{"id":662,"date":"2017-02-02T14:37:59","date_gmt":"2017-02-02T07:37:59","guid":{"rendered":"https:\/\/benhvienvietbi.vn\/en\/?p=662"},"modified":"2017-03-30T18:43:34","modified_gmt":"2017-03-30T11:43:34","slug":"dieu-tri-ho-tro-sinh-san-doi-voi-hoi-chung-buong-trung-da-nang","status":"publish","type":"post","link":"https:\/\/benhvienvietbi.vn\/en\/dieu-tri-ho-tro-sinh-san-doi-voi-hoi-chung-buong-trung-da-nang\/","title":{"rendered":"[:vi]Ph\u01b0\u01a1ng ph\u00e1p h\u1ed7 tr\u1ee3 sinh s\u1ea3n \u0111\u1ed1i v\u1edbi bu\u1ed3ng tr\u1ee9ng \u0111a nang[:]"},"content":{"rendered":"

[:vi]I.M\u1edf \u0111\u1ea7u:\"image037\"
\n<\/strong><\/p>\n

H\u1ed9i ch\u1ee9ng bu\u1ed3ng ch\u1ee9ng \u0111a nang(PCOS) l\u00e0 r\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong ph\u1ee5 n\u1eef \u1edf l\u1ee9a tu\u1ed5i sinh s\u1ea3n.\u0110i\u1ec1u tr\u1ecb PCOS ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng\u00a0 v\u00e0 tri\u1ec7u ch\u1ee9ng ki\u1ebfn ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn c\u01a1 s\u1edf y t\u1ebf nhi\u1ec1u nh\u1ea5t l\u00e0 tr\u00ecnh tr\u1ea1ng v\u00f4 sinh.M\u1ee5c ti\u00eau b\u00e0i n\u00e0y l\u00e0 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c ph\u00e1c \u0111\u1ed3 l\u00e2m s\u00e0ng d\u00e0nh cho ng\u01b0\u1eddi b\u1ecb PCOS c\u00f3 ch\u1ec9 \u0111\u1ecbnh th\u1ef1c hi\u1ec7n th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m.<\/p>\n

Theo \u0111\u1ed3ng thu\u1eadn c\u1ee7a ESHRE\/ASRM (Thessaloniki Consensus, 2008) v\u1ec1 \u0111i\u1ec1u tr\u1ecb v\u00f4 sinh do PCOS, TTTON \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh n\u1ebfu:<\/p>\n

-Th\u1ea5t b\u1ea1i sau \u0111i\u1ec1u tr\u1ecb: clomiphene citrate, \u0111\u1ed1t \u0111i\u1ec3m bu\u1ed3ng tr\u1ee9ng, g\u00e2y r\u1ee5ng tr\u1ee9ng ho\u1eb7c k\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng (c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p IUI)<\/p>\n

-Ho\u1eb7c PCOS \u0111i k\u00e8m v\u1edbi nguy\u00ean nh\u00e2n g\u00e2y v\u00f4 sinh nam, n\u1eef kh\u00e1c: v\u00f2i tr\u1ee9ng, l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung v\u1eeba\/n\u1eb7ng\u2026<\/p>\n

\u0110a s\u1ed1 ph\u1ee5 n\u1eef b\u1ecb PCOS c\u00f3 th\u1ec3 c\u00f3 thai sau v\u00e0i chu k\u00ec \u0111i\u1ec1u tr\u1ecb TTTON.Tuy nhi\u00ean, c\u00f3 m\u1ed9t s\u1ed1 v\u1ea5n \u0111\u1ec1 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u1ea7n quan t\u00e2m \u0111i\u1ec1u ch\u1ec9nh nh\u1eb1m t\u0103ng t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng TTTON v\u00e0 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng.<\/p>\n

II.M\u1ed9t s\u1ed1 v\u1ea5n \u0111\u1ec1 c\u1ea7n quan t\u00e2m tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n l\u00e0m TTTON \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n PCOS:<\/strong><\/p>\n

2.1.N\u1ed9i m\u1ea1c t\u1eed cung(NMTC) d\u00e0y:<\/p>\n

-T\u0103ng sinh NMTC do t\u00ecnh tr\u1ea1ng kh\u00f4ng ph\u00f2ng no\u00e3n k\u00e9o d\u00e0i, t\u1eed cung ti\u1ebfp x\u00fac th\u01b0\u1eddng xuy\u00ean, k\u00e9o d\u00e0i v\u1edbi estrogen m\u00e0 kh\u00f4ng c\u00f3 progesterone \u0111\u1ed1i kh\u00e1ng.\u0110i\u1ec1u tr\u1ecb progesterone t\u1eeb v\u00e0i ng\u00e0y \u0111\u1ebfn 12 ng\u00e0y c\u00f3 th\u1ec3 t\u1ea1o \u0111\u01b0\u1ee3c chu k\u1ef3 nh\u00e2n t\u1ea1o, n\u1ebfu ni\u00eam m\u1ea1c m\u1ecfng c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u chu k\u00ec k\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng l\u00e0m TTTON.<\/p>\n

-N\u1ebfu t\u0103ng sinh NMTC kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi progesterone c\u00f3 th\u1ec3 sinh thi\u1ebft NMTC ho\u1eb7c n\u1ea1o bu\u1ed3ng NMTC.<\/p>\n

\"qua-san-noi-mac-tu-cung\"<\/p>\n

H\u00ecnh \u1ea3nh qu\u00e1 s\u1ea3n n\u1ed9i m\u1ea1c t\u1eed cung<\/em><\/p>\n

2.2.NMTC m\u1ecfng, t\u1eed cung teo nh\u1ecf:<\/p>\n

-M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p PCOS nang nh\u1ecf, n\u1ed9i ti\u1ebft k\u00e9m k\u00e9o d\u00e0i d\u1eabn \u0111\u1ebfn t\u1eed cung thi\u1ebfu n\u1ed9i ti\u1ebft m\u1ea1n t\u00ednh, t\u1eed cung nh\u1ecf, ni\u00eam m\u1ea1c m\u1ecfng.<\/p>\n

-\u0110i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch cho estrogene t\u1ef1 nhi\u00ean trong 28 ng\u00e0y, k\u1ebft h\u1ee3p progesterone trong 2 tu\u1ea7n cu\u1ed1i.Th\u01b0\u1eddng sau 1-2 \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb t\u1eed cung s\u1ebd tr\u1edf v\u1ec1 k\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh l\u00e0m TTTON.<\/p>\n

2.3.Gi\u1ea3m c\u00e2n: n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 th\u1eeba c\u00e2n ho\u1eb7c b\u00e9o ph\u00ec c\u1ea7n c\u00f3 c\u00e1c bi\u1ec7n ph\u00e1p gi\u1ea3m c\u00e2n tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb.<\/p>\n

2.4.Kh\u00e1ng insulin v\u00e0 metformin:<\/p>\n

-Kh\u00e1ng insulin \u0111\u01b0\u1ee3c xem l\u00e0 nh\u1eefng r\u1ed1i lo\u1ea1n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong PCOS. Do \u0111\u00f3 metformin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u01b0\u1edbc khi TTTON gi\u00fap t\u0103ng hi\u1ec7u qu\u1ea3 k\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng v\u00e0 gi\u1ea3m nguy c\u01a1 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng.<\/p>\n

2.5.K\u00edch th\u00edch bu\u1ed3ng tr\u1ee9ng(KTBT) \u0111\u1ec3 TTTON trong PCOS:<\/p>\n

KTBT l\u00e0 v\u1ea5n \u0111\u1ec1 kh\u00f3 kh\u0103n v\u00e0 c\u00f3 nguy c\u01a1 cao nh\u1ea5t khi th\u1ef1c hi\u1ec7n TTTON tr\u00ean ng\u01b0\u1eddi c\u00f3 PCOS. Nh\u1eefng v\u1ea5n \u0111\u1ec1 c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i:<\/p>\n

+\u0110\u00e1p \u1ee9ng qu\u00e1 m\u1ee9c, h\u1ed9i ch\u1ee9ng qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng.<\/p>\n

+Kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi KTBT<\/p>\n

+N\u1ed3ng \u0111\u1ed9 estradiol qu\u00e1 cao khi KTBT c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn NMTC.<\/p>\n

III.C\u00e1c bi\u1ec7n ph\u00e1p kh\u1eafc ph\u1ee5c:<\/strong><\/p>\n

1.Nu\u00f4i tr\u1ee9ng tr\u01b0\u1edfng th\u00e0nh trong \u1ed1ng nghi\u1ec7m (IVM), kh\u00f4ng KTBT: \u0111\u1ed1i v\u1edbi k\u0129 thu\u1eadt n\u00e0y ch\u00fang ta kh\u00f4ng c\u1ea7n KTBT ho\u1eb7c ch\u1ec9 c\u1ea7n 1 l\u01b0\u1ee3ng nh\u1ecf FSH trong 3 ng\u00e0y \u0111\u1ec3 \u201cm\u1ed3i\u201d.T\u1ef7 l\u1ec7 thai l\u00e2m s\u00e0ng \u1edf Vi\u1ec7t Nam kho\u1ea3ng 30-35% v\u00e0 ho\u00e0n to\u00e0n lo\u1ea1i tr\u1eeb nguy c\u01a1 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng.<\/p>\n

