{"id":569,"date":"2021-05-10T23:47:26","date_gmt":"2021-05-10T16:47:26","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=569"},"modified":"2021-05-11T00:36:39","modified_gmt":"2021-05-10T17:36:39","slug":"u-klaskin","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/u-klaskin\/","title":{"rendered":"U Klaskin"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">BN Nam, 1971, \u0111\u1ebfn kh\u00e1m v\u00ec u gan.<br>Si\u00eau \u00c2m ghi nh\u1eadn h\u00ecnh \u1ea3nh nh\u01b0 sau. H\u00ecnh \u1ea3nh n\u00e0y kh\u00e1 \u1ea5n t\u01b0\u1ee3ng v\u00e0 h\u1eefu \u00edch cho BS m\u1edbi.<br>K\u00e8m sinh h\u00f3a v\u00e0 h\u00ecnh CT.<\/p>\n\n\n\n<figure class=\"wp-block-embed aligncenter is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-4-3 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"U gan hay\" width=\"640\" height=\"480\" src=\"https:\/\/www.youtube.com\/embed\/HgwCYdL-o94?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"638\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184057880_2011318629021443_7411307812454222808_n-1024x638.jpg\" alt=\"\" class=\"wp-image-571\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184057880_2011318629021443_7411307812454222808_n-1024x638.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184057880_2011318629021443_7411307812454222808_n-300x187.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184057880_2011318629021443_7411307812454222808_n-768x479.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184057880_2011318629021443_7411307812454222808_n.jpg 1442w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"378\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/183957107_2011334952353144_4293933120965041761_n-1024x378.jpg\" alt=\"\" class=\"wp-image-570\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/183957107_2011334952353144_4293933120965041761_n-1024x378.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/183957107_2011334952353144_4293933120965041761_n-300x111.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/183957107_2011334952353144_4293933120965041761_n-768x283.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/183957107_2011334952353144_4293933120965041761_n-1536x567.jpg 1536w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/183957107_2011334952353144_4293933120965041761_n.jpg 1818w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><\/div>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"921\" height=\"687\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184489222_2011625722324067_4036482377531033294_n.jpg\" alt=\"\" class=\"wp-image-573\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184489222_2011625722324067_4036482377531033294_n.jpg 921w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184489222_2011625722324067_4036482377531033294_n-300x224.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184489222_2011625722324067_4036482377531033294_n-768x573.jpg 768w\" sizes=\"auto, (max-width: 921px) 100vw, 921px\" \/><\/figure><\/div>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"936\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184985308_2011625818990724_8516053310039305223_n-1024x936.jpg\" alt=\"\" class=\"wp-image-575\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184985308_2011625818990724_8516053310039305223_n-1024x936.