Ibizamini by'irangi rya metilene ry'ubururu ku nkari zisohoka na fistula: icyo agatambaro k'ubururu kemeza

Ibyumweru bike nyuma yo kubagwa mu gice cyo hasi cy'inda, umurwayi abona ko ahora ava inkari. Atekereza ko ari ubwandu bwo mu ruhago, akarangiza imiti yica bagiteri yahawe, maze akayoberwa impamvu inkari zikomeza gusohoka uko byari bimeze. Iyo miti ntiyari gukemura ikibazo, kuko uko yumvaga ikibazo bitari byo. Ubwandu ni igihe mikorobe zinjira mu nyama z'umubiri. Fistula ni umwenge: umuyoboro udasanzwe uhuza imyanya ibiri yagombye kuba itandukanye, aha akaba ari uruhago n'igitsina cy'umugore. Nta muti wica bagiteri ufunga umwenge.

Iki ni cyo kibazo ikizamini cy'irangi rya metilene ry'ubururu cyagenewe. Icyo kizamini nta cyo kivura, ntikigaragaza ubwandu, kandi ntigihagije cyonyine ngo hemezwe ikibazo umurwayi afite. Gisubiza ikibazo kimwe gusa: amatembabuzi ari mu gitsina cy'umugore aturuka mu ruhago rwuzuyemo irangi? Ibintu byose bijyanye n'uko gikorwa, harimo n'ibituma kitagaragaza ukuri, bishingira kuri iyo ntego imwe. Incamake yacu ku ikoreshwa rya metilene y'ubururu mu buvuzi ishyira iri koreshwa mu gusuzuma hamwe n'ikoreshwa ryayo ryemewe n'irikiri mu bushakashatsi.

Igitekerezo cy'ingenzi: amatembabuzi y'ubururu agenzurwa nk'ikimenyetso cyo gukurikirana inzira

Ihame ryabyo ryagizwe ryoroshye ku bushake. Uruhago rwuzuzwa hifashishijwe agati kanyuzwamo amatembabuzi, ayo matembabuzi akinjira mu cyerekezo kinyuranye n'icyo inkari zisanzwe zisohokamo. Hakoreshwa amatembabuzi yo koza atarimo mikorobe, arimo irangi rya metilene ry'ubururu ryoroshywe. Mu gitsina cy'umugore ntihagombye kuba harimo amatembabuzi y'ubururu. Niba nyuma agaragaye mu gitsina ahantu hadasanzwe, bivuga ko hari inzira ihuza uruhago cyangwa umuyoboro usohora inkari mu ruhago n'igitsina. Irangi ni ikimenyetso cyo gukurikirana inzira, naho ikizamini kigamije kumenya aho inkari zisohokera.

Ibyo bihita bigira ibisobanuro bibiri. Icya mbere, ikizamini gishobora kubona gusa aho inkari zisohokera nyuma y'aho irangi ryashyizwe, ukurikije inzira zinyuramo. Irangi ry'ubururu riri mu ruhago ntirishobora na rimwe kugaragaza fistula ihuza umuyoboro uva mu mpyiko n'igitsina, kuko inkari zituruka muri uwo muyoboro wageragejwe zigera mu gitsina zitigeze zinjira mu ruhago. Icya kabiri, igisubizo kigaragaza ko inkari zisohoka cyerekana aho zisohokera, ariko ntikivuga uko inyama z'umubiri zimeze, ingano ya fistula, cyangwa uko yakosorwa. Ni yo mpamvu gutegura ibikorwa byo kubaga no gusuzuma buri gihe bisaba ibirenze ikizamini cy'irangi.

Ikizamini cy'udutambaro dutatu, intambwe ku yindi

Isuzuma ritangira mbere y'uko irangi iryo ari ryo ryose rikoreshwa. Isuzuma rikoresha igikoresho gifungura igitsina cy'umugore rishakisha inkari zitagira ibara ziteraniyemo, ndetse, niba ugaragara, n'umwenge wa fistula wo ku ruhande rw'igitsina. Amabwiriza y'i Burayi ajyanye na fistula z'inkari ashimangira cyane kubaza amateka y'umurwayi no gukora isuzuma ryibanda ku kibazo, kandi nta gisubizo cy'irangi kiruta ibyo amaso yibonera.

