Recent State Of Cervical Lesion In Qilu Hospital Hospitalized Patients And Clinical Evaluation Of Cervical Cold Knife Conization

ObjectiveTo evaluate the value of cold-knife conization (CKC) in diagnosis and management of cervical intraepithelial neoplasia (CIN),and to determine factors predicting post-cone residual disease in CIN and microinvasive cervical cancer.Materials and MethodsOf 120 patients who underwent conization due to CIN and microinvasive cervical cancer between January 2004 and November 2007, 79 patiens(group A) had CKC only and other 41 patiens (group B) underwent hysterectomy within 6 months post conization in Qilu Hospital of Shandong University. Datas were retrospectively reviewed including patients' age, breeding status, preoperative auxiliary examination (cytological examination and/or high-risk HPV test), biopsy histological result, operative time, blood loss, anesthesia modality, hospital day, cost of hospitalization and postopertative pathology etc. We analyzed their demographic features and pathologic parameters.ResultsDuring the study period, 120 women who matched the study inclusion were identified. The mean age of group A was 35.9±6.50 years (range 24-52).The mean breed times were 0.94±0.54(range 0-3), 11 patients were nullipara before conization. The pathological outcomes of conization specimen were 11 women CINI, 19 women CINII, 33 women CINIII (included 15 women CIS) and 1 woman microinvasive cancer, the conization specimen all with clear margin status. The mean age of group B was 42.22±9.13years (range32-62), 33 patients were <50 and 8 patients≥50, 8 women were postmenopausal. The mean breed times were 1.49±1.33(range 1-6).The conization histological results were CINIII in 31 cases (included 17 CIS), microinvasive carcinoma in 1 case and 9 cases of CINI-II. Of 37 women selected the extrafascia total hysterectomy, 2 transvaginal and the others by laparotomy route.One patient underwent a modified radical hysterectomy and pelvic lymphdenectomy.One with a radical hysterectomy and pelvic lymphdenectomy.The mean age, breed times and conization histological results between the two group were all statistically significant(P=0.000,0.003,0.000 respectively, t test)To compare the results between colpscopy directed biopsy (CDB) and conization, total coincidence was 71.67%, CINI/CINII/CINIII coincidence were 40.00%,46.43% and 85.29% respectively, the coincidence in group CINIII was significantly more accurate than that in group CINI/CINII ,the P value was 0.001 and 0.000 respectively(x~2 test). The anesthesia way include equidural anesthesia (EA), combined anesthesia by vein, and general anaesthesia (GA),43,23 and 4 patinets selected the above anesthesia way respectively. The average blood loss was 51±48.37ml(range 5-200ml) ; the average operative time was 40±17.27min(range 10-95min); the mean hospital day was 7.48±3.0 days (range 3-18 days) ; the mean cost of hospitalization was 4500.59 yuan. Follow-up time was 3-36 months.To compare the pathologic results between conization and post-cone in uterine, one patient found the lesion become more severtiy,while others cone and post-cone results were the same. Residual disease was noted in 5 women of whom 2 had recognized microinvasive squamous cell carcinoma, while 2 was CIN I and 1 was CINIII. The prevalence rates of positive residual lesions in the patients had increased with higher lesions of cervical neoplasia,which were 0%(0/9) , 7.14%(1/14) , 17.65%(3/17) and 100%(1/1),respectively in patients with CIN I-II,CIN III,and MIC (x~2=5.57,P=0.018<0.05).Residual lesions were more frequently found in patients with glandular involvement (26.32%,5/19) than in those with non-glandular involvement (0%,0/22).The difference was statistically significant (x~2=6.59,P=0.01 < 0.05) .ConclusionsCKC is significantly effective in diagnosis and treatment of CIN. The treatment of CIN should be individualization. CIN III and microinvasive cervical caner who were young, nullipara or desired preserve fertility ,CKC is a precedence choice,while patients who needn't to bear ,aged and in high risk could be treated by hysterectomy. After treated by CKC, patients must be follow-up closely. Severity of disease and glandular involvement patients had high risk to find disease residual post conization.