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Conization of the cervix: indications, methods of conducting and postoperative period

Pathological changes in the structure of the epithelium of the throat of the cervical canal are subject to compulsory treatment, in order to avoid complications that are life-threatening for women. For this purpose, a special operation is carried out - conization.

What it is? Conization of the cervix is ​​a procedure to remove a part of the external pharynx, on which the foci of pathologically altered tissues are located. Excision is made in the form of a cone: its base is the outer layer of the epithelium, and the apex goes deep into the cervical canal.

The operation allows complete removal of the affected tissue with relatively shallow invasion of the tumor.

Content

Indications for the procedure

Indications for conization

There must be serious grounds for excision. Conization is not prescribed to patients with normal erosion, which is well treatable by cauterization, freezing, or radio wave exposure. Surgical intervention is conducted for a number of reasons:

Cervical dysplasia. The condition is considered precancerous, so it is important to remove part of the organ with the capture of healthy tissue. This is necessary in order to ensure, with histological examination, that the focus of pathologically altered cells is completely excised.

The procedure can be prescribed at any stage of precancerous changes in the structure of the mucous membranes, but necessarily the conization of the cervix is ​​performed with dysplasia of 2 and 3 degrees.

Sites of pathologically altered epithelium with proliferation inside the cervix. In some cases, the results of a biopsy can determine the presence of atypical cells of an unknown genesis.

They are not yet a precancerous condition, but a gynecologist can not guarantee that the focus of altered tissues will not become malignant. Even more dangerous is the situation where the focus of atypical cells is extensive.

Malignant formation in the upper layers of the cervical epithelium. This is the borderline state of the transition of grade 3 dysplasia into cancer.

Cysts and polyps, located inside the cervical canal and posing a threat to the health of women.

Konenization is carried out in the first phase of the cycle shortly after the end of menstrual bleeding. This allows the wound surface, formed after surgery, to heal until the next menstruation.

Methods of conization, features

Methods of conization

Loop electroconic, schematic photo

The excision of the affected areas located on the mucous membrane of the cervix is ​​always carried out according to the same principle. But the ways of carrying out the operative intervention are different. For a long time only one technique was available to surgeons - knife conization.

But now, thanks to the invention of specialized equipment, the number of ways and methods of conization has increased: the removal of the cone-shaped fragment of the cervix can be performed with the help of a laser, a radio wave and by loop electro-coning.

The attending physician will choose the method that will prove to be the most optimal in this clinical picture.

Knife conization

  • Medical instruments: surgical scalpel;
  • Method of anesthesia: general or epidural;
  • Indications for use: grade 3 dysplasia, preinvasive and microinvasive (small germination) cervical cancer.

Manipulation

Шейка матки с помощью тампона обрабатывается раствором йода для того, чтобы хирургу были заметны области патологически измененного эпителия (они будут иметь белесый цвет). 1. The cervix with a tampon is treated with iodine solution so that the surgeon can see areas of pathologically altered epithelium (they will have whitish color). Before the operation, an advanced colposcopy will be performed.

Шейка матки фиксируется щипцами с двух сторон и низводится. 2. The cervix is ​​fixed with forceps from both sides and is reduced. In some cases, the surgeon fixes it with special sutures so that during the operation it does not move.

При помощи скальпеля врач начинает иссекать конусообразный фрагмент шейки матки. 3. Using a scalpel, the doctor begins to excise a cone-shaped fragment of the cervix. First, the scalpel is immersed a few millimeters deep and cut in a circle. The center of the circle is the cervical canal. Then the incised tissues are raised and fixed centrally with forceps.

The surgeon begins to deepen the incision and once again delineates a circle with a scalpel, but smaller in diameter than the previous one. The procedure is repeated until a whole cone-shaped tissue fragment is cut from the cervix. Since knife conization is indicated in severe lesions, then, usually, high excision is used.

Края раны коагулируют, чтобы предотвратить обильное кровотечение и ускорить процесс заживления раневой поверхности. 4. The edges of the wound coagulate to prevent profuse bleeding and accelerate the healing process of the wound surface. Excess blood is eliminated with a cotton pad.

The method of knife conization is considered the most traumatic - it leaves scars on the cervix. They try not to use it to treat women who want to have children in the future.

Radio wave conization

  • Medical instruments: device Surgitron;
  • Anesthesia: regional or general anesthesia;
  • Indications for use: pathological changes in the structure of the epithelium, dysplasia of 2 or 3 degrees.

Manipulation

В дополнение к местной анестезии перед радиоволновой конизацией шейки матки проводят обработку специальным гелем, содержащим анестетик. 1. In addition to local anesthesia before radio wave conization, cervical uteri are treated with a special gel containing an anesthetic. Then it is stained with iodine solution to identify foci of pathology.

Хирург вводит во влагалище зеркала, шейка матки фиксируется щипцами за переднюю губу таким образом, чтобы этот участок не входил в зону оперативного вмешательства. 2. The surgeon inserts a mirror into the vagina, the cervix of the uterus is fixed by forceps to the front lip so that this area does not enter the surgical intervention zone. The mucus is removed from the cervical canal.

Врач вводит конизатор в цервикальный канал до внутреннего маточного зева. 3. The doctor introduces the conizator into the cervical canal to the internal uterine throat. It sets the Surgutron apparatus in the "cut and coagulation" mode, and then selects the necessary power with which it will work. After this, the conidor is rotated once around its axis, and then extracted from the cervix along with the excised cone-shaped tissue fragment.

Кровяные веления устраняются с помощью тампона, а края раны коагулируются, что провоцирует сужение произведенного радиоволнового разреза. 4. Blood instructions are eliminated with a tampon, and the edges of the wound coagulate, which causes the narrowing of the produced radio wave cut.

