输卵管结扎术后后遗症

目的:探讨和分析输卵管结扎术后后遗症的发病规律,并找到一种有效的方法降低后遗症的发病率。方法:随机选取20例输卵管结扎术患者作为研究对象,总结输卵管结扎术后后遗症的主客观因素。结果:在输卵管结扎术后,20例患者中后遗症主要有五类,其中有6例腰部活动受限制,5例月经异常,4例性生活痛苦,3例下腹痛,2例有腹部创口瘘。结论:临床上输卵管结扎术后后遗症是非常常见的,严重的后遗症会影响妇女的生活质量,必须采取预防的手段,规范结扎,提高输卵管结扎术的质量,减少输卵管结扎术后并发症的发生,要严格手术适应证、规范手术操作、提高手术质量,让妇女得到一种非常安全又可靠的避孕方法。     

计生服务站提高绝育术质量的体会

目的探讨基层计划生育专业单位如何提高男女绝育手术的质量。方法通过16年来34105例男女结扎术的追踪、随访、观察手术效果和并发症情况。结果手术效果满意,失败率低[1,2],并发症少。结论科学的管理、严格的制度,遵守手术常规,掌握绝育术要领,不断总结经验,谨慎、戒骄戒躁,才能提高基层的绝育术质量。     

输精管结扎术后并发症影响性功能的原因及预防

目的探讨输精管结扎术后并发症影响性功能的原因及预防.方法分析并发症是影响性功能的主要原因,必须对受术者作好术前准备.术中熟练掌握各项技术操作,改进手术方法.术后注意观察,讲究卫生,解除思想负担,互相配合.结果统计随访受术者300例,没有1例发生术后并发症,不影响性生活.结论输精管结扎术是计生绝育有效措施,可以预防术后并发症,不影响性功能,确保男性健康.     

阴囊血肿28例治疗分析

<正> 输精管结扎术是目前公认的安全、简便、有效的男性节育方法,适应症选择或手术操作不当,可发生术后局部出血。现将笔者1992年以来治疗阴囊血肿28例分析报告如下。     

影响男性参与计划生育的因素:中国定性研究的发现

本项目于1993～1994年在中国开展。为达到研究的预期目的,在方法学方面采用定性研究技术,即通过集体访谈(FGDs)和个人深入访谈的方式来获取各类访谈对象的观念和行为方面的广泛信息,以探究影响男性参与的深层原因。访谈现场确定在四川、云南和吉林三省。本项目集体访谈对象类型主要包括避孕套使用者及其妻子,五年内男扎接受者及其妻子,采用女性方法的妇女及其丈夫等;个人访谈对象类型主要包括政策制定者、项目管理者、节育技术提供者和宗教领袖等。各省现场调查结束后,研究者使用统一拟定的提纲对集体访谈资料进行观点归类,并以个人访谈获取的关键信息加以补充,进而找出研究之主要发现。研究结果提示,影响男性参与计划生育的因素主要涉及政策与宣传、服务与技术、地理与文化和社会与心理等相互联系的诸多方面。根据主要发现提出的建议要点主要包括改善决策者男扎方面的知识,制定出有利于男性参与的鼓励性政策;加强避孕套提供过程的全面质量管理;进一步提高男扎服务质量并制定切实可行的规范;通过各种渠道宣传男扎知识,改进服务提供者的人际交流技巧,为广大群众提供咨询服务,进一步改善男性参与计划生育的意识并分担责任。     

影响经腹输卵管结扎术高危因素临床分析

目的:探讨高危因素对经腹输卵管结扎术的影响,提高手术成功率及安全性。方法:对202例行输卵管结扎术病例进行回顾性对照分析,分为无高危因素组90例,高危因素组112例,高危因素包括:有下腹部手术史42例、多次流产史(≥3次)28例、哺乳期39例、高龄(≥40岁)24例。结果:在高危因素组中有下腹部手术史者、多次流产史、高龄术中发生粘连情况明显多于无高危因素(P<0.05),手术时间明显长于无高危组(P<0.05),有5例因粘连严重致一侧结扎失败。哺乳期无明显影响。结论:有下腹部手术史、多次人流史、高龄对行输卵管结扎术成败有较大影响。     

3例少见输卵管结扎并发症的分析

目的：探讨输卵管结扎并发症的治疗方法和效果。方法：回顾本站于2005年10月～2009年3月，共施行输卵管结扎术1773例，手术均采用局麻下腹部小切口，改良波氏法。现将3例少见并发症遴选出来，进行回顾性分析，总结经验教训。结论：此种情况应引起同行特别是基层工作者的重视，从而增强工作责任心，切实提高手术质量，降低手术并发症，确保受术者的生殖健康。     

输精管结扎术后并发症8例分析

输精管结扎术后并发症８例分析贵州省黎平县大稼乡卫生院（５５７３１６）姜胜文输精管结扎术是一种对人体组织创伤少，手术时间短，术中、术后无痛苦，术后短时间即可恢复劳动的安全有效的男性绝育手术。我院在１９９４年１０月～１９９６年１２月期间共作输精管结扎术４...     

