Precancerous diseases of the female genital area. Malignant tumors of the external genital organs. Informative video: Fibromyoma - tumor of the uterus

Malignant diseases, as a rule, are preceded by pathological processes against which they arise. Timely diagnosis of precancerous diseases, their treatment are effective for cancer prevention. The basis of precancer is morphological changes, but when taking anamnesis and examination, it is necessary to take into account the clinical manifestations and the nature of the development of the disease.

Precancerous diseases of the vulva and vagina

The disease occurs most often in menopause and is characterized by gradually developing atrophy of the skin, mucosa, and subcutaneous tissue of the vulva. Kraurosis and leukoplakia are based on complex metabolic and neuroendocrine processes.

Crowrose. Pronounced atrophic processes are noted. Gradually, the skin of the labia wrinkles, atrophy of the mucosa occurs, the entrance to the vagina narrows. The process is accompanied by persistent itching, urination is difficult, sexual activity is impossible.

Leukoplakia. In this disease, dystrophic changes in the mucosa are accompanied by keratinization of the epithelium, which is manifested by the appearance of dry white plaques of various sizes in the area of the external genital organs. In addition to the vulva, leukoplakia can be localized on the mucous membrane of the vagina and cervix. The combination of kraurosis and leukoplakia requires increased attention and timely complex treatment, since there is a high risk of malignancy. Examination of patients includes mandatory colposcopy and biopsy.

Treatment patients should be complex, use general strengthening therapy, a sparing diet, sedatives, topical application of estrogen-containing ointments, novocaine blockades, a helium-neon laser, symptomatic therapy, etc. In the absence of the effect of the treatment, they resort to surgical treatment.

Background diseases of the cervix

Background diseases include true erosion, pseudo-erosion, ectropion, leukoplakia.

true erosion

This is a condition of the cervix in which part of the stratified squamous epithelium is missing. Erosion occurs against the background of traumatic and inflammatory effects on the cervix (radiation therapy, traumatic gynecological examination, colpitis). True erosion is a short process, after 5-10 days it turns into pseudo-erosion due to the cylindrical epithelium "creeping out" of the cervical canal and covering the surface of true erosion.

pseudo-erosion

It can exist for a long time - for years, it supports the inflammatory process in the cervix due to infection of the erosive glands. If left untreated, basal cell hyperactivity appears on the erosive surface, which is sometimes complicated by atypia, which makes it possible to attribute long-term pseudo-erosion to precancer.

Clinical manifestations of erosions and pseudo-erosions are uncharacteristic, the diagnosis is made during examination followed by additional research methods - colposcopy, biopsy.

Erosion treatment is mandatory. When choosing methods of treatment, it is necessary to take into account age, prescription of erosion, the presence or absence of childbirth in history. Conservative methods of treatment are used in nulliparous, with "fresh" erosions. As therapeutic measures, it is proposed to sanitize the vagina, use ointment tampons with anti-inflammatory and regenerating properties (sea buckthorn oil, fish oil, antibacterial emulsions). In the absence of the effect of conservative therapy, with long-term erosion, with erosion in those giving birth, surgical methods are the method of choice. The essence of surgical methods is reduced to the destruction of pathological substrates of pseudo-erosion, followed by their rejection. Then the former pseudo-erosion surface is regenerated.

Surgical methods:

diathermocoagulation. The technique and techniques of this procedure have been developed for a long time and are widely used. The efficiency of the method is about 70%. Negative sides - cicatricial deformity of the cervix with deep coagulation, menstrual irregularities, the risk of endometriosis. The method is not used in nulliparous;
cryotherapy(cryodestruction with liquid nitrogen). In recent years, it has occupied a prominent place in the treatment of pseudo-erosions. The advantages of this method are manifold: painlessness of the intervention, its bloodless nature, no risk of scar tissue formation, rapid epithelialization of the surface of the cervix after rejection of necrotic pseudo-erosion tissue. The method can be applied to nulliparous;
laser therapy. It is currently widely used for the treatment of pseudo-erosions. Laser radiation has a stimulating effect on regeneration processes in the absence of the risk of tissue scarring. Epithelialization occurs quickly on the 10-20th day after the procedure.

