Comparison Of The Efficacy Of Loop Electrosurgical Excision Procedure And Cold Knife Conization On High Grade Cerrical Intraepithelial Neoplasia

Background&ObjectiveCervical cancer is one of the most common gynecologic malignant tumors in the world. Cervical intraepithelial neoplasia (CIN) is recognized as the precancerous lesion. In recent years, the number of young CIN patients is increasing. Therefore, early diagnosis and apropriate treatment of CIN is increasing great attention to reduce the incidence and mortality of cervical cancer. There are many treatment methods for CIN, of which LEEP and CKC are the most common treatment methods. But as to their curative effect on CIN, different researchers hold different points. In this study, we conducted a retrospective analysis to compare the efficacy of LEEP and CKC.MethodsData of patients who had been diagnosed as CINII-CINIII before conization in Qilu Hospital of Shandong University, from January1,2011to December31,2013, were reviewed. Then we analyzed136cases with integrated clinical data and no complications retrospectively. The integrated clinical data included patients’age, telephone number, preoperative pregnancy condition, preoperative cytology, preoperative colposcopic biopsy pathology, conization pathology, margin status, whether cervical glands invovlved or not, the scope and depth of the lesion, the size and depth of conization, the distance from the deepest lesion to the cutting edge, the amount of bleeding and operation time. All patients were divided into LEEP group (65cases) and CKC group (71cases) according to the surgery methods which they had received in Qilu hospital. All the operations were performed within3to7days after menstruation for all patients. We used SPSS16.0software for statistical analysis.Results1. Blood loss and operation time:The average blood loss of LEEP group was (11.98±9.59) ml and the average operation time of LEEP group was (15.34±8.59)min; the average blood loss of CKC group was (27.77±24.84) ml and the average operation time of CKC group was(24.53±7.89)min; Blood loss and operation time of LEEP group was significantly less than CKC group, with statistically significance (P<0.05, P<0.05).2. Preoperative and postoperative pathology:In LEEP group, there were55cases (84.62%) of high-grade intraepithelial neoplasia,5cases (7.69%) of low-grade intraepithelial neoplasia and5cases (7.69%) of cervical chronic inflammation in postoperative pathological results. In CKC group, there were58cases (81.69%) of high-grade intraepithelial neoplasia,2cases (2.82%) of low-grade intraepithelial neoplasia,10cases (14.09%) of cervical chronic inflammation and cervical chronic inflammation with squamous metaplasia,1case (1.41%) tiny infiltrating carcinoma in postoperative pathological results. There was no statistically significant difference of preoperative and postoperative pathological consistent rate between two groups (P>0.05).3. The rate of cervical glands involved:There were44cases (67.69%) of postoperative pathology that invaded cervical glands in LEEP group and40cases (56.34%) in CKC group. There was no statistically significant difference between the two groups (P>0.05).4. Average size of the cervical conization tissue:The average area of the resected cervical tissue in LEEP group was (4.31±1.51) cm2and the average height was (1.38±0.33) cm. The average area of the resected cervical tissue in CKC group was (5.07±1.48) cm2and the average height was (2.03±0.44) cm. Therefore, the volume of the removed tissue between the two groups were statistically significant (P<0.05; P<0.05).5. The distance from conization margin to the deepest part of cervical lesion: Microscopically, the average depth of the lesion in LEEP was (0.71±0.23) mm, there are2cases of which the distance from the deepest part of cervical lesion to the cutting edge of the lesion smaller than2mm and63cases larger than2mm.The average depth of the lesion in CKC was (0.62±0.37) cm, there are2cases of which the distance from the deepest part of cervical lesion to the cutting edge of the lesion smaller than2mm and69cases larger than2mm. All the differences between the two groups were not statistically significant (P>0.05, P>0.05).6. Postoperative negative rate of edge:There are63cases (96.9%) of negative rate of edge after cervical conization in LEEP group and71cases (100%) in CKC group. There was no statistically significant difference between the two groups (P>0.05).7. The rate of postoperative recurrence:3patients (3.08%) had relapsed in LEEP group after conization and2cases (4.22%) had relapsed in CKC group. The recurrence rate of two groups showed no statistically significant difference (P>0.05).8. Postoperative pregnancy:In LEEP group,3cases (4.62%) had conceived after surgery, including one case of ectopic pregnancy, one case of early pregnancy line cervical cerclage and one case of full-term cesarean delivery. In CKC group,2patients (2.82%) had conceived after surgery, one case of premature delivery and one case of early pregnancy line cervical cerclage. Comparison of postoperative pregnancy rate, the difference was not statistically significant (P>0.05).ConclusionsBoth of CKC and LEEP are effective treatment methods for high grade cervical intraepithelial neoplasia. But, compared with CKC, LEEP has the advantages including less blood loss and operation time, smaller cervical conization tissue size, minor trauma and faster recovery. So, LEEP is very popular in clinic, especially among young CIN patients.