Цель исследования — разработка тактики ведения пациенток с доброкачественной ассоциированной с вирусом папилломы человека (ВПЧ) патологией шейки матки в репродуктивном возрасте. Материал и методы. Проведено динамическое наблюдение в течение 1,5 года за 122 пациентками репродуктивного возраста с доброкачественной ВПЧ-ассоциированной патологией шейки матки. С целью диагностики поражения шейки матки использовано сочетание двух методов: расширенной кольпоскопии и оптической когерентной томографии (ОКТ-кольпоскопия). Для определения прогностической роли комплексного лабораторного обследования в тактике ведения данных пациенток были использованы методы жидкостной цитологии, определения онкобелка Е7 ВПЧ 16-го и 18-го типов, а также вирусной нагрузки. Результаты. Проведение ОКТкольпоскопии в рамках консервативного мониторинга пациенток с доброкачественной ВПЧ-ассоциированной патологией позволяет неинвазивно оценивать структурное и функциональное состояние тканей шейки матки, что способствует снижению числа биопсий. Применение комплексной оценки результатов жидкостной цитологии, определения онкобелка Е7 ВПЧ 16-го и 18-го типов и вирусной нагрузки может использоваться в качестве прогнозирования неблагоприятного персистирующего течения папилломавирусной инфекции, определяя тактику ведения этих пациенток. Заключение. Применение предложенного алгоритма обследования больных с доброкачественным ассоциированным с вирусом папилломы человека поражением шейки матки позволит повысить эффективность диагностики, индивидуализировать тактический подход к каждой пациентке и минимизировать инвазивные вмешательства.

The objective of the investigation was to show the advisability of using optical coherence tomography (OCT) for noninvasive diagnostics and monitoring of treatments in gynecological practice for female patients of reproductive age.Materials and Methods. OCT studies were performed during standard gynecological procedures like laparoscopy and colposcopy, as well as in course of pelvic inflammatory diseases of cervical neoplasia, with the use of an OKT1300U (BioMedTech, Russia). 330 patients of reproductive age (aged 18-45) were examined. The methods used for numeric processing of the OCT images were based on an analysis of histograms and on calculation of the first derivative of the OCT signal over depth.Results. The use of OCT with numeric processing of the images increases the sensitivity of laparoscopy diagnosis of latent chronic salpingitis from 43.5 to 96.0%. In the case of minimal endometriosis, OCT can be used as a substitute for excisional biopsy for the visualization and verification of endometrioid heterotopias. The use of OCT in the case of cervical neoplasia in female patients of reproductive age enables a considerable decrease in surgical aggression during the diagnosis and treatment of cervical intraepithelial neoplasia and early forms of cancer.Conclusion. The use of OCT helps to maximize individualization and organ preservation during the diagnosis and treatment of gynecological pathology, and therefore to preserve the reproductive potential of young female patients.

In present work urgency of the problem of HPV-associated cervical disease in reproductive age is justified. While monitoring 170 patients new approaches of improvement of cervical cancer secondary prevention methodswere proposed. These methods optimize non-invasive diagnostics of HPV-related precancerous cervicitis as its early indicators. Taking into account increase in incidence of cervical cancer in reproductive age, various tactics of patients with human papilloma virus infection (HPV) follow up based on complementary usage of traditional methods and new optical technologies optical coherence tomography (OCT) in the diagnostic phase and photodynamic therapy (PDT) as a treatment method were considered. We justify the expediency of treatment withPolygynaxsuppository at different therapy stages of patients with chronic HPVand use of new modification of OCT (speed imaging 8-10 frames per second), which allows to determine the size of the tank and the main foci of infection that maximally eliminates random biopsy and allows to assess surface of eсtocervixafter treatment in dynamics. The authors suppose that the use of the proposed tactics in chronic cervicitis associated with HPV, will optimize the diagnostic process by eliminating unjustified cervical trauma, as well as to justify sparing therapeutic effect in women of reproductive age.

The work proved the urgency of the problem of HPV-associated cervical diseases in the reproductive age. In the process of observation 153 patients are offered approaches to the improvement of the methods of secondary prevention of cervical cancer through the optimization of non-invasive diagnosis of HPV-associated cervical infection as early precancerous indicators. Given the growth in the incidence of cervical cancer in the reproductive age, examined the options for management of patients with human papillomavirus infection (HPV) on the basis of the complementary use of traditional methods and new optical technologies – optical coherence tomography (OCT) on the diagnostic stage and photodynamic therapy (PDT) as a method of treatment. In the work of the expediency of a new modification of the OCT (speed of obtaining images of 8-10 fps), which allows you to define the size of the core and reservoir foci of infection, what is maximum excludes рандомные biopsy and allows to assess the dynamics of the surface lining of the ectocervix after treatment. The authors believe that the use of the proposed tactics with HPV – cervical unfection will allow to optimize the diagnostic process, eliminating unjustified trauma to the cervix of the uterus, as well as justify the gentle therapeutic effects in women of reproductive age.

FIELD: medicine. SUBSTANCE: invention relates to medicine, gynecology, oncology. High-speed optical coherence tomography (HOCT) is performed by means of probe under control of colposcopy at video frame rate, with the study of kinematic functional characteristics of cervical tissue: intensity of reverse signal dispersion, rate of signal extinction, change of value and number of subepithelial formations, characterising uniformity and variability of tissue vascularisation and vessel elasticity, mobility of whole image, motion of subepithelial formations. Examination is performed at central wavelength 1280 nm, power on object 0.75 mW, resolution 15-30 mcm, scanning depth 2 mm, by smooth movement of OCT-device probe on entire surface of cervix from cervical canal to periphery on 12 vectors of 12-h conventional clock face. If image with constant change of value and number of subepithelial rounded formations of small diameter with low capability of reverse dispersion, straight horizontal basal boundary of bottom layer of whole image is obtained, healthy cervical tissues are diagnosed, in case of presence of mobile subepithelial structures of large size with low capability of reverse dispersion, constant change of their shapes, low rate of signal extinction, indefinite shape of basal bottom boundary of lower layer, diagnosed is viral cervicitis, in case of absence of structural changes and presence of fluctuating movements of whole hOCT-image and broken basal boundary, precancer is diagnosed, if in zone of interest structural and dynamic changes and fluctuations of entire volume of whole hOCT-image are, malignant neoplasm is diagnosed. EFFECT: method makes it possible to increase accuracy of diagnostics, reduce examination time and trauma of manipulations. 2 cl, 3 ex