{"id":4456,"date":"2025-02-07T11:19:15","date_gmt":"2025-02-07T04:19:15","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?p=4456"},"modified":"2025-02-07T11:19:51","modified_gmt":"2025-02-07T04:19:51","slug":"danh-gia-ton-thuong-sun-chem-tren-hinh-anh-cong-huong-tu-va-noi-soi-khop-goi-o-benh-nhan-dut-day-chang-cheo-truoc","status":"publish","type":"post","link":"https:\/\/bsvothanhtoan.com\/en\/danh-gia-ton-thuong-sun-chem-tren-hinh-anh-cong-huong-tu-va-noi-soi-khop-goi-o-benh-nhan-dut-day-chang-cheo-truoc\/","title":{"rendered":"\u0110\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean h\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb v\u00e0 n\u1ed9i soi kh\u1edbp g\u1ed1i \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee9t d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc"},"content":{"rendered":"

V\u00f5 Th\u00e0nh To\u00e0n, Nguy\u1ec5n Thi\u00ean \u0110\u1ee9c, L\u00ea \u0110\u00ecnh Nguy\u00ean Anh, Nguy\u1ec5n V\u0103n K\u1ef3 Hi\u00ean, V\u01b0u Kh\u00e1nh Hi\u1ec7p, L\u00ea Anh T\u00fa, Phan L\u00ea Nguy\u00ean B\u00e1, Nguy\u1ec5n Minh D\u01b0\u01a1ng, Ng\u00f4 Ho\u00e0ng Vi\u1ec5n<\/em><\/p>\n

ABSTRACT<\/strong><\/p>\n

Gi\u1edbi thi\u1ec7u: T\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam th\u01b0\u1eddng x\u1ea3y ra c\u00f9ng v\u1edbi t\u1ed5n th\u01b0\u01a1ng DCCT (t\u1ec9 l\u1ec7 55 \u2013 80%), vi\u1ec7c kh\u00f4ng ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT s\u1ebd khi\u1ebfn v\u1ebft r\u00e1ch s\u1ebd ph\u1ee9c t\u1ea1p h\u01a1n v\u00e0 kh\u00f3 s\u1eeda ch\u1eefa h\u01a1n theo th\u1eddi gian. M\u1ee5c ti\u00eau: x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p gi\u1eefa c\u1ed9ng h\u01b0\u1edfng t\u1eeb (CHT) v\u1edbi n\u1ed9i soi kh\u1edbp g\u1ed1i trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u1ee9t d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc (DCCT). \u0110\u1ed1i t\u01b0\u1ee3ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u: nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u m\u00f4 t\u1ea3 lo\u1ea1t ca tr\u00ean 91 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ee5p CHT kh\u1edbp g\u1ed1i v\u00e0 ch\u1ea9n \u0111o\u00e1n \u0111\u1ee9t DCCT th\u00f4ng qua n\u1ed9i soi kh\u1edbp g\u1ed1i t\u1ea1i B\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t t\u1eeb 04\/2023 \u0111\u1ebfn 04\/2024. K\u1ebft qu\u1ea3: \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a CHT v\u00e0 m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p v\u1edbi n\u1ed9i soi trong ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam l\u00e0 70,3%, ch\u1ec9 s\u1ed1 Kappa=0,401, p<0,00 1cho th\u1ea5y m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p th\u1ea5p gi\u1eefa k\u1ebft qu\u1ea3 CHT v\u00e0 n\u1ed9i soi. \u0110\u1ed1i v\u1edbi ch\u1ea9n \u0111o\u00e1n v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam l\u00e0 57,1%, ch\u1ec9 s\u1ed1 Kappa=0,346, p<0,001 cho th\u1ea5y m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p th\u1ea5p gi\u1eefa k\u1ebft qu\u1ea3 CHT v\u00e0 n\u1ed9i soi. Trong ch\u1ea9n \u0111o\u00e1n v\u00f9ng t\u1ed5n th\u01b0\u01a1ng, c\u00e1c ch\u1ec9 s\u1ed1 n\u00e0y \u0111\u1ea1t tr\u00ean 85% v\u1edbi h\u1ec7 s\u1ed1 Kappa dao \u0111\u1ed9ng t\u1eeb 0,3 \u0111\u1ebfn 0,57, p<0,001 t\u00f9y theo v\u1ecb tr\u00ed v\u00e0 v\u00f9ng s\u1ee5n ch\u00eam t\u1ed5n th\u01b0\u01a1ng. Trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam, \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a CHT v\u00e0 m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p v\u1edbi n\u1ed9i soi \u0111\u1ea1t tr\u00ean 89% v\u1edbi h\u1ec7 s\u1ed1 Kappa dao \u0111\u1ed9ng t\u1eeb 0,258 \u0111\u1ebfn 0,616, p<0,001 t\u00f9y theo v\u1ecb tr\u00ed v\u00e0 h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng. K\u1ebft lu\u1eadn: c\u00f3 s\u1ef1 t\u01b0\u01a1ng h\u1ee3p m\u1ee9c \u0111\u1ed9 t\u1eeb t\u1ed1i thi\u1ec3u \u0111\u1ebfn trung b\u00ecnh gi\u1eefa CHT v\u1edbi n\u1ed9i soi trong ph\u00e1t hi\u1ec7n, ch\u1ea9n \u0111o\u00e1n v\u1ecb tr\u00ed, v\u00f9ng v\u00e0 h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT, t\u1eeb \u0111\u00f3 c\u1ea7n c\u00e2n nh\u1eafc k\u0129 tr\u01b0\u1edbc khi k\u1ebft lu\u1eadn t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean CHT \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT. T\u1eeb kho\u00e1: d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc, c\u1ed9ng h\u01b0\u1edfng t\u1eeb, n\u1ed9i soi kh\u1edbp g\u1ed1i, s\u1ee5n ch\u00eam<\/p>\n

