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宫腔镜输卵管阻塞术(依舒瑞®)的初步经验。

Initial experience with hysteroscopic tubal occlusion (Essure®).

作者信息

Depes Daniella De Batista, Pereira Ana Maria Gomes, Lippi Umberto Gazi, Martins João Alfredo, Lopes Reginaldo Guedes Coelho

机构信息

Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", São Paulo, SP, Brazil.

出版信息

Einstein (Sao Paulo). 2016 Apr-Jun;14(2):130-4. doi: 10.1590/S1679-45082016AO3717.

DOI:10.1590/S1679-45082016AO3717
PMID:27462885
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4943345/
Abstract

OBJECTIVE

To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®).

METHODS

This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia.

RESULTS

Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method.

CONCLUSIONS

Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied.

OBJETIVO

Avaliar os resultados das primeiras oclusões tubárias realizadas pela via histeroscópica (Essure®).

MÉTODOS: Estudo prospectivo com 38 pacientes, sendo 73,7% caucasianas, com média de idade de 34,5 anos, e com 3 gestações e 2,7 partos em média. Do total, 86,8% das pacientes fizeram preparo prévio do endométrio. Todos os procedimentos foram ambulatoriais e sem anestesia.

RESULTADOS

A taxa de inserção do dispositivo foi de 100%, com tempo médio de 4 minutos e 50 segundos. Segundo a Escala Visual Analógica, a dor média obtida foi de três, e 55,3% das mulheres não referiram qualquer dor após o método. Ocorreu um caso de reflexo vagal e 89,5% das pacientes retornaram às atividades normais no mesmo dia. Após 3 meses, 89,5% das pacientes encontravam-se muito satisfeitas com o método. A radiografia simples da pelve evidenciou 92,1% de dispositivos tópicos, ocorrendo um caso de expulsão unilateral. Após 4 anos de seguimento, não houve falha do método.

CONCLUSÃO: A oclusão tubária por via histeroscópica em regime ambulatorial e sem anestesia foi um procedimento rápido, bem tolerado, isento de complicações graves e com alta taxa de sucesso e satisfação das pacientes.

摘要

目的

评估宫腔镜下(依萱蕊®)早期输卵管闭塞的效果。

方法

这项前瞻性研究纳入了38例患者,其中73.7%为白人,平均年龄34.5岁,平均怀孕3次,分娩2.7次。共有86.8%的患者此前对子宫内膜进行了预处理。所有手术均在门诊进行,无需麻醉。

结果

装置置入率为100%,平均时间为4分50秒。根据视觉模拟量表,报告的平均疼痛程度为3级,55.3%的女性术后未报告疼痛。术后发生1例迷走反射,89.5%的患者在同一天恢复正常活动。3个月后,89.5%的患者对该方法非常满意。骨盆平片显示92.1%的局部装置位置正常,发生1例单侧排出。随访4年,该方法未出现失败情况。

结论

门诊宫腔镜下无需麻醉的输卵管闭塞术是一种操作迅速且耐受性良好的手术。未观察到严重并发症,成功率高,患者满意。

目的

评估通过宫腔镜(依萱蕊®)进行的首次输卵管闭塞的结果。

方法

对38例患者进行前瞻性研究,其中73.7%为白种人,平均年龄34.5岁,平均怀孕3次,分娩2.7次。总体而言,86.8%的患者进行了子宫内膜预处理。所有手术均为门诊手术,无需麻醉。

结果

装置置入率为100%,平均时间为4分5秒。根据视觉模拟量表,平均疼痛评分为3分,55.3%的女性术后未提及任何疼痛。发生1例迷走反射,89.5%的患者在同一天恢复正常活动。3个月后,89.5%的患者对该方法非常满意。骨盆简单X线检查显示92.1%的局部装置在位,发生1例单侧排出。随访4年后,该方法未失败。

结论

门诊宫腔镜下无需麻醉的输卵管闭塞术是一种快速、耐受性良好、无严重并发症、成功率高且患者满意的手术。

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本文引用的文献

1
[Definitive contraception with Essure device: Single institutional experience on 517 procedures].
Ginecol Obstet Mex. 2015 Jan;83(1):16-22.
2
Hysteroscopy and contraception.宫腔镜检查与避孕。
Best Pract Res Clin Obstet Gynaecol. 2015 Oct;29(7):940-50. doi: 10.1016/j.bpobgyn.2015.03.013. Epub 2015 Mar 31.
3
Effectiveness and feasibility of hysteroscopic sterilization techniques: a systematic review and meta-analysis.宫腔镜绝育技术的有效性和可行性:系统评价和荟萃分析。
Fertil Steril. 2015 Jun;103(6):1516-25.e1-3. doi: 10.1016/j.fertnstert.2015.03.009. Epub 2015 Apr 22.
4
Conceptualizing risk and effectiveness: a qualitative study of women's and providers' perceptions of nonsurgical female permanent contraception.风险与效果的概念化:一项关于女性及医疗服务提供者对非手术女性永久性避孕看法的定性研究
Contraception. 2015 Aug;92(2):128-34. doi: 10.1016/j.contraception.2015.03.002. Epub 2015 Mar 6.
5
Management of complications encountered with Essure hysteroscopic sterilization: a systematic review.爱舒丽宫腔镜绝育术相关并发症的管理:一项系统综述
J Minim Invasive Gynecol. 2014 Sep-Oct;21(5):733-43. doi: 10.1016/j.jmig.2014.03.019. Epub 2014 Apr 24.
6
Hysteroscopic sterilization: 10-year retrospective analysis of worldwide pregnancy reports.宫腔镜绝育术:全球妊娠报告的10年回顾性分析
J Minim Invasive Gynecol. 2014 Mar-Apr;21(2):245-51. doi: 10.1016/j.jmig.2013.09.016. Epub 2013 Oct 12.
7
Oral analgesia vs intravenous conscious sedation during Essure Micro-Insert sterilization procedure: randomized, double-blind, controlled trial.口服镇痛与静脉清醒镇静在 Essure 微植入绝育术中的比较:随机、双盲、对照试验。
J Minim Invasive Gynecol. 2011 Jan-Feb;18(1):108-11. doi: 10.1016/j.jmig.2010.10.006.
8
Satisfaction and tolerance with office hysteroscopic tubal sterilization.门诊宫腔镜输卵管绝育术的满意度与耐受性
Fertil Steril. 2008 Oct;90(4):1182-6. doi: 10.1016/j.fertnstert.2007.08.007. Epub 2008 Jan 16.