Tuhinga
Te puru metilīni mō te minamina pūmau o te nono: ngā taunakitanga me ngā herenga
Whakaarohia tētahi tūroro kua whakamātau i ngā kirīmi ārai, ngā rongoā patu harore, ngā pani pūtaiaki, me ngā panonitanga ki ngā tikanga akuaku mō ngā marama, engari ka minamina tonu te nono ia pō. Ka kōrero tētahi mātanga pokanga whēkau nui me te tōu mō te werohanga waikano puru ki roto i te kiri huri noa i te nono. Ko te whakaaro o te nuinga o ngā kaipānui, he wai whakamauru ka taupoki i te kiri, pēnei i tētahi atu kirīmi pani ka tukuna mā te ngira. He ariā kē tō te tukanga e kōrerotia ana. Ka whara i a ia ngā pito io tairongo ririki i te paparanga o roto o te kiri hei aukati i te huringa minamina me te rakuraku. Ko ngā taunakitanga e tautoko ana i tēnei, he huinga iti o ngā rangahau raupapa kēhi pokanga kāore he rōpū whakataurite, ā, kāore i ōrite te aroturuki.
Ka arotake tēnei tuhinga i aua tuhinga rangahau. Ka whakamārama i ngā mahi o te tukanga mātanga, ngā take me whakakore i mua i te kī kāore i te mōhiotia te pūtake o te minamina, ngā pūrongo a ngā tohutoro matua e rua, me ngā wāhi e ngoikore ana ngā taunakitanga. Mō ngā kōrero whakamārama mō te pūhui ake, tirohia te āhua o te mahi a te puru metilīni i te taumata pūtau, me te rārangi whānui ake o ngā whakamahinga hauora kua whakamanatia, e rangahaua tonutia ana hoki.
He tukanga, ehara i te kirīmi
Ko te werohanga puru metilīni ki roto i te kiri, ki raro tonu rānei i te kiri, mō te minamina o te nono kāore i te mōhiotia te pūtake, kāore hoki e whakautu ki ngā maimoatanga, he tukanga urutomo ka mahia e te ngaio haumanu. I ngā kawa kua whakaputaina, ka tukuna te puru metilīni kua waimehatia ki te paparanga o roto o te kiri huri noa i te nono kua pāngia, i raro i ngā tikanga horomata. Ko te tikanga, ka whakamahia te whakamoe ā-rohe, te aukati io ā-rohe rānei, ā, ka takoto tapapa te tūroro. Ko te tikanga mahi e whāia ana, ko te whakakore matū i ngā pito io tairongo e tata ana ki te mata. Ka whakamārama te American Society of Colon and Rectal Surgeons i te werohanga ki roto, ki raro hoki i te kiri kua pāngia, ā, ka whakatūpato ka tūpono te pakaru o te kiri, te kōpukupuku tuwhera rānei, ki te tukuna kia tata rawa ki te mata.
E toru ngā rerekētanga matua. Tuatahi, ehara te puru metilīni ka pania ki te mata o te kiri i te maimoatanga i arotakengia e ēnei rangahau, ā, kāore he taunakitanga ōrite e whakaatu ana ka taea e ia te whakakapi i te tukanga werohanga ki roto i te kiri. Tuarua, kāore e taea te whakatau mai i ngā kawa kua whakaputaina he pai te werohanga whaiaro. Ko te whakahaere i te hōhonu te āhuatanga matua mō te haumaru: ki te pāpaku rawa, ka tūpono te kōpukupuku tuwhera me te mate o te kiko; ki te hōhonu rawa, ki te kore rānei te tikanga e horomata, ka tūpono te whēwhē pirau me te wharanga o ngā hanganga tinana. Tuatoru, ko te werohanga puru metilīni arumoni e hokona ana i te United States kua tapaina mō te maimoatanga ā-iaia o te methemoglobinemia ka puta i muri i te whānautanga, nō reira kāore te werohanga ki roto i te kiri huri noa i te nono i roto i ngā whakamahinga kua whakaaetia ki te tapanga. Me arotake hoki ngā kaipānui e kai ana i ngā rongoā e pā ana ki te serotonin i ngā whakatūpato mō te mate serotonin me ngā pāhekoheko rongoā, ka kōrerotia anō i raro nei.
