Methylene blue muendosikopi yemudumbu nematumbu uye mukromoendosikopi

Zvinwiwa zviviri zvebhuruu zvine morekuru rimwe chete, asi hapana zvimwe zvakawanda zvazvakafanana. Mukamuri yeendosikopi, chiremba anopfapfaidza methylene blue yakasanganiswa kuti isanyanya kukora parukoko rwemukati meura hukuru kuitira kuti maronda akati sandara aonekwe zviri nyore. Kumba, mumwe munhu anodira madonhwe ebhuruu kubva mubhodhoro rakatengwa muchitoro mumvura sechikamu chemaitiro ekuchengetedza utano. Kuvhiringidza zvinhu izvi zviviri kukanganisa pakunzwisisa, kwete kungokanganisa uwandu hunoshandiswa: chimwe inzira yekuita kuti zvinhu zvionekwe pakutsvaga chirwere, ichiitwa nemisanganiswa yekushandisa pakurapa, chimwewo chigadzirwa chevatengi. Chinyorwa ichi chinotsanangura kushandiswa muendosikopi, uko dhayi iri mudziyo wekubatsira kuona, kwete mushonga wezvinenge zvaonekwa. Kuti uwane mufananidzo wakakura wekushandiswa kwekurapa kwakasimbiswa nekwachiri kuedzwa, ona tsananguro yekushandiswa kwemethylene blue mukurapa.

Kupenda pamusoro: dhayi inopinda mumasero mapenyu, kwete yekungoratidza nzvimbo

Kuita kuti zvinhu zvionekwe zviri nani nedhayi panguva yeendosikopi kunonzi kromoendosikopi. Methylene blue inoita zvinonzi nenyanzvi dzinoongorora chirwere kupenda masero mapenyu kana kupenda kunoitika nokutorwa kwedhayi: masero mapenyu epamusoro anotora zvinhu anopinza dhayi mucytoplasm yawo, saka rukoko rune utano rwemukati runopendwa zvakati fananei, nepo nzvimbo dzine kukura kwemasero kusina kujairika, kuzvimba, kana kenza dzichitora dhayi shoma kana kupendwa nemavara asingafananani. Musiyano uyu unoratidza maumbirwo erukoko rwemukati ayo chiedza chichena chega chingasaratidza, kunyanya maronda akati sandara.

Mashandiro aya akasiyana neeindigo carmine, imwe dhayi yagara ichishandiswa mukromoendosikopi. Indigo carmine haitombotorwi zvakanyanya nemasero; inoungana mumakomba nemumigero, ichisimbisa kuonekwa kwemaumbirwo epamusoro. Uku kupenda kunoratidza misiyano, kwete kupenda masero mapenyu. Ongororo dzinowanzobatanidza dhayi mbiri idzi pasi pekromoendosikopi inoshandisa dhayi, saka kubatsira kunonzi kunowanikwa nekromoendosikopi kazhinji hakurevi kuti methylene blue pachayo inobatsira zvakadaro.

Maitiro acho anoda kunyatsoteverwa. Mukromoendosikopi inoshandisa methylene blue muura hukuru hwose, anoita endosikopi anopfapfaidza dhayi inenge 0.1% chikamu nechikamu nepachubhu yekateta, omirira ingangoita miniti kuti itorwe nemasero, ozosveta yakawandisa asati aongorora. Dhayi inosvika pakukora kweinenge 0.5% inoshandiswa mumaitiro anonangana nenzvimbo dzakasarudzwa kana anoshandisa kukudza mufananidzo, asi 0.1% ndiyo inowanzoshandiswa muura hukuru hwose. Maitiro ose aya anoda kuti ura hunge hwacheneswa chaizvo uye anowedzera nguva yebasa. Zvipingamupinyi izvi zvakaita kuti pave nemusanganiswa unopenda ura hukuru kuongorora kusati kwatanga.

