Darwish A, Gadallah H
Department of Obstetrics and Gynecology, Assiut University Hospital, Egypt.
Int J Gynaecol Obstet. 1998 Jun;61(3):261-7. doi: 10.1016/s0020-7292(98)00042-3.
To test the value of diagnosing and treating cervical lesions at the first colposcopic visit using large loop excision of the transformation zone (LLETZ) based on abnormal colposcopic findings as compared with punch biopsies followed by subsequent therapy accordingly.
Among 1255 patients with a clinically suspicious cervix, 119 patients with abnormal and satisfactory colposcopy were divided into two groups. In group A (53 patients) multiple cervical punch biopsies were taken. In group B (66 patients), LLETZ under local paracervical anesthesia was done.
Cervical intraepithelial neoplasia was diagnosed in 25 and 29 cases, condyloma acuminatum in seven and six cases, granulomatous cervicitis including tuberculous and bilharzial cervicitis was diagnosed in two and four cases in groups A and B, respectively. Endocervical adenocarcinoma was diagnosed in two cases in group B whereas microinvasive squamous cell carcinoma was diagnosed in one case in each group. Histopathologic assessment of the specimens obtained in group B revealed minimal coagulation artifact, adequate biopsies and free margins in all but three cases (4.5%) who needed further treatment by hysterectomy. In group B, only one case was complicated by a second hemorrhage and the overtreatment rate was 30.3%. On follow-up visits 20 patients (38%) and 59 patients (89%) were satisfied with the procedure in both groups, respectively. Further treatment was required in 29 cases in group A (55%) after initial assessment of punch biopsies and in three cases in group B (4.5%). Persistent abnormal colposcopic findings at follow-up visits 3 months after diathermy coagulation were seen in five patients (9.4%) in group A.
LLETZ at the first colposcopic visit is a practical and fast method of treating most cervical lesions with limited complications and has the advantage of eliminating a second session of treatment. These advantages, particularly in developing countries, may outweigh the high overtreatment rate of this procedure. Many cervical lesions can be properly treated using large loop excision of the transformation zone at the first colposcopic visit. This may help save time and resources, especially in developing countries.
比较基于阴道镜异常发现采用转化区大环形切除术（LLETZ）在首次阴道镜检查时诊断和治疗宫颈病变的价值与先行活检钳活检再相应后续治疗的价值。
在1255例临床怀疑宫颈病变的患者中，119例阴道镜检查异常且满意的患者被分为两组。A组（53例）进行多次宫颈活检钳活检。B组（66例）在宫颈旁局部麻醉下进行LLETZ。
A组和B组分别诊断出25例和29例宫颈上皮内瘤变，7例和6例尖锐湿疣，2例和4例肉芽肿性宫颈炎（包括结核性和血吸虫性宫颈炎）。B组诊断出2例宫颈管腺癌，每组各诊断出1例微浸润鳞状细胞癌。对B组获取标本的组织病理学评估显示，除3例（4.5%）需要子宫切除进一步治疗的病例外，其余病例均有轻微凝血假象、足够的活检组织及切缘阴性。B组仅1例发生二次出血并发症，过度治疗率为30.3%。随访时，两组分别有20例（38%）和59例（89%）对手术满意。A组在活检钳活检初步评估后有29例（55%）需要进一步治疗，B组有3例（4.5%）需要进一步治疗。在电凝治疗3个月后的随访中，A组有5例（9.4%）患者阴道镜检查结果持续异常。
首次阴道镜检查时采用LLETZ是一种治疗大多数宫颈病变的实用且快速的方法，并发症有限，且具有无需二次治疗的优势。这些优势，尤其是在发展中国家，可能超过该手术较高的过度治疗率。许多宫颈病变在首次阴道镜检查时采用转化区大环形切除术即可得到妥善治疗。这可能有助于节省时间和资源，尤其是在发展中国家。
