Inyandiko
Ubururu bwa metilene ku bubabare nyuma yo kubaga hemoroyide: icyo igerageza rigaragaza
Umuganga ubaga arasaba ko hemoroyide zikurwaho. Umurwayi yumva ijambo rimwe gusa: ububabare. Ikibazo gihita gikurikiraho. Ese hari umuti ushyirwa ahabagwa mu gihe cyo kubaga watuma icyumweru cya mbere cyoroha? Amagerageza atatu agabanya abarwayi mu matsinda ku buryo bwa tombola asuzuma umuti umwe ushobora gukoreshwa: ubururu bwa metilene buterwa mu ruhu rukikije umwenge w'ikibuno mu gihe cyo kubaga. Buri gerageza rigaragaza ububabare buke mu minsi ya mbere iyo hakoreshejwe ubururu bwa metilene. Buri gerageza kandi rifite imbogamizi zigena aho uwo mwanzuro ushobora kugarukira.
Uru rupapuro rugereranya ayo magerageza atatu. Rwandikiwe ubwoko bubiri bw'abasomyi. Umurwayi ashobora kurukoresha ategura ibibazo azabaza itsinda rimubaga. Umwanditsi ashobora kurukoresha agenzura ibyo ubushakashatsi ku bubabare bwo mu gice kivurwa bwanditse koko, umunsi ku munsi.
Icyo aya magerageza asuzuma n'icyo adasuzuma
Buri gerageza ryakiriye abantu bakuru babagwaga hakoreshejwe uburyo bwa Milligan-Morgan bwo gukuraho hemoroyide, aho bazikata bakazikuraho bagasiga igikomere kidafunze. Muri buri gerageza, umuganga yateye ubururu bwa metilene hafi y'ahabagwaga mu gihe umurwayi yari yahawe ikinya. Ibyapimwe byari ububabare nyuma yo kubagwa, ikoreshwa ry'imiti y'inyongera igabanya ububabare, n'ingorane.
Nta na rimwe muri aya magerageza atatu ryasuzumye kuribwa kw'igihe kirekire ku mwenge w'ikibuno, kuvura ibisebe byasadutse ku mwenge w'ikibuno, cyangwa ibimenyetso bya hemoroyide zitabazwe. Ubushakashatsi ku kuribwa buvugwa gusa nk'amakuru afasha gusobanura uburyo umuti ukekwaho gukora, ari bwo kugabanya by'igihe gito ubushobozi bw'imyakura yo muri ako gace bwo kumva, ntabwo ari byo byageragejwe. Igerageza ryo mu 2024 ntiryakiriye abafite n'igisebe cyasadutse cyangwa fistula. Igerageza ryo mu 2026 ntiryakiriye abafite igisebe cyasadutse, fistula, ikibyimba kirimo amashyira, cyangwa indi ndwara y'amara. Niba ibipimo by'ububabare bikugora kubisobanukirwa, inyandiko ivuga uko wasoma igerageza ku bubabare isobanura VAS na NRS mbere yo kugereranya imibare. Kuribwa n'ibisebe byasadutse ni ibibazo bitandukanye; reba inyandiko ku bisebe byasadutse ku mwenge w'ikibuno n'ibibazo byo kuribwa kugira ngo umenye neza imbibi z'ibivugwa.
Uko amagerageza atatu yateguwe
Uburyo bwo gutanga umuti buratandukanye bihagije ku buryo butagomba gufatwa nk'aho ari bumwe. Ingano nini y'umuti ikubye inshuro icumi ntoya, kandi igihe utangirwa, igice cy'urwungano rw'umubiri uterwamo, n'itsinda ryo kugereranya byose biratandukanye. Kubaga ni bumwe mu buryo bwo kuvura hemoroyide; aya magerageza asuzuma gusa ububabare nyuma yo kubagwa.
