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双侧输卵管切除术用于永久性避孕:病例系列和限制实践改变的因素。

Salpingectomie bilatérale aux fins de contraception permanente : série de cas et facteurs limitant le changement de pratique.

机构信息

Médecin résidente, Service d'obstétrique-gynécologie générale, Département d'obstétrique et gynécologie, Centre hospitalier universitaire de Sherbrooke.

Obstétricienne-gynécologue, Service d'obstétrique et gynécologie, Hôpital régional de Rimouski, Centre intégré de santé et de services sociaux du Bas-St-Laurent.

出版信息

J Obstet Gynaecol Can. 2020 Aug;42(8):948-952. doi: 10.1016/j.jogc.2020.02.004. Epub 2020 Apr 25.

Abstract

OBJECTIVE

The Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Society of Gynaecologic Oncology of Canada (GOC) recommend complete removal of the fallopian tubes as a permanent contraceptive method because of its association with a reduced risk of ovarian cancer. Currently, many women are not offered bilateral salpingectomy as an alternative to tubal ligation for permanent contraception.

METHOD

As part of a quality improvement initiative, we reviewed all cases of sterilization performed at our university centre between 1 January and 31 December 2018. A literature review of the clinical and ethical considerations that prevent clinicians from offering bilateral salpingectomy as permanent contraception is also presented.

RESULTS

The records of 111 women who underwent tubal sterilization were reviewed. Of these, 31.5% underwent bilateral salpingectomy; 46.8% underwent tubal fulguration; 12.6% underwent clip ligation; and 9.1% underwent tubal implant ligation (Essure). According to the information on file, only 36.3% of women were offered bilateral salpingectomy, and of these, 83.8% chose this method.

CONCLUSION

Bilateral salpingectomy should be offered to all women seeking permanent contraception. The benefits and very low risks associated with this procedure should make it a first choice option.

摘要

目的

加拿大妇产科医师学会(SOGC)和加拿大妇科肿瘤学会(GOC)建议将输卵管完全切除作为一种永久性避孕方法,因为它与降低卵巢癌风险有关。目前,许多妇女没有被提供双侧输卵管切除术作为输卵管结扎术的替代方法,用于永久性避孕。

方法

作为一项质量改进计划的一部分,我们回顾了 2018 年 1 月 1 日至 12 月 31 日期间在我们大学中心进行的所有绝育手术病例。还对阻止临床医生提供双侧输卵管切除术作为永久性避孕的临床和伦理考虑因素进行了文献复习。

结果

对 111 名接受输卵管绝育术的妇女的记录进行了审查。其中,31.5%行双侧输卵管切除术;46.8%行输卵管电灼术;12.6%行夹结扎术;9.1%行输卵管植入结扎术(Essure)。根据档案中的信息,只有 36.3%的妇女被提供了双侧输卵管切除术,其中 83.8%选择了这种方法。

结论

应向所有寻求永久性避孕的妇女提供双侧输卵管切除术。该手术的益处和极低的风险使其成为首选方案。

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