Woman's Health University Center, Assiut University, Assiut, Egypt.
J Low Genit Tract Dis. 2013 Jul;17(3):248-54. doi: 10.1097/LGT.0b013e31827527e3.
This study aimed to compare efficacy, tolerability, and safety of trichloroacetic acid (TCA) painting versus monopolar spray coagulation of the cervix for treating persistent benign cervical lesions.
A prospective randomized controlled trial was done in a tertiary care referral facility and university hospital. A total of 246 cases with objective evidence of benign cervical lesions were divided into 2 groups according to the line of management. Group A was composed of 126 cases subjected to spray monopolar coagulation, whereas group B was composed of 120 cases subjected to TCA application. Cervical smearing and colposcopy with or without cervical biopsy were performed to exclude underlying malignant lesions. Trichloroacetic acid painting or spray monopolar coagulation of the benign cervical lesion(s) was also performed. Follow-up was performed to assess relief of symptoms and cervical morphology for 1 month. Main outcome measures include success of management tool, relief of symptoms, and normal cervical morphology after 1 month of therapy.
A statistically significant cure rate of cervical lesions after treatment in both groups without significant difference between both groups was reported. Failure rate was reported more in group B than group A mainly owing to hypertrophied ectopy and cervical polyp. Patient in group A reported low satisfaction (26.9%) and poor tolerability rate (44.5%) as compared with patients in group B, who reported high satisfaction (77.5%) and good tolerability rate (77.5%), this difference was statistically significant.
Both topical application of 70% TCA and monopolar spray coagulation offer considerable efficacy, acceptable success rates, and minimal complications. Spray coagulation is significantly superior in terms of less persistent or incompletely healed lesions. Nevertheless, topical application of 70% TCA has the advantages of simplicity, higher patient tolerability, and safety, which can be widely used by gynecologists who have limited experience with surgical procedures. It is highly recommended if the cervical lesion is ectopy or nonspecific cervicitis but not hypertrophic lesion such as hypertrophic ectopy or polyp.
本研究旨在比较三氯乙酸（TCA）涂药与宫颈单极喷雾凝固治疗持续性良性宫颈病变的疗效、耐受性和安全性。
在一家三级保健转诊机构和大学医院进行了一项前瞻性随机对照试验。共有 246 例有良性宫颈病变客观证据的患者根据治疗方案分为两组。A 组 126 例患者接受喷雾单极凝固治疗，B 组 120 例患者接受 TCA 应用。进行宫颈涂片和阴道镜检查，必要时进行宫颈活检，以排除潜在的恶性病变。还对良性宫颈病变进行 TCA 涂药或宫颈单极喷雾凝固治疗。进行随访以评估治疗 1 个月后的症状缓解和宫颈形态。主要观察指标包括治疗工具的成功率、症状缓解和治疗 1 个月后宫颈形态正常。
报告了两组患者宫颈病变治疗后均有统计学显著的治愈率，且两组间无显著差异。B 组的失败率高于 A 组，主要是由于宫颈息肉和宫颈肥大。A 组患者的满意度较低（26.9%）和耐受性较差（44.5%），而 B 组患者的满意度较高（77.5%）和耐受性较好（77.5%），差异有统计学意义。
TCA 70%涂药和宫颈单极喷雾凝固均可提供相当的疗效、可接受的成功率和最小的并发症。就持续性或未完全愈合的病变而言，喷雾凝固法具有显著优势。然而，TCA 70%涂药具有简单、更高的患者耐受性和安全性优势，经验有限的妇科医生可广泛应用。如果宫颈病变为异位或非特异性宫颈炎，而非宫颈肥大病变如宫颈息肉或肥大，建议使用 TCA 70%涂药。
