{"id":735,"date":"2021-07-16T09:36:51","date_gmt":"2021-07-16T02:36:51","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=735"},"modified":"2022-02-14T21:49:06","modified_gmt":"2022-02-14T14:49:06","slug":"kieu-dang-pho-mach-mau-trong-chai-gan","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/kieu-dang-pho-mach-mau-trong-chai-gan\/","title":{"rendered":"KI\u1ec2U D\u1ea0NG PH\u1ed4 M\u1ea0CH M\u00c1U TRONG CHAI GAN"},"content":{"rendered":"\n

BS NGUY\u1ec4N THI\u1ec6N H\u00d9NG
<\/strong>B\u00e0i vi\u1ebft g\u1ed1c<\/a>
DOI<\/a><\/p>\n\n\n\n

Trong khi \u0111\u00e3 bi\u1ebft r\u00f5 hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ea3o chi\u1ec1u d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch C\u1eeda, c\u00f2n c\u00f3 c\u00e1c ki\u1ec3u ph\u1ed5 kh\u00e1c, tuy kh\u00f4ng d\u1ec5 hi\u1ec3u, l\u1ea1i c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd. B\u00e0i n\u00e0y th\u1ea3o lu\u1eadn c\u00e1c \u0111\u1eb7c tr\u01b0ng ph\u1ed5 kh\u00e1c nhau c\u1ee7a t\u0129nh m\u1ea1ch C\u1eeda, \u0111\u1ed9ng m\u1ea1ch gan, v\u00e0 t\u0129nh m\u1ea1ch gan \u1edf b\u1ec7nh nh\u00e2n chai gan ho\u1eb7c c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan v\u00e0 c\u00e1c th\u1ee7 thu\u1eadt.
Hi\u1ec3u bi\u1ebft c\u00e1c ki\u1ec3u ph\u1ed5 gi\u00fap th\u00eam th\u00f4ng tin nh\u1eb1m x\u00e1c \u0111\u1ecbnh h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb. Si\u00eau \u00e2m Doppler kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c [invaluable]  khi c\u00e2n nh\u1eafc gh\u00e9p gan v\u00e0 ch\u1ea9n \u0111o\u00e1n chai gan v\u00e0 cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda.

Portal Venous Flow Patterns in Cirrhosis<\/strong>
Portal Vein Pulsatility
Sluggish or Slow Portal Venous Flow
Helical Flow Pattern
To-and-Fro Portal Venous Flow Pattern
Flow Reversal
Stagnant Portal Flow and Thrombosis
Portal Vein Aneurysm
Pseudothrombosis<\/p>\n\n\n\n

Hepatic Vein Flow Patterns in Cirrhosis Patients<\/strong>
Hepatic Arterial Changes<\/strong>
Increased Resistive Index
Increased Hepatic Artery Velocity

Portal Venous Flow Patterns in Cirrhosis<\/strong>

T\u0129nh m\u1ea1ch C\u1eeda c\u00f3 ph\u1ed5 \u0111\u1eadp [xung h\u00f3a]<\/strong><\/p>\n\n\n\n

C\u00e1c d\u1ea1ng s\u00f3ng t\u0129nh m\u1ea1ch C\u1eeda b\u00ecnh th\u01b0\u1eddng th\u01b0\u1eddng th\u1ea5y u\u1ed1n nh\u1eb9  (H\u00ecnh. 1). <\/p>\n\n\n\n

\"usg-15020-f1.gif\"\/<\/figure>\n\n\n\n

\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n chai gan, th\u00f4ng n\u1ed1i  arterio-portal l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh cho hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng  pulsatility. T\u0103ng pulsatility c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng c\u00e1ch t\u00ednh ch\u1ec9 s\u1ed1 pulsatility; ch\u1ec9 s\u1ed1  pulsatility <\/strong>\u0111\u01b0\u1ee3c \u0111o b\u1eb1ng ph\u1ea7n ch\u00eanh l\u1ec7ch gi\u1eefa v\u1eadn t\u1ed1c \u0111\u1ec9nh t\u00e2m thu v\u00e0 v\u1eadn t\u1ed1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng chia cho v\u1eadn t\u1ed1c trung b\u00ecnh. T\u0103ng  ch\u1ec9 s\u1ed1 pulsatility x\u1ea3y ra do vi\u1ec7c truy\u1ec1n t\u1ea3i \u00e1p l\u1ef1c tr\u00ean xoang gan trong th\u00ec cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng [ 3,4]. Ngo\u00e0i ra, ch\u1ec9 s\u1ed1 pulsatility t\u0103ng (l\u1edbn h\u01a1n 0,5) c\u00f3 th\u1ec3 x\u1ea3y ra v\u1edbi \u00e1p l\u1ef1c nh\u0129 ph\u1ea3i cao, c\u00f3 th\u1ec3 th\u1ea5y \u1edf suy tim ph\u1ea3i v\u00e0 suy van ba l\u00e1. 
C\u01a1 s\u1edf shunting arterio-portal l\u00e0 s\u1ef1 bi\u1ebfn d\u1ea1ng c\u1ea5u tr\u00fac th\u1ea5y \u1edf b\u1ec7nh nh\u00e2n chai gan k\u1ebft h\u1ee3p v\u1edbi d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch C\u1eeda \u0111\u1ea3o ng\u01b0\u1ee3c  v\u00e0 t\u0103ng tr\u1edf kh\u00e1ng  c\u00e1c t\u0129nh m\u1ea1ch nh\u1ecf trong gan. H\u01a1n n\u1eefa, ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan, th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n chai gan, c\u00f3 th\u1ec3 g\u00e2y shunting quanh u  qua c\u00e1c t\u0129nh m\u1ea1ch tho\u00e1t. Sinh thi\u1ebft gan tr\u00ean b\u1ec7nh nh\u00e2n chai gan c\u0169ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 h\u00ecnh th\u00e0nh  r\u00f2 arterio-portal. Shunting arterio-portal trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p chai gan c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u0103ng pulsatility t\u0129nh m\u1ea1ch C\u1eeda (H\u00ecnh. 2) [5]. <\/p>\n\n\n\n

