Clinical Analysis On Treatment Of Cervical Intraepithelial Neoplasia By LEEP And CKC

Objective:To compare the efficacies of loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC) in treatment of cervical intraepithelial neoplasia(CIN) so as to discuss the advantages and disadvantages of two methods treatment.Methods:62 patients with CIN were selected from the outpatient and inpatient department of gynaecology, the first affiliated hospital of Kunming Medical University from September 2013 to September 2014. All the patients were diagnosed as CIN Ⅰ～ CIN Ⅲ by biopsy under colposcope. All patients were randomly divided into LEEP group (n=31) and CKC group (n=31).Retrospective analysis of the 62 cases of CIN was done and the operating time, intraoperative blood loss, postoperative bleeding, postoperative cervical adhesion, postoperative infection, clinical effect and change of histopathologic results before and after operation, were noted.Results:The comparision of the two groups regarding operating time and intraoperative blood loss: in the LEEP group, the mean operating time was 8.1±4.4 minutes and the average intraoperative blood loss was 6.8±2.8 ml. In CKC group,the mean operating time was 35.8±11.9 minutes and the average intraoperative blood loss was 21.7±29.0 ml. Compared with CKC group, the LEEP group had shorter operating time and the intraoperative blood loss was less. The differences between the two groups were statistically significant (P＜0.05).The comparison of the postoperative complications among the two groups: in the LEEP group, postoperative bleeding and postoperative infection was found in 1 case (3.2%) each. None of the patients in this group had cervical canal adhesion. In CKC group, postoperative bleeding was found in 2 cases (6.5%).The postoperative infection and cervical canal adhesion was found in 1 case (3.2%) each. The complication rate in CKC group and LEEP group was 12.9% and 6.5%, showing no statistical significance (P> 0.05).The histopathological examination results before and after the surgery between the two groups: In the LEEP group, the results were consistent in 17 cases (54.8%), undergraded in 5 cases (16.1%) and overgraded in 9 cases (29%); in preoperative and postoperative pathological biopsies and final specimens. In the CKC group, the results were consistent in 16 cases (51.6%), undergraded in 6 cases (19.4%) and overgraded in 9 cases (29%).The pathological diagnosis in LEEP group was better than CKC group. The rate of pathological undergrading in LEEP group was less than CKC group. The two groups had same rate of pathological overgrading. There was no statistical significance between the two groups (P> 0.05).Treatment effect between two groups:LEEP group, out of the 31 patients, one of the patients was diagnosed as carcinoma in situ which required total hysterectomy. Among the remaining 30 patients, postoperative residual lesions were seen in 2 cases (6.7%), recurrence in 2 cases (6.7%) and the cure rate was 86.7%. In CKC group, out of 31 patients, one patient was diagnosed with squamous cell carcinoma in situ involving the glands, which required total hysterectomy after 2 months. The remaining 30 patients were followed up, none of the patients had residual lesions, recurrence was seen in 1 case (3.3%) and the cure rate was 96.7%. CKC group had better cure rate than LEEP group, but the difference between the two groups was not statistically significant (P> 0.05).Conclusion:The effectiveness of LEEP is similar to cervical cold knife conization in the treatment of the cervical intraepithelial neoplasia; but the LEEP requires less operating time and intraoperative blood loss is less compared to CKC. The postoperative complications between the two groups are similar and statistically insignificant. LEEP is a simple, minimally invasive procedure and is readily accepted by patients compared to CKC.