| Igerageza | Abarwayi basesenguwe | Uburyo bwo gutanga ubururu bwa metilene | Itsinda ryo kugereranya n'ubuvuzi busanzwe |
|---|---|---|---|
| Sim na Tan 2014 | 67 (ubururu bwa metilene 37, itsinda ryo kugereranya 30), gukuraho hemoroyide hakoreshejwe ubushyuhe bw'amashanyarazi igikomere kigasigara kidafunze | 4 mL z'ubururu bwa metilene bwa 1 ku ijana (40 mg) zivanze na 16 mL za bupivacaine ya 0.5 ku ijana, baterwa mu ruhu rukikije umwenge w'ikibuno mbere yo gutangira gukata | Bupivacaine imwe, hiyongereyeho amazi y'umunyu aho kuba irangi ry'ubururu; paracetamol nk'umuti usanzwe hamwe na diclofenac byavuzwe mu makuru yakuwe mu nyandiko ku nshuro ya kabiri |
| Azhough 2024 | 97 (ubururu bwa metilene 48, itsinda ryo kugereranya 49), hemoroyide zo mu rwego rwa III cyangwa IV, itsinda rimwe ribaga, ikinya cyo mu ruti rw'umugongo | 5 mL z'ubururu bwa metilene bwa 1 ku ijana (50 mg), baterwa mu ruhu ahantu hatanu, 1 mL kuri buri hantu, nko kuri 2 cm uvuye ku nkombe y'ahaciwe, nyuma yo gukuraho hemoroyide | 5 mL za bupivacaine ya 0.5 ku ijana nyuma yo gukuraho hemoroyide; ketorolac ihabwa ku bihe byagenwe, tramadol nk'umuti w'inyongera, hanyuma naproxen hamwe na acetaminophen na codeine igihe cyo gusezererwa |
| Zhu 2026 | 60 (30 muri buri tsinda), hemoroyide zo imbere n'inyuma, umuganga umwe ubaga, ikinya cyo mu gice cyo hasi cy'umugongo | Ubururu bwavangiye bukagera kuri 0.1 ku ijana (1 mL ya 1 ku ijana hiyongereyeho 9 mL z'amazi y'umunyu), 0.5 kugeza kuri 1 mL kuri buri hantu haciwe, buterwa mu buryo bumeze nk'umufana hanyuma hagakandwa buhoro igihe gito, igiteranyo cya 5 mL cyangwa munsi yaho (5 mg cyangwa munsi yaho), nyuma yo gukuraho hemoroyide | Nta muti uterwa aho habazwe; lornoxicam 8 mg igihe umurwayi ayisabye, hakaba nibura amasaha 6 hagati y'ingano ebyiri zitanzwe |
Hari ibintu bibiri by'ingenzi mu mitegurire. Icya mbere, amagerageza yo mu 2014 no mu 2024 agereranya irangi na bupivacaine iterwa mu gice kivurwa, bityo itandukaniro ryose rikaba ingaruka irangi ryongera ku muti w'ikinya cyo muri ako gace; naho igerageza ryo mu 2026 rigereranya irangi no kudatera umuti muri ako gace. Icya kabiri, guhisha itsinda umuntu arimo ntibikora neza aho ibara ry'ubururu rigaragara. Abanditsi b'igerageza ryo mu 2026 bavuga ko guhinduka kw'ibara ry'inyama z'umubiri n'inkari byatumye guhisha ayo makuru neza bidashoboka, ibyo bigatuma amanota y'ububabare atangwa uko umurwayi abyumva ashobora kubogama.
Ububabare kuri buri munsi nyuma yo kubagwa
Icyo yose ahuriyeho ni itandukaniro mu minsi ya mbere, hanyuma ibisubizo bikagenda byegerana. Buri gerageza rikoresha igipimo gitandukanye, bityo soma buri rimwe ukurikije igipimo cyaryo. Uburyo rusange busobanurwa mu nyandiko yo kugabanya ububabare nyuma yo kubagwa, ivuga ku miti isanzwe igabanya ububabare n'uko imiti y'inyongera iteganywa.
