Comparison On The Clinical Value In The Treatment Of HISL And The Thermal Effects To Cervical Specimens Between Two Kinds Of Electrosurgical Excision

ObjectiveThis study is conducted to compare the clinical effect of transcervical resection(TCRC)and loop electrosurgical excision procedure(LEEP)in the treatment of high-grade cervical squamous intraepithelial lesion(HSIL),and analyzes the thermal effect from TCRC and LEEP procedures on the pathological diagnosis of cervical specimen margin,so that exploring the clinical value of TCRC in the treatment of HSIL.MethodsWe analyzed retrospectively 949 patients with HSIL who received cervical conization at Guangdong General Hospital,Guangdong Academy of Medical Sciences or Zhujiang Hospital,from January 2009 to December 2015.Among the patients included,418 patients were treated with TCRC(TCRC group)while 531 patients were treated with LEEP(LEEP group).The intraoperative condition,postoperative pathological diagnosis,clinical outcomes,complications and subsequent pregnancy outcomes were compared by the methods of Two independent samples t-test,Chi-square test and Fisher's exact test between two groups.We also analyzed retrospectively 58 patients with HSIL who received cervical conization treated at Guangdong General Hospital,Guangdong Academy of Medical Sciences,from October 2016 to June 2017.Among the 58 patients included,29 patients underwent LEEP and the other 29 patients underwent TCRC.The gross pathology and morphologic changes,the depth of tissue thermal damage and postoperative pathological diagnosis were compared by the methods of Two independent samples t-test,Chi-square test and Fisher's exact test between the two groups.ResultsOne,the intraoperative condition of the two groups:The blood loss volume of TCRC and LEEP group was 9.1±3.2ml and 18.4±2.8ml(P=0.019),and the hospitalization days of TCRC group and LEEP group were 3.2±1.2days and 2.8±2.3days(P=0.245).No one during TCRC procedure while 2(0.4%)patients during LEEP procedure experienced the side hurting.Two,the pathology of the two groups:Compared the diagnoses of cone pathology with the preoperative cervical biopsy pathology,the rates of coincidence in the TCRC group and LEEP group were 82.3%and 85.3%(P=0.408).The incidences of positive margin of TCRC and LEEP groups were 12.4%and 36.6%(P<0.001),In addition,110(26.3%)cases of suspected intrauterine lesions were detected and resected in the TCRC group,and 82(74.5%)cases were diagnosed as endometrial polyps.Three,the operative effects of the two groups:The incidences of persistent lesion,recurrent lesion and clearness of TCRC and LEEP groups were 3.4%and 9.9%(P<0.001),1.4%and 3.8%(P=0.042),95.2%and 86.3%(P<0.001).Four,the complications of the two groups:The rates of cervical adhesions,pelvic pain,pregnancy,premature delivery,vaginal delivery,cesarean section were comparable between two groups.Five,the thermal injury of specimens in the two groups:Under the light microscope,the thermal injury of the two groups displayed as carbonation zone and solidification zone,the tissue and cell morphology of the solidification zone changed to a certain extent,and the morphological changes of the homologous cells were similar,while the thermal damage of malignant cells was different from that of normal cells.The depth of thermal injury in TCRC group and LEEP group was1.22±0.43mm and 0.90±0.43mm respectively(P<0.05).There was no significant difference in the distribution of thermal injury degree.The comparison of preoperative and postoperative pathological diagnosis results was comparable between the two groups.ConclusionsTCRC,a new endoscopic technique,combines the hysteroscopy with cervical conization.Comparing with LEEP,TCRC relates to less bleeding,accurate location,higher rate of lesion clearance and lower rate of lesion recurrence,and TCRC is also useful for detecting and/or removing intrauterine lesions during surgery.Moreover,TCRC does not increase the operation time and prolong the hospitalization days.Besides,the incidences of cervical adhesions,pelvic pain,postoperative gravidity,delivery mode were comparable to LEEP.;moreove,the thermal injury of the two groups displayed as carbonation zone and solidification zone,although TCRC causes a modest thermal damage than the LEEP,the comparison of preoperative and postoperative pathological diagnosis results and the distribution of thermal injury degree of the two groups are comparable.Therefore,TCRC is safe and feasible in the treatment of HSIL.It may become one of the methods of diagnosis and treatment of HSIL,and even to be an important supplement.