Analysis Of The Related Residual Factors And Clinical Procedures In The Patients Of 131 Who Receiving LEEP For HSIL

Objective:To investigate the related residual factors in the patients with high-level cervical intraepithelial neoplasia(CIN)who had positive resection margins after the initial loop electrosurgical excision procedure(LEEP)and the next step of the clinical treatment.To explore the high risk factors for evaluating the residual lesions,and to reduce the residual rate of the lesions in the future clinical work.The Research Object and Methods:A restrospective collection of 131 patients' clinical data from January 2013 to October2016 was analyzed.These patients with primary LEEP underwent the second complete hysterectomy because of surgical resection margin.Evaluate the related factors,and carry on the single factor and the multi factor regression analysis.The analysis includes: Patients' age,menopausal status,pregnancy,parity,the cervical epithelial gland is involved or not,the initial LEEP cone height and cone width,the Thinprep cytologic test(TCT),HPV DNA HC2 detection,the infection subtype of HPV,the cervical lesions level,the time interval between the initial LEEP and the second complete hysterectomy,the operation time of the second complete hysterectomy,the amount of blood of the second complete hysterectomy and so on.Results:1.The average age of the 131 patients in this study was(51.22±7.78)years.The results showed that there were 52 cases of residual lesions,the residual rate being 39.70%.2.In univairate anajysis,the related residual factors in the patients after the initial loop electrosurgical excision procedure(LEEP)are: the cervical epithelial gland is involved(OR=2.31),with significant difference(P<0.05).And the preoperative HR-HPV DNA examination>300RLU/CO(OR=2.13),with significant difference(P<0.05).But the Patients' age,menopausal status,pregnancy,parity,the initial LEEP cone height and cone width,the Thinprep cytologic test(TCT),the infection subtype of HPV,the cervical lesions level,the time interval between the initial LEEP and the second complete hysterectomy,the operation time of the second complete hysterectomy,the amount of blood of the second complete hysterectomy Were not correlation with the positive margin.3.In multivariate Logistic regression,the cervical epithelial gland is involved and the preoperative HR-HPV DNA examination>300RLU/CO were high risk factors associated with the positive margin.4.According to the conization margins and the lesion distance on positive margins,the cases were divided into four groups(>3mm,1-3mm,<1mm,margin visible lesions),the residual lesion rate were 11.11%(1/9),11.76%(2/17),12.90%(8/62)and 95.35%(41/43),there were statistically significant differences between the 4 groups(p<0.05).5.The outcome of high-risk HPV after complete resection of the uterus: The load was effectively decreased after follow-up 12 months,of which 124 cases of high-risk HPV loading completely negative.Conclusion:Through this research,we know: the cervical epithelial gland is involved and the preoperative HR-HPV DNA examination>300RLU/CO were high risk factors associated with the positive margin.Therefore,patients in the process of diagnosis and treatment with the high level of CIN and high risk factors should be focused on.It is necessary to take into account the second operation if the resection margins are positive.