I-methylene blue ekutholeni ama-lymph node okuqala: odayi, izinto zokulandela umkhondo, nokunemba

Udokotela ohlinzayo owelapha umdlavuza webele osesigabeni sokuqala ubhekene nombuzo oqondile: ingabe isimila sesifinyelele kuma-lymph node asekhwapheni? Ukukhipha wonke la ma-node kuyawuphendula lo mbuzo, kodwa kudala ubungozi bokuvuvukala ngenxa yokunqwabelana kwe-lymph nezinkinga zengalo ezihlala isikhathi eside ezigulini eziningi okugcina kutholakala ukuthi umdlavuza awukho kuma-node azo. Umqondo we-sentinel node uvumela ukuhlinzwa okulinganiselwe. I-node yokuqala, noma iqoqo elincane lama-node, ethola uketshezi oluphuma endaweni yesimila iyatholwa ngesikhathi sokuhlinzwa, ikhishwe, bese ihlolwa. Uma ingenawo umdlavuza, kungenzeka ukuthi nawo wonke ama-node akuleyo ndawo awunawo, ngakho kungagwenywa ukuwakhishwa wonke.

Ngakho konke kuncike ekutholeni leyo node ngendlela ethembekile. Yilokho okwenziwa izinto zokulandela umkhondo, futhi kulapho i-methylene blue ingena khona.

Izinto ezimbili zokulandela umkhondo, izimpawu ezimbili ezibonakalayo

Ukudideka okuvamile kuthatha udayi oluhlaza okwesibhakabhaka nento yokulandela umkhondo ekhipha imisebe njengokungathi kuyizinhlobo zento eyodwa. Kuyizinto ezihlukene eziveza izimpawu ezihlukene.

Udayi oluhlaza okwesibhakabhaka (i-methylene blue, i-isosulfan blue, noma i-patent blue) ujovwa eduze kwesimila noma kwendilinga ezungeze ingono, uhambe emigudwini ye-lymph, bese ufaka umgudu ne-node umbala oluhlaza okwesibhakabhaka obonakalayo. Udokotela ohlinzayo ulandela lowo mbala ngamehlo.

Into yokulandela umkhondo ekhipha imisebe (ngokuvamile i-technetium-99m sulfur colloid) ijovwa ngokwehlukana, ihambe ngomzila ofanayo wokugeleza koketshezi, bese ikhipha ama-photon e-gamma atholwa ngomshini ophathwa ngesandla. Ithola ama-node ajulile, anombala ongagqamile, noma angabonakali.

Ukuhlanganisa lezi zinto kubizwa ngokuthi indlela yokusebenzisa izinto ezimbili zokulandela umkhondo, futhi kuseyindlela evamile okuqhathaniswa nayo ezinye ekusebenzeni kwanamuhla. Indlela ngayinye isiza lapho enye ingase yehluleke khona: umshini uzwa lokho iso elingakuboni, kanti udayi ubonisa lokho umshini okwazi ukukhomba indawo yakho ngokulinganisa kuphela. Ingxenye esele yalesi sihloko iqhathanisa i-methylene blue nezinye izindlela ngaphakathi kwalolu hlaka.

I-methylene blue iyodwa: ukutholwa okuphezulu, kodwa imiphumela ephika umdlavuza ngokungeyikho iyakhathaza

Isilinganiso esihlanganisiwe esinamandla kunazo zonke sokusetshenziswa kwe-methylene blue iyodwa sivela ekubuyekezweni okuhlelekile nasekuhlaziyweni okuhlanganisiwe kwezifundo ezingu-18 ezigulini ezingu-1,559 ezinomdlavuza webele, okwakungabonakali ngokuhlolwa ukuthi ungenile kuma-node asekhwapheni. Izifundo ezazisebenzisa abanye odayi abaluhlaza okwesibhakabhaka noma izindlela ezihlanganisa ama-radioisotope zazingafakiwe, ngakho lesi yisilinganiso esigxile ekusebenzeni kwe-methylene blue iyodwa.

Izinga lokutholwa elihlanganisiwe lalingu-91% (95% CI 88 kuya ku-94%). Ngamazwi alula: cishe ezinqubweni ezingu-9 kwezingu-10 ezazanywa, kwatholwa okungenani i-node eyodwa yokuqala. Izifundo ngazinye zazisukela ku-75 kuya ku-100%, kunokwehluka okukhulu phakathi kwazo (I² cishe 68%), okwakubonisa ukwehluka kwamandla ezixazululo (ikakhulukazi 1%), umthamo woketshezi (0.1 kuya ku-10 mL, ngokuvamile 2 noma 5 mL), izindawo zokujova (ezungeze isimila noma ngaphansi kwendilinga ezungeze ingono), izindlela zokuhlola izicubu, nolwazi lodokotela ohlinzayo.