Mu igerageza ryagabanyije abarwayi mu matsinda ku buryo bwa tombola, uruhande rumwe rutazi itsinda barimo, ku bururu bwa metilene buterwa mu ruhu nyuma yo gukuraho hemoroyide hakoreshejwe ubushyuhe bw'amashanyarazi igikomere kigasigara kidafunze, abarwayi bagiye bandika buri munsi ububabare bwabo bakoresheje igipimo kigaragazwa n'umurongo. Impuzandengo y'ububabare yari hasi ku buryo bufite akamaro mu mibare ku bahawe ubururu bwa metilene ku minsi ya 1 kugeza ku wa 3 nyuma yo kubagwa, kandi ikoreshwa rya paracetamol na ryo ryari rito muri icyo gihe; nyuma y'umunsi wa 3, nta nyungu ifite akamaro mu mibare yagaragaye. Amanota nyayo y'impuzandengo ntaboneka mu ncamake ishobora gusomwa, bityo iri sesengura ntirihimba imibare ya buri munsi.
Mu igerageza ku bururu bwa metilene buterwa mu ruhu nyuma yo gukuraho hemoroyide, aho abarwayi n'abasuzuma batazi itsinda barimo, abarwayi bandikaga buri munsi mbere yo kuryama ububabare bwinshi kurusha ubundi bumvise uwo munsi, bakoresheje igipimo cy'amanota 11, kuva kuri 0 kugeza kuri 10, mu minsi 14. Itandukaniro ryari rifite akamaro mu mibare ku minsi ya 1 kugeza ku wa 7, p iri munsi ya 0.001 buri munsi, ariko ntiryari rifite akamaro mu mibare ku minsi ya 8 kugeza ku wa 14:
- Umunsi wa 1: ubururu 4.08 wongeyeho cyangwa ukuyemo 1.23, itsinda ryo kugereranya 5.20 wongeyeho cyangwa ukuyemo 1.40.
- Umunsi wa 2: ubururu 3.94 wongeyeho cyangwa ukuyemo 1.17, itsinda ryo kugereranya 5.22 wongeyeho cyangwa ukuyemo 0.87.
- Umunsi wa 3: ubururu 3.90 wongeyeho cyangwa ukuyemo 1.10, itsinda ryo kugereranya 5.02 wongeyeho cyangwa ukuyemo 0.95.
- Umunsi wa 4: ubururu 3.71 wongeyeho cyangwa ukuyemo 1.25, itsinda ryo kugereranya 4.71 wongeyeho cyangwa ukuyemo 1.21.
- Umunsi wa 5: ubururu 3.60 wongeyeho cyangwa ukuyemo 1.27, itsinda ryo kugereranya 4.67 wongeyeho cyangwa ukuyemo 1.21.
- Umunsi wa 6: ubururu 3.46 wongeyeho cyangwa ukuyemo 1.27, itsinda ryo kugereranya 4.31 wongeyeho cyangwa ukuyemo 1.21.
- Umunsi wa 7: ubururu 3.35 wongeyeho cyangwa ukuyemo 1.27, itsinda ryo kugereranya 3.92 wongeyeho cyangwa ukuyemo 1.21.
- Iminsi ya 8 kugeza ku wa 14: mu matsinda yombi amanota aragabanuka akagera hafi ya 2.5 kugeza kuri 3.5, nta tandukaniro rifite akamaro mu mibare hagati y'amatsinda kuri buri munsi muri iyo minsi yakurikiyeho (p zose ziri hejuru ya 0.2).
Mu bushakashatsi bwo mu 2026 bwagabanyije abarwayi mu matsinda ku buryo bwa tombola ku bururu bwa metilene bwavangiye buterwa mu gice cyabazwe nyuma yo kubaga hakoreshejwe uburyo bwa Milligan-Morgan, ububabare igihe umuntu aruhutse, bwapimwe ku gipimo kigaragazwa n'umurongo kuva kuri 0 kugeza kuri 10, bwari buke ku bahawe ubururu bwa metilene nyuma y'amasaha 6, 24, 48, na 72, p iri munsi ya 0.001 kuri buri gihe cyapimwe. Impuzandengo nyayo igaragara gusa mu gishushanyo aho kuba mu mbonerahamwe y'imibare, bityo iri sesengura rivuga uko ibisubizo byagenze ritabanje guhindura uburebure bw'imirongo yo ku gishushanyo mu mibare isa n'aho ari nyayo kandi atari yo.
