HC VIN PHNG TH KHU CK1-16 CHA

M U
3 thng gia v cui siu m c th phn bit c

vng ngc v bng. Ngc thai nhi nm trn c honh Ct dc: c honh l ng phn m km, gii hn gia tim+phi trn v gan+lch di Trung tht chim v tr trung tm lng ngc. Phn ln tim nm lch tri ng gia trung tht.

CU TRC PHI

C HONH

Hnh nh c honh phi

Tnh cht m vang khc bit gia phi v gan. Phi

tng m hn gan.

Hnh nh c honh tri

D dy v tim cng bn

BNH L
Thiu sn phi
Thot v honh Phi bit lp

Bnh phi tuyn nang

Trn dch mng phi HC tc nghn ng th cao

THIU SN PHI
Him gp
L tnh trng thiu nhu m phi Nguyn nhn do ri lon giai on u ca bo thai

Thng i km vi bnh tim bm sinh: TLN,TLT, cn

l bu dc, thot v honh.

THIU SN PHI

THIU SN PHI

THIU SN PHI

THIU SN PHI

THIU SN PHI

THIU SN PHI
Ch s: chu vi ngc/chu vi bng
Chu vi ngc(TC) o khng nh chu vi bng(AC) phi

loi tr phn da. Tnh ch s TC/AC, ch s ny t khi thay i theo tui thai. Bnh thng TC/AC 0,8 sau 20 tun. Nu <0,8 xem nh thiu sn phi, thai s cht sau sinh.

PHI BIT LP

PHI BIT LP
L d dng bm sinh him gp, l mt thy phi khng

c chc nng h hp. Tn thng l nang, nhiu nang cha dch, c khi cha kh hoc khi c. Khng c kh ph qun v ng mch phi, c ng mch nui t i tun hon thng l t nhnh ca ng mch ch ngc hoc ng mch ch bng. TM hi lu thng lTM ch di hoc h TM azygos V tr: thng phn thy y sau, bn tri> bn phi

PHI BIT LP
C hai loi phi bit lp:
Phi bit lp trong thy: tn thng c bao bc

bi t chc phi ca thy phi Phi bit lp ngoi thy: c bao bc bi mng phi ring Hnh nh siu m: Khi tng m nm pha sau phi Km theo a i, ph thai.

PHI BIT LP

PHI BIT LP

PHI BIT LP

PHI BIT LP

PHI BIT LP

PHI BIT LP
Thng c hnh tam gic, tng m, cn chn on

phn bit vi bnh phi tuyn nang type III, da vo siu m Doppler mu. Phi bit lp: ng mch nui xut pht t ng mch ch. Bnh phi tuyn nang: ng mch nui xut pht t ng mch phi

PHI BIT LP

PHI BIT LP

PHI BIT LP

Vng tng m y phi tri c cung cp mu nui bi MC

PHI BIT LP

PHI BIT LP

PHI BIT LP

PHI BIT LP C TRC V SAU SINH

PHI BIT LP C TRC V SAU SINH

PHI BIT LP

PHI BIT LP

PHI BIT LP

THOT V HONH

THOT V HONH
Nguyn nhn: c honh ng khng hon ho tun

th 10 ca phi, lm cc cu trc trong bng thot ln trn lng ngc. Tn sut 1/2000-1/5000 ca sinh. rng 2-3cm n c honh Thi im pht hin: ty vo rng ca l thot v. C th sm t tun 17-20. 20-53% kt hp vi cc d tt bm sinh khc: tim, TKTW, RLNST.

THOT V HONH
V tr: thot v nu pha trc th qua l Morgagni v

pha sau th qua l Bochdalek, cng c th thot v qua khe thc qun. Thot v bn phi chim 20%, bn tri chim 80% (qua l Bochdalek tri).

THOT V HONH

THOT V HONH
Mt s im cn lu :
Cn phi ngh n thot v honh khi khng thy d

dy nm trong bng Vic thy vm honh dng nh ton vn khng loi tr thot v honh Lt ct 4 bung tim rt quan trng chn on thot v honh: nu d dy nm cnh tim th phi ngh n thot v honh.

