The Clinical Treatment Evaluation Of Two Surgical Methods On High-grade CIN With Glandular Involvement

Background and Research Aims Most studies have not only shown that glandular involvement is the high-risk factor of persistent lesion and recurrence for patients with high-grade cervical intraepithelial neoplasia after accepting relevant operations, but patients with glandular involvement have a higher degree of cellular proliferation than those without. However, there lacks explicit standards on clinical treatments toward patients with glandular involvement. This thesis aims to discuss whether there is a necessity of treating patients with glandular involvement after being diagnosed of high-grade cervical intraepithelial neoplasia(CINⅡ ~ Ⅲ) and those without differently during the process of clinical treatment and to compare the therapeutic effects of two surgical methods on high-grade cervical intraepithelial neoplasia—cold knife conization(CKC) and complete hysterectomy.Methodology This thesis etrospectively analyzes 215 clinical cases of the patients who are diagnosed as having CINⅡ~Ⅲ(148 cases of glandular involvement) from January in 2013 to June in 2014 after cervical biopsy in The Third Affiliated Hospital of Zhengzhou University. The patients are divided into two categories according to the results of biopsy—67 cases of CINⅡ~Ⅲ patients without glandular involvement while 148 cases with glandular involvement. Meanwhile, all the patients in the first category that without glandular involvement accept cervical conization and they are proved as not concerning glandular involvement after operations. However, the second category that with glandular involvement is further divided into two groups—89 cases of cervical conization(CKC) and 59 cases of complete hysterectomy. This thesis will make several comparisons. One is the pathological coincidence and the involvement of incisal edge before and after operations between the group of CINⅡ ~ Ⅲ without glandular involvement which deals with conization(CKC), and the other one of CINⅡ~Ⅲ with glandular involvement which deals with conization(CKC). The others are the pathological coincidence, follow ups and postoperative infection rate, duration of operation, bleeding volume during operation, cost of operation, duration of hospitalization between the group of CINⅡ~Ⅲ with glandular involvement which deals with conization(CKC) and the one of CINⅡ~Ⅲ with glandular involvement which deals with hysterectomy. Such pathological comparisons adopt self-contrasted method. Furthermore, there are 27 cases of patients who are diagnosed as having CINⅡ~Ⅲglandular involvement after conization(CKC) accept second operations, recording the pathological results of their residuary cervixes.Result 1.The comparison between CINⅡ~Ⅲ without glandular involvement which deals with conization(CKC) and the one with glandular involvement which deals with the same method: pathological degradation rate, coincidence, progression rate of these two groups after operation respectively are: 41.7%, 55.2%, 2.9%; 19.1%, 70.7%, 10.1%; there is a significant statistical overall distribution difference in(P=0,004); the degradation rate of the group without glandular involvement is remarkably higher than the one with glandular involvement(P=0.002), the coincidence of the former is lower than the latter(P=0.045), but the progression rate after operation has no significant statistical difference(P=0.160). The positive rates of incisal edge are 1.4% and 5.6%, the difference has no statistical significance(P=0.365). 2.The comparison between CIN2-3 patients with glandular involvement deals with conization(CKC) and the group with same illness but deals with hysterectomy: pathological degradation rate, coincidence, progression rate of these two groups after operation respectively are: 19.1%, 70.7%, 10.1%; 18.6%, 69.4%, 11.8%; the difference has no statistical significance(P=0.945). The accumulated abnormal rates during follow ups: there are 5 abnormal cases in the group of conization after operation, namely 5.9%(5/84); there is 1 abnormal case in the one of hysterectomy, namely 1.6%(1/59). As for operations concerning elements such as the postoperative infection rate, duration of operation, bleeding volume during operation, cost of operation, duration of hospitalization, the numerical values of CINⅡ~Ⅲ patients with glandular involvement that deals with hysterectomy are all greater than the one deals with conization(CKC). 3.There is no cases of discovering remnant cervical cancer in residual cervixes among the patients who accept second operations. However, 40.7% of the patients are spotted to have lesion of CINⅠ~Ⅲ.Conclusion 1. Patients who receive CKC with high-grade CIN with glandular involvement performs a lower pathological degradation rate and a higher coincidence than those without. 2. CKC is safe, reliable and economical treatment for patients with high-grade CIN with glandular involvement. There should be constant and strict follow-ups for this kinds of patients. 3. Hysterectomy is still an important treatment for patients with high-grade CIN with glandular involvement, but not the initial one.