{"id":4932,"date":"2018-07-31T06:22:17","date_gmt":"2018-07-30T23:22:17","guid":{"rendered":"https:\/\/yhoccongdong.org\/du-an-khac\/2018\/07\/31\/di-dang-dong-tinh-mach\/"},"modified":"2024-03-17T03:46:25","modified_gmt":"2024-03-16T20:46:25","slug":"di-dang-dong-tinh-mach","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/du-an-khac\/di-dang-dong-tinh-mach\/","title":{"rendered":"D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch"},"content":{"rendered":"<h2 id=\"di-dang-dong-tinh-mach-la-gi\">D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch l\u00e0 g\u00ec?<\/h2>\n<p style=\"text-align: center\"><img decoding=\"async\" style=\"width: 287px;height: 270px\" src=\"\/\/yhoccongdong.org\/Documents\/776_avm.jpg\" \/><\/p>\n<p><strong>D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch (Arteriovenous Malformations &#8211; AVM) l\u00e0 m\u1ed9t \u0111\u00e1m m\u1ea1ch m\u00e1u (\u0111\u1ed9ng v\u00e0 t\u0129nh m\u1ea1ch) b\u1ea5t th\u01b0\u1eddng, s\u1eafp x\u1ebfp l\u1ed9n x\u1ed9n v\u00e0 d\u1ec5 ch\u1ea3y m\u00e1u<\/strong>. AVM c\u00f3 th\u1ec3 x\u1ea3y ra b\u1ea5t c\u1ee9 n\u01a1i n\u00e0o trong c\u01a1 th\u1ec3, nh\u01b0ng AVM \u1edf n\u00e3o v\u00e0 c\u1ed9t s\u1ed1ng khi xu\u1ea5t huy\u1ebft s\u1ebd g\u00e2y nguy c\u01a1 th\u1eadt s\u1ef1. B\u1edfi v\u00ec b\u1ed9 n\u00e3o v\u00e0 m\u1ea1ch m\u00e1u nu\u00f4i n\u00f3 \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh c\u00f9ng nhau trong qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n ph\u00f4i thai, n\u00ean m\u1ea1ch m\u00e1u b\u1ea5t th\u01b0\u1eddng th\u01b0\u1eddng g\u1eafn li\u1ec1n v\u1edbi m\u00f4 n\u00e3o b\u1ea5t th\u01b0\u1eddng. Do \u0111\u00f3, AVM th\u01b0\u1eddng \u0111i k\u00e8m m\u00f4 n\u00e3o b\u1ea5t th\u01b0\u1eddng xung quanh, nh\u1edd \u0111\u00f3 c\u00f3 th\u1ec3 c\u1eaft b\u1ecf AVM m\u00e0 kh\u00f4ng l\u00e0m t\u1ed5n th\u01b0\u01a1ng m\u00f4 n\u00e3o b\u00ecnh th\u01b0\u1eddng.<\/p>\n<p>D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch \u1edf m\u00e0ng n\u00e3o (m\u00e0ng c\u1ee9ng) c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n sau ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u ho\u1eb7c c\u1ed9t s\u1ed1ng (b\u1ec7nh m\u1eafc ph\u1ea3i). AVM trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 d\u00f2 \u0111\u1ed9ng t\u0129nh m\u1ea1ch (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 r\u00f2 ho\u1eb7c th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch &#8211; Arteriovenous Fistula &#8211; AVF).<\/p>\n<p><strong> T\u1ea7n su\u1ea5t m\u1edbi m\u1eafc (<\/strong><strong>incidence) <\/strong> <strong> v\u00e0 t\u1ea7n su\u1ea5t l\u01b0u h\u00e0nh (<\/strong><strong>prevalence<\/strong><strong>) <\/strong><\/p>\n<ul>\n<li><strong>T\u1ea7n su\u1ea5t m\u1edbi m\u1eafc<\/strong>: \u01b0\u1edbc t\u00ednh c\u00f3 1 ca b\u1ec7nh m\u1edbi trong 100.000 d\u00e2n m\u1ed7i n\u0103m.