Methylene blue mu isuzuma ry'uburumbuke: icyo chromopertubation igaragaza koko

Ibisubizo by'ishakisha kuri methylene blue n'uburumbuke bivanga ibyemezo bibiri bitandukanye. Icya mbere ni uko isuzuma rikoresha irangi ry'ubururu kwa muganga rishobora kugaragaza niba imiyoboro y'intanga ngore ifunguye. Icya kabiri ni uko gufata methylene blue byongera uburumbuke cyangwa bikazamura ubuziranenge bw'intanga ngabo cyangwa intanga ngore. Icya mbere gusa ni cyo kijyanye na chromopertubation. Icya kabiri nticyasuzumwe kandi ntikiri mu bigize ubu buryo bwo gusuzuma. Iryo tandukaniro ni ryo rigenga ibisobanuro byose bikurikira.

Ikibazo gifite akamaro hano kirihariye kurushaho. Iyo irangi ry'ubururu rishyizwe muri nyababyeyi mu buryo bugenzurwa n'abaganga, maze amazi akagaragara asohoka anyuze mu muyoboro, uwo muyoboro uba ufunguye muri ako kanya. Iyo nta mazi agaragara anyuramo, igisubizo ntikiba cyizewe nk'uko gisa. Igereranya ryakozwe mu 2021 ku buryo bubiri bwo gukoresha iri suzuma ry'irangi rigaragaza neza aho igisubizo cyizewe n'aho kitizewe.

Igitekerezo shingiro: isuzuma ry'uko amazi anyura, si uburyo bwo kuvura uburumbuke

Buri muyoboro w'intanga ngore ni inzira ifunganye iva muri nyababyeyi yerekeza ku gasabo k'intanga ngore. Chromopertubation isuzuma ikintu kimwe kuri iyo nzira: niba amazi ashobora kuyinyuramo. Methylene blue ni cyo kimenyetso gituma bigaragara ko amazi anyura, kuko ibara ryayo ryijimye rigaragara neza ku nyama zifite ibara ryoroheje.

Uburyo bwo gutangira ni bumwe aho iri suzuma rikorerwa hose. Irangi ryinjizwa rinyuze mu nkondo y'umura rikagera mu mwanya w'imbere muri nyababyeyi, maze umuganga akareba ibikurikiraho. Iyo irangi risohoka ku mpera ya kure y'umuyoboro, bivuga ko ufunguye. Iyo irangi ryireka maze rigasubira inyuma, bivuga ko umuyoboro usa n'ufunze. Igisubizo kigarukira ku kunyura kw'amazi, mu cyerekezo kimwe, ku munsi umwe.

Ubu ni uburyo bwo gusuzuma bukorwa n'umuganga. Ubukorerwa mu cyumba cy'isuzuma bukorwa mu gihe cya hysteroscopy, aho igikoresho kininiye gikoreshwa mu kureba imbere muri nyababyeyi. Ubukorerwa mu cyumba cy'ibagiro bukorwa mu gihe cya laparoscopy, aho igikoresho gikoreshwa mu kureba inyuma y'imiyoboro no mu nda yo hasi, akenshi umurwayi yasinzirijwe burundu. Nta na bumwe umuntu yikorera, kandi nta na bumwe butanga umuti ugamije guhindura uburumbuke. Irangi ni ikimenyetso gikurikiranwa uko kinyura kigakomeza. Ibisobanuro by'uko methylene blue ikora nk'irangi bifasha kubyumva, naho ikibazo gitandukanye cy'uko wasoma ubushakashatsi kuri methylene blue gisobanura impamvu ingaruka ibonetse muri laboratwari itigera iba kimwe n'uburyo bwo kuvura umurwayi.

