Related Issues of Different Loop Electrocautery Excision Procedure Types for Different Degrees of Cervical Intraepithelial Neoplasia

Abstract

Objective To investigate the related issues of different section types and extent of loop electrosurgical excision procedure (LEEP) for the treatment of different degrees of cervical intraepithelial neoplasia(CIN). Methods Four hundred and forty-six patients with CIN (108 patients with CIN Ⅰ, 232 ones with CIN Ⅱ and 106 ones with CIN Ⅲ) who were treated in the department of gynecology of Jinan Military Hospital since February 2006 to October 2009, were retrospectively studied their clinical materials, in which included healing process and side effect in the different section type and extent of LEEP. The mean follow-up times was(24.5±5.5) months (range from 8 to 32 months). The types and indications of LEEP we used in this study included: ①group A (n=109):≥2/3 cervical surface area was cut off like cone-shape, for the 109 patients with CIN Ⅱ-Ⅲ;②group B(n=203):≥2/3 one was cut off like mushroom-shape, for the 203 patients with CIN Ⅰ-Ⅱ; ③group C(n=90): ≤1/3 one was cut off like ring - shallow - mushroom-shape, for the CIN Ⅰ who wished to give-birth; ④group D (n= 44): peeling cervical rind, for the CIN Ⅰ or doubtful CIN Ⅰ who wished to give-birth. All bleeding spots were coagulated for hemostasis using spherical electrode. All patients gave and signed informed consent and the study was approved by the Institutional Review Board of the Jinan Military General Hospital. Informed consent was obtained from all participates. Results The correspond rate of the tissue pathological-results after LEEP to the multi-spotbiopsy pathological-results before LEEP was 87.4% (390/446), the noncoincidence rate was 12.5(56/ 446), among them there were 6.5 % (29/446) aggravated results. In this study of the A, B, C and D groups: ①the total cure rate of LEEP for different CIN were respectively 99.1% (108/109) in group A, 98.5% (200/203) in group B, 100.0% (90/90) in group C and 93.2% (41/44) in group D. ②The cervical healing-times of group A to D were (7.5±1.0) weeks, (6.5±0.5) weeks, (5.5±0.5) weeks and (4.5± 0.5) weeks, respectively. ③The lose blood of group A to D were (58.4 ± 23.8) mL, (29.9 ± 12.3) mL, (11.1±3.8) mL and (4.0±1.4) mL, respectively. The 56 patients who wished to give-birth were 31 ones with CIN Ⅰ, 14 with CIN Ⅱ and 11 with CIN Ⅱ-Ⅲ. After more than 2 years of follow-up, the pregnancy rates were respectively 80.6%(25/31),71.4%(10/14)and 27.3%(3/11). Conclusion Treatment for CIN by LEEP-typy should be individualized, according to different degrees. Key words: loop electrosurgical excision procedure; cervical intraepithelial neoplasia; curative effect; operating type