HC VIN PHNG TH KHU CK1-16 CHA

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

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

CU TRC PHI

C HONH

Hnh nh c honh phi Tnh cht m vang khc bit gia phi v gan. Phi

tng m hn gan.

Hnh nh c honh tri D dy v tim cng bn

BNH L Thiu sn phi Thot v honh Phi bit lp

Bnh phi tuyn nang Trn dch mng phi HC tc nghn ng th cao

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

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

l bu dc, thot v honh.

THIU SN PHI

THIU SN PHI

THIU SN PHI

THIU SN PHI

THIU SN PHI

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

loi tr phn da. Tnh ch s TC/AC, ch s ny t khi thay i theo tui thai. Bnh thng TC/AC 0,8 sau 20 tun. Nu bn phi

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

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

PHI BIT LP

PHI BIT LP

PHI BIT LP

PHI BIT LP

PHI BIT LP

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

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

PHI BIT LP

PHI BIT LP

PHI BIT LP

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

PHI BIT LP

PHI BIT LP

PHI BIT LP

PHI BIT LP C TRC V SAU SINH

PHI BIT LP C TRC V SAU SINH

PHI BIT LP

PHI BIT LP

PHI BIT LP

THOT V HONH

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

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

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

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

THOT V HONH

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

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

THOT V HONH TRI (80%) Khi cu trc m khng ng nht trong lng ngc tri

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

THOT V HONH T

THOT V HONH T

THOT V HONH T

XQ LNG NGC SAU SINH

THOT V HONH T

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

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

THOT V HONH T

THOT V HONH T

THOT V HONH PHI Khi cu trc m ng nht trong lng ngc phi

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

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

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

THOT V HONH PHI

THOT V HONH PHI

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

THOT V HONH PHI

THOT V HONH PHI

TRN DCH MNG PHI C th nguyn pht, trn dng chp, thng xy ra 1

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

TRN DCH MNG PHI T

65

TRAN DCH MANG PHOI T

66

TRN DCH MNG PHI TRI

TRN DCH MNG PHI HAI BN

TRN DCH MP HAI BN

TRN DCH MP HAI BN TRONG BNH CNH PH THAI

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

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

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

lng tt Loi II: 40% gm nhng nang nh hn, k