Chii chinonzi Endoscopic Ultrasound? Chinangwa, Maitiro & Mhedzisiro

Endoscopic ultrasound (EUS) inzira yakakosha inobatanidza endoscopy uye ultrasound kuti uwane mifananidzo yakadzama yemugwagwa wako wekudya nezvombo zvakavakidzana. Funga nezvazvo sekunge uine maturusi maviri ane simba ekuongorora achishanda pamwe chete - chubhu inochinjika ine kamera (endoscope) uye masaisai eruzha (ultrasound) - kuti uone nzvimbo dzinogona kupotsa kumwe kuyedzwa.

Nzira iyi inobatsira vanachiremba kuti vaongorore madziro eesophagus yako, dumbu, duodenum, uye zvivakwa zvakavakidzana zvakaita sepankreas, chiropa, uye lymph nodes. Iyo ultrasound probe pamucheto weendoscope inogona kugadzira mifananidzo yakadzama zvinoshamisa nekuti inoswedera pedyo nezvombo izvi kupfuura maultrasound echinyakare ekunze.

Chii chinonzi endoscopic ultrasound?

Endoscopic ultrasound inzira yekuongorora isingapindi zvishoma inopa vanachiremba maonero epedyo emuviri wako wekudya nezvombo zvakavakidzana. Munguva yekuyedzwa, chubhu yakatetepa, inochinjika inonzi endoscope inopfuudzwa zvinyoro nyoro nemuromo wako uye ichienda mumugwagwa wako wekudya.

Chinhu chakakosha cheendoscope iyi iiyo diki ultrasound probe pamucheto wayo. Iyi probe inotumira masaisai eruzha epamusoro-frequency ayo anodzoka kuti agadzire mifananidzo yakadzama yezvikamu zvetishu uye zvivakwa. Nekuti iyo ultrasound iri pedyo nezvombo zviri kuongororwa, mifananidzo yakajeka uye yakarurama.

EUS inogona kuongorora zvikamu zvetishu izvo zvimwe zviyedzo zvekuongorora zvisingakwanise kuona zvakanaka. Zvinonyanya kukosha pakuona pancreas, bile ducts, uye akadzika akaturika emadziro emugwagwa wekudya. Izvi zvinoita kuti ive chishandiso chikuru chekuona shanduko dzekutanga kana kusagadzikana izvo zvingasaratidzika paCT scans kana MRIs.

Nei endoscopic ultrasound ichiitwa?

Chiremba wako angakurudzira EUS pavanoda kuferefeta zviratidzo kana zvawanikwa zvinoda kuongororwa zvakanyanya hurongwa hwako hwekugaya chikafu nenhengo dzakapoteredza. Maitiro aya anobatsira zvikuru pakuongorora mamiriro anokanganisa pancreas, bile ducts, kana akadzika ekuita kwako chikafu.

Zvikonzero zvakajairika zveEUS zvinosanganisira kuongorora kurwadziwa mudumbu kusingatsananguriki, kuferefeta mapundu epancreatic kana cysts, uye kuongorora mamwe marudzi ekenza. Maitiro acho anogona kubatsira kuona kana kukura kwacho kuri benign kana malignant, uye kana kenza iripo, yakapararira kusvika papi.

EUS inokoshawo pakutungamira biopsies kana masampuli etishu achidiwa kubva kunzvimbo dzakaoma kusvika. Ultrasound guidance inobvumira vanachiremba kuti vatarise zvakananga nzvimbo dzinofungidzirwa uye kutora masampuli zvakachengeteka. Uyezve, inogona kubatsira kuongorora matambudziko e bile duct, kuferefeta kurasikirwa uremu kusingatsananguriki, uye kuongorora mamiriro ekuzvimba epancreas.

Vamwe vanhu vanoda EUS kuti vatarise mamiriro anozivikanwa nekufamba kwenguva. Semuenzaniso, kana uine pancreatic cysts, chiremba wako angashandisa EUS kutevera chero shanduko muhukuru kana chitarisiko. Inoshandiswawo kuongorora mhinduro dzekurapa mune mamwe marudzi ekenza uye kuronga maitiro ekuvhiya.

Ndeapi maitiro eendoscopic ultrasound?

