{"id":995,"date":"2024-02-10T20:36:32","date_gmt":"2024-02-10T13:36:32","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=995"},"modified":"2024-02-14T23:29:23","modified_gmt":"2024-02-14T16:29:23","slug":"congenital-chloride-diarrhea","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/congenital-chloride-diarrhea\/","title":{"rendered":"Ti\u00eau ch\u1ea3y m\u1ea5t Clo b\u1ea9m sinh (Congenital chloride diarrhea)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Cuillier, F, MD*, Alessandri JL, MD**, Kauffman E, MD***, Heiser M, MD***<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Article Published:<\/strong>&nbsp;Sep 6, 2006<\/p>\n\n\n\n<hr class=\"wp-block-separator has-text-color has-vivid-red-color has-alpha-channel-opacity has-vivid-red-background-color has-background is-style-wide\"\/>\n\n\n\n<p class=\"has-medium-font-size wp-block-paragraph\"><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\"><strong>T\u00d3M T\u1eaeT<\/strong><\/mark><\/p>\n\n\n\n<hr class=\"wp-block-separator has-text-color has-vivid-red-color has-alpha-channel-opacity has-vivid-red-background-color has-background is-style-wide\"\/>\n\n\n\n<ol class=\"wp-block-list\">\n<li class=\"has-large-font-size\">D\u1ea5u hi\u1ec7u si\u00eau \u00e2m: d\u00e3n \u0111\u1ec1u c\u00e1c quai ru\u1ed9t non<sup data-fn=\"f4ff71e1-ce49-45a2-a836-681aa143e42f\" class=\"fn\"><a href=\"#f4ff71e1-ce49-45a2-a836-681aa143e42f\" id=\"f4ff71e1-ce49-45a2-a836-681aa143e42f-link\">1<\/a><\/sup> + \u0111a \u1ed1i -&gt; ngh\u0129 ngay \u0111\u1ebfn ti\u00eau ch\u1ea3y m\u1ea5t Clo b\u1ea9m sinh.<\/li>\n\n\n\n<li class=\"has-large-font-size\">Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh: n\u1ed3ng \u0111\u1ed9 Clo trong ph\u00e2n cao<\/li>\n\n\n\n<li class=\"has-large-font-size\">Ch\u01b0a c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, ch\u1ee7 y\u1ebfu luy\u1ec7n t\u1eadp th\u00f3i quen \u0111i v\u1ec7 sinh. Ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 li\u1ec7u ph\u00e1p thay th\u1ebf mu\u1ed1i t\u00edch t\u1ef1c c\u00f3 hi\u1ec7u qu\u1ea3 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong.<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\"\/>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>\u0110\u1ecbnh ngh\u0129a:<\/strong> Ti\u00eau ch\u1ea3y m\u1ea5t Clo b\u1ea9m sinh l\u00e0 m\u1ed9t khi\u1ebfm khuy\u1ebft b\u1ea9m sinh \u0111\u1eb7c bi\u1ec7t hi\u1ebfm g\u1eb7p trong v\u1eadn chuy\u1ec3n Clo \u1edf h\u1ed3i tr\u00e0ng. H\u1eadu qu\u1ea3 l\u00e0 ti\u00eau ch\u1ea3y th\u1ea9m th\u1ea5u k\u00e9o d\u00e0i. \u0110a \u1ed1i \u1edf m\u1eb9, ch\u01b0\u1edbng b\u1ee5ng, ti\u00eau ch\u1ea3y ph\u00e2n n\u01b0\u1edbc v\u00e0 n\u1ed3ng \u0111\u1ed9 Clo trong ph\u00e2n cao &gt; 90 mmol\/l l\u00e0 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m ch\u00ednh trong th\u1eddi k\u1ef3 s\u01a1 sinh.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>B\u00e1o c\u00e1o tr\u01b0\u1eddng h\u1ee3p: <\/strong>Thai ph\u1ee5 20 tu\u1ed5i, con so. Cha m\u1eb9 hai b\u00ean c\u00f3 quan h\u1ec7 c\u1eadn huy\u1ebft. S\u00e0ng l\u1ecdc qu\u00fd 1 b\u00ecnh th\u01b0\u1eddng. L\u1ea7n si\u00eau \u00e2m th\u1ee9 hai c\u0169ng b\u00ecnh th\u01b0\u1eddng. \u1ede tu\u1ea7n 32, b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t s\u1ed1 c\u01a1n co t\u1eed cung v\u00e0  si\u00eau \u00e2m cho th\u1ea5y m\u1ed9t s\u1ed1 b\u1ea5t th\u01b0\u1eddng \u1edf \u0111\u01b0\u1eddng ru\u1ed9t v\u00e0 \u0111a \u1ed1i. Ch\u1ecdc \u1ed1i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 x\u00e9t nghi\u1ec7m karyotype v\u00e0 c\u0169ng \u0111\u1ec3 