Inqaku
Imethylene blue yokurhawuzelelwa komngxuma welindle okuqhubekayo: ubungqina nemida
Khawucinge ngesigulana esizame iikhrimu ezikhusela ulusu, amayeza okulwa umngundo, izithambiso ze-steroid, nokutshintsha indlela yococeko kangangeenyanga, kodwa ukurhawuzelelwa komngxuma welindle ebusuku kusaqhubeka. Ugqirha otyanda ikholoni nomqolo welindle ukhankanya ukutofwa kwedayi eluhlaza kulusu olujikeleze umngxuma welindle. Uninzi lwabafundi lucinga ngolwelo oluthomalalisayo olugquma ulusu, njengekhrimu yokuthambisa efakwa ngenaliti. Le nkqubo kuthethwa ngayo isebenza ngengcamango eyahlukileyo. Yonzakalisa iziphelo ezincinci zemithambo-luvo yezivamvo kumaleko wedermis ukuze iphule umjikelo wokurhawuzelelwa nokukrwela, yaye ubungqina obuyixhasayo buvela kwiqela elincinci lothotho lweemeko zotyando olungenamaqela othelekiso nolunokulandelwa okungalinganiyo.
Eli nqaku liphonononga ezo ncwadi zophando. Lichaza okubandakanywa yile nkqubo yengcali, izinto ekufuneka zikhutshelwe ngaphandle ngaphambi kokuba ukurhawuzelelwa kuthiwe akunamvelaphi yaziwayo, ingxelo yemithombo emibini ephambili, neendawo apho ubungqina bunganelanga khona. Ukuze ufumane imvelaphi ngale khompawundi ngokwayo, jonga indlela imethylene blue esebenza ngayo kwinqanaba leeseli, kunye noluhlu olubanzi lokusetyenziswa kwezonyango okugunyazisiweyo nokusaphandwayo.
Yinkqubo, hayi ikhrimu
Ukutofwa kwemethylene blue ngaphakathi kolusu okanye kanye ngaphantsi kwalo ukunyanga ipruritus ani engenamvelaphi yaziwayo nengaphenduliyo kunyango yinkqubo engena emzimbeni eyenziwa yingcali yezonyango. Iiprothokholi ezipapashiweyo zifaka imethylene blue exutyiweyo kumaleko wedermis wolusu oluchaphazelekileyo olujikeleze umngxuma welindle, phantsi kweemeko ezingenazintsholongwane, ngokuqhelekileyo kusetyenziswa iyeza lokuphelisa uvakalelo kwindawo ethile okanye ukuvalwa kwemithambo-luvo yommandla, isigulana silele ngesisu. Indlela ekujoliswe kuyo kukutshatyalaliswa ngekhemikhali kweziphelo zemithambo-luvo yezivamvo ezikufutshane nomphezulu. IAmerican Society of Colon and Rectal Surgeons ichaza ukutofwa ngaphakathi nangaphantsi kolusu oluchaphazelekileyo yaye ilumkisa ukuba ukutofa kufutshane kakhulu nomphezulu kunomngcipheko wokonakala kolusu okanye wokubakho kwezilonda.
Iiyantlukwano ezintathu zibalulekile. Okokuqala, imethylene blue ethambiswa phezu kolusu ayilulo ungenelelo oluvavanywe zezi zifundo, yaye abukho ubungqina obuthelekisekayo obubonisa ukuba inokuthatha indawo yenkqubo yokutofwa ngaphakathi kolusu. Okwesibini, ukuzitofa akunakuxhaswa ngokwandisa intsingiselo yeeprothokholi ezipapashiweyo. Ukulawula ubunzulu yeyona nto ibalulekileyo kukhuseleko: ukutofa kufutshane kakhulu nomphezulu kunomngcipheko wezilonda nokufa kwezicubu, kanti ukutofa nzulu kakhulu okanye ukusebenzisa indlela engenacoceko oluthintela iintsholongwane kunomngcipheko wethumba elinobofu nokonzakala kwamalungu omzimba. Okwesithathu, imethylene blue etofwayo ethengiswa eUnited States ibhalelwe ukunyanga imethemoglobinemia efunyenwe emva kokuzalwa ngokutofwa emthanjeni, ngoko ukusetyenziswa ngaphakathi kolusu olujikeleze umngxuma welindle kungaphandle kokusetyenziswa okubhalwe kwileyibhile. Abafundi abasebenzisa amayeza achaphazela iserotonin bafanele baphonononge izilumkiso ngesifo seserotonin nokusebenzisana kwamayeza, ekuxoxwa ngazo ngakumbi ngezantsi.
