Risk Factors Analysis And Clinical Outcome Of Residual Or Recurrence Of Cervical Intraepithelial Neoplasm After Cone Resection

BackgroundCervical intraepithelial neoplasia(CIN)is a kind of cervical lesion that is closely related to the occurrence of cervical infiltrating carcinoma.In China,more than 130,000 new cases of cervical cancer are found every year,and the incidence tends to be younger.Cervical cancer has seriously threatened women’s health.It is very important for early detection and treatment of CIN.There are also many methods for CIN treatment.Cervical coning can preserve fertility of patients and conduct pathological examination,so it has become a common method for CIN surgery at present.But studies have shown that there are postoperative recurrences regardless of the treatment.Therefore,it is very important to explore the risk factors of postoperative recurrence and residual CIN.In addition,at present,there are few studies on postoperative transformation of CIN,and more clinical studies on postoperative transformation of CIN are needed to determine the effectiveness of surgery and recurrence rule.Therefore,in this study,CIN patients undergoing coning surgery were selected as the research objects,and the risk factors of postoperative recurrence and residual CIN were discussed by retrospective analysis.The prognosis of patients with high-grade CIN was also discussed within 4 years after surgery.Objective1.To explore the risk factors of postoperative residual and recurrence of cervical intraepithelial neoplasia.2.To explore the prognosis of high-grade CIN patients 4 years after surgery.MethodsThe study was mainly conducted by retrospective analysis.The study subjects were CIN(All of them were high grade CIN)patients admitted to our hospital from January 2013 to August 2014.The age,birth,pregnancy,menopause,number of CIN3 lesions,preoperative pathological grade,surgical method,positive surgical margin,preoperative HPV infection,gland involvement,HPV infection 6 months after surgery,family history of cancer,SCC,alcohol consumption,smoking and other conditions were statistically analyzed.The risk factors of cervical intraepithelial neoplasia were analyzed.All cases were followed up at least 4 years after surgery,Postoperative follow-up was conducted at 6,12,18,24,30,36,42 and 48 months.Follow-up methods: HPV detection and TCT detection were performed in the outpatient department of our hospital.If vaginal or cervical abnormalities and cytological manifestations were found under colposcopy,pathological biopsy should be further performed to confirm the diagnosis through pathological examination results.Results1.203 patients with cervical intraepithelial neoplasia were followed up for 4 years,28 patients had recurrence,6 patients had residual disease,and the recurrence and residual rate was 16.75%.2.After COX analysis of multiple factors,birth rate,menopause,operation metho,3~4 quadrant of CIN lesions,pathological grade CIN2,3/CIN3,positive surgical margin,and persistent postoperative HPV infection were independent risk factors for postoperative recurrence and residual CIN.3.The positive rate of TCT in CIN patients was 16.75% after 4 years of follow-up.The TCT positive rate(12.81%)was significantly higher in CIN patients half a year to 2 years after surgery than in patients 2.5 years to 4 years after surgery(3.94%),and the difference was statistically significant(P<0.05).4.4 years of follow-up,the positive rate of HPV in CIN grade patients six months to two years after surgery(11.82%)was significantly higher than that in patients 2.5 years to four years after surgery(4.43%),and the difference was statistically significant(P<0.05).Conclusion1.Birth frequency≥3,menopause,3~4 quadrans of CIN lesions,pathological grade CIN2,3/CIN 3,positive surgical margins,and persistent postoperative HPV infection,LEEP operation are independent risk factors for postoperative recurrence and residual CIN.2.For High grade CIN patients,half a year to two years after surgery is the most common time period for TCT positive and HPV infection.Therefore,postoperative follow-up,TCT and HPV monitoring should be strengthened to timely detect postoperative residual lesions and recurrence,so as to achieve early intervention and treatment.