Piritsi rinopenda richibva mukati

Lumeblue, inonziwo methylene blue MMX, mushonga uri muchimiro chepiritsi rinonwiwa richiburitsa zviri mariri zvishoma nezvishoma kwenguva yakareba. Wakatenderwa muEU semushonga wekubatsira kutsvaga chirwere nekuita kuti maronda emuura hukuru nerectum aonekwe zviri nani pakoronosikopi yekuongorora kana yekuramba ichitevera mamiriro emurwere. Mvumo yekutengeswa yakapiwa muna Nyamavhuvhu 2020, sezvinotsanangurwa mutsananguro yemushonga yeEMA. Uwandu hunoshandiswa mapiritsi masere e25 mg, anokwana 200 mg pamwe chete, anomedzwa akazara panguva kana pashure pekugadzirira ura kunoshandisa PEG, manheru ekoronosikopi isati yaitwa, achinwiwa muzvikamu zvinotevedzana zve3-3-2.

Chinhu chikuru pamagadzirirwo acho igadziriro yeMMX. Rukoko rwayo rwekunze runomira asidhi yemudumbu, rwobva rwaputsika panenge paine pH 7 pedyo nechikamu chekupedzisira cheura hudiki. Ipapo inoburitsa dhayi zvishoma nezvishoma kuitira kuti rukoko rwemukati meura hukuru rusangane nayo kwenguva yakareba uye zvakati fananei. Panotanga koronosikopi, ura hukuru hunenge hwatopendwa. Izvi zvinoita kuti Lumeblue ive mushonga wekubatsira kutsvaga chirwere unodzorwa nemitemo, une uwandu hwakatarwa uye chinangwa chekushandiswa chakatsanangurwa. Izvi zvakasiyana nemushonga wemvura unopfapfaidzwa neanoita endosikopi uye nechero chigadzirwa cheutano chinotengeswa muzvitoro. Misanganiswa mitatu iyi inopindura mibvunzo yakasiyana uye haigoni kutsivaniswa; misanganiswa inotengeswa muzvitoro inokurukurwa yoga mugwaro rezvokuwedzera pakudya nezvinyorwa zvepazvigadzirwa.

Zvakawanikwa nezvidzidzo zvekuona maronda muura hukuru

Humbowo hwakasimba zvikuru pamusoro pemethylene blue pachayo mukuona maronda emuura hukuru nerectum hunobva muyedzo wechikamu III weMB-MMX wakashumwa naRepici nevamwe (PubMed 30742834): varwere 1,205 vaiongororwa kana kuteverwa mamiriro avo vakagoverwa zvisina kurongwa kuti vapiwe 200 mg MB-MMX kana chinhu chisina mushonga. Kuonekwa kweadenoma kana carcinoma kwakasimbiswa nekuongorora nyama kwaiva 56.29% zvichienzaniswa ne47.81%, musiyano chaiwo weinenge 8.5 mapoinzi epesenti. Kubatsira kwakanyatsooneka pamaronda asina chimiro chepolyp nemadiki zvikuru, pasina mukana wakakosha kune makuru kana ane chimiro chepolyp.

Humbowo hwekare hwekupfapfaidza dhayi hunonyanya kubva pakuongororwa kwevanhu vane chirwere chekuzvimba kwematumbu, kwete pakuongororwa kwevanhu vane njodzi iri pakati nepakati. Kiesslich nevamwe vakagovera zvisina kurongwa varwere 165 vaiva neulcerative colitis yenguva refu kuti vaongororwe nekoronosikopi yakajairika kana nekromoendosikopi inoshandisa 0.1% methylene blue, vakawana kukura kwemasero kusina kujairika mukati merukoko rwepamusoro kwakaita 32 zvichienzaniswa ne10 (PubMed 12671882). Mucolitis ine chokuita neIBD, kutora zvimedu zvenyama zvekuongorora kubva panzvimbo dzakasarudzwa nedhayi yakapfapfaidzwa kwakapfuurawo kutora zvimedu zvisina kusarudzwa nzvimbo, muyedzo wakaitwa naMarion nevamwe (PubMed 18844620). Izvi zvawanikwa zvine chokuita nekutevera colitis uye zvinofanira kunzwisiswa mumamiriro iwayo, pamwe chete nehurukuro yakatsaurirwa kumethylene blue nechirwere chekuzvimba kwematumbu.

