Sills E Scott, Li Xiang, Wood Samuel H, Jones Christopher A
Center for Advanced Genetics, Carlsbad, CA, USA.
Department of Obstetrics and Gynecology, Palomar Medical Center, Escondido, CA, USA.
Obstet Gynecol Sci. 2017 May;60(3):296-302. doi: 10.5468/ogs.2017.60.3.296. Epub 2017 May 15.
Although previous research has suggested that risk for reoperation among hysteroscopic sterilization (HS) patients is more than ten times higher than for patients undergoing standard laparoscopic tubal ligation, little has been reported about these subsequent procedures.
This descriptive cohort study used a confidential online questionnaire to gather data from women (n=3,803) who volunteered information on HS followed by device removal surgery performed due to new symptoms developing after Essure placement.
In this sample, mean age was 35.6 years and women undergoing hysterectomy after HS comprised 64.9% (n=2,468). Median interval between HS and hysterectomy was 3.7 (interquartile range, 3.9) years and mean age at hysterectomy was 36.3 years. Some patients (n=1,035) sought removal of HS devices and fallopian tubes only, while other miscellaneous gynecological procedures were also occasionally performed for Essure-associated symptoms. When data from all patients who had any post-Essure surgery besides hysterectomy were aggregated (e.g., device removal + "other" cases, n=1,335) and compared to those cases undergoing hysterectomy, mean age was significantly lower than for the hysterectomy group (34.4 vs. 36.3 years, respectively; <0.01); uterus-conserving surgeries were also typically performed significantly earlier than hysterectomy (<0.01).
This investigation is the first to characterize specific gynecological operations after Essure, and suggests that the predominant surgical answer to HS complaints is hysterectomy for many women. Dissatisfaction with HS may represent an important indication for hysterectomy and additional study is needed to quantify this phenomenon.
尽管先前的研究表明，宫腔镜绝育术（HS）患者再次手术的风险比接受标准腹腔镜输卵管结扎术的患者高出十多倍，但关于这些后续手术的报道却很少。
这项描述性队列研究使用了一份保密的在线问卷，从3803名女性中收集数据，这些女性自愿提供了HS相关信息，以及因放置Essure后出现新症状而进行的器械取出手术的信息。
在这个样本中，平均年龄为35.6岁，HS术后接受子宫切除术的女性占64.9%（n = 2468）。HS与子宫切除术之间的中位间隔时间为3.7年（四分位间距为3.9年），子宫切除术时的平均年龄为36.3岁。一些患者（n = 1035）仅寻求取出HS器械和输卵管，而其他一些妇科手术也偶尔因Essure相关症状而进行。当汇总所有除子宫切除术外还进行了任何Essure术后手术的患者的数据（例如，器械取出 + “其他”病例，n = 1335）并与接受子宫切除术的病例进行比较时，平均年龄显著低于子宫切除组（分别为34.4岁和36.3岁；P < 0.01）；保留子宫的手术通常也比子宫切除术进行得早得多（P < 0.01）。
这项调查首次描述了Essure术后的特定妇科手术，并表明对于许多女性来说，针对HS投诉的主要手术方式是子宫切除术。对HS的不满可能是子宫切除术的一个重要指征，需要进一步研究来量化这一现象。
