{"id":704,"date":"2017-02-27T17:04:09","date_gmt":"2017-02-27T10:04:09","guid":{"rendered":"https:\/\/benhvienvietbi.vn\/en\/?p=704"},"modified":"2018-10-20T16:17:21","modified_gmt":"2018-10-20T09:17:21","slug":"roi-loan-phong-noan","status":"publish","type":"post","link":"https:\/\/benhvienvietbi.vn\/en\/roi-loan-phong-noan\/","title":{"rendered":"[:vi]R\u1ed1i lo\u1ea1n ph\u00f3ng no\u00e3n[:]"},"content":{"rendered":"

[:vi]I.\u0110\u1ea1i c\u01b0\u01a1ng:<\/strong><\/p>\n

R\u1ed1i lo\u1ea1n ph\u00f3ng no\u00e3n (RLPN) th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn v\u00f4 sinh, chi\u1ebfm kho\u1ea3ng 40% c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u00f4 sinh n\u1eef l\u00e0 do RLPN.RLPN bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi nhi\u1ec1u d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng kh\u00e1c nhau nh\u01b0: v\u00f4 kinh, kinh kh\u00f4ng \u0111\u1ec1u, b\u00e9o ph\u00ec\u2026Bi\u1ebfn ch\u1ee9ng mu\u1ed9n c\u1ee7a RLPN l\u00e0 ung thu n\u1ed9i m\u1ea1c t\u1eed cung ho\u1eb7c ung th\u01b0 v\u00fa.\u0110i\u1ec1u tr\u1ecb v\u00f4 sinh li\u00ean quan \u0111\u1ebfn RLPN ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o c\u00e1c thu\u1ed1c g\u00e2y ph\u00f3ng no\u00e3n ho\u1eb7c t\u1ea1o c\u00e1c chu k\u00ec c\u00f3 nang no\u00e3n ph\u00e1t tri\u1ec3n gi\u00fap \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 c\u00f3 thai v\u00e0 tr\u00e1nh nh\u1eefng bi\u1ebfn ch\u1ee9ng mu\u1ed9n do RLPN g\u00e2y ra.<\/p>\n

\"090109_vo-sinh543\"<\/p>\n

II.Nguy\u00ean nh\u00e2n:<\/strong><\/p>\n

1.Do b\u1ea5t th\u01b0\u1eddng t\u1ea1i trung t\u00e2m.<\/p>\n

Qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n nang no\u00e3n v\u00e0 ph\u00f3ng no\u00e3n di\u1ec5n ra \u0111\u1ec1u \u0111\u1eb7n do ho\u1ea1t \u0111\u1ed9ng ki\u1ec3m so\u00e1t c\u1ee7a tr\u1ee5c h\u1ea1 \u0111\u1ed3i-tuy\u1ebfn y\u00ean-bu\u1ed3ng tr\u1ee9ng v\u1edbi s\u1ef1 ch\u1ebf ti\u1ebft theo xung c\u1ee7a GnRH t\u1eeb v\u00f9ng h\u1ea1 \u0111\u1ed3i \u0111i\u1ec1u h\u00f2a s\u1ef1 ch\u1ebf ti\u1ebft c\u00e1c gonadotrpins c\u1ee7a tuy\u1ebfn y\u00ean v\u00e0 sau \u0111\u00f3 l\u00e0 c\u00e1c hormone t\u1ea1i bu\u1ed3ng tr\u1ee9ng.Khi GnRH b\u1ecb \u1ee9c ch\u1ebf s\u1ef1 ch\u1ebf ti\u1ebft gonadotropins c\u1ee7a tuy\u1ebfn y\u00ean kh\u00f4ng c\u00f3 d\u1ea1ng c\u00e1c \u0111\u1ec9nh, kh\u00f4ng c\u00f3 \u0111\u1ec9nh LH v\u00e0 kh\u00f4ng c\u00f3 ph\u00f3ng no\u00e3n.<\/p>\n

M\u1ed9t tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t l\u00e0 h\u1ed9i ch\u1ee9ng t\u0103ng prolacin m\u00e1u \u00a0d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n kinh nguy\u1ec7t \u1edf pha ho\u00e0ng th\u1ebf, \u0111\u1ebfn kh\u00f4ng ph\u00f3ng no\u00e3n v\u00e0 cu\u1ed1i c\u00f9ng v\u00f4 kinh do GnRH b\u1ecb \u1ee9c ch\u1ebf ho\u00e0n to\u00e0n.<\/p>\n

