C\u00e2u 1:T\u00ecnh h\u00ecnh d\u1ecbch t\u1ec5 h\u1ecdc ung th\u01b0 \u1edf Vi\u1ec7t Nam v\u00e0 tr\u00ean th\u1ebf gi\u1edbi<\/p>\n
1. T\u1ec8 L\u1ec6 M\u1edaI M\u1eaeC<\/p>\n
\u0110\u01b0\u1ee3c t\u00ednh b\u1eb1ng s\u1ed1 ca m\u1edbi m\u1eafc trong qu\u1ea7n th\u1ec3 tr\u00ean 100.000 d\u00e2n t\u00ednh trong 1 n\u0103m, \u0111\u00e2y l\u00e0 c\u00e1ch t\u00ednh c\u00e1ch t\u1ed1t nh\u1ea5t c\u1ee7a t\u1ea7n xu\u1ea5t m\u1eafc ung th\u01b0 . Hi\u1ec7n nay tr\u00ean th\u1ebf gi\u1edbi c\u00f3 kho\u1ea3ng 200 trung t\u00e2m ghi nh\u1eadn ung th\u01b0 qu\u1ea7n th\u1ec3 \u0111ang ho\u1ea1t \u0111\u1ed9ng.<\/p>\n
Ng\u01b0\u1eddi ta \u01b0\u1edbc l\u01b0\u1ee3ng t\u1ed5ng s\u1ed1 ca ung th\u01b0 m\u1edbi m\u1eafc tr\u00ean th\u1ebf gi\u1edbi nh\u01b0 sau: N\u0103m 1980: 6,4 tri\u1ec7u; N\u0103m 1985: 7,6 tri\u1ec7u; N\u0103m 2000: (ph\u1ecfng \u0111o\u00e1n) 10,3 tri\u1ec7u<\/p>\n
T\u1ec9 l\u1ec7 m\u1edbi m\u1eafc th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 cung c\u1ea5p nh\u1eefng d\u1eef li\u1ec7u v\u1ec1 s\u1ef1 xu\u1ea5t hi\u1ec7n ung th\u01b0 trong qu\u1ea7n th\u1ec3 d\u00e2n c\u01b0 theo nh\u00f3m tu\u1ed5i, gi\u1edbi t\u00ednh v\u00e0 ch\u1ee7ng t\u1ed9c…Ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 t\u00ednh t\u1ec9 l\u1ec7 m\u1edbi m\u1eafc cho to\u00e0n b\u1ed9 d\u00e2n c\u01b0 ho\u1eb7c t\u1eebng b\u1ed9 ph\u1eadn c\u1ee7a qu\u1ea7n th\u1ec3 d\u00e2n c\u01b0 v\u1edbi nh\u1eefng \u0111\u1eb7c tr\u01b0ng ph\u00e2n b\u1ed1 kh\u00e1c nhau.<\/p>\n
Qua c\u00e1c b\u1ea3ng th\u1ed1ng k\u00ea ung th\u01b0 tr\u00ean th\u1ebf gi\u1edbi v\u00e0 H\u00e0 N\u1ed9i h\u00e0ng n\u0103m, th\u1ea5y c\u00f3 s\u1ef1 gi\u1ed1ng nhau v\u00e0 kh\u00e1c nhau nh\u01b0 sau:<\/p>\n
Gi\u1ed1ng nhau v\u1ec1 t\u1ec9 l\u1ec7 c\u00e1c ung th\u01b0 \u1edf c\u00e1c v\u1ecb tr\u00ed: ph\u1ed5i, d\u1ea1 d\u00e0y, v\u00fa, tr\u1ef1c tr\u00e0ng, th\u00e2n t\u1eed cung.<\/p>\n
Nhi\u1ec1u h\u01a1n th\u1ebf gi\u1edbi: c\u00e1c ung th\u01b0 gan, mi\u1ec7ng h\u1ecdng, v\u00f2m, lymph\u00f4, b\u1ec7nh b\u1ea1ch c\u1ea7u.<\/p>\n
\u00cdt h\u01a1n: c\u00e1c ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn, b\u00e0ng quang, c\u1ed5 t\u1eed cung v\u00e0 th\u1ef1c qu\u1ea3n.<\/p>\n
T\u1ec9 l\u1ec7 nam \/n\u1eef = 5\/4<\/p>\n
\u1ede th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh, c\u00e1c ung th\u01b0 hay g\u1eb7p l\u00e0: c\u1ed5 t\u1eed cung, gan, ph\u1ed5i, v\u00fa, v\u00f2m. So s\u00e1nh H\u00e0 N\u1ed9i (mi\u1ec1n B\u1eafc) v\u1edbi mi\u1ec1n Nam c\u0169ng th\u1ea5y c\u00f3 nhi\u1ec1u \u0111i\u1ec3m kh\u00e1c bi\u1ec7t:<\/p>\n
H\u00e0 N\u1ed9i: Hay g\u1eb7p ung th\u01b0 d\u1ea1 d\u00e0y 14%, \u00edt g\u1eb7p ung th\u01b0 c\u1ed5 t\u1eed cung 6%<\/p>\n
TP H\u1ed3 Ch\u00ed Minh: Hay g\u1eb7p ung th\u01b0 c\u1ed5 t\u1eed cung 40%, \u00edt g\u1eb7p ung th\u01b0 d\u1ea1 d\u00e0y 2%.<\/p>\n
T\u1ec9 l\u1ec7 m\u1eafc th\u00f4 1 n\u0103m v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c ung th\u01b0: Nam: 112\/100.000 d\u00e2n\/n\u0103m; N\u1eef: 86,4\/100.000 d\u00e2n\/n\u0103m.<\/p>\n
T\u00ednh chung cho c\u1ea3 2 gi\u1edbi 99\/100.000 d\u00e2n\/n\u0103m.<\/p>\n
N\u1ebfu \u0111em so s\u00e1nh t\u1ec9 l\u1ec7 m\u1eafc ung th\u01b0 \u1edf Vi\u1ec7t Nam v\u00e0 m\u1ed9t s\u1ed1 n\u01b0\u1edbc xung quanh (Th\u00e1i Lan, Trung Qu\u1ed1c, Singapore, Malaixia…) th\u00ec qua th\u1ed1ng k\u00ea h\u00e3y c\u00f2n th\u1ea5p nh\u01b0ng n\u1ebfu suy t\u1eeb H\u00e0 N\u1ed9i th\u00ec n\u01b0\u1edbc ta kho\u1ea3ng 70.000 ca m\u1edbi m\u1eafc h\u00e0ng n\u0103m.<\/p>\n
2. T\u1ec8 L\u1ec6 T\u1eec VONG<\/p>\n
\u0110\u01b0\u1ee3c t\u00ednh b\u1eb1ng s\u1ed1 ca t\u1eed vong tr\u00ean 100.000 d\u00e2n m\u1ed7i n\u0103m.<\/p>\n
T\u1ec9 l\u1ec7 n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c ph\u1ea3n \u00e1nh cho to\u00e0n b\u1ed9 d\u00e2n c\u01b0 hay cho t\u1eebng gi\u1edbi t\u00ednh, nh\u00f3m tu\u1ed5i…<\/p>\n
\u1ede nhi\u1ec1u n\u01b0\u1edbc, \u0111a s\u1ed1 ca t\u1eed vong do b\u1ec7nh ung th\u01b0 ph\u1ee5 thu\u1ed9c \u0111\u00e1ng k\u1ec3 v\u00e0o c\u1ea5u tr\u00fac tu\u1ed5i c\u1ee7a y\u1ebfu t\u1ed1 d\u00e2n c\u01b0 (s\u1ef1 gia t\u0103ng c\u1ee7a t\u1ec9 l\u1ec7 gi\u00e0, m\u00e0 ph\u1ea7n l\u1edbn ung th\u01b0 g\u1eb7p \u1edf l\u1ee9a tu\u1ed5i n\u00e0y), v\u00e0 m\u1ed9t m\u1ee9c \u0111\u1ed9 n\u00e0o \u0111\u00f3 ph\u1ee5 thu\u1ed9c v\u00e0o nh\u1eefng ti\u1ebfn b\u1ed9 ch\u1ea9n \u0111o\u00e1n, nh\u1edd n\u00f3 m\u00e0 b\u1ec7nh ung th\u01b0 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc l\u00fac ch\u1ebft.<\/p>\n
Ch\u1ec9 s\u1ed1 \u0111o th\u1eddi gian r\u00fat ng\u1eafn c\u1ee7a l\u00e2m s\u00e0ng (PYLL): D\u00f9ng \u0111\u1ec3 \u0111o \u1ea3nh h\u01b0\u1edfng c\u1ee7a b\u1ec7nh v\u1edbi s\u1ee9c kh\u1ecfe c\u1ed9ng \u0111\u1ed3ng, n\u00f3 \u0111em l\u1ea1i nh\u1eefng h\u00ecnh \u1ea3nh ch\u00ednh x\u00e1c c\u1ee7a v\u1ea5n \u0111\u1ec1 t\u1eed vong b\u1edfi l\u1ebd t\u1eed vong \u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i c\u00f3 \u00fd ngh\u0129a tr\u1ea7m tr\u1ecdng h\u01a1n \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i.<\/p>\n
VD: \u1edf Nh\u1eadt B\u1ea3n, ung th\u01b0 d\u1ea1 d\u00e0y \u0111\u1ee9ng h\u00e0ng th\u1ee9 nh\u1ea5t cho c\u1ea3 hai gi\u1edbi: 26% t\u1ed5ng s\u1ed1 c\u00e1c PYLL \u1edf nam; 26% t\u1ed5ng s\u1ed1 c\u00e1c PYLL \u1edf n\u1eef.<\/p>\n
Ung th\u01b0 v\u00fa \u1edf ph\u1ee5 n\u1eef M\u1ef9 c\u00f3 t\u1ec9 l\u1ec7 cao nh\u1ea5t (24%)<\/p>\n
3. T\u1ec8 L\u1ec6 M\u1eaeC B\u1ec6NH TO\u00c0N B\u1ed8<\/p>\n
L\u00e0 con s\u1ed1 \u01b0\u1edbc t\u00ednh v\u1ec1 s\u1ed1 ng\u01b0\u1eddi m\u1eafc ung th\u01b0 (\u1edf t\u1ea5t c\u1ea3 c\u00e1c v\u1ecb tr\u00ed ung th\u01b0 hay g\u1ed9p l\u1ea1i \u1edf m\u1ed9t v\u1ecb tr\u00ed n\u00e0o \u0111\u00f3) nh\u1eefng ng\u01b0\u1eddi n\u00e0y s\u1ed1ng t\u1ea1i m\u1ed9t th\u1eddi \u0111i\u1ec3m nh\u1ea5t \u0111\u1ecbnh ho\u1eb7c v\u00e0o m\u1ed9t th\u1eddi \u0111i\u1ec3m trong kho\u1ea3ng m\u1ed9t th\u1eddi gian x\u00e1c \u0111\u1ecbnh.<\/p>\n
D\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 g\u00e1nh n\u1eb7ng v\u1ec1 b\u1ec7nh t\u1eadt c\u1ee7a c\u1ed9ng \u0111\u1ed3ng.<\/p>\n
\u0110\u01b0\u1ee3c t\u00ednh b\u1eb1ng t\u1ed5ng s\u1ed1 ca ung th\u01b0 tr\u00ean 100.000 d\u00e2n n\u1ebfu c\u0103n c\u1ee9 v\u00e0o s\u1ed1 d\u00e2n n\u00f3i chung ho\u1eb7c \u0111\u01b0\u1ee3c bi\u1ec3u th\u1ecb nh\u01b0 m\u1ed9t t\u1ec9 l\u1ec7 n\u1ebfu c\u0103n c\u1ee9 v\u00e0o s\u1ed1 ca b\u1ec7nh \u0111\u01b0\u1ee3c th\u1ed1ng k\u00ea \u1edf b\u1ec7nh vi\u1ec7n.<\/p>\n
T\u0103ng theo t\u1ec9 l\u1ec7 m\u1edbi m\u1eafc v\u00e0 kho\u1ea3ng th\u1eddi gian trung b\u00ecnh m\u00e0 b\u1ec7nh k\u00e9o d\u00e0i.<\/p>\n
v C\u00e1c lo\u1ea1i ung th\u01b0 th\u01b0\u1eddng g\u1eb7p:<\/p>\n
Nam<\/p>\n
N\u1eef<\/p>\n
1<\/p>\n
Gan<\/p>\n
C\u1ed5 TC<\/p>\n
2<\/p>\n
Ph\u1ed5i<\/p>\n
V\u00fa<\/p>\n
3<\/p>\n
D\u1ea1 d\u00e0y<\/p>\n
\u0110\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n
4<\/p>\n
\u0110\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n
Ph\u1ed5i<\/p>\n
5<\/p>\n
Tuy\u1ebfn ti\u1ec1n li\u1ec7t<\/p>\n
D\u1ea1 d\u00e0y<\/p>\n
6<\/p>\n
H\u1ed1c mi\u1ec7ng<\/p>\n
Gan<\/p>\n
7<\/p>\n
V\u00f2m h\u1ea7u<\/p>\n
Bu\u1ed3ng tr\u1ee9ng<\/p>\n
8<\/p>\n
Th\u1ef1c qu\u1ea3n<\/p>\n
Tuy\u1ebfn gi\u00e1p<\/p>\n
9<\/p>\n
Lympho<\/p>\n
Th\u00e2n TC<\/p>\n
10<\/p>\n
B\u1ec7nh BC<\/p>\n
B\u1ec7nh BC<\/p>\n
KH\u00c1I NI\u1ec6M UNG TH\u01af: Ung th\u01b0 l\u00e0 b\u1ec7nh l\u00fd \u00e1c t\u00ednh c\u1ee7a t\u1ebf b\u00e0o, khi b\u1ecb k\u00edch th\u00edch c\u1ee7a c\u00e1c t\u00e1c nh\u00e2n g\u00e2y ung th\u01b0, t\u1ebf b\u00e0o t\u0103ng sinh m\u1ed9t c\u00e1ch v\u00f4 h\u1ea1n \u0111\u1ed9, v\u00f4 t\u1ed5 ch\u1ee9c, kh\u00f4ng tu\u00e2n theo c\u01a1 ch\u1ebf ki\u1ec3m so\u00e1t v\u1ec1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u01a1 th\u1ec3.<\/p>\n
C\u00e2u 2:Nguy\u00ean nh\u00e2n g\u00e2y ung th\u01b0<\/p>\n
I. T\u00c1C NH\u00c2N V\u1eacT L\u00dd<\/p>\n
1. B\u1ee9c x\u1ea1 ion h\u00f3a:l\u00e0 ngu\u1ed3n tia ph\u00f3ng x\u1ea1 ph\u00e1t ra t\u1eeb c\u00e1c ch\u1ea5t ph\u00f3ng x\u1ea1 t\u1ef1 nhi\u00ean ho\u1eb7c t\u1eeb ngu\u1ed3n b\u1ee9c x\u1ea1 nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c d\u00f9ng trong khoa h\u1ecdc v\u00e0 y h\u1ecdc c\u00f3 kh\u1ea3 n\u0103ng ion h\u00f3a v\u1eadt ch\u1ea5t khi b\u1ecb chi\u1ebfu x\u1ea1<\/p>\n
– Chi\u1ebfm kho\u1ea3ng 2 \u2013 3% trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ecb ung th\u01b0, ch\u1ee7 y\u1ebfu l\u00e0 K gi\u00e1p, ph\u1ed5i, b\u1ea1ch c\u1ea7u<\/p>\n
– T\u00e1c \u0111\u1ed9ng c\u1ee7a tia ph\u00f3ng x\u1ea1 ph\u1ee5 thu\u1ed9c v\u00e0o 3 y\u1ebfu t\u1ed1<\/p>\n
+ Tu\u1ed5i ti\u1ebfp x\u00fac c\u00e0ng nh\u1ecf c\u00e0ng nguy hi\u1ec3m (nh\u1ea5t l\u00e0 b\u00e0o thai). Vi\u1ec7c s\u1eed d\u1ee5ng si\u00eau \u00e2m chu\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh thai nhi thay cho X-quang l\u00e0 ti\u1ebfn b\u1ed9 r\u1ea5t l\u1edbn<\/p>\n
+ M\u1ed1i li\u00ean h\u1ec7 li\u1ec1u – \u0111\u00e1p \u1ee9ng<\/p>\n
+ C\u01a1 quan b\u1ecb chi\u1ebfu x\u1ea1: tuy\u1ebfn gi\u00e1p, t\u1ee7y x\u01b0\u01a1ng r\u1ea5t nh\u1ea1y c\u1ea3m v\u1edbi tia x\u1ea1<\/p>\n
2. B\u1ee9c x\u1ea1 c\u1ef1c t\u00edm:c\u00f3 trong \u00e1nh s\u00e1ng m\u1eb7t tr\u1eddi. C\u00e0ng g\u1ea7n x\u00edch \u0111\u1ea1o tia c\u1ef1c t\u00edm c\u00e0ng m\u1ea1nh<\/p>\n
– Ch\u1ee7 y\u1ebfu g\u00e2y ra K da. Nh\u1eefng ng\u01b0\u1eddi l\u00e0m vi\u1ec7c ngo\u00e0i tr\u1eddi nh\u01b0 c\u00f4ng nh\u00e2n, th\u1ee3 x\u00e2y d\u1ef1ng, c\u00f4ng nh\u00e2n l\u00e0m \u0111\u01b0\u1eddng c\u00f3 t\u1ec9 l\u1ec7 ung th\u01b0 t\u1ebf b\u00e0o \u0111\u00e1y v\u00e0 t\u1ebf b\u00e0o v\u1ea3y \u1edf v\u00f9ng da h\u1edf (\u0111\u1ea7u, g\u00e1y, c\u1ed5) cao h\u01a1n ng\u01b0\u1eddi l\u00e0m vi\u1ec7c trong nh\u00e0. Ng\u01b0\u1eddi da tr\u1eafng \u1edf v\u00f9ng nhi\u1ec7t \u0111\u1edbi c\u00f3 t\u1ec9 l\u1ec7 ung th\u01b0 h\u1eafc t\u1ed1 nhi\u1ec1u h\u01a1n ng\u01b0\u1eddi da m\u00e0u<\/p>\n
– Tr\u00e0o l\u01b0u t\u1eafm n\u1eafng th\u00e1i qu\u00e1 c\u1ee7a ng\u01b0\u1eddi da tr\u1eafng ch\u1ecbu \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u c\u1ee7a tia c\u1ef1c t\u00edm. Tr\u1ebb em c\u0169ng kh\u00f4ng n\u00ean ti\u1ebfp x\u00fac nhi\u1ec1u v\u1edbi tia c\u1ef1c t\u00edm<\/p>\n
II. T\u00c1C NH\u00c2N H\u00d3A H\u1eccC<\/p>\n
1. Thu\u1ed1c l\u00e1:L\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a kho\u1ea3ng 90% ung th\u01b0 ph\u1ebf qu\u1ea3n. T\u00ednh chung thu\u1ed1c l\u00e1 g\u00e2y ra kho\u1ea3ng 30% trong s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 ch\u1ee7 y\u1ebfu l\u00e0 ung th\u01b0 ph\u1ebf qu\u1ea3n v\u00e0 m\u1ed9t s\u1ed1 ung th\u01b0 v\u00f9ng m\u0169i h\u1ecdng, ung th\u01b0 t\u1ee5y, ung th\u01b0 \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u. Th\u1ed1ng k\u00ea cho th\u1ea5y:<\/p>\n
\u2022 Ng\u01b0\u1eddi h\u00fat thu\u1ed1c c\u00f3 nguy c\u01a1 m\u1eafc ung th\u01b0 ph\u1ebf qu\u1ea3n g\u1ea5p 10 l\u1ea7n ng\u01b0\u1eddi kh\u00f4ng h\u00fat<\/p>\n
\u2022 N\u1ebfu nghi\u1ec7n h\u00fat n\u1eb7ng tr\u00ean 20 \u0111i\u1ebfu\/ng\u00e0y nguy c\u01a1 cao h\u01a1n 15-20 l\u1ea7n<\/p>\n
\u2022 H\u00fat thu\u1ed1c \u1edf tu\u1ed5i c\u00e0ng tr\u1ebb nguy c\u01a1 c\u00e0ng cao<\/p>\n
\u2022 H\u00fat thu\u1ed1c l\u00e1 n\u00e2u nguy c\u01a1 cao h\u01a1n thu\u1ed1c l\u00e1 v\u00e0ng<\/p>\n
\u2022 H\u00fat thu\u1ed1c l\u00e0o, \u0103n tr\u1ea7u thu\u1ed1c c\u00f3 nguy c\u01a1 c\u00e0ng cao h\u01a1n<\/p>\n
\u2022 Ng\u01b0\u1eddi \u0111ang nghi\u1ec7n h\u00fat m\u00e0 b\u1ecf h\u00fat thu\u1ed1c c\u0169ng gi\u1ea3m \u0111\u01b0\u1ee3c nguy c\u01a1<\/p>\n
\u2022 Nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c th\u1ee5 \u0111\u1ed9ng c\u0169ng c\u00f3 nguy c\u01a1 ung th\u01b0<\/p>\n
\u2022 Tr\u1ebb em nhi\u1ec5m kh\u00f3i thu\u1ed1c l\u00e1 r\u1ea5t nguy h\u1ea1i<\/p>\n
2. Dinh d\u01b0\u1ee1ng:\u0110\u01b0\u1eddng ti\u00eau h\u00f3a h\u00e0ng ng\u00e0y ti\u1ebfp x\u00fac v\u1edbi ngu\u1ed3n dinh d\u01b0\u1ee1ng t\u1eeb th\u1ef1c ph\u1ea9m, th\u1ea3i c\u00e1c ch\u1ea5t c\u1eb7n b\u00e3. B\u1ea3n th\u00e2n th\u1ef1c ph\u1ea9m kh\u00f4ng g\u00e2y ung th\u01b0 nh\u01b0ng \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 c\u00e1c ch\u1ea5t b\u1ea3o qu\u1ea3n th\u1ef1c ph\u1ea9m, c\u00e1c ch\u1ea5t trung gian chuy\u1ec3n h\u00f3a th\u1ef1c ph\u1ea9m v\u00e0 ch\u1ea5t sinh ra t\u1eeb n\u1ea5m m\u1ed1c ng\u0169 c\u1ed1c<\/p>\n
– Dinh d\u01b0\u1ee1ng chi\u1ebfm 35% trong c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh ung th\u01b0. Nhi\u1ec1u ung th\u01b0 c\u00f3 li\u00ean quan d\u1ebfn dinh d\u01b0\u1ee1ng nh\u01b0 K th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0y, gan, \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, v\u00f2m h\u1ecdng, v\u00fa, n\u1ed9i ti\u1ebft,\u2026<\/p>\n
– M\u1ed1i li\u00ean quan gi\u1eefa dinh d\u01b0\u1ee1ng v\u1edbi ung th\u01b0 \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n \u1edf 2 kh\u00eda c\u1ea1nh ch\u00ednh:<\/p>\n
\u00b7 C\u00e1c ch\u1ea5t g\u00e2y ung th\u01b0 c\u00f3 trong th\u1ef1c ph\u1ea9m, th\u1ee9c \u0103n:<\/p>\n
\u00a7 Nitrosamin v\u00e0 c\u00e1c h\u1ee3p ch\u1ea5t N\u2013nitroso kh\u00e1c \u00e0 K d\u1ea1 d\u00e0y<\/p>\n
\u00a7 Aflatoxin \u00e0 K gan nguy\u00ean ph\u00e1t<\/p>\n
\u00a7 Ph\u1ea9m nhu\u1ed9m th\u1ef1c ph\u1ea9m<\/p>\n
\u00a7 M\u1ed9t s\u1ed1 c\u00e1ch n\u1ea5u th\u1ee9c \u0103n v\u00e0 b\u1ea3o qu\u1ea3n th\u1ef1c ph\u1ea9m t\u1ea1o ra ch\u1ea5t g\u00e2y ung th\u01b0<\/p>\n
\u00b7 Kh\u1ea9u ph\u1ea9n \u0103n: c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong g\u00e2y b\u1ec7nh c\u0169ng nh\u01b0 gi\u1ea3m nguy c\u01a1 ung th\u01b0. V\u00ed d\u1ee5:<\/p>\n
\u00a7 ch\u1ebf \u0111\u1ed9 \u0103n nhi\u1ec1u m\u1ee1 c\u00f3 li\u00ean quan \u0111\u1ebfn K \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n
\u00a7 Trong hoa qu\u1ea3 v\u00e0 rau xanh c\u00f3 ch\u1ee9a nhi\u1ec1u vitamin v\u00e0 ch\u1ea5t x\u01a1 h\u1ea1n ch\u1ebf ung th\u01b0<\/p>\n
3. Nh\u1eefng y\u1ebfu t\u1ed1 ngh\u1ec1 nghi\u1ec7p<\/p>\n
– Khi l\u00e0m vi\u1ec7c trong m\u00f4i tr\u01b0\u1eddng ngh\u1ec1 nghi\u1ec7p con ng\u01b0\u1eddi ti\u1ebfp x\u00fac v\u1edbi c\u1ea3 b\u1ee9c x\u1ea1 ion h\u00f3a v\u00e0 virus, nh\u01b0ng nh\u1eefng t\u00e1c nh\u00e2n sinh ung th\u01b0 quan tr\u1ecdng nh\u1ea5t trong ngh\u1ec1 nghi\u1ec7p ch\u00ednh l\u00e0 c\u00e1c h\u00f3a ch\u1ea5t \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. C\u00e1c ung th\u01b0 do ngh\u1ec1 nghi\u1ec7p th\u01b0\u1eddng x\u1ea3y ra \u1edf c\u00e1c c\u01a1 quan ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp nh\u01b0 da v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u01a1 quan h\u00f4 h\u1ea5p, ngo\u00e0i ra ph\u1ea3i k\u1ec3 \u0111\u1ebfn ung th\u01b0 \u1edf c\u01a1 quan c\u00f3 nhi\u1ec7m v\u1ee5 b\u00e0i ti\u1ebft c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f2n ho\u1ea1t t\u00ednh nh\u01b0 \u1edf \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u.<\/p>\n