Maitiro eEUS anowanzo tora maminitsi makumi matatu kusvika makumi mapfumbamwe uye anowanzoitwa semaitiro ekunze. Uchasvika kuchipatara kana kiriniki uine mirairo yakakosha yekugadzirira, iyo inowanzo sanganisira kutsanya kwemaawa 8-12 pamberi.

Maitiro asati atanga, uchagamuchira conscious sedation kuburikidza neIV line kuti ikubatsire kuzorora uye kuderedza kusagadzikana. Sedation inoita kuti vanhu vazhinji vabatwe nehope uye vanyatsoita zvakanaka panguva yese yekuedzwa. Chikwata chako chekurapa chichatarisa zviratidzo zvako zvakakosha nguva dzose panguva yemaitiro.

Zvinoitika panguva yemaitiro acho:

1. Muchazorara padivi rako rekuruboshwe patafura yekuvhenekera
2. Mouth guard inoiswa kuchengetedza mazino ako uye endoscope
3. Chiremba anonyatso tungamira endoscope nemuromo wako uye pasi pahuro pako
4. Sezvo scope ichifamba nemugumbo rako rekudya, ultrasound probe inogadzira mifananidzo
5. Chiremba anoongorora nzvimbo dzakasiyana uye anogona kutora sampuli yematishu kana zvichidikanwa
6. Mhepo kana mvura zvinogona kuiswa kuti zvivandudze kuona
7. Nzira yese yekudya inonyatsoongororwa usati wabvisa scope

Munguva yekuongorora, unogona kunzwa kumwe kumanikidzwa kana kusagadzikana kudiki sezvo endoscope ichifamba, asi sedation inobatsira kuderedza izvi. Vanhu vazhinji havayeuki zvakawanda nezvekuongorora mushure meizvozvo nekuda kwezvinodhaka.

Kana biopsy ichidikanwa, unogona kunzwa kunzwa kudiki, asi izvi zvinowanzo kuve zvishoma uye zvinotsungirirwa zvakanaka. Chikamu che ultrasound hachina kurwadza zvachose sezvo ichishandisa masaisai eruzha panzvimbo yekushandisa chero kupi zvako kwemuviri.

Maitiro ekugadzirira endoscopic ultrasound yako?

Kugadzirira kwakakodzera kwakakosha kuti kuongorora kwe EUS kubudirire. Chiremba wako achapa mirairo chaiyo, asi kugadzirira kunowanzo kutanga zuva risati raitwa bvunzo. Kutevera matungamirirwo aya zvakanyatso chengeta mifananidzo yakajeka uye kuderedza njodzi yematambudziko.

Nhanho yakakosha yekugadzirira ndeyekutsanya kwemaawa 8-12 isati yaitwa. Izvi zvinoreva kuti hapana chikafu, zvinwiwa, chingamu, kana zvihwitsi mushure menguva yakatarwa. Kuva mudumbu risina chinhu kunodzivirira zvikamu zvechikafu kubva mukupindira mukuongorora uye kunoderedza njodzi yekufema panguva ye sedation.

Iwe unozofanirwawo kukurukura mishonga yako nechikwata chako chehutano. Dzimwe mishonga inogona kudikanwa kuti igadziriswe kana kumiswa kwenguva pfupi, kunyanya zvinoderedza ropa senge warfarin kana anticoagulants itsva. Zvisinei, usambomira kutora mishonga yakarairwa usina mirairo yakajeka kubva kuna chiremba wako.

Mamwe matanho ekugadzirira anosanganisira:

• Kuronga munhu wekukutyaira kumba mushure mekuvhiyiwa
• Kupfeka mbatya dzakanaka, dzakasununguka
• Kubvisa zvishongo, mazino ekugadzira, uye makontakiti lens pamberi pebvunzo
• Kuzivisa vashandi nezve allergy, kunyanya kumishonga kana latex
• Kukurukura chero zvinonetsa nezve sedation kana maitiro
• Kuunza runyorwa rwemishonga iripo uye nhoroondo yekurapa

Kana uine chirwere cheshuga, chiremba wako achapa mirairo yakakosha yekugadzirisa shuga yeropa rako nemishonga panguva yekutsanya. Vanhu vane matambudziko emoyo kana mamwe matambudziko akakomba ekurapa vangangoda matanho ekuwedzera kana kuongororwa.

