Meta Analysis Of The Clinical Outcomes Of Loop Electrosurgical Excision Procedure Versus Cold Knife Conization For High-grade Squamous Intraepithelial Lesion

Objective:To evaluate the clinical outcomes of Loop Electrosurgical Excision Procedure(LEEP)and Cold Knife Conization(CKC)in the treatment of High-grade Squamous Intraepithelial Lesion(HSIL)by meta-analysis and provide medical evidence for clinical diagnosis and treatment of High-grade Squamous Intraepithelial Lesion.Methods:To retrieve the literature by searching English database(PubMed,EMBASE,Cochrane Library)and Chinese database(China National Knowledge Infrastructure,the Wanfang Database and the VIP Database).The retrieval time ranges from the time when the database was built to December 2018.According to the established criteria of the inclusion and exclusion of literature,we screened all the literature strictly and finally acquired published research of Randomized Controlled trials(RCT)to compare the clinical outcomes of Loop Electrosurgical Excision Procedure(LEEP)versus Cold Knife Conization(CKC)for High-grade Squamous Intraepithelial Lesion(HSIL).The quality of the included literature was evaluated using the 5.1.0Cochrane collaboration risk assessment tool.After extracting relevant data,the Review Mananger5.3 software provided by Cochrane collaboration was used for statistical analysis.All the outcome indicators were Dichotomous variables,and relative risk(RR)and 95% confidence interval(CI)were used to express the outcome indicators.Results:A total of 17 Randomized Controlled trials(RCT)were eventually included,with a total number of 2015 cases,including 1049 cases in the LEEP group and 966 cases in the CKC group.Results of the meta analysis showed that there were no statistically significant differences(P >0.05)between LEEP group and CKC group in recurrence rate at 6 months after surgery,lesion residue,marginal positive rate and postoperative infection rate.While postoperative recurrence rate at 12 months after surgery(RR=2.71,95%CI[1.17,6.29],P=0.02),postoperative recurrence rate at24 months after surgery(RR=2.38,95%CI [1.16,4.89],P=0.02),postoperative bleeding rate(RR=0.59,95%CI[0.38,0.90],P=0.02),cervical stenosis or adhesion(RR=0.34,95%CI[0.20,0.59],P < 0.0001),preterm delivery rate(RR=0.40,95%CI[0.18,0.90],P=0.03)between the two groups showed statistically significant difference.Conclusion:1.LEEP and CKC have similar effects on aspects of marginal positive rate,postoperative residual rate and recent recurrence rate in the treatment of High-grade Squamous Intraepithelial Lesion,but the long-term recurrence rate of CKC is low.CKC is of great value in the diagnosis and treatment of extensive cervical lesions and early-stage invasive carcinoma.2.Compared with CKC,LEEP has a low incidence of postoperative hemorrhage,cervical stenosis or adhesion,premature delivery and other short-term and long-term complications in the treatment of High-grade Squamous Intraepithelial Lesion.LEEP has less adverse effects on pregnancy,it is a therapeutic method worthy of clinical promotion for High-grade Squamous Intraepithelial Lesion,especially for young patients who wish to retain reproductive function.