转诊中心对不可触及避孕植入物取出的经验。
Referral Center Experience With Nonpalpable Contraceptive Implant Removals.
机构信息
Departments of Obstetrics and Gynecology and Public Health Science, University of California, Davis, Sacramento, California.
出版信息
Obstet Gynecol. 2019 Oct;134(4):801-806. doi: 10.1097/AOG.0000000000003457.
OBJECTIVE
To describe our experience with office removal of nonpalpable contraceptive implants at our referral center.
METHODS
We performed a retrospective cohort study by reviewing the charts of patients referred to our family planning specialty center for nonpalpable or complex contraceptive implant removal from January 2015 through December 2018. We localized nonpalpable implants using high-frequency ultrasonography and skin mapping in radiology, followed by attempted removal in the office using local anesthesia and a modified vasectomy clamp. We abstracted information on demographics, implant location, and outcomes.
RESULTS
Of 61 referrals, 55 patients attended their scheduled appointments. Seven patients had palpable implants; six elected removal. The other 48 patients had ultrasound localization, which identified 47 (98%) of the implants; the remaining patient had successful localization with computed tomography imaging. Nonpalpable implants were suprafascial (n=22), subfascial (n=25) and intrafascial (n=1); four of these patients opted to delay removal. Of 50 attempted office removals, all palpable (n=6), all nonpalpable suprafascial (n=21 [100%, 95% CI 83-100%]), and 19 out of 23 (83%, 95% CI 67-98%) subfascial implants were successful. Three of the four patients with failed subfascial implant office removal had successful operating room removal with a collaborative orthopedic surgeon; the other patient sought removal elsewhere. Transient postprocedure neuropathic complaints were noted in 7 out of 23 (30%, 95% CI 12-49%) subfascial and 1 out of 21 (5%, 95% CI 0-13%) suprafascial removals (P=.048). Nonpalpable implants were more likely to be subfascial in nonobese patients (24/34, 71%) as compared with obese (1/13, 8%) patients (P<.001). Seven (28%) of the 25 subfascially located implants had been inserted during a removal-reinsertion procedure through the same incision.
CONCLUSION
Most nonpalpable contraceptive implants can be removed in the office by an experienced subspecialty health care provider after ultrasound localization. Some patients may experience transient postprocedure neuropathic pain. Nonpalpable implants in thinner women are more likely to be in a subfascial location.
目的
描述我们在转诊中心使用办公室移除法取出不可触及避孕植入物的经验。
方法
我们通过回顾 2015 年 1 月至 2018 年 12 月期间因不可触及或复杂避孕植入物而转至我们计划生育专科中心的患者的图表，进行了一项回顾性队列研究。我们使用高频超声和放射科的皮肤图对不可触及的植入物进行定位，然后在局麻下使用改良的输精管结扎夹尝试在办公室中进行取出。我们提取了人口统计学、植入物位置和结果的信息。
结果
61 例转诊中，55 例患者按计划就诊。7 例患者有可触及的植入物；其中 6 例选择取出。其余 48 例患者进行了超声定位，其中 47 例（98%）定位成功；另 1 例患者通过计算机断层成像成功定位。不可触及的植入物位于筋膜上（n=22）、筋膜下（n=25）和筋膜内（n=1）；其中 4 例患者选择延迟取出。50 例尝试在办公室中取出的植入物中，所有可触及的植入物（n=6）、所有不可触及的筋膜上植入物（n=21 [100%，95%CI 83-100%]）和 23 例中的 19 例（83%，95%CI 67-98%）筋膜下植入物均成功取出。4 例筋膜下植入物在办公室取出失败的患者中有 3 例与协作骨科医生一起在手术室成功取出；另 1 例患者在其他地方寻求取出。23 例筋膜下取出术中有 7 例（30%，95%CI 12-49%）和 21 例筋膜上取出术中有 1 例（5%，95%CI 0-13%）出现短暂的术后神经病理性疼痛（P=.048）。非肥胖患者中不可触及的植入物更可能位于筋膜下（24/34，71%），而非肥胖患者（1/13，8%）（P<.001）。25 例位于筋膜下的植入物中有 7 例（28%）是在同一切口通过取出-再植入手术插入的。
结论
有经验的专科医疗保健提供者在超声定位后，大多数不可触及的避孕植入物都可以在办公室中取出。一些患者可能会出现短暂的术后神经病理性疼痛。较瘦女性的不可触及植入物更可能位于筋膜下。
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