– G\u00e2y ra t\u1eeb 2-8% s\u1ed1 ung th\u01b0 t\u00f9y theo m\u1ed7i khu v\u1ef1c c\u00f4ng nghi\u1ec7p<\/p>\n
4. M\u1ed9t s\u1ed1 thu\u1ed1c v\u00e0 n\u1ed9i ti\u1ebft:<\/p>\n
– C\u00e1c ki\u1ec3u h\u00f3a tr\u1ecb ung th\u01b0 kh\u00e1c nhau l\u00e0m t\u0103ng nguy c\u01a1 b\u1ec7nh b\u1ea1ch c\u1ea7u: c\u00e1c thu\u1ed1c thu\u1ed9c nh\u00f3m akyl nh\u01b0 mephalan, chloram bucil, cyclophosphamid c\u00f3 li\u00ean quan r\u00f5 nh\u1ea5t<\/p>\n
– C\u00e1c thu\u1ed1c gi\u1ea3m \u0111au ch\u1ee9 phenacetin l\u00e0m t\u0103ng nguy c\u01a1 K th\u1eadn v\u00e0 K bi\u1ec3u m\u00f4 \u0111\u01b0\u1eddng ni\u1ec7u kh\u00e1c<\/p>\n
– Thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch azathioprien g\u00e2y u da,lympho kh\u00f4ng Hodgkin v\u00e0 c\u00e1c b\u1ec7nh \u00e1c t\u00ednh hi\u1ebfm g\u1eb7pkh\u00e1c<\/p>\n
– S\u1ef1 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch sau khi c\u1ea5y gh\u00e9p c\u01a1 quan c\u0169ng l\u00e0m BN c\u00f3 nguy c\u01a1 cao m\u1eafc b\u1ec7nh ung th\u01b0<\/p>\n
– M\u1ed9t s\u1ed1 lo\u1ea1i n\u1ed9i ti\u1ebft t\u1ed1 l\u00e0m t\u0103ng nguy c\u01a1 ung th\u01b0: DES \u00e0 K \u00e2 m \u0111 \u1ea1 o \u1edf con g\u00e1i c\u1ee7a h\u1ecd v\u00e0 K tinh ho\u00e0n \u0111\u1ed1i v\u1edbi con trai, \u0111i\u1ec1u tr\u1ecb thay th\u1ebf estrogen l\u00e0m t\u0103ng nguy c\u01a1 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung v\u00e0 bu\u1ed3ng tr\u1ee9ng<\/p>\n
III. C\u00c1C T\u00c1C NH\u00c2N SINH H\u1eccC<\/p>\n
1: Virus g\u00e2y ung th\u01b0<\/p>\n
\u00b7 Virus Epstein-barr:lo\u1ea1i virus n\u00e0y \u0111\u1ea7u ti\u00ean th\u1ea5y c\u00f3 m\u1eb7c \u1edf b\u1ec7nh ung th\u01b0 h\u00e0m d\u01b0\u1edbi c\u1ee7a tr\u1ebb em v\u00f9ng Uganda. V\u1ec1 sau ng\u01b0\u1eddi ta c\u00f2n ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c lo\u1ea1i virus n\u00e0y \u1edf trong c\u00e1c kh\u1ed1i ung th\u01b0 v\u00f2m m\u0169i h\u1ecdng. T\u1ec9 l\u1ec7 nhi\u1ec5m lo\u1ea1i virus n\u00e0y t\u01b0\u01a1ng \u0111\u1ed1i cao nh\u01b0ng s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 v\u00f2m kh\u00f4ng ph\u1ea3i l\u00e0 nhi\u1ec1u.<\/p>\n
\u00b7 Virus vi\u00eam gan B:Virus n\u00e0y khi x\u00e2m nh\u1eadp c\u01a1 th\u1ec3 g\u00e2y vi\u00eam gan c\u1ea5p, k\u1ec3 c\u1ea3 nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p tho\u00e1ng qua. Ti\u1ebfp theo l\u00e0 m\u1ed9t th\u1eddi k\u1ef3 d\u00e0i vi\u00eam gan m\u1ea1n ti\u1ebfn tri\u1ec3n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. T\u1ed5n th\u01b0\u01a1ng n\u00e0y qua th\u1eddi gian d\u00e0i s\u1ebd d\u1eabn \u0111\u1ebfn hai bi\u1ebfn ch\u1ee9ng quan tr\u1ecdng \u0111\u00f3 l\u00e0 x\u01a1 gan to\u00e0n b\u1ed9 v\u00e0 ung th\u01b0 t\u1ebf b\u00e0o gan. \u0110i\u1ec1u n\u00e0y ph\u1ea7n n\u00e0o gi\u1ea3i th\u00edch s\u1ef1 xu\u1ea5t hi\u1ec7n nhi\u1ec1u \u1ed5 nh\u1ecf trong ung th\u01b0 gan v\u00e0 t\u00ednh ch\u1ea5t t\u00e1i ph\u00e1t s\u1edbm sau c\u1eaft gan. Ngo\u00e0i ra, x\u01a1 gan \u0111\u00e3 l\u00e0m cho ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh ung th\u01b0 gan x\u1ea5u \u0111i r\u1ea5t nhi\u1ec1u.<\/p>\n
\u00b7 Virus g\u00e2y u nh\u00fa:\u1ede ng\u01b0\u1eddi th\u01b0\u1eddng truy\u1ec1n qua \u0111\u01b0\u1eddng sinh d\u1ee5c. Lo\u1ea1i n\u00e0y c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c ung th\u01b0 v\u00f9ng \u00e2m h\u1ed9, \u00e2 m \u0111 \u1ea1 o v\u00e0 c\u1ed5 t\u1eed cung.<\/p>\n
\u00b7 Virus HTLV 1: l\u00e0 lo\u1ea1i virus li\u00ean quan \u0111\u1ebfn b\u1ec7nh b\u1ea1ch c\u1ea7u t\u1ebf b\u00e0o T, g\u1eb7p \u1edf Nh\u1eadt B\u1ea3n v\u00e0 v\u00f9ng Caribe.<\/p>\n
2: K\u00fd sinh tr\u00f9ng v\u00e0 vi tr\u00f9ng c\u00f3 li\u00ean quan \u0111\u1ebfn ung th\u01b0:<\/p>\n
– Ch\u1ec9 m\u1ed9t lo\u1ea1i k\u00fd sinh tr\u00f9ng \u0111\u01b0\u1ee3c coi l\u00e0 nguy\u00ean nh\u00e2n ung th\u01b0, \u0111\u00f3 l\u00e0 s\u00e1n Schistosoma. Lo\u1ea1i s\u00e1n n\u00e0y c\u00f3 m\u1eb7t v\u1edbi ung th\u01b0 b\u00e0ng quang v\u00e0 m\u1ed9t s\u1ed1 \u00edt ung th\u01b0 ni\u1ec7u qu\u1ea3n. C\u01a1 ch\u1ebf ch\u01b0a r\u00f5<\/p>\n
– Lo\u1ea1i vi khu\u1ea9n \u0111ang \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn vai tr\u00f2 g\u00e2y vi\u00eam d\u1ea1 d\u00e0y m\u1ea1n v\u00e0 ung th\u01b0 d\u1ea1 d\u00e0y l\u00e0 VK HP.<\/p>\n
IV. SUY GI\u1ea2M MI\u1ec4N D\u1ecaCH V\u00c0 AIDS<\/p>\n
– Ng\u01b0\u1eddi b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch m\u1eafc ph\u1ea3i th\u01b0\u1eddng d\u1ec5 b\u1ecb ung th\u01b0 v\u00e0 th\u1eddi gian \u1ee7 b\u1ec7nh ng\u1eafn h\u01a1n, ch\u1ee7 y\u1ebfu l\u00e0 lymphoma h\u1ec7 v\u00f5ng<\/p>\n
– \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n gh\u00e9p gan \u2013 s\u1ef1 suy gi\u1ea3m mi\u1ec5n d\u1ecbch do thu\u1ed1c r\u00f5 nh\u1ea5t. Nguy c\u01a1 ung th\u01b0 t\u0103ng g\u1ea5p nhi\u1ec1u l\u1ea7n, c\u0169ng nh\u01b0 nguy c\u01a1 nhi\u1ec5m virus g\u00e2y ung th\u01b0 t\u0103ng l\u00ean<\/p>\n
– Ng\u01b0\u1eddi c\u00f3 HIV d\u01b0\u01a1ng t\u00ednh c\u00f3 nguy c\u01a1 cao b\u1ecb Sarcoma Kaposi v\u00e0 Lympho kh\u00f4ng Hodgkin<\/p>\n
C\u00e2u 3:Di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a ung th\u01b0<\/p>\n
1. Giai \u0111o\u1ea1n kh\u1edfi ph\u00e1t:<\/p>\n
Giai \u0111o\u1ea1n n\u00e0y b\u1eaft \u0111\u1ea7u th\u01b0\u1eddng l\u00e0 t\u1eeb t\u1ebf b\u00e0o g\u1ed1c, do ti\u1ebfp x\u00fac v\u1edbi ch\u1ea5t sinh ung th\u01b0 g\u00e2y ra nh\u1eefng \u0111\u1ed9t bi\u1ebfn, l\u00e0m thay \u0111\u1ed5i kh\u00f4ng h\u1ed3i ph\u1ee5c c\u1ee7a nh\u00e2n t\u1ebf b\u00e0o. C\u00e1c t\u1ebf b\u00e0o \u0111\u1ed9t bi\u1ebfn bi\u1ec3u hi\u1ec7n s\u1ef1 \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi m\u00f4i tr\u01b0\u1eddng v\u00e0 \u01b0u th\u1ebf t\u0103ng tr\u01b0\u1edfng ch\u1ecdn l\u1ecdc ng\u01b0\u1ee3c v\u1edbi t\u1ebf b\u00e0o b\u00ecnh th\u01b0\u1eddng \u1edf xung quanh.<\/p>\n
Qu\u00e1 tr\u00ecnh n\u00e0y di\u1ec5n ra r\u1ea5t nhanh v\u00e0 ho\u00e0n t\u1ea5t trong kho\u1ea3ng v\u00e0i ph\u1ea7n gi\u00e2y<\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m: kh\u00f4ng th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c \u0111\u01b0\u1ee3c.<\/p>\n
Hi\u1ec7n nay ch\u01b0a x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c ng\u01b0\u1ee1ng g\u00e2y kh\u1edfi ph\u00e1t.<\/p>\n
Nh\u1eefng t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c kh\u1edfi ph\u00e1t th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi t\u00edn hi\u1ec7u gian b\u00e0o v\u00e0 n\u1ed9i b\u00e0o. C\u00e1c t\u00edn hi\u1ec7u n\u00e0y c\u00f3 t\u00e1c d\u1ee5ng gi\u1eef v\u1eefng c\u1ea5u tr\u00fac n\u1ed9i m\u00f4. Trong cu\u1ed9c \u0111\u1eddi c\u1ee7a con ng\u01b0\u1eddi th\u00ec nhi\u1ec1u t\u1ebf b\u00e0o trong c\u01a1 th\u1ec3 c\u00f3 th\u1ec3 tr\u1ea3i qua qu\u00e1 tr\u00ecnh kh\u1edfi ph\u00e1t, nh\u01b0ng kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 c\u00e1 t\u1ebf b\u00e0o \u0111\u1ec1u sinh b\u1ec7nh.<\/p>\n
\u0110a s\u1ed1 tb \u0111\u01b0\u1ee3c kh\u1edfi ph\u00e1t th\u00ec ho\u1eb7c l\u00e0 kg ti\u1ebfn tri\u1ec3n th\u00eam, or l\u00e0 ch\u1ebft \u0111i, or b\u1ecb c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch v\u00f4 hi\u1ec7u h\u00f3a.<\/p>\n
2. Giai \u0111o\u1ea1n t\u0103ng tr\u01b0\u1edfng:<\/p>\n
Giai \u0111o\u1ea1n t\u0103ng tr\u01b0\u1edfng hay b\u00e0nh tr\u01b0\u1edbng ch\u1ecdn l\u1ecdc d\u00f2ng t\u1ebf b\u00e0o kh\u1edfi ph\u00e1t c\u00f3 th\u1ec3 ti\u1ebfp theo qu\u00e1 tr\u00ecnh kh\u1edfi ph\u00e1t v\u00e0 \u0111\u01b0\u1ee3c t\u1ea1o \u0111i\u1ec1u ki\u1ec7n v\u1edbi thay \u0111\u1ed5i v\u1eadt l\u00fd c\u1ee7a vi m\u00f4i tr\u01b0\u1eddng b\u00ecnh th\u01b0\u1eddng.<\/p>\n
3. Giai \u0111o\u1ea1n th\u00fac \u0111\u1ea9y:<\/p>\n
Bao g\u1ed3m s\u1ef1 thay \u0111\u1ed5i bi\u1ec3u hi\u1ec7n gen, s\u1ef1 b\u00e0nh tr\u01b0\u1edbng \u0111\u01a1n d\u00f2ng c\u00f3 ch\u1ecdn l\u1ecdc, v\u00e0 s\u1ef1 t\u0103ng sinh tb kh\u1edfi ph\u00e1t.<\/p>\n
Giai \u0111o\u1ea1n n\u00e0y bi\u1ec3u hi\u1ec7n \u0111\u1eb7c t\u00ednh ph\u1ee5c h\u1ed3i, k\u00e9o d\u00e0i c\u00f3 th\u1ec3 tr\u1ea3i qua nhi\u1ec1u b\u01b0\u1edbc v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o ng\u01b0\u1ee1ng c\u1ee7a t\u00e1c nh\u00e2n. Giai \u0111o\u1ea1n n\u00e0y kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng li\u00ean h\u1ee3p v\u00e0 \u0111\u01b0a \u0111\u1ebfn quan s\u00e1t ung th\u01b0 \u0111\u1ea1i th\u1ec3. M\u1ee9c \u0111\u1ed9 ti\u1ebfp x\u00fac c\u1ee7a con ng\u01b0\u1eddi v\u1edbi nh\u1eefng t\u00e1c nh\u00e2n th\u00fac \u0111\u1ea9y l\u00e0 kh\u00e1c nhau.<\/p>\n
T\u1eeb 50 n\u0103m nay, ng\u01b0\u1eddi ta \u0111\u00e3 bi\u1ebft \u0111\u1eb7c tr\u01b0ng c\u1ee7a qu\u00e1 tr\u00ecnh kh\u1edfi ph\u00e1t v\u00e0 th\u00fac \u0111\u1ea9y l\u00e0 r\u1ea5t kh\u00e1c nhau.<\/p>\n
Sinh ra ung th\u01b0 g\u1ed3m 2 giai \u0111o\u1ea1n: kh\u1edfi ph\u00e1t v\u00e0 th\u00fac \u0111\u1ea9y, trong \u0111\u00f3 kh\u1edfi ph\u00e1t x\u1ea3y ra tr\u01b0\u1edbc v\u00e0 c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t s\u1ef1 kh\u00e1c nhau:<\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m<\/p>\n
Kh\u1edfi ph\u00e1t<\/p>\n
Th\u00fac \u0111\u1ea9y<\/p>\n
Qu\u00e1 tr\u00ecnh<\/p>\n
\u0110\u1ed9t bi\u1ebfn<\/p>\n
Thay \u0111\u1ed5i gen, t\u0103ng sinh tb<\/p>\n
Kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c<\/p>\n
B\u1ea5t h\u1ed3i ph\u1ee5c<\/p>\n
H\u1ed3i ph\u1ee5c<\/p>\n
Th\u1eddi gian<\/p>\n
Ng\u1eafn<\/p>\n
K\u00e9o d\u00e0i<\/p>\n
S\u1ed1 b\u01b0\u1edbc<\/p>\n
M\u1ed9t<\/p>\n
Nhi\u1ec1u<\/p>\n
Ng\u01b0\u1ee1ng<\/p>\n
Kh\u00f4ng<\/p>\n
C\u00f3<\/p>\n
M\u1ee9c \u0111\u1ed9 ti\u1ebfp x\u00fac \u1edf ng\u01b0\u1eddi<\/p>\n
R\u1ea5t kh\u00f3 tr\u00e1nh<\/p>\n
Thay \u0111\u1ed5i<\/p>\n
T\u00ednh t\u00edch t\u1ee5<\/p>\n
T\u00edch t\u1ee5<\/p>\n
Kh\u00f4ng t\u00edch t\u1ee5<\/p>\n
T\u00ednh quan s\u00e1t<\/p>\n
Kh\u00f4ng quan s\u00e1t \u0111\u01b0\u1ee3c<\/p>\n
Quan s\u00e1t v\u1ec1 \u0111\u1ea1i th\u1ec3<\/p>\n
4. Giai \u0111o\u1ea1n chuy\u1ec3n bi\u1ebfn:Chuy\u1ec3n bi\u1ebfn l\u00e0 giai \u0111o\u1ea1n k\u1ebf ti\u1ebfp c\u1ee7a qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n ung th\u01b0, cho ph\u00e9p s\u1ef1 th\u00e2m nh\u1eadp hay xu\u1ea5t hi\u1ec7n nh\u1eefng \u1ed5 t\u1ebf b\u00e0o ung th\u01b0 nh\u1ecf, c\u00f3 t\u00ednh h\u1ed3i ph\u1ee5c b\u1eaft \u0111\u1ea7u \u0111i v\u00e0o ti\u1ebfn tr\u00ecnh kh\u00f4ng h\u1ed3i ph\u1ee5c v\u1ec1 h\u01b0\u1edbng \u00e1c t\u00ednh l\u00e2m s\u00e0ng.<\/p>\n
5. Giai \u0111o\u1ea1n lan tr\u00e0n:<\/p>\n
Sau giai \u0111o\u1ea1n chuy\u1ec3n bi\u1ebfn, ung th\u01b0 vi th\u1ec3 trai qua giai \u0111o\u1ea1n lan tr\u00e0n. Giai \u0111o\u1ea1n n\u00e0y \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 t\u0103ng tr\u01b0\u1edfng nh\u00f3m tb c\u01b0 tr\u00fa \u1edf m\u1ed9t m\u00f4 n\u00e0o \u0111\u00f3 \u0111ang b\u00e0nh tr\u01b0\u1edbng. Giai \u0111o\u1ea1n lan tr\u00e0n c\u00f3 th\u1ec3 ng\u1eafn, ch\u1ec9 k\u00e9o d\u00e0i v\u00e0i th\u00e1ng, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 trong nhi\u1ec1u n\u0103m. Trong giai \u0111o\u1ea1n n\u00e0y, kh\u1ed1i l\u01b0\u1ee3ng \u0111ang b\u00e0nh tr\u01b0\u1edbng gia t\u0103ng t\u1eeb 1.000 tb \u0111\u1ebfn 1.000.000 tb, nh\u01b0ng v\u1eabn c\u00f2n qu\u00e1 nh\u1ecf \u0111\u1ec3 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n b\u1eb1ng nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p ph\u00e2n t\u00edch \u0111\u01b0\u1ee3c.<\/p>\n
6. Giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n (x\u00e2m l\u1ea5n \u2013 di c\u0103n):<\/p>\n
Giai \u0111o\u1ea1n n\u00e0y \u0111\u1eb7c tr\u01b0ng b\u1eb1ng s\u1ef1 t\u0103ng l\u00ean v\u1ec1 k\u00edch th\u01b0\u1edbc c\u1ee7a kh\u1ed1i u do t\u0103ng tr\u01b0\u1edfng c\u1ee7a nh\u00f3m t\u1ebf b\u00e0o ung th\u01b0 c\u01b0 tr\u00fa \u1edf m\u1ed9t n\u01a1i n\u00e0o \u0111\u00f3. Giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n bao g\u1ed3m qu\u00e1 tr\u00ecnh x\u00e2m l\u1ea5n v\u00e0 di c\u0103n<\/p>\n
\u00b7 Qu\u00e1 tr\u00ecnh x\u00e2m l\u1ea5n: t\u1ed5 ch\u1ee9c ung th\u01b0 x\u00e2m l\u1ea5n nh\u1edd c\u00f3 c\u00e1c \u0111\u1eb7c t\u00ednh sau:<\/p>\n
o T\u00ednh di \u0111\u1ed9ng c\u1ee7a c\u00e1c tb \u00e1c t\u00ednh.<\/p>\n
o Kh\u1ea3 n\u0103ng ti\u00eau \u0111\u1ea1m \u1edf c\u1ea5u tr\u00fac n\u00e2ng \u0111\u1ee1 c\u1ee7a m\u00f4 v\u00e0 c\u01a1 quan.<\/p>\n
o M\u1ea5t s\u1ef1 \u1ee9c ch\u1ebf ti\u1ebfp x\u00fac c\u1ee7a c\u00e1c tb. S\u1ef1 lan r\u1ed9ng t\u1ea1i ch\u1ed7 c\u1ee7a u c\u00f3 th\u1ec3 b\u1ecb h\u1ea1n ch\u1ebf b\u1edfi x\u01b0\u01a1ng, s\u1ee5n v\u00e0 thanh m\u1ea1c.<\/p>\n
\u00b7 Qu\u00e1 tr\u00ecnh di c\u0103n: Di c\u0103n l\u00e0 m\u1ed9t hay nhi\u1ec1u tb K di chuy\u1ec3n t\u1eeb v\u1ecb tr\u00ed nguy\u00ean ph\u00e1t \u0111\u1ebfn v\u1ecb tr\u00ed m\u1edbi v\u00e0 ti\u1ebfp t\u1ee5c qu\u00e1 tr\u00ecnh t\u0103ng tr\u01b0\u1edfng t\u1ea1i \u0111\u00f3 v\u00e0 c\u00e1ch v\u1ecb tr\u00ed nguy\u00ean ph\u00e1 m\u1ed9t kho\u1ea3ng c\u00e1ch. N\u00f3 c\u00f3 th\u1ec3 di c\u0103n theo c\u00e1c \u0111\u01b0\u1eddng sau:<\/p>\n
o Theo \u0111\u01b0\u1eddng m\u00e1u. Khi lan b\u1eb1ng \u0111\u01b0\u1eddng m\u00e1u, tb di c\u0103n k\u1ebft th\u00fac \u1edf mao m\u1ea1ch v\u00e0 t\u0103ng tr\u01b0\u1edfng. S\u1ed1 l\u01b0\u1ee3ng tb di c\u0103n t\u1ec9 l\u1ec7 v\u1edbi k\u00edch th\u01b0\u1edbc c\u1ee7a kh\u1ed1i u.<\/p>\n
o Theo \u0111\u01b0\u1eddng b\u1ea1ch huy\u1ebft. khi lan b\u1eb1ng \u0111\u01b0\u1eddng b\u1ea1ch huy\u1ebft, tb K lan tr\u00e0n v\u00e0o h\u1ec7 th\u1ed1ng b\u1ea1ch m\u1ea1ch t\u1ea1i ch\u1ed7, \u0111\u00f4i khi l\u00e0m t\u1eafc ch\u00fang v\u00e0 sau n\u00e0y lan v\u00e0o c\u00e1c h\u1ea1ch lympho t\u1ea1i v\u00f9ng. H\u1ea1ch b\u1ea1ch huy\u1ebft th\u01b0\u1eddng b\u1ecb di c\u0103n \u0111i t\u1eeb g\u1ea7n \u0111\u1ebfn xa, qua c\u00e1c tr\u1ea1m h\u1ea1ch, c\u00f3 khi nh\u1ea3y c\u00f3c, b\u1ecf qua h\u1ea1ch g\u1ea7n.<\/p>\n
o Di c\u0103n theo \u0111\u01b0\u1eddng k\u1ebf c\u1eadn v\u00e0 m\u1eafc ph\u1ea3i: di c\u0103n hay \u0111i d\u1ecdc theo m\u1ea1ch m\u00e1u v\u00e0 th\u1ea7n kinh, theo l\u1ed1i \u00edt b\u1ecb c\u1ea3n tr\u1edf nh\u01b0: K d\u1ea1 d\u00e0y lan qua l\u1edbp thanh m\u1ea1c v\u00e0o \u1ed5 b\u1ee5ng g\u00e2y di c\u0103n K \u1edf bu\u1ed3ng tr\u1ee9ng. Dao m\u1ed5, d\u1ee5ng c\u1ee5 ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 g\u00e2y c\u1ea5y tb K ra n\u01a1i kh\u00e1c trong ph\u1eabu thu\u1eadt. N\u1ebfu m\u1ed5 tr\u1ef1c ti\u1ebfp v\u00e0o kh\u1ed1i u.<\/p>\n
\u00b7 V\u1ecb tr\u00ed c\u1ee7a di c\u0103n:V\u1ecb tr\u00ed di c\u0103n c\u1ee7a ung th\u01b0 kh\u00e1c nhau t\u00f9y theo c\u00e1c ung th\u01b0 nguy\u00ean ph\u00e1t.<\/p>\n
