X quang

d dy-t trng

Th.S Bi Hong T
H Y Hi Phng

i cng
Bnh

l d dy t trng l bnh th
ng gp
C th gy nhng bin chng
nghim trng
Trc kia chn on da vo X
quang
Hin ti s dng ni soi l ch
yu

i cng
Chp

dng:

d dy t trng vn c p

Khng ni soi c
Vng m ni soi
Tuyn huyn, khng c ni soi
nh gi mt cch tng th d dy v
t trng

Nc

ngoi: chp i quang kp

nhy tng ng vi ni soi

i cng
Cc

k thut thm khm

Chp i quang n
Chp i quang kp
Chp ct lp vi tnh (CT)
Siu m v siu m ni soi
Ni soi ng mm

Chy mu d
dy

Dng thuc gim au chng vim non

steroid

i cng

quang n (k thut)

Chun b bnh nhn : nhn n trc 8h, khng

ung thuc c Bismuth trc 3 ngy, khng chp
c ung hoc tht thuc baryte trc 1 tun
Cho bnh nhn ung thuc cn quang :
Baryte, tan trong nc.
nh gi thuc lu thng trong thc qun, d dy
Chp phim cc t th : ng thng, nm sp
(Serie), nm nga, nm nga u dc
(Trendelenburg)
Nu cn : chp phim p

i cng
nh

gi mt b phim d dy
Cc t th trn cc phim chp
ng : xem ton th, phn ng
Nm sp chch trc phi : nh gi
hang v, b cong nh, mn v
Nm nga: xem phnh v, tm v

i cng
Cc

t th trn cc phim chp

ng : c mc ngang baryte
Nm sp chch trc phi : khng cn
mc ngang baryte nhng phnh v
vn cn hi
Nm nga: phnh v y thuc,
phn ngang v hang v c hnh nh
i quang kp t nhin

Phnh v

Thn v
BCN

HTT
Hang v

BCL

TT
Mn v

Gc Treitz

i cng
Mt

dy

D
D
D
D

s thay i ca hnh thi d

dy
dy
dy
dy

tng thc tnh ngi bo

thng di ngi gy
ngi bnh thng
hnh thc nc

lot d dy v t trng
L

mt bnh thng gp
Do nhiu nguyn nhn gy nn
Lot d dy t gp hn so vi hnh
t trng
C th xy ra cc bin chng
nghim trng

Thng lot
Chy mu
Ung th ho
Hp mn v

lot d dy
nh

ngha v lot

L ng thuc
Tn ti thng xuyn trn cc phim
Kch

thc c th thay i
C th gp bt k v tr no
C th mt hoc nhiu (HC
Zollinger-Ellison)

lot d dy
Quan

nim hin nay v lot

Lot (+)

L lot lnh tnh

Thng li ln khi b cong
Hnh trn khi nhn thng
C vin ph n
Cc np nim mc qui t st chn
lot

lot d dy
Lot

(-)

L lot c tnh cht c tnh

Khng li ln khi b cong hoc
tt xung
Hnh mo m khi nhn thng
C vin ph n lan rng
Cc np nim mc dng li xa chn
lot

lot d dy
Hnh

nh trc tip

L ng thuc
Tu theo mc o su vo
thnh d dy s c cc hnh nh
khc nhau
Thnh d dy c 4 lp : nim mc, d
i nim mc, c, thanh mc

lot d dy
Hnh

nh trc tip ca lot BCN

Lot nng (lot cht) : Hnh gai
hng
Lot trong thnh : Hnh vung,
hnh nn, hnh bn cu
Lot sp thng : hnh lot c
cung (di ching, hnh nm
Cc lot thng bt : lot
Haudeck, hnh mi nhn, ngn tay
i gng

lot d dy
Cc

hnh nh gin tip

Co ko BCN lm d dy c hnh con sn

Ngn lm hnh ch V, ngn tay ch
im
Qui t nim mc
Cng mt on trn v di lot
Hang v tng trng lc, gim trng lc

lot d dy

Lot

d dy cc v tr t gp

Lot tin mn v : ko lch mn v

Lot ng mn v: nh, ko gp gc mn
v
Lot st tm v
Lot BCL : lot thng ln v nm
trong vng cung, np nim mc xp
theo hnh v hnh
Lot sn phnh v
Lot mt d dy : hnh du chm l
lng

Lot ng mn

lot t trng

Lot

hnh t trng hay gp

Thng lot mt
Khng gp trng hp no ung th ho
Lot t trng c th ung th ho
Hay gy bin chng

lot t trng

Lot

mi hnh t trng

Bnh thng HTT c hnh c hnh hoc

hnh tam gic
HTT khng bin dng
Khi thuc vi s thy lot
C qung ph n
Hnh nan hoa bnh xe

lot t trng

Lot

mn tnh hnh t trng

HTT bin dng : hnh hai cnh, ba
cnh, l c, ui n...
C khi ch cn ng thuc
Hnh ti Cole
Lot t trng : c hnh ht ngc xu
ch

lot t trng

Bin

chng : hp mn v

D dy hnh y chu
Gin to, tng nhu ng tng t khi
chiu
Baryte ri xung lp dch ng : hnh
tuyt ri
Cn thc n trong d dy
Baryte tn ti lu trong d dy (sau 6h)

