Kirurško liječenje preinvazivnih lezija vrata maternice

master's thesis

• Title (english): Surgical treatment of preinvasive cervical lesions
• Author: Antun Novko
• Mentor: Mato Pavić (mentor)
• Committee member: Joško Lešin (predsjednik povjerenstva)
• Committee member: Anko Antabak (član povjerenstva)
• Committee member: Mato Pavić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2024-09-11, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Preinvazivne lezije vrata maternice su novotvorine uglavnom pločastog epitela koje nastaju u transformacijskoj zoni vrata maternice i mogu progredirati u invazivni karcinom te predstavljaju sve veći globalni problem. Težina lezije određuje se citološki prema Bethesda sustavu ili prema udjelu epitela s abnormalnim stanicama. Dijele se na intraepitelne lezije niskog stupnja i visokog stupnja. Kod većine mladih žena, posebno onih mlađih od 25 godina, lezije često spontano regrediraju, što je ključno za donošenje odluka o liječenju. Humani papilomavirus (HPV) je glavni čimbenik rizika za nastanak preinvazivnih lezija. Iako je prisutnost HPV-a nužna za razvoj lezije, nije dovoljna sama po sebi; drugi čimbenici uključuju imunokompromitiranost, vaginalnu disbiozu, pušenje, infekciju Chlamydiom trachomatis, ranu seksualnu aktivnost, veći broj partnera, niži socioekonomski status i mnoge druge. Primarna prevencija uključuje cijepljenje koje je u nekim zemljama obavezno, dok se sekundarna prevencija provodi probirima kao što su PAPA test i HPV testiranje. Liječenje preinvazivnih lezija ovisi o raznim čimbenicima, uključujući dob pacijentice, paritet, veličinu i stupanj lezije te prethodno liječenje. Lezije niskog stupnja se ne liječe zbog visokog postotka samoizlječenja. Liječenje može uključivati ablacijske metode poput kriokirurgije i laserske ablacije, koje su brze i imaju nisku stopu morbiditeta, ali i veći broj recidiva te ekscizijske metode kao što su LLETZ, laser konizacija i konizacija hladnim nožem. Ekscizijskim metodama se može dobiti tkivo za analizu. Među ekscizijskim metodama, LLETZ pruža jednostavnost i nižu cijenu postupka uz isti broj komplikacija. Histerektomija se preporučuje ženama koje su završile s rađanjem i imaju patohistološku dijagnozu AIS na uzorku dobivenom dijagnostičkim ekscizijskim postupkom te je prihvatljiva ako ponovni dijagnostički postupak nije izvediv.

Abstract (english)

Preinvasive cervical lesions are primarily neoplasms of the squamous epithelium that arise in the transformation zone of the cervix and can progress to invasive carcinoma. They represent an increasing global problem. The severity of the lesion is determined cytologically according to the Bethesda system or by the proportion of epithelium containing abnormal cells. They are classified as low-grade and high-grade intraepithelial lesions. In most young women, especially those under 25, these lesions often regress spontaneously, which is crucial when making treatment decisions. Human papillomavirus (HPV) is the main risk factor for the development of preinvasive lesions. Although the presence of HPV is necessary for the development of lesions, it is not sufficient on its own; other factors include immunodeficiency, vaginal dysbiosis, smoking, Chlamydia trachomatis infection, early sexual activity, multiple sexual partners, lower socioeconomic status and others. Primary prevention includes vaccination, which is mandatory in some countries, while secondary prevention involves screening methods such as Pap tests and HPV testing. The treatment of preinvasive lesions depends on various factors, including the patient's age, parity, lesion size and grade, and previous treatments. Low-grade lesions are not treated due to the high rate of spontaneous regression. Treatment can involve ablative methods such as cryosurgery and laser ablation, which are quick and have low morbidity but higher recurrence rates, and excisional methods such as LLETZ, laser conization, and cold knife conization. Excisional methods provide tissue for analysis. Among excisional methods, LLETZ offers simplicity and lower cost with the same complication rate. A hysterectomy is recommended for women who have completed childbearing and have a pathohistological diagnosis of AIS on a sample obtained through a diagnostic excisional procedure. It is also considered acceptable if a repeat diagnostic procedure is not feasible.

• Keywords: cervikalne intraepitelne neoplazije; liječenje; kirurško liječenje; CIN
• Keywords (english): cervical intraepithelial neoplasia; treatment; surgical treatment; CIN
• Language: croatian
• URN:NBN: urn:nbn:hr:105:927576
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-09-04 12:14:15