子宮頸部病変に対するレーザー円錐切除術

抄録

Between 1985 and 1992, the CO₂ laser conization was used to treat and diagnose 212 women who were diagnosed by cytology studies, colposcopy and biopsy examination to have dysplasia, carcinoma in situ (CIS) and microinvasive carcinoma (MIC). One hundred forty six patients (69%) were performed laser conization in the outpatient unit. One hundred forty eight patients(70%) after conization were followed up by cytology, colposcopy and histology, and 3 moderate dysplasias and koilocytotic atypia (3%) were recurred from 3 patients with CIS and a patient with severe dysplasia, which had been treated by laser conization. One moderate dysplasia and koilocytotic atypia were treated by following laser vaporization. Two moderate dysplasias were treated by following transvaginal hysterectomy and disappeared following cervical biopsy. In 88 follow up cases of CIS and MIC with negative surgical margins, only one case showed moderate dyaplasia 3 years after laser conization. In 18 patient treated by subsequent hysterectomy, who were diagnosed as CIS and MIC with negative surgical margins by pathologic examination of conization specimens, microscopic examination of the hysterectomy specimens revealed moderate and mild dysplasias, but not CIS and MIC. From these results, CO₂ laser conization was a highly effective method for treating cervical intraepithelial lesions and had the added benefit of preserving reproductive function and anatomic integrity. We considered that laser conization could be a therapeutic procedure when both surgical margins of CIS and MIC are negative.