| Objective: This article discusses the coning of cervix with cold knife,electric knife and cold knife.(C-E-CKC)The efficacy of CKC in the treatment of high grade cervical intraepithelial lesions and its effect on preserving fertility function were designed to provide more suitable surgical methods for patients and to guide clinical practice.Research methods: From January 2013 to January 2017,a retrospective study was conducted on HSIL in obstetrics and gynecology department of Shengjing Hospital,affiliated to China Medical University,due to high grade intraepithelial lesions of the cervix.(CINII-CINIII)Patients undergoing cervical conization.A total of 138 patients were selected,including 81 cases in C-E-CKC group and 57 cases in CKC group.The selection criteria are:(1)The patient is diagnosed as HSIL by the senior pathologist in our department of pathology or after consultation.(CINII-CINIII);(2)Patients older than 40 years of age,and all operations in our hospital,the requirement of preserving fertility,were treated with modified cervical conization and CKC.(3)No other complications such as hypertension,diabetes,heart disease,etc.(4)The patients were followed up regularly after operation.Exclusion criteria:(1)Incomplete clinical data;(2)Missing patients;(3)Postoperative follow-up time less than 1 year(4)Cervical biopsy is diagnosed by external hospital,without consultation of pathology department of our hospital(5)Because of HSIL,the hysterectomy was performed after the diagnostic conization.(6)Microinvasive cervical carcinoma was confirmed by pathology after conization.(7)Patients with other reproductive system neoplasms and immune system diseases;(8)Previous patients with infertility or cervical dysfunction and congenital uterine dysplasia.Record the general situation of the patient: Including patient’s age,contact method,hospitalization time,pregnancy and childbirth before operation,cervical biopsy and pathology before operation,high risk HPV infection,smoking,Basic data such as intraoperative bleeding and operative time,length of conical tissue in different conversion areas,pathology after conization,incisal margin,whether or not the glands were involved,and postoperative reexamination,pregnancy,recurrence and complications.To analyze the effect of different surgical methods in the treatment of high grade intraepithelial lesions,to further explore the efficacy of C-E-CKC and CKC in the treatment of high grade intraepithelial lesions,and to provide more suitable operation methods for patients,and then to guide clinical practice.The statistical method was processed by SPSS 21.0 software.In this study,the patients’ age,intraoperative bleeding volume and bleeding time were used for measuring data.(±S)Representation;Those who accord with normal distribution and variance were tested by t test or non-parametric test,the count data were expressed by percentage,and tested by test and Fisher exact probability method.The level of test was bilateral(p < 0.05)and the difference was statistically significant.Results:1.There were no significant differences between the two groups in general clinical data,age,number of pregnancies,hospital stay,preoperative high-risk HPV infection and smoking status.(P>0.05).2.The average operation time,mean intraoperative bleeding and the average pyramidal length of different transformation zone of C-E-CKC group and CKC group were compared:The average operation time of C-E-CKC group is(29.60±5.989)min;Mean intraoperative bleeding was(14.01± 12.03)ml;The average pyramidal length of type I transformation zone is(1.56±0.18)Cm;The average vertebral body length of type II transformation area is(1.58±0.24);The average vertebral body length of III type transformation area was:(1.67±0.29)Cm;The average operative time in CKC group was(33.67±5.95)min;Mean intraoperative bleeding was(19.56.16.13)ml;The average pyramidal length of type I transformation zone is(1.71±0.34)cm;The average vertebral body length of type II transformation area is(1.80±0.37);The average vertebral body length of III type transformation area was:(2.20±0.27)cm;The C-E-CKC group was significantly smaller than the CKC group,and the difference was statistically significant.