C\u00e2u 1:\u00a0K\u1ef9 thu\u1eadt kh\u00e2u n\u1ed1i \u1ed1ng ti\u00eau h\u00f3a?<\/b><\/p>\n
1. C\u00e1c \u0111i\u1ec1u ki\u1ec7n c\u1ea7n c\u00f3 c\u1ee7a 1 \u0111\u01b0\u1eddng kh\u00e2u t\u1ed1t<\/b><\/p>\n
1) \u0110\u01b0\u1eddng kh\u00e2u ph\u1ea3i k\u00edn, trung b\u00ecnh 1 cm 3 m\u0169i<\/p>\n
2) \u0110\u01b0\u1eddng kh\u00e2u ph\u1ea3i ch\u1eafc, kh\u00f4ng b\u1ecb b\u1ee5c ch\u1ec9<\/p>\n
Ph\u1ee5 thu\u1ed9c v\u00e0o:<\/p>\n
– T\u00ecnh tr\u1ea1ng nu\u00f4i d\u01b0\u1ee1ng \u1edf th\u00e0nh ru\u1ed9t<\/p>\n
– T\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng c\u1ee7a ph\u1eabu thu\u1eadt<\/p>\n
– K\u1ef9 thu\u1eadt kh\u00e2u c\u1ee7a ph\u1eabu thu\u1eadt vi\u00ean v\u00e0 kim ch\u1ec9 s\u1eed d\u1ee5ng<\/p>\n
2. C\u00e1c ki\u1ec3u kh\u00e2u<\/b><\/p>\n
Kh\u00e2u v\u1eaft<\/p>\n
Kh\u00e2u m\u0169i r\u1eddi<\/p>\n
\u01afu \u0111i\u1ec3m<\/p>\n
Nhanh, k\u00edn, \u00e1p l\u1ef1c d\u00e0n \u0111\u1ec1u tr\u00ean \u0111\u01b0\u1eddng kh\u00e2u<\/p>\n
– \u00cdt g\u00e2y ph\u00f9 n\u1ec1<\/p>\n
– Kh\u00f4ng l\u00e0m h\u1eb9p kh\u1ea9u k\u00ednh. D\u1ec5 kh\u00e2u d\u00f9 kh\u1ea9u k\u00ednh kh\u00e1c nhau<\/p>\n
– \u0110\u01b0\u1eddng kh\u00e2u m\u1ec1m m\u1ea1i, co gi\u00e3n d\u1ec5 d\u00e0ng<\/p>\n
– Kh\u00e2u \u0111\u01b0\u1ee3c \u1edf ph\u1eabu tr\u01b0\u1eddng h\u1eb9p v\u00e0 s\u00e2u<\/p>\n
Nh\u01b0\u1ee3c \u0111i\u1ec3m<\/p>\n
– D\u1ec5 g\u00e2y ph\u00f9 n\u1ec1<\/p>\n
– D\u1ec5 l\u00e0m h\u1eb9p kh\u1ea9u k\u00ednh<\/p>\n
– Ch\u1eb7t qu\u00e1 g\u00e2y ho\u1ea1i t\u1eed, l\u1ecfng qu\u00e1 g\u00e2y ch\u1ea3y m\u00e1u<\/p>\n
M\u1ea5t nhi\u1ec1u th\u1eddi gian, \u00e1p l\u1ef1c kh\u00f4ng d\u00e0n \u0111\u1ec1u<\/p>\n
3. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e2u n\u1ed1i \u1ed1ng ti\u00eau h\u00f3a<\/b><\/p>\n
1) Ph\u01b0\u01a1ng ph\u00e1p kh\u00e2u m\u1ed9t l\u1edbp: l\u00e0 1 l\u1ea7n kh\u00e2u<\/p>\n
– Kh\u00e2u c\u1ea7m m\u00e1u tr\u01b0\u1edbc b\u1eb1ng c\u00e1c m\u0169i ch\u1eef X<\/p>\n
– Kh\u00e2u m\u0169i r\u1eddi<\/p>\n
– Kh\u00e2u l\u1edbp c\u01a1 v\u00e0 l\u1edbp d\u01b0\u1edbi ni\u00eam m\u1ea1c<\/p>\n
– Ni\u00eam m\u1ea1c l\u1ed9n v\u00e0o trong<\/p>\n
2) Ph\u01b0\u01a1ng ph\u00e1p kh\u00e2u hai l\u1edbp: l\u00e0 2 l\u1ea7n kh\u00e2u<\/p>\n
– L\u1edbp m\u1ed9t: kh\u00e2u to\u00e0n th\u1ec3, xuy\u00ean qua 4 l\u1edbp c\u1ee7a \u1ed1ng ti\u00eau h\u00f3a: c\u00f3 t\u00e1c d\u1ee5ng n\u1ed1i li\u1ec1n 2 m\u00e9p v\u00e0 c\u1ea7m m\u00e1u<\/p>\n
– L\u1edbp hai: kh\u00e2u thanh c\u01a1: c\u00f3 t\u00e1c d\u1ee5ng v\u00f9i l\u1edbp kh\u00e2u to\u00e0n th\u1ec3<\/p>\n
\u01afu \u0111i\u1ec3m: nhanh (n\u1ebfu l\u00e0 kh\u00e2u v\u1eaft), k\u00edn, ko \u0111\u00f2i h\u1ecfi nhi\u1ec1u v\u1ec1 k\u1ef9 thu\u1eadt<\/p>\n
Nh\u01b0\u1ee3c \u0111i\u1ec3m:<\/p>\n
+ D\u1ec5 g\u00e2y ph\u00f9 n\u1ec1<\/p>\n
+ D\u1ec5 l\u00e0m h\u1eb9p kh\u1ea9u k\u00ednh<\/p>\n
+ D\u1ec5 nhi\u1ec5m tr\u00f9ng \u1edf khe gi\u1eefa 2 \u0111\u01b0\u1eddng kh\u00e2u<\/p>\n
C\u00e2u 2:\u00a0C\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e2u n\u1ed1i ru\u1ed9t?<\/b><\/p>\n
1. C\u1eaft b\u1ecf m\u1ed9t \u0111o\u1ea1n ru\u1ed9t<\/b><\/p>\n
– Ch\u1ec9 \u0111\u1ecbnh:<\/p>\n
+ C\u00e1c v\u1ebft r\u00e1ch ngang ho\u1eb7c d\u1ecdc qu\u00e1 to kh\u00f4ng kh\u00e2u \u0111\u01b0\u1ee3c<\/p>\n
+ Nhi\u1ec1u v\u1ebft th\u01b0\u01a1ng li\u1ec1n nhau tr\u00ean c\u00f9ng 1 \u0111o\u1ea1n ru\u1ed9t<\/p>\n
+ T\u1ed5n th\u01b0\u01a1ng \u0110M m\u1ea1c treo d\u1eabn \u0111\u1ebfn ho\u1ea1i t\u1eed ho\u1eb7c thi\u1ec3u d\u01b0\u1ee1ng ru\u1ed9t<\/p>\n
+ C\u00e1c lo\u1ea1i u \u1edf ru\u1ed9t ho\u1eb7c m\u1ea1c treo c\u00f3 li\u00ean quan \u0111\u1ebfn ru\u1ed9t<\/p>\n
– K\u1ef9 thu\u1eadt:<\/p>\n
1) D\u00f9ng 2 clamp k\u1eb9p vu\u00f4ng g\u00f3c v\u1edbi tr\u1ee5c c\u1ee7a ru\u1ed9t<\/p>\n
2) C\u1eaft m\u1ea1c treo ru\u1ed9t:<\/p>\n
+ C\u1eaft 1 \u0111o\u1ea1n ru\u1ed9t ng\u1eafn th\u00ec c\u1eaft m\u1ea1c treo theo b\u1edd c\u1ee7a ru\u1ed9t<\/p>\n
+ C\u1eaft 1 \u0111o\u1ea1n ru\u1ed9t d\u00e0i th\u00ec c\u1eaft m\u1ea1c treo theo h\u00ecnh tam gi\u00e1c (\u0111\u1ec9nh v\u1ec1 ph\u00eda m\u1ea1c treo, \u0111\u00e1y v\u1ec1 ph\u00eda b\u1edd c\u1ee7a ru\u1ed9t)<\/p>\n
2. N\u1ed1i ru\u1ed9t t\u1eadn \u2013 t\u1eadn<\/b><\/p>\n
– L\u00e0 n\u1ed1i 2 m\u1eb7t t\u1eadn v\u1edbi nhau:<\/p>\n
1) D\u00f9ng 2 clamp k\u1eb9p ru\u1ed9t song song v\u1edbi nhau<\/p>\n
2) Kh\u00e2u 2 m\u0169i \u1edf 2 \u0111\u1ea7u l\u00e0m c\u01a1 s\u1edf<\/p>\n
3) Kh\u00e2u m\u00e9p sau tr\u01b0\u1edbc b\u1eb1ng c\u00e1c m\u0169i ch\u1ec9 r\u1eddi<\/p>\n
4) C\u1eaft ch\u1ec9 m\u00e9p sau, ti\u1ebfp t\u1ee5c kh\u00e2u m\u00e9p tr\u01b0\u1edbc<\/p>\n
– \u01afu \u0111i\u1ec3m: \u0111\u01b0\u1eddng \u0111i h\u1ee3p sinh l\u00fd<\/p>\n
– Nh\u01b0\u1ee3c \u0111i\u1ec3m: kh\u1ea9u k\u00ednh c\u1ee7a ru\u1ed9t ph\u1ea3i b\u1eb1ng nhau<\/p>\n
– Ch\u00fa \u00fd: kh\u00f4ng l\u00e0m h\u1eb9p kh\u1ea9u k\u00ednh c\u1ee7a ru\u1ed9t<\/p>\n
3. N\u1ed1i ru\u1ed9t b\u00ean \u2013 b\u00ean<\/b><\/p>\n
– L\u00e0 n\u1ed1i 2 m\u1eb7t b\u00ean v\u1edbi nhau, m\u1edf 1 l\u1ed7 th\u00f4ng \u1edf 2 b\u1edd t\u1ef1 do c\u1ee7a ru\u1ed9t<\/p>\n
– Nh\u01b0 n\u1ed1i:<\/p>\n
+ D\u1ea1 d\u00e0y \u2013 h\u1ed7ng tr\u00e0ng<\/p>\n
+ H\u1ed7ng tr\u00e0ng \u2013 h\u1ed3i tr\u00e0ng<\/p>\n
+ H\u1ed3i tr\u00e0ng \u2013 \u0111\u1ea1i tr\u00e0ng<\/p>\n
– \u01afu \u0111i\u1ec3m:<\/p>\n
+ Kh\u1ea9u k\u00ednh c\u1ee7a ru\u1ed9t c\u00f3 th\u1ec3 kh\u00e1c nhau<\/p>\n
+ \u0110\u1ed9 r\u1ed9ng c\u1ee7a mi\u1ec7ng n\u1ed1i t\u00f9y \u00fd<\/p>\n
+ Th\u1ee7 thu\u1eadt \u0111\u01a1n gi\u1ea3n, d\u1ec5 th\u1ef1c hi\u1ec7n<\/p>\n
– Nh\u01b0\u1ee3c \u0111i\u1ec3m: \u0111\u01b0\u1eddng \u0111i kh\u00f4ng sinh l\u00fd, d\u1ec5 t\u1ea1o th\u00e0nh t\u00fai c\u00f9ng, ph\u1ea3i \u0111\u00f3ng 2 \u0111\u1ea7u ru\u1ed9t<\/p>\n
K\u1ef9 thu\u1eadt \u0111\u00f3ng \u0111\u1ea7u ru\u1ed9t tr\u00ean k\u1eb9p nghi\u1ec1n Mayo:<\/i><\/p>\n
D\u00f9ng k\u1eb9p n\u00e0y k\u1eb9p ru\u1ed9t, c\u1eaft \u0111\u1ea7u ru\u1ed9t s\u00e1t v\u1edbi k\u1eb9p nghi\u1ec1n, l\u00e0m 1 \u0111\u01b0\u1eddng kh\u00e2u v\u1eaft tr\u00ean k\u1eb9p nghi\u1ec1n, bu\u1ed9c ch\u1ec9, l\u00e0m 1 m\u0169i kh\u00e2u h\u00ecnh t\u00fai v\u00f9i \u0111\u01b0\u1eddng kh\u00e2u tr\u00ean<\/p>\n
4. N\u1ed1i ru\u1ed9t t\u1eadn \u2013 b\u00ean:\u00a0<\/b>l\u00e0 n\u1ed1i m\u1eb7t t\u1eadn v\u1edbi m\u1eb7t b\u00ean, ph\u1ea3i \u0111\u00f3ng 1 \u0111\u1ea7u ru\u1ed9t<\/p>\n
C\u00e2u 3:\u00a0K\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt tho\u00e1t v\u1ecb b\u1eb9n?<\/b><\/p>\n
1. C\u00e1c th\u00ec k\u1ef9 thu\u1eadt<\/b><\/p>\n
– Th\u00ec 1:<\/p>\n
+ R\u1ea1ch da d\u00e0i 10 cm b\u1eaft \u0111\u1ea7u t\u1eeb gai mu theo \u0111\u01b0\u1eddng ph\u00e2n gi\u00e1c t\u1ea1o b\u1edfi b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng to v\u00e0 cung \u0111\u00f9i<\/p>\n
+ R\u1ea1ch c\u01a1 ch\u00e9o l\u1edbn, d\u00f9ng kocher k\u1eb9p v\u00e0o 2 m\u00e9p k\u00e9o ra 2 ph\u00eda<\/p>\n
– Th\u00ec 2: t\u00ecm v\u00e0 r\u1ea1ch bao tho\u00e1t v\u1ecb<\/p>\n
+ D\u00f9ng farabeuf k\u00e9o g\u00e2n k\u1ebft h\u1ee3p l\u00ean tr\u00ean, th\u1ea5y bao x\u01a1 chung xu\u1ea5t hi\u1ec7n, r\u1ea1ch bao x\u01a1 chung, l\u00e0m n\u1ebfp ph\u00fac m\u1ea1c \u0111\u1ec3 m\u1edf bao tho\u00e1t v\u1ecb cho \u0111\u1ebfn c\u1ed5 bao, \u0111\u1ea9y ru\u1ed9t v\u00e0 m\u1ea1c n\u1ed1i (n\u1ebfu c\u00f3) v\u00e0o trong \u1ed5 b\u1ee5ng, qua l\u1ed7 tho\u00e1t v\u1ecb \u0111\u1eb7t 1 metcher \u0111\u1ec3 kh\u00f4ng cho ru\u1ed9t r\u01a1i xu\u1ed1ng<\/p>\n
+ T\u00e1ch bao tho\u00e1t v\u1ecb kh\u1ecfi bao x\u01a1 chung b\u1eb1ng c\u00e1ch d\u00f9ng ng\u00f3n tr\u1ecf c\u1ee7a b\u00e0n tay tr\u00e1i cho v\u00e0o \u0111\u00e1y c\u1ee7a bao tho\u00e1t v\u1ecb, ng\u00f3n tr\u1ecf c\u1ee7a b\u00e0n tay ph\u1ea3i qu\u1ea5n g\u1ea1c \u0111\u1ea9y bao tho\u00e1t v\u1ecb t\u00e1ch kh\u1ecfi bao x\u01a1 chung v\u00e0 c\u00e1c th\u00e0nh ph\u1ea7n trong bao x\u01a1 chung. Ch\u00fa \u00fd: kh\u00f4ng l\u00e0m t\u1ed5n th\u01b0\u01a1ng c\u00e1c th\u00e0nh ph\u1ea7n trong bao x\u01a1 chung, t\u0129nh m\u1ea1ch th\u1eebng tinh<\/p>\n
– Th\u00ec 3: th\u1eaft v\u00e0 c\u1eaft bao tho\u00e1t v\u1ecb<\/p>\n
D\u00f9ng 1 s\u1ee3i ch\u1ec9 th\u1eaft bao tho\u00e1t v\u1ecb ngay l\u1ed7 b\u1eb9n trong v\u00e0 c\u1eaft bao tho\u00e1t v\u1ecb \u1edf ph\u00eda d\u01b0\u1edbi ho\u1eb7c treo c\u1ed5 bao tho\u00e1t v\u1ecb v\u00e0o g\u00e2n k\u1ebft h\u1ee3p<\/p>\n
– Th\u00ec 4: kh\u00e2u ph\u1ee5c h\u1ed3i th\u00e0nh b\u1ee5ng<\/p>\n
Theo 2 ph\u01b0\u01a1ng ph\u00e1p: tr\u01b0\u1edbc th\u1eebng tinh v\u00e0 sau th\u1eebng tinh, ch\u1ee7 y\u1ebfu l\u00e0 kh\u00e2u g\u00e2n k\u1ebft h\u1ee3p v\u1edbi cung \u0111\u00f9i<\/p>\n
+ PP kh\u00e2u tr\u01b0\u1edbc th\u1eebng tinh: kh\u00e2u b\u00ecnh di\u1ec7n b\u1edd sau c\u1ee7a cung \u0111\u00f9i v\u1edbi g\u00e2n k\u1ebft h\u1ee3p (\u0111\u00e2y l\u00e0 th\u00ec quan tr\u1ecdng, kh\u00e2u m\u0169i r\u1eddi), sau \u0111\u00f3 kh\u00e2u b\u00ecnh di\u1ec7n th\u1ee9 2 (c\u01a1 ch\u00e9o l\u1edbn v\u1edbi c\u01a1 ch\u00e9o l\u1edbn)<\/p>\n
