Inqaku
Imethylene blue kwiintlungu emva kotyando lweehemorrhoids: oko kuboniswa lulingo
Ugqirha wotyando ucebisa utyando lokususa iihemorrhoids. Isigulana siva igama elinye: iintlungu. Umbuzo ulandela ngokukhawuleza. Ngaba lukhona unyango olunikwa kwindawo yotyando, ngexesha lotyando, olunokwenza iveki yokuqala ibe lula? Izilingo ezintathu ezahlula abathathi-nxaxheba ngokungakhethiyo zivavanya enye indlela enokufaneleka: imethylene blue etofwa kulusu olujikeleze umngxuma wokukhupha ilindle ngexesha lotyando. Isilingo ngasinye sixela iintlungu ezisezantsi kwimihla yokuqala xa kusetyenziswe imethylene blue. Isilingo ngasinye sinemida echaphazela ukuba eso siphumo sinokusetyenziswa ngokubanzi kangakanani.
Eli phepha lithelekisa ezi zilingo zintathu ngokuzibeka ecaleni kwenye. Libhalelwe iintlobo ezimbini zabafundi. Isigulana sinokulisebenzisa ukulungiselela imibuzo yeqela lotyando. Umbhali unokulisebenzisa ukujonga oko uphando ngeentlungu zenkqubo yonyango kwindawo ethile lukubhalileyo ngokwenene, usuku nosuku.
Into ezi zilingo eziyiyo, nento ezingeyiyo
Isilingo ngasinye sabandakanya abantu abadala ababesenzelwa utyando lweMilligan-Morgan lokususa iihemorrhoids, oluzisusayo lushiye inxeba livulekile. Kwisilingo ngasinye, ingcali yezonyango yafaka imethylene blue kufutshane nendawo yotyando ngoxa isigulana sasiphantsi kweanesthesia. Iziphumo ezalinganiswayo yayiziintlungu emva kotyando, ukusetyenziswa kwamayeza ongezelelweyo okuthomalalisa iintlungu xa efuneka, neengxaki.
Akukho nasinye kwezi zilingo zintathu esaphanda ukurhawuzelelwa okungapheliyo komngxuma wokukhupha ilindle, unyango lokuqhekeka kwaloo mngxuma, okanye iimpawu zeehemorrhoids ezinganyangwanga ngotyando. Uphando ngokurhawuzelelwa lukhankanywa kuphela njengemvelaphi yendlela ekucingelwa ukuba unyango lusebenza ngayo, oko kukuthi, ukunciphisa okwethutyana uvakalelo lwemithambo-luvo yaloo ndawo, kungekhona njengokusetyenziswa okuvavanyiweyo. Isilingo sango-2024 sabakhuphela ngaphandle abantu ababenokuqhekeka okanye ifistula ngaxeshanye. Isilingo sango-2026 sabakhuphela ngaphandle abantu ababenokuqhekeka, ifistula, ithumba elinobovu, nezinye izifo zamathumbu. Ukuba izikali zeentlungu ziyakubhidanisa, indlela yokufunda isilingo seentlungu ichaza iVAS neNRS ngaphambi kokuba uthelekise amanani. Ukurhawuzelelwa nokuqhekeka ziingxaki ezahlukeneyo; jonga iimeko zokuqhekeka nokurhawuzelelwa komngxuma wokukhupha ilindle ukuze ugcine umda wolu phando ucacile.
Indlela ezacwangciswa ngayo ezi zilingo zintathu
Iindlela zokunika unyango zahluke ngokwaneleyo ukuba zingaphathwa njengohlobo olunye lokufumana unyango. Eyona dosi inkulu iphindwe kalishumi kweyona incinci, yaye ixesha lokunika unyango, umaleko wethishu, neqela lothelekiso zonke zahlukile. Utyando yenye yeendlela zokunyanga iihemorrhoids; ezi zilingo zijongene kuphela neentlungu emva kotyando.
