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Удаление бородавок — цены на удаление бородавок лазером и азотом в клинике в Москве

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Удаление бородавок

Акушер-гинеколог, кандидат медицинских наук Мгдесян К.К.

В последние годы проблема диагностики и лечения заболеваний, обусловленных и связанных с вирусами папилломы человека (ВПЧ) привлекает самое пристальное внимание гинекологов ввиду их широкого распространения, высокой контагиозности и доказанной онкогенности (некоторые типы ВПЧ считаются инициирующим фактором рака шейки матки).

Папилломавирусная инфекция гениталий (ПВИ) относится к заболеваниям, передаваемым половым путём. Однако имеются сообщения о наличии ВПЧ в амниотической жидкости беременных, возрастании в последнее время частоты папилломавирусных поражений гортани и бронхов у детей, что рассматривается как результат инфицирования при беременности.

Признаки ПВИ высоковариабельны и выявляются на шейке матки, влагалище, вульве, промежности, перианальной области в виде остроконечных, папиллярных, папуловидных кондилом и объединяются под обобщающим термином «экзофитные кондиломы». Важно отметить, что при наличии экзофитных кондилом наружных половых органов у 85% пациенток диагносцируются очаги ПВИ во влагалище и на шейке матки, причём часто — в бессимптомной форме. И почти у каждой четвёртой их них имеются ассоциированные с нею заболевания: цервикальные внутриэпителиальные неоплазии (CIN) той или иной степени тяжести – предраковые состояния шейки матки.

Взгляды на природу остроконечных кондилом подверглись большой эволюции, их появление считали следствием различных факторов (трихомониаз, сифилис, кандидоз, гонорея, приём антибиотиков…), либо рассматривали как вариант нормальной слизистой оболочки (что, к сожалению, наблюдается и в наши дни!).

Поскольку шейка матки наиболее «уязвима» для ВПЧ, особое внимание уделяется исследованиям данного органа. Структура этой патологии представлена плоскими и остроконечными кондиломами, различными изменениями эпителия шейки матки при наличии единичных клеток с койлоцитозом (специфические клетки для ПВИ).

Интересно то, что не в каждом случае вирус, закрепившийся в генной субстанции клетки, вызывает те или иные симптомы. Большую роль играет состояние иммунной системы организма. Исследование её функции, особенно при рецидивирующей вирусной инфекции, должно быть включено в комплекс обследования.

В процессе репликантного цикла геном ВПЧ экспрессирует от 8-до 10 белковых продуктов, наиболее важными с точки зрения онкогенных потенций ВПЧ являются онкобелки Е5, Е6, Е7. В частности, эффективность лечения напрямую зависит от уровня синтеза онкобелка Е7. Этот белок нейтрализует противовирусную активность альфа-ИФН (интерферона) за счёт того, что избирательно блокирует большинство генов, индуцируемых ИФН. Кроме того, Е7 внутриклеточно инактивирует фактор регуляции ИФН, который включает транскрипцию генов, кодирующих синтез противовирусных белков. Это говорит о том, что белок Е7 не только выполняет функции основного фактора малигнизации, но и определяет устойчивость клеток к ИФН-терапии.

Хочется отметить ещё один важный факт: предрак и начальные формы рака шейки матки, как правило, начинаются с функциональных нарушений, которые при осмотре невооружённым глазом (обычный осмотр гинеколога в зеркалах) не всегда определяются. И в этой стадии заболевания специфических симптомов и жалоб у женщины также может не быть…

В связи с этим, обязательным этапом обследования пациентки при обнаружении остроконечных кондилом любой локализации должен быть цитологический и кольпоскопический скрининг . При обнаружении соответствующих признаков ПВИ производится прицельная биопсия (в некоторых случаях с диагностическим выскабливанием слизистой цервикального канала).

С помощью ДНК-специфических методов все пациентки должны быть обследованы на наличие в вагинальном и цервикальном секрете ДНК ВПЧ. Следует отметить, что у каждой 7-й женщины ДНК ВПЧ обнаружить не удаётся, несмотря на очевидные признаки инфекции (здесь целесообразно двукратное исследование).

Эффективность лечения определяется как своевременной диагностикой, так и адекватным лечением и профилактикой рецидивов заболевания.

Учитывая то факт, что папилломавирусная инфекция передаётся половым путём, обследоваться и лечиться, при необходимости, должен и половой партнёр женщины, а на период терапии и в течении 6 месяцев после неё рекомендуется барьерная контрацепция (с помощью презерватива). Лечение проводится с учётом локализации, характера процесса, сопутствующих заболеваний. Обязательной является терапия других имеющихся инфекционных заболеваний и осуществлена коррекция микробиоценоза влагалища.

Все виды локального лечения направлены на удаление кондилом и атипически изменённого эпителия. Для этих целей используются различные виды химических коагулянтов, цитостатиков и физиохирургических методов (электроэксцизии, криодеструкции, лазерной вапоризации…). Одним из самых современных, перспективных высокоэффективных методов является радиохирургический.

Однако даже при наличии такого большого выбора методов лечения ПВИ бывают рецидивы. В связи с этим, наиболее оптимальным считается комплексный комбинированный метод терапии, когда локальное удаление кондилом производится на фоне системного противовирусного лечения. Учитывая то, что специфических анти-ВПЧ препаратов не существует, используется неспецифическая противорецидивная терапия (витамины, адаптогены, десенсибилизирующие средства, иммуномодуляторы…). Широко используются в последние годы интерфероны и их индукторы, обладающие противовирусным, антипролиферативным и иммуномодулирующим действием. Однако их применение должно быть обоснованным и требует индивидуального подбора.

Таким образом, ПВИ гениталий представляет собой полиморфную многоочаговую патологию кожи и слизистых оболочек нижнего отдела генитального тракта, диагностика и лечение которой в ряде случаев представляет определённые трудности, даже для врачей с опытом работы, но без специального обучения, подготовки и не имеющих в своём арсенале современных методов обследования; оборудования и аппаратуры.

Наш медицинский центр оказывает самый широкий спектр услуг. Вы всегда можете обратится к нам по вопросам дерматологии. Мы готовы оказать вам услуги лечения псориаза и лечения разноцветного лишая.

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