Imiti y'inyongera igabanya ububabare
Mu gutanga amakuru ku ikoreshwa ry'imiti y'inyongera ni ho amagerageza atandukaniye mu buryo amakuru atangwa neza.
Igerageza ryo mu 2014 rigaragaza ko ikoreshwa rya paracetamol ryari rito ku buryo bufite akamaro mu mibare ku bahawe ubururu bwa metilene mu minsi ya 1 kugeza ku wa 3, bihuye n'igihe ububabare bwagabanutse, ariko incamake ishobora gusomwa ntitanga ingano yakoreshejwe, imigabane y'abarwayi bayikoresheje, cyangwa agaciro nyako ka p.
Igerageza ryo mu 2024 ryateganyije ketorolac ku bihe byagenwe, tramadol nk'umuti w'inyongera, no kwandika ibinini byafashwe mu rugo, ariko ibisubizo byasohotse ntibigaragaza ingano yakoreshejwe muri buri tsinda. Kubura ayo makuru ubwabyo ni ikintu kigaragara: ibimenyetso byo kugabanuka k'ububabare bishingiye gusa ku manota y'ububabare.
Igerageza ryo mu 2026 ni ryo ritanga amakuru asobanutse kurusha ayandi kuri iyi ngingo. Impuzandengo y'igiteranyo cya lornoxicam mu masaha 72 yari 22.67 wongeyeho cyangwa ukuyemo 17.01 mg ku bahawe ubururu bwa metilene, ugereranyije na 56.80 wongeyeho cyangwa ukuyemo 9.32 mg mu itsinda ritigeze riterwa umuti, p iri munsi ya 0.001. Zirikana ko amatsinda atafashwe kimwe: itsinda ryo kugereranya ryahabwaga umuti ugabanya ububabare gusa iyo riwusabye, mu gihe itsinda ryahawe irangi ryakorewe igikorwa kimwe mu gihe cyo kubaga.
Ingorane no gukurikirana abarwayi
Nta gerageza rigaragaza ikimenyetso gikomeye cy'ikibazo cy'umutekano aho umuti watewe, ariko nta na rimwe ryateguwe kugira ngo ribone ingaruka mbi zidakunze kubaho cyangwa zigaragara nyuma y'igihe kirekire. Kugira ngo ubone amakuru ajyanye n'ibibazo bishobora kubaho, reba amakuru ku mutekano w'ubururu bwa metilene hamwe n'imbonerahamwe z'ingorane ziri hasi.
Incamake yo mu 2014 igaragaza igisubizo kimwe kigaragara cyane: ikigereranyo cy'ibyago byo kubura ubushobozi bwo kwihagarika mu buryo butunguranye igihe ubururu bwa metilene butakoreshejwe cyari 2.32, n'intera y'icyizere ya 95 ku ijana kuva kuri 1.75 kugeza kuri 3.07. Inshuro izindi ngorane zabayeho ntizatandukanye ku buryo bufite akamaro mu mibare.
Igerageza ryo mu 2024 ritanga amakuru y'ingorane ku minsi 14. Kubura ubushobozi bwo kwihagarika byabaye kuri 5 muri 48 bahawe ubururu no kuri 5 muri 49 bo mu itsinda ryo kugereranya. Kubura ubushobozi bwo kwifata by'igihe gito byabaye kuri 3 ugereranyije na 1, naho kuva amaraso kwaje nyuma kuba kuri 0 ugereranyije na 2. Gupfa kw'uruhu, kwandura, uruhu kugira icyo rurwanaho aho umuti watewe, no kugabanuka k'umwenge ntibyabaye ku muntu n'umwe mu matsinda yombi, naho kuribwa kwabaye rimwe muri buri tsinda. Nta tandukaniro na rimwe ryageze ku rugero rufite akamaro mu mibare.
