I-methylene blue ekuhloleni inzalo: lokho i-chromopertubation ekubonisayo ngempela

Imiphumela yokusesha nge-methylene blue nenzalo ixuba izimangalo ezimbili ezihlukene. Esokuqala ukuthi ukuhlola ngodayi oluhlaza okwesibhakabhaka emtholampilo kungabonisa ukuthi amashubhu e-fallopian avulekile yini. Esesibili ukuthi ukuthatha i-methylene blue kuthuthukisa inzalo, ikhwalithi yesidoda, noma ikhwalithi yamaqanda. Yisimangalo sokuqala kuphela esihlobene ne-chromopertubation. Esesibili asizange sihlolwe futhi asiyona ingxenye yale nqubo. Lokhu kwehlukanisa kuyisisekelo sakho konke okungezansi.

Umbuzo owusizo uqondene nento eyodwa. Lapho udayi oluhlaza okwesibhakabhaka ufakwa esibelethweni ngaphansi kwezimo zokuhlola emtholampilo, bese kubonakala uketshezi luphuma ngeshubhu, lelo shubhu livulekile ngaleso sikhathi. Lapho kungabonakali ukugeleza, impendulo ayiqinisekile ngendlela ebonakala ngayo. Ukuqhathaniswa kwango-2021 kwezindawo ezimbili zokuhlola ngodayi kubonisa kahle ukuthi imiphumela ithembeka kuphi nokuthi ingathembeki kuphi.

Umqondo: ukuhlolwa kokugeleza, hhayi ukwelashwa kwenzalo

Ishubhu ngalinye le-fallopian liwumgudu omncane osuka esibelethweni ubheke esizalweni seqanda. I-chromopertubation ihlola isici esisodwa salowo mgudu: ukuthi uketshezi lungadlula yini. I-methylene blue iyisikhombi esenza ukugeleza kubonakale, ngoba umbala wayo ojulile ugqama uma uqhathaniswa nezicubu eziphaphathekile.

Indlela yokuhlola iyafana kuzo zombili izindawo. Udayi ungena ngomlomo wesibeletho ungene emgodini wesibeletho, bese uchwepheshe wezempilo ebuka okwenzeka ngokulandelayo. Ukuphuma kukadayi ekugcineni okukude kweshubhu kusho ukuthi livulekile. Ukuqoqana kukadayi nokubuyela emuva kwawo kusho ukuthi libonakala livalekile. Umphumela uchaza ukudlula koketshezi, luya ohlangothini olulodwa, ngosuku olulodwa.

Lena yinqubo eyenziwa uchwepheshe wezempilo. Uhlobo olwenziwa egumbini lokubonana nodokotela lwenzeka ngesikhathi se-hysteroscopy, lapho ithuluzi elincane lokubuka libheka ngaphakathi kwesibeletho. Uhlobo olwenziwa egumbini lokuhlinzela lwenzeka ngesikhathi se-laparoscopy, lapho ithuluzi lokubuka libheka ingaphandle lamashubhu nendawo ye-pelvis, ngokuvamile umuntu elaliswe ngomuthi wokubulala izinzwa kuwo wonke umzimba. Alukho uhlobo umuntu azenzela lona, futhi alukho olunikeza umuthi ohloselwe ukushintsha inzalo. Udayi uyisikhombi esigeleza sidlule. Izincazelo zendlela i-methylene blue esebenza ngayo njengodayi ziyasiza lapha, futhi umbuzo ohlukile wokuthi lucutshungulwa kanjani ucwaningo lwe-methylene blue uchaza ukuthi kungani umphumela waselabhorethri ungalingani nokwelashwa emtholampilo.

