Ektopiya of a uterus neck
Ektopiya of a uterus neck — an atypical arrangement of the cylindrical (cubic) epithelium covering the tservikalny channel from within on a vaginal portion of a neck of the uterus normal covered with a flat epithelium. The uncomplicated ektopiya of a neck of a uterus does not give clinic; at complicated are noted bleach, contact bloody allocations, an itch in genitals, a dispareuniya. Ektopiya of a neck of a uterus is found at gynecologic survey; the diagnosis is specified by means of an expanded kolposkopiya, a cytologic research of scrape, if necessary - biopsies. Treatment of an uncomplicated ektopiya is not carried out; at the complicated forms etiotropny therapy is appointed, destruction of the changed centers is carried out.
Ektopiya of a uterus neck
For designation of an ektopiya of a neck of a uterus the gynecology quite often uses terms a pseudo-erosion, a false erosion, , a zhelezistomyshechny giperplaziya. Normal vaginal part of a neck of a uterus available to survey in mirrors, outside is covered by a multilayered flat epithelium whereas from within the cervical channel has a vystilka from a cylindrical epithelium. At a uterus neck ektopiya the border of transition of a cylindrical epithelium to flat is displaced to the area of an external pharynx, settling down on its circle or locally.
Ektopiya of a neck of a uterus comes to light at 40% of women; at 11,3% of patients this feature is congenital. The maximum frequency of an ektopiya of a neck of a uterus (40-50%) is observed at women 30 years are younger. The ektopiya in itself never passes into uterus neck cancer, however on its background the probability of development of malignant process increases.
Classification of an ektopiya of a neck of a uterus
By origin distinguish the congenital and acquired uterus neck ektopiya. Character of a course of a pseudo-erosion can be recidivous; a clinical form — uncomplicated and complicated. The modern kolposkopichesky nomenclature considers an uncomplicated ektopiya of a neck of a uterus as normal data and option of a physiological state. The complicated current of an ektopiya of a neck of a uterus, as a rule, is connected with the colpitises and tservitsita caused by an infection.
In case of violation of relationship of epitelialny and stromalny elements of a neck of a uterus the ektopiya is treated as . Histologically distinguish a ferruterous, papillary ektopiya of a neck of a uterus and a pseudo-erosion with a planocellular metaplaziya. At a ferruterous ektopiya congestions of glands with an extensive network of the ferruterous courses, inflammation signs come to light. At a papillary ektopiya growth of components of a stroma and formation of the sosochkovy structures covered with a cylindrical epithelium takes place.
Healing of an ektopiya of a neck of a uterus is followed by the return replacement of a cylindrical epithelium with cages of a mature flat epithelium, i.e. formation of a zone of transformation. Reserve cages which as a result of a differentiation at first turn into an unripe, and then mature metaplastic epithelium are involved in this process.
Carrying out a kolposkopiya allows to distinguish the unfinished and finished transformation zones. At adverse effects the cellular metaplaziya can break, leading to a uterus neck ektopiya recurrence. In case of overlapping the metaplastic layer of cages of the mouth of cervical glands forms retentsionny cysts of a neck of a uterus (a cyst nabotova).
Uterus neck ektopiya reasons
In the pubertatny and early reproductive period the ektopiya of a neck of a uterus is regarded as functional feature which cornerstone the relative giperestrogeniya is. Detection of a pseudo-erosion at pregnancy is also considered the physiological state caused by change of hormonal function of ovaries. Various theories explaining emergence of an ektopiya of a neck of a uterus connect this process with disgormonalny, inflammatory, immunological, traumatic factors.
Supporters of the theory of an inflammation explain formation of an ektopiya with the recidivous vaginita and endotservitsita caused by streptococci, colibacillus, STD activators (mycoplasmosis, a bacterial vaginosis, ureaplasmosis, clamidiosis, a human papillomavirus infection), etc. The pathological allocations influencing a vaginal part of a neck of a uterus cause a deskvamation of a flat epithelium with education on its place of a true erosion. Within 1-2 weeks the epithelium of an endotserviks extends to an erosion surface, covering it, and on the place of the last the site of an ektopiya is formed.
