Optimization of treatment tactic in women of reproductive age with dysplastic lesions of cervical epithelium and adenomyosis

В. К. Кондратюк, А. І. Нарольська, Н. Є. Горбань, Г. В. Чубей

Abstract


The study to analyze the results of treatment of reproductive age women with dysplastic lesions of the cervical epithelium and adenomyosis was performed. Study includes 70 women of reproductive age with dysplastic lesions of cervical epithelial and infection caused by high risk strains of human papillomavirus: the main group consisted of 40 women with adenomyosis and chronic inflammation of genitals, the comparison group included 30 patients with chronic inflammatory diseases of genitals.

According to the results of cytological examination of patients with dysplastic lesions of cervical epithelium and adenomyosis in 27.5% of women were detected squamous epithelial cells of uncertain origin; in 42.5% of cases are diagnosed low grade squamous intraepitelial lesion; in 30.0% – high grade squamous intraepitelial lesion. Cervical intraepithelial neoplasia grade I was histologically verified in 60.0% of women with dysplastic lesions of the squamous epithelium of the cervix and adenomyosis; cervical intraepithelial neoplasia grade II confirmed in 22.9% of cases; cervical intraepithelial neoplasia grade III was diagnosed in 17.1% of patients. In 82.5% of women with dysplastic lesions of cervical epithelium and adenomyosis identified pathological changes of the endometrium (simple and complex endometrial hyperplasia, endometrial polyps).

Treatment of dysplastic lesions of cervix epithelium in patients with adenomyosis include integrated anti-inflammatory therapy, radiowave surgery, vaginal suppositories Revitaksa, a synthetic progestin Orgametril®, herbal preparation Epigalin® and was effective in 77.5% of cases. Clinically it is manifested a decrease in the frequency of pain, dysuria manifestations, dyspareunia, restoration of physiological menstrual and menstrual blood loss, lack of spotting before and after menstruation, normalization of cytological, colposcopic and ultrasonographic data. Complex therapeutic measures in patients with dysplastic lesions of the squamous epithelium of cervix and adenomyosis allow to accelerate the timing of postoperative epithelialization of the wound surface and to reduce the incidence of complications and recurrences.


Keywords


cervix dysplasia; adenomyosis; radiowave surgery; progestins; conservative treatment; multifocal targeted therapy

References


Garcia, L., Isaacson, K. “Adenomyosis: review of the literature.” J Minim Invasive Gynecol 18 (2011): 428–437.

Dunselman, G.A.J., Vermeulen, N., Becker, C., et al. “Guidelines of the European Society of Human Reproduction and Embryology: Management of Women with Endometriosis.” Human Reproduction 29.3 (2014): 400–12.

Vovk, I.B., Zadorozhna, T.D., Chubei, G.V., et al. “Endometrium state in women with endometriosis.” Women’s Health 5.51 (2010): 160-2.

Sidorova, I.S., Kogan, E.A., Zairatiants, O.V., Hunanian, A.L., Levakov, S.A. “A new look at the nature of endometriosis (adenomyosis).” Obstetrics and Gynecology 3 (2002): 32–8.

Adamyan, L.V., Kulakov, V.I. Endometriosis. Moscow. Medicine (1998): 317 p.

Tatarchuk, T.F., Kalugina, L.V. “On the question of the prevention and treatment of hormone-dependent hyperproliferative diseases in women.” Women’s Health 7 (2013): 51–7.

Munoz, N., Bosch, F.X., de Sanjose, S., et al. “Epidemiologic classification of human papillomavirus types associated with cervical cancer.” N Engl J Med 348 (2003): 518–27.

Jemal, A., Bray, F., Melissa, M., et al. “Global cancer statistics.” Cancer J for Clinicians 61.2 (2011): 69–90.

Kiselev, V.I., Muizhnek, E.L. “Molecular mechanisms of developing cervical dysplasia: new knowledge – new opportunities. Clinical lection.” Messenger “Laboratory of DNA Diagnostic” 4.13 (2011).

Sidorova, I.S., Hunanian, A.L., Kogan, E.A., Levakov, S.A. “New aspects of the pathogenesis and pathogenetically therapy of adenomyosis.” Effective Pharmacotherapy in Obstetrics and Gynecology 4 (2006): 24–8.

Yashina, E.G. “Clinical experience in the treatment of adenomyosis. The path to the individual approach.” Women’s Health 5.101 (2015): 81–2.

Kiselev, V.I., Apolikhina, I.A., Muizhnek, E.L., et al. The pathogenetic approaches to HPV-associated cervical diseases treatment. The pathology of the cervix and genital infections. Ed. by V.N. Prilepskaya. Moscow. MEDpress-inform (2008): 87–94.

Kiselev, V.I., Liashenko, A.A. Molecular mechanisms of regulation of hyperplastic processes. Moscow. Publishing Dimitreyd schedule groups (2005): 348 p.

