Therapeutic Assessment of Vulvar Squamous Intraepithelial Lesions with CO2 Laser Vaporization in Immunosuppressed Patients

Abstract Objective A vulvar squamous intraepithelial lesion is deemed to be a preceding lesion to vulvar cancer, especially in women aged under 40 years, holders of an acquired or idiopathic immunosuppression. Several treatments have been used to treat these lesions. One of the aesthetically acceptable therapeutic methods is the CO2 laser vaporization. Methods In a transversal study, 46 records of immunosuppressed women bearing a vulvar low grade and/or high grade squamous intraepithelial lesion were selected out of the retrospective analysis, computing age, date of record, date of vulvar lesion treatment with CO2 laser, the time elapsed between the first and the last visit (in months), the number of visits, the presence or absence of condylomatous lesions in other female lower genital tract sites and whether or not recurrences and persistence of intraepithelial lesions have been noticed during the follow-up. Results Patients bearing vulvar high-grade squamous intraepithelial lesion and immunosuppressed (serumpositive forhumanimmunodeficiency virus [HIV] or with solid organs transplantation) have shown a higher level of persistence of lesions and a higher chance of having other areas of the female lower genital tract involved. Conclusion While the CO2 laser vaporization is the most conservative method for the treatment of vulvar high-grade intraepithelial lesions, it is far frombeing the ideal method, dueto the intrinsic infection features considered. The possibility of persistence, recurrences and spontaneous limited regression indicates that a closer surveillance in the long-term treated cases should be considered, in special for immunosuppressed patients.

【摘要】 目的 外阴鳞状上皮内病变（vulvar squamous intraepithelial lesion）被认为是外阴癌的癌前病变，尤其好发于40岁以下、存在获得性或特发性免疫抑制的女性群体。目前已有多种治疗方案用于此类病变的干预，其中二氧化碳激光汽化术（CO2 laser vaporization）是美学效果较为理想的治疗方式之一。方法 本研究为横断面研究，从回顾性分析队列中纳入46例免疫抑制女性患者的临床资料，所有患者均确诊为外阴低级别或高级别鳞状上皮内病变。收集并统计的研究指标包括：患者年龄、病历记录日期、二氧化碳激光治疗外阴病变的时间、首次与末次随访的间隔时长（单位：月）、随访次数、女性下生殖道其他部位是否存在湿疣样病变，以及随访期间是否出现上皮内病变残留或复发。结果 合并高级别外阴鳞状上皮内病变的免疫抑制患者（包括人类免疫缺陷病毒（HIV）血清学阳性者及实体器官移植受者），其病变残留率更高，且出现女性下生殖道其他部位受累的风险也显著升高。结论 尽管二氧化碳激光汽化术是治疗高级别外阴鳞状上皮内病变的最保守方案，但由于其本身存在感染相关的固有特性，该方法并非理想的治疗选择。病变残留、复发及自发性局限性消退的可能性提示，需对接受治疗的患者进行长期密切随访，尤其是免疫抑制人群。