Fumanisa unobangela kuqala: ukurhawuzelelwa okuninzi kunonobangela
Ipruritus ani ichaza uphawu, hayi isifo esinye. Izikhokelo zahlula oonobangela abaziwayo babe ngabo banxulumene nomngxuma nomqolo welindle, ulusu, usulelo, umzimba uphela, ukucaphuka, kunye neemeko zengqondo; zikwacebisa ukuthathwa kwembali yesigulana, ukuhlolwa komngxuma nomqolo welindle nge-anoscopy, kunye novavanyo olujoliswe kwizinto ezithile ngaphambi kokusebenzisa igama elithetha ukuba akukho mvelaphi yaziwayo. Izikhokelo zokusebenza zeItalian Society of Colorectal Surgery zichaza olu phando, kuquka ukuthathwa kweesampulu ngokuswayipha okanye ukukrwela, iimvavanyo zaselabhoratri, uvavanyo lwepatch lokufumanisa izinto ezicaphukisa ulusu, nokuthathwa kwesampulu yezicubu okukhethwa ngokweziphumo ezifunyenweyo.
Oonobangela abaqhelekileyo ekufuneka bakhutshelwe ngaphandle baquka iihæmorrhoids, ukuqhekeka kolusu, ifistula, amaqhekeza esikhumba ajingayo, ukuvuza kwelindle okanye ukungakwazi ukulibamba, ukuphuma kwenxalenye yomqolo welindle, neentsumpa, kunye nokudumba kolusu ngenxa yokudibana neesepha, amalaphu okusula, iziqholo, neemveliso zokuthambisa, kwakunye nokufuma nongcoliseko lwelindle olungabonakaliyo. Iimeko zolusu ezinokufana noku ziquka ipsoriasis, ilichen sclerosus, nelichen simplex chronicus. Usulelo luquka iCandida, umngundo wedermatophyte, iintshulube zepinworm, ukhwekhwe, noonobangela abasasazwa ngokwabelana ngesondo. Iimeko zomzimba ezinxulunyaniswa noku ziquka isifo seswekile, isifo sesibindi esiphazamisa ukuhamba kwenyongo, isifo sezintso esingapheliyo, neziphazamiso zethyroid. Izilonda eziqhubekayo, ezingaqhelekanga, okanye ezivulekileyo zifuna ukuthathwa kwesampulu yezicubu ukuze kukhutshelwe ngaphandle ukukhula kweeseli okungaqhelekanga kumaleko ogquma umngxuma welindle okanye isifo sePaget esingaphandle kwebele. Liqela elincinci kakhulu kuphela elineempawu eziqhubekayo nezinamandla nangona sele kwenziwe olu phando nonyango olungeneleliyo eliqwalaselwa ukuba litofwe; oku kukwayimbono yesikhokelo seASCRS sezigulana.
Oko kwafunyanwa luhlalutyo oludibanisa izifundo luka2023
Olona hlanganiso lubanzi luhlalutyo luka2023 oludibanisa izifundo ezineqela elinye, olwenziwa nguJia noogxa bakhe, olwadibanisa izifundo eziyi7 nezigulana eziyi225. Ukuphela kweempawu emva kokutofwa kanye kwakuyi76.1 ekhulwini (95 ekhulwini CI 64.9 ukuya ku87.3), kwenyuka kwafikelela ku85.4 ekhulwini emva kokutofwa okwesibini. Ukungabikho kweempawu okuxeliweyo kwakuyi75.3 ekhulwini kunyaka omnye kunye ne77.3 ekhulwini kwiminyaka emithathu, kwehla kwafikelela ku24.0 ekhulwini kwiminyaka emihlanu.
