Analysis The Efficacy Of Cervical Cold Knife Conization And LEEP In The Treatment Of CIN Ⅲ

Objects: Cervical intraepithelial neoplasia (CIN) is a precancerous lesionrelated to invasive cervical cancer, which reflects a continuous process ofcervical cancer, including a series of pathological changes from cervicaldysplasia(mild�'moderate�'severe)�'carcinoma in situ�'early invasivecancer�'invasive carcinoma. In recent years,with increaseing of CINpatients and younger,early diagnosis and treatment become s an importantmeans to reduce cervical cancer incidence and mortality, more and morepatients wish to preserve fertility. Then conization is the most important wayin the diagnosis and treatment of cervical lesions.it also preservefertility.CINⅢ (includingsevere cervical dysplasia and carcinoma in situ) is aprecancerous lesion, and most likely development into early invasive cancer orinvasive cervical cancer, so the correct and reasonable treatment of CIN Ⅲcan block further progress of cervical lesions,It can also preserve thereproductive function and quality of life.In this study, Our150patients withCIN Ⅲ were treated in loop electrosurical excision procedure surgery (LEEP)and cold knife conization surgery(CKC), to explore the clinical applicationvalue in CINⅢ of two kinds of different surgical way.Methods: Retrospective analysis150patients who were diagnosised ofCINⅢ by colposcopic biopsy in the Second Hospital of Hebei MedicalUniversity from Jan1st,2008to Dec31st,2012. there was no complications,They were divided into LEEP group and CKC group.LEEP:62patients, themean age is40.13±8.381years old, the mean marriage age is23.42±5.67years old,the mean parity is1.43±0.74; CKC:88cases, the average age is38.97±7.541years old, the mean marriage age is21.48±4.35years old,theaverage parity1.42±0.80. There is no statistically significant differencebetween the two groups’ generally data (P>0.05), they are comparable. LEEP group: Using multifunction LEEP knife,we began cutting at3mmto5mm outer edge of the extent of disease, the ring loop electrosurgicalexcisied the cervical from downlip to upperlip clockwise rotation. Theresection of cervical depth was accorded to their severity,and scope(15mm~25mm), If the range of cervical lesions was severe,we plused complement cutor large loop electrosurgical excision,then wound was coagulated, tookantibiotics and hemostatic postoperative.CKC group: surgery under spinalanesthesia or continuous epidural anesthesia,0.5cm~1cm far from the outeredge of the lesions,we made a circular incision with a scalpel, The width ofcone bottom was generally from2cm to3cm,high was2.5cm (no more thanendocervix).Adopted Stumdorf suture or Chen improved suture, in order toachieve the purpose of bleeding and cervical forming, using2to3Iodoformgauze to tamponade the cervical and vaginal. All excised tissues were sent forpathological examination, all of the patients were given intravenous antibioticsand hemostatic,After this,If the conization pathology was invasive carcinoma、carcinoma in situ, patients had other benign gynecological diseases, or theyhad no fertility requirements,they underwent secondary surgery to remove theuterus.Collect patients’ age, maternal times, the colposcopic biopsy, surgerytime, blood loss, conization pathology,the reason for secondary surgery(hysterectomy),residual cervical pathology,complications and follow-up,Compare LEEP group the pathology before and after surgery,postoperative complications, and follow-up to CKC group.Results: LEEP:62patients, the pathological level consistent before andafter the surgery were30cases, accounting for48.39%; lower than the formerwere24cases, accounting for38.71%; negative in7cases, accounting for11.29%;1case of invasive cervical cancer (early invasive), accounting for1.61%. CKC:88patients,before and after surgery, pathology consistent were43cases, accounting for48.87%; lower than the former were30cases,accounting for34.09%; negative in13cases, accounting for14.77%;2casesof invasive cervical cancer (1case of squamous cell differentiation and1caseof early invasive), accounting for2.27%, the pathological difference before and after conization of the two group was not statistically significant (P>0.05).LEEP group:11patients had secondary surgery, one cases of invasivecarcinoma took widely hysterectomy plus oophorotomy and pelvic lymphnode dissection, postoperative pathology was early invasive in cervicalsquamous cell carcinoma,10cases who took hysterectomy with postoperativepathological diagnosis of invasive carcinoma was1case,CINIII were4cases,lower than CINⅡwere4cases(including CINⅡ), chronic inflammation1case.CKC:18cases of reoperation, including two cases of invasive cervicalcancer underwent extensive hysterectomy plus oophorotomy and pelviclymphadenectomy,final pathology showed1case had squamous cellcarcinoma up to two grade, took chemotherapy,1case is chronic inflammation.16cases of hysterectomy patients cervical pathology results showed invasivecarcinoma were2cases,CIN Ⅲ2cases, CINⅡand lower than CINⅡ9cases,chronic inflamation3cases. There was no statistically significant btween thetwo groups’pathology after hysterectomy.Comparison of two surgical situations, The mean operative time of LEEPgroup was10.4±8.7min, the average amount of bleeding was15.3±4.2ml,The average operative time of CKC group was34.7±9.3min, the Ⅱsurgical time and blood loss, the differences were statistically significant, theLEEP group was significantly lower than the CKC group.About the postoperative complications, from three months to fiveyears,36cases lost follow-up(LEEP25cases,CKC11cases),only1patient(1.6%) in LEEP group had postoperative complications of postoperativebleeding, and hemostasis therapy took effection.5cases of CKC group hadpost-operative complications (5.7%),1case of cervical adhesions,1case ofcervical insufficiency,3cases of postoperative bleeding, and the amount ofbleeding was heavy to anemia,they all had hemostatic treatment, in which onecase took three surgeries to control the bleeding, In this study, the differenceof two group’s postoperative complication was not statistically significant.Were followed up all of the patients, In CKC group,1case (8.1%)recurrenced with abnomal cervical cells and HPV16infectived, then biopsy showed invasive, time to recurrence was2.5years after surgery, In LEEPgroup,3patients (1.3%)recurrenced, their cervical cytology were all abnomaland HPV16infectived,1case of them was composited with HPV33infection,recurrence time were1.5years,2years,2years, the two group’srelapse rate was no significant difference.Conclusion: CKC surgery and LEEP surgery has similar indications, nosignificant differences in the clinical efficacy of the two methords.LEEP hassignificantly lower operative time and blood loss than CKC, about thepostoperative bleeding,cervical adhesions,stenosis,incompetence,postoperativerecurrence, there was no statistically significant difference between the twokinds of surgeries. but LEEP brings lower trauma, less pain and lower costfaster recovery than CKC.