Optimizing surgical management of uterine cervix disorders
DOI: 10.32364/2618-8430-2022-5-3-188-193
I.Yu. Il’ina, Yu.E. Dobrokhotova
Pirogov Russian National Research Medical University, Moscow, Russian Federation
Aim: to improve outcomes of the surgical management of cervix disorders by using a hemostatic agent with antimicrobial activity.
Patients and Methods: the study included 47 women, 25–45 years of age, with CIN II/III to whom cervical radiofrequency ablation was performed. The main group comprised 26 (55.3%) patients. During the ablation procedure, a 1% aqueous solution of incomplete polyacrylic acid silver salt with integrated nanoparticles was used as an additional treatment for this group of patients. The control group consisted of 21 (44.7%) patients for whom the standard ablation technique was used. The assessed criteria included the clinical course and laboratory test results before and three months after the surgical treatment, as well as the bleeding rates.
Results: in the main group of patients, the mean leucocyte number in the smear after the treatment was 9.2±1.2 per field of vision, in the control group — 18.5±2.9; pH of the vaginal discharge — 4.2±0.2 (from 3.8 to 4.5) and 4.7±0.2 (from 4.2 to 5.8), respectively. Intraoperative bleeding from the surgical wound which required additional manipulations was reported in 2 (7.7%) patients of the main group and 2 (9.5%) patients of the control group. Ten days after the surgery, one patient (3.8%) from the main group had complaints on heavy bloody vaginal discharge. Three (14,3%) patients from the control group had the same complaint 11–13 days after the surgery (3.7 relative risk, 95% confidence interval (CI) 1,0–18,2) which required the use of tranexamic acid as tablets for oral administration. Three months after the surgery the clue cells were found in one (3.8%) patient of the main group and in 7 (33.3%) patients of the control group (8.7 relative risk, 95% CI 1.2–16.5), and the fungal mycelia — only in 8 (38.1%) patients of the control group.
Conclusion: the use of a 1% aqueous solution of incomplete polyacrylic acid silver salt with integrated nanoparticles during the cervical ablation resulted in a statistically significant reduction of the bleeding risk and improved the vaginal microflora profile in postoperative period.
Keywords: cervical dysplasia, cervical excision, cervical conization, bacterial vaginosis, hemostatic agent, bleeding.
For citation: Il’ina I.Yu., Dobrokhotova Yu.E. Optimizing surgical management of uterine cervix disorders. Russian Journal of Woman and Child Health. 2022;5(3):188–193 (in Russ.). DOI: 10.32364/2618-8430-2022-5-3-188-193.
Aim: to improve outcomes of the surgical management of cervix disorders by using a hemostatic agent with antimicrobial activity.
Patients and Methods: the study included 47 women, 25–45 years of age, with CIN II/III to whom cervical radiofrequency ablation was performed. The main group comprised 26 (55.3%) patients. During the ablation procedure, a 1% aqueous solution of incomplete polyacrylic acid silver salt with integrated nanoparticles was used as an additional treatment for this group of patients. The control group consisted of 21 (44.7%) patients for whom the standard ablation technique was used. The assessed criteria included the clinical course and laboratory test results before and three months after the surgical treatment, as well as the bleeding rates.
Results: in the main group of patients, the mean leucocyte number in the smear after the treatment was 9.2±1.2 per field of vision, in the control group — 18.5±2.9; pH of the vaginal discharge — 4.2±0.2 (from 3.8 to 4.5) and 4.7±0.2 (from 4.2 to 5.8), respectively. Intraoperative bleeding from the surgical wound which required additional manipulations was reported in 2 (7.7%) patients of the main group and 2 (9.5%) patients of the control group. Ten days after the surgery, one patient (3.8%) from the main group had complaints on heavy bloody vaginal discharge. Three (14,3%) patients from the control group had the same complaint 11–13 days after the surgery (3.7 relative risk, 95% confidence interval (CI) 1,0–18,2) which required the use of tranexamic acid as tablets for oral administration. Three months after the surgery the clue cells were found in one (3.8%) patient of the main group and in 7 (33.3%) patients of the control group (8.7 relative risk, 95% CI 1.2–16.5), and the fungal mycelia — only in 8 (38.1%) patients of the control group.
Conclusion: the use of a 1% aqueous solution of incomplete polyacrylic acid silver salt with integrated nanoparticles during the cervical ablation resulted in a statistically significant reduction of the bleeding risk and improved the vaginal microflora profile in postoperative period.
Keywords: cervical dysplasia, cervical excision, cervical conization, bacterial vaginosis, hemostatic agent, bleeding.