Kuba ufunguye ntibivuga ko umuyoboro umeze neza

Kuba umuyoboro ufunguye ni ikintu kimwe, naho imikorere yawo ni ikindi kintu kiragutse kurushaho. Umuyoboro ushobora kuba ufunguye ariko ntukore umurimo wawo: ubwandu cyangwa endometriose bishobora kwangiza utwoya duto twimura intanga ngore, nyamara inzira igakomeza kuba yagutse bihagije kugira ngo irangi rinyuremo. Inyama z'inkovu ziri hanze y'umuyoboro na zo zishobora gutuma agasabo k'intanga ngore kaguma kure, bityo intanga ngore ntijye mu muyoboro nubwo irangi risohoka nta nkomyi. Ahantu hafunganye igice hashobora gutambutsa umurongo muto w'irangi ariko hagafunga inzira y'intanga ngore irusha irangi ubunini.

Bityo igisubizo kigaragaza ko umuyoboro ufunguye gisubiza ikibazo gito ku buryo bwizewe mu rugero rushyize mu gaciro: amazi yanyuze mu muyoboro. Nticyemeza ko uruhu rutwikiriye imbere muri wo rumeze neza, ko ufata intanga ngore neza, cyangwa ko ibiwukikije mu nda yo hasi bimeze neza. Igisubizo kigaragaza ko ufunze cyo kirushaho kutizerwa, kuko impamvu z'igihe gito zishobora guhagarika amazi mu muyoboro ufunguye.

Icyo ubushakashatsi bwo mu 2021 bwagereranyije

Amakuru asobanutse kurusha ayandi agereranya ubu buryo bombi ava mu bushakashatsi bw'igerageza bwo mu 2021 bwakorewe ku bagore 80 bafite ikibazo cyo kutabyara muri AIIMS New Delhi, kandi uburyo bwakoreshejwe n'ibisubizo byose biboneka mu nyandiko ifunguye kuri bose. Buri witabiriye yari asanzwe ateganyirijwe hysteroscopy na laparoscopy. Abagore bari baramaze kwemezwa ko bafite umuyoboro ufunze, abazwiho kugira hydrosalpinx, cyangwa abafite ubwandu bukaze mu nda yo hasi ntibashyizwe muri ubwo bushakashatsi.

Buri mugore yakorewe amasuzuma abiri y'irangi akurikiranye. Habanje hysteroscopy mu cyumba cy'isuzuma, nta kinya: hinjijwe irangi ryavanzwe n'amazi, maze bareba kuri buri mwenge w'umuyoboro niba hari amazi agaragara anyuramo ndetse niba ibara ry'ubururu rishira mu mwanya w'imbere muri nyababyeyi. Hakurikiyeho minilaparoscopy umurwayi yasinzirijwe burundu, ari yo yafashwe nk'isuzuma fatizo ryo kugereranyaho: irangi ryanyujijwe mu gati kinjijwe muri nyababyeyi, maze buri muyoboro usuzumwa hashingiwe ku irangi rigaragara risohoka rijya mu nda yo hasi. Imiyoboro yombi yabazwe ukwawo, bitanga ibyarebwe 160.

Isuzuma fatizo ryasanze imiyoboro 136 muri 160 ifunguye (85 ku ijana). Isuzuma ryo mu cyumba cy'isuzuma ryagaragaje ko 125 ifunguye (78 ku ijana). Ibisubizo byahuriraga ku byinshi, ariko ntibyari kimwe ku gufunguka no ku gufunga: imiyoboro 119 yagaragaye ko ifunguye muri yombi, 18 igaragara ko ifunze muri yombi, 17 yagaragaye ko ifunze mu cyumba cy'isuzuma ariko ikagaragara ko ifunguye kuri laparoscopy, naho 6 igaragara ko ifunguye mu cyumba cy'isuzuma ariko ifunze kuri laparoscopy. Ugereranyije na laparoscopy nk'isuzuma fatizo, isuzuma ryo mu cyumba cy'isuzuma ryagaragaje ubushobozi bwa 87.5 ku ijana bwo kumenya imiyoboro ifunguye, ubushobozi bwa 75 ku ijana bwo kumenya imiyoboro ifunze, agaciro ka 95.2 ku ijana ko kwemeza igisubizo kivuga ko umuyoboro ufunguye, agaciro ka 51.4 ku ijana ko kwemeza igisubizo kivuga ko ufunze, n'ukuri kw'ibisubizo muri rusange kwa 85.6 ku ijana.

