Surgery for cervical dysplasia

Considering the pathogenesis of the disease associated with infection with the genital human papillomavirus (HPV), as well as the likelihood of malignancy of cervical dysplasia, in domestic and foreign gynecology, the only effective treatment method today is considered to be surgery for cervical dysplasia at stage CIN II-III.

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Indications for surgical treatment

The main indications for surgical treatment are grade 2-3 cervical dysplasia identified by a gynecologist and accurately diagnosed based on the patient’s examination.

An examination that provides the basis for surgical treatment of moderate and severe stages of cervical intraepithelial dysplasia necessarily includes the determination of abnormally modified cells in the epithelial tissue of the outer shell of the cervix, which is carried out on the basis of a Papanicolaou smear (PAP smear or PAP test) and its cytological examination.

If the result of this smear is positive, then abnormal cells in the exocevix have been detected, and the cytological report (cytogram) will indicate a high degree of squamous epithelial lesion - HSIL. This refers to moderate and severe dysplasia. And it should be borne in mind: the risk that these anomalies reflect precancerous changes reaches 71%, and the risk of cervical cancer is 7%.

To confirm the results of the PAP test and accurately determine the size and localization of dysplasia, an endoscopic examination of the cervix is performed - colposcopy, which allows for high-magnification visualization of epithelial cells and, using special biochemical test samples, distinguishing abnormal ones among them. It is important that the doctor sees in detail through the colposcope the so-called transition zone of the cervix, which is located between the two types of epithelium covering it - multilayered flat and cylindrical, since it is in this zone that all cell mutations begin in malignant neoplastic processes.

During colposcopy, indications for surgical treatment will include the presence of leukoplakia foci in the tissues of the transition zone of the cervix, the formation of new blood vessels (abnormal vascularization), the detection of new tissue in the dysplasia zone (plus tissue syndrome), etc.

During colcoposcopy (or during a separate biopsy), a sample of cervical epithelium is taken from the neoplasia area - a biopsy, the histological examination of which is intended to finally establish the degree of mutations and the intensity of mitosis of cervical epithelial cells and to verify the absence (or presence) of oncology. Only with complete identity of the histology and cytology results is a decision made on the need for surgery for cervical dysplasia and a method for performing it is selected.

Types of operations for cervical dysplasia

In modern gynecology, the following types of operations are used for cervical dysplasia:

• diathermocoagulation (loop electroexcision);
• resection (conical excision) using the "cold knife" method;
• laser cauterization (vaporization) or laser conization;
• cryodestruction (coagulation with liquefied nitrous oxide);
• amputation of the cervix.

Diathermocoagulation destroys pathological tissues by electrothermal coagulation of their protein components. The method is reliable, proven for decades, but leaves a layer of coagulated cells on the surface of the epidermis treated with current, through which the surgeon no longer sees how deep it is necessary to advance the working electrode, and acts intuitively. This inaccuracy results in rather deep burns with tissue necrosis, after healing of which an impressive scar remains on the cervix.

Resection of the affected tissues of the cervix in the form of their cone-shaped excision (conization) makes it possible to obtain a sample of the endothelium for histological examination, but this is the most invasive type of surgery for cervical dysplasia - with bleeding and longer tissue regeneration.

It should be noted that in most cases, surgery for grade 3 cervical dysplasia is performed either by diathermocoagulation, or by excision using the “cold knife” method, or using a laser.

Low-power laser cauterization is essentially evaporation, since the laser destroys pathological cells almost without a trace to a strictly specified depth (maximum - almost 7 mm), without affecting healthy epithelium. The operation requires local anesthesia, can cause a burn and uterine spasms, but does without blood (due to the simultaneous coagulation of damaged blood vessels).

In laser conization, the operation for cervical dysplasia, including grade 3 cervical dysplasia, is performed with a more powerful laser, however, it is possible to obtain a tissue sample for histology. Minor bloody discharge occurs only when the scab comes off, approximately at the end of the first week after the procedure.

Although cryodestruction does not require anesthesia, it is now used less and less, since this type of surgery for cervical dysplasia does not allow an objective assessment of the volume of removed tissue, which often leads to relapses of the pathology. Destroyed pathological tissues in the transformation zone cannot be removed during the procedure, and they will come off in the form of vaginal discharge for 10-14 days.

In addition, the specific structure of the loose scab that forms at the site of freezing prolongs the healing period of the postoperative wound and causes prolonged lymph secretion (lymphorrhoea). And immediately after cryodestruction, many patients experience a slowdown in heart rate and fainting.

During amputation of the cervix, the surgeon performs a high cone-shaped resection of tissues, preserving the organ. Of course, under general anesthesia.

The most common complications after cervical dysplasia surgery include bleeding, cervical scar deformation, narrowing of the cervical canal, and inflammation of the endometrium. There may be problems with the regularity of the menstrual cycle, as well as with the onset of pregnancy and childbirth.

Also, among postoperative complications, there is a high probability of not only an exacerbation of existing inflammatory processes in the pelvic area, but also a relapse of cervical dysplasia.

Rehabilitation period

From 35 to 50 days – this is how long the rehabilitation period after surgery for cervical dysplasia lasts on average.

During the first three to four weeks, there will be mucous and bloody vaginal discharge, and there will often be pain in the lower abdomen. Don't worry - that's how it should be. But there shouldn't be any heavy blood discharge or high temperature!

Gynecologists give all patients the following recommendations for the postoperative period:

• you need to wait with sex for two months;
• for the same period of time, forget about going to the pool, the beach, or the sauna;
• your water treatments are limited to a shower;
• your personal hygiene products for this time are only pads;
• if you take up sports later, you’ll go to the gym or fitness club in a couple of months;
• make sure you have helpers to help you lift heavy objects;
• more vegetables and fruits, less cakes and sweets.

And three months after you had surgery for cervical dysplasia, your doctor is waiting for you for an appointment.