2.B\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u00e1c t\u00edn hi\u1ec7u ph\u1ea3n h\u1ed3i:<\/p>\n

Estrogen tham gia t\u00edch c\u1ef1c v\u00e0o qu\u00e1 tr\u00ecnh \u0111i\u1ec1u h\u00f2a ph\u00f3ng no\u00e3n nh\u1edd 2 c\u01a1 ch\u1ebf ph\u1ea3n h\u1ed3i \u00e2m v\u00e0 ph\u1ea3n h\u1ed3i d\u01b0\u01a1ng l\u00ean tr\u1ee5c h\u1ea1 \u0111\u1ed3i-tuy\u1ebfn y\u00ean-bu\u1ed3ng tr\u1ee9ng. Khi n\u1ed3ng \u0111\u1ed9 Estradiol kh\u00f4ng gi\u1ea3m \u0111\u1ebfn m\u1ee9c FSH \u0111\u01b0\u1ee3c \u201ctho\u00e1t \u1ee9c ch\u1ebf\u201d \u0111\u1ec3 t\u0103ng ti\u1ebft tr\u1edf l\u1ea1i trong pha s\u1edbm c\u1ee7a giai \u0111o\u1ea1n nang no\u00e3n th\u00ec nang tr\u1ee9ng kh\u00f4ng th\u1ec3 ph\u00e1t tri\u1ec3n.Hay n\u1ed3ng \u0111\u1ed9 estradiol kh\u00f4ng \u0111\u1ee7 cao \u0111\u1ec3 t\u1ea1o ph\u1ea3n h\u1ed3i d\u01b0\u01a1ng \u1edf cu\u1ed1i pha nang no\u00e3n d\u1eabn \u0111\u1ebfn t\u0103ng ti\u1ebft LH v\u00e0 t\u1ea1o \u0111\u1ec9nh LH gi\u00fap tr\u01b0\u1edfng th\u00e0nh v\u00e0 ph\u00f3ng no\u00e3n.<\/p>\n

3.T\u00ecnh tr\u1ea1ng t\u1ea1i ch\u1ed7 c\u1ee7a bu\u1ed3ng tr\u1ee9ng:<\/p>\n

IGF-I \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t t\u1eeb t\u1ebf b\u00e0o v\u1ecf d\u01b0\u1edbi k\u00edch th\u00edch c\u1ee7a gonadotropin. IGF-I k\u00edch th\u00edch s\u1ef1 sinh s\u1ea3n v\u00e0 ph\u00e1t tri\u1ec3n c\u1ee7a t\u1ebf b\u1ea3o h\u1ea1t, ho\u1ea1t \u0111\u1ed9ng th\u01a1m h\u00f3a v\u00e0 t\u1ed5ng h\u1ee3p progesterone.IGF-II c\u00f3 th\u00ea ho\u1ea1t \u0111\u1ed9ng \u0111\u1eb7c bi\u1ec7t l\u00ean nang no\u00e3n v\u01b0\u1ee3t tr\u1ed9i<\/p>\n

FSH \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p c\u1ee7a protetin g\u1eafn k\u1ebft IGF. FSH k\u00edch th\u00edch s\u1ea3n xu\u1ea5t activin v\u00e0 inhibin t\u1eeb t\u1ebf b\u00e0o h\u1ea1t.<\/p>\n

Inhibin l\u00e0m t\u0103ng t\u1ed5ng h\u1ee3p androgen d\u01b0\u1edbi k\u00edch th\u00edch c\u1ee7a LH \u1edf t\u1ebf b\u00e0o v\u1ecf \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u1ee7 nguy\u00ean li\u1ec7u cho qu\u00e1 tr\u00ecnh th\u01a1m h\u00f3a x\u1ea3y ra \u1edf t\u1ebf b\u00e0o h\u1ea1t \u2026<\/p>\n

C\u00e1c qu\u00e1 tr\u00ecnh tr\u00ean ph\u1ea3i di\u1ec5n ra \u0111\u1ed3ng b\u1ed9 \u0111\u1ec3 t\u1ea1o m\u1ed9t chu k\u00ec ph\u00f3ng no\u00e3n b\u00ecnh th\u01b0\u1eddng.<\/p>\n

