Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California.
Obstet Gynecol. 2014 Jun;123(6):1339-1343. doi: 10.1097/AOG.0000000000000287.
Both ablative (cervical cryotherapy, laser ablation) and excisional methods (loop electrosurgical excision procedure, cold knife conization) can be effective at treating cervical precancer. Excisional procedures are associated with adverse obstetric outcomes including preterm delivery and perinatal mortality with the depth of excision potentially contributing to the adverse outcomes. Ablative therapies are now used much less commonly than loop electrosurgical excision procedure but have less of an effect on adverse obstetric outcomes and hence are effective alternatives for treating cervical precancer in reproductive-aged women. Morphometric data indicate that the vast majority of precancerous lesions are less than 5 mm deep, suggesting that treatments that reach 6-7 mm below the epithelium are adequate in women with satisfactory colposcopy. Cone biopsies, "top-hat" loop electrosurgical excision procedures, or the use of loop electrodes greater than 10 mm are therefore unnecessary for the majority of reproductive-aged women and increase risk of adverse obstetric outcomes. New consensus guidelines allow observation instead of treatment in appropriately selected young women. Until the association of excisional methods with adverse obstetric outcomes is clarified with more data, ablative methods should be revitalized and used by health care providers in appropriately selected patients. Treatment should be individualized based on patient's age, fertility desires, and colpopathologic findings.
消融（宫颈冷冻疗法、激光消融）和切除（环形电切术、冷刀锥切术）方法均可有效治疗宫颈癌前病变。切除方法与不良产科结局相关，包括早产和围产儿死亡，切除的深度可能导致不良结局。现在，消融疗法比环形电切术使用得少得多，但对不良产科结局的影响较小，因此是治疗育龄妇女宫颈癌前病变的有效替代方法。形态计量学数据表明，绝大多数癌前病变的深度小于 5 毫米，这表明对于阴道镜检查满意的女性，达到上皮下 6-7 毫米的治疗就足够了。因此，对于大多数育龄妇女来说，锥形活检、“帽子”环形电切术或使用大于 10 毫米的环形电极是不必要的，并且会增加不良产科结局的风险。新的共识指南允许在适当选择的年轻女性中进行观察而不是治疗。在更多数据阐明切除方法与不良产科结局的关联之前，消融方法应得到复兴，并由医疗保健提供者在适当选择的患者中使用。治疗应根据患者的年龄、生育愿望和阴道镜病理检查结果个体化。