PREAMBLE<\/strong><\/p>\n

T\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam th\u01b0\u1eddng x\u1ea3y ra c\u00f9ng v\u1edbi t\u1ed5n th\u01b0\u01a1ng DCCT (t\u1ec9 l\u1ec7 55 \u2013 80%), t\u1ec9 l\u1ec7 n\u00e0y \u0111\u1eb7c bi\u1ec7t cao \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed t\u1ed5n th\u01b0\u01a1ng DCCT nhi\u1ec1u l\u1ea7n tr\u01b0\u1edbc \u0111\u00f31,2. T\u1ed5n th\u01b0\u01a1ng c\u1ea3 hai c\u1ea5u tr\u00fac DCCT v\u00e0 s\u1ee5n ch\u00eam c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 \u1ed5n \u0111\u1ecbnh c\u1ee7a kh\u1edbp3,4. Vi\u1ec7c kh\u00f4ng ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT s\u1ebd khi\u1ebfn v\u1ebft r\u00e1ch s\u1ebd ph\u1ee9c t\u1ea1p h\u01a1n v\u00e0 kh\u00f3 s\u1eeda ch\u1eefa h\u01a1n theo th\u1eddi gian, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf khi t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam ngo\u00e0i (SCN)5. V\u1ec1 ti\u00ean l\u01b0\u1ee3ng, khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam k\u00e8m theo \u0111\u1ee9t DCCT, t\u1ec9 l\u1ec7 xu\u1ea5t hi\u1ec7n tho\u00e1i h\u00f3a kh\u1edbp \u1edf b\u1ec7nh nh\u00e2n l\u00ean \u0111\u1ebfn 60\u201390% sau 10\u201315 n\u0103m k\u1ec3 t\u1eeb ch\u1ea5n th\u01b0\u01a1ng ban \u0111\u1ea7u, h\u1ed3i ph\u1ee5c v\u1eadn \u0111\u1ed9ng sau ph\u1eabu thu\u1eadt k\u00e9m v\u00e0 t\u00ecnh tr\u1ea1ng tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i kh\u1edfi ph\u00e1t s\u1edbm5\u20138. Th\u0103m kh\u00e1m l\u00e2m s\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam th\u01b0\u1eddng g\u1eb7p kh\u00f3 kh\u0103n v\u00ec b\u1ec7nh nh\u00e2n sau ch\u1ea5n th\u01b0\u01a1ng c\u00f3 kh\u1ea3 n\u0103ng b\u1ecb s\u01b0ng n\u1ec1, \u0111au, tr\u00e0n d\u1ecbch, h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp g\u1ed1i. CHT v\u00e0 n\u1ed9i soi kh\u1edbp g\u1ed1i l\u00e0 hai ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n c\u00f3 gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n c\u00e1c t\u1ed5n th\u01b0\u01a1ng ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp g\u1ed1i. Tuy nhi\u00ean, c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn gi\u00e1 tr\u1ecb c\u1ee7a CHT trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam khi c\u00f3\u00a0 \u0111\u1ee9t DCCT. Khi \u0111\u1ee9t DCCT, \u0111\u1ed9 nh\u1ea1y c\u1ee7a CHT trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam trong (SCT) gi\u1ea3m t\u1eeb 97% xu\u1ed1ng 88% v\u00e0 SCN gi\u1ea3m t\u1eeb 94% xu\u1ed1ng 69% 2. Theo t\u00e1c gi\u1ea3 Tae-Seok Nam v\u00e0 c\u1ed9ng s\u1ef1, khi b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng DCCT, \u0111\u1ed9 nh\u1ea1y v\u00e0 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m c\u1ee7a CHT trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam gi\u1ea3m, d\u1eabn \u0111\u1ebfn \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a CHT th\u1ea5p9. V\u1eady gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam d\u1ef1a tr\u00ean h\u00ecnh \u1ea3nh CHT so v\u1edbi n\u1ed9i soi kh\u1edbp g\u1ed1i \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT l\u00e0 nh\u01b0 th\u1ebf n\u00e0o? V\u00ec v\u1eady, ch\u00fang t\u00f4i th\u1ef1c hi\u1ec7n nghi\u00ean c\u1ee9u \u201c\u0110\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean h\u00ecnh \u1ea3nh CHT v\u00e0 n\u1ed9i soi kh\u1edbp g\u1ed1i \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT\u201d nh\u1eb1m m\u1ee5c ti\u00eau x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 ph\u00f9 h\u1ee3p CHT v\u1edbi n\u1ed9i soi kh\u1edbp g\u1ed1i trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT.<\/p>\n

\u0110\u1ed0I T\u01af\u1ee2NG V\u00c0 PH\u01af\u01a0NG PH\u00c1P NGHI\u00caN C\u1ee8U<\/strong><\/p>\n

\u0110\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u: nghi\u00ean c\u1ee9u 91 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ee5p CHT kh\u1edbp g\u1ed1i v\u00e0 n\u1ed9i soi kh\u1edbp g\u1ed1i c\u00f3 t\u1ed5n th\u01b0\u01a1ng DCCT t\u1ea1i Khoa Ngo\u1ea1i Ch\u1ea5n th\u01b0\u01a1ng \u2013 Ch\u1ec9nh h\u00ecnh, B\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t t\u1eeb 04\/2023 \u0111\u1ebfn 04\/2024 Ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u: ti\u1ebfn c\u1ee9u m\u00f4 t\u1ea3 lo\u1ea1t ca Ti\u00eau chu\u1ea9n ch\u1ecdn m\u1eabu: t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh \u0111\u1ee9t DCCT th\u00f4ng qua n\u1ed9i soi kh\u1edbp g\u1ed1i v\u00e0 \u0111\u01b0\u1ee3c ch\u1ee5p CHT kh\u1edbp g\u1ed1i tr\u01b0\u1edbc m\u1ed5 t\u1ea1i khoa Ngo\u1ea1i Ch\u1ea5n th\u01b0\u01a1ng \u2013 Ch\u1ec9nh h\u00ecnh, B\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t t\u1eeb 04\/2023 \u0111\u1ebfn 04\/2024 v\u00e0 \u0111\u1ed3ng \u00fd tham gia nghi\u00ean c\u1ee9u. Ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb: c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed \u0111\u01b0\u1ee3c can thi\u1ec7p t\u00e1i t\u1ea1o d\u00e2y ch\u1eb1ng ch\u00e9o hay ph\u1eabu thu\u1eadt x\u01b0\u01a1ng, ph\u1ea7n m\u1ec1m v\u00f9ng g\u1ed1i; b\u1ec7nh nh\u00e2n \u0111\u1ee9t t\u1eeb hai d\u00e2y ch\u1eb1ng kh\u1edbp g\u1ed1i tr\u1edf l\u00ean; b\u1ec7nh nh\u00e2n kh\u00f4ng tham gia \u0111\u1ea7y \u0111\u1ee7 su\u1ed1t qu\u00e1 tr\u00ecnh theo d\u00f5i.<\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p thu th\u1eadp s\u1ed1 li\u1ec7u:<\/strong><\/p>\n