\u00b7 C\u01a1 quan hay di c\u0103n: ph\u1ed5i, gan, n\u00e3o, x\u01b0\u01a1ng.<\/p>\n
\u00b7 C\u01a1 quan \u00edt di c\u0103n:c\u01a1, da, tuy\u1ebfn \u1ee9c, l\u00e1ch.<\/p>\n
C\u00e2u 4:Tri\u1ec7u ch\u1ee9ng ung th\u01b0: LS, CLS, TNM<\/p>\n
I. C\u00c1C TRI\u1ec6U CH\u1ee8NG L\u00c2M S\u00c0NG<\/p>\n
1. Tri\u1ec7u ch\u1ee9ng b\u00e1o hi\u1ec7u ung th\u01b0<\/p>\n
L\u00e0 nh\u1eefng d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng xu\u1ea5t hi\u1ec7n t\u01b0\u01a1ng \u0111\u1ed1i s\u1edbm c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n s\u1edbm \u0111\u01b0\u1ee3cm\u1ed9t s\u1ed1 b\u1ec7nh ung th\u01b0. C\u00e1c d\u1ea5u hi\u1ec7u n\u00e0y th\u01b0\u1eddng ngh\u00e8o n\u00e0n, \u00edt \u0111\u1eb7c hi\u1ec7u, \u00edt \u1ea3nh h\u01b0\u1edfng t\u1edbing\u01b0\u1eddi b\u1ec7nh n\u00ean d\u1ec5 b\u1ecb b\u1ecf qua.<\/p>\n
-Ho k\u00e9o d\u00e0i l\u00e0 tri\u1ec7u ch\u1ee9ng s\u1edbm c\u1ee7a ungth\u01b0 ph\u1ebf qu\u1ea3n.<\/p>\n
– Xu\u1ea5t huy\u1ebft, ti\u1ebft d\u1ecbch b\u1ea5t th\u01b0\u1eddng b\u00e1o hi\u1ec7u nhi\u1ec1u b\u1ec7nh ung th\u01b0 nh\u01b0:<\/p>\n
Ch\u1ea3y m\u00e1u b\u1ea5t th\u01b0\u1eddng\u00e2m \u0111\u1ea1o b\u00e1o hi\u1ec7u ung th\u01b0 c\u1ed5 t\u1eed cung<\/p>\n
\u1ec8a ra m\u00e1u, nh\u1ea7y b\u00e1o ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n
Ch\u1ea3yd\u1ecbch b\u1ea5t th\u01b0\u1eddng \u0111\u1ea7u n\u00fam v\u00fa b\u00e1o \u0111\u1ed9ng ung th\u01b0 v\u00fa.<\/p>\n
– Thay \u0111\u1ed5i th\u00f3i quen \u0111\u1ea1i, ti\u1ec3u ti\u1ec7n b\u00e1o \u0111\u1ed9ng ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, ung th\u01b0 ti\u1ebft ni\u1ec7u sinhd\u1ee5c.<\/p>\n
– R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a k\u00e9o d\u00e0i l\u00e0 tri\u1ec7u ch\u1ee9ng s\u1edbm c\u1ee7a ung th\u01b0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a.<\/p>\n
– \u0110au \u0111\u1ea7u, \u00f9 tai 1 b\u00ean l\u00e0 d\u1ea5u hi\u1ec7u s\u1edbm c\u1ee7a ung th\u01b0 v\u00f2m m\u0169i h\u1ecdng.<\/p>\n
– N\u00f3i kh\u00f3 b\u00e1o \u0111\u1ed9ng ung th\u01b0 thanh qu\u1ea3n, nu\u1ed1t kh\u00f3 b\u00e1o \u0111\u1ed9ng ung th\u01b0 th\u1ef1c qu\u1ea3n.<\/p>\n
– N\u1ed5i u, c\u1ee5c c\u1ee9ng, ph\u00e1t tri\u1ec3n nhanh b\u00e1o \u0111\u1ed9ng ung th\u01b0 v\u00fa, ung th\u01b0 ph\u1ea7n m\u1ec1m.<\/p>\n
V\u1ebft lo\u00e9tdai d\u1eb3ng kh\u00f3 li\u1ec1n b\u00e1o \u0111\u1ed9ng ung th\u01b0 m\u00f4i, l\u01b0\u1ee1i, d\u1ea1 d\u00e0y..<\/p>\n
– Thay \u0111\u1ed5i t\u00ednh ch\u1ea5t, k\u00edch th\u01b0\u1edbc n\u1ed1t ru\u1ed3i b\u00e1o hi\u1ec7u ung th\u01b0 h\u1eafc t\u1ed1.<\/p>\n
– N\u1ed5i h\u1ea1ch b\u1ea5t th\u01b0\u1eddng, c\u1ee9ng, \u00edt \u0111au b\u00e1o \u0111\u1ed9ng h\u1ea1ch \u00e1c t\u00ednh.<\/p>\n
2. Tri\u1ec7u ch\u1ee9ng r\u00f5 r\u1ec7t<\/p>\n
S\u1ee5t c\u00e2n: B\u1ec7nh ung th\u01b0 \u1edf giai \u0111o\u1ea1n r\u00f5 r\u1ec7t v\u00e0 mu\u1ed9n th\u01b0\u1eddng g\u1ea7y s\u00fat nhanh ch\u00f3ng c\u00f3 th\u1ec3 s\u1ee5t 510kg trong v\u00e0i th\u00e1ng.<\/p>\n
\u0110au:<\/p>\n
Do t\u1ed5 ch\u1ee9c ung th\u01b0 x\u00e2m l\u1ea5n, ph\u00e1 h\u1ee7y c\u00e1c t\u1ed5 ch\u1ee9c xung quanh, c\u00e1c d\u00e2y th\u1ea7n kinh, ng\u01b0\u1eddib\u1ec7nh c\u00f3 th\u1ec3 ch\u1ebft v\u00ec \u0111au, suy ki\u1ec7t.<\/p>\n
H\u1ed9i ch\u1ee9ng b\u00edt t\u1eafc:Do kh\u1ed1i u thu\u1ed9c c\u00e1c t\u1ea1ng r\u1ed7ng ph\u00e1t tri\u1ec3n g\u00e2y b\u00edt t\u1eafc: ung th\u01b0 \u0111\u1ea1i tr\u00e0ng g\u00e2y t\u1eafc ru\u1ed9t; Kh\u1ed1iu hang v\u1ecb d\u1ea1 d\u00e0y g\u00e2y h\u1eb9p m\u00f4n v\u1ecb ; ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn g\u00e2y b\u00ed \u0111\u00e1i…<\/p>\n
Tri\u1ec7u ch\u1ee9ng ch\u00e8n \u00e9p:<\/p>\n
Do t\u1ed5 ch\u1ee9c ung th\u01b0 x\u00e2m l\u1ea5n, ch\u00e8n \u00e9p v\u00e0o c\u01a1 quan l\u00e2n c\u1eadn, ung th\u01b0 ph\u1ebf qu\u1ea3n ch\u00e8n \u00e9p v\u00e0ot\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean g\u00e2y ph\u00f9 \u00e1o kho\u00e1c.<\/p>\n
Kh\u1ed1i u v\u00f2m m\u0169i h\u1ecdng ch\u00e8n \u00e9p v\u00e0o c\u00e1c d\u00e2y th\u1ea7nkinh s\u1ecd g\u00e2y li\u1ec7t d\u00e2y th\u1ea7n kinh s\u1ecd.<\/p>\n
Ung th\u01b0 c\u1ed5 t\u1eed cung ch\u00e8n \u00e9p ni\u1ec7u qu\u1ea3n g\u00e2y ph\u00f9, v\u00f4ni\u1ec7u, u r\u00ea huy\u1ebft cao…<\/p>\n
Tri\u1ec7u ch\u1ee9ng di c\u0103n:<\/p>\n
Theo \u0111\u01b0\u1eddng b\u1ea1ch m\u1ea1ch di c\u0103n h\u1ea1ch.Theo \u0111\u01b0\u1eddng m\u00e1u g\u00e2y di c\u0103n c\u00e1c t\u1ea1ng gan, ph\u1ed5i. Dic\u0103n m\u00e0ng ph\u1ed5i g\u00e2y tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, Di c\u0103n ph\u00fac m\u1ea1c g\u00e2y c\u1ed5 ch\u01b0\u1edbng. Di c\u0103n x\u01b0\u01a1ngg\u00e2y g\u00e3y x\u01b0\u01a1ng b\u1ec7nh l\u00fd…<\/p>\n
3. H\u1ed9i ch\u1ee9ng c\u1eadn ung th\u01b0<\/p>\n
L\u00e0 m\u1ed9t nh\u00f3m c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 sinh h\u1ecdc do ho\u1ea1t \u0111\u1ed9ng mang t\u00ednh ch\u1ea5t n\u1ed9i ti\u1ebftc\u1ee7a m\u1ed9t s\u1ed1 ung th\u01b0. S\u1ed1t k\u00e9o d\u00e0i kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1eadn ung th\u01b0 g\u1eb7p trong b\u1ec7nh Hodgkin, u lymph\u00f4 \u00e1c t\u00ednh…Ung th\u01b0 ph\u1ebf qu\u1ea3n nh\u1ea5t l\u00e0 lo\u1ea1i t\u1ebfb\u00e0o nh\u1ecf hay ti\u1ebft ra c\u00e1c ch\u1ea5t n\u1ed9i ti\u1ebft nh\u01b0 STH g\u00e2y ra ph\u00ec \u0111\u1ea1i \u0111\u1ea7u chi, ti\u1ebft ra hocm\u00f4n d\u1ea1ngEstrogen g\u00e2y ra v\u00fa to \u1edf nam gi\u1edbi, ho\u1eb7c ti\u1ebft ra HAD g\u00e2y ra h\u1ed9i ch\u1ee9ng Schwartz Bartter:ph\u00f9, nhi\u1ec5m \u0111\u1ed9c da.<\/p>\n
M\u1ed9t s\u1ed1 ung th\u01b0 t\u1ee5y, K gi\u00e1p tr\u1ea1ng, ung th\u01b0 tuy\u1ebfn v\u00fa…c\u00f3 th\u1ec3 ti\u1ebft ra ACTH g\u00e2y rah\u1ed9i ch\u1ee9ng Cushing.<\/p>\n
H\u1ed9i ch\u1ee9ng Thyroxin huy\u1ebft cao, can xi huy\u1ebft cao l\u00e0 h\u1ed9i ch\u1ee9ng c\u1eadn ung th\u01b0 hay g\u1eb7p trongnhi\u1ec1u ung th\u01b0 nh\u01b0: ung th\u01b0 th\u1eadn, ung th\u01b0 ph\u1ed5i d\u1ea1ng bi\u1ec3u b\u00ec, ung th\u01b0 ph\u1ee5 khoa, ung th\u01b0ti\u00eau h\u00f3a.<\/p>\n
II. C\u00c1C PH\u01af\u01a0NG PH\u00c1P CH\u1ea8N \u0110O\u00c1N C\u1eacN L\u00c2M S\u00c0NG<\/p>\n
1. Ch\u1ea9n \u0111o\u00e1n n\u1ed9i soi<\/p>\n
N\u1ed9i soi l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u0103m kh\u00e1m c\u00e1c h\u1ed1c t\u1ef1 nhi\u00ean v\u00e0 m\u1ed9t s\u1ed1 n\u00f4i t\u1ea1ng c\u1ee7a c\u01a1 th\u1ec3 nh\u1eddph\u01b0\u01a1ng ti\u1ec7n quang h\u1ecdc: m\u00e1y n\u1ed9i soi. K\u1ef9 thu\u1eadt n\u1ed9i soi ph\u00e1t tri\u1ec3n nhanh ch\u00f3ng, ng\u00e0y c\u00e0nghi\u1ec7n \u0111\u1ea1i, ho\u00e0n thi\u1ec7n v\u00e0 ph\u00e1t tri\u1ec3n nh\u1edd s\u1ef1 ti\u1ebfn b\u1ed9 c\u1ee7a k\u1ef9 thu\u1eadt quang h\u1ecdc, k\u1ef9 ngh\u1ec7 \u0111i\u1ec7nt\u1eed vi m\u1ea1ch.<\/p>\n
N\u1ed9i soi \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n ung th\u01b0 d\u1ea1 d\u00e0y, ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng,ung th\u01b0 th\u1ef1c qu\u1ea3n, ung th\u01b0 thanh qu\u1ea3n, ung th\u01b0 ph\u1ebf qu\u1ea3n, ung th\u01b0 b\u00e0ng quang…<\/p>\n
N\u1ed9i soi cho ph\u00e9p ti\u1ebfn h\u00e0nh m\u1ed9t s\u1ed1 th\u1ee7 thu\u1eadt: sinh thi\u1ebft, c\u1eaft polpy, \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 t\u1ed5nth\u01b0\u01a1ng, b\u01a1m thu\u1ed1c c\u1ea3n quang \u0111\u1ec3 ch\u1ee5p X quang (ch\u1ee5p ng\u01b0\u1ee3c d\u00f2ng, ch\u1ee5p ph\u1ebf qu\u1ea3n). N\u1ed9isoi can thi\u1ec7p \u0111ang ph\u00e1t tri\u1ec3n nhanh ch\u00f3ng mang l\u1ea1i nhi\u1ec1u h\u1ee9a h\u1eb9n. Qua n\u1ed9i soi ng\u01b0\u1eddi tac\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh c\u00e1c ph\u1eabu thu\u1eadt nh\u01b0: c\u1eaft bu\u1ed3ng tr\u1ee9ng, c\u1eaft t\u00fai m\u1eadt, c\u1eaft ru\u1ed9t th\u1eeba, v\u00e9t h\u1ea1chch\u1eadu, c\u1eaft t\u1eed cung v\u00e0 c\u1eaft \u0111\u1ea1i tr\u00e0ng…ph\u1eabu thu\u1eadt n\u1ed9i soi l\u00e0 ph\u1eabu thu\u1eadt c\u1ee7a th\u1ebf k\u1ef7 21.<\/p>\n
2. Ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n quang<\/p>\n
– Ch\u1ee5p ph\u1ed5i, ch\u1ee5p x\u01b0\u01a1ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1p quan tr\u1ecdng nh\u1ea5t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n K x\u01b0\u01a1ng, K ph\u1ebf qu\u1ea3n ph\u1ed5i.<\/p>\n
– K\u1ef9 thu\u1eadt ch\u1ee5p v\u00fa cho ph\u00e9p ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c kh\u1ed1i u ung th\u01b0 \u1edf giai \u0111o\u1ea1n r\u1ea5t s\u1edbm v\u1edbi d\u1ea5u hi\u1ec7uv\u00f4i h\u00f3a r\u1ea5t nh\u1ecf. K\u1ef9 thu\u1eadt n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 kh\u00e1m ph\u00e1t hi\u1ec7nung th\u01b0 v\u00fa.<\/p>\n
– K\u1ef9 thu\u1eadt ch\u1ee5p \u0111i\u1ec7n quang c\u00f3 thu\u1ed1c c\u1ea3n quang: ch\u1ee5p h\u00e0ng lo\u1ea1t phim d\u1ea1 d\u00e0y \u0111\u1ec3 kh\u00e1m x\u00e9td\u1ea1 d\u00e0y, h\u00e0nh t\u00e1 tr\u00e0ng. Ch\u1ee5p khung \u0111\u1ea1i tr\u00e0ng khi kh\u00f4ng c\u00f3 n\u1ed9i soi ho\u1eb7c khi n\u1ed9i soi th\u1ea5tb\u1ea1i. Ng\u01b0\u1eddi Nh\u1eadt ph\u00e1t minh ra ph\u01b0\u01a1ng ph\u00e1p ch\u1ee5p \u0111\u1ed1i quang k\u00e9p cho ph\u00e9p ph\u00e1t hi\u1ec7nnh\u1eefng th\u01b0\u01a1ng t\u1ed5n nh\u1ecf c\u1ee7a d\u1ea1 d\u00e0y, \u0111\u1ea1i tr\u1ef1c tr\u00e0ng.<\/p>\n
– K\u1ef9 thu\u1eadt ch\u1ee5p m\u1ea1ch m\u00e1u: ch\u1ee5p \u0111\u1ed9ng, t\u0129nh m\u1ea1ch ch\u1ec9 \u0111\u1ecbnh trong m\u1ed9t s\u1ed1 ung th\u01b0 nh\u01b0: ungth\u01b0 th\u1eadn. Ch\u1ee5p b\u1ea1ch m\u1ea1ch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n h\u1ea1ch \u00e1c t\u00ednh ho\u1eb7c h\u1ea1ch di c\u0103n s\u00e2u.<\/p>\n
– Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT scan) l\u00e0 ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7n \u0111\u1ea1i v\u1edbi k\u1ef9 thu\u1eadt \u0111i\u1ec7n quang g\u1eafn v\u1edbim\u00e1y vi t\u00ednh, cho ph\u00e9p nghi\u00ean c\u1ee9u to\u00e0n b\u1ed9 c\u01a1 th\u1ec3 v\u00e0 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c nh\u1eefng kh\u1ed1i ur\u1ea5t nh\u1ecf \u1edf s\u00e2u nh\u01b0 u n\u00e3o, u trung th\u1ea5t, u sau ph\u00fac m\u1ea1c nh\u01b0 u khung ch\u1eadu….Khi ch\u1ee5p c\u1eaftl\u1edbp vi t\u00ednh, ng\u01b0\u1eddi b\u1ec7nh tho\u1ea3i m\u00e1i, \u00edt ch\u1ecbu \u0111\u1ed9c h\u1ea1i tuy nhi\u00ean gi\u00e1 th\u00e0nh c\u00f2n cao.<\/p>\n
3. Si\u00eau \u00e2m<\/p>\n
\u1ee8ng d\u1ee5ng nhi\u1ec1u trong ch\u1ea9n \u0111o\u00e1n ung th\u01b0: ph\u00e1t hi\u1ec7n c\u00e1ckh\u1ed1i u gan, u bu\u1ed3ng tr\u1ee9ng, u th\u1eadn…<\/p>\n
Si\u00eau \u00e2m cho bi\u1ebft \u0111\u01b0\u1ee3c t\u00ednh ch\u1ea5t c\u1ee7a u: u \u0111\u1eb7c ho\u1eb7c u nang. V\u1edbi nh\u1eefng \u0111\u1ea7u d\u00f2 c\u00f3 gi\u1ea3i t\u1ea7ncao, si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c m\u1ee9c x\u00e2m l\u1ea5n c\u1ee7a ung th\u01b0 v\u00e0o t\u1ed5 ch\u1ee9c xung quanh (trong K tr\u1ef1c tr\u00e0ng, K th\u1ef1c qu\u1ea3n…)<\/p>\n
Ch\u1ea9n \u0111o\u00e1n si\u00eau \u00e2m kinh t\u1ebf, kh\u00f4ng \u0111\u1ed9c h\u1ea1i, nh\u01b0ng r\u1ea5t kh\u00f3 th\u1ef1c hi\u1ec7n \u0111\u1ed1i v\u1edbi c\u00e1c t\u1ea1ng c\u00f3kh\u00f4ng kh\u00ed v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o kinh nghi\u1ec7m c\u1ee7a ng\u01b0\u1eddi \u0111\u1ecdc.<\/p>\n
4. \u0110\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1<\/p>\n
K\u1ef9 thu\u1eadt th\u0103m d\u00f2 m\u1ed9t s\u1ed1 c\u01a1 quan b\u1eb1ng nh\u1eefng ch\u1ea5t \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1 \u0111\u00e3 cho m\u1ed9t s\u1ed1 l\u1ee3i\u00edch trong ch\u1ea9n \u0111o\u00e1n ung th\u01b0. Ch\u1ee5p x\u1ea1 h\u00ecnh \u0111\u1ed3 gi\u00e1p tr\u1ea1ng b\u1eb1ng I131 gi\u00fap ch\u1ea9n \u0111\u00f3anung th\u01b0 gi\u00e1p tr\u1ea1ng. Ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e1t hi\u1ec7n di c\u0103n x\u01b0\u01a1ng b\u1eb1ng k\u1ef9 thu\u1eadtch\u1ee5p nh\u1ea5p nh\u00e1y x\u01b0\u01a1ng.<\/p>\n
K\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng nh\u1eefng kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng c\u00f3 g\u1eafn \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1 nh\u01b0 m\u1ed9t \u0111\u1ea7u d\u00f2\u0111\u1ec3 ch\u1ee5p nh\u1ea5p nh\u00e1y ph\u00e1t hi\u1ec7n nh\u1eefng kh\u1ed1i u \u0111\u1eb7c hi\u1ec7u, nh\u1eefng \u1ed5 di c\u0103n nh\u1ecf li ti trong c\u01a1th\u1ec3. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y m\u1edbi \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u, hy v\u1ecdng s\u1ebd mang l\u1ea1i nhi\u1ec1u h\u1ee9a h\u1eb9n.<\/p>\n
5. Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI)<\/p>\n
Ph\u01b0\u01a1ng ph\u00e1p ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb l\u00e0 ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7n \u0111\u1ea1i cho nh\u1eefng h\u00ecnh \u1ea3nh t\u1ed1t h\u01a1nch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u00e0 kh\u00f4ng g\u00e2y \u0111\u1ed9c h\u1ea1i cho ng\u01b0\u1eddi b\u1ec7nh. Nguy\u00ean l\u00fd c\u1ee7a ph\u01b0\u01a1ng ph\u00e1pph\u1ee5 thu\u1ed9c v\u00e0o t\u1eeb h\u1ecdc c\u1ee7a nh\u00e2n t\u1ebf b\u00e0o, ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1ed9 t\u1eadp trung c\u1ee7a H+, do c\u00f3th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c c\u00e1c t\u1ed5n th\u01b0\u01a1ng t\u00f9y theo m\u1ee9c \u0111\u1ed9 c\u1ed9ng h\u01b0\u1edfng t\u1eeb tr\u01b0\u1eddng h\u1ea1t nh\u00e2n.<\/p>\n
Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tr\u01b0\u1eddng c\u00f2n cho ph\u00e9p nghi\u00ean c\u1ee9u c\u00e1c kh\u1ed1i u v\u1ec1 ph\u01b0\u01a1ng di\u1ec7n sinhh\u1ecdc v\u00e0 h\u00f3a h\u1ecdc. Hi\u1ec7n nay ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tr\u01b0\u1eddng m\u1edbi ch\u1ec9 b\u1eaft \u0111\u1ea7u \u1edf n\u01b0\u1edbc ta v\u00ec m\u00e1yr\u1ea5t \u0111\u1eaft.<\/p>\n
6. Ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m ung th\u01b0<\/p>\n
L\u00e0 nh\u1eefng ch\u1ea5t xu\u1ea5t hi\u1ec7n v\u00e0 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 trong c\u01a1 th\u1ec3 li\u00ean quan t\u1edbi s\u1ef1 ph\u00e1t sinh v\u00e0ph\u00e1t tri\u1ec3n c\u1ee7a ung th\u01b0. Ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m ung th\u01b0 chia l\u00e0m 2 lo\u1ea1i ch\u00ednh.<\/p>\n
T\u1ebf b\u00e0o ch\u1ec9 \u0111i\u1ec3m:C\u00e1c kh\u00e1ng nguy\u00ean t\u1eadp trung tr\u00ean b\u1ec1 m\u1eb7t c\u1ee7a m\u00e0ng t\u1ebf b\u00e0o (nh\u01b0 trong b\u1ec7nh L\u01a1x\u00eami) v\u00e0c\u00e1c c\u01a1 quan th\u1ee5 c\u1ea3m n\u1ed9i ti\u1ebft trong ung th\u01b0 v\u00fa.<\/p>\n
D\u1ecbch th\u1ec3 ch\u1ec9 \u0111i\u1ec3m:<\/p>\n