+ PP kh\u00e2u sau th\u1eebng tinh (PP Bassini): d\u00f9ng farabeuf k\u00e9o nh\u1eb9 th\u1eebng tinh ra tr\u01b0\u1edbc, lu\u1ed3n ch\u1ec9 kh\u00e2u cung \u0111\u00f9i v\u1edbi g\u00e2n k\u1ebft h\u1ee3p, sau \u0111\u00f3 kh\u00e2u b\u00ecnh di\u1ec7n th\u1ee9 2 (c\u01a1 ch\u00e9o l\u1edbn v\u1edbi c\u01a1 ch\u00e9o l\u1edbn)<\/p>\n
2. \u0110\u1ed1i v\u1edbi tho\u00e1t v\u1ecb b\u1eb9n b\u1ea9m sinh<\/b><\/p>\n
C\u00e1c th\u00ec k\u1ef9 thu\u1eadt gi\u1ed1ng nh\u01b0 tr\u00ean, ch\u1ec9 c\u1ea7n kh\u00e2u c\u1ed5 bao tho\u00e1t v\u1ecb ho\u1eb7c l\u1ed9n 2 m\u00e9p bao tho\u00e1t v\u1ecb \u1edf g\u1ea7n c\u1ed5<\/p>\n
3. \u0110\u1ed1i v\u1edbi tho\u00e1t v\u1ecb b\u1eb9n ngh\u1eb9t<\/b><\/p>\n
1) R\u1ea1ch da, c\u01a1 v\u00e0 bao x\u01a1 chung nh\u01b0 tr\u00ean<\/p>\n
2) L\u00e0m n\u1ebfp ph\u00fac m\u1ea1c \u0111\u1ec3 m\u1edf bao tho\u00e1t v\u1ecb (ch\u00fa \u00fd ko l\u00e0m t\u1ed5n th\u01b0\u01a1ng c\u00e1c quai ru\u1ed9t v\u00ec c\u00f3 d\u1ecbch xu\u1ea5t ti\u1ebft)<\/p>\n
3) D\u00f9ng ng\u00f3n 1, 2, 3 c\u1ee7a b\u00e0n tay tr\u00e1i (c\u00f3 \u0111\u1ec7m g\u1ea1c) gi\u1eef to\u00e0n b\u1ed9 th\u00e0nh ph\u1ea7n tho\u00e1t v\u1ecb, tay ph\u1ea3i d\u00f9ng dao l\u1eadt ng\u1eeda l\u00ean tr\u00ean, c\u1eaft v\u00f2ng x\u01a1 c\u1ed5 bao tho\u00e1t v\u1ecb<\/p>\n
4) Ki\u1ec3m tra to\u00e0n b\u1ed9 th\u00e0nh ph\u1ea7n trong bao tho\u00e1t v\u1ecb, n\u1ebfu c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u00ec x\u1eed tr\u00ed<\/p>\n
5) C\u00e1c th\u00ec kh\u00e1c t\u01b0\u01a1ng t\u1ef1<\/p>\n
4. Tai bi\u1ebfn<\/b><\/p>\n
– T\u1ed5n th\u01b0\u01a1ng \u0110M \u0111\u00f9i<\/p>\n
– T\u1ed5n th\u01b0\u01a1ng th\u1eebng tinh<\/p>\n
– R\u1ea1ch v\u00e0o ru\u1ed9t trong khi m\u1edf bao tho\u00e1t v\u1ecb<\/p>\n
– T\u1ee5 m\u00e1u sau m\u1ed5<\/p>\n
– Nhi\u1ec5m tr\u00f9ng<\/p>\n
C\u00e2u 4:\u00a0K\u1ef9 thu\u1eadt n\u1ed1i d\u1ea1 d\u00e0y \u2013 h\u1ed7ng tr\u00e0ng?<\/b><\/p>\n
– C\u00f3 4 ki\u1ec3u n\u1ed1i:<\/p>\n
+ N\u1ed1i d\u1ea1 d\u00e0y \u2013 h\u1ed7ng tr\u00e0ng xuy\u00ean qua m\u1ea1c treo \u0110TN v\u00e0o m\u1eb7t sau d\u1ea1 d\u00e0y<\/p>\n
+ N\u1ed1i d\u1ea1 d\u00e0y \u2013 h\u1ed7ng tr\u00e0ng xuy\u00ean qua m\u1ea1c treo \u0110TN v\u00e0o m\u1eb7t tr\u01b0\u1edbc d\u1ea1 d\u00e0y<\/p>\n
+ N\u1ed1i d\u1ea1 d\u00e0y \u2013 h\u1ed7ng tr\u00e0ng qua m\u1eb7t tr\u01b0\u1edbc \u0110TN v\u00e0o m\u1eb7t sau d\u1ea1 d\u00e0y<\/p>\n
+ N\u1ed1i d\u1ea1 d\u00e0y \u2013 h\u1ed7ng tr\u00e0ng qua m\u1eb7t tr\u01b0\u1edbc \u0110TN v\u00e0o m\u1eb7t tr\u01b0\u1edbc d\u1ea1 d\u00e0y<\/p>\n
– Mu\u1ed1n \u0111\u1ea3m b\u1ea3o s\u1ef1 l\u01b0u th\u00f4ng t\u1ed1t t\u1eeb d\u1ea1 d\u00e0y qua h\u1ed7ng tr\u00e0ng c\u1ea7n ch\u00fa \u00fd:<\/p>\n
+ \u0110o\u1ea1n h\u1ed7ng tr\u00e0ng \u0111\u1ecbnh n\u1ed1i ph\u1ea3i ng\u1eafn nh\u1ea5t, tr\u1ef1c ti\u1ebfp v\u00e0 g\u1ea7n d\u1ea1 d\u00e0y nh\u1ea5t<\/p>\n
+ Mi\u1ec7ng n\u1ed1i ph\u1ea3i \u1edf n\u01a1i th\u1ea5p nh\u1ea5t c\u1ee7a d\u1ea1 d\u00e0y<\/p>\n
+ L\u01b0u th\u00f4ng c\u1ee7a t\u00e1 tr\u00e0ng ph\u1ea3i qua \u0111\u01b0\u1ee3c d\u1ea1 d\u00e0y \u0111\u1ec3 trung h\u00f2a d\u1ecbch v\u1ecb \u1edf d\u1ea1 d\u00e0y<\/p>\n
1. Ch\u1ec9 \u0111\u1ecbnh<\/b><\/p>\n
1) H\u1eb9p m\u00f4n v\u1ecb do ung th\u01b0<\/p>\n
2) H\u1eb9p m\u00f4n v\u1ecb do lo\u00e9t m\u00e0 t\u00ecnh tr\u1ea1ng to\u00e0n th\u00e2n ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng t\u1ea1i ch\u1ed7 kh\u00f4ng cho ph\u00e9p c\u1eaft d\u1ea1 d\u00e0y an to\u00e0n<\/p>\n
3) C\u1eaft d\u00e2y th\u1ea7n kinh X m\u00e0 kh\u00f4ng t\u1ea1o h\u00ecnh m\u00f4n v\u1ecb \u0111\u01b0\u1ee3c<\/p>\n
4) Kh\u00e2u l\u1ed7 th\u1ee7ng g\u00e2y ch\u00edt h\u1eb9p m\u00f4n v\u1ecb ho\u1eb7c h\u00e0nh t\u00e1 tr\u00e0ng m\u00e0 kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n t\u1ea1o h\u00ecnh m\u00f4n v\u1ecb<\/p>\n
2. K\u1ef9 thu\u1eadt n\u1ed1i d\u1ea1 d\u00e0y \u2013 h\u1ed7ng tr\u00e0ng xuy\u00ean qua m\u1ea1c treo \u0110TN v\u00e0o m\u1eb7t sau d\u1ea1 d\u00e0y<\/b><\/p>\n
– Th\u00ec 1: r\u1ea1ch da theo \u0111\u01b0\u1eddng tr\u1eafng gi\u1eefa tr\u00ean r\u1ed1n, d\u00f9ng farabeuf k\u00e9o v\u1ec1 2 ph\u00eda<\/p>\n
– Th\u00ec 2: t\u00ecm quai h\u1ed7ng tr\u00e0ng \u0111\u1ea7u ti\u00ean<\/p>\n
1) Ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng b\u00e0n tay tr\u00e1i, ng\u01b0\u1eddi ph\u1ee5 d\u00f9ng b\u00e0n tay ph\u1ea3i n\u00e2ng \u0110TN l\u00ean<\/p>\n
2) Ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng ng\u00f3n tr\u1ecf c\u1ee7a b\u00e0n tay ph\u1ea3i l\u1ea7n theo r\u1ec5 m\u1ea1c treo \u0110TN \u0111\u1ebfn s\u00e1t c\u1ed9t s\u1ed1ng b\u00ean tr\u00e1i, m\u00f3c l\u00ean quai ru\u1ed9t \u0111\u1ea7u ti\u00ean: 1 \u0111\u1ea7u d\u00ednh ch\u1eb7t, 1 \u0111\u1ea7u di \u0111\u1ed9ng (t\u01b0\u01a1ng \u1ee9ng v\u1edbi g\u00f3c treitz)<\/p>\n
3) Ch\u1ecdn ch\u1ed7 \u0111\u1ecbnh n\u1ed1i c\u00e1ch g\u00f3c treitz 8 cm (\u0111\u00ednh 1 s\u1ee3i ch\u1ec9 l\u00e0m m\u1ed1c)<\/p>\n
– Th\u00ec 3: t\u00ecm m\u1eb7t sau d\u1ea1 d\u00e0y<\/p>\n
1) \u0110\u01b0a m\u1ea1c n\u1ed1i l\u1edbn tr\u1ea3i v\u1ec1 ph\u00eda l\u1ed3ng ng\u1ef1c, n\u00e2ng \u0110TN l\u00ean, t\u00ecm ch\u1ed7 v\u00f4 m\u1ea1ch c\u1ee7a m\u1ea1c treo \u0110TN r\u1ea1ch 1 \u0111\u01b0\u1eddng d\u00e0i 8-10 cm<\/p>\n
2) Qua l\u1ed7 m\u1edf m\u1ea1c treo v\u00e0o h\u1eadu cung m\u1ea1c n\u1ed1i: d\u00f9ng 2 k\u1eb9p chaput k\u1eb9p v\u00e0o m\u1eb7t sau d\u1ea1 d\u00e0y k\u00e9o ra, 2 k\u1eb9p chaput c\u00e1ch nhau 8 cm, c\u00e1ch b\u1edd cong l\u1edbn 1.5 cm v\u00e0 s\u00e1t m\u00f4n v\u1ecb, d\u00f9ng clamp k\u1eb9p d\u1ea1 d\u00e0y \u1edf 2 \u0111\u1ea7u chaput<\/p>\n
3) D\u00f9ng 2 k\u1eb9p chaput k\u1eb9p v\u00e0o quai ru\u1ed9t, 2 k\u1eb9p chaput c\u00e1ch nhau 8 cm, d\u00f9ng clamp k\u1eb9p quai ru\u1ed9t \u1edf 2 \u0111\u1ea7u chaput<\/p>\n
– Th\u00ec 4: n\u1ed1i b\u00ean \u2013 b\u00ean 2 l\u1edbp<\/p>\n
1) \u0110\u1eb7t 2 clamp song song v\u1edbi nhau, kh\u00e2u \u0111\u00ednh 2 \u0111\u1ea7u \u0111\u1ecbnh n\u1ed1i, l\u00e0m 1 \u0111\u01b0\u1eddng kh\u00e2u v\u1eaft thanh c\u01a1 m\u00e9p sau t\u1eeb A \u0111\u1ebfn B, g\u00f3i kim ch\u1ec9 v\u00e0o g\u1ea1c<\/p>\n
2) R\u1ea1ch d\u1ea1 d\u00e0y v\u00e0 h\u1ed7ng tr\u00e0ng d\u00e0i 5-6 cm c\u00e1ch \u0111\u01b0\u1eddng kh\u00e2u thanh c\u01a1 m\u1ed7i b\u00ean 0.5 cm, c\u00e1ch 2 \u0111\u1ea7u m\u1ed7i b\u00ean 0.5 cm<\/p>\n
3) L\u00e0m 1 \u0111\u01b0\u1eddng kh\u00e2u v\u1eaft to\u00e0n th\u1ec3: m\u00e9p sau t\u1eeb A \u0111\u1ebfn B r\u1ed3i ti\u1ebfp t\u1ee5c kh\u00e2u m\u00e9p tr\u01b0\u1edbc t\u1eeb B v\u1ec1 A<\/p>\n
4) L\u1ea5y kim ch\u1ec9 g\u00f3i trong g\u1ea1c ti\u1ebfp t\u1ee5c kh\u00e2u thanh c\u01a1 m\u00e9p tr\u01b0\u1edbc t\u1eeb B v\u1ec1 A: v\u00f9i \u0111\u01b0\u1eddng kh\u00e2u to\u00e0n th\u1ec3<\/p>\n
5) Kh\u00e2u \u0111\u00ednh l\u1ed7 m\u1edf m\u1ea1c treo v\u00e0o d\u1ea1 d\u00e0y, \u0111\u00f3ng b\u1ee5ng<\/p>\n
3. Tai bi\u1ebfn<\/b><\/p>\n
– T\u1ed5n th\u01b0\u01a1ng \u0110M m\u1ea1c treo<\/p>\n
– Ch\u1ea3y m\u00e1u mi\u1ec7ng n\u1ed1i, b\u1ee5c mi\u1ec7ng n\u1ed1i, t\u1eafc mi\u1ec7ng n\u1ed1i, lo\u00e9t mi\u1ec7ng n\u1ed1i<\/p>\n
– H\u1ed9i ch\u1ee9ng quai \u0111\u1ebfn<\/p>\n
C\u00e2u 5:\u00a0K\u1ef9 thu\u1eadt m\u1edf kh\u00ed qu\u1ea3n?<\/b><\/p>\n
1. Ch\u1ec9 \u0111\u1ecbnh<\/b><\/p>\n
1) Tr\u1edf ng\u1ea1i \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean: v\u1ebft th\u01b0\u01a1ng v\u00f9ng m\u0169i, d\u1ecb v\u1eadt, b\u1ec7nh b\u1ea1ch h\u1ea7u<\/p>\n
2) C\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1ea3nh h\u01b0\u1edfng t\u1edbi TT h\u00f4 h\u1ea5p: u n\u00e3o, ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, vi\u00eam m\u00e0ng n\u00e3o<\/p>\n
3) 1 s\u1ed1 ph\u1eabu thu\u1eadt l\u1ed3ng ng\u1ef1c l\u00e0m \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e1c c\u01a1 h\u00f4 h\u1ea5p v\u00e0 s\u1ef1 co gi\u00e3n c\u1ee7a ph\u1ebf nang: c\u1eaft 1 \u0111o\u1ea1n ph\u1ed5i, b\u00f3c t\u00e1ch m\u00e0ng ph\u1ed5i<\/p>\n
4) D\u1ef1 ph\u00f2ng trong tr\u01b0\u1eddng h\u1ee3p di chuy\u1ec3n xa (ti\u00ean l\u01b0\u1ee3ng s\u1ef1 ng\u1ea1t th\u1edf c\u00f3 th\u1ec3 x\u1ea3y ra) ho\u1eb7c chu\u1ea9n b\u1ecb cho 1 ph\u1eabu thu\u1eadt l\u1edbn (u h\u1ea1 h\u1ecdng)<\/p>\n
2. K\u1ef9 thu\u1eadt<\/b><\/p>\n
1) D\u1ee5ng c\u1ee5: c\u00e1c d\u1ee5ng c\u1ee5 th\u00f4ng th\u01b0\u1eddng + canul Krishaber ho\u1eb7c canul Sjoberg<\/p>\n
2) Chu\u1ea9n b\u1ecb:<\/p>\n
– Tr\u01b0\u1eddng h\u1ee3p c\u1ea5p c\u1ee9u -> \u00edt khi g\u00e2y t\u00ea, tr\u01b0\u1eddng h\u1ee3p cho ph\u00e9p -> c\u00f3 th\u1ec3 g\u00e2y t\u00ea t\u1ea1i ch\u1ed7<\/p>\n
– B\u1ec7nh nh\u00e2n: k\u00ea g\u1ed1i \u1edf c\u1ed5 v\u00e0 vai, ng\u1eeda c\u1ed5<\/p>\n
– Ph\u1eabu thu\u1eadt vi\u00ean \u0111\u1ee9ng b\u00ean ph\u1ea3i, ng\u01b0\u1eddi ph\u1ee5 \u0111\u1ee9ng ph\u00eda tr\u00ean \u0111\u1ea7u BN<\/p>\n
3) C\u00e1c th\u00ec ph\u1eabu thu\u1eadt trong m\u1edf kh\u00ed qu\u1ea3n cao:<\/p>\n
– Th\u00ec 1:<\/p>\n
+ R\u1ea1ch da d\u00e0i 3-5 cm, b\u1eaft \u0111\u1ea7u t\u1eeb b\u1edd d\u01b0\u1edbi s\u1ee5n nh\u1eabn. Ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng ng\u00f3n 1, 3 c\u1ee7a b\u00e0n tay tr\u00e1i gi\u1eef l\u1ea5y s\u1ee5n nh\u1eabn, ng\u00f3n 2 t\u1ef3 d\u01b0\u1edbi v\u00f2ng s\u1ee5n \u0111\u1ec3 l\u00e0m m\u1ed1c<\/p>\n
+ R\u1ea1ch c\u00e1c l\u1edbp c\u00e2n c\u1ed5 (n\u00f4ng, gi\u1eefa), qua c\u00e1c l\u1edbp c\u00e2n th\u1ea5y c\u00e1c v\u00f2ng s\u1ee5n kh\u00ed qu\u1ea3n xu\u1ea5t hi\u1ec7n. Banh r\u1ed9ng v\u1ebft m\u1ed5<\/p>\n
– Th\u00ec 2: r\u1ea1ch kh\u00ed qu\u1ea3n<\/p>\n
+ Ng\u00f3n 2 trong qu\u00e1 tr\u00ecnh m\u1ed5 lu\u00f4n \u0111\u01b0a \u0111\u01b0\u1eddng kh\u00f4ng r\u1eddi kh\u00ed qu\u1ea3n<\/p>\n
+ \u0110\u01b0\u1eddng r\u1ea1ch b\u1eaft \u0111\u1ea7u t\u1eeb s\u1ee5n th\u1ee9 2, ch\u1ecdc s\u00e2u 5 mm, k\u00e9o d\u00e0i 1.5 cm<\/p>\n
– Th\u00ec 3: l\u1eafp canul Krishaber<\/p>\n
+ Tr\u01b0\u1eddng h\u1ee3p c\u00f3 banh 3 c\u00e0nh -> cho v\u00e0o v\u1ebft r\u1ea1ch \u0111\u1ec3 l\u1eafp canul v\u00e0o, tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 banh 3 c\u00e0nh -> l\u1eafp n\u00f2ng canul v\u00e0o v\u1ecf canul<\/p>\n
+ T\u1ef3 m\u00e9p ph\u1ea3i, n\u00e2ng m\u00e9p tr\u00e1i \u0111\u01b0\u1eddng r\u1ea1ch l\u00ean r\u1ed3i d\u1ef1ng \u0111\u1ee9ng canul, \u0111\u1ea9y canul xu\u1ed1ng d\u01b0\u1edbi, r\u00fat n\u00f2ng ra kh\u1ecfi v\u1ecf, l\u1eafp v\u00e0o trong v\u1ecf th\u00eam 1 v\u1ecf nh\u1ecf h\u01a1n<\/p>\n
– Th\u00ec 4: kh\u00e2u da<\/p>\n
Kh\u00e2u b\u1edbt \u0111\u01b0\u1eddng r\u1ea1ch da, c\u1ed1 \u0111\u1ecbnh canul = c\u00e1ch bu\u1ed9c ra ph\u00eda sau c\u1ed5 ho\u1eb7c kh\u00e2u v\u00e0o da b\u00ean c\u1ea1nh c\u1ed5<\/p>\n
4) Thay \u0111\u1ed5i k\u1ef9 thu\u1eadt:<\/p>\n
Thay \u0111\u1ed5i \u0111\u01b0\u1eddng r\u1ea1ch kh\u00ed qu\u1ea3n \u0111\u1ec3 l\u1eafp canul v\u00e0o d\u1ec5 d\u00e0ng ho\u1eb7c \u0111\u01b0\u1eddng r\u1ea1ch kh\u00ed qu\u1ea3n kh\u00f4ng tr\u00f9ng v\u1edbi \u0111\u01b0\u1eddng r\u1ea1ch da: r\u1ea1ch v\u00f2ng tr\u00f2n, r\u1ea1ch ch\u1eef U, r\u1ea1ch ch\u1eef th\u1eadp<\/p>\n
3. Ch\u0103m s\u00f3c<\/b><\/p>\n
– H\u00fat \u0111\u1eddm d\u00e3i cho BN<\/p>\n
– \u0110\u1ec3 BN trong ph\u00f2ng \u1ea5m th\u00edch h\u1ee3p (15-20oC), \u0111\u1eafp g\u1ea1c l\u00ean canul c\u00f3 t\u1ea9m d\u1ea7u gomenol<\/p>\n
– Ch\u1ed1ng nhi\u1ec5m tr\u00f9ng (kh\u00e1ng sinh), ch\u1ed1ng lo\u00e9t t\u1ea1i ch\u1ed7 (thay b\u0103ng s\u1ea1ch), ch\u1ed1ng lo\u00e9t to\u00e0n th\u00e2n (v\u1ec7 sinh v\u00e0 tr\u1edf l\u1eadt ng\u01b0\u1eddi)<\/p>\n
– T\u00f9y theo nguy\u00ean nh\u00e2n v\u00e0 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 r\u00fat canul (th\u01b0\u1eddng l\u00e0 ng\u00e0y th\u1ee9 7)<\/p>\n
4. Tai bi\u1ebfn<\/b><\/p>\n
1) \u0110\u01b0\u1eddng r\u1ea1ch xi\u00ean ngang 1 b\u00ean, ch\u1ecdc th\u1ee7ng th\u1ef1c qu\u1ea3n<\/p>\n
2) Ch\u1ea3y m\u00e1u, ng\u1ea1t th\u1edf, tr\u00e0n kh\u00ed v\u00e0 m\u00e1u v\u00e0o trung th\u1ea5t (m\u1edf kh\u00ed qu\u1ea3n th\u1ea5p)<\/p>\n
3) Nhi\u1ec5m tr\u00f9ng<\/p>\n
4) R\u00f2 kh\u00ed qu\u1ea3n, th\u1ef1c qu\u1ea3n, th\u00e2n \u0110M c\u00e1nh tay \u0111\u1ea7u<\/p>\n
C\u00e2u 6:\u00a0C\u00e1c th\u00ec k\u1ef9 thu\u1eadt m\u1ed5 ru\u1ed9t th\u1eeba?<\/b><\/p>\n
1) Chu\u1ea9n b\u1ecb:<\/p>\n
– BN n\u1eb1m h\u01a1i nghi\u00eang v\u1ec1 b\u00ean tr\u00e1i, ph\u1eabu thu\u1eadt vi\u00ean \u0111\u1ee9ng b\u00ean ph\u1ea3i, ng\u01b0\u1eddi ph\u1ee5 \u0111\u1ee9ng b\u00ean \u0111\u1ed1i di\u1ec7n<\/p>\n
– V\u1ec7 sinh v\u00f9ng m\u1ed5, g\u00e2y t\u00ea ho\u1eb7c g\u00e2y m\u00ea<\/p>\n
2) C\u00e1c th\u00ec k\u1ef9 thu\u1eadt:<\/p>\n
– Th\u00ec 1: r\u1ea1ch th\u00e0nh b\u1ee5ng<\/p>\n
+ R\u1ea1ch 1 \u0111\u01b0\u1eddng vu\u00f4ng g\u00f3c v\u1edbi \u0111\u01b0\u1eddng n\u1ed1i gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean \u0111\u1ebfn r\u1ed1n \u1edf 1\/3 ngo\u00e0i (\u0111\u01b0\u1eddng Mac Burney)<\/p>\n
+ R\u1ea1ch v\u00e0 t\u00e1ch c\u01a1 ch\u00e9o l\u1edbn, c\u01a1 ch\u00e9o b\u00e9, c\u01a1 ngang b\u1ee5ng, trong c\u00f9ng l\u00e0 ph\u00fac m\u1ea1c. D\u00f9ng farabeuf banh r\u1ed9ng v\u1ebft m\u1ed5<\/p>\n
+ Ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng k\u1eb9p ph\u1eabu t\u00edch, ng\u01b0\u1eddi ph\u1ee5 d\u00f9ng kocher: n\u00e2ng v\u00e0 c\u1eaft ph\u00fac m\u1ea1c. D\u00f9ng farabeuf banh r\u1ed9ng v\u1ebft m\u1ed5<\/p>\n
– Th\u00ec 2: t\u00ecm ru\u1ed9t th\u1eeba<\/p>\n
Ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng metcher \u0111\u1ea9y ru\u1ed9t non v\u1ec1 b\u00ean tr\u00e1i th\u00ec th\u1ea5y manh tr\u00e0ng c\u00f3 d\u1ea3i c\u01a1 d\u1ecdc, l\u1ea7n xu\u1ed1ng d\u01b0\u1edbi t\u00ecm th\u1ea5y ru\u1ed9t th\u1eeba, d\u00f9ng kocher k\u00e9o ru\u1ed9t th\u1eeba ra ngo\u00e0i<\/p>\n
– Th\u00ec 3: k\u1eb9p + c\u1eaft m\u1ea1c treo v\u00e0 \u0110M ru\u1ed9t th\u1eeba<\/p>\n
+ Ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng kocher ch\u1ecdc th\u1ee7ng m\u1ea1c treo s\u00e1t g\u1ed1c ru\u1ed9t th\u1eeba, ng\u01b0\u1eddi ph\u1ee5 d\u00f9ng kocher k\u1eb9p 2 s\u1ee3i ch\u1ec9 \u0111\u01b0a v\u00e0o: 1 s\u1ee3i bu\u1ed9c s\u00e1t g\u1ed1c ru\u1ed9t th\u1eeba, 1 s\u1ee3i bu\u1ed9c \u0110M ru\u1ed9t th\u1eeba<\/p>\n
+ Ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng kocher k\u1eb9p ph\u1ea7n ngo\u00e0i ru\u1ed9t th\u1eeba, c\u1eaft m\u1ea1c treo v\u00e0 \u0110M ru\u1ed9t th\u1eeba<\/p>\n
– Th\u00ec 4: ph\u1eabu thu\u1eadt vi\u00ean n\u00e2ng ru\u1ed9t th\u1eeba l\u00ean v\u00e0 l\u00e0m 1 m\u0169i kh\u00e2u h\u00ecnh t\u00fai quanh g\u1ed1c ru\u1ed9t th\u1eeba<\/p>\n
– Th\u00ec 5: c\u1eaft g\u1ed1c ru\u1ed9t th\u1eeba<\/p>\n
D\u00f9ng dao t\u1ea9m c\u1ed3n iod c\u1eaft g\u1ed1c ru\u1ed9t th\u1eeba, th\u1eaft m\u0169i kh\u00e2u h\u00ecnh t\u00fai \u0111\u1ec3 v\u00f9i m\u1ecfm c\u1eaft<\/p>\n
– Th\u00ec 6: ki\u1ec3m tra 70 cm h\u1ed3i tr\u00e0ng c\u00f3 t\u00fai th\u1eeba meckel hay kh\u00f4ng (n\u1ebfu c\u00f3 th\u00ec x\u1eed tr\u00ed)<\/p>\n
– Th\u00ec 7: \u0111\u00f3ng b\u1ee5ng<\/p>\n
+ Kh\u00e2u ph\u00fac m\u1ea1c (l\u1ed9n ra ngo\u00e0i, kh\u00e2u v\u1eaft, kh\u00e2u m\u0169i r\u1eddi ho\u1eb7c kh\u00e2u h\u00ecnh t\u00fai)<\/p>\n
+ Kh\u00e2u c\u01a1 ngang b\u1ee5ng v\u1edbi c\u01a1 ch\u00e9o b\u00e9<\/p>\n
+ Kh\u00e2u c\u01a1 ch\u00e9o l\u1edbn<\/p>\n
+ Kh\u00e2u da<\/p>\n
– Ch\u00fa \u00fd: n\u1ebfu ru\u1ed9t th\u1eeba n\u1eb1m sau manh tr\u00e0ng th\u00ec c\u1eaft ru\u1ed9t th\u1eeba ng\u01b0\u1ee3c d\u00f2ng<\/p>\n
3) Tai bi\u1ebfn:<\/p>\n
– Ch\u1ea3y m\u00e1u<\/p>\n
– Ch\u1ecdc th\u1ee7ng manh tr\u00e0ng, r\u00f2 manh tr\u00e0ng<\/p>\n
C\u00e2u 7:\u00a0Ph\u01b0\u01a1ng ph\u00e1p x\u1eed tr\u00ed v\u1ebft th\u01b0\u01a1ng m\u1ea1ch m\u00e1u?<\/b><\/p>\n
1. Th\u1eaft m\u1ea1ch m\u00e1u<\/b><\/p>\n
– \u0110\u01b0\u1ee3c \u00e1p d\u1ee5ng \u1edf nh\u1eefng v\u00f9ng c\u00f3 nhi\u1ec1u ng\u00e0nh b\u00ean, ng\u00e0nh n\u1ed1i (nh\u1ea5t l\u00e0 \u0111o\u1ea1n cu\u1ed1i c\u1ee7a chi) ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m qu\u00e1 l\u1edbn<\/p>\n
– \u01afu \u0111i\u1ec3m:<\/p>\n
+ C\u1ea7m m\u00e1u \u0111\u01b0\u1ee3c ngay<\/p>\n
+ Kh\u00f4ng ch\u1ea3y m\u00e1u th\u1ee9 ph\u00e1t hay t\u1eafc m\u1ea1ch<\/p>\n
+ Ti\u1ebfn h\u00e0nh nhanh ch\u00f3ng<\/p>\n
+ Kh\u00f4ng \u0111\u00f2i h\u1ecfi k\u1ef9 thu\u1eadt v\u00e0 trang thi\u1ebft b\u1ecb ph\u1ee9c t\u1ea1p<\/p>\n
– Ch\u00fa \u00fd:<\/p>\n
1) T\u00e1ch b\u1ecf l\u1edbp \u00e1o ngo\u00e0i \u0111\u1ec3 tr\u00e1nh d\u1eabn truy\u1ec1n xung TK v\u1ec1 v\u1eadn m\u1ea1ch. Tr\u01b0\u1edbc khi th\u1eaft v\u00e0 c\u1eaft, n\u00ean \u0111\u1ec3 m\u1ecfm c\u1ee7a \u0111\u1ea7u m\u1ea1ch m\u00e1u d\u00e0i<\/p>\n
2) Ch\u1ecdn \u0111i\u1ec3m th\u1eaft ph\u00f9 h\u1ee3p v\u1ec1 gi\u1ea3i ph\u1eabu (tr\u00e1nh v\u00f9ng nguy hi\u1ec3m)<\/p>\n
3) N\u00fat th\u1eaft ph\u1ea3i \u0111\u01b0\u1ee3c kh\u00e2u \u0111\u00ednh v\u1edbi t\u1ed5 ch\u1ee9c xung quanh \u0111\u1ec3 l\u00e0m \u0111i\u1ec3m t\u1ef1a, tr\u00e1nh ch\u1ea3y m\u00e1u th\u1ee9 ph\u00e1t<\/p>\n
2. Kh\u00e2u ph\u1ee5c h\u1ed3i l\u01b0u th\u00f4ng m\u1ea1ch m\u00e1u<\/b><\/p>\n
– Nguy\u00ean t\u1eafc:<\/p>\n
1) \u0110\u01b0\u1eddng kh\u00e2u ph\u1ea3i k\u00edn<\/p>\n
2) \u0110\u01b0\u1eddng kh\u00e2u ph\u1ea3i \u0111\u1ec3 l\u1edbp n\u1ed9i m\u1ea1c l\u1ed9n ra ngo\u00e0i, tr\u00e1nh t\u1eafc m\u1ea1ch<\/p>\n
3) Kh\u00f4ng l\u00e0m h\u1eb9p kh\u1ea9u k\u00ednh m\u1ea1ch m\u00e1u<\/p>\n
4) \u0110\u1ec3 tr\u00e1nh l\u00e0m t\u1ed5n th\u01b0\u01a1ng n\u1ed9i m\u1ea1c, ng\u01b0\u1eddi ta b\u01a1m v\u00e0o \u0111\u1ea7u m\u1ea1ch m\u00e1u huy\u1ebft thanh sinh l\u00fd c\u00f3 pha heparin<\/p>\n
– \u0110i\u1ec1u ki\u1ec7n kh\u00e2u ph\u1ee5c h\u1ed3i:<\/p>\n
+ V\u1ebft th\u01b0\u01a1ng \u0111\u1ebfn s\u1edbm, t\u01b0\u01a1ng \u0111\u1ed1i s\u1ea1ch, kh\u00f4ng b\u1ecb nhi\u1ec5m tr\u00f9ng<\/p>\n
+ Trang thi\u1ebft b\u1ecb v\u00e0 \u0111i\u1ec1u ki\u1ec7n k\u1ef9 thu\u1eadt cho ph\u00e9p, c\u00f3 BS chuy\u00ean ng\u00e0nh l\u00e0m<\/p>\n
