PH\u1ea6N H\u00c0NH CH\u00cdNH
\nH\u1ecc V\u00c0 T\u00caN B\u1ec6NH NH\u00c2N: NGUY\u1ec4N V\u0102N NG\u00c0 Tu\u1ed5i :36 Gi\u1edbi: Nam
\n\u0110\u1ecaA CH\u1ec8: R\u1ea1ch Gi\u00e1 \u2013 Ki\u00ean Giang
\nNG\u00c0Y NH\u1eacP VI\u1ec6N: 21\/2\/2006<\/p>\n
SV: H\u00c0 HU\u1ef2NH KIM Y\u1ebeN<\/p>\n
PH\u1ea6N CHUY\u00caN M\u00d4N
\nL\u00dd DO NH\u1eacP VI\u1ec6N : \u0110au b\u1ee5ng<\/p>\n
B\u1ec6NH S\u1eec
\nC\u00e1ch nh\u1eadp vi\u1ec7n 7 th\u00e1ng, b\u1ec7nh nh\u00e2n \u0111au \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb l\u1ec7ch ph\u1ea3i g\u1ea7n r\u1ed1n, c\u00f9ng kho\u1ea3ng th\u1eddi gian n\u00e0y, b\u1ec7nh nh\u00e2n s\u1edd th\u1ea5y 1 kh\u1ed1i u \u1edf v\u1ecb tr\u00ed \u0111au \u0111\u00e3 mi\u00eau t\u1ea3 \u1edf tr\u00ean. Sau \u0111\u00f3 2 th\u00e1ng, b\u1ec7nh nh\u00e2n b\u1eaft \u0111\u1ea7u \u0111au li\u00ean t\u1ee5c t\u1ea1i kh\u1ed1i u, \u0111au \u00e2m \u1ec9 c\u1ea3 ng\u00e0y v\u00e0 BN \u0111i ph\u00e2n l\u1ecfng ho\u00e0n to\u00e0n 1 l\u1ea7n\/ng\u00e0y. B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111i kh\u00e1m \u1edf B\u1ec7nh vi\u1ec7n H\u1eadu Giang nh\u01b0ng kh\u00f4ng ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c b\u1ec7nh n\u00ean l\u1ea1i v\u1ec1 nh\u00e0. V\u00e0i ng\u00e0y sau \u0111\u00f3, b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y \u0111au t\u0103ng l\u00ean, kh\u00f3 ch\u1ecbu kh\u00f4ng ng\u1ee7 \u0111\u01b0\u1ee3c n\u00ean \u0111i kh\u00e1m t\u1ea1i b\u1ec7nh vi\u1ec7n t\u01b0 \u1edf C\u1ea7n Th\u01a1. B\u1ec7nh vi\u1ec7n n\u00e0y ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh v\u1ec1 d\u1ea1 d\u00e0y. Kho\u1ea3ng n\u1eeda th\u00e1ng sau c\u01a1n \u0111au gi\u1ea3m d\u1ea7n tr\u1edf v\u1ec1 \u0111au \u00e2m \u1ec9 nh\u01b0 l\u00fac \u0111\u1ea7u. M\u1ed7i khi \u0111au \u0111\u01b0\u1ee3c v\u00e0i ph\u00fat khi b\u1ec7nh nh\u00e2n \u0111\u00e1nh h\u01a1i \u0111\u01b0\u1ee3c th\u00ec \u0111\u1ee1 \u0111au nh\u01b0ng sau \u0111\u00f3 l\u1ea1i \u0111au l\u1ea1i. BN th\u1ea5y \u0103n kh\u00f4ng ngon, m\u1ed7i khi ng\u1ed3i l\u00e2u \u0111\u1ee9ng d\u1eady th\u1ea5y t\u1ed1i s\u1ea7m m\u1eb7t kh\u00f4ng \u0111i \u0111\u01b0\u1ee3c ph\u1ea3i ng\u1ed3i xu\u1ed1ng ngh\u1ec9. C\u00e0ng ng\u00e0y s\u1ee9c kh\u1ecfe c\u00e0ng y\u1ebfu s\u1ee5t c\u00e2n 10 kg (trong 7 th\u00e1ng) n\u00ean BN l\u00ean Medic kh\u00e1m \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 c\u00f3 kh\u1ed1i u \u1edf \u0111\u1ea1i tr\u00e0ng.<\/p>\n
