影响输卵管吻合术后妊娠效果的相关因素

目的:探讨输卵管吻合术后妊娠率与原绝育方法、部位、绝育年限及吻合术后输卵管长度的关系。方法:回顾性分析了2006年6月～2011年4月施行输卵管吻合术216例妇女的妊娠情况。结果:216例受术者中,妊娠184例,其中异位妊娠7例,自然流产16例,总妊娠率85.19%。吻合术后1年内妊娠率达79.30%。银夹和抽芯包埋法绝育吻合后妊娠率显著高于潘氏法(P<0.05);输卵管端端吻合,以峡-峡部妊娠率显著高于其它几个部位(P<0.05),吻合术后妊娠率与绝育年限长短无统计学相关性(P>0.05),吻合术后输卵管长度<5 cm者妊娠率明显低于>5 cm者(P<0.05)。结论:输卵管吻合术后妊娠率与原绝育方法、部位及吻合术后输卵管长度密切相关。     

输卵管复通术失败后再次显微复通术效果观察

目的:探讨输卵管绝育后复通失败的原因和再次显微手术复通的效果。方法:对178例输卵管复通术失败者行再次显微复通术时的发现(粘连、炎症等)和再次复通术的效果进行分析。结果:178例再次显微复通输卵管356条,首次吻合部位粘连扭曲呈团状占49·44%(176/356),吻合部位有漏管形成占34·27%(122/356),单纯吻合部位堵塞占26·97%(96/356),输卵管伞端与卵巢粘连占9·55%(34/356),首次手术支架未取出占2·81%(10/356),在首次复通术时结扎术废用部分输卵管未切除占56·74%(202/356)。再次复通手术后随访2年以上,宫内妊娠率64·61%(115/178),其中足月分娩率64·04%(114/178);自然流产率2·25%(4/178),其中3例自然流产后又妊娠足月分娩;异位妊娠率1·12%(2/178)。结论:输卵管结扎后首次复通术造成吻合部位的粘连扭曲致输卵管不通是失败的主要原因,其它原因还有吻合部位漏管形成、结扎部废用输卵管切除不充分、输卵管伞端与卵巢粘连等。再次复通术后的宫内妊娠率较首次复通术明显下降。因此,首次输卵管复通术时的规范操作是提高复通术妊娠率的关键。     

Tubal ligation does not affect hormonal changes during the early menopausal transition

BACKGROUND: To determine if women with a bilateral tubal ligation (BTL) were more likely to experience hormonal changes indicative of the transition to menopause or an increase in menopausal symptoms compared to women without a BTL. METHODS: Menopausal symptoms and hormone profiles of 134 women reporting a BTL were compared throughout the course of a 4-year follow-up study to 172 women without a BTL. Generalized linear regression models for repeated measures were used to estimate the independent effect of BTL on menopausal symptoms and hormonal levels adjusted for covariates. RESULTS: Forty-four percent of women reported a BTL and over one-half of women with a BTL experienced hot flashes. Women with a BTL had similar hormonal levels over the study period compared to women without a BTL. In addition, no relationship was found between BTL and any of the menopausal symptoms, including hot flashes, decreased libido or increased anxiety adjusting for age, race, body mass index (BMI), education, menopausal status and parity. CONCLUSION: These findings document that women with a BTL have similar changes in sex hormone levels over the perimenopausal period compared to women without a BTL independent of other covariates. In addition, the reporting of menopausal symptoms was similar between the groups.     

腹腔镜下输卵管吻合术68例临床分析

目的:评价腹腔镜下输卵管吻合术的临床效果和影响因素。方法:对68例输卵管绝育术的患者行腹腔镜下6、12点输卵管吻合术,并统计术后宫内妊娠率、活产分娩率、异位妊娠发生率以及影响妊娠结局的因素。结果:随访至少24个月,68例中11例失访,随访成功的57例中术后宫内妊娠成功率80.7%(46/57),异位妊娠发生率5.2%(3/57),未孕11例,占19.2%(11/57)。其中46例宫内妊娠中,术后6个月内妊娠23例占50.0%,12个月内妊娠39例占84.8%,18个月内妊娠45例,占97.8%,除2例现孕8月外,已分娩42例,活产分娩率91.3%(42/46),自然流产2例,自然流产率4.3%(2/46)。≥40岁及以上患者宫内妊娠率为40.0%(2/5),<40岁患者宫内妊娠率为84.6%(44/52)。结论:腹腔镜下输卵管吻合术是最能体现腹腔镜这一微创手术优越性的手术,是绝育术后要求生育患者的一个较好的治疗选择。     

