Conization with a carbon dioxide laser as a uterine-preservation operation for patients with preinvasive cervical...

Preinvasive cervical carcinoma (PCC) is a disease entity of the uterine cervix resulting from carcinoma in situ and various degrees of dysplasia. These cases are conventionally treated by a total abdominal hysterectomy. Effective management that can preserve the uterus is more desirable than hysterectomy. In this report, we present the results and complications of laser conization as a uterine-preservation treatment. At our dysplasia clinic, cases of reproductive age diagnosed with PCC can voluntarily undergo laser conization. From June 1985 to May 1988, there were 26 cases who received this treatment. After treatment, they were regularly followed up for more than three years. Before and after surgery, these cases were evaluated by a Pap smear for cytology, colposcopy, a cervical punch biopsy and endocervical curettage for histopathology. Eighteen cases with a satisfactory colposcopy were treated by laser vaporizing conization. Eight cases with an unsatisfactory colposcopy were treated by laser excisional conization. Their mean age was 35.8 (SD 7.7) years, and parity was 1.5 (SD 0.9). The instrument used was a Sharplan CO2 laser model 720. The power density was around 1,000 W/cm2 for vaporization, and 1,500 W/cm2 for excisional conization. During the operations, there was little bleeding. No case required a blood transfusion. The vaginal discharge decreased within four days after treatment. The cervical epithelium on the operated wound began growing after the second week, and the cervix healed well in four to six weeks. After healing, the squamocolumnar junction in each case was visible on colposcopy. No case suffered from cervical stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)