2.Metformin n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u01b0\u1edbc TTTON \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng.<\/p>\n

3.Ph\u00e1c \u0111\u1ed3 KTBT: ph\u00e1c \u0111\u1ed3 antagonist l\u00e0 ph\u00e1c \u0111\u1ed3 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. Ph\u00e1c \u0111\u1ed3 antagonist gi\u1ea3m 50% nguy c\u00f3 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng.<\/p>\n

3.S\u1eed d\u1ee5ng FSH li\u1ec1u th\u1ea5p trong KTBT:\u0111\u1ed1i v\u1edbi nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng nguy c\u01a1 cao qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng li\u1ec1u FSH 100-150IU\/ng\u00e0y. C\u00e1 bi\u1ec7t c\u00f3 th\u1ec3 d\u00f9ng 75IU\/ng\u00e0y.<\/p>\n

4.S\u1eed d\u1ee5ng GnRH agonist thay th\u1ebf hCG trong tr\u01b0\u1edfng th\u00e0nh no\u00e3n:hCH l\u00e0 y\u1ebfu t\u1ed1 k\u00edch ho\u1ea1t qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng, vi\u1ec7c s\u1eed d\u1ee5ng GnRH thay th\u1ebf hCH gi\u00fap tri\u1ec7t ti\u00eau ho\u00e0n to\u00e0n qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng.<\/p>\n

5.M\u1ed9t t\u1ed5ng quan t\u1eeb th\u01b0 vi\u1ec7n Cochrane n\u0103m 2012 cho th\u1ea5y s\u1eed d\u1ee5ng Cabergoline \u0111\u1ec3 d\u1ef1 ph\u00f2ng qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng gi\u00fap gi\u1ea3m 50% nguy c\u01a1 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng.<\/p>\n

IV.K\u1ebft lu\u1eadn:<\/strong><\/p>\n

TTTON l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 cho ph\u1ee5 n\u1eef PCOS c\u00f3 ch\u1ec9 \u0111\u1ecbnh.Trong \u0111\u00f3 KTBT l\u00e0 kh\u00e2u kh\u00f3 kh\u0103n nh\u1ea5t khi th\u1ef1c hi\u1ec7n TTTON tr\u00ean ng\u01b0\u1eddi PCOS.Nguy c\u00f3 th\u01b0\u1eddng g\u1eb7p l\u00e0 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng. Hi\u1ec7n nay c\u00f3 nhi\u1ec1u bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng hi\u1ec7u qu\u1ea3 gi\u00fap gi\u1ea3m thi\u1ec3u ho\u1eb7c tri\u1ec7t ti\u00eau nguy c\u01a1 qu\u00e1 k\u00edch bu\u1ed3ng tr\u1ee9ng.<\/p>\n

T\u00e1c Gi\u1ea3: BS. Ho\u00e0ng Th\u1ecb Thu H\u00e0 \u00a0– \u00a0TS.BS. L\u00ea V\u01b0\u01a1ng V\u0103n V\u1ec7<\/em><\/p>\n

[:]<\/p>\n","protected":false},"excerpt":{"rendered":"

[:vi]H\u1ed9i ch\u1ee9ng bu\u1ed3ng ch\u1ee9ng \u0111a nang(PCOS) l\u00e0 r\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong ph\u1ee5 n\u1eef \u1edf l\u1ee9a tu\u1ed5i sinh s\u1ea3n.\u0110i\u1ec1u tr\u1ecb PCOS ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng v\u00e0 tri\u1ec7u ch\u1ee9ng ki\u1ebfn ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn c\u01a1 s\u1edf y t\u1ebf nhi\u1ec1u nh\u1ea5t l\u00e0 tr\u00ecnh tr\u1ea1ng v\u00f4 sinh.M\u1ee5c ti\u00eau b\u00e0i n\u00e0y l\u00e0 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c ph\u00e1c \u0111\u1ed3 l\u00e2m s\u00e0ng d\u00e0nh cho ng\u01b0\u1eddi b\u1ecb PCOS c\u00f3 ch\u1ec9 \u0111\u1ecbnh th\u1ef1c hi\u1ec7n th\u1ee5 tinh trong \u1ed1ng nghi\u1ec7m.[:]<\/p>\n","protected":false},"author":3,"featured_media":663,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[24,22],"tags":[],"class_list":["post-662","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nguyen-nhan","category-vo-sinh-hiem-muon"],"acf":[],"yoast_head":"\n[:vi]Ph\u01b0\u01a1ng ph\u00e1p h\u1ed7 tr\u1ee3 sinh s\u1ea3n \u0111\u1ed1i v\u1edbi bu\u1ed3ng tr\u1ee9ng \u0111a nang[:] - 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