Ongororo dzakafara dzinobatanidza zvabuda muzvidzidzo zvakawanda dzinotsigira kromoendosikopi inoshandisa dhayi pakuona maronda, kunyange dzichinyanya kuyedza indigo carmine: ongororo yeCochrane ya2016 yakawana mukana wakakura wekuona ronda rimwe chete kana kupfuura rine kukura kwemasero kusina kujairika (PubMed 27056645), uye ongororo yaAntonelli ya2022 yakabatanidza miedzo gumi yaigovera vanhu zvisina kurongwa yakashuma kuwedzera kwekuonekwa kweadenoma neinenge 20% zvichienzaniswa neboka rekufananidza (PubMed 35588768). Izvi zvinobatsira pakunzwisisa pfungwa yacho, asi hazvisi humbowo hwakanangana nemethylene blue.

Kuona maronda hakusi kurapa

Zvose zvawanikwa zviri pamusoro zvine chokuita nekuwana maronda, kwete kurapa kenza. Lumeblue yakatenderwa semushonga wekubatsira kutsvaga chirwere, uye muyedzo wayo wekunyoreswa wakayera mwero wekuonekwa kwemaronda, kwete kupindura kwebundu kumushonga, kudzoka kwechirwere, kana kurarama kwevarwere. Mashoko eEMA pachayo ane chisungo: kuona maronda zviri nani kungaita kuti njodzi yekenza iderere kana maronda awanikwa akabviswa. Musiyano we8.5 mapoinzi pakuona maronda haugoni kutaurwa sekuderedzwa kwekenza kana kufa ne8.5%. Vaverengi vanoongorora zvirevo zvekurapa vanofanira kunyatsosiyanisa izvi, sezvinotsanangurwa mugwaro rinofananidza humbowo hwemurabhoritari nehwevarwere pamusoro pemethylene blue nekenza.

Humbowo hwekushandiswa muchikamu chepamusoro chegadziriro yekugaya zvokudya hahuna kusimba zvakanyanya

Mugurokuro raBarrett, methylene blue inopenda nzvimbo dzine intestinal metaplasia ruvara rwebhuruu, izvo zvakapa pfungwa yekutora zvimedu zvenyama munzvimbo dzakapendwa pane kuzvitora mumativi mana pasina nzvimbo inenge yaonekwa. Zvawanikwa zvekutanga munzvimbo imwe chete zvairatidza tariro, asi zvidzidzo zvakakura uye zvakanyatsodzorwa hazvina kusimbisa mukana uri nani wekuona dysplasia. Ongororo ya2009 yakabatanidza zvidzidzo zvipfumbamwe haina kuwana kuwedzera kwakakosha maererano nehuwandu pakuona intestinal metaplasia, dysplasia, kana dysplasia yakanyanya nekenza ichangotanga, zvichienzaniswa nekutora zvimedu zvenyama nenzira yakarongeka (PubMed 19215918).

Mirayiridzo yakachinja. Mirayiridzo yazvino yeACG, ESGE, neASGE yekutevera gurokuro raBarrett inokurudzira kromoendosikopi inoshandisa acetic acid kana kromoendosikopi yemifananidzo inogadzirwa nemagetsi, nguva dzose pamwe chete nemaitiro akarongeka eSeattle ekutora zvimedu zvenyama. Haikurudziri kupfapfaidza methylene blue sechinotsiva kutora zvimedu zvenyama munzvimbo dzisina kusarudzwa. Saka kutaura kuti mirayiridzo inokurudzira kromoendosikopi hakurevi kuti inokurudzira kromoendosikopi yemethylene blue.

Chitsigiro chebhuruu chiri pasi peronda

Rukoko rwebhuruu runoonekwa pakubvisa rukoko rwemukati neendosikopi kana pakuparadzanisa nyama iri pasi parwo runomiririra imwe pfungwa yechitatu. Ipapo, kusimudzwa kunobva mumvura ine munyu kana imwe mvura inobayiwa pasi peronda kuti iriparadzanise nemadziro etsandanyama; madonhwe mashoma edhayi yebhuruu anowedzerwa kuitira kuti ari kuita basa aone chitsigiro chacho, rukoko panoparadzaniswa nyama, uye muganhu wakadzika. Ruvara runoratidza kwakaenda mvura yakabayiwa. Harutauri chinhu pamusoro pemetaplasia kana dysplasia, uye chinangwa charwo ndechekuchengeteka kwekucheka nekubvisa nyama. Nyaya iyi inokurukurwa pamwe chete nekumwe kushandiswa pakuvhiya mugwaro rekuvhiya nemaitiro ekutsvaga chirwere.

