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Obstet Gynecol：妇女绝育手术是选择宫腔镜还是腹腔镜？

2016-10-02 xing.T MedSci原创

绝育手术宫腔镜腹腔镜
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由此可见，相比于腹腔镜绝育术，宫腔镜绝育术可能会出现较高的妊娠率、更多的月经失调以及可能更多的宫腔镜手术，然而可以减少盆腔疼痛和腹腔内妇科手术几率。当妇女完成了术后的子宫输卵管造影后，这两种手术方法妊娠率似乎是相似的，但只有66%的女性这样做。

近日，妇产科领域权威杂志《obstetrics and gynecology》发表了研究文章，旨在比较腹腔镜和宫腔镜绝育术后妇女妇科疾病发病率情况。

该研究为回顾性队列研究，通过使用商业索赔管理数据库，统计了从2007年至2013年的数据，比较了腹腔镜和宫腔镜绝育术后，妇女妊娠率、月经失调、盆腔疼痛、宫腔镜手术几率以及经腹妇科手术几率的情况。研究者分析了妇女手术前后12个月乃至更长的连续数月的数据，将腹腔镜和宫腔镜绝育后妇女怀孕率进行比较，调整年龄、合并症、保险型后，用Cox比例风险模型进行评估。

该研究共有42391名妇女接受腹腔镜绝育术，27724例接受宫腔镜绝育术。研究者发现进行宫腔镜绝育术妇女妊娠率明显高于腹腔镜绝育术（校正风险比为1.20，95%可信区间1.09–1.33；2年妊娠风险分别为2.4% vs 2%）。只有66.1%（n=18318）的进行宫腔镜绝育术的妇女接受子宫输卵管造影，本组与那些接受腹腔镜绝育术妇女有类似的妊娠率（调整后的风险比为0.90，95%可信区间为0.80-1.02，2年妊娠风险分别为1.8% vs 2%）。


接受宫腔镜绝育术后，越来越多的女性被诊断出患有月经失调（调整后的风险比为1.23，95%可信区间为1.20–1.27；2年后风险分别为26.8% vs 22.3%），更多的妇女行宫腔镜手术（调整后的风险比为2.05，95%可信区间为1.96–2.14；2年后风险分别为13.8% vs 6.4%），但较少的妇女被诊断为盆腔疼痛（调整后的风险比为0.83，P＜001；2年后风险分别为21% vs 25.6%）以及较少的妇女进行腹腔内妇科手术（调整后的风险比为0.95，95% 可信区间为0.90–0.99；2年风险分别为7.7% vs 8.1%），包括全子宫切除术（调整后的风险比为0.65，95%可信区间为0.61–0.69；5年风险分别为10.9% vs 14.3%）。

由此可见，相比于腹腔镜绝育术，宫腔镜绝育术可能会出现较高的妊娠率、更多的月经失调以及可能更多的宫腔镜手术，然而可以减少盆腔疼痛和腹腔内妇科手术几率。当妇女完成了术后的子宫输卵管造影后，这两种手术方法妊娠率似乎是相似的，但只有66%的女性这样做。

原始出处：

Perkins,Rebecca B, et al. Gynecologic Outcomes After Hysteroscopic and Laparoscopic
Sterilization Procedures.obstetrics and gynecology.2016. 

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    2017-09-06 yhy100200

    #TET#

    0

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    2016-10-13 1249842em09(暂无昵称)

