Precancerous diseases of the female genital organs. Background and precancerous diseases of the cervix

Precancerous diseases include diseases characterized by a long-term (chronic) course of the degenerative process, and benign neoplasms that tend to malignize. Morphological precancerous processes include focal proliferation (without invasion), atypical epithelial growths, and cell atypia. Not every precancerous process necessarily turns into cancer. Precancerous diseases can exist for a very long time, and the cells do not undergo cancerous degeneration. In other cases, such a transformation occurs relatively quickly. Against the background of some diseases, for example papillary cysts, cancer occurs relatively often, against the background of others (kraurosis and vulvar leukoplakia) - much less often. The identification of precancerous diseases is also justified from the point of view that timely and radical treatment of these forms of diseases is the most effective prevention of cancer. Depending on the location of the pathological process, it is customary to distinguish between precancerous diseases of the external genital organs, cervix, uterine body and ovaries.

Precancerous diseases of the female genital organs. These include hyperkeratoses (leukoplakia and kraurosis) and limited pigmented formations with a tendency to growth and ulceration.

Leukoplakia of the vulva usually occurs during menopause or menopause. The occurrence of this pathology is associated with neuroendocrine disorders. The disease is characterized by the appearance of dry white plaques of varying sizes on the skin of the external genitalia, which can spread significantly. Phenomena of increased keratinization (hyperkeratosis and parakeratosis) are observed, followed by the development of a sclerotic process and tissue wrinkling. The main clinical symptom of leukoplakia is persistent skin itching in the external genital area. Itching is caused by scratching, abrasions and small wounds. The skin of the external genitalia is dry.
To treat this disease, ointments or globules containing estrogen drugs are used. In case of pronounced changes and severe itching, it is permissible to use small doses of estrogen orally or by injection. Along with the use of estrogens, diet (light plant foods, reduced consumption of table salt and spices) is of great importance. Hydrotherapy (warm sitz baths before bedtime) and medications that affect the central nervous system have a calming effect.

Kraurosis of the vulva- a dystrophic process that leads to wrinkling of the skin of the external genitalia, the disappearance of fatty tissue of the labia majora, subsequent atrophy of the skin, sebaceous and sweat glands. Due to the wrinkling of the tissues of the vulva, the entrance to the vagina sharply narrows, the skin becomes very dry and easily wounded. The disease is usually accompanied by itching, which leads to scratching and secondary inflammatory tissue changes. Kraurosis is observed more often during menopause or menopause, but sometimes occurs at a young age. With kraurosis, the death of elastic fibers, hyalinization of connective tissue, sclerosis of the connective tissue papillae of the skin with thinning of the epithelium covering them, and changes in nerve endings occur.

The ethnology of vulvar kraurosis has not been sufficiently studied. It is assumed that the occurrence of kraurosis is associated with a violation of tissue chemistry, the release of histamine and histamine-like substances. As a result of the effect of these substances on nerve receptors, itching and pain appear. Of great importance is dysfunction of the ovaries and adrenal cortex, as well as changes in the metabolism of vitamins (especially vitamin A). There is a neurotrophic theory of the occurrence of vulvar kraurosis.
For treatment, it is recommended to use estrogen hormones in combination with vitamin A. Some menopausal patients experience good results when using estrogens and androgens. To normalize the trophic function of the nervous system, a novocaine solution is injected into the subcutaneous tissue of the vulva using the tight creeping infiltrate method, a presacral novocaine blockade is performed, and the vulva is denervated by dissecting the pudendal nerve. In especially severe cases of the disease, if all described methods of therapy are unsuccessful, they resort to extirpation of the vulva. As a symptomatic remedy to reduce itching, you can use 0.5% prednisolone ointment or ointment with anesthesin. If areas suspicious for cancer are detected, a biopsy is indicated.

PRE-CANCER DISEASES OF THE CERVIX. Dyskeratoses are characterized by a more or less pronounced process of proliferation of stratified squamous epithelium, compaction and keratinization (keratinization) of the surface layers of the epithelium. In relation to malignancy, leukoplakia with a pronounced proliferation process and beginning cell atypia are dangerous. With leukoplakia, the mucous membrane is usually thickened, separate whitish areas are formed on its surface, which sometimes, without clear boundaries, pass into the unchanged mucous membrane. Leukoplakia sometimes looks like whitish plaques protruding on the surface of the mucous membrane. These areas and plaques are tightly fused to the underlying tissues. Leukoplakia of the cervix is very often asymptomatic and is discovered accidentally during a routine examination. In some women, the disease may be accompanied by increased secretion (leucorrhoea). In cases of infection, the discharge from the genital tract becomes purulent in nature.

Erythroplakia is characterized by atrophy of the superficial layers of the epithelium of the vaginal part of the cervix. The affected areas usually have a dark red color due to the fact that the vascular network located in the subepithelial layer is visible through the thinned (atrophied) layers of the epithelium. These changes can be observed especially well when examined using a colposcope.

Cervical polyps rarely develop into cancer. Oncological alertness should be caused by recurrent cervical polyps or their ulceration. Cervical polyps are removed and subjected to histological examination. For recurrent polyps, diagnostic curettage of the mucous membrane of the cervical canal is recommended.

Cervical erosions (glandular-muscular hyperplasia) can be classified as precancerous processes with a long course, relapses, increased proliferation processes, and the presence of atypical cells. An eroded ectropion can also create conditions for the development of cancer. Ectropion occurs as a result of damage to the cervix during childbirth (less commonly, abortion and other interventions) and its deformation due to scarring. With ectropion, the inverted mucous membrane of the cervical canal comes into contact with the acidic contents of the vagina, and pathogenic microbes penetrate into its glands. The resulting inflammatory process can exist for a long time, spreading beyond the external pharynx and contributing to the appearance of erosion. Treatment of erosive ectropion is carried out according to the rules for the treatment of erosions. Treatment of the concomitant inflammatory process is carried out, colposcopy, and, if indicated, a targeted biopsy with histological examination of the removed tissue. In case of erosion, diathermocoagulation and electropuncture are performed in the first circle of the gaping pharynx. After the scab is rejected and the wound surface heals, a narrowing of the gaping pharynx and the disappearance of erosion are often observed. If after diathermocoagulation the cervical deformity does not disappear, plastic surgery can be performed. In the absence of a lasting effect and recurrence of erosion, indications for surgical intervention arise (cousoid electrical excision, amputation of the cervix).

Precancerous diseases of the uterine body. Glandular hyperplasia of the endometrium is characterized by the proliferation of glands and stroma. Not all glandular hyperplasia of the mucous membrane of the uterine body is a precancerous condition; The greatest danger in this regard is the recurrent form of glandular hyperplasia, especially in elderly women.
Adenomatous polyps are characterized by a large accumulation of glandular tissue. In this case, the glandular epithelium may be in a state of hyperplasia. Precancerous diseases of the endometrium are expressed in lengthening and intensification of menstruation, as well as the occurrence of acyclic bleeding or spotting. The appearance of a suspicious symptom should be considered! bleeding during menopause. The detection of endometrial hyperplasia or adenomatous polyps in a patient during this period should always be considered as a precancerous process. In younger women, endometrial hyperplasia and adenomatous polyps can be considered a precancerous condition only in cases where these diseases recur after curettage of the uterine mucosa and subsequent correct conservative therapy.
A special place among precancerous diseases of the uterus is occupied by hydatidiform mole, which often precedes the development of chorionepithelioma. Based on clinical and morphological features, it is customary to distinguish the following three groups of hydatidiform mole: “benign”, “potentially malignant” and “apparently malignant”. In accordance with this classification, only the last two forms of hydatidiform mole should be classified as a precancerous condition. All women whose pregnancy ended with a hydatidiform mole should be monitored for a long time. In such patients, an immunological or biological reaction should be periodically performed with whole and diluted urine, which allows timely fasting! make a diagnosis of chorionepithelioma.

