6 Co tuT cung I Bao thai hoc II M o hoc III Cac u lanh tmh IV Cac u ac tmh I Bao thai hoc: Xem phan noi mac tu cung (ChifOng 5) II Mo hoc A Cac bo ldn te bao c o tron hinh thoi ben xoan voi co nhan hinh thoi dai, dau tu B Cac dao m o lien ket dac vdi nhieu dong mach va tTnh mach giCfa cac bo co C Q u a san va phi dai te bao c o tir cung thoi ky thai (dai 20 -6 0 |_im) III Cac u lanh tinh A Benh u tuyen co • Kh on g phai la u thuc thu • D a c trirng boi sir xam lan lanh tinh cua noi mac tir cung vao lop c o tu' cung • G a p 25-40% t6ng so mau tir cung diroc cat • Dai the: Tir cung to sau thirong day hon truo'c Dien cat co c o day can doi, lan toa voi dang be xoan va cac vung chira m au xam mau mau so-co-la 89 • Vi the: M o noi ma c tu cu ng n a m phia dudi noi mac tir c u n g nen it nhat m o t trudn g kinh co ng dai ldn (10 x 40) Noi m a c tir c u n g day cd the k h o n g cd chu c n a n g hoac co c h u c n a n g (che tiet, cac thay doi thai nghen) • L am sang: Rong kinh, dau bung kinh, tir cung to • Hiem gap thay doi ac tinh Tien luong rat tot vdi ung thir bieu md tuyen tai benh u tuyen co • Dieu tri: Chat tuong tu G n RH , hormon chu ky, hoac chat uc che tdng hop prostaglandin Cat tir cung la dieu tri chac chan B U co tron tu cung (dang xa) • La khoi u vung tieu khung thudng gap nhat: 20% phu nu tren 30 tudi co nguy co u co' tir cung • Vi tn: Dudi niem mac, to chuc ke va dudi mac (co the day ch an g hoac canh) • Dai the: La nhan m au trang chac, dien cat cd h'rnh be xoan Gia vo hoc cua td chuc xung qu anh cho phep cat u co • Vi the: Cac te bao co hinh thoi ng nhat nhan hinh dui sap xep kieu xoan de len • Dieu tri: Cat u co cat tir cung toan bo hoac cat qua soi buong tir cung • U co tron ngoai tu cung - Benh u c o tron tinh mach: La u c o xuat phat tu cung va tinh ma ch chau, sau di chuyen vao tinh m a c h chu dudi, tim phoi Hinh anh vi the lanh tinh: dien bien lam sang lanh tinh va keo dai Di6u tri: Cat tir cung va neu cd the, lay cac ton thirong ngoai tu cung - U co' tu cung lan tran phuc mac (LPD) • H ie m gap (60 trudng hop da duoc ghi nhan), chu yeu d phu n u cd thai • Dai the: Nhieu u co tu cung nho nam mac noi ldn, khoang phuc mac, dai-tieu trang, bang quang giong n hu ung thu bieu m d lan tran phuc mac • Vi the: U c o lanh tinh • Dieu tri: T A H - B S O mot so trudng hop: mot so thoai trien sau thai • Cac thay ddi thu' phat u co' - Thoai hoa kinh: T hu dn g gap nhat - Thoai trien nang - Thoai trien vdi hoa - N h i i m khuain va sinh mu (u x o d u d i niem mac) - Hoai tir (u co cd cuong) thoai trien dang thit thai - Cac thay ddi dan g sacdm: Hiem gap (0,5% ) • Cac tip m d hoc u khac cua u co' tron - U co' tron te bao: Mem dang cao su xam, cau tao gom cac te bao dai sat nhan hien lanh Lanh tinh - I) co' tron k\ quai (u c o tron bat thuong): Xay u co' tron tac mach thoi k\ thai va o' phu nu' dung tlnioc tranh thai Cau tao gom cac te bao co vdi nhan ldn tang 91 sac, da hinh thai va tao te bao kh6ng 16, nhu ng khong co hinh anh