Innovative technologies for the treatment of cervical intraepithelial neoplasia of the cervix

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Каттаходжаева M., Каршиева E., & Амонова Z. (2022). Innovative technologies for the treatment of cervical intraepithelial neoplasia of the cervix. in Library, 22(1), 1–3. извлечено от https://inlibrary.uz/index.php/archive/article/view/14772
М Каттаходжаева, Ташкентский государственный стоматологический институт

кафедра офтальмология с курсом гинекологии

Е Каршиева, Ташкентский государственный стоматологический институт

кафедра офтальмология с курсом гинекологии

З Амонова, Ташкентский государственный стоматологический институт

кафедра офтальмология с курсом гинекологии

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Аннотация

WHO  identifies  as  countering  cancer  mortality  such  main directions as – prevention, screening and early diagnosis of precancerous diseases and  early  stages.  Conditions  of  the  cervix  that  exist  for  a  long  time  against  the background inflammatory processes, belong to the risk group for the occurrence precancer. It must be remembered, that the ablation technique can be applied only if the  transformation  zone  is  completely  visualized  during  colposcopy,  there  is  no malignant invasive process and atypia of the glandular epithelium of the canal and there  is  no  discrepancy  in  the  data  of  cytological  and  histological  studies.  An important factor is the adequate treatment of this pathology. When taking a biopsy, excision or conization of the cervix, autopsy retention cysts, surgical treatment of ectropion, removal various neoplasms of the cervix, vagina or vulva, very important are the safety of electrosurgical technology, regulation the depth of tissue burn injury and  cosmetological  effects.  Thus,  the  issues  of  correct  choosing  a  method  of coagulation or ablation of the affected areas of the cervix, especially in women with ongoing fertility.

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INNOVATIVE TECHNOLOGIES FOR THE TREATMENT OF

CERVICAL INTRAEPITHELIAL NEOPLASIA OF THE CERVIX

Kattakhodjaeva M.Kh., Karshieva E.E., Amonova Z.D., the Department of

Ophthalmology with course of Gynecology of TSDI

Tashkent State Dental Institute, Uzbekistan

Relevance.

WHO identifies as countering cancer mortality such main

directions as – prevention, screening and early diagnosis of precancerous diseases
and early stages. Conditions of the cervix that exist for a long time against the
background inflammatory processes, belong to the risk group for the occurrence
precancer. It must be remembered, that the ablation technique can be applied only if
the transformation zone is completely visualized during colposcopy, there is no
malignant invasive process and atypia of the glandular epithelium of the canal and
there is no discrepancy in the data of cytological and histological studies. An
important factor is the adequate treatment of this pathology. When taking a biopsy,
excision or conization of the cervix, autopsy retention cysts, surgical treatment of
ectropion, removal various neoplasms of the cervix, vagina or vulva, very important
are the safety of electrosurgical technology, regulation the depth of tissue burn injury
and cosmetological effects. Thus, the issues of correct choosing a method of
coagulation or ablation of the affected areas of the cervix, especially in women with
ongoing fertility.

The purpose of this study

was to study the comparative efficacy and safety of

argon plasma coagulationand other methods of destruction of pathological foci of
the cervix with benign background and precancerous processes.

Materials and methods.

The object of the study was 67 women reproductive

age with various pathologies of the cervix. V the main group included 37 patients,
in whose treatment was used radio wave biopsy and argon ablation. In the treatment
of 30 women traditional diathermoelectrocoagulation was used using apparatus K57.
Radio wave biopsy and argon plasma coagulation procedures were carried out on
the "Fotek EA-141" in the first phase menstrual cycle – 5-9 days. Ablation was
performed under the condition complete colposcopic visualization of the
transformation zone and absence of discrepancy between the data of the conducted
surveys. For this, an argon plasma flow was used in the "Spray" mode and power of
36–38 W (soft, smooth argon plasma ablation). Anesthesia was not routinely
performed.

Research results.

