CC BY
9COLPOSCOPIC ANALYSIS OF CERVICAL PATHOLOGY IN WOMEN WITH
UTERINE FIBROIDS
Guljamol Fazliddinovna Makhmudova
Bukhara State Medical Institute
ABSTRACT
Some of the patients who underwent surgical treatment of uterine fibroids, from 60% to 95% of patients with reproductive ovaries, undergo radical surgery, which not only facilitates reproductive and menstrual function, but also leads to a greater number of vegetative-vascular and psycho-emotional changes. We used the colposcopic method to detect cervical pathologies in women with uterine fibroids. As a result of colposcopic examination, 22 (31.4%) patients of group 1, 10 (33.3%) patients of group 2 and 8 (32%) of the control group showed signs of inflammation of the cervix and the mucous membrane of the cervical canal, exoservicitis.
Keywords: uterine fibroids, cervical pathology, exoservicitis, endoservicitis, colposcopy.
Relevance: uterine fibroids in the reproductive organs are very common threesomes: in 13-27% of cases, uterine fibroids are present, primary infertility in every fifth patient is observed in every fourth patient with triplets, secondary infertility (1-5). Uterine fibroids From 60% to 95% of patients with surgical treatment of fibroids undergo radical surgery, which not only facilitates reproductive and menstrual function, but also leads to more vegetative-vascular and psychoemotional changes. Despite the fact that uterine fibroids are the most common disease in a woman's body, the treatment of this disease remains a complex and complex problem. All methods of treatment can be divided into two groups: conservative, surgical. The main goal of conservative treatment of uterine fibroids is to stop the growth or resorption of the tumor, which is used to prevent menometrorrhagia and anemia. A.L. Tiksomirov considers hormone therapy to be one of the main pathogenetic methods of conservative treatment of uterine fibroids (2000). Some time ago, it was recommended to use drugs of various types of androgens (testosterone propinate, methyltestosterone), progestogen (progesterone, pregnin) and tonomotor (pituitrin, hyphotosin, mammophysin). Recently, their use has been limited due to the lack of androgen effect (virile syndrome, amenorrhea, hoarseness of voice). Currently, norethisterone, orgometril, gestrinone, nemestran are recommended). Under the influence of these drugs, the fibroids and the uterus itself on average decrease to the size of 1-2 weeks of pregnancy, blood loss during menstruation decreases, the hemoglobin content normalizes. But if the fibroid reaches the size of 8 weeks of pregnancy, it will have clinical efficacy (1,3,4). Antigonodotropins (danazol,
gestrinone) and gonadoliberin agonists (Zolodex, diferilin, buserelin) with a steroid structure, they affect the size of myoma nodes, under their influence, the size of myoma nodes can decrease by 55%. But their effect is temporary, with the cessation of taking the drug and the restoration of menstrual functions, with symptoms of trophic disorders, an exponential growth of fibroids is observed in 67% of patients (2,3,5). Despite the great achievements of conservative treatment of uterine fibroids, drug treatment (primarily hormone therapy) is considered secondary. These drugs are recommended to stop the growth of the tumor, to cure the symptoms of the disease. Even the most modern medicines have a temporary effect [1-8].
The structure of cervical diseases with uterine fibroids, subtotal hysterectomy performed with cervical disease, as well as diseases of the cervix that are under the supervision of an uninhabited dispensary, the effectiveness of various treatment methods and rehabilitation after treatment of patients of the same group have not yet been sufficiently studied.
In order to achieve the effectiveness of the development of epidemiological features and comprehensive preventive measures in regions with high risk factors for cervical cancer, a number of scientific studies are being conducted around the world. The tasks in this regard are to assess and predict trends taking into account regional characteristics, based on an epidemiological analysis of the incidence and mortality from cervical cancer among women; it is based on a system of comparative estimates of the incidence and mortality from cervical cancer in areas with a high risk of the disease among women. The aim of the study: to study the position of the cervix and the tactics of cervical pathology in women who underwent total hysterectomy and did not undergo surgery due to uterine fibroids.
