The Lesions Residual Situation Analyse Of Hysterectomy After Cervical Conization

【 Objective 】1.To probe into the high risk factors of residual disease after cervical conization,we analyse the relationship between age, menopausal status, pregnancy time, production time, primary surgical methods, primary surgical cut edge situation, gland involvement, initial taper cut pathological level and residual disease. 2.To provide reference for clinical diagnosis and treatment,We analyse the necessity of hysterectomy after cervical conization for cervical intraepithelial neoplasia.【 Methods 】1.105 cases of patients with cervical intraepithelial neoplasia and operated hysterectomy after cervical conization due to cutting edge, or other risk factors(lesion level is high, the tired gland, after menopause, etc.)were collected in the affiliated union hospital of Fujian Medical University from November 1, 2010 to February 28, 2015.We make a retrospective control study of these medical records. 2. The research object of age, menopausal status, pregnancy time, production time, for the first time the cervical cone cutting preoperative TCT, first the cervical cone cutting methods and related pathology results, operation method and the final pathology inspection Chad result again was detailed recorded. 3. Statistics processing: the SPSS statistical package program 19.0 was used for all analysis. When p<0.05, the difference has statistics meaning.【 Results 】1. Divided into more than or equal to 45 years old group and Less than 45 years old group, there was no significant difference between the age and residual disease(P > 0.05). there was also no significant difference between menopausal status and residual disease(P > 0.05). 2. Divided pregnant times into less than or equal to 2 times group and more than 2 times, there was significant difference between pregnant time and residual disease(P <0.05).3. Divided production times into less than or equal to 2 times group and more than 2 times, there was no significant difference between production times and residual disease(P > 0.05). 4. Divided into ASC- US group, LSIL group and HSIL group(HSIL, ASC- P and suspicious carcinoma), the residual disease has no significant difference among them(P > 0.05). 5.70 cases who was operated LEEP was found residual uterine lesion, the total residual rate was 54.3%; 35 cases who was operated CKC was found residual uterine lesion, the total residual rate was 54.3% too.There was no significant difference between the two kinds of operation method and residual lesions(P > 0.05). 6.56 cases of positive cutting edge was found residual uterine lesion, the total residual rate was 46.7%; 49 cases of negative cutting edge was found residual uterine lesion, the total residual rate was 46.7%.There was no significant difference between the cutting edge and residual lesions(P > 0.05). 7.96 cases of Gland involvement accounts for 54.2% of the total residual rate.There was no significant difference between the Gland involvement and residual lesions(P > 0.05). 8. A comparison on cervical conization pathology and hysterectomy pathology : residual CIN II lesions rate 60%; CIN III lesions residual rate is 53.4%. 7 cases of invasive carcinoma, 4 cases of residual lesions for CIN III, 3 cases not seen lesions residual. there was no significant difference between CINII compared with CIN III above(including ductal carcinoma) lesions residual rate(P > 0.05).【 Conclusion 】1. Primary surgical specimens cut edge positive, possible risk factors for the pathological changes of residual pregnancy time, initial surgical procedure, involving the situation, the level of primary surgical pathologic glands may not be the pathological changes such as residual risk factors. 2. For younger, positive cutting edge, but not more than CIN Ⅲ of pathological level, strong fertility requirements can close follow-up, patients were followed up for content including HPV DNA, TCT, colposcope and histological examination, follow-up results was abnormal, can only repeat the cone cutting line. For older, no fertility requirements, positive cutting edge, more than 3 pregnant times patients,the hysterectomy was advised.