sieu am chan doan buou gan

7/24/2019 Sieu Am Chan Doan Buou Gan

1/109

1 November 2014 1

NHNG KH NNG V GII HNCA SIU M TNG PHN(CONTRAST- ENHANCED

SONOGRAPH!TRONG CH"N #O$N %U GAN

%S& NGU'N U) KHO$NG

%S& NGU'N UANG TR*NG

KHOA CH"N #O$N H+NH NH

%,NH VI,N AN %+NH TP&HCM


2/109

1 November 2014 2

N.I DUNGI& #/0 12345&I6&N57894 :; 1? @2345 B4&I& C1 F @B7@ @J45 =097 >? @2345 B4&

I1& C1 @B @2L0 ?7 564&I& C1 F07 @ @B7Q1 @2345 B4 J @B 45 ?/1B 1? @2345 B4&II5& SJ =4B B4B 4B 2L7 564 @94 =097 >? _D =097 >? @2345B4&

III&NB45 50L0 B/4 1? @J45 1BX4 J4 2L7 564&IV& K[@ :74&


3/109

1 November 2014 3

I& #I CNG

TJ45 1`45 0a1 =097 >? b45 B45 458c FB`45 ^@:d4 1BZ45 @6 cm thy bi ri@2L1 ?@ @e4 @B2345FB7 @Z @J45 564c 4Bf@ : @e4 @B2345 g1&

Bu gan ny l gc :4B B68 1c 1d4 @B\J h0 6 =6Jc1d4 :? @B9? 11 FB? 45B0a? i 1BX4 J4 B4B4B 4Jc 11 jk@ 45B0a? i =04B Bl6c B78[@ Bm1c ?0n4

o1B 4Jc 1d4 =04B @B0[@ FB`45p #l : 4B45 1>7 Bq0@B2r45 B0a4 6 @J45 d7 1BZ45 @6&


4/109

1 November 2014 4

T78 4B094c @2L1 FB0 g@ f4 i :? 5 @B9?c 1BZ45 @6@s Bq0 j\? @6 tn dng ht cc k thut trng !i"u#m 1B26 4B2Y

KBJ =@ o @^c F^1B @B2L1 B4B @B0 1? B60 1B0i7&

TB`45 @04 B78[@ 45 @u FBJ =@ =097 >? DJ:\&

TB`45 @04 ?645 @^4B 45 Bm1 @u FBJ =@ =097 >?@2345 B4&


5/109

1 November 2014 5

CBZ45 @6 =v Z@ 6 nh$ng u % nh&c i'm c(a cck thut !i"u #m t)ng *hn 48 t45 11 45B0941w7 1? 1BZ45 @6 1l @B =z b45 1BJ a4B 4B>4&


6/109

1 November 2014 6

I6& NGUN {) CA SIU M TNG PHN

V0a1 =z b45 11 0 l45 FB^ (?01J7:\=! :?@1 4B>4 @2345 B4 @J45 =097 >? 2|1 45B} [4 FB0452r0 @6 ~764 =@ @Bf8 B0a4 @2|45 @2345 B4 @J45

45 ?/1B 1B< FB0 3? 745 o1B ?7Q0 45 @2345@J45 ~7 @4B @B`45 @0? (G6?06F 64 SB6Bc !&H0a4 @2|45 48 2|1 @/J 494 0 11 0 l45 FB^ @/J

6 @J45 ~7 @4B 3? 745 o1B ?7Q0&


7/109

1 November 2014 7

# 11 0 l45 FB^ @ @B4B @1 4B>4 @2345 B4

@J45 =097 >?c 452r0 @6 B0 500 ~78[@ B60 f4 icf4 i @Bw 4Bf@Y

9: k;m b@J45 @7d4 BJ4

45J/0 0 ?`0 @2r45 =7f@ 16J @J45 @Bf@ (T!& #0i7 48 2|1 500 ~78[@ t45 11B 6J m1 11 0

l45 FB^ t45galactose-palmitic acidBJg1 :L v

phospholipid(phospholipid shell).

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _


8/109

1 November 2014 8

SJ =4B @Br0 5064 B>4 B


9/109

1 November 2014 9A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _

Cf7 @/J 0 l45 FB^ (SJ4JV7\!Y 5?

1l FB^ =7:B7 B\j6]:7J0\c 2|1 6Jm1 0 ?@ :L BJ=BJ:00=& K^1B@B2L1 @745 4B ?c ?& SJ46J0


10/109

1 November 2014 10

Vf4 i @Bw B60Y

.c %i b=ng kh> *hi ( nh? 2|@ ~76 @7d4BJ4 Be0 =67 FB0 2|1 1B^1B J @}4B ?/1B&M7Q4 4B2 8 11 0 l45 FB^ B0 1l F^1B @B2L1

-? (4Bq B34 F^1B @B2L1 B45 1d7!& C1 0 l45 FB^ w45 2|1 897 1d7 48 :

perfluorocarbon,sulphur hexafluoride&

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _


11/109

1 November 2014 11A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _

V0 l45 FB^ (SJ4JV7\!2L0 F^4B B04 0 0a4 @z1l F^1B @B2L1 @B68 e0&

V0 l45 FB^ (SJ4JV7\! (11 ?x0 @94 @45! 1l F^1B@B2L1 4Bq B34 B45 1d7 (11 ?x0 @94 \4!&


12/109

1 November 2014 12

VL0 11 1Bf@ @2345 B4 @B[ Ba ?L0c @Br0 5064 11 0l45 FB^ @4 @/0 @J45 ?7 FkJ 0 4B0i7 BZ@c < 1BJ0a1 FBJ =@ =097 >? @2345 B4 J 11 @B FB1

4B67& TB7Q1 2|1 1B^1B TM (J:7=! BJg1 @78i4 TM&

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _

J:7= 04]7=0J4


13/109

1 November 2014 13

TBr0 5064 @1 45 1


14/109

1 November 2014 14

C1 @1 b45 Bb f@ ^@Y 45w6c 74 4`4c 4l45 u45c1Bl45 ?g@c 4Bw1 d7c B/ B78[@ 4B&

TB7Q1 FB`45 1 L0 @B4c 564 4J&

T :a o @1 b45 Bb (c! @Bf B34 =J L0 451Bf@ @2345 B4 @J45 CT MRI&

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _


15/109

1 November 2014 15

- C1 0 l45 FB^ FB0 4B4 2|1 =l45 =097 >? =v @B68 e0 F^1B @B2L1 2L0 :s1 1?c F[@ ~7 : B4B @B4B =s 6J 45 :64 @q6 6 j745 ~764B&

