di\u1ec7n sau khi \u0111\u1ed1i chi\u1ebfu v\u1edbi c\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean CT.<\/p>\n\n\n

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H\u00ecnh 8. \u0110u\u00f4i t\u1ee5y c\u00f3 b\u1edd ph\u00e2n th\u00f9y \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 52 tu\u1ed5i.<\/strong> (A)<\/strong> C\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m chia \u0111\u00f4i m\u00e0n h\u00ecnh c\u1eaft d\u1ecdc v\u00e0 c\u1eaft ngang c\u1ee7a \u0111u\u00f4i t\u1ee5y thu \u0111\u01b0\u1ee3c qua m\u1eb7t trong c\u1ee7a l\u00e1ch cho th\u1ea5y d\u1ea1ng ph\u00e2n th\u00f9y b\u00ecnh th\u01b0\u1eddng (c\u00e1c m\u0169i t\u00ean) c\u1ee7a t\u1ee5y, h\u00ecnh \u1ea3nh n\u00e0y \u0111\u00e3 b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 m\u1ed9t t\u1ed5n th\u01b0\u01a1ng khu tr\u00fa t\u1ea1i r\u1ed1n l\u00e1ch do g\u00f3c ch\u00f9m tia v\u00e0 kh\u1ea3 n\u0103ng quan s\u00e1t h\u1ea1n ch\u1ebf ph\u1ea7n c\u00f2n l\u1ea1i c\u1ee7a t\u1ee5y. (B)<\/strong> H\u00ecnh \u1ea3nh CT c\u1eaft ngang t\u1eeb l\u1ea7n ch\u1ee5p tr\u01b0\u1edbc \u0111\u00f3 g\u1ea7n \u0111\u00e2y x\u00e1c nh\u1eadn s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a d\u1ea1ng ph\u00e2n th\u00f9y t\u1ee5y b\u00ecnh th\u01b0\u1eddng (m\u0169i t\u00ean), n\u00eau b\u1eadt t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c \u0111\u1ed1i chi\u1ebfu v\u1edbi c\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp v\u00e0 s\u1ef1 c\u1ea7n thi\u1ebft c\u1ee7a nhi\u1ec1u m\u1eb7t ph\u1eb3ng qu\u00e9t tr\u00ean si\u00eau \u00e2m \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ed1i li\u00ean quan c\u1ee7a ph\u1ea7n \u0111u\u00f4i t\u1ee5y ph\u00e2n th\u00f9y v\u1edbi ph\u1ea7n c\u00f2n l\u1ea1i c\u1ee7a t\u1ee5y nh\u1eb1m ng\u0103n ng\u1eeba ch\u1ea9n \u0111o\u00e1n nh\u1ea7m.<\/p>\n\n\n

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H\u00ecnh 9. S\u1ef1 l\u00f5m v\u00e0o c\u1ee7a l\u1edbp m\u1ee1 khu tr\u00fa b\u1ecb nh\u1ea7m l\u00e0 u t\u00e2n sinh t\u1ee5y \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n 71 tu\u1ed5i.<\/strong> (A)<\/strong> H\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft ngang t\u1ee5y cho th\u1ea5y m\u1ed9t n\u1ed1t gi\u1ea3m \u00e2m (m\u0169i t\u00ean), \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 u t\u00e2n sinh d\u1ea1ng \u0111\u1eb7c, t\u1ea1i ph\u1ea7n tr\u01b0\u1edbc c\u1ee7a th\u00e2n t\u1ee5y. (B)<\/strong> C\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean h\u00ecnh \u1ea3nh CT c\u1eaft ngang kh\u00f4ng ti\u00eam thu\u1ed1c c\u1ea3n quang tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e3 x\u00e1c nh\u1eadn t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd n\u00e0y (m\u0169i t\u00ean) \u0111\u1ea1i di\u1ec7n cho s\u1ef1 l\u00f5m v\u00e0o c\u1ee7a l\u1edbp m\u1ee1 khu tr\u00fa do s\u1ef1 li\u00ean t\u1ee5c c\u1ee7a n\u00f3 v\u1edbi l\u1edbp m\u1ee1 quanh t\u1ee5y. Ch\u1ea9n \u0111o\u00e1n n\u00e0y \u0111\u00e3 kh\u00f4ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o c\u1ee5 th\u1ec3 tr\u00ean CT do t\u00ednh ch\u1ea5t l\u00e0nh t\u00ednh c\u1ee7a t\u1ed5n th\u01b0\u01a1ng v\u00e0 v\u00ec n\u00f3 \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t ph\u00e1t hi\u1ec7n b\u00ecnh th\u01b0\u1eddng tr\u00ean h\u00ecnh \u1ea3nh CT. C\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m theo d\u00f5i cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 thay \u0111\u1ed5i n\u00e0o.<\/p>\n\n\n