Changes in family structure and regret following tubal sterilization

Tubal sterilization is one of the contraceptive methods whose use has increased the most in Brazil, but a growing number of women have expressed regret after the procedure. A case-control study was conducted at the Centro Integrado de Saúde Amaury de Medeiros (CISAM), Recife, Pernambuco, Brazil, in 1997 to investigate the association between changes in family structure and request for or submittal to surgical reversal of tubal sterilization, comparing 304 sterilized women who had requested or submitted to reversal of tubal sterilization and 304 women who were also sterilized but had not requested, had not submitted to, and who did not wish to submit to reversal. The simple and adjusted odds ratios were estimated using logistic regression. The results of the current study showed that death of children, partners without children prior to the current union, and partner change after tubal sterilization were associated with the request for or submittal to reversal of tubal sterilization. More strict criteria are suggested in the indication of tubal sterilization, including an in-depth profile of the woman requesting tubal sterilization and identification of risk factors for future regret.     

Compliance with Papanicolaou smear screening following tubal ligation in women with cervical cancer

To evaluate patient compliance with Papanicolaou (Pap) smear screening after tubal ligation compared with other methods of birth control in patients who develop cervical cancer, a retrospective review of 262 women with cervical cancer diagnosed at age < or = 70 years was undertaken at the Albert Einstein College of Medicine from January 1987 to December 1995. Demographic data, stage of the disease, histologic type, history of smoking, history of sexually transmitted disease (STD), and birth control use were recorded. The Pap screening history was obtained from all the patients. Women who had a bilateral tubal ligation (BTL) were compared with those who did not have this form of birth control. The date and result of their last Pap test prior to their diagnosis of cervical cancer was noted. Two hundred fourteen women with cervical cancer were evaluable. The clinical stage, mean age, history of smoking, and history of STD were similar for both groups. Gravidity among the BTL group was higher than in the non-BTL group (p < 0.01). Forty-eight (22.4%) women had a previous BTL. Twenty-seven of these 48 patients (56.3%) did not have a Pap smear within 3 years prior to the diagnosis of cervical cancer. Of the 166 patients, 61 (36.7%) did not have a Pap test within 3 years (p < 0.05). Fourteen women (29.2%) in the tubal ligation group never returned for a Pap test following the BTL. An average of 6.2+/-5.9 years elapsed since the last Pap test in the BTL group, with 4.0+/-5.1 years in the nontubal ligation group (p < 0.05). There was a correlation between the number of years since BTL (14.2+/-7.7) to the number of years since the last Pap test (6.2+/-5.9) (p < 0.05). Women who have had a BTL should be considered high risk because of poor screening compliance. A Pap test every 3 years is not adequate in this high-risk population group. We advocate improved counseling regarding the importance of continued annual Pap screening for women who are considering tubal ligation.     

Denying postpartum sterilization to women with Emergency Medicaid does not reduce hospital charges

BACKGROUND: To assess the change in hospital reimbursement resulting from a 2004 policy requiring immigrants with Emergency Medicaid (EM) to pay for sterilization following vaginal delivery, we examined rates of tubal ligation following vaginal [postpartum bilateral tubal ligation (PPBTL)] and cesarean [cesarean section with bilateral tubal ligation (CSBTL)] deliveries, and compared these to a Standard Medicaid (SM) population unaffected by the policy. STUDY DESIGN: Records of women who delivered at the Oregon Health and Science University between January 2000 and December 2006 were reviewed. Data examined included insurance, mode of delivery, sterilization and net revenue by delivery type. RESULTS: A total of 3612 SM patients and 4220 EM patients delivered in the 5 years before the policy, and 1628 SM patients and 2066 EM patients delivered in the 2 years after the policy. The incidence of PPBTL among EM patients delivering vaginally dropped from 9.9% prepolicy to 0.9% postpolicy (p<.01). Concurrently, CSBTL among EM patients having cesarean section increased from 18.8% prepolicy to 23.5% postpolicy (p=.03). Notably, no significant change in PPBTL (pre: 8.7%, post: 9.2%, p=1.0) or CSBTL (pre: 22.9%, post: 22.9%, p=.62) occurred in the SM group. The net revenue change for all deliveries with tubal ligations in the EM population postpolicy was -US$5284. CONCLUSION: Requiring out-of-pocket payment for sterilization following vaginal delivery in an EM population results in a decrease in PPBTL and an increase in CSBTL, and does not reduce hospital financial losses.     

