输卵管注药绝育术后盆腔X光片显影长度与绝育效果关系的生命表法分析

资料得自国家计划生育委员会科研项目“输卵管注药绝育术有效性安全性五年随访研究”。本文分析的特点是施该术后摄盆腔X光片测量粘堵剂充盈输卵管的显影长度,并按显影长度分组采用生命表法计算各亚组的粗累积失败率。结果显示,峡部≤1.4cm亚组和峡部≥1.5cm各亚组的粗累积失败率间差别经Log-rank检验有统计学意义(P<0.01),且粘堵剂复方苯酚糊剂(PAP)的绝育效果明显优于显影苯酚胶浆(PM)。在讨论中指出,由于PAP中含有极少量的阿的平,尽管该术在我国广泛应用中从未见到与女性生殖系统恶性肿瘤有关联的报导,但关注这一问题是极为重要的。为慎重起见,有必要在既往施该术较为普及的地区开展“病例-对照研究”以澄清或确证女性生殖系统恶性肿瘤的发生是否与实施本术后暴露于阿的平相联系,其研究结果将有助于决策。     

输卵管注药绝育术效果影响因素的logistic回归分析

一、资料与方法1.调查对象 :输卵管注药绝育术多中心临床研究在 1986年 4月至 1991年6月开展。被接纳进入该研究的共有170 5名受术合格对象。其纳入条件为术时年龄 2 0～ 35岁 ,已有两个或两个以上孩子的健康妇女 ,自愿接受本术 ,无禁忌者。术时按随机原则将复方苯酚糊剂(ＰＡＰ)和显影苯酚胶浆 (ＰＭ )分配给受术对象 ,ＰＡＰ组 871名 ,ＰＭ组 834名。施术采用经宫颈的输卵管间质部插管定量注药法 ,往受术者两侧输卵管内分别注入绝育药物 0 .0 8ｍｌ。手术后 7～14ｄ、3个月、1年、2年及 5年进行随访调查。最后共失访 2 7例 ,更换其他避孕…     

输卵管注药绝育术有效性安全性五年随访研究

研究设计采用多中心随机化临床试验,1705例合格受术对象被随机分配使用两种粘堵剂,867例使用8％阿的平苯酚糊剂(PAP),838例使用显影苯酚胶浆(PM)。两组受术对象人口学特征、妇科检查结果和术时情况均衡可比。五年随访率分别为97.5％和98.1％。多终点递减率生命表法分析表明,两组间各顺序月的粗累积失败率经log-rank检验均有显著差异。第60个顺序月的粗累积失败率,PAP组为4.61％,PM组为11.87％。PAP的节育效果显著优于PM。97.7％受术对象做了宫颈刮片检查,均未查见可疑癌细胞或癌细胞。同时,也未发现与粘堵剂可能有关的潜在疾患。这可能由于注入每侧输卵管内的粘堵剂的剂量(0.08ml)甚微之故。五年随访结果进一步表明,该术是一种简便、安全、有效的女性绝育术。作者建议在进一步改进粘堵剂配制、规范手术操作和加强施术技术标准化管理的基础上适时地推广这项新技术。     

输卵管注药绝育术副反应和并发症的近远期观察

采用多中心随机化临床试验,共接纳1705例合格受术对象,其中871例使用复方苯酚糊剂(PAP),834例使用显影苯酚胶浆(PM)。观察结果表明,术后发热率两组分别为8.0％和4.4％,组间差别有统计学意义。发热主要因药物反应所致。两组附件感染率分别为2.3‰和1.2‰。盆腔化学性腹膜炎发生率分别为1.1‰和2.4‰。未见子宫穿孔、盆腔脓肿和宫外孕。术后伴有轻度腹痛者分别占33.6％和30.8％,偶见重度者。腹痛与药物在卵管内充盈的长度和引起的组织反应范围明显有关。腰痛情况与腹痛相似。术后有症状者,多数在短时间内缓解,少数需对症治疗。术后,轻度子宫出血者两组分别为23.2％和18.0％。出血与术时取出节育器明显有关。本术对受术妇女月经无明显影响。五年随访做妇科检查和宫颈细胞学检查无阳性发现,也未查见与绝育药物主要成份有关的潜在疾患。研究表明,本术安全可靠。为进一步降低副反应和并发症的发生,研究机构应着重于现有药物配方的改进,并在保证效果的基础上,尽量减少阿的平含量。主管部门应重新估价这一技术,并加强施术管理和施术者培训,制定全国统一的操作规范,确保服务质量。本术现已得到广泛使用,有很大的发展前景,各界应予更大的关注。     

