Chenoy R, Billingham L, Irani S, Rollason T P, Luesley D M, Jordan J A
Academic Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Edgbaston, UK.
Br J Obstet Gynaecol. 1996 May;103(5):457-62. doi: 10.1111/j.1471-0528.1996.tb09773.x.
To determine the effect of directed punch biopsy trauma on the natural history of atypical cervical transformation zones.
A prospective randomised clinical trial.
Academic Unit colposcopy clinics in Birmingham.
One hundred and eighty women attending the colposcopy clinics were recruited over an 18 month period, of which 161 were eligible for analysis.
Three-way randomisation of patients into 1. no biopsy, 2. central biopsy and 3. peripheral biopsy groups. Quantitative assessment of the change in surface area and severity of cervical intra-epithelial neoplasia (CIN) lesions in each group measured six weeks apart using digital imaging colposcopy.
No significant difference in change in lesion size (P = 0.40) was noted in the three treatment groups. Results suggest that the severity of the lesion was underestimated by the peripheral biopsy.
The results of this study suggest that directed punch biopsy trauma does not have a significant effect on the immediate natural history of CIN. No statistically significant differences were found in lesion size whether biopsy was employed or not. In addition, the site of biopsy had no influence on the outcome. It appears, therefore, that tissue trauma from punch biopsy and the subsequent inflammatory and wound healing processes do not modify the course of CIN. The regressive changes observed after punch biopsy in previous natural history studies are probably not a result of the initial inflammatory response to biopsy trauma and subsequent re-epithelialisation with normal cells, but may result from processes that continue long after tissue repair is completed.
确定定向活检穿刺创伤对非典型宫颈转化区自然病程的影响。
一项前瞻性随机临床试验。
伯明翰的学术单位阴道镜诊所。
在18个月期间招募了180名到阴道镜诊所就诊的女性，其中161名符合分析条件。
将患者随机分为三组：1. 不进行活检；2. 中央活检；3. 周边活检。使用数字成像阴道镜，每隔六周对每组宫颈上皮内瘤变（CIN）病变的表面积变化和严重程度进行定量评估。
三个治疗组在病变大小变化方面无显著差异（P = 0.40）。结果表明，周边活检低估了病变的严重程度。
本研究结果表明，定向活检穿刺创伤对CIN的近期自然病程没有显著影响。无论是否进行活检，病变大小均未发现统计学上的显著差异。此外，活检部位对结果没有影响。因此，活检穿刺造成的组织创伤以及随后的炎症和伤口愈合过程似乎并未改变CIN的病程。在以往自然病程研究中，活检穿刺后观察到的退行性变化可能不是对活检创伤的初始炎症反应以及随后正常细胞重新上皮化的结果，而是可能源于组织修复完成后很长时间仍在继续的过程。
