Methylene blue pa endoscopy ya m'mimba ndi matumbo ndi chromoendoscopy

Madzi awiri abuluu ali ndi molekyulu imodzi yofanana, koma pafupifupi palibe china chofanana. M'chipinda cha endoscopy, dokotala amapopera methylene blue wochepetsedwa mphamvu pachikuto cha mkati mwa matumbo akulu kuti zilonda kapena zotupa zathyathyathya zioneke mosavuta. Kunyumba, munthu amafinya madontho abuluu kuchokera m'botolo logulitsidwa m'sitolo n'kuwaika m'madzi monga chizolowezi chosamalira thanzi. Kusokoneza ziwirizi ndi kulakwitsa pa kumvetsa cholinga chake, osati pa kuchuluka kwake kokha: chimodzi ndi njira yoonetsera zimene zili mkati kuti matenda azindikiridwe, pogwiritsa ntchito zinthu zokonzedwa kuti zigwiritsidwe ntchito kuchipatala; chinacho ndi chinthu chogulitsidwa kwa ogula. Nkhaniyi ikufotokoza mbali ya endoscopy, pamene utotowo ndi chida chothandiza kuona, osati mankhwala ochizira zimene zawoneka. Kuti muone chithunzi chonse cha ntchito zake zachipatala zovomerezeka ndi zoyesedwa pa kafukufuku, onani chidule cha ntchito za methylene blue m'zachipatala.

Kupaka utoto pamwamba: utoto wolowa m'maselo amoyo, osati wongounikira malo

Kuonetsera zinthu mothandizidwa ndi utoto pa endoscopy kumatchedwa chromoendoscopy. Methylene blue imagwira ntchito imene akatswiri oyesa minofu kuti azindikire matenda amatcha kupaka utoto m'maselo amoyo kapena kupaka utoto wolowetsedwa m'maselo: maselo amoyo a epithelium amene amayamwa zinthu amalowetsa utotowo mu cytoplasm yawo. Choncho, chikuto cha mkati chathanzi chimakhala ndi utoto wofanana ndithu, pamene malo okhala ndi dysplasia, kutupa, kapena khansa amayamwa utoto wochepa kapena amakhala ndi utoto wamawangamawanga. Kusiyana kumeneku kumasonyeza kapangidwe ka chikuto cha mkati kamene kuwala koyera kokha kungalephere kusonyeza, makamaka zilonda kapena zotupa zathyathyathya.

Mmene zimenezi zimagwirira ntchito n'kosiyana ndi indigo carmine, utoto wina wodziwika wa chromoendoscopy. Indigo carmine salowetsedwa kwambiri m'maselo; amaunjikana m'maenje ndi m'mizere ya pamwamba n'kupangitsa kusiyana kwa mawonekedwe a pamwambapo kuonekera kwambiri. Kumeneku ndi kupaka utoto wosiyanitsa mawonekedwe, osati wolowa m'maselo amoyo. Ndemanga za kafukufuku nthawi zambiri zimaphatikiza mitundu yonse iwiri ya utoto pansi pa chromoendoscopy yogwiritsa ntchito utoto. Choncho, phindu la chromoendoscopy lonse limene lanenedwa silitanthauza mwachindunji phindu la methylene blue payokha.

Njira yogwiritsira ntchito utotowo imafuna kusamala kwambiri. Pa chromoendoscopy ya matumbo akulu onse yogwiritsa ntchito methylene blue, katswiri wa endoscopy amapopera utoto wa pafupifupi 0.1% gawo ndi gawo kudzera mu chubu chaching'ono, amadikira pafupifupi mphindi imodzi kuti ulowe m'maselo, kenako amayamwa utoto wotsala asanayambe kuyang'anitsitsa. Mphamvu za utoto zofika pafupifupi 0.5% zimapezeka m'njira zoyang'ana malo enaake kapena zokulitsa chithunzi, koma 0.1% ndiyo njira yachizolowezi ya matumbo akulu onse. Ntchito yonseyi imafuna kuti matumbo ayeretsedwe bwino kwambiri komanso nthawi yowonjezera yogwiritsira ntchito zida. Zovuta zimenezi zinalimbikitsa kupanga mankhwala amene amapaka matumbo akulu utoto ntchitoyi isanayambe.

