Isihloko
I-methylene blue yokulunywa okuphikelelayo endunu: ubufakazi nemikhawulo
Cabanga ngesiguli esesizame okhilimu abavikela isikhumba, imithi elwa nesikhunta, amafutha anama-steroid, nezinguquko ekuhlanzekeni izinyanga eziningi, kodwa ukulunywa endunu njalo ebusuku kuyaqhubeka. Udokotela ohlinza ikholoni nomgudu wokugcina wamathumbu ukhuluma ngomjovo wedayi eluhlaza okwesibhakabhaka esikhunjeni esizungeze indunu. Abafundi abaningi bacabanga ngoketshezi oludambisayo olumboza isikhumba, njengomunye ukhilimu ogcotshwayo ofakwa ngenaliti. Inqubo okukhulunywa ngayo isebenza ngomqondo ohlukile. Ilimaza iziphetho ezincane zemizwa yokuzwa ongqimbeni lwe-dermis ukuze iphazamise umjikelezo wokulunywa nokuzinwaya, futhi ubufakazi obuyisekelayo buwuchungechunge oluncane lwemibiko yamacala okuhlinzwa engenamaqembu okuqhathanisa, enokulandelelwa okungalingani.
Lesi sihloko sibuyekeza lezo zincwadi zocwaningo. Sichaza ukuthi inqubo eyenziwa uchwepheshe ihilelani, ukuthi yini okufanele ikhishwe njengembangela ngaphambi kokuthi ukulunywa kubizwe ngokuthi akunambangela eyaziwayo, ukuthi imithombo emibili ebalulekile ibikani, nokuthi ubufakazi buntula kuphi. Ukuze uthole isizinda ngale nhlanganisela ngokwayo, bheka ukuthi i-methylene blue isebenza kanjani ezingeni lamaseli, kanye nohlu olubanzi lokusetshenziswa kwezokwelapha okugunyaziwe nokusacwaningwayo.
Inqubo, hhayi ukhilimu
Ukujova i-methylene blue ngaphakathi kwesikhumba noma ngaphansi kwaso ngqo ukuze kubhekwane nokulunywa endunu okungaphenduli ekwelashweni nokungenambangela eyaziwayo kuyinqubo ehlasela izicubu, eyenziwa uchwepheshe wezokwelapha. Izindlela ezishicilelwe zifaka i-methylene blue ehlanjululiwe ongqimbeni lwe-dermis lwesikhumba esithintekile esizungeze indunu ngaphansi kwezimo ezingenamagciwane, ngokuvamile kusetshenziswa isibulali-zinzwa sendawo noma ukuvinjelwa kwezinzwa kwesifunda, isiguli silele sibheke phansi. Indlela okuhloswe ukuthi isebenze ngayo ukubhubhisa ngamakhemikhali iziphetho zemizwa yokuzwa eziseduze nobuso besikhumba. I-American Society of Colon and Rectal Surgeons ichaza ukujova ngaphakathi nangaphansi kwesikhumba esithintekile futhi ixwayisa ngokuthi ukufaka umjovo eduze kakhulu nobuso besikhumba kungabangela ukonakala kwesikhumba noma izilonda.
Umehluko wezinto ezintathu ubalulekile. Okokuqala, i-methylene blue egcotshwa ebusweni besikhumba akuyona indlela lezi zifundo ezayihlola, futhi abukho ubufakazi obulinganayo obubonisa ukuthi ingathatha indawo yenqubo yomjovo ngaphakathi kwesikhumba. Okwesibili, ukuzijova akukwazi ukuthathwa njengokufanele ngokusekelwe ezindleleni ezishicilelwe. Ukulawula ukujula kuyisici esibalulekile sokuphepha: ukujova eduze kakhulu nobuso besikhumba kubeka engcupheni yezilonda nokufa kwezicubu, kanti ukujova kujule kakhulu noma ukusebenzisa indlela engangenamagciwane kubeka engcupheni yethumba nokulimala kwezakhi zomzimba. Okwesithathu, umjovo we-methylene blue othengiswa e-United States ubhaliselwe ukwelapha i-methemoglobinemia etholakala ngemva kokuzalwa ngokuwufaka emthanjeni, ngakho ukuwujova ngaphakathi kwesikhumba esizungeze indunu kungukusetshenziswa okungaphandle kwalokho okugunyaziwe. Abafundi abathatha imithi esebenza ku-serotonin kufanele babuyekeze izixwayiso nge-serotonin syndrome nokusebenzisana kwemithi, okuxoxwa ngazo kabanzi ngezansi.
