Những khái niệm về giải phẫu In vivo và nội soi (Phần 2) pot

Kham
cae
t~ng
trong
khoang
thfm
b~ng
dyng
cy
ChAn
dOkll1
x:ic
dinh
t1nldng kh
6ng
the:
(h,lt
dltr.;lC
neu
chI
dl,la
vuo
Iduim
him
sang,
do
(16
nhicu
phtldng
ph~lP
tham

khcim
bdng
dUl1g
ell
dft dltl;lc elva
vao
th
Vc
hnnh
tlnJ
ang
quy
nhli
nhung
phlwng
ph<lP bl'h buc)c
phai
thl.1!:
hi¢n
d~
ph:'l.t
hi~n
b¢nh
t~t;
trong
so'
nhting
phltang
phcl.p
nay

chung
t6i
s5
m6
l~l
IlHjt
~O
phlidng
phLl.P
hay
du'(1c
slt
d~
l
nl-:"
nh£l"t.
Di
~
n
ta
m d o: La
p!nidng
ph
up
thflm
khftm
eho
phep
phat
hl¢n

chiQc
nhilng
ton
tlHCdng
l'l
la
nJ
tim
ho:;ic
CllH
cae d(J/lg
m(
l ch
l'e/nll,
VU
X<lC
ctjnh dllqc
nhttng
ki~u
rOlioQII
"hip
lim.
Di
~ll
lam
dJ
lohe
hi~n
hai mQt
dlidng

ghl.
ll'en
d6
ng
ttai
ta
d{lI1h
nhung
mo'l: kh6.c
nhall
b&ng
InQl
sO'
eha
cil.i
hI
p,
Q.
I{,
S.
T :
nhung
thay
d6i
nay
i:'t
do
muc
di~n
tht;'phAt

sinh
hili
cd
lim,
ma
may
di~n
tam
do
g:hi
chtr.;lc
d
CIII':
giai
dm)n
kh{IC
nhau
trong
moi t.:hu
ky
co bop
cun
tim
(con
gqi lit
clw
hy
11111).
Khung
thay

d6i
eUH
muc
dit?1l
the
nay
:\u:"lt
hi~n
If
l do
hi~n
tLfgng
hlLli
q/c
vu tcii
('I/('
(ho~('
t5i
ph:ln
elje)
trong
hOl.ll
d9ng
ella
1('
boo
ni
tim.
• S6f1g P
phnt

sinh
do
hi~n
tugng
khi't
ct.te
<1
lam
nhi.
song
nay
co
dt}
clai
0,11
gifty,
V{I
c6
bien
uQ
cao
:1
Illlll.
-
DO(J11
P-R
th~
hi(m
khoang
thai

gian
giib
Itic
het
khlt
cljc
d
t{lm
nht
va bfit
dati
ldllt
cljt
d Inm
th~lt.
-
Plllk
hd
QRS
nAIl1
trong
khoang
QRS
L·Un.
qUl'\
lrinh
hill/
q/c
tJ
lam

lhit"i.
- DOl/II
ST
th6
hi~n
slj
ket
thuc
Jdllt
C{/e
(j
'am
tho", va
b:1t
dati IOI cl/c
(lai
phan
CLJC).
Tlwo
deh
d6. ngtfdi
ta
phan
bi~t
ba
pha:
pho
/(jill
IIhl.
pha

xUIlg
dj~ll
tham
nh(ip
VllO
COl"
t6m
lIlli"t.
vI'!
pha
thooi
lui.
T
rang
nhung
tnldng
hgp
b~nh
]5'.
lhi
til/Ollg
gill
(ti~;l1
liim
drl
th~
hi~n
cltfOi
nhicu
d;.lIl~

tI~)('
hit;!u kh:il.:
nhau,
eho
pllE!p
d\,fn
van
nlll"
lng d,)c
diem
d6 Illa
eh~n
ctO:l1l
cae
b¢nh
eua
lilll
(hinh
378.
379).
Chl;tp
m{l
c h
C,6
the
phin
hi~.n
dug
e
nhung

bi!nh
tim
bam
sillh,hol)c
I1UtC
phdi.
Ch{J.p
X
quang
mqch
e6
the
kh6ng
ch(J1L
ll,)('
ho(le ch(1n
lQc,
tuy
thea
dung
djeh
thuoc
can
Quang
dugc
t
icm
vao mt}t
fillh
mach

