Methylene blue pakuongorora kugona kubereka: zvinonyatsoratidzwa nechromopertubation

Zvinobuda pakutsvaga methylene blue nekugona kubereka zvinosanganisa zvirevo zviviri zvakasiyana. Chimwe ndechekuti muedzo wedhayi yebhuruu kukiriniki unogona kuratidza kana machubhu eFallopian akazaruka. Chimwe ndechekuti kutora methylene blue kunovandudza kugona kubereka, urume, kana kunaka kwemazai. Chirevo chekutanga chete ndicho chine chekuita nechromopertubation. Chechipiri hachina kuongororwa uye hachisi chikamu chemaitiro aya. Musiyano iwoyo ndiwo hwaro hwezvose zviri pasi apa.

Mubvunzo unobatsira wakanyatsojeka. Kana dhayi yebhuruu yaiswa muchibereko mumamiriro ekukiriniki, uye mvura ikaonekwa ichibuda nemuchubhu, chubhu iyoyo inenge yakazaruka panguva iyoyo. Kana pasina kuyerera kunoonekwa, mhinduro yacho haina chokwadi sezvainoratidzika. Kuenzaniswa kwakaitwa muna 2021 kwemiedzo yedhayi mumamiriro maviri kunoratidza chaipo panovimbika dudziro yacho nepanotadza.

Pfungwa yacho: muedzo wekuyerera, kwete kurapa kusagona kubereka

Chubhu imwe neimwe yeFallopian inzira nhete inobva muchibereko ichienda kudivi rechibereko chemazai. Chromopertubation inoongorora chinhu chimwe chenzira iyoyo: kana mvura ichigona kupfuura. Methylene blue ndiyo chiratidzo chinoita kuti kuyerera kuonekwe, nokuti ruvara rwayo rwakadzama runonyatsooneka pamativi emuviri ane ruvara rwakareruka.

Magadzirirwo acho akafanana mumamiriro ose ari maviri. Dhayi inopinda nemuromo wechibereko ichienda mukati mechibereko, uye nyanzvi yezveutano inotarisa zvinozoitika. Dhayi inobuda nekumagumo echubhu ari kure nechibereko inoreva kuti chubhu yakazaruka. Dhayi inoungana yobva yayerera ichidzokera inoreva kuti chubhu inoita seyakavharika. Dudziro iyi inotaura nezvekupfuura kwemvura, ichienda kudivi rimwe chete, pazuva rimwe chete.

Maitiro aya anoitwa nenyanzvi yezveutano. Muedzo wemukamuri rekuongororera unoitwa panguva yehysteroscopy, apo chishandiso chitete chekuona chinotarisa mukati mechibereko. Muedzo wemukamuri rokuvhiya unoitwa panguva yelaparoscopy, apo chishandiso chekuona chinotarisa kunze kwemachubhu nenzvimbo yemuchiuno, kazhinji munhu akapiwa mushonga unomurazva zvachose. Hapana pamiedzo iyi inoitwa nemunhu ari oga, uye hapana unopa mushonga une chinangwa chekuchinja kugona kubereka. Dhayi chiratidzo chinoyerera chichipfuura. Tsananguro dzemashandiro emethylene blue sedhayi dzinobatsira pano, uye mubvunzo wakasiyana wekuti tsvakurudzo yemethylene blue inoverengwa sei unotsanangura nei zvinoitika murabhoritari zvisingamborevi kurapa kunoitwa kukiriniki.

Kuvhurika hakurevi kushanda zvakanaka

Kuvhurika ipfungwa imwe chete, asi kushanda kwechubhu kunosanganisira zvakawanda. Chubhu inogona kuva yakazaruka asi ichitadza basa rayo: utachiona kana endometriosis zvinogona kukuvadza tunobvudzi tunofambisa zai, asi nzira ichisara yakafara zvakakwana kuti dhayi ipfuure; uye mavanga ari kunze kwechubhu anogona kubata chibereko chemazai chiri kure zvokuti zai harimbopindi, kunyange dhayi ichibuda isina chipingamupinyi. Nzira yakati nhete inogona kupfuudza dhayi inoyerera iri shoma asi ichitadzisa zai, iro rakakura kupfuura kuyerera ikoko.