Infection of a neck of a uterus is promoted by patrimonial injuries, injuries of a neck when performing medical abortions, a travmatization when using barrier contraception and spermitsidny means. The hormonal concept connects development of an ektopiya of a neck of a uterus with dysfunction of ovaries. It is noticed that the uterus neck ektopiya often meets at endometriosis, fibroma, a giperplaziya of a stroma of ovaries, violations of a menstrual cycle, early formation of menarche, etc. the states caused by a giperestrogeniya.
Supporters of the immunological theory consider decrease in the general protective functions as the leading etiologichesky moment. Early sex life, frequent change of sexual partners, existence of chronic ekstragenitalny pathology (diabetes, etc.), repeated childbirth, smoking contributes to formation of the acquired ektopiya of a neck of a uterus.
Uterus neck ektopiya symptoms
The uncomplicated ektopiya of a neck of a uterus does not cause symptomatology and is, as a rule, diagnosed at routine inspection of the gynecologist. In 80% of cases the complicated forms of an ektopiya of a neck of a uterus which are combined with inflammations or precancer changes (a dysplasia, a leukoplakia, uterus neck polyps) are observed. In the presence of an endotservitsit or a colpitis allocation is noted is more white, an itch, a dispaureniye, contact bleedings. Primary violations leading to a uterus neck ektopiya can cause frustration of a menstrual cycle or infertility.
Diagnostics of an ektopiya of a neck of a uterus
Existence of a congenital ektopiya of a neck of a uterus, as a rule, is established at primary address to the gynecologist. In case of diagnosis of the acquired pseudo-erosion its education on earlier not changed surface of a neck of a uterus is considered. At visual survey on a chair in an external pharynx the bright red center of an ektopiya having the wrong outlines is visible. The touch the tool to the site of a pseudo-erosion can cause easy bleeding.
At identification of an ektopiya of a neck of a uterus carrying out an expanded kolposkopiya is shown. In the course of the research the atypical site presented by a cylindrical epithelium and zones of transformation comes to light. In 40% of cases when conducting test of Schiller the abnormal kolposkopichesky picture is defined: leukoplakia, mosaic, punktation, iodnegative zones. Detection of these signs dictates need of profound inspection of the patient.
During diagnostics the microscopy, bacteriological crops, the PTsR-research separated uterus necks is carried out. At an ektopiya of a neck of a uterus the cytologic research of scrape which allows to reveal existence of cages of a flat and cylindrical epithelium, inflammation signs is obligatory. In case of identification of an abnormal kolposkopichesky and cytologic picture carrying out a biopsy of a neck of a uterus or a separate diagnostic scraping with a histologic research is required.
For studying functions of ovaries are performed functional tests, the hormonal status is investigated. At identification of hormonal violations consultation of the gynecologist-endocrinologist is carried out. Differential diagnostics of an ektopiya is carried out with a true erosion and cancer of a neck of a uterus.
Treatment of an ektopiya of a neck of a uterus
At an uncomplicated congenital ektopiya of a neck of a uterus treatment is not carried out; for the patient the dynamic observation allowing to reveal in due time deviations in development of a pseudo-erosion is established. Treatment of the complicated forms of an ektopiya of a neck of a uterus is carried out taking into account the available changes. Etiotropny antiviral and anti-inflammatory therapy is appointed, competent selection of contraception, correction of immune and hormonal violations is made.
After knocking over of infectious process destruction of the centers of an ektopiya of a neck of a uterus is carried out by methods of cryogenic influence, radio surgery, laser coagulation, a diatermokoagulyation, chemical coagulation. At identification of ov. Nabothi is made opening of cysts of a neck of a uterus. In case of detection of a leukoplakia, a dysplasia, polyps, endometriosis of a neck of a uterus the corresponding treatment of these states is shown.
Prevention and the forecast at a uterus neck ektopiya
Performing routine medical examinations, corrections of violations of an immune and hormonal homeostasis, timely treatment of sexually transmitted infections and inflammations, the increase in culture of the sexual relations sparing performance of gynecologic manipulations allows to prevent development of an ektopiya of a neck of a uterus.
At detection of a pseudo-erosion for an exception of development of pathological precancer processes regular kolpotsitologichesky control is shown. At a uterus neck ektopiya the forecast favorable.