Eighty patients with CIN grade III hospitalized in our hospital from 2006.6 to 2008.12 underwent general electric knife conical hysterectomy to observe their surgical results and complications; meanwhile, 100 patients with cold knife conical hysterectomy in the same period were selected as the control group for comparison. Fifty patients in the general electric knife conization group and 60 patients in the cold knife conization group with negative margins were randomly selected and followed up from 12 to 24 months to observe the difference in recurrence rate between the two groups.
Results
(1) The operative time was 15.2±5.7 minutes in the general electric knife conization group and 32.5±10.2 minutes in the cold knife conization group, and the operative time was shorter in the former group (P0.05);
(2) Postoperative cervical stump bleeding was 2 (2.50%) and 2 (2.00%) cases, respectively, with no significant difference between the two groups (P>0.05).
(3) Among the 50 patients in the general electric knife conization group at follow-up, there was one recurrence with a recurrence rate of 2.0%; among the 60 patients in the cold knife conization group, there was one recurrence with a recurrence rate of 1.67%, and there was no statistically significant recurrence rate in the two groups (P>0.05).
Conclusion
Cervical conization in patients with CIN grade III does not affect the integrity of the incision margin and can achieve the surgical effect of cold knife conization with the advantages of less operation time and less intraoperative bleeding, which is worth using in clinical practice.
1. Study subjects and methods
1.1 Study subjects-
In the general electric knife conization group, 80 patients with CIN grade III who were hospitalized from 2006.6 to 2008.12, with an average age of 35.6±6.8 years, operated on the 10th.5±5.2 days of menstrual cycle, and 100 patients with CIN grade III who were hospitalized at the same time, with an average age of 34.9±5.8 years, operated on the 11th.2±6.0 days of menstrual cycle, were selected. The diagnosis of CIN grade III was based on the pathology report of colposcopic biopsy.
1.2 Methods
1.2.1 Surgical method
After lumbar hard anesthesia, the bladder was placed in the cystotomy position and the vulva-vagina was routinely disinfected. The cervical area was then traction with rat-tooth forceps at 6 and 12 o’clock, and the cervical area was injected with 10-20 ml of 0.7% epinephrine, dilated to 7.0 or 7.5 with a Hegar cervical dilator and left in place. 5% iodine solution was applied to the cervix, and a circular incision was made 5-8 mm outside the iodine uncolored area of the cervix, and the lesion was conically excised in the direction of the cervical canal, and hemostasis was achieved by electrocoagulation. Make a mark. The Hegar cervical dilator was removed and iodoform gauze was placed, and a catheter was placed for urinary catheterization. In the cold knife conization group, the traditional surgical method was used.
1.3 Evaluation indexes were compared between the general electric knife group and the cold knife conization group in terms of operation time, intraoperative bleeding, incision margin, postoperative bleeding, fever and stump bleeding, and postoperative recurrence.
1.4 Statistical treatment
The t-test was used to compare the means between groups, and the chi-square test was used to compare the rates, and the test level was a=0.05.
2. Results
2.1 Surgical situation
The operation time was 15.2±5.7 minutes in the general electric knife conization group and 32.5±10.2 minutes in the cold knife conization group, the former operation time was shorter than the latter, the difference was statistically significant (P0.05) There were 180 cases in both groups, according to the postoperative case returns, 152 patients (84.4%) with CIN grade III or involved glands, CIN grade II, CINI grade A total of 25 patients (13.9%) with CIN III or chronic cervicitis, and 3 patients (1.7%) with microinvasive cancer or cervical cancer were selected for follow-up, reconsection, total hysterectomy, or radical cervical cancer surgery according to the patients’ age, fertility requirements, margin condition, and follow-up conditions.
2.2 Surgical complications
Postoperative fever (over 38.5°C) was observed in 5 (6.25%) and 6 (6.00%) cases in the general electric knife conization group and the cold knife conization group, respectively. The difference between the two groups was not significant (P>0.05); the postoperative cervical stump bleeding was 2 cases (2.50%) and 2 cases (2.00%), and the difference between the two groups was not statistically significant (P>0.05); the 2 patients with less postoperative stump bleeding were treated with vaginal gauze compression and symptomatic medication in the outpatient clinic, and the 2 patients with more stump bleeding were readmitted to the hospital. In addition, two patients in each group had prolonged menstruation or amenorrhea during the postoperative period, and ultrasound indicated blood accumulation in the uterine cavity and cervical adhesions, which improved after cervical dilation.
