Polyps of the tservikalny channel
Polyps of the tservikalny channel – the opukholevidny educations proceeding from a cylindrical epithelium of an endotserviks and growing in a uterus neck gleam. Polyps of the tservikalny channel usually prove belyam, contact bleedings, nagging pains. Diagnostics of polyps of a neck of a uterus includes carrying out vaginal survey, a kolposkopiya, tservikoskopiya, the histologic analysis of scrape of a neck of a uterus. Removal of a polyp of the tservikalny channel is made by untwisting of his leg and cauterization of a bed with the subsequent scraping of a mucous neck of a uterus.
Polyps of the tservikalny channel
Polyps of the tservikalny channel are formed as a result of focal proliferation of cages of an endotserviks and represent treelike soyedinitelnotkanny outgrowths on a thin or wide leg. Polyps of the tservikalny channel can grow in a gleam of the cervical channel or support its limits. Polyps grow in any department of a neck of a uterus, but are more often localized in the field of change of zones of an epithelium or an external pharynx. In case of multiple growths speak about a polypose of the tservikalny channel.
In structure of benign pathology of a neck of a uterus polyps make about 20-25%. Along with a uterus neck leukoplakia, an eritroplakiya, peaked condylomas, epidermoidny papillomas, erosion and pseudo-erosion polyps of the tservikalny channel carry to the background processes increasing risk of development of cancer of neck of a uterus and demanding constant observation of the gynecologist.
Classification of polyps of the tservikalny channel
The clinical gynecology uses several classifications of polyps of the tservikalny channel. On histologic type, depending on a ratio of a ferruterous, stromalny and vascular component, distinguish ferruterous, ferruterous and fibrous, fibrous, adenomatozny, angiomatozny polyps.
On distinctions in structure of an epitelialny cover allocate the polyps covered with a cylindrical, flat multilayered, and also high cylindrical or unripe epithelium with metaplastic changes. Taking into account prevalence of processes of proliferation and an epidermization differentiate simple, proliferating and polyps of the tservikalny channel.
Along with true polyps of the tservikalny channel, allocate detsidualny polyps, or pseudo-polyps which emergence is connected with pregnancy. Pseudo-polyps are deprived of a vascular leg and presented by detsidualny fabric - the transformed endometrium. If existence of detsidualny polyps of the tservikalny channel is accompanied by threat of termination of pregnancy, then their removal is made during a gestation.
Macroscopically true polyps of the tservikalny channel represent the structures with a diameter from 2 to 40 mm having the oval or rounded form, a smooth surface. Intensity of a vaskulyarization and vessels translucent through an integumentary epithelium cause coloring of polyps from light pink till claret color. On a consistence polyps of the tservikalny channel can be soft or dense, depending on contents in them fibrous fabric.
On a microscopic structure polyps of an endotserviks are similar to a mucous membrane of the cervical channel. In the basis or the central part of true polyps of the tservikalny channel there pass the blood vessels feeding a tumor.
Reasons of formation of polyps of the tservikalny channel
Questions of genesis of polyps of the tservikalny channel are insufficiently clear. More often polyps of an endotserviks are diagnosed for patients 40 years are more senior. It is considered that development of polyps of a neck of a uterus can be the cornerstone hormonal frustration, age changes in a female body, immune violations, stressful factors. As a favorable background for emergence of polyps of the tservikalny channel serves mechanical traumatizing a neck of a uterus during abortions, childbirth, diagnostic vyskablivaniye, hysteroscopies, and also chronic endotsertsivita - an inflammation mucous the cervical channel.
In 70-75% of observations polyps of the tservikalny channel are combined with an erosion or a pseudo-erosion of a neck of a uterus, uterus myoma, cysts of ovaries, endometriosis, dysfunction of ovaries, endometrium polyps, an atrophic colpitis. Also correlation dependence of frequency of occurrence of polyps of a neck of a uterus with violation of a microbiocenosis of a vagina and STD is noted: the candidiasis, a bacterial vaginosis, a human papillomavirus infection, genital herpes, ureaplasmosis, mycoplasmosis, clamidiosis, trichomoniasis mixed by infections.
