| Research background and objectiveThe incidence and mortality of cervical carcinoma are residing in two of the female malignancy, and the current onset is becoming younger, and a serious threat to the health of women. Cervical intraepithelial tumor-like change (cervical intraepithelial neoplasia CIN), CIN II and III level, and cervical lesions recognized, early detection and active treatment, not only can effectively block the course of the disease, and to preserve the reproductive capacity, reduce invasive cervical cancer incidence and mortality. Conization can accurately determine the grade and scope of early cervical lesions, clearly defined the existence of carcinoma, to avoid the lack of range of direct hysterectomy surgery, is currently the preferred method of diagnosis of CIN Ⅲ evel, fertility requirements, follow-up conditions in CIN Ⅲ and even early important treatment for patients with microscopic invasive measures. Conization method is divided into three kinds, namely traditional cold-knife conization (CKC), gradually developed in the1980s after loop electrosurgical excision procedure (the Loop Electrosurgical Excision Procedure, LEEP), and in recent years Explore carried out by hysteroscopic cervical conization (TCRC). LEEP because of its simple operation, the treatment of cervical lesions, including low-grade CIN and other safe and effective, while popular with some doctors welcome. But instead of conization with LEEP type used in the diagnosis and treatment of CIN Ⅲ level, because of its power and depth can be difficult to guarantee, and no cervical forming defects still have considerable differences, further research is needed. Cold-knife cervical cone cut because the cutting edge clear there is no thermal effect, conducive to pathological examination is still the widely used cervical cone cut way, and the cutting edge there is no thermal effect of impact, but the cold-knife cone cut of trauma relatively large some, the depth of cut subjective and arbitrary, and wound bleeding the high side, the cervical suture to stop bleeding after the formation of the shape is often irregular and less smooth. With hysteroscopy carried out and clinical use in recent years, our hospital carry out hysteroscopy under direct vision transurethral cervical conization, the advantages are:hysteroscopy into the uterine cavity, direct view and simultaneous removal of uterine lesions; can clearly see the mouth of the cervical canal histology accurate positioning, and removed under direct vision, and effectively guarantee the removal of the scope and to avoid missing; accurately and thoroughly through the ball electrode to stop bleeding, blood loss was minimal, The operation time was shorter; uterine distention medium wash the exposed bleeding points at the same time, rapid cooling to the wound tissue to reduce the cervical tissue thermal damage and carbonation, rapid postoperative recovery, and recurrence rate is low. This study used a retrospective clinical study metho, Select the row of hysteroscopic cervical conization (TCRC) for CIN III patients, and compared with the conventional cervical cold knife conization (CKC), observation of the two groups of operation time, bleeding volume, pathological concordance rate, recurrence rate, cervical adhesion rate and pregnancy rate, postoperative and long term clinical effectas of CIN III treatment. In order to investigate the hysteroscopic electrotomy instead of cold knife conization of the cervix in diagnosis and treatment of cervical intraepithelial neoplasia grade III (CIN Ⅲ),witch is more feasibility and safety method to provide clinical basis.MethodsFrom September2005to September2011, Zhujiang Hospital,139cases of gynecological inpatient who had effect of cervical conization, hospital outpatient preoperative diagnosis and the outer court biopsy CIN III level by the Court of Pathology consultation, of which85cases involving the gland. According to the force in operation mode is divided into group A and group B. Group A for the TCRC group, for after operation of hysteroscopic cervical conization (TCRC), A total of74patients, of which43cases involving the gland, age of23to54years old, average age37.7±11.3years; All patients had sexual history,10patients had pregnancy reproductive history, the rest of the history of both pregnancy and childbirth.Group B for the CKC group, for after operation of Cold knife conization of cervix (CKC), A total of65patients, of which42cases involving the gland, aged25to56years, mean age (38.9±5.2) years. All patients had sexual history, eight cases of patients with pregnancy, reproductive history, the rest of the history of both pregnancy and childbirth. The two groups of age and reproductive history comparison, the difference was not statistically significant. There was no surgical history of major diseases and had not received radiotherapy, chemotherapy and hormonal treatment. Diagnostic criteria:reference Yue Jie edited the seventh edition of Obstetrics and Gynecology "Chapter30of CIN pathology diagnosis and grading standards. All patients before colposcopy (Japan Olympus Company) under direct vision to locate the biopsy diagnosis of CIN III level, including severe dysplasia and carcinoma in situ. OUTCOME MEASURES:operative time, blood loss, the pathological diagnosis of CIN residue/recurrence rate. Patients