Home Removal Radio wave conization of the cervix bleeding. Conization of the cervix - what is it and how is the postoperative period? When is the procedure scheduled?

Removal

Radio wave conization of the cervix bleeding. Conization of the cervix - what is it and how is the postoperative period? When is the procedure scheduled?

Conization of the cervix is an operation in which a cone-shaped excision of the affected tissue is performed. The procedure is performed for therapeutic and diagnostic purposes for various diseases, when other methods have proven ineffective or cannot be used for any reason. Until recently, conization was carried out with a regular scalpel. In modern gynecology, radio waves and other techniques are actively used to obtain quick and guaranteed results.

Radio wave conization of the cervix is an excision of an area the right size using electromagnetic waves.

The goal of such treatment is to eliminate the pathological focus (erosion) and save the woman from the possible consequences of this pathology. Radioconization is recognized as one of the most effective and safe methods of therapy and is considered the best option for young nulliparous women.

Advantages of radio wave conization of the cervix

Compared to the classical technique, manipulation has a number of advantages:
Low invasiveness: radio waves are directed specifically at the pathological focus, healthy tissues are not affected;
Possibility of use in nulliparous women: after the procedure, the structure of the cervix is not disturbed, no scars remain;
Low risk of complications;
Minimal risk of bleeding: the wound surface is treated directly during the procedure, the vessels are coagulated;
Radical removal of affected tissue in one stage;
Possibility of obtaining tissues for histological examination;
Painless;
Short rehabilitation period (4 weeks);

Possibility of carrying out on an outpatient basis.

All these factors make radioconization the method of choice for the treatment of cervical pathology in women planning pregnancy.

On a note

Indications for surgery

Conization refers to surgical methods treatment of cervical diseases. IN clinical practice Various techniques for cone-shaped tissue excision can be used:

Knife – traditional excision of tissue with a scalpel;
Laser conization;
Radio wave conization.

All these factors make radioconization the method of choice for the treatment of cervical pathology in women planning pregnancy.

Reviews from patients clearly indicate that radio wave and laser conization are much better tolerated and usually proceed without complications.

Indications for conization:

Cervical dysplasia stages II and III (CIN);
Recurrent grade I dysplasia, not amenable to treatment by other methods;
Erosion of the cervix with pronounced cicatricial deformities;
Inability to visualize the transformation zone during colposcopy;
Spreading pathological process into the cervical canal;
Cancer in situ (stage 0, non-invasive cancer, that is, not extending beyond the epithelium) - in some cases.

The possibility of using one or another conization method depends on the technical equipment of the clinic and the qualifications of the doctor. Modern medical centers try to offer their patients cervical conization radio wave method. This is one of the most effective and safest ways surgical treatment, allowing you to radically solve the problem without consequences for reproductive health.

All these factors make radioconization the method of choice for the treatment of cervical pathology in women planning pregnancy.

The question of using one or another method of influence is always decided individually based on the severity of the patient’s condition and the presence of concomitant pathology.

For complicated erosion, ectropion, leukoplakia and other diseases, it is usually first used conservative methods(cauterization of the cervix with radio waves, etc.). Lack of effect is a reason to prescribe radio wave conization cervix.

Contraindications to surgical treatment

Radio wave conization is not performed in the following conditions:

Inflammatory process on the cervix;
Invasive cancer;
Pregnancy (the operation is performed after the birth of the child and completion of the lactation period).

Quite often, diseases of the cervix (dysplasia, ectropion) are combined with cervicitis - inflammation of the cervical canal. In addition to contact bleeding, profuse vaginal discharge with an unpleasant odor appears, and there is itching and burning in the vagina. Cervicitis not only aggravates the course of the disease, but also contributes to the development of complications. If conization is carried out against the background of active inflammation, the infection can spread to the overlying organs - the uterus and appendages. The operation is scheduled only after complete cure

For invasive cancer that has penetrated beyond the mucous layer, radioconization is not effective. In this situation, the only treatment may be to remove the uterus (hysterectomy).

Preparation for radio wave treatment

Before the procedure, a woman must undergo a full examination:

Smear for oncocytology;
Colposcopy;
Biopsy (if indicated);
Examination for STIs, including human papillomavirus (if a concomitant infection is suspected).

After the examination, the doctor makes a final diagnosis and determines treatment tactics. If a decision is made to perform radiosurgical conization of the cervix, the following tests are prescribed:

Survey smear on the flora;
Bacteriological culture from the cervical canal.

These examinations can also be carried out at the stage primary diagnosis to find the cause of erosion. Further additional tests are prescribed:

Blood chemistry;
General blood and urine tests;
Coagulogram;
Tests for infections (HIV, hepatitis, syphilis);
Determination of blood group and Rh factor;
ECG and consultation with a therapist.

Scheme of radioconization and the essence of the procedure

In most cases, the operation is performed under local anesthesia. For pain relief, an anesthetic injection is given into the cervix: 0.1% lidocaine along with adrenaline (to reduce bleeding). In special situations, the procedure can be performed under short-term anesthesia.

Radiosurgical conization of the cervix is prescribed in the first middle of the cycle. It is optimal to perform the operation on days 5-7. If a woman's menstruation lasts about 6-7 days, the procedure is postponed to another time. There should be no menstrual flow on the day of surgery.

All these factors make radioconization the method of choice for the treatment of cervical pathology in women planning pregnancy.

For postmenopausal women, conization is performed at any time.

Progress of the operation:

The patient is positioned on a gynecological chair;
The cervix is exposed in the speculum, the instrument is fixed;
Vaginal discharge is removed with a cotton swab;
Colposcopy is performed: pathologically altered areas of the cervix are recorded, the conization zone is determined;
Local anesthesia is performed;
The electrodes are connected, the radio knife is prepared;
The pathological area is excised in a cone shape radio wave knife. During the operation, the doctor captures the changed tissue on the cervix and 1/3 or 2/3 of the cervical canal;
The removed tissue is grabbed with tweezers;
The resulting material is sent to the laboratory for histological examination;
Bleeding areas coagulate.

The whole procedure takes about 15-20 minutes. After radiosurgical conization, sutures are not placed on the cervix, since bleeding is stopped directly during the procedure. This reduces the recovery period and significantly reduces the risk postoperative complications.

All these factors make radioconization the method of choice for the treatment of cervical pathology in women planning pregnancy.

Reviews of radioconization indicate that most patients tolerate this procedure well.
o It is not painful, and all that the patient experiences during the operation is some discomfort in the lower abdomen (provided adequate anesthesia is provided). The cervix heals faster than with other treatment regimens, and after 4 weeks the woman can return to her usual lifestyle. In the first two weeks after the operation, there may be minor bloody discharge that does not cause significant discomfort. Complications after radiosurgical conization are quite rare.

To carry out radio wave treatment, a modern Surgitron device is used. With its help, not only conization is carried out, but also radio wave loop excision - capturing a small area of the cervix with a thin wire loop.

All these factors make radioconization the method of choice for the treatment of cervical pathology in women planning pregnancy.

There is a slight difference between the concepts of conization and excision. Usually we talk about excision (or cone excision) when it is necessary to remove a small section of the cervix along with the lower part of the cervical canal. In foreign literature, this procedure is called LEEP. The term "conization" is correct when half or 2/3 of the cervical canal is removed, and a radioknife is used for this procedure. The technique is similar, the only difference is in the tools used.

Photos of the cervix before and after radioconization can be seen below.

