Study of histopathology reports of loop electrosurgical excision procedure of cervical transformation zone and their correlation with preprocedural cervical biopsy and/or cytology: An audit

Introduction: Loop electrosurgical procedure of the transformation zone of the cervix (LEEP) is the preferred method for many investigators for early detection and treatment of high grade intraepithelial neoplasia(HGCIN). Histopathology reports of LEEP should contain information about the diagnosis, presence or absence of neoplasia ( with its grade) and comment on excison margins. Aim: Our aim was to study LEEP reports for its contents and to see their correlation with preprocudure histology and/or cytology report. Results: Between 2011 and 2017, 44 LEEP reports were archived and studied for their contents from our records. Slides were not reviewed. Mean age was 47.66 years (median 47 years). Forty two (( 95.45%) reports mentioned that all the tissue was examined. Deep cut examination was mentioned in 17/44 cases (38.64%). The concordance rate between LEEP and preprocudure histology and /or cytology for CIN II plus diagnosis is 65.9%. A strict definition is used. If, however, diagnoses between inflammation and CIN I, ASC-H and inflammation, and ASC-H and CIN I are considered non discordant, then the concordance rate rises to 72.7 %. The breakup of discordant cases is given. Conclusion: Literature shows wide range of concordance due to variable definitions and variety of reasons; possible reasons are discussed.

Efectividad del cono LEEP en pacientes con lesiones intraepiteliales de alto grado en la Unidad de colposcopia del Servicio de Ginecología del Hospital de la Mujer / Effectiveness of the LEEP cone in patients with high-grade intraepithelial injuries in the colposcopy Unit of the Gynecology Service of La Mujer Hospital

OBJETIVO. Determinar la efectividad del CONO LEEP en pacientes con lesión intraepitelial de Alto Grado (LIE AG). MATERIAL Y MÉTODO. Estudio de tipo descriptivo, retrospectivo y transversal que incluyo a 68 pacientes quienes fueron sometidas a CONO LEEP por lesiones intraepiteliales de alto grado en el año 2014 en la unidad de colposcopia del Hospital de la Mujer. Se analizó la efectividad a través de la persistencia y/o recidiva de los controles posteriores en el año 2015. RESULTADOS. 33 pacientes realizaron control PAP posterior al CONO LEEP siendo el resultado citológico negativo para lesión intraepitelial más frecuente llegando a un porcentaje de 91% (30 pacientes). Se identificó que el 9% (3 pacientes) presento persistencia al tratamiento con CONO LEEP. CONCLUSIONES. El estudio determino la efectividad del procedimiento en las pacientes que acudieron a control citológico, se estimó en 91 %, lo cual demuestra que la conización es un método de ALTA EFECTIVIDAD con un 9% de persistencia encontrándose en los rangos esperados de persistencia de la NIC que es entre el 5 y el 17% de acuerdo a protocolos de Brasil, México y España.

OBJETIVE. To determine the effectiveness of the LEEP CONE in patients with High Grade Intraepithelial Lesion (HLL). MATERIAL AND METHOD. A descriptive, retrospective and crosssectional study that included 68 patients who underwent LEEP CONE for high-grade intraepithelial lesions in 2014 in the colposcopy unit of La Mujer Hospital. The effectiveness was analyzed through the persistence and / or recurrence of subsequent controls in 2015. RESULTS. 33 patients underwent PAP control after the LEEP CONE, the cytological result being negative for the most frequent intraepithelial lesion, reaching a percentage of 91% (30 patients). It was identified that 9% (3 patients) presented persistence to treatment with LEEP CONE. CONCLUSIONS. The study determined the effectiveness of the procedure in patients who attended cytological control, it was estimated at 91%, which shows that conization is a HIGH EFFECTIVENESS method with a 9% persistence, being in the expected ranges of persistence of the NIC which is between 5 and 17% according to the protocols of Brazil, Mexico and Spain.

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.