<\/li>\n<li><strong>T\u1ea7n su\u1ea5t b\u1ec7nh l\u01b0u h\u00e0nh<\/strong> \u01b0\u1edbc t\u00ednh l\u00e0 18 trong 100.000 d\u00e2n.<\/li>\n<li>Kho\u1ea3ng hai ph\u1ea7n ba s\u1ed1 tr\u01b0\u1eddng h\u1ee3p (2\/3) AVM x\u1ea3y ra tr\u01b0\u1edbc tu\u1ed5i 40.<\/li>\n<li>M\u1ed7i n\u0103m, kho\u1ea3ng 4 trong s\u1ed1 100 ng\u01b0\u1eddi c\u00f3 AVM s\u1ebd b\u1ecb xu\u1ea5t huy\u1ebft.<\/li>\n<li>M\u1ed7i l\u1ea7n xu\u1ea5t huy\u1ebft c\u00f3 nguy c\u01a1 15-20% nguy c\u01a1 t\u1eed vong hay \u0111\u1ed9t qu\u1ef5, 30% m\u1eafc b\u1ec7nh th\u1ea7n kinh, 10% t\u1eed vong.<\/li>\n<li>Khi xu\u1ea5t huy\u1ebft x\u1ea3y ra, n\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c v\u00f9ng \u0111\u01b0\u1ee3c th\u1ed1ng k\u00ea sau \u0111\u00e2y: trong nhu m\u00f4 n\u00e3o (41%), khoang d\u01b0\u1edbi nh\u1ec7n (24%), trong n\u00e3o th\u1ea5t (12%), v\u00e0 nhi\u1ec1u v\u00f9ng tr\u00ean (23%).<\/li>\n<li>AVM l\u00e0 nguy\u00ean nh\u00e2n th\u1ee9 hai c\u1ee7a xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n, sau ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o, chi\u1ebfm 10% c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n.<\/li>\n<li>Kho\u1ea3ng 1% c\u1ee7a nh\u1eefng ng\u01b0\u1eddi c\u00f3 AVM s\u1ebd c\u00f3 \u0111\u1ed9ng kinh l\u1ea7n \u0111\u1ea7u ti\u00ean.<\/li>\n<\/ul>\n<h2 id=\"trieu-chung-cua\u00a0di-dang-dong-tinh-mach\">Tri\u1ec7u ch\u1ee9ng c\u1ee7a\u00a0d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch<\/h2>\n<p><strong>Ng\u01b0\u1eddi b\u1ecb AVM c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng<\/strong>. AVM c\u00f3 xu h\u01b0\u1edbng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u00ecnh c\u1edd, khi kh\u00e1m nghi\u1ec7m t\u1eed thi hay trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb nh\u1eefng b\u1ec7nh kh\u00e1c. Tuy nhi\u00ean, kho\u1ea3ng 12 % nh\u1eefng ng\u01b0\u1eddi c\u00f3 AVM s\u1ebd g\u1eb7p c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1edbi m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng kh\u00e1c nhau. AVM c\u00f3 th\u1ec3 k\u00edch th\u00edch n\u00e3o xung quanh v\u00e0 g\u00e2y ra \u0111\u1ed9ng kinh ho\u1eb7c \u0111au \u0111\u1ea7u. <strong>Tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 xu\u1ea5t huy\u1ebft n\u00e3o<\/strong>. B\u1ea5t c\u1ee9 tri\u1ec7u ch\u1ee9ng n\u00e0o sau \u0111\u00e2y \u0111\u1ec1u c\u00f3 th\u1ec3 x\u1ea3y ra:<\/p>\n<ul>\n<li>\u0110\u1ed9ng kinh m\u1edbi kh\u1edfi ph\u00e1t.<\/li>\n<li>Li\u1ec7t ho\u1eb7c y\u1ebfu c\u01a1.<\/li>\n<li>M\u1ea5t ph\u1ed1i h\u1ee3p \u0111\u1ed9ng t\u00e1c.<\/li>\n<li>Kh\u00f3 l\u00e0m nh\u1eefng \u0111\u1ed9ng t\u00e1c ph\u1ee9c t\u1ea1p.<\/li>\n<li>Ch\u00f3ng m\u1eb7t.