30 KB2201 KB28 KB192920262009Arko, DarjaGorišek, BorutKodrič, TatjanaRepše-Fokter, AlenkaTakač, Iztokštevilka:1letnik:78str. I-43-I-48ISSN:1318-0347COBISSID:3482943URN:URN:NBN:SI:doc-IZZ4N5L1slSlovensko zdravniško društvoZdravniški vestnikCervical Intraepithelial NeoplasiaCervikalna intraepitelijska neoplazijaGinekološki kirurški postopkiGynecologic Surgical ProceduresKirurgijamaternični vratpreventivna medicinarak (medicina)surgerytherapyZdravljenjeMožnosti zdravljenja predrakastih sprememb materničnega vratu| Treatment options for the management of preinvasive cervical lesions|Background. To obtain a complete diagnosis of preinvasive cervical lesions, the results of cytology, colposcopy and histological biopsy are needed. Low-grade Iesions (LG-SIL, CIN 1) should be managed conservatively because such lesions can regress. Treatment is suggested if the abnormality persists for 2 years or if the lesion worsens in grade or size. High-grade lesions (HG-SIL, CIN 2 and 3) are managed by different treatment modalities. Ablative modalities include cryocautery, electrocoagulation diathermy and laser ablation. For ablative treatment only ectocervical lesions with entirely visible squamocolumnar junction visible are suitable. Small localized lesions of CIN 1 and 2 may be treated by cryocautery or electrocoagulation diathermy. Lesions entering the cervical canal cannot be destroyed with certainty. Laser destroys the tissue by evaporation and coagulation, and is useful if the dysplastic areas extend into the vaginal fornices. Excision modalities including loop diathermy excision, cold-knife conization, laser cone biopsy and hysterectomy provide specimens for histology. Loop diathermy excision is currently the most common treatment modality. Cold-knife conization is performed with a scalpel. The cone can be broad and shallow or narrow and deep, depending on the location and the size of the lesion. Laser cone biopsy is relatively costly and time-consuming. Histopathology aims to assess the nature of the lesion and to determine whether it has been removed completely. Conclusions.Treatment of preinvasive lesions is not completely harmless for the patient. Complications include hemorrhage, cervical stenosis or incomplete excision. Hysterectomy should be considered for a patient with CIN suffering from menorrhagia, uterine prolapse or leiomyomas as well as in cases of adenocarcinoma in situ, when the reproductive function has been completedIzhodišča. Popolna diagnoza predrakastih sprememb materničnega vratu temelji na citoloških, kolposkopskih in histoloških preiskavah. Spremembe nizke stopnje (PIL nizke stopnje, CIN 1) obravnavamo konzervativno, saj lahko spontano izginejo. Zdravljenje priporočamo, kadar je nepravilnost prisotna dve leti ali kadar sprememba napreduje v stopnji in velikosti. Spremembe visoke stopnje (PIL visoke stopnje, CIN 2 in 3) zdravimo na različne načine. Ablativne tehnike obsegajo krioterapijo, elektrokoagulacijsko diatermijo in lasersko ablacijo. Ablativne tehnike so primerne za uporabo le pri ektocervikalnih spremembah s povsem vidno transformacijsko cono. Majhne lokalizirane spremembe CIN 1 in 2 lahko zdravimo s krioterapijo ali elektrokoagulacijsko diatermijo. Sprememb, ki segajo v cervikalni kanal, ne moremo zanesljivo uničiti. Laser uniči tkivo z evaporizacijo in koagulacijo in je primeren za displastične spremembe, ki se širijo na nožnične oboke. Ekscizijske tehnike, ki obsegajo ekscizijo z diatermijsko zanko, konizacijo s skalpelom, lasersko konizacijo in histerektomijo, omogočajo pridobitev vzorca za histološko preiskavo. Ekscizija z diatermijsko zanko je trenutno najpogosteje uporabljeni način zdravljenja. Konizacijo opravimo s skalpelom. Konus je lahko, glede na lokalizacijo in velikost spremembe, širok in plitek ali pa ozek in globok. Laserska konizacija je sorezmerno draga in zamudna. Histopatološka preiskava omogoča določitev narave spremembe in določitev popolnosti odstranitve. Zaključki. Zdravljenje predrakastih sprememb ni povsem brez nevarnosti za bolnico. Zapleti obsegajo krvavitev, stenozo materničnega vratu in nepopolno odstranitev. Pri bolnicah s CIN, ki so zaključile z reprodukcijo in ki trpijo zaradi podaljšanih krvavitev, zdrsa maternice ali miomov, ali če je prisoten adenokarcinom in situ, pride v poštev odstranitev materniceTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo