Analysis Of Influencing Factors Of Total Hysterectomy In Patients With Negative Margin After Cold Knife Conization For High-grade Cervical Squamous Intraepithelial Lesion

Objective:To analyze the influencing factors of total hysterectomy for patients with negative margin after cervical cold knife conization and the risk factors of re lesion after cervical cold knife conization for high-grade cervical squamous intraepithelial lesion,so as to guide the further treatment after cervical cold knife conization.Methods:The clinical case data of patients with HSIL and negative margin in the second hospital of Shanxi Medical University from June 2014 to December 2019 were retrospectively analyzed.According to the choice of follow-up or total hysterectomy after cervical cold knife conization,they were divided into conization group and total hysterectomy group,and the influencing factors of total hysterectomy were analyzed;The conization group was divided into non lesion group and lesion group according to whether it was re lesion during followup.The risk factors of re lesion after cervical cold knife conization were analyzed;Univariate analysis and binary logistic regression analysis were used to study the independent risk factors of re lesion after cervical cold knife conization.Results:1.In this study,251 patients with negative cutting edge after cervical cold knife conization were collected.According to the follow-up or total hysterectomy after cervical cold knife conization,they were divided into conization group and total hysterectomy group.There were 212 cases in conization group and 39 cases in total hysterectomy group.Compared with the case data of the two groups,it can be seen that the patients in total hysterectomy group were older,more postmenopausal patients,more times of labor and more times of natural delivery,which were statistically significant.2.The conization group was again divided into non recurrence group and recurrence group according to whether it recurred during the follow-up.There were 180 cases in the non recurrence group and 32 cases in the recurrence group.Compared with the case data of the two groups,it can be seen that smokers are more likely to recur;Comparing the preoperative examination data of the two groups,it can be seen that the patients with gland accumulation and p16 positive are more likely to relapse.3.Univariate analysis was conducted on the collected factors that may affect the re lesion of patients with negative margin after cervical cold knife conization.It can be seen that previous abortion history,smoking,multiple types of human papilloma virus(HPV)infection,lesion number ≥ 3,lesion involving glands and p16 positive were related to the re lesion of patients with negative margin after cervical cold knife conization.The binary logistic regression analysis showed that p16 positive was an independent risk factor for re lesion in patients with negative margin after cervical cold knife conization.Conclusion:1.Among the patients with negative cutting edge after cold knife conization for highgrade cervical squamous intraepithelial lesion,patients with older age,menopause and more births are easy to choose total hysterectomy after conization,while young patients with fertility requirements often choose long-term follow-up after conization.2.P16 positive patients are more likely to become diseased again after operation.Some patients with p16 positive in patients with negative margin after cervical cold knife conization should be closely followed up and total hysterectomy should be performed in due time.