gian phan hoac < hinh anh gian phan/vi trudng (2 MF/HPF); co the nham vdi sacom c o t r o n Lanh tinh - U c o tron dang bieu m o (u nguyen bao co tron): Cac te bao tron hoac hinh da dien va co bao tuong sang, ua acid, sap xep dai hoac ludi Lanh tinh neu < MF/10 HPF (RJ K ur ma n va HJ Norris) C U dang u tuven (u trung bieu mo) • Hiem gap, giong vo'i u co tron, mau trang xam, duong kinh tir 0,5-2 cm • Duoc coi la u bieu m o lanh tinh (tuong tu n hu ton thuang cua voi trung) • Vi the: Cac khoang giong tuyen duoc lot boi te bao lat hoac te bao vuong va bao quanh bang tci chuc dem dac hoac co tron • Dit!u tri: Cat t6n thuong hoac cat tir cung D Nhan mo dem • Dai the: Hau n hu luon luon don doc, co ranh gidi ro: kich thuoc tir rat nho toi > cm • Vi the: Cac te bao de m noi mac tir cung tap trung hinh cau co' tir cung voi ria bi duiy: khong xam lan bach mach hoac xam lan mach mau Hinh anh gian phan < 10 MF/10 HPF (HJ Norris va HB Taylor) • Dac diem lam sang: Chav mau tir cung bat thudng cac ton thu'ong Ion • Dieu tri: Cat tir cung dud ng bung toan bo 02 • Lanh tinh, tien lupng tot E Benh mo dem (u co' mo dem mach bach huvet) • Dai the: U co tir cung hoac nho vao buong tir cung nhu mo t khoi dang polip • Vi the: Cac te bao dem noi mac tir cung voi su tham nhiem ria; nhan min; < 10 MF /10 HPF; thudng kern ton thuong mach m a u va bach huyet (HB Taylor va HJ Norris) • Co the lan ngoai tir cung va co the di can • Thuong tai phat tai tieu khung (50%) trir trudng hop khoi u nho • D u o c coi la sacom m o de m co dp biet hoa thap • L am sang: Chay m a u tir cung bat thuong, dau bung hoac dau vung tieu khung, tir cung to • D ieu tri: TA H- BSO : Progestogen khong ngat quang doi vdi trudn g hop tai phat hoac neu benh mo de m da xam lan > 50% ldp co' tir cung (JD Woodruff) • Tien luong: Tuo'ng ddi thuan lpi, tham chi vdi trudng hop tai phat lai tai chd IV Cac u ac tmh A Phan giai doan F IG O : Khong co Sir dung phan giai doan phau thuat ung thu bieu m o noi mac tu cung B Phan loai Oher cho sacom Sacom don thuan - D o n dang S a c o m m o d e m ( x u a t p h a t tir m o d e m n oi m a c tir c u n g ) 93 Sacom co tron (xuat phat tir u co hoac co tir cung binh thudng) Sacom mach Sacom xo - H6n tap (cuc hiem) Sacom c o van Sacom sun • Sacom xuong Sacom m o Sacom don thuan hon hop (don dang hoac hon tap) • U trung bi hon hop - Don dang: Ung thu bieu m o sacom - Hdn tap: U trung bi h6n hop (u M ul le r hon hop) C Phan loai sacom cua Nhom ung thu phu khoa (GOG): Sacom co tron, sacom mo dem, u trung bi hon hop (ung thu bieu mo sacom), cac sacom khac • Sacom co tron - Tudi mdc trung binh: 52 tudi, 20 % kh o ng sinh - Lam sang: Rong kinh hoac m au sau m a n kinh dau vung tieu khung khoi u bung - Ti le thoai trien sacom u co tir cung: < 0,5% - Dai the: U co me m hoai tir, kieu “ thit s on g” ; tir cung to toan bo sacom c o tron tir cung nguyen phat 94 - Vi the: Can chan doan phan biet voi u co te bao va u co ky quai Chain doan chu yeu dira tren so luong