I/go(J.i
ui
ho~(:
dua
qua
mi)t
6ng
thong
catheter
iuon
VilO
trang
h~
tht/flg til1h II/(lch
cllll
ire"
ho~c
chii
dltiJ.i.
Dung
d!
ch
iad
d
nhi~t
d(J
cd
lhe
va
VCJi

nong
d9
70(0'0
dttcjc
dua
vao
tlnh
m~ch
b~ng
m(it
bdm
tiam
tlj
dQng
dUCJi
ilp.
h,rc
5-7
kg!
Clll~.
Sau
2-3
gifly
lhi
co
the
chyp
dtfQc tim
phdi
~

sau
4-5
giilY
thi
chl,lp
du
cjc
cite
mqch
pluji.
va
sau
7-'
giay
thi
chl,lp
dLtgC
hlnh
anh
ClIO
c:ic
a"h
m(lcll
pilOt
va
tim
trcii.
•
•
Hinh

378.
Ca
sCI
giai
ph
au
h9C
cu.
di~n
lam
do
1
Nul
xoang-nhi
(nut
Keith-Flack):
2
Vecta
khu
eve
a
t3m
nhi:
3
Nut
nhT·lhat(nut
Tawara)4.
B6
HIs;
5.

VectakhU-Cl,rcavach
tim;
6.
Veeta
cu6i
khli
cvc
a
lam
th~l
;
7
Vecta
tai
ei/C
(t:ji
phan
cl/C);
8.
VeelakhCri
phal
khii
elfe
adTnh
lim
va
tam
lt1~t
Iral
Hinh

379.
Ill/ilng
ghi
di~n
lam
do
binh
Ihlli1ng
Thong
tim:
Cho
phep
tham
do tn,tc
1I6p C:1C
bluing
tim.
do
ap
hjc
trong
tim
(ap
Il,fC
tnmg
tam
nhl
va
tam
th(i't).

va
trong
m;.lch
(trong
r1¢ng
lnC!ch
phdi
va
trong
mao
lII(l('h
pha'i).
Thong
tim
cung
cho
phep
dua
vi\O
tim
cac
chat
uin
quang
va
chat
dbng
vi
ph6ng
xa.

cung
nhu'
lay
mau
mau
d~
dinh
. .
lUQng citc
khi
d
trong
miw
eua
tim
phdi
hOrlC
clla
(t(mg
m(Ich
ph//i.
,
can
Quang
C{)
thk
luon
mQt
catheter
\',\0

tl'ong
mOt
tlnh
n1(Ich a
uung
nep
khuyu,
l'oi
du'(l}
s1,l'
thea
dOl
bang
x
quang,
dfly
eng
th6ng
nay
v,lo
t{Ji
anI> m(Ich du:Ji rion
rai
vao
tlnh
lnQ-ch
chu
trCi~
va
v:10

tim
phai.
Tu
!lIn
phrii
con
c6
th6
d5y
tiep
ong
thong
vao
dr.!nR
In(lch ph6'i.
Sau
khi
dAu
ong
thong
da
V,'IO t(Ji
v~
ll'i
dV
ainh,
thi
ngU:di
ta
rut

ra
m()t ltiQng
mau
nh/)
dn
thiet
d~
dinh
IU:Qng
C{IC
khi
oxy
va
khi
carhonic,
rai
do
ap
IVc
d
hl'll
tl'Ong
long
11l1.H:h
ho(l.c
trong
huong
tim.
Do
{lp

lu'c
trong
tim
cung
d'lP
nhung
so
lieu
co
'Y'
ngl~la
dk chrin
donn
b9nh
tim
d
d,
kh~a
tim
m'.H:h
Hin
khoa
pho'i.
Phli(Jng'
phap
thong
tim
md
dall
bdi

FOl':-,:-;m<ln
(1929)
va
sau
d6
bdi
Cournard
va
1{'lng\.!s
(]~H1),
di'i
dUQc
Bradley
va
(3rnndjean
cili
tien:
cac
tac
giil.
nay
SlJ
dl,lng
['I·t/UJllg
tim,
ngh'la
la
dung
mQt
kim

tiem
cd l(in
h(m
de
ch(JC
tlnh
m(Ich.
roi
luon
qua
lhng
clla
kim
tiem
nay
melt
catheter
rat
mem,
nh6.
c6
rtudng
bnh
1
mm,
dai
130 em.
Gng
thr"ll1g'
catheter

dUQc
d.1y
thea
dong
mau
vao
teJl
nhung
buo'ng
tim
va
toi
cit
dong
mach
phi/i.
Voi
thli
thuQ.t
nay
b~nh
nh'an
e6 'thk
chill
dl,jng telt,
khong
gay
roi
lo?n
dang

kk
eho
hOI.1t
ctQng-
cua
tim,
v:\ co
thd
lam
1"i
ne'u cAn
thiet
(hlnh
380,
:381).
Ch\lp
phe
quan:
Du'<jc
thvc
hi~n
b~ng
(';\('h (tu'a
m¢t
chat
can
Quang
(lipiodol)
vao
Hong