- Ss 6J 45 48 =v 506 @W45 5f 4B0i7 :d4 4[7 4B2 6J 45 1


16/109

1 November 2014 16

VL0 11 0 l45 FB^ 1l F^1B @B2L1 @u -?c @B tn s cng hng@u c-MH&

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _


17/109

1 November 2014 17

DJ 8c F^1B @B^1B 11 0 l45 FB^ L0 1B? =l45 =097 >? 4W45

:2|45 @Bf (MI-?\1B64016: 04\j c_!c @6 4 /@ 2|1 =s 145B245 ? FB`45 B 11 0 l45 FB^&


18/109

1 November 2014 18

V0a1 =z b45 1B? =l45 =097 >? 4W45 :2|45 16J (B05B MI-B05B ?\1B64016: 04\j ! =v B 11 0 l45 FB^&


19/109

1 November 2014 19

C1 0 l45 FB^ =v :? @W45 @^4 B0a7 =097 >? @J45 :45 ?/1B&


20/109

1 November 2014 20

Vi B^6 =l45 >?c FB0 j7894 ~76 ?`0 @2r45 0 l45 FB^ 645

@/45 @B0 145 B245 @B @^4 B0a7 J @4 j/ @ i d7 =vFB`45 14 50 Z45 @d4 =Q 4B2 @d4 =Q B@ ? =v 5f _ccy:d4c B0a4 @2|45 48 2|1 5m0 : !"p #ng $h%ng tu&'n tnh(4J4-:04\6 \=J4=\! 18 : 13 = 1BJ

B4B 4Bsiu *m h+a *m vi cht tng ph/n (B6?J4011J4@6=@ 0?65045!&


21/109

1 November 2014 21

I& C$C K THUT TRONG SIU M TNG PHN

0. 1iu *m 23 vi cht tng ph/n (conventionalcontrast imaging)4

K @B7@ 2|1 =z b45 @J45 @Br0 F d7 1? @2345 B4& CB B@ B0a4 2|1 B0a7 w45 :? t5ng tn hi6u c7a

cht tng ph/n trong bu8ng tim v9 c"c m:ch m"u

ln.


22/109

1 November 2014 22

2. 1iu *m 3oppler vi cht tng ph/n (3opplercontrast imaging)4 K @B7@ s6 @94 =s 506 @W45 094 6J 45 18 494 B0a7 w45 DJ:\& #0i748 :? @W45 4B/8 1


23/109

1 November 2014 23

CJ:J DJ:\ @B4 (P!

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _

%:JJ?045 6@0]61@ =67 FB0 1B^1B

@B7Q1 @2345 B4&


24/109

1 November 2014 24

;. 1iu *m h+a *m vi cht tng ph/n (8 : F @B7@ 2|1 i 1 4B0i7 4Bf@ @J45 0

4W? @ :/0 >8& F @B7@ 48 452r0 @6 =z b45

F @B7@ J j745(PI-P7:=\ 04\=0J4! thu nh=n!"p #ng $h%ng tu&'n tnh (4J4-:04\6 \=J4=\!1m:ch m"u ln !'n mao m:ch&

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _


25/109

1 November 2014 25

K @B7@ J j745 (PI-7:=\ 04\=0J4!Y @B68 j745c 452r0 @6 B@ 0 _ j745

145 @d4 =Qc 4B245 j745 =67 :a1B 0 L0 j745 @2L1 ?@ 5l1

c =67 l @B74B4 B0 >? @u B60 j745 145 L0 4B67 F[@ ~7 : B0 >? L0 !"p #ngtu&'n tnh (:04\6 \=J4=\! @B @0a@ @097 :4 4B67c 14 B0 >? !"p #ng $h%ng

tu&'n tnh (4J4-:04\6 \=J4=\! =v 1l @^4 B0a7 FB`45 1l @^4 B0a7 Q0 L0 ?`c1l @^4 B0a7 1B L0 11 0 l45 FB^&


26/109


27/109

1 November 2014 27

?. 1iu *m l@e s"ng vi cht tng ph/n (Alash contrastimaging)trong ch' ! BC(Bechanical Cndex)cao4

Tu MI @Bf 452r0 @6 1B784 =645 MI 16J :? B B[@ 11 0 l45 FB^ 4t? @J45 45 FBJ =@c0 4B64B 1Bl45 @ :/0 1B[ MI @BfY d:a %m@c - % thAi gian ut hi8n trC lDi cht t)ng

*hn ' nh gi lu l&ng ti mu mEF KB0 1B784 =645 1B[ MI 16Jc 11 0 l45 FB^

45 :J/@ @/J 494 11 j745 @^4 B0a7 094 16J

5>8 494 B0a4 @2|45 :l\ =45&

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _


28/109

1 November 2014 28

HCCY %-MJ\{J-MI 1J4@6=@ USY

B0a4 0a4 11 ?/1B ?7

@J45 HCC

H05B-MI 1J4@6=@ USY]:6=B 1J4@6=@ 0?65\


29/109

1 November 2014 29

{J-MI DJ:\ 1J4@6=@

USY @Bf8 2|1 ?/1B ?747`0 0 J FBQ0 7

H05B-MI DJ:\ 1J4@6=@USY ]:6=B 1J4@6=@ 0?65\

S@\B640\ R& 0:=J4c MD \@ 6:& H6?J401 H\6@01 US 0@B M01J7:\ CJ4@6=@A5\4@Y I40@06: Ej\0\41\ SBJ045 I?J\ CB661@\06@0J4 J] H\?6450J?6c

H\6@J1\::7:6 C6104J?6c 64 M\@6=@6=0=&Dadiolog&. __Y-


30/109

1 November 2014 30

EF thu=t gia t5ng tn hi6u ti!a theo thGi gian (HemporalBaximun-Cntensit&-IroJectionimaging).