Nh\u1eefng ch\u1ea5t xu\u1ea5t hi\u1ec7n trong huy\u1ebft thanh, n\u01b0\u1edbc ti\u1ec3u, ho\u1eb7c c\u00e1c d\u1ecbch kh\u00e1c c\u1ee7a c\u01a1 th\u1ec3. C\u00e1cch\u1ea5t n\u00e0y \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p v\u00e0 b\u00e0i ti\u1ebft t\u1eeb kh\u1ed1i u ho\u1eb7c t\u1ea1o ra do s\u1ef1 ph\u1ea3n \u1ee9ng l\u1ea1i c\u1ee7a c\u01a1 th\u1ec3v\u1edbi t\u1ebf b\u00e0o ung th\u01b0.<\/p>\n
Hi\u1ec7n nay nh\u1edd vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng, ng\u01b0\u1eddi ta \u0111\u00e3 t\u00ecm ra nhi\u1ec1u kh\u00e1ng nguy\u00ean \u0111\u1eb7c bi\u1ec7t \u0111\u01b0\u1ee3c xem l\u00e0 c\u00e1c ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m ung th\u01b0 c\u00f3 gi\u00e1 tr\u1ecb nh\u01b0 CA 15.3 \u0111\u1eb7c hi\u1ec7uv\u1edbi K v\u00fa; CA 19.9 v\u1edbi K d\u1ea1 d\u00e0y, \u0111\u1ea1i tr\u1ef1c tr\u00e0ng; CA 72.4 v\u1edbi ung th\u01b0 d\u1ea1 d\u00e0y; SCC \u0111\u1eb7c hi\u1ec7u ung th\u01b0 bi\u1ec3u b\u00ec nh\u01b0 ung th\u01b0 c\u1ed5 t\u1eed cung.<\/p>\n
Ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m K c\u00f3 gi\u00e1 tr\u1ecb \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng, hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u00fap theod\u00f5i t\u00e1i ph\u00e1t sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n
7. Ch\u1ea9n \u0111o\u00e1n t\u1ebf b\u00e0o h\u1ecdc<\/p>\n
X\u00e9t nghi\u1ec7m t\u00ecm tb \u00e1c t\u00ednh t\u1eeb tb bong c\u1ee7a c\u01a1 th\u1ec3: X\u00e9t nghi\u1ec7m phi\u1ebfn \u0111\u1ed3 \u00e2 m \u0111 \u1ea1 o r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb trong ph\u00e1t hi\u1ec7n ung th\u01b0 c\u1ed5 t\u1eed cung. T\u00ecm tb ung th\u01b0 trong c\u00e1cd\u1ecbch m\u00e0ng ph\u1ed5i, d\u1ecbch m\u00e0ng b\u1ee5ng, d\u1ecbch r\u1eeda d\u1ea1 d\u00e0y…<\/p>\n
X\u00e9t nghi\u1ec7m t\u00ecm tb K t\u1eeb ch\u1ecdc h\u00fat c\u00e1c kh\u1ed1i u ho\u1eb7c c\u00e1c h\u1ea1ch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n m\u1ed9ts\u1ed1 ung th\u01b0 h\u1ea1ch \u00e1c t\u00ednh.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n t\u1ebf b\u00e0o h\u1ecdc cho nhi\u1ec1u \u01b0u \u0111i\u1ec3m nh\u01b0: nhanh, \u0111\u01a1n gi\u1ea3n, kinh t\u1ebf…Tuy nhi\u00ean v\u1eabnc\u00f2n t\u1ed3n t\u1ea1i m\u1ed9t t\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh ho\u1eb7c \u00e2m t\u00ednh gi\u1ea3.<\/p>\n
8. Ch\u1ea9n \u0111o\u00e1n gi\u1ea3i ph\u1eabu b\u1ec7nh<\/p>\n
Ch\u1ea9n \u0111o\u00e1n gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00e0 ph\u01b0\u01a1ng ph\u00e1p quy\u1ebft \u0111\u1ecbnh nh\u1ea5t \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh b\u1ec7nh ung th\u01b0.Ph\u00e2n lo\u1ea1i th\u1ec3 gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng v\u00e0 l\u00e0 c\u01a1 s\u1edf ch\u1ecdnl\u1ef1a ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb. \u0110\u1ec3 c\u00f3 m\u1eabu b\u1ec7nh ph\u1ea9m, ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh b\u1ea5m sinh thi\u1ebft, m\u1ed5sinh thi\u1ebft, sinh thi\u1ebft kim…<\/p>\n
C\u00e1c m\u1ea9u b\u1ec7nh ph\u1ea9m c\u00f2n gi\u00fap l\u00e0m nh\u1eefng x\u00e9t nghi\u1ec7m kh\u00e1cnh\u01b0: kh\u1ea3o s\u00e1t mi\u1ec5n d\u1ecbch h\u1ecdc c\u1ee7a c\u00e1c t\u1ebf b\u00e0o u lymph\u00f4 \u00e1c t\u00ednh, kh\u1ea3o s\u00e1t y\u1ebfu t\u1ed1 th\u1ee5 c\u1ea3mn\u1ed9i ti\u1ebft trong ung th\u01b0 v\u00fa. Ph\u01b0\u01a1ng ph\u00e1p sinh thi\u1ebft t\u1ee9c th\u00ec (c\u1eaft l\u1ea1nh) cho k\u1ebft qu\u1ea3 nhanh (15ph\u00fat) \u0111\u00e3 gi\u00fap \u00edch r\u1ea5t nhi\u1ec1u cho ph\u1eabu thu\u1eadt ung th\u01b0.<\/p>\n
III. CH\u1ea8N \u0110O\u00c1N GIAI \u0110O\u1ea0N THEO PH\u00c2N LO\u1ea0I TNM: G\u1ed3m 3 y\u1ebfu t\u1ed1<\/p>\n
1. T: U nguy\u00ean ph\u00e1t<\/p>\n
T0: Ch\u01b0a c\u00f3 d\u1ea5u hi\u1ec7u u nguy\u00ean ph\u00e1t<\/p>\n
Tis: Ung th\u01b0 n\u1ed9i m\u1ea1ch: u ch\u01b0a ph\u00e1 v\u1ee1 m\u00e0ng \u0111\u00e1y.<\/p>\n
T1 4: theo k\u00edch th\u01b0\u1edbc t\u0103ng d\u1ea7n ho\u1eb7c m\u1ee9c x\u00e2m l\u1ea5n t\u1ea1i ch\u1ed7 c\u1ee7a u nguy\u00ean ph\u00e1t.<\/p>\n
Tx: ch\u01b0a th\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c u nguy\u00ean ph\u00e1t.<\/p>\n
2. N: h\u1ea1ch t\u1ea1i v\u00f9ng<\/p>\n
N0: Ch\u01b0a c\u00f3 d\u1ea5u hi\u1ec7u x\u00e2m l\u1ea5n h\u1ea1ch t\u1ea1i v\u00f9ng<\/p>\n
N1 3: M\u1ee9c \u0111\u1ed9 t\u0103ng d\u1ea7n s\u1ef1 x\u00e2m l\u1ea5n h\u1ea1ch t\u1ea1i v\u00f9ng.<\/p>\n
NX: Ch\u01b0a th\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c h\u1ea1ch t\u1ea1i v\u00f9ng.<\/p>\n
3. M: Di c\u0103n xa<\/p>\n
M0: Ch\u01b0a di c\u0103n xa<\/p>\n
M1: Di c\u0103n xa<\/p>\n
Mx: Ch\u01b0a \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c di c\u0103n<\/p>\n
V\u00ed d\u1ee5 : s\u1eafp x\u1ebfp giai \u0111o\u1ea1n TNM trong ung th\u01b0 v\u00fa (theo UICC 2004)<\/p>\n
1. T: U nguy\u00ean ph\u00e1tT0: Ch\u01b0a c\u00f3 d\u1ea5u hi\u1ec7u u nguy\u00ean ph\u00e1t<\/p>\n
Tis: Ung th\u01b0 t\u1ea1i ch\u1ed7<\/p>\n
T1: U \u2264 2 cm.<\/p>\n
T2: U c\u00f3 k\u00edch th\u01b0\u1edbc t\u1eeb h\u01a1n 2 cm t\u1edbi 5 cm<\/p>\n
T3: U l\u1edbn h\u01a1n 5 cm<\/p>\n
T4: U m\u1ecdi k\u00edch th\u01b0\u1edbc v\u1edbi s\u1ef1 x\u00e2m l\u1ea5n.<\/p>\n
2. N: h\u1ea1ch t\u1ea1i v\u00f9ngN0: Ch\u01b0a s\u1edd th\u1ea5y h\u1ea1ch n\u00e1ch c\u00f9ng b\u00ean<\/p>\n
N1: H\u1ea1ch n\u00e1ch c\u00f9ng b\u00ean di \u0111\u1ed9ng<\/p>\n
N2: H\u1ea1ch n\u00e1ch c\u00f9ng b\u00ean c\u1ed1 \u0111\u1ecbnh<\/p>\n
N3(a,b,c): Di c\u0103n h\u1ea1ch h\u1ea1 \u0111\u00f2n, v\u00fa trong, th\u01b0\u1ee3ng \u0111\u00f2n c\u00f9ng b\u00ean<\/p>\n
3. M: Di c\u0103n xaM0: Ch\u01b0a c\u00f3 di c\u0103n xa<\/p>\n
M1: C\u00f3 di c\u0103n xa k\u1ec3 c\u1ea3 h\u1ea1ch th\u01b0\u1ee3ng \u0111\u00f2n<\/p>\n
C\u00e2u 5:Ph\u1eabu tr\u1ecb: nguy\u00ean t\u1eafc, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p<\/p>\n
I. NGUY\u00caN T\u1eaeC PH\u1eaaU THU\u1eacT UNG TH\u01af:<\/p>\n
1. Ph\u1eabu thu\u1eadt ung th\u01b0 ph\u1ea3i tu\u00e2n theo nguy\u00ean t\u1eafc chung c\u1ee7a \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ung th\u01b0 nh\u01b0: Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p; L\u1eadp k\u1ebf ho\u1ea1ch v\u00e0 b\u1ed5 sung k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb; Theo d\u00f5i \u0111\u1ecbnh k\u00ec sau \u0111i\u1ec1u tr\u1ecb<\/p>\n
2. Ph\u1eabu thu\u1eadt ung th\u01b0 ph\u1ea3i tu\u00e2n theo c\u00e1c nguy\u00ean t\u1eafc chung c\u1ee7a ngo\u1ea1i khoa c\u0169ng nh\u01b0 nh\u1eefng y\u00eau c\u1ea7u, \u0111\u00f2i h\u1ecfi v\u1ec1 g\u00e2y m\u00ea h\u1ed3i s\u1ee9c nh\u01b0 c\u00f3 th\u00eam b\u1ec7nh n\u1eb7ng ph\u1ed1i h\u1ee3p, th\u1ec3 tr\u1ea1ng b\u1ec7nh nh\u00e2n qu\u00e1 k\u00e9m, tu\u1ed5i qu\u00e1 cao kh\u00f4ng n\u00ean \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/p>\n
3. Ph\u1ea3i c\u00f3 chu\u1ea9n \u0111o\u00e1n b\u1ec7nh ch\u00ednh x\u00e1c, \u0111\u00fang giai \u0111o\u1ea1n tr\u01b0\u1edbc ph\u1eabu thu\u1eadt. Ch\u1eb3ng h\u1ea1n K x\u01b0\u01a1ng ph\u1ea3i c\u1eaft c\u1ee5t chi, nh\u01b0ng n\u1ebfu chu\u1ea9n \u0111o\u00e1n sai, GPB kh\u00f4ng ph\u1ea3i K x\u01b0\u01a1ng th\u00ec h\u1eadu qu\u1ea3 r\u1ea5t n\u1eb7ng n\u1ec1<\/p>\n
4. Ph\u1ea9u thu\u1eadt ung th\u01b0 ph\u1ea3i \u0111\u00fang ch\u1ec9 \u0111\u1ecbnh. Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n th\u01b0\u1eddng cho nh\u1eefng ung th\u01b0 t\u1ea1i ch\u1ed7 ho\u1eb7c t\u1ea1i v\u00f9ng. M\u1ed9t s\u1ed1 ung th\u01b0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt nh\u01b0 K v\u00fa th\u1ec3 vi\u00eam, khi kh\u1ed1i u \u0111ang vi\u00eam n\u00f3ng m\u00e0 can thi\u1ec7p ph\u1eabu thu\u1eadt s\u1ebd g\u00e2y nguy hi\u1ec3m t\u0103ng di b\u00e0o<\/p>\n
5. Ph\u1eabu thu\u1eadt ung th\u01b0 ph\u1ea3i \u0111\u00fang m\u1ee5c \u0111\u00edch<\/p>\n
6. Ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n ung th\u01b0 ph\u1ea3i theo nguy\u00ean t\u1eafc:<\/p>\n
– L\u1ea5y \u0111\u1ee7 r\u1ed9ng u v\u00e0 t\u1ed5 ch\u1ee9c quanh u (v\u00f9ng m\u00e0 t\u1ebf b\u00e0o K c\u00f3 th\u1ec3 x\u00e2m l\u1ea5n t\u1edbi) \u0111\u1ea3m b\u00e0o \u1edf di\u1ec7n c\u1eaft kh\u00f4ng c\u00f2n tb ung th\u01b0. Mu\u1ed1n v\u1eady ph\u1ea3i ki\u1ec3m tra di\u1ec7n c\u1eaft b\u1eb1ng soi vi th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc theo k\u0129 thu\u1eadt sinh thi\u1ebft c\u1eaft l\u1ea1nh. Di\u1ec7n c\u1eaft an to\u00e0n t\u00f9y theo lo\u1ea1i ung th\u01b0 nh\u01b0:<\/p>\n
Ung th\u01b0 da, v\u00fa c\u00e1ch u kho\u1ea3ng 2 cm<\/p>\n
K \u0111\u1ea1i tr\u00e0ng 5cm; K tr\u1ef1c tr\u00e0ng di\u1ec7n c\u1eaft d\u01b0\u1edbi c\u00e1ch u 2cm; K d\u1ea1 d\u00e0y c\u00e1ch u kho\u1ea3ng 6cm<\/p>\n
Ung th\u01b0 h\u1eafc t\u1ed1 m\u1ecfng d\u01b0\u1edbi 0.75mm: c\u00e1ch u 1cm, d\u00e0y h\u01a1n 1mm: di\u1ec7n c\u1eaft l\u00e0 3cm<\/p>\n
– N\u1ea1o v\u00e9t tri\u1ec7t \u0111\u1ec3 h\u1ec7 th\u1ed1ng h\u1ea1ch v\u00f9ng, nh\u1ea5t l\u00e0 khi \u0111\u00e3 c\u00f3 h\u1ea1ch b\u1ecb x\u00e2m l\u1ea5n ung th\u01b0, th\u01b0\u1eddng \u00e1p d\u1ee5ng v\u1edbi c\u00e1c ung th\u01b0 bi\u1ebfu m\u00f4, v\u00ed d\u1ee5 nh\u01b0 n\u1ea1o v\u00e9t h\u1ea1ch n\u00e1ch trong \u0111i\u1ec1u tr\u1ecb K v\u00fa, n\u1ea1o v\u00e9t h\u1ea1ch m\u1ea1ch treo trong \u0111i\u1ec1u tr\u1ecb K \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n
– Trong m\u1ed5 kh\u00f4ng \u0111\u01b0\u1ee3c gieo r\u1eafc t\u1ebf b\u00e0o K, kh\u00f4ng c\u1ea5y t\u1ebf b\u00e0o K \u1edf di\u1ec7n m\u1ed5<\/p>\n
II. C\u00c1C PH\u01af\u01a0NG PH\u00c1P \u0110I\u1ec0U TR\u1eca PH\u1eaaU THU\u1eacT UNG TH\u01af<\/p>\n
1. Ph\u1eabu thu\u1eadt d\u1ef1 ph\u00f2ng b\u1ec7nh ung th\u01b0<\/p>\n
Trong c\u00f4ng t\u00e1c ph\u00f2ng b\u1ec7nh ung th\u01b0, ph\u1eabu thu\u1eadt c\u0169ng gi\u1eef vai tr\u00f2 h\u1ebft s\u1ee9c quan tr\u1ecdng v\u00e0c\u1ea7n thi\u1ebft.<\/p>\n
C\u00f9ng v\u1edbi vi\u1ec7c ph\u00f2ng tr\u00e1nh c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y ung th\u01b0, ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf nh\u1eefng th\u01b0\u01a1ng t\u1ed5nti\u1ec1n ung th\u01b0 s\u1ebd g\u00f3p ph\u1ea7n t\u00edch c\u1ef1c l\u00e0m h\u1ea1 th\u1ea5p t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh. Nh\u1eefng ph\u1eabu thu\u1eadt d\u1ef1ph\u00f2ng c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng nh\u01b0:<\/p>\n
C\u1eaft b\u1ecf ch\u00edt h\u1eb9p bao quy \u0111\u1ea7u tr\u01b0\u1edbc 10 tu\u1ed5i.<\/p>\n
Ph\u1eabu thu\u1eadt c\u1eaft polyp \u0111\u1ea1i tr\u1ef1c tr\u00e0ng gi\u00fap ph\u00f2ng tr\u00e1nh b\u1ec7nh ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng.<\/p>\n
Kho\u00e9t ch\u00f3p c\u1ed5 t\u1eed cung \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 c\u1ed5 t\u1eed cung giai \u0111o\u1ea1n Tis l\u00e0 bi\u1ec7nph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng ch\u1ed1ng ung th\u01b0 c\u1ed5 t\u1eed cung c\u00f3 hi\u1ec7u qu\u1ea3.<\/p>\n
Theo khuy\u1ebfn c\u00e1o c\u1ee7a t\u1ed5 ch\u1ee9c y t\u1ebf th\u1ebf gi\u1edbi th\u00ec trong c\u01a1 th\u1ec3 c\u00f3 b\u1ea5t k\u1ef3 m\u1ed9t kh\u1ed1i un\u00e0o ho\u1eb7c nh\u1eefng t\u1ed5n th\u01b0\u01a1ng vi\u00eam lo\u00e9t \u0111i\u1ec1u tr\u1ecb d\u00e0i ng\u00e0y kh\u00f4ng kh\u1ecfi c\u0169ng n\u00ean c\u1eaft b\u1ecf \u0111i \u0111\u1ec3tr\u00e1nh ung th\u01b0.<\/p>\n
2. Ph\u1eabu thu\u1eadt ch\u1ea9n \u0111o\u00e1n ung th\u01b0<\/p>\n
Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh ung th\u01b0 ch\u1ec9 \u0111\u1ea7y \u0111\u1ee7, ch\u00ednh x\u00e1c v\u00e0 c\u00f3 gi\u00e1 tr\u1ecb khi c\u00f3 k\u1ebft qu\u1ea3 ch\u1ea9n \u0111o\u00e1n m\u00f4b\u1ec7nh h\u1ecdc. V\u00ec th\u1ebf ph\u1eabu thu\u1eadt l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n duy nh\u1ea5t \u0111\u1ec3 l\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9m. Ph\u1eabu thu\u1eadtch\u1ea9n \u0111o\u00e1n ung th\u01b0 bao g\u1ed3m nhi\u1ec1u lo\u1ea1i, nhi\u1ec1u m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau song ch\u00fang ph\u1ea3i tu\u00e2nth\u1ee7 nguy\u00ean t\u1eafc:<\/p>\n
\u0110\u01b0\u1eddng kim, \u0111\u01b0\u1eddng r\u1ea1ch sinh thi\u1ebft tr\u00f9ng v\u1edbi \u0111\u01b0\u1eddng m\u1ed5 sau n\u00e0y \u0111\u1ec3 c\u00f3 th\u1ec3 c\u1eaft g\u1ecdn t\u1ed5ch\u1ee9c ung th\u01b0.<\/p>\n
K\u00edch th\u01b0\u1edbc b\u1ec7nh ph\u1ea9m ph\u1ea3i \u0111\u1ee7, ph\u00f9 h\u1ee3p v\u1edbi y\u00eau c\u1ea7u x\u00e9t nghi\u1ec7m, ph\u1ea3i l\u1ea5y \u1edf nhi\u1ec1u v\u1ecbtr\u00ed, kh\u00f4ng l\u1ea5y \u1edf v\u00f9ng ho\u1ea1i t\u1eed nh\u1eb1m \u0111\u01b0a l\u1ea1i t\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh cao nh\u1ea5t.<\/p>\n
Qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt nh\u1eb9 nh\u00e0ng, g\u1ecdn g\u1ebd nh\u1eb1m tr\u00e1nh l\u00e2y lan, c\u1ea5y t\u1ebf b\u00e0o ung th\u01b0tr\u00ean \u0111\u01b0\u1eddng sinh thi\u1ebft.<\/p>\n
C\u00f3 nh\u1eefng h\u00ecnh th\u1ee9c ph\u1eabu thu\u1eadt ch\u1ea9n \u0111o\u00e1n nh\u01b0:<\/p>\n
Sinh thi\u1ebft b\u1eb1ng kim:<\/p>\n
L\u00e0 th\u1ee7 thu\u1eadt th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng trong ch\u1ea9n \u0111o\u00e1n c\u00e1c kh\u1ed1i u v\u00fa, h\u1ea1ch, u ph\u1ea7n m\u1ec1m,gan, ph\u1ed5i…<\/p>\n
Ng\u00e0y nay, \u0111\u01b0\u1ee3c s\u1ef1 h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m, sinh thi\u1ebft kim \u0111\u00e3 l\u1ea5y \u0111\u01b0\u1ee3c b\u1ec7nh ph\u1ea9m \u1edf kh\u1ed1i u nh\u1ecf k\u00edch th\u01b0\u1edbc ch\u1ec9 v\u00e0i centimet.<\/p>\n
Sinh thi\u1ebft kho\u00e9t ch\u00f3p ho\u1eb7c l\u1ea5y to\u00e0n b\u1ed9 u:<\/p>\n
V\u1edbi nh\u1eefng kh\u1ed1i u, h\u1ea1ch nh\u1ecf g\u1ecdn, t\u1ed1t nh\u1ea5t l\u1ea5y b\u1ecf to\u00e0n b\u1ed9 kh\u1ed1i u h\u1ea1ch, l\u00e0m nh\u01b0 v\u1eady s\u1ebdtr\u00e1nh l\u00e0m gieo r\u1eafc t\u1ebf b\u00e0o ung th\u01b0 v\u00e0o t\u1ed5 ch\u1ee9c l\u00e0nh, \u0111\u1ed3ng th\u1eddi s\u1ebd gi\u00fap cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1nm\u00f4 b\u1ec7nh h\u1ecdc d\u1ec5 d\u00e0ng v\u00e0 ch\u00ednh x\u00e1c h\u01a1n.<\/p>\n
V\u1edbi nh\u1eefng kh\u1ed1i u l\u1edbn, d\u00ednh, kh\u00f4ng th\u1ec3 l\u1ea5y g\u1ecdn \u0111\u01b0\u1ee3c, ta c\u00f3 th\u1ec3 l\u1ea5y \u0111i m\u1ed9t ph\u1ea7n kh\u1ed1i u \u0111\u1ec3l\u00e0m ch\u1ea9n \u0111o\u00e1n.Song ph\u1ea3i ch\u00fa \u00fd r\u1eb1ng:Vi\u1ec7c l\u00e0m n\u00e0y l\u00e0 h\u1ebft s\u1ee9c h\u1ea1n h\u1eefu, qu\u00e1 tr\u00ecnh ph\u1eabuthu\u1eadt ph\u1ea3i nh\u1eb9 nh\u00e0ng v\u00e0 sau khi c\u00f3 k.qu\u1ea3 c.\u0111o\u00e1n gi\u1ea3i ph\u1eabu b\u1ec7nh ph\u1ea3i x\u1eed l\u00fd ngaykh\u1ed1i u b\u1eb1ng x\u1ea1 tr\u1ecb, ho\u00e1 ch\u1ea5t ho\u1eb7c ph\u1eabu thu\u1eadt r\u1ed9ng r\u00e3i.<\/p>\n
M\u1edf b\u1ee5ng th\u0103m d\u00f2 v\u00e0 soi \u1ed5 b\u1ee5ng:Ch\u1ec9 \u0111\u1ecbnh n\u00e0y \u00e1p d\u1ee5ng cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u1ed5 b\u1ee5ng song ch\u01b0a c\u00f3 ch\u1ea9n\u0111o\u00e1n ch\u00ednh x\u00e1c b\u1ec7nh c\u0169ng nh\u01b0 giai \u0111o\u1ea1n b\u1ec7nh.<\/p>\n