D\u01b0\u1edbi \u0111\u00e2y l\u00e0 h\u00ecnh \u1ea3nh m\u00f4 t\u1ea3 quy tr\u00ecnh ph\u01b0\u01a1ng ph\u00e1p thu th\u1eadp s\u1ed1 li\u1ec7u t\u1ea1i khoa Ngo\u1ea1i Ch\u1ea5n th\u01b0\u01a1ng \u2013 Ch\u1ec9nh h\u00ecnh B\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t (H\u00ecnh 1). \u2022 B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ee5p CHT kh\u1edbp g\u1ed1i tr\u00ean m\u00e1y ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb Siemens MAGNETOM C, t\u1eeb l\u1ef1c 0,35 Tesla. C\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee5p theo c\u00e1c chu\u1ed7i xung T2W, T1W: STIR, PD theo ba m\u1eb7t ph\u1eb3ng (\u0111\u1ee9ng d\u1ecdc, \u0111\u1ee9ng ngang v\u00e0 n\u1eb1m ngang). \u2022 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean CHT: R\u00e1ch s\u1ee5n ch\u00eam \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00f3 1 trong c\u00e1c d\u1ea5u hi\u1ec7u10: \u2022 S\u1ee5n ch\u00eam c\u00f3 c\u01b0\u1eddng \u0111\u1ed9 t\u00edn hi\u1ec7u cao, k\u00e9o d\u00e0i \u0111\u1ebfn \u00edt nh\u1ea5t m\u1ed9t b\u1ec1 m\u1eb7t kh\u1edbp, c\u1ea7n \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y \u1edf \u00edt nh\u1ea5t hai l\u00e1t c\u1eaft (kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i l\u00e0 hai l\u00e1t c\u1eaft li\u1ec1n k\u1ec1 nhau, v\u00ed d\u1ee5: l\u00e1t c\u1eaft \u0111\u1ee9ng d\u1ecdc ho\u1eb7c l\u00e1t c\u1eaft ngang), trong tr\u01b0\u1eddng h\u1ee3p r\u00e1ch ki\u1ec3u quai x\u00e1ch c\u00f3 th\u1ec3 th\u1ea5y \u0111\u01b0\u1eddng t\u00edn hi\u1ec7u tr\u1ed1ng. \u2022 S\u1ee5n ch\u00eam c\u00f3 h\u00ecnh d\u00e1ng b\u1ea5t th\u01b0\u1eddng n\u1ebfu kh\u00f4ng c\u00f3 ph\u1eabu thu\u1eadt tr\u01b0\u1edbc \u0111\u00f3. T\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean CHT \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh 3 \u0111\u1ed9 (theo Lotysch v\u00e0 c\u1ed9ng s\u1ef1) 11\u2022 T\u1ea5t c\u1ea3 c\u00e1c ph\u1eabu thu\u1eadt vi\u00ean \u0111\u1ec1u tu\u00e2n th\u1ee7 quy tr\u00ecnh n\u1ed9i soi kh\u1edbp g\u1ed1i \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t v\u00e0 th\u00f4ng qua b\u1edfi h\u1ed9i \u0111\u1ed3ng y khoa b\u1ec7nh vi\u1ec7n. \u2022 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean n\u1ed9i soi \u0111\u01b0\u1ee3c ph\u00e2n \u0111\u1ed9 theo h\u1ec7 th\u1ed1ng ISAKOS12 \u2022 Nghi\u00ean c\u1ee9u th\u1ef1c hi\u1ec7n v\u1edbi c\u00e1c ch\u1ec9 ti\u00eau v\u1ec1 tu\u1ed5i, gi\u1edbi, ch\u00e2n thu\u1eadn, th\u1eddi gian t\u1ed5n th\u01b0\u01a1ng, ph\u00e2n t\u00edch c\u00e1c d\u1ea5u hi\u1ec7u t\u1ed5n th\u01b0\u01a1ng DCCT v\u00e0 s\u1ee5n ch\u00eam, c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ed1i h\u1ee3p th\u01b0\u1eddng g\u1eb7p so s\u00e1nh v\u1edbi n\u1ed9i soi ph\u1eabu thu\u1eadt v\u1edbi c\u00e1c test th\u1ed1ng k\u00ea nh\u1eb1m \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 ph\u00f9 h\u1ee3p gi\u1eefa c\u1ed9ng h\u01b0\u1edfng t\u1eeb v\u1edbi n\u1ed9i soi trong ch\u1ea9n \u0111o\u00e1n th\u1ec3 t\u1ed5n th\u01b0\u01a1ng DCCT v\u00e0 s\u1ee5n ch\u00eam. Ph\u01b0\u01a1ng ph\u00e1p x\u1eed l\u00fd s\u1ed1 li\u1ec7u C\u00e1c bi\u1ebfn \u0111\u1ecbnh l\u01b0\u1ee3ng tu\u00e2n theo ph\u00e2n ph\u1ed1i chu\u1ea9n s\u1eed d\u1ee5ng trung b\u00ecnh v\u00e0 \u0111\u1ed9 l\u1ec7ch chu\u1ea9n, c\u00e1c bi\u1ebfn \u0111\u1ecbnh t\u00ednh tr\u00ecnh b\u00e0y d\u01b0\u1edbi d\u1ea1ng t\u1ec9 l\u1ec7. D\u00f9ng ph\u00e9p ki\u1ec3m \u0111\u1ecbnh Chi b\u00ecnh ph\u01b0\u01a1ng \u0111\u1ed1i v\u1edbi bi\u1ebfn ph\u00e2n lo\u1ea1i, n\u1ebfu kh\u00f4ng th\u1ecfa \u0111i\u1ec1u ki\u1ec7n s\u1eed d\u1ee5ng th\u00ec d\u00f9ng ph\u00e9p ki\u1ec3m \u0111\u1ecbnh ch\u00ednh x\u00e1c Fisher. D\u00f9ng ph\u00e9p ki\u1ec3m Kappa \u0111\u1ec3 ki\u1ec3m tra m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p gi\u1eefa n\u1ed9i soi v\u00e0 CHT. C\u00e1c s\u1ed1 li\u1ec7u \u0111\u01b0\u1ee3c x\u1eed l\u00fd v\u1edbi ph\u1ea7n m\u1ec1m SPSS phi\u00ean b\u1ea3n 27.0.<\/p>\n

K\u1ebeT QU\u1ea2<\/strong><\/p>\n

Trong kho\u1ea3ng th\u1eddi gian t\u1eeb 01\/04\/2023 \u0111\u1ebfn 01\/04\/2024 c\u00f3 91 b\u1ec7nh nh\u00e2n (91 kh\u1edbp g\u1ed1i) th\u1ecfa ti\u00eau chu\u1ea9n \u0111\u01b0\u1ee3c thu th\u1eadp v\u00e0o nghi\u00ean c\u1ee9u, c\u00e1c k\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c nh\u01b0 sau:<\/p>\n

Research subjects<\/strong><\/p>\n

Trong s\u1ed1 91 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o nghi\u00ean c\u1ee9u n\u00e0y, ph\u1ea7n l\u1edbn l\u00e0 nam gi\u1edbi (62,6%), v\u1edbi t\u1ef7 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam cao h\u01a1n \u1edf nam gi\u1edbi (66,7%). Nh\u1eefng ng\u01b0\u1eddi tham gia d\u01b0\u1edbi 40 tu\u1ed5i chi\u1ebfm 59,3% d\u00e2n s\u1ed1 nghi\u00ean c\u1ee9u v\u00e0 73,8% t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam x\u1ea3y ra \u1edf nh\u00f3m tu\u1ed5i n\u00e0y. Ch\u00e2n thu\u1eadn b\u1ecb \u1ea3nh h\u01b0\u1edfng trong 69,1% c\u00e1c tr\u01b0\u1eddng h\u1ee3p, v\u1edbi 49,2% t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam x\u1ea3y ra \u1edf ch\u00e2n thu\u1eadn, so v\u1edbi 40,6% \u1edf ch\u00e2n kh\u00f4ng thu\u1eadn. H\u1ea7u h\u1ebft c\u00e1c t\u1ed5n th\u01b0\u01a1ng l\u00e0 c\u1ea5p t\u00ednh (72,5%), nh\u01b0ng t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf 84,0% b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng m\u00e3n t\u00ednh.<\/p>\n

M\u1ee9c \u0111\u1ed9 ph\u00f9 h\u1ee3p CHT v\u1edbi n\u1ed9i soi kh\u1edbp g\u1ed1i trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT<\/strong><\/p>\n

V\u1ec1 t\u1ef7 l\u1ec7 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam<\/p>\n

Qua k\u1ebft qu\u1ea3 \u1edf B\u1ea3ng 1, ch\u00fang t\u00f4i nh\u1eadn th\u1ea5y s\u1ed1 tr\u01b0\u1eddng h\u1ee3p d\u01b0\u01a1ng gi\u1ea3 chi\u1ebfm g\u1ea7n 14 tr\u01b0\u1eddng h\u1ee3p n\u00ean gi\u00e1 tr\u1ecb CHT trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam kh\u00f4ng cao. T\u1eeb \u0111\u00f3, m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p c\u1ee7a CHT v\u00e0 n\u1ed9i soi kh\u1edbp g\u1ed1i trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam ch\u1ec9 \u1edf m\u1ee9c t\u1ed1i ti\u1ec3u (Kappa 0,35) v\u00e0 con s\u1ed1 n\u00e0y c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea (p=0,001).<\/p>\n

V\u1ec1 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng:<\/strong><\/p>\n

Qua k\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c \u1edf B\u1ea3ng 2, ch\u00fang t\u00f4i nh\u1eadn th\u1ea5y r\u1eb1ng n\u1ebfu cho ch\u1ec9 x\u00e9t ri\u00eang t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u0111\u1ed9 3 tr\u00ean CHT th\u00ec \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u t\u0103ng l\u00ean 80,8%, m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p c\u0169ng t\u0103ng \u0111\u1ebfn m\u1ee9c trung b\u00ecnh v\u1edbi Kappa 0,45 c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. Tuy nhi\u00ean \u0111\u1ed9 nh\u1ea1y c\u00f3 ph\u1ea7n gi\u1ea3m ch\u1ec9 v\u1edbi 72,2%. C\u00f3 19\/22 tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng SCT \u0111\u1ed9 1 v\u00e0 2 tr\u00ean CHT cho k\u1ebft qu\u1ea3 kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng tr\u00ean n\u1ed9i soi, chi\u1ebfm 86,4%. Ch\u1ec9 3\/22 tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u0111\u1ed9 1 v\u00e0 2 tr\u00ean CHT ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c tr\u00ean n\u1ed9i soi (13,6%).<\/p>\n

\"Ch\u1ea9n
590 Published-3<\/figcaption><\/figure>\n

V\u1ec1 v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng:<\/strong><\/p>\n

