Research On The Related Issues Of Different LEEP Types For Treating Cervical Disease

Objective1,To investigate the related issues of different Leep (loop electrosurgical excision procedure, Leep) types for treating different nature and extent of cervical disease2,To investigate combined supplementary drug program after treatment by Leep eliminating HPV(human papilloma virus,HPV) infection clinical value.Methods1,To review the clinical data of 511 patients suffering from cervical disease,who were treated with the series of Leep types at gynecological department in Jinan Military General Hospital during July 2008 to december 2009.among the patients,there were 433 cervical erosion and 78 CIN(cervical intraepithelial neoplasia,CIN).The last diagnosis was the pathological higher one of biopy and Leep, depending on the implementation of four types of surgical conditions, each with indications, according to the scope of operation is divided into A, B, C, D. there were 39 cases of Leep-A,230 cases of Leep-B, 179 cases of Leep-C and 63 cases of Leep-D.detecting of different surgical healing process and the incidence of adverse reactions. the blood and the choice of operative type were observed.the postoperative follow-up contents include periodical observation of vaginal bleeding within 2 months,secretion substance and cervical recovery in the near future, the long-term postoperative follow-up contents include cytology, colposcopy and HPV testing at 3 months,6 months and every 6 months after the operation.If necessary we enforced colposcopy biopsy surgery and confirmed residual or relapse by histopathology. at last the clinical results of different operative type were contrasted and carried out statistical analysis. 2,In this study,75 cases of CIN-positive were HPV infection before Leep operation,postoperatiye taking voluntary principles divided into study group and control group,study group combined antiviral drugs (Shu-ning gel) a course,the control group simply treated by Leep,HPV testing at 3 months after Leep operation,at last the clearance rate of HPV infection in the two groups of patients were contrasted and carried out statistically analysis.Results1,In this study, with the tybe of Leep-A treating for cervical erosionⅢand combined degree lesions 20 cases, treating for CINⅡinvolved glands,CINⅢand preoperative biopsy in patients with carcinoma in situ 19 cases;with the tybe of Leep-B treating for cervical erosionⅡ-Ⅲdegree 197 cases.treating for CINⅠ-Ⅱ33 cases of cervical appearance grade erosionⅡ;with the tybe of Leep-C treating for cervical erosionⅡ164 cases, treating for CIN I 15 cases of cervical appearance of grade erosionⅠ;with the tybe of Leep-D treating for grade particle types of cervical erosionⅠ53 cases,treating for CIN I degrees 10 cases of cervical appearance of grade erosion I2,In this study, the blood loss are different in different operative types: A-type was 18.35±3.78ml, B-type was 9.87±1.29ml, C-type was 6.05±0.84ml, D-type was 1.97±0.35ml, significant increase in A-type than the B-type, A-type than the C-type, D-type significantly increased(P<0.01).3,In this study, the cervical healing time are different in different operative types:A-type was 7.79±0.47 week,B-type was 6.84±0.72 week,C-type was 5.47±0.70 week,D-type was 4.12±0.56 week.there were significant differences between different operative types(P<0.05).4,In this study,the histopathological examination results after Leep:which do not correspond were 10.00%(8/80),compared with the preoperative histopathological biopsy,about 8.75%(7/80) were aggravated.5,In this study, complications of Leep include bleeding, infection, cervical mucous membrane eversion, cervical canal stenosis, etc. there were significant differences between different operative types.(1)Bleeding risk was 1.97%(10/508):perative of A-type was 19.44%(7/36) B-type was 1.30%(3/230), C-type was 0.00%, D-type was 0.00%, there were significant differences observed between them (P<0.01). (2)Infection risk was 0.59%(3/508):there were no significant differences observed between them (P>0.05).(3)At postoperative 6 weeks.the incidence of-cervical mucous membrane eversion was 30.12%(153/508):perative of A-type was 27.78%(10/36),B-type was 28:26%(65/230),C-type was 43.58%(78/179). D-type was 0.00%. there were significant differences observed between them (P<0.01). at postoperative 8 weeks 91.50%(140/153) of patients could self-retract,only 8.50%(13/153) patients requires treatment(4)Cervical canal stenosis risk was 2.17%(11/508):operativeof A-type was 8.33%(3/36), B-type was 3.04%(7/230), C-type was 0.56%(1/179), D-type was 0.00%,there were significant differences observed between them (P<0.05).6,In this study, cervical styling satisfaction after Leep operation was 95.08%(483/508),recovery rate was 98.03%(498/508),there were no significant differences between different operative types(P>0.05).7,In this study, after treatment by Leep the clearance rate of HPV infection was 82.14%(23/28),there were no significant differences between different operative types(P>0.05).postoperative combined application of antiviral drugs group was 97.83%(45/46)there were obviously higher than the control group with simply treated by Leep(P<0.05).Conclusions1,Treatment of cervical lesions with Leep should individualized,Leep according to different nature and extent lesions with different operation.2,The blood loss and cervical healing time are different in different operative types,they goes up with the increased scope of conization.3,Complications of Leep include bleeding,infection,cervical mucous membrane eversion,cervical canal stenosis,etc. they goes up with the increased scope of conization.4,The operative types of Leep could contribute eliminate of HPV infection,there were no significant differences between four types of operation. postoperative combined with antiviral drugs elimination of HPV infection is better.