<\/li>\n<li>Nh\u1ee9c \u0111\u1ea7u.<\/li>\n<li>R\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c.<\/li>\n<li>N\u00f3i kh\u00f3 kh\u0103n.<\/li>\n<li>C\u1ea3m gi\u00e1c b\u1ea5t th\u01b0\u1eddng nh\u01b0 b\u1ecb t\u00ea, ng\u1ee9a ran, ho\u1eb7c \u0111au t\u1ef1 ph\u00e1t.<\/li>\n<li>Sa s\u00fat tr\u00ed tu\u1ec7.<\/li>\n<li>L\u00fa l\u1eabn.<\/li>\n<li>\u1ea2o gi\u00e1c.<\/li>\n<li>M\u1ea5t tr\u00ed nh\u1edb.<\/li>\n<\/ul>\n<h2 id=\"chan-doan-di-dang-dong-tinh-mach\">Ch\u1ea9n \u0111o\u00e1n d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch<\/h2>\n<p style=\"text-align: center\"><img decoding=\"async\" style=\"width: 184px;height: 240px\" src=\"\/\/yhoccongdong.org\/Documents\/777_avm-mri.jpg\" \/> <img decoding=\"async\" style=\"width: 242px;height: 240px\" src=\"\/\/yhoccongdong.org\/Documents\/781_avm_c.png\" \/><\/p>\n<p style=\"text-align: center\"><img decoding=\"async\" style=\"width: 215px;height: 229px\" src=\"\/\/yhoccongdong.org\/Documents\/778_avm4.png\" \/> <img decoding=\"async\" style=\"width: 231px;height: 229px\" src=\"\/\/yhoccongdong.org\/Documents\/779_avm-dsa-l---ica.jpg\" \/><\/p>\n<p style=\"text-align: center\"><span style=\"font-size: 14px\"> <em> H\u00ecnh kh\u1ea3o s\u00e1t \u0111\u01b0\u1ee3c c\u1ee7a nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c nhau \u0111\u1ec1u b\u1ecb d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch v\u1ecb tr\u00ed th\u00e1i d\u01b0\u01a1ng tr\u00e1i (m\u0169i t\u00ean m\u00e0u t\u00edm): ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) n\u00e3o (h\u00ecnh A), ch\u1ee5p m\u1ea1ch m\u00e1u n\u00e3o b\u1eb1ng CT (h\u00ecnh B), ch\u1ee5p m\u1ea1ch m\u00e1u n\u00e3o b\u1eb1ng MRI (h\u00ecnh C) v\u00e0 ch\u1ee5p m\u1ea1ch k\u1ef9 thu\u1eadt s\u1ed1 x\u00f3a n\u1ec1n (DSA \u2013 Digital Subtraction Angiography) (h\u00ecnh D). <\/em> <\/span><\/p>\n<p>AVM th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n nh\u1edd s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) v\u00e0 ch\u1ee5p m\u1ea1ch m\u00e1u. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c ch\u1ee5p \u0111\u1ecbnh k\u1ef3 \u0111\u1ec3 ph\u00e2n t\u00edch s\u1ef1 thay \u0111\u1ed5i v\u1ec1 k\u00edch th\u01b0\u1edbc c\u1ee7a AVM, xu\u1ea5t huy\u1ebft m\u1edbi, ho\u1eb7c xu\u1ea5t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng m\u1edbi.<\/p>\n<pre><em><strong>Xin xem th\u00eam b\u00e0i <a href=\"https:\/\/yhoccongdong.com\/thongtin\/chup-cong-huong-tu-mri-nao\/\" target=\"_blank\" rel=\"noopener\"> Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) n\u00e3o <\/a> <span style=\"line-height: 1.2em\"> v\u00e0 <a href=\"https:\/\/yhoccongdong.com\/thongtin\/chup-mach-mau-nao-bang-ct-hoac-mri\/\" target=\"_blank\" rel=\"noopener\"> Ch\u1ee5p m\u1ea1ch m\u00e1u n\u00e3o b\u1eb1ng