Thola imbangela kuqala: ukulunywa okuningi kunembangela
I-pruritus ani ichaza uphawu, hhayi isifo esisodwa. Imihlahlandlela ihlukanisa izimbangela ezibangelwa ezinye izimo njengeziphathelene nendunu nomgudu wokugcina wamathumbu, nesikhumba, nezifo ezithathelwanayo, nomzimba wonke, nokucasuka, kanye nezici ezingokwengqondo. Incoma ukuthathwa komlando wesiguli, ukuhlolwa kwendunu nomgudu wokugcina wamathumbu nge-anoscopy, nokuhlolwa okuqondiswe ezimbangeleni ezithile ngaphambi kokuthi kusetshenziswe ilebula ethi akunambangela eyaziwayo. Imigomo yokusebenza ye-Italian Society of Colorectal Surgery ibeka lolu hlelo lokuhlola, oluhlanganisa ukuthatha amasampula ngokuswayipha noma ukukhuhla, ukuhlolwa kwaselabhorethri, ukuhlolwa ngamaphetshi esikhumba, nokuthathwa kwesampula yezicubu okukhethwa ngokwalokho okutholakalayo.
Izimbangela ezivamile okufanele zikhishwe zihlanganisa ama-hemorrhoid, ukuqhekeka kwendunu, i-fistula, izicucu zesikhumba ezilengayo, ukuvuza kwendle noma ukungakwazi ukuyibamba, ukuphuma kwezicubu endaweni yazo, nezinsumpa. Kuhlanganisa nokuvuvukala kwesikhumba ngenxa yokuthintana nezinsipho, izinto zokusula, amakha, nemikhiqizo egcotshwayo, kanye nomswakama nokungcoliswa yindle okungabonakali kalula. Izimo zesikhumba ezibonakala ngendlela efanayo zihlanganisa i-psoriasis, i-lichen sclerosus, ne-lichen simplex chronicus. Izifo ezithathelwanayo zihlanganisa i-Candida, isikhunta sama-dermatophyte, izikelemu ze-pinworm, utwayi, nezimbangela ezithathelwana ngokocansi. Izimo zomzimba wonke ezihlotshaniswa nalokhu zihlanganisa isifo sikashukela, isifo sesibindi esiphazamisa ukugeleza kwenyongo, isifo sezinso esingamahlalakhona, nokuphazamiseka kwendlala yegilo. Izilonda eziphikelelayo, ezingajwayelekile, noma ezivulekile zidinga ukuthathwa kwesampula yezicubu ukuze kukhishwe i-anal intraepithelial neoplasia noma isifo sikaPaget esingaphandle kwebele. Iqembu elincane kakhulu kuphela elinezimpawu eziphikelelayo nezinamandla naphezu kwalokhu kuhlolwa nokunakekelwa okungahlaseli izicubu elicatshangelwa umjovo, okuwumbono futhi weziqondiso ze-ASCRS zeziguli.
Okutholwe ukuhlaziywa okuhlanganisiwe kwango-2023
Ukuhlanganiswa kobufakazi okubanzi kakhulu ukuhlaziywa okuhlanganisiwe kwango-2023 kwezifundo ezineqembu elilodwa okwenziwa uJia nozakwabo, okwahlanganisa izifundo eziyi-7 neziguli ezingama-225. Ukuphela kwezimpawu ngemva komjovo owodwa kwaba ngamaphesenti angu-76.1 (isikhawu sokwethembeka esingu-95 wamaphesenti, 64.9 kuya ku-87.3), kwakhuphukela kumaphesenti angu-85.4 ngemva komjovo wesibili. Ukungabikho kwezimpawu okubikiwe kwaba ngamaphesenti angu-75.3 ngonyaka owodwa nangu-77.3 eminyakeni emithathu, kwehlela kumaphesenti angu-24.0 eminyakeni emihlanu.
