Shepherd Rachel, Raker Christina A, Savella Gina M, Du Nan, Matteson Kristen A, Allen Rebecca H
Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley St, Providence, RI 02905 USA.
Contracept Reprod Med. 2016 Feb 23;1:1. doi: 10.1186/s40834-016-0008-3. eCollection 2016.
Surgical sterilization is a common method of contraception. There have been few studies evaluating the effect of obesity on procedural complications with either laparoscopic or hysteroscopic methods of sterilization. The purpose of this study was to compare the incidence of intraoperative complications of hysteroscopic tubal occlusion with laparoscopic tubal ligation among obese and nonobese women.
This retrospective cohort study compared women undergoing interval laparoscopic or hysteroscopic sterilization in the operating room between September 2009 and December 2011 at a single hospital. Serious complications included: unintended surgery, uterine perforation, anaphylaxis, blood transfusion, infection requiring antibiotics, hospital admission, fluid overload, myocardial infarction, and venous thromboembolism. Post-operative events included: nausea/vomiting, doctor evaluation or additional pain medication required in the recovery room, and emergency department visit within 2 weeks of surgery. The association between sterilization type and incidence of complications was examined overall, separately by BMI group, and also among patients who received general anesthesia.
A total of 433 laparoscopic and 277 hysteroscopic procedures were reviewed. The BMI distribution of the sample was 35 % normal weight, 31 % overweight, and 34 % obese which is comparable to the general US female population. No life-threatening events were identified. Serious complications were similar with 20 (4.6 %) in the laparoscopic group and 11 (4.0 %) in the hysteroscopic group ( = 0.9). The most common serious complications were bleeding from the tube, cervical laceration, and uterine perforation. Although not statistically significant, women with a BMI of 30 or greater had only 1 (1 %) serious complication in the hysteroscopic group compared to 7 (5.2 %) in the laparoscopic group. Postoperative events were increased in the laparoscopic group (16.2 %) compared to the hysteroscopic group (6.9 %), especially among overweight and obese women ( <0.01). Failure to complete the intended bilateral occlusion occurred for 14 women in the hysteroscopic group compared to just one woman in the laparoscopic group ( <0.001).
Both laparoscopic and hysteroscopic tubal sterilization are safe with few serious complications based on these data. No cases of laparotomy, blood transfusion, or life-threatening events were identified. There was no difference in serious complication rate by sterilization method. Overweight and obese women were no more likely to experience a serious complication with either method than women with a BMI <25. There were fewer postoperative events ( <0.01) with hysteroscopic sterilization, but far fewer failed laparoscopic procedures ( <0.001). These study findings can be used to enhance sterilization counseling.
手术绝育是一种常见的避孕方法。很少有研究评估肥胖对腹腔镜或宫腔镜绝育手术并发症的影响。本研究的目的是比较肥胖和非肥胖女性宫腔镜输卵管闭塞术与腹腔镜输卵管结扎术术中并发症的发生率。
这项回顾性队列研究比较了2009年9月至2011年12月在一家医院手术室接受择期腹腔镜或宫腔镜绝育术的女性。严重并发症包括：意外手术、子宫穿孔、过敏反应、输血、需要使用抗生素的感染、住院、液体超负荷、心肌梗死和静脉血栓栓塞。术后事件包括：恶心/呕吐、恢复室需要医生评估或额外的止痛药物，以及术后2周内的急诊科就诊。总体上、按BMI组分别以及在接受全身麻醉的患者中检查绝育类型与并发症发生率之间的关联。
共回顾了433例腹腔镜手术和277例宫腔镜手术。样本的BMI分布为35%正常体重、31%超重和34%肥胖，与美国女性总体人群相当。未发现危及生命的事件。严重并发症相似，腹腔镜组20例（4.6%），宫腔镜组11例（4.0%）（P = 0.9）。最常见的严重并发症是输卵管出血、宫颈裂伤和子宫穿孔。虽然无统计学意义，但BMI为30或更高的女性在宫腔镜组仅有1例（1%）严重并发症，而腹腔镜组有7例（5.2%）。与宫腔镜组（6.9%）相比，腹腔镜组术后事件增加（16.2%），尤其是超重和肥胖女性（P < 0.01）。宫腔镜组有14名女性未能完成预期的双侧闭塞，而腹腔镜组只有1名女性（P < 0.001）。
根据这些数据，腹腔镜和宫腔镜输卵管绝育术都是安全的，严重并发症很少。未发现剖腹手术、输血或危及生命事件的病例。绝育方法导致的严重并发症发生率无差异。超重和肥胖女性与BMI < 25的女性相比，两种方法发生严重并发症的可能性均不更高。宫腔镜绝育术后事件较少（P < 0.01），但腹腔镜手术失败的情况要少得多（P < 0.001）。这些研究结果可用于加强绝育咨询。