CT ho\u1eb7c MRI <\/a> <\/span><\/strong><\/em><\/pre>\n<p>N\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb, AVM c\u00f3 th\u1ec3 t\u0103ng k\u00edch th\u01b0\u1edbc v\u00e0 v\u1ee1, g\u00e2y <strong>xu\u1ea5t huy\u1ebft n\u00e3o<\/strong> ho\u1eb7c <strong>xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n<\/strong> v\u00e0 t\u1ed5n th\u01b0\u01a1ng n\u00e3o v\u0129nh vi\u1ec5n. Xu\u1ea5t huy\u1ebft s\u00e2u th\u01b0\u1eddng l\u00e0 ch\u1ec9 nh\u1eefng xu\u1ea5t huy\u1ebft trong nhu m\u00f4 n\u00e3o, xu\u1ea5t huy\u1ebft trong c\u00e1c m\u00e0ng n\u00e3o l\u00e0 xu\u1ea5t huy\u1ebft d\u01b0\u1edbi m\u00e0ng c\u1ee9ng ho\u1eb7c xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n.<\/p>\n<p>C\u00e1c t\u00e1c h\u1ea1i c\u1ee7a xu\u1ea5t huy\u1ebft t\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng. Xu\u1ea5t huy\u1ebft t\u1eeb AVM n\u1eb1m s\u00e2u trong nhu m\u00f4 n\u00e3o, th\u01b0\u1eddng g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh n\u1eb7ng h\u01a1n xu\u1ea5t huy\u1ebft \u1edf m\u00e0ng c\u1ee9ng ho\u1eb7c m\u00e0ng m\u1ec1m ho\u1eb7c tr\u00ean b\u1ec1 m\u1eb7t c\u1ee7a n\u00e3o ho\u1eb7c t\u1ee7y s\u1ed1ng. V\u1ecb tr\u00ed AVM l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng \u0111\u1ec3 xem x\u00e9t khi c\u00e2n nh\u1eafc nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt so v\u1edbi kh\u00f4ng ph\u1eabu thu\u1eadt. Ng\u0103n AVM v\u1ee1 v\u00e0 v\u1ee1 t\u00e1i ph\u00e1t l\u00e0 l\u00fd do ch\u00ednh cho khuy\u1ebfn c\u00e1o ph\u1eabu thu\u1eadt s\u1edbm.<\/p>\n<h2 id=\"dieu-tri-di-dang-dong-tinh-mach\">\u0110i\u1ec1u tr\u1ecb d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch<\/h2>\n<p>Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1ea3i mang nguy c\u01a1 th\u1ea5p nh\u1ea5t nh\u01b0ng c\u01a1 h\u1ed9i lo\u1ea1i b\u1ecf t\u1ed5n th\u01b0\u01a1ng cao nh\u1ea5t. Hi\u1ec7n c\u00f3 ba ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb AVM, bao g\u1ed3m: <strong>c\u1eaft b\u1ecf d\u1ecb d\u1ea1ng tr\u1ef1c ti\u1ebfp b\u1eb1ng vi ph\u1eabu (microsurgery), x\u1ea1 ph\u1eabu l\u1eadp th\u1ec3 (radiosurgery stereotactic), v\u00e0 can thi\u1ec7p n\u1ed9i m\u1ea1ch g\u00e2y t\u1eafc AVM (endovascular embolization)<\/strong>. M\u1eb7c d\u00f9 \u0111i\u1ec1u tr\u1ecb vi ph\u1eabu mang l\u1ea1i c\u01a1 h\u1ed9i lo\u1ea1i b\u1ecf ngay l\u1eadp t\u1ee9c AVM, nh\u01b0ng m\u1ed9t s\u1ed1 AVM c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t v\u1edbi s\u1ef1 k\u1ebft h\u1ee3p nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb. \u1ede m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, AVM \u0111\u01b0\u1ee3c theo d\u00f5i \u0111\u1ecbnh k\u1ef3, bi\u1ebft r\u1eb1ng c\u00f3 nguy c\u01a1 nh\u1ea5t \u0111\u1ecbnh x\u1ea3y ra xu\u1ea5t huy\u1ebft hay c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh kh\u00e1c nh\u01b0 co gi\u1eadt hay khi\u1ebfm khuy\u1ebft th\u1ea7n kinh khu tr\u00fa. Chi\u1ebfn l\u01b0\u1ee3c theo d\u00f5i n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o lo\u1ea1i AVM v\u00e0 kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc khi n\u00e0o xu\u1ea5t huy\u1ebft c\u00f3 th\u1ec3 s\u1ebd x\u1ea3y ra.