Clinical Analysis Of 293 Cases Of High Squamous Intraepithelial Lesion

Objective To investigate the diagnosis and treatment of high grade cervical squamous intraepithelial neoplasia(HSIL)and related negative factor of human papilloma virus(HPV)infection,to analyze the role of cold knife conization in the diagnosis and treatment of HSIL.Methods 293 cases undergoing cervical cold-knife conization for HSIL in gynecological department of Yanbian University affiliated hospital from January 2012 to December 2017 were collected.All patients were diagnosed by pathological examination before colposcopy.The age,nationality,menstruation and birth history were collected to correlate with HPV infection.The results of TCT,HPV,and pathological finding of colposcopy,cervical biopsy and after conization were collected and compared.TCT and HPV results during follow up were also collected and compared with preoperative results.SPSS 17.0 statistical software was used to analyze the relevant data.Results1.When postoperative pathology report was compared with preoperative HPV and TCT reports,this tests showed to have different detection rates of cervical lesions.The detection rates of HPV for CIN2,CIN3 and CC were 89.6%,87.5%and 92.3%and TCT were 81.3%,81.5%and 100%respectively.Preoperative colposcopy missed the diagnosis of CC by 4.4%(5 patients with IA1,4 patients with IA2,and 4 patients with IB1).2.When preoperative colposcopy biopsy report and postoperative pathology report were compared the pathological upgrade of CIN2 was found to be higher than CIN3,and the difference was statistically significant(P<0.05).3.The incidence of HPV infection was found to be lower in patients aged ≥45 years age than in patient with<45 of age.HPV infection rate is higher in patients with ≥3 times pregnant and in patients with ≥2 delivery.The incidence also increased as the age of sexual life is started at<25 years old.There was a higher rate of HPV infection by a history of vaginitis and the differences were statistically significant(P<0.05).The incidence of ≥2 deliveries and history of vaginitis were independent risk factors for preoperative infection of HPV(P<0.05);Age ≥45 is a protective factor for HPV infection(p<0.05).4.In patients with high-grade cervical lesions in Yanbian Autonomous Prefecture,the infection rates of the single types and mixed types of HPV was compared between Korean and Han nationalities,the difference of HPV 16 subtype and other subtypes in two ethnic groups was not statistically significant(P>0.05).5.During follow-up after a period of 3 months,negative HPV rate was 70.6%(161/228).Menopausal women have lower negative HPV rate than non-menopausal women.The preoperative single subtype HPV infection has higher negative rate post operatively than in mixed subtype infection.Simple 16 subtype infections have higher negative rates than mixed 16 subtype infections,and the difference were statistically significant(P<0.05).Conclusion1.Negative results with TCT and HPV screening alone cannot exclude cervical lesions.Cervical cold knife conization can perform comprehensive and accurate diagnosis of cervical lesions.2.HPV infection is affected by many factors,but the risk of HPV infection is decreasing after age 45.3.The body’s ability to clear HPV,decreased after menopause.Mixed subtype HPV infection is more difficult to remove than a single subtype HPV infection.4.The most common type of HPV infection in patients with HSIL is HPV 16 subtype.