Reznichenko, N.A., Beliavtseva, E.F. “Diagnosis and treatment of cervical pathology associated with sexually transmitted diseases.” Women’s Health 10.86 (2013): 39–42.

Heriak, S.M. “Preventive therapy for inflammatory process of the cervix and vagina in women of reproductive age.” Women’s Health 9.85 (2013): 157–61.

Vorobiova, L.I., Dunaevska, V.V., Goncharuk, I.V. “Clinical experience of vaginal suppositories revitaksa use after electrosurgical treatment of cervical pathology.” Women’s Health 8.94 (2014): 96–8.

Brown, J., Kives, S., Akhtar, M. “Progestagens and anti-progestagens for pain associated with endometriosis.” Cochrane Database Syst Rev 3 (2012): CD002122.

Jeng, C. J., Chuang, L., Shen, J. “A comparison of progestogens or oral contraceptives and gonadotropin-releasing hormone agonists for thetreatment of endometriosis: a systematic review.” Expert Opin Pharmacother 15.6 (2014): 767–73.

Zakharenko, N.F., Kovalenko, N.V., Manoliak, I.P. “On the issue of complex therapy of adenomyosis.” Reproductive Endocrinology 3.23 (2015): 28–33.

Ashok, B.T., Chen, Y.G., Liu, X., et al. “Multiple molecular targets of indole-3carbinol, a chemopreventive anti-estrogen in breast cancer.” Eur J Cancer Prev 11 (2002): 86–93.

Chatterji, U., Riby, J.E., Taniguchi, Т., et al. “Indole-3-carbinol stimulates transcription of the interferon gamma receptor 1 gene and augments interferon responsiveness in human breast cancer cells.” Carcinogenesis 25.7 1119–28.

Firestone, G.L., Bjeldanes, L.F. “Indole-3-carbinol and З-З-diindolylmethane antiproliferative signaling pathways control cellcycle gene transcription in human breast cancer cells by regulating promoter-Sp 1 transcription factor interactions.” J Nutr 133 (2003): 2448–55.

Reed, G.A., Peterson, K.S., Smith, H.J., et al. “A phase I study of indole-3-carbinol in women: tolerability and effects.” Cancer Epidemiol Biomarkers Prev 14.8 (2005): 1953–60.

Masuda, M., Suzuki, M., Lim, J.T.E., Weinstein, I.E. “Epigallocatechin-3-gallate inhibits activation of HER -2/new and downstream signaling pathways in human heat and neck and breast carcinoma cells.” Clin Cancer Res 9 (2003): 3486–91.

Thangapazham, R.L., Singh, A.K., Sharma, A., et.al. “Green tea polyphenols and its constituent epigallocatechin gallate inhibits proliferation of human breast cancer cells in vitro and in vivo.” Cancer Lett 8 (2007): 832–41.


GOST Style Citations


1. Garcia, L., Isaacson, K. “Adenomyosis: review of the literature.” J Minim Invasive Gynecol 18 (2011): 428–437.

2. Dunselman, G.A.J., Vermeulen, N., Becker, C., et al. “Guidelines of the European Society of Human Reproduction and Embryology: Management of Women with Endometriosis.” Human Reproduction 29.3 (2014): 400–12.

3. Вовк, І.Б. Стан ендометрія у жінок із генітальним ендометріозом / І.Б. Вовк, Т.Д. Задорожна, Г.В. Чубей та ін. // Здоровье женщины. – 2010. – № 5 (51). – С. 160–162.

4. Сидорова, И.С. Новый взгляд на природу эндометриоза (аденомиоза) / И.С. Сидорова, Е.А. Коган, О.В. Зайратьянц, А.Л. Унанян, С.А. Леваков // Акушерство и гинекология. – 2002. – № 3. – С. 32–38.

Sidorova, I.S., Kogan, E.A., Zairatiants, O.V., Hunanian, A.L., Levakov, S.A. “A new look at the nature of endometriosis (adenomyosis).” Obstetrics and Gynecology 3 (2002): 32–8.

5. Адамян, Л.В., Кулаков, В.И. Эндометриозы. – М.: Медицина. – 1998. – 317 с.

6. Татарчук, Т.Ф. К вопросу о профилактике и терапии гормонозависимых гиперпролиферативных заболеваний у женщин / Т.Ф. Татарчук, Л.В. Калугина // Здоровье женщины. – 2013. – № 7. – С. 51–57.

7. Munoz, N., Bosch, F.X., de Sanjose, S., et al. “Epidemiologic classification of human papillomavirus types associated with cervical cancer.” N Engl J Med 348 (2003): 518–27.