Vi\u1ec7c m\u1edf b\u1ee5ng cho ph\u00e9p ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c \u0111\u01b0\u1ee3c nh\u00ecn t\u1eadn m\u1eaft, s\u1edd t\u1eadn tay t\u1ed5n th\u01b0\u01a1ng, qua\u0111\u00f3 \u0111\u01b0a ra nh\u1eefng ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c, kh\u00e1ch quan v\u1ec1 lo\u1ea1i b\u1ec7nh giai \u0111o\u1ea1n b\u1ec7nh, \u0111\u1ed3ngth\u1eddi c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh sinh thi\u1ebft ho\u1eb7c \u0111\u00e1nh d\u1ea5u c\u00e1c v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng gi\u00fap cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecbsau n\u00e0y.<\/p>\n
V\u1edbi m\u1ed9t s\u1ed1 ung th\u01b0 (nh\u01b0 ung th\u01b0 bu\u1ed3ng tr\u1ee9ng), ng\u01b0\u1eddi ta c\u00f2n ti\u1ebfn h\u00e0nh m\u1edf b\u1ee5ng l\u1ea1i \u0111\u1ec3\u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng “ph\u1eabu thu\u1eadt second look”.<\/p>\n
Tr\u01b0\u1edbc \u0111\u00e2y, m\u1edf b\u1ee5ng th\u0103m d\u00f2 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i r\u1ed9ng r\u00e3i, song hi\u1ec7n m\u1ed9t s\u1ed1 tr\u01b0\u1eddngh\u1ee3p \u0111\u00e3 \u0111\u01b0\u1ee3c thay th\u1ebf b\u1eb1ng soi \u1edf b\u1ee5ng v\u00e0 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT Scan) hay ch\u1ee5p c\u1ed9ngh\u01b0\u1edfng t\u1eeb (MRI).<\/p>\n
3. Ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb ung th\u01b0<\/p>\n
C\u00f3 hai lo\u1ea1i ch\u1ec9 \u0111\u1ecbnh ch\u00ednh l\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n v\u00e0 t\u1ea1m th\u1eddi. Vi\u1ec7c \u00e1p d\u1ee5ng ch\u1ec9\u0111\u1ecbnh n\u00e0o ho\u00e0n to\u00e0n ph\u1ee5 thu\u1ed9c v\u00e0o giai \u0111o\u1ea1n b\u1ec7nh. Tuy nhi\u00ean, nhi\u1ec1u ung th\u01b0 khi ph\u00e1thi\u1ec7n ra b\u1ec7nh \u0111\u00e3 \u1edf giai \u0111o\u1ea1n mu\u1ed9n (giai \u0111o\u1ea1n III v\u00e0 IV) do \u0111\u00f3 h\u1ea1n ch\u1ebf nhi\u1ec1u \u0111\u1ebfn k\u1ebft qu\u1ea3\u0111i\u1ec1u tr\u1ecb. V\u00ec v\u1eady, tr\u01b0\u1edbc khi m\u1ed5, ng\u01b0\u1eddi ph\u1eabu thu\u1eadt vi\u00ean ph\u1ea3i c\u00f3 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u1ec1 giai\u0111o\u1ea1n b\u1ec7nh c\u0169ng nh\u01b0 ph\u1ea3i hi\u1ec3u r\u00f5 qu\u00e1 tr\u00ecnh ti\u1ebfn tri\u1ec3n t\u1ef1 nhi\u00ean c\u1ee7a lo\u1ea1i ung th\u01b0 m\u00e0 m\u00ecnh\u0111ang \u0111i\u1ec1u tr\u1ecb, t\u1eeb \u0111\u00f3 m\u1edbi c\u00f3 th\u00e1i \u0111\u1ed9 x\u1eed l\u00fd \u0111\u00fang.<\/p>\n
Ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n trong ung th\u01b0 c\u00f3 th\u1ec3 l\u00e0: Ph\u1eabu thu\u1eadt \u0111\u01a1n \u0111\u1ed9c (v\u1edbi nh\u1eefngtr\u01b0\u1eddng h\u1ee3p b\u1ec7nh \u1edf g\u0111 s\u1edbm t\u1ed5n th\u01b0\u01a1ng khu tr\u00fa ch\u01b0a di c\u0103n xa) ho\u1eb7c n\u1eb1m trongk\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p. Chi\u1ebfn l\u01b0\u1ee3c, chi\u1ebfn thu\u1eadt ph\u1ed1i h\u1ee3p nh\u01b0 th\u1ebfn\u00e0o ho\u00e0n to\u00e0n ph\u1ee5 thu\u1ed9c v\u00e0o t\u1eebng lo\u1ea1i b\u1ec7nh v\u00e0 t\u1eebng g\u0111 b\u1ec7nh m\u1ed9t c\u00e1ch c\u1ee5 th\u1ec3,ch\u00ednh x\u00e1c tr\u00ean m\u1ed7i tr\u01b0\u1eddng h\u1ee3p. Ph\u1eabu thu\u1eadt l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n chonhi\u1ec1u b\u1ec7nh ung th\u01b0 nh\u01b0 ung th\u01b0 d\u1ea1 d\u00e0y, \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, v\u00fa, c\u1ed5 t\u1eed cung, ph\u1ed5i, ph\u1ea7n m\u1ec1m…<\/p>\n
Ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb t\u1ea1m th\u1eddi ch\u1ec9 \u0111\u1ecbnh cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh \u1edf giai \u0111o\u1ea1n mu\u1ed9n, t\u1ed5nth\u01b0\u01a1ng \u0111\u00e3 lan r\u1ed9ng. C\u0103n c\u1ee9 v\u00e0o c\u00e1c bi\u1ebfn ch\u1ee9ng do K g\u00e2y ra m\u00e0 ph\u1eabu thu\u1eadt t\u1ea1mth\u1eddi c\u0169ng c\u00f3 c\u00e1c m\u1ee5c \u0111\u00edch kh\u00e1c nhau:<\/p>\n
Ph\u1eabu thu\u1eadt l\u1ea5y b\u1ecf u t\u1ed1i \u0111a: Khi kh\u1ed1i u l\u1edbn, d\u00ednh vi\u1ec7c c\u1eaft b\u1ecf kh\u1ed1i u tri\u1ec7t \u0111\u1ec3 kh\u00f3 th\u1ef1chi\u1ec7n, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n vi\u1ec7c c\u1eaft b\u1ecf u t\u1ed1i \u0111a. Vi\u1ec7c l\u00e0m n\u00e0y s\u1ebd l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 kh\u1ed1i l\u01b0\u1ee3ngt\u1ed5 ch\u1ee9c ung th\u01b0, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i \u0111\u1ec3 \u00e1p d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 sungkh\u00e1c (x\u1ea1 tr\u1ecb, ho\u00e1 tr\u1ecb…). V\u00ed d\u1ee5 nh\u01b0 trong ung th\u01b0 bu\u1ed3ng tr\u1ee9ng, ung th\u01b0 tinh ho\u00e0n…<\/p>\n
Ph\u1eabu thu\u1eadt ph\u1ee5c h\u1ed3i s\u1ef1 l\u01b0u th\u00f4ng: L\u00e0m h\u1eadu m\u00f4n nh\u00e2n t\u1ea1o, n\u1ed1i v\u1ecb tr\u00e0ng, n\u1ed1i t\u1eaft h\u1ed3i tr\u00e0ng \u0111\u1ea1i tr\u00e0ng, m\u1edf th\u00f4ng d\u1ea1 d\u00e0y, m\u1edf kh\u00ed qu\u1ea3n, m\u1edf th\u00f4ng b\u00e0ng quang….<\/p>\n
Ph\u1eabu thu\u1eadt c\u1ea7m m\u00e1u: Th\u1eaft \u0110M ch\u1eadu trong ung th\u01b0 c\u1ed5 t\u1eed cung, th\u1eaft m\u1ea1ch c\u1ea3nh trong ung th\u01b0 v\u00f2m.<\/p>\n
Ph\u1eabu thu\u1eadt s\u1ea1ch s\u1ebd ch\u1ec9 \u0111\u1ecbnh cho nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p nh\u01b0 ung th\u01b0 v\u00fa giai \u0111o\u1ea1n mu\u1ed9n, c\u00f3v\u1ee1 lo\u00e9t…<\/p>\n
Ph\u1eabu thu\u1eadt gi\u1ea3m \u0111au: Ph\u1eabu thu\u1eadt c\u1eaft c\u1ee5t chi, th\u00e1o kh\u1edbp trong ung th\u01b0 x\u01b0\u01a1ng, c\u1eaft th\u1ea7nkinh chi ph\u1ed1i v\u00f9ng t\u1ed5n th\u01b0\u01a1ng…<\/p>\n
Ph\u1eabu thu\u1eadt v\u1edbi ung th\u01b0 t\u00e1i ph\u00e1t v\u00e0 di c\u0103n<\/p>\n
T\u00e1i ph\u00e1t ung th\u01b0 l\u00e0 m\u1ed9t \u0111\u1eb7c t\u00ednh c\u1ee7a b\u1ec7nh ung th\u01b0. Tuy nhi\u00ean trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3pung th\u01b0 t\u00e1i ph\u00e1t sau \u0111i\u1ec1u tr\u1ecb nh\u01b0 ung th\u01b0 \u0111\u1ea1i tr\u00e0ng, gi\u00e1p tr\u1ea1ng…Vi\u1ec7c ph\u1eabu thu\u1eadt l\u1ea1i v\u1eabnc\u00f3 th\u1ec3 cho k\u1ebft qu\u1ea3 t\u1ed1t.Ch\u1ec9 \u0111\u1ecbnh m\u1ed5 l\u1ea1i tu\u1ef3 thu\u1ed9c v\u00e0o t\u1eebng lo\u1ea1i b\u1ec7nh, c\u0169ng nh\u01b0 kh\u1ea3 n\u0103ng l\u1ea5y b\u1ecf h\u1ebft nh\u1eefng t\u1ed5nth\u01b0\u01a1ng t\u00e1i ph\u00e1t \u0111\u00f3.<\/p>\n
Di c\u0103n ung th\u01b0 l\u00e0 giai \u0111o\u1ea1n cu\u1ed1i c\u00f9ng c\u1ee7a b\u1ec7nh, nh\u01b0ng nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p v\u1eabn c\u00f3 th\u1ec3\u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt cho k\u1ebft qu\u1ea3 ch\u1eb3ng h\u1ea1n nh\u01b0 ung th\u01b0 \u0111\u1ea1i tr\u00e0ng c\u00f3 di c\u0103n gan m\u1ed9t \u1ed5, n\u1ebfuph\u1eabu thu\u1eadt c\u1eaft \u0111\u1ea1i tr\u00e0ng v\u00e0 c\u1eaft nh\u00e2n di c\u0103n v\u1eabn cho k\u1ebft qu\u1ea3 kh\u1ea3 quan. N\u00f3i chung, th\u01b0\u1eddngch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt cho c\u00e1c di c\u0103n h\u1ea1ch v\u00f9ng. C\u00f2n v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p di c\u0103n kh\u00e1c, ch\u1ec9\u0111\u1ecbnh ph\u1eabu thu\u1eadt ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u1ef1a tr\u00ean nh\u1eefng ti\u00eau ch\u00ed sau:Th\u1eddi gian xu\u1ea5t hi\u1ec7n di c\u0103n mu\u1ed9n (t\u00ednh theo n\u0103m), U di c\u0103n khu tr\u00fa, \u0111\u01a1n \u0111\u1ed9c \u1edf m\u1ed9t c\u01a1 quan, S\u1ee9c kho\u1ebb b\u1ec7nh nh\u00e2n c\u00f3 cho ph\u00e9p kh\u00f4ng, tai bi\u1ebfn do ph\u1eabu thu\u1eadt l\u00e0 t\u1ed1i thi\u1ec3u<\/p>\n
Ph\u1eabu thu\u1eadt trong \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p (\u0111a m\u00f4 th\u1ee9c)<\/p>\n
Do nh\u1eefng \u0111\u1eb7c t\u00ednh c\u1ee7a b\u1ec7nh ung th\u01b0, m\u1ed9t trong nh\u1eefng nguy\u00ean t\u1eafc l\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p.Ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi \u0111i\u1ec1u tr\u1ecb ho\u00e1 ch\u1ea5t ho\u1eb7c x\u1ea1 tr\u1ecb nh\u1eb1m c\u1eaft gi\u1ea3m kh\u1ed1i u t\u1ea1o \u0111i\u1ec1uki\u1ec7n t\u1ed1t nh\u1ea5t cho \u0111i\u1ec1u tr\u1ecb ho\u00e1 ch\u1ea5t ho\u1eb7c x\u1ea1 tr\u1ecb. V\u00ed d\u1ee5 nh\u01b0 ph\u1eabu thu\u1eadt c\u00f4ng ph\u00e1 u trong\u0111i\u1ec1u tr\u1ecb ung th\u01b0 bu\u1ed3ng tr\u1ee9ng. Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf nh\u1eefng t\u1ed5 ch\u1ee9c ung th\u01b0 ho\u1ea1i t\u1eed, thi\u1ebfu oxynh\u01b0 \u1edf trung t\u00e2m \u1edf c\u00e1c kh\u1ed1i u c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn nh\u1eb1m l\u00e0m t\u0103ng th\u00eam nh\u1ea1y c\u1ea3m c\u1ee7a x\u1ea1 tr\u1ecbdo nh\u1eefng t\u1ed5 ch\u1ee9c thi\u1ebfu oxy r\u1ea5t kh\u00e1ng tia. \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt c\u00f2n c\u00f3 vai tr\u00f2 l\u00e0 ph\u01b0\u01a1ngph\u00e1p b\u1ed5 tr\u1ee3 cho x\u1ea1 tr\u1ecb, ho\u00e1 tr\u1ecb nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 v\u00f2m, sau x\u1ea1 tr\u1ecb li\u1ec1u tri\u1ec7t c\u0103nm\u00e0 v\u1eabn c\u00f2n t\u1ed3n t\u1ea1i kh\u1ed1i h\u1ea1ch c\u1ed5, c\u1ea7n thi\u1ebft ph\u1ea3i \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung b\u1eb1ng ph\u1eabu thu\u1eadt l\u1ea5yh\u1ea1ch. Tr\u01b0\u1eddng h\u1ee3p u lymph\u00f4 \u00e1c t\u00ednh bi\u1ec3u hi\u1ec7n \u1edf \u1ed1ng ti\u00eau ho\u00e1, ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb l\u00e0ph\u1ed1i h\u1ee3p gi\u1eefa ph\u1eabu thu\u1eadt v\u1edbi ho\u00e1 ch\u1ea5t.<\/p>\n
Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u01b0 c\u1eaft bu\u1ed3ng tr\u1ee9ng, c\u1eaft tinh ho\u00e0n trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa,tuy\u1ebfn ti\u1ec1n li\u1ec7t, vi\u1ec7c ph\u1eabu thu\u1eadt l\u00e0 nh\u1eb1m m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft<\/p>\n
4. Ph\u1eabu thu\u1eadt t\u1ea1o h\u00ecnh v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/p>\n
Ph\u1eabu thu\u1eadt t\u1ea1o h\u00ecnh l\u00e0 m\u1ed9t c\u00f4ng \u0111o\u1ea1n trong quy tr\u00ecnh ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb ung th\u01b0, c\u00f3 vaitr\u00f2 quan tr\u1ecdng trong s\u1ef1 h\u1ed3i ph\u1ee5c sau ph\u1eabu thu\u1eadt. Ph\u1eabu thu\u1eadt t\u1ea1o h\u00ecnh v\u00fa b\u1eb1ng v\u1ea1t da c\u01a1ho\u1eb7c b\u1eb1ng m\u1ed9t lo\u1ea1i t\u00fai silicon ch\u1ee9a n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd, \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n sau c\u1eaft tuy\u1ebfn v\u00fac\u1ee7a ph\u1ee5 n\u1eef l\u00e0m c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng cho ng\u01b0\u1eddi ph\u1ee5 n\u1eef.<\/p>\n
Trong ph\u1eabu thu\u1eadt ung th\u01b0 \u0111\u1ea7u c\u1ed5 nh\u1edd c\u00f3 k\u1ebft h\u1ee3p v\u1edbi ph\u1eabu thu\u1eadt t\u1ea1o h\u00ecnh s\u1ebd cho ph\u00e9p c\u1eaftr\u1ed9ng r\u00e3i kh\u1ed1i u l\u00e0m t\u0103ng th\u00eam t\u1ef7 l\u1ec7 \u0111i\u1ec1u tr\u1ecb kh\u1ecfi b\u1ec7nh<\/p>\n
5. C\u00e1c ph\u1eabu thu\u1eadt kh\u00e1c<\/p>\n
Ph\u1eabu thu\u1eadt \u0111\u00f4ng l\u1ea1nh, \u0111\u1ed1t \u0111i\u1ec7n, tia lade th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng cho ung th\u01b0 da lo\u1ea1i t\u1ebfb\u00e0o \u0111\u00e1y. \u0110\u1ed1t \u0111i\u1ec7n ho\u1eb7c lade \u1ee9ng d\u1ee5ng \u0111\u1ec3 c\u1ea7m m\u00e1u, gi\u1ea3m b\u1edbt kh\u1ed1i u ch\u1ed1ng b\u00edt t\u1eafc nh\u01b0ung th\u01b0 th\u1ef1c qu\u1ea3n, ung th\u01b0 tr\u1ef1c tr\u00e0ng kh\u00f4ngm\u1ed5 \u0111\u01b0\u1ee3c<\/p>\n
Ph\u1eabu thu\u1eadt n\u1ed9i soi l\u00e0 \u1ee9ng d\u1ee5ng nh\u1eefng ti\u1ebfn b\u1ed9 c\u1ee7a n\u1ed9i soi can thi\u1ec7p, ng\u00e0y c\u00e0ng c\u00f3 vai tr\u00f2trong ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb ung th\u01b0.<\/p>\n
C\u00e2u 6:X\u1ea1 tr\u1ecb: nguy\u00ean t\u1eafc, c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng, ch\u1ec9 \u0111\u1ecbnh, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p<\/p>\n
I. NGUY\u00caN T\u1eaeC \u0110I\u1ec0U TR\u1eca<\/p>\n
Tia b\u1ee9c x\u1ea1 l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y ung th\u01b0. B\u1edfi v\u1eady ng\u01b0\u1eddi ta khuy\u00ean r\u1eb1ngch\u1ec9 d\u00f9ng tia x\u1ea1 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ung th\u01b0, c\u00f2n \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh kh\u00e1cn\u00ean d\u00f9ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c.<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh x\u1ea1 tr\u1ecb cho b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc c\u1ee5 th\u1ec3 trong t\u1eebng tr\u01b0\u1eddng h\u1ee3p. Tr\u01b0\u1edbckhi \u0111i\u1ec1u tr\u1ecb ph\u1ea3i c\u00f3 m\u1ed9t ch\u1ea9n \u0111o\u00e1n th\u1eadt ch\u00ednh x\u00e1c (lo\u1ea1i b\u1ec7nh, giai \u0111o\u1ea1n, lo\u1ea1i t\u1ed5 ch\u1ee9c h\u1ecdc)v\u00e0 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ph\u1ea3i theo d\u00f5i li\u00ean t\u1ee5c, s\u00e1t sao.<\/p>\n
Vi\u1ec7c t\u00ednh to\u00e1n li\u1ec1u l\u01b0\u1ee3ng chi\u1ebfu x\u1ea1 ph\u1ea3i c\u1ee5 th\u1ec3, t\u1ef7 m\u1ef7, ch\u00ednh x\u00e1c \u0111\u1ea3m b\u1ea3o nguy\u00ean t\u1eafc li\u1ec1ut\u1ea1i u l\u00e0 t\u1ed1i \u0111a, li\u1ec1u t\u1ea1i ch\u1ed7 ch\u1ee9c l\u00e0nh l\u00e0 t\u1ed1i thi\u1ec3u nh\u1eb1m h\u1ea1n ch\u1ebf t\u1edbi m\u1ee9c th\u1ea5p nh\u1ea5t c\u00e1c \u1ea3nhh\u01b0\u1edfng kh\u00f4ng mong mu\u1ed1n c\u1ee7a tia x\u1ea1. Do v\u1eady ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c ph\u1ea3i c\u00f3 m\u1ed9t k\u1ebf ho\u1ea1ch\u0111i\u1ec1u tr\u1ecb r\u00f5 r\u00e0ng.<\/p>\n
II. C\u01a0 CH\u1ebe T\u00c1C D\u1ee4NG C\u1ee6A TIA X\u1ea0<\/p>\n
Sau khi v\u00e0o c\u01a1 th\u1ec3, tia x\u1ea1 g\u00e2y n\u00ean nh\u1eefng t\u00e1c d\u1ee5ng sau:<\/p>\n
1. \u0110\u1ed1i v\u1edbi t\u1ebf b\u00e0o<\/p>\n
– T\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp: Tia x\u1ea1 s\u1ebd t\u00e1c \u0111\u1ed9ng ngay \u0111\u1ebfn c\u00e1c chu\u1ed7i AND c\u1ee7a t\u1ebf b\u00e0o, l\u00e0m chochu\u1ed7i n\u00e0y b\u1ecb t\u1ed5n th\u01b0\u01a1ng: “G\u1eaby \u0111o\u1ea1n, \u0111\u1ea3o \u0111o\u1ea1n, \u0111\u1ee9t \u0111o\u1ea1n …” t\u1eeb \u0111\u00f3 t\u1ea1o ra c\u00e1c t\u1ebf b\u00e0o \u0111\u1ed9tbi\u1ebfn v\u00e0 d\u1ec5 b\u1ecb ch\u1ebft.<\/p>\n
– T\u00e1c d\u1ee5ng gi\u00e1n ti\u1ebfp: Tia x\u1ea1 g\u00e2y ra hi\u1ec7n t\u01b0\u1ee3ng ion ho\u00e1 t\u1ea1o ra c\u00e1c g\u1ed1c t\u1ef1 do (ch\u1ee7y\u1ebfu l\u00e0 c\u00e1c g\u1ed1c t\u1ef1 do c\u1ee7a ph\u00e2n t\u1eed n\u01b0\u1edbc) trong m\u00f4i tr\u01b0\u1eddng t\u1ebf b\u00e0o. C\u00e1c g\u1ed1c n\u00e0y s\u1ebd t\u00e1c d\u1ee5ngtr\u1ef1c ti\u1ebfp v\u00e0o c\u00e1c chu\u1ed7i AND, l\u00e0m thay \u0111\u1ed5i t\u00ednh th\u1ea5m c\u1ee7a m\u00e0ng t\u1ebf b\u00e0o v\u00ec v\u1eady c\u00e1c t\u1ebf b\u00e0od\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/p>\n
2. \u0110\u1ed1i v\u1edbi t\u1ed5 ch\u1ee9c<\/p>\n
