Analysis Of Diagnosis And Treatment Of 168 Cases Of Cervical Intraepithelial Neoplasia After Conization

Background and purposeWith the wide application of cervical lesion screening in women,cervical intraepithelial neoplasia can be discovered and treated in time,which makes the prognosis of cervical intraepithelial neoplasia improve significantly compared with before.Cervical intraepithelial neoplasia includes low-grade intraepithelial neoplasia and high-grade intraepithelial neoplasia.Cervical low-grade intraepithelial neoplasia is CINI,and cervical high-grade intraepithelial neoplasia includes CIN? and CIN?.The development of cervical high-grade intraepithelial neoplasia is a gradual evolutionary process,ranging from years to decades.In recent years,with the prevalence of premature sexual activity and sexual disorders,the incidence of these disorders has become younger and these patients have the need to preserve fertility.Therefore,cervical conization is particularly important in the diagnosis and treatment of cervical intraepithelial neoplasia.It has the dual value of diagnosis and treatment.However,the re-treatment of positive margins after cervical conization for cervical intraepithelial neoplasia is clinically deficient in the reference of large samples.Therefore,there is no specific standard for treatment.Clinically,the pathological lesions at the margin of the patient's surgical margin are often required.The grade,which fully integrates the patient's willingness to preserve fertility and whether the patient has good compliance,can choose close treatment for follow-up clinics,re-cervical conization,hysterectomy,etc.In this study,the county will be A comparative analysis of 168 positive cases of cervical intraepithelial neoplasia with a positive margin has been performed in the Central Hospital for the purpose of making effective and safe clinical treatment more suitable for these patients with positive margins.Materials and MethodsGeneral Information:From January 2006 to December 2015,696 cases of cervical conization due to"cervical intraepithelial neoplasia" were diagnosed in Shanxian Central Hospital.A total of 168 cases of positive patients with excision margins were reported after surgery,accounting for 24,1%.,aged between 24 and 76 years old,with an average age of(38.34±3.52)years old.Treatment:For patients with positive cervical margin after cervical intraepithelial neoplasia,collect their unique clinical symptoms,including:home address,pregnancy history,biopsy time,gynecological complications,cervical cytology(TCT)),the number of biopsy sites,the condition of the biopsy in our hospital's pathology department,the pathology after re-operation,the surgical route,and whether or not to proceed with the next step.All diagnoses are based on the highest pathological results,and the final diagnosis is the pathological result of biopsy,conization,or reoperation.With the patient's full and informed consent,according to the grade of pathological lesions at the margin of the patient's surgical margin,the patient's willingness to preserve reproductive function and whether the patient has good compliance are fully combined to inform the treatment of positive margins after conization of the cervix.Opinions:Close follow-up,re-cervical conization,hysterectomy,etc.ResultFor 168 patients with positive cervical margin after conization of cervical intraepithelial neoplasia,89 cases were selected for close follow-up visits,accounting for 52.9%;19 cases were selected for reconstructive cervical cold conization,accounting for 11.3%;48 cases were selected for hysterectomy,accounting for 28.5%;12 patients with positive margin of invasive cervical cancer underwent radical cervicectomy and radical hysterectomy,accounting for 7.3%.(1)89 cases with close follow-up were selected,56 patients had CIN-? pathology reported after conization and 33 patients had pathological reports of CIN?-?.Follow-up included HPV test,TCT,colposcopy,and cervical biopsy.The follow-up time was 20 months.The results showed that 14 patients had recurrence and the biopsy result was CIN?-?,among which 12 cases of high-risk HPV continued positive,2 In the case of HPV negative,the recurrence rate of HPV positive group was higher than that of negative group,and the difference was statistically significant(p<0.05).All the 14 patients with recurrence were follow-up patients with CIN?-? pathology after conization.None of the patients with pathological CINI after conization had recurrence.The recurrence rate of the higher pathological grade group was higher than that of the pathological grade in the two groups.In the low group,the difference was statistically significant(p<0.05).(2)Reconstructive cervical cold knife conization was performed in 19 cases.The pathological reports after the initial conization were CIN?-?.After reconecution,2 cases were chronic cervicitis,5 cases were CINI,and 11 cases were CIN?.-?,1 case of micro-invasive carcinoma.(3)48 patients underwent hysterectomy.The pathology after the initial operation was CIN?-?.Pathological reports after hysterectomy showed 6 cases of chronic cervical inflammation,12 cases of CINI,and 30 cases of CIN?-?.(4)12 patients with positive margins and incisional cervical cancer were treated with cervical resection in 2 cases,radical hysterectomy in 10 cases,postoperative pathologically invasive cervical squamous cell carcinoma in 11 cases,and CIN ? in 1 case..In the recone slice group,hysterectomy group and radical surgery group,the residual rate of the lesions was compared between the two groups.There was no significant difference in the residual rate between the recone slice group and the hysterectomy group(P>0.05).The difference between the radical surgery group and the recone slice group was statistically significant(P<0.05).The difference between the radical surgery group and the hysterectomy group was statistically significant(P<0.05).Conclusion1.Patients with positive cervical cone incision margin and higher follow-up pathological grade and high risk HPV positive patients after surgery have a higher chance of recurrence.2.For patients with positive resection margin after cervical conization,close follow-up clinic,recone cervical hysterectomy,and other treatment methods after the conization of the cervix,each has its own advantages and disadvantages,due to the positive margin patients after cervical conization With a high residual rate,reoperation is an important means of treating positive margins.