Bvunzo dzedhayi yemethylene blue dzekubuda kweweti nemikoto yefistula: zvinoratidzwa nedonje rekupima rine ruvara rwebhuruu

Masvondo mashoma mushure mekuvhiyiwa munzvimbo yemuhudyu, murwere anoona kuti weti iri kungoramba ichibuda isingadzoreki. Anofunga kuti ane utachiona mudundira, anopedza nguva yaakanzi atore mishonga inorwisa utachiona, uye anoshaya kuti sei kubuda kweweti kuchiramba kwakadaro. Mishonga iyi yaisazombobatsira, nokuti mafungiro echikonzero akanga asiri iwo. Utachiona hunoitika kana tupukanana twapinda munyama dzemuviri. Fistula igomba: mukoto usina kujairika unobatanidza nzvimbo mbiri dzinofanira kunge dzakaparadzana, apa dundira nemukati mesikarudzi yemukadzi. Hapana mushonga unorwisa utachiona unovhara gomba.

Aya ndiwo mamiriro akagadzirirwa bvunzo yedhayi yemethylene blue. Bvunzo iyi hairapi chinhu, haits­vagi utachiona, uye yoga haipi mhedziso yechirwere. Inopindura mubvunzo mumwe chete wakanyatsojeka: mvura iri mukati mesikarudzi yemukadzi iri kubva mudundira rakazadzwa nedhayi here? Zvose zvinoitwa pabvunzo iyi, kusanganisira nzira dzainogona kukanganisa nadzo, zvinobva pachinangwa chimwe chete ichocho. Tsananguro yedu yekushandiswa kwemethylene blue mukurapa inoisa basa iri rekuongorora pamwe chete nemabasa echinhu ichi akabvumirwa uye achiri kutsvakurudzwa.

Pfungwa huru: mvura yebhuruu inodzorwa sechiratidzo chekutevera nzira

Pfungwa yacho yakaitwa kuti ive nyore. Dundira rinozadzwa nekudzosera mvura nomuchubhu wecatheter, pachishandiswa mvura yekusukurudza isina utachiona ine methylene blue yakanyungudutswa kuti isanyanya kusimba. Mukati mesikarudzi yemukadzi hamufaniri kuva nemvura yebhuruu. Kana mvura yebhuruu ikazooneka imomo panzvimbo isina kujairika, pane nzira inobatanidza dundira kana urethra, chubhu inobudisa weti kunze kwemuviri, nemukati mesikarudzi yemukadzi. Dhayi chiratidzo chekutevera nzira, uye bvunzo iyi inzira yekutsvaga panobuda mvura.

Pane zvinhu zviviri zvinobva zvatevera. Chekutanga, bvunzo inogona kungowana kubuda kwemvura kunoitika mberi kwenzvimbo yakaiswa dhayi, tichitevera nzira inoyerera weti. Dhayi yebhuruu iri mudundira haigoni kumboratidza fistula inobatanidza ureter nemukati mesikarudzi yemukadzi, nokuti weti inobva muureter yakabatwa inosvika imomo isina kumbopinda mudundira. Chechipiri, mhedzisiro inoratidza kubuda kwemvura inoratidza nzvimbo yacho, asi haitauri nezvemamiriro enyama dzemuviri, kukura kwefistula, kana nzira yekuigadzirisa. Ndokusaka kuronga kuvhiya nemaitiro ekuongorora kuchigara kuchipfuura bvunzo yedhayi chete.

Bvunzo yemadonje matatu, nhanho nenhanho

Kuongorora kunotanga dhayi isati yashandiswa. Kuongorora nespeculum, mudziyo unovhura sikarudzi yemukadzi kuti mukati muonekwe, kunotsvaga weti isina ruvara inenge yaungana uye, kana richionekwa, buri refistula riri mukati mesikarudzi yemukadzi. Mirayiridzo yeEurope yezvirwere zvenzira dzeweti inokurudzira zvakasimba kutora nhoroondo yemurwere nekuongorora kwakanangana nefistula, uye hapana mhedzisiro yedhayi inokunda zvinonyatsoonekwa nemaziso.

