Ukuhlolwa ngodayi we-methylene blue kokuvuza komchamo nama-fistula: okufakazelwa yiswabhu eliluhlaza okwesibhakabhaka

Emasontweni ambalwa ngemva kokuhlinzwa endaweni ye-pelvis, isiguli sibona ukuthi umchamo uvuza ngokuqhubekayo. Sicabanga ukuthi sinokutheleleka esinyeni, siqede umjikelezo wemithi elwa namagciwane, bese sidideka lapho ukuvuza kuqhubeka kungashintshile. Le mithi yayingeke isebenze, ngoba indlela yokuqonda inkinga yayingalungile. Ukutheleleka kuwukungena kwamagciwane ezicutshini. I-fistula iyimbobo: umgudu ongajwayelekile oxhumanisa izindawo ezimbili okufanele zihlukaniswe, kulokhu okuyisinye nesitho sangasese sowesifazane. Awukho umuthi olwa namagciwane ovala imbobo.

Yilesi simo ukuhlolwa ngodayi we-methylene blue okwaklanyelwa sona. Lokhu kuhlolwa akwelaphi lutho, akutholi ukutheleleka, futhi akuhlonzi isimo ngokwakho kuphela. Kuphendula umbuzo owodwa oqondile: ingabe uketshezi olusesithweni sangasese luvela esinyeni esigcwaliswe ngodayi? Konke okuphathelene nale nqubo, kuhlanganise nezindlela engahluleka ngazo, kusukela kuleyo njongo eyodwa. Ukubuka kwethu konke ukusetshenziswa kwe-methylene blue kwezokwelapha kubeka lokhu kusetshenziswa ekuhlonzeni izimo kanye nemisebenzi yale nhlanganisela evunyelwe nesacwaningwayo.

Umqondo oyisisekelo: uketshezi oluluhlaza okwesibhakabhaka olulawulwayo njengomkhondo

Isimiso senziwe saba lula ngamabomu. Isinye sigcwaliswa nge-catheter, uketshezi lufakwe ngokuphambene nendlela umchamo ovame ukuphuma ngayo, kusetshenziswa uketshezi lokugeza olungenamagciwane oluqukethe i-methylene blue ehlanjululiwe. Isitho sangasese akufanele sibe noketshezi oluluhlaza okwesibhakabhaka. Uma uketshezi oluluhlaza okwesibhakabhaka luvela kuso endaweni engajwayelekile, kukhona ukuxhumana phakathi kwesinye noma i-urethra nesitho sangasese. Udayi uyinto yokulandela umkhondo, kanti ukuhlolwa kuyindlela yokuthola indawo yokuvuza.

Lokhu kuletha imiphumela emibili ngokushesha. Okokuqala, ukuhlolwa kungathola kuphela ukuvuza okusemzileni ongemuva kwendawo lapho udayi ufakwe khona. Udayi oluhlaza okwesibhakabhaka osesinyeni awukwazi ukuveza i-fistula phakathi kwe-ureter nesitho sangasese, ngoba umchamo ovela ku-ureter ethintekile ufika esithweni sangasese ungakaze ungene esinyeni. Okwesibili, umphumela okhombisa ukuvuza ukhomba indawo yokuvuza kodwa awusho lutho ngesimo sezicubu, ubukhulu be-fistula, noma indlela yokuyilungisa. Yingakho ukuhlela izinqubo zokuhlinza nezokuhlonza izimo kuhlala kudlulela ngale kokuhlolwa ngodayi.

Ukuhlolwa kwamaswabhu amathathu, isinyathelo ngesinyathelo

Ukuhlolwa kuqala ngaphambi kokusetshenziswa kwanoma yimuphi udayi. Ukuhlolwa nge-speculum kubheka ukunqwabelana komchamo ocacile futhi, uma sibonakala, isikhala se-fistula esivulekela esithweni sangasese. Umlando wesiguli nokuhlolwa okugxile enkingeni kunesincomo esiqinile eziqondisweni zaseYurophu zezifo zohlelo lomchamo mayelana nama-fistula omchamo, futhi awukho umphumela kadayi odlula lokho amehlo akubona ngokuqondile.