\"usg-15020-f2.gif\"\/<\/figure>\n\n\n\n

Do \u0111\u00f3, t\u0103ng pulsatility t\u0129nh m\u1ea1ch C\u1eeda \u1edf b\u1ec7nh nh\u00e2n chai gan, t\u00f9y thu\u1ed9c v\u00e0o  b\u1ec7nh s\u1eed, \u0111\u00e1nh gi\u00e1 c\u00f3 hi\u1ec7n di\u1ec7n hay kh\u00f4ng c\u1ee7a m\u1ed9t t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u ho\u1eb7c r\u00f2 arterio-portal. D\u1ea5u hi\u1ec7u th\u1ee9 ph\u00e1t m\u00e0 pulsatility c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n shunts arterio-portal  \u0111\u00f3 l\u00e0 \u0111\u1ed3ng b\u1ed9 v\u1edbi d\u1ea1ng s\u00f3ng \u0111\u1ed9ng m\u1ea1ch gan l\u00e2n c\u1eadn [6].
D\u00f2ng t\u0129nh m\u1ea1ch b\u1ea5t \u0111\u1ed9ng  ho\u1eb7c ch\u1eadm<\/strong>
Kho\u1ea3ng  b\u00ecnh th\u01b0\u1eddng c\u1ee7a v\u1eadn t\u1ed1c t\u00e2m thu cao nh\u1ea5t c\u1ee7a t\u0129nh m\u1ea1ch C\u1eeda (MPV) t\u1eeb 20 cm \/ gi\u00e2y \u0111\u1ebfn 40 cm \/ gi\u00e2y. N\u00f3i chung ngo\u00e0i vi\u1ec7c t\u0103ng kh\u1ea9u k\u00ednh MPV, v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y th\u1ea5p nh\u1ecf h\u01a1n 16cm \/ gi\u00e2y l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n  cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda [7]. Chai gan l\u00e0 do cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda  th\u1ee9 ph\u00e1t trong gan \u0111\u1ec3 l\u00e0m t\u0103ng tr\u1edf kh\u00e1ng \u1edf t\u0129nh m\u1ea1ch gan nh\u1ecf do x\u01a1 h\u00f3a gan [8]. V\u1eadn t\u1ed1c ch\u00ednh x\u00e1c c\u00e1c ph\u00e9p \u0111o trong MPV ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u th\u00f4ng s\u1ed1, bao g\u1ed3m g\u00f3c d\u00f2ng ch\u1ea3y ch\u00f9m \u00e2m [Doppler \/ beam-flow]. V\u1eadn t\u1ed1c d\u01b0\u01a1ng t\u00ednh gi\u1ea3 c\u00f3 th\u1ec3 l\u00e0 th\u1ee9 ph\u00e1t n\u1ebfu  g\u00f3c Doppler g\u1ea7n 90 \u0111\u1ed9 so v\u1edbi h\u01b0\u1edbng d\u00f2ng ch\u1ea3y [9]. S\u1ef1 l\u1ef1a ch\u1ecdn t\u1ea7n s\u1ed1 Doppler c\u0169ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111o v\u1eadn t\u1ed1c, v\u00ec t\u1ea7n s\u1ed1 cao h\u01a1n t\u1ea1o ra \u0111\u1ed9 ch\u00ednh x\u00e1c cao h\u01a1n  v\u1eadn t\u1ed1c trong khi t\u1ea7n s\u1ed1 th\u1ea5p h\u01a1n cho ph\u00e9p th\u00e2m nh\u1eadp t\u1ed1t h\u01a1n.
Cu\u1ed1i c\u00f9ng, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a m\u1ed9t d\u00f2ng ch\u1ea3y r\u1ed1i v\u00e0 l\u1ed7i l\u1ea5y m\u1eabu c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 \u0111\u00e1nh gi\u00e1 th\u1ea5p ho\u1eb7c cao qu\u00e1 m\u1ee9c c\u1ee7a v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y [10].<\/p>\n\n\n\n

Ki\u1ec3u d\u00f2ng ch\u1ea3y xo\u1eafn \u1ed1c<\/strong> D\u00f2ng ch\u1ea3y xo\u1eafn \u1ed1c l\u00e0 lo\u1ea1i d\u00f2ng ch\u1ea3y th\u1ee9 ph\u00e1t (\u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 m\u1ed9t d\u00f2ng ch\u1ea3y nh\u1ecf ch\u1ed3ng l\u00ean tr\u00ean d\u00f2ng ch\u1ea3y nguy\u00ean ph\u00e1t). D\u00f2ng ch\u1ea3y xo\u1eafn \u1ed1c g\u00e2y ra b\u1edfi d\u00f2ng ch\u1ea3y theo l\u1edbp [lamina flow] b\u1ecb x\u00e1o tr\u1ed9n [11,12]. S\u1ef1 thay \u0111\u1ed5i v\u1ec1 \u0111\u1ed9 nh\u1edbt, h\u00ecnh d\u1ea1ng m\u1ea1ch m\u00e1u, s\u1ef1 b\u1ea5t \u0111\u1ed1i x\u1ee9ng khu tr\u00fa d\u1ecdc theo th\u00e0nh m\u1ea1ch, v\u00e0 nh\u1eefng thay \u0111\u1ed5i v\u1ec1 h\u01b0\u1edbng v\u00e0 t\u1ed1c \u0111\u1ed9 d\u00f2ng ch\u1ea3y c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c ki\u1ec3u xo\u1eafn \u1ed1c n\u1ed5i b\u1eadt [13]. T\u1ea1o h\u00ecnh Doppler m\u00e0u cho th\u1ea5y c\u00e1c d\u1ea3i m\u00e0u \u0111\u1ecf v\u00e0 xanh xen k\u1ebd trong m\u1ed9t ki\u1ec3u xo\u1eafn \u1ed1c (H\u00ecnh 3). <\/p>\n\n\n\n

