Isihloko
I-methylene blue yobuhlungu ngemva kokuhlinzwa kwama-hemorrhoid: okuboniswa ukuhlolwa
Udokotela ohlinzayo uncoma ukususwa kwama-hemorrhoid. Isiguli sizwa igama elilodwa: ubuhlungu. Umbuzo ulandela ngokushesha. Ingabe kukhona ukwelashwa endaweni ehlinzwayo, okunikezwa ngesikhathi sokuhlinzwa, okwenza isonto lokuqala libe lula? Ukuhlolwa okuthathu okwabiwa ngokungahleliwe kuhlola indlela eyodwa engase isetshenziswe: i-methylene blue ejovwa esikhumbeni esizungeze indunu ngesikhathi sokuhlinzwa. Ukuhlolwa ngakunye kubika ubuhlungu obuncane ekuqaleni lapho kusetshenziswe i-methylene blue. Ukuhlolwa ngakunye kunemikhawulo ethinta ukuthi lowo mphumela ungasebenza nakwezinye izimo kangakanani.
Leli khasi liqhathanisa lokhu kuhlolwa okuthathu ndawonye. Libhalelwe izinhlobo ezimbili zabafundi. Isiguli singalisebenzisa ukulungiselela imibuzo yeqembu elihlinzayo. Umbhali angalisebenzisa ukuhlola lokho ucwaningo ngobuhlungu obuhlobene nezinqubo nokwelashwa endaweni ethile olukurekhode ngempela, usuku nosuku.
Lokho lokhu kuhlolwa okuyikho, nalokho okungekhona
Ukuhlolwa ngakunye kwabhalisa abantu abadala ababehlinzwa ngendlela ye-Milligan-Morgan yokususwa kwama-hemorrhoid, okuyindlela yokuwasika nokuwasusa kushiywe amanxeba evulekile. Ekuhlolweni ngakunye, udokotela wafaka i-methylene blue eduze kwendawo ehlinzwayo ngesikhathi isiguli sisafakwe umuthi wokubulala izinzwa. Imiphumela eyalinganiswa kwakuwubuhlungu ngemva kokuhlinzwa, ukusetshenziswa kwemithi eyengeziwe yokudambisa ubuhlungu, nezinkinga.
Akukho kulokhu kuhlolwa okuthathu okwacwaninga ukulunywa kwendunu okuhlala isikhathi eside, ukwelashwa kwemifantu endunu, noma izimpawu zama-hemorrhoid ezingelashwa ngokuhlinzwa. Ucwaningo ngokulunywa luvela kuphela njengesizinda sendlela okucatshangwa ukuthi lokhu kusebenza ngayo, okuwukunciphisa okwesikhashana ukuzwela kwemizwa yasendaweni, hhayi njengokusetshenziswa okuhloliwe. Ukuhlolwa kwango-2024 kwakungabandakanyi abantu ababenomfantu noma i-fistula ngesikhathi esifanayo. Ukuhlolwa kwango-2026 kwakungabandakanyi abantu ababenomfantu, i-fistula, ithumba, noma esinye isifo samathumbu. Uma izikali zobuhlungu zikudida, indlela yokufunda ukuhlolwa kobuhlungu ichaza i-VAS ne-NRS ngaphambi kokuba uqhathanise izinombolo. Ukulunywa nokudabuka kwezicubu kuyizinkinga ezihlukene; bheka izimo zemifantu endunu nokulunywa ukuze uqonde kahle imingcele yalolu cwaningo.
Indlela ukuhlolwa okuthathu okwakuhlelwe ngayo
Izindlela zokunikeza ukwelashwa zihlukene ngokwanele ukuthi akufanele zithathwe njengokwelashwa okukodwa okufanayo. Umehluko phakathi komthamo omncane nomkhulu uphindwe kayishumi, futhi isikhathi sokunikezwa, ungqimba lwezicubu, neqembu lokuqhathanisa konke kuyahluka. Ukuhlinzwa kungenye yezindlela zokwelapha ama-hemorrhoid; lokhu kuhlolwa kugxile kuphela ebuhlungwini bangemva kokuhlinzwa.