hinh anh gian phan ( M F ) tren 10 vi trudng ldn (HPF: x 400) • < M F /1 HPF: Lanh tmh • 5-9 M F / HPF: Khong khang dinh kha nang ac tinh • > M F /1 HPF: Ac tinh - Song them nam (Dinh va Woodruff) tdi M F / HPF: 94,6% tdi M F /1 HPF: 48, 2% > 10 M F /1 H P F 24,2% - Cac dac diem cho tien luong tot gom: Tinh trang t i i n man kinh, ft M F /H PF , kh on g co hoai tir, cd thoai hoa kinh, khu tru tai u c o tir cung, giai doan sdm - U bieu hien bat san, da hinh thai, te bao khon g 16 hoac dang bieu m o vdi > M F / H PF du o c coi la s aco m c o tron (RL K em ps on va M R Hendrickson) - Dieu tri: T A H -B SO Dieu tri hoa chat bP ti p (Adriamycin) khong co gia tri - Song the m nam: Giai doan I 56%: giai doan II-IV 7% (OM Salazar) • Sacom mo dem - La ket thuc ac tinh cua tang sinh mo dem (Nhan mo d e m - B e n h mo de m - Sacom m o dem) - La loai sacom hiem gap nhat 95 - Lam sang: Rong kinh chay mau sau man kinh khoi u bung, dau tieu khung - Dai the: U mau trang hoac hong xam, m e m va loi dang polip vao buong tu cung - Vi the: Cac dam te bao dem vo'i hinh anh gian phan tren 10 MF /10 HPF, thudng gap hinh anh nhan khong dien hinh xam lan ma ch m au va mac h bach huyet - U lan tran theo duon g bach m ac h va dudng mau - D i e u tri: TAH -BSO , co the di£u tri Progestogen, hoac dieu tri hoa chat bd tip - Tien lupng: Xau, song them nam giai doan I 55%: giai doan II-IV la 12% (O M Salazar) - Cac dac diem tien lupng xau: Kich thuoc u (> cm) va xam lan rong ngoai tu cung • U trung bi hon hop (ung thu bieu mo sacom) - Ch ie m kh oang 3%> tdi 6% tong so ung thu tu cung - Xa y nhung benh nhan nhieu tu6i hon (tuPi trung binh la 62), u ac tmh - 10-30%- cd tien sir tia xa vao khung chau (11-16 nam trudc do) - Dai the’: U m£m va dang polyp buong tu cung doi sa qua cd tu cung (1 /3 so trudng hop), doi rat ldn - Vi the: La su hPn hop giua cac phan ung thu bieu m d va sacom 96 • U n g thir bieu mo (tuyen hoac vay) vdi sacom md dem hoac sacom co tron: Ung thu bieu mo sacom, don dang • Ung thu bieu md vdi sacom sun hoac sacom co' van hoac saco m xuong: Ung tlur bieu m d sacdm, hon tap - X a m lan co tu cung thudng tai thoi diem chan doan (60% theo FJ DiSaia) - Di can hach bach huyet sdm (35% giai doan I [PJ DiSaia]) vdi cung tan so ddi vdi ung thu bieu md sacdm don dang hay hon tap - Di can giong vdi ung thu bieu md tuyen 75% tdi 80% cac trudng hop - Lam sang: Chay m au sau ma n kinh, hu am dao dau vung tieu khung khoi u bung - Dieu tri: TAH-BSO Dieu tri tia xa vao khung chau cd the kiem soat duoc tai chd tieu khung Dieu tri hoa chat bd tro it cd hieu qua - Cac yeu to quyet dinh tien luong: Do sau xam lan co' tu cung va inu'c lan rdng u (lan trail vao mach bach luiyet hoac du'dne mau) cac u khong ng nhat Cac yeu to khong dong nhat cd tac dun g phu den thoi gian song them (thdi gian song them khdmi tien trien benh trung binh la 22.7 thang so vdi 62.6 thaiiiz doi vdi loai ung thu bieu mo sacdm dong nhat) ■ - I'ien luong: Xau Song them nam giai doan I la 