gi\u1ea3m \u00e1p l\u1ef1c t\u1eed cung. \u1ede tu\u1ea7n th\u1ee9 33, t\u00ecnh tr\u1ea1ng <mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-cyan-blue-color\">\u0111a \u1ed1i m\u1ee9c \u0111\u1ed9 v\u1eeba<\/mark><sup data-fn=\"3aaa1304-5216-4530-8bdf-609553b9467e\" class=\"fn\"><a href=\"#3aaa1304-5216-4530-8bdf-609553b9467e\" id=\"3aaa1304-5216-4530-8bdf-609553b9467e-link\">2<\/a><\/sup> \u0111\u00e3 xu\u1ea5t hi\u1ec7n. Thai nhi b\u1ecb gi\u00e3n \u0111\u1ec1u, \u1ee9 d\u1ecbch v\u00e0 c\u00f3 v\u00e0i c\u01a1n co th\u1eaft c\u00e1c quai ru\u1ed9t non trong \u1ed5 b\u1ee5ng. D\u1ea1 d\u00e0y d\u01b0\u1eddng nh\u01b0 b\u1ecb \u00e9p l\u1ea1i b\u1edfi m\u1ed9t quai ru\u1ed9t non gi\u00e3n. C\u00f3 hydrocele (tr\u00e0n d\u1ecbch tinh m\u1ea1c \u1edf n\u1eef?) m\u1ed9t b\u00ean h\u1ed3i \u00e2m tr\u1ed1ng.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\">Th\u1eadt kh\u00f4ng may, s\u1ea3n ph\u1ee5 \u0111\u00e3 sinh ng\u00e3 \u00e2m \u0111\u1ea1o \u1edf tu\u1ea7n th\u1ee9 33. B\u00e9 l\u00e0 n\u1eef v\u1edbi b\u1ee5ng ch\u01b0\u1edbng nh\u1eb9. X quang b\u1ee5ng v\u00e0 \u0111\u1ea1i tr\u00e0ng c\u1ea3n quang \u0111\u1ec1u b\u00ecnh th\u01b0\u1eddng. Ban \u0111\u1ea7u kh\u00f4ng th\u1ea5y \u0111i c\u1ea7u ph\u00e2n su. Kh\u00f4ng n\u00f4n \u00f3i nh\u01b0ng ch\u01b0\u1edbng b\u1ee5ng. \u0110\u1ebfn ng\u00e0y th\u1ee9 2 b\u00e9 \u0111i ti\u00eau ph\u00e2n l\u1ecfng. B\u00e9 b\u1ecb ki\u1ec1m chuy\u1ec3n h\u00f3a v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m b\u1ea5t th\u01b0\u1eddng Na<sup>+<\/sup> huy\u1ebft thanh 102 mmol\/l, K<sup>+<\/sup> huy\u1ebft thanh 2,5 mmol\/l v\u00e0 Cl<sup>&#8211;<\/sup> huy\u1ebft thanh = mmol\/l (???). Ki\u1ec3m tra th\u00eam \u0111\u00e3 ph\u00e1t hi\u1ec7n ra n\u1ed3ng \u0111\u1ed9 Na<sup>+<\/sup> (25 mmol\/l), K<sub><sup>+<\/sup><\/sub> (48 mmol\/l) v\u00e0 Cl<sup>&#8211;<\/sup> (46 mmol\/l) trong ph\u00e2n.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\">Nh\u1eefng ph\u00e1t hi\u1ec7n tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 sau \u0111\u00e2y \u0111\u00e3 g\u1ee3i \u00fd v\u1ec1 b\u1ec7nh ti\u00eau ch\u1ea3y m\u1ea5t Clo b\u1ea9m sinh:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-large-font-size\">\u0110a \u1ed1i<\/li>\n\n\n\n<li class=\"has-large-font-size\">H\u00ecnh \u1ea3nh XQ b\u00ecnh th\u01b0\u1eddng<\/li>\n\n\n\n<li class=\"has-large-font-size\">Kh\u00f4ng n\u00f4n \u00f3i, kh\u00f4ng \u0111i c\u1ea7u ph\u00e2n su v\u00e0 ph\u00e2n b\u00ecnh th\u01b0\u1eddng<\/li>\n\n\n\n<li class=\"has-large-font-size\">Ch\u01b0\u1edbng b\u1ee5ng<\/li>\n\n\n\n<li class=\"has-large-font-size\">T\u0103ng bilirubin m\u00e1u, gi\u1ea3m Natri m\u00e1u, gi\u1ea3m Kali m\u00e1u, gi\u1ea3m Clo m\u00e1u, v\u00e0 ki\u1ec1m chuy\u1ec3n h\u00f3a<\/li>\n<\/ul>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\">\u0110i\u1ec1u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1edfi n\u1ed3ng \u0111\u1ed9 Clo trong ph\u00e2n cao. V\u00e0i ng\u00e0y sau, ch\u00fang t\u00f4i nh\u1eadn \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 ch\u1ecdc \u1ed1i (karyotype b\u00ecnh th\u01b0\u1eddng). Nh\u01b0ng n\u1ed3ng \u0111\u1ed9 clo r\u1ea5t cao.