RO HAU MON

BM NGOAI TONG QUAT

AI HOC Y DC - TP HO CHI MINH

1.
2.
3.
4.
5.

Trnh bay c nguyen nhan va sinh benh

hoc cua ro hau mon
Mo ta c cac the giai phau benh cua ro
hau mon
Chan oan c benh ro hau mon
Phat bieu c nh luat Goodsall
Trnh bay c nguyen tac ieu tr ro hau
mon

MC TIU

Ap xe quanh hau mon va ro hau mon la do

cung nguyen nhan va the hien tren lam
sang 2 dang : ap xe dang cap tnh va ro
dang man tnh .

M U

NGUYEN NHAN
AC HIEU 10%
Nhiem trung :

Lao, Crohn, HIV ,Nam

Ung th
Chan thng
Chieu xa
KHONG AC HIEU 90%
Nhiem trung Khe - Tuyen

Theo Chiari, Hermann, Defosses : nhiem

trung tuyen hau mon va ng dan cua
tuyen la nguyen nhan cua ro hau mon .
Nhiem vu cua tuyen hau mon cha
c biet chac chan.
Tuyen hau mon tiet ra chat nhay (mucin)
nhng co thanh phan khac vi chat tiet
cua niem mac trc trang .

SINH BENH HOC

Theo Mc.Coll: tuyen hau mon co cau

truc cua tuyen tao mui (scence
secretion)
Theo Shafik: tuyen hau mon khong phai
la tuyen that (true gland) ma ch la vet
tch con lai t s xep nep niem mac
trc trang oan cuoi.
Theo Parks & Eisenhammer: tuyen hau
mon hien dien gia 2 c that va 1-2/3
tuyen hien dien ong hau mon.

SINH BENH HOC

SINH BENH HOC

Parks & Eisenhammer : neu gia thuyet
khe tuyen (cryptoglandular hypothesis)
Eisenhammer cho la tat ca ap xe va ro
khong ac hieu la ket qua cua nhiem
trung t trong tuyen hau mon va
ong tuyen do s tac nghen ong dan

trong c that trong .

SINH BENH HOC

THUYET KHE TUYEN

SINH BENH HOC

THUYET KHE TUYEN

Cc khoang quanh hu mn

Hnh 1.10. Mot so khoang cua hau mon trc trang.

(Cac khoang di niem mac, sau hau mon nong, sau hau mon sau, sau trc trang
khong the hien hnh)

PHAN LOAI

Ro gia c that

Ro xuyen c that

Ro tren c that

Ro ngoai c that

Benh s va kham lam sang:

Ap xe : -en kham sm .
-Sng o nong va au canh
hau mon .
Ro : -en kham tre hn .
-au ngat quang va chay mu
tang sinh mon .
- au tang len khi mu khong
chay ra va giam au khi mu thoat ra

CHAN OAN

CHAN OAN
Theo Goodsall & Miles co 5 ieu thiet
yeu trong chan oan ro hau mon :
V tr lo ro ngoai .
V tr lo ro trong .

ng i cua ng ro nguyen phat .

S hien dien cua ng ro th phat .
Phat hien cac benh ly khac gay ra ro

Giup tm v tr lo ro trong
Ngoai tr :

-Lo ro ngoai cach hau

mon >3cm
-Ro do cac nguyen nhan
ac hieu nh Crohn , K

NH LUAT GOODSALL

CHAN OAN HNH ANH

Chup X-quang ng ro co bm
thuoc can quang .

Sieu am vi au do trong ong hau

mon (Anal-endosonography AES) .
Chup cong hng t (Magnetic
Resonance Imaging MRI)

CHUP NG RO CAN QUANG

Theo Kuypers
Xac nh chnh xac 25% cac ng ro .
Xac nh ung 24% v tr lo ro trong so
vi luc phau thuat .
Dng tnh gia 12% trng hp lo ro o
cao vao trc trang .
Khi chup bm thuoc can quang vi ap
lc cao de co nguy c lam lan rong o
nhiem trung .

X-quang ng ro co can quang

La phng phap re tien nhat va

cho ket qua chnh xac nhat .

La tieu chuan vang trong viec

anh gia toan bo c vong va phat
hien cac ap xe canh hau mon va
cac ng ro hau mon .

SIEU AM QUA LONG HM

SIEU AM HAU MON

SIEU AM HAU MON

Abces hnh mong nga

SIEU AM HAU MON

AES
Abces canh hau mon

SIEU AM HAU MON

SIEU AM HAU MON

Xac nh v tr o mu va ng ro ma
khong can s dung thuoc can quang .
Theo BV St. Mark hnh chup MRI so vi luc
phau thuat chnh xac :
- 86% ng ro nguyen phat .
- 97% ro hnh mong nga .
- 100% cac o ap xe canh hau mon .

CONG HNG T
MRI

CONG HNG T MRI

CONG HNG T MRI

Hnh abces canh hau mon

CONG HNG T MRI

Khuyet cua c vong ngoai

CONG HNG T MRI

Nguyen tac ieu tr :

Nhiem trung cap tnh la ch nh
sm cho phau thuat va dan lu .
Hai nguyen tac chnh cua mo ro
hau mon la :
-Bao ve an toan c that .
-Cat bo c ng ro .

IEU TR

CAC PHNG PHAP

IEU TR
Cat mo x ng ro (fistulectomy)
M ng ro (fistulotomy) .
Cot day thun (Prolonged seton
drainage).
Bm keo sinh hoc (treament fibrin
sealant).
Cat ng ro gian c that (LIFT)
Cat ng ro vi noi soi ho tr (VAAFT)