Imethylene blue kuvavanyo lokukwazi ukuzala: oko kuboniswa yi-chromopertubation ngokwenene

Iziphumo zokukhangela malunga nemethylene blue nokukwazi ukuzala zidibanisa amabango amabini ahlukeneyo. Elinye lelokuba uvavanyo ngedayi eluhlaza okwesibhakabhaka ekliniki lunokubonisa ukuba imibhobho yeFallopian ivulekile na. Elinye lelokuba ukuthatha imethylene blue kuphucula ukukwazi ukuzala, amadlozi, okanye umgangatho wamaqanda. Libango lokuqala kuphela elinxulumene ne-chromopertubation. Elesibini alizange livavanywe kwaye aliyiyo inxalenye yale nkqubo. Lo mahluko sisiseko sayo yonke into engezantsi.

Umbuzo oluncedo ugxile kwinto encinane ngakumbi. Xa idayi eluhlaza okwesibhakabhaka ifakwa esibelekweni phantsi kweemeko zekliniki, kuze kubonakale ulwelo luphuma ngombhobho, loo mbhobho uvulekile ngelo xesha. Xa kungekho kuhamba kolwelo kubonakalayo, impendulo ayiqinisekanga kangangoko ibonakala. Uthelekiso luka-2021 lweemeko ezimbini zovavanyo ngedayi lubonisa ngokuchanekileyo apho ukutolikwa kweziphumo kunokuthenjwa khona nalapho kungathembekanga khona.

Ingcamango: luvavanyo lokuhamba kolwelo, hayi unyango lokuphucula ukukwazi ukuzala

Umbhobho ngamnye weFallopian ngumjelo omxinwa osuka esibelekweni usiya kwi-ovari. I-chromopertubation ivavanya uphawu olunye lwaloo mjelo: ukuba ulwelo lunokudlula na kuwo. Imethylene blue sisiphawuli esenza ukuhamba kolwelo kubonakale, kuba umbala wayo oqaqambileyo wahluke ngokucacileyo kwizicwili ezikhanyayo.

Indlela esisiseko iyafana kuzo zombini iimeko. Idayi ingena ngomlomo wesibeleko iye kumngxuma wesibeleko, aze ugqirha abukele okwenzeka emva koko. Idayi ephuma kwisiphelo esikude sombhobho ithetha ukuba uvulekile. Idayi eqokelelanayo ize ibuye umva ithetha ukuba ubonakala uvalekile. Esi siphumo sithetha ngokudlula kolwelo, kwicala elinye, ngosuku olunye.

Le yinkqubo eyenziwa ngugqirha. Uhlobo olwenziwa kwigumbi lokubonisana lwenzeka ngexesha le-hysteroscopy, apho isixhobo esibhityileyo sokujonga sijonga ngaphakathi esibelekweni. Uhlobo olwenziwa kwigumbi lotyando lwenzeka ngexesha le-laparoscopy, apho isixhobo sokujonga sijonga umphandle wemibhobho kunye nommandla wesinqe, ngokuqhelekileyo phantsi kwe-anesthesia epheleleyo. Akukho hlobo umntu azenzela lona, kwaye akukho nanye kwezi nkqubo enika iyeza elenzelwe ukutshintsha ukukwazi ukuzala. Idayi sisiphawuli esidlula kunye nolwelo. Iingcaciso zendlela imethylene blue esebenza ngayo njengedayi ziluncedo apha, kwaye umbuzo owahlukileyo wendlela yokufunda uphando ngemethylene blue uchaza isizathu sokuba isiphumo saselebhu singaze silingane nonyango lwekliniki.

Ukuvuleka akuthethi ukuba yonke into iqhelekile

Ukuvuleka ngumbandela omnye, kanti ukusebenza kombhobho ngumbandela obanzi ngakumbi. Umbhobho unokuvuleka kodwa ungawenzi umsebenzi wawo: usulelo okanye i-endometriosis zinokonakalisa iintsinga ezincinane ezihambisa iqanda, ziwushiye umjelo ubanzi ngokwaneleyo ukuba idayi idlule, kwaye izicwili zamanxeba ngaphandle kombhobho zinokugcina i-ovari ikude, ukuze iqanda lingangeni nangona idayi iphuma ngokukhululekileyo. Ukucutheka okungaphelelanga kunokuvumela umsinga omncinane wedayi ukuba udlule kodwa kuthintele iqanda elikhulu ngakumbi.

