The management of cervical intraepithelial neoplasia: the use of the carbon dioxide laser

Vaporização a laser do cervix para tratamento da neoplasia intraepitelial cervical

O câncer cérvico-uterino é muito comum em vários países da América Latina. As estatísticas de mortalidade e as taxas de incidência demonstram a sua real importância. O cânver cérvico-uterino freqüentemente é uma doença progressiva iniciada com mudanças intra-epiteliais, que podem se transformar em um processo invasivo, sendo o nosso objetivo tratar precocemente estas lesões quando ainda é possível a cura de 100%. Em nosso estudo prospectivo foram selecionadas 21 pacientes com neoplasia cervical intra-epitelial reatreadas pela citplogia e diagnosticadas pela histopatologia após biópsia dirigida pela colposcopia. O método terapêutico empregado foi a vaporização a laser com o CO2. Tiveram como pré-requisito os seguintes critérios: informação segura pela colposcopia da zona de transformação e afastar a presença de câncer invasivo; a neoplasia epitelial cervical deve ocupar a ectocervix sem nenhuma extensão para o canal cervical e correlação positiva entre a citologia, colposcopia e histologia. O uso de laser CO2 com microscópio permitiu precisão na aplicação e com vantagens de ser um procedimento ambulatorial diminuindo estresse cirúrgico das pacientes. Foi realizado sem anestesia e com duração média de 15 minutos. A cicatrização completou-se em torno de três semanas e com cuidados operatórios mínimos. Somente dois casos tiveram sangramento vaginal discreto no quinto e décimo dia de pós-operatório, resolvido com tamponamento vaginal por 24 horas. A colposcopia, cirurgia e o seguimento foram feitos pelo autor, tendo uma paciente sido submetida a uma segunda vaporização no quinto mês de controle. Somente uma paciente teve recidiva no 26° mês de seguimento e complementará o tratamento. As vinte outras restantes estão em controle sem recidiva de doença. Em vista dos resultados obtivemos um percentual de cura de 95%, que coincide com a literatura. O uso de laser CO2 no tratamento das neoplasias cervicais intra-epiteliais (NIC) ou virais tem sido estimulado como uma alternativa digna de ser seguida pelas seguintes razões: cirurgia de não contato, tratamento rápido e indolor, diminuição das custas da internação; complicações mínimas e sem efeito subseqüente sobre a fertilidade e competência cervical, menor necrose térmica, e possibilidade de novo tratamento ambulatorial. Por estas razões e pelo alto percentual de cura podemos concluir que a cirurgia proposta foi vantajosa para o tratamento da neoplasia cervical intra-epitelial, quando comparada com outros métodos de tratamento.

A prospective study of the treatment of cervical intraepithelial neoplasia by loop electrosurgical excision procedure (LEEP) in Hong Kong population

From May to December 1990, 72 patients suffering from cervical intraepithelial neoplasia confirmed with guided biopsy were treated with loop electrosurgical excision procedure (LEEP) as outpatients under local anaesthesia. Overall success rate of a single treatment at 6 weeks follow-up was 88.9%. All the specimens obtained from the procedure were of good quality for histological examination. The overall significant complication rate of the procedure was 4.2% during treatment and 8.4% after treatment. The results suggested that LEEP is an effective and safe outpatient treatment for CIN lesions. It is easy to use and readily acceptable to patients. It also has the advantage of providing histological confirmation and more economical than the use of laser.

Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100 degrees C using the Semm cold coagulator: 14 years experience

A total of 1628 women with CIN 3 treated with the Semm cold coagulator between 1975 and 1989 was followed primarily by cytology. The standard suitability criteria for ablation were adhered to except that patients were treated at their first visit when the colposcopist expected that the diagnosis would be no worse than CIN 3. Overall 97% of the women were treated at their first visit. In 30 women (2%) the histology was glandular or worse than expected, but 22 of these showed no persistent cervical disease subsequently. Follow-up was achieved for 87% at 10 years. In actuarial terms the primary success rate was 95% at 1 year and 92% at 5 years, it was similar for all age groups. Repeat cold-coagulation for persistent/recurrent CIN 3 was less successful and is not advised. The outcome for 226 pregnancies established after treatment is known. The rates for miscarriage, preterm or operative delivery were not increased. Cold-coagulation of CIN 3 at 100 degrees C as performed by us is as effective as any other treatment and calls into question the need for more expensive practices.

Laser surgery for cervical intraepithelial neoplasia: principles and results

Four hundred twenty-nine consecutive cases of cervical intraepithelial neoplasia were managed by one of three techniques of carbon dioxide laser surgery: dome-shaped vaporization of ectocervical lesions, cylinder-shaped excision of endocervical disease, or a combination of the two in the case of ectocervical disease that extended into the lower cervical canal. Ninety-two patients (21.5%) had grade 1, 137 (31.9%) had grade 2, and 200 (46.6%) had grade 3 cervical intraepithelial neoplasia. The success rates subsequent to one surgical intervention were 97.8% for grade 1, 94.9% for grade 2, and 94.5% for grade 3 of the disease. Success for the entire patient population was 95.3% after the first treatment. A second treatment was required in 20 cases: 18 laser procedures and two hysterectomies. The overall success of laser surgery (one or two procedures) approached 100%. Complications were negligible. These findings suggest that these techniques are very effective in eliminating cervical intraepithelial neoplasia of all degrees when a planned approach is followed.