50%: giai doan II IV 12% (O M Salazar) 97 T7-LSPK • Cac sacom tir cung khac - Sacom tuyen (sacom tuyen Muller) • Xay d moi lu'a tuoi • Lam sang: Chay mau am dao bat thudng, dau tieu khung khoi u l6i qua co tu cung • Dai the: Giong vdi tang trudng kieu polip • Vi the: Bieu mo giong vdi noi mac tir cung tang sinh hoac khong hoat dong, mo dem khong dien hinh vdi hinh anh gian phan (> MF /10 HPF) (cac tuyen lanh tinh), m d dem ac tinh Cac tuyen sau duoc bao quanh la mo dem tang sinh te bao • Dieu tri: TAH-BSO theo sau bdi tia xa toan khung chau (Morrow va DE Townsend) • 1/3 so trudng hop tai phat sau thang tdi nam - Sacom co' van sacom sun sacom mach: Hiem gap 98 - La trirang hap phan tach sdm rau thai sau 20 tuan - Rau bong tai trung tarn, hoac ria, ban phan hoac toan bo - Kham dai the la cuc ky quan trong chain doan rau bong non: Vung xuat huyet lan vao mo rau va thay the no - Vi the co vai tro chain doan rat it - V a xoang ria: Rau bong tai ria, dugc xep vao loai rau bong ban phan - Lam sang: Th u an g ket hap vdi n h i i m doc thai nghen, tang huyet ap, chan thuong Dau hieu: Dau, soc, tir cun g co cung, suy thai hoac chet thai, giam fibrinogen mau, suy than cap IV Rau thai benh ly thai A Nhiem doc thai • Kh dng cd tdn thua ng m d hoc dac trung • Cac tdn thuong thudng gap la mac h mau cd nhoi m au rau thai rong va tu mau sau rau thai • Dai the’: Rau thai nho thudng nhuom mau phan xu • Vi the - Nhoi m au cap hoac man (ngung tap long rau vdi su tac cac khoang lien long rau) - X a vua cap cac tieu dong mac h m a n g dem cua me (hoai tu dang x a mach mau, tap trung dai thuc bao chua md tham nhiem bach cau da n nhan q ua nh m ac h mau) - Tap trung not hop bao cao tai cac vung khong nhdi mau (dau hieu Tennev-Parker hay hinh “ ban c d ' ') 186 B Churng tang nguyen hong cau thai • Rau thai to va phu: ti le thai: rau < 3: • Dai the: Rau thai nang voi mui rau lan, mau xanh xam, hoac xam vang, mun • Vi the: Long rau nd to - Nguyen bao nuoi chua trudng cd lien quan tdi giai doan mang thai: Hop bao day cung tdn tai vdi nguyen bao nuoi - Mo dem long rau phu va qua san: nhieu te bao Hofbauer; giam so luo'ng mach mau: mach mau gian chua hong cau cd nhan (binh thudng hdng cau cd nhan khong gap long rau sau nua ky thai nghen) C Lao • Hiem gap • Dai the: Cd nhung viing nho xam chac tren be mat thai doi cd ba dau (cu lao) • Vi the: Tang sinh te bao noi mac te bao khong Id da nhan true khuan lao D Giang mai • Hiem gap 187 • Dai the: Rau thai lan va nhay ban mui rau Ion mau xanh xam, tran va mun • Vi the: Long rau Ion hinh mu tang sinh x a m d dem giam mach mau thai viem noi mac dong mach mat trudng long rau tung d hoac toan bo Tuy nhien nhurng thay doi khong dac trung cho giang mai va co the thoai trien sau thai chet • Co the gap cac xoan khuan rau thai loai va chung co the xam nhap qua hang rao rau thai tai bat ky thdi diem nao cua qua trinh mang thai E Dai thao duong • Dai the: Rau thai to va phu Nguy co' mot ng ma ch ron tang (3-5%) • Vi the: Khong