bat thuong long nguc new
TRANSCRIPT
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BÂT THƯƠNG LÔNG NGƯC
BS Ha Tô Nguyên
BV Tư Du
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Bât thương phôi
Nang
Bronchogenic cyst
Esophageal cyst
Neuroenteric cyst
Cystic adenomatoid
malformation
Lung sequestration
Tăc thanh quan
Thoat vi hoanh
Thiêu san phôi
Bât san phôi
Tran dich dương trâp
Tran dich mang phôi tư
phat
Tran dich mang phôi
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Bronchogenic cyst
Thương la nang đơn gian, năm ơ thuy dươi.
Trong phôi: 70%, xuât hiên sơm va thông thương vơi cây phê quan.
Trung thât: 30%, xuât hiên trê va không thông vơi cây phê quan
Tiên lương tôt
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Bronchogenic cyst
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Cystic adenomatoid malformation
Tăng sinh tuyên dang nang phôi
Co 3 type:
1. Type 1: Nang lơn 2-7cm, môt/đa nang
2. Type 2: Nang nho hơn, thương <1cm
3. Type 3: Microcystic
Tiên lương: tôt nêu không diên tiên thanh phu thai.
Thương đơn đôc, không kem bât thương NST
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Cystic adenomatoid
malformation: Type I
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Cystic adenomatoid
malformation: Type II
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Cystic adenomatoid
malformation: Type II
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Cystic adenomatoid
malformation: Type III
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Cystic adenomatoid
malformation: Type III
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Sư thoai triên
Fine JUM 7:405, 1988
24 weeks 30 weeks 36 weeks
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Laryngeal atresia
Tăc thanh quan
Tăc nghen đương khi đao đoan trên
Phôi phi đai va echo day sang giông CAM III
3 dang
– subglottic
– glottic
– supraglottic
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Laryngeal atresia
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Lung sequestration
Khôi u không co chưc năng cua nhu mô
phôi, tach biêt vơi nhu mô phôi binh
thương, co môt mach mau nuôi va mang
phôi riêng biêt.
Đăt shunt dân lưu co thê giam nguy cơ thiêu
san phôi, phu thai va đa ôi.
Tư vong chu sinh 100% nêu kem phu thai.
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Lung sequestration:
Intralobar (cung mang phôi)
– 60% trai
– Thương ơ thuy đay va sau
– It kem bât thương khac
Extralobar (khac mang phôi)
– 80-90% trai, tre trai
– Thương kem bât thương khac
– Ơ trong hoăc ngoai lông ngưc
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Intralobar sequestration
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Extralobar intrathoracic
sequestration
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Lung hypoplasia: bênh căn
Không đu dich ôi: Bât san thân, loan san thân
Khung xương hep: (loan san xương) – Thanatophoric dysplasia
– Achondrogenesis
– Asphyxiating thoracic dysplasia
Không đu khoang không: – Thoat vi hoanh
– Tran dich mang phôi
– Cystic adenomatoid malformation.
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Chu vi ngưc # 80-100% Chu vi bu ng
80-100% Bung
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Lung agenesis
Không co phôi
Chân đoan phân biêt
– Cardiac deviation: dextroposition
– Dextrocardia = Sư di lêch do tai tim
– Dextroposition = Sư di lêch do tư bên ngoai.
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Lung agenesis
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Thoat vi hoanh
Thoat vi hoanh phia sau ( Bochdalek type):
– 75% ơ bên trai, tim bi đây lêch qua phai, la dâu hiêu sơm nhât, tang thoat vi la da day
– Nêu bên phai, tang thoat vi la gan, kho chân đoan vi sư khac biêt giưa gan va phôi it ( ca hai đêu echo day)
Thoat vi hoanh phia trươc (Morgagni type): hiêm <5%, năm phia trươc, chưa gan va ruôt
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Thoat vi hoanh
Tiên lương: Kho xac đinh trươc sanh.
– Đo ty lê phôi/đâu, thê tich phôi, MRI…
– Ty lê sông con 60% nêu đơn thuân.
– Bât thương hay đi kem: nhiêm săc thê va di tât
tim.
– Yêu tô tiên lương xâu: xuât hiên sơm trươc 24
tuân, phu thai, đa ôi, thai châm tăng trương
trong tư cung
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Thoat vi hoanh
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Sư tich dich trong phôi
Chylothorax: tran dich dương trâp
Pleural effusions: tran dich mang phôi
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Chylothorax
1:10,000
Thương bên phai
Hiêm khi hai bên
M2:F1
Bênh sinh:
– San xuât qua mưc
– Giam hâp thu
• Tăc nghen
• Dân lưu bât thương
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Chylothorax
Siêu âm:
– Phôi bi thiêu san, chen ep
– Trung thât bi di lêch
– Phu thai
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Chylothorax
Cac bât thương kem theo:
– Trisomy 21
– Pulmonary lymphangectasia
– Do khi thưc quan
– Extralobar lung sequestration
– Đa ôi
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Chylothorax: tiên lương
Tư vong tiên
sanh
46%
Chêt trong TC
18%
Tư vong sơ
sinh
27%
Sông con
9%
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Chylothorax
Xư tri
– Trươc 24 tuân: Châm dưt thai ky
– Sau 24 tuân:
• karyotype
• shunting.
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Tran dich mang phôi tư phat
Sau khi đa loai trư nhưng nguyên nhân sau:
– Phu thai
– chylothorax
– sequestration
– Bât thương NST.
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Tran dich mang phôi
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Tran dich mang phôi thoang qua
Sherer et al, The Fetus '91
37 weeks 34 weeks