Material and methods: 100 patients with uterine fibroids of two groups, with controlled uterine fibroids aged from 26 to 55 years, with an average of 37.3 ±0.8 uterine fibroids were analyzed.
Group 1 - 70 cases of uterine fibroids treated surgically;
By the 2nd group, 30 ael departments have been organized, which are under the supervision of a dispensary with uterine fibroids.
The control group consisted of 25 patients with an average age of 38.2±0.8 years, who
had no pathology in the uterine body.
Results:
During the examination of patients, the main emphasis was placed on the presence of pathology in the body and cervix during ananesia. The means and methods of contraception used by the patient were also emphasized. The main attention was paid to the complaints of patients, the factors of the development of diseases of the body and cervix were considered. The effectiveness of earlier treatment has been thoroughly studied. On average, 37.3±0.8 patients were examined, from 26 to 55 patients.
This is an examination and revision of the cervix area, the condition of the vagina and vulva, in which the epithelial layer of the cervix is enlarged 15 times under a microscope. Colposcopy-Leisegangll is viewed through a colposcope, the position of the epithelial fundus of the bund is performed in a position of 15-fold magnification [9-18]. Extended colposcopy was performed according to a generally accepted technique: the mucous membrane of the cervix is not treated at first, then treated with 3% acetic acid, at the end it is checked on an aqueous solution of 2% Lugol (Schiller probe). To evaluate colposcopic lubrication, we used the international colposcopic terminology, revised by the International Colposcopic Association (organization), which studies cervical pathology and colposcopy in Barcelona in 2003.
The material for cytological examination is taken from the upper part of the cervical canal, the transition zone and the endroservical. The lubricated grease is ground into a mixture of Nikoforov (1:1 most alcohol and ether) at a temperature of 20 minutes. The preparations are obtained with chalk based on the papanicolau method: hematoxylin chalk, phosphoric sulfuric acid and carrot G, then stained with green, brown Bismarck and Y-eosin.
He used the classification of Papanicolaou to evaluate the results of cytological examination. The result is typical for morphologically altered epithelial cells for the 2nd degree, typical for a cytogram based on normal cells for the 1st degree, in which there is the appearance or metaplasia of epithelial cells in an enlarged state of the nucleus, in the 3rd degree there is the appearance of clearly morphologically altered nuclei, called discariasis, characterized by the appearance of atypical cells of the 4th degree [19-28]. Morphological studies of biopsies of the cervix and deeply located tumors were carried out in the laboratory of pathomorphology.
As a result of colposcopic examination, 22 (31.4%) patients of group 1, 10 (33.3%) patients of group 2 and 8 (32%) of the control group showed signs of inflammation of the cervix and the mucous membrane of the cervical canal, exoservicitis. These patients had a red rash that appeared after treatment with a 3% solution of acetic acid based on hyperemia and edema. After the transfer of Schiller (cinema) si, it became known that these rashes were not smooth and dense. The namoen of cervicitis was caused by edema that was visible to the eye around the cervical canal, where hyperemia and yellowish fluid separated. The colcoscopic type of exoservitis, which was detected in combination with ectopic elements, was detected in 2 (2.8%) patients of group 1 and in 1 (3.3%) patients of group 2. During the same period, there was noticeable hyperemia and swelling of the external mucous membrane of the cervix, as well as a state of increased secretion of glands. There is also a case of an invisible rash. When analyzed with Lugol's solution, an uneven spot on the mucous membrane is observed.