– C\u00e1ch th\u1ee9c ti\u1ebfn h\u00e0nh: c\u00f3 3 c\u00e1ch:<\/p>\n
1) Kh\u00e2u m\u1ea1ch m\u00e1u:<\/p>\n
+ \u0110\u1ed1i v\u1edbi nh\u1eefng m\u1ea1ch m\u00e1u l\u1edbn, t\u1ed5n th\u01b0\u01a1ng 1 ph\u1ea7n, r\u00e1ch g\u1ecdn v\u00e0 s\u1ea1ch<\/p>\n
+ Kh\u00e2u m\u0169i r\u1eddi ho\u1eb7c m\u0169i ch\u1eef U<\/p>\n
2) N\u1ed1i m\u1ea1ch m\u00e1u:<\/p>\n
+ V\u1ebft th\u01b0\u01a1ng \u0111\u1ee9t ho\u00e0n to\u00e0n ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng nham nh\u1edf c\u1ea7n c\u1eaft l\u1ecdc \u0111\u1ec3 n\u1ed1i<\/p>\n
+ Kh\u00e2u c\u00e1c \u0111i\u1ec3m m\u1ed1c c\u1ee7a 2 m\u00e9p r\u1ed3i gh\u00e9p 2 \u0111\u1ea7u v\u00e0o nhau \u0111\u1ec3 kh\u00e2u cho \u0111\u1ec1u<\/p>\n
+ K\u00e9o 2 \u0111\u1ea7u m\u1ea1ch m\u00e1u tr\u00e1nh b\u1ecb c\u0103ng \u0111\u1ec3 ko l\u00e0m b\u1ee5c \u0111\u01b0\u1eddng kh\u00e2u<\/p>\n
3) Gh\u00e9p m\u1ea1ch m\u00e1u:<\/p>\n
+ Trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng 2 \u0111\u1ea7u qu\u00e1 xa sau khi \u0111\u00e3 ti\u1ebfn h\u00e0nh c\u1eaft l\u1ecdc<\/p>\n
+ Ch\u1ea5t li\u1ec7u \u0111\u1ec3 gh\u00e9p:<\/p>\n
(+) C\u00e1c TM t\u1ef1 th\u00e2n: tuy kh\u00f4ng b\u1ecb lo\u1ea1i b\u1ecf nh\u01b0ng d\u1ec5 g\u00e2y t\u1eafc m\u1ea1ch, ch\u1ec9 c\u00f3 th\u1ec3 gh\u00e9p 1 \u0111o\u1ea1n ng\u1eafn<\/p>\n
(+) C\u00e1c \u0110M d\u1ef1 tr\u1eef c\u1ee7a n\u1ea1n nh\u00e2n ch\u1ebft tr\u01b0\u1edbc 6h (b\u1ea3o qu\u1ea3n = dd merthiolat 5% \u1edf – 4oC)<\/p>\n
(+) C\u00e1c \u1ed1ng nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c trung t\u00ednh h\u00f3a nh\u01b0 silicon, dacron\u2026<\/p>\n
+ K\u1ef9 thu\u1eadt: kh\u00e2u = tay ho\u1eb7c = m\u00e1y, \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u1ed9 ch\u00ednh x\u00e1c cao: ng\u01b0\u1eddi ta s\u1eed d\u1ee5ng k\u00ednh hi\u1ec3n vi<\/p>\n
C\u00e2u 8:\u00a0C\u1eaft c\u1ee5t v\u00e0 th\u00e1o kh\u1edbp \u0111\u1ec3 h\u1edf?<\/b><\/p>\n
1. Ch\u1ec9 \u0111\u1ecbnh<\/b><\/p>\n
1) Chi b\u1ecb d\u1eadp n\u00e1t nhi\u1ec1u, m\u00e0:<\/p>\n
– Kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n mong manh<\/p>\n
– Vi\u1ec7c h\u1ed3i sinh \u0111\u00e3 ti\u1ebfn h\u00e0nh nh\u01b0ng kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3<\/p>\n
2) Chi b\u1ecb th\u01b0\u01a1ng, h\u1ee7y ho\u1ea1i t\u1ed5 ch\u1ee9c r\u1ed9ng l\u1edbn + nhi\u1ec5m tr\u00f9ng (ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng + b\u1ea9n -> kh\u1ea3 n\u0103ng nhi\u1ec5m tr\u00f9ng ko lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c sau khi c\u1eaft c\u1ee5t)<\/p>\n
3) N\u1eb7ng h\u01a1n v\u00e0 c\u1ea5p c\u1ee9u h\u01a1n l\u00e0 tr\u01b0\u1eddng h\u1ee3p ho\u1ea1i th\u01b0 sinh h\u01a1i<\/p>\n
2. K\u1ef9 thu\u1eadt<\/b><\/p>\n
1) Y\u00eau c\u1ea7u k\u1ef9 thu\u1eadt:<\/p>\n
– Nhanh ch\u00f3ng, nh\u1eb9 nh\u00e0ng, \u0111\u01a1n gi\u1ea3n<\/p>\n
– M\u1ecfm c\u1ee5t gi\u1eef \u0111\u01b0\u1ee3c c\u00e0ng d\u00e0i c\u00e0ng t\u1ed1t<\/p>\n
2) K\u1ef9 thu\u1eadt c\u1eaft c\u1ee5t \u0111\u1ec3 h\u1edf ki\u1ec3u khoanh gi\u00f2 (ki\u1ec3u ph\u1ed5 bi\u1ebfn nh\u1ea5t):<\/p>\n
– \u0110\u1eb7t garo ph\u00eda tr\u00ean n\u01a1i \u0111\u1ecbnh c\u1eaft c\u1ee5t. Tr\u01b0\u1eddng h\u1ee3p BN \u0111\u00e3 c\u00f3 garo th\u00ec \u0111\u1eb7t th\u00eam 1 garo th\u1ee9 2 v\u00e0 ti\u1ebfn h\u00e0nh c\u1eaft c\u1ee5t gi\u1eefa 2 garo<\/p>\n
– C\u1eaft da v\u00e0 c\u00e2n theo v\u1ea1t h\u00ecnh tr\u00f2n<\/p>\n
– Khi da \u0111\u00e3 co, c\u1eaft c\u01a1 ngay m\u00e9p da th\u1eb3ng g\u00f3c v\u1edbi tr\u1ee5c c\u1ee7a x\u01b0\u01a1ng. V\u00ec l\u1edbp c\u01a1 n\u00f4ng co nhi\u1ec1u h\u01a1n l\u1edbp c\u01a1 s\u00e2u n\u00ean ph\u1ea3i c\u1eaft t\u1eeb t\u1eeb t\u1eebng l\u1edbp sao cho c\u00e1c c\u01a1 c\u00f3 \u0111\u1ee7 th\u1eddi gian co r\u00fat => \u0111\u1ec3 cu\u1ed1i c\u00f9ng c\u1ea3 2 l\u1edbp c\u01a1 co v\u1ec1 tr\u00ean c\u00f9ng 1 thi\u1ebft di\u1ec7n<\/p>\n
– C\u1eaft m\u00e0ng x\u01b0\u01a1ng, r\u00f3c m\u00e0ng x\u01b0\u01a1ng ph\u1ea7n d\u01b0\u1edbi<\/p>\n
– C\u01b0a x\u01b0\u01a1ng th\u1ea5p h\u01a1n n\u01a1i c\u1eaft m\u00e0ng x\u01b0\u01a1ng 5 mm<\/p>\n
– T\u00ecm v\u00e0 th\u1eaft c\u00e1c m\u1ea1ch m\u00e1u<\/p>\n
– \u0110\u1ed1i v\u1edbi c\u00e1c d\u00e2y TK l\u1edbn th\u00ec ph\u1ea3i ti\u00eam novocain 1% tr\u01b0\u1edbc khi c\u1eaft<\/p>\n
– H\u1eadu ph\u1eabu: k\u00e9o li\u00ean t\u1ee5c ph\u1ea7n m\u1ec1m -> \u0111\u1ec1 ph\u00f2ng da co r\u00fat ng\u1eafn l\u1ea1i = b\u0103ng d\u00ednh d\u00e1n v\u00e0o m\u1eb7t ngo\u00e0i m\u1ecfm c\u1ee5t ho\u1eb7c = c\u00e1c m\u0169i ch\u1ec9 kh\u00e2u v\u00e0o m\u00e9p da c\u1ee7a m\u1ecfm c\u1ee5t<\/p>\n
3) Thay \u0111\u1ed5i k\u1ef9 thu\u1eadt:<\/p>\n
– C\u1eaft v\u1ea1t da b\u1ea7u d\u1ee5c \u0111\u1ec3 h\u1edf:<\/p>\n
+ C\u1eaft da v\u00e0 c\u00e2n theo v\u1ea1t b\u1ea7u d\u1ee5c: c\u1ef1c tr\u00ean tr\u01b0\u1edbc, c\u1ef1c d\u01b0\u1edbi sau ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i. L\u00f3c da v\u00e0 c\u00e2n t\u1eeb c\u1ef1c d\u01b0\u1edbi l\u00ean c\u1ef1c tr\u00ean. C\u1eaft c\u01a1 v\u00e0 x\u01b0\u01a1ng nh\u01b0 tr\u00ean<\/p>\n
+ Sau khi c\u1eaft xong: l\u1ed9n ng\u01b0\u1ee3c v\u1ea1t da l\u00ean tr\u00ean (nh\u01b0ng ko g\u1eadp th\u00e0nh g\u00f3c) \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o d\u1eabn l\u01b0u<\/p>\n
– C\u1eaft v\u1ea1t da kh\u00f4ng \u0111i\u1ec3n h\u00ecnh \u0111\u1ec3 h\u1edf:<\/p>\n
+ L\u1ee3i d\u1ee5ng v\u1ea1t da l\u00e0nh c\u00f2n l\u1ea1i \u1edf v\u00f9ng c\u1eaft c\u1ee5t \u0111\u1ec3 s\u1eeda l\u1ea1i m\u1ecfm c\u1ee5t v\u1ec1 sau<\/p>\n
+ C\u1eaft da v\u00e0 c\u00e2n theo v\u1ea1t b\u1ea5t k\u1ef3. C\u1eaft c\u01a1 v\u00e0 x\u01b0\u01a1ng nh\u01b0 tr\u00ean<\/p>\n
+ Sau khi c\u1eaft xong: l\u1ed9n ng\u01b0\u1ee3c v\u1ea1t da l\u00ean tr\u00ean (nh\u01b0ng ko g\u1eadp th\u00e0nh g\u00f3c) \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o d\u1eabn l\u01b0u<\/p>\n
3. S\u1eeda l\u1ea1i m\u1ecfm c\u1ee5t \u0111\u1ec3 h\u1edf:\u00a0<\/b>c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t khi BN c\u00f3 \u0111\u1ee7 c\u00e1c \u0111i\u1ec1u ki\u1ec7n sau:<\/p>\n
1) To\u00e0n th\u00e2n \u1ed5n \u0111\u1ecbnh, t\u00ecnh tr\u1ea1ng chung t\u01b0\u01a1ng \u0111\u1ed1i kh\u00e1<\/p>\n
2) T\u1ed5n th\u01b0\u01a1ng t\u1ea1i ch\u1ed7 \u1ed5n \u0111\u1ecbnh, h\u1ebft ph\u00f9 n\u1ec1, da l\u00e0nh l\u1eb7n, kh\u00f4ng c\u00f3 v\u1ea9y, \u0111\u1ea7u m\u1ecfm c\u1ee5t c\u00f3 t\u1ed5 ch\u1ee9c h\u1ea1t \u0111\u1ecf t\u01b0\u01a1i<\/p>\n
3) S\u1eeda l\u1ea1i m\u1ecfm c\u1ee5t nh\u01b0 th\u1ebf n\u00e0o:<\/p>\n
– N\u1ebfu m\u1ecfm c\u1ee5t d\u00e0i: c\u1eaft ng\u1eafn l\u1ea1i theo k\u1ef9 thu\u1eadt c\u1eaft c\u1ee5t \u0111\u00f3ng k\u00edn \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c chi\u1ec1u d\u00e0i l\u00fd t\u01b0\u1edfng<\/p>\n
– N\u1ebfu m\u1ecfm c\u1ee5t ng\u1eafn: vi\u1ec7c c\u1eaft ng\u1eafn l\u00e0 r\u1ea5t h\u1ea1n ch\u1ebf, ch\u1ec9 n\u00ean kh\u00e2u da<\/p>\n
C\u00e2u 9:\u00a0C\u1eaft c\u1ee5t v\u00e0 th\u00e1o kh\u1edbp \u0111\u00f3ng k\u00edn?<\/b><\/p>\n
1) Ph\u1ea3i m\u1ed5 th\u1eadt v\u00f4 tr\u00f9ng:<\/p>\n
– Ng\u00e0y tr\u01b0\u1edbc m\u1ed5: t\u1eafm r\u1eeda k\u1ef9 to\u00e0n th\u00e2n v\u00e0 t\u1ea1i ch\u1ed7<\/p>\n
– Ng\u00e0y h\u00f4m m\u1ed5: kh\u1eed tr\u00f9ng k\u1ef9 v\u00f9ng m\u1ed5<\/p>\n
2) \u0110\u1eb7t garo ph\u00eda tr\u00ean \u0111\u1ec3: m\u1ed5 s\u1ea1ch, d\u1ec5 th\u1ea5y, ti\u1ebft ki\u1ec7m m\u00e1u cho BN<\/p>\n
– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean (v\u00ec c\u00f3 th\u1ec3 g\u00e2y tai bi\u1ebfn)<\/p>\n
– \u0110\u1ec3 ti\u1ebft ki\u1ec7m m\u00e1u, tr\u01b0\u1edbc khi \u0111\u1eb7t garo: n\u00e2ng cao \u0111\u1ea7u chi 15o \u0111\u1ec3 d\u1ed3n m\u00e1u v\u1ec1 trung t\u00e2m. Trong tr\u01b0\u1eddng h\u1ee3p th\u00e1o kh\u1edbp h\u00e1ng, kh\u1edbp vai: c\u1ea7n th\u1eaft c\u00e1c m\u1ea1ch m\u00e1u l\u1edbn 2 ng\u00e0y tr\u01b0\u1edbc khi m\u1ed5<\/p>\n
3) X\u1eed tr\u00ed da: da ph\u1ea3i l\u00e0nh l\u1eb7n, \u0111\u01b0\u1ee3c nu\u00f4i d\u01b0\u1ee1ng t\u1ed1t, c\u00f3 c\u1ea3m gi\u00e1c b\u00ecnh th\u01b0\u1eddng<\/p>\n
– V\u1ea1t da che ph\u1ee7 bao g\u1ed3m l\u1edbp m\u1ee1 v\u00e0 c\u00f3 khi c\u1ea3 l\u1edbp c\u00e2n n\u00f4ng, n\u1ebfu l\u1edbp m\u1ee1 qu\u00e1 d\u00e0y th\u00ec ch\u1ec9 c\u1ea7n l\u1ea5y 1 l\u1edbp m\u1ecfng<\/p>\n
+ Tr\u00e1nh \u0111\u1ec3 s\u1eb9o v\u00e0o n\u01a1i t\u1ef3, t\u1ef1a c\u1ee7a m\u1ecfm c\u1ee5t l\u00ean chi gi\u1ea3<\/p>\n
+ S\u1eb9o \u1edf \u0111\u00e1y m\u1ecfm c\u1ee5t kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i qua x\u01b0\u01a1ng<\/p>\n
– T\u00ednh chi\u1ec1u d\u00e0i c\u1ee7a v\u1ea1t da: v\u1eeba \u0111\u1ee7, khi kh\u00e2u ch\u1ec9 h\u01a1i c\u0103ng<\/p>\n
+ Chi\u1ec1u d\u00e0i v\u1ea1t da \u0111\u01b0\u1ee3c t\u00ednh t\u1eeb m\u1ee9c c\u01b0a x\u01b0\u01a1ng, t\u1ed5ng chi\u1ec1u d\u00e0i c\u1ee7a 2 v\u1ea1t da ph\u1ee5 thu\u1ed9c v\u00e0o k\u1ef9 thu\u1eadt c\u1eaft c\u1ee5t<\/p>\n
