| ObjectiveThis study analyzed the pathological results and recurrence of patients with high-grade intraepithelial cervical disease after after cold knife conization,and investigated the risk factors related to postoperative recurrence.MethodsClinical data of 286 patients with pathologically diagnosed HSIL who underwent Cold Knife Conization(CKC)in the First Affiliated Hospital of Nanchang University from January 2016 to December 2016 were collected.They included the patient’s age,pregnancy,menopausal status,preoperative Human Papillomavirus(HPV)infection,Thinprep Cytology Test,TCT results,preoperative biopsy pathology,postoperative pathological diagnosis,surgical margin status,postoperative follow-up,if abnormal cytological results or HPV positive as colposcopy indication,according to preoperative cervical biopsy and postoperative conical pathological results,they were divided into three groups: Pathology in line with the group(taper cutting postoperative pathological agree with preoperative cervical biopsy pathology,the highest for HSIL),pathologic reversion group(taper cutting highest postoperative pathological diagnosis of LSIL or cervical chronic inflammation),pathological upgrade group(taper cutting highest postoperative pathological diagnosis of cervical invasive carcinoma,including for micro infiltrating carcinoma),analyze factors associated with postoperative pathological differences.A total of 192 patients who underwent total hysterectomy after conectomy and were not followed up regularly were included in the postoperative follow-up,and were divided into recurrence group and non-recurrence group according to postoperative recurrence,and the related risk factors for recurrence were analyzed.Result1.Among 286 patients with HSIL after conization,58 patients(20.28%)were in the pathologically degraded group,186 patients(65.03%)were in the pathologically consistent group,and 42 patients(14.69%)were in the pathologically advanced group.2.Multivariate regression analysis showed that no contact bleeding(OR=0.25,P=0.007)and preoperative TCT(NILM)(OR=0.25,P=0.049)were independent protective factors for pathological degradation.The pathological progression group and pathological conformity group were compared,contact bleeding(OR=3.12,P=0.003),menopause(OR=7.60,P<0.001)and preoperative TCT(HSIL)(OR=1.54,P=0.001)were independent risk factors for postoperative pathological progression.3.A total of 192 patients were followed up,including 17 cases(8.85%)in the recurrence group and 175 cases(91.15%)in the non-recurrence group.4.Univariate analysis of postoperative recurrence suggested that menopause,abnormal postoperative TCT results and postoperative persistent HPV infection had significant influence on postoperative recurrence(P<0.05),multivariate regression analysis suggested that menopause(OR=3.77,P=0.042)and postoperative persistent HPV infection(OR=11.77,P=0.011)were independent risk factors for recurrence after conectomy for HSIL(P<0.05).Conclusion1.Comparing the pathology of cervical after conectomy with that of preoperative cervical biopsy,there were postoperative pathological upgrading and pathological degradation.Non-contact bleeding and preoperative TCT(NILM)are protective factors for postoperative pathological degradation,while contact bleeding,menopause,and preoperative TCT(HSIL)are risk factors for postoperative pathological escalation.Patients with risk factors should be actively treated to achieve better therapeutic effect.2.Analysis of postoperative recurrence factors for HSIL showed that menopause and postoperative persistent HPV infection were independent risk factors for recurrence after coning for HSIL,and such patients should be closely followed up. |
