Clinical Analysis Of 125 Cases Of High Grade Squamous Intraepithelial Lesion

Sino-japanese fellowship at jilin university hospital,admitted in a maternity hospital of changchun city,jilin province people's hospital,125cases of patients with cervical HSIL onset age,clinical manifestation,detection methods,surgical methods and postoperative follow-up were retrospectively analyzed,provide better methods of diagnosis and treatment for HSIL.Methods:The fellowship at jilin university hospital were retrospectively analyzed,maternity hospital of changchun city,jilin province people's hospital on February 1,2014-January 31,2016 income courtyard line cone cervical cold knife cut method or total hysterectomy HSIL patients clinical data,a total of 125 cases.All patients have a thorough diagnosis and all preoperative tests must be from our hospital or other tertiary level A hospitals.All of the 125 patients had undergone preoperative cervical liquid-based cytology,human papillomavirus detection and multiple cervical biopsy under colposcopy,and were confirmed as HSIL by histopathological examination.Surgical methods include cervical cold knife conization and hysterectomy.Among them,102 cases were treated with cold knife conization(CKC)and 23 cases were treated with total hysterectomy.All patients with complete follow-up data.Postoperative follow-up including outpatient review and telephone follow-up.Follow-up time was 2 years.Follow-up included cervical,vaginal,liquid-based cytology at 3,6,12,and 24 months after discharge and human papillomavirus testing at 6,12,and 24 months after discharge.,biopsy under colposcope if necessary.Result:1,The age of onset of 125 patients with HSIL is as follows:The minimum age of patients 19 years old,the maximum age of 59 years,mean age 35±6.00 years;patients with high incidence of 29 to 39 years old.HSIL is showing a younger trend.2,The clinical manifestations of 125 patients with HSIL were as follows:There were no clinical symptoms in 65 patients(52.0%of the total),and 60 patients(48.0%of the total)had clinical symptoms.Among them,22 cases(17.6%of the total)showed vaginal discharge abnormalities,17 cases(13.6%of the total)showed vaginal discharge,and 11 cases(8.8%of the total)showed irregular vaginal bleeding.Ten patients(8.0%of the total)showed contact bleeding.3,125 patients with HSIL preoperative human papillomavirus test results are as follows:positive in 107 cases,accounting for 85.60%of the total;negative in 18 cases,accounting for 14.40%of the total.4,125 patients with HSIL preoperative liquid-based cytology results are as follows:no intraepithelial lesion cells or cancer cells(NILM)in 7cases,accounting for 5.60%of the total;unknown atypical Squamous cell(ASC-US)in 33 cases,accounting for 26.40%of the total;high-grade squamous intraepithelial lesions can not be excluded in atypical squamous cells(ASC-H)in 12 cases,the total proportion of 9.60%;Low-grade squamous intraepithelial lesions(L-SIL)in 23 cases,accounting for 18.40%of the total;high-grade squamous intraepithelial lesions(H-SIL)in 50 cases,accounting for 40.00%of the total.5,Compared with the pathological results of postoperative(cervicoconiotomy or total hysterectomy)biopsy in 125 cases with HSIL,the results were as follows:113 cases(90.40%)with pathologic inconsistencies and 12 cases(9.60%).Among them,5 cases of chronic inflammation,6 cases of low grade squamous epithelioma(LSIL),113cases of high grade squamous epithelioma(HSIL),and 1 case of early immersion carcinoma were suggested by pathological results after cerviotomy or total hysterectomy.6,Comparison of preoperative and postoperative pathologic levels:102 cases of HSIL were treated with cervical coldknife cone resection(CKC):93 cases(91.18%)were still treated with HSIL;5cases(4.90%)were pathologically downgraded to LSIL;Four cases(3.92%)suggested chronic cervicitis.The pathological results of 23cases after total hysterectomy showed that 20 cases(86.95%)were still HSIL,1 case(4.35%)was downgraded to LSIL,1 case(4.35%)was upgraded to early invasive cancer,and 1 case(4.35%)was indicated as chronic cervicitis.The two groups(i.e.cervical cold knife cone-cutting group and total hysterectomy group)had no statistical significance(2=0.532,P=0.47)7,Comparison of HPV clearance after surgery:107 of 125 HSIL patients were preoperative HPV positive,of which 88 were preoperative HPV patients in the cervical cold knife cone cutting group,and the infection rate was 86.27%(88/102).There were 19 cases of HPV infection before total hysterectomy and the infection rate was82.61%(19/23).There was no statistically significant difference between the two groups.There was no statistically significant difference between the 6 months,12 months and 24 months of preoperative HPV in 2 groups.8,Postoperative recurrence:4 cases(3.92%)had recurrent postoperative cervical cold knife conization and 1 case(4.35%)had recurred after hysterectomy.There was no significant difference between the two groups in the recurrence rate(?~2=0.120,P=0.73>0.05).Conclusion1,HSIL is showing a younger trend.2,HSIL patients often have no typical clinical symptoms,and cervical cancer screening should be included in the routine examination of women of childbearing age.3,TCT and HPV detection combined with vaginal biopsy can improve the detection rate of HSIL.4,Cervical cold knife cone cutting is the first choice for the treatment of HSIL.