影响经腹输卵管结扎术的危险因素分析

目的：对影响经腹输卵管结扎术的危险因素进行分析。方法：选取经腹输卵管结扎术治疗的100例患者的临床资料进行调查,分为危险因素组与无危险因素组,每组患者各50例,对其临床资料进行回顾性分析。危险因素包括多次流产史、下腹部手术史、哺乳以及高龄。结果：临床数据显示,无危险因素组患者术中出现粘连情况的例数要明显少于危险因素组中有多次流产史、下腹部手术史以及高龄患者（P〈0．05）,且手术时间明显短于危险因素组;危险因素组有3例患者因出现较为严重的粘连情况而造成一侧结扎的失败。哺乳期对手术没有明显的影响。结论：有多次流产史、下腹部手术史以及高龄均会对经腹输卵管结扎术的治疗结果产生重要的影响。     

输精管残端组合改良法行输精管结扎术260例临床分析

<正> 钳穿法输精管结扎术因方法简单、操作容易、效果可靠,被医务人员和育龄男性所接受。为提高钳穿法输精管结扎术成功率、降低再通率、减少并发症,笔者自2000年以来采用筋膜穿孔分层隔离远睾端输精管残端及两残端斜角反折的组合改良方法施行输精管结扎术260例,经临床观察,效果满意,现报告如下。     

Vasectomy responses

A study was commissioned by the Midwest Population Center in December 1971 of 190 vasectomy clients and their wives, who were sent a questionnaire 6 months after the operation, to determine why couples selected vasectomy to terminate childbearing, how they responded to the procedure, and what they were like psychologically. Reactions are given with the view that satisfied clients make good recruiters and dissatisfied clients scare others away. It was found that the operation is generally appreciated for giving life-long protection against unwanted children. Wives, particularly, are appreciative, and represent an untapped source of motivation to whom more communication should be addressed. 3 different sorts of responses were noted among clients: practical, emotional, and intellectual. For the practical, it is important to detail in advance of the operation the possible side effects so they should not become bitter should adverse reactions develop. To the emotional, vasectomy should be pictured as a freedom giver and worry killer in regard to sexual relations. To the intellectual, the philosophical and humanistic aspects of sterilization should be emphasized.     

Attitudes to vasectomy

4 surveys were conducted in the United Kingdom in an attempt to determine the personal and social factors influencing the decision to have a vasectomy. The surveys differed from other vasectomy studies in that they represented couples requesting a vasectomy and not only those who obtained a vasectomy. They include, therefore, individuals who were refused and those who changed their minds, as well as those individuals on whom the operation was performed. The surveys showed that by 1978 the majority of requests came from couples who had 2 children or less (70%), who came from social class 3 (64%), and where the wife was under age 35. There was a relative absence of high-parity couples, of the least skilled, and of those of African or Asian origin. The husbands viewed vasectomy as a final act of male contraceptive responsibility. The reasons for choosing vasectomy were to prevent further pregnancies and to protect the wife from the health risks of the oral contraceptive or the IUD and from the dangers of childbearing or the fear of pregnancy. The findings of the first 3 surveys were similar. All surveys suggested that men of low parity preferred vasectomy and that men of high parity and those of African or Asian origin were often reluctant to undergo a vasectomy. All the marriages described as successful remained so after vasectomy. Minor degrees of impotence, frigidity or lack of libido appeared to improve. 11% of the couples withdrew from the operation following the counseling session. The 476 couples requesting vasectomy in the first 3 surveys produced a wide range of anxieties over health, life problems, sexual enjoyment, contraception, children, marriage, and the change of life. There appeared to be marked differences between couples who undergo vasectomy and those choosing tubal ligation.     

输精管绝育术后冠状动脉粥样硬化性心脏病及高血压等的流行病学调查

本文报告了输精管绝育术后人群中冠心病、高血压等疾患的横断面调查资料。从1981年9月至1982年6月，在四川省六个市、县范围内，用整群抽样方法对30~65岁已婚男性25，076人进行了健康检查。实检人数为24，367人，受检率97.2%，统计分析的实际总数为23，766人。其中绝育者12，501人（平均绝育年限10.05年），未绝育者11，265人。通过比较分析，没有发现绝育术后冠心病、高血压的患病率及冠心病易患因素中高脂血症、糖尿病的患病率有增加的线索。还对708人作了三种抗精子抗体测定（GAT、FDT及SIT），结果在绝育组的冠心病人中测得阳性率及平均滴度效价都不比对照组高。整个调查结果表明，输精管绝育术是一种安全、有效、简便和经济的绝育方法。     

