U giáp tổ 9

• 1. NHM TRNH: T 9 _Y07B

2. Mc lc1) i cng2) Chn on3) iu tr4) Sn sc sau phu thut 3. 1.1 Gii phu tuyn gip 4. 1.2 Chc nng ca tuyn gip:- Chuyn ha c bn- Chuyn ha cc cht- H thn kinh- H tim mch- Hormone tng trng 5. 1.3 nh ngha U Gip U l mt khi m bt thng c kh nng tng trng (s lng t bo) qu mc bnh thng v kh nng ny vn tn ti d khng cn nguyn nhn gy ra n ( Willis) 6. 1.3 nh ngha U Gip Trn lm sng, t U nhm ch c hai loi l u tht v u gi 7. 1.4 Phn loiC nhiu cch phn loi u tuyn gip- Theo chc nng: cng gip, bnh gip, nhc gip.- Theo i th: u gip nhn, u gip lan ta.- Theo vi th: u gip nhu m, u gip th nangTheo lm sng: phi hp c i th v chc nng. 8. 1.5 U gip thng gp- Cng gip- U gip n thun- K gip 9. 2.1 Cng gipnh ngha: Cng gip l mt tnh trngtrong mt tuyn gip hot ngqu mc, hu qu l sn xut mts lng qu nhiu hormone tuyngip lu hnh trong mu gy ranhng tn hi v m v chuynha. Ton b cc tn hi ny cgi l nhim c gip, biu hinlm sng l hi chng cng gip. 10. 2.1 Cng gipNguyn nhn:Ngoi tuyn gip: Bnh Basedow Thuc: hormon tuyn gip Thai trng Ung th U thy trc tuyn ynTi tuyn gip U tuyn c tuyn gip Vim gip 11. 2.1 Cng gip Lm sng: Hi chng cng gip Ton thn: st cn nhanh, s nng, da m m hi, bntay m m hi nhng m.Tim mch: mt, hi hp, mch lun nhanh > 100ln/pht, lon nhp, suy tim.Thn kinh, c: d xc ng, ri lon tm thn, teoc, gim sc c, lit. U gip nhn hoc lan ta, c th c m thi (Basedow). Mt li (bnh Basedow) 12. 2.1 Cng gip Cn lm sng: T3, T4, TSH trong mu:. T3, T4 tng (nht l T3, T4 t do)v TSH gim. Siu m tuyn gip: tng kch thc, c nhn.Siu m doopler: tng sinh mch mu. X hnh tuyn gip bng Iod phng x 13. 2.2 U gip n thun nh ngha: U gip n thun l s ph i ca tuyn gip m nguyn nhn khng do ung th hay vim nhim v khng c tng hoc gim chc nng gip. 14. 2.2 U gip n thun Phn loi:- U gip lan to- U gip nhn 15. 2.2 U gip n thun Lm sng:- Khi u- Khng c triu chng ca hi chng cng gip- C th c du hiu chn p 16. 2.2 U gip n thun Cn lm sng:- Hormon tuyn gip: bnh thng- Siu m- FNA 17. 2.3 K gipTheo gii phu bnh: c 4 loi- Ung th biu m th nh- Ung th biu m th nang- Ung th biu m th tu- Ung th biu m khng bit ho 18. Carcinoma th nh 19. Carcinoma th nang 20. Carcinoma bit ha km 21. Carcinoma th ty 22. 2.3 K gip Theo TNM:T0: khng c u nguyn phtT1: u c d 4cm(T1,T2,T3 u cn nm trong v bao ca tuyn gip)T4: u c d bt k, xm ln ra ngoi v baoN0: khng c hchN1: c mt hch cng bn, d< 3cmN2: hch c d 3- 6cmN3: hch c d> 6cmM0: khng c di cn xaM1: c di cn xa 23. 2.3 K gip Lm sng:- Khi u- Hch c- Du hiu chn p, xm ln cc c quan ln cn 24. 2.3 K gip Cn lm sng- Siu m- FNA- Sinh thit- CT, MRI: kho st s xm ln vo cu trc gii phu lncn.- Calcitonin, CEA trong mu: tng trong carcinoma tuyngip dng ty. 25. 3.1 Cng gip/ Ni khoaThuc khng gip tng hp:- Thiouracil ( MTU, PTU): 50mg/vin- Imidazol ( Methidazol, Carbidazol, Thiamazol) : 5mg/vinLiu : tn cng 4- 8vin /ngy trong 2 thngduy tr 1- 2 vin/ngy trong 18- 24 thng 26. 3.1 Cng gip/ Ni khoaThuc c ch beta (Propranolol) Ideral 40mg: 1-2 vin/ngy, chia 4-6 ln ung 27. 