Gaborets Y. Treatment of cervical intraepithelial neoplasia combined with adenomyosis at women of reproductive age.

The thesis is devoted to the improvement of methods of examination and treatment of patients with cervical intraepithelial neoplasia combined with adenomyosis on the basis of complex clinical, colposcopical, cytological, histological, bacteriological, molecular-biological researches, ultrasound characteristic of pelvis organs and definition of hypothalamus-hypophysis-ovarian system function. We represent the results of retrospective analysis of 496 patients to whom total hysterectomy was performed because of adenomyosis with severe clinical symptoms and ineffective conservative (including hormonal) treatment. Hystologically diagnosis of adenomyosis and cervical pathology was confirmed in 84 % of cases, cervical intraepithelial neoplasia - in 11.2 % of cases. The results of own researches are interpreted in the basic group (150 patients with cervical intraepithelial neoplasia and adenomyosis) treated by the proposed method of treatment after definition of ethiopathogenetic variants and in the group of comparison (50 patients with cervical intraepithelial neoplasia and adenomyosis) treated by the standard technique. Control group was composed of 20 gynecologicaly healthy women of reproductive age. At comparison of colposcopical signs that are characteristic for cervical intraepithelial neoplasia and adenomyosis with the results of bacterioscopical, microbiological, molecular-biological (PCR), hormonal and ultrasound examinations two ethiopathogenetic variants of cervical intraepithelial neoplasia combined with adenomyosis were selected. To the first variant those cases were referred, at which cervical intraepithelial neoplasia of epithelium in metaplasia was ascertained, which colposcopically was found as fields (mosaic), punctation and precancer zone of transformation with positive acetic test and miliary structures on a background of infection (mainly HPV) and hyperestrogenemia. To the second ethiopathogenetic variant those cases were referred, at which colposcopically cervical intraepithelial neoplasia ofsquamous epithelium (leikoplakia, mosaic, punctation), unchangable after 3% acetic acid solution application, were observed. In both variants there were identical changes of hypothalamus-hypophysis-ovarian system function and ultrasound structure of miometrium which are characteristic mainly for the second and third stage of adenomyosis. On the basis of clinical-paraclinical and laboratory data, characteristic for 1 and 2 ethiopathogenetic treatment of cervical intraepithelial neoplasia (patent for useful model …) The treatment of the patients with cervical intraepithelial neoplasia and adenomyosis with the use of offered method is effective in 96,7 %, in the group of comparison, where the treatment was conducted on the standard technique - efficiency is equal to 42 %. Thus, the comparative analysis of the results of carried out research testifies to the authentically expressed increase of efficiency of treatment of patients with cervical intraepithelial neoplasia combined with adenomyosis treated by the offered method taking into account ethiopathogenetic variants.