| Isilingo | Izigulana ezihlalutyiweyo | Indlela yokunika imethylene blue | Unyango lweqela lothelekiso nokhathalelo oluqhelekileyo |
|---|---|---|---|
| Sim noTan 2014 | 67 (imethylene blue 37, iqela lothelekiso 30), utyando lokususa iihemorrhoids kusetyenziswa ubushushu bombane kuze kushiywe inxeba livulekile | 4 mL yemethylene blue eyi-1 ekhulwini (40 mg) exutywe ne-16 mL yebupivacaine eyi-0.5 ekhulwini, itofwe ngaphakathi kulusu olujikeleze umngxuma wokukhupha ilindle ngaphambi kokucandwa | Ibupivacaine efanayo kunye nesisombululo setyuwa endaweni yedayi eluhlaza okwesibhakabhaka; iparacetamol njengonyango oluqhelekileyo kunye nediclofenac, njengoko kuxelwe ekukhutshweni kwedatha okwenziwe ngomnye umthombo |
| Azhough 2024 | 97 (imethylene blue 48, iqela lothelekiso 49), inqanaba III okanye IV, iqela elinye lotyando, ianesthesia enikwa kumjelo womqolo | 5 mL yemethylene blue eyi-1 ekhulwini (50 mg), ifakwe ngaphakathi kulusu kwiindawo ezintlanu nge-1 mL kwindawo nganye, malunga ne-2 cm ukusuka kumda wenxeba lokusikwa, emva kokususwa kweehemorrhoids | 5 mL yebupivacaine eyi-0.5 ekhulwini emva kokususwa; iketorolac ngamaxesha acwangcisiweyo, itramadol xa kufuneka uncedo olongezelelweyo lweentlungu, emva koko inap roxen kunye neacetaminophen necodeine xa kukhutshwa isigulana esibhedlele |
| Zhu 2026 | 60 (30 kwiqela ngalinye), iihemorrhoids ezixubeneyo, ugqirha omnye wotyando, ianesthesia enikwa kummandla ongezantsi womqolo | Idayi eluhlaza okwesibhakabhaka exutywe yangama-0.1 ekhulwini (1 mL ye-1 ekhulwini kunye ne-9 mL yesisombululo setyuwa), 0.5 ukuya ku-1 mL kwinxeba ngalinye lokusikwa ngendlela esasazeka njengefeni, kulandelwe ukuphululwa okufutshane, iyonke ibe yi-5 mL okanye ngaphantsi (5 mg okanye ngaphantsi), emva kokususwa | Akukho nto itofwayo kwindawo yotyando; ilornoxicam 8 mg xa isigulana siyicela, kudlule ubuncinane iiyure ezi-6 phakathi kweedosi |
Imiba emibini yocwangciso ibalulekile. Okokuqala, izilingo zango-2014 nezango-2024 zithelekisa idayi nokufakwa kwebupivacaine kwithishu, ngoko nawuphi na umahluko sisiphumo esongezelelweyo sedayi phezu kweyeza lokuphelisa uvakalelo kuloo ndawo, ngoxa isilingo sango-2026 sithelekisa idayi nokungatofi nto kwindawo yotyando. Okwesibini, ukufihlwa kokuba ngubani ofumene luphi unyango kubuthathaka naphi na apho umbala oluhlaza okwesibhakabhaka ubonakala khona. Ababhali bango-2026 bathi ukutshintsha kombala wethishu nomchamo kwenza ukuba ukufihlwa okusebenzayo kungabinakwenzeka, nto leyo eshiya amanqaku eentlungu axhomekeke kumava esigulana esesichengeni sokuthambekela kwicala elithile.
Iintlungu ngokosuku emva kotyando
Ipateni efanayo kukwahlukana kwamanqaku ekuqaleni, kulandelwe kukusondelana kwawo. Isilingo ngasinye sisebenzisa isikali esahlukileyo, ngoko sifunde ngokwendlela yaso. Iindlela eziqhelekileyo zifumaneka kulawulo lweentlungu emva kotyando, oluchaza unyango oluqhelekileyo lokuthomalalisa iintlungu nokucwangciswa koncedo olongezelelweyo.