+ T\u1ed5ng chi\u1ec1u d\u00e0i c\u1ee7a 2 v\u1ea1t da = 3R (R l\u00e0 b\u00e1n k\u00ednh tr\u01b0\u1edbc sau c\u1ee7a \u0111o\u1ea1n chi n\u01a1i c\u01b0a x\u01b0\u01a1ng) l\u00e0 \u0111\u1ee7 (t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi 1 n\u1eeda chu vi l\u00e0 \u043fR) n\u00ean c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng nh\u01b0 sau:<\/p>\n
(+) \u0110o chu vi n\u01a1i c\u01b0a x\u01b0\u01a1ng, n\u1ebfu s\u1eed d\u1ee5ng 2 v\u1ea1t da = nhau th\u00ec chi\u1ec1u d\u00e0i m\u1ed7i v\u1ea1t da l\u00e0 1\/4 chu vi<\/p>\n
(+) T\u1ed5ng chi\u1ec1u d\u00e0i c\u1ee7a 2 v\u1ea1t da kh\u00f4ng thay \u0111\u1ed5i n\u00ean ta c\u00f3 th\u1ec3 ch\u1ee7 \u0111\u1ed9ng ch\u1ecdn v\u1ecb tr\u00ed cho \u0111\u01b0\u1eddng kh\u00e2u da n\u1eb1m l\u1ec7ch ra sau hay tr\u01b0\u1edbc b\u1eb1ng c\u00e1ch t\u0103ng chi\u1ec1u d\u00e0i v\u1ea1t tr\u01b0\u1edbc th\u00ec gi\u1ea3m chi\u1ec1u d\u00e0i v\u1ea1t sau<\/p>\n
(+) N\u1ebfu d\u00f9ng c\u01a1 \u0111\u1ed9n th\u00ec t\u1ed5ng chi\u1ec1u d\u00e0i c\u1ee7a 2 v\u1ea1t da = 4R<\/p>\n
4) X\u1eed tr\u00ed c\u01a1: c\u1eaft g\u1ecdn t\u1eebng nh\u00e1t, nh\u1eb9 nh\u00e0ng, kh\u00f4ng g\u00e2y \u0111\u1ee5ng d\u1eadp \u0111\u1ec3 tr\u00e1nh nhi\u1ec5m tr\u00f9ng v\u00e0 x\u01a1 h\u00f3a -> \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u00ednh \u0111\u00e0n h\u1ed3i v\u00e0 sinh l\u1ef1c c\u1ee7a c\u01a1 v\u1ec1 sau<\/p>\n
– T\u00ednh sao cho l\u1edbp c\u01a1 n\u00f4ng v\u00e0 l\u1edbp c\u01a1 s\u00e2u sau khi c\u1eaft xong s\u1ebd co v\u1ec1 ngang m\u1ee9c c\u01b0a x\u01b0\u01a1ng<\/p>\n
– L\u1edbp c\u01a1 s\u00e2u kh\u00e2u v\u00e0o m\u00e0ng x\u01b0\u01a1ng (l\u00e0 n\u01a1i b\u00e1m t\u1eadn m\u1edbi \u0111\u1ec3 v\u1eadn \u0111\u1ed9ng v\u00e0 \u0111i\u1ec1u khi\u1ec3n m\u1ecfm c\u1ee5t). L\u1edbp c\u01a1 n\u00f4ng kh\u00e2u v\u00e0o l\u1edbp c\u01a1 s\u00e2u<\/p>\n
– N\u1ebfu d\u00f9ng c\u01a1 \u0111\u1ed9n th\u00ec c\u1eaft c\u01a1 ngang m\u1ee9c da co r\u00fat (theo h\u01b0\u1edbng ch\u1ebfch 45o v\u1ec1 g\u1ed1c chi)<\/p>\n
5) C\u01b0a x\u01b0\u01a1ng:<\/p>\n
– D\u00f9ng \u0111\u0129a v\u00e9n c\u01a1 percy v\u00e9n c\u01a1 v\u1ec1 g\u1ed1c chi. C\u1eaft m\u00e0ng x\u01b0\u01a1ng, r\u00f3c m\u00e0ng x\u01b0\u01a1ng v\u1ec1 ph\u00eda d\u01b0\u1edbi<\/p>\n
– C\u01b0a x\u01b0\u01a1ng th\u1ea5p h\u01a1n n\u01a1i c\u1eaft m\u00e0ng x\u01b0\u01a1ng 5 mm<\/p>\n
6) X\u1eed tr\u00ed m\u1ea1ch m\u00e1u: \u0111\u1ed1i v\u1edbi m\u1ea1ch m\u00e1u l\u1edbn -> bu\u1ed9c 2 n\u00fat catgut, \u0111\u1ed1i v\u1edbi m\u1ea1ch m\u00e1u nh\u1ecf -> bu\u1ed9c 1 n\u00fat catgut. C\u1eaft ngang m\u1ee9c c\u01b0a x\u01b0\u01a1ng<\/p>\n
7) X\u1eed tr\u00ed th\u1ea7n kinh:<\/p>\n
– Nh\u1eb9 nh\u00e0ng ph\u1eabu t\u00edch l\u00ean cao, bu\u1ed9c 1 n\u00fat ch\u1ec9 lanh v\u00e0 c\u1eaft \u1edf d\u01b0\u1edbi n\u00fat ch\u1ec9 -> nh\u1eb1m v\u00f9i s\u00e2u m\u1ecfm c\u1ee5t TK trong t\u1ed5 ch\u1ee9c l\u00e0nh<\/p>\n
– \u0110\u1ed1i v\u1edbi c\u00e1c d\u00e2y TK l\u1edbn th\u00ec ph\u1ea3i ti\u00eam novocain 1% tr\u01b0\u1edbc khi c\u1eaft<\/p>\n
8) \u0110i\u1ec1u ch\u1ec9nh l\u1ea1i m\u1ecfm c\u1ee5t: th\u00e1o garo, c\u1ea7m m\u00e1u<\/p>\n
9) Kh\u00e2u k\u00edn m\u1ecfm c\u1ee5t, \u0111\u1eb7t 2 \u1ed1ng d\u1eabn l\u01b0u ra 2 b\u00ean m\u1ecfm c\u1ee5t<\/p>\n
C\u00e2u 10:\u00a0K\u1ef9 thu\u1eadt c\u1eaft c\u1ee5t \u0111\u00f9i 1\/3 gi\u1eefa?<\/b><\/p>\n
1) \u0110\u01b0\u1eddng r\u1ea1ch da:<\/p>\n
– R\u1ea1ch da v\u1ea1t tr\u01b0\u1edbc b\u1eaft \u0111\u1ea7u t\u1eeb 1 \u0111i\u1ec3m tr\u00ean \u0111\u01b0\u1eddng gi\u1eefa m\u1eb7t trong \u0111\u00f9i cao h\u01a1n m\u1ee9c c\u01b0a x\u01b0\u01a1ng 2 cm, r\u1ea1ch xu\u1ed1ng d\u01b0\u1edbi, ra tr\u01b0\u1edbc, v\u00f2ng l\u00ean tr\u00ean \u0111\u1ec3 c\u00f3 chi\u1ec1u d\u00e0i c\u1ee5t = 2R. Ti\u1ebfp t\u1ee5c \u0111i ra m\u1eb7t ngo\u00e0i \u0111\u00f9i, l\u00ean tr\u00ean, k\u1ebft th\u00fac \u1edf \u0111i\u1ec3m \u0111\u1ed1i x\u1ee9ng v\u1edbi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u<\/p>\n
– R\u1ea1ch n\u1ed1i 2 \u0111i\u1ec3m \u0111\u1ed1i x\u1ee9ng \u0111\u00f3 \u0111\u1ec3 c\u00f3 v\u1ea1t da t\u01b0\u01a1ng t\u1ef1 \u1edf ph\u00eda sau. L\u00f3c da v\u00e0 c\u00e2n l\u00ean tr\u00ean ngang m\u1ee9c c\u01b0a x\u01b0\u01a1ng<\/p>\n
2) X\u1eed tr\u00ed c\u01a1:<\/p>\n
– C\u1eaft ngang c\u00e1c c\u01a1 \u1edf v\u1ea1t tr\u01b0\u1edbc, r\u1ed3i v\u1ea1t sau, th\u1ea5p h\u01a1n m\u1ee9c c\u01b0a x\u01b0\u01a1ng 1.5 cm<\/p>\n
– N\u1ebfu mu\u1ed1n d\u00f9ng 1 l\u1edbp c\u01a1 m\u1ecfng \u0111\u1ec3 b\u1ecdc \u0111\u1ea7u m\u1ecfm c\u1ee5t th\u00ec c\u1eaft c\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i theo \u0111\u01b0\u1eddng r\u1ea1ch da, sau \u0111\u00f3 b\u00f3c 1 l\u1edbp c\u01a1 d\u00e0y 1.5 cm theo b\u1ec1 r\u1ed9ng c\u1ee7a v\u1ea1t da tr\u01b0\u1edbc, v\u1ea1t da sau c\u0169ng l\u00e0m t\u01b0\u01a1ng t\u1ef1<\/p>\n
– N\u1ebfu d\u00f9ng c\u01a1 \u0111\u1ed9n th\u00ec c\u1eaft c\u01a1 ngang m\u1ee9c da co r\u00fat (theo h\u01b0\u1edbng ch\u1ebfch 45o v\u1ec1 g\u1ed1c chi)<\/p>\n
3) C\u01b0a x\u01b0\u01a1ng:<\/p>\n
– D\u00f9ng \u0111\u0129a v\u00e9n c\u01a1 percy v\u00e9n c\u01a1 v\u1ec1 g\u1ed1c chi. C\u1eaft m\u00e0ng x\u01b0\u01a1ng, r\u00f3c m\u00e0ng x\u01b0\u01a1ng v\u1ec1 ph\u00eda d\u01b0\u1edbi<\/p>\n
– \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i l\u00e0 c\u00f3 \u0111\u01b0\u1eddng r\u00e1p \u1edf sau, kh\u00fac chi b\u1ecb c\u1eaft b\u1ecf l\u1ea1i n\u1eb7ng n\u00ean khi c\u01b0a x\u01b0\u01a1ng c\u1ea7n l\u01b0u \u00fd 2 \u0111i\u1ec1u:<\/p>\n
+ C\u01b0a x\u01b0\u01a1ng th\u1ea5p h\u01a1n n\u01a1i c\u1eaft m\u00e0ng x\u01b0\u01a1ng 5 mm t\u1eeb tr\u01b0\u1edbc ra sau, \u0111\u1ebfn khi s\u1eafp \u0111\u1ee9t -> \u0111\u1ed5i h\u01b0\u1edbng t\u1eeb trong ra ngo\u00e0i<\/p>\n
+ Tr\u1ee3 th\u1ee7 th\u1ee9 2 ph\u1ea3i \u0111\u1ee1 \u0111\u1ea7u chi \u0111\u1ec3 tr\u00e1nh m\u1ebb \u0111\u1ea7u x\u01b0\u01a1ng<\/p>\n
4) X\u1eed tr\u00ed m\u1ea1ch m\u00e1u, th\u1ea7n kinh:<\/p>\n
– T\u00ecm b\u00f3 m\u1ea1ch \u0111\u00f9i n\u00f4ng trong \u1ed1ng Hunter. Bu\u1ed9c ri\u00eang \u0110M, TM = 2 n\u00fat catgut ho\u1eb7c = 1 m\u0169i catgut v\u00e0 1 m\u0169i ch\u1ec9 lanh kh\u00e2u xuy\u00ean m\u1ea1ch \u1edf ph\u00eda d\u01b0\u1edbi<\/p>\n
– T\u00ecm d\u00e2y TK h\u00f4ng to \u1edf ph\u00eda tr\u01b0\u1edbc kh\u1ed1i c\u01a1 \u1ee5 ng\u1ed3i c\u1eb3ng ch\u00e2n (c\u01a1 b\u00e1n g\u00e2n, b\u00e1n m\u00e0ng), nh\u1eb9 nh\u00e0ng ph\u1eabu t\u00edch l\u00ean cao sau khi ti\u00eam novocain 1%, bu\u1ed9c 1 n\u00fat ch\u1ec9 lanh v\u00e0 c\u1eaft \u1edf d\u01b0\u1edbi n\u00fat ch\u1ec9 -> nh\u1eb1m v\u00f9i s\u00e2u m\u1ecfm c\u1ee5t TK trong t\u1ed5 ch\u1ee9c l\u00e0nh<\/p>\n
5) \u0110i\u1ec1u ch\u1ec9nh l\u1ea1i m\u1ecfm c\u1ee5t: th\u00e1o garo, c\u1ea7m m\u00e1u<\/p>\n
6) Kh\u00e2u m\u1ecfm c\u1ee5t:<\/p>\n
– L\u1edbp c\u01a1 s\u00e2u \u0111\u00e3 b\u00e1m v\u00e0o x\u01b0\u01a1ng -> kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i kh\u00e2u<\/p>\n
– Kh\u00e2u l\u1edbp c\u01a1 n\u00f4ng v\u00e0o l\u1edbp c\u01a1 s\u00e2u<\/p>\n
– N\u1ebfu d\u00f9ng c\u01a1 \u0111\u1ed9n th\u00ec kh\u00e2u theo t\u1eebng l\u1edbp, kh\u00e2u c\u00e1c c\u01a1 ph\u00eda tr\u01b0\u1edbc v\u1edbi c\u00e1c c\u01a1 ph\u00eda sau<\/p>\n
– Nh\u1ea5t thi\u1ebft ph\u1ea3i \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u (\u0111\u1eb7t 2 \u1ed1ng s\u00e1t x\u01b0\u01a1ng). N\u1ebfu d\u00f9ng c\u01a1 \u0111\u1ed9n: 1 \u1ed1ng \u0111\u1eb7t s\u00e1t x\u01b0\u01a1ng, 1 \u1ed1ng \u0111\u1eb7t d\u01b0\u1edbi da<\/p>\n
– Kh\u00e2u da<\/p>\n
C\u00e2u 11:\u00a0K\u1ef9 thu\u1eadt m\u1edf th\u00f4ng b\u00e0ng quang?<\/b><\/p>\n
1. Ch\u1ec9 \u0111\u1ecbnh<\/b><\/p>\n
– S\u1ecfi b\u00e0ng quang k\u1eb9t \u1edf c\u1ed5 b\u00e0ng quang v\u00e0 ni\u1ec7u \u0111\u1ea1o<\/p>\n
– Ung th\u01b0 c\u1ed5 b\u00e0ng quang, \u0111\u1ee9t ni\u1ec7u \u0111\u1ea1o, h\u1eb9p ni\u1ec7u \u0111\u1ea1o<\/p>\n
– U x\u01a1 TLT<\/p>\n
– T\u1ed5n th\u01b0\u01a1ng TKTW, TK ngo\u1ea1i bi\u00ean<\/p>\n
– Chu\u1ea9n b\u1ecb cho 1 th\u1ee7 thu\u1eadt ti\u1ebfp theo<\/p>\n
2. Chu\u1ea9n b\u1ecb<\/b><\/p>\n
– BN n\u1eb1m ng\u1eeda, ph\u1eabu thu\u1eadt vi\u00ean \u0111\u1ee9ng b\u00ean tr\u00e1i, ng\u01b0\u1eddi ph\u1ee5 \u0111\u1ee9ng b\u00ean \u0111\u1ed1i di\u1ec7n<\/p>\n
– V\u1ec7 sinh v\u00f9ng m\u1ed5, g\u00e2y t\u00ea ho\u1eb7c g\u00e2y m\u00ea<\/p>\n
3. C\u00e1c th\u00ec k\u1ef9 thu\u1eadt<\/b><\/p>\n
– Th\u00ec 1: r\u1ea1ch th\u00e0nh b\u1ee5ng<\/p>\n
1) R\u1ea1ch da b\u1eaft \u0111\u1ea7u t\u1eeb b\u1edd tr\u00ean kh\u1edbp mu theo \u0111\u01b0\u1eddng tr\u1eafng gi\u1eefa d\u00e0i 6-8 cm<\/p>\n
2) T\u00e1ch gi\u1eefa 2 c\u01a1 th\u1eb3ng to th\u1ea5y c\u00e2n r\u1ed1n tr\u01b0\u1edbc b\u00e0ng quang, m\u1edf c\u00e2n r\u1ed1n, \u0111\u1ea9y c\u00e2n r\u1ed1n l\u00ean tr\u00ean v\u1edbi t\u00fai c\u00f9ng<\/p>\n
3) D\u00f9ng metcher v\u00e0 farabeuf k\u00e9o ph\u00fac m\u1ea1c l\u00ean tr\u00ean<\/p>\n
– Th\u00ec 2: t\u00ecm b\u00e0ng quang<\/p>\n
