{"id":812,"date":"2021-08-29T15:31:59","date_gmt":"2021-08-29T15:31:59","guid":{"rendered":"http:\/\/phauthuatnhi.vn\/vi\/?p=812"},"modified":"2021-08-29T15:32:03","modified_gmt":"2021-08-29T15:32:03","slug":"chan-thuong-tuy-o-tre-em","status":"publish","type":"post","link":"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/chan-thuong-tuy-o-tre-em\/","title":{"rendered":"Ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y \u1edf tr\u1ebb em"},"content":{"rendered":"\n<p class=\"has-medium-font-size\"><strong>\u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/p>\n\n\n\n<ul><li>Ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y chi\u1ebfm 3 \u2013 12 % c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng k\u00edn \u1edf tr\u1ebb em. C\u01a1 ch\u1ebf th\u01b0\u1eddng da tai n\u1ea1n \u00f4 t\u00f4 hay xe \u0111\u1ea1p.<\/li><li>Do l\u00e0 t\u1ea1ng n\u1eb1m sau ph\u00fac m\u1ea1c, \u0111\u01b0\u1ee3c c\u00e1c t\u1ea1ng kh\u00e1c che ph\u1ee7, n\u00ean th\u01b0\u1eddng kh\u00f3 ch\u1ea9n \u0111o\u00e1n v\u00e0 d\u1ec5 b\u1ecf s\u00f3t th\u01b0\u01a1ng t\u1ed5n.<\/li><li>T\u1ec9 l\u1ec7 t\u1eed vong v\u1eabn cao \u1edf ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y m\u1ee9c \u0111\u1ed9 n\u1eb7ng.<\/li><li>Ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y kh\u00f4ng th\u01b0\u1eddng g\u1eb7p v\u00e0 th\u01b0\u1eddng k\u00e8m v\u1edbi t\u1ed5n th\u01b0\u01a1ng kh\u00e1c.<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Ph\u00e2n \u0111\u1ed9<\/strong><\/p>\n\n\n\n<p><strong>B\u1ea3ng 1: Ph\u00e2n \u0111\u1ed9 ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y theo AAST<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" width=\"818\" height=\"255\" src=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-tuy-1.jpg\" alt=\"\" class=\"wp-image-819\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-tuy-1.jpg 818w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-tuy-1-300x94.jpg 300w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-tuy-1-768x239.jpg 768w\" sizes=\"(max-width: 818px) 100vw, 818px\" \/><\/figure>\n\n\n\n<p><strong>\u00a0<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" width=\"500\" height=\"438\" src=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-tuy-2.jpg\" alt=\"\" class=\"wp-image-820\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-tuy-2.jpg 500w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-tuy-2-300x263.jpg 300w\" sizes=\"(max-width: 500px) 100vw, 500px\" \/><figcaption><strong>H\u00ecnh 1: Ph\u00e2n \u0111\u1ed9 ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y theo AAST<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n\n\n\n<ul><li>C\u01a1 ch\u1ebf, th\u1eddi \u0111i\u1ec3m ch\u1ea5n th\u01b0\u01a1ng.<\/li><li>Tri\u1ec7u ch\u1ee9ng x\u1ea3y ra sau khi b\u1ecb ch\u1ea5n th\u01b0\u01a1ng (\u0111au b\u1ee5ng, n\u00f4n\u2026).<\/li><li>S\u01a1 c\u1ee9u ban \u0111\u1ea7u \u0111\u00e3 th\u1ef1c hi\u1ec7n.<\/li><li>Ti\u1ec1n c\u0103n: b\u1ec7nh n\u1ec1n, ph\u1eabu thu\u1eadt tr\u01b0\u1edbc \u0111\u00f3.<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Kh\u00e1m:<\/strong><\/p>\n\n\n\n<ul><li>D\u1ea5u hi\u1ec7u sinh t\u1ed3n, c\u00f3 th\u1ec3 s\u1ed1c m\u1ea5t m\u00e1u<\/li><li>V\u1ebft b\u1ea7m, t\u1ee5 m\u00e1u, tr\u1ea7y x\u01b0\u1edbc, l\u1ed7 v\u1ebft th\u01b0\u01a1ng, b\u1ee5ng tr\u01b0\u1edbng.<\/li><li>V\u1ebft b\u1ea7m, t\u1ee5 m\u00e1u, tr\u1ea7y x\u01b0\u1edbc, b\u1ea7m m\u00e1u v\u00f9ng th\u01b0\u1ee3ng v\u1ecb.<\/li><li>Th\u0103m kh\u00e1m to\u00e0n di\u1ec7n tr\u00e1nh b\u1ecf s\u00f3t th\u01b0\u01a1ng t\u1ed5n kh\u00e1c k\u00e8m theo.<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m c\u1ea7n l\u00e0m?