Operation gynecological radio wave of the cervix. Conization of the cervix - what kind of operation is it, indications, preparation and types, consequences and recovery. What not to do after conization of the cervix

Cervical conization is a gentle and less invasive treatment for women's diseases. The pathological process in the genital area is not always amenable to therapeutic treatment.

In these cases, surgical manipulations on the organ are required to remove altered tissues and prevent the progression of the pathological process. Such a modern method is conization of the cervix, which is carried out through the vagina.

What is cervical conization surgery?

This is a cone-shaped removal of affected tissue from the cervical part of the organ and the cervical canal. The pathological focus is operated on with the inclusion of healthy tissue.

The operation of conization of the cervix allows you to effectively treat the pathology of the mucous membrane, while maintaining the possibility of pregnancy and bearing a healthy child.

In order for the outcome of the intervention to be positive, the patient must be aware of what a cone resection is on the genitals of a woman, and how it is performed. The operation takes place under local anesthesia and with a minimum of time.

Conization is performed on an inpatient basis, but hospitalization is not always necessary. A few hours later, after resection and examination by the attending physician, the patient is allowed to go home.

When is conization scheduled?

The following indications are relevant for conization of the cervix:

• dysplasia- this is a pathological change in the structure of a tissue site of an organ, which refers to precancerous diseases, and requires mandatory treatment. Surgical treatment is necessary at any stage of pathology development. Conization of the cervix with grade 3 dysplasia is a mandatory surgical intervention;
• the presence of abnormal cells in the upper epithelial layer of an organ tissue area (in cancer);
• polyps and cysts inside the cervical canal;
• scarring due to medical manipulations or ruptures during childbirth;
• migration of abnormal cells into the cervical canal, especially with a rapidly growing pathological focus;
• ectropion, leukoplakia of the body;
• cervical erosion, which, with various methods of treatment, does not give a positive result and progresses

The purpose of the operation

The main goal is to remove the affected tissue. However, during conization, pathological material of sufficient volume can be sent for histological examination. The laboratory determines the cause and gives a conclusion about the presence of an oncological disease or a chronic infection.

That is, the purpose of this manipulation is both therapeutic and diagnostic measures.

Conducting re-conization of the cervix is ​​rare, but can be carried out with a relapse after previous treatment of the pathological focus.

Preparing for the operation

Conization of the organ is carried out 3-5 days after menstruation. This is the optimal time for the body to recover before the next cycle and the absence of pregnancy is guaranteed.

A month before the conization, the preparation of the patient begins, when it is necessary to take the necessary tests and conduct the following studies:

• colposcopy of the cervical uterus;
• analysis of smears from the vagina and cervix for the presence of microflora and atypical cells;
• ultrasound examination of the pelvic organs;
• ECG of the heart;
• fluorography of the lungs;
• blood for hemoglobin, leukocytosis, ESR;
• blood for clotting;
• blood to determine the group and Rh factor;
• blood biochemistry for hepatitis;
• blood for AIDS and syphilis;
• urine for general analysis.

What are the types of conization?

Depending on the type of pathological process, age and individual characteristics of the patient, conization is done by various methods. What kind of surgery to perform, only the doctor decides.

There are several instrumental approaches for the operation:

• Loop technique- this is the most common way to remove pathological formations on the organ, which is carried out using a cone-shaped loop and a device for diathermocoagulation.
• Knife technique is conization with a scalpel, which is currently not used due to numerous complications.

Electroconization

• Electroconization of the cervix with dysplasia of any degree, it allows you to remove the pathological focus and stop the further development of the negative process;
• Electrodiathermoconization of the cervix can be in the form of a deep procedure, using triangular nozzles;
• diathermoelectroconization carried out using nozzles of shorter length, from one to three centimeters. It is important that when carrying out this method, there is no further gross deformation of the tissue, and the operation does not have a negative effect on the childbearing function of a woman.

Laser conization of the cervix

When using a laser technique, the impact on the pathology occurs with a laser beam. Carrying out laser conization of the cervix gives a minimum of postoperative complications, and the ability to regulate the amount of material taken for examination.

This method of conization has practically no effect on planning the possibility of conceiving and bearing a child.

• Radio wave technique It is aimed at destroying a pathologically altered part of an organ by exposing tissue cells to high-frequency alternating current. In this case, for radio wave conization of the cervix, surgeons use the Surgitron apparatus with a set of various electrodes. The value of the technique lies in the fact that during tissue dissection, coagulation of blood vessels occurs, which reduces the possibility of postoperative bleeding.
• Radioconization of the cervix provides an accurate impact on the pathological focus in the organ. The method is characterized by low pain and fast recovery after surgery. Complications, in the form of infection of the wound, are rare.
• Radiosurgical conization eliminates burns and destruction of healthy tissue. After manipulations, the function for childbearing is completely preserved.

cryoconization

Cryoconization is the use of liquid nitrogen to destroy the pathology of an organ by freezing. The method is relatively inexpensive and painless, since anesthesia of the organ occurs under the action of nitric oxide.