Nh\u1eadn bi\u1ebft b\u00e0ng quang b\u1edfi 2 TM tr\u01b0\u1edbc b\u00e0ng quang, c\u00e1c th\u1edb c\u01a1 d\u1ecdc v\u00e0 \u0111\u1ed9 r\u1eafn ch\u1eafc c\u1ee7a b\u00e0ng quang ho\u1eb7c d\u00f9ng b\u01a1m kim ti\u00eam ch\u1ecdc h\u00fat th\u00ec c\u00f3 n\u01b0\u1edbc ti\u1ec3u<\/p>\n
– Th\u00ec 3: m\u1edf b\u00e0ng quang<\/p>\n
D\u00f9ng 2 k\u1eb9p chaput ho\u1eb7c kh\u00e2u 2 s\u1ee3i ch\u1ec9 \u1edf m\u1eb7t tr\u01b0\u1edbc b\u00e0ng quang, k\u00e9o b\u00e0ng quang s\u00e1t v\u1edbi th\u00e0nh b\u1ee5ng, r\u1ea1ch v\u00e0o b\u00e0ng quang d\u00e0i 3-4 cm, d\u00f9ng m\u00e1y h\u00fat h\u1ebft n\u01b0\u1edbc ti\u1ec3u<\/p>\n
– Th\u00ec 4: \u0111\u00e1nh gi\u00e1 v\u00e0 gi\u1ea3i quy\u1ebft t\u1ed5n th\u01b0\u01a1ng<\/p>\n
Ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng ng\u00f3n tr\u1ecf c\u1ee7a b\u00e0n tay ph\u1ea3i cho v\u00e0o b\u00e0ng quang l\u1ea5y s\u1ecfi, ki\u1ec3m tra ni\u00eam m\u1ea1c, c\u1ed5 b\u00e0ng quang v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf b\u00e0ng quang, kh\u00e2u t\u1ed5n th\u01b0\u01a1ng \u1edf b\u00e0ng quang\u2026<\/p>\n
– Th\u00ec 5: kh\u00e2u b\u00e0ng quang<\/p>\n
+ B\u00e0ng quang ko nhi\u1ec5m tr\u00f9ng, n\u01b0\u1edbc ti\u1ec3u trong, ni\u00eam m\u1ea1c b\u00ecnh th\u01b0\u1eddng: kh\u00e2u m\u0169i r\u1eddi v\u1ebft m\u1ed5, \u0111\u1eb7t 1 sonde ni\u1ec7u \u0111\u1ea1o d\u1eabn l\u01b0u n\u01b0\u1edbc ti\u1ec3u<\/p>\n
+ B\u00e0ng quang b\u1ecb nhi\u1ec5m tr\u00f9ng, n\u01b0\u1edbc ti\u1ec3u \u0111\u1ee5c, ni\u00eam m\u1ea1c ph\u00f9 n\u1ec1: \u0111\u1eb7t 1 sonde pezze qua v\u1ebft m\u1ed5 v\u00e0o b\u00e0ng quang, kh\u00e2u m\u0169i r\u1eddi v\u1ebft m\u1ed5<\/p>\n
+ Kh\u00e2u \u0111\u00ednh b\u00e0ng quang v\u00e0o c\u00e1c l\u1edbp c\u01a1 c\u1ee7a th\u00e0nh b\u1ee5ng, \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u v\u00e0o khoang Retzius, \u0111\u00f3ng b\u1ee5ng<\/p>\n
4. Tai bi\u1ebfn<\/b><\/p>\n
– M\u1edf nh\u1ea7m v\u00e0o ph\u00fac m\u1ea1c<\/p>\n
– Nhi\u1ec5m tr\u00f9ng khoang Retzius<\/p>\n
C\u00e2u 12:\u00a0C\u1eaft \u0111o\u1ea1n x\u01b0\u01a1ng s\u01b0\u1eddn?<\/b><\/p>\n
1. Ch\u1ec9 \u0111\u1ecbnh<\/b><\/p>\n
– L\u00e0 giai \u0111o\u1ea1n \u0111\u1ea7u ti\u00ean \u0111\u1ec3 ti\u1ebfn h\u00e0nh c\u00e1c th\u1ee7 thu\u1eadt trong l\u1ed3ng ng\u1ef1c<\/p>\n
– Trong tr\u01b0\u1eddng h\u1ee3p th\u1ee7 thu\u1eadt v\u1ec1 th\u1eadn kh\u00f3: ta c\u00f3 th\u1ec3 c\u1eaft 1-2 x\u01b0\u01a1ng s\u01b0\u1eddn (XI, XII)<\/p>\n
2. C\u00e1c th\u00ec k\u1ef9 thu\u1eadt<\/b><\/p>\n
– Th\u00ec 1: r\u1ea1ch ph\u1ea7n m\u1ec1m<\/p>\n
+ \u0110\u01b0\u1eddng r\u1ea1ch d\u00e0i 3-10 cm, song song v\u1edbi h\u01b0\u1edbng \u0111i c\u1ee7a x\u01b0\u01a1ng s\u01b0\u1eddn<\/p>\n
+ N\u1ebfu c\u1eaft nhi\u1ec1u x\u01b0\u01a1ng s\u01b0\u1eddn c\u00f9ng l\u00fac: ta c\u00f3 th\u1ec3 r\u1ea1ch th\u00e0nh 1 v\u1ea1t ph\u1ea7n m\u1ec1m, h\u00ecnh th\u1ec3 thay \u0111\u1ed5i t\u00f9y theo s\u1ed1 l\u01b0\u1ee3ng x\u01b0\u01a1ng s\u01b0\u1eddn \u0111\u1ecbnh c\u1eaft<\/p>\n
– Th\u00ec 2: t\u00e1ch m\u00e0ng x\u01b0\u01a1ng ra kh\u1ecfi x\u01b0\u01a1ng s\u01b0\u1eddn<\/p>\n
1) R\u1ea1ch m\u00e0ng x\u01b0\u01a1ng:<\/p>\n
+ D\u00f9ng ng\u00f3n 1, 2 c\u1ee7a b\u00e0n tay tr\u00e1i: c\u1ed1 \u0111\u1ecbnh b\u1edd tr\u00ean v\u00e0 b\u1edd d\u01b0\u1edbi x\u01b0\u01a1ng s\u01b0\u1eddn<\/p>\n
+ R\u1ea1ch m\u00e0ng x\u01b0\u01a1ng theo \u0111\u01b0\u1eddng ch\u00ednh gi\u1eefa m\u1eb7t ngo\u00e0i x\u01b0\u01a1ng s\u01b0\u1eddn + \u0111\u00fang chi\u1ec1u d\u00e0i \u0111o\u1ea1n x\u01b0\u01a1ng \u0111\u1ecbnh c\u1eaft<\/p>\n
2) T\u00e1ch m\u1eb7t ngo\u00e0i m\u00e0ng x\u01b0\u01a1ng:<\/p>\n
D\u00f9ng tu\u1ed1t s\u01b0\u1eddn th\u1eb3ng t\u00e1ch nh\u1eb9 t\u1eeb sau ra tr\u01b0\u1edbc, t\u1eeb tr\u01b0\u1edbc ra sau cho \u0111\u1ebfn t\u1eadn b\u1edd tr\u00ean v\u00e0 b\u1edd d\u01b0\u1edbi x\u01b0\u01a1ng s\u01b0\u1eddn<\/p>\n
3) T\u00e1ch b\u1edd tr\u00ean v\u00e0 b\u1edd d\u01b0\u1edbi m\u00e0ng x\u01b0\u01a1ng:<\/p>\n
+ D\u00f9ng tu\u1ed1t s\u01b0\u1eddn cong (ch\u00fa \u00fd h\u01b0\u1edbng \u0111i c\u1ee7a c\u01a1 li\u00ean s\u01b0\u1eddn)<\/p>\n
+ B\u1edd tr\u00ean: t\u00e1ch t\u1eeb sau ra tr\u01b0\u1edbc<\/p>\n
+ B\u1edd d\u01b0\u1edbi: t\u00e1ch t\u1eeb tr\u01b0\u1edbc ra sau<\/p>\n
+ Thao t\u00e1c nh\u1eb9 nh\u00e0ng, kh\u00f4ng \u0111\u1ec3 tu\u1ed1t s\u01b0\u1eddn tr\u01b0\u1ee3t v\u00e0o trong l\u00e0m r\u00e1ch m\u00e0ng ph\u1ed5i<\/p>\n
4) T\u00e1ch m\u1eb7t trong m\u00e0ng x\u01b0\u01a1ng:<\/p>\n
+ D\u00f9ng tu\u1ed1t s\u01b0\u1eddn cong (t\u00e1ch t\u1eeb 1-2 cm)<\/p>\n
+ Sau \u0111\u00f3 d\u00f9ng tu\u1ed1t s\u01b0\u1eddn Doyen: t\u00e1ch nh\u1eb9 t\u1eeb sau ra tr\u01b0\u1edbc, t\u1eeb tr\u01b0\u1edbc ra sau \u0111\u1ec3 m\u00e0ng x\u01b0\u01a1ng r\u1eddi kh\u1ecfi m\u1eb7t trong d\u1ec5 d\u00e0ng, kh\u00f4ng l\u00e0m t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u v\u00e0 th\u1ea7n kinh<\/p>\n
– Th\u00ec 3: c\u1eaft x\u01b0\u01a1ng s\u01b0\u1eddn<\/p>\n
D\u00f9ng dao c\u1eaft s\u01b0\u1eddn, khi t\u00e1ch m\u00e0ng x\u01b0\u01a1ng \u0111\u1ebfn \u0111\u00e2u th\u00ec c\u1eaft x\u01b0\u01a1ng s\u01b0\u1eddn \u0111\u1ebfn \u0111\u00f3, c\u1eaft ph\u00eda sau r\u1ed3i \u0111\u1ebfn ph\u00eda tr\u01b0\u1edbc, \u0111\u01b0\u1eddng c\u1eaft vu\u00f4ng g\u00f3c v\u1edbi tr\u1ee5c c\u1ee7a x\u01b0\u01a1ng s\u01b0\u1eddn<\/p>\n
Ch\u00fa \u00fd:<\/i>\u00a0khi r\u1ea1ch v\u00e0 t\u00e1ch m\u00e0ng x\u01b0\u01a1ng th\u01b0\u1eddng hay ch\u1ea3y m\u00e1u: d\u00f9ng huy\u1ebft thanh \u1ea5m + oxy gi\u00e0 \u0111\u1eafp v\u00e0o \u0111o\u1ea1n x\u01b0\u01a1ng s\u01b0\u1eddn \u0111\u1ecbnh c\u1eaft, sau \u00edt ph\u00fat th\u00ec m\u00e1u c\u1ea7m l\u1ea1i, n\u1ebfu m\u00e1u c\u00f2n ch\u1ea3y th\u00ec kh\u00e2u c\u1ea7m m\u00e1u<\/p>\n
C\u00e2u 13:\u00a0M\u1edf b\u1ee5ng theo \u0111\u01b0\u1eddng tr\u1eafng gi\u1eefa tr\u00ean r\u1ed1n?<\/b><\/p>\n
1) Chu\u1ea9n b\u1ecb:<\/p>\n
– BN n\u1eb1m ng\u1eeda, k\u00ea g\u1ed1i \u1edf l\u01b0ng, ph\u1eabu thu\u1eadt vi\u00ean \u0111\u1ee9ng b\u00ean ph\u1ea3i, ng\u01b0\u1eddi ph\u1ee5 \u0111\u1ee9ng b\u00ean \u0111\u1ed1i di\u1ec7n, ng\u01b0\u1eddi th\u1ee9 2 \u0111\u1ee9ng b\u00ean tr\u00e1i ph\u1eabu thu\u1eadt vi\u00ean<\/p>\n
– V\u1ec7 sinh v\u00f9ng m\u1ed5, g\u00e2y t\u00ea ho\u1eb7c g\u00e2y m\u00ea<\/p>\n
2) C\u00e1c th\u00ec k\u1ef9 thu\u1eadt:<\/p>\n
– Th\u00ec 1: r\u1ea1ch da<\/p>\n
\u0110\u01b0\u1eddng r\u1ea1ch b\u1eaft \u0111\u1ea7u t\u1eeb m\u0169i \u1ee9c theo \u0111\u01b0\u1eddng tr\u1eafng gi\u1eefa \u0111\u1ebfn r\u1ed1n, l\u00fac kh\u1edfi \u0111\u1ea7u v\u00e0 k\u1ebft th\u00fac d\u1ef1ng \u0111\u1ee9ng m\u0169i dao<\/p>\n
– Th\u00ec 2: r\u1ea1ch c\u00e2n theo \u0111\u01b0\u1eddng r\u1ea1ch da<\/p>\n
– Th\u00ec 3: m\u1edf ph\u00fac m\u1ea1c<\/p>\n
+ Ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng k\u1eb9p ph\u1eabu t\u00edch, ng\u01b0\u1eddi ph\u1ee5 d\u00f9ng kocher: n\u00e2ng v\u00e0 r\u1ea1ch ph\u00fac m\u1ea1c d\u00e0i 3-5 cm<\/p>\n
+ M\u1edf r\u1ed9ng ph\u00fac m\u1ea1c l\u00ean tr\u00ean: ph\u1eabu thu\u1eadt vi\u00ean + ng\u01b0\u1eddi ph\u1ee5 d\u00f9ng ng\u00f3n tr\u1ecf c\u1ee7a b\u00e0n tay tr\u00e1i n\u00e2ng ph\u00fac m\u1ea1c l\u00ean r\u1ed3i d\u00f9ng k\u00e9o c\u1eaft<\/p>\n
+ M\u1edf r\u1ed9ng ph\u00fac m\u1ea1c xu\u1ed1ng d\u01b0\u1edbi: ph\u1eabu thu\u1eadt vi\u00ean d\u00f9ng ng\u00f3n tr\u1ecf v\u00e0 ng\u00f3n gi\u1eefa c\u1ee7a b\u00e0n tay tr\u00e1i n\u00e2ng ph\u00fac m\u1ea1c l\u00ean r\u1ed3i d\u00f9ng k\u00e9o c\u1eaft<\/p>\n
C\u00e2u 14:\u00a0\u0110\u00f3ng th\u00e0nh b\u1ee5ng?<\/b><\/p>\n
Theo ph\u01b0\u01a1ng ph\u00e1p m\u1ed9t l\u1edbp, hai l\u1edbp, ba l\u1edbp:<\/p>\n
1 l\u1edbp<\/p>\n
Kh\u00e2u da, c\u00e2n, c\u01a1, ph\u00fac m\u1ea1c = ch\u1ec9 kim lo\u1ea1i ho\u1eb7c ch\u1ec9 perlon<\/p>\n
2 l\u1edbp<\/p>\n
Th\u01b0\u1eddng \u1edf \u0111\u01b0\u1eddng tr\u1eafng gi\u1eefa tr\u00ean r\u1ed1n<\/p>\n
+ L\u1edbp 1: kh\u00e2u c\u00e2n, c\u01a1, ph\u00fac m\u1ea1c<\/p>\n
+ L\u1edbp 2: kh\u00e2u da<\/p>\n
3 l\u1edbp<\/p>\n
+ L\u1edbp m\u1ed9t: kh\u00e2u ph\u00fac m\u1ea1c = ch\u1ec9 catgut (ch\u1ec9 t\u1ef1 ti\u00eau)<\/p>\n
+ L\u1edbp hai: kh\u00e2u c\u00e2n, c\u01a1 b\u1eb1ng ch\u1ec9 perlon (ch\u1ec9 kh\u00f4ng ti\u00eau)<\/p>\n
+ L\u1edbp ba: kh\u00e2u da b\u1eb1ng ch\u1ec9 kh\u00f4ng ti\u00eau (lin, l\u1ee5a, nilon)<\/p>\n
C\u00e2u 15:\u00a0Tr\u00ecnh b\u00e0y c\u00e1c ph\u1eabu thu\u1eadt tr\u00ean \u1ed1ng ti\u00eau h\u00f3a?<\/b><\/p>\n
1. Kh\u00e2u c\u00e1c l\u1ed7 th\u1ee7ng ru\u1ed9t<\/b><\/p>\n
1) L\u1ed7 th\u1ee7ng nh\u1ecf: b\u1edd g\u1ecdn, s\u1ea1ch -> l\u00e0m 1 m\u0169i kh\u00e2u h\u00ecnh t\u00fai<\/p>\n
2) L\u1ed7 th\u1ee7ng v\u1eeba:<\/p>\n
– Kh\u00e2u m\u0169i ch\u1eef X<\/p>\n
– Kh\u00e2u v\u00f9i = m\u0169i kh\u00e2u h\u00ecnh t\u00fai<\/p>\n
3) L\u1ed7 th\u1ee7ng to: kh\u00e2u m\u0169i r\u1eddi vu\u00f4ng g\u00f3c v\u1edbi tr\u1ee5c c\u1ee7a ru\u1ed9t<\/p>\n