If the foci of the pathologically altered epithelium go beyond the excision area, additional rotation of the conizator is carried out, so that the region to be removed is wide enough to contain not only malignant cells, but also healthy tissue.

The undoubted advantage of radio wave conization is that it is suitable for women who later want to have a baby.

Laser conization

  • Medical instruments: laser CO2 laser 10.6 microns;
  • Method of anesthesia: local;
  • Indications for use: dysplasia of the outer throat of the cervix of 2 and 3 degrees.

Manipulation

Зону поражения зева шейки матки маркируют раствором Люголя, всю цервикальную жидкость удаляют. 1. The zone of lesion of the throat of the cervix is ​​marked with Lugol's solution, the entire cervical fluid is removed. The doctor makes local anesthesia, splitting the zone of alleged surgical intervention from all sides in a circle.

Во влагалище вводят кольпоскоп с лазерным аппаратом. 2. A colposcope with a laser device is inserted into the vagina. Part of the cervix, which is subject to excision, is fixed by a tool for clamping the tissues. Vaporization (evaporation) is performed sequentially, along the circumference, the center of which is the entrance to the cavity of the cervix.

The laser beam with each new circle gradually gets deeper into the fabric, the cut off area can be raised and retracted as it rotates.

After cutting off the cone-shaped fragment, the edges are welded. There is an alternative implementation of this operation, when the part of the cervix to be removed is evaporated with a laser (destruction). But then there is no material for histological examination.

После формирования конуса проводится лазерная шлифовка для того, чтобы выровнять края раны. 3. After the formation of the cone, laser resurfacing is performed in order to align the edges of the wound. Blood discharges are insignificant, their excess is removed with the help of tampons. Upon completion of the work, the cervix is ​​treated with green.

Loop electroconic (LLETZ)

  • Medical instruments: active electrode with a loop of various shapes;
  • Method of anesthesia: local, with Lidocaine or Novocain;
  • Indications for use: dysplasia of 2 and 3 degrees

Manipulation

Шейка матки обрабатывается раствором Люголя, затем врач проводит расширенную кольпоскопию. 1. The cervix is ​​treated with Lugol's solution, then the doctor performs an expanded colposcopy. The loop for the electrode is selected according to the results of the survey, so that it can cover the entire affected area. A passive electrode is placed under the buttocks to the patient.

Шейку матки фиксируют при помощи щипцов. 2. The cervix is ​​fixed with forceps. To perform cone-shaped excision, the doctor scrolls the electrode around its axis in such a way that the entire area of ​​the pathologically altered epithelium enters the circumscribed circle.

If the lesion is of medium size, excision should be carried out in one round. If the defeat of the external throat of the cervix is ​​extensive, the surgeon can do several rounds to completely remove a piece of tissue.

После иссечения хирург обрабатывает края раны с помощью коагуляции, чтобы остановить кровотечение. 3. After excision, the surgeon treats the edges of the wound with coagulation to stop bleeding. If the allocation is abundant, then the curettage of the cervical canal is made.

Postoperative period

Restoration after the operation occurs in different ways, as well as the healing period during conization of the cervix uteri - it all depends on the method by which the excision of affected areas of the mucosa was performed.

Knife conization - the restoration of the integrity of the mucous occurs in about 2 months. For the first 3 weeks, the patient will experience pain in the lower abdomen, which may be aggravated by prolonged walking or climbing the stairs.

During this time, douching, tampons and sexual contacts should be avoided so that there is no infection of the wound.

Radio wave conization - wound surface healing takes place in a month. In the first weeks when examining the cervix will be observed swelling. This method of excision involves the formation of a scab after conization of the cervix.

After 7 to 12 days, the scab leaves by itself, provoking bloody discharge.

Laser conization - healing of the cervix occurs after 4 weeks. Within 10-15 days will go serous spotting, which is the norm. During the postoperative period, spontaneous bleeding may occur.

Loop conization - wound healing takes place after 4-5 weeks. In the first days after excision, quite intense bloody discharge can be observed, especially if the lesion area was extensive and curettage was performed.

Postoperative complications

Postoperative period

Postoperative period of conization of the cervix can be burdened with various complications. They arise for several reasons: poor excision, non-compliance with asepsis during the procedure, or non-compliance with hygiene and medical prescriptions by the patient herself after surgery.

  • Bleeding from the cervical canal;
  • Appearance of purulent abscesses on the wound surface;
  • Stenosis (narrowing of the lumen) of the cervical canal;
  • Hydrorrhea (abundant prolonged watery discharge);
  • Relapses of cervical dysplasia.

Contraindications to conization

  1. Inflammation of the cervix of various etiologies.
  2. Invasive cervical cancer.
  3. Pregnancy.
  4. Lactation.
  5. Menstrual bleeding.
  6. Tears and deformation of the cervix.
  7. Absence of visualization of the border zone of pathological changes in the epithelium (with laser excision).

Pregnancy after conization of cervix uteri

In determining the method by which the excision of the affected area will be performed, the physician must first determine whether the woman is planning a pregnancy in the future.

If the patient's response is positive, then the least traumatic method of performing the operation is chosen, because pregnancy and childbirth after conization of the cervix are associated with certain difficulties, the main one of which is ischemic-cervical insufficiency.

With an increase in the duration of the cervical canal will open under the weight of the fetus, so such patients should be given increased attention of the doctor who will offer suturing the cervix or obstetric pessary, prescribes the exclusion of any physical exertion, and in some cases - a semi-postal regime.

Conization of the cervix is ​​an effective way to treat malignant changes in the structure of the epithelium of the external throat. If the disease is detected on time, then the woman has a good chance to recover and maintain reproductive functions after the operation.

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