Lezo zibalo zidinga ukufundwa ngokucophelela. Izifundo ezahlanganiswa zaziwuchungechunge lwamacala angenamaqembu okuqhathanisa kusukela ngo-1979 kuya ku-2019, zisebenzisa izindlela, ukugxila kwezixazululo, nemiphumela yokuhlola ehlukahlukene, futhi ukwehluka kwezibalo kwakukhulu. Amaphesenti esikhathi eside awaveli eqenjini elilodwa elalandelwa iminyaka emihlanu. Izifundo ezincane ezihlukene zanikeza idatha ngezikhathi ezihlukene, ngakho isibalo seminyaka emihlanu asiqinile. Izinkinga ezivamile kwakuwukushintsha kwesikhumba sibe nombala oluhlaza okwesibhakabhaka njengomdwebo womzimba okwesikhashana nokuba ndikindiki endaweni ezungeze indunu. Izehlakalo ezibikiwe zazihlanganisa ukutheleleka kwezicubu zesikhumba (cellulitis), ukuqoqana kwegazi ezicutshini (hematoma), ukuvuza kwendle kwesikhashana, ukubambeka komchamo, ithumba eliseduze nobuso besikhumba, noshintsho oluthatha isikhathi eside ekuzweni. Okubalulekile ukuthi uchungechunge lwamacala omlando lokufa kwezicubu zesikhumba olwenziwa u-Eusebio nozakwabo (1990) lwalungekho phakathi kwezifundo eziyisikhombisa ezahlanganiswa, ngakho ulimi oluqinisekisayo ngokuphepha ekuhlaziyweni okuhlanganisiwe alusho ukuthi ukufa kwezicubu akukaze kwenzeke. Isifinyezo sethu sephrofayela yokuphepha ye-methylene blue sibeka lezi zehlakalo esimweni sazo.
Okutholwe isifundo esisodwa esikhulu kunazo zonke
Isifundo esisodwa esikhulu kunazo zonke ukubuyekezwa kwango-2019 kwedatha eyedlule kusizindalwazi esasiqoqa idatha iya phambili, okwenziwa uKim nozakwabo. Ezigulini ezingama-362 ezafika zinokulunywa endunu, ezingama-259 zaba ngcono ngokwelashwa okungahlaseli izicubu, kwasala eziyi-103 ezazinezimpawu ezinzima ezingaphenduli ekwelashweni, ezelashwa ngomjovo ngaphakathi kwesikhumba. Indlela yaxuba u-5 mL wesisombululo sokuqala se-methylene blue esingu-1 wamaphesenti no-15 mL we-lidocaine engu-1 wamaphesenti, yanikeza u-20 mL wenhlanganisela yomjovo enokugxila kokugcina okungamaphesenti angu-0.25, yafakwa kusetshenziswa isibulali-zinzwa esivimba izinzwa zendawo ehlala phezu kwesihlalo. Lo mehluko phakathi kokugxila kwesisombululo sokuqala nokokugcina uyaphindaphindeka ezincwadini zocwaningo: amaphepha athi 1 wamaphesenti ngokuvamile achaza isisombululo sokuqala, hhayi ingxube ehlanjululiwe ejovwe ngempela.
Emavikini ayisithupha, ezingama-87 ezigulini ezingama-96 ezalandelwa (90.6 wamaphesenti) zahlukaniswa njengezithuthukile. Iziguli eziyisishiyagalombili kamuva zathola umjovo ophindwayo, kwaba nokuthuthuka kwezinhlanu. Eminyakeni emithathu, ezingama-53 ezigulini ezingama-62 ezazitholakala ekuhlolweni kwesikhathi eside (85.5 wamaphesenti) zazithuthukile, futhi phakathi kwezingama-53 ezaziphendule ekuqaleni, ezi-4 (7.5 wamaphesenti) zaphinda zaba nezimpawu. Ukulahleka kweziguli ekulandelelweni kunciphisa ukuqiniseka ngalezi zibalo: ezingama-62 kuphela kwezokuqala eziyi-103 zanikeza idatha yeminyaka emithathu. Umbala oluhlaza okwesibhakabhaka esikhunjeni waphikelela kwezingama-84 kwezingama-96 (87.5 wamaphesenti) emavikini ayisithupha, ngokuvamile wawufiphala ube amachashazi amancane cishe emavikini amane. I-hematoma yenzeka kwezi-6 kwezingama-62 (9.7 wamaphesenti) futhi yaphela ngokwayo. Ababhali abazange babike ukuvuza kwendle, i-cellulitis, ukufa kwezicubu, noma ithumba eqenjini labo.