Advantages of using the Surgitron device:

Low risk of developing inflammation and burns of the wound surface (tissue temperature at the incision site does not exceed 55 °C);

All manipulations are carried out gently, effortlessly, which eliminates compression and displacement of tissues;
Possibility of simultaneous tissue dissection and bleeding stop;
The operation is performed in a “dry wound” without bleeding, which improves visualization of the pathological focus;
Non-contact – low risk of infection;
Possibility of targeted impact on the pathological focus - healthy tissues are not damaged;
The procedure can be performed in close proximity to blood vessels and nerves.

As an alternative to Surgitron, the Fotek device can be used.

The cost of radiosurgical conization depends on the region and the status of the clinic. In Moscow, the price of the operation is 25-40 thousand rubles; in the regions the cost may be lower. If in antenatal clinic A radio wave device has been installed, the procedure can be done free of charge under the compulsory medical insurance policy.

For a speedy recovery, a woman should follow some rules during the first month after the procedure:

Sexual activity is prohibited until the mucous membrane of the cervix is completely restored (an average of 4 weeks);
It is not recommended to lift weights (more than 5 kg), exercise active species sports, physical overexertion;
It is forbidden to visit the swimming pool, bathhouse, sauna, or lie in a hot bath;
You cannot use tampons or douche;
You should not take any medications without a doctor's prescription.

On average, healing of the cervix occurs in 4-5 weeks. The cervix takes a long time to heal if a woman does not follow the doctor’s recommendations and violates the prescribed prohibitions.

Postoperative period: norm and pathology

In the first days after radio wave conization of the cervix, there is sanguineous discharge from the genital tract. Gradually, the volume of discharge decreases, and by the third week it completely disappears. A specific odor may appear from the discharge - not too strong, but unpleasant. By the end of the first month after surgery, all discharge should completely stop.

Nagging pain in the lower abdomen may occur directly during the procedure, as well as during the first week after surgery. The pain is mild, localized above the pubis in the center, and is not accompanied by a significant deterioration of the condition. If you don’t want to endure pain, you can take No-shpa or Nurofen (no more than 3 days in a row).

Radioconization of the cervix does not have a significant effect on the menstrual cycle, and most women have their periods on time. There may be a slight delay of up to 3-5 days. According to reviews, the first periods may be heavy and painful, but later the cycle is completely restored.

The general condition after surgery is usually satisfactory. Some women note an increase in body temperature to 37-37.5 °C. The temperature lasts no more than three days; antipyretics are not prescribed.

Moderate nagging pain in the lower abdomen, bloody vaginal discharge and a slight delay in menstruation are normal after conization.

Warning symptoms to look out for:

Continuous or increasing bleeding from the genital tract (profuse, with clots);
Severe pain in the lower abdomen;
Increased body temperature more than 37.5 °C;
The appearance of purulent discharge;
Copious discharge with an unpleasant odor 3 weeks after surgery;
Delay of menstruation for more than 7 days.

All these symptoms indicate the possible development of complications and require mandatory consultation with a doctor.

A follow-up examination by a doctor after conization is carried out after 2 weeks, colposcopy - after 4-6 months. If the examination results are good, the woman should visit the doctor every 6 months or more often if indicated.

Undesirable consequences and complications

Conization of the cervix using the radio wave method can lead to the development of the following complications:

Bleeding is an extremely rare complication, since the vessels coagulate immediately after the incision (1-2% of cases);
Wound infection - occurs when personal hygiene rules are not followed or when there is chronic cervicitis at the time of the operation (1-2%).

If for some reason conization was carried out repeatedly, the risk of the following complications increases:

Scarring of the cervix;
Cervical canal stenosis.

The use of modern techniques makes it possible to reduce the likelihood of such consequences to almost zero.

Pregnancy and childbirth after radioconization

Unlike other treatment methods, after radioconization, stenosis of the cervical canal does not occur and complications that can affect the course of pregnancy and childbirth do not develop. The cervix heals without scarring. The cervical canal remains patent and sperm can fertilize the egg without interference. After the therapy, a woman can conceive a child. It is recommended to plan pregnancy 2-3 months after surgery.

It is important to know

Properly performed radioconization does not interfere with conception, pregnancy, or natural childbirth.

Radioconization of the cervix does not affect the course of pregnancy and does not interfere with the development of the fetus. Since scars do not form on the cervix, the woman is not at risk of developing isthmic-cervical insufficiency. In the absence of other complications, a successful pregnancy and birth of a child is possible.

Childbirth after surgical treatment occurs without complications. A woman can safely give birth to a child through natural birth canal. Radio wave treatment is a gentle method that does not have a negative effect on the cervix, does not interfere with its stretching during childbirth and does not interfere with the birth of the baby.

The successful course of pregnancy and childbirth largely depends on how the postoperative period went. If a woman followed all the doctor’s recommendations and was regularly observed by a gynecologist, she has a very high chance of experiencing all the joy of motherhood without significant problems and complications.

Interesting video about the benefits of radio wave conization

mioma911.ru

What is conization of the cervix

Conization involves removing pathological tissue of the cervix or cervical canal in the form of a cone-shaped fragment. The purpose of the operation is:

Achievement therapeutic effect. Removing an area of pathological epithelium prevents further development of the disease. Treatment of dysplasia or non-invasive cancer is considered complete as a result of removal of the tumor or problematic area of the epithelium. Repeated conization is rarely used.
Diagnostic study. The tissue is removed and sent for histology - the study of the excised area of the epithelium. Timely detection of malignant epithelial cells as a result of histological examination of biomaterial obtained through conization increases the patient’s chances of recovery. In such cases, further treatment is prescribed.

Indications

The decision on the need for surgical manipulation is made by the doctor based on examination, colposcopy, and PAP smear examination. Indications for prescribing surgery are:

positive result of a smear or biopsy of the cervix;
pathologies of the mucous membranes of the cervical canal;
the presence of cervical dysplasia of 3-4 degrees;
cervical erosion;
deformation of the cervix (cervical ruptures after childbirth, rough scars).

Contraindications

If inflammatory diseases or infections (gonorrhea, chlamydia, trichomoniasis) are detected in a woman’s body, surgical procedures are postponed until these ailments are completely cured. The patient is prescribed antibiotics, and then successful course treatments are carried out surgery. If there is histological confirmation of invasive cancer, the conization method is not used.

Procedure methods

Excision of the cervix to remove problematic mucosal cells, tumors, and polyps is carried out using the following methods:

knife;
radio wave (loop conization);
laser conization.

Resection using a scalpel is almost never used due to the risk of complications after surgery. The most common method is radio wave. The advantages of this method are:

Minimally invasive intervention. Using an electrode you can produce complete removal the affected membrane of the cervix without affecting healthy tissue. The ability of the device to grind the surface after manipulation minimizes the risk of bleeding in the postoperative period.
Preservation of reproductive functions. Does not affect the ability to conceive and bear children, as it does not provoke tissue scarring.
Possibility of performing the procedure on an outpatient basis.

The latest development is the use of laser for surgical intervention. Method used:

when the tumor spreads from the mucous membrane of the cervix to the vagina;
with extensive lesions of dysplasia of the epithelial layer.

Disadvantage laser method the cost of the procedure is considered high. Not all clinics have expensive equipment; special training of staff is required to operate the device. The advantages of the method include:

High precision of manipulations. The equipment is the most effective; it can be used to perform gentle manipulations and avoid possible negative consequences - postoperative bleeding, severe tissue scarring.
Avoiding the development of infection after manipulation. The process is non-contact, without the use of tools, and the laser has the property of destroying pathogenic microflora.
No bleeding. Under the influence of the laser, coagulation of blood vessels occurs.
Preservation of a woman's reproductive function.