Ngoko isiphumo esibonisa ukuvuleka siphendula umbuzo omncinane ngokuqiniseka okufanelekileyo: ulwelo ludlule kumbhobho. Asiqinisekisi imeko yomaleko wangaphakathi, ukucholwa kweqanda, okanye ummandla wesinqe ojikelezileyo. Isiphumo esibonisa ukuvaleka sona asiqinisekanga ngakumbi, kuba iimeko zethutyana zinokumisa ukuhamba kolwelo kumbhobho ovulekileyo.

Oko kwathelekiswa luphononongo luka-2021

Ezona nkcukacha zicacileyo zothelekiso oluthe ngqo zivela kuphononongo lokuqala luka-2021 lwabasetyhini abangama-80 abangakwaziyo ukukhawula e-AIIMS New Delhi, kunye neendlela ezipheleleyo neziphumo ezifumanekayo kumbhalo ovuleleke kuye wonke umntu. Wonke umntu owayethatha inxaxheba wayesele ecwangciselwe i-hysterolaparoscopy. Abasetyhini ababenokuvaleka okuqinisekiswe ngaphambili, i-hydrosalpinx eyaziwayo, okanye usulelo oluqatha lommandla wesinqe abazange baqukwe.

Owasetyhini ngamnye wenziwa iimvavanyo ezimbini ngedayi zilandelelana. Okokuqala, i-hysteroscopy kwigumbi lokubonisana ngaphandle kwe-anesthesia: kwafakwa idayi exutywe nolwelo, kwaze kwajongwa ukuvuleka kombhobho ngamnye ukuze kubonwe ukuhamba kolwelo kunye nokuphela kombala oluhlaza okwesibhakabhaka kumngxuma wesibeleko. Emva koko kwenziwa i-minilaparoscopy phantsi kwe-anesthesia epheleleyo njengovavanyo lokuthelekisa: idayi yangena ngekhathetha engaphakathi esibelekweni, kwaze kwagwetywa umbhobho ngamnye ngokuphuma kwedayi okubonakalayo ukuya kummandla wesinqe. Imibhobho yomibini yabalwa ngokwahlukeneyo, nto leyo eyavelisa iziphumo ezili-160.

Uvavanyo lokuthelekisa lwafumanisa ukuba imibhobho eli-136 kweli-160 ivulekile (85 ekhulwini). Uvavanyo lwegumbi lokubonisana lwabonisa eli-125 ivulekile (78 ekhulwini). Ukuvumelana kwakulungile kodwa kwakungalingani: imibhobho eli-119 yayivulekile kuzo zombini iimvavanyo, eli-18 ivalekile kuzo zombini, eli-17 yaboniswa ivalekile luvavanyo lwegumbi lokubonisana kodwa ivulekile kwi-laparoscopy, kwaye emi-6 yaboniswa ivulekile luvavanyo lwegumbi lokubonisana kodwa ivalekile kwi-laparoscopy. Xa kuthelekiswa ne-laparoscopy njengovavanyo lokuthelekisa, uvavanyo lwegumbi lokubonisana lwabonisa amandla okubhaqa ukuvuleka angama-87.5 ekhulwini, amandla okuchonga ukuvaleka ngokuchanekileyo angama-75 ekhulwini, ixabiso lokuxela kwangaphambili isiphumo sokuvuleka elingama-95.2 ekhulwini, ixabiso lokuxela kwangaphambili isiphumo sokuvaleka elingama-51.4 ekhulwini, nokuchaneka ngokubanzi okungama-85.6 ekhulwini.

