Chronic endotservitsit — an infectious inflammatory disease mucous the tservikalny channel, lasting of two months and more. Differs in poor clinical symptomatology: increase in number of mucous vaginal allocations with the advent of impurity of pus in them and nagging pains in the bottom of a stomach. Apply survey in mirrors to diagnostics of an endotservitsit, an expanded kolposkopiya, transvaginal ultrasonography, laboratory researches. At treatment appoint etiotropny antimicrobic means, eubiotik, immunoproofreaders, physical therapy. According to indications carry out low-invasive surgical interventions, a trakheloplastika and a radiokonization.
Chronic tservitsita — one of the most frequent gynecologic diseases. Because of an asymptomatic current to establish their true prevalence extremely difficult. Usually the inflammation of an endotserviks is revealed at planned professional surveys or at the address concerning other diseases of the reproductive sphere. Are most subject to a disease of the woman of childbearing age (to 70% of patients with the established diagnosis), tservitsit occurs in a perimenopauza and in exceptional cases slightly less often — at girls before menarche. Importance of timely diagnostics and treatment of a chronic inflammatory disease of a neck of a uterus is caused by the increased risk of distribution of an inflammation on a uterus with appendages and malignant regeneration of the struck endotserviks.
Reasons of a chronic endotservitsit
The disease develops against the background of the undertreated or not diagnosed sharp inflammatory process and is caused by various microorganisms or their associations. The inflammation in an endotserviksa arises with the assistance of the following infectious agents:
- STD activators. By results of researches, chronic inflammatory process in the tservikalny channel is caused in a half of patients by causative agents of clamidiosis. Also viruses of simple herpes, papilloma of the person (VPCh), gonokokka, ureaplasma, mycoplasma, pale spirokheta can be an etiology.
- Opportunistic flora. The nonspecific inflammation arises at pathological activation of gramotritsatelny aerobes more often (enterokokk, escherichias, , a protea) and neklostridilny anaerobe bacterias (bakteroid and peptokokk). From the infection center also sow stafilokokk, streptococci, klostridiya, .
An important role in transition of a disease from sharp in a chronic phase is played by the contributing factors. Synchronization of process is provoked by easing of immunity at long physical activities, stresses, overcoolings, various diseases and reception of immunosupressor. Maintenance of an inflammation is promoted a gipoestrogenemiya, by uterus neck injuries at invasive procedures, constant irritation an intrauterine spiral, contraceptive caps and diaphragms, chemical agents (sour solutions for syringing, spermitsida, low-quality latex). The risk group is made by women with omission of a neck of a uterus and vagina, and also the patients conducting chaotic sexual life without barrier contraception.
At a chronic current of an endotservitsit in the center of an infection the slow inflammation getting into a parabasal and basal layer of an epithelium is constantly supported. At the same time the direct damaging role of microorganisms decreases, and decrease in local immunity and metaplastic processes become leaders. It leads to development of difficult vascular and mesenchymal reaction, replacement of a part of a cylindrical epithelium flat, to infiltration and consolidation of muscular and connecting tissue. Sekretorny activity of epitelialny cages remains raised that when overlapping mouths of tservikalny glands promotes formation of nabotovy cysts. The accelerated updating of epiteliotsit with delay of their differentiation, progressive decrease in apoptosis and increase of an atipiya is noted. At some patients process has recidivous character with a periodic aggravation.
Forms of a chronic endotservitsit are same, as well as at sharp inflammatory process. The main criteria of classification are:
- Type of the infectious agent. Inflammatory process can be the specific, resulted from infection STD, and nonspecific, caused by natural microflora at its pathological activation.
- Prevalence of an inflammation. At a focal (makulezny) endotservitsit certain sites of an endotserviks are surprised, at diffusion — all epithelium is involved in process. Chronic endotservitsit usually is diffusion.
Symptoms of a chronic endotservitsit
The clinical picture of a disease differs in extremely poor symptomatology. In most cases chronically proceeding endotservitsit becomes a casual find at planned or unplanned gynecologic inspection. Usually patients note insignificant increase in volume of vaginal allocations and change of their character. Bleach become muddy, dense, sometimes they have an unpleasant smell or in them blood streaks appear. At an inflammation aggravation the stupid, pulling, aching pains in the lower part of a stomach, an itch and burning in genitalia can disturb the woman. Sometimes the only sign it is long the existing inflammation in the cervical channel there is infertility or a habitual abortion.
