Indications: Clinically, the smear is abnormal or doctors suspect cervical lesions.
Contraindications Colposcopy is a kind of endoscope, but unlike other endoscopy, it needs to put the lens in the human body. As long as you aim at the cervix in vitro, you can check it quickly and conveniently, so there are almost no contraindications unless the patient can't cooperate or come to Korea during menstruation.
operating procedure
Before colposcopy, patients do not need to eat, enema, shave or anesthesia.
The combination of colposcope includes low-power binocular microscope, central lighting device and movable support. Generally, the most practical magnification is 8- 18 times. The green filter is placed between the light source and the tissue, and its main purpose is to emphasize the changes of uterine epithelial blood vessels and the color contrast between normal and abnormal.
During the examination, the patient lies on the inner table, his feet are relaxed and open, and the perineum and vagina do not need special disinfection. Doctors put colposcopy commonly known as duckbill into vagina, open vagina, and observe vulva and vagina for inflammation, ulcer, human papillomavirus infection or abnormal secretion with naked eyes and low-power microscope.
Pay attention to expose the cervix to prevent the cervical epithelium from being worn off. Find the transition zone or SCJ between squamous epithelium and glandular columnar epithelium, and repeat smear if necessary.
Colposcopy is aimed at the cervix in vitro, and the cervix can be diagnosed by magnifying it. If there is mucus or secretion on the cervix, it can be wiped clean with a cotton swab dipped in normal saline to avoid affecting the examination.
Check the cervix with a low-power microscope, observe its color, and pay attention to whether there are visible lesions, especially fragile parts or ulcers. Then, turn to a high-power microscope to examine the vascular morphology.
In order to show the lesion, apply 3-5% acetic acid solution to the cervix and upper vagina with cotton branches for at least 30 seconds. The longer the acetic acid stays, the more protein condenses, and the easier it is to see the lesion. At this time, continue to check the cervix with low magnification. If the transitional area can be completely seen, colposcopy will be satisfactory. When applying acetic acid, the patient will feel a little sour and spicy, but
Look for damage, such as acetic acid white epithelium, atypical blood vessels, mosaic, spots and so on. And look for the inner and outer edges of vinegar white lesions, and the inner edge should only stop at SCJ.
If we continue to check the cervix with green filter, we can see the boundaries of white vinegar lesions or abnormal blood vessels more easily.
At this time, ask yourself: Is it possible to invade cancer tissue? Did you see the focus and transition zone clearly? If yes, the inspection is satisfactory, otherwise it is unsatisfactory. And where is the most meaningful slice position?
Next, under colposcopy, cervical canal dilation (ECC) was performed, and the cervical canal about two centimeters long was systematically scraped by putting a spoon in SCJ. Then use tweezers to clamp the mucus gathered in the outer neck of the uterus at this time, so that the blood and the epithelial tissue of the inner neck of the uterus are coagulated and sent to pathological examination. This operation does not require anesthesia, and the patient just feels a little sore for a short time.
After ECC, the cervix was washed with acetic acid, and the number of sections was determined according to the number and size of lesions under colposcopy. The tissue taken under colposcopy is very small, and the patient does not need anesthesia. The wound is very small and there is only a little pain.
In order to stop bleeding, sometimes a piece of gauze is stuffed in the vagina, which can be taken out when the patient takes a bath at night.
The results of colposcopy, including the location of SCJ and the lesion, are clearly marked in the report, and the cross section is indicated by X.
Disinfection grade of materials used
Vulva and vagina do not need special disinfection.
Disinfection of materials
In principle, the main medical items are discarded after use, but they will be discarded after only one use and will not be reused. However, some instruments need to be disinfected before use, such as duckbill, tweezers and spoon. , and then sterilized according to the steps of (1) thorough cleaning and (2) clinical sterilization described in Disinfection and Sterilization of Medical Supplies.
Matters needing attention
Do not use vaginal plugs two days before colposcopy.
The hemostatic gauze in the patient's vagina can be taken out when taking a bath at night. If during this time, he feels that the blood has been flowing out or there is a lot of bleeding after the gauze is taken out, he should go to the emergency room of the hospital immediately, but this is very rare.