Tip cn lm sng
Trng hp lm sng
HNH CHNH :
Bnh nhn nam, 57 tui, a ch Bn Tre
Ngh nghip : nng dn
L DO NHP VIN: au ngc
BNH S :
Bnh nhn au ngc (T) m , iu tr bng thuc
gim au ti trm y t, nhng khng gim. au ngc ngy
cng tng dn, khm ti BV Bn Tre, chp X quang pht
hin bu phi nn chuyn BV Ung Bu
Trng hp lm sng
TIN CN:
- Ht thuc l: gi/ ngy x 30 nm
- Ung ru: thnh thong, khi c tic.
- Khng bnh l ni ngoi khoa.
VN CA BNH NHN:
au ngc
Bu phi
Chn on ung th
1. Chn on c quan mang bu
2. Chn on bn cht bu
3. Chn on giai on bnh
4. Chn on bn cht sinh hc bu
Lm sng Cn lm sng
Tnh hung lm sng
1. Pht hin tnh c
2. Triu chng ca bu nguyn pht
- Ho
- Ho mu
- Nng ngc
- Kh th
- Kh kh
- Vim phi
Tnh hung lm sng
3. Triu chng ca bu lan rng
trong lng ngc
- au ngc
- Hi chng tnh mch ch trn
- Khn ting
- Nut kh
- U Pancoast: au vai, cnh tay,
hi chng Horner
Tnh hung lm sng
4.Triu chng di cn:
- Ni hch c, hch nch.
- au xng, gy xng bnh l.
- Gan to, bng bng.
- Hi chng tng p lc ni s, du thn kinh khu tr.
- Ni cc u, cc di da.
Tnh hung lm sng
5. Triu chng tng qut:
- St cn
- Chn n
- Yu sc
- Hi chng cn ung th.
Bnh nhn thng n giai on tr, do c rt t triu chng giai on sm Ung th phi l k git ngi thm lng
Chn on Tnh hung lm sng
1. Chn on c quan mang bu
X quang ngc
Chn on Tnh hung lm sng
1. Chn on c quan mang bu
CT scan ngc
Chn on
1. Chn on c quan mang bu
CT ngc
- Pht hin bu.
- nh gi kh qun, ph qun chnh.
- Pht hin xm ln thnh ngc.
- nh gi xm ln mch mu.
- Pht hin di cn.
- nh v v hng dn sinh thit
bu
Chn on
1. Chn on c quan mang buMRI ngc
- Pht hin bu nm trong
vng phi xp
- Chng ch nh tim thuc cn
quang/ chp CT
Chn on
2. Chn on bn cht bu
Xquang ngcCT ngcMRI ngcPET_CT
Bu ngoi vi Bu trung tm
- Sinh thit qua da- Ni soi lng ngc- Ni soi ph qun- M ngc thm st
- T bo hc/ m.- Ni soi ph qun- M ngc thm st
Chn on
Chn on
2. Chn on bn cht bu
Ni soi ph qun
Chn on Tnh hung lm sng
2. Chn on bn cht bu
FNA xuyn thnh ngc : Carcinm tuyn
Chn on
2. Chn on bn cht bu
Ung th phi khng t bo nh (80%)
Ung th phi t bo nh (20%)
Carcinm
tuynCarcinm
t bo gaiCarcinm
t bo ln
10 15% 35 - 40% 30%
Chn on
2. Chn on giai on bnh
Chn on
2. Chn on giai on bnh
PET _CT
nhy : 89% c hiu 94%
Chn on Tnh hung lm sng
2. Chn on giai on bnh
- Siu m:
Hch trn n (P) 10 mm, ngh hch di cnGan bnh thng. Khng thy di cn tuyn thng thn.
- X hnh xng: bnh thng.
- MRI no: bnh thng
FNA hch trn n (P): hch vim
Chn on
- Kch thc bu.- V tr bu so vi Carena.- Xp phi, vim phi.- Xm ln: mng phi, trung tht, tim,
mch mu ln, kh qun, thc qun, ct sng, carena.
- Bu cc thy phi
- V tr hch di cn- Hch cng bn/ i bn.- Hch trn n
- Trn dch mng phi, mng tim.- Bu thy phi i bn- Di cn xa
T
N
M
Chn on
4. Chn on bn cht sinh hc
Chn on
Carcinm tuyn phi (T) cT3N0M0
KT LUN
- Triu chng ung th phi rt m h. Khi triu chng
r th bnh giai on tr.
- Chn on ch yu da vo cc phng tin cn lm
sng
- Cc phng tin chn on gii phu bnh ph thuc
vo v tr bu.
- Thng gp ung th phi khng t bo nh.
- Carcinm tuyn : ch bn cht sinh hc bu
Chn thnh cm n
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