Ung th d dy
L

mt ung th ph bin
ng th 2 sau K phi
nam gii, sau K CTC n
Chn on sm ci thin
c thi gian sng thm
Chn on giai on
mun thng d
Chn on da trn ni
soi v sinh thit l ch
yu
nh gi tng k trc
phu thut : dng siu
m ni soi, CT

Ung th d dy

Mi

pht

L nhng ung th mi pht trin lp

nim mc v di nim mc
Thng bnh nhn t i khm giai
on ny
Chn on giai on ny thng kh
khn
Nu khng nh gi cn thn d b st

Ung th d dy

Th

nhim cng
Hnh cng : khng thay i khi nhu
ng d dy i qua nh ming vn
trn sng
on cng c th thng, cong, ln
xung khi b cong hnh bc thang
Nu gc b cong nh : m rng
gc BCN
Hnh un sng kiu mi tn
Mn v : hnh nn, du hiu gin
tip : HTT qu p

Ung th d dy

Th

lot
L nhng lot (-), c tnh cht ung th
ngay t ban u. C th kt hp vi
nhim cng
Lot hnh a, hnh cao nguyn : lot
rng, li t so vi b cong, y c th
phng, nham nh, c chn c khot
Lot hnh thu knh : lot rng, vt
ngang qua b cong, t hoc khng li
ln so vi b cong, y c qung sng
ph n v c cc r ct ngang. Hay
gp phn ngang

Ung th d dy

Lot

kt hp vi nhim cng

Lot trong mt vng cung cng

Lot trn mt nn cng bng phng
Lot pha trn, di l mt on cng tt
xung
Th

si :

L nhng khi si nh, to nn hnh bt

x phng
Thng b st trn phim chp i quang
n

Polyp d dy

Polyp d dy

Ung th d dy
Ung

th ton pht

Chn on giai on ny n gin

C ba th nh mi pht
Bnh nhn thng n giai on ny
Ung th pht trin qua lp nim mc v
di nim mc
Khi ung th pht trin : thng kt hp
c ba th

Ung th d dy

Th

nhim cng
Hang v v tin mn v
Hnh phu : hang v cng ko di, c
th nham nh
Hnh m ch
Thn

v v phnh v : cht hp
thn v, c th lan ln trn phnh
v v thc qun, gc His m rng
Nhng hnh cng nh ung th mi pht
nhng lan rng hn
Ung th th chai t (Linite)

Ung th d dy

Th

u si
Hang v

Hnh nh li to
Hnh ng hm
Hnh u si n nham nh hang v
Mn v thng nhim cng nhng thuc vn lu
thng

Thn

D dy hnh hai ti
Phnh

v : Bng hi d dy xa khi vm
honh, hnh ni mt trng, khuyt thuc
phnh v.
Tm v: lan ln thc qun on di

Phn tn thng ung th d

dy (mi)
I: Tn thng li ln vo lng d dy
>5mm
IIa: Tn thng li ln so vi lp nim
mc <5mm
IIb: Bt u phng
IIc:Bt u b p xung nhng cha
qu lp c
III: Tn thng n ht lp c nim nh
ng cha qua ht lp thanh mc
IV: Ht thnh d dy v xm ln cc
c quan ln cn

D dy phu thut
C

nhiu kiu phu thut

Phu thut ct on v khng ct
on
Phu thut khng ct on
Ct dy X
Ni v trng
To hnh mn v
Phu

thut c ct on

Ct mt phn ca d dy v ni : Tnbn, tn-tn.

Ct ton b d dy

D dy phu thut
nh

gi tnh trng lu thng thuc v

ming ni (nu c):
Lot ming ni
Hp ming ni
Ung th ming ni

X quang thc qun

Th.S Bi Hong T
H Y Hi Phng

X quang thc qun

Bnh

l thc qun t gp
Trc kia chn on da vo X quang
Chn on da vo ni soi, sinh thit
X quang vn c s dng
nh gi tng k tn thng
Lu thng thuc cn quang trong thc
qun
nh gi ng r
nh gi tro ngc

X quang thc qun

Cc

phng php thm khm

Chp X quang thc qun c cn quang

Siu m ni soi vi u d thc qun
Chp CT : nh gi tng k tn thng
Ni soi ng mm

X quang thc qun

Thm

khm thc qun bng X quang

i quang n:
Cho bnh nhn ung Baryte
Chp cc t th ng thng, chch,
nm nga
Cn thit : trn lng trng g vi
Baryte
Dng thuc cn quang tan trong nc
trong trng hp tm ng r