Inqubo esemthethweni yamaswabhu amathathu, njengoba ichazwe embikweni wamagama ezobuchwepheshe we-ICS/IUGA, ihamba kanje. Amaswabhu amathathu esipontshi omile afakwa ngokulandelana esithweni sangasese: elilodwa phezulu, elilodwa phakathi, nelilodwa phansi. Ezinye izindlela zisebenzisa izigaxa ze-gauze, amabhola kakotini, noma i-tampon, kodwa amaswabhu amathathu ahlukene ayindlela emisiwe. Isinye sibe sesigcwaliswa nge-catheter ngoketshezi lokugeza oluluhlaza okwesibhakabhaka oluhlanjululiwe, bese uchwepheshe wezokwelapha ebheka uketshezi oluluhlaza okwesibhakabhaka oluphuma esikhaleni sesitho sangasese ngesikhathi sokugcwalisa. Ukufaka amaswabhu ngaphambi kokugcwalisa kubalulekile: ukufaka i-tampon ngemva kokuchitheka kukadayi eduze kwendawo yokungena kuqinisekisa ukuthi izongcoliswa ngodayi, futhi umphumela ungabi nancazelo.

Akukho umthamo owodwa, izinga lokugxila elilodwa, noma isikhathi esisodwa sokushiya udayi esinyeni esisebenza yonke indawo, futhi isihloko esithembekile kufanele sikusho lokho. Incwadi ye-FIGO yokuqeqesha ngokuhlinzwa kwe-fistula ichaza ukusebenzisa udayi ohlanjululiwe ongu-60 kuya ku-100 mL bese kuhlolwa ngokushesha; uma kungabonakali lutho, isiguli siyahamba futhi siphuze imizuzu engu-30 kuya ku-60 udayi usasesinyeni. Enye inqubo yangemva kokuhlinzwa yasebenzisa u-250 kuya ku-300 mL futhi yaxwayisa ngokukhethekile ukuthi ukugcwaliswa okunganele kudala imiphumela ephuthelwa ama-fistula amancane. Incazelo ye-ICS/IUGA ithi amaswabhu akhishwa ngemva kwemizuzu engu-10, kodwa ivumela kuze kufike emizuzwini engu-30 uma umgudu umncane kakhulu noma ugwegwile. Isiqondiso esisekelwe ebufakazini siwukugcwalisa ngokwanele ngesixazululo esihlanjululiwe ngokwenqubo yendawo, hhayi ukunquma indlela eyodwa okufanele isetshenziswe yonke indawo.

Ukufunda amaswabhu

Iswabhu ngalinye likhishwa lilodwa, bese kubhalwa ukuthi limanzi yini nokuthi linombala onjani. Ukuhunyushwa okujwayelekile, ngokulandela izincazelo ze-ICS/IUGA:

Umugqa oyingozi kakhulu ngowesibili. Umbala oluhlaza okwesibhakabhaka eswabhini eliphansi kuphela yiwona ongavela kalula ngaphandle kokuba khona kwe-fistula nhlobo, ngenxa yokuvuza okuvamile nge-urethra noma uketshezi oluluhlaza okwesibhakabhaka oluchithekela emuva lusuka embotsheni yayo. Iswabhu eliphansi eliluhlaza okwesibhakabhaka lodwa alikaze liqede uphenyo.

Ukuhlolwa ngodayi ababili: ukuhlukanisa isinye ne-ureter

Lapho umchamo uqhubeka uvela esithweni sangasese kodwa udayi osesinyeni ungaveli kuwo, ukusola kudlulela phezulu ku-ureter. Ukuhlolwa ngodayi ababili kwenza le mithombo emibili ihlukaniseke ngokubonakala. Isiguli siphuza i-phenazopyridine kuze kube umchamo uba nombala owolintshi ogqamile (incazelo esemthethweni isebenzisa u-200 mg kathathu ngosuku usuku olulodwa kuya kwezimbili, nakuba ezinye izinqubo zasemtholampilo zisebenzisa umthamo owodwa), bese isinye sigcwaliswa ngoketshezi lokugeza oluluhlaza okwesibhakabhaka njengaphambilini.

Umqondo uwukulandela indlela uketshezi oluhamba ngayo. Ibala eliluhlaza okwesibhakabhaka esithweni sangasese lisho ukuthi uketshezi luvela esinyeni noma ku-urethra. Ibala eliwolintshi elingenawo umbala oluhlaza okwesibhakabhaka lisho ukuthi uketshezi luvela kuma-ureter angaphezu kwesinye. Yomibili imibala isikisela ukuxhumana kuzo zombili izindawo. Umchamo ocacile engxenyeni ephezulu yesitho sangasese, nakuba isinye sinodayi oluhlaza okwesibhakabhaka, ukhomba umthombo ofanayo ophezulu njengombala owolintshi. Lena yinqubo yokuhlonza eqondiswa uchwepheshe wezokwelapha, hhayi ucwaningo lokuzizamela ekhaya.