Igerageza ryo mu 2026 ritanga amakuru y'amasaha 72 gusa. Kwandura k'uruhu n'inyama ziri munsi yarwo bikikije umwenge w'ikibuno, gupfa kw'uruhu, no kwipfundika kw'amaraso mu mitsi ikikije umwenge w'ikibuno ntibyabaye ku muntu n'umwe mu matsinda yombi. Ntirutanga imibare yakusanyijwe mu buryo buhoraho ku kubura ubushobozi bwo kwihagarika, kuva amaraso, kwandura, kubura ubushobozi bwo kwifata, gutinda gukira, cyangwa kongera kurwara. Guhinduka ubururu kw'inyama z'umubiri n'inkari byemezwa nk'ikibazo cyo guhisha itsinda umurwayi arimo, aho kubarwa nk'ibyabaye mu mbonerahamwe.
Uburebure bw'igihe cyo gukurikirana abarwayi ni bwo mbogamizi nyamukuru muri ayo magerageza atatu yose: hafi iminsi 14 mu magerageza abiri ya mbere n'amasaha 72 mu rya gatatu. Gutinda gukira, ubushobozi bwo kwifata mu gihe cy'amezi, no kongera kugira hemoroyide ntibishobora gusuzumwa hashingiwe kuri aya makuru.
Imbonerahamwe y'ibimenyetso kuri buri munsi nyuma yo kubagwa
Imbonerahamwe ikurikira ikubiyemo amakuru y'ingenzi y'uru rupapuro ahurijwe hamwe. Igaragaza ububabare, ikoreshwa ry'imiti y'inyongera, amatsinda yo kugereranya, ingorane, n'igihe cyo gukurikirana abarwayi ahantu hamwe.
| Igerageza | Ibimenyetso by'ububabare kuri buri munsi | Imiti y'inyongera igabanya ububabare | Itandukaniro n'itsinda ryo kugereranya | Ingorane | Gukurikirana abarwayi |
|---|---|---|---|---|---|
| Sim na Tan 2014, n ingana na 67 | VAS yari hasi ku bahawe ubururu ku minsi ya 1 kugeza ku wa 3; nta tandukaniro rifite akamaro mu mibare nyuma y'umunsi wa 3; impuzandengo nyayo ntiri mu ncamake ishobora gusomwa | Paracetamol yakoreshejwe gake ku bahawe ubururu ku minsi ya 1 kugeza ku wa 3; ingano ntizatanzwe | Ubururu hamwe na bupivacaine ugereranyije na bupivacaine hamwe n'amazi y'umunyu; bitandukanya ingaruka irangi ryiyongeraho | Ikigereranyo cy'ibyago byo kubura ubushobozi bwo kwihagarika cya 2.32 nta bururu bwakoreshejwe; ibindi byabaye ntibyagize itandukaniro rifite akamaro mu mibare | Kwandika ububabare buri munsi mu gihe cy'iminsi igera kuri 14 |
| Azhough 2024, n ingana na 97 | NRS y'ububabare bwinshi bw'umunsi yari hasi ku bahawe ubururu ku minsi ya 1 kugeza ku wa 7 (itandukaniro rya hafi amanota 1.1 mu ntangiriro, 0.6 ku munsi wa 7); nta tandukaniro ku minsi ya 8 kugeza ku wa 14 | Byateganyijwe mu buryo bwo gukora ubushakashatsi ariko ikoreshwa muri buri tsinda ntiryatangajwe | Ubururu 50 mg ugereranyije na bupivacaine; bitandukanya ingaruka irangi ryiyongeraho | Kubura ubushobozi bwo kwihagarika 5 ugereranyije na 5; kubura ubushobozi bwo kwifata by'igihe gito 3 ugereranyije na 1; kuva amaraso 0 ugereranyije na 2; gupfa kw'uruhu no kwandura 0 ugereranyije na 0; nta na kimwe gifite itandukaniro rifite akamaro mu mibare | Iminsi 14 |