Cherechedzo chaiyo pamusoro pekuchengeteka: chiedza pamwe nedhayi

Methylene blue chinhu chinoita kuti pave nekupindura kuchiedza, uye zvidzidzo zviviri zvakaita kuti vanoita endosikopi vangwarire. Olliver nevamwe vakaratidza kuti 0.5% methylene blue pamwe chete neendosikopi inoshandisa chiedza chichena zvakawedzera kukuvara kweDNA murukoko rwemukati rwegurokuro raBarrett, kuchiyerwa nemiedzo yecomet, asi dhayi isina chiedza haina kuita izvi (PubMed 12907012). Davies nevamwe vakawanawo zvakafanana muura hukuru: 0.1% methylene blue pamwe chete nechiedza chichena zvakakuvadza DNA yemasero eura hukuru murabhoritari nomumuviri mupenyu, asi indigo carmine haina kuita izvi (PubMed 17172595).

Kududzirwa kwakatendeseka kunofanira kuva kwakaganhurirwa: kukuvara kweDNA kwepakarepo kwakaratidzwa, kwete kenza. Hapana chidzidzo chakaratidza kuti kromoendosikopi yemethylene blue yakakonzera kenza muvarwere. Asi pamwe chete nekubatsira kushoma mugurokuro raBarrett, chiratidzo chinodzivisika chekukuvadza DNA chakaita kuti dhayi iyi isafarirwe ipapo. Ichi chimwe chezvikonzero nei mirayiridzo ichida dzimwe nzira. Mashoko akazara pamusoro pekubata dhayi nemigumisiro isingadiwi akaunganidzwa mugwaro rekuchengeteka nemigumisiro isingadiwi.

Pashure pekuongorora: ruvara rwebhuruu runotarisirwa

Methylene blue idhayi yakasimba, uye weti netsvina zvinova bhuruu kana girini kwechinguva pashure pekuongorora migumisiro yedhayi inotarisirwa, kwete matambudziko; weti inogona kuratidzika segirini nokuti dhayi yebhuruu inosanganiswa nezvinopa weti ruvara rweyero. Dhayi iri paganda inosiya ruvara rwebhuruu rwenguva pfupi. Pane yambiro imwe inoramba iripo pasinei netsananguro iyi inodzikamisa: ganda rinongoerekana rava bhuruu mumuviri wose, zvichiperekedzwa nekuomerwa nekufema kana kuchinja kwekuziva zviri kuitika, mamiriro akasiyana neruvara runoonekwa pamusoro peganda. Zvinoda kuongororwa nokukurumidza, kwete kumirira kuti ruvara rupere. Uye yambiro yekupedzisira pakunzwisisa: usambofungidzira kuti dhayi yakashandiswa ndeipi uchingotarisa ruvara chete. Kuonekwa kwebhuruu hakuratidzi kuti imethylene blue, nokuti zvimwe zvinhu zvinopawo nyama ruvara rwebhuruu.

Zvaunofanira kuyeuka

Funga nezvemapoka matatu akasiyana: kupenda pamusoro kunoshandisa kutorwa kwedhayi nemasero erukoko rwepamusoro, misanganiswa yekutsvaga chirwere inonwiwa inopenda ura hukuru pachine nguva pasi pemvumo yekutengeswa, uye mvura ine ruvara inoiswa pasi perukoko rwemukati kuratidza panochekwa nyama. Bvunza kuti chirevo chiri muboka ripi, kana humbowo hwacho hwakayera kuonekwa kwemaronda kana kurapwa, uye kuti musanganiswa upi nekukora kwakadini zvakanyatsoyedzwa. Zvidzidzo zvinotsigira misiyano iyi zvakanyorwa mumuunganidzwa wetsvakurudzo yemethylene blue.