(P=0.000,P=0.022,P=0.032,P=0.004,P=0.040).3.The preoperative and postoperative pathological coincidence rates of C-E-CKC group and CKC group were compared: HSIL after operation in C-E-CKC group(CINII,CINIII)There were 46 cases with LSIL,19 cases with cervicitis and 16 cases with cervicitis.The rate of coincidence with the preoperative pathological results was 56.79%,compared with the preoperative histopathological reduction rate of 43.21%,and the postoperative pathological negative rate was 19.75%.Postoperative pathology of CKC group is HSIL(CINII,CINIII)There were 34 cases with LSIL,10 cases with cervicitis and 13 cases with cervicitis.The rate of coincidence with the preoperative pathological results was 59.65%,compared with the preoperative histopathological reduction rate of 40.35%,and the postoperative pathological negative rate was 22.81%.There was no significant difference in pathological coincidence rate between the two groups before and after operation(P>0.05).4.Comparison of postoperative complications between C-E-CKC group and CKC group: Two cases of complications in C-E-CKC group((Bleeding was 0 cases,cervical canal adhesion or stenosis was 1 cases,infection was 1 cases).);The postoperative bleeding rate was 0,the infection rate was 1.23%,and the rate of cervical adhesion or stenosis was 1.23%.The incidence of complications was 2.47%.Complications in CKC group: 4 cases(Bleeding was 1 cases,cervical canal adhesion or stenosis was 1 cases,infection was 2 cases);The postoperative bleeding rate was 1.75%,the infection rate was 3.50%,and the rate of cervical adhesion or stenosis was 1.75%.The incidence of complications was 7.02%.There was no significant difference in the incidence of postoperative complications between the two groups.(P>0.05).5.The positive rate of the tangent margin,the lesion’s gland,the residual rate and the recurrence followed different years of C-E-CKC group and CKC group were compared:The positive rate of the tangent margin C-E-CKC group was 3.70%.(3/81)The rate of the lesion’s gland was 45.68%(37/81).The residual rate of lesion is 0(0/81).The recurrence rate was 1.23%(1/81).The positive rate of cut margin in group CKC was 3.51%(2/57);The rate of the lesion’s gland was 40.35%(23/57).The residual rate oflesion was 1.75%(1/57)The recurrence rate was 3.51%(2/57).There was no significant difference between the two groups in the positive rate of incisal margin,the rate of lesion involvement,the rate of residual lesion and the rate of recurrence.(P > 0.05).In the C-E-CKC group,no recurrence was found in 36 patients who had been followed up for 1-2 years,with a recurrence rate of 0(0/36);Of the 40 patients followed up for 3-4 years,1 patients relapsed,with a recurrence rate of 2.50%.(1/40);No recurrence was found in 5 patients who were followed up for 5 years,with a recurrence rate of 0(0/5).In the CKC group,no recurrence occurred in 22 patients who had been followed up for 1-2 years,with a recurrence rate of 0.(0/22);Of the 28 patients followed up for 3-4 years,1 patients relapsed,with a recurrence rate of 3.57%.(1/28);Of the 7 patients with a follow-up period of 5 years,1 patients had a recurrence rate of 14.29%.(1/7).There is no difference in safety between the two.(P > 0.05).6.The pregnancy rated and delivery of C-E-CKC group and CKC group were compared: The pregnancy rate in the C-E-CKC group was 35.8%.(29/81)The rate of delivery was 58.62%(17/29)The rate of mid-term abortion was 6.90%(2/29)The rate of infertility is 2.47%(2/81);The rate of pregnancy after operation in group CKC was 26.31%(15/57)The rate of delivery was 47.06%(8/15).The rate of mid-term abortion was 13.33%(2/15)The rate of infertility is 5.26%(3/57)There was no significant difference in pregnancy,delivery,abortion and infertility between the two groups(P>0.05).Among the patients who have been delivered,the rate of premature delivery in group C-E-CKC is 17.64%(3/17)The rate of premature rupture of membranes was 11.76%(2/17)Preventive encircling rate 23.53%(4/17)The rate of caesarean section is 94.12%(16/17);The preterm birth rate in group CKC was 37.50%(3/8)The rate of premature rupture of membranes was 25%(2/8)Preventive encircling rate 25%(2/8)The rate of caesarean section is 75%(6/8);There was no significant difference in pregnancy outcome between the two groups(P > 0.05).Conclusion: 1.C-E-CKC and CKC are safe and effective to treat high grade cervical intraepithelial lesions.2.Compared with CKC,the operation time of C-E-CKC was shorter,the intraoperative bleeding was less,and the cervical tissue resection was relatively small,which was more suitable for the patients who could maintain the integrity of the cervix and keep the fertility function.Therefore,it is worth popularizing in clinic. |
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