To Analysis Of Postoperative Recurrence And Residual Risk Factors Of Cervical Intraepithelial Neoplasia

Cervical intraepithelial neoplasia(CIN)is a group of invasive cervical cancer which is closely related to the occurrence of cervical lesions.This disease occurs mainly in women 25 to 35.Most of the low-level CINs can subside,but the high level of CIN has the possibility of cancer development that can develop into invasive carcinoma and is seen as precancerous lesions.In recent years,the incidence of CIN and cervical cancer gradually increased,and age of the disease is becoming more and more tend to be younger.Cervical intraepithelial neoplasia pathological grade three: CINI,CINII,CINIII,where CINIII includes severe atypical hyperplasia and carcinoma in situ.These three levels reflect the continuous process of developing cervical cancer from cervical lesions,and this process takes about 10 years.So do CIN early onset,early diagnosis,early treatment can reduce the incidence of cervical cancer.Clinical diagnosis of cervical cancer should follow the principle of "three steps" : the cervical cytological examination,colposcopy examination and pathological examination,pathological examination is the gold standard in the diagnosis of cervical cancer.Clinical treatments of CIN are laser treatment,electrocoagulation therapy,freezing and so on,but the traditional method of trauma with larger,with a greater incidence of postoperative complications and easy relapse.At present,the clinical application of cervical ring resection(LEEP)and cold knife conization(CKC)to treat cervical intraepithelial neoplasia,a significant therapeutic effect,but still patients with recurrence after surgery.In 2013,the American association of colposcopy and cervical pathology(ASCCP)new guidelines recommend screening for cervical cancer: the histological diagnosis of CIN2,CIN3 or CIN2/3 and inadequate colposcope examination,ECC for CIN2,CIN3 or CIN2/3 or CIN patients with unknown classification,surface treatment is not recommended,and recommended diagnostic cervical cone cut method,but after surgery will be 1%-25% of patients with treatment failure.CIN treatment failure may result inpostoperative recurrence of CIN,but also the development of the possibility of invasive cancer.Therefore,analysis of cervical conization after recurrence and residual risk factors,to distinguish between CIN patients at high risk of recurrence after treatment,and to close follow-up found postoperatively in patients with these lesions further treatment in time,can achieve the goal of early prevention of CIN recurrence,this can effectively control the disease recurrence,and progress.Through a retrospective case analysis method,this paper analyzed the relationship between CIN clinical data of patients and the residual CIN postoperative recurrence.Objective:To evaluate the clinical efficacy of LEEP and CKC in the treatment of CIN,through two kinds of surgical intraoperative bleeding,compared the postoperative complications and postoperative recurrence rate,according to the level of patients with lesions to provide safe and effective treatment for patients,reduce the recurrence of patients with postoperative residual,improve the cure rate of patients.To analyze the clinical and pathological data of CIN patients,to study the relationship between the recurrence and remission of CIN patients after operation and patients' age,pregnancy time,production time,menopausal status,preoperative pathologic stage,the CIN3 lesion points(? 3),degree of cervical erosion,surgical methods,postoperative pathology margin,gland involvement,preoperative and postoperative 6 Month HPV infection,SCC value,family history of cancer,smoking and drinking and other factors.Through the single factor and multivariate factors analysis,found high risk factors associated with postoperative recurrence and remission of patients with CIN,and distinguish high-risk patients who relapse after CIN treatment,postoperative follow-up of closely to them.If discover lesions further treatment in time,in order to achieve the goal of early prevention of CIN recurrence,effective control of disease recurrence and progression.Materials and Methods:To collect the clinical and pathological data of 256 patients with CIN from June 2012 to December 2014 in hospital,Using SPSS 19.0 statistical software for statistical analysis,t test,Pearson chi-square test and Logistic regression analysis and other methods.To analyze the clinical efficacy of LEEP and CKC in the treatment of CIN,to analyze the difference of cure rate and recurrence rate of CIN in two kinds of surgical methods.Thorough single factor and multiple factors analysis,to study the relationship between the recurrence and remission of CIN patients after operation and patients' age,pregnancy time,production time,menopausal status,preoperative pathologic stage,the CIN3 lesion points(? 3),degree of cervical erosion,surgical methods,postoperative pathology margin,gland involvement,preoperative and postoperative 6 Month HPV infection,SCC value,family history of cancer,smoking and drinking and other factors.Results:In this study,a total of 256 cases of CIN patients,of which 100 patients in the hospital outpatient LEEP surgery,156 patients in our hospital operating room CKC surgery.Postoperative follow-up of 24 months,a total of 20 patients with postoperative recurrence,LEEP group of 14 cases(14%),CKC groups in 6 cases(3.85%),Postoperative recurrence LEEP group was obviously higher than that of CKC group(OR = 4.070,95% CI = 1.509 10.979).So the treatment effect of CKC significantly higher than that of LEEP group.The clinical and pathological data of CIN patients were analyzed by single factor analysis came that,the recurrence of CIN was significantly correlated with production times(?2),menopause,preoperative pathological grade,the CIN3 lesion points(? 3 points),surgical mode,postoperative margin positive,postoperative 6 Month HPV continued positive(X2 = 7.024;7.449;12.502;5.769;8.723;15.00;40.693),the difference was statistically significant(P?0.05).But there was no correlation with patients' age,gestational age,degree of cervical erosion,preoperative HPV infection,SCC value,tumor family history,smoking drink and postoperative glandular involvement(P> 0.05).Multivariate logistic regression analysis was performed on the possible factors of recurrence of CIN.Menopause,CIN3 lesions higher than 3,postoperative margin positive,postoperative 6 Month HPV continued positive were independent risk factors for postoperative recurrence of CIN patients(OR= 22.853;7.625;16.351;29.691),the difference was statistically significant(P?0.05).Conclusion:For CIN treatment,CKC treatment is better than LEEP,CKC postoperative recurrence rate was significantly lower than LEEP.The recurrence of CIN was significantly correlated with production times(?2),menopause,preoperative pathological grade,the CIN3 lesion points(? 3 points),surgical mode,postoperative margin positive,postoperative 6 Month HPV continued positive and other factors.And there was no correlation with degree of cervical erosion,SCC value,tumor family history,smoking,drinking and so on.Menopause,CIN3 lesions higher than 3,postoperative margin positive,postoperative 6 Month HPV continued positive were independent risk factors for postoperative recurrence of CIN patients.