Endoplasia

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  • Publicado : 10 de septiembre de 2010
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Laser treatment of endocervical neoplasia

Laser therapy is an outpatient procedure and requires no general anaesthesia; only 1% of patients find laser therapy intolerable after local anaesthesia1.
The operation takes about 10 to 15 minutes which is acceptable to most patients.
The Laser is mounted on a colposcope during the procedure and the laser beam is directed by a
microslad undercolposcopic vision. This allows a precise control of the extent and depth of tissue destruction, so that extensive lesion and lesions involving glandular crypts can be satisfactorily treated. Blood loss during laser therapy is minimal because blood vessels less than 1 mm in diameter are sealed by the laser. In contrast to cryosurgery and electrodiathermy, laser injury to adjacent tissues is limited to0.3 mm and the amount of damaged tissue left at the end of the procedure is minimal.
These account for the reduced risk of infection and the minimal amount of vaginal discharge after laser therapy. Furthermore, healing of the cervix is rapid and normal cervical anatomy is preserved. The new squamocolumnar junction is usually situated on the ectocervix or at the cervical os which facilitatessubsequent follow up for persistent or recurrent disease. Cervical stenosis after laser therapy is rare and infertility caused by laser treatment has not been reported. Laser therapy is an outpatient procedure and requires no general anaesthesia; only 1% of patients find laser therapy intolerable after local anaesthesia1.
The operation takes about 10 to 15 minutes which is acceptable to most patients.The Laser is mounted on a colposcope during the procedure and the laser beam is directed by a microslad under colposcopic vision. This allows a precise control of the extent and depth of tissue destruction, so that extensive lesion and lesions involving glandular crypts can be satisfactorily treated. Blood loss during laser therapy is minimal because blood vessels less than 1 mm in diameter aresealed by the laser. In contrast to cryosurgery and electrodiathermy, laser injury to adjacent tissues is limited to 0.3 mm and the amount of damaged tissue left at the end of the procedure is minimal.
These account for the reduced risk of infection and the minimal amount of vaginal discharge after laser therapy. Furthermore, healing of the cervix is rapid and normal cervical anatomy ispreserved. The new squamocolumnar junction is usually situated on the ectocervix or at the cervical os which facilitates subsequent follow up for persistent or recurrent disease. Cervical stenosis after laser therapy is rare2 and infertility caused by laser treatment has not been reported.
3 different form.
There are 3 different forms of laser therapy. They are vaporization, excisional biopsy and acombination of the two.
Laser vaporization is technically simple compared with the other two. It is indicated for patients with CIN lesion with no suspicion of invasive carcinoma.
The area of vaporization includes the entire transformation zone and the surrounding tissue up to 3 mm. The depth of tissue vaporization is set to 7 mm because 99.8% of CIN lesion do not extend into cervical glandularcrypts for more than 4 mm4.
Laser excisional biopsy (laser conization) is technically not difficult in trained and experienced hands. The operation can be performed under local anaesthesia and finished in 10-15 minutes. The complication rate is similar to that of laser vaporization but is considerably less compared to that of cold knife conization. It involves the use of high power density laser beamto excise a piece of cylindrical or conical tissue around the cervical os
The width and length of the specimen is governed by the size and site of the CIN lesion. The advantage of laser excisional biopsy over laser vaporation is that pathological examination of the excised cervical tissue can be made. This allows early detection of incomplete removal of CIN lesion and any inadvertently missed...
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