Objective: To explore the value of CO2 laser therapy, photodynamic therapy, and follow-up observation in the management of cervical low-grade squamous intraepithelial lesion (LSIL). Methods: Women diagnosed with cervical LSIL and high risk human papillomavirus (HR-HPV) infection through colposcopy-guided biopsy from January 1, 2021 to December 31, 2023 were collected. According to a 1∶1 ratio, 107 cases were included in each of the laser treatment, photodynamic therapy, and follow-up groups. The complete remission rate and HR-HPV clearance rate were compared during the 6-12 months follow-up period. Results: (1) Comparison of clinical data among the three groups before treatment: the median age of the 321 patients was (34.9±8.1) years. Before treatment, cytological abnormalities were present in 51.7% (166/321) of patients, and 35.2% (113/321) had human papillomavirus (HPV) 16/18 infections. The accuracy rate of colposcopic diagnosis was 69.2% (222/321). Age, cytology results, HPV 16/18 infection, and colposcopy diagnosis in the laser group, photodynamic group, and follow-up group were compared, and there were not statistically significant differences (all P>0.05). (2) During the 6-12 months follow-up period, the complete remission rate was 89.7% (96/107) in the laser group, slightly higher than the 86.9% (93/107) in the photodynamic group, with no statistical difference between the two groups (χ2=0.41, P=0.523). However, both were significantly higher than the 64.5% (69/107) in the follow-up group (χ2=19.30, P<0.001; χ2=14.63, P<0.001). The HR-HPV clearance rates in the laser and photodynamic groups were 73.8% (79/107) and 68.2% (73/107), respectively, both significantly higher than the 32.7% (35/107) in the follow-up group (χ2=36.34, P<0.001; χ2=26.99, P<0.001), but with no statistical difference between the laser and photodynamic groups (χ2=0.82, P=0.366). Conclusions: CO2 laser therapy and photodynamic therapy are effective treatments for cervical LSIL, significantly superior to follow-up observation in terms of lesion remission and HR-HPV clearance rates. Individualized treatment plans could be developed based on the patient's age, duration of HR-HPV infection, colposcopic impression, and economic conditions.
目的： 探讨CO2激光治疗、光动力治疗和随访观察3种方法在子宫颈低级别鳞状上皮内病变（LSIL）管理中的意义。 方法： 收集2021年1月1日至2023年12月31日于复旦大学附属妇产科医院经阴道镜下活检病理诊断为子宫颈LSIL且合并高危型人乳头状瘤病毒（HR-HPV）感染的患者。由患者自愿选择治疗方式，根据1∶1配比，共纳入激光组、光动力组和随访组各107例。比较3组患者治疗后6~12个月随访时的病灶缓解率及HR-HPV转阴率。 结果： （1）治疗前3组患者一般临床病理资料的比较：321例子宫颈LSIL患者的年龄为（34.9±8.1）岁，治疗前51.7%（166/321）的患者存在细胞学异常，35.2%（113/321）的患者HPV 16和（或）18型（HPV 16/18型）阳性，阴道镜诊断的准确率为69.2%（222/321）。激光组、光动力组、随访组患者的年龄、细胞学结果、HPV 16/18型阳性率、阴道镜诊断结果分别比较，差异均无统计学意义（P均>0.05）。（2）治疗后3组患者病灶缓解率和HR-HPV转阴率的比较：治疗后6~12个月随访时，激光组的病灶缓解率高达89.7%（96/107），略高于光动力组的86.9%（93/107），两组比较，差异无统计学意义（χ2=0.41，P=0.523）；但两组均显著高于随访组（64.5%，69/107；χ2=19.30，P<0.001；χ2=14.63，P<0.001）。激光组和光动力组的HR-HPV转阴率分别为73.8%（79/107）和68.2%（73/107），均显著高于随访组（32.7%，35/107；χ2=36.34，P<0.001；χ2=26.99，P<0.001）；但激光组与光动力组间比较，差异则无统计学意义（χ2=0.82，P=0.366）。 结论： CO2激光和光动力是子宫颈LSIL有效的治疗方法，在病灶缓解率和HR-HPV转阴率方面均显著优于随访观察。在有病灶进展的高风险患者中，可根据患者的年龄、HR-HPV感染情况、阴道镜检查结果及经济条件制定个体化的方案。.