Shuɗin Methylene da Zafin Tiyatar Cire Basir: Shaidar Gwaje-gwaje

Likitan tiyata ya ba da shawarar tiyatar cire basir. Mara lafiya yana jin kalma ɗaya kawai: zafi. Tambaya ta biyo baya da sauri. Shin akwai maganin da ake yi a wurin tiyata, a lokacin aikin, wanda zai sauƙaƙa makon farko? Gwaje-gwaje uku na rarraba mahalarta bazuwar sun gwada wani zaɓi: allurar shuɗin methylene a fatar da ke kewaye da dubura a lokacin tiyata. Kowane gwaji ya ruwaito ƙarancin zafi a farkon lokaci tare da shuɗin methylene. Kowane gwaji kuma yana da iyakoki da ke shafar yadda za a iya amfani da wannan sakamakon.

Wannan shafi yana kwatanta gwaje-gwajen uku gefe da gefe. An rubuta shi domin nau'ikan masu karatu biyu. Mara lafiya zai iya amfani da shi wajen shirya tambayoyi ga ƙungiyar masu tiyata. Marubuci zai iya amfani da shi don tantance abin da binciken zafin hanyoyin aikin lafiya da ake yi a wani yanki na jiki ya rubuta a zahiri, rana bayan rana.

Abin da waɗannan gwaje-gwaje suke nazari, da abin da ba sa nazari

Kowane gwaji ya shigar da manya da ake yi wa tiyatar cire basir ta Milligan-Morgan, wato tiyatar buɗaɗɗen yanke basir. A kowane gwaji, ƙwararren lafiya ya sanya shuɗin methylene kusa da wurin tiyata yayin da mara lafiya yake ƙarƙashin maganin sa barci. Abubuwan da aka auna su ne zafin bayan tiyata, amfani da ƙarin maganin rage zafi idan ana buƙata, da matsaloli.

Babu ɗaya daga cikin gwaje-gwajen uku da ya nazarci ƙaiƙayin dubura mai ɗorewa, maganin tsagewar dubura, ko alamomin basir da ba a yi wa tiyata ba. Binciken ƙaiƙayi ya bayyana ne kawai a matsayin bayanin tushen wata hanyar aiki da aka yi hasashe: rage jin jijiyoyin wurin na ɗan lokaci, ba a matsayin amfanin da aka gwada ba. Gwajin 2024 ya ware masu tsagewar dubura da fistula da suke tare da basir. Gwajin 2026 ya ware masu tsagewar dubura, fistula, ƙurjin majina, da sauran cututtukan hanji. Idan ma'aunin zafi yana rikitar da kai, yadda ake karanta gwajin zafi yana bayyana VAS da NRS kafin ka kwatanta lambobi. Ƙaiƙayi da tsagewa matsaloli ne daban; duba yanayin tsagewar dubura da ƙaiƙayi don kada a gauraya iyakokin batutuwan.

Yadda aka tsara gwaje-gwajen uku

Tsarin amfani da maganin ya bambanta sosai, don haka bai kamata a ɗauke su a matsayin amfani iri ɗaya ba. Adadin magani ya bambanta har ninki goma, kuma lokacin bayarwa, shimfiɗar nama, da rukunin kwatantawa duk sun bambanta. Tiyata tana ɗaya daga cikin zaɓuɓɓukan maganin basir; waɗannan gwaje-gwajen sun shafi zafin bayan tiyata kaɗai.

