Tham My Book Zip 419 PDF

Nhng iu cn bit v phu thut thm m
MC LC
i iu v phu thut thm m ............................................................................................... 7
Yu cu phu thut................................................................................................................ 7
Cc loi phu thut thng thng ......................................................................................... 7
Nhng phng php phu thut thng thng trn c th ....................................................... 9
Ht m bng ......................................................................................................................... 9
Chnh hnh thnh bng.......................................................................................................... 9
Ht m v cng da cnh tay................................................................................................ 10
Phu thut nng ngc.......................................................................................................... 10
Phu thut thu nh tuyn v................................................................................................ 11
Phu thut thm m cho ph n sau khi sinh ......................................................................... 12
Phu thut n ngc............................................................................................................ 12
Phu thut c nh v cao hn ............................................................................................ 12
Phu thut chnh hnh thnh bng....................................................................................... 12
Ht m ................................................................................................................................ 12
Phu thut b phn sinh dc ngoi ..................................................................................... 13
iu tr vt nm mt sau khi sinh ....................................................................................... 13
iu tr thu nh tuyn v phi nam ..................................................................................... 14
C da mt ................................................................................................................................ 16
Nhng thnh tu mi trong vic lt da mt............................................................................ 18
K thut lt da..................................................................................................................... 18
Sau khi lt da mt bng TCA.............................................................................................. 19
Kt qu ca phng php lt da bng TCA theo thi gian................................................. 20
Ti to da mt.......................................................................................................................... 21
Phn bit cc loi da v cch chm sc .............................................................................. 21
Vitamin C v s lo ha...................................................................................................... 22
Vitamin E v s lo ha...................................................................................................... 23
nh hng ca nh nng mt tri i vi da ..................................................................... 24
nh hng ca thuc l i vi da ..................................................................................... 24
Bin i da khi ln.............................................................................................................. 26
iu tr da mt ........................................................................................................................ 28
Da mt en v tc qun....................................................................................................... 28
iu tr da b lo ha........................................................................................................... 28
Xa np nhn trn trn........................................................................................................ 29
Tim thuc chng np nhn mt...................................................................................... 29
Lt da mt bng TCA ......................................................................................................... 29
Sn sc sau khi lt da mt................................................................................................... 30
Tui no cng da mt c? ............................................................................................... 30
Cng da mt c b so khng? ............................................................................................ 30
Sau khi cng da mt phi ngh vic bao lu? ...................................................................... 30
Sau khi cng da mt phi trnh nng bao lu?.................................................................... 31
Sau khi cng da mt bao lu th c th ty lng mt?......................................................... 31
Sau khi cng da mt bao lu c th gi u v sy tc c? ............................................ 31
Phu thut da mt ngi cao tui ........................................................................................ 32
Nn chn cng hay lt da mt? ........................................................................................... 33
C nn va lt da mt va cng da mt? ............................................................................ 33
Sng n sau khi cng da mt............................................................................................... 33
Cng da bng ...................................................................................................................... 34
iu tr so mn...................................................................................................................... 35
Nguyn nhn gy mn ........................................................................................................ 35
Cc loi mn ....................................................................................................................... 36
Cch iu tr mn................................................................................................................ 37
phng v iu tr cc loi mn mt m khng li so thm ..................................... 39
iu tr so mn.................................................................................................................. 39
iu tr mn ko di ........................................................................................................... 40
Dng sa b ti tr so mn trng c?.............................................................................. 40
iu tr so mn mt........................................................................................................ 40
Thut c so ........................................................................................................................ 41
Ni nhiu mn do tui gi .................................................................................................. 41
iu tr so mt do thy u ............................................................................................... 41
iu tr so li do x l tai.................................................................................................. 41
iu tr so mi mt ........................................................................................................ 42
So do b rch mt............................................................................................................... 42
Thiu da ghp so mt ........................................................................................................ 43
iu tr so bng ln u v c ....................................................................................... 43
iu tr nhiu so c ........................................................................................................... 43
iu tr so li mt do ha cht ....................................................................................... 44
Lm mt hon ton so trn ................................................................................................ 44

So vng c do dng thuc gia truyn................................................................................ 44
iu tr thm m p xe vng mt........................................................................................ 45
iu tr so chn .............................................................................................................. 45
iu tr so chn do b bng ............................................................................................ 45
iu tr so bng bn tay ................................................................................................. 46
Xa cc vt so nh bn tay............................................................................................. 46
iu tr so ngn tay........................................................................................................ 46
Xa so bng laser .............................................................................................................. 46
iu tr so li vt m...................................................................................................... 47
Thi gian ct ch vt thng mt ..................................................................................... 47
C da trn mnh da c ghp............................................................................................ 47
Xa nt rui, vt xm.............................................................................................................. 49
iu tr nt rui ui mt ................................................................................................ 49
Nt rui mi mt................................................................................................................ 50
Nt rui d b chy mu da mt ....................................................................................... 50
iu tr cc nt en trn mt............................................................................................... 50
Phu thut xa vt xm chn my ................................................................................... 51
Xa vt xm lem mi di ................................................................................................ 51
Xa vt xm bng bn l?................................................................................................... 51
Xa vt xm cn mi .......................................................................................................... 52
Xa bt en trn mt........................................................................................................... 52
Bt vng m v c tri................................................................................................... 52
iu tr bt en vng mt bng laser.................................................................................. 53
Lm p mi, mt ................................................................................................................... 54
Phu thut lm mng mi ................................................................................................... 54
Sng sau khi ct mi........................................................................................................... 54
D tt mi v mi do h hm ch........................................................................................ 54
Ni mn nh sau khi xm mi............................................................................................ 54
Phu thut thm m mi sau khi bm mi ......................................................................... 55
Cy lng mi......................................................................................................................... 55
Lng mi cy c p vnh vin khng? ................................................................................ 55
Cy lng my ...................................................................................................................... 56
Thuc mc lng my .......................................................................................................... 56
Phu thut nng chn my .................................................................................................. 56
Xa vt qung thm mt v vt lem hai bn mp......................................................... 57

Ct mi mt c au lm khng? ........................................................................................... 57
Phu thut thm m mt cho mt sp ................................................................................. 57
Nguy him ca gii phu thm m mi mt ......................................................................... 57
Sng m v chy nc mt sau phu thut thm m.......................................................... 58
So bin chng khi ct mi di .......................................................................................... 58
iu tr so trn mi mt ...................................................................................................... 59
Mt b lm do chn thng mt.......................................................................................... 59
iu tr so ko lch mi mt ............................................................................................... 59
iu tr so mi mt bng thuc thng so........................................................................... 60
Chnh hnh tai, mi ................................................................................................................. 61
Phu thut v l tai.............................................................................................................. 61
V li ni rch tai khi b tiu ng, cao huyt p ............................................................. 61
iu tr tt vnh tai vnh..................................................................................................... 61
M li vnh tai vnh ........................................................................................................... 62
Phu thut to hnh vnh tai................................................................................................ 62
iu tr u sn trc vnh tai ............................................................................................... 62
Phu thut thm m u mi .............................................................................................. 63
Nng mi cao ln bng cch n sn.................................................................................. 63
iu tr so bt l mi ......................................................................................................... 64
Lm cho chn mi cao ln .................................................................................................. 64
Chnh hnh d tt bm sinh mt ........................................................................................ 65
iu tr d dng cnh mi do tt h mi bm sinh.............................................................. 65
Vo mi v vch ngn mi ................................................................................................. 65
Mi g cao sau khi sa mi ................................................................................................ 66
Phu thut iu tr cnh mi qu to .................................................................................... 66
Chnh hnh cho mi cao ln bng cht Gore-Tex ............................................................... 66
iu tr u nh chp mi ................................................................................................... 67
Tc hi ca cht silicn lng............................................................................................... 67
M ly ht silicn mi ..................................................................................................... 68
iu tr phn ng vi silicn lng bm mi....................................................................... 69
Gii phu thm m mi c bm silicn.............................................................................. 69
To hnh vt thng mt cht cnh mi .......................................................................... 69
Phu thut vch ngn v chnh hnh mi ............................................................................ 70
Thm m mi sau m vch ngn ........................................................................................ 70
Gii phu thm m mi khng thy so v khng cn ct ch ........................................... 70

Cy tc .................................................................................................................................... 71
Tc b xon ......................................................................................................................... 71
Tc qun v rng ................................................................................................................ 71
au chn tc ....................................................................................................................... 72
Phu thut cy tc ............................................................................................................... 72
Cy tc ................................................................................................................................ 73
Cy tc vng so da u ..................................................................................................... 73
Cy tc ni mt da u ....................................................................................................... 74
Cy tc vo hai bn thi dng........................................................................................... 74
Thuc tr rng tc t nhin ................................................................................................. 74
C s khoa hc ca phu thut ht m ................................................................................... 76
Phu thut gii quyt da v m tha c ........................................................................... 76
Ht m di cm ............................................................................................................. 76
Ht m bng ....................................................................................................................... 77
Ht m bng bm ln mt .................................................................................................. 77
Cy m vo ni m b hp.................................................................................................. 78
Ht m bng bm ln m v mp ming............................................................................ 78
Dng m bm vo cho ngc to ra....................................................................................... 79
Thuc lm tan m bng ...................................................................................................... 79
Lm gim m ...................................................................................................................... 79
Ht m kt hp vi iu tr so bng ................................................................................. 79
Chnh hnh thnh bng........................................................................................................ 80
Nn ht m bng trn hay bng di ................................................................................. 80
Cc nguy him ca phu thut ht m................................................................................ 81
Chun b khi ht m bng................................................................................................... 81
Cc loi phu thut thm m khc.......................................................................................... 82
Gii phu thm m cho bp chui nh li .......................................................................... 82
Phu thut cnh tay nh gn ............................................................................................... 82
Phu thut n cm............................................................................................................. 82
Lm y t chc vng mt.................................................................................................. 83
Xa ng tin nhn to m .............................................................................................. 83
iu tr mo mt do lit thn kinh 7 ................................................................................... 83
Chnh hnh u ngc ........................................................................................................... 84
Thu ngn u ngc.............................................................................................................. 84
Nng tuyn v cao ln......................................................................................................... 84

Phu thut n cho xng chu ln hn............................................................................. 85
Lm cm ch ....................................................................................................................... 85
Chn thng mt mng chn .............................................................................................. 85
Bnh tim v gii phu thm m .............................................................................................. 87
Ung th do bm silicn .......................................................................................................... 88
Tc hi ca silicn lng bm mt ....................................................................................... 88
i iu v phu thut thm m

Phu thut thm m l b mn y hc lm p cho con ngi, lm p
cho cuc sng. Nh s can thip ca ngnh gii phu thm m hin i, c
nhiu ngi t tin v thnh cng hn trong s nghip, tnh yu, hnh phc gia
nh. Khng t bnh nhn xa c hon ton mc cm v d tt bm sinh,
nhng khim khuyt ca c th do tai nn.
Yu cu phu thut
- T ngi cn thm m yu cu. Cc khch nh tui th thng c
cha m h tr.
- Gii phu thm m c thc hin nhm lm cho khch hng p hn,
theo ng mun ca h. Khch c gii thch bit trc cc kt qu c
th t c, nhng nguy him c th xy ra quyt nh chp nhn hay
khng.
- Yu cu ca phu thut vin i vi khch l cc thn ch hon ton
trng thnh, khe mnh v khng b bt c bnh g v th cht cng nh v
tinh thn, khng nghin ru, ma ty
Cc loi phu thut thng thng
Theo thng k ca Hi Phu thut To hnh v Thm m M, cc phu
thut thm m bao gm:
- Chnh hnh mi: L phu thut c thc hin nhiu nht, nhm lm
cho mi thng li, gii quyt ch g gia mi hoc lm cho u mi nh, p
li ( nhng ngi u mi qu to v xu). Thng phu thut mi ch c
thc hin khi mi pht trin y , tc l khong 15-16 tui phi n v ln
hn mt tui phi nam.
- Lm nh ngc: p dng cho mt s ph n ngc qu to, gy tr ngi
cho tm l v sinh hot. Phu thut ny thng cng c thc hin khi ngc
pht trin hon ton.
- Phu thut tai: Nhm iu tr tt tai vnh, c thc hin sau 5 tui.
- Gii quyt mn v cc vt so do mn: Nh c thuc Retin-A, vic iu
tr mn ngy nay kh d dng, c th gii quyt cc so mn lm cho gng
mt p tr li.
- Gii quyt bnh pht trin bt thng ca v nam gii: Bnh ny lm

cho mt hoc hai bn v ca phi nam c dng ging v ph n. Thng thc
hin cho ngi trn 16 tui.
- n ngc: Lm v to ln nhng ngi c tuyn v km pht trin,
c thc hin khi c th pht trin y , thng l trn 18 tui.
- Phu thut gip hai v u nhau: S bt i xng khng phi ch
kch thc ln nh m cn v tr cao thp.
- n cm: C th thc hin t 15 tui tr ln, thng lm cng lc vi
nng mi.
- Ht m mt s v tr cn thit nh i hoc mng: y khng phi l
phu thut lm cho gy i bt. Mt s ngi c trng lng c th bnh thng
vn mun lm phu thut ny lm ni r cc ng cong cn thit ca c
th.
Nhng phng php phu thut thng thng trn c th

Ht m bng
Trn th gii, phu thut ht m ngy cng c thc hin nhiu v c
nhiu tin b (an ton, n gin, kt qu cao). Trong cc v tr c ht m,
vng bng di rn l ni d cho kt qu tt nht.
Ht m bng thng c thc hin bng hai ng rch da nh (
1cm) pha di hai bn bng v mt ng pha di rn. Bc s s cho
ng ht nh vo ht lng m tha bng. Trc y, ng ht c s dng
kh ln, gy nhiu sang chn cho da bng v khin vng bng c nhiu gn
sng nh, khng c bng phng sau khi ht. Ngy nay, ngi ta ht vi
ng nh hn, thi gian phu thut di nhng kt qu tt hn. Tuy nhin,
c kt qu ny, da bng cn sn chc v n hi tt. i vi da bng mn v
nho qu, hoc c qu nhiu vt rn do mang thai nhiu ln, cn phu thut ct
bt da v chnh hnh thnh bng.
* Phng php v cm
Phng php thng dng l gy t ti ch vi thuc an thn nh. Cng
ngy, ngi ta cng t dng phng php gy m v thi gian hu phu ko di
v nguy him hn so vi gy t ti ch.
* Thi gian hu phu
Sau m, ngi c phu thut b au nh vng m vi ngy, bng
vn cn cng phng trong hai hoc ba tun. Cc vt m c ct ch mt tun
sau. Trong 10 ngy u, bnh nhn phi mang gaine (gen) p cht vng
bng m c ngy ln m; 10 ngy tip theo ch cn mang gaine ban ngy. Sau
mt thng, kt qu thy r; nhng phi 3 n 6 thng sau, da bng mi ph ln
vng m t nhin v p hon ton c.
Chnh hnh thnh bng
Do sinh nhiu ln hoc ln tui, da bng km n hi v chng xung.
Do , vic ht m n thun thng cha lm cho bng p tr li.
Phu thut chnh hnh thnh bng gii quyt c cc trng hp ny.
Phu thut thng bt u bng ht m. Ngay sau khi ht m xong, bc
s s ct b phn da pha di ca bng, ni che trong qun lt. Da tha c
tch ra v ko xung, ct b v may li vi phn di bng theo v tr ny. Ty
theo tnh trng da bng, phu thut c th ko di 1 n 3 gi.
10
Sau m, bnh nhn cn mang gaine trong mt thng. So m c mu

trong 3 thng u, s m dn t 1 n 3 nm. Ngi c ht m, cng da
bng nn theo ch dinh dng thch hp ngay t khi phu thut. Khi ht m,
lp m st da c gi nguyn lt cho da c m v p. Lp m ny s
dy ln khi c th tng trng.
Ht m v cng da cnh tay
mt s ngi, cnh tay qu to do ng nhiu m m, khin h rt
ngi khi mc o st nch. Phu thut thm m c th gii quyt cc trng hp
ny bng cch ht m v cng da.
nhng ngi tr, da cn n hi tt, ch cn ht m khng cng .
Nhng nhng ngi ln tui, sau khi ht m, da thng b tha ra v thng
xung, trng khng c gn v p. V vy, cn phi cng da li v ct b da
tha.
trnh so, khi lm phu thut ct b da, ngi ta thng m mt trong
ca cnh tay, ng m c th ko di n nch.
* Phng php v cm
Ty trng hp, c th dng phng php gy t ti ch hoc gy m.
Gy t ti ch kt hp vi thuc an thn c p dng trong a s trng hp.
Trong mt s trng hp c bit, bc s c th p dng phng php gy m.
* Sau m
Cnh tay s b cng, au khi a tay ln trong vng vi ngy sau phu
thut. Cnh tay phi c qun bng li trong vng hai tun. Trong vng 6
thng sau khi m, so ni m s c mu hng. N s m dn sau mt nm.
Phu thut nng ngc
mt s ph n mi sinh con, ln tui hoc b st cn qu nhiu, tuyn
v thng b thng xung thp. Phu thut thm m c th chnh hnh v lm
tuyn v gn, p li nh hi tr. Phu thut ny c th thc hin theo phng
php v cm ti ch (gy t ti ch) hay gy m. Ty theo tng trng hp
(ngc b thng nhiu hay t), sau khi m, bnh nhn c th c so nh vng
quanh phn da ca u v, hay so hnh T ngc t phn da ca v
xung di.
* Sau m
Ni m c ct ch sau 15 ngy. Ngi c phu thut cn bng p
hoc mang nt v cht c ngy v m trong mt thng.
11
Phu thut thu nh tuyn v

K thut m nhm thu li tuyn v qu ln, gy au lng v tr ngi cho
mt s hot ng v th dc, th thao... S pht trin qu mc ca tuyn v bt
u t tui dy th. cng lu, vic phu thut cng tr nn kh khn hn v
vi trng lng ca tuyn v, da s b gin ra, thng xung. Do , thi gian tt
nht phu thut l khong 14-15 tui; v vo thi im ny, da sn chc, n
hi tt. ngi ln tui, bc s phi m b da, m v mt phn m tuyn v.
Phu thut phc tp hn v so s r hn.
* Sau m
Ngc s c bng p trong 15 ngy, sau c thay bng nt v p
cht ngy m trong vng mt thng. Ch nn tp th dc sau hai thng sau.
12
Phu thut thm m cho ph n sau khi sinh

Khi tr thnh ngi m, bn khng th p nh thi cha mang thai
c. Hu ht ph n u hnh phc khi c mang thai v tr thnh ngi
m. Tuy nhin, vi mt s ngi, s thay i trn c th khi mang thai lm h
km vui. Khi ny, phu thut thm m khng nhng s gip h phc hi dng
v trc khi mang thai m cn ci thin n. Cc phu thut gip ph n sau khi
sinh ly li dng v trc khi mang thai gm c:
Phu thut n ngc
Trong thi gian mang thai, v cng ln do s pht trin ca cc tuyn
nhm to ra sa nui con. Mt s ngi c bn khon l vic cho con b s lm
ngc mnh xu i. iu ny khng ng, vic cho con b sa m rt tt cho s
pht trin c th ca chu b, ng thi kch thch s pht trin ca c th
ngi m v to tnh mu t gn b cho c hai m con. Sau thi gian cho con
b, cc tuyn tit sa ht hot ng c teo nh li, lm cho v b nh i so vi
lp da bao bc chung quanh. v to tr li v tip tc cng phng nh trc,
cn phu thut n v bng ti nc bin. Phu thut ny cng n gin, ngi
ta n vo di tuyn v hoc di c ngc mt ti nc, sau v s cng tr
li nh bnh thng.
Phu thut c nh v cao hn
Mt s ngi, sau nhiu ln c thai v cho con b, da vng tuyn v b
gin ra, lm cho tuyn v b h thp xung di v tr bnh thng m cc c
gng tp th dc u khng khc phc c. Phu thut thm m c th gii
quyt trng hp ny bng cch ct bt da v c nh v v v tr c. y l
phu thut treo v (mastopexie). Sau phu thut, tuyn v s gn v chc hn.
Phu thut chnh hnh thnh bng
Bng l ni cha thai nhi trong hn 9 thng, do da v cc t chc
thnh bng b thay i. Phu thut thm m c th iu tr trng hp ny bng
cch ht m, ct bt da v may cc c bng cho cht li.
Ht m
Mt s v tr nh hng, i, lng hoc cnh tay c th ng nhiu m,
lm c th mt cn i v km p. Vic phu thut ht m cc v tr ny s
lm c th gn, p hn.
13
Phu thut b phn sinh dc ngoi