C\u00f3 52 tr\u01b0\u1eddng h\u1ee3p CHT c\u00f3 n\u1ed9i soi cho k\u1ebft qu\u1ea3 ph\u00f9 h\u1ee3p ho\u00e0n to\u00e0n, chi\u1ebfm 57,1% bao g\u1ed3m: 4 tr\u01b0\u1eddng h\u1ee3p cho k\u1ebft qu\u1ea3 t\u1ed5n th\u01b0\u01a1ng c\u1ea3 2 s\u1ee5n ch\u00eam, 14 tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 t\u1ed5n th\u01b0\u01a1ng SCT, 7 tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 t\u1ed5n th\u01b0\u01a1ng SCN, 27 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam. T\u1eeb \u0111\u00f3 ch\u00fang t\u00f4i t\u00ednh \u0111\u01b0\u1ee3c gi\u00e1 tr\u1ecb c\u1ee7a CHT trong ch\u1ea9n \u0111o\u00e1n v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam (B\u1ea3ng 3). V\u1ec1 v\u00f9ng t\u1ed5n th\u01b0\u01a1ng Trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i, khi \u0111\u1ed1i chi\u1ebfu gi\u1eefa CHT v\u00e0 n\u1ed9i soi trong k\u1ebft qu\u1ea3 ch\u1ea9n \u0111o\u00e1n v\u00f9ng t\u1ed5n th\u01b0\u01a1ng SCT \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT, \u0111\u1ed9 nh\u1ea1y c\u1ee7a CHT khi ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng v\u00f9ng 1\/3 tr\u01b0\u1edbc v\u00e0 t\u1eeb 2 v\u00f9ng tr\u1edf l\u00ean ch\u1ec9 \u0111\u1ea1t 60%, 1\/3 gi\u1eefa v\u00e0 1\/3 sau \u0111\u1ea1t tr\u00ean 70%.<\/p>\n

V\u1ec1 h\u00ecnh th\u00e1i<\/strong><\/p>\n

\u0110\u1ed1i v\u1edbi SCT, c\u00f3 62 tr\u01b0\u1eddng h\u1ee3p CHT c\u00f3 n\u1ed9i soi cho k\u1ebft qu\u1ea3 ph\u00f9 h\u1ee3p ho\u00e0n to\u00e0n, chi\u1ebfm 63,2%. H\u1ec7 s\u1ed1 Kappa cho m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p l\u00e0 0,50 (p-value 0,001). \u0110\u1ed1i v\u1edbi SCN, c\u00f3 70 tr\u01b0\u1eddng h\u1ee3p CHT c\u00f3 n\u1ed9i soi cho k\u1ebft qu\u1ea3 ph\u00f9 h\u1ee3p ho\u00e0n to\u00e0n, chi\u1ebfm 76,92%. H\u1ec7 s\u1ed1 Kappa cho m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p l\u00e0 0,50 (p-value 0,001).<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean CHT so v\u1edbi n\u1ed9i soi kh\u1edbp g\u1ed1i \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT<\/strong><\/p>\n

K\u1ebft qu\u1ea3 ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean CHT b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1. Gi\u1edbi t\u00ednh kh\u00f4ng cho th\u1ea5y m\u1ed1i t\u01b0\u01a1ng quan \u0111\u00e1ng k\u1ec3 v\u1edbi t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam, nh\u01b0 \u0111\u01b0\u1ee3c ch\u1ec9 ra b\u1edfi ki\u1ec3m \u0111\u1ecbnh Chi-square (p = 0,46). Tuy nhi\u00ean, tu\u1ed5i t\u00e1c c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan \u0111\u00e1ng k\u1ec3 v\u1edbi t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam (p = 0,02), c\u0169ng nh\u01b0 b\u00ean ch\u00e2n b\u1ecb th\u01b0\u01a1ng, v\u1edbi h\u1ec7 s\u1ed1 Kappa l\u00e0 0,39 (p = 0,001). Ngo\u00e0i ra, th\u1eddi gian k\u1ec3 t\u1eeb khi b\u1ecb th\u01b0\u01a1ng c\u00f3 li\u00ean quan ch\u1eb7t ch\u1ebd v\u1edbi t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam, nh\u01b0 \u0111\u01b0\u1ee3c ch\u1ec9 ra b\u1edfi ki\u1ec3m \u0111\u1ecbnh Chi-square (p < 0,001).<\/p>\n

B\u00c0N LU\u1eacN<\/strong><\/p>\n

\u0110\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u Nh\u1eefng b\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u ch\u1ee7 y\u1ebfu l\u00e0 nam gi\u1edbi, c\u00f3 th\u1ec3 l\u00e0 do h\u1ecd tham gia nhi\u1ec1u h\u01a1n v\u00e0o c\u00e1c m\u00f4n th\u1ec3 thao c\u00f3 t\u00ednh ti\u1ebfp x\u00fac cao, l\u00e0m t\u0103ng nguy c\u01a1 ch\u1ea5n th\u01b0\u01a1ng so v\u1edbi n\u1eef gi\u1edbi, m\u1ed9t ph\u00e1t hi\u1ec7n ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c v\u1ec1 ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp g\u1ed1i t\u1ea1i Vi\u1ec7t Nam13. Nh\u00f3m tu\u1ed5i d\u01b0\u1edbi 40 c\u00f3 t\u1ef7 l\u1ec7 cao nh\u1ea5t (59,3%) v\u00e0 t\u1ef7 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam cao nh\u1ea5t (73,8%), v\u00ec nh\u00f3m n\u00e0y n\u0103ng \u0111\u1ed9ng h\u01a1n trong th\u1ec3 thao v\u00e0 lao \u0111\u1ed9ng, d\u1eabn \u0111\u1ebfn nguy c\u01a1 ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp g\u1ed1i cao h\u01a1n, bao g\u1ed3m t\u1ed5n th\u01b0\u01a1ng DCCT v\u00e0 s\u1ee5n ch\u00eam, ph\u00f9 h\u1ee3p v\u1edbi c\u1ea3 c\u00e1c nghi\u00ean c\u1ee9u trong n\u01b0\u1edbc v\u00e0 qu\u1ed1c t\u1ebf 14,15. Ch\u00e2n thu\u1eadn b\u1ecb th\u01b0\u01a1ng \u1edf 69,1% tr\u01b0\u1eddng h\u1ee3p, v\u00ec c\u00e1c chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a ch\u00e2n n\u00e0y th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn vi\u1ec7c du\u1ed7i kh\u1edbp g\u1ed1i v\u00e0 g\u1eadp h\u00f4ng nhi\u1ec1u h\u01a1n, khi\u1ebfn ch\u00e2n d\u1ec5 b\u1ecb ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ed9t ng\u1ed9t h\u01a1n16. H\u1ea7u h\u1ebft nh\u1eefng b\u1ec7nh nh\u00e2n tham gia (72,5%) b\u1ecb t\u1ed5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh, trong khi nh\u00f3m t\u1ed5n th\u01b0\u01a1ng m\u00e3n t\u00ednh c\u00f3 t\u1ef7 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam cao h\u01a1n (84,0%). Nh\u1eefng k\u1ebft qu\u1ea3 n\u00e0y t\u01b0\u01a1ng t\u1ef1 nh\u01b0 k\u1ebft qu\u1ea3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o b\u1edfi Millett v\u00e0 c\u1ed9ng s\u1ef1 (2002), ph\u00e1t hi\u1ec7n ra r\u1eb1ng 36% b\u1ec7nh nh\u00e2n t\u1ed5n th\u01b0\u01a1ng DCCT m\u00e3n t\u00ednh b\u1ecb t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam so v\u1edbi 11% \u1edf nh\u00f3m c\u1ea5p t\u00ednh17.<\/p>\n

M\u1ee9c \u0111\u1ed9 ph\u00f9 h\u1ee3p CHT v\u1edbi n\u1ed9i soi kh\u1edbp g\u1ed1i trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT<\/strong><\/p>\n