Piritsi limene limapaka utoto kuchokera mkati

Lumeblue, yomwe imatchedwanso methylene blue MMX, ndi piritsi lomeza limene limatulutsa mankhwala pang'onopang'ono kwa nthawi yaitali. Lavomerezedwa ku EU ngati chothandizira kuzindikira matenda mwa kuonetsera bwino zilonda kapena zotupa za m'matumbo akulu ndi m'gawo lomaliza la matumbo pa colonoscopy yofufuza kapena yowunika matenda. Chilolezo chake chogulitsidwa kuyambira August 2020 chafotokozedwa mu chidule cha mankhwalawa cha EMA. Mlingo wake ndi mapiritsi asanu ndi atatu a 25 mg, okwana 200 mg, amene amamezedwa athunthu panthawi yoyeretsa matumbo ndi zinthu zopangidwa ndi PEG kapena pambuyo pake, madzulo a tsiku lotsatira lake padzachitike colonoscopy, motsatizana m'magawo a 3-3-2.

Kapangidwe ka MMX ndiko mfundo yaikulu ya piritsili. Chophimba chake chimapirira asidi wa m'mimba ndipo chimasweka pafupi ndi pH 7 kumapeto kwa matumbo aang'ono. Kenako chimatulutsa utoto pang'onopang'ono kuti chikuto cha mkati mwa matumbo akulu chikhudzane nawo kwa nthawi yaitali komanso mofanana ndithu. Pofika nthawi yoyamba colonoscopy, matumbo akulu amakhala atapakidwa kale utoto. Zimenezi zimapangitsa Lumeblue kukhala mankhwala ozindikirira matenda omwe amayendetsedwa ndi malamulo, okhala ndi mlingo wokhazikika ndi ntchito yotchulidwa momveka bwino. Izi n'zosiyana ndi madzi amene katswiri wa endoscopy amapopera komanso chinthu chilichonse chosamalira thanzi chogulitsidwa m'masitolo. Mitundu itatuyi imakwaniritsa zolinga zosiyanasiyana ndipo siingalowe m'malo mwa inzake; madzi ogulitsidwa m'masitolo afotokozedwa padera mu kalozera wa zowonjezera zakudya ndi zolemba pa zinthu.

Zimene kafukufuku wa kuzindikira anapeza m'matumbo akulu

Umboni wamphamvu kwambiri wokhudza methylene blue payokha m'matumbo akulu ndi kafukufuku wa gawo la III wa MB-MMX wofotokozedwa ndi Repici ndi anzake (PubMed 30742834): odwala 1,205 ofufuzidwa kapena owunikidwa anagawidwa mwamwayi kuti alandire 200 mg MB-MMX kapena placebo. Chiwerengero cha kupeza adenoma kapena carcinoma zotsimikiziridwa mwa kuyesa minofu chinali 56.29% poyerekeza ndi 47.81%, kusiyana kwenikweni kwa pafupifupi 8.5 mfundo za peresenti. Kuwonjezeka koonekera kwambiri kunali pa zilonda kapena zotupa zosakhala ngati polyp komanso zazing'ono kwambiri, ndipo panalibe phindu lalikulu pa zazikulu kapena zooneka ngati polyp.

Umboni wakale wa kupopera utoto umachokera makamaka ku kuwunika matenda otupa m'matumbo, osati kufufuza anthu amene chiopsezo chawo chili pa mlingo wamba. Kiesslich ndi anzake anagawa mwamwayi odwala 165 omwe anali atakhala ndi ulcerative colitis kwa nthawi yaitali kuti achitiridwe colonoscopy yachizolowezi kapena chromoendoscopy yogwiritsa ntchito 0.1% methylene blue. Anapeza kukula kosazolowereka kwa maselo mkati mwa epithelium kokwana 32 poyerekeza ndi 10 (PubMed 12671882). Pa colitis ya IBD, kutenga tizidutswa ta minofu pamalo osankhidwa atapoperedwa utoto kunaperekanso zotsatira zabwino kuposa kutenga minofu pamalo osankhidwa mwachisawawa mu kafukufuku wa Marion ndi anzake (PubMed 18844620). Izi ndi zotsatira za kuwunika colitis ndipo ziyenera kumvetsedwa m'njira imeneyo, pamodzi ndi kufotokoza kwapadera kwa methylene blue ndi matenda otupa m'matumbo.

