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This is achieved by the excision or ablation of the squamous-cylindrical area up to the healthy tissue. In the case of persistence of high-grade lesions after repeated excision and if the patient does not want to preserve fertility, hysterectomy may be indicated.

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This is a surgical procedure that can be indicated for benign gynaecological pathology, preinvasive cervical neoplasia and stage IA1 of cervical cancer.

Conization was the surgical choice in patients with cervical intraepithelial neoplasia, under 35 years of age, who wanted to conserve fertility and did not have other gynaecological lesions. Hysterectomy was the surgical treatment in patients over 35 years of age, with finished pregnancy planning and associated uterine pathology to intraepithelial cervical neoplasia. Keywords management of cervical intraepithelial neoplasia, conservative treatment, radical treatment Rezumat Tratamentul neoplaziei intraepiteliale cervicale vizează eli­mi­­na­rea zonei de joncţiune, inclusiv a ţesuturilor anor­ma­­le.

Acest lucru se realizează prin excizia sau ablaţia zo­nei scuamo-cilindrice până la ţesutul sănătos. În cazul per­sis­ten­ţei leziunilor de grad înalt după excizie repetată şi în cazul în care pacienta nu doreşte să îşi prezerve fertilitatea, poate fi indicată histerectomia.

Dysplasie cervicale CIN1

Aceasta este o procedură chirurgicală care poa­te fi indicată pentru patologia ginecologică benignă, neo­pla­zia cervicală preinvazivă şi pentru stadiul IA1 al cancerulului de col uterin. Obiectivul studiului a fost selectarea pacientelor în funcţie de managementul neoplaziei intraepiteliale cer­vi­­ca­­­le, luând în considerare gradul leziunii cervicale, zona de extensie, vârsta pacientelor şi dorinţa de menţinere a fer­ti­­li­tă­ţii, precum şi patologia asociată cu leziunile cervicale.

Co­ni­za­ţia a fost procedura chirurgicală selectată la pacientele cu neoplazie intraepitelială cervicală, sub 35 de ani, care au dorit să-şi prezerve fertilitatea şi nu au avut alte leziuni gi­ne­­co­logice. Histerectomia a fost tratamentul chirurgical la pa­­cien­­te­le cu vârsta de peste 35 de ani, fără dorinţă de pro­creare şi patologie uterină asociată cu neoplazia cervicală intra­epi­te­lială. Cuvinte cheie managementul neoplaziei intraepiteliale cervicale tratament conservativ tratament radical Introduction The treatment of cervical intraepithelial neoplasia aims at removing the junction area, including abnormal tissues.

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Ablation procedures — electrofulguration, cryosurgery, carbon dioxide laser — are an effective therapeutic way for non-invasive lesions, but they destroy tissues and cannot perform a proper histological assessment. It is absolutely necessary to exclude papillomavirus laser ou conisation possibility of neoplasia by cytological, colposcopic and histological examinations before applying ablative procedures. Excision is a surgical procedure that allows the complete histological papillomavirus laser ou conisation of the piece, having both diagnostic and therapeutic character.

It is indicated for patients with suspected invasive cancer lesions and endocervical adenocarcinoma, high-grade lesion in cytology, unsatisfactory colposcopy and cervical intraepithelial neoplasia CIN diagnosed at the fragmentary biopsy, requiring treatment, and for patients with recurrent papillomavirus laser ou conisation glandular cell cytology AGC of recurrent high-grade CIN.

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The patients with recurrent CIN have an increased risk for occult invasive cancer 1. The excision procedures cancerul pulmonar este transmisibil with electric loop LEEP, conization — increase the risk of complications, affecting the papillomavirus laser ou conisation capacity: cervical canal stenosis, cervico-ischemic incompetence, premature birth, premature rupture of membranes 2.

The patients with an interval of less than months between conization and pregnancy are at risk of premature birth 3.

Corelaţii clinice şi paraclinice în managementul neoplaziei intraepiteliale cervicale

The association with premature birth is uncertain, a number of studies demonstrating an increase in risk, while other studies did not support this hypothesis On this basis, the treatment is preferred for the eradication of high-grade injuries. In the case of persistence of high-grade lesions after repeated excisions and if the patient does not want to preserve fertility, hysterectomy may be indicated. Simple hysterectomy involves the removal of the papillomavirus laser ou conisation and cervix, but does not involve the excision of parameters and paracolpos.

It is a surgical procedure that can be indicated for benign gynaecological pathology, preinvasive cervical neoplasia and stage IA1 of cervical cancer. Adenocarcinoma in situ is diagnosed at younger ages The therapeutic objective is to excise all affected tissues after eliminating the diagnosis of invasiveness. It is indicated the cold scalpel conization to keep the edges and to facilitate the histological interpretation.

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Hysterectomy is indicated after the maternity is ended 12, Method The study papillomavirus laser ou conisation conducted on a total of 44 patients, between January and May The patients were aged between 21 and 50 years old, and they were divided into two groups: years old and years old. Patients came in for routine gynaecological examination, persistent leucorrhoea or minimal vaginal bleeding after local washing or sexual intercourse.

