Важка дисплазія епітелію шийки матки та внутрішньоепітеліальна карцинома (ЦІН 3) з поширенням на склепіння та стінки піхви. Діагностика та лікування

Abstract

The objective: to study and systematize the main clinical variants of CIN 3 with the spread of atypical epithelium to the vaults and walls of the vagina; to develop complex approaches to the treatment of patients with CIN 3 with the spread of atypical epithelium to the vaults and walls of the vagina with neoadjuvant therapy and surgical treatment; to study the therapeutic effectiveness of the use of a2b-interferon in the form of vaginal suppositories and Tyloron in the complex treatment of patients with CIN 3 with the spread of abnormal epithelium to the vaults and walls of the vagina during the first stage of complex drug treatment. Patients and methods. A survey of 62 patients with histologically verified CIN 3 with the spread of atypical epithelium to the vaults and walls of the vagina was carried out. At the stage of neoadjuvant etiotropic therapy, the patients were randomized into two groups. 31 patients were included in the main group (A), 31 patients were included in the control group (B). In group A, patients with neoadjuvant were given б2b-interferon at 500 000 IU in the form of vaginal suppositories twice a day for 14 days and a Tyloron 1 tablet 125 mg once a day in a day No.10. In group B, the standard therapy is intended for patients – an a2b-interferon of 500 000 IU in the form of vaginal suppositories twice a day for 14 days. The surgical stage of treatment was carried out in accordance with the clinical and histological diagnosis and the variant of the process spread to the walls of the vagina. Diathermoconization of the cervix and combined vaginal trachelectomy type A with resection of the upper third of the vagina were performed. Results. Three clinical variants of CIN 3 with spreading to the vaults and walls of the vagina were established. The first clinical variant – CIN 3 is localized to ectocervix, CIN 1–2 (IHC p16 negative) is localized on the vaults and walls of the vagina. The second clinical variant – CIN 3 is localized on ectocervix and extends to the vault and walls of the vagina. The third clinical variant – CIN 3 is localized on ectocervix and multicentric dissemination of CIN 3 – on vaults and walls of the vagina. The choice of an integrated treatment program with a surgical component depends on the clinical option. Conclusions. 1. Three clinical variants of CIN 3 with spreading to the vault and walls of the vagina have been established. Half the patients had the first clinical variant. 2. The main colposcopic signs of CIN 3 with spreading to the vaults and walls of the vagina: dense acetic-white epithelium, coarse mosaic, a sign of the internal border. 3. In 3 weeks after the course of treatment with neoadjuvant therapy in combination of Тyloron with a2b-interferon in the form of vaginal suppositories, it is possible to achieve from 85 to 100.0% positive dynamics, whereas in the traditional method of treatment, from 41 to 75%, which is statistically significant less (p<0.01). 4. The study showed that there is a relatively strong statistically significant association of neoadjuvant therapy using a combination of Tyloron with interferon-a2b suppositories in the complex treatment of CIN3 with spreading to the vault and vaginal walls compared to conventional therapy (c21=10.64; j=0.41; p<0.01). After three weeks, the positive dynamics in the main group (A) significantly increased (RR=1.6; 95% CI: 1.2–2.2; p<0.01). Key words: CIN 3, vaginal vault, vagina, trachelectomy, treatment.