B\u00e0i so\u1ea1n c\u1ee7a b\u1ea1n nam K15a1 (XH)<\/p>\n
C\u00e2u 1: Vi\u00eam l\u00e0 g\u00ec? N\u00eau t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a qu\u00e1 tr\u00ecnh vi\u00eam?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 vi\u00eam<\/p>\n
1) Kh\u00e1i ni\u1ec7m:<\/p>\n
– Vi\u00eam \u2013 Phalogos: ngh\u0129a l\u00e0 l\u1eeda ch\u00e1y v\u1edbi 4 tri\u1ec7u ch\u1ee9ng c\u1ed5 \u0111i\u1ec3n: s\u01b0ng, n\u00f3ng, \u0111\u1ecf, \u0111au v\u00e0 \u0111\u01b0\u1ee3c coi l\u00e0 1 b\u1ec7nh (Galien, th\u1ebf k\u1ef7 II tr\u01b0\u1edbc c\u00f4ng nguy\u00ean)<\/p>\n
– Vi\u00eam: l\u00e0 1 ph\u1ea3n \u1ee9ng c\u1ee7a c\u01a1 th\u1ec3 ch\u1ed1ng l\u1ea1i s\u1ef1 x\u00e2m nh\u1eadp, 1 h\u00e0nh \u0111\u1ed9ng c\u00f3 l\u1ee3i \u0111\u1ec3 b\u1ea3o v\u1ec7 c\u01a1 th\u1ec3 n\u00ean kh\u00f4ng th\u1ec3 coi vi\u00eam l\u00e0 b\u1ec7nh<\/p>\n
– Vi\u00eam: l\u00e0 qu\u00e1 tr\u00ecnh r\u1ed1i lo\u1ea1n t\u1ea1m th\u1eddi \u0111\u1ec3 \u0111\u1ea1t t\u1edbi 1 c\u00e2n b\u1eb1ng m\u1edbi c\u1ee7a c\u01a1 th\u1ec3<\/p>\n
– Vi\u00eam: c\u00f3 li\u00ean quan \u0111\u1ebfn mi\u1ec5n d\u1ecbch (h\u1ec7 mi\u1ec5n d\u1ecbch: lympho b\u00e0o, t\u01b0\u01a1ng b\u00e0o, \u0110TB\u2026)<\/p>\n
– Vi\u00eam (inflammation): l\u00e0 1 \u0111\u00e1p \u1ee9ng b\u1ea3o v\u1ec7 c\u01a1 th\u1ec3 c\u1ee7a h\u1ec7 mi\u1ec5n d\u1ecbch tr\u01b0\u1edbc s\u1ef1 t\u1ea5n c\u00f4ng c\u1ee7a 1 t\u00e1c nh\u00e2n b\u00ean ngo\u00e0i ho\u1eb7c b\u00ean trong. \u0110\u00e2y l\u00e0 1 \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch t\u1ef1 nhi\u00ean<\/p>\n
– Vi\u00eam: l\u00e0 k\u1ebft qu\u1ea3 c\u00f3 t\u00ednh quy lu\u1eadt c\u1ee7a c\u00e1c t\u00e1c nh\u00e2n g\u00e2y vi\u00eam xu\u1ea5t hi\u1ec7n trong c\u01a1 th\u1ec3, l\u00e0 qu\u00e1 tr\u00ecnh ph\u1ee9c h\u1ee3p gi\u1eefa \u0111i\u1ec1u h\u00f2a v\u00e0 ph\u1ea3n \u1ee9ng<\/p>\n
2) \u0110\u1ecbnh ngh\u0129a:<\/p>\n
Vi\u00eam l\u00e0 qu\u00e1 tr\u00ecnh sinh l\u00fd g\u1ed3m nhi\u1ec1u ph\u1ea3n \u1ee9ng c\u1ee7a c\u01a1 th\u1ec3 \u1edf m\u00f4 v\u00e0 t\u1ebf b\u00e0o mang t\u00ednh ch\u1ea5t c\u1ee5c b\u1ed9 hay to\u00e0n th\u1ec3 nh\u1eb1m lo\u1ea1i b\u1ecf nguy\u00ean nh\u00e2n v\u00e0 thi\u1ebft l\u1eadp 1 c\u00e2n b\u1eb1ng m\u1edbi n\u00f3i chung l\u00e0 c\u00f3 l\u1ee3i cho c\u01a1 th\u1ec3<\/p>\n
2. Vi\u00eam tr\u1ea3i qua 4 giai \u0111o\u1ea1n<\/p>\n
– Giai \u0111o\u1ea1n kh\u1edfi \u0111\u1ea7u: g\u1ed3m 3 hi\u1ec7n t\u01b0\u1ee3ng ch\u00ednh: toan h\u00f3a nguy\u00ean ph\u00e1t, toan h\u00f3a th\u1ee9 ph\u00e1t v\u00e0 gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t trung gian ho\u1ea1t m\u1ea1ch<\/p>\n
– Giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng huy\u1ebft qu\u1ea3n \u2013 huy\u1ebft: g\u1ed3m 3 hi\u1ec7n t\u01b0\u1ee3ng ch\u00ednh: sung huy\u1ebft, ph\u00f9 vi\u00eam, b\u1ea1ch c\u1ea7u tho\u00e1t m\u1ea1ch<\/p>\n
– Giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng m\u00f4: g\u1ed3m 3 hi\u1ec7n t\u01b0\u1ee3ng ch\u00ednh: \u0111\u1ed9ng vi\u00ean, chuy\u1ec3n d\u1ea1ng, sinh s\u1ea3n t\u1ebf b\u00e0o<\/p>\n
– Giai \u0111o\u1ea1n h\u00e0n g\u1eafn (s\u1eeda ch\u1eefa) hay h\u1ee7y ho\u1ea1i<\/p>\n
3. Ph\u00e2n t\u00edch c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng ch\u00ednh c\u1ee7a m\u1ed7i giai \u0111o\u1ea1n<\/p>\n
1) Giai \u0111o\u1ea1n kh\u1edfi \u0111\u1ea7u:<\/p>\n
1.1) Toan h\u00f3a nguy\u00ean ph\u00e1t: chuy\u1ec3n h\u00f3a glucose:<\/p>\n
– B\u00ecnh th\u01b0\u1eddng (\u00e1i kh\u00ed): C6H12O6 + 6O2 \u2192 6CO2 + 6H2O + E<\/p>\n
– Vi\u00eam (y\u1ebfm kh\u00ed): C6H12O6 \u2192 2C3H6O3 + E<\/p>\n
Do thi\u1ebfu oxy, qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a glucose t\u1ea1o ra nhi\u1ec1u acid lactic g\u00e2y gi\u00e3n m\u1ea1ch v\u00e0 toan h\u00f3a v\u00f9ng vi\u00eam (pH t\u1eeb 6.8 gi\u1ea3m xu\u1ed1ng c\u00f2n 6)<\/p>\n
1.2) Toan h\u00f3a th\u1ee9 ph\u00e1t:<\/p>\n
– T\u00e1c \u0111\u1ed9ng k\u00e9o d\u00e0i c\u1ee7a vi\u00eam c\u00e0ng gi\u1ea3i ph\u00f3ng ra nhi\u1ec1u acid lactic l\u00e0m cho pH ti\u1ebfp t\u1ee5c gi\u1ea3m xu\u1ed1ng c\u00f2n 5.3<\/p>\n
– T\u1ebf b\u00e0o ho\u1ea1i t\u1eed -> m\u00e0ng c\u1ee7a c\u00e1c t\u00fai lysosome b\u1ecb v\u1ee1 -> gi\u1ea3i ph\u00f3ng c\u00e1c enzym th\u1ee7y ph\u00e2n -> th\u1ee7y ph\u00e2n c\u00e1c ch\u1ea5t kh\u00e1c nhau trong v\u00f9ng vi\u00eam th\u00e0nh c\u00e1c ch\u1ea5t c\u00f3 tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed nh\u1ecf h\u01a1n (acid h\u1eefu c\u01a1, peptid, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c peptid g\u00e2y gi\u00e3n m\u1ea1ch v\u00e0 t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch)<\/p>\n
1.3) Gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t trung gian ho\u1ea1t m\u1ea1ch:<\/p>\n
– Amin ho\u1ea1t m\u1ea1ch (histamin, serotonin)<\/p>\n
– C\u00e1c y\u1ebfu t\u1ed1 huy\u1ebft t\u01b0\u01a1ng (h\u1ec7 kinin, h\u1ec7 b\u1ed5 th\u1ec3)<\/p>\n
– Ch\u1ea5t chuy\u1ec3n h\u00f3a acid amin<\/p>\n
– Ch\u1ea5t b\u1ea1ch c\u1ea7u (leukotrien)<\/p>\n
– Ch\u1ea5t ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7<\/p>\n
– Lymphokin<\/p>\n
=> C\u00e1c ch\u1ea5t n\u00e0y t\u00e1c \u0111\u1ed9ng l\u00ean:<\/p>\n
+ C\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 v\u00e0 m\u00e0ng \u0111\u00e1y c\u1ee7a th\u00e0nh m\u1ea1ch: l\u00e0m gi\u00e3n m\u1ea1ch, t\u1ea1o ra d\u1ecbch r\u1ec9 vi\u00eam v\u00e0 g\u00e2y \u0111au<\/p>\n
+ H\u1ec7 TK c\u1ea3m gi\u00e1c t\u1ea1i v\u00f9ng vi\u00eam: t\u1eeb \u0111\u00f3 t\u00e1c \u0111\u1ed9ng l\u00ean c\u00e1c d\u00e2y TK v\u1eadn m\u1ea1ch ngo\u1ea1i vi -> l\u00e0m gi\u00e3n c\u00e1c ti\u1ec3u \u0110M g\u00e2y n\u00ean hi\u1ec7n t\u01b0\u1ee3ng sung huy\u1ebft<\/p>\n
2) Giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng huy\u1ebft qu\u1ea3n \u2013 huy\u1ebft:<\/p>\n
2.1) Sung huy\u1ebft:<\/p>\n
C\u00e1c ch\u1ea5t trung gian ho\u1ea1t m\u1ea1ch g\u00e2y t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4, t\u1ed5n th\u01b0\u01a1ng m\u00e0ng \u0111\u00e1y, t\u1ed5n th\u01b0\u01a1ng v\u00e1ch c\u00e1c mao qu\u1ea3n \u0111\u01b0a \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng sung huy\u1ebft \u0111\u1ed9ng v\u00e0 sau \u0111\u00f3 l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng sung huy\u1ebft t\u0129nh, c\u1ea3 2 hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y \u0111\u1ec1u d\u1eabn \u0111\u1ebfn c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng sau t\u1ea1i v\u00f9ng vi\u00eam<\/p>\n
2.2) Hi\u1ec7n t\u01b0\u1ee3ng r\u1ec9 vi\u00eam v\u00e0 ph\u00f9 vi\u00eam:<\/p>\n
– Do t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4, t\u1ed5n th\u01b0\u01a1ng m\u00e0ng \u0111\u00e1y, t\u1ed5n th\u01b0\u01a1ng v\u00e1ch c\u00e1c mao qu\u1ea3n l\u00e0m cho huy\u1ebft t\u01b0\u01a1ng trong l\u00f2ng m\u1ea1ch tho\u00e1t ra m\u00f4 k\u1ebd (r\u1ec9 vi\u00eam) mang theo nhi\u1ec1u protein, albumin, ph\u1ea3n \u1ee9ng rivalta (+), k\u00e9o theo n\u01b0\u1edbc trong l\u00f2ng m\u1ea1ch tho\u00e1t ra m\u00f4 k\u1ebd g\u00e2y n\u00ean hi\u1ec7n t\u01b0\u1ee3ng ph\u00f9 vi\u00eam<\/p>\n
– T\u00e1c \u0111\u1ed9ng c\u1ee7a ph\u00f9 vi\u00eam:<\/p>\n
+ C\u00f3 l\u1ee3i: l\u00e0m lo\u00e3ng c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh, c\u00e1c s\u1ee3i t\u01a1 huy\u1ebft t\u1ea1o th\u00e0nh m\u1ea1ng l\u01b0\u1edbi chia c\u1eaft v\u00e0 c\u1ed1 \u0111\u1ecbnh vi khu\u1ea9n -> h\u1ea1n ch\u1ebf kh\u00f4ng cho vi\u00eam lan r\u1ed9ng, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho b\u1ea1ch c\u1ea7u ho\u1ea1t \u0111\u1ed9ng th\u1ef1c b\u00e0o v\u00e0 vi\u00eam c\u00f3 th\u1ec3 d\u1eebng \u1edf \u0111\u00e2y m\u00e0 kh\u00f4ng \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng<\/p>\n
+ C\u00f3 h\u1ea1i:<\/p>\n
(+) G\u00e2y ch\u00e8n \u00e9p m\u00f4 xung quanh, g\u00e2y \u0111au, th\u1eadm ch\u00ed h\u1ea1n ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a 1 s\u1ed1 c\u01a1 quan v\u00e0 g\u00e2y vi\u00eam d\u00ednh c\u00e1c m\u00e0ng<\/p>\n
(+) D\u1ecbch ti\u1ebft tr\u00ean b\u1ec1 m\u1eb7t ni\u00eam m\u1ea1c, thanh m\u1ea1c: t\u1ea1o n\u00ean m\u00e0ng gi\u1ea3 trong b\u1ec7nh b\u1ea1ch h\u1ea7u, d\u1ecbch xu\u1ea5t ti\u1ebft trong vi\u00eam long \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean<\/p>\n
(+) D\u1ecbch ti\u1ebft tr\u00ean m\u00f4 k\u1ebd c\u1ee7a da g\u00e2y hi\u1ec7n t\u01b0\u1ee3ng n\u1edf to t\u1ebf b\u00e0o v\u00e0 c\u00e1c b\u1ecdng n\u01b0\u1edbc trong 1 s\u1ed1 b\u1ec7nh v\u1ec1 da<\/p>\n
2.3) B\u1ea1ch c\u1ea7u tho\u00e1t m\u1ea1ch: v\u00e0o v\u00f9ng vi\u00eam \u0111\u1ec3 ti\u00eau di\u1ec7t, lo\u1ea1i tr\u1eeb v\u1eadt l\u1ea1 (t\u00e1c nh\u00e2n g\u00e2y vi\u00eam) th\u00f4ng qua c\u00e1c b\u01b0\u1edbc:<\/p>\n
– Th\u00e0nh t\u1ee5 b\u1ea1ch c\u1ea7u<\/p>\n
– Xuy\u00ean m\u1ea1ch b\u1ea1ch c\u1ea7u<\/p>\n
– H\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng<\/p>\n
– Th\u1ef1c t\u01b0\u1ee3ng<\/p>\n
– \u1ea8m t\u01b0\u1ee3ng<\/p>\n
– Sau \u0111\u00f3 l\u00e0 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a ti\u1ec3u c\u1ea7u<\/p>\n
3) Giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng m\u00f4: g\u1ed3m 3 hi\u1ec7n t\u01b0\u1ee3ng<\/p>\n
(1) \u0110\u1ed9ng vi\u00ean: m\u1ecdi lo\u1ea1i m\u00f4 v\u00e0 t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c huy \u0111\u1ed9ng tham gia v\u00e0o qu\u00e1 tr\u00ecnh vi\u00eam<\/p>\n
(2) Chuy\u1ec3n d\u1ea1ng: thay \u0111\u1ed5i h\u00ecnh th\u00e1i nh\u1eb1m th\u00edch nghi v\u1edbi m\u00f4i tr\u01b0\u1eddng vi\u00eam v\u00e0 di \u0111\u1ed9ng h\u01a1n<\/p>\n
(3) Sinh s\u1ea3n t\u1ebf b\u00e0o: b\u1ed5 sung cho l\u01b0\u1ee3ng m\u00f4, t\u1ebf b\u00e0o b\u1ecb tho\u00e1i h\u00f3a v\u00e0 ho\u1ea1i t\u1eed<\/p>\n
3.1) H\u1ec7 t\u1ebf b\u00e0o: khi b\u1ea1ch c\u1ea7u kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c tr\u1ecdn v\u1eb9n nhi\u1ec7m v\u1ee5 th\u00ec c\u01a1 th\u1ec3 ph\u1ea3i huy \u0111\u1ed9ng h\u1ec7 t\u1ebf b\u00e0o \u0111\u01a1n nh\u00e2n \u0111\u1ebfn v\u00f9ng vi\u00eam \u0111\u1ec3 thay th\u1ebf b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n bao g\u1ed3m: lympho b\u00e0o, b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n, m\u00f4 b\u00e0o, 3 d\u00f2ng t\u1ebf b\u00e0o n\u00e0y ph\u00e2n b\u1ed1 r\u1ea3i r\u00e1c kh\u1eafp c\u01a1 th\u1ec3, ch\u00fang r\u1ea5t \u0111a d\u1ea1ng v\u1ec1 h\u00ecnh th\u00e1i, c\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi nhau t\u1ea1i v\u00f9ng vi\u00eam \u0111\u1ec3 th\u1ef1c hi\u1ec7n ch\u1ee9c n\u0103ng:<\/p>\n
+ Th\u1ef1c b\u00e0o v\u00e0 th\u00f4ng tin (b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n)<\/p>\n
+ S\u1ea3n xu\u1ea5t kh\u00e1ng th\u1ec3: lympho b\u00e0o B v\u00e0 T (KT t\u1ebf b\u00e0o v\u00e0 KT d\u1ecbch th\u1ec3)<\/p>\n
+ Lo\u1ea1i tr\u1eeb v\u1eadt l\u1ea1: lympho b\u00e0o B v\u00e0 T, b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n<\/p>\n
3.2) H\u1ec7 m\u00f4 li\u00ean k\u1ebft: c\u00f9ng song song v\u1edbi h\u1ec7 t\u1ebf b\u00e0o th\u00ec h\u1ec7 m\u00f4 li\u00ean k\u1ebft, h\u1ec7 bi\u1ec3u m\u00f4 c\u0169ng bi\u1ebfn \u0111\u1ed5i \u0111\u1ec3 t\u1ea1o ra c\u00e1c t\u1ebf b\u00e0o x\u01a1, s\u1ee3i t\u1ea1o keo, c\u00e1c n\u1ee5 huy\u1ebft qu\u1ea3n \u0111\u1ec3 t\u00e1i l\u1eadp t\u01b0\u1edbi m\u00e1u cho v\u00f9ng vi\u00eam, b\u00f9 \u0111\u1eafp v\u00e0 s\u1eeda ch\u1eefa t\u1ea1i v\u00f9ng vi\u00eam<\/p>\n
4) Giai \u0111o\u1ea1n h\u00e0n g\u1eafn (s\u1eeda ch\u1eefa) hay h\u1ee7y ho\u1ea1i:<\/p>\n
4.1) H\u00e0n g\u1eafn:<\/p>\n
+ N\u1ebfu v\u00f9ng vi\u00eam ti\u1ebfn tri\u1ec3n t\u1ed1t, c\u00e1c s\u1ea3n ph\u1ea9m ho\u1ea1i t\u1eed \u0111\u01b0\u1ee3c d\u1ecdn s\u1ea1ch, t\u00e1c nh\u00e2n g\u00e2y vi\u00eam \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb th\u00ec m\u00f4 vi\u00eam \u0111\u01b0\u1ee3c h\u00e0n g\u1eafn v\u1edbi s\u1ef1 t\u00e1i t\u1ea1o nhi\u1ec1u t\u1ebf b\u00e0o x\u01a1, nhi\u1ec1u n\u1ee5 huy\u1ebft qu\u1ea3n \u0111\u1ec3 bi\u1ec7t h\u00f3a th\u00e0nh c\u00e1c huy\u1ebft qu\u1ea3n t\u01b0\u1edbi m\u00e1u cho v\u00f9ng vi\u00eam, h\u1ec7 bi\u1ec3u m\u00f4 t\u0103ng sinh \u0111\u1ec3 b\u00f9 \u0111\u1eafp v\u00e0 s\u1eeda ch\u1eefa c\u00e1c c\u1ea5u tr\u00fac \u0111\u00e3 m\u1ea5t, vi\u00eam \u0111\u01b0\u1ee3c \u0111\u1ea9y l\u00f9i<\/p>\n
+ N\u1ebfu vi\u00eam g\u00e2y m\u1ea5t ch\u1ea5t nhi\u1ec1u th\u00ec qu\u00e1 tr\u00ecnh x\u01a1 h\u00f3a s\u1ebd t\u1ea1o th\u00e0nh s\u1eb9o, h\u1ea1n ch\u1ebf \u00edt nhi\u1ec1u \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng c\u01a1 n\u0103ng c\u1ee7a v\u00f9ng m\u00f4 b\u1ecb vi\u00eam<\/p>\n
4.2) Vi\u00eam ti\u1ebfp di\u1ec5n: n\u1ebfu t\u00e1c nh\u00e2n g\u00e2y vi\u00eam kh\u00f4ng \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb tri\u1ec7t \u0111\u1ec3, s\u1ef1 h\u1ee7y ho\u1ea1i v\u00e0 s\u1eeda ch\u1eefa t\u1ea1i v\u00f9ng vi\u00eam \u0111an xen nhau v\u00e0 vi\u00eam chuy\u1ec3n sang b\u00e1n c\u1ea5p hay m\u1ea1n t\u00ednh, qu\u00e1 tr\u00ecnh s\u1eeda ch\u1eefa kh\u00f3 kh\u0103n h\u01a1n r\u1ea5t nhi\u1ec1u, \u0111\u00f4i khi g\u00e2y h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng<\/p>\n
C\u00e2u 2: Vi\u00eam l\u00e0 g\u00ec? Tr\u00ecnh b\u00e0y c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng t\u1ed5n th\u01b0\u01a1ng ch\u00ednh trong giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng huy\u1ebft qu\u1ea3n \u2013 huy\u1ebft trong vi\u00eam?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 vi\u00eam: c\u00e2u 1<\/p>\n
2. C\u00e1c hi\u1ec7n t\u01b0\u1ee3ng t\u1ed5n th\u01b0\u01a1ng ch\u00ednh trong giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng huy\u1ebft qu\u1ea3n \u2013 huy\u1ebft: g\u1ed3m 3 hi\u1ec7n t\u01b0\u1ee3ng:<\/p>\n
1) Sung huy\u1ebft:<\/p>\n
– C\u00e1c ch\u1ea5t trung gian ho\u1ea1t m\u1ea1ch g\u00e2y t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4, t\u1ed5n th\u01b0\u01a1ng m\u00e0ng \u0111\u00e1y, t\u1ed5n th\u01b0\u01a1ng v\u00e1ch c\u00e1c mao qu\u1ea3n \u0111\u01b0a \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng sung huy\u1ebft \u0111\u1ed9ng:<\/p>\n
+ X\u1ea3y ra kho\u1ea3ng 10 ph\u00fat sau khi c\u00f3 t\u00e1c \u0111\u1ed9ng vi\u00eam, \u0111\u1ea1t t\u1ed1i \u0111a sau 15-60 ph\u00fat<\/p>\n
+ C\u00e1c c\u01a1 th\u1eaft m\u1edf r\u1ed9ng, m\u00e1u tr\u00e0n v\u00e0o to\u00e0n b\u1ed9 h\u1ec7 th\u1ed1ng vi m\u1ea1ch l\u00e0m t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn v\u00f9ng vi\u00eam<\/p>\n
+ L\u1edbp t\u1ebf b\u00e0o n\u1ed9i m\u00f4 tr\u1edf n\u00ean th\u00f4 r\u00e1p, s\u01b0ng to v\u00e0 c\u00f3 nhi\u1ec1u nh\u00fa l\u1ed3i, ch\u1ea5t ciment g\u1eafn gi\u1eefa c\u00e1c t\u1ebf b\u00e0o b\u1ecb l\u1ecfng l\u1ebbo, t\u1ea1o nhi\u1ec1u khe h\u1edf cho d\u1ecbch tho\u00e1t ra ngo\u00e0i<\/p>\n
+ C\u00e1c l\u1ed7 tr\u00ean m\u00e0ng \u0111\u00e1y r\u1ed9ng ra do t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c ch\u1ea5t m\u00e0 vi khu\u1ea9n ph\u00e2n gi\u1ea3i<\/p>\n
– V\u00e0 sau \u0111\u00f3 l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng sung huy\u1ebft t\u0129nh:<\/p>\n
+ Khi c\u00e1c ch\u1ea5t tho\u00e1t qu\u1ea3n nhi\u1ec1u, \u0111\u1ed9 qu\u00e1nh c\u1ee7a m\u00e1u trong l\u00f2ng m\u1ea1ch t\u0103ng l\u00ean l\u00e0m h\u1ed3ng c\u1ea7u d\u1ec5 k\u1ebft d\u00ednh, t\u1ea1o th\u00e0nh 1 chu\u1ed7i g\u00e2y b\u00edt t\u1eafc, d\u00f2ng m\u00e1u ch\u1ea3y ch\u1eadm l\u1ea1i<\/p>\n
+ M\u1eb7t kh\u00e1c, d\u1ecbch tho\u00e1t ra ngo\u00e0i g\u00e2y ch\u00e8n \u00e9p tr\u1edf l\u1ea1i th\u00e0nh m\u1ea1ch, c\u1ea3n tr\u1edf d\u00f2ng m\u00e1u \u0111i v\u1ec1 v\u00e0 g\u00e2y sung huy\u1ebft TM<\/p>\n
– C\u1ea3 2 hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y \u0111\u1ec1u d\u1eabn \u0111\u1ebfn c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng sau t\u1ea1i v\u00f9ng vi\u00eam:<\/p>\n
2) Hi\u1ec7n t\u01b0\u1ee3ng r\u1ec9 vi\u00eam v\u00e0 ph\u00f9 vi\u00eam:<\/p>\n
– \u0110\u1ecbnh ngh\u0129a: l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng \u1ee9 \u0111\u1ecdng d\u1ecbch \u1edf m\u00f4 k\u1ebd t\u1ebf b\u00e0o do m\u1ea5t c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i<\/p>\n
– C\u01a1 ch\u1ebf: do t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4, t\u1ed5n th\u01b0\u01a1ng m\u00e0ng \u0111\u00e1y, t\u1ed5n th\u01b0\u01a1ng v\u00e1ch c\u00e1c mao qu\u1ea3n l\u00e0m cho huy\u1ebft t\u01b0\u01a1ng trong l\u00f2ng m\u1ea1ch tho\u00e1t ra m\u00f4 k\u1ebd (r\u1ec9 vi\u00eam) mang theo nhi\u1ec1u protein, albumin, ph\u1ea3n \u1ee9ng rivalta (+), k\u00e9o theo n\u01b0\u1edbc trong l\u00f2ng m\u1ea1ch tho\u00e1t ra m\u00f4 k\u1ebd g\u00e2y n\u00ean hi\u1ec7n t\u01b0\u1ee3ng ph\u00f9 vi\u00eam<\/p>\n
3) B\u1ea1ch c\u1ea7u tho\u00e1t m\u1ea1ch: v\u00e0o v\u00f9ng vi\u00eam \u0111\u1ec3 ti\u00eau di\u1ec7t, lo\u1ea1i tr\u1eeb v\u1eadt l\u1ea1 (t\u00e1c nh\u00e2n g\u00e2y vi\u00eam) th\u00f4ng qua c\u00e1c b\u01b0\u1edbc:<\/p>\n
3.1) Th\u00e0nh t\u1ee5 b\u1ea1ch c\u1ea7u:<\/p>\n
+ B\u00ecnh th\u01b0\u1eddng b\u1ea1ch c\u1ea7u di chuy\u1ec3n trong m\u00e1u theo \u0111\u01b0\u1eddng tr\u1ee5c gi\u1eefa, nh\u01b0ng khi \u0111\u1ebfn \u1ed5 vi\u00eam ch\u00fang l\u1ea1i r\u1ebd sang 2 b\u00ean v\u00e0 b\u00e1m v\u00e0o th\u00e0nh m\u1ea1ch do v\u00e1ch m\u1ea1ch bi\u1ebfn \u0111\u1ed5i \u0111i\u1ec7n t\u00edch<\/p>\n
+ Ph\u00eda t\u1ebf b\u00e0o n\u1ed9i m\u00f4 th\u00e0nh m\u1ea1ch: b\u1ec1 m\u1eb7t c\u00e1c t\u1ebf b\u00e0o d\u00ednh qu\u00e1nh v\u00e0 c\u00f3 nhi\u1ec1u nh\u00fa l\u1ed3i, \u0111\u1ed3ng th\u1eddi c\u00f3 c\u00e1c ph\u00e2n t\u1eed d\u00ednh n\u1ed9i b\u00e0o \u0111\u1ec3 tr\u00f9ng h\u1ee3p v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 tr\u00ean b\u1ec1 m\u1eb7t b\u1ea1ch c\u1ea7u g\u00e2y k\u1ebft d\u00ednh<\/p>\n
+ Ph\u00eda b\u1ea1ch c\u1ea7u: b\u00ecnh th\u01b0\u1eddng trong t\u00fai n\u1ed9i b\u00e0o c\u1ee7a b\u1ea1ch c\u1ea7u c\u00f3 1 h\u1ec7 th\u1ed1ng g\u1ed3m 3 glycoprotein l\u00e0 LFA1, M0 v\u00e0 P150. Khi c\u00f3 c\u00e1c t\u00edn hi\u1ec7u trung gian, c\u00e1c s\u1ea3n ph\u1ea9m \u0111\u1ed9c t\u1ed1 c\u1ee7a vi khu\u1ea9n, c\u00e1c y\u1ebfu t\u1ed1 h\u01b0\u1edbng \u0111\u1ed9ng th\u00ec c\u00e1c glycoprotein n\u00e0y s\u1ebd \u0111\u01b0\u1ee3c ho\u1ea1t h\u00f3a v\u00e0 th\u00f2 ra b\u1ec1 m\u1eb7t c\u1ee7a b\u1ea1ch c\u1ea7u \u0111\u1ec3 \u0111\u1ebfn n\u01a1i c\u1ea7n thi\u1ebft<\/p>\n
3.2) Xuy\u00ean m\u1ea1ch b\u1ea1ch c\u1ea7u: b\u1ea1ch c\u1ea7u tho\u00e1t m\u1ea1ch do nhi\u1ec1u y\u1ebfu t\u1ed1 l\u00e0m t\u0103ng k\u1ebb h\u1edf n\u1ed9i m\u1ea1c:<\/p>\n