All three methods are used after extended colposcopy and biopsy to exclude the processes of severe dysplasia. After applying these methods, women are under careful dispensary observation.

Ectropion

Eversion of the mucous membrane of the cervical canal on the vaginal part of the cervix. Most often, these are the consequences of ruptures of the circular muscle fibers of the cervix. The cause of ruptures can be childbirth, traumatic expansion of the cervical canal of the cervix during abortion, diagnostic curettage of the uterine mucosa. In fact, ectropion is a combination of pseudo-erosion with cicatricial deformity of the cervix. After examination, the patient choose one or another method of surgical treatment. It is necessary to take into account age, the state of reproductive function and the degree of deformation of the cervix.

Leukoplakia of the cervix

It has no symptoms and is detected when examining the cervix with the help of mirrors. White spots are visible, which are local processes of keratinization of the stratified squamous epithelium. The cause may be immune disorders, dyshormonal changes and inflammatory processes. After the examination, individually selected treatment is carried out, which depends on the age, reproductive function of the patient. With simple leukoplakia in young women, cryodestruction and laser vaporization of the cervix are used. With leukoplakia with atypia, diathermoconization or amputation of the cervix is used, taking into account the age of the patient.

Dysplasia of the cervix.

The basis of dysplasia are the processes of proliferation. Depending on the degree of proliferation, the presence of atypical cells and the localization of the process in different layers of the epithelium, dysplasia is divided into mild, moderate and severe. Cervical dysplasia does not have typical clinical manifestations. Diagnosis of dysplasia includes examination with mirrors, swabs for atypical cells, colposcopy with targeted biopsy. The most accurate diagnosis is made by histological examination of the biopsy material.

Treatment dysplasia is carried out taking into account all diagnostic indicators and concomitant diseases.

Precancerous diseases of the endometrium

These include recurrent hyperplastic processes, adenomatosis, atypical endometrial hyperplasia. Increased proliferation of glandular tissue occurs as a result of dyshormonal disorders and can be established during a histological examination of the material obtained during hysteroscopy or diagnostic curettage of the mucous membrane of the uterine cavity. The leading role in the pathogenesis of hyperplastic processes belongs to hormonal disorders in the form of hyperestrogenism. However, hyperplastic processes in the endometrium can also occur in violation of tissue reception. The main clinical manifestations of hyperplastic processes are various kinds of uterine bleeding. The final diagnosis can be made with a comprehensive examination with a mandatory histological examination of the endometrium. You can get the material with diagnostic curettage of the uterine mucosa, with hysteroscopy or aspiration from the uterine cavity. Treatment of patients can be conservative - it is a normalizing hormone therapy, or operative - in the presence of organic diseases such as uterine fibroids, endometriosis, ovarian cysts, etc.

Precancerous diseases of the ovary

In 80-85% of cases of malignant ovarian tumors, cancer occurs secondarily with malignancy (malignancy) of benign ovarian tumors. Therefore, all cystomas are precancer. Patients are subject to surgical treatment. The volume of surgical intervention depends on the age of the patient and the nature of the tumor.

Timely detection of precancerous diseases of the female genital organs, examination of patients, treatment of precancerous diseases is a reliable prevention of cancer of the female genital organs. Early detection of precancerous diseases is possible only during mass preventive examinations. To this end, it is necessary to use all measures of explanatory work with the population - conversations, lectures, speeches in the media.

Precancerous diseases include diseases characterized by a long (chronic) course of the dystrophic process, and benign neoplasms that tend to become malignant. Morphological precancerous processes include focal proliferations (without invasion), atypical growths of the epithelium, cell atypia. Not every precancerous process necessarily turns into cancer. Precancerous diseases can exist for a very long time, and at the same time, cancerous degeneration of cells does not occur. In other cases, such a transformation occurs relatively quickly. Against the background of some diseases, such as papillary cystomas, cancer occurs relatively often, against the background of others (kraurosis and vulvar leukoplakia), much less frequently. Isolation of precancerous diseases is also justified from the point of view that timely and radical "treatment of these forms of diseases is the most effective cancer prevention. Depending on the localization of the pathological process, it is customary to distinguish precancerous diseases of the external genitalia, cervix, uterine body and ovaries.