Ithebula lekhwalithi yezifundo nokulandelelwa
Ithebula elingezansi liyinkomba eyinhloko yalokhu kubuyekezwa. Amazinga okugxila amakwe ngenkanyezi ayizilinganiso zengxube yokugcina, ngoba amaphepha amaningana abika kuphela amandla esisombululo sokuqala.
| Isifundo | Indlela yokucwaninga neziguli | Indlela yomjovo | Ukulandelelwa | Ukusebenza nokuphinda kwezimpawu | Imiphumela engemihle |
|---|---|---|---|---|---|
| Wolloch noDintsman, 1979 | Uchungechunge lwamacala, n=9 | Cishe 10 kuya ku-15 mL wesisombululo esingu-1%, ngaphansi kwesikhumba | Izinyanga ezi-3 kuya kweziyi-15 | Eziyisi-8 kweziyi-9 zathuthuka ngemva komjovo wokuqala; eziyi-9 kweziyi-9 ngemva kokuphinda | Imfiva cishe usuku olulodwa, esi-1 kweziyi-9 |
| Eusebio, Graham, noMody, 1990 | Uchungechunge lwamacala, n=23 | Kufika ku-30 mL wesisombululo esingu-0.5%, ukufakwa ngaphakathi kwesikhumba | Abaphendulile ngaphezu kwamaviki ayi-12, abanye kuze kube iminyaka eyi-9 | Ezingama-21 kwezingama-23 zaba nokuphendula okuphelele noma okuyingxenye ekuqaleni; izimpawu zaphinda kwezi-4 kwabayi-18 abaphendulile (22%) ngokulandelelwa isikhathi eside | Ukufa kwezicubu kuwo wonke ugqinsi lwesikhumba, ezi-3 kwezingama-23 (13%), okwakudinga ukususwa kwezicubu ezifile |
| Farouk noLee, 1997 | Uchungechunge olulandelwa kuya phambili, n=6 | 10 mL wesisombululo sokuqala esingu-1% kanye nesibulali-zinzwa namanzi anosawoti, cishe 0.44% ekugcineni* | Isikhathi esimaphakathi iminyaka emi-3, ibanga emi-2 kuya kwemi-5 | Ezi-5 kwezi-6 zaba nokuthuthuka okukhulu ekuqaleni; ukuphinda kwezimpawu okuqoqekayo cishe 20% ngonyaka owodwa, 40% eminyakeni emi-2, 60% eminyakeni emi-3 | Ukubambeka komchamo, ithumba eliseduze nobuso besikhumba, ukungakwazi ukubamba indle kwesikhashana, esi-1 kwezi-6 ngasinye |
| Botterill noSagar, 2002 | Uchungechunge olulandelwa kuya phambili, n=25 | 5 mL wesisombululo sokuqala esingu-1% kanye ne-lignocaine ne-hydrocortisone, cishe 0.25% ekugcineni* | Isikhathi esimaphakathi izinyanga eziyi-11, ibanga ezi-2 kuya kwezingama-25 | Eziyi-16 kwezingama-25 zazingenazimpawu ngemva komjovo owodwa; ezingama-22 kwezingama-25 (88%) ngemva kokuphinda | Ukuvuza kwendle kwesikhashana, esi-1 kwezingama-25, cishe izinsuku ezi-2 |
| Mentes nozakwabo, 2004 | Ukulandelelwa kuya phambili ngaphandle kokwabiwa okungahleliwe, n=30 | Cishe 15 mL ku-1% ekugcineni, kusuka esisombululweni sokuqala esingu-2% esihlanjululwe cishe 1:1, ngaphakathi kwesikhumba kanye nangaphansi kwaso eduze nobuso | Izinyanga eziyi-12 kwabaningi; izinyanga ezi-5 kuya kwezingama-24 | Ezingama-24 kwezingama-30 zazingenazimpawu enyangeni eyodwa; cishe ezingama-28 kwezingama-30 ngemva kokwelashwa futhi; ezingama-23 kwezingama-30 ezinyangeni eziyi-12; ukuphinda kwezimpawu cishe ezi-5 kwezingama-28 (18%) | I-cellulitis eyaphela ngokwayo, ezi-2 kwezingama-30 (7%) |