Soma iyo mibare nk'umusomyi, atari nk'impuguke mu ibarurishamibare. Igisubizo cyo mu cyumba cy'isuzuma kivuga ko umuyoboro ufunguye akenshi cyabaga ari cyo. Igisubizo kivuga ko ufunze cyari hafi y'amahirwe yo gutera igiceri: hafi kimwe cya kabiri gusa cy'ibisubizo byo mu cyumba cy'isuzuma byagaragazaga umuyoboro ufunze ni byo byemejwe kuri laparoscopy. Iryo tandukaniro ni ryo jambo rimwe rifite akamaro kanini mu bikorwa rivuye muri iyi nyandiko.

Impamvu igisubizo kigaragaza ko umuyoboro usa n'ufunze kitizewe cyane

Impamvu isanzwe kurusha izindi ni ukwikanya kw'imikaya. Inguni ya nyababyeyi aho umuyoboro utangirira ishobora kwikanya igihe gito, igakanda inzira yari ifunguye ikayifunga. Inyandiko ivuga ko amazi akonje n'ububabare buterwa no kwikanya bishobora kubitera. Ukwikanya kurashira, ariko igisubizo cyafashwe kukiriho gisa neza n'icy'umuzibiro nyakuri. Ni yo mpamvu igisubizo kimwe kigaragaza umuzibiro ku gice cy'umuyoboro cyegereye nyababyeyi, mu isuzuma rimwe iryo ari ryo ryose, gifatwa kigikeneye kwemezwa.

Uburyo bwo gukora isuzuma na bwo bushobora gutera amakosa. Kwinjiza irangi vuba bituma risubira inyuma bigasa n'aho umuyoboro ufunze, kandi kurebera ahantu hadakwiriye bishobora gutuma irangi risohoka ari rito ritagaragara. Muri ubu bushakashatsi, umuganga umwe ubaga kandi ufite ubunararibonye ni we wakoze amasuzuma yose, bityo itandukaniro mu bikorwa bisanzwe rishobora kuba rinini kurushaho.

Ingaruka ku byemezo by'abaganga irasobanutse. Umuyoboro usa n'ufunze mu isuzuma ry'irangi ryo mu cyumba cy'isuzuma ni impamvu yo kubyemeza, si umwanzuro w'indwara ugomba gushingirwaho wonyine. Kwemeza akenshi bisaba isuzuma fatizo rya laparoscopy cyangwa irindi suzuma ry'imiyoboro ryatoranyijwe n'itsinda ryita ku burumbuke, ibisubizo bigasobanurwa hamwe n'amateka y'ubuzima, ibyago by'ubwandu, n'amashusho y'isuzuma. Isuzuma ry'imiyoboro y'intanga ngore rikoresha methylene blue ryemeza ko umuyoboro ufunguye ku buryo bukomeye kurusha uko ryemeza ko udafunguye.

Ibyo kunyura kw'irangi bidashobora kugaragaza

Chromopertubation ipima kunyura kw'amazi. Hari ibibazo byinshi bifite akamaro ku burumbuke iri suzuma ritabona. Inyama z'inkovu zifatanya ibice bikikije umuyoboro ntizigaragara kuri hysteroscopy, ibona gusa umwanya w'imbere muri nyababyeyi n'imyenge y'imiyoboro. Laparoscopy izibona ku buryo butaziguye; muri ubu bushakashatsi, abagore 4 muri 80 basanganywe izo nyama zifatanya ibice kuri icyo cyiciro gusa, kandi ubushakashatsi bwabanje bugaragaza ko zongera amahirwe y'uko kunyura kw'irangi gutanga igisubizo gihumuriza kandi kitari cyo.

