{"id":2407,"date":"2023-09-27T07:00:36","date_gmt":"2023-09-27T00:00:36","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=2407"},"modified":"2024-12-24T15:08:52","modified_gmt":"2024-12-24T08:08:52","slug":"phau-thuat-noi-soi-khop-dieu-tri-sun","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/phau-thuat-noi-soi-khop-dieu-tri-sun\/","title":{"rendered":"Ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp – \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam"},"content":{"rendered":"

1. CH\u1ec8 \u0110\u1ecaNH PH\u1eaaU THU\u1eacT<\/span><\/h3>\n

– Tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh v\u1edbi \u0111au khe kh\u1edbp khi th\u0103m kh\u00e1m, l\u1ee5c kh\u1ee5c trong kh\u1edbp hay k\u1eb9t kh\u1edbp, gi\u1edbi h\u1ea1n t\u1ea7m v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp<\/span><\/p>\n

– D\u1ea5u hi\u1ec7u ng\u1ed3i x\u1ed5m hay l\u00ean xu\u1ed1ng c\u1ea7u thang kh\u00f3 kh\u0103n<\/span><\/p>\n

– Th\u0103m kh\u00e1m l\u00e2m s\u00e0ng c\u00f3 m\u1ed9t nghi\u1ec7m ph\u00e1p d\u01b0\u01a1ng t\u00ednh trong c\u00e1c nghi\u1ec7m ph\u00e1p: Appley, Mc Murray, Steimann I<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n th\u1ea5t b\u1ea1i<\/span><\/p>\n

– Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u00f3 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam<\/a>.<\/span><\/p>\n

Ch\u1ec9 \u0111\u1ecbnh kh\u00e2u s\u1ee5n ch\u00eam:<\/span><\/strong><\/p>\n

Trong nghi\u00ean c\u1ee9u, ch\u00fang t\u00f4i th\u1ed1ng nh\u1ea5t v\u1edbi ch\u1ec9 \u0111\u1ecbnh kh\u00e2u c\u1ee7a Timmy P.:<\/span><\/p>\n

– V\u1ecb tr\u00ed r\u00e1ch v\u00f9ng gi\u00e0u m\u1ea1ch m\u00e1u n\u01a1i ti\u1ebfp gi\u00e1p v\u1edbi bao kh\u1edbp (v\u00f9ng \u0111\u1ecf \u2013 \u0111\u1ecf v\u00e0 v\u00f9ng \u0111\u1ecf \u2013 tr\u1eafng), \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i c\u00e2n nh\u1eafc kh\u00e2u c\u1ea3 v\u00f9ng tr\u1eafng \u2013 tr\u1eafng<\/span><\/p>\n

– T\u1ed1t nh\u1ea5t l\u00e0 r\u00e1ch m\u1edbi kh\u00f4ng qu\u00e1 8 tu\u1ea7n. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh khi r\u00e1ch tr\u00ean 8 tu\u1ea7n<\/span><\/p>\n

– T\u1ed1t nh\u1ea5t l\u00e0 kh\u00e2u \u1edf b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 45 tu\u1ed5i, n\u1ebfu tr\u00ean 45 tu\u1ed5i c\u1ea7n c\u00e2n nh\u1eafc <\/span>[121]<\/span><\/p>\n

V\u1edbi nh\u1eefng hi\u1ec3u bi\u1ebft ng\u00e0y c\u00e0ng r\u00f5 h\u01a1n v\u1ec1 vai tr\u00f2 c\u1ee7a s\u1ee5n ch\u00eam, qu\u00e1 tr\u00ecnh v\u00e0 c\u01a1 ch\u1ebf li\u1ec1n s\u1ee5n, c\u00f9ng v\u1edbi c\u00e1c bi\u1ebfn ch\u1ee9ng v\u1ec1 l\u00e2u d\u00e0i do c\u1eaft s\u1ee5n ch\u00eam g\u00e2y n\u00ean. C\u00e1c t\u00e1c gi\u1ea3 tr\u00ean th\u1ebf gi\u1edbi \u0111\u1ec1u quan ni\u1ec7m c\u1ea7n kh\u00e2u b\u1ea3o t\u1ed3n t\u1ed1i \u0111a c\u00e1c r\u00e1ch s\u1ee5n ch\u00eam<\/a> do ch\u1ea5n th\u01b0\u01a1ng khi c\u00f3 th\u1ec3, \u0111\u1ec3 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng l\u00e2u d\u00e0i nh\u01b0: h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng, m\u1ea5t v\u1eefng, tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i<\/a>.<\/span><\/p>\n

2. PH\u01af\u01a0NG TI\u1ec6N D\u1ee4NG C\u1ee4<\/span><\/h3>\n

M\u00e1y n\u1ed9i soi nh\u00e3n hi\u1ec7u STORZ \u0111\u1ec3 th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt<\/span><\/p>\n

\"5.1\"
H\u00ecnh 5.1. H\u1ec7 th\u1ed1ng m\u00e1y n\u1ed9i soi (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) [21]<\/figcaption><\/figure>\n