1 group 2 group Control group
Ekso and endoservitsit 22 (31,4%) 10 (33,3%) 8 (32%)
Ektopic eksocervix 1 (1,4%) 2 (6,6%) 1 (5%)
Eksocervix's cist of32 (45,7%) nabotov 22 (73,3%) 10 (40,0%)
Eksocervit 27 (38,5%) 6 (20%) 4 (16%)
Polip of cervix 7 (10%) 2 (6,6%) 3 (12%)
Leykoplacia 4 (5,7%) 1 (3,3%) 1 (4%)
Ektopia 30 (42,8%) 11 (36,6%) 7 (28%)
CIN I-II 5 (27,8%)
Cancer 1 (5,5%)
During colposcopic examination, ectopia of the transformation zone was observed in 1 (1.4%) patient in the second group, 2 (6.6%) and 1 (5%) patient in the control group. After the operation, reddish spots appeared, which were formed due to the outflow of capillaries, after testing with a solution of acetic acid, without a clear appearance of a whitish spot. The vaginal mucosa was distinguished by the presence of edema, mild pain in the analyzed jar and sometimes bleeding. With the development of the inflammatory process after the Schiller test, the appearance of rashes in the non-smooth, iodonegative and iodopositive parts was observed as a result of desquamation and construction in some areas of the epithelium on the mucous membrane of the exoservix and vagina.
Colposcopy of Leukoplakia charaenida consists of iodonegative zones with clear boundaries, has a yellowish-white hue and uneven relief. There are no vascular manifestations in these zones. The leukoplakia zones were leaking when treated with acetic acid, when treated with Lugol's solution there was no pronounced prismatic glycogen epithelium. Cervical leukoplakia was detected in 1 group 4 (5.7%), in 2 groups 1 (3.3%) and in 1 (4%) patients of the control group.
The cervix is an ectopiaziphysiological phenomenon, it is not included in the diseases of the cervix. During colposcopy, the cylindrical epithelium has clear and smooth borders, the upper part of which is covered with a pale pink or red hue, and the multilayer is covered with a flat epithelium. At the point of transition of the cylindrical epithelium into the flat epithelium with several cavities, there are no signs of isolation of the haraen. In it, the fluid flowing out of the endoservix was slimy, transparent and sparse. When treated with 3% acetic acid, the upper part of the ectopia is clearly visible, which has acquired a whitish color. During the analysis of Schiller with Lugol's solution, the color of the epithelium did not change due to the absence of glycogen in its composition, but the multilayer flat epithelium around it received an even dark brown shade. Ectopia was detected in 30 (42.8%) patients from group 1, 11 (36.6%) from group 2 and 7 (28%) from the control group. Based on the instructions of the research groups, 18 patients underwent cervical biopsy, and the resulting material was analyzed in the pathology department.
Conclusion: when analyzing the obtained malumotlarni, it can be concluded that when analyzing patients in the group, it was found that children were infected with infectious diseases and extragenital diseases, and their frequency was not studied in the group. When analyzing patients with uterine fibroids, infectious and inflammatory gynecological diseases, mainly cervicitis and chronic salpingoopharitis of the musculature, attract attention. The analysis of patients with cervical pathology showed that 67% of the 2 main groups of patients had a certain number of diseases with the term cervical erosion. It is known that cervical erosion is a disease that is very rare and indicates desquamation of the epithelium, in this case, etiotropic treatment is recommended instead of destructive treatment. Many patients were treated with various destructive methods without additional examination and without an accurate diagnosis. During the study of the results of extended colposcopy, the same thing became known, fakatgina sometimes accurately correlates the colposcopic properties of the cervix, which are characteristic of patients with fibroids. Another thing that attracted attention was that in the structure of cervical pathology, patients of all groups had different degrees of inflammation of the EXO- and endoservix. The patients of the main group had more signs of cervitis than the patients of the control group. Cervical canal polyps are relatively rare in all groups of patients. On the basis of the inflammatory process of the cervix, various pathological changes were detected in some patients, that is, diseases
such as abnormal colposcopic zone of atypical transformation, iodonegative zones, leukoplakia, smooth warts.