<\/p>\n\n\n\n<div class=\"wp-block-columns\"><br \/><span style=\"font-size: 18pt;\">Ch\u00fa \u00fd c\u00e1c quai ru\u1ed9t non gi\u00e3n<\/span><\/div>\n<div class=\"wp-block-columns\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/pw\/ABLVV84Y8zbHun03mVGq15jCt-ICj7nfHLbMaQigcohjbAh4t84touFEf8cRVjU07H33xNp_-NsFYOcJMgTKYwiucX51kXVNe2XCmxBgY6TsCYY54lAaenWTGYGrdLg2Rccki-Bo4pl9EFtnDAz3AeT_hCc=w320-h246-s-no-gm\" alt=\"1\" width=\"320\" height=\"246\" \/>\u00a0<br \/><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/pw\/ABLVV85NIKbqD2-DlUbC7R9vAeLUuyAOS7S-XpM5hZyLSjX07ux2qzjMY8rCK495AMOQWrcp8boFkQMU118yLOqiGZs4Yc6SpRoOfeMG6KI8HnY_jV94lG0iF3U1USI8HrKI6RSaYlaQHSa1CuI_0nQj9HY=w320-h246-s-no-gm\" alt=\"2\" width=\"320\" height=\"246\" \/><\/div>\n<div class=\"wp-block-columns\">\u00a0<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/pw\/ABLVV86vMbD3_KSE4Jct_3WrCxYYYG9ATG5U7HCisrbBIGkPDrpAmwuUp_dl2d8Bjio8E75B4smTbSS7UP6Evl4kmwxAg0XoTwKZcrJzMPbLxLRpas_u7dWTADYduQgBt3BXfYMYr8fKfTrfHoPcFycQBR8=w320-h246-s-no-gm\" alt=\"4\" width=\"320\" height=\"300\" \/> \u00a0<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/pw\/ABLVV87BnpfSdYsUYrVjExXPRGxn3BpCXaTm1N08tleW_aUH0sONDEEHcjoV-AiZiBGdlO5Ho5fiXkjwVPmvmdj-Kk_vigJAzhxb1cnh_VWsCWPyaJzdYbEyAzIYE3Mz2us6f8jN_h7ert8OVNNXSpldH8s=w390-h300-s-no-gm\" alt=\"6\" width=\"390\" height=\"300\" \/><\/div>\n<p><span style=\"font-size: 18pt; color: initial;\">hydrocele m\u1ed9t b\u00ean v\u00e0 d\u1ea1 d\u00e0y l\u1ec7ch\u00a0<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/pw\/ABLVV840V9zB_YdiWqLx0RkMC2rk4ZUNBKW2S182MQF_5EmNNPP-Ix_-LSkmU5Sdk70zLLy5Ijt2vwys1hFoh0cVbhiDRoexUnvD3pH5BhCUMmLJOr9xRXHEWRWMwh6pJSgTrV8zennya1gu3pG02Kw8W3Y=w320-h246-s-no-gm\" alt=\"7\" width=\"320\" height=\"246\" \/> <img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/pw\/ABLVV840pzSc7if8VjIzQ8NRl3nWKDjxdSS5LGbmZY10JuLZIadSasJJ1FmmHrqQC4i61s-KKEOsU3gRs23g0iDZn9Jc90flmLQ8Kfy9FSuOQbZWN3Olw2Rr_8O_78AVXqP3-RTlDp9ZAbpqowNfTG_SBo4=w320-h246-s-no-gm\" alt=\"9\" width=\"320\" height=\"246\" \/><\/p>\n<p><span style=\"font-size: 18pt;\">\u0111a \u1ed1i<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/pw\/ABLVV85xmFx2f8tUFx7UCOdu9hBSPdeDV_Btad7CYvtVzFSB1nsEuM0uGmHToyHCPK6GwQWXNEzJctqAlLzERguOIzfxUmw2qnR6vSWiyXq3VJ9NWjGmP5NaAPhMmAoFpdAOQL0ycCraOvm7Uwj1yhnU-II=w320-h246-s-no-gm\" alt=\"8\" width=\"320\" height=\"246\" \/><\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>L\u1ecbch s\u1eed:<\/strong> B\u1ec7nh ti\u00eau ch\u1ea3y b\u1ea9m sinh m\u1ea5t Clo \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u1ea7n \u0111\u1ea7u ti\u00ean \u1edf Ph\u1ea7n Lan v\u00e0o n\u0103m 1945 v\u00e0 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf qu\u1ed1c gia n\u00e0y v\u00e0 \u1edf Kuwait.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>T\u1ef7 l\u1ec7 m\u1eafc:<\/strong> Ti\u00eau ch\u1ea3y m\u1ea5t Clo b\u1ea9m sinh l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n hi\u1ebfm g\u1eb7p, \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o ch\u1ee7 y\u1ebfu \u1edf Ph\u1ea7n Lan. \u0110\u00e2y l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n di truy\u1ec1n l\u1eb7n v\u1ec1 v\u1eadn chuy\u1ec3n Clo \u1edf \u0111o\u1ea1n xa h\u1ed3i tr\u00e0ng v\u00e0 \u0111\u1ea1i tr\u00e0ng. \u0110\u00e2y l\u00e0 m\u1ed9t ch\u1ee9ng r\u1ed1i lo\u1ea1n ph\u1ed5 bi\u1ebfn \u1edf Kuwait v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc l\u00e0 1\/3200 do t\u1ef7 l\u1ec7 h\u00f4n nh\u00e2n c\u1eadn huy\u1ebft \u1edf qu\u1ed1c gia n\u00e0y r\u1ea5t cao.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>Nguy\u00ean nh\u00e2n:<\/strong> S\u1ef1 v\u1eadn chuy\u1ec3n Clo b\u1ea5t th\u01b0\u1eddng \u1edf \u0111o\u1ea1n xa h\u1ed3i tr\u00e0ng v\u00e0 \u0111\u1ea1i tr\u00e0ng, \u0111\u00f3 l\u00e0 l\u00fd do t\u1ea1i sao c\u00f3 t\u00ecnh tr\u1ea1ng \u0111a \u1ed1i v\u00e0 ch\u01b0\u1edbng b\u1ee5ng trong th\u1eddi k\u1ef3 trong t\u1eed cung.