Bertelsen B, Tande T, Sandvei R, Hartveit F
Department of Pathology, The University of Bergen, Haukeland Hospital, Norway.
Acta Obstet Gynecol Scand. 1999 Jan;78(1):54-9.
Various grades of cervical intraepithelial neoplasia may occur following laser conization for grade 3 lesions. The aim of this study was to assess lesion-free survival after laser conization in cases with/without free resection margins, and to test whether detection of human papillomavirus infection and/or p53 expression in the cone lesion were useful predictors of lesion-free survival.
In 598 women treated for cervical intraepithelial neoplasia grade 3 the state of the resection margins was recorded and related to the findings on follow-up, up to 15 years post-operatively. Lesion-free survival times were analyzed by the Kaplan-Meier method. The presence/absence of human papillomavirus infection and/or p53 expression in the primary lesion was investigated in every fifth case by in situ hybridization and immunohistochemistry respectively.
Lesion-free survival was significantly more common after complete than incomplete excision of cervical intraepithelial neoplasia. In the latter, lesions tended to appear shortly after surgery, indicating the presence of residual disease. The few lesions appearing later were evenly divided between those with and those without complete excision. The results of the human papillomavirus and p53 investigations added no further information.
The presence of cervical intraepithelial neoplasia in the cone margin gives strong indication of potential treatment failure. In its absence laser conization is highly effective in the treatment of cervical intraepithelial neoplasia, and has the advantage of providing a specimen suitable for the necessary histological investigation.
3级宫颈上皮内瘤变行激光锥切术后可能出现不同程度的宫颈上皮内瘤变。本研究旨在评估有/无切缘阴性的情况下激光锥切术后无病变生存率，并检测锥切病变中人类乳头瘤病毒感染和/或p53表达是否为无病变生存的有效预测指标。
记录598例接受3级宫颈上皮内瘤变治疗的女性的切缘状态，并将其与术后长达15年的随访结果相关联。采用Kaplan-Meier法分析无病变生存时间。每5例患者中分别通过原位杂交和免疫组化研究原发病变中是否存在人类乳头瘤病毒感染和/或p53表达。
宫颈上皮内瘤变完全切除后的无病变生存明显比不完全切除更常见。在不完全切除的情况下，病变往往在术后不久出现，提示存在残留疾病。后期出现的少数病变在完全切除和未完全切除的患者中分布均匀。人类乳头瘤病毒和p53检测结果未提供更多信息。
锥切边缘存在宫颈上皮内瘤变强烈提示可能治疗失败。在无锥切边缘病变的情况下，激光锥切术在治疗宫颈上皮内瘤变方面非常有效，且具有提供适合必要组织学检查标本的优点。