Sleep Quality, its determinants and its Association with Academic Performance among the Students of a Medical College in Kerala

Sleep deprivation may have grave health consequences; resulting in increased disease morbidity and mortality. Prevalence of poor sleep quality is higher among medical compared to non-medical students and the general population. Poor sleep quality affects the academic performance of medical students and also their work performance in the future when they become practitioners. Hence, in this background, the present study was conducted. Objectives: The objectives of the study were to find out the prevalence of poor sleep quality among medical students, its determinants and also its association with academic performance. Materials and Methods: This was a cross-sectional study conducted at a Medical College, Wayanad District, Kerala, between May and November 2018. All the undergraduate medical students of the college were the study subjects. Data were collected using a predesigned and pretested self-administered questionnaire, i.e., the Pittsburgh Sleep Quality Index. Completed responses were obtained from a total of 684 students. Results: 62.4% were found to have good sleep quality and 37.6% poor sleep quality. The prevalence of poor sleep quality was more among 17–19 years age group, males, married, Phase I MBBS students, NRI quota students, subjects belonging to religion “others,” urban origin students and day scholars. However, only phase of MBBS and place of origin were found to have a statistically significant association (P=<0.01 for both). The prevalence of poor sleep quality was more among those who had failed in the previous university exam/internal assessment or who had passed in pass class when compared to those who had secured distinction/I/II class. However, the association was not found to be statistically significant (P = 0.39). Conclusions: The prevalence of poor sleep quality among the study subjects was lower. There was a significant association of male sex and Phase I, MBBS with poor sleep quality. There was no significant association between sleep quality and academic performance.

Tipificación viral en el seguimiento de conización: rol pronóstico de la persistencia del HPV post cono con asa / Viral typing in conization monitoring: prognostic role of HPV persistence post cone with loop

RESUMEN Fundamento: La persistencia del virus papiloma posterior a la conización del cuello uterino, se ha considerado un factor de riesgo para la persistencia de lesiones intra epiteliales (LIE) causadas por virus papiloma. Para determinar la asociación entre persistencia de lesión cervical y la presencia del virus papiloma posterior a la conización del cuello uterino, se realizó un estudio observacional prospectivo en un grupo de 123 pacientes portadoras de lesiones intraepiteliales de alto grado (LIEAG) tratadas con conización. Material y métodos: Se siguieron a 123 pacientes portadoras de LIEAG, ingresadas a la Unidad de Patología Cervical entre Abril de 2013 y Abril de 2014, las que fueron seguidas por 2 años hasta Abril de 2016. Se realizó genotipificación antes, y entre 4 a 6 meses posterior a la conización. Los datos se tabularon considerando la edad, paridad, tipo de virus, persistencia de LIE, reconización o requerimiento de histerectomía posterior. Resultados: La mediana de la edad fue de 37 años, el 91% fueron multíparas, y solo el 9% fueron nulíparas. El 56% ingresó por NIE III y el 44% por NIE II. Los virus más frecuentes fueron el 16, 31,58, 52 y 56. La persistencia de virus papiloma se constató en el 37% de las pacientes conizadas. La persistencia de LIE se observó en el 27% de las pacientes que fueron positivas para virus papiloma posterior a la conización, en comparación a sólo el 5% en las que fueron negativas. Del total de pacientes positivas para virus papiloma posterior a la conización, 12 de ellas presentaron persistencia de lesión confirmadas histológicamente por biopsia cervical, 8 pacientes requirieron recono por LIE de alto grado, 2 pacientes fueron a histerectomía y en 2 casos se realizó seguimiento estricto por NIE I. Cuando la tipificación post cono fue negativa solamente 3 pacientes requirieron conización y en sólo una se realizó seguimiento estricto por NIE I. Conclusión: La persistencia del virus papiloma posterior a la conización se asocia a mayor persistencia de LIEAG, mayor frecuencia de reconización o histerectomía posterior.

