{"id":10412,"date":"2022-09-12T17:30:13","date_gmt":"2022-09-12T10:30:13","guid":{"rendered":"https:\/\/easymed.vn\/?p=10412"},"modified":"2022-09-12T17:31:46","modified_gmt":"2022-09-12T10:31:46","slug":"lich-su-phat-trien-giai-phau-benh-trong-y-khoa-phan-ii","status":"publish","type":"post","link":"https:\/\/easymed.vn\/en\/lich-su-phat-trien-giai-phau-benh-trong-y-khoa-phan-ii\/","title":{"rendered":"L\u1ecaCH S\u1eec PH\u00c1T TRI\u1ec2N GI\u1ea2I PH\u1eaaU B\u1ec6NH TRONG Y KHOA (PH\u1ea6N II)"},"content":{"rendered":"

\u0110\u1ecaNH NGH\u0128A V\u00c0 PH\u00c2N LO\u1ea0I GI\u1ea2I PH\u1eaaU B\u1ec6NH H\u1eccC:<\/span><\/h3>\n

Gi\u1ea3i ph\u1eabu b\u1ec7nh h\u1ecdc, c\u00f2n g\u1ecdi l\u00e0 b\u1ec7nh h\u1ecdc, l\u00e0 m\u00f4n h\u1ecdc nghi\u00ean c\u1ee9u v\u1ec1 c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u1ee7a t\u1ebf b\u00e0o, m\u00f4 v\u00e0 c\u00e1c c\u01a1 quan trong c\u00e1c tr\u1ea1ng th\u00e1i b\u1ec7nh l\u00fd kh\u00e1c nhau.<\/span><\/p>\n

C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u1ee7a c\u01a1 quan quan s\u00e1t \u0111\u01b0\u1ee3c b\u1eb1ng m\u1eaft tr\u1ea7n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i th\u1ec3. T\u1ed5n th\u01b0\u01a1ng c\u1ee7a m\u00f4 v\u00e0 t\u1ebf b\u00e0o ch\u1ec9 c\u00f3 th\u1ec3 quan s\u00e1t \u0111\u01b0\u1ee3c d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi quang h\u1ecdc ho\u1eb7c k\u00ednh hi\u1ec3n vi \u0111i\u1ec7n t\u1eed, n\u00ean \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 t\u1ed5n th\u01b0\u01a1ng vi th\u1ec3 v\u00e0 si\u00eau vi th\u1ec3.<\/span><\/p>\n

Theo truy\u1ec1n th\u1ed1ng, m\u00f4n gi\u1ea3i ph\u1eabu b\u1ec7nh \u0111\u01b0\u1ee3c chia th\u00e0nh 2 ph\u1ea7n:<\/span><\/p>\n

Gi\u1ea3i ph\u1eabu b\u1ec7nh \u0111\u1ea1i c\u01b0\u01a1ng, nghi\u00ean c\u1ee9u v\u1ec1 c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a t\u1ebf b\u00e0o v\u00e0 m\u00f4, l\u00e0 c\u01a1 s\u1edf chung cho m\u1ecdi lo\u1ea1i b\u1ec7nh l\u00fd c\u1ee7a c\u00e1c c\u01a1 quan v\u00e0 c\u00e1c h\u1ec7 th\u1ed1ng kh\u00e1c nhau. Th\u00ed d\u1ee5 ph\u1ea3n \u1ee9ng<\/span> vi\u00eam <\/span>c\u1ea5p l\u00e0 m\u1ed9t t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n, c\u01a1 s\u1edf chung c\u1ee7a<\/span> vi\u00eam <\/span>ru\u1ed9t th\u1eeba c\u1ea5p,<\/span> vi\u00eam <\/span>ph\u1ed5i th\u00f9y…<\/span><\/p>\n

Gi\u1ea3i ph\u1eabu b\u1ec7nh chuy\u00ean bi\u1ec7t, nghi\u00ean c\u1ee9u v\u1ec1 c\u00e1c b\u1ec7nh l\u00fd ri\u00eang bi\u1ec7t c\u1ee7a t\u1eebng c\u01a1 quan ho\u1eb7c h\u1ec7 th\u1ed1ng. Th\u00ed d\u1ee5 nh\u01b0 b\u1ec7nh l\u00fd ph\u1ed5i, b\u1ec7nh l\u00fd da…<\/span><\/p>\n