+ T\u1ebf b\u00e0o n\u1ed9i m\u00f4 co ng\u1eafn l\u1ea1i t\u1ea1o n\u00ean nh\u1eefng k\u1ebb h\u1edf n\u1ed9i m\u1ea1c. Hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y x\u1ea3y ra s\u1edbm, ch\u1eebng 15-30 ph\u00fat \u1edf c\u00e1c TM nh\u1ecf<\/p>\n
+ C\u00e1c ch\u1ea5t cytokine<\/p>\n
+ C\u00e1c t\u00e1c nh\u00e2n g\u00e2y vi\u00eam<\/p>\n
+ Khi b\u1ecb vi\u00eam h\u1ee7y ho\u1ea1i, c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 lu\u00f4n t\u00e1i t\u1ea1o \u0111\u1ec3 h\u00ecnh th\u00e0nh c\u00e1c n\u1ee5 vi m\u1ea1ch m\u1edbi nh\u01b0ng v\u00e1ch vi m\u1ea1ch v\u1eabn c\u00f2n nhi\u1ec1u k\u1ebb h\u1edf<\/p>\n
+ Tho\u00e1t m\u1ea1ch s\u1edbm nh\u1ea5t l\u00e0 b\u1ea1ch c\u1ea7u trung t\u00ednh r\u1ed3i \u0111\u1ebfn b\u1ea1ch c\u1ea7u \u00e1i toan<\/p>\n
+ Hi\u1ec7n t\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u tho\u00e1t m\u1ea1ch k\u00e9o d\u00e0i 5-12 ph\u00fat<\/p>\n
3.3) H\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng: b\u1ea1ch c\u1ea7u di chuy\u1ec3n theo 1 h\u01b0\u1edbng nh\u1ea5t \u0111\u1ecbnh do \u1ea3nh h\u01b0\u1edfng c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 h\u00f3a h\u1ecdc v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 ho\u1ea1t t\u00e1c b\u1ea1ch c\u1ea7u<\/p>\n
+ G\u1ed3m h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng (+) v\u00e0 h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng (-)<\/p>\n
+ C\u00e1c y\u1ebfu t\u1ed1 h\u00f3a h\u1ecdc g\u00e2y h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng c\u00f3 2 ngu\u1ed3n g\u1ed1c: ngo\u1ea1i t\u1ea1o v\u00e0 n\u1ed9i t\u1ea1o<\/p>\n
3.4) T\u1ea1i v\u00f9ng vi\u00eam: b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n gi\u1ea3i ph\u00f3ng c\u00e1c enzym ch\u1ee9a s\u1eb5n trong lysosome, \u0111\u1eb7c bi\u1ec7t l\u00e0 r\u1ea5t nhi\u1ec1u hydrolase (enzym th\u1ee7y ph\u00e2n), k\u1ebft qu\u1ea3 c\u00f3 th\u1ec3 l\u00e0:<\/p>\n
+ T\u00e1c nh\u00e2n g\u00e2y vi\u00eam h\u1ee7y di\u1ec7t b\u1ea1ch c\u1ea7u t\u1ea1o n\u00ean m\u1ee7<\/p>\n
+ B\u1ea1ch c\u1ea7u \u0111a nh\u00e2n t\u1ef1 h\u1ee7y sau khi m\u00e0ng n\u1ed9i b\u00e0o c\u1ee7a lysosome b\u1ecb v\u1ee1<\/p>\n
+ Lysosome ch\u1ebf ti\u1ebft c\u00e1c ch\u1ea5t v\u00e0o kh\u00f4ng b\u00e0o trong b\u00e0o t\u01b0\u01a1ng r\u1ed3i gi\u1ea3i ph\u00f3ng enzym ra m\u00f4i tr\u01b0\u1eddng xung quanh t\u1ebf b\u00e0o: ti\u00eau h\u1ee7y c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y b\u1ec7nh v\u00e0 m\u00f4 k\u1ebf c\u1eadn<\/p>\n
3.5) Th\u1ef1c t\u01b0\u1ee3ng: b\u1ea1ch c\u1ea7u thu nh\u1eadn v\u00e0 ti\u00eau h\u00f3a c\u00e1c v\u1eadt l\u1ea1, g\u1ed3m 3 hi\u1ec7n t\u01b0\u1ee3ng:<\/p>\n
+ Nh\u1eadn bi\u1ebft v\u00e0 k\u1ebft d\u00ednh v\u1eadt l\u1ea1<\/p>\n
+ Thu nh\u1eadn<\/p>\n
+ Ti\u00eau h\u00f3a<\/p>\n
3.6) \u1ea8m t\u01b0\u1ee3ng: b\u1ea1ch c\u1ea7u thu nh\u1eadn v\u00e0 ti\u00eau h\u00f3a d\u1ecbch l\u1ecfng, \u0111\u01b0\u1ee3c k\u00edch th\u00edch nh\u1edd t\u0103ng c\u01b0\u1eddng anion \u1edf v\u00f9ng vi\u00eam, b\u1ecb gi\u1ea3m thi\u1ec3u do c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh ti\u00eau glucose ho\u1eb7c \u1ee9c ch\u1ebf n\u0103ng l\u01b0\u1ee3ng h\u00f4 h\u1ea5p t\u1ebf b\u00e0o<\/p>\n
3.7) Ho\u1ea1t \u0111\u1ed9ng c\u1ee7a ti\u1ec3u c\u1ea7u: \u0111\u01b0\u1ee3c ho\u1ea1t t\u00e1c nh\u1edd ti\u1ebfp c\u1eadn v\u1edbi ch\u1ea5t t\u1ea1o keo c\u1ee7a v\u00e1ch m\u1ea1ch sau khi t\u1ebf b\u00e0o n\u1ed9i m\u00f4 b\u1ecb h\u1ee7y ho\u1ea1i ho\u1eb7c co l\u1ea1i, c\u00e1c y\u1ebfu t\u1ed1 ho\u1ea1t t\u00e1c ti\u1ec3u c\u1ea7u<\/p>\n
3. \u00dd ngh\u0129a c\u1ee7a d\u1ecbch r\u1ec9 vi\u00eam \u2013 ph\u00f9<\/p>\n
1) C\u00f3 l\u1ee3i: l\u00e0m lo\u00e3ng c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh, c\u00e1c s\u1ee3i t\u01a1 huy\u1ebft t\u1ea1o th\u00e0nh m\u1ea1ng l\u01b0\u1edbi chia c\u1eaft v\u00e0 c\u1ed1 \u0111\u1ecbnh vi khu\u1ea9n -> h\u1ea1n ch\u1ebf kh\u00f4ng cho vi\u00eam lan r\u1ed9ng, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho b\u1ea1ch c\u1ea7u ho\u1ea1t \u0111\u1ed9ng th\u1ef1c b\u00e0o v\u00e0 vi\u00eam c\u00f3 th\u1ec3 d\u1eebng \u1edf \u0111\u00e2y m\u00e0 kh\u00f4ng \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng<\/p>\n
2) C\u00f3 h\u1ea1i:<\/p>\n
– G\u00e2y ch\u00e8n \u00e9p m\u00f4 xung quanh, g\u00e2y \u0111au, th\u1eadm ch\u00ed h\u1ea1n ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a 1 s\u1ed1 c\u01a1 quan v\u00e0 g\u00e2y vi\u00eam d\u00ednh c\u00e1c m\u00e0ng<\/p>\n
– D\u1ecbch ti\u1ebft tr\u00ean b\u1ec1 m\u1eb7t ni\u00eam m\u1ea1c, thanh m\u1ea1c: t\u1ea1o n\u00ean m\u00e0ng gi\u1ea3 trong b\u1ec7nh b\u1ea1ch h\u1ea7u, d\u1ecbch xu\u1ea5t ti\u1ebft trong vi\u00eam long \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean<\/p>\n
– D\u1ecbch ti\u1ebft tr\u00ean m\u00f4 k\u1ebd c\u1ee7a da g\u00e2y hi\u1ec7n t\u01b0\u1ee3ng n\u1edf to t\u1ebf b\u00e0o v\u00e0 c\u00e1c b\u1ecdng n\u01b0\u1edbc trong 1 s\u1ed1 b\u1ec7nh v\u1ec1 da<\/p>\n
C\u00e2u 3: Vi\u00eam l\u00e0 g\u00ec? Tr\u00ecnh b\u00e0y c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng t\u1ed5n th\u01b0\u01a1ng ch\u00ednh trong giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng m\u00f4 trong vi\u00eam?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 vi\u00eam: c\u00e2u 1<\/p>\n
2. C\u00e1c hi\u1ec7n t\u01b0\u1ee3ng t\u1ed5n th\u01b0\u01a1ng ch\u00ednh trong giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng m\u00f4: g\u1ed3m 3 hi\u1ec7n t\u01b0\u1ee3ng<\/p>\n
(1) \u0110\u1ed9ng vi\u00ean: m\u1ecdi lo\u1ea1i m\u00f4 v\u00e0 t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c huy \u0111\u1ed9ng tham gia v\u00e0o qu\u00e1 tr\u00ecnh vi\u00eam<\/p>\n
(2) Chuy\u1ec3n d\u1ea1ng: thay \u0111\u1ed5i h\u00ecnh th\u00e1i nh\u1eb1m th\u00edch nghi v\u1edbi m\u00f4i tr\u01b0\u1eddng vi\u00eam v\u00e0 di \u0111\u1ed9ng h\u01a1n<\/p>\n
(3) Sinh s\u1ea3n t\u1ebf b\u00e0o: b\u1ed5 sung cho l\u01b0\u1ee3ng m\u00f4, t\u1ebf b\u00e0o b\u1ecb tho\u00e1i h\u00f3a v\u00e0 ho\u1ea1i t\u1eed<\/p>\n
1) H\u1ec7 th\u01b0\u1ee3ng m\u00f4: trong \u0111i\u1ec1u ki\u1ec7n b\u00ecnh th\u01b0\u1eddng c\u00f3 vai tr\u00f2 nh\u01b0 \u201ch\u00e0ng r\u00e0o b\u1ea3o v\u1ec7\u201d t\u1ea1o n\u00ean ranh gi\u1edbi gi\u1eefa m\u00f4i tr\u01b0\u1eddng b\u00ean ngo\u00e0i v\u00e0 c\u01a1 th\u1ec3<\/p>\n
– Da: nh\u1edd l\u1edbp bi\u1ec3u m\u00f4 l\u00e1t t\u1ea7ng s\u1eebng h\u00f3a n\u00ean c\u00f3 th\u1ec3 ng\u0103n c\u1ea3n vi khu\u1ea9n, virus<\/p>\n
– Ni\u00eam m\u1ea1c: trong c\u01a1 th\u1ec3 c\u00f3 nhi\u1ec1u lo\u1ea1i c\u1ea5u tr\u00fac ni\u00eam m\u1ea1c nh\u01b0 v\u00f9ng h\u1ecdng mi\u1ec7ng, th\u1ef1c qu\u1ea3n, c\u1ed5 t\u1eed cung c\u00f3 c\u1ea5u tr\u00fac g\u1ea7n gi\u1ed1ng v\u1edbi da n\u00ean c\u00f3 c\u01a1 ch\u1ebf t\u01b0\u01a1ng t\u1ef1. Ni\u00eam m\u1ea1c tr\u1ee5 ch\u1ebf ti\u1ebft nh\u1ea7y c\u1ee7a h\u1ed1c m\u0169i, d\u1ea1 d\u00e0y, ru\u1ed9t: ch\u1ea5t nh\u1ea7y ch\u1ee9a enzym ti\u00eau h\u1ee7y c\u00f3 t\u00e1c d\u1ee5ng nh\u01b0 1 m\u00e0ng che ch\u1edf b\u1ec1 m\u1eb7t ni\u00eam m\u1ea1c<\/p>\n
– Khi vi\u00eam: hi\u1ec7n t\u01b0\u1ee3ng ch\u1ebf ti\u1ebft d\u1ecbch nh\u1ea7y t\u0103ng r\u00f5 r\u1ec7t<\/p>\n
– Khi vi\u00eam m\u1ea5t ch\u1ea5t: \u0111\u1ed3ng th\u1eddi v\u1edbi ph\u1ea7n m\u00f4 h\u1ea1t vi\u00eam t\u0103ng s\u1ea3n, \u0111\u1ec3 l\u1ea5p \u0111\u1ea7y ch\u1ed7 tr\u1ed1ng: l\u1edbp th\u01b0\u1ee3ng m\u00f4 c\u0169ng t\u0103ng s\u1ea3n \u1edf 2 b\u1edd \u1ed5 vi\u00eam r\u1ed3i lan d\u1ea7n \u0111\u1ebfn v\u00f9ng trung t\u00e2m gi\u00fap h\u00e0n g\u1eafn t\u1ed5n th\u01b0\u01a1ng. Khi l\u1edbp th\u01b0\u1ee3ng m\u00f4 kh\u00f4ng t\u0103ng s\u1ea3n \u0111\u1ea7y \u0111\u1ee7 d\u1eabn \u0111\u1ebfn h\u1eadu qu\u1ea3 th\u00e0nh s\u1eb9o<\/p>\n
2) H\u1ec7 m\u00f4 li\u00ean k\u1ebft:<\/p>\n
– Ph\u1ea3n \u1ee9ng c\u1ee7a h\u1ec7 n\u00e0y nh\u1eb1m t\u1ea1o n\u00ean nhi\u1ec1u t\u1ebf b\u00e0o m\u1edbi (nguy\u00ean b\u00e0o s\u1ee3i, t\u1ebf b\u00e0o s\u1ee3i, t\u1ebf b\u00e0o n\u1ed9i m\u00f4) v\u00e0 h\u00ecnh th\u00e0nh nhi\u1ec1u vi m\u1ea1ch t\u00e2n t\u1ea1o k\u00e8m theo nhi\u1ec1u t\u1ebf b\u00e0o vi\u00eam t\u1ea1o n\u00ean m\u00f4 h\u1ea1t vi\u00eam: c\u00f3 d\u1ea1ng \u0111\u1ea1i th\u1ec3 gi\u1ed1ng 1 n\u1ee5 th\u1ecbt, nh\u00f4 cao, g\u1ed3m nh\u1eefng h\u1ea1t nh\u1ecf li ti, m\u00e0u \u0111\u1ecf s\u1eabm, d\u1ec5 ch\u1ea3y m\u00e1u<\/p>\n
– Ph\u1ea3n \u1ee9ng \u1edf m\u00f4 li\u00ean k\u1ebft t\u1ea1o n\u00ean nh\u1eefng v\u00f9ng h\u00f3a s\u1ee3i, h\u00f3a x\u01a1 v\u00e0 cu\u1ed1i c\u00f9ng t\u1ea1o th\u00e0nh s\u1eb9o<\/p>\n
3) H\u1ec7 \u0111\u01a1n nh\u00e2n th\u1ef1c b\u00e0o:<\/p>\n
– \u0110\u00e2y l\u00e0 h\u1ec7 m\u00f4 hi\u1ec7n di\u1ec7n \u1edf nhi\u1ec1u n\u01a1i trong c\u01a1 th\u1ec3, bao g\u1ed3m nhi\u1ec1u lo\u1ea1i t\u1ebf b\u00e0o kh\u00e1c nhau: m\u00f4 b\u00e0o, b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n, t\u1ebf b\u00e0o h\u1ed1c ph\u1ed5i, t\u1ebf b\u00e0o trung m\u1ea1c, t\u1ebf b\u00e0o th\u1ea7n kinh \u0111\u1ec7m, h\u1ee7y c\u1ed1t b\u00e0o\u2026<\/p>\n
– Ch\u1ee9c n\u0103ng:<\/p>\n
+ Ti\u00eau h\u00f3a v\u1eadt l\u1ea1: \u0103n c\u00e1c d\u1ecb v\u1eadt ngo\u1ea1i t\u1ea1o v\u00e0 n\u1ed9i t\u1ea1o, c\u00e1c ch\u1ea5t c\u1eb7n b\u00e3 chuy\u1ec3n h\u00f3a\u2026<\/p>\n
+ Th\u00f4ng tin \u0111\u1ebfn h\u1ec7 lympho b\u00e0o \u0111\u1ec3 g\u00e2y c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n nhi\u1ec5m qua trung gian t\u1ebf b\u00e0o v\u00e0 th\u1ec3 d\u1ecbch<\/p>\n
3.1) B\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n:<\/p>\n
+ \u0110\u01b0\u1ee3c ho\u1ea1t h\u00f3a \u0111\u1ec3 tr\u1edf th\u00e0nh \u0111\u1ea1i th\u1ef1c b\u00e0o nh\u1edd 3 lo\u1ea1i lymphokin:<\/p>\n
(1) Y\u1ebfu t\u1ed1 ho\u1ea1t h\u00f3a \u0111\u1ea1i th\u1ef1c b\u00e0o (MAF)<\/p>\n
(2) Y\u1ebfu t\u1ed1 ho\u1ea1t h\u00f3a \u0111\u1eb7c hi\u1ec7u (specific MAF)<\/p>\n
(3) C\u00e1c interferon c\u00f3 vai tr\u00f2 t\u0103ng c\u01b0\u1eddng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c \u1ed1ng nh\u1ecf n\u1ed9i b\u00e0o t\u01b0\u01a1ng v\u00e0 th\u1ef1c t\u01b0\u1ee3ng<\/p>\n
+ Ch\u1ebf ti\u1ebft v\u00e0o m\u00f4 k\u1ebd nhi\u1ec1u ch\u1ea5t c\u00f3 ho\u1ea1t \u0111\u1ed9ng:<\/p>\n
(1) K\u00edch th\u00edch t\u0103ng s\u1ea3n nguy\u00ean b\u00e0o s\u1ee3i, t\u1ed5ng h\u1ee3p ch\u1ea5t t\u1ea1o keo v\u00e0 t\u00e1i t\u1ea1o m\u1ea1ch m\u00e1u<\/p>\n
(2) K\u00edch th\u00edch c\u00e1c lympho b\u00e0o B v\u00e0 T t\u0103ng s\u1ea3n \u0111\u1ec3 ho\u1ea1t \u0111\u1ed9ng m\u1ea1nh h\u01a1n<\/p>\n
3.2) \u0110\u1ea1i th\u1ef1c b\u00e0o:<\/p>\n
+ Qu\u00e1 tr\u00ecnh t\u0103ng s\u1ea3n, di chuy\u1ec3n v\u00e0 ho\u1ea1t t\u00e1c c\u1ee7a \u0110TB ch\u1ecbu \u1ea3nh h\u01b0\u1edfng c\u1ee7a nhi\u1ec1u y\u1ebfu t\u1ed1 (c\u00e1c cytokine, c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh, c\u00e1c ch\u1ea5t n\u1ed9i ti\u1ebft, c\u00e1c ch\u1ea5t trung gian h\u00f3a h\u1ecdc\u2026)<\/p>\n
+ Vai tr\u00f2 c\u1ee7a \u0110TB r\u1ea5t quan tr\u1ecdng nh\u1eb1m lo\u1ea1i b\u1ecf c\u00e1c t\u00e1c nh\u00e2n c\u00f3 h\u1ea1i \u0111\u1ed1i v\u1edbi c\u01a1 th\u1ec3, ch\u1ed1ng l\u1ea1i c\u00e1c t\u1ebf b\u00e0o u, tham gia c\u00e1c \u0111\u00e1p \u1ee9ng mi\u1ec5n nhi\u1ec5m<\/p>\n
+ Ho\u1ea1t \u0111\u1ed9ng c\u1ee7a \u0110TB r\u1ea5t \u0111a d\u1ea1ng bao g\u1ed3m:<\/p>\n
(1) Nh\u1eadp b\u00e0o (d\u01b0\u1edbi d\u1ea1ng th\u1ef1c b\u00e0o v\u00e0 \u1ea9m b\u00e0o)<\/p>\n
(2) Ti\u00eau h\u00f3a c\u00e1c v\u1eadt l\u1ea1 n\u1ed9i b\u00e0o nh\u1edd c\u00e1c lysosome v\u00e0 b\u00e0o t\u01b0\u01a1ng<\/p>\n
(3) Ho\u1ea1t t\u00e1c lympho b\u00e0o B v\u00e0 T<\/p>\n
(4) Ch\u1ebf ti\u1ebft nhi\u1ec1u ch\u1ea5t \u0111\u1eb7c hi\u1ec7u: c\u00e1c enzym t\u1eeb h\u1ea1t b\u00e0o t\u01b0\u01a1ng, protease trung t\u00ednh, c\u00e1c lipid c\u00f3 ho\u1ea1t t\u00ednh sinh h\u1ecdc, y\u1ebfu t\u1ed1 ho\u1ea1t t\u00e1c, y\u1ebfu t\u1ed1 \u1ee9c ch\u1ebf, y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed u<\/p>\n
(5) Chuy\u1ec3n d\u1ea1ng tr\u1edf th\u00e0nh \u0111\u1ea1i b\u00e0o ho\u1eb7c tho\u00e1i b\u00e0o<\/p>\n
3.3) \u0110\u1ea1i b\u00e0o: k\u00edch th\u01b0\u1edbc l\u1edbn v\u00e0 ch\u1ee9a t\u1edbi h\u00e0ng ch\u1ee5c nh\u00e2n, \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh do nhi\u1ec1u \u0110TB k\u1ebft d\u00ednh v\u1edbi nhau ho\u1eb7c do \u0110TB c\u00f3 nh\u00e2n chia nh\u01b0ng b\u00e0o t\u01b0\u01a1ng kh\u00f4ng ph\u00e2n chia, c\u00f3 2 d\u1ea1ng:<\/p>\n
+ \u0110\u1ea1i b\u00e0o Muller: nh\u00e2n x\u1ebfp kh\u00f4ng \u0111\u1ec1u \u1edf v\u00f9ng trung t\u00e2m, hi\u1ec7n di\u1ec7n \u1edf c\u00e1c u h\u1ea1t d\u1ecb v\u1eadt<\/p>\n
+ \u0110\u1ea1i b\u00e0o Langhans: nh\u00e2n x\u1ebfp h\u00ecnh m\u00f3ng ng\u1ef1a \u1edf v\u00f9ng ngo\u1ea1i vi, th\u01b0\u1eddng g\u1eb7p trong vi\u00eam \u0111\u1eb7c hi\u1ec7u<\/p>\n
3.4) Tho\u00e1i b\u00e0o: l\u00e0 \u0110TB c\u00f3 b\u00e0o t\u01b0\u01a1ng r\u1ed9ng, \u01b0a toan, h\u00ecnh b\u1ea7u d\u1ee5c d\u00e0i, th\u01b0\u1eddng x\u1ebfp song song ho\u1eb7c gi\u1ed1ng bi\u1ec3u m\u00f4. \u0110\u00e3 chuy\u1ec3n d\u1ea1ng, m\u1ea5t kh\u1ea3 n\u0103ng di chuy\u1ec3n l\u1eabn ho\u1ea1t \u0111\u1ed9ng nh\u01b0ng c\u00f3 kh\u1ea3 n\u0103ng ch\u1ebf ti\u1ebft m\u1ea1nh<\/p>\n
4) H\u1ec7 lympho b\u00e0o: c\u00f3 th\u1ec3 nh\u1eadn bi\u1ebft c\u00e1c lo\u1ea1i lympho b\u00e0o sau:<\/p>\n
4.1) Lympho b\u00e0o T:<\/p>\n
+ Lympho b\u00e0o T t\u00e1c \u0111\u1ed9ng (Te): nh\u1eadn bi\u1ebft kh\u00e1ng nguy\u00ean, ch\u1ebf ti\u1ebft lymphokin<\/p>\n
+ Lympho b\u00e0o T \u0111\u1ed9c h\u1ea1i t\u1ebf b\u00e0o (Tc): h\u1ee7y di\u1ec7t kh\u00e1ng nguy\u00ean<\/p>\n
+ Lympho b\u00e0o T \u0111i\u1ec1u h\u00f2a: g\u1ed3m 2 nh\u00f3m:<\/p>\n
(1) Lympho b\u00e0o T tr\u1ee3 gi\u00fap (Th): gi\u00fap Tc t\u0103ng s\u1ea3n, k\u00edch th\u00edch lympho b\u00e0o B t\u0103ng s\u1ea3n v\u00e0 chuy\u1ec3n d\u1ea1ng t\u01b0\u01a1ng b\u00e0o<\/p>\n
(2) Lympho b\u00e0o T \u1ee9c ch\u1ebf \u0111\u1ed9c h\u1ea1i t\u1ebf b\u00e0o (Ts): h\u1ee7y b\u1ecf vi\u1ec7c s\u1ea3n xu\u1ea5t kh\u00e1ng th\u1ec3 t\u1eeb lympho b\u00e0o T<\/p>\n
+ Lympho b\u00e0o T tr\u00ed nh\u1edb (Tm): g\u00e2y 1 \u0111\u00e1p \u1ee9ng mi\u1ec5n nhi\u1ec5m th\u1ee9 ph\u00e1t khi ti\u1ebfp c\u1eadn v\u1edbi kh\u00e1ng nguy\u00ean<\/p>\n
4.2) Lympho b\u00e0o B: ch\u1ebf ti\u1ebft c\u00e1c IgA, B, D, E, F. Lympho b\u00e0o B c\u00f3 kh\u1ea3 n\u0103ng mi\u1ec5n nhi\u1ec5m d\u01b0\u1edbi ho\u1ea1t t\u00e1c c\u1ee7a \u0110TB \u0111\u00e3 \u0103n kh\u00e1ng nguy\u00ean ho\u1eb7c d\u01b0\u1edbi \u1ea3nh h\u01b0\u1edfng c\u1ee7a lympho b\u00e0o T<\/p>\n
4.3) Lympho b\u00e0o v\u00f4 \u0111\u1ecbnh: g\u1ed3m:<\/p>\n
+ T\u1ebf b\u00e0o di\u1ec7t t\u1ef1 nhi\u00ean (Natural Killer)<\/p>\n
+ T\u1ebf b\u00e0o di\u1ec7t mang c\u00e1c th\u1ee5 th\u1ec3 m\u00e0ng v\u00e0 c\u00f3 th\u1ec3 di\u1ec7t t\u1ebf b\u00e0o \u0111\u00edch<\/p>\n
+ T\u1ebf b\u00e0o di\u1ec7t lympho b\u00e0o \u0111\u00e3 \u0111\u01b0\u1ee3c ho\u1ea1t t\u00e1c<\/p>\n
4.4) T\u01b0\u01a1ng b\u00e0o<\/p>\n
3. Xu h\u01b0\u1edbng ph\u00e1t tri\u1ec3n c\u1ee7a vi\u00eam sau giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng m\u00f4: c\u00f3 2 xu h\u01b0\u1edbng<\/p>\n
1) H\u00e0n g\u1eafn:<\/p>\n
– N\u1ebfu v\u00f9ng vi\u00eam ti\u1ebfn tri\u1ec3n t\u1ed1t, c\u00e1c s\u1ea3n ph\u1ea9m ho\u1ea1i t\u1eed \u0111\u01b0\u1ee3c d\u1ecdn s\u1ea1ch, t\u00e1c nh\u00e2n g\u00e2y vi\u00eam \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb th\u00ec m\u00f4 vi\u00eam \u0111\u01b0\u1ee3c h\u00e0n g\u1eafn v\u1edbi s\u1ef1 t\u00e1i t\u1ea1o nhi\u1ec1u t\u1ebf b\u00e0o x\u01a1, nhi\u1ec1u n\u1ee5 huy\u1ebft qu\u1ea3n \u0111\u1ec3 bi\u1ec7t h\u00f3a th\u00e0nh c\u00e1c huy\u1ebft qu\u1ea3n t\u01b0\u1edbi m\u00e1u cho v\u00f9ng vi\u00eam, h\u1ec7 bi\u1ec3u m\u00f4 t\u0103ng sinh \u0111\u1ec3 b\u00f9 \u0111\u1eafp v\u00e0 s\u1eeda ch\u1eefa c\u00e1c c\u1ea5u tr\u00fac \u0111\u00e3 m\u1ea5t, vi\u00eam \u0111\u01b0\u1ee3c \u0111\u1ea9y l\u00f9i<\/p>\n
– N\u1ebfu vi\u00eam g\u00e2y m\u1ea5t ch\u1ea5t nhi\u1ec1u th\u00ec qu\u00e1 tr\u00ecnh x\u01a1 h\u00f3a s\u1ebd t\u1ea1o th\u00e0nh s\u1eb9o, h\u1ea1n ch\u1ebf \u00edt nhi\u1ec1u \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng c\u01a1 n\u0103ng c\u1ee7a v\u00f9ng m\u00f4 b\u1ecb vi\u00eam<\/p>\n
2) Vi\u00eam ti\u1ebfp di\u1ec5n: n\u1ebfu t\u00e1c nh\u00e2n g\u00e2y vi\u00eam kh\u00f4ng \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb tri\u1ec7t \u0111\u1ec3, s\u1ef1 h\u1ee7y ho\u1ea1i v\u00e0 s\u1eeda ch\u1eefa t\u1ea1i v\u00f9ng vi\u00eam \u0111an xen nhau v\u00e0 vi\u00eam chuy\u1ec3n sang b\u00e1n c\u1ea5p hay m\u1ea1n t\u00ednh, qu\u00e1 tr\u00ecnh s\u1eeda ch\u1eefa kh\u00f3 kh\u0103n h\u01a1n r\u1ea5t nhi\u1ec1u, \u0111\u00f4i khi g\u00e2y h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng<\/p>\n
C\u00e2u 4: Vi\u00eam lao l\u00e0 g\u00ec? Tr\u00ecnh b\u00e0y t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a vi\u00eam lao?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 vi\u00eam lao<\/p>\n
1) Kh\u00e1i ni\u1ec7m:<\/p>\n
– Vi\u00eam lao l\u00e0 1 vi\u00eam \u0111\u1eb7c hi\u1ec7u, kh\u00e1c v\u1edbi vi\u00eam th\u00f4ng th\u01b0\u1eddng v\u00ec c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m ri\u00eang bi\u1ec7t:<\/p>\n
+ T\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i th\u1ec3 ho\u00e0n to\u00e0n r\u00f5 r\u1ec7t<\/p>\n
+ T\u1ed5n th\u01b0\u01a1ng vi th\u1ec3 c\u00f3 h\u00ecnh \u1ea3nh nang, \u0111\u1eb7c th\u00f9 l\u00e0 nang lao<\/p>\n
+ Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng \u0111\u00f3 gi\u00fap ta ngh\u0129 \u0111\u1ebfn t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh: tr\u1ef1c khu\u1ea9n Koch<\/p>\n
– \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a tr\u1ef1c khu\u1ea9n Koch:<\/p>\n
+ L\u00e0 tr\u1ef1c khu\u1ea9n kh\u00e1ng c\u1ed3n, kh\u00e1ng acid v\u00e0 \u00e1i kh\u00ed, sinh s\u1ea3n y\u1ebfu, g\u00e2y n\u00ean ho\u1ea1i t\u1eed \u0111\u00f4ng k\u1ebft, thu\u1ea7n nh\u1ea5t, \u01b0a eosin v\u00e0 g\u00e2y n\u00ean s\u1ef1 m\u1eabn c\u1ea3m khi x\u00e2m ph\u1ea1m l\u1ea7n th\u1ee9 2<\/p>\n
+ C\u00f3 th\u1ec3 l\u00e2y theo \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p g\u00e2y lao ph\u1ed5i, \u0111\u01b0\u1eddng b\u1ea1ch m\u1ea1ch, \u0111\u01b0\u1eddng m\u00e1u g\u00e2y lao h\u1ea1ch v\u00e0 t\u00f9y theo s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u1ee7a c\u01a1 th\u1ec3 m\u00e0 tr\u1ef1c khu\u1ea9n Koch c\u00f3 th\u1ec3 g\u00e2y n\u00ean b\u1ec7nh to\u00e0n th\u00e2n<\/p>\n