Gwaji	Marasa lafiya da aka yi nazarin bayanansu	Tsarin amfani da shuɗin methylene	Rukunin kwatantawa da kulawar yau da kullum
Sim da Tan 2014	67 (shuɗin methylene 37, rukunin kwatantawa 30), buɗaɗɗiyar tiyatar cire basir ta diathermy	4 mL na shuɗin methylene mai 1 percent (40 mg) da aka gauraya da 16 mL na bupivacaine mai 0.5 percent, allura cikin fata a kewayen dubura kafin raba nama	Bupivacaine iri ɗaya tare da ruwan gishiri maimakon rinin shuɗi; an ruwaito paracetamol tare da diclofenac a matsayin magungunan yau da kullum a wani nazari da ya ciro bayanan gwajin
Azhough 2024	97 (shuɗin methylene 48, rukunin kwatantawa 49), mataki III ko IV, ƙungiyar tiyata ɗaya, maganin kashe ji ta kashin baya	5 mL na shuɗin methylene mai 1 percent (50 mg), a matsayin wuraren ajiya biyar na 1 mL cikin fata, kusan 2 cm daga gefen yankewar, bayan cire basir	5 mL na bupivacaine mai 0.5 percent bayan cire basir; ketorolac bisa jadawali, tramadol a matsayin ƙarin maganin rage zafi idan ana buƙata, sannan naproxen tare da acetaminophen da codeine lokacin sallama
Zhu 2026	60 (30 a kowane rukuni), basir na ciki da waje tare, likitan tiyata ɗaya, maganin kashe ji ta yankin ƙasan baya	Shuɗi mai 0.1 percent da aka tsarma (1 mL na mai 1 percent tare da 9 mL na ruwan gishiri), 0.5 zuwa 1 mL ga kowace yankewa cikin tsarin buɗewa kamar abaniko tare da tausa na ɗan lokaci, jimilla 5 mL ko ƙasa da haka (5 mg ko ƙasa da haka), bayan cire basir	Babu allura a wurin tiyata; lornoxicam 8 mg idan mara lafiya ya nema, tare da aƙalla sa'o'i 6 tsakanin kowace bayarwa

Abubuwa biyu na tsarin gwajin suna da muhimmanci. Na farko, gwaje-gwajen 2014 da 2024 sun kwatanta rini da shigar da bupivacaine cikin nama, don haka duk wani bambanci shi ne ƙarin tasirin rinin a kan maganin kashe ji na wurin, yayin da gwajin 2026 ya kwatanta rini da rashin allura a wurin tiyata. Na biyu, ɓoye wa mahalarta sanin rukunin da suke ciki yana da rauni duk inda tabon shuɗi yake bayyana. Marubutan gwajin 2026 sun bayyana cewa sauyin launin nama da fitsari ya sa ɓoye rukunin da kyau ya zama ba zai yiwu ba, wanda ya bar maki na zafin da mahalarta suka bayar a buɗe ga son zuciya.

Zafi a kowace rana bayan tiyata

Abin da ya zama gama gari shi ne bambanci a farkon lokaci, sannan sakamakon ya kusanto juna. Kowane gwaji yana amfani da ma'auni daban, don haka a karanta kowanne bisa tsarin nasa. Hanyoyin gaba ɗaya suna cikin kula da zafi bayan tiyata, wanda ya shafi magungunan rage zafi na yau da kullum da tsarin ƙarin magani idan ana buƙata.

A cikin wani gwajin rarraba mahalarta bazuwar da aka ɓoye rukunin ga ɓangare ɗaya kan shuɗin methylene cikin fata bayan buɗaɗɗiyar tiyatar cire basir ta diathermy, marasa lafiya sun riƙa rubuta zafinsu a kundin ma'aunin layin gani. Matsakaicin zafi ya yi ƙasa sosai a ƙididdiga tare da shuɗin methylene a ranakun 1 zuwa 3 bayan tiyata, tare da ƙarancin amfani da paracetamol a wannan lokacin, kuma babu wani muhimmin amfani a ƙididdiga bayan rana ta 3. Babu takamaiman matsakaicin maki a rubutun taƙaitaccen rahoton da ake iya samu, don haka wannan bitar ba ta ƙirƙiri lambobin kowace rana ba.

