Study On The Safety After Treatment In Cervical Intraepithelial Neoplasia ? By Cervical Conization In The Preservation Of Uterus

Objective: To investigate the safety after treatmented in cervical intraepithelial neoplasia ? by cervical conization in the preservation of uterus.Methods: The subjects included 602 cases of CINIII after cervical conization and 132 cases of CINIII after hysterectomy from January 2010 to December 2015 at our Hospital,602 cases by cervical conization as study group,132 cases by hysterectomy as control group.The preoperative HPV infection characteristics,postoperative HPV infection status,and outcomes after surgery were compared between the conization group and the hysterectomy group.Results:(1)The high age of CINIII was 41-50 years old among 734 patients.(2)Among 734 patients,the HPV16 infection rate was 43.05%(316/734),the HPV18 infection rate was 6.40%(47/734),and the HPV16/18 combined other type of multiple infection rate was 1.92%(14/734).The preoperative HPV infection rates was 94.52%(569/602)in the conization group,and the HPV infection rates was 96.97%(128/132)in the hysterectomy group,there were no statistical difference in the HPV infection rates between the two groups.(P>0.05).The three most common HPV subtypes in the conization group were HPV16 30.79%(175/569)?HPV58 12.13%(69/569)? HPV52 9.31%(53/569);The three most common HPV subtypes in the hysterectomy group were HPV16 32.81%(42/128)?HPV58 9.38%(12/128)?HPV52 7.81%(10/128);(3)In the postoperative 6 months,12 months and 24 months,the negative rates respectively in the conization group were 77.86%(433/569)?86.64%(493/569)?92.62%(527/569);The hysterectomy group's negative rates were: 75.78%(97/128)?85.16%(109/128)?and 92.19%(118/128).In HPV negative rates between 6 months,12 months,and 24 months after operation showed no statistically significant difference in both the conization group and the hysterectomy group(P>0.05).(4)The persistent infection rates of HPV at 24 months after operation in the conization group was 7.38%(42/569)and 7.81%(10/128)in the hysterectomy group.Compared the difference of HPV persistent infection rates between the conization group and the hysterectomy group,the results were not statistically significant(P>0.05).The three highest detection rates of HPV subtypes in the conization group were: HPV16 32.73%(18/55)?HPV52 18.18%(10/55)and HPV58 10.91%(6/55).The three highest detection rates of HPV subtypes in the hysterectomy group were:HPV 16 27.78%(5/18)?HPV52 16.67%(3/18),and HPV58 11.11%(2/18);There was no significant difference in the detection rate of HPV16?52 and 58(P>0.05).(5)There were 26 patients occurred recurrence in the conization group,among them,CINIII 11 cases,the recurrence rate was 1.83%(11/602),CINII 10 ceses,the recurrence rate was 1.66%(10/602),and CINI 3 case,the recurrence rate was 0.50%(3/602);progress to invasive carcinoma: 2 cases,the progression rate was 0.33%(2/602).There were 5 patients occurred recurrence in the hysterectomy group,among them,VAIN? 1 case,the recurrence rate was 0.76%(1/132),VAIN II 2 cases,the recurrence rate was 1.52%(2/132),and VAINI 2 cases,the recurrence rate was 1.52%(2/132);The three highest detection rates of HPV subtypes in relapsed patients were HPV 16 32.26%(10/31)?HPV52 22.58%(7/31)?HPV58 12.90%(4/31).The HPV subtypes detected in the conization progression group were HPV16 type 50%(1/2)and HPV18 type 50%(1/2).(6)The recurrence rates in the conization group was 4.32%(26/602),and the recurrence rate in the hysterectomy group was 3.79%(5/132);there was no significant difference in the recurrence rates between the conization group and the hysterectomy group(P>0.05).The conization group progress rate was 0.33%(2/602),the hysterectomy group progress rate was 0.0%(0/132),there was no statistically significant difference in the rates of progress between the conization group and the hysterectomy group(P>0.05).The recurrence time range of the conization group was 6-58 months,the average time was(29.8±16.5)months,the median recurrence time was 29months;the recurrence time range of the hysterectomy group was 8-39 months,the average time was(26.4±11.8)months,the median recurrence time was 27 months,the recurrence time was not statistically significant in the both of groups(P>0.05).The high recurrence time in the conization group and the hysterectomy group was within 25-36 months and the recurrence rates were 26.92%(7/26)and 40%(2/5)respectively.In the conization group,the recurrence rates in the <51-year-old and ?51-year old patients were: 46.15%(12/26)and 53.85%(14/26);in the hysterectomy group,the recurrence rates were 40%(2/5)and 60%(3/5);there was no significant difference in the relapse age between the two groups(P>0.05).Conclusions:(1)HPV16,58,52 are the major subtypes of CINIII,and it is also the main types of HPV persistent infection and recurrence after CINIII surgery.(2)It is safe to preserve the uterus after conization of CINIII,but it is necessary to be careful to preserve the uterus in patients with HPV16?18 infection.(3)CINIII should be closely followed up for 2-3 years after surgery.?51-year-old patients are at high risk of relapse.