K @B7@ 48 50Q45 4B2 F@B7@ 1Bb 4B L0 @Q1 @B@ 1B? (@Br0 5064 :

=45 ? ?4 @ - FkJ0! @J45 45Ba @B7@ 4B0[4B ? w45 b45 @B2r45@Bf8 : 1Bb BJ BJ6 45Ba

@B7@&

S@\B640\ R& 0:=J4 \@ 6:& R\6:-T0?\ T\?J6: M6j0?7?-I4@\4=0@8-PJ\1@0J4 I?65045 J]

H\6@01 {\=0J4= 0@B CJ4@6=@-E4B641\ SJ4J56B8& AR _ Y-


31/109

1 November 2014 31

S3 ?04B BJ/ 1BJ @Bf8 MI @Bf 2|1 78 @ @J45?@ FBJ45 @Br0 5064 0 F[@ @BZ1 t45 11B 1B784

=645 MI 16J :? 45 :J/@ 11 l45 FB^&

S@\B640\ R& 0:=J4 \@ 6:& R\6:-T0?\ T\?J6: M6j0?7?-I4@\4=0@8-PJ\1@0J4 I?65045 J]

H\6@01 {\=0J4= 0@B CJ4@6=@-E4B641\ SJ4J56B8& AR _ Y-


32/109

1 November 2014 32

HCCY SA @2345 B4 @B`45

@B2r45 1B @Bf8 @W45 B0 >?FB`45 45 4Bf@&

HCCY MIP 1BJ @Bf8 1f7 @Z1?/1B ?7 @J45 2L7&


33/109

1 November 2014 33

SJ4JV7\Y 5? 1l Bd4 745 o1B (?: N6C: ! Bd4 @ (_?5!& T6 @4:4 L0 4B67c :1 i7 FBJ45 c =67 l 1Br 1BJ 11 l45 FB^ :L4c @6

2|1 ?@ B4 o1B @45 =6&

A& {& %6\@ \@ 6:&

CJ4@6=@ M\06 04U:@6=J4J56B8&S045\& _


34/109

1 November 2014 34

SJ4JV7\Y

- #2r45 @09? 1B^1B 2|1 1B7X4 o L0 1B/1 6 4Q0 L0 Q45 @B`45 @J45 @}4B?/1B -G (04@6\4J7= 16447:6!&

{f8 2r45 @09? 1B^1B TM 14B @68 @0 ( @4B o 2L45 FB0 @6FBJ =@ 564!&

KB`45 45 F0?c 0 l45 FB^ 1l @B o B B


35/109

1 November 2014 35

I1& C$C TH+ TI M$U GAN

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _

TB`45 @B2r45 @6 :? @B 45 ?/1BY c @B @}4B ?/1B 1z6Y @B @n (=047=J06: B6=\!Y &


36/109

1 November 2014 36

I1& C$C KIU %T THUC TNG PHN VO TH+ #.NG MCH CA U GAN

KB`45 @W45 >?Y 4645c4Q@ :J/4 =4c HCC =L?

TW45 >? :64 @q6 45 4Bf@ BJg1 FB`45Y

0 1W4 507 @2L0 ?7c :8?BJ?6c NH

TW45 >? /45 0i4Y 0 1W4c CCC(1BJ:6450J1\::7:6 16104J?6!

O:64J C6@6:64Jc MD\@ 6:& R\6:-T0?\

H6?J401 CJ4@6=@M6@\06:=\10]01 US

J] J16: {0\{\=0J4=&

R60JG6B01=

__Y-


37/109

1 November 2014 37

TW45 >? /45 4Q@ 45J/00Y B\?6450J?6

TW45 >? @B\J B4B 464 BJ6YNH

TW45 >? /45 2r45 v :f? @f?c 1l @B F? @B9??/1B ?7 47`0 6J ~764B 0 J FBQ0 7Y HCC

O:64J C6@6:64Jc MD\@ 6:& R\6:-T0?\

H6?J401 CJ4@6=@M6@\06:=\10]01 US

J] J16: {0\

{\=0J4=&R60JG6B01=__Y-


38/109

1 November 2014 38

II& NHNG KH NNG CA SIU M TRONG

CH"N #O$N %U GAN

%2L7 564 : :J/0 2L7 2|1 5g L0 @d4 =7f@ FB 16J @J45 ~7 @4B@BW? FB? a4B Bt45 458&

C1 2L7 :4B @^4B @B2r45 5g 5? 1lY

%2L7 ?7 564 (B\6@01 B\?6450J?6!&

TW45 =4 4Q@ FB7 @Z (J16: 4J7:6 B8\:6=06!&

%2L7 @78[4 564 (B\6@01 6\4J?6!& C1 2L7 1 @^4B @B2r45 5g 5? 1lY

%2L7 @[ J 564 457894 B@ (B\6@J1\::7:6 16104J?6!&

T1 TM 1z6 : B4B 4B FB @B2r45 5g @J45 HCC& %2L7 0 1W4 564 (B\6@01 ?\@6=@6=0=!&


39/109

1 November 2014 39

II6& %U M$U GANHEPATIC HEMANGIOMA

%2L7 ?7 : lDi bu lnht>nh thAng gG* nht C ganc

j8 6 L0 @d4 =7f@ >4 =Q& %a4B j8 6 C tt c cc l@a

tuHic 4B245 @B2r45 5g B34 452r0 :L4c Gc bi8t l *h n$(NN6?!&

Te 1Bw1 Bm1Y 2L7 ?7 5?nhi


40/109

1 November 2014 40

%U M$U GAN HEPATIC HEMANGIOMA

& #04 B4BY

- %2L7 ?7 1l k>ch thc nh?I J K LcmI 50L0 B/4 hc B0 >?8 45 4Bf@ (B4B 4B dDng m nn! (@W45 B0 >? J 1l

4B0i7 ?g@ 45W4 11B 1a !au >t gG* nhng c= gi trN trng chOn nbu muF

_& KB`45 04 B4BY

- %2L7 ?7 :L4cJ P LcmI c= hQi #m dy khEng Qng nht %itrung t#m hQi #m k;m (=J j3 1J::65\4c FBJ645 ?/1B ?7 :L4!&

- V`0 Bl6 @J45 2L7 ?7 B0[? 5g&

- Cd4 :27 ;Y bu m:ch m"u c@ thK c@ h8i *m $Lm trn nMn gannhiNm mO.