The objective gynaecological examination revealed the shape and consistency of the cervix, the presence or absence of macroscopically visible exocervical lesions.

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Investigations such as cervico-vaginal cytology, HPV testing and genotyping, colposcopy and fragmentary biopsy or conization were performed to determine the papillomavirus laser ou conisation of cervical lesions.

Detailed anamnesis, gynaecological clinical examination, biopsy curettage and ultrasound revealed in 17 patients uterine-associated lesions such as uterine fibromatosis and endometrial hyperplasia. The histopathological diagnosis was based on tissue fragments obtained by biopsy or cervical conization and endouterine fractionated curettage. The treatment of cervical intraepithelial neoplasia was established according to the conditions, indications and contraindications, and consisted in conization or hysterectomy.

Table 1.

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Table 2. The distribution of patients by the results of the cervical-vaginal cytology test Figure 1. Figures 2 and 3.

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Table 3. The treatment of these patients was total hysterectomy to achieve the excision of the cervical lesions and the uterine pathological body.

Under these circumstances, cervical lesion has priority in setting the therapeutic decision, and not the age or the preservation of fertility. These patients were predominantly under the age of 35 or wanted to maintain fertility, papillomavirus laser ou conisation they had conservative treatment.

Table 4. The distribution of patients by the results of histopathological examinations Discussion The surgical treatment in patients younger than 35 years old who wanted to conserve fertility benefited from conization, both as a biopsy method and as a treatment, although conization increases the risk of adverse effects on the reproductive function.

Post-surgical monitoring is required. Patients with CIN and negative resection margins are monitored by cytology examination once every 6 months until two consecutive negative results are obtained and then routinely supervised; one can test the presence of HPV DNA between 6 and 12 months after the treatment followed by colposcopy if HPV DNA is detected, because it is a marker of papillomavirus laser ou conisation persistence of the disease The cytological screening is recommended to be performed for at least 20 papillomavirus laser ou conisation because there is an increased risk of cervical neoplasia after the diagnosis of high-grade CIN.

If the excision margins are positive for CIN 2 or CIN 3, cytology and biopsy are recommended between 4 and 6 months Although hysterectomy is an unacceptable procedure for CIN 1, 2 and 3 18 lesions, the surgical treatment of patients over 35 years of age who had uterine polifibromatosis, endometrial hyperplasia and who had completed pregnancy planning after making biopsies and establishing the diagnosis benefited from hysterectomy.

Figure 5.

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Under these circumstances, there is a risk for a local recurrence, and for this reason monitoring by cytological screening of the vagina is required Conclusions The decision on the management of cervical intraepithelial neoplasia took into account the degree of cervical lesion, the extent papillomavirus laser ou conisation the surface, the age of the patients, and the desire for maternity, as well as the pathology associated with the cervical lesions.

Conization was the surgical choice in patients with cervical intraepithelial neoplasia, under 35 years of age, who wanted to conserve fertility and did not have other papillomavirus laser ou conisation injuries. Hysterectomy was the papillomavirus laser ou conisation treatment in patients over 35 years of age, with finished pregnancy planning and uterine pathology associated to intraepithelial cervical neoplasia.

Se pare ca varicele de col uterin

Conflict of interests: The authors declare no conflict of interests. Pattern of treatment failure following laser for cervical intraepithelial neoplasia: implications for follow-up protocol. Obstet Gynecol. Am J Obstet Gynecol.

Încărcat de

Time from cervical conization to pregnancy and preterm birth. Loop electrosurgical excision procedure and the risk for preterm birth. Obstetrics outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Treatment for cervical intraepithelial neoplasia and risk for preterm delivery.

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The effect of loop electrosurgical excision procedure on future pregnancy outcome. Loop electrosurgical excision procedure and risk of preterm birth.

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American College of Obstetricians and Gynecologists. Cervical cancer in adolescents: screening, evaluation and management. Committee opinion NoAugust a. Correlation between preoperative diagnosis and histopathological changes in preneoplastic cervical lesions.

Dragosloveanu C, Vlădăreanu R. Cervical adenocarcinoma in situ: a systematic review of therapeutic options and predictors of persistent or recurrent disease.

Obstet Gynecol Surv. Management and follow-up of patients with adenocarcinoma in situ of the uterine cervix. Gynecol Oncol. The importance of primary screening in early detection of cervical dysplastic lesions. Bălulescu I, Badea M. Interobserver variability in the interpretation of cervical smears, a must for developing an internal laboratory quality control system. Papillomavirus laser ou conisation cytology screening.

Practice Bulletin. DecemberNo.

Clinical and paraclinical correlations in the management of cervical intraepithelial neoplasia

Wright TC Jr. Cervical cancer screening in the 21st century: is it time to retire the Pap smear? Clin Obstet Gynecol. American Cancer Society guideline for the early detection of cervical neoplasia and cancer.

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