Radio wave conization at what time is it done. Radio wave conization of the cervix: indications and features. Features of various techniques

Conization of the cervix is ​​the removal of part of the cervix and is an effective way to diagnose and treat many pathologies of the reproductive system. The procedure can be performed in various ways depending on age, indications, and desire to have children.

The most gentle and popular are electroconization and radio wave conization. Cryodestruction is extremely rarely prescribed. Knife conization is currently used for cancer lesions.

The procedure can be performed either on an outpatient basis or in a hospital setting, under local or general anesthesia, depending on the chosen intervention option. After conization, certain restrictions must be observed. The rehabilitation period ranges from one to several months. After conization, it is possible to have children if you choose the appropriate surgical technique. The cost of the procedure starts from 2500 rubles and increases depending on the type of intervention.

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What is conization of the cervix, its types

Conization is a surgical procedure during which part of the cervix is ​​removed for therapeutic or diagnostic purposes. This operation is aimed at removing a section of mucous membrane with a “cone”, hence the name – conization.

Changed tissue of the cervix up to the cervical canal is subject to resection, which is subsequently sent for cytology. An area 5-7 millimeters thick at the border with healthy tissue is captured in order to then determine the extent and depth of the lesion. That is, the cone includes the vaginal part of the cervix, partially the cervical canal and all the changed tissues with the transformation zone.

If during the study dystrophic changes were identified, then the operation is considered curative, and if atypical cells are found, then this indicates a malignant process, which means that conization was diagnostic, and radical surgery on the genital organs is required.

Conization has made it possible to treat and diagnose many processes in the cervical area; various methods have now been developed for removing tissue in the genital organs. The choice of method is based on various parameters: the woman’s age, expected diagnosis, desire to have children in the future, body condition and the presence of contraindications. There are several main types of procedure.

Depending on the volume of tissue removed, the following are distinguished:

• superficial - only a small layer of tissue is removed;
• low – removal at the level of the lower third of the cervical canal;
• average – at level 2/3;
• high – almost the entire cervix is ​​resected.

When is it appointed?

Conization of the cervix is ​​prescribed both for treatment by removing the altered area, and for diagnosing the resulting tissue for changes in cell structure. Indications include:

• second and third degrees. The second degree affects the middle and lower layers of the epithelium, and the third affects all layers, reaching the outer pharynx.
• Leukoplakia (keratinization of the mucous membrane) as a background disease that contributes to the development of cancer pathology in the future.
• Ectropion is a pathological condition of the cervix, in which the mucous membrane of the cervical canal turns into the vaginal part, and also contributes to degeneration into cancer.
• and pseudo-erosion. Erosion is a complete destruction of the epithelium of the cervical canal, while with pseudo-erosion there is an atypical arrangement of the columnar epithelium.
• Cystic formations in this area, including those of endometrioid origin.
• Suspicion of an oncological lesion based on the results of colposcopy or taking a smear from the vagina for cytology.
• Cervical polyps.
• Recurrent dysplasia after surgery.
• Pronounced cicatricial changes in the cervix.
• Identified altered epithelium of the cervix based on the results of colposcopy and smear sampling.

The purpose of conization is to isolate and study the material, so both the changed area and 3-4 millimeters of healthy tissue are captured. The depth of excision largely depends on the method of exposure, but most often it is 5-10 millimeters, which allows you to find out the depth of spread of the pathological process on the cervix.

Radio wave

Radio wave conization is the excision of a pathological area using electromagnetic waves. The operation is performed under local anesthesia, and an anesthetic injection is given into the cervix. The operation is performed on days 5-7 of the cycle in the absence of vaginal discharge. The cervix is ​​fixed in the mirrors, colposcopy is performed, then electrodes are connected and the affected area is removed in a cone shape using a radio knife, capturing from one to two thirds of the cervical canal.

The resulting material is sent for cytology. The whole procedure takes 15-20 minutes. In this case, no sutures are applied, the vessels are coagulated. This reduces the risk of scar changes in the postoperative period.

After the operation, minor sanguineous discharge is observed from the vagina for one to two weeks. During the procedure itself and for several days after, nagging pain in the abdomen is bothersome. The menstrual cycle may be interrupted by 3-5 days. But in general, this operation proceeds without significant changes or complications.

Radioconization is one of the most popular, safe and effective techniques.

Electroconization

Electroconization is the removal of affected tissue by cone-shaped excision using an electric current. It is fed to an electrode loop, which removes the affected tissue. The only significant disadvantage of this method is the inability to control the depth of exposure.

The operation is performed under anesthesia on the tenth day of menstruation. First, the doctor dilates the genital tract, removes all vaginal discharge and stains the intended area with a special dye. Before all manipulations, an anesthetic injection is given into the cervix.

Using a loop with electrodes in a circular motion, the affected area is removed 3-4 millimeters beyond the border of changes, while the expected depth will be 5-7 millimeters, the vessels are coagulated. The material is then sent for research.

After such an operation, the recovery period lasts about a month. There is also slight vaginal discharge, mild pain in the lower abdomen and changes in the cycle. At this time, it is necessary to observe a protective regime. The procedure can be performed on an outpatient basis.

Electrodiathermoconization, diathermoconization

Electrodiathermoconization is a more extensive intervention, which is recommended to be done only for women who have given birth or for nulliparous women if an oncological process is suspected. Diathermoconization is used for all indications for conization of the cervix. The procedure is suitable for both therapeutic and diagnostic purposes.

It is based on the effect of high voltage electric current, which is created between two electrodes: one is inserted into the vagina, and the other is placed under the woman’s lower back. The manipulation is performed mainly under local anesthesia. The affected area is excised with a special loop, and the vessels are coagulated with electrodes.

Despite the thermal effect and the absence of stitches, after this operation the risk of scarring is quite high. Other complications are also possible, including difficulties with conception and pregnancy, endometriosis.

Full recovery of the body after such a procedure occurs after 2-3 months, provided that all recommendations for the regimen are followed. The operation is scheduled on days 6-8 of the cycle. A full examination is also necessary before it is carried out. Contraindications to the technique are the same as when using electroconization.

Knife, surgical

Knife or surgical conization is the oldest method of cone-shaped excision of altered tissue of the cervix. In this case, the affected area is excised with a scalpel to the required depth and length. Knife conization requires general anesthesia and the operation takes place in a hospital. Currently, it is performed if there are contraindications to radio wave or electroconization, as well as if an oncological process is suspected.

During surgery, tissue can be excised sufficiently to remove cancerous tissue. After the operation, there is a long recovery period; the procedure itself is quite traumatic; it is undesirable to perform it on nulliparous women. The operation is also performed at the beginning of the cycle. After the procedure, high-quality diagnostic material is obtained.

Laser

Laser conization is based on the use of a laser to remove diseased tissue. This operation also requires general or local anesthesia. The affected area is removed with high precision, but healthy tissue near the removal site may be burned, especially if the woman moves.

Laser surgery allows you to expand the scope during the procedure and is suitable for large areas of damage or bending of the uterus. Vessels are also effectively coagulated, and the risk of postoperative inflammation is minimal.

Laser conization can be used in nulliparous women because it minimizes the risk of scar tissue formation and hormonal changes after the procedure. The operation itself is practically bloodless, but is technically complex and very expensive, which is why the technique is not very popular. It is also difficult to obtain high-quality diagnostic material, since the surrounding tissues are burned.

Cryoconization

Cryoconization involves the destruction of tissue by a cryoprobe under the influence of very low temperatures. They try to carry out the procedure provided that the affected area has small and clear boundaries, and the woman’s age is no more than 30-35 years.

The operation is performed under local anesthesia on an outpatient basis and does not affect reproductive function. A cryo-element is applied to the affected area for 3 minutes, during which the area is destroyed. In this case, it is impossible to obtain diagnostic material, and the tissues located along the borders may be exposed to cold.

After the operation, spasms in the muscles of the uterus and copious watery discharge from the vagina are observed for a long time. Cryoconization is practically not used these days.

PEE of the cervix - what is it?

PEE is a loop excision (excision) of the cervix. The tissue is excised with a heated thin loop to which a low voltage current is applied. Removal and coagulation occur simultaneously. The operation is performed under local anesthesia.

Conization is a deeper version of excision, in which the penetration depth reaches 8-10 millimeters. During excision, more superficial layers are affected.

Collecting a smear during electroconization of the cervix using the Fotek device

When performing electroconization of the cervix using the Fotek device, a high-quality smear is collected. The Fotek device is a generator of high-frequency electrical waves that successfully destroy pathological tissues without damaging healthy ones.