It should be noted that pathological cervical jaundice has been poorly studied in patients with gynecological diseases. More precisely, research work on the characteristics and frequency of cervical diseases that occur in combination with the pathology of the reproductive system is rather insufficient. There are no clear indications for differentiated treatment of patients with gynecological pathology. Analyzing the literature, we see that the cervix is an organ that requires hormones, like the uterus itself, and pathological changes indicate a commonality of specific pathogenetics based on development. But from the point of view of anatomical and functional nuances, the cervix is an organ in an autonomous state, therefore, the pathology that develops in it, in particular gynecological pathologies, has not yet been fully studied. In particular, in patients with cervical problems, the structure of the disease of patients who were not treated surgically included in the dispensary control, the condition of the cervix in patients after subtotal hysterectomy, the structure of cervical diseases has not been fully studied. The fertility of methods of cervical treatment and rehabilitation after treatment was also not determined. Due to its high qualities, the upper method of investigation is considered one of the advanced methods by which diagnostics is carried out. But if the diagnosis is indicated, then the method of morphological examination of the biopsy of the cervix is considered a gentle method.
REFERENCES
[1] Makhmudova G.F. Age-related clinical,anatomical and morphological features of malignant tumors of the cervix// Journal of science and technology//2021.-P.-475-480.
[2] Guljamol Fazliddinonvna Makhmudova, Adkhambek Uygunovich Nurboboyev.Treatment of mechanical jaundice via the modern way// Scientific progress, 2021.-№6.-P.530-537
[3] Махмудова Г. Ф., Темирова, Д. В., &Баротова, Ш. Б. (2021). Бачадон буйни хавфли усмаларининг ёшга xosxycycMTrap^/Academic research in educational sciences // 2(5).-Б.-186-196. https://doi.org/10.24411/2181-1385-202100871
[4] Maxmudova G.F.,Soxibova Z.R., Mamedov U.S., Nurboboyev A.U. Fertil va keksa yoshli ayollarda bachadon bo'yni xavfli o'smalari tahlili (Buxoro viloyatida)//Oriental Renaissance: Innovative, educational, natural and social sciences//-2021.-V 8.-B. 175184.
[5] Nurboboyev A.U., Makhmudova G.F. Miniinvazive approach in the complex treatment of tumor and stone etiology of mechanical jaundice// International journal on Orange technology// Vol 3. Issue 9. Sep.2021.-P. 85-90
[6] Karieva, E. S., & Maksudova, F. K. (2017). Use of Mathematical Planning Methods for Selecting Optimum Combined Gel Compositions. Pharmaceutical Chemistry Journal, 51(5), 411-415.
[7] Кариева, Ё. С., & Максудова, Ф. Х. (2017). Использование методов математического планирования для выбора оптимального состава комбинированной гелевой композиции. Химико-фармацевтический журнал, 51(5), 60-64.
[8] Khadjimetova, K. R., Karieva, Е. S., & Maksudova, F. K. STUDY OF RHEOLOGICAL PROPERTIES OF DEXPANTHENOL GEL. ФАРМАЦИЯ ИШИНИ ТАШКИЛ ЭТИШ, 71.
[9] Maksudova, F. K., & Karieva, E. S. (2014). The diclofenac sodium release kinetics examination from 3% gel "in vitro" experiments. European journal of natural history, (2), 23-25.
[10] Azimov, A. A., Maksudova, F. K., Usmonova, M. K., & Yarkulova, Y. M. (2021). Marketing Research of the Pharmaceutical Market of Restorative Action Drugs of the Republic of Uzbekistan. European Journal of Life Safety and Stability (2660-9630), 12, 338-342.
[11] Агабабян, Л. Р., Гайибов, С. С., & Носирова, З. А. (2017). Особенности течения медикаментозного прерывания беременности у женщин с рубцом на матке. International scientific review, (2 (33)).