cny
phi':'
quan;
chl,lp
phe
quan
cho
phep
HIm
r6
ban
chat
eua
nhung
t6'n
thuong
n,\m
6
vung
vuot
qui,
t:lm
cua
ky
thuut
soi
pli(/
quan
(n(li
~oi

phe
quan),
va
do d6
eho
ph6p
phi,t
hi¢n
dUQc
nhling
uSn
thuong
ma
chVP X
quang
truyen
thong
khong
ph
at
hi9n
dUQC.
ChlJp
pM/
quan
dUQc
chi
dinh
trong
tat

ca
cile
trudng
hQp
nghi
ngd
kho\
u
phi
quan·phoi,
ginn
phe
quan,
hang
phe
qu::i.n
va
hyp
phe
quan.
Tuy
nhien,
ky
thuQ.t
nay
co nhuQc
diJm
la
tQ.o
thuQ.n

Ie;!i
cho
nhi€;m
khu~n
va
x~p
ph6'i
(hlnh
382,
383).
Trudc
khi
th\lc
hi~n
chlJp
phi
quan,
thi
b~t
bUQc
phili
soi
thanh
quan,
nhAm
philt
hi9n
t6'n
thuong
co

th~
co a day
than
kinh
qu~it
ngU:~jc
(tieng
noi
hai
giQng),
va
bang
cach
nay
lo?i
tru
dUQc
nhung
kh6
khan
cho
th8.y
thuoe
kham
b¢nh.
Soi
phe
quan:
La
phuong

phap
t6t
nha't
d~
tham
kham
khi
quan
va
nhung
phi
quan
goe
va
phi
quan
thuy
cua
ph6'i.
Soi
phe'
quan
hay
dU:Qc
511
dl,lng
trong
khoa
ph6'i
va

khoa
phftu
thu.(it
long
ng1,l'c,
nh.§.m
lam
r6
ban
chat
cua
nhung
vet
md
kh6ng
diJn
hinh
tren
cite
phim
X
quang
chVP
long
ngvc.
Vdi ml,le
dfch
nay,
ngudi
ta

sU'
dy.ng
ong
soi
pM/
quan
mflm
(hlnh
384),
ong
nay
cho
phep
chvp
anh
nhling
hinh
:lnh
nhin
thay
khi
soi,
lay
di v(l.t
roi
vao
cay
khi-phf/
quan,
va

lam
sinh
thief
cac
mo
benh,
tham
chi
riot
riifn
d@
dieu
tri
mQt
so
k'h6i u
~he'
quan
Hmh
tinh
(hinh
;385).
D@
tien
hanh
soi
phe'
quan,
can
phai

hi~u
biet
kg
ve
d~nh
khu
cua
thanh
quan.
5V
phan
bo
cua
cay
phe'
quan
va
kich
thu:dc
cua
nhung
10
qua
d6
dinh
luon
ong
soi.
NQi
soi

thljc
quan-d~
day-ruQt:
Da
trd
thanh
mQt
phuong
phap
tham
kham
th\!e
hanh
thudng
quy,
nhC!
c6 mQt
dVng
Cl,l
vdi
cha't
lU:Qng
ky
thw}t
cao
dUQc
dua
vilo
S11
dvng,

cho
phep
phat
hi~n
du'r;lc
nhung
t6'n
thuong
nha
nhat.
DVng
Cl,l
dl1Qc
dua
vao
th1,l'e
hanh
dau
tic.n
la
o'ng soi
d{L
day
nita
me'm
eua
Schindler
(1932),
tiep
sau

d6
la
ong
soi
riC!
day sqi
Quang
hr;c
cua
Hirschowitz
(1958).
roi
tdi
61~g
soi k(/t
trang
cua
Overholt
(1960)
va
Wi
nay
la
nhGng
dlj.ng
Clj.
sqi
Quang
h9C
uJi

"anh
sang
[r;wh".
Nfji soi
d(}
ddy-rufjt,
kh6ng
nhGng
co
tac
dVng
kh~ng
dinh
nhung
t6'n
thuong
do
X
quang
phat
hi~n,
ma
con
eho
phep
chfln
doan
dUQe
tbn
thuong

tren
nhGng
di~n
tich
nh6,
va
nh$n
dinh
dUQC
tinh
tr"ng
cua
cac
mo
d
quanh
tbn
thuong.
Ngoai
ra,
soi
d(}
day-ru(Jt
con
cho
phep
lam
sinh
thiet
va

th<)m
chi
dieu
tri
(vi
dv
H(y
di
v$t,
dot
di~n
cac
khoi
u Elllh
tinh,
v

v )
(hinh
386·390).
383
Hinh
380
.
Thong
tim:
chat
can
quang
da

vilo
Uri
tam
that
phai
(chyp
tam
that)
Hinh
381.
Thong
tim:
chat
can
quang
da
vilo
tai
cac
d¢ng
m~ch
vilnh
(c
h
yp
m~ch
van
h
tim)
384