Cervical excision is a more general concept that includes conization. The procedure is performed in various ways, in which the excision of a surface area is carried out to a shallow depth. During excision, diagnostic material can be obtained.

Cone biopsy is a narrower concept than conization. During a biopsy, only diagnostic altered material is collected within the affected and healthy tissues without affecting the altered area. Such a biopsy is performed specifically and solely for diagnostic purposes.

Conization of the cervix: how the operation is performed

Conization of the cervix is ​​an operation and takes place in several stages:

1. the first is called preparatory, at this stage an anamnesis is collected and all necessary examinations and consultations are carried out
2. treatment stage, in some cases the woman is hospitalized in a hospital;
3. Conization ends with a rehabilitation period in which the woman undergoes recovery after the intervention.

The operation itself involves anesthesia, which is carried out both locally and generally, as well as direct intervention on the pelvic organs.

Watch this video about what cervical conization is:

For erosion

For erosion, it is recommended to use electrodiathermocoagulation, radio wave conization of the cervix or excision of the cervix. The procedure can be done on an outpatient basis. First, the woman is seated in a gynecological chair, dilators and speculums are placed, and an anesthetic is injected into the cervical area. After the onset of anesthesia, the affected surface is examined and the boundaries are determined. Next, the erosion site is precisely cauterized with an electrode.

For young nulliparous women, the method of choice is radio wave conization or electroconization, but diathermoconization is best avoided due to the high risk of damage to healthy tissue.

After surgery, you may experience some slight discharge that goes away after a few weeks. The operation area does not require additional processing.

For dysplasia

For cervical dysplasia, the site can be removed by any method, but the method of choice is often electrocoagulation due to the low risk of complications. Diagnostic examination of the material is also a mandatory element, so methods such as laser conization or cryoconization are not suitable.

With dysplasia, a change in the normal tissue architecture occurs, which is a close object of attention due to the possibility of malignancy. An electric knife is used to remove tissue to a depth of 5-7 millimeters and at a distance of 3 millimeters from the border of the lesion. The surface of the neck is first treated with dyes using special techniques to determine the boundaries of removal.

Cyst removal

A cyst is a benign cavity formation with liquid contents. Sometimes cysts are located on the cervix, which complicates the processes of conceiving and bearing a child and serves as an indication for their removal. Common techniques for this are radio wave or electroconization. Sometimes laser removal is used if a woman has already given birth. If the cysts reach large sizes, they must be removed surgically.

Before electroconization, a woman should collect all the necessary tests and consult a therapist who will give her recommendations regarding concomitant pathologies. You should definitely undergo a colposcopy and vaginal smears from a gynecologist, since if there is an infection or inflammation, the procedure will be postponed.

Many patients experience stress and fear before the procedure, so it is useful to take a course of sedatives before the procedure. Drugs for the treatment of underlying diseases do not require discontinuation in the preoperative period. A woman should avoid hypothermia and infections so as not to have contraindications at the time of treatment.

Preparation for the event

Preparation for the procedure consists of collecting tests, consultations with a specialist and procedures on the eve of the intervention. In order to make any variant of conization, you must:

• pass ;
• take a vaginal smear;
• perform a colposcopy;
• culture a smear for bacterial flora;
• do an ultrasound of the pelvic organs;
• according to age indications - mammography;
• visit a gynecologist.

The woman should have a complete gynecological history, including all operations, pregnancies and their outcomes. You also need to make sure there are no sexually transmitted infections. To do this, you can donate blood for antibodies to the relevant pathogens. From general clinical studies it is necessary:

• take general and biochemical blood tests;
• take a general urine test;
• do a coagulogram, determine the blood type and Rh factor, if the intervention is planned in a hospital;
• blood tests for HIV, hepatitis B and C, syphilis;
• do an ECG;
• consult a therapist.

The general practitioner will prescribe additional examinations based on the accompanying background pathologies: monitoring blood sugar levels in diabetes, thyroid hormones in hypo- or hyperthyroidism. All background pathologies must be in a state of compensation. It is imperative to collect an allergy history, especially for anesthetic and narcotic drugs, as well as antibiotics.

A few days before the operation, douching, sex, and the use of any vaginal forms of drugs are prohibited. The day before, you need to carry out hygienic treatment of the skin: shave and wash thoroughly without irritating products.

A light dinner is allowed. If general anesthesia is required, an enema is performed. On the morning of surgery, a light breakfast or no breakfast is allowed under general anesthesia. Taking vital medications is discussed with your doctor. You need to take a hygienic shower.

Why is formaldehyde needed for conization?

Formalin for conization is necessary to preserve the obtained histological material. This environment in which the tissue is placed, exposure to formalin prevents the decomposition of organic tissues and the proliferation of microbes in them. This substance does not enter the woman’s body in any way.

Does it hurt to do

Each woman can answer differently the question of whether conization is painful. During the procedure itself, anesthesia is given: local or general. Sometimes the patient experiences an unpleasant pulling sensation when she is conscious. After anesthesia, pain may intensify: slight nagging pain for two to three weeks after surgery is considered normal. It is allowed to take painkillers and antispasmodics in a short course to relieve symptoms. The following should be of concern:

• pain intensity increased;
• the rhythm of pain has changed;
• began to be accompanied by bloody discharge;
• The pain lasts for more than a month.

If these signs occur, you should consult a doctor.

How long does the operation take?

Conization lasts on average 15-30 minutes if the operation proceeds without complications. The surgical knife method may take longer due to the scale of the actions and last about an hour. If complications develop, such as bleeding or organ rupture, the intervention may take up to two hours. The duration of anesthesia also affects the operation time: half an hour for local and 2-4 hours for general.

Is anesthesia necessary?

Some conization options require general intravenous or epidural anesthesia. Such interventions include:

• laser conization;
• diathermoconization;
• cryoconization.

Brief general intravenous anesthesia is often chosen for these procedures. Knife conization is performed under full general anesthesia. Other methods are limited to local anesthesia by injecting an anesthetic into the cervix; Lidocaine or Novocaine is often used.

Conization of the cervix and postoperative period

The postoperative period for conization of the cervix greatly depends on the method of operation and its outcomes. Electroconization and radio wave conization are considered low-traumatic, but the use of a laser, high-frequency electric current, low temperatures or a scalpel increases rehabilitation to several months. Also, these methods negatively affect reproductive function and are not used without vital indications for women who have not given birth.

How does healing proceed?

Healing occurs by restoring blood flow to the affected area and the formation of connective tissue at the site of exposure. Scarring reaches a particularly large scale when exposed to a laser, high-frequency electric current or liquid nitrogen. In these cases, significant scarring may form on the cervix.

In other cases, the cavity heals without much of a trace. The condition of the whole organism is of great importance for the restoration of the layer: the absence of inflammation and infections, as well as compliance with the prescribed restrictions.

How long does it last

The healing process lasts from two to eight weeks. With low-traumatic options, after 2 weeks all sanguineous discharge from the vagina stops and pain disappears. After a month, the cycle is restored. With extensive and traumatic exposure, the regeneration process increases to two months.

Temperature

After surgery, the temperature may rise to low-grade levels on the first day. It can also be observed with a burn after a laser or powerful current. The next day the temperature should be normal. Its increase indicates the development of complications - inflammation or infection; it is important to consult a doctor immediately.

How to wash yourself

You should wash yourself regularly; for this you do not need to use any special hygiene products for the skin that can cause irritation, just warm and clean water. Movements should be soft and massaging; all folds of the skin should be thoroughly washed. You should move from front to back.

It is advisable to shave the genital area after surgery in order to better control the condition of the external genitalia. Douching should not be done at this time. Washing should end with careful blotting with a clean, dry towel; do not rub delicate skin and mucous membranes.

Why does pain occur?

Pain after conization occurs due to trauma to the sensitive surface, pain receptors are triggered. There is also a short-term spasm of the smooth muscle fibers of the uterus, which worries the woman for some time due to changes in the structure of the cervical wall: the area is overgrown with connective tissue, the crust falls off at the site of exposure (scab), as well as slight bleeding.

Severe pain after surgery indicates an inflammatory process, severe bleeding or injury to nearby organs.

Causes of itching

The main causes of itching after conization are infectious lesions of the vagina. With candidiasis or thrush, the itching can be unbearable, and voluminous cheesy contents are released from the genital area. With other vaginal dysbiosis, itching may be moderate and accompanied by general discomfort in this area. Skin irritation from hygiene products or synthetic underwear can also cause discomfort.

Before and after conization, the cervix is ​​treated with an antiseptic, often using Lugol's solution or a 3% acetic acid solution, which also makes it possible to identify the boundaries of surface changes. In the future, additional treatment of the cervix is ​​needed only in case of large-scale intervention - in this case, the woman is in the hospital.