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>C\u01a1 ch\u1ebf b\u1ec7nh sinh: <\/strong>Ti\u00eau ch\u1ea3y m\u1ea5t Clo b\u1ea9m sinh l\u00e0 b\u1ec7nh di truy\u1ec1n theo gen l\u1eb7n tr\u00ean NST th\u01b0\u1eddng g\u00e2y r\u1ed1i lo\u1ea1n trao \u0111\u1ed5i Cl\/HCO3 \u1edf ru\u1ed9t do \u0111\u1ed9t bi\u1ebfn gen SLC26A3 v\u00e0 \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng ti\u00eau ch\u1ea3y clorua dai d\u1eb3ng sau sinh. Khi\u1ebfm khuy\u1ebft c\u01a1 b\u1ea3n l\u00e0 s\u1ef1 t\u00e1i h\u1ea5p thu Clo c\u1ee7a t\u1ebf b\u00e0o ni\u00eam m\u1ea1c ru\u1ed9t, li\u00ean quan \u0111\u1ebfn vi\u1ec7c v\u1eadn chuy\u1ec3n bicarbonate b\u1ecb suy gi\u1ea3m. H\u1eadu qu\u1ea3 l\u00e0 ti\u00eau ch\u1ea3y trong t\u1eed cung v\u00e0 \u0111a \u1ed1i, th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn sinh non. Sau sinh, tr\u1ebb s\u01a1 sinh b\u1ecb h\u1ea1 clo m\u00e1u, h\u1ea1 natri m\u00e1u, h\u1ea1 kali m\u00e1u v\u00e0 ki\u1ec1m chuy\u1ec3n h\u00f3a.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>D\u1ea5u hi\u1ec7u si\u00eau \u00e2m:<\/strong> B\u1ea5t ch\u1ea5p nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m \u0111i\u1ec3n h\u00ecnh c\u1ee7a b\u1ec7nh n\u00e0y, 75% tr\u01b0\u1eddng h\u1ee3p \u1edf Kuwait \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n sau giai \u0111o\u1ea1n s\u01a1 sinh, t\u1ea5t c\u1ea3 \u0111\u1ec1u c\u00f3 bi\u1ec3u hi\u1ec7n ti\u00eau ch\u1ea3y m\u1ea1n t\u00ednh v\u00e0 ch\u1eadm ph\u00e1t tri\u1ec3n v\u1edbi gi\u1ea3m Clo m\u00e1u, gi\u1ea3m Kali m\u00e1u, ki\u1ec1m chuy\u1ec3n h\u00f3a. Tuy nhi\u00ean, si\u00eau \u00e2m ti\u1ec1n s\u1ea3n c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c quai ru\u1ed9t gi\u00e3n k\u00e8m theo t\u00ecnh tr\u1ea1ng \u0111a \u1ed1i, g\u1ee3i \u00fd b\u1ec7nh ti\u00eau ch\u1ea3y b\u1ea9m sinh m\u1ea5t Clo. Ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng n\u1ed3ng \u0111\u1ed9 Clo trong ph\u00e2n cao.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>\u00dd ngh\u0129a:<\/strong> Khi quan s\u00e1t th\u1ea5y t\u00ecnh tr\u1ea1ng gi\u00e3n \u0111\u1ec1u c\u00e1c quai ru\u1ed9t \u0111i\u1ec3n h\u00ecnh k\u00e8m \u0111a \u1ed1i, ch\u00fang ta n\u00ean ngh\u0129 \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n ti\u00eau ch\u1ea3y m\u1ea5t Clo b\u1ea9m sinh.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t: <\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-large-font-size\">H\u1eb9p h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng ho\u1eb7c l\u1ed7 h\u1eadu m\u00f4n kh\u00f4ng th\u1ee7ng: D\u00e3n ch\u1ee7 y\u1ebfu c\u00e1c quai \u0111\u1ea1i tr\u00e0ng v\u00e0 c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 \u0111a \u1ed1i<\/li>\n\n\n\n<li class=\"has-large-font-size\">D\u1ecb d\u1ea1ng v\u00f4 h\u1ea1ch<sup data-fn=\"1e2e00d4-87f7-4a13-b111-8bccb06dc424\" class=\"fn\"><a href=\"#1e2e00d4-87f7-4a13-b111-8bccb06dc424\" id=\"1e2e00d4-87f7-4a13-b111-8bccb06dc424-link\">3<\/a><\/sup> \u0111\u1ea1i tr\u00e0ng hay b\u1ec7nh Hirschsprung: Ho\u00e0n to\u00e0n kh\u00f4ng c\u00f3 t\u1ebf b\u00e0o h\u1ea1ch \u1edf c\u1ea3 \u0111\u00e1m r\u1ed1i d\u01b0\u1edbi ni\u00eam (Meissner&#8217;s) v\u00e0 \u0111\u00e1m r\u1ed1i th\u1ea7n kinh (Auerbach&#8217;s) c\u1ee7a ru\u1ed9t. Khi b\u1ec7nh li\u00ean quan \u0111\u1ebfn h\u1ed3i tr\u00e0ng v\u00e0 \u00edt g\u1eb7p h\u01a1n l\u00e0 h\u1ed7ng tr\u00e0ng, b\u1ec7nh \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 b\u1ec7nh Jirasek-Zuelzer-Wilson.