Izinga elihlanganisiwe lemiphumela ephika umdlavuza ngokungeyikho lalingu-13% (95% CI 9 kuya ku-18%). Leli zinga liphendula umbuzo ohlukile kowezinga lokutholwa: ezigulini ezazinomdlavuza ngempela kuma-node, kwakuyingxenye engakanani lapho ukuhlolwa kwe-node yokuqala kwakuthi ngokungeyikho awukho umdlavuza? Indlela ingase iphumelele kahle esilinganisweni sokuqala kodwa ingaphumeleli kahle kwesesibili, futhi yilokho kanye okwenzeka lapha. Ukukwazi ukuthola umdlavuza uma ukhona kwakungu-87%, inani lokubikezela ukungabi nawo lapho ukuhlolwa kuwuphika lalingu-91%, kanti ukunemba kukonke kwakungu-94%.

Ababhali babheka ukutholwa okungu-91% njengokwamukelekayo, kodwa imiphumela ephika umdlavuza ngokungeyikho engu-13% njengokuphakeme kakhulu uma iqhathaniswa nezinga lokuhlinza abalicaphunile, futhi banxusa ukuqapha ekuthembeleni ku-methylene blue iyodwa. Ukuqhathaniswa kwamaqembu amancane akutholanga mehluko obalulekile phakathi kwemithamo engu-2 mL nengu-5 mL noma phakathi kokujova eduze kwesimila nokujova ngaphansi kwendilinga ezungeze ingono, kodwa izikhawu zokuqiniseka zazibanzi ngokwanele ukuthi ukwehluka kwangempela kungakhishwa ngokuphelele. Ubufakazi abukhombisanga amandla esixazululo, umthamo woketshezi, noma indawo yokujova engcono kunazo zonke. Ukuze uthole umongo wokuthi ulimi lwemithamo lufundwa kanjani emibhalweni yezokwelapha, bheka indlela yokufunda iphrothokholi yezokwelapha ye-methylene blue.

I-methylene blue iyodwa uma iqhathaniswa ne-methylene blue kanye nento yokulandela umkhondo ekhipha imisebe

Isivivinyo esenziwa esikhungweni esisodwa eHyderabad, esabela ngokungahleliwe iziguli ezingu-60 ezinomdlavuza webele osesigabeni sokuqala emaqenjini, sabela iziguli ezingu-30 ku-5 mL we-methylene blue iyodwa nezingu-30 kudayi ofanayo kanye ne-1 mCi ye-technetium-99m sulfur colloid ehlungiwe. Ngemva kwalokho zonke iziguli zakhishwa ama-node asekhwapheni asele, lokhu kusetshenziswa njengezinga lokuqhathanisa. Womabili amaqembu athola okungenani i-node eyodwa yokuqala kuzo zonke iziguli ezingu-30 (ukutholwa okungu-100% eqenjini ngalinye), ngesilinganiso senani lama-node atholwayo esicishe sifane (ama-node angu-3.16 uma kuqhathaniswa nangu-3.20).

Lelo zinga lokutholwa eliphelele libonakala likholisa kuze kubhekwe ubukhulu besampula. Kwakukhona iziguli ezingu-7 kuphela eqenjini ngalinye ezazitholakale zinomdlavuza kuma-node okuqala, ngakho zonke izilinganiso zokuxilonga zincike ezenzakalweni ezimbalwa nje, futhi azikho izikhawu zokuqiniseka ezabikwa. Amanani abhalwe ephepheni ngokuthi “imiphumela ephika umdlavuza ngokungeyikho” (8.6% uma kuqhathaniswa no-4.3%) nawo asebenzisa idinomineyitha engajwayelekile: ahlukanisa imiphumela ephika umdlavuza ngokungeyikho ngayo yonke imiphumela yokuhlola ephika umdlavuza, esikhundleni sazo zonke iziguli ezazinomdlavuza ngempela kuma-node. Lokhu kuwenza asondele kakhulu kokukodwa kususwe inani lokubikezela ukungabi nomdlavuza lapho ukuhlolwa kuwuphika, kunasezingeni elijwayelekile lemiphumela ephika umdlavuza ngokungeyikho. Izibalo zokukwazi ukuthola abanomdlavuza nokukwazi ukukhomba abangenawo zibonakala zigxile ekubikezeleni umdlavuza owengeziwe kuma-node angewona awokuqala, kunokuthola noma yikuphi ukusabalala komdlavuza ekhwapheni. Ngakho la manani akufanele ahlanganiswe nezilinganiso ezijwayelekile ezifana no-13% ongenhla.