\u00a0 \u00a0 \u00a0H\u1ec7 th\u1ed1ng \u1ed1ng k\u00ednh n\u1ed9i soi: <\/span><\/strong>trocar \u0111\u1ea7u t\u00f9, qua \u0111\u00f3 \u0111\u01b0a \u1ed1ng k\u00ednh n\u1ed9i soi v\u00e0o \u1ed5 kh\u1edbp. Hai b\u00ean th\u00e0nh c\u1ee7a trocar c\u00f3 \u0111\u01b0\u1eddng d\u1eabn n\u01b0\u1edbc v\u00e0o v\u00e0 d\u1eabn n\u01b0\u1edbc ra. \u1ed0ng k\u00ednh n\u1ed9i soi c\u1ee7a <\/span>Stryker c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 4 mm v\u00e0 m\u1eb7t v\u00e1t ti\u00eau chu\u1ea9n 30<\/span>o <\/span>\u0111\u1ec3 vi\u1ec7c quan s\u00e1t c\u00e1c v\u1ecb tr\u00ed trong \u1ed5 kh\u1edbp \u0111\u01b0\u1ee3c thu\u1eadn l\u1ee3i h\u01a1n.<\/span><\/p>\n

\"5.2\"
H\u00ecnh 5.2. \u1ed0ng soi v\u00e0 troca (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014)<\/figcaption><\/figure>\n

\u00a0 \u00a0 \u00a0Ngu\u1ed3n s\u00e1ng c\u00f9ng v\u1edbi d\u00e2y c\u00e1p quang<\/strong>: <\/span>ngu\u1ed3n s\u00e1ng v\u1edbi \u00e1nh s\u00e1ng l\u1ea1nh Xenon \u0111\u1ec3 kh\u00f4ng l\u00e0m n\u00f3ng t\u1ed5 ch\u1ee9c trong kh\u1edbp. D\u00e2y c\u00e1p quang n\u1ed1i t\u1eeb ngu\u1ed3n s\u00e1ng \u0111\u1ebfn \u1ed1ng k\u00ednh n\u1ed9i soi \u0111\u01b0a \u00e1nh s\u00e1ng v\u00e0o trong \u1ed5 kh\u1edbp \u0111\u1ec3 quan s\u00e1t r\u00f5 c\u00e1c th\u00e0nh ph\u1ea7n trong kh\u1edbp.<\/span><\/p>\n

\u00a0 \u00a0 \u00a0H\u1ec7 th\u1ed1ng camera v\u1edbi m\u00e0n h\u00ecnh<\/strong>: <\/span>hi\u1ec3n th\u1ecb h\u00ecnh \u1ea3nh b\u00ean trong kh\u1edbp g\u1ed1i ra m\u00e0n h\u00ecnh \u0111\u1ec3 quan s\u00e1t.<\/span><\/p>\n

\u00a0 \u00a0 \u00a0H\u1ec7 th\u1ed1ng b\u01a1m r\u1eeda v\u00e0o \u1ed5 kh\u1edbp<\/strong>: <\/span>h\u1ec7 th\u1ed1ng n\u00e0y cho ph\u00e9p v\u1eeba \u0111\u1ed3ng th\u1eddi b\u01a1m dung d\u1ecbch v\u00e0o \u1ed5 kh\u1edbp l\u00e0m cho \u1ed5 kh\u1edbp d\u00e3n r\u1ed9ng ra, thu\u1eadn l\u1ee3i cho vi\u1ec7c quan s\u00e1t v\u00e0 ti\u1ebfn h\u00e0nh k\u1ef9 thu\u1eadt, v\u1eeba h\u00fat d\u1ecbch ra \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o cho dung d\u1ecbch trong \u1ed5 kh\u1edbp lu\u00f4n s\u1ea1ch v\u00e0 trong su\u1ed1t. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng n\u01b0\u1edbc mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng, dung d\u1ecbch Ringerlactat ho\u1eb7c n\u01b0\u1edbc c\u1ea5t v\u00f4 tr\u00f9ng.<\/span><\/span><\/p>\n

\u00a0 \u00a0 H\u1ec7 th\u1ed1ng m\u00e1y b\u00e0o kh\u1edbp<\/strong>: \u0111\u00e2y l\u00e0 d\u1ee5ng c\u1ee5 chuy\u00ean d\u1ee5ng cho ph\u00e9p c\u00f3 th\u1ec3 m\u00e0i, c\u1eaft, g\u1ecdt nh\u1eefng t\u1ed5 ch\u1ee9c b\u1ec7nh l\u00fd.<\/span><\/span><\/p>\n

\u00a0 \u00a0 \u00a0Gi\u00e1 \u0111\u1ee1 ch\u00e2n<\/strong>: trong ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp<\/a> g\u1ed1i, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c n\u1eb1m ng\u1eeda tr\u00ean b\u00e0n, \u0111\u00f9i c\u1ea7n \u0111\u01b0\u1ee3c gi\u1eef ch\u1eb7t trong m\u1ed9t gi\u00e1 \u0111\u1ee1 \u0111\u1ec3 c\u00f3 th\u1ec3 xoay v\u1eb7n kh\u1edbp g\u1ed1i l\u00e0m r\u1ed9ng t\u1eebng b\u00ean khe kh\u1edbp.<\/span><\/span><\/p>\n

\u00a0 \u00a0 \u00a0Garo h\u01a1i:<\/strong> ph\u1eabu thu\u1eadt n\u1ed9i soi \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh trong t\u00ecnh tr\u1ea1ng kh\u1edbp \u0111\u00e3 \u0111\u01b0\u1ee3c d\u1ed3n h\u1ebft m\u00e1u. N\u1ebfu garo \u0111\u1eb7t kh\u00f4ng t\u1ed1t, m\u00e1u c\u00f2n ch\u1ea3y s\u1ebd r\u1ea5t kh\u00f3 kh\u0103n khi th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt v\u00ec kh\u00f4ng cho ph\u00e9p quan s\u00e1t r\u00f5 th\u01b0\u01a1ng t\u1ed5n.<\/span><\/span><\/p>\n

