Cook L A, Van Vliet H, Lopez L M, Pun A, Gallo M F
Christchurch School of Medicine, Public Health and General Practice, Christchurch, New Zealand.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD003991. doi: 10.1002/14651858.CD003991.pub3.
Vasectomy is an increasingly popular and effective family planning method. A variety of vasectomy techniques are used worldwide, including various vas occlusion techniques (excision and ligation, thermal or electrocautery, and mechanical and chemical occlusion methods), as well as vasectomy with vas irrigation or with fascial interposition. Vasectomy guidelines largely rely on information from observational studies. Ideally, the choice of vasectomy techniques should be based on the best available evidence from randomized controlled trials.
The objective of this review was to compare the effectiveness, safety, acceptability and costs of vasectomy techniques for male sterilization.
We searched the computerized databases of CENTRAL, MEDLINE, EMBASE, POPLINE and LILACS. In addition, we searched the reference lists of relevant articles and book chapters.
We included randomized controlled trials comparing vasectomy techniques.
We assessed all titles and abstracts located in the literature searches. Two reviewers independently extracted data from articles identified for inclusion. Outcome measures include contraceptive efficacy, safety, discontinuation, and acceptability.
Six studies met the inclusion criteria. One trial compared vas occlusion with clips versus a conventional vasectomy technique. No difference was found in failure to reach azoospermia. Three trials examined vasectomy with vas irrigation. Two studies looked at irrigation with water versus no irrigation, while one examined irrigation with water versus the spermicide euflavine. None found a difference between the groups for time to azoospermia. However, one trial reported that the median number of ejaculations to azoospermia was lower in the euflavine group compared to the water irrigation group. One high-quality trial compared vasectomy with fascial interposition versus vasectomy without fascial interposition. The fascial interposition group was less likely to have vasectomy failure. Fascial interposition had more surgical difficulties, but the groups were similar in side effects. Lastly, one trial found that an intra-vas was less likely to produce azoospermia than was no-scalpel vasectomy. More men were satisfied with the intra-vas device, however.
AUTHORS' CONCLUSIONS: For vas occlusion with clips or vasectomy with vas irrigation, no conclusions can be made as those studies were of low quality and underpowered. Fascial interposition reduced vasectomy failure. An intra-vas device was less effective in reducing sperm count than was no-scalpel vasectomy. Randomized controlled trials examining other vasectomy techniques were not available. More and better quality research is needed to examine vasectomy techniques.
输精管结扎术是一种越来越受欢迎且有效的计划生育方法。全球使用了多种输精管结扎技术，包括各种输精管闭塞技术（切除与结扎、热灼或电灼以及机械和化学闭塞方法），以及输精管冲洗或筋膜置入的输精管结扎术。输精管结扎术指南很大程度上依赖于观察性研究的信息。理想情况下，输精管结扎技术的选择应基于随机对照试验的最佳现有证据。
本综述的目的是比较用于男性绝育的输精管结扎技术的有效性、安全性、可接受性和成本。
我们检索了Cochrane系统评价数据库、医学索引数据库、荷兰医学文摘数据库、人口与健康数据库和拉丁美洲及加勒比地区卫生科学数据库的计算机化数据库。此外，我们还检索了相关文章和书籍章节的参考文献列表。
我们纳入了比较输精管结扎技术的随机对照试验。
我们评估了文献检索中找到的所有标题和摘要。两名综述作者独立从确定纳入的文章中提取数据。结局指标包括避孕效果、安全性、停用情况和可接受性。
六项研究符合纳入标准。一项试验比较了使用夹子进行输精管闭塞与传统输精管结扎技术。在达到无精子症方面未发现差异。三项试验研究了输精管冲洗的输精管结扎术。两项研究比较了用水冲洗与不冲洗，而一项研究比较了用水冲洗与用杀精子剂优黄酮冲洗。在达到无精子症的时间方面，各组之间均未发现差异。然而，一项试验报告称，与水冲洗组相比，优黄酮组达到无精子症的射精次数中位数更低。一项高质量试验比较了筋膜置入的输精管结扎术与无筋膜置入的输精管结扎术。筋膜置入组输精管结扎失败的可能性较小。筋膜置入手术难度更大，但两组在副作用方面相似。最后，一项试验发现，输精管内置入装置产生无精子症的可能性低于无手术刀输精管结扎术。然而，更多男性对输精管内置入装置感到满意。
对于使用夹子进行输精管闭塞或输精管冲洗的输精管结扎术，由于这些研究质量低且效能不足，无法得出结论。筋膜置入可减少输精管结扎失败。输精管内置入装置在降低精子数量方面不如无手术刀输精管结扎术有效。未找到检验其他输精管结扎技术的随机对照试验。需要更多且质量更高的研究来检验输精管结扎技术。