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H\u00ecnh 10. B\u1ec7nh l\u00fd \u00e1c t\u00ednh nguy\u00ean ph\u00e1t t\u1ea1i t\u1ee5y b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 l\u00e1ch ph\u1ee5 \u1edf b\u1ec7nh nh\u00e2n 65 tu\u1ed5i nh\u1eadp vi\u1ec7n v\u00ec \u0111au th\u01b0\u1ee3ng v\u1ecb dai d\u1eb3ng.<\/strong> H\u00ecnh si\u00eau \u00e2m c\u1eaft d\u1ecdc l\u00e1ch cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng quanh l\u00e1ch (m\u0169i t\u00ean) v\u1edbi b\u1edd kh\u00f4ng \u0111\u1ec1u. Si\u00eau \u00e2m Doppler m\u00e0u (kh\u00f4ng hi\u1ec3n th\u1ecb) cho th\u1ea5y t\u0103ng sinh m\u1ea1ch m\u00e1u n\u1ed5i b\u1eadt \u1edf ngo\u1ea1i vi v\u00e0 b\u00ean trong. T\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 l\u00e1ch ph\u1ee5 tr\u00ean si\u00eau \u00e2m m\u1eb7c d\u00f9 c\u00f3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m kh\u00f4ng \u0111i\u1ec3n h\u00ecnh v\u00e0 ph\u00e1t hi\u1ec7n nhi\u1ec1u t\u1ed5n th\u01b0\u01a1ng gan g\u1ee3i \u00fd di c\u0103n. M\u00f4 t\u1ee5y nhi\u1ec5m m\u1ee1 k\u1ebf c\u1eadn (c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean) \u0111\u00e3 kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n. C\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean CT th\u00ec \u0111\u1ed9ng m\u1ea1ch theo d\u00f5i (H\u00ecnh S4) x\u00e1c nh\u1eadn t\u1ed5n th\u01b0\u01a1ng l\u00e0 b\u1ec7nh l\u00fd \u00e1c t\u00ednh nguy\u00ean ph\u00e1t t\u1ea1i t\u1ee5y. T\u0129nh m\u1ea1ch l\u00e1ch b\u1ecb huy\u1ebft kh\u1ed1i \u0111\u01b0\u1ee3c th\u1ea5y tr\u00ean CT th\u00ec t\u0129nh m\u1ea1ch nh\u01b0ng b\u1ecb b\u1ecf s\u00f3t tr\u00ean si\u00eau \u00e2m.<\/p>\n\n\n

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H\u00ecnh 11. U th\u1ea7n kinh n\u1ed9i ti\u1ebft \u0111u\u00f4i t\u1ee5y b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 kh\u1ed1i u tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn \u1edf b\u1ec7nh nh\u00e2n 73 tu\u1ed5i.<\/strong> H\u00ecnh si\u00eau \u00e2m c\u1eaft ngang cho th\u1ea5y m\u1ed9t t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u0111\u1eb7c-nang gi\u1edbi h\u1ea1n r\u00f5 (m\u0169i t\u00ean) n\u1eb1m c\u1ea1nh l\u00e1ch (kh\u00f4ng hi\u1ec3n th\u1ecb) v\u1edbi v\u1ebb g\u1ea7n k\u1ec1 th\u1eadn tr\u00e1i (LK). T\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1ee3c di\u1ec5n gi\u1ea3i l\u00e0 u tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn do v\u1ecb tr\u00ed n\u1eb1m tr\u00ean th\u1eadn c\u1ee7a n\u00f3. M\u00f4 t\u1ee5y nhi\u1ec5m m\u1ee1 k\u1ebf c\u1eadn (c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean) \u0111\u00e3 b\u1ecb b\u1ecf s\u00f3t.<\/p>\n\n\n