Precancerous diseases of the ovaries. These include some types of ovarian cysts. Most often, cilioepithelial (papillary) cystomas undergo malignant transformation, and pseudomucinous ones are much less common. It should be remembered that ovarian cancer most often develops precisely because of these types of cysts.

Lecture 11.

In the cervix, there is a vaginal part, protruding into the lumen of the vagina, and a supravaginal part, located above the attachment of the vaginal walls to the uterus, consisting mainly of connective and muscle tissue, in which vessels and nerves are located. The vaginal part of the cervix is covered with stratified squamous epithelium, called the exocervix. Muscle tissue is mainly contained in the upper third of the cervix and is represented by circularly located muscle fibers with layers of elastic and collagen fibers, the functional activity of which is ensured by sympathetic and parasympathetic innervation. Muscle tissue provides the obturator function of the cervix; during pregnancy and childbirth, it forms the lower segment of the birth canal. The cervical canal has a spindle-shaped shape, its length from the external pharynx to the isthmus is no more than 4 cm and its width is not more than 4 mm, the external pharynx is round or in the form of a transverse slit. Ts.k. covered with single row tall columnar epithelium and is called the endocervix. The multilayered squamous epithelium of the vaginal part of the uterus is a highly differentiated tissue with a complex structure and certain functional features. The epithelium covering the cervix consists of 4 layers:

1) basal, which are immature epithelial cells located on the basement membrane in one row. These cells have uneven contours and vary in size. The basement membrane separates the squamous stratified epithelium from the underlying connective tissue;

2) above the basal cells there is a layer of parabasal cells arranged in several rows. Cells of the basal and parabasal layers have mitotic activity;

3) the layer of intermediate cells consists of 6-7 layers of moderately differentiated cells;

4) the superficial layer is represented by 2-3 rows of superficial cells, which tend to become keratinized and are easily subject to desquamation depending on the phase of the menstrual cycle.

The main function of stratified squamous epithelium, like any epithelium located on the border with the external environment, is protective. Keratin clumps provide strength to the mucous membrane and thereby create a mechanical barrier; the immunological barrier is created by lactic acid, which is formed due to glycogen metabolism with the participation of lactobacilli. In the cervix, the boundary of 2 genetically different types of epithelium is the transition area between the squamous stratified epithelium of the vaginal part and the high columnar epithelium of the mucous membrane of the central nervous system. This area has complex histoarchitecture.

In women of reproductive age, in most cases it coincides with the area of the external pharynx. However, it can also be located on the vaginal part of the uterus, which is associated with age, as well as hormonal balance in the body.

Diagnosis of cervical pathology:

1. examination of the cervix using vaginal speculum.

3. Cervicoscopy

Cervical erosion– defect of the uterine epithelium with exposure of subepithelial tissue.

Etiology: according to etiology, the following types of uterine erosion are distinguished:

1) inflammatory; its development is considered the result of maceration and rejection of stratified squamous epithelium during inflammatory processes

2) specific, the result of a specific inflammation (syphilis, tuberculosis)

3) traumatic, may be a consequence of injury from gynecological instruments

4) burn; the result of scab rejection after chemical, electrical, laser or cryogenic exposure.

5) trophic; usually accompanies uterine prolapse or is a consequence of radiation therapy.

6) cancerous, malignant tumor of the uterus.

Pathogenesis:

Exposure to various etiological factors leads to focal desquamation or maceration of the stratified epithelium of the vaginal part of the uterus.

Clinical picture.

With the development of e. patients sometimes note the appearance of bloody discharge from the genital tract.

Diagnostics.

O.z. – a deep defect of the epithelium in the form of a red spot. In case of traumatic and, in some cases, inflammatory erosion, a section of rising squamous epithelium can be found along its edge.

To determine the density of the cervix, the Krobak test is used: probing the ulcer with a metal probe. The test is considered positive if the probe easily penetrates the tissue.

Syphilitic erosion is characterized by: 1) small size 5-10 mm, 2) round or oval shape, 3) saucer-shaped, non-plumb edges, 4) smooth shiny bottom; 5) red, sometimes with a grayish tint.

At the base of syphilitic erosion, a compaction visible to the naked eye is determined, raising the erosion above the surrounding tissues. Syphilitic erosion is painless and does not bleed on contact. Krobak's test is negative. With mechanical impact, the appearance of a transparent serous discharge is noted from the erosion.

Tuberculous erosion is characterized by undermined edges, and multiplicity of lesions is also possible.

Cancerous erosion is characterized by: 1) uneven raised ridge-like edges; 2) crater-shaped bottom covered with necrotic plaque; 3) slight bleeding on contact.

The exophytic tumor is clearly visible against the background of a sharply deformed and hypertrophied neck. uteri of wooden density. The Krobak test is positive: the probe easily penetrates the tumor tissue.

Decubital ulcer has sharply defined edges, its bottom is usually covered with a pus-like coating.

2. Colposcopy (simple, extended)

3. Cervicoscopy

4. Cytological research method.

If you suspect cervical cancer and radiation erosion, consultation with a gynecological oncologist is necessary. If there is a suspicion of syphilitic erosion - a dermatovenerologist, for tuberculous lesions of the uterus - a phthisiatrician.

Treatment.

Non-drug - if there are indications for stimulation of reparative processes in order to epithelize erosion of traumatic and inflammatory origin, low-intensity radiation of a helium-neon session is used (10 sessions of 5-10 minutes).

Drug treatment - for the purpose of epithelization, tampons with ointments that have antibacterial, anti-inflammatory and regenerating effects (levosin, levomekol) are widely used.

For radiation erosion, ointments are applied topically to accelerate the processes of cellular regeneration and stimulate cellular and humoral immunity (methyluracil ointment 10%).

With cancerous erosion and e. With a specific etiology, stimulation of reparative processes is not included in the complex of therapeutic measures.

Ectopic cervix– displacement of the boundaries of the columnar epithelium to the vaginal part of the uterus.

Etiology: acquired ectopia is considered as a polyetiological disease caused by the influence of a number of factors. There are 1) exogenous and 2) endogenous factors. Exogenous factors include infectious, viral and traumatic. Endogenous – disturbance of hormonal homeostasis (menarche before 12 years of age, disruption of the menstrual cycle and reproductive function), changes in immune status (presence of chronic extragenital and gynecological diseases, occupational hazards).

The factor of hereditary predisposition, the possible influence of COCs and smoking on the development of uterine ectopia are still being discussed.

Clinic. Uncomplicated forms of uterine ectopia do not have specific clinical manifestations, and most often it is diagnosed during a preventive gynecological examination.

A complicated form of cervical ectopia is observed in more than 80% of cases. In a complicated form, ectopia is combined with inflammatory, precancerous processes of the uterus.

Diagnosis of cervical pathology:

1.examination of the cervix using vaginal speculum.

2. Colposcopy (simple, extended)

3. Cervicoscopy

4. Cytological research method.

Differential diagnostics carried out with cervical cancer; true erosions of the uterus.

Treatment:

Treatment goals: elimination of concomitant inflammation, correction of hormonal and immune disorders, correction of vaginal microbiocenosis, destruction of pathological changes in cervical tissue.

