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

The clinical comparison study on safety,efficacy and acceptability of two kinds of fallopian tube sterilization operation

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FSH>10U/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。

Objective： Though compared the local anesthesia single hole laparoscopic bipolar coagulation tubal steriliza- tion with transabdominal proximal core package fallopian tube buried sterilization, to evaluate safety, effectiveness and acceptability of local anesthesia single hole laparoscopic tubal sterilization, and to explore the influence of these two kinds of fallopian tube sterilization operation on ovarian function short-term and long-term. Methods.. In 14 counties of Guizhou province, 914 patients experienced local anesthesia single hole laparoscopic bipolar coagulation tubal steriliza- tion （in the laparoscopic group）were randomly selected from January 2014 to December 2014, and at the same time, 893 patients experienced transabdominal proximal core tube sterilization bag buried fallopian （in laparotomy group） were also randomly selected. The patients in the two groups were observed and evaluated during operation and at follow up post operation. Some of women in the two groups were given ovarian function assessment by venous blood samples. Results.. The amount of bleeding during operation, the rate of complications, and rate of adverse influence on ovarian function at one month post operation of patients in the laparoscopic group were significant lower than those of patients in the laparotomy group （P〈0.05）. And pain degree during operation, operative time, rate of postoperative pain, postoperative observing time, and rate of satisfaction of patients in the laparoscopic group were significant better than those of patients in the laparotomy group （P〈0.05）. At one month after operation, though the level of Based sex hor-mone levels of patients in both group had no significant change, the number of patients with FSH 〉10 U/L and FSH/ LH over 2 in the laparotomy group was significantly higher than that of patients in the laparoscopic group. Conclusion..Local anesthesia single hole laparoscopic fallopian tube sterilization operation is a safe, effective, simple operation for fallopian tube sterilization, which has the characteristics of less pain, quick recovery, and good acceptability, and it has less adverse influence on ovarian function compared to transabdominal fallopian tube sterilization operation.