Symptoms of polyps of the tservikalny channel
Small and single polyps of the tservikalny channel often do not cause symptomatology and come to light incidentally. Usually the demonstration of clinical manifestations is connected with secondary changes in polyps - injuries, infection, an inflammation, an ulceration. In this case emergence of the discomfortable and pulling pain in the bottom of a stomach is noted, pathological serous or serous and purulent is more white. At a travmatization of a polyp of the tservikalny channel there are allocations of sanious character or contact bleedings.
Violation of a menstrual cycle and infertility at polyps of the tservikalny channel is, as a rule, connected with the accompanying pathology or the reasons which caused formation of polyps. In rather exceptional cases the malignization of cervical polyps is noted.
At pregnant women polyps of the tservikalny channel to a type of reflex irritation of a neck of a uterus can create threat of spontaneous termination of pregnancy from early terms. Among other gestational complications there can be a low arrangement of a placenta, the istmiko-tservikalny insufficiency (ITI).
Diagnostics of polyps of the tservikalny channel
As the basic principles of diagnostics of polyps of the tservikalny channel serve their visual detection, studying by means of a kolposkopiya (tservikoskopiya), ultrasonography, a knife biopsy of a neck of a uterus with a scraping of the tservikalny channel.
At gynecologic survey in mirrors the thickening and a hypertrophy of a neck of a uterus and speakers from the tservikalny channel bright pink polipovidny formations of a rounded or grozdyevidny shape is visualized. The polyps covered with a multilayered epithelium with processes of a keratinization have whitish coloring; at violation of blood circulation in a polyp it gets dark or violet color. At polyps, prolabiruyushchy in a gleam of a vagina, depending on quantity of stromalny elements the soft or is firm-elastichesky consistence is defined.
Kolposkopiya and a tservikoskopiya allow to see small polyps of the tservikalny channel, in more detail to consider their structure, existence of an inflammation, necrosis, surface ulceration, and also other available changes of a neck of a uterus. For an exception of endometrialny polyps in a cavity of a uterus gynecologic ultrasonography is carried out.
After visual inspection the biopsy with a fractional scraping of walls of a neck of a uterus and a histologic research of material is made. Before expeditious removal of polyps of the tservikalny channel the research of dabs on an infection is conducted by methods of a bakposev and PTsR. In case of identification of STD their preliminary course therapy with control of an izlechennost is shown.
Treatment of polyps of the tservikalny channel
Any polyps of the tservikalny channel are the indication to removal. In aseptic conditions after a uterus neck exposure mirrors the polyp of the tservikalny channel is taken an okonchaty clip and deleted, making the turning-off movements. Then make a scraping of the cervical channel the curette, trying to obtain careful removal of a leg of a polyp. The bed of a polyp is in addition processed by a cryogenic or radio-frequency method. At ekhografichesky signs of changes of endometrium carry out hysteroscopy with a diagnostic scraping of a cavity of a uterus.
The polyps located close to an external pharynx are klinovidno excised with imposing of a ketgutovy seam. The polyps which are localized in the top departments of the tservikalny channel demand aim removal under gisteroskopichesky control. Remote material goes to a histologic research for studying of high quality of a polyp of the tservikalny channel. Further depending on laboratory data anti-inflammatory or hormonal therapy can be appointed.
Recuring polyposes of the cervical channel serves as the indication to cone-shaped amputation of a neck of a uterus. Removal of polyps of the tservikalny channel during pregnancy is made in case the amount of education exceeds 10 mm, its rapid growth, bleedings, signs of a necrosis or an initial malignization (diskarioz) of a polyp is noted.
Complications of polyps of the tservikalny channel
Recurrence of polyps of the tservikalny channel develops during incomplete removal of a leg of a new growth. Thermal burns owing to cauterization of a bed of a polyp, a striktura and stenoses of a neck of a uterus are in rare instances noted. Unextracted polyps of the tservikalny channel can provoke bleeding, support infections of a genital tract, cause a cervical factor of infertility, malignizirovatsya. Conducting pregnancy with polyps of the tservikalny channel demands from patients prevention of a spontaneous abortion, ITsN, premature birth, a uterus neck distotion.
Prevention of polyps of the tservikalny channel
Serve as conditions of prevention of polyps of the tservikalny channel: passing of regular dispensary survey, the prevention and timely therapy of gynecologic and endocrine pathology, an exception of the injuring impacts on a uterus neck. At emergence of suspicious symptoms it is necessary to undergo immediately inspection at the gynecologist.