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184985308_2011625818990724_8516053310039305223_n-300x274.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184985308_2011625818990724_8516053310039305223_n-768x702.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184985308_2011625818990724_8516053310039305223_n-1536x1404.jpg 1536w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184985308_2011625818990724_8516053310039305223_n.jpg 1653w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><\/div>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"832\" height=\"126\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184275609_2011361125683860_7913676847190586625_n.jpg\" alt=\"\" class=\"wp-image-572\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184275609_2011361125683860_7913676847190586625_n.jpg 832w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184275609_2011361125683860_7913676847190586625_n-300x45.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184275609_2011361125683860_7913676847190586625_n-768x116.jpg 768w\" sizes=\"auto, (max-width: 832px) 100vw, 832px\" \/><\/figure><\/div>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"192\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184860422_2011625845657388_4851642722159386464_n-1024x192.jpg\" alt=\"\" class=\"wp-image-574\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184860422_2011625845657388_4851642722159386464_n-1024x192.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184860422_2011625845657388_4851642722159386464_n-300x56.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184860422_2011625845657388_4851642722159386464_n-768x144.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/05\/184860422_2011625845657388_4851642722159386464_n.jpg 1042w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><\/div>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>Si\u00eau \u00e2m: ghi nh\u00e2n kh\u1ed1i t\u1ed5n th\u01b0\u01a1ng h\u01a1i gi\u1ea3m \u00e2m so v\u1edbi nhu m\u00f4 gan, \u0111i\u1ec3m \u0111\u1eb7c bi\u1ec7t \u1ea5n t\u01b0\u1ee3ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng n\u00e0y l\u00e0 n\u1eb1m ngay r\u1ed1n gan, c\u00f3 g\u00e2y d\u00e3n nh\u1eb9 \u0111\u01b0\u1eddng m\u1eadt \u1edf ngo\u1ea1i vi, Halo r\u1ea5t r\u00f5 g\u1ee3i \u00fd m\u1ed9t b\u1ec7nh l\u00fd \u00e1c t\u00ednh di\u1ec5n ti\u1ebfn nhanh. \u0110i\u1ec3m \u0111\u1eb7c bi\u1ec7t n\u1eefa l\u00e0 t\u1ed5n th\u01b0\u01a1ng n\u00e0y c\u00f3 xu h\u01b0\u1edbng bao quanh kho\u1ea3ng c\u1eeda ch\u1ee9 kh\u00f4ng x\u00f4 \u0111\u1ea9y m\u1ea1ch m\u00e1u ( d\u1ea5u hi\u1ec7u th\u01b0\u1eddng th\u1ea5y trong HCC)\u2026.t\u1eeb nh\u1eefng d\u1ea5u hi\u1ec7u tr\u00ean th\u00ec tr\u00ean SA \u0111\u00e3 r\u1ea5t g\u1ee3i \u00fd t\u1ed5n th\u01b0\u01a1ng K \u0111\u01b0\u1eddng m\u1eadt, \u1edf r\u1ed1n gan th\u00ec li\u00ean quan m\u1ed9t d\u1ea1ng \u00edt g\u1eb7p c\u1ee7a K \u0111\u01b0\u1eddng m\u1eadt \u0111\u00f3 l\u00e0 KLATSKIN TUMOR.