La manani afuna ukufundwa ngononophelo. Izifundo ezadityaniswayo zaziluthotho olungenamaqela othelekiso olususela ku1979 ukuya ku2019, luneendlela, ugxininiso lwezinyibilikiso, neziphumo zokuvavanya ezahlukahlukeneyo, yaye ukwahlukahlukana ngokwezibalo kwakuphezulu. Iipesenti zexesha elide aziveli kwiqela elinye elalandelwa iminyaka emihlanu. Izifundo ezincinci ezahlukileyo zanikela idatha ngamaxesha ahlukeneyo, ngoko inani leminyaka emihlanu alomelelanga. Iingxaki eziqhelekileyo yayikukushiyeka kombala oluhlaza okwexeshana kulusu nokundindisholo okujikeleze umngxuma welindle; iziganeko ezixeliweyo zaquka usulelo lwecellulitis, ukuqokelelana kwegazi kwizicubu, ukuvuza kwelindle okwexeshana, ukungakwazi ukukhupha umchamo, ithumba elinobofu elikufutshane nomphezulu, nokutshintsha kwemvakalelo okuhlala ixesha elide. Ngokubalulekileyo, uthotho lwembali lokufa kwezicubu zolusu lukaEusebio noogxa bakhe (1990) lwalungekho phakathi kwezifundo ezisixhenxe ezadityaniswayo, ngoko amazwi aqinisekisayo ngokhuseleko kolu hlalutyo awathethi ukuba ukufa kwezicubu akuzange kwenzeke. Isishwankathelo sethu seprofayili yokhuseleko lwemethylene blue sibeka ezi ziganeko kumxholo ofanelekileyo.
Oko kwafunyanwa sesona sifundo sinye sikhulu
Esona sifundo sinye sikhulu luphononongo luka2019 olubuyela emva kwisiseko sedatha esasiqokelelwe kulandelwa izigulana ukuya phambili, olwenziwa nguKim noogxa bakhe. Kwizigulana eziyi362 ezafika zinokurhawuzelelwa komngxuma welindle, eziyi259 zaphucuka ngonyango olungeneleliyo, kwashiyeka eziyi103 ezineempawu ezinzima ezingaphenduliyo kunyango, ezanyangwa ngokutofwa ngaphakathi kolusu. Iprothokholi yaxuba i5 mL yesinyibilikiso sokuqala semethylene blue esiyi1 ekhulwini kunye ne15 mL yelidocaine eyi1 ekhulwini, kwafumaneka i20 mL yomxube wokutofa onogxininiso lokugqibela olumalunga ne0.25 ekhulwini, eyafakwa kusetyenziswa indlela ye-saddle block yokuphelisa uvakalelo. Lo mahluko phakathi kogxininiso lwesinyibilikiso sokuqala nolomxube wokugqibela uyaphindaphindeka kwiincwadi zophando: amaphepha athi 1 ekhulwini adla ngokuchaza isinyibilikiso sokuqala, hayi umxube oxutyiweyo otofwayo ngokwenene.
Kwiiveki ezintandathu, izigulana eziyi87 kweziyi96 ezalandelwayo (90.6 ekhulwini) zachazwa njengeziphucukileyo. Izigulana ezisibhozo zaphinda zatofwa kamva, ezintlanu zaphucuka. Kwiminyaka emithathu, izigulana eziyi53 kweziyi62 ezazifumaneka kuvavanyo lwexesha elide (85.5 ekhulwini) zaziphucukile, yaye kweziyi53 ezaziphendule ekuqaleni, eziyi4 (7.5 ekhulwini) zaphinda zaba neempawu. Ukulahleka kwezigulana ekulandelweni kuthintela ukuthembeka kwala manani: kuphela eziyi62 kweziyi103 zokuqala ezanikela idatha yeminyaka emithathu. Ukushiyeka kombala oluhlaza kulusu kwaqhubeka kweziyi84 kweziyi96 (87.5 ekhulwini) kwiiveki ezintandathu, ngokuqhelekileyo kuncipha kube ngamachokoza amancinane malunga neeveki ezine. Ukuqokelelana kwegazi kwizicubu kwenzeka kweziyi6 kweziyi62 (9.7 ekhulwini) kwaza kwaphela ngokwako. Ababhali baxela ukuba kwakungekho kuvuza kwelindle, cellulitis, kufa kwezicubu, okanye amathumba anobofu kwiqela labo.