cd dac diem dac hieu: long rau chua trudng thanh, phu long rau, va tang sinh nguyen bao nuoi V Cac benh viem A Viem mang di va mang dem • Thud ng gap (10% tong so ca de) • Nhiem khuan nguoc dong cd the true tiep tdi duo c cac mang va cd the qua rau thai vao tuan hoan me 188 • Vi khuan thu'ong gap nhat la: Echerichia coli tu cau lien cau lan huyet (3 nhom B • Vi the!: Cac te bao viem tai mang dem va mang di phia dudi B Viem rau thai • Mo long rau bi ton thuong thu phat sau cac mang nuoi bi tdn thuong hoac vi khuain cd the tdi rau thai qua mau me • Vi the: Tham n h i i m te bao viem long rau (viem long rau) • Tru'c khuain Listeria monocytogetv Tao cac vi ap-xe long rau, cac ma ng va cac co' quan cua thai • Toxoplasmia: Tham n h ii m limpho bao vao long rau; vi khuain gap dien cat cac mang • C y t o m e g a l o v i r u s ( C M V ) : Cd ca c the vui tr on g n h a n u'a acid tr on g cac te bao noi m a c , te bao H o f b a u e r , hoac ng u ye n bao nuoi la cac da c d i e m chain d o a n b e n h nhi en hiem cd the xac dinh Hoai tu' m o d e m long rau, tha m nh iem limpho-tu'o'ng bao va vie m m a c h go'i y kha nang nh ie m k h u a n C M V Ti le thai nhi m a c n h i e m k h u a n thai nhi la 0.2% d e n 2 % t ro n g td n g so ca de so ng VI U lanh (u mach mang dem) va cac ton thuong nguyen bao nuoi khong u A U mach mang dem 189 • La tdn thuang lanh tmh thuang gap nhat cua rau thai • U tron, chac, mau sam co vo hoc ki'ch thudc thay doi (< cm), thudng nam rau thai • Vi the: Kieu m ao mach biet hoa ro; noi mac va m o x a vdi cac te bao dem mang dem; mao ma ch chu a mau thai • Lam sang: La n g u y e n nhan hie m g a p c u a rau thai k h d n g hieu qua, k e m the o vdi cac bat th u d n g v i d ic h di va thai nhi, de non B Cac ton thirong nguyen bao nuoi khong phai u • Vi tri rau thai to bat thudng - T h a m n h i i m nguyen bao nuoi trung gian va h a p bao nuoi vao noi mac tu cung va co' tu cung tai vi tri rau bam - Xay chua trung, thai binh thudng hoac say thai - Cd the kho phan biet vo'i u nguyen bao nuoi tai vi tri rau thai (PSTT) - Cac tien trien sinh ly se duoc g ia i quyet tu nhien sau mang thai • Not tai vi tri rau thai - La su ngung tap nho cac nguyen bao nuoi trung gian gap nao thai 190 - Cau tao gom cac vi the cac chat kinh kem theo nguyen bao nuoi trung gian thoai hoa - Co nhung vung nho vi tri rau bam tu nhung lan mang thai trudc - Khong co vai tro tren lam sang VII Benh ac tmh: Benh nguyen bao nuoi thai (GTD) A Phan loai benh nguyen bao nuoi thai • Chua trung - Hoan toan (kinh dien) - Ban phan • Chua trung xam nhap • Ung thu bieu mo rau • U nguyen bao nuoi tai vi tri rau thai (PSTT) B Phan giai doan benh nguyen bao nuoi thai • Giai doan I: G TD khu tru tai than tu cung • Giai doan II: G TD lan rong to'i phan phu va cac cau true sinh due khac • Giai doan III: G T D lan rong tdi phoi kem theo vdi ton thuong dud ng sinh due hoac khong 191 '• Giai doan IV: Di can cac vi tri khac C Chua trung (hoan toan hoac ban phan) • T;'in so: 