| Zhu 2026, n ingana na 60 | VAS igihe umuntu aruhutse yari hasi ku bahawe ubururu ku masaha 6, 24, 48, 72, p iri munsi ya 0.001 kuri buri gihe; impuzandengo iri mu gishushanyo gusa | Igiteranyo cya lornoxicam 22.67 ugereranyije na 56.80 mg, p iri munsi ya 0.001 | Ubururu bwavangiye 5 mg cyangwa munsi yaho ugereranyije no kudaterwa umuti; itandukaniro rinini kurusha ayandi mu mitegurire | Kwandura k'uruhu n'inyama ziri munsi yarwo, gupfa kw'uruhu, kwipfundika kw'amaraso mu mitsi 0 ugereranyije na 0; kubura ubushobozi bwo kwihagarika, kuva amaraso, gukira, no kongera kurwara ntibyatangajwe mu buryo buhoraho | Amasaha 72 |
Icyo ibi bivuze mu kugisha inama umuganga ubaga
Amagerageza atatu mato, buri rimwe ryakorewe ku kigo kimwe, yakoresheje ingano eshatu zitandukanye z'irangi zigereranywa n'uburyo bubiri butandukanye bwo kuvura amatsinda yo kugereranya, ahuriza ku kuba ububabare buba buke mu minsi ya mbere nyuma yo gukuraho hemoroyide iyo ubururu bwa metilene bwongewe mu gihe cyo kubaga. Ikimenyetso cyo kugabanuka k'ububabare kimara igihe kirekire kurusha ibindi kigera ku minsi 7. Amakuru y'imiti y'inyongera ashyigikira ibyo bisubizo mu magerageza abiri, ariko ntaboneka mu rya gatatu. Igihe gito cyo gukurikirana abarwayi n'umubare muto w'abitabiriye ntibishobora gukuraho ko habaho ingaruka zidakunze kubaho cyangwa zigaragara nyuma y'igihe kirekire.
Ibibazo bikwiye kubazwa umuganga ubaga:
- Ni ubuhe buryo bwo kubaga buteganyijwe, kandi ni ubuhe buryo bwo kuvura aho habagwa busanzwe bukoreshwa aho?
- Ese hari gutera irangi ry'ubururu mu gice kibagwa bitangwa, ku yihe ngano no mu kihe gice cy'urwungano rw'umubiri, kandi bigereranywa n'ubuhe buryo bundi?
- Ni iyihe miti isanzwe n'iy'inyongera igabanya ububabare iteganyijwe, kandi ikoreshwa ryayo ryandikwa rite?
- Kubura ubushobozi bwo kwihagarika, kuva amaraso, kwandura, n'ubushobozi bwo kwifata bikurikiranwa bite, kandi mu gihe cy'ibyumweru bingahe?
- Guhinduka ubururu by'igihe gito kw'uruhu cyangwa inkari bitegerejwe kumera bite, kandi iryo bara rishira ryari?
Ku banditsi basesengura ubushakashatsi ku bubabare bujyanye n'ibikorwa byo kuvura, urutonde rw'ibyo kugenzura ni rugufi: ubukana nyabwo bw'umuti, ubunini bw'amazi, n'igiteranyo cy'ingano y'umuti; igice cy'urwungano rw'umubiri uterwamo n'igihe utangirwa ugereranyije n'igihe cyo gukuraho igice kibagwa; umuti ukora uri mu rushinge rw'itsinda ryo kugereranya; imiti isanzwe igabanya ububabare itangwa ku bihe byagenwe ugereranyije n'itangwa iyo umurwayi ayisabye; igiteranyo cy'imiti y'inyongera muri buri tsinda; amanota y'ububabare atangazwa kuri buri munsi; n'imbonerahamwe y'ingorane igaragaza umubare wose w'abarwayi buri mubare ubarirwaho n'igihe cyo kubakurikirana. Hatabayeho ayo makuru, umwanzuro uhuriweho ku ngano y'umuti nta bimenyetso biwushyigikira, kuko irangi rya 50 mg riterwa mu ruhu rikagereranywa na bupivacaine, n'irangi rya 5 mg riterwa munsi y'uruhu rikagereranywa no kudatanga umuti, ari uburyo bubiri butandukanye bwo kuvura.