Me tautohu tuatahi: he pūtake tō te nuinga o te minamina
Ko te minamina o te nono he tohu, ehara i te mate kotahi. Ka whakarōpū ngā aratohu i ngā pūtake tuarua hei take nō te nono me te tōu, nō te kiri, nō te whakapokenga, nō te tinana whānui, nō te whakapā whakapōrearea, nō te hinengaro hoki. Ka tūtohu kia kohia te hītori, kia tirohia te nono me te tōu mā te karu tirotiro nono, ā, kia mahia ngā whakamātautau e hāngai ana i mua i te kī kāore i te mōhiotia te pūtake. Ka whakatakoto ngā paearu mahi a te Italian Society of Colorectal Surgery i tēnei aromātai, tae atu ki ngā tauira pani, ngā waruwaru kiri rānei, ngā whakamātautau taiwhanga, ngā whakamātautau whakapiri kiri, me te tango tauira kiko e kōwhiria ana i runga i ngā kitenga.
Ko ngā pūtake noa me whakakore ko ngā pukupuku toto o te nono, te kapiti, te ara kōhao rerekē, ngā tāpiritanga kiri, te turuturu tūtae, te kore whakahaere rānei i te tūtae, te hekenga o te kiko ki waho, me ngā kiritona. Me whakakore hoki te mumura kiri nā te whakapā ki ngā hopi, ngā muru, ngā kakara, me ngā hua pani, me te mākū me te poke tūtae kāore e kitea ana. Ko ngā mate kiri e rite ana ngā tohu ko te psoriasis, te lichen sclerosus, me te lichen simplex chronicus. Ko ngā whakapokenga ko Candida, ngā harore dermatophyte, te noke titi, te māngeongeo, me ngā pūtake ka tuku mā te ai. Ko ngā mate o te tinana whānui e pā ana ko te mate huka, te mate ate nā te aukatinga o te rere ate, te mate tākihi mauroa, me ngā mate repe tāiroiro. Me tango tauira kiko i ngā pānga pūmau, rerekē, kua kōpukupuku tuwhera rānei, hei whakakore i te tipu pūtau rerekē i roto i te paparanga mata o te nono, i te mate Paget kei waho i te ū rānei. Ko te rōpū tino iti anake he tohu pūmau, he tohu kaha tonu ahakoa tēnei aromātai me te tiaki kore urutomo ka whakaarohia mō te werohanga. Koinei hoki te tūnga o ngā aratohu tūroro a ASCRS.
Ngā kitenga o te tātari-meta o 2023
Ko te whakahiatotanga whānui rawa ko tētahi tātari-meta rōpū kotahi nā Jia me ōna hoa i 2023, i whakakotahi i ngā rangahau 7 me ngā tūroro 225. Ko te ngaronga o ngā tohu i muri i te werohanga kotahi he 76.1 ōrau (awhe whakapono 95 ōrau, 64.9 ki te 87.3), ka piki ki te 85.4 ōrau i muri i te werohanga tuarua. Ko te whakamāurutanga i pūrongotia he 75.3 ōrau i te kotahi tau, he 77.3 ōrau i te toru tau, ka heke ki te 24.0 ōrau i te rima tau.
Me āta pānui aua tau. Ko ngā rangahau i whakakotahitia he rangahau raupapa kāore he rōpū whakataurite, mai i 1979 ki 2019. He rerekē ngā tikanga, ngā kukūtanga, me ngā paearu putanga, ā, he nui te rerekētanga ā-tauanga. Kāore ngā ōrau wā roa i ahu mai i tētahi rōpū kotahi i aroturukitia mō te rima tau. Nā ngā rangahau iti rerekē ngā raraunga mō ngā wā rerekē, nō reira he ngoikore te whika mō te rima tau. Ko ngā raruraru noa ko te tae puru rangitahi ka mau ki te kiri me te kore rongo huri noa i te nono. Ko ngā pānga i pūrongotia ko te mumura whakapoke o te kiri me ngā kiko o raro, te kohinga toto, te turuturu tūtae rangitahi, te mau o te mimi, te whēwhē pirau pāpaku, me te rongo kua rerekē mō te wā roa. Kia mōhiotia, kāore te rangahau raupapa o mua nā Eusebio me ōna hoa (1990), i pūrongo i te mate o te kiko kiri, i roto i ngā rangahau e whitu i whakakotahitia. Nō reira, ehara ngā kupu whakaāhuru mō te haumaru i roto i te tātari-meta i te tohu kāore rawa te mate o te kiko i puta. Ka whakamārama tā mātou whakarāpopototanga o te haumaru o te puru metilīni i te horopaki o ēnei pānga.