<\/p>\n<h3><strong> L\u1ea5y d\u1ecb d\u1ea1ng tr\u1ef1c ti\u1ebfp b\u1eb1ng vi ph\u1eabu (Microsurgery) <\/strong><\/h3>\n<p>B\u1edfi v\u00ec b\u1ea3n ch\u1ea5t c\u1ee7a AVM l\u00e0 b\u1ea9m sinh, do v\u1eady h\u1ea7u h\u1ebft tr\u01b0\u1eddng h\u1ee3p m\u00f4 n\u00e3o xung quanh c\u0169ng b\u1ea5t th\u01b0\u1eddng, n\u00ean c\u00f3 th\u1ec3 c\u1eaft b\u1ecf ch\u00fang m\u00e0 \u00edt l\u00e0m t\u1ed5n th\u01b0\u01a1ng m\u00f4 n\u00e3o b\u00ecnh th\u01b0\u1eddng. \u0110\u00e2y l\u00e0 c\u01a1 s\u1edf c\u0169ng nh\u01b0 chi\u1ebfn l\u01b0\u1ee3c cho ph\u1eabu thu\u1eadt c\u1eaft d\u1ecb d\u1ea1ng vi ph\u1eabu. Ph\u1eabu thu\u1eadt th\u01b0\u1eddng l\u00e0 m\u1ed5 ch\u01b0\u01a1ng tr\u00ecnh (kh\u00f4ng c\u1ea5p c\u1ee9u), ngo\u1ea1i tr\u1eeb nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u c\u00f3 m\u00e1u t\u1ee5 l\u1edbn, \u0111e d\u1ecda t\u00ednh m\u1ea1ng. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, ch\u1ec9 nh\u1eefng AVM \u1edf v\u1ecb tr\u00ed n\u00f4ng, c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t ngay, m\u1edbi \u0111\u01b0\u1ee3c l\u1ea5y c\u00f9ng v\u1edbi kh\u1ed1i m\u00e1u t\u1ee5. Khi m\u00e1u t\u1ee5 g\u00e2y ra b\u1edfi m\u1ed9t AVM ph\u1ee9c t\u1ea1p, c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y ra v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1eddi gian \u0111\u1ec3 ph\u1ee5c h\u1ed3i cho \u0111\u1ebfn khi c\u00f3 th\u1ec3 kh\u1ea3o s\u00e1t chi ti\u1ebft v\u1ec1 b\u1ea3n ch\u1ea5t \u0111\u00edch x\u00e1c c\u1ee7a AVM.<\/p>\n<p>N\u1ebfu ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf l\u00e0 c\u1ea7n thi\u1ebft, b\u00e1c s\u0129 ngo\u1ea1i th\u1ea7n kinh s\u1ebd m\u1edf s\u1ecd (craniotomy) ph\u1eabu t\u00edch vi ph\u1eabu \u0111\u1ec3 \u0111\u1ebfn d\u1ecb d\u1ea1ng. Vi\u1ec7c s\u1eed d\u1ee5ng k\u00ednh vi ph\u1eabu v\u00e0 h\u1ec7 th\u1ed1ng \u0111\u1ecbnh v\u1ecb l\u1eadp th\u1ec3 (navigation) cho ph\u00e9p ph\u1eabu thu\u1eadt an to\u00e0n h\u01a1n v\u1edbi x\u00e2m h\u1ea1i \u00edt nh\u1ea5t c\u00f3 th\u1ec3 l\u00ean m\u00f4 n\u00e3o b\u00ecnh th\u01b0\u1eddng. Sau khi m\u1edf h\u1ed9p s\u1ecd ra, kh\u1ed1i m\u1ea1ch m\u00e1u d\u1ecb d\u1ea1ng s\u1ebd \u0111\u01b0\u1ee3c \u0111\u00f3ng k\u00edn d\u1ea7n b\u1eb1ng c\u00e1c k\u1eb9p m\u1ea1ch m\u00e1u (clip) \u0111\u1eb7c bi\u1ec7t, v\u00e0 c\u1eaft b\u1ecf. Sau \u0111\u00f3, x\u01b0\u01a1ng s\u1ecd s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1eb7t l\u1ea1i, c\u1ed1 \u0111\u1ecbnh b\u1eb1ng c\u00e1c n\u1eb9p nh\u1ecf, da \u0111\u1ea7u \u0111\u01b0\u1ee3c may l\u1ea1i.