Giovannucci E, Tosteson T D, Speizer F E, Vessey M P, Colditz G A
Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, MA.
N Engl J Med. 1992 May 21;326(21):1392-8. doi: 10.1056/NEJM199205213262104.
Vasectomy is a reliable and widely accepted method of contraception, but there is some uncertainty and few data about a possible long-term adverse effect on health.
We examined the relation between vasectomy and mortality rates from cardiovascular disease, cancer, and all causes in a retrospective cohort of husbands of members of the Nurses' Health Study. In 1989 we obtained data by questionnaire on 14,607 men who had undergone vasectomy as of 1976 and 14,607 men who had not.
Among the men who were free of cancer at the start of the study, 1052 died: 446 of cardiovascular disease, 341 of cancer, and 265 of other causes. Vasectomy was associated with reductions in mortality from all causes (age-adjusted relative risk, 0.85; 95 percent confidence interval, 0.76 to 0.96) and mortality from cardiovascular disease (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.92). Vasectomy was unrelated to mortality from all forms of cancer (relative risk, 1.01; 95 percent confidence interval, 0.82 to 1.25). Among men who had a vasectomy at least 20 years earlier, the procedure had no relation to mortality from all causes (relative risk, 1.11; 95 percent confidence interval, 0.92 to 1.33) or that from cardiovascular disease (relative risk, 0.85; 95 percent confidence interval, 0.63 to 1.16). However, mortality from cancer was increased in men who had a vasectomy at least 20 years earlier (relative risk, 1.44; 95 percent confidence interval, 1.07 to 1.92). The excess risk of cancer in these men was due primarily to lung cancer. None of the observed associations were confounded by smoking habits, body-mass index, alcohol consumption, or educational level.
Vasectomy is not associated with an increase in overall mortality or mortality from cardiovascular disease. Our study also found no increase in overall mortality from cancer after vasectomy, but there was an apparent increase in the risk of cancer 20 or more years after vasectomy that requires further study.
输精管切除术是一种可靠且被广泛接受的避孕方法，但对于其可能对健康产生的长期不良影响存在一些不确定性且数据较少。
我们在护士健康研究成员的丈夫这一回顾性队列中，研究了输精管切除术与心血管疾病、癌症及所有原因导致的死亡率之间的关系。1989年，我们通过问卷调查获取了截至1976年已接受输精管切除术的14607名男性以及未接受该手术的14607名男性的数据。
在研究开始时无癌症的男性中，有1052人死亡：446人死于心血管疾病，341人死于癌症，265人死于其他原因。输精管切除术与所有原因导致的死亡率降低相关（年龄调整相对风险为0.85；95%置信区间为0.76至0.96），与心血管疾病导致的死亡率降低相关（相对风险为0.76；95%置信区间为0.63至0.92）。输精管切除术与所有形式癌症导致的死亡率无关（相对风险为1.01；95%置信区间为0.82至1.25）。在至少20年前接受输精管切除术的男性中，该手术与所有原因导致的死亡率无关（相对风险为1.11；95%置信区间为0.92至1.33），与心血管疾病导致的死亡率也无关（相对风险为0.85；95%置信区间为0.63至1.16）。然而，至少20年前接受输精管切除术的男性中，癌症导致的死亡率有所增加（相对风险为1.44；95%置信区间为1.07至1.92）。这些男性中癌症风险的增加主要归因于肺癌。观察到的关联均未受到吸烟习惯、体重指数、饮酒量或教育水平的混淆。
输精管切除术与总体死亡率或心血管疾病导致的死亡率增加无关。我们的研究还发现输精管切除术后癌症导致的总体死亡率没有增加，但输精管切除术后20年或更长时间癌症风险明显增加，这需要进一步研究。