Hinh
382.
Ch~p
ph.
quan:
Ph6i
Irai
va
phan
nhanh
C,;at
cay
ph.
quan
(
nh
in lit
phia
ben
)
385
Hinh
383
.
Ch~p
ph.
quan
:
ph6i
tn;i

va
phan
nhanh
cua
cay
ph.
quan
(nhin
tCJ
phia
truac)
386
Tuy
theo
vi
trf
soi,
th
u thuiitt
119i
soi
dl;l
day-ru<}t n6i
ehu
ng
dUQc
philn
bi~t
th
anh

:
801
th(/c
quon.
soi
d(,l
day,
soi
kel
trong.
S
o;
t1u,Ic
quan
cho
phep
tr
\1
C
tiep
quan
sal
long th(/c quim. Bb.ng cach soi th\1c
qu:ln. ngudi
ta
kham
xet
be
m~t
eua

lOp
niJI/l
I1I(1C th\1c
quan.
blnh
thltdng
c6
mall
hong
I1hl.lt.
vdj
nhung
nep
ch~y
thea
chicu
d9C. khl dlta
ong
soi vao
thl
cac
nep
gian
ra
\',~l
niem
mac
trb
nen
nhAn. Hdn

nua,
neu
co
ton
tintdng
thl
soi th\1c
quan
co
th~
xac
djnh
dUQc
vj
tri.
biin
chat
va kich
thudc
cua
ton thlfdng.
dong
thdi
tien
hanh
sinh
thiel,
hoi).c
co
t

h ~
lfiy di v{lt
ra,
liim d6ng (dot)
nh
u
ng
vet
loet
va
chich
ap
xe·
th¢c
Quan
neu
c6. S
oi
tht!c Quan cu
ng
la
mQt
phltdng
t
i
~
n
ra
t
c6

fe
h
d~
ch~n
d08n
cae
trltdng
hQp:
thoat
ut
hOGnh d
l6
tht!c Quan, uiem tht!c
quan
Ba
rr
ett,
giiin
tlnh m(1ch tht!c quan,
h~
p
lht!c
Quan,
va
ung
thl1 tht!c
quan
(hlnh
396, 387).
Soi

dq
diJ.Y
va
ch'fp
hinh
ni
em
mf!
c
da
day
noi
soi
Ia
nhung
phltdng
phap
rat
. .
huu
feh,
thudng
rat
dn
thiet
trong
v
i
~e
tham

kh
am
ni
em
rrU;
IC
dl;l
day, nhlim mve dich
ch~n
doan
.
lam
sin
h
thiet
ho<)c
l
fiy
dt
v*t.
Cae
hi
nh
anh
n9t
soi
khi-phe
qu.an
Hinh
384.

Ngi
soi khi •
ph.
qw'n
1.
Hi
nh
anh
thanh
mOn;
2.
HlOh
anh
ella
khi
quan
va
hai
16
eua
pM
quan
g6c
phai
va
trai,
3.
Hinh
anh
VI

tri
ph~m
nhanh
ella
phE1"
quan
thuy
tn~n
;
4
Dllong
hO
hap
trim
va
rAy
khi-ph~
quan;
5.
6ng
soi
phaquan
~m
VOl
anh
sang
lanh
387
,
3

•
,
,
Hinh
385.
Cae
hinh
anh
n¢i
soi
phe
quan
(1-6)
1.
Di
v~t
i'J
ph~
qufm
phan
Ihuy
dlnh
eua
thuy
dLlm
phoi
phai;
2.
Hinh
anh

u
phe
quim
viem
9i6n9
vo;
hinh
anh
lao:
3.
Hinh
anh
l
oet
do
lao
a
phe
qulm
g6c
trtli;
4.
Kh6i
u
ac
tfnh
cr
phe
quan
g6c