Husiku hwekuvhiyiwa kwako, edza kuwana zororo rakakwana uye gara uine mvura yakakwana kusvikira nguva yekutsanya yatanga. Kana iwe uchinzwa uchinetseka nezve bvunzo, kurukura izvi nechikwata chako chehutano - vanogona kupa rutsigiro rwekuwedzera uye kupindura chero mibvunzo yaungave uine.

Maitiro ekuverenga mhedzisiro yako yeendoscopic ultrasound?

Kunzwisisa mhedzisiro yako yeEUS kunotanga nekuziva kuti radiologist kana gastroenterologist achanyatsoongorora mifananidzo yese uye zvawanikwa asati apa mushumo wakadzama. Iwe kazhinji haugamuchire mhedzisiro nekukasira mushure mekuvhiyiwa, sezvo mifananidzo ichida kuongororwa nekuchenjerera uye kududzirwa.

Mhedzisiro yeEUS yakajairika inoratidza nhengo uye matishu ane saizi inotarisirwa, chimiro, uye chitarisiko. Madziro emugero wako wekudya anofanira kuoneka sematanho akasiyana ane ukobvu hwakajairika, uye nhengo dzepedyo dzakaita sepankreas dzinofanira kuve nechimiro chimwe chete pasina huwandu kana cysts.

Zvakawanikwa zvisina kujairika zvinogona kusanganisira akati wandei emhando dzakasiyana dzekuchinja. Madziro emugero wekudya wakakora anogona kuratidza kuzvimba kana kenza, nepo huwandu kana nodules zvinogona kuratidza tumors kana lymph nodes yakakura. Cysts, iyo inoita senzvimbo dzakazadzwa nemvura, dzinowanzoita benign asi dzinogona kuda kuongororwa.

Zvakawanikwa zvakajairika uye zvinoreva zvazvinogona kusanganisira:

• Mavhiri emupancreas - anogona kunge ari ma cysts asina njodzi, shanduko dzinokonzerwa nekuzvimba, kana kenza
• Ma lymph nodes akakura - anogona kuratidza hutachiona, kuzvimba, kana kupararira kwekenza
• Shanduko dzemubile duct - dzinogona kuratidza matombo, strictures, kana zvimwe zvivhariso
• Kukora kwemadziro - kunogona kuratidza kuzvimba, hutachiona, kana malignancy
• Shanduko dzemuvascular - dzinogona kuratidza portal hypertension kana zvimwe zvikonzero zvekutenderera

Chiremba wako achatsanangura zvinorehwa nezvawanikwa kune mamiriro ako chaiwo uye hutano. Zvinhu zvakawanda zvisina kujairika zvinoonekwa paEUS hazvina njodzi uye zvinongoda kutarisa chete, nepo zvimwe zvingangoda kumwe kuyedzwa kana kurapwa. Mamiriro ezvinhu ezviratidzo zvako uye nhoroondo yako yekurapa akakosha pakududzira mhedzisiro nemazvo.

Kana masampuli etishu akatorwa panguva yacho, mhedzisiro iyoyo inowanzo tora mazuva akati wandei kusvika vhiki kuti agadziriswe. Chiremba wako achakubata nemhedzisiro yebiopsy uye achakurukura chero matanho anodiwa anotevera zvichibva pazvose zvawanikwa pamwe chete.

Ndezvipi zvinhu zvinoita kuti munhu ade endoscopic ultrasound?

Zvimwe zvinhu zvinogona kuwedzera mukana wako wekuda nzira yeEUS. Zera ndechimwe chinhu chekufunga, sezvo mamiriro akawanda anoda kuongororwa kweEUS achiwedzera kuwanda sezvatinokura, kunyanya mushure memakore makumi mashanu.

Nhoroondo yemhuri inoita basa rakakosha pakuona kukosha kweEUS. Kana iwe uine hama dzine kenza yepamusoro, kenza yemugumbo rekudya, kana mamwe ma genetic syndromes, chiremba wako anogona kukurudzira EUS yekutarisa kana kuongorora zviratidzo zvinonetsa.

Zvimwe zviratidzo uye mamiriro anowanzo kutungamira kune EUS kutumirwa. Kurwadziwa mudumbu kunoramba kuripo, kunyanya mudumbu repamusoro, kunogona kupa mvumo yekuferefeta kana mamwe maedzo asina kupa mhinduro. Kurasikirwa uremu kusingatsananguriki, jaundice, kana shanduko mumaitiro ematumbo zvinogona zvakare kukonzera kudiwa kwekuongorora uku kwakadzama.