*C\u00e1c d\u1ee5ng c\u1ee5 ph\u1eabu thu\u1eadt c\u1ea7n thi\u1ebft:<\/span><\/strong><\/em><\/p>\n

– D\u1ee5ng c\u1ee5 n\u1ed9i soi x\u1eed l\u00fd r\u00e1ch s\u1ee5n ch\u00eam<\/span>\u00a0<\/span><\/p>\n

\"5.3\"
H\u00ecnh 5.3. M\u1ed9t s\u1ed1 d\u1ee5ng c\u1ee5 ph\u1eabu thu\u1eadt n\u1ed9i soi x\u1eed l\u00fd r\u00e1ch s\u1ee5n ch\u00eam (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) [21]<\/figcaption><\/figure>\n

– D\u1ee5ng c\u1ee5 n\u1ed9i soi kh\u00e2u s\u1ee5n ch\u00eam t\u1eeb ngo\u00e0i v\u00e0o trong (outside \u2013 in): hai kim ch\u1ecdc t\u1ee7y s\u1ed1ng ho\u1eb7c hai kim 18<\/span>\u00d7<\/span>40 mm, ch\u1ec9 PDS s\u1ed1: 0 ho\u1eb7c 1<\/span><\/p>\n

\"5.4\"
H\u00ecnh 5.4. Kim 18 x 40 mm d\u00f9ng \u0111\u1ec3 kh\u00e2u r\u00e1ch s\u1ee5n ch\u00eam<\/a> b\u1eb1ng k\u1ef9 thu\u1eadt kh\u00e2u t\u1eeb ngo\u00e0i v\u00e0o trong (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) [21]<\/figcaption><\/figure>
\"5.5\"
H\u00ecnh 5.5. Kim ch\u1ecdc t\u1ee7y s\u1ed1ng v\u00e0 th\u00f2ng l\u1ecdng d\u00f9ng \u0111\u1ec3 kh\u00e2u r\u00e1ch s\u1ee5n ch\u00eam b\u1eb1ng k\u1ef9 thu\u1eadt kh\u00e2u t\u1eeb ngo\u00e0i v\u00e0o trong (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014)<\/figcaption><\/figure><\/p>\n

– D\u1ee5ng c\u1ee5 n\u1ed9i soi kh\u00e2u s\u1ee5n ch\u00eam ho\u00e0n to\u00e0n b\u00ean trong (all inside)<\/span><\/p>\n

\"5.6\"
H\u00ecnh 5.6. C\u00e1c d\u1ee5ng c\u1ee5 kh\u00e2u s\u1ee5n ch\u00eam qua n\u1ed9i soi ho\u00e0n to\u00e0n trong kh\u1edbp<\/figcaption><\/figure>\n

(Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) <\/span>[21]<\/span><\/p>\n

– D\u1ee5ng c\u1ee5 n\u1ed9i soi kh\u00e2u s\u1ee5n ch\u00eam t\u1eeb trong ra ngo\u00e0i (inside \u2013 out)<\/span><\/p>\n

\"5.7\"<\/p>\n

\"5.7.1\"<\/p>\n

\"5.7.2\"
H\u00ecnh 5.7. C\u00e1c d\u1ee5ng c\u1ee5 kh\u00e2u s\u1ee5n ch\u00eam qua n\u1ed9i soi t\u1eeb trong ra ngo\u00e0i kh\u1edbp<\/figcaption><\/figure>\n

3. PH\u01af\u01a0NG PH\u00c1P V\u00d4 C\u1ea2M V\u00c0 T\u01af TH\u1ebe B\u1ec6NH NH\u00c2N <\/span><\/h3>\n

3.1. Ph\u01b0\u01a1ng ph\u00e1p v\u00f4 c\u1ea3m<\/span><\/h3>\n

T\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c g\u00e2y t\u00ea t\u1ee7y s\u1ed1ng, \u0111\u1ea3m b\u1ea3o v\u00f4 c\u1ea3m t\u1ed1t \u0111\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng co c\u1ee9ng c\u01a1 v\u00e0 chi th\u1ec3 khi v\u1eadn \u0111\u1ed9ng, c\u00f3 th\u1ec3 g\u00e2y g\u00e3y d\u1ee5ng c\u1ee5 ph\u1eabu thu\u1eadt trong kh\u1edbp.<\/span><\/p>\n

3.2. T\u01b0 th\u1ebf c\u1ee7a b\u1ec7nh nh\u00e2n<\/span><\/h3>\n

T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, \u0111\u00f9i \u0111\u01b0\u1ee3c \u0111\u1eb7t c\u1ed1 \u0111\u1ecbnh ch\u1eafc v\u00e0o m\u1ed9t gi\u00e1 \u0111\u1ee1 \u1edf \u0111o\u1ea1n 1\/3 gi\u1eefa ti\u1ebfp gi\u00e1p 1\/3 d\u01b0\u1edbi \u0111\u00f9i. Garo \u0111\u1eb7t \u1edf \u0111o\u1ea1n 1\/3 gi\u1eefa \u0111\u00f9i. G\u1ed1i c\u00f3 th\u1ec3 g\u1ea5p t\u1edbi 100<\/span>o<\/span>. C\u1ea7n ch\u00fa \u00fd l\u00e0 v\u1ea3i tr\u1ea3i v\u00f4 khu\u1ea9n ph\u1ea3i b\u1ea3o \u0111\u1ea3m k\u00edn v\u00e0 kh\u00f4ng b\u1ecb x\u00f4 l\u1ec7ch khi ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt. V\u00f4 khu\u1ea9n trong n\u1ed9i soi kh\u1edbp l\u00e0 m\u1ed9t y\u00eau c\u1ea7u r\u1ea5t nghi\u00eam ng\u1eb7t<\/span><\/p>\n

