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9УДК 618.146-006.6-036.22-084:616-071 (470.66) ВНЕДРЕНИЯ НОВЫХ ИННОВАЦМИОННЫХ ФОРМ ПУТИ ОПТИМИЗАЦИИ ПРОФИЛАКТИКИ И РАННЕЙ ДИАГНОСТИКИ РАКА
ШЕЙКИ МАТКИ
Исакова Д.Б.
Андижанский государственный медицинский институт
В этой статье представлен сравнительный анализ данных традиционной и жидкостной цитологии, были изучены результаты, которые сильно отличаются друг от друга, кроме того, в статье говорится, что гистологическое исследование может подтвердить диагноз, ложноположительные результаты традиционных мазков шейки матки, а также результаты сообщалось о других современных исследованиях
Ключевые слова: профилактика, оптимизация, рак шейки матки, диагностика.
YANGI INNOVATSION SHAKLLARNI JORIY ETISH BACHADON BO'YNI SARATONI PROFILAKTIKASI VA ERTA TASHXISINI OPTIMALLASHTIRISH YO'LLARI
Ushbu maqolada an'anaviy va suyuq sitologiya ma'lumotlarining qiyosiy tahlili keltirilgan, ularning natijalari bir-biridan juda farq qilishi o'rganilgan, bundan tashqari maqolada gistologik tekshiruv tashxisni tasdiqlashi mumkinligi, bachadon bo'yni an'anaviy smearlarining noto'g'ri ijobiy natijalari, va boshqa zamonaviy tadqiqotlar natijalari ma'lumotlari keltirib o'tilgan.
Kalitso'zlar: oldini olish, optimallashtirish, bachadon bo'yni saratoni, diagnostika.
INTRODUCTION OF NEW INNOVATIVE FORMS WAYS TO OPTIMIZE THE PREVENTION AND EARLY DIAGNOSIS OF
CERVICAL CANCER
This article presents a comparative analysis of the data of traditional and liquid cytology, the results of which are very different from each other, histological examination can confirm the diagnosis, false positive results of traditional smears from the cervix can be detected in 5% of cases, that is, dysplasia can be detected in the place where it is actually detected, and the results of liquid cytological studies
Keywords: prevention, optimization, cervical cancer, diagnosis.
Introduction. Cervical cancer is one of the most common oncological diseases and accounts for about 12-20% of malignant neoplasms of the female genital organs[1,4,10].
Considering the fact that cervical cancer is a visual localization and for its detection there is no need to use expensive equipment and complex research techniques, but rather the competent use of long-existing accessible and informative methods of morphological and endoscopic diagnostics [5,7,8]. This allows timely treatment of background and precancerous processes of the cervix and completely prevent the development of cervical cancer.
However, at present, cervical cancer is detected in a significant part of patients already at the late stages of the disease (III-IV), when the effectiveness of modern treatment methods decreases sharply, which affects the survival time of this contingent [2,9]. As is known, survival after specialized treatment for cervical cancer is inversely proportional to the stage of the disease.
Inflammatory diseases of the pelvic organs occupy a leading position in the structure of gynecological diseases and are the most common cause of women's reproductive health disorders. A significant proportion of them are inflammatory processes of the cervix - endo- and exocervicitis [3,7]. The increase in the prevalence of cervicitis is associated with an increase in the number of cases of atypical course of the infectious process, as well as with little or no symptoms, even in the acute stage.
Chronic cervicitis, along with inflammatory complications, can cause the development of infertility, miscarriage, premature birth, intrauterine infection of the fetus, postpartum purulent-septic complications, plays an important role in the formation of dysplasia and cervical cancer [6,8]. In
recent years, there have been trends in the incidence of cervical cancer in women in the age group up to 29 years. The risk of cervical cancer associated with highly oncogenic HPV types and the lack of effective etiotropic agents for the treatment of this infection require finding the most optimal choice of drugs or their combinations during therapy. In this perspective, it is very important to identify the oncogenic potential of the virus, since this determines the need for conservative or operative treatment tactics.
The purpose of the study. Evaluation of new organizational forms of early diagnosis of cervical cancer in the conditions of the formation of the Andijan region.
Materials and methods of research. 200 women aged 18-52 years with signs of chronic exo-and endocervicitis were examined: the main group consisted of 547 patients with the presence of HPV infection, the comparison group consisted of 224 women with the absence of HPV.
The results of the study. As a result of the examination of patients of both groups, it turned out that 61% of them had sexually transmitted infections: every third has an association with conditionally pathogenic microflora, and every second has a combination of 2 to 4 infectious agents.
According to the results of PCR diagnostics, infection with high-oncogenic HPV types in women of the main group without signs of cervical dysplasia was 67.8%, low-oncogenic - 49.6%. In the presence of Cin isolation, the frequency of HPV of highly oncogenic serotypes significantly prevails over low-oncogenic ones and amounts to 84.2 and 27.4%, respectively, which confirms the role of HPV in the formation of proliferative pathology of the cervix. Mixed infection with various types of HPV was recorded in 46% of cases. 22% of women had 2 types of HPV, 15% - 3 types, 9% - 4 or more. Type 16 was most often detected - in 26.3% of cases, type 58 - in 10.6%, type 18 - in 8.4%, type 31 - in 7.8%, type 33 - in 6.1%.
