Singh Madan, Mansour Diana, Richardson David
Department of Obstetrics and Gynaecology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
J Fam Plann Reprod Health Care. 2006 Jul;32(3):153-6. doi: 10.1783/147118906777888549.
Implanon insertion appears to be an easy procedure, but in a small minority of cases difficulties have been encountered with removal if the rod is impalpable.
Patients were referred to the contraceptive and sexual health service with non-palpable Implanon. Following a clinical assessment and examination of the arm where the implant had been inserted, an ultrasound examination was carried out to identify and locate the implant. These implants were subsequently removed, some under general anaesthesia and others under local anaesthesia.
Twenty-seven patients were referred to the unit with impalpable Implanon rods. In four cases the rods were palpable and were removed in the clinic setting without the need for further intervention. Positive identification of the implants was achieved in 21 of the remaining 23 cases using ultrasound. No implant was detected in two cases and etonogestrel was not demonstrated serologically in either woman, suggesting non-insertion. All 21 Implanon rods identified by ultrasound were successfully removed. In just over 52% of women a previous attempt at removal had been undertaken prior to referral.
It is possible to identify and locate impalpable Implanon rods with the aid of ultrasound, facilitating their subsequent safe removal. Although previous reports have identified the position of 'lost' implants using ultrasound, this is the first case series to discuss measuring the skin/implant depth. This parameter, together with the precise position of the implant (in muscle or fat), aids removal. All health professionals inserting and removing contraceptive implants should have been appropriately trained.
皮下埋植避孕剂（Implanon）的植入似乎是一个简单的操作，但在少数情况下，如果无法触及皮下埋植剂，取出时会遇到困难。
无法触及皮下埋植避孕剂的患者被转诊至避孕与性健康服务机构。在对植入部位的手臂进行临床评估和检查后，进行超声检查以识别和定位皮下埋植剂。随后取出这些皮下埋植剂，一些在全身麻醉下取出，另一些在局部麻醉下取出。
27例患者因无法触及皮下埋植避孕剂而被转诊至该科室。其中4例皮下埋植剂可触及，在门诊环境下取出，无需进一步干预。在其余23例中的21例中，通过超声成功识别出皮下埋植剂。2例未检测到皮下埋植剂，且两名女性血清学检测均未显示有依托孕烯，提示未进行植入。通过超声识别出的所有21根皮下埋植避孕剂均成功取出。略超过52%的女性在转诊前曾尝试取出皮下埋植剂。
借助超声可以识别和定位无法触及的皮下埋植避孕剂，便于随后安全取出。尽管之前的报告已使用超声确定了“丢失”皮下埋植剂的位置，但这是第一个讨论测量皮肤/皮下埋植剂深度的病例系列。该参数以及皮下埋植剂的精确位置（在肌肉或脂肪中）有助于取出。所有进行避孕植入剂植入和取出操作的卫生专业人员都应接受适当培训。
