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Xinming Yin, Li Zhu, Weiwei Tan, Xiaolan Zhu, Songping Liu, Wenlin Xu
(Department of Gynecology, Maternal and Child Care Service Center, Zhenjiang 4th Hospital, Zhenjiang, Jiangsu, China (mainland))
Med Sci Monit 2018; 24:9063-9072
This study was conducted to observe the influence of different time intervals between prior cervical conization and posterior hysterectomy on postoperative infection in female patients with cervical intraepithelial neoplasia or cancer.
MATERIAL AND METHODS: Medical records of 170 patients who underwent hysterectomy following cervical conization between November 2010 and September 2016 at the Zhenjiang 4th Hospital were reviewed. According to the interval between hysterectomy and cervical conization, patients were classified into 1–2-week, 4–5-week, and 6-week groups. The outcomes of 46 patients who underwent conization with iodoform gauze inside the vagina were observed.
RESULTS: The total postoperative infection rate after hysterectomy was 25.3% (43/170). The expression levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high mobility group box 1 (HMGB1) in the cervical secretions and tissues were found to gradually increase, peaking at 2 weeks after conization, then significantly decreasing 3–6 weeks onwards. Compared with the 1–2-week group, the 4–5-week and 6-week groups exhibited significantly lower infection rates (2/42, 4.8%, 4–5-week group; 0%, 0/33, 6-week group; vs. 41/95, 43.2%, 1–2-week group; p<0.001). In the 1–2-week group in particular, the postoperative infection rate after laparoscopic hysterectomy was significantly higher than the rate after abdominal hysterectomy (21/35, 60% vs. 20/60, 33%, p=0.0177). In addition, the vaginal and cervical wound infection rates after conization in patients treated with iodoform were significantly lower than the rates in those without iodoform treatment (p<0.05).
CONCLUSIONS: Hysterectomy should be performed at least 4 weeks after conization. Treatment with iodoform would be beneficial.