What is a scab, what does it look like and how does it come off?

On the wound surface, after removing a defect or altered membrane, a scab is formed - this is a kind of crust of coagulated protein of the underlying tissues and blood cells, which looks like a thin dark film and comes off a few days after the operation. A scab appears with any wound impact on the epithelial surface and is a normal stage of healing.

Will they give me sick leave?

After manipulation on an outpatient basis, sick leave will not be given. If the operation was carried out in a hospital and general anesthesia was given, then it will be issued for 7-10 days, if necessary, it can be extended to 14. If complications develop with any conization technique, a sick leave certificate must be issued for the treatment of the developed complication for the required period.

Contraindications after conization of the cervix

After conization of the cervix, there are certain contraindications that are temporary.

• have sex, both vaginal and anal, unprotected oral;
• perform heavy physical activity;
• lift more than one and a half kilograms;
• use tampons;
• use vaginal suppositories or tablets;
• use special hygiene products;
• do douching;
• go to the pool or sauna;
• swim in open waters;
• wear tight, synthetic underwear.

With low-impact methods, they act within a month; with extensive options, such as a laser or a knife, they must be limited to several months.

Medicines such as aspirin and other anticoagulants should be used with caution, as there is still a risk of bleeding after many types of conization.

Discharge after conization of the cervix

After conization of the cervix, slight vaginal discharge of a soft pinkish hue is observed for some time. This applies to variants of the norm. A change in the nature and amount of discharge may indicate the development of a complication.

Norm

The norm is the discharge of a small amount of sanguineous discharge over several weeks with a tendency to decrease. The discharge has a delicate pinkish tint, a concentration of medium viscosity and leaves smearing marks on the laundry. They do not have a pungent odor, the maximum amount disappears during the first day. Towards the end of the rehabilitation period, they become serous and then mucous.

Periods after

The conization operation is performed on days 6-10 of the cycle, after which the next menstruation will begin. They can linger for several days; 3 to 7 are considered normal. Conization does not cause significant hormonal changes, but diseases that are indications for this procedure can disrupt the cycle.

Bleeding is often complicated by:

• laser conization;
• cryodestruction;
• knife conization;
• electrodiathermoconization.

Exposure to high-frequency electrical current does not allow depth control, which can cause unplanned vascular damage. Some pathologies of the uterus and cervix themselves contribute to heavy blood loss: tumors, endometrial damage.

Bleeding after conization is diagnosed by general and specific symptoms. Common ones include:

• weakness, dizziness;
• flickering of flies before the eyes;
• pallor;
• anemia in blood tests;
• frequent heartbeat.

Among the specific ones, the doctor will be alerted to pain in the abdomen and heavy bleeding.

Complications and consequences after conization of the cervix

Conization of the cervix sometimes occurs with undesirable complications and consequences, this is facilitated by both a violation of the surgical technique itself and the somatic background of the patient.

Conization of the cervix if it is not carried out completely can cause the spread of the pathological process, especially of an oncological nature. A traumatic effect on an organ causes a disruption in adaptation and helps stimulate pathological transformations if the impact on the area was not radical and justified.

If high-quality diagnostic material is not obtained when malignant degeneration is suspected, this may lead to an incorrect diagnostic decision and further treatment. It is important to choose the right conization option depending on the indications.

Recovery after conization of the cervix

Recovery after conization of the cervix requires compliance with all prescribed restrictions and contraindications, taking painkillers and anti-inflammatory drugs if necessary.

A woman should adhere to simple recommendations: the patient should protect herself from infections, hypothermia, she must follow a work and rest schedule, and eat well. Anti-inflammatory drugs can be used as symptomatic therapy:

• Ibuprofen;
• Paracetamol;
• Naproxen;
• Ketoprofen;
• Diclofenac.

Medicines should be used in a limited course, combined with proton pump inhibitors in the presence of gastrointestinal pathologies (gastritis or a history of ulcers). These drugs should also be prescribed with caution to persons with cardiac or hematological pathologies.

Locally, you can prescribe drugs that will stimulate recovery or fight microbes. After surgery, a course of antibiotic prophylaxis may be necessary, depending on the extent of the procedure.

Treatment: suppositories, drugs

The following can be used as local medications and suppositories for treatment:

• Depanthol;
• Methyluracil suppositories;
• Levomekol;
• Acylact.

They are effective ten days after surgery. When dysbiosis develops, antimicrobial drugs are prescribed:

• Hexicon;
• Rumizol;
• Terzhinan;
• Diflucan.

Treatment must be selected and agreed upon with a gynecologist after additional examination; self-medication should not be done.

Sex after

Sex after conization is allowed after a month, 4 weeks should be sexual rest. After this period, a woman should resort to protection during sexual intercourse.

Pregnancy and childbirth

Pregnancy and childbirth after cervical conization are possible, but this intervention seriously increases the risk of infertility, especially with extensive exposure. It is not advisable for nulliparous women to do:

• laser conization;
• cryodestruction;
• knife method;
• diathermoconization.

In general, conization is aimed at treating gynecological pathologies leading to infertility, and in some cases helps a woman overcome this problem.

Sports after surgery

Sports after surgery should be reasonably limited: for a week after the intervention, any physical activity other than walking at an easy pace is prohibited. For a month you cannot run, swim, exercise in the gym with weights, jump, or engage in extreme sports. The tension of the anterior abdominal wall should be significantly limited; heavy lifting should not be allowed.

Relapse after conization of the cervix

Often, after cervical conization, recurrence of pathological changes may occur due to incomplete removal of the affected tissue, ongoing hormonal imbalance, or re-formation of a scar if the procedure was done due to cervical scarring. 30-45 days after this, a control examination is done and, and after 2-4 months, a control colposcopy is performed and a smear is taken for cytology, PCR for HPV (human papillomavirus).

Can HPV come back?

After conization of the cervix, HPV may reappear even with complete exposure to the affected area, especially with active, ongoing infection from the outside. Conization is not an absolute protection against HPV, because the virus is located in the epithelium and is active in half of the cases after surgery.

Is repeat surgery necessary?

Often, after recurrence of cervical changes, repeat conization is prescribed, but this increases the risk of complications, especially for nulliparous women. Repeated surgery is sometimes necessary for cicatricial and recurrent dystrophic and ulcerative lesions.

Cost of cervical conization surgery

The cost of cervical conization surgery greatly depends on the technique:

• diathermocoagulation or electroconization cost from 2500 to 5000 rubles;
• radio wave technique will cost 3000-7000;
• The most expensive are laser conization and the knife method - from 40 thousand rubles in private clinics.

The invoice must also include the cost of tests and consultation with specialists. The average bill for preparatory activities will be from 5 to 7 thousand rubles.

Conization of the cervix is ​​the removal of part of an organ for certain indications. Depending on the clinical situation, any of the existing methods can be chosen (electroconization, laser, cryoconization, knife, etc.). To minimize the risk of complications, you must follow all doctor's recommendations after the procedure.

Useful video

Watch this video about why relapse occurs after conization of the cervix:

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Conization of the cervix is ​​an operation in which a cone-shaped excision of the affected tissue is performed. The procedure is performed for therapeutic and diagnostic purposes for various diseases, when other methods have proven ineffective or cannot be used for any reason. Until recently, conization was carried out with a regular scalpel. In modern gynecology, radio waves and other techniques are actively used to obtain quick and guaranteed results.

Radio wave conization of the cervix is ​​the excision of an area of ​​the desired size using electromagnetic waves. The goal of such treatment is to eliminate the pathological focus (erosion) and save the woman from the possible consequences of this pathology. Radioconization is recognized as one of the most effective and safe methods of therapy and is considered the best option for young nulliparous women.

Advantages of radio wave conization of the cervix

Compared to the classical technique, manipulation has a number of advantages:

• Low invasiveness: radio waves are directed specifically at the pathological focus, healthy tissues are not affected;
• Possibility of use in nulliparous women: after the procedure, the structure of the cervix is ​​not disturbed, no scars remain;
• Low risk of complications;
• Minimal risk of bleeding: the wound surface is treated directly during the procedure, the vessels are coagulated;
• Radical removal of affected tissue in one stage;
• Possibility of obtaining tissues for histological examination;
• Painless;
• Short rehabilitation period (4 weeks);
• Possibility of carrying out on an outpatient basis.

All these factors make radioconization the method of choice for the treatment of cervical pathology in women planning pregnancy.

On a note

As an alternative, the doctor may suggest laser conization - an effective, comfortable and safe treatment method.