Khi sinh, phn ngoi b phn sinh dc c th b rch hoc gin rng.
Phu thut chnh hnh m h (labioplasty) gip lm p v hp li pha ngoi c
quan sinh dc n.
iu tr vt nm mt sau khi sinh
Vi nghin cu cho thy khong 3/4 ph n khi mang thai c th b nm
da mt cht t. Nu vt nm nm biu b, c th iu tr bng cch lt da mt.
L ph n ang mang thai ln u hoc sp sa mang thai, bn s bn
khon nhiu v vic tnh trng mang thai v nui con bng sa m s gy mt
s thay i trn c th. Phn ln nhng thay i ny c th gii quyt c nh
phu thut thm m. y l mt ng gp quan trng ca ngnh phu thut
trong vic em li nim vui, hnh phc cho gia nh. V vy, bn c th yn
tm v c cch gii quyt tt p cho nhng thay i ca c th trong thi
gian ti.
14
iu tr thu nh tuyn v phi nam

phi nam c mt s ngi v c bit pht trin ging nh n gii.
l bnh v nam b ha (gynecomastia). Tnh trng ny c th xy ra mt hay
hai bn ngc v chim t l kh cao, c th t 40 n 60%, theo thng k M.
Nguyn nhn l do dng mt s thuc no (thuc c kch thch t n,
hoc thuc gip ln cn c cht corticoides), do b bnh v gan hoc ni tit.
Bt thng ny c th iu tr bng phu thut. c bit, phu thut thm m
c th iu chnh ngc tr li hon ton bnh thng vi rt t so ni m.
Ngi cn phu thut phi hon ton bnh thng v th cht ln tinh
thn. Nhng ngi qu nng cn, nghin ru hay nghin ma ty khng phi l
i tng cho phu thut ny. Bc s s khuyn h ngng dng cc loi thuc
gy nn tnh trng trn. Nu ngc bnh thng tr li th khng cn phu thut.
Trc khi phu thut, cn tm nguyn nhn gy gynecomastia nh ri
lon chc nng gan, dng cc loi thuc c kch thch t n, hoc cc loi thuc
gip ln cn c cht corticoides. Bnh nhn cng c chp X-quang tuyn v,
khng ch loi tr kh nng ung th v m cn bit cu trc tuyn v c
nhiu m m hay nhiu t chc tuyn chn ng phu thut thch hp.
Chun b phu thut
Ty trng hp, bnh nhn s c dn v ch n ung v dng mt
s thuc trc.
Mt s iu cn lu
- Nn ngng ht thuc mt hoc hai tun trc khi m v trong thi gian
m cho n khi vt m lnh hn, v thuc l gy chm lnh vt m.
- a s ngi bnh c th ra v sau phu thut, nhng mt s t trng
hp cn nm li qua m. Bc s phu thut s cho bit c th.
- Ty trng hp, c th gy t ti ch hoc gy m.
Phu thut c th tin hnh theo nhiu cch. a s l m theo ng
vng quanh nm v, tc l gii hn gia da v da trng v. C th kt
hp ht m hoc ct bt da ngc khi cn.
Sau phu thut
15
Vng ngc s c qun bng cht trong vi ngy. Quanh ch m s

sng n trong vi tun, c khi vi thng. Bn s c khuyn i li bnh thng
mt vi ngy sau m v s c ct ch mt hoc hai tun sau.
- Hot ng tnh dc nn hn ch trong mt hoc hai tun.
- C ng mnh c th thc hin sau ba tun. Trnh cc mn th thao c
th va chm, gy sang chn vng ngc mi m trong t nht 4 tun.
- Trong su thng u nn trnh nng vng m v c th gy so thm
en, xu. Khi ra nng (nh tm bin) nn dng kem chng nng.
Cc nguy him c th gp do phu thut
Ging nh cc phu thut khc, ngi c nhu cu phu thut iu tr v
b n ha c bit trc v mt s bin chng c th xy ra (d rt t) nh:
- Nhim trng.
- Tn thng da ngc.
- Chy mu nhiu khi m.
- Phn ng vi thuc t.
- ng dch trong tuyn v mt thi gian.
- Ni m b so xu.
- u v b bin dng.
Sau phu thut, nu hai bn v khng u, khng i xng nhau, phi
phu thut li sau mt thi gian.
Ngi c gii phu cn ng v chp nhn cc ri ro nu c (khng
do mun ca bc s gii phu).
Phu thut iu tr bnh n ha tuyn v phi nam c kt qu tt v lu
di. Nu p dng k thut m theo phng php thm m, so ni m rt nh
v ngc tr li gn nh hon ton ging ngc nam gii bnh thng.
16
C da mt
C da mt l phng php iu tr rt c kt qu trong trng hp da mt
b g gh, xu do so mn, chn thng hay do phu thut. Ngoi ra, c da mt
cn c dng trong mt s trng hp c bit nh:
- Da mt b lo ha do nh nng mt tri.
- iu tr mn ang tin trin do da mt qu dy.
- Bnh nhn iu tr mn rt nhiu bng khng sinh nhng khng t kt
qu.
Phu thut c da mt kh phc tp, i hi phu thut vin phi c kin
thc y cng nh kinh nghim v phu thut.
D vic c da mt c ngi Ai Cp thc hin 1.500 nm trc cng
nguyn nhng cc phu thut c da hin i ch mi c thc hin t nm
1905 do Kromeyer, phu thut vin ngi c thc hin nhm gii quyt cc
so mn. Kromeyer cng b rng, phng php mi dng my c da rt c
kt qu trong phu thut v da. Tc gi cng cho bit nu khng c vt qu
tng h b th kt qu s tt, khng b so. Kt qu ca ni c da p hay xu l
ty theo tng vng v theo tng ngi mt. Cc nhn nh ny rt quan trng
v lm nn tng cho phu thut v da sau ny.
T thp nin 1980 c mt s tin b trong c da nh sau:
- Yarborough gii thiu phng php c da sm gii quyt cc so do
chn thng.
- Johnson ngh ghp da ri tng khm nh gii quyt cc so su.
- Hankke ni r tc dng ca nhiu loi thuc t lnh ti ch trong vic
gy tn thng da. ng cng cho bit c th dng phng php c da iu
tr u si thn kinh.
- Mandy nghin cu vic dng tretinoin trc khi c da.
- Pinskin v cc tc gi khc nghin cu tc dng ca cc gc c thm
cht sinh hc trong vic lm lnh so ni c da.
T nm 1990 v sau, c da mt thnh mt chuyn ngnh n nh
lm phng li da mt b li lm do chn thng hay bnh tt.
17
Cc ch nh c da mt gm c:
- Mn ang tin trin.
- So do mn.
- So do chn thng.
- So do phu thut.
- Da b lo ha do nh nng mt tri.
- iu tr cc np nhn mt.
- Ri lon sc t.
- Xa vt xm da: Tnh trng da b chn thng, dnh cc d vt vo
ging nh b xm c th iu tr rt tt bng phng php c da. Vic c da nu
c thc hin ngay sau khi b thng, s phng nga c tnh trng da b
thm en. Nhng nu ngi bnh n bc s mun, vt thng lnh da non
ri th phi ch n 8 tun sau mi nn c da. C da trong giai on ny ngoi
vic ly d vt cn gip cho so do chn thng c p.
Xa vt xm thm m thng kh khn nu vt xm kh su. Thng
ch nn c da xa vt xm cho ngi trn 25 tui, thc s mun xa vt xm v
tm l hon ton n nh.
- Bnh mi b bin dng, sn si ging mi ln (Rhinophyma).
- Bnh u si thn kinh da: Khong 85% bnh nhn b u si thn kinh c
bnh tch mt, lm cho da mt xu i nhiu. Phu thut s gii quyt cc khi
u ln, nhng khng th m hng trm u nh. Do , c da mt l bin php tt
nht gii quyt cc trng hp ny.
- Bnh Trichepithelioma: L loi u ngoi da, gy bin dng da mt rt
nhiu. Mt s trng hp c th thoi ha thnh ung th t bo y da.
Phng php c da mt iu tr bnh ny cho kt qu rt tt. C t trng hp
bnh ti pht.
18
Nhng thnh tu mi trong vic lt da mt

Lt da mt l phng php ly bt lp ngoi ca da (danh t y hc l
tng sng) gm cc t bo da b thoi ha, dy ln v cha ng nhiu bnh
tch ca s lo ha. Thuc lt thng l cc ha cht, tc dng ln da mt, n
mn cc lp da pha ngoi. Ty theo su ca lp da b n mn, ngi ta chia
lt da mt lm ba loi:
- Lt nh: Ly ht lp biu b n tng t bo y nm gia phn biu b
v b.
- Lt trung bnh: su n phn gai b ca da.
- Lt su: Phn da lt su n phn t chc mng ca da.
Yu cu i vi thuc lt mt l cch dng n gin nht, t bin chng
cho da mt v t nguy him cho sc khe ngi s dng. Vi cc yu cu ,
thuc lt da bng axit trichloroacetic (gi tt l TCA) p ng c cc yu cu
. Thuc ny khng c cho c th, khng gy d ng. Cc dung dch pha vo
nc c th dng cc nng khc nhau khi cn thit. Sau khi pha ch, thuc
c th gi c khong hai nm.
K thut lt da
Da mt cn c chun b sch trc hai tun. Ngi bnh cn sn sng
lt, khng trang im khi n phng mch. Da mt c lm sch bng axit
glycolic 5%, sau st trng vi cn 70 . Khng dng acetone hay cc cht
ty da khc ra da v cc cht ny c th lm cho bnh nhn kh chu v
khin TCA ngm vo su hn trong da. Tc dng ca cc cht thuc ra da l
lm sch lp biu b, lm cho mng v sch lp tng sng. Nu cn lt da su,
c th tng nng axt hoc lt da bng cch thoa thuc nhiu ln.
Sau khi ra sch da, khch c t nm trn bn m (u cao khong
45 ). T th ny lm cho thuc lt khng chy vo mt. Khng cn s dng
my theo di nhp tim mc d c th bc s mun c sn ng truyn tnh
mch truyn cc thuc an thn. Cm gic b nng do lt bng TCA
thng nh v s ht trong vi pht.
Cch lt da c p dng chung cho tt c cc dung dch thuc lt c
nng khc nhau. Bc s s dng ming gc nh xp li lm i bi thuc
TCA ln da. Dng que bng bi thuc ln da cng c nhng khng
mnh thuc thm u ln da.
19
TCA l ha cht c tc dng tt v lm ng cht protein da, lm cho

da trng nhanh v cng cng vng trng. Tnh cht khi lt nh v lt trung bnh
c th sp theo th t nh sau:
- Da khng c mu trng: Da c v bng v lng hn nhng khng thay
i mu sc. y l trng hp ch lt lp biu b bn ngoi.
- Da c trng nh khng u: Thm vo v bng sng ca da, trn da
thy ri rc cc im trng. y l lt da su gia lp biu b.
- Da trng hon ton vi mu hng pha di: L lt da su n tng y
ca biu b.
- Da trng cng v khng c lp hng di: y l lt da su n ht
gai b v b.
Ngi ta dng TCA nng t 10% n 25% lt da su biu b v
nng 30% n 40% lt da su n gai b v b. Chiu su ca lp da c
lt ph thuc vo s chun b trc, nhn, b dy ca da, s lng cht axit
c dng. Vic bi li cht axit trn da trng s lm axit thm su vo da
hn. Do , an ton, nn dng TCA nng thp v bi nhiu ln khi cn.
Sau khi bi thuc, lt n su cn thit, bc s s lau mt ngi bnh
vi nc thng thng. iu ny gip pha long cht axit ng, ngn khng
cho axit thm su. Sau , thoa da bng kem Hydrocortisone 1% cho da c
t u. iu ny lm bnh nhn d chu v gim cm gic nga.
Sau khi lt da mt bng TCA
Ngi c bi thuc TCA nn ra mt hai ln mi ngy vi cc loi x
phng ra mt nh v bi da bng kem Hydrocortisone 1% thng xuyn cho
da c mm. Khng cn bi khng sinh. Cc trng hp lt mt mnh (su
trung bnh) c th ung khng sinh trong 5-7 ngy sau khi lt da. V vic lt da
khng to vt thng h nn khng cn dng khng sinh trc v trong khi lt
da.
Nu b nhim trng da (do vi trng staphylococcus hay streptococcus,
him gp), nn dng thuc khng sinh cephalosporin, ung ngy hai ln.
- Lt nh (biu b): Lnh trong 3 n 4 ngy.
- Lt su hn (gai b): Lnh trong 6 n 8 ngy.
iu quan trng l 48 gi sau khi da lt c lnh, bnh nhn phi dng
thuc Retin-A hay axit alphahydroxy cng vi hydroquinone v thuc che nng
ph rng. Da tr li bnh thng sau khi bi thuc hai thng. Trong thi gian
, bnh nhn phi trnh nng, c theo di v dng thuc dng da thch
hp.
20
Do khng gy cc vt thng su nn cc bin chng nh so, nhim

trng, da b ko di v mt mu vnh vin rt t xy ra.
Kt qu ca phng php lt da bng TCA theo thi gian
Lt da su c kt qu rt lu. Vi phng php lt nh, nu c dng thm
cc thuc dng da th kt qu lu hn, c th ko di n c nm (nu khng
dng da, kt qu ch c khong 3 thng). cc trng hp lt su, tc dng
ko di n nhiu nm.
Thi im bi thuc lt ln k tip c xc nh ty theo ln lt u l
nh hay mnh. Nu lt nh, c th lt li sau mt hai tun. Nu lt su trung
bnh, cn ch 6 tun v nu lt su th phi ch t nht 2 thng.
Tm li, TCA l thuc lt da mi d dng v t tai bin, l phng tin
an ton lm tr ha da mt, em li ma xun cho da mt, gp c th con
ngi.
21
Ti to da mt
Phn bit cc loi da v cch chm sc
"Chu 18 tui, hay ni nhiu mn. Bc s da liu ni chu b da dy,
nhn. Da dy l g? C bao nhiu loi da mt v cch chm sc nh th no?".
Ni mt cch tng qut, da mt c chia lm ba loi: da nhn, da kh
v da mn. Da nhn thng dy, d b mn. phn bit cc loi da, chu c
th c bng phn loi nh sau:
Loi da
Nhn
Chn on
Nn trnh
Sn sc v iu tr
- Da dy v bng.
- n cho sm da.
- Dng x phng nhiu du.
- Phn dy thy r gia - Tia t ngoi ca mt tri - Thoa kem c cht gm mi

mt, nht l mi, rnh gia (cn dng kem chng nng). tun hai ln, sau ra sch.
mi v m.
- Cc cht c th gy mn.
- Kem chng nhn.
- Cc l chn lng gin
rng.
- X phng c glycrine
- Nhiu cht nhy, nht l
mi v cnh mi.
Kh
- Da cng v nhm.
- X phng ty mnh.
- X phng nhiu du
amandes douces.
- C cm gic cng, b - Cc dung dch c pha ru.

chm chch, b bng nh
- Nc c cht vi.
- Kem nui da v gi nc.
mt.
Mn
(nhy
cm)
- Da km mm v km n
hi.
- Dng x phng nhiu.
- Ra mt cn thn v chm
lau kh.
- Da mng, trong.
- Thuc thoa c ru.
- Dng dung dch cho nhiu

nc, nhiu cht m.
- Da trng, hng, trong

sut.
- Da sng, lng lnh.
- Da d tn thng khi b
lnh, gi hoc nng qu.
- nh nng mt tri ma h
hay ma ng.
- X phng nhiu du.

- Ra mt nh v cn thn.
- C cm gic ko cng,
chm chch hay nga da.
Khi bit da mt thuc loi no ri, cn sn sc da theo hng dn trn c ln da p,

b mn v lu lo ho.
22
Vitamin C v s lo ha
"Nghe ni vic n tri cy gip ta lu gi v tri cy c nhiu vitamin C.
iu c ng khng? Vai tr ca vitamin C trong vic ngn chn s lo ha
nh th no?".
ng l tri cy rt tt cho sc khe. Trong tri cy, ngoi vitamin C ra
cn c rt nhiu vitamin khc v cht m thc vt d tiu ha, t gy hi cho
sc khe hn tht ln, tht b.
Ngi thiu vitamin C c th b bnh Scorbut (mt bnh gy st nh,
thiu mu, chy mu li, ri lon tiu ha, suy kit, c th dn n t vong).
Ngy xa, bnh ny thng xy ra cc thy th sng mt thi gian di trn
bin, khng n rau qu.
Nm 1928, Szent Goryi tm ra vitamin C t rau ci. Pht hin ca ng
c gii Nobel nm 1937. C th con ngi khng th tng hp
c vitamin C cng nh mt s vitamin cn thit khc. Do , con ngi cn
dng thc n c nhiu vitamin C. Nhu cu v vitamin C hng ngy ca ngi
khe mnh hon ton l 60-100 mg. Nhu cu ny gia tng ph n mang thai,
ngi cho con b, sau phu thut, ang dng bnh hay vn ng c th nhiu.
Ngy nay, tnh trng thiu vitamin C vn cn xy ra do cch n ung
cha hp l. Vic nu nng thc n qu lu, dng nhiu cc thc phm ng
hp... c th gy thiu ht vitamin C. Bn cnh , vic ht thuc l v ung
ru lm gia tng nhu cu v vitamin C mi ngy. mt s ngi, dinh dng
km, ri lon v hp th rut cng gy ra thiu vitamin C mn tnh. Vic b
sung vitamin C thng xuyn bng cch n tri cy hoc ung thuc s khin
tnh trng sc khe c ci thin r rt (v th cht cng nh v tm l).
Vitamin cng c tc dng chng xy ha. N tham d vo rt nhiu phn
ng bin dng ca t bo c th. Lng vitamin C d tr mu v cc t
bo gim dn khi gi. Nhiu ngi bn khon v vic c th lm chm s lo
ha bng cch bt u dng nhiu vitamin C t mt la tui no khng? Cu
hi ny n nay cha c gii p.
Nhiu nghin cu cho thy, vitamin C c kh nng:
- Kch thch chc nng min dch ca c th, lm mnh thm cc thuc
tim phng, nht l thuc phng cm cm. c ch nh trong trng hp
nhim trng ko di nh herpes, zona, vim nhim ng h hp ngi c c
a d ng.
- Lm lnh so nhanh, c hiu qu tt trong s bin dng sn cc
ngi c bnh v sn khp.
23
- Phng nga bnh x m ng mch bng cch lm gim cht m,

triglycerid v cholesterol trong mu.
- Bo v c th, lm gim c ngi ung ru hay ht thuc.
- Tng cng sc mnh c bp v lm chm cm gic mt mi khi vn
ng, chi th thao.
Mt s nh khoa hc cn cho rng vitamin C c tc dng bo v c th
chng li bnh ung th, nht l ung th d dy.
Vitamin C c thi ra nhanh theo ng tiu, do nu dng nhiu
cng khng s b qu liu.
Vitamin E v s lo ha
"Ti mi 45 tui m da b nhn nhiu, trng gi hn tui. Mt vi ngi
bn khuyn nn ung vitamin E. Vitamin E c th lm tr trung c khng?
Ti rt ngi ung thuc, thay v ung vitamin E ti c th n cc thc n no?".
Vitamin E nm trong nhm thuc iu tr nhm ngn chn s xy ha
cc gc t do trong c th (bn cnh vitamin C, selen...). Hin tng xy ha
cc gc t do trong c th c th a n nhiu bnh v tim, tiu ha, no... v
lm cho ngi gi i nhanh, nht l da.
Cc gc t do tn cng vo nhng yu t cu thnh mng t bo, c bit
l cc cht m to thnh mng t bo, cc axit nhn t bo. H thng bo v c
th s chng li hin tng ny. Tuy nhin, s chng li ca c th ngy cng
yu i. Vic ung ru, ht thuc v tia t ngoi lm c th phng thch nhiu
gc t do hn. V vy, cn dng thm cc cht chng xy ha t bn ngoi.
Vitamin E c chit xut t du ca la m ln u tin nm 1936. N
cng c trong mt s cht nh gan b, chui, to, o, la m, ht ng, tiu,
trng.... Tuy nhin, cc thc n nhiu vitamin E nht l ht la m v du thc
vt. Liu dng mi ngy l 5-12 mg cho ngi ln (nam n bng nhau).
Ngoi vic ngn chn tc dng c hi ca cc gc t do, vitamin E cn
c tc dng ging nh aspirine, ngn chn s kt dnh tiu cu, gip gim nguy
c tc mch ngi b bnh tim mch. Nhiu ngi ngh vitamin E c th thc
y s pht trin tinh trng nam gii, nht l ngi ln tui. Nhng cho n
nay cha c nghin cu no xc nhn iu ny.
Tm li, c ch ngn nga s lo ha ca vitamin E l lm chm s xy
ha cc cht quan trng ca c th v gim bt s kt dnh ca cc tiu cu
trong mch mu. Trng hp c th ca bn c th dng sinh t E. Nu ngi
ung thuc, bn c th dng cc thc phm k trn.
24
nh hng ca nh nng mt tri i vi da

"Xin bc s cho bit nh nng mt tri c hi hay c li cho da?".
Nhng ngi thiu vitamin D (khng nhiu) cn phi nng. Nhng vi
a s, nh nng mt tri rt c hi v lm da nhanh b lo ha, c th a n
bnh ung th da v sau. Cn thn trng khi ngh ngi hay lm vic ngoi nng
trnh cc tc dng c hi.
nh nng trc tip chiu vo da s gy tc hi ti a vo ma h, vo
gia tra. vng cng cao (so vi mc nc bin), nh hng ny cng ln.
nh sng mt tri c th lm da sm mu ngay c khi tri c nhiu my. Khng
ch nh nng chiu trc tip m ngay c nh phn chiu ca tia t ngoi mt
t, trn ct, trn nc, trn c hay ngay c trn tuyt cng gy hi cho da.
Tc dng ca cc tia t ngoi (UV) ln da l khng ging nhau:
- UVA lm cho da sm li. N xuyn qua biu b v 20% n c vng
b.
- UVB gy ra bnh cm do nng. N b chn li tng sng, 20% n
nim mc v 10% n cc gai b. Chnh 10% ny tham d vo vic to cc np
nhn.
* Cc tc hi ca tia t ngoi vi cu trc da:
- v tr phn t: Do tc dng quang ha, mt s phn t cc cht b
phn hy, phng thch gc t do.
- v tr t bo: Cu trc xon ca ADN b thay i, nh hng n s
tng hp ca t bo.
- b mt da v cc np nhn: Sau khi b nng lm ln, cc np nhn
tr nn nhiu hn, rng hn v su hn.
Tm li, i vi ngi Vit Nam, nh nng mt tri c hi cho da, cho
sc khe nhiu hn c li. Do , nn hn ch vic phi mnh di nng v cn
c bin php bo v khi lm vic lin tc ngoi nng.
nh hng ca thuc l i vi da
"Ti lm ti x ng di. bun ng khi li xe ban m, ti
thng ht thuc l, lu thnh nghin. Ti mi 29 tui m trng gi, da
cng ngy cng xu. Ht thuc l c nh hng g n da khng?".
Dng thuc l d di hnh thc no (ht hay l nhai) u c hi cho sc
khe, tng nguy c ung th hng, phi, vim ph qun mn, bnh tim mch,
25
bnh l mch mu chi di. Tc dng c hi l do cc cht c trong thuc l

gy ra, bao gm:
- Nicotine: Nh c tnh tan trong m, nicotine xuyn qua c hng ro
nim mc v da. N c phn tn khp c th v tp trung ti cc ni chnh:
h thn kinh trung ng, gan, tuyn thng thn. Cht ny c nhiu nh hng
n c th:
+ Tng tc dng ca tuyn thng thn trong thi gian u.
+ Gim s sn xut cht histamine (cht gy d ng).
+ Thay i s tng hp protein v d tr serotogene).
Vic ht thuc l lu ngy s gy ng c cht nicotine, dn n cc tn
thng mch mu quan trng nh co mch ko di, gia tng s kt dnh cc
tiu cu. Kt qu l ri lon tun hon. Ri lon ny kt hp vi cc ri lon v
bin dng, v cc kch thch t sinh dc, dn n tng s lo ha da.
- Kh CO2: Lm ri lon s chuyn ch xy t hng cu n cc m v
t bo.
- Cc cht kch thch c aldehydes v phenol: Lm xo trn hot ng
lun chuyn ca b my h hp.
- Cc cht than gy ung th.
* Tc hi ca thuc l i vi da
1. Biu hin da:
- Da b lo ha sm.
- Nim mc b tn thng (vim hng do thuc l).
- u ngn tay b vng.
- D ng da khi tip xc vi thuc l.
Gng mt in hnh ca mt ngi da trng nghin thuc l l c nhiu
np nhn ln nh, da b teo li, nht nht, mu vng, xm... Phn ln cc triu
chng ny biu hin r hn phi n v ngi phi nng nhiu.
Thuc l v tia t ngoi c tc dng phi hp trong vic gy lo ha da.
Tuy nhin, tc hi do tia t ngoi gy ra mnh hn.
2. S hiu bit hin ti ca chng ta cha gii thch c ht tc dng
ca thuc l ln da v c ch gy lo ha. Ngi ta ch thy c thuc l gy
26
ra cc tn thng mch mu, lm chm tr s vi tun hon ti da v gy suy

tun hon da.
Thuc l c tc dng khng kch thch t n. Nu ht nhiu thuc l, ph
n b mn kinh sm hn bnh thng.
Ngoi ra, thuc l c cc tc hi sau:
- Suy gim h thng min dch da (qua s trung gian ca t bo
langerhans).
- To thnh cc gc t do gy hi cho da.
- Ph hy vitamin C.
Tm li, thuc l tht s c tc dng lm da b lo ha nhanh. Cng
ngy, ngi ta cng chng minh c iu ny mt cch y hn. Nh vy,
vic khng ht thuc l khng nhng gip ta trnh c mt s bnh nguy
him (nh ung th thanh qun, ung th phi..) m cn gi cho da c tr
trung lu hn.
Bin i da khi ln
"Khi ln tui, da vn gi nguyn hay c thay i?"
S lo ha da chu nh hng ca nhiu yu t nh di truyn, ni tit,
mi trng chung quanh, dinh dng v c hc. Trn phng din vi th, s
lo ha da c cc c im sau:
- Lp biu b t t mng li, da c tnh cht axit hn.
- Phn ni tip gia biu b v b cng mng li.
- Phn b cc si lin kt ri lon, si n hi gim, lng dch thm vo
gim, lng mu nui da gim v cc thnh mch d v.
Lo ha c chia lm 4 giai on:
- Giai on 0: Da bnh thng.
- Giai on 1: Vo khong 40 tui.
+ Cc si n hi ri nhau ra, b ct on v bt u bin mt. Cc si
pha ngoi cng lm thnh mt lp mng, khng c t chc si di lp biu
b.
+ T chc si lin kt (collagene) khng thay i.
- Giai on 2 v 3: Trn 45 tui
27
+ Cc si n hi gn nh bin mt hon ton.

