Care after cold knife conization of the uterine cervix

  There is a consensus that treatment of high-grade cervical intraepithelial neoplasia (CIN II-III) by cervical cold knife conization (i.e., partial removal of cervical tissue by scalpel conization, hereafter referred to as conization) is effective in reducing the incidence of cervical cancer. The surgical excision of cervical tissue starts from the normal tissue outside the diseased area of the cervix, and most of the cervical and cervical canal mucosa is removed in a conical shape. The excised tissues are diagnosed histopathologically, and special attention is paid to the presence of high-grade lesions at the edge of the excision to clarify the diagnosis and CIN classification and to guide the next step of treatment. This article summarizes the common precautions after conectomy.  1.General postoperative care After discharge, patients should eat a diet with high nutrition, high protein, vitamin-rich and easy to digest, avoid excessive spicy food, pay attention to rest, stay in bed as much as possible, avoid strenuous activities and heavy physical activities; about 1 week after surgery, there will be vaginal discharge in the form of light bloody liquid, which may last 1-3 months, because the shape of the cervix is reshaped after conization surgery, and there will be a lot of discharge during the healing process. This is because the shape of the cervix is reshaped after conization and there will be a lot of discharge during the healing process. The discharge, if not removed in time, will affect the healing on the one hand and risk infection on the other. During this period it is important to perform careful vaginal douching. Our experience is to use 5 ml of 36% polymethylphenol sulfonyl solution to 200-250 ml of warm water (ratio 1:40 to 1:50) every other day. Of course, vaginal douching should be stopped during menstruation and when there is significant vaginal bleeding. In addition, during this period, you should keep your vulva clean, abstain from sexual intercourse (3 months is recommended), tub baths and sitz baths. In addition, due to pelvic congestion after conization, patients may experience lower abdominal discomfort and abdominal cramping, which may last for about 3 months and then be relieved, which is a normal situation and need not be overly nervous.  2, the treatment of common complications after conization ① postoperative bleeding: after conization cervical wound bleeding again cases of clinical occurrence, mostly for the debridement bleeding. This kind of debridement bleeding often appears 1-2 weeks after conization and lasts 1-2 weeks. However, if the vaginal bleeding is at or greater than menstrual volume and is bright red, the patient should return to the hospital for appropriate treatment, such as vaginal gauze compression to stop the bleeding. If compression is ineffective, cervical suturing may be required again.  ②Pelvic infections: The necrotic bleeding of the cervical tissue disrupts the physiological environment of the cervix and vagina and its immune function, which provides good conditions for pathogens to live and reproduce in the vagina and cervix on the one hand, increasing the risk of infection. Therefore, if there is fever, lower abdominal pain, increased vaginal discharge, cloudy, purulent and smelly, it should be promptly treated by a doctor.  ③Cervical adhesions: During the process of forming and healing the cervical wound after conization, cervical adhesions may occur if vaginal douching is not careful, or if the cervix is not dilated enough during the operation, or if the cervical filling is not long enough after the operation. If the menstrual blood is not discharged smoothly after conization and accumulates in the uterine cavity causing obvious lower abdominal pain, the patient should seek medical attention promptly.  Cervical insufficiency: due to the absence of cervical mucosa and reduced mucus secretion, coupled with the relaxation of the cervical opening, the cervical barrier to the invasion of external pathogens is lost, and the pathogens are more likely to spread upward when the lower genital tract is infected, causing infection of the internal genital tract and pelvis, resulting in the possibility of infertility; on the other hand, for women with fertility requirements, due to the relaxation of the endocervical opening after conization, patients have a higher chance of spontaneous abortion during pregnancy than non-conization patients. On the other hand, for women with fertility requirements, due to the relaxation of the endocervix after conization, patients have a higher chance of spontaneous abortion during pregnancy than non-conectomy patients, especially in mid-term pregnancy, attention should be paid to the presence of obvious symptoms of cervical relaxation and pre-eclampsia (including vaginal bleeding, abdominal pain, etc.), and if necessary, endocervical cerclage needs to be performed at 12-18 weeks of pregnancy to reduce the risk of miscarriage and preterm delivery.  3, further treatment of pathology after conization ① Positive cut margin: the status of pathological cut margin after cervical conization may be a risk factor for the persistence or recurrence of CIN. According to the level of CIN at the cut edge, high-risk HPV surveillance, the patient’s age, his or her wishes, and follow-up conditions, a comprehensive assessment will be made and the appropriate treatment will be given. If the margin is CINI, it can be observed and not treated; if the margin is CIN II-III, liquid-based cytology will be repeated after 3-6 months of follow-up or cervical conization will be performed again. For patients with CIN III margins, who cannot repeat conization, who do not have fertility requirements, and who have difficulty in follow-up, total hysterectomy is feasible. In case of adenocarcinoma in situ, aggressive treatment is recommended due to the multifocal and jumpy nature of the lesion.  ②Infiltrating carcinoma of the cervix: Due to the limited biopsy sampling sites and the large range of cervical tissues for conization, there may be infiltrating carcinoma foci that were not detected before conization. It is generally believed that the preoperative precancerous lesion of the cervix, CIN III, has about 5% chance of being cervical cancer in postoperative pathology. If the postoperative pathology is cervical cancer, the appropriate surgical treatment can be used. These cervical cancer patients are generally early staged and generally have good prognosis after further treatment, so don’t be too nervous.  4. Follow-up after conization The risk of recurrence is significantly reduced in patients with negative margins after cervical conization for CIN, therefore, for these patients, cervical conization treatment is sufficient and no further treatment is needed, but long-term close follow-up is still necessary. Related studies have found that recurrence after CIN conization treatment occurs mostly within 2 years after surgery, and it is recommended to follow up every 3 months in the first year after surgery; every 6 months in the second year; and then once a year for 10 years, before returning to the routine screening process. The follow-up interval can of course also be decided according to the high-risk HPV infection. For example, for patients with high-risk HPV negativity, the follow-up interval can be extended appropriately.