For citation: Il’ina I.Yu., Dobrokhotova Yu.E. Optimizing surgical management of uterine cervix disorders. Russian Journal of Woman and Child Health. 2022;5(3):188–193 (in Russ.). DOI: 10.32364/2618-8430-2022-5-3-188-193.
About the authors:
Irina Yu. Il’ina — Dr. Sc. (Med.), professor of the Department of Obstetrics & Gynecology of the Medical Faculty, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD 0000-0003-4510-4244.
Yuliya E. Dobrokhotova — Dr. Sc. (Med.), Professor, Head of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD 0000-0002-7830-2290.
Contact information: Irina Yu. Il’ina, e-mail: iliyina@mail.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 02.06.2022.
Revised 28.06.2022.
Accepted 21.07.2022.
References
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9. Levakov S.A., Kedrova A.G., Kozhurina E.V., Vanke N.S. The choice of the method of treatment of cervical dysplasia in women of the reproductive period. Effective pharmacotherapy. 2010;3:50–52 (in Russ.).
10. Levakov S.A., Borovkova E.I., SHeshukova N.A. еt al. A complex approach to treatment of female patients of reproductive age with precancerous diseases of the cervix. Gynecology, Obstetrics and Perinatology. 2015;14(3):46–48 (in Russ.).
11. Edwards K., Fatehi M., Fogel J. Post-Menopausal Status and Risk for Cervical Dysplasia. Gulf J Oncolog. 2022;1(38):31–37. PMID: 35156642.
12. Dobrokhotova Yu.E., Ilyina I.Yu. Treatment of vaginal infectious diseases. RMJ. 2017;15:1108–1110 (in Russ.).
13. De Castro-Sobrinho J.M., Rabelo-Santos S.H., Fugueiredo-Alves R.R. Bacterial vaginosis and inflammatory response showed association with severity of cervical neoplasia in HPV-positive women. Diagn Cytopathol. 2016;44(2):80–86. DOI: 10.1002/dc.23388.
14. Zarochentseva N.V., Dzhidzhikhia L.K., Bashankaeva Yu.N., Nabieva V.N. Excisional treatments for cervical intraepithelial neoplasias. Obstetrics and Gynecology: News, Opinions, Training. 2020;8(4):37–47 (in Russ.). DOI: 10.24411/2303-9698-2020-14005.
15. Basu P., Taghavi K., Hu S.Y. et al. Management of cervical premalignant lesions. Curr Probl Cancer. 2018;42(2):29–136. DOI: 10.1016/j.currproblcancer.2018.01.010.
16. Toyoda S., Okada H., Tsujino H. A. et al. Postoperative cytological findings from the use of the Integran microfibrillar collagen hemostatic matrix in conization. Diagn Cytopathol. 2018;46(7):624–626. DOI: 10.1002/dc.23907.
17. Tanaka Y., Ueda Y., Kakuda M. et al. Predictors for recurrent/persistent high-grade intraepithelial lesions and cervical stenosis after therapeutic conization: a retrospective analysis of 522 cases. Int J Clin Oncol. 2017;22(5):921–926. DOI: 10.1007/s10147-017-1124-z.
18. Xie M., Zhang X., Yu M. et al. Evaluation of the cervix after cervical conization by transvaginal elastography. J Ultrasound Med. 2018;37(5):1109–1114. DOI: 10.1002/jum.14457.
19. Hasegawa K., Torii Y., Kato R. et al. The problems of cervical conization for postmenopausal patients. Eur J Gynaecol Oncol. 2016;37(3):327–331. PMID: 27352558.
20. Korolenkova L.I. Cervical intraepithelial neoplasia and early forms of cervical cancer: clinical and morphological concept of cervical carcinogenesis. М.; 2017 (in Russ.).
21. Siegler E., Goldberg Y., Siegler Y. et al. The association between clearance of human papillomavirus after conization for cervical cancer and absence of cancer. J Low Genit Tract Dis. 2021;25(4):276–280. DOI: 10.1097/LGT.0000000000000622.
22. Velentzis L.S., Brotherton J.M.L., Canfell K. Recurrent disease after treatment for cervical pre-cancer: determining whether prophylactic HPV vaccination could play a role in prevention of secondary lesions. Climacteric. 2019;22(6):596–602. DOI: 10.1080/13697137.2019.1600500.
23. Bogani G., Tagliabue E., Ferla S. et al. Nomogram-based prediction of cervical dysplasia persistence/recurrence. Eur J Cancer Prev. 2019;28(5):435–440. DOI: 10.1097/CEJ.0000000000000475.