T\u00ecnh tr\u1ea1ng l\u00fac nh\u1eadp vi\u1ec7n:<\/p>\n
Th\u1ec3 tr\u1ea1ng g\u1ea7y
\nDa ni\u00eam nh\u1ea1t, k\u1ebft m\u1ea1c m\u1eaft kh\u00f4ng v\u00e0ng
\nC\u00f3 1 kh\u1ed1i u v\u00f9ng c\u1ea1nh r\u1ed1n P, d =6x9cm, \u1ea5n \u0111au
\nDHST: M\u1ea1ch: 90l\/ph Nhi\u1ec7t \u0111\u1ed9: 37oC
\nHA: 110\/70 mmHg Nh\u1ecbp th\u1edf: 20l\/ph
\nDi\u1ec5n ti\u1ebfn v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n \u0111\u1ebfn l\u00fac kh\u00e1m:
\nB\u1ec7nh nh\u00e2n v\u1eabn than \u0111au \u00e2m \u1ec9 v\u00f9ng c\u00f3 kh\u1ed1i u nh\u01b0ng \u0111\u1ee1 \u0111au h\u01a1n khi \u1edf nh\u00e0. V\u1eabn ti\u00eau l\u1ecfng, v\u1eabn \u0111\u00e1nh h\u01a1i \u0111\u01b0\u1ee3c.<\/p>\n
TI\u1ec0N C\u0102N:
\nB\u1ea3n th\u00e2n: Kh\u1ecfe
\nTh\u00f3i quen: Th\u1ec9nh tho\u1ea3ng c\u00f3 u\u1ed3ng r\u01b0\u1ee3u nh\u01b0ng kh\u00f4ng r\u00f5 l\u01b0\u1ee3ng
\nGia \u0111\u00ecnh: Ch\u01b0a ai c\u00f3 b\u1ec7nh l\u00fd li\u00ean quan (kh\u00f4ng ai b\u1ecb \u0111a polyp)<\/p>\n
KH\u00c1M L\u00c2M S\u00c0NG:
\nSinh hi\u1ec7u: M 80l\/ph. HA 120\/80mmHg. NT 20l\/ph. N\u0110 37oC
\n1. Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n:
\nT\u1ec9nh t\u00e1o, ti\u1ebfp x\u00fac t\u1ed1t.
\nTh\u1ec3 tr\u1ea1ng g\u1ea7y.
\nDa ni\u00eam nh\u1ea1t, m\u00f3ng tay m\u1ea5t b\u00f3ng.
\nDa kh\u00f4ng v\u00e0ng, k\u1ebft m\u1ea1c m\u1eaft kh\u00f4ng v\u00e0ng.
\nKh\u00f4ng ph\u00f9.
\n2. \u0110\u1ea7u m\u1eb7t c\u1ed5:
\nT\u0129nh m\u1ea1ch c\u1ed5 kh\u00f4ng n\u1ed5i \u1edf t\u01b0 th\u1ebf 45o
\nKh\u00f4ng s\u1edd th\u1ea5y h\u1ea1ch c\u1ed5.
\n3. H\u1ec7 h\u00f4 h\u1ea5p
\nL\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf. Kh\u00f4ng co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5.
\nPh\u1ed5i: Rung thanh \u0111\u1ec1u hai b\u00ean. R\u00ec r\u00e0o ph\u1ebf nang \u00eam d\u1ecbu, kh\u00f4ng rale b\u1ec7nh l\u00fd.
\n4. Tim m\u1ea1ch: T\u1ea7n s\u1ed1 80l\/ph; T1, T2 \u0111\u1ec1u r\u00f5. Kh\u00f4ng \u00e2m th\u1ed5i b\u1ec7nh l\u00fd.
