Yap Shui-Jean, Nathan Elizabeth, Farrell Louise
King Edward Memorial Hospital, Perth, Western Australia, Australia.
Department of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2020 Jun;60(3):438-443. doi: 10.1111/ajo.13121. Epub 2020 Jan 30.
Large loop excision of the transformation zone (LLETZ) is the preferred treatment for cervical intraepithelial neoplasia due to its effectiveness and ability to be performed in an outpatient setting under local anaesthesia (LA). Although current guidelines recommend that most LLETZ can be performed under LA, there is paucity in clinical data of patients' perspectives of outpatient LLETZ.
Determining patient acceptability of outpatient LLETZ through assessment of anxiety and pain scores, and comparing treatment outcomes with current standards in terms of margins status, negative histology, short-term morbidity rates and follow-up attendance.
This study was conducted at a tertiary hospital over two years (2014-2016). Patients undergoing outpatient LLETZ completed a three-part questionnaire (before, immediately after and 4-6 weeks post-procedure).
One hundred and five patients underwent outpatient LLETZ. Mean pain score was 2 (range 0-8). Pre-procedure anxiety was common but most resolved post-procedure. Women who did not have a prior LLETZ discussion were more likely to report moderate-severe anxiety levels pre-procedure, compared with women who did (odds ratio 3.00, 95% CI 1.11-8.09, P = 0.030). There were no differences found in pain scores when comparing pre-procedure anxiety levels, prior discussion of LLETZ or mode of anaesthesia. Specimen margins were involved in 42.9%. No association was found between positive cervical margin status and age, pre-procedure anxiety or post-procedure pain scores. Most patients were satisfied and attended follow-up appointments.
Large loop excision of the transformation zone under LA is a well-tolerated procedure with high satisfaction and follow-up rates. Clinicians need to initiate early discussions regarding treatment to minimise procedure-related anxiety.
由于其有效性以及能够在门诊局部麻醉（LA）下进行，转化区大环形切除术（LLETZ）是宫颈上皮内瘤变的首选治疗方法。尽管当前指南建议大多数LLETZ可在局部麻醉下进行，但关于患者对门诊LLETZ看法的临床数据却很匮乏。
通过评估焦虑和疼痛评分来确定患者对门诊LLETZ的可接受性，并在切缘状态、组织学阴性、短期发病率和随访依从性方面将治疗结果与当前标准进行比较。
本研究在一家三级医院进行，为期两年（2014 - 2016年）。接受门诊LLETZ的患者完成了一份三部分问卷（术前、术后即刻以及术后4 - 6周）。
105例患者接受了门诊LLETZ。平均疼痛评分为2分（范围0 - 8分）。术前焦虑很常见，但大多数在术后得到缓解。与进行过LLETZ术前讨论的女性相比，未进行过LLETZ术前讨论的女性更有可能报告术前存在中度至重度焦虑水平（比值比3.00，95%可信区间1.11 - 8.09，P = 0.030）。在比较术前焦虑水平、LLETZ术前讨论情况或麻醉方式时，疼痛评分未发现差异。42.9%的标本切缘受累。宫颈切缘阳性状态与年龄、术前焦虑或术后疼痛评分之间未发现关联。大多数患者感到满意并参加了随访预约。
局部麻醉下的转化区大环形切除术耐受性良好，满意度和随访率较高。临床医生需要尽早开始关于治疗的讨论，以尽量减少与手术相关的焦虑。