Now this type of operation is not used, since there is no possibility of an accurate calculation of the power of the effect of the freezing factor on the pathology. In addition, there is no possibility for histological examination of the site of the affected tissue of the organ.

How is conization performed?

The presence of modern methods of carrying out therapeutic and diagnostic manipulations on the reproductive organs of a woman makes it possible to perform an operation on the uterus in the shortest possible time. The operation is performed in a day hospital.

No special preparation is required before manipulation. Recommended shaving of pubic hair, bowel and bladder emptying. Conization is carried out in the morning on an empty stomach. How quickly the operation takes place depends on the type of technique chosen by the doctor.

Basically, the resection lasts about half an hour.

Surgery is performed on a gynecological chair under local anesthesia with the use of sedatives or under short-term intravenous anesthesia.

The operation begins with a visual examination on the mirrors of the neck with its treatment with Lugol's solution or acetic acid.

The pathological segment, after applying one or another solution, changes its color.

After the tests, the organ is infiltrated with novocaine or lidocaine, followed by conization of the affected tissue area, about 5 mm thick.

The early postoperative period lasts two hours, during which the patient must be in a day hospital. After this time, the woman is released home.

After operation

Conization does not have a negative impact on the health of a woman, since modern equipment used for manipulation makes it quick and less painful.

Basically, the recovery period after conization proceeds without complications. Minor pains in the lower abdomen and discharge persist, lasting up to three weeks. The nature of the secret may be bloody or brown.

During the recovery period, treatment after conization of the cervix is ​​mainly symptomatic.

After resection, a scab forms on the organ, which begins to be torn off and comes out in the second week after the operation. During this time, the amount of discharge may increase.

Main restrictions

In order for the postoperative period of conization of the cervix to go smoothly and without any complications in the patient's condition, she must follow certain rules that imply restrictions for six weeks:

• peace in intimate life;
• pool exclusion, saunas, baths and baths;
• weight lifting restriction up to three kilograms;
• exclusion of tampons from use in personal hygiene;
• withdrawal from the use of drugs blood thinners (aspirin).

If, after conization, a temperature appears or the general condition worsens, this is an indication for an immediate consultation with a doctor.

How does the neck heal?

Healing after conization of the cervix, if the recovery period goes smoothly, occurs quite quickly. Within one and a half to two weeks, the scab leaves, after which the wound epithelizes. Complete healing occurs within three to four months.

During this period, it is necessary to visit a doctor who will give recommendations on what the patient should know about her body after conization and how the cervix is ​​healing.

These may be the following manifestations:

• increased amount of bleeding for more than four weeks;
• burning and itching in the vulva;
• soreness in the abdomen after a quiet period;
• resumption of allocations after their termination.

During this period, therapeutic measures are not carried out, but according to indications, taking into account the type of operation performed, candles or douching may be prescribed by the doctor.

How does the scab come off after conization?

After resection, a crust forms on the wound surface, which is a layer of dead cells.

What does a scab look like?

It can be grayish or yellow in color and has a soft texture. The discharge of the scab in most women goes unnoticed.

The crust covering the wound protects it from the penetration of pathogenic microbes. Under it, a new layer of epithelial cells is formed, during the formation of which, the scab begins to move away. On average, its rejection begins to occur on the 5th or 7th day after conization.

In this case, the type of surgical intervention plays a role, when the term for the discharge of the crust can increase up to 7-10 days and the possibility of an increase in the volume of bleeding.

Possible Complications

Complications after conization of the cervix are rare, but possible.

It can be:

• prolonged and heavy bleeding;
• inflammatory processes in the genital area;
• cicatricial changes;
• cervical organ failure during pregnancy;
• endometriosis.

Childbirth after conization of the cervix may be premature due to disorders in the organ, that is, in the weakness of its muscular layer.

Growing pregnancy, putting pressure on the incompetent cervical organ, is the cause of fetal prolapse and premature opening of the birth canal.

In rare cases, in the postoperative period, stenosis of the cervical canal develops, which leads to the impossibility of conception. Therefore, women planning a pregnancy are not recommended to carry out conization before conception, but to treat the disease conservatively.

Bleeding after conization

Uterine bleeding, as a consequence of conization of the cervix, is rare, only in 2% of cases, since the operation takes place in tissues in a place where large vessels do not anatomically pass.

The cause of this complication may be technical errors during the operation, as well as a violation of the cycle of menstruation. If there is damage to the vessel, then the help of a doctor and the use of hemostatic agents are required.

Allocations

The organ can bleed for a long time, even up to four months. Healing occurs naturally, so this process cannot be accelerated. Allocations after conization of the cervix appear immediately after surgery.

After a week - one and a half, when the scab begins to depart, the discharge is more than normal and may stop seven days after the discharge of the scab, and may persist for a month after the operation. Sometimes the operated uterus releases blood for up to three to four months.

Pain in the postoperative period

Recovery after conization proceeds with a slight pain syndrome, which is localized in the lower abdomen and is similar in nature to pain on critical days.