ABSTRACT Backgroud: The persistence of papilloma virus after conization of the cervix has been considered a risk factor for the persistence of cervical intra epithelial lesion (CIN) caused by papilloma virus. Aim: In order to determine the association between cervical lesion persistence and the presence of papilloma virus after conization, a prospective observational study was performed in a group of 123 patients with intraepithelial lesions treated with conization. Material and methods: We followed 123 patients with high grade CIN who were admitted to the Cervical Pathology Unit, between April 2013 and April 2014; they were followed for 2 years until April 2016. Viral genotyping was done before, and among the 4 to 6 months after the LEEP. Data were tabulated considering age, parity, type of virus, persistence of CIN, reconization or requirement of posterior hysterectomy. Results: The median age was 37 years, 91% were multiparous, and only 9% were nulliparous. 56% had NIE III and 44% NIE II. The most frequent viruses were 16, 31, 58, 52 and 56. The persistence of papillomavirus was present in 37% of patients. The persistence of CIN was observed in 27% of patients who were positive for papilloma virus after conization, compared to only 5% in those who were negative. Of the total number of patients positive for papilloma virus, in 12 of them had intra epitelial lesions were confirmed by cervical biopsy, 8 patients required recone for high grade CIN, 2 patients underwent hysterectomy, and 2 patients underwent follows up strictly by CIN I. When post cone typing was negative only 3 patients required conization and only one was followed strictly by CIN I.

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.

Recurrencia/persistencia de neoplasia intraepitelial cervical posterior a cono LEEP en el Instituto Nacional de Enfermedades Neoplásicas / Recurrence/persistence of cervical intraepithelial neoplasia after undergoing a LEEP conization at Instituto Nacional de Enfermedades Neoplásicas

Objetivo: Determinar la incidencia de recurrencia/persistencia de neoplasia intraepitelial cervical (NIC) en pacientes sometidos a procedimiento de escisión electroquirúrgica en asa (cono LEEP) en el Servicio de Ginecología Oncológica del Instituto Nacional de Enfermedades Neoplásicas (INEN). Materiales y métodos: Estudio de cohorte, retrospectivo en el cual se revisaron las historias clínicas de pacientes sometidos a cono LEEP durante el periodo de enero del 2002 a diciembre del 2003. Los pacientes fueron divididos en un grupo con margen comprometido y otro con margen negativo después del procedimiento de cono LEEP. El seguimiento de los pacientes se realizó cada 3 meses con examen físico, PAP y colposcopía. El desenlace fue la recurrencia de NIC. Para valorar el riesgo de recurrencia de NIC entre los grupos de estudio se calculó el riesgo relativo (RR) con su respectivo intervalo de confianza (IC) al 95%. Resultados: En total 451 pacientes fueron sometidos a cono LEEP durante el periodo de estudio. La edad promedio fue 35.32 años, el promedio de parejas sexuales fue 2.1 y el promedio de hijos fue 2.7. Presentaron margen comprometido 109 (25%) y margen negativo 342 (75%). De ellos solo 94 y 102, respectivamente, cumplían los criterios de elegibilidad y fueron seguidos. La media de seguimiento fue de 21.74 meses. La incidencia de recurrencia/persistencia dentro de los pacientes con margen comprometido fue 5.5% mientras que la incidencia de recurrencia en un grupo de pacientes con margen negativo fue 1.96% No encontramos diferencias significativas en el riesgo de padecer recurrencia de NIC en el grupo de pacientes con margen comprometido versus los pacientes con margen negativo. RR= 2.7; IC 95% (0.41 a 33.8). Conclusión: No se encontró diferencia significativa en la incidencia de neoplasia intracervical para pacientes con margen comprometido y los pacientes con margen negativo.

Objective: To determine the incidence of recurrence/persistence of cervical intraepithelial neoplasia (CIN) in patients who underwent a loop electrosurgical excision procedure (LEEP) at the Department of Gynecologic Oncology of Instituto Nacional de Enfermedades Neoplásicas (INEN). Materials and methods: A retrospective cohort study in which medical records of patients who underwent a LEEP conization from January 2002 to December 2003 were examined. After the LEEP conization, patients were divided into two groups: one with positive margin and another one with negative margin. Follow-up was performed every 3 months and consisted of a physical examination, Pap test and colposcopy. The outcome was recurrence of CIN. To assess the risk of CIN recurrence among the study groups, relative risk (RR) and its respective 95% confidence interval (CI) were calculated. Results: A total of 451 patients underwent a LEEP conization during the study period. The mean age was 35.32 years old, the mean number of sexual partners was 2.1 and the mean number of children was 2.7. One hundred and nine (109) patients (25%) showed a positive margin and 342 (75%) showed a negative one. Out of these subjects, only 94 and 102, respectively, met the eligibility criteria and were followed. The mean follow-up period was 21.74 months. The incidence of recurrence/persistence in patients with positive margin was 5.5%, while the incidence of recurrence/persistence in the group of patients with negative margin was 1.96%. We found no significant differences in the risk of CIN recurrence in the group of patients with positive margin versus patients with negative margin. RR = 2.7, 95% CI (0.41 to 33.8). Conclusion: There was no significant difference in the incidence of cervical intraepithelial neoplasia between patients with positive margin and patients with negative margin.

