Penna Carlo, Fallani M Grazia, Fambrini Massimiliano, Zipoli Elisa, Marchionni Mauro
Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.
J Reprod Med. 2002 Nov;47(11):913-8.
To evaluate CO2 laser excision, vaporization and combined techniques for treatment of vulvar intraepithelial neoplasia (VIN).
Thirty-nine cases of VIN 3, 15 cases of VIN 2 and 9 of VIN 1, for a total of 63 patients with histologically proven VIN, underwent laser excision or vaporization under colposcopic guidance, using local anesthesia, in an outpatient setting or after day-surgery admission. Clinical aspects, cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia (VaIN) association, types of CO2 laser treatment, follow-up, recurrences and second treatments were evaluated.
Twenty-seven (41.3%) patients underwent laser vaporization, and 37 (58.7%) with VIN 3, underwent laser excision or the combined technique. Colposcopic and biopsy examinations of patients with VIN revealed three cases of CIN 3 and nine cases of VaIN 3; two patients had concomitant VIN 3, CIN 3 and VaIN 3. Local anesthesia, using 2% carbocaine, and outpatient or day-surgery treatments were possible in all cases. A small incidence of intraoperative complications (4.8%) and absence of postoperative complications were observed. A single session was curative in 76.9% of patients treated with laser vaporization and in 78.4% of those treated with laser excision. Eleven cases of recurrent VIN and two cases of invasive vulvar carcinoma were observed during follow-up. A second laser procedure was carred out in all cases of relapsed VIN, with an overall cure rate of 96.8% after two treatments. Radical vulvectomy associated with inguinal-femoral lymphadenectomy was performed in the two cases of invasive carcinoma.
CO2 laser surgery permits treatment of VIN in an outpatient or day-surgery setting under local anesthesia with excellent cosmetic and functional results. The treatment can also be adjusted to the patient's specific needs, with the possibility of calibrating the depth of the vaporized and removed tissues. Excisional treatment is the preferred method because it permits histologic evaluation of the excised tissue and detection of possible occult early invasion.
评估二氧化碳激光切除、汽化及联合技术治疗外阴上皮内瘤变(VIN)的效果。
39例VIN 3、15例VIN 2和9例VIN 1患者,共63例经组织学证实为VIN的患者,在门诊或日间手术入院后,于阴道镜引导下采用局部麻醉,接受激光切除或汽化治疗。评估临床情况、宫颈上皮内瘤变(CIN)和阴道上皮内瘤变(VaIN)的相关性、二氧化碳激光治疗类型、随访、复发情况及二次治疗情况。
27例(41.3%)患者接受激光汽化治疗,37例(58.7%)VIN 3患者接受激光切除或联合技术治疗。对VIN患者进行阴道镜和活检检查发现3例CIN 3和9例VaIN 3;2例患者同时患有VIN 3、CIN 3和VaIN 3。所有病例均可用2%卡波卡因进行局部麻醉,并在门诊或日间手术治疗。观察到术中并发症发生率较低(4.8%)且无术后并发症。单次治疗对76.9%接受激光汽化治疗的患者和78.4%接受激光切除治疗的患者有效。随访期间观察到11例VIN复发和2例浸润性外阴癌。所有复发性VIN病例均进行了第二次激光治疗,两次治疗后总治愈率为96.8%。对2例浸润性癌患者实施了根治性外阴切除术及腹股沟股淋巴结切除术。
二氧化碳激光手术可在局部麻醉下于门诊或日间手术环境中治疗VIN,具有极佳的美容和功能效果。该治疗还可根据患者的具体需求进行调整,能够校准汽化和切除组织的深度。切除治疗是首选方法,因为它允许对切除组织进行组织学评估并检测可能隐匿的早期浸润。