CO_2激光气化治疗高级别阴道上皮内瘤变的价值  

The Value of CO_2 Laser Vaporization in Treatment of High-Grade Vaginal Intraepithelial Neoplasia

作　　者：董晶[1] 汪清[1] 郑瑞莲[1] 陈敏[1] 高蜀君[1] 谢锋[1] 张宏伟[1] 杜明[1] 丰华[1] 刁雯静[1] 宋昱[1] 朱彩英[1] 隋龙[1] 

机构地区：[1]复旦大学附属妇产科医院宫颈疾病诊疗中心,上海200090

出　　处：《实用妇产科杂志》2014年第3期208-211,共4页Journal of Practical Obstetrics and Gynecology

基　　金：上海市科委资助项目(编号:10411961000)

摘　　要：目的：探讨CO2激光气化治疗高级别阴道上皮内瘤变（VAINⅡ-Ⅲ）的疗效。方法：收集2003年3月至2011年8月复旦大学附属妇产科医院宫颈疾病诊疗中心行CO2激光气化治疗178例VAINⅡ-Ⅲ患者的临床资料，回顾性分析其临床效果。结果：①CO2激光气化治疗平均时间8．3分钟（5—10分钟），术中出血量很少（〈1m1）。术后阴道排液平均时间6．7天，妇科检查均未发现阴道黏膜红肿、糜烂、溃疡等异常情况。②术后平均随访36个月（15～119月），其中8例失访。170例患者中，8例在随访时发现癌灶而改手术或放射治疗，占4．71％。其余患者分别经过1～6次激光治疗，累计治愈率分别为59．41％、71．17％、82．35％、88．24％、92．35％、95．29％。③单次激光术后6、12、24、36个月的累计复发率分别为10．59％、18．24％、21．18％、22．35％。多次激光术后6、12、24、36个月的累计复发率分别为2．35％、3．53％、4．71％、5．29％。结论：采用CO，激光气化治疗VAINⅡ～Ⅲ，定位精确、安全有效、损伤小、愈合快，尤其适用于多发性病灶。随着激光次数的递增，累计治愈率逐步提高，随着随访时间的延长，累计复发率的增幅逐渐减缓。CO2激光气化可作为VAINⅡ～Ⅲ的首选治疗方案。Objective：To evaluate the value of CO2 laser vaporization in treatment of high-grade vaginal intraepithelial neoplasia （VAIN Ⅱ ）, Methods：The data of 170 VAIN Ⅱ-Ⅲ patients collected from March 2003 to August 2011 who received CO2 laser vaporization treatment in our hospital, were an- alyzed retrospectively. Results： （2）The average operation duration was 8.3 minutes （ ranging 5～ 10 min）, and the average blood loss was less than 1 ml. The average duration of vaginal discharge after sur- gery was 6.7 days. No red swelling, erosion, or ulcer of vagina was found in gynecological examination. The average follow-up period was 36 months （ranging 15 - 119 months）, of which 8 cases failed to be fol- lowed-up. Among the 170 cases, malignant diseases were observed in 8 patients （4. 71%） during the fol- low-up and they then underwent surgeries and radio therapies. The rest of the patients underwent 1 to 6 cy- cles of laser therapies and the cumulative cure rates were 59.41% ,71.17% ,82.35% ,88.24% ,92, 35%, and 95.29%, respectively. （3）6,12,24, and 36 months after surgery, the cumulative recurrence rates follow- ing single laser therapy were 10.59%, 18.24% ,21.18%, and 22.35%, respectively; while the cumulative recurrence rates following multiple laser therapies were 2.35% ,3. 53% ,4.71%, and 5： 29%, respectively. Conclusions：CO2 laser vaporization is safe and effective for treatment of high-grade VAIN. Its main benefits include accurate positioning, minimal invasion, quick recovery, and feasibility to multiple lesions, The accu- mulative cure rate increases with the treatment cycles.

关 键 词：CO2激光气化 高级别阴道上皮内瘤变 治愈率 

分 类 号：R737.34[医药卫生—肿瘤]