Non-drug treatment. Cryodestruction, laser coagulation, radiosurgery. The choice of method depends on the pathology with which the ectopia of the uterus is combined.

Diathermocoagulation.

Diathermocoagulation is based on the use of high-frequency current, which causes thermal melting of tissue, while the human body is included in the electrical circuit and heat generation occurs in the cervical tissue itself.

Possible complications: 1) bleeding, 2) stenosis and stricture of the cervical canal, 3) extravasates, telangiectasia and subepithelial hematomas 4) endometriosis 5) impaired tissue trophism 6) formation of rough scars 7) reproductive dysfunction: a) infertility b) spontaneous miscarriages c) premature birth d) cervical dystocia during childbirth 8) exacerbation of inflammatory processes of the internal genital organs 9) menstrual irregularities 10) pain syndrome 11) long-term course of reparative processes 12) cervical cancer 13) leukoplakia 14) relapses of the disease 15) thermal burns.

Cryodestruction

Liquid gases are used as a cooling agent: nitrogen, nitrous oxide, carbon dioxide.

The degree, speed and depth of cooling can be adjusted by dropping different amounts of gas vapor and changing the duration of the exposure. Cryoprobes of various shapes, which can be selected depending on the size of the pathological area, are frozen until a rim of frost appears around the tip at a distance of 2-2.5 mm. At the same time, part of the c.c. is also processed. Under the influence of low temperatures, the following processes occur in tissues: 1) crystallization 2) concentration of electrolytes 3) denaturation 4) disruption of microcirculation and ischemia.

As a consequence of these changes, cryonecrosis occurs, which forms within 1-3 days. The necrosis zone, both deep into the tissue and on the surface, is always smaller than the freezing zone. The advantage of the method is painlessness, explained by the rapid destruction of sensitive nerve endings, bloodlessness, and the possibility of use on an outpatient basis.

Flaws:

Insignificant depth of impact, impossibility of local removal of a local area with minimal trauma to the underlying tissues, high frequency of relapses. When studying individual results, 13% of women showed traces of cervical coagulation.

Laser coagulation

Healing Features:

After removal of the pathological focus, a zone of superficial coagulation necrosis is formed at the border. Due to the low penetrating ability, the necrosis zone does not exceed 0.5-0.7 mm. The formation of a scab has significant differences from other methods: all pathological tissue is completely evaporated and a zone of necrosis is formed within healthy tissue. This contributes to the rapid rejection of the coagulation film, loosely associated with the underlying tissues and an earlier onset of regeneration. In addition, the absence or minimal damage to surrounding tissues, minor leukocyte infiltration, reduction in the phase of exudation and proliferation contributes to the rapid healing of the uterus with the absence of gross scarring and stenosis.

Ectropion – eversion of the mucous membrane of the cervical canal.

Etiology. In young women who have not had pregnancies or childbirth, ectropion has a functional origin. Congenital ectropion is rare. The reason for the acquired e. consider postpartum uterine ruptures.

Clinic

Ectropion has no specific clinical manifestations and is usually detected during a routine examination.

Diagnostics.

1.examination of the cervix using vaginal speculum.

2. Colposcopy (simple, extended)

3. Cervicoscopy

4. Cytological research method.

Treatment.

Treatment goals.

1) restoration of the anatomy and architectonics of the uterus

2) elimination of concomitant inflammation

3) correction of vaginal microbiocenosis

Surgical treatment is indicated for all patients with uterine ectropion. Excision or conization of the uterus is performed. Reconstructive plastic surgery is recommended for severe uterine ruptures.

Leukoplakia– a pathological process associated with keratinization of stratified squamous epithelium. The term lekoplakia (translated from Greek) - white plaque, was proposed by Schwimmer in 1887 and to this day remains generally accepted in the domestic literature and clinical practice, but abroad clinicians and pathomorphologists prefer the term “dyskeratosis”.

Classification.

Currently, the clinical and morphological classification of I, A, Yakovleva and B.G. is considered generally accepted. Kukute, according to which simple cervical cancer is classified as a background process, and cervical cancer with atypia is considered a precancerous condition.

The etiology has not been sufficiently studied.

There are endogenous and exogenous factors:

1) endogenous factors include disruption of hormonal homeostasis, changes in immune status

2) exogenous factors - infectious, viral, chemical and traumatic effects.

It has been established that the occurrence of cervical cancer in women of reproductive age is preceded by inflammatory processes of the uterus and appendages with menstrual dysfunction. PVI of the genital organs is detected in more than 50% of patients with cervical cancer. The role of hyperestrogenism in the pathogenesis of cervical cancer has been proven.

Chemical and traumatic effects play an important role in the occurrence of cervical cancer: more than a third of patients with cervical cancer previously received intensive and inadequate treatment for cervical ectopia, 33% of patients with cervical cancer previously underwent diathermocoagulation. uterus.

Clinical picture. The course is asymptomatic, there are no specific complaints.

Diagnostics

1.examination of the cervix using vaginal speculum.

2. Colposcopy (simple, extended)

3. Cervicoscopy

4. Cytological research method.

Treatment.

Non-medicinal - use diathermocoagulation, cryogenic exposure, laser destruction.

Drug treatment: carrying out etiotropic anti-inflammatory therapy according to generally accepted schemes, correction of vaginal microbiocenosis, correction of hormonal disorders, correction of immune disorders.

Surgery. When LSM is combined with pronounced deformation and hypertrophy of the neck. uterus, it is advisable to use surgical methods of treatment: diathermocoagulation, knife, laser, ultrasound or radio wave excision, or conization, amputation. uterus, reconstructive plastic surgery.

In 1968, Richart proposed using a classification of precancerous conditions of the cervix into three degrees " cervical intraepithelial neoplasia (CIN)." CIN I corresponds to mild epithelial dysplasia, CIN II to moderate, CIN III to severe epithelial dysplasia and intraepithelial carcinoma. Group CIN I should include the so-called flat condylomas associated with infection of the cervix with HPV. Etiological factors: early onset of sexual activity, the presence of a large number of sexual partners, childbirth at a very young age. HPV 16, 18 are carcinogenic factors, and types 31,33,35 are possible carcinogens.

Tobacco smoking plays an important role, and some tobacco ingredients are found in increased concentrations in vaginal contents. They have the ability to transform into carcinogenic agents - nitrosamines in the presence of a specific bacterial infection.

Among the STIs most often found in patients with CIN are: HSV2, CMV, Gardnerella, Candida, Mycoplasma, and Chlamydia. An association of CIN with bacterial vaginosis has been determined.

1. Mild (simple) dysplasia. The cells of the overlying sections retain their normal structure and polarity of arrangement. Mitotic figures retain their normal appearance and are found only in the lower half of the epithelial layer. The nuclear-cytoplasmic ratio is maintained in a volume characteristic of a given epithelial layer. The epithelial cells of the upper section appear mature and differentiated.

2. Moderate dysplasia is characterized by the detection of pathological changes in the epithelial layer in its entire lower half.

3. Severe dysplasia is characterized by the fact that in addition to significant proliferation of cells of the basal and parabasal layers, hyperchromic nuclei appear, the nuclear-cytoplasmic ratio is disrupted towards an increase in the nucleus; mitoses are common, although they retain a normal appearance. Signs of cell maturation and differentiation are found only in the most superficial part of the epithelial layer.

In intraepithelial preinvasive uterine cancer, the entire epithelial layer is represented by cells indistinguishable from the cells of true invasive cancer.

