目的:比较剖宫产时接受机会性输卵管切除术(另一次手术中切除输卵管以降低卵巢癌风险;本文称为输卵管切除术)的患者与接受输卵管结扎术的患者的围手术期和术后并发症。
方法:一项基于人群的回顾性队列研究。
方法:纳入18,184例患者,其中8,440例接受了输卵管切除术,9,744例接受了输卵管结扎术。
方法:将剖宫产期间接受输卵管切除术的患者与剖宫产期间接受输卵管结扎术的患者进行比较。
方法:我们检查了1)围手术期结局,包括操作时间,住院时间,手术并发症,如感染,贫血,切口并发症,骨盆器官受伤,或手术室返回,2)术后并发症,包括手术后感染的医生访问,或者导致超声波或实验室的访问,出院后6周内再入院,和3)按处方配药抗生素或处方镇痛药的可能性。
结果:与输卵管结扎患者相比,输卵管切除术组围手术期并发症的几率降低(调整后的优势比,0.77;95%置信区间0.61-0.99)。手术感染的医生就诊风险没有增加,手术并发症,或在出院后6周内再次入院接受输卵管切除术。进行输卵管切除术的人服用非甾体抗炎药的几率增加了18%,服用阿片类药物的几率增加了23%(调整后的优势比,1.18;95%置信区间1.07-1.28,调整后的赔率比,1.23%;95%置信区间分别为1.12-1.35)。
结论:在这种基于人群的情况下,剖宫产术中输卵管切除术的真实世界研究,我们报告了接受输卵管切除术的患者和接受输卵管结扎术的患者的围手术期并发症减少,术后并发症无差异.在出院后的6周内,输卵管切除术患者服用非甾体类抗炎药和阿片类药物的可能性增加。这个结果应该谨慎解释,因为我们没有非处方药使用的数据,因此,我们的数据中并没有记录到所有的处方镇痛药.我们的数据表明,剖宫产后的输卵管切除术是提供有效避孕和降低卵巢癌风险的安全方法。
OBJECTIVE: To compare perioperative and postoperative complications in patients who underwent opportunistic
salpingectomy (OS) (removal of the fallopian tubes for ovarian cancer risk reduction during another surgery) at the time of cesarean section (C-section) with those in patients who underwent tubal ligation.
METHODS: A population-based, retrospective cohort
study.
METHODS: British Columbia, Canada.
METHODS: A total of 18,184 patients were included in this
study, of whom 8,440 and 9,744 underwent OS and tubal ligation, respectively.
METHODS: Patients who underwent OS during a C-section were compared with those who underwent tubal ligation during a C-section.
METHODS: We examined the perioperative outcomes, including operating room time, length of hospital stay, surgical complications such as infections, anemia, incision complications, injury to a pelvic organ, or operating room return; postoperative complications, including physician visits for a postoperative infection or visits that resulted in ultrasound or laboratory examinations and hospital readmissions in the 6 weeks after discharge; and likelihood to fill a prescription for antibiotics or analgesics.
RESULTS: The OS group had decreased odds of perioperative complications compared with the tubal ligation group (adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.61-0.99). Patients who underwent OS did not have increased risks of physician visits for surgical complications, such as infection, or hospital readmissions in the 6 weeks after hospital discharge. In addition, these patients had 18% and 23% increased odds of filling prescriptions for nonsteroidal anti-inflammatory drugs (aOR, 1.18; 95% CI, 1.07-1.28) and opioids (aOR, 1.23%; 95% CI, 1.12-1.35), respectively.
CONCLUSIONS: In this population-based, real-world
study of OS at C-section, we report decreased perioperative complications and no difference in postoperative complications between patients who underwent OS and those who underwent tubal ligation. Patients who underwent OS had an increased likelihood of filling a prescription for nonsteroidal anti-inflammatory drugs and opioids in the 6 weeks after hospital discharge. This result should be interpreted with caution because we did not have data on over-the-counter medication use and, thus, not all prescription analgesics were captured in our data. Our data suggest that OS after C-section is a safe way to provide effective contraception and ovarian cancer risk reduction.