Analysis Of Treatment Of Patients With Positive Pathological Margin After Conical Resection With Cervical Lesions

Objective:Analysis of cold knife conization(Cold knife conization,CKC)or Loop electrosurgical excision procedure(Loop electrosurgical excision procedure,LEEP)due to High-grade squamous intraepithelial lesions(High-grade squamous intraepithelial lesions,HSIL)at the cervix.Post-cut-edge positive patients used different clinical treatment measures to study the prognosis and return of disease after the treatment measures,and to explore the stratified management of the post-cut-edge positive patients.Methods:Retrospective analysis of clinical pathology data of 266 patients with positive circacuttion due to HSIL’s cervical cone-cut operation at Qingdao University Hospital from June 1,2013,to June 1,2019,Including:age,pregnancy,deli very,menopausal status,postoperative pathology level,postoperative cause and scope,re-surgery method,post-operative pathology,preoperative and postoperative cytology and HPV infection and so on.Choose regular follow-up observation or re-exercise of LEEP,CKC,full hysterectomy or extensive full hysterectomy according to the patient’s condition and wishes.All patients are regularly followed up after surgery,with thin-layered liquid-based cytology examinations(Thinprep cytologic test,TCT)and HPV testing(HCII or HPV component at ion),cervical biopsy under the cytoscope and endometrial scraping of the cervix(Endocervical curettage,ECC)if cytological abnormalities or persistent HPV infections are carried out,and no lesions remain and residual lesions are detected in a timely manner.Recurrence and progress of the lesions in time.Analysis of the follow-up and re-surgery treatment prognosis of patients with an edge,comparing the positive rate of cut-off in different surgical methods,supplementing the clinical pathological characteristics of the postoperative lesions residue group and the non-diseased residual group,calculating the rate of lesions residue and analyzing the high-risk factors of lesions residues.Results:Among the 3614 patients,the cut edge was positive 266.For example,the total positive rate 7.3%Among them,886 cases of first cone cut LEEP,56 cases of postoperative cut edge positive,positive rate of 6.3%,first line CKC 2728 cases,postoperative cut edge positive 210 cases,positive rate of 7.7%,the difference between the two groups of positive rate is not statistically significant(p>0.05).The 266 patients who were positive for the cut edge were divided into the follow-up group(n=142)and the treatment group(n=124),and the patients in the treatment group were treated with re-cervical cone cutting,full hysterectomy or extensive hysterectomy,re-diagnosis of postoperative pathology as chronic cervicitis 45 cases,low-grade squamous intraepithelial lesions(Low-grade squamous intraepithelial lesion,LSIL)15 cases,30 cases of HSIL,cervical cancer(Cervical cancer,CC)34 cases,the results showed that the pathological HSIL and above lesions residual rate of 51.6%(64/124);The factors related to single-factor analysis of lesion residue group and non-disease residue group showed that the differences between the two groups of internal and external cut-off edge positive,multi-point cut-edge positive,and postoperative HPV continuous infection were statistically significant(p<0.05).The differentiated factors were further incorporated into Logistic regression analysis,and the factors related to the multi-factor analysis of lesions residue group and non-disease residue group showed:positive internal and external cut edge(OR value:16.40),multi-point cut edge positive(OR value:5.416),postoperative HPV continuous infection(OR value:7.30)as an independent residual risk factor for cervical cone cutting pathogenic cut-off positive patients.Conclusion:Patients with pathologically positive pathogenic edge after cervical cone cutting need to be evaluated according to the need for fertility and the high-risk factors of lesion residues.For those with high risk factors of disease residue,it is recommended to perform a cone or full hysterectomy in conjunction with the patient’s fertility requirements.Those who do not have high risk factors for lesions residue can choose strict follow-up as a priority to avoid over-diagnosis and treatment.