<\/p>\n<h3><strong> X\u1ea1 ph\u1eabu l\u1eadp th\u1ec3 (Radiosurgery Stereotactic) <\/strong><\/h3>\n<p>X\u1ea1 ph\u1eabu l\u1eadp th\u1ec3 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u s\u1eed d\u1ee5ng m\u00e1y t\u00ednh h\u01b0\u1edbng d\u1eabn \u0111\u1ec3 t\u1eadp trung tia x\u1ea1 v\u00e0o \u1ed5 d\u1ecb d\u1ea1ng. B\u1ee9c x\u1ea1 s\u1ebd l\u00e0m m\u1ea1ch m\u00e1u d\u1ecb d\u1ea1ng \u0111\u00f3ng d\u1ea7n l\u1ea1i. Th\u1eadt kh\u00f4ng may, x\u1ea1 ph\u1eabu l\u1eadp th\u1ec3 th\u01b0\u1eddng gi\u1edbi h\u1ea1n \u1edf nh\u1eefng t\u1ed5n th\u01b0\u01a1ng c\u00f3 \u0111\u01b0\u1eddng k\u00ednh d\u01b0\u1edbi 3,5 cm v\u00e0 c\u00f3 th\u1ec3 m\u1ea5t \u0111\u1ebfn hai n\u0103m \u0111\u1ec3 t\u1eafc ho\u00e0n to\u00e0n d\u1ecb d\u1ea1ng. V\u00ec l\u00fd do n\u00e0y n\u00f3 kh\u00f4ng ph\u1ea3i l\u00e0 ph\u01b0\u01a1ng ph\u00e1p l\u00fd t\u01b0\u1edfng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb AVM \u0111\u00e3 xu\u1ea5t huy\u1ebft, tr\u1eeb khi ph\u1eabu thu\u1eadt kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c. B\u1edfi v\u00ec b\u1ee9c x\u1ea1 ion h\u00f3a c\u00f3 h\u1ea1i cho c\u1ea3 m\u00f4 b\u00ecnh th\u01b0\u1eddng c\u0169ng nh\u01b0 m\u1ea1ch m\u00e1u d\u1ecb d\u1ea1ng, n\u00ean n\u00f3 ph\u1ea3i \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng h\u1ebft s\u1ee9c th\u1eadn tr\u1ecdng. Kh\u00f4ng th\u1ec3 tr\u00e1nh chi\u1ebfu x\u1ea1 l\u00ean m\u00f4 n\u00e3o b\u00ecnh th\u01b0\u1eddng trong khi \u0111i\u1ec1u tr\u1ecb x\u1ea1 ph\u1eabu v\u00ec tia x\u1ea1 ph\u1ea3i \u0111i qua n\u00e3o khi \u0111\u1ebfn m\u1ee5c ti\u00eau d\u1ecb d\u1ea1ng.<\/p>\n<h3><strong> G\u00e2y t\u1eafc n\u1ed9i m\u1ea1ch (<\/strong><strong>Endovascular embolization) <\/strong><\/h3>\n<p>G\u00e2y t\u1eafc n\u1ed9i m\u1ea1ch l\u00e0 k\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng nh\u1eefng \u1ed1ng th\u00f4ng m\u1ea1ch si\u00eau nh\u1ecf (microcatheter) thi\u1ebft k\u1ebf \u0111\u1eb7c bi\u1ec7t, lu\u1ed3n tr\u1ef1c ti\u1ebfp v\u00e0o d\u1ecb d\u1ea1ng d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a ch\u1ee5p m\u1ea1ch m\u00e1u. T\u1ed5n th\u01b0\u01a1ng s\u1ebd \u0111\u01b0\u1ee3c b\u00edt k\u00edn t\u1eeb b\u00ean trong b\u1eb1ng k\u1ef9 thu\u1eadt g\u00e2y thuy\u00ean t\u1eafc. Khi \u1ed1ng th\u00f4ng \u0111\u1ebfn \u0111\u01b0\u1ee3c \u1ed5 d\u1ecb d\u1ea1ng, b\u00e1c s\u0129 s\u1ebd b\u01a1m keo l\u1ecfng ho\u1eb7c c\u00e1c h\u1ea1t \u0111\u1ec3 g\u00e2y t\u1eafc c\u00e1c ph\u1ea7n c\u1ee7a d\u1ecb d\u1ea1ng ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch nu\u00f4i c\u1ee7a n\u00f3. Ch\u1ea5t li\u1ec7u g\u00e2y t\u1eafc l\u00e0 c\u00e1c lo\u1ea1i