2) \u0110\u1ecbnh ngh\u0129a: vi\u00eam lao l\u00e0 ph\u1ea3n \u1ee9ng c\u1ee7a c\u01a1 th\u1ec3 ch\u1ed1ng l\u1ea1i s\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a tr\u1ef1c khu\u1ea9n lao (Micobacterium Tuberculosis)<\/p>\n
2. C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a vi\u00eam lao<\/p>\n
Nh\u01b0 vi\u00eam n\u00f3i chung, qu\u00e1 tr\u00ecnh vi\u00eam lao c\u0169ng ti\u1ebfn tri\u1ec3n qua c\u00e1c giai \u0111o\u1ea1n nh\u01b0ng v\u1edbi nh\u1eefng ph\u1ea3n \u1ee9ng th\u1ea7m k\u00edn h\u01a1n, \u00edt r\u1ea7m r\u1ed9 h\u01a1n. Do \u0111\u00f3, \u00edt khi ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1ec7nh \u1edf giai \u0111o\u1ea1n \u0111\u1ea7u khi tr\u1ef1c khu\u1ea9n Koch x\u00e2m nh\u1eadp v\u00e0o c\u01a1 th\u1ec3<\/p>\n
1) T\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i th\u1ec3: c\u00f3 th\u1ec3 g\u1eb7p d\u01b0\u1edbi 2 d\u1ea1ng<\/p>\n
– D\u1ea1ng lan t\u1ecfa: th\u01b0\u1eddng chi\u1ebfm c\u1ea3 1 th\u00f9y ph\u1ed5i ho\u1eb7c 1 v\u00f9ng c\u1ee7a m\u00e0ng n\u00e3o v\u1edbi h\u00ecnh th\u00e1i x\u00e2m nh\u1eadp b\u00e3 \u0111\u1eadu, tho\u00e1i h\u00f3a nh\u1ea7y. Hi\u1ebfm g\u1eb7p<\/p>\n
– D\u1ea1ng khu tr\u00fa: \u0111\u00e2y l\u00e0 lo\u1ea1i ph\u1ed5 bi\u1ebfn v\u00e0 c\u00f3 nhi\u1ec1u h\u00ecnh th\u00e1i kh\u00e1c nhau:<\/p>\n
1.1) H\u1ea1t lao:<\/p>\n
+ C\u00f2n g\u1ecdi l\u00e0 h\u1ea1t k\u00ea, l\u00e0 t\u1ed5n th\u01b0\u01a1ng lao nh\u1ecf nh\u1ea5t c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y b\u1eb1ng m\u1eaft th\u01b0\u1eddng, k\u00edch th\u01b0\u1edbc t\u1eeb 1-5 mm, h\u00ecnh tr\u00f2n, m\u00e0u tr\u1eafng<\/p>\n
+ T\u1ed5n th\u01b0\u01a1ng n\u00e0y th\u01b0\u1eddng g\u1eb7p trong lao k\u00ea \u1edf ph\u1ed5i, gan, l\u00e1ch, th\u1eadn, lao k\u00ea m\u00e0ng n\u00e3o<\/p>\n
1.2) C\u1ee7 lao:<\/p>\n
+ G\u1ed3m nhi\u1ec1u h\u1ea1t lao g\u1ed9p l\u1ea1i, c\u00f2n ranh gi\u1edbi, k\u00edch th\u01b0\u1edbc v\u00e0i mm \u0111\u1ebfn 3 cm, m\u00e0u tr\u1eafng, c\u00f3 trung t\u00e2m m\u00e0u v\u00e0ng (do ho\u1ea1i t\u1eed b\u00e3 \u0111\u1eadu), \u0111\u1ee9ng th\u00e0nh \u0111\u00e1m v\u00e2y quanh 1 ph\u1ebf qu\u1ea3n nh\u1ecf<\/p>\n
+ Ch\u00ednh nh\u1eefng t\u1ed5n th\u01b0\u01a1ng n\u00e0y h\u00ecnh th\u00e0nh n\u00ean t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a b\u1ec7nh lao<\/p>\n
1.3) C\u1ee7 s\u1ed1ng: g\u1ed3m nhi\u1ec1u c\u1ee7 lao, ranh gi\u1edbi kh\u00f4ng r\u00f5, v\u00f9ng trung t\u00e2m c\u00f3 th\u1ec3 g\u1eb7p ho\u1ea1i t\u1eed b\u00e3 \u0111\u1eadu<\/p>\n
1.4) Nang h\u00f3a: g\u1ed3m nhi\u1ec1u c\u1ee7 s\u1ed1ng v\u00e0 c\u00f3 v\u1ecf x\u01a1 bao quanh<\/p>\n
2) T\u1ed5n th\u01b0\u01a1ng vi th\u1ec3: trong vi\u00eam lao, t\u1ed5n th\u01b0\u01a1ng vi th\u1ec3 c\u0169ng tr\u1ea3i qua c\u00e1c giai \u0111o\u1ea1n nh\u01b0 trong vi\u00eam n\u00f3i chung<\/p>\n
2.1) Giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng huy\u1ebft qu\u1ea3n \u2013 huy\u1ebft:<\/p>\n
– L\u00e0 ph\u1ea3n \u1ee9ng vi\u00eam xu\u1ea5t ti\u1ebft x\u1ea3y ra s\u1edbm nh\u1ea5t tr\u00ean c\u01a1 th\u1ec3 ng\u01b0\u1eddi l\u00e0nh c\u00f3 nhi\u1ec5m lao<\/p>\n
– V\u00e0i gi\u1edd sau khi tr\u1ef1c khu\u1ea9n lao x\u00e2m nh\u1eadp g\u00e2y n\u00ean nh\u1eefng t\u1ed5n th\u01b0\u01a1ng th\u00e0nh m\u1ea1ch t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh tho\u00e1t m\u1ea1ch ti\u1ebfn l\u1ea1i \u1ed5 nhi\u1ec5m lao v\u00e0 \u0103n c\u00e1c tr\u1ef1c khu\u1ea9n lao, s\u1ef1 th\u1ef1c b\u00e0o n\u00e0y kh\u00f4ng m\u1ea1nh m\u1ebd nh\u01b0 trong vi\u00eam do vi khu\u1ea9n sinh m\u1ee7 m\u00e0 nhanh ch\u00f3ng nh\u01b0\u1eddng ch\u1ed7 cho \u0110TB<\/p>\n
– C\u00e1c \u0110TB n\u00e0y \u0103n c\u1ea3 tr\u1ef1c khu\u1ea9n lao t\u1ef1 do v\u00e0 c\u1ea3 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh \u0111\u00e3 th\u1ef1c khu\u1ea9n<\/p>\n
– M\u1ed9t s\u1ed1 \u00edt tr\u1ef1c khu\u1ea9n lao nh\u00e2n l\u00ean trong \u0111\u1ea1i th\u1ef1c b\u00e0o v\u00e0 gi\u1ebft ch\u1ebft \u0111\u1ea1i th\u1ef1c b\u00e0o<\/p>\n
– M\u1ed9t s\u1ed1 \u0111\u1ea1i th\u1ef1c b\u00e0o bi\u1ebfn \u0111\u1ed5i kh\u00e1c th\u01b0\u1eddng ho\u1eb7c tho\u00e1i h\u00f3a th\u00e0nh nh\u1eefng t\u1ebf b\u00e0o to, h\u00ecnh \u0111a gi\u00e1c ho\u1eb7c h\u00ecnh thoi, s\u00e1ng m\u00e0u, nguy\u00ean sinh ch\u1ea5t kh\u00f4ng r\u00f5, v\u1eb7n v\u1eb9o nh\u01b0 v\u1ecf \u0111\u1eadu hay \u0111\u1ebf d\u00e9p, n\u1eeda gi\u1ed1ng t\u1ebf b\u00e0o bi\u1ec3u m\u00f4, n\u1eeda gi\u1ed1ng t\u1ebf b\u00e0o c\u1ee7a m\u00f4 li\u00ean k\u1ebft, n\u1ed1i \u0111u\u00f4i nhau t\u1ea1o th\u00e0nh m\u1ea1ng l\u01b0\u1edbi v\u00e0 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 t\u1ebf b\u00e0o b\u00e1n b\u00ean<\/p>\n
– B\u00ean c\u1ea1nh \u0111\u00f3 c\u0169ng xu\u1ea5t hi\u1ec7n nh\u1eefng t\u1ebf b\u00e0o to c\u00f3 nhi\u1ec1u nh\u00e2n nh\u01b0ng ch\u01b0a ph\u1ea3i l\u00e0 \u0111\u1ea1i b\u00e0o Langhans<\/p>\n
– Tr\u1ef1c khu\u1ea9n lao b\u1ecb h\u1ee7y ho\u1ea1i s\u1ebd gi\u1ea3i ph\u00f3ng nhi\u1ec1u ph\u00e2n t\u1eed h\u00f3a h\u1ecdc ph\u1ee9c t\u1ea1p -> t\u1ea1o m\u00f4i tr\u01b0\u1eddng nh\u1ea1y c\u1ea3m v\u1edbi tr\u1ef1c khu\u1ea9n v\u00e0 k\u00edch th\u00edch m\u00f4 -> t\u0103ng s\u1ea3n t\u1ebf b\u00e0o \u0111\u1ec3 h\u00ecnh th\u00e0nh nang lao<\/p>\n
2.2) Giai \u0111o\u1ea1n ph\u1ea3n \u1ee9ng m\u00f4:<\/p>\n
– V\u00e0o kho\u1ea3ng tu\u1ea7n th\u1ee9 2 ho\u1eb7c 3, ph\u1ea3n \u1ee9ng nang b\u1eaft \u0111\u1ea7u h\u00ecnh th\u00e0nh v\u1edbi trung t\u00e2m l\u00e0 ho\u1ea1i t\u1eed b\u00e3 \u0111\u1eadu<\/p>\n
– H\u00ecnh th\u00e0nh do nhi\u1ec1u nguy\u00ean nh\u00e2n:<\/p>\n
+ Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9<\/p>\n
+ T\u00e1c \u0111\u1ed9ng c\u1ee7a acid phtioic<\/p>\n
+ Ch\u1ea5t phosphatid<\/p>\n
+ T\u00ecnh tr\u1ea1ng nh\u1ea1y c\u1ea3m c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh<\/p>\n
– H\u00ecnh \u1ea3nh ho\u1ea1i t\u1eed b\u00e3 \u0111\u1eadu v\u1ec1 \u0111\u1ea1i th\u1ec3 c\u00f3 m\u00e0u x\u00e1m tr\u1eafng, \u0111\u1eb7c qu\u00e1nh ho\u1eb7c m\u1ec1m gi\u1ed1ng nh\u01b0 \u0111\u1eadu h\u1ee7, chao, h\u00ecnh \u1ea3nh vi th\u1ec3 thu\u1ea7n nh\u1ea5t v\u00f4 c\u1ea5u tr\u00fac, nhu\u1ed9m b\u1eaft m\u00e0u h\u1ed3ng, ch\u1ea5t ho\u1ea1i t\u1eed c\u00f3 th\u1ec3 h\u00f3a l\u1ecfng, h\u00f3a s\u1ee3i ho\u1eb7c t\u1ea1o nang lao<\/p>\n
– Nang lao v\u1edbi trung t\u00e2m l\u00e0 ho\u1ea1i t\u1eed b\u00e3 \u0111\u1eadu, b\u00ean ngo\u00e0i \u0111\u01b0\u1ee3c bao b\u1ecdc b\u1edfi:<\/p>\n
+ Tho\u00e1i b\u00e0o s\u1eafp x\u1ebfp l\u1ed9n x\u1ed9n hay t\u1ea1o th\u00e0nh m\u1ea1ng l\u01b0\u1edbi h\u01b0\u1edbng t\u00e2m<\/p>\n
+ Xen k\u1ebd v\u00e0o \u0111\u00f3 l\u00e0 \u0111\u1ea1i b\u00e0o Langhans<\/p>\n
+ Ngo\u00e0i c\u00f9ng l\u00e0 v\u00e0nh \u0111ai lympho xen l\u1eabn c\u00e1c s\u1ee3i li\u00ean v\u00f5ng v\u00e0 t\u1ebf b\u00e0o x\u01a1<\/p>\n
2.3) Giai \u0111o\u1ea1n s\u1eeda ch\u1eefa h\u00e0n g\u1eafn:<\/p>\n
– Vi\u00eam lao th\u01b0\u1eddng chuy\u1ec3n sang m\u1ea1n t\u00ednh v\u00e0 do v\u1eady ph\u1ea3n \u1ee9ng x\u01a1 h\u00f3a th\u01b0\u1eddng n\u1ed5i tr\u1ed9i<\/p>\n
– Trong giai \u0111o\u1ea1n h\u00ecnh th\u00e0nh nang lao, n\u1ebfu \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u \u0111\u00fang ph\u00e1c \u0111\u1ed3:<\/p>\n
+ Tr\u1ef1c khu\u1ea9n lao b\u1ecb ti\u00eau di\u1ec7t<\/p>\n
+ C\u00e1c nang lao kh\u00f4ng l\u1edbn<\/p>\n
+ T\u1ed5 ch\u1ee9c x\u01a1 t\u0103ng s\u1ea3n -> x\u00e2m nh\u1eadp v\u00e0o v\u00f9ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ec3 l\u1ea1i c\u00e1c s\u1eb9o nh\u1ecf r\u1ea3i r\u00e1c v\u00e0 t\u1ef1 tho\u00e1i tri\u1ec3n<\/p>\n
+ V\u1ecf bao x\u01a1 c\u00f3 th\u1ec3 ng\u0103n c\u1ea3n vi\u00eam lao ph\u00e1t tri\u1ec3n r\u1ed9ng<\/p>\n
+ Canxi t\u1eeb huy\u1ebft thanh \u0111\u1ebfn l\u1eafng \u0111\u1ecdng \u1edf v\u00f9ng t\u1ed5n th\u01b0\u01a1ng: sau 2 th\u00e1ng th\u1ea5y hi\u1ec7n t\u01b0\u1ee3ng canxi h\u00f3a \u1edf \u1ed5 lao nguy\u00ean ph\u00e1t (lao s\u01a1 nhi\u1ec5m), \u1ed5 lao th\u1ee9 ph\u00e1t l\u00e0 tr\u00ean 6 th\u00e1ng<\/p>\n
– Ng\u01b0\u1ee3c l\u1ea1i, tr\u1ef1c khu\u1ea9n lao nh\u00e2n l\u00ean m\u1ea1nh trong d\u1ecbch r\u1ec9 vi\u00eam, trong c\u00e1c \u0110TB v\u00e0 t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3, qu\u00e1 tr\u00ecnh ho\u1ea1i t\u1eed x\u1ea3y ra r\u1ed9ng<\/p>\n
– S\u1ef1 x\u01a1 h\u00f3a t\u1ea1o n\u00ean nh\u1eefng h\u1ed1c hay \u0111\u01b0a \u0111\u1ebfn s\u1ef1 h\u1ee7y ho\u1ea1i l\u1edbn ch\u1ee9c n\u0103ng \u1edf ph\u1ee7 t\u1ea1ng v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn lao to\u00e0n th\u00e2n<\/p>\n
C\u00e2u 5: Vi\u00eam phong l\u00e0 g\u00ec? Tr\u00ecnh b\u00e0y t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a vi\u00eam phong? N\u00eau s\u1ef1 kh\u00e1c nhau gi\u1eefa nang lao v\u00e0 nang phong?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 vi\u00eam phong<\/p>\n
1) Kh\u00e1i ni\u1ec7m: tr\u1ef1c khu\u1ea9n phong c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n
– L\u00e0 tr\u1ef1c khu\u1ea9n kh\u00e1ng c\u1ed3n, kh\u00e1ng acid v\u00e0 \u00e1i kh\u00ed, sinh s\u1ea3n y\u1ebfu gi\u1ed1ng nh\u01b0 tr\u1ef1c khu\u1ea9n lao nh\u01b0ng th\u01b0\u1eddng h\u1ee3p th\u00e0nh t\u1eebng \u0111\u00e1m h\u00ecnh c\u1ea7u<\/p>\n
– Ch\u1ec9 s\u1ed1ng trong c\u00e1c t\u1ebf b\u00e0o \u0111\u01a1n nh\u00e2n c\u1ee7a m\u00f4 b\u1ecb nhi\u1ec5m khu\u1ea9n, sinh tr\u01b0\u1edfng ch\u1eadm<\/p>\n
– B\u1ec7nh phong \u0111\u01b0\u1ee3c chia th\u00e0nh 5 nh\u00f3m \u0111i t\u1eeb l\u00e0nh nh\u1ea5t \u0111\u1ebfn tr\u1ea7m tr\u1ecdng nh\u1ea5t:<\/p>\n
+ Phong c\u1ee7 (TT)<\/p>\n
+ Phong gi\u00e1p bi\u00ean \u0111\u01b0\u1ee3c chia th\u00e0nh 3 nh\u00f3m:<\/p>\n
(+) Gi\u00e1p bi\u00ean c\u1ee7 (BT)<\/p>\n
(+) Gi\u00e1p bi\u00ean \u2013 gi\u00e1p bi\u00ean (BB)<\/p>\n
(+) Gi\u00e1p bi\u00ean \u2013 u phong (BL)<\/p>\n
+ Phong u (LL)<\/p>\n
Lo\u1ea1i T l\u00e0 lo\u1ea1i c\u00f3 t\u1ed5n th\u01b0\u01a1ng khu tr\u00fa v\u00e0 l\u00e0nh nh\u1ea5t, trong t\u1ed5n th\u01b0\u01a1ng h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3 tr\u1ef1c khu\u1ea9n phong<\/p>\n
Lo\u1ea1i L c\u00f3 t\u1ed5n th\u01b0\u01a1ng lan t\u1ecfa v\u00e0 ch\u1ee9a nhi\u1ec1u tr\u1ef1c khu\u1ea9n phong, l\u00e0 lo\u1ea1i tr\u1ea7m tr\u1ecdng<\/p>\n
C\u00e1c lo\u1ea1i tr\u00ean c\u00f3 th\u1ec3 chuy\u1ec3n h\u00f3a l\u1eabn nhau t\u00f9y theo ph\u01b0\u01a1ng h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb v\u00e0 kh\u1ea3 n\u0103ng mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3<\/p>\n
2) \u0110\u1ecbnh ngh\u0129a:<\/p>\n
Vi\u00eam phong l\u00e0 ph\u1ea3n \u1ee9ng vi\u00eam \u0111\u1eb7c hi\u1ec7u c\u1ee7a c\u01a1 th\u1ec3 v\u1edbi s\u1ef1 x\u00e2m nh\u1eadp t\u1eeb tr\u1ef1c khu\u1ea9n phong. \u0110\u00e2y l\u00e0 1 lo\u1ea1i vi tr\u00f9ng kh\u00e1ng c\u1ed3n, kh\u00e1ng toan, l\u00e2y do s\u1ef1 ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp da v\u00e0 ni\u00eam m\u1ea1c<\/p>\n
2. C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a vi\u00eam phong<\/p>\n
1) Phong c\u1ee7:<\/p>\n
1.1) T\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i th\u1ec3:<\/p>\n
+ Da v\u00e0 ni\u00eam m\u1ea1c: t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu \u1edf da bi\u1ec3u hi\u1ec7n l\u00e0 nh\u1eefng h\u1ea1t nh\u1ecf n\u1eb1m n\u00f4ng, tr\u00f2n, k\u00edch th\u01b0\u1edbc kho\u1ea3ng 0.5 cm, m\u00e0u h\u1ed3ng, m\u1eb7t nh\u1eb5n, \u0111\u1ee9ng ri\u00eang l\u1ebb ho\u1eb7c h\u1ee3p th\u00e0nh \u0111\u00e1m, kh\u00f4ng c\u00f3 xu h\u01b0\u1edbng lan r\u1ed9ng. H\u1ea1t phong th\u01b0\u1eddng m\u1ecdc \u1edf m\u1eb7t, m\u00f4ng, \u0111\u00f9i, c\u1eb3ng tay\u2026 \u0111\u1eb7c bi\u1ec7t c\u00e1c v\u00f9ng n\u00e0y m\u1ea5t c\u1ea3m gi\u00e1c \u0111au, n\u00f3ng, l\u1ea1nh<\/p>\n
+ Th\u1ea7n kinh: c\u00e1c d\u00e2y TK ngo\u1ea1i bi\u00ean nh\u01b0 TK tr\u1ee5, TK khoeo, \u0111\u00e1m r\u1ed1i TK c\u1ed5 n\u00f4ng s\u01b0ng to. T\u1ed5n th\u01b0\u01a1ng TK \u0111\u01b0a \u0111\u1ebfn nh\u1eefng r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng, bi\u1ec3u hi\u1ec7n l\u00e0:<\/p>\n
(+) C\u00e1c m\u00f3ng teo nh\u1ecf, m\u1ee7n n\u00e1t (nh\u1ea5t l\u00e0 m\u00f3ng ch\u00e2n)<\/p>\n
(+) Da teo, bong v\u1ea3y, r\u1ea1n n\u1ee9t, m\u00e0u t\u00edm t\u00e1i<\/p>\n
(+) B\u00e0n ch\u00e2n c\u00f3 khi b\u1ecb lo\u00e9t th\u1ee7ng, ho\u1ea1i t\u1eed, tr\u01a1 x\u01b0\u01a1ng, c\u1ee5t \u0111\u1ed1t<\/p>\n
(+) C\u00e1c x\u01b0\u01a1ng \u0111\u1ea7u chi m\u1ec1m d\u1ea7n, m\u1ea5t v\u00f4i, ng\u1eafn l\u1ea1i g\u00e2y phong c\u00f9n, phong c\u1ee5t<\/p>\n
(+) Gi\u00e1c m\u1ea1c c\u0169ng c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng g\u00e2y m\u00f9 l\u00f2a<\/p>\n
(+) \u0110\u1eb7c bi\u1ec7t c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 b\u1ecb b\u1ed9i nhi\u1ec5m sinh ra m\u00f9i h\u00f4i th\u1ed1i<\/p>\n
+ Ph\u1ea3n \u1ee9ng Mitsuda (+) r\u00f5 r\u1ec7t: c\u00e1ch l\u00e0m: l\u1ea5y u phong nghi\u1ec1n n\u00e1t, \u0111un s\u00f4i, \u0111em l\u1ecdc r\u1ed3i tr\u1ed9n v\u1edbi phenol v\u00e0 ti\u00eam trong da<\/p>\n
1.2) T\u1ed5n th\u01b0\u01a1ng vi th\u1ec3:<\/p>\n
+ Sinh thi\u1ebft da th\u1ea5y: th\u01b0\u1ee3ng b\u00ec teo \u0111\u00e9t nhi\u1ec1u hay \u00edt t\u00f9y theo v\u1ecb tr\u00ed sinh thi\u1ebft, c\u00f3 ch\u1ed7 l\u1ea1i s\u1eebng h\u00f3a, qu\u00e1 s\u1ea3n t\u01b0\u01a1ng \u0111\u1ed1i nhi\u1ec1u. Trung b\u00ec th\u1ea5y r\u1ea3i r\u00e1c nhi\u1ec1u nang phong nh\u1ecf. C\u00e1c nang phong th\u01b0\u1eddng t\u1ee5 t\u1eadp quanh c\u00e1c huy\u1ebft qu\u1ea3n, nang l\u00f4ng, tuy\u1ebfn b\u00e3, tuy\u1ebfn m\u1ed3 h\u00f4i v\u00e0 h\u1ee7y ho\u1ea1i c\u00e1c th\u00e0nh ph\u1ea7n n\u00e0y. C\u1ea5u t\u1ea1o nang phong g\u1ed3m: trung t\u00e2m l\u00e0 1 s\u1ed1 \u0111\u1ea1i b\u00e0o Langhans, xung quanh l\u00e0 c\u00e1c t\u1ebf b\u00e0o b\u00e1n li\u00ean l\u1eabn lympho b\u00e0o l\u00e0m th\u00e0nh 1 v\u00e0nh \u0111ai t\u01b0\u01a1ng \u0111\u1ed1i r\u00f5. Nhu\u1ed9m Ziehl \u2013 Neelsen th\u1ea5y r\u1ea5t \u00edt ho\u1eb7c kh\u00f4ng t\u00ecm th\u1ea5y tr\u1ef1c khu\u1ea9n phong<\/p>\n
+ Th\u1ea7n kinh: c\u00e1c d\u00e2y TK ph\u00f9 v\u00e0 x\u00e2m nh\u1eadp nhi\u1ec1u t\u1ebf b\u00e0o vi\u00eam, \u0111\u00f4i khi t\u1ea1o th\u00e0nh nang phong, d\u1ea7n d\u1ea7n d\u00e2y TK x\u01a1 h\u00f3a v\u00e0 c\u00f3 th\u1ec3 v\u00f4i h\u00f3a<\/p>\n
2) Phong u:<\/p>\n
2.1) T\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i th\u1ec3:<\/p>\n
+ Da v\u00e0 ni\u00eam m\u1ea1c: c\u00e1c t\u1ed5n th\u01b0\u01a1ng da th\u00e2m nhi\u1ec5m s\u00e2u, b\u1edd kh\u00f4ng \u0111\u1ec1u, ch\u1ee9a r\u1ea5t nhi\u1ec1u tr\u1ef1c khu\u1ea9n phong v\u00e0 th\u01b0\u1eddng k\u00e8m theo 1 vi\u00eam m\u0169i tr\u1ef1c khu\u1ea9n phong. Do h\u1ea1t phong x\u00e2m nh\u1eadp s\u00e2u v\u00e0 to n\u00ean g\u1ecdi l\u00e0 u phong<\/p>\n
+ C\u00f3 2 lo\u1ea1i u phong:<\/p>\n
(+) U d\u01b0\u1edbi trung b\u00ec: c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e0y c\u00f3 khi kh\u00f4ng r\u00f5 v\u00ec n\u1eb1m r\u1ea5t s\u00e2u, n\u1eafn l\u1ed5n nh\u1ed5n, c\u1ee9ng nh\u01b0 h\u1ea1t ch\u00ec, \u0111\u01b0\u1eddng k\u00ednh 0.2-1 cm, \u0111\u00f4i khi c\u00f3 th\u1ec3 lo\u00e9t<\/p>\n
(+) U trong trung b\u00ec: c\u00e1c u n\u00e0y n\u1eb1m n\u00f4ng h\u01a1n, r\u1eafn, c\u00f3 m\u00e0u h\u1ed3ng ho\u1eb7c m\u00e0u \u0111\u1ed3ng \u0111\u1ecf, b\u1edd r\u00f5, \u0111\u01b0\u1eddng k\u00ednh 1 cm, h\u1ee3p th\u00e0nh \u0111\u00e1m tr\u00f2n, b\u1ec1 m\u1eb7t b\u1ecfng v\u00ec l\u00f4ng r\u1ee5ng, th\u01b0\u1ee3ng b\u00ec m\u1ecfng, teo \u0111\u00e9t, \u0111\u00f4i khi r\u1ea1n n\u1ee9t<\/p>\n
+ V\u1ecb tr\u00ed: th\u01b0\u1eddng m\u1ecdc \u1edf m\u1eb7t, \u0111\u1ea7u ng\u00f3n tay, ng\u00f3n ch\u00e2n, b\u1ed9 ph\u1eadn sinh d\u1ee5c ho\u1eb7c lan r\u1ed9ng to\u00e0n th\u00e2n g\u00e2y ho\u1ea1i t\u1eed v\u00e0 l\u1edf lo\u00e9t. Khi \u1edf m\u1eb7t, c\u00e1c u th\u01b0\u1eddng m\u1ecdc \u0111\u1ed1i x\u1ee9ng \u1edf 2 c\u00e1nh m\u0169i, 2 g\u00f2 m\u00e1 v\u00e0 g\u1ed3 tr\u00e1n l\u00e0m cho m\u1eb7t bi\u1ebfn d\u1ea1ng gi\u1ed1ng \u201cm\u1eb7t s\u01b0 t\u1eed\u201d<\/p>\n
+ Ph\u1ea3n \u1ee9ng Mitsuda bao gi\u1edd c\u0169ng (-)<\/p>\n
2.2) T\u1ed5n th\u01b0\u01a1ng vi th\u1ec3:<\/p>\n
+ Sinh thi\u1ebft da th\u1ea5y:<\/p>\n
(+) Th\u01b0\u1ee3ng b\u00ec teo m\u1ecfng c\u00f3 khi ch\u1ec9 c\u00f2n 1 hay 2 h\u00e0ng t\u1ebf b\u00e0o, nh\u00fa ch\u00e2n b\u00ec m\u1ea5t d\u1ea7n, ranh gi\u1edbi gi\u1eefa th\u01b0\u1ee3ng b\u00ec v\u00e0 trung b\u00ec g\u1ea7n nh\u01b0 1 \u0111\u01b0\u1eddng th\u1eb3ng, ngay d\u01b0\u1edbi th\u01b0\u1ee3ng b\u00ec c\u00f3 1 kho\u1ea3ng s\u00e1ng kh\u00f4ng c\u00f3 t\u1ebf b\u00e0o g\u1ecdi l\u00e0 vi\u1ec1n s\u00e1ng Unna<\/p>\n
(+) Trung b\u00ec c\u00f3 khi s\u00e2u xu\u1ed1ng h\u1ea1 b\u00ec, th\u1ea5y xu\u1ea5t hi\u1ec7n nhi\u1ec1u t\u1ebf b\u00e0o vi\u00eam nh\u01b0 t\u1ebf b\u00e0o b\u00e1n li\u00ean, lympho b\u00e0o, \u0110TB, t\u01b0\u01a1ng b\u00e0o, t\u1ebf b\u00e0o x\u01a1\u2026 nh\u01b0ng kh\u00f4ng t\u1ea1o th\u00e0nh nang. \u0110\u1eb7c bi\u1ec7t c\u00f3 th\u1ec3 th\u1ea5y nh\u1eefng \u0110TB to, s\u00e1ng, trong b\u00e0o t\u01b0\u01a1ng c\u00f3 nhi\u1ec1u h\u1ed1c th\u1ef1c b\u00e0o g\u1ecdi l\u00e0 t\u1ebf b\u00e0o Virchow. Trong h\u1ed1c n\u00e0y ch\u1ee9a m\u1ee1 v\u00e0 \u0111\u1eb7c bi\u1ec7t mang nhi\u1ec1u tr\u1ef1c khu\u1ea9n phong h\u1ee3p th\u00e0nh t\u1eebng \u0111\u00e1m tr\u00f2n. C\u00e1c th\u00e0nh ph\u1ea7n ph\u1ee5 thu\u1ed9c da \u0111\u1ec1u b\u1ecb ph\u00e1 h\u1ee7y<\/p>\n
+ Nhu\u1ed9m Ziehl \u2013 Neelsen th\u1ea5y r\u1ea5t nhi\u1ec1u tr\u1ef1c khu\u1ea9n phong trong b\u00e0o t\u01b0\u01a1ng c\u00e1c t\u1ebf b\u00e0o Virchow, \u1edf m\u00f4 li\u00ean k\u1ebft ngo\u00e0i t\u1ebf b\u00e0o v\u00e0 \u0111\u00f4i khi trong c\u1ea3 bi\u1ec3u m\u00f4 l\u00e1t t\u1ea7ng<\/p>\n
3) Phong b\u1ea5t \u0111\u1ecbnh:<\/p>\n
3.1) T\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i th\u1ec3:<\/p>\n
+ Bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng nh\u1eefng v\u1ebft d\u00e1t, thi\u1ec3u s\u1eafc, t\u0103ng s\u1eafc, v\u00f4 s\u1eafc, m\u00e0u \u0111\u1ed3ng ho\u1eb7c h\u1ed3ng ban, thi\u1ec3u c\u1ea3m ho\u1eb7c v\u00f4 c\u1ea3m<\/p>\n
+ Ph\u1ea3n \u1ee9ng Mitsuda th\u01b0\u1eddng kh\u00f4ng r\u00f5 r\u1ec7t: ho\u1eb7c (-), ho\u1eb7c (+)<\/p>\n
3.2) T\u1ed5n th\u01b0\u01a1ng vi th\u1ec3:<\/p>\n
+ Gi\u1ed1ng nh\u01b0 1 vi\u00eam b\u00ec kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/p>\n