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H\u00ecnh 12. U nh\u1ea7y nh\u00fa trong \u1ed1ng t\u1ee5y (IPMN) nh\u00e1nh b\u00ean \u1edf \u0111u\u00f4i t\u1ee5y c\u00f3 ch\u1ee9a n\u1ed1t th\u00e0nh v\u00e0 b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 nang th\u1eadn tr\u00e1i ph\u1ee9c t\u1ea1p \u1edf b\u1ec7nh nh\u00e2n 80 tu\u1ed5i c\u00f3 ti\u1ec1n s\u1eed ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o th\u1eadn ph\u1ea3i.<\/strong> (A)<\/strong> C\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m c\u1eaft ngang v\u00e0 c\u1eaft d\u1ecdc chia \u0111\u00f4i m\u00e0n h\u00ecnh cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng nang gi\u1edbi h\u1ea1n r\u00f5 (c\u00e1c m\u0169i t\u00ean) v\u1edbi n\u1ed1t th\u00e0nh t\u0103ng \u00e2m xu\u1ea5t ph\u00e1t t\u1eeb t\u1ee5y (\u0111\u1ea7u m\u0169i t\u00ean) nh\u01b0ng n\u1eb1m r\u1ea5t g\u1ea7n th\u1eadn tr\u00e1i (LK) do \u0111\u00e8 \u00e9p \u0111\u1ea7u d\u00f2. Vi\u1ec7c kh\u00f4ng nh\u1eadn ra s\u1ef1 v\u1eafng m\u1eb7t c\u1ee7a d\u1ea5u hi\u1ec7u vu\u1ed1t (t\u1eeb th\u1eadn) c\u00e0ng g\u00f3p ph\u1ea7n d\u1eabn \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n nh\u1ea7m. (B)<\/strong> H\u00ecnh si\u00eau \u00e2m theo d\u00f5i 6 th\u00e1ng sau cho th\u1ea5y r\u00f5 h\u01a1n ngu\u1ed3n g\u1ed1c c\u1ee7a t\u1ed5n th\u01b0\u01a1ng (m\u0169i t\u00ean) t\u1eeb \u0111u\u00f4i t\u1ee5y (\u0111\u1ea7u m\u0169i t\u00ean) nh\u1edd \u00e1p d\u1ee5ng k\u1ef9 thu\u1eadt \u0111\u00e8 \u00e9p \u0111\u1ea7u d\u00f2 t\u1eebng m\u1ee9c \u0111\u1ed9, gi\u00fap \u0111\u1ea9y t\u1ed5n th\u01b0\u01a1ng ra xa th\u1eadn v\u00e0 l\u00e1ch k\u1ebf c\u1eadn. Tr\u00ean ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1eadt t\u1ee5y (kh\u00f4ng hi\u1ec3n th\u1ecb) th\u1ef1c hi\u1ec7n v\u00e0i n\u0103m tr\u01b0\u1edbc \u0111\u00f3, t\u1ed5n th\u01b0\u01a1ng \u0111u\u00f4i t\u1ee5y, khi \u0111\u00f3 nh\u1ecf h\u01a1n v\u00e0 sau \u0111\u00f3 b\u1ecb m\u1ea5t d\u1ea5u theo d\u00f5i, \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn.<\/p>\n\n\n