keo \u0111\u00f4ng nhanh v\u00e0 tr\u01a1 v\u1ec1 m\u1eb7t sinh h\u1ecdc, h\u1ea1t polyvinyl alcohol, hay c\u00e1c s\u1ee3i titanium. M\u1eb7c d\u00f9 ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 th\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c gi\u1ea3m k\u00edch th\u01b0\u1edbc c\u1ee7a AVM, nh\u01b0ng hi\u1ebfm khi c\u00f3 th\u1ec3 lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n \u0111\u01b0\u1ee3c n\u00f3. \u0110i\u1ec1u tr\u1ecb n\u00e0y c\u00f3 th\u1ec3 gi\u00fap ph\u1eabu thu\u1eadt c\u1eaft AVM sau \u0111\u00f3 an to\u00e0n h\u01a1n, ho\u1eb7c c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m k\u00edch th\u01b0\u1edbc c\u1ee7a AVM v\u1ec1 k\u00edch th\u01b0\u1edbc m\u00e0 x\u1ea1 ph\u1eabu hi\u1ec7u qu\u1ea3 h\u01a1n. Th\u1ee7 thu\u1eadt n\u00e0y c\u0169ng \u0111i k\u00e8m v\u1edbi nguy c\u01a1 \u0111\u00e1ng k\u1ec3, do kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1eddng \u0111i c\u1ee7a c\u00e1c v\u1eadt li\u1ec7u g\u00e2y t\u1eafc. Ch\u00fang c\u00f3 th\u1ec3 g\u00e2y t\u1eafc ngh\u1ebdn c\u00e1c m\u1ea1ch m\u00e1u b\u00ecnh th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn \u0111\u1ed9t qu\u1ef5, ho\u1eb7c t\u1eafc m\u1ea1ch tho\u00e1t c\u1ee7a kh\u1ed1i d\u1ecb d\u1ea1ng g\u00e2y xu\u1ea5t huy\u1ebft (v\u1ee1 AVM). Do \u0111\u00f3, nh\u1eefng th\u1ee7 thu\u1eadt n\u00e0y c\u0169ng ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc h\u1ebft s\u1ee9c c\u1ea9n th\u1eadn, v\u1edbi \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng to\u00e0n di\u1ec7n.<\/p>\n<h2 id=\"tien-luong-di-dang-dong-tinh-mach\">Ti\u00ean l\u01b0\u1ee3ng d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch<\/h2>\n<p>Ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed c\u1ee7a AVM, m\u1ee9c \u0111\u1ed9 xu\u1ea5t huy\u1ebft, c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh. Nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt l\u1ea5y d\u1ecb d\u1ea1ng tr\u1ef1c ti\u1ebfp b\u1eb1ng vi ph\u1eabu ph\u1ee5c h\u1ed3i tuy\u1ec7t v\u1eddi v\u00e0 nhanh ch\u00f3ng sau v\u00e0i ng\u00e0y nh\u1eadp vi\u1ec7n. Sau ho\u1eb7c trong khi ph\u1eabu thu\u1eadt, b\u00e1c s\u0129 cho ch\u1ee5p m\u1ea1ch m\u00e1u \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n c\u1ee7a AVM. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c coi l\u00e0 ch\u1eefa kh\u1ecfi n\u1ebfu AVM \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n. Kho\u1ea3ng 5-10 % AVM c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1eefa kh\u1ecfi b\u1eb1ng thuy\u00ean t\u1eafc n\u1ed9i m\u1ea1ch \u0111\u01a1n thu\u1ea7n.