X quang thc qun

Gii

phu v sinh l

Chia lm 3 on chnh : C, ngc, bng

C bn ch n lm : Sn nhn, quai MC,
ph qun gc tri v on chui qua honh
Ni vi d dy bi tm v
Gc to bi thc qun v tm v l gc
His
on bng ngn, i trc MCB
Lu thng trong thc qun: nh trng lc,
nhu ng

Co tht tm v (Achalasia)

Hay

gp ngi nhiu tui

Cn gi l phnh to thc qun
Lm sng: nghn c
Do ri lon m ri di nim mc
iu tr trit bng phu thut
X quang:

Trn phim chp phi thng quy : hnh

nh ng thc qun b lch, mc nc
hi trong trung tht
Hnh nh bng m trong trung tht

Co tht tm v (Achalasia)
Chp

thc qun c cn quang

Thc qun gin to tu mc : gin

nh, gin to hnh bt tt
C thc n trong thc qun
Thc qun thng trc, b mm mi
Khng thy hnh nh hp ca thc
qun
Thuc cn quang lu thng xung d dy
tng t

Co tht tm v (Achalasia)
Chp

thc qun c cn quang

Hp ti v tr tm v : thc qun thun

nh, c hnh nh ui c ci, mi
kim
Bng hi d dy cn t hoc khng cn

Mt s bnh l thc qun lnh

tnh

Bng thc qun :

Do ung phi cc cht n mn nh acid,
xt, mt s cht khc nh Javel
Hay gp on thp ca thc qun
Do nguyn nhn tia x : c th gp bt
k on no

Mt s bnh l thc qun lnh

tnh

X quang:
Hnh

nh thc qun hp tng on

Hp trn mt on di
Trc cn i
Lu thng thuc trong thc qun lin tc
on trn hp gin t hoc nhiu tu theo
mc hp v thi gian b bnh

Mt s bnh l thc qun lnh

tnh

Gin tnh mch thc qun

Gp trong trng hp tng p lc TMC, hay gp
nht trong x gan
Thng gp mt phn ba di thc qun
C th bm sinh

X quang:
Hnh

nh nhng hnh sng trn tp trung

nh chm nho, chui ht
Cc vt sng di ngon ngoo
Cc hnh gi u.

Mt s bnh l thc qun lnh

tnh

Ti tha thc qun

L mt bt thng bm sinh
C th gp bt k v tr no ca thc
qun
C th nh hoc rt to, n vi cm
Ti tha thc qun on c: ti tha Zenker
Hay

gp st l trn thc qun

Nm pha sau, bn tri
Phim thng: hnh bn nguyt c mc ngang
Nghing: hnh ti c cung y thc qun ra tr
c

Mt s bnh l thc qun lnh

tnh

Ti tha thc qun

Ti tha mt phn ba gia v di
C

cung
C c khi rng khng gi c thuc cn
quang
C khi chp nm mi thy

Mt s bnh l thc qun lnh

tnh

Thot v honh
L hin tng cc tng trong bng thot
v ln trn khoang lng ngc
C nhiu loi thot v honh:
Thot

v khe honh
Thot v do khim khuyt c honh

Thot v honh c th do cc nguyn

nhn khc nhau : bm sinh, chn thng,
khng r nguyn nhn, do phu thut
Ch cp n thot v khe honh

Mt s bnh l thc qun lnh

tnh

Thot v khe honh

Thot v trt : hay gp.
Hnh

nh phnh v v tm v d dy cng
chui ln khoang lng ngc

Thot v cun : t gp hn
Ch

c phnh v b li ln trn lng ngc

Tm v vn di bng

Thot v do thc qun ngn

Hay

km vim thc qun, lot

C tht d
i
Tm v
Khi
thot v

C
honh

D dy phu thut (ni

Pean), c ung th v thot v
honh

Ung th thc qun

L

mt bnh thng gp thc qun

Chim khong 2% cc ung th
Gp ngi nhiu tui
Nam nhiu hn n
Lm sng ch yu l nut nghn
Chn on bng ni soi v sinh thit
tin lng cho iu tr : kt hp vi chn
on hnh nh gm : X quang quy c,
siu m ni soi, chp CT
C ba th nh ung th d dy

Ung th thc qun

Hnh

qun

nh X quang trong ung th thc

L hnh khuyt thuc kn o khi cn

nh==>Chp i quang kp, siu m ni
soi
L hnh hp lch trc, khc khuu, khng
nhu ng
Thuc cn quang vn i qua on hp
Thc qun on trn gin

Ung th thc qun

Phn

quang

bit trn X

U lnh tnh
Thc qun b t
ngoi vo
Bng thc qun
Ti thc
qun

T ngoi
vo