Irai·
ung
thlt
bi~u
me
d~ng
sui;
5.
Kh6i
u
lanh
tfnh
alhuy
durn
phd
i
phai;
6.
Hinh
anh
nQi
soi
cua
~nh
Hodgkin
bi~u hi~n
aphe
quiln.
Cae
nep

thanh
am
(day
thanh
am)
va
15
thllc
Quan
Day
vi
(day
d?
day);
Hinh
386.
N¢i
soi
thl!e
quan
-
d~
day
- ru¢t
388
Vung
hang
vi
va
mOn

vi
2 3
•
,
,
Hinh
387.
Hinh
anh
n(li
soi
th\fc
quan
-
d~
day
(1
-
6)
1.
Dl
v~t
(hal
hi;mh
ohan)
n~m
trong
thllcquan;
2.
H~p

thL!Cqufm
do
kh6i
u
ac
tinh;
3.
Carcinom
tung
thll)
atam
vi;
4.Vi~m
teo
da
dAy
lam
I¢
rO
cae
m~ch
mau
trong
m(lt
tMmg
hap
thi~u
mau
tang
sac;

5.
H
inh
anh
tOn
thuang
trong
~nh
Mallory·Weiss;
6.
Polyp
d~
day.
. i
'''':=i
~:::~iii
Onglui
.
: :::
6n9
tl)Y
phl,l
(6ng
Sanlorini)
:
~~~;j
609
m~t
chi
(6n9

ChoteO()(:)-
Gai
(nhu)
til
trang
to
-
li-

(h~c
nurn
ruQI
Ian)
,,
609
gan
phai
va
trai
JJ
0,"
gan
chung
6n9
m~t
eM
(6n9
CholeOoc)
609
Ivy

chinh
(6n9
Wirsung).
PhUc
hap
til
trang
-
luy
-
dlJOng
-
m~t
Hinh
388
.
N(li
soi
to
tranlJ
Hinh
imh
nOi
soi
(g
ai
ta
trang
10)
389

Hinh
anh
nQi
soi
g6c
k~t
Irang
phai
(g6c
gan)
Hinh
ilmh
~i
soi
manh
Irang
va
van
h6i-manh
trang
(ho~c
van
k~1
Irang)
Hinh
389.
Ngi
soi
ket
trang

,
Hinh
390
.
Hinh
anh
ngi
soi
ket
trang
HlOh
anh
nQi
soi
k~llrang
ngang
Hinh
anh
nOi
soi
k~1
trang
sigma
1.
ViElm
k~t
!rang
cap
tfnh
; 2.

Gia
polyp
(thit
thCra
gia);
3.
TOn
thuang
ung
Ihlf
Iran
n/in
vi~m
k~t
trang
"
•
Hinh
391.
Nhilng
di~m
chQc
,5
b~ng
a.
Thi~t
d6
cat
ngang
b~ng

trinh
bay
ky
thu~t
chqc
6
bung
;
b.
Thanh
bung
truac
,
tr~n
d6dimh
da"u
nhung
diem
choc
6
bung
390
v(lt.
Nhd
soi va chl,lp
hinh
niem
m(l.C
d~
day

n<)i
soi,
nguCli
ta
co
th~
xiic
dinh
mQt
cach
chfnh
X3.C
vi
trL
hinh
th~,
va kich
thuoc
clla
vet
loct
dc;t
day
va
tinh
tr:;mg ella mo a
xung
quanh
vet
loet,

eung
nhu
xac
dinh
duc:;lc
bim
chat,
hlnh
th~
va
so
hlQng cac
polyp,
va
muc
cll}
n(\Ilg clla
ung
t/ut
dc;t
day,
v v
(hinh
386. 387).
So;
lei
lri
m g:
eho
phep

chtin do8.n
dU<;jc
[mit
ta
(rang
va
uiem
ta
trang
trong
nhung
tl'ltdng
hc:;lp
X Quang
truyen
thong
6ng
cO
nong
(troca)
d~
chqc
sinh
thi~t
Sang
Quang
K~t
trang
sigma
kh6ng

phat
hi~n
tha'y.
Soi
lei
trang
cung
cho
phep
ph
at
hi~n
polyp
va
tui
thila
a
ta
trang,
ung
thil
uitng bong Vater
va
ung
thil
tU1. v v
(hinh
388).
So
i k e't

tr
a ng: cho
phep
thi1m
kham
trt!c
tiep
toan
bl}
khung
ket
trang,
k~
d.
do~n
cuoi h6i
trang
.
6ng
soi
ket
trang
co
hai
lo~i
voi kfch thuOc khac nhau:
mQt
lo~i
trung
binb, dai 130 cm, va m9t

lOf,li
dai 180 cm.
Soi
ket
trang
cho
phep
chAn
doan
duc:;lc
cac
b~nh
uiem ket
trang,
ban
chat