4) V\u1ebft r\u00e1ch ru\u1ed9t: n\u1ebfu v\u1ebft r\u00e1ch c\u00f3 b\u1edd nham nh\u1edf th\u00ec x\u00e9n m\u00e9p cho g\u1ecdn, l\u00e0m 2 m\u0169i kh\u00e2u c\u01a1 s\u1edf, c\u0103ng ngang v\u1ebft r\u00e1ch \u0111\u1ec3 kh\u00e2u k\u00edn theo chi\u1ec1u ngang (bi\u1ebfn d\u1ecdc th\u00e0nh ngang)<\/p>\n
2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e2u n\u1ed1i ru\u1ed9t:<\/b>\u00a0c\u00e2u 2<\/p>\n
C\u00e2u 16:\u00a0\u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 c\u1eaft c\u1ee5t chi?<\/b><\/p>\n
1) Y\u00eau c\u1ea7u: lo\u1ea1i b\u1ecf 1 \u0111o\u1ea1n chi mang b\u1ec7nh, chi c\u00f3 d\u1ecb d\u1ea1ng, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho BN mang \u0111\u01b0\u1ee3c chi gi\u1ea3 ho\u1ea1t \u0111\u1ed9ng t\u1ed1t. 2 \u0111i\u1ec1u ki\u1ec7n c\u1ee7a 1 m\u1ecfm c\u1ee5t t\u1ed1t (\u0111\u1ec3 s\u1eed d\u1ee5ng chi gi\u1ea3):<\/p>\n
– M\u1ecfm c\u1ee5t ph\u1ea3i l\u00e0nh l\u1eb7n, kh\u00f4ng \u0111au, s\u1eb9o nh\u1ecf, kh\u1edbp ph\u00eda tr\u00ean ho\u1ea1t \u0111\u1ed9ng t\u1ed1t<\/p>\n
– M\u1ecfm c\u1ee5t c\u00f3 chi\u1ec1u d\u00e0i th\u00edch \u0111\u00e1ng l\u00e0 m\u1ecfm c\u1ee5t c\u00f3 c\u00e1nh tay \u0111\u00f2n \u0111\u1ee7 kh\u1ecfe, s\u1eed d\u1ee5ng chi gi\u1ea3 kh\u00f4ng b\u1ecb h\u1ea1n ch\u1ebf (g\u1ecdi l\u00e0 chi\u1ec1u d\u00e0i l\u00fd t\u01b0\u1edfng). M\u1ecfm c\u1ee5t ko c\u00f3 chi\u1ec1u d\u00e0i l\u00fd t\u01b0\u1edfng nh\u01b0ng l\u1eafp v\u00e0 s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c chi gi\u1ea3 (g\u1ecdi l\u00e0 chi\u1ec1u d\u00e0i c\u00f3 \u00edch). Khi m\u1ecfm c\u1ee5t ng\u1eafn qu\u00e1 ho\u1eb7c d\u00e0i qu\u00e1 l\u00e0m c\u1ea3n tr\u1edf l\u1eafp v\u00e0 s\u1eed d\u1ee5ng chi gi\u1ea3 (g\u1ecdi l\u00e0 chi\u1ec1u d\u00e0i kh\u00f3 s\u1eed d\u1ee5ng)<\/p>\n
2) K\u1ef9 thu\u1eadt c\u1eaft c\u1ee5t c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o:<\/p>\n
– Tu\u1ed5i<\/p>\n
– Lo\u1ea1i b\u1ec7nh<\/p>\n
– Ho\u00e0n c\u1ea3nh kinh t\u1ebf x\u00e3 h\u1ed9i, \u0111i\u1ec1u ki\u1ec7n sinh ho\u1ea1t t\u01b0\u01a1ng lai, nguy\u1ec7n v\u1ecdng c\u1ee7a BN<\/p>\n
3) Ph\u00e2n lo\u1ea1i: 2 lo\u1ea1i<\/p>\n
– C\u1eaft c\u1ee5t \u0111\u1ec3 h\u1edf: ch\u1ee7 y\u1ebfu l\u00e0 c\u1ee9u s\u1ed1ng t\u00ednh m\u1ea1ng BN, ph\u1eabu thu\u1eadt ph\u1ea3i \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh nhanh v\u00e0 \u0111\u01a1n gi\u1ea3n, y\u00eau c\u1ea7u l\u1eafp \u0111\u01b0\u1ee3c chi gi\u1ea3 tr\u1edf th\u00e0nh th\u1ee9 y\u1ebfu<\/p>\n
– C\u1eaft c\u1ee5t \u0111\u00f3ng k\u00edn: \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n theo k\u1ebf ho\u1ea1ch, ti\u1ebfn h\u00e0nh th\u1eadn tr\u1ecdng, t\u00ednh to\u00e1n ch\u00ednh x\u00e1c, \u0111\u1ea3m b\u1ea3o c\u00e1c ti\u00eau chu\u1ea9n \u0111\u1ec3 l\u1eafp chi gi\u1ea3<\/p>\n
4) Sinh l\u00fd c\u1ee7a m\u1ecfm c\u1ee5t:<\/p>\n
– Da:<\/p>\n
+ Hi\u1ec7n t\u01b0\u1ee3ng co r\u00fat: x\u1ea3y ra s\u1edbm, chi\u1ec1u d\u00e0i co r\u00fat ph\u1ee5 thu\u1ed9c v\u00e0o t\u1eebng v\u00f9ng<\/p>\n
+ Hi\u1ec7n t\u01b0\u1ee3ng r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng: ph\u00f9 n\u1ec1 trong th\u1eddi gian \u0111\u1ea7u, sau \u0111\u00f3 gi\u1ea3m \u0111i v\u00e0 ti\u1ebfn t\u1edbi l\u00e0nh s\u1eb9o. N\u1ebfu da b\u1ecb \u0111\u1ee5ng d\u1eadp ho\u1eb7c thi\u1ebfu s\u1ef1 ch\u0103m s\u00f3c: ph\u00f9 n\u1ec1 k\u00e9o d\u00e0i l\u00e0m da bi\u1ebfn \u0111\u1ed5i m\u00e0u s\u1eafc, n\u1eb7ng h\u01a1n s\u1ebd d\u1eabn t\u1edbi lo\u00e9t<\/p>\n
– C\u01a1:<\/p>\n
+ Hi\u1ec7n t\u01b0\u1ee3ng co r\u00fat: x\u1ea3y ra s\u1edbm, l\u1edbp c\u01a1 n\u00f4ng co nhi\u1ec1u h\u01a1n l\u1edbp c\u01a1 s\u00e2u<\/p>\n
+ Hi\u1ec7n t\u01b0\u1ee3ng r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng: ph\u00f9 n\u1ec1 trong th\u1eddi gian \u0111\u1ea7u, sau \u0111\u00f3 gi\u1ea3m \u0111i (th\u1ea5y r\u00f5 hi\u1ec7n t\u01b0\u1ee3ng teo c\u01a1). N\u1ebfu c\u01a1 b\u1ecb \u0111\u1ee5ng d\u1eadp th\u00ec c\u00f3 th\u1ec3 d\u1eabn t\u1edbi x\u01a1 h\u00f3a<\/p>\n
– M\u1ea1ch m\u00e1u: teo nh\u1ecf d\u1ea7n l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 nu\u00f4i d\u01b0\u1ee1ng m\u1ecfm c\u1ee5t<\/p>\n
– Th\u1ea7n kinh: c\u00e1c tr\u1ee5 tr\u1ee5c TK m\u1ecdc d\u00e0i ra, n\u1ebfu x\u1eed tr\u00ed kh\u00f4ng t\u1ed1t: v\u1ec1 sau c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n u TK -> g\u00e2y \u0111au cho m\u1ecfm c\u1ee5t<\/p>\n
– X\u01b0\u01a1ng:<\/p>\n
+ \u1ede ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh: x\u01b0\u01a1ng m\u1ea5t v\u00f4i, d\u1ea7n tr\u1edf n\u00ean x\u1ed1p v\u00e0 teo nh\u1ecf<\/p>\n
+ \u1ede tr\u1ebb con: x\u01b0\u01a1ng v\u1eabn ti\u1ebfp t\u1ee5c ph\u00e1t tri\u1ec3n v\u1ec1 chi\u1ec1u d\u00e0i -> ch\u00f2i ra ngo\u00e0i v\u00e0 ph\u1ea3i s\u1eeda l\u1ea1i m\u1ecfm c\u1ee5t<\/p>\n
5) D\u1ee5ng c\u1ee5 ri\u00eang trong c\u1eaft c\u1ee5t:<\/p>\n
– Dao: 1 dao d\u00e0i 15-20 cm + 1 dao c\u00f3 s\u1ed1ng d\u00e0y \u0111\u1ec3 th\u00e1o kh\u1edbp<\/p>\n
– C\u01b0a: c\u01b0a con \u0111\u1ec3 c\u01b0a c\u00e1c x\u01b0\u01a1ng nh\u1ecf, c\u01b0a khung \u0111\u1ec3 c\u01b0a c\u00e1c x\u01b0\u01a1ng l\u1edbn<\/p>\n
– K\u00ecm g\u1eb7m x\u01b0\u01a1ng: c\u1eaft c\u00e1c x\u01b0\u01a1ng nh\u1ecf ho\u1eb7c s\u1eeda \u0111\u1ea7u x\u01b0\u01a1ng<\/p>\n
– R\u00f3c x\u01b0\u01a1ng v\u00e0 n\u1ea1o x\u01b0\u01a1ng<\/p>\n
– R\u0169a<\/p>\n
– \u0110\u0129a v\u00e9n c\u01a1 percy ho\u1eb7c 1 vu\u00f4ng v\u1ea3i c\u00f3 2-3 d\u1ea3i<\/p>\n
C\u00e2u 17:\u00a0Tr\u00ecnh b\u00e0y nh\u1eefng \u0111i\u1ec1u c\u01a1 b\u1ea3n \u0111\u1ec3 x\u1eed tr\u00ed v\u1ebft th\u01b0\u01a1ng m\u1ea1ch m\u00e1u?<\/b><\/p>\n
1. \u0110\u01b0\u1eddng r\u1ea1ch da v\u00e0o \u0110M<\/b><\/p>\n
– Trong tr\u01b0\u1eddng h\u1ee3p cho ph\u00e9p: r\u1ea1ch theo \u0111\u01b0\u1eddng \u0111\u1ecbnh h\u01b0\u1edbng c\u1ee7a \u0110M<\/p>\n
– Khi t\u1ed5n th\u01b0\u01a1ng qu\u00e1 r\u1ed9ng: \u0111\u01b0\u1eddng r\u1ea1ch ph\u1ea3i d\u1ef1a v\u00e0o m\u1ed1i li\u00ean quan v\u1ec1 gi\u1ea3i ph\u1eabu tr\u00ean \u0111\u01b0\u1eddng \u0111\u1ecbnh h\u01b0\u1edbng \u0111\u1ec3 t\u00ecm \u0110M (\u0110M b\u1ecb \u0111\u1ee9t, co l\u1ea1i v\u00e0 t\u1ee5t v\u00e0o s\u00e2u b\u00ean trong)<\/p>\n
– \u0110\u01b0\u1eddng r\u1ea1ch ph\u1ea3i t\u00f4n tr\u1ecdng c\u00e1c ng\u00e0nh b\u00ean v\u00e0 ng\u00e0nh n\u1ed1i \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng ph\u00eda d\u01b0\u1edbi c\u1ee7a chi<\/p>\n
2. Gi\u1ea3i quy\u1ebft t\u1ed5n th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m:\u00a0<\/b>c\u1eaft l\u1ecdc h\u1ebft t\u1ed5 ch\u1ee9c d\u1eadp n\u00e1t<\/p>\n
– \u0110\u1ed1i v\u1edbi da: n\u1ebfu thi\u1ebfu da th\u00ec v\u1ec1 sau gh\u00e9p da, \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o l\u01b0u th\u00f4ng m\u1ea1ch m\u00e1u t\u1ed1t c\u1ea7n \u0111\u01b0\u1ee3c quay v\u1ea1t da (theo nguy\u00ean t\u1eafc v\u1ebft th\u01b0\u01a1ng h\u1edf ko kh\u00e2u k\u00edn)<\/p>\n
– \u0110\u1ed1i v\u1edbi c\u01a1: c\u1eaft l\u1ecdc h\u1ebft t\u1ed5 ch\u1ee9c d\u1eadp n\u00e1t (cho \u0111\u1ebfn khi r\u1edbm m\u00e1u l\u00e0 \u0111\u01b0\u1ee3c), n\u1ebfu cho ph\u00e9p: l\u00e0m \u0111i\u1ec7n sinh l\u00fd c\u01a1 (khi c\u01a1 co gi\u1eadt l\u00e0 \u0111\u1ebfn t\u1ed5 ch\u1ee9c l\u00e0nh), l\u1ea5y h\u1ebft c\u00e1c d\u1ecb v\u1eadt g\u1ea7n m\u1ea1ch m\u00e1u. Ch\u00fa \u00fd: lu\u00f4n \u0111\u1ec3 da h\u1edf v\u00e0 gi\u1ea3i quy\u1ebft \u1edf th\u00ec 2: kh\u00e2u ho\u1eb7c gh\u00e9p da<\/p>\n
3. Ki\u1ec3m tra, nh\u1eadn x\u00e9t t\u1ed5n th\u01b0\u01a1ng \u0111\u1ec3 c\u00f3 th\u00e1i \u0111\u1ed9 x\u1eed tr\u00ed<\/b><\/p>\n
– M\u1ea1ch m\u00e1u c\u00f3 th\u1ec3 b\u1ecb \u0111\u1ee9t 1 ph\u1ea7n hay to\u00e0n ph\u1ea7n: n\u1ebfu ko s\u01a1 c\u1ee9u s\u1ebd d\u1eabn t\u1edbi t\u1eed vong, n\u1ebfu \u0111\u01b0\u1ee3c s\u01a1 c\u1ee9u t\u1ed1t (garo, b\u0103ng \u00e9p) th\u00ec k\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt s\u1ebd t\u1ed1t. C\u00f3 khi t\u1ef1 c\u1ea7m m\u00e1u \u0111\u01b0\u1ee3c nh\u1edd c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng (\u1edf nh\u1eefng m\u1ea1ch m\u00e1u TB v\u00e0 nh\u1ecf, nh\u1ea5t l\u00e0 nh\u1eefng n\u01a1i c\u00f3 l\u1edbp c\u01a1 d\u00e0y che ph\u1ee7)<\/p>\n
– Khi t\u1ed5n th\u01b0\u01a1ng \u1edf d\u1ea1ng \u0111\u1ee5ng d\u1eadp: \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn l\u1edbp n\u1ed9i m\u1ea1c g\u00e2y co th\u1eaft ho\u1eb7c t\u1eafc m\u1ea1ch<\/p>\n
C\u00e2u 18:\u00a0Ch\u1ec9 \u0111\u1ecbnh v\u00e0 nh\u1eefng \u0111i\u1ec3m c\u01a1 b\u1ea3n trong b\u1ed9c l\u1ed9 \u0111\u1ed9ng m\u1ea1ch?<\/b><\/p>\n
1. Ch\u1ec9 \u0111\u1ecbnh b\u1ed9c l\u1ed9 \u0110M<\/b><\/p>\n
– \u0110\u1ec3 x\u1eed tr\u00ed c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u<\/p>\n
– \u0110\u1ec3 x\u1eed tr\u00ed c\u00e1c di ch\u1ee9ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u: ph\u00ecnh \u0111\u1ed9ng t\u0129nh m\u1ea1ch\u2026<\/p>\n
– \u0110\u1ec3 x\u1eed tr\u00ed c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eafc m\u1ea1ch<\/p>\n
– \u0110\u1ec3 c\u1eaft m\u1ea1ng l\u01b0\u1edbi TK giao c\u1ea3m quanh \u0110M<\/p>\n