Tuy nhi\u00ean, m\u1ee5c \u0111\u00edch t\u1ed1i h\u1eadu c\u1ee7a m\u00f4n gi\u1ea3i ph\u1eabu b\u1ec7nh kh\u00f4ng ch\u1ec9 \u0111\u01a1n thu\u1ea7n m\u00f4 t\u1ea3 t\u1ed5n th\u01b0\u01a1ng. Tr\u00e1i l\u1ea1i, th\u00f4ng qua vi\u1ec7c ph\u00e2n t\u00edch c\u00e1c h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng, n\u00f3 t\u00ecm hi\u1ec3u v\u1ec1 nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh, gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf b\u1ec7nh sinh v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng do t\u1ed5n th\u01b0\u01a1ng g\u00e2y ra \u0111\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o vi\u1ec7c ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng tr\u00e1nh b\u1ec7nh. V\u00ec v\u1eady, n\u1ed9i dung c\u01a1 b\u1ea3n c\u1ee7a m\u00f4n gi\u1ea3i ph\u1eabu b\u1ec7nh g\u1ed3m c\u00f3 4 m\u1eb7t: nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh, c\u01a1 ch\u1ebf b\u1ec7nh sinh, h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng v\u00e0 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng li\u00ean quan v\u1edbi t\u1ed5n th\u01b0\u01a1ng.<\/span><\/p>\n

V\u1eacT LI\u1ec6U NGHI\u00caN C\u1ee8U C\u1ee6A GI\u1ea2I PH\u1eaaU B\u1ec6NH H\u1eccC<\/span><\/h3>\n

C\u00e1c v\u1eadt li\u1ec7u nghi\u00ean c\u1ee9u c\u1ee7a gi\u1ea3i ph\u1eabu b\u1ec7nh h\u1ecdc g\u1ed3m nhi\u1ec1u lo\u1ea1i:<\/span><\/p>\n

T\u1eed thi\u1ebft:<\/span><\/h4>\n

L\u00e0 thi th\u1ec3 ho\u1eb7c nh\u1eefng m\u1eabu m\u00f4 \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb b\u1ec7nh nh\u00e2n \u0111\u00e3 <\/span>ch\u1ebft<\/span>. Gi\u1ea3i ph\u1eabu t\u1eed thi gi\u00fap x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y <\/span>ch\u1ebft<\/span>, ki\u1ec3m nghi\u1ec7m c\u00e1c ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng nh\u1eb1m r\u00fat kinh nghi\u1ec7m \u0111\u1ec3 n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh. C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y t\u1ea1i<\/span> M\u1ef9 <\/span>cho th\u1ea5y c\u00f3 \u0111\u1ebfn 30% ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng \u0111\u00e3 kh\u00f4ng \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn tr\u00ean t\u1eed thi\u1ebft; ch\u00ednh v\u00ec v\u1eady m\u00e0 \u1edf c\u00e1c vi\u1ec7n gi\u1ea3i ph\u1eabu b\u1ec7nh ho\u1eb7c c\u00e1c s\u00e1ch gi\u1ea3i ph\u1eabu b\u1ec7nh th\u01b0\u1eddng c\u00f3 \u0111\u1ec1 c\u00e2u “Mortui vivos docet” (ng\u01b0\u1eddi<\/span> ch\u1ebft <\/span>d\u1ea1y ng\u01b0\u1eddi s\u1ed1ng) (H\u00ecnh 14).<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 14: T\u1eed thi\u1ebft 1 ca tr\u1ebb s\u01a1 sinh t\u1eed vong v\u00ec suy h\u00f4 h\u1ea5p cho th\u1ea5y nguy\u00ean nh\u00e2n l\u00e0 do tho\u00e1t v\u1ecb c\u01a1 ho\u00e0nh b\u1ea9m sinh b\u00ean tr\u00e1i khi\u1ebfn d\u1ea1 d\u00e0y v\u00e0 ru\u1ed9t l\u1ecdt v\u00e0o l\u1ed3ng ng\u1ef1c g\u00e2y ch\u00e8n \u00e9p<\/span><\/em><\/p>\n

