*Department of Gynecologic Surgery-Gynecologic Oncology, Hospital Universitario Materno-Infantil Vall d'Hebron †Department of Epidemiology and Statistics, Hospitals de la Vall d'Hebron, Barcelona ‡Department of Gynecologic Surgery-Gynecologic Oncology, Hospital Clinic i Provincial de Barcelona, Spain.
J Low Genit Tract Dis. 1997 Oct;1(4):229-33. doi: 10.1097/00128360-199710000-00006.
Our aim was to compare cervical intraepithelial neoplasia (CIN) treatment results in the use of large-loop excision of the transformation zone (LLETZ), laser vaporization, and cold-knife cone biopsy.
We included in the study patients with CIN lesions diagnosed at the Hospital Universitario Materno-Infantil Vall d'Hebron and Hospital Clinic i Provincial de Barcelona, Barcelona, Spain, between March 1991 and March 1994. Patients with unsatisfactory colposcopy were excluded from the study. One hundred twenty-three patients were included in this study: 98 patients were compared for LLETZ treatment versus laser vaporization, and 69 CIN3 patients were compared for three treatments: LLETZ, laser vaporization, and knife cone biopsy. Patients were followed at 3-month intervals for at least 1 year. Follow-up included physical examination, cervical Papanicolaou (Pap) smear, cervical colposcopy, and a colposcopically guided biopsy when required. Treatment failure (persistence or recurrence) was defined by the presence of CIN confirmed histologically by a colposcopically guided biopsy.
The mean age of patients was 34.1 years. The agreement between histology from the colposcopically guided biopsy and the surgical specimen was 60%, and the kappa coefficient was 40.7% (moderate agreement). Three cases of microinvasive carcinoma were diagnosed in patients whose initial diagnosis was CIN3 on colpobiopsy (4% of invasion in the initial CIN3 group of patients). In a comparison of LLETZ with laser treatment for all CIN grades, the unique independent prognostic factor for persistence-recurrence of the disease was the colposcopic size of the primary lesion (relative risk, 4.9; Cl, 1.33-18.45).
We conclude that the LLETZ procedure for CIN treatment demonstrates an advantage over destructive methods for detection of occult microinvasive and invasive cancer. This process is a simple outpatient technique with the same failure as that of laser vaporization in all CIN grades. In the treatment of CIN3, cold-knife cone biopsy had better cure rates. Close follow-up is required in these patients, because of their risk of developing recurrent CIN or invasive carcinoma.
比较经宫颈环形电切术(LLETZ)、激光汽化和冷刀锥切治疗宫颈上皮内瘤变(CIN)的效果。
研究对象为 1991 年 3 月至 1994 年 3 月期间在西班牙巴塞罗那的 Vall d'Hebron 母婴医院和 Clinic i Provincial 医院就诊、经阴道镜检查诊断为 CIN 病变的患者。不符合阴道镜检查标准的患者被排除在研究之外。共有 123 例患者入组本研究:98 例患者比较了 LLETZ 治疗与激光汽化治疗的效果,69 例 CIN3 患者比较了 LLETZ、激光汽化和冷刀锥切 3 种治疗方法的效果。所有患者均至少随访 1 年,每 3 个月进行 1 次随访,包括体格检查、宫颈巴氏涂片、阴道镜检查和必要时行阴道镜引导下活检。治疗失败(持续存在或复发)定义为经阴道镜引导下活检证实的组织学 CIN 病变。
患者的平均年龄为 34.1 岁。阴道镜引导下活检与手术标本的组织学结果一致性为 60%,kappa 系数为 40.7%(中度一致)。3 例初始诊断为 CIN3 的患者诊断为微浸润性宫颈癌(初始 CIN3 组患者的浸润比例为 4%)。在比较 LLETZ 与激光治疗所有 CIN 级别的效果时,疾病持续/复发的唯一独立预后因素是阴道镜下原发病变的大小(相对危险度为 4.9;Cl 为 1.33~18.45)。
我们的结论是,对于隐匿性微浸润和浸润性宫颈癌的检测,LLETZ 治疗 CIN 的效果优于破坏性方法。这是一种简单的门诊技术,在所有 CIN 级别中与激光汽化的失败率相同。在治疗 CIN3 时,冷刀锥切的治愈率更高。由于这些患者有发生 CIN 复发或浸润性癌的风险,需要对其进行密切随访。