Alvarez R D, Helm C W, Edwards R P, Naumann R W, Partridge E E, Shingleton H M, McGee J A, Hall J B, Higgins R V, Malone J M
University of Alabama at Birmingham 35233-7333.
Gynecol Oncol. 1994 Feb;52(2):175-9. doi: 10.1006/gyno.1994.1027.
Three hundred seventy-five patients with CIN on referral Pap and with a distinct cervical lesion on colposcopy were prospectively randomized to treatment with LLETZ or to standard colposcopic evaluation with directed cervical biopsies, endocervical curettage, and laser ablation of the transformation zone for biopsy proven CIN. Of the 195 patients that randomized to treatment with LLETZ, 32.5% had no evidence of dysplasia, 26.5% had CIN 1, 17.3% had CIN 2, 22.7% had CIN 3, and 0.5% had microinvasive carcinoma on final histologic evaluation. Of the 180 patients randomized to laser ablation, initial cervical biopsies demonstrated no evidence of dysplasia in 52.8% of patients, CIN 1 in 22.0%, CIN 2 in 18.3%, and CIN 3 in 5.7%. Only 114 (63.3%) of the women in the laser group required therapy. Complications were comparable for each treatment arm. Only 6.7% of patients randomized to LLETZ and 4.4% with laser ablation had persistent CIN on follow-up Pap. LLETZ appears to be effective, well tolerated, and less expensive, but the cost savings advantage of LLETZ over laser ablation may not apply to patients with CIN 1 on referral Pap smear since many do not require treatment.
375例转诊巴氏涂片检查发现宫颈上皮内瘤变（CIN）且阴道镜检查发现明显宫颈病变的患者被前瞻性随机分为两组，一组接受环形电切术（LLETZ）治疗，另一组接受标准阴道镜评估，包括定向宫颈活检、宫颈管刮除术以及对活检证实为CIN的转化区进行激光消融。在随机接受LLETZ治疗的195例患者中，最终组织学评估显示32.5%无发育异常证据，26.5%为CIN 1，17.3%为CIN 2，22.7%为CIN 3，0.5%为微浸润癌。在随机接受激光消融的180例患者中，最初的宫颈活检显示52.8%的患者无发育异常证据，22.0%为CIN 1，18.3%为CIN 2，5.7%为CIN 3。激光治疗组中只有114例（63.3%）女性需要治疗。各治疗组的并发症情况相当。随机接受LLETZ治疗的患者中只有6.7%以及接受激光消融治疗的患者中4.4%在随访巴氏涂片检查时有持续性CIN。LLETZ似乎有效、耐受性良好且费用较低，但LLETZ相对于激光消融的成本节约优势可能不适用于转诊巴氏涂片检查为CIN 1的患者，因为许多此类患者不需要治疗。
