Operation for cervical dysplasia

Given 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 method of treatment to date is surgery for cervical dysplasia in the CIN II-III stage.

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Indications for surgical treatment

The main indications for surgical treatment are revealed by a gynecologist and on the basis of a patient's examination accurately diagnosed dysplasia of the cervix of 2-3 degree.

The examination that provides the basis for the operative treatment of moderate and severe stages of cervical intraepithelial dysplasia necessarily involves the detection of abnormally altered cells in the epithelial tissue of the outer cervix, which is performed on the basis of a Pap smear (PAP smear or PAP-test) and its cytological study.

If the result of this smear is positive, then abnormal cells in exotsevix are detected, and a high degree of lesion of the flat epithelium - HSIL - will be indicated in the cytological report (cytogram). 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 - 7%.

To confirm the result of the PAP test and to accurately determine the size and location of dysplasia, an endoscopic examination of the cervix is performed - colposcopy, which allows to visualize epithelial cells in a large magnification and to distinguish among them abnormal by means of special biochemical test samples. It is important that the doctor, through the colposcope, see in detail the so-called cervical transition zone, which lies between the two kinds of epithelium covering it - multilayered flat and cylindrical, since it is in this zone that all cell mutations begin with inferior neoplastic processes.

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

During the colposcopy (or during a separate biopsy), a sample of the cervical epithelium from the site of the neoplasia is taken - a biopsy specimen, the histological study 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 the full identity of the results of histology and cytology is the decision made about the need for surgery for cervical dysplasia and the method of its conduct is chosen.

Types of operations for cervical dysplasia

In modern gynecology, these types of operations are used for cervical dysplasia, such as:

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

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

Resection of the affected cervical tissue 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 kind of operations for dysplasia of the cervix - with bleeding and a longer tissue regeneration.

It should be noted that in most cases, surgery for dysplasia of the cervix of the third degree is carried out either by diathermocoagulation, or by excision by the "cold knife" method, or by means of a laser.

Laser cautery of low power, in fact, is evaporation, since the laser almost completely destroys the pathological cells at a strictly prescribed depth (maximal - almost 7 mm), without touching the healthy epithelium. The operation requires local anesthesia, can cause burns and cramps of the uterus, but does without blood (due to simultaneous coagulation of damaged blood vessels).

With laser conization, surgery for cervical dysplasia, including cervical dysplasia of grade 3, is performed with a more powerful laser, however, a tissue sample for histology can be obtained. Minor spotting occurs only when the scab leaves, at about the end of the first week after the procedure.

Going cryodestruction does not require anesthesia, it is now being resorted to less often, since this type of operation for dysplasia of the cervix does not provide an opportunity to objectively assess the volume of the removed tissues, which often leads to relapses of pathology. Destroyed pathological tissues in the transformation zone can not be removed during the procedure, and they will depart as vaginal discharge within 10-14 days.

In addition, the specific structure of loose scab, which is formed at the site of freezing, stretches the healing period of the postoperative wound and causes a prolonged release of lymph (lymph). And right after cryodestruction, many patients have a slow heart rate and fainting conditions.

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

The most characteristic complications after the operation of cervical dysplasia include bleeding, cervical deformity of the cervix, narrowing of its 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, as a postoperative complication, there is a high probability of not only exacerbating the inflammatory processes in the pelvic area that have existed in women, but also relapse of cervical dysplasia.

Rehabilitation period

From 35 to 50 days - this is how much the rehabilitation period lasts after the operation for cervical dysplasia.

During the first three to four weeks, mucopurulent vaginal discharge is observed, often hurts in the lower abdomen. Do not worry - it should be so. But there should not be strong discharge of blood and high temperature!

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

• within two months you need to wait with sex;
• for the same period, forget the way to the pool, to the beach, to the sauna;
• Your water procedures are limited to showers;
• your personal hygiene at this time - just pads;
• Sports will be done later - go to the gym or fitness club after a couple of months;
• take care of helpers for lifting weights;
• more vegetables and fruits, fewer cakes and sweets.

And three months after the operation for cervical dysplasia was performed, your attending physician is waiting for you at the reception.