+ Si lin kt xp khng theo t chc no c bit, ri b, bung tha ra.
+ Cc t bo si ngng bi tit.
Gii thch mt cch khoa hc th nh vy. Nhng c th hiu n gin
hn l cng ln tui, da cng km n hi, km p v khi b vt thng th
chm lnh hn ngi tr.
Da mt b mt mu
"Ti 47 tui, gn y da mt c vi ch mt mu, tr thnh trng, khng
bit do nguyn nhn g. Ti c dng rt nhiu thuc nhng khng c kt qu.
Vy ti cn iu tr nh th no?".
Da b mt mu c th do bm sinh (mi sinh ra c) hay do bnh mc
phi sau khi sinh. Nguyn nhn gy mt mu da sau khi sinh l bnh ngoi da
nh nhim vi nm, so m, mt s t trng hp do bi thuc lt da mt hay c
da mt.
Mt mu da c iu tr ty theo nguyn nhn. Trong trng hp mt
mu do nhim nm (thng gi l lang ben), vic iu tr c thc hin tng
i d (bng cch dng thuc tr nm ngoi da). Cc trng hp da mt mu
khc thng kh iu tr hn. i khi phi dng phng php xm thm m
mi to li c mu sc ging da bnh thng.
28
iu tr da mt
"Ti 27 tui, l nam tip vin cho nh hng nn cng cn c b ngoi
mt cht. Da mt ti lc trc b mn, nay cng cha hon ton ht hn. Ri
rc trn da mt c vi ni ni mn km vi rt nhiu so xu. C cch g ht
hn mn v lm da lng p khng?".
Da mt bn c l thuc loi da dy v nhiu cht nhn, d b mn ko
di. Bn nn iu tr cho mn ht hn trc khi tin hnh cc k thut khc.
Vic iu tr cho ht mn cng kh phc tp v mt nhiu thi gian. Bn phi
sinh hot, n ung iu , king c mt s thc n v dng thuc iu tr mn
theo hng dn ca bc s chuyn khoa da liu. Sau khi ht mn, ty theo so
mn su hay cn, bn c th dng thuc lt da mt hay c da mt. Nhng ngi
b so mn su qu i khi phi khot b so v ghp da.
Da mt en v tc qun
"Em 16 tui, da mt rt en v tc li qun. Xin bc s cho bit lm th
no cho da mt trng v tc ht qun?".
Da mt hay ni chung, da ca ton c th v ngay c tc chu nh hng
ca yu t di truyn.
Gii phu thm m hay cc m phm khng th lm thay i cu trc,
mu sc da nhng c th gip cho da, tc khe mnh v trnh cc tc nhn lm
chng xu i. Chu c trnh nng v gi da u lun c sch th da v tc s
pht trin tt. Nu mun da mt trng hn mt cht, chu phi dng m phm
thoa nh ln da. Chu ng mc cm v da khng c trng. Da mu cng c
nt p ring ca n v trong s hoa hu th gii ngy cng nhiu ngi da
mu.
iu tr da b lo ha
"Ti 65 tui, trc y da mt rt mng v mn nhng mt vi nm gn
y, da b dy ln, c nhiu np nhn v ni nhng mn en nh. Xin bc s ch
dn cch khc phc".
y l trng hp da b lo ha, va dy ln, c ni nhiu bnh tch mu
sm, va c nhiu np nhn. Cch iu tr trc mt l dng thuc lt da, cho
da mng v sn li. V sau, nu da tip tc nhn nhiu, phi lm phu thut
cng da.
29
Xa np nhn trn trn

"Ti 50 tui, khng bit c phi v lm vic v suy ngh nhiu khng m
trn c rt nhiu np nhn. C cch no xa c np nhn trn khng?".
ngi ln tui, da trn b nhn nhiu, mt phn do c da b co tht li,
phn khc do da trn gim n hi. Mun ht nhn, phi phu thut ct ngang
cc c trn b co tht v ct bt da trn b nho, mt n hi. trnh so,
ngi ta thng m sau chn tc khong 1cm. Mt s ngi trn qu cao v t
tc c th m ngay ni gip gia da trn v tc. Khi cng da, ngoi vic ly bt
da lm cho trn thng li cn c th ko phn da u xung thp mt t cho trn
bt cao.
Tim thuc chng np nhn mt
"Ti 53 tui, mt v ui mt c kh nhiu np nhn, nht l vng trn.
Ti c nghe phng php cng da mt, m lm phng da, nhng ti rt s m.
Nghe ni nc ngoi c loi thuc no tim vo c th lm ht np nhn
v da phng li. iu c ng khng?".
Thuc chng np nhn mt da trn c ch chng co tht ca c da
mt. mt s ngi ln tui, do s co tht ca mt s c vng mi, vng mt
v c da trn, da b chng li, to thnh cc np nhn. Do , c th xa cc
np nhn ny bng cch ngn chn s co tht ca cc c bp lin h. Thuc
c dng l cht chit xut t vi trng Clostridium Botilimun. Ngi ta
nghin cu mt nhm c t c bit ca vi trng ny, pha long vi liu rt
nh, dng ti ch thy c kt qu tt trong iu tr chng co tht c mt v
mt. Thuc c tn l Botox, cn c tn l Dysport, c th dng xa np nhn
mt.
Lt da mt bng TCA
"Trc kia da ti rt trng. Nhng v cuc sng, ti phi bn chi ra
ng, nay da mt rt kh, nm v en. Ti c nghe n cht lt da mt TCA.
Vy TCA l g? Ti c lt c bng cht TCA khng? Cht ny mua u v
c t lm khng?".
TCA l thuc lt da mt loi mi, c rt nhiu u im nh khng c,
c th lt da dy hay mng ty theo nng v lng thuc thoa nhiu hay t.
Thuc ny c th dng cho mi trng hp da mt b xu i do nh nng mt
tri hay do cao tui.
Hin nay, mt s thm m vin TP HCM c thuc ny, gi khng t
lm. Bn c th lin h v hi trc tip cc c s gii phu thm m.
30
Sn sc sau khi lt da mt
"Ti lt da mt hai tun mt c s gii phu thm m. Kt qu cng
kh. Mun gi kt qu ny c lu cn phi lm g?".
Mun cho da mt p lu, sau khi lt da cn ch :
- Trnh nng: y l yu t quan trng nht. Vic tip xc vi nh nng
mt tri c th gy nm da mt v gy ung th da v sau.
- Dng kem dng da thng xuyn.
Tui no cng da mt c?
"Ti 59 tui, da mt b nhn nhiu. Ti mun c tr trung hn mt
cht, c th cng da mt c khng?".
V chuyn cng da mt, trc y ngi ta quan nim ch nn cng cho
ngi ln tui, tc l trn nm mi tui. Nhng cng ngy, s ngi tr mun
cng da mt cng nhiu. Khng phi ch c Vit Nam m nhiu nc trn th
gii cng th. Ngi ta mong tr p tui ang lm vic hng say, tr p
thnh cng hn trong tnh yu v s nghip. Hin nay ch nh cng da mt t
ph thuc vo tui tc. Ngi no da b nhn nhiu, sc khe cn tt l c th
cng c. Trng hp c th ca b chc l phu thut c.
Cng da mt c b so khng?
"Nghe cc bn ni cng da mt s tr v p tr li, nhng ti rt s b
so xu. Cng da mt c b so nhiu lm khng?"
Cng da mt l mt phu thut tch da ra, ko thng li v ct b phn da
tha nn c so nh ni m. So ny rt nh, kh thy, mt phn c tc
che v cng ngy cng m i, rt kh nhn ra.
Sau khi cng da mt phi ngh vic bao lu?
"Ti nm nay 50 tui, mun cng da mt cho bt np nhn. iu ny c
hi g khng? Ngi ln tui cng da c nguy him g khng? Phi ngh lm
vic bao lu? Hin ti vn ang lm vic, cng vic ti i hi phi giao tip
nhiu nn rt mc cm v ln da b lo ha ca mnh".
Trng hp ca ch nu cng da mt s cho kt qu rt tt v da nhn
nhiu v tui cha cao lm. Cng da l mt phu thut ngoi da v t chc di
da, khng c g nguy him lm nu so vi cc phu thut khc. Vi cc tin b
mi ngy nay, phu thut ch lm gy t ti ch, thi gian m khong 3 n 4
gi. M xong ngh 15 pht l c th v nh, khong 1 tun sau tr li ct ch.
Sau khi m, ni m c bng bng t gc nh, ngi c phu thut vn i
li, sinh hot bnh thng. Ch cn ngh cng tc mt tun l . Cn king
31
lm vic nng, gi ni m kh sch. Trnh ng chm mnh hoc lm bn ni

m. King n mt t thc n gy d ng nh c bin, rau mung...
Sau khi cng da mt phi trnh nng bao lu?
"Ti l nhn vin lm vic trong phng lnh, khng tip xc vi bi bm
hay ha cht g. Ti mun cng da mt nhng nghe ni sau khi m phi hn
ch ra nng. Nh vy nu i lm vic bng xe gn my th c hi g khng?".
Mt tri l tc nhn lm da b thoi ha nhanh. Ngoi tc dng thc y
s tng hp vitamin D, vic phi nng hon ton khng c li g. Nhng ngi
vng xch o c nhiu nguy c b tia t ngoi trong nh sng mt tri gy ra
nhng tn thng khng hi phc. Tn thng ny lm da b gi i d tui mi
45 hay 50. Do , ngay c khi khng gii phu thm m, chng ta cng khng
nn phi nng nhiu. Khi tip xc vi nng, nh i tm bin chng hn, ng
nn phi nng lu qu. Nn dng cc loi kem che ch da phn da tip xc
vi nng.
Sau khi cng da mt, lc ra nng nn i nn hoc che . Trong trng
hp c th ca b, sau khi cng da mt n nh, b c th i lm bnh thng,
khng gp tr ngi g.
Sau khi cng da mt bao lu th c th ty lng mt?
"Mt ti c t lng mng nh, thnh thong ti phi n thm m vin
ty lng. Xin bc s cho bit sau khi cng da mt bao lu ti c th ty lng mt
nh trc?".
Bn n su tun sau phu thut, b c th dng cht ty lng. Tuy
nhin, nu c kt hp vi lt hay c mt th ch c ty lng khi da hon ton
bnh thng, tc l da mt ht mu (thng t 10 n 12 tun sau).
Sau khi cng da mt bao lu c th gi u v sy tc c?
"Ti tc di; iu c gy tr ngi g cho phu thut khng? Sau
khi m bao lu ti c th gi u v sy tc bnh thng?".
Tc di hay ngn g cng phu thut c. Trc khi phu thut, b nn
gi u tht sch. Sau phu thut khong hai tun, khi vt m lnh tt, b c th
gi u v sy tc. Tuy nhin, trong vng 4 n 6 tun u, b khng nn dng
my sy tc qu nng.
32
Phu thut da mt ngi cao tui

"Ti nm nay 68 tui, sc khe hon ton bnh thng. Ti mun cng
da mt c khng? Da ngi ln tui khc vi ngi tr nh th no?".
Tui 68 c hi cao lm phu thut. Nhng nu c th hon ton khe
mnh th c th phu thut cng da mt hay bt c phu thut to hnh thm m
no. So vi da ngi tr tui, da ngi cao tui c mt s khc bit sau:
* Cc triu chng bn trong
- Xut hin cc np nhn c v mt.
- Da b teo li, lp m lin kt b mng i.
- Xut hin cc ban mu (purpura) do thnh mch d v.
- C cc t chc ging nh so gi hnh sao lng, bn tay v cnh tay.
* Cc triu chng bn ngoi (do nh nng mt tri gy ra):
- Cc np nhn.
- Da dy, cng, th nhm v kh do s gim tuyn b v tuyn m
hi, lp nc v m bo v pha ngoi da khng cn na.
- Da lo ha, c nhiu m ht, mn, ging nh tr i mi. Trn, m v
c c nhiu np nhn su, c trng hp b ung th da.
- Chc nng sinh l ca da gim:
+ Gim kh nng lnh so, trao i kh v bc hi nc qua da.
+ Gim sc chu ng i vi cc sang chn.
+ Gim phn ng min dch, kh nng iu ha nhit v sn xut
vitamin D.
+ Gim sc bo v i vi nh nng mt tri.
Tm li, da ngi ln tui khi phu thut s chm lnh hn. Nhng c
tnh ny thay i ty thuc iu kin sng, lm vic v mi trng xung quanh
ca mi ngi.
33
Nn chn cng hay lt da mt?

"Ti nm nay 34 tui. Trc y da mt ti trng v mn, rt p. Trong
vi nm gn y, c l do i nng nhiu, da b dy ln v c nhiu ch nm
en. Trng hp ca ti nn cng da hay lt da mt? Ti trng th trnh nng
c v yu cu cng vic?".
Phng php cng da mt c dng khi da mt b nhn nhiu, nht l
nhng ngi ln tui. Trc y, ngi ta ch cng cho nhng ngi trn 40
tui; ngy cng c nhiu ngi tr mun cng da. Hin nay, vn tui khng
c ch nhiu na, bt c tui no, gii no, da mt b nhn l c th cng
c, cng nhiu t ty mc nhn.
Tuy nhin, khi da mt thng hon ton th khng cn cng, nh trng
hp ca bn. Do cng vic, phi i nng nhiu, da mt ca bn bt u c hin
tng lo ha. Trng hp ny nn lt da. Sau lt nu dng cc loi kem
dng da, chng nng th cng khng c g ng ngi lm khi i nng. Ngy
nay, c nhiu ph n che hu nh kn c mt khi lm vic ngoi nng; iu
ny rt tt. Nhng khi trong bng mt cng cn ch n s phn chiu ca
nh nng t mt t ln da.
C nn va lt da mt va cng da mt?
"Da mt ti hi xu, i thm m vin th c khuyn nn lt da cho
mng li v cng cho da thng ra. Hai phng php ny cng p dng th da
s mn, tr ra rt nhiu. Nhng ti khng bit c th thc hin cng lc lt da
mt v cng da mt khng? Nn lt da trc hay cng da trc?".
ng l lt da mt v cng da mt u l hai cch lm cho tr li. Lt da
cho da mng i, xa bt phn da dy, xu, lm cho da non v tr ra. Cng da
mt lm cho da thng li, xa ht cc ch da b nhn, xu. Hai cch ny cng
kt hp th da s tr v p nhiu.
Da c nui dng nh cc mch mu di da. Phng php cng da
mt tch da ra khi ngun nui dng ca chng v t li mt ch mi. ch
ny, mch mu s mc ln v nui tip, thay th mch mu c b mt i. Thi
gian mu nui mc tt l khong 2 n 3 thng. Do , nn cng da mt trc
vi thng ri lt da. Nu lt da cng lc hoc trc khi cng th ni m kh
lnh, c th cho so xu. Lt da sm qu khi da cha bnh thng th c th da
lt b thiu mu nui, nhim trng ko di v cho kt qu xu hn lc cha lt.
Sng n sau khi cng da mt
"Ti c phu thut cng da mt cch y hai thng. Hin nay, ni
cng da cn sng n nhiu. Nh vy c cn phi phu thut li khng?".
34
Cng da mt c nhiu k thut. Cc k thut ny nhm tch da mt ra

khi t chc bn di ri cng cho thng li. S khc nhau ca cc phu thut
l tch da mt nng hay su. Mt s k thut c lm thm cc th thut khc
na nh ko cng cc t chc c ca da mt hay ht m mt v c.
Phu thut cng da c th lm sng n vng mt mt thi gian (t mt
n nhiu thng). C mt s t trng hp phi sau ba hay su thng mi ht
sng. Do , trng hp ca c nu khng b sng hay au nhc (do nhim
trng ni m) th chc khng cn phu thut li.
Cng da bng
"Trc y da bng ti rt p. Sau khi sinh chu xong, ti b gy i
nhiu, da b nhn, rt xu. C th cng cho da bng phng ra nh cng da mt
c khng? Cng da nh vy v sau c thai tr li c khng?".
Ging nh da mt, da bng cng c th cng. Phu thut cng da bng
phi bc tch rng, tn nhiu thi gian hn v sau khi cng phi bng cht t
hm. Ty theo trng hp, nu sau khi cng, rn b ko lch nhiu th qu phi
thay i v tr mi cho rn, n cn i vi vng da bng mi.
Sau khi cng da bng, bn vn c th mang bu li bnh thng v da s
gin ra cho thch hp vi bng khi mang thai.
35
iu tr so mn
Nguyn nhn gy mn
Mn l bnh mn tnh ca nang lng, nu khng c iu tr tt c th
dn n nhiu so xu mt. Bnh xut hin vo tui dy th v xy ra
khong 80% ngi tui v thnh nin, chm dt vo tui t 18 n 20. C mt
s ngi bnh ko di n khi trng thnh. y l mt loi bnh di truyn,
xy ra vng mt v phn trn ngc, ni c nhiu tuyn b.
C ba hin tng bnh l xy ra nang lng a n s hnh thnh mn:
1. S bi tit cht b
C hin tng tng s bi tit cht b l do:
- S gia tng hot tnh ca men 5 alpha-rductase chuyn testostrone
thnh dihydrotestostrone.
- Gim protein mang testostrone lu thng, i khi lm tng
testostrone ti nang lng.
- Sn xut qu nhiu andrognes ph n, gy ra nam ha, rng tc v
mn.
2. Tng s sng ha ni bi tip b (l chn lng)
Cc cht b cha mt lng axit bo cao, kch thch l chn lng v lm
tng s sng ha. S k sinh ca vi sinh vt mn tn l Propionibactrium
Acnes (PA) cng sinh ra cht men thy phn triglycerides thnh axit bo. PA
tng sinh nhiu, to ra cc cht sng v cht b, hnh thnh ci mn.
Ngi ta phn bit 2 loi ci mn: loi l ra ngoi thnh chm en v
loi kn dng u nang nh. S hnh thnh ci mn cn do nh hng ca cc yu
t bn ngoi nh:
- Dng cc loi m phm c nhiu cht m (cht nhn)
- Dng cht lu hunh.
- nh mt tri.
- Sc nng.
- m.
36
3. Vim nang nng

Do s v mng bao mng ca ci mn, vi trng PA tit ra cc men
hualuronidases, protases, amylases lm tan mng bao ci mn. Cht lysosyme
c phng thch lm v ti nang lng v hnh thnh t chc m ht vim. V
lm sng, y l cc mn m, i khi l nhng nang cng su di da.
Cc loi mn
Cc dng mn nng
C th xut hin rt nhanh sau tui dy th, sau mt t c dng ci mn
hay mn m.
- Mn bc to: y l dng mn ni g ln, trong cha nang m, thng
xy ra phi nam. Cc khi u ht vim c th chuyn thnh p xe, r m, v
sau thnh so cng, lm da xung rt xu. y l dng mn ca cc em trai,
thng lng hay mt trc ngc. phi n, loi mn ny thng kt hp vi
bnh nam ha.
- Mn dng conglobata: Theo sau mn bc to, cc loi mn to ln, au
nhiu, mn t li thnh m v r m ra da. Bnh ko di n tui trng thnh
v gy nhiu so xu.
- Mn th nng: L loi mn conglobata c i km theo st, au nhc cc
khp xng v nh hng n ton trng ngi bnh. Ni mn b lot, ng
vy, chy mu.
Mn tr em
- Tr nh: Xy ra khong 3 n 6 thng sau khi sinh, mt c ci mn v
mn. Bnh ny ch xy ra trong mt thi gian ngn do nh hng kch thch t
nam ca ngi m.
- Mn tr ln: Thng t gp, l mn a dng ca tr v thnh nin, xy
ra nhng a tr cha m b mn nhiu.
Mn ngi ln
Bnh tch vim l ch yu
- n ng: Bnh tch ch yu c v lng dng conglobata hay dng
mn nng.
- phi n: Ch yu l mn do kch thch t, thng xy ra quanh ming
v vng hm di.
37
Cc thuc trnh thai c androgne v progestrone c th gy ra v lm

mn nng thm.
Nu ngi bnh c triu chng nam ha, phi tm xem c u thng thn
hay u bung trng khng. c bit, triu chng ny ph n c th do yu t
tm l.
Bnh mn th pht
Xy ra do dng m phm, tip xc vi cc tc nhn vt l, ha hc hay
do dng thuc.
- Mn do dng m phm: Dng ci mn hoc nhng nang nh quanh
ming. Bnh xy ra do dng m phm c nhiu cht nhn, khng thch hp vi
da.
- Mn do tip xc vi cc ha cht.
- Mn do ngh nghip: Do tip xc vi cht hydrocarbures (c trong du
ha), to thnh ci mn hay nt mn da ni tip xc.
- Cc tc nhn vt l nh tia X, tia Cobalt c th gy mn nhiu tun sau
khi x tr. Tia t ngoi trong nh mt tri c tnh cht dit trng nhng cng
gy mn.
- Mn do dng thuc tr bnh: Thng dng vim nhiu hn l to
thnh ci mn.
Cc loi thuc gy ni mn thng gp l loi Corticoides dng bi mt
hay ung; cc loi thuc c cht Halogne nh Brome (Calcibronat), it (thuc
tr bu tuyn gip trng c), Cobalt (c trong sinh t B12), Flour (c trong
kem nh rng).
Cc thuc tr ng kinh nh Gardnal, Diphnylhydantoine,
Trimetadoine nu c dng mt thi gian di cng c th gy ni mn
ngi ln.
Mt s loi thuc khc cng c th gy mn nh: Mui ca Lithium,
Rifampicine, cc loi thuc cha cht Progestrone tng hp.
Cch iu tr mn
Vic iu tr mn nhm ba mc ch: gim bt cht nhn, lm tan ci
mn v lm gim phn ng vim.
1. Lm gim cht nhn
38
- Dng thuc c ch men 5 alpha-rductase, gm Progestrone t nhin