<\/strong><\/p>\n\n\n\n<ul><li>M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m m\u00e1u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng m\u1ea5t m\u00e1u, c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111i k\u00e8m.<\/li><li>Si\u00eau \u00e2m b\u1ee5ng: cho h\u00ecnh \u1ea3nh g\u1ee3i \u00fd \u0111\u00e1nh gi\u00e1 nhu m\u00f4 t\u1ee5y v\u00e0 m\u1ee9c \u0111\u1ed9 ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y, c\u00e1c t\u1ea1ng kh\u00e1c k\u00e8m theo, nh\u01b0ng \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1eb7c hi\u1ec7u kh\u00f4ng cao.<\/li><li>XQuang d\u1ea1 d\u00e0y-t\u00e1 tr\u00e0ng c\u00f3 c\u1ea3n quang c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi nghi ng\u1edd t\u1ed5n th\u01b0\u01a1ng v\u00f9ng t\u00e1 tr\u00e0ng \u0111i k\u00e8m<\/li><li>Ch\u1ee5p CT scan s\u1edbm cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 b\u1ec7nh s\u1eed v\u00e0 th\u0103m kh\u00e1m nghi ng\u1edd ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y (\u0111\u1ed9 nh\u1ea1y 69-100%).<\/li><li>ERCP cho ph\u00e9p x\u00e1c \u0111\u1ecbnh r\u00f5 t\u00ecnh tr\u1ea1ng v\u00e0 v\u1ecb tr\u00ed th\u01b0\u01a1ng t\u1ed5n c\u1ee7a \u1ed1ng t\u1ee5y. \u0110\u1eb7t stent \u1ed1ng t\u1ee5y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n qua ERCP trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ch\u1ecdn l\u1ecdc.<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>\u0110i\u1ec1u tr\u1ecb<\/strong><\/p>\n\n\n\n<ul><li>\u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n v\u1edbi dinh d\u01b0\u1ee1ng t\u0129nh m\u1ea1ch ho\u00e0n to\u00e0n \u0111\u01b0\u1ee3c xem l\u00e0 \u0111i\u1ec1u tr\u1ecb ti\u00eau ch\u1ea9n v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y.<\/li><li>Cho \u0103n s\u1edbm qua th\u00f4ng m\u0169i d\u1ea1 d\u00e0y- h\u1ed7ng tr\u00e0ng ho\u1eb7c qua m\u1edf h\u1ed7ng tr\u00e0ng ra da.<\/li><li>K\u1ebft h\u1ee3p kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng, gi\u1ea3m \u0111au.<\/li><li>Octreotide \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 gi\u1ea3m bi\u1ebfn ch\u1ee9ng r\u00f2 t\u1ee5y.<\/li><li>PPIs \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u01b0\u1eddng quy v\u1edbi nhi\u1ec1u l\u1ee3i \u00edch.<ul><li>Gi\u1ea3m vi\u00eam t\u1ee5y.<\/li><li>Gi\u1ea3m nguy c\u01a1 vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y tr\u00ean b\u1ec7nh nh\u00e2n nh\u1ecbn \u0103n \u0111\u01b0\u1eddng mi\u1ec7ng l\u00e2u ng\u00e0y.<\/li><li>Gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a men t\u1ee5y tr\u1ef1c ti\u1ebfp v\u00e0o c\u00e1c ti\u1ec3u \u0111\u1ea3o t\u1ee5y v\u00e0 \u1ed1ng t\u1ee5y.<\/li><\/ul><\/li><li>ERCP gi\u00fap ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 \u0111\u1eb7t stent cho t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng cao.<\/li><\/ul>\n\n\n\n<p><strong>Khi n\u00e0o c\u1ea7n \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/strong><\/p>\n\n\n\n<ul><li>V\u1ea5n \u0111\u1ec1 \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c \u0111\u1eb7t ra khi ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y m\u1ee9c \u0111\u1ed9 III, IV, V t\u00f9y di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng, huy\u1ebft \u0111\u1ed9ng, c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt c\u1eaft ph\u1ea7n xa c\u1ee7a t\u1ee5y, b\u1ea3o t\u1ed3n l\u00e1ch.<\/li><\/ul>\n\n\n\n<p><strong>Ti\u00ean l\u01b0\u1ee3ng<\/strong><\/p>\n\n\n\n<ul><li>H\u1ea7u h\u1ebft \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n cho k\u1ebft qu\u1ea3 t\u1ed1t n\u1ebfu t\u00ecnh tr\u1ea1ng ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y kh\u00f4ng \u1ea3nh h\u01b0\u1edfng huy\u1ebft \u0111\u1ed9ng.