| AIM: Uterine cervix cancer is one of the common gynaecological tumors. Its incidence rate is on the top of female reproductive malignant tumors. CIN is a series of precancerous change closely related to inrosive cervical cancer. It reflects the sequent procedure in the occurrence and development of cervical cancer. Early diagnosis and treatment of CIN can prevent cervical cancer. With the development of the detective methods and teniques and the wide use of colposcope CIN have been increasingly diagnosed and its age of onset is younger. Many patients with CIN appet to remain procreative.Therefore,it appears very important to keep their breeding function especially for those who are young and haven't got a baby. Recently, following therapeutic progress of CIN, abdominal hysterectomy is no longer the first method of CIN cure.There are no special symptoms or signs for most of the patients with CIN. So half of the patiens can not be diagnosed early without cervical cytological test. It is necessary that woman with sexual life should Leep regularity every year, if the result is abnormal, high-risk HPV-DNA monitoring,colposcopy and cervical biopsy should be taken to make a final diagnosis. Then early treatment can be done and the procreative ability can be remained with proper curng methods. So it is especially important to approach early diagnosis and treatment of CIN. The conculsions of researches in and abroad disagree on whether young patients with CIN especially CIN III can remain precreative. 80 patients aging from 21-35 are adopted in this research including 45 with CIN II and 35 with CINIII. They underwent Leep treatment and signed the informed consent before operation. All the patients were followed up in forms of TCT,HPV-DNA monitoring, if preoperative HPV-DNA is positive, colposcope and cervical biopsy if essential in the next six months to two years according to different situations to know the therapeutic efficacy and to expound the value announcement and the importance of follow-up of Leep in curing CIN II /III. to offer evidence for young CINIII patients.CASES AND METHODS1 Selected cases:232 patients with CIN were selected from 2006.8-2008.12.They were diagnosed by gynaecological examination,TCT,high-risk HPV monitoring,colposcopy and cervical biopsy at the out-patient of the third affliated of Luohe Medical College and of Zhengzhou University. 80 cases were selected from them who were CIN II /III , HPV positive were 85 cases, aging from 21 to 35.2 MethodsAll the cases underwent colposcopy and biopsy. Leep carried out if the pathological results were CIN II / III .Operation can be done after the routine examinations such as blood routine,urine routine,four items for hemagglutinin and three items for immunology are normal. Operation time:3-7 days after menstruation. 3% acetic acid and iodi liquer is used on the cervix before Leep to reasure the ambit of the leison. Electrode started working 5mm outer from the exoloma of the leision,the triangular electrode eccope the cervical canal for 15-20mm clockwisely and the gyrate electrode ablate the cervix excessively for 10-15mm deeper to make it done adequately. All the tissues cut down should be on pathological diagnosis.3 Follow-upFurther consultation is need one week and one month postop. to know the vaginal bleeding,excretion and the cervical wound surface. More should be done if abnormal. All the cases did TCT three months postop.. Colposcopy and biopsy is needed if TCT is abnormal. If TCT is normal for three times the follow-up can be done once a half year and once a year two years postop. with a normal TCT. High risk HPV-DNA monitoring is needed for those who have a preoperative positive result.4 Statistical treatmentData were analyzed by SPSS 11.0 software though t test or x~2 test, P<0.05 were considered with statistical significance.RESULTS1 Comparison between biopsy under colposcope and the pathological results after Leep45 CIN II and 35 CINIII is diagnosed for the former while 44 CIN and 1 inflammation is diagnosed for the latter. For the 35 CINIII,2 graded to early infiltrating carcinoma and 1 degred to CIN II, 1 degred to inflammation.2 Raw surfaceOne week after Leep vaginal discharge,light yellow or red, is more and the crust on the cervical surface began to form. It began to ablate with sprinkle vaginal bleeding at the second week. Fresh epithelium grew at the third to four weeks and the raw surface is bright red and became completely epithelization from the sixth to eighth week.3 Follow-up postop.Three months to two years is needed according to different operation time. The follow-up rate achieved to 100% for the next three months and six months and to 98.18%(55/56) at the second year postop.3.1 At the third month 80 cases were followed up with TCT 75(93.75%) normal and 5(6.25%) abnormal. There were erythema,punctiform blood vessel and mosaicism blood vessel on the cervical surface under colposcope while 3 were innocent and 1 CIN II is detected. 11 positive HPV-DNA were checked out for the total 58 high risk HPV-DNA monitoring.3.2 At the sixth month 80 cases were rechecked. The normal is 78(97.5%) and the abnormal is 2(2.5%) while the colposcopy and biopsy confirmed to be inflammation. 11 cases were inspected for the high risk HPV-DNA with 3 positive results. 3.3 At the twelve month 68 cases were rechecked. The normal is 67(98.5%) and the abnormal is 1(1.5%) while the colposcopy and biopsy confirmed to be inflammation. 3 cases were inspected for the high risk HPV-DNA with 3 positive results.3.4 At the eightteen month 60 cases were rechecked. The normal is 60(100%) and no abnormal, 1 cases were inspected for the high risk HPV-DNA with 1 positive results.3.5 At the second year 55 cases were rechecked. The normal is 54(98.18%) and the abnormal is 1(1.82%) while the colposcopy and biopsy confirmed to be CIN I . 1 cases were inspected for the high risk HPV-DNA with 1 positive results, who is the same person with the abnormal of TCT.4 Pregnancy and delilvery after LEEP13 cases got pregnancy with 5 term birth,7 induced abortion because of family planning and 1 three months for pregnancy still under follow-up now. For the first 5 cases, all the neonate developed normally and 4 were born through vaginal and 1 for cesearn section without premature rupture of membrane.CONCLUSION1 Leep is a safe and effective therapy for CIN II,CINIII. It doesn't influence the pathophysi ology of the tissue.2 The young patients with CINIII who wants to remain precreative can choose leep which does not influence later pregnancy or delivery. But long-term follow-up is needed. |
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