Kwisilingo esahlula abathathi-nxaxheba ngokungakhethiyo, sifihla unyango kwicala elinye, semethylene blue efakwe ngaphakathi kulusu emva kotyando lokususa iihemorrhoids ngobushushu bombane kushiywe inxeba livulekile, izigulana zagcina idayari yesikali sokulinganisa iintlungu ngokubonakalayo. Umndilili weentlungu wawusezantsi ngokubalulekileyo ngokweenkcukacha-manani xa kusetyenziswe imethylene blue kwiintsuku 1 ukuya ku-3 emva kotyando, kusetyenziswa neparacetamol encinci kwelo xesha, yaye kungekho nzuzo ibalulekileyo emva kosuku 3. Amanqaku omndilili achanekileyo akafumaneki kumbhalo wesishwankathelo onokufikelelwa kuwo, ngoko olu hlaziyo aluzenzeli amanani osuku ngalunye.
Kwisilingo esifihla unyango kumacala omabini semethylene blue efakwe ngaphakathi kulusu emva kokususwa kweehemorrhoids, izigulana zabhala ezona ntlungu ziphezulu ezazizivile ngosuku ngalunye ngexesha lokulala, kwisikali esinamanqaku ali-11 ukusuka ku-0 ukuya ku-10, kangangeentsuku ezili-14. Umahluko wawubalulekile ngokweenkcukacha-manani kwiintsuku 1 ukuya ku-7, u-p engaphantsi kwe-0.001 ngosuku ngalunye, yaye wawungabalulekanga kwiintsuku 8 ukuya ku-14:
- Usuku 1: idayi eluhlaza okwesibhakabhaka 4.08 dibanisa okanye thabatha 1.23, iqela lothelekiso 5.20 dibanisa okanye thabatha 1.40.
- Usuku 2: idayi eluhlaza okwesibhakabhaka 3.94 dibanisa okanye thabatha 1.17, iqela lothelekiso 5.22 dibanisa okanye thabatha 0.87.
- Usuku 3: idayi eluhlaza okwesibhakabhaka 3.90 dibanisa okanye thabatha 1.10, iqela lothelekiso 5.02 dibanisa okanye thabatha 0.95.
- Usuku 4: idayi eluhlaza okwesibhakabhaka 3.71 dibanisa okanye thabatha 1.25, iqela lothelekiso 4.71 dibanisa okanye thabatha 1.21.
- Usuku 5: idayi eluhlaza okwesibhakabhaka 3.60 dibanisa okanye thabatha 1.27, iqela lothelekiso 4.67 dibanisa okanye thabatha 1.21.
- Usuku 6: idayi eluhlaza okwesibhakabhaka 3.46 dibanisa okanye thabatha 1.27, iqela lothelekiso 4.31 dibanisa okanye thabatha 1.21.
- Usuku 7: idayi eluhlaza okwesibhakabhaka 3.35 dibanisa okanye thabatha 1.27, iqela lothelekiso 3.92 dibanisa okanye thabatha 1.21.
- Iintsuku 8 ukuya ku-14: amanqaku kumaqela omabini ayehla asondele malunga no-2.5 ukuya ku-3.5, kungekho mahluko ubalulekileyo phakathi kwamaqela nakweyiphi na kwezi ntsuku zamva (onke amaxabiso ka-p angaphezulu kwe-0.2).
Kuphononongo lwango-2026 olwahlula abathathi-nxaxheba ngokungakhethiyo lokufakwa kwemethylene blue exutyiweyo kwithishu emva kotyando lweMilligan-Morgan, iintlungu xa isigulana siphumle, ezilinganiswa ngesikali esibonakalayo sika-0 ukuya ku-10, zazisezantsi xa kusetyenziswe imethylene blue kwiiyure ezi-6, 24, 48, ne-72, u-p engaphantsi kwe-0.001 ngexesha ngalinye. Imindilili echanekileyo ibonakala kuphela kumzobo endaweni yetheyibhile yamanani, ngoko olu hlaziyo luxela ipateni ngaphandle kokuguqula ubude obuboniswe kwigrafu bube ngamanani abonakala echaneke ngakumbi kunokuba kunjalo.