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

Helicity l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c nh\u1eadn ra trong thay \u0111\u1ed5i  kh\u1ea9u k\u00ednh khu tr\u00fa  \u1edf h\u00e0nh c\u1ea3nh. C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh cho th\u1ea5y  d\u00f2ng ch\u1ea3y xo\u1eafn \u1ed1c c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a d\u00f2ng bi\u1ebfn d\u1ea1ng x\u00e1o tr\u1ed9n ho\u1eb7c d\u00f2ng ch\u1ea3y r\u1ed1i [14]. H\u01a1n n\u1eefa, m\u1ed9t s\u1ed1 nh\u00e0 nghi\u00ean c\u1ee9u \u0111\u00e3  gi\u1ea3 thuy\u1ebft r\u1eb1ng ki\u1ec3u d\u00f2ng ch\u1ea3y n\u00e0y c\u00f3 th\u1ec3 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ng\u0103n ng\u1eeba qu\u00e1 tr\u00ecnh sinh x\u01a1 v\u00e0 t\u0103ng s\u1ea3n x\u01a1 l\u1edbp n\u1ed9i m\u1ea1c m\u1ea1ch m\u00e1u [15]. Helicity, m\u1eb7c d\u00f9 th\u01b0\u1eddng tho\u00e1ng qua, g\u1eb7p  trong c\u1ea3 gh\u00e9p gan v\u00e0 transjugular intrahepatic portosystemic shunt (TIPS). N\u1ebfu d\u00f2ng ch\u1ea3y xo\u1eafn \u1ed1c dai d\u1eb3ng k\u00e9o d\u00e0i, l\u00e0 do  k\u1ebft h\u1ee3p c\u1ee7a t\u0103ng v\u1eadn t\u1ed1c t\u0129nh m\u1ea1ch C\u1eeda  v\u1edbi t\u0103ng h\u1eb9p t\u0129nh m\u1ea1ch C\u1eeda (H\u00ecnh 4). 

<\/p>\n\n\n\n

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

D\u00f2ng xo\u1eafn \u1ed1c \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p gan l\u00e0 do s\u1ef1 thay \u0111\u1ed5i \u0111\u01b0\u1eddng k\u00ednh t\u0129nh m\u1ea1ch C\u1eeda gi\u1eefa m\u1ea1ch m\u00e1u ng\u01b0\u1eddi cho v\u00e0 m\u1ea1ch m\u00e1u ng\u01b0\u1eddi nh\u1eadn, v\u00e0 th\u1ea5y r\u00f5  khi  kh\u00e1c bi\u1ec7t thi\u1ebft di\u1ec7n gi\u1eefa c\u00e1c t\u0129nh m\u1ea1ch C\u1eeda l\u1edbn h\u01a1n 50%. \u0110i\u1ec1u n\u00e0y ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c t\u00e1c gi\u1ea3 kh\u00e1c, b\u00e1o c\u00e1o r\u1eb1ng di\u1ec7n t\u00edch m\u1eb7t c\u1eaft ngang m\u1ea1ch m\u00e1u g\u00e2y ra s\u1ef1 ph\u00e2n ly d\u00f2ng ch\u1ea3y, t\u1ea1o ra ki\u1ec3u v\u00f2ng tr\u00f2n [16]. C\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng ngay sau khi gh\u00e9p gan, d\u00f2ng ch\u1ea3y xo\u1eafn \u1ed1c trong t\u0129nh m\u1ea1ch c\u1eeda \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft do v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y gi\u1ea3m v\u00e0 ch\u1ea3y r\u1ed1i  c\u1ee5c b\u1ed9 [17]. D\u00f2ng ch\u1ea3y xo\u1eafn \u1ed1c c\u0169ng th\u1ea5y \u1edf  nh\u1eefng ng\u01b0\u1eddi nh\u1eadn TIPS. Trong m\u1ed9t ph\u00e2n t\u00edch ti\u1ebfn c\u1ee9u, t\u1ea7n su\u1ea5t c\u1ee7a d\u00f2ng ch\u1ea3y xo\u1eafn \u1ed1c sau \u0111\u1eb7t TIPS \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 28% sau khi \u0111\u1eb7t v\u1edbi th\u1eddi gian xu\u1ea5t hi\u1ec7n thay \u0111\u1ed5i . Th\u1ee7 thu\u1eadt TIPS l\u00e0m thay \u0111\u1ed5i c\u00e1c th\u00f4ng s\u1ed1 huy\u1ebft \u0111\u1ed9ng c\u1ee7a d\u00f2ng ch\u1ea3y, bao g\u1ed3m v\u1eadn t\u1ed1c t\u0129nh m\u1ea1ch c\u1eeda, h\u01b0\u1edbng d\u00f2ng ch\u1ea3y v\u00e0 t\u00ednh ch\u1ea5t \u0111\u1eadp c\u1ee7a d\u00f2ng ch\u1ea3y [18]. S\u1ed1 l\u01b0\u1ee3ng d\u00f2ng ch\u1ea3y r\u1ed1i \u0111\u01b0\u1ee3c t\u1ea1o ra b\u1edfi nh\u1eefng thay \u0111\u1ed5i \u0111\u1ed9ng h\u1ecdc n\u00e0y kh\u00e1c nhau gi\u1eefa c\u00e1c b\u1ec7nh nh\u00e2n, v\u00e0 kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c li\u1ec7u m\u1ed9t d\u00f2ng ch\u1ea3y xo\u1eafn \u1ed1c c\u00f3 x\u1ea3y ra \u1edf h\u1eadu ph\u1eabu hay kh\u00f4ng.
Ki\u1ec3u d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch C\u1eeda To-and-Fro [t\u1edbi-lui]<\/strong>
V\u1edbi s\u1ef1 gia t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch C\u1eeda,  v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch C\u1eeda  gi\u1ea3m li\u00ean t\u1ee5c \u0111\u1ebfn m\u1ee9c tr\u00ec tr\u1ec7. Khi \u0111i\u1ec1u n\u00e0y x\u1ea3y ra, c\u00f3 th\u1ec3 g\u1eb7p hi\u1ec7n t\u01b0\u1ee3ng c\u1ee7a d\u00f2ng ch\u1ea3y t\u1edbi v\u00e0 lui , do \u0111\u00f3, c\u1ed9t m\u00e1u g\u1ea7n nh\u01b0 tr\u00ec tr\u1ec7 trong t\u0129nh m\u1ea1ch C\u1eeda b\u1ecb l\u1ec7ch v\u00e0o v\u00e0 ra kh\u1ecfi gan v\u1edbi chu k\u1ef3 h\u00f4 h\u1ea5p. \u1ea2nh h\u01b0\u1edfng c\u1ee7a d\u00f2ng ch\u1ea3y \u0111\u1ea3o ng\u01b0\u1ee3c t\u1ea1m th\u1eddi ho\u1eb7c ng\u1eebng d\u00f2ng ch\u1ea3y v\u1ec1 ph\u00eda tr\u01b0\u1edbc trong th\u00ec h\u00edt v\u00e0o c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c m\u00f4 ph\u1ecfng b\u1eb1ng th\u1ee7 thu\u1eadt Valsalva, \u0111i\u1ec1u n\u00e0y c\u0169ng d\u1eabn \u0111\u1ebfn d\u00f2ng ch\u1ea3y xa gan [hepatofugal ] tho\u00e1ng qua (H\u00ecnh 5). Khi cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda n\u1eb7ng h\u01a1n, s\u1ef1 tr\u00ec tr\u1ec7 c\u1ee7a c\u1ed9t m\u00e1u s\u1ebd g\u00e2y ra huy\u1ebft kh\u1ed1i ho\u1eb7c tr\u1edf th\u00e0nh  d\u00f2ng ch\u1ea3y \u0111\u1ea3o ng\u01b0\u1ee3c.<\/p>\n\n\n\n

