ct chan doan u mau gan

8/18/2019 CT Chan Doan u Mau Gan

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n o¸n ×n n

u m¸u gan Bïi Hoµng Tó§¹i häc Y H¶i Phßng


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§¹i c¬ng

• Lµ mét tæn th¬ng hay gÆp• hi!m "#$% &'n ()* c+ th, -.n /!n 0#1% 2 T3

-4 n56nam7$6" hoÆc 86" tïy th9o t:ng t;c gi¶• Thng c+ t?i4@ chAng µ Ct D¶y ?a Ei!n

chAng• FGi §H thI th


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§¹i c¬ng

• ;c ph¬ng ph;p §H / Wc ;p &Xngt?ong chn /o;n @ m;@ ganZ[ \i.@ 'm[ LFT[ S]^ J?_t t)tM

[ hXp m¹ch[ \cintig?aphy


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Gi¶i phÉu bÖnh

• §¹i th,Z[ ` nh bcm c+ mµ@ / hoÆc phGt Danh

[ ` dcm c+ mµ@ / (em* nhi@ thïy mói*c+ th, th_y D¬ µ >i h+a

• Fi th,Z

[ ;c Hf m;@ Gi thµnh -µ Ei,@ m> &t J@ m;@[ th, hangM Gi ;ch D¬ µ >i ho; hoÆc c;c

c@én mao m¹ch nhJ th, mao m¹chM


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Fi th,


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ChÈn ®o¸n h×nh ¶nh

• Th, /i,n hInh Jthng /i,n hInh


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ThÓ ®iÓn h×nh trªn siªu©m

• \i.@ 'm[ Lµ hInh ¶nh tng 'm

[ ]anh giGi ?[ B< c+ th, /@ hoÆc =h>ng[ + tng 'm phCa (a@[ Th


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C¸c ph¬ng ph¸p h¸c

• hXp LFT[ HInh gi¶m t3 t?äng t?Gc ti.m

[ \a@ ti.m th@)c ng_m th@)c t: ngo¹i i µot?@ng t'm JP9?iph9?a- to c9nt?ip9ta-M

[ §Oy th@)c thI m@én


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• éng hng t: JS]^M[ li¶m tCn hi4@ t?.n T" \

[ Tng tCn hi4@ m¹nh t?.n T$ \ Jt¬ng /¬ng &Vch no tyM

[ \a@ ti.m th@)c ng_m th@)c t: ngo¹i i µo

t?@ng t'm[ §é nh¹y µ /é /Æc hi4@ -.n /!n K%*

/é chCnh D;c KK%


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• \cintig?aphy[ kïng TcKKm gqn Gi hfng cO@

[ §é nh¹y µ /Æc hi4@ =ho¶ng %


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ChÈn ®o¸n h×nh ¶nh

• Th, /i,n hInh Jthng /i,n hInh


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ThÓ h!ng ®iÓn h×nhtrªn siªu ©m

• li¶m 'm Jt?.n nn gan nhiNm mQM• + in tng 'm• RCch thGc -Gn* c+ D¬ h+a* >i h+a• ` m;@ th, hang

• ` m;@ th, -an ta• ` m;@ Ei!n chAng ch¶y m;@


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li¶m 'm t?.n nn gantn 'm


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rm =h>ng /fng /@


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rm =h>ng /fng /@


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Rh)i c+ in tng 'm


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` m;@ th, hang Ginhi@ ïng gi¶m 'm

t?ong =h)i


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` m;@ th, -an ta


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` m;@ c+ ch¶y m;@


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• §a phOn nh5ng @ m;@ =h>ng /i,n hInhnµy / Wc chn /o;n t?.n T &o tCnh ch_t

ng_m th@)c /Æc Ei4t ca n+• U!@ =h>ng /;nh gi; / Wc t?.n T thI/;nh gi; t?.n S]^

• Sét () t?