This is a normal recovery process after surgery and does not cause any special sensations of discomfort. The doctor, in this case, may prescribe painkillers.

The stomach stops hurting a few days after the resection. But if the pain becomes more intense, a mandatory consultation with a doctor is necessary.

Pregnancy after conization

The availability of modern equipment allows for surgical intervention with minimal complications. For patients planning cervical conization and pregnancy, resection is carried out using the most minimally invasive techniques, that is, radio wave or laser.

Pregnancy after conization generally proceeds normally. If there is postoperative insufficiency of the cervical canal, it is easily corrected by applying an obstetric pessary to the organ.

It consists of rings made of silicone or plastic, interconnected and having three sizes, which are installed at 20 and removed at 38 weeks.

Pregnancy after conization of the cervix is ​​successfully carried out, and the child is born naturally.

Restoration of the menstrual cycle

Surgery does not affect the menstrual cycle. Menstruation after conization of the cervix comes at the right time, but plentifully. In some cases, iron preparations are prescribed by the doctor to compensate for blood loss.

The risk of bleeding is associated with hormonal changes in the body caused by the operation, but their regularity is preserved.

Full recovery of the organ after surgery takes three to four months, so the abundance of discharge during this period is functional and does not require specific treatment.

In some cases, if hemoglobin falls and the color of the blood changes, symptomatic treatment is carried out.

Therefore, pregnancy after conization occurs after its final recovery. Violation of the hormonal background with a pathological change in the menstrual cycle is observed in 20% of cases. In this case, such a contingent of patients needs medical therapy prescribed by a doctor.

Childbirth after conization of the cervix can be natural or by caesarean section. Cone resection has no effect on the development of the baby.

The tactics of conducting childbirth depends on the size of the postoperative scar on the organ:

• If the seam is small, then under the strict supervision of a doctor, a woman gives birth herself or with the help of forceps.
• If there is a large scar may allow a caesarean section.

But in any case, pregnancy and successful delivery after resection are possible both first and subsequent.

Operation cost

The cost of laser or radio wave conization of the cervix in the same city, depending on the clinic, modern equipment and qualifications of doctors, will be different. Moscow differs from the medical services provided from other cities.

The cost of the operation in the capital will be from 40 to 50 thousand rubles , and in the regions from 8 to 15 thousand rubles.

Suspicion of cervical dysplasia is a serious situation that requires prompt resolution. After all, the dysplastic process is considered a harbinger of cancer. The standard in such cases is cervical conization - the surgical removal of a cone-shaped fragment of the mucosa for subsequent histological examination. In addition to diagnostics, excision of pathologically altered tissues solves the therapeutic problem.

Where to do conization of the cervix in Moscow?

The ART programs that our center specializes in are a science-intensive field of medicine. All gynecological operations in the Life Line are carried out using high technologies in accordance with current international standards.

• The decision on the need for conization is made by an experienced gynecologist on an individual basis, based on the results of a comprehensive examination.
• The operation is performed by doctors with many years of experience in gynecological surgery, who regularly improve their level at conferences, workshops and seminars
• Qualified observation after conization reduces the risk of negative consequences to zero
  

Indications

The most common reason for prescribing conization of the cervix is ​​the detection of dysplasia. The goal is to study the obtained biomaterial for the presence of malignant processes and the removal of dysplasia as such. In some cases, excision of the mucosal area affected by the dysplastic process is sufficient for treatment.

Less commonly, surgery is prescribed for the treatment of cervical erosion, removal of:

• adhesions that violate the patency of the cervical canal;
• polyps, cystic formations;
• scar tissue formed after a complicated birth or abortion.

Contraindications: inflammatory processes in the acute stage (when the inflammation is cured, the issue of conization rises again), cervical cancer, pregnancy.

Cervical conization - methods

The operation has long been introduced into gynecological practice. The traditional method of carrying out is "knife" conization, when the altered tissues are removed with a conventional scalpel. This outdated technology is now little used due to the high risk of complications and long recovery times.

Laser and radio wave methods meet modern standards.

• Conization of the cervix with a laser. The specialist outlines the area with the changed mucosa with a laser beam, capturing a couple of millimeters of healthy tissue. At the same time, the edges of the intervention zone are cauterized. Laser conization takes a minimum of time, does not lead to bleeding and pain. Complications are practically excluded.
• Radio wave conization. Excision is made by tissue destruction using high-frequency alternating current. Radioconization is carried out using special equipment - an electric generator and a set of electrodes. The advantage of the technique is the accuracy of the impact. Bleeding during radio wave surgery is extremely rare, pain is short-lived and mild.

The Life Line Reproduction Center practices laser conization of the cervix. The choice of this method is due to the fact that it is less traumatic and is easily tolerated by patients. The high precision of excision is ensured by a modern laser device and the skill of our gynecological surgeons.

Preparation and holding

The operation is always preceded by an examination. It is necessary to make sure that conization is necessary and to identify contraindications, if any.