va vi
trf
cac
K~t
trang
I~n
Tuirnat
Gan
•
lach
(~I
Mac
n6i
IOn

Ket
trang
xu6ng.
Hinh
392.
N¢i
soi 6
b~ng
:
ky
thu~t
thl/c
hien
chQc
il
b~ng
.
hinh
anh
binh thlfang
cua
cac
t~ng
trong
(;
phuc
m~c
Hinh
anh
gan

va
lui
rn~t
H
inh
anh
xcr
gan
Hinh
anh
un~l
thll
di
can
vao
gan
Hinh
smh
dinh
Hinh
393
.
Cac
hinh
anh
n¢i
soi 6
b~ng
b~nh
Iy

391
lui
Ihila.
ph
itt
hi(m
cac
polyp
khong
ung
tint
hoa.
tang
san
va
ung
thv
hoa.
phat
hi~n
wIg
till!
kef.
trang
va
lo(w
san
nUJch
mdu.
v v

(hlnh
389.
390).
Soi
trl/c
trang-Idit
trang
sigma:
eho
phcp
quan
sat
tn!c
tiep
niem
m~e
clla trllc
trclllg
va clla
ket
trang
sigma.
Khi soi trUc
tr:'tng.ket
trang
sigma
thi
b~nh
nhl1n

phai'(j
ttl the'
quy
g6i
va
tt!a
ngl.;l'C
trim
bim
kham.
C'[lc
d\mg
CI,l
kham
phai
dttt;lc
boi
trCjn
r9ng
bltng
nhieu
vaselin.
Moi Miu.
d~y
6ng
sal
thea
chiell
htlong
ve

phia
r6n
cua
b~nh
nhan;
;:;au
khi
da
da)'
6ng
van
du
de?
sau,
thi
rut
nang
6ng
ra.
va
bAt
dau
quan
sat.
a
ngang
muc
eua
cd thiil
van

hg.u mem,
long
6ng
h(lU
mon
hll1h
tron.
voj
nhung
nep
(van)
toa
ra
Hinh
394.
Tham
do
ni~u
d~o
bang ong
thOng (xong) co
dolu
hinh qua
o·
liu
Hinh
396.
Hinh
anh
soi

ni~u
d~o
(ni~u
d~o
binh thl/ilng)
A.
H6
Iren·1,!
nui
(h6
Iren-tl6i
linh);
B. l)
nui
(d6i
tmh):
C.
Mao
ni~u
d<;lo
392
xllng
qllanh
nhv
nan
hoa
banh
xe. Toi
dO
5au

tu
2,5
den
3 em
thi
cac
nep
(vim) n6i
tren
hiem
thay
hdn,
nhVng
neu
vao
sau
hdn
thi
tha)'
bong
trlle
trang
Ind l"9ng
ra,
va
dai
hdn
nhieu
50
voi

6ng
soi
trl.;l'C
trang,
di.e nep niem
m(lC
nam
ngang
b~t
dau
xuat
hl¢n. Tal
09
5au
1~?·14
em,
thi
nh1n
thay
d
dau
ong
soi
nep
van
tf'(te trang-kef.
(rimg
sigma.
Ngay
sau

khi
dVa
ang
sai
VilO
toi
ket
trang
sigma
thl
hinh
anh
eua
ruot
thay
(t6i
hiin:
nhieu
nep
nho
n.iem
m~e
xuat
hii;!n.
6ng
sai
d£y vao
kh6
khan
hon,

va
e6
th~
quan
sat
thay
hinh
anh
ket
trang
bi
dill
ra,
sung
huyet,
phil
ne.
10€L
dvdi
nhieu
th~
khae
nhau.
vilt
xuat
huyet.
vung
co
b.;ii
m~e

ehe
phu,
h9P
ket
trang
va
khat
u
(hinh
389. 390).
7'
~)
t'·
G,,6'"
-
-::I'
'
(~p~
Hinh
3,
95.
Ky
thu~t
thong
ni~u
d~o
ella
nam
gidi
a.

Lau
n1a
III
ngoai
ni¢u
dao
(10
sao)
bang
dung
d!ch
di~t
khuan;
b.
OlIa
6ng
th
Ong
(xOng)
vao
ni¢u
d<;lo
Irong
di~u
ki
¢n
vO
khuan;
c.
Bam

ph6ng
b6ng
Foley;
d.
Chuan
bf
bu¢c
c6
d!nh
6ng
tMng
(xOng);
e·.
6ng
thOng
(xOng)
da
d1lQC
bu{lcc6d!nh
Soi
hau
man:
B6
sung
them
cho
cach
t!Hlm
hhd;n
trzk

trang-h¢iu m()n
b6ng
ngon
to.Y. y1\
cho
phep
chi£n
doan
d,c
b~nh
cua
pldin
/ji~g
h¢u
mdn,
ChQc
()
bVng
thl1dng
hay
dl1Qc
thl)'C
hi~n
trong
th1jC
h,inh
