Westberg Julie, Scott Fiona, Creinin Mitchell D
University of California, Davis; Sacramento, CA, United States.
University of California, Davis; Sacramento, CA, United States.
Contraception. 2017 May;95(5):505-508. doi: 10.1016/j.contraception.2017.02.017. Epub 2017 Feb 21.
Compare immediate and short-term complications and surgical times among women having laparoscopic salpingectomy or tubal occlusion for female sterilization.
We used billing data to identify women having laparoscopic sterilization at our training institution between July 1, 2011, and June 30, 2015. We performed a retrospective chart review to extract demographic information, surgical times and complications within 30 days, including unscheduled clinic or emergency room visits. We categorized complications as immediate (prior to discharge) and short-term (within 30 days after the procedure). Surgeries including additional procedures other than IUD removal were considered mixed operations. Mixed operations and unilateral sterilization procedures were only included in safety evaluations.
The 149 procedures included 81 salpingectomies (including 18 mixed operations and 2 unilateral salpingectomies) and 68 tubal occlusions (including 8 mixed operations). All procedures involved Obstetrics and Gynecology residents. Salpingectomy and occlusion procedures had similar immediate (2.5% vs. 2.9%, p=1.0) and short-term (4.9% vs. 14.7%, p=.051) complication rates. Surgical time averaged 6 min longer for salpingectomies than occlusion procedures (44 vs. 38 min, respectively, p=.018). Average surgical times were shorter with more experienced (3rd/4th year) residents than less experienced (1st/2nd year) residents for both salpingectomy (32±18 min vs. 46±13 min, respectively, p=.124) and occlusion procedures (32±13 min vs. 41±12 min, respectively, p=.026).
Salpingectomy for female sterilization takes slightly longer to complete than tubal occlusion procedures without evidence that it increases complications.
Laparoscopic salpingectomy is a safe alternative to tubal occlusion with only a small increase in surgical time. Because salpingectomy offers higher efficacy and more ovarian cancer protection than occlusion procedures, salpingectomy should be an option offered to women seeking laparoscopic sterilization.
比较接受腹腔镜输卵管切除术或输卵管阻塞绝育术的女性的近期和短期并发症及手术时间。
我们利用计费数据识别2011年7月1日至2015年6月30日在我们培训机构接受腹腔镜绝育术的女性。我们进行了回顾性病历审查，以提取人口统计学信息、手术时间和30天内的并发症，包括非计划的门诊或急诊就诊。我们将并发症分为即刻（出院前）和短期（术后30天内）。包括除取出宫内节育器以外的其他手术的手术被视为混合手术。混合手术和单侧绝育手术仅纳入安全性评估。
149例手术包括81例输卵管切除术（包括18例混合手术和2例单侧输卵管切除术）和68例输卵管阻塞术（包括8例混合手术）。所有手术均由妇产科住院医师进行。输卵管切除术和阻塞术的即刻并发症发生率相似（分别为2.5%和2.9%，p = 1.0），短期并发症发生率也相似（分别为4.9%和14.7%，p = 0.051）。输卵管切除术的平均手术时间比阻塞术长6分钟（分别为44分钟和38分钟，p = 0.018）。对于输卵管切除术（分别为32±18分钟和46±13分钟，p = 0.124）和阻塞术（分别为32±13分钟和41±12分钟，p = 0.026），经验更丰富（第3/4年）的住院医师的平均手术时间比经验较少（第1/2年）的住院医师短。
女性绝育的输卵管切除术完成时间比输卵管阻塞术略长，但没有证据表明其会增加并发症。
腹腔镜输卵管切除术是输卵管阻塞术的一种安全替代方法，手术时间仅略有增加。由于输卵管切除术比阻塞术具有更高的疗效和更多的卵巢癌保护作用，输卵管切除术应作为寻求腹腔镜绝育的女性的一种选择。