24. Levakov S.A., Borovkova E.I., Matyuhina E.G. CIN: regression in 3.5 weeks? The possibilities of CIN regression against the background of nonspecific antimicrobial therapy with a local combination agent. Status praesens. Gynecology, obstetrics, infertile marriage. 2016;2(31):73–79 (in Russ.).
25. Sims T.T., Biegert G.W., Ramogola-Masire D. et al. Tumor microbial diversity and compositional differences among women in Botswana with high-grade cervical dysplasia and cervical cancer. Int J Gynecol Cancer. 2020;30(8):1151–1156. DOI: 10.1136/ijgc-2020-001547.
26. Oh H.Y. The association of uterine cervical microbiota with an increased risk for cervical intraepithelial neoplasia in Korea. Clin Microbiol Infect. 2015;21(7):674.e1–674.e9. DOI: 10.1016/j.cmi.2015.02.026.
27. Ievleva N.F., Chigova G.V., Permina N.E. Comparative efficacy of uterus cervix diseases treatment. Far Eastern Medical Journal. 2013;3:46–49 (in Russ.).
28. Kyurdzidi S.O., Uvarova E.V., Hashchenko E.P. Local hemostasis with the use of polymetalloacrylates. Reproductive health of children and adolescents. 2022;18(1):41–46 (in Russ.).
29. Forbes G.L., Merkulova A., Pinheiro A. et al. Poly (acrylic acid) (PAA) is a contact system activator with properties to stop hemorrhage. Thromb Res. 2020;193:142–145. DOI: 10.1016/j.thromres.2020.06.011.
30. Kuznecova M.V., Parshakov A.A., Kuznetsova M.P. et al. The effect of the surgical hemostatic drug Hemoblock on bacterial colonization in vitro. Clinical microbiology and antimicrobial chemotherapy. 2020; 22(1):67–70 (in Russ.). DOI: 10.36488/cmac.2020.1.67-70.
2. Cervical intraepithelial neoplasia, erosion and ectropion of the cervix. Clinical recommendations. 2020 (in Russ.).
3. Aminodova I.P., Posiseeva L.V. Recurrent cervical dysplasia: Risk factors, treatment policy correction, rehabilitation. Russian Bulletin of Obstetrician-Gynecologist. 2017;17(6):67–72 (in Russ.). DOI: 10.17116/rosakush201717667-72.
4. Davydov M.I., Aksel E.M. Statistics of malignant neoplasms in Russia and CIS countries in 2012. M.; 2014 (in Russ.).
5. Guidelines for outpatient care in obstetrics and gynecology. Serov V.N., Sukhikh G.T., Prilepskaya V.N., Radzinsky V.E., eds. M.: GEOTAR-Media; 2016 (in Russ.).
6. Cervix, vagina, vulva. Physiology, pathology, colposcopy, aesthetic correction: A guide for practicing physicians. Rogovskaya S.I., Lipova E.V., eds. M.: StatusPraesens; 2014:52–71 (in Russ.).
7. Bairamova G.R., Baranov I.I., Ezhova L.S. et al. Squamous intraepithelial cervix lesions: possible early diagnostics and management. Doctor.ru. 2019:11(166):61–67 (in Russ.). DOI: 10/31550/1727-2378-2019-166-11-61-67.
8. Cohen O., Schejter E., Agizim R. et al. Postcoital bleeding is a predictor for cervical dysplasia. PLoS One. 2019;14(5):e0217396. DOI: 10.1371/journal.pone.0217396.
9. Levakov S.A., Kedrova A.G., Kozhurina E.V., Vanke N.S. The choice of the method of treatment of cervical dysplasia in women of the reproductive period. Effective pharmacotherapy. 2010;3:50–52 (in Russ.).
10. Levakov S.A., Borovkova E.I., SHeshukova N.A. еt al. A complex approach to treatment of female patients of reproductive age with precancerous diseases of the cervix. Gynecology, Obstetrics and Perinatology. 2015;14(3):46–48 (in Russ.).
11. Edwards K., Fatehi M., Fogel J. Post-Menopausal Status and Risk for Cervical Dysplasia. Gulf J Oncolog. 2022;1(38):31–37. PMID: 35156642.
12. Dobrokhotova Yu.E., Ilyina I.Yu. Treatment of vaginal infectious diseases. RMJ. 2017;15:1108–1110 (in Russ.).
13. De Castro-Sobrinho J.M., Rabelo-Santos S.H., Fugueiredo-Alves R.R. Bacterial vaginosis and inflammatory response showed association with severity of cervical neoplasia in HPV-positive women. Diagn Cytopathol. 2016;44(2):80–86. DOI: 10.1002/dc.23388.