1/2500 trudng hop thai tai M y 1/125 tai Dai loan • Dai the: La mot khoi nang ktch thudc thay doi (tron dudng kmh cm); cd the cd cac ma nh rau thai binh thudng neu la chira trung ban phan • Vi the - Long rau truong to chua dich be chua trung tarn (cac khoang lom duoc mo trung m d bao quanh) - Mat hoan toan hoac rat it ma ch mau thai - T a n g sinh cac te bao nuoi go m cd: N gu ye n bao nuoi, nguyen bao nuoi trung gian va hop bao nuoi • L am sang: Chay mau am dao, tien san giat trudc 24 tuan mang thai; cuong giap trang tu cung to hon tuoi thai nang hoang the vd HCG tang cao hinh anh sieu am kieu bao tuyet Tien trien khong bien chung 80% cac trudng hop (V4 trudng hop tieii trien chira trung xam laii hiem chuve n ung thu bieu md rau • Dieu tri: Nao hut: cat tir cung neu benh nhan de nhieu 192 D Su khac giua clnia trung toan bo va chua trung ban phan • Chua trung toan bo: Co nguon goc tir bo: kieu nhan XX (96%) va XY (4r/ r ): long rau nude, khong co phoi 18% chuyen dang ac tmh • Chira trung ban phan: Co su gop phan tir ngudi me; kieu nhan: Boi nhiihn sac the bat thudng (thudng gap nhat la tarn boi); long rau nude hdn hop vdi long rau binh thuong; cd phoi, day ron va mang thai: cac mang long rau va nhung dam vui nguyen bao nuoi; 2.1% chuyen dang ac tmh (T Kajii va K O ma ) • Theo ddi: Dinh luong (3HCG hang loat (chira trung toan bo va chira tru'ng ban phan); dieu tri hoa chat ham luo'ng (3HCG hinh cao nguyen hoac gia tang (Methotrexate Actinomycin D) • Chira trung ban phan chiem 25% tdng so trudng hop thai trung E Chua tru'ng xam nhap (u tuyen m a n g de m pha huy) • Thuc te khong the chi dua vao nao thai de chan doan: thuong chan doan thong qua benh phaim cat tir cung • Vi the: Long rau nude xam Ian ldp co' tir cung: sinh san qua muc nguyen bao nuoi • Lam sang: Chay mau khong cam va HCG tang cao sau hut thai trung; u khu tru tai tir cung hiem di can phoi am 193 dao, hoac am ho: chay mau am dao nang hoac chay mau o phuc mac • Di^u tri: D i e u tri hoa c t k e m th e o h o ac k h o n g vdi cat tu c un g • Tien luong tot F Ung thu bieu md rau • U ac tmh tang trudng nguyen bao nuoi khon g duoc kiem soat • 50% cd t i l n sir chira trung trudc do; 30% say thai; 20% thai binh thudng • Dai the: U m l m chay mau • Vi the: Thieu long rau va tang sinh ngu yen bao nuoi trung gian, ngu yen bao nuoi va hop bao nuoi; chay mau: hoai tir • La m sang: Chay mau; HC G cao, di can phoi nao than, gan, ruot non lach va am dao • Dieu tri: Dieu tri hoa chat (A ctinomycin D Methotrexate, Chlorambucil) • Tien lu o n g d be n h n g u y e n ba o nuoi k h o n g di can: G a n n h u c h u a khoi c h u a khoi % 194 100%; b e n h n g u y e n b ao n uo i di ca n • Cac yeu to tien Iirgng xau: Dibenh lau (thdi gian tu lan cd thai cudi cung > thang), ham luong HCG trudc didu tri cao ( > 0 mlU/mL) di can nao hoac gan, dac biet trudc di6u tri hoa chat, u nguyen bao nuoi thai sau thdi ky thai G U nguyen hao nuoi tai vi tri rau ham (PSTT) • Duoc Kurman Norris va Scully md ta