宫腔镜直视下行输卵管插管注入粘堵剂绝育术408例效果观察

目的:观察宫腔镜直视下行输卵管插管注入粘堵剂绝育术的临床效果。方法:宫腔镜直视下输卵管通液证明输卵管通畅后,向管腔内注入复方苯酚糊0.03ml,X光平片显示输卵管内药物充盈长度≥1.0cm为显影合格,显影不合格者3个月后行宫腔镜下输卵管插管通液复查。结果:408例受术者共804条输卵管注药,显影合格767条,占95.4%,经通液复查证明一次注药成功率为99.38%(799条),经1~3年随访,术后无明显副反应、并发症和异位妊娠发生。结论:宫腔镜直视下输卵管插管注入粘堵剂绝育术避免了经腹部小切口绝育术的风险和痛苦,手术安全、简便、无创伤、成功率高,注药微量,副反应轻微,为群众乐于选择的绝育手术。     

86例介入治疗输卵管阻塞性不孕症的护理

目的:探讨介入治疗输卵管阻塞性不孕症的护理.方法:对86例输卵管阻塞性不孕的患者,应用双腔球囊、泥鳅导丝、3F单弯导管对双侧输卵管进行造影剂造影、再通、注射药物治疗,加强术前、术中、术后护理.结果:间质部、峡部复通率92.54％、90.67％.术后1年随访,34例怀孕,妊娠率39.53％.结论:介入治疗输卵管阻塞性不孕症配合良好的术前、术中、术后的护理,可以提高输卵管阻塞性不孕症治疗效果.     

改良输卵管宫角植入术在结扎术后输卵管近段病理性闭塞复通中的应用探讨

对60例输卵管结扎术后近段闭塞(间质部及峡部)妇女采用改良输卵管子宫角植入术,并对部分病例切除的近段输卵管标本进行病理形态学观察。病理检查发现:①输卵管慢性炎症;②输卵管子宫内膜异位症;③管腔内增生的纤维组织填塞。术后随访50例(83.33％),输卵管通畅46例(92％),宫内妊娠29例(58％),校正妊娠率为63.04％,宫外孕1例,表明宫角植入术用于此类结扎术后输卵管近段闭塞病例的复通有较好疗效。对此术式的关键点及术后宫内妊娠率与绝育年限、年龄、术后输卵管长度的关系作了分析。     

输卵管再通术治疗输卵管阻塞性不孕症疗效分析

目的评价选择性输卵管造影与再通术在输卵管阻塞性不孕症诊治中的作用。方法选择经输卵管造影证实输卵管间质部、峡部或壶腹部阻塞的187例不孕妇女的356支输卵管进行选择性输卵管造影及再通术,术中灌注抗粘连药物。术后随访6～24个月。结果再通成功率85．1％,妊娠率29．4％,无1例发生严重并发症。结论选择性输卵管造影和再通术是目前诊治输卵管阻塞性不孕症的一种安全有效且值得推广的方法。     

输卵管注药绝育术有效性及安全性的前瞻性流行病学研究

本文为一项输卵管注药绝育术的前瞻性队列研究。队列1使用显影苯酚胶浆共834例,队列2使用8%阿的平苯酚糊剂871例。二年随访率98.5%。生命表法分析,第24个顺序月每100名妇女的累积成功率两队列分别为91.9%和97.4%。其间有显著性差别。绝育效果主要取决于输卵管注药后X光显影的充盈长度。多元判别分析也显示同样的结论。所有研究对象在术中和术后未见严重并发症。术后发烧,队列2 (8%)高于队列1(4.4%)。本术对月经无明显影响。研究结果表明该术是一种简便、安全、有效的女性绝育术。     

直视下输卵管移植术治疗不育不孕11例临床分析

目的 探讨直视下输卵管移植术治疗不育不孕的简易方法.方法 回顾性分析我科收治的11例采用直视下开放式宫角输卵管移植治疗峡部和间质部阻塞性不育不孕症患者的临床资料.结果 11例患者共移植12条输卵管,全部治愈出院,无并发症发生；术后行输卵管通液试验,9例通畅、2例不完全通畅,通畅率81.8％；随访6个月～2年,9例成功怀孕.结论 采用直视下开放式宫角输卵管移植治疗峡部和间质部阻塞性不育不孕症,技术简单、易行,再通率高,值得在基层医院推广.     

