It has become a consensus that cold knife conization (that is, conization with scalpel to remove part of cervical tissue, hereinafter referred to as conization) can effectively reduce the incidence of cervical cancer. The scope of surgical resection of cervical tissue starts from the normal tissue outside the cervical lesion area, and most of the cervical and cervical canal mucosa are removed conically. All the resected tissues have histopathological diagnosis, so special attention should be paid to whether there are high-grade lesions at the resection edge, so as to make a clear diagnosis and CIN classification and guide the next treatment. This paper summarizes the common precautions behind the cone.

1, general nursing after operation: After discharge, the patients' diet is mainly high in nutrition, high in protein, rich in vitamins and easy to digest, avoiding excessive spicy food, paying attention to rest, staying in bed as much as possible, and avoiding strenuous activities and heavy physical activities; Leucorrhea began to appear around 1 week after operation, and it was a pale bloody liquid, which may last for 1-3 months. This is because the shape of the cervix is reshaped after conization, and there will be a lot of secretions during the healing process. If the secretion is not removed in time, on the one hand, it will affect the healing, on the other hand, there will be the risk of infection. In the meantime, it is important to have a serious vaginal irrigation. The experience of our hospital is to wash vagina every other day with 5ml of 36% cresol sulfonic acid solution mixed with 200-250ml warm water (the ratio is about 1:40 ~ 1:50). Of course, vaginal irrigation should be stopped during menstruation and when there is obvious vaginal bleeding. In addition, during this period, the vulva should be kept clean, sexual life is forbidden (abstinence for 3 months is recommended), and bath and sitz bath are forbidden. In addition, due to pelvic congestion after conization, patients may have lower abdominal discomfort and abdominal distension, which can be relieved after about 3 months. This is normal, so don't be too nervous.

2. Treatment of common complications after coning:

① Postoperative bleeding: Cases of recurrent bleeding from cervical wound after conization often occur, mostly scabbing bleeding. This kind of desquamation bleeding often occurs 1-2 weeks after coning and lasts 1-2 weeks. For patients, scab bleeding generally does not need treatment, but if the amount of vaginal bleeding reaches or exceeds menstrual flow and the color is bright red, they should go back to the hospital in time for corresponding treatment, such as vaginal gauze packing to stop bleeding. If the compression fails, it may be necessary to perform cervical suture again.

② Pelvic infection: Necrosis and bleeding of cervical wound tissue destroyed the physiological environment and immune function of cervix and vagina, on the one hand, it provided good survival and reproduction conditions for pathogens parasitic in vagina and cervix, and increased the risk of infection. Therefore, if you have fever, lower abdominal pain, increased leucorrhea, turbidity, purulent, smelly, etc., you should see a doctor in time.

③ Cervical adhesion: In the process of shaping and healing of cervical wound after conization, cervical adhesion will occur if vaginal irrigation is not serious, or the cervical dilatation during operation is not enough, or the cervical packing time after operation is not long enough. If menstrual blood is not discharged smoothly after conization, and it accumulates in the uterine cavity and causes obvious lower abdominal pain, the patient should seek medical attention in time.

(4) Cervical incompetence: due to the loss of cervical mucosa, the secretion of mucus is reduced, and the cervix is slack, the barrier function of the cervix against the invasion of foreign pathogens is lost. When the lower reproductive tract is infected, the pathogens are more likely to spread upwards, causing internal reproductive tract and pelvic infection, resulting in infertility; On the other hand, for women who have fertility requirements, the probability of spontaneous abortion is higher than that of those who do not have conization, especially in the second trimester, attention should be paid to whether there are obvious symptoms of cervical relaxation and threatened abortion (including vaginal bleeding and abdominal pain). ), if necessary, it is necessary to perform internal cervical ligation at 12- 18 weeks of pregnancy to reduce abortion and abortion.

3. Further treatment of pathology after conization.

① Positive margin: Pathological margin after cervical conization may be a risk factor for persistence or recurrence of CIN. According to the level of CIN at the margin, the monitoring of high-risk human papillomavirus, the patient's age, willingness and follow-up, the corresponding treatment was made. If the cutting edge is CINI, it can be observed without treatment; If the incision edge is CINII-III, they will be followed up for 3-6 months for liquid-based cytology or cervical conization. Total hysterectomy is feasible for patients with CINⅲ incision, unable to repeat conization, no fertility requirements and difficult follow-up If it is carcinoma in situ, active treatment is recommended because it is multifocal and jumping lesion.

② Invasive carcinoma of the cervix: Because the biopsy site is limited, the scope of cervical tissue is large during conization, and there may be invasive carcinoma foci that were not found before conization. It is generally believed that the possibility of cervical precancerous lesion CINⅲ before operation and cervical cancer after operation is about 5%. If the postoperative pathology is cervical cancer, corresponding surgical treatment can be taken. Patients with this kind of cervical cancer generally stage earlier, and the prognosis is generally better after further treatment, so there is no need to be too nervous.

4. Follow-up after conization

The recurrence risk of patients with negative margin after CIN cervical conization is obviously reduced, so for such patients, cervical conization treatment is enough, and no further treatment is needed, but long-term close follow-up is still needed. Related studies have found that the recurrence of CIN after conization treatment mostly occurs within 2 years after operation, and it is recommended to follow up every 3 months after operation 1 year/time; Follow-up every 6 months in the second year 1 time; After that, 1 visit every year for 10 years, and then return to the routine screening process. Of course, the follow-up interval can also be determined according to the high-risk human papillomavirus infection. For high-risk patients with negative human papillomavirus, the follow-up interval can be appropriately extended.