41/109

1 November 2014 41


42/109

1 November 2014 42

C& M& R7?61F \@ 6:& D0654J=@01 U:@6=J74& E0@0J4& _&

%2L7 ?7 1l B0 >? Fk? @94 4i4 564 4B0n? ?& H4B4B @W45 >? B^6 =67 50Z 1BX4 J4 2L7 ?7&


43/109

1 November 2014 43

#6 e #6 @B8 V45 B0 >? Fk? @745 @>?

NQ@ `0 Bl6 @J45 2L7M@ e 1l 0i4 B0 >? 8 H0 >? FB`45 45 4Bf@

%U M$U GAN HEPATIC HEMANGIOMA


44/109

1 November 2014 44

U U G C G O

& S097 >? DJ:\Y

- D45 1B8 @J45 2L7 ?7 1l %n tc rt th*I d %y !i"u #m J**l7rkhEng bRt &c *hH mu trng bu muF

& S097 >? @2345 B4Y

-Pu m"u Q 2cmY @W45 >? 45 4Bf@ J @B 45 ?/1B&-Pu m"u R 2cmY

Th ng mch (30): tng m dng nt ngoi vi.

+ Th tnh mch ca (0): tng m !an v"o t#$ng tm %ngnh&t.

- VL0 4B45 2L7 :L4c FB0 [4 @B @n (- ! =s @W45 >? ?L0 @ 49445 4Bf@&

TB 45 ?/1B TB @n

TB @}4B ?/1B 1z6


45/109

1 November 2014 45

S097 >? _D TB #M

TB TMC

V0\J


46/109

1 November 2014 46

- PSt thuc d:ng nt ngo:i vi lan dn v9o trung t*m th&trn siu *m, TH v9 BDC c@ chch thuc tng ph/n l9 du

hi6u $h" !Uc hi6u !K chVn !o"n bu m"u.

- Hu& nhin, ph/i h't s#c lu W rXng4 YZ bu di c5n c@ h[nh/nh bSt thuc ging bu m"u.


47/109

1 November 2014 47

II& TNG SN NT KHU TR(OCA{ NODU{AR HPERP{ASIA-NH!

%2L7 564 lnh t>nh thAng gG*th@ hai=67 2L7 ?7(B\?6450J?6!&

TB2r45 @Bf8 *h n$ trS(NN6?!c B@ B0a4 @4B 1r&

PBb 4 ung thuc ngTa thai1l@B :? 2L7 B@ @04&

UVW bu )n -cc 2r45 F^4B 1?c 4t? 5d4 i ?g@ 564c @B2r45: r 2L0&

_-_ NH 6 e& %2L7 1l r hc @B2r45 6 1745

(:J7:6@\!& NH H\?6450J?6 F[@ B| @J45

_ @2r45 B|& Xan YZ[\Xan Y3[]^\_FCT 64 MR I?65045 J] %\4054 H\6@01 64 %0:068 T7?J=&K6\4 M& HJ@J4c MD&

(Dadiographics. Y-&!


48/109

1 November 2014 48

%2L7 : =s @W45 =4 :4B @^4B6JgQm cc t b ganI 3B5u*``7rc Q45 ?@ ?/1B

?7& Rf@ @B2r45 c= ! ) C trung

t#mc @u =J @745 @>? 1l 4B0i7

1B 45W4 B2L45 i 45J/0 0@B\J B4B 464 BJ6&

TB2r45 khEng thy %Ei h=a

@J45 2L7&

CT 64 MR I?65045 J] %\4054 H\6@01 64 %0:068 T7?J=&K6\4 M& HJ@J4c MD&(Dadiographics. Y-&!


49/109

1 November 2014 49

TNG SN NT KHU TR

(OCA{ NODU{AR HPERP{ASIA - NH!& S097 >?Y

J b? !=t % bu thAng c= hQi #m t)ng t: nhumE gan YVW trAng h&*[I 1d4 s6 J =s j` X8 ?/1B?7 BJg1 0[4 /45 r 564 4B4 0[@&

2L7 1l B0 >? Fk?c 1l B0 >? 8& %2L7 @B2r45 c= ! trung t#m hQi #m k;mF

_& DJ:\Y Df7 B0a7 g1 B0a7 B4B @6 @ 2|1*hH -ng mDch C trung t#m %itrC khng th* % ch cc nhnh t?a ra th7 hnh nanha&


50/109

1 November 2014 50

KBQ0 45 B0 >? (0=J\1BJ!c 1B4 k

?/1B ?7c @Z0 ?@&

M/1B ?7 @745 @>? L0 11

4B4B @q6 6 @B\J B4B 464 BJ6&


51/109

1 November 2014 51

V6:\0\ V0:5604 \@ 6: &I?65\0\ 7 J0\c \= J0\= 0:060\=c 7 P641\6= \@ \ :6R6@\& __& _

KBQ0 45 B0 >? (0=J\1BJ!c 1B4 k

?/1B ?7 (\4045 =054 (!!&

%@ 2|1 Be 45 ?/1B

@745 @>?&


52/109

1 November 2014 52

TNG SN NT KHU TR

(OCA{ NODU{AR HPERP{ASIA - NH!

& S097 >? @2345 B4Y Df7 B0a7 g1 B0a7 B4B @6 @Bf8 ! trung t#m tMng #m th7 hnhnan ha % th -ng mDch FB`45 @W45 >? J @B TM1z6 @B @n&


53/109

1 November 2014 53

M65J@ %6440564c MD \@ 6:& %:JJ :J P6@@\4= 04 J16: {0\ {\=0J4= 6@ M01J7:\-\4B641\ US& R60JG6B01= __Y_-


54/109

1 November 2014 54

S097 >? _D TB #M

TB TMC

V0\J


55/109

1 November 2014 55

-Ih*n b m:ch m"u (1\ 3oppler) hoUc t5ng *m theo h[nh nanhoa (1\ tng ph/n) l9 du hi6u !Uc hi6u !K chVn !o"n H5ngs/n nt $hu tr].

- Hu& nhin,ch]ng ta cn ch] W l9 !%i $hi s^o n9& c+n c@ thKth& trong


56/109

1 November 2014 56

II1& %U TUN GAN(HEPATIC ADENOMA!