III.Ch\u1ea9n \u0111o\u00e1n:<\/strong><\/p>\n

P<\/strong>h\u00f3ng no\u00e3n l\u00e0 m\u1ed9t hi\u1ec7n t\u01b0\u1ee3ng x\u1ea3y ra t\u1ea1i m\u1ed9t th\u1eddi \u0111i\u1ec3m ch\u00ednh x\u00e1c, m\u00e0 tr\u01b0\u1edbc v\u00e0 sau th\u1eddi \u0111i\u1ec3m \u0111\u00f3, c\u00f3 r\u1ea5t nhi\u1ec1u nh\u1eefng thay \u0111\u1ed5i v\u1ec1 h\u00ednh th\u00e1i v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a bu\u1ed3ng tr\u1ee9ng, tr\u1ee5c h\u1ea1 \u0111\u1ed3i-tuy\u1ebfn y\u00ean-bu\u1ed3ng tr\u1ee9ng v\u00e0 c\u00e1c c\u01a1 quan \u0111\u00edch c\u00f3 li\u00ean quan.<\/p>\n

\u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00f3ng no\u00e3n ch\u00fang ta c\u1ea7n n\u1eafm v\u1ee9ng sinh l\u00fd chu k\u00ec kinh nguy\u1ec7t b\u00ecnh th\u01b0\u1eddng. B\u1ea5t k\u1ef3 nh\u1eefng thay \u0111\u1ed5i n\u00e0o v\u1ec1 m\u1eb7t h\u00ecnh th\u00e1i, ch\u1ee9c n\u0103ng c\u1ee7a chu k\u00ec kinh nguy\u1ec7t b\u00ecnh thu\u1eddng \u0111\u1ec1u c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng l\u00e0m d\u1ea5u hi\u1ec7u ch\u1ea9n \u0111o\u00e1n ph\u00f3ng no\u00e3n.<\/p>\n

1.C\u00e1c test l\u00e2m s\u00e0ng:<\/p>\n

-H\u1ecfi b\u1ec7nh s\u1eed: khai th\u00e1c chu k\u00ec kinh nguy\u1ec7t, c\u00e1c d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd c\u00f3 ph\u00f3ng no\u00e3n nh\u01b0: t\u0103ng th\u00e2n nhi\u1ec7t xung quanh ng\u00e0y gi\u1eefa chu k\u00ec kinh, ra nhi\u1ec1u ch\u1ea5t nh\u1ea7y trong dai d\u00ednh \u1edf \u00e2m \u0111\u1ea1o\u2026<\/p>\n

-Bi\u1ec3u \u0111\u1ed3 th\u00e2n nhi\u1ec7t:<\/p>\n

Nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 th\u01b0\u1eddng t\u0103ng 0.3-0.5 \u0111\u1ed9 C trong giai \u0111o\u1ea1n ho\u00e0ng th\u1ec3 do t\u00e1c \u0111\u1ed9ng \u0111i\u1ec1u h\u00f2a th\u00e2n nhi\u1ec7t c\u1ee7a progesterone\u00a0 \u1edf v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i v\u00e0 khi n\u1ed3ng \u0111\u1ed9 progesterone kho\u1ea3ng 4ng\/ml hay cao h\u01a1n.Do \u0111\u00f3 nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 th\u01b0\u1eddng t\u0103ng sau khi xu\u1ea5t hi\u1ec7n \u0111\u1ec9nh LH 2 ng\u00e0y.<\/p>\n

-Ch\u1ea5t nh\u1ea7y c\u1ed5 t\u1eed cung:<\/p>\n

Estrogen th\u00fac \u0111\u1ea9y m\u1ed9t l\u01b0\u1ee3ng l\u1edbn ch\u1ea5t nh\u1ea7y c\u1ed5 t\u1eed cung l\u1ecfng, dai, d\u00ednh\u00a0 v\u00e0 c\u00f3 h\u00ecnh \u1ea3nh l\u00e1 d\u01b0\u01a1ng x\u1ec9.Ng\u01b0\u1ee3c l\u1ea1i progesterone l\u00e0m cho ch\u1ea5t nh\u1ea7y c\u1ed5 t\u1eed cung \u0111\u1eb7c l\u1ea1i.Do \u0111\u00f3 xung quanh th\u1eddi \u0111i\u1ec3m ph\u00f3ng no\u00e3n ch\u1ea5t nh\u1ea7y c\u1ed5 t\u1eed cung s\u1ea3n xu\u1ea5t nhi\u1ec1u v\u00e0 th\u01b0\u1eddng d\u00ednh, dai do \u1ea3nh h\u01b0\u1edfng c\u1ee7a estrogen.<\/p>\n