The preliminary examination includes:

• examination of the patient by a gynecologist;
• flora research;
• pap smear;
• blood tests (for infections, general, biochemical);
• PCR diagnostics;
• colposcopy.

The exact list of necessary diagnostic measures, the patient receives from the doctor. The studies are carried out in the own laboratory of the Line of Life, hence the high accuracy and promptness of the results.

Conization is preferably done immediately after menstruation, on the 5th-6th day of the cycle. How to prepare for it? The only recommendation is not to eat 8 hours before the intervention.

How is cervical conization performed?

The manipulation takes about 15 minutes, takes place transvaginally, with general or local anesthesia. First, the doctor inserts a dilator into the patient's vagina to gain access to the cervix. The next step is the removal of a cone-shaped fragment of the epithelium with a surgical laser. The affected area is removed at one time and sent to our laboratory for histological examination.

When the procedure is completed, the patient remains in the clinic for a few more hours under the supervision of staff. Then we let her go home.

Postoperative period

After laser conization of the cervix, women do not experience pain, except for mild discomfort. Rehabilitation outpatient. If the operation was performed with a laser or radio wave method, the likelihood of complications is minimal. In case of acute pain, severe uterine bleeding or high fever, you should immediately seek medical help.

It takes about a month for the cervix to heal completely. For this period, you need to take a break in sexual activity, cancel trips to the bath, sauna, swimming pool. Another rule of rehabilitation is the limitation of physical activity.

Pregnancy after conization of the cervix

« Will I be able to conceive and give birth after the operation?» - this is, perhaps, the most frequent question of the Life Line patients before conization. Answerpositive.

The intervention, if it was carried out by a laser or radio wave method, practically does not affect the ability to conceive. But you can plan a baby only 12 months after the procedure, not earlier. Before conception, expectant mothers with a history of conization are recommended to undergo a more thorough examination.

Conization can reduce the elasticity of the uterus. This is associated with a slight increase in the risk of complications during the bearing of the baby. Therefore, it is recommended to entrust the management of pregnancy to an experienced obstetrician-gynecologist.

In the Life Line Reproduction Center, conization of the cervix is ​​performed using the latest laser equipment. The likelihood of recurrence and the risk of complications are minimal. You can make an appointment with a gynecologist by phone or by sending an application through the website.

Conization of the cervix- is very popular today among the number of gynecological manipulations. It is the removal of the affected fragment of the cervical canal, sometimes with the capture of the neck itself.

The operation received its own term, thanks to the form in which the tissue section is excised, visually resembles a cone. This surgery means a very short and minimally traumatic intervention, which can also be carried out under stationary conditions.

Indications for conization of the cervix

Conization of the uterine cervix is ​​carried out with such pathologies as:

Types of conization

Medical gynecological practice today has several methods of conization.

knife

This method of surgical manipulation is currently used quite often.

Characteristics of knife conization:

1. Its strict indication is the presence of abnormal growth and formation of cervical tissues.
2. We will apply this method also for amputation of polyps, cysts and other neoplasms, including oncological ones.
3. Knife conization of the uterine neck is used in situations where other methods of resection are not acceptable. This method is quite serious. There must be an urgent reason for doing so.
4. The conization method is not recommended for women who wish to have children in the future. A likely consequence of the intervention is compression of the cervical canal. This indicates that it will become very difficult for a woman to become pregnant.

laser

Features of laser conization:

1. A similar method of conization of the uterine cervix means the use of a new word in gynecological medicine - a laser.
2. By means of a laser, doctors have the opportunity to amputate the affected part of the cervical canal as accurately and cleanly as possible.
3. During excision, doctors have the ability to adjust and change the initially planned volumes of the biopsy specimen (biomaterial for study).
4. The consequences of this intervention are reduced to zero. The postoperative time is characterized by not so long painful manifestations and the presence of minor bleeding.

The ability to become pregnant and bear a fetus using this method is much improved in comparison with the knife method.

The most basic and perhaps the only disadvantage of laser excision is the cost of the operation. This expensive method becomes unacceptable for many women.

Radio wave (loop)

Preparation and conduct of the operation:

1. There is a list of mandatory requirements for conducting a loop study. They are necessary for a complete study of the patient's condition. This list opens with a smear test for microflora and pathogens. Radio wave surgery makes it possible to eliminate any processes of deviation or neoplasm in the uterine cervix.
2. The duration of the surgical procedure is no more than 15 minutes. Despite the fact that with regards to time, the section seems simple, in fact it is a very complicated operation.
3. The surgical procedure is carried out on specific days of the menstrual cycle.
4. Radio wave conization implies a direct effect on the pathological localization of the electric current. Under its action, atypical cells begin to die.
5. Recovery time is approximately 2-3 weeks. During healing, you can not wash in the bath, exercise and exclude sexual intercourse.