Zvikonzero zvinowanzoita kuti zviite EUS zvinosanganisira:

• Nhoroondo yemunhu yema cysts epancreatic kana masasi
• Pancreatitis isingaperi kana pancreatitis inodzoka yakaoma
• Zvakawanikwa zvisina kujairika paCT kana MRI scans
• Zviratidzo zvebundu zvakakwira mumiedzo yeropa
• Nhoroondo yapfuura yemamwe marudzi ekenza yematumbo ekugaya
• Genetic syndromes dzine hukama nekuwedzera njodzi yekenza
• Nhoroondo yekusvuta, iyo inowedzera njodzi yekenza yepancratic
• Chirwere cheshuga chinomuka kamwe kamwe muvanhu vakuru

Zvimwe zvezvinhu zvehupenyu zvinogonawo kukanganisa kudiwa kweEUS. Kushandisa doro zvakanyanya kunowedzera njodzi ye pancreatitis uye matambudziko ane hukama anogona kuda kuongororwa. Kusvuta hakungowedzeri njodzi yekenza chete asi kunogonawo kubatsira kumatambudziko akasiyana ekugaya.

Kuva nemamwe mamiriro ezvinhu ekurapa kunoita kuti EUS iwedzere kukurudzirwa. Izvi zvinosanganisira inflammatory bowel disease, hereditary pancreatitis, kana yapfuura radiation therapy kumudumbu. Vanhu vane izvi mamiriro vanowanzo kuda kutarisa kwakadzama kwematumbo avo ekugaya uye nhengo dzakapoteredza.

Ndezvipi zvingaitika zvinogona kuitika zveendoscopic ultrasound?

EUS kazhinji inzira yakachengeteka, asi semaitiro ese ekurapa, inotakura njodzi. Matambudziko akakomba haawanzoitiki, achiitika mune isingasviki 1% yenzira, asi zvakakosha kunzwisisa zvinogona kuitika.

Mhedzisiro yakajairika ndeyekureruka uye yenguva pfupi. Izvi zvinosanganisira huro inorwadza kwezuva kana maviri mushure mekuita, bloating yakapfava kubva kumhepo yakaunzwa panguva yekuongorora, uye kuneta kwenguva pfupi kubva mukudzikamisa. Vanhu vazhinji vanonzwa vakadzokera kune zvakajairika mukati me24 maawa.

Matambudziko akakomba asi asingawanzoitiki anogona kuitika, kunyanya kana masampuli etishu achitorwa. Kubuda ropa kunogoneka, kunyanya kana iwe uchitora mishonga inoderedza ropa kana uine mamwe mamiriro ekurapa. Njodzi yakakwira kana biopsies dzichiitwa, asi kubuda ropa kwakakosha kunoda kurapwa hakusi kwakajairika.

Zvingaitika zvinosanganisira:

• Kubvaruka (kubvaruka) kwemadziro emudumbu - kashoma kwazvo asi kwakakomba
• Kubuda ropa kubva kunzvimbo dzebhayopsi - kazhinji kadiki uye kunomira pachako
• Utachiona - hausi kazhinji nekushandisa nzira yakachena
• Kuita kune mishonga yekuzorodza - kashoma asi kunogona kuva kwakakomba
• Aspiration - kufema mukati mezviri mudumbu, kunodzivirirwa nekutsanya
• Pancreatitis - kuzvimba kunokonzerwa nemaitiro, kashoma kwazvo
• Matambudziko emoyo nemitsipa yeropa - ane chekuita nekuzorodzwa muvarwere vane njodzi yakakwirira

Zvimwe zvinhu zvinogona kuwedzera njodzi yako yematambudziko. Zera repamusoro, mamiriro akawanda ekurapa, matambudziko ekuumbwa kweropa, uye kuvhiyiwa kwemudumbu kwakapfuura zvinogona kuwedzera zvishoma njodzi. Chikwata chako chekurapa chichanyatsoongorora mamiriro ako ega usati waenderera mberi.

Zviratidzo zvinoda kutariswa kwekurapa nekukurumidza mushure meEUS zvinosanganisira kurwadziwa kwakanyanya mudumbu, kurutsa kunoramba kuripo, fivha, kuoma kumedza, kana kubuda ropa kwakanyanya. Matambudziko mazhinji, kana akaitika, anoonekwa mukati memaawa mashoma ekutanga mushure mekuita.