Uburyo busanzwe bw'ikizamini cy'udutambaro dutatu, nk'uko busobanurwa muri raporo y'ICS/IUGA ku magambo akoreshwa, bukorwa gutya. Udutambaro dutatu twa siponji twumye dushyirwa mu gitsina dukurikirana: kamwe hejuru, kamwe hagati, kamwe hasi. Hari uburyo bukoresha udupfunyika twa gaze, udupamba tubumbye, cyangwa tampon, ariko udutambaro dutatu dutandukanye ni bwo buryo bwashyizweho nk'igipimo. Uruhago ruhita rwuzuzwa amatembabuzi yo koza arimo irangi ry'ubururu ryoroshywe, anyujijwe mu gati, kandi umuganga akareba niba amatembabuzi y'ubururu asohoka mu mwenge wo mu gitsina mu gihe uruhago rwuzuzwa. Gushyiramo udutambaro mbere yo kuzuza uruhago ni ngombwa: gushyiramo tampon nyuma y'uko irangi ryamenetse hafi y'umuryango w'igitsina bituma byanze bikunze yanduzwa, maze igisubizo kikaba nta cyo gisobanura.

Nta ngano imwe y'amatembabuzi, nta gipimo kimwe cy'irangi, cyangwa igihe kimwe cyo kurirekeramo bikoreshwa hose, kandi inyandiko ivuga ukuri yagombye kubivuga. Igitabo cya FIGO cyo guhugura mu kubaga fistula kivuga 60 kugeza kuri 100 mL z'irangi ryoroshywe, hagahita harebwa ibigaragara; iyo nta kigaragaye, umurwayi aragenda kandi akanywa mu gihe cy'iminota 30 kugeza kuri 60, irangi rikiri mu ruhago. Uburyo bumwe bwo gusuzuma nyuma yo kubagwa bwakoresheje 250 kugeza kuri 300 mL, bunaburira by'umwihariko ko kutuzuza uruhago bihagije bituma fistula nto zitagaragara mu kizamini nubwo zihari. Igisobanuro cya ICS/IUGA giteganya gukuramo udutambaro nyuma y'iminota 10, ariko kikemerera kugeza ku minota 30 iyo umuyoboro ari muto cyane cyangwa wizingazinze. Amabwiriza afite ishingiro ni ukuzuza uruhago bihagije hakoreshejwe umuti woroshywe hakurikijwe amabwiriza y'aho ikizamini gikorerwa, aho gutanga uburyo bumwe bwakoreshwa hose.

Gusoma ibisubizo ku dutambaro

Buri gatambaro gakurwamo ukwako, hakandikwa niba gatose n'ibara gafite. Dore uko ibisubizo bisanzwe bisobanurwa hakurikijwe ibisobanuro bya ICS/IUGA:

Umurongo wa kabiri ni wo ushobora guteza kwibeshya gukomeye kurusha iyindi. Kuba agatambaro ko hasi cyane konyine gafite ibara ry'ubururu ni cyo gisubizo cyoroshye kubona nta fistula ihari, bitewe n'inkari zisohokera mu muyoboro usanzwe cyangwa amatembabuzi y'ubururu ameneka agasubira inyuma avuye ku mwenge usohora inkari. Agatambaro ko hasi k'ubururu konyine ntikigera gihagije ngo ikibazo gifatwe nk'icyasobanutse.

Ikizamini cy'amabara abiri: gutandukanya uruhago n'umuyoboro uva mu mpyiko

Iyo inkari zikomeza kugaragara mu gitsina ariko irangi ryo mu ruhago ntirizigaragaremo, hakekwa ko ikibazo kiri hejuru y'uruhago, mu muyoboro uva mu mpyiko. Ikizamini cy'amabara abiri gituma aho inkari zituruka hombi hatandukanywa n'amaso. Umurwayi afata phenazopyridine anyuze mu kanwa kugeza inkari zibaye orange igaragara cyane (igisobanuro cyemewe kivuga 200 mg inshuro eshatu ku munsi mu gihe cy'umunsi umwe kugeza ku minsi ibiri, nubwo amabwiriza amwe yo mu mavuriro akoresha gufata umuti inshuro imwe gusa), hanyuma uruhago rukuzuzwa amatembabuzi yo koza y'ubururu nk'uko byakozwe mbere.

Uko bisobanurwa ni ugukurikirana inzira amatembabuzi anyuramo. Ibara ry'ubururu mu gitsina risobanura ko amatembabuzi yaturutse mu ruhago cyangwa mu muyoboro usohora inkari. Ibara rya orange ridaherekejwe n'ubururu risobanura ko amatembabuzi yaturutse mu miyoboro iva mu mpyiko iri hejuru y'uruhago. Amabara yombi yerekana ko hashobora kuba hari inzira zidasanzwe muri ibyo bice byombi. Inkari zitagira ibara ziri mu gice cyo hejuru cy'igitsina, nubwo mu ruhago harimo irangi ry'ubururu, na zo zerekana ko zituruka hejuru y'uruhago, kimwe n'ibara rya orange. Ubu ni uburyo bwo gusuzuma buyoborwa n'umuganga, si igerageza ryo gukorera mu rugo.

