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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2020, Vol. 16 ›› Issue (04): 483 -491. doi: 10.3877/cma.j.issn.1673-5250.2020.04.017

Special Issue: ；

Original Article

Clinical effects of CO2 laser on cervical intraepithelial neoplasia and vaginal intraepithelial neoplasia

Yu Xue1, Dan Wu1,†(), Zhunan Li1, Zhengrong Zhang1, Jing Lin1, Ying Xu1, Zhenhong Xiong1, Dan Cao1   

  1. 1. Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
  • Received:2020-01-08 Revised:2020-05-18 Published:2020-08-01
  • Corresponding author: Dan Wu
  • About author:
    Corresponding author: Wu Dan, Email:
  • Supported by:
    National Key Research and Development Program of China(2018YFC1002102); Shanghai Shen-Kang Hospital Development Center for Clinical Technology Innovation Project(SHDC12016209)
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Objective

To investigate the clinical efficacy of CO2 laser in the treatment of cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia (VaIN).

Methods

A retrospective analysis was conducted on 607 patients with CIN and (or) VaIN, who were hospitalized at International Peace Maternity and Child Health Hospital, Affiliated to Shanghai Jiaotong University School of Medicine from January 2016 to December 2016. Independent-samples t test was used for statistical analysis of age between different patients. Chi-square test was used to compare the composition ratio of different CO2 laser positions, the composition ratio of different CO2 laser times and the history of loop electrosurgical excision procedure (LEEP). Multivariate unconditional logistic regression analysis was used to analyze influencing factors of human papillomavirus (HPV) negative rate and pathological degradation after CO2 laser treatment. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

Results

① The total effective rate of CO2 laser treatment was 95.4% (579/607), and the disease recurrence rate was 4.6% (28/607). Among them, the effective rates of CO2 laser treatment for CIN, VaIN and CIN with VaIN were 95.3% (430/451), 98.1% (102/104) and 90.4% (47/52), respectively. ② After CO2 laser treatment, the negative rate of HPV was 74.1% (450/607). The negative rates of HPV in CIN, VaIN and CIN with VaIN were 80.0% (361/451), 54.8% (57/104) and 61.5% (32/52), respectively. ③ Multiple unconditional logistic regression analysis showed that the history of LEEP (OR=0.500, 95%CI: 0.273-0.915, P=0.025) was an independent protective factor for HPV turning negative 2 years after CIN and/or VaIN patients received CO2 laser treatment. ④ After CO2 laser treatment, the rate of pathological grade reduction was 93.7% (569/607). Among them, the pathological grade reduction rates of CIN, VaIN and CIN with VaIN were 93.6% (422/451), 98.1% (102/104) and 86.5% (45/52), respectively. Multiple unconditional logistic regression analysis showed that the location of CO2 laser treatment was cervix with vagina (OR=11.727, 95%CI: 1.337-102.859, P=0.026), which was an independent risk factor for CIN and/or VaIN patients′ pathological grade reduction after CO2 laser treatment.

Conclusion

CO2 laser treatment of CIN and (or) VaIN is safe and effective. After treatment of CO2 laser, HPV becomes negative and the pathological grade decreases due to different factors in CIN and (or) VaIN patients.