Itheyibhile yomgangatho wezifundo nokulandelwa
Itheyibhile engezantsi ngowona mthombo ungundoqo wolu phononongo. Ugxininiso oluphawulwe nge-asterisk luqikelelo lomxube wokugqibela, kuba amaphepha aliqela axela kuphela amandla esinyibilikiso sokuqala.
| Isifundo | Uyilo nezigulana | Iprothokholi yokutofa | Ukulandelwa | Ukusebenza nokuphinda kuvele kweempawu | Iziphumo ezingathandekiyo |
|---|---|---|---|---|---|
| Wolloch noDintsman, 1979 | Uthotho lweemeko, n=9 | Malunga ne10 ukuya ku15 mL yesinyibilikiso esiyi1%, ngaphantsi kolusu | Iinyanga eziyi3 ukuya ku15 | Eziyi8 kweziyi9 zaphucuka emva kokutofwa kokuqala; eziyi9 kweziyi9 emva kokuphinda kutofwe | Umkhuhlane malunga nosuku olunye, esi1 kweziyi9 |
| Eusebio, Graham, noMody, 1990 | Uthotho lweemeko, n=23 | Ukuya kutsho kwi30 mL yesinyibilikiso esiyi0.5%, sifakwa sisasazwe ngaphakathi kolusu | Abaphendulileyo ngaphaya kweeveki eziyi12, abanye ukuya kwiminyaka eyi9 | Eziyi21 kweziyi23 zaphendula ngokupheleleyo okanye ngokuyinxenye ekuqaleni; iimpawu zaphinda zavela kweziyi4 kwabayi18 abaphendulileyo (22%) xa kulandelwa ixesha elide | Ukufa kwezicubu kulo lonke ubukhulu bolusu, eziyi3 kweziyi23 (13%), kufuna ukususwa kwezicubu ezifileyo |
| Farouk noLee, 1997 | Uthotho olulandelwa ukuya phambili, n=6 | I10 mL yesinyibilikiso sokuqala esiyi1% kunye neyeza lokuphelisa uvakalelo nesinyibilikiso setyuwa, malunga ne0.44% ekugqibeleni* | Ixesha eliphakathi yiminyaka eyi3, ukusuka kweyi2 ukuya kweyi5 | Eziyi5 kweziyi6 zaphucuka kakhulu ekuqaleni; ukuphinda kuvele kweempawu okuqokelelweyo malunga ne20% kunyaka oyi1, 40% kwiminyaka eyi2, 60% kwiminyaka eyi3 | Ukungakwazi ukukhupha umchamo, ithumba elinobofu elikufutshane nomphezulu, ukungakwazi ukubamba ilindle okwexeshana, esi1 kweziyi6 kwimeko nganye |
| Botterill noSagar, 2002 | Uthotho olulandelwa ukuya phambili, n=25 | I5 mL yesinyibilikiso sokuqala esiyi1% kunye nelignocaine nehydrocortisone, malunga ne0.25% ekugqibeleni* | Ixesha eliphakathi ziinyanga eziyi11, ukusuka kweziyi2 ukuya kweziyi25 | Eziyi16 kweziyi25 azinazimpawu emva kokutofwa kanye; eziyi22 kweziyi25 (88%) emva kokuphinda kutofwe | Ukuvuza kwelindle okwexeshana, esi1 kweziyi25, malunga neentsuku eziyi2 |
| Mentes noogxa, 2004 | Silandelwa ukuya phambili, ngaphandle kokwabiwa ngokungakhethiyo, n=30 | Malunga ne15 mL enogxininiso lokugqibela lwe1%, evela kwisinyibilikiso sokuqala esiyi2% esixutywe malunga ne1:1, ngaphakathi kolusu nangaphantsi kwalo kufutshane nomphezulu | Iinyanga eziyi12 kuninzi; iinyanga eziyi5 ukuya ku24 | Eziyi24 kweziyi30 azinazimpawu kwinyanga eyi1; malunga neziyi28 kweziyi30 emva kokuphinda kunyangwe; eziyi23 kweziyi30 kwiinyanga eziyi12; iimpawu zaphinda zavela malunga neziyi5 kweziyi28 (18%) | Icellulitis ephela ngokwayo, eziyi2 kweziyi30 (7%) |