hang
ngay,
trong
nhling

tni('ing h(ip
dip
cuu,
nham
X3.C
dinh
chfln
doan
djeh
trong
C;
phuc
)TIl,ie,
bAn
chat
cua
djch
nay
~1:1
l11;'tu.
mu,
hoi) c
dich khac), va
trong
cac
h~nh
m{Hl
tinh
thi
ch9C

6 bVng
d@
rut
bOt
dlch
di'
tnMng
(bang
nudc)
(hinh
391).
:"I{li
soi
(":"
bVng
dtit;lc
cac
bac
sy
ngo~i
khoa
V<'I
ehuyen
khoa
tieu
hoa
i'1
chilu
Au,
v,)

cac
bac
sy
phv
khoa
d
Hoa
Ky
hay
si'r
dl}ng.
Kg
thu.$.t
nay
eho
phep
chtln
doan
llhH~Ll
b~nh
eua
cae
t?ng
trong
6 bVng,
va
tr5.nh
eho
b~nh
nhan

kh6ng
phai
md
6'
bf,lng
tlur
In
eli).
Thurn
kham
ni~u
d~o:
Trude
khi
thl.je
hi~n
phai
lam
v~
sinh
va
vo
khucin
kg
cang
ni¢u
d[Jo,
Sau
d6, du'oi
dieu

ki~n
vo
khuin
tuy(~t
d8i,
dua
mQt
ong
thong
(catheter)
dAu
hinh
qua
6-liu
(hinh
qua
bfru
dvc)
cd
so
16
ho(1c
18
(hinh
394)
hoi},c
mQt
que
nang
Benique

c(l
so'
40
VaQ
ni¢u
dc;ro.
Bang
cach
nay
co
the'
danh
gia
dUQc
kich
thudc
long
ni~u
d,~o,
dQ
dim
hoi
cua
ni~u
d?o,
cung
nhti
nhung
v*t
can

co
thi
c6
(nhu
polyp,
50i,
cho
h~p
v

v
).
Doi
vdi
phl}
nu
(nhat
la
phV
nil
co
thai)
thi
ca.
ong
thong
mfm
Iftn
/{ng
thong

kim
lO(Li
deu
co
th~
si'r
dvng
dUQc.
Trong
trl1dng
hQp d(le
bi~t,
co
th@
d~t
(rrlg
thang
(xongJ co
bong
(xong
Foley)
d~
lllu
trong
mQt
khoimg
thdi
gian
nao
d6,

nhung
phai
tinh
Wi
nguy
cd
nhiem
khuAn
co
th~
x,iy
ra
ve
sau
(hinh
393).
Soi
ni¢u
d(lO
dl1Qe
thl.jc
hi~n
b~ng
mQt
6'ng soi
ni~u
d(w,
quan
sat
trl)'C

tiep
ho*e
gian
tiep
(Mac
Carty).
Ong soi ni?u
dc;ro
Mac
Carty
hay
dUQc
Stl
d\,lng
nhat
VI
cho
phep
quan
sat
dong
thdi
dur;fc
ca
ni?u d(w
sau,
c6'
bang
Quang
va

uung
tam
giac
day
bang
quang
(g9i
18.
ky
thu~t
soi
ni~u
dc;ra-
bang
Quang),
Soi
ni~u
d(lo co
th~
cho
phep
chAn
doan
d b(l
may
tiet
ni~u
mQt
cach
dang

tin
c~y
(hinh
396).
Soi
bang
Quang:
La
phuong
phap
tham
kham
tn;t.c
bep
phia
trong
cua
bang
quang.
Voi
mvc
dieh
miy,
thi
co
th~
sl1
dVng
nhung
dVng

cv
khac
nhau
nhu
sau:
{i'ng
soi
bang
Quang
ddn
thuan,
chi
cho
phep
quan
sat
d
ph?m
vi
bang
quang;
({ng
sOL
hang
Quang vdi (tng
thong
mQt ben hoijc
hai
ben,
dUQc

511
dVng
khi
muon
tham
kham
c8.
bang
Quang
va
cac
ni~u
qudn
(voi
mvc
dieh
chir.
do
an
ho:).c chlJp bri
th(in
nguQc
dong);
may
soi-tan
soi
hang
Quang
dUr;fc
Stl

d\lng
vdi
ml}c
dlch
nghien
nho
vvn
vien
soi
d
trong
bang
quang,
Nhilng
yeu
diu
trong
ky
thul}t
soi
bang
quang
la
ni¢u
d(Lo
phai
th6ng,
dung
rich
bang

quang
Wong
doi
du,
va
dich
dua
vao
bang
Quang ph8.i
trong
suot
(kh6ng
vAn
dvc).
Sau
khi
dua
ong
soi
vao
bang
quang,
thi
quan
sat
cang
d~y
dli
va

cang
co
phuong
phap
cang
