Time：2023-04-01 03:13:49 source：psychiatricethics.com author：Prevent anxiety Read：116次

Lip knife, how profitable is it?

Cervical erosion and cervical polyps are common manifestations of chronic cervicitis, which not only have a long course of disease, but also have potential malignant tendencies. Although the extensive development of gynecological screening enables early diagnosis and early treatment of many patients, many of them, especially those with severe disease, often cannot be cured for a long time. At this time, qualified hospitals will recommend "LEEP" (Leep Knife) treatment to patients. So, how "sharp" is the Lip Knife in treating cervical disease?

Principle

LEEP is called "high frequency radio wave circumcision" in Chinese. High-risk area (usually the cervical squamocolumnar junction), to treat various cervical lesions, prevent cervical cancer, and retain complete and continuous specimens for pathological examination, and can be performed without hospitalization, anesthesia, and admission to the operating room. In fact, the Lip Knife is not a real knife, but a device that can generate ultra-high frequency radio waves of 3.8 MHz. At the moment of contact with the body, the tissue absorbs the radio waves, the water in the cells oscillates, evaporates, and the cells rupture, thereby separating the tissues. , to complete various surgical purposes such as cutting and hemostasis. The lip knife is different from the traditional electric knife: the electric knife relies on the high heat generated by the device itself to cut, stop bleeding, etc., and the wound looks like a scorch. There are many types of "blade" of Lip Knife, including ring, spherical, needle, triangle, square, etc., to meet the needs of different area sizes, depth of lesions, and therapeutic efficacy. It is a minimally invasive surgery, with small tissue damage and a depth of damage less than 20 mm. The phenomenon of tissue pulling and carbonization caused by traditional electrocautery rarely occurs, and the pain is small. No anesthesia or only local infiltration anesthesia is used. Lip knife is generally used for cervical diseases, such as cervical erosion caused by chronic cervicitis, cervical valgus, cervical leukoplakia, cervical polyps, Nessler's cyst, etc. It is also suitable for cervical condyloma, severe atypical hyperplasia of cervical cells, etc. But it is not suitable for cervical carcinoma in situ, because some studies have pointed out that the recurrence rate after LEEP treatment of carcinoma in situ is 29%, which is higher than other traditional treatment methods. The operation is generally carried out within 3 to 7 days after the patient's menstrual period is clean, and there is no time limit for women who have been menopausal. Mothers can choose to do it 3 months after delivery and 2 months after miscarriage; According to foreign reports, for pregnant women, Lip Knife surgery can also be performed, and the safety is the same as that of non-pregnant women.

Impacts

Does LEEP have any effect on fertility? Can patients with fertility requirements be treated in this way? This is the question that most people care about. Theoretically, the Lip Knife excises the transitional zone of the cervical epithelium and some of the cervical tissue below it, removes the erosion surface of the cervix, and forms scar tissue, thereby curing the erosion of the cervix, and the effect is remarkable. However, because the cervix is ​​damaged, it will have a potential impact on fertility after surgery: part of the cervical tissue and cervical canal tissue will be removed during the operation, which may cause cervical canal adhesions and cervical canal fibrous tissue hyperplasia, making it difficult to dilate the cervical canal during natural childbirth. Prolonged labor, or acquired cervical insufficiency due to shortening of the cervical canal, resulting in late spontaneous abortion, premature labor, and acute labor. Clinically, there are many controversies in the medical community at home and abroad about the effect of LEEP on pregnancy. A more consistent view is that when the resection is too deep (greater than 25 mm), the increased risk of preterm birth is almost inevitable, and it has a certain impact on pregnancy; however, in patients after LEEP, if the length of the cervical canal is adequately examined by transvaginal B-ultrasound, Trial delivery is still possible. Therefore, its effect on pregnancy is largely dependent on the depth of resection, which in turn is related to the condition of the lesion and the proficiency of the physician. For patients with severe cervical inflammation, long-term cure, and no fertility requirements, LEEP may be a good treatment method. However, due to the risk of fertility, clinicians generally do not recommend this operation for patients with mild or moderate cervical erosion, and more careful consideration should be given to women who are sterile or who are planning to have a second child.

Compare

There are various physical therapy methods for severe cervical erosion, among which microwave, focused ultrasound and Lip knife. What are the characteristics of each of these three, and how to choose? Microwave therapy cannot remove the affected area, but generates a microwave electromagnetic field through the probe, which makes the ions in the local tissue vibrate and rotate rapidly, and instantaneously generate a small range of high heat, cauterizing the affected area to achieve the purpose of treatment. Focused ultrasound therapy relies on biological effects such as thermal effect and cavitation effect generated by the interaction of ultrasound with biological tissues to treat cervical lesions. Because ultrasound has good tissue penetration, it can act deep in the cervical tissue, and the cells of the diseased tissue are more sensitive to the action of ultrasound, so it can destroy the deep diseased cells. Compared with the Lip Knife, the depth of microwave treatment is limited, and the boundary of tissue destruction by focused ultrasound is not clear enough, so the first two are slightly inferior in the cure rate of severe cervical erosion. Moreover, microwave and focused ultrasound cannot take tissue for pathological examination. Even if a cervical smear, colposcopy or biopsy has been done before surgery, there will be a certain chance of missed diagnosis. It can reduce the missed diagnosis of cervical cancer and uterine intraepithelial neoplasia, so that patients can receive timely treatment. However, the adverse reactions of focused ultrasound treatment are small, there is no acute tissue necrosis visible to the naked eye, and there is no process of knot shedding and epithelial repair after other physical therapy treatment, so there is no obvious bleeding after treatment, only transient congestion, Edema, or a small amount of vaginal discharge. The adverse reactions and severity of microwave therapy are similar to LEEP, with more vaginal bleeding and fluid than menstrual flow, but because the effect of microwave is relatively shallow, the risk of causing excessive cervical damage and affecting pregnancy is relatively small. If the indications are met, and the patient wants a one-time cure, and is unwilling to spend time and money again, the Lip Knife treatment with a high single-shot cure rate and pathological diagnosis is a better choice.

(责任编辑：Emergency treatment)

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