%2L7 @78[4 564 5g ch( yu C *h n$ ung thuc ngTathaic 1 0a@ 4 `45 45 =@\J0 45 Bl6 BJg1 %N o a4B

s @ 5:81J5\4& TB2r45 B@ B0a4 J 2L7 j7f@ B78[@& TJ45 2L7 thAng c= nh$ng %ng ut huytI nhQi muI c=

th' %Ei h=aI ch@a meF z @^Y

%2L7 1?Y N5u45 @B7Q1 45u6 @B60 @B\J h0& %2L7 1? 2L0 6J 564Y Me 1@ q&

KB78[4 1J FB`45 ?645 @B60 (4578 13 2L7 J j7f@B78[@!&

CT 64 MR I?65045 J] %\4054 H\6@01 64 %0:068 T7?J=&K6\4 M& HJ@J4c MD&

(Dadiographics. Y-&!


57/109

1 November 2014 57

%U TUN GAN

(HEPATIC ADENOMA!'. i$ m:

%2L7 1l hQi #m dy\Qng\gim #m =J L0 4B7 ?` 564c%? ba gi c= hQi #m k;m6J ~764B&

KB0 1l j7f@ B78[@ @B 2L7 1l B0 >? FB`45 45 4Bf@&*. o,,!-#: .= th' thy *hH mDch mu trng % fuanh buF


58/109

1 November 2014 58

H60 @2r45 B| A\4J?6 j7f@ B78[@

%2L7 B0 >? 8 L0 q 6J 50 6J ~764B %2L7 1l B0 >? ?q45

%U TUN GAN


59/109

1 November 2014 59

%U TUN GAN

(HEPATIC ADENOMA!3. i$ m t/ng ,hn:

_ Hh[ !ng m:ch (;`)4 tMng #m Qng nht hGc khEng QngnhtF

_ Hh[ HB ca (`)4 @e4 @B2345 1l hQi #m gim nhng %nca h)n nhu mE gan k cnF

Hh[ trN (0`)4 tHn th)ng c= - hQi #m ging nhu mE gan&

TB 45 ?/1B TB TM 1z6 TB @n


60/109

1 November 2014 60

M/1B ?7 6J ~764B 7 TB 45 ?/1B

TB TM 1z6 TB @n


61/109

1 November 2014 61

-Pu tu&'n gan gUp ch7 &'u *h n$ ung thuc ngTa

thai.

-Pi'n ch#ng 1$&t h$2t trong bu rt thGng gUp.

- 1\ tng ph/n cho th& bu t5ng *m v9o th[ !ng m:chnhng khEng c= hi8n t&ng a!hut, !iMu n9& gi]p ta ph*nbi6t vi


62/109

1 November 2014 62

II& %U T %O GAN NGUN PH$T

HEPATOCE{{U{AR CARCINOMA - HCC HCC : bu c t>nh C gan

thAng gG* nht& Nl 1x45 :2L7 @094 B@ @B2r45 5g 4Bf@&

%2L7 @B2r45 @Bf8 tr"n n


63/109

1 November 2014 63

& NT TRONG NHU M GAN 2|1 1B06 :? 4Bl?Y4Q@ @0 =04B (\5\4\6@0\ 4J7:\!c 4Q@ :J/4 =4(8=:6=@01 4J7:\! HCC&

a. jt t"i sinh (regenerative nodule)4 : %ng nhu mE gan*h Di ' * @ng %i fu trnh hDi tc !: thay Hitun hn hGc cc k>ch th>ch khc 1l @B ~764 =@@Bf8 a4B :; j3 564 BJg1 FB`45 J j3 564 (B0 1Bw45%7-CB060c a4B @s ?0n4y!& T6 5m0 : ?61J4J7:\ FB0 2r45 F^4B ??& T6 5m0 : ?01J4J7:\ FB0 2r45 F^4B ??& jhkng nt Q Ymm thGng $h%ng thK th& !c vi c"c

phng ti6n chVn !o"n h[nh /nh hi6n t:i. NQ@ @0 =04B J 36 ca cung c* mu&

b. jt lo:n s/n (d&splastic nodule)46J 5? 4B45 T% 564


64/109

1 November 2014 64

:J/4 =4c ?/1B ?7 @>4 =04B& K^1B @B2L1 ??c 2|1j\? : nt tinh Y*r7malignant[ d c= th' c=nh$ng H nh? ,.. trng nt lDn !n Ynt trng nt!&

NQ@ :J/4 =4 L0 - c th* Yl grad7[ thAng d 36

ca cung c* muc @J45 FB0 4Q@ :J/4 =4 L0 - c caYhigh grad7[ thAng d -ng mDch gan cung c* muF

R01B6 {& %6J4c MD \@ 6:& S1\\4045 @B\ C0BJ@01 {0\ ]J H\6@J1\::7:6 C6104J?60@B CT 64 MR I?65045Y OJ@740@0\= 64 P0@]6::=&Dadiographics. __YS-S_


65/109

1 November 2014 65

c. ?4B0n?&

HCC d -ng mDch gan cung c* muF

H7==604 \@ 6:& %\4054 \=7= M6:05464@ H\6@01 NJ7:\= MR I?65045 04045= 0@BP6@BJ:J501 CJ\:6@0J4& (Dadiographics. ____Y_-&!

