Predictive factors and follow-up treatment of residual cervical lesions after primary cervical conization / 中国医师进修杂志

ABSTRACT

Objective:To explore the necessity of supplementary operation after primary cervical conization for cervical lesions and the choosing method of reoperation, so as to provide clinical data for further stratification treatment after primary conization.Methods:A prospective study was performed in 116 patients with complete data due to cervical biopsy diagnosis of cervical lesions who first received cervical conization, and received supplementary surgeries within 6 months at Wenzhou People Hospital from March 2016 to March 2018, and 17 cases who received radical resection diagnosed grade Ⅰa1 with vascular infiltration or above were excluded. The patients were divided into residual and non-residual according to residual disease of supplementary surgical specimens. The residual rates of clinical and pathological factors (including incision margin, gland involvement, curettage of cervical canal) were analyzed by univariate analysis. The factors of P ≤ 0.10 were further analyzed by progressive Logistic regression. The clinical and pathological data of 41 patients undergoing repeated conization were analyzed. The follow-up data were analyzed and summarized. Results:Univariate analysis showed that the residual rate of disease in the patients with positive margin, endocervical cone margin involvement and other positive margin was 55.36% (31/56), 63.64% (14/22) and 50.00% (17/34), respectively, higher than that of the patients with negative margin 30.00% (18/60) with statistical significance ( P<0.05). There was no significant difference in pregnancy (≥ 3), parity (≥ 2), symptomatic cases between the two groups, but all P < 0.10. Multivariate analysis showed that both endocervical cone margin involvement and vaginal incision margin were independent risk factors for residual disease, and OR was 4.083 (95% CI 1.459 to 11.430, P = 0.007) and 2.333 (95% CI 0.978 to 5.569, P = 0.056); 19 cases (46.34%) of cervical lesions and 11 cases (26.83%) of high-grade cervical lesions were found in 41 cases after repeated conization. 2 cases (4.88%) of positive margin of incision were supplemented with total hysterectomy; the incidence of intraoperative massive bleeding was 4.88% (2/41). The incidence of massive hemorrhage after operation was 2.43% (1/41). Conclusions:Margin involvement and vaginal incision margin might predict the occurrence of residual disease. Additional surgery should be considered in these cases. Repeat conization can remove residual cervical lesions with minimal trauma and can be used as the preferred treatment.