Key words: Cervical intraepithelial neoplasia, Vaginal intraepithelial neoplasia, Laser therapy, Human papillomavirus, Logistic models, Women
表1 CIN和(或)VaIN患者接受CO2激光治疗后2年，HPV转阴影响因素的单因素分析结果
HPV检查结果 例数 年龄(岁，±s) 绝经[例数(%)] LEEP史[例数(%)] 治疗前TCT结果[例数(%)] 治疗前HPV感染亚型
≤ASC-US ≥LSIL HPV-16 HPV-18 其他HPV亚型a
转阴 450 39.2±11.3 53(11.8) 41(9.1) 343(76.2) 107(23.7) 106(23.6) 47(10.4) 360(80.0)
未转阴 157 47.4±13.7 55(35.0) 36(23.0) 96(61.1) 61(38.9) 23(14.6) 3(1.9) 147(93.6)
检验值 ? t＝—5.026 χ2＝43.030 χ2＝20.067 χ2＝13.215 χ2＝5.516 χ2＝10.113 χ2＝15.715
P值 ? <0.001 <0.001 <0.001 <0.001 0.019 <0.001 <0.001
HPV检查结果 例数 治疗前宫颈和(或)阴道活组织病理学检查结果[例数(%)] CO2激光治疗次数[例数(%)] CO2激光治疗部位[例数(%)]
湿疣 ≥CIN1/VaIN1 1次 ≥2次 宫颈 阴道 宫颈＋阴道
转阴 450 232(51.6) 218(48.4) 402(89.3) 48(10.7) 361(80.2) 57(12.7) 32(7.1)
未转阴 157 70(44.6) 87(55.4) 116(73.9) 41(26.1) 90(57.3) 47(29.9) 20(12.8)
检验值 ? χ2＝2.262 χ2＝22.199 χ2＝32.776
P值 ? 0.133 <0.001 <0.001
表2 CIN和(或)VaIN患者接受CO2激光治疗后2年，HPV转阴影响因素的多因素非条件logistic回归分析变量含义及赋值情况
自变量/因变量 变量名 赋值
HPV转阴情况 y y＝0表示未转阴，y＝1表示转阴
年龄 x1 x1表示患者实际年龄
是否绝经 x2 x2＝0表示否，x2＝1表示是
LEEP史 x3 x3＝0表示无LEEP史，x3＝1表示有LEEP史
治疗前TCT结果 x4 x4＝0表示治疗前TCT结果为≤ASC-US，x4＝1表示治疗前TCT结果为≥LSIL
治疗前HPV感染亚型 x5 x5＝1表示治疗前感染HPV-16，x5＝2表示治疗前感染HPV-18，x5＝3表示治疗前感染其他HPV亚型
CO2激光治疗部位 x6 x6＝1表示宫颈，x6＝2表示阴道，x6＝3表示宫颈＋阴道
CO2激光治疗次数 x7 x7＝1表示1次，x7＝2表示≥2次
表3 CIN和(或)VaIN患者接受CO2激光治疗后2年，HPV转阴影响因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
常数项 2.138 0.896 5.688 0.017 8.478 —
年龄 -0.013 0.016 0.674 0.412 0.987 0.956～1.019
是否绝经 -0.617 0.474 1.693 0.193 0.540 0.213～1.367
LEEP史 -0.693 0.308 5.055 0.025 0.500 0.273～0.915
治疗前TCT结果 -0.047 0.132 0.125 0.724 0.954 0.736～1.237
治疗前HPV感染亚型 -0.110 0.090 1.491 0.222 0.896 0.751～1.069
CO2激光治疗次数 -0.503 0.271 3.449 0.063 0.605 0.356～1.028
CO2激光治疗部位 — — 7.653 0.022 — —
? 阴道 0.646 0.441 2.151 0.142 1.908 0.805～4.525
? 宫颈＋阴道 -0.175 0.468 0.139 0.709 0.840 0.335～2.102
表4 CIN和(或)VaIN患者接受CO2激光治疗后2年，病理级别降低影响因素的单因素分析结果
病理级别降低情况 例数 年龄(岁，±s) 绝经[例数(%)] LEEP史[例数(%)] 治疗前TCT结果[例数(%)] 治疗前HPV感染亚型
≤ASC-US ≥LSIL HPV-16 HPV-18 其他HPV亚型a
降低 569 41.6±12.4 101(17.8) 69(12.1) 415(72.9) 154(27.1) 124(21.8) 49(8.6) 480(84.4)
未降低 38 39.1±13.5 7(18.4) 8(21.1) 24(63.2) 14(36.8) 5(13.2) 1(2.6) 27(71.1)
检验值 ? t＝—0.997 χ2＝0.011 χ2＝2.562 χ2＝1.701 χ2＝1.587 χ2＝0.987 χ2＝4.583
P值 ? 0.319 0.917 0.109 0.192 0.208 0.320 0.032
病理级别降低情况 例数 治疗前宫颈和(或)阴道活组织病理学检查结果[例数(%)] CO2激光治疗次数[例数(%)] CO2激光治疗部位[例数(%)]
湿疣 ≥CIN1/VaIN1 1次 ≥2次 宫颈 阴道 宫颈＋阴道
降低 569 274(48.2) 294(51.7) 490(86.1) 79(13.9) 422(74.2) 102(17.9) 45(7.9)
未降低 38 27(71.1) 11(28.9) 28(73.7) 10(26.3) 29(76.3) 2(5.3) 7(18.4)
检验值 ? χ2＝7.357 χ2＝4.400 χ2＝8.052
P值 ? 0.007 0.036 0.018
表5 CIN和(或)VaIN患者接受CO2激光治疗后2年，病理级别降低影响因素的多因素非条件logistic回归分析的变量含义及赋值情况
自变量/因变量 变量名 赋值
病理级别降低 y y＝0表示未降低，y＝1表示降低
治疗前宫颈和(或)阴道活组织病理学检查结果 x1 x1＝0表示湿疣，x1＝1表示≥CIN1/VaIN1
CO2激光治疗次数 x2 x2＝1表示接受CO2激光治疗次数为1次，x2＝2表示接受CO2激光治疗次数≥2次
CO2激光治疗部位 x3 x3＝1表示CO2激光治疗部位为宫颈，x3＝2表示CO2激光治疗部位为阴道，x3＝3表示CO2激光治疗部位为宫颈＋阴道
表6 CIN和(或)VaIN患者接受CO2激光治疗后2年，病理级别降低影响因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
常数项 1.685 0.882 3.653 0.056 5.394 —
治疗前宫颈和(或)活组织病理学检查结果 0.737 0.412 3.193 0.074 2.090 0.931～4.690
CO2激光治疗次数 -0.509 0.310 2.697 0.101 0.601 0.327～1.104
CO2激光治疗部位 — — 5.408 0.080 — —
? 阴道 0.550 0.524 1.103 0.294 1.734 0.621～4.843
? 宫颈＋阴道 2.462 1.108 4.938 0.026 11.727 1.337～102.859
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