Observation of clinical effect of LEEP combined with vaginal cytology in the treatment of cervical precancerous lesions / 中国基层医药

Objective To explore the clinical efficacy of the combination of the vaginal and high frequency electric wave loop(LEEP) in the treatment of cervical precancerous lesions.Methods The clinical data of 76 cases with cervical precancerous lesions confirmed by postoperative pathological examination were collected,Pathologic biopsy was conducted under colposcope.For patients with operative indication, LEEP operation was carried out under colposcope and analyzed vaginal microscopic pathological biopsy diagnosis accurate rate.The operation time,bleeding volume and treatment were observed.Results Satisfactory colposcopy and biopsy results difference had statistical significance;colposcopy with biopsy diagnosis accurate rate was 90.79%.The average operation time was (6.42±1.21)min.The mean operative bleeding was (10.45±2.31)mL.Postoperative 3 months, TCT negative rate was 95.83%(92/96).After 6 months of TCT negative rate was 100.00%(76/76).Conclusion LEEP combined with vaginal cytology in the treatment of cervical precancerous lesions has less invasion,less bleeding,shorter hospitalization time,and can effectively remove the lesion site,it is worthy of recommending.

Clinical Observation of Oxymatrine Membrane,rhEGF Gel Combined with Yunnan Baiyao for Postopera-tive Cervical Wound after LEEP / 中国药房

OBJECTIVE:To explore the clinical efficacy and safety of oxymatrine membrane,rhEGF gel respectively com-bined with Yunnan baiyao for postoperative cervical wound after LEEP. METHODS:300 patients with cervical intraepithelial neo-plasia(CIN)Ⅱ and Ⅲ were divided into group A,B,C(100 cases in each group)based on CIN grading and stratification and random sampling in each stratification. After conventional LEEP,patients in group A were cleaned the wound by 0.9% Sodium chloride injection,spraying Yunnan baiyao powder,once only after surgery;patients in group B were additionally given recombi-nant human epidermal growth factor (rhEGF) on the basis of group A,once every week after surgery,for 3 weeks;patients in group C were additionally given oxymatrine membrane on the basis of group A,1 tablet every evening after surgery,for 2 weeks. Postoperative bleeding,bleeding duration,rebleeding and duration after postoperative bleeding stopped,postoperative drainage du-ration,the incidence of adverse reactions in 3 groups were observed. RESULTS:The patients of postoperative bleeding,bleeding time ≥7 d and rebleeding after stopping bleeding in group B were significantly lower than group A;the incidence of bleeding time ≥7 d in group C was significantly lower than group A,the proporition of postoperative drainage duration for less than 7 d was significantly higher than group A,for 8-13 d was significantly less than group A;early wound healing rate in group B and group C were significantly better than group A,with statistical significances (P0.05),and there were no obvious adverse reactions in 3 groups. CONCLU-SIONS:Oxymatrine membrane and rhEGF gel respectively combined with Yunnan baiyao have better healing than Yunnan baiyao alone,do not increase the incidence of adverse reactions,while there is no significant difference in oxymatrine membrane and rhEGF gel.