K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u n\u00e0y cho th\u1ea5y s\u1ef1 ph\u00f9 h\u1ee3p t\u1eeb t\u1ed1i thi\u1ec3u \u0111\u1ebfn trung b\u00ecnh gi\u1eefa CHT v\u00e0 n\u1ed9i soi kh\u1edbp g\u1ed1i trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u1edf b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u1ee9t DCCT. \u0110\u1ed9 ch\u00ednh x\u00e1c chung c\u1ee7a CHT l\u00e0 69,2%, v\u1edbi t\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 cao, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam m\u1ee9c \u0111\u1ed9 th\u1ea5p. Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00e2y, ch\u1eb3ng h\u1ea1n nh\u01b0 nghi\u00ean c\u1ee9u c\u1ee7a Gursoy v\u00e0 c\u1ed9ng s\u1ef118 , trong \u0111\u00f3 b\u00e1o c\u00e1o nh\u1eefng s\u1ef1 kh\u00e1c bi\u1ec7t t\u01b0\u01a1ng t\u1ef1 gi\u1eefa CHT v\u00e0 n\u1ed9i soi kh\u1edbp \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng DCCT. B\u1ea3ng so s\u00e1nh \u0111\u1ed9 nh\u1ea1y, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u v\u00e0 nh\u1eefng ph\u00e1t hi\u1ec7n ch\u00ednh c\u1ee7a CHT trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng SCT c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c nhau, cung c\u1ea5p b\u1ed1i c\u1ea3nh r\u1ed9ng h\u01a1n cho k\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u (B\u1ea3ng 4).<\/p>\n

M\u1ed9t trong nh\u1eefng th\u00e1ch th\u1ee9c ch\u00ednh khi s\u1eed d\u1ee5ng CHT \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam khi c\u00f3 \u0111\u1ee9t DCCT l\u00e0 s\u1ef1 can thi\u1ec7p do s\u01b0ng m\u00f4 m\u1ec1m, tr\u00e0n d\u1ecbch v\u00e0 nh\u1eefng thay \u0111\u1ed5i li\u00ean quan \u0111\u1ebfn ch\u1ea5n th\u01b0\u01a1ng trong t\u00edn hi\u1ec7u s\u1ee5n ch\u00eam. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch t\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 cao \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf v\u00f9ng \u0111\u1ecf-\u0111\u1ecf c\u1ee7a s\u1ee5n ch\u00eam, n\u01a1i t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u00e3 l\u00e0nh tr\u01b0\u1edbc khi n\u1ed9i soi kh\u1edbp nh\u01b0ng v\u1eabn xu\u1ea5t hi\u1ec7n tr\u00ean CHT. Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y ph\u00f9 h\u1ee3p v\u1edbi c\u00f4ng tr\u00ecnh c\u1ee7a Van Dyck v\u00e0 c\u1ed9ng s\u1ef119 ng\u01b0\u1eddi \u0111\u00e3 b\u00e1o c\u00e1o r\u1eb1ng \u0111\u1ed9 nh\u1ea1y c\u1ee7a CHT \u0111\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam nh\u1eb9 ch\u1ec9 l\u00e0 60%.<\/p>\n

V\u1ec1 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng, nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng th\u1ea5p \u1edf c\u1ea3 SCT v\u00e0 SCN kh\u00e1c bi\u1ec7t so v\u1edbi nghi\u00ean c\u1ee9u c\u1ee7a t\u00e1c gi\u1ea3 Gursoy v\u00e0 c\u1ed9ng s\u1ef1 (2019) do t\u00e1c gi\u1ea3 c\u0169ng ph\u00e2n \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean CHT th\u00e0nh 3 \u0111\u1ed9 nh\u01b0 ch\u00fang t\u00f4i tuy nhi\u00ean l\u1ea1i xem r\u00e1ch \u0111\u1ed9 1,2 tr\u00ean CHT l\u00e0 s\u1ee5n ch\u00eam b\u00ecnh th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng cao18. \u0110i\u1ec1u th\u00fa v\u1ecb l\u00e0 khi ch\u1ec9 xem x\u00e9t c\u00e1c t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u0111\u1ed9 3, gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a CHT \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, v\u1edbi \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u \u0111\u1ea1t 80,8%. \u0110i\u1ec1u n\u00e0y cho th\u1ea5y CHT c\u00f3 th\u1ec3 \u0111\u00e1ng tin c\u1eady h\u01a1n trong vi\u1ec7c ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng nghi\u00eam tr\u1ecdng h\u01a1n, c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng c\u1ea7n can thi\u1ec7p ph\u1eabu thu\u1eadt.<\/p>\n

\"Chuy\u00ean
590 Published-5<\/figcaption><\/figure>\n

Tuy\u00a0 nhi\u00ean, \u0111\u1ed9 nh\u1ea1y th\u1ea5p h\u01a1n trong vi\u1ec7c ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u00edt nghi\u00eam tr\u1ecdng h\u01a1n cho th\u1ea5y CHT kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0m c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n duy nh\u1ea5t, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd l\u00e2m s\u00e0ng v\u1ec1 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam l\u00e0 cao.<\/p>\n

Trong ch\u1ea9n \u0111o\u00e1n v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng, t\u1ec9 l\u1ec7 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 tr\u00ean CHT cao. \u0110i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c cho l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu xung quanh s\u1ee5n ch\u00eam nh\u01b0 sau: v\u1ecb tr\u00ed d\u00e2y ch\u1eb1ng li\u00ean s\u1ee5n ch\u00eam \u1ea5n v\u00e0o s\u1eebng tr\u01b0\u1edbc SCN, d\u00e2y ch\u1eb1ng khoeo \u0111i qua g\u00f3c sau ngo\u00e0i SCN, nhi\u1ec5u do 1 ph\u1ea7n s\u1ee5n ch\u00eam l\u1ec7ch h\u01b0\u1edbng v\u1edbi t\u1eeb tr\u01b0\u1eddng (th\u01b0\u1eddng \u1edf s\u1eebng sau SCN), t\u1ea5t c\u1ea3 y\u1ebfu t\u1ed1 tr\u00ean \u0111\u1ec1u g\u00e2y d\u01b0\u01a1ng t\u00ednh gi\u1ea3 tr\u00ean CHT. Trong khi \u0111\u00f3 t\u1ef7 l\u1ec7 \u00e2m t\u00ednh gi\u1ea3 tr\u00ean CHT cao khi ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng SCN. Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 l\u00e0 do b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng DCCT \u0111\u01a1n \u0111\u1ed9c s\u1ebd b\u1ecb t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam ti\u1ebfp theo trong kho\u1ea3ng th\u1eddi gian gi\u1eefa t\u1eeb khi ch\u1ee5p phim CHT \u0111\u1ebfn khi n\u1ed9i soi kh\u1edbp g\u1ed1i. Ngo\u00e0i ra, Van Dyck v\u00e0 c\u00e1c \u0111\u1ed3ng nghi\u1ec7p (2007) c\u0169ng cho c\u00e1c k\u1ebft qu\u1ea3 t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi \u0111\u1ed9 nh\u1ea1y ch\u1ec9 60% cho r\u1eb1ng nh\u1eefng t\u1ed5n th\u01b0\u01a1ng b\u1ecb b\u1ecf s\u00f3t \u1edf s\u1ee5n ch\u00eam th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn nh\u1eefng d\u1ea5u hi\u1ec7u t\u1ed5n th\u01b0\u01a1ng tinh t\u1ebf, \u1ea9n gi\u1ea5u c\u1ee7a s\u1ee5n ch\u00eam tr\u00ean CHT v\u00e0 qua \u0111\u00f3 ph\u1ea3n \u00e1nh v\u1ec1 tr\u00ecnh \u0111\u1ed9 \u0111\u1ecdc CHT t\u1eeb nh\u1eefng b\u00e1c s\u0129 kh\u00e1c nhau19. So s\u00e1nh v\u1edbi nghi\u00ean c\u1ee9u c\u1ee7a t\u00e1c gi\u1ea3 S. H. Kim (2021) c\u0169ng ghi nh\u1eadn t\u00ecnh tr\u1ea1ng \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ea5p l\u1ea7n l\u01b0\u1ee3t l\u00e0 67% v\u00e0 65% khi ch\u1ea9n \u0111o\u00e1n v\u1ecb tr\u00ed s\u1ee5n ch\u00eam t\u1ed5n th\u01b0\u01a1ng20. T\u1ed5n th\u01b0\u01a1ng DCCT \u0111\u01a1n \u0111\u1ed9c s\u1ebd b\u1ecb t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam ti\u1ebfp theo trong kho\u1ea3ng th\u1eddi gian gi\u1eefa t\u1eeb khi ch\u1ee5p phim CHT \u0111\u1ebfn khi n\u1ed9i soi kh\u1edbp g\u1ed1i. \u0110\u1ed9 d\u1ed1c c\u1ee7a s\u1ee5n ch\u00eam tr\u00ean l\u1ed3i c\u1ee7 ch\u00e0y v\u00e0 gi\u1ea3i ph\u1eabu ph\u1ee9c t\u1ea1p li\u00ean quan \u0111\u1ebfn g\u1ed1c c\u1ee7a d\u00e2y ch\u1eb1ng s\u1ee5n ch\u00eam-\u0111\u00f9i. T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng b\u1ecf s\u00f3t th\u01b0\u1eddng n\u1eb1m tr\u00ean \u0111\u01b0\u1eddng n\u1ed1i gi\u1eefa s\u1eebng sau SCT v\u1edbi \u0111i\u1ec3m b\u00e1m d\u00e2y ch\u1eb1ng nh\u1eefng tr\u01b0\u1eddng h\u1ee3p r\u00e1ch \u1edf v\u00f9ng r\u00eca c\u1ee7a s\u1eebng sau, s\u00e1t bao kh\u1edbp d\u1ec5 b\u1ecb nh\u1ea7m l\u00e0 v\u00f9ng SCN kh\u00f4ng li\u00ean k\u1ebft v\u1edbi bao kh\u1edbp n\u00ean \u0111\u1ec3 s\u00f3t.<\/p>\n

