- Ac tinh hoa: bien chiing muon va it 4 Dieu trj
4. Dieu trj ung thu dai true trang Dieu tri ngoai khoa:
Dieu tri ngoai khoa:
- Chong chi dinh: suy mon, tuoi cao, carcinose lan toa. - Chu&n bi benh nhan triidc phau thuat: truyen mau neu
thieu mau nang, dinh diidng va boi phu ntfdc dien giai, chuan bi dai tn ic trang, khang sinh triidc mo, thong
bao cho benh nhan biet kha nang lam hau mon nhan tao +/- va nguy cd that bai.
- Md bung: danh gia miic do tham nhiem, sinh thiet gan, phuc mac, te bao dich co triidng, kham buong triing va cac tang khac.
- Cat bo khoi u: ranh gidi an toan cach vung ton thiidng 5cm vdi dai trang, 2cm vdi triic trang nao vet hach. + Dai trang: cat n i a dai trang (phai, trai hoac ngang). Noi hoi trang - dai trang, dai trang - triic trang, cat dai trang toan bo vdi noi hoi trang - hau mon.
+ Triic trang: cat rong triic trang va mac treo triic trang
Neu 1/3 tren (> 10cm cach cd that hau mon): cat triic trang sigm a va noi dai trang - triic trang.
Neu 1/3 giuia: cat triic trang - sigm a, noi dai trang - hau mon.
- Neu 1/3 diidi (4-6 cm cach cd that hau mon) cat dai trang trai va hau mon nhan tao.
Chu y :
- N eu khoi u kh on g cat ditc)c, co the noi tat dai trang hay hau mon nhan tao ket hdp vdi chay tia hay lazer.
- N eu khoi u da di cdn: co the chi dinh ph au thuat cat dai trang va cat bo khoi di cdn (phoi, gan) ket hap chay tia va hoa chat.
3 bien chiing sau p h a u thuat
- Ia chay man tinh nhat la cat nvfa dai trang phai. - Roi loan tieu tien va tinh due.
- Tai phat.
Noi khoa :
H oa tri lieu
Chi dinh
- Tiep sau dieu tri ngoai khoa
- K tien trien giai doan C (phan loa i Dukes): giam tien trien va tvf vong.
- Dieu tri tam thdi (K di can): cai thien chat ltfdng cuoc song.
5 Fu + acid folinic tinh mach trong 6 thang.
5 Fu + acid folinic, Oxaliplatin Ininotecan + chi dinh tia xa.
chi dinh tia xa : trtfdc p h lu thuat: K trtic trang T 3 - Giam nguy cd tai phat tai cho va cai thien thdi gian song. - 45 Gy (nhieu lieu) rai ra trong 5 tuan.