The Comparison Of CO₂ Laser Vaporization,Electrocautery And Surgical Resection In The Treatment Of High-grade Vaginal Intraepithelial Neoplasia

Vaginal intraepithelial neplsia（VAIN）is a vaginal lesion of varying degrees of atypical hyperplasia confined to the upper vaginal cortex,According to the differentiation ability and clinical risk of squamous cells,it is divided into low grade intraepithelial neoplsia（LSIL）and high grade intraepithelial neoplsia（HSIL）.Vain I refers to the vaginal squamous cell lesions with mature differentiation ability,most of which can be naturally subsided,generally can be temporarily observed,and no special treatment is given.Vain II-III is an intraepithelial lesion mainly composed of immature squamous cell hyperplasia that cannot mature and differentiate.It has a high risk of recurrence or progression to invasive carcinoma,so intervention should be given as soon as possible to reduce the risk of malignant transformation.Due to the special site of VAIN II-III lesions,the appropriate treatment method should be selected based on comprehensive consideration of the patient’s age,fertility requirements,asexual needs,site,range,quantity and grade of the lesions.At present,the main treatment methods include non-operative treatment and surgical treatment.Non-surgical treatment mainly includes local drug therapy and physical therapy,which includes CO₂ laser gasification,electrocautery,condensation,photodynamic therapy and radiation therapy.At present,the commonly used clinical treatment methods include CO₂ laser gasification,electrocautery and surgical resection.ObjectiveTo investigate the effect of CO₂ laser gasification,electrocautery and surgical resection in the treatment of high-grade vaginal intraepithelial neoplasia and its influence on sexual life,and to provide a basis for the development of individualized treatment plan.Materials and methods1 Study objectA total of 157 patients after hysterectomy treated in the Third Affiliated Hospital of Zhengzhou University due to VAIN II-III from September 2018 to August 2020were selected and divided into three groups according to treatment methods.The laser group（60 cases）was treated with CO₂ laser gasification,the electrocautery group（51cases）was treated with electrocautery,and the excision group（46 cases）was treated with simple surgical resection.They were followed up 6 months after treatment.In the laser group,2 cases quit and 7 cases were lost to follow-up.In the electrocautery group,3 cases quit and 10 cases were lost to follow-up.In the excision group,2 cases dropped out midway and 9 cases were lost to follow-up.Finally,51 patients were followed up successfully in the laser group,38 patients in the electrocautery group,and 35 patients in the excision group.Of the 124 subjects,74 had hysterectomy for CIN,39 for early cervical cancer,and 11 for other non-cervical lesions.Among the124 Vain II-III patients,the lesion site was at the vaginal stump in 87 cases,14 cases at the 1/3 of the left vaginal wall,7 cases at the 1/3 of the right vaginal wall,3 cases at the lower 2/3 of the vagina,9 cases at the vaginal stump combined with the 1/3 of the left vaginal wall,and 4 cases at the vaginal stump combined with the 1/3 of the right vaginal wall.The average age of the laser group was（47.69±8.48）years old,ranging from 32 to 63 years old.The average number of pregnancies was（3.14±1.47）.The average number of births was（2.06±0.97）.The average age of electrocautery group was（49.79±8.92）years old,ranging from 31 to 67 years old.The average number of pregnancies was（3.21±1.19）.The average number of births was（2.16±0.89）.The average age of the resection group was（50.26±8.80）years old,ranging from 32 to 67years old.The average number of pregnancies was（3.03±1.50）.The average number of births was（2.03±0.86）.Pairwise comparison of age,gestational order and delivery order among the three groups showed no statistical significance and was comparable（P>0.05）.2 research methodThe laser group adopted the Smartxide2 dot matrix carbon dioxide laser treatment instrument produced by Italy DEKA company.The treatment parameters were selected and adjusted:the power range was 5-10W,the laser beam was positioned and pointed at the lesion,the layer by layer gasification,the laser spot diameter was 1-3mm,the depth was controlled at 2-3mm,and the laser boundary was beyond the lesion area by 10mm or more.The ablation electroknife of Nanchang Yuanhe Zezhong Technology Co.,Ltd was used in the electrocautery group.The