The Research Of Clinical Choice With Cervical Intraepithelial Neoplasia Grade â…¢

Research BackgroundCervical intraepithelial neoplasia (CIN)(including cervical severe dysplasia a-nd carcinoma in situ) is cervical lesions. In some patients, CIN can develop int-ocervical cancer after10years of development.Therefore, early diagnosis and b1-ock the development is very important.In recent years, as cervical lesions cytology diagnosis technology improvem-ent and the wide application of colposcopy.Government departments and clinical doctors Attaches great importance to it.A growing number of CIN patients is ear-ly diagnosis and treatment, effective prevention of the occurrence of cervical ca-ncer. This is undoubtedly the gospel for the patients, also had a positive social value and economic value (to reduce the cost of treatment).However, as CIN III patients’diagnosis rates have increased, the proper and effective treatment has gr-adually become the problems faced by front-line medical workers.For CIN III patients, choose conization to confirm the diagnosis has been n-o dispute. Conization pathological diagnosis remains of CIN III cases, their sub-sequent treatment of choice is indeed very confusing clinical problem. Present, i-n view of the patient the fear of cancer, doctors concern of clinical relapse, ma-ny cases choose the extrafascia hysterectomy as therapy. Hysterectomy is necessa-ry? Whether the existence of over-treatment? patients wishing to preserve fertilit-y, if clear indications of the treatment? For these problems is the lack of consu-ltation card. Traditional clinical treatment recommendations, for positive margins of cerv-ical intraepithelial neoplasia patients suggest hysterectomy, But Kim et al [1] rep-orted that it is possible that conservative treatment for positive margins after cer-vical excision of CIN in patients, the recurrence rate of positive margins with p atients underwent additional hysterectomy is not decrease, and may lead to the o-ccurrence of vaginal epithelial neoplasia (VIN), while increasing the psychologic-al pressure of patients with various complications and patients. Thus, looking fo-r specific hysterectomy indications are very important.In clinical diagnosis and treatment process, conization choice of style is m-ore controversial. LEEP has been because of its simple, efficient, low cost and respected by a great clinician. Undoubtedly CIN II and part of the patients with cervical hypertrophy, LEEP surgery can be a one-time completion of treatment, i-s a very good choice. And for CINIII patients, there is need to subsequent tr-eatment choices (whether hysterectomy), the LEEP and CKC which one is better? At present there are different views. And only clearly solve this problem, can pr-ovide keep the uterus.This study was to evaluate the clinical data of our hospital. Evaluate the p-ositive exocervical margins and positive endocervical margins pathological findin-gs and prognosis after conization, in order to find a clear indication of the CIN III patients to retain the uterus.evaluate and analyze efficacy of CKC and LEEP above information, clear of CIN III patients suitable conization. To improve the guidance for the clinical treatment of choiceObjectiveExplore the significance of the conservative treatment of cervical intraepith-elial neoplasia with cervical margin-positive patients, as well as margin in the choice of surgical procedure and subsequent treatment of the important position; compare the efficacy of the CKC and LEEP treatment, and explore the feasibility o-f the CKC in the treatment of patients with CIN III; compare the efficacy of the sur- gery if the incision suture in CKC, to explore the effectiveness of the suture in the CKC surgery, especially for patients to want to preserve fertility in CIN III(moderate and severe dysplasia and carcinoma in situ) patients provides the th-eoretical basis for clinical treatment.MethodCollected228cases of cervical intraepithelial neoplasia grade III patients from Ja-nuary2008to December2010in our hospital, surgical treatment of78patients are conization followed by hysterectomy, surgical treatment of150cases are conizati-on only. Comparison the cervical hi stopatho logic findings of positive exocervical margins and positive endocervical margins, and follow-up of TCT and HPV-DN-A testing results in postoperative in cervical conization additional hysterectomy a-nd only conization, Meanwhile, In150patients with cervical conization only,6-9cases Of LEEP group,81cases of CKC group, patients with positive margin im-pact of factors analyzed by univariate and logistic analyzes to compare LEEP group an d the CKC group.Meanwhile, compare mean operative time, mean intraoperative b-lood loss, length of hospital stay, postoperative bleeding, postoperative cervical s-tenosis and postoperative pathological findings in LEEP group and the CKC gro-up. Compare intraoperative blood loss, postoperative bleeding and postoperative hospital days in suture group and the non-closure group of CKC.Result(1) In78routine non-conservative treatment patients,28(35.9%) patients w-ith positive margins, two cases of patients with positive exocervical margins and14cases of patients with positive endocervical margins were found residual diseas-e after hysterectomy, the two group difference was statistically significant.In150c-ases of conservative treatment.one cases (10%) with positive exocervical margi-ns and8cases (61.5%) with positive endocervical margins relapse, compare bot-h relapse rate, the difference was statistically significant (P=0.037).Two groups of 51cases of patients with positive margins, two cases (10.5%) of patients with posi-tive exocervical margins were recurrence,12cases (37.5%) cases with positive e-ndocervical margins were recurrence, the recurrence rate of tow group difference was statistically significant (P=0.037).(2)150patients who underwent conization, the univariate analysis:compare LEEP group and CKC group positive margin rate, the difference was statistically signi-ficant (P=0.04). Multivariate logistic regression analysis, different surgical approac-h is a positive margin highly relevant factor. The relative risk0.395. And its partial regr-ession coefficient was-0.930, it indicated the positive margin rate of the LEEP group were higher than positive margin rate in the CKC group, LEEP treatment of cervical margin is one of the positive risk factors.(3) Compared the LEEP group and the CKC group preoperative pathology a-nd the pathological exactly the same rate, the complications the cure rate, the diff-erence were no statistical significant(P>0.05).(4)31cases of postoperative wound suture patients with coagulation with iodofor-m gauze to stop bleeding, two cases due to active bleeding,underwent re-incision sutu-re. Compare the intraoperative blood loss, postoperative bleeding, postoperative hospital stay in suture group and the non-closure group of CKC, there were sig-nificant differences(P<0.05).ConclusionLearned from the study:conservative treatment can be safely used in pati-ents with positive exocervical margins of close follow-up; CKC can be better used in patients with cervical intraepithelial neoplasia; incision surgery can be b-etter applied to hemostatic effects in CKC.