Goldhaber M K, Armstrong M A, Golditch I M, Sheehe P R, Petitti D B, Friedman G D
Division of Research, Kaiser Permanente Medical Care Program of Northern California, Oakland 94611.
Am J Epidemiol. 1993 Oct 1;138(7):508-21. doi: 10.1093/oxfordjournals.aje.a116885.
To study the long-term risk of hysterectomy after tubal sterilization, the authors analyzed historical hospital discharge data on 39,502 parous women sterilized during 1971-1984 and 40,505 comparison women matched on age, race, parity, and interval since last birth. Sterilized women were significantly more likely than were comparison women to undergo hysterectomy (relative risk (RR) = 1.35, 95% confidence interval (CI) 1.26-1.44), especially for diagnoses of menstrual dysfunction and pelvic pain (RR = 1.88, 95% CI 1.65-2.13). Higher relative risks were not associated with greater tissue-destructive methods of tubal occlusion. Relative risks were highest for women who were young on the reference date (RR = 2.45, 95% CI 1.79-3.36 for women aged 20-24 years), but declined steadily as age increased (RR = 0.96, 95% CI 0.72-1.28 for women aged 40-49 years). In all age groups, relative risks were significantly above 1.00 after 7 years of follow-up. Reasons for elevated risks may be related to a greater willingness of sterilized women to forgo their uteruses. The emergence of greater risk in all age groups, however, prevents the authors from ruling out a possible latent biologic effect of tubal sterilization.
为研究输卵管绝育术后子宫切除术的长期风险，作者分析了1971年至1984年间39502名经产妇绝育的历史医院出院数据，以及40505名在年龄、种族、产次和距上次分娩时间方面与之匹配的对照女性的数据。绝育女性比对照女性更有可能接受子宫切除术（相对风险（RR）=1.35，95%置信区间（CI）1.26 - 1.44），尤其是因月经功能障碍和盆腔疼痛而进行子宫切除术的情况（RR = 1.88，95%CI 1.65 - 2.13）。较高的相对风险与输卵管闭塞的更具组织破坏性的方法无关。在参考日期时年轻的女性相对风险最高（20 - 24岁女性的RR = 2.45，95%CI 1.79 - 3.36），但随着年龄增长相对风险稳步下降（40 - 49岁女性的RR = 0.96，95%CI 0.72 - 1.28）。在所有年龄组中，随访7年后相对风险均显著高于1.00。风险升高的原因可能与绝育女性更愿意切除子宫有关。然而，所有年龄组中风险的增加使作者无法排除输卵管绝育可能存在的潜在生物学效应。