Regret following female sterilization at a young age: a systematic review

Women who undergo sterilization may later regret this decision. This systematic review examines whether age at sterilization is associated with poststerilization regret. Using MEDLINE and EMBASE, we identified 19 articles that examined associations between women's age at sterilization and later regret, requests for sterilization reversal and undergoing sterilization reversal or requesting in vitro fertilization (IVF) procedures. Study results showed that the younger women were at the time of sterilization, the more likely they were to report regretting that decision. Women undergoing sterilization at the age 30 years or younger were about twice as likely as those over 30 to express regret. They were also from 3.5 to 18 times as likely to request information about reversing the procedure and about 8 times as likely to actually undergo reversal or an evaluation for IVF. Results of studies that examined risk by continuous age showed a consistent inverse relationship between women's age at sterilization and their likelihood of regretting having had the procedure.     

两种输卵管绝育术式安全性、有效性及可接受性的临床对比研究

目的:通过对局麻单孔腹腔镜双极电凝输卵管绝育术、经腹近端抽芯包埋输卵管绝育术的比较,评估局麻单孔腹腔镜输卵管绝育术的安全性、有效性、可接受性及两种术式术后对卵巢功能的近期及远期影响。方法:在贵州省14个项目县随机抽取2014年1-12月行局麻单孔腹腔镜双极电凝输卵管绝育术妇女914例(腹腔镜组)、经腹近端抽芯包埋输卵管绝育术妇女893例(经腹组),对两组术中观察和术后随访进行评估,同时对两组与未行输卵管绝育术(未绝育组)部分妇女,抽取不同时期静脉血进行卵巢功能评估。结果:腹腔镜组术中出血量、术后并发症发生情况、术后1个月卵巢功能等安全性指标优于经腹组(P均0.05),术中疼痛度、手术时间、术后疼痛感、留观时间、满意率等可接受性指标优于经腹组(P均0.05)。腹腔镜组和经腹组术后1个月基础性激素水平无显著改变,但经腹组术后基础FSH10U/L、基础FSH/LH升高2的比例显著高于腹腔镜组(P均0.05)。结论:局麻单孔腹腔镜手术是一种安全、有效、操作简单、痛苦小、恢复快,更易被手术对象接受的手术方法,对卵巢功能的近期影响小于经腹手术。     

局麻单孔腹腔镜电凝绝育术618例临床效果观察

目的:探讨局麻单孔腹腔镜电凝绝育术(简称电凝绝育术)的有效性、安全性及可接受性。方法:分析618例行电凝绝育术的已婚育龄妇女术时相关指标及术后第1、3、6、12个月随访情况。结果:604例(97.73%)成功行电凝绝育术,6例(0.97%)因盆腔粘连无法暴露一侧输卵管仅行单侧输卵管电凝绝育术,8例(1.29%)因气腹针穿刺失败或因盆腔严重粘连无法暴露输卵管而未进行手术。术后1年妊娠1例(0.16%);613例(99.19%)术中出血<5ml;589例(96.56%)于电凝开始时5～10s诉下腹疼痛,可忍受,10s后无疼痛感;6例(0.97%)合并粘连并影响操作,进行粘连松解;150例(24.39%)镜下发现盆腔异常情况;17例(2.79%)发生非严重手术并发症,均未造成严重后果。平均手术时间19.36min,平均留观时间30.52min。术后第1,3,6,12个月随访时部分观察对象出现不同程度的腹痛、腰痛、劳动力下降、月经改变等情况,经对症处理、心理疏导后恢复正常,满意度达97.83%。结论:单孔腹腔镜电凝绝育术是一种安全、有效、育龄群众易接受的女性绝育方法,值得临床应用。     

输卵管外科手术在治疗输卵管性不孕中的应用

输卵管因素引起的不孕（简称输卵管性不孕）是女性不孕的首要原因,主要包括近端输卵管梗阻、输卵管绝育术和输卵管远端粘连、闭锁、积水。在辅助生殖技术占据生殖医学主导地位的今天,生殖手术在治疗输卵管性不孕中的地位并未改变。综合考虑患者的年龄、卵巢储备功能、术后输卵管功能、男方精液参数等指标后有指征地实施个体化生殖手术,不仅可以取得较满意的临床妊娠率和活产率,还可以恢复患者多次自然受孕的能力,这与我国现行生育政策更为贴合。针对输卵管病变部位的不同,采取的术式也各异,主要有近端输卵管吻合术、输卵管导丝介入术、中段输卵管吻合术、输卵管粘连分解术、输卵管伞端成形术、输卵管造口术、输卵管切除术和输卵管结扎术。     