Clinical value of LEEP biopsy combined with frozen section in diagnosis and treatment of cervical intraepithelial neoplasia grade Ⅲ / 医学研究生学报

Objective Cold knife conization combined with frozen section were usually used in assessing the severity of the disease and the scope of the operation in cervical intraepithelial neoplasia class Ⅲ (CIN Ⅲ) patients before the total hysterectomy.In this study,LEEP biopsy combined with frozen section was used for preoperative assessment in CIN Ⅲ patients.The clinical value of this approach in assessing disease severity and operation scope before total hysterectomy will be analyzed.Methods We retrospectively analyzed the results of colposcopy biopsy,LEEP biopsy frozen sections,paraffin sections and postoperative residual cervix pathological biopsy in 168 cases with CIN Ⅲ admitted to our hospital from January 2011 to December 2012.Results LEEP biopsy combined with frozen sections showed that 64.88％ (109/168) results of frozen section were consistent with the results of cervical colposcopy biopsy,22.02％ (37/168) were degraded and 13.09％ (22/168) were upgraded to microfocal invasive cancer or invasive cancer.The pathological results of paraffin section showed that 109 cases(64.88％) of CIN Ⅲ lever,33 cases (19.6％) of inflammatory and CIN Ⅰ-H,26 cases (15.4％) of micro invasive carcinoma and invasive carcinoma were consistent with the results of cervical colposcopy biopsy.The accuracy of LEEP frozen biopsy was 95.2％ (κ=0).Among the 146 residual cervixs of CIN Ⅲ patients diagnosised by LEEP biopsy,51.3 ％ (75/146) had pathological changes.Comparison of cervical col poscopy biopsy and final diagnosis,26 cases of invasive cancer were missed diagnosis by cervical colposcopy biopsy.Conclusion LEEP biopsy combined with frozen section can provide a quick and accurate assessment before cystectomy in CIN Ⅲ patients.It is feasible to determine the surgical range according to frozen section biopsy.

Effect of LEEP knife combined with biopsy in patients with small invasive cervical cancer / 中国内镜杂志

Objective To explore the effect of the application of cervical loop electric knife (LEEP) in the patients with cervical micro invasive cancer.Methods Clinical data of 66 patients with minimal invasive carcinoma diagnosed by LEEP cone resection in our hospital from June 2013 to June were retrospectively analyzed. Preoperative and postoperative patients with LEEP were compared with 66 patients who underwent biopsy with biopsy, the diagnosis of micro invasive carcinoma was compared with LEEP cone resection.Results The results of colposcopy biopsy were detected in 2 cases of LSIL, 60 cases of HSIL and 1 cases of AIS, 3 cases were diagnosed as cervical microinvasive carcinoma or suspicious cervical microinvasive carcinoma, the sensitivity was 4.54%, the misdiagnosis rate was 95.46%; LEEP conization were detected in 1 cases of LSIL, 44 cases of HSIL and 1 cases of AIS, 20 cases negative margin. There was no significant difference in the thickness and area of the resected tissue between the three groups (P > 0.05). The depth of the resected tissue was significantly higher than that in the HSIL and AIS group, the HSIL and AIS groups were significantly higher than the LSIL group, the difference was statistically significant (P 0.05). Cut edge positive group, positive margin group and interstitial fiber positive margin group of patients with postoperative residual disease rates were 25.00%, 15.38% and 23.80%, the difference was not statistically significant (P > 0.05).Conclusion The rate of missed diagnosis of small invasive cervical cancer is higher, and the diagnosis rate can be improved by the combination of LEEP and cone resection.

Clinical efficacy of LEEP knife combined with chitosan cervical antibacterial film in the treatment of chronic cervicitis and its psychological intervention / 中国生化药物杂志

Objective To investigate and analyze the clinical efficacy of LEEP knife combined with chitosan cervical antibacterial membrane in the treatment of chronic cervicitis and to observe the psychological intervention. Methods 100 cases of Chronic Cervicitis Patients in our hospital from January 2015 to October 2016 were selected as the research object. They were randomly divided into the control group and the experimental group, each group had 50 cases. Patients in the control group were treated with LEEP knife surgery, and no drugs were used after the operation. The patients in the experimental group were treated with LEEP knife combined with chitosan and cervical antibacterial membrane. Psychological intervention was carried out, and the mental health of the patients was paid close attention to, and communication and communication with patients were strengthened. The therapeutic effects of the experimental group and the control group were compared and analyzed. Results After the corresponding treatment, the effective rate of the experimental group and the control group was 100.0%. The cure rate of the control group was 80.0%, significantly lower than that of the experimental group(96.0%), the difference was statistically significant (P<0.05). After treatment, the SAS score of the experimental group was (40.1±6.2) points, and the SDS score was (38.4±7.9) points. The scores of SAS in the control group were (49.6±7.2) points, and the SDS score was (48.2±8.5) points. There were three cases of complications in the experimental group, the incidence of complications was significantly lower than that of the control group (20.0%), The difference was statistically significant (P<0.05). Conclusion The clinical effect of LEEP knife combined with chitosan cervical antibacterial membrane in the treatment of chronic cervicitis treated with psychological intervention, high cure rate, low probability of complications, significantly improve patients' negative emotions, has clinical significance.