Apparatus Surgitron

At present, most of the operations are performed using the apparatus Surgitron:

cryoconization

Surgery is performed using contact substances under the influence of low temperatures, often liquid gases - nitrogen, freon or carbon dioxide. The duration of cryoapplication is approximately 4 minutes. This method is applicable for not so significant background tissue transformations.

Advantages:

• A small area of ​​tissue necrosis
• Minor traumatization of adjacent tissues,
• The non-occurrence of scars
• The painlessness of the manipulation itself.

Contraindications to the procedure

The procedure is contraindicated in:

After that, a therapeutic course is carried out to eliminate an infectious lesion or inflammation of the female reproductive organs. As usual, the therapeutic course is presented in the application of appropriate antibiotic sensitization, anti-inflammatory treatment.

cervical conization surgery

Training

The preparation of the patient is a comprehensive examination in the hospital:

Operation progress

Typically, the manipulation takes about half an hour. Taking into account the method of operation and the condition of the patient, general, short-acting parenteral anesthesia or local anesthesia is used.

The operation is carried out:

What can not be done after the operation?

Postoperative period

Rehabilitation after surgery, in any individual case, is different, as is the healing period for conization of the cervix - everything depends on the way in which the removal of the affected parts of the mucous membrane was carried out.

Knife conization

radio wave conization

Laser conization

1. The return of the integrity of the cervix is ​​expected after a month.
2. In the course of 10-15 days, serous hemorrhages will be released, this is absolutely normal.
3. Spontaneous bleeding may occur during the postoperative time.

1. Complete healing of the wound occurs after about a month.
2. In the initial days after the operation, a sufficiently large amount of bloody discharge can be detected, in particular, if the area of ​​​​removal was large and curettage was performed.

How does healing take place?

This question worries no less than the question of the intervention itself. Following how the conization is performed, the postoperative period in different patients may vary, albeit slightly.

It all depends on the neck itself, the volume of the excised fragment, and other nuances of the operation process:

Relapses after cauterization of the cervix

Despite the fact that the amount of return of abnormal growth and development of tissues becomes less after a hysterectomy, it is believed that in such situations it is necessary to take smears for examination from time to time.

The occurrence of relapses of oncology of the uterine cervix in situ after conization and laboratory study of standard fragments of the removed material of the uterine cervix, which is performed in order to be able to control the usefulness of the excision, is 1.2%. The frequency of episodes of growth into invasive cancer is 2.1%.

There is a danger of a recurrence of pathology in a situation of technical complexity of conization, which occurs due to some specific structural features of the cervix.

During the manipulation itself, it is not easy for the surgeon to determine the depth of the excision, and thus unnecessarily large parts of a healthy organ can be captured.

In some cases, in nulliparous women, the doctor removes a very small amount of the affected cervix, which can lead to the return of abnormal growth and development of the tissues of the excised organ.

And yet, the main fear for many patients with problems in the uterine cervix is ​​the fear of surgery and the possible complications that affect the woman's reproductive function.

In what cases should you immediately contact a doctor?

You need to see a doctor immediately if:

For most patients, this surgery was a successful milestone on the way to recovery and desired motherhood.

When there is a need to perform conization of the cervix, for example, with improper growth and formation of cervical tissue of the 3rd degree, the procedure should not be feared.

Existing methods of treatment ensured that the probable risks were reduced to zero, and, as a result, the ability to motherhood was achieved.

Complications and consequences

Postoperative complications almost never occur. This becomes possible due to the fact that at present the operation is carried out with the use of high technologies and modern medicines.

However, these conditions are not able to fully guarantee the non-occurrence of complications in the patient.

Presumptive manifestations after cervical conization:

• long and large amount of bleeding;
• infection of the pelvic organs;
• compression of the cervical passage;
• insufficiency of cervical tone during the period of bearing a child;
• miscarriage or early delivery;
• scar tissue of the neck.

Having nothing to do with how the conization of the cervix is ​​​​carried out - with a knife or loop method, a seal almost always occurs on the tissues. In a normal state, it does not cause concern to a woman and cannot cause difficulties in the future.

Conization and pregnancy

Is it possible to give birth after conization of the cervix?

The assumption of a complete loss of the ability to become pregnant is definitely not true.

All that is required is to postpone conception, childbearing and childbirth for a year or a couple of years.

The probability of fertilization decreases due to the narrowness of the cervix or cervical canal. However, transformation due to deviation or non-excised tissue could make the canal narrower at times.

Informative history of conization is necessarily reflected in the medical documents of the expectant mother. There is still a risk of premature delivery due to the fact that the cervix is ​​not able to withstand the pressure of the weight of the burdened uterus.

When the doctor suspects such a threat, the imposition of retaining sutures can help. They are removed before delivery itself. In some cases, you need to do a caesarean section.

Operation cost

In pricing, the method of conization becomes a decisive factor.

Cost varies by area from 10 to 40 thousand rubles.

Content

Excision or conization of the cervix is ​​an operative intervention that refers to minor surgery in the field of gynecology. The procedure consists in extracting or destroying a cone-shaped area from part of the cervical canal and cervix. Manipulation is one of the main methods of treating precancerous pathologies. Histology after conization of the cervix is ​​one of the most informative methods for diagnosing the presence of oncology of the reproductive organs.