Sinh thi\u1ebft:<\/span><\/h4>\n

L\u00e0 c\u00e1c m\u1eabu m\u00f4 \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb ng\u01b0\u1eddi s\u1ed1ng nh\u1eb1m ph\u1ee5c v\u1ee5 cho <\/span>c\u00f4<\/span>ng t\u00e1c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb. C\u00e1c m\u1eabu m\u00f4 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y ra theo nhi\u1ec1u c\u00e1ch (H\u00ecnh 15):<\/span><\/p>\n

Ph\u1eabu thi\u1ebft<\/em>: m\u1ed9t m\u1eabu m\u00f4, m\u1ed9t ph\u1ea7n ho\u1eb7c to\u00e0n b\u1ed9 m\u1ed9t c\u01a1 quan b\u1ecb b\u1ec7nh \u0111\u01b0\u1ee3c l\u1ea5y ra b\u1eb1ng ph\u1eabu thu\u1eadt. Th\u00ed d\u1ee5: m\u1ed9t ph\u1ea7n h\u1ea1ch c\u1ed5, to\u00e0n b\u1ed9 d\u1ea1 d\u00e0y, m\u1ed9t th\u00f9y gi\u00e1p.<\/span><\/p>\n

Sinh thi\u1ebft qua n\u1ed9i soi<\/em>: nh\u1edd \u1ed1ng n\u1ed9i soi, c\u00f3 th\u1ec3 d\u00f9ng k\u00ecm k\u1eb9p c\u1eaft m\u1ed9t m\u1eabu m\u00f4 nh\u1ecf n\u1eb1m s\u00e2u trong \u0111\u01b0\u1eddng ti\u00eau ho\u00e1, \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p ho\u1eb7c ti\u1ebft ni\u1ec7u.<\/span><\/p>\n

Sinh thi\u1ebft b\u1eb1ng kim<\/em>: nh\u1edd c\u00e1c lo\u1ea1i kim \u0111\u1eb7c bi\u1ec7t, c\u00f3 th\u1ec3 l\u1ea5y \u0111\u01b0\u1ee3c m\u1ed9t m\u1eabu nh\u1ecf m\u00f4 gan, th\u1eadn, m\u00e0ng ph\u1ed5i ho\u1eb7c t\u1ee7y x\u01b0\u01a1ng…<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 15: Sinh thi\u1ebft polyp \u0111\u1ea1i tr\u00e0ng qua n\u1ed9i soi (A); sinh thi\u1ebft ch\u1ecdc h\u00fat b\u1eb1ng kim nh\u1ecf (B)<\/span><\/em><\/p>\n

M\u1ed9t lo\u1ea1i v\u1eadt li\u1ec7u kh\u00e1c c\u00f3 th\u1ec3 l\u1ea5y ra t\u1eeb ng\u01b0\u1eddi s\u1ed1ng \u0111\u1ec3 kh\u1ea3o s\u00e1t l\u00e0 c\u00e1c lo\u1ea1i t\u1ebf b\u00e0o c\u00f3 trong d\u1ecbch c\u01a1 th\u1ec3 (d\u1ecbch m\u00e0ng ph\u1ed5i, d\u1ecbch m\u00e0ng b\u1ee5ng, n\u01b0\u1edbc ti\u1ec3u), ho\u1eb7c c\u00e1c t\u1ebf b\u00e0o bong tr\u00f3c t\u1ef1 nhi\u00ean t\u1eeb c\u00e1c lo\u1ea1i bi\u1ec3u m\u00f4 ph\u1ee7 (bi\u1ec3u m\u00f4 ph\u1ee7 \u00e2m \u0111\u1ea1o – c\u1ed5 t\u1eed cung, bi\u1ec3u m\u00f4 ph\u1ebf qu\u1ea3n). C\u00f3 th\u1ec3 d\u00f9ng m\u1ed9t s\u1ed1 lo\u1ea1i d\u1ee5ng c\u1ee5 nh\u01b0 que g\u1ed7, c\u00e2y ch\u1ed5i \u0111\u1ec3 l\u00e0m t\u0103ng s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o bong ra. Ngo\u00e0i ra, ta c\u0169ng c\u00f3 th\u1ec3 h\u00fat \u0111\u01b0\u1ee3c c\u00e1c t\u1ebf b\u00e0o c\u1ee7a b\u1ea5t k\u1ef3 c\u01a1 quan n\u00e0o trong c\u01a1 th\u1ec3 nh\u1edd v\u00e0o m\u1ed9t kim nh\u1ecf (c\u1ee1 23-24), g\u1ecdi l\u00e0 ph\u01b0\u01a1ng<\/span> ph\u00e1p <\/span>sinh thi\u1ebft ch\u1ecdc h\u00fat b\u1eb1ng kim nh\u1ecf (FNAB: fine needle aspiration biopsy)<\/span><\/p>\n

