Why and how is conization of the cervix done?24.05.2022
Cervical conization is one of the methods for treating precancerous and background conditions in women. It consists in removing the cone-shaped region of the cervix and part of the cervical canal. This allows you to completely eliminate the likelihood of developing cancer, as it radically eliminates the problem. In some cases, a small area is excised and a histological examination is performed to identify atypical cells.
Indications and contraindications
The main purpose of conization is to remove areas that are highly likely to degenerate into a malignant neoplasm. This is the only method that helps to prevent a dangerous disease. Excision is also used for diagnosis.
Cervical conization is not for everyone
Indications for excision are:
- detection of altered epithelium;
- the presence of cancer cells in the smear;
- dysplasia II-III degree;
- cervical polyposis;
- scars as a result of rupture, trauma;
- eversion of the neck;
- inefficiency of electrocoagulation, laser treatment, cold exposure.
The operation is not performed for invasive cancer, which is confirmed histologically after colposcopy, as well as in the presence of acute or chronic infection.
It is not recommended to do it with an exacerbation of any disease or the inability to determine the boundaries of the altered epithelium.
The doctor should explain in detail the purpose and risks of the operation.
Manipulation is planned for 1-2 days after the end of menstruation. At this time, estrogen levels are at their highest and promote a speedy recovery. A month before the intervention, a woman should undergo an examination by a gynecologist, pass smears on the vaginal microflora, cytology and colposcopy.
If an inflammatory disease is detected during the check, it is completely cured and only then proceed to conization.
If other diseases are suspected, an ultrasound examination of the organs located in the small pelvis and lymph nodes may be prescribed. Altered tissues are examined using histological analysis.
There is a list of tests that must be passed without fail in two weeks, and only after studying the results, carry out the operation. This list includes:
- general clinical analysis of urine and blood;
- identification of the group and Rh factor of blood;
- testing for HIV infection and specific diseases (syphilis, hepatitis B and C);
- coagulogram, since poor coagulability can lead to bleeding, and high coagulability can lead to the formation of blood clots;
- X-ray of the lungs or fluorogram (if they have not been performed for more than one year).
The doctor explains to the patient what it is – conization, how it will be carried out, and also predicts the likelihood of complications after the intervention.
What is the operation
Conization takes place in several stages:
- A complete removal of tissues is performed, while a part of visible healthy cells is necessarily captured 7 mm from the edge of the pathological area.
- The resulting tissue is examined in the laboratory.
- When a negative result is obtained for an invasive form of cancer, treatment is considered successful and ends there.
- If the result is positive and degenerate cells are found, conization is considered a diagnostic procedure, then time is maintained for recovery in the postoperative period, and then a radical treatment of oncopathology is planned.
Currently, several types of conization have been developed, it can be carried out in the following ways:
- surgical method using a scalpel;
- electric current;
- radio waves;
- loop electroexcision.
The first two methods are used extremely rarely, as they are considered outdated and lead to the appearance of coarse scar tissue on the neck. This is unacceptable for a woman who is planning a pregnancy. During childbirth, with this complication, there will be problems with disclosure. These interventions are also accompanied by significant blood loss. The same results can be obtained using a laser.
Radio wave conization is considered more effective, does not burn tissue, does not cause bleeding. Its positive side is the absence of infectious complications, pain and a short rehabilitation period. But the most innovative way to perform an excision is to use a wire loop that wraps around the desired area and removes the tissue without damage.
The operation can be carried out in different ways.
The technique allows you to save the material for further histological examination. And blood vessels and nerve fibers are immediately coagulated during the intervention. Therefore, it proceeds painlessly and bloodlessly.
How does it go
First, the boundaries of the focus are determined, a preliminary colposcopy helps to determine them. In a modern clinic with new equipment and qualified personnel, the intervention does not require much time, in most cases it ends successfully and without complications. The longest conization time is about half an hour.
The surgical method was used everywhere 40 years ago, now almost no one does such operations, since they have serious consequences in the form of adhesions or scars. Before excision of the cone-shaped area, the affected tissue is smeared with iodine, while the areas with altered cells become white. The cervix is fixed with forceps, excised with a scalpel. The wound is coagulating.
Radio wave intervention is carried out using special devices. The mucous secretions on the neck are removed with a napkin, then the application area is treated with an anesthetic gel, lubricated with iodine. After that, the surgeon inserts a radioknife and, under the control of a mirror, makes a circular motion, the wound surface undergoes coagulation. The whole process takes no more than 15 minutes.
However, the consequences of such excision in the form of bleeding or infection are usually minimal.
Laser conization is performed under local anesthesia and is virtually painless. The disadvantage is that the tissue is not preserved and therefore a biopsy must first be done.
Loop electroconization is carried out using an electrode and a loop with a suitable shape. A prerequisite is the complete coverage of the affected area. Local anesthesia is used for anesthesia. The cervix is fixed, and a passive electrode is placed under the pelvis. After treating the removal area with Lugol or iodine, a loop is applied and the affected tissue is removed. The whole process takes about 25 minutes. Thanks to this technique, it is possible to save the cut tissue unchanged and send it for research.
With any type of intervention, short, mild pain or discomfort in the lower abdomen during the first two days is considered the norm. For their relief, it is allowed to use non-steroidal anti-inflammatory drugs. They help relieve soreness and prevent the development of inflammation. Light discharge with blood is also considered normal, it can last 10-20 days.
To avoid negative consequences, it is important to prepare for the operation and follow all the doctor’s prescriptions.
The doctor during the recovery period within 30 days of the postoperative period explains in detail that:
- you can not spin;
- bath, sauna and pool are also temporarily prohibited;
- after surgery, hygiene procedures are performed only in the shower, the water should only be slightly warm;
- do not lift heavy objects, do gymnastics and physical work;
- when menstruation comes, you need to use only pads, tampons are prohibited;
- refrain from intimate contact.
If the discharge becomes profuse, dark or green, you should immediately consult a doctor. This phenomenon indicates possible complications.
Special treatment in the absence of complications is not required. After complete healing, the cycle and all functions return to normal.
Modern methods of conization of the cervix can minimize the number of complications, but in isolated cases they are still observed. It can be:
- joining the infection;
- neck narrowing;
- isthmic-cervical insufficiency;
- cicatricial changes.
Monthly 30-60 days after the intervention, they become regular, the normal cycle is restored. Pregnancy after surgery from conception, gestation to childbirth proceeds as in ordinary women. In very rare cases, isthmic-cervical insufficiency may occur, which interferes with the bearing of the fetus. Problems in childbirth are likely if the cervix does not open due to cicatricial changes, but this phenomenon is practically not observed with modern methods of intervention.
Cervical conization refers to both therapeutic and diagnostic measures. It helps to avoid the degeneration of the affected tissue into a cancerous tumor or detects a problem at an early stage. Thanks to modern equipment and highly qualified doctors, this operation can be carried out almost bloodlessly. For women of childbearing age, it is important that it is possible to become pregnant after excision, bear a fetus and give birth to a healthy baby.
See also: cervical conization