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D\u00f2ng ch\u1ea3y \u0111\u1ea3o ng\u01b0\u1ee3c <\/strong> [Flow Reversal]

D\u00f2ng ch\u1ea3y  t\u0129nh m\u1ea1ch C\u1eeda th\u01b0\u1eddng l\u00e0 h\u01b0\u1edbng v\u1ec1 gan [hepatopetal].  \u0110\u1ea3o ng\u01b0\u1ee3c d\u00f2ng ch\u1ea3y (ho\u1eb7c d\u00f2ng ch\u1ea3y xa gan [hepatofugal]) th\u1ea5y trong tr\u01b0\u1eddng h\u1ee3p cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda (H\u00ecnh 6). <\/p>\n\n\n\n

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\u0110\u1eb7c bi\u1ec7t, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n chai gan, t\u1eafc ngh\u1ebdn c\u00e1c t\u0129nh m\u1ea1ch nh\u1ecf trong gan v\u00e0 c\u00e1c xoang gan do x\u01a1 h\u00f3a gan, \u0111\u01b0\u1ee3c ch\u1ee9ng minh b\u1edfi shunting  arterio-portal v\u00e0 porto-system, cu\u1ed1i c\u00f9ng d\u1eabn \u0111\u1ebfn \u0111\u1ea3o ng\u01b0\u1ee3c d\u00f2ng ch\u1ea3y. \u0110\u1ea3o ng\u01b0\u1ee3c d\u00f2ng ch\u1ea3y \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng ph\u1ed5 v\u00e0 si\u00eau \u00e2m m\u00e0u Doppler. C\u00e1c b\u1ea9y si\u00eau \u00e2m c\u00f3 th\u1ec3 x\u1ea3y ra do bi\u1ebfn d\u1ecb  gi\u1ea3i ph\u1eabu t\u0129nh m\u1ea1ch C\u1eeda, d\u1eabn \u0111\u1ebfn \u0111\u1ea3o ng\u01b0\u1ee3c d\u00f2ng ch\u1ea3y d\u01b0\u01a1ng t\u00ednh gi\u1ea3, t\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a \u0111\u1ea7u d\u00f2 si\u00eau \u00e2m. C\u00e1c \u0111\u1ed9ng m\u1ea1ch b\u00e0ng h\u1ec7 trong gan kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, ch\u1ee7 y\u1ebfu th\u1ea5y sau gh\u00e9p gan h\u01a1n l\u00e0 \u1edf b\u1ec7nh nh\u00e2n chai gan, cho th\u1ea5y d\u00f2ng ch\u1ea3y t\u1eeb bao gan \u0111\u1ebfn r\u1ed1n gan v\u00e0 c\u00f3 th\u1ec3 b\u1ecb nh\u1ea7m l\u1eabn v\u1edbi d\u00f2ng ch\u1ea3y hepatofugal trong h\u1ec7 t\u0129nh m\u1ea1ch c\u1eeda [19]. H\u01a1n n\u1eefa, aliasing do  t\u1ea7n s\u1ed1 l\u1eb7p xung th\u1ea5p l\u00e0 artifact, c\u00f3 th\u1ec3 b\u1ecb l\u1ea7m  nh\u01b0 m\u1ed9t d\u00f2ng  t\u0129nh m\u1ea1ch \u0111\u1ea3o ng\u01b0\u1ee3c. Porto-systemic shunting ho\u1eb7c porto-systemic collateral formation g\u00e2y ra b\u1edfi vi\u1ec7c m\u1edf l\u1ea1i c\u00e1c th\u00f4ng n\u1ed1i porto-systemic v\u1ed1n b\u1ecb x\u1eb9p. M\u1ed9t s\u1ed1 m\u1ea1ch m\u00e1u  thu\u1ed9c h\u1ec7 th\u1ed1ng porto-systemic  th\u00f4ng th\u01b0\u1eddng bao g\u1ed3m t\u0129nh m\u1ea1ch v\u00e0nh v\u1ecb (v\u1ecb tr\u00e1i), varices d\u1ea1 d\u00e0y, th\u1ef1c qu\u1ea3n v\u00e0 t\u0129nh m\u1ea1ch c\u1ea1nh th\u1ef1c qu\u1ea3n, gi\u00e3n t\u0129nh m\u1ea1ch \u1ed5 b\u1ee5ng v\u00e0 t\u0129nh m\u1ea1ch r\u1ed1n t\u00e1i l\u1eadp  (H\u00ecnh 7), gi\u00e3n t\u0129nh m\u1ea1ch c\u1ea1nh s\u1ed1ng-sau ph\u00fac m\u1ea1c v\u00e0 quanh t\u00fai m\u1eadt pericholecystic (H\u00ecnh 8), quanh c\u1eeda periportal (H\u00ecnh 9), v\u00e0 c\u00e1c t\u0129nh m\u1ea1ch quanh l\u00e1ch  perisplenic. C\u00e1c shunts d\u1ea1 d\u00e0y v\u00e0 th\u1eadn l\u1eb1ch plenorenal l\u00e0 c\u00e1c v\u00ed d\u1ee5 kh\u00e1c v\u1ec1 c\u00e1c varices [20].<\/p>\n\n\n\n

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Stagnant Portal Flow [kh\u00f4ng th\u1ea5y d\u00f2ng ch\u1ea3y TM C\u1eeda] v\u00e0 Thrombosis<\/strong> Cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda  to\u00e0n ph\u00e1t  l\u00e0m tr\u00ec tr\u1ec7 ho\u00e0n to\u00e0n  d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch C\u1eeda  v\u00e0  k\u1ebft h\u1ee3p v\u1edbi h\u00f3a x\u01a1 gan n\u1eb7ng n\u00ean d\u00f2ng ch\u1ea3y v\u1ec1 ph\u00eda tr\u01b0\u1edbc h\u1ea7u nh\u01b0 kh\u00f4ng th\u1ea5y (H\u00ecnh 10).<\/p>\n\n\n\n

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 H\u01a1n n\u1eefa, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch C\u1eeda  th\u01b0\u1eddng c\u00f3 echo k\u00e9m v\u00e0  kh\u00f3 ph\u00e2n bi\u1ec7t tr\u00ean h\u00ecnh thang \u0111\u1ed9 x\u00e1m. Do \u0111\u00f3, c\u1ea7n thi\u1ebft  \u0111\u00e1nh gi\u00e1 MPV tr\u00ean c\u1ea3 thang x\u00e1m  v\u00e0 m\u00e0u Doppler  (H\u00ecnh 11). <\/p>\n\n\n\n

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Kh\u00f4ng th\u1ea5y d\u00f2ng ch\u1ea3y trong c\u00e1c khu v\u1ef1c t\u1eafc ngh\u1ebdn th\u1ee9 ph\u00e1t cho m\u1ed9t kh\u1ed1i u nh\u1ea1t ho\u1eb7c  u huy\u1ebft kh\u1ed1i. Y\u1ebfu t\u1ed1 gi\u00fap ph\u00e2n bi\u1ec7t  gi\u1eefa m\u1ed9t c\u1ee5c m\u00e1u \u0111\u00f4ng v\u00e0 m\u1ed9t u huy\u1ebft kh\u1ed1i, ho\u1eb7c t\u00e1i th\u00f4ng  c\u1ee7a m\u1ed9t u huy\u1ebft kh\u1ed1i  l\u00e0 x\u00e1c \u0111\u1ecbnh xem d\u00f2ng m\u00e1u c\u00f3 \u0111\u1eadp hay kh\u00f4ng, nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p  u huy\u1ebft kh\u1ed1i, ho\u1eb7c d\u1ea1ng s\u00f3ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch C\u1eeda,  nh\u01b0 \u0111\u00e3 th\u1ea5y trong tr\u01b0\u1eddng h\u1ee3p t\u00e1i th\u00f4ng u huy\u1ebft kh\u1ed1i. C\u00e1c d\u1ea5u hi\u1ec7u th\u1ee9 ph\u00e1t c\u1ee7a huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch c\u1eeda khi kh\u1ea3o s\u00e1t  Doppler  g\u1ed3m s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a tu\u1ea7n ho\u00e0n b\u00ean quanh t\u0129nh m\u1ea1ch C\u1eeda, bi\u1ec3u di\u1ec5n s\u1ef1 xoang h\u00f3a t\u0129nh m\u1ea1ch C\u1eeda, v\u1edbi d\u00f2ng ch\u1ea3y h\u01b0\u1edbng gan (H\u00ecnh 12) [21].<\/p>\n\n\n\n

