Microwave combined with herbal medicine for mild cervical intraepithelial neoplasia

  Cervical cancer is the second most common malignant tumor after breast cancer among women worldwide, accounting for half of all malignant tumors of female reproductive organs, and the incidence of cervical cancer in young people has been increasing at an annual rate of 2%-3% in recent years [1], which shows that cervical cancer is one of the risk factors that seriously threatens the physical and mental health of women. Cervical Intraepithelial Neoplasia (CIN) is a collective term for a group of precancerous lesions closely related to invasive cervical cancer, which are classified into I, II and III degrees according to the degree of cervical epithelial heterogeneous hyperplasia. The risk of development or carcinoma of mild cervical intraepithelial neoplasia (CIN I) is 15%, and the development of CIN into invasive cervical cancer is 7 times higher than that without CIN [1], so early diagnosis and early treatment are important factors to improve the long-term survival rate of cervical cancer. The main clinically applied treatment methods are vaginal nadir, physical therapy (eg. CO2 laser), cervical loop electrosurgery (LEEP), total hysterectomy, etc. In order to select the treatment plan scientifically and make the patients get proper treatment, our hospital started to explore the method of microwave combined with traditional Chinese medicine since 1991 and achieved good efficacy in recent years, which is reported as follows.  1.1 Clinical data 1.1 Case selection Patients who were diagnosed with CINⅠ by colposcopic biopsy according to the Bethesda System [2], after performing ultra-thin cell testing (TCT) in non-menstrual period and non-pregnancy, except for normal smears and benign reactive changes, were pathologically confirmed.  1.2 General data All cases were obtained from patients attending our Chinese medicine and oncology clinics from September 1, 1999 to June 30, 2002. They were divided into 89 cases in the treatment group and 80 cases in the follow-up group according to the presence or absence of cervical erosion, with a minimum age of 21 years and a maximum age of 64 years. When comparing the data of the two groups, except for one item of cervical erosion, there was no significant difference (P>0.05), which was comparable.  2 Methods 2.1 Treatment method Patients in the treatment group were treated 3-7 days after menstruation, except for acute inflammation of internal and external genital organs, under routine disinfection, with microwave output power 12mA for contact treatment, 4 seconds per point, the radiator was placed close to the erosion surface, starting from the lower lip of the cervix and extending outward from the ectocervix, the coagulation area beyond the edge of the erosion surface 0.3cm. the same method was used to treat the upper lip of the cervix. Finally, the ectocervix was coagulated by the ectocervix into the cervical canal for 0.5cm cone for one week to achieve a slightly yellowish tissue coagulation with a uniform, flat and dry surface. After the operation, a threaded gauze ball soaked in rehabilitative new liquid was placed to make close contact with the cervix, which was kept for 3 hours and then removed by the patient himself, and thereafter the drug was applied once a week (discontinued during menstruation). Postoperative intercourse and tub bathing were prohibited until the wound healed. Patients in the follow-up group did not undergo any manual intervention.  2.2 Observation Items Patients in the treatment group were retested with TCT once at 6, 12 and 24 months after microwave surgery, and patients in the follow-up group were retested with colposcopy once at 6, 12 and 24 months after diagnosis, except for normal smears and benign reactive changes.  2.3 Statistical methods All data were statistically processed by SPSS10.0 medical statistical software with X2 test.  3 Results 3.1 Efficacy criteria Patients in the treatment group were cured when no CIN lesions existed in the review. Patients in the follow-up group were considered to be converted if no CIN lesion existed in the review.  3.2 Efficacy of patients in both groups All 89 patients in the treatment group had healed cervical wound and smooth cervical surface within 5-8 weeks after microwave surgery. The cure rate was 97.75% with 87 cases cured at 6, 12 and 24 months after surgery. In the follow-up group, 53 patients were converted to normal 6 months after diagnosis, 63 patients were converted to normal 12 months after diagnosis, and 66 patients were converted to normal 24 months after diagnosis, with a conversion rate of 66.25%, 78.75%, and 82.50%, respectively. The conversion rate of all periods in the follow-up group was lower than the cure rate of the treatment group.  4 Discussion 4.1 Microwaves belong to high frequency electromagnetic waves, wavelength and frequency between ultra-short wave and infrared, using the principle of polarized molecules, can make the tissue water molecules, electrolytes separation, and switch position according to the direction of the electric field, the water molecules high-speed rotation friction heat, the tissue temperature rises rapidly, with a safe, accurate, strong ability to destroy tissue and penetrate the muscle. After treatment, the local tissue coagulation, degeneration, necrosis, vascular occlusion, the necrotic tissue is shed and the squamous epithelium is newly repaired, and the appearance and texture of the cervix are also restored to normal after repair.  4.2 The rehabilitation liquid produced by Sichuan Jiaonengda Panxi Pharmaceutical Co., Ltd. is a biological product extracted from the dried body of the American cockroach. The drug can be absorbed through the mucous membrane quickly, promote vascular renewal, improve microcirculation, eliminate inflammation and edema, promote tissue regeneration, thus reducing the amount of vaginal drainage and the chance of bleeding and infection after microwave surgery, and play a supplementary therapeutic role. In addition, Rehabin Liquid has been proved by pharmacological experiments to promote healing by stimulating immunologically active cells (macrophages, multi-lineage nuclear leukocytes), and also anti-infection and release free radicals to kill microorganisms through direct phagocytosis, or secrete active substances such as interleukin I, interferon, prostaglandins and leukotrienes to regulate inflammation and tissue regeneration. When macrophages are stimulated by yeast polysaccharides that are subject to the action of tonics release oxygen radicals, which play an important role in intracellular killing of microorganisms, and have toxic and immunomodulatory properties on tumor cells. [4] has been widely used clinically in the treatment of malignant tumors, but there is no corresponding report in the field of gynecology, and further research is needed.  4.3 Of 555 patients with CIN I followed by Nassiell [5], 16% progressed to CIN III after 39 months. ostor [6] summarized the literature from 1993 and concluded that 11% of cases would progress to CIN III. Syrjanen [7] suggested in a 14-year follow-up report that the rate of progression of CIN I to CIN III was 14.2%. All the above data illustrate another aspect of the importance of early diagnosis and early treatment of CIN I patients. The clinical vaginal nasal medication is based on the incorporation of genetic interferon pessary, and the recommended course of treatment is mostly 3 months, and there is constant discharge of incompletely dissolved medication during the medication process, and the cure rate varies widely in the literature. the recovery of cervical elasticity after CO2 laser treatment is poor, and there are disadvantages of more bleeding and cervical stenosis. From the results of this paper, there was a significant difference between the CO2 laser group and the treatment group in terms of cure rate, but the conclusion is debatable because of the problem of sample comparability. the LLETZ (large loop excision of the migrating zone) group and the total hysterectomy group were not significantly different from the treatment group in terms of cure rate, but the literature reports that LLETZ may have thermal damage to the tissue [8], excessive intraoperative tissue removal, postoperative bleeding, infection, increased chances of cervical adhesions and cervical insufficiency. After total hysterectomy more patients, especially young patients who have not had children, lose their fertility. In summary, I believe that microwave combined with rehabilitation of new liquid treatment of CIN Ⅰ patients, in the outpatient clinic can be performed, the economic burden is light, the operation time is short, less traumatic, less intraoperative and postoperative complications, and the efficacy of the exact, is a more convenient, safe and effective method of treatment of CIN Ⅰ patients.  4.4 Because the number of cases accumulated in this paper is not enough, the clinical observation and follow-up time is not long enough, so the long-term efficacy of microwave combined with rehabilitation new liquid treatment is yet to be further observed and discussed.