Mosseri Juliette, Hocquemiller Raphaël, Mergui Jean-Luc, Uzan Catherine, Canlorbe Geoffroy
Assistance Publique des Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière hospital, Department of Gynecologic and Breast Surgery and Oncology, Paris, France.
Assistance Publique des Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière hospital, Department of Gynecologic and Breast Surgery and Oncology, Paris, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France.
J Gynecol Obstet Hum Reprod. 2022 Apr;51(4):102341. doi: 10.1016/j.jogoh.2022.102341. Epub 2022 Feb 16.
To evaluate the effectiveness and obstetric outcomes after laser conization for cervical intraepithelial neoplasia.
This retrospective study included 757 patients who underwent laser conization between 2014 and 2020. Patients with a diagnosis of invasive lesions or adenocarcinoma in situ were excluded. Histological data from the conization specimen, pre and postoperative histological and virological data (Human PapillomaVirus (HPV) test) and obstetric outcomes were collected from the medical record. The primary endpoint was the negative surgical margin rates after laser conization. The secondary endpoint were the size of the operative specimen, the postoperative virological test results (3 to 6 months after surgery), factors associated with negative or positive margin and postoperative obstetric outcomes (prematurity). Patient characteristics and outcomes were compared using Student's t-test, χ² test, or Fisher exact test. Values of p ≤ 0.05 were considered significant.
This study included 757 patients. Negative surgical margins were obtained in 76.1% of the cases and were associated with more negative HPV tests at 6 months (64.9% vs. 52.5%, p = 0.006) and fewer repeat surgeries (0.2% vs. 2.2%, p = 0.013) than for patients with positive margins. Among the patients under 43 years at the time of conization, 71 achieved a pregnancy with a term >22 weeks, and of these 66 (93%) delivered at term (≥37 weeks).
Laser conization appears to be an effective technique for the management of cervical intraepithelial neoplasia both in terms of the quality of the resection margins and the obstetric prognosis.
评估宫颈上皮内瘤变激光锥切术后的有效性及产科结局。
这项回顾性研究纳入了2014年至2020年间接受激光锥切术的757例患者。排除诊断为浸润性病变或原位腺癌的患者。从病历中收集锥切标本的组织学数据、术前和术后的组织学及病毒学数据（人乳头瘤病毒（HPV）检测）以及产科结局。主要终点是激光锥切术后手术切缘阴性率。次要终点是手术标本大小、术后病毒学检测结果（术后3至6个月）、与切缘阴性或阳性相关的因素以及术后产科结局（早产）。使用学生t检验、χ²检验或Fisher精确检验比较患者特征和结局。p≤0.05的值被认为具有统计学意义。
本研究纳入757例患者。76.1%的病例获得了阴性手术切缘，与切缘阳性的患者相比，术后6个月HPV检测阴性的比例更高（64.9%对52.5%，p = 0.006），再次手术的比例更低（0.2%对2.2%，p = 0.013）。在锥切时年龄小于43岁的患者中，71例实现了孕周>22周的妊娠，其中66例（93%）足月分娩（≥37周）。
就切除切缘质量和产科预后而言，激光锥切术似乎是治疗宫颈上皮内瘤变的一种有效技术。