Clinical manifestations are not pathognomonic. Almost half of the patients had no obvious signs of cervical damage; the existing symptoms were due to concomitant gynecological diseases.

Complaints of leucorrhoea, bleeding from the genital tract, pain in the lower abdomen and lumbar region.

Epithelial dysplasia can be observed on a visually unchanged neck, but more often they occur against the background of various lesions detected using additional techniques, including cytological examination of smears, colposcopy, targeted biopsy with simultaneous study of scrapings of the mucous membrane of the central nervous system. The main role in the diagnosis of precancerous conditions of the uterus is played by histological examination of pathologically altered areas of the uterus.

Treatment.

The type of therapy is determined individually depending on the type of pathology and the age of the patients, since in young patients the pathological process primarily affects the exocervix, and in old age - the cervical canal. In young patients, therapeutic measures are predominantly organ-preserving in nature.

In case of an inflammatory process, it is necessary to conduct a bacteriological and bacterioscopic examination of the vaginal flora. When a herpetic infection, chlamydia, or gardnerellosis is detected, it is advisable to carry out bacterial therapy with subsequent normalization of the vaginal microbiocenosis through the use of various biological products in the form of lacto- and bifidobacteria.

Patients whose examination reveals mild dysplasia can be subjected to dynamic observation with conservative treatment. In the absence of regression of pathological changes within several months, patients are shown an intervention such as diathermocoagulation, cryodestruction or laser evaporation of pathological changes in areas of the cervix.

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Introduction

1. Leukoplakia of the vulva

2. Kraurosis of the vulva

Conclusion

Literature

Introduction

The development of malignant tumors of the female genital organs is usually preceded by various pathological conditions against which they arise.

Precancerous diseases of the external genitalia and vagina, cervix, endometrium and ovaries are distinguished.

Precancerous diseases of the external genitalia include chronic degenerative processes of the skin, mucous membranes and subcutaneous fatty tissue of the vulva - kraurosis and leukoplakia and limited pigment formations with a tendency to growth and ulceration.

Due to the increasing proportion of elderly women among the population, kraurosis and leukoplakia of the external female genitalia have now begun to occur earlier. The significance of these diseases in the pathology of the female reproductive system is determined not only by the persistence of symptoms and ineffective therapy, but also by the fact that in a certain percentage of cases these diseases, especially leukoplakia, can develop into cancer. For many years now, both diseases have been rightfully classified as precancerous.

1. Leukoplakia of the vulva

Leukoplakia of the vulva usually occurs during menopause or menopause. The occurrence of this pathology is associated with neuroendocrine disorders.

The disease is characterized by the appearance of dry white plaques of varying sizes on the skin of the external genitalia, which can spread significantly.

Phenomena of increased keratinization (hyperkeratosis and parakeratosis) are observed, followed by the development of a sclerotic process and tissue wrinkling. The main clinical symptom of leukoplakia is persistent skin itching in the external genital area. Itching is caused by scratching, abrasions and small wounds. The skin of the external genitalia is dry.

Leukoplakia - opalescent or milky-white spots on the mucous membrane with epithelial hyperplasia and infiltration of subepithelial tissue. Hyper- and parakeratosis and acanthosis are found in the integumentary epithelium. Subsequently, tissue sclerosis develops.

Based on the severity of leukoplakia, they are classified into:

· flat,

hypertrophic and

· warty form.

Leukoplakia, which appears as dry white or bluish-white plaques, may be localized in limited areas or may spread throughout the vulva.

The combination of kraurosis and vulvar leukoplakia is especially unfavorable with regard to malignancy. These diseases can be asymptomatic and are detected only during preventive examinations. However, kraurosis is often accompanied by long-term, long-term, painful night itching, which leads to neurotic disorders, sleep disorders and disability. As a result of persistent itching, scratches, abrasions, cracks and, ultimately, inflammation of the vulva appear.

The diagnosis is made based on the clinical picture. Additional research methods include colposcopy and Schiller's test (when the external genitalia is lubricated with Lugol's alcohol solution, areas of leukoplakia are not stained). Areas suspected of malignancy, selected during colposcopy, are subjected to biopsy and histological examination.

To treat this disease, ointments containing estrogen drugs are used. In case of pronounced changes and severe itching, it is permissible to use small doses of estrogen orally or by injection. Along with the use of estrogens, diet (light plant foods, reduced consumption of table salt and spices) is of great importance. Hydrotherapy (warm sitz baths before bedtime) and medications that affect the central nervous system have a calming effect.

Hormonal therapy with estrogenic and iridogenic hormones is recommended (1 ml of 0.1% solution of estradiol dipropionate and 1 ml of 1% solution of testosterone propionate in one syringe once a week for 5-7 weeks). The same hormonal agents are prescribed locally in the form of ointments, creams, and globules. Ointments with glucocorticoids (fluorocort, sinalar, locacorten) are used. At the same time, sedatives and sleeping pills are prescribed.

Precancerous diseases of the vagina include leuko- and erythroplakia. Vaginal leukoplakia is a keratinization of squamous stratified epithelium, which looks like a whitish film or plaque, and sometimes papillomas.

Erythroplakia is characterized by thinning of the surface layers of the epithelium with keratinization phenomena. The boundaries of erythroplakia are clear, the surface is shiny, bright red spots bleed easily when touched.

A biopsy is required for diagnosis.

Of the treatment methods, cryotherapy or surgery is the most appropriate.

2. Kraurosis of the vulva

Due to the wrinkling of the tissues of the vulva, the entrance to the vagina sharply narrows, the skin becomes very dry and easily wounded. The disease is usually accompanied by itching, which leads to scratching and secondary inflammatory tissue changes. Kraurosis is observed more often during menopause or menopause, but sometimes occurs at a young age. With kraurosis, the death of elastic fibers, hyalinization of connective tissue, sclerosis of the connective tissue papillae of the skin with thinning of the epithelium covering them, and changes in nerve endings occur.

Stage 1- characterized by swelling, hyperemia, itching in the area of the external genitalia. The labia majora and minora are swollen and cyanotic.

Stage 2- atrophic changes progress, the labia majora and minora become flattened, the clitoris atrophies, the skin becomes dry and whitish, and the entrance to the vagina narrows.

Stage 3(sclerotic) - complete atrophy and sclerosis of the external genitalia develops. There is no hair on the labia majora, the skin and mucous membranes become thinner and acquire a dull pearlescent color with a gray-blue tint (the appearance of a crumpled parchment sheet).

There is a narrowing of the entrance to the vagina, the external opening of the urethra and the anus. Difficulty in sexual intercourse and urination.

The etiology of vulvar kraurosis has not been sufficiently studied. It is assumed that the occurrence of kraurosis is associated with a violation of tissue chemistry, the release of histamine and histamine-like substances. As a result of the effect of these substances on nerve receptors, itching and pain appear. Of great importance is dysfunction of the ovaries and adrenal cortex, as well as changes in the metabolism of vitamins (especially vitamin A). There is a neurotrophic theory of the occurrence of vulvar kraurosis.

To normalize the trophic function of the nervous system, a novocaine solution is injected into the subcutaneous tissue of the vulva using the tight creeping infiltrate method, a presacral novocaine blockade is performed, and the vulva is denervated by dissecting the pudendal nerve. In especially severe cases of the disease, if all described methods of therapy are unsuccessful, they resort to extirpation of the vulva. As a symptomatic remedy to reduce itching, you can use 0.5% prednisolone ointment or ointment with anesthesin. If areas suspicious for cancer are detected, a biopsy is indicated.