I-cystoscopy negumbi lokuhlinzela

Ukuhlolwa ngodayi kusebenza nangakolunye uhlangothi. Ngesikhathi sokuhlinzwa endaweni ye-pelvis, isinye singagcwaliswa ngokuphambene nendlela umchamo ovame ukuphuma ngayo ngoketshezi lokugeza olunombala oluhlaza okwesibhakabhaka, ngesikhathi kubhekwa indawo ehlinzwayo; uketshezi oluluhlaza okwesibhakabhaka olukhuphukela kuleyo ndawo lukhomba imbobo esinyeni, futhi lokhu kungaphindwa ngemva kokulungiswa ukuze kuhlolwe ukuthi ukuvalwa kubonakala kungavuzi yini. Enye indlela ebikiwe yasebenzisa kuze kufike ku-600 mL ngale njongo, okufanele kuqondwe njengombiko wokuhlinza hhayi njengomthamo ojwayelekile okufanele ufakwe kuzo zonke izinye.

I-cystoscopy ichaza lokho amaswabhu angakwazi ukukuchaza: inani, ubukhulu, nendawo yezimbobo zesinye nokuhlobana kwazo ne-trigone nezimbobo zokungena zama-ureter. Iziqondiso zaseYurophu zincoma i-cystoscopy ehambisana nokugcwaliswa ngoketshezi olunombala olufakwa ngokuphambene nendlela umchamo ovame ukuphuma ngayo ukuze kuqinisekiswe i-fistula, kodwa ziphawula ukuthi ubufakazi obusekelayo bunomkhawulo. Enye indlela ehlobene kodwa ehlukile ihlola ukuthi ama-ureter avulekile yini ngesikhathi se-cystoscopy ngokubheka imifudlana kadayi ephuma ezimbotsheni zawo. Lapha into yokulandela umkhondo kufanele ifike ivela phezulu, ngegazi noma ngomchamo, ngoba udayi ofakwe ngaphakathi kwesinye usuvele usemzileni ongemva kwama-ureter futhi awukwazi ukuwahlola. Ukudidanisa le mizila emibili kadayi yilona kanye iphutha lokuqonda ithebula lamaswabhu elihloselwe ukulivimbela. Imininingwane yalezi zindlela zokuhlinza itholakala kumhlahlandlela wethu ohambisana nalona we-methylene blue ekuhlinzeni nasekuhlonzeni izimo.

Kungani ukuhlolwa kungaphutha kuzo zombili izinhlangothi

Umphumela othi akukho ukuvuza kube kukhona unezimbangela ezivamile ezimbalwa: ukugcwaliswa okuncane kakhulu kwesinye, umgudu omncane kakhulu noma ogwegwile obudinga isikhathi esingaphezu kwemizuzu eyishumi, ukuvuza okwenzeka ngezikhathi ezithile noma okuncike ekumeni komzimba, i-fistula phakathi kwe-ureter nesitho sangasese udayi osesinyeni ongeke uyifinyelele, noma i-fistula yesibili efihlwe yileyo etholwe kuqala. Kolunye ucwaningo olubheka emuva lweziguli ezingu-56 ezazine-fistula ngemva kokuhlinzwa, ukuhlolwa ngodayi okungu-10 kokungu-13 okwenziwa ngaphambi kokudluliselwa kweziguli kwabanye ochwepheshe kwabonisa ukuvuza. Leso sibalo sika-10 kokungu-13 kwesinye isikhathi sicashunwa sengathi silinganisa ikhono lokuhlolwa lokuthola ama-fistula akhona. Akunjalo: iqembu lalikhethwe ngokukhethekile futhi ucwaningo aluzange lwaklanywa njengocwaningo lokunemba kokuhlonza. Ucwaningo lwango-2020 lweziguli zangemva kokuhlinzwa lusekela ukuhlolwa ngodayi njengendlela esheshayo yokuqala, hhayi njengesibalo esilinganisiwe sekhono lokuthola ama-fistula.

Imiphumela ethi kukhona ukuvuza nge-fistula kube kungekho, kanye nemiphumela edukisayo, ngokuvamile ihlobene nokungcoliswa: udayi ochitheka ngesikhathi kufakwa i-tampon, umchamo omuncwa izinto ezifakiwe bese usabalala kuzo, ukuchama ngesikhathi sokuhlolwa, noma ukuhluleka ukubamba umchamo okuvamile ngenxa yokucindezeleka kwesinye noma isifiso esiphuthumayo sokuchama, okushiya ibala eswabhini eliphansi. Akukho kulokhu okukhombisa i-fistula, yingakho ukubheka ngokuqondile ngesikhathi sokugcwalisa nokubheka imbobo ye-urethra ukuze kubonakale ukugeleza okubuyela emuva kuyingxenye yenqubo, hhayi izengezo zokuzikhethela.

