Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York; the Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado Anschutz Medical Campus, Aurora, Colorado; the Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, Connecticut; and the Departments of Urology and Obstetrics and Gynecology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
Obstet Gynecol. 2019 Feb;133(2):323-331. doi: 10.1097/AOG.0000000000003092.
To evaluate 7-year outcomes after hysteroscopic and laparoscopic sterilizations, including subsequent tubal interventions and hysterectomies.
This observational cohort study included women undergoing hysteroscopic and laparoscopic sterilizations in outpatient and ambulatory surgical settings in New York State during 2005-2016. We examined subsequent procedures (tubal ligation or resection, and hysterectomy not related to uterine leiomyomas or gynecologic tumors) after the index procedures. After propensity score matching, we used Kaplan-Meier analysis to obtain estimated risks of subsequent procedures within 7 years of index sterilization procedures, and Cox proportional hazard models to compare the differences between groups.
We identified 10,143 and 53,206 women who underwent interval hysteroscopic and laparoscopic sterilizations, respectively, in New York State during 2005-2016. The mean age of the cohort was 34.2 years (range 18-80). The propensity score-matched cohort consisted of 10,109 pairs of women. The estimated risk of undergoing an additional tubal ligation or resection within 7 years was higher after hysteroscopic sterilization than it was after laparoscopic sterilization (3.9% vs 1.6%, HR 2.89, 95% CI 2.33-3.57). The difference was most pronounced within the initial year after attempted sterilization (1.5% vs 0.2%; HR 6.39, 95% CI 4.16-9.80). There was no significant difference in the risk of receiving a hysterectomy (0.9% vs 1.2%; HR 0.73, 95% CI 0.53-1.00) between women who underwent hysteroscopic and laparoscopic sterilizations.
Patients undergoing hysteroscopic sterilization have a higher risk of receiving an additional tubal resection or ligation than those undergoing laparoscopic sterilization, particularly within the first year of the index procedure. There is no difference in undergoing a subsequent hysterectomy between the two groups. With limited evidence of outcomes after hysteroscopic sterilization beyond 7 years and existing reports of removals years after initial implantations, continuous monitoring of long-term outcomes for women who received the device is warranted.
评估宫腔镜和腹腔镜绝育术 7 年后的结局，包括随后的输卵管干预和子宫切除术。
本观察性队列研究纳入了 2005 年至 2016 年期间在纽约州门诊和日间手术环境下接受宫腔镜和腹腔镜绝育术的女性。我们检查了索引手术后的后续手术（输卵管结扎或切除术，以及与子宫肌瘤或妇科肿瘤无关的子宫切除术）。在进行倾向评分匹配后，我们使用 Kaplan-Meier 分析获得索引绝育手术后 7 年内后续手术的估计风险，并使用 Cox 比例风险模型比较组间差异。
我们在 2005 年至 2016 年期间确定了 10143 名和 53206 名分别接受间隔宫腔镜和腹腔镜绝育术的女性。队列的平均年龄为 34.2 岁（18-80 岁）。在倾向评分匹配的队列中，有 10109 对女性。7 年内行额外输卵管结扎或切除术的估计风险宫腔镜绝育术后高于腹腔镜绝育术后（3.9%比 1.6%，HR 2.89，95%CI 2.33-3.57）。在尝试绝育后的最初一年内差异最为明显（1.5%比 0.2%；HR 6.39，95%CI 4.16-9.80）。宫腔镜和腹腔镜绝育术的女性接受子宫切除术的风险无显著差异（0.9%比 1.2%；HR 0.73，95%CI 0.53-1.00）。
与腹腔镜绝育术相比，行宫腔镜绝育术的患者有更高的接受额外输卵管切除术或结扎术的风险，尤其是在索引手术的第一年。两组之间接受后续子宫切除术的风险无差异。鉴于宫腔镜绝育术后 7 年以上的结局证据有限，以及初始植入多年后切除的报告，有必要对接受该器械的女性进行长期结局的持续监测。