T\u1ed5 ch\u1ee9c ung th\u01b0 l\u00e0 m\u1ed9t t\u1eadp h\u1ee3p g\u1ed3m nhi\u1ec1u t\u1ebf b\u00e0o,s\u1ef1 teo nh\u1ecf t\u1ed5 ch\u1ee9c ung th\u01b0 sau chi\u1ebfu x\u1ea1 l\u00e0 k\u1ebft qu\u1ea3 qu\u00e1 tr\u00ecnh l\u00e0m ch\u1ebft t\u1ebf b\u00e0o. Qu\u00e1 tr\u00ecnhn\u00e0y x\u1ea3y ra nhanh ch\u1ee9ng t\u1ecf t\u1ed5 ch\u1ee9c ung th\u01b0 \u0111\u00f3 nh\u1ea1y c\u1ea3m v\u1edbi tia x\u1ea1.<\/p>\n
M\u1eb7t kh\u00e1c ng\u01b0\u1eddi ta th\u1ea5y c\u00f3 m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 nh\u1ea1y c\u1ea3m c\u1ee7a t\u1ebf b\u00e0ov\u00e0 c\u1ee7a t\u1ed5 ch\u1ee9c ung th\u01b0 \u0111\u1ed1i v\u1edbi tia x\u1ea1.<\/p>\n
Vi\u1ec7c cung c\u1ea5p oxy t\u1ed1t s\u1ebd l\u00e0m t\u0103ng \u0111\u1ed9 nh\u1ea1y c\u1ea3m c\u1ee7a t\u1ebf b\u00e0o v\u1edbi tia x\u1ea1. Th\u1ef1c t\u1ebf l\u00e2m s\u00e0ngcho th\u1ea5y nh\u1eefng t\u1ed5 ch\u1ee9c n\u00e0o \u0111\u01b0\u1ee3c t\u01b0\u1edbi m\u00e1u t\u1ed1t, gi\u1ea7u oxy th\u00ec nh\u1ea1y c\u1ea3m v\u1edbi tia h\u01a1n l\u00e0nh\u1eefng t\u1ed5 ch\u1ee9c \u0111\u01b0\u1ee3c t\u01b0\u1edbi m\u00e1u k\u00e9m. V\u00ec v\u1eady, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 \u00e1p d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p\u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n \u1edf trong ph\u00f2ng c\u00f3 h\u00e0m l\u01b0\u1ee3ng oxy cao \u00e1p.<\/p>\n
M\u1ee9c \u0111\u1ed9 bi\u1ec7t ho\u00e1 c\u1ee7a t\u1ebf b\u00e0o ung th\u01b0 c\u0169ng c\u00f3 vai tr\u00f2 to l\u1edbn quy\u1ebft \u0111\u1ecbnh s\u1ef1 \u0111\u00e1p \u1ee9ng c\u1ee7a t\u1ed5ch\u1ee9c ung th\u01b0 v\u1edbi tia x\u1ea1. Ng\u01b0\u1eddi ta th\u1ea5y r\u1eb1ng c\u00e1c t\u1ebf b\u00e0o c\u00e0ng k\u00e9m bi\u1ec7t ho\u00e1 th\u00ec c\u00e0ng nh\u1ea1yc\u1ea3m v\u1edbi tia x\u1ea1ng\u01b0\u1ee3c l\u1ea1i c\u00e1c t\u1ed5 ch\u1ee9c m\u00e0 t\u1ebf b\u00e0o ung th\u01b0 thu\u1ed9c lo\u1ea1i bi\u1ec7t ho\u00e1 cao th\u00ec r\u1ea5t tr\u01a1 v\u1edbi tia x\u1ea1<\/p>\n
III. C\u00c1C K\u1ef8 THU\u1eacT X\u1ea0 TR\u1ecaC\u00e1c ph\u01b0\u01a1ng ph\u00e1p chi\u1ebfu x\u1ea1<\/p>\n
1. Chi\u1ebfu x\u1ea1 t\u1eeb ngo\u00e0i v\u00e0o<\/p>\n
Ngu\u1ed3n x\u1ea1 \u0111\u1eb7t ngo\u00e0i c\u01a1 th\u1ec3 ng\u01b0\u1eddi b\u1ec7nh. M\u00e1y s\u1ebd h\u01b0\u1edbng c\u00e1c ch\u00f9m tia m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1cv\u00e0o v\u00f9ng th\u01b0\u01a1ng t\u1ed5n (v\u00f9ng c\u1ea7n x\u1ea1 tr\u1ecb).<\/p>\n
\u01afu \u0111i\u1ec3m:<\/p>\n
K\u1ef9 thu\u1eadt th\u1ef1c hi\u1ec7n nhanh, g\u1ecdn, \u00edt g\u00e2y kh\u00f3 ch\u1ecbu cho ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n
C\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u1edf di\u1ec7n t\u01b0\u01a1ng \u0111\u1ed1i r\u1ed9ng v\u00e0 \u1edf nhi\u1ec1u v\u00f9ng t\u1ed5n th\u01b0\u01a1ng kh\u00e1c nhau.<\/p>\n
K\u1ef9 thu\u1eadt: Tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb ph\u1ea3i x\u00e1c \u0111\u1ecbnh m\u1ed9t c\u00e1ch c\u1ee5 th\u1ec3, ch\u00ednh x\u00e1c v\u1ecb tr\u00ed v\u00e0 th\u1ec3 t\u00edchv\u00f9ng c\u1ea7n chi\u1ebfu x\u1ea1. Vi\u1ec7c t\u00ednh to\u00e1n li\u1ec1u l\u01b0\u1ee3ng ph\u1ea3i ch\u00ednh x\u00e1c t\u1ef7 m\u1ef7 v\u1eeba \u0111\u1ee7 \u0111\u1ec3 ti\u00eau di\u1ec7t t\u1ebfb\u00e0o ung th\u01b0 b\u1edfi l\u1ebd c\u00e1c t\u1ed5 ch\u1ee9c l\u00e0nh, t\u1ebf b\u00e0o l\u00e0nh n\u1eb1m trong v\u00f9ng chi\u1ebfu c\u0169ng b\u1ecb t\u1ed5nth\u01b0\u01a1ng do tia.<\/p>\n
2. X\u1ea1 tr\u1ecb \u00e1p s\u00e1t.<\/p>\n
C\u00e1c ngu\u1ed3n x\u1ea1 (nh\u01b0 radium, Cesium, Iridium) \u0111\u01b0\u1ee3c \u0111\u1eb7t \u00e1p s\u00e1t ho\u1eb7c c\u1eafm tr\u1ef1c ti\u1ebfp v\u00e0ov\u00f9ng th\u01b0\u01a1ng t\u1ed5n. M\u1ed9t s\u1ed1 c\u00e1c \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1 d\u1ea1ng l\u1ecfng nh\u01b0 I131, ph\u1ed1tpho 32 c\u00f3th\u1ec3 d\u00f9ng b\u01a1m tr\u1ef1c ti\u1ebfp v\u00e0o trong c\u01a1 th\u1ec3 \u0111\u1ec3 nh\u1eb1m ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c t\u1ebf b\u00e0o ungth\u01b0.<\/p>\n
\u01afu \u0111i\u1ec3m:Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y gi\u00fap n\u00e2ng li\u1ec1u t\u1ea1i ch\u1ed7 l\u00ean cao trong khi c\u00e1c t\u1ed5 ch\u1ee9c l\u00e0nh xung quanh \u00edtb\u1ecb \u1ea3nh h\u01b0\u1edfng h\u01a1n l\u00e0 chi\u1ebfu x\u1ea1 t\u1eeb ngo\u00e0i v\u00e0o do s\u1ef1 gi\u1ea3m li\u1ec1u nhanh xung quanh ngu\u1ed3n.<\/p>\n
K\u1ef9 thu\u1eadt: Khi th\u1ef1c hi\u1ec7n ph\u1ea3i c\u00f3 s\u1ef1 chu\u1ea9n b\u1ecb c\u1ee5 th\u1ec3 (\u1edf c\u1ea3 th\u1ea7y thu\u1ed1c v\u00e0 b\u1ec7nh nh\u00e2n).Nhi\u1ec1u l\u00fac t\u1ea1o n\u00ean s\u1ef1 kh\u00f3 ch\u1ecbu cho ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n
Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y ch\u1ec9 \u00e1p d\u1ee5ng \u0111\u01b0\u1ee3c \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 u \u1edf m\u1ed9t s\u1ed1 v\u1ecb tr\u00ed nh\u1ea5t \u0111\u1ecbnh (da, h\u1ed1c t\u1ef1nhi\u00ean) v\u00e0 ch\u1ec9 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c khi b\u1ec7nh c\u00f2n \u1edf giai \u0111o\u1ea1n t\u01b0\u01a1ng \u0111\u1ed1i s\u1edbm.<\/p>\n
IV. C\u00c1C CH\u1ec8 \u0110\u1ecaNH X\u1ea0 TR\u1eca<\/p>\n
Trong ung th\u01b0, \u0111\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00f3 ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i r\u1ed9ng, c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0nh\u1eb1m nhi\u1ec1u m\u1ee5c \u0111\u00edch kh\u00e1c nhau.<\/p>\n
1. \u0110i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3<\/p>\n
\u0110\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c \u0111\u00edch n\u00e0y, khi chi\u1ebfu x\u1ea1 ph\u1ea3i \u0111\u1ea3m b\u1ea3o 2 y\u00eau c\u1ea7u sau:<\/p>\n
\u00d8 V\u00f9ng chi\u1ebfu ph\u1ea3i bao tr\u00f9m to\u00e0n b\u1ed9 kh\u1ed1i u v\u00e0 nh\u1eefng n\u01a1i m\u00e0 t\u1ebf b\u00e0o ung th\u01b0 c\u00f3 kh\u1ea3 n\u0103ngx\u00e2m l\u1ea5n t\u1edbi.<\/p>\n
\u00d8 Tia to\u00e0n b\u1ed9 h\u1ec7 th\u1ed1ng h\u1ea1ch khu v\u1ef1c. \u0110\u00f3 l\u00e0 nh\u1eefng h\u1ea1ch b\u1ea1ch huy\u1ebft c\u00f3 nguy c\u01a1 cao b\u1ecb dic\u0103n ung th\u01b0.<\/p>\n
Do v\u1eady ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c x\u1ea1 tr\u1ecb c\u1ea7n ph\u1ea3i l\u1eadp ra cho \u0111\u01b0\u1ee3c ph\u01b0\u01a1ng \u00e1n, chi\u1ebfn thu\u1eadt v\u00e0 k\u1ef9thu\u1eadt th\u00ec m\u1edbi c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 cho ng\u01b0\u1eddi b\u1ec7nh. \u0110i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 c\u00f3 th\u1ec3 l\u00e0:<\/p>\n
\u0110i\u1ec1u tr\u1ecb \u0111\u01a1n \u0111\u1ed9c: V\u00ed d\u1ee5 ung th\u01b0 v\u00f2m m\u0169i h\u1ecdng<\/p>\n
\u0110i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p v\u1edbi ph\u1eabu thu\u1eadt:<\/p>\n
C\u00e1ch ph\u1ed1i h\u1ee3p tu\u1ef3 theo lo\u1ea1i b\u1ec7nh v\u00e0 giai \u0111o\u1ea1n b\u1ec7nh. Tia c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc ho\u1eb7c sauph\u1eabu thu\u1eadt,c\u0169ng c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p xen k\u1ebd (v\u00ed d\u1ee5 ung th\u01b0 v\u00fa, ung th\u01b0 c\u1ed5 t\u1eed cung).<\/p>\n
M\u1ed9t \u0111i\u1ec3m \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng l\u00e0 tia x\u1ea1 \u0111\u00e3 g\u00f3p ph\u1ea7n l\u00e0m cho b\u1ec7nh nh\u00e2n ung th\u01b0 t\u1eebch\u1ed7 kh\u00f4ng ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c tr\u1edf th\u00e0nh ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n\u0111\u01b0\u1ee3c: ung th\u01b0 tr\u1ef1c tr\u00e0ng, c\u1ed5 t\u1eed cung… \u1edf giai \u0111o\u1ea1n mu\u1ed9n, sao cho kh\u1ed1i u thu nh\u1ecfl\u1ea1i s\u1ebd c\u00f3 kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt tri\u1ec7t c\u0103n, do v\u1eady t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb l\u00ean r\u1ea5t nhi\u1ec1u.<\/p>\n
X\u1ea1 tr\u1ecb ph\u1ed1i h\u1ee3p v\u1edbi ho\u00e1 ch\u1ea5t<\/p>\n
S\u1ef1 ph\u1ed1i h\u1ee3p x\u1ea1 tr\u1ecb v\u00e0 ho\u00e1 ch\u1ea5t nhi\u1ec1u khi \u0111\u01b0a l\u1ea1i k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n \u0111\u1ed9c m\u1ed9tph\u01b0\u01a1ng ph\u00e1p trong m\u1ed9t s\u1ed1 lo\u1ea1i ung th\u01b0.<\/p>\n
Tia x\u1ea1 tr\u1ef1c ti\u1ebfp v\u00e0o kh\u1ed1i u nguy\u00ean ph\u00e1t s\u1ebd l\u00e0m gi\u1ea3m th\u1ec3 t\u00edch c\u1ee7a m\u1ed9t kh\u1ed1i u qu\u00e1 l\u1edbn, v\u00ecv\u1eady s\u1ebd t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho ho\u00e1 ch\u1ea5t ti\u00eau di\u1ec7t t\u1ebf b\u00e0o ung th\u01b0 c\u00f2n l\u1ea1i.<\/p>\n
Ng\u01b0\u1ee3c l\u1ea1i, m\u1ed9t s\u1ed1 lo\u1ea1i ho\u00e1 ch\u1ea5t s\u1ebd l\u00e0m t\u0103ng s\u1ee9c ch\u1ecbu \u0111\u1ef1ng c\u1ee7a t\u1ebf b\u00e0o l\u00e0nh \u0111\u1ed1i v\u1edbi tia x\u1ea1 do v\u1eady c\u00f3 th\u1ec3 n\u00e2ng li\u1ec1u x\u1ea1 l\u00ean cao \u0111\u1ec3\u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 kh\u1ed1i ung th\u01b0. B\u00ean c\u1ea1nh \u0111\u00f3, ho\u00e1 ch\u1ea5t s\u1ebd ti\u00eau di\u1ec7t t\u1ea5t c\u1ea3 c\u00e1c tb ung th\u01b0\u0111\u00e3 di c\u0103n xa m\u00e0 tia kh\u00f4ng v\u1edbi t\u1edbi \u0111\u01b0\u1ee3c.<\/p>\n
2. X\u1ea1 tr\u1ecb t\u1ea1m th\u1eddi<\/p>\n
\u00c1p d\u1ee5ng v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh \u1edf giai \u0111o\u1ea1n mu\u1ed9n, kh\u00f4ng th\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 \u0111\u01b0\u1ee3c.\u1ede Vi\u1ec7t Nam, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u1ebfn b\u1ec7nh vi\u1ec7n \u1edf giai \u0111o\u1ea1n mu\u1ed9n l\u00e0 r\u1ea5t cao. Theo \u01b0\u1edbc t\u00ednhc\u1ee7a b\u1ec7nh vi\u1ec7n K th\u00ec c\u00f3 kho\u1ea3ng 70 80% b\u1ec7nh nh\u00e2n \u0111\u1ebfn vi\u1ec7n \u1edf giai \u0111o\u1ea1n mu\u1ed9n, b\u1ec7nh \u0111\u00e3lan r\u1ed9ng v\u00e0 c\u00f3 bi\u1ebfn ch\u1ee9ng. V\u00ec v\u1eady x\u1ea1 tr\u1ecb t\u1ea1m th\u1eddi th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nhi\u1ec1u, xong tu\u1ef3t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3 m\u00e0 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb nh\u1eb1m c\u00e1c m\u1ee5c \u0111\u00edch kh\u00e1c nhau.<\/p>\n
X\u1ea1 tr\u1ecb nh\u1eb1m gi\u1ea3m v\u00e0 ch\u1ed1ng l\u1ea1i c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a ung th\u01b0: Nh\u01b0 \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111au,ch\u1ed1ng ch\u00e8n \u00e9p, b\u00edt t\u1eafc, ch\u1ed1ng ch\u1ea3y m\u00e1u.<\/p>\n
V\u00ed d\u1ee5:<\/p>\n
Kh\u1ed1i u trung th\u1ea5t g\u00e2y ch\u00e8n \u00e9p trung th\u1ea5t.<\/p>\n
H\u1ea1ch l\u1edbn ch\u00e8n \u00e9p \u0111\u01b0\u1eddng tu\u1ea7n ho\u00e0n m\u00e1u v\u00e0 b\u1ea1ch huy\u1ebft<\/p>\n
Di c\u0103n v\u00e0o x\u01b0\u01a1ng c\u1ee7a c\u00e1c ung th\u01b0 g\u00e2y \u0111au \u0111\u1edbn d\u1eef d\u1ed9i.<\/p>\n
C\u1ea7m m\u00e1u trong ung th\u01b0 c\u1ed5 t\u1eed cung giai \u0111o\u1ea1n mu\u1ed9n.<\/p>\n
X\u1ea1 tr\u1ecb \u0111\u1ec3 \u0111\u1ec1 ph\u00f2ng c\u00e1c bi\u1ebfn ch\u1ee9ng ung th\u01b0 c\u00f3 th\u1ec3 x\u1ea3y ra, l\u00e0m ch\u1eadm t\u1ed1c \u0111\u1ed9 ph\u00e1t tri\u1ec3n c\u1ee7ab\u1ec7nh, c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng \u0111\u1eddi s\u1ed1ng cho b\u1ec7nh nh\u00e2n. T\u1eeb \u0111\u00f3 ph\u1ea7n n\u00e0o k\u00e9o d\u00e0i th\u00eam \u0111\u1eddis\u1ed1ng v\u00e0 l\u00e0m cho h\u1ecd s\u1ed1ng tho\u1ea3i m\u00e1i h\u01a1n trong nh\u1eefng ng\u00e0y c\u00f2n l\u1ea1i.<\/p>\n
* M\u1ed9t s\u1ed1 k\u0129 thu\u1eadt m\u1edbi<\/p>\n
\u00b7 X\u1ea1 ph\u1eabu \u0111\u1ecbnh v\u1ecb SRS<\/p>\n
\u00b7 X\u1ea1 tr\u1ecb \u0111\u1ecbnh v\u1ecb SRT<\/p>\n
\u00b7 X\u1ea1 tr\u1ecb v\u1edbi \u1ed5ng chu\u1ea9n tr\u1ef1c nhi\u1ec1u l\u00e1<\/p>\n
\u00b7 X\u1ea1 tr\u1ecb theo th\u1ec3 t\u00edch kh\u1ed1i u<\/p>\n
C\u00e2u 7:H\u00f3a tr\u1ecb: nguy\u00ean t\u1eafc, c\u00e1c lo\u1ea1i thu\u1ed1c, t\u00e1c d\u1ee5ng ph\u1ee5, c\u00e1c t\u00e1c nh\u00e2n sinh h\u1ecdc, \u0111i\u1ec1u tr\u1ecb tr\u00fang \u0111\u00edch<\/p>\n
1. Nguy\u00ean t\u1eafc h\u00f3a tr\u1ecb trong K:<\/p>\n
1) D\u00f9ng ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c c\u00f3 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng kh\u00e1c nhau.<\/p>\n
2) Kh\u00f4ng ph\u1ed1i h\u1ee3p nhi\u1ec1u thu\u1ed1c c\u00f3 c\u00f9ng \u0111\u1ed9c t\u00ednh tr\u00ean c\u00f9ng m\u1ed9t c\u01a1 quan.<\/p>\n
3) D\u00f9ng li\u1ec1u cao, t\u1eebng \u0111\u1ee3t ng\u1eaft qu\u00e3ng c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n d\u00f9ng li\u1ec1u th\u1ea5p k\u00e9o d\u00e0i.<\/p>\n
4) Kh\u00f4ng d\u00f9ng h\u00f3a ch\u1ea5t m\u00e0 b\u1ea3n th\u00e2n n\u00f3 \u00edt hi\u1ec7u qu\u1ea3 khi d\u00f9ng \u0111\u01a1n \u0111\u1ed9c.<\/p>\n
5) C\u1ea7n c\u00f3 bi\u1ec7n ph\u00e1p h\u1ea1n ch\u1ebf bi\u1ebfn ch\u1ee9ng do \u0111i\u1ec1u tr\u1ecb h\u00f3a tr\u1ecb li\u1ec7u g\u00e2y ra.<\/p>\n
\u00b7 D\u00f9ng thu\u1ed1c kh\u00e1ng sau m\u1ed7i l\u1ea7n \u0111i\u1ec1u tr\u1ecb h\u00f3a ch\u1ea5t.<\/p>\n
\u00b7 Gh\u00e9p t\u1ee7y x\u01b0\u01a1ng: l\u1ea5y t\u1ee7y x\u01b0\u01a1ng c\u1ee7a ng\u01b0\u1eddi th\u1ea5y c\u00f3 c\u00f9ng nh\u00f3m HLA c\u1ea5t gi\u1eef tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb h\u00f3a ch\u1ea5t li\u1ec1u cao \u0111\u1ec3 truy\u1ec1n l\u1ea1i sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n
\u00b7 D\u00f9ng c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng t\u1ea1o huy\u1ebft.<\/p>\n
2. C\u00e1c lo\u1ea1i thu\u1ed1c<\/p>\n
Nh\u00f3m t\u00e1c nh\u00e2n<\/p>\n
M\u1ee5c ti\u00eau<\/p>\n
C\u1ea5u tr\u00fac h\u00f3a h\u1ecdc<\/p>\n
C\u00e1c t\u00e1c nh\u00e2n ng\u0103n ch\u1eb7n t\u1ed5ng h\u1ee3p DNA b\u1eb1ng alkyl h\u00f3a c\u00f3 ngu\u1ed3n g\u1ed1c t\u1ed5ng h\u1ee3p (c\u00e1c t\u00e1c nh\u00e2n alkyl h\u00f3a)<\/p>\n
Li\u00ean k\u1ebft ch\u00e9o DNA<\/p>\n
– Nitrogen mustard<\/p>\n
– Ethyle limin<\/p>\n
– Sulfonic acid ester<\/p>\n
– Epoxide<\/p>\n
– Nitrosourea<\/p>\n
– Halogenated hexitol<\/p>\n
– H\u1ee3p ch\u1ea5t plantinum<\/p>\n
Kh\u00e1ng sinh kh\u00e1ng u<\/p>\n
Xen gi\u1eefa DNA l\u00e0m \u0111\u1ee9t g\u00e3y DNA<\/p>\n
– Athracylin,ActinomycinD, Mitomycin C, Bleomycin<\/p>\n
– C\u00e1c kh\u00e1ng acid folic, kh\u00e1ng purin, kh\u00e1ng pirimidin<\/p>\n
– C\u00e1c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p protein v\u00e0 a.a<\/p>\n
C\u00e1c \u1ee9c ch\u1ebf giai \u0111o\u1ea1n gi\u00e1n ph\u00e2n h\u00ecnh thoi<\/p>\n
Ng\u0103n c\u1ea3n h\u00ecnh th\u1ee9c thoi trong k\u00ec gi\u00e1n ph\u00e2n<\/p>\n
– Alkaloid nh\u00f3m vinca<\/p>\n
– Podophylin<\/p>\n
– Colchicin<\/p>\n
H\u1ed7n h\u1ee3p<\/p>\n
Kh\u00f4ng x\u00e1c \u0111\u1ecbnh<\/p>\n
– Alkyl amin ( HMM, PMM)<\/p>\n
– Dacabazin<\/p>\n
– Procabazin<\/p>\n
C\u00e1c taxane<\/p>\n
L\u00e0m \u0111\u00f4ng c\u1ee9ng c\u00e1c vi qu\u1ea3n n\u1ed9i tb<\/p>\n
Toxol, taxotere<\/p>\n
C\u00e1c camptothecin<\/p>\n
