Cates W, Schulz K F, Grimes D A, Horowitz A J, Lyon F A, Kravitz F H, Frisch M J
JAMA. 1982 Aug 6;248(5):559-63.
Some clinicians have hesitated to perform dilatation and evacuation (D & E) procedures at 13 weeks' gestation or later because D & Es are more difficult to perform safely than suction-curettage procedures. Moreover, many clinicians still believe all second-trimester abortion procedures should be performed in a hospital. To evaluate these concerns, we analyzed 24,664 abortion performed between 1973 and 1978 by four physicians associated with a large outpatient abortion facility; 3,711 (15%) of the abortions were second-trimester procedures. Dilatation and evacuation was associated with a lower rate of serious complications per 100 procedures (0.23) than instillation of either dinoprost (prostaglandin F2 alpha) (1.28) or hypertonic saline (2.26). In addition, D & E had lower rates for most other specific complications. We conclude that D & E, while requiring more operator skill than earlier suction-curettage procedures, can be learned by gynecologists familiar with suction-curettage, can be performed more safely than the alternative instillation procedures, and can be safely practiced in selected ambulatory settings.
一些临床医生对于在妊娠13周及以后进行扩张刮宫术（D&E）有所犹豫，因为与吸刮术相比，D&E术更难安全实施。此外，许多临床医生仍然认为所有孕中期堕胎手术都应在医院进行。为了评估这些担忧，我们分析了1973年至1978年间由一家大型门诊堕胎机构的四位医生实施的24,664例堕胎手术；其中3,711例（15%）为孕中期手术。每100例手术中，扩张刮宫术的严重并发症发生率（0.23）低于前列腺素F2α（地诺前列素）引产术（1.28）或高渗盐水引产术（2.26）。此外，D&E术在大多数其他特定并发症方面的发生率也较低。我们得出结论，虽然D&E术比早期的吸刮术需要更多的操作技能，但熟悉吸刮术的妇科医生可以学会，它比替代的引产术实施起来更安全，并且可以在选定的门诊环境中安全进行。