Saka mugumisiro unoratidza kuvhurika unopindura mubvunzo muduku nechivimbo chine mwero: mvura yapfuura nemuchubhu. Hausimbisi kuti rukoko rwemukati, kutorwa kwezai, kana nzvimbo yemuchiuno yakatenderedza zviri kushanda zvakanaka. Mugumisiro unoratidza kuvharika unotovimbika zvishoma, nokuti mamiriro enguva pfupi anogona kumisa kuyerera nemuchubhu yakazaruka.

Zvakafananidzwa netsvakurudzo ya2021

Mashoko akajeka zvikuru ekuenzanisa miedzo iyi zvakananga anobva mutsvakurudzo yekutanga ya2021 yevakadzi 80 vaisagona kubata pamuviri paAIIMS New Delhi, uye nzira dzose dzakashandiswa nemigumisiro zvinowanikwa mumashoko anoverengwa mahara. Munhu wese akapinda mutsvakurudzo akanga atove akarongerwa hysterolaparoscopy. Vakadzi vakanga vambosimbiswa kuvharika kwemachubhu, vaizivikanwa kuti vane hydrosalpinx, kana vaiva neutachiona hwakanyanya hwemuchiuno panguva iyoyo havana kuiswa mutsvakurudzo.

Mukadzi mumwe nemumwe akaitwa miedzo miviri yedhayi ichitevedzana. Pakutanga, hysteroscopy yemukamuri rekuongororera isina mushonga wokutindivadza: dhayi yakasanganiswa nemvura yakaiswa, uye buri rechubhu imwe neimwe rakatariswa kuona kuyerera kwaioneka pamwe nokupera kwebhuruu mukati mechibereko. Zvadaro pakaitwa minilaparoscopy munhu akapiwa mushonga unomurazva zvachose, semuedzo wekuenzanisira: dhayi yakapfuura nemupombi wakaiswa muchibereko, uye chubhu imwe neimwe yakaongororwa zvichienderana nekubuda kwedhayi kwaioneka munzvimbo yemuchiuno. Machubhu ose ari maviri akaverengwa rimwe nerimwe, zvichipa ongororo 160.

Muedzo wekuenzanisira wakawana machubhu 136 pa160 akazaruka (85 percent). Muedzo wemukamuri rekuongororera wakati 125 akazaruka (78 percent). Miedzo yacho yaiwirirana zvakanaka asi kwete zvakaenzana pamigumisiro yose: machubhu 119 akaonekwa akazaruka pamiedzo yose iri miviri, 18 akavharika pamiedzo yose iri miviri, 17 akanzi akavharika nemuedzo wemukamuri rekuongororera asi akazaruka palaparoscopy, uye 6 akanzi akazaruka nemuedzo wemukamuri rekuongororera asi akavharika palaparoscopy. Laparoscopy ichishandiswa semuedzo wekuenzanisira, muedzo wemukamuri rekuongororera wakaratidza 87.5 percent pakukwanisa kuona machubhu akazaruka, 75 percent pakukwanisa kuona asina kuvhurika, 95.2 percent pakuvimbika kwemugumisiro unoti akazaruka, 51.4 percent pakuvimbika kwemugumisiro unoti akavharika, uye 85.6 percent pakururama kwese.