| Sutherland, Faragher, noFrizelle, 2009 | Uchungechunge olulandelwa kuya phambili olwenziwa udokotela ohlinzayo oyedwa, n=49 | 10 mL wesisombululo sokuqala esingu-1% kanye ne-bupivacaine ene-adrenaline ne-methylprednisolone, cishe 0.32% ekugcineni* | Ikakhulukazi amaviki ama-4 nayi-8 | Ukuthuthuka kwezingama-47 kwezingama-49 (96%); ukuphela ngokuphelele kwezimpawu kwezingama-28 kwezingama-49 ngemva komjovo owodwa, ezingama-32 kwezingama-49 (65%) ngemva kokuphinda | Ukushintsha ekwazini ukubamba indle kweziyi-7 kwezingama-49 (14%), kwaphela phakathi cishe kwezinsuku eziyi-10 namaviki ayi-6; ukuncipha kokuzwa okubangela ukucindezeleka kwezi-2 kwezingama-49 (4%) |
| Samalavicius nozakwabo, 2012 | Uchungechunge olulandelwa kuya phambili, n=10 | Kwabikwa 15 mL wesisombululo esingu-1%, ngaphakathi kwesikhumba | Isikhathi esimaphakathi izinyanga ezingama-47, ibanga ezingama-29 kuya kwezingama-60 | Eziyi-10 kweziyi-10 zaziphelile izimpawu emavikini ama-4; ukuphinda kwezimpawu kweziyisi-8 kweziyi-10 (80%) ngokubhekwa isikhathi eside | Ukuba ndikindiki nokushintsha kombala wesikhumba kwesikhashana; ukuvuvukala kuze kube cishe izinyanga ezi-2; akubikwanga ukufa kwezicubu |
| Kim, Kim, noLee, 2019 | Ukubuyekezwa kwedatha eyedlule kusizindalwazi esasiqoqa idatha iya phambili, n=103 abelashwa | 5 mL wesisombululo sokuqala esingu-1% kanye no-15 mL we-lidocaine engu-1%, cishe 0.25% ekugcineni* | Amaviki ayi-6 (ezingama-96 kweziyi-103) neminyaka emi-3 (ezingama-62 kweziyi-103) | Ezingama-87 kwezingama-96 zathuthuka emavikini ayi-6 (91%); ezingama-53 kwezingama-62 zathuthuka eminyakeni emi-3 (86%); ukuphinda kwezimpawu kwezi-4 kwabaphendulile abangama-53 (8%) | Ukushintsha kombala wesikhumba kwezingama-84 kwezingama-96 emavikini ayi-6 (88%); i-hematoma kwezi-6 kwezingama-62 (10%); akukho ukuvuza kwendle, i-cellulitis, ukufa kwezicubu, noma ithumba |
Iphethini kuyo yonke imigqa iyafana. Ukuphendula kwasekuqaleni kuvame ukuba phezulu, kuyilapho izilinganiso zokuphinda kwezimpawu zincike kakhulu ekutheni iziguli zibhekwa isikhathi esingakanani nokuthi zingaki ezisala ekulandelelweni. USamalavicius wabika ukuphela kwezimpawu kwasekuqaleni okungu-100 wamaphesenti kodwa ukuphinda ekugcineni okungu-80 wamaphesenti ngesikhathi esimaphakathi sezinyanga ezingama-47; uKim wabika ukuphinda okungaphansi kwama-8 wamaphesenti eminyakeni emithathu phakathi kwabaphendulile abaqhubeka nokulandelelwa. Amasampula amancane, imijovo ephindwayo, imiphumela yokuhlola ehlukene, nokulahleka kweziguli ekulandelelweni kwenza ukuqhathanisa okuqondile kungathembeki.
