[Utilization of CO2 lasers in continuous or pulsed mode for conizations: apropos of 230 cases]

A retrospective study with the aim of analysing efficiency, anatomical and functional consequences of a conservative methodology for the treatment of cervical intra-epithelial neoplasias (CIN) using carbon dioxide laser.

Two hundred and thirty patients were treated and studied with an average waiting period of 38 months. During the study new methodology allowed a cut in the pulse regimen with adjustments in high energy levels. This allowed us to subdivide the study into two groups, respectively 113 and 117 patients, and to provide a differential rate of immediate and late complications. The pre-therapy lesion assessment led to a diagnosis of severe dysplasia (53%), carcinoma in situ (19.1%), mild dysplasia (20.4%) and investigational conization 7%; in one case, conization was provided for adenocarcinoma in situ.

The anatomo-pathologic results showed 2.1% microinvasive tumors, 22.2% epidermoid carcinoma in situ, 2.1% adenocarcinoma in situ, 53.6% severe dysplasia, 14% mild dysplasia, 0.9% low dysplasia, and 5.2% viral lesions without dysplasia. The excision limit are in sano in 95.2% of cases, and non in sano for the endocervix in 2.2% of cases and for the ectocervix in 2.6% of cases.

Needing second surgical intervention hemorrhage rates were 1.8% during the first period (2/113) and 1.7% according to the second period (2/117). No infectious complications were reported in the two series. As for delayed and long-term complications, incomplete stenosis rates (uterine cervix permeability up to n degree 3 Hegar dilatator) reached respectively 3.5% of cases (4/113) and 1.7% (2/117); complete stenosis rates were 2.6% (3/113) and 0% (0/117). RECURRENCES: Nine recurrent cases (5.9%) were divided into two low dysplasia, four moderate dysplasia, one severe dysplasia, one epidermoid carcinoma in situ and one infiltrating carcinoma.

The less aggressive possible choice of a conservative therapy allows not only young patients to conserve their fertility but also to preserve cervical anatomy and to facilitate diagnosis of a recurrent case. The decrease in the complications rates that we have allocated first to the use of carbon dioxide laser and second to the pulsed beam emphasize quality research throughout our experience.