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Ph\u00ecnh t\u0129nh m\u1ea1ch C\u1eeda<\/strong>
MPV b\u00ecnh th\u01b0\u1eddng c\u00f3 kh\u1ea9u k\u00ednh  l\u00ean \u0111\u1ebfn 13 mm, v\u00e0 ph\u00ecnh  t\u0129nh m\u1ea1ch c\u1eeda l\u00e0 gi\u00e3n n\u1edf khu tr\u00fa d\u1ea1ng t\u00fai [saccular] ho\u1eb7c h\u00ecnh thoi  [fusiform] c\u1ee7a h\u1ec7 t\u0129nh m\u1ea1ch C\u1eeda. Ph\u00ecnh t\u0129nh m\u1ea1ch c\u1eeda c\u00f3 th\u1ec3 b\u1ea9m sinh ho\u1eb7c m\u1eafc ph\u1ea3i, do suy y\u1ebfu th\u00e0nh t\u0129nh m\u1ea1ch v\u1edbi k\u00edch th\u01b0\u1edbc  \u00edt nh\u1ea5t 20 mm. C\u00e1c nguy\u00ean nh\u00e2n bao g\u1ed3m cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda, vi\u00eam t\u1ee5y, ch\u1ea5n th\u01b0\u01a1ng v\u00e0 nguy\u00ean nh\u00e2n h\u1eadu ph\u1eabu [22]. H\u00ecnh \u1ea3nh m\u00e0u x\u00e1m th\u01b0\u1eddng cho th\u1ea5y m\u1ed9t MPV gi\u00e3n ra khu tr\u00fa, trong khi h\u00ecnh \u1ea3nh Doppler cho th\u1ea5y d\u00f2ng ch\u1ea3y r\u1ed1i ho\u1eb7c d\u1ea5u \u00e2m d\u01b0\u01a1ng trong ph\u00ecnh m\u1ea1ch, d\u00f2ng ch\u1ea3y tr\u00ec tr\u1ec7, ho\u1eb7c huy\u1ebft  kh\u1ed1i  li\u00ean quan v\u1edbi ph\u00ecnh  m\u1ea1ch (H\u00ecnh 13).<\/p>\n\n\n\n

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Huy\u1ebft kh\u1ed1i gi\u1ea3<\/strong> Kh\u00f4ng th\u1ea5y d\u00f2ng ch\u1ea3y c\u00f3 th\u1ec3 l\u00e0 x\u1ea3o \u1ea3nh, th\u1ee9 ph\u00e1t do setting [thi\u1ebft l\u1eadp] Doppler. V\u00ed d\u1ee5, m\u1ed9t thi\u1ebft l\u1eadp thang v\u1eadn t\u1ed1c cao c\u00f3 th\u1ec3 b\u1ecf l\u1ee1 v\u1eadn t\u1ed1c d\u01b0\u1edbi gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng, g\u00e2y ra m\u1ea5t d\u00f2ng ch\u1ea3y. Lo\u1ea1i t\u1ea7n s\u1ed1 \u0111\u1ea7u d\u00f2, \u0111\u1ed9 s\u00e2u m\u1ea1ch m\u00e1u, v\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 \/ g\u00f3c Doppler, ho\u1eb7c b\u1ea5t k\u1ef3 c\u1ea5u tr\u00fac c\u1ea3n tr\u1edf n\u00e0o g\u00e2y \u0111o v\u1eadn t\u1ed1c kh\u00f4ng ch\u00ednh x\u00e1c, d\u1eabn \u0111\u1ebfn v\u00f9ng d\u01b0\u01a1ng t\u00ednh gi\u1ea3  ho\u1eb7c m\u1ea5t d\u00f2ng ch\u1ea3y. Do \u0111\u00f3, c\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c thi\u1ebft l\u1eadp  Doppler, b\u1ed9 l\u1ecdc, t\u1ea7n s\u1ed1 \u0111\u1ea7u d\u00f2 s\u1eed d\u1ee5ng v\u00e0 g\u00f3c Doppler ph\u00e1t s\u00f3ng \u00e2m [insonation] \u0111\u1ec3 tr\u00e1nh v\u1ea5n \u0111\u1ec1 n\u00e0y (H\u00ecnh 14).<\/p>\n\n\n\n

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Ki\u1ec3u d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch gan \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan<\/strong>
D\u1ea1ng s\u00f3ng b\u00ecnh th\u01b0\u1eddng trong t\u0129nh m\u1ea1ch gan l\u00e0 ba pha [triphasic] v\u1edbi hai giai \u0111o\u1ea1n hepatofugal li\u00ean quan \u0111\u1ebfn th\u00ec  t\u00e2m tr\u01b0\u01a1ng c\u1ee7a t\u00e2m nh\u0129 v\u00e0 t\u00e2m th\u1ea5t (H\u00ecnh 15). <\/p>\n\n\n\n