\n5. H\u1ec7 ti\u00eau h\u00f3a:
\nB\u1ee5ng m\u1ec1m, kh\u00f4ng ch\u01b0\u1edbng di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf. Kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169.
\nC\u00f3 1 kh\u1ed1i u v\u00f9ng th\u01b0\u1ee3ng v\u1ecb l\u1ec7ch ph\u1ea3i g\u1ea7n r\u1ed1n, c\u00e1ch r\u1ed1n 2cm, d = 6x9cm, b\u1edd r\u00f5, m\u1eadt \u0111\u1ed9 ch\u1eafc, b\u1ec1 m\u1eb7t kh\u00f4ng tr\u01a1n l\u00e1ng, \u1ea5n \u0111au t\u1ee9c, kh\u00f4ng di \u0111\u1ed9ng.
\nKh\u00f4ng s\u1edd th\u1ea5y h\u1ea1ch \u1edf v\u00f9ng b\u1ee5ng
\nGan l\u00e1ch kh\u00f4ng s\u1edd ch\u1ea1m, chi\u1ec1u cao gan 11cm.
\nG\u00f5 trong, kh\u00f4ng \u0111\u1ee5c v\u00f9ng th\u1ea5p.
\nKh\u00f4ng nghe \u0111\u01b0\u1ee3c \u00e2m th\u1ed3i \u1edf kh\u1ed1i u.
\n6.Ti\u1ebft ni\u1ec7u:
\nC\u1ea7u b\u00e0ng quang(-). Ch\u1ea1m th\u1eadn (-). B\u1eadp b\u1ec1nh th\u1eadn (-).
\n7. H\u1ec7 sinh d\u1ee5c:
\nKh\u00f4ng s\u1edd th\u1ea5y h\u1ea1ch b\u1eb9n.
\n8. C\u01a1 quan kh\u00e1c: Ch\u01b0a ph\u00e1t hi\u1ec7n b\u1ec7nh l\u00fd.<\/p>\n
\u0110\u1eb6T V\u1ea4N \u0110\u1ec0:
\nB\u1ec7nh nh\u00e2n nam 36 tu\u1ed5i nh\u1eadp vi\u1ec7n v\u00ec \u0111au b\u1ee5ng.
\nB\u1ec7nh kh\u1edfi ph\u00e1t c\u00e1ch nh\u1eadp vi\u1ec7n 7 th\u00e1ng.
\nTri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:
\n7 th\u00e1ng \u0111au t\u1ea1i kh\u1ed1i u, \u0111au qu\u1eb7n t\u1eebng c\u01a1n chuy\u1ec3n sang \u0111au \u00e2m \u1ec9, \u0111au kh\u00f4ng li\u00ean quan \u0111\u1ebfn b\u1eefa \u0103n.
\n7 th\u00e1ng ti\u00eau ch\u1ea3y, ph\u00e2n l\u1ecfng kh\u00f4ng \u0111\u00e0m nh\u1edbt hay m\u1ee7 m\u00e1u, \u0111i 1 l\u1ea7n\/ng\u00e0y.
\nD\u1ea5u hi\u1ec7u b\u00e1n t\u1eafc ru\u1ed9t (d\u1ea5u Koenig): \u0111au qu\u1eb7n b\u1ee5ng, b\u1ee5ng n\u1ed5i g\u1ed3 (BN c\u1ea3m gi\u00e1c kh\u1ed1i u to l\u00ean r\u1ed3i x\u1eb9p xu\u1ed1ng m\u1ed7i khi \u0111au), trung ti\u1ec7n \u0111\u01b0\u1ee3c th\u00ec \u0111\u1ee1 \u0111au.<\/p>\n
\u0102n k\u00e9m ngon, s\u1ee5t c\u00e2n 10 kg trong 7 th\u00e1ng. X\u00e2y x\u1ea9m m\u1eb7t m\u00e0y.<\/p>\n
Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:
\nTh\u1ec3 tr\u1ea1ng g\u1ea7y.
\nDa ni\u00eam nh\u1ea1t, m\u00f3ng tay m\u1ea5t b\u00f3ng.