Hydrosalpinx, umuyoboro wabyimbye kubera amazi aterwa n'umuzibiro ku mpera yawo ya kure, ni ikindi kibazo isuzuma rishobora kutabona: abari bazwiho kuyigira ntibashyizwe mu bushakashatsi, nyamara hydrosalpinx yari itaramenyekana yagaragaye kuri laparoscopy mu bagore 7 muri 80. Endometriose, kwangirika kw'uruhu rutwikiriye imbere mu muyoboro, no kutabasha gufata intanga ngore neza na byo byuzuza uru rutonde. Ni yo mpamvu amabwiriza agenga isuzuma ry'uburumbuke asobanura chromopertubation nk'igikorwa gikorerwa igihe laparoscopy isanzwe ikenewe kubera izindi mpamvu, nk'uko bigaragara mu gitekerezo cya komite ya ASRM ku isuzuma ryo kutabyara. Amakuru yagutse ku mutekano wo gukoresha methylene blue agira akamaro igihe hagenzurwa niba isuzuma iryo ari ryo ryose risaba kubaga rikwiye gukorwa.

Uko itandukanye n'andi masuzuma y'imiyoboro

Hysterosalpingography (HSG) inyujiza mu nkondo y'umura ikinyabutabire kigaragara ku mashusho ya radiyo, maze igakoresha ayo mashusho kugira ngo igaragaze imiterere y'umwanya w'imbere muri nyababyeyi n'imiyoboro. Yerekana irangi risohoka nk'uko chromopertubation ibikora, ariko yo ikoresha imirasire, ntishobora gusuzuma ibice byo mu nda yo hasi biri hanze ya nyababyeyi n'imiyoboro, kandi na yo ishobora guhura n'ikibazo cyo kwikanya ku nguni ya nyababyeyi.

Isuzuma rya ecographie rikoresha amazi y'umunyu rishyira ayo mazi atarimo mikorobe mu mwanya w'imbere muri nyababyeyi, mu gihe igikoresho cyo mu gitsina gifata amashusho yawo. Amashusho akoresheje amazi y'umunyu gusa asuzuma cyane cyane uwo mwanya: kubona amazi mu nda yo hasi byerekana ko nibura umuyoboro umwe ufunguye, ariko akenshi ntibishobora kugaragaza uwo ari wo. Ecographie ikoresha ifuro cyangwa utubumbe duto cyane tw'umwuka kugira ngo amashusho arusheho kugaragara ikurikirana buri muyoboro ukwawo, bityo ikaba ari yo yegereye cyane isuzuma ry'irangi.

Umutekano n'aho isuzuma rikorerwa mu magambo yoroshye

Mu bushakashatsi bwakorewe ku barwayi 80, abanditsi bavuze ko nta ngorane zikomeye cyangwa zoroheje zatewe na rimwe muri ayo masuzuma abiri y'irangi. Ibyo birahumuriza muri iryo gerageza rito, ariko ntibivuga ko nta byago na mba bihari: raporo z'abarwayi nyuma ya chromopertubation zivuga ku ngaruka zidasanzwe ziterwa n'umubiri wakira nabi cyane ikinyabutabire, methemoglobinemia, irangi ryinjira mu miyoboro y'amaraso, n'ingorane zo mu bihaha, ariko urugero ibyo bibaho ntirupimwe neza.

Hari ingingo ebyiri zikurikira. Uburyo bwa laparoscopy bwongeraho ibyago bisanzwe byo kubagwa no guterwa ikinya, ari yo mpamvu bukorerwa gusa abo gusuzumwa mu gihe cyo kubagwa bisanzwe biteganyijwe. Kandi nta na kimwe muri ibi gikoreshwa mu rugo: ubukana bw'irangi, kutabamo mikorobe, aho rishyirwa, no kwitegura ubutabazi bwihutirwa byose bireba itsinda ry'abaganga.

Bityo, incamake iboneye igomba kugira imbibi. Chromopertubation ikoresheje methylene blue igaragaza niba amazi anyura mu muyoboro igihe bareba, kandi igisubizo kivuga ko ufunguye kirizewe cyane kurusha ikivuga ko ufunze. Nt ipima imikorere y'umuyoboro, ntibona impamvu zose zo kutabyara ziri mu nda yo hasi, kandi nta kintu na kimwe ivura. Umuntu wese usabwe iri suzuma akwiye kubaza ibibazo bitatu: riteganyijwe gukorerwa he kandi kuki, bizagenda bite niba igisubizo kigaragaza ko umuyoboro ufunze, kandi ni ibihe bindi byabonetse byahindura gahunda.