When performing work under supervision there were 87

women aged 16 to 38 years (average age 22.3±1.7 years) with benign pathological
processes epithelium of the cervix. Before applying the methods of argon plasma
tissue coagulation and other methods of destruction of pathological foci in for this
pathology of the cervix, all 67 patients were selected after conducting a
comprehensive examination: cytological, general clinical examination, extended
colposcopy, diagnostics by PCR, bacteriological and bacterioscopic examination of
discharge from the cervical canal and vagina, excluding infectious and inflammatory
processes. At colposcopic studies revealed the following diseases: ectopia of
columnar epithelium - in 21 patients (37%), benign transformation zone - in 12


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(21%), a combination the listed processes were diagnosed in 17 (30%), subepithelial
endometriosis - 7 (12%). The listed pathological processes of the cervix with the
same frequency were distributed in both groups of patients. II group – 30 women
who underwent cryodestruction cervix. The intervention was carried out on an
outpatient basis. If necessary sanitation of the vagina, anti-inflammatory therapy was
prescribed. Usually in during the operation, the patient noted slight discomfort in the
lower abdomen or a "tingling sensation" that did not require application medicines.
The duration of the operation was 10-15 minutes. There were no complications
during and after the procedure. At the end of the intervention, the patients were
discharged home with recommendations to refrain from sexual intercourse until the
control examination after 1.5 months, limit physical activity, exclude bathing and, if
necessary, use panty liners. The clinical efficacy of therapy was assessed by the
positive dynamics of clinical symptoms, colposcopic and cytological picture. As a
result of the poll after the execution procedure, it was found that in the I group of
women pain in the form of moderate tingling or burning sensation was noted by 30%
of patients. Complaints in duration were within 2-5 minutes, later the feeling of
discomfort was not manifested. In women of the II group, pain sensations of varying
severity were present in 15 (79%) patients, which forced the use of injecting the
cervix 2% - 1 ml lidocaine or ultracaine or treatment of the cervix with a drug
lidocaine spray, prescribe various pain medications after procedures. Painful
sensations were noted for 2-4 hours. In the postoperative period, the wound exudate
was presented by scanty serous or smearing secretions that lasted 6-11 days. When
the scab is rejected from the wound surface the cervix on the 7-10th day in all cases
did not require excretion therapeutic measures. In group II, where
diathermodestruction was used pathological foci, abundant watery discharge were
observed in all 100% of patients within 20 days, then the intensity gradually
decreased, completely disappeared after 28-30 days. When conducting control
colposcopy 28-30 days after the treatment it was noted that in group I, after argon
plasma coagulation of tissues complete epithelialization of the cervical tissue
occurred in 90% of patients, the average period of complete epithelialization was 35
days (25-45 days earlier, than in the comparison group. In the group of patients after
diathermodestruction cervix with colposcopy after 35 days complete
epithelialization was found only in 38.8% of women, and the average period of full
epithelialization was 3 months. Cicatricial changes were present in 22% of cases.
Re-intervention after diathermodestruction 4 women had to perform the method of
argon plasma coagulation. Control examination and extended colposcopy were
performed after 1.5-2 months after surgery and, if necessary, further in dynamics. It
was found that the average duration of healing of the cervix after procedures were
42 ± 2.5 days. Delayed epithelialization (50-60 days) noted in 3 cases, and in all
these situations the procedure argon plasma coagulation of the neck was carried out
after sanitation vagina due to bacterial vaginosis and/or STIs-mycoplasma,
ureaplasma and human papillomavirus infections; after examination, such patients
were prescribed dexpanthenol vaginally (in candles) and Actovegin (in pills) orally
in standard course dosages.

Conclusions.


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In accordance with the results obtained, a number of conclusions can be drawn

about the expediency of using the method of argon plasma coagulation in treatment
of pathology of the cervix. The advantages of this method are: - the possibility
simultaneous and quick removal of pathological tissues from a large lesion focus; -
minimal discomfort during the operation, which allows you to refuse anesthesia in
most cases; - absence of physical contact of the working part of the tool with tissues
of the patient negates the possibility of infection and formation of carbon deposits
on the electrode, provides the ability to control depth and area of coagulation; - the
bloodlessness of the intervention and the absence of smoke ensures the doctor good
visualization and the ability to produce fast and accurate manipulations; - the
sterilizing effect of radio waves allows you to use it when treatment of persistent
chronic cervicitis; - preservation of the shape of the cervix and the absence of rough
scarring allow to apply this method to nulliparous and planning repeated pregnancy
to women; - short time of postoperative wound healing.

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