Indications for surgery

Conization refers to surgical methods for treating diseases of the cervix. In clinical practice, various techniques for cone-shaped tissue excision can be used:

• Knife – traditional excision of tissue with a scalpel;
• Laser conization;
• Radio wave conization.

On a note

Reviews from patients clearly indicate that radio wave and laser conization are much better tolerated and usually proceed without complications.

Indications for conization:

• Cervical dysplasia stages II and III (CIN);
• Recurrent grade I dysplasia, not amenable to treatment by other methods;
• Erosion of the cervix with pronounced cicatricial deformities;
• Inability to visualize the transformation zone during colposcopy;
• Spread of the pathological process into the cervical canal;
• Cancer in situ (stage 0, non-invasive cancer, that is, not extending beyond the epithelium) - in some cases.

The possibility of using one or another conization method depends on the technical equipment of the clinic and the qualifications of the doctor. Modern medical centers are trying to offer their patients conization of the cervix using the radio wave method. This is one of the most effective and safest methods of surgical treatment, allowing you to radically solve the problem without consequences for reproductive health.

On a note

The question of using one or another method of influence is always decided individually based on the severity of the patient’s condition and the presence of concomitant pathology.

For complicated erosion, ectropion, leukoplakia and other diseases, conservative methods are usually first used (cauterization of the cervix with radio waves, etc.). Lack of effect is a reason to prescribe radio wave conization of the cervix.

Contraindications to surgical treatment

Radio wave conization is not performed in the following conditions:

• Inflammatory process on the cervix;
• Invasive cancer;
• Pregnancy (the operation is performed after the birth of the child and completion of the lactation period).

Quite often, diseases of the cervix (dysplasia, ectropion) are combined with cervicitis - inflammation of the cervical canal. In addition to contact bleeding, profuse vaginal discharge with an unpleasant odor appears, and there is itching and burning in the vagina. Cervicitis not only aggravates the course of the disease, but also contributes to the development of complications. If conization is carried out against the background of active inflammation, the infection can spread to the overlying organs - the uterus and appendages. The operation is prescribed only after complete cure of cervicitis.

For invasive cancer that has penetrated beyond the mucous layer, radioconization is not effective. In this situation, the only treatment may be to remove the uterus (hysterectomy).

Preparation for radio wave treatment

Before the procedure, a woman must undergo a full examination:

• Smear for oncocytology;
• Colposcopy;
• Biopsy (if indicated);
• Examination for STIs, including human papillomavirus (if a concomitant infection is suspected).

After the examination, the doctor makes a final diagnosis and determines treatment tactics. If a decision is made to perform radiosurgical conization of the cervix, the following tests are prescribed:

• Survey smear on the flora;
• Bacteriological culture from the cervical canal.

These examinations can also be carried out at the stage of primary diagnosis to find the cause of erosion. Further additional tests are prescribed:

• Blood chemistry;
• General blood and urine tests;
• Coagulogram;
• Tests for infections (HIV, hepatitis, syphilis);
• Determination of blood group and Rh factor;
• ECG and consultation with a therapist.

Scheme of radioconization and the essence of the procedure

In most cases, the operation is performed under local anesthesia. For pain relief, an anesthetic injection is given into the cervix: 0.1% lidocaine along with adrenaline (to reduce bleeding). In special situations, the procedure can be performed under short-term anesthesia.

Radiosurgical conization of the cervix is ​​prescribed in the first middle of the cycle. It is optimal to perform the operation on days 5-7. If a woman's menstruation lasts about 6-7 days, the procedure is postponed to another time. There should be no menstrual flow on the day of surgery.

On a note

For postmenopausal women, conization is performed at any time.

Progress of the operation:

1. The patient is positioned on a gynecological chair;
2. The cervix is ​​exposed in the speculum, the instrument is fixed;
3. Vaginal discharge is removed with a cotton swab;
4. Colposcopy is performed: pathologically altered areas of the cervix are recorded, the conization zone is determined;
5. Local anesthesia is performed;
6. The electrodes are connected, the radio knife is prepared;
7. The pathological area is excised in a cone shape with a radio wave knife. During the operation, the doctor captures the changed tissue on the cervix and 1/3 or 2/3 of the cervical canal;
8. The removed tissue is grabbed with tweezers;
9. The resulting material is sent to the laboratory for histological examination;
10. Bleeding areas coagulate.

The whole procedure takes about 15-20 minutes. After radiosurgical conization, sutures are not placed on the cervix, since bleeding is stopped directly during the procedure. This reduces the recovery period and significantly reduces the risk of postoperative complications.

On a note

Reviews of radioconization indicate that most patients tolerate this procedure well.
o It is not painful, and all that the patient experiences during the operation is some discomfort in the lower abdomen (provided adequate anesthesia is provided). The cervix heals faster than with other treatment regimens, and after 4 weeks the woman can return to her usual lifestyle. In the first two weeks after the operation, there may be minor bloody discharge that does not cause significant discomfort. Complications after radiosurgical conization are quite rare.

To carry out radio wave treatment, a modern Surgitron device is used. With its help, not only conization is carried out, but also radio wave loop excision - capturing a small area of ​​the cervix with a thin wire loop.

On a note

There is a slight difference between the concepts of conization and excision. Usually we talk about excision (or cone excision) when it is necessary to remove a small section of the cervix along with the lower part of the cervical canal. In foreign literature, this procedure is called LEEP. The term "conization" is correct when half or 2/3 of the cervical canal is removed, and a radioknife is used for this procedure. The technique is similar, the only difference is in the tools used.

Photos of the cervix before and after radioconization can be seen below.

Advantages of using the Surgitron device:

• Low risk of developing inflammation and burns of the wound surface (tissue temperature at the incision site does not exceed 55 °C);


• All manipulations are carried out gently, effortlessly, which eliminates compression and displacement of tissues;
• Possibility of simultaneous tissue dissection and bleeding stop;
• The operation is performed in a “dry wound” without bleeding, which improves visualization of the pathological focus;
• Non-contact – low risk of infection;
• Possibility of targeted impact on the pathological focus - healthy tissues are not damaged;
• The procedure can be performed in close proximity to blood vessels and nerves.

As an alternative to Surgitron, the Fotek device can be used.

The cost of radiosurgical conization depends on the region and the status of the clinic. In Moscow, the price of the operation is 25-40 thousand rubles; in the regions the cost may be lower. If a radio wave machine is installed in the antenatal clinic, the procedure can be done free of charge under the compulsory medical insurance policy.

For a speedy recovery, a woman should follow some rules during the first month after the procedure:

• Sexual activity is prohibited until the mucous membrane of the cervix is ​​completely restored (an average of 4 weeks);
• It is not recommended to lift weights (more than 5 kg), engage in active sports, or physically overexert;
• It is forbidden to visit the swimming pool, bathhouse, sauna, or lie in a hot bath;
• You cannot use tampons or douche;
• You should not take any medications without a doctor's prescription.

On average, healing of the cervix occurs in 4-5 weeks. The cervix takes a long time to heal if a woman does not follow the doctor’s recommendations and violates the prescribed prohibitions.

Postoperative period: norm and pathology

In the first days after radio wave conization of the cervix, there is sanguineous discharge from the genital tract. Gradually, the volume of discharge decreases, and by the third week it completely disappears. A specific odor may appear from the discharge - not too strong, but unpleasant. By the end of the first month after surgery, all discharge should completely stop.

Nagging pain in the lower abdomen may occur directly during the procedure, as well as during the first week after surgery. The pain is mild, localized above the pubis in the center, and is not accompanied by a significant deterioration of the condition. If you don’t want to endure pain, you can take No-shpa or Nurofen (no more than 3 days in a row).

Radioconization of the cervix does not have a significant effect on the menstrual cycle, and most women have their periods on time. There may be a slight delay of up to 3-5 days. According to reviews, the first periods may be heavy and painful, but later the cycle is completely restored.

The general condition after surgery is usually satisfactory. Some women note an increase in body temperature to 37-37.5 °C. The temperature lasts no more than three days; antipyretics are not prescribed.

Moderate nagging pain in the lower abdomen, sanguineous vaginal discharge and a slight delay in menstruation are normal after conization.

Warning symptoms to look out for:

• Continuous or increasing bleeding from the genital tract (profuse, with clots);
• Severe pain in the lower abdomen;
• Increased body temperature more than 37.5 °C;
• The appearance of purulent discharge;
• Copious discharge with an unpleasant odor 3 weeks after surgery;
• Delay of menstruation for more than 7 days.

All these symptoms indicate the possible development of complications and require mandatory consultation with a doctor.

A follow-up examination by a doctor after conization is carried out after 2 weeks, colposcopy - after 4-6 months. If the examination results are good, the woman should visit the doctor every 6 months or more often if indicated.

