AP-HP, Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Clamart F-92140, France.
Hum Reprod. 2011 Oct;26(10):2683-9. doi: 10.1093/humrep/der242. Epub 2011 Aug 16.
The aim of this study was to assess the diagnostic accuracy of three-dimensional ultrasound (3D-US) for determining the position of Essure microinserts and the success of sterilization by the Essure method.
This retrospective observational study examined the case records of 311 women who underwent hysteroscopic sterilization from October 2002 through October 2008. Imaging with 3D-US or pelvic X-radiography or both was performed 3 months after the procedure to verify device position. Hysterosalpingography (HSG) was performed when a bilateral procedure was not completed because of a history of salpingectomy or blocked tube, when doubt persisted after 3D-US or pelvic radiography, or for comparative purposes in a prospective study. The positions seen on 3D-US were classified in four categories according to a specific scale we devised.
The insertion procedure was completed in 94.2% patients. Only 90.5% underwent imaging verification of the device 3 months afterwards. In all, 227 3D-US, 175 pelvic radiography and 64 HSG imaging procedures were performed. Visualization of the device was possible in 99.6% of the 3D-US images. According to our classification, 3D-US was appropriate for assessing device position for 195 (85.9%) patients. The need for HSG confirmation was significantly lower with 3D-US than radiographic imaging (14.1 versus 26.8%, P = 0.001). 3D-US examinations, compared with the results of HSG as the reference test, had a sensitivity of 100% and a specificity of 76.6%. Neither pregnancy nor early expulsion occurred when 3D-US found that the devices were correctly placed.
3D-US is a simple technique for assessing the position of Essure(®) microinserts, even after concomitant endometrial surgery. The 3D-US classification presented here appears to make it possible to use HSG for back-up confirmation only when the microinsert is found in a very distal position on 3D-US and thus to protect the majority of women from the negative effects of pelvic radiography and HSG.
本研究旨在评估三维超声（3D-US）在确定 Essure 微植入物位置和 Essure 绝育方法的成功率方面的诊断准确性。
这是一项回顾性观察性研究，检查了 2002 年 10 月至 2008 年 10 月期间接受宫腔镜绝育的 311 名女性的病历。术后 3 个月，通过 3D-US 或盆腔 X 射线或两者联合进行影像学检查，以验证器械位置。当双侧手术因输卵管切除术史或阻塞性输卵管、3D-US 或盆腔射线照相术仍有疑问或为前瞻性研究的比较目的而未完成时，进行子宫输卵管造影术（HSG）。根据我们设计的特定量表，将 3D-US 上看到的位置分为四类。
插入程序在 94.2%的患者中完成。只有 90.5%的患者在术后 3 个月进行了器械影像学验证。共进行了 227 次 3D-US、175 次盆腔射线照相术和 64 次 HSG 成像程序。99.6%的 3D-US 图像可观察到器械。根据我们的分类，3D-US 适合评估 195 名（85.9%）患者的器械位置。与放射影像学相比，3D-US 确认 HSG 的需求显著降低（14.1%比 26.8%，P=0.001）。3D-US 检查与 HSG 作为参考测试的结果相比，灵敏度为 100%，特异性为 76.6%。当 3D-US 发现器械正确放置时，既没有怀孕也没有早期排出。
3D-US 是一种评估 Essure(®)微植入物位置的简单技术，即使在同时进行子宫内膜手术之后也是如此。这里提出的 3D-US 分类似乎使得仅在 3D-US 上发现微植入物位于非常远端位置时才需要 HSG 进行后备确认成为可能，从而使大多数女性免受盆腔射线照相术和 HSG 的负面影响。