Maitiro epamutemo ebvunzo yemadonje matatu, sezvaanotsanangurwa mumushumo wemazwi eICS/IUGA, anoitwa seizvi. Madonje matatu akaoma echipanji ekuongorora anoiswa mukati mesikarudzi yemukadzi achitevedzana: rimwe kumusoro, rimwe pakati, rimwe pasi. Dzimwe nzira dzinoshandisa gauze yakapetwa, mabhora edonje, kana tampon, asi madonje matatu akaparadzana ndiwo maitiro akaiswa sechiyero. Dundira rinobva razadzwa nomucatheter nemvura yekusukurudza ine dhayi yebhuruu isina kunyanya kusimba, uye nyanzvi yezveutano inotarisa kana mvura yebhuruu ichibuda paburi riri mukati mesikarudzi yemukadzi panguva yekuzadza. Kuisa madonje usati wazadza kwakakosha: kuisa tampon mushure mekunge dhayi yadirana pedyo nemusuwo wesikarudzi kunoita kuti itosvibiswe nedhayi uye mhedzisiro ishaye zvainoreva.

Hapana huwandu humwe chete, kusimba kumwe chete kwedhayi, kana nguva imwe chete yekuisiya irimo inoshandiswa kwose kwose, uye chinyorwa chinotendeseka chinofanira kutaura izvi. Bhuku reFIGO rekudzidzisa kuvhiya fistula rinotsanangura kushandisa 60 kusvika 100 mL yedhayi yakasanganiswa nemvura, zvichiteverwa nekuongorora pakarepo; kana pasina chinoonekwa, murwere anofamba uye anonwa kwemaminitsi 30 kusvika 60 dhayi ichiri mudundira. Imwe nzira inoshandiswa mushure mekuvhiyiwa yakashandisa 250 kusvika 300 mL uye yakanyatoyambira kuti kusazadza zvakakwana kunogona kupa mhedzisiro yokuti hapana fistula kunyange iripo kana iri diki. Tsananguro yeICS/IUGA inoti madonje anobviswa mushure memaminitsi 10, asi inobvumira kusvika pamaminitsi 30 kana mukoto uri mudiki zvikuru kana wakamonereka. Murayiridzo une hwaro ndewekuzadza zvakakwana nemvura ine dhayi isina kunyanya kusimba maererano nemaitiro enzvimbo yacho, kwete kurayira musanganiswa mumwe chete unofanira kushandiswa kwose kwose.

Kududzira madonje ekupima

Donje rimwe nerimwe rinobviswa roga, uye kunyorwa kuti rakanyorova here uye rine ruvara rwupi. Kududzira kwakajairika, kuchitevera tsananguro dzeICS/IUGA:

Mutsara wechipiri ndiwo une ngozi zvikuru. Ruvara rwebhuruu padonje repasi chete ndirwo runonyanya kuoneka zviri nyore pasina kana fistula, nokuda kwekubuda kweweti kwakajairika muurethra kana mvura yebhuruu inodzokera ichibva paburi rayo. Donje repasi rine ruvara rwebhuruu roga harimbopedzi kuongorora.

Bvunzo yemadhayi maviri: kusiyanisa dundira neureter

Kana weti ikaramba ichionekwa mukati mesikarudzi yemukadzi asi dhayi yemudundira isingaoneki mairi, fungidziro inoenda kunzvimbo dziri pamusoro pedundira, kuureter. Bvunzo yemadhayi maviri inoita kuti nzvimbo mbiri idzi dzinosiyanisika neruvara. Murwere anonwa phenazopyridine kusvikira weti yaita ruvara rweorenji rwakajeka (tsananguro yepamutemo inoshandisa 200 mg katatu pazuva kwezuva rimwe kusvika maviri, kunyange zvazvo dzimwe nzira dzemumakiriniki dzichishandisa kutora mushonga kamwe chete), uye dundira rinobva razadzwa nemvura yekusukurudza yebhuruu sezvakamboitwa.

Pfungwa yacho iri pakutevera nzira inofambwa nemvura. Ruvara rwebhuruu mukati mesikarudzi yemukadzi runoreva kuti mvura yabva mudundira kana muurethra. Ruvara rweorenji rusina bhuruu runoreva kuti mvura yasvika ichibva mumaureter ari pamusoro pedundira. Mavara ose ari maviri anoratidza kuti panogona kuva nemikoto inobatanidza munzvimbo dzose dziri mbiri. Weti isina ruvara iri kumusoro kwemukati mesikarudzi yemukadzi kunyange dundira riine dhayi yebhuruu inonongedzerawo kunzvimbo dziri pamusoro pedundira, sezvinoita ruvara rweorenji. Aya maitiro ekuongorora anotungamirirwa nenyanzvi yezveutano, kwete chiedzo chekuitira kumba.

Cystoscopy nekamuri rekuvhiyira

Bvunzo yedhayi inoshandawo kana ichiongororwa kubva kune rumwe rutivi. Pakuvhiya munzvimbo yemuhudyu, dundira rinogona kuzadzwa nekudzosera mvura yekusukurudza ine ruvara rwebhuruu uku nzvimbo iri kuvhiyiwa ichitariswa; mvura yebhuruu inokwira ichipinda munzvimbo iyi inoratidza buri mudundira, uye nzira iyi inogona kudzokororwa mushure mekugadzirisa kuti kuonekwe kana pakavharwa pachiita sepasingapindi mvura. Imwe nzira yakashumwa yakashandisa kusvika ku600 mL nokuda kwechinangwa ichi, izvo zvinofanira kunzwisiswa semushumo wekuvhiya, kwete sechiyero chinofanira kupihwa dundira rimwe nerimwe.

Cystoscopy, kuongorora mukati medundira nemudziyo wekuona, inotsanangura zvisingaratidzwi nemadonje: huwandu, kukura, nenzvimbo yemaburi edundira uye kuti ari papi kana zvichienzaniswa netrigone nemaburi emaureter. Mirayiridzo yeEurope inokurudzira cystoscopy pamwe nekuzadza dundira nemvura ine ruvara ichidzoserwa mariri kuti fistula isimbiswe, ichicherechedzawo kuti humbowo huripo hushoma. Imwe nzira ine ukama neiyi asi yakasiyana nayo inoongorora kana maureter akavhurika panguva yecystoscopy, nokutarisa kuyerera kwedhayi ichibuda mumaburi emaureter. Pano chiratidzo chinofanira kusvika chichibva pamusoro, kuburikidza neropa kana weti, nokuti dhayi inoiswa mukati medundira yatove mberi kwemaureter munzira yekuyerera kweweti uye haigoni kuaongorora. Kuvhiringidza nzira mbiri idzi dzedhayi ndiyo chaiyo mhando yekukanganisa kunzwisisa iyo tafura yemadonje yakagadzirirwa kudzivirira. Tsananguro dzakadzama dzenzira idzi dzekuvhiya dziri mugwaro redu rinoperekedza iri pamusoro pemethylene blue pakuvhiya nekuongorora.

Nei bvunzo ichikanganisa kumativi ose

Mhedzisiro isingaratidzi fistula kunyange iripo ine zvikonzero zvishoma zvinowanzoitika: kuzadza dundira zvishoma, mukoto mudiki zvikuru kana wakamonereka waida nguva inopfuura maminitsi gumi, kubuda kweweti kunoitika pano neapo kana kunoenderana nekumira kwemuviri, fistula yeureter nemukati mesikarudzi yemukadzi isingambosvikwi nedhayi yemudundira, kana fistula yechipiri yakavanzika neyekutanga yawanikwa. Mune imwe ongororo yezvinyorwa zvekare yevarwere 56 vaiva nefistula mushure mekuvhiyiwa, 10 pabvunzo 13 dzedhayi dzakaitwa vasati vatumirwa kune dzimwe nyanzvi dzakaratidza fistula. Nhamba iyoyo ye10 pa13 dzimwe nguva inotaurwa sokunge ndiyo chiyero chekugona kwebvunzo kuona fistula iripo. Haisi iyo: boka revarwere rakanga rakasarudzwa zvikuru uye ongororo yacho haina kumbogadzirirwa kuyera kunyatsoshanda kwebvunzo pakuziva chirwere. Ongororo yavarwere mushure mekuvhiyiwa ya2020 inotsigira bvunzo yedhayi senzira inokurumidza yekutanga kuongorora, kwete senhamba yakayerwa yekugona kwayo kuona fistula iripo.

Mhedzisiro inoratidza fistula iyo isipo uye mhedzisiro inotsausa zvinonyanya kubva pakusvibiswa nedhayi: dhayi yadirana pakuisa tampon, weti inofamba ichitevedza zvinhu zvakaiswa mukati, kuita weti panguva yebvunzo, kana kusadzora weti kwakajairika kunoitika pakuwedzera kwesimba padundira kana pakuda kuita weti nechimbichimbi kuchipa donje repasi ruvara. Hapana pane izvi chinoratidza fistula, ndokusaka kunyatsoona panguva yekuzadza uye kutarisa paburi reurethra kuti mvura iri kudzokera here zviri chikamu chemaitiro acho, kwete zvimwe zvingangosiiwa.

