Clinical Analysis Of 607 Cases Of Cervical And Vaginal Lesions Treated By CO₂ Laser

Objective:To study the therapeutic effect and influencing factors of cervical lesions and vaginal lesions treated by CO₂ laser through retrospective analysis of clinical data.Through single factor analysis and multi-factor analysis,we find out the high-risk factors that affect the therapeutic effect after CO₂ laser surgery,so as to provide theoretical support for the clinical search for the suitable population for laser treatment of cervical and vaginal lesions.Methods:From January 2016 to December 2016,607 cases of cervical lesions and（or）vaginal lesions treated by CO₂ laser in the International Peace Maternal and Child Health Hospital affiliated to Shanghai Jiaotong University Medical College were retrospectively analyzed,including age,preoperative TCT、HPV、biopsy pathological results、laser site、laser frequency、TCT、HPV、biopsy pathological results、Leep operation after operations and so on.Patients were reexamined 2 months later after laser operation to observe the healing of the lesion.TCT and HPV examinations were performed at 6 and 12 months after operation,and colposcopy was performed if abnormalities occurred（TCT≥ASCUS、HPV is positive）.Six months after CO₂ laser treatment,TCT and biopsy pathology were degraded,the results of HPV became negative,which were called effective.TCT and biopsy pathology persisted or escalated,the results of HPV did not become negative,which were called ineffective.Patients with effective laser treatment were followed up for two years,and it was found that TCT and biopsy pathology were degraded and then upgraded,HPV infection again or subtype changed which were called recurrence.Patients were followed up for 2years after CO₂ laser operation.TCT and biopsy pathology were degraded and HPV turned negative which were called total effective.In this study,SPSS21.0 software is used for statistical analysis of data.T-test,chi-square test and logistic regression model were used to analyze the correlation between the clinical efficacy of cervical and vagina lesions’patients after CO₂ laser surgery and their age、menopause、laser location、preoperative TCT、preoperative pathological grade of biopsy、HPV infection、the subtype of HPV infection、laser frequency and LEEP operations.P<0.05 was statistically significant.Results:Of 607 cases,503 cases were CIN,156 cases were VaIN,including 52 cases of CIN combined with VaIN.The youngest age was 18 years old and the oldest was 70 years old.Of 607cases,302 were condyloma,281 were CIN I or VaIN I and 24 were HSIL.Preoperative high-risk HPV positive was found in 475cases（78.3%）,and HPV negative in 132 cases（21.7%）.The overall effective rate was 95.4%,the effective rate of CIN was 94.8%,and the effective rate of VaIN was95.5%.The total HPV negative rate was 74.1%,HPV negative rate of CIN was 78.1%and HPV negative rate of VaIN was 57.1%.The overall pathological downgrading rate was 93.7%,the pathological downgrading rate of CIN was 92.8%,and the pathological grade of VaIN was 94.2%.Laser location and LEEP operations are independent influencing factors for HPV negative conversion rate.Preoperative pathological grade of biopsy is an independent influencing factor for pathological degradation rate.Conclusion:HPV infection is closely related to CIN and VaIN infection.CO₂ laser treatment of cervical and vaginal low grade squamous intraepithelial lesions is safe and effective.