– \u0110\u1ec3 c\u1ea7m m\u00e1u t\u1ea1m th\u1eddi ph\u00eda tr\u00ean khi ti\u1ebfn h\u00e0nh 1 th\u1ee7 thu\u1eadt (\u1edf v\u00f9ng s\u00e2u) g\u1eb7p tai bi\u1ebfn ch\u1ea3y m\u00e1u<\/p>\n
2. Nh\u1eefng \u0111i\u1ec3m c\u01a1 b\u1ea3n trong b\u1ed9c l\u1ed9 \u0110M<\/b><\/p>\n
1) V\u1ec1 gi\u1ea3i ph\u1eabu:<\/p>\n
– \u0110M c\u00f3 nguy\u00ean \u1ee7y, \u0111\u01b0\u1eddng \u0111i v\u00e0 t\u1eadn c\u00f9ng, \u0111\u01b0\u1eddng \u0111\u1ecbnh h\u01b0\u1edbng l\u00e0 \u0111\u01b0\u1eddng \u0111i c\u1ee7a \u0110M. D\u1ef1a tr\u00ean \u0111\u01b0\u1eddng \u0111\u1ecbnh h\u01b0\u1edbng \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1eddng r\u1ea1ch da v\u00e0o \u0110M thu\u1eadn l\u1ee3i, kh\u00f4ng b\u1ecb l\u1ea1c v\u00e0 \u00edt nguy hi\u1ec3m<\/p>\n
– D\u1ef1a tr\u00ean c\u00e1c m\u1ed1c, c\u00e1c li\u00ean quan m\u1eadt thi\u1ebft v\u1edbi \u0110M: ta tu\u1ea7n t\u1ef1 l\u1ea7n t\u1edbi \u0110M. Th\u01b0\u1eddng th\u00ec 1 \u0110M bao gi\u1edd c\u0169ng c\u00f3 c\u01a1 t\u00f9y h\u00e0nh (m\u1ed1c qu\u00fd nh\u1ea5t)<\/p>\n
– 1 \u0110M l\u1edbn th\u01b0\u1eddng l\u00e0 tr\u1ee5c c\u1ee7a 1 b\u00f3 m\u1ea1ch TK. Khi b\u1ed9c l\u1ed9: c\u00e1c thao t\u00e1c tr\u00e1nh l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn TK v\u00e0 TM<\/p>\n
– C\u00e1c ng\u00e0nh b\u00ean v\u00e0 ng\u00e0nh n\u1ed1i c\u1ee7a \u0110M gi\u00fap ta hi\u1ec3u \u0111\u01b0\u1ee3c s\u1ef1 t\u00e1i l\u1eadp tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 sau khi \u0110M b\u1ecb th\u1eaft<\/p>\n
2) C\u1ea5u tr\u00fac c\u1ee7a \u0110M: g\u1ed3m 3 l\u1edbp \u00e1o<\/p>\n
– L\u1edbp \u00e1o ngo\u00e0i: g\u1ed3m t\u1ed5 ch\u1ee9c x\u01a1 v\u00e0 m\u1ea1ng l\u01b0\u1edbi TK giao c\u1ea3m<\/p>\n
+ Khi \u0110M b\u1ecb c\u1eaft \u0111\u1ee9t: l\u1edbp \u00e1o ngo\u00e0i co \u00edt n\u00ean bao tr\u00f9m l\u00ean 2 l\u1edbp c\u00f2n l\u1ea1i<\/p>\n
+ Trong th\u1ee7 thu\u1eadt kh\u00e2u \u0110M: n\u1ebfu \u0111\u1ec3 l\u1edbp \u00e1o ngo\u00e0i l\u1ed9n v\u00e0o trong \u0111\u01b0\u1eddng kh\u00e2u th\u00ec s\u1ebd g\u00e2y huy\u1ebft kh\u1ed1i<\/p>\n
+ Trong th\u1ee7 thu\u1eadt th\u1eaft \u0110M: ph\u1ea3i th\u1eaft \u1edf d\u01b0\u1edbi l\u1edbp \u00e1o ngo\u00e0i<\/p>\n
– L\u1edbp \u00e1o gi\u1eefa: g\u1ed3m c\u00e1c th\u1edb c\u01a1<\/p>\n
Khi \u0110M b\u1ecb c\u1eaft \u0111\u1ee9t: l\u1edbp \u00e1o gi\u1eefa co l\u1ea1i, thu h\u1eb9p kh\u1ea9u k\u00ednh -> t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng b\u1ecbt k\u00edn \u0110M<\/p>\n
– L\u1edbp \u00e1o trong:<\/p>\n
Khi ch\u1ea5n th\u01b0\u01a1ng: l\u1edbp \u00e1o trong d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng, h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i l\u00e0m t\u1eafc \u0110M<\/p>\n
3) K\u1ef9 thu\u1eadt b\u1ed9c l\u1ed9 \u0110M: tuy m\u1ed7i \u0110M c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m ri\u00eang v\u1ec1 gi\u1ea3i ph\u1eabu, nh\u01b0ng \u0111\u1ec3 b\u1ed9c l\u1ed9 b\u1ea5t k\u1ef3 1 \u0110M n\u00e0o c\u0169ng ph\u1ea3i \u0111i nh\u1eefng b\u01b0\u1edbc gi\u1ed1ng nhau:<\/p>\n
– K\u1ebb \u0111\u01b0\u1eddng \u0111\u1ecbnh h\u01b0\u1edbng c\u1ee7a \u0110M<\/p>\n
– R\u1ea1ch da v\u00e0 c\u00e2n theo tr\u1ee5c c\u1ee7a \u0111\u01b0\u1eddng \u0111\u1ecbnh h\u01b0\u1edbng<\/p>\n
– T\u00f9y theo c\u01a1 t\u00f9y h\u00e0nh v\u00e0 c\u00e1c m\u1ed1c \u0111\u1ec3 l\u1ea7n t\u1edbi \u0110M<\/p>\n
– B\u1ed9c l\u1ed9 v\u00e0 t\u00e1ch tr\u1ea7n \u0110M<\/p>\n
C\u00e2u 19:\u00a0M\u1edf m\u00e0ng ph\u1ed5i?<\/b><\/p>\n
1. Ch\u1ec9 \u0111\u1ecbnh<\/b><\/p>\n
– D\u1eabn l\u01b0u m\u1ee7 (vi\u00eam m\u00e0ng ph\u1ed5i m\u1ee7) v\u00e0 m\u00e1u (ch\u1ea5n th\u01b0\u01a1ng l\u1ed3ng ng\u1ef1c)<\/p>\n
– D\u1eabn l\u01b0u kh\u00ed (TKMP)<\/p>\n
2. Nguy\u00ean t\u1eafc<\/b><\/p>\n
– Chu\u1ea9n b\u1ecb BN: ch\u1ee5p ph\u1ed5i, ch\u1ecdc h\u00fat th\u0103m d\u00f2 tr\u01b0\u1edbc<\/p>\n
– Ch\u1ecdn v\u1ecb tr\u00ed m\u1edf m\u00e0ng ph\u1ed5i: \u0111i\u1ec3m giao nhau gi\u1eefa khoang li\u00ean s\u01b0\u1eddn 8 v\u00e0 \u0111\u01b0\u1eddng n\u00e1ch gi\u1eefa<\/p>\n
3. K\u1ef9 thu\u1eadt<\/b><\/p>\n
1) M\u1edf m\u00e0ng ph\u1ed5i t\u1ed1i thi\u1ec3u:<\/p>\n
– D\u1ee5ng c\u1ee5:<\/p>\n
+ Tr\u00f4ca<\/p>\n
+ 1 \u1ed1ng d\u1eabn l\u01b0u b\u1eb1ng cao su, sonde nelaton<\/p>\n
+ 1 d\u00e2y cao su d\u00e0i 1 m<\/p>\n
+ 1 l\u1ecd th\u1ee7y tinh c\u00f3 chia \u0111\u1ed9 t\u1eeb 500 ml \u0111\u1ebfn 1 lit<\/p>\n
– T\u01b0 th\u1ebf BN: ng\u1ed3i quay l\u01b0ng v\u1ec1 ph\u00eda ph\u1eabu thu\u1eadt vi\u00ean<\/p>\n
– C\u00e1c th\u00ec k\u1ef9 thu\u1eadt:<\/p>\n
+ Th\u00ec 1: g\u00e2y t\u00ea, r\u1ea1ch da d\u00e0i 1 cm, ch\u1ecdc tr\u00f4ca qua KLS (v\u1eeba ch\u1ecdc v\u1eeba xoay)<\/p>\n
+ Th\u00ec 2: l\u1ea5y kocher k\u1eb9p \u1ed1ng d\u1eabn l\u01b0u r\u1ed3i lu\u1ed3n qua tr\u00f4ca v\u00e0o trong khoang m\u00e0ng ph\u1ed5i. R\u00fat t\u1eeb t\u1eeb tr\u00f4ca ra ngo\u00e0i<\/p>\n
+ Th\u00ec 3: kh\u00e2u c\u1ed1 \u0111\u1ecbnh \u1ed1ng d\u1eabn l\u01b0u (= ch\u1ec9 lanh), kh\u00e2u ph\u1ea7n m\u1ec1m<\/p>\n
– Thay \u0111\u1ed5i k\u1ef9 thu\u1eadt: n\u1ebfu ko c\u00f3 tr\u00f4ca, d\u00f9ng dao r\u1ea1ch t\u1eeb t\u1eeb qua da v\u00e0 c\u01a1, \u0111i s\u00e1t b\u1edd tr\u00ean c\u1ee7a x\u01b0\u01a1ng s\u01b0\u1eddn v\u00e0o trong KMP r\u1ed3i l\u1ea5y kocher cong k\u1eb9p \u1ed1ng d\u1eabn l\u01b0u \u0111\u01b0a v\u00e0o<\/p>\n
2) M\u1edf m\u00e0ng ph\u1ed5i c\u00f3 c\u1eaft \u0111o\u1ea1n x\u01b0\u01a1ng s\u01b0\u1eddn:<\/p>\n
– Ch\u1ec9 \u0111\u1ecbnh: khi c\u00f3 m\u1ee7 \u0111\u1eb7c, ko d\u1eabn l\u01b0u \u0111\u01b0\u1ee3c qua KLS<\/p>\n
– K\u1ef9 thu\u1eadt:<\/p>\n
+ C\u1eaft \u0111o\u1ea1n x\u01b0\u01a1ng s\u01b0\u1eddn 3-5 cm<\/p>\n
+ R\u1ea1ch m\u00e0ng ph\u1ed5i -> d\u00f9ng kocher banh r\u1ed9ng v\u1ebft r\u1ea1ch ho\u1eb7c d\u00f9ng ng\u00f3n tay tr\u1ecf l\u1ea5y m\u1ee7 \u0111\u1ecdng -> \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u to -> kh\u00e2u c\u1ed1 \u0111\u1ecbnh \u1ed1ng d\u1eabn l\u01b0u (= ch\u1ec9 lanh), kh\u00e2u ph\u1ea7n m\u1ec1m<\/p>\n
C\u00e2u 20:\u00a0K\u1ef9 thu\u1eadt b\u1ed9c l\u1ed9 \u0110M c\u1ea3nh?<\/b><\/p>\n
1. Chu\u1ea9n b\u1ecb<\/b><\/p>\n
– BN n\u1eb1m ng\u1eeda v\u00e0 quay \u0111\u1ea7u sang b\u00ean \u0111\u1ed1i di\u1ec7n, ph\u1eabu thu\u1eadt vi\u00ean \u0111\u1ee9ng b\u00ean c\u1ea7n b\u1ed9c l\u1ed9, ng\u01b0\u1eddi ph\u1ee5 \u0111\u1ee9ng b\u00ean \u0111\u1ed1i di\u1ec7n<\/p>\n
– V\u1ec7 sinh v\u00f9ng m\u1ed5, g\u00e2y t\u00ea ho\u1eb7c g\u00e2y m\u00ea<\/p>\n
2. K\u1ef9 thu\u1eadt<\/b><\/p>\n
– X\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1eddng r\u1ea1ch da: d\u1ecdc theo b\u1edd tr\u01b0\u1edbc c\u01a1 \u1ee9c \u0111\u00f2n ch\u0169m, t\u1eeb h\u00f5m \u1ee9c t\u1edbi x\u01b0\u01a1ng ch\u0169m<\/p>\n
– R\u1ea1ch da theo \u0111\u01b0\u1eddng \u0111\u00e3 x\u00e1c \u0111\u1ecbnh<\/p>\n
– G\u1eb7p TM c\u1ea3nh ngo\u00e0i: th\u1eaft v\u00e0 c\u1eaft<\/p>\n
– G\u1eb7p c\u00e2n c\u1ed5 n\u00f4ng: m\u1edf c\u00e2n c\u1ed5 n\u00f4ng<\/p>\n
– V\u00e9n c\u01a1 \u1ee9c \u0111\u00f2n ch\u0169m ra ngo\u00e0i s\u1ebd th\u1ea5y c\u00e2n c\u1ed5 gi\u1eefa<\/p>\n
– M\u1edf c\u00e2n c\u1ed5 gi\u1eefa s\u1ebd th\u1ea5y c\u01a1 2 th\u00e2n v\u00e0 TM c\u1ea3nh trong<\/p>\n
– Th\u1eaft v\u00e0 c\u1eaft TM gi\u00e1p l\u01b0\u1ee1i m\u1eb7t (nh\u00e1nh c\u1ee7a TM c\u1ea3nh trong), v\u00e9n TM c\u1ea3nh trong ra ngo\u00e0i s\u1ebd th\u1ea5y \u0110M c\u1ea3nh chung<\/p>\n
– Ph\u1eabu t\u00edch l\u00ean cao s\u1ebd th\u1ea5y n\u01a1i chia \u0111\u00f4i c\u1ee7a \u0110M c\u1ea3nh chung: \u0110M c\u1ea3nh ngo\u00e0i n\u1eb1m ph\u00eda tr\u01b0\u1edbc trong v\u00e0 chia nh\u00e1nh<\/p>\n","protected":false},"excerpt":{"rendered":"
C\u00e2u 1:\u00a0K\u1ef9 thu\u1eadt kh\u00e2u n\u1ed1i \u1ed1ng ti\u00eau h\u00f3a? 1. C\u00e1c \u0111i\u1ec1u ki\u1ec7n c\u1ea7n c\u00f3 c\u1ee7a 1 \u0111\u01b0\u1eddng kh\u00e2u t\u1ed1t 1) \u0110\u01b0\u1eddng kh\u00e2u ph\u1ea3i k\u00edn, trung b\u00ecnh 1 cm 3 m\u0169i 2) \u0110\u01b0\u1eddng kh\u00e2u ph\u1ea3i ch\u1eafc, kh\u00f4ng b\u1ecb b\u1ee5c ch\u1ec9 Ph\u1ee5 thu\u1ed9c v\u00e0o: – T\u00ecnh tr\u1ea1ng nu\u00f4i d\u01b0\u1ee1ng \u1edf th\u00e0nh ru\u1ed9t – T\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng …<\/p>\n","protected":false},"author":10,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30,42,132],"tags":[],"class_list":["post-2053","post","type-post","status-publish","format-standard","","category-mon-co-so","category-mon-ky-nang","category-phau-thuat-thuc-hanh-mon-co-so"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2053","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=2053"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2053\/revisions"}],"predecessor-version":[{"id":2054,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2053\/revisions\/2054"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2053"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2053"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2053"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}