Amayeza ongezelelweyo okuthomalalisa iintlungu
Ukuxelwa kokusetyenziswa kwamayeza ongezelelweyo kulapho ezi zilingo zahlukana khona ngomgangatho wengxelo.
Isilingo sango-2014 sixela ukusetyenziswa kweparacetamol okusezantsi ngokubalulekileyo ngokweenkcukacha-manani xa kusetyenziswe imethylene blue kwiintsuku 1 ukuya ku-3, ngokuhambelana nexesha esabonisa ngalo umahluko kwiintlungu, kodwa isishwankathelo esifumanekayo asiniki zixa, milinganiselo yabantu abayisebenzisileyo, okanye ixabiso lika-p elichanekileyo.
Isilingo sango-2024 sachaza iketorolac ecwangcisiweyo kunye netramadol xa kufuneka uncedo olongezelelweyo, nokubhalwa kweepilisi ezisetyenziswe ekhaya, kodwa iziphumo ezipapashiweyo azixeli ukusetyenziswa kwiqela ngalinye. Oko kungabikho kwedatha nako kubalulekile: ubungqina bokuthomalaliswa kweentlungu buxhomekeke kumanqaku eentlungu kuphela.
Isilingo sango-2026 sinika eyona datha icacileyo kulo mba. Ilornoxicam iyonke kwiiyure ezingama-72 yayinomndilili we-22.67 dibanisa okanye thabatha 17.01 mg xa kusetyenziswe imethylene blue, xa kuthelekiswa ne-56.80 dibanisa okanye thabatha 9.32 mg kwiqela elingatofwanga, u-p engaphantsi kwe-0.001. Qaphela ukungalingani: iqela lothelekiso lafumana amayeza okuthomalalisa iintlungu kuphela xa liwacelile, ngoxa iqela ledayi lafumana unyango olunye ngexesha lotyando.
Iingxaki nokulandelelwa kwezigulana
Akukho silingo sixela uphawu olukhulu lwengxaki yokhuseleko kwindawo yotyando, kodwa akukho nasinye esasiyilelwe ukubona umonakalo onqabileyo okanye ovela kamva. Ukuze ufumane umxholo ngeengozi, jonga inkcazelo yokhuseleko lwemethylene blue kunye neetheyibhile zeengxaki ezingezantsi.
Isishwankathelo sango-2014 sibalaselisa isiphumo esinye esiphawulekayo: umlinganiselo womngcipheko wokungakwazi ukukhupha umchamo okuvela ngesiquphe xa imethylene blue ingasetyenziswanga wawuyi-2.32, unesithuba sokuzithemba se-95 ekhulwini esisuka ku-1.75 ukuya ku-3.07. Amaqondo ezinye iingxaki awazange ahluke ngokubalulekileyo ngokweenkcukacha-manani.
Isilingo sango-2024 sixela iingxaki kwiintsuku ezili-14. Ukungakwazi ukukhupha umchamo kwenzeka kubantu aba-5 kwabangama-48 abafumana idayi eluhlaza okwesibhakabhaka nakwaba-5 kwabangama-49 kwiqela lothelekiso. Ukungakwazi ukuzibamba okwethutyana kwenzeka kwaba-3 xa kuthelekiswa no-1, yaye ukopha okwavela kamva kwenzeka ku-0 xa kuthelekiswa naba-2. Ukufa kwezicubu zolusu, usulelo, ukusabela kolusu kwindawo yotyando, nokucutheka komngxuma akwenzekanga nakweliphi na iqela, yaye ukurhawuzelelwa kwenzeka kube kanye kwiqela ngalinye. Akukho namnye umahluko owafikelela ekubalulekeni ngokweenkcukacha-manani.
