Upload
bme50
View
233
Download
0
Embed Size (px)
Citation preview
8/18/2019 CT Chan Doan u Mau Gan
1/54
n o¸n ×n n
u m¸u gan Bïi Hoµng Tó§¹i häc Y H¶i Phßng
8/18/2019 CT Chan Doan u Mau Gan
2/54
§¹i c¬ng
• Lµ mét tæn th¬ng hay gÆp• hi!m "#$% &'n ()* c+ th, -.n /!n 0#1% 2 T3
-4 n56nam7$6" hoÆc 86" tïy th9o t:ng t;c gi¶• Thng c+ t?i4@ chAng µ Ct D¶y ?a Ei!n
chAng• FGi §H thI th
8/18/2019 CT Chan Doan u Mau Gan
3/54
8/18/2019 CT Chan Doan u Mau Gan
4/54
§¹i c¬ng
• ;c ph¬ng ph;p §H / Wc ;p &Xngt?ong chn /o;n @ m;@ ganZ[ \i.@ 'm[ LFT[ S]^ J?_t t)tM
[ hXp m¹ch[ \cintig?aphy
8/18/2019 CT Chan Doan u Mau Gan
5/54
Gi¶i phÉu bÖnh
• §¹i th,Z[ ` nh bcm c+ mµ@ / hoÆc phGt Danh
[ ` dcm c+ mµ@ / (em* nhi@ thïy mói*c+ th, th_y D¬ µ >i h+a
• Fi th,Z
[ ;c Hf m;@ Gi thµnh -µ Ei,@ m> &t J@ m;@[ th, hangM Gi ;ch D¬ µ >i ho; hoÆc c;c
c@én mao m¹ch nhJ th, mao m¹chM
8/18/2019 CT Chan Doan u Mau Gan
6/54
8/18/2019 CT Chan Doan u Mau Gan
7/54
8/18/2019 CT Chan Doan u Mau Gan
8/54
Fi th,
8/18/2019 CT Chan Doan u Mau Gan
9/54
ChÈn ®o¸n h×nh ¶nh
• Th, /i,n hInh Jthng /i,n hInh
8/18/2019 CT Chan Doan u Mau Gan
10/54
ThÓ ®iÓn h×nh trªn siªu©m
• \i.@ 'm[ Lµ hInh ¶nh tng 'm
[ ]anh giGi ?[ B< c+ th, /@ hoÆc =h>ng[ + tng 'm phCa (a@[ Th
8/18/2019 CT Chan Doan u Mau Gan
11/54
C¸c ph¬ng ph¸p h¸c
• hXp LFT[ HInh gi¶m t3 t?äng t?Gc ti.m
[ \a@ ti.m th@)c ng_m th@)c t: ngo¹i i µot?@ng t'm JP9?iph9?a- to c9nt?ip9ta-M
[ §Oy th@)c thI m@én
8/18/2019 CT Chan Doan u Mau Gan
12/54
C¸c ph¬ng ph¸p h¸c
• éng hng t: JS]^M[ li¶m tCn hi4@ t?.n T" \
[ Tng tCn hi4@ m¹nh t?.n T$ \ 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%
8/18/2019 CT Chan Doan u Mau Gan
13/54
C¸c ph¬ng ph¸p h¸c
• \cintig?aphy[ kïng TcKKm gqn Gi hfng cO@
[ §é nh¹y µ /Æc hi4@ =ho¶ng %
8/18/2019 CT Chan Doan u Mau Gan
14/54
8/18/2019 CT Chan Doan u Mau Gan
15/54
8/18/2019 CT Chan Doan u Mau Gan
16/54
8/18/2019 CT Chan Doan u Mau Gan
17/54
8/18/2019 CT Chan Doan u Mau Gan
18/54
8/18/2019 CT Chan Doan u Mau Gan
19/54
ChÈn ®o¸n h×nh ¶nh
• Th, /i,n hInh Jthng /i,n hInh
8/18/2019 CT Chan Doan u Mau Gan
20/54
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;@
8/18/2019 CT Chan Doan u Mau Gan
21/54
li¶m 'm t?.n nn gantn 'm
8/18/2019 CT Chan Doan u Mau Gan
22/54
rm =h>ng /fng /@
8/18/2019 CT Chan Doan u Mau Gan
23/54
rm =h>ng /fng /@
8/18/2019 CT Chan Doan u Mau Gan
24/54
Rh)i c+ in tng 'm
8/18/2019 CT Chan Doan u Mau Gan
25/54
` m;@ th, hang Ginhi@ ïng gi¶m 'm
t?ong =h)i
8/18/2019 CT Chan Doan u Mau Gan
26/54
` m;@ th, -an ta
8/18/2019 CT Chan Doan u Mau Gan
27/54
` m;@ c+ ch¶y m;@
8/18/2019 CT Chan Doan u Mau Gan
28/54
• §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?
8/18/2019 CT Chan Doan u Mau Gan
29/54
"#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
8/18/2019 CT Chan Doan u Mau Gan
30/54
T µ S]^ ca @m;@ t?.n nn gan
nhiNm mQ ( m u c) shunt ®#ng*
8/18/2019 CT Chan Doan u Mau Gan
31/54
T S]^
nginapa
( m¸u c) shunt ®#ng*t+nh m¹ch c,a
8/18/2019 CT Chan Doan u Mau Gan
32/54
H9mangiomato(i(
8/18/2019 CT Chan Doan u Mau Gan
33/54
` m;@ c+c@)ng
8/18/2019 CT Chan Doan u Mau Gan
34/54
( 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:@
8/18/2019 CT Chan Doan u Mau Gan
35/54
( m¸u93nE c)2¸ch
trong
C
T
"/
0
8/18/2019 CT Chan Doan u Mau Gan
36/54
( m u c) 2!i
8/18/2019 CT Chan Doan u Mau Gan
37/54
` 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
8/18/2019 CT Chan Doan u Mau Gan
38/54
T
S]^ nap
8/18/2019 CT Chan Doan u Mau Gan
39/54
Gi$ng 23i FCC
8/18/2019 CT Chan Doan u Mau Gan
40/54
Gi$ng Gi S JBU / mæ @ /¹it?µngM
8/18/2019 CT Chan Doan u Mau Gan
41/54
8/18/2019 CT Chan Doan u Mau Gan
42/54
( m¸u ti8n triÓn nhanh
• T: "K1#"KK• Th
8/18/2019 CT Chan Doan u Mau Gan
43/54
` 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$i h& 3i t th
8/18/2019 CT Chan Doan u Mau Gan
44/54
h$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
8/18/2019 CT Chan Doan u Mau Gan
45/54
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
8/18/2019 CT Chan Doan u Mau Gan
46/54
Ch¶@ m¸utrong u
8/18/2019 CT Chan Doan u Mau Gan
47/54
h|n xp µo TSk
8/18/2019 CT Chan Doan u Mau Gan
48/54
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
8/18/2019 CT Chan Doan u Mau Gan
49/54
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
8/18/2019 CT Chan Doan u Mau Gan
50/54
8/18/2019 CT Chan Doan u Mau Gan
51/54
8/18/2019 CT Chan Doan u Mau Gan
52/54
8/18/2019 CT Chan Doan u Mau Gan
53/54
8/18/2019 CT Chan Doan u Mau Gan
54/54