Precancerous diseases of the female genital organs. These include hyperkeratosis (leukoplakia and kraurosis) and limited pigmented lesions with a tendency to grow and ulcerate.

Leukoplakia of the vulva usually occurs in menopause or menopause. The occurrence of this pathology is associated with neuroendocrine disorders. The disease is characterized by the appearance on the skin of the external genital organs of dry white plaques of various sizes, which can have a significant spread. There are phenomena of increased keratinization (hyperkeratosis and parakeratosis) with the subsequent development of the sclerotic process and wrinkling of the tissue. The main clinical symptom of leukoplakia is persistent pruritus in the vulva. Itching causes scratching, abrasions and small wounds. The skin of the external genital organs is dry.

To treat this disease, ointments or globules containing estrogen preparations are used. With pronounced changes and severe itching, it is permissible to use small doses of estrogens orally or as an injection. Along with the use of estrogen, diet is of great importance (light plant foods, reduced consumption of salt and spices). Calming effects are provided by hydrotherapy (warm sitz baths before bedtime) and medications that act on the central nervous system.

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

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

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

PRECANCER DISEASES OF THE CERVIC. Dyskeratoses are characterized by a more or less pronounced process of proliferation of stratified squamous epithelium, compaction and keratinization (keratinization) of the surface layers of the epithelium. With regard to malignancy, there is a danger of leukoplakia with a pronounced proliferation process and incipient cell atypism. With leukoplakia, the mucous membrane is usually thickened, separate whitish areas are formed on its surface, which sometimes pass into the unchanged mucous membrane without clear boundaries. Leukoplakia sometimes has the appearance of whitish plaques protruding from the surface of the mucous membrane. These areas and plaques are tightly soldered to the underlying tissues. Leukoplakia of the cervix is very often asymptomatic and is detected by chance during a routine examination. In some women, the disease may be accompanied by increased secretion (leucorrhea). In cases of infection, "discharge from the genital tract becomes purulent in nature.

For erythroplakia, atrophy of the surface layers of the epithelium of the vaginal part of the cervix is typical. The affected areas usually have a dark red color due to the fact that the vascular network located in the subepithelial layer shines through the thinned (atrophied) layers of the epithelium. Especially well, these changes can be observed when examining with a colposcope.

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

Erosion of the cervix (glandular-muscular hyperplasia) can be attributed to precancerous processes with a long course, relapses, increased proliferation processes, and the presence of atypical cells. Erosed ectropion can also create conditions for the development of cancer. Ectropion occurs as a result of damage to the cervix during childbirth (less often abortion and other interventions) and its deformation during scarring. With ectropion, the everted mucous membrane of the cervical canal comes into contact with the acidic contents of the vagina, and pathogenic microbes penetrate into its glands. The emerging inflammatory process can exist for a long time, spreading beyond the external pharynx and contributing to the appearance of erosion. Treatment of erosipane ectropion is carried out according to the rules of erosion therapy. The concomitant inflammatory process is treated, colposcopy, if indicated, targeted biopsy with histological examination of the tissue removed. With erosion, diathermocoagulation and electropuncture are performed. I circle of the gaping pharynx. After rejection of the scab and healing of the wound surface, a narrowing of the gaping pharynx and the disappearance of erosion are often observed. If after diathermocoagulation the deformation of the neck has not disappeared, plastic surgery can be applied. In the absence of a lasting effect and recurrence of erosion, there are indications for surgical intervention (coius-like electroexcision, amputation of the cervix).