<\/li>\n\n\n\n<li class=\"has-large-font-size\">T\u1eafc ru\u1ed9t: do b\u1ea5t th\u01b0\u1eddng v\u1ec1 gi\u1ea3i ph\u1eabu (t\u1eafc ph\u00e2n su, h\u1eb9p ru\u1ed9t, d\u1ea3i d\u00ednh (?) v.v.. Tuy nhi\u00ean, c\u00e1c quai ru\u1ed9t gi\u00e3n ra kh\u00f4ng \u0111\u1ec1u \u0111\u1eb7n v\u00e0 c\u00f3 th\u1ec3 ch\u1ee9a \u0111\u1ea7y ph\u00e2n su nh\u01b0 trong <em><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">b\u1ec7nh nh\u1ea7y nh\u1edbt (Mucoviscidosis)<\/mark><\/em><sup data-fn=\"166874f2-8876-46db-a1ea-87d1fc074b22\" class=\"fn\"><a href=\"#166874f2-8876-46db-a1ea-87d1fc074b22\" id=\"166874f2-8876-46db-a1ea-87d1fc074b22-link\">4<\/a><\/sup>.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>C\u00e1c b\u1ea5t th\u01b0\u1eddng li\u00ean quan:<\/strong> N\u1ed3ng \u0111\u1ed9 Clo trong ph\u00e2n v\u01b0\u1ee3t qu\u00e1 t\u1ed5ng n\u1ed3ng \u0111\u1ed9 natri v\u00e0 kali g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n. T\u00ecnh tr\u1ea1ng n\u00e0y c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc sinh. Si\u00eau \u00e2m c\u00f3 th\u1ec3 cho th\u1ea5y s\u1ef1 c\u0103ng gi\u00e3n \u0111\u1ec1u \u0111\u1eb7n c\u1ee7a c\u00e1c quai ru\u1ed9t non sau 25 tu\u1ea7n. T\u00ecnh tr\u1ea1ng \u0111a \u1ed1i v\u00e0 sinh non lu\u00f4n hi\u1ec7n di\u1ec7n.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>Ti\u00ean l\u01b0\u1ee3ng:<\/strong> Th\u1eadt kh\u00f4ng may, ch\u01b0a c\u00f3 c\u00e1ch \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ti\u00eau ch\u1ea3y m\u1ea5t Clo b\u1ea9m sinh, nh\u01b0ng tr\u1ebb m\u1eafc b\u1ec7nh n\u00e0y \u0111\u01b0\u1ee3c t\u1eadp \u0111i v\u1ec7 sinh \u1edf \u0111\u1ed9 tu\u1ed5i b\u00ecnh th\u01b0\u1eddng. Kh\u1ea3 n\u0103ng th\u00edch \u1ee9ng x\u00e3 h\u1ed9i c\u1ee7a h\u1ecd c\u00f3 th\u1ec3 b\u1ecb suy gi\u1ea3m, nh\u01b0ng ti\u00ean l\u01b0\u1ee3ng t\u1ed1t n\u1ebfu Kali c\u0169ng nh\u01b0 Natri v\u00e0 Clo \u0111\u01b0\u1ee3c thay th\u1ebf th\u01b0\u1eddng xuy\u00ean.<\/p>\n\n\n\n<p class=\"has-large-font-size wp-block-paragraph\"><strong>Qu\u1ea3n l\u00fd<\/strong>: Th\u01b0\u1eddng l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng. Li\u1ec7u ph\u00e1p thay th\u1ebf b\u1eb1ng NaCl v\u00e0 KCl \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 nh\u01b0ng ti\u00ean l\u01b0\u1ee3ng l\u00e2u d\u00e0i v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng. Tuy nhi\u00ean, ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 li\u1ec7u ph\u00e1p thay th\u1ebf mu\u1ed1i t\u00edch c\u1ef1c c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng v\u00e0 gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u1ef7 l\u1ec7 t\u1eed vong. \u0110\u00e1i d\u1ea7m, s\u00f3n ph\u00e2n v\u00e0 nh\u1eadp vi\u1ec7n v\u00ec vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t th\u01b0\u1eddng g\u1eb7p, \u0111\u1eb7c bi\u1ec7t trong th\u1eddi th\u01a1 \u1ea5u. C\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 l\u00e0 b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i, t\u0103ng ur\u00ea m\u00e1u, v\u00f4 sinh, <mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-green-cyan-color\"><em>spermatoceles<\/em><\/mark><sup data-fn=\"5f982208-e90f-4d51-9d9e-4964789da848\" class=\"fn\"><a href=\"#5f982208-e90f-4d51-9d9e-4964789da848\" id=\"5f982208-e90f-4d51-9d9e-4964789da848-link\">5<\/a><\/sup>, vi\u00eam ru\u1ed9t, tho\u00e1t v\u1ecb b\u1eb9n, t\u0103ng n\u1ed3ng \u0111\u1ed9 Clo trong m\u1ed3 h\u00f4i (?).