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Nh\u1eefng thay \u0111\u1ed5i v\u1ec1 x\u01a1 ho\u1eb7c vi\u00eam c\u0169ng nh\u01b0 l\u1eafng \u0111\u1ecdng m\u1ee1 trong gan c\u00f3 th\u1ec3 t\u1ea1o ra d\u00f2ng ch\u1ea3y \u0111\u01a1n pha [24]. Trong tr\u01b0\u1eddng h\u1ee3p chai gan giai \u0111o\u1ea1n cu\u1ed1i, c\u1ea5u \u200b\u200btr\u00fac gan m\u00e9o d\u1ea1ng  l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 kh\u1ea9u k\u00ednh ho\u1eb7c kh\u00f4ng th\u1ea5y c\u00e1c t\u0129nh m\u1ea1ch gan [25]. Nh\u1eefng thay \u0111\u1ed5i d\u1ea1ng s\u00f3ng s\u1edbm \u1edf b\u1ec7nh nh\u00e2n chai gan bao g\u1ed3m l\u00e0m ph\u1ed5 r\u1ed9ng ra  v\u00e0 l\u00e0m gi\u1ea3m s\u00f3ng b\u00ecnh th\u01b0\u1eddng, ch\u1ea3y ng\u01b0\u1ee3c [retrograde], s\u00f3ng t\u00e2m thu c\u1ee7a d\u1ea1ng s\u00f3ng t\u0129nh m\u1ea1ch gan [26]. Sau \u0111\u00f3, m\u00f4 h\u00ecnh d\u1ea1ng s\u00f3ng ba pha b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 b\u1ecb gi\u1ea3m ho\u1eb7c thay th\u1ebf b\u1eb1ng ki\u1ec3u \u0111\u01a1n pha (H\u00ecnh 16).
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Do \u0111\u00f3, d\u1ea1ng s\u00f3ng t\u0129nh m\u1ea1ch gan \u0111\u01a1n pha cho th\u1ea5y t\u00ecnh tr\u1ea1ng cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda. Nh\u1eefng thay \u0111\u1ed5i v\u1ec1 tu\u1ea7n ho\u00e0n b\u00ean c\u0169ng c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 h\u00f3a xung c\u1ee7a t\u0129nh m\u1ea1ch gan. S\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a t\u0129nh m\u1ea1ch r\u1ed1n l\u00e0 m\u1ed9t ph\u00e1t hi\u1ec7n kh\u00e1 th\u01b0\u1eddng xuy\u00ean \u1edf b\u1ec7nh nh\u00e2n chai gan, l\u00e0m thay \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng h\u1ecdc c\u1ee7a gan. D\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch C\u1eeda c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi s\u1ef1 t\u1ed3n t\u1ea1i  t\u0129nh m\u1ea1ch r\u1ed1n, nh\u01b0ng tr\u1edf kh\u00e1ng \u0111\u1ed9ng m\u1ea1ch gan v\u00e0 d\u00f2ng ch\u1ea3y kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng [27]. S\u1ef1 gi\u1ea3m phasicity c\u1ee7a t\u0129nh m\u1ea1ch gan c\u0169ng li\u00ean quan \u0111\u1ebfn h\u1eb9p m\u1ea1ch m\u00e1u gan ho\u1eb7c huy\u1ebft kh\u1ed1i. C\u00f3 th\u00eam c\u00e1c y\u1ebfu t\u1ed1 sinh l\u00fd nh\u01b0 \u00e1p l\u1ef1c trong \u1ed5 b\u1ee5ng cao do th\u1ee7 thu\u1eadt Valsalva ho\u1eb7c ng\u01b0ng h\u00f4 h\u1ea5p cu\u1ed1i th\u00ec th\u1edf ra, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn d\u1ea1ng s\u00f3ng \u0111\u01a1n pha.