V\u1ec1 v\u00f9ng t\u1ed5n th\u01b0\u01a1ng, khi so s\u00e1nh v\u1edbi nghi\u00ean c\u1ee9u c\u1ee7a S.H. Kim (2021) cho th\u1ea5y s\u1ef1 t\u01b0\u01a1ng \u0111\u1ed3ng v\u1ec1 \u0111\u1ed9 nh\u1ea1y c\u1ee7a CHT khi ch\u1ea9n \u0111o\u00e1n v\u00f9ng t\u1ed5n th\u01b0\u01a1ng SCT <70%20. \u0110\u1eb7c bi\u1ec7t, 1\/3 tr\u01b0\u1edbc s\u1ee5n ch\u00eam l\u00e0 v\u00f9ng \u00edt t\u1ed5n th\u01b0\u01a1ng h\u01a1n n\u00ean c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch v\u00ec sao v\u00f9ng n\u00e0y d\u1ec5 b\u1ecb b\u1ecf s\u00f3t21. Tuy nhi\u00ean nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i c\u00f3 ph\u1ea7n kh\u00e1c bi\u1ec7t so v\u1edbi nghi\u00ean c\u1ee9u kh\u00e1c khi h\u1ec7 s\u1ed1 Kappa c\u1ee7a 2 v\u00f9ng tr\u01b0\u1edbc v\u00e0 gi\u1eefa SCT ch\u1ec9 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee9c t\u1eeb t\u1ed1i thi\u1ec3u \u0111\u1ebfn th\u1ea5p (0,299-0,433) c\u00f2n c\u1ee7a Chhabra (2019) l\u00e0 t\u1eeb th\u1ea5p \u0111\u1ebfn trung b\u00ecnh (0,56-0,72)22. \u0110\u1ed3ng th\u1eddi h\u1ec7 s\u1ed1 Kappa c\u0169ng g\u1ea7n t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi v\u1edbi nghi\u00ean c\u1ee9u Chhabra (2019) khi ch\u1ea9n \u0111o\u00e1n t\u1ea1i 1\/3 tr\u01b0\u1edbc v\u00e0 gi\u1eefa SCN (0,58 v\u00e0 0,43) v\u1edbi m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng h\u1ee3p th\u1ea5p22. Tuy nhi\u00ean nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i c\u00f3 ph\u1ea7n kh\u00e1c bi\u1ec7t khi so v\u1edbi 1\/3 sau SCN ch\u1ec9 \u0111\u1ea1t m\u1ee9c t\u01b0\u01a1ng h\u1ee3p th\u1ea5p. S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y c\u00f3 th\u1ec3 do m\u00e1y m\u00f3c, k\u1ef9 n\u0103ng ng\u01b0\u1eddi \u0111\u1ecdc, k\u1ef9 n\u0103ng ng\u01b0\u1eddi ch\u1ee5p kh\u00f4ng gi\u1ed1ng nhau gi\u1eefa 2 nghi\u00ean c\u1ee9u, do quy chu\u1ea9n v\u1ec1 x\u00e9t 1=3 tr\u01b0\u1edbc gi\u1eefa sau v\u1eabn c\u00f2n qu\u00e1 chi ti\u1ebft , kh\u00f3 \u00e1p d\u1ee5ng tr\u00ean CHT, c\u00e1c TH t\u1ed5n th\u01b0\u01a1ng v\u00f9ng tr\u1edf l\u00ean hay l\u00e0 1 v\u00f9ng d\u1eabn \u0111\u1ebfn ng\u01b0\u1eddi \u0111\u1ecdc CHT \u0111\u1ecdc kh\u00e1c so v\u1edbi b\u00e1c s\u0129 l\u00e2m s\u00e0ng, \u0111i\u1ec3m b\u00e1m c\u1ee7a d\u00e2y ch\u1eb1ng gian s\u1ee5n ch\u00eam \u0111\u1ebfn s\u1eebng tr\u01b0\u1edbc, g\u00e2n c\u01a1 khoeo ch\u1ea1y qua g\u1ea7n g\u00f3c sau ngo\u00e0i c\u1ee7a SCN v\u00e0 nguy\u00ean \u1ee7y c\u1ee7a d\u00e2y ch\u1eb1ng s\u1ee5n ch\u00eam \u0111\u00f9i t\u1eeb s\u1eebng sau SCN20,22. V\u1ec1 h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng, khi so s\u00e1nh v\u1edbi nghi\u00ean c\u1ee9u c\u1ee7a S.H. Kim (2021). C\u00e1c k\u1ebft qu\u1ea3 ch\u1ea9n \u0111o\u00e1n t\u1ed5ng th\u1ec3 c\u1ee7a CHT trong nghi\u00ean c\u1ee9u n\u00e0y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00f3, cho th\u1ea5y n\u00f3 c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn cho t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam kh\u1edbp g\u1ed1i. Tuy nhi\u00ean, gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a CHT trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng n\u1ed9i \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y th\u1ea5p h\u01a1n so v\u1edbi gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n t\u1ed5ng th\u1ec3. Trong nghi\u00ean c\u1ee9u c\u1ee7a Anderson v\u00e0 c\u1ed9ng s\u1ef1, s\u1ef1 \u0111\u1ed3ng nh\u1ea5t gi\u1eefa c\u00e1c nh\u00e0 quan s\u00e1t v\u1ec1 c\u00e1c gi\u00e1 tr\u1ecb CHT trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam kh\u1edbp g\u1ed1i dao \u0111\u1ed9ng t\u1eeb trung b\u00ecnh \u0111\u1ebfn \u0111\u00e1ng k\u1ec3, v\u1edbi c\u00e1c gi\u00e1 tr\u1ecb kappa t\u1eeb 0,46 \u0111\u1ebfn 0,72. Dunn v\u00e0 \u0111\u1ed3ng nghi\u1ec7p c\u0169ng b\u00e1o c\u00e1o s\u1ef1 \u0111\u1ed3ng nh\u1ea5t t\u1eeb trung b\u00ecnh \u0111\u1ebfn \u0111\u00e1ng k\u1ec3 gi\u1eefa k\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt v\u00e0 CHT trong ph\u00e2n lo\u1ea1i lo\u1ea1i v\u00e0 v\u1ecb tr\u00ed c\u1ee7a t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam (kappa: 0,61 \u2013 0,63)23. Trong m\u1ed9t nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e1nh gi\u00e1 m\u1ed1i t\u01b0\u01a1ng quan gi\u1eefa t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam g\u1ed1i qua ph\u1eabu thu\u1eadt th\u1ea9m m\u1ef9 v\u00e0 k\u1ebft qu\u1ea3 CHT s\u1eed d\u1ee5ng ph\u00e2n lo\u1ea1i c\u1ee7a ISAKOS, c\u00e1c gi\u00e1 tr\u1ecb kappa ch\u1ec9 ra s\u1ef1 \u0111\u1ed3ng nh\u1ea5t trung b\u00ecnh24. K\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u n\u00e0y t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00f3 v\u1ec1 s\u1ef1 \u0111\u1ed3ng nh\u1ea5t v\u00e0 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n, bao g\u1ed3m \u0111\u1ed9 nh\u1ea1y, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u v\u00e0 \u0111\u1ed9 ch\u00ednh x\u00e1c. Do \u0111\u00f3, CHT c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0m c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam, nh\u01b0ng kh\u00f4ng th\u00edch h\u1ee3p \u0111\u1ec3 ph\u00e2n lo\u1ea1i chi ti\u1ebft lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam kh\u1edbp g\u1ed1i s\u1eed d\u1ee5ng ti\u00eau chu\u1ea9n ISAKOS hi\u1ec7n t\u1ea1i20. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng tr\u1ea3i qua qu\u00e1 tr\u00ecnh t\u00e1i t\u1ea1o DCCT, \u0111\u1ed9 ch\u00ednh x\u00e1c ch\u1ea9n \u0111o\u00e1n c\u1ee7a CHT \u0111\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam c\u00f3 th\u1ec3 th\u1eadm ch\u00ed c\u00f2n th\u1ea5p h\u01a1n. C\u00e1c nghi\u00ean c\u1ee9u c\u1ee7a Gursoy v\u00e0 c\u1ed9ng s\u1ef1 (2019)18 v\u00e0 Kim v\u00e0 c\u1ed9ng s\u1ef1 (2021)20 \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng CHT k\u00e9m tin c\u1eady h\u01a1n trong ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam khi t\u1ed5n th\u01b0\u01a1ng DCCT kh\u00f4ng \u0111\u01b0\u1ee3c x\u1eed l\u00fd, v\u00ec t\u00ecnh tr\u1ea1ng r\u00e1ch s\u1ee5n ch\u00eam c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n theo th\u1eddi gian. S\u1ef1 ti\u1ebfn tri\u1ec3n n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean CHT v\u00e0 \u0111\u00e1nh gi\u00e1 n\u1ed9i soi kh\u1edbp, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p m\u00e3n t\u00ednh khi tho\u00e1i h\u00f3a s\u1ee5n ch\u00eam c\u00f3 th\u1ec3 x\u1ea3y ra trong kho\u1ea3ng th\u1eddi gian gi\u1eefa th\u1eddi \u0111i\u1ec3m ch\u1ee5p CHT v\u00e0 ph\u1eabu thu\u1eadt.<\/p>\n