\"5.8\"
H\u00ecnh 5.8. T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) [21]<\/figcaption><\/figure>\n

4. K\u1ef8 THU\u1eacT TI\u1ebeN H\u00c0NH<\/span><\/h3>\n

Tr\u01b0\u1edbc h\u1ebft, b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, kh\u1edbp g\u1ed1i \u1edf t\u01b0 th\u1ebf g\u1ea5p 90<\/span>o<\/span>, x\u00e1c \u0111\u1ecbnh \u0111i\u1ec3m m\u1ed1c gi\u1ea3i ph\u1eabu \u0111\u1ec3 r\u1ea1ch da, qua \u0111\u00f3 \u0111\u01b0a h\u1ec7 th\u1ed1ng d\u1ee5ng c\u1ee5 v\u00e0o quan s\u00e1t, th\u0103m d\u00f2, \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb, ch\u00fang t\u00f4i th\u01b0\u1eddng s\u1eed d\u1ee5ng hai \u0111\u01b0\u1eddng.<\/span><\/p>\n

\"5.9\"
H\u00ecnh 5.9. \u0110\u01b0\u1eddng v\u00e0o kh\u1edbp g\u1ed1i (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) [21]<\/figcaption><\/figure>\n

– \u0110\u01b0\u1eddng tr\u01b0\u1edbc ngo\u00e0i: \u0111i\u1ec3m m\u1ed1c d\u1ecdc b\u1edd ngo\u00e0i g\u00e2n b\u00e1nh ch\u00e8, \u0111\u01b0\u1eddng ch\u00e9o d\u1ecdc theo l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 \u0111\u01b0\u1eddng theo b\u1edd tr\u01b0\u1edbc ngo\u00e0i c\u1ee7a m\u00e2m ch\u00e0y. Ba \u0111\u01b0\u1eddng n\u00e0y t\u1ea1o th\u00e0nh m\u1ed9t tam gi\u00e1c, trong di\u1ec7n t\u00edch c\u1ee7a tam gi\u00e1c n\u00e0y l\u00e0 v\u1ecb tr\u00ed c\u00f3 th\u1ec3 v\u00e0o kh\u1edbp g\u1ed1i. D\u00f9ng dao r\u1ea1ch d\u00e0i kho\u1ea3ng 0,5 cm qua da v\u00e0 m\u00f4 d\u01b0\u1edbi da, d\u00f9ng troca \u0111\u01b0a v\u00e0o \u1ed5 kh\u1edbp, m\u1edf van cho dung d\u1ecbch r\u1eeda v\u00e0o kh\u1edbp, h\u00fat r\u1eeda cho \u0111\u1ebfn khi n\u01b0\u1edbc trong.<\/span><\/p>\n

– \u0110\u01b0\u1eddng tr\u01b0\u1edbc trong: \u0111i\u1ec3m m\u1ed1c \u0111\u1ed1i di\u1ec7n ph\u00eda trong khe kh\u1edbp, d\u00f9ng dao r\u1ea1ch da 0,5 cm.<\/span><\/p>\n

– \u0110\u01b0\u1eddng sau b\u00ean: c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng khi kh\u00e2u s\u1eebng sau s\u1ee5n ch\u00eam. Gi\u00fap quan s\u00e1t k\u1ef9 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 d\u1ec5 thao t\u00e1c khi d\u00f9ng k\u1ef9 thu\u1eadt kh\u00e2u t\u1eeb trong ra ngo\u00e0i.<\/span><\/p>\n

Sau khi \u0111\u00e3 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed \u0111\u01b0\u1eddng v\u00e0o kh\u1edbp g\u1ed1i, ph\u1eabu thu\u1eadt vi\u00ean \u0111\u01b0a \u1ed1ng soi v\u00e0o \u0111\u1ec3 quan s\u00e1t theo m\u1ed9t tr\u00ecnh t\u1ef1 nh\u1ea5t \u0111\u1ecbnh t\u1eebng v\u1ecb tr\u00ed c\u1ee7a kh\u1edbp g\u1ed1i nh\u01b0: t\u00fai b\u1ecbt c\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i, m\u1eb7t kh\u1edbp l\u1ed3i c\u1ea7u b\u00e1nh ch\u00e8, m\u1eb7t s\u1ee5n sau x\u01b0\u01a1ng b\u00e1nh ch\u00e8<\/a>, ng\u0103n kh\u1edbp ph\u00eda ngo\u00e0i, s\u1ee5n ch\u00eam v\u00e0 l\u1ed3i c\u1ea7u ngo\u00e0i, ng\u0103n kh\u1edbp ph\u00eda trong, s\u1ee5n ch\u00eam trong v\u00e0 m\u00e2m ch\u00e0y, l\u1ed3i c\u1ea7u trong x\u01b0\u01a1ng \u0111\u00f9i, v\u1ecb tr\u00ed h\u1ed1 li\u00ean h\u1ed3i c\u1ea7u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng d\u00e2y ch\u1eb1ng ch\u00e9o<\/a>. \u0110\u01b0a que th\u0103m d\u00f2 qua \u0111\u01b0\u1eddng tr\u01b0\u1edbc trong v\u00e0o trong kh\u1edbp \u0111\u1ec3 ki\u1ec3m tra, x\u00e1c \u0111\u1ecbnh h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam trong kh\u1edbp, t\u1ed5n th\u01b0\u01a1ng v\u1ecb tr\u00ed s\u1eebng tr\u01b0\u1edbc, s\u1eebng gi\u1eefa hay s\u1eebng sau (xem H\u00ecnh 5.6)<\/span><\/p>\n