Undesirable consequences and complications

Conization of the cervix using the radio wave method can lead to the development of the following complications:

• Bleeding is an extremely rare complication, since the vessels coagulate immediately after the incision (1-2% of cases);
• Wound infection – occurs when personal hygiene rules are not observed or in the presence of chronic cervicitis at the time of surgery (1-2%).

If for some reason conization was carried out repeatedly, the risk of the following complications increases:

• Scarring of the cervix;
• Cervical canal stenosis.

The use of modern techniques makes it possible to reduce the likelihood of such consequences to almost zero.

Pregnancy and childbirth after radioconization

Unlike other treatment methods, after radioconization, stenosis of the cervical canal does not occur and complications that can affect the course of pregnancy and childbirth do not develop. The cervix heals without scarring. The cervical canal remains patent and sperm can fertilize the egg without interference. After the therapy, a woman can conceive a child. It is recommended to plan pregnancy 2-3 months after surgery.

It is important to know

Properly performed radioconization does not interfere with conception, pregnancy, or natural childbirth.

Radioconization of the cervix does not affect the course of pregnancy and does not interfere with the development of the fetus. Since scars do not form on the cervix, the woman is not at risk of developing isthmic-cervical insufficiency. In the absence of other complications, a successful pregnancy and birth of a child is possible.

Childbirth after surgical treatment occurs without complications. A woman can safely give birth to a child through the vaginal birth canal. Radio wave treatment is a gentle method that does not have a negative effect on the cervix, does not interfere with its stretching during childbirth and does not interfere with the birth of the baby.

The successful course of pregnancy and childbirth largely depends on how the postoperative period went. If a woman followed all the doctor’s recommendations and was regularly observed by a gynecologist, she has a very high chance of experiencing all the joy of motherhood without significant problems and complications.

Interesting video about the benefits of radio wave conization

mioma911.ru

What is conization of the cervix

Conization involves removing pathological tissue of the cervix or cervical canal in the form of a cone-shaped fragment. The purpose of the operation is:

1. Achieving a therapeutic effect. Removing an area of ​​pathological epithelium prevents further development of the disease. Treatment of dysplasia or non-invasive cancer is considered complete as a result of removal of the tumor or problematic area of ​​the epithelium. Repeated conization is rarely used.
2. Diagnostic study. The tissue is removed and sent for histology - the study of the excised area of ​​​​the epithelium. Timely detection of malignant epithelial cells as a result of histological examination of biomaterial obtained through conization increases the patient’s chances of recovery. In such cases, further treatment is prescribed.

Indications

The decision on the need for surgical manipulation is made by the doctor based on an examination, colposcopy, and a smear examination for a PAP test. Indications for prescribing surgery are:

• positive result of a smear or biopsy of the cervix;
• pathologies of the mucous membranes of the cervical canal;
• the presence of cervical dysplasia of 3-4 degrees;
• cervical erosion;
• deformation of the cervix (cervical ruptures after childbirth, rough scars).

Contraindications

If inflammatory diseases or infections (gonorrhea, chlamydia, trichomoniasis) are detected in a woman’s body, surgical procedures are postponed until these ailments are completely cured. The patient is prescribed antibiotics, and after a successful course of treatment, surgery is performed. If there is histological confirmation of invasive cancer, the conization method is not used.

Procedure methods

Excision of the cervix to remove problematic mucosal cells, tumors, and polyps is carried out using the following methods:

• knife;
• radio wave (loop conization);
• laser conization.

Resection using a scalpel is almost never used due to the risk of complications after surgery. The most common method is radio wave. The advantages of this method are:

1. Minimally invasive intervention. Using an electrode, it is possible to completely remove the affected membrane of the cervix without affecting healthy tissue. The ability of the device to grind the surface after manipulation minimizes the risk of bleeding in the postoperative period.
2. Preservation of reproductive functions. Does not affect the ability to conceive and bear children, as it does not provoke tissue scarring.
3. Possibility of performing the procedure on an outpatient basis.

The latest development is the use of laser for surgical intervention. Method used:

• when the tumor spreads from the mucous membrane of the cervix to the vagina;
• with extensive lesions of dysplasia of the epithelial layer.

The disadvantage of the laser method is the high cost of the procedure. Not all clinics have expensive equipment; special training of staff is required to operate the device. The advantages of the method include:

1. High precision of manipulations. The equipment is the most effective; it can be used to perform gentle manipulations and avoid possible negative consequences - postoperative bleeding, severe tissue scarring.
2. Avoiding the development of infection after manipulation. The process is non-contact, without the use of tools, and the laser has the property of destroying pathogenic microflora.
3. No bleeding. Under the influence of the laser, coagulation of blood vessels occurs.
4. Preservation of a woman's reproductive function.

Preparation

Before the operation, the doctor prescribes the following diagnostic examination to the patient:

• general and biochemical blood test to determine the level of basic indicators and to establish the absence or presence of syphilis, HIV, hepatitis A and C;
• Analysis of urine;
• bacterioscopic analysis of smears for flora;
• biopsy;
• colposcopy (examination using a device that magnifies the examined surface by 40 times);
• PCR diagnostics (to detect the presence of infection in the body at an early stage, during the incubation period).

How is the operation performed?

With all methods used, surgery is performed immediately after the end of menstruation, but no later than the eleventh day from the start of menstruation. During this period, the possibility of the patient becoming pregnant is excluded. The almost complete absence of nerve endings in the epithelial layer makes the procedure less painful, but anesthesia is used in all cases.

Knife

Of the existing methods, this operation is the most traumatic, but it provides ideal biomaterial for research. Prescribed when it is impossible to use other methods. The cone of the cervix is ​​excised using this method using a scalpel, so the operation is accompanied by heavy bleeding and a long healing period. The surgical procedure is performed by a gynecologist in a hospital setting under general anesthesia or spinal anesthesia. The procedure lasts less than an hour. After the operation, the patient remains under doctor's supervision for 24 hours.

Laser

For surgical treatment of gynecological diseases, a laser with a diameter of 1 mm and 2-3 mm is used. The principle of their operation differs. A larger diameter (2-3 mm) is used to evaporate the affected tissue (vaporization). Under the influence of the energy of the gliding beam, only the cells of the upper layer of the epithelium evaporate, the lower ones are not affected, and a scab is formed. The procedure is carried out quickly, up to 7 minutes, but after it it is impossible to obtain a biopsy sample. Used to cauterize the cervix during erosion.

A thin high-frequency beam acts as a scalpel to excise the cone-shaped part in the affected area. In this case, the doctor receives material for research. Under the influence of the beam energy, coagulation of blood vessels occurs, and there is no bleeding. The use of a laser requires maximum immobilization of the patient, so the procedure is performed under general anesthesia, although it is considered painless.

Radio wave

Electroconization of the cervix for dysplasia and tumors is carried out using the Surgitron apparatus. The procedure is performed with an electrode that emits radio waves. In the photo it looks like a loop. Radioconization takes place under local anesthesia and takes 15-30 minutes. The loop is placed 3 mm above the affected area, the device is turned on, and the pathological area of ​​tissue is removed. The surgeon controls the actions using a colposcope. After the operation, the patient's condition was under the supervision of a doctor for 4 hours.

Healing period

The patient's recovery time after surgery depends on the chosen method. A short period of tissue healing (2-3 weeks) when using a laser or radio wave method. When performing manipulations with a scalpel, the postoperative period lasts longer. At this time, patients should exclude:

• taking baths (use only shower);
• physical activity (sports, lifting more than 3 kg);
• use of tampons, suppositories;
• sexual intercourse;
• douching;
• taking anticoagulants (Aspirin).

How does the scab come off after conization of the patient’s cervix? During the postoperative period, patients should not be bothered by nagging pain in the lower abdomen, reminiscent of sensations during menstruation. Moderate brown discharge after conization of the cervix is ​​also considered normal. Such manifestations indicate natural processes - the removal and removal of the scab from the body.

Treatment after conization of the cervix

To avoid complications in the postoperative period, patients are recommended to undergo treatment with antibiotics, drugs to strengthen the immune system, and a complex of vitamins. After two weeks, the doctor examines the patient and sets a date for taking a smear for cytological examination. After surgery, regular examinations are recommended for 5 years.

Complications

You should consult a doctor if alarming symptoms occur: intense pain in the lumbar region, itching, unpleasant odor of discharge, loss of appetite, fever. Such manifestations in the postoperative period indicate the addition of an infection and the need for therapy. If bleeding occurs, patients are given sutures or cauterized vessels.