+ G\u1ed3m nhi\u1ec1u lympho b\u00e0o, m\u00f4 b\u00e0o th\u1ea5m nh\u1eadp lan t\u1ecfa ho\u1eb7c v\u00e2y quanh c\u00e1c ph\u1ea7n ph\u1ee5 c\u1ee7a da<\/p>\n
4) Phong gi\u00e1p bi\u00ean:<\/p>\n
4.1) T\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i th\u1ec3:<\/p>\n
+ Bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng nh\u1eefng d\u00e1t, s\u1ea9n, k\u00edch th\u01b0\u1edbc kh\u00e1 l\u1edbn k\u00e8m theo c\u00e1c t\u1ed5n th\u01b0\u01a1ng v\u1ec7 tinh, nh\u1ecf \u1edf v\u00f9ng k\u1ebf c\u1eadn<\/p>\n
+ Ph\u1ea3n \u1ee9ng Mitsuda thay \u0111\u1ed5i t\u00f9y thu\u1ed9c h\u01b0\u1edbng ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh<\/p>\n
4.2) T\u1ed5n th\u01b0\u01a1ng vi th\u1ec3: l\u00e0m sinh thi\u1ebft da:<\/p>\n
C\u00f3 t\u1ed5n th\u01b0\u01a1ng nh\u1ecb d\u1ea1ng: bao g\u1ed3m c\u00e1c v\u00f9ng th\u1ea5m nh\u1eadp vi\u00eam phong lan t\u1ecfa (gi\u1ed1ng phong u) xen k\u1ebd v\u1edbi c\u00e1c nang phong (gi\u1ed1ng phong c\u1ee7)<\/p>\n
3. S\u1ef1 kh\u00e1c nhau gi\u1eefa nang lao v\u00e0 nang phong<\/p>\n
Nang lao<\/p>\n
Nang phong<\/p>\n
– C\u00f3 \u1edf vi\u00eam lao<\/p>\n
– C\u1ea5u tr\u00fac: h\u00ecnh tr\u00f2n ho\u1eb7c b\u1ea7u d\u1ee5c<\/p>\n
– T\u1ed5n th\u01b0\u01a1ng khu tr\u00fa: ch\u1ee7 y\u1ebfu \u1edf ph\u1ed5i, c\u00f3 th\u1ec3 t\u1edbi h\u1ea1ch lympho, \u1ed1ng ti\u00eau h\u00f3a, gan, th\u1eadn, n\u00e3o<\/p>\n
– C\u1ea5u t\u1ea1o:<\/p>\n
+ Trung t\u00e2m l\u00e0 ho\u1ea1i t\u1eed b\u00e3 \u0111\u1eadu<\/p>\n
+ G\u1ed3m tho\u00e1i b\u00e0o, \u0111\u1ea1i b\u00e0o Langhans, lympho b\u00e0o<\/p>\n
– C\u00f3 \u1edf vi\u00eam phong<\/p>\n
– C\u1ea5u tr\u00fac: kh\u00f4ng c\u1ed1 \u0111\u1ecbnh<\/p>\n
– T\u1ed5n th\u01b0\u01a1ng khu tr\u00fa trong l\u1edbp b\u00ec<\/p>\n
– C\u1ea5u t\u1ea1o:<\/p>\n
+ Trung t\u00e2m kh\u00f4ng c\u00f3 ho\u1ea1i t\u1eed b\u00e3 \u0111\u1eadu<\/p>\n
+ T\u01b0\u01a1ng t\u1ef1 nang lao<\/p>\n
C\u00e2u 6: N\u00eau nh\u1eefng hi\u1ec3u bi\u1ebft c\u01a1 b\u1ea3n v\u1ec1 u? So s\u00e1nh gi\u1eefa u v\u00e0 vi\u00eam kh\u00f4ng \u0111\u1eb7c hi\u1ec7u?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 u<\/p>\n
1) Kh\u00e1i ni\u1ec7m:<\/p>\n
Kh\u00f4ng c\u00f3 1 \u0111\u1ecbnh ngh\u0129a n\u00e0o v\u1ec1 u \u0111\u01b0\u1ee3c coi l\u00e0 \u0111\u1ea9y \u0111\u1ee7 v\u00e0 th\u1ecfa \u0111\u00e1ng v\u00ec b\u1ea3n ch\u1ea5t ch\u00ednh x\u00e1c v\u1ec1 u v\u00e0 nguy\u00ean nh\u00e2n sinh ra u ch\u01b0a r\u00f5 r\u00e0ng. Do \u0111\u00f3, c\u00e1c m\u00f4 t\u1ea3 sau \u0111\u00e2y \u0111\u01b0\u1ee3c coi l\u00e0 1 danh ph\u00e1p c\u1ee7a u h\u01a1n l\u00e0 1 \u0111\u1ecbnh ngh\u0129a:<\/p>\n
– U l\u00e0 1 kh\u1ed1i m\u00f4 m\u1edbi \u0111\u01b0\u1ee3c sinh ra (kh\u1ed1i m\u00f4 t\u00e2n t\u1ea1o) do s\u1ef1 sinh s\u1ea3n nhanh v\u00e0 qu\u00e1 m\u1ea1nh c\u1ee7a 1 d\u00f2ng t\u1ebf b\u00e0o n\u00e0o \u0111\u00f3 trong c\u01a1 th\u1ec3 (g\u1ecdi l\u00e0 d\u00f2ng t\u1ebf b\u00e0o g\u1ed1c)<\/p>\n
– S\u1ef1 sinh s\u1ea3n qu\u00e1 m\u1ea1nh n\u00e0y l\u00e0 li\u00ean t\u1ee5c v\u00e0 kh\u00f4ng h\u00e0i h\u00f2a v\u1edbi c\u00e1c m\u00f4 k\u1ebf c\u1eadn (kh\u00f4ng tu\u00e2n theo quy lu\u1eadt \u0111\u1ed3ng t\u1ed3n c\u1ee7a c\u01a1 th\u1ec3)<\/p>\n
– Khi u \u0111\u00e3 h\u00ecnh th\u00e0nh th\u00ec t\u1ed3n t\u1ea1i m\u00e3i cho d\u00f9 c\u00e1c y\u1ebfu t\u1ed1 sinh u \u0111\u00e3 m\u1ea5t \u0111i, trong m\u00f4 u lu\u00f4n c\u00f3 s\u1ef1 m\u1ea5t th\u0103ng b\u1eb1ng v\u00e0 kh\u00f4ng c\u00f3 ch\u1ee9c n\u0103ng h\u1eefu \u00edch \u0111\u1ed1i v\u1edbi c\u01a1 th\u1ec3. U l\u00e0 v\u1eadt k\u00fd sinh<\/p>\n
2) \u0110\u1ecbnh ngh\u0129a:<\/p>\n
U l\u00e0 kh\u1ed1i m\u00f4 t\u00e2n t\u1ea1o, \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh do s\u1ef1 t\u0103ng s\u1ea3n b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o, th\u01b0\u1eddng t\u1ed3n t\u1ea1i l\u00e2u d\u00e0i (ho\u1eb7c v\u0129nh vi\u1ec5n) tr\u00ean sinh v\u1eadt, \u00edt ph\u1ee5 thu\u1ed9c v\u00e0o quy lu\u1eadt c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i (quy lu\u1eadt \u0111\u1ed3ng t\u1ed3n) c\u1ee7a c\u01a1 th\u1ec3, c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n l\u00e0nh t\u00ednh ho\u1eb7c \u00e1c t\u00ednh<\/p>\n
2. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a u<\/p>\n
1) Ngu\u1ed3n g\u1ed1c c\u1ee7a u:<\/p>\n
– U c\u00f3 th\u1ec3 xu\u1ea5t ph\u00e1t t\u1eeb c\u00e1c t\u1ebf b\u00e0o \u0111\u00e3 b\u1ecb chuy\u1ec3n d\u1ea1ng c\u1ee7a b\u1ea5t k\u1ef3 m\u00f4 n\u00e0o trong c\u01a1 th\u1ec3. Tuy v\u1eady, u hay g\u1eb7p h\u01a1n \u1edf nh\u1eefng m\u00f4 c\u00f2n duy tr\u00ec hi\u1ec7n t\u01b0\u1ee3ng ph\u00e2n b\u00e0o th\u01b0\u1eddng xuy\u00ean nh\u01b0 bi\u1ec3u m\u00f4, m\u00f4 li\u00ean k\u1ebft. S\u1ef1 sinh s\u1ea3n c\u1ee7a c\u00e1c t\u1ebf b\u00e0o u c\u00f3 t\u00ednh t\u1ef1 \u0111\u1ed9ng, kh\u00f4ng c\u00f2n b\u1ecb ki\u1ec3m so\u00e1t b\u1edfi c\u00e1c c\u01a1 ch\u1ebf \u0111i\u1ec1u h\u00f2a t\u0103ng tr\u01b0\u1edfng b\u00ecnh th\u01b0\u1eddng trong c\u01a1 th\u1ec3. Ch\u00ednh v\u00ec v\u1eady m\u00e0 u v\u1eabn ti\u1ebfp t\u1ee5c l\u1edbn l\u00ean trong khi b\u1ec7nh nh\u00e2n ng\u00e0y m\u1ed9t suy m\u00f2n, c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf k\u1ecbp th\u1eddi<\/p>\n
– U nguy\u00ean b\u00e0o nu\u00f4i sinh ra t\u1eeb t\u1ebf b\u00e0o ph\u00f4i thai \u2013 l\u00e0 nh\u1eefng t\u1ebf b\u00e0o c\u1ee7a 1 c\u01a1 th\u1ec3 kh\u00e1c<\/p>\n
– \u0110\u1ea1i \u0111a s\u1ed1 c\u00e1c u \u0111\u1ec1u c\u00f3 nh\u1eefng t\u1ebf b\u00e0o sinh ra t\u1eeb 1 lo\u1ea1i t\u1ebf b\u00e0o ngu\u1ed3n, ch\u1ec9 c\u00f3 1 s\u1ed1 nh\u1ecf xu\u1ea5t ph\u00e1t tr\u00ean 2 lo\u1ea1i t\u1ebf b\u00e0o k\u1ebft h\u1ee3p gi\u1eefa bi\u1ec3u m\u00f4 v\u00e0 m\u00f4 li\u00ean k\u1ebft<\/p>\n
2) C\u1ea5u t\u1ea1o m\u00f4 u: c\u0169ng nh\u01b0 m\u00f4 b\u00ecnh th\u01b0\u1eddng, u c\u0169ng c\u00f3 c\u00e1c t\u1ebf b\u00e0o c\u01a1 s\u1edf v\u00e0 m\u00f4 \u0111\u1ec7m<\/p>\n
2.1) Kh\u1ed1i u ch\u1ec9 g\u1ed3m 1 lo\u1ea1i t\u1ebf b\u00e0o:<\/p>\n
+ C\u01a1 b\u1ea3n u: l\u00e0 th\u00e0nh ph\u1ea7n c\u01a1 s\u1edf c\u1ee7a u, d\u1ef1a v\u00e0o \u0111\u00f3 ta c\u00f3 th\u1ec3 ph\u00e2n \u0111\u1ecbnh u thu\u1ed9c v\u1ec1 th\u00e0nh ph\u1ea7n bi\u1ec3u m\u00f4, m\u00f4 li\u00ean k\u1ebft hay c\u1ea3 2. N\u1ebfu u thu\u1ed9c v\u1ec1 bi\u1ec3u m\u00f4 th\u00ec c\u01a1 b\u1ea3n u v\u00e0 m\u00f4 \u0111\u1ec7m u ph\u00e2n bi\u1ec7t v\u1edbi nhau r\u00f5 r\u1ec7t, n\u1ebfu thu\u1ed9c v\u1ec1 m\u00f4 li\u00ean k\u1ebft th\u00ec kh\u00f3 nh\u1eadn ra gi\u1eefa c\u01a1 b\u1ea3n u v\u00e0 m\u00f4 \u0111\u1ec7m u<\/p>\n
+ M\u00f4 \u0111\u1ec7m u: l\u00e0 khung li\u00ean k\u1ebft \u2013 huy\u1ebft qu\u1ea3n, c\u00f3 vai tr\u00f2 nu\u00f4i d\u01b0\u1ee1ng t\u1ebf b\u00e0o u. Th\u00e0nh ph\u1ea7n m\u00f4 \u0111\u1ec7m g\u1ed3m c\u00f3: m\u00f4 li\u00ean k\u1ebft, huy\u1ebft qu\u1ea3n v\u00e0 b\u1ea1ch huy\u1ebft qu\u1ea3n, c\u00e1c c\u1ea5u tr\u00fac th\u1ea7n kinh, c\u00e1c t\u1ebf b\u00e0o ph\u1ea3n \u1ee9ng nh\u01b0 lympho b\u00e0o, \u0110TB, b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n, b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n\u2026<\/p>\n
2.2) Kh\u1ed1i u c\u00f3 nhi\u1ec1u lo\u1ea1i t\u1ebf b\u00e0o:<\/p>\n
+ Kh\u1ed1i u c\u00f3 nhi\u1ec1u lo\u1ea1i t\u1ebf b\u00e0o xu\u1ea5t ph\u00e1t t\u1eeb 1 l\u00e1 thai: g\u1ecdi l\u00e0 u h\u1ed7n h\u1ee3p<\/p>\n
+ Kh\u1ed1i u c\u00f3 nhi\u1ec1u lo\u1ea1i t\u1ebf b\u00e0o xu\u1ea5t ph\u00e1t t\u1eeb nhi\u1ec1u l\u00e1 thai: g\u1ecdi l\u00e0 u qu\u00e1i, th\u01b0\u1eddng g\u1eb7p \u1edf bu\u1ed3ng tr\u1ee9ng v\u00e0 tinh ho\u00e0n<\/p>\n
3) \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a u l\u00e0nh t\u00ednh v\u00e0 u \u00e1c t\u00ednh:<\/p>\n
3.1) U l\u00e0nh t\u00ednh: 4 \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n
+ Ph\u00e1t tri\u1ec3n ch\u1eadm v\u00e0 t\u1ea1i ch\u1ed7: u l\u00e0nh m\u1ecdc t\u1ea1i ch\u1ed7, th\u01b0\u1eddng ph\u00e1t tri\u1ec3n ch\u1eadm, kh\u00f4ng l\u00e0m ch\u1ebft ng\u01b0\u1eddi, tr\u1eeb khi m\u1ecdc v\u00e0o v\u1ecb tr\u00ed hi\u1ec3m y\u1ebfu. C\u00f3 th\u1ec3 c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng l\u1edbn sau nhi\u1ec1u n\u0103m ti\u1ebfn tri\u1ec3n<\/p>\n
+ C\u00f3 ranh gi\u1edbi r\u00f5 r\u1ec7t: nh\u00ecn \u0111\u1ea1i th\u1ec3, u l\u00e0nh c\u00f3 v\u1ecf x\u01a1 bao b\u1ecdc n\u00ean d\u1ec5 b\u00f3c t\u00e1ch to\u00e0n b\u1ed9 kh\u1ed1i u. Do \u0111\u00f3 u l\u00e0nh ch\u1ec9 c\u00f3 xu h\u01b0\u1edbng ch\u00e8n \u00e9p ch\u1ee9 kh\u00f4ng x\u00e2m nh\u1eadp<\/p>\n
+ C\u1ea5u tr\u00fac g\u1ea7n gi\u1ed1ng m\u00f4 b\u00ecnh th\u01b0\u1eddng: v\u1ec1 vi th\u1ec3, u l\u00e0nh t\u00e1i t\u1ea1o l\u1ea1i 1 c\u00e1ch trung th\u00e0nh c\u1ea5u tr\u00fac m\u00f4 sinh ra n\u00f3, kh\u00f4ng \u0111\u1ea3o l\u1ed9n c\u1ea5u tr\u00fac, kh\u00f4ng x\u00e2m nh\u1eadp, nh\u01b0ng c\u00f3 s\u1ef1 ch\u00e8n \u00e9p<\/p>\n
+ U l\u00e0nh hi\u1ebfm khi t\u00e1i ph\u00e1t v\u00e0 di c\u0103n:<\/p>\n
(+) V\u00ec kh\u00f4ng x\u00e2m nh\u1eadp n\u00ean n\u1ebfu u l\u00e0nh \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf tri\u1ec7t \u0111\u1ec3, u kh\u00f4ng m\u1ecdc l\u1ea1i n\u1eefa (tr\u1eeb u d\u1ea1ng l\u00e1 tuy\u1ebfn v\u00fa)<\/p>\n
(+) Kh\u00f4ng bao gi\u1edd th\u1ea5y u l\u00e0nh di c\u0103n theo c\u00e1c \u0111\u01b0\u1eddng m\u00e1u hay \u0111\u01b0\u1eddng b\u1ea1ch huy\u1ebft \u0111\u1ebfn n\u01a1i kh\u00e1c c\u00e1ch xa ch\u1ed7 ph\u00e1t sinh<\/p>\n
3.2) U \u00e1c t\u00ednh: 4 \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n
+ Ph\u00e1t tri\u1ec3n nhanh, x\u00e2m nh\u1eadp: u \u00e1c th\u01b0\u1eddng ph\u00e1t tri\u1ec3n nhanh, x\u00e2m nh\u1eadp v\u00e0 th\u01b0\u1eddng g\u00e2y ch\u1ebft ng\u01b0\u1eddi trong v\u00f2ng v\u00e0i th\u00e1ng \u0111\u1ebfn v\u00e0i n\u0103m. S\u1ef1 b\u00e0nh tr\u01b0\u1edbng c\u1ee7a kh\u1ed1i u kh\u00f4ng bao gi\u1edd ng\u1eebng<\/p>\n
+ Ranh gi\u1edbi c\u1ee7a u v\u1edbi m\u00f4 xung quanh kh\u00f4ng r\u00f5 r\u1ec7t: u \u00e1c t\u00ednh c\u00f3 gi\u1edbi h\u1ea1n v\u1edbi m\u00f4 l\u00e0nh kh\u00f4ng r\u00f5 r\u00e0ng, c\u00f3 nhi\u1ec1u r\u1ec5 x\u00e2m nh\u1eadp<\/p>\n
+ C\u1ea5u tr\u00fac kh\u00f4ng gi\u1ed1ng v\u1edbi m\u00f4 c\u00f3 c\u00f9ng ngu\u1ed3n g\u1ed1c:<\/p>\n
(+) V\u1ec1 vi th\u1ec3, n\u00f3i chung c\u00e1c u \u00e1c t\u00ednh qu\u00e1 s\u1ea3n m\u1ea1nh, ph\u00e1 v\u1ee1 l\u1edbp \u0111\u00e1y, chui v\u00e0o l\u1edbp \u0111\u1ec7m g\u00e2y \u0111\u1ea3o l\u1ed9n c\u1ea5u tr\u00fac, t\u1ea1o n\u00ean nh\u1eefng kh\u1ed1i u \u0111\u1eadm m\u00e0u, nh\u00e2n kh\u00f4ng \u0111\u1ec1u, nh\u00e2n qu\u00e1i, nh\u00e2n chia<\/p>\n
(+) T\u1ebf b\u00e0o u ph\u1ea7n l\u1edbn l\u00e0 t\u1ebf b\u00e0o non (tho\u00e1i s\u1ea3n), ch\u1ec9 g\u1ee3i l\u1ea1i ph\u1ea7n n\u00e0o m\u00f4 g\u1ed1c c\u1ee7a u<\/p>\n
+ R\u1ea5t d\u1ec5 t\u00e1i ph\u00e1t, di c\u0103n: d\u00f9 \u0111\u00e3 c\u1eaft b\u1ecf r\u1ed9ng r\u00e3i, do t\u00ednh ch\u1ea5t x\u00e2m nh\u1eadp s\u00e2u v\u00e0 lan xa c\u1ee7a ch\u00fang, c\u00e1c m\u00f4 ung th\u01b0 d\u1ec5 d\u00e0ng m\u1ecdc tr\u1edf l\u1ea1i ho\u1eb7c t\u1ea1i ch\u1ed7, ho\u1eb7c di c\u0103n xa<\/p>\n
3. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a vi\u00eam<\/p>\n
– \u0110\u1ecbnh ngh\u0129a: c\u00e2u 1<\/p>\n
– Qu\u00e1 tr\u00ecnh n\u00e0y x\u1ea3y ra \u1edf b\u1ed9 m\u00e1y li\u00ean k\u1ebft v\u00e0 vi m\u1ea1ch, g\u00e2y ra nh\u1eefng r\u1ed1i lo\u1ea1n ch\u1ee7 y\u1ebfu v\u1ec1 h\u00f3a t\u1ed5 ch\u1ee9c v\u00e0 t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch, d\u1eabn \u0111\u1ebfn c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng tho\u00e1t huy\u1ebft t\u01b0\u01a1ng, xuy\u00ean b\u1ea1ch c\u1ea7u, t\u0103ng sinh t\u1ebf b\u00e0o t\u1ea1i \u1ed5 vi\u00eam, th\u1ef1c b\u00e0o<\/p>\n
– G\u00e2y ra 4 tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh: s\u01b0ng, n\u00f3ng, \u0111\u1ecf, \u0111au<\/p>\n
– \u0110\u1eb7c \u0111i\u1ec3m ch\u00ednh:<\/p>\n
+ Ph\u1ea3n \u1ee9ng vi\u00eam ch\u1ec9 x\u1ea3y ra \u1edf c\u00e1c \u0111\u1ed9ng v\u1eadt c\u00f3 h\u1ec7 th\u1ea7n kinh ph\u00e1t tri\u1ec3n<\/p>\n
+ Bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam th\u01b0\u1eddng ch\u1ec9 xu\u1ea5t hi\u1ec7n t\u1ea1i ch\u1ed7 (n\u01a1i t\u00e1c nh\u00e2n g\u00e2y vi\u00eam x\u00e2m nh\u1eadp) nh\u01b0ng \u0111\u00f3 l\u00e0 1 ph\u1ea3n \u1ee9ng to\u00e0n th\u00e2n bao g\u1ed3m 2 m\u1eb7t \u0111\u1ed1i l\u1eadp:<\/p>\n
1) Qu\u00e1 tr\u00ecnh b\u1ec7nh l\u00fd ph\u00e1 h\u1ee7y<\/p>\n
2) Qu\u00e1 tr\u00ecnh b\u1ea3o v\u1ec7 ph\u00e1t tri\u1ec3n<\/p>\n
+ M\u1eb7c d\u00f9 nguy\u00ean nh\u00e2n g\u00e2y ra vi\u00eam r\u1ea5t kh\u00e1c nhau nh\u01b0ng t\u1ed5n th\u01b0\u01a1ng vi\u00eam l\u1ea1i g\u00e2y ra c\u00f9ng 1 ki\u1ec3u ph\u1ea3n \u1ee9ng v\u00e0 c\u00f3 th\u1ec3 b\u1ecb \u1ee9c ch\u1ebf b\u1edfi c\u00f9ng 1 t\u00e1c nh\u00e2n d\u01b0\u1ee3c l\u00fd<\/p>\n
+ Tuy nhi\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean kh\u00f4ng ph\u1ea3i bao gi\u1edd c\u0169ng th\u1ec3 hi\u1ec7n \u0111\u1ea7y \u0111\u1ee7. C\u00f2n c\u00f3 kh\u1ea3 n\u0103ng vi\u00eam n\u1eb7ng<\/p>\n
+ Th\u01b0\u1eddng di\u1ec5n ti\u1ebfn qua 4 giai \u0111o\u1ea1n:<\/p>\n
1) Giai \u0111o\u1ea1n c\u00e1c ph\u1ea3n \u1ee9ng h\u00f3a sinh<\/p>\n
2) Giai \u0111o\u1ea1n c\u00e1c ph\u1ea3n \u1ee9ng huy\u1ebft qu\u1ea3n \u2013 huy\u1ebft<\/p>\n
3) Giai \u0111o\u1ea1n c\u00e1c ph\u1ea3n \u1ee9ng m\u00f4<\/p>\n
4) Giai \u0111o\u1ea1n c\u00e1c ph\u1ea3n \u1ee9ng s\u1eeda ch\u1eefa hay h\u1ee7y ho\u1ea1i<\/p>\n
4. S\u1ef1 kh\u00e1c nhau gi\u1eefa u v\u00e0 vi\u00eam kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/p>\n
U<\/p>\n
Vi\u00eam kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/p>\n
1) U t\u1ea1o ra 1 m\u00f4 m\u1edbi: m\u00f4 n\u00e0y b\u1ea5t th\u01b0\u1eddng c\u1ea3 v\u1ec1 s\u1ed1 l\u01b0\u1ee3ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng<\/p>\n
2) U kh\u00f4ng ch\u1ecbu s\u1ef1 ch\u1ec9 huy c\u1ee7a c\u01a1 th\u1ec3: u l\u00e0 1 m\u00f4 th\u1eeba, k\u00fd sinh tr\u00ean c\u01a1 th\u1ec3, ch\u1ec9 g\u00e2y h\u1ea1i khi t\u1ed3n t\u1ea1i<\/p>\n
3) Sinh s\u1ea3n t\u1ebf b\u00e0o kh\u00f4ng gi\u1edbi h\u1ea1n v\u1ec1 kh\u00f4ng gian v\u00e0 th\u1eddi gian<\/p>\n
4) Qu\u00e1 s\u1ea3n kh\u00f4ng ng\u1eebng l\u1ea1i khi h\u1ebft k\u00edch th\u00edch<\/p>\n
5) Nguy\u00ean nh\u00e2n ch\u01b0a r\u00f5, kh\u00f4ng ng\u0103n ch\u1eb7n \u0111\u01b0\u1ee3c ti\u1ebfn tri\u1ec3n<\/p>\n
1) Vi\u00eam l\u00e0m thay \u0111\u1ed5i 1 m\u00f4 s\u1eb5n c\u00f3: vi\u00eam huy \u0111\u1ed9ng h\u1ec7 lympho \u2013 \u0111\u01a1n b\u00e0o r\u1ea5t \u0111a d\u1ea1ng nh\u01b0ng c\u0169ng \u0111\u1ea3m nh\u1eadn c\u00e1c ch\u1ee9c n\u0103ng \u0111\u1ed1i n\u1ed9i v\u00e0 \u0111\u1ed1i ngo\u1ea1i b\u1ea3o v\u1ec7 c\u01a1 th\u1ec3<\/p>\n
2) Vi\u00eam ch\u1ecbu s\u1ef1 ch\u1ec9 huy c\u1ee7a c\u01a1 th\u1ec3: vi\u00eam ti\u1ebfn tri\u1ec3n t\u00f9y theo y\u00eau c\u1ea7u \u0111\u00e1p \u1ee9ng v\u1edbi s\u1ef1 x\u00e2m ph\u1ea1m, thay \u0111\u1ed5i t\u00f9y c\u01a1 \u0111\u1ecba<\/p>\n
3) Sinh s\u1ea3n t\u1ebf b\u00e0o c\u00f3 gi\u1edbi h\u1ea1n v\u1ec1 kh\u00f4ng gian v\u00e0 th\u1eddi gian<\/p>\n
4) Vi\u00eam ng\u1eebng l\u1ea1i khi k\u00edch th\u00edch \u0111\u00e3 h\u1ebft<\/p>\n
5) Nguy\u00ean nh\u00e2n \u0111\u00e3 r\u00f5, trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 ng\u0103n ch\u1eb7n \u0111\u01b0\u1ee3c ti\u1ebfn tri\u1ec3n<\/p>\n
C\u00e2u 7: Ung th\u01b0 l\u00e0 g\u00ec? Tr\u00ecnh b\u00e0y t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a ung th\u01b0?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 ung th\u01b0<\/p>\n
1) Kh\u00e1i ni\u1ec7m:<\/p>\n
– Ung th\u01b0 (u \u00e1c) l\u00e0 lo\u1ea1i u c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m ri\u00eang bi\u1ec7t, th\u01b0\u1eddng ti\u1ebfn tri\u1ec3n nhanh v\u00e0 th\u01b0\u1eddng l\u00e0m ch\u1ebft ng\u01b0\u1eddi (n\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi)<\/p>\n
– Ung th\u01b0 c\u00f3 thu\u1eadt ng\u1eef l\u00e0 cancer \u2013 ngh\u0129a l\u00e0 con cua: do c\u00e1c kh\u1ed1i u \u00e1c t\u00ednh x\u00e2m l\u1ea5n v\u00e0 b\u00e1m ch\u1eb7t v\u00e0o m\u00f4 xung quanh nh\u01b0 nh\u1eefng c\u00e0ng cua<\/p>\n
2) \u0110\u1ecbnh ngh\u0129a:<\/p>\n
Ung th\u01b0 l\u00e0 kh\u1ed1i m\u00f4 t\u00e2n t\u1ea1o, c\u00f3 gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5 r\u00e0ng do t\u1ebf b\u00e0o t\u0103ng s\u1ea3n b\u1ea5t th\u01b0\u1eddng, ph\u00e1t tri\u1ec3n r\u1ea5t nhanh, x\u00e2m nh\u1eadp v\u00e0 ph\u00e1 h\u1ee7y c\u00e1c m\u00f4 xung quanh, gieo r\u1eafc t\u1ebf b\u00e0o ung th\u01b0 trong c\u01a1 th\u1ec3 g\u00e2y n\u00ean hi\u1ec7n t\u01b0\u1ee3ng ph\u1ed5 bi\u1ebfn l\u00e0 di c\u0103n v\u00e0 t\u00e1i ph\u00e1t, do \u0111\u00f3 th\u01b0\u1eddng g\u00e2y ch\u1ebft ng\u01b0\u1eddi trong v\u00f2ng v\u00e0i th\u00e1ng \u0111\u1ebfn v\u00e0i n\u0103m<\/p>\n
2. T\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a ung th\u01b0<\/p>\n
1) T\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i th\u1ec3:<\/p>\n
1.1) V\u1ecb tr\u00ed:<\/p>\n
+ B\u1ea5t k\u1ef3 t\u1ea1ng n\u00e0o, v\u1ecb tr\u00ed n\u00e0o trong c\u01a1 th\u1ec3 c\u0169ng c\u00f3 th\u1ec3 h\u00ecnh th\u00e0nh ung th\u01b0<\/p>\n
+ C\u00f3 nh\u1eefng t\u1ea1ng, v\u1ecb tr\u00ed hi\u1ebfm g\u1eb7p ung th\u01b0 nh\u01b0: kh\u00ed qu\u1ea3n, tim, l\u00e1ch\u2026<\/p>\n
+ Ngay tr\u00ean 1 t\u1ea1ng, xu\u1ea5t \u0111\u1ed9 ung th\u01b0 c\u0169ng kh\u00e1c nhau t\u00f9y v\u00f9ng:<\/p>\n
(+) Th\u1ef1c qu\u1ea3n: 1\/3 d\u01b0\u1edbi chi\u1ebfm 52%<\/p>\n
(+) Carcinoma tuy\u1ebfn v\u00fa: 1\/4 tr\u00ean ngo\u00e0i l\u00e0 ch\u1ee7 y\u1ebfu<\/p>\n
(+) \u0110\u1ea1i tr\u00e0ng: tr\u1ef1c tr\u00e0ng chi\u1ebfm 50%<\/p>\n
(+) Carcinoma t\u1ebf b\u00e0o \u0111\u00e1y: v\u00f9ng da l\u1ed9 thi\u00ean nhi\u1ec1u h\u01a1n tr\u00ean th\u00e2n ng\u01b0\u1eddi<\/p>\n
1.2) H\u00ecnh d\u1ea1ng:<\/p>\n
+ T\u00f9y thu\u1ed9c v\u1ecb tr\u00ed, t\u1ea1ng v\u00e0 lo\u1ea1i m\u00f4: kh\u1ed1i ung th\u01b0 c\u00f3 nhi\u1ec1u h\u00ecnh d\u1ea1ng kh\u00e1c nhau<\/p>\n
+ Ung th\u01b0 bi\u1ec3u m\u00f4 ph\u1ee7 (da, ni\u00eam m\u1ea1c, ph\u1ebf qu\u1ea3n, ti\u00eau h\u00f3a, ti\u1ebft ni\u1ec7u\u2026) g\u1ed3m 3 d\u1ea1ng:<\/p>\n
(+) D\u1ea1ng s\u00f9i: ch\u1ed3i nh\u00f4 tr\u00ean b\u1ec1 m\u1eb7t, \u0111\u00f4i khi s\u1ea7n s\u00f9i nh\u01b0 b\u00f4ng c\u1ea3i, \u0111\u00f4i khi c\u00f3 cu\u1ed1ng. D\u1ea1ng n\u00e0y th\u01b0\u1eddng th\u1ea5y \u1edf carcinoma c\u1ee7a da, c\u1ed5 t\u1eed cung, d\u1ea1 d\u00e0y\u2026<\/p>\n