[12] Агабабян, Л. Р., & Насирова, З. А. (2017). Послеабортный уход-особенности контрацепции. In Фундаментальные и прикладные исследования науки XXI века. Шаг в будущее (pp. 48-50).
[13] Agababyan, L. R. (2019). i dr. Osobennosti chistoprogestinovoy kontratseptsii u zhenshchin s preeklampsiyey/eklapmsiyey. Voprosy nauki i obrazovaniya, (26), 75.
[14] Агабабян, Л. Р., & Ахмедова, А. Т. (2017). Возможности коррекции климактерических расстройств у женщин с противопоказанием к заместительной гормональной терапии. Problemy Reproduktsii, 23(3).
[15] Makhmudova, S. E., & Agababyan, L. R. (2016). The rehabilitation of patients, suffering vulvovaginal candidiasis (vvk), taking combined oral contraceptives (COCS). Национальная Ассоциация Ученых, (5), 32-32.
[16] Агабабян, Л. Р., Ахмедова, А. Т., Абдуллаева, Л. М., Насирова, З. А., & Махмудова, С. Э. (2019). Негормональная коррекция климактерических расстройств у женщин с эндометриозом. Вопросы науки и образования, (26 (75)).
[17] Makhmudova, S. E., & Agababyan, L. R. (2016). Effectiveness and acceptability of the prolonged combined oral contraceptives in women with anemia. In Новый вектор развития научной деятельности. Вызовы и решения (pp. 35-37).
[18] Махмудова, С. Э., & Агабабян, Л. Р. (2016). Контрацептивная эффективность и неконтрацептивные преимущества непрерывного режима приема кок у женщин с железодефицитной анемией. In ПРОФЕССИОНАЛ ГОДА 2016 (pp. 127-131).
[19] Nasirova, Z. A., & Agababyan, L. R. (2020). Reproductive behavior of women after cesarean section. International scientific review, (LXX), 88-92.
[20] Агабабян, Л. Р., & Хамзаев, Ф. И. (2018). Метаболические показатели у женщин с миомой матки на фоне избыточной массы тела. In ДОСТИЖЕНИЯ ВУЗОВСКОЙ НАУКИ 2018 (pp. 224-227).
[21] Махмудова, С. Э., & Атаева, Ф. Н. (2018). Опыт применения модульной системы для овладения педагогическими навыками в подготовке резидентов магистратуры по специальности" акушерства и гинекологии". In ЛУЧШАЯ НАУЧНАЯ СТАТЬЯ2018 (pp. 290-293).
[22] Makhmudova, S. E., & Ataeva, F. N. (2019). Evolutionary views on hypertensive disorders in pregnancy (literature review). In Advaced science (pp. 183-187).
[23] Махмудова, С. Э. (2017). Проблема диагностики экстрагенитального эндометриоза. Евразийский союз ученых, (10-1 (43)).
[24] Негмаджанов, Б. Б., Насимова, Н. Р., & Ганиев, Ф. И. (2019). Хирургическое лечение пролапса гениталий женщин репродуктивного возраста. Достижения науки и образования, (10 (51)).
[25] Махмудова, С. Э., Хамраев, Х. Х., & Ермонов, Р. Б. (2018). Современные представления о влияние пролонгированной оральной контрацепции на организм женщины. In ДОСТИЖЕНИЯ ВУЗОВСКОЙ НАУКИ 2018 (pp. 218-223).
[26] Махмудова, С. Э. (2017). Совершенствование методов контрацепции у женщин с анемией. In World science: problems and innovations (pp. 233-235).
[27] Агабабян, Л. Р., & Махмудова, С. Э. (2017). Современные подходы лечения железодефицитной анемии у женщин фертильного возраста. Вестник врача, 18.
[28] Махмудова, С. Э. (2016). Контраептивные и неконтрацептивные эффекты кок и принципы их применения после аборта. Евразийский союз ученых, (29-1).