Preparation

Before the operation, the doctor prescribes the following diagnostic examination to the patient:

general and biochemical analysis blood to determine the level of basic indicators and to establish the absence or presence of syphilis, HIV, hepatitis A and C;
Analysis of urine;
bacterioscopic analysis of smears for flora;
biopsy;
colposcopy (examination using a device that magnifies the examined surface by 40 times);
PCR diagnostics (to detect the presence of infection in the body at an early stage, during the incubation period).

How is the operation performed?

For all methods used surgical intervention carried out immediately after the end of menstruation, but no later than the eleventh day from the start of menstruation. During this period, the possibility of the patient becoming pregnant is excluded. Almost complete absence in epithelial layer nerve endings makes the procedure less painful, but anesthesia is used in all cases.

Knife

Of the existing methods, this operation is the most traumatic, but it provides ideal biomaterial for research. Prescribed when it is impossible to use other methods. The cone of the cervix is excised using this method using a scalpel, so the operation is accompanied by heavy bleeding and a long healing period. The surgical procedure is performed by a gynecologist in a hospital setting under general anesthesia or under spinal anesthesia. The procedure lasts less than an hour. After the operation, the patient remains under doctor's supervision for 24 hours.

Laser

For surgical treatment gynecological diseases use a laser with a diameter of 1 mm and 2-3 mm. The principle of their operation differs. A larger diameter (2-3 mm) is used to evaporate the affected tissue (vaporization). Under the influence of the energy of the gliding beam, only the cells of the upper layer of the epithelium evaporate, the lower ones are not affected, and a scab is formed. The procedure is carried out quickly, up to 7 minutes, but after it it is impossible to obtain a biopsy sample. Used to cauterize the cervix during erosion.

A thin high-frequency beam acts as a scalpel to excise the cone-shaped part in the affected area. In this case, the doctor receives material for research. Under the influence of the beam energy, coagulation of blood vessels occurs, and there is no bleeding. The use of a laser requires maximum immobilization of the patient, so the procedure is performed under general anesthesia, although it is considered painless.

Radio wave

Electroconization of the cervix for dysplasia and tumors is carried out using the Surgitron apparatus. The procedure is performed with an electrode that emits radio waves. In the photo it looks like a loop. Radioconization takes place under local anesthesia and takes 15-30 minutes. The loop is placed 3 mm above the affected area, the device is turned on, and the pathological area of tissue is removed. The surgeon controls the actions using a colposcope. After the operation, the patient's condition was under the supervision of a doctor for 4 hours.

Healing period

The patient's recovery time after surgery depends on the chosen method. A short period of tissue healing (2-3 weeks) when using a laser or radio wave method. When performing manipulations with a scalpel, the postoperative period lasts longer. At this time, patients should exclude:

taking baths (use only shower);
physical activity (sports, lifting more than 3 kg);
use of tampons, suppositories;
sexual intercourse;
douching;
taking anticoagulants (Aspirin).

How does the scab come off after conization of the patient’s cervix? During the postoperative period, patients should not be bothered by nagging pain in the lower abdomen, reminiscent of sensations during menstruation. Moderate brown discharge after conization of the cervix is also considered normal. Such manifestations indicate natural processes - the removal and removal of the scab from the body.

Treatment after conization of the cervix

To avoid complications in the postoperative period, patients are recommended to undergo treatment with antibiotics, drugs to strengthen the immune system, and a complex of vitamins. After two weeks, the doctor examines the patient and sets a date for taking a smear for cytological examination. After surgery it is recommended regular examination for 5 years.

Complications

You should consult a doctor if alarming symptoms occur: intense pain in the lumbar region, itching, appearance unpleasant odor discharge, loss of appetite, fever. Such manifestations in the postoperative period indicate the addition of an infection and the need for therapy. If bleeding occurs, patients are given sutures or cauterized vessels.

Consequences

Advantageously, the use of laser eliminates negative effects in the postoperative period. Rarely, undesirable consequences are observed when using the radio wave method (endometriosis, bleeding, infection). The use of the knife method is associated with the risk of re-bleeding within 14 days after surgery.

Menstruation after surgery occurs at the usual time. Menstruation may be characterized by heavy discharge, the inclusion of blood clots, and a longer duration. Sometimes, before the onset of menstruation, brown discharge is observed. Such manifestations are considered normal in the postoperative period. Long periods (more than two weeks) should cause concern.

Childbirth after the procedure

Customer reviews after the operation are mostly positive. Doctors recommend that patients postpone pregnancy for two years after the procedure. Sometimes narrowing of the cervical canal complicates conception, but does not exclude it. When pregnancy occurs, gynecologists prevent the possibility of miscarriage by placing a suture on the uterus. Impaired cervical dilatation during labor due to scarring can be avoided with caesarean section.

sovets.net

Indications for conization

Such surgical intervention is carried out in case of visible pathological changes in the tissues of the cervix, if grade 2-3 dysplasia of the cervical epithelium is detected in smear analysis. In addition, manipulations are performed in conditions such as:

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

Preparation

The operation is planned immediately after the end of menstruation (on 1-2 “dry” days) due to increased level estrogen during this period, which promotes enhanced epithelial regeneration and rapid recovery. Before the procedure, the following diagnostic tests are prescribed::

smear for cytology, microflora;
general blood and urine tests;
hemostasiogram (blood clotting test);
colcoscopy (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 emerged. Familiarize yourself with the main methods of performing this gynecological manipulation, their advantages and disadvantages:

Vidkonization	Advantages of the method	Flaws
Radio wave	the procedure is performed under local anesthesia; the risk of bleeding and complications is minimal; There is no risk of burning surrounding healthy tissue.
Laser	helps to accurately determine the depth of required destruction; it is possible to carry out the procedure in cases of extensive pathological changes or the spread of the transformation area to the vaginal mucosa; successfully used for various cervical deformities.	high risk of thermal burn of surrounding tissues; high cost of the procedure; the need for general anesthesia.
	allows you to obtain a high-quality preparation for histological examination.	often causes dangerous complications(bleeding, perforation).
Loop	does not injure surrounding tissues; the procedure is inexpensive; the risk of complications is minimal.	it is impossible to control the depth of destruction; there is a risk of postoperative bleeding; the procedure has Negative influence on the ability to bear a fetus.
Cryoconization	the procedure is performed under local anesthesia; the necrosis zone is limited; complications are excluded.	there is no possibility to take tissue for research; the doctor cannot control the depth of destruction.

How is the operation performed?

All conization techniques are carried out in stationary conditions. The duration of the manipulation ranges from 20 to 60 minutes, depending on the method used. The type of operation and 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:

The doctor removes the changed section of the cervical wall.
The extracted tissue is sent for pathohistological examination.
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.
If there are indirect signs requiring removal of the dysplasia zone, the operation is considered a diagnostic step. At the same time, more radical treatment is planned.

Radio wave conization

Surgery is performed using coagulation of damaged tissues using 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, the operation is minimally traumatic, so the patient retains full reproductive function. The indications for radioconization are::

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

Laser

Conization of the cervix using a laser helps to precisely excise pathological areas of the mucous membrane. During the operation, the doctor can change and regulate the volume of tissue extracted (material for research). Among the negative consequences after using a laser are:

burns on mucous tissue;
high probability of relapse of pathology;
formation of scars on the cervix.