3. Complex treatment of patients with leukoplakia and kraurosis

Treatment of patients with leukoplakia and kraurosis of the external female genitalia is a complex and not yet fully resolved problem.

Kraurosis and leukoplakia have a chronic, long-term course.

Treating them requires patience from both the doctor and the patient.

It is based on the toilet of the external genitalia, diet, hormone therapy, ultrasound, alcohol-procaine blockades, cryotherapy, and if there is no effect, vulvectomy is performed.

Therapy should begin with general effects, which are widely combined with local procedures.

· Psychotherapy is of great importance, aimed primarily at developing in the patient confidence in the possibility of a cure for this long-term and painful disease.

· Toilet the external genitalia should be performed repeatedly during the day with boiled water (without soap) with the addition of sodium bicarbonate, chamomile or calendula infusions.

· You should not use solutions of potassium permanganate or boric acid, as they dry out and irritate tissues. Wearing woolen and synthetic underwear is contraindicated as it increases itching.

· Rational diet therapy plays a significant role. Nutrition should be complete, sufficient in calories and vitamin content. Carbohydrate intake should be somewhat limited.

· Irritating dishes and spices are excluded. Dairy-vegetable diet. Spicy foods and alcoholic drinks are prohibited.

· Compliance with the necessary hygiene regime is of great importance. Underwear should not fit tightly to the body, so as not to cause an additional feeling of itching.

· You should completely avoid wearing underwear made of synthetic fabrics.

Drug treatment includes the prescription of general and local agents; it is advisable to combine it with novocaine blockade and physiotherapy. In some extremely severe cases, if conservative therapy is unsuccessful, surgical treatment must be resorted to.

Women with precancerous diseases of the external genitalia and vagina should be under medical supervision and visit an antenatal clinic once every 3-6 months.

4. The role of the midwife in the examination room in organizing preventive complications

Numerous observations of oncology specialists show that reducing cancer mortality depends not so much on improving treatment methods, but on improving the diagnosis of cancer.

The most important area of cancer control is tumor prevention, which includes timely detection and treatment of diseases that precede the development of cancer. Considering that precancerous diseases and initial forms of cancer of various organs occur, as a rule, with extremely scant clinical manifestations and do not cause people to see a doctor, active identification of patients among the population is of particular importance. The successful implementation of the task of early detection of malignant tumors and precancerous diseases of external localizations largely depends on the active participation in this work of a team of thousands of paramedics and midwives.

Considering that early forms of cancer and precancerous diseases in the vast majority of cases are asymptomatic and do not cause the need to see a doctor, the active involvement of women for preventive examinations is of decisive importance.

Asymptomatic background and precancerous processes and the earliest forms of cancer can be detected if women undergo preventive examinations.

They are held once or twice a year in examination rooms of clinics, paramedic and obstetric centers, antenatal clinics, and during visits to industrial enterprises.

During medical examinations, the cervix is examined in a speculum, a vaginal examination is performed, and smears are taken from the cervix for cytological examination. When examining the cervix in the speculum, various pathological conditions are revealed, which are called precancerous (precancerous) and background (benign). Among them, pseudo-erosions, ectopias, eroded ectropions, true erosions, leukoplakias, polyps of the cervical canal and dysplasia are known. From the point of view of preventing cervical cancer, it is important to identify background and precancerous diseases, the timely treatment of which reliably prevents the latter from developing into cancer.

Prevention of complications of pregnancy, childbirth and perinatal pathology carried out in consultation in two main directions related to primary and secondary prevention.

Primary prevention comes down to preventing pregnancy complications in healthy women.

The essence of secondary prevention is to prevent the transition of the initial manifestations of obstetric pathology to severe forms.

In the implementation of primary prevention, the joint work of an obstetrician-gynecologist and a pediatrician is of utmost importance. Contacts with perinatologists, the number of which is increasing, are very useful. It is known that a woman’s reproductive system is formed in the early stages of ontogenesis. Its development depends on the conditions of intrauterine life, the characteristics of the neonatal period and childhood. The health status of generations largely depends on the system for preventing diseases in parents, obstetric care for women, and the entire range of treatment and preventive measures inherent in children's healthcare.

When developing reproductive function, the following are of great importance:

1) clinical examination of girls and adolescents with the participation of an obstetrician-gynecologist;

2) sanitary educational work with the participation of doctors of various specialties (pediatrician, obstetrician-gynecologist, hygienist, physical education and sports specialist, etc.);

3) rational use of children's health facilities;

4) timely diagnosis and treatment of diseases of the reproductive system (inflammatory processes, metabolic disorders, endocrine disorders, etc.) as secondary prevention of abnormalities of future generative function

The state of health and the process of formation of the reproductive system are influenced by factors such as nutrition, working conditions, and sports. The importance of good nutrition is known, especially in childhood and during puberty.

The population is not sufficiently informed about the dangers of excess nutrition, which is accompanied by nutritional obesity and subsequent functional failure of the ovaries and other endocrine glands. Stabilization of obesity, which began in childhood or during puberty, often leads to reproductive dysfunction (infertility, spontaneous miscarriages) and labor anomalies (weakness of labor, bleeding, etc.). In this regard, in the prevention of obstetric pathology, a balanced diet that meets the needs of the mother and fetus is of great importance.

Intellectual and emotional overload can cause neuroendocrine disorders, which have an adverse effect on the course of future pregnancy and childbirth, therefore the correct general regimen and care for pregnant women at work and at home are extremely important.

Caution must be exercised when prescribing medications, especially hormonal drugs. They should be used when indicated, taking into account side effects, allergic and toxic reactions, unnecessary (or harmful) effects on the fetus.

Midwives at antenatal clinics should join the fight against alcohol and smoking, which have an adverse effect on the body (nervous, endocrine, cardiovascular, digestive systems, liver, kidneys and other organs) and the future offspring of women and men.

In the prevention of obstetric pathology, the most important role is played by prevention, early diagnosis and rational treatment of extragenital diseases, which complicate the course of pregnancy and predispose to the development of toxicosis in pregnant women. Of equal importance is the prevention of gynecological diseases, which often cause miscarriage and other complications of pregnancy and childbirth.

Prevention of extragenital pathology and gynecological diseases is facilitated by medical examination of the entire female population. Rehabilitation activities organized in the antenatal clinic also affect the course and outcome of subsequent pregnancies. Many women who have suffered severe types of obstetric pathology and gynecological diseases are subject to restorative treatment (rehabilitation).

In terms of preventing obstetric pathology, clinical observation and rehabilitation treatment (as indicated) for women who have suffered:

late toxicosis, the outcome of which is often hypertension, disorders of the endocrine system, metabolism, kidney function and other disorders;

postpartum diseases of infectious etiology, characterized by the complexity of pathogenesis due to the participation of all the most important systems (immune, nervous, vascular, hematopoietic, etc.) and the possibility of stabilizing residual pathological processes;

3) obstetric operations, especially in the presence of pathological processes that preceded surgical interventions and occurred in the postoperative period; 4) all women with residual focal pathological processes (associated with previous obstetric pathology) and secondary functional disorders, pain syndrome and other disorders

Medical examination and primary prevention of pregnancy complications are among the main activities of antenatal clinics. The essence of this work comes down to involvement in consultation in the early stages of pregnancy, a thorough examination of the pregnant woman, systematic monitoring of her health and the development of pregnancy, recommendations regarding the general regimen, personal hygiene, nutrition, hygienic gymnastics. The reasonable use of natural factors, timely and correctly carried out psychoprophylactic preparation for childbirth are of great importance.

Careful observation and treatment in the antenatal clinic (physiotherapy, balanced nutrition, prenatal preparation taking into account the pathogenesis and clinical picture of the underlying disease, etc.) help reduce the amount of bleeding during pregnancy and 2.7 times

Preventive hospitalization is also practiced for conditions that threaten complications of pregnancy and childbirth (the risk of premature termination of pregnancy, early referral to hospital for pregnant women who have undergone uterine surgery, breech presentation, multiple pregnancy, etc.).

One of the main factors for increasing the efficiency of examination rooms is special training and systematic advanced training for midwives in examination rooms. The nature of the work of a midwife in an examination room places great responsibility on her, and the fate of a woman often depends on her professional knowledge and ability to apply it in everyday activities. The midwife should understand the tasks and goals of preventive examinations, the role of the examination room in the anticancer fight, be familiar with the clinical manifestations and the basics of recognizing precancerous diseases, cancer of external localizations and female genital organs. She must be able to maintain documentation and records of examinations in the examination room.

leukoplakia kraurosis precancerous disease

Conclusion

In solving the problem of preventing gynecological complications in women, a special role belongs to examination rooms, which are a special unit of clinics designed to conduct preventive examinations of the female population.

Timely detection of precancerous diseases and their radical treatment is not particularly difficult; it is easy to do and easily tolerated. At the same time, there is a real opportunity to prevent the development of such a dangerous disease as cancer

Examination rooms play a big role in prevention and early diagnosis.

During a vaginal examination, in a large percentage of cases, the midwife identifies tumors of the ovaries, fallopian tubes and uterine body, which, even after reaching a significant size, do not give any clinical manifestations. Developing for a long time, these tumors turn into a malignant tumor.

In addition, the skin is thoroughly examined in the examination room. At the same time, all, even small, seals are examined and palpated. Ulcerated areas are also examined. Imprint smears are taken from the surface of the skin for cytological examination, which provides very significant assistance in making the correct diagnosis. Tumors of the mammary glands are relatively easy to detect: cancerous tumors are distinguished by their density and some wrinkling of the gland tissue in the tumor area, which is why asymmetry of the mammary glands is observed. However, tumors should not be allowed to develop to such a state. Cancer can be prevented if every woman periodically carefully checks her mammary glands herself or is examined by a midwife in the examination room.

Literature

1. Obstetrics and gynecology: practical recommendations / ed. Kulakova V.I.. M., 2005 - 497p.

2. Bodyazhina V.I. Obstetric care in antenatal clinic, M.: Medicine 2002 - 120 p.

3. Zagrebina V.A., Torchinov A.M. Gynecology - M.: Medicine, 1998 - 175 p.

4. Kretova N.E., Smirnova L.M. Obstetrics and gynecology, M.: Medicine, 2000 - 85 p.

5. Kulikova N.I. Lineva O.I., The role of midwives in examination rooms in the prevention and early diagnosis of cancer of visual localizations in women - M.: Medicine, 2002 - 78 p.

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Precancerous diseases of the female genital organs. These include hyperkeratoses (leukoplakia and kraurosis) and limited pigmented formations with a tendency to growth and ulceration.

To treat this disease, ointments or globules containing estrogen drugs are used. In case of pronounced changes and severe itching, it is permissible to use small doses of estrogen orally or by injection. Along with the use of estrogens, diet (light plant foods, reduced consumption of table salt and spices) is of great importance. Hydrotherapy (warm sitz baths before bedtime) and medications that affect the central nervous system have a calming effect.

Kraurosis of the vulva is a dystrophic process that leads to wrinkling of the skin of the external genitalia, the disappearance of fatty tissue of the labia majora, subsequent atrophy of the skin, sebaceous and sweat glands. Due to the wrinkling of the tissues of the vulva, the entrance to the vagina sharply narrows, the skin becomes very dry and easily wounded. The disease is usually accompanied by itching, which leads to scratching and secondary inflammatory tissue changes. Kraurosis is observed more often during menopause or menopause, but sometimes occurs at a young age. With kraurosis, the death of elastic fibers, hyalinization of connective tissue, sclerosis of the connective tissue papillae of the skin with thinning of the epithelium covering them, and changes in nerve endings occur.

For treatment, it is recommended to use estrogen hormones in combination with vitamin A. Some menopausal patients experience good results when using estrogens and androgens. To normalize the trophic function of the nervous system, a novocaine solution is injected into the subcutaneous tissue of the vulva using the tight creeping infiltrate method, a presacral novocaine blockade is performed, and the vulva is denervated by dissecting the pudendal nerve. In especially severe cases of the disease, if all described methods of therapy are unsuccessful, they resort to extirpation of the vulva. As a symptomatic remedy to reduce itching, you can use 0.5% prednisolone ointment or ointment with anesthesin. If areas suspicious for cancer are detected, a biopsy is indicated.

PRE-CANCER DISEASES OF THE CERVIX. Dyskeratoses are characterized by a more or less pronounced process of proliferation of stratified squamous epithelium, compaction and keratinization (keratinization) of the surface layers of the epithelium. In relation to malignancy, leukoplakia with a pronounced proliferation process and beginning cell atypia are dangerous. With leukoplakia, the mucous membrane is usually thickened, separate whitish areas are formed on its surface, which sometimes, without clear boundaries, pass into the unchanged mucous membrane. Leukoplakia sometimes looks like whitish plaques protruding on the surface of the mucous membrane. These areas and plaques are tightly fused to the underlying tissues. Leukoplakia of the cervix is very often asymptomatic and is discovered accidentally during a routine examination. In some women, the disease may be accompanied by increased secretion (leucorrhoea). In cases of infection, the discharge from the genital tract becomes purulent in nature.

Adenomatous polyps are characterized by a large accumulation of glandular tissue. In this case, the glandular epithelium may be in a state of hyperplasia. Precancerous diseases of the endometrium are expressed in lengthening and intensification of menstruation, as well as the occurrence of acyclic bleeding or spotting. The appearance of a suspicious symptom should be considered! bleeding during menopause. The detection of endometrial hyperplasia or adenomatous polyps in a patient during this period should always be considered as a precancerous process. In younger women, endometrial hyperplasia and adenomatous polyps can be considered a precancerous condition only in cases where these diseases recur after curettage of the uterine mucosa and subsequent correct conservative therapy.

A special place among precancerous diseases of the uterus is occupied by hydatidiform mole, which often precedes the development of chorionepithelioma. Based on clinical and morphological features, it is customary to distinguish the following three groups of hydatidiform mole: “benign”, “potentially malignant” and “apparently malignant”. In accordance with this classification, only the last two forms of hydatidiform mole should be classified as a precancerous condition. All women whose pregnancy ended with a hydatidiform mole should be monitored for a long time. In such patients, an immunological or biological reaction should be periodically performed with whole and diluted urine, which allows timely fasting! make a diagnosis of chorionepithelioma.

21) precancerous diseases of the female genital organs see question 20.

Damage to the genital organs

In the practice of obstetrics and gynecology, injuries to the genital organs outside the birth act are observed quite rarely. They are classified as follows:

ruptures during sexual intercourse;

damage caused by foreign bodies in the genital tract;

injury to the external genitalia and vagina of a domestic or industrial nature caused by any sharp object;

genital bruises, crush marks;

stab, cut and gunshot wounds of the genitals; damage due to medical activities.