A cikin wani gwajin da aka ɓoye rukunin ga ɓangarori biyu kan shuɗin methylene cikin fata bayan tiyatar cire basir, marasa lafiya sun rubuta mafi girman zafin da suka ji kowace rana lokacin kwanciya barci a kan ma'auni mai maki 11 daga 0 zuwa 10, na tsawon kwanaki 14. Bambancin ya kasance muhimmi a ƙididdiga a ranakun 1 zuwa 7, da p ƙasa da 0.001 kowace rana, amma bai kasance muhimmi ba a ranakun 8 zuwa 14:

Rana ta 1: shuɗi 4.08 ƙari ko ragi 1.23, rukunin kwatantawa 5.20 ƙari ko ragi 1.40.
Rana ta 2: shuɗi 3.94 ƙari ko ragi 1.17, rukunin kwatantawa 5.22 ƙari ko ragi 0.87.
Rana ta 3: shuɗi 3.90 ƙari ko ragi 1.10, rukunin kwatantawa 5.02 ƙari ko ragi 0.95.
Rana ta 4: shuɗi 3.71 ƙari ko ragi 1.25, rukunin kwatantawa 4.71 ƙari ko ragi 1.21.
Rana ta 5: shuɗi 3.60 ƙari ko ragi 1.27, rukunin kwatantawa 4.67 ƙari ko ragi 1.21.
Rana ta 6: shuɗi 3.46 ƙari ko ragi 1.27, rukunin kwatantawa 4.31 ƙari ko ragi 1.21.
Rana ta 7: shuɗi 3.35 ƙari ko ragi 1.27, rukunin kwatantawa 3.92 ƙari ko ragi 1.21.
Ranakun 8 zuwa 14: maki a rukunonin biyu sun ragu zuwa kusan 2.5 zuwa 3.5, ba tare da wani bambanci mai muhimmanci a ƙididdiga tsakanin rukunonin a kowace daga cikin waɗannan ranakun baya ba (duk p sun haura 0.2).

A cikin wani binciken 2026 na rarraba mahalarta bazuwar kan shigar da shuɗin methylene da aka tsarma cikin nama bayan tiyatar Milligan-Morgan, zafin lokacin hutawa a ma'aunin gani daga 0 zuwa 10 ya yi ƙasa tare da shuɗin methylene a sa'o'i 6, 24, 48, da 72, da p ƙasa da 0.001 a kowane lokaci. Takamaiman matsakaicin maki sun bayyana ne kawai a zane maimakon jadawalin lambobi, don haka wannan bitar ta ruwaito yanayin sakamakon ba tare da mai da tsayin layukan zane lambobi masu nuna daidaito na ƙarya ba.

Ƙarin magungunan rage zafi idan ana buƙata

Rahotannin amfani da ƙarin maganin rage zafi idan ana buƙata su ne inda ingancin bayanan gwaje-gwajen ya bambanta.

Gwajin 2014 ya ruwaito raguwar amfani da paracetamol mai muhimmanci a ƙididdiga tare da shuɗin methylene a ranakun 1 zuwa 3, wanda ya dace da lokacin da aka samu raguwar zafi, amma taƙaitaccen rahoton da ake iya samu bai bayar da adadi, kaso, ko takamaiman ƙimar p ba.

Gwajin 2024 ya ƙayyade ketorolac bisa jadawali tare da tramadol a matsayin ƙarin maganin rage zafi idan ana buƙata, da kuma rubuta amfani da ƙwayoyin magani a gida, amma sakamakon da aka wallafa bai ruwaito yawan amfani a kowane rukuni ba. Wannan rashin bayanai kansa wani sakamako ne: alamar raguwar zafin ta dogara ne kan maki na zafi kaɗai.

Gwajin 2026 shi ne mafi bayyana a nan. Jimillar lornoxicam a cikin sa'o'i 72 ta kai matsakaicin 22.67 ƙari ko ragi 17.01 mg tare da shuɗin methylene, idan aka kwatanta da 56.80 ƙari ko ragi 9.32 mg a rukunin da ba a yi wa allura ba, da p ƙasa da 0.001. A lura da rashin daidaiton tsarin: rukunin kwatantawa ya samu maganin rage zafi ne kawai idan ya nema, yayin da rukunin rini ya samu aikin magani guda ɗaya a lokacin tiyata.

Matsaloli da bibiyar marasa lafiya

Babu gwajin da ya ruwaito babbar alamar matsalar aminci a wurin tiyata, amma ba a tsara kowanne don gano illa mai wuya ko wadda ke bayyana daga baya ba. Don ƙarin fahimtar haɗurra, duba bayanan aminci na shuɗin methylene tare da jadawalin matsalolin da ke ƙasa.