| Ukuhlolwa | Iziguli ezahlaziywa | Indlela yokunikeza i-methylene blue | Iqembu lokuqhathanisa nokunakekelwa okuvamile |
|---|---|---|---|
| Sim noTan 2014 | 67 (i-methylene blue 37, iqembu lokuqhathanisa 30), ukususwa kwama-hemorrhoid ngendlela evulekile ye-diathermy | 4 mL we-methylene blue engamaphesenti angu-1 (40 mg) exutshwe no-16 mL we-bupivacaine engamaphesenti angu-0.5, ejovwa ngaphakathi kwesikhumba esizungeze indunu ngaphambi kokuhlukaniswa kwezicubu | I-bupivacaine efanayo nosawoti oncibilikisiwe esikhundleni sikadayi oluhlaza okwesibhakabhaka; i-paracetamol njengomuthi ovamile kanye ne-diclofenac kwabikwa ekukhishweni kwesibili kwedatha |
| Azhough 2024 | 97 (i-methylene blue 48, iqembu lokuqhathanisa 49), izinga III noma IV, iqembu elilodwa elihlinzayo, umuthi wokubulala izinzwa emgogodleni | 5 mL we-methylene blue engamaphesenti angu-1 (50 mg) efakwa ezindaweni ezinhlanu ngaphakathi kwesikhumba, 1 mL endaweni ngayinye, cishe ku-2 cm ukusuka onqenqemeni lwenxeba lokusikwa, ngemva kokususwa kwezicubu | 5 mL we-bupivacaine engamaphesenti angu-0.5 ngemva kokususwa kwezicubu; i-ketorolac ngezikhathi ezihleliwe, i-tramadol eyengeziwe uma idingeka, bese kuba i-naproxen ne-acetaminophen ne-codeine lapho isiguli sikhishwa esibhedlela |
| Zhu 2026 | 60 (30 eqenjini ngalinye), ama-hemorrhoid angaphakathi nangaphandle, udokotela ohlinzayo oyedwa, umuthi wokubulala izinzwa esifundeni esingezansi somgogodla | Udayi oluhlaza okwesibhakabhaka ohlanjululwe waba ngamaphesenti angu-0.1 (1 mL wamaphesenti angu-1 no-9 mL wosawoti oncibilikisiwe), 0.5 kuya ku-1 mL enxebeni ngalinye lokusikwa ngendlela evuleka njengefeni, kulandelwe ukubhucungwa kafushane, isamba esingu-5 mL noma ngaphansi (5 mg noma ngaphansi), ngemva kokususwa kwezicubu | Akukho mjovo wasendaweni; i-lornoxicam 8 mg uma isiguli siyicela, kube okungenani namahora angu-6 phakathi kwemithamo |
Amaphuzu amabili okwakheka kokuhlolwa abalulekile. Okokuqala, ukuhlolwa kwango-2014 nokwango-2024 kuqhathanisa udayi nokufakwa kwe-bupivacaine ezicutshini, ngakho noma yimuphi umehluko uwumphumela owengeziwe kadayi phezu komuthi wokubulala izinzwa wasendaweni, kanti ukuhlolwa kwango-2026 kuqhathanisa udayi nokunganikezwa komjovo wasendaweni. Okwesibili, ukufihla ukuthi umuntu ukuliphi iqembu kuba buthaka lapho umbala oluhlaza okwesibhakabhaka ubonakala khona. Ababhali bango-2026 bathi ukushintsha kombala wezicubu nomchamo kwenza ukufihlwa kwamaqembu ngendlela esebenzayo kungenzeki, okushiya izilinganiso zobuhlungu ezincike embonweni wesiguli zisengozini yokuchema.
Ubuhlungu ngosuku ngemva kokuhlinzwa
Iphethini efanayo iwukuthi amaqembu ayahluka ekuqaleni, bese imiphumela yawo isondelana. Ukuhlolwa ngakunye kusebenzisa isikali esihlukile, ngakho funda ngakunye ngokwendlela yaso. Izindlela ezivamile zitholakala ekulawulweni kobuhlungu ngemva kokuhlinzwa, okuhlanganisa imithi evamile yokudambisa ubuhlungu nokuhlelwa kwemithi eyengeziwe uma idingeka.