    #NEC#

    0

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    2016-10-04 xinxin088

    #腹腔镜#

    0

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    2016-10-04 日月

    #宫腔镜#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2011257, encodeId=e5be201125e8e, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Wed Sep 06 09:50:00 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2043921, encodeId=569920439212f, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Thu Oct 13 07:50:00 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1276358, encodeId=16db12e63588d, content=<a href='/topic/show?id=768685612db' target=_blank style='color:#2F92EE;'>#腹腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85612, encryptionId=768685612db, topicName=腹腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=xinxin088, createdTime=Tue Oct 04 03:50:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418461, encodeId=9355141846194, content=<a href='/topic/show?id=545d462842c' target=_blank style='color:#2F92EE;'>#宫腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46284, encryptionId=545d462842c, topicName=宫腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=692a3365960, createdName=日月, createdTime=Tue Oct 04 03:50:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139579, encodeId=ba441395e9b1, content=相比于腹腔镜绝育术，宫腔镜绝育术可能会出现较高的妊娠率、更多的月经失调以及可能更多的宫腔镜手术！, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Mon Oct 03 16:23:22 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139577, encodeId=ee081395e7e8, content=宫腔镜比腹腔镜创伤小！但是手术难度大！, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Mon Oct 03 16:22:41 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139576, encodeId=ac2b1395e65f, content=宫腔镜比腹腔镜创伤小！, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Mon Oct 03 16:22:18 CST 2016, time=2016-10-03, status=1, ipAttribution=)]
    2016-10-03 1e0d99ddm02(暂无匿称)

    相比于腹腔镜绝育术，宫腔镜绝育术可能会出现较高的妊娠率、更多的月经失调以及可能更多的宫腔镜手术！

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2011257, encodeId=e5be201125e8e, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Wed Sep 06 09:50:00 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2043921, encodeId=569920439212f, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Thu Oct 13 07:50:00 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1276358, encodeId=16db12e63588d, content=<a href='/topic/show?id=768685612db' target=_blank style='color:#2F92EE;'>#腹腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85612, encryptionId=768685612db, topicName=腹腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=xinxin088, createdTime=Tue Oct 04 03:50:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418461, encodeId=9355141846194, content=<a href='/topic/show?id=545d462842c' target=_blank style='color:#2F92EE;'>#宫腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46284, encryptionId=545d462842c, topicName=宫腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=692a3365960, createdName=日月, createdTime=Tue Oct 04 03:50:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139579, encodeId=ba441395e9b1, content=相比于腹腔镜绝育术，宫腔镜绝育术可能会出现较高的妊娠率、更多的月经失调以及可能更多的宫腔镜手术！, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Mon Oct 03 16:23:22 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139577, encodeId=ee081395e7e8, content=宫腔镜比腹腔镜创伤小！但是手术难度大！, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Mon Oct 03 16:22:41 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139576, encodeId=ac2b1395e65f, content=宫腔镜比腹腔镜创伤小！, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Mon Oct 03 16:22:18 CST 2016, time=2016-10-03, status=1, ipAttribution=)]
    2016-10-03 1e0d99ddm02(暂无匿称)

    宫腔镜比腹腔镜创伤小！但是手术难度大！

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2011257, encodeId=e5be201125e8e, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Wed Sep 06 09:50:00 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2043921, encodeId=569920439212f, content=<a href='/topic/show?id=8513126129d' target=_blank style='color:#2F92EE;'>#NEC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12612, encryptionId=8513126129d, topicName=NEC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Thu Oct 13 07:50:00 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1276358, encodeId=16db12e63588d, content=<a href='/topic/show?id=768685612db' target=_blank style='color:#2F92EE;'>#腹腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85612, encryptionId=768685612db, topicName=腹腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=xinxin088, createdTime=Tue Oct 04 03:50:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418461, encodeId=9355141846194, content=<a href='/topic/show?id=545d462842c' target=_blank style='color:#2F92EE;'>#宫腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46284, encryptionId=545d462842c, topicName=宫腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=692a3365960, createdName=日月, createdTime=Tue Oct 04 03:50:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139579, encodeId=ba441395e9b1, content=相比于腹腔镜绝育术，宫腔镜绝育术可能会出现较高的妊娠率、更多的月经失调以及可能更多的宫腔镜手术！, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Mon Oct 03 16:23:22 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139577, encodeId=ee081395e7e8, content=宫腔镜比腹腔镜创伤小！但是手术难度大！, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Mon Oct 03 16:22:41 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139576, encodeId=ac2b1395e65f, content=宫腔镜比腹腔镜创伤小！, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Mon Oct 03 16:22:18 CST 2016, time=2016-10-03, status=1, ipAttribution=)]
    2016-10-03 1e0d99ddm02(暂无匿称)

    宫腔镜比腹腔镜创伤小！

    0