Methylene blue pa kuyabwa kosatha ku kutulukira chimbudzi: umboni ndi malire ake

Ganizirani wodwala amene wayesera mafuta oteteza khungu, mankhwala opha bowa, mafuta a steroid, ndi kusintha mmene amadzisamalirira paukhondo kwa miyezi ingapo, koma kuyabwa ku kutulukira chimbudzi usiku uliwonse kukupitirirabe. Dokotala wa opaleshoni ya matumbo aakulu ndi thumbo lomaliza akutchula kubaya utoto wabuluu m'khungu lozungulira potulukira chimbudzi. Owerenga ambiri angaganize za madzi oziziritsa khungu amene amalikuta, ngati mafuta ena opaka amene alowetsedwa ndi singano. Koma njirayi imagwira ntchito mosiyana. Imawononga malekezero ang'onoang'ono a mitsempha yozindikira kukhudzidwa m'gawo lamkati la khungu kuti ithetse kuzungulira kwa kuyabwa ndi kukanda, ndipo umboni wake umachokera ku maphunziro ochepa a magulu a odwala ochitidwa njirayi, opanda gulu loyerekeza, omwe anatsatiridwa mosiyanasiyana.

Nkhaniyi ikuunika zolemba za kafukufukuzo. Ikufotokoza zimene njira yochitidwa ndi katswiriyi imaphatikizapo, zimene ziyenera kuchotsedwa pa zifukwa zotheka kuyabwa kusanatchulidwe kuti kulibe chifukwa chodziwika, zimene zolemba ziwiri zofunika zikunena, ndi pamene umboni ukuperewera. Kuti mudziwe za mankhwalawa, onani mmene methylene blue imagwirira ntchito pa mlingo wa maselo, komanso mndandanda waukulu wa ntchito zachipatala zovomerezedwa ndi zomwe zikufufuzidwa.

Njira yochitidwa ndi katswiri, osati mafuta opaka

Kubaya methylene blue mkati mwa khungu kapena pansi penipeni pa khungu pochiza kuyabwa ku kutulukira chimbudzi kosadziwika chifukwa chake komanso kosamva chithandizo ndi njira yolowetsa singano m'thupi yochitidwa ndi katswiri wa zachipatala. Njira zofalitsidwa zimalowetsa methylene blue yosungunulidwa m'gawo lamkati la khungu lozungulira potulukira chimbudzi lomwe lakhudzidwa, potsatira njira zopewera majeremusi. Nthawi zambiri amagwiritsa ntchito mankhwala ochititsa dzanzi pamalopo kapena otsekereza mitsempha ya dera linalake, wodwalayo atagona chafufumimba. Cholinga chake ndi kuwononga malekezero a mitsempha yozindikira kukhudzidwa yomwe ili pafupi ndi pamwamba pa khungu pogwiritsa ntchito mankhwala. American Society of Colon and Rectal Surgeons imafotokoza kubaya mkati mwa khungu lomwe lakhudzidwa komanso pansi pake, ndipo imachenjeza kuti kubaya pafupi kwambiri ndi pamwamba pa khungu kungapangitse khungu kuwonongeka kapena kukhala ndi zilonda.

Kusiyanitsa zinthu zitatu n'kofunika. Choyamba, methylene blue yopaka pamwamba pa khungu si njira imene maphunzirowa anaunika, ndipo palibe umboni wofanana wosonyeza kuti ingalowe m'malo mwa kubaya mkati mwa khungu. Chachiwiri, njira zofalitsidwazi sizingatengedwe ngati maziko a kudzibaya nokha. Kuwongolera kuya kwa jakisoni n'kofunika kwambiri pa chitetezo: kubaya pafupi kwambiri ndi pamwamba kungayambitse zilonda ndi kufa kwa minofu; kubaya mozama kwambiri kapena kugwiritsa ntchito njira zosapewa majeremusi kungayambitse thumba la mafinya ndi kuvulala kwa ziwalo. Chachitatu, methylene blue ya jakisoni yogulitsidwa ku United States yalembedwa kuti igwiritsidwe ntchito kudzera m'mtsempha pochiza methemoglobinemia yomwe munthu wapeza, choncho kubaya mkati mwa khungu lozungulira potulukira chimbudzi ndi ntchito yosatchulidwa pa chilolezo cha mankhwalawo. Owerenga amene akumwa mankhwala okhudza serotonin ayeneranso kuwerenga machenjezo a serotonin syndrome ndi kuyanjana kwa mankhwala, omwe afotokozedwanso pansipa.

