Butorac Dražan, Škrtić Bernarda, Pitner Iva, Kuna Krunoslav, Djaković Ivka
Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
Acta Clin Croat. 2024 Oct;63(2):300-305. doi: 10.20471/acc.2024.63.02.5.
The aim was to compare the efficiency of large loop excision of the transformation zone (LLETZ) and cold-knife conization according to the incidence of positive cone margins in histopathologic analysis of the cervical cone. In the study, data obtained from 568 female patients with cone biopsy due to cervical changes during a four-year period (2012-2015) were retrospectively analyzed. Group 1 included patients who were operated on using LLETZ technique and group 2 consisted of patients with cold-knife cone biopsy. LLETZ was a method of choice in 334 (59%) patients, whereas 234 (41%) patients underwent cold-knife cone biopsy. The percentage of positive cone margins was much higher with LLETZ technique, even 39% (131 patients), as compared to 20% with cold-knife cone biopsy. In conclusion, the technique and cone configuration should be individualized, depending on the specifics of the lesion. The transformation zone is not always removed during one LLETZ procedure. High percentage of positive cone margins is not a disadvantage of LLETZ technique because of differences in indications, approach and multiple cutting. The real success of conization can be measured only by the relapse frequency over a long period of time with a high number of patients.
目的是根据宫颈锥切组织病理学分析中切缘阳性的发生率，比较转化区大环状切除术（LLETZ）和冷刀锥切术的效率。在该研究中，对2012年至2015年四年期间因宫颈病变接受锥切活检的568例女性患者的数据进行了回顾性分析。第1组包括采用LLETZ技术进行手术的患者，第2组由接受冷刀锥切活检的患者组成。334例（59%）患者选择LLETZ方法，而234例（41%）患者接受冷刀锥切活检。LLETZ技术的锥切缘阳性百分比要高得多，甚至达到39%（131例患者），而冷刀锥切活检为20%。总之，技术和锥切形态应根据病变的具体情况个体化。在一次LLETZ手术中并不总是能切除转化区。锥切缘阳性百分比高并非LLETZ技术的缺点，因为在适应证、手术方式和多次切割方面存在差异。锥切术的真正成功只能通过大量患者长期的复发频率来衡量。
