Frietze Gabriel, Leyser-Whalen Ophra, Rahman Mahbubur, Rouhani Mahta, Berenson Abbey B
Department of Psychology, The University of Texas at El Paso , El Paso, TX.
Department of Sociology and Anthropology, The University of Texas at El Paso , El Paso, TX.
J Gynecol Surg. 2015 Dec 1;31(6):308-317. doi: 10.1089/gyn.2015.0054.
The Essure (Bayer HealthCare Pharmaceuticals, Leverkusen, Germany) female sterilization procedure entails using a hysteroscope to guide a microinsert into the Fallopian tube openings. Failed placement can lead to patient dissatisfaction, repeat procedures, unintended or ectopic pregnancy, perforation of internal organs, or need for subsequent medical interventions. Additional interventions increase women's health risks, and costs for patients and the health care industry. Demonstrated successful placement rates are 63%-100%. To date, there have not been any systematic analyses of variables associated with placement rates. The aims of this review were: (1) to estimate the average rate of successful bilateral Essure microinsert placement on first attempt; and (2) to identify variables associated with successful placement. A meta-analysis was conducted on 64 published studies and 19 variables. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all published studies between November 2001 and February 2015 were reviewed. The studies were taken from from PubMed and Google Scholar, and by using the the "snowball" method that reported variables associated with successful bilateral Essure placement rates. The weighted average rate of successful bilateral microinsert placement on first attempt was 92% (0.92 [95% confidence interval: 0.904-0.931]). Variables associated with successful placements were: (1) newer device models; (2) higher body mass index; and (3) a higher percent of patients who received local anesthesia. The data gathered for this review indicate that the highest bilateral success rates may be obtained by utilizing the newest Essure device model with local anesthesia in heavier patients. More standardized data reporting in published Essure studies is recommended. (J GYNECOL SURG 31:308).
依萱芮（Essure，德国拜耳医疗保健制药公司，勒沃库森）女性绝育手术需要使用宫腔镜将微型植入物置入输卵管开口处。植入失败可能导致患者不满、需再次手术、意外怀孕或异位妊娠、内脏穿孔，或需要后续医疗干预。额外的干预会增加女性的健康风险，以及患者和医疗行业的成本。已证实的成功植入率为63% - 100%。迄今为止，尚未对与植入率相关的变量进行任何系统分析。本综述的目的是：（1）估计首次尝试时双侧依萱芮微型植入物成功放置的平均率；（2）确定与成功放置相关的变量。对64项已发表研究和19个变量进行了荟萃分析。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对2001年11月至2015年2月期间所有已发表的研究进行了综述。这些研究来自PubMed和谷歌学术，并采用“滚雪球”方法报告与双侧依萱芮成功植入率相关的变量。首次尝试时双侧微型植入物成功放置的加权平均率为92%（0.92 [95%置信区间：0.904 - 0.931]）。与成功放置相关的变量为：（1）更新的设备型号；（2）较高的体重指数；（3）接受局部麻醉的患者比例较高。本次综述收集的数据表明，在体重较大的患者中使用最新的依萱芮设备型号并进行局部麻醉，可能获得最高的双侧成功率。建议依萱芮已发表研究中报告更标准化的数据。（《妇科手术学杂志》31:308）