Kusanthula kophatikiza kafukufuku wambiri kumasonyeza kuti chromoendoscopy yogwiritsa ntchito utoto imathandiza kuzindikira, koma kafukufukuyu anayesa makamaka indigo carmine: ndemanga ya Cochrane ya 2016 inapeza mwayi wokulirapo wopeza chilonda kapena chotupa chimodzi kapena zingapo za kukula kosazolowereka kwa maselo (PubMed 27056645). Kusanthula kophatikiza kafukufuku wa Antonelli kwa 2022, komwe kunaphatikiza mayesero khumi ogawa anthu mwamwayi, kunanena kuti kuzindikira adenoma kunawonjezeka ndi pafupifupi 20% poyerekeza ndi njira ina (PubMed 35588768). Zimenezi n'zothandiza pa mfundo ya kugwiritsa ntchito utoto, koma si umboni wa methylene blue payokha.

Kuzindikira si kuchiza

Zotsatira zonse pamwambazi zikukhudza kupeza zilonda kapena zotupa, osati kuchiza khansa. Lumeblue yavomerezedwa ngati chothandizira kuzindikira matenda, ndipo kafukufuku wake wolembetsera anayeza kuchuluka kwa kuzindikira, osati mmene zotupa zimayankhira mankhwala, kubwereranso kwa matenda, kapena kupitiriza kukhala ndi moyo. Mawu a EMA enieni amanena zimene zingatheke malinga ndi zomwe zachitika: kuzindikira bwino kungachepetse chiopsezo cha khansa ngati zilonda kapena zotupa zopezedwazo zichotsedwa. Kusiyana kwa kuzindikira kwa 8.5 mfundo sikungafotokozedwenso ngati kuchepa kwa khansa kapena imfa ndi 8.5%. Owerenga amene akuwunika zonena za kuchiza ayenera kusiyanitsa zimenezi momveka bwino, monga mmene kalozera wa kusiyana kwa umboni wa mu labotale ndi wa odwala wokhudza methylene blue ndi khansa akufotokozera.

Umboni wa gawo lapamwamba la njira ya chakudya ndi wofooka kwambiri

Pa kusintha kwa Barrett m'chubu cholumikiza pakamwa ndi m'mimba, methylene blue amapaka mtundu wabuluu maselo amene asintha kukhala ngati a m'matumbo. Zimenezi zinapereka lingaliro lakuti minofu yoyesedwa itengedwe pamalo opakidwa utotowo m'malo motenga mwakhungu kuchokera m'magawo anayi ozungulira. Zotsatira zoyambirira za malo amodzi zinkaoneka zolimbikitsa, koma kafukufuku wokulirapo komanso wolamulidwa bwino sanatsimikizire phindu pa kuzindikira dysplasia. Kusanthula kophatikiza kafukufuku zisanu ndi zinayi kwa 2009 sikunapeze kuwonjezeka kofunika mwa ziwerengero pa kupeza kusintha kwa maselo kukhala ngati a m'matumbo, dysplasia, kapena dysplasia yapamwamba ndi khansa yoyambirira, poyerekeza ndi kutenga minofu motsatira ndondomeko (PubMed 19215918).

Malangizo anasintha. Malangizo amakono a ACG, ESGE, ndi ASGE owunika kusintha kwa Barrett amalimbikitsa chromoendoscopy pogwiritsa ntchito acetic acid kapena chromoendoscopy ya pakompyuta yopanga kusiyana kwa zithunzi. Nthawi zonse zimenezi zimachitika pamodzi ndi ndondomeko yokhazikika ya Seattle yotengera minofu yoyesedwa, osati kupopera methylene blue m'malo motenga minofu mwachisawawa. Choncho, kunena kuti malangizo amalimbikitsa chromoendoscopy sikutanthauza kuti amalimbikitsa chromoendoscopy ya methylene blue.

Wosanjikiza wabuluu pansi pa chilonda kapena chotupa

Wosanjikiza wabuluu wooneka pa kuchotsa chikuto cha mkati kapena kudula minofu yapansi pake pogwiritsa ntchito endoscopy ndi ntchito yachitatu yosiyananso. Pamenepo, kukweza minofu kumachitika chifukwa cha madzi amchere kapena madzi ena obayidwa pansi pa chilonda kapena chotupa kuti achilekanitse ndi khoma la minofu. Madontho ochepa a utoto wabuluu amawonjezedwa kuti wogwira ntchitoyo aone wosanjikiza wokwezawo, malo odulirapo, ndi malire akuya. Mtunduwu umasonyeza kumene madzi obayidwawo apita. Sunena chilichonse chokhudza metaplasia kapena dysplasia, ndipo cholinga chake ndi chitetezo pa ntchito yodula ndi kuchotsa minofu. Nkhaniyi yafotokozedwa pamodzi ndi ntchito zina za pa opaleshoni mu kalozera wa opaleshoni ndi njira zozindikirira matenda.