<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"has-large-font-size wp-block-paragraph\"><em><a href=\"https:\/\/thefetus.net\/content\/congenital-chloride-diarrhea\" target=\"_blank\" rel=\"noreferrer noopener\">thefetus.net<\/a><\/em><\/p>\n<\/blockquote>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"has-large-font-size wp-block-paragraph\"><strong><em>M\u1ed9t v\u00e0i l\u01b0u \u00fd:<\/em><\/strong><\/p>\n<\/blockquote>\n\n\n<ol class=\"wp-block-footnotes has-large-font-size\"><li id=\"f4ff71e1-ce49-45a2-a836-681aa143e42f\"><strong><em>Ti\u00eau chu\u1ea9n d\u00e3n ru\u1ed9t non: \u00a0<br><\/em><\/strong>+ Gi\u00e3n ru\u1ed9t l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng th\u01b0\u1eddng g\u1eb7p trong tam c\u00e1 nguy\u1ec7t th\u1ee9 ba v\u00e0 h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh l\u00fd \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn <mark class=\"has-inline-color has-vivid-red-color\"><strong><em>gi\u00e3n ru\u1ed9t non &gt;\u200914\u2009mm<\/em><\/strong><\/mark> (Theo h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m qu\u00fd 3 ISOUG 2024)<br>+ B\u00ecnh th\u01b0\u1eddng <mark class=\"has-inline-color has-vivid-red-color\"><strong><em>\u0111\u01b0\u1eddng k\u00ednh ru\u1ed9t non &lt; 7mm<\/em><\/strong><\/mark>, \u00edt khi th\u1ea5y ru\u1ed9t non, th\u01b0\u1eddng th\u1ea5y nhu \u0111\u1ed9ng sau 25w. \u0110\u01b0\u1eddng <mark class=\"has-inline-color has-vivid-red-color\"><strong><em>k\u00ednh t\u1ed1i \u0111a ru\u1ed9t gi\u00e0 8mm l\u00fac 24w, 16-18mm l\u00fac 25-28 tu\u1ea7n<\/em><\/strong><\/mark>. \u1ede TCN 2 th\u01b0\u1eddng kh\u00f4ng th\u1ea5y RG, \u1edf TCG 3 c\u00f3 th\u1ec3 th\u1ea5y RG do ph\u00e2n su c\u00f3 \u0111\u1ed9 echo d\u00e0y nh\u1eb9. <a href=\"#f4ff71e1-ce49-45a2-a836-681aa143e42f-link\" aria-label=\"Chuy\u1ec3n \u0111\u1ebfn ph\u1ea7n tham kh\u1ea3o ch\u00fa th\u00edch cu\u1ed1i trang 1\">\u21a9\ufe0e<\/a><\/li><li id=\"3aaa1304-5216-4530-8bdf-609553b9467e\"><strong><em>Ti\u00eau chu\u1ea9n v\u00e0 ph\u00e2n \u0111\u1ed9 \u0111a \u1ed1i<br><\/em><\/strong><img decoding=\"async\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2024\/02\/image-1.png\" alt=\"\">Ph\u00e2n \u0111\u1ed9 \u0111a \u1ed1i &#8211; Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb BV T\u1eeb D\u0169 2022 <a href=\"#3aaa1304-5216-4530-8bdf-609553b9467e-link\" aria-label=\"Chuy\u1ec3n \u0111\u1ebfn ph\u1ea7n tham kh\u1ea3o ch\u00fa th\u00edch cu\u1ed1i trang 2\">\u21a9\ufe0e<\/a><\/li><li id=\"1e2e00d4-87f7-4a13-b111-8bccb06dc424\"><strong><em>D\u1ecb d\u1ea1ng v\u00f4 h\u1ea1ch: <\/em><\/strong><a href=\"https:\/\/www.phacdochuabenh.com\/nhi-khoa\/ngoai-khoa\/DI-DANG-VO-HACH.php\" target=\"_blank\" rel=\"noreferrer noopener\">Link<\/a> <a href=\"#1e2e00d4-87f7-4a13-b111-8bccb06dc424-link\" aria-label=\"Chuy\u1ec3n \u0111\u1ebfn ph\u1ea7n tham kh\u1ea3o ch\u00fa th\u00edch cu\u1ed1i trang 3\">\u21a9\ufe0e<\/a><\/li><li id=\"166874f2-8876-46db-a1ea-87d1fc074b22\"><strong><em>B\u1ec7nh nh\u1ea7y nh\u1edbt:  <\/em><\/strong><a href=\"https:\/\/vi.wikipedia.org\/wiki\/X%C6%A1_nang\" target=\"_blank\" rel=\"noreferrer noopener\">Link<\/a>, <a href=\"https:\/\/vnexpress.net\/benh-nhay-nhot-o-tre-so-sinh-2362060.htm\" target=\"_blank\" rel=\"noreferrer noopener\">Link 2<\/a> <a href=\"#166874f2-8876-46db-a1ea-87d1fc074b22-link\" aria-label=\"Chuy\u1ec3n \u0111\u1ebfn ph\u1ea7n tham kh\u1ea3o ch\u00fa th\u00edch cu\u1ed1i trang 4\">\u21a9\ufe0e<\/a><\/li><li id=\"5f982208-e90f-4d51-9d9e-4964789da848\"><strong><em>Spermatoceles<\/em><\/strong>:<br>The most common epididymal mass is a cyst, which includes epididymal cysts and spermatoceles. Both were seen in 20% to 40% of all asymptomatic patients studied by Leung et al.,144, and were multiple in 30% of cases. Both epididymal cysts and spermatoceles are thought to result from dilatation of the epididymal ductules, but