Indications for conization

Such a surgical intervention is performed with visible pathological changes in the tissues on the neck, when dysplasia of the cervical epithelium of 2-3 degrees is detected in the analysis of smears. In addition, manipulations are performed under such conditions as:

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

Training

The operation is planned immediately after the end of menstruation (for 1-2 "dry" days) due to the increased level of estrogen during this period, which contributes to enhanced regeneration of the epithelium and rapid recovery. Before the procedure, the following diagnostic studies are prescribed:

• a smear for cytology, microflora;
• general blood and urine tests;
• hemostasiogram (blood clotting test);
• colposcopy (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 appeared. Check out the main ways to carry out this gynecological manipulation, their advantages and disadvantages:

How is the operation

All conization techniques are carried out in stationary conditions. The duration of the manipulation is from 20 to 60 minutes, depending on the method used. The type of operation, 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 part of the cervical wall.
2. The extracted tissue is sent for histopathological 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 that require removal of the dysplasia zone, the operation is considered a diagnostic stage. At the same time, more radical treatment is planned.

radio wave conization

Surgical intervention is carried out using coagulation of damaged tissues with 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, there is a low invasiveness of the operation, so the patient retains her reproductive function in full. The indications for radioconization are:

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

laser

Conization of the cervix with a laser helps to precisely excise the pathological zones of the mucous membrane. During the operation, the doctor can change and regulate the amount of tissue removed (material for research). Among the negative consequences after the use of a laser are:

• burns on mucous tissue;
• high probability of recurrence of pathology;
• formation of scars on the neck.

The postoperative period after laser conization is accompanied by dark scanty discharge, which 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 with a scalpel. Knife manipulation is considered very traumatic, therefore, it is rarely used today., only in cases where it is not possible to implement alternative methods of conization. The postoperative period after tissue excision with a scalpel is long and painful. Possible complications include:

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

Loopback

Diathermoconization or electroconization of the cervix with dysplasia and other pathological changes in tissues is used very often. 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;
• with erosion;
• to eliminate cicatricial deformities;
• at cervical eversion.

The loop conization technique is high-tech, helps to significantly reduce the risk of bleeding and scarring, and soft tissue damage. The biological material taken with the electric loop is not damaged, which contributes to a more accurate histological examination. Diathermoconization of the cervix is ​​inexpensive.

cryoconization

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

• minor erosion of the mucous membrane;
• benign polyps of small size (up to 1 cm);
• the presence of cicatricial deformities.

Postoperative period

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

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

Before the discharge of the scab after conization of the cervix and complete healing of tissues, a woman is forbidden to perform certain actions. She can not use hygienic tampons, vaginal suppositories and tablets, douching, go to the pool, bath or sauna, take a bath. In addition, it is important to limit physical activity, exposure to stress and nervous strain, and carefully observe personal hygiene. Unprotected sex should be avoided for two to three weeks.

Effects

Since the operation uses the latest techniques and equipment, 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, miscarriage;
• cicatricial deformity of the cervix;
• dizziness;
• endometriosis (inflammation of the lining of the uterus);
• inflammation of the mucous membrane of the vagina;
• increase in body temperature;
• isthmic-cervical insufficiency (premature opening) of the neck;
• narrowing of the external os of the cervical canal.

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

Menstruation after conization of the cervix

After conization, menstruation comes at the appointed time. Sometimes there may be a delay (for 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, plentiful, dark in color and accompanied by aching pains. The intensity of these characteristics depends on the individual characteristics of the woman's health, the nature and extent of the intervention.

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

Dysplasia recurrence

According to statistics, the effectiveness of conization as a method of eliminating dysplasia and preventing the development of cancer is low. In addition, there is a high probability of recurrence of the pathology and the development of a severe form of the disease up to oncology, which entails the removal of the uterus. The reason for this phenomenon is the human papillomavirus (HPV) of the reproductive organs, which remains in the cells of the epithelial tissue and continues to actively spread. After manipulation, recurrence 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 provoke the activation of pathological cells and the development of tumors. In some cases, to save the life of a woman (in the presence of metastases to the lymph nodes or other organs), it is necessary to remove all the reproductive organs, nearby fiber 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 an operation is necessary, less traumatic methods (laser or radio wave) are used. To prevent inflammation, miscarriage, premature birth, after recovery, conception can be planned no earlier than a year later.

The operation negatively affects the ability of a woman to bear a child. In some cases, when damaged tissues are removed, a large area of ​​the cervical canal is excised, after which the structure is disturbed and the muscle layer is weakened. Under the weight of the fetus, amniotic fluid, the cervix can open much earlier than the due date, provoking premature birth. To prevent this phenomenon, a special suture or ring is placed on the cervical canal. Operations performed on the cervix are an indication for a caesarean section.

