Trollip G S, Fisher M, Naidoo A, Theron P D, Heyns C F
Department of Urology, Stellenbosch University and Tygerberg Hospital, Tygerberg, Western Cape.
S Afr Med J. 2009 Apr;99(4):238-42.
To evaluate the safety and efficacy of vasectomy performed under local anaesthesia by junior doctors at a secondary level hospital as part of a free family planning service.
Men requesting vasectomy were counselled and given written instructions to use alternative contraception until two semen analyses 3 and 4 months after vasectomy had confirmed azoospermia. Bilateral vasectomy was performed as an outpatient procedure under local anaesthesia by junior urology registrars. Statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, Fisher's exact or Spearman's rank correlation tests as appropriate.
Between January 2004 and December 2005, 479 men underwent vasectomy at Karl Bremer Hospital, Western Cape, South Africa; their average age was 36.1 (range 21 - 66) years, they had a median of 2 (range 0 - 10) children, and only 19% had 4 or more children. The average operation time was 15.5 (range 5 - 53) minutes. Complications occurred in 12.9%; these were pain (7.3%), swelling (5.4%), haematoma (1.3%), sepsis (1%), difficulty locating the vas (1%), vasovagal episode (0.6%), bleeding (0.6%), wound rupture (0.4%) and dysuria (0.2%) (some men had more than one complication). Of the men 63.3% returned for one semen analysis and 17.5% for a second. The vasectomy failure rate ranged from 0.4% (sperm persisting > 365 days after vasectomy) to 2.3% (sperm seen > 180 days after vasectomy and/or in the second semen specimen). No pregnancies were reported. The complication (5.6%) and failure rates (0%) were lowest for the registrar who had performed the smallest number of vasectomies and whose average operation time was longest. Comparing the first one-third of procedures performed by each of the doctors with the last one-third, there was a significant decrease in average operating times but not in complication rates.
Vasectomy can be performed safely and effectively by junior doctors as an outpatient procedure under local anaesthesia, and should be actively promoted in South Africa as a safe and effective form of male contraception.
评估二级医院的初级医生在免费计划生育服务中实施局部麻醉下输精管结扎术的安全性和有效性。
对要求进行输精管结扎术的男性进行咨询，并给予书面指示，要求其在输精管结扎术后3个月和4个月的两次精液分析确认无精子症之前使用其他避孕方法。双侧输精管结扎术由泌尿外科初级住院医生在局部麻醉下作为门诊手术进行。根据情况使用曼-惠特尼检验、克鲁斯卡尔-沃利斯检验、费舍尔精确检验或斯皮尔曼等级相关检验进行统计分析。
2004年1月至2005年12月期间，南非西开普省卡尔·布雷默医院有479名男性接受了输精管结扎术；他们的平均年龄为36.1岁（范围21 - 66岁），子女中位数为2个（范围0 - 10个），只有19%的男性有4个或更多子女。平均手术时间为15.5分钟（范围5 - 53分钟）。并发症发生率为12.9%；包括疼痛（7.3%）、肿胀（5.4%）、血肿（1.3%）、败血症（1%）、输精管定位困难（1%）、血管迷走神经发作（0.6%）、出血（0.6%）、伤口破裂（0.4%）和排尿困难（0.2%）（一些男性有不止一种并发症）。63.3%的男性返回进行了一次精液分析，17.5%的男性进行了第二次精液分析。输精管结扎失败率在0.4%（输精管结扎术后精子持续存在>365天）至2.3%（输精管结扎术后>180天和/或在第二次精液标本中见到精子）之间。未报告妊娠情况。进行输精管结扎术数量最少且平均手术时间最长的住院医生的并发症发生率（5.6%）和失败率（0%）最低。将每位医生所进行的前三分之一手术与最后三分之一手术进行比较，平均手术时间显著减少，但并发症发生率没有变化。
初级医生在局部麻醉下作为门诊手术能够安全有效地实施输精管结扎术，在南非应作为一种安全有效的男性避孕方式积极推广。