_& K T %O GAN NGUN PH$T HCC


66/109

1 November 2014 66

a. i$ m *:- K 1l @B )n -c YjW[I 6 e BJg1 @B>? 4B0n?&

- K 1l hQi #m thay Hi(thAng hQi #m k;m khi Ang k>nh KLcmc

45J0 6 1l @B 8 BJg1 B4 B|!&- Rf@ @B2r45 @Bf8 q 6J j3 6J ~764B 2L7 (%i8 2|1 j\? : f7 B0a7 FB 1B78940a@ 1? FB`4545 4Bf@&

- V`0 Bl6 :45 m45 ? @J45 2L7 ^@ 5g&

- V 2L7 5>8ut huyt c= th' gG* %i bu C di %?c @78 t45 ^@5g&

- ,uyt khi hGc #m ln 36 thAng thy L0 HCCc TM 1z6 @B2r45

o B34 11 TM 564 ( @2r45 B|!&


67/109

1 November 2014 67

KBQ0 7 B>4 @B8 VIIIc B0 >? 8 FB`4545 4Bf@ q 6J ?q45c B0 >? Fk?&



68/109

1 November 2014 68

4. i$ m o,,!-#:

- Cl @B @Bf8 -ng mDch ba fuanh buI i % bu % nh$ng cu trocmDch mu hpn -n trng bu Ychatic *att7rn[F

- DJ:\ j745Y N52r0 @6 4B4 @Bf8Z91 c(a /6 trng bu thAng tMng

ca ! %i Z91 c(a /6 ganB0 BJg1 @0& DJ 1l =s B0a4 0a4 c(a cc !hunt /6 gan36 ca 45 1B8 @Q1

16J J ?7 @u 430 :s1 16J e i 430 :s1 @Bf&

6Dch mu nuEi bu thAng ngqn ng un khocc 4B45 1B 7Q4FBZ1 =v :? 1BJ 45 1B8 1l 4 @Q1 @W45 16J&

PSVY \6F =8=@J:01 \:J10@8c 4 @Q1 4B @>? @B7&


69/109

1 November 2014 69


70/109

1 November 2014 70


71/109

1 November 2014 71

%2L7 564 L0 4B45 ?/1B ?745Jt4 45JJ 94 @J45&

PSV 1


72/109

1 November 2014 72


c. i$ m t/ng ,hn:

- Hh[ !ng m:ch (;`)4 tMng #m khEng Qng nht1l @B @Bf8

4B45 2r45 tMng #m hpn -n Ychatic *att7rn[F- Hh[ HB ca (`)4 @e4 @B2345 50? >? =J L0 4B7 ?` 564 F[

14 (hi5n t6ng 7a8h9o$t!&

,i8n t&ng a!hut50Z 1BX4 J4 HCC& PB>4 0a@ L0 4Q@ @0 =04BY FB`45 @W45 >? J @B 45 ?/1Bc

tMng #m % th 36 ca % th tr&

PB>4 0a@ L0 4Q@ :J/4 =4Y tMng #m % th -ng mDch %th 36 caF


73/109

1 November 2014 73

O:64J C6@6:64Jc MD \@ 6:& R\6:-T0?\ H6?J401 CJ4@6=@ M6@\06:=\10]01 USJ] J16: {0\ {\=0J4=& R 60JG6B01= __Y-

6=B-J7@B\4J?\4J4


74/109

1 November 2014 74

KBQ0 7 1l 0i4 B0>? Fk? 564 (P!&

TB TMC6=B-J7@ HCC

TB #M-MIP


75/109

1 November 2014 75

TB #MY FB`45 @W45 >?

TB TMCY @W45 >? FB`45 45 4Bf@ TB @nY 45 >?

PJ\ DJ:\

NQ@ @0 =04B

S097 >? _D


76/109

1 November 2014 76

PJ\DJ:\Y 1l @^4

B0a7 ?/1B ?7@J45 7

TB 45 ?/1BY @W45 >?45 4Bf@

TB @nY 45>? (0=J\1BJ01

6\6641\!&

NQ@ :J/4 =4

& TC TNH MCH CA


77/109

1 November 2014 77

(PORTA{ VEIN OCC{USION!

{27 ; t45 @1 TM 1z6 1l @B JY

H78[@ FBQ0 TM 1z6&

>? :f4 TM 1z6&

V 1l @B 26 [4 1B784 /45 jJ645 B645 TM1z6&

T6 1d4 B0 B>4 0a@ 2|1 11 B4B @B0 48 1


78/109

1 November 2014 78

; g - * G g

TMC d huyt khiF- n hi8u muc9s t)ng *hn khEng tMng #m Ydu hi8u kuda Y[-


79/109

1 November 2014 79

H78[@ FBQ0 TMCH78[@ FBQ0 4B4B

(T! TMC


80/109

1 November 2014 80

OF76 =054 (-!

\4054 J@6: @BJ?7= HCC

NJ0J U\4Jc MD \@ 6:& CB661@\06@0J4 J] PJ@6: V\04 TBJ?7= 0@B @B\ U=\J] CJ4@6=@-E4B641\ SJ4J56B8& U:@6=J74 M\ _ _Y-_

KB`45 1l @^4 B0a7 DJ:\ SA @2345 B4Y FB`45 @W45 >?

& M {N TNH MCH CA (PORTA{ VEIN INVASION!- ;nh nghaY H4B @B4B @e 1Bw1 ?` 7 @J45 :45 TM 1z6c 1d4 B0 B>4

0a@ L0 B78[@ FBQ0 TM 1z6& T6 14 5m0 : h$2t >hi c t>nh TM 1z6


81/109

1 November 2014 81

SA @2345 B4 @W45 >? OF76 =054 (!Y ?6:05464@ J@6: @BJ?7=

0a@ L0 B78[@ FBQ0 TM 1z6& T6 14 5m0 : h$2t >hi c t>nh TM 1z6(?6:05464@ J@6: @BJ?7=!&

- nh 36 ca chp bN #m lnc hQi #m c= th'dycJ**l7r c= *hH -ng mDchc9s t)ng *hn tMng #m Ydu hi8ukuda Y[[F

- ? 1l @B 45 4Bf@ BJg1 FB`45 45 4Bf@


82/109

1 November 2014 82

HCC 6 e 1l B0 >? 8& H78[@

FBQ0 TM 1z6&

DJ:\ 1BJ @Bf8 1l Be 45

?/1B U j>? :f4 TM 1z6&

H0=B6? T1B\:\0c MD \@ 6:& SJ4J56B8 J] D0]]7=\ {0\ D0=\6=\& U:@6=J74 M\ __ _Y_-_


83/109

1 November 2014 83

H78[@ FBQ0 TM 1z6&DJ:\ 1BJ @Bf8 1l Be45 ?/1B U j>? :f4

TM 1z6&

CT 1l 1B^1B @B7Q1 1BJ@Bf8 ?/1B ?7 @>4 =04B@J45 FBQ0 7 j>? :f4&


84/109

1 November 2014 84

OF76 =054 (! ?6:05464@ J@6: @BJ?7= HCC

NJ0J U\4Jc MD \@ 6:& CB661@\06@0J4 J] PJ@6: V\04 TBJ?7= 0@B @B\ U=\ J]CJ4@6=@-E4B641\ SJ4J56B8& U:@6=J74 M\ _ _Y-_

KB`45 1l @^4 B0a7 DJ:\ SA @2345 B4Y @W45 >?