<\/p>\n<p><strong> T\u00e0i li\u1ec7u tham kh\u1ea3o <\/strong><\/p>\n<p><a href=\"http:\/\/www.aans.org\/Patient%20Information\/Conditions%20and%20Treatments\/Arteriovenous%20Malformations.aspx\"> http:\/\/www.aans.org\/Patient%20Information\/Conditions%20and%20Treatments\/Arteriovenous%20Malformations.aspx <\/a><br \/>\n<a style=\"line-height: 1.6em\" href=\"http:\/\/www.taafonline.org\/am_about.html\"> http:\/\/www.taafonline.org\/am_about.html <\/a><br \/>\n<a style=\"line-height: 1.6em\" href=\"http:\/\/www.mayfieldclinic.com\/MC_hope\/Story_christine.htm#.UrQM9dJdXNk\"> http:\/\/www.mayfieldclinic.com\/MC_hope\/Story_christine.htm#.UrQM9dJdXNk <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch (Arteriovenous Malformations &#8211; AVM) l\u00e0 m\u1ed9t \u0111\u00e1m m\u1ea1ch m\u00e1u (\u0111\u1ed9ng v\u00e0 t\u0129nh m\u1ea1ch) b\u1ea5t th\u01b0\u1eddng, s\u1eafp x\u1ebfp l\u1ed9n x\u1ed9n, v\u00e0 d\u1ec5 ch\u1ea3y m\u00e1u<\/p>\n","protected":false},"author":41,"featured_media":4933,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5251,4025,5148,5214,5215],"tags":[4047,4049,4048],"series":[1731],"coauthors":[1772],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch - Y H\u1ecdc C\u1ed9ng \u0110\u1ed3ng<\/title>\n<meta name=\"description\" content=\"D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch (Arteriovenous Malformations - AVM) l\u00e0 m\u1ed9t \u0111\u00e1m m\u1ea1ch m\u00e1u (\u0111\u1ed9ng v\u00e0 t\u0129nh m\u1ea1ch) b\u1ea5t th\u01b0\u1eddng, s\u1eafp x\u1ebfp l\u1ed9n x\u1ed9n, v\u00e0 d\u1ec5 ch\u1ea3y m\u00e1u\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/yhoccongdong.com\/du-an-khac\/di-dang-dong-tinh-mach\/\" \/>\n<meta property=\"og:locale\" content=\"vi_VN\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch - Y H\u1ecdc C\u1ed9ng \u0110\u1ed3ng\" \/>\n<meta property=\"og:description\" content=\"D\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch (Arteriovenous Malformations - AVM) l\u00e0 m\u1ed9t \u0111\u00e1m m\u1ea1ch m\u00e1u (\u0111\u1ed9ng v\u00e0 t\u0129nh m\u1ea1ch) b\u1ea5t th\u01b0\u1eddng, s\u1eafp x\u1ebfp l\u1ed9n x\u1ed9n, v\u00e0 d\u1ec5 ch\u1ea3y m\u00e1u\" \/>\n<meta property=\"og:url\" content=\"https:\/\/yhoccongdong.com\/du-an-khac\/di-dang-dong-tinh-mach\/\" \/>\n<meta property=\"og:site_name\" content=\"D\u1ef1 \u00e1n kh\u00e1c\" \/>\n<meta property=\"article:author\" content=\"http:\/\/facebook.com\/lam.xuannha\" \/>\n<meta property=\"article:published_time\" content=\"2018-07-30T23:22:17+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-03-16T20:46:25+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/yhoccongdong.com\/du-an-khac\/wp-content\/uploads\/sites\/6\/2015\/12\/6728-thongtin-di-dang-dong-tinh-mach.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"400\" \/>\n\t<meta property=\"og:image:height\" content=\"300\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BS. 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