Nh\u1eefng h\u1ea1n ch\u1ebf c\u1ee7a nghi\u00ean c\u1ee9u n\u00e0y bao g\u1ed3m thi\u1ebft k\u1ebf m\u1ed9t trung t\u00e2m v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb CHT c\u1ee5 th\u1ec3, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a ch\u1ea9n \u0111o\u00e1n. Ngo\u00e0i ra, quy m\u00f4 m\u1eabu t\u01b0\u01a1ng \u0111\u1ed1i nh\u1ecf v\u00e0 vi\u1ec7c lo\u1ea1i tr\u1eeb nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam \u0111\u01a1n \u0111\u1ed9c c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf kh\u1ea3 n\u0103ng kh\u00e1i qu\u00e1t h\u00f3a c\u1ee7a c\u00e1c ph\u00e1t hi\u1ec7n. C\u00e1c nghi\u00ean c\u1ee9u trong t\u01b0\u01a1ng lai n\u00ean h\u01b0\u1edbng \u0111\u1ebfn vi\u1ec7c bao g\u1ed3m qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n r\u1ed9ng h\u01a1n v\u00e0 \u0111i\u1ec1u tra gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a CHT \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb \u0111\u1ee9t DCCT.<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean CHT so v\u1edbi n\u1ed9i soi kh\u1edbp g\u1ed1i \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT<\/strong><\/p>\n

Gi\u1edbi t\u00ednh kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam, ph\u00f9 h\u1ee3p v\u1edbi ph\u00e1t hi\u1ec7n c\u1ee7a Neil Ghodadra v\u00e0 c\u1ed9ng s\u1ef1 (2012)15 S\u1ef1 th\u1ed1ng nh\u1ea5t gi\u1eefa CHT v\u00e0 n\u1ed9i soi kh\u1edbp g\u1ed1i trong vi\u1ec7c ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam thay \u0111\u1ed5i theo \u0111\u1ed9 tu\u1ed5i, ph\u00f9 h\u1ee3p v\u1edbi nghi\u00ean c\u1ee9u c\u1ee7a Tae-Seok Nam v\u00e0 c\u1ed9ng s\u1ef1 (2014) v\u00e0 Seong Hwan Kim v\u00e0 c\u1ed9ng s\u1ef1 (2021)9,20. T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf ch\u00e2n thu\u1eadn, d\u1ec5 b\u1ecb ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ed9t ng\u1ed9t v\u00e0 d\u1ea7n d\u1ea7n do du\u1ed7i kh\u1edbp g\u1ed1i nhi\u1ec1u h\u01a1n, g\u1eadp h\u00f4ng v\u00e0 ch\u1ecbu t\u1ea3i h\u00e0ng ng\u00e0y. Th\u1eddi gian k\u1ec3 t\u1eeb khi ch\u1ea5n th\u01b0\u01a1ng c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan \u0111\u00e1ng k\u1ec3 v\u1edbi t\u1ef7 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam (p < 0,001), v\u1edbi s\u1ef1 th\u1ed1ng nh\u1ea5t cao h\u01a1n gi\u1eefa CHT v\u00e0 n\u1ed9i soi kh\u1edbp g\u1ed1i \u1edf nh\u00f3m t\u1ed5n th\u01b0\u01a1ng m\u00e3n t\u00ednh (> 8 tu\u1ea7n, Kappa = 0,50) so v\u1edbi nh\u00f3m c\u1ea5p t\u00ednh (\u22648 tu\u1ea7n, Kappa = 0,28).<\/p>\n

CONCLUDE<\/strong><\/p>\n

C\u00f3 s\u1ef1 t\u01b0\u01a1ng h\u1ee3p m\u1ee9c \u0111\u1ed9 t\u1eeb t\u1ed1i thi\u1ec3u \u0111\u1ebfn trung b\u00ecnh gi\u1eefa CHT v\u1edbi n\u1ed9i soi trong ph\u00e1t hi\u1ec7n, ch\u1ea9n \u0111o\u00e1n v\u1ecb tr\u00ed, v\u00f9ng v\u00e0 h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT, t\u1eeb \u0111\u00f3 c\u1ea7n c\u00e2n nh\u1eafc k\u0129 tr\u01b0\u1edbc khi k\u1ebft lu\u1eadn t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam tr\u00ean CHT \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ee9t DCCT.<\/p>\n

XUNG \u0110\u1ed8T L\u1ee2I \u00cdCH<\/strong><\/p>\n

C\u00e1c t\u00e1c gi\u1ea3 tham gia cam k\u1ebft kh\u00f4ng c\u00f3 xung \u0111\u1ed9t l\u1ee3i \u00edch x\u1ea3y ra.<\/p>\n

T\u00c0I TR\u1ee2<\/strong><\/p>\n

Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c t\u00e0i tr\u1ee3 b\u1edfi \u0110\u1ea1i h\u1ecdc Qu\u1ed1c gia Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh (\u0110HQG-HCM) trong khu\u00f4n kh\u1ed5 \u0110\u1ec1 t\u00e0i m\u00e3 s\u1ed1 C2024-44-05.<\/p>\n