85/109

1 November 2014 85

OF76 =054 (! ?6:05464@ J@6: @BJ?7= HCC=

NJ0J U\4Jc MD \@ 6:& CB661@\06@0J4 J] PJ@6: V\04 TBJ?7= 0@B @B\ U=\ J]CJ4@6=@-E4B641\ SJ4J56B8& U:@6=J74 M\ _ _Y-_

DJ:\Y @ 2|1 Be 45 ?/1BSA @2345 B4Y @W45 >?

1& CHUN DNG OANG HANG TNH MCH CA


86/109

1 November 2014 86

(PORTA{ CAVERNOUS TRANSORMATION!9 ;nh ngha:Jn nC mDng li tnh mDch nh? ung fuanh Dn 36

ca bN tRcc B4B @B4B @7d4 BJ4 bng h8 fuanh 36 ca& H> hu&'t

$hi HB ca cho !'n $hi h[nh th9nh ch$2?n dng 1oang hang c@n,hi A ' nm.9 8 1B4 k @u 45J0

J Q45 ?@ 1B4 0a@ L0/6 gan dn nC C b8nh nh#n ) ganY chv c= m-t

mDch mu dnI J**l7r *hH /6& PB>4 0a@ L0#m ln 36 caw J**l7r *hH /6&

9 ? :f4 TM 1z6&


87/109

1 November 2014 87

J=\B K&T&{\\& {\\ 1J?7@\ J8 @J?J56B8 0@B MRI 1J\:6@0J4& &

H78[@ FBQ0 TMC

%6 4W? =67Y 1B784 /45jJ645 B645 TMC


88/109

1 November 2014 88

#2r45 1@ 60 B0-Q4Y TM 1z6@B68 @B[ 0 1f7 @Z1 /45 4645 1l

1B 45W4 p

CB784 /45 jJ645 B645 TMC

C& M& R7?61F \@ 6:& D0654J=@01 U:@6=J74& E0@0J4& _&

%N 4c @7e0c j3 564&

- Y j3 564-:1B @J-45 b45&


89/109

1 November 2014 89

- Y @W45 TM 1z6 (DY ??!&

- Y B78[@ FBQ0 TM 1z6&

- Y p

CB784 /45 jJ645 B645 TM 1z6


90/109

1 November 2014 90

KBQ0 7 B>4 @B8 II-IIIc B78[@ FBQ0 TM 1z6 1B^4Bc 1B784 /45 jJ645 B645TM 1z6 L0 Be TM 1/4B TM 1z6 o B78[@ FBQ0&


91/109

1 November 2014 91

KBQ0 7

H78[@ FBQ0 TMC

CB784 /45 jJ645B645 TMC


92/109

1 November 2014 92

-


93/109

3i c5n hQi #m dy4

%U DI CN GAN HEPATIC METASTASIS

? 3i c5n %Ei h=a4


94/109

1 November 2014 94

&3i c5n hQi #m dy4

- K Q45 @097 Bl6&

- R\46: 1\:: 16104J?6&

- CBJ0J16104J?6&

- C6104J0 @7?J&

2. 3i c5n hQi #m m?ng4- K Z&

- K Be0&

- {8?BJ?6&&3i c5n hnh bia (target pattern)4- K Be0&

?. 3i c5n %Ei h=a4

- M7104J7= 6\4J16104J?6&

- O=@\J5\401 =61J?6&

Y. 3i c5n dDng nang4

- C8=@6\4J16104J?6 1


95/109

1 November 2014 95

D0 1W4 @u CBJ0J16104J?6 D0 1W4 `0 Bl6 @u 6\4J16104J?6 /0 @45

D0 1W4 B4B 06 @u K Be0


96/109

1 November 2014 96

TBJ?6= A:\1B@ \@ 6:& CJ4@6=@-E4B641\ U:@6=J74 04 C:04016: P61@01\& _

S097 >? @2345 B4Y 2L7 @ @B7Q1 /45 0i4 (45BJ @2L0 ?7!c @ @B7Q145 4Bf@ (507 @2L0 ?7! @B 45 ?/1B @B TMC @B @nc 1 B60 :J/0

2L7 i7 1l B0 >? Fk? B34 4e0 @ @94 4i4 4B7 ?` 564 4B @B2r45& #0i748 50Z @Bf8 h 4B45 @e4 @B2345 1?c n o q =l@ FB0 :? =097 >? _D&

D0 1W4 45BJ @2L0 ?7(B8J6=17:6 ?\@6=@6=0=! @u

745 @B2 Z (\6=@ 16104J?6!


97/109

1 November 2014 97

745 @B2 Z (\6=@ 16104J?6!

TB 45 ?/1B

TB @}4B ?/1B 1z6

TB @n

TBJ?6= A:\1B@ \@ 6:& CJ4@6=@-E4B641\ U:@6=J74 04 C:04016:

P61@01\& _


98/109

1 November 2014 98D0 1W4 507 @2L0 ?7 (B8\6=17:6 ?\@6=@6=0=!

S097 >? _D

TB @}4B ?/1B 1z6 TB @n

TB 45 ?/1B


99/109

1 November 2014 99

S097 >? _DY 1B @Bf8 4Q@ B0>? Fk?

S097 >? @2345 B4Y 1 : 4B0i74Q@ 0 1W4&


100/109

1 November 2014 100

-Pu di c5n gan thGng ngho ti m"u, tu& nhin !%i $hita cng gUp bu di c5n gi9u ti m"u.

-3 ngho ha& gi9u ti m"u, th[ siu *m tng ph/n th[HB ca v9 th[ trN, tn thng !Mu c@ h[nh /nh h8i *m $Lmni b=t trn nMn gan b[nh thGng.

