1

SOI ONG MAT CHU

PGS.TS.O TRONG HAI
DHYD TP.HCM
BM. NGOAI
BA 0Ah0 Y8
BEhh h0C h00A
2
Muc tieu
1. CJ che benh sinh soi sac to J duJng mat
2. Bac diem lam sang
8. XhCLS & hinh anh
4. Bien chung

3

4
5
6
7
Dch te hoc
BhA va viet ham
Soi sac to J 0MC va 00 (ng.hat)
Au My
Soi cholesterol J TM S0MC (th.hat)
vi tri soi (vh) TM 0MC
TruJc day : 15% GO8O%

hien nay : 5OGO% 8O4O%




8
So bn Soi TM Soi BM
Soi
TM + BM
LuJng Linh ha
(Khanh hoa)
1O871OO2 G72 71% 25 % 7 %
Fham 0uy hien
(0Y vien 1O8)
1O881OOO 11G 52% G2%
hguyen hgoc hien
(Khanh hoa)
1O881OOO 428 58% 27% 1O
Bv BhY0 1OO42OO1 51GO 8O,2% 7,4% 8,4
THONG KE SOI MAT
VIET NAM
9
Yeu to thuan li
0iJi nu
Tuoi tu 4O GO
BJi song kinh te tha
An uong thieu dam
ve sinh kem
10
C che benh sinh soi sac to
Iun dua hap duong maI
hTM 0 0h MkT ThIE0 kM
ph maI Iuraro1,4LarIona
8IururonIdasa
8IIIIrubIna kh 8IIIrubIna T
6a
++

8IIIrubInaIa 6aIrIum
80I VIEh 80I V0h, 80I 80h
11
SO I VU N , SO I NHO qua c c vo ng Oddi

ta tra ng ha u mo n

SO I TO

ke t oa n cuo i OMC di chuye n le n xuo ng

TA C MA T

CA P TNH T NG T MA N TNH

phu ne , co tha t c Oddi ng ma t pha tre n da n to
va ng da t ng t

AU ( +++ ) NHIE M TRU NG NG MA T

hu y hoa i da n to ch c gan

X GAN
IEh 8IEh
12
Lam sang
au hIau vIam duong maI
Tam rhung 6hk60T . au 8oI Vang da
au vung Iam gIar 6hauIIard IvaI
an Io & dau
TuI maI ( )
au hIau soI kaI rap Inh
au quan du doI, rhua soI & rhua vang da
oI khI khong IrIau rhung

13
Can LS
XET h0hEM
Mau: Bilirubin F.Alk.
T.Frothrombin T0 0uick
ALT, AST
0ros 1,7ml
Mac Lagan > 5 dv
huJc tieu: Sac to mat (+) Muoi mat (+)
Fhan: Stercobilin ()

14
CHAN OAN HNH ANH
Siu m bng
Kinh dien, vai tro tam soat.
0e bo sot soi J doan cuoi 0MC va soi co kich thuJc nho ( do
nhay 48% va do dac hieu G4%)
Kha nang chan doan soi 0MC khoang 5O8O%.
Khi khong thay soi 0MC can luu y dau hieu gian tie la duJng
mat trong va ngoai gan gian
can MRCF hoac ERCF.

Gross BH, Harter LP, Gore RM, et al. Ultrasonic evaluation of common bile duct stones:
Prospective comparison with endoscopic retrograde cholangiopancreatography.
Radiology 1983;146:471-474
16
Sieu am bung
Soi 0MC
0MC
00T
00F
SIEU AM NOI SOI (EUS)
So sanh vJi ERCF, EuS la chan doan vJi do chinh xac O5%, do
nhay O8%, do dac hieu OO%, tien doan duJng OO%, tien doan
am O8%.
uu diem:
t xam hai
Khong co bien chung |8j
Bo han giai cao hJn ERCF nen co the hat hien nhung
soi nho doan cuoi 0MC.
hhuJc diem: dat tien va can chuyen gia.
Buscarini E, Tansini P, Vallisa D, et al. EUS for suspected choledocholithiasis: Do benefits outweigh costs?
A prospective, controlled study. Gastrointest Endosc 2003;57:510-518
SIEU AM NOI SOI (EUS)
STM
TM
HV
SOMC oan cuoi
OMC
TT
19
XQ ng mat
ERCP

PTC
S0 0MC
S0 0Ah
S0 0MC
S0 TM
Kim Chiba
1968 Mac Kune
ERCP chan oan
1973 Kawai
ERCP can thiep
1982 Frey
72 ca SM co oi chieu KQ
phau thuat
ERCP chn oan
o nhay 90%
o ac hieu 98%
o chnh xac 96%
ERCP
Frey CF, Burbige EJ, Meinke WB, et al. Endoscopic retrograde cholangiopancreatography.
Am J Surg 1982;144:109-114
21
CT gan mat
80I T0h kh
22
MRCP
S0 B0Ah Cu0 0MC
23
MRCP
t xam hai , xac nh hay loai tr soi
Cohen (2002)- 97 bn MRCP o nhay tuy kch thc soi
soi >10 mm 100%
soi 6-10 mm 89%
soi < 5 mm 71%
Ke (2003)- 267 bn MRCP co o nhay 100% va o ac hieu
96%, tien oan am 100%.

So sanh : MRCP o phan giai thap hn bo sot soi nho
ERCP han che khi khong at c catheter
hoac khi bn a cat da day theo Billroth II .
MRCP thay soi khong can ERCP, tranh c bien chng
XQM TRONG MO (IOC)
Miri//i 1O8O 0C / mo mJ
hgay nay 0C / FThS o bung.

Thanh cong 751OO%
Bo nhay 85 Bo dac hieu 8G%
Tien doan duJng O4% Tien doan am O5%
0uJng tinh gia O,8%.

Co nen chu 0C thuJng quy?
(hat hien soi & bat thuJng 0FBM)
Chi dinh
Bh co tien can vang da
Bilirubin > 1mg%
0MC > Omm do tren sieu am.
Trong khi mo thay 0MC dan.


26
XQ NG MAT TRONG MO
Trong mo m
Trong mo noi soi
Sieu am trong mo NS (IOUS)
NOI SOI NG MAT TRONG MO
Trong long OMC Cho phan chia 2 OG
30
Bien chng
viem duJng mat
viem tui mat ca
viem mu duJng mat
Axe duJng mat
Chay mau duJng mat
hTh Soc hT



viem gan man XJ gan
Roi loan dong mau
STC hC gan than
viem tuy ca
Ro mat ruot Tac ruot
Axe gan vJ len nguc, F0,
tim.

31
Viem ng mat
Binh thuJng co mot luJng
nho vi trung tu ruot len he mat
Soi gay be tac lam vi trung
tang truJng trong he mat
32
Viem tui mat cap
hinh anh vach tui mat day khong deu, hu ne
33
Viem ng mat mu
0ich mat chua hoa mu
0ich mat chua day mu
va vi trung
34
Ap-xe ng mat
hinh anh nhieu
o axe doc
duJng mat
giong nhu chum
hoa
35
Nhiem trung huyet
Tac mat gay hTh va suy gan, suy than
36
Ro mat tieu hoa
37
Viem phuc mac mat