Pezani chifukwa kaye: kuyabwa kochuluka kumakhala ndi chifukwa

Pruritus ani ndi dzina la chizindikiro cha kuyabwa ku kutulukira chimbudzi, osati la matenda amodzi. Malangizo amagawa zoyambitsa zake m'magulu a mavuto a potulukira chimbudzi ndi thumbo lomaliza, matenda a khungu, matenda opatsirana, matenda okhudza thupi lonse, zinthu zokwiyitsa khungu, ndi mavuto ochokera m'maganizo. Amalimbikitsa kufufuza mbiri ya wodwala, kuunika potulukira chimbudzi ndi thumbo lomaliza pogwiritsa ntchito anoscopy, ndi mayeso olunjika pa zifukwa zomwe zikuganiziridwa, asanatchule kuyabwa kuti kulibe chifukwa chodziwika. Malangizo a ntchito zachipatala a Italian Society of Colorectal Surgery amafotokoza kufufuza kumeneku, kuphatikizapo kutenga zitsanzo ndi swab kapena kukanda pang'ono khungu, mayeso a labotale, kuyesa zinthu zoyambitsa ziwengo pozipaka pakhungu, ndi kutenga kachidutswa ka minofu kuti kayesedwe, malinga ndi zomwe zapezeka.

Zifukwa zodziwika zomwe ziyenera kufufuzidwa ndi kuchotsedwa zikuphatikizapo zotupa za mitsempha ku kutulukira chimbudzi, mng'alu, njira yachilendo yolumikiza ziwalo kapena khungu, tizidutswa ta khungu tolenjekeka, kutayikira kwa chimbudzi kapena kulephera kuchigwira, kutulukira panja kwa minofu ya thumbo, ndi njerewere. Zimaphatikizanso kutupa kwa khungu chifukwa chokhudzana ndi sopo, zopukutira, zonunkhiritsa, ndi mankhwala opaka, komanso chinyezi ndi kuipitsidwa ndi chimbudzi kosaoneka mosavuta. Matenda a khungu omwe angafanane ndi kuyabwako ndi psoriasis, lichen sclerosus, ndi lichen simplex chronicus. Matenda opatsirana amaphatikizapo Candida, dermatophytes, nyongolotsi za pinworm, mphere, ndi zoyambitsa zopatsirana pogonana. Matenda a thupi lonse omwe angagwirizane ndi kuyabwa ndi shuga, matenda a chiwindi omwe amalepheretsa kuyenda kwa ndulu, matenda a impso osatha, ndi mavuto a chithokomiro. Zilonda kapena malo osintha khungu omwe sakutha, ndi achilendo, kapena ali ndi zilonda zotseguka amafunika kutengedwa kachidutswa ka minofu kuti kayesedwe, kuti achotse kuthekera kwa anal intraepithelial neoplasia kapena matenda a Paget omwe ali kunja kwa bere. Gulu laling'ono kwambiri lokha la anthu omwe zizindikiro zawo zikupitirirabe komanso zili zamphamvu ngakhale atafufuzidwa chonchi ndi kulandira chithandizo chosachita opaleshoni limaganiziridwa kuti lingalandire jakisoni. Izinso n'zimene malangizo a ASCRS kwa odwala amanena.

Zimene kusanthula kophatikiza maphunziro kwa 2023 kunapeza

Kusanthula kotakata kwambiri ndi kusanthula kophatikiza maphunziro a gulu limodzi kwa 2023 kochitidwa ndi Jia ndi anzake, komwe kunaphatikiza maphunziro 7 ndi odwala 225. Kuyabwa kunatha pambuyo pa jakisoni imodzi mwa 76.1 peresenti (95 peresenti CI 64.9 mpaka 87.3), ndipo chiwerengerocho chinakwera kufika 85.4 peresenti pambuyo pa jakisoni yachiwiri. Kusakhalanso ndi zizindikiro kunanenedwa kuti kunali 75.3 peresenti pa chaka chimodzi ndi 77.3 peresenti pa zaka zitatu, kenako kunatsika kufika 24.0 peresenti pa zaka zisanu.

Ziwerengerozi ziyenera kuwerengedwa mosamala. Maphunziro ophatikizidwawo anali a magulu a odwala opanda gulu loyerekeza, ochitika kuyambira 1979 mpaka 2019, okhala ndi njira, mphamvu za mankhwala m'madzi, ndi zotsatira zoyezedwa zosiyanasiyana. Kusiyanasiyana kwa ziwerengero kunalinso kwakukulu. Maperesenti a nthawi yaitali sachokera ku gulu limodzi lotsatiridwa kwa zaka zisanu. Maphunziro ang'onoang'ono osiyanasiyana anapereka deta pa nthawi zosiyanasiyana, choncho chiwerengero cha zaka zisanu si cholimba. Mavuto ofala anali khungu kukhala ngati lalembedwa mphini yabuluu kwakanthawi ndi dzanzi lozungulira potulukira chimbudzi. Zochitika zina zomwe zinanenedwa zinaphatikizapo cellulitis, magazi kuunjikana m'minofu, kutayikira kwa chimbudzi kwakanthawi, kulephera kutulutsa mkodzo, thumba la mafinya pafupi ndi pamwamba pa khungu, ndi kusintha kwa kumva kukhudzidwa komwe kunatenga nthawi yaitali. Chofunika kwambiri n'chakuti kafukufuku wakale wa Eusebio ndi anzake (1990), yemwe ananena za kufa kwa minofu ya khungu, sanali m'maphunziro asanu ndi awiri ophatikizidwawo. Choncho mawu olimbikitsa okhudza chitetezo m'kusanthula kophatikizako sakutanthauza kuti kufa kwa minofu sikunachitikepo. Chidule chathu cha chitetezo cha methylene blue chimafotokoza zochitikazi mogwirizana ndi nkhani yake yonse.