II]& TIU CHU"N CH"N #O$N PHN %I,T {NH TNH - $C TNHCA SIU M _D V SIU M TNG PHN


101/109

1 November 2014 101

S@\B640\ R& 0:=J4c MD \@ 6:& D0654J=0= J] J16: {0\ M6==\= J4 U:@6=J4J56B8-CJ?60=J4 J] U4\4B641\ 64 CJ4@6=@-E4B641\ S164=& U:@6=J74 M\ _ _Y-

{OI %U SIU M H+NH NH

{NH TNH _D - H0 >? 8 45 4Bf@&- H0 >? Fk? L0 0i4 B0 >? 8&

- TW45 >? B^6 =67&

TNG PHN - KB`45 1l B0a4 @2|45 6=B-J7@ J @B TM 1z6&

$C TNH _D - V0i4 B0 >? Fk? ~764B @e4 @B2345&- Te4 @B2345 B4B 06&

- H0 >? Fk?&

TNG PHN - H0a4 @2|45 6=B-J7@ @B TM 1z6&

II5& SO S$NH H+NH NH %U GAN TRN SIU M _DV SIU M TNG PHN

CH"N #O$N SIU M _D SIU M TNG PHN


102/109

1 November 2014 102

S@\B640\ R& 0:=J4c MD \@ 6:& D0654J=0= J] J16: {0\ M6==\= J4U:@6=J4J56B8-CJ?60=J4 J] U4\4B641\ 64 CJ4@6=@-E4B641\ S164=&

U:@6=J74 M\ _ _Y- (?J0]0\!&

CH"N #O$N SIU M _D SIU M TNG PHN

H\?6450J?6 - H0 >? 8 45 4Bf@&

- H0 >? Fk? L0 0i4 B0 >? 8&

- TW45 >? B^6 =67&

- TW45 >? /45 4Q@ 45J/0 0&

- TW45 >? :64 d4 J @745 @>?&

- D78 @ =s @W45 >?&NH - Te4 @B2345 F^4 J L0 B0a7 w45

1BJ4 1B&- TW45 >? @B\J B4B 464 BJ6&

- TW45 >? ?/4B 45 4Bf@&

HCC - H0 >? @B68 e0 L0 0i4 B0 >?Fk? (q 6J!&

- TW45 >? :64 @q6 J @B 45 ?/1B&- 6=B-J7@ J @B TM 1z6&

M\@6=@6=0= - H0 >? Fk?&

- H0 >? FB`45 45 4Bf@&

- V0i4 B0 >? Fk?&

-TW45 >? /45 0i4&

-6=B-J7@ 4B64B 1Bl45 BJ4 @J4&

III& GII HN CA SIU M TRONG CH"N #O$N %U GAN


103/109

1 November 2014 103

S097 >? _D DJ:\ 14 4B0i7 B/4 1B[ 4B245 !i"u #mt)ng *hn ch thy c= - nhDy % - Gc hi8u ca trng

chOn n cc bu ganF DE$ mch mF$Y 4B/8 (!c g1 B0a7 (!&

Tng 8n nt !"nh tGnhY 4B/8 (!c g1 B0a7

(!& H t 4"o gan ng$2n ,hFt: 4B/8 (!c g1 B0a7

(!&

H di cn ganY 4B/8 (!c g1 B0a7 (!&

O:64J C6@6:64Jc MD \@ 6:& R\6:-T0?\ H6?J401 CJ4@6=@ M6@\06:=\10]01 USJ] J16: {0\ {\=0J4=& R 60JG6B01= __Y-


104/109

1 November 2014 104

SO S$NH S %T THUC TNG PHN GIA SIU M V CT ON C TRONGK GAN NGUN PH$T TRN %,NH NHN GAN

A4@J40J G0J50J \@ 6:& CJ4@6=@-E4B641\ SJ4J56B01 A\6641\ J] H\6@J1\::7:6C6104J?6 04 P6@0\4@= 0@B C0BJ=0=Y CJ?60=J4 0@B CJ4@6=@-E4B641\ H\:016: CT

A\6641\&\D _ Y-_

IV& KT {UN


105/109

1 November 2014 105

S097 >? 1BX4 J4 : F @B7@ 5B0 B4B khEng #m lnI %EhDic rS ti? @ @B4B B2345 @0a4 B45 d7 @J45 0a1 B@B0a4 11 2L7 564 4Bf@ : SIU M TNG PHN&

V : k thut *h thu-c % ngAi lm 494 ?7Q4 /@ 2|1F[@ ~7 @Q@c 452r0 FB? =097 >? B0 :7`4 :7`4 4>45 16J @6845Bi t45 11B Bm1 Bq0 @Bs1 B4B @B@ 4B0i7&

N5J0 6c 452r0 :? i 1BX4 J4 B4B 4B B0 :7`4 :7`4 4BLt45Y9i"u #m chv l ci b=ng c(a !: thtI d = ta *hi lxgii cc du hi8u !i"u #m bqng cch *hi h&* %i cc d$ki8n c(a l#m !ng % cn l#m !ngF

TI {I,U THAM KHO

C& M& R7?61F \@ 6:& D0654J=@01 U:@6=J74& E0@0J4& _&


106/109

1 November 2014 106

A& {& %6\@ \@ 6:& CJ4@6=@ M\06 04 U:@6=J4J56B8& S045\& _ TBJ?6= A:\1B@ \@ 6:& CJ4@6=@-E4B641\ U:@6=J74 04 C:04016: P61@01\&

_

M65J@ %6440564c MD \@ 6:& %:JJ :J P6@@\4= 04 J16: {0\ {\=0J4=6@ M01J7:\-\4B641\ US& R60JG6B01= __Y_- T6\ K8J745 K0?c MD \@ 6:& H\6@01 T7?J=Y CJ4@6=@ A5\4@-E4B641\?\4@

P6@@\4= 0@B P7:=\-I4\=0J4 H6?J401 US&Dadiolog&. __Y-& S@\B640\ R& 0:=J4c MD \@ 6:& H6?J401 H\6@01 US 0@B M01J7:\

CJ4@6=@ A5\4@Y I40@06: Ej\0\41\ SBJ045 I?J\ CB661@\06@0J4 J]H\?6450J?6c H\6@J1\::7:6 C6104J?6c 64 M\@6=@6=0=&Dadiolog&.__Y-

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sieu am chan doan buou gan

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