(Progestosol), Promestrine (Delipoderme), kt hp km vi vitamin B6
(Alphane). Cc cht ny trn l thuyt rt tt, nhng thc t khng cho kt qu
nhiu lm. i vi ph n, dng cht khng Androgne. c hai phi, c th
dng Isortinoine.
- Cc kch t n tc dng trn ba cch:
+ Tng SHBG (globulin mang kch thch t sinh dc), lm gim
testotrone t do hot ng.
+ c ch cc im tip nhn kch thch t nam tuyn b.
+ Gim s sn xut Androgne bung trng.
Cc thuc ny kt hp vi actate cyprotrone hay mt loi thuc
progest rone khng c tc dng ca kch t nam.
Thuc c dng cho ph n ln tui. i vi ph n tr, c th dng
oestrogen vi liu 30 n 50 mcg (Ovanon 50, Varnoline 30). Ngy nay, Diane
l loi thuc c nhiu ngi dng hn. Thng n thng th t mi c kt
qu. Cn dng thuc mt thi gian di, nhiu khi hn mt nm.
- Thuc Isotretinoine hay Roaccutane: Dng iu tr mn nng. C
ch tc dng l lm gim nhanh chng s bi tit ca tuyn b khng do c ch
ni tit. Tc dng c ch tuyn b ny tn ti ngay c khi ngng dng thuc.
Tip theo, thuc cn lm ci mn c y ra ngoi, gim s lng vi trng Pa,
gim phn ng kch thch t bo vim ca c th. Liu dng l 0,5 mg/kg/ngy
trong 300 ngy.
Thuc ny lm kh da v c th gy mt s tc dng ph nh nhc u,
au nhc khp xng, khng dng c cho ph n mang thai.... N ch c
dng khi b mn nhiu, iu tr thuc khc khng kt qu.
2. Lm tan ci mn
Cc thuc ny lm sch da, y ci mn ra (hai hoc ba thng sau khi bt
u iu tr ni khoa).
- Cc loi thuc thoa ngoi da nh Isotrtinoine loi dung dch (gel) kt
hp vi khng sinh ti ch cho kt qu tng i tt v t b phn ng ph.
- iu tr tng qut vi cc thuc khng vim, khng sinh ti ch v ton
thn
3. iu tr so mn
39
Sau khi ht hn mn t 6 thng n 1 nm, c th iu tr mn bng

phng php lt, c da mt hoc phu thut ct b so v ghp da.
Trn thc t, vic iu tr mn thng t kt qu v cc nguyn nhn gy
mn t c ch v gii quyt trit . Cc so ny tuy vy vn iu tr c
bng phu thut thm m.
phng v iu tr cc loi mn mt m khng li so thm
"Chu rt s b mn. C mt s bn gi cng tui b mn, sau da mt
c nhiu so thm en rt xu. C cch no khi b mn khng, v khi l b
mn ri th nn iu tr nh th no khi b so xu?".
Cu hi ca chu kh di, gm hai chuyn: phng v iu tr mn.
Chng ta bit mn do nguyn nhn bn ngoi v bn trong c th gy ra.
Cc nguyn nhn bn ngoi l: d ng vi m phm, ha cht, mt s loi thuc
iu tr bnh; nhim trng da mt do vi trng Propionibacterum Acnes...
Nguyn nhn bn trong c th l: da tit nhiu cht nhn (do nh hng ca
kch thch t nam), da b sng ha nhiu ni cc l chn lng mt v vim
nhim ti ch da mt. Do c nhiu nguyn nhn nh vy nn i vi tng
trng hp c th, phi xem u l nguyn nhn chnh gy mn v iu tr tp
trung vo .
Ni chung, vic gi da mt c sch tt, ch dng m phm khi cn
thit, hn ch tip xc vi ha cht, c ch dinh dng, ngh ngi iu c
th gip chu trnh c mt s trng hp v mn.
Khi b mn, nn iu tr sm v ng cch trnh so xu. Khi b so
ri, d c iu tr tht tch cc vi cc phng tin cn thit, da cng kh tr
li hon ton nh trc.
iu tr so mn
"Khi b so thm do mn li th nn lm g tr ht?".
Cch iu tr khc nhau ty theo so su hay cn.
- i vi cc l so mn su, phi ct b v ghp da. Mi l so c
ghp mt mnh da trn nh. Mt thi gian sau, khi da mc u v phng li s
khng thy l.
- Vt thm hoc so cn: C th c da cho bng phng li. Phng php
c da mt cn c dng iu tr cc trng hp mn do da sng ha
nhiu cc l chn lng (thng gi l da mt dy). y l mt cch iu tr
mi. C da mt c p dng khi iu tr mn bng phng php thng thng
ko di m kt qu t. Dng cch ny phi ht sc cn thn, trnh nhim trng
lan rng v sau khi c da phi trnh nng nhiu thng.
40
- i vi ngi b kt hp c hai bnh tch, va b so su, va b vt

thm, vic iu tr phc tp hn. C th phi lt hoc c da mt trc lm
gim tng ngoi cng, cho da mng li. Sau khi n nh, ct b so v ghp da.
iu tr mn ko di
"Chu nm nay 22 tui, da mt tng i nhiu cht nhn, c bit
khong mt nm nay chu b rt nhiu mn. Chu dng rt nhiu loi thuc,
king c n ung rt cn thn nhng mn cng khng ht c. Ti sao vy?".
Mn do nhiu nguyn nhn gy ra. a s trng hp kh tm nguyn
nhn. Mt s trng hp tm ng nguyn nhn ri nhng vic iu tr cng
mt rt nhiu thi gian, c khi phi mt nhiu thng. Do , chu khng nn
qu lo lng, c t t chc bnh s khi thi. Trong trng hp cn thit lm, b
mn ko di, iu tr thuc khng kt qu, c th dng phng php c da mt.
Dng sa b ti tr so mn trng c?
"Nm nay ti 25 tui, trc y c nhiu mn trng c. Hin nay mn
gim nhng li nhiu so lm, khin da kh v sn. Ti c th dng sa b
ti bi ln da mt vo mi bui sng c khng? Khi lm nh vy c ci
thin c g khng v ti c phi king nng khng?".
Rt tic l ti cha c c ti liu no ni v vic dng sa b ti
cho da mt b so v kh do mn. Tuy nhin, sa b c th lm da kh (nh
cht bo trong sa). Ngoi ra, cc cht m, vitamin, khng th c trong sa c
th cng gip nui dng trc tip da v lm gim nhim trng da do mn. Tuy
nhin, c ch nn dng sa con b hon ton khe mnh v sa mi c ly
t b ra. Trnh dng sa lu (v n c th cha vi trng gy bnh) v ch nn
bi sa ln da mt ngy vi ln, sau nn ra sch. Nu kt qu tt, c c tip
tc, nu xu i th ngng, chc khng c g hi.
iu tr so mn mt
"Trc y, ti c rt nhiu mn hai bn m. Sau khi lp gia nh v
sinh chu b vi nm th hon ton ht hn mn, nhng da mt hin cn rt
nhiu so mn nh. Nu lm mt cc so mn ny th hay bit my! Xin bc s
cho bit c cch no lm ht so mn khng?".
Trng hp ny c th dng phng php lt da mt trc ly bt cc
t chc da dy, xu chung quanh ni so mn, lm cho da mng li v mm
hn. Sau vi tun, tin hnh c da mt, c da vi ln, mi ln cch nhau
vi thng. Sau khi c da, nu cn mt vi ch so mn su qu, c th ct b
so v ghp da. Ni chung vic iu tr tn nhiu thi gian v kh phc tp.
Trong sut thi gian iu tr, c cn trnh nng.
41
Thut c so
"Ti nm nay 24 tui, c so kh ln trn do b ng hi cn nh. C
th c cho so ny bng li c khng?".
K thut c so thng dng cho cc so nh nhng b li ln cao hn da
mt. So ca bn kh ln, nhng bn khng cho bit c th kch thc c no
nn kh quyt nh nn c hay lm p bng k thut khc nh ct b so, ghp
da hoc chuyn vt da.
Ni nhiu mn do tui gi
"Nm nay ti 74 tui, ngi vn khe, nhng da mt ni nhiu vt en,
g cao ln, khi ra mt ti thy rt kh chu. l bnh g v cch iu tr nh
th no?".
Da mt ng b cc bnh tch lo ha, c th iu tr bng cch ct t
in cc ch da g cao ln cho bng phng li.
iu tr so mt do thy u
"Con gi ti nm nay 16 tui, trc y mt nm chu b ni thy u
trn mt. C hai nt thy u b nhim trng thnh so kh su. Phi lm sao
xa so ny? Nn c so hay m ct so ri may li?".
So nt thy u b nhim trng thng hnh trn v kh su. Do , kh
c cho so bng da chung quanh m khng lm tn thng nhiu n da chung
quanh. Cch iu tr tt nht l m ct b so ri may li, hoc ghp da vo ch
so trn ct b, ging nh so mn su vy.
iu tr so li do x l tai
"Con gi ti nm nay 11 tui. cho chu c th eo hoa tai nh cc b
khc, ti c nh ngi x l tai cho chu cch y 1 nm. Sau , ni x l
tai b so li ngy cng ln. Ti nh ngi phu thut hai ln ri nhng ni
m vn b so li. C cch g tr dt so li khng?".
C mt s ngi thuc c a so li, khi b chn thng rch da, ni
rch s thnh so li rt xu. Ngoi ra, c mt s ngi khc khng thuc tng
so li nhng khi vt thng hoc vt m khng c phu thut tt, b sang
chn nhiu hay b nhim trng m cng b so li. iu tr so li, cn phu
thut ct b ch li, may li k v theo di. Phi tim thuc chng so nu so
bt u li ln tr li.
42
iu tr so mi mt
"Cch y hai tun, ti b tai nn giao thng, mt b nhiu vt rch,
c may li v ct ch. Nhng so to qu, gn y ni mi trn ca ti so c
v li ln. Phi iu tr nh th no?".
Trng hp ny so cn ang tin trin, cha bit n s li tip hay gim
bt. Nn ch mt thi gian na, c th mt hai thng, so hon ton n nh.
Vic iu tr khi s c kt qu tt hn.
C hai cch iu tr v sau: Phu thut cho so nh li hoc c cc so li
cho bng li. Ty v tr, c th dng cch ny hay cch khc, c khi phi kt
hp c hai nh ct may li cc so xu mt v c mi trn.
So do b rch mt
"Cch y mt thng, do mt chuyn hiu lm vi hng xm, ti b rch
mt mt ng di t tai xung n cm. Vt thng gy chy mu nhiu qu
nn ti phi vo cp cu mt trm y t gn nh. Lc , bc s cm mu
v may li vt thng cho ti. Sau khi may, vt thng xu qu, b rng gn 1
cm v nhiu ch may b lch, da b chng nhiu. Ti c gng ch cho lnh v
ngi khe mt cht. n nay, so kh lnh, mi ngy soi gng, nhn thy
so mt l ti mun cht cho ri. Ti kh tm qu. Nu khng tr ht so ny
chc c ngy ti t t v b mc cm qu ln. Xin bc s hy gip ti".
Rt tic l do mt chuyn hiu lm m bn b tai nn ny. Chuyn xy
ra cng hi kh gii quyt v hai l do:
Th nht, so mi c mt thng, cc t chc chung quanh so cn
vim, nu phu thut th kt qu s khng p bng so n nh (thng 6
thng sau).
Th hai, phu thut thm m khng lm mt so c (ging nh gng
v khng bao gi lnh), ch lm cho so nh li v kh thy sau mt thi gian.
D sao, nu so ko lch nhiu v xu nh vy th cng nn m li. Tuy nhin,
phi chp nhn l sau m, chc chn bn s cha p ngay v d phu thut
kho lo n th no i na, nu nhn k cng thy c so.
Vn quan trng l n nh tm l, chuyn khng may xy ra ri,
mnh phi chp nhn v c gng sng vui vi nhng g cn li. cuc i,
ngoi sc p ra cn rt nhiu th khc cng quan trng nh tnh yu nam n,
tnh thng yu vi ngi thn v vic phn u t c mt nguyn vng,
c m hay l tng g . Do , bn khng nn tm n ci cht mong
gii quyt nhng bun phin, nhng bt hnh trong cuc i. Tri li, cn phi
c gng sng tt p, y hn, thnh cng hn mi ngi nhn vo mnh
vi s thng yu, qu mn v knh trng.
43
Thiu da ghp so mt
"Chu nm nay 17 tui, cch y 10 ngy chu ng xe my, b mt mt
khong da 2 cm2 g m bn tri. Khi vo cp cu bnh vin, bc s cho
bit khng may li c v thiu da v khi may c th b ko lch mt. Vy chu
phi lm sao? Xin bc s cho bit kin, chu lo qu v i u cng phi bng
mt li hoi, rt bt tin".
i vi trng hp ca chu, cch tt nht l m ghp da ri, c th
ghp da dy hoc mng cng c. Da tt nht ghp vo mt l da pha sau
tai, hoc da vng trn xng n gnh. Cc ni ny da t lng v c cu trc
tng i ging da mt. Da i ghp cng c nhng c th c mu khc
vi da mt.
Khuynh hng chung ca cc so vng mt l ngy cng thu hp li. Nu
chu ngi phu thut, ngi ghp da th c vy, dn dn so cng nh bt,
khng c g phi lo lng qu.
iu tr so bng ln u v c
"Con ti nm nay 16 tui. Cch y 6 thng, khng may chu b bng do
l ga du lch n, b so nhiu mt bn mt v c. Chu c bnh vin cp
cu n nh, v ghp da phn b bng. Mc d vy, so cng cn rt ln.
Chu rt bun v mt cm vi cc bn v vt so ny. C cch g lm ht so
c khng?".
So do chn thng hay do bng rt kh l mt hon ton c. Bnh
vin cng c gng iu tr cho chu qua nguy him v lnh vt bng. Chu
cng c ghp da, nhng chc l cha c p hon ton. C th chu
phi phu thut tip mt vi ln na. ng nn kin nhn a chu i ti khm
li ti khoa iu tr bng lc trc, nh gii quyt tip; hoc n mt c s gii
phu thm m no hi kin c th xem sao.
iu tr nhiu so c
"Trc y 3 nm, ti b lao hch, c c nhiu hch lm bin dng, rt
xu. Ti iu tr lao hch n nh. Sau , bc s c phu thut ly hch cho
ti. Nay c bng phng li, nhng sau phu thut, c c nhiu so ri rc
nhiu ni, lm ti rt ngi khi mc o khng c. Lm th no xa ht so
ny?".
C th phu thut chnh hnh li cho so nm theo cc ng nhn ca da
c. Sau mt thi gian, so m s kh thy hn. Ngoi ra, cn mt cch iu tr
khc l nu so khng ln lm v g gh, c th c cho so nh, bng li nh
da c, cng kh thy. Phi xem c th trng hp mi quyt nh c.
44
iu tr so li mt do ha cht
"Ti lm vic mt x nghip v ha cht. Cch nay mt nm, v ri ro
khi lm vic, ti b bng mt do cht axit. Ni bng thnh so li co ko, rt
xu. C th iu tr c khng? C cn nhiu thi gian lm khng?".
c im ca bng do cht axit l gy hoi t c, c ngha l bnh tch
b chy nm li thnh khi m cng v m bn di thnh so, ngy cng co
ko, lm bin dng cc t chc ln cn. Bn b bng mt nm ri, giai on
hoi t qua, hin gi c tnh trng so li, co ko. Ty tng trng hp, c
th phu thut ct b m so v ph t chc ct b bng vt da bn cnh, hoc
ghp da ri. Ty theo so nhiu hay t, bn c th phu thut mt hoc nhiu
ln, mi ln cch nhau khong 1 n 2 thng. Thi gian ny cn thit cc
mch mu nui dng t chc thay th m so c pht trin tt, bo m
mnh m ghp hoc chuyn n khng b hoi t v sau.
Lm mt hon ton so trn
"Ti nm nay 27 tui, do trc y b tai nn giao thng nn c so nh
ni trn. Ti gii phu thm m mt ln, so c nh bt. Nhng mi ln soi
gng, nhn k vn thy n, ti rt bun. C cch no lm mt hon ton so
ny c khng?".
Gii phu thm m ch lm cho so nh bt v tm cch du n vo mt
ni kh thy ch khng lm mt so c. Trng hp ca bn, khng bit tnh
trng so c xu lm khng, nu khng th bn ng nn gii phu na, t t
so cng s m.
So vng c do dng thuc gia truyn
"Trc y vi nm, v hay b m nhiu trong c, ti i khm mt ni
c gii thiu l chuyn tr bu c bng thuc dn tc. Ti y, ti c cho
mt loi thuc gia truyn g p ln c. Sau khi p thuc, da c ti nng
rt nhiu, v sau ni , li ln thnh so rt xu. Ti rt hi hn v vic ny
v i iu tr nhiu ni, nhng vn khng ht so c. Bc s iu tr
tim thuc vo so 3 ln, nhng so cng khng ht c. Ti phi lm g
khc phc tnh trng ny?".
Thuc dn tc khi p vo da c nu gy so li nh vy th c kh nng
l trong thuc c cha cht axit (c th axit ly tri cy hay ha cht). Bnh
tch ny cng ging nh so do bng ha cht, cn phi ct b so v chnh
hnh da li. May mn cho b l ch so li khng nhiu lm, da c li n hi
tt. Mt s trng hp so rng hn, c th gy co rt vng c, iu tr rt phc
tp.
45
iu tr thm m p xe vng mt
"Ti nm nay 34 tui, cch y 4 thng, m tri t nhin b sng v
mng m. Ti ung thuc khng sinh v bi thuc 1 thng th ht sng,
nhng vng da vn cn ty v chy nc hoi. Ti iu tr lin tc n
nay nhng ch lot vn khng lnh, khin khi ra ng lc no cng phi bng
li mt bn mt, rt kh chu. Ti phi lm g?".
Nhim trng da vng mt n thun t khi ko di nh vy. Ch iu
tr 4 thng ri, c l p xe n nh, nhng phn da mt pha ngoi ti p xe
b vim, d ng vi cc loi thuc bi da.
Cn phi khm k mi xc nh c nguyn nhn v c cch iu tr c
th. Tuy nhin, ch nn th mu xem c th c b bnh g ton thn kt hp, gy
chm lnh so v nhim trng ko di (nh tiu ng, suy gim min dch)
khng. Mt s u nang bm sinh mt c th cng c triu chng ging nh
vy.
D sao, bnh ko di lu, ch nn iu tr trit sm, nhm trnh gy
so xu cho da mt.
iu tr so chn
"Cch y hai nm, ti b ng xe, b so bp chui chn tri ( 4 x 5
cm). So ny khng b li nhng lm cho da mt mu, thnh mt vt ln mu
trng. Ti c bi nhiu loi thuc nhng da khng tr li bnh thng c.
Ti rt bun v mc cm khi phi mc vy ngn. C cch no lm cho ch
nh li hoc cng mu vi da c khng bc s?".
T chc trng chn ca c l m so do chn thng. May mn l so
khng b li. Mun cho da vng ny tr li mu nh trc th phi ct b ht t
chc so i v ghp da mi vo. Hin nay y hc cha c cch g lm mt so
ngoi cch ghp da hoc chuyn vt da t ni khc n.
iu tr so chn do b bng
"Tha bc s, ti nm nay 34 tui, trc y mt nm b ng xe, phn da
pha sau chn chm vo b xe my nng gy bng. So bng rt xu, to
khong 2 x 5 cm, li ln, mu en sm. Ti bi rt nhiu thuc chng so
nhng khng c kt qu g ht. Nh vy c cn phu thut khng?".
So da chn c to qu v li b li nhiu. Cch iu tr tt nht by gi l
phu thut ct b so v c th phi ghp da ri ni m cho b cng khi may
li. Sau m phi tip tc theo di, nu quanh ni ghp da so li ti pht, phi
tim thuc chng so.
46
iu tr so bng bn tay
"Em ti nm nay 16 tui, trc y 6 thng b bng nng bn tay phi.
Nay ni bng lnh ri, nhng so co rt rt nhiu lm cc ngn tay khng
c ng c. C cch g iu tr cho bn tay ht so v c th c ng bnh
thng khng?".
Trng hp ny phi phu thut ct b ht t chc so rt, to hnh li
cc gn co dui ngn tay, ghp da.... Phu thut kh phc tp. Ch nn a
em i khm Trung tm Chn thng Chnh hnh TP H Ch Minh c
hng dn c th.
Xa cc vt so nh bn tay
"Ti nm nay 43 tui, 3 thng trc, khi i d ngoi, ti b kin cn
nhiu ch da lng bn tay, vt cn nh nhng rt nga, lm ti phi gi
thng xuyn, gy try nh da. Ch try tng khng c g ng k,
khng ng rt lu lnh v v sau li gy nhiu so nh g ln lng bn tay,
rt xu. Da vng so cng b mt mu. Ti phi lm sao y?".
Cc vt cn ca kin hoc cn trng c th gy vim do nhim trng v
d ng. Do , cn iu tr ngay bng cc thuc khng sinh, khng vim, chng
d ng. Mt s trng hp nng cn iu tr tch cc chng sc do phn ng
qu mnh ca c th (nh b ong t). Trng hp ca b b phn ng nh v
vim ko di, gy so li v mt sc t da. Cch iu tr hin ti ging nh iu
tr so li, tc l ct b so v may thm m li.
iu tr so ngn tay
"Trc y mt thng, chu b ng, rch da lng ngn tay, ni rch c
vi ht ct ri vo. By gi vt thng lnh, nhng so li rt xu v c
my chm en. C cn phi m thm m li khng?".
Rt tic l lc b rch da, ngn tay chu khng c phu thut ct lc v
lm sch vt thng ng mc (tc l ly sch bi ct hay t trong vt
thng). By gi so lnh ri v ang tin trin, cha nn phu thut li. Phi
ch t 3 n 6 thng sau, khi so n nh hn; nu xu qu th phu thut li,
ct b so, ly lun cc ht bi, ct, may li, so s p hn. Trng hp so
khng xu lm, khng m cng c v vic phu thut cc ni da b cng
nh mt lng khp ngn tay, u gi, khuu tay rt d gy so li.
Xa so bng laser
"Ti nm nay 30 tui, va i dng laser xa so mt. Din tch mi
vt xa chng 0,5 cm2 (c 5 vt xa). n nay hn 3 tun ri, tuy da
lnh li bnh thng nhng vt xa vn c mu hng. Lc mi xa so xong,
bc s c a mt loi thuc bi mu trng nh kem. H ni bi tit dch, ti
47
dng 4 ngy ri ngng v vt thng kh. Ti king nng k. Mong bc s

cho vi li khuyn".
Xa so bng laser l dng tia laser t nhng phn g cao hoc xu
ca so. Sau khi t, ni lnh s c mu hng mt thi gian, c khi n vi
thng mi ht. Trong thi gian so lnh, cn trnh nng. C trnh khng i
ngoi nng l tt ri, nhng nn ch thm nh nng phn chiu vo da mt
khi gp mt ng, bi ct hay cc vt phn chiu khc. Ngoi ra, c cng cn
trnh cc thc n c th gy so li hoc d ng nh rau mung, c bin...
iu tr so li vt m
"Ti sinh m cch y ba thng. Bc s may li ni m rt kho, lc
va mi ct ch so nh, rt p. Nhng gn y so li ln d ti vn thoa
thuc chng so li v king n rt k. Liu c phi m li cho so p hn
khng?".
So ca c mi c ba thng, c th cn thay i, phi ch thm su
thng mi nn can thip. C hai trng hp c th xy ra:
- So ch qu pht n thun: Vic m chnh so cho kt qu tt.
- So li: Thng do c a so li hoc nh hng di truyn, iu tr
kh hn. Sau khi phu thut, t l ti pht cao. Loi so ny thng xut hin
mt s ni c bit ca c th nh vng vai, trc ngc, trn rn hay sau tay.
C th iu tr bng cch tim cht cortisone hay x tr.
Thi gian ct ch vt thng mt
"Ti b ng, mt p vo cnh sc ca nn nh, vt thng kh su,
c trm y t cm mu v khu li. Sau 7 ngy ct ch, vt thng h ra v
gy so rt xu. i vi vt thng mt, my ngy th ct ch c? C phi
do ct ch sm qu m vt thng ti khng c p khng?".
Thi gian 7 ngy l ct ch cc vt m mt. Vng mt c nhiu
mch mu nui hn ni khc nn vt thng mau lnh hn. trnh so ni
cc ng ch may da, ngi ta c th ct ch sm hn, khong trn 4 ngy l
c. Tuy nhin ni m b ko cng qu, hoc bnh nhn ln tui, ang suy
yu hay dinh dng km, c th phi hn 7 ngy, hoc i khi 10 ngy mi ct
ch c.
Trng hp ca c, c th vt thng b bm dp nhiu khi ng nn so
xu thi ch khng phi do ct ch sm.
C da trn mnh da c ghp
"Cch y 5 nm chu b thng, mt cht da mt, c ghp da.
Ni ghp lnh tng i tt, cng mu vi da mt nhng b hi g gh. Chu
48
mun c cho phn da ny bng phng li c khng? C s khi c, mnh da