\"5.10\"
H\u00ecnh 5.10. C\u00e1c v\u1ecb tr\u00ed th\u0103m d\u00f2 kh\u1edbp g\u1ed1i<\/figcaption><\/figure>\n

A: T\u00fai b\u1ecbt c\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i<\/span><\/p>\n

B: M\u1eb7t kh\u1edbp b\u00e1nh ch\u00e8 l\u1ed3i c\u1ea7u \u0111\u00f9i<\/span><\/p>\n

C: N\u1ebfp b\u00e1nh ch\u00e8 trong<\/span><\/p>\n

D, E: S\u1eebng sau s\u1ee5n ch\u00eam trong<\/span><\/p>\n

F: S\u1eebng tr\u01b0\u1edbc s\u1ee5n ch\u00eam trong<\/span><\/p>\n

G: D\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc<\/a> <\/span><\/p>\n

I; H: S\u1eebng sau s\u1ee5n ch\u00eam ngo\u00e0i<\/span><\/p>\n

\u00a0J: G\u00e2n c\u01a1 khoeo<\/span><\/p>\n

(Ngu\u1ed3n: General principles of arthroscopy \u2013 Campbell\u2019 operative orthopaedics \u2013 David Sisk T., 1999)<\/span>[59]<\/span><\/p>\n

4.1. \u0110\u00e1nh gi\u00e1 h\u00ecnh th\u00e1i th\u01b0\u01a1ng t\u1ed5n r\u00e1ch s\u1ee5n ch\u00eam v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ed1i h\u1ee3p qua n\u1ed9i soi<\/span><\/h3>\n

– Qua n\u1ed9i soi, s\u1eed d\u1ee5ng que th\u0103m d\u00f2 \u0111\u00e1nh gi\u00e1 c\u00e1c th\u01b0\u01a1ng t\u1ed5n s\u1ee5n ch\u00eam: r\u00e1ch s\u1ee5n ch\u00eam trong hay ngo\u00e0i, v\u1ecb tr\u00ed s\u1eebng n\u00e0o c\u1ee7a s\u1ee5n ch\u00eam, thu\u1ed9c v\u00f9ng c\u1ea5p m\u00e1u n\u00e0o, h\u00ecnh th\u00e1i c\u1ee7a \u0111\u01b0\u1eddng r\u00e1ch theo ph\u00e2n lo\u1ea1i c\u1ee7a O\u2019Connor, t\u1eeb \u0111\u00f3 c\u00f3 h\u01b0\u1edbng x\u1eed tr\u00ed th\u00edch h\u1ee3p v\u00e0 l\u1ef1a ch\u1ecdn k\u1ef9 thu\u1eadt kh\u00e2u ph\u00f9 h\u1ee3p.<\/span><\/p>\n

– \u0110\u00e1nh gi\u00e1 c\u00e1c th\u01b0\u01a1ng t\u1ed5n ph\u1ed1i h\u1ee3p: vi\u00eam bao ho\u1ea1t m\u1ea1c, chu\u1ed9t kh\u1edbp, lo\u00e9t b\u1ec1 m\u1eb7t s\u1ee5n kh\u1edbp hay kh\u00f4ng, n\u1ebfu c\u00f3 \u1edf m\u1ee9c \u0111\u1ed9 nh\u01b0 th\u1ebf n\u00e0o. Qua \u0111\u00f3 x\u1eed l\u00fd c\u00e1c th\u01b0\u01a1ng t\u1ed5n ph\u1ed1i h\u1ee3p n\u00e0y.<\/span><\/p>\n

4.2. K\u1ef9 thu\u1eadt kh\u00e2u s\u1ee5n ch\u00eam<\/span><\/h3>\n

Sau khi \u0111\u00e1nh gi\u00e1 th\u01b0\u01a1ng t\u1ed5n c\u1ee7a s\u1ee5n ch\u00eam c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e2u, ch\u00fang t\u00f4i<\/a> d\u00f9ng l\u01b0\u1ee1i b\u00e0o kh\u1edbp l\u00e0m m\u1edbi l\u1ea1i m\u1eb7t r\u00e1ch c\u1ee7a s\u1ee5n ch\u00eam. Ri\u00eang \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p s\u1ee5n ch\u00eam r\u00e1ch ki\u1ec3u quai x\u00e1ch g\u00e2y k\u1eb9t v\u00e0o kh\u1edbp th\u00ec c\u1ea5n ph\u1ea3i d\u00f9ng que th\u0103m d\u00f2 \u0111\u01b0a ph\u1ea7n s\u1ee5n ch\u00eam v\u1ec1 v\u1ecb tr\u00ed b\u00ecnh th\u01b0\u1eddng tr\u01b0\u1edbc khi l\u00e0m m\u1edbi b\u1ec1 m\u1eb7t n\u01a1i r\u00e1ch.<\/span><\/p>\n

Ch\u00fang t\u00f4i kh\u00e2u s\u1ee5n ch\u00eam m\u1ed7i m\u0169i th\u01b0\u1eddng c\u00e1ch nhau 2 mm, chi\u1ec1u d\u00e0i m\u1ed7i m\u0169i kh\u00e2u th\u01b0\u1eddng l\u00e0 5 mm.<\/span><\/p>\n

