The latest data show gynecological gynecological examination, cervical erosion accounted for 50% of the proportion of gynecological clinic ~
The latest data show gynecological gynecological examination, cervical erosion accounted for 50% of the proportion of gynecological clinic ~ 85%, the main population was 25 ~ 45 years old women of childbearing age population, the incidence rate is about 23%, early marriage and childbearing, fertility, abortion, sexual history, with more sexual partners for high risk factors. It is believed that there is no evidence of evidence-based medicine to prove the correlation between herpes simplex and syphilis infection.
"Cervical erosion" is an obsolete term
The previous view that chronic cervicitis mainly manifested as cervical erosion, cervical hypertrophy, cervical polyp and cervical gland cyst, but cervical erosion has not as a chronic cervicitis, because the latter has a large number of diffuse interstitial infiltration of lymphocytes. "Cervical erosion" is the diagnosis terms obsolete, since the latest version of the seven year medical textbooks has been canceled this term, called cervical ectopic columnar epithelium (columnar ectopy), because of the cervical erosion mostly physiological performance, rather than the pathology caused by the absence of epithelial erosion, seen in adolescence, fertility the age of women and oral contraceptives, hormone use and secretion of pregnant women.
Women in the estrogen receptor, cervical columnar epithelium into the cervix, squamo columnar junction exposed, makes the cervical os of cervix vaginal showed fine granular red zone, colposcopic see the transformation zone broadening, red area is columnar epithelium, the epithelial layer thick, red at the bottom of the display quality. Cervical erosion is a clinical signs, can be used to describe the cervical morphology and not as a noun in diagnosis of gynecological examination, influence of newborn girls about 1/3 by maternal hormones are congenital cervical erosion, can fade.
Clinically, most of the erosion is false erosion, 3% acetic acid under colposcopy can be seen in the red part of the grape string change, due to columnar epithelial edema caused by. Even if the inflammatory stimulation causes the squamous epithelium to lose its vitality and fall off, it is only a transient pathological process, which is soon covered by columnar epithelium.
Leucorrhea increased as the main performance, sometimes as the only performance, color yellow viscous, or leucorrhea with blood, a small number of patients with contact bleeding. The secretion of inflammatory long-term stimulation of the vulva, also can cause vulva pruritus. If the infection, inflammation can be communicated along the cervical lymph node and uterine ligament and parametrial connective tissue appeared, lumbar pain, abdominal bulge and other symptoms. In addition, cervical sticky purulent secretion, is not conducive to sperm through, can cause infertility.
Mild erosion and asymptomatic, cytology (more than 21 years old) and HPV (over 30 years) showed no abnormalities, routine cervical cancer screening program can, if for 2 ~ 3 years of negative cytology screening, but once every 3 years, in the severe erosion elimination of malignant change after physical therapy.
Physical therapy is the most commonly used local therapy, the main principle is the physical method to destroy the cervical epithelium, promote the growth of new squamous epithelium, repair wounds, short course of treatment, good effect, can be implemented in the clinic. For moderate and severe erosion area is larger, the depth of infiltration is more applicable to the general can be cured once.
Electric ironing: pressure to move back and forth, more than 3 mm the organization boundary erosion, milky white or yellowish after smearing gentian violet 1%. Near the cervix of the tube burning deep, up to 0.5 ~ 1 cm in the tube, the edge of shallow burning, postoperative more than 2 to 3 days secretion, within a few weeks of vaginal bleeding within a few weeks, from 2 to 3 weeks to repair the wound scab squamous epithelium began to repair, cure rate of 80%.
Laser treatment: laser charring erosion tissue, 3 weeks after the operation, the skin peeling off, wound repair. The irradiation range over the edge of the 2 mm, the depth of 2 ~ 3 mm, or 4 to 5 mm, the cure rate was 80% ~ 90%. The cure time was 1 ~ 3 months, and the removal of callus, running water, bleeding, etc.. Pregnant women and menorrhagia, combined with systemic diseases are disabled. Once a month, gynecological examination follow up, 1 to February after the menstrual cycle may be ahead of schedule, the amount of increase, prolonged menstruation. Follow up in February, pay attention to whether or not cervical canal stenosis.