in both groups were the routine use of antibiotics for48h to prevent infection. The postoperative follow-up:3months,6months,12months, then once a year, a total follow-up of1to5years. Review each line the cervical TCT examination And quantitative HPV.such as abnormal colposcopy and biopsy, to understand whether the CIN lesions exist; tracking menstruation, the uterine cavity and cervical canal adhesions, pregnancy and pregnancy outcome situation. Statistical software SPSS19. Analysis, each set of data, homogeneity of variance test, each group deviation (mean comparison using t-test; measurement data, t test, count data using the χ2test, P<0.05was considered statistically significant. ResultsIn the1.Two groups of patients:TCRC group mean operative time was (15.1±3.2) min, mean blood volume (12.5±1.8) ml, CKC, mean operative time (25±3.8) min, intraoperative The mean blood loss (21.6±2.4) ml. Two sets of intraoperative blood loss, operative time, CKC group than TCRC group difference was statistically significant (P<0.001,0.001).2.postoperative pathological conditions:the TCRC group preoperative biopsy and postoperative pathology results consistent accounting for75.71%(53/70cases), CKC, group colposcopic biopsy and the pathological results consistent accounting for75.41%(46/61cases) The two groups, no statistically significant difference (P=0.851).3. two groups of surgery:the TCRC group surgery in17cases of endometrial abnormalities, underwent curettage or endometrial electrosurgical excision, pathological three cases of endometrial polyps in11cases of simple endometrial hyperplasia, three cases of secretory phase endometrium. Patients were followed up for74cases (1-6months),26cases because of conization postoperative pathological prompt in CIN Ⅲinvolving glands were older, non-reproductive requirements and insisted that the hysterectomy, postoperative pathology were not suggestive of CIN lesion residue; in6months after TCRC,CIN residual0cases and all cases are HPV test (-); patients were followed up for6months or more, four cases of recurrence (including one case of CIN Ⅱ cases of CIN Ⅰ-Ⅱ,2cases of CIN I), monitoring of HPV negative, all cases continue to follow-up once a year. The TCRC group the cure rate was94.6%(70/74cases), the recurrence rate was5.4%(4/74cases). CKC group patients were followed up65cases (1-6months), including28cases of CIN III involving the gland, patients with fertility requirements and insisted that the hysterectomy, postoperative pathology were not suggestive of CIN lesion residue; in6months after CKC, CIN residual0cases and all cases are HPV test (-); patients were followed up for6months or more,12cases of recurrence (including one case of CIN Ⅲ and HPV test (+),who had non-reproductive requirements and insisted that the hysterectomy, the postoperative pathology suggests that CINⅢ;2cases of CIN Ⅱ,4cases of CIN Ⅰ-Ⅱ,5cases of CIN Ⅰ), monitoring of HPV negative, all cases continue to follow-up once a year. CKC group the cure rate was81.5%(53/65cases), the recurrence rate was18.5%(12/65cases). The second surgery the proportion of difference between the two groups not statistically significant (P=0.338); postoperative cure rate, relapse rate, a higher cure rate and lower relapse rate the TCRC group compared to the CKC group, there was significant difference (P=0.016,0.016).4.Two groups in the rate of postoperative bleeding, infection, endocervical adhesions, and other complications, a low incidence of the TCRC postoperative bleeding rate, cervical adhesion rate than CKC group, the difference was statistically significant (P=0.015,0.040). The remaining complications (infection, dysmenorrhea) were no significant differences (P=0.896,0.758).5. Pregnancy,9cases were followed up for5postoperative pregnancy:TCRC group, possession of birth as required by36.0%(n=9/25cases), where:0cases of premature birth, five cases of full-term birth, cesarean section three cases (1cases in which fetal distress, operative reason for the two cases of mental and social factors), one cases of CIN III patients1year after natural conception, and is now pregnant more than7months, generally in good condition. CKC group patients were followed up six cases of pregnancy, and possession of27.3%(n=6/22cases) fertility requirements, including:(pregnant35weeks) preterm1cases, full-term birth3cases,2cases of cesarean section (surgical reasons for the spirit social factors). The two groups, compared with pregnancy rate, Premature delivery rate,vaginal delivery rate, cesarean rate, had no statistically significant difference (P=0.645,0.187,0.909,1.000).Conclusion1、CRC used in treatment of CIN Ⅲ level visualization, minimally invasive, simple, accurate, thorough, etc, and while addressing the uterine lesions, to maintain the integrity of the cervical, lower rate of disease recurrence, it is worth further research and popularization.2、 CIN III patients treated by TCRC were less bleeding, shorter operation time, less complications, accurate positioning, higher cure rate, lower relapse rate, and had no adverse effects on pregnancy compared with traditional cold knife conization of cervix (CKC).3、 CIN III patients choose line of cervical conization must be followed up closely, in TCT detection at the same time with the HPV (high risk) detection. |
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