Wafunde la manani njengomfundi, hayi njengengcali yezibalo. Isiphumo sokuvuleka esivela kuvavanyo lwegumbi lokubonisana sasiqhele ukuchaneka. Isiphumo sokuvaleka sasisondele kwithuba lamashumi amahlanu kumashumi amahlanu: malunga nesiqingatha kuphela seziphumo zokuvaleka zegumbi lokubonisana ezaqinisekiswa kwi-laparoscopy. Oku kungalingani yeyona nto iluncedo kakhulu ekusebenzeni ekweli phepha.

Isizathu sokuba ukuvaleka okubonakalayo kube sisiphumo esingaqinisekanga ngakumbi

Esona sizathu siqhelekileyo kukuqina kwemisipha okwethutyana. Ikona yesibeleko apho umbhobho uqala khona inokufinyela okwethutyana ize icinezele umjelo ovulekileyo uvaleke. Ulwelo olubandayo kunye neentlungu zokuqaqanjelwa zixoxwa kweli phepha njengezinto ezinokubangela oku. Ukufinyela kuyaphela, kodwa isiphumo esithathwe ngelo xesha sibonakala sifana nokuvaleka kokwenene, nto leyo ebangela ukuba ukuvaleka okukodwa kwisiphelo esikufuphi nesibeleko kulo naluphi na uvavanyo olunye kungamkelwa ngaphandle kwamathandabuzo.

Indlela yokwenza uvavanyo nayo yongeza iimpazamo. Ukufaka idayi ngokukhawuleza kubangela ukubuyela kolwelo umva okufana nokuvaleka, kwaye ukujonga kwicala elingafanelekanga kunokwenza ukuba ukuphuma kwedayi okuncinane kungabonwa. Uphononongo lusebenzise ugqirha wotyando omnye onamava ngalo lonke ixesha, ngoko umahluko kwindlela yokusebenza eqhelekileyo usenokuba mkhulu ngakumbi.

Isiphumo soku kwinkqubo yekliniki silandela ngokuthe ngqo. Ukuvaleka okubonakalayo kuvavanyo ngedayi kwigumbi lokubonisana sisizathu sokuqinisekisa, hayi uxilongo ekufanele kusetyenzwe ngalo lodwa. Ukuqinisekisa kudla ngokuthetha uvavanyo lokuthelekisa lwe-laparoscopy okanye olunye uvavanyo lwemibhobho olukhethwe liqela elijongene nokukwazi ukuzala, lutolikwe kunye nembali yesigulana, umngcipheko wosulelo, nemifanekiso yovavanyo. Uvavanyo lwemethylene blue lwemibhobho yeFallopian luqinisekisa ukuvuleka ngokomelela ngakumbi kunokuba lukuqinisekisa ukungavuleki.

Oko ukuhamba kwedayi kungenakukubona

I-chromopertubation ilinganisa ukudlula kolwelo. Iimeko ezininzi ezibalulekileyo ekukwazini ukuzala azibonakali kolu vavanyo. Ukuncamathelana kwezicwili ezijikeleze umbhobho, okuyimicu yezicwili zamanxeba ejikeleze umbhobho, akubonakali nge-hysteroscope, ebona kuphela umngxuma wesibeleko neendawo zokuvuleka kwemibhobho. I-laparoscopy ikubona ngokuthe ngqo; kolu phononongo abasetyhini aba-4 kwabangama-80 bafunyaniswa benokuncamathelana kwezicwili kwelo nqanaba kuphela, kwaye umsebenzi wangaphambili ubonisa ukuba oku kwandisa amathuba esiphumo sokuhamba kolwelo esinika isiqinisekiso sobuxoki.

I-hydrosalpinx, umbhobho odumbe ngenxa yolwelo olubangelwe kukuvaleka kwisiphelo esikude nesibeleko, nayo ayibonakali kakuhle kolu vavanyo: iimeko ezaziwayo azizange ziqukwe, kodwa i-hydrosalpinx ebingaziwa yabonakala kwi-laparoscopy kwabasetyhini abasi-7 kwabangama-80. I-endometriosis, ukonakala komaleko wangaphakathi, kunye nokuphazamiseka kokucholwa kweqanda zigqibezela olu luhlu. Yiyo loo nto izikhokelo zokuvavanya ukukwazi ukuzala zichaza i-chromopertubation njengenyathelo elenziwa xa kukho esinye isizathu sokwenza i-laparoscopy, njengoko kuboniswa luluvo lwekomiti ye-ASRM ngovavanyo lokungakwazi ukukhawula. Umxholo obanzi weenkcukacha zokhuseleko lwemethylene blue ubalulekile xa kuqwalaselwa naluphi na uvavanyo lotyando.

