- Ac tinh hoa: bien chiing muon va it 4 Dieu trj
3. Chan doan tui thira dai trang the co trieu chumg
- Viem tui thCfa Sigm a cap: la bien chiing thiidng gap cua tui thCfa 25%.
Lam sang: benh canh viem ruot thCfa ben trai d benh nhan > 40 tuoi luon phai nghia den benh canh viem tui thiia.
- Dau duf doi dai dang d ho' chau trai, sot, roi loan nhu dong, hoi chiing kich thi'ch triic trang, tui mat.
- Co m ang hoac phan ling d ho chau trai, tham triic trang dau.
- H/C viem , cay mau, tang bach cau da nhan trung tinh.
X et nghiem :
- Chup cat 16p vi tinh o bung va tieu khung cap vdi hinh anh khoi dam on g tieu hoa.
+ KhSng dinh chan doan: day thanh Sigma, viem quanh dai trang, tui thiia nhin ro.
+ Tim bien chiing: ap xe, ro.
+ Loai truf benh tiet nieu, phu khoa.
- Co the chup khung dai trang doi quang kep.
- Noi soi dai trang cap khong can thiet va nguy hiem. Se can soi dai trang sau khi qua giai doan cap, triicfc phau thuat de loai trii ung thii Sigma.
Dieu tri:
- N oi k h o a: giam dau, chiidm da tren bung, khang sinh tinh mach hoat pho rong, co tac dong tdi vi khuan Gram (-) va ky khi trong 15 ngay, che do an khong co ba, theo doi lam sang nghiem ngat de phat hien bien chiing.
- N goai khoa:
+ Dam bao nguyen tac khong chi dinh tai tao liiu thong ong tieu hoa ngay.
+ Cap ciiu.
- Chi dinh: neu dau lien tuc hoac sot hoac co bien chiing. - Hinh thiic: cat dai trang Sigm a dong mom triic trang
diia dau dai trang ra ngoai (phau thuat H artm ann), d nhiing trUOng hop can thiet noi tat dai trang - triic trang va lay mau dai trang Sigm a lam mo benh hoc. - M uon sau 2 - 3 thang:
+ M uc dich: phong tai phat.
+ Chi dinh: sau 2 cdn viem tui thiia hoac ngay sau cdn dau tien.
+ Hinh thiic: cat dai trang Sigm a tdi van triic trang Sigma + tai lap liiu thong ong tieu hoa (mo noi soi), lam giai phau benh manh cat.
2 bien chiing thiidng gap cua viem tui thiia Sigma cap
- Viem phuc mac do thung tui thiia: + Chi dinh phau thuat cap.
+ Ty le tii vong cao 15 - 35%. - Ap xe quanh Sigma:
trai.
+ Chup khung dai trang doi quang (hinh anh de ep t\i
ngoai, doi khi thay lo ro), chup cat 16p vi tinh. + Dieu tri:
N oi khoa: dieu tri ban dau, khang sinh pho rong va ket hdp khang sinh
N goai khoa thi 2: Dan liiu qua da hay cat dai trang Sigma
3 bien chiing hiem gap cua tui thiia: R o:
£
- O ap xe quanh Sigm a vao tang lan can.
- Ro dai trang - bang quang thiidng gap nhat (50% nhiem trung tiet nieu, dai ra khi, dai ra mau).
- Ro dai trang am dao va Sigm a - triic trang hiem gap. - Chan doan ban g CT.
- Dieu tri ngoai khoa lanh.
Hep dai trang Sigm a va tac (loai trii K dai trang Sigm a) bang noi soi dai trang:
- Xet nghiem : chup khung dai trang doi quang (hep dai trang Sigm a dong tam, deu). Chup CT bung, tieu khung, soi dai trang (sau khi loai tri* thung)
- Dieu tri noi khoa (hoi siic va khang sinh)
- Dieu tri ngoai khoa neu noi khoa that bai hoac co bien chiing (thung xa vao ca manh trang, cat dai trang Sigm a vdi noi dai trang - triic trang, neu gian dai trang nhieu: phau thuat H artm ann hoac hau mon nhan tao.
C hay m au: hiem , thiidng la bien chiing cua tui thiia dai trang phai.