Analysis on 101 cases of laparoscopic total hysterectomy after cervical conization for high level cervical intraepithelial neoplasia III

Objective To analyze the clinical data of laparoscopic total hysterectomy after cervical cold knife conization (CKC) in patients with cervical intraepithelial neoplasia (CIN), and study the supplemental treatment methods after cervical cold knife conization in patients with CIN Ⅲ. Methods The clinical data of 101 patients with CIN Ⅲwere retrospectively analyzed, the patients were treatment with laparoscopic total hysterectomy after cervical cold knife conization. Results Among the 101 patients, the accordant pathological result of cervical biopsy under colposcopy and cervical cold knife conization was in 68 cases (67.3%), while 6 cases (5.9%) pathological upgraded to invasive carcinoma. The positive margins after cervical cold knife conization was in 23 cases, and negative margins was in 78 cases. Among the positive margins patients, 11 cases had residual lesion, including 2 cases of CINⅠ, 2 cases of CIN Ⅱ, 5 cases of CIN Ⅲ, 2 cases of microinvasive carcinoma. The rate of residual lesions was 47.8% (11/23). Among the negative margins patients, 7 cases had residual lesion, including 4 cases of CIN Ⅰ, 2 cases of CIN Ⅱ, 1 case of CIN Ⅲ. The rate of residual lesions was 9.0% (7/78). There was statistical difference in the rate of residual lesions between 2 groups (P<0.05). Conclusions The cervical biopsy under colposcopy has high risk of missing diagnosis of cervical cancer, thus it can not replace the diagnosis of cervical cold knife conization. There is still a certain percentage of residual lesions in the negative margins of cervical cold knife conization. The patients with recurrence or residual risk factors may be considered further surgical treatment. Key words: Cervical intraepithelial neoplasia; Conization; Hysterectomy; Laparoscopes; Retrospective studies