Clinical Analysis Of CIN Ⅱ-Ⅲ Treatment By Multiple Punch Biopsy Under Colposcopy And Loop Electrosurgical Excision Procedure

In recent years, with the cervical cancer screening extensively developed,invasive cancer can be seen rarely in clinical,and the patient of cervical intraepithelial neoplasia is increasing gradually and becomes more younger year by year, expecially in the young woman with frequent sex life and sexually transmitted diseases.The process of cervical cancer includes CIN (Ⅰ-grade→Ⅱ-grade→Ⅲ-grade),early invasive cancer,invasive cancer.The key of decreasing the rate of cervical cancar is timely and proper treatment with CIN.So there is important clinical significance to recognize the feature of CIN and give proper treatment .The pathogenesis age of CIN is focus on 30～40 mostly.It is reported that in recently two years the detection rate of CIN and crvical cancer is increasing in the women under the age of 35.Especially the pathogenesis age of CINⅡ～Ⅲis 10 years less than that of 6 years ago.Most patients of CIN have no special signs and symptoms.Some patients have increased vaginal discharge,with or not with the smell.And some can have contact bleeding or irregular vaginal bleeding. The symptoms can have no obvious lesions.Cervical smooth, partial leukoplakia, Chronic cervicitis,Cervical erosion and Polyp et al can be seen on the patient of CIN.At present more mature screening method of cervical precancerous lesions mainly are cervical cytology,HPV-DNA detection, colposcopy detection and so on.The positive rate of conventional cervical cytology detection is low,and the positive case is easily missed.When there is cervical contact bleeding,the smear is usually full of blood.So it is too hard to get the accurate cytology result.Yet the liquid-based cervical cytology and high-risk HPV detection can hardly be promoted because the relatively poor economic and technical .So multiple punch biopsy under colposcopy is the best method to diagnose.But,we need to notice that when it is not satisfied with the exposure of cervical conversion area there is limitations to inspect cervical canals.So to those patients with suspicious we need combine with LEEP and avoid misdiagnosis as far as possible.And we also need pay attention to the location and depth when we take issue.Because cervical precancerous lesions and early cervical cancer are hardly identified by the naked eye and the issue is taken with blinedness,the positive rate of conventional biopsy on 3,6,9,12 four pots is not high.So colposcopy is widely used in the diagnosis of CIN. Colposcopy improves resolution by the magnifying tecnology .The key position it observed is the conversion area at the junction of cervical squamous epithelium and columnar epithelium which is the high incidence area of cervical precancerous lesions.To biopsy on the position where abnormal pictures were found can increase the positive rate of biopsy. Multiple punch biopsy under colposcopy is an important method to detect the cervical early lesions which is more sensitive and specifical to the diagnosis of early cervical cancer and CIN. Multiple punch biopsy under colposcopy has defects also in the area of diagnosing cervical disease.For example, colposcopy cannot get the issue in the cervical canals.Cervical lesions,especially cervical preinvasive carcinoma is mostly multicentric,but the vision and material taken are limited and superficial by colposcopy so it can hardly judge that the mesenchymal has been invaved or not,the depth of glands involved,and the situation of the cervical canals invoved which can be missed.Loop electrosurgical excision procedure is a new Electro-therapy which was created first by Cartier.It is not only simple,convenient and time saving but also safe, ecomomical and effective on the area of the diagnosis and treatment of cervical lesions.It is applied more and more widely and show its espesial clinical value and superiority.For example,it can be used at clinic,needn't complex conditions and equipment,so it is easy to learn.It can diagnose and treat the disease synchronously.It can also eccope the cervical abnormal lesions and go on pathology diagnosis.And decrease the misdiagnose rate of early cervical cacer.LEEP dose not affect pregnancy,and save maintenance fee and narcotic charges and so patients is easy to accept.It is the most important