| ObjectiveThe main purpose of this study was to explore the high risk factors of recurrence of cervical high grade squamous intraepithelial lesions(HSIL)after primary cone resection in childbearing age,and to further explore the individualized management strategy of HSIL postoperative patients in childbearing age.Prevent or reduce the effect of reoperation on fertility and reproductive health.Method1.Collection between January 2015 and December 2019,institute and the first people’s hospital in guangzhou nansha branch line colposcope guided biopsy pathologic diagnosis of HSIL a total of 508 cases of patients,and were treated by LEEP(Loop electrosurgical excision procedure)treatment,choosing to complete the regular follow-up and related content index of the first cutting cone postoperative follow-up ranging in age from 18 to 50 childbearing age between patients with complete disease A total of 278 cases were collected.2.Regular follow-up after the initial official neckline conization,including medical history,symptoms and signs,routine examination of female department,TCT,HPV detection,etc.The method of cytology combined with HPV detection was followed up for 1-5 years.After the postoperative pathological diagnosis of quality control,if no abnormality was found,the patients were followed up every 4-6 months in the first year after the operation,and every 6-12 months from the second year after the operation.If no signs of lesions were found,If no abnormality was found after 2consecutive examinations within 12 months,the patient should be reexamined once every 3 years.If gynecological routine examination found macroscopic lesions or TCT results were positive(including ASCUS,ASC-H,LSIL,HSIL,SCC,AGC,AIS)or HPV positive patients,they were referred to coldoscopy,cervical biopsy,cervical tube curettation(ECC)and cervical conization again if necessary.3.Retrospective analysis was conducted to determine whether the age,gestational order,birth order,HPV infection,TCT,colposcopic biopsy,type of transformation zone,surgical margin status,lesion gland involvement,lesion involvement multiquadrant and other factors of the patients with recurrence were relevant factors for the recurrence of patients after primary cervical HSIL coning.4.Statistical methodsSPSS 21.0 software was used for statistical analysis of the data.Count data was represented by rate(%).X~2test was used for univariate analysis and logistic regression analysis was used for multivariate analysis;P<0.05 was considered statistically significant.Result1.Twenty-three of the 278 patients with cervical HSIL primary coning at child-bearing age had positive margins,including 0 cases of CINI(00.00%,0/23),10 cases of CIN II(43.48%,10/23),and 13 cases of CIN III(56.52%,13/23).Among the 23patients with positive incisor margins,17 side lesions recurred(73.91%,17/23),including 0 cases of CINI(0/7,00.00%),5 cases of CIN II(5/17,29.41%),and 12cases of CIN III(12/17,70.59%).There was a significant correlation between CIN level and recurrence rate in patients with positive incisor margin after primary conization(P<0.05).2.There were 44 cases of recurrence after primary conization,and 14 cases(14/44,31.82%)were found to have recurrence in the first year,16 cases(16/44,36.36%)in the 24th year,8 cases(8/44,18.18%)in the third year,and 4 cases(4/44,36.36%)in the fourth year during the follow-up.9.09%),2 cases(2/44,4.55%)recurred in the 5th year,and most of the patients with focal recurrence after primary conization recurred within 2 years.3.The age distribution of patients with recurrence after primary conization ranged from 22 to 48 years old,with a mean age of 44.7+8.6 years old and a median age of 46 years old,including 0 cases aged 18-19 years old(0/44,0.00%)and 8 cases aged 20-29 years old(8/44,18.18%).14 patients aged 30-39 years(14/44,31.82%)and22 patients aged 40-50 years(22/44,50.00%);The risk of relapse in age≥40 years was 2.44 times that in age<40 years age had statistically significant effect on postoperative recurrence(P<0.05).4.Of the 44 patients in the relapse group,21 cases(21181,11.60%)were type I,15 cases(15/77,19.48%)were type II.There were 8 cases of II type(8/20,40.00%).The recurrence rate of patients with II and III type of transformation zone was significantly higher than that of patients with I type of transformation zone.Patients with different types of transformation zone had significant difference in recurrence risk(P<0.05).5.Preoperative TCT detection was performed in 44 cases of recurrence group,including 24 cases of HSIL(24/98,24.49%),9 cases of LSIL(9/66,13.54%),8 cases of ASC-H(8/74,10.81%),and 3 cases of ASCUS(3/40,7.50%).The preoperative TCT level was closely related to postoperative recurrence,and the higher the preoperative TCT level was,the higher the postoperative recurrence rate was,and the influence on postoperative recurrence risk was statistically significant(P<0.05).6.Pathology after the first conectomy indicated that 155 cases were involved in the gland,38 cases had recurrence,with a recurrence rate of 24.51%(38/155);123cases were not involved in the gland,and 6 cases had recurrence,with a recurrence rate of 4.88%(6/123).The risk of recurrence increased with the increase of the probability of lesion involvement of the gland,and the lesion involvement of the gland was a risk factor for postoperative recurrence,with statistical significance(P<0.05).Conclusion1.The main risk factors for recurrence after primary conization were advanced age(≥40years old),transformation zone III type,and positive incision margin.2.For patients with positive incisional margins after coning,the risk of recurrence of lesions can be predicted according to the type of CIN in incisional margins.The higher the CIN level,the higher the risk of recurrence.3.Most of the patients with recurrence of cervical lesions after primary HSIL coning during child-bearing age had recurrence within 2 years(recurrence rate36.36%). |
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