THOT V HONH TRI (80%)

Khi cu trc m khng ng nht trong lng ngc tri

y trung tht sang phi. Hin din d dy trong lng ngc: cu trc ti dch, thnh nhn ng thi khng thy d dy trong bng. S t on ca c honh: thng thy qua mt ct dc, qua cc cu trc trong bng i ln lng ngc. Quan st thy nhu ng rut trong lng ngc Chuyn ng nghch thng ca cc cu trc trong bng vi h hp ca thai nhi: trong th ht vo cc cu trc bn phi bng chuyn ng xung di, trong khi cc cu trc bn tri bng li chuyn ng ln trn hoc i vo lng ngc.

THOT V HONH T

THOT V HONH T

THOT V HONH T

XQ LNG NGC SAU SINH

THOT V HONH T

THOT V HONH T
Khi thot v gan vo lng ngc: cu trc m ng

nht, lin tc vi cu trc gan trong bng qua l thot v. iu ny c chn on x bng Doppler mu khi thy c s lin tc ca mch mu gan, mch mu gan c hng i bt thng. Thiu sn phi P v tim b y qua phi, phi P b p li, c KT nh, thng nm sau tim Ph thai v cc bt thng khc.

THOT V HONH T

THOT V HONH T

THOT V HONH PHI

Khi cu trc m ng nht trong lng ngc phi

(gan) y trung tht sang tri. Chnh v cu trc m ca gan v phi u ng nht nn ta rt d b st thot v honh phi. Tuy nhin phi tng m hn gan Tim b y sang tri l ch im bt thng trong lng ngc TM rn thng b y lch qua phi Dng Doppler mu chn on xc nh da vo cu trc mch mu gan Thng c dch t do trong lng ngc

Lu
Thot v honh phi, d dy khng nm trong lng

ngc nn khi khng thy d dy lt ct 4 bung tim khng loi tr c thot v honh phi

THOT V HONH PHI

THOT V HONH PHI

Thot v honh phi y tim sang tri. Gan trong lng ngc vi hnh nh c trng ca cc tnh mch gan (cc mi tn). i trng gc gan C

THOT V HONH PHI

THOT V HONH PHI

TRN DCH MNG PHI

C th nguyn pht, trn dng chp, thng xy ra 1

bn. C th th pht: Ph thai Hygroma kystique Trn dch c hai bn v cn xng Siu m: hnh nh c dch trong mng phi Tim v trung tht b y

TRN DCH MNG PHI T

65

TRAN DCH MANG PHOI T

66

TRN DCH MNG PHI TRI

TRN DCH MNG PHI HAI BN

TRN DCH MP HAI BN

TRN DCH MP HAI BN TRONG BNH CNH PH THAI

BNH PHI TUYN NANG

L d dng cu trc phi
Nhu m phi tng m vang C nhiu nang to nh khng

u, khng thng vi nhau, c th ch c 1 nang duy nht Chn p trung tht y ngc vm honh Km theo ph thai, a i

BNH PHI TUYN NANG

Da vo kch thc nang STOCKER chia lm 3 type:
Type I: 50% gm nhng nang ln, k>15mm, tin

lng tt Loi II: 40% gm nhng nang nh hn, k<15mm, tin lng km Loi III: 10%, gm nhng nang nh li ti <5mm, tin lng xu.

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG TYPE I

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG

BNH PHI TUYN NANG TYPE III

BNH PHI TUYN NANG

BNH PHI TUYN NANG

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO
Do tc nghn ng th cao nn dch tit trong phi

khng thot ra c khin hai phi cng phng y vm honh dt xung Dch tit cng vi nhiu mt ngn cch trong m mm to nn hnh nh tng m ng nht c hai phi Kh ph qun gin ra, lp dy dch c hnh trng m Thai nhi c th b ph thai do p sut trong lng ngc gia tng-> mu ca tnh mch kh tr v tim

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO

HC TC NGHN NG TH CAO

TNG KT

Thot v honh: Thot v honh tri: d dy trong lng ngc Thot v honh phi: d dy khng nm trong lng ngc Trn dch mng phi: nguyn pht thng 1 bn, th pht thng hai bn Bnh phi tuyn nang: ng mch nui t ng mch phi Phi bit lp: ng mch nui t ng mch ch Bnh phi tuyn nang type III: thng tn thng 1 bn phi HC tc nghn ng th cao: tn thng c hai phi

Xin cm n!