2.3 Postoperative recurrence
Among the 50 patients in the general electric knife conization group, there was one recurrence in the general electric knife conization group and one recurrence in the cold knife conization group, which was CIN grade II, with a recurrence rate of 2.0%. The recurrence rate in the two groups was not statistically significant (P>0.05).
Discussion
1. The feasibility of cervical conization in patients with CIN grade III by general electric knife
At present, the main treatment for patients with CIN grade III is cold knife conization, which has the advantages of ensuring sufficient resection area and clear margins, and has both diagnostic and therapeutic value. However, it has the shortcomings of high intraoperative bleeding, cervical adhesions and cervical insufficiency complications. Recently, some scholars have used general electric knife to perform cervical conization in patients with CIN grade III, and have made preliminary studies on the operation and postoperative complications, but no consensus has been reached on the effect on the margin and the recurrence of the operation. In this study, 80 patients with CIN grade III underwent general electric knife conical hysterectomy, while 100 patients with cold knife conical hysterectomy were selected as a control group for comparison. In order to reduce intraoperative and postoperative bleeding, the incidence of infection, and the occurrence of distant cervical adhesions, we chose to perform the procedure around the 11th day of the menstrual cycle and to improve vaginal cleanliness by preoperative vaginal douching. The study showed that the operative time was 15.2±5.7 minutes in the general electric knife conization group and 32.5±10.2 minutes in the cold knife conization group, with the former having a shorter operative time (P0.05). It is consistent with the findings of Zhao Jun et al [1].
2. Cervical conization by general electric knife in patients with CIN grade III does not affect the status of the incision margin
The assessment of the status of the incision margin is a major concern in cervical conization and has been a controversial issue in the use of the Leeper knife and general electric knife for cervical conization. The LeeP knife is used to perform cervical conization, although the charring effect is slight, because of the shallow conization of the cervical tissue, it is easy to cause residual lesions and has a high rate of positive margins, and is currently used mainly for CIN grade II and CINI. In contrast to the LeeP knife, the ordinary electric knife pair has a charring effect, which was considered in previous studies to affect the pathological diagnosis of the cut edge and thus the diagnosis of the condition as well as the subsequent treatment [5]. In this study, during cervical conization, the distance of the cutting edge from the lesion was about 5-8 mm, and the height of cervical conization was 20.6±6.3 mm and 21.4±7.1 mm in the general electric knife conization group and cold knife conization group, respectively, with no significant difference between the two groups (P>0.05); the number of positive endocervical cutting edges in the general electric knife group and cold knife conization group was 5 (6.25%) and 6 (6.00%), respectively. The difference was not statistically significant (P>0.05), suggesting that cervical conization with general electric knife did not affect the margin condition while maintaining a certain lesion margin distance and appropriate cervical conization height.
3. Cervical conization by general electric knife in patients with CIN grade III did not affect postoperative recurrence
There is a certain recurrence rate after cervical conization in CIN grade III patients, and the main reasons for recurrence are positive cervical margins and persistent HPV infection. Liu Yan et al [7] followed up 294 margin-negative patients after CKC for 1-107 months, of which 288 cases (98.1%) were recurrence-free and 6 cases were recurrent, with a recurrence rate of 1.9%. In this study, 50 patients in the general electric knife conization group and 60 patients in the cold knife conization group with negative margins were randomly selected and followed up from 12 to 24 months, and among the 50 patients in the general electric knife conization group, there was one recurrence, with a recurrence rate of 2.0%; among the 60 patients in the cold knife conization group, there was one recurrence, with a recurrence rate of 1.67%. The recurrence rate in both groups was not statistically significant (P>0.05), suggesting that cervical conization by general electric knife did not affect the recurrence after conization.