X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam c\u1ea7n kh\u00e2u. T\u00f9y theo v\u1ecb tr\u00ed th\u01b0\u01a1ng t\u1ed5n, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng m\u1ed9t trong c\u00e1c k\u1ef9 thu\u1eadt sau \u0111\u00e2y:<\/span><\/p>\n

Kh\u00e2u s\u1ee5n ch\u00eam t\u1eeb ngo\u00e0i v\u00e0o trong (outside – in)<\/span><\/strong><\/p>\n

\"5.11\"
H\u00ecnh 5.11. S\u01a1 \u0111\u1ed3 kh\u00e2u s\u1ee5n ch\u00eam theo k\u1ef9 thu\u1eadt t\u1eeb ngo\u00e0i v\u00e0o trong (Ngu\u1ed3n: Suturing of the meniscal tear \u2013 A.Papoutsidakis 2012) [95]<\/figcaption><\/figure>\n

 <\/p>\n

\u0110\u1ecbnh v\u1ecb, ch\u1ecdc hai kim t\u1eeb ngo\u00e0i v\u00e0o n\u01a1i s\u1ee5n ch\u00eam c\u1ea7n kh\u00e2u (kim 18<\/span>\u00d7<\/span>40 mm ho\u1eb7c kim ch\u1ecdc t\u1ee7y s\u1ed1ng \u0111\u1ed1i v\u1edbi c\u00e1c v\u1ecb tr\u00ed xa, kh\u1edbp g\u1ed1i c\u00f3 m\u00f4 d\u01b0\u1edbi da d\u00e0y).<\/span><\/p>\n

Lu\u1ed3n ch\u1ec9 PDS (s\u1ed1 0 ho\u1eb7c s\u1ed1 1) qua hai kim. Kim ph\u00eda xa l\u00e0 ch\u1ec9 \u0111\u01a1n, kim ph\u00eda g\u1ea7n l\u00e0 ch\u1ec9 \u0111\u00f4i ho\u1eb7c lu\u1ed3n PDS \u0111\u01a1n qua kim ph\u00eda xa, kim ph\u00eda g\u1ea7n lu\u1ed3n ch\u1ec9 th\u00e9p c\u00f3 th\u00f2ng l\u1ecdng \u1edf \u0111\u1ea7u (H\u00ecnh 5.7). Sau \u0111\u00f3 d\u00f9ng d\u1ee5ng c\u1ee5 \u0111\u01b0a \u0111\u1ea7u s\u1ee3i ch\u1ec9 \u1edf kim ph\u00eda xa v\u00e0o th\u00f2ng l\u1ecdng ch\u1ec9 \u0111\u00f4i (ho\u1eb7c th\u00f2ng l\u1ecdng c\u1ee7a ch\u1ec9 th\u00e9p) sau \u0111\u00f3 k\u00e9o s\u1ee3i ch\u1ec9 n\u00e0y ra ngo\u00e0i theo l\u00f2ng kim ph\u00eda g\u1ea7n ra ngo\u00e0i v\u00e0 bu\u1ed9t ch\u1ec9. C\u1ea7n ph\u1ea3i r\u1ea1ch da gi\u1eefa hai s\u1ee3i ch\u1ec9 v\u00e0 b\u00f3c t\u00e1ch m\u00f4 m\u1ec1m \u0111\u1ec3 n\u01a1 bu\u1ed9t s\u00e1t v\u00e0o bao kh\u1edbp. K\u1ef9 thu\u1eadt n\u00e0y \u00e1p d\u1ee5ng cho c\u00e1c r\u00e1ch th\u00e2n ho\u1eb7c s\u1eebng tr\u01b0\u1edbc s\u1ee5n ch\u00eam, \u1edf v\u1ecb tr\u00ed s\u1eebng sau s\u1ee5n ch\u00eam th\u00ec kh\u00f3 kh\u0103n h\u01a1n do s\u1eebng sau ch\u1eafc h\u01a1n, b\u1ecb che khu\u1ea5t, ph\u1eabu tr\u01b0\u1eddng h\u1eb9p, do \u0111\u00f3 kh\u00f3 thao t\u00e1c, \u0111\u00f4i khi kh\u00f4ng ho\u00e0n h\u1ea3o nh\u01b0 mong mu\u1ed1n v\u00e0 d\u1ec5 g\u00e2y c\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u, th\u1ea7n kinh.<\/span><\/p>\n

\"5.12\"
H\u00ecnh 5.12. Kh\u00e2u s\u1ee5n ch\u00eam theo k\u1ef9 thu\u1eadt t\u1eeb ngo\u00e0i v\u00e0o trong (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014)<\/figcaption><\/figure>
\"5.13\"
H\u00ecnh 5.13. X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam c\u1ea7n kh\u00e2u (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) [21]<\/figcaption><\/figure>
\"5.14\"
H\u00ecnh 5.14. \u0110\u1ecbnh v\u1ecb, lu\u1ed3n ch\u1ec9 PDS (s\u1ed1 0 ho\u1eb7c s\u1ed1 1) qua kim<\/figcaption><\/figure>
\"5.15\"
H\u00ecnh 5.15. Kh\u00e2u s\u1ee5n ch\u00eam theo k\u1ef9 thu\u1eadt t\u1eeb ngo\u00e0i v\u00e0o trong<\/figcaption><\/figure>
\"5.16\"
H\u00ecnh 5.16. Ki\u1ec3m tra sau m\u0169i kh\u00e2u \u0111\u1ea7u ti\u00ean (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014)<\/figcaption><\/figure>
\"5.17\"
H\u00ecnh 5.17. Sau khi ho\u00e0n t\u1ea5t kh\u00e2u s\u1ee5n ch\u00eam (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) [<\/figcaption><\/figure><\/p>\n