Incazelo engavikeleka yalesi sivivinyo ilinganiselwe: esikhungweni esisodwa esinolwazi, zombili izindlela zathola okungenani i-node eyodwa esigulini ngasinye. Ukuthi ukunemba kwazo ekuxilongeni kuyafana akuqinisekiswa indlela isivivinyo esaklanywa ngayo, futhi ukungatholakali komehluko obalulekile ezigulini ezingu-60 akuqinisekisi ukulingana. Inzuzo yalesi sivivinyo ekusebenzeni itholakala esimweni esenziwa kuso. Lapho imithi yenuzi ingatholakali, i-methylene blue iyodwa yakwazi ukuthola i-node kuzo zonke iziguli lapha. Yingakho ababhali bayiphakamisa njengendlela esebenzisekayo uma enye ingatholakali, hhayi njengendlela efakazelwe ukuthi iyalingana nayo.

Inothi mayelana nomthombo wesithathu

Imiyalelo yalesi sihloko yayibala ukubuyekezwa okuhlelekile kwango-2025 okuqhathanisa i-methylene blue ezindaweni ezihlukahlukene zomdlavuza. Lelo phepha selokhu lahoxiswa ngoFebhuwari 2026 ngenxa yemithombo engavumelekile, kanti umbhali obhekele ukuxhumana wathi amaphutha ayevela kumathuluzi asizwa ubuhlakani bokwenziwa. Amanani alo ahlanganisiwe awafakiwe kulokhu kubuyekezwa. Ukulisho kubalulekile ngesizathu esisodwa: amakhophi amadala ezibalo zalo asazungeza ku-inthanethi, futhi akufanele acashunwe.

I-isosulfan blue uma iqhathaniswa ne-methylene blue

Mayelana nokusetshenziswa kukadayi we-methylene blue ekutholeni imigudu nama-node e-lymph uma kuqhathaniswa ne-isosulfan blue, ukulinganiswa kwezinzuzo nobungozi okusekelwa yimibhalo kuyavumelana: ngokungezwani komzimba okusabalele i-methylene blue ingcono, kodwa ngokulimala kwezicubu endaweni yokujova akukho okungcono ngokusobala, futhi ukujova i-methylene blue eduze nobuso besikhumba kubi kancane.

Ukubuyekezwa okuhlelekile okuhlanganisa izinqubo zama-node okuqala ezingu-61,951 kwathola izigameko ezingu-94 zokusabela okukhulu kokungezwani komzimba, i-anaphylaxis (izinga lilonke elinesisindo cishe 0.061%), kanti i-isosulfan blue yayinezinga elilinganisiwe eliphakeme kunawo wonke, cishe 0.16%. Imithamo emincane yoketshezi lukadayi nokujova ngaphakathi esikhumbeni kwakuhlotshaniswa namazinga aphansi. Uchungechunge oludala lwamacala ezokwelapha lukhomba okufanayo, olunye uchungechunge lwesikhungo samabele lubika ukusabela kokungezwani komzimba ezigulini ezingu-3 kwezingu-351 ezathola i-isosulfan blue. Ngakho i-methylene blue ngokuvamile ichazwa njengeyenza i-anaphylaxis kancane, nakuba ubungozi bayo bungewona uziro.

Inkinga egqamile ye-methylene blue isendaweni yokujova: ukuvuvukala, izilonda, nokufa kwezicubu zesikhumba noma zamafutha, ikakhulukazi ngemva kokujova eduze nobuso besikhumba noma ngaphakathi esikhumbeni. Ekuhlaziyweni okuhlanganisiwe kwezifundo ezingu-18 ze-methylene blue, iziguli ezimbili kwesinye isifundo zaba nokufa kwezicubu zesikhumba endaweni yokujova, isiguli esisodwa kwesinye saba nokufa kwezicubu zesikhumba nezingaphansi kwaso ngemva kokujova ngaphansi kwendilinga ezungeze ingono, kanti iziguli ezintathu esifundweni sesithathu zaba nokusabela kokungezwani komzimba esikhumbeni. Akukho ukungezwani ne-methylene blue okusongela ukuphila okwabonakala kuleyo datha. Isivivinyo esabela iziguli ezingu-60 ngokungahleliwe sabika ukuthi kwakungekho nhlobo imiphumela emibi ye-methylene blue, kodwa njengoba kwakuneziguli ezingu-30 kuphela ezayithola eqenjini ngalinye, lokho kutholwa akunamandla amakhulu njengobufakazi.

Umbala oluhlaza okwesibhakabhaka uhlala isikhathi esingakanani

Iziguli zivame ukukubuza lokhu, futhi impendulo eqotho ihlukanisa odayi, ngoba iningi ledatha yokuhlala kombala isikhathi eside liphathelene ne-patent blue, hhayi udayi otholwe yisiguli.