Verenga nhamba idzi semuverengi, kwete senyanzvi yezviverengero. Mugumisiro waiti chubhu yakazaruka pamuedzo wemukamuri rekuongororera waiwanzova wakarurama. Mugumisiro waiti yakavharika wakanga wakada kufanana nekukanda mari kuti uone divi rinowira pamusoro: dzinenge hafu chete dzemigumisiro yaiti yakavharika pamuedzo wemukamuri rekuongororera ndiyo yakasimbiswa palaparoscopy. Kusiyana ikoko pakuvimbika kwemigumisiro ndicho chinhu chimwe chinonyanya kubatsira pakushandisa zvakanyorwa mutsvakurudzo iyi.

Nei kuvharika kunofungidzirwa kuri mugumisiro usinganyanyi kuvimbika

Chikonzero chinowanzoitika ndechekubata kwetsandanyama kamwe kamwe. Kona yechibereko panotangira chubhu inogona kubata kwenguva pfupi yovhara nzira yakazaruka. Gwaro iri rinotaura kuti mvura inotonhora nemarwadzo ekubata kwetsandanyama zvingakonzera izvi. Kubata uku kunopera, asi zvinoonekwa kana muedzo waitwa panguva yacho zvakafanana chaizvo nekuvharika kwechokwadi. Ndokusaka mugumisiro mumwe chete unoratidza kuvharika kwechubhu pedyo nechibereko, pasina humwe humbowo, usingangovimbwi nawo.

Maitiro emuedzo anowedzerawo kukanganisa. Kuisa dhayi nokukurumidza kunoita kuti iyerere ichidzokera, zvichitaridzika sekuvharika, uye kutarisa nekona isina kunaka kunogona kutadza kuona dhayi shoma iri kubuda. Tsvakurudzo iyi yakashandisa chiremba mumwe chete ane ruzivo pakuvhiya kubva pakutanga kusvika pakupedzisira, saka kusiyana kwemaitiro mukushanda kwezuva nezuva kungangova kukuru kupfuura uku.

Zvinoreva izvi pakiriniki zvinotevera zvakananga. Kuvharika kunofungidzirwa pamuedzo wedhayi wemukamuri rekuongororera chikonzero chekutsvaga kusimbiswa, kwete chirwere chasimbiswa chingaitirwa matanho chiri choga. Kusimbiswa kunowanzoreva muedzo wekuenzanisira welaparoscopy kana imwe ongororo yemachubhu inosarudzwa neboka rinobata nyaya dzekugona kubereka, ichidudzirwa pamwe nenhoroondo yezveutano, njodzi yeutachiona, nemifananidzo yekuongorora. Muedzo wemethylene blue wemachubhu eFallopian unosimbisa kuvhurika zvakanyanya kupfuura zvaunosimbisa kusavhurika.

Zvisingagoni kuonekwa nekuyerera kwedhayi

Chromopertubation inoyera kupfuura kwemvura. Mamiriro akati wandei ane chekuita nekugona kubereka haagoni kuonekwa nemuedzo iwoyo. Kubatana kunokonzerwa nemavanga akatenderedza chubhu, anonzi peritubal adhesions, hakuonekwi nehysteroscope, iyo inoona mukati mechibereko nemaburi emachubhu chete. Laparoscopy inokuona zvakananga; mutsvakurudzo iyi vakadzi 4 pa80 vakawanikwa vaine kubatana kwakadaro padanho iroro chete, uye tsvakurudzo dzakapfuura dzinoratidza kuti kunowedzera mukana wekuti kuyerera kwedhayi kupe mugumisiro unonyepera kuvimbisa kuti zvinhu zvakanaka.

Hydrosalpinx, chubhu inozvimba nemvura nokuda kwekuvharika kumagumo ari kure nechibereko, ndechimwe chinhu chisingaonekwi nemuedzo uyu: vakadzi vaizivikanwa kuti vanayo havana kuiswa mutsvakurudzo, asi hydrosalpinx yakanga isati yazivikanwa yakaonekwa palaparoscopy muvakadzi 7 pa80. Endometriosis, kukuvadzwa kwerukoko rwemukati, uye kusashanda zvakanaka kwekutora zai zvinopedzisa runyorwa urwu. Ndokusaka nhungamiro dzekuongorora kugona kubereka dzichitsanangura chromopertubation sedanho rinoitwa kana laparoscopy yatodiwa nechimwe chikonzero, sezvinoratidzwa mumaonero ekomiti yeASRM pamusoro pekuongorora kusagona kubata pamuviri. Mashoko akazara pamusoro pekuchengeteka kwemethylene blue anokosha pakufunga nezveongororo ipi neipi inosanganisira kuvhiya.