Price

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

Video

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

Conization of the cervix is ​​an operation that belongs to a low-surgical technique in gynecology. It consists in removing a cone-shaped area from the cervix and part of the cervical canal, hence the name of the operation. Conization is one of the methods of treatment of background and precancerous diseases of the cervix.

When is conization indicated?

Conization is carried out with visible pathological areas on the cervix, as well as when dysplasia of the cervical epithelium is detected in smears that are taken from women annually at medical examinations.

The main conditions in which conization is carried out:

• The presence of zones of altered epithelium during colposcopy.
• Identification of atypical cells in smears.
• Dysplasia of 2-3 degrees according to the results of a morphological study.
• erosion.
• Leukoplakia.
• Ectropion (eversion).
• Polyps of the cervix.
• Cicatricial deformities of the cervix after ruptures, injuries, previous manipulations on the cervix.
• Recurrence of dysplasia after electrocoagulation, laser vaporization, cryodestruction.

Nevertheless, the main reason why a woman is sent for conization is a cytological or histologically detected cervical dysplasia. Dysplasia is a violation of the normal differentiation of layers of stratified epithelium. It is believed that dysplasia in most cases turns into cancer. In other classifications (especially abroad), you can find the term "cervical intraepithelial neoplasia" (CIN), in which there are three degrees. Conization is performed mainly in CIN II.

The purpose of the operation

Therefore, the main goal of the conization operation is the removal of areas in which the mechanism of cancerous degeneration of cells has already been launched and the prevention of the development of cervical cancer. The operation performs two tasks: diagnosis and treatment.

1. A section of the mucosa with pathological changes within the unchanged tissue is removed (healthy tissue is captured within 5-7 mm).
2. The removed part of the cervix is ​​sent for histopathological examination.
3. If the study excludes invasive cancer, and the edges of the removed cone do not contain dysplastic changes, the pathology is considered radically cured.
4. If during the study there are doubts about the incomplete removal of the dysplasia zone or the presence of invasive cancer, conization is considered a diagnostic step. In this case, another more radical treatment is planned.

Preparing for the operation

Conization is planned immediately after the completion of the next menstruation (for 1-2 dry days). This is done because in the first phase of the cycle, the level of estrogens rises, which contribute to the proliferation (enhanced recovery) of the epithelium and the speedy healing.

You need to prepare in advance. When planning the operation, a gynecological examination, colposcopy are performed at least a month in advance, smears are taken for microflora, for cytology.

Perhaps an ultrasound of the pelvic organs and lymph nodes will be prescribed. If necessary, the doctor may take a biopsy from the most suspicious area.

If an inflammatory process is detected in the vagina, appropriate anti-inflammatory treatment is carried out until normal smear results are obtained.

2 weeks before the proposed operation, tests are prescribed:

• General blood and urine tests.
• Blood for syphilis.
• Antibodies to HIV, viral hepatitis B, C.
• Hemostasiogram.
• Determination of blood group and Rh factor.
• Fluorography (within a year).
• Electrocardiogram.
• Therapist's review.

No conization:

1. In the presence of an inflammatory process in the vagina and cervix.
2. For biopsy-proven invasive cancer.
3. With acute infectious diseases.
4. With poorly defined boundaries of the transformation of the epithelium.
5. If the boundaries of the pathology go beyond the technical possibilities of treatment.
6. With decompensation of chronic diseases (heart failure, hypertension, diabetes mellitus, renal and hepatic insufficiency).
7. Violation of blood clotting.

What are the types of conization

Conizations are classified according to the physical factor by which the area of ​​tissue is removed:

• Knife.
• Laser.
• Cryoconization.
• Electroconization.

By volume they distinguish:

1. Economical conization (cone-shaped biopsy) - the size of the removed area is not more than 1-1.5 cm.
2. High conization - with the removal of 2/3 or more of the length of the cervical canal.

Knife conization of the cervix

A section of the cervix is ​​cut out with an ordinary scalpel. Until the 80s of the last century, knife conization was the main method for obtaining diagnostic material when detecting atypia in smears.

Currently performed very rarely due to the high complication rate.(bleeding, perforation, formation of rough scars after surgery). Complications after knife conization are noted in 10% of cases (with other more modern methods - in 1-2%).

However, it is knife conization that makes it possible to obtain a preparation for research of better quality than with laser or electric wave removal. Therefore, this type of conization is still used in a number of clinics.

Laser conization of the cervix

The desired area is removed by exposure to a high-intensity laser beam. The operation is low-traumatic, almost bloodless and painless.

Benefits of laser conization:

Flaws:

1. There is a risk of burning surrounding healthy tissue.
2. In most cases, general anesthesia is required for maximum immobilization (the patient should not move).
3. The method is quite expensive.

Radio wave conization of the cervix

Other terms: electroconization, electric wave conization, diathermoelectroconization.

For these purposes, the apparatus of radio wave surgery "Surgitron" is used. It is an electric generator and a set of various electrodes.

Tissue destruction is achieved by exposure to high-frequency alternating current.

