“见即治疗”宫颈转化区电外科环切术

'See and treat' electrosurgical loop excision of the cervical transformation zone.

作者信息

Ferris D G, Hainer B L, Pfenninger J L, Zuber T J

机构信息

Department of Family Medicine, Medical College of Georgia, Augusta 30912, USA.

出版信息

J Fam Pract. 1996 Mar;42(3):253-7.

PMID:8636676

Abstract

BACKGROUND

"See and treat" electrosurgical loop excision of the cervical transformation zone (ELECTZ) is an excisional surgical procedure that enables simultaneous histologic diagnosis and treatment of premalignant cervical disease, thus eliminating the need for a preliminary cervical biopsy and an additional patient visit. Indications for the procedure include an abnormal cervical Papanicolaou (Pap) smear and a colposcopic impression of cervical intraepithelial neoplasia (CIN). The purpose of this study was to assess the "see and treat" ELECTZ procedure performed by family physicians.

METHODS

Women who were scheduled for colposcopic evaluation because of an abnormal cervical cytology report were enrolled from the practices of three family physician colposcopists located at three sites. The "see and treat" ELECTZ procedure was performed on patients with both abnormal Pap smear results and abnormal colposcopic findings. Procedural complications were documented. Subjects were evaluated at follow-up examinations during the first postoperative year to determine therapeutic cure.

RESULTS

"See and treat" ELECTZ was performed on 48 women. The histologic results from "see and treat" ELECTZ were normal for 36.1% of subjects. When subjects with a low-grade lesion on Pap smear were considered, 40.7% had normal loop histologic findings. Of women with a preoperative colposcopic impression of low-grade lesion, 54.2% had normal histologic results, and 12% of women with a high-grade colposcopic impression had normal histologic results (P<.001). When the colposcopic impression was reported as high-grade disease, 82% of loop specimens were reported as CIN 2 or 3.

CONCLUSIONS

Selective use of "see and treat" ELECTZ may be appropriate only when practiced by experienced colposcopists who are able to reliably differentiate low-grade from high-grade disease by means of colposcopy, and if cytologic and colposcopic findings unequivocally indicate high-grade cervical disease.

摘要

背景

“直视并治疗”宫颈转化区电外科环切术（ELECTZ）是一种切除性手术，可同时对宫颈癌前病变进行组织学诊断和治疗，从而无需进行初步宫颈活检以及患者再次就诊。该手术的适应证包括宫颈巴氏涂片异常以及阴道镜检查提示宫颈上皮内瘤变（CIN）。本研究的目的是评估家庭医生实施的“直视并治疗”ELECTZ手术。

方法

从位于三个地点的三名家庭医生阴道镜检查医师的诊所中，招募因宫颈细胞学报告异常而计划接受阴道镜评估的女性。对巴氏涂片结果异常且阴道镜检查结果异常的患者实施“直视并治疗”ELECTZ手术。记录手术并发症。在术后第一年的随访检查中对受试者进行评估，以确定治疗效果。

结果

对48名女性实施了“直视并治疗”ELECTZ手术。“直视并治疗”ELECTZ的组织学结果显示，36.1%的受试者正常。当考虑巴氏涂片为低级别病变的受试者时，40.7%的环形切除组织学结果正常。术前阴道镜检查提示为低级别病变的女性中，54.2%组织学结果正常，而阴道镜检查提示为高级别病变的女性中，12%组织学结果正常（P<0.001）。当阴道镜检查提示为高级别病变时，82%的环形切除标本报告为CIN 2或3。