Ngā kitenga o te rangahau takitahi nui rawa
Ko te rangahau takitahi nui rawa ko tētahi arotake whakamuri o tētahi pātengi raraunga anga whakamua nā Kim me ōna hoa i 2019. O ngā tūroro 362 i tae mai nā te minamina o te nono, i pai ake te āhua o te 259 mā te maimoatanga kore urutomo. I mahue mai te 103 he tohu kino tonu kāore i whakautu ki te maimoatanga, ā, i maimoatia mā te werohanga ki roto i te kiri. I whakaranua e te kawa te 5 mL o te wairewa taketake puru metilīni 1 ōrau ki te 15 mL o te lidocaine 1 ōrau, ka puta te 20 mL o te ranunga werohanga, he tata ki te 0.25 ōrau te kukūtanga whakamutunga. I tukuna i raro i te whakamoe aukati io o te rohe nohoanga. Ka puta anō tēnei rerekētanga i waenga i te kukūtanga taketake me te kukūtanga whakamutunga puta noa i ngā tuhinga rangahau: ko ngā pepa e kī ana he 1 ōrau, i te nuinga o te wā e kōrero ana mō te wairewa taketake, kaua mō te ranunga kua waimehatia i werohia tūturu.
I te ono wiki, 87 o ngā tūroro 96 i aroturukitia (90.6 ōrau) i whakarōpūhia kua pai ake. Tokowaru ngā tūroro i whiwhi werohanga anō i muri mai, ā, i pai ake te tokorima. I te toru tau, 53 o ngā tūroro 62 i wātea mō te aromātai wā roa (85.5 ōrau) kua pai ake. O te 53 i whakautu pai i te tīmatanga, i hoki mai ngā tohu ki te 4 (7.5 ōrau). Ka whakawhāitihia te tikanga o ēnei whika e te ngaronga o ngā tūroro i te aroturuki: 62 anake o te 103 taketake i tuku raraunga mō te toru tau. I mau tonu te tae puru ki te kiri o te 84 o te 96 (87.5 ōrau) i te ono wiki; i te nuinga o te wā kua memeha ki ngā wāhi ririki rite ki te pito ngira i te takiwā o te whā wiki. I puta te kohinga toto ki te 6 o te 62 (9.7 ōrau), ā, i memeha noa iho. I pūrongo ngā kaituhi kāore he turuturu tūtae, he mumura whakapoke o te kiri me ngā kiko o raro, he mate o te kiko, he whēwhē pirau rānei i tō rātou rōpū.
Te ripanga kounga rangahau me te aroturuki
Ko te ripanga i raro nei te tohutoro matua mō tēnei arotake. Ko ngā kukūtanga kua tohua ki te whetūriki he whakatau tata mō te ranunga whakamutunga, nā te mea ko te kaha anake o te wairewa taketake i pūrongotia e ētahi pepa.
| Rangahau | Hoahoa me ngā tūroro | Kawa werohanga | Aroturuki | Whaihua me te hokinga mai | Ngā putanga kino |
|---|---|---|---|---|---|
| Wolloch me Dintsman, 1979 | Raupapa kēhi, n=9 | Tata ki te 10 ki te 15 mL o te wairewa 1%, ki raro i te kiri | 3 ki te 15 marama | I pai ake te 8 o te 9 i muri i te werohanga tuatahi; te 9 o te 9 i muri i te werohanga anō | Kirikā mō te kotahi rā pea, 1 o te 9 |
| Eusebio, Graham, me Mody, 1990 | Raupapa kēhi, n=23 | Tae atu ki te 30 mL o te wairewa 0.5%, ka tukuna kia kuhukuhu ki roto i te kiri | Ngā tūroro i whakautu pai, i tua atu i te 12 wiki, ētahi ki te 9 tau | 21 o te 23 i whakautu katoa, wāhanga rānei i te tīmatanga; i hoki mai ngā tohu ki te 4 o te 18 i whakautu pai (22%) i te roanga ake o te aroturuki | Mate o te kiko puta noa i te mātotoru katoa o te kiri, 3 o te 23 (13%), me tango te kiko mate |
| Farouk me Lee, 1997 | Raupapa anga whakamua, n=6 | 10 mL wairewa taketake 1% me te rongoā whakamoe me te wairewa tote, tata ki te 0.44% whakamutunga* | Tau waenga 3 tau, awhe 2 ki te 5 | 5 o te 6 i tino pai ake i te tīmatanga; te hokinga mai whakahiato, tata ki te 20% i te 1 tau, 40% i te 2 tau, 60% i te 3 tau | Mau o te mimi, whēwhē pirau pāpaku, kore whakahaere rangitahi i te tūtae, 1 o te 6 mō ia pānga |