Precancerous diseases of the body of the uterus. Glandular hyperplasia of the endometrium is characterized by the growth of glands and stroma. Not every glandular hyperplasia of the mucous membrane of the body of the uterus is a precancerous condition; the greatest danger in this regard is the recurrent form of glandular hyperplasia, especially in older women.

Adenomatous polyps are characterized by a large accumulation of glandular tissue. In this case, the glandular epithelium may be in a state of hyperplasia. Precancerous diseases of the endometrium are expressed in the lengthening and intensification of menstruation, as well as the occurrence of acyclic bleeding or spotting. A suspicious symptom should be considered the appearance of! bleeding during menopause. The detection of endometrial hyperplasia or adenomatous polyps in a patient during this period should always be considered as a precancerous process. In younger women, endometrial hyperplasia and adenomatous polyps can be considered a precancerous condition only in cases where these diseases recur after 1 curettage of the uterine mucosa and subsequent correct conservative therapy.

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

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

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

Genital injuries

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

breaks during sexual intercourse;

damage caused by foreign bodies in the genital tract;

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

bruises of the genitals, crush;

stab, cut and gunshot wounds of the genital organs; injuries due to medical practice.

Regardless of the cause of the damage, a thorough examination in a hospital is required to determine its volume, which includes, along with the initial examination, special methods (rectoscopy, cystoscopy, radiography, ultrasonography and NMR, etc.).

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

Damage to the female genital organs associated with sexual intercourse. The main diagnostic sign of an injury to the vulva and vagina is bleeding, which is especially dangerous if the cavernous bodies of the clitoris (corpus cavernosus clitoridis) are damaged. Occasionally, the cause of bleeding requiring surgical hemostasis may be a rupture of the fleshy septum of the vagina. Usually, one or more sutures are placed on the vessels, they are chipped with novocaine and adrenaline hydrochloride. Sometimes a short press of the vessel is sufficient.

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

Vaginal ruptures can occur when a woman’s body is abnormally positioned during intercourse, violent sexual intercourse, especially when intoxicated, as well as when foreign objects are used in violence songs, etc. Typical damage in such circumstances is a rupture of the vaginal vaults.

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

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

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

administered for therapeutic purposes;

administered for the purpose of medical or criminal abortion.

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

If it is known that the damaging object did not have sharp ends and cutting edges, and the manipulations are immediately stopped, then we can limit ourselves to monitoring the patient.

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

Hospitalization is the only correct solution. At the same time, due to the unclear nature and extent of the injury, even in the presence of a pronounced pain syndrome, anesthesia is contraindicated.

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

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

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

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

If, during examination at the pre-hospital stage, an object that caused injury is found in the genital tract, then it should not be removed, as this may increase bleeding.

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

to lie in tissues squeezed by two moving rigid objects (for example, in the soft tissues of the vulva relative to the underlying pubic bone under the action of a rigid object).

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

Prolonged pressing of the injury site to the underlying bone may not give the expected results, but it is still resorted to for the period of transportation to the hospital.

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

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

Extensive cellular spaces can accommodate a significant amount of bleeding blood. In this case, hemodynamic disorders up to shock testify to blood loss.

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

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

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

There are almost no exhaustive statistics regarding the frequency of bullet injuries to the internal genital organs, but in modern conditions women can become victims of violence. Therefore, this type of injury in the practice of an ambulance doctor is not at all excluded.

The experience of military conflicts has shown that the majority of wounded women with damage to the pelvic organs die at the pre-hospital stage from bleeding and shock. Bullet wounds are not always adequately assessed. The task is facilitated with a penetrating wound. If there is an inlet and outlet of the wound channel, it is easy to imagine its direction and the probable amount of damage to the internal genital organs. The situation is completely different when there is a blind bullet wound.

When making a decision, the ambulance doctor must proceed on the assumption that multiple injuries of the internal organs have occurred as a result of the injury, until the opposite is proved. In this regard, the most appropriate hospitalization of the wounded in a multidisciplinary hospital with urgent surgical and gynecological departments.

