Sagot P, Lopes P, Audoin A F, Dantal F, Anger P, Lerat M F
Département de Gynécologie-Obstétrique et Biologie de la Reproduction, CHR Nantes.
J Gynecol Obstet Biol Reprod (Paris). 1988;17(5):661-74.
Carbon dioxide laser was used in 79% of the 141 conservative treatments carried out for grade 3 cervical intra-epithelial neoplasia (CIN III) between the years 1982 and 1986 (41% vaporized and 38% coned out by using the laser as against 21% that were treated by scalpel conisation. The mean age of the women treated in this way by the laser was low (28.5 years of age and 32.5 years as against 38.1). Their parity was also low (0.8 and 1.2 as against 2.2). The lesions were very often spread out on the ectocervix and sometimes going into the vagina (26 and 9% as against 26%) or associated with koilocytosis (65.5 and 47.2% as against 41.3%). In one out of two cases vaporisation of the lesion is contra-indicated and the three diagnostic methods that are used (an ecto and endocervical smear, colposcopy and multiple directed small biopsies) do not make it certain that there is no underlying invasion of the tissues. Vaporisation and conisation are easily carried out under colposcopic control and are associated with widespread lesions at the squamo-columnar junction. These treatments sometimes have to be repeated; then they give a cure rate of 92-96% as against 96%. They are more reliable than conventional surgery for widespread lesions and they do make it possible to keep to the morphology of the cervix and thus make it possible for the cervix that is treated to behave more physiologically. It is also much easier and more reliable in these cases to carry out follow-up for carcinoma. This follow-up should be carried out on two occasions. The triple diagnostic method should be carried out again at the third month (2 smears, colposcopy and colposcopically directed small biopsies). This makes it possible to diagnose and treat early the cases where there has been failure of the original treatment. Then ecto and endocervical smears should be repeated at 3-monthly intervals, then at 6-monthly intervals and finally annually to screen for recurrences of these neoplastic conditions, and for koilocytosis which sometimes repeat themselves in an extensive manner.
1982年至1986年间，对141例3级宫颈上皮内瘤变（CIN III）进行的保守治疗中，79%使用了二氧化碳激光（41%采用激光汽化，38%采用激光锥形切除，而采用手术刀锥形切除的占21%）。接受激光治疗的女性平均年龄较低（分别为28.5岁和32.5岁，而采用手术刀锥形切除的为38.1岁）。她们的产次也较低（分别为0.8和1.2，而采用手术刀锥形切除的为2.2）。病变常常累及宫颈外口，有时还会蔓延至阴道（分别为26%和9%，而采用手术刀锥形切除的为26%），或伴有挖空细胞（分别为65.5%和47.2%，而采用手术刀锥形切除的为41.3%）。在二分之一的病例中，病变汽化是禁忌的，并且所采用的三种诊断方法（宫颈外口和宫颈管涂片、阴道镜检查和多处定向小活检）并不能确定是否不存在潜在的组织浸润。汽化和锥形切除在阴道镜控制下很容易进行，并且与鳞柱状交界处的广泛病变有关。这些治疗有时需要重复进行；重复治疗后的治愈率为92 - 96%，而采用手术刀锥形切除的治愈率为96%。对于广泛病变，它们比传统手术更可靠，并且确实能够保持宫颈的形态，从而使接受治疗的宫颈表现得更接近生理状态。在这些病例中，对癌症进行随访也更加容易和可靠。这种随访应分两次进行。在第三个月应再次采用三联诊断方法（2次涂片、阴道镜检查和阴道镜引导下的小活检）。这使得能够早期诊断和治疗最初治疗失败的病例。然后，应每隔3个月、6个月，最后每年重复进行宫颈外口和宫颈管涂片，以筛查这些肿瘤性疾病的复发情况以及有时会广泛复发的挖空细胞。