Contraceptive effectiveness of two insertions of quinacrine: results from 10-year follow-up in Vietnam

BACKGROUND: This study was conducted to evaluate the long-term effectiveness of two insertions of quinacrine pellets for nonsurgical sterilization among women in northern Vietnam. STUDY DESIGN: Observational cohort study of 1335 women who received two quinacrine insertions between 1989 and 1993. RESULTS: About 90% of the study population participated in the last round of interviews. Cumulative follow-up time for this cohort was 14,294 person-years. The 1-, 5- and 10-year cumulative pregnancy probabilities for quinacrine were 3.3% (95% CI, 2.4-4.3), 10.0% (95% CI, 8.4-11.6) and 12.1% (95% CI, 10.4-13.9), respectively. Pregnancy estimates with quinacrine in this cohort were higher than that reported from US-based research on surgical tubal sterilization and higher than results of quinacrine sterilization in Chile. Quinacrine effectiveness was better among older women. CONCLUSION: The effectiveness of quinacrine in Vietnam was lower than other forms of sterilization. Factors such as inconsistent training and use of various insertion techniques may have contributed to the relatively high failure rate.     

Sterilization regret among U.S. couples

The 1982 US National Survey of Family Growth included questions aimed at measuring sterilization regret. Of the 8583 couples in the survey who were protected from pregnancy by vasectomy or tubal ligation, 26% indicated they would like to have more children and 10% desire sterilization reversal. The proportion of women who want more children despite sterilization is highest (42%) among those aged 20-29 years, then declines with rising age to a low of 13% among women 40-44 years of age. Of all women who assert they want a reversal, 62% are aged 25-34 years. Blacks comprise 11% of contraceptively sterilized couples in the US but 18% of those who want the procedure reversed; similarly, Hispanics make up 6% of contraceptively sterilized couples but 17% of those expressing a desire for reversal. Significantly higher percentages of Medicaid recipients desire sterilization reversal, although this may reflect the fact that poor women are generally younger. Women who were not currently married were significantly more likely than married women to desire reversal (21% versus 8%). Finally, women who were sterilized before the age of 30 years were significantly more likely than those who were older at the time of the procedure to want another child (33% versus 17%) and to desire reversal (14% versus 6%). It is recognized that the responses to this question are not a good indication of the strength of sterilization regret, and they do not provide an accurate measure of need or potential demand for sterilization reversal. However, these findings do reflect a substantial level of dissatisfaction with sterilization as a means of fertility control. Providers of sterilization services should be aware that 10% or more of their patients may later regret their decision. It is possible that if more acceptable methods of reversible contraception were available, fewer women would resort to sterilization at young ages and the level of regret would be reduced.     

Demographic trends in tubal sterilization: United States, 1970-1978.

In the period 1970-1977, an estimated 4,236,000 women 15-44 years of age had tubal sterilization operations in United States hospitals. Both the number and the rate of tubal sterilizations increased each year from 1970-1977, but in 1978 both declined. Tubal sterilization rates for Black women were higher than for White women. Black women also tended to be younger at the time of tubal sterilization. For the nation as a whole, the mean age at the time of tubal sterilization remained constant at about 30 with the youngest age group having the highest proportion of never-married women.     

Reversal of female sterilisation: a comparative study

In 80 women who had reversal of sterilisation, a study was made of their clinical features at the time of sterilisation and of the factors related to successful outcome. Compared with controls at the time of sterilisation, the women requesting reversal were younger, of lower social class and of higher parity; in addition they were more likely to have an unstable relationship and to have been sterilised following a recent pregnancy. After reversal, intrauterine pregnancy occurred in 26/80 (32.5%) and ectopic pregnancy in 6/80 (7.5%), the majority of successful pregnancies occurring in younger women within one year of reversal following a non-destructive method of tubal occlusion. There was no evidence that techniques of management, including the use of an operating microscope, significantly influenced outcome, and controlled trials will be required to establish their efficacy.     