ghp b trc ra khng?".
C ghp da c 5 nm, mnh da ghp lnh v c nui dng
tt. Nay mun c cho b mnh ghp bng phng hn cng c, tuy nhin th
thut phi ht sc nh nhng, ch c nh biu b (lp ngoi cng ca da) thi.
Trnh gy sang chn, c th nh hng n h thng mu nui mnh da ghp,
lm so xu i.
49
Xa nt rui, vt xm
iu tr nt rui ui mt
"Ti c mt nt rui ng knh 0,5 cm pha di ui mt. Khng bit
c phi l do nt rui ny khng m ti gp rt nhiu chuyn bun v tnh cm.
Ti mun ph n c khng? C s chuyn thnh ung th khng? Sau khi
ph, mt c so xu lm khng?".
Nt rui di ui mt l nt rui c nhiu ngi yu cu xa i
nht. C th ni gn mt, gn ni nc mt chy xung m ngi ta ngh
nt rui ny s khin h gp nhiu chuyn bun. Khng ch phi n m nhiu
ngi phi nam, ln tui cng mun xa nt rui v tr ny sau mt vi
chuyn khng may v tnh cm. Ngc li, i vi cc nt rui v tr khc
(quanh ming, di cm) th t ngi mun xa.
Nt rui mt hay bt c ch no khc trn c th u c th xa c
bng nhiu cch: t bng in, bng tia laser, hay m ct b ging nh m
mt khi u thng thng. Mt s nt rui nh c th c hy b bng cch
dng ha cht chm ln nhiu ln. Nhng d lm bt c cch no, xa nt rui
cng l mt th thut ngoi khoa, tc l ngi thc hin phi c kin thc v y
khoa v phu thut. H phi hiu r nguyn tc v trng, thc hin trong iu
kin v trng tuyt i trnh lm m, so xu ni xa. H phi bit nn ct
b phn no, ni no phi thn trng khi ct, bit cch phn bit nt rui bnh
thng vi ung th t bo y da nh th no; sau khi ct c nn th gii
phu bnh xem phi l ung th da khng, khi ung th phi iu tr ra sao...
Ni th nghe di dng nh vy, nhng cch thc hin th n gin thi:
Bn n mt c s phu thut thm m c uy tn, v mt lc sau c th ra v
vi nt rui bin mt hon ton.
Vic nt rui qu to hoc c th bn ang b mt bnh g c th gy
tr ngi cho phu thut hoc nh hng n vic lnh so v sau. Bn nn lm
mt s xt nghim v iu tr cho c th hon ton khe mnh trc khi xa
nt rui.
Vic xa nt rui khng gy ung th nu thc hin ng k thut. Sau
khi xa, so rt nh v mt s trng hp hu nh khng thy. Nt rui ca
bn xa c, khng s so xu v khng nh hng g n sc khe v sau.
50
Nt rui mi mt
"T lu, mi mt di ca ti c mt nt rui nh, mu en, st lng mi.
Cch y vi thng, t nhin nt rui ln ln nhanh thnh mt khi en, rng
khong 1 cm, lm mi mt rt kh chu. Ti nm nay 50 tui, huyt p cao v h
van tim; c nn m ct nt rui ny khng?".
a s nt rui cc khi u mi mt l u lnh (chim 75%). Tuy nhin,
cng c mt s trng hp chuyn sang ung th da (loi ung th t bo en).
Loi ung th ny thng da vng m v lan rng ln mi mt. Khi u t
nhin ln nhanh ln trong mt thi gian ngn, c th chuyn sang ung th. Cn
phi phu thut ct rng quanh u, gi bnh phm i xt nghim chn on
v xc nh iu tr tip nu cn.
Trng hp bnh nhn b huyt p cao v h van tim, nn iu tr tch
cc cho huyt p n nh; khi phu thut, cn thc hin v trng tuyt i,
trnh dng thuc nh hng n tim; dng khng sinh trc, trong v sau khi
m phng vim ni tm mc. Vi s chun b k nh vy th chc khng c
g nguy him khi m u.
Nt rui d b chy mu da mt
"Tha bc s, ti nm nay 60 tui; t hai thng nay m phi t nhin
ni ln nt rui, khng en lm, rt d chy mu khi chm n. Nt rui ny
ln kh nhanh so vi cc nt rui khc mt. Nh vy c g nguy him khng
v cch iu tr nh th no?".
Trng hp bnh u da mt ca ng c th khng phi nt rui bnh
thng m l mt dng bu ngoi da, c nhiu kh nng l u lnh tnh (thng
c gi l u nh hay bu gai). U ln nhanh, ng nn iu tr sm. Cch iu
tr l ct b u bng dao m thng hay dao in. Phu thut rt n gin, khi u
ct ra nn gi th gii phu bnh loi tr trng hp bnh ung th da, cn
phi theo di v iu tr tip sau khi m.
iu tr cc nt en trn mt
"Ti nm nay 32 tui, trn mt gn y c nhiu nt rui en qu, vy c
g nguy him khng? Phi iu tr nh th no, xin bc s vui lng cho bit?".
Cc nt rui en trn mt tui bn kh nhiu, khng bit c phi l do
bn lm vic nhiu ngoi nng hay lm trong cc c s cng nghip, tip xc
nhiu vi tia t ngoi (c trong nh nng mt tri v mt s my mc cng
nghip). Nt en trn mt khng ch lm cho mt b xu i m cn c th
chuyn bin thnh ung th da v sau. Do , nn gii quyt xa cc nt en ny
bng t in hay phu thut. Sau khi phu thut, c th ly t chc en ny
th gii phu bnh pht hin v iu tr sm bnh ung th da.
51
Cng ngy, nguy c bnh ung th da cng ln, c th do cng vic tip
xc nhiu vi nh nng v do ha cht cng nghip thi ra trong khng kh,
khin kh nng ngn chn tia t ngoi ca tng ozon km hn lc trc. Do ,
cn hn ch tip xc thng xuyn vi nh nng mt tri.
Phu thut xa vt xm chn my
"Tha bc s, cch y hai nm ti c xm chn my hai bn mt thm
m vin. Vt xm kh ln khin lng my rm, trng rt d, ti c gng xa
nhiu ln nhng khng t kt qu, li sinh nhiu so. C cch g lm cho vt
xm nh bt c khng?".
Trng hp ca b cn phi xem c th mi quyt nh c. Tuy nhin,
nu b c gng xa nhiu ln v ni chn my c nhiu so th nn gii phu
ct bt phn xm cho nh li, ng thi gii quyt so ni chn my lun.
Xa vt xm lem mi di
"Trc y 3 thng, ti c i xm mi mt mt thm m vin. C l c
k thut vin cha quen vic lm nn sau khi xm xong, ti thy vt mc mt
lan rng xung pha di n gn 1 cm. C k thut vin cho bit y ch l vt
mc b lem ra thi, t t s ht, nhng n nay vt lem vn cn. Nh vy phi
lm sao bc s?".
Trng hp ca c, c l phi ct b phn da b xm lem v may li, nh
ct mi di vy. C mt cch khc na xa vt xm l c da, nhng khng
p dng c trong trng hp ny v phn lem gn mi mt qu, s khi c da s
nh hng di mt.
Xa vt xm bng bn l?
"Trc y, nghe theo li bn b, ti c nh ngi xm mt hnh vo
mnh. Sau ti rt hi hn, mun tm cch b vt xm nhng cha lm c.
Ti dng x phng ch rt mnh, rt nhiu ln nhng khng ht. C ln ti
dng bn l nhng nng qu, khng chu ni. Ni da t b bng, so rt
xu, nhng vt xm vn cn. Vy c cch no xa c vt xm ny khng bc
s?".
C th xa vt xm bng nhiu cch, ty theo ln v su khi xm.
i vi vt xm nh, phu thut ct b l n gin nht. i vi vt xm ln,
phi t in, t bng laser hoc c da.
Phng php c da khng li so, nhng vi nhng vt xm bng tay
kh su, phi c nhiu ln mi ht hn c.
52
Xa vt xm cn mi
"Chu nh bn xm hnh vo ngc cch y 2 ngy. Nay gia nh ry la
d qu, chu mun xa i ngay c khng bc s?".
Vt xm ca chu xa c, nhng phi ch mt thi gian cho ni xm
n nh, thng l 2 n 3 thng sau. By gi vt xm cn mi, nu xa s d
b sng, au v d cho so xu.
Xa bt en trn mt
"Con gi ti nm nay 14 tui, gng mt kh p nhng rt tic l c
mt bt en nh khong 1 cm x 3 cm mp, trng nh dnh nh ni vy. Chu
i hc b bn chc l n vng b dnh l, rt xu h. C cch no xa bt en
ny c khng bc s? Sau khi xa c li nhiu so lm khng?"
Bt en trn mt l mt d tt bm sinh, thng c mt s ngi. Bt
ny nu khng iu tr s tn ti mi n sut i. Ty theo kch thc ca bt
en m c nhiu cch iu tr khc nhau.
- i vi bt en nh, c th ct b hon ton ri may da li. y l cch
iu tr n gin nht.
- Vi cc bt en tng i ln (b rng trn 2 cm), c th m lm hai
ln, ln u ct bt mt phn; sau 6 thng n mt nm, phu thut ln th hai
ly ht phn cn li. S d phi m hai ln v bt en ln qu, nu bc tch
rng th khng da mt che kn phn va ly i. Vic c gng may ghp
li s lm ko lch mt, mi hoc mi gn . Hn na, ni m b ko cng,
thiu mu nui, kh lnh v cho so xu. Thi gian ch i rt cn thit cho da
v mch mu nui pht trin.
Cn mt cch khc l phu thut mt ln ly trn bt en, ly da ri
ni khc ghp vo ni m.
- Vi cc bt en chim mt phn hay na mt, vic iu tr phc tp
hn. Phi dng vt da bn cnh hoc xa chuyn n, thay th phn bt en
c ly i. Phi phu thut hin nhiu ln mi gii quyt c ht bt en v
to li khun mt bnh thng.
Trng hp c th ca con b, do bt en khng rng lm nn c th ct
b ri may li mt ln. S khng b so nhiu lm u, ch l mt ng nh
nh ch tay thi.
Bt vng m v c tri
"Em nm nay 21 tui, c mt bt ln m v c bn tri. Xin hi
Vit Nam hin c th cha ht hon ton ci bt ny khng? Sau khi cha, em
c b bin chng g khng?".
53
Ci bt , theo nh em ni, l mt loi u mu phng. Cn phi xem k

mi xc nh c chc chn l bnh g v c cch iu tr thch hp. Tuy
nhin, xt mt cch tng qut, c hai cch iu tr loi d dng da bm sinh ny.
- Ct b ton b bt v ghp da ri.
- M chuyn vt da bn cnh ph ln, sau khi ct b bt .
Ni chung, cch iu tr kh phc tp v c khi phi phu thut nhiu
ln. Sau m c t so, so s m dn sau vi nm.
iu tr bt en vng mt bng laser
"Con gi ti nm nay 18 tui, khi sinh ra c mt bt mu en sm mt.
Bt ny ngy cng ln v rng ra, chim gn ht m tri. Chu rt mc cm v
bt ny, lm ti rt kh tm. Nghe ni y hc ngy nay rt tin b, c th cha
tr c bt bng tia laser. Vy c th dng laser tr cho con ti c
khng? Cn c cch iu tr no khc khng?".
Nh tia laser, rt nhiu bnh tt vn trc y phi phu thut rt phc
tp nay c th gii quyt n gin hn nhiu (nh cc khi u trong phi, c
th iu tr bng chiu laser thay v phi phu thut m lng ngc). Trong gii
phu thm m, laser cng c dng nhiu c da mt, xa cc vt xm, iu
tr so li. My laser dng cho thm m rt t tin, iu tr bng laser rt tn
km. Php, vic iu tr so li vng mt tn khong 20.000 quan Php,
tng ng vi 40 triu ng Vit Nam.
Hin Vit Nam cng c nhiu loi tia laser, nhng a s u c dng
nh dao phu thut v chi ph khng cao lm. B c th lin h vi cc bnh
vin hi thm chi tit. Trong trng hp ca con b, ngoi chiu tia laser ra,
c th phu thut ct b da b en ra v ghp da khc vo.
54
Lm p mi, mt
Phu thut lm mng mi
"Chu nm nay 18 tui, ngi th bnh thng, nhng mi trn hi dy
v b nh ra pha trc, rt km thm m. Chu mun ct cho mi mng bt v
khng nh ra nh vy na, c c khng? C b nhiu so khng?".
Mi trn v mi di u c th m cho mng li hoc to hnh cho dy
ra, mun c dng ging tri tim cng c.
Trng hp ca chu, c th ct mi trn cho mng li v ko phn nh
ra vo trong. Sau m, chu s khng thy so v phu thut c lm phn
mi pha trong ming.
Sng sau khi ct mi
"Chu c mi trn hi dy, mun ct cho mng bt, nhng rt s au v
sng sau khi ct. Xin bc s cho bit sau khi ct, mi c b sng nhiu lm
khng v bao lu th ht?".
Phu thut ct mi s ly bt da mi v mt t t chc c vng mi. Khi
m, bc s c gy t nn chu ch b au cht xu khi tim thuc t m thi.
Ngy nay, vi phng php pha thuc t mi, bnh nhn rt t au khi bm
thuc vo, d s lng thuc t kh ln. Sau khi ct, vng mi s b sng 12 tun, nhng phi vi thng sau, mi mi p bnh thng c.
D tt mi v mi do h hm ch
"Chu b h mi v hm ch bm sinh, c m v mi v hm ch.
Nhng hin nay mi chu vn cha c cn xng lm. Mi chu cha c
phu thut nn mt bn mi b b ra v l mi rng hn bnh thng. Chu c
th phu thut chnh hnh li cho mi hai bn u nhau v mi p hn
khng?".
Trng hp ca chu c th phu thut cho p hn, m cng lc c mi
v mi. Kt qu tuy khng hon ton nh ngi bnh thng, nhng chc chn
s p hn by gi nhiu.
Ni mn nh sau khi xm mi
"Ti xm mi c ba ngy. Sau khi xm, quanh b mi v hai bn
mp b ni nhng mn nc nh rt au. Vy cn tr bng thuc g?".
55
C th vng da quanh ni xm mi b nhim loi virus Herpes hay Zona

g . Bn cn dng thm thuc iu tr nhim virus (nh Zovirax chng hn).
Khi thy cc triu chng ny, bn nn i khm bnh c hng dn cch
iu tr.
Phu thut thm m mi sau khi bm mi
"Cch y hai nm, v nghe li bn r, ti c nh ngi bm silicn
mi di tr thnh hnh tri tim cho p. Nhng c l ngi ta chch nhiu
thuc qu nn gi y mi di ti lc no cng tr ra, rt xu. C th m ly
bt silicn hay ct bt mi di li, hoc lm mi tr li nh trc khng?".
Cht silicn hay bt c cht lng no khc khi c bm vo mi s
phn tn quanh ni bm. Ty tng cht, chng c th c hp thu mt phn
vo mu, phn cn li nm ri rc gia t bo hoc nm trong cc t bo pht
trin ln ra. Do , khng th ly ra ring cht bm vo c v kh c th ly
ht cht c bm. Phu thut thm m trong trng hp ny ch nhm gii
quyt nhng bin dng xu cho p li thi, tc l ly mt phn ln cht silicn
chung vi t chc ca mi, cho mi p li (ging nh ct mi xu cho p
li). Chc chn l c kt qu tt.
Cy lng mi
"Lng mi ti tha qu, mi ln trang im u phi v thm rt mt th
gi. Sau ny ti c xm nn cng . Thy nhiu bn lng mi di v cong rt
p. Nghe ni c th cy lng mi c. Ti xm nh vy th khi cy c nh
hng g khng?".
Lng mi hay bt c lng ch no ca c th u cy c, k thut cy
ging nh cy la vy thi. Ly mt s lng ch rm ri cy vo ch tha.
Thng ngi ta ly mt t tc, tch ra tng si v cy vo b mi, xen k vi
nhng si lng mi c sn t trc. Lng mi c cy vo s mc di ra nh
tc. Khi di qu mc mong mun, c th ct v un cong theo mun.
Thng vic cy lng mi phi thc hin vi ln mi p hon ton. Mi
ln cy cch nhau vi thng. Nhng ln sau, bc s cy m li nhng ch tha
v nh b mt vi si mc khng p.
C th cy lng mi ln ni c vt xm nu da ni xm tt, khng b vim
hoc so (lm nh hng n s nui dng lng c cy).
Lng mi cy c p vnh vin khng?
"Xin vui lng cho em bit lng mi cy c p c vnh vin khng hay
ch tn ti vi nm ri tr li nh lc cha cy? Nu cy th sau ny c bnh g
v mt hay ung th khng?".
56
Cy lng mi l mt phu thut, nu thc hin ng theo cc yu cu cn

thit th khng nguy him g. Kt qu phu thut s vnh vin, ging nh ghp
da t thn trn mi mt vy, khng nh hng g n mt, khng s b ung th
hay bnh g khc.
Mi mt t nhin hay c xm u cy lng mi c, thm ch mi
mt b so, hon ton khng cn si lng mi no ht cng cy c.
Cy lng my
"Nu cy lng mi c th lng my c cy c khng? Cy lng my
thnh cng th tt ri, nhng n c chu nm yn hay di ra mi, v c xp vo
da hay c dng ln nh tc r tre?".
ng l lng my, hay bt c lng ch no trn c th cng c th cy
c bng tc nh cy lng mi vy. Sau khi cy vo, lng my s mc di nh
tc, cn phi ct thng xuyn. Mun lng my t nhin v nm yn xp vo
da, khng xng ln nh tc r tre th phi cy cho n nm theo chiu ca si
lng my t nhin.
Thuc mc lng my
"Ti nm nay 28 tui, l nam gii, nhng lng my mc rt tha, t v
nht. Xin ch cho ti loi thuc bi lng my mc m, dy v en hn".
Hin nay cha c loi thuc no bi ln cho lng my hay ru tc mc
nhiu hn mt cch chc chn. Cch duy nht l phi phu thut ly chn tc
cy vo lng my.
Phu thut nng chn my
"Ti nm nay 54 tui, chn my ti lu nay b cp xung pha ngoi,
trng c v bun lm sao y. Nghe ni gii phu thm m c th lm cho chn
my cao ln c? C b nhiu so lm khng?".
Ngi cng ln tui, chn my cng b chng xung khin nt mt c v
mt mi, bun thm. Do , khng ring g Vit Nam m nhiu nc trn th
gii, ngi ta cng lm phu thut cho chn my cao hn. Ngoi ra, cc ph n
tr u M cng thch chn my xch ln theo kiu ng.
Gii phu nng chn my cao ln c thc hin theo 3 cch:
- Ct bt phn da trn chn my ri may li cho cao hn.
- C nh chn my cao ln khi cng da mt v khi ct da mi mt trn.
- Tch rng chn my ln trn v c nh chn my v tr mi.
57
Trng hp ct b da trn chn my c th li so nh pha trn chn