the contents of these masses differ.14 Epididymal cysts contain clear serous fluid, whereas spermatoceles are filled with spermatozoa and sediment containing lymphocytes, fat globules, and cellular debris, giving the fluid a thick, milky appearance.3 Both lesions may result from prior episodes of epididymitis or trauma. Spermatoceles and epididymal cysts appear identical on sonography: anechoic, circumscribed masses with no or few internal echoes. Loculations and septations are often seen (Fig. 22.25). In rare cases, a spermatocele may be hyperechoic.9 Differentiation between a spermatocele and an epididymal cyst is rarely important clinically. Spermatoceles almost always occur in the head of the epididymis and represent cystic dilatation of efferent ductules, whereas epididymal cysts arise throughout the length of the epididymis.<br><br><img decoding=\"async\" src=\"https:\/\/lh3.googleusercontent.com\/pw\/ABLVV84kLMqhz3NjKk9LnT9QfhAH5hO-TL1rqU1bELGKVcsXZKeNkAhL1MpE7ReO5ERnKUSdX_svFrLpZtvFNjmm5T89r7AEevngvFcEV848EIL38fCAvLKk0JMNfcK3VymXw3y7bCjPMEZVcK1Rd-wi7d4=w805-h850-s-no-gm\" alt=\"\">(A) Spermatocele. Longitudinal scan shows an anechoic cyst in head of the epididymis. (B) Spermatocele. Longitudinal scan shows a large cyst containing internal echoes in head of the epididymis. (C) Septate spermatocele. Longitudinal scan shows a septate cyst in head of the epididymis. (D) Epididymal cyst. Longitudinal scan shows a cyst in body of the epididymis. <a href=\"#5f982208-e90f-4d51-9d9e-4964789da848-link\" aria-label=\"Chuy\u1ec3n \u0111\u1ebfn ph\u1ea7n tham kh\u1ea3o ch\u00fa th\u00edch cu\u1ed1i trang 5\">\u21a9\ufe0e<\/a><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>D\u00e3n \u0111\u1ec1u c\u00e1c quai ru\u1ed9t non k\u00e8m \u0111a \u1ed1i v\u00e0 h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1u sinh non.<\/p>\n","protected":false},"author":1,"featured_media":1006,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"[{\"content\":\"<strong><em>Ti\u00eau chu\u1ea9n d\u00e3n ru\u1ed9t non: \u00a0<br><\/em><\/strong>+ Gi\u00e3n ru\u1ed9t l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng th\u01b0\u1eddng g\u1eb7p trong tam c\u00e1 nguy\u1ec7t th\u1ee9 ba v\u00e0 h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh l\u00fd \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn <mark style=\\\"background-color:rgba(0, 0, 0, 0)\\\" class=\\\"has-inline-color has-vivid-red-color\\\"><strong><em>gi\u00e3n ru\u1ed9t non >\u200914\u2009mm<\/em><\/strong><\/mark> (Theo h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m qu\u00fd 3 ISOUG 2024)<br>+ B\u00ecnh th\u01b0\u1eddng <mark style=\\\"background-color:rgba(0, 0, 0, 0)\\\" class=\\\"has-inline-color has-vivid-red-color\\\"><strong><em>\u0111\u01b0\u1eddng k\u00ednh ru\u1ed9t non &lt; 7mm<\/em><\/strong><\/mark>, \u00edt khi th\u1ea5y ru\u1ed9t non, th\u01b0\u1eddng th\u1ea5y nhu \u0111\u1ed9ng sau 25w. \u0110\u01b0\u1eddng <mark style=\\\"background-color:rgba(0, 0, 0, 0)\\\" class=\\\"has-inline-color has-vivid-red-color\\\"><strong><em>k\u00ednh t\u1ed1i \u0111a ru\u1ed9t gi\u00e0 8mm l\u00fac 24w, 16-18mm l\u00fac 25-28 tu\u1ea7n<\/em><\/strong><\/mark>. \u1ede TCN 2 th\u01b0\u1eddng kh\u00f4ng th\u1ea5y RG, \u1edf TCG 3 c\u00f3 th\u1ec3 th\u1ea5y RG do ph\u00e2n su c\u00f3 \u0111\u1ed9 echo d\u00e0y nh\u1eb9.