Gariepy Aileen M, Creinin Mitchell D, Smith Kenneth J, Xu Xiao
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA.
Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA 95817, USA.
Contraception. 2014 Aug;90(2):174-81. doi: 10.1016/j.contraception.2014.03.010. Epub 2014 Apr 25.
To compare the expected probability of pregnancy after hysteroscopic versus laparoscopic sterilization based on available data using decision analysis.
We developed an evidence-based Markov model to estimate the probability of pregnancy over 10 years after three different female sterilization procedures: hysteroscopic, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation. Parameter estimates for procedure success, probability of completing follow-up testing and risk of pregnancy after different sterilization procedures were obtained from published sources.
In the base case analysis at all points in time after the sterilization procedure, the initial and cumulative risk of pregnancy after sterilization is higher in women opting for hysteroscopic than either laparoscopic band or bipolar sterilization. The expected pregnancy rates per 1000 women at 1 year are 57, 7 and 3 for hysteroscopic sterilization, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation, respectively. At 10 years, the cumulative pregnancy rates per 1000 women are 96, 24 and 30, respectively. Sensitivity analyses suggest that the three procedures would have an equivalent pregnancy risk of approximately 80 per 1000 women at 10 years if the probability of successful laparoscopic (band or bipolar) sterilization drops below 90% and successful coil placement on first hysteroscopic attempt increases to 98% or if the probability of undergoing a hysterosalpingogram increases to 100%.
Based on available data, the expected population risk of pregnancy is higher after hysteroscopic than laparoscopic sterilization. Consistent with existing contraceptive classification, future characterization of hysteroscopic sterilization should distinguish "perfect" and "typical" use failure rates.
Pregnancy probability at 1 year and over 10 years is expected to be higher in women having hysteroscopic as compared to laparoscopic sterilization.
基于现有数据，采用决策分析比较宫腔镜绝育术与腹腔镜绝育术后的预期妊娠概率。
我们开发了一个基于证据的马尔可夫模型，以估计三种不同女性绝育术后10年内的妊娠概率，这三种绝育术分别为：宫腔镜绝育术、腹腔镜硅胶带应用绝育术和腹腔镜双极电凝绝育术。手术成功率、完成后续检查的概率以及不同绝育术后的妊娠风险的参数估计值均来自已发表的资料。
在绝育术后所有时间点的基础病例分析中，选择宫腔镜绝育术的女性绝育术后的初始妊娠风险和累积妊娠风险均高于腹腔镜硅胶带绝育术或腹腔镜双极电凝绝育术。宫腔镜绝育术、腹腔镜硅胶带应用绝育术和腹腔镜双极电凝绝育术每1000名女性在1年时的预期妊娠率分别为57、7和3。在10年时，每1000名女性的累积妊娠率分别为96、24和30。敏感性分析表明，如果腹腔镜（硅胶带或双极）绝育术成功的概率降至90%以下，且宫腔镜首次尝试放置节育环成功的概率增至98%，或者接受子宫输卵管造影的概率增至100%，那么这三种手术在10年时每1000名女性的妊娠风险将大致相等，约为80。
基于现有数据，宫腔镜绝育术后的预期人群妊娠风险高于腹腔镜绝育术。与现有的避孕分类一致，未来宫腔镜绝育术的特征描述应区分“完美”和“典型”使用失败率。
与腹腔镜绝育术相比，接受宫腔镜绝育术的女性在1年及10年以上的妊娠概率预计更高。
