Arthuis Chloé J, Simon Emmanuel G, Hébert Thomas, Marret Henri
Department of Obstetrics, Gynecology, Reproductive Medicine and Fetal Medicine, University Hospital Center of Tours, Tours, France; Inserm UMR930, François Rabelais University, Tours, France; Department of Obstetrics and Gynecology, Hôpital Mère-Enfant, Nantes, France.
Department of Obstetrics, Gynecology, Reproductive Medicine and Fetal Medicine, University Hospital Center of Tours, Tours, France; Inserm UMR930, François Rabelais University, Tours, France.
J Minim Invasive Gynecol. 2017 Jul-Aug;24(5):803-810. doi: 10.1016/j.jmig.2017.02.026. Epub 2017 Apr 5.
To determine whether the number of coils visualized in the uterotubal junction at the end of hysteroscopic microinsert placement predicts successful tubal occlusion.
Cohort retrospective study (Canadian Task Force classification II-2).
Department of obstetrics and gynecology in a teaching hospital.
One hundred fifty-three women underwent tubal microinsert placement for permanent birth control from 2010 through 2014. The local institutional review board approved this study.
Three-dimensional transvaginal ultrasound (3D TVU) was routinely performed 3 months after hysteroscopic microinsert placement to check position in the fallopian tube.
The correlation between the number of coils visible at the uterotubal junction at the end of the hysteroscopic microinsert placement procedure and the device position on the 3-month follow-up 3D TVU in 141 patients was evaluated. The analysis included 276 microinserts placed during hysteroscopy. The median number of coils visible after the hysteroscopic procedure was 4 (interquartile range, 3-5). Devices for 30 patients (21.3%) were incorrectly positioned according to the 3-month follow-up 3D TVU, and hysterosalpingography was recommended. In those patients the median number of coils was in both the right (interquartile range, 2-4) and left (interquartile range, 1-3) uterotubal junctions. The number of coils visible at the uterotubal junction at the end of the placement procedure was the only factor that predicted whether the microinsert was well positioned at the 3-month 3D TVU confirmation (odds ratio, .44; 95% confidence interval, .28-.63). When 5 or more coils were visible, no incorrectly placed microinsert could be seen on the follow-up 3D TVU; the negative predictive value was 100%. No pregnancies were reported.
The number of coils observed at the uterotubal junction at the time of microinsert placement should be considered a significant predictive factor of accurate and successful microinsert placement.
确定宫腔镜下微插入器放置结束时在子宫输卵管连接处可见的线圈数量是否能预测输卵管闭塞成功。
队列回顾性研究（加拿大工作组分类II-2）。
一家教学医院的妇产科。
2010年至2014年期间，153名妇女接受了输卵管微插入器放置以进行永久性节育。当地机构审查委员会批准了本研究。
宫腔镜下微插入器放置3个月后常规进行三维经阴道超声（3D TVU）检查，以检查其在输卵管内的位置。
评估了141例患者宫腔镜下微插入器放置结束时子宫输卵管连接处可见的线圈数量与3个月随访时3D TVU检查中装置位置之间的相关性。分析包括宫腔镜检查期间放置的276个微插入器。宫腔镜检查后可见的线圈数量中位数为4（四分位间距，3-5）。根据3个月随访的3D TVU检查结果，30例患者（21.3%）的装置位置不正确，建议进行子宫输卵管造影。在这些患者中，子宫输卵管连接处右侧（四分位间距，2-4）和左侧（四分位间距，1-3）的线圈数量中位数均较低。放置结束时子宫输卵管连接处可见的线圈数量是预测微插入器在3个月3D TVU确认时位置是否良好的唯一因素（优势比，0.44；95%置信区间，0.28-0.63）。当可见5个或更多线圈时，随访的3D TVU检查中未见放置位置不正确的微插入器；阴性预测值为100%。未报告妊娠情况。
微插入器放置时子宫输卵管连接处观察到的线圈数量应被视为微插入器准确、成功放置的重要预测因素。