treatment parameters were selected and adjusted as follows:the power range was20-25W,each treatment point was 2-3s,the depth of electrocautery was controlled within 2-3mm,and the boundary was more than 5mm beyond the lesion area.In the excision group,local excision was performed with a cold knife with a margin5-10mm away from the lesion.After excision,1-0 suture was used.3 Observation indexes and postoperative follow-upObjective Outcome indicators:According to the treatment process of cervical intraepithelial lesion（CIN）,more than 2 experienced pathologists underwent the"three-step"diagnostic process of"cytology,colposcopy and histology",and compared the colposcopy pathological results after treatment with the three methods,the negative ones indicated that the treatment was effective.The human papilloma virus（HPV）detection kit of Hollojt Medical Technology Co.,Ltd was used to detect HPV infection by APTIMA method,and the therapeutic effect of three treatment methods on HPV negative conversion was evaluated.Subjective observation indexes:the female sexual distress scale-revised（FSDS-R）and the female sexual function index（FSFI）evaluation before and after the three methods of treatment of sexual satisfaction(FSDS-R score range 0～52 points,13 points or higher indicates that there is sexual life,the higher the score shows that the stronger the degree,the lower the sexual satisfaction.FSFI includes sexual desire,patient’s subjective arousal ability,vaginal lubrication during sexual activity,orgasm,sexual satisfaction and pain during intercourse.The total score ranges from 2 to 36,and the higher the score,the higher the sexual satisfaction.Postoperative follow-up:Outpatient follow-up and telephone follow-up were mainly used.Follow-up time was 6 months after treatment.4 Statistical methodSPSS 23.0 software was used for statistical analysis.Measurement data were normally distributed and expressed as（?x±s）.Two independent samples t-test was used for comparison between groups.The statistical data were calculated as percentage（%）,and theχ² test was used to get down to 0.05,with a P<0.05 being the statistically significant difference.Result1 The three groups of patients were effective 6 months after treatmentIn the laser group,the effective rate of colposcopy histology was 90.20%（46/51）6 months after treatment.6 months after treatment,the effective rate of colposcopy histology was 84.11%（32/38）in the electrocautery group.In the excision group,the effective rate was 94.29%（33/35）by colposcopy histology 6 months after treatment.6months after treatment,there was no statistical significance in pairwise comparison of effective rate among 3 groups（P>0.05）.2 HPV turned negative 6 months after treatment in the three groupsBefore treatment,the HPV infection rates in the laser group,electrocautery group and excision group were 90.20%（46/51）,92.11%（35/38）and 91.43%（32/35）,respectively.There was no significant difference in HPV infection rate between the three groups before treatment（P>0.05）.After treatment,the HPV infection rates in the laser group,electrocautery group and excision group were 72.55%（37/51）,73.68%（28/38）and 65.71%（23/35）,respectively.Compared with before treatment,the HPV infection rate of the three groups after treatment was lower than that before treatment,and the difference was statistically significant（P<0.05）.After treatment,the HPV conversion rates in the laser group,the electrocution group and the excision group were 19.57%（9/46）,20.00%（7/35）and 28.13%（9/32）,respectively.After treatment,there was no statistical significance in the negative HPV conversion rate among the three groups（P>0.05）.3 Sexual loss of patients in the three groups after treatmentIn the laser group,electrocautery group and excision group,the rate of sexual loss 6 months after treatment was 3.92%（2/51）,7.89%（3/38）and 51.43%（18/35）respectively.There was no significant difference between the laser group and the electrocautery group（P>0.05）.Compared with the laser group,the rate of sexual loss in the resection group was higher,and the difference was statistically significant（P<0.05）.Compared with the electrocautery group,the rate of loss of sexual life was higher in the resection group,and the difference was statistically significant（P<0.05）.4 Evaluation of FSDS-R before and after treatment in the three groupsBefore treatment,the FSDS-R scores of the laser group,the electrocution group and the excision group were 17.61±6.73,16.2±6.59 and 15.12±5.29,respectively.Pairwise comparison of