The Short-term and Long-term Clinical Effect of Leep Knife Treatment of Chronic Cervicitis / 昆明医科大学学报

Objective To explore the short-term and long-term clinical effect of leep knife treatment of chronic cervicitis. Methods A single-center, prospective, randomized, controlled study was used, 120 patients with chronic cervicitis were randomly divided into observation group and control group, each group of 60 patients. Patients in the observation group were treated with (LEEP) knife, parameters setting frequency was 3.8 MHz, power was 30 ~ 40W, patients in the control group were treated with microwave. The intraoperative and postoperative recovery and relapse were compared between two groups. Results The intraoperative blood loss, operative time, postoperative vaginal discharge time in the observation group were significantly less than control group, there was a significantly statistical difference (P<0.001) . After two weeks and three months , the cure rate in observation group were 70% and 98.33% respectively, the cure rate in control group were 16.67% and 51.67%, there was a significantly statistical difference (P <0.01) . After 2 weeks and 3 months, the infection rate and recurrence rate in the observation group were significantly lower than the control group, there was a significantly statistical difference (P <0.05) . Conclusion Leep knife for treatment of chronic cervicitis patients has lower postoperative recurrence, lower infection rate and higher cure rate in short-term and long-term, and less intraoperative trauma, shorter operation time, and has important clinical significance for the prognosis of patients.

The Clinical Analysis of Humanized Nursing Measures for Imparoving Therapeutic Effects in Patiens with Cervical Erosion / 昆明医科大学学报

Objective To analyze humanized nursing measures for improving therapeutic effects in patients with cervical erosion.Methods We 80 patients with cervical erosion admitted in our hospital from March 2012 to September 2014.According to random number table,they were divided into two groups,the observation group and the control group,with 40 patients in each.patients in both groups were treated by LEEP knife circumcision surgery.The observation group was given humanized nursing,and the control group was traditional nursing.The effective rate of treatment,the incidence of postoperative complications and the scores of Self-Rating Anxiety Scale and Self-Rating Depression Scale was compared between two groups.Results The total effective rate of treatment in observation group was 92.5％,which was 75.5％ in control group.The difference was statistically significant (P＜ 0.05).The incidence of postoperative complications of observation group was 10.0％,which was 32.5％ in control group.The difference had statistically significant (P ＜0.05).significantly lower than that of control group (27.8％).All the differences were statistically significant (P＜0.05).Before given nursing,the scores of SAS and SDS between two groups were no significant difference (P ＞0.05) The scores in observation group were significantly lower than those of control group (P＜0.05) Conclusion The humanized nursing measures can improve the therapeutic effects of patences with cervical erosion,promote the recovery of patients' physical and mental health,and is worth of further clinical application.

Comparison of effects between Leep knife operation and Vaginal ligation operation in submucous uterine myoma / 中国基层医药

Objective To compare the clinical application value between Leep knife operation and Vaginal ligation operation in submucous uterine myoma during the basic-level hospital.Methods According to digital table method,63 cases with submucous uterine myomas were randomly divided into the trial group and control group,33 cases in the trial group used the Leep knife,30 cases in the control group used vaginal ligation operation.Results The amounts of the trial group such as operation time,complications bleeding,operation stump bleeding rate and menstrual disorder improvement rate were (8 ± 3)min,(7 ± 3)mL,0.0％,91.0％,while the amounts of the control group were (10 ± 3) min,(10 ± 4) mL,13.3％,70.0％.The difference was statistically significant (t =2.642,3.387,x2 =4.698,4.455,all P ＜ 0.05).Conclusion Leep knife operation is better than Vaginal ligation operation,because it has shorter operation time,less complications bleeding,lower operation stump bleeding rate and higher menstrual disorder improvement rate.It is worthy of applying in the basic-level hospital.