The postoperative period after laser conization is accompanied by dark, scanty discharge, which can last for 7-10 days. pain syndrome and general discomfort. Pregnancy after such an intervention usually proceeds favorably, the risk of premature birth or miscarriage is minimal. The main disadvantage of manipulation is its high cost.

Knife

This operation is performed using a scalpel. Knife manipulation is considered very traumatic, so it is rarely used today, only in cases where it is not possible to implement alternative methods conization. The postoperative period after excision of tissue with a scalpel is long and painful. Possible complications include:

excessive bleeding due to vascular damage;
infection of the internal genital organs by pathogenic microorganisms;
incomplete healing of the postoperative wound;
formation of a rough connective tissue scar.

Loop

Diathermoconization or electroconization of the cervix for dysplasia and other pathological tissue changes is used very often. The 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;
for erosions;
to eliminate scar deformities;
with cervical eversion.

The loop conization technique is high-tech and helps to significantly reduce the risk of bleeding, scarring, and soft tissue damage. Biological material taken using an electric loop is not damaged, which facilitates more accurate histological examination. Diathermoconization of the cervix is low cost.

Cryoconization

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

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

Postoperative period

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

taking medications from the group of nonsteroidal anti-inflammatory drugs (NSAIDs), for example, Diclofenac, Ibuprofen;
use of antibiotics wide range actions (Ampicillin, Ceftriaxone);
washing with antiseptics(Miramistin, weak solution of acetic acid).

Until the scab leaves after conization of the cervix and complete healing of the tissue, the woman is prohibited from performing certain actions. She can't use sanitary tampons vaginal suppositories and tablets, do douching, visit the pool, bathhouse or sauna, take a bath. In addition, it is important to limit physical activity, stress and nervous overstrain, carefully observe personal hygiene. Unprotected sexual intercourse should be avoided for two to three weeks.

Consequences

Since the operation uses the latest techniques and equipment, complications after surgery 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, miscarriages;
cicatricial deformation of the cervix;
dizziness;
endometriosis (inflammation of the lining of the uterus);
inflammation of the vaginal mucosa;
increased body temperature;
isthmic-cervical insufficiency (premature dilatation) of the cervix;
narrowing of the external os of the cervical canal.

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

Menstruation after conization of the cervix

After conization, menstruation comes on time. Sometimes there may be a delay (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, more abundant, dark in color and is accompanied by aching pain. The intensity of these characteristics depends on individual characteristics

the woman’s health, the nature and extent of the intervention performed. Normally, subject to all recommendations and prescriptions of the attending physician, the menstrual cycle is quickly restored and all reproductive functions are saved. If bleeding continues for more than 10-14 days, you must visit a gynecologist for an examination. diagnostic studies

and determining the required volume of treatment measures.

Recurrence of dysplasia

If a histological examination after conization reveals cancer cells, the doctor immediately prescribes treatment (radiation therapy, chemotherapy). The operation can trigger the activation of pathological cells and the development of tumors. In some cases, to save a woman’s life (in the presence of metastases to the lymph nodes or other organs), it is necessary to remove all reproductive organs, nearby tissue 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 surgery is necessary, less traumatic methods are used (laser or radio wave). To prevent inflammation, miscarriages, premature birth, after recovery you can plan to conceive no earlier than a year later.

The operation negatively affects a woman’s ability to bear a child. In some cases, when removing damaged tissue, a large area of the cervical canal of the cervix is excised, after which the structure is disrupted and the muscle layer is weakened. Under the weight of the fetus and amniotic fluid, the cervix can open much earlier than expected, provoking premature birth. To prevent this phenomenon, a special suture or ring is placed on the cervical canal. Surgeries performed on the cervix are an indication for cesarean section.

Price

Conization can be performed on a woman free of charge under a compulsory or voluntary health insurance policy. If desired, the patient can contact the paid clinic, having previously read reviews of the work of its specialists. The cost of such an operation depends on the method of implementation and the need for additional instrumental studies. Check out the approximate price of conization in Moscow:

vrachmedik.ru

What is conization of the cervix?

This is a minimally invasive method for diagnosing and treating atypically changed cervical epithelium. Provided that the disease is diagnosed in a timely manner, the patient will have a high chance of recovery and preservation of reproductive function.

How is conization of the cervix performed? The manipulation is practiced in a hospital setting, and there is not always a need for the woman to be hospitalized. Since the surgical intervention is minimal and low-traumatic, many patients are discharged home on the day of surgery, or, in extreme cases, the next day.

The procedure can be carried out in several ways. The most modern and gentle methods are laser and radio wave methods.

Indications and contraindications

The list of main indications for cervical conization includes:

Cervical dysplasia. A precancerous condition that requires mandatory treatment. The operation involves the capture of healthy tissue, since it is important to ensure that the focus of altered cellular structures after conization of the cervix is completely destroyed. Surgical treatment dysplasia is allowed to be performed at any stage of the disease. Conization of the cervix for grade 3 dysplasia should be performed on all patients without exception.
Malignant changes in the upper epithelium of the cervix. It means a precancerous condition associated with the transition of last-degree dysplasia to oncology.
Cystic and polypous formations that are localized inside the cervical canal.
Pathological change in the epithelium with migration of atypical cells into the cervical canal. Is not cancer, but no doctor can guarantee its subsequent good quality. The most dangerous case is when pathological foci rapidly increase.
Deformation of the cervix or the presence of scar changes on it that formed after birth tissue ruptures.
Ectropion of the cervix, as a result of which the mucous membrane is turned inside the vagina.

Manipulation is contraindicated for invasive cervical cancer. The list of contraindications also includes sexually transmitted infections and exacerbation of chronic pathologies in the pelvic organs. In these cases, the procedure is postponed while treatment for these conditions is completed.

Preparing for surgery

Any operation requires preliminary preparation. Before conization, a woman needs to undergo urine and blood tests, a biopsy of the tissues to be operated on, colposcopy, and a smear for microflora.

On what day is cervical conization done? The manipulation is carried out after the end of menstrual bleeding in the first phase of the cycle. Thanks to this approach, the wound surface that is formed during the operation will have time to heal before the next menstruation. Before the operation, at least 8 hours before the operation, the woman is not recommended to eat.

The procedure can be performed using local or general anesthesia. The duration of the manipulation depends on the diagnosis. On average it lasts approximately 30 minutes.

Histology after conization of the cervix is mandatory. The biopsy specimen is sent directly from the operating room to the laboratory for careful examination. If malignant cells are detected in it, the woman will be prescribed appropriate treatment after conization of the cervix.

Conization technique

Exist following methods treatment:

laser;
radio wave;
loop;
knife.

Laser conization allows precise excision of the cervix damaged tissue. During laser surgery, specialists can change and adjust the previously assumed volumes of the biopsy or surgical field (material for research). Undesirable consequences after laser conization of the cervix are minimal. The postoperative period is accompanied by scanty discharge and general discomfort. Pregnancy after this type of intervention is quite possible, since this method has virtually no effect on the chances of becoming a mother. The main disadvantage of this manipulation is its cost.

Radio wave conization cervix is carried out by coagulation of damaged tissues. That is, using radio waves aimed at altered tissues, their killing is achieved. Complications after radio wave conization of the cervix using the coagulation method are also minimal, and the risk of bleeding is reduced to zero. In this case, there is little trauma, so in most cases a woman does not lose the opportunity to become pregnant and give birth in the future.

