Analysis of fertility preservation and HPV negative conversion rate of LEEP by separating the vesicorectal space / 复旦学报（医学版）

Objective To explore the eradication rate of human papillomavirus(HPV)and gestational outcome of patients with high-grade squamous intraepithelial disease of the cervix(HSIL)after loop electrosurgical excision procedure(LEEP)by transvaginal dissection of the vesicorectal form the cervix.Methods A total of 53 patients treated with LEEP by transvaginal dissection of the vesicorectal form the cervix in Obstetrics and Gynecology Hospital,Fudan University from Jan to Dec,2019 were investigated.Clinical information of cervical cytological examination,HPV test and cervical biopsy under colposcopy were followed up for 6,12 and 24 months post-LEEP were collected.HPV infection in these 53 patients were compared before and after LEEP surgery.The rate of successful fertility of the cohort,the HPV conversion rate of patients with hysterectomy and LEEP done were compared.The association between the pathological type and positive surgical margin and the association between HPV infection type and positive surgical margin were analyzed.Results HPV infection rate of was 94.3%(50/53)and the proportion of HPV16 and/or 18 infection was 75.5%(40/53).Mono-HPV infection rate(69.8%,37/53)was significantly higher than mixed HPV infection rate(22.7%,13/53).Thirty-eight patients(71.7%)were found with positive surgical margin in previous LEEP operation.Fifteen patients had recurrence(28.3%)and 40 patients(75.5%)successfully delivered baby after surgery.Postoperative pathology was mainly HSIL,accounting for 66%(30/53),and 28.3%patients(15/53)had no pathological change.Forty cases had satisfying fertility-conservative operation outcome with negative surgical margin,and 38 patients eradicated HPV infection after LEEP,which took up 95%of patients with satisfying fertility-conservative operation.There was no significant difference of positive resection margin rate in between groups of HPV16/18 infection and other types.Five cases had successful delivery(12.5%,5/40)with 1 case of vaginal delivery and 4 cases of cesarean section.Among these 5 cases,3 cases undertook preventive cervical cerclage,with 1 case of vaginal delivery and 2 cases of cesarean sections.Conclusion HPV eradication rate and surgical outcome could be significantly improved by LEEP with transvaginal dissection of the vesicorectal from the cervix,which satisfied the fertility preservation of females at reproductive age.

Neoplasia intraepitelial escamosa cervical de alto grau: abordagem ambulatorial / High-grade cervical intraepithelial neoplasia: outpatient approach

As neoplasias intraepiteliais cervicais correspondem a alterações identificadas por rastreamento citológico cervical e estudo histológico, pós-biópsia incisional guiada por colposcopia ou procedimento diagnóstico excisional. Podem ser tratadas com abordagens conservadoras e procedimentos excisionais. A vacinação anti-HPV e o tratamento excisional oportuno constituem, respectivamente, prevenção primária e secundária contra o câncer do colo uterino.(AU)

Cervical intraephitelial neoplasms correspond to changes identified by cervical citological screening and histological study, post-incisional biopsy guided by colposcopy or excisional diagnostic procedure. They can be treated with conservative approaches and excision procedures. Anti-HPV vaccination and timely excional treatment are primary and secondary prevention against cervical cancer, respectively.(AU)

Neoplasia intraepitelial escamosa cervical: abordagem por estimativas de risco / Cervical squamous intraepithelial neoplasia: risk estimation approach

As neoplasias intraepiteliais cervicais representam a fase pré-tumoral da neoplasia invasiva do colo uterino; são identificadas por citologia e testes de DNA-HPV e conduzidas por intervenções ambulatoriais. A perspectiva de estimativas de risco, para abordagem de tais lesões, constitui uma verdadeira mudança de paradigma, tendo em vista que as recomendações serão baseadas em riscos, não em resultados.(AU)

Cervical intraepithelial neoplasms represent the pre-tumor phase of invasive cervical cancer; identified by cytology, HPV-DNA testing and conducted by outpatient interventions. The perspective of risk estimates, to address such injuries, constitutes a true paradigm shift, considering that recomendations will be based on risks, not results.(AU)

Histerectomia radical após parto cesáreo por adenocarcinoma de colo uterino: relato de caso / Radical hysterectomy after c-section in cervical adenocarcinoma: a case report