Hi\u1ec7n nay, \u00edt \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

-Sinh thi\u1ebft n\u1ed9i m\u1ea1c t\u1eed cung(NMTC):<\/p>\n

H\u00ecnh \u1ea3nh m\u00f4 h\u1ecdc c\u1ee7a NMTC \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c \u1ea3nh h\u01b0\u1edfng c\u1ee7a estrogen v\u00e0 progesterone l\u00ean NMTC. L\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng giai \u0111o\u1ea1n ho\u00e0ng th\u1ec3, do \u0111\u00f3 \u0111\u00e1nh gi\u00e1 hi\u1ec7n t\u01b0\u1ee3ng ph\u00f3ng no\u00e3n b\u00ecnh th\u01b0\u1eddng.<\/p>\n

Sinh thi\u1ebft NMTC n\u00ean \u0111\u01b0\u1ee3c l\u00e0m v\u00e0o ng\u00e0y 12 chu k\u00ec sau xu\u1ea5t hi\u1ec7n \u0111\u1ec9nh LH trong n\u01b0\u1edbc ti\u1ec3u.Tuy nhi\u00ean, v\u1ea5n \u0111\u1ec1 n\u00e0y c\u00f2n \u0111ang g\u00e2y tranh c\u00e3i v\u00ec kh\u00f4ng th\u1ec3 \u0111\u00e1nh gi\u00e1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ho\u00e0ng th\u1ec3 v\u00e0o m\u1ed9t l\u1ea7n sinh thi\u1ebft NMTC.<\/p>\n

-Si\u00eau \u00e2m:<\/p>\n

\u0110\u1eb7c bi\u1ec7t l\u00e0 si\u00eau \u00e2m \u0111\u1ea7u d\u00f2 \u00e2m \u0111\u1ea1o l\u00e0 c\u00f4ng c\u1ee5 h\u1eefu hi\u1ec7u gi\u00fap \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng, sinh l\u00fd, b\u1ec7nh l\u00fd c\u1ee7a bu\u1ed3ng tr\u1ee9ng. \u1ee8ng d\u1ee5ng trong vi\u1ec7c theo d\u00f5i s\u1ef1 ph\u00e1t tri\u1ec3n nang no\u00e3n.C\u1ea7n \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh nhi\u1ec1u l\u1ea7n trong m\u1ed9t chu k\u00ec.\u0110\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n gi\u1ea3n, r\u1ebb ti\u1ec1n, kh\u00f4ng g\u00e2y phi\u1ec1n h\u00e0, \u0111au \u0111\u1edbn cho b\u1ec7nh nh\u00e2n. Hi\u1ec7n nay si\u00eau \u00e2m \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng kh\u00e1 r\u1ed9ng r\u00e3i v\u00e0 mang l\u1ea1i hi\u1ec7u qu\u1ea3 cao.<\/p>\n

2.C\u00e1c test n\u1ed9i ti\u1ebft:<\/p>\n

-Estrogen:<\/p>\n

N\u1ed3ng \u0111\u1ed9 estradiol t\u0103ng d\u1ea7n trong m\u00e1u \u1edf giai \u0111o\u1ea1n nang no\u00e3n, \u0111\u1ea1t \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh ngay tr\u01b0\u1edbc kh\u1edfi ph\u00e1t \u0111\u1ec9nh LH v\u00e0 36 gi\u1edd tr\u01b0\u1edbc ph\u00f3ng no\u00e3n. Tuy nhi\u00ean \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00f3ng no\u00e3n c\u1ea7n x\u00e9t nghi\u1ec7m m\u00e1u nhi\u1ec1u l\u1ea7n, g\u00e2y phi\u1ec1n h\u00e0 v\u00e0 \u0111au \u0111\u1edbn cho b\u1ec7nh nh\u00e2n.V\u00ec v\u1eady m\u1ed9t s\u1ed1 ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a estrogen \u0111\u01b0\u1ee3c \u0111\u1ecbnh l\u01b0\u1ee3ng trong n\u01b0\u1edbc ti\u1ec3u b\u1eb1ng k\u0129 thu\u1eadt EIA \u0111\u00e3 \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00f3ng no\u00e3n.<\/p>\n