Union status, marital history and female contraceptive sterilization in the United States

CONTEXT: Much of what is known about the choice of sterilization as a contraceptive method is based on data from married women or couples. Because of increasing rates of cohabitation, divorce and repartnering, however, the relationship context in which sterilization decisions are made has changed. METHODS: The 1995 National Survey of Family Growth includes the complete birth and union histories of 10,277 white, black and Hispanic women. The distribution of union status and marital history at the time of tubal sterilization was estimated for these three racial and ethnic groups among the 799 women who had had a tubal ligation in 1990-1995 before age 40. Cox proportional hazard regression models were used to estimate the effects of union status and marital history on the risk of tubal sterilization. The analysis controlled for the woman's age, parity, race and ethnicity education, region, experience of an unwanted birth and calendar period. RESULTS: Among women who obtained a tubal sterilization, most whites (79%) and Hispanics (66%) were married when they had the operation, compared with only 36% of black women. At the time of their sterilization, 46% of black women had never been married. Among all women, regardless of race and ethnicity and net of all controls, the probability of tubal sterilization is about 25% lower for single, never-married women than for cohabiting or married women. Cohabitation does not reduce the likelihood in comparison to marriage, however. Higher rates of tubal sterilization among Hispanic women are accounted for by their higher parity at each age; differences in parity or marriage by race only partially account for the relatively higher rates of tubal sterilization among black women. CONCLUSIONS: Because women currently spend greater proportions of their lives outside of marriage or in less-stable cohabiting partnerships than they did in the past, they are increasingly likely to make the decision to seek sterilization on their own. As a result, the gender gap in contraceptive sterilization will likely increase. The possibility of partnership change is an important consideration in choosing sterilization as a contraceptive method.     

Contraceptive sterilization use among married men in the United States: results from the male sample of the National Survey of Family Growth

Background

Surgical sterilization has many advantages. Previous information on prevalence and correlates was based on surveys of women.

Study Design

We estimated the prevalence of vasectomy and tubal ligation of partners for male participants in the 2002 National Survey of Family Growth, a nationally representative survey of US residents aged 15-44 years. We identified factors associated with sterilizations using bivariate and multivariate techniques.

Results

The findings revealed that 13.3% of married men reported having had a vasectomy and 13.8% reported tubal sterilization in their partners. Vasectomy increased with older age and greater number of biological children, non-Hispanic white ethnicity, having ever gone to a family planning clinic. Tubal sterilization use was more likely among men who had not attended college, those of older age and those with live births.

Discussion

One in eight married men reported having vasectomies. Men who rely on vasectomies have a somewhat different profile than those whose partners have had tubal sterilizations.     

Long-term regret among 216 sterilized women. A six-year follow-up investigation

Six years after tubal sterilization 16 of 208 women reported serious regret. The desire for another child in a new relationship was given as the main reason for later regret, although other causes were also reported. No association between age, parity, time or type of tubal sterilization and later regret was demonstrated. However, a greater proportion of regretters than of the remainder had been recommended the sterilization by a doctor at abortion application. The regretters had undergone more abortions before their sterilization, and the study revealed more unstable marriages with consequently less support from the spouse at sterilization in the regretting group. Post-sterilization regret is discussed within the framework of life events and social support.     

Tubal sterilization in the United States, 1994-1996

CONTEXT: Although the number and rate of tubal sterilizations, the settings in which they are performed and the characteristics of women obtaining sterilization procedures provide important information on contraceptive practice and trends in the United States, such data have not been collected and tabulated for manyyears. METHODS: Information on tubal sterilizations from the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery was analyzed to estimate the number and characteristics of women having a tubal sterilization procedure in the United States during the period 1994-1996 and the resulting rates of tubal sterilization. These results were compared with those of previous studies to examine trends in clinical setting, in the timing of the procedure and in patient characteristics. RESULTS: In 1994-1996, more than two million tubal sterilizations were performed, for an average annual rate of 1 1.5 per 1,000 women; half were performed postpartum and half were interval procedures (i. e., were unrelated by timing to a pregnancy). All postpartum procedures were performed during inpatient hospital stays, while 96% of interval procedures were outpatient procedures. Postpartum sterilization rates were higher than interval sterilization rates among women 20-29 years of age; interval sterilization procedures were more common than postpartum procedures at ages 35-49. Sterilization rates were highest in the South. For postpartum procedures, private insurance was the expectedprimary source of payment for 48% and Medicaid was expected to pay for 41 %; for interval sterilization procedures, private insurance was the expected primary source of payment for 68% and Medicaid for 24%. CONCLUSIONS: Outpatient tubal sterilizations andprocedures using laparoscopy have increased substantially since the last comprehensive analysis of tubal sterilization in 1987, an indication of the effect of technical advances on the provision of this service. Continued surveillance of both inpatient and outpatient procedures is necessary to monitor the role of tubal sterilization in contraceptive practice.