<\/p><p>+ V\u1ec1 CT: t\u1ed5n th\u01b0\u01a1ng b\u1eaft thu\u1ed1c \u00edt c\u1ea3 th\u00ec \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch, n\u00ean r\u1ea5t g\u1ee3i \u00fd K \u0111\u01b0\u1eddng m\u1eadt, r\u1ea5t \u00edt ngh\u0129 HCC.<\/p><p>+ Sinh h\u00f3a: CA 19-9 t\u0103ng cao, AFP b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng vi\u00eam gan B,C c\u00e0ng ph\u00f9 h\u1ee3p K \u0111\u01b0\u1eddng m\u1eadt.<\/p><p>D\u00f9 r\u1ea5t nghi ng\u1edd nh\u01b0ng v\u1eabn ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng x\u00e1c \u0111\u1ecbnh, v\u00e0 BN \u0111\u00e3 \u0111c th\u1ef1c hi\u1ec7n core biopsy. Ch\u1ec9 th\u1ef1c hi\u1ec7n core sau SA 6 ng\u00e0y nh\u01b0ng LS khi \u0111\u00f3 ho\u00e0n to\u00e0n kh\u00e1c, BN \u0111\u00e3 b\u1ecb ch\u00e8n \u00e9p g\u00e2y d\u00e3n n\u1eb7ng \u0111\u01b0\u1eddng m\u1eadt trong gan, \u0111\u00e3 \u0111\u01b0\u1ee3c d\u1eabn l\u01b0u \u0111\u01b0\u1eddng m\u1eadt xuy\u00ean gan qua da d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a SA c\u1ea3 gan ph\u1ea3i v\u00e0 tr\u00e1i\u2026.cho th\u1ea5y ti\u00ean l\u01b0\u1ee3ng r\u1ea5t x\u1ea5u.<\/p><p>T\u00f3m l\u1ea1i: Ca n\u00e0y v\u1ec1 H\u00ecnh \u1ea3nh, sinh h\u00f3a l\u00e0 g\u1ea7n nh\u01b0 kinh \u0111i\u1ec3n c\u1ee7a K \u0111\u01b0\u1eddng m\u1eadt, \u1ea5n t\u01b0\u1ee3ng l\u00e0 th\u1ec3 b\u1ec7nh \u00edt g\u1eb7p nh\u01b0ng ti\u00ean l\u01b0\u1ee3ng r\u1ea5t x\u1ea5u ( KLATSKIN TUMOR).SA ch\u00fang ta kh\u00f4ng ch\u1ec9 c\u00f3 vai tr\u00f2 \u0111\u1ecbnh h\u01b0\u1edbng ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00f2n c\u00f3 th\u1ec3 gi\u00fap th\u1ef1c hi\u1ec7n m\u1ed9t s\u1ed1 th\u1ee7 thu\u1eadt \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, v\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng.XIN CHIA S\u1eba CAS KINH \u0110I\u1ec2N. C\u00e1m \u01a1n t\u1ea5t c\u1ea3 qu\u00fd anh ch\u1ecb \u0111\u00e3 chia s\u1ebb quan \u0111i\u1ec3m.<\/p><cite><a rel=\"noreferrer noopener\" href=\"https:\/\/www.facebook.com\/groups\/398711700780903\/permalink\/788310885154314\/?comment_id=788551781796891&amp;cft[0]=AZUDw-3R1dA5yqfDrx7n1yKbzkCBJuscXkg6Jqo6O5DHaiMv3d3-ZkoujVM0L5iczjdUWNiYVheazPxzfu-H33GVV8hsfGRz4NCq9JDv664CYDcCsl-I3tB1orUm86CsG_xQrVmswRtnoOA4WjG8_N73&amp;tn=R]-R\" target=\"_blank\">bs Th\u1ecbnh Nguy\u1ec5n<\/a><\/cite><\/blockquote>\n\n\n\n<pre class=\"wp-block-code\"><code>Ngu\u1ed3n b\u00e0i vi\u1ebft:\nhttps:&#47;&#47;www.facebook.com\/groups\/398711700780903\/permalink\/788310885154314\/<\/code><\/pre>\n\n\n\n<p class=\"wp-block-paragraph\">Ung th\u01b0 \u00a0\u0111\u01b0\u1eddng m\u1eadt r\u1ed1n gan \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 b\u1edfi\u00a0Altemeir\u00a0trong n\u0103m 1957.\u00a0Sau \u0111\u00f3, m\u1ed9t lo\u1ea1t 13 b\u1ec7nh nh\u00e2n v\u1edbi ch\u1ea9n \u0111o\u00e1n n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o b\u1edfi\u00a0Klatskin\u00a0trong n\u0103m 1965.\u00a0K\u1ec3 t\u1eeb th\u1eddi gian \u0111\u00f3, Ung th\u01b0 \u00a0\u0111\u01b0\u1eddng m\u1eadt r\u1ed1n gan \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 U Klatskin.