(+) D\u1ea1ng lo\u00e9t:<\/p>\n
(-) Kh\u1ed1i ung th\u01b0 c\u00f3 th\u1ec3 b\u1ecb tho\u00e1i h\u00f3a, ho\u1ea1i t\u1eed t\u1ea1o n\u00ean nh\u1eefng \u1ed5 lo\u00e9t, th\u01b0\u1eddng r\u1ed9ng l\u1edbn h\u01a1n c\u00e1c \u1ed5 vi\u00eam th\u00f4ng th\u01b0\u1eddng<\/p>\n
Vd: lo\u00e9t d\u1ea1 d\u00e0y th\u01b0\u1eddng (\u0111\u01b0\u1eddng k\u00ednh 2-3 cm), lo\u00e9t d\u1ea1 d\u00e0y trong ung th\u01b0 (\u0111\u01b0\u1eddng k\u00ednh 5 cm)<\/p>\n
(-) Th\u01b0\u1eddng g\u1eb7p trong ung th\u01b0 d\u1ea1 d\u00e0y, ung th\u01b0 ru\u1ed9t, ung th\u01b0 tuy\u1ebfn v\u00fa<\/p>\n
(+) D\u1ea1ng x\u00e2m nh\u1eadp:<\/p>\n
(-) Kh\u1ed1i ung th\u01b0 c\u00f3 nhi\u1ec1u nh\u00e1nh lan r\u1ed9ng v\u00e0o m\u00f4 k\u1ebf c\u1eadn<\/p>\n
(-) Ch\u00ednh m\u00f4 ung th\u01b0 x\u00e2m nh\u1eadp \u0111\u00e3 t\u1ea1o n\u00ean h\u00ecnh \u1ea3nh da cam \u1edf ung th\u01b0 tuy\u1ebfn v\u00fa v\u00e0 l\u00e0m \u0111\u1ea7u n\u00fam v\u00fa t\u1ee5t l\u00f5m v\u00e0o trong<\/p>\n
+ Ung th\u01b0 t\u1ea1ng \u0111\u1eb7c (gan, n\u00e3o, th\u1eadn) bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi c\u00e1c d\u1ea1ng:<\/p>\n
(+) Kh\u1ed1i l\u1edbn, tr\u00f2n ho\u1eb7c b\u1ea7u d\u1ee5c<\/p>\n
(+) Nhi\u1ec1u c\u1ee5c nh\u1ecf, k\u00edch th\u01b0\u1edbc kh\u00f4ng \u0111\u1ec1u<\/p>\n
(+) Nang v\u1edbi nh\u1eefng khoang nh\u1ecf, ch\u1ee9a d\u1ecbch v\u00e0 m\u00f4 ho\u1ea1i t\u1eed<\/p>\n
(+) H\u1ea1t nh\u00e2n: m\u00f4 ung th\u01b0 c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf v\u00e0i cm n\u1eb1m g\u1ecdn gi\u1eefa v\u00f9ng m\u00f4 l\u00e0nh n\u00ean r\u1ea5t kh\u00f3 ph\u00e1t hi\u1ec7n<\/p>\n
1.3) K\u00edch th\u01b0\u1edbc: t\u00f9y v\u1ecb tr\u00ed, kh\u1ed1i ung th\u01b0 c\u00f3 k\u00edch th\u01b0\u1edbc kh\u00e1c nhau:<\/p>\n
+ L\u1edbn: \u0111\u01b0\u1eddng k\u00ednh 5-10 cm, l\u00e0m thay \u0111\u1ed5i h\u00ecnh d\u1ea1ng t\u1ea1ng b\u1ec7nh<\/p>\n
+ Nh\u1ecf: \u0111\u01b0\u1eddng k\u00ednh 2-5 cm, \u00edt l\u00e0m bi\u1ebfn d\u1ea1ng m\u00f4 b\u1ec7nh<\/p>\n
+ R\u1ea5t nh\u1ecf: nhi\u1ec1u khi kh\u00f4ng ph\u00e1t hi\u1ec7n tr\u00ean l\u00e2m s\u00e0ng<\/p>\n
1.4) V\u1ecf bao: kh\u1ed1i ung th\u01b0 \u00edt c\u00f3 v\u1ecf bao n\u00ean d\u1ec5 d\u00ednh v\u00e0o m\u00f4 k\u1ebf c\u1eadn, lan r\u1ed9ng n\u00ean kh\u00f3 b\u00f3c t\u00e1ch, c\u1eaft b\u1ecf tr\u1ecdn v\u1eb9n<\/p>\n
1.5) M\u00e0u s\u1eafc: khi c\u1eaft \u0111\u00f4i kh\u1ed1i ung th\u01b0 th\u01b0\u1eddng th\u1ea5y nhi\u1ec1u m\u00e0u s\u1eafc, c\u00f3 nhi\u1ec1u v\u00f9ng ch\u1ea3y m\u00e1u, ho\u1ea1i t\u1eed huy\u1ebft, \u0111\u1ecf r\u1ef1c, xen k\u1ebd v\u1edbi c\u00e1c \u0111\u00e1m m\u00f4 tho\u00e1i h\u00f3a ho\u1ea1i t\u1eed m\u00e0u v\u00e0ng k\u00e8m theo nhi\u1ec1u nang d\u1ecbch n\u00e2u \u0111en<\/p>\n
1.6) M\u1eadt \u0111\u1ed9: t\u00f9y thu\u1ed9c t\u1ea1ng v\u00e0 lo\u1ea1i m\u00f4, kh\u1ed1i ung th\u01b0 c\u00f3 nhi\u1ec1u m\u1eadt \u0111\u1ed9 kh\u00e1c nhau:<\/p>\n
+ Ch\u1eafc \u0111\u1eb7c: ung th\u01b0 gan<\/p>\n
+ Nang d\u1ecbch: ung th\u01b0 bu\u1ed3ng tr\u1ee9ng<\/p>\n
1.7) Ung th\u01b0 nhi\u1ec1u \u1ed5:<\/p>\n
+ M\u00f4 ung th\u01b0 c\u00f3 th\u1ec3 hi\u1ec7n di\u1ec7n nhi\u1ec1u \u1ed5 tr\u00ean c\u00f9ng 1 t\u1ea1ng<\/p>\n
+ M\u00f4 ung th\u01b0 c\u00f3 th\u1ec3 hi\u1ec7n di\u1ec7n nhi\u1ec1u \u1ed5 \u1edf nh\u1eefng t\u1ea1ng \u0111\u00f4i<\/p>\n
+ M\u00f4 ung th\u01b0 c\u00f3 th\u1ec3 hi\u1ec7n di\u1ec7n nhi\u1ec1u \u1ed5 \u1edf nh\u1eefng t\u1ea1ng kh\u00e1c nhau<\/p>\n
2) T\u1ed5n th\u01b0\u01a1ng vi th\u1ec3:<\/p>\n
M\u00f4 ung th\u01b0 g\u1ed3m 2 th\u00e0nh ph\u1ea7n c\u1ea5u t\u1ea1o: m\u00f4 ch\u1ee7 (g\u1ed3m c\u00e1c t\u1ebf b\u00e0o ung th\u01b0) v\u00e0 m\u00f4 \u0111\u1ec7m (g\u1ed3m c\u00e1c t\u1ebf b\u00e0o li\u00ean k\u1ebft v\u00e0 m\u1ea1ch m\u00e1u)<\/p>\n
2.1) M\u00f4 ch\u1ee7 c\u00f3 nh\u1eefng thay \u0111\u1ed5i r\u00f5 r\u1ec7t \u1edf m\u00e0ng t\u1ebf b\u00e0o, b\u00e0o t\u01b0\u01a1ng v\u00e0 nh\u00e2n t\u1ebf b\u00e0o<\/p>\n
– M\u00e0ng t\u1ebf b\u00e0o:<\/p>\n
+ Tr\u1edf n\u00ean kh\u00f4ng thu\u1ea7n nh\u1ea5t: do c\u00e1c ph\u00e2n t\u1eed lipid, glucid, protid thay \u0111\u1ed5i c\u1ea5u tr\u00fac. Nh\u1eefng bi\u1ebfn \u0111\u1ed5i \u0111i\u1ec7n t\u00edch l\u00e0m m\u00e0ng t\u1ebf b\u00e0o ung th\u01b0 c\u00f3 \u0111i\u1ec7n \u00e2m m\u1ea1nh h\u01a1n so v\u1edbi t\u1ebf b\u00e0o b\u00ecnh th\u01b0\u1eddng -> l\u00e0m cho m\u00e0ng t\u1ebf b\u00e0o m\u1ea5t kh\u1ea3 n\u0103ng k\u1ebft d\u00ednh, t\u1ebf b\u00e0o ung th\u01b0 d\u1ec5 bong r\u1eddi nhau v\u00e0 r\u01a1i v\u00e0o khoang c\u01a1 th\u1ec3<\/p>\n
+ M\u00e0ng t\u1ebf b\u00e0o ung th\u01b0 c\u00f3 nh\u1eefng bi\u1ebfn \u0111\u1ed5i r\u00f5 r\u1ec7t n\u00ean kh\u00f4ng c\u00f2n t\u00ednh ch\u1ea5t \u1ee9c ch\u1ebf ti\u1ebfp c\u1eadn g\u00e2y n\u00ean hi\u1ec7n t\u01b0\u1ee3ng ph\u00e2n b\u00e0o v\u00f4 h\u1ea1n: c\u00e1c t\u1ebf b\u00e0o t\u0103ng s\u1ea3n, ph\u00e1t tri\u1ec3n, lan r\u1ed9ng m\u00e3i trong kh\u00f4ng gian v\u00f4 t\u1eadn<\/p>\n
+ C\u00e1c bi\u1ebfn \u0111\u1ed5i m\u00e0ng l\u00e0m cho t\u1ebf b\u00e0o u kh\u00f4ng c\u00f2n nh\u1eadn s\u1ef1 \u0111i\u1ec1u ch\u1ec9nh n\u1ed9i m\u00f4 v\u00e0 d\u1ec5 x\u00e2m nh\u1eadp v\u00e0o m\u00f4 k\u1ebf c\u1eadn<\/p>\n
+ C\u00e1c \u201ckh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t\u201d m\u1edbi (th\u01b0\u1eddng kh\u00f4ng mang t\u00ednh ch\u1ea5t \u0111\u1eb7c hi\u1ec7u c\u1ee7a kh\u1ed1i u v\u00e0 kh\u00f4ng xu\u1ea5t hi\u1ec7n \u1edf t\u1ebf b\u00e0o b\u00ecnh th\u01b0\u1eddng) xu\u1ea5t hi\u1ec7n tr\u00ean m\u00e0ng t\u1ebf b\u00e0o ung th\u01b0<\/p>\n
– B\u00e0o t\u01b0\u01a1ng:<\/p>\n
+ C\u00e1c b\u00e0o v\u1eadt \u0111\u1ec1u b\u1ecb t\u1ed5n th\u01b0\u01a1ng: l\u01b0\u1edbi n\u1ed9i b\u00e0o, ty th\u1ec3 b\u1ecb bi\u1ebfn \u0111\u1ed5i, b\u1ed9 golgi ph\u00ec \u0111\u1ea1i, c\u00e1c ribosom k\u1ebft d\u00ednh nhau<\/p>\n
+ B\u00e0o t\u01b0\u01a1ng c\u00f3 th\u1ec3 ch\u1ee9a nhi\u1ec1u ch\u1ea5t nh\u1ea7y: \u0111\u1ea9y nh\u00e2n v\u1ec1 1 ph\u00eda, t\u1ea1o h\u00ecnh \u1ea3nh t\u1ebf b\u00e0o nh\u1eabn<\/p>\n
+ B\u00e0o t\u01b0\u01a1ng c\u00f3 th\u1ec3 ch\u1ee9a nhi\u1ec1u glycogen: l\u00e0m cho t\u1ebf b\u00e0o c\u00f3 d\u1ea1ng s\u00e1ng trong<\/p>\n
+ B\u00e0o t\u01b0\u01a1ng c\u00f3 th\u1ec3 ch\u1ee9a nhi\u1ec1u h\u1eafc t\u1ed1<\/p>\n
+ B\u00e0o t\u01b0\u01a1ng tr\u1edf n\u00ean \u01b0a acid r\u00f5 r\u1ec7t do s\u1ea3n sinh nhi\u1ec1u ch\u1ea5t s\u1eebng<\/p>\n
– Nh\u00e2n t\u1ebf b\u00e0o:<\/p>\n
+ Ph\u00ec \u0111\u1ea1i, to g\u1ea5p 2-3 l\u1ea7n b\u00ecnh th\u01b0\u1eddng, ki\u1ec1m t\u00ednh, t\u0103ng s\u1eafc. H\u1ea1t nh\u00e2n c\u0169ng bi\u1ebfn \u0111\u1ed5i<\/p>\n
+ S\u1ed1 l\u01b0\u1ee3ng NST thay \u0111\u1ed5i (ho\u1eb7c t\u0103ng, ho\u1eb7c gi\u1ea3m r\u00f5 r\u1ec7t), c\u1ea5u tr\u00fac NST kh\u00f4ng b\u00ecnh th\u01b0\u1eddng<\/p>\n
+ Qu\u00e1 tr\u00ecnh ph\u00e2n b\u00e0o kh\u00f4ng \u0111\u1ec1u, kh\u00f4ng \u0111\u1ed1i x\u1ee9ng, ph\u00e2n b\u00e0o th\u01b0\u1eddng c\u00f3 nhi\u1ec1u c\u1ef1c l\u00e0m cho nh\u00e2n t\u1ebf b\u00e0o c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn v\u00e0 nh\u00e2n x\u00f9 x\u00ec, qu\u00e1i l\u1ea1<\/p>\n
+ Ngo\u00e0i nguy\u00ean ph\u00e2n c\u00f2n c\u00f3 tr\u1ef1c ph\u00e2n: nh\u00e2n v\u00e0 b\u00e0o t\u01b0\u01a1ng b\u1ecb k\u00e9o d\u00e0i r\u1ed3i c\u1eaft \u0111o\u1ea1n th\u00e0nh m\u1ea3nh nh\u1ecf l\u00e0m cho qu\u00e1 tr\u00ecnh t\u0103ng s\u1ea3n ung th\u01b0 tr\u1edf n\u00ean r\u1ea5t m\u1ea1nh v\u00e0 nhanh<\/p>\n
2.2) M\u00f4 \u0111\u1ec7m c\u0169ng c\u00f3 nhi\u1ec1u bi\u1ebfn \u0111\u1ed5i:<\/p>\n
– Th\u1ea5m nh\u1eadp t\u1ebf b\u00e0o vi\u00eam<\/p>\n
– T\u0103ng s\u1ea3n vi m\u1ea1ch, b\u1ecb ung th\u01b0 x\u00e2m nh\u1eadp: l\u1ea5p t\u1eafc m\u1ea1ch, v\u1ee1 m\u1ea1ch d\u1eabn \u0111\u1ebfn ch\u1ea3y m\u00e1u, \u1ed5 ho\u1ea1i t\u1eed huy\u1ebft<\/p>\n
– M\u00f4 \u0111\u1ec7m c\u00f3 th\u1ec3 b\u1ecb tho\u00e1i h\u00f3a trong, tho\u00e1i h\u00f3a nh\u1ea7y<\/p>\n
– L\u1eafng \u0111\u1ecdng nh\u1eefng ch\u1ea5t b\u1ea5t th\u01b0\u1eddng (l\u1eafng \u0111\u1ecdng canxi th\u00e0nh \u1ed5 kh\u00f4ng \u0111\u1ec1u trong carcinoma tuy\u1ebfn gi\u00e1p)<\/p>\n
– C\u00f3 th\u1ec3 chuy\u1ec3n s\u1ea3n th\u00e0nh s\u1ee5n, x\u01b0\u01a1ng (carcinoma \u0111a d\u1ea1ng tuy\u1ebfn n\u01b0\u1edbc b\u1ecdt)<\/p>\n
– C\u00f3 th\u1ec3 t\u0103ng s\u1ea3n qu\u00e1 m\u1ee9c t\u1ea1o th\u00e0nh nh\u1eefng v\u00f9ng x\u01a1 r\u1eafn: l\u00e0m kh\u1ed1i ung th\u01b0 teo c\u1ee9ng (carcinoma x\u01a1 chai d\u1ea1 d\u00e0y)<\/p>\n
– Nh\u1eefng thay \u0111\u1ed5i \u1edf m\u00f4 \u0111\u1ec7m l\u00e0 k\u1ebft qu\u1ea3 t\u01b0\u01a1ng h\u1ed7 c\u1ee7a m\u00f4 ung th\u01b0 v\u00e0 c\u01a1 th\u1ec3<\/p>\n
C\u00e2u 8: N\u00eau nh\u1eefng hi\u1ec3u bi\u1ebft c\u01a1 b\u1ea3n v\u1ec1 u? N\u00eau c\u00e1c y\u1ebfu t\u1ed1 \u0111\u1ec3 ph\u00e2n bi\u1ec7t u l\u00e0nh t\u00ednh v\u00e0 u \u00e1c t\u00ednh?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 u: c\u00e2u 6<\/p>\n
2. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a u l\u00e0nh t\u00ednh: 4 \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n
1) Ph\u00e1t tri\u1ec3n ch\u1eadm v\u00e0 t\u1ea1i ch\u1ed7:<\/p>\n
– U l\u00e0nh m\u1ecdc t\u1ea1i ch\u1ed7, th\u01b0\u1eddng ph\u00e1t tri\u1ec3n ch\u1eadm, kh\u00f4ng l\u00e0m ch\u1ebft ng\u01b0\u1eddi, tr\u1eeb khi m\u1ecdc v\u00e0o v\u1ecb tr\u00ed hi\u1ec3m y\u1ebfu<\/p>\n
– C\u00f3 th\u1ec3 c\u00f3 kh\u1ed1i l\u01b0\u1ee3ng l\u1edbn sau nhi\u1ec1u n\u0103m ti\u1ebfn tri\u1ec3n<\/p>\n
2) C\u00f3 ranh gi\u1edbi r\u00f5 r\u1ec7t:<\/p>\n
– Nh\u00ecn \u0111\u1ea1i th\u1ec3, u l\u00e0nh c\u00f3 v\u1ecf x\u01a1 bao b\u1ecdc n\u00ean d\u1ec5 b\u00f3c t\u00e1ch to\u00e0n b\u1ed9 kh\u1ed1i u<\/p>\n
Vd: u m\u1ee1 l\u00e0nh, u x\u01a1 tuy\u1ebfn v\u00fa, u c\u01a1 tr\u01a1n t\u1eed cung<\/p>\n
– Do \u0111\u00f3, u l\u00e0nh ch\u1ec9 c\u00f3 xu h\u01b0\u1edbng ch\u00e8n \u00e9p ch\u1ee9 kh\u00f4ng x\u00e2m nh\u1eadp<\/p>\n
Vd: u tuy\u1ebfn \u0111\u1ea1i tr\u00e0ng: c\u00f3 r\u1ea5t nhi\u1ec1u tuy\u1ebfn lieberkuhn ch\u1ebf ti\u1ebft nh\u1ea7y nh\u01b0 tuy\u1ebfn b\u00ecnh th\u01b0\u1eddng, c\u00e1c tuy\u1ebfn v\u1eabn n\u1eb1m tr\u00ean c\u01a1 ni\u00eam<\/p>\n
3) C\u1ea5u tr\u00fac g\u1ea7n gi\u1ed1ng m\u00f4 b\u00ecnh th\u01b0\u1eddng<\/p>\n
V\u1ec1 vi th\u1ec3, u l\u00e0nh t\u00e1i t\u1ea1o l\u1ea1i 1 c\u00e1ch trung th\u00e0nh c\u1ea5u tr\u00fac m\u00f4 sinh ra n\u00f3, kh\u00f4ng \u0111\u1ea3o l\u1ed9n c\u1ea5u tr\u00fac, kh\u00f4ng x\u00e2m nh\u1eadp, nh\u01b0ng c\u00f3 s\u1ef1 ch\u00e8n \u00e9p<\/p>\n
4) U l\u00e0nh hi\u1ebfm khi t\u00e1i ph\u00e1t v\u00e0 di c\u0103n:<\/p>\n
– V\u00ec kh\u00f4ng x\u00e2m nh\u1eadp n\u00ean n\u1ebfu u l\u00e0nh \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf tri\u1ec7t \u0111\u1ec3, u kh\u00f4ng m\u1ecdc l\u1ea1i n\u1eefa (tr\u1eeb u d\u1ea1ng l\u00e1 tuy\u1ebfn v\u00fa)<\/p>\n
– Kh\u00f4ng bao gi\u1edd th\u1ea5y u l\u00e0nh di c\u0103n theo c\u00e1c \u0111\u01b0\u1eddng m\u00e1u hay \u0111\u01b0\u1eddng b\u1ea1ch huy\u1ebft \u0111\u1ebfn n\u01a1i kh\u00e1c c\u00e1ch xa ch\u1ed7 ph\u00e1t sinh<\/p>\n
3. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a u \u00e1c t\u00ednh: 4 \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n
1) Ph\u00e1t tri\u1ec3n nhanh, x\u00e2m nh\u1eadp:<\/p>\n
– U \u00e1c th\u01b0\u1eddng ph\u00e1t tri\u1ec3n nhanh, x\u00e2m nh\u1eadp v\u00e0 th\u01b0\u1eddng g\u00e2y ch\u1ebft ng\u01b0\u1eddi trong v\u00f2ng v\u00e0i th\u00e1ng \u0111\u1ebfn v\u00e0i n\u0103m<\/p>\n
– S\u1ef1 b\u00e0nh tr\u01b0\u1edbng c\u1ee7a kh\u1ed1i u kh\u00f4ng bao gi\u1edd ng\u1eebng<\/p>\n
– Theo c\u00e1c nghi\u00ean c\u1ee9u m\u1edbi \u0111\u00e2y, kh\u1ed1i u th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n khi \u0111\u1ea1t \u0111\u1ebfn k\u00edch th\u01b0\u1edbc 1 cm, l\u00fac n\u00e0y n\u00f3 c\u00f3 s\u1ed1 l\u01b0\u1ee3ng kho\u1ea3ng 1 t\u1ef7 t\u1ebf b\u00e0o v\u00e0 \u0111\u00e3 ti\u1ebfn tri\u1ec3n \u0111\u01b0\u1ee3c 6 n\u0103m k\u1ec3 t\u1eeb khi \u0111\u01b0\u1ee3c nh\u00e2n \u0111\u00f4i t\u1eeb 1 t\u1ebf b\u00e0o ung th\u01b0 \u0111\u1ea7u ti\u00ean<\/p>\n
– Chu k\u1ef3 nh\u00e2n \u0111\u00f4i k\u00edch th\u01b0\u1edbc kh\u1ed1i u trong kho\u1ea3ng 45 ng\u00e0y \u2013 450 ng\u00e0y. Sau 450 ng\u00e0y m\u00e0 kh\u1ed1i u kh\u00f4ng t\u0103ng l\u00ean g\u1ea5p \u0111\u00f4i th\u00ec kh\u1ed1i u \u0111\u00f3 kh\u00f3 c\u00f3 kh\u1ea3 n\u0103ng l\u00e0 u l\u00e0nh t\u00ednh<\/p>\n
2) Ranh gi\u1edbi c\u1ee7a u v\u1edbi m\u00f4 xung quanh kh\u00f4ng r\u00f5 r\u1ec7t:<\/p>\n
U \u00e1c c\u00f3 gi\u1edbi h\u1ea1n v\u1edbi m\u00f4 l\u00e0nh kh\u00f4ng r\u00f5 r\u00e0ng, c\u00f3 nhi\u1ec1u r\u1ec5 x\u00e2m nh\u1eadp: ch\u00ednh v\u00ec v\u1eady ung th\u01b0 c\u00f3 thu\u1eadt ng\u1eef l\u00e0 cancer \u2013 ti\u1ebfng la tinh c\u00f3 ngh\u0129a l\u00e0 con cua, do c\u00e1c kh\u1ed1i u x\u00e2m l\u1ea5n v\u00e0 b\u00e1m ch\u1eb7t v\u00e0o m\u00f4 xung quanh nh\u01b0 nh\u1eefng c\u00e0ng cua<\/p>\n
3) C\u1ea5u tr\u00fac kh\u00f4ng gi\u1ed1ng v\u1edbi m\u00f4 c\u00f3 c\u00f9ng ngu\u1ed3n g\u1ed1c:<\/p>\n
– V\u1ec1 vi th\u1ec3, n\u00f3i chung c\u00e1c u \u00e1c qu\u00e1 s\u1ea3n m\u1ea1nh, ph\u00e1 v\u1ee1 l\u1edbp \u0111\u00e1y, chui v\u00e0o l\u1edbp \u0111\u1ec7m g\u00e2y \u0111\u1ea3o l\u1ed9n c\u1ea5u tr\u00fac, t\u1ea1o n\u00ean nh\u1eefng kh\u1ed1i u \u0111\u1eadm m\u00e0u, nh\u00e2n kh\u00f4ng \u0111\u1ec1u, nh\u00e2n qu\u00e1i, nh\u00e2n chia<\/p>\n
– T\u1ebf b\u00e0o u ph\u1ea7n l\u1edbn l\u00e0 t\u1ebf b\u00e0o non (tho\u00e1i s\u1ea3n), ch\u1ec9 g\u1ee3i l\u1ea1i ph\u1ea7n n\u00e0o m\u00f4 g\u1ed1c c\u1ee7a u<\/p>\n
4) R\u1ea5t d\u1ec5 t\u00e1i ph\u00e1t, di c\u0103n: d\u00f9 \u0111\u00e3 c\u1eaft b\u1ecf r\u1ed9ng r\u00e3i, do t\u00ednh ch\u1ea5t x\u00e2m nh\u1eadp s\u00e2u v\u00e0 lan xa c\u1ee7a ch\u00fang, c\u00e1c m\u00f4 ung th\u01b0 d\u1ec5 d\u00e0ng m\u1ecdc tr\u1edf l\u1ea1i ho\u1eb7c t\u1ea1i ch\u1ed7, ho\u1eb7c di c\u0103n xa<\/p>\n
4. So s\u00e1nh gi\u1eefa u l\u00e0nh t\u00ednh v\u00e0 u \u00e1c t\u00ednh<\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m<\/p>\n
U l\u00e0nh t\u00ednh<\/p>\n
U \u00e1c t\u00ednh<\/p>\n
\u0110\u1ea1i th\u1ec3<\/p>\n
C\u00f3 v\u1ecf bao, ranh gi\u1edbi r\u00f5 r\u1ec7t, kh\u00f4ng x\u00e2m nh\u1eadp, di \u0111\u1ed9ng d\u1ec5 khi s\u1edd n\u1eafn, d\u1ec5 b\u00f3c t\u00e1ch khi ph\u1eabu thu\u1eadt<\/p>\n
Kh\u00f4ng c\u00f3 v\u1ecf bao, ranh gi\u1edbi kh\u00f4ng r\u00f5 r\u1ec7t, x\u00e2m nh\u1eadp s\u00e2u v\u00e0o m\u00f4 xung quanh, \u00edt di \u0111\u1ed9ng, t\u1ea1o th\u00e0nh 1 kh\u1ed1i c\u1ee9ng ch\u1eafc<\/p>\n
Vi th\u1ec3<\/p>\n
C\u1ea5u t\u1ea1o gi\u1ed1ng m\u00f4 l\u00e0nh, kh\u00f4ng c\u00f3 ho\u1eb7c c\u00f3 \u00edt nh\u00e2n chia, kh\u00f4ng c\u00f3 nh\u00e2n qu\u00e1i v\u00e0 h\u1ea1t nh\u00e2n. C\u1ea5u tr\u00fac u kh\u00f4ng b\u1ecb \u0111\u1ea3o l\u1ed9n<\/p>\n
C\u1ea5u t\u1ea1o kh\u00f4ng gi\u1ed1ng m\u00f4 l\u00e0nh, c\u00f3 nhi\u1ec1u nh\u00e2n chia b\u1ea5t th\u01b0\u1eddng, nh\u00e2n kh\u00f4ng \u0111\u1ec1u, c\u00f3 nh\u00e2n qu\u00e1i, c\u00f3 h\u1ea1t nh\u00e2n. C\u1ea5u tr\u00fac u b\u1ecb \u0111\u1ea3o l\u1ed9n<\/p>\n
Ti\u1ebfn tri\u1ec3n<\/p>\n
Ti\u1ebfn tri\u1ec3n ch\u1eadm, ph\u00e1t tri\u1ec3n l\u1ea1c ch\u1ed7, kh\u00f4ng l\u00e0m ch\u1ebft ng\u01b0\u1eddi, kh\u00f4ng x\u00e2m l\u1ea5n v\u00e0 di c\u0103n<\/p>\n
Ti\u1ebfn tri\u1ec3n nhanh, g\u00e2y ch\u1ebft ng\u01b0\u1eddi do ch\u1ea3y m\u00e1u, ho\u1ea1i t\u1eed, t\u1eafc m\u1ea1ch, suy m\u00f2n, di c\u0103n<\/p>\n
\u0110i\u1ec1u tr\u1ecb<\/p>\n
Kh\u1ecfi h\u1eb3n khi \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf<\/p>\n
D\u1ec5 t\u00e1i ph\u00e1t, \u0111i\u1ec1u tr\u1ecb kh\u00f3 kh\u0103n<\/p>\n
C\u00e2u 9: T\u1ebf b\u00e0o ung th\u01b0 l\u00e0 g\u00ec? Tr\u00ecnh b\u00e0y c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1ebf b\u00e0o ung th\u01b0?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u1ec1 t\u1ebf b\u00e0o ung th\u01b0<\/p>\n
1) Kh\u00e1i ni\u1ec7m:<\/p>\n
T\u1ebf b\u00e0o ung th\u01b0 l\u00e0 nh\u1eefng t\u1ebf b\u00e0o t\u0103ng s\u1ea3n qu\u00e1 m\u1ee9c c\u00f3 t\u00ednh t\u1ef1 \u0111\u1ed9ng do m\u1ea5t s\u1ef1 \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c ki\u1ec3m so\u00e1t b\u00ecnh th\u01b0\u1eddng c\u1ee7a c\u01a1 th\u1ec3, ph\u00e1t tri\u1ec3n r\u1ea5t nhanh, lan r\u1ed9ng h\u1ee7y ho\u1ea1i, c\u00f3 kh\u1ea3 n\u0103ng x\u00e2m l\u1ea5n c\u00e1c m\u00f4 kh\u00e1c b\u1eb1ng c\u00e1ch ph\u00e1t tri\u1ec3n tr\u1ef1c ti\u1ebfp v\u00e0o m\u00f4 l\u00e2n c\u1eadn ho\u1eb7c di c\u0103n kh\u1eafp n\u01a1i trong c\u01a1 th\u1ec3 (t\u1ea1o n\u00ean nh\u1eefng ung th\u01b0 th\u1ee9 ph\u00e1t), d\u1ec5 t\u00e1i ph\u00e1t v\u00e0 th\u01b0\u1eddng g\u00e2y t\u1eed vong n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u00fang v\u00e0 k\u1ecbp th\u1eddi<\/p>\n
2) D\u00f2ng t\u1ebf b\u00e0o t\u0103ng s\u1ea3n sinh ra u g\u1ecdi l\u00e0 nhu m\u00f4 kh\u1ed1i u, quy\u1ebft \u0111\u1ecbnh b\u1ea3n ch\u1ea5t c\u1ee7a u<\/p>\n
C\u00e1c t\u1ebf b\u00e0o ung th\u01b0 trong 1 kh\u1ed1i u (bao g\u1ed3m c\u1ea3 t\u1ebf b\u00e0o \u0111\u00e3 di c\u0103n) \u0111\u1ec1u xu\u1ea5t ph\u00e1t t\u1eeb 1 t\u1ebf b\u00e0o duy nh\u1ea5t ph\u00e2n chia m\u00e0 th\u00e0nh. Do \u0111\u00f3 b\u1ea3n ch\u1ea5t c\u1ee7a u ph\u1ee5 thu\u1ed9c v\u00e0o lo\u1ea1i t\u1ebf b\u00e0o h\u00ecnh th\u00e0nh n\u00ean nhu m\u00f4 kh\u1ed1i u<\/p>\n
+ Ung th\u01b0 bi\u1ec3u m\u00f4: b\u1eaft ngu\u1ed3n t\u1eeb t\u1ebf b\u00e0o bi\u1ec3u m\u00f4<\/p>\n
Vd: \u1ed1ng ti\u00eau h\u00f3a, tuy\u1ebfn ti\u00eau h\u00f3a<\/p>\n
+ B\u1ec7nh l\u00fd m\u00e1u \u00e1c t\u00ednh: b\u1ec7nh b\u1ea1ch c\u1ea7u v\u00e0 u lympho b\u00e0o xu\u1ea5t ph\u00e1t t\u1eeb m\u00e1u v\u00e0 t\u1ee7y x\u01b0\u01a1ng<\/p>\n
+ Ung th\u01b0 m\u00f4 li\u00ean k\u1ebft: xu\u1ea5t ph\u00e1t t\u1eeb m\u00f4 li\u00ean k\u1ebft, c\u01a1, x\u01b0\u01a1ng<\/p>\n
+ U h\u1eafc t\u1ed1: b\u1eaft ngu\u1ed3n t\u1eeb t\u1ebf b\u00e0o s\u1eafc t\u1ed1<\/p>\n
+ U qu\u00e1i: b\u1eaft ngu\u1ed3n t\u1eeb t\u1ebf b\u00e0o m\u1ea7m<\/p>\n
Vd:<\/p>\n
U x\u01b0\u01a1ng: t\u1ebf b\u00e0o u c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb t\u1ebf b\u00e0o x\u01b0\u01a1ng<\/p>\n
U tuy\u1ebfn v\u00fa: t\u1ebf b\u00e0o u c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 tuy\u1ebfn v\u00fa<\/p>\n
U t\u1ebf b\u00e0o gai: t\u1ebf b\u00e0o u c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb t\u1ebf b\u00e0o gai c\u1ee7a bi\u1ec3u m\u00f4 da<\/p>\n
2. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1ebf b\u00e0o ung th\u01b0<\/p>\n
1) T\u0103ng s\u1ea3n t\u1ebf b\u00e0o:<\/p>\n
– R\u00f5 r\u1ec7t, mang t\u00ednh \u0111\u1ed9c l\u1eadp, kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o nh\u1eefng quy lu\u1eadt c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i c\u1ee7a c\u01a1 th\u1ec3<\/p>\n
– Mang t\u00ednh h\u1ed7n lo\u1ea1n: c\u00e1c ph\u00e2n b\u00e0o th\u01b0\u1eddng kh\u00f4ng \u0111i\u1ec3n h\u00ecnh k\u00e8m theo nh\u1eefng NST b\u1ea5t th\u01b0\u1eddng l\u00e0m cho t\u1ebf b\u00e0o ung th\u01b0 c\u00f3 h\u00ecnh th\u00e1i, k\u00edch th\u01b0\u1edbc kh\u00f4ng \u0111i\u1ec3n h\u00ecnh<\/p>\n
– Do t\u0103ng s\u1ea3n t\u1ebf b\u00e0o m\u1ea1nh n\u00ean kh\u1ed1i ung th\u01b0 ph\u00e1t tri\u1ec3n r\u1ea5t nhanh v\u00e0 \u0111\u1ea1t k\u00edch th\u01b0\u1edbc r\u1ea5t l\u1edbn trong th\u1eddi gian ng\u1eafn<\/p>\n
2) Chuy\u1ec3n h\u00f3a t\u1ebf b\u00e0o:<\/p>\n
– Nhu c\u1ea7u n\u0103ng l\u01b0\u1ee3ng r\u1ea5t l\u1edbn c\u1ee7a t\u1ebf b\u00e0o ung th\u01b0 \u0111\u00f2i h\u1ecfi ho\u1ea1t \u0111\u1ed9ng chuy\u1ec3n h\u00f3a m\u1ea1nh, qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p ADN v\u00e0 ARN t\u0103ng<\/p>\n
– Qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng glycogen \u1edf t\u1ebf b\u00e0o ung th\u01b0 theo con \u0111\u01b0\u1eddng y\u1ebfm kh\u00ed c\u0169ng t\u0103ng l\u00e0m \u1ee9 \u0111\u1ecdng nhi\u1ec1u acid lactic<\/p>\n
– M\u00f4 ung th\u01b0 kh\u00f4ng c\u00f2n ch\u1ee9a nhi\u1ec1u glycogen n\u00ean kh\u00f4ng c\u1ed1 \u0111\u1ecbnh \u0111\u01b0\u1ee3c ch\u1ea5t iod, do \u0111\u00f3 m\u00f4 kh\u00f4ng \u0111\u1ed5i m\u00e0u khi b\u00f4i dung d\u1ecbch lugol (nghi\u1ec7m ph\u00e1p Schiller)<\/p>\n
3) Chuy\u1ec3n s\u1ea3n: th\u01b0\u1eddng xuy\u00ean x\u1ea3y ra do r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a:<\/p>\n
– Ni\u00eam m\u1ea1c tr\u1ee5 c\u1ee7a ph\u1ebf qu\u1ea3n, ni\u00eam m\u1ea1c tuy\u1ebfn c\u1ee7a n\u1ed9i m\u1ea1c t\u1eed cung c\u00f3 th\u1ec3 chuy\u1ec3n s\u1ea3n th\u00e0nh th\u01b0\u1ee3ng b\u00ec<\/p>\n
– M\u00f4 li\u00ean k\u1ebft c\u00f3 th\u1ec3 chuy\u1ec3n s\u1ea3n th\u00e0nh s\u1ee5n, x\u01b0\u01a1ng<\/p>\n
4) Bi\u1ec7t h\u00f3a t\u1ebf b\u00e0o: t\u1ea1i m\u00f4 ch\u1ee7, c\u00e1c t\u1ebf b\u00e0o ung th\u01b0 c\u00f3 th\u1ec3 s\u1eafp x\u1ebfp th\u00e0nh d\u00e2y, \u1ed1ng, tuy\u1ebfn\u2026 v\u1edbi c\u00e1c m\u1ee9c \u0111\u1ed9 bi\u1ec7t h\u00f3a kh\u00e1c nhau: bi\u1ec7t h\u00f3a t\u1ed1t ho\u1eb7c v\u1eeba, kh\u00f4ng bi\u1ec7t h\u00f3a ho\u1eb7c tho\u00e1i s\u1ea3n<\/p>\n
– Ung th\u01b0 bi\u1ec7t h\u00f3a t\u1ed1t:<\/p>\n
+ H\u00ecnh th\u00e1i, c\u1ea5u tr\u00fac c\u1ee7a m\u00f4 ch\u1ee7 gi\u1ed1ng m\u00f4 nguy\u00ean \u1ee7y<\/p>\n
+ Vd:<\/p>\n
(+) Carcinoma tuy\u1ebfn d\u1ea1 d\u00e0y: v\u1edbi l\u00f2ng \u1ed1ng r\u00f5 r\u1ec7t<\/p>\n
(+) Carcinoma tuy\u1ebfn Lieberkuhn c\u1ee7a \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n
(+) Carcinoma tuy\u1ebfn ph\u1ebf qu\u1ea3n<\/p>\n
(+) Carcinoma tuy\u1ebfn c\u1ee7a th\u1eadn<\/p>\n
(+) Carcinoma t\u1ebf b\u00e0o gai c\u1ee7a da, c\u1ee7a d\u01b0\u01a1ng v\u1eadt: v\u1edbi nh\u1eefng c\u1ea7u s\u1eebng r\u00f5 r\u1ec7t<\/p>\n
(+) Carcinoma t\u1ebf b\u00e0o gai c\u1ee7a c\u1ed5 t\u1eed cung<\/p>\n
– Ung th\u01b0 kh\u00f4ng bi\u1ec7t h\u00f3a:<\/p>\n
+ H\u00ecnh th\u00e1i, c\u1ea5u tr\u00fac m\u00f4 ho\u00e0n to\u00e0n kh\u00e1c m\u00f4 nguy\u00ean \u1ee7y nh\u01b0ng v\u1eabn c\u00f2n c\u00f3 th\u1ec3 nh\u1eadn bi\u1ebft \u0111\u00f3 l\u00e0 c\u1ea5u tr\u00fac bi\u1ec3u m\u00f4 \u0111\u1ec3 ph\u00e2n bi\u1ec7t gi\u1eefa carcinoma v\u00e0 sarcoma<\/p>\n
+ Vd: carcinoma kh\u00f4ng bi\u1ec7t h\u00f3a c\u1ee7a d\u1ea1 d\u00e0y: g\u1ed3m nh\u1eefng t\u1ebf b\u00e0o tr\u00f2n nh\u1ecf, ch\u1ee9a nh\u1ea7y (d\u1ea1ng t\u1ebf b\u00e0o nh\u1eabn), kh\u00f4ng x\u1ebfp th\u00e0nh tuy\u1ebfn m\u00e0 r\u1ea3i r\u00e1c x\u00e2m nh\u1eadp v\u00e1ch c\u01a1 v\u00e0 g\u00e2y ph\u1ea3n \u1ee9ng h\u00f3a s\u1ee3i, gi\u00e0u m\u00f4 \u0111\u1ec7m t\u1ea1o n\u00ean d\u1ea1ng carcinoma x\u01a1 chai<\/p>\n
– Ung th\u01b0 tho\u00e1i s\u1ea3n:<\/p>\n
+ H\u00ecnh th\u00e1i, c\u1ea5u tr\u00fac m\u00f4 ho\u00e0n to\u00e0n kh\u00e1c v\u1edbi m\u00f4 nguy\u00ean \u1ee7y, \u0111\u00f4i khi c\u0169ng kh\u00f3 x\u00e1c \u0111\u1ecbnh \u0111\u00f3 l\u00e0 c\u1ea5u tr\u00fac bi\u1ec3u m\u00f4 v\u00e0 c\u00e0ng kh\u00f3 ph\u00e2n bi\u1ec7t v\u1edbi sarcoma<\/p>\n
+ Vd:<\/p>\n
(+) Carcinoma tho\u00e1i s\u1ea3n c\u1ee7a v\u00f2m h\u1ecdng<\/p>\n
(+) Carcinoma tho\u00e1i s\u1ea3n c\u1ee7a ph\u1ed5i<\/p>\n
5) Ho\u1ea1t \u0111\u1ed9ng ch\u1ebf ti\u1ebft:<\/p>\n
– M\u00f4 ung th\u01b0 c\u00f3 th\u1ec3 ch\u1ebf ti\u1ebft nhi\u1ec1u ph\u00e2n t\u1eed sinh h\u1ecdc, d\u1ec5 ph\u00e1t hi\u1ec7n trong m\u00e1u, n\u01b0\u1edbc ti\u1ec3u ho\u1eb7c \u1edf ngay m\u00f4 u<\/p>\n
– Tuy nhi\u00ean nh\u1eefng ch\u1ea5t \u0111\u00f3 kh\u00f4ng mang gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u00ec:<\/p>\n
+ Kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho th\u1ec3 b\u1ec7nh<\/p>\n
+ Kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho 1 lo\u1ea1i ung th\u01b0 ri\u00eang bi\u1ec7t<\/p>\n
+ Th\u01b0\u1eddng ph\u00e1t hi\u1ec7n \u1edf giai \u0111o\u1ea1n mu\u1ed9n: kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n s\u1edbm<\/p>\n
– C\u00e1c ch\u1ea5t ch\u1ebf ti\u1ebft:<\/p>\n
+ Alpha foeto protein (AFP): K gan, K tinh ho\u00e0n, u ngh\u1ecbch ph\u00f4i \u00e1c\u2026<\/p>\n
+ Kh\u00e1ng nguy\u00ean carcinoma ph\u00f4i (CEA): carcinoma ph\u1ebf qu\u1ea3n, th\u1ef1c qu\u1ea3n, t\u1ee5y, tuy\u1ebfn v\u00fa\u2026<\/p>\n
+ Ch\u1ea5t Human chorionic gonadotropin (hCG): K tinh ho\u00e0n, K v\u00fa, K gan\u2026<\/p>\n
+ Ch\u1ea5t Catecholamin: u nguy\u00ean b\u00e0o th\u1ea7n kinh, u h\u1eafc t\u1ed1 \u00e1c\u2026<\/p>\n
+ Serotonin v\u00e0 c\u00e1c s\u1ea3n ph\u1ea9m d\u1ecb h\u00f3a: u carcinoid (d\u1ea1 d\u00e0y, ru\u1ed9t non, ph\u1ebf qu\u1ea3n\u2026)<\/p>\n
+ C\u00e1c enzym ch\u1ebf bi\u1ebft bao g\u1ed3m:<\/p>\n
(+) Phosphatase ki\u1ec1m: K gan<\/p>\n
(+) Phosphatase acid: K TLT<\/p>\n
(+) Gamma glutamin transferase (GGT): K gan, K t\u1ee7y x\u01b0\u01a1ng\u2026<\/p>\n
(+) Lactat dehydrogenase (LDH): u lympho \u00e1c, K \u0111\u01b0\u1eddng ti\u00eau h\u00f3a\u2026<\/p>\n
(+) Enzym ti\u00eau \u0111\u1ea1m: hyaluronidase, protease, amin peptidase\u2026<\/p>\n
+ C\u00e1c ch\u1ea5t kh\u00e1c: gamma foetoprotein (K ph\u1ebf qu\u1ea3n), calcitonin (K \u0111a b\u00e0o d\u1ea1ng tho\u00e1i tr\u1ea1ng)<\/p>\n
+ Kh\u00e1ng nguy\u00ean c\u1ee7a u: CA 125 (K bu\u1ed3ng tr\u1ee9ng), CA 19-9 (K t\u1ee5y)\u2026<\/p>\n
– H\u1ed9i ch\u1ee9ng c\u1eadn ung th\u01b0: m\u00f4 K c\u00f3 th\u1ec3 ch\u1ebf ti\u1ebft c\u00e1c \u0111a peptid mang \u0111\u1eb7c t\u00ednh hormon thu\u1ed9c d\u1ea1ng ACTH, FSH, LH v\u00e0 c\u00f3 c\u1ea5u tr\u00fac kh\u00f4ng ho\u00e0n to\u00e0n gi\u1ed1ng hormon t\u01b0\u01a1ng \u1ee9ng g\u00e2y ra bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 sinh h\u1ecdc kh\u00f4ng \u0111\u1eb7c hi\u1ec7u xu\u1ea5t hi\u1ec7n tr\u01b0\u1edbc ho\u1eb7c \u0111\u1ed3ng th\u1eddi v\u1edbi b\u1ec7nh ung th\u01b0<\/p>\n
C\u00e2u 10: Tr\u00ecnh b\u00e0y nh\u1eefng t\u1ed5n th\u01b0\u01a1ng do r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a t\u1ebf b\u00e0o?<\/p>\n
1. \u0110\u1ecbnh ngh\u0129a t\u1ebf b\u00e0o, ch\u1ee9c n\u0103ng c\u01a1 b\u1ea3n c\u1ee7a t\u1ebf b\u00e0o<\/p>\n
T\u1ebf b\u00e0o l\u00e0 \u0111\u01a1n v\u1ecb sinh h\u1ecdc c\u01a1 b\u1ea3n c\u1ee7a c\u01a1 th\u1ec3 ng\u01b0\u1eddi, g\u1ed3m nhi\u1ec1u th\u00e0nh ph\u1ea7n c\u1ea5u tr\u00fac ph\u1ee9c t\u1ea1p v\u1edbi nh\u1eefng ch\u1ee9c n\u0103ng kh\u00e1c nhau \u0111\u1ec3 t\u1ea1o n\u00ean c\u00e1c ho\u1ea1t \u0111\u1ed9ng phong ph\u00fa c\u1ee7a c\u01a1 th\u1ec3<\/p>\n
1) Ho\u1ea1t \u0111\u1ed9ng sinh t\u1ed3n: s\u1ef1 ho\u00e0n ch\u1ec9nh trong c\u00e1c th\u00e0nh ph\u1ea7n c\u1ea5u tr\u00fac (m\u00e0ng, b\u00e0o t\u01b0\u01a1ng, nh\u00e2n\u2026)<\/p>\n
2) Ho\u1ea1t \u0111\u1ed9ng chuy\u1ec3n h\u00f3a: trao \u0111\u1ed5i ch\u1ea5t v\u1edbi m\u00f4i tr\u01b0\u1eddng b\u00ean ngo\u00e0i \u0111\u1ea3m b\u1ea3o s\u1ef1 t\u1ed3n t\u1ea1i v\u00e0 ph\u00e1t tri\u1ec3n<\/p>\n
3) Ho\u1ea1t \u0111\u1ed9ng th\u00edch nghi: kh\u1ea3 n\u0103ng thay \u0111\u1ed5i h\u00ecnh th\u00e1i, c\u1ea5u tr\u00fac ph\u00f9 h\u1ee3p v\u1edbi \u0111i\u1ec1u ki\u1ec7n m\u00f4i tr\u01b0\u1eddng<\/p>\n
4) Ho\u1ea1t \u0111\u1ed9ng sinh s\u1ea3n: lu\u00f4n ph\u00e2n chia t\u1ea1o t\u1ebf b\u00e0o m\u1edbi \u0111\u1ec3 ph\u00e1t tri\u1ec3n c\u01a1 th\u1ec3 v\u00e0 thay th\u1ebf t\u1ebf b\u00e0o c\u0169<\/p>\n
2. T\u1ed5n th\u01b0\u01a1ng do r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a t\u1ebf b\u00e0o<\/p>\n
2.1) Ph\u00ec \u0111\u1ea1i t\u1ebf b\u00e0o:<\/p>\n
– L\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng kh\u1ed1i l\u01b0\u1ee3ng v\u00e0 k\u00edch th\u01b0\u1edbc t\u1ebf b\u00e0o, l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a qu\u00e1 tr\u00ecnh t\u0103ng chuy\u1ec3n h\u00f3a, t\u0103ng trao \u0111\u1ed5i ch\u1ea5t v\u1edbi m\u00f4i tr\u01b0\u1eddng b\u00ean ngo\u00e0i<\/p>\n
– C\u00e1c b\u00e0o quan (ty th\u1ec3, ribosom) c\u0169ng gia t\u0103ng v\u1ec1 s\u1ed1 l\u01b0\u1ee3ng v\u00e0 k\u00edch th\u01b0\u1edbc<\/p>\n
– Ph\u00ec \u0111\u1ea1i t\u1ebf b\u00e0o c\u00f3 th\u1ec3 ho\u1eb7c kh\u00f4ng th\u1ec3 kh\u1ea3 h\u1ed3i, c\u00f3 th\u1ec3 g\u00e2y ph\u00ec \u0111\u1ea1i c\u1ea3 1 v\u00f9ng m\u00f4 ho\u1eb7c c\u01a1 quan<\/p>\n
– C\u00f3 th\u1ec3 g\u1eb7p ph\u00ec \u0111\u1ea1i t\u1ebf b\u00e0o trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p sinh l\u00fd ho\u1eb7c b\u1ec7nh l\u00fd:<\/p>\n
+ Sinh l\u00fd: ph\u00ec \u0111\u1ea1i c\u01a1 b\u1eafp \u1edf l\u1ef1c s\u0129 c\u1eed t\u1ea1, t\u1eed cung n\u1edf to \u1edf ph\u1ee5 n\u1eef c\u00f3 thai<\/p>\n
+ B\u1ec7nh l\u00fd:<\/p>\n
(+) Th\u1ea5t tr\u00e1i ph\u00ec \u0111\u1ea1i trong THA, h\u1eb9p van 2 l\u00e1, b\u1ec7nh tim b\u1ea9m sinh<\/p>\n
(+) V\u00e1ch d\u1ea1 d\u00e0y ph\u00ec \u0111\u1ea1i trong b\u1ec7nh h\u1eb9p m\u00f4n v\u1ecb<\/p>\n
(+) Nhu m\u00f4 gan ph\u00ec \u0111\u1ea1i b\u00f9 tr\u1eeb trong tr\u01b0\u1eddng h\u1ee3p c\u1eaft b\u1ecf gan\u2026<\/p>\n
2.2) Teo \u0111\u00e9t t\u1ebf b\u00e0o:<\/p>\n
– L\u00e0 hi\u1ec7n t\u01b0\u1ee3ng gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng, k\u00edch th\u01b0\u1edbc t\u1ebf b\u00e0o do sinh ch\u1ea5t \u00edt d\u01b0\u1edbi m\u1ee9c b\u00ecnh th\u01b0\u1eddng, c\u00e1c b\u00e0o quan c\u0169ng gi\u1ea3m s\u00fat v\u1ec1 c\u1ea3 l\u01b0\u1ee3ng v\u00e0 ch\u1ea5t<\/p>\n
– L\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a qu\u00e1 tr\u00ecnh gi\u1ea3m chuy\u1ec3n h\u00f3a<\/p>\n
– C\u00f3 th\u1ec3 l\u00e0m cho 1 v\u00f9ng m\u00f4 ho\u1eb7c 1 t\u1ea1ng teo nh\u1ecf<\/p>\n
– Nguy\u00ean nh\u00e2n:<\/p>\n
+ Sinh l\u00fd: do m\u00f4 v\u00e0 t\u1ea1ng tho\u00e1i tri\u1ec3n l\u00fac v\u1ec1 gi\u00e0 (teo c\u01a1, m\u1ee1 -> n\u1ebfp nh\u0103n), teo tuy\u1ebfn \u1ee9c khi tr\u01b0\u1edfng th\u00e0nh<\/p>\n
+ Thi\u1ebfu dinh d\u01b0\u1ee1ng, \u0111\u00f3i \u0103n<\/p>\n
+ Thi\u1ebfu ho\u1ea1t \u0111\u1ed9ng<\/p>\n
+ T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh: b\u1ea1i li\u1ec7t -> teo c\u01a1<\/p>\n
+ Thi\u1ebfu oxy do gi\u1ea3m l\u01b0\u1ee3ng m\u00e1u nu\u00f4i<\/p>\n
+ R\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft:<\/p>\n
(+) S\u1eed d\u1ee5ng corticoid k\u00e9o d\u00e0i -> teo v\u1ecf th\u01b0\u1ee3ng th\u1eadn<\/p>\n
(+) Hormon ho\u1ea1t \u0111\u1ed9ng \u0111\u1ed1i kh\u00e1ng v\u1edbi c\u01a1 quan ti\u1ebfp nh\u1eadn:<\/p>\n
(-) Estrogen ng\u0103n t\u1ea1o tinh tr\u00f9ng -> teo \u1ed1ng sinh tinh<\/p>\n
(-) Th\u1eddi k\u1ef3 b\u00e0o thai: estrogen g\u00e2y teo \u0111\u00e9t \u1ed1ng Wolff, androgen g\u00e2y teo \u0111\u00e9t \u1ed1ng Muller<\/p>\n
2.3) Tho\u00e1i h\u00f3a t\u1ebf b\u00e0o:<\/p>\n
– L\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng \u1edf b\u00e0o t\u01b0\u01a1ng v\u00e0 c\u00e1c b\u00e0o quan, hi\u1ebfm khi \u1edf nh\u00e2n<\/p>\n
– K\u00edch th\u01b0\u1edbc t\u1ebf b\u00e0o trong tho\u00e1i h\u00f3a c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c teo \u0111\u00e9t<\/p>\n
– Tho\u00e1i h\u00f3a l\u00e0 t\u1ed5n th\u01b0\u01a1ng kh\u1ea3 h\u1ed3i, nh\u01b0ng n\u1ebfu t\u1ed5n th\u01b0\u01a1ng qu\u00e1 n\u1eb7ng v\u00e0 k\u00e9o d\u00e0i c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ho\u1ea1i t\u1eed t\u1ebf b\u00e0o<\/p>\n
– C\u00f3 nhi\u1ec1u d\u1ea1ng tho\u00e1i h\u00f3a t\u1ebf b\u00e0o:<\/p>\n
(1) Tho\u00e1i h\u00f3a \u0111\u1ee5c: t\u1ebf b\u00e0o ph\u1ed3ng to, b\u00e0o t\u01b0\u01a1ng v\u1ea9n \u0111\u1ee5c, ty th\u1ec3 ph\u1ed3ng to, l\u01b0\u1edbi n\u1ed9i b\u00e0o gi\u00e3n r\u1ed9ng<\/p>\n
(2) Tho\u00e1i h\u00f3a h\u1ea1t: c\u00f3 nh\u1eefng h\u1ea1t nh\u1ecf li ti \u1edf b\u00e0o t\u01b0\u01a1ng, th\u01b0\u1eddng th\u1ea5y \u1edf b\u00e0o t\u01b0\u01a1ng t\u1ebf b\u00e0o gan trong b\u1ec7nh vi\u00eam gan si\u00eau vi. Nguy\u00ean nh\u00e2n l\u00e0 do r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a protein<\/p>\n
(3) Tho\u00e1i h\u00f3a h\u1ed1c: l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng h\u00ecnh th\u00e0nh c\u00e1c khoang, h\u1ed1c nh\u1ecf trong b\u00e0o t\u01b0\u01a1ng t\u1ebf b\u00e0o. C\u00e1c khoang \u0111\u00f3 c\u00f3 th\u1ec3 tr\u1ed1ng r\u1ed7ng ho\u1eb7c ch\u1ee9a glycogen, m\u1ee1\u2026 th\u01b0\u1eddng th\u1ea5y \u1edf c\u00e1c t\u1ebf b\u00e0o malpighi, t\u1ebf b\u00e0o \u0111\u00e1y \u1edf l\u1edbp th\u01b0\u1ee3ng b\u00ec. Tho\u00e1i h\u00f3a h\u1ed1c c\u00f3 th\u1ec3 do:<\/p>\n
(+) T\u1ed5n th\u01b0\u01a1ng c\u00e1c b\u00e0o quan nh\u01b0 l\u01b0\u1edbi n\u1ed9i b\u00e0o v\u00e0 ty th\u1ec3<\/p>\n
(+) \u1ea8m t\u01b0\u1ee3ng qu\u00e1 m\u1ea1nh<\/p>\n
(+) C\u00e1c khoang l\u01b0\u1edbi n\u1ed9i b\u00e0o ch\u1ee9a d\u1ecbch l\u1ecfng ho\u1eb7c lipid ho\u1eb7c glycogen<\/p>\n
(4) Tho\u00e1i h\u00f3a n\u01b0\u1edbc: l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng ng\u1ea5m n\u01b0\u1edbc lan t\u1ecfa l\u00e0m t\u1ebf b\u00e0o s\u00e1ng trong, b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o b\u1ecb bi\u1ebfn \u0111\u1ed5i, l\u01b0\u1edbi n\u1ed9i b\u00e0o gi\u00e3n r\u1ed9ng, ty th\u1ec3 ph\u1ed3ng to t\u1ea1o th\u00e0nh nhi\u1ec1u t\u00fai n\u1ed9i b\u00e0o<\/p>\n
(5) Tho\u00e1i h\u00f3a m\u1ee1: l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n nh\u1eefng h\u1ea1t m\u1ee1 b\u1ea5t th\u01b0\u1eddng \u1edf b\u00e0o t\u01b0\u01a1ng, trong ty th\u1ec3. Th\u01b0\u1eddng th\u1ea5y \u1edf t\u1ebf b\u00e0o gan c\u00e1c tr\u1ebb nh\u1ecf m\u1eafc b\u1ec7nh suy dinh d\u01b0\u1ee1ng, \u1edf ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim, b\u1ec7nh x\u01a1 gan<\/p>\n
(6) Tho\u00e1i h\u00f3a glycogen: b\u00e0o t\u01b0\u01a1ng ch\u1ee9a nh\u1eefng h\u1ea1t glycogen k\u00e8m gi\u00e1ng h\u00f3a c\u00e1c protein c\u1ea5u tr\u00fac<\/p>\n
(7) Tho\u00e1i h\u00f3a trong:<\/p>\n
(+) T\u1ebf b\u00e0o v\u00e0 m\u00f4 c\u00f3 nh\u1eefng bi\u1ebfn \u0111\u1ed5i t\u1ea1o th\u00e0nh 1 \u0111\u00e1m thu\u1ea7n nh\u1ea5t, v\u00f4 d\u1ea1ng, c\u00f3 m\u00e0u h\u1ed3ng nh\u1ea1t (khi nhu\u1ed9m m\u00e0u eosin)<\/p>\n
(+) L\u01b0\u1edbi n\u1ed9i b\u00e0o h\u1ea1t co r\u00fam, l\u1edbp m\u00e0ng ngo\u00e0i \u1ee9 \u0111\u1ea7y ch\u1ea5t l\u1ea1<\/p>\n
(+) Trong b\u00e0o t\u01b0\u01a1ng l\u1eafng \u0111\u1ecdng nhi\u1ec1u s\u1ee3i nh\u1ecf (8-10 nm). Tho\u00e1i h\u00f3a trong c\u00f3 th\u1ec3 hi\u1ec7n di\u1ec7n \u1edf:<\/p>\n
(-) B\u00e0o t\u01b0\u01a1ng: d\u01b0\u1edbi d\u1ea1ng th\u1ec3 Russell \u1edf t\u01b0\u01a1ng b\u00e0o<\/p>\n
(-) M\u00f4: d\u01b0\u1edbi d\u1ea1ng nh\u1eefng c\u1ee5c tr\u00f2n, thu\u1ea7n nh\u1ea5t (c\u00f2n g\u1ecdi l\u00e0 h\u00ecnh \u1ea3nh d\u1ea5u xi) \u1edf c\u1ea7u th\u1eadn trong vi\u00eam c\u1ea7u th\u1eadn m\u1ea1n<\/p>\n
2.4) Ho\u1ea1i t\u1eed t\u1ebf b\u00e0o:<\/p>\n
– L\u00e0 t\u00ecnh tr\u1ea1ng t\u1ebf b\u00e0o kh\u00f4ng c\u00f2n ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng, bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi 2 d\u1ea1ng: sinh l\u00fd ho\u1eb7c b\u1ec7nh l\u00fd (tr\u00ean c\u01a1 th\u1ec3 s\u1ed1ng)<\/p>\n
– Hi\u1ec7n t\u01b0\u1ee3ng bi\u1ebfn \u0111\u1ed5i l\u00e0m tan r\u00e3 t\u1ebf b\u00e0o \u1edf c\u01a1 th\u1ec3 ch\u1ebft g\u1ecdi l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng t\u1ef1 ti\u00eau<\/p>\n
(1) Ho\u1ea1i t\u1eed sinh h\u1ecdc:<\/p>\n
+ C\u00f3 th\u1ec3 coi nh\u01b0 1 qu\u00e1 tr\u00ecnh ch\u1ebft t\u1ebf b\u00e0o \u0111\u00e3 \u0111\u01b0\u1ee3c \u201cch\u01b0\u01a1ng tr\u00ecnh h\u00f3a\u201d. Gi\u00fap cho s\u1ef1 t\u1ea1o ph\u00f4i, t\u1ea1o t\u1ea1ng v\u00e0 ph\u00e1t tri\u1ec3n c\u01a1 th\u1ec3<\/p>\n
+ \u0110\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi nhi\u1ec1u h\u00ecnh th\u00e1i:<\/p>\n
(+) Ni\u00eam m\u1ea1c t\u1eed cung tho\u00e1i h\u00f3a \u0111\u1ec3 chu\u1ea9n b\u1ecb cho tr\u1ee9ng<\/p>\n
(+) H\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u t\u1ef1 h\u1ee7y sau 1 th\u1eddi gian ho\u1ea1t \u0111\u1ed9ng\u2026<\/p>\n
+ Gi\u00fap \u0111i\u1ec1u h\u00f2a m\u1eadt \u0111\u1ed9 v\u00e0 s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o b\u00ecnh th\u01b0\u1eddng, th\u1ea3i b\u1ecf nh\u1eefng t\u1ebf b\u00e0o kh\u00f4ng c\u1ea7n thi\u1ebft<\/p>\n
(2) Ho\u1ea1i t\u1eed b\u1ec7nh l\u00fd:<\/p>\n
– L\u00e0 qu\u00e1 tr\u00ecnh ch\u1ebft t\u1ebf b\u00e0o do nhi\u1ec1u nguy\u00ean nh\u00e2n t\u00e1c h\u1ea1i kh\u00e1c nhau:<\/p>\n
+ R\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n m\u00e1u: ng\u01b0ng m\u00e1u (huy\u1ebft kh\u1ed1i, huy\u1ebft t\u1eafc\u2026), v\u00f4 huy\u1ebft (gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u)<\/p>\n
+ V\u1eadt l\u00fd: ch\u1ea5n th\u01b0\u01a1ng c\u01a1 h\u1ecdc, bi\u1ebfn \u0111\u1ed5i nhi\u1ec7t \u0111\u1ed9 (ch\u00e1y n\u1eafng, b\u0103ng gi\u00e1), \u00e1p su\u1ea5t kh\u00ed quy\u1ec3n<\/p>\n
+ H\u00f3a h\u1ecdc: c\u00e1c ch\u1ea5t \u0111\u1ed9c n\u1ed9i t\u1ea1o (enzym ti\u00eau protein c\u1ee7a c\u00e1c t\u1ebf b\u00e0o) v\u00e0 ngo\u1ea1i t\u1ea1o (Hg l\u00e0m ch\u1ebft t\u1ebf b\u00e0o \u1ed1ng th\u1eadn, chloroform t\u00e1c h\u1ea1i \u0111\u1ebfn t\u1ebf b\u00e0o gan\u2026 c\u00e1c ch\u1ea5t \u00f4 nhi\u1ec5m m\u00f4i tr\u01b0\u1eddng nh\u01b0 thu\u1ed1c di\u1ec7t c\u00f4n tr\u00f9ng, ng\u1ed9 \u0111\u1ed9c r\u01b0\u1ee3u, ma t\u00fay\u2026)<\/p>\n
+ \u0110\u1ed9c t\u1ed1 sinh v\u1eadt (vi khu\u1ea9n, virus, n\u1ea5m, k\u00fd sinh tr\u00f9ng)<\/p>\n