Voluntary sterilization in Guatemala: a comparison of men and women

Report of a study comparing 500 men and 419 women who had undergone voluntary sterilization in Guatemala City, in terms of their sociodemographic characteristics, attitudes and motivations regarding the operation, reactions to the quality of attention received in the clinic, postoperative complaints, and the effect of the operation on health and sex life. In both groups over 90% reported no regret about the operation. Changes in health status or sex life after the operation emerged as very important correlates of satisfaction among both men and women. Acceptors tended to be married or live in consensual union, be Catholic but not very religious, have an average of 4 children, have used contraceptives prior to the operation (especially the pill), have a favorable attitude toward the attention received from clinic personnel, and report no change or a change for the better in their general health and sex life. However, the following differences did emerge between men and women: men were better educated and held more prestigious jobs; most men reported their wives to be in favor of their vasectomy, where 33% of the women said that their husbands had been indifferent; men were more likely to experience pain or discomfort in the 1st few days after the operation but less likely to lose time from work or lost fewer days (4.0 versus 5.5); among women, pain or discomfort with the operation was related to satisfaction--those experiencing pain were more likely to regret having had the operation; men, by contrast, were more likely than women to experience pain or discomfort, but this was not related to satisfaction with the operation a year or more afterwards. Recommendations include studying the effect of increased educational/promotional efforts among men with lower levels of education and more careful screening to detect individuals who may already be experiencing some type of sexual problem or have unrealistic expectations. Reasons for the higher rate of female sterilizations in Guatemala (15:1 or 5.7 tubal ligations to 1 vasectomy) include perceptions of less negative psychological consequences, attitudes of health practitioners, and use of the procedure on an outpatient basis. In general Guatemala has a low rate of family planning acceptance compared to surrounding countries.     

Vasectomy: views of Latinos and white men

Vasectomy has gained wide acceptance as a safe, effective, and efficient method of birth control. Knowledge regarding the satisfaction of patients who have undergone the procedure has been well documented. In contrast, there is little data examining the attitude of men in general to the procedure or attempting to interpret these attitudes in a cultural context. Moreover, there appears to be widespread belief by providers that acceptance of the operation is poor among ethnic minorities such as Latinos and blacks. A questionnaire was distributed to 50 white and 50 Latino men at a large county hospital to determine ethnic differences in attitudes toward vasectomy. Only 54 percent of the Latino respondents stated they knew what a vasectomy was compared with 96 percent of the white respondents. Among respondents who knew what a vasectomy was, 50 percent of Latinos and 61 percent of whites stated they would not consider vasectomy in the event that they did not want more children. There was little support for the hypothesis that machismo played an important part in the negative responses by the Latino men or that fears of impotence played a role in the attitudes of both groups. This study suggests that a stronger emphasis on education regarding this procedure should be directed to the Latino male population.     

Postvasectomy semen analysis: why patients don't follow-up.

Semen analysis following elective vasectomy is necessary to confirm that the procedure was successful. However, many patients fail to follow postoperative instructions to obtain semen analysis. One hundred forty-one patients who had undergone vasectomy at the Family Practice Center of the Medical College of Ohio were surveyed to assess reasons for a poor rate of follow-up after vasectomy. Only 26 percent of respondents had returned two or more semen samples following surgery. Forty-five percent had not returned any samples. The inconvenience and embarrassment of having to bring semen specimens to the laboratory were identified as factors that can affect patient adherence to instructions. Respondents who had not returned any semen specimens were more likely to answer that their spouse would not be very upset if the vasectomy failed and pregnancy resulted. Our survey results identify issues for improving patient care following vasectomy. These include patient education and postoperative protocols.     

Modelling cost-effectiveness of different vasectomy methods in India, Kenya, and Mexico

Background

Vasectomy is generally considered a safe and effective method of permanent contraception. The historical effectiveness of vasectomy has been questioned by recent research results indicating that the most commonly used method of vasectomy – simple ligation and excision (L and E) – appears to have a relatively high failure rate, with reported pregnancy rates as high as 4%. Updated methods such as fascial interposition (FI) and thermal cautery can lower the rate of failure but may require additional financial investments and may not be appropriate for low-resource clinics. In order to better compare the cost-effectiveness of these different vasectomy methods, we modelled the costs of different vasectomy methods using cost data collected in India, Kenya, and Mexico and effectiveness data from the latest published research.

Methods

The costs associated with providing vasectomies were determined in each country through interviews with clinic staff. Costs collected were economic, direct, programme costs of fixed vasectomy services but did not include large capital expenses or general recurrent costs for the health care facility. Estimates of the time required to provide service were gained through interviews and training costs were based on the total costs of vasectomy training programmes in each country. Effectiveness data were obtained from recent published studies and comparative cost-effectiveness was determined using cost per couple years of protection (CYP).