Bullet wounds during pregnancy are especially dangerous. Damage to the uterus usually causes a lot of blood loss. A wounded pregnant woman must be hospitalized in the obstetric department of a multidisciplinary hospital.

23) preparation of the patient for gynecological surgery, planned and emergency

Surgical treatment is widely used in gynecology. The success of the operation depends on various factors.

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

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

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

In preparation for the operation, an examination is carried out, concomitant diseases are identified, and the diagnosis is clarified. Then, during these events, the method of anesthesia, the volume of surgical intervention are chosen, and the patient is prepared for surgery. Preparation consists in psychoprophylaxis, the correct emotional mood. Also, in some cases, it is necessary to carry out preventive treatment of concomitant diseases.

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

There is a standard set of studies that must be carried out for each patient before surgery. It includes a medical history, general and special objective examinations, as well as laboratory and additional studies: general urine and blood tests, determining the number of platelets, blood clotting time and bleeding duration, prothrombin index, biochemical studies (for residual nitrogen, sugar, bilirubin, total protein), be sure to determine the blood type and Rh affiliation.

Chest X-ray, electrocardiogram, determination of the Wassermann reaction are also necessary. In addition, smears from the vagina are examined for flora, as well as from the cervical canal for atypical cells. Be sure to test for HIV.

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Introduction

1. Leukoplakia of the vulva

2. Kraurosis of the vulva

Conclusion

Literature

Introduction

The development of malignant tumors of the female genital organs, as a rule, is preceded by various pathological conditions against which they occur.

Allocate precancerous diseases of the vulva and vagina, cervix, endometrium and ovaries.

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

Due to the increasing proportion of elderly women in the population, kraurosis and leukoplakia of the external female genital organs are now occurring earlier. The significance of these diseases in the pathology of the female reproductive system is determined not only by the persistence of symptoms and ineffective therapy, but also by the fact that in a certain percentage of cases these diseases, especially leukoplakia, can turn into cancer. For many years, both diseases have been rightly considered to be precancerous.

1. Leukoplakia of the vulva

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

The disease is characterized by the appearance on the skin of the external genital organs of dry white plaques of various sizes, which can have a significant spread.

There are phenomena of increased keratinization (hyperkeratosis and parakeratosis) with the subsequent development of the sclerotic process and wrinkling of the tissue. The main clinical symptom of leukoplakia is persistent pruritus in the vulva. Itching causes scratching, abrasions and small wounds. The skin of the external genital organs is dry.

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

According to the severity of leukoplakia, there are

flat,

hypertrophic and

warty shape.

Leukoplakia in the form of dry white or bluish-white plaques may be located in limited areas or may spread throughout the vulva.

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

The diagnosis is made on the basis of the clinical picture. Of the additional research methods, colposcopy, Schiller's test are used (when lubricating the external genital organs with Lugol's alcohol solution, the areas of leukoplakia do not stain). Areas suspected of malignancy, selected during colposcopy, are biopsied and histologically examined.

To treat this disease, ointments containing estrogen preparations are used. With pronounced changes and severe itching, it is permissible to use small doses of estrogens orally or as an injection. Along with the use of estrogen, diet is of great importance (light plant foods, reduced consumption of salt and spices). Calming effects are provided by hydrotherapy (warm sitz baths before bedtime) and medications that act on the central nervous system.

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

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

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

A biopsy is needed for diagnosis.

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

2. Kraurosis of the vulva

Kraurosis of the vulva is a dystrophic process that leads to wrinkling of the skin of the external genital organs, the disappearance of fatty tissue of the labia majora, subsequent atrophy of the skin, sebaceous and sweat glands.

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

1 stage- characterized by edema, hyperemia, itching in the vulva. Large and small labia are edematous and cyanotic.

2 stage- atrophic changes progress, the labia majora and minora are flattened, the clitoris atrophy occurs, the skin becomes dry, whitish in color, the entrance to the vagina narrows.