Kh\u00e2u s\u1ee5n ch\u00eam t\u1eeb trong ra ngo\u00e0i (inside \u2013 out)<\/span><\/strong><\/p>\n

\"5.18\"
H\u00ecnh 5.18. S\u01a1 \u0111\u1ed3 kh\u00e2u s\u1ee5n ch\u00eam theo k\u1ef9 thu\u1eadt t\u1eeb trong ra ngo\u00e0i (Ngu\u1ed3n: Suturing of the meniscal tear \u2013 A.Papoutsidakis, 2012) [95]<\/figcaption><\/figure>
\"5.19\"
H\u00ecnh 5.19. Kh\u00e2u s\u1ee5n ch\u00eam theo k\u1ef9 thu\u1eadt t\u1eeb trong ra ngo\u00e0i (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) [21]<\/figcaption><\/figure><\/p>\n

T\u01b0\u01a1ng t\u1ef1 nh\u01b0 k\u1ef9 thu\u1eadt kh\u00e2u s\u1ee5n ch\u00eam t\u1eeb ngo\u00e0i v\u00e0o trong, tuy nhi\u00ean nh\u1edd c\u00e1c d\u1ee5ng c\u1ee5 ta th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt t\u1eeb trong ra ngo\u00e0i. \u0110i\u1ec1u n\u00e0y gi\u00fap ta ti\u1ebfp c\u1eadn v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng c\u1ee7a s\u1ee5n ch\u00eam nhanh h\u01a1n v\u00e0 ch\u00ednh x\u00e1c h\u01a1n<\/span><\/p>\n

D\u00f9ng d\u1ee5ng c\u1ee5 \u0111\u1ecbnh v\u1ecb n\u01a1i c\u1ea7n kh\u00e2u tr\u00ean s\u1ee5n ch\u00eam, xuy\u00ean d\u1ee5ng c\u1ee5 t\u1eeb trong ra ngo\u00e0i kh\u1edbp, ti\u1ebfp t\u1ee5c d\u00f9ng d\u1ee5ng c\u1ee5 \u0111\u1ecbnh v\u1ecb n\u01a1i c\u1ea7n kh\u00e2u ti\u1ebfp theo \u1edf s\u1ee5n ch\u00eam, xuy\u00ean d\u1ee5ng c\u1ee5 t\u1eeb trong ra ngo\u00e0i kh\u1edbp. Sau \u0111\u00f3 lu\u1ed3n ch\u1ec9 \u0111\u01a1n t\u1eeb trong ra ngo\u00e0i qua d\u1ee5ng c\u1ee5 \u0111\u1ea7u ti\u00ean, lu\u1ed3n ch\u1ec9 \u0111\u00f4i ho\u1eb7c ch\u1ec9 c\u00f3 l\u1ecdng t\u1eeb trong ra ngo\u00e0i qua d\u1ee5ng c\u1ee5 th\u1ee9 hai (xem H\u00ecnh 5.9 v\u00e0 H\u00ecnh 5.10), sau \u0111\u00f3 bu\u1ed9t ch\u1ec9 nh\u01b0 c\u00e1ch kh\u00e2u t\u1eeb ngo\u00e0i v\u00e0o.<\/span><\/p>\n

C\u0169ng gi\u1ed1ng nh\u01b0 k\u1ef9 thu\u1eadt kh\u00e2u s\u1ee5n ch\u00eam t\u1eeb ngo\u00e0i v\u00e0o trong, k\u1ef9 thu\u1eadt n\u00e0y \u00e1p d\u1ee5ng cho c\u00e1c r\u00e1ch th\u00e2n ho\u1eb7c s\u1eebng tr\u01b0\u1edbc s\u1ee5n ch\u00eam, \u1edf v\u1ecb tr\u00ed s\u1eebng sau s\u1ee5n ch\u00eam th\u00ec kh\u00f3 kh\u0103n h\u01a1n, d\u1ec5 g\u00e2y c\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u, th\u1ea7n kinh<\/a>. Do \u0111\u00f3, nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f3 kh\u0103n, ch\u00fang t\u00f4i m\u1edf th\u00eam \u0111\u01b0\u1eddng v\u00e0o sau b\u00ean \u0111\u1ec3 d\u1ec5 thao t\u00e1c v\u00e0 quan s\u00e1t k\u1ef9, tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng.<\/span><\/p>\n

Kh\u00e2u s\u1ee5n ch\u00eam ho\u00e0n to\u00e0n b\u00ean trong (all inside)<\/span><\/strong><\/p>\n

– <\/span>V\u1edbi lo\u1ea1i d\u1ee5ng c\u1ee5 ch\u1ec9 l\u00e0 m\u1ecf neo (anchor): <\/span>d\u00f9ng d\u1ee5ng c\u1ee5 \u201cneo\u201d th\u1eb3ng v\u00e0o v\u1ecb tr\u00ed c\u1ea7n kh\u00e2u \u1edf s\u1ee5n ch\u00eam. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y kh\u00e1 \u0111\u01a1n gi\u1ea3n, tuy nhi\u00ean kh\u00f4ng t\u1ea1o \u0111\u01b0\u1ee3c l\u1ef1c n\u00e9o \u00e9p \u0111\u1ec1u kh\u1eafp \u0111\u01b0\u1eddng r\u00e1ch s\u1ee5n ch\u00eam, n\u00ean kh\u1ea3 n\u0103ng li\u1ec1n s\u1eb9o k\u00e9m. Hi\u1ec7n nay \u00edt s\u1eed d\u1ee5ng<\/span><\/p>\n