Imikhawulo umfundi okufanele ayikhumbule
Alukho uvivinyo olunokwabiwa okungahleliwe olusekela le nqubo. Zonke izilinganiso zokusebenza ezingenhla zivela ochungechungeni lwamacala angenamaqembu okuqhathanisa noma eqenjini elihlolwe ngokubheka idatha eyedlule, ngakho ukuphendula ku-placebo, ukubuyela kwezilinganiso ezingeni elivamile, nezinyathelo zokuhlanzeka ezisetshenziswa ngesikhathi esifanayo akunakuhlukaniswa nomphumela wokwelashwa. Izindlela ziyahlukahluka ongqimbeni okufakwa kulo umjovo, umthamo woketshezi, indlela okubikwa ngayo ukugxila, ingxube yesibulali-zinzwa, nokusetshenziswa kwama-steroid, okusho ukuthi awukho umthamo obekwe ngendlela efanayo: qhathanisa ukugxila kwezingxube zokugcina, hhayi amalebula ezisombululo zokuqala. Uchungechunge lweziguli ezi-6 kuya kweziyi-103 alukwazi ukusungula imvamisa yezehlakalo ezingavamile njengokuzwela ngokweqile noma ukusabela komzimba wonke, futhi ukulandelelwa kokuphinda kwezimpawu sekudlule isikhathi eside akuphelele ezifundweni eziningi.
Umlando wokufa kwezicubu kufanele ushiwo ngokucacile. Iziguli ezi-3 kwezingama-23 ochungechungeni luka-Eusebio lwango-1990 zaba nokufa kwezicubu kuwo wonke ugqinsi lwesikhumba, okwakudinga ukususwa kwezicubu ezifile. Kusukela lapho indlela isiguqukele ezingxubeni zokugcina ezihlanjululwe kakhulu nasekufakweni ngaphakathi kwesikhumba kunokufakwa ngokujulile, futhi uchungechunge lwakamuva lubika izinkinga ezingezimbi kakhulu. Nokho, isenzakalo somlando siyingxenye yerekhodi futhi sixwayisa ngokungayamukeli le nqubo ngokunganaki.
Izixwayiso zemithi eziphathelene nomzimba wonke nazo ziyasebenza ngokomgomo. Ulwazi lwamanje lokunikeza umjovo we-methylene blue lunesixwayiso esibiyelwe ngebhokisi nge-serotonin syndrome engabulala uma isetshenziswa nemithi esebenza ku-serotonin nama-opioid, lubala imibiko ye-anaphylaxis, futhi luvimbela ukusetshenziswa lapho kukhona ukuntuleka kwe-G6PD noma ukuzwela okukhulu ngokweqile kudayi we-thiazine. Lezi zixwayiso zivela ikakhulukazi ekusetshenzisweni komuthi emthanjeni okuthinta umzimba wonke, futhi izinga lomuthi elifinyelela emzimbeni wonke ngemva komjovo endaweni ezungeze indunu alikalilinganiswa kahle, ngakho akunakucatshangwa ukuthi azibalulekile. Yisho yonke imithi yokucindezeleka kwengqondo, ama-opioid, nesimo sakho se-G6PD ngaphambi kwanoma iyiphi inqubo ye-methylene blue.
Ubani ongaxoxa ngayo nochwepheshe wezokwelapha
Iqembu elingacatshangelwa lincane: labo abanokulunywa okungenambangela eyaziwayo okuphikelelayo ngemva kokufunwa kwezimbangela ezivela kwezinye izimo nokwehluleka kwezinyathelo ezingahlaseli izicubu, okunzima ngokwanele ukuthi ukushintsha kombala wesikhumba, ukuba ndikindiki, nengozi encane yokutheleleka noma ukuphazamiseka kokubamba indle kube yimiphumela abangayamukela. Letha ukulandelana kwezimpawu ngokwesikhathi, izindlela zokwelashwa zangaphambilini nezinsuku zazo, imibiko yokuhlolwa ehlanganisa i-anoscopy nanoma yikuphi ukuhlolwa kwesampula yezicubu, kanye nohlu oluphelele lwemithi. Imibuzo ewusizo iqoqwe emibuzweni yethu ongayibuza uchwepheshe wezokwelapha nge-methylene blue. Ungafuni umjovo kumhlinzeki wezokwelapha oweqa ukuhlolwa kokuthola imbangela, futhi ungalokothi uzame ukuzijova.