Title Liječenje predinvazivnih lezija vrata maternice Title (english) Treatment of preinvasive cervical lesions Author Maša Alfirević Mentor Vladimir Banović (mentor)Committee member Slavko Orešković (predsjednik povjerenstva)Committee member Dinka Pavičić Baldani (član povjerenstva)Committee member Vladimir Banović (član povjerenstva)Granter University of Zagreb Defense date and country 2018-07-13, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Predinvazivne lezije vrata maternice danas se sve češće javljaju u žena mlađe dobi i s ciljem očuvanja fertilnosti sve se više daje prednost poštednijim metodama liječenja. Glavnu ulogu u njihovu nastajanju ima HPV infekcija visoko rizičnim tipovima kao i ostali rizični čimbenici: rizično spolno ponašanje, rano stupanje u spolne odnose, pušenje i drugi. Prije samog liječenja treba imati na umu da te lezije imaju sposobnost spontane regresije tako da se kod cervikalnih intraepitelnih neoplazija
... More tipa I (CIN I) može i odgoditi uz redovite citološke i po potrebi kolposkopske preglede. Liječenju se pristupa koristeći lokalnodestruktivne ili ekscizijske metode. Cilj lokalnodestruktivnih metoda je liječenje lezija nižeg stupnja kolposkopski vidljive promjene u zoni preobrazbe (eng. transformation zone - TZ) koja ne prodire u cervikalni kanal i one nemaju adekvatan tkivni uzorak za patohistološku analizu. U njih spadaju krioterapija, laserska vaporizacija i danas rijetko izvođene hladna koagulacija i radikalna dijatermija. Ekscizijske metode danas imaju prednost u liječenju jer pružaju uklanjanje cijele TZ bez destrukcije tkivnog uzorka koji se dalje može patohistološki analizirati. U njih spadaju konizacija nožem, CO2 laserska konusna biopsija, elektrodijatermijska ekscizija i histerektomija. Najčešće korištene metode liječenja CIN-a su elektrodijatermijska ekscizija TZ velikom petljom (eng. Large loop excision of the transformation zone - LLETZ) i krioterapija s obzirom da ih prate visoke stope izlječenja i nizak morbiditet. Kod liječenja cervikalnih glandularnih intraepitelnih neoplazija (CGIN), koje se sve češće nalaze kao slučajni nalaz uz CIN promjene, rijetko se koristi LLETZ. Najveću prednost ima konizacija nožem zbog dovoljne dubine uzorka, ali i histerektomija kao najradikalnija metoda kod žena koje su u pred- ili postmenopauzi sa dodatnom ginekološkom patologijom, kojima fertilitetna sposobnost nije prioritet, uz dokazan adenokarcinom in situ (lat. adenocarcinoma in situ – AIS) i isključene invazivne tumore. Konačno, nakon liječenja potrebno je redovito obavljati kontrolne citološke i po potrebi kolposkopske preglede s HPV-DNK testiranjima. Less Abstract (english) Today, preinvasive cervical lesions are increasingly common in younger women, and in order to preserve their fertility conservative treatment is preferred to other methods. Preinvasive cervical lesions are usually caused by HPV infection with certain types as well as other risk factors: risky sexual behavior, early sexual intercourse, smoking, and others. Before treatment, it should be considered that these lesions have the ability of spontaneous regression so that cervical intraepithelial
... More neoplasia (CIN 1) treatment can be delayed by regular cytological and, if necessary, colposcopic examinations. Treatment is accessed using ablation or excision methods. The aim of the former is to treat lower-stage lesions of colposcopically visible transformation zone (TZ) changes that do not penetrate the cervical canal and have no adequate tissue pattern for pathohistological analysis. Ablation methods are cryotherapy, laser vaporization, and the nowadays rarely performed cold coagulation and radical diathermy. Today, excision methods are the treatment of preference because they provide removal of the entire TZ without destruction of a tissue sample that can be further pathohistologically analyzed. Excision methods are cold knife conization, CO2 laser cone biopsy, electrodiathermy, and hysterectomy. The most commonly used treatments of CIN are large loop excision of the transformation zone (LLETZ) and cryotherapy, as they are accompanied by high healing rates and low morbidity. In the treatment of cervical glandular intraepithelial neoplasia (CGIN), which is increasingly found as a random finding with CIN changes, LLETZ is rarely used. Cold knife conization brings the greatest benefit due to the sufficient depth of the sample. Hysterectomy, although a radical method, is suggested for pre- or postmenopausal women with additional gynecological pathology, whose fertility is not a priority, with proven cervical adenocarcinoma in situ (AIS) and excluded invasive tumors. Finally, follow-up should include cytological and, if necessary, colposcopic examinations with HPV DNA testing. Less Keywords
predinvazivne lezije vrata maternice
HPV infekcija
liječenje
lokalnodestruktivne metode
ekscizijske metode
Keywords (english)
preinvasive cervical lesions
HPV infection
treatment
ablation methods
excision methods
Language croatian URN:NBN urn:nbn:hr:105:277670 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2018-12-28 09:49:28