14. Zarochentseva N.V., Dzhidzhikhia L.K., Bashankaeva Yu.N., Nabieva V.N. Excisional treatments for cervical intraepithelial neoplasias. Obstetrics and Gynecology: News, Opinions, Training. 2020;8(4):37–47 (in Russ.). DOI: 10.24411/2303-9698-2020-14005.
15. Basu P., Taghavi K., Hu S.Y. et al. Management of cervical premalignant lesions. Curr Probl Cancer. 2018;42(2):29–136. DOI: 10.1016/j.currproblcancer.2018.01.010.
16. Toyoda S., Okada H., Tsujino H. A. et al. Postoperative cytological findings from the use of the Integran microfibrillar collagen hemostatic matrix in conization. Diagn Cytopathol. 2018;46(7):624–626. DOI: 10.1002/dc.23907.
17. Tanaka Y., Ueda Y., Kakuda M. et al. Predictors for recurrent/persistent high-grade intraepithelial lesions and cervical stenosis after therapeutic conization: a retrospective analysis of 522 cases. Int J Clin Oncol. 2017;22(5):921–926. DOI: 10.1007/s10147-017-1124-z.
18. Xie M., Zhang X., Yu M. et al. Evaluation of the cervix after cervical conization by transvaginal elastography. J Ultrasound Med. 2018;37(5):1109–1114. DOI: 10.1002/jum.14457.
19. Hasegawa K., Torii Y., Kato R. et al. The problems of cervical conization for postmenopausal patients. Eur J Gynaecol Oncol. 2016;37(3):327–331. PMID: 27352558.
20. Korolenkova L.I. Cervical intraepithelial neoplasia and early forms of cervical cancer: clinical and morphological concept of cervical carcinogenesis. М.; 2017 (in Russ.).
21. Siegler E., Goldberg Y., Siegler Y. et al. The association between clearance of human papillomavirus after conization for cervical cancer and absence of cancer. J Low Genit Tract Dis. 2021;25(4):276–280. DOI: 10.1097/LGT.0000000000000622.
22. Velentzis L.S., Brotherton J.M.L., Canfell K. Recurrent disease after treatment for cervical pre-cancer: determining whether prophylactic HPV vaccination could play a role in prevention of secondary lesions. Climacteric. 2019;22(6):596–602. DOI: 10.1080/13697137.2019.1600500.
23. Bogani G., Tagliabue E., Ferla S. et al. Nomogram-based prediction of cervical dysplasia persistence/recurrence. Eur J Cancer Prev. 2019;28(5):435–440. DOI: 10.1097/CEJ.0000000000000475.
24. Levakov S.A., Borovkova E.I., Matyuhina E.G. CIN: regression in 3.5 weeks? The possibilities of CIN regression against the background of nonspecific antimicrobial therapy with a local combination agent. Status praesens. Gynecology, obstetrics, infertile marriage. 2016;2(31):73–79 (in Russ.).
25. Sims T.T., Biegert G.W., Ramogola-Masire D. et al. Tumor microbial diversity and compositional differences among women in Botswana with high-grade cervical dysplasia and cervical cancer. Int J Gynecol Cancer. 2020;30(8):1151–1156. DOI: 10.1136/ijgc-2020-001547.
26. Oh H.Y. The association of uterine cervical microbiota with an increased risk for cervical intraepithelial neoplasia in Korea. Clin Microbiol Infect. 2015;21(7):674.e1–674.e9. DOI: 10.1016/j.cmi.2015.02.026.
27. Ievleva N.F., Chigova G.V., Permina N.E. Comparative efficacy of uterus cervix diseases treatment. Far Eastern Medical Journal. 2013;3:46–49 (in Russ.).
28. Kyurdzidi S.O., Uvarova E.V., Hashchenko E.P. Local hemostasis with the use of polymetalloacrylates. Reproductive health of children and adolescents. 2022;18(1):41–46 (in Russ.).
29. Forbes G.L., Merkulova A., Pinheiro A. et al. Poly (acrylic acid) (PAA) is a contact system activator with properties to stop hemorrhage. Thromb Res. 2020;193:142–145. DOI: 10.1016/j.thromres.2020.06.011.
30. Kuznecova M.V., Parshakov A.A., Kuznetsova M.P. et al. The effect of the surgical hemostatic drug Hemoblock on bacterial colonization in vitro. Clinical microbiology and antimicrobial chemotherapy. 2020; 22(1):67–70 (in Russ.). DOI: 10.36488/cmac.2020.1.67-70.
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