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"#t s$ tr%ng h&p ®'cbiÖt

• ` m;@ s@; -Gn• ` m;@ ng_m th@)c nhanh

• ` m;@ c+ ho¹i tu µ D¬ h+a gi)ng H• ` m;@ c+ >i h+a• ` m;@ c+ c@)ng•

` m;@ c+ (h@nt /éng#tvnh m¹ch cua• H9mangiomato(i(• ` m;@ ph;t t?i,n nhanh• li)ng Gi &i cn

• Ph)i hWp Gi tæn th¬ng =h;c


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T µ S]^ ca @m;@ t?.n nn gan

nhiNm mQ ( m u c) shunt ®#ng*


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T S]^

nginapa

( m¸u c) shunt ®#ng*t+nh m¹ch c,a


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H9mangiomato(i(


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` m;@ c+c@)ng


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( m¸u ng-m thu$cnhanh ."/01 th%ng 23iu nh4 5ch th3c 67cmChÈn ®o¸n ph©n biÖt 23i " ®8n gan

®'c biÖt 9: 23i c¸c ung th n#i ti8t 2:nh-t 9: 23i c¸c u tiÓu ®¶o .0s9;t c;991m

.?;9a@;A phas;1BB( m¸u cn ®D@ thu$cE" th× h!ng c) ®'c t5nh n:@


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( m¸u93nE c)2¸ch

trong

C

T

"/

0


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( m u c) 2!i


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` m;@ hya-in h+a JHya-iniw9&h9mangiomaM

• Ugng hoµn toµn /Oy th@)c• S]^Z Tng tCn hi4@ t?.n T$ \ nhng =h>ng

m¹nh


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T

S]^ nap


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Gi$ng 23i FCC


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Gi$ng Gi S JBU / mæ @ /¹it?µngM


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( m¸u ti8n triÓn nhanh

• T: "K1#"KK• Th


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` m;@ &¹ng =xn hoÆc nhi @ æJy(tic o? m@-ti-oc@-a?

h9mangiomaM• + mAc &Vch#&Vch• Sét () t;c gi¶ cho

?jng n!@ c+ mAc&Vch#&Vch t?.n Tµ S]^* =h>ng th_yt?.n (i.@ 'm gWi z

cho @ m;@

h$i h& 3i t th


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h$i h&p 23i tHn th¬ngh¸c

• Ph)i hWp Gi @ gan =h;c• Tæn th¬ng cïng Gi tng (¶n n)t ïng

t?.n phX n5 &ïng th@)c t?;nh thai


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Ii8n chJng

• h¶y m;@ t?ong @• Fi.m nhiNm =h)i @

• {oqn c@)ng J§)i Gi @ c+ c@)ngM• §| xp µo tvnh m¹ch

• H Ra(aEach#S9??itt


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Ch¶@ m¸utrong u


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h|n xp µo TSk


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FC Kasabach*";rritt

• Ra(aEach#S9??itt -µ mét Ei!n chAng hi!m gÆp canh5ng @ m;@ ngngm;@ Eao gfm c+ />ng m;@ néi m¹ch* cXc m;@/>ng µ D¬ h+a E.n t?ong @ m;@2 T: E4nh -z />ngm;@ =h@ t?ó Ean /O@ c+ th, ti!n t?i,n /!n tngD¬ h+a h4 th)ng µ gi¶m ti,@ cO@ &n /!n he@s@¶ tu ong t?ong =ho¶ng $ /!n % E4nh nh'n2

• Ra(aEach#S9??itt (yn&?om9 i( a ?a?9 comp-ication o}h9patic h9mangioma( in a&@-t(2 ^t i( a coag@-opathy

con(i(ting o} int?aa(c@-a? coag@-ation* c-otting* an&~E?ino-y(i( ithin th9 h9mangioma J01M2 Th9 initia--y-oca-iw9& coag@-opathy may p?og?9(( to (9con&a?yinc?9a(9& (y(t9mic ~E?ino-y(i( an&th?omEocytop9nia J0M* -9a&ing to a }ata- o@tcom9in $%[% o} pati9nt(2


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FC Kasabach*";rritt

• §)i Gi t?€ 9m H nµy c+ th, D¶y ?a t?.nnn E4nh nh'n /a @ m;@ JRh>ng ch @m;@ ganM

•U!@ D¶y ?a /)i Gi t?€ c+ @ m;@ ganZ th


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