输卵管绝育术后再次妊娠2例并文献复习

输卵管绝育术是国际上常用的女性长效避孕手段之一,主要包括输卵管切除术、输卵管阻塞术和输卵管结扎术,这些术式各有特点,可以不同地在腹腔镜手术、宫腔镜手术或者开腹手术中实现。其中输卵管切除术具有输卵管重塑不可逆性,因而避孕效果显著;而输卵管阻塞术和输卵管结扎术两种术式虽然具有输卵管重塑的可逆性,但是存在一定的避孕失败率,其原因目前并不完全清楚,但具有多方面性。现回顾本院2例输卵管绝育术后再次妊娠的病例,并对输卵管绝育术进行简要文献复习,以期引起妇产科医生的重视,准确处置。     

输卵管内节育器的研究及应用现状

输卵管绝育术是中国育龄人群应用较多的避孕节育方法之一。但绝育术是有创伤手术,存在一定并发症及后遗症,可接受性差。因此,提供高效、安全、可复、微创或无创的女性避孕绝育方法是目前研究的重点。最近,输卵管内节育器（intra-tubal device,ITD）的研究取得了新的进展,ITD为非创伤性手术,不良反应及并发症都很少,使用者如需要再生育,取出ITD即可恢复,其有可能取代传统的输卵管绝育术,为育龄妇女提供一种新的、无创伤性及可逆性的避孕节育方法。     

Tubal sterilization by means of endoluminal coagulation: an in vivo study in rabbits

This study was conducted to investigate the effectiveness and safety of endoluminal tubal coagulation in obliterating the tubal lumen in rabbits. Forty female rabbits were subjected to laparotomy and hysterotomy. Endoluminal tubal coagulation was induced over a length of 3 cm in the proximal, extramural fallopian tube by using a heated stainless steel cannula or a cylindrical diffusing tip emitting argon laser radiation for one to 5 minutes. Tubal patency was evaluated by observing patterns of injected methylene blue and/or breeding success rates. Postoperative recovery was uneventful in all animals. A negative methylene blue test indicated occlusion in 51 of 52 tubes (tubal occlusion rate 98.1%), and a contraception rate of 100% in all 17 uteri in which the tube had been treated. The described endoluminal tubal coagulation method proved suitable for safe and effective sterilization in rabbits and has potential as a new transcervical tubal sterilization method for humans.     

Locus of control and choice of contraceptive method

The purpose was to assess the relationship between locus of control and the contraceptive method chosen. It was used the Levenson's Multidimensional Locus of Control Scale and 191 women was interviewed. Users of male condoms presented greater Internality than the monthly contraceptive injection users. Regarding the External locus of control (Powerful Others), the implant users presented less Externality than those who used condoms, tubal ligation, three-monthly injections and the IUD. Regarding the External locus of control (Chance), the implant users presented smaller scores than those who opted for tubal ligation, three-monthly injections and the IUD. It was observed also that monthly injections users presented smaller scores of External locus of control (Chance) than the women who were three-monthly injections users.     

Prolonged effectiveness of Norplant(R) capsule implants: a 7-year study

Soft tubing Norplant(R) contraceptive implants were studied in 1210 women for 7 years to measure the duration of effectiveness and the magnitude of the pregnancy rates over that time. Mean age at enrollment was 27.4 years. Of the enrollees, 42% were US residents. One-sixth (16.1%) weighed >/=70 kg at the time of implant placement. At the end of 5 years, the cumulative pregnancy rate was 1.1/100; at the end of 7 years, it was 1.9/100. No pregnancies occurred to any of the 400 women who enrolled in the study at age >/=30 years and who weighed <100 kg. Among women aged 18-33 years, the 7-year Norplant pregnancy rates are comparable to the median pregnancy rates of tubal sterilization methods for women of the same age and duration of use. For women aged >/=34 years, without regard to weight at admission, the 7-year effectiveness of soft tubing Norplant equals or surpasses that of tubal sterilization. For continuing implant users, annual pregnancy rates <1.0/100 in years 6 and 7, together with low cumulative pregnancy rates, testify that Norplant capsule implants remain highly effective for 7 years.     

Demographic and clinical profile of human immunodeficiency virus-infected postpartum women who undergo sterilization

The decision of human immunodeficiency virus (HIV)-infected women to accept a contraceptive method has implications related to the prevention of HIV infection to their children. A case-control study was performed in 57 HIV seropositive pregnant women with prenatal care and delivery at the National Institute of Perinatology, Mexico City. Thirty-five cases were women who accepted postpartum sterilization and twenty-two controls were women who refused this method. The acceptance of tubal occlusion was statistically more frequent in multiparous women, and in those with previous children infected with HIV. The antecedent of at least one previous pregnancy had an association with the acceptance of tubal occlusion with an OR of 11.2 (CI 95% 2.9 to 42.9); having at least one previous child HIV-infected had an OR of 4.6 (CI 95% 1.3 to 23.1). The stratified analysis did not show modification of the association strength between previous pregnancy and the precedent of previous children HIV-infected with the acceptance of sterilization.