Regardless of the cause of the damage, determining its volume requires a thorough examination in a hospital setting, which includes, along with the initial examination, special methods (rectoscopy, cystoscopy, radiography, ultrasonography and nuclear magnetic resonance imaging, etc.).

The varied nature of injuries and complaints, many variants of the course of the disease depending on age, constitution and other factors require individual medical tactics. Knowledge of generally accepted tactical decisions allows the emergency physician to begin emergency measures at the prehospital stage, which will then be continued in the hospital.

Damage to the female genital organs associated with sexual intercourse. The main diagnostic sign of injury to the external genitalia and vagina is bleeding, which is especially dangerous when the cavernous bodies of the clitoris (corpus cavernosus clitoridis) are damaged. Rarely, the cause of bleeding requiring surgical hemostasis can be a rupture of the fleshy vaginal septum. Usually one or more sutures are placed on the vessels, injected with novocaine and adrenaline hydrochloride. Sometimes short-term pressure on the vessel is enough.

With hypoplasia of the external genitalia, their atrophy in older women, as well as in the presence of scars after injuries and ulcers of inflammatory origin, the rupture of the vaginal mucosa can extend deeper into the external genitalia, urethra and perineum. In these cases, a surgical suture will be required to achieve hemostasis.

Vaginal ruptures can occur due to an abnormal position of the woman’s body during sexual intercourse, violent sexual intercourse, especially in a state of intoxication, as well as when foreign objects are used in violence, etc. A typical injury in such circumstances is a rupture of the vaginal vaults.

Doctors often observe extensive damage to the external genitalia and adjacent organs. Forensic practice abounds in such observations, especially when examining minors who have been raped. Characterized by extensive ruptures of the vagina, rectum, vaginal vaults, up to penetration into the abdominal cavity and intestinal prolapse. In some cases, the bladder is damaged. Delayed diagnosis of vaginal ruptures can lead to anemia, peritonitis and sepsis.

Injuries to the pelvic organs are diagnosed only in a specialized institution, therefore, at the slightest suspicion of injury, patients are hospitalized in a hospital.

Damage due to penetration of foreign bodies into the genital tract. Foreign bodies introduced into the genital tract can cause serious problems. From the genital tract, foreign bodies of various shapes can penetrate into adjacent organs, pelvic tissue and the abdominal cavity. Depending on the circumstances and purpose for which foreign bodies were introduced into the genital tract, the nature of the damage may vary. There are 2 groups of damaging objects:

introduced for medicinal purposes;

introduced for the purpose of producing a medical or criminal abortion.

The list of circumstances and causes of damage to the genital tract at the everyday level can be significantly expanded: from small objects, often of plant origin (beans, peas, sunflower seeds, pumpkins, etc.), which children hide during games, and modern vibrators for masturbation to random large objects used for the purposes of violence and hooliganism.

If it is known that the damaging object did not have sharp ends or cutting edges, and manipulations are stopped immediately, then you can limit yourself to observing the patient.

The leading symptoms of genital trauma: pain, bleeding, shock, fever, leakage of urine and intestinal contents from the genital tract. If the damage occurred in an out-of-hospital setting, then of the two decisions - to operate or not to operate - the first is chosen, since this will save the patient from fatal complications.

The only correct solution would be hospitalization. Moreover, due to the unclear nature and extent of the injury, even in the presence of severe pain, anesthesia is contraindicated.

Many difficulties associated with the provision of ambulance and emergency medical care for trauma, blood loss and shock can be successfully overcome if, in the interests of continuity at the stages of medical evacuation, the ambulance team, when deciding to transport the patient, transmits information about this to the hospital where the patient will be delivered.

Injury to the external genitalia and vagina of a domestic or industrial nature caused by any sharp object. Damage of this nature is caused by various reasons, for example, falling on a sharp object, attack by cattle, etc. There is a known case when, while skiing from a mountain, a girl ran into a stump with sharp branches. In addition to the fracture of the ischial bones, she had multiple injuries to the pelvic organs.

A wounding object can penetrate the genitals directly through the vagina, perineum, rectum, abdominal wall, damaging the genitals and adjacent organs (intestines, bladder and urethra, large vessels). The variety of injuries corresponds to their multisymptoms. It is significant that under the same conditions, some victims develop pain, bleeding and shock, while others do not even experience dizziness, and they get to the hospital on their own.

The main danger is injury to internal organs, blood vessels and contamination of the wound. This can be detected already during the initial examination, noting the leakage of urine, intestinal contents and blood from the wound. However, despite the large volume of damage and involvement of the arteries, in some cases the bleeding may be insignificant, apparently due to crushing of the tissue.

If, during a prehospital examination, an object that caused injury is found in the genital tract, it should not be removed, as this may increase bleeding.

Bruises of the genital organs, crushing. These injuries can occur, for example, in traffic accidents. Large hemorrhages, even open wounds, can form

to be in tissues compressed by two moving hard objects (for example, in the soft tissues of the vulva relative to the underlying pubic bone under the influence of a hard object).

A feature of bruised wounds is the large depth of damage with a relatively small size. The threat is posed by damage to the cavernous bodies of the clitoris - a source of severe bleeding, which is difficult to undergo surgical hemostasis due to additional blood loss from places where clamps are applied, needle pricks and even ligatures.

Long-term pressing of the injury site to the underlying bone may not give the expected results, but it is still used during transportation to the hospital.

Bleeding may also be accompanied by an attempt to achieve hemostasis by injecting a bleeding wound with a solution of novocaine and adrenaline hydrochloride. It should be borne in mind that damage to the external genitalia due to blunt force trauma is more often observed in pregnant women, which is probably due to increased blood supply and varicose veins under the influence of sex hormones.

Under the influence of trauma with a blunt object, subcutaneous hematomas can occur, and if the venous plexus of the vagina is damaged, hematomas are formed that spread in the direction of the ischiorectal recess (fossa ischiorectalis) and the perineum (on one or both sides).

Vast cellular spaces can accommodate a significant volume of flowing blood. In this case, blood loss is indicated by hemodynamic disorders up to shock.

Damage to the external genitalia may be accompanied by injury to adjacent organs (polytrauma), in particular fractures of the pelvic bones. In this case, very complex combined injuries can occur, for example, rupture of the urethra, separation of the vaginal tube from the vestibule (vestibulum vulvae), often with damage to the internal genital organs (separation of the uterus from the vaginal vault, formation of hematomas, etc.).

In case of polytrauma, it is rarely possible to avoid transection and limit oneself to conservative measures. The multiple nature of the injuries is an indication for emergency hospitalization in the surgical department of a multidisciplinary hospital.

Stab, cut and bullet wounds of the genitals are described in violent acts against a person on sexual grounds. These are usually simple wounds with cut edges. They can be superficial or deep (the internal genital and adjacent organs are damaged). The topography of the internal genital organs is such that it provides them with fairly reliable protection. Only during pregnancy, the genital organs, extending beyond the pelvis, lose this protection and can be damaged along with other abdominal organs.

There are almost no comprehensive statistical data regarding the frequency of bullet injuries to the internal genital organs, but in modern conditions women can become victims of violence. Therefore, this type of injury is not completely excluded in the practice of an emergency physician.

The experience of military conflicts has shown that the majority of wounded women with damage to the pelvic organs die in the prehospital stage from bleeding and shock. Bullet wounds are not always assessed adequately. The task is easier with a through wound. If there are entrance and exit openings of the wound canal, it is not difficult to imagine its direction and the likely extent of damage to the internal genital organs. The situation is completely different when there is a blind bullet wound.

