J Natl Cancer Inst:男默女泪!215万男性随访38年发现,输精管结扎与前列腺癌风险增加15%有关

2019-05-31 奇点糕 奇点网

出于各种原因,男性结扎相对来说一直是个比较禁忌的话题,大家对它的了解也并不多。每当看到有人问“结扎之后是不是就不能做爱做的事了”的时候,奇点糕就觉得莫名好笑,你们对结扎到底是有什么误解啊?

出于各种原因,男性结扎相对来说一直是个比较禁忌的话题,大家对它的了解也并不多。每当看到有人问“结扎之后是不是就不能做爱做的事了”的时候,奇点糕就觉得莫名好笑,你们对结扎到底是有什么误解啊?

其实,输精管结扎本身是一个简单的小手术,真正值得担心的还是结扎后,从长期来看,会不会提高一些疾病的风险,例如说,前列腺癌。



红色虚线圆圈处为结扎的输精管(图片来源:wiki.org)

在《美国国家癌症研究所杂志》(JNCI)上,丹麦Statens Serum研究所的研究人员对丹麦全国215万男性,随访38年的数据进行了分析。

他们得出结论:与未结扎过的男性相比,结扎男性患前列腺癌的风险增加15%,而且这种增加与经济因素等的差异无关。但同时,他们患其他癌症的风险也下降了9%。

这项研究中,患者的数据都来自丹麦公民登记挂号系统(CRS),研究人员选择了出生于1937年1月1日和1996年12月31日之间的全部男性,从1977年1月1日开始随访,到2014年12月31日停止。

在所有的2150162名男性中,有139550人(6.5%)出于绝育的目的接受过结扎,他们结扎的中位年龄为38.3岁。在随访过程中,共有26238人(1.2%)被检查出前列腺癌,诊断时的中位年龄为65.4岁。根据这些数据,研究人员得出了刚刚我们提到过的结果,与未结扎的男性相比,结扎男性患前列腺癌的风险增加了15%(rr=1.15),其他癌症的风险则降低了9%(rr=0.91)。



结扎后的不同时间里,前列腺癌风险的增加情况

不过,这9%的降低部分是因为吸烟/饮酒相关癌症的风险降低导致的,这也从侧面说明了,平均而言,接受结扎的男性生活得更加健康(递给大家一个眼神,大家自己体会一下)。

按照时间段来说,稳定的风险增加15%的结果是从结扎后10年开始的。而在结扎后第一年内,前列腺癌的风险增加最多,不过也不用太担心,因为这个结果没什么显着的统计学意义,而且,这一组里只有6名患者。

在丹麦,从2004年开始,癌症患者的就诊记录里才有癌症分期的信息,研究人员也根据这部分数据分析了结扎对诊断为早期和中到晚期前列腺癌风险的影响,发现,结扎后,总的来说,早期和中到晚期前列腺癌风险的增加是差不多的。

当然了,前列腺癌的其他风险因素也有很多,为了更加清晰的突出结扎的影响,研究人员对患者的婚姻状况、后代数量、看医生的频率、接受结扎的年龄和结扎的年限等因素都进行了逐一的分析。


图片来源:pixabay.com

结果表明,在结扎与前列腺癌风险增加这方面,只有后代数量与它们有比较强的关联,有三个孩子的,风险增加16%,四个的增加25%,而五个及以上的更是增加了31%!(emmm,所以要扎早点扎,不要生太多了之后再扎?)

除此之外,不在医院而是在私人诊所接受结扎,还有社会经济地位的差异,以及肿瘤分期定义的变更这些因素都对结扎增加前列腺癌风险没有什么影响。

至于BMI、运动情况、蛋白质摄入和前列腺癌家族史这些风险因素,受限于队列本身,CRS不会记录这些,所以研究人员并没有进行分析。但他们检索了过去的研究,发现一些关于结扎和前列腺癌的研究表明,调整了这几个因素后,对结果的影响并不大。所以,研究人员认为,虽然他们并没有分析这几点,但也不会影响结果的权威性。

关于避孕呢,一直以来,绝大部分的关注点都在女性身上,无论是短效避孕药、避孕环,还是皮下埋植等等,至于选择结扎的男性,可以说是极少。

而对于女性来说,最常用的避孕方法,短效避孕药,其实也会增加乳腺癌的风险[4]。研究人员也提到,结扎对前列腺癌绝对风险的增加其实并不算多,与短效避孕药对女性乳腺癌风险的增加是相似的。

不过总的来说,这个研究还是揭示了一个可能很重要的全球性公共卫生问题,鉴于之前的此类研究大都存在随访期短或是分析的偏倚较大等问题,研究人员建议,未来,还是需要更多的研究来巩固这一结论,解释其中的机制。

原始出处:Husby A, Wohlfahrt J, Melbye M. Vasectomy and prostate cancer risk: a 38-year nationwide cohort study. J Natl Cancer Inst. 2019 May 23. 

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    2019-11-20 liye789132251
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    2019-09-28 qidongfanjian
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    2019-12-09 sjq027
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    2019-06-20 drj2003
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    2019-06-01 misszhang

    前列腺癌相关研究,学习了,谢谢梅斯

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    学习了,谢谢分享

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