V\u1eadt li\u1ec7u th\u1ef1c nghi\u1ec7m:<\/span><\/h4>\n

X\u00e2y d\u1ef1ng tr\u00ean s\u00fac v\u1eadt c\u00e1c m\u00f4 h\u00ecnh b\u1ec7nh t\u1eadt t\u01b0\u01a1ng t\u1ef1 c\u00e1c b\u1ec7nh l\u00fd c\u1ee7a ng\u01b0\u1eddi, \u0111\u1ec3 kh\u1ea3o s\u00e1t c\u00e1c h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng k\u00e8m theo; \u0111\u1eb7t c\u01a1 s\u1edf cho vi\u1ec7c t\u00ecm hi\u1ec3u nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh, c\u01a1 ch\u1ebf b\u1ec7nh sinh, di\u1ec5n ti\u1ebfn c\u1ee7a b\u1ec7nh, v\u00e0 th\u1eed nghi\u1ec7m c\u00e1c ph\u01b0\u01a1ng<\/span> ph\u00e1p <\/span>\u0111i\u1ec1u tr\u1ecb m\u1edbi (H\u00ecnh 16).<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 16: G\u00e2y u nh\u00fa tr\u00ean da chu\u1ed9t b\u1eb1ng benzanthracene, g\u00e2y ung th\u01b0 gan chu\u1ed9t b\u1eb1ng nitrosamine<\/span><\/em><\/p>\n

PH\u01af\u01a0NG<\/span> PH\u00c1P <\/span>NGHI\u00caN C\u1ee8U C\u1ee6A GI\u1ea2I PH\u1eaaU B\u1ec6NH<\/span><\/h3>\n

Quan s\u00e1t \u0111\u1ea1i th\u1ec3:<\/span><\/h4>\n

Nghi\u00ean c\u1ee9u b\u1eb1ng m\u1eaft tr\u1ea7n t\u1ea5t c\u1ea3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh th\u00e1i (nh\u01b0 k\u00edch th\u01b0\u1edbc, m\u00e0u s\u1eafc, m\u1eadt \u0111\u1ed9, gi\u1edbi h\u1ea1n, v\u1ecf bao…) c\u1ee7a m\u1ed9t c\u01a1 quan b\u1ec7nh l\u00fd.<\/span><\/p>\n