Ukuvuleka akusho ukusebenza okuvamile

Ukuvuleka kungumqondo owodwa, kanti ukusebenza kwamashubhu kungumqondo obanzi. Ishubhu lingavuleka kodwa lehluleke ukwenza umsebenzi walo: ukutheleleka noma i-endometriosis kungalimaza iziyaziyazana ezihambisa iqanda, kuyilapho umgudu usavuleke ngokwanele ukuba udayi udlule. Izicubu zesibazi ezingaphandle kweshubhu zingagcina isizalo seqanda sikude, kangangokuthi iqanda alingeni nakuba udayi uphuma ngokukhululeka. Ukuncipha komgudu engxenyeni ethile kungavumela ukugeleza okuncane kukadayi kodwa kuvimbele iqanda elikhulu kunakho.

Ngakho umphumela wokuvuleka uphendula umbuzo omncane ngokuzethemba okunengqondo: uketshezi ludlule eshubhini. Awuqinisekisi isimo solwelwesi lwangaphakathi, ukuthathwa kweqanda, noma indawo ezungezile ye-pelvis. Umphumela wokuvaleka awuqinile nakakhulu, ngoba izimo zesikhashana zingamisa ukugeleza eshubhini elivulekile.

Lokho okwaqhathaniswa ucwaningo lwango-2021

Imininingwane ecace kakhulu yokuqhathanisa ngokuqondile ivela ocwaningweni lokuqala lwango-2021 lwabesifazane abangu-80 ababenenkinga yokuthola abantwana e-AIIMS New Delhi, futhi izindlela eziphelele nemiphumela kuyatholakala embhalweni ofinyeleleka mahhala. Wonke umuntu owayebambe iqhaza wayesehlelelwe i-hysterolaparoscopy. Abesifazane ababeseqinisekisiwe ngaphambili ukuthi banokuvaleka, ababene-hydrosalpinx eyaziwayo, noma ababenokutheleleka okukhulu okusanda kuqala endaweni ye-pelvis abangeniswanga.

Owesifazane ngamunye wahlolwa ngodayi kabili ngokulandelana. Okokuqala, kwenziwa i-hysteroscopy egumbini lokubonana nodokotela ngaphandle komuthi wokubulala izinzwa: kwafakwa udayi ohlanjululiwe, kwase kubhekwa imbobo yeshubhu ngalinye ukuze kubonakale ukugeleza kanye nokuphela kombala oluhlaza okwesibhakabhaka emgodini wesibeletho. Kwabe sekwenziwa i-minilaparoscopy umuntu elaliswe ngomuthi wokubulala izinzwa kuwo wonke umzimba, njengokuhlola okuyisilinganiso sokuqhathanisa: udayi wadlula nge-catheter engaphakathi kwesibeletho, futhi ishubhu ngalinye lahlolwa ngokubona udayi uphuma uye endaweni ye-pelvis. Womabili amashubhu abalwa ngokwehlukana, kwaba nokubonwa okungu-160.

Ukuhlola okuyisilinganiso sokuqhathanisa kwathola ukuthi amashubhu angu-136 kwangu-160 avulekile (amaphesenti angu-85). Ukuhlola kwasegumbini lokubonana nodokotela kwathi angu-125 avulekile (amaphesenti angu-78). Ukuvumelana kwemiphumela kwakukuhle kodwa kungalingani: amashubhu angu-119 atholakala evulekile kuzo zombili izivivinyo, angu-18 evalekile kuzo zombili, angu-17 kwathiwa avalekile ekuhlolweni kwasegumbini lokubonana nodokotela kodwa atholakala evulekile ku-laparoscopy, kwathi angu-6 kwathiwa avulekile ekuhlolweni kwasegumbini lokubonana nodokotela kodwa atholakala evalekile ku-laparoscopy. Uma kuqhathaniswa ne-laparoscopy njengesilinganiso, ukuhlola kwasegumbini lokubonana nodokotela kwabonisa ikhono lokuthola amashubhu avulekile elingamaphesenti angu-87.5, ikhono lokuhlonza avalekile elingamaphesenti angu-75, inani lokubikezela eliqondile elingamaphesenti angu-95.2, inani lokubikezela eliphikayo elingamaphesenti angu-51.4, nokunemba kukonke okungamaphesenti angu-85.6.