\u1ee9c ch\u1ebf men topoisomerase I<\/p>\n
Camptothecin, CPT \u2013 11<\/p>\n
C\u00e1c hormone<\/p>\n
– Androgen<\/p>\n
– Estrogen<\/p>\n
– Steroid<\/p>\n
– Progestin<\/p>\n
– C\u00e1c thu\u1ed1c t\u00e1c d\u1ee5ng<\/p>\n
– Anti adrogen<\/p>\n
– Anti estrogen<\/p>\n
– Anti streroid<\/p>\n
3. T\u00e1c d\u1ee5ng ph\u1ee5<\/p>\n
\u00b7 T\u1ee7y x\u01b0\u01a1ng: gi\u1ea3m b\u1ea1ch c\u1ea7u, gi\u1ea3m ti\u1ec3u c\u1ea7u<\/p>\n
\u00b7 \u0110\u01b0\u1eddng ti\u00eau h\u00f3a: vi\u00eam mi\u1ec7ng, \u1ec9a ch\u1ea3y, li\u1ec7t ru\u1ed9t<\/p>\n
\u00b7 Da: x\u1ea1m da, r\u1ee5ng t\u00f3c<\/p>\n
\u00b7 H\u1ec7 th\u1ea7n kinh: d\u1ecb c\u1ea3m, b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i vi, \u0111i\u1ebfc, ng\u1ee7 l\u1ecbm (l\u01a1 m\u01a1)<\/p>\n
\u00b7 Tim: suy tim (mu\u1ed9n v\u1ec1 l\u00e2u d\u00e0i)<\/p>\n
\u00b7 Ph\u1ed5i: vi\u00eam x\u01a1 (mu\u1ed9n)<\/p>\n
\u00b7 T\u1ee5y: vi\u00eam t\u1ee5y<\/p>\n
\u00b7 T\u1eed cung: ch\u1ea3y m\u00e1u t\u1eed cung<\/p>\n
\u00b7 B\u00e0ng quang: vi\u00eam b\u00e0ng quang<\/p>\n
\u00b7 Gan: ch\u1ee9c n\u0103ng gan kh\u00f4ng b\u00ecnh th\u01b0\u1eddng<\/p>\n
\u00b7 Th\u1eadn: ch\u1ee9c n\u0103ng th\u1eadn kh\u00f4ng b\u00ecnh th\u01b0\u1eddng<\/p>\n
4. C\u00e1c t\u00e1c nh\u00e2n \u0111i\u1ec1u h\u00f2a sinh h\u1ecdc<\/p>\n
4.1. C\u00e1c interferon (INF): C\u00e1c interferon l\u00e0 m\u1ed9t nh\u00f3m c\u00e1c h\u1ee3p ch\u1ebft do b\u1ea1ch c\u1ea7u s\u1ea3n xu\u1ea5t ra, c\u00f3 16 lo\u1ea1i v\u1edbi t\u00e1c d\u1ee5ng kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t. C\u00f3 3 lo\u1ea1i INF ch\u1ee7 y\u1ebfu l\u00e0 \u03b1, \u03b2, \u03b4 trong \u0111\u00f3 INF \u03b1 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t v\u00e0 c\u00f3 ho\u1ea1t t\u00ednh r\u00f5 r\u1ec7t trong b\u1ec7nh b\u1ea1ch c\u1ea7u t\u1ebf b\u00e0o t\u00f3c, b\u1ea1ch c\u1ea7u m\u1ea1n t\u00ednh th\u1ec3 t\u1ee7y, b\u1ec7nh \u0111a u t\u1ee7y v\u00e0 m\u1ed9t s\u1ed1 u lympho \u00e1c t\u00ednh kh\u00f4ng Hodgkin, K th\u1eadn, h\u1eafc t\u1ed1, Kaposi, bi\u1ec3u m\u00f4<\/p>\n
4.2. C\u00e1c interleukin (IL): L\u00e0 s\u1ea3n ph\u1ea9m c\u1ee7a c\u00e1c lympho b\u00e0o ho\u1ea1t h\u00f3a v\u00e0 \u0111\u00f3ng vai tr\u00f2 trung t\u00e2m trong s\u1ef1 \u0111i\u1ec1u h\u00f2a c\u00e1c t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch. Trong nh\u00f3m n\u00e0y c\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn IL \u2013 2 \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1ea1o ra b\u1eb1ng c\u00f4ng ngh\u1ec7 gen v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb K bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o th\u1eadn v\u00e0 K h\u1eafc t\u1ed1<\/p>\n
4.3. C\u00e1c kh\u00e1ng th\u1ebf \u0111\u01a1n d\u00f2ng: L\u00e0 s\u1ea3n ph\u1ea9m c\u1ee7a c\u00e1c t\u1ebf b\u00e0o lai t\u1ea1o gi\u1eefa c\u00e1c t\u1ebf b\u00e0o Lympho B v\u00e0 t\u1ebf b\u00e0o u t\u1ee7y. C\u00f3 kh\u1ea3 n\u0103ng ti\u00eau di\u1ec7t c\u00e1c t\u1ebf b\u00e0o K tr\u00ean c\u01a1 th\u1ec3. Ngo\u00e0i ra ng\u01b0\u1eddi ta c\u00f2n g\u1eafn I131 ho\u1eb7c c\u00e1c thu\u1ed1c ch\u1ed1ng ung th\u01b0 v\u00e0o c\u00e1c kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng \u0111\u1ec3 t\u1ea1p trung t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb l\u00ean t\u1ebf b\u00e0o ung th\u01b0 c\u0169ng nh\u01b0 ph\u00e1t hi\u1ec7n di c\u0103n b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p x\u1ea1 k\u00ed<\/p>\n
4.4. C\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng t\u1ea1p huy\u1ebft: L\u00e0 m\u1ed9t nh\u00f3m c\u00e1c ch\u1ea5t ti\u1ebft ra t\u1eeb t\u1ebf b\u00e0o lympho v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o c\u00f3 t\u00e1c d\u1ee5ng k\u00edch th\u00edch t\u0103ng tr\u01b0\u1edfng t\u1ea1o huy\u1ebft, l\u00e0m gi\u1ea3m c\u00e1c p\u1ee9 ph\u1ee5 c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb h\u00f3a ch\u1ea5t. Nh\u1edd \u0111\u00f3 gi\u1ea3m \u0111\u01b0\u1ee3c c\u00e1c bi\u1ebfn ch\u1ee9ng, gi\u1ea3m nhu c\u1ea7u truy\u1ec1n m\u00e1u v\u00e0 h\u1ed7 tr\u1ee3 h\u1eefu \u00edch cho b\u1ec7nh nh\u00e2n ung th\u01b0 b\u00ean c\u1ea1nh c\u00e1c thu\u1ed1c n\u00e2ng \u0111\u1ee1 kh\u00e1c<\/p>\n
5. \u0110i\u1ec1u tr\u1ecb tr\u00fang \u0111\u00edch<\/p>\n
\u0110i\u1ec1u tr\u1ecb tr\u00fang \u0111\u00edch l\u00e0 d\u00f9ng thu\u1ed1c c\u1ea3n tr\u1edf c\u00e1c ph\u00e2n t\u1eed \u0111\u1eb7c hi\u1ec7u, nh\u1eb1m k\u00ecm h\u00e3m s\u1ef1 t\u0103ng tr\u01b0\u1edfng v\u00e0 ph\u00e1t tri\u1ec3n c\u1ee7a ung th\u01b0. \u0110i\u1ec1u tr\u1ecb tr\u00fang \u0111\u00edch trong ung th\u01b0 n\u00f3i m\u1ed9t c\u00e1ch \u0111\u01a1n gi\u1ea3n l\u00e0 ph\u01b0\u01a1ng ph\u00e1p nh\u1eb1m v\u00e0o t\u1ebf b\u00e0o ung th\u01b0 m\u00e0 di\u1ec7t. V\u1edbi quan ni\u1ec7m n\u00e0y th\u00ec b\u1ea5t k\u1ef3 lo\u1ea1i thu\u1ed1c n\u00e0o m\u00e0 ch\u1ec9 t\u00ecm \u0111\u1ebfn t\u1ebf b\u00e0o ung th\u01b0 \u0111\u1ec3 di\u1ec7t nh\u1edd nh\u1eadn ra \u0111\u01b0\u1ee3c nh\u1eefng n\u00e9t kh\u00e1c th\u01b0\u1eddng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o n\u00e0y ho\u1eb7c \u0111\u00e1nh v\u00e0o nh\u1eefng ch\u1ed7 \u201cs\u01a1 h\u1edf\u201d c\u1ee7a t\u1ebf b\u00e0o ung th\u01b0 trong khi kh\u00f4ng g\u00e2y ra ho\u1eb7c g\u00e2y r\u1ea5t \u00edt t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn t\u1ebf b\u00e0o l\u00e0nh, \u0111\u1ebfn ch\u1ee9c n\u0103ng b\u00ecnh th\u01b0\u1eddng c\u1ee7a c\u00e1c c\u01a1 quan, b\u1ed9 ph\u1eadn \u0111\u1ec1u \u0111\u01b0\u1ee3c coi l\u00e0 \u0111i\u1ec1u tr\u1ecb tr\u00fang \u0111\u00edch.<\/p>\n
\u0110i\u1ec1u tr\u1ecb tr\u00fang \u0111\u00edch l\u00e0 ti\u1ebfn b\u1ed9 m\u1edbi trong l\u0129nh v\u1ef1c chuy\u00ean s\u00e2u c\u1ee7a \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa \u0111\u1ed1i v\u1edbi K, nh\u1edd \u1ee9ng d\u1ee5ng c\u00e1c th\u00e0nh t\u1ef1u trong nghi\u00ean c\u1ee9u v\u1ec1 sinh h\u1ecdc ph\u00e2n t\u1eed. \u0110i\u1ec1u tr\u1ecb tr\u00fang \u0111\u00edch c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kinh \u0111i\u1ec3n nh\u01b0 ph\u1eabu thu\u1eadt, chi\u1ebfu tia x\u1ea1, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng h\u00f3a ch\u1ea5t nh\u1eb1m k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng v\u00e0 gi\u1ea3m b\u1edbt t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng cho ng\u01b0\u1eddi b\u1ec7nh. Hi\u1ec7n nay, \u0111ang nghi\u00ean c\u1ee9u v\u00e0 \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb tr\u00fang \u0111\u00edch trong nhi\u1ec1u lo\u1ea1i K nh\u01b0: v\u00fa, ph\u1ed5i, \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, gan, t\u1ee5y, v\u00f9ng \u0111\u1ea7u c\u1ed5\u2026<\/p>\n
C\u00f3 nhi\u1ec1u lo\u1ea1i thu\u1ed1c t\u00e1c \u0111\u1ed9ng v\u00e0o \u0111\u00edch, v\u00e0o c\u00e1c qu\u00e1 tr\u00ecnh kh\u00e1c nhau \u0111\u1ec3 k\u00ecm h\u00e3m s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a kh\u1ed1i u. V\u1edbi c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 nghi\u00ean c\u1ee9u cho \u0111\u1ebfn nay, ch\u00fang ta c\u00f3 th\u1ec3 ph\u00e2n nh\u00f3m theo c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng ch\u00ednh nh\u01b0 sau:<\/p>\n
\u00b7 Nh\u00f3m \u1ee9c ch\u1ebf c\u00e1c gen k\u00edch th\u00edch t\u1ebf b\u00e0o ph\u00e1t tri\u1ec3n<\/p>\n
\u00b7 Nh\u00f3m \u1ee9c ch\u1ebf t\u0103ng sinh m\u1ea1ch m\u00e1u<\/p>\n
\u00b7 Nh\u00f3m t\u00e1c \u0111\u1ed9ng theo c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch<\/p>\n
\u00b7 C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00edch kh\u00e1c<\/p>\n
Trong m\u1ed7i nh\u00f3m l\u1ea1i c\u00f3 nh\u1eefng thu\u1ed1c thu\u1ed9c lo\u1ea1i c\u00e1c ph\u00e2n t\u1eed nh\u1ecf, c\u00f3 nh\u1eefng thu\u1ed1c thu\u1ed9c lo\u1ea1i kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng. C\u00f3 nh\u1eefng thu\u1ed1c v\u1eeba c\u00f3 t\u00e1c d\u1ee5ng theo c\u00e1c c\u01a1 ch\u1ebf nh\u01b0 lo\u1ea1i 1 v\u1eeba c\u00f3 t\u00e1c d\u1ee5ng nh\u01b0 lo\u1ea1i 2 ho\u1eb7c v\u1eeba c\u00f3 t\u00e1c d\u1ee5ng nh\u01b0 lo\u1ea1i 1 v\u1eeba c\u00f3 t\u00e1c d\u1ee5ng nh\u01b0 lo\u1ea1i 3.<\/p>\n
C\u00e2u 8:D\u1ef1 ph\u00f2ng b\u01b0\u1edbc 1, b\u01b0\u1edbc 2<\/p>\n
I. NH\u1eeeNG V\u1ea4N \u0110\u1ec0 C\u1ee4 TH\u1ec2 C\u1ea6N PH\u1ea2I L\u00c0M TRONG D\u1ef0 PH\u00d2NG B\u01af\u1edaC 1<\/p>\n
L\u00e0 ph\u00f2ng ng\u1eeba ban \u0111\u1ea7u nh\u1eb1m c\u1ed1 g\u1eafng lo\u1ea1i tr\u1eeb ho\u1eb7c gi\u1ea3m t\u1ed1i \u0111a s\u1ef1 ti\u1ebfp x\u00fac v\u1edbi c\u00e1c ch\u1ea5t g\u00e2y ung th\u01b0 \u0111\u1ec3 ph\u00f2ng kh\u00f4ng cho x\u1ea3y ra s\u1ef1 kh\u1edfi ph\u00e1t v\u00e0 kh\u1edfi \u0111\u1ed9ng b\u1ec7nh ung th\u01b0. \u0110\u00e2y l\u00e0 b\u01b0\u1edbc t\u00edch c\u1ef1c nh\u1ea5t.<\/p>\n
Mu\u1ed1n d\u1ef1 ph\u00f2ng ung th\u01b0 t\u1ed1t nh\u1ea5t ph\u1ea3i c\u00f3 chi\u1ebfn thu\u1eadt d\u1ef1 ph\u00f2ng v\u00e0 ph\u1ea3i d\u1ef1a v\u00e0o 2 y\u1ebfu t\u1ed1:<\/p>\n
1. D\u1ecbch t\u1ec5 h\u1ecdc ung th\u01b0<\/p>\n
\u00c1p d\u1ee5ng bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng cho nh\u1eefng lo\u1ea1i ung th\u01b0 c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh cao trong c\u1ed9ng \u0111\u1ed3ng.<\/p>\n
2. Nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y ung th\u01b0<\/p>\n
a.H\u00fat thu\u1ed1c l\u00e1:<\/p>\n
G\u00e2y 30% ung th\u01b0 c\u00e1c lo\u1ea1i; 90% ung th\u01b0 ph\u1ed5i; 75% ung th\u01b0 mi\u1ec7ng, thanh qu\u1ea3n, th\u1ef1c qu\u1ea3n; 5% ung th\u01b0 b\u00e0ng quang.<\/p>\n
Nguy c\u01a1 g\u00e2y ung th\u01b0 t\u0103ng theo th\u1eddi gian h\u00fat thu\u1ed1c, h\u00fat thu\u1ed1c l\u00e1 th\u1ee5 \u0111\u1ed9ng c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1<\/p>\n
Do \u0111\u00f3 c\u1ea7n ph\u1ea3i: + Tuy\u00ean truy\u1ec1n t\u00e1c h\u1ea1i c\u1ee7a thu\u1ed1c l\u00e1<\/p>\n
+ Ch\u1ed1ng h\u00fat thu\u1ed1c l\u00e1 n\u01a1i c\u00f4ng c\u1ed9ng<\/p>\n
+ Khuy\u00ean nh\u1eefng ng\u01b0\u1eddi \u0111ang h\u00fat thu\u1ed1c ng\u1eebng h\u00fat .<\/p>\n
+ H\u1ed7 tr\u1ee3 cho ng\u01b0\u1eddi b\u1ec7nh ng\u1eebng h\u00fat<\/p>\n
+ T\u1ed5 ch\u1ee9c th\u0103m kh\u00e1m theo d\u00f5i \u0111\u1ecbnh k\u1ef3.<\/p>\n
Ch\u00fa \u00fd tuy\u00ean truy\u1ec1n \u0111\u1ed1i v\u1edbi nh\u1eefng thanh thi\u1ebfu ni\u00ean ch\u01b0a bao gi\u1edd h\u00fat thu\u1ed1c, v\u00e0 ph\u1ee5 n\u1eef mang thai.<\/p>\n
b. Dinh d\u01b0\u1ee1ng:<\/p>\n
Y\u1ebfu t\u1ed1 dinh d\u01b0\u1ee1ng \u0111\u01b0\u1ee3c x\u1ebfp l\u00e0 nguy\u00ean nh\u00e2n quan tr\u1ecdng th\u1ee9 hai g\u00e2y b\u1ec7nh ung th\u01b0 v\u00e0 t\u1eed vong.<\/p>\n
Tr\u00e1nh \u0103n nhi\u1ec1u m\u1ee1, gia v\u1ecb, v\u00e0 \u0103n c\u00e1c lo\u1ea1i th\u1ee9c \u0103n b\u1ecb m\u1ed1c. Tr\u00e1nh u\u1ed1ng n\u01b0\u1edbc ho\u1eb7c th\u1ee9c \u0103n qu\u00e1 n\u00f3ng<\/p>\n
C\u1ea7n t\u0103ng c\u01b0\u1eddng \u0103n nhi\u1ec1u hoa qu\u1ea3, rau v\u00e0 c\u00e1c lo\u1ea1i vitamin. C\u00e1c ch\u1ea5t vitamin nh\u1ea5t l\u00e0 b\u00ea ta car\u00f4ten, trong c\u00e1c rau qu\u1ea3 c\u00f3 m\u00e0u \u0111\u1ecf (c\u00e0 r\u1ed1t, c\u00e0 chua…) c\u00f3 t\u00ednh ch\u1ea5t ch\u1ed1ng ung th\u01b0.<\/p>\n
C\u00e2n b\u1eb1ng dinh d\u01b0\u1ee1ng trong kh\u1ea9u ph\u1ea7n \u0103n<\/p>\n
R\u01b0\u1ee3u: G\u00e2y K gan, mi\u1ec7ng, th\u1ef1c qu\u1ea3n v\u00e0 ph\u1ea7n tr\u00ean thanh qu\u1ea3n. Quan t\u00e2m h\u01a1n c\u1ea3 l\u00e0 m\u1ed1i li\u00ean k\u1ebft gi\u1eefa thu\u1ed1c l\u00e1 v\u00e0 r\u01b0\u1ee3u c\u00f3 t\u00e1c d\u1ee5ng c\u1ed9ng h\u01b0\u1edfng tr\u00ean ung th\u01b0 v\u00f9ng \u0111\u1ea7u c\u1ed5. N\u00ean ch\u1ecdn \u0111\u1ed3 u\u1ed1ng kh\u00f4ng c\u00f3 c\u1ed3n<\/p>\n
c.Tia x\u1ea1:<\/p>\n
B\u1ee9c x\u1ea1 c\u1ef1c t\u00edm (UV) do ph\u01a1i n\u1eafng qu\u00e1 \u0111\u1ed9 \u0111\u01b0\u1ee3c xem l\u00e0 t\u00e1c nh\u00e2n g\u00e2y ung th\u01b0 da (c\u00f3 v\u00e0 kh\u00f4ng c\u00f3 s\u1eafc t\u1ed1). C\u1ea9n th\u1eadn che ch\u1eafn \u0111\u1ea7y \u0111\u1ee7 khi l\u00e0m c\u00f4ng t\u00e1c X quang, ph\u00f3ng x\u1ea1, tr\u00e1nh ph\u01a1i n\u1eafng qu\u00e1 l\u00e2u<\/p>\n
d.C\u00e1c virut:<\/p>\n
C\u00f3 virut \u0111\u01b0\u1ee3c bi\u1ebft l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ung th\u01b0 \u1edf ng\u01b0\u1eddi l\u00e0: Virut vi\u00eam gan B, virut Epstein Barr, virut b\u01b0\u1edbu gai (HPV) v\u00e0 virut g\u00e2y b\u1ec7nh b\u1ea1ch c\u1ea7u d\u00f2ng lympho T \u1edf ng\u01b0\u1eddi (HTLV). V\u00ec v\u1eady lo\u1ea1i tr\u1eeb virut vi\u00eam gan b\u1eb1ng c\u00e1ch ti\u00eam ch\u1ee7ng vacxin, ung th\u01b0 c\u1ed5 t\u1eed b\u1eb1ng c\u00e1ch ti\u00eam vacxin ch\u1ed1ng HPV,…<\/p>\n
e.T\u00e1c d\u1ee5ng ph\u1ee5 do d\u00f9ng thu\u1ed1c: R\u1ea5t c\u1ea9n th\u1eadn khi d\u00f9ng thu\u1ed1c n\u1ed9i ti\u1ebft n\u1eef, c\u00e1c ch\u1ea5t ch\u1ed1ng ung th\u01b0 nh\u00f3m c\u00f3 nh\u00e2n Alkyl. Nh\u1ea5t l\u00e0 \u0111\u1ed1i v\u1edbi tr\u1ebb em c\u1ea7n tuy\u1ec7t \u0111\u1ed1i tr\u00e1nh.<\/p>\n
f.Y\u1ebfu t\u1ed1 di truy\u1ec1n:<\/p>\n
LS g\u0111 c\u0169ng xem l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 hay g\u1eb7p c\u1ee7a m\u1ed9t s\u1ed1 lo\u1ea1i ung th\u01b0 nh\u01b0: K v\u00fa, K \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, K v\u00f5ng m\u1ea1c m\u1eaft, b\u1ec7nh kh\u00f4 da nhi\u1ec5m s\u1eafc t\u1ed1. \u1ede m\u1ed9t s\u1ed1 n\u01b0\u1edbc c\u00f3 ph\u00f2ng kh\u00e1m gien \u0111\u1ec3 t\u00ecm gien g\u00e2y ung th\u01b0.<\/p>\n
Ph\u00f2ng b\u1ec7nh th\u00f4ng qua t\u00e1c \u0111\u1ed9ng v\u00e0o y\u1ebfu t\u1ed1 di truy\u1ec1n, v\u00ed d\u1ee5:<\/p>\n
+ B\u1ec7nh x\u01a1 da nhi\u1ec5m s\u1eafc: Kh\u00f4ng ra n\u1eafng<\/p>\n
+ \u0110a polip gia \u0111\u00ecnh: C\u1eaft Polip, c\u1eaft \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/p>\n
g. Kh\u00e1c<\/p>\n
Sinh \u0111\u1ebb c\u00f3 k\u1ebf ho\u1eb7ch v\u00e0 v\u1ec7 sinh sinh d\u1ee5c, quan h\u1ec7 t \u00ec n h d \u1ee5 c an to\u00e0n<\/p>\n
Ph\u00f2ng b\u1ec7nh ngh\u1ec1 nghi\u1ec7p v\u00e0 m\u00f4i tr\u01b0\u1eddng x.q: Ch\u1ed1ng \u00f4 nhi\u1ec5m kh\u00f4ng kh\u00ed, n\u01b0\u1edbc sinh ho\u1ea1t, n\u01b0\u1edbc th\u1ea3i,…<\/p>\n
II. D\u1ef0 PH\u00d2NG B\u01af\u1edaC 2<\/p>\n
L\u00e0 s\u00e0ng l\u1ecdc v\u00e0 ph\u00e1t hi\u1ec7n s\u1edbm nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh, th\u00e2m ch\u00ed nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ee7a 1 t\u00ecnh tr\u1ea1ng ti\u1ec1n ung th\u01b0 nh\u01b0: s\u00e0ng l\u1ecdc ph\u00e1t hi\u1ec7n ung th\u01b0 c\u1ed5 t\u1eed cung, v\u00fa, \u0111\u1ea1i tr\u1ef1c tr\u00e0ng…<\/p>\n
Qu\u00e1 tr\u00ecnh n\u00e0y ch\u1ec9 c\u00f3 hi\u1ec7u qu\u1ea3 \u1edf 1 s\u1ed1 b\u1ec7nh c\u00f3 ph\u1ea3n \u1ee9ng \u0111\u1eb7c hi\u1ec7u, nh\u01b0ng l\u00e0 chi\u1ebfn l\u01b0\u1ee3c duy nh\u1ea5t c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong do ung th\u01b0<\/p>\n