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">\u0110\u1ecbnh ngh\u0129a, sinh b\u1ec7nh h\u1ecdc v\u00e0 d\u1ecbch t\u1ec5 h\u1ecdc<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt m\u1eadt c\u00f3 th\u1ec3 x\u1ea3y ra b\u1ea5t c\u1ee9 &nbsp;n\u01a1i n\u00e0o d\u1ecdc theo \u0111\u01b0\u1eddng m\u1eadt t\u1eeb b\u00f3ng Vater \u0111\u1ebfn t\u1eadn c\u00e1c \u1ed1ng gan ri\u00eang.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt l\u00e0 b\u1ec7nh l\u00fd \u00e1c t\u00ednh hi\u1ebfm g\u1eb7p, chi\u1ebfm kho\u1ea3ng 2% t\u1ed5ng s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ung th\u01b0. Tuy nhi\u00ean, ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt l\u00e0 b\u1ec7nh l\u00fd \u00e1c t\u00ednh ph\u1ed5 bi\u1ebfn th\u1ee9 &nbsp;nh\u00ec c\u1ee7a gan m\u1eadt, ch\u1ec9 \u0111\u1ee9ng sau ung th\u01b0 t\u1ebf b\u00e0o gan.&nbsp;Kho\u1ea3ng 15.000 tr\u01b0\u1eddng h\u1ee3p m\u1edbi c\u1ee7a gan v\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 \u0111\u01b0\u1eddng m\u1eadt \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n h\u00e0ng n\u0103m t\u1ea1i Hoa K\u1ef3, v\u1edbi kho\u1ea3ng 10% c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 c\u00e1c kh\u1ed1i u Klatskin.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">90% ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt nguy\u00ean ph\u00e1t l\u00e0 ung th\u01b0 &nbsp;\u0111\u01b0\u1eddng m\u1eadt ngo\u00e0i gan, trong \u0111\u00f3 60-80% l\u00e0 ung th\u01b0 ng\u00e3 ba \u1ed1ng gan (kh\u1ed1i u Klatskin), 25% l\u00e0 ung th\u01b0 \u0111o\u1ea1n cu\u1ed1i \u1ed1ng m\u1eadt ch\u1ee7 (bao g\u1ed3m ung th\u01b0 b\u00f3ng Vater).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nam&nbsp;gi\u1edbi v\u00e0 n\u1eef &nbsp;gi\u1edbi c\u00f3 nguy c\u01a1 b\u1ecb ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt ngang nhau. \u0110\u1ed9 tu\u1ed5i c\u00e0ng cao, nguy c\u01a1 b\u1ecb ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt c\u00e0ng l\u1edbn.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">90% ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt l\u00e0 ung th\u01b0 \u1ed1ng tuy\u1ebfn (ductal adenocarcinoma).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nguy\u00ean nh\u00e2n c\u1ee7a ung th\u01b0 &nbsp;\u0111\u01b0\u1eddng m\u1eadt kh\u00f4ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nh\u1eefng \u0111i\u1ec1u ki\u1ec7n kh\u00e1c nhau nh\u01b0 vi\u00eam \u0111\u01b0\u1eddng m\u1eadt (cholangitis), s\u1ecfi, t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng m\u1eadt c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ea7n xu\u1ea5t gia t\u0103ng carcinoma \u0111\u01b0\u1eddng m\u1eadt. V\u00ed d\u1ee5, nh\u1eefng b\u1ec7nh nh\u00e2n v\u1edbi vi\u00eam x\u01a1 chai \u0111\u01b0\u1eddng m\u1eadt nguy\u00ean ph\u00e1t (PSC: primary sclerosing cholangitis) c\u00f3 kh\u1ea3 n\u0103ng t\u1eeb 6 \u0111\u1ebfn 30% ph\u00e1t tri\u1ec3n th\u00e0nh carcinoma \u0111\u01b0\u1eddng m\u1eadt trong su\u1ed1t cu\u1ed9c \u0111\u1eddi c\u1ee7a h\u1ecd, v\u00e0 kh\u1ecfang 10% \u0111\u1ebfn 30% c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i&nbsp;&nbsp; gh\u00e9p gan do PSC c\u00f3 carcinoma \u0111\u01b0\u1eddng m\u1eadt