Isilingo sango-2026 sixela kuphela iiyure ezingama-72. Usulelo lolusu nezicubu eziphantsi kwalo olujikeleze umngxuma wokukhupha ilindle, ukufa kwezicubu zolusu, namahlwili egazi ajikeleze loo mngxuma akwenzekanga nakweliphi na iqela. Asiniki manani aqokelelwe ngendlela ecwangcisiweyo ngokungakwazi ukukhupha umchamo, ukopha, usulelo, ukungakwazi ukuzibamba, ukuphola okulibazisekileyo, okanye ukubuyela kwengxaki. Ukudaywa kwethishu nomchamo kube luhlaza okwesibhakabhaka kuyavunywa njengengxaki yokufihla unyango, kunokuba kubhalwe kwitheyibhile njengesiganeko.
Ubude bokulandelelwa kwezigulana ngowona mda uphambili kuzo zontathu ezi zilingo: malunga neentsuku ezili-14 kwizilingo ezimbini zokuqala neeyure ezingama-72 kwesesithathu. Ukulibaziseka kokuphola, ukukwazi ukuzibamba ekuhambeni kweenyanga, nokuphinda kuvele iihemorrhoids akunakugwetywa ngale datha.
Itheyibhile yobungqina ngokosuku emva kotyando
Itheyibhile engezantsi ihlanganisa ulwazi oluphambili lweli phepha. Igcina iintlungu, ukusetyenziswa kwamayeza ongezelelweyo, amaqela othelekiso, iingxaki, nokulandelelwa kwezigulana kumbono omnye.
| Isilingo | Ubungqina beentlungu ngokosuku | Amayeza ongezelelweyo okuthomalalisa iintlungu | Umahluko wonyango lweqela lothelekiso | Iingxaki | Ukulandelelwa kwezigulana |
|---|---|---|---|---|---|
| Sim noTan 2014, n ilingana no-67 | IVAS isezantsi ngedayi eluhlaza okwesibhakabhaka kwiintsuku 1 ukuya ku-3; akukho mahluko ubalulekileyo emva kosuku 3; imindilili echanekileyo ayikho kwisishwankathelo esifumanekayo | Iparacetamol isetyenziswa kancinci ngedayi eluhlaza okwesibhakabhaka kwiintsuku 1 ukuya ku-3; izixa azinikwanga | Idayi eluhlaza okwesibhakabhaka kunye nebupivacaine xa kuthelekiswa nebupivacaine kunye nesisombululo setyuwa; kubeka bucala isiphumo esongezelelweyo sedayi | Umlinganiselo womngcipheko wokungakwazi ukukhupha umchamo 2.32 ngaphandle kwedayi eluhlaza okwesibhakabhaka; ezinye iziganeko azahlukanga ngokubalulekileyo | Idayari yeentlungu malunga neentsuku ezili-14 |
| Azhough 2024, n ilingana no-97 | Eyona NRS iphezulu yosuku ngalunye isezantsi ngedayi eluhlaza okwesibhakabhaka kwiintsuku 1 ukuya ku-7 (umsantsa umalunga namanqaku ayi-1.1 ekuqaleni, 0.6 ngosuku 7); akukho mahluko kwiintsuku 8 ukuya ku-14 | Inkqubo ichaziwe kodwa ukusetyenziswa kwiqela ngalinye akuxelwanga | Idayi eluhlaza okwesibhakabhaka 50 mg xa kuthelekiswa nebupivacaine; kubeka bucala isiphumo esongezelelweyo sedayi | Ukungakwazi ukukhupha umchamo 5 xa kuthelekiswa no-5; ukungakwazi ukuzibamba okwethutyana 3 xa kuthelekiswa no-1; ukopha 0 xa kuthelekiswa no-2; ukufa kwezicubu nosulelo 0 xa kuthelekiswa no-0; akukho mahluko ubalulekileyo | Iintsuku ezili-14 |