Consequences

Advantageously, the use of laser eliminates negative effects in the postoperative period. Rarely, undesirable consequences are observed when using the radio wave method (endometriosis, bleeding, infection). The use of the knife method is associated with the risk of re-bleeding within 14 days after surgery.

Menstruation after surgery occurs at the usual time. Menstruation may be characterized by heavy discharge, the inclusion of blood clots, and a longer duration. Sometimes brown discharge is observed before the onset of menstruation. Such manifestations are considered normal in the postoperative period. Long periods (more than two weeks) should cause concern.

Childbirth after the procedure

Customer reviews after the operation are mostly positive. Doctors recommend that patients postpone pregnancy for two years after the procedure. Sometimes narrowing of the cervical canal complicates conception, but does not exclude it. When pregnancy occurs, gynecologists prevent the possibility of miscarriage by placing a suture on the uterus. Impaired cervical dilatation during labor due to scarring can be avoided by caesarean section.

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Indications for conization

Such surgical intervention is carried out in case of visible pathological changes in the tissues of the cervix, if grade 2-3 dysplasia of the cervical epithelium is detected in smear analysis. In addition, manipulations are performed in conditions such as:

• erosions and polyps of the cervix;
• leukoplakia;
• cicatricial deformities of the cervix;
• cervical eversion (ectropion);
• recurrence of cervical dysplasia;
• the presence of atypical cells in the smear.

Preparation

The operation is planned immediately after the end of menstruation (on the 1-2 “dry” day) due to the increased level of estrogen during this period, which promotes enhanced regeneration of the epithelium and rapid recovery. Before the procedure, the following diagnostic tests are prescribed::

• smear for cytology, microflora;
• general blood and urine tests;
• hemostasiogram (blood clotting test);
• colcoscopy (diagnostic examination of the vagina);
• fluorography;
• electrocardiogram;
• tissue biopsy;
• ultrasound examination (ultrasound) of the pelvic organs;
• testing for syphilis, HIV, hepatitis B, C;
• blood test to determine the group and Rh factor.

Kinds

With the development of medical technology, many new methods of conization surgery have emerged. Familiarize yourself with the main methods of performing this gynecological manipulation, their advantages and disadvantages:

How is the operation performed?

All conization techniques are carried out in stationary conditions. The duration of the manipulation ranges from 20 to 60 minutes, depending on the method used. The type of operation and the volume of necessary interventions are determined by the size and degree of dysplasia, the presence of concomitant pathologies, the age and condition of the patient. The procedure is carried out according to the following scheme:

1. The doctor removes the changed section of the cervical wall.
2. The extracted tissue is sent for pathohistological examination.
3. If the analysis excludes invasive cancer and the surface of the removed cone does not show signs of dysplastic changes, the disease is considered cured.
4. If there are indirect signs requiring removal of the dysplasia zone, the operation is considered a diagnostic step. At the same time, more radical treatment is planned.

Radio wave conization

Surgery is performed using coagulation of damaged tissues using directed high-frequency waves. Radioconization of the cervix is ​​considered the most gentle method of removing pathology; complications after the procedure are minimal. In addition, the operation is minimally traumatic, so the patient retains full reproductive function. The indications for radioconization are::

• erosion of the mucous membrane;
• dysplasia of the first and second degree;
• leukoplakia.

Laser

Conization of the cervix using a laser helps to precisely excise pathological areas of the mucous membrane. During the operation, the doctor can change and regulate the volume of tissue extracted (material for research). Among the negative consequences after using a laser are:

• burns on mucous tissue;
• high probability of relapse of pathology;
• formation of scars on the cervix.

The postoperative period after laser conization is accompanied by dark, scanty discharge that can last for 7-10 days, pain and general discomfort. Pregnancy after such an intervention proceeds, as a rule, favorably, the risk of premature birth or miscarriage is minimal. The main disadvantage of manipulation is its high cost.

Knife

This operation is performed using a scalpel. Knife manipulation is considered very traumatic, so it is rarely used today, only in cases where it is not possible to implement alternative methods of conization. The postoperative period after excision of tissue with a scalpel is long and painful. Possible complications include:

• excessive bleeding due to vascular damage;
• infection of the internal genital organs by pathogenic microorganisms;
• incomplete healing of the postoperative wound;
• formation of a rough connective tissue scar.

Loop

Diathermoconization or electroconization of the cervix for dysplasia and other pathological tissue changes is used very often. The manipulation is carried out with a special electrode in the form of a loop through which alternating current “flows”. Loop conization is prescribed in the following cases:

• in the presence of cysts, cervical polyps;
• for erosions;
• to eliminate scar deformities;
• with cervical eversion.

The loop conization technique is high-tech and helps to significantly reduce the risk of bleeding, scarring, and soft tissue damage. Biological material taken using an electric loop is not damaged, which facilitates more accurate histological examination. Diathermoconization of the cervix is ​​low cost.

Cryoconization

Surgical treatment during cryoconization is carried out using contact cooling substances under the influence of very low temperatures; pathological tissues are literally frozen. As a rule, liquid nitrogen, freon or carbon dioxide are used for this. The duration of the manipulations is about five minutes. Cryoconization is indicated for the following pathologies:

• minor erosions of the mucous membrane;
• small benign polyps (up to 1 cm);
• presence of scar deformities.

Postoperative period

In the first few days after surgery, the patient is often bothered by nagging pain in the lower abdomen. Treatment after conization of the cervix includes drug therapy:

• taking medications from the group of nonsteroidal anti-inflammatory drugs (NSAIDs), for example, Diclofenac, Ibuprofen;
• use of broad-spectrum antibiotics (Ampicillin, Ceftriaxone);
• washing with antiseptic agents (Miramistin, weak solution of acetic acid).

Until the scab leaves after conization of the cervix and complete healing of the tissue, the woman is prohibited from performing certain actions. She should not use hygienic tampons, vaginal suppositories and tablets, douche, visit the pool, bathhouse or sauna, or take a bath. In addition, it is important to limit physical activity, exposure to stress and nervous tension, and carefully observe personal hygiene. Unprotected sexual intercourse should be avoided for two to three weeks.

Consequences

Since the latest techniques and equipment are used during the operation, complications after the operation are very rare. Among the possible negative consequences of conization are:

• bacterial infections of the genital tract;
• heavy, prolonged bleeding;
• stenosis (pathological narrowing) of the cervical canal;
• premature birth, miscarriages;
• cicatricial deformation of the cervix;
• dizziness;
• endometriosis (inflammation of the lining of the uterus);
• inflammation of the vaginal mucosa;
• increased body temperature;
• isthmic-cervical insufficiency (premature dilatation) of the cervix;
• narrowing of the external os of the cervical canal.

The development of consequences after cervical conization surgery depends on the method of the procedure, the general health of the woman (presence of chronic pathologies, foci of infection in the body). Complications may appear in the early and late postoperative period. Long-term consequences include painful menstruation and miscarriage.

Menstruation after conization of the cervix

After conization, menstruation comes on time. Sometimes there may be a delay (1-3 days) due to the fact that a small crust forms on the mucous membrane - a scab. The first discharge after conization of the cervix is ​​longer, more abundant, dark in color and is accompanied by aching pain. The intensity of these characteristics depends on the individual characteristics of the woman’s health, the nature and scope of the intervention performed.

Normally, if all recommendations and prescriptions of the attending physician are followed, the menstrual cycle is quickly restored and all reproductive functions are preserved. If bleeding continues for more than 10-14 days, it is necessary to visit a gynecologist for an examination, diagnostic studies and determination of the required volume of treatment measures.

Recurrence of dysplasia

According to statistics, the effectiveness of conization as a method of eliminating dysplasia and preventing the development of cancer is low. In addition, there remains a high probability of relapse of the pathology and the development of a severe form of the disease, including oncology, which entails removal of the uterus. The reason for this phenomenon is the human papillomavirus (HPV) of the reproductive organs, which persists in the cells of epithelial tissue and continues to actively spread. After manipulation, relapse of dysplasia develops in 70% of cases.

If a histological examination after conization reveals cancer cells, the doctor immediately prescribes treatment (radiation therapy, chemotherapy). The operation can trigger the activation of pathological cells and the development of tumors. In some cases, to save a woman’s life (in the presence of metastases to the lymph nodes or other organs), it is necessary to remove all reproductive organs, nearby tissue and lymph nodes.

Pregnancy after conization

For nulliparous girls and women planning a second child, it is better to use alternative, more gentle methods of treating dysplasia. If surgery is necessary, less traumatic methods are used (laser or radio wave). To prevent inflammation, miscarriages, premature birth, after recovery you can plan to conceive no earlier than a year later.

