Between March 1, 1990, and February 29,2992,188 CO2 laser conization were performed. All women enrolled in this study had cervical cytology, colposcopy, and colposcopically directed biopsies. Indications of laser conization were that directed
biopsy
specimen was proved CIN 3 or suggests possible stromal invasion. In all of the cases the procedures were carried out with the patients under local anesthesia. The laser power is turned up to 23 W and the spot size is reduced to 0.5mm in diameter.
The
height of cone specimen was 1.5 to 32cm. The cone apex is cut with a sharp scalpel. Excisional cone sections(2,256) were evaluated for lesion length, depth and clear margin. A patient was considered cured of disease when the Papanicolaou smear
and
colposcopic examination were normal for a period of 1 year or more.
Of the 188 women with managed by laser conization, 96(51.1%) were aged 39 or less and 6(3.2%)were unlliparous. Of the 129 women with diagnosed CIN 3 on a colposcopically directed biopsy, 29(22.5%) were microinvasive carcinoma and 2(1.6%) were
invasive
carcinoma of the cervix. 17(9.0%) women had the diagnosis of invasive carcinoma made on conization in the absence of any cytological, colposcopical or directed punch biopsy forewarning of invasive carcinoma.
CIN 3, 135(91.8%) women who had a laser conization showing negative margin, 135(100%) had no evidence of persistent or recurrent disease during follow-up examination. The 12(8.2%) women who had positive marging were performed hysterectomy.
3(1.6%) women had bleeding that required transfusion. One case of pelvic infection and one case of cervical stenosis were observed.
The laser excisional cone provides a largo and excellent specimen for the pathologist to review because the diameter of burned tissue was 0.2mm.
This study demonstrated tat CO2 laser conization was a highly effective method for treating high grade cervical intraepithelial neoplasia and added benefit of preserving reproductive carcinoma.
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