8. Jemal, A., Bray, F., Melissa, M., et al. “Global cancer statistics.” Cancer J for Clinicians 61.2 (2011): 69–90.

9. Киселев, В. И. Молекулярные механизмы развития дисплазии шейки матки: новые знания – новые возможности. Клиническая лекция / В.И. Киселев, Е.Л. Муйжнек // Вестник «Лаборатории ДНК диагностики». – 2011. – № 4 (13).

10. Сидорова, И.С. Новые аспекты патогенеза и патогенетически обоснованной терапии аденомиоза / И.С. Сидорова, А.Л. Унанян, Е.А. Коган, С.А. Леваков // Эффективная фармакотерапия в акушерстве и гинекологии». – 2006. – № 4. – С. 24–28.

Sidorova, I.S., Hunanian, A.L., Kogan, E.A., Levakov, S.A. “New aspects of the pathogenesis and pathogenetically therapy of adenomyosis.” Effective Pharmacotherapy in Obstetrics and Gynecology 4 (2006): 24–8.

11. Яшина, Е.Г. Клинический опыт лечения аденомиоза. Путь к индивидуальному подходу / Е.Г. Яшина // Здоровье женщины. – 2015. – № 5 (101). – C. 81–82.

12. Киселев, В.И., Аполихина, И.А., Муйжнек, Е.Л. и др. Патогенетические подходы к лечению ВПЧ-ассоциированных заболеваний шейки матки. Патология шейки матки и генитальные инфекции // Под ред. В.Н. Прилепской. – М.: МЕДпресс-информ. – 2008. – С. 87–94.

13. Киселев, В.И., Ляшенко, А.А. Молекулярные механизмы регуляции гиперпластических процессов. – М.: Издательство Димитрейд график групп. – 2005. – 348 с.

14. Резниченко, Н.А. Диагностика и лечение патологии шейки матки, ассоциированной с сексуально- трансмиссивными заболеваниями / Н.А. Резниченко, Е.Ф. Белявцева // Здоровье женщины. – 2013. – № 10 (86). – С. 39–42.

15. Геряк, С.М. Протирецидивна терапія при запальних процесах шийки матки та піхви у жінок репродуктивного віку // Здоровье женщины. – 2013. – № 9 (85). – С.157–161.

16. Воробйова, Л.І. Клінічний досвід застосування вагінальних супозиторіїв Ревітакса після електрохірургічного лікування патології шийки матки / Л.І. Воробйова, В.В. Дунаєвська, І.В. Гончарук // Здоровье женщины. – 2014. – № 8 (94). – C. 96–98.

17. Brown, J., Kives, S., Akhtar, M. “Progestagens and anti-progestagens for pain associated with endometriosis.” Cochrane Database Syst Rev 3 (2012): CD002122.

18. Jeng, C. J., Chuang, L., Shen, J. “A comparison of progestogens or oral contraceptives and gonadotropin-releasing hormone agonists for thetreatment of endometriosis: a systematic review.” Expert Opin Pharmacother 15.6 (2014): 767–73.

19. Захаренко, Н.Ф. До питання комплексної терапії аденоміозу / Н.Ф. Захаренко, Н.В. Коваленко, І.П. Маноляк // Репродуктивна ендокринологія. – 2015. – № 33 (23). – С. 28–33.

20. Ashok, B.T., Chen, Y.G., Liu, X., et al. “Multiple molecular targets of indole-3carbinol, a chemopreventive anti-estrogen in breast cancer.” Eur J Cancer Prev 11 (2002): 86–93.

21. Chatterji, U., Riby, J.E., Taniguchi, Т., et al. “Indole-3-carbinol stimulates transcription of the interferon gamma receptor 1 gene and augments interferon responsiveness in human breast cancer cells.” Carcinogenesis 25.7 1119–28.

22. Firestone, G.L., Bjeldanes, L.F. “Indole-3-carbinol and З-З-diindolylmethane antiproliferative signaling pathways control cellcycle gene transcription in human breast cancer cells by regulating promoter-Sp 1 transcription factor interactions.” J Nutr 133 (2003): 2448–55.

23. Reed, G.A., Peterson, K.S., Smith, H.J., et al. “A phase I study of indole-3-carbinol in women: tolerability and effects.” Cancer Epidemiol Biomarkers Prev 14.8 (2005): 1953–60.

24. Masuda, M., Suzuki, M., Lim, J.T.E., Weinstein, I.E. “Epigallocatechin-3-gallate inhibits activation of HER -2/new and downstream signaling pathways in human heat and neck and breast carcinoma cells.” Clin Cancer Res 9 (2003): 3486–91.

25. Thangapazham, R.L., Singh, A.K., Sharma, A., et.al. “Green tea polyphenols and its constituent epigallocatechin gallate inhibits proliferation of human breast cancer cells in vitro and in vivo.” Cancer Lett 8 (2007): 832–41.





DOI: http://dx.doi.org/10.18370/2309-4117.2016.29.54-59

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