Ek ukuhlolweni okwabiwa ngokungahleliwe, okufihlelwe uhlangothi olulodwa, kwe-methylene blue ejovwa ngaphakathi kwesikhumba ngemva kokususwa kwama-hemorrhoid ngendlela evulekile ye-diathermy, iziguli zagcina idayari yesikali esibonakalayo sokulinganisa ubuhlungu. Isilinganiso esimaphakathi sobuhlungu sasiphansi ngokubalulekile ngokwezibalo nge-methylene blue ezinsukwini ezingu-1 kuya ku-3 ngemva kokuhlinzwa, nokusetshenziswa kwe-paracetamol kwakuphansi ngaleso sikhathi, futhi kwakungekho nzuzo ebalulekile ngokwezibalo ngemva kosuku 3. Izilinganiso eziqondile ezimaphakathi azitholakali embhalweni wesifinyezo ofinyelelekayo, ngakho lokhu kubuyekezwa akuziqambeli izinombolo zosuku ngalunye.
Ek ukuhlolweni okufihlelwe izinhlangothi ezimbili kwe-methylene blue ejovwa ngaphakathi kwesikhumba ngemva kokususwa kwama-hemorrhoid, iziguli zarekhoda ubuhlungu bazo obukhulu kakhulu ngosuku ngalunye lapho ziyolala, esikalini esinamaphuzu angu-11 ukusuka ku-0 kuya ku-10, izinsuku ezingu-14. Umehluko wawubalulekile ngokwezibalo ezinsukwini ezingu-1 kuya ku-7, u-p engaphansi kuka-0.001 ngosuku ngalunye, futhi wawungabalulekile ngokwezibalo ezinsukwini ezingu-8 kuya ku-14:
- Usuku 1: udayi oluhlaza okwesibhakabhaka 4.08 kuhlanganiswe noma kususwe 1.23, iqembu lokuqhathanisa 5.20 kuhlanganiswe noma kususwe 1.40.
- Usuku 2: udayi oluhlaza okwesibhakabhaka 3.94 kuhlanganiswe noma kususwe 1.17, iqembu lokuqhathanisa 5.22 kuhlanganiswe noma kususwe 0.87.
- Usuku 3: udayi oluhlaza okwesibhakabhaka 3.90 kuhlanganiswe noma kususwe 1.10, iqembu lokuqhathanisa 5.02 kuhlanganiswe noma kususwe 0.95.
- Usuku 4: udayi oluhlaza okwesibhakabhaka 3.71 kuhlanganiswe noma kususwe 1.25, iqembu lokuqhathanisa 4.71 kuhlanganiswe noma kususwe 1.21.
- Usuku 5: udayi oluhlaza okwesibhakabhaka 3.60 kuhlanganiswe noma kususwe 1.27, iqembu lokuqhathanisa 4.67 kuhlanganiswe noma kususwe 1.21.
- Usuku 6: udayi oluhlaza okwesibhakabhaka 3.46 kuhlanganiswe noma kususwe 1.27, iqembu lokuqhathanisa 4.31 kuhlanganiswe noma kususwe 1.21.
- Usuku 7: udayi oluhlaza okwesibhakabhaka 3.35 kuhlanganiswe noma kususwe 1.27, iqembu lokuqhathanisa 3.92 kuhlanganiswe noma kususwe 1.21.
- Izinsuku 8 kuya ku-14: womabili amaqembu ehla aya cishe ku-2.5 kuya ku-3.5, kungabikho umehluko obalulekile ngokwezibalo phakathi kwamaqembu kunoma yiluphi lwalezi zinsuku zakamuva (wonke amanani ka-p angaphezu kuka-0.2).
Ocwaningweni lwango-2026 olwabiwa ngokungahleliwe lokufakwa kwe-methylene blue ehlanjululwe ezicutshini ngemva kokuhlinzwa kwe-Milligan-Morgan, ubuhlungu ngesikhathi sokuphumula esikalini esibonakalayo sika-0 kuya ku-10 babuphansi nge-methylene blue emahoreni angu-6, 24, 48, nangu-72, u-p engaphansi kuka-0.001 esikhathini ngasinye. Izilinganiso eziqondile ezimaphakathi zivela kuphela njengomdwebo kunokuba zibe yithebula lezinombolo, ngakho lokhu kubuyekezwa kubika iphethini ngaphandle kokuguqula ukuphakama kwemigqa egrafini kube ukunemba okungelona iqiniso.