Because of decrease in protective properties of a mucous stopper and existence of the constant center of an inflammation the risk of development of an endometritis, a salpingit, adneksit with the remote consequences in the form of infertility and not incubation of pregnancy increases. In two thirds of cases chronic endotservitsit is followed an ektopiy neck of a uterus. According to experts in the sphere of gynecology, at this disease the probability of a malignization of fabrics significantly increases. The inflammation of an endotserviks plays a role in development of obstetric pathology with pre-natal infection of a fruit and its covers, premature izlitiy amniotic waters, postnatal is purulent - septic complications.
Because of not specificity of symptomatology at diagnosis data of fizikalny, tool and laboratory researches have major importance. To the patient with suspicion on chronic endotservitsit it is carried out:
- Survey on a chair. At a research in mirrors the external pharynx of the tservikalny channel is hyperemic, the neck of a uterus is edematous. Sites of the raised bleeding can come to light, mucous and it is purulent - mucous allocations.
- Expanded kolposkopiya. Vessels of an epitelialny layer of a neck of a uterus are expanded, the centers with vascular loops come to light. The mucous membrane looks edematous. Other pathological processes can be defined (a pseudo-erosion, an erosion, etc.).
- Laboratory researches. For definition of the causative agent of a disease carry out microscopy and crops of dab (with antibiotikogrammy), PTsR-diagnostics, special serological methods (RIF, IFA).
- Dab cytology from the tservikalny channel. Allows to estimate degree of an involvement into an inflammation of cages of an endotserviks. The analysis is effective for early identification of dystrophic, displastichesky processes, an atipiya and a possible ozlokachestvleniye.
- Ultrasonography of a neck of a uterus. The neck of a uterus is increased in sizes, thickened. At its structure there are gipoekhogenny inclusions (a cyst nabotova). The method allows to exclude or in due time to reveal the combined cancer of a neck of a uterus.
Treatment of a chronic endotservitsit
At the confirmed diagnosis of a chronic inflammation of an endotserviks integrated etiopatogenetichesky approach is recommended. Conservative therapy which main objectives are is preferable:
- Elimination of the center of an infection. Taking into account sensitivity of the causative agent of a disease appoint antibiotics, antifungal, protivotrikhomonadny, antichlamydial and other means. Usually oral administration of medicines and their parenteral introduction supplement with local influence (vaginal candles, etc.).
- Restoration of a vaginal biocenosis. Owing to a chronic inflammation and use of antimicrobic means in a vagina the normal balance of microorganisms is broken. Timely purpose of eubiotichesky medicines allows to warn a recurrence of an endotservitsit and activation of opportunistic flora.
- Immunnokorigiruyushchy therapy. As a background for development of a disease it becomes frequent an immunodeficiency, vitamino-mineral complexes and stimulators of immunity are shown to patients. Their application allows to increase the general and local resilience to infectious agents, and also to normalize the immune answer.
At treatment of a chronic endotservitsit the combination medicamentous and physical therapy is effective. Physiotherapeutic techniques strengthen anti-inflammatory effect of antibacterial means and accelerate processes of a reparation. To patients appoint low-frequency and high-frequency magnetotherapy, a magnesium electrophoresis in a uterine zone, diadynamic currents, DMV, vaginal laser therapy, a darsonvalization through a vaginal electrode, mud tampons. In certain cases conservative treatment of an endotservitsit is supplemented with surgical methods. At detection of a large number of nabotovy cysts in which can persistirovat the activator carry out a diatermopunktura. At a persistent current cryodestruction, laser vaporization, radio coagulation are shown. If the chronic inflammation is combined with deformation of a neck, a dysplasia of an epithelium or elongation, carrying out a radiokonization and trakheloplastika is possible.
Forecast and prevention
Despite need of long-term treatment, the forecast at a chronic endotservitsit favorable. The recurrence of a disease is possible only at permanent decrease in immunity and existence of an inflammation in other departments of a female genital. For prevention timely adequate treatment of a sharp endotservitsit, regular surveys at the gynecologist, the ordered sexual life, barrier methods of contraception (are recommended especially at frequent change of sexual partners). The purposes of secondary prevention is the prevention of complications of a disease, first of all — development of malignant neoplaziya and infertility.