Application of total hysterectomy in treatment of cervical intraepithelial neoplasia / 第二军医大学学报

ABSTRACT

Objective To investigate the clinical value of total hysterectomy in the treatment of cervical intraepithelial neoplasia. Methods We retrospectively analyzed the clinicaldata of 283 patients undergoing total hysterectomy for cervical intraepithelial neoplasia in Changhii Hospital of Second Military Medical University from Jan. 2009 to Dec. 2016. Among the patients, 206 cases received loop electrosurgical excision procedure CLEEP) before total hysterectomy (pre-operative LEEP group), 28 only received total hysterectomy directly after colposcopy biopsy (hysterectomy group) and 49 received LEEP during total hysterectomy (intra-operative LEEP group). The changes of pathological grade and the lesion residual rates of the patients before and after operation were compared. The effect of clinicopathological features (age, pregnancy times, partus times, abortion times, menopausal years, pathology, human papilloma virus (HPV) infection, tumor family history and so on) on postoperative residual lesion were analyzed by univariate and multivariate analysis. Results The cure rate, lesionresidual rate, pathological downgrade rate and pathological upgrade rate in the pre-operative LEEP group was 35. 92%(74/206), 64. 08%(132/206), 63. 11% (130/ 206) and 3. 88% (8/206), respectively, and two cases with canceration were found. In the hysterectomy group, the consistent rate of pathological diagnosis before and after operation, pathological downgrade rate and pathological upgrade rate were 57. 14%(16/28), 35. 71 %(10/28) and 7 14%(2/28), respectively, and one case with invasive carcinoma was found after operation. The lesion residual rate, pathological downgrading rate and pathologicil upgrading rate in the intra- operative LEEP group were 40. 82% (20/49), 65. 31% (32/49) and 8. 16% (4/49), respectively, and two cases with invasive carcinoma were found after operation. Univariate analysis showed that age and menopausal years were the factors influencing lesion remaining after LEEP (P<0. 05). Multivariate analysis showed that patients with longer menopausal years had lower risk of lesion remaining (P = 0. 02). The pregnancy times, partus times, abortion times, lesion involving glands, positive margins, HPV infection and family history of cancer had no significant effects on postoperative lesion remaining. Conclusion Total hysterectomy plays an important role in preventing the recurrence of cervical precancerous lesion and reducing the incidence of invasive carcinoma. It is suitable for people with few screening opportunities, poor follow-up conditions and no fertility requirements. Patients with high grade intraepithelial lesion who are not menopausalor have short menopausal years need to be followed up more closely and can receive total hysterectomy if necessary.