S\u00e0ng l\u1ecdc l\u00e0 c\u00e1ch \u0111\u00e1nh gi\u00e1 m\u1ed7i c\u00e1 th\u1ec3 hay c\u1ed9ng \u0111\u1ed3ng, kho\u1ebb m\u1ea1nh v\u1ec1 m\u1eb7t LS, nh\u1eb1m ph\u00e1t hi\u1ec7n K ti\u1ec1n \u1ea9n hay th\u01b0\u01a1ng t\u1ed5n ti\u1ec1n ung th\u01b0 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb kh\u1ecfi. M\u1ee5c ti\u00eau c\u1ee7a s\u00e0ng l\u1ecdc nh\u1eb1m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong do ung th\u01b0.<\/p>\n
1.Nh\u1eefng nguy\u00ean t\u1eafc s\u00e0ng l\u1ecdc ung th\u01b0<\/p>\n
Nguy\u00ean t\u1eafc s\u00e0ng l\u1ecdc tr\u01b0\u1edbc ti\u00ean ph\u1ee5 thu\u1ed9c v\u00e0o b\u1ec7nh K: D\u1ecbch t\u1ec5 h\u1ecdc, sinh b\u1ec7nh h\u1ecdc, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111.tr\u1ecb<\/p>\n
D\u1ecbch t\u1ec5: B\u1ec7nh ung th\u01b0 s\u00e0ng l\u1ecdc ph\u1ea3i l\u00e0 b\u1ec7nh ph\u1ed5 bi\u1ebfn v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kho\u1ebb c\u1ed9ng \u0111\u1ed3ng. S\u00e0ng l\u1ecdc ph\u1ea3i l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong v\u1ec1 m\u1eb7t d\u1ecbch t\u1ec5<\/p>\n
L\u1ecbch s\u1eed t\u1ef1 nhi\u00ean:ung th\u01b0 s\u00e0ng l\u1ecdc ph\u1ea3i c\u00f3 giai \u0111o\u1ea1n ti\u1ec1n l\u00e2m s\u00e0ng k\u00e9o d\u00e0i, c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n tr\u01b0\u1edbc khi c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng ho\u1eb7c di c\u0103n c\u1ee7a b\u1ec7nh.<\/p>\n
\u0110i\u1ec1u tr\u1ecb: B\u1ec7nh ung th\u01b0 s\u00e0ng l\u1ecdc ch\u1ec9 c\u00f3 \u00fd ngh\u0129a khi b\u1ec7nh \u0111i\u1ec1u tr\u1ecb c\u00f3 k\u1ebft qu\u1ea3 \u1edf giai \u0111o\u1ea1n s\u1edbm<\/p>\n
Ch\u1ea9n \u0111o\u00e1n: B\u1ec7nh ung th\u01b0 mu\u1ed1n s\u00e0ng l\u1ecdc c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n b\u1eb1ng kh\u00e1m l\u00e2m s\u00e0ng ho\u1eb7c c\u1eadn l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 test s\u00e0ng l\u1ecdc.<\/p>\n
2.Test s\u00e0ng l\u1ecdc ung th\u01b0 ph\u1ea3i \u0111\u1ea1t c\u00e1c ti\u00eau chu\u1ea9n<\/p>\n
Test s\u00e0ng l\u1ecdc ph\u1ea3i \u0111\u01a1n gi\u1ea3n, th\u00edch h\u1ee3p, \u0111\u01b0\u1ee3c b\u1ec7nh nh\u00e2n v\u00e0 c\u1ed9ng \u0111\u1ed3ng ch\u1ea5p nh\u1eadn<\/p>\n
Gi\u00e1 th\u00e0nh h\u1ea1,<\/p>\n
\u00cdt t\u00e1c d\u1ee5ng ph\u1ee5<\/p>\n
\u0110\u1ed9 nh\u1ea1y( Kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n ung th\u01b0 \u0111\u1eb7c hi\u1ec7u), \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u( Kh\u1ea3 n\u0103ng lo\u1ea1i tr\u1eeb ung th\u01b0 t\u1ed1t), d\u1ef1 b\u00e1o d\u01b0\u01a1ng t\u00ednh c\u00e0ng cao c\u00e0ng t\u1ed1t<\/p>\n
Trong th\u1ef1c t\u1ebf ch\u00fang ta r\u1ea5t mong mu\u1ed1n \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a x\u00e9t nghi\u1ec7m cao, nh\u01b0ng khi \u0111\u1ed9 nh\u1ea1y t\u0103ng l\u00ean th\u00ec \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u s\u1ebd gi\u1ea3m \u0111i. Ch\u00ednh v\u00ec v\u1eady 1 test c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng v\u00e0o s\u00e0ng l\u1ecdc th\u00ec ph\u1ea3I \u0111\u1ea3m b\u1ea3o \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u tr\u00ean 80%.<\/p>\n
Th\u1ef1c t\u1ebf s\u00e0ng l\u1ecdc ung th\u01b0 c\u00f3 t\u00e1c d\u1ee5ng ph\u00e1t hi\u1ec7n b\u1ec7nh \u1edf giai \u0111o\u1ea1n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi khi \u0111\u00f3 s\u1ebd ti\u1ebft ki\u1ec7m \u0111\u01b0\u1ee3c r\u1ea5t nhi\u1ec1u ti\u1ec1n so v\u1edbi ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u1edf giai \u0111o\u1ea1n mu\u1ed9n<\/p>\n
3. \u01afu, nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a s\u00e0ng l\u1ecdc ung th\u01b0<\/p>\n
\u01afu \u0111i\u1ec3m:<\/p>\n
+ Ph\u00e1t hi\u1ec7n s\u1edbm UT<\/p>\n
+ Gi\u1ea3m t\u1eed vong do UT<\/p>\n
+ K\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng<\/p>\n
+ T\u0103ng t\u1ef7 l\u1ec7 b\u1ea3o t\u1ed3n<\/p>\n
+ Y\u00ean t\u00e2m lo\u1ea1i tr\u1eeb UT<\/p>\n
Nh\u01b0\u1ee3c \u0111i\u1ec3m:<\/p>\n
+ Phi\u1ec1n to\u00e1i c\u1ee7a c\u00e1c test<\/p>\n
+ D\u01b0\u01a1ng t\u00ednh gi\u1ea3 can thi\u1ec7p kh\u00f4ng c\u1ea7n thi\u1ebft<\/p>\n
+ \u00c2m t\u00ednh gi\u1ea3 b\u1ecf s\u00f3t UT<\/p>\n
+ Lo l\u1eafng do s\u00e0ng l\u1ecdc ph\u00e1t hi\u1ec7n b\u1ec7nh s\u1edbm \u1edf ng\u01b0\u1eddi kho\u1ebb<\/p>\n
+ T\u1ed1n k\u00e9m k\u00ednh t\u1ebf<\/p>\n
4. V\u00ed d\u1ee5<\/p>\n
a. S\u00e0ng l\u1ecdc ung th\u01b0 v\u00fa: C\u00f3 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p s\u00e0ng l\u1ecdc sau:<\/p>\n
T\u1ef1 kh\u00e1m v\u00fa:<\/p>\n
L\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt \u00edt t\u1ed1n k\u00e9m v\u00e0 v\u00f4 h\u1ea1i \u0111\u1ed1i v\u1edbi tuy\u1ebfn v\u00fa. Th\u1ef1c hi\u1ec7n t\u1ef1 kh\u00e1m v\u00fa m\u1ed9t th\u00e1ng m\u1ed9t l\u1ea7n v\u00e0 kh\u00e1m sau khi s\u1ea1ch kinh 5 ng\u00e0y. Th\u01b0\u1eddng ch\u1ea9n \u0111o\u00e1n ra b\u1ec7nh khi u nh\u1ecf, h\u1ea1ch di c\u0103n \u00edt h\u01a1n nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng th\u1ef1c h\u00e0nh t\u1ef1 kh\u00e1m v\u00fa. Do v\u1eady, c\u1ea7n ph\u1ea3i ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i c\u00e1ch t\u1ef1 kh\u00e1m v\u00fa qua c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n th\u00f4ng tin \u0111\u1ea1i ch\u00fang.<\/p>\n
Kh\u00e1m l\u00e2m s\u00e0ng tuy\u1ebfn v\u00fa:<\/p>\n
L\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng d\u1ee5ng \u0111\u1ec3 kh\u00e1m cho t\u1ea5t c\u1ea3 ph\u1ee5 n\u1eef tr\u00ean 40 tu\u1ed5i \u00edt nh\u1ea5t m\u1ed9t n\u0103m m\u1ed9t l\u1ea7n.<\/p>\n
Ch\u1ee5p tuy\u1ebfn v\u00fa:<\/p>\n
Ch\u1ee5p v\u00fa kh\u00f4ng chu\u1ea9n b\u1ecb \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong: x\u00e1c \u0111\u1ecbnh b\u1ec7nh v\u00e0 s\u00e0ng l\u1ecdc ung th\u01b0 v\u00fa.<\/p>\n
V\u1edbi ph\u1ee5 n\u1eef tr\u00ean 40 tu\u1ed5i n\u1eb1m trong di\u1ec7n “nguy c\u01a1 cao”, m\u1ed9t n\u0103m n\u00ean ch\u1ee5p v\u00fa kh\u00f4ng chu\u1ea9n b\u1ecb 1 l\u1ea7n.<\/p>\n
\u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef tr\u00ean 50 tu\u1ed5i, vi\u1ec7c s\u00e0ng l\u1ecdc b\u1eb1ng ch\u1ee5p tuy\u1ebfn v\u00fa c\u0169ng c\u00f3 hi\u1ec7u qu\u1ea3 t\u1ed1t.<\/p>\n
b. S\u00e0ng l\u1ecdc ung th\u01b0 c\u1ed5 t\u1eed cung<\/p>\n
Ung th\u01b0 x\u00e2m l\u1ea5n c\u1ed5 t\u1eed cung c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00f2ng ng\u1eeba n\u1ebfu s\u00e0ng l\u1ecdc \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh b\u1edfi s\u1ef1 ch\u00ednh x\u00e1c c\u1ee7a Pap test hay t\u1ebf b\u00e0o h\u1ecdc \u00e2 m \u0111 \u1ea1 o m\u1ed7i n\u0103m m\u1ed9t \u0111\u1ebfn hai l\u1ea7n \u1edf ph\u1ee5 n\u1eef tr\u00ean 30 tu\u1ed5i \u0111\u00e3 c\u00f3 gia \u0111\u00ecnh.<\/p>\n
N\u1ebfu kh\u00f4ng c\u00f3 ch\u01b0\u01a1ng tr\u00ecnh s\u00e0ng l\u1ecdc c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u01b0\u1ee3c t\u1ed5 ch\u1ee9c b\u1edfi h\u1ec7 th\u1ed1ng y t\u1ebf c\u1ed9ng \u0111\u1ed3ng, c\u00e1c b\u00e1c s\u0129 c\u00f3 th\u1ec3 ch\u1ecdn l\u1ecdc c\u00e1c BN \u0111\u1ec3 s\u00e0ng l\u1ecdc. B\u1edfi \u00edch l\u1ee3i c\u1ee7a vi\u1ec7c s\u00e0ng l\u1ecdc ung th\u01b0 c\u1ed5 t\u1eed cung \u0111\u00e3 l\u00e0m gi\u1ea3m 30% c\u00e1c tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 x\u00e2m l\u1ea5n. \u1edf nhi\u1ec1u n\u01b0\u1edbc \u0111\u00e3 \u00e1p d\u1ee5ng c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh s\u00e0ng l\u1ecdc c\u00f3 t\u1ed5 ch\u1ee9c.<\/p>\n
T\u1ea1i c\u00e1c \u0111\u1ecba ph\u01b0\u01a1ng kh\u00f4ng c\u00f3 ph\u01b0\u01a1ng ti\u1ec7n x\u00e9t nghi\u1ec7m \u0111\u1ec3 l\u00e0m Pap test, c\u00f3 th\u1ec3 kh\u00e1m c\u1ed5 t\u1eed cung b\u1eb1ng m\u1eaft v\u1edbi m\u1ecf v\u1ecbt v\u00e0 \u0111\u1ee7 \u00e1nh s\u00e1ng cho c\u00e1c ph\u1ee5 n\u1eef c\u00f3 gia \u0111\u00ecnh, tr\u00ean 30 tu\u1ed5i. N\u1ebfu c\u00f3 b\u1ea5t th\u01b0\u1eddng s\u1ebd \u0111\u01b0a sang b\u1ed9 ph\u1eadn x\u00e1c \u0111\u1ecbnh b\u1ec7nh v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/p>\n
C\u00e1c ph\u01b0\u01a1ng ph\u00e1p:<\/p>\n
+Kh\u00e1m b\u1eb1ng m\u1eaft l\u00e0 m\u1ed9t ph\u1ea7n kh\u00f4ng t\u00e1ch r\u1eddi c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh s\u00e0ng l\u1ecdc v\u1edbi t\u1ebf b\u00e0o c\u1ed5 t\u1eed cung.<\/p>\n
+L\u00e0m th\u1eed nghi\u1ec7m Lugol.<\/p>\n
+Soi c\u1ed5 t\u1eed cung \u0111\u1ec3 ph\u00f3ng \u0111\u1ea1i c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf c\u1ed5 t\u1eed cung.<\/p>\n
+Kho\u00e9t ch\u00f3p c\u1ed5 t\u1eed cung: V\u1eeba ch\u1ea9n \u0111o\u00e1n v\u1eeba \u0111i\u1ec1u tr\u1ecb c\u00e1c ung th\u01b0 ti\u1ec1n x\u00e2m l\u1ea5n.<\/p>\n
c. S\u00e0ng l\u1ecdc ung th\u01b0 \u0111\u1ea1i tr\u00e0ng v\u00e0 tr\u1ef1c tr\u00e0ng<\/p>\n
\u1ede nhi\u1ec1u n\u01b0\u1edbc ph\u00e1t tri\u1ec3n, ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u0111\u1ee9ng h\u00e0ng th\u1ee9 2 sau ung th\u01b0 ph\u1ed5i.<\/p>\n
Chi\u1ebfn l\u01b0\u1ee3c s\u00e0ng l\u1ecdc nh\u1eb1m v\u00e0o c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 nguy c\u01a1 cao, \u0111\u1eb7c bi\u1ec7t t\u1eadp trung v\u00e0o nh\u1eefng ng\u01b0\u1eddi c\u00f3 tu\u1ed5i kho\u1ea3ng 50 \u0111\u1ebfn 70.<\/p>\n
C\u00e1c nghi\u1ec7m ph\u00e1p s\u00e0ng l\u1ecdc:<\/p>\n
+X\u00e9t nghi\u1ec7m m\u00e1u ti\u1ec1m \u1ea9n trong ph\u00e2n (FOBT)<\/p>\n
Ph\u00e1t hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng Peroxidase c\u1ee7a huy\u1ebft c\u1ea7u t\u1ed1.<\/p>\n
C\u00e1c x\u00e9t nghi\u1ec7m s\u00e0ng l\u1ecdc cho th\u1ea5y kho\u1ea3ng 2% FOBT d\u01b0\u01a1ng t\u00ednh v\u00e0 gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n c\u1ee7a test cho c\u1ea3 u tuy\u1ebfn l\u00e0nh v\u00e0 ung th\u01b0 t\u1eeb 20 30%. Ch\u00fa \u00fd c\u00f3 x\u00e9t nghi\u1ec7m d\u01b0\u01a1ng t\u00ednh gi\u1ea3.<\/p>\n
+N\u1ed9i soi: Vi\u1ec7c soi \u0111\u1ea1i tr\u00e0ng v\u00e0 tr\u1ef1c tr\u00e0ng \u0111\u00e3 s\u1eed d\u1ee5ng nh\u01b0 m\u1ed9t x\u00e9t nghi\u1ec7m s\u00e0ng l\u1ecdc \u0111\u01a1n \u0111\u1ed9c hay k\u1ebft h\u1ee3p v\u1edbi FOBT. Vi\u1ec7c theo d\u00f5i c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 nguy c\u01a1 cao n\u00ean d\u00f9ng test FOBT n\u1ebfu FOBT d\u01b0\u01a1ng t\u00ednh, ch\u1ec9 \u0111\u1ecbnh soi \u0111\u1ea1i tr\u00e0ng, tr\u1ef1c tr\u00e0ng.<\/p>\n
d. S\u00e0ng l\u1ecdc c\u00e1c ung th\u01b0 kh\u00e1c<\/p>\n
\u0110\u1ed1i v\u1edbi ung th\u01b0 gan nguy\u00ean ph\u00e1t:<\/p>\n
S\u00e0ng l\u1ecdc b\u1eb1ng c\u00e1ch \u0111o \u03b1 fetoprotein trong huy\u1ebft thanh nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u00e3 b\u1ecb vi\u00eam gan si\u00eau vi tr\u00f9ng B.<\/p>\n
Si\u00eau \u00e2m \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 theo d\u00f5i c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 k\u1ebft qu\u1ea3 b\u1ea5t th\u01b0\u1eddng.<\/p>\n
\u0110\u1ed1i v\u1edbi ung th\u01b0 v\u00f2m h\u1ecdng:<\/p>\n
S\u00e0ng l\u1ecdc b\u1eb1ng c\u00e1ch \u0111o l\u01b0\u1ee3ng kh\u00e1ng th\u1ec3 IgA c\u1ee7a virut Epstein Barr cho d\u00e2n \u1edf v\u00f9ng hay m\u1eafc lo\u1ea1i K n\u00e0y.<\/p>\n
\u0110\u1ed1i v\u1edbi ung th\u01b0 v\u00f9ng h\u1ecdng mi\u1ec7ng:<\/p>\n
Th\u0103m kh\u00e1m b\u1eb1ng m\u1eaft c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 nguy c\u01a1 cao, c\u1ea7n k\u1ebft h\u1ee3p v\u1edbi c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh gi\u00e1o d\u1ee5c cho d\u00e2n ch\u00fang bi\u1ebft l\u00e0 l\u00e0m t\u0103ng l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c ph\u00e1t hi\u1ec7n ung th\u01b0 s\u1edbm v\u00e0 c\u00e1c t\u00ecnh tr\u1ea1ng ti\u1ec1n ung th\u01b0.<\/p>\n
\u0110\u1ed1i v\u1edbi ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn:<\/p>\n
C\u1ea3 3 x\u00e9t nghi\u1ec7m c\u00f3 kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n b\u1ec7nh khi ch\u01b0a c\u00f3 tri\u1ec7u ch\u1ee9ng LS: th\u0103m kh\u00e1m tr\u1ef1c tr\u00e0ng b\u1eb1ng tay, si\u00eau \u00e2m qua tr\u1ef1c tr\u00e0ng, kh\u00e1ng nguy\u00ean \u0111\u1eb7c hi\u1ec7u c\u1ee7a tuy\u1ebfn ti\u1ec1n li\u1ec7t.<\/p>\n
\u0110\u1ed1i v\u1edbi ung th\u01b0 tuy\u1ebfn gi\u00e1p:<\/p>\n
C\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u00e3 chi\u1ebfu x\u1ea1 v\u00e0o v\u00f9ng \u0111\u1ea7u c\u1ed5 khi c\u00f2n th\u01a1 \u1ea5u s\u1ebd c\u00f3 nguy c\u01a1 cao c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c kh\u00e1m l\u00e2m s\u00e0ng \u0111\u1ecbnh k\u1ef3, x\u00e9t nghi\u1ec7m Calcitonin v\u00e0 Thyroglobulin.<\/p>\n
\u0110\u1ed1i v\u1edbi ung th\u01b0 ph\u1ebf qu\u1ea3n ph\u1ed5i:<\/p>\n
N\u00ean ch\u1ee5p X quang ph\u1ed5i \u0111\u1ecbnh k\u1ef3 h\u00e0ng n\u0103m cho nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c tr\u00ean 45 tu\u1ed5i \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm t\u1ed5n th\u01b0\u01a1ng khi c\u00e1c kh\u1ed1i u c\u00f2n nh\u1ecf.<\/p>\n
\u0110\u1ed1i v\u1edbi ung th\u01b0 d\u1ea1 d\u00e0y:<\/p>\n
C\u1ea7n l\u00e0m X quang d\u1ea1 d\u00e0y v\u00e0 n\u1ed9i soi tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao (tu\u1ed5i, ti\u1ec1n s\u1eed b\u1ec7nh vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y m\u1ea1n t\u00ednh).<\/p>\n
\u0110\u1ed1i v\u1edbi ung th\u01b0 h\u1eafc t\u1ed1:<\/p>\n
Bi\u1ec7n ph\u00e1p quan tr\u1ecdng l\u00e0 quan s\u00e1t b\u1eb1ng m\u1eaft v\u1edbi nh\u1eefng c\u00e1n b\u1ed9 y t\u1ebf \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n t\u1ed1t. Kh\u00e1m t\u1ef7 m\u1ec9.<\/p>\n","protected":false},"excerpt":{"rendered":"
C\u00e2u 1:T\u00ecnh h\u00ecnh d\u1ecbch t\u1ec5 h\u1ecdc ung th\u01b0 \u1edf Vi\u1ec7t Nam v\u00e0 tr\u00ean th\u1ebf gi\u1edbi 1. T\u1ec8 L\u1ec6 M\u1edaI M\u1eaeC \u0110\u01b0\u1ee3c t\u00ednh b\u1eb1ng s\u1ed1 ca m\u1edbi m\u1eafc trong qu\u1ea7n th\u1ec3 tr\u00ean 100.000 d\u00e2n t\u00ednh trong 1 n\u0103m, \u0111\u00e2y l\u00e0 c\u00e1ch t\u00ednh c\u00e1ch t\u1ed1t nh\u1ea5t c\u1ee7a t\u1ea7n xu\u1ea5t m\u1eafc ung th\u01b0 . Hi\u1ec7n nay tr\u00ean th\u1ebf …<\/p>\n","protected":false},"author":10,"featured_media":2136,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[72,73],"tags":[],"class_list":["post-2035","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-chuyen-khoa-le","category-ung-thu"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2035","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=2035"}],"version-history":[{"count":3,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2035\/revisions"}],"predecessor-version":[{"id":2319,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2035\/revisions\/2319"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/2136"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2035"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2035"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2035"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}