PH\u00ca DUY\u1ec6T V\u1ec0 \u0110\u1ea0O \u0110\u1ee8C<\/strong><\/p>\n

T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u \u0111\u1ec1u t\u1ef1 nguy\u1ec7n v\u00e0 \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o r\u00f5 r\u00e0ng v\u1ec1 m\u1ee5c \u0111\u00edch v\u00e0 \u00fd ngh\u0129a c\u1ee7a nghi\u00ean c\u1ee9u. M\u1ecdi th\u00f4ng tin \u0111\u1ec1u \u0111\u01b0\u1ee3c gi\u1eef b\u00ed m\u1eadt v\u00e0 ch\u1ec9 s\u1eed d\u1ee5ng cho m\u1ee5c \u0111\u00edch nghi\u00ean c\u1ee9u khoa h\u1ecdc. Nghi\u00ean c\u1ee9u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c H\u1ed9i \u0111\u1ed3ng \u0110\u1ea1o \u0111\u1ee9c Nghi\u00ean c\u1ee9u Y sinh h\u1ecdc c\u1ee7a Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Khoa h\u1ecdc S\u1ee9c kh\u1ecfe (S\u1ed1 tham chi\u1ebfu 06\/Q\u0110-IRB-VN01.017) v\u00e0 H\u1ed9i \u0111\u1ed3ng \u0110\u1ea1o \u0111\u1ee9c Nghi\u00ean c\u1ee9u Y sinh h\u1ecdc c\u1ee7a B\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t (S\u1ed1 tham chi\u1ebfu 17\/2023\/BVTN-H\u0110Y\u0110) ch\u1ea5p thu\u1eadn.<\/p>\n

S\u1ef0 \u0110\u00d3NG G\u00d3P C\u1ee6A T\u00c1C GI\u1ea2<\/strong><\/p>\n

T\u00e1c gi\u1ea3 V\u00f5 Th\u00e0nh To\u00e0n: \u0111\u1ec1 xu\u1ea5t \u00fd t\u01b0\u1edfng v\u00e0 ch\u1ee7 tr\u00ec nghi\u00ean c\u1ee9u, vi\u1ebft b\u1ea3n th\u1ea3o g\u1ed1c; T\u00e1c gi\u1ea3 Nguy\u1ec5n Thi\u00ean \u0110\u1ee9c: \u0111\u1ec1 xu\u1ea5t \u00fd t\u01b0\u1edfng v\u00e0 ch\u1ee7 tr\u00ec nghi\u00ean c\u1ee9u, vi\u1ebft b\u1ea3n th\u1ea3o g\u1ed1c, \u0111i\u1ec1u tra, gi\u00e1m s\u00e1t; T\u00e1c gi\u1ea3 L\u00ea \u0110\u00ecnh Nguy\u00ean Anh: Vi\u1ebft, Xem x\u00e9t v\u00e0 Bi\u00ean t\u1eadp; T\u00e1c gi\u1ea3 Nguy\u1ec5n V\u0103n K\u1ef3 Hi\u00ean: Vi\u1ebft, Xem x\u00e9t v\u00e0 Bi\u00ean t\u1eadp; T\u00e1c gi\u1ea3 V\u01b0u Kh\u00e1nh Hi\u1ec7p: Vi\u1ebft, Xem x\u00e9t v\u00e0 Bi\u00ean t\u1eadp; T\u00e1c gi\u1ea3 L\u00ea Anh T\u00fa: Vi\u1ebft, Xem x\u00e9t v\u00e0 Bi\u00ean t\u1eadp; T\u00e1c gi\u1ea3 Phan L\u00ea Nguy\u00ean B\u00e1: Vi\u1ebft, Xem x\u00e9t v\u00e0 Bi\u00ean t\u1eadp T\u00e1c gi\u1ea3 Nguy\u1ec5n Minh D\u01b0\u01a1ng, Ng\u00f4 Ho\u00e0ng Vi\u1ec5n: h\u1ed7 tr\u1ee3 l\u1ea5y s\u1ed1 li\u1ec7u. T\u1ea5t c\u1ea3 c\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 \u0111\u1ecdc v\u00e0 \u0111\u1ed3ng \u00fd v\u1edbi phi\u00ean b\u1ea3n \u0111\u00e3 xu\u1ea5t b\u1ea3n c\u1ee7a b\u1ea3n th\u1ea3o.<\/p>\n

L\u1edcI C\u1ea2M \u01a0N<\/strong><\/p>\n

Ch\u00fang t\u00f4i xin c\u1ea3m \u01a1n c\u1ea3m \u01a1n c\u00e1c th\u1ea7y c\u00f4 v\u00e0 c\u00e1c b\u00e1c s\u0129 t\u1ea1i Khoa Ngo\u1ea1i Ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh \u2013 b\u1ec7nh vi\u1ec7nTh\u1ed1ng Nh\u1ea5t \u0111\u00e3 ph\u00ea duy\u1ec7t nghi\u00ean c\u1ee9u v\u00e0 cho ph\u00e9p ch\u00fang t\u00f4i truy xu\u1ea5t s\u1ed1 li\u1ec7u. Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c t\u00e0i tr\u1ee3 b\u1edfi \u0110\u1ea1i h\u1ecdc Qu\u1ed1c gia Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh (\u0110HQG-HCM) trong khu\u00f4n kh\u1ed5 \u0110\u1ec1 t\u00e0i m\u00e3 s\u1ed1 C2024-44-05. Ch\u00fang t\u00f4i xin c\u1ea3m \u01a1n Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Khoa h\u1ecdc S\u1ee9c kh\u1ecfe, \u0110\u1ea1i h\u1ecdc Qu\u1ed1c gia Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh \u0111\u00e3 h\u1ed7 tr\u1ee3 th\u1eddi gian v\u00e0 t\u00e0i tr\u1ee3 cho nghi\u00ean c\u1ee9u n\u00e0y.<\/p>\n

REFERENCES<\/strong><\/p>\n

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    2. Denti M. Synthesis. In: Hulet C, Pereira H, Peretti G, Denti M, eds. Surgery of the Meniscus. Springer Berlin Heidelberg; 2016:173-173<\/li>\n<\/ol>","protected":false},"excerpt":{"rendered":"

      V\u00f5 Th\u00e0nh To\u00e0n, Nguy\u1ec5n Thi\u00ean \u0110\u1ee9c, L\u00ea \u0110\u00ecnh Nguy\u00ean Anh, Nguy\u1ec5n V\u0103n K\u1ef3 Hi\u00ean, V\u01b0u Kh\u00e1nh Hi\u1ec7p, L\u00ea Anh T\u00fa, Phan L\u00ea Nguy\u00ean B\u00e1, Nguy\u1ec5n Minh D\u01b0\u01a1ng, Ng\u00f4 Ho\u00e0ng Vi\u1ec5n T\u00d3M T\u1eaeT Gi\u1edbi thi\u1ec7u: T\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam th\u01b0\u1eddng x\u1ea3y ra c\u00f9ng v\u1edbi t\u1ed5n th\u01b0\u01a1ng DCCT (t\u1ec9 l\u1ec7 55 \u2013 80%), vi\u1ec7c kh\u00f4ng ph\u00e1t hi\u1ec7n […]<\/p>\n","protected":false},"author":5,"featured_media":4460,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nxb":"","tac-gia":"","the-loai":"","nam-xuat-ban":"","ngon-ngu":"","isbn":"","gia":"","muc-luc":"","footnotes":""},"categories":[1,144],"tags":[],"class_list":["post-4456","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bai-chia-se","category-ket-qua-dieu-tri"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/posts\/4456","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/comments?post=4456"}],"version-history":[{"count":4,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/posts\/4456\/revisions"}],"predecessor-version":[{"id":4462,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/posts\/4456\/revisions\/4462"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/4460"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=4456"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/categories?post=4456"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=4456"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}