Taƙaitaccen rahoton 2014 ya jaddada sakamako ɗaya mai ɗaukar hankali: rabon haɗarin kasa fitar da fitsari kwatsam lokacin da ba a yi amfani da shuɗin methylene ba ya kasance 2.32, tare da tazarar amincewa ta 95 percent daga 1.75 zuwa 3.07. Yawan sauran matsalolin bai bambanta sosai a ƙididdiga ba.

Gwajin 2024 ya ruwaito matsaloli a kwanaki 14. Kasa fitar da fitsari ya faru ga 5 daga cikin 48 a rukunin shuɗi da 5 daga cikin 49 a rukunin kwatantawa. Rashin iya riƙe bayan gida na ɗan lokaci ya faru ga 3 idan aka kwatanta da 1, kuma zubar jini da ya biyo baya ya faru ga 0 idan aka kwatanta da 2. Mutuwar fatar wurin, kamuwa da cuta, martanin fatar wurin ga magani, da ƙuntacewar hanyar dubura duk sun kasance sifili a rukunonin biyu, kuma ƙaiƙayi ya faru sau ɗaya a kowane rukuni. Babu wani bambancin da ya kai muhimmanci a ƙididdiga.

Gwajin 2026 ya ruwaito sa'o'i 72 kaɗai. Kumburin fata da naman ƙarƙashinta sakamakon kamuwa da cuta a kewayen dubura, mutuwar fatar wurin, da daskarewar jini a kewayen dubura duk sun kasance sifili a rukunonin biyu. Bai bayar da lambobi cikin tsari kan kasa fitar da fitsari, zubar jini, kamuwa da cuta, rashin iya riƙe bayan gida, jinkirin warkewa, ko dawowar basir ba. An amince da tabon shuɗi a nama da fitsari a matsayin matsalar ɓoye rukunin, maimakon a jera shi a jadawali a matsayin abin da ya faru.

Tsawon bibiyar marasa lafiya shi ne babban abin da ya iyakance duk gwaje-gwajen uku: kusan kwanaki 14 a gwaje-gwajen biyu na farko da sa'o'i 72 a na uku. Ba za a iya tantance jinkirin warkewa, iya riƙe bayan gida na tsawon watanni, da dawowar basir daga waɗannan bayanai ba.

Jadawalin shaidar kowace rana bayan tiyata

Jadawalin da ke ƙasa shi ne haɗaɗɗen tushen bayanan wannan shafi. Ya haɗa zafi, amfani da ƙarin maganin rage zafi, rukunonin kwatantawa, matsaloli, da bibiyar marasa lafiya a wuri ɗaya.

Gwaji	Alamar zafi a kowace rana	Ƙarin maganin rage zafi idan ana buƙata	Bambancin rukunin kwatantawa	Matsaloli	Bibiyar marasa lafiya
Sim da Tan 2014, n ya yi daidai da 67	VAS ya yi ƙasa tare da shuɗi a ranakun 1 zuwa 3; babu bambanci mai muhimmanci bayan rana ta 3; babu takamaiman matsakaicin maki a taƙaitaccen rahoton da ake iya samu	Amfani da paracetamol ya yi ƙasa tare da shuɗi a ranakun 1 zuwa 3; ba a bayar da adadi ba	Shuɗi tare da bupivacaine idan aka kwatanta da bupivacaine tare da ruwan gishiri; yana ware ƙarin tasirin rini	Rabon haɗarin kasa fitar da fitsari 2.32 ba tare da shuɗi ba; sauran abubuwan da suka faru ba su bambanta sosai a ƙididdiga ba	Kundin rubuta zafi na kusan kwanaki 14
Azhough 2024, n ya yi daidai da 97	Mafi girman NRS na kowace rana ya yi ƙasa tare da shuɗi a ranakun 1 zuwa 7 (tazara kusan maki 1.1 a farkon lokaci, 0.6 a rana ta 7); babu bambanci a ranakun 8 zuwa 14	An ƙayyade tsarin amfani amma ba a ruwaito amfani a kowane rukuni ba	Shuɗi 50 mg idan aka kwatanta da bupivacaine; yana ware ƙarin tasirin rini	Kasa fitar da fitsari 5 da 5; rashin iya riƙe bayan gida na ɗan lokaci 3 da 1; zubar jini 0 da 2; mutuwar nama da kamuwa da cuta 0 da 0; babu wanda ya nuna muhimmanci a ƙididdiga	Kwanaki 14
Zhu 2026, n ya yi daidai da 60	VAS lokacin hutawa ya yi ƙasa tare da shuɗi a sa'o'i 6, 24, 48, 72, da p ƙasa da 0.001 a kowanne; matsakaicin maki a zane kawai	Jimillar lornoxicam 22.67 idan aka kwatanta da 56.80 mg, p ƙasa da 0.001	Shuɗi da aka tsarma 5 mg ko ƙasa da haka idan aka kwatanta da rashin allura; mafi girman bambancin tsarin magani	Kumburin fata sakamakon kamuwa da cuta, mutuwar nama, daskarewar jini 0 da 0; ba a ruwaito kasa fitar da fitsari, zubar jini, warkewa, ko dawowar basir cikin tsari ba	Sa'o'i 72