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

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

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

To normalize the trophic function of the nervous system, novocaine solution is injected into the subcutaneous tissue of the vulva by the method of tight creeping infiltrate, a presacral novocaine blockade is performed, and the vulva is denervated by dissecting the pudendal nerve. In especially severe cases of the disease, with the failure of all the described methods of therapy, they resort to extirpation of the vulva. As a symptomatic remedy that reduces itching, 0.5% prednisolone ointment or anesthesin ointment can be used. If areas suspected of cancer are found, a biopsy is indicated.

3. Comprehensive treatment of patients with leukoplakia and kraurosis

Treatment of patients with leukoplakia and kraurosis of the external female genital organs is a complex and still not completely solved problem.

Kraurosis and leukoplakia have a chronic long course.

Their treatment requires patience from both the doctor and the patient.

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

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

Psychotherapy is of great importance, aimed primarily at developing the patient's confidence in the possibility of a cure for this long and painful illness.

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

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

· Rational diet therapy plays an important role. Nutrition should be complete, sufficient in calories and vitamins. Carbohydrate intake should be somewhat limited.

· Irritating dishes and spices are excluded. The diet is dairy and vegetable. Spicy foods and alcoholic beverages are prohibited.

· Observance of the necessary hygienic regimen is of great importance. Underwear should not fit snugly to the body, so as not to cause an additional feeling of itching.

· It is necessary to completely exclude the wearing of underwear made of synthetic fabrics.

Drug treatment includes the appointment of general and local agents, it is advisable to combine it with novocaine blockade and physiotherapy. In some extremely severe cases, with the failure of conservative therapy, one has to resort to surgical treatment.

Women with precancerous diseases of the external genitalia and vagina should be under dispensary observation and visit the antenatal clinic 1 time in 3-6 ms.

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

Numerous observations by oncologists show that the reduction in cancer mortality depends not so much on improving treatment methods, but on improving the diagnosis of cancer.

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

Considering that early forms of cancer and precancerous diseases in the vast majority of cases are asymptomatic and do not cause the need to see a doctor, it is crucial to actively involve women in preventive examinations.

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

They are held once or twice a year in the examination rooms of polyclinics, feldsher-obstetric stations, antenatal clinics, and when visiting industrial enterprises.

During professional examinations, the cervix is examined in the mirrors, a vaginal examination is performed, swabs are taken from the cervix for cytological examination. When examining the cervix in the mirrors, various pathological conditions are revealed, which are called precancerous (precancerous) and background (benign). Among them are known pseudo-erosion, ectopia, eroded ectropion, true erosion, leukoplakia, cervical canal polyps and dysplasia. From the point of view of cervical cancer prevention, it is important to identify background and precancerous diseases, the timely treatment of which reliably prevents the latter from turning into cancer.

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

Primary prevention is to prevent pregnancy complications in healthy women.

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

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

In the development of reproductive function, the following are of great importance:

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

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

3) rational use of children's health institutions;

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

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

The population is not sufficiently informed about the dangers of overnutrition, which is accompanied by alimentary obesity and subsequent functional insufficiency of the ovaries and other endocrine glands. Stabilization of obesity, which began in childhood or during puberty, often leads to reproductive disorders (infertility, spontaneous miscarriages) and birth abnormalities (weak birth forces, bleeding, etc.). In this regard, in the prevention of obstetric pathology, a balanced diet that meets the needs of the mother and fetus is of great importance.

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

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

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

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

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

In terms of preventing obstetric pathology, dispensary observation and rehabilitation treatment (according to indications) of women who have undergone:

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

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

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

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

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

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

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

leukoplakia kraurosis precancerous disease

Conclusion

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

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

Examination rooms play an important role in prevention and early diagnosis.

In a vaginal examination, in a large percentage of cases, the midwife reveals tumors of the ovaries, fallopian tubes and the body of the uterus, which, even when they reach a significant size, do not give any clinical manifestations. Long developing, these tumors pass into a malignant tumor.

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

Literature

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

2. Bodyazhina V.I. Obstetric care in women's consultation, M.: Medicine 2002 - 120s.

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

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

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

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