| Cervical cancer is one of the most common cancers among worldwide.High-grade cervical intraepithelial neoplasia is considered to be a precancerous lesion of cervical cancer.If left untreated,there is a risk of developing invasive cancer.With the widespread and scientific application of cervical cancer screening,the detection rate of cervical precancerous lesions is increasing year by year.Cervical biopsy under colposcopy is the gold standard for diagnosing cervical cancer and its precursors.Studies have reported that colposcopic biopsy can diagnose most of the patients,and there are still some misdiagnoses.Studies have reported a high rate of missed diagnosis in postmenopausal patients,and a large number of studies are still needed to confirm the coincidence rate of colposcopy biopsy.To maximize the protection of women who are developing cervical cancer from the results of false negative tests.The guidelines for cervical cancer screening abnormalities and management of cervical precancerous lesions indicate that cervical conization is the preferred surgical method for the diagnosis and treatment of cervical dysplasia and early cancer.At present,there are various types of cervical conization in the clinic,from the earliest cervical cold knife conization,laser cervical conization to the current circular electrosurgical operation,electrocautery cervical conization,hysteroscopic cervical conization Surgery,hysteroscopy-assisted cervical cold knife conization,etc.Cervical cone cutting methods are constantly being developed and improved in clinical applications.Various surgical methods have their own advantages and disadvantages.However,the best cervical cone cutting method has not been finalized..Concern about the positive margin rate after CIN treatment is increasing,and the effect of different surgical treatments on the positive margin rate is unclear.Studies have reported that high-risk factors for positive margins include: incomplete resection of the lesion,lesion location,size and severity,Age,treatment and whether there is high-risk human papillomavirus after treatment.The problem has been studied in depth for decades,but there is still a lot of debate about which of these factors or the combination of factors most accurately predicts treatment failure.Based on the above controversy,this study aims to explore the application value of cold knife macrocone in the diagnosis and treatment of high-grade cervical intraepithelial neoplasia.Purpose:To explore the therapeutic effect and application value of cold knife macrocone in high-grade cervical intraepithelial neoplasia,as well as the high-risk factors of positive resection margin after conization,and provide a basis for clinical selection of cervical conization.Method:A total of 570 patients diagnosed with high-grade cervical intraepithelial neoplasia preoperatively at Wuhan Central Hospital from January 1,2014 to January 01,2018,who were cold-knife macrocone for the first time,were retrospectively analyzed.Follow up by phone,check the electronic medical record,collect the patient's age,parity,menopause status,preoperative HPV test results and TCT test results;collect colposcopy pathological grade,postoperative pathological results after coneectomy,postoperative pathological results and postoperative Complications;postoperative follow-up to understand the short-and long-term postoperative complications and recurrence after cold knife conization.In this study,the data was collected and analyzed through self-control,and the matching rate of pathological results after colposcopy and cone cutting,the positive rate of cold knife cone cutting margin,the related factors of positive cutting margin,short-and long-term postoperative complications and surgery were compared.Follow-up to understand the recurrence after cold knife conization.Result:(1)The positive rate of TCT was 72.4%(315/435),and the missed diagnosis rate was 27.6%(120/435);(2)The positive rate of high-risk HPV is 97.89%(558/570),and the negative rate is 2.11%(12/570);(3)The coincidence rate between colposcopy biopsy pathology and post-conization pathology results was 68.25%(389/570),of which the coincidence rate was 51.05%(121/237)in the CINII group and 80.48%(268/333)in the CINIII group);(4)The positive rate of incisal margin after coneectomy was 10.35%(59/570);(5)Comparison of pathology after coneectomy and secondary surgery: 98 patients underwent secondary surgery,including 61 patients with negative margins and 37 patients with positive margins.The residual rate of lesions in patients with negative margins after the second surgery was 19.6%(12/61),and the residual rate of patients with positive margins was 59.46%(22/37).(6)Univariate analysis of 570 high-grade CIN patients with positive margins: age(> 50 years),menopause,CIN lesions,and cervical epithelial gland involvement are all related to positive margins after cervical conization((P <0.05).The positive rate of cut-off margin was 17.97% for ages> 50 years,and the positive rate of cut-off margin for menopausal patients was 16.77%.(7)LOGISTIC regression analysis of positive postoperative margin: age,lesion grade,and gland are risk factors for positive postoperative margin.The higher the CIN lesion level,the greater the risk.(8)The complication rate after coneectomy was 1.93%.There were 8 cases(1.4%)of postoperative hemorrhage,1 case(0.2%)of cervical stenosis,and 2 cases(0.3%)of premature delivery without other short-and long-term complications.(9)The follow-up subjects in this study were 420 patients who were not further treated after conization,of which 168 patients were lost to follow-up.The HPV conversion rate was 81.7%(206/252),the recurrence rate was 8.3%(21/252),and the recurrence rate was higher in the first two years.Conclusion: 1.Cold knife conization has the dual functions of perfect diagnosis and treatment in the treatment of high-level CIN.The postoperative HPV conversion rate is high,the recurrence rate is low,and the complications are few.It can effectively protect the reproductive function of young patients.The first choice for the treatment of high-grade CIN.2.Age(> 50 years old),menopause,tired glands,and CIN lesions are risk factors for positive margins.3.Patients need to be actively followed up for 20-30 years after cold knife conization,especially in the first two years after surgery... |
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