红外凝固治疗高级别肛门发育异常的临床效果：系统评价。

Clinical results of infrared coagulation as a treatment of high-grade anal dysplasia: a systematic review.

机构信息

Colorectal Surgery Unit, Department of General Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.

Lluita Contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.

出版信息

Tech Coloproctol. 2019 Aug;23(8):707-712. doi: 10.1007/s10151-019-02041-7. Epub 2019 Jul 23.

DOI:10.1007/s10151-019-02041-7

PMID:31338711

Abstract

BACKGROUND

Anal intraepithelial neoplasia (AIN) (or low/high grade squamous intraepithelial neoplasia (L/HSIL)) is the precursor of anal of early invasive anal cancer. Different treatment options for local ablation of localized lesions have been reported. The aim of this study was to analyze the clinical efficacy and safety of infrared coagulation for the treatment of anal dysplasia.

METHODS

A search of the literature was performed in 2019 using PubMed and Cochrane to identify all eligible trials published reporting data on the treatment of anal dysplasia with infrared coagulation. The percentage of squamous cell carcinoma of the the anus that developed in the follow-up and results on major complications after treatment were the primary outcomes.

RESULTS

Twenty-four articles were identified from which 6 were selected with a total of 360 patients included, with a median age of 41.8 years. Three studies were prospective and 3 retrospective, only one was a randomized trial. All articles included males, 4 articles included HIV-positive women and only one article included non HIV infected males. No patient developed major complications after infrared coagulation therapy. Pain was the most common symptom found after the procedure in the different series and mild bleeding that did not require transfusion was the most common complication occurring in 4 to 78% of patients. Median follow-up was between 4.7 and 69 months. No patient developed squamous cell carcinoma after infrared treatment. Recurrent HSIL varied from 10 to 38%. Two studies reported results from follow-up of untreated patients showing that between 72 and 93% of them had persistent HSIL at last follow-up and 4.8% developed squamous cell carcinoma.

CONCLUSIONS

Infrared coagulation is a safe and effective method for ablation of high-grade anal dysplasia that could help prevent anal cancer. Continued surveillance is recommended due to the risk of recurrence.

摘要

背景

肛门上皮内瘤变（AIN）（或低/高级别鳞状上皮内瘤变（L/HSIL））是肛门早期浸润性癌的前体。已经报道了用于局部消融局限性病变的不同治疗选择。本研究旨在分析红外凝固治疗肛门发育不良的临床疗效和安全性。

方法

2019 年在 PubMed 和 Cochrane 上进行了文献检索，以确定所有发表的关于红外凝固治疗肛门发育不良的数据报告的合格试验。随访中肛门鳞癌的百分比和治疗后主要并发症的结果是主要结局。

结果

从 24 篇文章中确定了 6 篇文章，其中包括 360 名患者，中位年龄为 41.8 岁。3 项研究为前瞻性，3 项为回顾性，仅有 1 项为随机试验。所有文章均包括男性，4 篇文章包括 HIV 阳性女性，仅有 1 篇文章包括非 HIV 感染男性。红外凝固治疗后无患者发生主要并发症。不同系列中最常见的症状是治疗后疼痛，最常见的并发症是轻度出血，发生率为 4%至 78%。中位随访时间为 4.7 至 69 个月。红外治疗后无患者发生鳞状细胞癌。HSIL 复发率为 10%至 38%。两项研究报告了未治疗患者的随访结果，表明最后随访时 72%至 93%的患者仍存在 HSIL，4.8%的患者发生了鳞状细胞癌。