An even more advanced method of radio wave conization is radiosurgical loop excision.

radio wave conization of the cervix

The desired area is cut out with a loop electrode specially designed for this purpose.

The doctor selects an electrode with a loop of the desired size (the area to be removed should be 3-4 mm larger than the size of the pathological focus). A high-frequency current is applied to the electrode. By rotating the loop electrode in a circle, a section of the neck is cut to a depth of 5-8 mm.

Advantages of the method:

• Can be performed under local anesthesia.
• Damaged blood vessels are immediately coagulated - the risk of bleeding is minimal.
• The temperature in the destruction zone does not exceed 45-55 degrees. There is no risk of burning surrounding healthy tissue.
• Allows you to take a piece of tissue for examination less damaged than with the laser method.
• Very low complication rate.

To date, this method of conization is the most common.

Video: radio wave conization of the cervix

cryoconization

By exposure to the freezing action of nitric oxide, the pathological focus is destroyed. The method is painless and relatively inexpensive. In our country, at present, it is practically not used. It is believed that it is not always possible to accurately calculate the power of the freezing factor, and the main goal of conization is also not fulfilled - there is no tissue area left that can be examined.

How is conization surgery performed?

This operation does not require long-term hospitalization. It can be carried out in a day hospital or a one-day hospital.

The whole operation takes no more than 20 minutes.

After operation

After the conization, the patient stays in the ward for about 2 hours, then she can go home.

As a rule, aching pains in the lower abdomen (similar to menstruation) are noted for several days. Everyone will have vaginal discharge after this procedure. But the number and timing of them may be different. Abundant bleeding should not be. Usually it is a clear serous discharge mixed with blood, or light brown, or smearing. The discharge may have an unpleasant odor.

For some, the cessation of discharge is noted after a week, for some it continues until the next menstruation. Your first period after surgery may be heavier than usual.

Main restrictions

The cervix after conization is an open wound. Therefore, as with the healing of any wound, it is necessary to minimize the impact on it. Namely:

• Do not have vaginal intercourse for a month.
• Do not use vaginal tampons.
• Do not take a bath (wash in the shower).
• Do not lift weights over 3 kg.
• Banya and sauna are excluded.
• Don't swim.
• Avoid overheating.
• Do not take drugs that prevent blood clotting (aspirin).

How does the neck heal

With an uncomplicated postoperative course, the healing of the cervix occurs quite quickly. Approximately on the 7-10th day, the scab that covers the wound leaves after the coagulation of the vessels, and the epithelialization of the wound begins. Complete healing occurs by 3-4 months.

Usually at this time, a second examination by a gynecologist is carried out. If a woman doubts that something is going wrong, she should see a doctor earlier. Usually these points are always discussed, and the patient knows about suspicious symptom X:

1. Profuse bleeding, as during menstruation
2. Increase in body temperature.
3. Continued discharge for more than 4 weeks or no decrease in discharge by 3 weeks.
4. Burning and itching in the vagina.
5. The appearance of pain in the lower abdomen some time after the operation (pain for several days immediately after conization is normal).
6. The appearance of secretions after the "dry" period.

As a rule, no additional effects on the neck are required during this period. But in some cases, douching or suppositories may be prescribed.

A smear for cytology should be taken 3-4 months after the operation and subsequently every six months for 3 years. If atypical cells are not detected, after 3 years, you can undergo a regular check-up once a year.

Possible Complications

Complications with modern types of conization are observed quite rarely (in 1-2%).

• Bleeding.
• Attachment of infection with the development of inflammation.
• Cicatricial deformity of the cervix.
• Miscarriage (spontaneous abortion and premature birth).
• Endometriosis.
• Violation of the menstrual cycle.

Pregnancy after conization

With various pathological processes in the cervix in nulliparous women, or in women who are planning a second pregnancy, the most sparing methods should be chosen, if possible without disturbing the structure of the cervix (erosion coagulation, polypectomy).

But if stage 2-3 dysplasia is histologically confirmed, conization is still inevitable in this case. At the same time, modern methods are selected (laser and radio wave conization), the risk of complications in which is minimal.

It is advisable to plan a pregnancy after conization no earlier than one year after the operation.

As a rule, conization does not affect the ability to conceive. But sometimes in cases of too extensive resection of tissues, repeated conizations, complicated course, narrowing of the cervical canal due to the development of adhesions is possible. Then the process of fertilization will be difficult.

But the consequences of conization can have a negative impact on the normal bearing of pregnancy and natural childbirth much more often than on conception. This is explained by the fact that the operation still somewhat changes the structure of the cervix, it can be shortened, its elasticity may decrease. Therefore, women who have undergone conization may experience miscarriage to the full term: the cervix simply cannot withstand the load, it may open prematurely.

Vaginal delivery in women who have undergone conization is possible. But doctors must be completely sure that the cervix is ​​sufficiently elastic. In practice, delivery in such women is almost always carried out using a caesarean flow. Obstetricians are afraid of inadequate disclosure of the cervix during childbirth.