Imithi eyengeziwe yokudambisa ubuhlungu
Ukusetshenziswa kwemithi eyengeziwe lapho idingeka yikho lapho ukuhlolwa kuhluka khona ngekhwalithi yokubika.
Ukuhlolwa kwango-2014 kubika ukusetshenziswa kwe-paracetamol okuphansi ngokubalulekile ngokwezibalo nge-methylene blue ngezinsuku ezingu-1 kuya ku-3, okuhambisana nesikhathi lapho ubuhlungu babuphansi khona, kodwa isifinyezo esifinyelelekayo asinikezi amanani asetshenzisiwe, izilinganiso zeziguli eziyisebenzisile, noma inani eliqondile lika-p.
Ukuhlolwa kwango-2024 kwacacisa i-ketorolac ngezikhathi ezihleliwe, i-tramadol eyengeziwe uma idingeka, nokurekhodwa kwamaphilisi asetshenziswa ekhaya, kodwa imiphumela eshicilelwe ayibiki ukusetshenziswa eqenjini ngalinye. Lokho kungabikho kuyinto etholakele ngokwako: ubufakazi bokudanjiswa kobuhlungu busekelwe ezilinganisweni zobuhlungu kuphela.
Ukuhlolwa kwango-2026 kucace kakhulu kulokhu. Isamba se-lornoxicam emahoreni angu-72 sasinesilinganiso esimaphakathi esingu-22.67 kuhlanganiswe noma kususwe 17.01 mg nge-methylene blue, uma kuqhathaniswa no-56.80 kuhlanganiswe noma kususwe 9.32 mg eqenjini elingajovwanga, u-p engaphansi kuka-0.001. Qaphela ukungalingani: iqembu lokuqhathanisa lathola umuthi wokudambisa ubuhlungu kuphela lapho liwucela, kanti iqembu likadayi lathola ukungenelela okukodwa ngesikhathi sokuhlinzwa.
Izinkinga nokulandelela
Akukho ukuhlolwa okubika uphawu olukhulu lwenkinga yokuphepha endaweni yokwelashwa, kodwa akukho nokukodwa okwakuhlelelwe ukuthola ukulimala okungavamile noma okuvela kamuva. Ukuze uthole umongo wezingozi, bheka iphrofayili yokuphepha kwe-methylene blue kanye namathebula ezinkinga angezansi.
Isifinyezo sango-2014 sigqamisa umphumela owodwa ophawulekayo: isilinganiso sobungozi bokubambeka komchamo okuzumayo lapho i-methylene blue ingasetshenziswanga sasingu-2.32, nesikhawu sokuzethemba esingamaphesenti angu-95 ukusuka ku-1.75 kuya ku-3.07. Amazinga ezinye izinkinga ayengahlukile ngokubalulekile ngokwezibalo.
Ukuhlolwa kwango-2024 kubika izinkinga ezinsukwini ezingu-14. Ukubambeka komchamo kwenzeka kwabangu-5 kwabangu-48 abathola udayi oluhlaza okwesibhakabhaka nakwabangu-5 kwabangu-49 beqembu lokuqhathanisa. Ukungakwazi ukuzibamba okwesikhashana kwenzeka kwabangu-3 uma kuqhathaniswa no-1, nokopha okwenzeka kamuva kwabangu-0 uma kuqhathaniswa no-2. Ukufa kwezicubu zesikhumba, ukutheleleka, ukusabela kwesikhumba endaweni yokwelashwa, nokuncipha komgudu kwakunguziro kuwo womabili amaqembu, futhi ukulunywa kwenzeka kumuntu oyedwa eqenjini ngalinye. Awukho umehluko owafinyelela ezingeni lokubaluleka ngokwezibalo.