that the operation time of LEEP is short,bleeding during operation is little also,and the rate of postoperative complications is low.And after LEEP new junction of cervical squamous epithelium and columnar epithelium is clear,it is convenient on the follow-up tracking of cytology and colposcopy.Because cervical cancer and CIN mostly access in cervical transitional zone,and LEEP can send pathological examination,so it can decrease and even prevent the misdiagnosis of invasion and avoid inadequate treatment of serious lesions.Objective To study the clinical question of multiple punch biopsy under colposcopy combining with LEEP for the management of cervical intraepithelial neoplasiaⅡ～Ⅲ.It can offer some clinical experience to the diagnosis and treatment to high-grade CIN to prevent early cancer.Methods A retrospective analysis was performed of 56 CINⅡ～Ⅲcases after multiple punch biopsy under colposcopy treatment by LEEP in China and Japanese Friendship Hospital of Jilin University and the hospital of gynaecology and obstetrics in changchun between January 2006 and June 2007. To discuss the effect of diagnosis and treatment of CINⅡ～Ⅲby multiple punch biopsy under colposcopy combination with LEEP .And compare and analyse the pathological result and recurrence with the two opration .Results 1.In the 56 CINⅡ～Ⅲ,the coincidence rate of pathologic diagnosis was 69.64%(39/56 ) , and pathological result going up was 5.36%(3/56) . possibly because we can get little or skin-deep tissue by multiple punch biopsy .When the focus is preinvasive carcinoma,or the focus is in the cervical canals, cervical punch can hardly be procedured. The pathological process in partes profunda is leave out. LEEP can apply a great lot of tissue to pathologic examination and vanquish disadvantage to cervical multiple punch biopsy ,and reduce misdiagnosis and mistreatment . The posoperation pathologic diagnosis downgrades 25%(14/56). It is possible that before operation the multiple punch biopsy under colposcopy get the tissue in the most serious part ,and the foucus originally a little so that pathological result posopreation is not more serious than that before . Through X2 test ,P<0.05.There was significant difference.It explained that it is limited by multiple punch biopsy under colposcopy to diagnose CINⅡ～Ⅲ. It is more accurate to diagnose CINⅡ～Ⅲby LEEP.2. Two patients who received another operation because after LEEP the pathologic diagnosis are CINⅢinvolving glands and preinvasive carcinoma were omissed. Others reviewed after LEEP, the pathology confirmed that the lesions residues is 1 case,and there are 2 recurrenced who are treated by LEEP.The cure rate was 94.4%(51/54), and the recurrence rate was 3.7%(2/54),which is matched with literature reported.3. The rate of postoperative complications is low.In the research the rate of postoperative complications is 3.57%(2/56)in 56 cases. Bleeding during operation is little,and there is only 1 case bleeding from vaginal which had been better after coagulation.And 1 case appeared abdominal pain whose symptom was disappeared after applying antibiotics.There was no fever and cervical canals narrow.Conclsion 1.Those whose cervical cytology examinations ,including cervical smear and cervical liquid-based cytology are abnormal need definitude the grade and range of cervical lesions by multiple punch biopsy under colposcopy and apply some pathology bisis to the method of diagnosis and treatment.2.LEEP is a safe and effective method to treat CINⅡ～Ⅲ.Its high cure rate,less postoperative complications and facilitate the follow-up make it a preferred method to treat high-grade CIN.And it is effecive to reccurence of CIN,and it can be used repeated.3.In the field of the diagnosis of CINⅡ～Ⅲand early cervical invasive cancer multiple punch biopsy under colposcopy cannot instead of LEEP. LEEP can make up to the inadequation to the diagnosis of cervical lesions by multiple punch biopsy under colposcopy.So to those whose pathological diagnosis result is abnormal by multiple punch biopsy under colposcopy,LEEP that can be performed to choose the therapy metherd apllied reliable histological anatomy basis.4.Diagnosing high-grade CIN by multiple punch biopsy under colposcopy combination with LEEP can raise early diagnosis and accuracy of cervical cancer ,and prevent the misdiagnosis of early cervical cancer.