b\u1ecb che l\u1ea5p t\u1ea1i th\u1eddi \u0111i\u1ec3m gh\u00e9p. H\u01a1n n\u1eefa, 2% \u0111\u1ebfn 25% b\u1ec7nh nh\u00e2n nang \u1ed1ng m\u1eadt ch\u1ee7 v\u00e0 5% b\u1ec7nh nh\u00e2n s\u1ecfi gan ph\u00e1t tri\u1ec3n ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt. V\u00ec th\u1ebf, t\u1eafc m\u1eadt n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb khi x\u1ea3y ra, th\u00ed d\u1ee5 nh\u01b0 ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf ngay c\u1ea3 khi nang \u1ed1ng m\u1eadt ch\u1ee7 kh\u00f4ng tri\u1ec7u ch\u1ee9ng .<br>Ghi nh\u1eadn m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 g\u00e2y ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt:<br>-Nhi\u1ec5m s\u00e1n l\u00e1 gan<br>-B\u1ec7nh t\u00fai m\u1eadt<br>-Vi\u00eam x\u01a1 \u0111\u01b0\u1eddng ru\u1ed9t<br>-Vi\u00eam lo\u00e9t \u0111\u1ea1i tr\u00e0ng<br>-Vi\u00eam gan C k\u00e8m nhi\u1ec5m k\u00fd sinh tr\u00f9ng<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ph\u00e2n Lo\u1ea1i<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ph\u00e2n lo\u1ea1i ung th\u01b0 ng\u00e3 ba \u1ed1ng gan theo Bismuth (h\u00ecnh 1):<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">o&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;T\u00fdp I: kh\u1ed1i u gi\u1edbi h\u1ea1n \u1edf \u1ed1ng gan chung<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">o&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;T\u00fdp II: kh\u1ed1i u x\u00e2n l\u1ea5n v\u00e0o ng\u00e3 ba \u1ed1ng gan<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">o&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;T\u00fdp IIIa v\u00e0 IIIb: kh\u1ed1i u x\u00e2n l\u1ea5n v\u00e0o \u1ed1ng gan ph\u1ea3i hay \u1ed1ng gan tr\u00e1i \u0111o\u1ea1n trong gan<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">o\u00a0\u00a0\u00a0\u00a0\u00a0T\u00fdp IV: kh\u1ed1i u x\u00e2n l\u1ea5n v\u00e0o \u1ed1ng gan ph\u1ea3i v\u00e0 \u1ed1ng gan tr\u00e1i \u0111o\u1ea1n trong gan<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"https:\/\/i1.wp.com\/i1324.photobucket.com\/albums\/u616\/lyhoaanhminh\/15-01-custom-size-572-572_zps0db830ae.jpg?zoom=2\" alt=\"\"\/><\/figure><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">V\u00e0ng da do t\u1eafc m\u1eadt x\u1ea3y ra trong 100% c\u00e1c tr\u01b0\u1eddng h\u1ee3p (n\u1ebfu t\u00ednh lu\u00f4n ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt trong gan, t\u1ec9 l\u1ec7 n\u00e0y l\u00e0 h\u01a1n 90%). \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a v\u00e0ng da trong ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt l\u00e0: v\u00e0ng da t\u1eafc m\u1eadt ho\u00e0n to\u00e0n (da v\u00e0ng s\u1eadm, ng\u1ee9a, ph\u00e2n tr\u1eafng nh\u01b0 \u201cc\u1ee9t c\u00f2\u201d), kh\u00f4ng \u0111au, kh\u00f4ng k\u00e8m s\u1ed1t.