Ukuhlolwa kwango-2026 kubika amahora angu-72 kuphela. Ukutheleleka kwesikhumba nezicubu ezingaphansi kwaso ezizungeze indunu, ukufa kwezicubu zesikhumba, nokwakheka kwamahlule egazi azungeze indunu kwakunguziro kuwo womabili amaqembu. Akunikezi izinombolo eziqoqwe ngokuhlelekile ngokubambeka komchamo, ukopha, ukutheleleka, ukungakwazi ukuzibamba, ukubambezeleka kokuphola, noma ukuphinda kuvele kwama-hemorrhoid. Ukushintsha kwezicubu nomchamo kube luhlaza okwesibhakabhaka kuvunywa njengenkinga yokufihla amaqembu kunokuba kufakwe etafuleni njengesigameko.
Ubude bokulandelela buwumkhawulo omkhulu kukho konke lokhu kuhlolwa okuthathu: cishe izinsuku ezingu-14 ekuhlolweni kokuqala okubili namahora angu-72 kokwesithathu. Ukubambezeleka kokuphola, ikhono lokuzibamba phakathi nezinyanga, nokuphinda kuvele kwama-hemorrhoid akunakwahlulelwa ngale datha.
Ithebula lobufakazi ngosuku ngemva kokuhlinzwa
Ithebula elingezansi liyisifinyezo esihlanganisiwe saleli khasi. Ligcina ubuhlungu, ukusetshenziswa kwemithi eyengeziwe, amaqembu okuqhathanisa, izinkinga, nokulandelela kubonakala ndawonye.
| Ukuhlolwa | Ubufakazi bobuhlungu ngosuku | Imithi eyengeziwe yokudambisa ubuhlungu | Umehluko eqenjini lokuqhathanisa | Izinkinga | Ukulandelela |
|---|---|---|---|---|---|
| Sim noTan 2014, n ilingana no-67 | I-VAS iphansi ngodayi oluhlaza okwesibhakabhaka ngezinsuku ezingu-1 kuya ku-3; akukho mehluko obalulekile ngokwezibalo ngemva kosuku 3; izilinganiso eziqondile ezimaphakathi azikho esifinyezweni esifinyelelekayo | I-paracetamol incane ngodayi oluhlaza okwesibhakabhaka ngezinsuku ezingu-1 kuya ku-3; amanani awanikeziwe | Udayi oluhlaza okwesibhakabhaka ne-bupivacaine uma kuqhathaniswa ne-bupivacaine nosawoti oncibilikisiwe; kuhlukanisa umphumela owengeziwe kadayi | Isilinganiso sobungozi bokubambeka komchamo singu-2.32 ngaphandle kukadayi oluhlaza okwesibhakabhaka; ezinye izigameko azihlukile ngokubalulekile ngokwezibalo | Idayari yobuhlungu cishe izinsuku ezingu-14 |
| Azhough 2024, n ilingana no-97 | I-NRS yobuhlungu obukhulu kakhulu ngosuku iphansi ngodayi oluhlaza okwesibhakabhaka ngezinsuku ezingu-1 kuya ku-7 (igebe licishe libe ngamaphuzu angu-1.1 ekuqaleni, 0.6 ngosuku 7); akukho mehluko ngezinsuku ezingu-8 kuya ku-14 | Indlela yokunikeza imithi yacaciswa kodwa ukusetshenziswa eqenjini ngalinye akubikwanga | Udayi oluhlaza okwesibhakabhaka 50 mg uma kuqhathaniswa ne-bupivacaine; kuhlukanisa umphumela owengeziwe kadayi | Ukubambeka komchamo 5 uma kuqhathaniswa no-5; ukungakwazi ukuzibamba okwesikhashana 3 uma kuqhathaniswa no-1; ukopha 0 uma kuqhathaniswa no-2; ukufa kwezicubu nokutheleleka 0 uma kuqhathaniswa no-0; akukho okubalulekile ngokwezibalo | Izinsuku ezingu-14 |