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H\u00ecnh 13. Gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch l\u00e1ch b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 u t\u00e2n sinh t\u1ee5y d\u1ea1ng \u0111\u1eb7c-nang \u1edf b\u1ec7nh nh\u00e2n 68 tu\u1ed5i c\u00f3 ti\u1ec1n s\u1eed t\u00e9 ng\u00e3 g\u1ea7n \u0111\u00e2y.<\/strong> (A)<\/strong> H\u00ecnh si\u00eau \u00e2m c\u1eaft d\u1ecdc cho th\u1ea5y m\u1ed9t t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u0111\u1eb7c-nang (m\u0169i t\u00ean d\u00e0i) g\u1ea7n l\u00e1ch ban \u0111\u1ea7u b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 u t\u00e2n sinh \u0111u\u00f4i t\u1ee5y (m\u0169i t\u00ean ng\u1eafn). Tuy nhi\u00ean, kh\u00f4ng c\u00f3 kh\u1ea3o s\u00e1t si\u00eau \u00e2m Doppler m\u00e0u n\u00e0o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n, v\u00e0 h\u00ecnh \u1ea3nh kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t c\u1ee7a l\u00e1ch (c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean) \u0111\u00e3 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u00fang m\u1ee9c. (B)<\/strong> H\u00ecnh \u1ea3nh Doppler m\u00e0u thu \u0111\u01b0\u1ee3c t\u1ea1i l\u1ea7n si\u00eau \u00e2m theo d\u00f5i v\u00e0i ng\u00e0y sau \u0111\u00f3 do \u0111au dai d\u1eb3ng v\u00f9ng th\u01b0\u1ee3ng v\u1ecb tr\u00e1i cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1ee3c cho l\u00e0 \u1edf t\u1ee5y th\u1ef1c ch\u1ea5t l\u00e0 gi\u1ea3 ph\u00ecnh m\u1ea1ch (m\u0169i t\u00ean) li\u00ean quan \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch l\u00e1ch. Ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn tr\u00ean CT theo d\u00f5i (H\u00ecnh S7).<\/p>\n\n\n

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H\u00ecnh 14. U t\u00e2n sinh d\u1ea1ng nang thanh d\u1ecbch c\u1ee7a t\u1ee5y b\u1ecb nh\u1ea7m l\u00e0 th\u1eadn tr\u00e1i teo nh\u1ecf \u1edf m\u1ed9t ph\u1ee5 n\u1eef 86 tu\u1ed5i b\u1ecb sa s\u00fat tr\u00ed tu\u1ec7, ng\u01b0\u1eddi \u0111\u00e3 hi\u1ebfn th\u1eadn tr\u00e1i h\u01a1n 10 n\u0103m tr\u01b0\u1edbc.<\/strong> H\u00ecnh si\u00eau \u00e2m c\u1eaft d\u1ecdc cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng nang nhi\u1ec1u h\u1ed1c (m\u0169i t\u00ean) n\u1eb1m tr\u01b0\u1edbc t\u0129nh m\u1ea1ch l\u00e1ch (\u0111\u1ea7u m\u0169i t\u00ean). Ngu\u1ed3n g\u1ed1c th\u1ef1c s\u1ef1 c\u1ee7a t\u1ed5n th\u01b0\u01a1ng t\u1eeb \u0111u\u00f4i t\u1ee5y \u0111\u00e3 b\u1ecb b\u1ecf s\u00f3t, d\u1eabn \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 th\u1eadn tr\u00e1i teo nh\u1ecf c\u00f3 nhi\u1ec1u nang. Sai s\u00f3t n\u00e0y c\u00e0ng tr\u1ea7m tr\u1ecdng h\u01a1n do kh\u00f4ng xem l\u1ea1i ti\u1ec1n s\u1eed c\u1eaft th\u1eadn tr\u00e1i tr\u01b0\u1edbc \u0111\u00f3 c\u1ee7a b\u1ec7nh nh\u00e2n. C\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean MRI theo d\u00f5i x\u00e1c nh\u1eadn ch\u1ea9n \u0111o\u00e1n u t\u00e2n sinh d\u1ea1ng nang thanh d\u1ecbch t\u1ea1i \u0111u\u00f4i t\u1ee5y (H\u00ecnh S8).<\/p>\n\n\n

