Study On The Efficacy Of Cervicectomy In The Treatment Of Postmenopausal Patients With High-grade Cervical Squamous Intraepithelial Lesion

Objective:To study the efficacy of cervicectomy in the treatment of postmenopausal patients with high-grade cervical squamous intraepithelial lesion.Methods:94 clinical cases are recruited,which involved 94 postmenopausal patients who had been diagnosed as HSIL before treatment in Second Affiliated Hospital of Soochow University between September 2017 and September 2019.All cases were divided into two groups according to the treatment method,namely the cervicectomy group and the cervical ring-cutting group(LEEP group),each group consists of 47 cases.The two groups are statistically compared with SPSS 25.0 on some widely used metrics,including the age of the patients,postoperative complications,the rate of positive margins of the specimens after operation,the HPV conversion rate 6 months after operation,the rate of recurrence of lesions and postoperative WHOQOL-100 Quality of life scale scores.Results:1.Comparison of operation conditions.The blood loss was(18.36±10.38)ml in cervicectomy group and(10.28±3.84)ml in LEEP group,the difference between the two groups was statistically significant(p<0.001).The operation time was(25.74±6.91)min in cervicectomy group and(15.26±2.79)min in LEEP group,the difference between the two groups was statistically significant(p<0.001).The length of stay in two groups was(4.21±0.78)d and(3.94±0.53)d,the difference between the two groups was statistically significant(p=0.047).2.Comparison of incidence of postoperative complications.There was 1 case of cervical canal adhesion in cervicectomy group(2.13%)and 1 case in LEEP group(2.13%),there were 2 cases of wound bleeding in cervicectomy group(4.26%)and 1 case in LEEP group(2.13%),there was no postoperative incision infection in both groups.The total incidence of postoperative complications in cervicectomy group was 6.38%,while that in LEEP group was 4.26%,the difference was not statistically significant(p=1.00).3,Comparison of the rate of positive margins of the specimens after operation postoperative positive rate of margin.Postoperative pathology showed no positive margin in cervicectomy group(0.00%),while there were 6 cases(12.77%)in the LEEP group,the difference between the two groups was statistically significant(p=0.035).Comparison of the HPV conversion rate 6 months after operation.The conversion rate of HPV in cervicectomy group was 88.89%,but that in LEEP group was 67.39%,the difference between the two groups was statistically significant(p=0.013).Comparison of the rate of postoperative recurrence of lesions in a follow-up from 6 months to 2 years after operation.recurrence was not seen in cervicectomy group(0.00%),while in LEEP group,there were 6 cases(12.77%),the difference between the two groups was statistically significant(p=0.035).4.The postoperative WHOQOL-100 Quality of life scale scores in the cervical excision group were scored 74.40±11.52,35.06±5.41,59.74±10.65,50.60±8.34,38.72±9.53,100.60±29.81,11.64±3.70 in the areas of quality of life,physiology,psychology,independence,social relations,environment and religion.These scores in LEEP group were 77.53±10.00,37.79±9.86,63.98±11.62,53.68±9.76,41.23±7.99,103.98±26.94,12.62±2.54.The difference of postoperative quality of life between two groups was not statistically significant(p=0.163).Conclusion:In the treatment of postmenopausal patients with high-grade cervical squamous intraepithelial lesions,LEEP has the advantages including less blood loss,shorter operation time and length of stay.Compared with LEEP,cervicectomy can increase the negative conversion rate of HPV,reduce the postoperative positive rate of margin and the recurrence rate of cervical intraepithelial neoplasia.There was no significant difference on the quality of life of patients after operation and postoperative complications including cervical canal adhesion,postoperative wound bleeding and incision infection after cervicectomy and LEEP.Cervicectomy is a operation with a wide range of applications.However,prospective randomized controlled trials are needed before clinical application.