Funda lezo zinombolo njengomfundi, hhayi njengochwepheshe wezibalo. Isinqumo sokuthi ishubhu livulekile ekuhlolweni kwasegumbini lokubonana nodokotela sasivame ukuba siqondile. Isinqumo sokuthi livalekile sasicishe sifane nokuphonsa uhlamvu lwemali: cishe yingxenye kuphela yemiphumela yokuvaleka yasegumbini lokubonana nodokotela eyaqinisekiswa ku-laparoscopy. Lokho kungalingani yiqiniso elilodwa elisebenziseka kakhulu kulo mbiko.

Kungani ukubonakala kokuvaleka kungumphumela ongaqinile kangako

Isizathu esivame kakhulu ukugoqeka kwemisipha kungazelelwe. Ikhona lesibeletho lapho ishubhu liqala khona lingafinyela isikhashana bese livala umgudu ovulekile. Lo mbiko uxoxa ngoketshezi olubandayo nobuhlungu bamajaqamba njengezinto ezingase zikuqalise. Ukufinyela kuyaphela, kodwa umphumela othathwe ngesikhathi kwenzeka ubukeka ufana ncamashi nowokuvaleka kwangempela. Yingakho ukuvaleka okubonakala kuphela engxenyeni yeshubhu eseduze nesibeletho ekuhlolweni okukodwa kubhekwa ngokungabaza.

Indlela yokwenza nayo yengeza amaphutha. Ukufaka udayi ngokushesha kubangela ukubuyela emuva koketshezi okufana nokuvaleka, futhi indawo yokubuka engafanele ingenza ukugeleza okuncane kungabonakali. Lolu cwaningo lwasebenzisa udokotela ohlinzayo oyedwa onolwazi kuyo yonke inqubo, ngakho ukuhlukahluka emsebenzini ojwayelekile kungenzeka kube kukhulu kunalokhu.

Umphumela walokhu ekunakekelweni kweziguli ucacile. Ukubonakala kokuvaleka ekuhlolweni ngodayi egumbini lokubonana nodokotela kuyisizathu sokuqinisekisa, hhayi ukuxilongwa okungathathelwa izinyathelo kukodwa. Ukuqinisekisa ngokuvamile kusho ukuhlola kwe-laparoscopy okuyisilinganiso sokuqhathanisa noma okunye ukuhlolwa kwamashubhu okukhethwa ithimba elibhekele inzalo, kuchazwe kuhlanganiswe nomlando wezempilo, ubungozi bokutheleleka, nezithombe zokuhlola. Ukuhlolwa kwamashubhu e-fallopian nge-methylene blue kuqinisekisa ukuvuleka ngamandla kunendlela okukuphika ngayo.

Lokho ukugeleza kukadayi okungakwazi ukukubona

I-chromopertubation ilinganisa ukudlula koketshezi. Izimo eziningana ezibalulekile enzalweni azibonakali kulokhu kubuka. Ukunamathelana kwezicubu ezizungeze ishubhu, okuyimichilo yezicubu zesibazi, akubonakali nge-hysteroscope, ebona kuphela umgodi wesibeletho nezimbobo zamashubhu. I-laparoscopy ikubona ngokuqondile; kulolu cwaningo, abesifazane abangu-4 kwabangu-80 batholakala benokunamathelana kwezicubu kuleso sigaba kuphela, futhi ucwaningo lwangaphambili lubonisa ukuthi lokhu kwandisa amathuba omphumela wokugeleza oqinisekisa ngokungeyikho ukuthi konke kuhamba kahle.