Research progress on clinical application of Sophorae Flavescentis Radix gelatum / 中草药

Sophorae Flavescentis Radix, drying root of Sophora flavescens which is a leguminous plant of genus Robinia Linn., is rich in a variety of chemical compositions so as to have extensive biological activities. Sophorae Flavescentis Radix Gelatum (SFRG), a product of Guiyang Xintian Pharmaceutical Co., Ltd., is used to treat gynecological chronic inflammations such as cervical erosion, trichomonas vaginitis, and vaginal fungal infection. Recent reports at home and abroad suggest that in addition to the above indications, SFRG has been clinically used in adjuvant physical therapy of cervical erosion and bacterial vaginitis, senile vaginitis, mixed vaginitis vaginal inflammation, and andrology medication. This review is designed to summary these new applications of SFRG.

Effect and nursing of patients with cervical erosion managed with operations in two surgical methods / 现代临床护理

Objective To compare the effects of loop electrosurgical excision procedure(LEEP knife)and microwave on cervical erosion and study the nursing effects.Methods One hundred and fifty cases of cervical erosion patients from January to December 2013 in our hospital were selected and randomly divided into observation group and control group with 75 cases in each group.Patients in the observation group were treated with LEEP knife and the control group with microwave treatment.All patients were nursed conventionally.The operative time,blood loss and efficacy of two groups were analyzed.Result Patients in the observation group had less blood loss,shorter operation time and a better curative effect than the control group with statistical difference(all P<0.05).Conclusions Compared with microwave treatment,LEEP knife can effectively treat the cervical erosion.Preparation before operation,mental care and knowledge-related nursing are critical for the smooth manipulation of the operation.

Clinical observation of cervical intra-epithelial neoplasia with high risk HPV infection after LEEP treatment / 中国基层医药

Objective To explore the curative effect of loop electrosurgical excision procedure (LEEP) on cervical intra-epithelial neoplasia(CIN) infected with high risk human papilloma virus (HR-HPV).Methods 80 CIN patients with HPV infection underwent LEEP were selected.HR-HPV DNA load was detected before operation and 3 months after operation,and at the same time,vaginal examination and cervical directed biopsy were conducted.Results Before LEEP operation,the differences between different levels of CIN HPV load were not significant(P ＞0.05,F =0.45).3 months after operation,CIN Ⅰ grade 19 cases (86.4％) turned to chronic inflammation,CIN Ⅱgrade 36 cases (83.7％) turned to chronic inflammation,CINⅢ grade 13 patients (86.6％) were chronic inflammation.Cervical HPV load postoperatively negative rate was 85％ and the lower HPV load,the higher postoperatively negative rate.Conclusion LEEP is the effective treatment for cervical lesion and can significantly decrease the HPV-DNA loading at cervix.

The impact of LEEP knife treatment of cervical intraepithelial neoplasia on pregnancy and delivery mode / 中国综合临床

Objective A retrospective analysis was conducted to explore the impact of LEEP knife treatment of cervical intraepithelial neoplasia (CIN) on women's pregnancy outcomes and modes of delivery.Methods Fifty-eight women were recruited as the experimental group from our hospital.They accepted LEEP surgery for treatment of CIN during 2009 and became pregnant before December 2011.Sixty pregnant women without history of LEEP surgery were randomly selected as the control group from January 2010 to December 2011.A retrospective analysis of the study groups was conducted to investigate the pregnancy situations,two-wire receiver modes of delivery and pregnancy outcome of participants.Results There was no significant difference between the two groups on rates of abortion,vaginal delivery and cesarean section (P ＞ 0.05).The experimental group had significantly higher rates of preterm birth than control group (12.07％ vs.1.67％,x2 =5.049,P ＜ 0.05).No significant difference was observed between the two groups on rates of premature rupture of membranes,cervical laceration,postpartum hemorrhage,low birth weight and neonatal asphyxia(P ＞ 0.05).Conclusion LEEP knife treatment of CIN has no significant effect on mode of delivery or pregnancy outcome,but may increase the incidence of preterm birth.Management of pregnant women with history of CIN and LEEP surgery should be strengthened.