High risk factors and preventive measures of cervical adhesion caused by loop electrosurgical excision procedure

Abstract

Objective To investigate the high risk factors of cervical adhesion caused by loop electrosurgical excision procedure (LEEP), and to find out the effective measures to prevent cervical adhesion caused by LEEP. Methods From January 2013 to December 2014, a total of 603 cases of menopausal transition and postmenopausal patients who received LEEP treatment in International Peace Maternity & Child Health Hospital of China Welfare Institute with taking cervical adhesion prevention measures after LEEP were enrolled into study group. From January 2003 to December 2012, a total of 10 863 cases of patients who received LEEP treatment in International Peace Maternity & Child Health Hospital of China Welfare Institute without taking cervical adhesion prevention measures after LEEP were enrolled into non-intervention group. According to the different cervical adhesion prevention measures after LEEP in study group: placing intrauterine device (IUD) which was T type ring with tail wire once after the treatment of LEEP or using Hegar cervical dilator for physical cervical dilatation, the menopausal transition and postmenopausal patients in study group were further divided into IUD subgroup (n=144) and physical dilator subgroup (n=459). And in the non-intervention group, the menopausal transition and postmenopausal women were included into control group (n=2 270). The incidence of cervical adhesion caused by LEEP in non-intervention group and the related risk factors of cervical adhesion caused by LEEP were analyzed by retrospective analysis method. By following up the study group, the effects of cervical adhesion intervention measures were analyzed prospectively. The incidences of cervical adhesion caused by LEEP in study group and control group, and the incidences of cervical adhesion caused by LEEP and genital tract infection in IUD subgroup and physical dilator subgroup were statistically compared to evaluate the effects of the cervical adhesion intervention measures. There were no statistical differences between the study group and control group, IUD subgroup and physical dilator subgroup in the basic data such as age, gravidity and parity, ratio of type of disease, mode of delivery and so on (P>0.05). Results ①The incidence of cervical adhesion caused by LEEP in non-intervention group was 9.6% (1 042/10 863). In non-intervention group, the incidences of cervical adhesion caused by LEEP in the patients with menopausal transition and menopause, previous cesarean section delivery and conization depth >10 mm were obviously higher than those in the patients with mature period, the previous vaginal delivery, conization depth 0.05). ②The incidence of cervical adhesion caused by LEEP in study group was 10.6% (64/603), which was significantly lower than that in control group (43.8%, 995/2 270), and the difference was statistically significant (χ2=225.90, P<0.001). The incidences of cervical adhesion caused by LEEP in IUD subgroup and physical dilator subgroup were 18.1% (26/144) and 8.3% (38/459), respectively, and they were both obviously lower than that in control group, and both the differences were statistically significant (χ2=36.87, P<0.001; χ2=205.16, P<0.001). The incidences of cervical adhesion caused by LEEP in physical dilator subgroup was obviously lower than that in IUD subgroup, and the difference was statistically significant (χ2=11.04, P<0.001). ③In IUD subgroup, the expulsion rate of IUD was 41.0% (59/144). The genital tract infection rate in IUD subgroup was 24.3% (35/144), which was significantly higher than that in physical expansion subgroup (8.5%, 39/459), and the difference was statistically significant (χ2=25.45, P<0.001). Conclusions The three high risk factors of cervical adhesion caused by LEEP are menopause, delivery mode and conization depth. Both IUD and Hegar cervical dilator can significantly reduce the incidence of cervical adhesion caused by LEEP, but physical dilator method is better and more effective than IUD, and IUD is easy to fall off and the genital tract infection rate is higher than physical dilator method, so physical dilatation of the cervix is a more economical and effective method for the prevention of cervical adhesion after LEEP. Key words: Cervix uteri; Cervical intraepithelial neoplasia; Loop electrosurgical excision procedure; Cervical adhesion; Program evaluation