Loop method considered the optimal choice. In terms of affordability, it is more attractive than laser treatment; in terms of technicality, it is performed at the same level. Rehabilitation after conization of the cervix using the loop method proceeds quickly and smoothly - with virtually no pain or discharge. When manipulating the cervical tissue, an electrode loop is used, which accurately and accurately cuts off the damaged tissue of the cervical canal.

Knife method is already outdated and used very rarely. How is this type of cervical conization surgery performed? The doctor uses a surgical scalpel to excise the damaged tissue. The method is fraught with a long recovery period; the patient experiences significant discomfort in the form of pain and bleeding. The consequences of cervical conization in this case are often quite serious, including subsequent miscarriage and infertility.

Postoperative period

The next day after the intervention, the patient can be discharged. The exception applies to the knife method. If conization of the cervix is performed using the radio wave method or laser, the patient is discharged on the day of surgery. But despite this, the woman will have to visit a specialist for further monitoring.

Patients are naturally interested in how the healing of the cervix proceeds after conization in the postoperative period.

Postoperative symptoms are as follows:

abdominal pain;
bleeding within 3 weeks after the procedure;
spotting brown discharge within a month after surgery.

The healing period after conization of the cervix lasts up to 3 months. It all depends on the type of intervention and the characteristics of the patient’s body.

Discharge after conization of the cervix is considered a natural phenomenon. During healing after the intervention, a so-called scab forms in the tissues, which begins to come out from the second week after the manipulation. From this moment on, the amount of discharge from the genital tract may increase.

Many patients claim that they felt the scab coming off after conization of the cervix, and even saw what it looked like, and after it, the discharge returned to normal in a short time. At the same time, other women who underwent surgery noted that they did not experience any special sensations when the scab passed away or increased discharge from the genital tract.

Cause for concern may be elevated temperature after conization of the cervix, general weakness and deterioration of health.

In order for the recovery period after the intervention to be successful, the patient must follow the following recommendations over the next 6 weeks:

avoid sexual activity;
refuse douching, baths and saunas;
exclude physical activity, do not lift heavy things;
do not use tampons;
do not take drugs that increase bleeding.

Pregnancy after conization

Conception, carrying a baby and childbirth after conization of the cervix cannot be an exception. The main thing is to follow all the doctor’s recommendations during rehabilitation and the gestation period itself.

What features may occur during pregnancy and childbirth after conization of the cervix:

For many women, the doctor places a suture on the cervix to prevent its early opening. This is explained by the fact that the consequence of conization of the cervix is scar tissue changes, due to which muscle tone the organ becomes weaker. As a result, cervical insufficiency may occur. This means that at any moment it can open and the pregnancy will be terminated. To avoid this, sutures are applied.
Is it possible to give birth naturally after conization of the cervix? Most likely no. The operation undergone is an indication for a cesarean section.
During pregnancy, the patient must be under mandatory medical supervision.

Complications

Complications after conization of the cervix practically do not occur. This is due to the fact that nowadays the operation is carried out using modern methods and the latest equipment. But these factors cannot fully guarantee the absence of possible complications.

What may be the consequences after conization of the cervix:

prolonged and heavy bleeding;
infection of the genital organs;
stenosis of the cervical canal;
isthmic-cervical insufficiency of the cervix during pregnancy;
spontaneous miscarriage or premature birth;
cicatricial changes in the tissues of the reproductive organ.

Regardless of how cervical conization is done - knife or loop method, a scar almost always remains on the tissue. Normally, it should not bother the patient or cause her any discomfort in the future.

There are practically no negative consequences of laser and radio wave conization of the cervix; no traces are left on the cervix - the tissues heal quickly and easily. Wherein possible complications are kept to a minimum.

Urgent need to apply for medical care under the following conditions:

discharge after conization of the cervix continues for more than 3 weeks and/or has acquired an unpleasant odor;
strong pain sensations appeared in the lower abdomen that were not there before;
body temperature above 38°C;
bleeding appeared after conization of the cervix, and the woman does not know what to do.

For many patients, the operation became a successful step on the path to recovery and long-awaited motherhood. If there is a need for conization of the cervix, for example, with grade 3 dysplasia, there is no need to be afraid of the procedure. Modern treatment methods have reduced possible risks to a minimum, and in exchange receive priceless health.

mama66.ru

Indications for surgery

Conization is a procedure for removing a cone-shaped area of the cervix and cervical canal, one of the methods of treating precancerous pathologies. You can see what tissues with atypical cells look like in the photo.

When surgery is required:

the presence of pathological areas in the cervix;
detection of atypical cells in a smear;
with dysplasia of 2.3 degrees;
erosions, polyps;
leukoplakia;
cervical inversion.

Conization is carried out to remove scars on the cervix after ruptures, injuries; surgery is necessary if, after treatment with cryodestruction and electrocoagulation, relapse of dysplasia is observed.

Preparation for conization surgery

Surgery is carried out 1–2 days after the complete completion of monthly discharge - in the first phase of the cycle, the level of estrogen increases, these hormones contribute to the rapid restoration and healing of the epithelium.

List of mandatory tests:

clinical blood and urine analysis;
tests for HIV, syphilis, hepatitis;
determination of blood group, Rh factor;
coagulogram;
fluorography;

A month before the operation, a full gynecological examination, colposcopy, a smear for cytology and microflora, and an ultrasound of the pelvic organs are performed. If signs of infectious or inflammatory diseases are detected, anti-inflammatory therapy is carried out.

Types of conization of the cervix

With any surgical technique, the area of the affected mucosa is cut out, while 5–7 cm of healthy tissue is captured. With economical conization (cone-shaped biopsy), the size of the removed area is 1–1.5 cm; with high conization, 65% or more of the length of the cervical canal is removed.

Knife

The operation is performed using a scalpel under general or epidural anesthesia; 40 years ago this method was considered the only way to remove damaged areas of the cervix. Nowadays this method of intervention is rarely used due to the large number of complications - heavy bleeding, scar formation, tissue perforation.

The main indications are precancerous pathologies, malignant tumors at the initial stage of development, grade 3 dysplasia. Price – 4.5–5.5 thousand rubles.

How the operation works:

The affected areas of the epithelium are treated with iodine solution; areas with atypical cells acquire a whitish tint.
An extended colposcopy is performed.
The cervix is fixed with forceps.
A cone-shaped area is excised with a scalpel.
The edges of the wound are coagulated to prevent severe bleeding.
Blood is removed with sterile cotton pads.
The duration of the operation is 20–30 minutes.

After the knife method, scars remain on the cervix, which prevent conception and normal childbearing, so the operation is performed on women who have already given birth.

Radio wave conization

Radio excision is carried out using a Surgitron or Fotek device, which acts on the affected tissue with a high-frequency radio wave knife; general or regional anesthesia is used for the operation. Price – 10–15 thousand rubles.

How the operation works:

The affected area is treated with a gel with an anesthetic effect.
The affected area of the epithelium is isolated with iodine solution.
Speculums are inserted into the vagina, the cervix is fixed, and mucus is removed from the cervical canal.
A conizer is inserted into the cervical canal, and the desired mode is selected on the device.
A circle is made with a radio knife and the excised mucosal tissue is removed.
The blood is removed, the edges of the wound are coagulated, and the tissue is sent to the laboratory for further study.
The duration of the operation is 15 minutes.

Radiosurgery is an effective and common way to treat dysplasia. Advantages - minimal risk of bleeding and damage to healthy tissue, minimal recovery period, complications rarely occur.

Laser conization

Excision of damaged tissue is carried out with a laser beam under local anesthesia. Price – 12–25 thousand rubles.