Bvunzo yedhayi inoratidza kubuda kwemvura haisi mhedzisiro yeutachiona hwenzira dzeweti, uye zvinopesana nazvo ndizvozvo

Utachiona hwenzira dzeweti hahugadziri mukoto pakati pedundira nemukati mesikarudzi yemukadzi, saka utachiona hwoga hahumbokwanisi kuita kuti mvura yebhuruu inobva mudundira rakazadzwa nenzira inodzorwa ibude kunze kweburi reurethra. Mamiriro maviri aya ane zviratidzo zvinofanana uye anogona kuvapo pamwe chete, ndicho chaicho chikonzero chinoita kuti avhiringidzwe. Kuda kuita weti nechimbichimbi uye kusadzora weti kunokonzerwa nechido ichi nokuda kweutachiona kunobudisa weti nomuurethra yakajairika; weti inobuda nefistula inoipfuura neimwe nzira. Kuongorora weti uye kurera tupukanana twemuweti murabhoritari zvichiri kukosha kana utachiona huchifungidzirwa, uye kuyera creatinine mumvura yatorwa mukati mesikarudzi yemukadzi kunogona kusimbisa kuti mvura yacho iweti, kunyange zvazvo izvi zvoga zvisingagoni kuratidza panobuda weti. Cherechedzawo chimwe chinogona kuvhiringidza mhedzisiro: mimwe mishonga yakasanganiswa yenzira dzeweti ine methylene blue inochinja ruvara rweweti pachayo, saka zvakakodzera kuudza nyanzvi yezveutano nezvayo ongororo ipi neipi inoshandisa dhayi isati yaitwa.

Zvinofanira kuramba zvichiitwa mushure memadonje ekupima

Bvunzo yedhayi inotanga kuongorora; haiipedzi. Kuongorora nzvimbo yemuhudyu kunotarisa mamiriro enyama dzemuviri, mavanga, nenzvimbo yefistula. Cystoscopy neurethroscopy zvinoratidza maburi ari mukati kusati kwaitwa kugadzirisa kupi zvako. Kana pachifungidzirwa kuti weti iri kubva muureter kana chimiro chenhengo chisina kujeka, CT inoshandisa chinhu chinobatsira kuti mifananidzo ive yakajeka, ichitorwa pachikamu chekupedzisira chekubudiswa kwacho muweti, kana MRI inoratidza nzira dzepamusoro dzeweti; retrograde pyelography, kuongorora nemifananidzo pachidzoserwa chinhu chinooneka pamifananidzo muureter, inogona kutsanangura ureter isina kujeka zvakananga. Pane ongororo dzakaenzanisa neultrasound: mune imwe ongororo diki yekuti nzira yacho ingashanda here pavarwere gumi nevaviri, color Doppler yakavandudzwa nechinhu chinobatsira kujekesa mifananidzo yakaronga zvakarurama 11 panyaya 12, asi mhedzisiro iyoyo ndeyenzira yeultrasound, kwete yebvunzo yedhayi (Volkmer nevamwe, 2000).

Bvunzo yedhayi inodzokororwawo mushure mekurapwa. Kurudziro dzeFIGO dzemaitiro akanaka dzinoti bvunzo yedhayi iitwe mazuva 10 kusvika 14 mushure mekugadzirisa fistula, catheter isati yabviswa, murwere achikosora achitariswa (Browning nevamwe, 2025). Mhedzisiro isingaratidzi kubuda kweweti pakushanya ikoko inoreva kuti hapana kubuda kweweti nefistula kwaratidzwa panguva iyoyo; haivimbisi kuti kubuda kweweti gare gare nokuda kwekusadzora weti, kutadza kubudisa weti yose, utachiona, kana nzvimbo yeureter isina kuwanikwa hakuzomboitiki.

Methylene blue ine rimwe basa rekuongorora rinofanira kuchengetwa rakaparadzana nebasa refistula: inoshandiswawo kuongorora kana machubhu anotakura mazai kubva mumaovary kuenda muchibereko akavhurika, maitiro anotsanangurwa mugwaro redu rekuongorora kugona kubata pamuviri nekuvhurika kwemachubhu aya. Dhayi imwe chete, mubvunzo wakasiyana, nhengo dzakasiyana. Kuchengeta mubvunzo wakabatana nemhedzisiro ndihwo hwaro hwose hwebvunzo dzedhayi. Donje rekupima rine ruvara rwebhuruu rinoratidza kuti nzira iripo. Zvimwe zvose, kukura kwayo, kugona kwayo kugadziriswa, uye zvinotarisirwa mberi, zvichiri kufanira kuongororwa.