Analysis of the concomitant flora of the cervical canal showed that more often papillomavirus infection was accompanied by chlamydia, ureaplasmas, mycoplasmas, Candida fungi, Gardnerella, gram-positive cocci and gram-negative rods against the background of the absence or sharp decrease in the content of lactobacilli. It should be noted that in patients with HPV infection, infection of the cervical canal with pathogens such as chlamydia, mycoplasma, ureaplasma, trichomonas, HSV is observed much more often than in the absence of HPV.
According to the results of liquid cytological examination, 188 women with chronic cervicitis revealed cervical epithelial dysplasia (74 - Kin, I, 64 - Qin II, 50 -Qin III degree), of which 169 patients - with the presence of HPV and 19 - with the absence.
It should be noted that women with dysplasia, as a rule, had an atypical colposcopic picture in the form of acetobelic epithelium, leukoplakia, punctuation, mosaic and their combinations. In 583 patients with chronic cervicitis without signs of dysplasia, the colposcopic picture manifested itself in the form of diffuse hyperemia and swelling of the exocervix with pronounced and easily bleeding vessels, in 318 of them - in combination with iodine-negative areas, gentle punctuation and/or mosaic. Thus, in a larger number of patients with chronic cervicitis, the colposcopic picture is characterized by atypical changes in the cervix, which often leads to the unjustified use of destructive methods of treatment.
When analyzing the data on the total duration of sexual life in the anamnesis of the surveyed residents of the region, there was a tendency to increase the risk of developing cervical cancer with an increase in the number of years of sexual life. But the data obtained are statistically insignificant.
Sexual dissatisfaction over a long period in patients with cervical cancer was noted in 58.7% of cases, and in women of the control group - in 41.5%. Normal sexual satisfaction in sexual intercourse was noted in sick women only in 29.1%, in women of the control group - in 42.5% of cases (p<0.05).
We have established significant differences on such a basis as the "number of sexual partners". In terms of the number of extramarital sexual contacts, patients with cervical cancer outnumbered the control group, and the greatest difference between the compared groups was observed in cases of more than four sexual partners (32.3% among sick women versus 19.5% in the control group, p<0.05).
Among the examined women who had cervical cancer, 25.9% were not protected from pregnancy. Those who were protected from pregnancy used various means: mechanical - 25.1%, chemical - 3.6%, hormonal - 7.2%, interrupted sexual intercourse - 32.5%, cycle - 5.7%. Women in the control group used oral contraceptives 1.2 times less than patients with cervical cancer, and were 1.3 times less likely to be protected by interrupted sexual intercourse (p<0.05). And although the differences are unreliable, these facts are extremely important because they lead to a number of dishormonal and psychogenic disorders in the body.
The fact that the number of sick women who used mechanical contraceptives turned out to be almost twice as much (47.5%) compared to healthy women (25.1%) confirms the pathogenetic significance of this factor (p<0.05).
Pronounced links with the incidence of cervical cancer were found in relation to the age of women at first birth. Thus, among the sick women, in comparison with the control group, persons with first childbirth aged over 40 years prevailed (4.3% and 3.1%, respectively). The number of women who did not have childbirth was significantly lower compared to the group of patients with malignant tumors (2.4% vs. 7.6% in the control).
Among women with cervical cancer, there is a greater percentage of people with a significant number of abortions (more than six) in the anamnesis than in the control group (29.4% vs. 13.5%, respectively, p<0.05). Among healthy women, 2.2 times more often there were women who had no history of abortion.
When statistically verified, the reliability of the dependence of the occurrence of cervical cancer on age at the first abortion turned out to be valid (p<0.05). For example, the first abortion before the age of 18 was more often registered among patients with cervical cancer (2.9%).
Among patients with cervical cancer more often than in the control group of women, there were cases with the presence of endocrine pathology - thyrotoxicosis, diabetes mellitus, etc. (28.7% and 19.2%, respectively, p<0.05) and diseases of the urinary system - cystitis, pyelonephritis, urolithiasis (12.6% and 7.8%, respectively, p<0.05).
Prevention of cervical cancer depends entirely on the complex of organizational forms of possible access to highly qualified specialists (oncogynecologists), the availability of highly informative research methods, the need to use methods of individual prediction of the risk of its occurrence in this contingent of women and to ensure timely treatment of precancerous pathology of the cervix in modern health conditions.
Taking into account the fact that the informativeness of the cytological method is determined by the level of training of specialists and the quality of material sampling, the advantages of liquid cytological examination over the traditional one are obvious: the latter was associated with a high level of both false positive and false negative results. In this regard, the liquid method is a more reliable laboratory test, which allows us to recommend it for the examination of women with cervical pathology.
Conclusion. The results of the analysis of the main indicators of cancer care for the female population indicate a positive trend associated with the introduction of highly qualified specialists in the conditions of Andijan of the female population, the development of an algorithm for the examination and selection of persons with high cancer risk using diagnostic prognostic coefficient maps, in addition to the activities carried out by the AOOD. It is important that preventive measures and the program as a whole, which affected the main indicators in oncogynecology in this region, retain a prolonged effect on their value in the conditions of the established oncological service in the AOOD.
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