A comparison study of post-operative infection analysis of cold-knife conization and loop electrosurgical excision procedure for cervical high-grade squamous intraepithelial lesion

BACKGROUND: High-grade squamous intraepithelial lesion (HSIL) is a premalignant condition of the cervical cancer. Loop electrosurgical excision procedure (LEEP) and cold-knife conization (CKC) were the most effective treatment. Most studies focused on the recurrence rate, positive margin rate, residual disease rate, secondary hemorrhage or cervical stenosis of these two methods. At present, there are few researches about the post-operative infection comparing LEEP with CKC for treating HSIL. METHODS: One hundred and fourteen patients diagnosed as HSIL were underwent cold conization (n=43) or LEEP (n=71), according to 1:2 matching approximately and being divided randomly into two groups. The information, including the post-operational inflammatory complications, the leucorrhea abnormalities, the pathogens isolated from cervical secretions and pathological reports, were collected for comparison. RESULTS: There was no significant difference between them in bleeding, diameter, depth or volume of tissue between two groups. However, the operation time of the CKC group (24.81±11.09) minutes was longer than that of LEEP group (15.79±9.82) minutes. Seventeen patients of the LEEP group were admitted postoperatively as emergencies for secondary-hemorrhage. But it did not happen in CKC group. During the follow-up period, 28 patients (CKC 8 vs. LEEP 20) were diagnosis as reproductive tract infections. Fourteen patients (CKC 6 vs. LEEP 8) had leucorrhea abnormalities. Eighteen patient (CKC 3 vs. LEEP 15) isolated pathogens from their cervical secretions. There was no significant correlation between leucorrhea abnormality and cervical secretion abnormality. The positive rate of cervical secretion infection in the LEEP group was higher than the CKC group (P<0.05). The inflammatory response and process had some pathological difference in post-operation time of two groups, especially in those secondary hemorrhage cases. CONCLUSIONS: These two excision procedures for treating HSIL have their respective advantages and disadvantages. This study indicates that the incidence of persistent cervical infection after the CKC operation with Sturmdorf suturing is lower than that of after LEEP surgery. Clinicians should pay attention to the pathogen isolated from cervical post-operative secretion. It is conducive to find hidden pathogens and control subsequent surgical inflammation.