the FSDS-R scores of the three groups before treatment showed no significant difference（P>0.05）.After treatment,FSDS-R scores of the laser group and the electrocautery group were 18.10±7.16 points and 20.03±7.18points,respectively,and there was no statistical significance compared with that before treatment（P>0.05）.The FSDS-R score of the resection group after treatment was 32.71±7.70 points higher than that before treatment,and the difference was statistically significant（P<0.05）.After treatment,there was no significant difference between the laser group and the electrocautery group（P>0.05）.After treatment,the score of the excision group was higher than that of the electrocautery group and the laser group,and the difference was statistically significant（P<0.05）.5 FSFI evaluation of patients in the three groups before and after treatmentLaser group,the electric bright group and excision group before treatment in patients with sexual desire,FSFI evoke the subjectivity of the capacity,the sexual activity vaginal lubrication and sexual climax of sexual intercourse,sexual satisfaction,pain score,respectively（3.33±1.39 points,3.67±1.21 points and 3.11±1.35）,（3.60±1.36 points,3.69±1.27 points and 3.23±1.38）,（2.76±1.06 points,2.84±1.20 points and 3.02±1.29）,（2.27±0.78 points,2.24±0.80 points and 2.38±0.85points）,（3.62±1.12 points,3.76±1.14 points and 3.46±1.26 points）,（3.64±1.28 points,3.52±1.12 points and 3.34±1.30 points）;Postoperative FSFI6 scores in the three groups were（3.33±1.33 points,3.14±1.45 points and 2.47±1.66 points）,（3.68±1.29points,3.14±1.14 points and 2.82±1.85 points）,（2.63±1.03 points,2.11±0.76 points and 2.03±1.51 points）,（2.24±0.72 points,1.81±0.48 points and 1.41±0.87 points）,（3.60±1.04 points,3.08±1.02 points and 1.88±0.95 points）,（3.42±1.03 points,3.39±1.19 points and 2.08±1.35 points）.Before treatment,there was no significant difference in the scores of 6 fields of FSFI among the three groups（P>0.05）.There was no significant difference in the scores of 6 FSFI fields in the laser group 6months after treatment（P>0.05）.June electric bright group after treatment compared with before treatment,patients with sexual desire,sexual intercourse subjectivity evoke ability and pain score three areas,there was no statistically significant difference（P>0.05）,and sexual activity vaginal lubrication,orgasm and sexual satisfaction scores are lower than before treatment in the field of 3,the difference was statistically significant（P<0.05）.June excision group after treatment compared with before treatment,patients with sexual desire and the subjectivity of arouse ability in the field of two grade,there was no statistically significant difference（P>0.05）,and sexual activity vaginal lubrication,orgasm,sexual satisfaction and pain during sex in the field of four scores are lower than before treatment,the difference was statistically significant（P<0.05）.At 6 months after treatment,the scores of subjective arousal,vaginal lubrication during sexual activity,orgasm and sexual satisfaction in the electrocautery group were lower than those in the laser group,and the differences were statistically significant（P<0.05）.There was no significant difference in sexual desire and pain during intercourse between the electrocautery group and the laser group 6 months after treatment（P>0.05）.At 6 months after treatment,the scores of vaginal lubrication,orgasm,sexual satisfaction and pain during sexual activity in the resection group were lower than those in the electrocautery group,and the difference was statistically significant（P<0.05）.At 6 months after treatment,there was no significant difference in sexual desire and subjective arousal ability between the excision group and the electrocautery group（P>0.05）.At 6 months after treatment,sexual desire,subjective arousal,vaginal lubrication during sexual activity,orgasm,sexual satisfaction and pain during intercourse in the resection group were all lower than those in the laser group,with statistical significance（P<0.05）.Conclusion1.CO₂ laser gasification,electrocautery and surgical resection are all effective methods for the treatment of high-grade vaginal intraepithelial lesions.2.CO₂ laser gasification,electrocautery and surgical resection have certain therapeutic effects on HPV infection in high-grade vaginal intraepithelial lesions.3.The effect of CO₂ laser gasification on female sexual function in the treatment of high-grade vaginal intraepithelial lesions is less than that of electrocautery and surgical resection.