Quan s\u00e1t vi th\u1ec3 v\u00e0 si\u00eau vi th\u1ec3:<\/span><\/h4>\n

Nghi\u00ean c\u1ee9u c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u1ee7a t\u1ebf b\u00e0o v\u00e0 m\u00f4 d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi quang h\u1ecdc ho\u1eb7c k\u00ednh hi\u1ec3n vi \u0111i\u1ec7n t\u1eed. \u0110\u1ec3 quan s\u00e1t \u0111\u01b0\u1ee3c d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi quang h\u1ecdc, m\u1eabu m\u00f4 ph\u1ea3i \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh, c\u1eaft m\u1ecfng 5 <\/span>micromet<\/span> v\u00e0 nhu\u1ed9m m\u00e0u, th\u1eddi gian chu\u1ea9n b\u1ecb m\u1ea5t kho\u1ea3ng 3-4 ng\u00e0y. Quan s\u00e1t si\u00eau vi th\u1ec3 \u0111\u00f2i h\u1ecfi m\u1eabu m\u00f4 ph\u1ea3i \u0111\u01b0\u1ee3c c\u1eaft m\u1ecfng \u0111\u1ebfn 0,1 <\/span>micromet<\/span>, th\u1eddi gian chu\u1ea9n b\u1ecb m\u1ea5t h\u00e0ng th\u00e1ng do \u0111\u00f3 \u00edt c\u00f3 t\u00ednh \u1ee9ng d\u1ee5ng trong ch\u1ea9n \u0111o\u00e1n gi\u1ea3i ph\u1eabu b\u1ec7nh th\u01b0\u1eddng ng\u00e0y, ch\u1ee7 y\u1ebfu \u0111\u1ec3 ph\u1ee5c v\u1ee5 cho nghi\u00ean c\u1ee9u.<\/span><\/p>\n

Ph\u01b0\u01a1ng<\/span> ph\u00e1p <\/span>nhu\u1ed9m th\u01b0\u1eddng quy trong c\u00e1c labo gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00e0 ph\u01b0\u01a1ng<\/span> ph\u00e1p <\/span>nhu\u1ed9m Hematoxylin-Eosin: t\u1ebf b\u00e0o s\u1ebd c\u00f3 nh\u00e2n b\u1eaft m\u00e0u t\u00edm c\u00f2n b\u00e0o t\u01b0\u01a1ng th\u00ec b\u1eaft m\u00e0u h\u1ed3ng (H\u00ecnh 17A). Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, c\u00f3 th\u1ec3 d\u00f9ng th\u00eam c\u00e1c ph\u01b0\u01a1ng<\/span> ph\u00e1p <\/span>nhu\u1ed9m h\u00f3a m\u00f4 (c\u00f2n g\u1ecdi l\u00e0 nhu\u1ed9m \u0111\u1eb7c bi\u1ec7t) \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ed9t s\u1ed1 c\u1ea5u tr\u00fac c\u1ee7a t\u1ebf b\u00e0o v\u00e0 m\u00f4 d\u1ef1a v\u00e0o \u00e1i t\u00ednh \u0111\u1eb7c bi\u1ec7t c\u1ee7a <\/span>ch\u00fa<\/span>ng \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 lo\u1ea1i ho\u00e1 ch\u1ea5t n\u00e0o \u0111\u00f3. Th\u00ed d\u1ee5 nhu\u1ed9m Fontana gi\u00fap ph\u00e1t hi\u1ec7n h\u1eafc t\u1ed1 melanin, nhu\u1ed9m PAS \u0111\u1ec3 ph\u00e1t hi\u1ec7n glycogen v\u00e0 ch\u1ea5t nh\u1ea7y, nhu\u1ed9m Trichrome \u0111\u1ec3 th\u1ea5y r\u00f5 s\u1ee3i collagen…(H\u00ecnh 17 B,C)<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 17: Ni\u00eam m\u1ea1c \u0111\u1ea1i tr\u00e0ng nhu\u1ed9m Hematoxylin-Eosin (A); nhu\u1ed9m Trichrome, th\u1ea5y r\u00f5 m\u00e0ng \u0111\u00e1y b\u1eaft m\u00e0u xanh d\u01b0\u01a1ng; nhu\u1ed9m PAS (periodic acid-Schiff), gi\u1ecdt ch\u1ea5t nh\u1ea7y c\u1ee7a t\u1ebf b\u00e0o \u0111\u00e0i b\u1eaft m\u00e0u h\u1ed3ng.<\/span><\/em><\/p>\n