tot,
Doi
vdi
vi~c
dinh
hudng
a
trong
long
bang
quang,
thi
can
phai
nh$,n
ra
ba
m8c
dfrn
du'dng
sau
day:
b9t
khong
khi,

cac
l6
ni~u
quan,
va
co'
bang
Quang.
B9t
khong
khi
18.
do
kh6ng
khi
di
vao
khi
dua
dich
vao
d~
lam
phong
bang
quang,
bQt
khi
nay
se

n6'i
len
phia
treD
d
dinh
bang
quang,
Xoay
ong
soi
bang
Quang
quanh
trvc
dQc
tdi
vi
tri
""4
gi(j"
va
"8
gid"
(giong
ki~u
kim
xoay
tr€m
m~t

d6ng
ho),
thi
se
nhin
thay
eac
l6
ni~u
q
uan
(hinh
397),
Rut
nh~
ong
soi
bang
Quang
ra
mQt
do~n
thi
se
nhin
thay
co'
bang
Quang
(tam

giac
day
bang
Quang),
Binh
thudng,
niem
m(lc
bang
Quang
hdi
bong,
mau
do
hang,
hoi
sftm
han
d
vung
tam
giac
day
bang
quang,
va
e6
cae
nep
va

ranh
mong
h~p
hinh
diy.
BAng ky
thu$.t
soi
bang
quang,
co
th@
phat
hi~n
dUQc
nhung
t*t
bAm
sinh,
t6n
thuong
viem,
cac
viEm soi, d! v$.t
va
kh6'i u
v

v.,
trong

bang
quang
(hinh
398),
Soi
bang
Quang
tiem
chat
mau
dUQe
thl)'c
hi~n
sau
khi
soi
bang
quang
truyen
thong,
roi
tiem
vao
tlnh
mlilch 4
ml
dung
dich
indigo-carmin
4%.

Trong
trudng
hQp
chuc
nang
th$,n
binh
thudng,
thi
th$,n
se
bai
tiet
eha't
mau
nay
qua
ni~u
quiin
xuong
bang
quang,
va
se
bAt dAu
nhin
thay
chat
393
milU ph1,lt

ra
d tJ
ni~u
quan
vao
6·8
phtit
sau
khi
tiem
(hlnh
399).
C
h\1p
b
~
th(in:
Duqc th
\,tc
h
i~n
sau
kh
i
Hoi
ni~u
quan.bang
quang,
roi
qua

Dng
thong
(catheter)
luon
s~n
vilo
ni~u
quan,
bdm
thUDC
can
quang
nguqc
len
bi
th¢n
(hinh
400).
Kham
X
quang
nhung
t(lng
nay
cling
dLf(Jc
th\,tc
hi~n
voi
cung

m¢t
muc
d(>
phei'
bien
nhll
v~y.
Trong
kham
lam
sang
thl
nhung
ky
thw:tt
chl:lP
(X
Quang)
thljc
quan
(hlnh
401),
cJll.lP
d(L
day·ta
trang
(hlnh
402),
chl.J.p
ke'l

trang
(hlnh
403),
ho(ie
chl.J.p
b
e'
lh{in
(hlnh
404),
deu
mang
J(li
nhieu
lqi
fch
eho
vi~c
ehan
doim
b~nh
.
. .
, .
,:
"
, ,
Hinh
397
,

Soi
bang
quang
(N
¢i
soi
bang
quang)
394
1.
Xoay
huang
6ng
soi
bang
Quang
W
10
ngoai
ni~u
dao;
2.
Phat
hi$n
da
!hay
bQt
khOng
khf
cr

dinh
eua
bang
Quang:
3.
Hinh
lmh
soi
bang
Quang:
A·
L6
ni$u
qulm
~n
phai
;
B·
N~p
gian
16
ni~u
quan;
c-
L6
ni~u
quan
ben
Irai
~~

"lif
'.
,
'"!J:
"
•

•
· ,
•
•
,
•
Hinh
anh.
cae;
hat
ton
thuang
lao
Hinh
anh
ung
thu
biau
m6
bang
Quang
.
Hinh

398,
Hinh
anh
soi
banll
quang
Chat
mau
Mm
vila
ITnh
m~ch
bai
ti~t
qua
than
xu6ng
bang
Quang
xuat
hi~n
a
16
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.
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398
rai
li~u
tham
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chQn
IQc
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