my, so ny m dn v sau. Cc phu thut khc khng li so chn my.
Xa vt qung thm mt v vt lem hai bn mp
"Lm cch g xa bt qung thm mt v vt lem hai bn mp?".
iu quan trng l tm nguyn nhn gy ra qung thm mt v vt lem
hai bn mp. C th l bt en bm sinh hoc do bnh ca c th, do d
ng vi thuc tr bnh.
gii quyt ti ch, c th dng thuc lt da mt hoc ct b da tha
mi di chung vi mt phn vt qung thm.
Ct mi mt c au lm khng?
"Em thy cc bn mt mt m ct mt thnh hai m, mt to ln v lng mi
trng rt p. Em rt mun ct nhng em nht lm, khng bit c au lm
khng?".
Phu thut thm m mi mt, thng gi l ct mi mt, l mt cuc m
nh thi, ch au cht t da khi tim thuc t. Phu thut hon ton khng gy
au. Sau khi ht thuc t, c thuc gim au ung cho ti khi lnh.
Nhng ngi khng c yn tm hoc hi lo s c th dng thuc an thn
trc khi m.
Phu thut thm m mt cho mt sp
"Ti nm nay 60 tui, da mi trn sp xung nhiu khin ti rt kh chu.
Ti lm vic ti nh, phi tip khch thng xuyn. Nu ct bt da mi trn mt
cht cho sp xung th chc chn s d chu hn. Ti khng mun ct m to
nh cc c gi tr, ch thch c mi mt, gi mt t c c khng?".
Thng tui 60 cha phi l cao lm c th gp tr ngi khi phu
thut. C kh nhiu ngi trn 60 tui thch lm p, phn ln u c m v
hi lng vi kt qu t c. Ngi b bnh ca tui gi nh cao huyt p, tiu
ng hay cc bnh mn tnh khc khng nn m nu ang iu tr hoc cha
n nh.
Nguy him ca gii phu thm m mi mt
"Ti nm nay 40 tui, mi mt trn lc trc hai m rt p, cch vi nm
nay da hi tha v c t m ng lm mi mt hi b sp. Nghe ni gii phu
thm m c th lm mt p nh xa. Vic c ng khng v ct mt c g
nguy him khng?".
ngi ln tui, khi ct mt phi b bt da, c v m tha mi mt.
Sau phu thut, mt tr i nhiu, c th ging nh mt hi tr. Cng nh cc
58
phu thut khc, phu thut ct mt, ngoi vic thc hin ng theo k thut
ngoi khoa vt m lnh tt, ngi phu thut cn phi kho tay th mt mi
p. Do , nu n mt c s gii phu c trang b tt v phu thut vin
chuyn nghip th chc khng c g nguy him
Sng m v chy nc mt sau phu thut thm m
"Cch y 6 thng, ti c n mt c s gii phu thm m ct mi
di. Sau phu thut, phn di mt phi sng nhiu, mi mt b ko lch xung
v chy nc mt. Ti tr li ni gii phu, c bc s m ly mu bm ra,
cho ung thuc v tim mt loi thuc g vo m. Sau , ti vn b sng
nh m, hay chy nc mt, vng m bn phi b au nhc thng xuyn.
Bc s phu thut cho ti ung v tim rt nhiu loi thuc nhng khng
khi bnh. Ti c bnh g v phi lm sao?".
Trng hp ny kh c bit. C th khi ct mi di, bc s phu thut
ly da nhiu qu nn mi b ko lch, gic mc mt b kch thch nhiu, d
lm chy nc mt. Ngoi ra, ln phu thut ly mu t c th lm tn thng
dy thn kinh s 5, gy au nhc nhiu.
Cn au nhc nhiu ni m phi c th do mt bnh khc khng lin
quan ti phu thut mi di (nh vim xoang hm phi hoc au thn kinh s 5
v cn chng hn).
Bn cn chp phim X-quang v lm mt s xt nghim cn thit nh gi
bnh tch ri ty theo bnh m c cch iu tr thch hp.
So bin chng khi ct mi di
"Sau khi ti ct mi di ( c 1 thng), phn m mi di vn cn
nhiu, so m c nhiu ht nh hai bn, li lm rt xu; b mi di b lt ra
ngoi lm mt thng xn v hay chy nc mt. Ti sao? Ti bi nhiu
loi kem chng so nhng khng bt".
y l trng hp thng gp khi ct bt da mi di. Nguyn nhn c
th l phu thut gy sng n nhiu quanh mi di, ct b nhiu da qu, gy
thiu da mi di, may li ni m khng theo k thut thm m...
Ch cn kin nhn ch i thm mt thi gian na. Khi so v t chc
vim n quanh mi mt hon ton n nh (t hai n su thng), nu so vn
cn xu v mt cha c p th c th phu thut li, ct b so, ghp da ri
hoc ct bt mt gc sn mi di cho b mi khng b lt ra ngoi.
Nhng thuc chng so nu c dng lu m khng em li kt qu
g th c th ngng. Cn trnh so tip xc nhiu vi nh nng mt tri (
so khi b thm en) v trnh cc thc n gy d ng (gy li so).
59
iu tr so trn mi mt
"Con gi ti lc nh b bnh mi mt bn tri, gy vim, r m ra ngoi.
Sau khi iu tr n nh, mi mt c nhiu so li lm rt xu. mi mt chu, da
xp li rt nhiu np nhn; khi ng, mt nhm khng c kn hon ton. Chu
mun xa so, c c khng? C g nguy him khng?".
y l trng hp nhiu so mi mt, tng i kh gii quyt v thiu da
nhiu. Mun cho mt p hn, phi m ct b so v ghp da ri vo phn da
b mt i. S c t so quanh mnh da ghp vo. Cc so ny m i theo thi
gian v mt s p hn trc khi phu thut nhiu.
Phu thut hi phc tp mt cht nhng khng nguy him lm u, b
hy yn tm.
Mt b lm do chn thng mt
"Cch y 6 thng ti b chn thng vng xng g m bn tri. Mt
tri b bm nhiu, iu tr c tun mi ht sng. Sau khi mt hon ton bnh
phc (khong mt thng sau), mt tri ti b lm su hn mt phi. Ti sao li
nh vy? Phi iu tr nh th no?".
Sau khi chn thng hc mt, mt b lm vo do hai nguyn nhn: t
chc m hc mt b sang chn, thiu mu nui v hoi t; thnh di xng
mt b v, m ri vo xoang hm.
iu tr lm mt sau chn thng tng i kh, thng phi ghp m
vo. Do , khi chn thng thnh xng mt xy ra, cn khm k mt v
cc cu trc ln cn nh xoang trn, xoang hm hay xoang sn phu thut
cp cu ngay khi cn. Vic phu thut nhm mc ch gii quyt c v chc
nng v thm m. Trng hp ca c may mn l mt khng b m, v cc
trng hp nng c th m mt do mu t chn p.
iu tr so ko lch mi mt
"Cch y 2 tun, ti b tai nn lm mt mt phn da mi mt bn tri.
Vo cp cu trm y t, ti c may li vt thng. Nay vt thng lnh
ri, nhng mt khng ng kn c khi nhm li, lm trng mt b v hay
chy nc mt, rt kh chu. Ti c phi phu thut li khng? C th m ngay
by gi hay phi ch mt thi gian na?".
Cc trng hp b so ngoi da do tai nn hay do phu thut thng cn
thi gian t 3 n 6 thng n nh. Thng ngi ta phi ch khi so n
nh hn mi phu thut iu chnh li cho p hn. Phu thut trong thi gian
so ang tin trin, cha n nh thng cho kt qu rt hn ch.
60
Tuy nhin, vi loi so gy bin dng nhiu hoc nh hng n chc

nng sinh l ca c th th phi gii quyt ngay. Trng hp ca ng cng vy,
cn phu thut li sm, to hnh li phn da mi mt mt i v che ch gic mc
khi b kch thch do mt nhm khng kn. Nu lu, ng c th b vim kt
gic mc dn n m mt.
iu tr so mi mt bng thuc thng so
"Chu nm nay 19 tui, cch y 6 thng b ng xe, b thng ui
mi mt phi. So kh to, nhng chu rt s b m li. C thuc g tim vo so
ny cho n nh li khng? Tim thuc nh vy c g nguy him i vi mt
khng?".
Thuc chng so l cht thuc c cha corticoid. Ngoi tc dng ph
trn ton c th, thuc c th gy m mt nu c tim gn mt.
61
Chnh hnh tai, mi

Phu thut v l tai
"Ti nm nay 70 tui, ni x l tai hi b gin rng nn hoa tai c ri ra
hoi. Ti khng thch chng din g, nhng khi d m ci hi con chu m
tai trng, khng eo hoa th thy cng chng hay lm. Phu thut thm m
c v l tai li c khng?".
V l tai l mt phu thut nh, n gin, c th lm ti cc c s gii
phu thm m hay cc bnh vin c khoa ngoi, khoa tai mi hng.
V li ni rch tai khi b tiu ng, cao huyt p
"L tai ca ti b rch. Hai nm nay ti li b tiu ng v huyt p
cao. Vic phu thut tai c g nguy him khng?".
V li ni rch vnh tai l chuyn n gin, khng c g tr ngi lm
d b b tiu ng hay cao huyt p. Tuy nhin, b nn iu tr tiu ng v
cao huyt p cho tht n nh; vic phu thut s nguy him v kt qu tt
hn.
iu tr tt vnh tai vnh
"Ti c a con nm nay 6 tui. Chu c mt im hi c bit l vnh
tai b vnh v pha trc trng hi khc thng. Chu rt xu h khi i hc v
thng b bn tru chc l cu b tai th. C th phu thut cho vnh tai tr
nn ging ngi bnh thng c khng? Lm nh vy c g nguy him
khng?".
D tt vnh tai vnh Vit Nam t gp, nhiu ngi cho l chuyn
bnh thng, khng cn iu tr cng c. nc ngoi, nh Php chng hn,
y l d tt thng gp v l mt trong nhng phu thut to hnh vnh tai
thng lm nht. Tai vnh l do sn vnh tai b cong un ra pha trc, khin
vnh tai ngang ra, vnh v phi trc ging nh tai th. Vnh tai hai bn phi
u nhau, ta mi nghe r u c hai bn. Vnh tai vnh l mt d tt lm tr
ngi cho mt s sinh hot v km thm m.
Mun cho tai tr nn bnh thng, nn phu thut un cong vnh tai li
khi tr c 7 tui tr ln, lc tai pht trin kh. Phu thut ny rt n gin.
Tr em nh phi gy m. Ngi ln th ty trng hp, c th gy t hay gy
m cng c. Cc bin chng sau m l chy mu v vim sn lm bin dng
vnh tai. Nu phu thut cn thn th bin chng ny t xy ra.
62
Sau khi m, c th sc nghe con bn s gim cht t do ng truyn m

thanh vo tai thay i. Pha sau tai s c so nh, mt s trng hp so b li
ln, cn iu tr chng so li. Ni chung, nu phu thut k th khng c tai
bin g ng ngi.
M li vnh tai vnh
"Ti c vnh tai (hai bn) b d tt vnh ra trc. Cch nay 2 nm, ti c
n mt c s gii phu thm m chnh hnh vnh tai. Kt qu m cng kh,
vnh tai xp li u hai bn, ni m khng b so g ng k. Nhng khi nhn
mnh qua gng, ti khng c hi lng lm v phn cao ca vnh tai cha
c xp li nhiu. Ti mun phu thut thm mt ln na, khng bit c nn
khng, tha bc s?".
Phu thut chnh hnh vnh tai trong trng hp tai vnh tng i n
gin v t l thnh cng kh cao. Tuy nhin, cng c mt s tai bin hoc bin
chng lc phu thut v sau khi m. Tai bin khi phu thut l chy mu lm
bin dng vnh tai, sng n ni m hoc vim sn vnh tai. Bin chng sau m
l so xu, vnh tai khng i xng nhau. Mt s t trng hp ngi c
phu thut b nghe km cht t do ng tai b ko lch.
Trong trng hp ca bn, kt qu m c nh vy l tt ri. Nu m
thm ln na, c th sau khi m li c mt vi yu t pht sinh khin bn li
khng hi lng. Cng m nhiu ln cng gy chn thng sn v d a n
vim sn hay so li. Bn nn bng lng vi kt qu t c, ng phu thut
thm na, khng c li.
Phu thut to hnh vnh tai
"Tha bc s, chu nm nay 18 tui. Tht khng may cho chu, do mt
chuyn hiu lm gia bn b, chu b a bn cn t ht phn na vnh tai
tri, phn pha trn. Lc b tai nn, chu qun ch ly vnh tai t ri ra;
vo vin cp cu cm mu xong, nh ngi nh tm li phn vnh tai b cn
th mt. C th to hnh li vnh tai chu khng?".
Trong cc phu thut to hnh, to hnh vnh tai l mt trong nhng phu
thut kh nht v phi ly sn sn cy vo di da sau tai. Phu thut phi
c tin hnh nhiu ln, ko di mt hai nm mi xong hon ton, song kt
qu th khng c nh mong mun.
iu tr u sn trc vnh tai
"Con gi ti nm nay 14 tui, sc khe tt, pha trc vnh tai bn tri
ni ln khi u nh, cng nh sn. U ny c t lc mi sinh, khi chu ln th
n c ln thm mt cht. C th phu thut chu c vnh tai bnh thng
khng? Phu thut c li nhiu so lm khng?".
63
Khi u pha trc vnh tai con bn c th l d tt bm sinh ca sn vnh

tai. May mn cho chu l vnh tai pht trin y ht, ch tha ra pha trc
mt cht thi. Phn tha ny cng c th ct b, khng c g nguy him. So
li cng nh thi, s m dn theo thi gian. i vi mt s d tt khc nh
khng c vnh tai hay vnh tai nh, khng pht trin hoc bin dng, iu tr
phu thut rt kh khn m kt qu cng khng kh quan lm.
Phu thut thm m u mi
"u mi em to qu, th v rt km thm m. C cch no lm cho u
mi nh, gn li c khng?".
u mi to do hai phn: phn cnh mi v chp mi. Gii phu thm m
cnh mi (ct cnh mi) tng i d. Tht ra ch c mt s ngi cnh mi
qu to, qu th mi cn ct bt. a s nhng trng hp n bc s thm m
ct cnh mi u l to hnh li cnh mi hoc tin nh mi cho p (tin
nh hay ca mi trc l phn thng t mt vo mi, thng gi l l mi).
Ngoi vic to hnh mi cho mi hp li, vic chnh hnh cnh mi cn c th
lm mi thp xung hoc cao ln thm cht t nh khp cnh mi li. Tin b
mi nht ca phu thut thm m cnh mi l m ng pha trong ming.
ng m ny khng c so v thng c may bng ch t tan, khng cn
ct ch.
Gii phu thm m chp mi phc tp hn. Nhiu trng hp phi ct b
sn cnh mi hay sn vch ngn, u mi mi nh v gn li c. C mt s
trng hp u mi to v bin dng, cn phi ghp thm sn.
Ni chung, trong nhiu trng hp, gii phu thm m mi rt phc tp.
Vic gii quyt u mi to cng khng ch n gin l can thip trn u mi
n thun. Nhiu khi cn phi chnh thm xng mi cho thng li hoc h
thp bt phn gia mi b g ln.
Nng mi cao ln bng cch n sn
"Chu nm nay 19 tui. Khng may l mi chu tt qu, ai cng ch.
Chu rt mun lm mi cao ln bng cht sn t nhin ca c th, nh vy c
c khng?".
Mt s ngi s b d ng vi cht n khc c th nn ch trng gii
quyt cc khim khuyt bng cht liu ca chnh c th. Nhiu loi cht liu
nh xng, sn c chuyn t ni ny n ni khc. Phu thut n mi cao
ln c th thc hin bng xng chu, xng s, sn vnh tai, sn xng sn.
thc hin phu thut ny, bnh nhn phi chu hai ca m, mt ly xng
hoc sn v mt nhn mnh ghp. Kt qu l c bnh nhn v thy thuc u
rt yn tm, khng lo phn ng ca c th i vi mnh ghp na.
64
Tuy nhin, v thm m th sau mt thi gian, mnh ghp s thay i nh

xng b mn i, sn cong li cht t. Do , kt qu v thm m ca phng
php ny nhiu khi km hn n bng silicn cng. Ngi c phu thut rt
hay au sau m, ni ly mnh ghp au nhiu hn mi. Do , chu nn suy
ngh k khi quyt nh sa mi bng sn hay xng ca c th mnh.
iu tr so bt l mi
"Ti nm nay 24 tui, b bng vng mt do ha cht cch y hn 1
nm. Ni bng lnh, nhng l mi ti cng ngy cng hp li lm cho mt
ti tr nn rt xu. Gn y ti khng th c bng mi, ton th ming lm
ming lun kh, rt kh chu. Ti c nn m c th th li bng mi
khng?".
Trng hp ca bn kh ph bin. C th phu thut to hnh l mi li
c bng cch m ct rng, b t chc x quanh l mi, ghp da hoc nim
mc vo, sau t ng nong khong 6 n 9 thng.
trnh b so hp nh vy, thng khi b bng quanh l mi, bnh
nhn phi ch theo di, nu thy bt u hp l c k hoch t ng nong
lin, kt qu s p hn.
Lm cho chn mi cao ln
"Con gi ti nm nay 27 tui, tnh kh kho, nghe theo li ch rut n
mt thm m vin sa mi. Bc s ct hai bn cnh mi, mi bn 0,6 cm
lm mi bin dng, ng knh l mi rt nh nn h hp rt kh khn. T lc
gii phu n nay (4 thng ri), n b n v c du hiu ri lon tm thn.
Xin bc s cho bit c cch no phc hi mi chu nh trc m (tc l lm
cho chn mi cao ln) khng?".
Trng hp ny hi kh v hai l do:
- Bnh nhn c du hiu ri lon tm thn, mong mun c mi p
theo ring. Sau khi phu thut khng va , by gi mun tr li nh trc
khi m. D k thut m c hon ho nh th no i na cng khng th tr li
hnh nh mi ging 100% nh lc trc m c. Ch cn mt t l nh khc
trc m thi l c th bnh tm thn c th nng thm. Do , b nn a
chu i khm v iu tr chuyn khoa tm thn trc.
- V chnh hnh mi cho cao ln, cho th d hn th c th lm c
bng cch tch da hai bn mi a cao ln, hoc dng sn vnh tai ghp vo
cnh mi. Tuy nhin, nh ni trn, mi sa li s c t so nh, khng th
p hon ton nh mi t nhin c.
65
Chnh hnh d tt bm sinh mt

"Con gi ti nm nay 17 tui, lc mi sinh chu b d tt h mi, h hm
ch v hm di b a ra ngoi nhiu. Chu c phu thut v mi, v
mng hu v chnh hnh hm di. Nhng n nay, phn mi v gia mt cn
b lm vo v cnh mi hai bn khng u. Chu c cn phi phu thut na
khng? Phu thut c phc tp lm khng? Chu cn nh m phi m nhiu
ln nn qu ti rt ngi".
Vic iu tr d tt bm sinh mt kh phc tp, thng phi phu thut
nhiu ln, ty theo mc d tt. Con ch tuy c phu thut nhiu ln,
nhng do c th pht trin, gng mt cng pht trin theo, cc phn xng,
sn, c mt thay i v c lc tr nn khng cn i, cn phi iu chnh li.
Trong cc phu thut ny, phu thut chnh hnh xng phc tp v cn nhiu
thi gian nht. Cc phu thut iu chnh da v phn mm n gin hn. Nu
c iu kin, nn phu thut thm mt vi ln na cho tht hon chnh. Trng
hp kh khn qu, c th khng m cng c. Tnh thng ca cha m i
vi con ci tht v tn, tuy nhin, ch nn ngh thm l d m nhiu ln na,
gng mt chu tuy p hn trc nhiu, nhng cng kh p nh ngi bnh
thng c.
iu tr d dng cnh mi do tt h mi bm sinh
"Con ti 14 tui, b tt h mi t nh, c phu thut v mi li. Kt
qu cng kh p, nhng cnh mi bn h mi b ra v l mi rng hn bnh
thng. Phu thut thm m c chnh li c d dng ny khng? Sau m c
b nhiu so lm khng?".
Trng hp ny c th phu thut bng cch m nng sn cnh mi ng
ln v thu hp l mi bn d tt nh li, u vi pha bn bnh thng. Phu
thut ny thc hin vi cc ng m bn trong mi, khng li so bn
ngoi.
Vo mi v vch ngn mi
"Ti 37 tui, mi b nght nhiu bn tri, nhn bn ngoi thy sng mi
cng b lch sang tri. Ti i khm bnh chuyn khoa Tai mi hng, bc s
cho bit b so vch ngn v vo c thp mi sang tri. C th phu thut cho
vch ngn v mi thng li khng? Nn lm hai ln hay mt ln?".
a s trng hp vo vch ngn v vo c thp mi l do chn thng,
mi b chm vo vt cng. Tuy nhin, cng c mt s ngi khng b chn
thng g nhng mi v vch ngn cng b vo. Vo thp mi lm khun mt
mt cn i, km thm m. Vo vch ngn nhiu gy nght mi thng xuyn
v c th a n vim xoang.
66
Phu thut vo vch ngn mi kh n gin, cc khoa tai mi hng c

phu thut u lm c. Chnh hnh thp mi kh hn, thuc lnh vc to hnh
thm m, t c ni lm. Do , trong trng hp ca bn, c th m vch ngn
trc, sau phu thut chnh hnh thp mi sau. C th tm ni no bc s c
th lm cng lc hai phu thut cng c.
Mi g cao sau khi sa mi
"Ti 34 tui, cch y 5 nm ti c lm phu thut n mi cho cao ln.
Cch y vi thng, khi ch k, ti thy phn gia mi c v g cao hn
trc. Nh vy c sao khng v c th sa li cho ht g khng?".
C khng cho bit trc khi phu thut thm m, mi c c b g cao ln
khng, thnh ra cng kh ni. C mt s ngi mi t nhin b g ln gia.
Khi sng mi nhn to vo, nu khng ch , phn ny tit tc cao nh
trc, lm mi khng cn xng v khng c thng p. Mt s rt t trng
hp c th b khi u mi hay b chn thng gy t mu hoc gy xng mi,
lm mi bin dng.
Trng hp c km gy xng hoc khi u mi cn phi gii quyt
bnh tch trc khi lm thm m li. Cc trng hp khc c th phu thut
thm m li ngay c.
Phu thut iu tr cnh mi qu to
"Chu 18 tui, d n king rt cn thn nhng mi vn c rt nhiu mn.
L mi chu th bnh thng thi, khng rng lm, nhng hai cnh mi rt to
v rt xu. C cch no lm cho cnh mi mnh nh v mng li khng?".
Trong trng hp ca chu, nu mun cho cnh mi mng li th phi
phu thut gt bt sn cnh mi. Phu thut ny kh hn ct cnh mi n
thun v phi tch da ra v gt bt sn cnh mi cho mng li, hoc ct c sn
v da cnh mi cho mng li. Cch sau n gin hn, nhng phi ch giu
so cho kho trnh mi b bin dng xu.
Chu nn nh tr mn mi ht hn trc khi phu thut trnh nhim
trng khi m.
Chnh hnh cho mi cao ln bng cht Gore-Tex
"Ti 43 tui, mun phu thut cho mi cao ln; nhng ti d b d ng,
s khi cht silicn cng vo, c th s khng chu c. Nghe ni c cht
Gore-Tex t gy d ng hn. Vy ti c th dng cht ny n mi thay
silicn cng khng?".
Dng cht Gore-Tex n mi cao ln cng c, nhng ch nh
chnh ca Gore-Tex l lm cho phn mm y ln. Cht ny mm, gi t hn
silicn cng, cha c dng nhiu Vit Nam. Theo cc ti liu c ph
67
bin trn th gii th dng n cng tt, nhng khng phi l hon ton khng
gy d ng. Do , b nn suy ngh v tham kho thm kin ca bc s gii
phu thm m trc khi quyt nh dng cht ny lm p mi.
iu tr u nh chp mi
"Ti 25 tui, cch y 1 thng, trn phn da chp mi t nhin ni ln
u nh mu trng, ngy cng ln dn. Ti bi rt nhiu thuc nhng khng
khi. U ny khng au, khng chy mu, nu dng ngn tay bm t phn trn
ra th vi ba sau u li ni to ln nh trc. Xincho bit l u g, c nguy
him khng v cch iu tr nh th no?".
Theo nh bn t, y l mt loi u nh thng gp ngoi da. U ny
lnh tnh, thng gi l bu gai hay u nh. U ny hay ti pht nu iu tr
khng trit . Cch iu tr l phu thut ct b u bng dao thng hay ct t
bng dao in. Sau khi ct t chc u, nn gi xt nghim mu bnh phm
xc nh bnh v loi tr trng hp ung th da giai on u.
Tc hi ca cht silicn lng
"Mi ti khng thp lm, nhng hi b gy ch tip gia mi v trn.
Ti mun ch ny cao ln mt cht, nhng rt s phu thut. Thay v m, bc
s c th bm cho ti mt cht g (nh silicn chng hn) cho mi cao ln
cht nh khng?".
Mt cht c cho vo c th thay th cc phn ca c th b thiu
(nh xa cc np nhn, bm vo cc phn b lm cho y ln, bm vo ni c
bit cn lm to ln) cn c cc yu t sau:
1. D tm vi gi khng t lm.
2. C th ch to c ng theo mu yu cu.
3. C th tit trng nhiu ln v gi c nhit bnh thng, khng
b h hoc bin cht.
4. Cy vo c th d dng.
5. Ch gy phn ng ti ch, to thnh m x bao bc chung quanh.
6. Khng b m chung quanh lm bin i cht.
7. Khng gy phn ng ha hc vi c th.
8. Khng gy phn ng ca c th chng li cht cy vo.
9. Bm vo mt khng gy m mt.
10. Khng c cho c th.
68
11. Khng gy ung th.