3.1 Cng gip/ Ni khoa Iod v c (Lugol)- Dng trong cn bo gip, chun b trc m- Dung dch Lugol 5% ( 1ml= 20 git cha 126.5 mg Iod): ung 5- 10 git x 2ln/ngy, vo cc ba n chnh 28. 3.1 Cng gip/ Ngoi khoa Mc ch:- Ct gim th tch tuyn gip- Ct b nhn c Ch nh:- U gip lan ta c kch thc ln- U gip nhn c, a nhn ha c- iu tr ni km hiu qu 29. 3.1 Cng gip/ Ngoi khoa Thi im phu thut: bnh gip Phng php phu thut: ct b gn ht tuyn gip(Basedow, a nhn ha c), ct b thy gip cha nhnc. Chun b trc m- Lugol 5%: ung 1 2 tun trc khi m.- Propranodol: ngng trc m 7 10 ngy. 30. 3.1 Cng gip/ ng v phng xI131 Thi im s dng: bnh tim, cng gip iu tr nnh Chng ch nh: ph n c thai, tr em, cn nhc nhngbnh nhn tr. 31. 3.2 U gip n thun/ Ni khoa U lan to:- U mi: Levothyroxin 100- 200 g/ ngy, ti thiu trong 6thng- U lu ngy: gip n nh U gip nhn:Ch nh cho nhng trng hp u nh, mi, nguy c ungth thp 32. 3.2 U gip n thun/ Ngoi khoa U lan to- Ch nh: u ln, c bin chng chn p, thng trungtht, khng ng nht- Mc ch: ct gim th tch tuyn gip U gip nhn- Ch nh: nhn ln, lu ngy, nguy c ung th cao,iu tr ni khoa tht bi- Mc ch: ly ht nhn- Phng php: ct bn phn thu, ct thu, ct gn httuyn gip 33. 3.3 K gip/ phu thut L la chn u tin, c bn nht. Carcinoma dng nh: ct thu, ct gn trn hoc tonb tuyn gip no hch c. Carcinoma khng bit ha, xm ln nhiu: ct mtphn tuyn gip gim chn p m kh qun ra da 34. 3.3 K gip/ x tr ng v phng x I131- Ch nh: sau ct tuyn gip do carcinoma bit ha- Khng c ch nh iu tr cho carcinoma khng bit hav dng ty X ngoi:Ch nh cho carcinoma khng bit ha v dng ty 35. 3.3 K gip/ Hormon Ch nh: carcinoma bit ho Dng sut i, sau phu thut hay sau x Thuc: Levothyroxin t c ch nh bnh nhn > 50t 36. 3.3 K gip Nhm nguy c Nhm nguy c thp caoTui < 40 nam, < 50 > 40 nam, >50 n nKch thc u< 5cm> 5cmXm ln trc ln ChaCcnDi cn xaChaC 37. 3.3 K gip/ K hoch iu tr Carcinoma tuyn gip bit ha- Nhm nguy c thp: ct thy gip + hormone nn.- Nhm nguy c cao: ct ton b tuyn gip v no lyhch (nu c di cn hch) + I131 + hormone nn. Carcinoma tuyn gip khng bit ha: Ct trn tuyngip nu u cn khu tr, c khi ch ct c mt phntuyn gip gii quyt tnh trng chn p (thng phim kh qun ra da) + x ngoi + ha tr Carcinoma tuyn gip dng ty: Ct ton b tuyn gipv no hch + x ngoi 38. 4.1 ng dn luTheo di tnh cht dch dn luThi gian rt: 24- 48h 39. 4.2 Thay bng Khi cn ng dn lu Nhng ngysau, khng cn thay bng 40. 4.3 Ct chTt nht l 5 ngy 41. 4.6 n ungn thc n nh, khng king cNu gy m: n sau khi tnh hnNu gy t: n ngay sau m 42. 4.7. Bin chng Bin chng nguy him n tnh mng- Chy mu: thng gp nht.Vt m n, c bnh, kh th, tm, chn p kh qun t vong X tr: ct ch ly mu t gii p, ni kh qun v m licm mu.- Xp kh qun (bnh nhn ln tui, u gip thng trung tht):Suy h hpX tr: t ni kh qun, m kh qun ra da- Cn bo gipX tr: bm qua snde mi d dy liu cao PTU + Lugol 5%+Propranolol; truyn dung dch mn, ngt ng trng 4 -5 lt 43. 4.7. Bin chng Bin chng khng gy nguy him n tnh mng:- tetanie tm thi hay vnh vin (tn thng tuyn ph gip)- khn ting (tn thng thn kinh hi thanh qun, ph nthanh qun)- ging nh (tn thng nhnh ngoi ca thn kinh thanhqun trn)- cng gip ti pht, nhc gip. 44. Xin chn thnh cm n!