-Progesterone:<\/p>\n

\u0110\u1ecbnh l\u01b0\u1ee3ng progesterone l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t \u0111\u1ec1 ch\u1ea9n \u0111o\u00e1n ph\u00f3ng no\u00e3n. Khi n\u1ed3ng \u0111\u1ed9 progesterone trong m\u00e1u l\u1edbn h\u01a1n 10ng\/ml c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng chu k\u00ed c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng ph\u00f3ng no\u00e3n.Tuy nhi\u00ean c\u00f2n nhi\u1ec1u tranh c\u00e3i trong vi\u1ec7c \u0111\u1ecbnh l\u01b0\u1ee3ng 1 l\u1ea7n hay nhi\u1ec1u l\u1ea7n v\u00e0 th\u1eddi \u0111i\u1ec3m \u0111\u1ecbnh l\u01b0\u1ee3ng progesterone. Ngo\u00e0i ra c\u00f3 th\u1ec3 \u0111\u1ecbnh l\u01b0\u1ee3ng ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a progesterone trong n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

-LH<\/p>\n

Nh\u1eefng thay \u0111\u1ed5i b\u1ea5t th\u01b0\u1eddng c\u1ee7a n\u1ed3ng \u0111\u1ed9 LH c\u0169ng nh\u01b0 thay \u0111\u1ed5i c\u1ee7a \u0111\u1ec9nh LH \u1edf gi\u1eefa chu k\u00ec c\u00f3 th\u1ec3 g\u1ee3i \u00fd nguy\u00ean nh\u00e2n b\u1ea5t th\u01b0\u1eddng c\u1ee7a giai \u0111o\u1ea1n ho\u00e0ng th\u1ec3.<\/p>\n

\u0110\u1ecbnh l\u01b0\u1ee3ng LH trong m\u00e1u c\u1ea7n \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh m\u1ed7i ng\u00e0y (c\u00f9ng m\u1ed9t th\u1eddi \u0111i\u1ec3m) t\u1eeb 3-4 ng\u00e0y tr\u01b0\u1edbc th\u1eddi \u0111i\u1ec3m c\u00f3 nghi ng\u1edd ph\u00f3ng no\u00e3n. Khi b\u1eaft \u0111\u1ea7u c\u00f3 gia t\u0103ng n\u1ed3ng \u0111\u1ed9 LH c\u1ea7n th\u1ef1c hi\u1ec7n test m\u1ed7i 12 gi\u1edd \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u1ec9nh LH \u1edf gi\u1eefa chu k\u00ec. Tuy nhi\u00ean vi\u1ec7c \u0111\u1ecbnh l\u01b0\u1ee3ng nh\u01b0 th\u1ebf g\u00e2y phi\u1ec1n h\u00e0 v\u00e0 \u0111au \u0111\u1edbn cho b\u1ec7nh nh\u00e2n. \u0110\u1ecbnh l\u01b0\u1ee3ng LH trong n\u01b0\u1edbc ti\u1ec3u kh\u1ea3 thi h\u01a1n. V\u00e0o gi\u1eefa chu k\u00ec s\u1ef1 gia t\u0103ng n\u1ed3ng \u0111\u1ed9 LH trong n\u01b0\u1edbc ti\u1ec3u theo sau n\u1ed3ng \u0111\u1ed9 LH trong m\u00e1u kho\u1ea3ng 12 gi\u1edd.<\/p>\n

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

RLPN l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n g\u00e2y v\u00f4 sinh n\u1eef kh\u00e1 th\u01b0\u1eddng g\u1eb7p.Ch\u1ea5n \u0111o\u00e1n RLPN \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n c\u00f4ng phu v\u00e0 c\u00f3 th\u1ec3 c\u1ea7n k\u1ebft h\u1ee3p nhi\u1ec1u test t\u00f9y theo m\u1ee5c \u0111\u00edch ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Bs.\u00a0Luy\u1ec7n Th\u1ecb Ng\u1ecdc Dung\u00a0\u2013 TS.BS. L\u00ea V\u01b0\u01a1ng V\u0103n V\u1ec7<\/em><\/p>\n

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

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