Evaluation Of Hysteroscopic Coagulation Adjuvant Cold Knife Conization In The Treatment Of High-grade Cervical Squamous Intraepithelial Lesion

PART 1 Evaluation of hysteroscopic coagulation adjuvant cold knife conization in the treatment of high-grade cervical squamous intraepithelial lesionObjectiveTo compare the clinical efficacy,complications,prognosis and pathological effects of cold knife conization(CKC),transcervical resection of cervical lesion(TCRC)and hysteroscopic coagulation adjuvant cold knife conization(HCKC)in the treatment of high-grade cervical squamous intraepithelial lesion(HSIL),and to explore the effect of HCKC in the treatment of HSIL.Application value provides a basis for decision-making in clinical surgical methods.MethodsWe made a retrospective analysis of the clinical data of 438 patients who were first diagnosed as HSIL and received cervical conization at Zhujiang Hospital of Southern Medical University from January 2013 to June 2017.According to the different types of conizations,the patients were divided into three groups:CKC group,TCRC group and HCKC group.There were 158 cases in the CKC group,130 cases in the TCRC group,and 150 cases in the HCKC group.One-way analysis of variance,chi-square test and Fisher exact probability analysis were used to compare the intraoperative situation,postoperative complications,surgical outcome,postoperative pathological conditions and pregnancy and delivery conditions of the three groups.Results1.The average operation time of the three groups was 22.9±12.7min,13.0±12.5min,and 15.1±24.3min.The CKC group had the longest operation time,the HCKC group was the second,and the TCRC group was the shortest(P<0.05).The hospitalization days were 4.3±1.33d,3.1±1.52d,and3.3±1.23d.The hospital stay in the CKC group was longer than that in the CKC group and the TCRC group(P<0.05).The intraoperative blood loss volume of three groups was 20.3±18.3ml,10.4±11.4ml,and 16.0±13.2ml,respectively.There was a statistically significant difference between the three groups(P<0.05).The CKC group had the most bleeding during surgery,the TCRC group was the least.2.35 cases of uterine lesions were found and treated in the TCRC group,including 21 cases of endometrial polyps,5 cases of cervical polyps,and 9 cases of cesarean scar diverticulums.And 41 cases of uterine lesions were found and treated in the HCKC group,including 30 cases of endometrial polyps,7 cases of cervical polyps,and 4 cases of cesarean scar diverticulums.There was no significant difference in the rate of detection of uterine lesions(P>0.05).3.The pathological coincidence rates of the three groups were 74.7%,71.5%,and 73.3%(P>0.05).The incidences of positive margin of CKC group and HCKC group were 3.8%and 3.3%(P>0.05),and most of the TCRC group did not report the margin.Only one patient had a positive margin.4.Comparison of curative effects:Within 6 months after the surgery,the residual rates of CIN in the three groups were 4.4%,4.6%,and 4.0%(P>0.05).The clearance rates of HPV were 93.7%,94.6%,and 96.0%(P>0.05).Within 12 months after the surgery,the recurrence rates of CIN in the three groups were 1.89%,1.53%,and 1.33%(P>0.05),the clearance rates of HPV were 97.4%,99.2%,and 98.0%(P>0.05),there was no significant difference in the three groups.5.Recent complications:The incidence of postoperative infection in the three groups was 5.1%,4.6%,and 4.7%,there was no significant difference in the three groups(P>0.05).The postoperative bleeding rate was 6.3%,3.0%,and 3.3%.The bleeding rate in CKC group was significantly higher than that in TCRC group and CKC group(P<0.05).There was no significant difference between TCRC group and HCKC group(P>0.05)6.Long-term complications:the incidence of less menstrual flow,prolonged menstruation and dysmenorrhea in HCKC group were lower than those in CKC group and TCRC group(P<0.05).The incidence of cervical canal adhesion was higher in the CKC group than that in TCRC group and HCKC group(P<0.05),there was no significant difference between TCRC group and HCKC group(P>0.05).7.There were 40,32,and 33 patients in each group had fertility requirements.The postoperative delivery rates of the three groups were 62.5%,75.0%,and 78.8%.The postoperative delivery rate in CKC group was lower than that in TCRC group and HCKC group(P<0.05).The premature rates of the three groups were 24.0%,20.8%,and 19.2%.The late abortion rates of the three groups were 12.5%,7.1%,and 5.4%.The incidence of premature rupture of membranes was 20.0%,16.7%,and 15.4%.The incidence of premature,late abortion,and premature rupture of membranes were significantly higher in CKC group than those in TCRC group and HCKC group(P<0.05).There was no significant difference between TCRC group and HCKC group(P>0.05).ConclusionCKC,TCRC,and HCKC have the similarly good effects in the treatment of HSIL.CKC and HCKC can better observe the cutting margin of the specimen.HCKC retains the advantages of CKC with the integrity of surgical specimen,and takes the advantages of hysteroscopy.There is no need for cervical suture.It is easy to operate and reduces the amount of bleeding during and after surgerythe operation.In addition to short operation time and hospital stay,HCKC can also resect of cervical and tntrauterine lesions at same time.In addition,HCKC does not increase the risk of postoperative long-term complications.lt is one kind of relatively ideal cervical conization.PART 2 The expression and significance of NMDA receptor in the ovarian teratoma tissue of patients complicated with anti-N-methyl-D-aspartate receptor encephalitis.ObjectiveTo detect the expression of N-methyl-D-aspartate(NMDA)receptor in the ovarian teratoma tissue of patients complicated with anti-NMDA receptor encephalitis,analyze its expression characteristics.To analyze the correlation between anti-NMDA receptor encephalitis and NMDA receptor in the ovarian teratoma.Further to study of the relationship between anti-NMDA receptor encephalitis and ovarian teratoma.MethodsAll cases were obtained from Ja1.2014 to Jul.2018 at Zhujiang Hospital of Southern Medical University,including 8 ovarian teratoma tissue with anti-NMDA receptor encephalitis,40 ovarian teratoma tissue without encephalitis(half of them contain nerve tissue,and half of them not)and 20 normal ovarian tissue.Immunohistochemical method was used to detect the expression of NMDA receptor in ovarian tissue of each group.Then To analyze the correlation between anti-NMDA receptor encephalitis and NMDA receptor in the ovarian teratoma.ResultsThe positive expression of NMDA receptor was reddish brown staining.The NMDA receptors were mainly expressed in the cytoplasm of ovarian teratoma,especially in the squamous epithelial tissue.The closer to the basal layer tissue,the higher the expression intensity.The positive rate of NMDA receptor in teratoma with anti-NMDA receptor encephalitis was higher than that of simple ovarian teratoma and normal ovarian tissue(P<0.05).Conclusion1.High expression of NMDA receptor in ovarian teratoma tissue may be involved in the development of anti-N-MDA receptor encephalitis.2.The squamous epithelial tissue of ovarian teratoma may be a true antigen-presenting site and a key location leading to anti-NMDA receptor encephalitis.