Zimene kafukufuku mmodzi wamkulu kwambiri anapeza

Kafukufuku mmodzi wamkulu kwambiri ndi kuunika kwa 2019 kochitidwa ndi Kim ndi anzake, koyang'ana m'mbuyo pa nkhokwe ya deta yomwe inasonkhanitsidwa motsatira odwala kupita m'tsogolo. Mwa odwala 362 omwe anabwera ndi kuyabwa ku kutulukira chimbudzi, 259 anapeza bwino ndi chithandizo chosachita opaleshoni. Izi zinasiya 103 omwe anali ndi zizindikiro zamphamvu zosamva chithandizo ndipo anachizidwa ndi jakisoni mkati mwa khungu. Njirayo inasakaniza 5 mL ya methylene blue yoyambirira ya 1 peresenti ndi 15 mL ya lidocaine ya 1 peresenti, kupanga 20 mL ya madzi obaya okhala ndi mphamvu yomaliza ya pafupifupi 0.25 peresenti, ndipo anabayidwa atachititsidwa dzanzi ndi saddle block. Kusiyanitsa mphamvu ya madzi oyambirira ndi mphamvu ya madzi omaliza kumabwerezabwereza m'mabuku a kafukufuku: zolemba zomwe zimati 1 peresenti nthawi zambiri zimafotokoza madzi oyambirira, osati osakaniza osungunulidwa omwe anabayidwadi.

Pa masabata asanu ndi limodzi, odwala 87 mwa 96 omwe anatsatiridwa (90.6 peresenti) anaikidwa m'gulu la omwe anapeza bwino. Odwala asanu ndi atatu pambuyo pake analandira jakisoni yobwereza, ndipo asanu anapeza bwino. Pa zaka zitatu, odwala 53 mwa 62 omwe analipo kuti aunikidwe kwa nthawi yaitali (85.5 peresenti) anali atapeza bwino, ndipo mwa 53 omwe anapeza bwino koyamba, 4 (7.5 peresenti) anali ndi kuyabwa kobwerera. Kuchepa kwa odwala omwe anapitiriza kutsatiridwa kumachepetsa kudalirika kwa ziwerengerozi: 62 okha mwa 103 oyambirira ndi omwe anapereka deta ya zaka zitatu. Khungu kukhala ngati lalembedwa mphini yabuluu kunapitirira mwa 84 mwa 96 (87.5 peresenti) pa masabata asanu ndi limodzi, ndipo kawirikawiri kunafooka mpaka kukhala timadontho ting'onoang'ono pofika pafupifupi masabata anayi. Magazi kuunjikana m'minofu kunachitika mwa 6 mwa 62 (9.7 peresenti) ndipo kunatha kokha. Olemba kafukufukuyo sananene za kutayikira kwa chimbudzi, cellulitis, kufa kwa minofu, kapena thumba la mafinya m'gulu lawo.

Tebulo la kudalirika kwa maphunziro ndi kutsatira odwala

Tebulo ili pansipa ndilo gwero lalikulu la mfundo za kuunika kumeneku. Mphamvu za mankhwala m'madzi zomwe zalembedwa ndi nyenyezi ndi kuyerekeza kwa osakaniza omaliza, chifukwa zolemba zingapo zinanena mphamvu ya madzi oyambirira okha.

Zomwe zikuoneka m'mizere yonse zikufanana. Kupeza bwino koyambirira nthawi zambiri kumakhala kwakukulu, koma kuyerekeza kubwerera kwa kuyabwa kumadalira kwambiri kutalika kwa nthawi yotsatira odwala ndi kuchuluka kwa omwe akupitirizabe kutsatiridwa. Samalavicius ananena kuti kuyabwa kunatha koyambirira mwa 100 peresenti koma kenako kunabwerera mwa 80 peresenti pa nthawi yapakati ya miyezi 47; Kim ananena kuti kunabwerera mwa ochepera 8 peresenti pa zaka zitatu mwa omwe anapeza bwino ndipo anapitiriza kutsatiridwa. Magulu ang'onoang'ono, kubwereza majakisoni, kusiyana kwa zotsatira zoyezedwa, ndi kuchepa kwa odwala otsatiridwa zimapangitsa kuyerekezera mwachindunji kukhala kosadalirika.