G\u1ea7n \u0111\u00e2y, k\u1ef9 thu\u1eadt h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i trong c\u00e1c labo gi\u1ea3i ph\u1eabu b\u1ec7nh t\u1ea1i Tp.HCM \u0111\u1ec3 h\u1ed7 tr\u1ee3 cho ch\u1ea9n \u0111o\u00e1n. \u0110\u00e2y l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt nhu\u1ed9m \u0111\u1eb7c bi\u1ec7t, s\u1eed d\u1ee5ng ph\u1ea3n \u1ee9ng k\u1ebft h\u1ee3p kh\u00e1ng nguy\u00ean – kh\u00e1ng th\u1ec3 nh\u1eb1m ph\u00e1t hi\u1ec7n nh\u1eefng th\u00e0nh ph\u1ea7n c\u1ea5u t\u1ea1o (c\u00e1c kh\u00e1ng nguy\u00ean) c\u00f3 trong t\u1ebf b\u00e0o v\u00e0 m\u00f4. V\u1ecb tr\u00ed k\u1ebft h\u1ee3p kh\u00e1ng nguy\u00ean – kh\u00e1ng th\u1ec3 s\u1ebd \u0111\u01b0\u1ee3c hi\u1ec3n th\u1ecb nh\u1edd c\u00e1c ho\u00e1 ch\u1ea5t. (H\u00ecnh 18)<\/span><\/p>\n

T\u00f9y theo ho\u00e1 ch\u1ea5t hi\u1ec3n th\u1ecb, ph\u00e2n bi\u1ec7t hai ph\u01b0\u01a1ng<\/span> ph\u00e1p <\/span>nhu\u1ed9m h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch ch\u00ednh:<\/span><\/p>\n

Mi\u1ec5n d\u1ecbch hu\u1ef3nh quang:<\/span><\/h4>\n

Kh\u00e1ng th\u1ec3 \u0111\u01b0\u1ee3c g\u1eafn v\u1edbi ch\u1ea5t ph\u00e1t hu\u1ef3nh quang. N\u1ebfu c\u00f3 ph\u1ea3n \u1ee9ng k\u1ebft h\u1ee3p kh\u00e1ng nguy\u00ean – kh\u00e1ng th\u1ec3 (ngh\u0129a l\u00e0 c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a kh\u00e1ng nguy\u00ean c\u1ea7n t\u00ecm trong m\u1eabu m\u00f4), ph\u1ee9c h\u1ee3p kh\u00e1ng nguy\u00ean-kh\u00e1ng th\u1ec3 s\u1ebd ph\u00e1t quang khi \u0111\u01b0\u1ee3c k\u00edch th\u00edch b\u1edfi tia c\u1ef1c t\u00edm, quan s\u00e1t d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi hu\u1ef3nh quang.<\/span><\/p>\n

Ch\u1ea5t ph\u00e1t hu\u1ef3nh quang c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c g\u1eafn tr\u1ef1c ti\u1ebfp v\u00e0o kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u, g\u1ecdi l\u00e0 ph\u01b0\u01a1ng<\/span> ph\u00e1p <\/span>mi\u1ec5n d\u1ecbch hu\u1ef3nh quang tr\u1ef1c ti\u1ebfp; ho\u1eb7c g\u1eafn v\u00e0o kh\u00e1ng th\u1ec3 th\u1ee9 hai \u0111\u1eb7c hi\u1ec7u v\u1edbi kh\u00e1ng th\u1ec3 th\u1ee9 nh\u1ea5t, g\u1ecdi l\u00e0 mi\u1ec5n d\u1ecbch hu\u1ef3nh quang gi\u00e1n ti\u1ebfp.<\/span><\/p>\n

Mi\u1ec5n d\u1ecbch hu\u1ef3nh quang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ch\u1ee7 y\u1ebfu trong ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh l\u00fd c\u1ea7u th\u1eadn v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd c\u1ee7a da (H\u00ecnh 19A).<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 18: Mi\u1ec5n d\u1ecbch hu\u1ef3nh quang v\u00e0 mi\u1ec5n d\u1ecbch men, tr\u1ef1c ti\u1ebfp (A) v\u00e0 gi\u00e1n ti\u1ebfp (B)<\/span><\/em><\/p>\n