Abin da wannan yake nufi yayin tattaunawa da likitan tiyata

Ƙananan gwaje-gwaje uku, kowanne a cibiyar guda ɗaya, sun yi amfani da adadin rini uku daban-daban idan aka kwatanta da nau'ikan rukunin kwatantawa biyu. Dukkansu sun yarda cewa zafi ya yi ƙasa a ranakun farko bayan cire basir idan aka ƙara shuɗin methylene a lokacin tiyata. Alamar raguwar zafi mafi ɗorewa ta kai kwanaki 7. Bayanan ƙarin maganin rage zafi sun goyi bayan wannan yanayi a gwaje-gwaje biyu, kuma babu su a na uku. Gajeriyar bibiyar marasa lafiya da ƙarancin mahalarta ba za su iya kawar da yiwuwar illa mai wuya ko wadda ke bayyana daga baya ba.

Tambayoyin da ya dace a kai wa likitan tiyata:

Wace tiyata aka shirya, kuma waɗanne matakan magani a wurin tiyata ake riga ake yi a matsayin al'ada a can?
Ana bayar da shigar da wani rinin shuɗi cikin nama kuwa, a wane adadi da shimfiɗar nama, kuma idan aka kwatanta da wane madadin?
Waɗanne magungunan rage zafi na yau da kullum da ƙarin magunguna idan ana buƙata aka tsara, kuma yaya ake rubuta amfani da su?
Yaya ake bin diddigin kasa fitar da fitsari, zubar jini, kamuwa da cuta, da iya riƙe bayan gida, kuma na tsawon makonni nawa?
Yaya ake tsammanin tabon shuɗi na ɗan lokaci a fata ko fitsari zai kasance, kuma yaushe yake gushewa?

Ga marubutan da ke bitar binciken zafin hanyoyin aikin lafiya, jerin abubuwan dubawa gajere ne: takamaiman ƙarfi, yawan ruwa, da jimillar adadin magani; shimfiɗar nama da lokacin bayarwa dangane da lokacin cire basir; sinadarin magani mai aiki a cikin sirinjin rukunin kwatantawa; magungunan rage zafi na yau da kullum bisa jadawali idan aka kwatanta da na lokacin buƙata; jimillar ƙarin maganin rage zafi a kowane rukuni; maki na zafi da aka ruwaito kowace rana; da jadawalin matsaloli tare da jimillar mutanen da aka yi amfani da su wajen lissafi da tsawon bibiyar marasa lafiya. Ba tare da waɗannan bayanai ba, babu goyon bayan da'awar haɗaɗɗen sakamako game da adadin magani, domin rini 50 mg cikin fata idan aka kwatanta da bupivacaine da rini 5 mg ƙarƙashin fata idan aka kwatanta da babu magani, hanyoyin magani ne daban-daban.