The operation negatively affects a woman’s ability to bear a child. In some cases, when removing damaged tissue, a large area of ​​the cervical canal of the cervix is ​​excised, after which the structure is disrupted and the muscle layer is weakened. Under the weight of the fetus and amniotic fluid, the cervix can open much earlier than expected, provoking premature birth. To prevent this phenomenon, a special suture or ring is placed on the cervical canal. Surgeries performed on the cervix are indications for cesarean section.

Price

Conization can be performed on a woman free of charge under a compulsory or voluntary health insurance policy. If desired, the patient can go to a paid clinic to perform surgery, having previously read reviews of the work of its specialists. The cost of such an operation depends on the method of implementation and the need for additional instrumental studies. Check out the approximate price of conization in Moscow:

vrachmedik.ru

What is conization of the cervix?

This is a minimally invasive method for diagnosing and treating atypically changed cervical epithelium. Provided that the disease is diagnosed in a timely manner, the patient will have a high chance of recovery and preservation of reproductive function.

How is conization of the cervix performed? Manipulation is practiced in a hospital setting, and there is not always a need for the woman to be hospitalized. Since the surgical intervention is minimal and low-traumatic, many patients are discharged home on the day of surgery, or, in extreme cases, the next day.

The procedure can be carried out in several ways. The most modern and gentle methods are laser and radio wave methods.

Indications and contraindications

The list of main indications for cervical conization includes:

• Cervical dysplasia. A precancerous condition that requires mandatory treatment. The operation involves the capture of healthy tissue, since it is important to ensure that the focus of altered cellular structures after conization of the cervix is ​​completely destroyed. Surgical treatment of dysplasia is allowed at any stage of the disease. Conization of the cervix for grade 3 dysplasia should be performed on all patients without exception.
• Malignant changes in the upper epithelium of the cervix. It means a precancerous condition associated with the transition of last-degree dysplasia to oncology.
• Cystic and polypous formations that are localized inside the cervical canal.
• Pathological change in the epithelium with migration of atypical cells into the cervical canal. It is not a cancerous disease, but no doctor can guarantee its subsequent benignity. The most dangerous case is when pathological foci rapidly increase.
• Deformation of the cervix or the presence of scar changes on it that formed after birth tissue ruptures.
• Ectropion of the cervix, as a result of which the mucous membrane is turned inside the vagina.

Manipulation is contraindicated for invasive cervical cancer. The list of contraindications also includes sexually transmitted infections and exacerbation of chronic pathologies in the pelvic organs. In these cases, the procedure is postponed while you undergo treatment for these conditions.

Preparing for surgery

Any operation requires preliminary preparation. Before conization, a woman needs to undergo urine and blood tests, a biopsy of the tissues to be operated on, colposcopy, and a smear for microflora.

On what day is cervical conization done? The manipulation is carried out after the end of menstrual bleeding in the first phase of the cycle. Thanks to this approach, the wound surface that is formed during the operation will have time to heal before the next period. Before the operation, at least 8 hours before the operation, the woman is not recommended to eat.

The procedure can be performed using local or general anesthesia. The duration of the manipulation depends on the diagnosis. On average it lasts approximately 30 minutes.

Histology after conization of the cervix is ​​mandatory. The biopsy specimen is sent directly from the operating room to the laboratory for careful examination. If malignant cells are detected in it, the woman will be prescribed appropriate treatment after conization of the cervix.

Conization technique

The following treatment methods are available:

• laser;
• radio wave;
• loop;
• knife.

Laser conization cervix allows you to precisely excise damaged tissue. During laser surgery, specialists can change and adjust the previously assumed volumes of the biopsy or surgical field (material for research). Undesirable consequences after laser conization of the cervix are minimal. The postoperative period is accompanied by scanty discharge and general discomfort. Pregnancy after this type of intervention is quite possible, since this method has virtually no effect on the chances of becoming a mother. The main disadvantage of this manipulation is its cost.

Radio wave conization cervix is ​​carried out by coagulation of damaged tissues. That is, using radio waves aimed at altered tissues, their killing is achieved. Complications after radio wave conization of the cervix using the coagulation method are also minimal, and the risk of bleeding is reduced to zero. In this case, there is little trauma, so in most cases a woman does not lose the opportunity to become pregnant and give birth in the future.

Loop method considered the optimal choice. In terms of affordability, it is more attractive than laser treatment; in terms of technicality, it is performed at the same level. Rehabilitation after conization of the cervix using the loop method proceeds quickly and without problems - with virtually no pain or discharge. When manipulating the cervical tissue, an electrode loop is used, which accurately and accurately cuts off the damaged tissue of the cervical canal.

Knife method is already outdated and used very rarely. How is this type of cervical conization surgery performed? The doctor uses a surgical scalpel to excise the damaged tissue. The method is fraught with a long recovery period; the patient experiences significant discomfort in the form of pain and bleeding. The consequences of cervical conization in this case are often quite serious, including subsequent miscarriage and infertility.

Postoperative period

The next day after the intervention, the patient can be discharged. The exception applies to the knife method. If conization of the cervix is ​​performed using the radio wave method or laser, the patient is discharged on the day of surgery. But despite this, the woman will have to visit a specialist for further monitoring.

Patients are naturally interested in how the healing of the cervix proceeds after conization in the postoperative period.

Postoperative symptoms are as follows:

• abdominal pain;
• bleeding within 3 weeks after the procedure;
• spotting brown discharge for a month after surgery.

The healing period after conization of the cervix lasts up to 3 months. It all depends on the type of intervention and the characteristics of the patient’s body.

Discharge after conization of the cervix is ​​considered a natural phenomenon. During healing after the intervention, a so-called scab forms in the tissues, which begins to come out from the second week after the manipulation. From this moment on, the amount of discharge from the genital tract may increase.

Many patients claim that they felt the scab coming off after conization of the cervix, and even saw what it looked like, and after it, the discharge returned to normal in a short time. At the same time, other women who underwent surgery noted that they did not experience any special sensations when the scab passed away or increased discharge from the genital tract.

Causes for alarm may be increased temperature after conization of the cervix, general weakness and deterioration in well-being.

In order for the recovery period after the intervention to be successful, the patient must follow the following recommendations over the next 6 weeks:

• avoid sexual activity;
• refuse douching, baths and saunas;
• exclude physical activity, do not lift heavy things;
• do not use tampons;
• do not take drugs that increase bleeding.

Pregnancy after conization

Conception, carrying a baby and childbirth after conization of the cervix cannot be an exception. The main thing is to follow all the doctor’s recommendations during rehabilitation and the gestation period itself.

What features may occur during pregnancy and childbirth after conization of the cervix:

• For many women, the doctor places a suture on the cervix to prevent its early opening. This is explained by the fact that the consequence of conization of the cervix is ​​scar tissue changes, which causes the muscle tone of the organ to become weaker. As a result, cervical insufficiency may occur. This means that at any moment it can open and the pregnancy will be terminated. To avoid this, sutures are applied.
• Is it possible to give birth naturally after conization of the cervix? Most likely no. The previous operation is an indication for a cesarean section.
• During pregnancy, the patient must be under mandatory medical supervision.

Complications

Complications after conization of the cervix practically do not occur. This is due to the fact that nowadays the operation is carried out using modern methods and the latest equipment. But these factors cannot fully guarantee the absence of possible complications.

What may be the consequences after conization of the cervix:

• prolonged and heavy bleeding;
• infection of the genital organs;
• stenosis of the cervical canal;
• isthmic-cervical insufficiency of the cervix during pregnancy;
• spontaneous miscarriage or premature birth;
• cicatricial changes in the tissues of the reproductive organ.

Regardless of how cervical conization is done - knife or loop method, a scar almost always remains on the tissue. Normally, it should not bother the patient or cause her any discomfort in the future.

There are practically no negative consequences of laser and radio wave conization of the cervix; no traces are left on the cervix - the tissues heal quickly and easily. In this case, possible complications are minimized.

It is necessary to urgently seek medical help for the following conditions:

• discharge after conization of the cervix continues for more than 3 weeks and/or has acquired an unpleasant odor;
• strong pain sensations appeared in the lower abdomen that were not there before;
• body temperature above 38°C;
• bleeding appeared after conization of the cervix, and the woman does not know what to do.

For many patients, the operation became a successful step on the path to recovery and long-awaited motherhood. If there is a need for conization of the cervix, for example, with grade 3 dysplasia, there is no need to be afraid of the procedure. Modern treatment methods have made it possible to reduce possible risks to a minimum, and in exchange gain invaluable health.

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Indications for surgery

Conization is a procedure for removing a cone-shaped area of ​​the cervix and cervical canal, one of the methods of treating precancerous pathologies. You can see what tissues with atypical cells look like in the photo.

