| Background objective: Cervical intraepithelial neoplasia(CIN)is a group of cervical precancerous lesions.Early detection and treatment of CIN can prevent cervical cancer from developing.At present,for high-grade intraepithelial neoplasia,the main treatment method is surgery.Various forms of cervical coneectomy are currently recognized as the preferred surgical method.Extrafascial hysterectomy is also the second surgical method selected by some patients.There are pros and cons to each procedure.This article focuses on comparing the clinical efficacy of the two procedures and predicting risk factors for postoperative recurrence.Methods:This article selected 610 patients who underwent colposcopy from January 2008 to February 2019 and were diagnosed with high-grade cervical intraepithelial neoplasia by biopsy pathology.These patients underwent surgical treatment(including cervical cold knife cone resection and extrafascial hysterectomy).They were divided into the cone resection group and extrafascial hysterectomy group according to the operation method,and retrospective telephone follow-up was performed to compare the two surgical procedures.Lesion range,pathological consistency before and after surgery,postoperative margin,postoperative recurrence of disease,postoperative HPV negative rate are compared.Results: 1.Compared with the cone resection group and the extrafascial hysterectomy group,the probabilities of positive margins respectively were 15.3% and 4.2%.The difference was statistically significant(P <0.05).2.For HSIL patients,the recurrence rate of postoperative lesions respectively was 1.3% and0.8% in the cone-cut group and the extrafascial hysterectomy group.There was no significant difference(P> 0.05),Both groups relapsed within 2 years after surgery.3.In the cone-cut group,the HPV negative rate at 6,12,18,24,and 36 months after surgery respectively were 65.7%,79.4%,82.0%,83.3%,and 85.4%.6,12,18,24,and36 months HPV negative rate in the extrafascial hysterectomy group was 58.7%,76.2%,79.4%,82.5%,84.1%.Postoperative various times of the two groups was no significant difference in HPV negative rate(P> 0.05);4.The probability of cervical cancer detection in the cone-cut group and extrafascial hysterectomy grouprespectively were 0.5% and 1.4%,and there was no significant difference(P> 0.05).In both groups,cervical cancer can be detected with comparable results.5.The correlation between TCT classification before operation and the range of cervical HSIL is statistically significant(P <0.05).The higher the TCT level,the wider the range of cervical HSIL;6.The correlation of HPV infection before operation,the range of cervical HSIL,and postoperative positive margins was statistically significant(P <0.05): When preoperative high-risk HPV infection,the risk of positive margins after the incision were greater;The greater the range of cervical HSIL lesions,the risk of positive postoperative margins is greater.Conclusion: For cervical HSIL,both procedures can play a therapeutic role,but the positive rate of the margin after extrafascial hysterectomy is lower than that of the conical group;Although there is no significant difference in HPV negative rate rate and disease recurrence after the two procedures,but coneectomy is the current standard treatment method for HSIL because of its dual role of diagnosis + treatment,simple surgical operation,and small trauma for patients.The patient who is old and has no fertility requirements,or combined with other gynecological diseases,which are indications for hysterectomy or postmenopausal patients that have difficulty in conization,and exclude malignant tumors in the gynecological system,can choose extrafascial hysterectomy.Regardless of the type of surgery performed,there is a certain recurrence rate,especially 2 years of after surgery,follow-up observation should be strictly regular to prevent recurrence. |
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