| Sutherland, Faragher, noFrizelle, 2009 | Uthotho olulandelwa ukuya phambili logqirha omnye wotyando, n=49 | I10 mL yesinyibilikiso sokuqala esiyi1% kunye nebupivacaine eneadrenaline nemethylprednisolone, malunga ne0.32% ekugqibeleni* | Ubukhulu becala iiveki eziyi4 neziyi8 | Ukuphucuka kweziyi47 kweziyi49 (96%); ukuphela kweempawu ngokupheleleyo kweziyi28 kweziyi49 emva kokutofwa kanye, eziyi32 kweziyi49 (65%) emva kokuphinda kutofwe | Ukutshintsha kokukwazi ukubamba ilindle kweziyi7 kweziyi49 (14%), kwaphela phakathi kweentsuku ezimalunga ne10 ukuya kwiiveki eziyi6; ukuncipha kwemvakalelo okubangela inkxwaleko kweziyi2 kweziyi49 (4%) |
| Samalavicius noogxa, 2012 | Uthotho olulandelwa ukuya phambili, n=10 | Kwaxelwa i15 mL yesinyibilikiso esiyi1%, ngaphakathi kolusu | Ixesha eliphakathi ziinyanga eziyi47, ukusuka kweziyi29 ukuya kweziyi60 | Eziyi10 kweziyi10 zaphela iimpawu kwiiveki eziyi4; iimpawu zaphinda zavela kweziyi8 kweziyi10 (80%) xa ziqwalaselwa ixesha elide | Ukundindisholo nokushiyeka kombala kulusu okwexeshana; ukudumba ukuya kutsho malunga neenyanga eziyi2; akuxelwanga kufa kwezicubu |
| Kim, Kim, noLee, 2019 | Uphononongo olubuyela emva kwisiseko sedatha eqokelelwe ngokulandelela ukuya phambili, n=103 ezanyangwayo | I5 mL yesinyibilikiso sokuqala esiyi1% kunye ne15 mL yelidocaine eyi1%, malunga ne0.25% ekugqibeleni* | Iiveki eziyi6 (eziyi96 kweziyi103) neminyaka eyi3 (eziyi62 kweziyi103) | Eziyi87 kweziyi96 zaphucuka kwiiveki eziyi6 (91%); eziyi53 kweziyi62 zaphucuka kwiminyaka eyi3 (86%); iimpawu zaphinda zavela kweziyi4 kwabayi53 abaphendulileyo (8%) | Ukushiyeka kombala kulusu kweziyi84 kweziyi96 kwiiveki eziyi6 (88%); ukuqokelelana kwegazi kwizicubu kweziyi6 kweziyi62 (10%); akukho kuvuza kwelindle, cellulitis, kufa kwezicubu, okanye thumba linobofu |
Ipateni kwimiqolo iyafana. Ukuphendula kwangethuba kudla ngokuba phezulu, kanti uqikelelo lokuphinda kuvele kweempawu luxhomekeke kakhulu ekubeni izigulana ziqwalaselwa ixesha elingakanani nokuba zingaphi eziqhubeka nokulandelwa. USamalavicius waxela ukuphela kweempawu kwangethuba kwi100 ekhulwini, kodwa iimpawu zaphinda zavela ekugqibeleni kwi80 ekhulwini ngexesha eliphakathi leenyanga eziyi47; uKim waxela ukuphinda kuvele kweempawu ngaphantsi kwe8 ekhulwini kwiminyaka emithathu phakathi kwabaphendulileyo abaqhubeka nokulandelwa. Iisampulu ezincinci, ukuphindwa kweenaliti, iziphumo zokuvavanya ezahlukileyo, nokulahleka kwezigulana ekulandelweni kwenza ukuba ukuthelekisa ngokuthe ngqo kungathembeki.