Kusiyana kwayo nemimwe miedzo yemachubhu

Hysterosalpingography (HSG) inopfuudza chinhu chinonyatsooneka paX-ray nemuromo wechibereko, yoshandisa mifananidzo yeX-ray kuratidza chimiro chemukati mechibereko nemachubhu. Inonyora kubuda kwechinhu ichocho sezvinoita chromopertubation, asi inosanganisira mwaranzi, haigoni kuongorora kunze kwenhengo dzemuchiuno, uye ine dambudziko rimwe chete rekubata kwetsandanyama pakona yechibereko.

Ultrasound yemvura ine munyu inoisa mvura ine munyu isina utachiona mukati mechibereko, uku chishandiso chinoiswa musikarudzi chichitora mifananidzo yacho. Kutora mifananidzo nemvura ine munyu chete kunonyanya kuongorora mukati mechibereko: mvura iri munzvimbo yemuchiuno inoratidza kuti chubhu imwe chete kana kupfuura yakazaruka, asi kazhinji hakugoni kutaura kuti ndeipi. Ultrasound inoshandisa furo kana tutubvu twuduku tunonyatsooneka inotevera chubhu imwe neimwe, uye ndiyo inonyanya kufanana nemuedzo wedhayi.

Kuchengeteka nenzvimbo inoitirwa muedzo, nemashoko ari nyore

Mutsvakurudzo yevanhu 80, vanyori vakati hapana matambudziko makuru kana maduku akakonzerwa nemuedzo upi neupi wedhayi. Izvi zvinopa chivimbo mukati mets vakurudzo yekutanga duku, asi hazvirevi kuti hapana njodzi: mishumo yezviitiko zvakatevera chromopertubation inotsanangura matambudziko asingawanzoitiki ekunyanyisa kupindura kwemuviri kudhayi, methemoglobinemia, kupinda kwedhayi mutsinga dzeropa, uye matambudziko emapapu, asi kuwanda kwazvinoitika hakuna kuyerwa zvakajeka.

Pane zvinhu zviviri zvinobva pane izvi. Muedzo unoshandisa laparoscopy unowedzera njodzi dzinowanzoenderana nekuvhiya nemushonga wokutindivadza, ndokusaka uchingoitirwa vanhu vanenge vatorongerwa kuongororwa kunosanganisira kuvhiya. Uye hapana pazviri zvinogona kungoendeswa pakushandiswa kumba: kusimba kwedhayi, kusava neutachiona, painoiswa, uye kugadzirira kubata dambudziko rechimbichimbi zvese zviri mumaoko eboka rezveutano.

Saka pfupiso yakarurama inofanira kutaurwa iine miganhu yayo. Chromopertubation inoshandisa methylene blue inoratidza kana mvura ichipfuura nemuchubhu painenge ichitariswa, uye mugumisiro unoratidza kuvhurika unovimbika zvikuru kupfuura unoratidza kuvharika. Haiyeri kushanda kwechubhu, haiwani chikonzero chose chemuchiuno chinotadzisa kubata pamuviri, uye hairapi chinhu. Munhu wese anenge achipiwa mukana wekuita muedzo uyu anofanira kubvunza mibvunzo mitatu: muedzo wakarongwa kuitirwa papi uye nei, chii chinozoitwa kana mugumisiro ukaratidza kuvharika, uye ndezvipi zvimwe zvinowanikwa zvingachinja chirongwa.