Mathevet P, Dargent D, Roy M, Beau G
Department of Gynecology and Obstetrics, Hôpital E. Herriot, Lyon, France.
Gynecol Oncol. 1994 Aug;54(2):175-9. doi: 10.1006/gyno.1994.1189.
Three different techniques of cervical excision, cold knife conization, laser conization, and loop electrosurgical excisional procedure (LEEP) were prospectively compared with respect to treatment reliability, effectiveness, and safety. One hundred ten women with CIN1-2 and the squamnocolumnar junction not seen or CIN3 at the original diagnosis were randomized to treatment with cold knife conization (n = 37), laser conization (n = 37), or LEEP (n = 36). All three treatments were performed with local anesthesia on an outpatient basis. The mean age, histologic features (original and histology of the conization), endocervical involvement, and ectocervical extension were similar in the three groups. Blood loss and operating time were less (P < 0.01) in the LEEP group (5.4 cc of mean blood loss and 5.4 min mean duration time) than in the two other groups (16.2 cc and 14.0 min for cold knife conization, 21.5 cc and 15.6 min for laser conization). Volumes of the cones were evaluated: LEEP cones and laser cones were smaller than the cold knife cones (P < 0.001). During the pathological review of the conization, the major problem was difficulty in evaluating the lesion and its margins due to the coagulation induced by the laser or the LEEP. This alteration was present in 53% of the LEEP conization specimens and in 51% of the laser conization specimens. In the majority of the cases the coagulation was mild, but in one case (LEEP group) and in two cases (laser group) the conization was totally altered by the coagulation, and in 31% of all the LEEP conizations and 38% of all the laser conizations, evaluation of the entire margin was not possible due to coagulation of the tissue. During postoperative follow-up, the number of complications was the same in the three groups (two episodes of post-operative bleeding in each of the three groups). Two months after the treatment the cervix was evaluated: the os was diminished in the cold knife group compared to the two other groups and as a result, the squamnocolumnar junction was not seen in entirety in 50% of cold knife cases, in 19% of LEEP cases, and in 20% of laser cases. These results suggest that in our hands: (1) laser conization is relatively costly and time consuming and alters the tissues significantly, and (2) the choice between cold knife and LEEP is more difficult--cold knife gives a sample adequate for histological evaluation (including evaluation of the margins), while the LEEP procedure is technically easier and less time consuming but sometimes induces electrocautery artifact so that evaluation of the margins is not possible.
对宫颈切除的三种不同技术，即冷刀锥切术、激光锥切术和环形电切术（LEEP），在治疗可靠性、有效性和安全性方面进行了前瞻性比较。110例最初诊断为CIN1-2且未见到鳞柱交界或CIN3的女性被随机分为冷刀锥切术治疗组（n = 37）、激光锥切术治疗组（n = 37）或LEEP治疗组（n = 36）。所有三种治疗均在门诊局部麻醉下进行。三组的平均年龄、组织学特征（锥切术的原始及术后组织学情况）、宫颈管受累情况及宫颈外口扩展情况相似。LEEP组的失血量和手术时间较少（P < 0.01）（平均失血量5.4 cc，平均持续时间5.4分钟），低于其他两组（冷刀锥切术分别为16.2 cc和14.0分钟，激光锥切术分别为21.5 cc和15.6分钟）。对锥切组织的体积进行了评估：LEEP锥切组织和激光锥切组织小于冷刀锥切组织（P < 0.001）。在锥切术的病理检查过程中，主要问题是由于激光或LEEP引起的凝固，难以评估病变及其边缘。这种改变在53%的LEEP锥切标本和51%的激光锥切标本中存在。在大多数情况下，凝固较轻，但在1例（LEEP组）和2例（激光组）中，锥切术完全被凝固改变，在所有LEEP锥切术的31%和所有激光锥切术的38%中，由于组织凝固无法评估整个边缘。在术后随访期间，三组的并发症数量相同（三组各有2例术后出血）。治疗两个月后对宫颈进行评估：与其他两组相比，冷刀组宫颈外口缩小，因此，50%的冷刀病例、19%的LEEP病例和20%的激光病例中未完全见到鳞柱交界。这些结果表明，在我们的研究中：（1）激光锥切术成本相对较高且耗时，对组织的改变较大；（2）冷刀锥切术和LEEP之间的选择更为困难——冷刀锥切术能提供足够的组织样本用于组织学评估（包括边缘评估），而LEEP操作在技术上更简单、耗时更少，但有时会产生电灼伪像，导致无法评估边缘情况。
