| BackgroundCervical cancer (CC) is one of the three kinds of malignant carcinoma in female genital system. Each year there are about500.000new cases, accounting for5percents of the new cases of cancer. Every year there are200,000cases die of cervical cancer, and the patients become younger in average age. Large studies show that the occur and develop of cervical cancer is the development from the quantitative to qualitative changes, as well as the inevitability from gradual transformation to mutation, and it takes about ten years. For this reason, the development of cervical cancer is a long process. We can find more precancerous lesion by means of cervical screening. We can give an early intervention and an early treatment to these patients, thus reducing the incidence and mortality of cervical cancer.With the development of cervical screening, the death rate of CC is distinctly dropped, and we can find more and more precancerous lesions namely cervical intra-epithelial neoplasia(CIN). Thus the treatments of CIN become hot. For the past few years, cervical lesions present a younger trend. Thus keeping the ability to have children becomes the therapeutic principle of the treatment of cervical intraepithelial neoplasia(CIN). Cervical conizations (LEEP and cold knife conization CKC) is an effective mean to treat CIN. However, with the wide use of cervical conization, there are still positive lesions left in incisal margin after conization. We are faced with the problem how to have an effective follow-up and whether a second operation is needed. It is of great significance to forecast whether there is residual disease or recurrence after cervical conization for the patients and the doctors. So far, domestic related reports are few, and most are descriptive research. Foreign related reports are most concentrated on predicting the remnant or recurrence according to edge condition of cone cut specimens. Whether the grades of cervical lesion have relation with residual disease after LEEP has different opinions. Study revealed:148cases of CIN3and I a cervical squamous cell carcinoma of the cervix LEEP line or cold knife cone to cut method the cut edge positive and do a second surgery, and find postoperative residual lesions may have relation with lesion grades.In this essay, we do a research on the40cases who have a hysterectomy after LEEP, comparing the pathology after LEEP and after the hysterectomy, to find whether the grades of cervical lesion have relation with residual disease. At the same time, we make a follow-up to the85cases of CIN after LEEP, to explore the high risk factors of residual disease.Objective1. To make a comparison of the pathology after LEEP and hysterectomy the same term, and to verify whether the grades of cervical lesion have relation with residual disease after LEEP.2. We make a follow-up to the patients after LEEP, to probe into the high risk factors of residual disease after LEEP.Method1.125cases of patients with cervical intraepithelial neoplasia and were operated by LEEP were collected in the first affiliated hospital of Zhengzhou University from September2009to November2011, we make a retrospective control study of medical records.All the patients met the criteria of the study and the data is integrity. The patients are divided into LEEP group (group A=85) and LEEP+Hysterectomy group (group B=40) according to the surgical method.2. The patients in group A should have regular TCT and HPV check after cervical conization, and vaginal mirror biopsy should be put into practice if there is necessary. If the histology confirms there is CIN as before, remnant or recurrence will be diagnosed. If the result of TCT is abnormal within half a year after operation, as well as is confirmed by the histology, remnant is diagnosed. If the result of TCT is normal within half a year after operation, but the histology confirms there is CIN half years later, recurrence is diagnosed.3. Statistics processing:the SPSS statistical package program17.0was used for all analysis. T test is used in the numerical variable. Chi-square test is used to the classified variable, the normality test and homogeneity of variance test are conducted before chi-square test. The significant level is a=0.05。Whenp<0.05, the difference has statistics meaning.Result1A comparison between colposcopy biopsy and LEEP pathologyA comparison between colposcopy biopsy and LEEP pathology:total of91(72.8%) cases were accord. The diagnose accordance rate of CIN1, CIN2, CIN3were65.0%,55.6%and84.0%respectively. Three groups have two two chi-square test, the comparison between CIN1and CIN2:χ2=0.47,.P>0.05; the comparison between CIN1and CIN3:x2=5.07,P<0.025; the comparison between CIN2and CIN3: χ2=12.86,P<0.005. The diagnose accordance rate of colposcopy biopsy and LEEP pathology was higher in group CIN3than that of group CIN1and group CIN2.2A comparison on clinical Pathological features and the age between two groupThe pathological features of group A:4cases of LEEP pathological were chronic cervicitis,15cases were CIN1,18cases were CIN2,48cases were CIN3. There are19(22.35%) cases of low-grade cervical lesion (chronic cervicitis and CIN1) and66(77.65%) cases of high-grade cervical lesion(CIN2and CIN3) in group A. The pathological features of group B:7cases of LEEP pathological were CIN1,11cases were CIN2,18cases were CIN3,1case was microinfiltrating carcinoma. There are7(1.75%) cases of low-grade cervical lesion and33(82.5%) cases of high-grade cervical lesion in group B. The result of chi-square test:χ2=4.86,P<0.05.The lesions level of the Patients in group A was lower than that of group A(P<0.01).The average age of group A was(42.4±7.9)years, the average age of group B was(48.7±8.1)years. T test is used to compare the age, t=4.25, P<0.05. The average age of group A was lesser than group B.3A comparison on LEEP pathology and hysterectomy pathology between two groups40cases of patients were given LEEP and then were given hysterectomy, LEEP pathology was in full compliance with hysterectomy pathology in39cases of patients. The LEEP pathology was CIN3involved glands in one case of patient, and was found microinvasion in the patient’s hysterectomy pathology,her lesion level become higher.4Residual disease tatus of uterine lesions after LEEP then hysterectomy3cases who were given hysterectomy after LEEP were found residual uterine lesion, the total residual rate was7.5%. In the3cases of parients, one case of patient was microinvasive carcinoma, one case was CIN3, one case was CIN1.37cases were not found uterine lesion. The CIN patients with higher levels, have higher lesions residual rate. The lesion residual rate in CIN1-2, CIN3and microinvasive carcinoma were0(0/18),9.52%(2/21) and100%(1/1) respectively. From the analysis of the retention rate, with increasing residual lesions and disease incidence and heighten.5Risk factors analysis of residual disease after LEEP23recurrent cases are founded in the85cases, the recurrence rate is27.1%(23/85). Gland involvement accounts for60.86%among the total recurrent cases(14/26); Gland involvement accounts for19.35%among the no recurrent cases(12/62).The difference has statistics meaning(x2=13.62, P<0.005,).The research which is referred to the result of Jeong-YeolPark and combined the Logistic regression analysis classified the patients into two groups:RLU/PC>500and RLU/PC<500. The group RLU/PC>500have27cases; the group RLU/PC<500have58cases.18cases are founded residual disease in the group RLU/PC>500(78.26%),9cases are founded no residual disease in the group RLU/PC>500(14.51%). The difference has statistics meaning(χ2=31.45, P<0.005).Conclusion1. Vaginal microscopically biopsy can not replace the role in the LEEP CIN treatment. It plays a very important role in diagnosis of CIN.2. LEEP postoperative residual lesions incidence increased with the increase of the level with lesions.3. After the treatment of cervical intraepithelial neoplasia by LEEP, the pati-ents need to have close follow-up. RLU/PC>500before conization, gland involved are the high risk factors of residual disease. |
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