Cervical conization is a surgical procedure to remove a part of the cervix in gynecology and obstetrics, which is to cut off a part of the cervical tissue in the shape of a cone from the outside to the inside. On one hand, it is to perform a pathological examination and confirm the lesions of the cervix; on the other hand, it is also a treatment method to remove the lesions.
At the beginning of the cervical cone biopsy surgery, it was performed by anatomical knife (i.e., cold knife cone biopsy), which has the advantage of clear margins, which is conducive to pathological examination. The disadvantages are that it requires hospitalization, anesthesia, a long operation time, and a high risk of bleeding during the operation.
Nowadays, the loop electrosurgical excision procedure (LEEP, also known as LEEP knife) has been widely used, with the advantage of being simple and easy to perform, not requiring hospitalization, and the operation time is short, only about 5 to 10 minutes.
However, the depth of LEEP knife cutting is often questioned, and due to concerns in the medical community about current destruction of the margin by electricity, electricity knife cone biopsy has not been recommended. However, after a large amount of medical practice and clinical data summary in recent years, it is believed that the effect of electric knife cone biopsy is comparable to that of cold knife cone biopsy, and there is less bleeding. There is no significant difference between the two in terms of the removal of lesions and recurrence. The positive rate of the cervical cone biopsy margin increases with the severity of the lesion. It is well known that patients with positive margin have a higher probability of lesion progression and recurrence, but negative margin does not guarantee that there are no residual lesions in the remaining cervix, and the incidence of residual lesions is also proportional to the severity of the lesion, although the chance of occurrence is lower than that of positive margin patients. The involvement of cervical glands and the multicentricity of the lesion are decisive factors for the residual or recurrent lesions after cone biopsy. In summary, circular electrosurgical excision, due to its time-saving, simple, safe, and inexpensive nature, has become the best method of cone biopsy and has been widely used in clinical practice.
There is currently controversy regarding the cervical cone biopsy in pregnant women. Some scholars believe that cone biopsy in pregnant women can lead to preterm delivery and low birth weight infants, while some people believe that the positive rate of the margin and the incidence of residual lesions are high. However, most believe that cone biopsy during pregnancy is safe and effective. RaioL et al. proposed that after adjusting known risk factors, the depth of cone biopsy exceeding 10mm in pregnant women is a decisive factor for preterm delivery. Therefore, the depth of cone biopsy in pregnant women should be less than 10mm, which requires a stricter selection of indications for cone biopsy.
The pathological findings of the cone biopsy must specify whether the margin is positive, whether the cervical glands are involved, and whether the lesion is multicentric.
1. What are the causes of cervical cone biopsy
1. The cervical smear cytology examination has been found to have malignant cells multiple times, the colposcopy examination is normal, and for those with negative cervical biopsy or fractional cervical canal curettage, a cervical cone biopsy should be performed for further diagnosis.
2. The cervical biopsy has been diagnosed as high-grade squamous intraepithelial lesion (HSIL, including CIN II-III, cervical in situ carcinoma), cervical in situ adenocarcinoma, and microscopic findings show minimal invasive cervical cancer (cervical Ia1). To determine the extent of surgery, a cervical cone biopsy can be performed first, and the removed cervical tissue can be subjected to further pathological examination to clarify the degree of lesion and guide the selection of surgical extent.
3. Suspected cervical adenocarcinoma, but cervical biopsy or cervical canal scraping is negative.
4. For patients with chronic cervical inflammation, cervical hypertrophy, hyperplasia, and inversion, and those with poor treatment effects after conservative treatment, small-scale cervical conization surgery can be performed for treatment.
2. What complications can cervical conization surgery easily lead to?
1. Postoperative hemorrhage. Immediate postoperative hemorrhage is due to poor hemostasis during surgery. Secondary hemorrhage often occurs 5-12 days after surgery, and is more common in deep resection of lesions and those with concurrent infection.纱布 compression, cryotherapy, electrocautery, re-suturing, and occasionally hysterectomy can be used according to the amount of bleeding.
2. Perforation of the uterus or cervical perforation, although extremely rare, but once it occurs, it may require the removal of the uterus.
3. Postoperative pelvic infection, which requires antibiotic treatment.
3. Narrowing of the uterine cervix. There is an incidence rate of about 1-5%, according to literature reports, the incidence rate of cervical adhesion is related to the age of the patient being over 50 years and the depth of conization being over 2 cm. Patients may experience dysmenorrhea, menstrual retention, and even amenorrhea, or brown or black vaginal spotting during the menstrual period. Cervical adhesion patients can use cervical dilators to dilate the cervix.
3. What are the typical symptoms of cervical conization surgery?
1. It is best to choose any day during the period from the clean menstrual period to one week before the next menstrual period to perform the surgery.
2. Before surgery, blood routine and coagulation time should be tested, as well as liver and kidney function, syphilis, HIV, hepatitis B, hepatitis C, and at the same time, an electrocardiogram should be performed.
3. Perform routine vaginal discharge examination before surgery, such as trichomoniasis, mold, and pus cells to exclude vaginitis before surgery. Pay attention to perineal cleanliness to prevent postoperative infection.
4. Avoid sexual life within two months after surgery to prevent bleeding and wound infection.
5. If there is vaginal bleeding beyond the amount of menstruation after surgery, go to the best local hospital immediately to stop the bleeding. Excessive vaginal bleeding can be life-threatening.
7. Conventional methods for treating cervical conization surgery in Western medicine
1. Surgical Procedures:
(1) Location is the same as cold knife conization.
(2) Push out the entire loop of the electrocautery device, use the speculum as the fulcrum when cutting the anterior lip, and there is often no definite fulcrum when cutting the posterior lip. Cutting usually starts at 6 o'clock and proceeds clockwise, starting with the foot pedal, and moving the handle or spring of the cutting hand when a cutting action is felt in the hand, cutting the tissue to the required depth as needed. The electrocautery loop is then moved into the endoscope sheath, the foot pedal is released, and the tissue is completely cut off. Cut in an arc from the inside out, the speed should not be too fast, otherwise bleeding may occur. After cutting, the cervix is in a 'shallow bowl' or 'mushroom head' shape. For CIN patients, high-risk areas guided by colposcopy should be separated for pathological examination. Generally, the cutting range exceeds the normal tissue by 1mm, and the ideal cutting depth is 7mm. For cervical canal polyps or polypoid hyperplasia, cutting can be performed under hysteroscope vision, and the base can be completely removed. For CIN II, III, and patients with a lesion diameter ≥2.5cm, cold knife conization should be used.
2. Indications:
(1) Cervical erosion, hypertrophy, polyps, cervical canal polyps, and polypoid hyperplasia.