Thay \u0111\u1ed5i \u0111\u1ed9ng m\u1ea1ch gan<\/strong> Kh\u00f4ng gi\u1ed1ng nh\u01b0 c\u00e1c ki\u1ec3u d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch c\u1eeda \u1edf b\u1ec7nh nh\u00e2n chai gan, ch\u1ec9 s\u1ed1 tr\u1edf kh\u00e1ng \u0111\u1ed9ng m\u1ea1ch gan c\u0169ng nh\u01b0 c\u00e1c ch\u1ec9 s\u1ed1 \u0111\u1ed9ng m\u1ea1ch m\u1ea1c treo tr\u00e0ng tr\u00ean kh\u00f4ng t\u01b0\u01a1ng quan v\u1edbi giai \u0111o\u1ea1n x\u01a1 gan. Tuy nhi\u00ean, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n chai gan, b\u00f9 tr\u1eeb \u0111\u1ed9ng m\u1ea1ch gan x\u1ea3y ra khi d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch c\u1eeda b\u1ecb nguy h\u1ea1i [28]. H\u01a1n n\u1eefa, s\u1ef1 \u0111i\u1ec1u h\u00f2a d\u00f2ng ch\u1ea3y \u0111\u1ed9ng m\u1ea1ch gan \u1edf b\u1ec7nh nh\u00e2n chai gan \u0111\u01b0\u1ee3c duy tr\u00ec th\u00f4ng qua m\u1ed9t c\u01a1 ch\u1ebf \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u0111\u00e1p \u1ee9ng \u0111\u1ec7m \u0111\u1ed9ng m\u1ea1ch gan <\/strong>[hepatic arterial buffer response], l\u00e0m t\u0103ng d\u00f2ng ch\u1ea3y  trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y [29].
T\u0103ng Ch\u1ec9 s\u1ed1 Tr\u1edf kh\u00e1ng RI<\/strong> Tr\u1edf kh\u00e1ng \u0111\u1ed9ng m\u1ea1ch gan thay \u0111\u1ed5i v\u1edbi gi\u00e1 tr\u1ecb t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch C\u1eeda [30]. Th\u1eadt kh\u00f4ng may, ch\u1ec9 s\u1ed1 tr\u1edf kh\u00e1ng \u0111\u1ed9ng m\u1ea1ch gan kh\u00f4ng t\u01b0\u01a1ng quan v\u1edbi m\u1ee9c \u0111\u1ed9 chai gan. Kh\u00f4ng r\u00f5 li\u1ec7u c\u00f3 m\u1ed9t th\u1ee9 t\u1ef1 th\u1eddi gian c\u00f3 th\u1ec3 d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c gi\u1eefa nh\u1eefng thay \u0111\u1ed5i trong \u0111\u1ed9ng m\u1ea1ch gan v\u00e0 nh\u1eefng thay \u0111\u1ed5i trong flow t\u0129nh m\u1ea1ch c\u1eeda hay kh\u00f4ng [31,32]. \u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u v\u00e0 \u0111\u1ed9 nh\u1ea1y c\u1ee7a ch\u1ec9 s\u1ed1  tr\u1edf kh\u00e1ng \u0111\u1ed9ng m\u1ea1ch gan (RI) l\u1edbn h\u01a1n 0,77 \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n chai gan th\u1ea5p l\u1ea7n l\u01b0\u1ee3t \u1edf m\u1ee9c 70% v\u00e0 68% [33]. Tr\u01b0\u1eddng h\u1ee3p duy nh\u1ea5t c\u00f3 \u00edch c\u1ee7a RI \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong ca suy gan t\u1ed1i c\u1ea5p do vi\u00eam gan si\u00eau vi c\u1ea5p t\u00ednh: RI l\u1edbn h\u01a1n 0,74 c\u00f3 \u0111\u1ed9 nh\u1ea1y 84% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 94% cho m\u1ed9t suy gan t\u1ed1i c\u1ea5p [34]. Kh\u00f4ng t\u00ecm th\u1ea5y gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n n\u00e0o trong tr\u01b0\u1eddng h\u1ee3p chai gan m\u00e3n t\u00ednh. Ch\u00fang ta bi\u1ebft r\u1eb1ng c\u00f3 s\u1ef1 thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 trong vi\u1ec7c l\u1ea5y m\u1eabu RI, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o vi\u1ec7c thi\u1ebfu kh\u1ea3 n\u0103ng d\u1ef1 \u0111o\u00e1n v\u00e0 k\u1ebft h\u1ee3p v\u1edbi m\u1ee9c \u0111\u1ed9 chai gan c\u1ee7a RI [35]. \u0110\u00e1nh gi\u00e1 RI trong tr\u01b0\u1eddng h\u1ee3p th\u1ea3i gh\u00e9p gan c\u0169ng c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n k\u00e9m c\u1ee7a vi\u1ec7c th\u1ea3i gh\u00e9p x\u1ea5u \u0111i so v\u1edbi c\u1ea3i thi\u1ec7n [36].
T\u0103ng v\u1eadn t\u1ed1c \u0111\u1ed9ng m\u1ea1ch gan<\/strong>
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u00ecnh th\u01b0\u1eddng, \u0111\u1ed9ng m\u1ea1ch gan l\u00e0 \u0111\u1ed9ng m\u1ea1ch h\u1ec7 th\u1ed1ng c\u00f3 tr\u1edf kh\u00e1ng th\u1ea5p v\u1edbi d\u1ea1ng s\u00f3ng \u0111\u01a1n pha.<\/em> V\u1eadn t\u1ed1c t\u00e2m thu cao nh\u1ea5t x\u1ea5p x\u1ec9 100 cm \/ gi\u00e2y. M\u1eb7c d\u00f9 kh\u00f4ng ph\u1ea3i l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u00e1ng tin c\u1eady, trong tr\u01b0\u1eddng h\u1ee3p cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda ho\u1eb7c huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch C\u1eeda, c\u1ea3 hai \u0111\u1ec1u l\u00e0m gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng t\u0129nh m\u1ea1ch trong gan, t\u1ed1c \u0111\u1ed9 v\u00e0 v\u1eadn t\u1ed1c \u0111\u1ed9ng m\u1ea1ch c\u00f3 th\u1ec3 t\u0103ng l\u00ean nh\u01b0 m\u1ed9t \u0111\u00e1p \u1ee9ng b\u00f9 tr\u1eeb (H\u00ecnh 17) [3].<\/p>\n\n\n\n

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

B\u1ec7nh nh\u00e2n b\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch C\u1eeda \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 \u0111\u00e3 l\u00e0m gi\u1ea3m ch\u1ec9 s\u1ed1 tr\u1edf kh\u00e1ng \u0111\u1ed9ng m\u1ea1ch gan, trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u1ecf h\u01a1n 0,50. Gi\u1ea3m v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch C\u1eeda v\u1edbi t\u0103ng d\u00f2ng ch\u1ea3y  \u0111\u1ed9ng m\u1ea1ch gan v\u00e0 t\u0103ng v\u1eadn t\u1ed1c g\u00e2y gi\u1ea3m ch\u1ec9 s\u1ed1 m\u1ea1ch m\u00e1u gan, \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao trong ch\u1ea9n \u0111o\u00e1n chai gan v\u00e0 cao \u00e1p t\u0129nh m\u1ea1ch C\u1eeda [37].<\/p>\n","protected":false},"excerpt":{"rendered":"

BS NGUY\u1ec4N THI\u1ec6N H\u00d9NGB\u00e0i vi\u1ebft g\u1ed1cDOI Trong khi \u0111\u00e3 bi\u1ebft r\u00f5 hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ea3o chi\u1ec1u d\u00f2ng ch\u1ea3y t\u0129nh m\u1ea1ch C\u1eeda, c\u00f2n c\u00f3 c\u00e1c ki\u1ec3u ph\u1ed5<\/p>\n","protected":false},"author":1,"featured_media":751,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,2,50,5,71],"tags":[72,51],"class_list":["post-735","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bung-tq","category-doc-sach-cho-vui","category-mach-mau","category-sieu-am","category-tap-chi-bao-cao","tag-doppler-gan","tag-mach-mau"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/735","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=735"}],"version-history":[{"count":5,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/735\/revisions"}],"predecessor-version":[{"id":893,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/735\/revisions\/893"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media\/751"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=735"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=735"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=735"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}