Analysis Of The Related Factors In HSIL Patients With Positive Margins Diagnosed By The Initial Conization

Objective:To analyze the related factors of postoperative residual lesions in patients with high grade squamous intraepithelial lesions diagnosed by primary cervical conization surgery.In order to evaluate the effect of primary cervical conization,the changes of pathological grade and the residual rate of lesion were analyzed by analyzing the change of pathological grade and the residual rate of lesion after the individualized treating the primary cervical conization.Materials and methods:A retrospective collection of 66 patients clinical data had been done from August 1st 2010 to October 31st 2017 at the Second Hospital of Shandong University.The patients need to fit the conditions below:the pathological combined high-grade squamous intraepithelial lesions with positive margins diagnosed of the initial conization,and the patients was individualized treated within 6 months after the initial conization.We calculated the residual rate of pathological changes after initial conization and analyzed the related factors by counting the clinical,pathological and postoperative data of the patients.By comparing the residual rate and pathological grade of the initial conization with different surgical methods,we discussed the effect of the first cervical conization operation.Results:1.66 patients were included in the group,42 of them underwent LEEP operation and 24 patients underwent cold knife conization.The pathological results suggested that 22 cases of CIN ? and 44 cases of CIN ?.Among the 66 patients,pathological specimens of the 27 cases were CIN ?,and 39 cases of the resection margin were CIN?.2.Sixty-six patients chose different methods of individualized treating according to age,fertility requirements,menopause,or other reproductive system diseases,in which a total of 28 patients were selected for the second operation,and eight patients chose CKC again and 20 underwent hysterectomy.The remaining 38 patients all chose conservative treatment that regular follow-up.There were 21 patients with residual lesions and 45 patients without residual lesions.The overall residual rate was 31.8%.3.Univariate analysis of multiple sets of data.The results of the study suggested that the age,liquid-based cytology test results,high-risk HPV DNA test,colposcopic impression,positive margin,and the range of positive margins all have statistical significance,which were a relevant factor in the occurrence of postoperative residual lesions in patients with positive margins of cervical high-grade intraepithelial lesions.The relevant factors of P<0.10 in the above analysis results were analyzed by multi-factors,and two-category Logistic regression analysis method was selected to analyze the data.Inappropriate colposcopy,positive internal margin and multiple quadrants involved by positive margins are the high risk factors for residual lesions after initial conization of patients.4.In 66 cases,42 cases were treated with LEEP surgery and 24 cases with cold knife conization of cervix at initial conization.The proportion of primary LEEP is lower than CKC in pathological grade after initial conization.However,the proportion of patients with no pathological grade change and that increased in the final pathological outcome of initial LEEP surgery was significantly higher than that in the initial CKC surgery.The choice of the initial cervical conization had a certain influence on the occurrence and development of cervical lesions.5.All patients were followed up regularly after individualized reprocessing.The average follow-up time was 6-60 months.Only one patient was found to have relapsed at the end of follow-up.The overall recurrence rate was 1.5%.Conclusions:1.In the patients with high grade intraepithelial lesions and positive margins after initial cervical conization,the overall residual rate after individualized retreatment was 31.8%.It is recommended that this part of the patients should be treated basing on their age,with or without fertility requirements and postoperative lesion levels and other factors for individualized retreatment in clinical work.2.Inappropriate colposcopy,positive internal margin and multiple quadrants involved by positive margins are the high risk factors for residual lesions after initial conization of patients.The results suggest that patients with these factors have higher probability of residual lesions after surgery and need to be treated further treatment and closely followed-up.3.The CKC treating the patients with high-grade cervical lesions and positive margins,is more effective than the patients with LEEP surgery.