When making a decision, the emergency physician must proceed from the assumption that the injury caused multiple injuries to internal organs until the contrary is proven. In this regard, it is most appropriate to hospitalize the wounded woman in a multidisciplinary hospital with urgent surgical and gynecological departments.

Bullet wounds are especially dangerous during pregnancy. Injuries to the uterus usually cause significant blood loss. An injured pregnant woman must be hospitalized in the obstetric department of a multidisciplinary hospital.

23) preparing the patient for gynecological surgery, planned and emergency

Surgical treatment has become widespread in gynecology. The success of the operation depends on various factors.

First among them is the presence of precise indications for surgical intervention. In the event that the disease threatens the life and health of the patient and this danger can only be eliminated through surgical intervention, the operation will be indicated and its implementation will be justified.

It is necessary to take into account not only the indications, but also contraindications for surgery, which may be associated with pathology of other organs. Contraindications to surgery are considered both when surgical treatment is planned and when there is an emergency need for surgery. General contraindications to operations are acute infectious diseases, such as tonsillitis, pneumonia, however, in the case of an ectopic pregnancy or bleeding, surgical intervention will have to be resorted to. Elective surgeries in case of acute infectious process will be postponed.

In order for the outcome to be favorable, it is necessary to carry out a whole range of therapeutic and preventive measures before the operation, during it and in the postoperative period.

In preparation for surgery, an examination is carried out, concomitant diseases are identified, and the diagnosis is clarified. Then, during these activities, the method of pain relief, the extent of surgical intervention are selected, and the patient is prepared for surgery. Preparation consists of psychoprophylaxis and the right emotional mood. Also, in some cases, it is necessary to carry out preventive treatment of concomitant diseases.

In connection with the above, preparation for surgery can take from a few minutes in an emergency to several days or weeks in elective operations. It should be noted that part of the examination or treatment can be carried out on an outpatient basis, before the patient is admitted to the hospital.

There is a standard set of studies that every patient must undergo before surgery. It includes a medical history, general and special objective examinations, as well as laboratory and additional tests: general urine and blood tests, determination of platelet count, blood clotting time and bleeding duration, prothrombin index, biochemical studies (for residual nitrogen, sugar, bilirubin, total protein), it is necessary to determine the blood type and Rh affiliation.

An X-ray of the chest organs, an electrocardiogram, and a determination of the Wasserman reaction are also required. In addition, smears from the vagina are examined for flora, as well as from the cervical canal for atypical cells. HIV testing is mandatory.

No one knows the exact cause of cancer in one location or another. But, there are a number of pathologies that are considered precancerous and without proper timely treatment can provoke the development of a malignant tumor. Thus, cervical cancer can be caused not only by the human papilloma virus or exposure to carcinogenic substances, but also by chronic pathologies that have not been treated for years.

Most pathologies of the female genital organs, which are considered precancerous diseases, respond well to treatment. And with timely treatment, they do not give a single chance to the oncological process to develop, but in case of neglect of health and lack of treatment, the disease will sooner or later degenerate into a cancerous tumor.

Cervical cancer

Oncology can develop as a result of the lack of treatment for the following pathologies:

cervical erosion;
polyps;
leukoplakia;
cervical dysplasia, its deformation, etc.

Erosion

A common pathology in women is erosion. It occurs both in very young girls and in older women. The disease consists of a violation of the integrity of the epithelium of the cervix, causing an ulcer. The pathology may not manifest itself for a long time, but without treatment, cervical erosion can develop into cancer. In order to exclude this possibility, it is necessary to undergo a preventive examination by a gynecologist at least once every six months. If there is erosion, the doctor will prescribe treatment; as a rule, it consists of cauterizing the ulcer using liquid nitrogen or current.

The procedure is performed without hospitalization, without the use of anesthesia and takes no more than 10-20 minutes. The only obligatory condition before cauterization is to take a sample of eroded tissue for histological analysis, to exclude that cervical erosion has developed into cancer.

Informative video: E Rosia - precancerous disease of the cervix

Erosion can occur for a number of reasons:

hormonal imbalance;
weakened immune system;
inflammatory processes in the female genital organs;
mechanical damage to the cervical mucosa.

Erosion has no characteristic symptoms. Basically, women do not feel any discomfort, pain or other symptoms and learn about the presence of a problem after examination by a gynecologist. In rare cases, when there are significant lesions of the mucous membrane, bloody or bloody discharge may appear after or during sexual intercourse. In this case, you should immediately contact a specialist.

In addition to cauterization with electric current or freezing with liquid nitrogen, other methods, such as radio waves or lasers, may be offered in the treatment of erosion. The latest therapy methods are the most modern and have a limited number of side effects.

Leukoplakia

In addition to uterine erosion, treatment of the cervix can also occur due to other diseases, one of which is leukoplakia. The disease consists of damage to the mucous membrane of a woman’s lower genital tract. Visually, such changes are characterized by compaction and keratinization of the epithelial layer, on which a white or dirty gray coating appears.

Leukoplakia can be of several types:

erosive- in this case, cracks or small ulcers form on the surface of the white plaque;
flat- the most asymptomatic form, as a rule, does not show any signs of its existence. As the disease progresses, whitish lesions appear that do not rise above the epithelium and do not cause pain. Basically, this form is detected during examination by a doctor;
warty- the lesions in this case rise above the epithelium in the form of small growths. They can be layered one on top of the other, so that the walls of the cervix become lumpy. This form is considered the most dangerous and more often than others degenerates into a cancerous tumor.

When a pathology is detected, the affected tissue is always taken for histological analysis using. The exact causes of the development of leukoplakia have not yet been studied reliably.

Informative video: Leukoplakia of the cervix

The symptoms of the disease depend on its form. For example, the warty form often brings discomfort, pain and a burning sensation. In the erosive form, patients notice bloody discharge, especially after sexual intercourse, and sometimes itching. The flat form rarely manifests itself, except for the presence of a white coating, which can only be seen by a doctor during examination.

The following methods can be proposed for the treatment of pathology:

chemical coagulation;
cryodestruction;
radio wave surgery;
electrocoagulation;
laser application.

Polyps

Benign formations in the form of polyps can transform into the development of a cancerous tumor without timely therapy. Polyps are pear-shaped or villous growths. They can be attached to the mucosa on a wide base or a thin stalk. They can be single or multiple.

Development of a cancerous tumor

Polyps themselves do not harm the body, but they can cause the development of cancer or uterine bleeding, and therefore require timely treatment. Therapy consists of removing these growths; most often, a radical method is used for this - polypectomy.

Uterine fibroids

A common disease among women, it is characterized by the formation of a benign tumor in the uterus from its muscular layer. For a long time, fibroids do not manifest themselves until they reach a significant size. With large nodes, the tumor can be palpated by the doctor even through the abdominal cavity. This form is dangerous due to bleeding and degeneration into cancer. Symptoms include pain in the back, buttocks and lower abdomen. Pain appears as a result of the large weight of fibroids and its pressure on the nerve endings. Bowel and bladder disorders may also be diagnosed.

Informative video: Fibroids - a tumor of the uterus

Therapy depends on the size of the fibroids and individual indicators. As a rule, they resort to the surgical method.

Each of the described pathologies, with timely diagnosis, responds well to treatment. But, without therapy, there is a high probability of developing cancer, and this pathology will be much more difficult to cope with. For prevention purposes, doctors recommend systematically attending specialized examinations with a gynecologist. Don't be indifferent to your health!