\"5.20\"
H\u00ecnh 5.20. Kh\u00e2u s\u1ee5n ch\u00eam theo k\u1ef9 thu\u1eadt ho\u00e0n to\u00e0n b\u00ean trong b\u1eb1ng m\u1ecf neo (Ngu\u1ed3n: Suturing of the meniscal tear \u2013 A.Papoutsidakis (2012) [95]<\/figcaption><\/figure>\n

– V\u1edbi lo\u1ea1i d\u1ee5ng c\u1ee5 v\u1eeba c\u00f3 m\u1ecf neo v\u1eeba c\u00f3 ch\u1ec9 k\u1ebft h\u1ee3p: <\/span>c\u00f3 c\u00e1c lo\u1ea1i d\u1ee5ng c\u1ee5 nh\u01b0: Fast-Fix, Mitek.<\/span>\u00a0<\/p>\n

\"5.21\"
H\u00ecnh 5.21. Kh\u00e2u s\u1ee5n ch\u00eam theo k\u1ef9 thu\u1eadt ho\u00e0n to\u00e0n b\u00ean trong b\u1eb1ng Fast-Fix (Ngu\u1ed3n: Suturing of the meniscal tear \u2013 A.Papoutsidakis (2012) [95]<\/figcaption><\/figure>
\"5.22\"
H\u00ecnh 5.22. Kh\u00e2u s\u1ee5n ch\u00eam theo k\u1ef9 thu\u1eadt ho\u00e0n to\u00e0n b\u00ean trong b\u1eb1ng Mitek (Ngu\u1ed3n: Suturing of the meniscal tear \u2013 A.Papoutsidakis (2012) [95]<\/figcaption><\/figure><\/p>\n

 <\/p>\n

\"5.23\"<\/p>\n

\"5.23.1\"
H\u00ecnh 5.23. H\u00ecnh \u1ea3nh n\u1ed9i soi kh\u00e2u s\u1ee5n ch\u00eam theo k\u1ef9 thu\u1eadt ho\u00e0n to\u00e0n b\u00ean trong (Ngu\u1ed3n: Nghi\u00ean c\u1ee9u \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam do ch\u1ea5n th\u01b0\u01a1ng b\u1eb1ng kh\u00e2u n\u1ed9i soi \u2013 V\u00f5 Th\u00e0nh To\u00e0n \u2013 2014) [21]<\/figcaption><\/figure>\n

Nh\u1edd c\u00e1c d\u1ee5ng c\u1ee5 h\u1ed7 tr\u1ee3 n\u00ean thao t\u00e1c trong k\u1ef9 thu\u1eadt kh\u00e2u s\u1ee5n ch\u00eam ho\u00e0n to\u00e0n b\u00ean trong kh\u00e1 \u0111\u01a1n gi\u1ea3n. Sau khi x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng, d\u00f9ng d\u1ee5ng c\u1ee5 kh\u00e2u s\u1ee5n ch\u00eam c\u1ed1 \u0111\u1ecbnh ch\u1ec9 v\u00e0o v\u1ecb tr\u00ed c\u1ea7n kh\u00e2u (c\u00e1c m\u1ecf neo s\u1ebd c\u1ed1 \u0111\u1ecbnh), sau \u0111\u00f3 kh\u00e2u ti\u1ebfp m\u1ed9t m\u0169i kh\u00e2u n\u1eefa \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh m\u1ecf neo th\u1ee9 hai. Cu\u1ed1i c\u00f9ng k\u00e9o d\u1ee5ng c\u1ee5 xi\u1ebft ch\u1eb7t v\u00e0 c\u1eaft ch\u1ec9 (\u0111\u1ed1i v\u1edbi lo\u1ea1i d\u1ee5ng c\u1ee5 v\u1eeba c\u00f3 m\u1ecf neo v\u00e0 v\u1eeba c\u00f3 ch\u1ec9). L\u1ef1c \u00e9p c\u1ee7a ch\u1ec9 v\u00e0 m\u1ecf neo s\u1ebd ph\u1ed1i h\u1ee3p d\u00e0n \u0111\u1ec1u tr\u00ean \u0111\u01b0\u1eddng r\u00e1ch c\u1ee7a s\u1ee5n, gi\u00fap cho qu\u00e1 tr\u00ecnh li\u1ec1n s\u1ee5n t\u1ed1t h\u01a1n [41],[48],[77],[89],[92]. \u0110\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p kh\u00e2u c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng cho m\u1ecdi v\u1ecb tr\u00ed r\u00e1ch c\u1ee7a s\u1ee5n ch\u00eam, tuy nhi\u00ean, chi ph\u00ed cao.\u00a0<\/span><\/p>\n","protected":false},"featured_media":4417,"comment_status":"open","ping_status":"closed","template":"","tags":[233,234],"chuyen-muc":[58],"class_list":["post-2407","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-dieu-tri-ton-thuong-sun-chem","tag-phau-thuat-noi-soi-khop","chuyen-muc-dieu-tri-co-ban-trong-chan-thuong-chinh-hinh"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang"}],"about":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/types\/bai-giang"}],"replies":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/comments?post=2407"}],"version-history":[{"count":1,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2407\/revisions"}],"predecessor-version":[{"id":4418,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2407\/revisions\/4418"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/4417"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=2407"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=2407"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=2407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}