+ C\u00e1c b\u1ec7nh vi\u00eam nhi\u1ec5m v\u00e0 t\u1ef1 mi\u1ec5n<\/p>\n
+ C\u00e1c bi\u1ebfn \u0111\u1ed5i gen c\u00f3 th\u1ec3 t\u1ea1o n\u00ean b\u1ec7nh b\u1ea9m sinh, d\u1ecb t\u1eadt, thi\u1ebfu nhi\u1ec1u enzym g\u00e2y t\u00e1c h\u1ea1i cho chuy\u1ec3n h\u00f3a t\u1ebf b\u00e0o<\/p>\n
– D\u1ea5u hi\u1ec7u ho\u1ea1i t\u1eed:<\/p>\n
(1) Nh\u00e2n:<\/p>\n
+ \u0110\u00f4ng: thu nh\u1ecf, co r\u00fam th\u00e0nh 1 kh\u1ed1i \u0111\u1eb7c, t\u0103ng s\u1eafc, ki\u1ec1m t\u00ednh<\/p>\n
+ V\u1ee1: v\u1ee5n r\u1eddi th\u00e0nh nhi\u1ec1u m\u1ea3nh nh\u1ecf<\/p>\n
+ Tan: d\u1ea7n d\u1ea7n bi\u1ebfn m\u1ea5t<\/p>\n
(2) B\u00e0o t\u01b0\u01a1ng, b\u00e0o quan t\u1ed5n th\u01b0\u01a1ng tho\u00e1i h\u00f3a n\u1eb7ng, v\u00ec v\u1eady t\u1ed5n th\u01b0\u01a1ng r\u1ea5t n\u1eb7ng v\u00e0 kh\u00f4ng kh\u1ea3 h\u1ed3i<\/p>\n
– D\u1ea1ng:<\/p>\n
(1) Ho\u1ea1i t\u1eed n\u01b0\u1edbc:<\/p>\n
+ Th\u01b0\u1eddng \u1edf m\u00f4 n\u00e3o sau 1 ch\u1ea5n th\u01b0\u01a1ng\/ ng\u01b0ng m\u00e1u<\/p>\n
+ V\u00f9ng t\u1ed5n th\u01b0\u01a1ng c\u00f3 m\u00e0u x\u00e1m tr\u1eafng, qu\u00e1nh \u0111\u1eb7c r\u1ed3i h\u00f3a l\u1ecfng do enzym n\u1ed9i b\u00e0o h\u1ee7y m\u00f4, g\u1ed3m c\u00e1c \u0110TB c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb t\u1ebf b\u00e0o th\u1ea7n kinh \u0111\u1ec7m \u0111\u1ebfn \u0103n c\u00e1c m\u1ea3nh v\u1ee5n ho\u1ea1i t\u1eed<\/p>\n
(2) Ho\u1ea1i t\u1eed \u0111\u00f4ng:<\/p>\n
+ Th\u01b0\u1eddng \u1edf tim, th\u1eadn, l\u00e1ch do ng\u01b0ng m\u00e1u \u0111\u1ed9t ng\u1ed9t\/ \u0111\u1ed9c t\u1ed1 c\u1ee7a vi khu\u1ea9n hay h\u00f3a ch\u1ea5t<\/p>\n
+ V\u00f9ng t\u1ed5n th\u01b0\u01a1ng c\u00f3 m\u00e0u x\u00e1m tr\u1eafng, kh\u00f4 r\u1eafn v\u1edbi b\u00f3ng m\u1edd c\u1ea5u tr\u00fac c\u0169<\/p>\n
(3) Ho\u1ea1i t\u1eed m\u1ee1:<\/p>\n
+ D\u1ea1ng ho\u1ea1i t\u1eed n\u01b0\u1edbc c\u1ee7a m\u00f4 m\u1ee1<\/p>\n
+ D\u01b0\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a lipase: m\u1ee1 -> glycerol + acid b\u00e9o t\u1ef1 do, acid b\u00e9o l\u1eafng \u0111\u1ecdng th\u00e0nh \u0111\u00e1m que ho\u1eb7c \u0111\u01b0\u1ee3c x\u00e0 ph\u00f2ng h\u00f3a v\u1edbi mu\u1ed1i ki\u1ec1m -> v\u00f9ng ho\u1ea1i t\u1eed c\u00f3 m\u00e0u v\u00e0ng tr\u1eafng, nh\u00e3o<\/p>\n
(4) Ho\u1ea1i t\u1eed b\u00e3 \u0111\u1eadu:<\/p>\n
+ Do lipoid \u1edf v\u1ecf tr\u1ef1c khu\u1ea9n Koch g\u00e2y \u0111\u1ed9c cho t\u1ebf b\u00e0o v\u00e0 m\u00f4<\/p>\n
+ V\u00f9ng t\u1ed5n th\u01b0\u01a1ng c\u00f3 m\u00e0u tr\u1eafng v\u00e0ng, t\u1ed3n t\u1ea1i l\u00e2u do tr\u1ef1c khu\u1ea9n Koch \u1ee9c ch\u1ebf enzym th\u1ee7y ph\u00e2n n\u1ed9i b\u00e0o<\/p>\n
(5) Ho\u1ea1i t\u1eed ch\u1ea3y m\u00e1u:<\/p>\n
+ Ho\u1ea1i t\u1eed \u0111\u00f4ng\/ n\u01b0\u1edbc + ch\u1ea3y m\u00e1u tr\u00e0n ng\u1eadp lan r\u1ed9ng \u1edf m\u00f4<\/p>\n
+ \u0110\u01b0\u1eddng m\u00e1u tr\u1edf v\u1ec1 b\u1ecb l\u1ea5p t\u1eafc -> v\u00e1ch m\u1ea1ch v\u00e0 c\u1ea5u tr\u00fac m\u00f4 ho\u1ea1i t\u1eed -> tr\u00e0n ng\u1eadp m\u00e1u, v\u00f9ng k\u1ebf c\u1eadn \u0111\u1ecf v\u00e0 s\u01b0ng ph\u1ed3ng. G\u1eb7p trong ho\u1ea1i t\u1eed thi\u1ebfu m\u00e1u v\u00e0 ch\u1ea3y m\u00e1u \u1edf ph\u1ed5i<\/p>\n
+ Ho\u1eb7c ch\u1ea3y m\u00e1u tr\u00e0n ng\u1eadp -> thi\u1ebfu m\u00e1u -> ho\u1ea1i t\u1eed v\u00f9ng ch\u1ea3y m\u00e1u v\u00e0 v\u00f9ng k\u1ebf c\u1eadn. G\u1eb7p trong ch\u1ea3y m\u00e1u l\u1edbn \u1edf kh\u1ed1i u tinh ho\u00e0n<\/p>\n
(6) Ho\u1ea1i t\u1eed t\u01a1 huy\u1ebft:<\/p>\n
+ Th\u01b0\u1eddng x\u1ea3y ra tr\u00ean v\u00e1ch \u0110M nh\u1ecf c\u1ee7a ng\u01b0\u1eddi THA, \u1edf m\u00f4 li\u00ean k\u1ebft c\u1ee7a ng\u01b0\u1eddi b\u1ecb b\u1ec7nh vi\u00eam n\u00fat quanh \u0110M<\/p>\n
+ V\u00f9ng t\u1ed5n th\u01b0\u01a1ng c\u00f3 d\u1ea1ng nh\u1eefng h\u1ea1t kh\u00f4ng thu\u1ea7n nh\u1ea5t, b\u1eaft eosin m\u00e0u h\u1ed3ng nh\u1ea1t<\/p>\n
+ Nguy\u00ean nh\u00e2n do r\u1ed1i lo\u1ea1n mi\u1ec5n nhi\u1ec5m<\/p>\n
(7) Ho\u1ea1i t\u1eed canxi h\u00f3a:<\/p>\n
+ L\u00e0 1 d\u1ea1ng ho\u1ea1i t\u1eed mu\u1ed9n (v\u00ec qu\u00e1 tr\u00ecnh h\u00f3a canxi th\u01b0\u1eddng x\u1ea3y ra ch\u1eadm) do th\u1ea5m v\u00f4i d\u01b0\u1edbi d\u1ea1ng nh\u1eefng \u0111\u00e1m, nh\u1eefng kh\u1ed1i \u0111\u1eb7c, \u01b0a ki\u1ec1m, c\u00f3 h\u00ecnh th\u00e1i v\u00e0 k\u00edch th\u01b0\u1edbc r\u1ea5t kh\u00e1c nhau, \u0111\u00f4i khi r\u1eafn nh\u01b0 \u0111\u00e1<\/p>\n
+ Th\u01b0\u1eddng x\u1ea3y ra \u1edf c\u00e1c ho\u1ea1i t\u1eed \u0111\u00f4ng, ho\u1ea1i t\u1eed m\u1ee1 v\u00e0 ho\u1ea1i t\u1eed b\u00e3 \u0111\u1eadu<\/p>\n
+ Qu\u00e1 tr\u00ecnh l\u1eafng \u0111\u1ecdng canxi c\u00f3 l\u1ebd li\u00ean quan \u0111\u1ebfn: s\u1ef1 gi\u1ea3m \u00e1p l\u1ef1c CO2 \u1edf m\u00f4 vi\u00eam, t\u00ednh ki\u1ec1m c\u1ee7a m\u00f4 ho\u1ea1i t\u1eed, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a phosphatase ki\u1ec1m<\/p>\n
(8) Ho\u1ea1i t\u1eed ho\u1ea1i th\u01b0:<\/p>\n
+ B\u1ea3n ch\u1ea5t l\u00e0 ho\u1ea1i t\u1eed \u0111\u00f4ng<\/p>\n
+ Th\u01b0\u1eddng x\u1ea3y ra \u1edf \u0111\u1ea7u chi<\/p>\n
+ Ho\u1ea1i th\u01b0 \u01b0\u1edbt:<\/p>\n
(+) Ho\u1ea1i t\u1eed \u0111\u00f4ng c\u1ee7a c\u00e1c chi b\u1ecb nhi\u1ec5m khu\u1ea9n<\/p>\n
(+) Nhi\u1ec5m khu\u1ea9n t\u1ed5 ch\u1ee9c ho\u1ea1i t\u1eed \u0111\u00f4ng d\u1eabn \u0111\u1ebfn vi\u00eam v\u00e0 ho\u1ea1i t\u1eed n\u01b0\u1edbc th\u1ee9 ph\u00e1t<\/p>\n
(+) D\u1ecbch m\u00e0u n\u00e2u b\u1ea9n l\u1eabn m\u00e1u, h\u00f4i th\u1ed1i v\u00e0 ch\u1ee9a nhi\u1ec1u b\u1ecdt kh\u00ed<\/p>\n
+ Ho\u1ea1i th\u01b0 kh\u00f4:<\/p>\n
(+) Ho\u1ea1i t\u1eed \u0111\u00f4ng b\u1ecb m\u1ea5t n\u01b0\u1edbc do b\u1ed1c h\u01a1i, do s\u1ee9c n\u00f3ng l\u00e0m t\u1ed5 ch\u1ee9c kh\u00f4 ki\u1ec7t v\u00e0 l\u00e0m cho c\u00e1c men t\u1ef1 ph\u00e2n h\u1ee7y b\u1ecb \u1ee9c ch\u1ebf<\/p>\n
(+) Ho\u1ea1i t\u1eed n\u00e0y c\u00f2n g\u1ecdi l\u00e0 mummy h\u00f3a (do thi\u1ebfu m\u00e1u nu\u00f4i d\u01b0\u1ee1ng g\u00e2y n\u00ean)<\/p>\n
(+) C\u00e1c t\u1ebf b\u00e0o r\u00fam r\u00f3 v\u00e0 \u0111\u00f4ng \u0111\u1eb7c<\/p>\n
2.5) Th\u1ea5m nh\u1eadp t\u1ebf b\u00e0o:<\/p>\n
– L\u00e0 hi\u1ec7n t\u01b0\u1ee3ng b\u00e0o t\u01b0\u01a1ng ch\u1ee9a nh\u1eefng ch\u1ea5t c\u00f3 s\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u h\u01a1n b\u00ecnh th\u01b0\u1eddng. Vi\u1ec7c thu nh\u1eadn c\u00e1c ch\u1ea5t \u0111\u00f3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n qua nh\u1eadp b\u00e0o (\u1ea9m t\u01b0\u1ee3ng \u0111\u1ed1i v\u1edbi d\u1ecbch l\u1ecfng v\u00e0 th\u1ef1c t\u01b0\u1ee3ng \u0111\u1ed1i v\u1edbi th\u1ec3 \u0111\u1eb7c) r\u1ed3i k\u1ebft h\u1ee3p v\u1edbi c\u00e1c lysosom n\u1ed9i b\u00e0o \u0111\u1ec3 t\u1ea1o n\u00ean nh\u1eefng th\u1ec3 th\u1ef1c v\u00e0 \u0111\u01b0\u1ee3c ti\u00eau h\u00f3a b\u1eb1ng c\u00e1c enzym th\u1ee7y ph\u00e2n<\/p>\n
– C\u00e1c ch\u1ea5t th\u1ea5m nh\u1eadp th\u01b0\u1eddng c\u00f3 2 ngu\u1ed3n g\u1ed1c:<\/p>\n
+ Ngo\u1ea1i t\u1ea1o: b\u1ee5i than, b\u1ee5i kho\u00e1ng, m\u1ea3nh v\u1ee5n oxyt s\u1eaft, ch\u00ec\u2026 c\u00e1c s\u1eafc t\u1ed1 d\u00f9ng \u0111\u1ec3 x\u0103m da<\/p>\n
+ N\u1ed9i t\u1ea1o: glycogen th\u1ea5m nh\u1eadp v\u00e0o th\u01b0\u1ee3ng m\u00f4 \u1ed1ng l\u01b0\u1ee3n xa, \u0111o\u1ea1n xu\u1ed1ng c\u1ee7a quai Henle \u1edf \u1ed1ng th\u1eadn, v\u00e0o t\u1ebf b\u00e0o gan, t\u1ebf b\u00e0o \u03b2 tuy\u1ebfn t\u1ee5y trong ti\u1ec3u \u0111\u01b0\u1eddng. Ho\u1eb7c nh\u01b0 c\u00e1c ch\u1ea5t h\u00ecnh th\u00e0nh trong c\u01a1 th\u1ec3 (melanin, hemoglobin\u2026)<\/p>\n
C\u00e2u 11: Tr\u00ecnh b\u00e0y nh\u1eefng t\u1ed5n th\u01b0\u01a1ng do r\u1ed1i lo\u1ea1n th\u00edch nghi?<\/p>\n
1. Kh\u00e1i ni\u1ec7m v\u1ec1 s\u1ef1 th\u00edch nghi t\u1ebf b\u00e0o<\/p>\n
– C\u01a1 th\u1ec3 sinh v\u1eadt \u0111\u01b0\u1ee3c c\u1ea5u tr\u00fac b\u1edfi nhi\u1ec1u lo\u1ea1i t\u1ebf b\u00e0o r\u1ea5t kh\u00e1c nhau, s\u1ef1 phong ph\u00fa v\u1ec1 c\u1ea5u tr\u00fac \u0111\u00f3 bi\u1ec3u hi\u1ec7n t\u00ednh th\u00edch nghi c\u1ee7a sinh v\u1eadt \u0111\u1ed1i v\u1edbi \u0111i\u1ec1u ki\u1ec7n s\u1ed1ng \u1edf m\u00f4i tr\u01b0\u1eddng xung quanh<\/p>\n
– \u0110\u00f3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a m\u1ed1i quan h\u1ec7 qua l\u1ea1i trong su\u1ed1t h\u00e0ng tri\u1ec7u n\u0103m gi\u1eefa t\u1ebf b\u00e0o v\u00e0 m\u00f4i tr\u01b0\u1eddng. Bi\u1ec7t h\u00f3a t\u1ebf b\u00e0o ch\u00ednh l\u00e0 qu\u00e1 tr\u00ecnh th\u00edch nghi ch\u1eadm ch\u1ea1p, k\u00edn \u0111\u00e1o c\u1ee7a sinh v\u1eadt k\u1ebf ti\u1ebfp nhau qua bao th\u1ebf h\u1ec7 \u0111\u1ec3 t\u1ea1o n\u00ean nh\u1eefng h\u00ecnh th\u00e1i th\u00edch \u1ee9ng nh\u1ea5t \u0111\u1ecbnh<\/p>\n
2. T\u1ed5n th\u01b0\u01a1ng do r\u1ed1i lo\u1ea1n th\u00edch nghi: khi m\u00f4i tr\u01b0\u1eddng b\u00ean ngo\u00e0i thay \u0111\u1ed5i s\u1ebd t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn t\u00ednh th\u00edch nghi c\u1ee7a t\u1ebf b\u00e0o, g\u00e2y ra nh\u1eefng bi\u1ebfn \u0111\u1ed5i v\u1ec1 h\u00ecnh th\u00e1i v\u00e0 \u0111\u00f4i khi c\u1ea3 c\u1ea5u tr\u00fac t\u1ebf b\u00e0o. Nh\u1eefng bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac \u0111\u00f3 bao g\u1ed3m:<\/p>\n
2.1) Bi\u1ec7t h\u00f3a v\u00e0 r\u1ed1i lo\u1ea1n bi\u1ec7t h\u00f3a t\u1ebf b\u00e0o:<\/p>\n
– \u1ede nh\u1eefng v\u00f9ng m\u00f4 sinh s\u1ea3n, m\u1ed7i ph\u00e2n b\u00e0o \u0111\u1ec1u cho 2 t\u1ebf b\u00e0o con: 1 t\u1ebf b\u00e0o thay th\u1ebf t\u1ebf b\u00e0o m\u1eb9, 1 t\u1ebf b\u00e0o bi\u1ec7t h\u00f3a theo ph\u01b0\u01a1ng th\u1ee9c b\u00ecnh th\u01b0\u1eddng c\u1ee7a v\u00f9ng m\u00f4 \u0111\u00f3<\/p>\n
– Qu\u00e1 tr\u00ecnh bi\u1ec7t h\u00f3a \u0111\u00f3 c\u00f3 th\u1ec3 kh\u00f4ng x\u1ea3y ra ho\u1eb7c ng\u01b0ng l\u1ea1i gi\u1eefa ch\u1eebng l\u00e0m cho t\u1ebf b\u00e0o kh\u00f4ng \u0111\u1ea1t \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 tr\u01b0\u1edfng th\u00e0nh<\/p>\n
– Do \u0111\u00f3 m\u1ed7i d\u00f2ng t\u1ebf b\u00e0o c\u00f3 th\u1ec3 \u1edf nh\u1eefng m\u1ee9c \u0111\u1ed9 bi\u1ec7t h\u00f3a kh\u00e1c nhau: bi\u1ec7t h\u00f3a r\u00f5, bi\u1ec7t h\u00f3a v\u1eeba, bi\u1ec7t h\u00f3a k\u00e9m<\/p>\n
(1) H\u00ecnh th\u00e1i c\u1ee7a t\u1ebf b\u00e0o ch\u01b0a bi\u1ec7t h\u00f3a:<\/p>\n
+ T\u1ebf b\u00e0o tr\u00f2n<\/p>\n
+ Kh\u00f4ng c\u00f3 nh\u1eefng h\u00ecnh nh\u00f4 ngo\u00e0i b\u00e0o t\u01b0\u01a1ng<\/p>\n
+ Nh\u00e2n to, th\u01b0\u1eddng c\u00f3 ph\u00e2n b\u00e0o, h\u1ea1t nh\u00e2n l\u1edbn<\/p>\n
+ B\u00e0o t\u01b0\u01a1ng \u01b0a ki\u1ec1m r\u00f5 r\u1ec7t v\u00ec r\u1ea5t gi\u00e0u polysom t\u1ef1 do ch\u1ee9a nhi\u1ec1u ARN<\/p>\n
+ C\u00f3 \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 b\u00e0o v\u1eadt<\/p>\n
(2) Nh\u1eefng r\u1ed1i lo\u1ea1n c\u1ee7a bi\u1ec7t h\u00f3a: th\u01b0\u1eddng x\u1ea3y ra \u1edf m\u1ecdi m\u1ee9c \u0111\u1ed9, m\u1ecdi lo\u1ea1i t\u1ebf b\u00e0o v\u00e0 m\u00f4, \u1edf ph\u00f4i thai, tr\u1ebb nh\u1ecf ho\u1eb7c ng\u01b0\u1eddi l\u1edbn. Do nhi\u1ec1u nguy\u00ean nh\u00e2n: vi\u00eam, r\u1ed1i lo\u1ea1n th\u00edch nghi, d\u1ecb t\u1eadt b\u1ea9m sinh, r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a<\/p>\n
(3) C\u01a1 ch\u1ebf b\u1ec7nh sinh: c\u00f3 l\u1ebd do:<\/p>\n
+ T\u00e1c \u0111\u1ed9ng c\u1ee7a nh\u1eefng ch\u1ea5t c\u1ea3m \u1ee9ng v\u1ed1n v\u1eabn c\u1ea7n thi\u1ebft cho s\u1ef1 bi\u1ec7t h\u00f3a v\u00e0 tr\u01b0\u1edfng th\u00e0nh c\u1ee7a t\u1ebf b\u00e0o n\u00e0y b\u1ecb thi\u1ebfu h\u1ee5t ho\u1eb7c b\u1ecb ng\u0103n ch\u1eb7n<\/p>\n
+ T\u00e1c \u0111\u1ed9ng c\u1ee7a nhi\u1ec1u y\u1ebfu t\u1ed1 g\u00e2y ra ph\u00e2n b\u00e0o tr\u01b0\u1edbc ho\u1eb7c trong qu\u00e1 tr\u00ecnh bi\u1ec7t h\u00f3a t\u1ebf b\u00e0o<\/p>\n
2.2) Chuy\u1ec3n d\u1ea1ng:<\/p>\n
L\u00e0 s\u1ef1 thay \u0111\u1ed5i v\u1ec1 h\u00ecnh th\u00e1i t\u1ebf b\u00e0o, mang t\u00ednh ch\u1ea5t sinh l\u00fd b\u00ecnh th\u01b0\u1eddng ho\u1eb7c b\u1ec7nh l\u00fd. Chuy\u1ec3n d\u1ea1ng c\u00f3 th\u1ec3 \u1edf:<\/p>\n
(1) M\u1ee9c \u0111\u1ed9 nh\u1eb9: ch\u1ec9 c\u00f3 nh\u1eefng bi\u1ebfn \u0111\u1ed5i v\u1ec1 h\u00ecnh th\u00e1i b\u00ean ngo\u00e0i c\u1ee7a t\u1ebf b\u00e0o m\u00e0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u1ea5u t\u1ea1o b\u00ean trong<\/p>\n
Vd: t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 tuy\u1ebfn gi\u00e1p t\u1eeb t\u1ebf b\u00e0o h\u00ecnh kh\u1ed1i vu\u00f4ng s\u1ebd tr\u1edf th\u00e0nh t\u1ebf b\u00e0o d\u1eb9t nh\u01b0 t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c trong b\u1ec7nh ph\u00ecnh gi\u00e1p keo<\/p>\n
(2) M\u1ee9c \u0111\u1ed9 n\u1eb7ng: chuy\u1ec3n d\u1ea1ng l\u00e0m thay \u0111\u1ed5i h\u00ecnh th\u00e1i b\u00ean ngo\u00e0i, c\u1ea5u tr\u00fac v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a t\u1ebf b\u00e0o<\/p>\n
Vd: t\u1ebf b\u00e0o m\u00f4 th\u1ea7n kinh \u0111\u1ec7m chuy\u1ec3n d\u1ea1ng th\u00e0nh \u0111\u1ea1i th\u1ef1c b\u00e0o c\u00f3 h\u00ecnh th\u00e1i v\u00e0 ch\u1ee9c n\u0103ng ho\u00e0n to\u00e0n kh\u00e1c v\u1edbi ban \u0111\u1ea7u<\/p>\n
2.3) Chuy\u1ec3n s\u1ea3n:<\/p>\n
– L\u00e0 hi\u1ec7n t\u01b0\u1ee3ng thay \u0111\u1ed5i v\u1ec1 h\u00ecnh th\u00e1i v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a 1 lo\u1ea1i t\u1ebf b\u00e0o ho\u1eb7c m\u00f4 sang 1 lo\u1ea1i t\u1ebf b\u00e0o ho\u1eb7c m\u00f4 kh\u00e1c<\/p>\n
– Nh\u01b0 v\u1eady, s\u1ef1 thay \u0111\u1ed5i \u0111\u00f3 t\u1ea1o n\u00ean 1 m\u00f4 m\u1edbi, v\u1eabn b\u00ecnh th\u01b0\u1eddng v\u1ec1 m\u1eb7t h\u00ecnh th\u00e1i nh\u01b0ng b\u1ea5t th\u01b0\u1eddng v\u1ec1 v\u1ecb tr\u00ed<\/p>\n
Vd: chuy\u1ec3n s\u1ea3n bi\u1ec3u m\u00f4 (chuy\u1ec3n s\u1ea3n malpighi, chuy\u1ec3n s\u1ea3n tr\u1ee5, chuy\u1ec3n s\u1ea3n nh\u1ea7y, chuy\u1ec3n s\u1ea3n ru\u1ed9t), chuy\u1ec3n s\u1ea3n m\u00f4 li\u00ean k\u1ebft (s\u1ee5n, x\u01b0\u01a1ng)<\/p>\n
– Chuy\u1ec3n s\u1ea3n l\u00e0 1 t\u1ed5n th\u01b0\u01a1ng c\u00f3 t\u00ednh kh\u1ea3 h\u1ed3i:<\/p>\n
+ C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y ra chuy\u1ec3n s\u1ea3n c\u00f3 th\u1ec3 l\u00e0: vi\u00eam m\u1ea1n, r\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft, r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng, y\u1ebfu t\u1ed1 h\u00f3a h\u1ecdc\u2026<\/p>\n
+ C\u1ea7n ph\u00e2n bi\u1ec7t chuy\u1ec3n s\u1ea3n v\u1edbi hi\u1ec7n t\u01b0\u1ee3ng l\u1ea1c ch\u1ed7 (t\u00ecnh tr\u1ea1ng m\u00f4 c\u00f3 v\u1ecb tr\u00ed kh\u00f4ng \u0111\u00fang n\u01a1i b\u00ecnh th\u01b0\u1eddng, do d\u1ecb t\u1eadt trong qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n)<\/p>\n
2.4) Ngh\u1ecbch s\u1ea3n:<\/p>\n
– L\u00e0 hi\u1ec7n t\u01b0\u1ee3ng t\u1ebf b\u00e0o v\u00e0 m\u00f4 c\u00f3 nh\u1eefng bi\u1ebfn \u0111\u1ed5i v\u1ec1 h\u00ecnh th\u00e1i v\u00e0 c\u1ea5u tr\u00fac. Ngh\u1ecbch s\u1ea3n \u0111\u1ed3ng ngh\u0129a v\u1edbi r\u1ed1i lo\u1ea1n ph\u00e1t tri\u1ec3n<\/p>\n
– Ngh\u1ecbch s\u1ea3n c\u00f3 th\u1ec3 \u1edf m\u1ee9c \u0111\u1ed9: nh\u1eb9, v\u1eeba ho\u1eb7c n\u1eb7ng. Ngh\u1ecbch s\u1ea3n k\u00e9o d\u00e0i c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ung th\u01b0<\/p>\n
– Nguy\u00ean nh\u00e2n: r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng, vi\u00eam m\u1ea1n, ung th\u01b0 t\u1ea1i ch\u1ed7<\/p>\n
Vd:<\/p>\n
+ B\u1ec7nh Paget x\u01b0\u01a1ng: ngh\u1ecbch s\u1ea3n l\u00e0m thay \u0111\u1ed5i c\u1ea5u tr\u00fac b\u1ed9 x\u01b0\u01a1ng, xen k\u1ebd gi\u1eefa v\u00f9ng t\u1ea1o x\u01b0\u01a1ng v\u00e0 h\u1ee7y x\u01b0\u01a1ng<\/p>\n
+ B\u1ec7nh ngh\u1ecbch d\u01b0\u1ee1ng nang s\u1ee3i tuy\u1ebfn v\u00fa: c\u00e1c \u1ed1ng tuy\u1ebfn t\u0103ng s\u1ea3n bi\u1ec3u m\u00f4 t\u1ea1o nang \u1ed1ng s\u1eefa nh\u1ecf, chuy\u1ec3n s\u1ea3n m\u00f4 li\u00ean k\u1ebft l\u00e0m teo \u0111\u00e9t m\u00f4 m\u1ee1<\/p>\n
+ Ngh\u1ecbch s\u1ea3n c\u1ed5 t\u1eed cung: l\u1edbp t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 t\u0103ng s\u1ea3n, th\u1ee9 t\u1ef1 c\u1ea5u tr\u00fac b\u1ecb \u0111\u1ea3o ng\u01b0\u1ee3c<\/p>\n
2.5) Tho\u00e1i s\u1ea3n:<\/p>\n
– L\u00e0 hi\u1ec7n t\u01b0\u1ee3ng t\u1ebf b\u00e0o tho\u00e1i tri\u1ec3n tr\u1edf th\u00e0nh kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, \u0111\u00f4i khi c\u00f3 h\u00ecnh th\u00e1i, t\u00ednh ch\u1ea5t c\u1ee7a t\u1ebf b\u00e0o ch\u01b0a bi\u1ec7t h\u00f3a, ph\u00f4i thai. V\u00ec v\u1eady, tho\u00e1i s\u1ea3n th\u01b0\u1eddng \u0111\u1ed3ng ngh\u0129a v\u1edbi gi\u1ea3m bi\u1ec7t h\u00f3a<\/p>\n
– T\u1ebf b\u00e0o tho\u00e1i s\u1ea3n th\u01b0\u1eddng c\u00f3 h\u00ecnh th\u00e1i kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, c\u00f3 khi l\u00e0 nh\u1eefng t\u1ebf b\u00e0o nh\u1ecf, c\u00f3 khi l\u00e0 nh\u1eefng t\u1ebf b\u00e0o l\u1edbn, \u0111\u00f4i khi nhi\u1ec1u nh\u00e2n<\/p>\n
– Hi\u1ec7n t\u01b0\u1ee3ng tho\u00e1i s\u1ea3n th\u01b0\u1eddng th\u1ea5y trong 1 s\u1ed1 ung th\u01b0, nh\u1eefng lo\u1ea1i u \u00e1c t\u00ednh n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 carcinoma tho\u00e1i s\u1ea3n, c\u00f3 th\u1ec3 g\u1ed3m nh\u1eefng t\u1ebf b\u00e0o l\u1edbn ho\u1eb7c nh\u1ecf, carcinoma tho\u00e1i s\u1ea3n th\u01b0\u1eddng c\u00f3 t\u00ednh \u00e1c cao<\/p>\n
C\u00e2u 12: Tr\u00ecnh b\u00e0y nh\u1eefng t\u1ed5n th\u01b0\u01a1ng do r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n m\u00e1u?<\/p>\n
1. Ph\u00f9<\/p>\n
– \u1ede ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh, c\u00e1c ch\u1ea5t d\u1ecbch chi\u1ebfm 60-70% tr\u1ecdng l\u01b0\u1ee3n c\u01a1 th\u1ec3, trong \u0111o 1\/3 n\u1eb1m ngo\u00e0i t\u1ebf b\u00e0o (l\u00f2ng m\u1ea1ch v\u00e0 m\u00f4 \u0111\u1ec7m k\u1ebd), 2\/3 n\u1eb1m trong t\u1ebf b\u00e0o. Kho\u1ea3ng 2\/3 l\u01b0\u1ee3ng d\u1ecbch ngo\u00e0i t\u1ebf b\u00e0o n\u1eb1m trong m\u00f4 \u0111\u1ec7m k\u1ebd, 1\/3 n\u1eb1m trong l\u00f2ng m\u1ea1ch. L\u01b0\u1ee3ng d\u1ecbch \u1edf c\u00e1c khu v\u1ef1c lu\u00f4n trao \u0111\u1ed5i v\u1edbi nhau v\u00e0 \u0111\u01b0\u1ee3c duy tr\u00ec nh\u1edd v\u00e0o \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u c\u1ee7a c\u00e1c th\u00e0nh ph\u1ea7n h\u00f2a tan nh\u01b0 protein (ch\u1ee7 y\u1ebfu l\u00e0 albumin) trong l\u00f2ng m\u1ea1ch, sodium trong m\u00f4 \u0111\u1ec7m k\u1ebd v\u00e0 potassium trong t\u1ebf b\u00e0o, \u00e1p l\u1ef1c th\u1ee7y t\u0129nh c\u1ee7a huy\u1ebft t\u01b0\u01a1ng v\u00e0 m\u00f4 k\u1ebd, s\u1ef1 to\u00e0n v\u1eb9n c\u1ee7a n\u1ed9i m\u00f4 m\u1ea1ch m\u00e1u, m\u1ea1ch lympho<\/p>\n
– Nh\u1eefng \u00e1p l\u1ef1c c\u00f3 xu h\u01b0\u1edbng \u0111\u1ea9y d\u1ecbch ra ngo\u00e0i:<\/p>\n
+ \u00c1p l\u1ef1c th\u1ee7y t\u0129nh huy\u1ebft t\u01b0\u01a1ng<\/p>\n
