Analysis Of Long-dated Security And Effectiveness For High-grade Cervical Intraepithelial Neoplasia With Loop Electrosurgical Excision Procedure

Objective：1. To analyze the high grade cervical intraepithelial neoplasia (CINII,CINIII)clinical features of follow-up patients and evaluate the security and effectiveness ofloop electrosurgical excision procedure (LEEP) for high grade cervical intraepithelialneoplasia.2.To discuss the value of TCT and HPV during follow-up, the high riskfactors of residual or recurrence, and the obstetric outcomes after LEEP.Methods：1.Selection of the pathological diagnosis result as CINII, CINII after LEEPconservative treatment under colposcope in The First Affiliated Hospital of WannanMedical College gynecology outpatient colposcope studio from Jan2008to Dec2010.Regular following up321patients on the average duration of52.2months whowere diagnosed as CINII,CINIII after LEEP treatment and accepting Thin-prepliquid-based Cytology Test (TCT) and/or human papilloma virus (HPV) strains test,then taking colposcopy to the patients whose diagnosis were ASCUS or above afterTCT,persistent HPV infection or with suspected chief complaint regarding pathologicalresult as final diagnosis.2. Using SPSS16.0the collected data were analyzed bydescriptive statistic;Chi-square test was used to compare the rate;Logistic regressionanalyzing the residual or reoccurrence factors of cervical intraepithelial neoplasia afterLEEP,α <0.05for the inspection criteria.Results：1. After5years follow-up,1residual case in3months,11recurrence cases and1Pelvic lymph node metastatic squamous cell carcinoma case were found;309cases were not found cervical lesion.The treatment of LEEP for high gradecervical intraepithelial neoplasia cure rate is96.26%, fail rate is3.74%.2.17patientshad positive TCT, total25times;it were confirmed the recurrence:HSIL(2/2),LSIL(5/9), ASC-H(1/4), ASCUS(4/10) respectively, the corresponding positive forecastvalue were100%、55.56%、25.00%、40.00%.3. HPV strains test to241case (testingrate75.1%) of patients after operation;HPV positive was80cases (1-5times), total131times. HR-HPV16,58,52,18positive cases were23,16,14,7respectively, correspondingmisdiagnosis rate were5.6%,6.25%,14.29%,0%respectively though combiningTCT,periodic review and colposcopy.Chi-square was used to compare HPV infectionrate after LEEP, p=0.01, that means from statistical the HPV infection rates haddecreasing trend to the follow-up after LEEP.Chi-square test was used to compare HPVclearance rate after operation but before LEEP,p<0.01,the LEEP clearance result toHPV infective patients after operation is obvious.4. The sensitivity, specificity,positiveand negative predictive corresponding values of TCT test, HPV genotyping testing andcombined test were68.75%,99.27%,44.00%,99.73;92.00%,90.43%,17.16%,99.81%;90.00%,99.81%,81.81%,99.90%respectively.6.With logistic regressionanalysis revealed: menopause (p=0.001), positive margin (p=0.035), HPV infection(p=0.006),all were residual or recurrent high risk factors of high grade cervicalintraepithelial neoplasia after LEEP;age(p=0.639),CIN grade (p=0.262) and glandinvolvement(p=0.496),no statistic relation to recurrence after operation, were not thehigh factors of residual or recurrence.7.In five years follow-up,15of16Postoperativewere natural conception, who had fertility desires pregnancy rate was93.75%.Expectfor1case of premature in36+4weeks and1case of pregnant for4months,they all hadterm cesarean delivery.41cases of pregnancy,total51times(1-3times);24casesreceived induced abortion,total29times(1-2times), who did not have fertility desirespregnancy.18cases of reproductive history count19times (1-2times);Their prematurerupture of membranes and preterm birth rate was both10%(2/20).All of them hadcesarean delivery. Conclusions：1.LEEP is a secure and effectiveness treatment to high gradecervical intraepithelial neoplasia.2. TCT combined with HPV test is a reliable method topostoperative follow-up.The co-test has a high positive and negative predictivevalue.3.postoperative follow-up program should be based on each patient’sComprehensive situation,that is margin,post operative HPV genotyping testing andmenopausal.The program should be strengthen about the detection of high risk patientsand developed into individualized screening program.4.LEEP does not significant affectthe pregnancy outcome.