| Zhu 2026, n ilingana no-60 | IVAS xa isigulana siphumle isezantsi ngedayi eluhlaza okwesibhakabhaka kwiiyure ezi-6, 24, 48, 72, u-p engaphantsi kwe-0.001 ngexesha ngalinye; imindilili ikumzobo kuphela | Ilornoxicam iyonke 22.67 xa kuthelekiswa ne-56.80 mg, u-p engaphantsi kwe-0.001 | Idayi eluhlaza okwesibhakabhaka exutyiweyo eyi-5 mg okanye ngaphantsi xa kuthelekiswa nokungatofwa; owona mahluko mkhulu kulwakhiwo lothelekiso | Usulelo lolusu nezicubu eziphantsi kwalo, ukufa kwezicubu, namahlwili egazi 0 xa kuthelekiswa no-0; ukungakwazi ukukhupha umchamo, ukopha, ukuphola, nokubuyela kwengxaki akuxelwanga ngendlela ecwangcisiweyo | Iiyure ezingama-72 |
Intsingiselo yoku kudliwano-ndlebe nogqirha wotyando
Izilingo ezintathu ezincinci, ngasinye senziwe kwiziko elinye, zisebenzisa iidosi ezintathu ezahlukeneyo zedayi xa zithelekiswa neentlobo ezimbini ezahlukeneyo zonyango lothelekiso, ziyavumelana ukuba iintlungu zisezantsi kwiintsuku zokuqala emva kokususwa kweehemorrhoids xa imethylene blue yongezwa ngexesha lotyando. Obona bungqina buhlala ixesha elide buhlala iintsuku ezisi-7. Idatha yamayeza ongezelelweyo iyayixhasa le pateni kwizilingo ezimbini, yaye ayikho kwesesithathu. Ukulandelelwa okufutshane neesampuli ezincinci akunakukhupha amathuba eziphumo ezingaqhelekanga okanye ezivela kamva.
Imibuzo efanelekileyo yokuyisa kugqirha wotyando:
- Loluphi utyando olucwangcisiweyo, yaye ngawaphi amanyathelo asetyenziswa kwindawo yotyando asele eyinxalenye yokhathalelo oluqhelekileyo apho?
- Ngaba kufakwa nayiphi na idayi eluhlaza okwesibhakabhaka kwithishu, ngeyiphi idosi nakowuphi umaleko, yaye ithelekiswa nayiphi enye indlela?
- Ngawaphi amayeza aqhelekileyo nawongezelelweyo okuthomalalisa iintlungu acwangcisiweyo, yaye ukusetyenziswa kwawo kubhalwa njani?
- Ukungakwazi ukukhupha umchamo, ukopha, usulelo, nokukwazi ukuzibamba kulandelelwa njani, yaye kangangeeveki ezingaphi?
- Kufanele kulindelwe ukuba ukudaywa okwethutyana kolusu okanye komchamo kube luhlaza okwesibhakabhaka kubonakale njani, yaye kuphele nini?
Kubabhali abahlola uphando ngeentlungu ezinxulumene neenkqubo zonyango, uluhlu lokujonga lufutshane: uxinaniso oluchanekileyo, umthamo, nedosi iyonke; umaleko wethishu nexesha lokunika unyango xa lithelekiswa nokususwa; iyeza elisebenzayo elikwisirinji yeqela lothelekiso; unyango oluqhelekileyo lokuthomalalisa iintlungu olucwangcisiweyo xa luthelekiswa nolunikwa xa luceliwe; izixa zizonke zamayeza ongezelelweyo kwiqela ngalinye; amanqaku eentlungu axelwe ngosuku ngalunye; netheyibhile yeengxaki enamanani abantu asisiseko sokubala nexesha lokulandelelwa. Ngaphandle kwezo nkcukacha, ibango elihlanganisiweyo malunga nedosi alixhaswanga, kuba idayi eyi-50 mg efakwe ngaphakathi kulusu xa ithelekiswa nebupivacaine nedayi eyi-5 mg efakwe ngaphantsi kolusu xa ithelekiswa nokungafakwa nto ziindlela zonyango ezahlukeneyo.