Chikwata chako chehutano chinotora matanho akawanda ekuderedza njodzi, kusanganisira kusarudzwa kwakanyatsoita kwevarwere, kugadzirira kwakakodzera, nzira yakachena, uye kuongorora pedyo panguva uye mushure mekuita. Kubatsirwa kwekuwana ruzivo rwakakosha rwekuongorora kazhinji kunopfuura njodzi diki dziripo.

Ndingatarisira riini chiremba nezve mhedzisiro yeendoscopic ultrasound?

Unofanira kubata chiremba wako nekukurumidza kana uine zviratidzo zvinonetsa mushure mekuita kwako EUS. Nepo vanhu vazhinji vachipora nekukurumidza vasina matambudziko, zviratidzo zvimwe zvinoda kutariswa kwekurapa nekukurumidza kuti uve nechokwadi chekuchengeteka kwako uye kugara zvakanaka.

Kurwadziwa kwakanyanya mudumbu kunowedzera pane kuvandudza chiratidzo chitsvuku chinoda kuongororwa nekukurumidza. Saizvozvowo, kurutsa kunoramba kuripo, kunyanya kana usingakwanise kuchengeta mvura pasi, kunoda kutarisirwa kwekurapa nekukurumidza. Zviratidzo izvi zvinogona kuratidza matambudziko anoda kurapwa nekukurumidza.

Taura nechiremba wako nekukasira kana ukaona:

• Kurwadziwa kwakanyanya mudumbu kana kuwedzera
• Kurutsa kusingagumi kana kusakwanisa kuchengeta mvura pasi
• Fivha inodarika 101°F (38.3°C)
• Kutadza kumedza izvo zvisingavandudzi mushure memaawa makumi maviri nemana
• Zviratidzo zvekubuda ropa senge zvigaro zvitema kana kurutsa ropa
• Dizziness yakanyanya kana kufenda
• Kurwadziwa kwechipfuva kusinganzwisisike kana kutadza kufema

Kuti uwane zvakajairika zvekutevera nezve mhedzisiro yako, vanachiremba vazhinji vanoronga musangano wekutevera mukati mevhiki imwe kana maviri mushure mekuita. Izvi zvinopa nguva yekuti zvese zvawanikwa zviongororwe zvakadzama uye kuti chero mhedzisiro yebiopsy idzoke kubva murabhoritari.

Usamirira musangano wako wakarongwa kana uine mibvunzo kana kunetsekana nezve mhedzisiro yako. Vanachiremba vazhinji vane nhare dzevanamukoti kana masaiti evarwere kwaunogona kubvunza mibvunzo pakati pekushanya. Zviri nani nguva dzose kubvunza nezve chimwe chinhu chiri kukunetesa pane kumirira nekushamisika.

Kana EUS yako yakaratidza zvinhu zvinoda kuenderera mberi nekuongorora kana kurapwa, chiremba wako achagadzira chirongwa chakajeka chekutevera. Izvi zvinogona kusanganisira kudzokorora imaging, mamwe maedzo, kana kutumira kune nyanzvi. Ita shuwa kuti unonzwisisa nguva uye kukosha kwekutevera chero kurapwa kunokurudzirwa.

Mibvunzo inowanzo bvunzwa nezve endoscopic ultrasound

Q.1 Ko endoscopic ultrasound bvunzo yakanaka here kenza yepakati?

Hongu, EUS inoonekwa seimwe yenzira dzakanakisa dzekutsvaga nekutora kenza yepakati. Inogona kuziva tuma tumor tudiki tusingazviratidzi zvakajeka paCT scans kana MRIs, kunyanya idzo diki pane masendimita maviri. Kuswedera pedyo kwe ultrasound probe kupakati kunopa mhando yepamusoro yemifananidzo.

EUS inobatsira zvikuru pakutsvaga nhanho yekenza yepakati kana yangowanikwa. Inogona kuratidza kana kenza yapararira kumidzi yeropa iri pedyo, lymph nodes, kana zvimwe zvikamu zvemuviri, izvo zviri ruzivo rwakakosha pakuronga kurapwa. Ruzivo urwu rwekutsvaga nhanho runobatsira vanachiremba kuti vaone kana kuvhiyiwa kuchibvira uye kuti rudzii rwekurapa rwaizobudirira zvikuru.

