子宮頚部病変のレーザー蒸散療法

Abstract

Between 1979 and 1991, three hundred and sixty-five patients with biopsy proven cervical intraepithelial neoplasia (CIN) with satisfactory colposcopy were treated with the carbon dioxide laser in an outpatient setting and 293 have been followed for one year to 12 years after the laser vaporization. There have been 43 treatment failures, of which 56%of the patients had the second lesion detected during the first year of follow-up. The second lesion consisted of 22 mild dysplasias, 14 moderate dysplasias, 4 severe dysplasias, and 3 CIS. In 6 cases, the grade of the second lesions were higher than that before the laser treatment. There have been no case diagnosed as invasive cancer after laser treatment. The estimated 5-year remission rates calculated by Kaplan-Meier methods were 81.6%for mild dysplasia, 8 2.2%for moderate dysplasia, 82.6%for severe dysplasia and 92.0%for CIS. Of the 43 failures, 11 of the lesions disappeared spontaneously, 26 were treated with repeated laser vaporization, and 6 were treated by conization and/or hysterectomy. Four of the patients with repeated laser recurred and were treated by conization or TVH. All the failure cases have been followed for more than one year after the last treatment and found to have no evidence of disease. Consequently, 283 of 293 cases (96.6%) have been managed satisfactorily by laser treatment alone at outpatient setting. No patients experienced postoperative infection or bleeding requiring hospitalization. These results reconfirm the efficacy and safety of laser vaporization for all form of CIN.