| Zhu 2026, n ilingana no-60 | I-VAS ngesikhathi sokuphumula iphansi ngodayi oluhlaza okwesibhakabhaka emahoreni angu-6, 24, 48, 72, u-p engaphansi kuka-0.001 ngasinye; izilinganiso ezimaphakathi zisemfanekisweni kuphela | Isamba se-lornoxicam 22.67 uma kuqhathaniswa no-56.80 mg, u-p engaphansi kuka-0.001 | Udayi oluhlaza okwesibhakabhaka ohlanjululwe ongu-5 mg noma ngaphansi uma kuqhathaniswa nokungajovwa; umehluko omkhulu kakhulu ekwakhekeni kokuhlolwa | Ukutheleleka kwesikhumba nezicubu ezingaphansi kwaso, ukufa kwezicubu, nokwakheka kwamahlule egazi 0 uma kuqhathaniswa no-0; ukubambeka komchamo, ukopha, ukuphola, nokuphinda kuvele kwama-hemorrhoid akubikwanga ngokuhlelekile | Amahora angu-72 |
Lokhu kusho ukuthini ekubonisaneni nodokotela ohlinzayo
Ukuhlolwa okuthathu okuncane, ngakunye okwenziwa esikhungweni esisodwa, kusebenzisa imithamo emithathu ehlukene kadayi uma kuqhathaniswa nezinhlobo ezimbili ezihlukene zamaqembu okuqhathanisa, kuyavumelana ngokuthi ubuhlungu buphansi ezinsukwini zokuqala ngemva kokususwa kwama-hemorrhoid lapho i-methylene blue yengezwa ngesikhathi sokuhlinzwa. Ubufakazi bokwehla kobuhlungu obuhlala isikhathi eside kakhulu bufinyelela ezinsukwini ezingu-7. Idatha yemithi eyengeziwe isekela le phethini ekuhlolweni okubili futhi ayikho kokwesithathu. Ukulandelela okufushane namaqembu eziguli amancane akunakukhipha amathuba emiphumela engavamile noma evela kamuva.
Imibuzo okufanele uyiyise kudokotela ohlinzayo:
- Yikuphi ukuhlinzwa okuhleliwe, futhi yiziphi izinyathelo zasendaweni esezivele ziyinqubo evamile lapho?
- Ingabe kunikezwa ukufakwa kwanoma yimuphi udayi oluhlaza okwesibhakabhaka ezicutshini, ngamuphi umthamo nakuluphi ungqimba, futhi esikhundleni sayiphi enye indlela?
- Yimiphi imithi evamile neyengeziwe yokudambisa ubuhlungu ehleliwe, futhi ukusetshenziswa kwayo kurekhodwa kanjani?
- Ukubambeka komchamo, ukopha, ukutheleleka, nekhono lokuzibamba kulandelelwa kanjani, futhi amasonto amangaki?
- Ukushintsha kwesikhumba noma komchamo kube luhlaza okwesibhakabhaka okwesikhashana kufanele kulindeleke ukuthi kubukeke kanjani, futhi kufiphala nini?
Kubabhali ababuyekeza ucwaningo ngobuhlungu obuhlobene nezinqubo, uhlu lokuhlola lufushane: ukugxila okuqondile kwengxube, umthamo woketshezi, nesamba somthamo; ungqimba lwezicubu nesikhathi sokunikezwa uma kuqhathaniswa nokususwa kwezicubu; into esebenzayo esesirinjini seqembu lokuqhathanisa; imithi evamile yokudambisa ubuhlungu enikezwa ngezikhathi ezihleliwe uma kuqhathaniswa nenikezwa lapho icelwa; izamba zemithi eyengeziwe eqenjini ngalinye; izilinganiso zobuhlungu ezibikwa ngosuku ngalunye; kanye nethebula lezinkinga elinezinani zabantu ezisetshenziswe ukubala izilinganiso nobude besikhathi sokulandelela. Ngaphandle kwalawo maphuzu, isimangalo esihlanganisa ukuhlolwa ngomthamo asisekelwa, ngoba udayi ongu-50 mg ojovwa ngaphakathi kwesikhumba uma kuqhathaniswa ne-bupivacaine kanye nodayi ongu-5 mg ojovwa ngaphansi kwesikhumba uma kuqhathaniswa nokunganikezwa lutho kuyizindlela zokungenelela ezihlukene.