Kureba mu ruhago na kamera no mu cyumba cyo kubagiramo

Ikizamini cy'irangi gishobora no gukoreshwa harebwa ku rundi ruhande. Mu gihe cyo kubaga mu gice cyo hasi cy'inda, uruhago rushobora kuzuzwa amatembabuzi yo koza afite ibara ry'ubururu, anyujijwe mu cyerekezo kinyuranye n'icyo inkari zisohokamo, mu gihe harebwa ahabagirwamo. Amatembabuzi y'ubururu azamuka akajya ahabagirwamo agaragaza umwenge mu ruhago, kandi icyo gikorwa gishobora gusubirwamo nyuma yo kuwufunga kugira ngo harebwe niba nta matembabuzi agaragara anyuramo. Uburyo bumwe bwatangajwe bwakoresheje kugeza kuri 600 mL kuri iyo ntego; ibyo bikwiye gufatwa nka raporo y'uko igikorwa cyo kubaga cyakozwe, aho kuba igipimo kigomba gukoreshwa kuri buri ruhago.

Kureba mu ruhago na kamera bigaragaza ibyo udutambaro tudashobora kwerekana: umubare, ingano n'aho imyenge yo mu ruhago iri, ndetse n'isano yayo n'agace ka mpandeshatu ko mu ruhago n'imyenge y'imiyoboro iva mu mpyiko. Amabwiriza y'i Burayi asaba kureba mu ruhago na kamera no kuruzuza amatembabuzi afite ibara anyujijwe mu cyerekezo kinyuranye n'icyo inkari zisohokamo kugira ngo hemezwe fistula, ariko akavuga ko ibimenyetso bya siyansi bibishyigikira bikiri bike. Ikindi gikorwa gifitanye isano n'icyo, ariko gitandukanye na cyo, ni ukureba niba imiyoboro iva mu mpyiko ifunguye mu gihe cyo kureba mu ruhago na kamera, harebwa utugezi tw'irangi dusohoka mu myenge yayo. Aha ikimenyetso kigomba kuza giturutse hejuru, kinyuze mu maraso cyangwa mu nkari, kuko irangi ryashyizwe mu ruhago riba riri nyuma y'iyo miyoboro mu nzira y'inkari, bityo ntirishobore kuyisuzuma. Kwitiranya izo nzira ebyiri z'irangi ni ryo kosa mu gusobanukirwa imikorere imbonerahamwe y'udutambaro igamije gukumira. Ibisobanuro birambuye kuri ubwo buryo bukoreshwa mu kubaga biri mu nyandiko yacu ijyana n'iyi ku ikoreshwa rya metilene y'ubururu mu kubaga no gusuzuma.

Impamvu ikizamini gishobora kwibeshya mu byerekezo byombi

Hari impamvu nke zikunze gutuma ikizamini kitagaragaza ikibazo kandi gihari: kuzuza uruhago bike cyane; umuyoboro muto cyane cyangwa wizingazinze wari ukeneye iminota irenga icumi; inkari zisohoka rimwe na rimwe cyangwa bitewe n'uko umubiri uhagaze; fistula ihuza umuyoboro uva mu mpyiko n'igitsina irangi ryo mu ruhago ridashobora kugeraho; cyangwa fistula ya kabiri itagaragaye kubera iya mbere yabonetse. Mu bushakashatsi bumwe bwasubiye mu makuru y'abarwayi 56 bari bafite fistula nyuma yo kubagwa, ibizamini by'irangi 10 muri 13 byakozwe mbere yo koherezwa ahandi kwivuza byagaragaje ikibazo. Icyo gipimo cya 10-muri-13 rimwe na rimwe gitangazwa nk'aho cyerekana ubushobozi bw'ikizamini bwo kubona ikibazo iyo gihari. Si ko biri: abo barwayi bari baratoranyijwe mu buryo bwihariye, kandi ubushakashatsi ntibwari bwarateguwe nk'igerageza ripima ukuri kw'ibizamini. Ubushakashatsi bwo mu 2020 ku barwayi bari barabazwe bushyigikira ikizamini cy'irangi nk'uburyo bwihuse bwo gutangiriraho, si nk'igipimo cyapimwe cy'ubushobozi bwacyo bwo kubona ikibazo.

Ibisubizo bigaragaza ikibazo kandi kidahari, cyangwa biyobya, ahanini biterwa no kwanduzwa n'irangi: irangi rimenetse mu gihe cyo gushyiramo tampon, inkari zigenda zinjira mu dutambaro dushyizwemo, kwihagarika mu gihe cy'ikizamini, cyangwa kutabasha gufata inkari bisanzwe bitewe n'umuvuduko ku ruhago cyangwa ubushake bukomeye bwo kwihagarika, bigatuma agatambaro ko hasi cyane gafata ibara. Nta na kimwe muri ibyo cyerekana fistula. Ni yo mpamvu kwitegereza mu gihe uruhago rwuzuzwa no kureba ku mwenge usohora inkari niba hari amatembabuzi asubira inyuma ari ibice bigize ikizamini, atari inyongera umuntu ashobora kureka.