Indlela eyahluke ngayo kwezinye iimvavanyo zemibhobho

I-hysterosalpingography (HSG) idlulisa isiphawuli esibonakala kwi-X-ray ngomlomo wesibeleko, ize isebenzise imifanekiso ye-X-ray ukubonisa imida yomngxuma wesibeleko neyemibhobho. Ibhala ukuphuma kwesiphawuli njenge-chromopertubation, kodwa yongeza imitha, ayikwazi ukuhlola ummandla wesinqe ongaphandle, kwaye nayo inengxaki yokufinyela kwemisipha kwikona yesibeleko.

I-ultrasound esebenzisa ulwelo lwetyuwa ifaka ulwelo lwetyuwa olungenazintsholongwane kumngxuma wesibeleko ngoxa isixhobo esifakwe kwilungu lobufazi sithatha imifanekiso. Ukuthatha imifanekiso ngolwelo lwetyuwa olungenaso isiphawuli ikakhulu luvavanyo lomngxuma wesibeleko: ulwelo kummandla wesinqe lubonisa ukuba ubuncinane umbhobho omnye uvulekile, kodwa ngokuqhelekileyo alukwazi ukubonisa ukuba ngowuphi. I-ultrasound esebenzisa isiphawuli esinogwebu okanye amaqamza amancinane ilandelela umbhobho ngamnye kwaye ifana ngakumbi novavanyo ngedayi.

Ukhuseleko nendawo eyenziwa kuyo, ngamazwi alula

Kuphononongo lwezigulana ezingama-80, ababhali abachazanga naziphi na iingxaki ezinkulu okanye ezincinane ezivela kulo naluphi na uvavanyo ngedayi. Oku kuyakhuthaza phakathi kwemida yophononongo lokuqala oluncinane, kodwa akuthethi ukuba akukho mngcipheko: iingxelo zezehlo emva kwe-chromopertubation zichaza ukusabela okunqabileyo kobuntununtunu obugqithisileyo, i-methemoglobinemia, ukungena kwedayi kwimithambo yegazi, kunye neengxaki zemiphunga, kodwa izinga lokwenzeka kwazo alikalilinganiswa kakuhle.

Oku kukhokelela kwiingongoma ezimbini. Uhlobo lwe-laparoscopy longeza imingcipheko eqhelekileyo yotyando ne-anesthesia, nto leyo ebangela ukuba lugcinelwe iimeko apho ukuhlolwa ngotyando sele kucwangcisiwe. Kwaye akukho nto kule nkqubo edluliselwa ekusetyenzisweni ekhaya: amandla omxube, ukungabikho kwezintsholongwane, indawo yokuwufaka, nokulungela iimeko ezingxamisekileyo luxanduva lweqela lekliniki.

Ngoko isishwankathelo esifanelekileyo sinemiqathango. I-chromopertubation ngemethylene blue ibonisa ukuba ulwelo ludlula na kumbhobho xa kubukelwe, kwaye isiphumo sokuvuleka sithembeke kakhulu ngakumbi kunesokuvaleka. Ayilinganisi ukusebenza kombhobho, ayifumani zonke izizathu zokungakwazi ukukhawula ezikummandla wesinqe, kwaye ayinyangi nantoni na. Nabani na onikwa ithuba lokwenza olu vavanyo kufuneka abuze imibuzo emithathu: yeyiphi indawo nendlela ecwangcisiweyo, kwaye kutheni; kwenzeka ntoni xa isiphumo sibonisa ukuvaleka; kwaye zeziphi ezinye izinto ezinokufunyanwa eziya kutshintsha isicwangciso.