Malire amene wowerenga ayenera kukumbukira

Palibe kafukufuku wogawa odwala mwamwayi m'magulu omwe amathandiza njirayi. Kuyerekeza kulikonse kwa kuchita bwino pamwambapa kumachokera ku maphunziro a magulu opanda gulu loyerekeza kapena gulu lounikidwa poyang'ana m'mbuyo. Choncho kusintha chifukwa choyembekezera chithandizo, kubwerera kwa zizindikiro ku mlingo wawo wamba, ndi njira zaukhondo zomwe zinkachitika nthawi yomweyo sizingasiyanitsidwe ndi zotsatira za chithandizochi. Njira zimasiyana pa gawo lomwe jakisoni amalowetsedwa, kuchuluka kwa madzi, mmene mphamvu ya mankhwala imanenedwera, kusakaniza ndi mankhwala ochititsa dzanzi, ndi kugwiritsa ntchito steroid. Izi zikutanthauza kuti palibe mlingo umodzi wokhazikitsidwa: yerekezerani mphamvu ya osakaniza omaliza, osati zolemba za madzi oyambirira. Maphunziro a odwala 6 mpaka 103 sangathe kudziwa kuchuluka kwa zochitika zosowa monga ziwengo zamphamvu kapena mavuto okhudza thupi lonse, ndipo kutsatira odwala kuti adziwe kubwerera kwa kuyabwa mochedwa sikunamalizidwe m'maphunziro ambiri.

Mbiri ya kufa kwa minofu iyenera kunenedwa momveka bwino. Odwala atatu mwa 23 m'kafukufuku wa Eusebio wa 1990 anali ndi kufa kwa minofu m'makulidwe onse a khungu komwe kunafunika kuchotsa minofu yakufayo. Kuyambira pamenepo, njira zasintha n'kuyamba kugwiritsa ntchito osakaniza omaliza osungunulidwa kwambiri komanso kubaya mkati mwa khungu m'malo mobaya mozama. Maphunziro otsatira anena za mavuto ocheperako, koma chochitika chakalechi ndi mbali ya mbiri ndipo chikuchenjeza kuti njirayi isayambidwe mosasamala.

Machenjezo a mankhwala okhudza thupi lonse ayeneranso kuganiziridwa. Malangizo amakono operekera methylene blue ya jakisoni ali ndi chenjezo m'bokosi lokhudza serotonin syndrome yomwe ingaphe munthu akagwiritsa ntchito mankhwala okhudza serotonin ndi opioids. Amatchulanso malipoti a anaphylaxis, ndipo amaletsa kugwiritsa ntchito mankhwalawa ngati munthu ali ndi kusowa kwa G6PD kapena ziwengo zamphamvu ku utoto wa thiazine. Machenjezowa amachokera makamaka ku kugwiritsa ntchito mankhwalawa kudzera m'mtsempha kuti afalikire m'thupi lonse. Kuchuluka komwe kumafikira thupi lonse pambuyo pa kubaya mozungulira potulukira chimbudzi sikunayezedwe bwino, choncho sizingoganiziridwa kuti machenjezowa alibe ntchito. Dziwitsani katswiri za mankhwala onse a kuvutika maganizo, opioids, ndi momwe G6PD yanu ilili musanachitidwe njira iliyonse yogwiritsa ntchito methylene blue.

Amene angakambirane za njirayi ndi katswiri wa zachipatala

Anthu omwe angaganiziridwe ndi ochepa: omwe ali ndi kuyabwa kopanda chifukwa chodziwika komwe kukupitirirabe pambuyo pofufuza zifukwa zina ndi kulephera kwa njira zosachita opaleshoni, ndipo kuyabwako n'koopsa moti angavomereze khungu kukhala ngati lalembedwa mphini, dzanzi, ndi chiopsezo chaching'ono cha matenda kapena kusintha kwa kutha kugwira chimbudzi. Bweretsani ndondomeko ya nthawi yomwe zizindikiro zakhala zikuchitika, chithandizo cham'mbuyomo pamodzi ndi madeti ake, malipoti a mayeso kuphatikizapo anoscopy ndi kuyezetsa kulikonse kwa kachidutswa ka minofu, komanso mndandanda wonse wa mankhwala. Mfundo zothandiza pokambirana zasonkhanitsidwa mu mafunso athu oti mufunse katswiri wa zachipatala za methylene blue. Musapemphe jakisoni kwa katswiri amene amadumpha kufufuza chifukwa cha kuyabwa, ndipo musayese kudzibaya nokha.