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c bao g\u1ed3m: \u0111au \u00e2m \u1ec9 v\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, ch\u00e1n \u0103n, s\u1ee5t c\u00e2n\u2026<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Khi th\u0103m kh\u00e1m l\u00e2m s\u00e0ng, ngo\u00e0i v\u00e0ng da, gan to l\u00e0 d\u1ea5u hi\u1ec7u th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. Gan th\u01b0\u1eddng to m\u1ec1m v\u1edbi b\u1edd t\u00f9. Gan to, m\u1eadt \u0111\u1ed9 ch\u1eafc, b\u1edd s\u1eafc l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a x\u01a1 gan do t\u1eafc m\u1eadt, g\u1eb7p trong ung th\u01b0 khu tr\u00fa \u1edf m\u1ed9t \u1ed1ng gan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">BN b\u1ecb ung th\u01b0 \u0111o\u1ea1n cu\u1ed1i \u1ed1ng m\u1eadt ch\u1ee7 s\u1ebd c\u00f3 t\u00fai m\u1eadt c\u0103ng to (d\u1ea5u hi\u1ec7u Courvoisier).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">BN b\u1ecb ung th\u01b0 \u0111o\u1ea1n v\u00f9ng quanh b\u00f3ng Vater c\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n sau:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">o&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Thi\u1ebfu m\u00e1u (do ch\u1ea3y m\u00e1u r\u1ec9 r\u00e3 v\u00e0o l\u00f2ng t\u00e1 tr\u00e0ng)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">o&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Vi\u00eam tu\u1ef5, ti\u00eau ph\u00e2n m\u1ee1 (do t\u1eafc ngh\u1ebdn \u1ed1ng tu\u1ef5)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">S\u1ed1t l\u00e0 tri\u1ec7u ch\u1ee9ng hi\u1ebfm khi x\u1ea3y ra trong ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt ngo\u00e0i gan. S\u1ed1t, n\u1ebfu c\u00f3, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n sau c\u00e1c can thi\u1ec7p \u0111\u01b0\u1eddng m\u1eadt ch\u1ea9n \u0111o\u00e1n (PTC, ERCP).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ch\u1ea9n \u0111o\u00e1n CLS<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vi\u1ec7c \u0111\u00e1nh gi\u00e1 b\u1eb1ng X quang\u00a0 c\u00e2y \u0111\u01b0\u1eddng m\u1eadt \u0111\u00e3 c\u00f3 nh\u1eefng c\u1ea3i thi\u1ec7n v\u01b0\u1ee3t b\u1eadc v\u00e0o cu\u1ed1i th\u1eadp ni\u00ean qua. B\u01b0\u1edbc \u0111\u1ea7u ti\u00ean l\u00e0 si\u00eau \u00e2m b\u1ee5ng. S\u1ef1 gi\u00e3n c\u1ee7a \u1ed1ng m\u1eadt l\u00e0 h\u00ecnh \u1ea3nh s\u1edbm v\u00e0 v\u1ecb tr\u00ed ch\u00edt h\u1eb9p m\u1eadt c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. T\u1ea1i c\u00f9ng th\u1eddi \u0111i\u1ec3m n\u00e0y, t\u00ecnh tr\u1ea1ng kh\u00f4ng b\u1ecb t\u1eafc ngh\u1ebdn c\u1ee7a \u0111\u1ed9ng m\u1ea1ch gan ch\u00ednh v\u00e0 t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 c\u00e1c nh\u00e1nh c\u1ee7a ch\u00fang c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1eb1ng si\u00eau \u00e2m Doppler. Sau \u0111\u00f3, CT xo\u1eafn \u1ed1c nhi\u1ec1u phase n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u00e2u h\u01a1n ph\u1ea1m vi th\u00e2m nhi\u1ec5m c\u1ee7a\u00a0 kh\u1ed1i u v\u00e0 s\u1ef1 di c\u0103n xa n\u1ebfu c\u00f3. N\u1ebfu kh\u1ed1i u c\u00f3 v\u1ecb tr\u00ed \u1edf ch\u1ed7 ph\u00e2n nh\u00e1nh hay b\u00ean tr\u00ean v\u00e0 li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u0103ng bilirubin th\u00ec X quang \u0111\u01b0\u1eddng m\u1eadt qua gan d\u01b0\u1edbi da (PTC: percutaneous transhepatic cholangiography) \u0111\u1ec3 t\u00ecm ki\u1ebfm \u0111\u01b0\u1eddng d\u1eabn m\u1eadt c\u1ee7a c\u1ea3 hai nh\u00e1nh \u0111\u01b0\u1eddng m\u1eadt