Izimpawu zesikhashana ezifana nama-tattoo ngemva kwe-methylene blue zaziwa kahle, futhi olunye uchungechunge olukhulu lwamacala e-methylene blue lwazibika njengokuphela kwenkinga ephawulekayo. Nge-isosulfan blue, imibiko eshicilelwe ichaza ukushintsha kombala wesikhumba okuhlala amahora kuya emasontweni. Izibalo ezizungezayo zokuhlala kombala isikhathi eside (umbala obonakalayo ku-36.5% weziguli ezinyangeni ezingu-12, ku-23.6% ezinyangeni ezingu-24, naku-8.6% ngemva kwezinyanga ezingu-36) zivela ochungechungeni olwalulandela iziguli kusukela ekuqaleni zisebenzisa i-patent blue, udayi ohlobene kodwa ohlukile, futhi akufanele zicashunwe njengezibalo ze-methylene blue. Elinye iqembu leziguli lapho laba odayi ababili baqhathaniswa khona ngokuqondile lathola ukushintsha kombala ku-14.1% nge-methylene blue uma kuqhathaniswa no-23.7% nge-patent blue. Ubufakazi besikhathi eside obuqhathanisa ngokuqondile i-methylene blue ne-isosulfan blue buncane, ngakho noma yisiphi isihloko esinikeza inani lezinyanga umbala we-methylene blue ohlala ngazo ngaphandle kokusho udayi nesifundo siyaqagela. Umchamo oluhlaza okwesibhakabhaka noma oluhlaza okotshani ngemva kokumuncwa kukadayi emzimbeni ungowesikhashana futhi ubhaliwe ngodayi abaluhlaza okwesibhakabhaka ngokujwayelekile, kodwa akukho sifundo sama-node okuqala esibuyekeziwe esilinganise ukuthi lokhu kwenzeka kangaki, ngakho akukho zinga lokwenzeka okufanele libikwe lapha. Abafundi abacabangela ukuphepha okubanzi bangase futhi bafune isifingqo semiphumela emibi ye-methylene blue kanye nemininingwane yokusebenzisana kwayo neminye imithi.

Ukuqhathaniswa kwezinto zokulandela umkhondo nemiphumela elinganiswayo

Ukufunda ubufakazi njengomuntu ofuna ukuqiniseka

Umehluko wezinto ezintathu usekela sonke lesi sihloko. Okokuqala, izinga lokutholwa lilinganisa ukuthi indlela iyakwazi yini ukwenza umsebenzi wokuthola i-node; izinga lemiphumela ephika umdlavuza ngokungeyikho lilinganisa ukuthi umphumela othi awukho umdlavuza ungathenjwa yini. I-methylene blue iyodwa iphumelela esivivinyweni sokuqala ngokukhululeka kakhulu kunakwesesibili. Okwesibili, udayi oluhlaza okwesibhakabhaka nento yokulandela umkhondo ekhipha imisebe kuyizindlela ezizimele zokuthola ama-node, ngakho “udayi uma uqhathaniswa nento yokulandela umkhondo” kuwukuqhathanisa okungafanele; ukukhetha kwangempela kuphakathi kukadayi yedwa (odingekayo lapho imithi yenuzi ingekho) nodayi kanye nento yokulandela umkhondo (indlela okuqhathaniswa nayo lapho itholakala). Okwesithathu, ukuqhathaniswa kokuphepha kufanele kusho igama likadayi: i-isosulfan blue inobubi bokungezwani komzimba okusabalele, i-methylene blue inenkinga yokufa kwezicubu endaweni yokujova ngemva kokujova eduze nobuso besikhumba, kanti izibalo zokuhlala kombala isikhathi eside kunazo zonke zingezepatent blue.

Esigulini noma kumnakekeli, imibuzo okufanele ilethwe kudokotela ohlinzayo iqondile: yimuphi udayi ozosetshenziswa, ingabe uhlanganiswa nento yokulandela umkhondo ekhipha imisebe, mangaki ama-node okuqala avame ukukhishwa, futhi leli thimba libe nemiphumela enjani ngokutholwa nangemiphumela ephika umdlavuza ngokungeyikho? Ukuze uthole ulwazi lwesisekelo ngalokho udayi okwenzayo emzimbeni wonke nangendlela ocwaningwa ngayo, bheka isayensi yokusebenza kwe-methylene blue emzimbeni nokusabalala kwayo kanye nendlela ucwaningo lwezokwelapha lwe-methylene blue oluhlolwa ngayo. Futhi, njengoba isigameko sokuhoxiswa kwephepha sibonisa, hlola usuku nesimo sanoma yikuphi ukubuyekezwa okuboniswa kona: lapho ubufakazi bushintsha ngokushesha, ngisho nesibalo esihlanganisiwe esinonyaka owodwa nje singase sibe sesihoxisiwe.