\nKh\u1ed1i u v\u00f9ng th\u01b0\u1ee3ng v\u1ecb l\u1ec7ch P g\u1ea7n r\u1ed1n c\u00e1ch r\u1ed1n 2 cm, d = 6x9cm, b\u1edd r\u00f5, m\u1eadt \u0111\u1ed9 ch\u1eafc, b\u1ec1 m\u1eb7t kh\u00f4ng tr\u01a1n l\u00e1ng, kh\u00f4ng di \u0111\u1ed9ng, \u1ea5n \u0111au t\u1ee9c.
\nKh\u00f4ng s\u1edd th\u1ea5y h\u1ea1ch ngo\u1ea1i vi v\u00e0 h\u1ea1ch v\u00f9ng b\u1ee5ng c\u0169ng nh\u01b0 h\u1ea1ch b\u1eb9n.
\nTi\u1ec1n c\u0103n: gia \u0111\u00ecnh kh\u00f4ng c\u00f3 ai b\u1ecb \u0111a polyp.<\/p>\n
BI\u1ec6N LU\u1eacN L\u00c2M S\u00c0NG:
\n_ B\u1ec7nh nh\u00e2n 7 th\u00e1ng nay \u0111i c\u1ea7u ph\u00e2n l\u1ecfng kh\u00f4ng c\u00f3 \u0111\u00e0m nh\u1edbt hay m\u1ee7 m\u00e1u. Th\u1ec3 tr\u1ea1ng m\u1ec7t m\u1ecfi, c\u00f3 d\u1ea5u hi\u1ec7u thi\u1ebfu m\u00e1u m\u1ea1n: da xanh ni\u00eam nh\u1ea1t m\u00f3ng tay m\u1ea5t b\u00f3ng, s\u1ee5t c\u00e2n, c\u00f3 d\u1ea5u hi\u1ec7u b\u00e1n t\u1eafc ru\u1ed9t (d\u1ea5u Koenig). G\u1ee3i \u00fd nhi\u1ec1u \u0111\u1ebfn u \u0111\u1ea1i tr\u00e0ng. Kh\u00e1m th\u1ea5y kh\u1ed1i u \u1edf b\u1ee5ng b\u00ean ph\u1ea3i nh\u01b0 \u0111\u00e3 m\u00f4 t\u1ea3 \u1edf tr\u00ean th\u00ec ngh\u1ec9 u n\u00e0y \u1edf \u0111\u1ea1i tr\u00e0ng l\u00ean ph\u00eda tr\u00ean hay \u1edf \u0111\u1ea1i tr\u00e0ng ngang. Kh\u1ea3 n\u0103ng l\u00e0 K cao nh\u1ea5t l\u00e0 b\u1ec7nh nh\u00e2n c\u00f2n tr\u1ebb tu\u1ed5i.
\n\u0110au li\u00ean t\u1ee5c ch\u1ed7 kh\u1ed1i u v\u00e0 khi kh\u00e1m \u1ea5n v\u00e0o \u0111\u00f3 BN \u0111au t\u1ee9c g\u1ee3i \u00fd c\u00f3 th\u1ec3 kh\u1ed1i u \u0111\u00e3 x\u00e2m l\u1ea5n ph\u00fac m\u1ea1c n\u00ean k\u00edch th\u00edch g\u00e2y \u0111au. Theo ph\u00e2n \u0111\u1ed9 TNM c\u00f3 th\u1ec3 l\u00e0 T3 hay T4 c\u1ea7n l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m CLS \u0111\u1ec3 t\u00ecm kh\u1ea3o s\u00e1t s\u1ef1 x\u00e2m l\u1ea5n c\u1ee7a kh\u1ed1i u. Kh\u00e1m ch\u01b0a ph\u00e1t hi\u1ec7n h\u1ea1ch di c\u0103n hay s\u1ef1 di c\u0103n xa. N\u00ean ngh\u0129 nhi\u1ec1u l\u00e0 giai \u0111o\u1ea1n II theo TNM. Ch\u01b0a c\u00f3 bi\u1ebfn ch\u1ee9ng nh\u01b0 t\u1eafc ru\u1ed9t do BN kh\u00f4ng n\u00f4n, kh\u00f4ng ch\u01b0\u1edbng, v\u1eabn trung v\u00e0 \u0111\u1ea1i ti\u1ec7n \u0111\u01b0\u1ee3c. Ch\u01b0a c\u00f3 r\u00f2 (u \u1edf \u0111\u1ea1i tr\u00e0ng ngang) v\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a do b\u1ec7nh nh\u00e2n kh\u00f4ng n\u00f4n ra th\u1ee9 gi\u1ed1ng ph\u00e2n hay n\u00f4n ra m\u00e1u, kh\u00f4ng \u0111i ph\u00e2n s\u1ed1ng, th\u1ec3 tr\u1ea1ng kh\u00f4ng suy s\u1ee5p nhanh.
