Comparative Analysis Of The Efficacy Of Two Kinds Of Cervical Conization In The Treatment Of High-grade Cervical Lesions

Objective: High-grade squamous intraepithelial lesion(HSIL)refers to cervical squamous intraepithelial lesions that have a significant progression to invasive cancer risk,including CINII and CINIII grades with positive p16 staining.Lesions and previously named severe atypical hyperplasia and carcinoma in situ.Cervical cancer is a gynecological malignant tumor that can be prevented and treated early.The development of cervical intraepithelial neoplasia into cervical cancer is a gradual development process.In recent years,patients with cervical intraepithelial neoplasia have gradually become younger,and the preservation of fertility is an urgent need of patients.Cervical conization is the preferred treatment for patients with cervical intraepithelial neoplasia with fertility needs.Therefore,whether this treatment will affect the pregnancy outcome of patients has become a hot topic of concern.Clinically,the pathological results of multi-point biopsy of colposcopy are CIN II,CIN II~ CIN III or CIN III,which are indications for cervical conization.Cervical conization includes the Loop Electrosurgical Excision Procedure(LEEP)and the Cold Knife Conization(CKC).In this study,we compared the intraoperative bleeding,the length of surgery,the residual and recurrence of the lesion after surgery,the change of cervical canal length and the appearance of the cervicovaginal part,the presence or absence of cervical canal adhesion,postoperative Bleeding,infection and abortion,premature delivery,etc.,seeking the best way to treat highgrade intraepithelial neoplasia of the cervix.Method: Retrospective analysis of 130 patients with pathological diagnosis of CIN II,CIN II~CIN III or CIN III admitted to our hospital from January 1,2013 to December 31,2018.No preoperative surgical complications and previous surgery were selected.Cases with no history of physical therapy and surgical treatment,high-risk human papillomavirus(HR-HPV),and complete clinical data,divided into LEEP group and CKC group.LEEP group: 77 patients,with an average age of(38.72±7.536)years,with an average birth of 1.28±0.53.CKC group: 53 cases,mean age(39.12±6.982)years old,average birth time 1.35±0.67.All patients had TCT results with different subtypes of human papillomavirus infection.There was no significant difference between the two groups(P>0.05),which was comparable.1.1 Collecting intraoperative bleeding,length of operation,residual or recurrence of postoperative lesions,changes in cervical canal length and cervix appearance at 6 months after surgery,presence or absence of cervical canal adhesions,postoperative bleeding and infection,etc.Situation,statistical analysis was performed.1.2 LEEP group and CKC group were followed up for pregnancy as LEEP pregnancy group and CKC pregnancy group,including LEEP pregnancy group: 24 cases,mean age(29.43±4.27)years old,average yield 0.75±0.34.CKC pregnancy group: 15 cases,the average age(33.52 ± 2.36)years,the average number of births was 0.92 ± 0.46.The incidence of abortion and the incidence of preterm birth were analyzed and compared between the two groups.Result:1.The average operation time in the LEEP group was(9.6 ± 5.8)min,and the mean blood loss was(16.6 ± 3.8)ml.The average operation time of the CKC group was(42 ± 10.1)min,and the mean blood loss was(67.5 ± 14.8)ml.The LEEP group had shorter operation time and less intraoperative blood loss than the CKC group.2.There were 77 patients in the LEEP group,6 patients had residual operation,including 4 cases with postoperative pathological margin and 2 cases with negative pathological margin.There were 53 patients in the CKC group,and 3 patients had postoperative residual disease.Among them,1 case was positive for postoperative pathological margin and 2 cases were negative for postoperative pathological margin.There was no significant difference in the residual rates between the two groups.The difference was not statistically significant.3.There were 3 recurrences in the LEEP group and 1 recurrence in the CKC group.There was no significant difference in recurrence rates between the two groups.The difference was not statistically significant.4.There was 1 case of postoperative hemorrhage in the LEEP group,no cervical adhesions,no postoperative infection;4 cases of postoperative bleeding in the CKC group,2 cases of cervical adhesions,no postoperative infection.The incidence of complications in the LEEP group was significantly lower than that in the CKC group,?2=6.189,P=0.013,P<0.05,which was statistically significant.5.The length of cervical in the LEEP group before surgery:(30.25 ± 5.05)mm;the length of the cervix at 6 months after surgery:(30.14 ± 5.73)mm.The length of the cervix before operation in the CKC group was(26.57±1.53)mm;the length of the cervix at 6 months after surgery was(26.29±1.38)mm.The difference was not statistically significant.The LEEP group was reviewed 6 months after operation,and the cervix and vaginal area were intact.The cervicovaginal part of the CKC group was re-examined 6 months after surgery,and some even disappeared.6.There were 24 patients in the LEEP pregnancy group,including no abortion,1 case of premature birth;15 cases of CKC pregnancy group,including 1 case of abortion and 1 case of premature birth.The difference was not statistically significant.Conclusion:1.LEEP has the advantages of shorter operation time,less intraoperative blood loss,less postoperative complications and more complete cervix vaginal morphology than CKC.For patients with HSIL,especially those with fertility requirements,LEEP is a more suitable surgical procedure..2.Patients with positive margins should be followed closely.HPV should be highly valued during follow-up.If HPV high-risk type continues to be infected,appropriate treatment should be given..