I-hydrosalpinx, okuyishubhu elivuvukele ligcwele uketshezi ngenxa yokuvaleka ekugcineni okukude, nayo iyinto engase ingabonakali: abantu ababesaziwa ukuthi banayo abangeniswanga, kodwa i-hydrosalpinx eyayingakabonwa yatholakala ku-laparoscopy kwabesifazane abangu-7 kwabangu-80. I-endometriosis, ukulimala kolwelwesi lwangaphakathi, nokuphazamiseka kokuthathwa kweqanda kuphelelisa lolu hlu. Yingakho iziqondiso zenzalo zichaza i-chromopertubation njengesinyathelo esenziwa lapho i-laparoscopy isivele idingeka ngenxa yezinye izizathu, njengoba kuboniswa embonweni wekomidi le-ASRM mayelana nokuhlolwa kwenkinga yokuthola abantwana. Umongo obanzi wemininingwane yokuphepha kwe-methylene blue ubalulekile lapho kucatshangelwa noma yikuphi ukuhlolwa okuhilela ukuhlinzwa.

Kwehluka kanjani kokunye ukuhlolwa kwamashubhu

I-hysterosalpingography (HSG) idlulisa ngomlomo wesibeletho uketshezi olugqamisa izithombe ze-X-ray, bese isebenzisa lezo zithombe ukubonisa ukwakheka komgodi wesibeletho namashubhu. Iqopha ukuphuma koketshezi njenge-chromopertubation kodwa yengeza imisebe, ayikwazi ukuhlola ingaphandle lendawo ye-pelvis, futhi nayo iba nenkinga yokugoqeka kwemisipha ekhoneni lesibeletho.

Ukuhlolwa nge-ultrasound namanzi anosawoti kufaka amanzi anosawoti angenawo amagciwane emgodini wesibeletho, kuyilapho ithuluzi elifakwa esithweni sangasese lithatha izithombe zawo. Ukuthatha izithombe ngamanzi anosawoti kuphela kuhlola ikakhulukazi umgodi wesibeletho: uketshezi endaweni ye-pelvis lusikisela ukuthi okungenani ishubhu elilodwa livulekile, kodwa ngokuvamile akukwazi ukusho ukuthi yiliphi. I-ultrasound esebenzisa igwebu noma amabhamuza amancane ukuze kugqame izithombe ilandelela ishubhu ngalinye futhi ifana kakhulu nokuhlola ngodayi.

Ukuphepha nendawo yokuhlola ngamazwi alula

Ocwaningweni lweziguli ezingu-80, ababhali babika ukuthi azibanga khona izinkinga ezinkulu noma ezincane ezivela kunoma yikuphi kokuhlolwa okubili ngodayi. Lokho kuyanikeza ukuqiniseka ngaphakathi kwalolu cwaningo lokuqala oluncane, kodwa akusho ukuthi abukho ubungozi: imibiko yezigameko ngemva kwe-chromopertubation ichaza ukusabela okungavamile kokuzwela ngokweqile, i-methemoglobinemia, ukungena kukadayi emithanjeni yegazi, nezinkinga zamaphaphu, kanti ukuthi lokhu kwenzeka kangakanani akukalinganiswa kahle.

Kulandela amaphuzu amabili. Uhlobo lwe-laparoscopy lwengeza ubungozi obujwayelekile bokuhlinzwa nomuthi wokubulala izinzwa, yingakho lugcinelwa izimo lapho ukuhlola ngokuhlinza sekuhleliwe kakade. Futhi akukho kulokhu okungadluliselwa ekusetshenzisweni ekhaya: amandla engxube, ukungabi namagciwane, indawo yokufakwa, nokulungela izimo eziphuthumayo kungumthwalo wethimba lezempilo.

Ngakho isifinyezo esifanele sincike ezimweni. I-chromopertubation nge-methylene blue ibonisa ukuthi uketshezi luyadlula yini eshubhini ngesikhathi kubhekiwe, futhi umphumela wokuvuleka uthembeka kakhulu kunowokuvaleka. Ayilinganisi ukusebenza kwamashubhu, ayitholi zonke izimbangela zokungatholi abantwana ezisendaweni ye-pelvis, futhi ayelaphi lutho. Noma ubani onikezwa lolu hlolo kufanele abuze imibuzo emithathu: kuhlelwe ukuthi lwenziwe kuphi futhi kungani, kwenzekani uma umphumela ubonisa ukuvaleka, nokuthi yikuphi okunye okutholakele okungashintsha uhlelo.