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H\u00ecnh 15. M\u00f4 l\u00e1ch l\u1ea1c ch\u1ed7 trong t\u1ee5y (Splenosis) b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 l\u00e1ch ph\u1ee5 ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng t\u1ee5y trong qu\u00e1 tr\u00ecnh si\u00eau \u00e2m t\u1ea7m so\u00e1t \u0111\u1ecbnh k\u1ef3 (kh\u00f4ng hi\u1ec3n th\u1ecb) \u1edf b\u1ec7nh nh\u00e2n 69 tu\u1ed5i b\u1ecb vi\u00eam gan B v\u00e0 c\u00f3 ti\u1ec1n s\u1eed m\u1edf b\u1ee5ng tr\u01b0\u1edbc \u0111\u00f3 do v\u1ee1 l\u00e1ch.<\/strong> (A)<\/strong> H\u00ecnh \u1ea3nh th\u00ec \u0111\u1ed9ng m\u1ea1ch t\u1eeb CT cho th\u1ea5y m\u1ed9t kh\u1ed1i gi\u1edbi h\u1ea1n r\u00f5 (m\u0169i t\u00ean) v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m ng\u1ea5m thu\u1ed1c t\u01b0\u01a1ng t\u1ef1 nh\u01b0 mong \u0111\u1ee3i \u1edf l\u00e1ch t\u1ef1 nhi\u00ean, g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n m\u00f4 l\u00e1ch l\u1ea1c ch\u1ed7 trong t\u1ee5y. Tuy nhi\u00ean, do \u0111\u00e3 c\u1eaft l\u00e1ch tr\u01b0\u1edbc \u0111\u00f3, b\u00e1c s\u0129 ch\u1ec9 \u0111\u1ecbnh y\u00eau c\u1ea7u x\u00e1c nh\u1eadn th\u00eam ch\u1ea9n \u0111o\u00e1n b\u1eb1ng si\u00eau \u00e2m c\u1ea3n quang (CEUS) ho\u1eb7c x\u1ea1 h\u00ecnh keo l\u01b0u hu\u1ef3nh. (B)<\/strong> H\u00ecnh \u1ea3nh CEUS cho th\u1ea5y c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m ng\u1ea5m thu\u1ed1c t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u1edf l\u00e1ch trong t\u1ea5t c\u1ea3 c\u00e1c th\u00ec, bao g\u1ed3m s\u1ef1 l\u01b0u gi\u1eef ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n (c\u00e1c m\u0169i t\u00ean) trong c\u00e1c th\u00ec mu\u1ed9n. MI = ch\u1ec9 s\u1ed1 c\u01a1.<\/p>\n\n\n

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H\u00ecnh 16. Ung th\u01b0 bi\u1ec3u m\u00f4 tuy\u1ebfn l\u1edbn \u1edf m\u1ecfm m\u00f3c t\u1ee5y b\u1ecb b\u1ecf s\u00f3t tr\u00ean si\u00eau \u00e2m \u1edf b\u1ec7nh nh\u00e2n 74 tu\u1ed5i b\u1ecb \u0111au b\u1ee5ng.<\/strong> H\u00ecnh si\u00eau \u00e2m c\u1eaft ngang cho th\u1ea5y t\u1ee5y c\u00f3 v\u1ebb b\u00ecnh th\u01b0\u1eddng. T\u00e1 tr\u00e0ng gi\u00e3n c\u0103ng (m\u0169i t\u00ean) v\u00e0 d\u1ea1 d\u00e0y (c\u00e1c \u0111\u1ea7u m\u0169i t\u00ean) k\u1ebf c\u1eadn \u0111\u00e3 b\u1ecb b\u1ecf s\u00f3t; s\u1ef1 b\u1ecf s\u00f3t n\u00e0y l\u1ebd ra c\u00f3 th\u1ec3 ch\u1ec9 \u0111i\u1ec3m cho m\u1ed9t kh\u1ed1i u g\u00e2y t\u1eafc ngh\u1ebdn ti\u1ec1m \u1ea9n. M\u1ecfm m\u00f3c \u0111\u00e3 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u1ea7y \u0111\u1ee7. CT theo d\u00f5i th\u1ef1c hi\u1ec7n 2 ng\u00e0y sau do \u0111au b\u1ee5ng dai d\u1eb3ng \u0111\u00e3 ph\u00e1t hi\u1ec7n m\u1ed9t kh\u1ed1i 5 cm t\u1ea1i m\u1ecfm m\u00f3c (H\u00ecnh S9).<\/p>\n\n\n