When surgery is required:

• the presence of pathological areas in the cervix;
• detection of atypical cells in a smear;
• with dysplasia of 2.3 degrees;
• erosions, polyps;
• leukoplakia;
• cervical inversion.

Conization is carried out to remove scars on the cervix after ruptures, injuries; surgery is necessary if, after treatment with cryodestruction and electrocoagulation, relapse of dysplasia is observed.

Preparation for conization surgery

Surgery is carried out 1–2 days after the complete completion of monthly discharge - in the first phase of the cycle, the level of estrogen increases, these hormones contribute to the rapid restoration and healing of the epithelium.

List of mandatory tests:

• clinical blood and urine analysis;
• tests for HIV, syphilis, hepatitis;
• determination of blood group, Rh factor;
• coagulogram;
• fluorography;

A month before the operation, a full gynecological examination, colposcopy, a smear for cytology and microflora, and an ultrasound of the pelvic organs are performed. If signs of infectious or inflammatory diseases are detected, anti-inflammatory therapy is carried out.

Types of conization of the cervix

With any surgical technique, the area of ​​the affected mucosa is cut out, while 5–7 cm of healthy tissue is captured. With economical conization (cone-shaped biopsy), the size of the removed area is 1–1.5 cm; with high conization, 65% or more of the length of the cervical canal is removed.

Knife

The operation is performed using a scalpel under general or epidural anesthesia; 40 years ago this method was considered the only way to remove damaged areas of the cervix. Now this method of intervention is rarely used due to the large number of complications - severe bleeding, scarring, tissue perforation.

The main indications are precancerous pathologies, malignant tumors at the initial stage of development, grade 3 dysplasia. Price – 4.5–5.5 thousand rubles.

How the operation works:

1. The affected areas of the epithelium are treated with iodine solution; areas with atypical cells acquire a whitish tint.
2. An extended colposcopy is performed.
3. The cervix is ​​fixed with forceps.
4. A cone-shaped area is excised with a scalpel.
5. The edges of the wound are coagulated to prevent severe bleeding.
6. Blood is removed with sterile cotton pads.
7. The duration of the operation is 20–30 minutes.

After the knife method, scars remain on the cervix, which prevent conception and normal childbearing, so the operation is performed on women who have already given birth.

Radio wave conization

Radio excision is carried out using a Surgitron or Fotek device, which acts on the affected tissue with a high-frequency radio wave knife; general or regional anesthesia is used for the operation. Price – 10–15 thousand rubles.

How the operation works:

1. The affected area is treated with a gel with an anesthetic effect.
2. The affected area of ​​the epithelium is isolated with iodine solution.
3. Speculums are inserted into the vagina, the cervix is ​​fixed, and mucus is removed from the cervical canal.
4. A conizer is inserted into the cervical canal, and the desired mode is selected on the device.
5. A circle is made with a radio knife and the excised mucosal tissue is removed.
6. The blood is removed, the edges of the wound are coagulated, and the tissue is sent to the laboratory for further study.
7. The duration of the operation is 15 minutes.

Radiosurgery is an effective and common way to treat dysplasia. Advantages - minimal risk of bleeding and damage to healthy tissue, minimal recovery period, complications rarely occur.

Laser conization

Excision of damaged tissue is carried out with a laser beam under local anesthesia. Price – 12–25 thousand rubles.

After anesthesia and treatment of the affected area with iodine solution, a colposcope with a laser is inserted into the uterine cavity. Under the influence of high temperatures, damaged tissue is quickly evaporated, the edges of the wound are soldered and polished. The duration of the operation is 15 minutes.

Loop electroconization

During the intervention, an electrode with a loop of different shapes is used, the operation is performed at stages 2, 3 of dysplasia under local anesthesia. The cost of the operation is 11–20 thousand rubles.

Stages of diathermoconization:

1. The cervix is ​​treated with Lugol's solution or iodine.
2. An extended colposcopy is performed and the shape of the loop is selected so that it covers the entire affected area.
3. The cervix is ​​fixed, and a passive electrode is placed under the patient’s buttocks.
4. The loop is twisted so that all tissues with pathological changes remain inside the circle; the number of turns depends on the degree of dysplasia and the size of the area with atypical cells.
5. The wound is coagulated.
6. The duration of the operation is 25 minutes.

With this method of conization, biological material can be obtained almost unchanged, which allows one to obtain the most accurate histological results.

Postoperative period

After conization, the patient is under medical supervision for 2–3 hours; if no complications are observed, the woman is sent home. The average duration of the recovery period is 1–3 months, the timing depends on the individual characteristics of the body, the initial size of the cone, the condition of the cervix, and the type of surgical intervention.

In the absence of complications, the healing process of the cervix occurs without any particular discomfort. After 7–10 days, the scab comes off, which closes the wound after cauterization of the vessels, and the process of restoration of the epithelium begins.

For several days after the operation, minor nagging pain is observed in the lower abdomen; vaginal spotting of a dark brown color does not always occur; it may disappear after a week, or continue until the next period. Active sex life after surgery, physical fatigue, taking Aspirin and other blood-thinning drugs can increase the intensity of bleeding.

What not to do for 1–2 months after surgery:

• have sex;
• lift weights more than 3 kg;
• perform douching;
• use sanitary tampons;
• visit the swimming pool, bathhouse, sauna;
• take a bath - you can only wash in the shower;
• overheating and hypothermia must be avoided.

Repeated cytology is performed 3–4 months after surgery, then every six months for 3 years. If atypical cells do not appear, complete recovery is diagnosed; a preventive examination by a gynecologist can be performed once a year.

Pregnancy after conization

It is advisable to plan a pregnancy after conization one year after the intervention; the operation rarely affects the ability to conceive; problems arise with extensive resection or recurrence of dysplasia.

Conization negatively affects pregnancy - after the operation, the structure of the cervix changes, it becomes less elastic and shortens. Women often experience miscarriage - the cervix cannot withstand increased loads and dilates prematurely.

Natural birth after conization is possible, but in practice, delivery almost always occurs by cesarean section, since doctors are afraid of incomplete dilatation of the uterus.

Possible consequences and complications

Negative consequences after conization occur in approximately 1–2% of women. Possible complications are bleeding, the development of an inflammatory process due to infection, scarring, endometriosis, and menstrual irregularities.

Contraindications to conization of the cervix

Conization allows you to get rid of dysplasia and prevent the development of severe pathologies, but the operation has a number of contraindications.

In what cases is the cervical cone not removed:

• the presence of foci of inflammation in the cervix, vagina;
• acute infectious pathologies;
• if it is impossible to clearly determine the boundaries of epithelial transformation;
• the area of ​​the affected epithelium is extensive;
• cardiac, renal, liver failure, hypertension;
• diabetes;
• poor blood clotting.

Conization is prescribed to remove the affected cone-shaped area of ​​the cervix. The removed tissues must be examined for the presence of cancer cells. After the procedure, the woman is regularly observed by the attending physician for 2 weeks. Radio wave conization of the cervix is ​​performed using surgitron, a radio wave surgical generator.

When is the procedure scheduled?

Radio wave conization is exposure to electrodes with high-frequency electrical discharges. It differs from conventional electrocoagulation in that it has higher frequencies of current supply, prevents burns of nearby tissues, and reduces the time of exposure to the organ.

This procedure is indicated for patients who are suspected of developing grade 2 or 3 hyperplasia, the growth of cancer cells both inside and outside the cervix. For timely detection of pathological processes, it is recommended to visit a gynecologist annually for a standard examination.

Indications for radio wave conization:

1. Leukoplakia – keratinization of the mucous membrane.
2. Formation of polyps in the cervical area.
3. Erosive changes.
4. The presence of atypical cells in the smear.
5. Ectropion is an eversion of the mucous membrane into the vaginal area.
6. The presence of scars that appeared after various medical interventions, childbirth with ruptures, deformities.
7. After a morphological examination, dysplasia of 2 and 3 degrees was detected.
8. The presence of deeply altered areas of the epithelium, usually detected by colposcopy.
9. Relapse of dysplasia that occurred after laser vaporization or electrocoagulation.

The most common reason for this is the development of dysplasia. This disease is accompanied by damage to the mucous membrane and deeper layers of the cervix. The procedure is indicated for grade 2 dysplasia.

Contraindications

Contraindications include infectious diseases of the genitourinary system. Before conization, it is necessary to carry out a range of tests that will confirm or exclude an infectious component. In case of a positive result, antibacterial treatment is first carried out, then a repeat colposcopy. The possibility of safe conization is confirmed.