Mubvunzo 2. Ko ultrasound isina kujairika inogara ichireva kenza here?

Kwete, zviwanikwa zveEUS zvisina kujairika hazvirevi nguva dzose kenza. Mamiriro mazhinji anogona kukonzera maonekero asina kujairika pa ultrasound, kusanganisira benign cysts, kuzvimba, zvirwere, uye kukura kusina kenza. Muchokwadi, vazhinji vezviwanikwa zvisina kujairika vanozoratidza mamiriro akanaka anoda kutarisa pane kurapwa kwakanyanya.

Semuenzaniso, pancreatic cysts inowanzo wanikwa panguva yeEUS, uye mazhinji acho akanaka uye haadi kurapwa. Chronic pancreatitis, bile duct stones, uye mamiriro ekuzvimba anogonawo kugadzira maonekero asina kujairika asina chekuita nekenza. Ichi ndicho chikonzero sampuli yematishu uye mamwe maedzo anowanzoitwa kuti aone chaiwo maitiro ezviwanikwa zvisina kujairika.

Mubvunzo 3. Zvinotora nguva yakareba sei kuti uwane mhedzisiro yeendoscopic ultrasound?

Zviwanikwa zvekutanga kubva pakuongorora kwekuona zvinowanzo kuwanikwa mukati memazuva mashoma ekuvhiyiwa kwako. Chiremba wako anogona kukuudza nezve kusajairika kuri pachena kana zviwanikwa zvakajairika zvinonyaradza nekukurumidza mushure mekuongorora mifananidzo uye zvinyorwa zvemaitiro.

Zvisinei, kana sampuli yematishu yakatorwa panguva yekuvhiyiwa, mhedzisiro yakazara inowanzo tora mazuva mashanu kusvika manomwe ebhizinesi. Mamwe maedzo akakosha pamasampuli ematishu anogona kutora nguva yakareba, kusvika kumavhiki maviri mune dzimwe nguva. Chikwata chako chehutano chichakuzivisa nezve nguva yakatarisirwa yemamiriro ako chaiwo uye ichakubata nekukurumidza sezvo mhedzisiro yese iripo.

Mubvunzo 4. Ndingadya zvakajairika mushure meendoscopic ultrasound here?

Kazhinji unogona kutangazve kudya kana migumisiro yekupedzisira yashanda uye wakamuka zvizere, kazhinji maawa 2-4 mushure mekuvhiyiwa. Tangira nezvinhu zvishoma zvemvura yakajeka semvura kana juzi reapuro kuti uve nechokwadi chekuti unogona kumedza zvakanaka pasina chero kutsamwa kwehuro.

Kana ukashandisa mvura zvakanaka, unogona zvishoma nezvishoma kuenda kuzvokudya zvakapfava wobva wadzokera kune zvako zvakajairika. Zvisinei, kana sampuli yematishu yakatorwa panguva yekuvhiyiwa, chiremba wako angakurudzira kudzivisa doro nemishonga yakati wandei kwemaawa 24-48 kuderedza njodzi yekubuda ropa. Nguva dzose tevera mirairo chaiyo mushure mekuvhiyiwa yakapihwa nechikwata chako chehutano.

Q.5 Ko endoscopic ultrasound yakanyatsojeka kupfuura CT scan here?

EUS uye CT scans ndiyo bvunzo dzinowedzerana idzo dzese dzine zvakanakira zvakakosha. EUS inowanzoita zvakanyatsojeka pakuongorora pancreas, bile ducts, uye zvikamu zvemadziro emugumbo rekudya nekuti ultrasound probe inoswedera pedyo zvikuru nezvivakwa izvi kupfuura kufungidzira kwekunze kunogona kuita.

Pekuona tumor diki dzepancreatic, kubatanidzwa kweguruva remuviri, uye kuongorora kudzika kwekenza, EUS inowanzoita zvakanyanya kupfuura CT scans. Zvisinei, CT scans dziri nani pakuwana mufananidzo wese wekudya kwese uye pakuona kupararira kwakawanda kwechirwere. Vanachiremba vazhinji vanoshandisa bvunzo dzese pamwechete kuti vawane mufananidzo wakakwana sezvinobvira, sezvo imwe neimwe ichipa ruzivo runokosha asi rwakasiyana.