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H\u00ecnh 17. U nh\u1ea7y nh\u00fa trong \u1ed1ng t\u1ee5y (IPMN) nh\u00e1nh b\u00ean \u1edf b\u1ec7nh nh\u00e2n 72 tu\u1ed5i.<\/strong> (A)<\/strong> H\u00ecnh si\u00eau \u00e2m c\u1eaft ngang ban \u0111\u1ea7u c\u1ee7a t\u1ee5y s\u1eed d\u1ee5ng \u0111\u1ea7u d\u00f2 cong cho th\u1ea5y m\u1ed9t nang c\u00f3 v\u1ebb l\u00e0 \u0111\u01a1n h\u1ed1c k\u00edch th\u01b0\u1edbc 0,7 cm (m\u0169i t\u00ean) \u1edf th\u00e2n t\u1ee5y. (B)<\/strong> T\u1ea1i l\u1ea7n si\u00eau \u00e2m theo d\u00f5i 3 th\u00e1ng sau, \u0111\u1ea7u d\u00f2 ph\u1eb3ng \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 th\u00eam, l\u00fac n\u00e0y t\u1ed5n th\u01b0\u01a1ng (m\u0169i t\u00ean) \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 ch\u00ednh x\u00e1c h\u01a1n l\u00e0 m\u1ed9t t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng nang ph\u00e2n th\u00f9y k\u00edch th\u01b0\u1edbc 1,6 cm v\u1edbi m\u1ed9t v\u00e1ch m\u1ecfng. Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y n\u00eau b\u1eadt t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c l\u1ef1a ch\u1ecdn \u0111\u1ea7u d\u00f2 trong m\u1ed9t s\u1ed1 t\u00ecnh hu\u1ed1ng nh\u1ea5t \u0111\u1ecbnh, c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n vi\u1ec7c x\u00e1c \u0111\u1ecbnh \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u1ea5u tr\u00fac ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng t\u01b0\u01a1ng \u0111\u1ed1i n\u00f4ng. C\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb m\u1eadt t\u1ee5y sau \u0111\u00f3 (kh\u00f4ng hi\u1ec3n th\u1ecb) x\u00e1c nh\u1eadn c\u00e1c ph\u00e1t hi\u1ec7n si\u00eau \u00e2m v\u1ec1 IPMN nh\u00e1nh b\u00ean.<\/p>\n","protected":false},"excerpt":{"rendered":"

M\u1eb7c d\u00f9 si\u00eau \u00e2m t\u1ee5y r\u1ea5t h\u1eefu \u00edch, ph\u01b0\u01a1ng ph\u00e1p n\u00e0y th\u01b0\u1eddng c\u00f3 hi\u1ec7u qu\u1ea3 h\u1ea1n ch\u1ebf do gi\u1ea3i ph\u1eabu ph\u1ee9c t\u1ea1p c\u1ee7a t\u1ee5y v\u00e0 c\u00e1c c\u1ea5u tr\u00fac quanh t\u1ee5y, \u0111i\u1ec1u n\u00e0y t\u1ea5t y\u1ebfu d\u1eabn \u0111\u1ebfn c\u00e1c l\u1ed7i ch\u1ea9n \u0111o\u00e1n.<\/p>\n","protected":false},"author":1,"featured_media":1239,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,41,32,5,71],"tags":[],"class_list":["post-1237","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-doc-sach-cho-vui","category-english-corner","category-hoc-sieu-am-tu-con-so-0","category-sieu-am","category-tap-chi-bao-cao"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1237","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/comments?post=1237"}],"version-history":[{"count":6,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1237\/revisions"}],"predecessor-version":[{"id":1249,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1237\/revisions\/1249"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media\/1239"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=1237"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=1237"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=1237"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}