Mfundo yeniyeni ya chitetezo: kuwala pamodzi ndi utoto

Methylene blue ndi chinthu chimene chimayambitsa zochitika za mankhwala chikakhudzidwa ndi kuwala, ndipo kafukufuku iwiri inapatsa akatswiri a endoscopy chifukwa choganizira mosamala. Olliver ndi anzake anasonyeza kuti 0.5% methylene blue pamodzi ndi endoscopy ya kuwala koyera zinawonjezera kuwonongeka kwa DNA mu chikuto cha mkati chokhala ndi kusintha kwa Barrett pa mayeso a comet, pamene utoto wopanda kuwala sunachite zimenezi (PubMed 12907012). Davies ndi anzake anapeza zotsatira zofanana m'matumbo akulu: 0.1% methylene blue pamodzi ndi kuwala koyera zinawononga DNA ya maselo a m'matumbo akulu mu labotale komanso m'thupi lamoyo, pamene indigo carmine sanachite zimenezi (PubMed 17172595).

Kutanthauzira kolondola kuli ndi malire: zinasonyeza kuwonongeka kwa DNA kwa nthawi yomweyo, osati khansa yotsimikiziridwa. Palibe kafukufuku amene anasonyeza kuti chromoendoscopy ya methylene blue imayambitsa khansa mwa odwala. Koma pamodzi ndi phindu lofooka pa kusintha kwa Barrett, chizindikiro chopeweka cha kuwonongeka kwa majini chinapangitsa utotowu kukhala wosakondedwa pa ntchito imeneyo. Ichi ndi chimodzi mwa zifukwa zimene malangizo amasankhira njira zina. Mfundo zokhudza kugwiritsa ntchito mosamala ndi zotsatira zosafunika zasonkhanitsidwa mu buku lofotokozera chitetezo ndi zotsatira zoyipa.

Pambuyo pa ntchito: mtundu wabuluu umayembekezeredwa

Methylene blue ndi utoto wamphamvu, ndipo mkodzo ndi chimbudzi kukhala zabuluu kapena zobiriwira kwa kanthawi pambuyo pake ndi zotsatira zoyembekezeredwa za utotowo, osati zovuta; mkodzo ungawoneke wobiriwira chifukwa utoto wabuluu umasakanikirana ndi zinthu zachikasu zopatsa mkodzo mtundu. Utoto ukafika pakhungu umasiya mtundu wabuluu kwa kanthawi. Chenjezo limodzi limakhalabe lofunika ngakhale pali mawu otonthoza amenewa: khungu likayamba kumene kukhala labuluu m'malo ambiri, pamodzi ndi kuvutika kupuma kapena kusintha kwa kuzindikira, zimenezi n'zosiyana ndi utoto wooneka pamwamba pa khungu ndipo zimafuna kuwunikidwa mwachangu, osati kungodikirira kuti maonekedwe asinthe. Ndipo chenjezo lomaliza pa kumvetsa mfundo: musaganize kuti mukudziwa utoto umene wagwiritsidwa ntchito chifukwa cha mtundu wokha. Kuoneka kwa buluu sikutsimikizira methylene blue, chifukwa zinthu zinanso zimapatsa minofu mtundu wabuluu.

Mfundo zofunika kukumbukira

Ganizirani magulu atatu osiyana: kupaka utoto pamwamba pogwiritsa ntchito kulowa kwake m'maselo a epithelium, mankhwala omezera ozindikirira matenda amene amapaka matumbo akulu utoto pasadakhale pansi pa chilolezo chogulitsidwa, ndi madzi okhala ndi mtundu obayidwa pansi pa chikuto cha mkati kuti asonyeze malo odulirapo. Funsani kuti zimene zikunenedwa zili m'gulu liti, ngati umboni wake unayeza kuzindikira kapena kuchiza, komanso mtundu wokonzedwa ndi mphamvu zake zimene zinayesedwa kwenikweni. Kafukufuku wotsimikizira kusiyana kumeneku walembedwa mu laibulale ya kafukufuku wa methylene blue.