• Optimization of management tactics for patients with complicated cervical ectopy

Optimization of management tactics for patients with complicated cervical ectopy

HEALTH OF WOMAN. 2017.3(119):86–91; doi 10.15574/HW.2017.119.86

Pyrohova V. I., Mazur Yu. Yu., Shurpyak S. A.
Lviv national medical University named Danylo Galitsky

Preservation of a significant frequency of cervical pathology and a tendency to long-term recurrent course, the possibility of malignant transformation predetermine the urgency of finding effective methods of treatment.

The objective: develop and evaluate the effectiveness of managing algorithm for patients with complicated form of cervical ectopy.

Patients and methods. Was carried comprehensive examination and treatment of 68 women aged 18–35 years with cervical ectopy.Were performed pelvic organs ultrasound, simple and advanced colposcopy, investigation of thyroid function, D-status, hormonal balance, vaginal microbiota, cytological examination of cervical smears. By blind method, depending on treatment method patients were divided into two groups of 34 women. Patients of the main group underwent systemic correction of D-deficiency, dyshormonal disorders by Epigalin 1 capsule three times a day, Aquadetrim at a dose of 3000 MО/day and topical application of Depantol suppositories (twice a day for 10 days before and 10 days after intervention, starting from 5 days), in the group of comparison, examination and management of patients were carried out according to the current recommendations of Ukraine Ministry of Health.

Results. After 10-day course of systemic and topical therapy by Depantol in the main group we observed a reduction in the frequency of endocervicitis from 41.2% to 5.9%, an increase of vagina normocenosis percentage from 8.8% to 88.2% with normalization of the cytological pattern – an increase in the percentage of I type of Pap smear from 29.4% to 94.1%; visually and with colposcopy, healing of cervical ectopia (first detected) was found in 40.0% of women at 25.0% in the comparison group.

Conclusion. Complex pre- and postoperative therapy with topical application of Depantol in patients with cervical ectopy allows to achieve a stable correction of dysbiotic disorders due to a decrease in bacterial contamination, qualitative and quantitative changes in microflora, and an increase in the number of endogenous lactobacilli. Normalization of hormonal homeostasis, correction of D-status due to the synergistic effect of Epigaline, Aquadetrim allows to increase the effectiveness of topical therapeutic measures, which allows reducing the time of cervix epithelization, to reduce frequency of complications after destruction and to reduce the frequency of recurrences of cervical ectopy. The management of patients with cervical ectopy based on the proposed diagnostic treatment measures aimed correction of the microflora of the vaginal biotope, activation of immunity, normalization of the hormonal balance, enhancement of the reparative processes of the cervix and helps to improve the effectiveness of treatment for both newly diagnosed and complicated forms of cervical ectopy from 84.0% to 95.5%, reduces need in lesion destruction.

Key words: cervical ectopy, radio wave destruction, Depantol, Epigaline, vitamin D deficiency.

REFERENCES

1. Hvorostuhina NF, Miheeva YuV, Novichkov DA i dr. 2014. Analiz prichin retsidivirovaniya ektopii sheyki matki posle koagulyatsii. Fundamentalnyie issledovaniya 10(3):562–566.

2. Badretdinova FF, Kortunova VV. 2015. Reproduktivnaya funktsiya zhenschin posle destruktivnyih operatsiy na sheyke matki. Akusherstvo, ginekologiya i reproduktsiya 1:54–58.

3. Burtushkina NK, Kupert AF. 2011. Effektivnost radiovolnovogo metoda lecheniya dobrokachestvennyih zabolevaniy sheyki matki. Sibirskiy meditsinskiy zhurnal 2:74–76.

4. Vaganova SE. 2010. Kombinirovannoe lechenie dobrokachestvennyih zabolevaniy sheyki matki. Akusherstvo i ginekologiya 5:116–120.

5. Kulavskiy VA, Nasyirova SF. 2000. Psevdoeroziya sheyki matki u nerozhavshih zhenschin (klinika, diagnostika, lechenie). Ufa:153.

6. Miheeva YuV, Hvorostuhina NF, Novichkov DA. 2016. Sovremennyiy podhod k lecheniyu oslozhnennoy ektopii sheyki matki. Akusherstvo, ginekologiya i reproduktsiya 2:24–31.

7. Prilepskaya VN. 2008. Patologiya sheyki matki i genitalnyie infektsii. M, MEDpress-inform:385.

8. Rogovskaya SI, Terebneva LA, Podzolkova NM. 2014. Kompleksnaya terapiya zabolevaniy sheyki matki s primeneniem preparatov depantol i lavomaks. Akusherstvo i ginekologiya 10:95–103.

9. Rogovskaya SI. 2014. Mikrobiotsenoz vlagalischa i tservikalnaya patologiya. Consilium Medicum. 16(6):51–55.

10. Hwang LY, Ma Y, Shiboski SC et al. 2012. Active squamous metaplasia of the cervical epitheliumis associated with subsequent acquisition of human papillomavirus 16 infection among healthy young women. J. Infect. Dis. 206(4):504–11. https://doi.org/10.1093/infdis/jis398; PMid:22696500 PMCid:PMC3491738

11. Walker P et al. 2003. International terminology of colposcopy: an updated report from the International Federation for cervical pathology and colposcopy. Obstet. Gynecol. 101(1):1775–1777. https://doi.org/10.1097/00006250-200301000-00032; https://doi.org/10.1016/S0029-7844(02)02581-4

12. Tempera G, Furneri PM. 2010. Management of aerobic vaginitis. Gynecol. Obstet. Invest. 70;4:244–249. https://doi.org/10.1159/000314013; PMid:21051843