+ \u00c1p l\u1ef1c th\u1ea9m th\u1ea5u m\u00f4 k\u1ebd<\/p>\n
– Nh\u1eefng \u00e1p l\u1ef1c c\u00f3 xu h\u01b0\u1edbng h\u00fat d\u1ecbch v\u00e0o l\u00f2ng m\u1ea1ch:<\/p>\n
+ \u00c1p l\u1ef1c th\u1ea9m th\u1ea5u huy\u1ebft t\u01b0\u01a1ng<\/p>\n
+ \u00c1p l\u1ef1c th\u1ee7y t\u0129nh m\u00f4 k\u1ebd<\/p>\n
– Khi c\u00e2n b\u1eb1ng n\u00e0y b\u1ecb ph\u00e1 v\u1ee1 s\u1ebd d\u1eabn \u0111\u1ebfn ph\u00f9<\/p>\n
– Nh\u01b0 v\u1eady, ph\u00f9 l\u00e0 s\u1ef1 \u1ee9 \u0111\u1ecdng b\u1ea5t th\u01b0\u1eddng c\u00e1c d\u1ecbch trong m\u00f4 \u0111\u1ec7m k\u1ebd, c\u00f2n \u1ee9 \u0111\u1ecdng d\u1ecbch \u1edf trong t\u1ebf b\u00e0o l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng th\u1ee7ng \u0111\u1ee5c \u0111\u1ed3ng th\u1ea9m th\u1ea5u, do \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u thay \u0111\u1ed5i b\u1ea5t th\u01b0\u1eddng l\u00e0m cho n\u01b0\u1edbc th\u00e2m nh\u1eadp qua m\u00e0ng t\u1ebf b\u00e0o v\u00e0o trong b\u00e0o t\u01b0\u01a1ng. H\u00ecnh th\u00e1i \u0111\u1ea1i th\u1ec3 v\u00e0 vi th\u1ec3 c\u1ee7a ph\u00f9 t\u00f9y thu\u1ed9c v\u1ecb tr\u00ed v\u00e0 c\u1ea5u tr\u00fac c\u1ee7a t\u1ea1ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng<\/p>\n
1) \u0110\u1ea1i th\u1ec3:<\/p>\n
+ C\u00e1c t\u1ea1ng ph\u00f9 th\u01b0\u1eddng s\u01b0ng to h\u01a1n b\u00ecnh th\u01b0\u1eddng, m\u00e0u nh\u1ea1t, m\u1ec1m v\u00e0 c\u00f3 tr\u1ecdng l\u01b0\u1ee3ng l\u1edbn<\/p>\n
+ Di\u1ec7n c\u1eaft c\u00f3 ch\u1ea3y d\u1ecbch m\u00e0u v\u00e0ng nh\u1ea1t<\/p>\n
+ Ph\u00f9 hi\u1ec7n di\u1ec7n \u1edf: m\u00f4 d\u01b0\u1edbi da v\u1edbi d\u1ea5u hi\u1ec7u \u201c\u1ea5n l\u00f5m\u201d, ph\u00f9 ph\u1ed5i (l\u00e0m m\u1ea5t t\u00ednh x\u1ed1p nh\u1eb9, ph\u1ed5i ch\u1eafc h\u01a1n b\u00ecnh th\u01b0\u1eddng, c\u1eaft ngang ch\u1ea3y d\u1ecbch h\u1ed3ng l\u1eabn b\u1ecdt), ph\u00f9 tim (d\u1ecbch ph\u00f9 th\u01b0\u1eddng t\u00edch t\u1ee5 \u1edf nh\u1eefng n\u01a1i th\u1ea5p c\u1ee7a c\u01a1 th\u1ec3 nh\u01b0 m\u1eaft c\u00e1 ch\u00e2n, mu ch\u00e2n), ph\u00f9 th\u1eadn (bi\u1ec3u hi\u1ec7n r\u00f5 \u1edf m\u1eb7t, nh\u1ea5t l\u00e0 mi m\u1eaft)<\/p>\n
+ D\u1ecbch ph\u00f9 c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf bao tim (g\u1ecdi l\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim), khoang m\u00e0ng b\u1ee5ng (g\u1ecdi l\u00e0 c\u1ed5 ch\u01b0\u1edbng), khoang m\u00e0ng ph\u1ed5i (g\u1ecdi l\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i), m\u00e0ng tinh ho\u00e0n, bao kh\u1edbp\u2026<\/p>\n
2) Vi th\u1ec3:<\/p>\n
+ D\u1ecbch ph\u00f9 c\u00f3 d\u1ea1ng thu\u1ea7n nh\u1ea5t, r\u1ea5t \u01b0a toan n\u1ebfu ch\u1ee9a nhi\u1ec1u protein, c\u00f3 th\u1ec3 hi\u1ec7n di\u1ec7n \u1edf: m\u00f4 \u0111\u1ec7m (l\u00e0m c\u00e1c t\u1ebf b\u00e0o s\u1ee3i b\u1ecb t\u00e1ch bi\u1ec7t nhau), l\u00f2ng h\u1ed1c ph\u1ed5i (g\u00e2y ph\u00f9 ph\u1ed5i, tr\u00ean ti\u00eau b\u1ea3n m\u00f4 h\u1ecdc ch\u1ec9 th\u1ea5y \u0111\u01b0\u1ee3c nh\u1eefng l\u1eafng c\u1eb7n m\u00e0u h\u1ed3ng d\u1ea1ng h\u1ea1t n\u1eb1m trong l\u00f2ng ph\u1ebf nang<\/p>\n
+ Trong ph\u00f9 n\u00e3o, \u1ee9 d\u1ecbch bao quanh vi m\u1ea1ch v\u00e0 \u1edf m\u00f4 th\u1ea7n kinh \u0111\u1ec7m, d\u1ecbch ph\u00f9 g\u00e2y ph\u00e1t t\u00e1n t\u1ed5 ch\u1ee9c s\u1ee3i l\u00e0m cho ch\u1ea5t x\u00e1m v\u00e0 ch\u1ea5t tr\u1eafng d\u01b0\u1eddng nh\u01b0 l\u1ecfng ra, ph\u00f9 m\u00f4 d\u01b0\u1edbi th\u01b0\u1ee3ng b\u00ec t\u1ea1o n\u00ean 1 b\u1ecdng n\u01b0\u1edbc d\u01b0\u1edbi da<\/p>\n
3) \u0110\u1eb7c \u0111i\u1ec3m h\u00f3a sinh: c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t 2 d\u1ea1ng d\u1ecbch ph\u00f9:<\/p>\n
+ D\u1ecbch ti\u1ebft hay d\u1ecbch xu\u1ea5t: gi\u00e0u protein v\u00e0 nh\u1eefng ch\u1ea5t d\u1ea1ng keo, c\u00f3 t\u1ef7 tr\u1ecdng l\u1edbn h\u01a1n 1.018-1.020, h\u00ecnh th\u00e0nh trong qu\u00e1 tr\u00ecnh vi\u00eam do t\u0103ng t\u00ednh th\u1ea5m vi m\u1ea1ch<\/p>\n
+ D\u1ecbch th\u1ea5m hay d\u1ecbch qua: ngh\u00e8o protein v\u00e0 nh\u1eefng ch\u1ea5t d\u1ea1ng keo, c\u00f3 t\u1ef7 tr\u1ecdng nh\u1ecf h\u01a1n 1.015-1.018, h\u00ecnh th\u00e0nh kh\u00f4ng do vi\u00eam m\u00e0 do t\u0103ng \u00e1p l\u1ef1c tu\u1ea7n ho\u00e0n ho\u1eb7c gi\u1ea3m \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u huy\u1ebft t\u01b0\u01a1ng<\/p>\n
2. Sung huy\u1ebft<\/p>\n
L\u00e0 t\u00ecnh tr\u1ea1ng \u1ee9 m\u00e1u qu\u00e1 m\u1ee9c trong c\u00e1c m\u1ea1ch m\u00e1u \u0111\u00e3 b\u1ecb gi\u00e3n c\u1ee7a 1 m\u00f4 ho\u1eb7c 1 c\u01a1 quan. \u0110\u00e2y l\u00e0 1 t\u1ed5n th\u01b0\u01a1ng kh\u1ea3 h\u1ed3i<\/p>\n
1) Sung huy\u1ebft \u0111\u1ed9ng:<\/p>\n
– L\u00e0 hi\u1ec7n t\u01b0\u1ee3ng \u0111\u01b0a t\u1edbi qu\u00e1 nhi\u1ec1u m\u00e1u \u0110M trong c\u00e1c \u0110M, ti\u1ec3u \u0110M v\u00e0 c\u00e1c vi m\u1ea1ch, c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf h\u1ec7 TM n\u1ebfu c\u00f3 n\u1ed1i th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch<\/p>\n
– V\u00f9ng t\u1ed5n th\u01b0\u01a1ng c\u00f3 m\u00e0u \u0111\u1ecf, s\u01b0ng to do ph\u00f9, nhi\u1ec7t \u0111\u1ed9 t\u0103ng cao<\/p>\n
– H\u00ecnh \u1ea3nh vi th\u1ec3: c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 s\u01b0ng to l\u1ed3i v\u00e0o trong l\u00f2ng m\u1ea1ch \u0111\u00e3 b\u1ecb gi\u00e3n, \u0111\u00f4i khi k\u00e8m theo ph\u00f9 v\u00e0 ch\u1ea3y m\u00e1u do tho\u00e1t qu\u1ea3n<\/p>\n
– Sung huy\u1ebft \u0111\u1ed9ng x\u1ea3y ra do nh\u1eefng c\u01a1 ch\u1ebf TK giao c\u1ea3m v\u00e0 \u0111\u1ed1i giao c\u1ea3m c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec1u h\u00f2a l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0 tr\u01b0\u01a1ng l\u1ef1c \u0110M. Nh\u1eefng c\u01a1 ch\u1ebf \u0111\u00f3 b\u1ecb \u1ee9c ch\u1ebf ho\u1eb7c k\u00edch th\u00edch b\u1edfi c\u00e1c c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nhau: t\u00e1c nh\u00e2n v\u1eadt l\u00fd, h\u00f3a h\u1ecdc, n\u1ed9i ti\u1ebft t\u1ed1, ch\u1ea5t trung gian h\u00f3a h\u1ecdc trong vi\u00eam, t\u00e1c nh\u00e2n t\u00e2m l\u00fd (\u0111\u1ecf m\u1eb7t), t\u00e1c \u0111\u1ed9ng ngo\u1ea1i khoa (c\u1eaft d\u00e2y TK giao c\u1ea3m d\u1ec5 g\u00e2y gi\u00e3n m\u1ea1ch d\u01b0\u1edbi v\u00f9ng c\u1eaft, l\u00e0m v\u1ebft th\u01b0\u01a1ng d\u1ec5 h\u00f3a s\u1eb9o)<\/p>\n
2) Sung huy\u1ebft t\u0129nh:<\/p>\n
– L\u00e0 s\u1ef1 t\u00edch t\u1ee5 m\u00e1u trong c\u00e1c vi m\u1ea1ch, ti\u1ec3u TM v\u00e0 TM, ng\u01b0\u1eddi ta c\u00f2n g\u1ecdi l\u00e0 s\u1ef1 t\u00f9 h\u00e3m hay \u1ee9 tr\u1ec7 m\u00e1u<\/p>\n
– V\u00f9ng sung huy\u1ebft t\u0129nh s\u01b0ng ph\u00f9, m\u00e0u t\u00edm s\u1eabm, gi\u1ea3m nhi\u1ec7t \u0111\u1ed9. Khi c\u1eaft ch\u1ea3y d\u1ecbch s\u00e1nh, \u0111en s\u1eabm<\/p>\n
– H\u00ecnh \u1ea3nh vi th\u1ec3: d\u1ec5 th\u1ea5y gi\u00e3n m\u1ea1ch, th\u01b0\u1eddng k\u00e8m theo ph\u00f9 v\u00e0 ch\u1ea3y m\u00e1u m\u00f4 k\u1ebd<\/p>\n
– Nguy\u00ean nh\u00e2n: ch\u00e8n \u00e9p TM k\u00e9o d\u00e0i do kh\u1ed1i u ho\u1eb7c c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c ngo\u00e0i TM, huy\u1ebft kh\u1ed1i TM, d\u1ecb d\u1ea1ng th\u00e0nh m\u1ea1ch b\u1ea9m sinh ho\u1eb7c m\u1eafc ph\u1ea3i, suy tim\u2026<\/p>\n
– H\u1eadu qu\u1ea3 c\u1ee7a sung huy\u1ebft t\u0129nh l\u00e0 t\u0103ng \u00e1p l\u1ef1c th\u1ee7y t\u0129nh trong l\u00f2ng ti\u1ec3u TM v\u00e0 vi m\u1ea1ch, k\u00e8m theo v\u00f4 oxy d\u1eabn \u0111\u1ebfn teo \u0111\u00e9t, tho\u00e1i h\u00f3a, ho\u1ea1i t\u1eed t\u1ebf b\u00e0o, c\u00f3 th\u1ec3 g\u00e2y x\u01a1 h\u00f3a v\u00e0 huy\u1ebft kh\u1ed1i TM<\/p>\n
3. Xu\u1ea5t huy\u1ebft (ch\u1ea3y m\u00e1u)<\/p>\n
– L\u00e0 s\u1ef1 tho\u00e1t m\u00e1u ra ngo\u00e0i h\u1ec7 tu\u1ea7n ho\u00e0n, c\u00f3 th\u1ec3 khu tr\u00fa t\u1ea1i 1 \u0111i\u1ec3m trong c\u01a1 th\u1ec3 ho\u1eb7c nhi\u1ec1u \u1ed5 r\u1ea3i r\u00e1c<\/p>\n
– Ch\u1ea3y m\u00e1u c\u00f3 th\u1ec3 t\u1eeb:<\/p>\n
+ \u0110M: m\u00e1u \u0111\u1ecf, th\u00e0nh tia theo nh\u1ecbp m\u1ea1ch<\/p>\n
+ TM: m\u00e1u m\u00e0u s\u1eabm, ch\u1ea3y \u0111\u1ec1u \u0111\u1eb7n<\/p>\n
+ Vi m\u1ea1ch: th\u00e0nh ch\u1ea5m ho\u1eb7c \u0111\u00e1m lan r\u1ed9ng c\u1ea3 1 v\u00f9ng<\/p>\n
+ Tim: hi\u1ebfm g\u1eb7p nh\u01b0ng nguy k\u1ecbch<\/p>\n
– V\u1ecb tr\u00ed ch\u1ea3y m\u00e1u: m\u00e1u c\u00f3 th\u1ec3 ch\u1ea3y ra ngo\u00e0i c\u01a1 th\u1ec3 g\u1ecdi l\u00e0 ch\u1ea3y m\u00e1u ngo\u1ea1i ho\u1eb7c t\u00edch t\u1ee5 trong c\u01a1 th\u1ec3 g\u1ecdi l\u00e0 ch\u1ea3y m\u00e1u n\u1ed9i: m\u00e1u n\u1eb1m trong m\u00f4 k\u1ebd, trong c\u00e1c khoang thanh m\u1ea1c ho\u1eb7c c\u00e1c \u1ed1ng t\u1ef1 nhi\u00ean (\u0111\u01b0\u1eddng th\u1edf, \u0111\u01b0\u1eddng ti\u00eau h\u00f3a)<\/p>\n
+ Ch\u1ea3y m\u00e1u ngo\u1ea1i: t\u00f9y theo v\u1ecb tr\u00ed ch\u1ea3y m\u00e1u c\u00f3 nh\u1eefng t\u00ean g\u1ecdi kh\u00e1c nhau: ch\u1ea3y m\u00e1u m\u0169i, ho ra m\u00e1u, n\u00f4n ra m\u00e1u, \u0111\u00e1i ra m\u00e1u, \u1ec9a ra m\u00e1u, rong kinh<\/p>\n
+ Ch\u1ea3y m\u00e1u n\u1ed9i: g\u1ed3m ban m\u00e1u, ch\u1ea5m m\u00e1u, b\u1ea7m m\u00e1u, t\u1ee5 m\u00e1u, tr\u00e0n m\u00e1u<\/p>\n
4. Huy\u1ebft kh\u1ed1i<\/p>\n
L\u00e0 s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng trong l\u00f2ng b\u1ed9 m\u00e1y tu\u1ea7n ho\u00e0n (\u0110M, TM, vi m\u1ea1ch ho\u1eb7c v\u00f9ng tim). Khi l\u1ea5p ho\u00e0n to\u00e0n l\u00f2ng m\u1ea1ch ho\u1eb7c bu\u1ed3ng tim g\u1ecdi l\u00e0 huy\u1ebft kh\u1ed1i l\u1ea5p, khi ch\u1ec9 l\u00e0 1 m\u1ea3ng d\u00e0y ho\u1eb7c m\u1ecfng b\u00e1m v\u00e0o m\u1eb7t trong l\u00f2ng m\u1ea1ch ho\u1eb7c n\u1ed9i t\u00e2m m\u1ea1c g\u1ecdi l\u00e0 huy\u1ebft kh\u1ed1i th\u00e0nh<\/p>\n
1) H\u00ecnh th\u00e1i:<\/p>\n
1.1) C\u1ee5c huy\u1ebft kh\u1ed1i \u0111\u1ecf: \u00edt g\u1eb7p, l\u00e0 1 c\u1ee5c m\u00e1u \u0111\u00f4ng l\u1edbn g\u1ed3m m\u1ea1ng l\u01b0\u1edbi t\u01a1 huy\u1ebft l\u1edbn ch\u1ee9a h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u m\u00e0u \u0111\u1ecf s\u1eabm gi\u1ed1ng c\u1ee5c m\u00e1u \u0111\u00f4ng trong \u1ed1ng nghi\u1ec7m. Th\u01b0\u1eddng g\u1eb7p huy\u1ebft kh\u1ed1i \u0111\u1ecf trong b\u1ec7nh tr\u0129 khi ti\u00eam thu\u1ed1c g\u00e2y x\u01a1 h\u00f3a \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb gi\u00e3n TM<\/p>\n
1.2) C\u1ee5c huy\u1ebft kh\u1ed1i tr\u1eafng: k\u00edch th\u01b0\u1edbc nh\u1ecf, nh\u1ea7y v\u00e0 r\u1ea5t d\u00ednh, bao g\u1ed3m nh\u1eefng \u0111\u00e1m ti\u1ec3u c\u1ea7u l\u1eabn v\u1edbi s\u1ee3i t\u01a1 huy\u1ebft v\u00e0 1 \u00edt b\u1ea1ch c\u1ea7u. C\u00e1c ti\u1ec3u c\u1ea7u t\u1ef1 h\u1ee7y nhanh t\u1ea1o th\u00e0nh 1 kh\u1ed1i d\u1ea1ng h\u1ea1t \u01b0a toan gi\u1ed1ng nh\u01b0 1 n\u00fat ti\u1ec3u c\u1ea7u c\u1ea7m m\u00e1u<\/p>\n
1.3) C\u1ee5c huy\u1ebft kh\u1ed1i h\u1ed7n h\u1ee3p: r\u1ea5t hay g\u1eb7p, m\u1eadt \u0111\u1ed9 ch\u1eafc nh\u01b0ng m\u1ee7n, g\u1ed3m 3 ph\u1ea7n:<\/p>\n
+ \u0110\u1ea7u: g\u1ed3m nh\u1eefng \u0111\u00e1m ti\u1ec3u c\u1ea7u d\u00ednh v\u00e0o v\u00e1ch m\u1ea1ch<\/p>\n
+ Th\u00e2n: th\u1eb3ng g\u00f3c v\u1edbi v\u00e1ch m\u1ea1ch n\u1ebfu l\u00e0 huy\u1ebft kh\u1ed1i l\u1ea5p, song song v\u1edbi v\u00e1ch m\u1ea1ch n\u1ebfu l\u00e0 huy\u1ebft kh\u1ed1i th\u00e0nh. C\u1ea5u t\u1ea1o g\u1ed3m nh\u1eefng v\u1ea1ch tr\u1eafng (v\u1ea1ch Zahn g\u1ed3m nh\u1eefng \u0111\u00e1m ti\u1ec3u c\u1ea7u) v\u00e0 \u0111\u1ecf (do t\u01a1 huy\u1ebft \u0111\u00f4ng \u0111\u1eb7c) xen k\u1ebd nhau<\/p>\n
+ \u0110u\u00f4i: l\u00e0 c\u1ee5c m\u00e1u \u0111\u00f4ng, m\u00e0u \u0111\u1ecf thu\u1ea7n nh\u1ea5t, m\u1ea3nh, \u00edt d\u00ednh, b\u01a1i l\u01a1 l\u1eedng trong l\u00f2ng m\u1ea1ch, d\u1ec5 bong d\u01b0\u1edbi \u00e1p l\u1ef1c c\u1ee7a d\u00f2ng m\u00e1u<\/p>\n
2) B\u1ec7nh sinh: 3 y\u1ebfu t\u1ed1 g\u00e2y n\u00ean huy\u1ebft kh\u1ed1i:<\/p>\n
2.1) T\u1ed5n th\u01b0\u01a1ng n\u1ed9i m\u00f4 l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh<\/p>\n
2.2) T\u0103ng t\u00ednh \u0111\u00f4ng m\u00e1u<\/p>\n
2.3) R\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng h\u1ecdc<\/p>\n
5. Huy\u1ebft t\u1eafc<\/p>\n
– L\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a 2 hi\u1ec7n t\u01b0\u1ee3ng k\u1ebf ti\u1ebfp nhau: s\u1ef1 di chuy\u1ec3n c\u1ee7a 1 v\u1eadt l\u1ea1 trong v\u00f2ng tu\u1ea7n ho\u00e0n v\u00e0 d\u1eebng l\u1ea1i \u0111\u1ed9t ng\u1ed9t trong 1 m\u1ea1ch m\u00e1u: g\u00e2y n\u00ean c\u1ee5c huy\u1ebft t\u1eafc<\/p>\n
– B\u1ea3n ch\u1ea5t c\u1ee7a c\u1ee5c huy\u1ebft t\u1eafc: b\u1ea5t k\u1ef3 1 v\u1eadt n\u00e0o kh\u00f4ng tan trong m\u00e1u d\u01b0\u1edbi d\u1ea1ng ch\u1ea5t r\u1eafn, kh\u00ed, m\u1ee1, h\u1ed7n d\u1ecbch\u2026 \u0111\u1ec1u g\u00e2y n\u00ean huy\u1ebft t\u1eafc. Ph\u1ea7n l\u1edbn c\u00e1c c\u1ee5c huy\u1ebft t\u1eafc sinh ra t\u1eeb trong c\u01a1 th\u1ec3: 90% l\u00e0 nh\u1eefng m\u1ea3nh bong ra t\u1eeb 1 huy\u1ebft kh\u1ed1i, sau \u0111\u00f3 l\u00e0 c\u00e1c m\u1ea3nh x\u01a1 v\u1eefa, b\u00f3ng h\u01a1i, gi\u1ecdt m\u1ee1, t\u1ebf b\u00e0o ung th\u01b0\u2026 C\u1ee5c huy\u1ebft t\u1eafc ngo\u1ea1i sinh hi\u1ebfm h\u01a1n: vi khu\u1ea9n, n\u1ea5m, kh\u00f4ng kh\u00ed l\u1ecdt v\u00e0o khi truy\u1ec1n d\u1ecbch ho\u1eb7c \u0111\u01b0a \u1ed1ng th\u00f4ng th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n\u2026<\/p>\n
– H\u1eadu qu\u1ea3:<\/p>\n
+ C\u01a1 h\u1ecdc: l\u1ea5p m\u1ea1ch g\u00e2y ho\u1ea1i t\u1eed, thi\u1ebfu m\u00e1u m\u00f4, nh\u1ed3i m\u00e1u ph\u1ed5i<\/p>\n
+ G\u00e2y t\u1ed5n th\u01b0\u01a1ng n\u1ed9i m\u00f4<\/p>\n
+ G\u00e2y vi\u00eam nhi\u1ec5m, n\u1ebfu huy\u1ebft t\u1eafc ung th\u01b0 g\u00e2y di c\u0103n<\/p>\n
6. Nh\u1ed3i m\u00e1u<\/p>\n
– Nh\u1ed3i m\u00e1u l\u00e0 1 v\u00f9ng ho\u1ea1i t\u1eed c\u00f3 ranh gi\u1edbi do l\u1ea5p t\u1eafc \u0110M cung c\u1ea5p ho\u1eb7c TM \u0111i, g\u00e2y thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ho\u00e0n to\u00e0n<\/p>\n
– Nh\u1ed3i m\u00e1u tr\u1eafng khi v\u00f9ng ho\u1ea1i t\u1eed kh\u00f4ng c\u00f3 h\u1ed3ng c\u1ea7u v\u00e0 nh\u1ed3i m\u00e1u \u0111\u1ecf hay ch\u1ea3y m\u00e1u khi v\u00f9ng ho\u1ea1i t\u1eed tr\u00e0n ng\u1eadp h\u1ed3ng c\u1ea7u<\/p>\n
1) Nh\u1ed3i m\u00e1u tr\u1eafng:<\/p>\n
+ Th\u01b0\u1eddng g\u1eb7p \u1edf th\u1eadn, l\u00e1ch, n\u00e3o v\u00e0 c\u01a1 tim (nh\u1eefng t\u1ea1ng \u0111\u1eb7c c\u00f3 h\u1ec7 th\u1ed1ng m\u1ea1ch t\u1eadn). L\u1ea5p t\u1eafc \u0110M c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf th\u00e2n ch\u00ednh ho\u1eb7c c\u00e1c nh\u00e1nh c\u1ee7a n\u00f3, v\u00ec v\u1eady 1 t\u1ea1ng c\u00f3 th\u1ec3 b\u1ecb 1 \u1ed5 ho\u1eb7c nhi\u1ec1u \u1ed5<\/p>\n
+ H\u00ecnh th\u00e1i:<\/p>\n
(+) V\u00f9ng trung t\u00e2m ho\u1ea1i t\u1eed \u0111\u00f4ng m\u00e0u tr\u1eafng v\u00e0ng, m\u1eadt \u0111\u1ed9 ch\u1eafc ho\u1eb7c m\u1ec1m, h\u01a1i l\u1ed3i l\u00ean m\u1eb7t c\u01a1 quan, h\u00ecnh th\u00e1i v\u00e0 k\u00edch th\u01b0\u1edbc kh\u00e1 r\u00f5, t\u01b0\u01a1ng \u1ee9ng v\u1edbi v\u00f9ng gi\u1ea3i ph\u1eabu c\u1ee7a \u0110M b\u1ecb l\u1ea5p t\u1eafc: h\u00ecnh tam gi\u00e1c c\u00f3 \u0111\u1ec9nh quay v\u1ec1 ph\u00eda r\u1ed1n (\u1edf th\u1eadn) ho\u1eb7c h\u00ecnh \u0111a v\u00f2ng, vu\u00f4ng (\u1edf l\u00e1ch). Tr\u00ean vi th\u1ec3 v\u1eabn c\u00f2n nh\u1eadn th\u1ea5y c\u1ea5u tr\u00fac m\u00f4, c\u00e1c t\u1ebf b\u00e0o c\u00f3 b\u00e0o t\u01b0\u01a1ng \u01b0a toan, thu\u1ea7n nh\u1ea5t, nh\u00e2n \u0111\u00f4ng ho\u1eb7c m\u1ea5t nh\u00e2n<\/p>\n
(+) 1 ri\u1ec1m m\u1ecfng m\u00e0u x\u00e1m nh\u1ea1t \u1edf ngo\u1ea1i vi, t\u01b0\u01a1ng \u1ee9ng v\u1edbi ph\u1ea7n m\u00f4 b\u1ecb x\u00e2m l\u1ea5n b\u1edfi c\u00e1c t\u1ebf b\u00e0o t\u1ef1 do: b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n, m\u00f4 b\u00e0o v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o, k\u00e8m theo sung huy\u1ebft v\u00e0 ph\u00f9<\/p>\n
(+) V\u00e0nh \u0111ai ngo\u00e0i c\u00f9ng, n\u01a1i ti\u1ebfp gi\u00e1p v\u1edbi m\u00f4 l\u00e0nh c\u00f3 m\u00e0u \u0111\u1ecf t\u00edm do gi\u00e3n m\u1ea1ch v\u00e0 sung huy\u1ebft<\/p>\n
2) Nh\u1ed3i m\u00e1u \u0111\u1ecf:<\/p>\n
+ Hay g\u1eb7p \u1edf c\u00e1c t\u1ea1ng r\u1ed7ng, m\u00f4 m\u1ec1m nh\u01b0 ph\u1ed5i, ru\u1ed9t, l\u1ea5p t\u1eafc \u0110M c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf c\u00e1c m\u1ea1ch m\u00e1u c\u00f3 k\u00edch th\u01b0\u1edbc kh\u00e1c nhau, th\u01b0\u1eddng k\u00e8m theo r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n ch\u1ee9c n\u0103ng ho\u1eb7c th\u1ef1c th\u1ec3 c\u1ee7a l\u01b0\u1edbi TM t\u01b0\u01a1ng \u1ee9ng<\/p>\n
+ H\u00ecnh th\u00e1i: \u1ed5 nh\u1ed3i m\u00e1u c\u00f3 ranh gi\u1edbi r\u00f5, h\u00ecnh vu\u00f4ng ho\u1eb7c tam gi\u00e1c c\u00f3 \u0111\u00e1y quay v\u1ec1 m\u00e0ng ph\u1ed5i, \u0111\u1ec9nh h\u01b0\u1edbng v\u1ec1 r\u1ed1n ph\u1ed5i n\u01a1i \u0110M b\u1ecb t\u1eafc, m\u1eadt \u0111\u1ed9 ch\u1eafc, \u1ee9 \u0111\u1ea7y m\u00e1u \u0111en s\u1eabm, v\u00f9ng ngo\u1ea1i vi th\u01b0\u1eddng ch\u1ea3y m\u00e1u. T\u1ed5n th\u01b0\u01a1ng vi th\u1ec3 g\u1ed3m 3 v\u00f9ng:<\/p>\n
(+) V\u00f9ng trung t\u00e2m ho\u1ea1i t\u1eed ch\u1ea3y m\u00e1u<\/p>\n
(+) V\u00f9ng ngo\u1ea1i vi l\u00e0 c\u00e1c ph\u1ebf nang ch\u1ee9a \u0111\u1ea7y d\u1ecbch ph\u00f9, b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n<\/p>\n
(+) V\u00e0nh \u0111ai ngo\u00e0i c\u00f9ng sung huy\u1ebft \u0111\u01a1n thu\u1ea7n<\/p>\n","protected":false},"excerpt":{"rendered":"
B\u00e0i so\u1ea1n c\u1ee7a b\u1ea1n nam K15a1 (XH) C\u00e2u 1: Vi\u00eam l\u00e0 g\u00ec? N\u00eau t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a qu\u00e1 tr\u00ecnh vi\u00eam? 1. Kh\u00e1i ni\u1ec7m v\u00e0 \u0111\u1ecbnh ngh\u0129a v\u1ec1 vi\u00eam 1) Kh\u00e1i ni\u1ec7m: – Vi\u00eam \u2013 Phalogos: ngh\u0129a l\u00e0 l\u1eeda ch\u00e1y v\u1edbi 4 tri\u1ec7u ch\u1ee9ng c\u1ed5 \u0111i\u1ec3n: s\u01b0ng, n\u00f3ng, \u0111\u1ecf, \u0111au v\u00e0 \u0111\u01b0\u1ee3c coi l\u00e0 1 …<\/p>\n","protected":false},"author":10,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30,40],"tags":[],"class_list":["post-2011","post","type-post","status-publish","format-standard","","category-mon-co-so","category-giai-phau-benh"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2011","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=2011"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2011\/revisions"}],"predecessor-version":[{"id":2012,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2011\/revisions\/2012"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2011"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2011"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2011"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}