Frozen treatment: liquid nitrogen as the cold source, the local rapid cooling to -196 DEG C to make the erosion surface freezing, necrosis, shedding. Does not form scar, generally does not cause cervical stenosis, especially for those who have fertility requirements. The lesion diameter should not exceed 4 cm, the area is not more than 2/3.
The principle of freezing is rapid freezing and slow temperature, rapid cooling, long exposure to the cervix is easy to form the crystallization, slow rewarming is conducive to the dissolution of ice crystals on the cell to further mechanical damage. The cure rate was 80% ~ 90%. The average healing time was 2 months, the main drawback is that the amount of vaginal discharge, long time, continued for 2 to 4 weeks, the highest daily from 200 to 300 ml.
Microwave treatment: instantaneous heat effect of 44 to 61 DEG C to solidify the tissue, cure rate of 90%.
Pome treatment: local irradiation erosion surface so that the wounds are uniform gray, irradiation depth of 2 ~ 3 mm, the cure rate was 80%.
Physical therapy notes
1 gynecological examination to exclude acute pelvic inflammatory disease and genital tumors;
2 specific infection of the first treatment of inflammation;
3 operation time 3 months postpartum, 2 months after the abortion, menstruation 3 ~ 7 days, who is after January with surgery, consider the ring, first consider on the treatment of cervical erosion;
4 prohibit sexual life after operation from 2 to March;
5 postoperative attention to cervical stenosis;
6 fertility requirements, the need to give birth to the doctor to explain the history of cervical treatment.
For simple erosion, superficial lesions in patients with small area can be 10% to 20% silver nitrate (per week, 3 ~ 4 times a course of treatment) and 5% potassium dichromate solution (2 ~ 3 weeks at a time, 1 to 4 times of wound healing, no bath). Because of its strong corrosiveness and small dosage, it is suitable for primary hospitals.
Jieeryin lotion, vaginal wash or bath (half a basin of warm water, every 15-20 minutes), once a day, the two Monday of course.
Before treatment should be excluded from the leucorrhea routine of reproductive tract infection, eliminate bacteria and fungi and Trichomonas infection, so as not to affect the postoperative healing. Severe erosion and cervical canal, cervical hypertrophy, or more than the method of treatment is invalid, suspected of precancerous lesions, the feasibility of cold knife conization, so as to avoid the influence of LEEP knife cutting edge of tissue pathology.
Conization of cervix
Differential diagnosis of cervical intraepithelial neoplasia, cervical cancer and cervical condyloma acuminatum. Routine gynecological examination, genital itching, leucorrhea and other inflammatory symptoms of routine leucorrhea routine detection of specific pathogens. If there is a specific stain to the corresponding drug treatment.
Epidemiological investigation showed that the incidence of cervical erosion in women with cervical cancer is 6 to 7 times the normal population, untreated cervical erosion, the incidence of cervical cancer in the 0.2%, it should actively carry out health care for women. More than 21 years history of sexual life in cervical cancer cytology smear screening examination within 24 hours prior to avoid sexual intercourse, vaginal douche, medicine and gynecological examination. If 2 to 3 consecutive years of negative cytology can be screened every 3 years.
HPV infection is a major risk factor for cervical cancer, a population infection rate is as high as 70% to 80%, with a peak age of 18 to 28 years old, 30 years old the following is a transient infection, usually 8 to 10 months away, only 10% to 15% of the population of persistent infection (interval at least half a year and two consecutive once infected the same virus type). The monitoring of HPV PDA approved often for high-risk and low-risk types of little significance, less than 30 years old high infection rate but independent clearance rate is high, is not recommended for routine HPV monitoring, 30 ~ 65 years old joint two check, once every 5 years. More than 65 years old asymptomatic people can exit screening.
HPV cytology treatment after --5 years of screening -ASC-US5 years after the screening of +ASC-US +-1 years after colposcopy combined screening: DXY reprint
Author: Liu Yu