Department of Human Genetics, McGill University, Montreal, QC, Canada.
BJOG. 2014 Jul;121(8):929-42. doi: 10.1111/1471-0528.12655. Epub 2014 Mar 6.
Cold coagulation is an ablative method for treatment of cervical intraepithelial neoplasia (CIN). Despite reports of efficacy against all grades of CIN (CIN1-3), cold coagulation has been infrequently used since the 1980s, and was absent from the recent Cochrane review on CIN treatment.
To provide a systematic review of cold coagulation efficacy and acceptability for CIN treatment through meta-analysis of clinical reports and a randomised control trial.
A literature search in PubMed, Web of Science, EMBASE, and regional databases yielded 388 papers. Title, abstract and/or reference list review identified 22 papers describing cold coagulation treatment of CIN, with 13 providing adequate data for inclusion in the meta-analysis.
Publications or conference abstracts describing original data (number of women treated, followed up and cured, provider type, cure definition) were retained. No language or publication date limitations were imposed.
Data extracted from 13 studies were pooled, and statistical analyses of proportion cured were conducted with data stratified by lesion grade and study region.
Among 4569 CIN patients treated with cold coagulation, summary proportion cured of 96% [95% confidence interval (CI) 92-99%] and 95% (92-98%) were obtained for CIN1 and CIN2-3 disease, respectively. Side-effects and adverse effects were infrequent, and fertility was not impaired.
Cold coagulation CIN cure rates were comparable to those of other excisional and ablative methods. Cold coagulation is indicated for all grades of CIN, is safe, quick and acceptable, and may be of particular relevance for use in resource-limited settings.
冷刀切除是治疗宫颈上皮内瘤变（CIN）的一种消融方法。尽管有报道称其对所有级别（CIN1-3）的 CIN 均有效，但自 20 世纪 80 年代以来，冷刀切除的应用频率较低，且最近的 CIN 治疗 Cochrane 综述中并未提及。
通过对临床报告和随机对照试验的荟萃分析，提供冷刀切除治疗 CIN 的疗效和可接受性的系统评价。
在 PubMed、Web of Science、EMBASE 和区域数据库中进行文献检索，共获得 388 篇论文。通过标题、摘要和/或参考文献回顾，确定了 22 篇描述冷刀切除治疗 CIN 的论文，其中 13 篇提供了足够的数据进行荟萃分析。
保留描述原始数据（治疗、随访和治愈的女性人数、提供者类型、治愈定义）的出版物或会议摘要。未对语言或出版日期施加限制。
从 13 项研究中提取数据，并根据病变级别和研究区域对数据进行分层，对治愈比例进行统计分析。
在接受冷刀切除治疗的 4569 例 CIN 患者中，CIN1 和 CIN2-3 疾病的总治愈率分别为 96%（95%置信区间 92-99%）和 95%（92-98%）。副作用和不良反应较少，且不影响生育能力。
冷刀切除 CIN 的治愈率与其他切除和消融方法相当。冷刀切除适用于所有级别 CIN，安全、快速且可接受，在资源有限的环境中可能具有特别重要的意义。