Ikizamini cy'irangi kigaragaza inzira idasanzwe si igisubizo cy'ubwandu bw'inzira z'inkari, kandi n'ibinyuranye ni uko

Ubwandu bw'inzira z'inkari ntiburema umuyoboro uhuza uruhago n'igitsina, bityo ubwandu bwonyine ntibushobora gutuma amatembabuzi y'ubururu asohokera ahandi hatari ku mwenge usanzwe usohora inkari mu kizamini kigenzurwa. Ibyo bibazo byombi bishobora kugira ibimenyetso bisa kandi bikabaho icyarimwe, ari na yo mpamvu byitiranywa. Ubushake bwihutirwa bwo kwihagarika no kutabasha gufata inkari bujyana na bwo bitewe n'ubwandu bituma inkari zisohokera mu muyoboro usanzwe; inkari zisohoka kubera fistula zo ntiziwunyuramo. Gusuzuma inkari no kuzihingamo mikorobe biracyari ngombwa iyo hakekwa ubwandu, kandi gupima kreatinine mu matembabuzi yakusanyijwe mu gitsina bishobora kwemeza ko ari inkari, nubwo bidashobora byonyine kwerekana aho zisohokera. Hari ikindi gishobora gutera urujijo: imiti imwe ivanze igenewe ibibazo by'inkari irimo metilene y'ubururu ubwayo ihindura ibara ry'inkari. Ni byiza kubibwira umuganga mbere y'isuzuma iryo ari ryo ryose rikoresha irangi.

Ibigomba gukomeza gukorwa nyuma y'udutambaro

Ikizamini cy'irangi gitangiza isuzuma; ntikirirangiza. Isuzuma ry'igice cyo hasi cy'inda rireba uko inyama z'umubiri zimeze, inkovu, n'aho fistula iri. Kureba mu ruhago no mu muyoboro usohora inkari hifashishijwe kamera bigaragaza aho imyenge y'imbere iri mbere y'uko hagira igisanwa. Iyo hakekwa ko inkari zituruka mu muyoboro uva mu mpyiko cyangwa imiterere y'ingingo idasobanutse, CT ikoresha umuti utuma ingingo zigaragara neza, harimo amashusho afatwa mu cyiciro cyo gusohora uwo muti gitinze, cyangwa MRI, bigaragaza igice cyo hejuru cy'inzira z'inkari. Gufata amashusho y'inzira iva mu mpyiko hifashishijwe umuti winjizwa uva hasi uzamuka bishobora kugaragaza mu buryo butaziguye umuyoboro utari usobanutse. Hari n'ubushakashatsi bugereranya ibyo n'uburyo bwa ultrasound: mu bushakashatsi buto ku barwayi cumi na babiri bwo kureba niba ubwo buryo bushoboka, Doppler y'amabara yongerewe umuti utuma amashusho agaragara neza yashyize mu byiciro neza ibibazo 11 muri 12, ariko icyo gisubizo ni icy'uburyo bwa ultrasound, si icy'ikizamini cy'irangi (Volkmer na bagenzi be, 2000).

Ikizamini cy'irangi kirongera kigakoreshwa nyuma y'ubuvuzi. Inama za FIGO ku mikorere myiza zisaba gusuzuma hakoreshejwe irangi nyuma y'iminsi 10 kugeza kuri 14 fistula isanwe, mbere yo gukuramo agati k'inkari, umurwayi akorora mu gihe yitegerejwe (Browning na bagenzi be, 2025). Iyo ikizamini kitagaragaje ikibazo kuri iryo suzuma, bivuga ko icyo gihe nta nkari zisohokera muri fistula zagaragajwe; ntibyemeza ko nyuma hatazongera kubaho inkari zisohoka bitewe no kutabasha kuzifata, kuguma mu ruhago kwazo, ubwandu, cyangwa aho zituruka mu muyoboro uva mu mpyiko hatari habonetse.

Metilene y'ubururu ifite ikindi ikoreshwa mu gusuzuma gikwiye gutandukanywa n'isuzuma rya fistula: ikoreshwa no kureba niba imiyoboro inyuzamo intanga ngore ifunguye, igikorwa gisobanurwa mu nyandiko yacu ku bizamini by'uburumbuke no gusuzuma niba imiyoboro y'intanga ngore ifunguye. Irangi ni rimwe, ariko ikibazo kiratandukanye n'ingingo zisuzumwa ziratandukanye. Guhuza buri gisubizo n'ikibazo cyabajijwe ni ryo hame rigenga ibizamini by'irangi. Agatambaro k'ubururu kemeza ko hari inzira. Ibindi byose, ingano yayo, niba ishobora gusanwa, n'uko biteganyijwe ko ikibazo kizagenda, biracyakeneye gusuzumwa.