| Botterill me Sagar, 2002 | Raupapa anga whakamua, n=25 | 5 mL wairewa taketake 1% me te lignocaine me te hydrocortisone, tata ki te 0.25% whakamutunga* | Tau waenga 11 marama, awhe 2 ki te 25 | 16 o te 25 kāore he tohu i muri i te werohanga kotahi; 22 o te 25 (88%) i muri i te werohanga anō | Turuturu tūtae rangitahi, 1 o te 25, tata ki te 2 rā |
| Mentes me ōna hoa, 2004 | Anga whakamua, kāore i tohaina matapōkeretia, n=30 | Tata ki te 15 mL i te 1% whakamutunga, mai i te wairewa taketake 2% kua waimehatia tata ki te 1:1, ki roto i te kiri me raro pāpaku i te kiri | 12 marama mō te nuinga; 5 ki te 24 marama | 24 o te 30 kāore he tohu i te 1 marama; tata ki te 28 o te 30 i muri i te maimoatanga anō; 23 o te 30 i te 12 marama; hokinga mai, tata ki te 5 o te 28 (18%) | Mumura whakapoke o te kiri me ngā kiko o raro i mutu noa iho, 2 o te 30 (7%) |
| Sutherland, Faragher, me Frizelle, 2009 | Raupapa anga whakamua nā te mātanga pokanga kotahi, n=49 | 10 mL wairewa taketake 1% me te bupivacaine whai adrenaline me te methylprednisolone, tata ki te 0.32% whakamutunga* | Ko te nuinga i te 4 me te 8 wiki | I pai ake te 47 o te 49 (96%); i ngaro katoa ngā tohu ki te 28 o te 49 i muri i te werohanga kotahi, ki te 32 o te 49 (65%) i muri i te werohanga anō | Rerekētanga ki te whakahaere tūtae, 7 o te 49 (14%), i mutu i roto i te tata ki te 10 rā ki te 6 wiki; hekenga rongo whakararu, 2 o te 49 (4%) |
| Samalavicius me ōna hoa, 2012 | Raupapa anga whakamua, n=10 | I pūrongotia te 15 mL o te wairewa 1%, ki roto i te kiri | Tau waenga 47 marama, awhe 29 ki te 60 | I ngaro ngā tohu ki te 10 o te 10 i mua i te 4 wiki; i hoki mai ki te 8 o te 10 (80%) i te aroturuki roa | Kore rongo rangitahi me te tae ka mau ki te kiri; pupuhi mō te tata ki te 2 marama; kāore i pūrongotia he mate o te kiko |
| Kim, Kim, me Lee, 2019 | Arotake whakamuri o te pātengi raraunga anga whakamua, n=103 i maimoatia | 5 mL wairewa taketake 1% me te 15 mL lidocaine 1%, tata ki te 0.25% whakamutunga* | 6 wiki (96 o te 103) me te 3 tau (62 o te 103) | I pai ake te 87 o te 96 i te 6 wiki (91%); i pai ake te 53 o te 62 i te 3 tau (86%); i hoki mai ngā tohu ki te 4 o te 53 i whakautu pai (8%) | Tae ka mau ki te kiri, 84 o te 96 i te 6 wiki (88%); kohinga toto, 6 o te 62 (10%); kāore he turuturu tūtae, he mumura whakapoke o te kiri me ngā kiko o raro, he mate o te kiko, he whēwhē pirau rānei |
He ōrite te tauira puta noa i ngā rārangi. He nui te urupare pai i te tīmatanga i te nuinga o te wā, engari ka tino whakawhirinaki ngā whakatau tata mō te hokinga mai ki te roa o te aroturuki i ngā tūroro me te tokomaha e noho tonu ana ki taua aroturuki. I pūrongo a Samalavicius i te ngaronga wawe o ngā tohu ki te 100 ōrau, engari i hoki mai ngā tohu ki te 80 ōrau i te mutunga, i te wā aroturuki tau waenga o te 47 marama. I pūrongo a Kim i te hokinga mai ki raro iho i te 8 ōrau i te toru tau i waenga i ngā tūroro i whakautu pai, i noho tonu hoki ki te aroturuki. Nā ngā tauira iti, ngā werohanga anō, ngā paearu putanga rerekē, me te ngaronga o ngā tūroro i te aroturuki, kāore e pono te whakataurite tika.