<\/li><li>R\u00f2 t\u1ee5y l\u00e0 bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t sau \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt trong ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y. Di\u1ec5n ti\u1ebfn \u1ed5n \u0111\u1ecbnh sau d\u1eabn l\u01b0u ra da 1-2 tu\u1ea7n.<\/li><li>C\u00f3 10-25% tr\u01b0\u1eddng h\u1ee3p h\u00ecnh th\u00e0nh \u00e1p xe quanh t\u1ee5y, s\u1ebd \u0111\u01b0\u1ee3c d\u1eabn l\u01b0u qua da v\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m.<\/li><li>Nang gi\u1ea3 t\u1ee5y c\u00f3 th\u1ec3 h\u00ecnh th\u00e0nh sau nhi\u1ec1u tu\u1ea7n, nhi\u1ec1u th\u00e1ng sau ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y (tham kh\u1ea3m th\u00eam trong b\u00e0i nang gi\u1ea3 t\u1ee5y)<\/li><\/ul>\n\n\n\n<p><strong><em>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/em><\/strong><\/p>\n\n\n\n<ul><li>Alain Abdo, Niraj Jani and Steven C Cunningham. Pancreatic duct disruption and nonoperative management: the SEALANTS approach. Hepatobiliary Pancreat Dis Int,Vol-12, No.3\u00a0 June 15.<\/li><li>Brian R. Englum, Brian C. Gulack, Henry E. Rice, John E. Scarborough, Obinna O. Adibe. Management of blunt pancreatic trauma in children: Review of the National Trauma Data Bank. Journal of Pediatric Surgery 51 (2016) 1526\u20131531.<\/li><li>Calogero Iacono, Marianna Zicari , Simone Conci, Alessandro Valdegamberi, Michela De Angelis, Corrado Pedrazzani, Andrea Ruzzenente, Alfredo Guglielmi. Management of pancreatic trauma: A pancreatic surgeon&#8217;s point of view, Pancreatology (2015).<\/li><li>E. Degiannis *, M. Glapa, S.P. Loukogeorgakis, M.D. Smith. Management of pancreatic trauma. Injury, Int. J. Care Injured (2008) 39, 21\u201429.<\/li><li>Kjetil S\u00f8reide, Thomas G. Weiser, Rowan W. Parks. Clinical update on management of pancreatic trauma. International Hepato-Pancreato-Biliary Association (2018);1-10.<\/li><li>Waibek BH, Rotondo MMF. Damage control surgery: it\u2019s evolution over the last 20 years. Rev Col Bras Cir. 2012; 39: 314\u2013321.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<div class=\"mh-excerpt\"><p>\u0110\u1ea1i c\u01b0\u01a1ng Ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y chi\u1ebfm 3 \u2013 12 % c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng k\u00edn \u1edf tr\u1ebb em. C\u01a1 ch\u1ebf th\u01b0\u1eddng da tai n\u1ea1n \u00f4 t\u00f4 hay xe \u0111\u1ea1p. Do l\u00e0 t\u1ea1ng n\u1eb1m <a class=\"mh-excerpt-more\" href=\"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/chan-thuong-tuy-o-tre-em\/\" title=\"Ch\u1ea5n th\u01b0\u01a1ng t\u1ee5y \u1edf tr\u1ebb em\">[&#8230;]<\/a><\/p>\n<\/div>","protected":false},"author":4,"featured_media":821,"comment_status":"open","ping_status":"open","sticky":false,"template":"template-full.php","format":"standard","meta":[],"categories":[4,16],"tags":[],"_links":{"self":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/812"}],"collection":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/comments?post=812"}],"version-history":[{"count":2,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/812\/revisions"}],"predecessor-version":[{"id":822,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/812\/revisions\/822"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media\/821"}],"wp:attachment":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media?parent=812"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/categories?post=812"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/tags?post=812"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}