12. Khng gy sinh qui thai.
13. Khng gy phn ng d ng hay vim nhim.
14. C th chu c chn ng c hc.
15. C yu t vt l ging nh cc m chung quanh ni cy ca c th.
16. c t chc chung quanh dung np lu di.
17. Khng b thoi ha.
18. Tn ti lu di ti ni c cy vo, b c th hp thu rt t hay khng
b hp thu theo thi gian.
p ng c 18 tiu chun trn, silicn lng l cht kh tt cy vo
c th. N c dng ph bin trong hn 20 nm nay rt nhiu nc trn
th gii. Nhng vic dng cht ny Vit Nam gp mt s tr ngi. Rt nhiu
ngi bm silicn lng vo mi b phn ng, phi m nhiu ln nhng khng
gii quyt trit c tai bin ny. Do , silicn lng b cm dng ti TP
H Ch Minh.
Trng hp ca b nn phu thut nng mi bng silicn cng hoc sn
ca c th, khng nn tim bt c cht g lm p vo ngi v c th gy hi
v sau.
M ly ht silicn mi
"Trc y ti c bm 2 ml silicn vo mi, c m mt ln cch
y mt nm ly ra. Sau khi m, bnh ch gim cht t ch khng ht hn
c. Gn y, ch bm silicn trc li sng nhiu ln, mi bin dng rt
xu. C cn m li na khng?".
Hin gi cha c cch no m ly ht cht silicn bm vo mi m
khng phi ct m rng da v phn mm mi. Nh vy, mi s b bin dng
rt xu. Tht ra, khi m ly m mi, ni bm silicn th ngi ta ch thy
bnh tch vim khng c hiu, khng th no bit cht silicn bm vo
nhiu nm trc c cn li hay khng.
Do , phu thut ch dng trong trng hp mi b bin dng nhiu
hoc b sng au nhiu. Trng hp ca b m mt ln ri, nhng bnh vn
cha ht, hin ang sng au, c l nn dng thuc khng vim mt thi gian
v theo di. Cha nn m li ngay v c th sau ln m ny, bnh cng khng
dt hn.
69
iu tr phn ng vi silicn lng bm mi

"Ti 45 tui, cch y 3 nm c bm silicn lng vo mi cho mi cao
hn. Sau 1 nm, vng da mi sng n rt au, ti m no ra. Sau khi
no, mi b xp xu qu nn ti c nh bc s t mnh silicn cng vo. By
gi mi li b sng v trn mi c l r nh, khi n c nc trong trong chy
ra. Ti phi lm sao h bc s?".
Ch nn ly mnh silicn ra v no tip t chc vim mi, ni c
bm silicn lng lc trc. nhng t chc c bm silicn lng thng xy
ra phn ng vim v kh iu tr dt im. Do , khng nn t thm cht n
mi vo, d cht l silicn cng hay cht xng, sn ca chnh c th.
Gii phu thm m mi c bm silicn
"Ti 34 tui, 5 nm trc c bm silicn vo mi cho cao ln. T n
nay, ni bm silicn vn bnh thng, khng b sng au g ht nhng khng
c p. Nay ti mun gii phu thm m t sng mi vo cho p hn, c
c khng?".
Rt nhiu trng hp b d ng do bm silicon lng vo mi, iu tr rt
kh, nhiu khi phi gii phu nhiu ln nhng khng gii quyt c ht bnh.
Thi gian phn ng vi silicn thay i ty ngi. C ngi vi nm, c ngi
5-10 nm sau mi b phn ng. Bn khng b d ng vi silicn mi l rt may.
Tuy nhin, nu phu thut t sng mi vo, t l b vim ni bm silicn c s
cao, c th phi m gii quyt cc t chc vim ny, thm ch phi ly mnh
silicn cng ra.
Tm li, bn khng nn phu thut thm m trn mi bm silicn, hay
ng hn l khng nn lm mt th thut hay phu thut g mi nu cha
thc s cn thit cho sc khe. V cc phu thut ny s kch thch v to iu
kin cho mi phn ng li t chc ca mi, vng bm silicn vo t nhiu nm
trc.
To hnh vt thng mt cht cnh mi
"Ti 27 tui, 2 nm trc b tai nn lao ng, cnh mi bn phi b mt
mt mnh nh, c phu thut cp cu may li. Sau khi may, mi phi ti
hp hn mi tri, trng rt kh coi. C cch no lm cho mi hai bn cn xng
c khng?".
Cc vt thng mt cht mi c th to hnh li c bng cch ly
phn sn vnh tai ghp vo hoc chuyn vt da bn cnh mi ln. Ngoi ra, cn
mt cch na l ct cnh mi bn tri cho nh li bng bn phi, nu mi bn
phi khng xu lm v khng hp lm. y l cch n gin nht, t b so
nht. Dng phng php no c li nht cng ty trng hp, phi xem c th
mi gii quyt c.
70
Phu thut vch ngn v chnh hnh mi

"Ti 29 tui, b vim mi, vo vch ngn mi v mi thp. Sau khi iu
tr ht vim mi, ti cng ht hn nght mi. Nhng bc s khuyn nn m vch
ngn trnh vim mi ti pht. Ti c tht s cn phi m vch ngn v lun
tin lm cho mi cao ln c khng? Nn thc hin 1 hay 2 ln?".
Hu nh ngi no, vch ngn mi cng b vo mt cht, Nu vo t
th khng c vn g, khng m cng c. Phi khm trc tip ngi bnh
mi xc nh c nn m hay khng. C th phu thut iu tr vch ngn mi
v thm m mi cng lc cng c. Tuy nhin, a s bnh nhn thch phu
thut iu tr vch ngn trc, khi n nh s phu thut thm m mi sau. Vic
ny c li l mnh chia ra hai loi phu thut, iu tr ring v thm m ring
cho tt c u t kt qu tt.
Sa li mi cho cao ln khng lm cho bnh mi b nng thm.
Thm m mi sau m vch ngn
"Ti 30 tui, trc y mi cng cao bnh thng. Sau do b vo vch
ngn mi v phi m vch ngn nn mi ti b xp xung phn gia, trng rt
xu. C m sa li cho mi cao ln c khng?".
Mt trong nhng hu qu ca phu thut vch ngn mi l lm mi b
xp xung khi phu thut ly phn cao ca vch ngn b vo. Cc trng hp
ny c th khc phc bng cch phu thut n mi cao ln. Cch m cng
ging nh m thm m bnh thng, tuy rng phu thut c kh hn cht t v
so dnh do m vch ngn c.
Gii phu thm m mi khng thy so v khng cn ct ch
"Chu 20 tui. Mi khi soi gng thy mi mnh hi thp v b lm mt
cht gia, chu c c gi n cao v thng ln mt cht th p bit my!
Gn y, chu c nghe ni TP H Ch Minh, ngi ta c th gii phu thm
m cho mi cao ln m khng thy so g ht; m xong v lin khng cn ct
ch, chuyn c th tin c khng?".
Phng php gii phu thm m mi khng li so v khi ct ch l
phng php tng i mi v c thc hin mt s ni TP. H Ch
Minh. Phng php ny rt tin, khch gii phu mi trong nhiu trng hp
ch cn gp bc s phu thut mt ln l c mi p ngay. ng m c thc
hin pha di mi trn, tch rng ln trc xng mi n trn. t sng mi
vo xong, ni m c may li bng ch ta, khng cn ct ch v hon ton
khng thy so m bn ngoi.
Ngoi vic khng li so, khng cn ct ch, phng php phu thut
ny cn c li l mi d lnh hn v ni m hon ton cch bit vi mi, khng
s b cc bnh nh vim mi nh hng n ni m. Tuy nhin, phu thut kh
hn cc phng php sa mi thng thng.
71
Cy tc
Tc b xon
"Tc ti b xon (ngi ta gi l tc su) rt nhiu. Ch ti bo nh t t
s ht, nhng sau khi nh nhiu ln tc mc li vn th; ngoi ra tc li b vn,
khng thng. C phi do mu xu hay do du gi? Hin nay mi ln gi hay
chi u, ti u b rng rt nhiu tc. C phi nh vy l da u c vn
khng (v trc y ti c tiu phu u m da u sau gy)?".
Tc t nhin b xon thng do yu t di truyn. Bn nn lu xem
trong gia nh c ai tc b xon ging nh vy khng. Mun lm cho tc thng
li chc phi chi thuc, nhng tc mi mc ra s li b xon tip. Nhiu khi tc
xon cng c nt p ring, do c nhiu ngi tc thng li mun un xon
xon cho p.
M u m da u c th lm hng mt s chn tc, do vng so m
thng khng mc tc. Nhng khi so lnh lu ri th khng cn g phi lo
na; khng phi do u m m tc d b rng u. Vic bn hay b rng tc mi
ln gi u hoc chi tc c th do nguyn nhn khc nh bnh da u (vi nm
vng da u, vim nhim vng da u do gi hay nh tc thng xuyn...). C
th b mt bnh g cha hon ton hi phc hoc dng mt vi loi thuc tr
bnh c bit nh thuc tr bnh ung th cng c th gy rng tc. Bn khng
dng thuc iu tr g, c th khng b rng tc do thuc.
Tm li, bn ng nn nh tc na. Hy gi da u lun sch v lnh
mnh, gi sc khe tt, tc d xon nhng s mc p. Nn ch thng mi
tc c bit ca mnh, nn qu n v chm sc n cn thn v l mt nt p
c bit ca ring bn m ngi khc kh c c.
Tc qun v rng
"Trc khi ti lp gia nh, tc ti di v thng. Sau khi ly chng v
sinh con, mi ln chi tc hoc gi u, tc ti rng rt nhiu. Nhng si mi
mc ra b qun t ngoi ngn vo, lm cho tc ti by gi khng cn sun
thng nh hi trc na. V cng vic, ti phi ng ngoi tri sut ngy n
10 gi ti mi ngh. C phi v vy m tc rng nhiu v qun khng? Hay l
ti c bnh g khc nn mi nh hng nh vy?".
Vic c gia nh v sinh con c th nh hng n sc khe chung trong
mt thi gian nht nh. nh hng c th lm xo trn s pht trin ca tc
theo c ch ton thn. Khi ht b xo trn, thng tc mc tr li nh c vi
cu trc, hnh dng nh trc. Ngoi vic ng ngoi tri sut ngy, nguyn
72
nhn hin tng d rng tc v tc mi mc khng c tt ca bn c th cn

l bnh da u (chn tc) hay mt bnh g ca c th, gy xo trn s mc
tc v tc d rng. Bn nn i khm bc s chuyn khoa da liu c hng
dn v iu tr c th.
au chn tc
"Chu 18 tui, cch y 7 thng b au chn tc, khi ra gi hay chi u
th b au. Hi chu gi u thng xuyn bng cc du gi thng thng
v i nhum tc en mt ln. Chu thng xuyn thc rt khuya hc, c
thi gian th au nhiu v c thi gian th au t. Bnh ny ko di t n
by gi. Chu n ung sinh hot bnh thng, da u khng c biu hin g l.
Vng au nhiu nht l vng nh u. Chu rt lo lng v bnh ca chu".
Trc khi b au da u, chu c nhum tc en mt ln v sau gi
u thng xuyn bng cc du gi thng thng. Chng bnh au da nh u
ca chu c nhiu kh nng l do vim hoc d ng da ti ch thi, ch khng
c g trm trng n ni chu phi lo s nhiu, nh hng n vic hc.
Cch iu tr cng n gin thi, chu cn ht tc ngn, gi da u lun
c sch, nn chi tc bng lc tha mt cht v dng t thuc khng sinh
hay khng vim. Nu bnh khng thuyn gim hoc c g chu khng yn tm
lm, hy n khm bc s chuyn khoa da liu.
Phu thut cy tc
"Ti 51 tui, tc b rng nhiu, nht l nh u. Trong phu thut
thm m c cch no lm cho tc mc li vng ny khng? C thuc bi hay
cch no gii quyt c vic ny khng?".
Rng tc vng nh u lm tr da u ra thng gi l bnh hi u, l
trng hp kh thng gp trong gii phu thm m. Nguyn nhn gy rng
tc loi ny l chn tc b thoi ha khi n mt tui no . Nguyn nhn ca
s thoi ha n nay vn cha c bit, c nhiu kh nng do di truyn.
Khng c loi thuc bi no iu tr c trng hp ny. Mun iu tr,
bn phi dng n mt trong cc phu thut sau y:
- Ct bt phn da b mt tc sau khi ko gin cc ni cn tc ph ln,
lm hp ch b mt tc li.
- Cy tc vo ch thiu. Phu thut cy tc l ly tc t vng sau hoc
vng no tc mc dy, cy vo ch thiu, ging nh cy la vy. Mt vi chi
tit v phu thut ny:
+ Phu thut ty theo cy tc nhiu hay t.
+ Thi gian m t 1 n 3 gi.
73
+ C th gy t hay m.
+ Sau m c cm gic au, cng v trong thi gian u tc mc c v
khng c t nhin, sau mt thi gian s bnh thng tr li.
+ Cc bin chng ca phu thut ny gm: tc mc khng t nhin,
nhim trng, so xu, tc cy mc km... Cc bin chng ny t xy ra.
+ Sau cy tc, khch gii phu c th i lm tr li sau t 3 n 5 ngy.
Sau 10 ngy hay 3 tun, c th lm vic nng c. Ty theo loi phu thut,
phi trn 18 thng tc mi mc y v p c. Sau thi gian ny, c th
cy thm tc nu mun
+ Kt qu cy tc l vnh vin.
Tm li, trng hp ca bn c th cy tc c. Khi cy tc, bn s
c bc s gii phu gii thch c th hn v kt qu v nhng vic cn chun
b cho phu thut ny.
Cy tc
"Ti nm nay 45 tui, tc rng nhiu nh u, t nhin rng, khng
do bnh chn tc hay bnh g khc. Ti c dng nhiu loi thuc mc tc
nhng khng kt qu, vy phi iu tr nh th no? C cy tc c khng?
C my kiu cy tc v khi cy vo, c s tc no khng mc hay tip tc rng
khng?".
Vn mc tc v rng tc phi nam chu nh hng ca nhiu yu t,
trong yu t di truyn rt quan trng. Mi si tc c nui dng do chn
tc c tui th nht nh ty theo v tr. Tc vng trn v nh u c tui th
ngn nht. iu tr rng tc gy hi u, ngi ta ly tc nhng vng mc
vnh vin cy vo vng b hi. Tc ny c chn tc mang m di truyn ca ni
n sinh ra, s tip tc mc vnh vin ni mi c cy vo.
C nhiu cch cy tc, cy tng dy, tng nhm hay tng si mt, ty
thi quen ca bc s gii phu. Cch cy ring tng si tc cho kt qu tt nht
v t nhin nht.
Cy tc vng so da u
"Ti 32 tui, cch y hai nm b tai nn giao thng, b rch v mt cht
mt khong rng da u vng trn. Vng ny cho n nay vn khng mc
tc. C th cy cho tc mc vo ch so ny khng?".
C th cy tc li ch so vng da trn bn. Tuy nhin, nu ni ny so
xu qu, vn mu nui km th kt qu ca k thut cy tc c th b hn ch
hn khi cy tc vo da u bnh thng. Nu so khng ln lm, c th ct b
so ri may da li sau khi bc tch rng di da vng chung quanh.
74
Cy tc ni mt da u
"Con gi ti 18 tui, mt ln do s ng gn my tut la, tc ca
chu b my qun vo v ko mnh lm tut lun ht mt mng da u. Chu
c m cp cu, cm mu v sau ghp da li mt mnh ln (khong 20
cm ng knh). ch hin b mt tc, ch cn t tc hai bn v pha sau
thi. Chu phi i tc gi thng xuyn. C cch no lm cho phn da u
mi ghp vo ny mc tc khng? Hoc c cch no trng tc vo khng?".
Trng hp ca con gi ng hi kh v mt nhiu tc qu. Trong phu
thut thm m c phng php cy tc, ly tc phn cn li trn da u ri
trng ri ra nhng ni khng c tc. Nhng vi phn tc cn li vn t i,
nu ly thm s cng lm tc tha i; trong khi ni cn trng li qu rng.
Ngoi cy tc, cn mt cch na l ko gin da u cho phn da c tc
rng ra ri ct b dn phn da khng tc. Nhng phng php ny khng t
c kt qa bao nhiu v tc cn li t qu.
Cy tc vo hai bn thi dng
"Ti nm nay 27 tui, tc rng nhiu hai bn thi dng, mi bn 5
cm vung. Ti mun cy tc vo c c khng? Ni no lm c?".
Tnh trng rng tc ca bn hi c bit, khng bit trong gia nh bn
c ai ging nh vy khng. Nu khng, c th hin tng rng tc ny do bnh
ca da u hoc mt tnh trng bnh l, bt thng ca c th. Phi khm bnh
v tm ra nguyn nhn gy rng tc, iu tr c nguyn nhn ny th tc c
th mc li c.
Bn mun cy tc cng c, Thnh ph H Ch Minh c nhiu c s
gii phu thm m lm c k thut ny.
Thuc tr rng tc t nhin
"Ti 50 tui, tc vng trn t nhin rng nhiu. Nghe ni c phng
php cy tc, em tc ni ny cy sang ni khc, cng hay. Nhng nh vy l
mnh c tc ch ny li mt tc ch khc, ti khng thch lm. C cch g
lm cho tc mc thm m khng phi mt tc ni khc khng?".
iu mong mun ca bn cng l mong mun chung ca mi ngi.
Ung hoc bi mt loi thuc g tc khng rng na hoc mc thm ln,
khi phi m x g ht th cn g hay bng. Tic thay, ngy nay ngi ta cha
tm c thuc .
Rng tc t nhin khi ln tui nh trng hp ca bn l do di truyn.
Chn tc vng c bit ca da u b cht DHT trong mu ph hy. Lm sao
cho c th ng c cht ny? Trong nghin cu iu tr bnh qu pht tuyn
75
tin lit phi nam, ngi ta thy cht Finasteride dng vi liu thp c th
lm c vic ny. Thuc c iu ch vi tn thng mi l Propecia, c tc
dng ngn chn s bin i kch thch t nam (Testosterone) thnh DHT.
Thuc ny lm chm rng tc 83% ngi c th nghim, nhng khng
dng c cho ph n v c th gy qui thai. Ngoi ra, n c th gy tc dng
ph nh gim ham mun v tnh dc v gim 2% tinh trng.
Tm li, thuc ung Propecia lm chm s rng tc t nhin do di
truyn, c tc dng rt hn ch trong vic kch thch mc tc. iu bt tin l
phi dng thuc mt thi gian di. Nu ngng dng thuc, cc kt qu t
c s bin mt trong vng mt nm. Cho n nay, cha mt nghin cu no
thi gian kt lun l vic dng thuc trong nhiu nm c gy nguy him
g thm na khng.
76
C s khoa hc ca phu thut ht m

"Chu l mt sinh vin TP H Ch Minh. Nghe ni hin nay trong phu
thut ht m, ngi ta c th ly bt phn m ni khng mong mun. Mong
bc s ni tht r v vic ny".
Ht m l thao tc y khoa, da trn c s khoa hc rt vng chc v
c thc hin ti nhiu nc trn th gii.
Nhiu ngi than phin l m ng nhng ni khng mong mun
ca c th, nh hng nhiu n thm m ca con ngi. Ph n thng b m
tha ng hng, i v bng. n ng cng m hng v bng. M
nhng ni ny khng b gim bt khi tp luyn hoc king n. Thng ngi
bnh gim m mt v ngc trc khi gim m nhng ni ny.
Ngay c khi tp luyn nhiu, ngi ta vn thy m khng gim cht no
nhng ni ngoan c ny. Yu t di truyn lm m ng rt kh gii quyt.
Vic tp luyn c th u n thng xuyn lm gim s lng m trong c th
nhng cng lm c bp pht trin, tng thm khi lng ca c th. Thm vo
, do nng lng s dng tng ln nn c th tch t m nhiu hn.
Phu thut gii quyt da v m tha c
"Ti 62 tui, sc khe vn bnh thng nhng c nhn v ng m nhiu
qu. C cch g lm cho da thng li v c ht m ng khng?".
Trng hp ny rt ph bin, nguyn nhn l tui gi lm t chc da
km n hi. C th gii quyt bng k thut cng da mt, c kt hp vi ht
m c. Nu da mt b khng b nhn lm, c th ch ht m v cng da c
cng c.
Ht m di cm
"Ti nm nay 54 tui, vng c, vng di cm c nhiu m qu. C th
m ly bt m ra c khng? Phu thut c li nhiu so khng?".
B c th phu thut ly bt m di cm. Sau m s c vt so ngang
nh. Trong phu thut thm m c, ngi ta tm cch du so vo di cm,
so ny thng c cc np nhn da c che khut... Cng c cch khc na
l ht m, so li nh v hu nh khng ng k.
77
Ht m bng
"Ti nm nay 37 tui, ngi cng bnh thng, khng nng cn lm,
nhng phn bng pha di rn c nhiu m qu, ti rt mun lm gim m i.
Nghe ni c phu thut ht m bng, ti rt thch. Xin bc s cho bit s qua v
phu thut ny, cm n bc s nhiu".
Ht m l phu thut thm m c thc hin ngy cng nhiu trn th
gii. Phu thut ny cng ngy cng c nhiu tin b: an ton, n gin v kt
qu tt.
Trong cc v tr c ht m, vng bng di rn l ni d cho kt qu
tt nht.
Ht m bng thng c thc hin bng hai ng rch da nh 1cm
pha di rn. Bc s s cho ng ht nh vo ht lng m tha bng.
Trc y, ngi ta ht bng ng ht ln, gy nhiu sang chn cho da bng v
sau khi ht vng bng c nhiu gn sng nh, khng c bng phng. Ngy
nay, ngi ta ht vi ng ht nh hn, thi gian phu thut lu hn, nhng kt
qu p hn. Tuy nhin, c kt qu tt, da bng cn sn chc v n hi
tt. i vi da bng mn v nho qu, hoc c qu nhiu vt rn do mang thai
nhiu ln, cn phu thut ct bt da v chnh hnh thnh bng.
- Phng php v cm: Thng l gy t ti ch vi thuc an thn nh.
Cng ngy ngi ta cng t dng phng php gy m v thi gian hu phu
ko di v nguy him hn gy t ti ch.
- Thi gian hu phu: Sau m, ngi c phu thut b au nh vng
m vi ngy, bng vn cn cng phng trong hai hoc ba tun. Cc vt m
c ct ch mt tun sau. Trong 10 ngy u, bnh nhn phi mang gaine
p cht vng m c ngy ln m, 10 ngy tip theo, ch cn mang gaine ban
ngy. Sau mt thng, kt qu thy r; nhng phi 3-6 thng sau, da bng
mi ph ln vng m t nhin v p hon ton c.
Ht m bng bm ln mt
"Chu nghe ni thm m vin c ht m bng hoc i bm ln mt.
K thut ny c lm c khng? C nh hng g khng?".
ng l c ht m bng hoc i c, m ny c th b i hay bm ln
ni khc nh mt. K thut ny nu lm ng th cng khng nh hng g.
Ni c bm m vo s b xp bt mt t sau 5-6 thng do m b hp thu.
Thng phi bm vi ln cch nhau mt thi gian vi thng mi c kt qu
nh mong mun.
78
Cy m vo ni m b hp
"Chu chng may b tai nn, hin gi vng m hp li v b so li.
Chu nghe ni cc thm m vin c cy ghp m cho y. Vy sau khi cy, m
chu c c y n nh mong mun khng?".
Cy ghp m l ly t chc m t ni khc cy vo mt v tr mi b
li s thiu m ni c cy. M m c ly ni c nhiu m (nh bng
chng hn) v ghp vo vng thiu m (thng mt hoc tuyn v) cho ni
ny y ln, trng p hn.
Trong trng hp ca bn, cn xem li ni m b lm l do xng m
lm vo khi b v hay l do cht m m b mt i. Nu ng do xng m b
v, ln th c th cn phu thut nng xng ln hay l ghp xng, v vic
ghp m khng lm cho hai bn m cn i nhau.
Ht m bng bm ln m v mp ming
"Ti 25 tui, cha c gia nh, nh con nhng ny bng ti rt nhiu. C
th ht m c khng? K thut siu m tan m l sao?Nu ly m bng hoc
i bm ln g m v mp ming th sau bao lu m s tan. K thut ny c
cn nm dng bnh khng? C th ly m ngi khc bm vo khng?".
Trong trng hp ca c, phu thut ht m bng s cho kt qu tt.
Ngi ta thng ngh rng ht m l phng php lm cho ngi gy i nhng
thc ra, phu thut ny ch yu l ly bt m nhng ni khng mong mun
ca c th, lm cho ngi p thm.
Theo l thuyt, t bo m b ht i ri s mt vnh vin, nhng cc t bo
cn li c th d tr m nhiu v tng kch thc ln. Do , sau ht m, bn
vn phi tip tc king n v tp th dc thng xuyn. Gi c nh vy th
c th khi phi ht m ln th hai.
Tuy nhin mt s ngi sau khi ht m, p ri li mun p thm
mt vi v tr no . Do , thng ba hoc su thng sau l c th ht m ln
th hai c.
Phng php ht m c dng siu m l thm b phn siu m cng vi
ng ht ly m nhng ni kh ht bng cch lm m tan i, ht ra d hn.
Ht m cng nh cc phu thut khc, nu lm ng k thut th khng c
nguy him g ng k.
Hin nay cha ai cy m ngi khc vo v khng c li, nhiu khi phi
dng phng php lm gim min dch c th khng loi tr m m ny.
79
Dng m bm vo cho ngc to ra