After anesthesia and treatment of the affected area with iodine solution, a colposcope with a laser is inserted into the uterine cavity. Under the influence of high temperatures, damaged tissue is quickly evaporated, the edges of the wound are soldered and polished. The duration of the operation is 15 minutes.

Loop electroconization

During the intervention, an electrode with a loop is used different shapes, the operation is performed at stages 2, 3 of dysplasia under local anesthesia. The cost of the operation is 11–20 thousand rubles.

Stages of diathermoconization:

The cervix is treated with Lugol's solution or iodine.
An extended colposcopy is performed and the shape of the loop is selected so that it covers the entire affected area.
The cervix is fixed, and a passive electrode is placed under the patient’s buttocks.
The loop is twisted so that all tissues with pathological changes remain inside the circle; the number of turns depends on the degree of dysplasia and the size of the area with atypical cells.
The wound is coagulated.
The duration of the operation is 25 minutes.

With this method of conization, biological material can be obtained almost unchanged, which allows one to obtain the most accurate histological results.

Postoperative period

After conization, the patient is under medical supervision for 2–3 hours; if no complications are observed, the woman is sent home. The average duration of the recovery period is 1–3 months, the timing depends on the individual characteristics of the body, the initial size of the cone, the condition of the cervix, and the type of surgical intervention.

In the absence of complications, the healing process of the cervix proceeds without any special discomfort. After 7–10 days, the scab comes off, which closes the wound after cauterization of the vessels, and the process of restoration of the epithelium begins.

For several days after the operation, minor nagging pain is observed in the lower abdomen; vaginal spotting of a dark brown color does not always occur; it may disappear after a week, or continue until the next period. Active sex life after surgery, physical fatigue, taking Aspirin and other blood-thinning drugs can increase the intensity of bleeding.

What not to do for 1–2 months after surgery:

have sex;
lift weights more than 3 kg;
douching;
use sanitary tampons;
visit the swimming pool, bathhouse, sauna;
take a bath - you can only wash in the shower;
overheating and hypothermia must be avoided.

Repeated cytology is performed 3–4 months after surgery, then every six months for 3 years. If atypical cells do not appear, complete recovery is diagnosed; a preventive examination by a gynecologist can be performed once a year.

Pregnancy after conization

It is advisable to plan a pregnancy after conization one year after the intervention; the operation rarely affects the ability to conceive; problems arise with extensive resection or recurrence of dysplasia.

Conization negatively affects pregnancy - after the operation, the structure of the cervix changes, it becomes less elastic and shortens. Women often experience miscarriage - the cervix cannot withstand increased loads and dilates prematurely.

Natural birth after conization is possible, but in practice, delivery almost always occurs by cesarean section, since doctors are afraid of incomplete dilatation of the uterus.

Possible consequences and complications

Negative consequences after conization occur in approximately 1–2% of women. Possible complications are bleeding, the development of an inflammatory process due to infection, scarring, endometriosis, and menstrual irregularities.

Contraindications to conization of the cervix

Conization allows you to get rid of dysplasia and prevent the development of severe pathologies, but the operation has a number of contraindications.

In what cases is the cervical cone not removed:

the presence of foci of inflammation in the cervix, vagina;
acute infectious pathologies;
if it is impossible to clearly determine the boundaries of epithelial transformation;
the area of the affected epithelium is extensive;
cardiac, renal, liver failure, hypertension;
diabetes;
poor blood clotting.

Content

If the doctor recommends conization of the cervix, then there are good reasons for this. This is a serious operation, during which the center of the cervix with foci of pathologically altered epithelium is cut out in a cone shape. Many gynecologists recommend radio wave conization of the cervix. The doctor who prescribes this procedure should tell you what it is.

Equipment used

Doctors also call radio wave conization diathermoelectroconization. It is carried out with special devices:

"Surgitron";
Greenland;
RadioSurg;
"Fotek".

These are radio wave surgical generators. With their help, an incision is made into soft tissues and their coagulation using radio waves in the megahertz range.

The radio waves generated by the devices allow you to carefully make an incision and coagulate the wound surface. In this case, postoperative discomfort is minimized, and the likelihood of infection is reduced to zero.

Most devices used to conize the affected cervix using the radio wave method have a “cut with coagulation” mode. It allows you not only to cut off the required area, but also to immediately coagulate the treated surface, on which there is a large accumulation of blood vessels. But if necessary, the doctor can first cut out the tissue of the cervix and then carry out coagulation.

Preparing for surgery

Performing radio wave conization of the cervix is considered planned operation which is carried out after examining the patient. The list of mandatory studies includes the following:

general urine and blood tests;
checking the Rh factor, blood group;
assessment of the blood coagulation system;
taking bacterial cultures from the vagina and from the surface of the cervix;
conducting smears for atypical cells;
extended colposcopy;
tests for HIV, hepatitis B and C, and other infectious diseases.

It is also advisable to do an ECG and ultrasound of the pelvic organs.

The operation is scheduled after completing all prescribed examinations.

If contraindications to radio wave conization of the cervix are identified, the planned surgical procedure is canceled or postponed.

Features of the operation

Radio wave conization is carried out by gynecological surgeons. Optimal time for its implementation is the 5th – 7th day of the menstrual cycle. This period is chosen because the tissues have time to heal before the next menstruation. In addition, immediately after menstruation there is a high probability of non-pregnancy.

Conization takes 15-20 minutes and is carried out as follows:

the woman is located in the operating room in a gynecological chair;
Disposable plastic mirrors are inserted into the vagina (metal mirrors conduct current, so their use during radio wave conization is prohibited);
all vaginal and cervical discharge is removed with a tampon;
the cervix is brought down to the vaginal opening and fixed;
a special electrode is placed under the buttocks;
the area that is planned to be removed is treated with iodine solution (Lugol) to identify pathologically altered epithelium: the affected areas remain unstained;
the condition is assessed by colposcopy;
the conizer is inserted into the center of the cervix, inside the cervical canal;
the radio wave surgical generator is switched to the “cut” or “cut and coagulation” mode and the required power is selected;
the conizer itself is rotated around the axis and removed; together with the loop, the part of the cervix cut out by radio waves is pulled out;
the collected blood is removed with a swab; if necessary, the wound surface and edges are coagulated: this allows the incision to be narrowed.

The cervix is anesthetized by injecting an anesthetic solution (the tissue loses sensitivity after a few minutes). As a rule, a solution of Lidocaine 2% is used. During conization, adrenaline is added to the anesthetic; it is necessary to reduce bleeding.

Local anesthesia can be replaced with general anesthesia if the patient is not affected by drugs, used for local anesthesia, or she is allergic to these medications. Intravenous anesthesia is also given to women who experience severe fear.

The use of local anesthesia is possible due to the fact that the conizer heats up to no more than 55 0C. Tissues are cut under the influence of radio waves, not high temperatures. The area is captured so that not only the pathological epithelium is cut out, but also 3-4 mm of healthy tissue. This minimizes the likelihood that some problem area will remain. The standard cone depth is 5-8 mm.

Indications for surgery

Understanding what radio wave conization of the cervix means should be done by those patients who:

stage 2–3 dysplasia was detected, confirmed by histological examination;
part of the cervical mucosa turns into the vagina (ectropion);
A PAP test showed that there are cancerous or precancerous cells in the cervix;
Colposcopy revealed that there is a prismatic epithelium on the cervix, which is normally located in the cervical canal.