\n_C\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi K hang v\u1ecb do BN c\u0169ng ch\u00e1n \u0103n th\u1ec3 tr\u1ea1ng g\u1ea7y s\u00fat v\u00e0 v\u1ecb tr\u00ed c\u0169ng nh\u01b0 t\u00ednh ch\u1ea5t kh\u1ed1i u c\u0169ng gi\u1ed1ng K hang v\u1ecb. Tuy nhi\u00ean K hang v\u1ecb th\u00ec kh\u00f4ng c\u00f3 b\u00e1n t\u1eafc ru\u1ed9t.
\n_\u00cdt ngh\u0129 \u0111\u1ebfn lao h\u1ed3i manh tr\u00e0ng do BN kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed lao, kh\u00f4ng s\u1ed1t v\u1ec1 chi\u1ec1u.<\/p>\n
CH\u1ea8N \u0110O\u00c1N L\u00c2M S\u00c0NG
\nUng th\u01b0 \u0111\u1ea1i tr\u00e0ng ngang giai \u0111o\u1ea1n II theo TNM ch\u01b0a bi\u1ebfn ch\u1ee9ng.<\/p>\n
CH\u1ea8N \u0110O\u00c1N PH\u00c2N BI\u1ec6T
\n1. Ung th\u01b0 \u0111\u1ea1i tr\u00e0ng ph\u1ea3i giai \u0111o\u1ea1n II ch\u01b0a bi\u1ebfn ch\u1ee9ng
\n2. Ung th\u01b0 hang v\u1ecb
\n3. Lao h\u1ed3i manh tr\u00e0ng<\/p>\n
C\u1eacN L\u00c2M S\u00c0NG
\nC\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e3 c\u00f3:
\n1.CTM:
\nWBC: 13,7 K\/ul<\/p>\n
Neutrophil :10,3 K\/ul
\nRBC: 3,75 M\/ul
\nHb: 7,8 g\/dl
\nHct: 25,1 %
\nMCV: 66,7 fL<\/p>\n
MCHC: 31 g\/dl
\nMCH: 20,7 pg
\nMCHC: 31 g\/dl
\nPlt: 677 K\/ul
\nFibrinogen: 414mg\/dl
\n2. H\u00f3a sinh:
\nGlucose : 5mmol\/l
\nUre : 4,9mmol\/l
\nCreatinin: 66mmol\/l
\nProtid TP : 76g\/l
\nC\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c:
\n1. 13\/2 S\u00c2 : v\u00f9ng \u00bd ph\u1ea3i b\u1ee5ng tr\u01b0\u1edbc c\u01a1 psoas l\u00ean \u0111\u1ebfn d\u01b0\u1edbi gan c\u00f3 1 kh\u1ed1i \u0111\u1eb7c echo k\u00e9m, c\u00f3 v\u00f4i h\u00f3a nh\u1ecf, gi\u1edbi h\u1ea1n r\u00f5 b\u1edd kh\u00f4ng \u0111\u1ec1u d =122x66mm c\u00f3 \u00edt m\u1ea1ch m\u00e1u, k\u00e9m di \u0111\u1ed9ng.
\nKL: kh\u1ed1i u \u00bd b\u1ee5ng b\u00ean ph\u1ea3i ngh\u0129 b\u01b0\u1edbu sau ph\u00fac m\u1ea1c.
\n2. CT-Scan: h\u00ecnh \u1ea3nh c\u00e1c quai ru\u1ed9t non n\u1eb1m b\u00ean tr\u00e1i, khung \u0111\u1ea1i tr\u00e0ng n\u1eb1m b\u00ean ph\u1ea3i, th\u01b0\u01a1ng t\u1ed5n d\u00e0y v\u00e1ch \u0111\u1ea1i tr\u00e0ng v\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, v\u00e1ch d\u00e0y kh\u00f4ng \u0111\u1ec1u t\u1ea1o mass k\u00edch th\u01b0\u1edbc 10x7cm. Th\u01b0\u01a1ng t\u1ed5n b\u1eaft thu\u1ed1c c\u1ea3n quang kh\u00f4ng \u0111\u1ed1ng nh\u1ea5t c\u00f3 d\u00ednh xung quanh. Kh\u00f4ng h\u1ea1ch v\u00f9ng kh\u1ea3o s\u00e1t, kh\u00f4ng d\u1ecbch t\u1ef1 do.
\nKL: U \u0111\u1ea1i tr\u00e0ng t\u1ea1o mass k\u00edch th\u01b0\u1edbc 10x7cm v\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i c\u00f3 d\u00ednh xung quanh\/ru\u1ed9t xoay b\u1ea5t to\u00e0n.
\n3. 14\/2 N\u1ed9i soi: \u0111\u1ea1i tr\u00e0ng g\u00f3c gan c\u00f3 sang th\u01b0\u01a1ng b\u01b0\u1edbu ch\u1ed1i s\u00f9i to, x\u00e2m l\u1ea5n h\u1eb9p l\u00f2ng \u0111\u1ea1i tr\u00e0ng =>sinh thi\u1ebft.
\nKL: theo d\u00f5i K \u0111\u1ea1i tr\u00e0ng g\u00f3c gan \u0111\u1ecdan tr\u01b0\u1edbc b\u01b0\u1edbu b\u00ecnh th\u01b0\u1eddng.
\nC\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e3 c\u00f3 \u1edf c\u00e1c b\u1ec7nh vi\u1ec7n t\u1ec9nh:
\nNg\u00e0y 27\/9\/2005 Si\u00eau \u00e2m t\u1ea1i BV H\u1eadu Giang:
\nV\u00f9ng th\u01b0\u1ee3ng v\u1ecb l\u1ec7ch ph\u1ea3i c\u00f3 focal echo d\u00e0y kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t d=55,4\u00d733,9mm. Theo d\u00f5i u d\u1ea1 d\u00e0y
\nNg\u00e0y 1\/10\/2005 N\u1ed9i soi:
\nVi\u00eam ph\u00f9 n\u1ec1 hang v\u1ecb.
\n\u0110\u1ec1 ngh\u1ecb CLS:<\/p>\n
X-quang ph\u1ed5i t\u00ecm di c\u0103n ph\u1ed5i
\nUIV tim di c\u0103n \u0111\u01b0\u1eddng ni\u1ec7u
\nSi\u00eau \u00e2m b\u1ee5ng \u0111\u00e1nh gi\u00e1 s\u1ef1 ch\u00e8n \u00e9p 2 th\u1eadn
\nTh\u1ee7 thu\u1eadt:
\nGPB: C\u00e1c t\u1ebf b\u00e0o d\u1ecb d\u1ea1ng, nh\u00e2n qu\u00e1i, nh\u00e2n t\u0103ng s\u1eafc. C\u00e1c t\u1ebf b\u00e0o h\u1ee3p th\u00e0nh d\u1ea1ng \u1ed1ng tuy\u1ebfn kh\u00f4ng r\u00f5 r\u1ec7t, x\u00e2m nh\u1eadp. M\u00f4 \u0111\u1ec7m c\u00f3 ph\u1ea3n \u1ee9ng vi\u00eam.