"Ch ti mun bm ngc, nhng khng bit k thut no p m khng
hi sc khe?".
C mt s ngi bm m vo ngc cho ngc to ln thay v phi gii
phu n ngc bng ti nc mui hay ti silicn. Phng php ny thng
phi thc hin nhiu ln, mi ln bm vi mt s lng m va phi (t 50 ml
n 100 ml m). Nu bm nhiu cng mt lc th s khng mu nui m
mi, dn n b hoi t mt phn, phi phu thut ly ra. Ngoi ra, khi bm m
vo, c trng hp m m c t chc x bao bc ging nh nhng khi u
nh ngc, kh phn bit vi ung th. Do , cch n gin v an ton nht
hin nay lm ngc ln ln l phu thut n ngc bng ti nc mui sinh
l.
Thuc lm tan m bng
"C thuc no lm tiu phn m bng m khng nh hng ti sc khe
khng?".
bng bt m, c th n t cht tht m, tp th dc, vn ng c th
nhiu. Cc loi thuc ung tiu m c gi tr rt t. Trng hp m qu nhiu,
lm phu thut ht m l tt nht.
Lm gim m
"Chu 17 tui, cao khong 154 cm, nng ti 52 kg. S o ba vng ca
con l: 88-69-92. Chu bo lm phi khng ? C loi thuc no lm cho tan
m ton thn khng? Chu bn i lm, khng tp th dc mi sng c".
tui 17, chu cha th i thm m vin c. Hin nay, iu chu c
th lm l hn ch n m v gi cho ng ln cn. Tuy chu khng tp th dc
theo s hng dn ca i truyn hnh mi sng c nhng nu cng vic
hng ngy l cng vic chn tay th cng l mt cch th dc.
Chu nn ch vn ng u c bp c pht trin u n, trnh
lm vic nhiu qu mt bn tay hoc chn v nh vy c th s mt cn i.
Ht m kt hp vi iu tr so bng
"Trc y bng ti rt thon, p. Sau khi sinh m (cch y 5 nm),
bng ti c mt so ln rt xu. Gn y, c th do ln cn cht t nn bng
tch kh nhiu m. C th lm phu thut ht m kt hp vi chnh hnh so
bng cho hp c khng? Lm nh vy c g nguy him khng?".
Ht m bng rt c kt qu, phu thut ny lm gim nhanh chng lng
m nhng ch khng mong mun m khng c phng php no so snh
c. Trng hp ca ch, ngoi vic d m bng cn c thm so xu cn
80
gii quyt. C th ht m xong th phu thut tip chnh hnh so v thnh

bng. Phu thut ny ngoi vic lm cho so p hn cn gip ct bt da v
cng da cho thnh bng p li.
Chnh hnh thnh bng
"Xin bc s cho bit khi no mi cn m chnh hnh thnh bng?".
Sau khi sinh nhiu ln hoc ln tui, da bng km n hi v chng
xung, vic ht m n thun thng cha lm cho bng p tr li nh
thi cn tr. Phu thut chnh hnh thnh bng gii quyt c cc trng hp
ny.
Phu thut thng bt u bng ht m. Ngay sau khi ht m xong, bc
s s ct b phn da pha di ca bng, ni c che trong qun lt, trnh
so. Da tha c tch ra v ko xung, ct b v may li vi phn di bng
theo v tr ny. Ty theo tnh hnh da bng, phu thut c th ko di 1 n 3
gi.
Chnh hnh thnh bng thng cn phi gy m. Sau m, bnh nhn cn
mang gaine trong mt thng. Trong 3 thng u, so m mu , sau m dn
trong 1-3 nm.
Ngi c ht m v cng da bng nn theo ch dinh dng thch
hp ngay t trc khi phu thut. Khi ht m, lp m st da c gi nguyn
lt cho da c m v p. Lp m ny s dy ln khi c th tng trng....
Nn ht m bng trn hay bng di
"Bng ti nhiu m qu, nht l phn di rn. C th ht m mt ln
c trn v di rn c khng? Nn ht phn no trc v phn no ht d
hn?".
Trong phu thut ht m vng bng, ngi ta thng chia lm hai vng
c khc nhau cht t v gii phu l phn bng trn rn v phn di rn, tm
gi l phn bng trn v bng di.
Bng di l ni l tng nht ht m. y l vng thng b ng
m nhiu hn, t chc m tng i mm, t mch mu, ht ra d v t chy
mu khi ht.
bng trn, lp da dy hn v cha t m hn bng di. Bng trn to
phn ln l do s pht trin ca t chc c v da bng, ngoi tr mt s t
ngi c lp m dy n my phn. T chc m cht hn v tng i d chy
mu hn pha di nn thng kh ht hn. Trng hp ca c c v khng b
tha m nhiu lm, c th ht bng di thi, nu mun ht c di v trn
mt ln cng c.
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Cc nguy him ca phu thut ht m

"Xin bc s cho bit mt s nguy him c th xy ra khi phu thut ht
m, c nn ht m hay khng?".
Ht m hay bt c thao tc y khoa no cng c th gy nguy him, cng
nh nguy him c th xy ra khi mnh i ngoi ng vy (vp ng hay b tai
nn giao thng). Tuy nhin, khng phi v c mt s ngi b tai nn khi i
ngoi ng m mnh nh hoi.
Cc nguy him khi ht m l ni ht b sng, chy dch, m vo mu gy
tc nghn mt s mch mu. Sau khi ht m, c th vng ht khng c u,
da b chng, xu....
Cc tai bin ny cng ngy cng t xy ra v mi ln ht nu ch ht vi
s lng va phi th hu nh khng c tai bin g. Vy bn hy yn tm v c
th ht m ti c s gii phu thm m no m bn tin tng.
Chun b khi ht m bng
"Cn phi chun b g trc khi phu thut, vic phu thut c nguy
him g khng?".
Phu thut ht m bng di n gin, cho kt qu tt v d thc hin
hn bng trn v ni ny t chc m lng lo, d ht ra hn. Tui ht m tt
nht l khong 40. Nu 50 tui m vn khe mnh th khng c g ng ngi
khi ht m. bo m kt qu tt khi ht m, bc s s cho lm mt s xt
nghim trc m nh th mu (xem c b nhim trng hoc ri lon ng mu
g khng), o in tim. C th phi lm mt s xt nghim cn thit khc ty
theo tnh hnh sc khe ca bnh nhn. Bnh nhn nn k cho bc s bit hin
ang ung thuc g, c d ng thuc hoc tng phu thut g khng c k
hoch chun b tt.
Nu sc khe hon ton tt th vic ht m bng di khng c g ng
ngi. Phu thut s tin hnh vi phng php gy t ti ch, bnh nhn c th
ni chuyn vi bc s trong lc phu thut. Phu thut c tin hnh trong 1-2
gi, ty theo lng m nhiu hay t. Sau phu thut mt gi, bnh nhn c
th v nh c, ngy sau n ti khm thay bng v sau 1 tun th ct ch.
Nguy him do ht m thng xy ra khi ht qu nhiu ni, qu nhiu m
cng mt lc, thi gian m ko di. Do , i vi nhng ngi c nhiu m
tha nhiu ni trn c th, nn chia phu thut ra lm nhiu ln.
82
Cc loi phu thut thm m khc

Gii phu thm m cho bp chui nh li
"Chu mi 18 tui m sao hai bp chui chn to qu. Khi mc ngn
tp th thao chu rt xu h v ti bn chu c chc chu c i chn ging
con trai.... C cch no lm cho hai bp chui nh v p li c khng?".
Bp chui to l do cu trc ca bp chui c nhiu m hoc do vn ng
nhiu (nh i b, leo ni, bng) khin bp tht to ra. Ngoi ra, mt s
ngi c xng rt to nn bp chui cng to theo.
Trng hp ca c, bp chui to khng bit do nguyn nhn g. Nu do
nhiu m, c th ht bt m. Cch gii quyt ny hu nh khng li so.
Cn bp chui to do c th pht trin nhiu hoc do xng ln th cha thy ti
liu no ni cch iu tr. Vic phu thut c th khng c li cho sc khe
chung v li nhiu so km thm m.
Phu thut cnh tay nh gn
"C cch no lm cho tay mnh nh, thon li khng bc s?"
Cnh tay to c th do hai nguyn nhn: C bp pht trin nhiu ( mt s
ngi tp th dc, th thao thng xuyn, nht l nhng lc s c t hay tp th
dc thm m) hoc c nhiu t chc m di da tay. Mun cnh tay nh bt,
trong trng hp th nht, phi gim vn ng cnh tay li. Trng hp cnh
tay to do ng nhiu m, c th phu thut ht bt m cnh tay.
Phu thut n cm
"Chu 16 tui, cm hi lm (khng c nh ra nh cc bn). Nghe ni
phu thut thm m lm mi cao ln c, vy c lm cm nh ra c khng?
n cm bng cht g? C nguy him lm khng? Sau khi m c b so
khng?".
Phu thut n cm cng ging nh n cho mi cao ln vy. Cht n
c hai loi l xng t c th hoc l cht n bn ngoi.
Xng c dng n cm chnh l xng hm di, vng cm.
Ngi ta ca xng hm di ri ko ra trc mt cht, c nh li v tr
mi. Nh vy l c cm nh ra ngay, nhiu hay t ty theo mnh mun. Phu
thut ny kh phc tp v phi ca xng, kt hp xng. Mt cch khc n
gin hn l dng cht silicn cng, ging nh loi silicn n mi, t vo pha
83
trc cm. Sau khi m thng khng thy so v ng m c du vo pha

trong ming hoc pha di cm.
Lm y t chc vng mt
"Ti 24 tui, cch y 2 nm b tai nn gy xng m, gy lm mt bn
m. Lc b tai nn, vng m v mt b sng nhiu nn khng bit. n khi ht
sng (mt thng sau) mi thy g m bn cao bn thp, bc s cho bit xng
gy lin cng ri, khng lm g c. By gi mi ln nhn mt mnh trong
gng ti rt bun v mc cm. C cch g lm cho xng m hai bn cn i
li nh xa khng?"
Tnh trng gy xng g m do tai nn giao thng kh ph bin. Tnh
trng t c ch n v thng b mu t che kn. Hn na, n cng khng
gy ri lon chc nng g ng k. Rt t trng hp gy g m gy m mt
hoc ri lon vn ng mt. Trng hp trt khp cn hoc khng h ming to
c cng him. Do , nu b nhiu chn thng cng lc vng mt, gy
xng m hay b lng qun nhiu nht, li d chng km thm m.
Mt tun sau khi b tai nn, xng gy lin li, rt kh iu tr. Sau
mt thng th hu nh khng nn xng li c. Do , ch cn mt cch duy
nht lm cho g m hai bn cn i nhau l phu thut chnh hnh, ghp xng
hoc sn vo pha bn m b lm, hoc dng cc cht nhn to nh silicn cng
hoc collagen ghp vo (cch ny c li hn v ch phi m mt ni vng mt
thi).
Xa ng tin nhn to m
"Ti 34 tui, 5 nm trc c gii phu thm m lm ng tin hai bn
m. Khng may l 2 ng tin ny su qu nn ngay c khi khng ci, m
cng b lm. Ti mun xa b chng c c khng? C b nhiu so lm
khng?".
ng tin ny c th xa c bng cch phu thut mt trong m,
khng gy thm so g ngoi da ht.
iu tr mo mt do lit thn kinh 7
"Chu 20 tui, 6 nm trc do b cm nn gng mt b mo xch sang
mt bn, bc s bo l lit thn kinh 7 ngoi bin. Chu dng rt nhiu
thuc, c chm cu na nhng bnh khng ht. Nhng lc ci a vi bn b
nu tnh c thy mnh trong gng l chu git mnh v mt b mo nhiu hn.
C cch no cho gng mt chu bnh thng tr li khng h bc s?".
Trng hp ca chu kh ph bin. ng nh cc bc s iu tr cho
chu ni, y l bnh lit thn kinh 7 ngoi bin, c nhiu kh nng do
nhim virus. S c 12 si thn kinh, thn kinh 7 l thn kinh ch huy vn ng
84
c, da mt, bi tit nc mt v v gic mt bn li. Ngy xa, ngi ta gi

bnh ny l lit thn kinh 7 ngoi bin khng r nguyn nhn, hay lit do lnh
v ngh rng thi tit lnh lm mu nui ti thn kinh 7 b gim. Cc trng hp
ny a s t hi phc (c th n 90% t hi phc sau vi tun) d c iu tr
hay khng. Tui no cng c th b bnh, khng may bnh li xy ra cho chu
vo tui mi trng thnh v li khng hi phc.
Vic gii quyt lit thn kinh 7 ngoi bin thuc chuyn khoa Tai mi
hng v phu thut to hnh. Thng dy thn kinh ny cng b lit khi b bin
chng ca bnh chy m tai (con ng m dy thn kinh ny i qua nm trong
xng tai). Do , khi dy thn kinh 7 b lit do lnh m qu 6 tun khng hi
phc, bc s Tai mi hng c th phu thut gim p lc ng xng v bao thn
kinh vo n. Phu thut ny gip nhiu ngi ht lit. i vi cc trng
hp b lit sau nhiu nm, c th phu thut ni thn kinh hay to hnh vng
mt cho p li. Chu c th iu tr th mt trong cc cch trn xem sao, chc
l s tm li c phn no s cn i, nt p ca khun mt trc khi bnh.
Chnh hnh u ngc
"Ti 54 tui, c l do lc trc khi nui con bng sa m nn phn da
ngc b gin rng, khng c p. Nay ti mun ct bt phn da ny, ch
li t da st u ngc, c c khng? Phu thut ny c li nhiu so
lm khng?".
Phu thut ny cng c nhiu ngi lm, tng i n gin. Ch cn
gy t ti ch, phu thut vin s ct i vng da pha ngoi, rng hay hp ty
, sau tch rng phn da trng pha ngoi v may li. So m s nm gia
phn da trng v da , khng thy r. Phu thut ny ngoi vic lm cho phn
da u ngc nh li cn c tc dng lm cho da ngc c cng hn, p
hn.
Thu ngn u ngc
"Ti 30 tui, u ngc kh di, nh ra khi tuyn v n 3 cm, mc o
ngc b cn. Ti mun phu thut cho u ngc ngn bt c khng, sau ny
c gp tr ngi g trong vic cho con b khng?".
Trong trng hp ca bn, do phn da bc quanh cc ng dn sa b nh
ra nhiu nn u ngc cm ln, hi khc thng. Phu thut thm m c th
gii quyt c tnh trng ny bng cch ct bt da u ngc (phn nh
cao). Cc ng dn sa vn gi nguyn. Nh vy, vic cho con b s khng gp
tr ngi g.
Nng tuyn v cao ln
"Ti 45 tui, c 4 ngi con u ln. C l do ti lun cho cc con b
bng sa m nn b chy x xung, trng khng p, khin ti phi mc o
85
ngc thng xuyn. Ti c th phu thut cho ngc cao ln, ht chy x khng?
Sau khi m c b nhiu so lm khng?".
M phng ngc ln cao (y hc gi l treo tuyn v) l mt phn quan
trng trong gii phu thm m v. Ngc b x khng phi ch v cho con b.
Nhiu ngi khng c con nhng khi ln tui cng b x ngc do cc t chc
m thoi ha v da gim tnh n hi. Ty theo v tr u ngc (nm v) vi
ng ni gia v vi thnh ngc m ngi ta chia ngc x ra lm 3 mc .
Phu thut treo ngc c thc hin bng cch ct b da tuyn v v di
chuyn u v ln cao hn, tr v v tr thi cn tr. Sau m, s c so nh
quanh u v v pha di u v. So ny s m dn theo thi gian.
Tm li, trng hp ca b rt hay xy ra, c th phu thut v hu ht
nhng ngi c phu thut u hi lng vi kt qu.
Phu thut n cho xng chu ln hn
"Ti 46 tui, my nm trc c th cng cn i, kh p. Gn y, c l
do hi ln cn nn vng eo ti khng c gn v mng ca ti c v hi nh.
C cch no m chnh hnh cho xng chu ln hn mt cht khng?".
Hin nay cha c phu thut no lm cho xng chu ln hn. Tuy
nhin, mng c ln, phu thut thm m c hai cch gii quyt: ht m
vng hng hai bn cho eo nh li hoc bm m vo mng cho mng ln hn.
C th thc hin hai vic ny cng lc, trc ht ht m cho eo nh li, xong
ly m bm vo mng. Tuy nhin, vic bm m vo mng phi c thc
hin nhiu ln, mi ln mt t th mi c kt qu tt c. Nu bm vo mt
lng ln m, c th s khng nui dng kp, c th gy hoi t v lm mng
xu i.
Lm cm ch
"Chu l con trai, xem phim thy c vi nam din vin cm ch trng rt
hay. Chu nm nay 18 tui, c cch no gii phu cho cm ch c khng?
C b nhiu so khng?".
Phu thut cm ch cng n gin, sau m c mt vt so nh 1 cm
giu pha di cm, rt kh thy. Thng th ngi 15 tui tr ln c th
phu thut.
Chn thng mt mng chn
"Chu 22 tui, cch y my hm b mt ht mng chn p t bn phi
khi i trt nc cng vin. Chu ch b chm mnh mt ci thi, khng au
lm, khng ng mt lc sau thy chy mu ngn chn, xem li th mng chn
khng cn na. Nh vy c sao khng, liu mng chn chu c mc tr li
khng hay l mt hn?".
86
Chu ch b mt mng chn thi, t chc u ngn chn, ni mng chn

mc ra tht cn tt, khng b bm gip g nhiu, v sau mng chn s mc ra
thi, chu yn tm.
87
Bnh tim v gii phu thm m

"Chu nm nay 22 tui, rt thch lm p. Thy cc bn lm gii phu
thm m mi, mt p, t nhin chu cng mun lm lm. Nhng chu b bnh
tim bm sinh, khi lm vic g mt l hay ngt xu; thnh thong c nhng cn
ri lon nhp tim. Vy chu c lm gii phu thm m c khng? C g nguy
him khng?".
Gii phu thm m l nhu cu chung ca mi ngi. Ngi khe v
ngi km sc khe u mong mun c p nh nhau. y khng phi ch
l nhu cu ca ngi vn minh, c mc sng cao m cn l nhu cu ca cc dn
tc t ngi trn th gii. Do , mong mun ca chu c phu thut thm
m p hn l rt chnh ng. Chu c th phu thut c bt c v tr no
ca c th m chu mun. Tuy nhin, v c bnh tim, chu c th gp tai bin
trong phu thut. V vy, chu nn hi thm kin ca bc s chuyn khoa tim
mch trc khi phu thut chun b thuc men cn thit. Khi i m, chu
nn bo cho bc s gii phu thm m bit tnh trng sc khe ca mnh c
s chun b cc loi thuc hay phng php gy t thch hp.
88
Ung th do bm silicn
" c ngi no b ung th do bm silicn cha?".
Silicn c hai loi:
- Loi cng dng t vo mi, cm hoc m cho t chc ny cao, p
hn, cho n nay vn dng v cho kt qu tng i tt, khng gy nguy him
g, khi cn c th ly b ra.
- Loi lng bm vo di da v vng mi, m... C mt s ngi b phn
ng sng , au nhc hay bin dng xu, phi iu tr. Hin nay, cha c bng
chng xc nh silicn gy ung th. Vit Nam cng nh trn th gii cha c
bnh nhn no b ung th do bm silicn.
Tc hi ca silicn lng bm mt
"Ti 45 tui, 10 nm trc c bm mt t silicn lng vo mt cho p,
ni bm cng m, khng b sng g. Vi nm sau, ni bm thuc b ng vi
cng, nhng khng b au. n nay, da mt ti bt u nhn nhiu, ni m
c bm silicn b chy x xung rt xu.
Ti thng xuyn b bnh, ht bnh ny n bnh khc. Gn y, nghe
ni c ngi bm silicn vo ngc b tai bin phi vo bnh vin, ti lo qu.
C phi do bm silicn vo mt my nm trc m b nhiu bnh qu nh vy
khng? By gi ti c nn m ly silicn mt ra khng? Ti sao bm silicn
ngc m li b nguy him n ni phi vo nm bnh vin vy?".
Theo y vn th gii, cho n nay, silicn vn l thuc tt nht lm y
cc phn khim khuyt ca c th. Ngoi cc nhc im nh ni bm thuc
vo mt thi gian sau c th b ng vi cng hoc sng ty ln, hu nh
silicn khng gy bnh g khc. Trc y, ngi ta ngh silicn c th gy
bnh thp khp, bnh t min; nhng qua cc nghin cu ca rt nhiu bnh
vin v c s nghin cu y hc th gii, iu ny c ci chnh.
Vit Nam, rt nhiu ngi bm silicn vo mi b phn ng iu tr rt
phc tp, c ngi phi phu thut nhiu ln m khng dt c bnh. Mt s
ngi khc dng thng xuyn thuc corticoides, b tc dng ph ca
corticoides rt kh chu. Nhng cho ti by gi (sau 20 nm s dng), ngi ta
xc nhn s an ton ca silicn vi c th.
Vic dng silicn lng ngc cng vy. Hin nay, nhng ngi c
phu thut cy ti silicn vo tuyn v (d ti ny cn nguyn hay b v), cht
silicn khng gy hai g cho ton c th. Trng hp bm silicn vo ngc b
89
phn ng nng phi vo vin iu tr c th l do c th phn ng vi loi thuc

dng khi phu thut.
Trc khi quyt nh phu thut ly silicn ra hay khng, phi khm k
trnh trng hp phu thut nhiu ln m khng c kt qu nh mong
mun.

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Nhng iu cn bit v phu thut thm m

Nhng iu cn bit v phu thut thm m

Lm mt hon ton so trn ................................................................................................ 44

Nhng iu cn bit v phu thut thm m

Xa vt qung thm mt v vt lem hai bn mp......................................................... 57

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Gii phu thm m mi khng thy so v khng cn ct ch ........................................... 70

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i iu v phu thut thm m

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Khi bit da mt thuc loi no ri, cn sn sc da theo hng dn trn c ln da p,

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nh hng ca nh nng mt tri i vi da

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bnh l mch mu chi di. Tc dng c hi l do cc cht c trong thuc l

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lm vic nng, gi ni m kh sch. Trnh ng chm mnh hoc lm bn ni