n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 nh\u00ecn th\u1ea5y gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a ch\u1ed7 h\u1eb9p, nh\u1eefng th\u00f4ng tin ch\u00ednh x\u00e1c \u0111\u1ec3 c\u00f3 \u0111\u00e1nh gi\u00e1 tin c\u1eady, v\u00e0 \u0111\u1ec3 gi\u1ea3i quy\u1ebft vi\u1ec7c t\u1eafc m\u1eadt. N\u1ebfu carcinoma \u0111\u01b0\u1eddng m\u1eadt \u1edf v\u1ecb tr\u00ed gi\u1eefa ho\u1eb7c d\u01b0\u1edbi c\u1ee7a \u1ed1ng m\u1eadt th\u00ec n\u1ed9i soi \u0111\u01b0\u1eddng m\u1eadt ng\u01b0\u1ee3c d\u00f2ng (ERCP: endoscopic retrograde cholangiography) l\u00e0 th\u00edch h\u1ee3p. M\u1eabu kh\u1ed1i u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y b\u1eb1ng n\u1ed9i soi ch\u1ea3i r\u1eeda hay sinh thi\u1ebft b\u1eb1ng kim qua h\u01b0\u1edbng d\u1eabn c\u1ee7a CT hay si\u00eau \u00e2m. Ch\u1ee5p X quang m\u1ea1ch th\u00ec th\u01b0\u1eddng kh\u00f4ng n\u00ean th\u1ef1c hi\u1ec7n v\u00e0 n\u00ean h\u1ea1n ch\u1ebf v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p m\u00e0 s\u1ef1 li\u00ean quan m\u1ea1ch m\u00e1u v\u1eabn c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng \u1edf nh\u1eefng ki\u1ec3m tra \u00edt x\u00e2m l\u1ea5n kh\u00e1c . Ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt b\u1eb1ng c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRC: magnetic resonance cholangiography) l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt m\u1edbi, c\u00f3 kh\u1ea3 n\u0103ng nh\u00ecn th\u1ea5y \u0111\u01b0\u1eddng m\u1eadt m\u00e0 kh\u00f4ng x\u00e2m l\u1ea5n. Trong khi vai tr\u00f2 c\u1ee7a MRC \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi PTC hay ERCP c\u00f2n \u0111\u01b0\u1ee3c \u0111\u00e1nh g\u00eda th\u00ec n\u00f3 v\u1eabn c\u00f3 nh\u1eefng \u01b0u \u0111i\u1ec3m c\u00f3 \u00fd ngh\u0129a \u1edf nh\u1eefng tr\u1ebb em hay khi nh\u1eefng ph\u01b0\u01a1ng th\u1ee9c ch\u1ea9n \u0111\u00f3an kh\u00e1c kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c. V\u1edbi nh\u1eefng ph\u00e1t tri\u1ec3n sau n\u00e0y, k\u1ef9 thu\u1eadt n\u00e0y s\u1ebd c\u00f3 kh\u1ea3 n\u0103ng nhanh ch\u00f3ng tr\u1edf th\u00e0nh m\u1ed9t ki\u1ec3m tra ch\u1ea9n \u0111\u00f3an th\u01b0\u1eddng quy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Qu\u00e9t PET (positron- emission tomography) \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng th\u1ee9c ch\u1ea9n \u0111\u00f3an cho vi\u1ec7c ph\u00e1t hi\u1ec7n carcinoma \u0111\u01b0\u1eddng m\u1eadt, \u0111\u1eb7c bi\u1ec7t cho vi\u1ec7c ki\u1ec3m tra nh\u1eefng vi\u00eam \u0111\u01b0\u1eddng m\u1eadt x\u01a1 c\u1ee9ng b\u00ec nguy\u00ean ph\u00e1t . Trong nh\u00f3m c\u1ee7a ch\u00fang t\u00f4i, ch\u00fang t\u00f4i th\u1ea5ym\u1ed9t s\u1ef1 nh\u1ea1y c\u1ea3m cao c\u1ee7a qu\u00e9t PET\u0111\u1ed1i v\u1edbi carcinoma \u0111\u01b0\u1eddng m\u1eadt trong gan l\u00e0 tr\u00ean 90% . Nh\u1eefng k\u1ebft qu\u1ea3 c\u1ee7a scan PET \u0111\u1ed1i v\u1edbi nh\u1eefng kh\u1ed1i u \u0111\u01b0\u1eddng m\u1eadt ng\u00f2ai gan th\u00ec v\u1edbi s\u1ef1 nh\u1ea1y c\u1ea3m th\u1ea5p ch\u1ec9 60%. Hi\u1ec7n nay, ch\u00fang t\u00f4i kh\u00f4ng th\u1ef1c hi\u1ec7n qu\u00e9t PET nh\u1eb1m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt ng\u00f2ai gan. Cu\u1ed1i c\u00f9ng, si\u00eau \u00e2m trong ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u01b0\u1eddng quy t\u1ea1i l\u00fac ph\u1eabu th\u1ee5\u00e2t \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ph\u1ea1m vi c\u1ee7a s\u1ef1 ph\u00e1t tri\u1ec3n kh\u1ed1i u trong gan.