Umphumela wokuhlolwa ngodayi okhombisa ukuvuza awuwona umphumela we-UTI, futhi ngokuphambene nalokho

Ukutheleleka ohlelweni lomchamo akudali umgudu phakathi kwesinye nesitho sangasese, ngakho ukutheleleka kukodwa akukwazi ukubangela ukuvuza okuluhlaza okwesibhakabhaka ngaphandle kwembobo ye-urethra ngaphansi kwezimo ezilawulwayo. Lezi zimo ezimbili zinezimpawu ezifanayo futhi zingaba khona ngesikhathi esisodwa, okuyisona sizathu sokuthi zididaniswe. Isifiso esiphuthumayo sokuchama nokuhluleka ukubamba umchamo ngenxa yaso okubangelwa ukutheleleka kuholela ekuphumeni komchamo nge-urethra evamile; ukuvuza nge-fistula kuyayidlula. Ukuhlaziywa komchamo nokuhlolwa kokukhuliswa kwamagciwane kusabalulekile lapho kusolwa ukutheleleka, futhi ukukala i-creatinine oketshezini oluqoqwe esithweni sangasese kungaqinisekisa ukuthi lolo ketshezi ngumchamo, nakuba lokho kukodwa kungakwazi ukukhomba indawo yokuvuza. Qaphela okunye okungadida imiphumela: eminye imithi eyinhlanganisela yezinkinga zomchamo equkethe i-methylene blue ishintsha umbala womchamo ngokwayo, ngakho kubalulekile ukuyisho kuchwepheshe wezokwelapha ngaphambi kwanoma yikuphi ukuhlola okusebenzisa udayi.

Okusadinga ukwenzeka ngemva kwamaswabhu

Ukuhlolwa ngodayi kuqala uphenyo; akuluqedi. Ukuhlolwa kwendawo ye-pelvis kuhlola isimo sezicubu, izibazi, nendawo ye-fistula. I-cystoscopy ne-urethroscopy zikhomba izikhala zangaphakathi ngaphambi kwanoma yikuphi ukulungiswa. Lapho kusolwa umthombo ose-ureter noma ukwakheka kwezitho kungacacile, i-CT enento eyenza izithombe zicace, ethathwa esigabeni sakamuva sokukhishwa kwaleyo nto ngomchamo, noma i-MRI ibonisa ingxenye ephezulu yohlelo lomchamo, kanti i-retrograde pyelography ingachaza ngokuqondile i-ureter okungaqinisekwa ngayo. Kukhona izifundo zokuqhathanisa nge-ultrasound: ocwaningweni oluncane lweziguli eziyishumi nambili lokuhlola ukuthi indlela ingasebenza yini, i-color Doppler ethuthukiswe ngento eyenza izithombe zicace yahlukanisa kahle izimo ezingu-11 kwezingu-12, kodwa lowo mphumela ungowendlela ye-ultrasound, hhayi owokuhlolwa ngodayi (uVolkmer nozakwabo, 2000).

Ukuhlolwa ngodayi kuyasetshenziswa futhi ngemva kokwelashwa. Izincomo ze-FIGO zokusebenza okuhle zeluleka ukuhlola ngodayi ezinsukwini ezingu-10 kuya ku-14 ngemva kokulungiswa kwe-fistula, ngaphambi kokukhishwa kwe-catheter, isiguli sikhwehlela sibhekiwe (uBrowning nozakwabo, 2025). Umphumela ongabonisi ukuvuza kulokho kuvakasha usho ukuthi akukho ukuvuza nge-fistula okubonisiwe ngaleso sikhathi; awuqinisekisi ukuthi ngeke kube khona ukuvuza kamuva ngenxa yokuhluleka ukubamba umchamo, ukugcinwa komchamo esinyeni, ukutheleleka, noma umthombo ose-ureter ongabonwanga.

I-methylene blue inomunye umsebenzi wokuhlonza okufanele ugcinwe uhlukile ekuhlolweni kwe-fistula: iphinde isetshenziswe ukuhlola ukuthi amashubhu e-fallopian avulekile yini, okuyinqubo echazwe kumhlahlandlela wethu wokuhlolwa kwenzalo nokuhlolwa kokuvuleka kwamashubhu. Udayi ofanayo, umbuzo ohlukile, izitho ezihlukile. Ukugcina umbuzo uxhumene nomphumela kuyisisekelo sakho konke ukuhlolwa ngodayi. Iswabhu eliluhlaza okwesibhakabhaka lifakazela ukuthi kukhona umzila. Konke okunye, ubukhulu, ukuthi kungalungiseka yini, nesibikezelo somphumela, kusadinga ukuhlolwa.