Ngā herenga me maumahara te kaipānui
Kāore he whakamātautau matapōkere e tautoko ana i tēnei tukanga. Ko ia whakatau tata mō te whaihua i runga ake nei i ahu mai i ngā rangahau raupapa kāore he rōpū whakataurite, i tētahi rangahau rōpū whakamuri rānei. Nō reira, kāore e taea te wehe te urupare ki te maimoatanga rūpahu, te hoki o ngā inenga ki te toharite, me ngā tikanga akuaku i mahia i taua wā, i te pānga o te maimoatanga. He rerekē ngā kawa mō te paparanga e werohia ana, te rōrahi, te pūrongo kukūtanga, te tāpiringa rongoā whakamoe, me te whakamahinga pūtaiaki. Nō reira, kāore he horopeta kua whakatauritea: whakatauritea ngā kukūtanga o te ranunga whakamutunga, kaua ngā tapanga o te wairewa taketake. Kāore ngā rangahau raupapa o te 6 ki te 103 tūroro e āhei ki te whakatau i te auautanga o ngā pānga onge, pēnei i te tairongo nui rawa, i ngā tauhohenga o te tinana whānui rānei. Kāore hoki i oti te aroturuki mō te hokinga mai tōmuri i te nuinga o ngā rangahau.
Me kōrero mārama mō te hītori o te mate o te kiko. Tokotoru o ngā tūroro 23 i te rangahau raupapa a Eusebio o 1990 i pāngia e te mate o te kiko puta noa i te mātotoru katoa o te kiri, ā, me tango te kiko mate. Mai i tērā wā, kua neke ngā tikanga ki ngā ranunga whakamutunga kua kaha ake te waimehatia, me te tuku ki roto i te kiri, kaua ki te hōhonutanga. Ka pūrongo ngā rangahau raupapa o muri mai i ngā raruraru māmā ake, engari kei roto tonu taua pānga o mua i te rekoata, ā, e tohu ana kia kaua e tango noa i tēnei tukanga me te kore āta whakaaro.
E hāngai ana hoki ngā whakatūpato rongoā mō te tinana whānui, i runga i te mātāpono. Kei roto i ngā mōhiohio tohutohu rongoā o nāianei mō te werohanga puru metilīni he whakatūpato pouaka mō te mate serotonin ka mate pea te tangata, ina whakamahia me ngā rongoā e pā ana ki te serotonin me ngā opioid. Ka whakarārangi hoki i ngā pūrongo mō te tauhohenga mate pāwera tino kino, ā, ka aukati i te whakamahinga mō te hunga he hapa G6PD, he tairongo tino kino rānei ki ngā waikano thiazine. Ko te nuinga o ēnei whakatūpato i ahu mai i te whakamahinga ā-iaia mō te tinana whānui. Kāore hoki i tino inehia te nui o te matū ka tae ki te tinana whānui i muri i te werohanga huri noa i te nono, nō reira kāore e tika kia whakapaetia kāore ēnei whakatūpato e hāngai ana. Whakamōhiotia ngā rongoā whakamauru pōuritanga katoa, ngā opioid katoa, me tō āhua G6PD i mua i tētahi tukanga puru metilīni.
Ko wai ka kōrero pea mō tēnei ki tētahi ngaio haumanu
He whāiti te rōpū e whakaarohia ana: ko te hunga he minamina kāore i te mōhiotia te pūtake, e mau tonu ana i muri i te rapu i ngā pūtake tuarua me te korenga o ngā tikanga kore urutomo e whai hua. Me tino kino ngā tohu kia whakaaetia ai te tae ka mau ki te kiri, te kore rongo, me te tūponotanga iti o te whakapokenga, o te whakararu rānei i te whakahaere tūtae, hei utu mō ngā painga ka puta pea. Kawea mai he rārangi wā o ngā tohu, ngā maimoatanga o mua me ō rātou rā, ngā pūrongo whakamātautau tae atu ki te tirohanga mā te karu tirotiro nono me ngā tauira kiko kua tangohia, me tētahi rārangi katoa o ngā rongoā. Kua kohia ngā pātai whaihua ki tā mātou ngā pātai hei tuku ki tētahi ngaio haumanu mō te puru metilīni. Kaua e whai werohanga mai i tētahi kaiwhakarato e hipa ana i te aromātai hei tautohu i te pūtake, ā, kaua rawa e whakamātau ki te wero i a koe anō.