\",\"id\":\"f4ff71e1-ce49-45a2-a836-681aa143e42f\"},{\"content\":\"<strong><em>Ti\u00eau chu\u1ea9n v\u00e0 ph\u00e2n \u0111\u1ed9 \u0111a \u1ed1i<br><\/em><\/strong><img src=\\\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2024\/02\/image-1.png\\\" alt=\\\"\\\">Ph\u00e2n \u0111\u1ed9 \u0111a \u1ed1i - Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb BV T\u1eeb D\u0169 2022\",\"id\":\"3aaa1304-5216-4530-8bdf-609553b9467e\"},{\"content\":\"<strong><em>D\u1ecb d\u1ea1ng v\u00f4 h\u1ea1ch: <\/em><\/strong><a href=\\\"https:\/\/www.phacdochuabenh.com\/nhi-khoa\/ngoai-khoa\/DI-DANG-VO-HACH.php\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Link<\/a>\",\"id\":\"1e2e00d4-87f7-4a13-b111-8bccb06dc424\"},{\"content\":\"<strong><em>B\u1ec7nh nh\u1ea7y nh\u1edbt:  <\/em><\/strong><a href=\\\"https:\/\/vi.wikipedia.org\/wiki\/X%C6%A1_nang\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Link<\/a>, <a href=\\\"https:\/\/vnexpress.net\/benh-nhay-nhot-o-tre-so-sinh-2362060.htm\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Link 2<\/a>\",\"id\":\"166874f2-8876-46db-a1ea-87d1fc074b22\"},{\"content\":\"<strong><em>Spermatoceles<\/em><\/strong>:<br>The most common epididymal mass is a cyst, which includes epididymal cysts and spermatoceles. Both were seen in 20% to 40% of all asymptomatic patients studied by Leung et al.,144, and were multiple in 30% of cases. Both epididymal cysts and spermatoceles are thought to result from dilatation of the epididymal ductules, but the contents of these masses differ.14 Epididymal cysts contain clear serous fluid, whereas spermatoceles are filled with spermatozoa and sediment containing lymphocytes, fat globules, and cellular debris, giving the fluid a thick, milky appearance.3 Both lesions may result from prior episodes of epididymitis or trauma. Spermatoceles and epididymal cysts appear identical on sonography: anechoic, circumscribed masses with no or few internal echoes. Loculations and septations are often seen (Fig. 22.25). In rare cases, a spermatocele may be hyperechoic.9 Differentiation between a spermatocele and an epididymal cyst is rarely important clinically. Spermatoceles almost always occur in the head of the epididymis and represent cystic dilatation of efferent ductules, whereas epididymal cysts arise throughout the length of the epididymis.<br><br><img src=\\\"https:\/\/lh3.googleusercontent.com\/pw\/ABLVV84kLMqhz3NjKk9LnT9QfhAH5hO-TL1rqU1bELGKVcsXZKeNkAhL1MpE7ReO5ERnKUSdX_svFrLpZtvFNjmm5T89r7AEevngvFcEV848EIL38fCAvLKk0JMNfcK3VymXw3y7bCjPMEZVcK1Rd-wi7d4=w805-h850-s-no-gm\\\" alt=\\\"\\\">(A) Spermatocele. Longitudinal scan shows an anechoic cyst in head of the epididymis. (B) Spermatocele. Longitudinal scan shows a large cyst containing internal echoes in head of the epididymis. (C) Septate spermatocele. Longitudinal scan shows a septate cyst in head of the epididymis. (D) Epididymal cyst. Longitudinal scan shows a cyst in body of the epididymis.\",\"id\":\"5f982208-e90f-4d51-9d9e-4964789da848\"}]"},"categories":[2,41,78],"tags":[],"class_list":["post-995","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-doc-sach-cho-vui","category-english-corner","category-the-fetus-net"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/995","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=995"}],"version-history":[{"count":31,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/995\/revisions"}],"predecessor-version":[{"id":1069,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/995\/revisions\/1069"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media\/1006"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=995"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=995"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=995"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}