Radio wave conization allows not only to remove the problem area, but also to examine tissues in order to identify cancer cells. If the patient had dysplasia, then during the operation the pathologically changed cells are cut out. This method is considered effective method treatment of dysplasia.

The procedure allows you to detect invasive cancer on early stages. Thanks to this, the effectiveness of surgical treatment increases to 97%.

List of contraindications

In some cases, doctors do not even recommend radio wave conization. The list of contraindications includes:

period of pregnancy and breastfeeding;
presence of menstrual bleeding;
invasive cervical cancer;
various infectious and inflammatory diseases of the genitourinary system;
exacerbation of chronic diseases.

If possible, radio wave conization is postponed. The operation is performed after there are no contraindications to its implementation.

If invasive cancer is confirmed, the planned radio wave conization is canceled, and the woman is sent to an oncology clinic.

Recovery period

After radio wave conization, patients recover quite quickly. The woman is left under observation for 2-4 hours, then she can be sent home.

In the first days of the postoperative period, patients complain of pulling, aching pain. The appearance of heavy discharge after surgical bleeding is considered normal. They can be serous-bloody or brown, in some they are whitish with various inclusions.

On days 5-8, the process of scab removal begins. This is the name given to the accumulation of dead cells that forms during coagulation of the wound surface. The process of scab rejection begins after new epithelium has formed under it. Sometimes its discharge is accompanied by an increase in the intensity of blood discharge.

The patient's condition should be monitored by a doctor. If bleeding starts or severe sharp pains, then an urgent consultation with a gynecologist is required. The woman may need hospitalization.

You should see your doctor 2 weeks after the operation. He must evaluate the condition of the cervix and make sure that there are no negative consequences of radio wave conization of the cervix. During the examination, a colposcopy is performed and a smear is taken for cytology. For 5 years after surgery, it is necessary for the patient to visit a gynecologist once every 3 months.

The cervix heals after radio wave conization in most women within 4 weeks. After the first menstruation, it should be completely covered with new epithelium. But in some cases, the recovery process may be delayed - this depends on the body’s individual ability to regenerate tissue and the volume of tissue removed.

To prevent complications some gynecologists prescribe antibacterial therapy.

Established restrictions

It is possible to prevent the development of complications after radio wave conization of the cervix if you follow the recommendations of doctors. They prohibit:

intense physical activity;
lifting weights (from 5 kg);
swimming in open reservoirs, pools;
visiting baths, saunas;
douching;
use of tampons;
sexual acts.

These recommendations must be followed for 6 weeks from the date of surgery. When heavy discharge appears and at the beginning of menstruation, you can only use sanitary pads. It is easy to injure an unhealed cervix, so any manipulation with penetration into the vagina is prohibited.

Possible complications

After performing radio wave conization of the cervix, negative consequences occur extremely rarely. But the possibility of their occurrence cannot be ruled out. Therefore, a woman needs to know in which cases an urgent consultation with a gynecologist is required.

Possible postoperative complications include:

bleeding;
infection of the wound surface;
stenosis (pathological narrowing) of the cervical canal.

Bleeding is possible if not all vessels were cauterized during surgery. It can also begin when the scab comes off. This situation is possible if the new epithelium has not yet fully formed or it was damaged during the process of crust rejection.

You should contact a doctor if you notice an unpleasant odor in your discharge. This indicates a possible infection. You should also consult a doctor if your body temperature rises (if it rises to a level of 37.5 0C or higher).

The first and second periods after conization differ from normal ones: they pass more abundantly. Their duration also increases. But, as a rule, by the third cycle the condition is completely normalized.

Long-term complications of radio wave conization include:

deterioration of fertility (possibly due to stenosis of the cervical canal or impaired properties of cervical mucus);
development of isthmic-cervical insufficiency during pregnancy.

Isthmic-cervical insufficiency is a fairly rare complication of conization. But if the patient has been diagnosed with this, then she must strictly follow all the recommendations of the gynecologist. In this condition, the cervix is unable to support the growing fetus - it begins to open. The likelihood of late miscarriage, the onset of premature labor, or infection through an open cervical canal increases.

But you should not refuse radio wave conization due to the risk of complications. They appear in only 1-3% of patients.

Conization of the cervix is a gentle and less invasive method of treating female diseases. The pathological process occurring in the genital area is not always amenable to therapeutic treatment.

In these cases, surgical manipulation of the organ is required to remove the changed tissue and prevent the progression of the pathological process. So 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, including healthy tissue.

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

For the outcome of the intervention to be positive, the patient must be aware of what cone-shaped resection is on the female genital organs and how it is performed. The operation is performed under local anesthesia and with minimal time.

Conization is carried out inpatiently, but hospitalization is not always necessary. A few hours later, after resection and examination by the attending physician, the patient is sent home.

When is conization prescribed?

The following indications are relevant for conization of the cervix:

dysplasia is a pathological change in the structure of an area of organ tissue, which is classified as a precancerous disease and requires mandatory treatment. Surgical treatment is necessary at any stage of pathology development. Conization of the cervix for grade 3 dysplasia is a mandatory surgical procedure;
presence of atypical cells in the upper epithelial layer of an organ tissue area (for cancer);
polyps and cystic formations inside the cervical canal;
scarring due to medical manipulations or ruptures during childbirth;
migration of atypical cells into the cervical canal, especially with a rapidly growing pathological focus;
ectropion, organ leukoplakia;
cervical erosion, which, at in various ways does not provide treatment positive result and progresses

Purpose of the operation

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

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

Repeated conization of the cervix is rarely performed, but can be performed in case of relapse after previous treatment of the pathological focus.

Preparing for surgery

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

A month before 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 group and Rh factor;
blood biochemistry for hepatitis;
blood for AIDS and syphilis;
urine for general analysis.

What types of conization are there?

Depending on the type of pathological process, age and individual characteristics of the patient, conization is performed various methods. Only the doctor decides which surgical intervention to perform.

There are several instrumental approaches for performing the operation:

Loop technique- This is the most common method of removing pathological formations on an organ, which is carried out using a cone-shaped loop and a diathermocoagulation device.
Knife technique- This is conization using a scalpel, which is currently not used due to numerous complications.

Electroconization

Electroconization of the cervix for 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 attachments;
Diathermoelectroconization carried out using nozzles of shorter length, from one to three centimeters. It is important that when this method is carried out, gross deformation of the tissue does not occur in the future, and the operation does not have a negative effect on the woman’s reproductive function.

Laser conization of the cervix

When using a laser technique, the pathology is affected by a laser beam. Laser conization of the cervix provides a minimum of postoperative complications and the ability to regulate the volume of material taken for examination.

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

Radio wave technique is aimed at destroying a pathologically changed area 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 when tissue is dissected, coagulation of blood vessels occurs, which reduces the possibility of postoperative bleeding.
Radioconization of the cervix provides precise exposure to the pathological focus in the organ. The method is characterized by low pain and fast recovery after operation. Complications such as wound infection are rare.
Radiosurgical conization eliminates burns and destruction of healthy organ tissue. After manipulation, the function for childbearing is completely preserved.

Cryoconization

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

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

How is conization surgery performed?

The availability of modern techniques for carrying out therapeutic and diagnostic manipulations on a woman’s reproductive organs makes it possible to perform surgery on the uterus in as soon as possible. The operation is carried out under conditions day hospital.

Before manipulation special training not required. It is recommended to shave pubic hair and empty the bowels and bladder. 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.

In general, resection lasts about half an hour.

The 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 of the cervix on the mirrors and treating it 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 remain in a day hospital. After this time, the woman is sent home.