Mi\u1ec5n d\u1ecbch men:<\/span><\/h4>\n

Kh\u00e1ng th\u1ec3 \u0111\u01b0\u1ee3c g\u1eafn v\u1edbi men (enzyme). Khi cho th\u00eam ch\u1ea5t hi\u1ec7n m\u00e0u v\u00e0o m\u1eabu m\u00f4, men l\u00e0m k\u1ebft t\u1ee7a ch\u1ea5t m\u00e0u (th\u01b0\u1eddng l\u00e0 m\u00e0u n\u00e2u) t\u1ea1i v\u1ecb tr\u00ed ph\u1ee9c h\u1ee3p kh\u00e1ng nguy\u00ean-kh\u00e1ng th\u1ec3, nh\u1edd \u0111\u00f3 th\u1ea5y \u0111\u01b0\u1ee3c d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi quang h\u1ecdc.<\/span><\/p>\n

C\u0169ng gi\u1ed1ng nh\u01b0 v\u1edbi ch\u1ea5t ph\u00e1t hu\u1ef3nh quang, n\u1ebfu men \u0111\u01b0\u1ee3c g\u1eafn tr\u1ef1c ti\u1ebfp v\u00e0o kh\u00e1ng th\u1ec3 th\u1ee9 nh\u1ea5t \u0111\u1eb7c hi\u1ec7u v\u1edbi kh\u00e1ng nguy\u00ean, g\u1ecdi l\u00e0 ph\u01b0\u01a1ng<\/span> ph\u00e1p <\/span>mi\u1ec5n d\u1ecbch men tr\u1ef1c ti\u1ebfp. Khi men \u0111\u01b0\u1ee3c g\u1eafn v\u00e0o kh\u00e1ng th\u1ec3 th\u1ee9 hai \u0111\u1eb7c hi\u1ec7u v\u1edbi kh\u00e1ng th\u1ec3 th\u1ee9 nh\u1ea5t, g\u1ecdi l\u00e0 mi\u1ec5n d\u1ecbch men gi\u00e1n ti\u1ebfp.<\/span><\/p>\n

Mi\u1ec5n d\u1ecbch men \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u trong ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh l\u00fd u b\u01b0\u1edbu, gi\u00fap x\u00e1c \u0111\u1ecbnh ngu\u1ed3n g\u1ed1c c\u1ee7a c\u00e1c kh\u1ed1i u c\u00f3 \u0111\u1ed9 bi\u1ec7t ho\u00e1 qu\u00e1 k\u00e9m ho\u1eb7c kh\u00f4ng bi\u1ec7t ho\u00e1 \u0111\u1ec3 ph\u00e2n bi\u1ec7t gi\u1eefa carcinom, sarcom hay lymphoma (H\u00ecnh 19B). Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, ch\u1eb3ng h\u1ea1n \u0111\u1ed1i v\u1edbi ung th\u01b0 v\u00fa, mi\u1ec5n d\u1ecbch men c\u00f2n c\u00f3 gi\u00e1 tr\u1ecb \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng v\u00e0 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb (\u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft estrogen, th\u1ee5 th\u1ec3 Her-2\/neu).<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 19: Ho\u00e1 m\u00f4 mi\u1ec5n d\u1ecbch hu\u1ef3nh quang, d\u00f9ng kh\u00e1ng th\u1ec3 hu\u1ef3nh quang ch\u1ed1ng IgA cho th\u1ea5y c\u00f3 s\u1ef1 l\u1eafng \u0111\u1ecdng c\u1ee7a IgA \u1edf v\u00f9ng gi\u00e3n mao m\u1ea1ch trong b\u1ec7nh th\u1eadn IgA (A). M\u1ed9t u k\u00e9m bi\u1ec7t ho\u00e1 c\u1ea5u t\u1ea1o b\u1edfi t\u1ebf b\u00e0o h\u00ecnh thoi tr\u00f4ng gi\u1ed1ng nh\u01b0 m\u1ed9t sarcoma (B1), nhu\u1ed9m h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch men v\u1edbi kh\u00e1ng th\u1ec3 ch\u1ed1ng cytokeratin cho th\u1ea5y t\u1ebf b\u00e0o u b\u1eaft m\u00e0u n\u00e2u (B2), ch\u1ee9ng t\u1ecf \u0111\u00e2y l\u00e0 m\u1ed9t carcin\u00f4m ch\u1ee9 kh\u00f4ng ph\u1ea3i l\u00e0 sarcoma.<\/span><\/em><\/p>\n

Ngo\u00e0i ra, c\u00e1c k\u1ef9 thu\u1eadt ti\u00ean ti\u1ebfn \u1ee9ng d\u1ee5ng sinh h\u1ecdc ph\u00e2n t\u1eed nh\u01b0 k\u1ef9 thu\u1eadt lai gh\u00e9p t\u1ea1i ch\u1ed7 ph\u00e1t hu\u1ef3nh quang (fluorescent in situ hybridization, FISH), ph\u1ea3n \u1ee9ng chu\u1ed7i polymerase (polymerase chain reaction, PCR), v.v. c\u0169ng \u0111ang t\u1eebng b\u01b0\u1edbc \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o s\u1eed d\u1ee5ng trong labo gi\u1ea3i ph\u1eabu b\u1ec7nh nh\u1eb1m ph\u1ee5c v\u1ee5 cho <\/span>c\u00f4<\/span>ng t\u00e1c ch\u1ea9n \u0111o\u00e1n; c\u00e1c k\u1ef9 thu\u1eadt n\u00e0y tuy c\u00f3 \u0111\u1ed9 ch\u00ednh x\u00e1c cao nh\u01b0ng chi ph\u00ed c\u0169ng cao kh\u00f4ng k\u00e9m! (H\u00ecnh 20).<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 20: K\u1ef9 thu\u1eadt FISH cho th\u1ea5y c\u00f3 s\u1ef1 khu\u1ebfch \u0111\u1ea1i gen HER-2\/neu l\u00ean g\u1ea5p 3 l\u1ea7n (bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u00e1c \u0111\u1ed1m \u0111\u1ecf trong nh\u00e2n) \u1edf c\u00e1c t\u1ebf b\u00e0o carcinoma tuy\u1ebfn v\u00fa (B) so v\u1edbi t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 \u1ed1ng tuy\u1ebfn v\u00fa b\u00ecnh th\u01b0\u1eddng (A).<\/span><\/em><\/p>\n

\u0110\u1ed1i chi\u1ebfu l\u00e2m s\u00e0ng – gi\u1ea3i ph\u1eabu b\u1ec7nh<\/span><\/h4>\n

L\u00e0 ho\u1ea1t \u0111\u1ed9ng ph\u1ed1i h\u1ee3p th\u01b0\u1eddng xuy\u00ean c\u1ea7n ph\u1ea3i c\u00f3 gi\u1eefa c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng, b\u00e1c s\u0129 gi\u1ea3i ph\u1eabu b\u1ec7nh v\u00e0 c\u00e1c b\u00e1c s\u0129 thu\u1ed9c c\u00e1c khoa c\u1eadn l\u00e2m s\u00e0ng kh\u00e1c nh\u01b0 X-quang, si\u00eau \u00e2m; \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang \u0111\u1eafn, c\u0169ng nh\u01b0 \u0111\u1ec3 r\u00fat kinh nghi\u1ec7m \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n t\u1eed vong.<\/span><\/p>","protected":false},"excerpt":{"rendered":"

\u0110\u1ecaNH NGH\u0128A V\u00c0 PH\u00c2N LO\u1ea0I GI\u1ea2I PH\u1eaaU B\u1ec6NH H\u1eccC: Gi\u1ea3i ph\u1eabu b\u1ec7nh h\u1ecdc, c\u00f2n g\u1ecdi l\u00e0 b\u1ec7nh h\u1ecdc,<\/p>","protected":false},"author":21,"featured_media":10418,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-10412","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-giai-phau"],"_links":{"self":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/10412","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/comments?post=10412"}],"version-history":[{"count":2,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/10412\/revisions"}],"predecessor-version":[{"id":10422,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/10412\/revisions\/10422"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/media\/10418"}],"wp:attachment":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/media?parent=10412"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/categories?post=10412"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/tags?post=10412"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}