Інтраепітеліальна неоплазія вульви: сучасний погляд на проблему, способи курації (огляд літератури); власний клінічний досвід застосування фотодинамічного методу лікування

Abstract

Introduction. Vulvar intraepithelial neoplasia is a precancerous pathology of the vulva and is a very important medical and social problem. All the efforts of medical science are aimed at finding and developing the latest organ-preserving methods for the treatment of vulvar intraepithelial neoplasia. One of them is photodynamic therapy-method that allows preserving the anatomical structure of the organ. The aim of the study. The aim of the article is to carry out an analytical review of the literature on modern views on the problem of vulvar intraepithelial neoplasia, methods of its management and to present the results of the own clinical expertise of using a photodynamic method for its treatment. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of studying the results of current scientific research on modern views on the problem of vulvar intraepithelial neoplasia, methods of its management have been used in the article. Fifty-six literature sources in English have been studied and analyzed. The sources have been taken in the following scientometric medical databases: PubMed-NCBI, Medline, ResearchGate, CochraneLibrary, EMBASE by keywords: intraepithelial neoplasia of the vulva, vulvar intraepithelial neoplasia (VIN), photodynamic therapy (PDT), treatment of vulvar intraepithelial neoplasia; VIN treatment. The results of own clinical expertise of using the photodynamic method for vulvar intraepithelial neoplasia treatment have been described in the article as well. Results. During the PS infusion and the period before the PDT session, the general condition of the patients was satisfactory, and the symptoms of cutaneous phototoxicity, allergic reactions, which were accompanied by severe dysfunctions of vital organs, were absent after it. Despite the premedication carried out before the PDT session, the patients had moderate pain syndrome (I-II degrees) after the session as well as moderately pronounced edema in the area of pathological tissues being under the influence of photoirradiation. Within 1-5 days after treatment, the beginning of the formation of a dark brown or black area of photochemical necrosis was noted. After 3, 6 and 24 months of observation of patients with precancerosis of the vulva, remission of clinical symptoms (pruritus in the vulva) in the treated pathological foci was stated. It should be noted that the insufficient effectiveness of PDT in five cases was due to the use of subtherapeutic doses of PS “Photolon®”. During the follow-up examination at 3, 6 and 24 months in 20 out of 30 patients who received a photosensibilizer session in a subtherapeutic dose followed by photoirradiation of high power (1.0 W), both clinically and morphologically complete regression was noted being justified from both treatment and financial point of view. In the post-procedural period, all patients who were treated with PDT are recommended to: observe the light regime for 3-4 days; adequate pain relief use; hygiene; sexual rest; local treatment. Conclusions. The real advantage of photodynamic therapy associated with vulvar intraepithelial neoplasia is its ability to treat the multifocal disease with minimal tissue destruction, preservation of the vulva anatomy and excellent cosmetic results. These properties confirm the photodynamic therapy to be an effective method in vulvar intraepithelial neoplasia treatment.