Results

In each country, the labour to provide the vasectomy and follow-up services accounts for the greatest portion of the overall cost. Because each country almost exclusively used one vasectomy method at all of the clinics included in the study, we modelled costs based on the additional material, labour, and training costs required in each country. Using a model of a robust vasectomy program, more effective methods such as FI and thermal cautery reduce the cost per CYP of a vasectomy by $0.08 – $0.55.

Conclusion

Based on the results presented, more effective methods of vasectomy – including FI, thermal cautery, and thermal cautery combined with FI – are more cost-effective than L and E alone. Analysis shows that for a programme in which a minimum of 20 clients undergo vasectomies per month, the cost per CYP is reduced in all three countries by updated vasectomy methods.     

Public opinion on and potential demand for vasectomy in semi-rural Guatemala.

In this study of 1,600 men aged 25-50 from semi-rural Guatemala, three-fourths had heard of vasectomy. Among these, 54 per cent approved of it. However, the survey reveals a widespread lack of knowledge regarding the procedure, as well as negative perceptions or doubts about its effect on sexual performance, ability to do hard work, health, and manhood. One-fourth of the respondents who knew of vasectomy and who desired no more children expressed interest in having the operation, a finding which raises questions as to the potential (unrecognized) demand for vasectomy in other developing countries.     

Does vasectomy cause prostate cancer?

Vasectomy is the process in which a man's vas deferens are severed, with the cut ends folded back and tied off to prevent the release of sperm from his testicles to the urethra and out of the penis. The procedure may be conducted in a doctor's office under local anesthesia, is almost 100% effective in preventing pregnancy, and leaves sexual function fully intact. Since sperm comprise less than 5% of semen, even the amount of ejaculated fluid does not change noticeably. 20% of American men over age 35 years have had a vasectomy. Despite vasectomy's simplicity and effectiveness, debate exists over whether vasectomy may increase the risk of prostate cancer, the most common malignancy in men. Two large, well-designed Harvard studies were published in 1993 in the Journal of the American Medical Association which suggest that such a relationship may exist. The two studies compared the number of prostate-cancer diagnoses in almost 25,000 men who had undergone vasectomy with nearly 50,000 men who had not. Men who had undergone vasectomy more than 20 years earlier were almost twice as likely as their unsterilized counterparts to have been diagnosed with prostate cancer. Overall, the rate of such diagnoses was about 60% higher among the men who had been sterilized. These widely-reported studies rekindled earlier fears of a possible prostate-cancer risk and no doubt convinced some men to avoid the operation or to have it reversed if they had already gone through with it. Four earlier studies also suggested a link between prostate cancer and vasectomy. Seven other reports, however, have found no connection. Several studies even indicate that men who undergo vasectomy live longer than other men. Many researchers believe that the Harvard studies' findings are simply the result of earlier and better diagnosis of prostate cancer among sterilized men rather than due to an actual increased risk of the cancer.     

Vasectomy and subsequent cardiovascular disease in US physicians.

Due to previous animal research suggesting accelerated atherosclerosis following vasectomy, we examined whether vasectomy increases the risk of subsequent cardiovascular disease (CVD), including myocardial infarction (MI), angina pectoris, coronary revascularization, and stroke, in the US Physicians' Health Study. Of 22,071 US male physicians participating in the study, aged 40 to 84 years at entry and free from cardiovascular disease and cancer, 21,028 reported on the 60-month questionnaire whether they had undergone vasectomy prior to randomization. Of the 4546 physicians with vasectomy, 1159 had undergone the procedure at least 15 years before entry. During 258,892 person-years of follow-up, we documented 773 cases of MI (719 nonfatal and 54 fatal), 1907 cases of angina pectoris or coronary revascularization, and 604 confirmed cases of ischemic or hemorrhagic stroke (566 nonfatal and 38 fatal). When compared to men without prior vasectomy, the multivariate relative risk (RR) of total MI adjusted for age and other coronary risk factors was 0.94 (95% confidence interval [CI], 0.77-1.14) among men with vasectomy. Risk estimates for fatal and nonfatal events did not appreciably differ from each other. For angina or coronary revascularization or both, the multivariate relative risk was 0.99 (0.88-1.12) and for total stroke the RR was 0.95 (0.75-1.21). For men who had undergone vasectomy 15 or more years previously, the multivariate relative risks were 0.98 (0.73-1.32) for total MI, 1.17 (0.87-1.57) for total stroke, and 1.12 (0.94-1.35) for angina/revascularization. These results provide reassuring evidence that vasectomy does not materially increase the risk of subsequent cardiovascular disease, even 15 or more years following the procedure.