Djeffal Hachem, Blouet Marie, Pizzoferato Anne-Cécile, Vardon Delphine, Belloy Frederique, Pelage Jean-Pierre
1 Department of Diagnostic Imaging and Interventional Radiology, Caen University and Medical Center , Caen , France.
2 Université de Caen Basse-Normandie , Caen , France.
Br J Radiol. 2018 Oct;91(1090):20170686. doi: 10.1259/bjr.20170686. Epub 2018 Jul 13.
Tubal sterilization with Essure inserts has become a prevalent alternative to laparoscopic sterilization because of its minimal invasiveness. It is a well-tolerated ambulatory procedure that provides reliable permanent contraception without the risks associated with laparoscopic surgery and general anesthesia. Correct positioning of the Essure device is necessary to achieve the fibrotic reaction induced by the polyethylene terephthalate fibers, subsequently resulting in tubal occlusion usually within 3 months. After uneventful procedures with satisfactory bilateral placement, only the correct position of the devices needs to be confirmed at follow-up. The imaging techniques used to asses Essure devices may vary depending on the country and its recommendations. The gold-standard test to ascertain tubal occlusion remains the hysterosalpingography but after uneventful procedures, vaginal-ultrasound proved to be a reliable alternative to confirm the proper position of the inserts. Radiologists have been increasingly confronted to post-procedural evaluations and despite the efficiency rate of the Essure device, its use still exposes to a low risk of complications and malfunctions such as unwanted pregnancies, device misplacement, tubal or uterine perforation, and chronic pelvic pain. Unintended pregnancies are mostly due to patient or physician non-compliance and misinterpretation of post-procedural examinations by radiologists which emphasizes the importance of their training in Essure device assessment. This pictorial review discusses the imaging methods used to asses Essure implants and illustrates the possible complications related to them.
由于微创性，使用埃苏尔（Essure）植入物进行输卵管绝育已成为腹腔镜绝育的一种普遍替代方法。这是一种耐受性良好的门诊手术，可提供可靠的永久避孕效果，且无腹腔镜手术和全身麻醉相关的风险。为了实现由聚对苯二甲酸乙二酯纤维诱导的纤维化反应，进而通常在3个月内导致输卵管闭塞，埃苏尔装置的正确放置是必要的。在双侧放置满意且手术顺利完成后，随访时仅需确认装置的正确位置。用于评估埃苏尔装置的成像技术可能因国家及其建议而异。确定输卵管闭塞的金标准测试仍然是子宫输卵管造影，但在手术顺利完成后，经阴道超声被证明是确认植入物正确位置的可靠替代方法。放射科医生越来越多地面临术后评估，尽管埃苏尔装置的有效率较高，但其使用仍存在低风险的并发症和故障，如意外怀孕、装置误置、输卵管或子宫穿孔以及慢性盆腔疼痛。意外怀孕主要是由于患者或医生不遵守规定以及放射科医生对术后检查的错误解读，这凸显了他们在埃苏尔装置评估方面培训的重要性。本图文综述讨论了用于评估埃苏尔植入物的成像方法，并说明了与之相关的可能并发症。
