The Clinical Application Value Of Cervical Cold Knife Conization In The High Grade Cervical Intraepithelial Neoplasia

Objective:Under retrospective analysis about 446 example of high level cervical squamous intraepithelial lesions(CINII and CINIII)clinical data,summarizing age,menopausal status,cervical multi-point biopsy under colposcope pathologic results and the cervical cone cutting postoperative pathologic result differences,cervical cold knife taper cutting cut edge conditions after operation,postoperative cutting edge positive follow-up treatment and relapse of postoperative follow-up indicators,analyzing the cervical cold knife cut method(CKC)cone at a high level value of the diagnosis and treatment of cervical intraepithelial neoplasia.Destination:A retrospective analysis was conducted on 446 patients who were admitted to the Inner Mongolia people's hospital from January 2010 to December 2016 and were diagnosed with high-grade cervical squamous intraepithelial lesions(CINII and CINIII)by preoperative colposcopic cervical biopsy and received conical cervical cryotomy.The pathological results of cervical biopsy under colposcope and cervical cold knife coning after operation were compared and analyzed by self-contrast method.The patients' age,menopausal status,lesion level,preoperative and postoperative lesion level changes,postoperative pathological indication of surgical margin,postoperative surgical margin positive follow-up treatment and postoperative follow-up for recurrence were recorded and analyzed.The factors affecting the positive surgical margin of CKC and postoperative recurrence were analyzed.The information collected will be unified into the computer,using the statistical software SPSS 20.0 on data processing and statistical analysis of count data take chi-square test,with P<0.05 was statistically significant.The research mainly includes the following aspects:Firstly,the data of 446 cases confirmed pathologically by multi-point cervical biopsy under colposcope were retrospectively analyzed.The difference between preoperative colposcopic biopsy and postoperative pathological results was statistically analyzed by self-contrast method.Secondly,the preoperative CDB pathological results were divided into CINII and CINIII,and the chi-square test was used to compare whether the difference in positive rate of surgical margin between the two was statistically significant.Thirdly,446 cases were divided into three groups according to age(20-40 years old/41-60 years old/61-80 years old),and chi-square test was used to compare the difference of positive rate of incised margin and recurrence rate after CKC operation.Fourthly,446 patients were divided into the menopausal group and the non-menopausal group,and the chi-square test was used to compare the difference of positive rate of the incisional margin and recurrence rate after CKC.Fifthly,patients with chronic cervicitis,CINI,CINII,CINIII and invasive cancer with paraffin pathology after cervical cold knife cone resection were followed up by telephone.The chi-square test was used to compare the difference of recurrence rate.Sixthly,446 cases were divided into the positive group and the negative group according to the situation of the cutting edge after the cervical cold knife coning operation.The chi-square test was used to compare the difference of recurrence rate between the two groups.Seventhly,67 patients with positive incisal margins after CKC surgery were divided into the group with follow-up treatment and the group without follow-up treatment.The chi-square test was used to compare the recurrence rates of the two groups.Results:1.The complete coincidence rate between preoperative CDB pathological results and postoperative CKC pathological results was 47.53%(212/446).CINII was 30.57%(48/157)and CINIII was 56.75%(164/289)(see table 1).Postoperative pathological upgrading of CKC accounted for 15.70%(70/446),among which the rate of CINII upgrading was 28.66%(45/157).The CINIII upgrade rate was 8.65%(25/289)(see table 1).Postoperative pathological degradation of CKC accounted for 36.77%(164/446).The degradation rate of CINII was 40.76%(64/157).The CINIII degradation rate was 34.60%(100/289)(see table 1).2.The positive rate of margin after CINII grade cervical cold knife coning operation was 10.19%,and the positive rate of margin after CINIII grade cervical cold knife coning operation was 17.65%?The difference in positive rate of incised margin was statistically significant(?2=4.43,P=0.035)(see table 2).3.The positive rate of surgical margin in patients aged 20-40 years was 12.14%,that in patients aged 41-60 years was 16.40%,and that in patients aged 61-80 years was 21.74%.The positive rate of surgical margin in the three age groups was not statistically significant(?2=2.311,P=0.315)(see table 3).The recurrence rate of patients aged 20-40 years was 5.20%.The recurrence rate of patients aged 41-60 years was 3.20%.The recurrence rate of 61-80 years old patients was 4.35%,and there was no statistical significance in the recurrence rate of the three age groups(?2=2.941,P=0.816)(see table 6).4.The positive rate of surgical margin was 20.45%in the menopausal group and 13.69%in the unmenopausal group,and the difference between the two groups was not statistically significant(?2=2.534,P=0.111)(see table 4).The recurrence rate was 6.82%in postmenopausal group and 3.35%in non-menopausal group,and the difference was not statistically significant(?2=4.373,P=0.224)(see table 7).5.The follow-up recurrence rate after Cervical cold knife cone resection was 4.04%,including 0%for chronic cervicitis,1.85%for CINI grade,1.96%for CINII grade,5.90%for CINIII grade and 10.34%for invasive cancer.The follow-up recurrence rate after Cervical cold knife cone resection was statistically significant(?2=43.69,P=0.000017)(see table 5).6.The recurrence rate of negative cases and positive cases was 2.37%and 13.43%,respectively.The difference in the recurrence rate of postoperative resection margin was statistically significant(?2=19.261,P=0.000241)(see table 8).7.The recurrence rate of follow-up patients with positive margin after CKC was 5.78%.The recurrence rate of those who did not receive follow-up treatment was 40%,and the difference was statistically significant(?2=13.677,P=0.001)(see table 9).Conclusion:Cervical cold knife conization still plays an important role in the diagnosis and treatment of high-grade squamous intraepithelial lesions of the cervix.CINII and CINIII CKC showed statistically significant difference in the positive rate of the cutting edge after surgery,and the higher the CIN level was,the higher the positive rate of the cutting edge was.Age and menopause had no significant difference in the positive rate of postoperative incision margin of CKC.There were statistically significant differences in the recurrence rates of different paraffin pathological results after cervical cold knife conization.The higher the severity of cervical lesions was,the higher the recurrence rate was.There was no significant difference between age and menopause in postoperative follow-up for recurrence of CKC.The difference in recurrence rate after CKC was statistically significant.Patients with positive margins have a higher recurrence rate than patients with negative margins.Patients with positive margins had lower recurrence rates than those without follow-up treatment.For patients without fertility requirements,follow-up treatment is recommended.