Imida umfundi afanele ayikhumbule
Akukho lingo olwabela izigulana kumaqela ngokungakhethiyo oluxhasa le nkqubo. Lonke uqikelelo lokusebenza olungentla luvela kuthotho olungenamaqela othelekiso okanye kwiqela eliphononongwa ngokubuyela emva, ngoko ukuphendula kwiplacebo, ukubuyela kwinqanaba eliqhelekileyo, namanyathelo ococeko asetyenziswa ngaxeshanye akunakwahlulwa kwimpembelelo yonyango. Iiprothokholi ziyahluka kumaleko okutofwa kuwo, umthamo, indlela yokuxela ugxininiso, ukuxutywa kwamayeza okuphelisa uvakalelo, nokusetyenziswa kwee-steroid, nto leyo ethetha ukuba akukho dosi ibekwe njengomgangatho: thelekisa ugxininiso lwemixube yokugqibela, hayi iileyibhile zezinyibilikiso zokuqala. Uthotho lwezigulana eziyi6 ukuya ku103 alunako ukumisela izinga leziganeko ezinqabileyo ezifana novakalelo olugqithisileyo okanye ukusabela komzimba uphela, yaye ukulandelwa kokuphinda kuvele kweempawu emva kwexesha akuphelelanga kuninzi lwezifundo.
Imbali yokufa kwezicubu ifanele ichazwe ngokucacileyo. Izigulana ezintathu kweziyi23 kuthotho lukaEusebio luka1990 zaba nokufa kwezicubu kulo lonke ubukhulu bolusu, okwafuna ukususwa kwezicubu ezifileyo. Ukususela ngoko indlela yokusebenza itshintshele kwimixube yokugqibela exutywe ngakumbi nasekutofweni ngaphakathi kolusu endaweni yokutofwa nzulu, yaye uthotho lwamva luxela iingxaki ezingenabuzaza kangako, kodwa esi siganeko sembali siyinxalenye yengxelo yaye sisilumkiso sokungayamkeli le nkqubo ngokungakhathali.
Izilumkiso zamayeza achaphazela umzimba uphela nazo ziyasebenza ngokomgaqo. Ulwazi lwangoku lokumisela imethylene blue etofwayo lunesilumkiso esikwibhokisi ngesifo seserotonin esinokubulala xa isetyenziswa namayeza achaphazela iserotonin kunye nee-opioid, ludwelisa iingxelo ze-anaphylaxis, yaye luyakwalela ukusetyenziswa xa kukho ukunqongophala kweG6PD okanye uvakalelo olugqithisileyo olukhulu kwiidayi zethiazine. Ezi zilumkiso zisuka ikakhulu ekusetyenzisweni ngokutofwa emthanjeni okuchaphazela umzimba uphela, yaye umlinganiselo wokuchanabeka komzimba uphela emva kokutofwa kwindawo ejikeleze umngxuma welindle awukaziwa kakuhle, ngoko akunakucingelwa ukuba azibalulekanga. Xela onke amayeza okulwa ukudakumba, ii-opioid, nemeko yakho yeG6PD ngaphambi kwayo nayiphi na inkqubo yemethylene blue.
Ngubani onokuxoxa ngayo nengcali yezonyango
Iqela labantu abanokuqwalaselwa lincinci: abo banokurhawuzelelwa okungenamvelaphi yaziwayo okuqhubekayo emva kokuba oonobangela abaziwayo bekhangelwe namanyathelo angangeneleliyo engaphumelelanga, yaye okunzima ngokwaneleyo ukuba ukushiyeka kombala kulusu, ukundindisholo, nomngcipheko omncinci wosulelo okanye wokuphazamiseka kokubamba ilindle kube ziziphumo ezamkelekileyo xa zithelekiswa nako. Yiza noluhlu lwexesha leempawu, unyango oludlulileyo nemihla yalo, iingxelo zovavanyo eziquka i-anoscopy nayo nayiphi na isampulu yezicubu ethathiweyo, kunye noluhlu olupheleleyo lwamayeza. Imibuzo eluncedo iqokelelwe kwimibuzo yethu onokuyibuza ingcali yezonyango ngemethylene blue. Musa ukufuna ukutofwa yingcali etsiba uphando lokufumanisa unobangela, yaye ungaze uzame ukuzitofa.