Mundialmente, o câncer de colo uterino ocupa o quarto lugar das neoplasias em mulheres, porém, nos países em desenvolvimento, as taxas de incidência superam de forma impactante os casos de países desenvolvidos. Apesar de ser um evento incomum durante a gestação, é cada vez mais observado, o que talvez possa ser atribuído às gestações programadas em idades mais avançadas. O caso descrito refere-se a uma paciente de 32 anos de idade, diagnosticada no terceiro trimestre da gestação com adenocarcinoma de origem endocervical com estadiamento anatomopatológico final (FIGO 2018) 1B2. Ela foi submetida à abordagem cirúrgica como tratamento inicial. Foi adotada como conduta a resolução da gestação, com boa vitalidade fetal, ao final da 34ª semana, após corticoterapia para maturação pulmonar fetal. Foi realizado parto cesariano seguido de histerectomia radical tipo C1 na classificação de Querleu e Morrow associado a linfadenectomia pélvica, no mesmo ato operatório.(AU)

Worldwide, cervical cancer ranks fourth in female cancers, but when assessing data from developing countries, incidence rates are significantly higher than in developed countries. Although it is an uncommon event during pregnancy, it is increasingly observed, which may perhaps be justified due to pregnancies postponed at older ages. The case described relates to a 32-year-old woman diagnosed in the third trimester of pregnancy with endocervical adenocarcinoma, whose final anatomopathological staging (FIGO 2018) was IB2. The same was submitted to the surgical approach as an initial treatment. It was adopted as a conduct, the resolution of pregnancy, with good fetal viability, at the end of the 34th week, after corticosteroid therapy for fetal lung maturation. The patient underwent cesarean section followed by radical type C1 hysterectomy in the classification of Querleu and Morrow associated with pelvic lymphadenectomy in the same surgery.(AU)

Células glandulares atípicas: abordagem ginecológica / Atypical glandular cells: gynecological approach

As células glandulares atípicas representam 0,2% a 2,1% dos resultados dos testes de Papanicolaou. Mesmo com essa baixa prevalência, tem um significado importante no diagnóstico do câncer cervical e endometrial, tendo em vista que tais células e subcategorias, associadas à idade da paciente, podem prenunciar um número expressivo de doença intraepitelial, doença invasiva do endocérvix, endométrio e até neoplasias anexiais. E não se pode esquecer do importante número de resultados histológicos benignos, identificados no seguimento dessas pacientes, muitas vezes assintomáticas.(AU)

Atypical glandular cells represent 0,2% to 2,1% of Pap test results even with this low prevalence has an important significance in the diagnosis of cervical and endometrial cancer, considering that such cells and subcategories associated with the patient's age can predict a significant number of intraepithelial disease, invasive disease of the endometrium, endocervix and even adnexial neoplasms; no forgetting the important number of benign histological results, identified in the follow up of these patients, often asymptomatic.(AU)

Adenocarcinoma cervical in situ: abordagem na atenção primária e secundária à saúde / Cervical adenocarcinoma in situ: approach in primary and secondary health care

O adenocarcinoma cervical in situ é uma doença rara, totalmente curável, diagnosticada predominantemente por meio de rastreamento cervicouterino seguido de biópsia guiada por colposcopia e/ou conização. O tratamento em pacientes que desejam preservar a fertilidade pode ser realizado num contexto ambulatorial; aquelas com paridade definida deverão ser abordadas em nível terciário.(AU)

Cervical adenocarcinoma in situ is a rare, fully curable disease diagnosed predominantly through cervical-uterine screening followed by colposcopy-guided biopsy and/or conization. Treatment in patients wishing to preserve fertility may be performed in an outpatient setting; those with defined parity should be approached at the tertiary level.(AU)

Prevalence and Management of CIN by Colposcopy among VIA Positive Cases in a Tertiary Level Hospital of Bangladesh

Background: Cervical cancer is the second most commoncancer among women in Bangladesh where CIN is theforerunner. Visual inspection of cervix with acetic acid (VIA) isadopted as national cervical cancer screening programme inBangladesh. All positive VIA cases are evaluated bycolposcopy.Objective: This population-based study was conducted inFaridpur Medical College Hospital for 6 years (2013 - 2018) toevaluate the prevalence of CIN among the VIA positive casesand performance of the clinic for colposcopic management ofCIN.Materials and Methods: A total of 2102 VIA positive caseswere evaluated by colposcopy during the study period.International Federation of Cervical Pathology and Colposcopy(IFCPC) 2011 nomenclature was used for colposcopicdiagnosis. Diagnosed CIN were treated accordingly.Results: During the study period, 548 (26.1%) cases werecolposcopically diagnosed as CIN. Among them, 370 (65.5%)were low grade squamous intraepithelial lesion (CIN-I) and 178(32.5%) were high grade squamous intraepithelial lesion (CINII and III). Colposcopicaly diagnosed 237 (64.1%) of low gradesquamous intraepithelial lesion (LSIL) and 132 (74.2 %) of highgrade squamous intraepithelial lesion (HSIL) casesreceived treatment and histopathological confirmation.Treatment produces were used like thermocoagulation, LoopElectrosurgical Excision Procedure (LEEP), biopsy,hysterectomy and post treatment follow up.Conclusion: From this study, we got information about thedemography and prevalence of CIN among VIA positive casesat the same time management of CIN to prevent invasivecervical cancer. We adopted ‘See and treat’ protocol formanagement, which is well accepted, feasible and useful inBangladesh.

Development of an environment-friendly and sterile four- blade vaginal dilator for LEEP surgery / 中国医学装备

Objective: To develop an environment-friendly and sterile four- blade vaginal dilator so as to resolve the problem of polluting environment that petroleum-based plastics released hydrogen chloride, dioxin and other poisonous and cancerogenic substance. Methods: The lower blade of the environment-friendly and sterile four-blade vaginal dilator was used as fixed blade, and upper blade, left blade and right blade were extensible and closable. And in the left and right blades, there were built-in smog exhaust tubes. And based on the previous invention of the twin-blades vaginal dilator, the device has been redesigned and developed by adding the left blades, right blades, locating sleeve and other related parts. Results: When the device expanded, both of left and right blades could extend out, and when it closed, both of them could be folded into the upper and lower blades. Therefore, it was safety and effective. Besides, the built-in smoking tubes of left and right blades could quickly exhaust harmful smog by the closest distance, and the plastics used in this device was not only environmentally friendly, but also it was insulation and cost-effective. Conclusion: The environment-friendly and sterile four-blades vaginal dilator used in LEEP surgery resolved two problems included the constructs of imported four-blades vaginal dilator were complex and the left and right blades couldn't extend out. And it effectively enhance the expand distance between left and right blades, and it enlarges operation field and surgery space. Besides, the use of the environmentally friendly plastics avoids the environmental pollution caused by the release of hydrogen chloride, dioxins and other toxic and carcinogenic substances when built-out smoking tubes and petroleum base plastics were incinerated. Therefore, it enhances the surgical quality.

Role of p16, Ki-67 and human papilloma virus type in the shunt treatment of cervical intraepithelial neoplasiaⅡ / 肿瘤研究与临床

Objective To investigate the role of p16,Ki-67 and human papilloma virus(HPV)type in the shunt treatment of cervical intraepithelial neoplasia (CIN) Ⅱ. Methods The paraffin block on file and the pathological results from loop electrosurgical excision procedure (LEEP) of 377 CIN Ⅱpatients diagnosed with colposcope examination accompanied by cervical high-risk HPV infection in the Affiliated Hospital of Inner Mongolia Medical University of Obstetrics and Gynecology Department from January 2014 to October 2016 were collected. The paraffin sections were stained with p16 and Ki-67 immunohistochemistry. The correlation between the expression of p16 and Ki-67 in biopsy tissues and the pathological results after LEEP was analyzed.HPV type and pathological results after LEEP were also analyzed.Results LEEP postoperative pathological grade in 337 cases of CINⅡpatients was divided into two groups(＜CINⅡ and ≥CINⅡ). There was no statistical difference in age between the two groups (t = 3.078, P = 0.063). There were statistical differences in the expressions of p16+and Ki-67+between the two groups[3.6 %(8/233) vs. 88.5 % (92/104), χ 2=235.54,P<0.001; 3.0 %(7/233) vs. 76.9 % (80/104), χ 2= 197.63, P< 0.001]. There was a statistical difference in HPV infection type between the two groups (χ2= 12.713, P = 0.005). The sensitivity and specificity of p16+and Ki-67+for LEEP postoperative≥CINⅡ was 88.89 % vs.77.78 % and 95.96 % vs.95.80 % respectively. There was a statistical difference in group type of p16 and Ki-67 in both groups (χ2=304.28, P< 0.001). The sensitivity of p16+Ki-67+was 90.73 % and the specificity was 98.74 % in CINⅡpatients for LEEP postoperative. Conclusions The expressions of p16 and Ki-67 can guide the colposcopic biopsy for the treatment of CINⅡ. For CINⅡpatients with p16+Ki-67+, the active treatment should be taken. Close observation needs to follow for p16 and Ki-67 single negative or double negative patients. Active treatment should be performed for CINⅡpatients with HPV16 type infection in CINII. Age can not be used as the basis for the patients with shunt CINⅡ.

El método CONO-UC: un protocolo integrado de toma de decisión y manejo de lesiones pre-invasoras del cuello uterino útil para especialistas jóvenes / The CONO-UC method: an integrated protocol for decision-making and management of pre-invasive cervical lesions useful for young specialists

OBJETIVOS: En la actualidad, existe una alta tasa de sobre-tratamiento de lesiones precursoras cervicales, la cual, en su causalidad, depende de la inexperiencia del operador que toma las decisiones. El objetivo del presente trabajo fue desarrollar un método estandarizado de ponderación/juicio de variables diagnósticas y tratamiento útiles de ser usadas por especialistas jóvenes a fin de minimizar el riesgo de manejo inadecuado. MATERIALES Y MÉTODOS: Se incluyeron 471 pacientes referidos por citología anormal y tratados mediante asa de LEEP. Se calcularon la sensibilidad, la especificidad, los valores predictivos y las relaciones de probabilidad para el diagnóstico de NIE2+ para cada uno de los métodos de diagnóstico. A cada residente se le enseñó un protocolo estandarizado de tratamiento mediante asa. Una vez identificados los mejores predictores, se construyó una escala de puntaje que ponderaba las variables y se definió mediante curva ROC el major punto de corte para la predicción de NIE2+. Las diferencias entre los grupos se compararon mediante Chi-cuadrado, ANOVA o t-test. Se construyó curva de fallas mediante el método de 1-Kaplan Meier. RESULTADOS: La prevalencia de NIE2+ en esta cohorte fue 66%. La concordancia entre las pruebas diagnósticas fue baja, teniendo la colposcopia el peor valor predictivo positivo y el mayor riesgo de sobre-tratamiento. Para la escala de puntaje se incluyeron la edad, la citología, la colposcopia (estratificación basada en la extensión de compromiso por cuadrantes), la biopsia por mascada y la concordancia entre pruebas diagnósticas. Un puntaje≥ 9 asociado al uso de un protocolo estandarizado, obtuvo tasas de sobre-tratamiento <15%, de recurrencias de NIE2+ <5% a 5 años y una baja tasa de procedimientos sub-óptimos o con complicaciones (<2 %). CONCLUSIONES: El método CONO-UC al combinar un sistema de puntaje integrado (punto de corte) con un protocolo estandarizado de excisión, permite minimizar el riesgo de sobretratamiento o tratamiento inadecuado, por parte de especialistas jóvenes, de lesiones preinvasoras del cuello uterino, reduciendo además el número de procedimientos indicados innecesariamente y manteniendo una alta tasa de éxito terapéutico.

GOALS: Currently, there is a high rate of over-treatment of precursor cervical lesions, which, in their causality, depends on the inexperience of the decision-making operator. The objective of the present study was to develop a standardized method of weighting / judgment of diagnostic variables and treatment useful to be used by young specialists in order to minimize the risk of improper handling. MATERIAL AND METHODS: We included 471 patients referred by abnormal cytology and treated by LEEP. Sensitivity, specificity, predictive values and likelihood ratios for the diagnosis of CIN2+ were calculated for each of the diagnostic methods. Each resident was taught a standardized protocol to carry out a LEEP procedure. Once the best predictors were identified, a scoring scale was constructed that weighted the variables and the best cut-off point for the prediction of CIN2+ was defined by ROC curve. Differences between groups were compared using Chi-square, ANOVA or t-test. Failure curves were built up using the 1-Kaplan Meier method. RESULTS: The prevalence of CIN2+ in this cohort was 66%. The agreement between the diagnostic tests was low, with colposcopy having the worst positive predictive value and the highest risk of over-treatment. Age, cytology, colposcopy (stratification based on the extent of compromise by quadrants), punch biopsy, and agreement between diagnostic tests were included for building the scoring scale. A score ≥ 9 in association with the use of a standardized protocol obtained rates of over-treatment <15%, recurrences of CIN2+ <5% at 5-year follow-up and a low rate of suboptimal procedures or complications (<2%). CONCLUSIONS: The UC-CONE method, by combining an integrated scoring system with a standardized excision protocol, minimizes the risk of over-treatment or inadequate treatment of pre-invasive cervical lesions by young specialists, reducing the number of procedures indicated unnecessarily and maintaining a high rate of therapeutic success.

Clinical Effect of EaLeSu on CIN Ⅱ~ⅢPatients with HPV Infection Treated with LEEP / 昆明医科大学学报

ObjectiveTo investigate the clinical effect of EaLeSu on cervical intraepithelial neoplasia(CIN Ⅱ~Ⅲ)patients with HPV infection treated with loop electrosurgical excision procedure(LEEP). Methods 165 cases of CIN Ⅱ~Ⅲpatients with HPV infection who underwent LEEP operation were randomly divided into observation group(n=83)and control group(n=82). In the observation group,patients were given a piece of EaLeSu in cervical wound at once in postoperative and two vaginal EaLeSu per day from the first postoperative day for eight consecutive days. The patients in the control group were treated with routine debridement and wound dressing with iodine. We observed the vaginal drainage times within 4 weeks after operative,bleeding rate,cervical wound repair,and cervical HPV DNA infection after 6 months. Results There were significant differences in the bleeding rate,vaginal drainage time,cervical wound repair and HPV DNA infection between the two groups(P < 0.05). Conclusion EaLeSu showed a definite effect on cervical intraepithelial neoplasia(CIN Ⅱ~Ⅲ)patients with HPV infection treated with LEEP.

Effect of LEEP combined interferon and recombinant human interleukin-2 on CIN associated high-risk HPV / 实用肿瘤学杂志

Objective To observe the therapeutic effect of cervical intraepithelial neoplasia Ⅱ( CINⅡ) associated high risk HPV with LEEP combined interferon and recombinant human interleukin -2.Methods One hundred and sixty patients with CIN Ⅱwere selected during Feb.2012 and Feb.2013.The patients were random-ly divided into four groups(40 patients in each group):the control group(LEEP),group A(LEEP united with in-terferon),group B(LEEP united with recombinant human interleukin -2)and group C(LEEP united with inter-feron and recombinant human interleukin -2).TCT,colposcope examination and HPV were reviewed ,and the curative effects , postoperative complications and negative conversion rate of HPV -DNA were compared after three and six months of the treatment .Results The cure rate and negative conversion rate of HPV -DNA in group C were 92.5%and 95%,which were significantly higher than others groups ( P<0.05) after six months of treatment .The time of wound healing ,duration of vaginal discharge and bleeding time in group C were also shorter than others groups(P<0.05).Conclusion The therapeutic effect of LEEP combined with interferon and recom-binant human interleukin -2 is superior to LEEP and LEEP united interferon or interleukin -2,which is not only shorter healing time ,but also fewer complications .The therapeutic method is worthy to be applied widely .

Clinical Evaluation of Recombinant Human Interferon Alpha-2 b Combined with LEEP in the Treatment of Cervical Ectopic Columnar Epithelium with Chronic Cervicitis / 中国药师

Objective:To investigate the clinical efficacy of recombinant human interferon alpha -2b combined with Loop electro-sugical excision procedure( LEEP)in the treatment of cervical ectopic columnar epithelium with chronic cervicitis. Methods:The med-ical records of 68 cases of cervical ectopic columnar epithelium with chronic cervicitis in our hospital from April 2012 to April 2014 treated with LEEP were analyzed retrospectively. The control group(30 cases)was treated with LEEP combined with 5-day postopera-tive oral administration of antibiotics to prevent infection,and the treatment group(38 cases)was given recombinant human interferon alpha -2b through vagina additionally,every other day for 20 days every month after menstrua. After 6 courses of treatment,the clinical efficacy,vaginal bleeding time,vaginal discharge duration,wound healing time and HPV persistent infection were compared between the two groups. Results:The cure rate of the control group was 66. 67%,while that of the treatment group was 92. 11%,and the difference was significant(P<0. 05). Totally 19 cases in the control group were with wound healing(accounted for 63. 33%),while that in the treatment group was 32 cases(accounted for 84. 21%),the difference was significant(P<0. 05). And the vaginal bleeding time,vaginal discharge duration,and wound healing time of the treatment group were all significantly shorter than those of the control group(P<0. 05). After the treatment,the HPV persistent infection rate in the control group was 16. 67%,while that in the treatment group was 0%,and the difference was statistically significant(P<0. 05). The two groups during the treatment process had no obvious adverse reactions,indicating high drug safety. Conclusion:Recombinant human interferon alpha-2b combined with LEEP in the treat-ment of cervical ectopic columnar epithelium is safe and effective,which can effectively shorten the wound healing time,vaginal bleed-ing time and vaginal discharge duration,and is worthy of promotion in clinics.

Application of comfort care in loop electrosurgical excision procedure in treatment of chronic cervicitis / 中国实用护理杂志

Objective To explore the application of comfort care in loop electrosurgical excision procedure (LEEP) in treatment of chronic cervicitis.Methods 130 patients who used LEEP to treat chronic cervicitis were collected from June to December 2011 in our Hospital,then they were randomly divided into the observation group (68 cases) and the control group (62 cases).The observation group used comfort care and the control group used general nursing.The effects of care,operation time,bleeding volume,anxiety and pain degree of the two groups were compared.Results The effect of care in the observation group was superior to the control group.Compared with the control group,the operation time was shortened,the amount of bleeding was decreased,the degree of anxiety and pain was obviously relieved.Conclusions Comfort care can improve the degree of comfort of the patients who used LEEP to treat chronic cervicitis,and is conducive to the rehabilitation of the disease.

The effect of curative and uterine cervical shaping of different loop electrosurgical excision procedure in treatment of chronic cervicitis / 中国医师进修杂志

Objective To investigate the effect of curative and uterine cervical shaping of different loop electrosurgical excision procedure (LEEP) in treatment of chronic cervicitis.Methods Selected 369 patients with chronic cervicitis,and they were divided into shallow ring excision (SRE) group (123 patients),deep ring excision (DRE) group (123 patients) and LEEP conization (LEEPC) group(123 patients).In each group,they were divided into three subgroups according to the degree and type of erosion.The clinical efficacy of three groups were compared after treatment of 3 months.Results The recovery rate of mild uterine cervical erosion with symptom and midrange uterine cervical erosion,granular pattern uterine cervical erosion and simple uterine cervical erosion among three groups had no significant difference (P ＞ 0.05).In LEEPC group,the recovery rate of severe and mastoid uterine cervical erosion were significantly higher than those in SRE group and DRE group [80.49％ (33/41) vs.63.41％ (26/41) and 58.54％ (24/41),88.24％ (45/51) vs.71.43％ (40/56) and 74.55％ (41/55)] (P ＜ 0.05).The satisfactory rate of uterine cervical shaping among three groups had no significant difference (P ＞ 0.05).Conclusions The three kinds of LEEP have a higher satisfactory rate of uterine cervical shaping.However,different surgical procedure on different level and different type have different efficacy.Clinicians need to choose the right surgery according to the patient's condition.

Effect of combining loop electrosurgical excision procedure and recombinant human interferon α2b suppository in treatment of cervical intraepithelial neoplasia / 中国基层医药

Objective To study the effect of combining loop electrosurgical excision procedure (LEEP) and recombinant human interferon α2b (rhIFNα-2b) suppository in treatment of cervical intraepithelial neoplasia (CIN).Methods Prospective,random and control study was conducted in 82 patients with CINⅠ-CINⅢ.Before canting out LEEP to these patients,all women were performed HPV DNA detection by the method of Hybri Max.Among these patients,41 patients were assigned to the studying group,in which the patients were given rhIFNα-2b suppository for three courses of treatment after LEEP.The other 41 patients who carried out LEEP simply were assigned to the control group.Liquid-based ThinPrep cytology test (TCT) and HPV DNA were examined in the sixth and twelfth month after treatment.Results In the studying group,the cure rate was 90.2％ when LEEP ended six months,and the cure rate was 100.0％ when LEEP ended twelve months.In the control group,the cure rate was 43.9％ when LEEP ended six months,and the cure rate was 61.0％ when LEEP ended twelve months.In the sixth and twelfth month after LEEP,the difference was significant when we compared the cure rate between the two groups (x2 =19.93,19.89,all P ＜ 0.05).Conclusion The clinical effect of combining LEEP and rhIFNα-2b suppository is better than LEEP in treatment of CIN.The method can remove or destroy the cervical lesions effectively and inhibit HPV replication and spread of HPV infection.

Therapeutic effect of LEEP in the treatment of patients with cervical intraepithelial neoplasia and its influence on pregnancy outcome / 中国基层医药

Objective To explore the therapeutic effect of loop electrosurgical excision procedure (LEEP)in the treatment of patients with cervical intraepithelial neoplasia (CIN) and its influence on pregnancy outcome.Methods 62 women with CIN who underwent LEEP were selected as treatment group,and 63 women with CIN who did not undergo LEEP in the same period were selected as control group.Then the curative effect and the pregnancy outcome were observed.Results The total effective rate was 93.65％ in the treatment group and 76.19％ in the control group,the difference was significant (x2 =7.034,P ＜ 0.01).The operation blood loss,operation time and the day of colporrhagia after operation in the treatment group were less than those in the control group(all P ＜ 0.05).There were no significant differences in the gestational age,incidence rates of abortion and cesarean section between the two groups (all P ＞ 0.05),while there were significant difference in the incidences of preterm delivery,premature rupture of membrane and low birth weight infant (all P ＜ 0.05).Conclusion LEEP is an effective treatment for patients with CIN,which can increase the incidence rates of preterm delivery,premature rupture of membrane and low birth weight infant,but not increase the gestational age,incidence rates of abortion and cesarean section.

Eficacia del manejo electroquirúrgico con asa diatérmica para eliminar el virus papiloma causante de lesiones cervicales

Introducción: La infección por el virus del papiloma humano (VPH) es causa del cáncer cervicouterino y sus lesiones precursoras; la efectividad del tratamiento de estas últimas se evalúa por histopatología. Sin embargo, la persistencia del virus puede condicionar la aparición de nuevas lesiones. Objetivos: Evaluar la eficacia de la electrocirugía con asa diatérmica para la eliminación del VPH en pacientes con lesiones cervicales. Diseño: Estudio prospectivo, descriptivo, longitudinal y observacional. Institución: Hospital General de la Secretaria de Salud (SS) en Chetumal, Quintana Roo, México. Participantes: Mujeres con displasias y diagnóstico citológico de LEIBG o LEIAG. Metodología: Ciento cuatro mujeres referidas a la clínica de colposcopia fueron estudiadas. Se les tomó una muestra cervical para identificar al virus. Posteriormente fueron tratadas con electrocirugía con asa diatérmica. A todas las pacientes positivas se les tomó una muestra a las ocho semanas posteriores al tratamiento, para una nueva determinación viral. Principales medidas de resultados: Negativización de la presencia del virus papiloma. Resultados: El 26,9% de las mujeres resultó positiva a la presencia del virus en la primera muestra. El diagnóstico histopatológico de estas mujeres fue lesión escamosa intraepitelial de grado bajo (35,7%) y alto (64,3%), respectivamente. Las 28 pacientes fueron negativas al virus a las 8 semanas. Conclusiones: El tratamiento con asa diatérmica fue efectivo par la eliminación del ADN viral.

Background: Human papillomavirus infection causes cervical cancer and precursor lesions. Treatment effectiveness is determined by histopathology. Persistence of the virus may condition the appearance of new lesions. Objectives: To determine effectiveness of loop electrosurgical excision procedure for HPV clearance in patients with cervical intraepithelial neoplasia. Design: Prospective, descriptive, longitudinal, observational study. setting: Hospital General de la Secretaria de Salud (SS) en Chetumal, Quintana Roo, Mexico. Participants: Women with clinical dysplasia and cytology diagnosis of LGSIL or HGSIL. Interventions: One hundred four women referred to the colposcopy clinic were enrolled; a cervical sample was taken to identify HPV. All were treated by loop diathermy. HPV positive patients were tested again 8 weeks later for new HPV determination. Main outcome measures: Negativization of papillomavirus. Results: In the first sample 26.9% were virus positive. Histopathology diagnosis was respectively low grade (35.7%) and high grade (64.3%) squamous intraepithelial lesion. None of the 28 patients showed viral DNA 8 weeks later. Conclusions: Treatment by loop electrosurgical excision was effective to eliminate viral DNA.

Single visit approach for management of cervical intraepithelial neoplasia by visual inspection & loop electrosurgical excision procedure.

Background & objectives: Developing a feasible and sustainable model of cervical cancer screening in developing countries continues to be a challenge because of lack of facilities and awareness in the population and poor compliance with screening and treatment. This study was aimed to evaluate a single visit approach (SVA) for the management of cervical intraepithelial neoplasia (CIN) using visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) along with loop electrosurgical excision procedure (LEEP) in women attending Gynaecology OPD in a tertiary care hospital in north India. Methods: In this hospital-based study, 450 women receiving opportunistic screening by conventional Pap cytology were also screened by VIA and VILI. VIA/VILI positive cases underwent same-day colposcopy and biopsy of all lesions. If the modified Reid score was >3, the patient underwent LEEP at the same visit. Results: Of the 450 women screened, 86 (19.1%) and 92 (20.5%) women were VIA and VILI positive, respectively. Detection rates of VIA, VILI and cytology findings at ASCUS threshold were 33.3, 35.5 and 24.4 per 1000, women, respectively to detect a lesion >CIN1. For detection of CIN2+ lesion, detection rates of VIA, VILI and cytology were 20, 22.2 and 22.2 per 1000 women, respectively. Sixteen patients with Reid score >3 underwent the See-and-treat protocol. The overtreatment rate was 12.5 per cent and the efficacy of LEEP was 81.3 per cent. There were no major complications. Interpretation & conclusions: The sensitivity of VIA/VILI was comparable to cytology. A single visit approach using visual screening methods at community level by trained paramedical personnel followed by a combination of ablative and excisional therapy can help to decrease the incidence of cervical neoplasia.

Early human papillomavirus testing predicts residual/recurrent disease after LEEP / 부인종양

OBJECTIVE: The purpose of this study was to determine the predictive factors for residual/recurrent disease and to analyze the timing for Pap smears and human papillomavirus (HPV) testing during follow-up after loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 2 or worse. METHODS: We retrospectively analyzed 183 patients (mean age, 39.3 years) with CIN 2/3 who were treated with LEEP. Post-LEEP follow-up was performed by Pap smear and HPV hybrid capture2 (HC2) testing. The definition of persistent/recurrent disease was biopsy-proven CIN 2 or worse. RESULTS: Among 183 patients, punch biopsies were CIN 2 in 31 (16.9%) and CIN 3 in 152 (83.1%). HPV HC2 tests before LEEP were positive in 170 (95.5%) of 178 patients. During follow-up, 12 patients (6.6%) had residual/recurrent CIN 2+. LEEP margin status was a significant predictive factor for persistent/recurrent disease. Other factors such as age, HPV HC2 viral load (> or =100 relative light units), and HPV typing (type 16/18 vs. other types) did not predict recurrence. Early HPV HC2 testing at 3 months after LEEP detected all cases of residual/recurrent disease. The sensitivity and negative predictive value of the HPV HC2 test for residual/recurrent disease were both 100% at 3 and 6 months. CONCLUSION: Margin involvement in conization specimens was a significant factor predicting residual/recurrent disease after LEEP. HPV test results at 3 and 6 months after treatment were comparable. Early 3-month follow-up testing after LEEP can offer timely information about residual/recurrent disease and alleviate patient anxiety early about treatment failure.