nam 1976 • La dang hiem gap nhat cua benh nguyen bao nuoi thai • Cd the nham vdi ung thu bieu md rau • Dai the: Mot khoi dang polip buong hoac thudng gap nhat la tu' cung • Vi the - Nguyen bao nuoi trung gian cau tao gom cac dai te bao mot nhan da dien ldn vdi nhan da hinh thai va bao tu'ong bat nhuom kep - Khong cd quan the hai loai te bao nguyen bao nuoi va hop bao nuoi khdng chay mau hoac hoai tu, duon g tmh manh vdi Lactogen rau thai ngu'di - Tien luong xau neu so luong te bao gian phan > MF/HPF (Scully) 195 • Lam sang: Vo kinh hoac chay mau am dao tu cung to bang kfch thuoc thai 8-16 tuan xet nghiem thai duo'ng tmh 1/3 so trudng hop, thu thuat nong va nao (D&C) thudng lam thiing tu cung (5/12 trudng hop), HCG thap • Da p ung kem vdi hoa tri • Tien luong tot vdi cat tir cung (50 trudng hop thi trudng hop chet) • D uoc coi nh u phan ung tai vi tri rau thai cuc ky cao (viem hop bao c o tir cung) ■ VIII Cac u th itp h a t A Di can rau thai tir u cua me • Di can tdi rau thai qua dud ng mau va chi xay d benh nhan cd benh lan toa rong • Theo tan so giam dan la: Ung thu hac to, ung thu vu va ung thu phe quan • Rau thai d benh u hac to ac tinh: U cd the nhin thav duoc la cac not cd mau nau hoac mau den, kich thudc thav ddi md rau thai Vi the cho thay cac dai te bao hac toiiac tinh khoang long rau B I)i can rau thai cua u thai • Hiem gap Tir u nguyen bao than kinh 1% • Rau thai to mau xanh xam nang (1000 g) • Vi the: Nhung dam cac nguyen bao than kinh lam tac cac mach long rau cua thai 197 M UC LU C Tran £ 1-AmhO - NIEU D A O 31 3- AM D A O 35 4-COTUCUNG 47 5- N0I M A C T U C U N G 69 - C O TU C U N G 89 7- VOI TRUNG 99 8- BUONG TRUNG: ] 1] VIEM, C A C TON THUONG K HO NG U, SU BIET H O A G O TINH SINH DUC BAT THUONG VA SUY BUONG TRUNG SOM 9- KHAl QUAT VE KHOI U BUONG TRUNG 125 10- C A C KHOI U BIEU M O BUONG TRUNG 131 11 - C A C U TE BAO MAM BUONG TRUNG 145 12- C A C U OEM SINH DUC BUONG TRUNG 159 13- C A C U BUONG TRUNG KHAC 167 14- U M A C TREO VOI TU C U N G , DAY C H A N G TU 173 C U N G VA PHUC M AC 5- RAU THAI 198 177 NHA XUAT BAN Y HOC LAM SANG PHU KHOA VA GIAI PHAU BENH ■ ■ Chju trach nhiem xuat ban HOANG TRONG QUANG Bien tap: BS VAN CHI SCra ban in: NHOM BIEN D|CH Trinh bay bia: CHU HUNG In 1000 cuon, kho 14,5x20,5 cm tai Xi/dng in Nha xuat ban Y hoc Giay phep xuat ban so: 317 - 1522/XB - QLXB 20/12/2002 In xong va nop li/u chieu quy I nam 2003 ... trung binh la 62), u ac tmh - 10 -30%- cd tien sir tia xa vao khung chau (11 -16 nam trudc do) - Dai the’: U m£m va dang polyp buong tu cung doi sa qua cd tu cung (1 /3 so trudng hop), doi rat ldn... t u y e n rd, de n h a m vdi un g thu bieu 11 10 tu y e n - D i i m tri: C a c t h u o c c h o n g l ao va p h a u t h u a t • Viem A ctinom yces 10 3 - Hiem gap thuong kern theo vai IUD - Vi... luong hinh anh gian phan ( M F ) tren 10 vi trudng ldn (HPF: x 400) • < M F /1 HPF: Lanh tmh • 5-9 M F / HPF: Khong khang dinh kha nang ac tinh • > M F /1 HPF: Ac tinh - Song them nam (Dinh va