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"https:\/\/i2.wp.com\/i1324.photobucket.com\/albums\/u616\/lyhoaanhminh\/SAthayuklaskinog1EA7nTMc1EEDa_zps4413073a.gif?zoom=2\" alt=\"\"\/><figcaption>h\u00ecnh \u1ea3nh si\u00eau \u00e2m cho th\u1ea5y 1 kh\u1ed1i u \u0111\u01b0\u1eddng m\u1eadt \u1edf r\u1ed1n gan (U Klaskin)<br><\/figcaption><\/figure><\/div>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"https:\/\/i1.wp.com\/i1324.photobucket.com\/albums\/u616\/lyhoaanhminh\/CTklaskin_zps9cd31c96.gif?zoom=2\" alt=\"\"\/><figcaption>H\u00ecnh \u1ea3nh CT cho th\u1ea5y U Klaskin<\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Ch\u1ea9n \u0111o\u00e1n m\u00f4 h\u1ecdc tr\u01b0\u1edbc ph\u1eabu thu\u1eadt m\u1ed9t kh\u1ed1i u Klatskin c\u00f3 th\u1ec3 l\u00e0 v\u00f4 c\u00f9ng kh\u00f3 kh\u0103n \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c.\u00a0M\u1eb7c d\u00f9 sinh thi\u1ebft qua da v\u00e0 brushings cho t\u1ebf b\u00e0o h\u1ecdc c\u00f3 gi\u00e1 tr\u1ecb n\u1ebfu t\u00edch c\u1ef1c cho b\u1ec7nh \u00e1c t\u00ednh, ch\u00fang th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi \u0111\u1ed9 nh\u1ea1y t\u01b0\u01a1ng \u0111\u1ed1i th\u1ea5p (&lt;50%).N\u00f3i chung, m\u1ed9t ch\u1ea9n \u0111o\u00e1n m\u00f4 kh\u00f4ng ph\u1ea3i l\u00e0 c\u1ea7n thi\u1ebft tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh can thi\u1ec7p ph\u1eabu thu\u1eadt.\u00a0Tuy nhi\u00ean, ch\u1ea9n \u0111o\u00e1n m\u00f4 l\u00e0 quan tr\u1ecdng \u0111\u1ec3 ph\u00e2n bi\u1ec7t m\u1ed9t h\u1eb9p do x\u01a1 vi\u00eam \u0111\u01b0\u1eddng m\u1eadt v\u1edbi ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt.<\/p>\n\n\n\n<pre class=\"wp-block-code\"><code>https:&#47;&#47;thuctapngoai.wordpress.com\/2012\/12\/31\/9707\/<\/code><\/pre>\n","protected":false},"excerpt":{"rendered":"<p>BN Nam, 1971, \u0111\u1ebfn kh\u00e1m v\u00ec u gan.Si\u00eau \u00c2m ghi nh\u1eadn h\u00ecnh \u1ea3nh nh\u01b0 sau. H\u00ecnh \u1ea3nh n\u00e0y kh\u00e1 \u1ea5n t\u01b0\u1ee3ng v\u00e0 h\u1eefu \u00edch cho<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,5],"tags":[61,60],"class_list":["post-569","post","type-post","status-publish","format-standard","hentry","category-bung-tq","category-sieu-am","tag-adenocarcinoma","tag-klaskin"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/569","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=569"}],"version-history":[{"count":4,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/569\/revisions"}],"predecessor-version":[{"id":581,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/569\/revisions\/581"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=569"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=569"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=569"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}