After operation

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

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

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

After resection, a scab forms on the organ, which begins to be rejected and come out in the second week from the moment of surgery. During this time, the volume of discharge may increase.

Basic restrictions

In order for the postoperative period of cervical conization 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;
exclusion of visiting the pool, saunas, baths and baths;
Limitation in lifting weights up to three kilograms;
eliminating tampons from use in personal hygiene;
exclusion from use medicines that help thin the blood (aspirin).

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

How does the cervix 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 comes off, after which the wound epithelializes. 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 volume bloody discharge more than four weeks;
burning and itching in the vulva area;
pain in the abdominal area after a quiet period;
resumption of discharge after its cessation.

In this period therapeutic measures are not carried out, but according to indications, taking into account the type of operation performed, the doctor may prescribe suppositories or douching.

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 may be grayish or yellow color, having a soft consistency. The removal of the scab goes unnoticed in most women.

The crust covering the wound protects it from penetration of pathogenic microbes. A new layer of epithelial cells is formed under it, and when it is formed, the scab begins to come off. 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 period of removal of the crust can increase to 7–10 days and the possibility of an increase in the volume of bloody discharge.

Possible complications

Complications after cervical conization are rare, but possible.

It can be:

prolonged and heavy bleeding;
inflammatory processes in the genital area;
scar changes;
cervical organ insufficiency during pregnancy;
endometriosis.

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

Growing pregnancy, putting pressure on the incompetent cervical organ, causes prolapse of the fetus and premature opening of the birth canal.

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

Bleeding after conization

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

The cause of this complication may be technical errors during the operation, as well as disruption of the menstrual cycle. If a vessel is damaged, then the help of a doctor and the use of hemostatic agents are required.

Discharge

The organ may bleed long time, even up to four months. Healing occurs naturally, so this process cannot be accelerated. Discharge after conization of the cervix appears immediately after surgery.

After a week or a week and a half, when the scab begins to come off, the discharge is greater than normal and may stop seven days after the scab comes off, or may persist for a month after the operation. Sometimes the operated uterus secretes blood for up to three to four months.

Pain in the postoperative period

Recovery after conization occurs with minor pain, which is localized in the lower abdomen and is similar in nature to pain during menstruation.

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

The stomach stops hurting a few days after 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 surgical intervention to be performed with minimal complications. For patients planning conization of the cervix 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 postoperative insufficiency of the cervical canal appears, 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 to term, 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 scheduled time, but in abundance. In some cases, the doctor prescribes iron supplements to compensate for blood loss.

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

Complete recovery of the organ after surgery occurs within three to four months, so the abundance of discharge during this period is functional in nature and does not require specific treatment.

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

Therefore, pregnancy after conization occurs after its final restoration. Hormonal imbalance with pathological changes 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 cervical conization can be natural or by caesarean section. Cone-shaped resection does not have any effect on the development of the baby.

The tactics of labor management depend on the size of the postoperative scar on the organ:

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

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

Cost of the operation

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 vary. Moscow is different from those provided medical services 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.

In 2% of cases, photodynamic therapy cannot be used without conization. It is required to clarify the diagnosis in case of significant cicatricial deformities of the cervix and in those rare cases when (PDT) as the method of choice is impossible.

Yes, this is not a reservation. I practice a therapeutic and organ-preserving approach to treatment, and the results speak for themselves - in 98% of cases, surgical conization of the cervix is not necessary. It is not required even to obtain a tissue sample (biopathic specimen) for histological examination. Why?

On the one hand, even at stage 1B cancer we have more than 80% chance of a process proceeding without metastases. On the other hand, after photodynamic therapy, the patient remains under my quarterly monitoring for a year, and any negative dynamics are immediately corrected by a repeat PDT procedure, and, if necessary, by surgery.

I am a practicing surgeon, so many of my conclusions were drawn from my own experience. At the end of the article, I will tell you which conization method I use in my practice and why.

Advantages

The method allows you to obtain an ideal biopath for histological examination and establish the diagnosis as accurately as possible.

Disadvantages of the method

Of all the methods of conization of the cervix, this method is considered the most traumatic. Conization with a scalpel causes heavy bleeding, has a long postoperative period and the highest percentage of complications:

narrowing (stenosis) of the cervical canal, which leads to infertility;

isthmic-cervical insufficiency, which is fraught with miscarriage at 16-36 weeks due to spontaneous dilatation of the cervix, and it will not be possible to do without suturing the cervix;

scars formed after the procedure make it difficult to transform the cervix into the birth canal and require a cesarean section for delivery;

Impaired cervical mucus production increases the risk of infection of the uterus and fetus.

Method 2. Loop conization of the cervix with an electric knife (electroconization of the cervix, LEEP, LLETZ)

In the USA, the procedure is called LEEP - Loop electrosurgical excision procedure, in Europe - LLETZ - Large loop excision of Transformation zone. Medical name This procedure is excision.

Video of loop conization of the cervix -

A high-frequency electric current heats a thin wire loop, which at temperatures above 80 ° C acquires the properties of a scalpel.

For the operation, the size and shape of the loop (semicircular, square or triangular) is selected in such a way as to remove the transformation zone in one pass.

After the operation, the bleeding vessels are “cauterized” with a spherical electrode.

High conization with removal of the inner region of the cervical canal is performed a little differently. It uses a so-called “sail” electrode.

The electrode is inserted into the cervix and rotated once or twice. This removes the cone-shaped area of the cervix.

The operation ends with treating the wound with an antiseptic.

Flaws

The thermal effect on the tissue remains, and cell death still occurs in the incision area.

Method 5. Laser conization of the cervix

Laser conization of the cervix is usually performed with a CO2 (carbon dioxide) laser.

If you dive into physics, lasers are a high-energy flow. Lasers for laser surgery operate in several modes.

1. The beam, less than 1 mm in diameter, is used like a laser scalpel. They use it almost the same way as a regular scalpel - they excise a cone. Using a laser in this mode is considered unreasonably expensive, although it allows you to obtain a biopath with almost no charred edges.

2. 2-3 mm beam is used to evaporate tissue. This process is also called vaporization, destruction or ablation.

Under the influence of high energy laser beam The water in the tissues heats up and evaporates in a fraction of a second. Evaporates along with tissues.

Laser ablation is carried out with micron precision - depending on the settings, to a depth of 20 to 200 microns. Therefore, to carry out conization to a significant depth, several laser passes are required.

The depth of vaporization when using a laser is 2-3 mm on the cervix, and up to 5-6 mm in the cervical canal area. Therefore, laser conization is used only for treatment of first degree dysplasia, less often – the second.

The laser requires high precision, therefore, in order to exclude accidental movements of the patient, laser conization is always performed under general anesthesia.

Disadvantages of laser conization

Laser conization has a very significant drawback. I do not use it in my practice, because after this procedure it is impossible to obtain tissue for reliable histology - in the vaporization mode, taking a biopath is impossible, and in the scalpel mode, the tissues have extensive thermal damage, which makes the biopath unsuitable for a full histological examination.

The laser method also has one more drawback - not all surgeons can get used to non-contact work with tissues.

In the article we looked at various types of cervical conization. In my practice, I prefer the loop radiosurgical method. On the one hand, minimal thermal damage to tissues is the key fast healing cervix. On the other hand, this technique, in combination with RDV curettage of the cervical canal, provides complete and most reliable information about the current diagnosis.

One PDT procedure eliminates the virus in the cervical canal and is the most reliable existing techniques lifelong prevention of recurrence and cervical cancer.