\nCarcinoma tuy\u1ebfn, bi\u1ec7t h\u00f3a v\u1eeba x\u00e2m nh\u1eadp c\u1ee7a \u0111\u1ea1i tr\u00e0ng.<\/p>\n
BI\u1ec6N LU\u1eacN CH\u1ea8N \u0110O\u00c1N (L\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng)
\n_ CTM th\u1ea5y BC t\u0103ng cao ch\u1ee9ng t\u1ecf c\u00f3 nhi\u1ec5m tr\u00f9ng m\u00e0 tr\u00ean l\u00e2m kh\u00f4ng ghi nh\u1eadn c\u00f3 s\u1ef1 nhi\u1ec5m tr\u00f9ng n\u00e0o n\u00ean c\u00f3 th\u1ec3 nh\u1edd GPB gi\u1ea3i th\u00edch ph\u1ea3n \u1ee9ng vi\u00eam t\u1ea1i kh\u1ed1i u.
\n_ HC, Hb, Hct, MCV, MCH \u0111\u1ec1u gi\u1ea3m => thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u nh\u1ecf nh\u01b0\u1ee3c s\u1eafc cho th\u1ea5y c\u00f3 t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u m\u1ea1n, ph\u00f9 h\u1ee3p v\u1edbi l\u00e2m s\u00e0ng.
\n_CT-Scan cho th\u1ea5y u \u0111\u1ea1i tr\u00e0ng ch\u01b0a di c\u0103n h\u1ea1ch v\u00e0 c\u00f3 s\u1ef1 x\u00e2m l\u1ea5n xung quanh ph\u00f9 h\u1ee3p bi\u1ec7n lu\u1eadn LS l\u00e0 ch\u01b0a c\u00f3 di c\u0103n h\u1ea1ch v\u00e0 c\u00f3 x\u00e2m l\u1ea5n.
\n_N\u1ed9i soi v\u00e0 sinh thi\u1ebft cho th\u1ea5y \u0111\u00e2y l\u00e0 K \u0111\u1ea1i tr\u00e0ng g\u00f3c gan v\u00e0 ch\u01b0a th\u1ea5y di c\u0103n.
\n_Nh\u01b0ng n\u00ean \u0111\u1ec1 ngh\u1ecb CLS kh\u00e1c nh\u01b0 \u0111\u00e3 \u0111\u1ec1 ngh\u1ecb \u1edf tr\u00ean \u0111\u1ec3 t\u00ecm di c\u0103n \u1edf h\u1ec7 ni\u1ec7u, ph\u1ed5i.<\/p>\n
CH\u1ea8N \u0110O\u00c1N SAU C\u00d9NG C\u1ee6A PH\u1ea6N KH\u00c1M TR\u01af\u1edaC M\u1ed4 :
\nUng th\u01b0 \u0111\u1ea1i tr\u00e0ng g\u00f3c gan giai \u0111o\u1ea1n II ch\u01b0a bi\u1ebfn ch\u1ee9ng.<\/p>\n","protected":false},"excerpt":{"rendered":"
PH\u1ea6N H\u00c0NH CH\u00cdNH H\u1ecc V\u00c0 T\u00caN B\u1ec6NH NH\u00c2N: NGUY\u1ec4N V\u0102N NG\u00c0 Tu\u1ed5i :36 Gi\u1edbi: Nam \u0110\u1ecaA CH\u1ec8: R\u1ea1ch Gi\u00e1 \u2013 Ki\u00ean Giang NG\u00c0Y NH\u1eacP VI\u1ec6N: 21\/2\/2006 SV: H\u00c0 HU\u1ef2NH KIM Y\u1ebeN PH\u1ea6N CHUY\u00caN M\u00d4N L\u00dd DO NH\u1eacP VI\u1ec6N : \u0110au b\u1ee5ng B\u1ec6NH S\u1eec C\u00e1ch nh\u1eadp vi\u1ec7n 7 th\u00e1ng, b\u1ec7nh nh\u00e2n \u0111au \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb …<\/p>\n","protected":false},"author":10,"featured_media":4495,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[72,73],"tags":[],"class_list":["post-2044","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\/2044","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=2044"}],"version-history":[{"count":2,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2044\/revisions"}],"predecessor-version":[{"id":4519,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2044\/revisions\/4519"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/4495"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2044"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2044"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2044"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}